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Sex differences in 123I-mIBG scintigraphy imaging techniques in patients with heart failure. 心力衰竭患者123I-mIBG闪烁成像技术的性别差异。
IF 3.1 3区 医学 Q3 ENGINEERING, BIOMEDICAL Pub Date : 2023-07-01 Epub Date: 2023-07-24 DOI: 10.1080/17434440.2023.2239139
Miriam Conte, Maria Silvia De Feo, Viviana Frantellizzi, Arianna Di Rocco, Alessio Farcomeni, Flaminia De Cristofaro, Ricci Maria, Antonio Rosario Pisani, Giuseppe Rubini, Giuseppe De Vincentis

Background: 123I-mIBG-scintigraphy could be a useful stratifying tool for patients with heart failure (HF). The purpose of this retrospective study is to evaluate whether there are differences between men and women with HF in terms of the prediction of cardiac arrhythmic events (AE).

Research and methods: A total of 306 patients, before implantable-cardioverter-defibrillator (ICD) implantation, were evaluated. They underwent 123I-mIBG-scintigraphy and an evaluation of the results was performed after 85 months of follow-up. Early and late planar and SPECT cardiac images were acquired. Heart-to-mediastinum ratio (HM) for planar images and the sum of the segmental scores (SS) for SPECT were calculated.

Results: In the general population, age, early SS (ESS), late SS (LSS), and ejection fraction (EF) were statistically significant for the prediction of AE at Cox regression, while early and late HM (eHM,lHM) were not significative for the prediction of AE. Population was divided into females and males and univariate analysis was conducted separately for the two cohorts: no significant variables for prediction of AE were found in females. For males, ESS, LSS, EF, and late HM were statistically significant predictors of AE. The overall survival was similar in males and females, but the risk of AE is lower in males than in females.

Conclusions: 123I-mIBG represents a more effective tool for the prediction of AE in male patients than in women.

背景:123I mIBG闪烁显像可能是心力衰竭(HF)患者的一种有用的分层工具。本回顾性研究的目的是评估男性和女性HF患者在预测心律失常事件(AE)方面是否存在差异。研究和方法:在植入心律转复除颤器(ICD)之前,共对306名患者进行了评估。他们接受了123I mIBG闪烁扫描,并在85岁后对结果进行了评估 随访数月。采集早期和晚期平面和SPECT心脏图像。计算平面图像的心纵隔比(HM)和SPECT的节段评分之和(SS)。结果:在一般人群中,年龄、早期SS(ESS)、晚期SS(LSS)和射血分数(EF)在Cox回归预测AE方面具有统计学意义,而早期和晚期HM(eHM,lHM)对预测AE没有统计学意义。将人群分为女性和男性,并分别对两个队列进行单变量分析:在女性中未发现预测AE的显著变量。对于男性,ESS、LSS、EF和晚期HM是AE的统计学显著预测因素。男性和女性的总生存率相似,但男性发生AE的风险低于女性。结论:123I-mIBG是预测男性患者AE的一种比女性患者更有效的工具。
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引用次数: 0
A contemporary systematic review of the complications associated with SURGICEL. 外科手术并发症的当代系统综述。
IF 3.1 3区 医学 Q3 ENGINEERING, BIOMEDICAL Pub Date : 2023-07-01 Epub Date: 2023-08-04 DOI: 10.1080/17434440.2023.2242776
Matthew Masoudi, Jacob Wiseman, Sam M Wiseman

Background: This review aims to summarize the findings from recent literature (2010-2022) reporting on complications that resulted from the surgical use of SURGICEL for intraoperative hemostasis.

Methods: A literature search was conducted using the MEDLINE (OVID), Embase, and Cochrane Central Register of Controlled Trials - CENTRAL (OVID) databases. The studies were sorted into case reports and other study types for data extraction. Covidence was used for data extraction and statistics were descriptive.

