Volume Reduction Research Articles

Laser ablation for spongiform thyroid nodules: identifying baseline nodule volume and energy to be delivered for successful treatment.

Laser ablation (LA) is a minimally invasive treatment. It has been widely used since the early 2000s to induce volume reduction of symptomatic benign thyroid nodules. Up to 40% of laser-treated nodules have been reported to achieve a volume reduction of <50% (technique inefficacy) at 12 months and tend to regrow over time. This study aimed to assess the optimal baseline volume and energy to be delivered to minimize technique inefficacy. This was a retrospective study. Data were collected, including baseline volume, energy delivered, and 12-month volume reduction ratio (VRR) of spongiform nodules (EU-TIRADS 2) treated with LA between 2010 and 2020. Based on these data, the optimal baseline volume and energy to be delivered were calculated to maximize the rate of nodules with technique efficacy (VRR ≥ 50% at 12-month follow-up). A total of 205 patients with spongiform nodules were included in this study. The energy delivered was positively associated with VRR. However, no association was observed between baseline volume and VRR. Delivering energy ≥500 J/mL to nodules with a mean baseline volume of 11.4 ± 4 mL resulted in technique efficacy in 83% of cases. Treating spongiform nodules with a baseline volume of ≤15 mL and delivering energy ≥500 J/mL are key factors for achieving a relevant rate of technique efficacy.

Physiologic validation of the compensatory reserve metric obtained from pulse oximetry: A step towards advanced medical monitoring on the battlefield.

The Compensatory Reserve Metric (CRM) provides a time sensitive indicator of hemodynamic decompensation. However, its in-field utility is limited due to the size and cost-intensive nature of standard vital sign monitors or photoplethysmographic volume-clamp (PPGVC) devices used to measure arterial waveforms. In this regard, photoplethysmographic measurements obtained from pulse oximetry (PPGPO) may serve as a useful, portable alternative. This study aimed to validate CRM values obtained using PPGPO. Forty-nine healthy adults (25 females) underwent a graded lower body negative pressure (LBNP) protocol to simulate hemorrhage. Arterial waveforms were sampled using PPGPO and PPGVC. The CRM was calculated using a one-dimensional convolutional neural network. Cardiac output and stroke volume were measured using PPGVC. A brachial artery catheter was used to measure intraarterial pressure. A 3-lead ECG was used to measure heart rate. Fixed-effect linear mixed models with repeated measures were used to examine the association between CRM values and physiologic variables. Log-rank analyses were used to examine differences in shock determination during LBNP between monitored hemodynamic parameters. The median LBNP stage reached was 70 mmHg (Range: 45-100 mmHg). Relative to baseline, at tolerance there was a 47±12% reduction in stroke volume, 64±27% increase in heart rate, and 21±7% reduction in systolic blood pressure (P<0.001 for all). CRM values obtained with both PPGPO and PPGVC were associated with changes in heart rate (P<0.001), stroke volume (P<0.001), and pulse pressure (P<0.001). Furthermore, they provided an earlier detection of hemodynamic shock relative to the traditional metrics of shock index (P<0.001 for both), systolic blood pressure (P<0.001 for both), and heart rate (P=0.001 for both). The CRM obtained from PPGPO provides a valid, time-sensitized prediction of hemodynamic decompensation, opening the door to provide military medical personnel noninvasive in-field advanced capability for early detection of hemorrhage and imminent onset of shock. Diagnostic Tests or Criteria, Level IV.

Reverse remodeling of mitral leaflets after medical treatment in recent-onset dilated cardiomyopathy.

