Background
The current treatment strategy for many patients with varicose veins is endovenous thermal ablation. The most common forms of this are endovenous laser ablation (EVLA) and radiofrequency ...ablation (RFA). However, at present there is no clear consensus on which of these treatments is superior. The objective of this study was to compare EVLA with two forms of RFA: direct RFA (dRFA; radiofrequency‐induced thermotherapy) and indirect RFA (iRFA; VNUS ClosureFast™).
Methods
Patients with symptomatic great saphenous vein (GSV) incompetence were randomized to receive EVLA, dRFA or iRFA. Patients were followed up at 2 weeks, 6 and 12 months. The primary outcome was GSV occlusion rate. Secondary outcomes included Venous Clinical Severity Score (VCSS), Aberdeen Varicose Vein Questionnaire (AVVQ) score and adverse events.
Results
Some 450 patients received the allocated treatment (EVLA, 148; dRFA, 152; iRFA, 150). The intention‐to‐treat analysis showed occlusion rates of 75·0 (95 per cent c.i. 68·0 to 82·0), 59·9 (52·1 to 67·7) and 81·3 (75·1 to 87·6) per cent respectively after 1 year (P = 0·007 for EVLA versus dRFA, P < 0·001 for dRFA versus iRFA, P = 0·208 for EVLA versus iRFA). VCSS improved significantly for all treatments with no significant differences between them. AVVQ scores also improved significantly for all treatments, but iRFA had significantly better scores than dRFA at 12 months. Significantly more adverse events were reported after treatment with EVLA (103) than after dRFA (61) and iRFA (65), especially more pain.
Conclusion
Primary GSV occlusion rates were better after iRFA and EVLA than dRFA. All three interventions were effective in improving the clinical severity of varicose veins at 1 year.
In this RCT, endovenous laser ablation (EVLA) was compared with two forms of radiofrequency ablation (RFA), direct RFA (radiofrequency‐induced thermotherapy, dRFA) and indirect RFA (with VNUS ClosureFast™, iRFA) for the treatment of incompetent great saphenous veins (GSVs). Some 450 patients were randomized to receive EVLA (148), dRFA (152) or iRFA (150). Primary GSV occlusion rates were better following both iRFA and EVLA than dRFA, and all three interventions were effective in improving the clinical severity of varicose veins at 1 year.
Lower occlusion rates with radiofrequency
Background
Multiple treatment options are generally available for most diseases. Shared decision‐making (SDM) helps patients and physicians choose the treatment option that best fits a patient's ...preferences. This review aimed to assess the extent to which SDM is applied during surgical consultations, and the metrics used to measure SDM and SDM‐related outcomes.
Methods
This was a systematic review of observational studies and clinical trials that measured SDM during consultations in which surgery was a treatment option. Embase, MEDLINE and CENTRAL were searched. Study selection, quality assessment and data extraction were conducted by two investigators independently.
Results
Thirty‐two articles were included. SDM was measured using nine different metrics. Thirty‐six per cent of 13 176 patients and surgeons perceived their consultation as SDM, as opposed to patient‐ or surgeon‐driven. Surgeons more often perceived the decision‐making process as SDM than patients (43·6 versus 29·3 per cent respectively). SDM levels scored objectively using the OPTION and Decision Analysis System for Oncology instruments ranged from 7 to 39 per cent. Subjective SDM levels as perceived by surgeons and patients ranged from 54 to 93 per cent. Patients experienced a higher level of SDM during consultations than surgeons (93 versus 84 per cent). Twenty‐five different SDM‐related outcomes were reported.
Conclusion
At present, SDM in surgery is still in its infancy, although surgeons and patients both think of it favourably. Future studies should evaluate the effect of new interventions to improve SDM during surgical consultations, and its assessment using available standardized and validated metrics.
Heterogeneous data
Thanks to its compact structure, mechanical endurance, and low bias voltage, the silicon photomultiplier (SiPM) can be used in small-size applications which require reduced power consumption. In ...order to detect the light intensity as low as a single photon, the front-end electronics has to amplify and shape the signal of the photodetector. The low-power design cannot impair the performance of readout electronics or limit the capabilities of the SiPM itself. This paper presents a two-channel integrated circuit (IC) designed in Austria Mikro Systeme CMOS 350-nm technology dedicated for the SiPM-based applications. The input stage is a super-common-gate architecture. Each channel of the IC consists of an amplifier and a peak detector with an offset reduction circuit. The power consumption of the single channel is less than 3 mW from the single voltage supply (3.3 V). Moreover, the number of channels of the IC can be easily increased thanks to small dimensions of the circuit. This paper presents a detailed analysis of the IC including: noise performance with adjustment of the input transistor's size, transient and dc simulations of the amplifier and the peak detector, and the introduction of a simple offset reduction technique for the peak detector. The measurement results obtained with two SiPM detectors are presented.
Shared decision-making improves the quality of patient care. Unfortunately, shared decision-making is not yet common practice among vascular surgeons. Thus, decision support tools were developed to ...assist vascular surgeons and their patients in using shared decision-making. This trial aims to evaluate the effectiveness and implementation of decision support tools to improve shared decision-making during vascular surgical consultations in which a treatment decision is to be made.
