Pooled Analysis of the Efficacy and Safety of Video Capsule Endoscopy in Patients with Implantable Cardiac Devices

© 2019 Rabih Tabet et al. Background. To date, video capsule endoscopy (VCE) is still contraindicated by the FDA and the main manufacturers of Cardiac Implantable Electronic Devices (CIED) in patients with CIED, given a theoretical electromagnetic interference and possible device malfunction. Objectives. The objective of this study was to assess the safety profile and efficacy of VCE in patients with implantable cardiac devices through analyzing the risk of mutual interference. Methods. A systematic review of PubMed, Web of Science, and Embase databases was conducted. Peer-reviewed original articles, published in the English language and containing capsule endoscopy AND pacemaker , defibrillator OR left ventricular assist device as keywords, were selected. Studies performed in vitro, isolated case reports, and abstracts/posters were excluded. Results. A total of 735 VCE procedures were performed in patients with cardiac devices in various clinical settings. Cardiac events were not seen in any case. Interference on capsule images transmission was noted in 5 cases (left ventricular assist device (LVAD)) where few images were lost when the capsule was closest to the device. Finally, interference between capsule and telemetry leads was noted in 6 cases (4 Permanent Pacemakers (PPM), 2 Implantable Cardioverter-Defibrillator (ICD)) leading to image artifacts. Discussion. Adverse cardiac events were not seen in any study. Loss of images occurred when the VCE was in proximity to the device (only with LVAD) or after telemetry leads installation without affecting the completion rate and diagnostic yield of VCE. Conclusion. VCE is safe and remains efficient in patients with cardiac devices. If cardiac monitoring is required, wired systems are preferable

Vascular Function and Handgrip Strength in Rheumatoid Arthritis Patients

Objective. To examine the relationship of handgrip strength with forearm blood flow (BF) and vascular resistance (VR) in rheumatoid arthritis (RA) patients. Methods. Forearm BF at rest (RBF) and after upper arm occlusion (RHBF), and handgrip strength were examined in 78 individuals (RA = 42 and controls (CT) = 36). Subsequently, VR at rest (RVR) and after occlusion (RHVR) were calculated. Results. The patients' RBF (P = 0.02) and RHBF (P = 0.0001) were less, whereas RVR (P = 0.002) and RHVR (P = 0.0001) were greater as compared to the CTs. Similarly, handgrip strength was lower in the RAs (P = 0.0001). Finally, handgrip strength was directly associated with RBF (r = 0.43; P = 0.0001), and RHBF (r = 0.5; P = 0.0001), and inversely related to RVR (r = −0.3; P = 0.009) and RHVR (r = −0.3; P = 0.007). Conclusion. The present study uniquely identifies an association between regional measures of forearm blood flow and handgrip strength in patients and healthy control. In addition, this study confirms the presence of vascular and muscle dysfunction in patients with rheumatoid arthritis, as evidenced by lower forearm blood flow indices, at rest and following occlusion, and lower handgrip strength as compared to healthy individuals

Temporal variations of black carbon in Guangzhou, China, in summer 2006

In situ measurements of the mass concentration of black carbon (BC) and mixing ratios of carbon monoxide (CO) and carbon dioxide (CO<sub>2</sub>) were made at Guangzhou, an urban measurement site in the Pearl River Delta (PRD), China, in July 2006. The average ± standard deviation (SD) concentrations of BC, CO, and CO<sub>2</sub> were 4.7± 2.3 μgC m<sup>−3</sup>, 798± 459 ppbv, and 400± 13 ppmv, respectively. The trends of these species were mainly controlled by synoptic-scale changes in meteorology during the campaign. Based on back trajectories, data are analyzed separately for two different air mass types representing northerly and southerly flows. The northerly air masses, which constituted ~25% of the campaign, originated mostly in the PRD and hence represent observations on regional scales. On the other hand, during southerly flow (~75%), the measurements were influenced by dilution due to cleaner marine air. The diurnal patterns of BC, CO, and CO<sub>2</sub> exhibited peak concentrations during the morning and evening hours coinciding with rush-hour traffic. The ratios of OC/BC were lower during the morning hour peaks in the concentrations of primary pollutants due to their fresh emissions mainly from vehicular traffic in Guangzhou. The diurnal variations of BC observed in southerly air masses tended to follow the traffic patterns of heavy-duty vehicles (HDV) in Guangzhou, while the roles of other sources need to be investigated. The slopes of ΔBC/ΔCO, ΔBC/ΔCO<sub>2</sub>, and ΔCO/ΔCO<sub>2</sub> observed during northerly flows were 0.0045 μgC m<sup>−3</sup>/ppbv, 0.13 μgC m<sup>−3</sup>/ppmv, and 49.4 ppbv/ppmv, respectively, agreeing reasonably with their respective emission ratios derived from regional emission inventories

