Radiation Time Research Articles

Optimizing neurointerventional procedures: an algorithm for embolization coil detection and automated collimation to enable dose reduction.

Monitoring radiation dose and time parameters during radiological interventions is crucial, especially in neurointerventional procedures, such as aneurysm treatment with embolization coils. The algorithm presented detects the presence of these embolization coils in medical images. It establishes a bounding box as a reference for automated collimation, with the primary objective being to enhance the efficiency and safety of neurointerventional procedures by actively optimizing image quality while minimizing patient dose. Two distinct methodologies are evaluated in our study. The first involves deep learning, employing the Faster R-CNN model with a ResNet-50 FPN as a backbone and a RetinaNet model. The second method utilizes a classical blob detection approach, serving as a benchmark for comparison. We performed a fivefold cross-validation, and our top-performing model achieved mean mAP@75 of 0.84 across all folds on validation data and mean mAP@75 of 0.94 on independent test data. Since we use an upscaled bounding box, achieving 100% overlap between ground truth and prediction is not necessary. To highlight the real-world applications of our algorithm, we conducted a simulation featuring a coil constructed from an alloy wire, effectively showcasing the implementation of automatic collimation. This resulted in a notable reduction in the dose area product, signifying the reduction of stochastic risks for both patients and medical staff by minimizing scatter radiation. Additionally, our algorithm assists in avoiding extreme brightness or darkness in X-ray angiography images during narrow collimation, ultimately streamlining the collimation process for physicians. To our knowledge, this marks the initial attempt at an approach successfully detecting embolization coils, showcasing the extended applications of integrating detection results into the X-ray angiography system. The method we present has the potential for broader application, allowing its extension to detect other medical objects utilized in interventional procedures.

Factors influencing haulout behaviour of non-breeding weddell seals (Leptonychotes weddellii) at Cape Royds, Antarctica

The Weddell seal (Leptonychotes weddellii) is a fast-ice obligate species that plays an important role as both predator and prey within the high-latitude, coastal Southern Ocean. Weddell seals are affected by pressures of marine resource extraction and variation in sea-ice extent and characteristics that are affected by climate. Thus, monitoring their population dynamics provides an indicator of the effectiveness of fisheries management, and impacts of changing climate in the high latitude Southern Ocean ecosystem. Satellite imagery is increasingly being used to monitor the populations of this species, but assessment techniques require a better understanding of the environmental factors influencing the likelihood that individuals will be on the sea-ice and therefore visible in a satellite image. Addressing that goal, we captured 5054 trail camera photos during spring 2017 in the 24-h light at Cape Royds, Antarctica, and then counted seals on the fast ice every 30 min over 59 days. Using a generalised additive model (63% deviance explained) we described the haulout behaviour of non-breeding Weddell seals according to time of day, date, air temperature, pressure, solar radiation, and wind speed. We found that the seals’ haulout cycle is driven to a significant degree by weather variables, primarily temperature and wind speed. Quantifying these haulout patterns can be used to determine the time of day, and under what conditions, that most seals are hauled out. Integrating environmental parameters to correct time-of-day patterns would allow better cross-site abundance comparisons, leading to better Weddell seal population estimates for the Ross Sea region and the wider coastal Antarctica.

A comparative study of shockwave intravascular lithotripsy and conventional percutaneous coronary intervention in the treatment of severe coronary artery calcification lesions

BackgroundThe purpose of this study was to evaluate the effectiveness of intravascular lithotripsy (IVL) in the treatment of severe coronary artery calcification (CAC) lesions.MethodsIn this study, we selected patients diagnosed with severe CAC lesions confirmed by coronary angiography (CAG) who were hospitalized in Yulin First People’s Hospital between December 2021 and December 2022 and required percutaneous coronary intervention (PCI). Using a random number table, we divided all patients into the IVL group and the PCI group in the order of interventional therapy. We compared both groups in terms of the surgical success rate, intraoperative manipulation characteristics, procedural complication, and cumulative incidence of major adverse cardiovascular events (MACE).Results(1) There were no differences in the surgical success rate, incidence of MACE, and occurrence of procedural complication between the two groups; (2) Compared with the conventional PCI group, patients in the IVL group used fewer predilatation balloons, and the difference was statistically significant (all P < 0.05); (3) Compared with the conventional PCI group, patients in the IVL group had lesser surgery time and lesser radiation time, with lesser proportion of patients who were assisted with stent implantation using coronary artery rotational atherectomy, and this difference was statistically significant (P < 0.05); (4) The mean stent diameter and length in the IVL group was greater than those in the conventional PCI group but the difference was not statistically significant (P > 0.05).ConclusionIn this study, we found that IVL was a highly safe and effective procedure in the treatment of severe CAC lesions that did not increase the surgery and radiation time, and it could also reduce the use of predilatation balloons, thus improving the management of CAC lesions. Thus, IVL can be a novel choice in treating severe CAC lesions.