The growth of mitral leaflets (MLs) adaptive to left ventricluar (LV) remodeling has been observed. However, the elasticity of MLs upon mechanical stimuli would be supposed if it shrinks with LV reverse remodeling (LVRR). Patients with idiopathic recent-onset dilated cardiomyopathy (RODCM) (n = 82) and 50 matched normal controls (NC) were prospectively enrolled. Echocardiography was performed at baseline and 6 months of follow-up for the anterior and posterior mitral leaflet (AML and PML) length, mitral annular dimension (MAD), and tenting height (TH). LVRR was measured as a ≥ 15% reduction in LV end-diastolic volume (LVEDV). After 6 months, LVRR was achieved in 69.5% of patients. The AML (28 ± 3 vs. 26 ± 3 mm, p = 0.004) and PML (19 ± 4 vs. 17 ± 3 mm, p < 0.001) decreased in length, as well as the MAD (31 ± 5 vs. 28 ± 5 mm, p = 0.001) and TH (10 ± 3 vs. 8 ± 2 mm, p < 0.001). Compared with the NC group, the AML and PML of the RODCM group were 16.7% and 35.7% longer at baseline and remained 8.3% and 21.2% longer at follow-up, respectively. The change in AML or PML correlated moderately with that in LVEDV (r = 0.487, p < 0.001; r = 0.516, p < 0.001, respectively). The AML and PML length decreased in the LVRR (+) subgroup (AML, 28 ± 3 vs. 26 ± 3 mm, p = 0.001; PML, 20 ± 4 vs. 16 ± 3 mm, p < 0.001), but remained the same in the LVRR (-) subgroup (27 ± 4 vs. 28 ± 4 mm, p = 0.318; 17 ± 3 vs. 17 ± 3 mm, p = 0.790). Enlarged MLs could reverse accompanied by LV reverse remodeling. This study provided the other facet of ML plasticity adaptive to mechanical stretching.

Structure-function relationship of oat flour fractions when blended with wheat flour: Instrumental and nutritional quality characterization of resulting breads.

The present work investigated the structure-function relationship of dry fractionated oat flour (DFOF) as a techno-functional ingredient using bread as a model system. Mechanically, DFOF fractions (F), that is, F1: <224µm, F2: 250-280µm, F3: 280-500µm, F4: 500-600µm, and whole oat flour (F5) were blended with white wheat flour at 10%, 30%, and 50% substitution levels for bread making. The blended flours, doughs, and bread samples were assessed for their techno-functional, nutritional, and structural characteristics. The results of Mixolab and the Rapid Visco Analyzer show that the 50% substituted F3 fraction exhibits the highest water absorption properties (69.53%), whereas the 50% F1 fraction exhibits the highest peak viscosity of the past slurry. Analysis of bread samples revealed a lower particle size of DFOF fractions and higher supplementation levels, increased β-glucan levels (0.13-1.29g/100 bread (db), reduced fermentable monosaccharides, that is, glucose (1.44-0.33g/100g), and fructose (1.06-0.28g/100g). The effect of particle size surpassed the substitution level effect on bread volume reduction. The lowest hardness value for F1 is 10%, and the highest value for F2 is 50%. The total number of cells in the bread slice decreased from the control to the F4 fraction (50%). Multi-criteria analysis indicated that DFOF fractions produced breads with similar structure and higher nutritional value developed from white wheat flour. PRACTICAL APPLICATION: The use of mechanically fractionated oat flours fractions in white wheat flour breads can improve the nutritional profile without affecting the physical properties of the bread product. Based on the oat flour fractions, bakers and food processing companies can tailor the bread formulations for high β-glucan, high fiber, and low reduced sugar claims.

Ethanol extract of Ziziphus nummularia ameliorates formaldehyde-induced arthritis in rats by regulating oxidative stress biomarkers and haematological profile.

Rheumatoid arthritis is an autoimmune inflammatory disorder that mainly affects bone and cartilage architecture. The continuous use of NSAIDs and DMARDs is associated with severe toxic effects. Therefore, the current study was designed to scrutinize herb-based therapy for the treatment of RA. To evaluate the anti-arthritic activity of ethanol extract of Ziziphus nummularia using formaldehyde-induced arthritic model in rats and elucidate the possible mechanism for anti-arthritic activity. Anti-arthritic activity of ETZN was studied at three oral doses, i.e., 200, 400, and 600mg/kg. Selected doses were studied using various clinical parameters viz. paw volume, inflammatory index, motility test, stair test, anti-nociceptive efficacy, walking track analysis, and motor activity) from day 1 to day 10. On the last day, the animals were killed for the evaluation of hematological parameters, oxidative stress biomarkers, and histological and radiographic studies of the hind paw. Treatment with ETZN 400mg/kg and 600mg/kg markedly elicited a significant reduction in paw volume, inflammatory index, and nociceptive action compared to diseased animals. Furthermore, the anti-inflammatory activity was confirmed by increased latency of pain threshold in thermal and mechanical algesia models. The anti-arthritic activity is mainly attributed to a reduction in oxidative stress biomarkers as well as restoration of haematological profile in treated animals when compared to diseased animals. Lastly, the anti-arthritic potential was confirmed by histological and radiological analysis which revealed a marked reduction in inflammatory cells and bone destruction as compared to diseased animals. The study revealed that ETZN exhibits significant anti-arthritic activity via modulation of oxidative stress biomarkers, restoration of hematological profile, and reduction in bone erosion.

