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Please see the Editorial Comment by Domen Plut discussing this article. Background: Image-guided interventions for Budd-Chiari syndrome (BCS) reduce hepatic congestion, thereby reducing liver stiff...

Gas forming liver abscess (GFLA) though rare is seen in diabetic patients. Rupture of such abscesses usually requires surgical intervention. These cases are associated with high morbidity and mortality due to sepsis. Tuberculous liver abscesses are more often silent in presentation. GFLA formed in the background of a tuberculous liver abscess is rare. We present a case of ruptured GFLA with underlying tuberculous pathology in a normoglycemic patient. The abscess was managed by image guided intervention. A brief case report along with review of literature is presented.

We have set out to develop a catheter-based theranostic system that: (a) identifies diseased and at-risk myocardium via endocardial detection of systemically delivered β-emitting radiotracers and (b) utilizes molecular signals to guide delivery of therapeutics to appropriate tissue via direct intramyocardial injection. Our prototype device consists of a miniature β-radiation detector contained within the tip of a flexible intravascular catheter. The catheter can be adapted to incorporate an injection port and retractable needle for therapeutic delivery. The performance of the β-detection catheter was assessed in vitro with various β-emitting radionuclides and ex vivo in hearts of pigs following systemic injection of 18F-fluorodeoxyglucose (18F-FDG) at 1-week post-myocardial infarction. Regional catheter-based endocardial measurements of 18F activity were compared to regional tissue activity from PET/CT images and gamma counting. The β-detection catheter demonstrated sensitive in vitro detection of β-radiation from 22Na (β+), 18F (β+), and 204Tl (β-), with minimal sensitivity to γ-radiation. For 18F, the catheter demonstrated a sensitivity of 4067 counts/s/μCi in contact and a spatial resolution of 1.1 mm FWHM. Ex vivo measurements of endocardial 18F activity with the β-detection catheter in the chronic pig infarct model demonstrated good qualitative and quantitative correlation with regional tissue activity from PET/CT images and gamma counting. The prototype β-detection catheter demonstrates sensitive and selective detection of β- and β+ emissions over a wide range of energies and enables high-fidelity ex vivo characterization of endocardial activity from systemically delivered 18F-FDG.

The spinal epidural and posterior ligamentous complex spaces are important anatomic regions which are the target of various radiologic procedures in the cervical, thoracic and lumbar spine for the purpose of analgesia and anaesthesia. Given the frequency with which procedures are performed in and around the epidural space, a sound understanding of the associated anatomy is paramount to ensure the safety and efficacy of procedural intervention.

While coaches are considered at risk of experiencing burnout, there is an absence of intervention studies addressing this syndrome. The purpose of this qualitative study was to conduct a self-regulation intervention with five Canadian developmental (n = 2) and elite (n = 3) sport coaches (three men, two women) experiencing moderate to high levels of burnout and examine the perceived impact of this intervention on their self-regulation capacity and experiences of burnout and well-being. The content analysis of the coaches’ outtake interviews and five bi-weekly journals revealed that all five of them learned to self-regulate more effectively by developing various competencies (e.g., strategic planning for their well-being, self-monitoring) and strategies (e.g., task delegation, facilitative self-talk). Four of the coaches also perceived improvements in their symptoms of burnout and well-being. Sport psychology interventions individualized for coaches are a promising means for helping them manage burnout and enhance their overall functioning.

Breast imaging capacity in Tanzania is currently very limited. In a country of almost 60 million people, mammographic units are exceedingly rare. The few existing units are compromised by lack of maintenance and quality control and extremely limited technologist training. Breast cancer incidence continues to increase in East Africa, while the ability to accurately diagnose and differentiate benign and malignant breast disease remains a challenge. However, as ultrasound technology improves and becomes more affordable, there is increased access to devices including hand-held point of care ultrasound. Additionally, there has been a recent expansion in the training of academic radiologists in Tanzania, creating an opportunity for possible sustainable improvement of breast imaging and intervention. Our initial efforts at the Muhimbili Academic Medical Center (MAMC) included social media advertising for symptomatic and asymptomatic women, followed by screening (clinical breast exam) and subsequent ultrasound imaging of symptomatic women. We then initiated a workflow for ultrasound-guided breast intervention, performed biopsies, reviewed results by local pathologists, and brought the postbiopsy patients back for radiologic–pathologic correlation, wound assessment, and coordination of follow-up and treatment.

