Therapy Monitoring Research Articles

Design and validation of the ADNI MR protocol.

Phase four of the Alzheimer's Disease Neuroimaging Initiative (ADNI4) magnetic resonance imaging (MRI) protocols aim to maintain longitudinal consistency across two decades of data acquisition, while adopting new technologies. Here we describe and justify the study's design and targeted biomarkers. The ADNI4 MRI protocol includes nine MRI sequences. Some sequences require the latest hardware and software system upgrades and are continuously rolled out as they become available at each site. The main sequence additions/changes in ADNI4 are: (1) compressed sensing (CS) T1-weighting, (2) pseudo-continuous arterial spin labeling (ASL) on all three vendors (GE, Siemens, Philips), (3) multiple-post-labeling-delay ASL, (4) 1 mm3 isotropic 3D fluid-attenuated inversion recovery, and (5) CS 3D T2-weighted. ADNI4 aims to help the neuroimaging community extract valuable imaging biomarkers and provide a database to test the impact of advanced imaging strategies on diagnostic accuracy and disease sensitivity among individuals lying on the cognitively normal to impaired spectrum. HIGHLIGHTS: A summary of MRI protocols for phase four of the Alzheimer's Disease Neuroimaging Initiative (ADNI 4). The design and justification for the ADNI 4 MRI protocols. Compressed sensing and multi-band advances have been applied to improve scan time. ADNI4 protocols aim to streamline safety screening and therapy monitoring. The ADNI4 database will be a valuable test bed for academic research.

Active Surface-Enhanced Raman Spectroscopy (SERS): A Novel Concept for Enhancing Signal Contrast in Complex Matrices Using External Perturbation.

Noninvasive detection of surface-enhanced Raman spectroscopy (SERS) signals from deep within tissue represents a common challenge in many biological and clinical applications including disease diagnosis and therapy monitoring. Such signals are typically weak and not readily discernible from often much larger Raman and fluorescence background signals (e.g., from surrounding tissue). Consequently, suboptimal sensitivity in the detection of SERS signals is often achieved in these situations. Similar issues can arise in SERS measurements in other diffusely scattering samples and complex matrices. Here, we propose a novel concept, active SERS, for the efficient retrieval of SERS signals from deep within complex matrices such as biological tissues that mitigates these issues. It relies on applying an external perturbation to the sample to alter the SERS signal from nanoparticles (NPs) deep inside the matrix. A measurement with and without, or before and after, such perturbation then can provide powerful contrasting data enabling an effective elimination of the matrix signals to reveal more clearly the desired SERS signal without the interfering background and associated artifacts. The concept is demonstrated using ultrasound (US) as an external source of perturbation and SERS NPs inserted deep within a heterogeneous tissue phantom mimicking a cluster of NPs accumulated within a small target lesion. The overall SERS signal intensity induced by the applied US perturbation decreased by ∼21% and the SERS signal contrast was considerably improved by eliminating subtraction artifacts present in a conventional measurement performed at a neighboring spatial location in a heterogeneous tissue sample. Although the technique was demonstrated with SERS gold NPs with a standard Raman label, it is envisaged that active SERS NPs (both the nanoscale metal geometry and Raman label) could be specifically designed to deliver an augmented response to the external stimulus to further enhance the achievable SERS signal contrast and yield even greater improvement in detection sensitivity. The method was demonstrated using transmission Raman spectroscopy; however, it is also applicable to other Raman implementations including spatially offset Raman spectroscopy and conventional Raman spectroscopy performed both at depth and at surfaces of complex matrices.

Circadian rhythm of brain-derived neurotrophic factor in serum and plasma.