Combination of Supramicrosurgical Lymphatico-Venular Anastomosis (sLVA) and Lymph-Sparing Liposuction in Treating Cancer-Related Lymphedema: Rationale for a Regional One-Stage Approach

Objective: Cancer-related lymphedema represents a potential complication of cancer treatment. The aim of this study is to evaluate the effectiveness of the combination of lymphatico-venular anastomosis and liposuction in the treatment of secondary lymphedema. Methods: We present a retrospective analysis of patients affected by cancer-related unilateral limb lymphedema. Inclusion criteria included previous neoplastic pathology with the consequent development of unilateral limb lymphedema, while the exclusion criteria included the presence of comorbidities and the persistence of cancer, as well as previous lymphatic surgery. The outcomes to be included were a reduction in the limb volume and lymphangitis rate, and an improvement in the quality of life. Patients' data were assessed before surgery and 1 year after surgery. Perioperative management included clinical and ultrasonographical evaluations. Under local anesthesia, lymphatico-venular anastomosis with the supramicrosurgical technique and the liposuction of the affected limb was performed in the same surgical session. Results: A total of 24 patients were enrolled in the study. One year after the surgery, an average volume reduction of 37.9% was registered (p = 0.0000000596). The lymphangitis rate decreased after surgery from 4.67 to 0.95 per year (p = 0.000007899). The quality-of-life score improved from 68.7 to 16 according to the LLIS scale. Conclusions: The combination of LVA and liposuction represents a valid strategy for treating cancer-related lymphedema, ensuring stable results over time. In addition, it can be performed under local anesthesia, resulting in being minimally invasive and well-tolerated by patients. This paper reports on the short-term efficacy of this combined technique.

Clinical and Radiological Response following Single-Session Gamma Knife Radiosurgery in Cavernous Sinus Hemangiomas.

Purpose: Cavernous sinus hemangiomas (CSH) represent 2-3% of lesions occupying the cavernous sinus. The optimal management strategy for CSH in not established, with microsurgical resection and radiosurgery employed alone or in combination. Therefore, we aimed to analyse the efficacy and safety of Gamma Knife Radiosurgery(GKRS) for CSH in a cohort of primary and residual CSH. Methods: A retrospective analysis of 33 patients(26 primary and 7 residual CSH) that underwent single-session GKRS between 2012 and 2021 for CSH was performed. Demographic, clinical, radiological and follow-up data were acquired, and clinicoradiological response following GKRS was assessed. Results: The mean age of the cohort was 4313.5 years(range 10–77). There were 9 males (27.3%) and 24 females(72.7%). The median lesion volume was 6.9cc, ranging 1.46 to 19.06cc. The mean dose administered to the tumor margin was 13.501.5Gy(Range 12 to 15Gy). The median duration of clinical follow-up was 41 months, over which period the mean reduction in tumor volume was 87.6%. Complete response, defined as absence of tumor on follow-up imaging occurred in 23 patients(69.7%). Twenty-three patients(69.7%) showed clinical improvement following GKRS. There were no radiation-induced complications. Conclusions: CSH have a distinct radiological appearance and a predictable response to radiosurgery. When used primarily in radiologically diagnosed CSH and as adjunctive therapy supplementing a subtotal excision, GKRS produces a high rate of volume reduction with improvement of neurological function and minimal cranial nerve morbidity. Therefore, GKRS presents a viable alternative to surgery without the morbidity associated with surgical resection.

Characterizing molecular and synaptic signatures in mouse models of late-onset Alzheimer's disease independent of amyloid and tau pathology.