Background: Intravascular ultrasound (IVUS) shows vascular structures and positions of interventional devices in cross sectional-short axis to support interventions, especially for complex lesions. On the other hand, extravascular ultrasound (EVUS) visualizes the devices and vessel structures in long and short axis and reduces the radiation exposure by avoiding the use of fluoroscopy during guidewire manipulation. The images obtained from EVUS handling to guide the guidewire manipulation in both long and short axis is more difficult, time consuming, and stressful than IVUS, which is in short axis only. To solve this issue, we propose a novel guidewire crossing method in conjunctive with the use of both modalities, named “extra and intravascular ultrasound (E&IVUS)” guided intervention.Main text: This is the first report of a combined use of EVUS and IVUS for femoropopliteal occlusions. EVUS-guided intervention is mandatory to check the position of the device in long and short axis. However, the images of long axis are sometimes different from the original ones when EVUS is required to image from the short axis to the long axis. E&IVUS allows to dedicate EVUS to acquisition of the long axis and IVUS to the short axis view when confirming the device position. As a result, E&IVUS shortens the operation time and reduces the stress due to the manipulation of the probe to switch from the long to short axis image and vice versa. Moreover, we can accurately manipulate the guidewire to perform intimal tracking according to the information of EVUS long axis and the IVUS short axis images. Case involved a 76-year-old female with right superficial femoral artery occlusion was angiographically contrasted from a contralateral 6-Fr sheath. A hard wire supported with an over-the-wire typed IVUS was advanced into the CTO with EVUS and IVUS to confirm their positions until the guidewire crossing. We repeatedly performed this process, and all intimal tracking succeeded. The drug-coating balloons appropriately sized by IVUS measurement were deployed. Finally, a sufficient blood flow was achieved without complications.Conclusions: E&IVUS is a preferred strategy than using EVUS or IVUS alone. We should evaluate the clinical outcomes of this technique.

Predicting whether a chronic stroke patient is likely to benefit from a specific intervention can help patients establish reasonable expectations. It also provides the basis for candidates selecting for the intervention. Recent convergent evidence supports the value of network-based approach for understanding the relationship between dysfunctional neural activity and motor deficits after stroke. In this study, we applied resting-state brain connectivity networks to investigate intervention-specific predictive biomarkers of motor improvement in 22 chronic stroke participants who received either combined action observation with EEG-guided robot-hand training (Neural Guided-Action Observation Group, n = 12, age: 34–68 years) or robot-hand training without action observation and EEG guidance (non-Neural Guided-text group, n = 10, age: 42–57 years). The robot hand in Neural Guided-Action Observation training was activated only when significant mu suppression (8–12 Hz) was detected from participant's EEG signals in ipsilesional hemisphere while it was randomly activated in non-Neural Guided-text training. Only the Neural Guided-Action Observation group showed a significant long-term improvement in their upper-limb motor functions (p 0.5). The results of brain connectivity estimated via EEG coherence showed that the pre-training interhemispheric connectivity of delta, theta, alpha and contralesional connectivity of beta were motor improvement related in the Neural Guided-Action Observation group. They can not only differentiate participants with good and poor recovery (interhemispheric delta: p = 0.047, Hedges' g = 1.409; interhemispheric theta: p = 0.046, Hedges' g = 1.333; interhemispheric alpha: p = 0.038, Hedges' g = 1.536; contralesional beta: p = 0.027, Hedges' g = 1.613) but also significantly correlated with post-training intervention gains (interhemispheric delta: r = -0.901, p 0.05). Partial least square regression showed that the combination of pre-training interhemispheric and contralesional local connectivity could precisely predict intervention gains in the Neural Guided-Action Observation group with a strong correlation between predicted and observed intervention gains (r = 0.82) and between predicted and observed intervention outcomes (r = 0.90). In summary, EEG-based resting-state brain connectivity networks may serve clinical decision-making by offering an approach to predicting Neural Guided-Action Observation training-induced motor improvement.

Patellar tendinopathy is a common cause of knee pain and functional impairment in athletes. It is commonly managed using conservative measures such as physiotherapy, but cases that are refractory to such treatment may require a more invasive approach. Various forms of image-guided injection therapy have been described in the literature. We present a case of successful treatment of chronic patellar tendinopathy with calcification with the first reported use of a three-pronged image-guided approach, consisting of dry needling, high volume image-guided injection (but at a reduced dose) and barbotage applied in a single sitting. The patient reported resolution of symptoms persisting to 1 year postprocedure. We suggest that this management option, if supported by further positive research findings, could be used in the future in the management of certain cases of patellar tendinopathy with calcification where conservative measures have failed.