The neurotrophic growth factor brain-derived neurotrophic factor (BDNF) plays a crucial role in various neurodegenerative and psychiatric diseases, such as Alzheimer's disease, schizophrenia and depression. BDNF has been proposed as a potential biomarker for diagnosis, prognosis and monitoring therapy. Understanding the factors influencing BDNF levels and whether they follow a circadian rhythm is essential for interpreting fluctuations in BDNF measurements. We aimed to investigate the circadian rhythm of BDNF by collecting multiple peripheral venous blood samples from young, healthy male participants at 12 different time points over 24h. In addition, vital parameters, cortisol and insulin like growth factor 1 (IGF1) were measured to explore potential regulatory mechanisms, interfering variables and their correlations with BDNF concentration. The findings revealed that plasma BDNF did not exhibit any significant fluctuations over 24h, suggesting the absence of a circadian rhythm. However, serum BDNF levels decreased during sleep. Furthermore, serum BDNF showed a positive correlation with heart rate but a negative correlation with IGF1. No significant correlation was observed between cortisol and BDNF or IGF1. Although plasma BDNF suggests steady-state conditions, the decline of serum BDNF during the nocturnal period could be attributed to physical inactivity and associated with reduced haemodynamic blood flow (heart rate reduction during sleep). The type of sample collection (peripheral venous cannula vs. blood sampling using a butterfly system) does not significantly affect the measured BDNF levels. The sample collection during the day did not significantly affect BDNF analysis, emphasizing the importance of considering activity levels rather than timing when designing standardized protocols for BDNF assessments.

Optimizing Solid Microneedle Design: A Comprehensive ML-Augmented DOE Approach.

Microneedles (MNs), that is, a matrix of micrometer-scale needles, have diverse applications in drug delivery, skincare therapy, and health monitoring. MNs offer a minimally invasive alternative to hypodermic needles, characterized by rapid and painless procedures, cost-effective fabrication methods, and reduced tissue damage. This study explores four MN designs, cone-shaped, tapered cone-shaped, pyramidal with a square base, and pyramidal with a triangular-shaped base, and their optimization based on predefined criteria. The workflow encompasses three loading conditions: compressive load during insertion, critical buckling load, and bending loading resulting from incorrect insertion. Geometric parameters such as base radius/width, tip radius/width, height, and tapered angle tip influence the output criteria, namely, total deformation, critical buckling loads, factor of safety (FOS), and bending stress. The comprehensive framework employing a design of experiment approach within the ANSYS workbench toolbox establishes a mathematical model and a response surface fitting model. The resulting regression model, sensitivity chart, and response curve are used to create a multiobjective optimization problem that helps achieve an optimized MN geometrical design across the introduced four shapes, integrating machine learning (ML) techniques. This study contributes valuable insights into a potential ML-augmented optimization framework for MNs via needle designs to stay durable for various physiologically relevant conditions.

Mycobacterium genavense detection in a blood smear from a domestic ferret

AbstractThe domestic ferret is sensitive to mycobacterial infections, which are likely underdiagnosed. There are limited reports of therapy for mycobacteriosis in ferrets and most have failed. A ferret in poor body condition revealed marked organomegaly on diagnostic imaging. The complete blood count revealed a mild pseudoeosinophilia, which might be attributed to negatively stained bacilli phagocytised by monocytes observed in the blood smear. Ziehl–Neelsen stain was performed and showed acid‐fast bacilli within monocytes. Fine‐needle aspirates of the spleen and liver revealed the same finding. Mycobacterium genavense was identified by PCR and DNA sequencing from peripheral blood. Treatment with rifampicin, clarithromycin and enrofloxacin was initiated. The disseminated mycobacteriosis was suspected from the observation of bacilli on the blood smear. After 16 months, the ferret is still undergoing treatment. To prevent recurrence, continued monitoring of drug toxicity and effective therapy will be maintained even after the resolution of clinical signs (mostly organomegaly).