Intraoperative radiotherapy electron boost in advanced and recurrent epithelial ovarian carcinoma: a retrospective study

<p>Abstract</p> <p>Background</p> <p>Relapses of epithelial ovarian carcinoma (EOC) have a poor prognosis and are almost always fatal. The aim of this study was to evaluate the clinical outcome and toxicity of intraoperative electron beam radiation therapy (IOERT) in advanced and recurrent EOC.</p> <p>Methods</p> <p>Forty-five women with EOC were treated with IOERT. Twenty-five patients had primary disease (PD) without distant metastasis at IOERT, and 20 patients had an isolated local recurrence (ILR) after surgery. All 45 patients in this series underwent optimal cytoreductive (≤ 1 cm) surgery. The whole pelvic (WP) radiotherapy was intraoperatively delivered using 12 Mev electron beam; 43 patients received 18-20 Gy and two patients received 10 Gy. Thirty-three patients received postoperateive intraperitoneal (IP) chemotherapy, while seven patients received intravenous (IV) chemotherapy. Five patients refused concurrent chemotherapy. Overall survival (OS) rates were analyzed using the Kaplan-Meier method.</p> <p>Results</p> <p>Tumor recurrence and metastasis were observed in 16 patients (35.6%). Of those, 14 patients (31.1%) relapsed and two patients (4.4%) had distant metastasis alone. Eight of 25 (32%) local failures were observed in the PD group, as compared to 6/20 (30%) in the ILR group (<it>P </it>= 0.885). Actuarial local control at five year follow-up was 31/45 (68.9%). Seventeen of the total 45 (37.8%) patients died. Nine of 25 (36%) in the PD group died, as compared to 8 of 20 (40%) in the ILR group. The 5-year OS and disease-free survival (DFS) rates were 28/45 (62.2%) and 25/45 (55.6%), respectively. In the PD group, the 5-year OS and DFS rates were 16/25 (64%) and 14/25 (56%) (<it>P </it>> 0.05, <it>vs</it>. the ILR group at 12/20 and 11/20, respectively). The OS and DFS in the IOERT plus IP group were 25/33 (75.8%) and 23/33 (69.7%), respectively, which were superior to the rates achieved with IOERT plus IV chemotherapy (<it>P </it>< 0.05, 2/7 and 1/7, respectively). The major complication of IOERT was neuropathy. Five (11.1%) patients developed peripheral neurotoxicity.</p> <p>Conclusions</p> <p>IOERT may be feasible and effective as a boosting technique for advanced and recurrent ovarian cancer. IOERT plus IP chemotherapy may achieve high locoregional disease control and survival benefit with a low risk of toxicity. Peripheral nerves in the IOERT field are dose-limiting structures requiring nerve protection policies or a dose compromise to ensure against severe neurological damage.</p

Phytochemical Investigation for the Main Active Constituents in Arctium lappa L. Cultivated in Iraq

Burdock ( Arctium lappa), is among the most popular plants in traditional medicine and it is associated with several biological effects. Literature survey revealed the presence of phenylpropanoid compounds .The most widespread are hydroxycinnamic acids ( mainly caffeic acid and chlorogenic acid) and lignans (mainly arctiin and arctigenin). This work will confirm the presence of these compounds in Arctium lappa, cultivated in Iraq, in both root and leaf samples.  The dried plant samples were extracted by soxhlet with 80% methanol then separated the main constituents by thin layer chromatography (TLC) and high performance liquid  chromatography (HPLC). Identification of the isolated compounds was carried out by UV, IR, and compared with reference standards using TLC, HPLC and  HPTLC. Keywords: Actium  lappa, hydroxycinnamic acid,  Lignan, Phytochemical

Prothrombin complex concentrate and fatal thrombotic adverse events: A complication to keep in mind.

Thromboembolic events such as deep vein thrombosis and pulmonary embolism are well-known complications that can occur after prothrombin complex concentrate therapy. However, acute myocardial infarction is a very rare but potentially life-threatening complication that was exclusively described in patients with bleeding disorders who received chronic and recurrent concentrate infusions. We report the case of a 70 year-old male patient with cholangiocarcinoma who was admitted to our hospital with worsening fatigue and weakness. His stay was complicated by uncontrolled bleeding secondary to rivaroxaban use and advanced liver disease. By the end of the prothrombin complex concentrate infusion used to reverse his coagulopathy, patient developed ST-segment elevation myocardial infarction with cardiogenic shock and passed away. This is the first reported case of acute myocardial infarction that occurs in a patient without hemophilia and after the first prothrombin complex concentrate infusion