scholarly journals Electromagnetic-Guided Interstitial Catheter Navigation for Gynecological Brachytherapy: a Phase I Trial (E-MINT)

2021 ◽  
Author(s):  
Alam Khan
Keyword(s):  
Real Time ◽  
Catheter Placement ◽  
Operational Performance ◽  
Interstitial Brachytherapy ◽  
Prospective Clinical Study ◽  
Clinical Workflow ◽  
Electromagnetic Navigation ◽  
Sequence Of Events ◽  
Catheter Navigation ◽  
The Mean

<div>Catheter insertion for gynecological interstitial brachytherapy is a challenging surgical procedure due to the lack of real-time guidance available to Radiation Oncologists. To mitigate the limitations associated with catheter placement, electromagnetic navigation (EMN) was proposed as a solution to the current interstitial brachytherapy workflow. The sequence of events leading up to the completion of this project were as follows, the validation of the system and then the application of the EMN system in a clinical trial. Using a phantom-based validation method, submillimetric accuracy and jitter was characterized for the operational performance of an EMN system in a brachytherapy operating room environment.</div><div>Following validation, the EMN system was used for catheter placement in 5 patients, in an ongoing prospective clinical study. The mean catheter deflection documented was 3.52 +/- 2.53 mm when adopting EMN as a form of real-time guidance compared to 5.48 +/- 3.63 mm when the standard clinical workflow (SCW) was employed. The mean catheter spacing when using EMN was 9.31 +/- 4.81 mm compared to 7.09 +/- 6.06 mm when the SCW was followed. Also, the mean intraoperative time was 50.00 +/- 18.80 minutes for EMN and 38.20 +/- 15.29 minutes for the SCW.</div><div>The results of this project demonstrate that electromagnetic navigated interstitial catheter placement is promising as a real-time guidance option for the interstitial gynecological brachytherapy workflow. <br></div>

scholarly journals Electromagnetic-Guided Interstitial Catheter Navigation for Gynecological Brachytherapy: a Phase I Trial (E-MINT)

2021 ◽  
Author(s):  
Alam Khan
Keyword(s):  
Real Time ◽  
Catheter Placement ◽  
Operational Performance ◽  
Interstitial Brachytherapy ◽  
Prospective Clinical Study ◽  
Clinical Workflow ◽  
Electromagnetic Navigation ◽  
Sequence Of Events ◽  
Catheter Navigation ◽  
The Mean

<div>Catheter insertion for gynecological interstitial brachytherapy is a challenging surgical procedure due to the lack of real-time guidance available to Radiation Oncologists. To mitigate the limitations associated with catheter placement, electromagnetic navigation (EMN) was proposed as a solution to the current interstitial brachytherapy workflow. The sequence of events leading up to the completion of this project were as follows, the validation of the system and then the application of the EMN system in a clinical trial. Using a phantom-based validation method, submillimetric accuracy and jitter was characterized for the operational performance of an EMN system in a brachytherapy operating room environment.</div><div>Following validation, the EMN system was used for catheter placement in 5 patients, in an ongoing prospective clinical study. The mean catheter deflection documented was 3.52 +/- 2.53 mm when adopting EMN as a form of real-time guidance compared to 5.48 +/- 3.63 mm when the standard clinical workflow (SCW) was employed. The mean catheter spacing when using EMN was 9.31 +/- 4.81 mm compared to 7.09 +/- 6.06 mm when the SCW was followed. Also, the mean intraoperative time was 50.00 +/- 18.80 minutes for EMN and 38.20 +/- 15.29 minutes for the SCW.</div><div>The results of this project demonstrate that electromagnetic navigated interstitial catheter placement is promising as a real-time guidance option for the interstitial gynecological brachytherapy workflow. <br></div>

scholarly journals Electrical stimulator with mechanomyography-based real-time monitoring, muscle fatigue detection, and safety shut-off: a pilot study

2020 ◽  
Vol 65 (4) ◽  
pp. 461-468
Author(s):  
Jannatul Naeem ◽  
Nur Azah Hamzaid ◽  
Amelia Wong Azman ◽  
Manfred Bijak
Keyword(s):  
Muscle Fatigue ◽  
Real Time ◽  
Isometric Force ◽  
Mean Square ◽  
Clear Indication ◽  
Initial Value ◽  
Cord Injury ◽  
The Mean ◽  
Electrical Stimulator ◽  
Fatigue Detection