Analysis of the National Formulary Drug Supply Chain with Its Availability in the Pharmacy Installation of the Government General Hospital (RSUD) Dr. Sitanala Tangerang City

This study explores the pharmaceutical supply chain management of the National Formulary at RSUP Dr. Sitanala in Tangerang City, aiming to identify obstacles to drug availability and formulate effective and efficient solutions. Acknowledging quality healthcare as a fundamental human right and a critical investment for a nation's future, this research emphasizes the importance of high-quality healthcare services. These services encompass not only treatment but also health promotion and disease prevention through the adoption of clean and healthy living habits. Drug availability is a major pillar in the provision of quality healthcare services. Effective and efficient management of the pharmaceutical supply chain, particularly regarding National Formulary drugs, is crucial in ensuring the availability of medications at healthcare facilities. This research employs a comprehensive analysis of the supply chain processes at RSUP Dr. Sitanala, examining stages such as drug selection, demand planning, procurement, receipt, storage, distribution, drug control, therapy monitoring, prescription preparation, drug dispensation, and medication administration. The study's methodology involves a case study approach, integrating theoretical management principles and interdisciplinary pharmacy management with compliance to regulations, as outlined in Permenkes No. 76 of 2016. Findings from RSUP Dr. Sitanala indicate that the hospital's pharmaceutical management practices align with contemporary health and pharmacy management theories, emphasizing structured systems, stringent verification, and effective interprofessional communication to ensure medication safety and efficacy. The study identifies challenges in information technology and interdisciplinary coordination as areas needing improvement. Nonetheless, a commitment to continuous improvement and adherence to regulatory standards reflects RSUP Dr. Sitanala's dedication to enhancing the quality of pharmaceutical management and healthcare services. The implications of this research extend beyond RSUP Dr. Sitanala, offering valuable recommendations for improving drug supply chain management in other healthcare institutions in Indonesia. By enhancing access to and the quality of healthcare services, this study contributes to the broader goal of achieving the highest possible level of health for individuals, reflecting the perspective of human rights and investment in the nation's future health.

Long-term successfull management of recurrent episodes of nontuberculous mycobacterial infection in an apparently healthy Chinese woman

BackgroundDisseminated non-tuberculous mycobacteria (dNTM) infections are mostly reported among individuals with an underlying congenital or acquired immunodeficiency or receiving immunosuppressive treatment, but are rarely documented in otherwise healthy subjects.Case presentationWe describe a case of recurrent disseminated mycobacterial infection in an apparently immunocompetent Chinese woman. Mycobacterium szulgai and Mycobacterium avium-complex were identified in distinct episodes. Long-term antimycobacterial therapy was administered given the occurrence of recurrent events when off-treatment. Successful management over more than 10 years and immunologic data are reported.ConclusionsThis case-report highlights that dNTM should be suspected also among apparently immunocompetent hosts and that thorough assessment of underling immune-impairments is helpful to define patients’ management. Long-term antimycobacterial therapy and close monitoring is required to grant successful outcomes in case of recurrent dNTM infections.

Optimizing the post-CAR T monitoring period in recipients of axicabtagene ciloleucel, tisagenlecleucel, and lisocabtagene maraleucel

AbstractCD19–directed chimeric antigen receptor T-cell (CAR T) therapies, including axicabtagene ciloleucel (axi-cel), tisagenlecleucel (tisa-cel), and lisocabtagene maraleucel (liso-cel), have transformed the treatment landscape for B-cell non-Hodgkin lymphoma, showcasing significant efficacy but also highlighting toxicity risks such as cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS). The US Food and Drug Administration has mandated patients remain close to the treatment center for 4 weeks as part of a Risk Evaluation and Mitigation Strategy to monitor and manage these toxicities, which, although cautious, may add to cost of care, be burdensome for patients and their families, and present challenges related to patient access and socioeconomic disparities. This retrospective study across 9 centers involving 475 patients infused with axi-cel, tisa-cel, and liso-cel from 2018 to 2023 aimed to assess CRS and ICANS onset and duration, as well as causes of nonrelapse mortality (NRM) in real-world CAR T recipients. Although differences were noted in the incidence and duration of CRS and ICANS between CAR T products, new-onset CRS and ICANS are exceedingly rare after 2 weeks after infusion (0% and 0.7% of patients, respectively). No new cases of CRS occurred after 2 weeks and a single case of new-onset ICANS occurred in the third week after infusion. NRM is driven by ICANS in the early follow-up period (1.1% until day 28) and then by infection through 3 months after infusion (1.2%). This study provides valuable insights into optimizing CAR T therapy monitoring, and our findings may provide a framework to reduce physical and financial constraints for patients.

