Balloon Applicator Research Articles

TCT-448 Real-World Application of Sirolimus-Coated Balloons in Acute Coronary Syndrome

TCT-448 Real-World Application of Sirolimus-Coated Balloons in Acute Coronary Syndrome

Kidney disease, diabetes, and diameter stenosis predict Rotablation bailout in modified balloon application for severely calcified coronary lesions.

Modified balloon (MB) treatment in severely calcified coronary artery lesions is an established technique. However, some lesions require Rotablation (RA) as bailout strategy. This study aimed to assess predictors of switch from MB to RA and its impact on procedural and midterm outcomes. Four hundred and eighty-three consecutive patients were included undergoing MB treatment (n = 204) with a scoring or cutting balloon, or upfront RA treatment (n = 279) serving as control cohort. Strategy switch from MB to RA was performed in 19 of 204 patients. Procedural success was defined as successful stent implantation and TIMI III flow. In the MB cohort, median age was 72 [63-78] years, 75.5% were male and 42.1% had acute coronary syndrome. Procedure success was achieved in 89.4% of the switch group versus 98.4% of the MB only group (p < 0.001) and in 96.4% of the RA cohort. In the switch group, periprocedural complications (31.6% vs. 8.1% vs. 11.8%, p = 0.007), radiation dose (149 [126-252] vs. 59 [30-97] vs. 102 [59-156] Gcm2; p < 0.001) and contrast volume (250 [190-250] vs. 190 [150-250] vs. 195 [190--250] mL; p < 0.001) were significantly higher. Diabetes (OR 3.8, 95%CI 1.1-13.9, p = 0.042), chronic kidney disease stage 4 or 5 (OR 19.0, 95%CI 3.3-108.6, p < 0.001) and pronounced calcification resulting in higher angiographic diameter stenosis (OR 1.13, 95%CI 1.1-1.2, p = 0.001) independently predicted strategy switch. Midterm results were not affected by strategy switch regarding 1-year target lesion revascularization rates (86% vs. 89% vs. 89%; log-rank p = 0.95). Primary RA strategy might be considered in patients with severely calcified coronary artery lesions with high angiographic diameter stenosis, diabetes or impaired renal function due to increased periprocedural complication rates, radiation dose, and contrast volume following strategy switch.

Distribution of antral lesions with the novel size-adjustable cryoballoon for pulmonary vein isolation and the differences based on left atrial remodeling.

The novel cryoballoon with 28 mm or 31 mm adjustable diameters, aims to achieve a wide antral pulmonary vein isolation (PVI). However, the distribution of antral lesions and their variations based on left atrial (LA) remodeling require further clarification. We evaluated 22 patients (67 [59.5-74.8] years, 19 males) who underwent PVI of atrial fibrillation (AF) (13 paroxysmal AF [PAF] and 9 non-PAF) using size-adjustable cryoballoons. LA electro-anatomical mapping was performed post-PVI with three-dimensional mapping systems. We assessed the shapes of the LA and pulmonary veins (PVs) and the distribution of isolated areas (IAs), comparing the results between PAF and non-PAF patients. In the left PVs (LPVs), the distance between the PV orifice and IA edge (PVos-IA) was larger on the roof and posterior segments (~15 mm) but relatively smaller on the anterior segment near the PV ridge (<10 mm). For the right PVs (RPVs), it was more extensive in the posterior segment (10-15 mm). Comparing PAF and non-PAF, there were no significant differences in the PVos-IA except for the right posterior-carina segment, antrum IA (LPVs: 5.9 ± 1.6 vs. 5.8 ± 0.8 cm², p = .81; RPVs: 4.8 ± 2.3 vs. 4.8 ± 1.2 cm², p = .81), distances between the right and left IAs on the LA posterior wall (LAPW), and un-isolated LAPW area (9.0 ± 4.9 vs. 9.9 ± 2.5 cm², p = .62). No individual PVIs were observed in either group. Two patients exhibited overlapping IAs on the roof, and one patient who underwent 31 mm balloon applications for all PVs exhibited an LAPW isolation. The size-adjustable cryoballoon achieved a wide antral PVI even in non-PAF patients.

Increasing the Dye Payload of Cetuximab-IRDye800CW Enables Photodynamic Therapy.