Comparison of robot-assisted versus fluoroscopy-guided transforaminal lumbar interbody fusion (TLIF) for lumbar degenerative diseases: a systematic review and meta-analysis of randomized controlled trails and cohort studies

BackgroundAs an emerging technology in robot-assisted (RA) surgery, the potential benefits of its application in transforaminal lumbar interbody fusion (TLIF) lack substantial support from current evidence.ObjectiveWe aimed to investigate whether the RA TLIF is superior to FG TLIF in the treatment of lumbar degenerative disease.MethodsWe systematically reviewed studies comparing RA versus FG TLIF for lumbar degenerative diseases through July 2022 by searching PubMed, Embase, Web of Science, CINAHL (EBSCO), Chinese National Knowledge Infrastructure (CNKI), WanFang, VIP, and the Cochrane Library, as well as the references of published review articles. Both cohort studies (CSs) and randomized controlled trials (RCTs) were included. Evaluation criteria included the accuracy of percutaneous pedicle screw placement, proximal facet joint violation (FJV), radiation exposure, duration of surgery, estimated blood loss (EBL), and surgical revision. Methodological quality was assessed using the Cochrane risk of bias and ROBINS-I Tool. Random-effects models were used, and the standardized mean difference (SMD) was employed as the effect measure. We conducted subgroup analyses based on surgical type, the specific robot system used, and the study design. Two investigators independently screened abstracts and full-text articles, and the certainty of evidence was graded using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach.ResultsOur search identified 539 articles, of which 21 met the inclusion criteria for quantitative analysis. Meta-analysis revealed that RA had 1.03-folds higher “clinically acceptable” accuracy than FG (RR: 1.0382, 95% CI: 1.0273–1.0493). And RA had 1.12-folds higher “perfect” accuracy than FG group (RR: 1.1167, 95% CI: 1.0726–1.1626). In the case of proximal FJV, our results indicate a 74% reduction in occurrences for patients undergoing RA pedicle screw placement compared to those in the FG group (RR: 0.2606, 95%CI: 0.2063- 0.3293). Seventeen CSs and two RCTs reported the duration of time. The results of CSs suggest that there is no significant difference between RA and FG group (SMD: 0.1111, 95%CI: -0.391–0.6131), but the results of RCTs suggest that the patients who underwent RA-TLIF need more surgery time than FG (SMD: 3.7213, 95%CI: 3.0756–4.3669). Sixteen CSs and two RCTs reported the EBL. The results suggest that the patients who underwent RA pedicle screw placement had fewer EBL than FG group (CSs: SMD: -1.9151, 95%CI: -3.1265–0.7036, RCTs: SMD: -5.9010, 95%CI: -8.7238–3.0782). For radiation exposure, the results of CSs suggest that there is no significant difference in radiation time between RA and FG group (SMD: -0.5256, 95%CI: -1.4357–0.3845), but the patients who underwent RA pedicle screw placement had fewer radiation dose than FG group (SMD: -2.2682, 95%CI: -3.1953–1.3411). And four CSs and one RCT reported the number of revision case. The results of CSs suggest that there is no significant difference in the number of revision case between RA and FG group (RR: 0.4087,95% CI 0.1592–1.0495). Our findings are limited by the residual heterogeneity of the included studies, which may limit the interpretation of the results.ConclusionIn TLIF, RA technology exhibits enhanced precision in pedicle screw placement when compared to FG methods. This accuracy contributes to advantages such as the protection of adjacent facet joints and reductions in intraoperative radiation dosage and blood loss. However, the longer preoperative preparation time associated with RA procedures results in comparable surgical duration and radiation time to FG techniques. Presently, FG screw placement remains the predominant approach, with clinical surgeons possessing greater proficiency in its application. Consequently, the integration of RA into TLIF surgery may not be considered the optimal choice.Systematic review registrationPROSPERO CRD42023441600.

Non-invasive laser therapy effect on lipid profile and renal function in metabolic syndrome: randomized control trial