Does Nociception Level Index-Guided Opioid Administration Reduce Intraoperative Opioid Consumption? A Systematic Review and Meta-Analysis.

The nociception level (NOL) index is a quantitative parameter derived from physiological signals to measure intraoperative nociception. The aim of this systematic review and meta-analysis was to evaluate if NOL monitoring reduces intraoperative opioid use compared to conventional therapy (opioid administered at clinician discretion). This meta-analysis comprises randomized clinical trials comparing NOL-guided opioid administration to conventional therapy in adult patients undergoing any type of surgery. A systematic search of PubMed, Scopus, and CENTRAL databases was conducted. The primary outcome was intraoperative opioid consumption and the effect estimate of the NOL index was measured using the standardized mean difference (SMD) where 0.20 is considered a small and 0.80 a large effect size. A random-effects model with Hartung-Knapp-Sidik-Jonkman adjustment was applied to estimate the treatment effect. Heterogeneity was explored clinically and statistically (using the inconsistency I² statistic, prediction intervals, and influence analysis). The quality (certainty) of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) guidelines methodology. This review comprised 9 trials (519 patients). The intraoperative opioid SMD (NOL monitoring versus conventional therapy) was -0.26 (95% confidence interval [CI], -0.82 to 0.30; P = .31; low certainty of evidence). We observed substantial clinical (intraoperative opioid regimens) and statistical heterogeneity with the I² statistic being 86% (95% CI, 75%-92%). The prediction interval was between -1.95 and 1.42 indicating where the SMD between NOL and conventional therapy would lie if a similar study were conducted in the future. This meta-analysis does not provide evidence supporting the role of NOL monitoring in reducing intraoperative opioid consumption.

Electrochemical Label-free Methods for Ultrasensitive Multiplex Protein Profiling of Infectious Diseases.

Electrochemical detection methods are the more appropriate detection methods when it comes to the sensitive and specific determination of biomarkers. Biomarkers are the biological targets for disease diagnosis and monitoring. This review focuses on recent advances in label-free detection of biomarkers for infectious disease diagnosis. The current state of the art for rapid detection of infectious diseases and their clinical applications and challenges were discussed. Label-free electroanalytical methods are probably the most promising means to achieve this. We are currently in the early stages of the emerging technology of using label-free electrochemistry of proteins to develop biosensors. To date, antibody-based biosensors have been intensively developed, although many improvements in reproducibility and sensitivity are still needed. Moreover, there is no doubt that a growing number of aptamers and hopefully label-free biosensors based on nanomaterials will soon be used for disease diagnosis and therapy monitoring. And also here in this review article, we have discussed recent developments in the diagnosis of bacterial and viral infections, as well as the current status of the use of label-free electrochemical methods for monitoring inflammatory diseases.

Fast ultrasonic ablation monitoring: An innovative approach using ultrasound RF signals and singular value decomposition

Microwave ablation (MWA) can rapidly lead to tumor cell necrosis by heating local tissues using electromagnetic field energy, making it a highly efficient modality widely utilized in clinical ablation surgeries. However, the lack of timely and accurate intraoperative monitoring methods is a critical issue that urgently needs to be addressed in MWA. This article introduces an innovative approach for real-time monitoring of ablation therapies by the combination of ultrasound radio frequency (RF) signal acquisition and singular value decomposition (SVD), which breaks through the limitations of current monitoring techniques during MWA procedures. Due to the difference in acoustic scattering properties between the gas generated in high-temperature ablated region and the non-ablated tissues, the current new method aimed to apply SVD analyses to ultrasound RF signals scattered from the tissues, through which the range of gas generation could be determined and then the ablation area could be estimated. Eventually, high-precision differentiation between ablated and non-ablated tissues could be achieved, enabling real-time adjustment and improvement of MWA strategies. Validated through ex vivo experiments on pig liver, this technique demonstrated a relative error in monitoring the size of ablation region of approximately 7%, indicating a strong correlation with actual ablation outcomes. The study indicated the proposed method should have great potential to improve the precision and safety of MWA therapy.