MODEL-AD (Model Organism Development and Evaluation for Late-Onset Alzheimer's Disease) is creating and distributing novel mouse models with humanized, clinically relevant genetic risk factors to capture the trajectory and progression of late-onset Alzheimer's disease (LOAD) more accurately. We created the LOAD2 model by combining apolipoprotein E4 (APOE4), Trem2*R47H, and humanized amyloid-beta (Aβ). Mice were subjected to a control diet or a high-fat/high-sugar diet (LOAD2+HFD). We assessed disease-relevant outcome measures in plasma and brain including neuroinflammation, Aβ, neurodegeneration, neuroimaging, and multi-omics. By 18 months, LOAD2+HFD mice exhibited sex-specific neuron loss, elevated insoluble brain Aβ42, increased plasma neurofilament light chain (NfL), and altered gene/protein expression related to lipid metabolism and synaptic function. Imaging showed reductions in brain volume and neurovascular uncoupling. Deficits in acquiring touchscreen-based cognitive tasks were observed. The comprehensive characterization of LOAD2+HFD mice reveals that this model is important for preclinical studies seeking to understand disease trajectory and progression of LOAD prior to or independent of amyloid plaques and tau tangles. By 18 months, unlike control mice (e.g., LOAD2 mice fed a control diet, CD), LOAD2+HFD mice presented subtle but significant loss of neurons in the cortex, elevated levels of insoluble Ab42 in the brain, and increased plasma neurofilament light chain (NfL). Transcriptomics and proteomics showed changes in gene/proteins relating to a variety of disease-relevant processes including lipid metabolism and synaptic function. In vivo imaging revealed an age-dependent reduction in brain region volume (MRI) and neurovascular uncoupling (PET/CT). LOAD2+HFD mice also demonstrated deficits in acquisition of touchscreen-based cognitive tasks.

The effect of long-term alendronic acid treatment on Modic changes in the lumbar spine: a gender and age-matched study

BackgroundLow back pain (LBP) affects a significant proportion of the adult population. Potent anti-resorptive drugs such as intravenous zoledronic acid have been demonstrated to reduce Modic changes (MCs) upon magnetic resonance imaging (MRI) of the spine and concomitantly decrease associated LBP. It is uncertain whether oral alendronic acid has a similar effect.Methods82 subjects were recruited in this case-control study. Treatment subjects (n = 41) received oral alendronic acid treatment for at least 1-year and were matched by gender and age (± 2) to control subjects (n = 41) not receiving any anti-osteoporotic medication. The prevalence, type, and extent of MCs were quantified upon T1 and T2-weighted MRIs of the lumbosacral spine.ResultsTreatment subjects received oral alendronic acid for 124.0 ± 62.1 weeks at the time of MRI assessment and exhibited a lower prevalence of MCs over the lumbosacral spine (18/41 vs. 30/41, p < 0.001) as compared to control subjects. Amongst both groups, type 2 MCs were predominant. Quantification of type 2 MCs in treatment subjects revealed a significant reduction in area (113 ± 106 mm2 vs. 231 ± 144 mm2, p < 0.01) and volume (453 ± 427 mm3 vs. 925 ± 575 mm3, p < 0.01) affected by type 2 MCs in comparison to matched controls.ConclusionOral alendronic acid may be useful in the treatment of MC-associated LBP in patients with concomitant osteoporosis.

Brain structure comparison among Parkinson disease, essential tremor, and healthy controls using 7T MRI.

Both Parkinson disease (PD) and Essential tremor (ET) are movement disorders causing tremors in elderly individuals. Although PD and ET are different disease, they often present with similar initial symptoms, making their differentiation challenging with magnetic resonance imaging (MRI) techniques. This study aimed to identify structural brain differences among PD, ET, and health controls (HCs) using 7-Tesla (T) MRI. We assessed the whole-brain parcellation in gray matter volume, thickness, subcortical volume, and small regions of basal ganglia in PD (n = 18), ET (n = 15), and HCs (n = 18), who were matched for age and sex. Brain structure analysis was performed automatic segmentation through Freesurfer software. Small regions of basal ganglia were manually segmented by ITK-SNAP. Additionally, we examined the associations between clinical indicators (symptom duration, unified Parkinson diseases rating scale (UPDRS), and clinical rating scale for tremor (CRST)) and brain structure. PD showed a significant reduction in gray matter volume in the postcentral region compared to ET. ET showed a significant reduction in cerebellum volume compared to HCs. There was a negative correlation between CRST scores (B and C) and gray matter thickness in right superior frontal in ET. This study demonstrated potential of 7T MRI in differentiating brain structure differences among PD, ET, and HCs. Specific findings, such as parietal lobe atrophy in PD compared to ET and cerebellum atrophy in ET compared to HCs, the importance of advanced imaging techniques in accurately diagnosing and distinguishing between movement disorders that present with similar initial symptoms.