Cetuximab (Cet)-IRDye800CW, among other antibody-IRDye800CW conjugates, is a potentially effective tool for delineating tumor margins during fluorescence image-guided surgery (IGS). However, residual disease often leads to recurrence. Photodynamic therapy (PDT) following IGS is proposed as an approach to eliminate residual disease but suffers from a lack of molecular specificity for cancer cells. Antibody-targeted PDT offers a potential solution for this specificity problem. In this study, we show, for the first time, that Cet-IRDye800CW is capable of antibody-targeted PDT in vitro when the payload of dye molecules is increased from 2 (clinical version) to 11 per antibody. Cet-IRDye800CW (1:11) produces singlet oxygen, hydroxyl radicals, and peroxynitrite upon activation with 810 nm light. In vitro assays on FaDu head and neck cancer cells confirm that Cet-IRDye800CW (1:11) maintains cancer cell binding specificity and is capable of inducing up to ∼90% phototoxicity in FaDu cancer cells. The phototoxicity of Cet-IRDye800CW conjugates using 810 nm light follows a dye payload-dependent trend. Cet-IRDye800CW (1:11) is also found to be more phototoxic to FaDu cancer cells and less toxic in the dark than the approved chromophore indocyanine green, which can also act as a PDT agent. We propose that antibody-targeted PDT using high-payload Cet-IRDye800CW (1:11) could hold potential for eliminating residual disease postoperatively when using sustained illumination devices, such as fiber optic patches and implantable surgical bed balloon applicators. This approach could also potentially be applicable to a wide variety of resectable cancers that are amenable to IGS-PDT, using their respective approved full-length antibodies as a template for high-payload IRDye800CW conjugation.

Manufacturing process and annealing influence on the dynamic mechanical properties and physical structure of LLDPE thin films

Thin films of Linear Low-Density Polyethylene are used for stratospheric balloon applications. They undergo tensile mechanical stress on a wide range of temperatures [-95; 55]°C. The aim of this study is to compare the influence of blown film and double-bubble manufacturing processes on the crystalline phase and mechanical properties of the films through their operating temperatures (flight, storage, and transportation temperatures). Dynamic Mechanical Analysis and Differential Scanning Calorimetry have been used to monitor the dynamic mechanical properties in tension mode and the crystalline phase of the films respectively. The films mechanical properties are dependent on their manufacturing process. The double-bubble process allows isotropic tensile mechanical properties regarding stretching direction, whereas the blown film process favors only transversal direction. To simulate different storage conditions, annealing has been performed. The influence of annealing on the tensile mechanical properties of the films depends mainly on the internal stress stored during manufacturing. The double-bubble process produces a biaxially stretched film with a higher stretching ratio than blown films. The dissipated internal stress can be associated with thermal shrinkage and goes up to 10 % for the biaxially stretched film. The more internal stress is stored, the more E′ and E″ increases. Annealing also favors the formation of a secondary crystalline phase that is dependent on annealing temperature and time, and exhibits αc relaxation. After annealing, the amorphous phase is less stretched, and the crystalline phase keeps its orientation.

Research progress of drug eluting balloon in arterial circulatory system.

The arterial circulatory system diseases are common in clinical practice, and their treatment options have been of great interest due to their high morbidity and mortality. Drug-eluting balloons, as a new type of endovascular interventional treatment option, can avoid the long-term implantation of metal stents and is a new type of angioplasty without stents, so drug-eluting balloons have better therapeutic effects in some arterial circulatory diseases and have been initially used in clinical practice. In this review, we first describe the development, process, and mechanism of drug-eluting balloons. Then we summarize the current studies on the application of drug-eluting balloons in coronary artery lesions, in-stent restenosis, and peripheral vascular disease. As well as the technical difficulties and complications in the application of drug-eluting balloons and possible management options, in order to provide ideas and help for future in-depth studies and provide new strategies for the treatment of more arterial system diseases.

Evaluating delivered radiation dose in intraoperative radiotherapy for breast cancer using TLD

The extra radiation that it delivers has been questioned by patients, physicians, and the public for early breast cancer patients of intraoperative radiotherapy (IORT). This investigation concerns a left breast Rando phantom with a lumpectomy cavity of 30 cm3 of left breast of Rando phantom made of polymethylmethacrylate (PMMA). Thermoluminescent dosimetry (TLD) was used to evaluate the extra radiation dose or air kerma (kair) rate under IORT from 20 Gy, 50 kV of an Xoft Axxent system. TLDs were first calibrated using 50 kV photons, and then inserted at phantom positions that were close to the positions of the represented organs and tissues. Equivalent doses (DT) delivered to the organ at risks (OAR) were evaluated according to ICRP 103. Entrance surface doses (ESD) or skin doses (Dskin) varied markedly among positions close to the lumpectomy cavity. The dose was 20 Gy at the surface of a balloon applicator and kair varied from 6.40 ± 0.92 Gy down to 1.20 ± 0.30 mGy along the left-right axis of the 17th slice of Rando. These experimental results are compared with those in the literature. The shielding effect of the tungsten-impregnated rubber was also evaluated. This study supports recommendations to patients, relatives, physicians and radiologists concerning IORT.

