Interventional Procedures Research Articles

Exposure Time Dependence of Operators’ Head Entrance Air Kerma in Interventional Radiology Measured by TLD-100H Chips

Interventional radiology offers minimally invasive procedures guided by real-time imaging, reducing surgical risks and enhancing patient recovery. While beneficial to patients, these advancements increase occupational hazards for physicians due to chronic exposure to ionizing radiation. This exposure raises health risks like radiation-induced cataracts, cardiovascular disease, and cancer. Despite regulations like the European Council Directive 2013/59/EURATOM, which sets limits on whole-body and eye lens doses, no dose limits exist for the brain and meninges, since the brain has traditionally been considered a radioresistant organ. Recent studies, however, have highlighted radiation-induced brain damage, suggesting that meningeal exposure in interventional radiology may be underestimated. This study evaluates the entrance air Cumulative mean annual entrance air kerma to the skullull during interventional radiology procedures, using thermoluminescent dosimeters and controlled exposure simulations. Data were collected by varying the exposure time and analyzing the contribution to the entrance air kerma on each side of the head. The results indicate that, considering the attenuation of the cranial bone, the absorbed dose to the brain, obtained by averaging the head entrance air kerma for the right, front, and left sides of the operator’s head, could represent 0.81% to 2.18% of the annual regulatory limit in Italy of 20 mSv for the average annual effective dose of exposed workers (LD 101/2020). These results provide an assessment of brain exposure, highlighting the relatively low but non-negligible contribution of brain irradiation to the overall occupational dose constraint. Additionally, a correlation between entrance air kerma and the Kerma-Area Product was observed, providing a potential method for improved dose estimation and enhanced radiation safety for interventional radiologists.

Multidisciplinary aerodigestive team meetings for the management of complex airway patients.

Multidisciplinary aerodigestive team meetings for the management of complex airway patients.

Protocol of Brief Behavioral Treatment for insomnia intervention for adult patients with cancer and their sleep-partner caregivers.

Protocol of Brief Behavioral Treatment for insomnia intervention for adult patients with cancer and their sleep-partner caregivers.

A new data science trajectory for analysing multiple studies: a case study in physical activity research.

The analysis of complex mechanisms within population data, and within sub-populations, can be empowered by combining datasets, for example to gain more understanding of change processes of health-related behaviours. Because of the complexity of this kind of research, it is valuable to provide more specific guidelines for such analyses than given in standard data science methodologies. Thereto, we propose a generic procedure for applied data science research in which the data from multiple studies are included. Furthermore, we describe its steps and associated considerations in detail to guide other researchers. Moreover, we illustrate the application of the described steps in our proposed procedure (presented in the graphical abstract) by means of a case study, i.e., a physical activity (PA) intervention study, in which we provided new insights into PA change processes by analyzing an integrated dataset using Bayesian networks. The strengths of our proposed methodology are subsequently illustrated, by comparing this data science trajectories protocol to the classic CRISP-DM procedure. Finally, some possibilities to extend the methodology are discussed.-A detailed process description for multidisciplinary data science research on multiple studies.-Examples from a case study illustrate methodological key points.

A tool for assessing sex/gender bias in epidemiological studies of occupational health: Pilot testing on studies of sedentary behaviour at the workplace and cardiometabolic health

Background The perspective of sex/gender bias is often missing in tools used to assess study risk of bias in systematic reviews. The aim was to pilot a checklist using an aetiological occupational health research question regarding the impact of sedentary behaviour at the workplace and cardiometabolic health. The checklist examined whether the consideration of sex/gender was associated with different study characteristics. Methods A sex/gender checklist developed based on a synopsis of existing instruments with input from the Cochrane Sex/Gender Methods Group was adapted for the present study. This checklist comprises four categories: 1. “Background and conceptual considerations” (3 items), 2. “Study design” (2 items), 3. “Study procedures of investigation or intervention and statistical analysis” (2 items), and 4. “Presentation and interpretation of findings” (3 items). Two independent reviewers evaluated all included studies. Bivariate and multivariable logistic regression analyses were used to examine the consideration of sex/gender across study designs, years of publication, and risk of bias levels (based on the Scottish Intercollegiate Guidelines Network [SIGN]). Results Of the 49 studies evaluated with the checklist, none provided detailed information, 69% (n = 34) provided basic information and 31% (n = 15) no information for the consideration of sex/gender. No intervention study provided information for the first two categories. In the third category, all intervention studies (n = 17) and case-control studies (n = 5) provided basic information on sex/gender, while two of the 23 cohort studies did not. In the fourth category, detailed information was found for all study designs (n = 8). Bivariate analyses revealed no association between the consideration of sex/gender and the year of publication (OR per year = 0.89; 95% CI: 0.65, 1.23). A low risk of bias level was not associated with consideration of sex/gender (OR = 0.60; 95% CI: 0.14; 2.50). Compared to intervention studies the odds of considering sex/gender was increased by a factor of 3.6 (95% CI: 1.0, 12.8) in observational studies. Conclusion The adapted checklist was applicable to assess the consideration of sex/gender in all studies. None of the primary studies considered sex/gender perspectives in all of the four categories. Further optimisation of the sex/gender tool seems warranted, based on further research on weighting individual categories or items and application of the checklist for occupational epidemiology in general.