INTRODUCTION. Metabolic syndrome (MetS) represents an assortment of interconnected metabolic risk factors, particularly central obesity, dyslipidemia, and hyperglycemia. These variables have a detrimental impact on renal function and contribute to increased mortality. This timeline necessitates a prompt approach that enables the deployment of safe and non-intrusive therapeutic equipment in conjunction with therapy for MetS patients. Accordingly, we aim to investigate whether using a low-level laser (LLL) watch device as a non-invasive instrument enhances multiple metabolic parameters, so it may be a practical therapeutic approach for managing metabolic disorders. AIM. To investigate the effect of non-invasive laser therapy on parameters of lipid profile and renal function in patients with metabolic syndrome. MATERIALS AND METHODS. This study enrolled 40 MetS patients of both genders aged 45–65 years. The study group received a 12-week treatment consisting of oral hypoglycemic medication and LLL therapy (LLLT), which involved three weekly sessions performed in the morning, targeting the wrist area using a continual output diode laser (skin contact mode, maximum power: 0.005 W, beam spot area: 0.03 cm2, energy density: 288 J/cm3, and radiation time: 1800 s). The control group only received hypoglycemia medications. Laboratory lipid profile and renal function measurements were conducted prior to and following the trial. RESULTS. Following a 12-week laser watch therapy, the results revealed a significant decline in total cholesterol (TC), triglycerides (TG), and low-density lipoprotein (LDL) levels and an increase in high-density lipoprotein (HDL) levels, which was slightly improved in the control (p 0.00). Moreover, glomerular filtration rate (GFR) and creatinine levels were significantly improved, while the control group did not experience any significant improvement (p 0.5). DISCUSSION. Combining non-invasive laser therapy with hypoglycemic medications significantly improved the lipid profile in patients with MetS; however, kidney function, like GFR and creatinine levels, was enhanced. Furthermore, lower TC and TG levels might be due to the reduction of glycation and promoted LDL receptors which increased LDL catabolism. CONCLUSION. Non-invasive laser therapy enhances lipid profile and renal function in MetS patients. Furthermore, the control group had a minimal effect on the lipid profile and no effect on renal function.

Design, fabrication and testing of Al/p-Si Schottky and pn junctions for radiation studies

Strip and pixels sensors, fabricated on high resistivity silicon substrate, normally of p-type, are used in detectors for High Energy Physics (HEP) typically in a hybrid detector assembly. Furthermore, and owing to their inherent advantages over hybrid sensors, Monolithic Active Pixel Sensors (MAPS) fabricated in CMOS technology have been increasingly implemented in HEP experiments. In all cases, their use in higher radiation areas (HL-LHC and beyond) will require options to improve their radiation hardness and time resolution. These aspects demand a deep understanding of their radiation damage and reliable models to predict their behaviours at high fluences. As a first step, we fabricated several Schottky and n-on-p diodes, to allow a comparison of results and provide a backup solution for test devices, on 6 or 4-inch p-type silicon wafers with 50 μm epitaxial thickness and of doping concentration as they are normally used in HEP detectors and CMOS MAPS devices. In this paper, details of the design and fabrication process, along with test results of the fabricated devices before irradiation, will be provided. Additional test results on irradiated devices will be provided in subsequent publications.

Collaborative adsorption and photocatalytic degradation of high concentration pharmaceutical pollutants in water using a novel dendritic fibrous nano-silica modified with chitosan and UiO-66

This study presents a novel hybrid mesoporous material for degrading drug pollutants in water. The hybrid materials, derived from UiO-66 metal-organic framework and chitosan, coated on nano-silica, showed excellent drug adsorption through hydrogen-bonding interactions and efficient photodegradation of antibiotics. The hybrid material's enhanced conductivity and reduced band gap significantly improved pollution reduction by minimising electron-hole recombination. This allows for more efficient charge transport and better light absorption, boosting the material's ability to break down pollutants. Structural and morphological analyses were conducted using various techniques, including scanning electron microscopy, X-ray diffraction, Fourier transform infrared spectroscopy, transmission electron microscopy, Brunauer-Emmett-Teller analysis, X-ray photoelectron spectroscopy, and thermogravimetric analysis. Optimising the adsorption-photodegradation process involved investigating pH, catalyst dose, and radiation time. Non-linear optimisation revealed an efficiency exceeding 85 % for 400 mg/L tetracycline and doxycycline, the model antibiotics. The optimal parameters for maximal elimination were determined as pH = 4.3, hybrid mesosphere dose = 4.0 mg/mL, and radiation time = 10 min. Kinetic studies favored pseudo-second-order diffusion models over pseudo-first-order models. The hybrid mesosphere showed sustained efficiency after three cycles and performed well in real aqueous samples, removing over 80 % of each antibiotic. This study demonstrates the potential of the hybrid mesoporous material for removing pharmaceutical pollutants in water systems.

A facile synthesis of water-soluble copper nanoclusters as label-free fluorescent probes for rapid, selective and sensitive determination of alizarin red

Copper nanoclusters (FA@CuNCs) emitting blue fluorescence were successfully developed via a one-pot technique. In this method, the copper chloride, folic acid and hydrazine hydrate were applied as a precursor, protective agent and reducing agent, respectively. The absorption, fluorescence excitation and emission spectra of FA@CuNCs were carried out by using ultraviolet–visible and fluorescence spectrometry, respectively. The morphology, particle size, functional groups, oxidation states of elements of FA@CuNCs were discussed via using transmission electron microscopy (TEM), Fourier transform infrared spectroscopy (FT-IR) and X-ray photoelectron spectroscopy (XPS). The stability of FA@CuNCs was studied under various conditions, such as storage time at 25 ℃, ultraviolet radiation time, sodium chloride solutione and pH. The FA@CuNCs displayed blue fluorescence under the excitation wavelength of 361 nm, and the fluorescence quantum yield was 7.45 %. As a result of the inner filter effect, the alizarin red could significantly weaken the blue fluorescence of FA@CuNCs. Thus, the as-prepared FA@CuNCs could be utilized as fluorescence nanosensors for the trace determination of alizarin red. This platform suggested an excellent linear range for alizarin red varying from 0.5 to 200 μM with a fitting coefficient of 0.9955. The detection limit was calculated to be 0.064 μM in the light of the 3b/k (b and k refer to the standard deviation and slope of fitted curve, respectively). Furthermore, the as-developed FA@CuNCs could be used to detect the alizarin red in real samples and for the sensing of temperature.