Results: Of the total 560 articles screened, 73 papers were selected for a full-text review and 70 studies were included in this review. A total of 7,242 participants were included in the studies (case studies n = 93, others n = 7149). 67/70 of the included studies reported complications when SURGICEL was used intraoperatively. Reported complications included: SURGICEL induced masses (granulomas, abscesses, hematomas, cysts) (n = 25), hemorrhagic complications (n = 12), masses misdiagnosed as tumors, cardiovascular, nervous system, and hepatobiliary complications, pain, and infections. Other complications included: fistulas, erectile dysfunction, chorioamnionitis, swelling, urinary leak, renal failure, and anaphylaxis.

Conclusions: Publications reporting on complications associated with the use of SURGICEL intraoperatively have continued to emerge. Future studies should compare how the types and rates of complications compare between SURGICEL and alternative hemostatic agents.

背景:本综述旨在总结最近文献(2010-2022)中关于外科手术使用SURGICEL进行术中止血引起并发症的研究结果。方法:使用MEDLINE(OVID)、Embase和Cochrane对照试验中央登记册-Central数据库进行文献检索。这些研究被分类为病例报告和其他研究类型,用于数据提取。Covidence用于数据提取,统计数据具有描述性。结果:在筛选的560篇文章中,73篇论文被选为全文综述,70项研究被纳入本综述。共有7242名参与者被纳入研究(案例研究 = 93,其他n = 7149)。67/70的纳入研究报告了术中使用SURGICEL时的并发症。报告的并发症包括:外科手术引起的肿块(肉芽肿、脓肿、血肿、囊肿)(n = 25),出血性并发症(n = 12) ,肿块被误诊为肿瘤、心血管、神经系统和肝胆并发症、疼痛和感染。其他并发症包括:瘘管、勃起功能障碍、绒毛膜羊膜炎、肿胀、尿漏、肾衰竭和过敏反应。结论:关于术中使用SURGICEL并发症的报道不断出现。未来的研究应该比较SURGICEL和替代止血剂之间并发症的类型和发生率的比较。
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引用次数: 0
Device profile of the Orchid safety release valve for the prevention of accidental catheter dislodgement. 兰花安全释放阀的装置外形,用于防止导管意外脱位。
IF 3.1 3区 医学 Q3 ENGINEERING, BIOMEDICAL Pub Date : 2023-07-01 DOI: 10.1080/17434440.2023.2216383
Nancy Moureau

Introduction: More than 4 out of 5 patients in acute care require intravenous catheters. Complications of catheter dislodgement and failure are commonly reported at rates of 15-69% causing interrupted treatment and greater resource consumption when catheter replacement is required.

Areas covered: This manuscript outlines unmet needs in the prevention of catheter dislodgement and how a novel safety release device (Orchid SRV™, Linear Health Sciences) might address these gaps based on available evidence.

Expert opinion: Healthcare initiatives focus on reducing complications and associated costs with the delivery of intravenous treatments. Tension-activated safety release valve devices, attached to intravenous tubing, are a new feature that adds a level of safety to intravenous catheters to reduce mechanical catheter dislodgement when a pull force of greater than 3 pounds is applied. Incorporating a tension-activated accessory into and between existing intravenous tubing and the catheter and extension set protects the catheter from dislodgement. Flow continues until excessive pull force separates and closes the flow pathway in both directions, while the SRV provides a quick replacement to reestablish flow. The safety release valve is used to prevent accidental catheter dislodgement, limit tubing contamination, and avoid more serious complications while maintaining a functional catheter.