The relationship between imaging features, therapeutic response, and overall survival in pediatric diffuse intrinsic pontine glioma

We aimed to evaluate the relationship between imaging features, therapeutic responses (comparative cross-product and volumetric measurements), and overall survival (OS) in pediatric diffuse intrinsic pontine glioma (DIPG). A total of 134 patients (≤ 18 years) diagnosed with DIPG were included. Univariate and multivariate analyses were performed to evaluate correlations of clinical and imaging features and therapeutic responses with OS. The correlation between cross-product (CP) and volume thresholds in partial response (PR) was evaluated by linear regression. The log-rank test was used to compare OS patients with discordant therapeutic response classifications and those with concordant classifications. In univariate analysis, characteristics related to worse OS included lower Karnofsky, larger extrapontine extension, ring-enhancement, necrosis, non-PR, and increased ring enhancement post-radiotherapy. In the multivariate analysis, Karnofsky, necrosis, extrapontine extension, and therapeutic response can predict OS. A 25% CP reduction (PR) correlated with a 32% volume reduction (R2 = 0.888). Eight patients had discordant therapeutic response classifications according to CP (25%) and volume (32%). This eight patients’ median survival time was 13.0 months, significantly higher than that in the non-PR group (8.9 months), in which responses were consistently classified as non-PR based on CP (25%) and volume (32%). We identified correlations between imaging features, therapeutic responses, and OS; this information is crucial for future clinical trials. Tumor volume may represent the DIPG growth pattern more accurately than CP measurement and can be used to evaluate therapeutic response.

Influence of Invisalign precision bite ramp utilization on deep bite correction and root length in adults

ABSTRACT Objectives To assess the influence of Invisalign precision bite ramp use on skeletal deep overbite correction and root length and volume of maxillary anterior teeth. Materials and Methods This was a retrospective study of 60 adults with skeletal deep overbite. Patients were divided into three groups: Invisalign (Align Technology, San Jose, Calif) with precision bite ramps (Invisalign with Bite Ramps [IBR] = 12), Invisalign with no bite ramps (INBR = 22), and full-fixed appliances (FFA = 26). Cone beam computed tomography records at T1 (pretreatment) and T2 (posttreatment) were used to measure eight skeletal, nine dental, and three soft-tissue cephalometric variables. Maxillary anterior teeth root length (mm), root volume (mm3), and percent root volume loss between T1 and T2 (%) were also recorded. Results Significant changes from T1 to T2 among the three groups were seen in ANB(o), lower face height (%), ODI (overbite depth indicator) (o), and U1–SN (o). Reduction in root length was significantly less (P &amp;lt; .001) in the INBR and IBR groups compared to the FFA group. Reduction in root volume and percent volume loss were significantly higher in the INBR group compared to the IBR group (P &amp;lt; .001), but the difference between the two Invisalign groups and the FFA group was not significant. Conclusions Skeletal deep overbite correction using Invisalign with or without bite ramps is comparable to FFA. Reduction in root length was significantly less with Invisalign compared to FFA. Bite ramps influenced root volume and volume loss but not root length.

Twenty four-month follow-up after bullectomy, unilateral and bilateral lung volume reduction surgery: a single-center retrospective analysis of consecutive cases

PurposeWhile pharmacologic therapy remains the cornerstone of lung emphysema treatment, surgery is an additional therapeutic option in selected patient groups with advanced emphysema. The aim of lung volume reduction surgery (LVRS) is to improve lung function, exercise capacity, quality of life and survival. We sought to determine the therapeutic value of surgical resection in specific patients with lung emphysema.Patients and methodsA retrospective study was performed consisting of 58 patients with lung emphysema who underwent surgical intervention over a 10-year period and were followed for 2 years postoperatively. The clinical characteristics recorded were FEV1 (forced expiratory volume in 1 s), the 6-min walk test (6-MWT), the Modified Medical Research Council (mMRC), body mass index (BMI) and quality of life prior to and 6, 12 and 24 months after surgical intervention. Moreover, all peri- and post-operative complications were noted.ResultsOut of 58 emphysema patients (72% male, FEV1 (L) 2.21 ± 0.17, RV (L) 3.39 ± 0.55), 19 underwent surgical bullectomy, 31 unilateral LVRS and 8 sequential bilateral LVRS. Six months after surgery, there was a statistically significant improvement in FEV1, RV, TLC, 6-MWT and mMRC. Over a period of 12 to 24 months postoperatively, clinical benefit gradually declines most likely due to COPD progression but patients still experienced a significant improvement in FEV1. The most common postoperative complications were persistent air leakage (> 7 days), arrhythmia and subcutaneous emphysema in 60%, 51.6% and 22.4%, respectively. No deaths were observed after surgical intervention.ConclusionIn a selected patient population, surgery led to significant improvement of lung function parameters, exercise capacity and quality of life. Over a period of 12 to 24 months postoperatively, clinical benefit gradually decreased most likely due to COPD progression.