Enhancing bioactive content in Malus sylvestris peel extract for antioxidant source using microwave-assisted extraction (MAE) and predicting the potential of ant nests

Background The apple peel is one of the byproducts of apple beverage production that is still underutilized. While considerable information regarding apple peel extract is available, its utilization remains limited. Yet, apple peel contains numerous bioactive components that offer various health benefits. Based on this, information regarding the bioactive components in apple peel and their health potential is required. Methods The research consisted of two stages, namely Stage 1, which involved in silico analysis of the bioactive content in apples and predicted the potential of ant nests using the Structural Activity Relationship (SAR) approach Pass Online. In Stage 2, in vitro analysis of apple peel extraction as a natural antioxidant source was conducted using treatment time radiation (3 minutes, 6 minutes, 9 minutes, and 12 minutes). The extract was characterized based on phenolic, flavonoid, antioxidant activity, quercetin, and functional groups using Fourier Transform Infrared Spectroscopy (FTIR). Results Stage 1: gave results that several bioactive were identified such as chlorogenic acid, epicatechin, phloridzin, catechin, hyperoside, quercitrin, quercetin, and pectin. Based on SAR, the bioactive compounds have functional potential as anti-inflammatory, lipid metabolism regulators, free radical scavengers, lipid peroxidase inhibitors, antihypercholesterolemic, and insulin promoters. Stage 2: Radiation times of the MAE method had a significant effect (P&lt;0.05) on the phenolic content, and antioxidant activity and was highly significant (P&lt;0.01) on the flavonoid content of Malus sylvestris. Radiation time for 12 minutes of MAE gave higher phenolic, flavonoid, and antioxidant activity of Malus sylvestris peel extract. The IR spectra of the Malus sylvestris extract increased as the radiation time increased. Conclusions The optimum radiation time was at 12 minutes with the result of phenolic content at 14.73 mg GAE/g, flavonoid content at 29,62 ppm, antioxidant activity at 95,09%, and the IR spectra at 1031.92 cm−1, 1390.68 cm−1, 2833.43 cm−1, 2945.3 cm−1, 3346.5 cm−1, 3354.21 cm−1.

RADT-11. PROTON BEAM THERAPY (PBT) FOR CENTRAL NERVOUS SYSTEM (CNS) TUMOURS IN CHILDREN: A CANADIAN PEDIATRIC BRAIN TUMOUR CONSORTIUM STUDY

Abstract BACKGROUND Radiotherapy is important for treating pediatric CNS tumours. The main modalities include photon therapy and PBT. PBT offers potential advantages over photon therapy in children since its precise dose control can limit long-term side effects. However, Canadian patients needing PBT are referred to the United States (US) because PBT is unavailable in Canada. We aimed to describe PBT use and outcomes over time for Canadian pediatric patients with CNS tumours. METHODS Patient demographics, treatment characteristics, and outcomes were extracted from medical records of patients from 10/13 Canadian provinces/territories. Patients diagnosed with a CNS tumour at ≤20 years old between 2001-2021 who received curative-intent PBT were included. PBT plans were compared using Fisher’s exact or Kruskal-Wallis rank sum tests. Overall survival (OS) was estimated using the Kaplan-Meier method. RESULTS Of 195 patients (59.0% male) included in the study, majority were from Alberta (28.7%), Quebec (26.7%), British Columbia (22.6%), and Ontario (20.5%). Median age at diagnosis was 8.0 years. Most tumours (77.9%) were non-metastatic. Medulloblastoma was the most common diagnosis (30.8%). Provinces/territories referred patients to proton centres in the same geographical regions, except Alberta (74.5% referred to Florida). Referral numbers have increased ~180%/year since 2011. Median time from diagnosis to PBT was 126 days [11-5236] for all patients, and 36 days [21-1313] for medulloblastoma. Radiation doses, irradiation site, therapy duration, and time to treatment were not different (p≥0.2) across all PBT facilities for medulloblastoma. 5-year OS were 86.8% and 73.0% for the PBT study population and the Cancer in Young People-Canada reference population, respectively, in those aged &amp;lt;15 years. CONCLUSIONS Given the unavailability of PBT in Canada, pediatric CNS tumour patients were referred to US PBT facilities close in proximity. Further studies are needed to better understand provincial referral patterns and barriers to equitable PBT access across Canada.