Background: Intra-vascular ultrasound (IVUS) and coronary computed tomography angiography (CCTA) are tools to guidepercutaneous coronary intervention (PCI). Aim of the work: This study aimed at comparing procedural outcome and MACCEs of IVUS, CCTA and angiography, guided PCI. Patients and methods: Prospective, single centered study. 90patients undergoing elective PCI distributed to 3 groups. Group A: IVUS guided PCI, group B: CCTA planned PCI and group C: angiography guided PCI. Procedural details and MACCEs were compared. Results: Most of the patients in this study were males (84.4%). Group B used significant amount of contrast, 50 - 380 ml (161.67 ± 71.97, P = 0.042). Also group B had significant longer stents, 12 - 48mm (23.76 ± 7.47, P = 0.008). Group A had significant number ofpatients who needed post-stenting balloon dilatation, 28 patients (93.34%), P=0.009.Most of the patients had satisfactory results withTIMI 3 flow (94.37%). No MACCEs were detected during the hospital stay. At 30 days follow-up, no significant difference found between the 3 groups. Conclusion: IVUS assed accurately the need of post-stenting balloon dilatation. CCTA is associated with larger amount of contrast use, longer lesion detection and subsequent longer stents deployed incomparison to IVUS and angiography alone.

There is little evidence relating to the effects of adding guidance to internet-based gambling interventions. The primary aim was to compare the effectiveness of an online self-directed cognitive-behavioural gambling program (GamblingLess) with and without therapist-delivered guidance. It was hypothesised that, compared to the unguided intervention, the guided intervention would result in superior improvements in gambling symptom severity, urges, frequency, expenditure, psychological distress, quality of life and help-seeking. A two-arm, parallel-group, randomised trial with pragmatic features and three post-baseline evaluations (8 weeks, 12 weeks, 24 months) was conducted with 206 gamblers (106 unguided; 101 guided). Participants in both conditions reported significant improvements in gambling symptom severity, urges, frequency, expenditure, and psychological distress across the evaluation period, even after using intention-to-treat analyses and controlling for other low- and high-intensity help-seeking, as well as clinically significant changes in gambling symptom severity (69% recovered/improved). The guided intervention resulted in additional improvements to urges and frequency, within-group change in quality of life, and somewhat higher rates of clinically significant change (77% cf. 61%). These findings, which support the delivery of this intervention, suggest that guidance may offer some advantages but further research is required to establish when and for whom human support adds value.

Thoracic spine is less interested in doctors because thoracic pain is relatively uncommon compared to cervical or lumbar pain. In addition, risk of spinal cord injury and lung injury makes doctors hesitate to give injections to thoracic area. However, US and CT guided injections can visualize nerves, vessels, and other organs and can manage thoracic pain safely and effectively. In this chapter, authors introduce safe and effective injection techniques in thoracic spine.

Introduction: Achieving stent optimization on intravascular ultrasound (IVUS) is associated with favorable clinical outcomes in new-generation drug-eluting stents (DESs) implantation. Little is known about the stent optimization criteria in lesion subsets assorted according to vessel size and lesion length. Hypothesis: We hypothesized lesion-specific IVUS criteria could provide a better prediction for the outcomes after DES implantation for diffuse coronary lesions. Methods: From four randomized trials comparing IVUS and angiography guidance in long coronary lesions, a total of 1,194 patients who underwent IVUS-guided intervention with DESs ≥26 mm in length were included. Primary endpoint was a major adverse cardiac event (MACE), defined as a composite of cardiovascular death, myocardial infarction, target vessel revascularization, or stent thrombosis at 1 year following intervention. Results: MACE occurred in 41 (3.4%) patients. Among possible combinations of absolute and relative expansion criteria, the combination best predicting MACE was minimal stent area (MSA) ≥5.4 mm 2 or 80% of mean lumen area (MLA) (Youden index=0.250) in overall patients. In 2x2 factorial subgroup analyses, the MSA cutoff was 4.9 mm 2 or 85% of MLA for shorter (2 or 85% for shorter lesions with a larger vessel diameter (RVD ≥3.0 mm) (Index=0.211). In longer lesions (≥30 mm), the MSA cutoff was 5.5 mm 2 or 70% of MLA for smaller vessels (RVD 2 or 70% for larger vessels (RVD ≥3.0 mm) (Index=0.578). Conclusions: When IVUS is used to optimize DES implantations for long coronary stenoses, applying different criteria according to angiographic parameters might improve the outcomes. In relatively longer lesions with a larger vessel diameter, pursuing to achieve a higher absolute MSA value rather than relative expansion might be more important.

