153 research outputs found
Atrial fibrillation: the current epidemic.
Atrial fibrillation (AF) is the most common arrhythmia diagnosed in clinical practice. The consequences of AF have been clearly established in multiple large observational cohort studies and include increased stroke and systemic embolism rates if no oral anticoagulation is prescribed, with increased morbidity and mortality. With the worldwide aging of the population characterized by a large influx of "baby boomers" with or without risk factors for developing AF, an epidemic is forecasted within the next 10 to 20 years. Although not all studies support this evidence, it is clear that AF is on the rise and a significant amount of health resources are invested in detecting and managing AF. This review focuses on the worldwide burden of AF and reviews global health strategies focused on improving detection, prevention and risk stratification of AF, recently recommended by the World Heart Federation
Implementation of an intraoperative electron radiotherapy in vivo dosimetry program
Background:
Intraoperative electron radiotherapy (IOERT) is a highly selective radiotherapy technique which aims
to treat restricted anatomic volumes during oncological surgery and is now the subject of intense re-evaluation. In
vivo dosimetry has been recommended for IOERT and has been identified as a risk-reduction intervention in the
context of an IOERT risk analysis. Despite reports of fruitful experiences, information about in vivo dosimetry in
intraoperative radiotherapy is somewhat scarce. Therefore, the aim of this paper is to report our experience in
developing a program of in vivo dosimetry for IOERT, from both multidisciplinary and practical approaches, in a
consistent patient series. We also report several current weaknesses.
Methods:
Reinforced TN-502RDM-H mobile metal oxide semico
nductor field effect tran
sistors (MOSFETs) and
Gafchromic MD-55-2 films were used as a redundant in vivo treatment verification system with an Elekta
Precise fixed linear accelerator for calibrations and tre
atments. In vivo dosimetry was performed in 45 patients
in cases involving primary tumors or relapses. The m
ost frequent primary tumors were breast (37 %) and
colorectal (29 %), and local recurrences among relapses was 83 %. We made 50 attempts to measure with
MOSFETs and 48 attempts to measure with films in th
e treatment zones. The surgical team placed both
detectors with supervision from the radiation oncologist and following their instructions.
Results:
The program was considered an overall success by the different professionals involved. The absorbed doses
measured with MOSFETs and films were 93.8 ± 6.7 % and 97.9 ± 9.0 % (mean ±
SD
) respectively using a scale in which
90 % is the prescribed dose and 100 % is the maximum absorbed dose delivered by the beam. However, in 10 % of
cases we experienced dosimetric problems due to detector misalignment, a situation which might be avoided with
additional checks. The useful MOSFET lifetime length and the film sterilization procedure should also be controlled.
Conclusions:
It is feasible to establish an in vivo dosimetry program for a wide set of locations treated with
IOERT using a multidisciplinary approach according to the skills of the professionals present and the detectors
used; oncological surgeons
’
commitment is key to success in this context. Films are more unstable and show
higher uncertainty than MOSFETs but are cheaper and
are useful and convenient if real-time treatment
monitoring is not necessary.This work was supported by grants IPT-300000-2010-3 and PI11/01659 from
the Spanish Government and ERDF funds
Do Omega-3 fatty acids prevent atrial fibrillation after open heart surgery? A meta-analysis of randomized controlled trials
OBJECTIVES: N-3 polyunsaturated fatty acids have been proposed as a novel treatment for preventing postoperative atrial fibrillation due to their potential anti-inflammatory and anti-arrhythmic effects. However, randomized studies have yielded conflicting results. The objective of this study is to review randomized trials of N-3 polyunsaturated fatty acid use for postoperative atrial fibrillation. METHODS: Using the CENTRAL, PUBMED, EMBASE, and LILACS databases, a literature search was conducted to identify all of the studies in human subjects that reported the effects of N-3 polyunsaturated fatty acids on the prevention of postoperative atrial fibrillation in cardiac surgery patients. The final search was performed on January 30, 2011. There was no language restriction, and the search strategy only involved terms for N-3 polyunsaturated fatty acids (or fish oil), atrial fibrillation, and cardiac surgery. To be included, the studies had to be randomized (open or blinded), and the enrolled patients had to be >18 years of age. RESULTS: Four randomized studies (three double-blind, one open-label) that enrolled 538 patients were identified. The patients were predominantly male, the mean age was 62.3 years, and most of the patients exhibited a normal left atrial size and ejection fraction. N-3 polyunsaturated fatty acid use was not associated with a reduction in postoperative atrial fibrillation. Similar results were observed when the open-label study was excluded. CONCLUSIONS: There is insufficient evidence to suggest that treatment with N-3 polyunsaturated fatty acids reduces postoperative atrial fibrillation. Therefore, their routine use in patients undergoing cardiac surgery is not recommended
Efficacy and safety outcomes of recanalization procedures in patients with acute symptomatic pulmonary embolism: systematic review and network meta-analysis.
Background We aimed to review the efficacy and
safety of recanalisation procedures for the treatment of
PE.
Methods We searched PubMed, the Cochrane
Library, EMBASE, EBSCO, Web of Science and CINAHL
databases from inception through 31 July 2015 and
included randomised clinical trials that compared the
effect of a recanalisation procedure versus each other or
anticoagulant therapy in patients diagnosed with PE. We
used network meta-analysis and multivariate randomeffects
meta-regression to estimate pooled differences
between each intervention and meta-regression to
assess the association between trial characteristics and
the reported effects of recanalisation procedures versus
anticoagulation.
Results For all-cause mortality, there were no
significant differences in event rates between any of the
recanalisation procedures and anticoagulant treatment
(full-dose thrombolysis: OR 0.60; 95% CI0.36 to 1.01;
low-dose thrombolysis: 0.47; 95%CI 0.14 to 1.59; and
catheter-associated thrombolysis: 0.31; 95%CI 0.01 to
7.96). Full-dose thrombolysis increased the risk of major
bleeding (2.00; 95%CI 1.06 to 3.78) compared with
anticoagulation. Catheter-directed thrombolysis was
associated with the lowest probability of dying (surface
under the cumulative ranking curve (SUCRA), 0.67),
followed by low-dose thrombolysis (SUCRA, 0.66) and
full-dose thrombolysis (SUCRA, 0.55). Similarly, low-dose
thrombolysis was associated with the lowest probability
of major bleeding (SUCRA, 0.61), followed by catheterdirected
thrombolysis (SUCRA, 0.54) and full-dose
thrombolysis (SUCRA, 0.17). The results were similar in
sensitivity analyses based on restricting only to studies in
haemodynamically stable patients with PE.
Conclusions In the treatment of PE, recanalisation
procedures do not seem to offer a clear advantage
compared with standard anticoagulation. Low-dose
thrombolysis was associated with the lowest probability
of dying and bleedingpre-print549 K
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