Study on the characteristics and kinetics of microwave hot air combined drying of peanut pods

Drying is an important means to maintain the quality of peanut pods and reduce the risk of mildew. Microwave hot air combined drying is renowned for its efficacy, low-energy consumption, and superior processing quality, rendering it suitable for peanut pod drying. However, its efficacy hinges greatly on various parameters. To enhance drying efficiency and quality, the drying kinetics of peanut pods using microwave hot air combined drying equipment were investigated. Varying microwave power (1.2 kW, 2.4 kW, 3.6 kW), hot air temperature (30 °C, 35 °C, 40 °C, 45 °C), air velocity (0.4 m/s, 0.7 m/s, 1 m/s), and microwave radiation time (4 min, 6 min) were examined. Results indicated a decline in drying time, moisture ratio, and drying rate with increasing microwave power, hot air temperature, air velocity, and microwave radiation time. Peroxide and acid values complied with national standards. The Verma model exhibited optimal fitting. At 45 °C, peanut pod moisture diffusion coefficient was 3.022 × 10−9 m2 s−1, specific energy consumption at 30 °C was 5302 kJ/kg, and thermal efficiency was 42.6 %. The synergistic drying of peanut pods by microwave and hot air has a high moisture diffusion coefficient and thermal efficiency. The kinetic and energy analysis of the drying process can furnish some theoretical foundation for subsequent microwave hot air drying and equipment parameter adjustment.

3D Printing of Subclavian Artery: Utility for Preprocedural Planning and Correlation With Subclavian Artery Percutaneous Vascular Interventions.

Three-dimensional (3D) printing for subclavian artery (SA) percutaneous vascular interventions (PVI) may allow superior understanding of patient specific complex anatomy and aid with preprocedural planning. Five patients with computed tomography angiography (CTA) of the neck who underwent SA PVI were queried retrospectively. 3D printing of aortic arch and great vessels was accomplished with 3D slicer software and painted with acrylic paint to highlight anatomic features. The aortic arch type and implications for preprocedural planning for SA interventions including complex chronic total occlusion (CTO) lesions were determined. Comparisons were made with SA angiograms and 3D-CTA. Of the 5 patients, type I (n = 2), type II (n = 1), and type III (n = 2) aortic arches were identified. Proximal and distal reference vessel size and total lesion length were determined using a digital millimeter caliper and correlated with intraprocedural balloons and stents. In 3D-printed models (3D-PMs) of patients with SA-CTO (n = 2), cap morphology (tapered vs blunt) and distal vessel filling were visualized, permitting optimal arterial access site selection for successful cap crossing. The vertebral arteries (VAs) were also 3D printed which further allowed the ability to delineate optimal stent deployment site (proximal or distal to VA), a common dilemma that is faced intraprocedurally. The 3D-PMs also allowed preprocedural precision in stent and balloon size and length, potentially leading to procedural efficiency and cost-effectiveness. 3D printing of aortic arch and great vessel anatomy for SA-PVI allows multiple procedure-related factors to be predicted in advance, translating to decrease in contrast volume, radiation time, procedure and fluoroscopic time, thereby improving procedure and cost efficiency.

A modified position for optimized skeletal maturity assessment of AIS patients and its impact on 3D spinal and pelvic parameters.

A hands-on-wall (HOW) position for low-dose stereoradiography of adolescent idiopathic scoliosis (AIS) patients would allow for skeletal maturity assessment of the hand and wrist. Our aims were twofold: confirm the reliability and validity of skeletal maturity assessment using the HOW radiographs and compare the spinal and pelvic 3D parameters to those of standard hands-on-cheeks (HOC) stereoradiographs. Seventy AIS patients underwent two successive stereoradiographs and a standard hand and wrist radiograph on the same day. Patients were randomly assigned to begin with HOW and follow with HOC, or vice versa. Raters assessed digital skeletal age (DSA), Sanders Simplified Skeletal Maturity (SSMS) and Thumb Ossification Composite Index (TOCI). 3D reconstructions of the spine and pelvis bones were performed for each stereoradiograph to measure nine clinically relevant spinal and pelvic 3D parameters. Inter-rater and intra-rater reliabilities were excellent for DSA, SSMS and TOCI with both standard radiographs and HOW (ICC > 0.95). Strong correlation was found between ratings of both imaging types (ICC > 0.95). In the 3D reconstructions, kyphosis and sacral slope were slightly decreased in the HOW position, but within the clinical margin of error. All other parameters did not differ significantly between positions (p < 0.05). The results suggest that HOW stereoradiographs allow clinicians to assess skeletal maturity of the hand and wrist with adequate reliability and validity. We recommend that scoliosis clinics adopt the HOW position to assess skeletal maturity because there is no significant clinical impact on the spinal and pelvic evaluation, and on radiation exposure, cost or time.