简介:超过4 / 5的急症患者需要静脉留置导管。导尿管脱位和失败的并发症发生率通常为15-69%,导致治疗中断,需要更换导尿管时资源消耗更大。涵盖领域:本文概述了预防导管脱位的未满足需求,以及一种新型安全释放装置(Orchid SRV™,Linear Health Sciences)如何根据现有证据解决这些差距。专家意见:医疗保健举措的重点是减少静脉注射治疗的并发症和相关费用。张力激活安全释放阀装置,附在静脉导管上,是一项新功能,增加了静脉导管的安全性,以减少在施加大于3磅的拉力时机械导管脱位。将张力激活的附件纳入现有静脉导管和导管之间,并保护导管不脱位。流体会继续流动,直到过大的拉力分离并关闭两个方向的流动通道,而SRV提供了快速的替换以重新建立流动。安全释放阀用于防止意外的导管脱位,限制导管污染,在保持导管功能的同时避免更严重的并发症。
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引用次数: 0
inHEART Models software - novel 3D cardiac modeling solution. inHEART Models软件-新颖的三维心脏建模解决方案。
IF 3.1 3区 医学 Q3 ENGINEERING, BIOMEDICAL Pub Date : 2023-07-01 Epub Date: 2023-08-18 DOI: 10.1080/17434440.2023.2247983
Leah A John, Brett Tomashitis, Zain Gowani, Dan Levin, Chau Vo, Ian John, Jeffrey R Winterfield

Introduction: Advanced cardiac imaging is an important component in pre-procedural planning for ventricular tachycardia (VT) ablations. inHEART's proprietary software, inHEART Models, and its academic version, Multimodality Platform for Specific Imaging in Cardiology (MUSIC), provide detailed characterization of anatomical structures and scars.

Areas covered: This review highlights the current overview of the market and offers insight into inHEART Models and MUSIC and its application during VT ablations with supporting case examples. An overview of the clinical profile and regulatory status of inHEART Models, and other competing technologies, such as Automatic Detection of Arrhythmia Substrate (ADAS) 3D software and Catheter Precision's View into Ventricular Onset (VIVO), are also discussed.

Expert opinion: inHEART and MUSIC utilization has increased over the last few years and continues to establish its presence as an important aspect of VT ablations. Its unique proprietary software sets itself apart from others in the field. The introduction of dual source-photon counting detector computed tomography (PCD-CT) is expected to make significant advancements in the field and take imaging to a new level. inHEART's continued research in cardiac imaging and digital technology is expected to increase as is its global presence in the electrophysiology (EP) community.

引言:高级心脏成像是室性心动过速(VT)消融术前计划的重要组成部分。inHEART的专有软件inHEART Models及其学术版心脏病特异性成像多模态平台(MUSIC)提供了解剖结构和疤痕的详细特征。所涵盖的领域:本综述重点介绍了当前的市场概况,并提供了对inHEART模型和MUSIC及其在室性心动过速消融过程中的应用的见解,以及支持性案例。还讨论了inHEART模型的临床概况和监管状况,以及其他竞争技术,如心律失常底物自动检测(ADAS)3D软件和Catheter Precision的心室发病视图(VIVO)。专家意见:inHEART和MUSIC的使用在过去几年中有所增加,并继续将其作为室性心动过速消融的一个重要方面。其独特的专有软件使自己在该领域与众不同。双源光子计数探测器计算机断层扫描(PCD-CT)的引入有望在该领域取得重大进展,并将成像提升到一个新的水平。inHEART在心脏成像和数字技术方面的持续研究预计将增加,其在电生理学(EP)领域的全球影响力也将增加。
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引用次数: 0
Electromagnetic interference from automobile passive keyless entry in cardiovascular implantable electronic devices. 心血管植入式电子设备中汽车无源无钥匙进入的电磁干扰。
IF 3.1 3区 医学 Q3 ENGINEERING, BIOMEDICAL Pub Date : 2023-07-01 Epub Date: 2023-09-05 DOI: 10.1080/17434440.2023.2255126
Narawudt Prasertwitayakij, Taradol Komolmis, Siriluck Gunaparn, Cheeranun Pisespongsa, Arintaya Phrommintikul, Wanwarang Wongcharoen, Teerapat Nantsupawat

Introduction: The automobile passive keyless entry (PKE) system is a potential source of electromagnetic interference (EMI). We aim to determine the incidence and significance of EMI from automobile PKE system in cardiovascular implantable electronic device (CIED) patients.