Effects of serial NT-proBNP measurements in patients with acute decompensated heart failure: Results of the POC-HF pilot trial.

Serial N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurements have proven to be useful for therapy monitoring in patients hospitalized for acute decompensated heart failure (ADHF). The POC-HF pilot study investigated whether serial NT-proBNP measurements influenced treatment decisions in these patients. Patients hospitalized for ADHF were randomly assigned to an intervention group (serial NT-proBNP measurements made available to treating physicians) or a control group (care as usual). HF therapy was administered at the discretion of the treating physician. The primary endpoint was dose changes in HF therapy during hospitalization. Secondary endpoints included changes in NT-proBNP levels, recovery from HF symptoms, length of hospital stay, and quality of life. 52 patients (35% female; mean age 81.8 years) were included. The availability of serial NT-proBNP values was associated with higher dosages of ACE inhibitors (relative treatment effect (RTE) day 11:0.74, p=0.007) and loop diuretics (RTE day 11:0.77, p=0.005), and lower dosages of beta-blockers (RTE day 11:0.43, p=0.002). NT-proBNP levels decreased (-752 pg/ml, p=0.162) and recovery rates from ADHF symptoms were more pronounced in the intervention group, but without statistical significance. No differences were found in terms of the length of hospital stay and quality of life. The results of this pilot trial indicate that serial NT-proBNP measurements are possibly associated with faster up-titration of HF medication, more pronounced NT-proBNP decrease, and faster recovery from symptoms than symptom-guided therapy in patients hospitalized for ADHF. These preliminary findings require further validation through larger studies. http://www.swissethics.ch BASEC-ID 2017-01030, registered on 28 December 2017.

The effects of laryngeal mask versus endotracheal tube on atelectasis after general anesthesia induction assessed by lung ultrasound: A randomized controlled trial

Study objectiveThis study aims to evaluate the impact of Supreme™ laryngeal masks versus endotracheal tubes on atelectasis during general anesthesia using lung ultrasound (LUS), and provide evidence for respiratory management. DesignA single-center, double-blind, randomized controlled trial was conducted. SettingThe study was conducted in both the operating room and the post-anesthesia care unit, with follow-up assessments performed in the ward. PatientsEnrollment included 180 cases undergoing non-laparoscopic surgeries in gynecology, urology, and orthopedic limb surgeries. InterventionsPatients were randomly assigned 1:1 to the endotracheal intubation or laryngeal mask group. MeasurementsLUS scores were recorded across 12 lung regions at baseline, 15 min after airway establishment, at the end of surgery, and 30 min following airway removal. Outcome measures encompassed the oxygenation index, dynamic lung compliance, incidence of postoperative pulmonary complications, throat pain, and other postoperative complications assessed at 24 and 48 h postoperatively. The primary outcome focused on the LUS score in all 12 lung regions at 15 min after airway establishment. Main resultsIntention-to-treat analysis of 177 subjects revealed endotracheal intubation led to significantly higher LUS scores at 15 min {P < 0.001, mean difference 4.15 ± 0.60, 95% CI [2.97, 5.33]}, end of surgery (P < 0.001, mean difference 3.37 ± 0.68, 95% CI [2.02, 4.72]), and 30 min post-removal (P < 0.001, mean difference 2.63 ± 0.48, 95% CI [1.68, 3.58]). No major complications occurred in the two groups. ConclusionsCompared to endotracheal intubation, laryngeal masks effectively reduce atelectasis formation and progression in gynecological, urological non-laparoscopic, and orthopedic limb surgeries. However, caution is warranted when generalizing these findings to surgeries with a higher risk of laryngeal mask leakage or obese patients. Additionally, the efficacy of laryngeal masks in reducing postoperative atelectasis remains uncertain when comprehensive monitoring of muscle relaxation and reversal therapy is employed.

