The effect of pre-procedure sublingual nitroglycerin on radial artery diameter and Allen’s test outcome - relevance to transradial catheterization

Background The radial artery is increasingly used for cardiac procedures, but is a relatively small vessel that is prone to spasm when instrumented. Intra-arterial nitroglycerine has been shown to reduce radial spasm but first requires arterial access. We investigated the effect of pre-procedure sublingual nitroglycerin (NTG) on the diameter of the radial artery in a large cohort of patients. Methods 305 subjects underwent ultrasound measurement of their radial and ulnar arteries in both arms before and after the administration of 800 μg of sublingual NTG. The Allen's test was also performed in the subjects prior to and after NTG. Results Radial artery diameter in this Caucasian study group is larger than that reported for other populations. The administration of sublingual NTG significantly increased the size of the right radial artery from 2.88 ± 0.36 mm to 3.36 ± 0.40 mm in men and from 2.23 ± 0.37 up to 2.74 ± 0.36 mm in women. There were also significant increases in left radial, right and left ulnar artery diameters in males and females with NTG. There was no significant effect of NTG on blood pressure. In all patients with an unfavourable Allen's test, retesting following sublingual NTG resulted in transition to a favourable Allen's. Conclusion Caucasian populations have larger calibre radial arteries compared to other geographic areas. Sublingual NTG is effective at dilating the radial artery in both men and women. This may make radial artery puncture and cannulation less challenging and should be considered in all patients in the absence of contraindications. The results of Allen's testing are dynamic and its usefulness for screening prior to transradial access is undetermined

Prä- und posttherapeutische Larynxbildgebung

Zusammenfassung: Sowohl CT als auch MRT und neuerdings die PET-CT sind unentbehrliche Zusatzuntersuchungen zur Diagnostik und Stadieneinteilung von Tumoren des Larynx. Sie sind der klinischen Untersuchung (einschließlich endoskopischer Biopsie) beigeordnet und ergänzen diese komplementär. Eine sehr genaue Kenntnis der submukösen Tumorausbreitungswege, der diagnostischen Zeichen der Tumorinfiltration und deren Konsequenzen für Stadieneinteilung und Therapie sind unentbehrlich für die Interpretation von CT-, MRT- und PET-CT-Bildern. Sowohl CT als auch MRT sind hochsensitive Untersuchungen zum Nachweis der neoplastischen Infiltration des präepi- und paraglottischen Raums, der Subglottis und des Knorpels. Die Spezifität ist jedoch mit beiden Methoden weniger hoch als zunächst erwartet, wodurch eine Tendenz zum Überschätzen der Tumorausbreitung resultiert. Neuere Untersuchungen haben jedoch gezeigt, dass die Spezifität der MRT mittels Anwendung neuer diagnostischer Kriterien signifikant verbessert werden kann, da eine Unterscheidung zwischen Tumor und peritumoraler Entzündung in vielen Fällen möglich ist. Der sehr hohe negative Vorhersagewert der beiden Schnittbildverfahren ist aus klinischer Sicht wichtig, da er es ermöglicht, die neoplastische Knorpelinfiltration auszuschließen. Beide Methoden verbessern signifikant die prätherapeutische Stagingtreffsicherheit, wenn sie zusätzlich zur Endoskopie eingesetzt werden. Bei submukösen Tumoren liefern sowohl CT als auch MRT wertvolle Hinweise auf eine mögliche Ätiologie, auf das Ausmaß des submukösen Wachstums und die geeignete Biopsiestelle. Sie spielen auch eine wichtige Rolle bei der Diagnose von Laryngozelen, der Abklärung von N.-laryngeus-recurrens-Paresen und Larynxfrakture

Optimal Homotopy Asymptotic Method for Solving Delay Differential Equations

We extend for the first time the applicability of the optimal homotopy asymptotic method (OHAM) to find the algorithm of approximate analytic solution of delay differential equations (DDEs). The analytical solutions for various examples of linear and nonlinear and system of initial value problems of DDEs are obtained successfully by this method. However, this approach does not depend on small or large parameters in comparison to other perturbation methods. This method provides us with a convenient way to control the convergence of approximation series. The results which are obtained revealed that the proposed method is explicit, effective, and easy to use

Incidence and sociodemographic characteristics of eczema diagnosis in children: a cohort study

Letter to the Editor

Intravascular imaging-guided intracoronary lithotripsy: First real-world experience