ESUR consensus MRI for endometriosis: indications, reporting, and classifications

Abstract Objective To propose an update of ESUR endometriosis guidelines to reflect advances in MRI indications, reporting, and classifications. Methods The ESUR Research Committee appointed two chairs (I.T.N., L.M.) to supervise the development of the updated guidelines. Following literature research, a survey was delivered to 20 experts in gynecological imaging from 10 countries. Two rounds of surveys were conducted to obtain a consensus according to a Delphi process method. In this article, the results regarding MR indication, the use of standardized reports, and classifications are presented Results Magnetic resonance imaging (MRI) is recommended when transvaginal ultrasonography is inconclusive in diagnosing endometriosis or negative, in a symptomatic patient, before surgery or interventional procedure, or after surgical treatment if symptoms persist. ESUR panelists consider the roles of an MR classification: to improve communication between radiologist and surgeon (100%, 20/20) and between the radiologist and the patient (45%, 9/20), to predict operating time if surgery is planned (70%, 14/20), to predict the length of hospital stay after surgery (40%, 8/20), and to predict postoperative complications (70%, 14/20). ESUR panelists strongly agree that using an MR classification is useful (19/20, 95%), especially the radiological score, deep-pelvic endometriosis index (dPEI). Among the ESUR expert group, 9/20 experts (45%) used or agreed to use drawings in their report to improve communication with patients. Conclusion Standardized MR reporting is crucial and should include the use of MR classification. Drawings are considered an option, knowing that communication with the patient and surgeon is of paramount importance. Key Points Question ESUR’s endometriosis guidelines were last published in 2017; an update is provided to reflect advances in MRI indications, reporting, and classifications. Findings MRI is advised for inconclusive/negative transvaginal ultrasound in symptomatic patients, before surgery, or post-treatment if symptoms persist. A structured report enhances communication with surgeons and patients. Clinical relevance A standardized report based on a compartmental analysis of the location of endometriotic nodules, with optional drawings, is essential for comprehensive mapping and optimal communication with both patient and surgeon. Graphical Abstract

Periprocedural Safety of Interventional Electrophysiological Procedures in Octogenarians and Nonagenarians.

Catheter ablation is an established treatment for cardiac arrhythmia. There is a lack of data on invasive electrophysiological (EP) procedures in aged patients. Consecutive patients ≥ 80 years who underwent catheter ablation or left atrial appendage closure procedures between January 2005 and December 2017 in a high-volume center were retrospectively studied and compared to a matched control group of individuals < 80 years of age. The aged group consisted of 486 patients who underwent 566 procedures at a mean age of 82.7 ± 2.5 years (range 80-95 years). A cohort of 480 patients aged < 80 years (mean age 64.1 ± 13.3 years) with 566 procedures served as a control group. Performed procedures were atrial arrhythmia ablation including atrial fibrillation treatment (n = 366, 64.7%), cavotricuspid isthmus ablation (n = 139, 24.6%), ablation of ventricular arrhythmias (n = 57, 10.1%), and left atrial appendage closure (n = 12, 2.1%). There were numerically more procedures with major complications after treatment of elderly patients (32 [5.7%] vs. 21 [3.5%] procedures, p = 0.12), as well as numerically more procedures accompanied by intrahospital deaths (6 [1.1%] vs. 1 [0.2%] procedure, p = 0.12). The rate of minor complications was significantly higher in aged patients as compared to younger controls (31 [5.1%] vs. 17 [20%] procedures, p = 0.039). Invasive EP procedures in octogenarians and nonagenarians are feasible, however a significantly higher incidence of minor periprocedural complications and a trend toward more severe complications and intrahospital fatalities were observed compared to younger patients. These findings support an individual risk-benefit assessment for elderly individuals before invasive EP treatments are conducted.