The current state of the problem, clinical-pathogenetic approaches to the diagnosis and management tactics of fetal growth restriction

Fetal growth restriction is a common complication of pregnancy with a complex etiology and limited possibilities of diagnosis and treatment. The relevance of this difficult obstetric problem is determined by various published diagnostic criteria, relatively low detection rates, and limited options for prevention and treatment.Fetal growth restriction is defined as the inability of the fetus to reach its genetically determined growth potential, most often due to abnormal placentation. Forms of fetal growth restriction with early or late onset are distinguished based on the gestational age determined during prenatal ultrasound diagnosis. According to most recommendations, the 32nd week of pregnancy is set as the cut-off point for distinguishing between early and late onset fetal growth restriction.The definition underlying this classification is based on differences between these two phenotypes of fetal growth restriction in severity, natural history, Doppler findings, association with hypertensive complications, placental features, and management. It is important to distinguish two separate conditions: fetal growth restriction and small-for-gestational fetus, which differ in short-term and long-term perinatal outcomes.A fetus is defined as small for gestational age if the estimated weight or weight of the fetus at birth is below the 10th percentile. Fetal growth restriction is diagnosed if the estimated fetal weight is below the 3rd percentile or a combination of pathological blood flow in the umbilical arteries and/or uterine arteries in fetuses with an estimated weight below the 10th percentile. It can also occur in fetuses and newborns with a body weight above the 10th percentile.The need to distinguish between fetal growth restriction and small-for-gestational-age fetus is related to the fact that fetal growth restriction is the main cause of stillbirth, neonatal death, higher perinatal morbidity, as well as increased risk of diseases in adulthood.The article analyzes the approaches to differentiating fetal growth restriction from small growth retardation in terms of fetal gestation period and further increasing the accuracy of diagnosis, as well as the modern concept of pathogenesis, with an emphasis on oxidant stress as a key molecular mechanism of adverse outcomes. Appropriate interventions during pregnancy to reduce perinatal complications should include antenatal monitoring and drug therapy.

Preclinical evaluation of [225Ac]Ac-crown-TATE – An alpha-emitting radiopharmaceutical for neuroendocrine tumors

BackgroundTargeted alpha therapy (TAT) of somatostatin receptor-2 (SSTR2) positive neuroendocrine tumors (NETs) involving Ac-225 ([225Ac]Ac-DOTA-TATE) has previously demonstrated improved therapeutic efficacy over conventional beta particle-emitting peptide receptor radionuclide therapy agents. DOTA-TATE requires harsh radiolabeling conditions for chelation of [225Ac]Ac3+, which can limit the achievable molar activities and thus therapeutic efficacy of such TAT treatments. Macropa-TATE was recently highlighted as a potential alternative to DOTA-TATE, owing to the mild radiolabeling conditions and high affinity toward [225Ac]Ac3+; however, elevated liver and kidney uptake were noted as a major limitation and a suitable imaging radionuclide is yet to be reported, which will be required for patient dosimetry studies and assessment of therapeutic benefit. Previously, [155Tb]Tb-crown-TATE has shown highly effective imaging of NETs in preclinical SPECT/CT studies, with high tumor uptake and low non-target accumulation; these favourable properties and the versatile coordination behavior of the crown chelator may therefore show promise for combination with Ac-225 for TAT. MethodsCrown-TATE was labeled with Ac-225, and radiochemical yield was analyzed as the function of crown-TATE concentration. LogD7.4 was measured as the indication of hydrophilicity. Free [225Ac]Ac3+ release from [225Ac]Ac-crown-TATE in human serum was studied. Biodistribution studies of [225Ac]Ac-crown-TATE in mice bearing AR42J tumors was evaluated at 1, 4, 24, 48, and 120 h, and the absorbed dose to major organs calculated. Therapy-monitoring studies with AR42J tumor bearing mice were undertaken using 30 kBq and 55 kBq doses of [225Ac]Ac-crown-TATE and compared to controls treated with PBS or crown-TATE. Results[225Ac]Ac-crown-TATE was successfully prepared with high molar activity (640 kBq/nmol), and characterized as a moderately hydrophilic radioligand (LogD7.4 = −1.355 ± 0.135). No release of bound Ac-225 was observed over 9 days in human serum. Biodistribution studies of [225Ac]Ac-crown-TATE showed good initial tumor uptake (11.1 ± 1.7% IA/g at 4 h) which was sustained up to 120 h p.i. (6.92 ± 2.03% IA/g). Dosimetry calculations showed the highest absorbed dose was delivered to the tumors. Therapy monitoring studies demonstrated significant (log-rank test, P < 0.005) improved survival in both treatment groups compared to controls. ConclusionsThis preclinical study demonstrated the therapeutic efficacy of [225Ac]Ac-crown-TATE for treatment of NETs, and highlights the potential of using crown chelator for stable chelation of Ac-225 under mild conditions.