Aim To evaluate the response measures in continuing an image-guided intervention service in two tertiary-level musculoskeletal oncology centres during the COVID-19 pandemic. Materials and methods The present study was a retrospective review of all patients undergoing image-guided intervention in the computed tomography (CT) and normal ultrasound (US) rooms from 24 March 2020 to 24 May 2020 (during the COVID-19 pandemic peak) at Royal National Orthopaedic Hospital, London, and Royal Orthopaedic Hospital, Bristol, UK. Measures were put in place to address air pressures, airflow direction, aerosol generation, and the safe utilisation of existing scanning rooms and work lists for interventional procedures. Results Three hundred and thirty-one patients (164 at Royal National Orthopaedic Hospital and 167 at Royal Orthopaedic Hospital) underwent image-guided procedures at both sites in the CT and US rooms. At the Royal National Orthopaedic Hospital, 40% of all procedures were performed under general anaesthesia. These consisted of 47 CT biopsies, seven CT radiofrequency ablations (RFAs), and 12 US biopsies. At the Royal Orthopaedic Hospital, 86% of all procedures were performed under local anaesthetic, with no general anaesthetic procedures. These consisted of 61 CT biopsies and 83 US biopsies. All 256 patients having procedures in the CT room had no post-procedural complications or COVID-19-related symptoms and morbidity on follow-up. Conclusion By adopting a pragmatic approach with meticulous planning, a limited, but fully functional image-guided interventional list can be run without any adverse patient outcomes., Highlights • COVID-19 has had a significant impact on CT interventional procedures. • Air pressures and appropriate ventilation systems need to be considered. • A pragmatic and meticulous approach is crucial in operating a functional service.

Purpose: This study explored participant views of a web-based physical activity intervention for older adults and examined how they resonate with the key principles that guided intervention development. Methods: Qualitative interviews were carried out with 52 older adults. A deductive qualitative analysis approach was taken, based around the intervention’s key principles. Results: Participants expressed mostly positive views of the intervention features, broadly confirming the appropriateness of the key principles, which were to: (a) encourage intrinsic motivation for physical activity, (b) minimize the risk of users receiving activity suggestions that are inappropriate or unsafe, (c) offer users choice regarding the activities they engage with and build confidence to undertake more activity, and (d) minimize the cognitive load and need to engage with the intervention website. The findings also identified ways in which content could be improved to further increase acceptability. Conclusion: This study illustrates how using the person-based approach has enabled the identification and implementation of features that older adults appreciate.

Made available in DSpace on 2021-06-25T11:46:08Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-10-29 Portuguese Foundation for Science and Technology INCD - FCT FEDER In this study we modelled possible causes and consequences of student burnout and engagement on academic efficacy and dropout intention in university students. Further we asked, can student engagement protect against the effects of burnout? In total 4,061 university students from Portugal, Brazil, Mozambique, the United Kingdom, the United States of America, Finland, Serbia, and Macao SAR, Taiwan participated in this study. With the data collected we analyzed the influence of Social Support, Coping Strategies, and school/course related variables on student engagement and burnout using structural equation modeling. We also analyzed the effect of student engagement, student burnout, and their interaction, on Academic Performance and Dropout Intention. We found that both student engagement and burnout are good predictors of subjective academic performance and dropout intention. However, student burnout suppresses the effect of student engagement on these variables. This result has strong implications for practitioners and administrators. To prevent student dropout, it is not enough to promote student engagement-additionally, and importantly, levels of student burnout must be kept low. Other variables such as social support and coping strategies are also relevant predictors of student engagement and burnout and should be considered when implementing preventive actions, self-help and guided intervention programs for college students. ISPA Inst Univ, William James Ctr Res, Lisbon, Portugal Nord Univ, Fac Educ & Arts, Bodo, Norway Natl Univ Tainan, Dept Educ, Tainan, Taiwan Univ Macau, Fac Educ, Taipa, Macau, Peoples R China Univ Pedag, Maputo, Mozambique Univ Belgrade, Fac Philosophy, Dept Psychol, Belgrade, Serbia Northern Illinois Univ, Dept ETRA, De Kalb, IL 60115 USA Univ Estadual Paulista, Fac Pharmaceut Sci, Araraquara, SP, Brazil Univ Estadual Paulista, Fac Pharmaceut Sci, Araraquara, SP, Brazil Portuguese Foundation for Science and Technology: UID/PSI/04810/2019 FEDER: 22153-01/SAICT/2016

To determine the impact of renal biomarker-guided implementation of the Kidney Disease Improving Global Outcomes (KDIGO) care bundle on the incidence of acute kidney injury (AKI) after major noncardiac surgery in a single-center unblinded randomized clinical trial.Early optimization of volume status and discontinuation of nephrotoxic medication before the occurrence of AKI may be the crucial step to reduce preventable AKI.The urinary biomarker-triggered KDIGO care bundle (early optimization of fluid status, maintenance of perfusion pressure, discontinuation of nephrotoxic agents) was compared to standard intensive care unit (ICU) care in 121 patients with an increased AKI risk after major abdominal surgery that was determined by urinary biomarker (inhibitor of metalloproteinase-2 × insulin-like growth factor-binding protein 7)0.3. Incidence of overall AKI, severity of AKI, length of stay, major kidney events at discharge, and cost effectiveness were evaluated.The overall stages of AKI were not statistically different between the 2 groups, but in patients with inhibitor of metalloproteinase-2 × insulin-like growth factor-binding protein 7 values of 0.3 to 2.0 a subgroup analysis demonstrated a significantly reduced incidence of AKI 13/48 (27.1%) in the intervention group compared to control 24/50 (48.0%, P = 0.03). Incidence of moderate and severe AKI (P = 0.04), incidence of creatinine increase25% of baseline value (P = 0.01), length of ICU, and hospital stay (P = 0.04) were significantly lower in the intervention group. Intervention was associated with cost reduction. There were no significant differences regarding renal replacement therapy, in-hospital mortality, or major kidney events at hospital discharge.Early biomarker-based prediction of imminent AKI followed by implementation of KDIGO care bundle reduced AKI severity, postoperative creatinine increase, length of ICU, and hospital stay in patients after major noncardiac surgery.