AbstractFunctional electrical stimulation (FES) has been used to produce force-related activities on the paralyzed muscle among spinal cord injury (SCI) individuals. Early muscle fatigue is an issue in all FES applications. If not properly monitored, overstimulation can occur, which can lead to muscle damage. A real-time mechanomyography (MMG)-based FES system was implemented on the quadriceps muscles of three individuals with SCI to generate an isometric force on both legs. Three threshold drop levels of MMG-root mean square (MMG-RMS) feature (thr50, thr60, and thr70; representing 50%, 60%, and 70% drop from initial MMG-RMS values, respectively) were used to terminate the stimulation session. The mean stimulation time increased when the MMG-RMS drop threshold increased (thr50: 22.7 s, thr60: 25.7 s, and thr70: 27.3 s), indicating longer sessions when lower performance drop was allowed. Moreover, at thr70, the torque dropped below 50% from the initial value in 14 trials, more than at thr50 and thr60. This is a clear indication of muscle fatigue detection using the MMG-RMS value. The stimulation time at thr70 was significantly longer (p = 0.013) than that at thr50. The results demonstrated that a real-time MMG-based FES monitoring system has the potential to prevent the onset of critical muscle fatigue in individuals with SCI in prolonged FES sessions.

scholarly journals Feasibility study of real-time online text-based CBT to support self-management for people with type 1 diabetes: the Diabetes On-line Therapy (DOT) Study

2021 ◽  
Vol 9 (1) ◽  
pp. e001934
Author(s):  
Anne M Doherty ◽  
Anne Herrmann-Werner ◽  
Arann Rowe ◽  
Jennie Brown ◽  
Scott Weich ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Real Time ◽  
Instant Messaging ◽  
Controlled Trial ◽  
Self Management ◽  
Diabetes Distress ◽  
The Mean ◽  
Distress Scale

IntroductionThis study examines the feasibility of conducting diabetes-focused cognitive–behavioral therapy (CBT) via a secure online real-time instant messaging system intervention to support self-management and improve glycemic control in people with type 1 diabetes.Research design and methodsWe used a pre–post uncontrolled intervention design over 12 months. We recruited adults with type 1 diabetes and suboptimal glycemic control (HbA1c ≥69 mmol/mol (DCCT 8.5%) for 12 months) across four hospitals in London. The intervention comprised 10 sessions of diabetes-focused CBT delivered by diabetes specialist nurses. The primary outcomes were number of eligible patients, rates of recruitment and follow-up, number of sessions completed and SD of the main outcome measure, change in HbA1c over 12 months. We measured the feasibility of collecting secondary outcomes, that is, depression measured using Patient Health Questionnaire-9 (PHQ-9), anxiety measured Generalised Anxiety Disorder (GAD) and the Diabetes Distress Scale (DDS).ResultsWe screened 3177 patients, of whom 638 were potentially eligible, from whom 71 (11.1%) were recruited. The mean age was 28.1 (13.1) years, and the mean HbA1c was 84.6 mmol/mol (17.8), DCCT 9.9%. Forty-six (65%) patients had at least 1 session and 29 (41%) completed all sessions. There was a significant reduction in HbA1c over 12 months (mean difference −6.2 (2.3) mmol/mol, DCCT 0.6%, p=0.038). The change scores in PHQ-9, GAD and DDS also improved.ConclusionsIt would be feasible to conduct a full-scale text-based synchronized real-time diabetes-focused CBT as an efficacy randomized controlled trial.

scholarly journals Utilization of laser interstitial thermotherapy guided by real-time thermal MRI as an alternative to separation surgery in the management of spinal metastasis

2015 ◽  
Vol 23 (4) ◽  
pp. 400-411 ◽  
Author(s):  
Claudio E. Tatsui ◽  
R. Jason Stafford ◽  
Jing Li ◽  
Jonathan N. Sellin ◽  
Behrang Amini ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Spinal Cord ◽  
Real Time ◽  
Spinal Cord Compression ◽  
Spinal Metastasis ◽  
Cord Compression ◽  
The Mean ◽  
Interstitial Thermotherapy