Pharmacological inhibition of receptor-interacting protein kinase 2 (RIPK2) elicits neuroprotective effects following experimental ischemic stroke

Ischemic stroke induces a debilitating neurological insult, where inflammatory processes contribute greatly to the expansion and growth of the injury. Receptor-interacting protein kinase 2 (RIPK2) is most well-known for its role as the obligate kinase for NOD1/2 pattern recognition receptor signaling and is implicated in the pathology of various inflammatory conditions. Compared to a sham-operated control, ischemic stroke resulted in a dramatic increase in the active, phosphorylated form of RIPK2, indicating that RIPK2 may be implicated in the response to stroke injury. Here, we assessed the effects of pharmacological inhibition of RIPK2 to improve post-stroke outcomes in mice subjected to experimental ischemic stroke. We found that treatment at the onset of reperfusion with a RIPK2 inhibitor, which inhibits the phosphorylation and activation of RIPK2, resulted in marked improvements in post-stroke behavioral outcomes compared to the vehicle-administered group assessed 24 h after stroke. RIPK2 inhibitor-treated mice exhibited dramatic reductions in infarct volume, concurrent with reduced damage to the blood-brain barrier, as evidenced by reduced levels of active matrix metalloproteinase-9 (MMP-9) and leakage of blood-borne albumin in the ipsilateral cortex. To explore the protective mechanism of RIPK2 inhibition, we next pretreated mice with RIPK2 inhibitor or vehicle and examined transcriptomic alterations occurring in the ischemic brain 6 h after stroke. We observed a dramatic reduction in neuroinflammatory markers in the ipsilateral cortex of the inhibitor-treated group while also attaining a comprehensive view of the vast transcriptomic alterations occurring in the brain with inhibitor treatment through bulk RNA-sequencing of the injured cortex. Overall, we provide significant novel evidence that RIPK2 may represent a viable target for post-stroke pharmacotherapy and potentially other neuroinflammatory conditions.

Lung volume reduction surgery is safe and feasible after initial endobronchial valve treatment for emphysema patients.

Bronchoscopic lung volume reduction with endobronchial valves is a guideline treatment leading to improved pulmonary function, exercise tolerance, and quality of life, in patients with advanced emphysema, severe hyperinflation and no collateral ventilation. After valve-treatment, loss of the initial lung volume reduction effect can occur, as well as local valve-induced complications such as persistent hemoptysis. In these cases, a surgical lobectomy can be considered to achieve similar efficacy outcomes. We evaluated the safety and feasibility of a video assisted thoracoscopic surgery -lobectomy after valve-treatment. This single-center retrospective study included patients who underwent an elective lobectomy after previous valve-treatment. Data was evaluated for safety and efficacy for the additional surgical procedure. Twenty one patients (73% female, median age 67 (7) years, FEV1 29 (7) %pred, and residual volume 223 (58) %pred) were included. There was no 90 days mortality, and no post-operative Intensive Care admissions. Pulmonary infections (14%) and prolonged air leak (14%) were the most common complications. In patients who underwent surgery due to loss or lack of effect of valve-treatment, a lobectomy led to a significant improvement in pulmonary function; median FEV1 +75 (193)ml (p < 0.013), Forced Vital Capacity +450 (572) ml (p 0.001), Residual Volume -665 (715) ml (p 0.005). In patients who underwent a lobectomy because of complications of valve-treatment, all complications were resolved after surgery. We demonstrate that an elective lobectomy after an initial valve-treatment is safe, feasible, and restores the lung volume reduction effect.