Remimazolam and Esketamine for CT-Guided Aortic Graft Infection Drainage in a Patient with Severe Systematic Comorbidities: A Case Report

Background/Objectives: The management of patients with severe systemic comorbidities undergoing radiologic interventional procedures presents a significant challenge for anesthesiologists. Selecting an appropriate combination of anesthetic drugs is crucial to ensure a safe, painless procedure, facilitate rapid recovery, and minimalize complications. Here, we present a case of a 68-year-old female patient of ASA V status with a history of diabetes, coronary artery disease, and severe chronic obstructive pulmonary disease due to lung emphysema and dependence on a home oxygenator, requiring sedation for CT-guided percutaneous drainage of the aortic graft infection. Methods: After on-site emergent patient preparation and several position adjustments, sedation was initiated and maintained using continuous infusions of remimazolam and esketamine. Results: Throughout the procedure, the patient remained sedated, comfortable, and free of unwanted movements. The patient was hemodynamically stable and maintained oxygen saturation between 92 and 96%. Conclusions: In our opinion, the combination of remimazolam and esketamine demonstrated an effective and safe profile for procedural sedation. This approach holds the potential to influence standard operating protocols, particularly for patients with severe and multiple comorbidities requiring personalized anesthetic management.

Corticosteroid Use in Musculoskeletal and Neuraxial Interventions: Effects on Glycemic Control.

Effective multidisciplinary pain management involves an in-depth knowledge not only of diagnosis and treatment but of how interventional procedures affect patients across all health domains. One of the most common pharmacological tools utilized in patients suffering from chronic pain disorders is corticosteroids. Corticosteroids are leveraged for their anti-inflammatory properties across a wide range of disorders. This review examines the role of corticosteroids and pain management with a specific focus on their metabolic impact regarding glucose metabolism. Corticosteroids have been shown to increase gluconeogenesis, resulting in reduced insulin sensitivity and an impaired peripheral glucose uptake. These varied responses to corticosteroids are especially concerning given the high prevalence of diabetes mellitus in chronic pain patients. There is well-documented evidence of not only transient hyperglycemia but emerging literature on prolonged glycemic disturbances that may have a greater effect on patients than previously recognized. A review of the available literature reveals variations in hyperglycemia depending on corticosteroid type, dose, and various patient-specific factors. Some research does suggest that lower corticosteroid dosages can provide similar therapeutic benefits and potentially reduce glycemic aberrations. Given the current evidence, clinicians should closely monitor patients' hemoglobin A1C levels when determining the risks and benefits of an interventional procedure and consider alternative pain management strategies when appropriate. Future research should focus on optimizing corticosteroid selection and dosing to balance the safety, particularly in diabetic or prediabetic patient populations.

Drug-Coated Balloons in All-Comer Population-Are We There Yet?

With the advancement of interventional coronary procedures, drug-coated balloons have become an increasingly common alternative to drug-eluting stents in the treatment of various lesions. This paradigm shift stems from several advantages that DCBs entail, including a reduction in stent length burden, the possibility of late vessel positive remodeling, and the preservation of bifurcation anatomy. Conversely, several studies compared the efficacy of DCB treatment to stents or POBA in various scenarios. In this review, we will discuss the areas in which a DCB can be of paramount importance. We will begin by examining the role of DCBs in in-stent restenosis, for which the current practice guidelines do not clearly state the role of this technology, as opposed to the previous ones, in which it was mentioned as a first-line armamentarium. We will then discuss the indications and advantages of using DCBs in de novo lesions, concerning both small and large vessels, with growing emphasis on diffuse lesions. Lastly, we will address the current data on the use of DCBs in special scenarios such as the treatment of chronic total occlusion and left main and bifurcation lesions, without forgetting the primordial role of drug-eluting stents in all these lesions.

The Effect of Aromatherapy on Pain and Anxiety Levels Before Breast Biopsy: A Randomized Controlled Trial.