OBJECT High-grade malignant spinal cord compression is commonly managed with a combination of surgery aimed at removing the epidural tumor, followed by spinal stereotactic radiosurgery (SSRS) aimed at local tumor control. The authors here introduce the use of spinal laser interstitial thermotherapy (SLITT) as an alternative to surgery prior to SSRS. METHODS Patients with a high degree of epidural malignant compression due to radioresistant tumors were selected for study. Visual analog scale (VAS) scores for pain and quality of life were obtained before and within 30 and 60 days after treatment. A laser probe was percutaneously placed in the epidural space. Real-time thermal MRI was used to monitor tissue damage in the region of interest. All patients received postoperative SSRS. The maximum thickness of the epidural tumor was measured, and the degree of epidural spinal cord compression (ESCC) was scored in pre- and postprocedure MRI. RESULTS In the 11 patients eligible for study, the mean VAS score for pain decreased from 6.18 in the preoperative period to 4.27 within 30 days and 2.8 within 60 days after the procedure. A similar VAS interrogating the percentage of quality of life demonstrated improvement from 60% preoperatively to 70% within both 30 and 60 days after treatment. Imaging follow-up 2 months after the procedure demonstrated a significant reduction in the mean thickness of the epidural tumor from 8.82 mm (95% CI 7.38–10.25) before treatment to 6.36 mm (95% CI 4.65–8.07) after SLITT and SSRS (p = 0.0001). The median preoperative ESCC Grade 2 was scored as 4, which was significantly higher than the score of 2 for Grade 1b (p = 0.04) on imaging follow-up 2 months after the procedure. CONCLUTIONS The authors present the first report on an innovative minimally invasive alternative to surgery in the management of spinal metastasis. In their early experience, SLITT has provided local control with low morbidity and improvement in both pain and the quality of life of patients.

scholarly journals Interventional MRI-guided catheter placement and real time drug delivery to the central nervous system

2016 ◽  
Vol 16 (6) ◽  
pp. 635-639 ◽  
Author(s):  
Seunggu J. Han ◽  
Krystof Bankiewicz ◽  
Nicholas A. Butowski ◽  
Paul S. Larson ◽  
Manish K. Aghi
Keyword(s):  
Drug Delivery ◽  
Central Nervous System ◽  
Nervous System ◽  
Real Time ◽  
Interventional Mri ◽  
Catheter Placement ◽  
The Central Nervous System ◽  
Mri Guided

scholarly journals Single Dose of Methotrexate Therapy Followed By Suction Curettage for Management of Cesarean Scar Pregnancy

2019 ◽  
Vol 3 (1) ◽  
pp. 01-04
Author(s):  
Hend S Saleh ◽  
Hala E Sherif ◽  
Eman M Mahfouz
Keyword(s):  
Single Dose ◽  
Gestational Age ◽  
Wedge Resection ◽  
Rare Condition ◽  
Prospective Clinical Study ◽  
Maternal Complications ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar ◽  
Suction Curettage ◽  
The Mean

Objective Implantation of the pregnancy in a cesarean scar is a rare condition named ; Cesarean scar pregnancy (CSP). Maternal complications can be prevented with the early diagnosis and an appropriate management .It is a Prospective clinical study to evaluate the efficacy and success rate of single dose use of methotrexate (MTX) followed by dilation and suction (D&S) regimen in management of women with cesarean scar pregnancy (CSP) . Methods 50mg of MTX in the form of a single dose Intramuscular injection then cervical dilatation and suction aspiration with a Karman cannula(D&S) under guidance of ultrasound after 48 preeceeded by vaginal misoprostol 2 tablet (200 mg) 4 hours ago. Results The mean gestational age at diagnosis was (8.5±1.6 ) and The mean level of serum b-human chorionic gonadotropin was (7424±2.560 ) and The mean gestational age of pregnancy was (8.5±1.6 ) .88.7% is the successive rate without complication need intervention, 2 (5.7%) patients needed intrauterine Foley's catheter for 24 hours as a mechanical hemostasis . 2 (5.7 %) had laparotomy with wedge resection of the gestational sac lesion and successful repair of the uterine defect and one (2.8 %)underwent subtotal hysterectomy. Conclusion: Systemic single dose MTX injection followed by D&S is an effective and harmless management for CSP. Nevertheless more studies are required to prove the efficiency, safety, and reproductive outcome of variant modalities in treatment of CSP.