Activated Carbon Prepared from Date Pits Using Microwave Heating

Activated carbon (AC) adsorption remains one of the most technically efficient water treatment processes. However, its high preparation cost, mainly due to energy-intensive methods, has led to research on developing efficient and cost-effective preparation methods using less expensive materials such as agricultural waste. The objective of our study was to use date pits for the preparation of AC that can be used for water treatment (Adsorption and elimination of dyes). For the activation process, a microwave radiation under steam method was employed. The AC prepared from date pits /H3PO4/carbonization 400°C using the steam-microwave radiation activation technique (radiation time: 15 minutes, power: 700W) demonstrated promising results. The adsorption tests show 80% removal rate of the reactive dye (Drimaren ROT CL-5B GR) from water. This study highlights the potential of date pits as a viable source for producing AC from bio-material. The obtained product was analysed by FTIR and MEB.

Role of BMI on radiation dose in patients undergoing pulmonary vein isolation by pulsed field, cryoballoon and high-power-short-duration radiofrequency ablation

Abstract Background Different ablation modalities for pulmonary vein isolation (PVI) have been established. Since recent data from a randomized trial showed non-inferiority for pulse field ablation (PFA) vs. cryoballoon (CBA) or radiofrequency ablation (RFA) it seems reasonable to evaluate procedural parameters of these modalities in specific subgroups. Purpose The aim of this study was to evaluate radiation dose and procedural parameters in patients with body mass index (BMI) &amp;gt;26 kg/m² vs. ≤26 kg/m² undergoing PVI with different modalities. Methods Data of n=409 patients (140 PFA, 125 CBA, 144 RFA) having undergone PVI in three German centers for either paroxysmal or persistent atrial fibrillation were analysed. The primary endpoint was total radiation dose (Dose Area Product, DAP). Patients were analyzed with respect to BMI&amp;gt; vs. ≤26 kg/m² in PFA, CBA and RFA (with high-power short duration applications) groups, respectively. Secondary endpoints were radiation time and procedure time. Results The study included predominantly male patients (63.1%) with a mean age of 67.8±10.5 years. Cardiovascular risk factors were comparable within the groups, while the overall CHA2DS2-VASc-score was higher in CBA patients, which was largely influenced by a higher proportion of women in the CBA group. BMI was well balanced between the modalities (PFA: 28.7±5.6 kg/m² vs CBA: 28.5±6.0 kg/m² vs HPSD-RFA: 28.3±4.8 kg/m², p=0.78) as well as the proportion of patients with extreme obesity (BMI &amp;gt;30 kg/m²). The overall DAP was the lowest in the PFA group (370.2±274.6 µGym2) followed by HPSD-RFA (471.4±385.3 µGym2) and the highest in the CBA (1260.9±1053.5 µGym2) group. The radiation time was longest in the CBA group (16.6±17.0min) while being comparatively lower in PFA and HPSD-RFA groups (9.4±6.8 vs. 9.4±5.8 min). Procedure time was the shortest in the PFA group (79.6±30.5min), while being longest in the HPSD-RFA group (111.9±55.3 min). When stratifying patients according to BMI&amp;gt; 26 kg/m², there was a significant increase in DAP in all modalities, with the lowest mean increase in DAP in the PFA group (Δ143.84 µGym2), followed by HPSD-RFA (Δ329.54 µGym2) and the highest increase in the CBA group (Δ691.17 µGym2) (Figure 1). No difference was observed in radiation or procedure time when stratifying patients to BMI. (Figure 2) Conclusion Our study analyzing differences of radiation exposure according to elevated BMI among various PVI techniques shows that while there is a significant increase of DAP in patients with BMI &amp;gt;26 kg/m² in all modalities, the lowest increase is registered in the PFA collective. These results suggest that PVI performed with PFA, if available, or HPSD-RFA should be the energy sources of choice in obese patients with respect to radiation exposure.

Comparison of pulsed field ablation and thermal ablation for repeat procedures after failed prior thermal ablation for atrial fibrillation