Anxiety and related disorders are common and cognitive behavior therapy (CBT) has been demonstrated to be an effective treatment for these disorders. However, patients face many barriers to accessing this treatment. Remote delivery of treatment using bibliotherapy-administered CBT (BCBT) has the potential to increase accessibility to evidence-based treatment for patients with anxiety and related disorders. This study investigated the effectiveness of a transdiagnostic BCBT intervention in two open trials. While the BCBT intervention in both studies were identical, the first study was unguided (i.e., no clinician support provided), and the second study was guided (i.e., patients were provided with brief clinician support via telephone). Twenty-three participants with mixed anxiety disorders completed the first Study (unguided treatment) and results exhibited significant reductions on the primary outcome measure with within-group effect sizes of d = 1.29 (95% CI 0.64–1.91) at post-treatment and d = 1.52 (95% CI 0.84–2.15) at 3-month follow up. Forty-one participants with various anxiety and related disorders completed Study 2 (guided intervention) and results were similar to Study 1 with large within-group effect sizes seen at post-treatment (d = 0.95; 95% CI 0.49–1.40) and 3-month follow up (d = 0.87; 95% CI 0.41–1.31). In both studies participants found the intervention to be highly acceptable, and benchmarking analyses indicated that the outcomes were largely consistent with those of controlled trials. These are the first studies to investigate the effectiveness of a transdiagnostic BCBT program for the treatment of anxiety and related disorders and the results demonstrate preliminary support for this treatment methodology.

Background and objectives Peripheral nerve block is an important component of the multimodal analgesia for total knee arthroplasty. Novel interventional techniques of ultrasound-guided nerve block supplying the posterior knee joint capsule require knowledge of the innervation of the posterior capsule. The objectives of this cadaveric study were to determine the course, frequency, and distribution of the articular branches innervating the posterior knee joint capsule and their relationships to anatomical landmarks. Methods Fifteen lightly embalmed specimens were meticulously dissected. The origin of articular branches was identified, their frequency recorded, and the course documented in relation to anatomical landmarks. The capsular distribution of articular branches was documented and a frequency map generated. Results In all specimens, articular branches from the posterior division of the obturator and tibial nerves were found to supply the posterior capsule. Additionally, articular branches from common fibular nerve and sciatic nerve were found in eight (53%) and three (20%) specimens, respectively. The capsular distribution of tibial nerve spanned the entire posterior capsule. The posterior division of obturator nerve supplied the superomedial aspect of the posterior capsule overlapping with the tibial nerve. The superolateral aspect of the posterior capsule was innervated by the tibial nerve and, when present, the common fibular/sciatic nerves. Conclusions Frequency map of the course and distribution of the articular branches and their relationship to anatomical landmarks form an anatomical basis for peripheral nerve block approaches that provide analgesia to the posterior knee joint capsule.

This paper describes a framework of algorithms for the active localization and tracking of flexible needles and targets during image-guided percutaneous interventions. The needle and target configurations are tracked by Bayesian filters employing models of the needle and target motions and measurements of the current system state obtained from an intra-operative imaging system which is controlled by an entropy-minimizing active localization algorithm. Versions of the system were built using particle and unscented Kalman filters and their performance was measured using both simulations and hardware experiments with real magnetic resonance imaging data of needle insertions into gel phantoms. Performance of the localization algorithms is given in terms of accuracy of the predictions and computational efficiency is discussed.

OBJECTIVE This study aims to investigate failure factors in retrograde wire-guided cannulation (retrograde approach) for the treatment of coronary chronic total occlusion (CTO). METHODS Data of 285 patients treated for CTO using retrograde approach in the General Hospital of Shenyang Military Region from August 2004 to May 2016 were collected. RESULTS The average age of the 285 patients was 63.89 ± 11.3 years old. Multivariate analysis revealed that the operation risk factors include the number of diseased vessels, collateral circulation, as well as whether anterograde intervention for CTO target vessels was previously performed (OR = 0.875, 95% CI = 0.779-0.940, P= 0.026) and whether other vessels were intervened (OR = 22.372, 95% CI = 2.059-243.031, P= 0.011). CONCLUSION Based on the present study, the success rate of retrograde approach for CTO was negatively correlated with the number of diseased vessels and collateral circulation. It was furthermore of importance whether anterograde intervention for CTO target vessels was previously performed and whether other vessels beside CTO vessels were intervened, which were also risk factors.