Aromatherapy is widely used in the management of symptoms caused by interventional procedures. This randomized controlled trial evaluated the effectiveness of lavender and lavender-peppermint aromatherapy before breast biopsy for reducing women's pain and anxiety. This trial was conducted in the breast outpatient clinic of a university hospital in İstanbul between July 2021 and March 2023. Patients were randomly assigned to one of two intervention groups; lavender or lavender-peppermint or the control group. Twenty minutes before the breast biopsy, a small pad impregnated with lavender or lavender-peppermint essential oil was attached to each patient at shoulder level, allowing for inhalation. The patients' anxiety and pain levels were assessed before and after the biopsy procedure using the state anxiety inventory and visual analogue scale, respectively. Study population was 135 patients, equally divided between lavender, lavender-peppermint or control groups (each n = 45). The mean age of the patients was 46.30±10.31 years, 76% were married, 65.9% were employed, and 64.4% underwent thick-needle biopsy. After the biopsy, reported anxiety and pain levels had decreased significantly more in the aromatherapy groups compared to the control group (p<0.05). However, no significant difference was found between the lavender and lavender-peppermint groups in terms of anxiety and pain reduction (p>0.05). Anxiety and pain levels were positively correlated (r = 0.406; p<0.001). The use of lavender and lavender-peppermint essential oil via inhalation before breast biopsy was effective in reducing reported anxiety and pain levels. Implementing lavender and lavender-peppermint essential oil inhalation before interventional procedures may offer a simple and cost-effective approach to improving patient outcomes.

Three-dimensional image analyses for diagnosis and treatment of adrenal diseases – a systematic review

Abstract Background Adrenal abnormalities are common imaging findings requiring comprehensive workup. Invasive diagnostic and therapeutic procedures, including adrenal surgery, demand expertise to mitigate the risk of severe complications. Recent applications of 3D image analyses range from enhanced diagnosis to therapeutic guidance with anatomical visualisation. This study assesses the efficacy and clinical utility of 3D image analyses in managing adrenal disease. Methods This systematic review, registered with PROSPERO (CRD42024500783), adheres to PRISMA guidelines. Searches of PubMed, Google Scholar and ClinicalTrials.gov up to August 2024 identified eligible studies. Extracted data included imaging modalities, 3D applications for diagnosis or treatment, volumetric techniques (segmentation and surface rendering), and differentiation between pathologic and normal adrenal glands. Technological maturity was assessed with the IDEAL framework. Results Out of 1812 studies screened, 30 met inclusion criteria, encompassing 4050 imaging exams (1356F/1579M, and 10 studies with 1115 cases), predominantly CT studies (27, 90%; 2 MRI, 6.7%; 1CT/MRI 3.3%). Volumetric reconstructions employed manual, semiautomatic and automatic methods for digital visualisation, and 3D printing in 2 studies (6.7%). 3D analyses of normal vs. neoplastic adrenal tissue supported diagnosis in 17 (56.7%) studies, and treatment in 13 (43.3%), improving understanding of respective anatomical features and planning for operative and interventional procedures. These applications were assessed as corresponding to early IDEAL stages (1-Innovation and 2-Development/Exploration). Conclusion 3D image analyses show promise in optimising adrenal disease management by aiding adrenal lesion characterisation and treatment optimisation through pre- and intraprocedural guidance. Further clinical assessment and long-term studies are warranted to establish the broader clinical impact.

Volumetric soft tissue perfusion assessment on a region basis from x-ray angiography images: Motion compensation.