Abstract Background Procedural efficiency and long-term clinical outcome after a first pulmonary vein isolation (PVI) for atrial fibrillation (AF) with pulsed-field ablation (PFA) has recently been reported to be non-inferior compared to radiofrequency ablation (RFA) and cryoballoon ablation (CBA). Studies comparing PFA and RFA for a first redo procedure in patients with failed prior thermal PVI are lacking. Purpose We sought to compare procedural efficiency and 1-year success rate (i.e maintenance of sinus rhythm) between PFA and RFA in patients undergoing a first redo procedure due to recurrence of atrial tachyarrhythmias after a prior thermal PVI. Methods Patients with recurrences after a 90-day blanking period following an index PVI with either RFA or CBA referred for a first redo ablation were enrolled. All redo procedures were done using a 3D electro-anatomical mapping to identify PV reconnections and guide repeat PVI by either PFA or RFA. In cases of incomplete or ostial isolation, the PFA group was treated using the standard 8-applications per vein while the CLOSE protocol was used for segmental PVI completion in the RFA group. Extra-PV lesion sets were added at the discretion of the treating physician. Patients were followed with 7d-Holter ECGs 3, 6, and 12 months after reablation. Recurring arrhythmias were categorized as persistent AF, paroxysmal AF, or atrial flutter. Secondary endpoints were periprocedural complications, total ablation time, radiation time and exposure. Results A total of 220 patients (median age 67 [IQR 58-74] years, 64% male, 64% persistent AF) were enrolled and equally treated with PFA or RFA (110 in both groups). There were no statistically significant differences in the clinical characteristics at baseline. Procedure time was shorter in the PFA group (95 vs. 122 minutes, p=0.001) whereas radiation time and dose were higher in the PFA group (17.0 vs. 6.4 minutes, p=&amp;lt;0.001 and 4.9 vs. 2.2 Gycm2, p=&amp;lt;0.001). Additional posterior wall ablation (PFA) or roof line (RFA) was performed predominantly in the PFA group (61 patients, 55.5 %) and in 5 patients (4.5 %) in the RFA group (p=0.001). Major complications occurred in 3 patients in the PFA group and in 1 patient in the RFA group (see Picture 2). Freedom from arrhythmia in Kaplan-Meier analysis 12 months after the reablation was 61% (CI 50-74%) in the PFA group and 59% (CI 49-71%; log-rank test p=0.81). No differences in outcomes were observed in the pooled group between paroxysmal AF (60%, CI: 50-72%) and persistent AF (61%, CI: 51-73%, p=0.64). Recurrence of organized atrial tachycardia was more common in the PFA group (p=0.018) Conclusion In patients undergoing a first redo procedure after a first round of thermal PVI and with recurrence of atrial tachyarrhythmia, PFA for reablation resulted in shorter procedure times compared to RFA despite more frequent posterior wall ablation. Long-term arrhythmia-free survival after the redo procedure was similar in both groups.Kaplan-Meier analysis of redo proceduresProcedure and outcome data

First experiences with protected VT ablation using surgical Impella 5.5

Abstract Introduction Ablation of ventricular arrhythmias (VA) is still challenging due to the complex substrate of the underlying heart disease. Depending on specific risk factors acute hemodynamic decompensation during or after VT ablation procedures may occur and hemodynamic support may be required. Protected VA ablation with different devices has been evaluated but associated complications like bleeding, vascular closure or weaning from the device have been restrictive. We present data on a dedicated approach to patients with anticipated hemodynamic deterioration using preventive surgical Impella support. Method 5 patients (2 female) underwent protected VT ablation under our standardized protocol. Indication for Impella support was severely impaired left ventricular function and multiple medical therapy refractory ventricular arrhythmias. 4 patients had conventional VT ablation before. Mean age was 66,8 years, mean CHADSVASC 4,4, 1 patient with non-ischemic cardiomyopathy (CMP), 1 with hypertrophic non-obstructive CMP, 3 patients with ischemic CMP. Mean EF was 20%, mean mixed venous saturation was 36 %, mean PAINESD score 27. In all patients a 5.5. Impella was implanted surgically 1 day before planned VT ablation via the right subclavian artery. VT ablation procedure started with substrate mapping, VT induction and activation mapping of the inducible VT to identify the critical VT isthmus. Ablation was directed to dissection of the critical isthmus of inducible VAs and elimination of all late potentials within low voltage areas. The Impella device was explanted after weaning off the hemodynamic support. Results Implantation of Impella 5.5 was successfully performed in all patients in general anesthesia without any complication via surgical approach. Specifically, no access site vascular complications were noted. In 4 patients the VT ablation procedure was performed in analgosedation, 1 patient in GA as this patient was intubated due to recurrent VA requiring defibrillation. Mean procedure time was 125 min, radiation time 1,3 min, inducible VTs 1,3 , median 2 morphologies. In all patients all inducible VTs could be eliminated, in 1 patient polymorphic VA was still inducible at the end of the procedure. Impella was explanted after mean 5,2 days (3-11 days). No complications occurred. All patients were discharged alive on heart failure medication and in 2 patients with amiodaron. At a mean follow up of 3.5 months, all patients are alive without VA recurrence and heart failure decompensation. Conclusion Surgical Impella implantation for protected VT ablation in severe heart failure patients is feasible and allows for effective VT mapping and ablation. Access site safety and protection for heart failure decompensation in addition to the possibility of individually mobilisation and weaning after the procedure make this protocol an attractive option. Prospective evaluation of standardized indication is needed.