We describe a novel and safe needle-holding method that we have termed the ‘dual steristrip technique’. This technique can be used to stabilize the bone biopsy needle without the need for the radiologist’s hand to be in close proximity to the X-ray beam during CT-guided intervention. The dual steristrip technique uses steristrips to stabilize the bone biopsy needle and allows for accurate assessment of needle position and trajectory. This involves affixing one end of a steristrip to the skin 2 cm from the needle skin entry point, wrapping the mid-section of the steristrip around the biopsy needle and affixing the other end of the steristrip to the skin at the opposite side of the needle 2 cm from the needle skin entry point. A second steristrip is then applied in a similar fashion at 90° to the first steristrip. In our institution, we have used the dual steristrip technique to stabilize the biopsy needle in certain cases where assessment of needle position/trajectory can be more challenging. This includes cases where there is a paucity of soft tissues overlying the bone or if the bone lesion is located in the superficial cortex. We have found it to be successful in 80% of cases. The dual steristrip technique is a safe and effective needle stabilization method that should be considered by the interventional radiologist in challenging CT-guided bone biopsy cases.

The main objective of radiation management in interventional radiology is to minimise the unnecessary use of radiation. Fluoroscopically guided interventional procedures (FGI) are performed with increasing frequency in operating theatre for a growing number of procedures. In this view, we evaluate the occupational eye dose of an interventional radiologist (IR) for different dosimeter positions commonly utilised in the FGI procedures. Herein, one IR was examined for a period of three months while performing the 65 FGI procedures of different types. Eye doses of the IR were measured using the optically-stimulated luminescence dosimeters called the nanoDots (Landauer, Inc.). The IR wore the protective lead glasses equipped with the nanoDots (on the left and right eye) during the observations period. All the nanoDot measurements were conducted using the microStar reader system (Landauer Inc.). The eye dose of the IR per dose area product (DAP) was discerned to be 0.85 ± 0.13 μSv.Gy−1.cm−2 for the left eye with the protection. The estimated annual eye dose of 18.32 mSv.y−1 was below the recommended dose limit (20 mSv.y−1). The mean eye dose and DAP correlation was observed to be significant and insignificantly related to the fluoroscopy time (p

This review article describes the potential range of image-guided interventional procedures performed following foot and ankle ligament and/or tendon repair. Diagnosis of the cause of recurrent or persistent pain/symptoms in this postoperative group is challenging and requires a coordinated clinical and radiologic assessment. This directs appropriate treatment including image-guided intervention that may be used both as a diagnostic tool and a therapeutic option. There is a paucity of high-quality studies on the role of image-guided intervention in the foot and ankle after ligament/tendon repair. Many of the procedures used in this group are extrapolated from other areas of the body or the preoperative scenario. We review the role of imaging to identify the cause of postsurgical symptoms and to direct appropriate image-guided intervention. The available injectables and their roles are discussed. Specific surgical procedures are described including lateral ligament repair, Achilles repair, posterior tibialis tendon surgery, and peroneal tendon surgery.

Background: It is not clear whether village health teams (VHTs) can be empowered to participate in interventions to prevent and control hypertension and diabetes in older adults in Uganda. We conducted this study in rural Uganda to establish if VHTs could be effectively trained to use a smart phone guided intervention to link older people with hypertension and diabetes to care. We also explored the experiences of VHTs in managing older adults with health problems, their knowledge of hypertension and diabetes and their understanding of referral systems. We also explored their experiences with smartphones. Methods: We conducted in-depth interviews (IDIs) with and trained 20 VHTs randomly selected from Bukulula sub-county in Kalungu district from October 2017-December 2018. We used interview guides to explore topics relevant to our study objectives. VHTs were trained to measure blood sugar and blood pressure using digital machines. VHTs were trained on identifying symptoms of diabetes mellitus. Data from IDIs were analysed using thematic content analysis. Competence tests were used to evaluate the training. Results: Most of the VHTs were female (75%). All VHTs had some knowledge on hypertension and diabetes and other chronic diseases. They did not have any experience in treating older adults since they had been trained to deal mainly with children. Half of the VHTs owned smartphones. All were willing to participate in an intervention using a smartphone to link older adults with hypertension and diabetes mellitus to care. By the end of the training, all but three participants could comprehend the symptoms of diabetes and measure blood sugar and blood pressure. Conclusion: Village health teams in the study setting need training in managing the health needs of older adults before engaging with an intervention using smartphones to link older adults with diabetes mellitus and hypertension to care.