Assessing the soft tissue perfusion quantitatively in interventional suites before, during, and after interventional procedures is desired. The method, if possible, has to assess the perfusion volumetrically and quantitatively, be robust against lesion overlaps and patient motion, require no additional radiation dose, be quick (possibly in real-time), and fit to the clinical workflow well. We have developed a method called IPEN (for Intra-operative PErfusion assessment with No gantry rotation) that has potential to accomplish all of the desired goals except for the patient motion. The innovation with IPEN is not to reconstruct volumetric images, but to estimate enhancement of multiple three-dimensional regions-of-interest directly from x-ray projections acquired at one angle. To further develop the IPEN method such that it can compensate for patient motion when the patient moves quickly during the angiography scan but stays still otherwise. The proposed motion-compensating IPEN (MCI) consists of the following three steps: (Step 1) The time segment is broken into multiple segments, that is, a set of rapid motion segments and a set of stationary segments; (Step 2) the MCI estimates ROI enhancement within each stationary segment; and (Step 3) MCI connects segments. The performance of the proposed MCI and the original IPEN were assessed using the digital perfusion phantom, simulating 13 ischemic stroke "patients." The head moved within 0.6 s each time, and seven times during 16-s scans; motion magnitude parameter a (for±a mm and±a degrees) was 0.0 (no motion), 0.5, 2.0, 5.0, and 25.0 for each scan. The accuracy of time-enhancement curves (TECs) and calculated perfusion-like parameter ("max-slope" for the maximum of slope of TEC; similar to Patlak plot analysis) was assessed. In addition, the effect of the motion segments on the accuracy of the estimated TEC has been studied systematically. Head motion induced very severe inconsistency and artifact in synthesized digital subtraction angiography images. The original IPEN had disjoint TECs, and the correlation coefficients (r) against the true values decreased from 0.475 at a=0.5 to 0.023 at a=25.0. The proposed MCI provided smooth and accurate TECs with r=0.995 at a=0.5 and r=0.989 at a=25.0. The 𝓁2-norm of the error vectors of the max-slope values was 5.6-64.2 (d.l.) for the original IPEN, whereas it was<0.1 for the MCI for the motion magnitudes investigated. There was an strong linear relationship between the non-linearity of the derivative of TECs and biases in TEC: r was 0.999. MCI would have a significant bias when a lengthy motion occurs when an ROI enhancement changes non-linearly during the time. The proposed MCI can compensate for the patient motion very effectively and accurately when the motion is not continuous and the ROI enhancement does not change non-linearly and significantly during the motion segment.

The role of antimicrobial prophylaxis in brachytherapy for prostate, breast and gynaecological cancer: a narrative review.

Proper antimicrobial prophylaxis is critical for reducing the risk of infection during interventional procedures. Brachytherapy, a highly effective radiation therapy for various malignancies, allows for precise radiation delivery; however, the use of foreign material as instrumentation for brachytherapy potentially increases the risk of infection. Understanding infectious complications and proper antimicrobial use in this case is essential for successful outcomes and patient safety. The aim of this review is to provide insights and summarize existing information on the infectious complications of brachytherapy in prostate, breast and gynaecological (cervical and endometrial) cancer, as well as on the potential benefit, if any, of administering antimicrobial prophylaxis. Infectious complication rates in prostate, breast and gynaecological cancer brachytherapy remain low with diverse prophylactic regimens, emphasizing the need to identify risk factors for tailored practices. The choice of the antimicrobial regimen, type of device and modality influences the probability of infectious complications. There is minimal overlap of existing brachytherapy guidelines with surgical prophylaxis guidelines. Infectious outcomes and antimicrobial resistance are underreported, and guidance for antimicrobial-resistant organisms is scarce. When indicated, prophylaxis for less than 24 h is efficient. More studies oriented towards antimicrobial prophylaxis on this specific population are needed.

Comparison of Dexmedetomidine and Midazolam in Sedoanalgesia for Lumbar Facet Radiofrequency Ablation.

Lumbar facet radiofrequency ablation (LFRA) is a painful procedure. Sedation may be applied to improve patient comfort during the procedure however, deep sedation should be avoided to maintain the patient cooperation. The purpose of this study was to compare dexmedetomidine and midazolam in sedoanalgesia for LFRA. Patients planning to undergo LFRA were included in this cross-sectional, observational study. Following a bolus dose, intravenous infusion of dexmedetomidine was administered in Group D, while intravenous midazolam was given in Group M. Intraoperative vital signs, procedural pain severity (Numerical Rating Scale-NRS), Patient Satisfaction Score (PSS), Operator Satisfaction Score (OSS), and complications were recorded. A total of 96 patients were included in the study. Group D consisted of 47 and Group M of 49 patients. Procedural NRS, PSS, and OSS were significantly in favor of Group D. Mean procedural NRS of Group D was 2.91±2.03, and 4.14±2.17 in Group M ( P =0.005). The rate of unsatisfactory PSS was one (2.1%) in Group D and seven (20%) in Group M ( P =0.03). The rate of unsatisfactory OSS results was two (4.2%) in Group D and sixteen (32.6%) in Group M ( P <0.001). While over-sedation and low oxygen saturation were significantly more frequent in Group M, hypotension was higher in Group D. In sedoanalgesia for LFRA, dexmedetomidine is superior to midazolam with lower procedural pain, higher satisfaction scores and improved patient cooperation. The results of this study can be considered for sedoanalgesia in other interventional pain procedures.