Methods: This was a single-center cross-sectional study conducted at Maharaj Nakorn Chiang Mai hospital, Thailand. Patients with CIED were instructed to lock and unlock two automobiles using the PKE system. Any EMI or arrhythmias were detected by CIED interrogation and single-lead electrocardiogram event recorder. We also used a spectrum analyzer to identify the automobiles working frequency bandwidth.

Results: There was a total of 102 CIED patients. Device types included 48.0% defibrillators, 37.3% permanent pacemakers, and 14.7% cardiac resynchronization therapy device. Both interrogated data from device and event monitor revealed no incidence of EMI during the PKE activation. We failed to identify the working frequency bandwidth of the two studied cars due to very low signal strength, thus blended in with the background noise.

Conclusions: Automobile PKE systems transmitted very low power signals. Therefore, under normal circumstances, CIED patients can use automobile PKE system safely without any EMI regardless of key fob positions in relation to the CIED pulse generator.

Trial registration: The study was registered at ClinicalTrials.gov (https://clinicaltrials.gov), and the identification number is NCT03016390.

简介:汽车无钥匙进入系统是一个潜在的电磁干扰源。我们的目的是确定心血管植入式电子设备(CIED)患者中来自汽车PKE系统的EMI的发生率和意义。方法:这是一项在泰国Maharaj Nakorn清迈医院进行的单中心横断面研究。CIED患者被要求使用PKE系统锁定和解锁两辆汽车。通过CIED询问和单导联心电图事件记录器检测任何EMI或心律失常。我们还使用频谱分析仪来识别汽车的工作频带。结果:共有102例CIED患者。设备类型包括48.0%的除颤器、37.3%的永久性起搏器和14.7%的心脏再同步治疗设备。来自设备和事件监测器的询问数据均显示,在PKE激活期间未发生EMI。由于信号强度很低,我们未能确定两辆被研究汽车的工作频率带宽,因此与背景噪声混合在一起。结论:汽车PKE系统传输的信号功率很低。因此,在正常情况下,无论钥匙扣相对于CIED脉冲发生器的位置如何,CIED患者都可以在没有任何EMI的情况下安全地使用汽车PKE系统。试验注册:该研究已在ClinicalTrials.gov上注册(https://clinicaltrials.gov),标识号为NCT03016390。
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引用次数: 0
The current state, challenges, and future directions of deep brain stimulation for obsessive compulsive disorder. 强迫症脑深部刺激的现状、挑战和未来方向。
IF 3.1 3区 医学 Q3 ENGINEERING, BIOMEDICAL Pub Date : 2023-07-01 Epub Date: 2023-09-07 DOI: 10.1080/17434440.2023.2252732
Lauren Fanty, Jun Yu, Nita Chen, Drew Fletcher, Grace Hey, Michael Okun, Josh Wong

Introduction: Obsessive-compulsive disorder (OCD) is clinically and pathologically heterogenous, with symptoms often refractory to first-line treatments. Deep brain stimulation (DBS) for the treatment of refractory OCD provides an opportunity to adjust and individualize neuromodulation targeting aberrant circuitry underlying OCD. The tailoring of DBS therapy may allow precision in symptom control based on patient-specific pathology. Progress has been made in understanding the potential targets for DBS intervention; however, a consensus on an optimal target has not been agreed upon.

Areas covered: A literature review of DBS for OCD was performed by querying the PubMed database. The following topics were covered: the evolution of DBS targeting in OCD, the concept of an underlying unified connectomic network, current DBS targets, challenges facing the field, and future directions which could advance personalized DBS in this challenging population.

Expert opinion: To continue the increasing efficacy of DBS for OCD, we must further explore the optimal DBS response across clinical profiles and neuropsychiatric domains of OCD as well as how interventions targeting multiple points in an aberrant circuit, multiple aberrant circuits, or a connectivity hub impact clinical response. Additionally, biomarkers would be invaluable in programming adjustments and creating a closed-loop paradigm to address symptom fluctuation in daily life.