e24021 Background: The Geriatric 8 (G8) is a simplified screening tool to select the appropriate elderly patients for chemotherapy. Vulnerable patients with impaired G8 score might need additional comprehensive geriatric assessment (CGA) with intervention for individual problem. However, the impact of CGA and therapeutic intervention on rate of complete chemotherapy among these patients is rarely addressed. This study aims to evaluate the benefit of CGA guided intervention. Methods: A single center, randomized, open-label study which included newly diagnosed elderly cancer patients (age ≥ 65) with impaired G8 score (≤ 14) who were designated for chemotherapy. After the enrollment, patients were randomized to 1:1 ratio to receive CGA guided intervention (intervention group) or usual care (control group). The primary end point was the rate of complete chemotherapy at 90-day. Associated factors for complete chemotherapy were evaluated. Results: Between June 2019 and December 2019, 52 patients were randomized (26 patients for intervention group and 26 patients for control group). Mean age was 72 years, 59.6% was female, 40.4% had breast cancer and 51.9% had early stage cancer. With G8 assessment, 55.8% had intermediate (score 11-14) and 44.2% had low (score < 11) impaired G8 score. All baseline characteristics were balanced. Using per protocol analysis, there was no significant difference in rate of complete chemotherapy between groups (61.9% vs 50%, OR 1.63; 95%Cl 0.51-5.23; p = 0.42). Considering subgroup analysis in the intermediate G8 score patients, the intervention group had a significant higher rate of complete chemotherapy than control group (81.8% vs 66.7%, OR 2.71; p = 0.02), but no significant difference in low G8 score group (40% vs 27.3%, OR 1.78; p = 0.58). In univariate analysis, age below 75 years, BMI > 20 kg/m2 and intermediate G8 score showed significant factors for improving rate of complete chemotherapy. Conclusions: This is the first study in south-east Asia using CGA and intervention to improve rate of completion in chemotherapy. Although the CGA and intervention had no significant difference but had tendency to be better in completion rate of chemotherapy than usual care. The intermediate-impaired G8 score subgroup is more likely to benefit from CGA guided intervention for complete chemotherapy as planned.

Radiation-related tissue injuries after medical radiation procedures, such as fluoroscopically guided intervention (FGI), have been reported in patients. Real-time monitoring of medical radiation exposure administered to patients during FGI is important to avoid such tissue injuries. In our previous study, we reported a novel (prototype) real-time radiation system for FGI. However, the prototype sensor indicated low sensitivity to radiation exposure from the side and back, although it had high-quality fundamental characteristics. Therefore, we developed a novel 4-channel sensor with modified shape and size than the previous sensor, and evaluated the basic performance (i.e., measured the energy, dose linearity, dose rate, and angular dependence) of the novel and previous sensors. Both sensors of our real-time dosimeter system demonstrated the low energy dependence, excellent dose linearity (R2 = 1.0000), and good dose rate dependence (i.e., within 5% statistical difference). Besides, the sensitivity of 0&deg, &plusmn, 180&deg, in the horizontal and vertical directions was almost 100% sensitivity for the new sensor, which significantly improved the angular dependence. Moreover, the novel dosimeter exerted less influence on X-ray images (fluoroscopy) than other sensors because of modifying a small shape and size. Therefore, the developed dosimeter system is expected to be useful for measuring the exposure of patients to radiation doses during FGI procedures.

Background: Ultrasonogram guided intervention in chronic shoulder pain is well known for relief of pain and improvement of range of movement (ROM) of affected shoulder joint. Ultrasonogram gives accuracy helps in localized corticosteroid delivery. Corticosteroids relieve the pain by its anti-inflammatory effect. There is conflicting evidence available regarding the effectiveness of the intervention in chronic shoulder pain, questioned in many studies. We planned this study to evaluate the efficacy of ultrasonogram guided intervention in chronic shoulder pain in a tertiary teaching hospital of rural Bengal.Methods: The prospective observational study was carried out in 100 patients with chronic shoulder pain attending pain clinic who fulfilled predetermined inclusion criteria. Patients were injected with 40 mg of depomethyl prednisolone and 10 ml of 1% preservative free lignocaine via standard posterior approach. Then half an hour of standard shoulder range of motion (ROM) exercise regimen was performed under supervision. Pre injection and post injection pain level were scored by visual analogue score (VAS) shoulder exercises were taught and home-based physiotherapy was carried out by patients themselves. Patient were followed at 4, 8, and 12 weeks.Results: The mean age of patients was 53.23±5.680 years with 63 % male study subjects, After the intervention, excellent result in VAS score and improvement of ROM observed in patients. There was statistically significant difference from baseline in both pain relief and shoulder movement.Conclusions: USG guided intervention is effective in pain relief and in improvement in ROM in chronic shoulder pain in long term.