Advancing education in interventional psychiatry: scoping review of simulation training and the future of virtual reality-based learning.

Interventional psychiatric procedures such as electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) have become increasingly important therapeutic options for managing severe or treatment-resistant mental illnesses. However, research suggests that gaps in training students in these techniques represent a rate-limiting step for their further dissemination and accessibility for the public. Studies have shown that the majority of psychiatry residents lack necessary competency and self-confidence in performing these treatments. Simulation based training has served as a gold standard for training procedural skills in medicine. Simulation-based training environments, particularly immersive reality technology (e.g., virtual reality [VR]), represent a promising novel avenue for trainees to develop the necessary skills for delivering these treatments. This scoping review discusses the current training in interventional psychiatry and how simulation-based training, specifically VR, can improve pedagogy in this area. In this scoping review, a literature search was conducted on the PubMed database using specific search terms such as "simulat*", "training", "ECT", "TMS", "neuromodulation", and "interventional psychiatry". The search was limited to studies with language in English from 1980 to 2023. The initial search yielded 2094 articles, of which 4 evaluated the effectiveness of simulation approaches for ECT and were included in this review. No published studies were identified regarding VR-based education in ECT or rTMS. This scoping review provides an overview of the current landscape of pedagogical methods in interventional psychiatry and highlights the identified gaps in both the existing literature and the potential application of simulation-based environments, including VR, within this field. Considering the ongoing shift in medical education towards competency-based training, this review discusses the needs and benefits of VR-based simulators as an avenue to enhance competency in interventional psychiatry. Leveraging existing experience in the use of VR-based simulators in procedural skill acquisition in surgery and anesthesia, as well as recommendations on how to translate this approach to clinical training in psychiatry, are also discussed.

Real time intravascular ultrasound evaluation and stent selection for cerebral venous sinus stenosis associated with idiopathic intracranial hypertension

The value of intravascular ultrasound (IVUS) in the diagnosis and treatment of the venous system is not well established. Introducing a novel approach to utilizing IVUS to evaluate cerebral venous sinus (CVS) stenosis and select stent. Idiopathic intracranial hypertension (IIH) patients with CVS stenosis who underwent IVUS-guided stenting were included in the data analysis from January 2014 to February 2022. The degree of maximum stenosis was determined based on the cross-sectional area (CSA) measured by IVUS, and a stent selection method was applied in the study. Follow-up evaluations were conducted at 6 months to 1 year after endovascular treatment to assess symptom improvement. Additionally, repeated digital subtraction angiography (DSA) or Magnetic resonance venography (MRV) / CT venography（CTV） was performed to evaluate the stent patency at 6 months to 1 year post-procedure. The study included 61 patients. IVUS indicated a lower degree of stenosis compared to conventional DSA measurements when evaluating the degree of stenotic segments preprocedure (74.84 ± 10.12% vs. 78.48 ± 8.72%, p = 0.035). Post-procedural CSA of the most severe stenotic segments showed significant improvement (36.44 ± 8.07 mm2 vs. 7.42 ± 3.28 mm2, p < 0.001). The stent achieved complete expansion (mean stent expansion index, 0.93 ± 0.20) with no significant change in the structure of the reference segment. The trans-stenotic mean pressure gradients (MPGs) across 61 patients significantly decreased from 11.00 ± 6.23 mmHg to 2.09 ± 2.34 mmHg. 47 out of 61 patients received imaging follow-up; among them, 44 (93.6%) demonstrated stent patency in the follow-up imaging. IVUS has great potential to evaluate the degree and extent of CVS stenosis, assist stent selection, and optimize stent position during the interventional procedure in conjunction with DSA.

Integrating the Interleukins in the Biomarker Panel for the Diagnosis and Prognosis of Patients with Acute Coronary Syndromes: Unraveling a Multifaceted Conundrum.