Gonadotropin-releasing hormone antagonist (relugolix) for treatment of uterine adenomyosis with symptomatic endometriosis

Objective: To determine the effects of relugolix administration for uterine adenomyosis on uterine volume and subjective symptoms. Methods: This retrospective observational study included 30 patients with clinical symptoms of endometriosis complicated with uterine adenomyosis who were treated with 40 mg/day of relugolix orally for &gt;16 weeks. The uterine volume was calculated pre- and post-administration, and the volume percentage post-administration. Furthermore, the presence or absence of subjective post-administration symptoms and adverse effects were also examined. Results: The median (interquartile range) long diameter, short diameter, width, and volume of the patients’ uteri pre- and post-administration of relugolix significantly decreased from 9.63 (9.02–11.00) to 8.00 (6.84–9.12) cm, 6.47 (5.58–8.02) to 5.00 (4.26–5.63) cm, 6.91 (5.68–8.46) to 5.49 (4.58–6.00) cm, and 221.04 (146.52–390.26) to 111.90 (71.59–165.84) cm3, respectively ( p &lt; 0.001 for all four items). Additionally, the uterus volume post-administration was 48.30% (33.88–62.54%) of that pre-administration. Heavy menstrual bleeding, dysmenorrhea, and chronic pelvic pain occurred in 23 (76.7%), 21 (70.0%), and 13 (43.3%) of the 30 patients, respectively; however, all patients experienced resolution of all symptoms. Nine, three, and one patients had hot flashes, mild arthralgia, and a mild headache, respectively. No cases of persistent irregular or heavy bleeding were observed during treatment. Conclusions: Relugolix contributes to volume reduction and eliminates subjective symptoms of uterine adenomyosis, suggesting that it is an effective treatment for uterine adenomyosis.

Impact and timing of pulmonary rehabilitation in patients undergoing bronchoscopic lung volume reduction with endobronchial valves: A multicentre randomized controlled trial in patients with severe emphysema.

Both bronchoscopic lung volume reduction with endobronchial valves (BLVR-EBV) and pulmonary rehabilitation (PR) are effective treatments for improving exercise capacity and patient-reported outcomes in patients with severe Chronic Obstructive Pulmonary Disease (COPD). According to current recommendations, all BLVR-EBV patients should have undergone PR first. Our aim was to study the effects of PR both before and after BLVR-EBV compared to BLVR-EBV alone. We included patients with severe COPD who were eligible for BLVR-EBV and PR. Participants were randomized into three groups: PR before BLVR-EBV, PR after BLVR-EBV or BLVR-EBV without PR. The primary outcome was change in constant work rate cycle test (CWRT) endurance time at 6-month follow-up of the PR groups compared to BLVR-EBV alone. Secondary endpoints included changes in 6-minute walking test, daily step count, dyspnoea and health-related quality of life. Ninety-seven participants were included. At 6-month follow-up, there was no difference in change in CWRT endurance time between the PR before BLVR-EBV and BLVR-EBV alone groups (median: 421 [IQR: 44; 1304] vs. 787 [123; 1024] seconds, p = 0.82) or in any of the secondary endpoints, but the PR after BLVR-EBV group exhibited a smaller improvement in CWRT endurance time (median: 107 [IQR: 2; 573], p = 0.04) and health-related quality of life compared to BLVR-EBV alone. The addition of PR to BLVR-EBV did not result in increased exercise capacity, daily step count or improved patient-reported outcomes compared to BLVR-EBV alone, neither when PR was administered before BLVR-EBV nor when PR was administered after BLVR-EBV.

Surgery versus sclerotherapy versus combined therapy in head and neck lymphatic malformations in the pediatric population: systematic review and meta-analysis.