A myocardial bridge is a segment of an epicardial coronary artery tunneled within the myocardium, which clinically ranges from an incidental finding to an etiology of acute coronary syndrome. Determining the hemodynamic significance with instantaneous wave-free ratio (iFR) can guide medical vs.

Optical coherence tomography (OCT) is an increasingly available intracoronary imaging modality that provides highresolution imaging of coronary arteries and guides operators in percutaneous coronary intervention (PCI) by accurately defining luminal geometry and detailed plaque composition. The two cases under discussion in this report, presented with acute ST elevation myocardial infarction (STEMI) with angiography showing minor narrowing (

Recent studies suggest the efficacy of family-based treatment (FBT) among youth with anorexia nervosa (AN) in intensive treatment settings. This study aimed to assess weight outcomes in youth who received an FBT intervention while hospitalized for medical complications of AN. Parental self-efficacy among participating caregivers was also measured. Post-discharge weights of 49 participants were compared with weights of 44 youth who were hospitalized prior to the provision of the FBT intervention. Youth who received the FBT intervention gained significantly more weight than youth in the retrospective treatment as usual group at 3 and 6 months following discharge. FBT youth were 2.84 times more likely than retrospective treatment as usual youth to achieve at least 95% of treatment goal weight at 6 months post-discharge. Finally, parental self-efficacy significantly increased in caregivers who participated in the FBT intervention. Findings provided preliminary support for the provision of FBT to medically hospitalized youth with AN.

Background and objectives Many patients with obsessive compulsive disorder (OCD) go untreated due to a large treatment gap and fear of engaging in cognitive behavioral therapy. The present study investigated the effectiveness of mindfulness based training delivered as a bibliotherapeutic self-help approach, as an alternative and accessible intervention. Methods Eighty-seven participants with OCD anonymously completed an online baseline assessment that included measures of OCD and depression. Subsequently, they were randomly assigned to either mindfulness training or progressive muscle relaxation and received manuals accompanied by audio files. All participants were approached for reassessment six weeks later. Results No changes on any of the scales could be found in either the experimental or control group at post-assessment, even though all participants exercising mindfulness found the manual to be useful. Limitations Due to the mode of application, the study leaves open the possibility that mindfulness training is beneficial for OCD patients when delivered as a therapist guided intervention. Conclusions The effectiveness of mindfulness training as a self-help intervention was not supported in this study. Further work is needed to clarify whether mindfulness is feasible as a treatment for OCD.

Although many patients benefit greatly from fluoroscopically guided intervention (IVR) procedures such as percutaneous coronary intervention (PCI), one of the major disadvantages associated with these procedures, such as cardiac IVR, is the increased patient radiation dose. This study compared the entrance surface doses of x-ray equipment for cardiac IVR at the same seven cardiac catheterization laboratories between today and the past to determine the radiation doses of current cardiac IVR x-ray systems.This study was conducted in 2001, 2007, and 2014 at the same seven cardiac catheterization laboratories in and around Sendai City, Japan. The entrance surface doses with cineangiography and fluoroscopy were compared in 2001 (11 x-ray systems), 2007, and 2014 (12 x-ray systems) using a 20-cm-thick acrylic plate and skin dose monitor. The x-ray conditions used in the measurements, including the image receptor field magnification mode and the recording speed for cineangiography and fluoroscopy, were those-normally used in the facilities performing PCI. Although presently, the entrance doses of x-ray equipment used for cardiac IVR tend to be lower than previously (fluoroscopy dose in 2001, 19.3 +/- 6.3 mGy/min; in 2014, 13.2 +/- 6.5 mGy/min), some equipment has a high radiation dose. In addition, the dose differences of the x-ray systems in 2014 were greater than those in the past (fluoroscopy dose in 2001, 3.4-fold; in 2014, 10.5-fold).In IVR procedures, managing the radiation dose of cardiac IVR x-ray systems is a very important issue. Periodical measurement of the radiation dose of the x-ray equipment used for both cineangiography and fluoroscopy for cardiac IVR is necessary.

When dealing with flush ostial chronic total occlusion (CTO) and no viable retrograde option, the only way to perform recanalization is through an antegrade approach. Such a procedure can be extremely difficult considering the ambiguity of the proximal cap. We demonstrate how we solved ambiguity of the proximal cap of an ostial obtuse marginal CTO with the help of cardiac multidetector computed tomography (MDCT). We also discuss several techniques including bilateral radial approach with home-made sheathless large-bore catheters, IVUS-guided cap puncture, ping-pong guide catheters engagement in the left main, and bioresorbable vascular scaffold (BVS) for an ostial left circumflex disease that we all used in our CTO case.