Low-Dose vs High-Dose Drug-Coated Balloon for Symptomatic Femoropopliteal Artery Disease: The PROSPECT MONSTER Study Outcomes

BackgroundRandomized trials have shown comparable outcomes between second-generation low-dose drug-coated balloons (LD-DCBs) and first-generation high-dose drug-coated balloons (HD-DCBs); but the trial patients had low clinical complexity, and there were no comparisons in medically complex populations. ObjectivesThe aim of this study was to compare outcomes between an LD-DCB (Ranger; 2.0 μg/mm2) and an HD-DCB (IN.PACT; 3.5 μg/mm2) in patients with symptomatic femoropopliteal artery disease. MethodsPROSPECT MONSTER (Prospective Comparison of Second-Generation Low-Dose Drug-Coated Balloon With High-Dose Drug-Coated Balloon) was a prospective, multicenter, nonrandomized trial that prospectively collected data from 581 patients who underwent endovascular therapy with the LD-DCB (n = 370) or the HD-DCB (n = 211) for symptomatic femoropopliteal artery disease (Rutherford classes 2-5). The primary outcome was the 1-year primary patency of the LD-DCB in comparison with that of the HD-DCB, as evaluated using propensity score matching. The incidence of impaired flow after drug-coated balloon application was also evaluated. ResultsPropensity score matching extracted 163 pairs (358 and 163 patients in the LD-DCB and HD-DCB groups, respectively), with no significant intergroup difference in baseline characteristics. The 1-year primary patency rates in the matched population were similar between the LD-DCB and HD-DCB groups (87.0% [95% CI: 82.5%-91.7%] vs 81.3% [95% CI: 74.8%-88.5%]; HR: 0.93; 95% CI: 0.55-1.59; P = 0.79), as was the incidence of impaired flow (13.6% vs 9.8%; OR: 1.46; 95% CI: 0.78-2.73; P = 0.24). No baseline characteristics had any significant interaction effects on the association of the LD-DCB vs the HD-DCB and 1-year restenosis risk. ConclusionsLD-DCBs demonstrate efficacy and safety comparable with HD-DCBs in patients with complex clinical backgrounds, suggesting that drug-coated balloon treatment using a lower dose may be possible.

Methodology, Deployment, and Performance of Pico Balloons in Antarctica

Abstract During the 2022/23 Antarctic summer, eight pico balloon flights were deployed from Neumayer Station III (70.6666°S, 8.2667°W), yielding valuable insights into the Antarctic stratospheric wind structure. Pico balloons maintain a lower altitude compared to larger superpressure balloons, floating between 9 and 15 km MSL. The most impressive flight lasted an astounding 98 days, completing eight circumnavigations of the Southern Hemisphere. Throughout the flights, pico balloons encountered diverse air masses, displaying zonal velocities ranging from −50 to 250 km h−1 and meridional velocities between ±100 km h−1. Total wind speeds observed were extensive, spanning from 2.0 to 270 km h−1. A significant finding revealed that lower-flying pico balloons could rise due to convection underneath the flight paths, influenced by high convective available potential energy environments, resulting in changes to the balloons’ float density. Moreover, the flights demonstrated that pico balloons tended to drift farther south compared to larger stratospheric balloons, with some balloons reaching up to 8° south of the equator and 2° from the South Pole. This article explores the pressure-testing process and deployment techniques for pico balloons, showcasing their transformation from inexpensive party balloons (costing less than $20) into efficient superpressure balloons. The logistical demands for pico balloon flights were minimal, with a single person transporting all materials for the balloons (excluding lifting gas) to the Antarctic continent in carry-on luggage. The authors aim to promote the application of pico balloons to a wider scientific community by demonstrating their usefulness. Significance Statement Pico balloons are small party-sized balloons that are capable of floating at lower altitudes than traditional superpressure balloons. In Antarctica, where research is challenging due to harsh weather and limited resources, pico balloons present an affordable and easy-to-deploy alternative to traditional research methods. By studying the distinctive wind patterns at lower altitudes around Antarctica, pico balloons can provide valuable insights into this remote region. By demonstrating the potential use of pico balloons for scientific purposes, this study aims to offer the atmospheric community a new method of conducting research on a global scale.