引言:强迫症(OCD)在临床和病理上都是异质性的,其症状往往难以一线治疗。脑深部刺激(DBS)治疗难治性强迫症提供了一个调整和个体化神经调控靶向强迫症下异常电路的机会。DBS治疗的定制可以允许基于患者特定病理学的症状控制的精确性。在了解DBS干预的潜在目标方面取得了进展;然而,关于最佳目标的共识尚未达成。涵盖领域:通过查询PubMed数据库对DBS治疗强迫症进行文献综述。涵盖了以下主题:强迫症中DBS靶向的演变,底层统一连接组网络的概念,当前DBS靶向,该领域面临的挑战,以及在这一具有挑战性的人群中推进个性化DBS的未来方向。专家意见:为了继续提高DBS治疗强迫症的疗效,我们必须进一步探索强迫症临床特征和神经精神领域的最佳DBS反应,以及针对异常回路、多个异常回路或连接中枢中多个点的干预措施如何影响临床反应。此外,生物标志物在编程调整和创建闭环范式以解决日常生活中的症状波动方面将是非常宝贵的。
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引用次数: 0
Histological examination of tooth-derived biomaterials obtained from different devices. 从不同设备获得的牙齿衍生生物材料的组织学检查。
IF 3.1 3区 医学 Q3 ENGINEERING, BIOMEDICAL Pub Date : 2023-07-01 Epub Date: 2023-08-28 DOI: 10.1080/17434440.2023.2251891
Robert Dłucik, Bogusława Orzechowska-Wylęgała, Daniel Dłucik, Katarzyna Bogus

Aim: The aim of the present study was to investigate the histological differences between samples processed by different devices and to confirm safe clinical application of different dentin matrix obtained from three devices: BonMaker, Tooth Transformer, and Smart Dentin Grinder in regeneration of maxillary defects.

Research design: The study involved 39 patients with two-wall or three-wall defects who underwent bone augmentation procedures in the maxilla using dentin matrix grafts from the BonMaker, Tooth Transformer, and Smart Dentin Grinder devices. Histological examination was conducted on samples obtained from patients who received each device. In this article, histological samples have been selected and are presented.

Results: In all patients, bone defects were successfully augmented with ground dentin matrix. The histological examination revealed no inflammation and a good connection between the bone and dentin matrix and clinically all patients were qualified for implant placement.

Conclusions: After comparing the BonMaker, Tooth Transformer, and Smart Dentin Grinder devices in our practice, we concluded that all these systems have the potential for obtaining regenerative material from the patient's teeth.