To systematically review current literature on the treatment of lymphatic malformations (LMs) of the head and neck to guide treatment strategy. A systematic review and meta-analysis of literature until 16 November 2021 was performed on treatments of LMs in the head and neck. Out of 9044 articles, 54 studies were eligible for inclusion with 26 studies providing detailed participant data. A total number of 1573 patients with a mean age of 21.22months were analysed. Comparative meta-analysis did not reveal significant differences two proportions of volume reduction (≥ 50% and 100%) between sclerotherapy and surgical treatment. Regression demonstrated that positive predictors for volume reduction were surgery 17 (95% CI 0.26-34; p = 0.047) and treatment of macrocystic lesions 19 (95% CI 5.5-32; p = 0.006). Treatment of mixed lesions also demonstrated a trend towards achieving a greater volume reduction (p = 0.052). A higher de Serres stage of the lesion had a negative effect on the amount of volume reduction -3.7 (95% CI -7.0 to -0.35; p = 0.030). This comprehensive meta-analysis demonstrated no significant difference in volume reduction between various treatment modalities at study level. However, individual patient data indicated that surgery and larger cyst types are associated with a significant higher percentage of volume reduction, whereas a higher de Serres stage negatively impacted the amount of volume reduction. These findings can be used for patient counseling and treatment planning based on cyst type and de Serres stage. However volume reduction constitutes just one objective within a more complex treatment spectrum.

Effect of systemic vascular resistance on the agreement between stroke volume by non-invasive pulse wave analysis and Doppler ultrasound in healthy volunteers.

Stroke volume can be estimated beat-to-beat and non-invasively by pulse wave analysis (PWA). However, its reliability has been questioned during marked alterations in systemic vascular resistance (SVR). We studied the effect of SVR on the agreement between stroke volume by PWA and Doppler ultrasound during reductions in stroke volume in healthy volunteers. In a previous study we simultaneously measured stroke volume by PWA (SVPWA) and suprasternal Doppler ultrasound (SVUS). We exposed 16 healthy volunteers to lower body negative pressure (LBNP) to reduce stroke volume in combination with isometric hand grip to elevate SVR. LBNP was increased by 20 mmHg every 6 minutes from 0 to 80 mmHg, or until hemodynamic decompensation. The agreement between SVPWA and SVUS was examined using Bland-Altman analysis with mixed regression. Within-subject limits of agreement (LOA) was calculated from the residual standard deviation. SVRUS was calculated from SVUS. We allowed for a sloped bias line by introducing the mean of the methods and SVRUS as explanatory variables to examine whether the agreement was dependent on the magnitude of stroke volume and SVRUS. Bias ± limits of agreement (LOA) was 27.0 ± 30.1 mL. The within-subject LOA was ±11.1 mL. The within-subject percentage error was 14.6%. The difference between methods decreased with higher means of the methods (-0.15 mL/mL, confidence interval (CI): -0.19 to -0.11, P<0.001). The difference between methods increased with higher SVRUS (0.60 mL/mmHg × min × L-1, 95% CI: 0.48 to 0.72, P<0.001). PWA overestimated stroke volume compared to Doppler ultrasound during reductions in stroke volume and elevated SVR in healthy volunteers. The agreement between SVPWA and SVUS decreased during increases in SVR. This is relevant in settings where a high level of reliability is required.

A reduction in tumor volume exceeding 65% predicts a good histological response to neoadjuvant chemotherapy in patients with Ewing sarcoma.

No consensus exists for tumor volume response criteria in patients with Ewing sarcoma. This study aimed to identify an optimal cutoff for predicting a good histological response by analyzing tumor volume changes and tumor necrosis after neoadjuvant chemotherapy. We performed a retrospective analysis of 184 Ewing sarcoma patients, analyzing tumor volume changes before and after neoadjuvant chemotherapy. Patients were divided into two groups based on histological response: good (tumor necrosis ≥ 95%) and poor (tumor necrosis < 95%) responders. The receiver operating characteristic (ROC) area under the curve (AUC) method was used to determine the optimal thresholds for predicting the histological response. Additionally, the prognostic value of this cutoff for relapse-free survival was assessed. Out of 184 patients, 83 (45%) had tumor necrosis ≥ 95%, while 101 (55%) had tumor necrosis < 95%. ROC analysis identified the optimal cutoff for a good histological response as over 65% tumor volume reduction (AUC = 0.69; p < 0.001). Patients with volume reduction of ≥ 65% had a higher likelihood of a good histological response than those with lesser reductions (p = 0.004; odds ratio = 2.61). Multivariable analysis indicated a correlation between poor histological response and reduced relapse-free survival (hazard ratio = 2.17; p = 0.01), while tumor volume reduction itself did not impact survival. We reported that a tumor volume reduction of ≥ 65% was able to predict a good histological response in Ewing sarcoma patients. We recommend preoperative tumor volume assessment to identify patients at greater risk for poor histological response who could benefit from more intensive chemotherapy protocols or additional radiotherapy.