Novoglan device for treatment of adult phimosis: Novoglan-01 open-label clinical trial on safety, efficacy and tolerability.

At present, the only definitive treatment for adult phimosis is circumcision, which is a surgical removal of the prepuce. Novoglan is a novel device that could offer patients with phimosis an alternative to surgery. It is based on application of custom-moulded balloons for gradual skin remodelling and prepuce dilatation. This open-label clinical trial aimed to investigate the safety, efficacy and tolerability of the Novoglan treatment. A prospective trial was conducted on 20 patients with adult phimosis recruited at Macquarie University Hospital and Princess Alexandra Hospital. After eligibility screening and enrolment, patients were provided with the Novoglan product and training. The treatment involved twice daily 10-minute applications for a duration of 4-8 weeks with patient's degree of phimosis assessed before and at 6-8 weeks after the initiation of the treatment. Participants were also asked to complete questionnaires aimed to assess the safety and tolerability of the Novoglan treatment. The treatment was successful with improved foreskin retraction in 90% of patients and all patients achieving full foreskin retraction after the treatment. Ninety-five percent of patients reported reduced level of anxiety, and over 60% of patients reported reduced pain/discomfort during sexual activity or in general. Similarly, 95% of patients were moderately-to-very satisfied with the treatment and would recommend Novoglan to others. No adverse events were observed and only 15% of participants reported minor side effects. The Novoglan-01 trial demonstrated high safety, efficacy and tolerability of the Novoglan treatment for adult phimosis and its high potential as a conservative alternative to circumcision or steroid cream treatment. The Novoglan-01 study has been registered with the Australia and New Zealand Clinical Trial Registry under the reference ACTRN 1262 10009 24853, dated 15 July 2021.

Stratospheric-trace-gas-profile retrievals from balloon-borne limb imaging of mid-infrared emission spectra

Abstract. The Limb Imaging Fourier Transform Spectrometer Experiment (LIFE) instrument is a balloon-borne prototype of a satellite instrument designed to take vertical images of atmospheric limb emission spectra in the 700–1400 cm−1 wavenumber range from the upper-troposphere–lower-stratosphere (UTLS) altitude region of the atmosphere. The prototype builds on the success of past and existing instruments while reducing the complexity of the imaging design. This paper details the results of a demonstration flight on a stabilized stratospheric balloon gondola from Timmins, Canada, in August 2019. Retrievals of vertical trace gas profiles for the important greenhouse gases H2O, O3, CH4, and N2O, as well as HNO3, are performed using an optimal estimation approach and the SASKTRAN radiative transfer model. The retrieved profiles are compared to approximately coincident observations made by the Atmospheric Chemistry Experiment Fourier Transform Spectrometer (ACE-FTS) solar occultation and Microwave Limb Sounder (MLS) instruments. An evaluation of the LIFE measurements is performed, and areas of improvement are identified. This work increases the overall technical readiness of the approach for future balloon, aircraft, and space applications.

A pilot study of repeated 5-aminolevulinic acid photodynamic therapy for cervical intraepithelial neoplasia by a newly developed intravaginal irradiation system

The pilot study was performed to assess the usefulness of a newly developed patientand physician-friendly intravaginal irradiation system for photodynamic therapy with 5-aminolevulinic acid (5-ALA PDT) for cervical intraepithelial neoplasia (CIN). We used an intravaginal balloon applicator to make the cervix upright and to adjust the position and direction of the laser source in the vagina, resulting in minimal patient discomfort and minimal effort required by the physician during irradiation. Ten outpatients of CIN2 or 3 with high-risk human papillomavirus (HPV) infection without a history of HPV vaccination were treated by 5-ALA PDT. Each patient underwent PDT four times every two weeks. Nine patients showed pathological improvement, and the HPV clearance rate was 80%, and no recurrence was observed at two-years follow-up. Serum anti-HPV16 antibodies were detected in seven patients, and the antibody levels of three patients were high, equivalent to those acquired after HPV vaccination. Our newly developed irradiation system enabled easy repeat 5-ALA PDT in the outpatient clinic resulting in the improvement of CIN lesions and HPV clearance. Our results also suggested that repeated 5-ALA PDT might enhance HPV antibody production in CIN patients.