scholarly journals A randomized, comparative, open clinical trial for evaluating the efficacy of PP/JLN/107/09-10 Syrup in the management of Functional Constipation

2020 ◽  
Vol 5 (06) ◽  
pp. 43-50
Author(s):  
M. Ramadas ◽  
Padmanabha Rugvedi ◽  
Pankaj Kumar Gupta ◽  
Rajiva Kumar Rai ◽  
JLN Sastry
Keyword(s):  
Functional Constipation ◽  
Abdominal Distension ◽  
Prospective Clinical Study ◽  
Rome Ii Criteria ◽  
Herbal Formulation ◽  
Associated Symptoms ◽  
The Mean ◽  
Trial Drug ◽  
To Receive

Context: Functional constipation which has no underlying organic causes is difficult to be allopathic treatment for long term due to its side effects and undeniable effect, thus a natural balanced and compatible formulation needs to be validated. Objectives: Current study aimed to assess a poly-herbal formulation in management of functional constipation. Material and Methods: This study was 28 days, two armed, randomized, open labeled, prospective clinical study. 60 clinically confirmed cases of functional constipation patients randomized to receive orally either 2 teaspoonful of PP/JLN/107/09-10 Syrup or 1 teaspoonful of 5- 6 gm of Isabgol powder. Results were analyzed as per Rome II criteria and other associated symptoms like headache, acidity, belching, barborgysmy, flatulence and abdominal dis tension or bloating which are recorded on VAS score. Results: PP/JLN/107/09-10 scored over Isabgol on four out of six parameters of Rome II Criteria viz., frequency of bowel movement, straining at defecation, lumpy I har dstool formation, feeling of incomplete evacuation, feeling of ano-rectal blockage and manual maneuvers (p less than 0.001). Trial drugs showed comparable effects (p > 0.05) in reducing the mean scores of associated symptoms like headache, acidity, belching, borgorgysmy, flatulence and abdominal distension. However, trial drug was found to perform statistically significant result in more number of parameters in comparison to Isabgol. Conclusion: PP/JLN/107/09-10 was found to be effective and safe in reliving functional constipation.

scholarly journals Comparison of 0.05% cyclosporine and 3% diquafosol solution for dry eye patients: A randomized, blinded, multicenter clinical trial

2019 ◽  
Author(s):  
Chang Hyun Park ◽  
Hyung Keun Lee ◽  
Mee Kum Kim ◽  
Eun Chul Kim ◽  
Jae Yong Kim ◽  
...  
Keyword(s):  
Dry Eye ◽  
Clinical Effectiveness ◽  
Prospective Clinical Study ◽  
Eye Drops ◽  
Drug Compliance ◽  
Ocular Surface Disease Index ◽  
Drug Usage ◽  
Early Improvement ◽  
Treatment Groups ◽  
The Mean

Abstract Background This study is aim to compare the clinical effectiveness between the two most prominent dry eye disease (DED)-specific eye drops, 0.05% cyclosporine (CN) and 3% diquafosol (DQ). Methods This is a multi-centered, randomized, masked, prospective clinical study. A total of 227 eyes from 227 DED patients were randomly allocated to use CN twice per day or DQ six times daily. Cornea and conjunctival staining scores (NEI scale), tear break-up time (TBUT), Schirmer test scores, and ocular surface disease index (OSDI) score were measured at baseline, 4 and 12 weeks after treatment. Results At 12 weeks after treatment, NEI scaled scores were reduced from the baseline by -6.60 for CN and -6.63 for DQ group (P=0.9739 between groups). TBUT and Schirmer values for CN were significantly improved from the baseline at 4 and 12 weeks (P< 0.0001). However, for DQ, TBUT showed significant improvement at week 12 only (P=0.0281). Mean OSDI score differences from the baseline to 12 weeks were -13.03±19.63 in CN and -16.11±20.87 in DQ, respectively (P=0.854 between groups). Regarding drug compliance, the mean instillation frequency of CN was lesser than that of DQ (P<0.001). Conclusions The level of improvement regarding NEI, TBUT, and OSDI scores were not significantly different between the two treatment groups. However, with regards to the early improvement of TBUT and patient compliance, patients using CN improved faster and with greater adherence to drug usage than did those treated with DQ. Trial registration: KCT0002180, Registered 23 December 2016 (retrospectively registered)

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