目的:本研究的目的是研究不同设备处理的样本之间的组织学差异,并确认从BonMaker、Tooth Transformer和Smart dentin Grinder三种设备获得的不同牙本质基质在上颌缺损再生中的安全临床应用。研究设计:该研究涉及39名患有两壁或三壁缺陷的患者,他们使用BonMaker、Tooth Transformer和Smart dentin Grinder设备的牙本质基质移植物在上颌骨进行了骨增强手术。对从接受每种装置的患者身上获得的样本进行组织学检查。在这篇文章中,组织学样本已经被选择并呈现。结果:在所有患者中,骨缺损均成功地用磨碎的牙本质基质修复。组织学检查显示没有炎症,骨和牙本质基质之间有良好的连接,临床上所有患者都符合植入条件。结论:在比较了我们实践中的BonMaker、Tooth Transformer和Smart Dentin Grinder设备后,我们得出结论,所有这些系统都有可能从患者的牙齿中获得再生材料。
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引用次数: 0
HOPE for a better selection of patients for cardiac contractility modulation. 希望能更好地选择心脏收缩力调节的患者。
IF 3.1 3区 医学 Q3 ENGINEERING, BIOMEDICAL Pub Date : 2023-07-01 DOI: 10.1080/17434440.2023.2217329
Daniele Masarone, Ishu Rao, Giuseppe Pacileo
Cardiac contractility modulation (CCM) is an innovative devicebased therapy for the treatment of patients with heart failure (HF) with mildly reduced ejection fraction (HFmrEF) and reduced ejection fraction (HFrEF) with a narrow QRS complex (and therefore with no indication for cardiac resynchronization therapy). The CCM therapy is based on the delivery, by an impulse pocket generator (Optimizer Smart®), of high-voltage (≈7.5 V) and long-duration (≈20 ms) biphasic electrical signals to the septal wall of the right ventricle during the absolute refractory period of the myocardium [1]. Therefore, these signals do not cause a novel myocardial contraction, but induce an improvement in calcium handling and, consequently, an increase in myocardial contractility [2]. Besides improving calcium handling, CCM therapy induces several positive effects (Table 1) that affects the entire biology of the failing myocardium [3–5]. In randomized controlled trials, CCM therapy improves functional capacity (i.e. VO2 peak at cardiopulmonary exercise test) [6]; also, in a real-world registry, CCM therapy is associated with a lower rate of HF-related hospitalizations [7]. In addition, CCM therapy induces both left and right ventricular reverse remodeling [8–10]. Based on the results of these randomized clinical trials, the Optimizer Smart® system has been approved in countries covered by CE markings since October 2016 and granted United States Food and Drug Administration (FDA) approval in March 2019. As with all device-based therapies for HF, appropriate patient selection is crucial for increasing the possibility of clinical and echocardiographic response. Because no practical guidance on proper patient selection for CCM therapy is currently provided by the European Society of Cardiology and the American College of Cardiology/American Heart Association guidelines [11,12], we proposed the HOPE algorithm as a simple tool for screening and selecting outpatients with HFrEF/HFmrEF in which CCM therapy is more likely to be effective (Figure 1).
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引用次数: 1
Readmission rate and healthcare utilization outcomes of computer-assisted fluoroscopy-based hip navigation versus manual total hip arthroplasty. 基于计算机辅助荧光透视的髋关节导航与人工全髋关节置换术的再移植率和医疗保健利用结果。
IF 3.1 3区 医学 Q3 ENGINEERING, BIOMEDICAL Pub Date : 2023-07-01 Epub Date: 2023-07-25 DOI: 10.1080/17434440.2023.2238609
William G Hamilton, Robert A Sershon, Anshu Gupta, Laura Goldstein, Mina Kabiri, Chantal E Holy, Rodrigo Diaz

Introduction: The study evaluates the technology of fluoroscopy-based hip navigation that has shown to improve implant positioning in total hip arthroplasty (THA).

Methods: Premier Healthcare data for patients undergoing manual THA or fluoroscopy-based hip navigation THA between 1 January 2016-30 September 2021, were analyzed 90- and 365-day post-THA. The primary outcome was inpatient readmission. Secondary outcomes were operating room (OR) time, length of stay, discharge status, and hospital costs. Baseline covariate differences were balanced using fine stratification and analyzed using generalized linear models.

Results: Among 4,080 fluoroscopy-based hip navigation THA and 429,533 manual THA balanced patients, hip-related readmission rates were statistically significantly lower for the fluoroscopy-based hip navigation THA cohort vs. manual THA for both 90-day (odd ratio [95% CI]: 0.69 [0.52 to 0.91] and 365-day (0.63 [0.49 to 0.81] follow-up. OR time was higher with fluoroscopy-based hip navigation THA vs. manual THA (134.65 vs. 132.04 minutes); however, fluoroscopy-based hip navigation THA patients were more likely to be discharged to home (93.73% vs. 90.11%) vs. manual THA. Hospital costs were not different between cohorts at 90- and 365-day post-operative.

Conclusions: Fluoroscopy-based hip navigation THA resulted in fewer readmissions, greater discharge to home, and similar hospital costs compared to manual THA.