PO-02-092 POSTERIOR WALL ISOLATION VIA A MULTI-ELECTRODE RADIOFREQUENCY BALLOON CATHETER: FEASIBILITY, TECHNICAL CONSIDERATIONS, ENDOSCOPIC FINDINGS, AND COMPARISON WITH CRYOBALLOON TECHNOLOGIES

Posterior Wall (PW) isolation is an important adjunctive ablation target in patients with non-paroxysmal atrial fibrillation (AF). Traditionally performed with point-by-point radiofrequency ablation, PW isolation can be also achieved with different cryoballoon technologies. To assess the feasibility of PW isolation with the novel RF balloon catheter and perform a comparison with cryoballoon technologies. We prospectively enrolled 35 consecutive patients with persistent AF scheduled for first-time ablation with the Heliostar device. Procedural data were compared with those from 100 persistent AF patients undergoing pulmonary vein (PV) plus PW isolation with a cryoablation device. The ratio RF balloon/cryoballoon was 1:3 for each operator involved in the study, aiming at avoiding any imbalance related to different experience. Single-shot PV isolation was achieved in a significantly higher number of cases with the RF balloon technology (92.6% vs 72.5%; p<0.001). PW isolation was achieved with a similar number of balloon applications (11±4 with the Heliostar versus 11±2 with the cryoballoon; p=0.36) but a significant shorter time among RF balloon patients (225±83s versus 1273±280s with cryoballoon; p<0.001). Primary safety endpoint occurred in none of the Heliostar patients versus 10 (12.5%; 8 transient phrenic nerve palsies, 1 major groin hematoma, 1 femoral pseudoaneurism) patients in the cryoballoon group (p=0.06). Primary efficacy endpoint was achieved in all (100%) Heliostar patients versus 75 (93.7%) Cryoballoon ones (p=0.37). Oesophageal endoscopy did not show any signs of thermal lesions in Heliostar patients with luminal temperature rise. RF balloon-based PW isolation was safe and promoted shorter procedural times compared to similar cryoballoon-based ablation procedures.

Posterior wall isolation via a multi-electrode radiofrequency balloon catheter: feasibility, technical considerations, endoscopic findings and comparison with cryoballoon technologies.

Posterior wall (PW) isolation is an important adjunctive ablation target in patients with non-paroxysmal atrial fibrillation (AF). Traditionally performed with point-by-point radiofrequency (RF) ablation, PW isolation has also been performed with different cryoballoon technologies. We aimed at assessing the feasibility of PW isolation with the novel RF balloon catheter Heliostar™ (Biosense Webster, CA, USA). We prospectively enrolled 32 consecutive patients with persistent AF scheduled for first-time ablation with the Heliostar™ device. Procedural data were compared with those from 96 consecutive persistent AF patients undergoing pulmonary vein (PV) plus PW isolation with a cryoballoon device. The ratio RF balloon/cryoballoon was 1:3 for each operator involved in the study, aiming at avoiding any imbalance related to different experience. Single-shot PV isolation was documented in a significantly higher number of cases with the RF balloon technology compared to cryoballoon ablation (89.8% vs. 81.0%; p = 0.02, respectively). PW isolation was achieved with a similar number of balloon applications between the two groups (11 ± 4 with the RF balloon versus 11 ± 2 with the cryoballoon; p = 0.16), but in a significantly shorter time among RF balloon patients (228 ± 72s versus 1274 ± 277s with cryoballoon; p < 0.001). Primary safety endpoint occurred in none of the RF balloon patients versus 5 (5.2%) patients in the cryoballoon group (p = 0.33). Primary efficacy endpoint was achieved in all (100%) RF balloon patients versus 93 (96.9%) cryoballoon ones (p = 0.57). Oesophageal endoscopy did not show any signs of thermal lesions in RF balloon patients with luminal temperature rise. RF balloon-based PW isolation was safe and promoted shorter procedure times compared to similar cryoballoon-based ablation procedures.

Factors of Affecting the Success of Intragastric Balloon.