Background and Objectives: Despite the latest advancements in interventional procedures and pharmacological therapy, the incidence of heart failure and death rate following an acute myocardial remain unacceptably high. This study was designed in response to the limited and conflicting literature data regarding the diagnostic and prognostic role of modern inflammatory biomarkers in patients with coronary artery disease. Materials and Methods: We conducted a case-control, prospective observational study. A total of 145 patients were analyzed, of whom 105 patients had an acute coronary syndrome diagnosis and represented the study group, while 40 patients with a chronic coronary syndrome diagnosis represented the control group. This study investigates the diagnostic and prognostic role of the interleukin 1β (IL-1β), interleukin 6 (IL-6), interleukin 10 (IL-10), Growth differentiation factor 15 (GDF-15), and classic biomarkers in patients with ischemic coronary heart disease. Results: IL-1β exhibited a prognostic role, being significantly correlated with a left ventricular ejection fraction below 30%. GDF-15 plays a dual role, as a cardio-inflammatory biomarker, being significantly correlated with both N-terminal pro-brain natriuretic peptide (NT-proBNP), and IL-1β, IL-6, and CRP. At the same time, GDF-15 represents a surrogate marker for renal dysfunction. According to the ROC analysis, patients at high mortality risk can be identified with adequate accuracy by cardiac troponin, GDF-15, and IL-10, in addition to NT-proBNP. Logistic regression models confirmed NT-proBNP and IL-10 as mortality predictors. Conclusions: IL-1β stands out for its significant prognostic role, while IL-6 did not demonstrate a diagnostic or prognostic role in acute myocardial infarction patients. IL-10 demonstrated superior predictive value in terms of fatal prognosis compared with the other modern biomarkers. GDF-15 is representative of a multivalent biomarker involved in inflammation, heart failure, and renal dysfunction.

Role of Artificial Intelligence in Musculoskeletal Interventions.

Artificial intelligence (AI) has rapidly emerged as a transformative force in musculoskeletal imaging and interventional radiology. This article explores how AI-based methods-including machine learning (ML) and deep learning (DL)-streamline diagnostic processes, guide interventions, and improve patient outcomes. Key applications discussed include ultrasound-guided procedures for joints, nerves, and tumor-targeted interventions, along with CT-guided biopsies and ablations, and fluoroscopy-guided facet joint and nerve block injections. AI-powered segmentation algorithms, real-time feedback systems, and dose-optimization protocols collectively enable greater precision, operator consistency, and patient safety. In rehabilitation, AI-driven wearables and predictive models facilitate personalized exercise programs that can accelerate recovery and enhance long-term function. While challenges persist-such as data standardization, regulatory hurdles, and clinical adoption-ongoing interdisciplinary collaboration, federated learning models, and the integration of genomic and environmental data hold promise for expanding AI's capabilities. As personalized medicine continues to advance, AI is poised to refine risk stratification, reduce radiation exposure, and support minimally invasive, patient-specific interventions, ultimately reshaping musculoskeletal care from early detection and diagnosis to individualized treatment and rehabilitation.

Tissue Reactions (Deterministic Effects) in Diagnostic and Interventional Radiology: An Integrative Review of Recent Literature&lt;i&gt;&lt;/i&gt;

Ninety-eight percent of the global average individual dose delivered by artificial sources of ionizing radiation results from their use in medical applications, especially for diagnostic and interventional purposes. Although the benefits of radiation in medicine are widely recognized, exposure to this agent can cause harmful effects on the health of exposed individuals. Radiation applications for diagnostic purposes are generally associated with low doses, but interventional procedures may involve much higher doses. In the 2000s and 2010s, several publications described tissue reactions in patients and professionals exposed during interventional radiological procedures. This work aimed to review the literature on the most recent reports (last decade) on the occurrence of tissue reactions after diagnostic or interventional radiological procedures. The PubMed search tool was used to search and select publications on the topic. Although 826 articles were initially selected, only 5 presented relevant content for this review. The low number of articles in the final selection may be a result of the methodology we used or an actual reduction in the number of individuals presenting these effects in more recent years, due to the growing concerns about radiological protection in these practices. Among the articles analyzed, there were reports of skin lesions, as well as thinning or hair loss in patients exposed to doses (cumulative air kerma at the reference point) above 3.5 Gy. However, these reactions are rare and do not appear in most patients, even among those who received higher doses. An increased frequency of lens opacities (cataracts) has also been reported in occupationally exposed professionals. An adequate assessment of the occurrence of these effects is essential to try to understand their causes and minimize the frequency or consequences of their occurrence. Carrying out research like this can help with this task.