Drug-Drug Interactions in Hospitalized Urological Patients: A Retrospective Cohort Study.

Exposure to potential drug-drug interactions (pDDIs) can be a notable source of avoidable drug-related harm that requires adequate management to prevent medical errors. We aimed to evaluate pDDIs and associated factors in hospitalized urological patients on admission, during hospitalization, and on discharge. A retrospective cohort study was conducted at the Clinic of Urology of the University Clinical Centre Kragujevac, Serbia. To detect pDDIs, we used Lexicomp, which categorizes pDDIs as follows: X (avoid combination), D (consider therapy modification), C (monitor therapy), B (no action needed), and A (no known interaction). Multiple linear regression analysis was used to identify factors associated with the number of pDDIs. More than half of the 220 included patients had at least one pDDI on admission and discharge (57.3% and 63.6%, respectively), whereas 95.0% had at least one pDDI during hospitalization. The total number and number of X, D, C, and B categories of pDDIs were the highest during hospitalization and the lowest on admission. Duration of hospitalization, arrhythmias, dementia, renal failure, cancer, surgery during hospitalization, number of prescribed drugs, and various pharmacological drug classes were risk factors for a higher number of pDDIs, while age, ischemic heart disease, hypertension, and development of infection during hospitalization were protective factors in at least one of the stages. The impact of renal colic depended on the stage and category of pDDI. More than half of the urological patients were exposed to at least one pDDIs at all stages. Medical professionals should regularly screen for pDDIs, particularly in patients with risk factors.

Use of Lung Ultrasound in Cystic Fibrosis: Is It a Valuable Tool?

Cystic fibrosis (CF) is a multisystem disorder characterized by progressive respiratory deterioration, significantly impacting both quality of life and survival. Over the years, lung ultrasound (LUS) has emerged as a promising tool in pediatric respiratory due to its safety profile and ease at the bedside. In the era of highly effective CF modulator therapies and improved life expectancy, the use of non-ionizing radiation techniques could become an integral part of CF management, particularly in the pediatric population. The present review explores the potential role of LUS in CF management based on available data, analyzing all publications from January 2015 to January 2024, focusing on two key areas: LUS in CF pulmonary exacerbation and its utility in routine clinical management. Nonetheless, LUS exhibits a robust correlation with computed tomography (CT) scans and serves as an additional, user-friendly imaging modality in CF management, demonstrating high specificity and sensitivity in identification, especially in consolidations and atelectasis in the CF population. Due to its ability, LUS could be an instrument to monitor exacerbations with consolidations and to establish therapy duration and monitor atelectasis over time or their evolution after therapeutic bronchoalveolar lavage. On the basis of our analysis, sufficient data emerged showing a good correlation between LUS score and respiratory function tests. Good sensitivity and specificity of the methodology have been found in rare CF pulmonary complications such as effusion and pneumothorax. Regarding its use in follow-up management, the literature reports a moderate correlation between LUS scores and the type, extent, and CT severity score of bronchiectasis. A future validation of ultrasound scores specifically in CF patients could improve the use of LUS to identify pulmonary exacerbations and monitor disease progression. However, further research is needed to comprehensively establish the role of LUS in the CF population, particularly in elucidating its broader utility and long-term impact on patient care.