Our aim was to determine the efficacy and safety of intragastric balloon (IGB) application and the factors affecting its success by evaluating the results of patients who underwent IGB. A total of 277 consecutive patients that underwent IGB between January 2019-September 2020 in our clinic were evaluated. Patients' demographic data, height and weight before the IGB procedure, weight at 6 and 12 months after the procedure, follow-up period, complication status, and whether they received dietician's assistance during the follow-up were recorded. In 5 (1.8%) patients, IGB was removed for various reasons before the standard period of 6 months. The mean age of the patients was 35.6±9.5 years, the mean baseline weight and body mass index (BMI) was 92.6±14kg and 33.5±5.4kg/m 2 respectively. The mean follow-up time was 13±4.9 months, whereas in 146(53.6%) patients the follow-up was≥12 months. In the 6-month follow-up, the mean %excess weight loss and %body weight loss were 65.65±25.19% and 14.69±6.96%, respectively, whereas at the 12-month follow-up they were 32.38±24.79% and 6.56±5.31%, respectively. High BMI (odds ratio=1.2, 95% CI=1.0-1.2) and not receiving dietitian's assistance (odds ratio=8.5, 95% CI=3.1-23.7) were independent risk factors for unsuccessful IGB application at both 6-month and 12-month follow-ups. IGB application is a relatively effective and safe weight loss treatment for overweight and obese individuals. High BMI and not getting help from a dietician are risk factors for failure of IGB. To increase compliance with dieticians and therefore success of IGB application, patients should undergo psychiatric evaluation before IGB procedure, and receive psychiatric support, if necessary.

Novel application of drug-coated balloons in coronary heart disease: A narrative review.

The incidence of coronary heart disease (CAD) has soared over the years, and coronary intervention has become an increasingly important therapeutic approach. The past decade has witnessed unprecedented developments in therapeutic medical instruments. Given that drug-coated balloons bring many benefits, they are indicated for an increasing number of conditions. In this article, we review the results of current clinical trials about drug-coated balloons and summarize their safety and clinical progression in different coronary artery diseases, laying the groundwork for basic research, and clinical therapeutics of this patient population.

Calculated and measured radiation dose for the low energy xoft axxent eBT X-ray source

PurposeIn this study, it was aimed to evaluate the functionality to deliver different prescription dose except 20 Gy for the Xoft Axxent Ebt (electronic Brachytherapy) system and analyzing the system in terms of radiation dosimetry in water and 0.9% isotonic Sodium Chloride (NaCl) solution.Materials and methodsIn the Xoft Axxent eBT, different prescription dose in single fraction were calculated for different balloon applicator volumes based on source position and irradiation times. EBT-XD Gafchromic film was calibrated at 6MV photon energy. A balloon applicator filled with 0.9% isotonic NaCl solution was used to deliver a radiation dose of 20 Gy, 16 Gy, 10 Gy on the applicator surface. Then the balloon applicator was filled with water and the same measurements were repeated. Finally, the balloon applicator was irradiated by positioning it at different distances in the water phantom to simulate the isodose contour.ResultsAt the time the balloon applicator was filled with water and 0,9% NaCl solution, the difference between the planned dose and the absorbed dose was ~ 2% vs. 15% for 30 cc, ~ 5% vs. 14% for 35 cc and ~ 3,5% vs. 10% for 40 cc respectively. Finally, the absorbed dose at a distance of 1 cm from the applicator surface was measured as 9.63 Gy.ConclusionIn this study, it was showed that different prescription dose could be possible to deliver in the Xoft Axxent eBT system based on the standard plan. In addition, the absorbed dose was higher than the planned dose depending on the effective atomic number of NaCl solution comparing to water due to photoelectric effect in low energy photons. By measuring the dose distributions at different distances from the balloon applicator surface, the absorbed dose in tissue equivalent medium was determined and the isodose contours characteristics was simulated.

Comparison of the Results of Intragastric Gastric Balloon Application Versus Sleeve Gastrectomy on the Quality of Life in Patients Who Were Diagnosed as Asthma

Aim: We have aimed to compare the postoperative outcomes of asthmatic patients who have underwent laparoscopic sleeve gastrectomy (LSG) versus intragastric balloon(IGB) application.Materials and Methods: Total of asthmatic 84 patients who have underwent LSG versus IGB due to morbid obesity between March 2019 and February 2021 in the tertiary surgery department have retrospectively analyzed. Demographic findings, global symptom scores, and length of the stay in hospital of patients were evaluated. The patients in present resarch have similar in terms of BMI, age, and gender. Statistically significant results were accepted as p&amp;lt;0.05.Results: The mean age of the patients participating in the study were 42.32±6.51 (range 28–54), mean BMI were 42.3±6.7 kg/m² (range 41–52). There were no major complications and mortality were observed in patients. Age and gender were defined as independent risk factors by multivariant logistic regression analysis, Age, p:0.054, (OR (95%CI): 2.017), BMI, p:0.067. (OR (95%CI): 1.379), Gender was determined as p:0.110 (OR (95%CI): 0.928.Conclusion: We have concluded that although the morbidity of sleeve gastrectomy is higher than the gastric balloon application process, LSG provides more improvement in quality of life than IGB process.