Effect of Corona Discharge Plasma Radiation on the Viability of True Shallot Seeds (Allium cepa L. var. aggregatum)

TSS (True Shallot Seed) need to be developed to address the quality and quality of shallot seeds. The seeds, however, still has constraints on its viability and germination. The objective of this study was to investigate the effect of corona discharge plasma radiation on the viability of true shallot seeds. The research was conducted in March - April 2023 at the Plasma Laboratory, Faculty of Science and Mathematics, Diponegoro University, and the germination test experiments at the the Agricultural Technology Research and Assessment Installation (IP2TP Ungaran). The experiment was designed completely randomized with 6 treatments of radiation time consisting of P0 (without radiation), P1 (5 min), P2 (10 min), P3 (15 min), P4 (20 min), and P5 (25 min). All treatments were carried out with 5 replications. The collected data were processed using ANOVA and then continued with the DMRT test. The results showed that the corona plasma radiation treatment for 15-25 min affected the parameters of germination, germination rate, seed growth rate, vigor index, seed uniformity, and sprout length. Keywords: Plasm, Radiation, Shallots, TSS.

Host microbiome depletion attenuates biofluid metabolite responses following radiation exposure.

Development of novel biodosimetry assays and medical countermeasures is needed to obtain a level of radiation preparedness in the event of malicious or accidental mass exposures to ionizing radiation (IR). For biodosimetry, metabolic profiling with mass spectrometry (MS) platforms has identified several small molecules in easily accessible biofluids that are promising for dose reconstruction. As our microbiome has profound effects on biofluid metabolite composition, it is of interest how variation in the host microbiome may affect metabolomics based biodosimetry. Here, we 'knocked out' the microbiome of male and female C57BL/6 mice (Abx mice) using antibiotics and then irradiated (0, 3, or 8 Gy) them to determine the role of the host microbiome on biofluid radiation signatures (1 and 3 d urine, 3 d serum). Biofluid metabolite levels were compared to a sham and irradiated group of mice with a normal microbiome (Abx-con mice). To compare post-irradiation effects in urine, we calculated the Spearman's correlation coefficients of metabolite levels with radiation dose. For selected metabolites of interest, we performed more detailed analyses using linear mixed effect models to determine the effects of radiation dose, time, and microbiome depletion. Serum metabolite levels were compared using an ANOVA. Several metabolites were affected after antibiotic administration in the tryptophan and amino acid pathways, sterol hormone, xenobiotic and bile acid pathways (urine) and lipid metabolism (serum), with a post-irradiation attenuative effect observed for Abx mice. In urine, dose×time interactions were supported for a defined radiation metabolite panel (carnitine, hexosamine-valine-isoleucine [Hex-V-I], creatine, citric acid, and Nε,Nε,Nε-trimethyllysine [TML]) and dose for N1-acetylspermidine, which also provided excellent (AUROC ≥ 0.90) to good (AUROC ≥ 0.80) sensitivity and specificity according to the area under the receiver operator characteristic curve (AUROC) analysis. In serum, a panel consisting of carnitine, citric acid, lysophosphatidylcholine (LysoPC) (14:0), LysoPC (20:3), and LysoPC (22:5) also gave excellent to good sensitivity and specificity for identifying post-irradiated individuals at 3 d. Although the microbiome affected the basal levels and/or post-irradiation levels of these metabolites, their utility in dose reconstruction irrespective of microbiome status is encouraging for the use of metabolomics as a novel biodosimetry assay.

Early multicentric outcomes of the on-label and CE-marked combination of the Endurant with the Radiant chimney graft for the chimney endovascular aortic repair (EnChEVAR): The LaMuR Registry.

The aim of this study was to evaluate the early results of the CE-marked standardized device combination consisting of Endurant and the Radiant chimney graft (En-ChEVAR) for the treatment of juxtarenal aortic aneurysms. We analyzed multicentric non-industry sponsored case series evaluating the EnChEVAR technique for patients treated between December 2022 and February 2024. Clinical, perioperative procedure-related and radiological data were collected. The primary outcome measure was the freedom of a type Ia gutter-related endoleak at postoperative computed tomography angiography (CTA). Secondary outcome measures included early type Ia endoleak-related reinterventions, target vessel complications including dissection or loss of target vessel, major adverse events, and mortality. Continuous variables were presented as median (interquartile range [IQR]) and categorical variables as count and percentage. Ten patients were included in the present study. Eight (80%) were males, in nine cases a single chimney was implanted, and the other one was a double chimney graft placement. The treated aneurysms had an infrarenal neck length of 3.4 (1.2) mm. The rate of main body oversizing was 30%. The new neck length after chimney graft placement was 18 (3) mm. The median procedural time was 130 (17) mm, contrast medium use was 109 (26) mL, radiation time was 45 (12) min. The technical success was 100%. No type Ia endoleak was detected at the postoperative CTA. There were no target vessel issues. No major adverse events or death were observed. First reported cohort of patients treated with EnChEVAR demonstrated reproducible clinical and procedural outcomes within the 3 vascular centers with total exclusion of the aneurysms, patent renal arteries, and no evidence of gutter-related type IA endoleak. Further evidence with larger sample size of treated patients and longer follow-up are needed.