Clinical Utility of Global Longitudinal Strain in Cancer Therapy Monitoring

Clinical Utility of Global Longitudinal Strain in Cancer Therapy Monitoring

Risk Factors and Drug Therapy Monitoring in CKD Patients (Chronic Kidney Disease)

Chronic Kidney Disease (CKD) is a global health problem that affects millions of people, characterized by a progressive decline in kidney function. This study aims to determine Drug Related Problems (DRPs) in the treatment management of CKD (Chronic Kidney Disease) patients. This study used the literature review method. The research results from the collected literature will be summarized and presented in the form of descriptive analysis. Researchers will conduct literature searches through online sites such as Google Scholar, PubMed, ResearchGate, Elsevier, and NCBI. The keywords used are “CKD risk factors” and “drug therapy for CKD patients”. The results of the search for relevant literature will be collected and selected according to the inclusion criteria. The research results from the collected literature will be presented in the form of a descriptive table. The table will include information such as author, year of publication, article title, and summary of the study results. The prevalence of drug-related problems (DRP) in CKD patients ranges from 12% to 87%. Commonly found problems include ineffective treatment, inappropriate drug selection, and drug dosing issues. Regular drug monitoring and dose adjustment are essential to reduce adverse drug reactions and improve patient outcomes. Effective drug therapy management and patient education are essential to improve the quality of care and life of CKD patients. In conclusion, this study emphasizes the importance of identifying and addressing drug-related problems (DRPs) to improve treatment effectiveness in CKD patients. Close drug monitoring and comprehensive patient education are key components in the optimal management of CKD.

Dosimetry of microbeam radiotherapy by flexible hydrogenated amorphous silicon detectors

Objective. Detectors that can provide accurate dosimetry for microbeam radiation therapy (MRT) must possess intrinsic radiation hardness, a high dynamic range, and a micron-scale spatial resolution. In this work we characterize hydrogenated amorphous silicon detectors for MRT dosimetry, presenting a novel combination of flexible, ultra-thin and radiation-hard features. Approach. Two detectors are explored: an n-type/intrinsic/p-type planar diode (NIP) and an NIP with an additional charge selective layer (NIP + CSC). Results. The sensitivity of the NIP + CSC detector was greater than the NIP detector for all measurement conditions. At 1 V and 0 kGy under the 3T Cu–Cu synchrotron broadbeam, the NIP + CSC detector sensitivity of (7.76 ± 0.01) pC cGy−1 outperformed the NIP detector sensitivity of (3.55 ± 0.23) pC cGy−1 by 219%. The energy dependence of both detectors matches closely to the attenuation coefficient ratio of silicon against water. Radiation damage measurements of both detectors out to 40 kGy revealed a higher radiation tolerance in the NIP detector compared to the NIP + CSC (17.2% and 33.5% degradations, respectively). Percentage depth dose profiles matched the PTW microDiamond detector’s performance to within ±6% for all beam filtrations except in 3T Al–Al due to energy dependence. The 3T Cu–Cu microbeam field profile was reconstructed and returned microbeam width and peak-to-peak values of (51 ± 1) μm and (405 ± 5) μm, respectively. The peak-to-valley dose ratio was measured as a function of depth and agrees within error to the values obtained with the PTW microDiamond. X-ray beam induced charge mapping of the detector revealed minimal dose perturbations from extra-cameral materials. Significance. The detectors are comparable to commercially available dosimeters for quality assurance in MRT. With added benefits of being micron-sized and possessing a flexible water-equivalent substrate, these detectors are attractive candidates for quality assurance, in-vivo dosimetry and in-line beam monitoring for MRT and FLASH therapy.