Effects of different stent size selection on pipeline embolization device treatment of intracranial aneurysms.

Pipeline embolization device (PED) is becoming increasingly common in therapeutic practice. In idealized model studies, treatment effectiveness may vary with different stent sizes in the same vasculature. The true effect of stent size selection in the clinical setting remains unknown, however. To determine the true effect of stent size selection in the clinical setting. It is a retrospective review. A retrospective review was conducted on consecutive patients with aneurysms treated with a PED at our institution. The primary exposures were the difference between the diameter of the stent and the parent artery (DD) and the difference between the length of the stent and the aneurysm neck (DL). The outcomes were the clinical and angiographic results, perioperative complications, balloon application, and in-stent stenosis. The results were generated using univariable and multivariable logistic regression and restricted cubic spline (RCS) curves. A larger DD was significantly associated with incomplete occlusion [odds ratio (OR) = 2.37; 95% confidence interval (CI) = 1.43-3.98; p < 0.001], while a larger DL was significantly associated with balloon application (OR = 1.12; 95% CI = 1.02-1.23; p = 0.021) and in-stent stenosis (>25%) (OR = 1.07; 95% CI = 1.01-1.16; p = 0.042). The RCS curve indicated that the risk of incomplete occlusion increased as the DD became larger, the possibility of balloon application increased as the DL increased when the DL was >5.7 mm, and the risk of in-stent stenosis (>25%) increased as the DL increased. In the clinical setting, stent selection was associated with treatment effectiveness and may add to the treatment burden. These occurrences should be considered for aneurysms treated with PED.

Anesthesia management in patients with abnormally invasive placenta: A single-center experience

Aim: Postpartum hemorrhage is a life-threatening obstetric emergent clinical situation accompanied by blood loss of more than 500 ml after vaginal delivery and more than 1000 ml after cesarean section. This situation, frequently encountered in placental adhesion anomalies, is essential in terms of follow-up, treatment, and multidisciplinary management. We aimed to retrospectively evaluate the perioperative anesthesia management, transfusion requirement, and postoperative intensive care unit requirement of patients diagnosed with placental invasion anomaly who had an intraoperative hemorrhage&#x0D; Methods: In our single-center study, a total of 58 female patients diagnosed with of placental invasion anomaly with a cesarean section between 2017-2020 were examined. Patients under 18 years of age and missing data were excluded from the study. Demographic data of patients (age, American Society of Anesthesiologists score (ASA)), diagnosis, duration of operation, perioperative laboratory findings, anesthesia type, perioperative hemodynamics (highest heart rate, lowest mean arterial pressure, shock index), amount of bleeding, blood products, and fluids used, surgical interventions (B-Lynch, Bacri balloon application, uterine artery ligation, hysterectomy), intraoperative vasopressor/inotrope use, ICU stay, laboratory results in the first 24 hours postoperatively, and total hospital stay were recorded.&#x0D; Results: In the preoperative evaluation, 27 (46.5%) patients were diagnosed with placenta accreta, and placenta previa was diagnosed in 19 (32.7%) patients. Perioperatively mean of 3.08 ± 1.7 units of Red blood cell was used. In patients with postoperative intensive care unit hospitalization, the highest intraoperative lactate value was 3.5±1.8 mmol/L, shock index was 1.3±0.3 (0.6-1.8). In patients given intraoperative fibrinogen concentrate, the intraoperative shock index was 1.5±0.2 (0.9-1.8), the amount of intraoperative bleeding was 2575±302.2 ml, and the fibrinogen levels measured in the first 24 hours after surgery were 294.7±79.7 mg/dl.&#x0D; Conclusions: Anesthesia management of patients diagnosed with abnormal placental invasion is important because of significant hemorrhage. Due to unstable hemodynamics, preoperative blood product preparation with a multidisciplinary approach and a postoperative intensive care unit plan should be made for these patients.