引言:该研究评估了基于荧光透视的髋关节导航技术,该技术已被证明可以改善全髋关节置换术(THA)中的植入物定位。方法:分析2021年1月1日至2021年9月30日期间接受手动THA或基于荧光透视髋关节导航THA的患者在THA后90天和365天的Premier Healthcare数据。主要结果是住院患者再次入院。次要结果是手术室(OR)时间、住院时间、出院状态和住院费用。基线协变量差异使用精细分层进行平衡,并使用广义线性模型进行分析。结果:4080例基于透视的髋关节导航THA和429533例手动THA平衡患者中,在90天(奇数比[95%CI]:0.69[0.52-0.91])和365天(0.63[0.49-0.81])的随访中,基于荧光透视的髋关节导航THA队列的髋关节相关再入院率在统计学上显著低于手动THA。基于荧光透视髋关节导航的THA的OR时间高于手动THA(134.65vs.132.04 分钟);然而,与手动THA相比,基于荧光透视的髋关节导航THA患者更有可能出院回家(93.73%对90.11%)。术后90天和365天的住院费用在不同队列之间没有差异。结论:与手动THA相比,基于荧光镜的髋关节导航THA导致更少的再次入院、更多的出院回家以及相似的住院费用。
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引用次数: 0
Learning curve and factors influencing successful robot-assisted bilateral sentinel lymph node mapping in early-stage cervical cancer: an observational cohort study. 早期宫颈癌机器人辅助双侧前哨淋巴结定位成功的学习曲线和影响因素:一项观察性队列研究。
IF 3.1 3区 医学 Q3 ENGINEERING, BIOMEDICAL Pub Date : 2023-07-01 DOI: 10.1080/17434440.2023.2212157
Ilse G T Baeten, Jacob P Hoogendam, Arthur J A T Braat, Bart de Keizer, Cornelis G Gerestein, Ronald P Zweemer

Objectives: To evaluate whether a learning curve affects the bilateral sentinel lymph node (SLN) detection in early-stage cervical cancer.

Methods: All patients with FIGO (2018) stage IA1-IB2 or IIA1 cervical cancer who had undergone robot-assisted SLN mapping performed with a combination of preoperative technetium-99m nanocolloids (including preoperative imaging) and intraoperative blue dye were retrospectively included. Risk-adjusted cumulative sum (RA-CUSUM) analysis was used to determine if a learning curve based on bilateral SLN detection existed in this cohort.

Results: A total of 227 cervical cancer patients were included. In 98.2% of patients (223/227) at least one SLN was detected. The bilateral SLN detection rate was 87.2% (198/227). Except for age (OR 1.06 per year, 95%CI 1.02-1.09), no significant risk factors for non-bilateral SLN detection were found (e.g., prior conization, BMI or FIGO stage). The RA-CUSUM analysis showed no clear learning phase during the first procedures and cumulative bilateral detection rate remained at least 80% during the entire inclusion period.

Conclusions: In this single-institution experience, we observed no learning curve affecting robot-assisted SLN mapping using a radiotracer and blue dye in early-stage cervical cancer patients, with stable bilateral detection rates of at least 80% when adhering to a standardized methodology.

目的:探讨学习曲线对早期宫颈癌双侧前哨淋巴结(SLN)检测的影响。方法:回顾性分析所有FIGO (2018) IA1-IB2期或IIA1期宫颈癌患者,这些患者接受了机器人辅助SLN定位,术前使用技术-99m纳米胶体(包括术前成像)和术中蓝色染料联合进行SLN定位。采用风险调整累积和(RA-CUSUM)分析来确定该队列中是否存在基于双侧SLN检测的学习曲线。结果:共纳入227例宫颈癌患者。98.2%的患者(223/227)至少检出一种SLN。双侧SLN检出率为87.2%(198/227)。除年龄(OR 1.06 /年,95%CI 1.02-1.09)外,未发现非双侧SLN检测的显著危险因素(例如,既往锥化,BMI或FIGO分期)。RA-CUSUM分析显示,在第一次手术中没有明确的学习阶段,在整个纳入期间,累积双侧检出率保持在80%以上。结论:在这个单一机构的经验中,我们观察到没有学习曲线影响早期宫颈癌患者使用放射性示踪剂和蓝色染料的机器人辅助SLN定位,当坚持标准化方法时,稳定的双侧检出率至少为80%。
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引用次数: 0
期刊
Expert Review of Medical Devices
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