Background and Aims: Coronary calcification remains a significant challenge for the contemporary interventional cardiologist. We aim to describe the use of intravascular lithotripsy (IVL) in a range of real-world settings. Methods: A retrospective two-center analysis of patients treated with IVL between June 2018 and November 2019. Technical and procedural success, as well as procedural complications and 30-day outcomes (death, myocardial infarction, or repeat target vessel revascularization), was recorded. Results: Sixty-five patients underwent IVL: 80% were male and the mean age was 70.1 ± 12.0 years. 54% of patients presented with acute coronary syndrome (ACS) and 68% of patients had intracoronary imaging. Twelve patients required IVL within pre-existing stents, and 12 underwent IVL in the left main stem. All balloons were successfully delivered with 98.5% procedural success. There was a significant gain in MLA post PCI of 261.9 ± 100% following IVL. There were two procedural complications. At 30-day follow-up, there was one death, and one patient required a repeat procedure due to stent underexpansion. Conclusions: In this largest real-world series of imaging-guided IVL for calcified lesions to date, we demonstrate that IVL is deliverable, safe, and effective at calcium modification especially when intracoronary imaging is used

MRI of the lung (3/3)-current applications and future perspectives

BACKGROUND: MRI of the lung is recommended in a number of clinical indications. Having a non-radiation alternative is particularly attractive in children and young subjects, or pregnant women. METHODS: Provided there is sufficient expertise, magnetic resonance imaging (MRI) may be considered as the preferential modality in specific clinical conditions such as cystic fibrosis and acute pulmonary embolism, since additional functional information on respiratory mechanics and regional lung perfusion is provided. In other cases, such as tumours and pneumonia in children, lung MRI may be considered an alternative or adjunct to other modalities with at least similar diagnostic value. RESULTS: In interstitial lung disease, the clinical utility of MRI remains to be proven, but it could provide additional information that will be beneficial in research, or at some stage in clinical practice. Customised protocols for chest imaging combine fast breath-hold acquisitions from a "buffet" of sequences. Having introduced details of imaging protocols in previous articles, the aim of this manuscript is to discuss the advantages and limitations of lung MRI in current clinical practice. CONCLUSION: New developments and future perspectives such as motion-compensated imaging with self-navigated sequences or fast Fourier decomposition MRI for non-contrast enhanced ventilation- and perfusion-weighted imaging of the lung are discussed. Main Messages • MRI evolves as a third lung imaging modality, combining morphological and functional information. • It may be considered first choice in cystic fibrosis and pulmonary embolism of young and pregnant patients. • In other cases (tumours, pneumonia in children), it is an alternative or adjunct to X-ray and CT. • In interstitial lung disease, it serves for research, but the clinical value remains to be proven. • New users are advised to make themselves familiar with the particular advantages and limitations

Defining and measuring “eczema control”: An international qualitative study to explore the views of those living with and treating atopic eczema

Background Atopic eczema (also known as eczema) is a chronic, inflammatory skin condition that often afflicts patients’ health and wellbeing. The Harmonising Outcome Measures for Eczema (HOME) initiative recommends that “long-term control of eczema” is measured in all clinical trials 3 months or longer in duration. However, little has been published on what eczema control means to those living with or treating atopic eczema. Objectives To i) develop understanding of what eczema control means to patients, carers and clinicians and ii) explore the feasibility and acceptability of different ways of measuring eczema control in the long-term. Methods Online focus groups explored patients/carers experiences in the UK, USA, the Netherlands, France, Sweden and Japan, and an international online survey gathered views of clinicians. The Framework Method was used to analyse the focus groups and thematic analysis was used to analyse survey data. All findings were integrated into a theoretical framework to create overarching themes that cut across these diverse groups. Results Eight focus groups with patients (16 years+) and eight groups with carers of children took place (N=97). Sixty-two people took part in the survey. Eczema control was described as a multifaceted construct involving changes in disease activity, the treatment and management of the condition, and psychological, social and physical functioning. Patient /carer measurement allows personal accounts and frequent measurement, whilst clinician measurement was deemed less subjective. The burden on patients/carers and issues for analysing and interpreting data should be considered. Conclusions This study formed the basis of judging the content validity and feasibility of measurement instruments/methods to assess control of eczema in clinical trials. This online approach to an international qualitative study is an example of how core outcome set developers with limited resources can engage with multiple stakeholder groups on an international basis to inform consensus meeting discussions