The study design is a multicentre stepped-wedge cluster-randomised trial. Eligible patients are adult patients, visiting the outpatient clinic of a participating medical centre for whom several treatment options are feasible and who face a primary treatment decision for their abdominal aortic aneurysm, carotid artery disease, intermittent claudication, or varicose veins. Patients and vascular surgeons in the intervention group receive decision support tools that may help them adopt shared decision-making when making the final treatment decision. These decision support tools are decision aids, consultation cards, decision cards, and a practical training. Decision aids are informative websites that help patients become more aware of the pros and cons of the treatment options and their preferences regarding the treatment choice. Consultation cards with text or decision cards with images are used by vascular surgeons during consultation to determine which aspect of a treatment is most important to their patient. In the training vascular surgeons can practice shared decision-making with a patient actor, guided by a medical psychologist. This trial aims to include 502 vascular surgical patients to achieve a clinically relevant improvement in shared decision-making of 10 out of 100 points, using the 5-item OPTION instrument to score the audio-recordings of consultations.
In the OVIDIUS trial the available decision support tools for vascular surgical patients are implemented in clinical practice. We will evaluate whether these tools actually improve shared decision-making in the consultation room. The stepped-wedge cluster-randomised study design will ensure that at the end of the study all participating centres have implemented at least some of the decision support tools and thereby a certain level of shared decision-making.
Netherlands Trial Registry, NTR6487 . Registered 7 June 2017. URL: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6487.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The study of open charm meson production provides an efficient tool for the investigation of the properties of hot and dense matter formed in nucleus–nucleus collisions. The interpretation of the ...existing di-muon data from the CERN SPS suffers from a lack of knowledge on the mechanism and properties of the open charm particle production. Due to this, the heavy-ion programme of the NA61/SHINE experiment at the CERN SPS has been extended by precise measurements of charm hadrons with short lifetimes. A new Vertex Detector for measurements of the rare processes of open charm production in nucleus–nucleus collisions was designed to meet the challenges of track registration and high resolution in primary and secondary vertex reconstruction. A small-acceptance version of the vertex detector was installed in 2016 and tested with Pb + Pb collisions at 150
A
GeV
/
c
. It was also operating during the physics data taking on Xe + La and Pb + Pb collisions at 150
A
GeV
/
c
conducted in 2017 and 2018. This paper presents the detector design and construction, data calibration, event reconstruction, and analysis procedure.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Measurements of inclusive spectra and mean multiplicities of
π
±
, K
±
, p and
p
¯
produced in inelastic p + p interactions at incident projectile momenta of 20, 31, 40, 80 and 158
GeV
/
c
(
s
=
...6.3, 7.7, 8.8, 12.3 and 17.3
GeV
, respectively) were performed at the CERN Super Proton Synchrotron using the large acceptance NA61/SHINE hadron spectrometer. Spectra are presented as function of rapidity and transverse momentum and are compared to predictions of current models. The measurements serve as the baseline in the NA61/SHINE study of the properties of the onset of deconfinement and search for the critical point of strongly interacting matter.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Focal segmental glomerulosclerosis (FSGS) is a kidney disease with progressive glomerular scarring and a clinical presentation of nephrotic syndrome. FSGS is a common primary glomerular disorder that ...causes renal dysfunction which progresses slowly over time to end-stage renal disease. Most cases of FSGS are idiopathic Although kidney transplantation is a potentially curative treatment, 40% of patients have recurrence of FSGS after transplantation. In this review a brief summary of the pathogenesis causing FSGS in humans is given, and a variety of animal models used to study FSGS is discussed. These animal models include the reduction of renal mass by resecting 5/6 of the kidney, reduction of renal mass due to systemic diseases such as hypertension, hyperlipidemia or SLE, drug-induced FSGS using adriamycin, puromycin or streptozotocin, virus-induced FSGS, genetically-induced FSGS such as via Mpv-17 inactivation and α-actinin 4 and podocin knockouts, and a model for circulating permeability factors. In addition, an animal model that spontaneously develops FSGS is discussed. To date, there is no exact understanding of the pathogenesis of idiopathic FSGS, and there is no definite curative treatment. One requirement facilitating FSGS research is an animal model that resembles human FSGS. Most animal models induce secondary forms of FSGS in an acute manner. The ideal animal model for primary FSGS, however, should mimic the human primary form in that it develops spontaneously and has a slow chronic progression. Such models are currently not available. We conclude that there is a need for a better animal model to investigate the pathogenesis and potential treatment options of FSGS.
This paper reports measurements of two-pion femtoscopic correlations in Be+Be collisions at a beam momentum of 150
A
GeV
/
c
(energy available in the center-of-mass system for nucleon pair
s
NN
=
...16.84
GeV) by the NA61/SHINE experiment at the CERN SPS accelerator. The obtained momentum space correlation functions can be well described by a Lévy distributed source model. The transverse mass dependence of the Lévy source parameters is presented, and their possible theoretical interpretations are discussed. The results show that the Lévy exponent
α
is approximately constant as a function of
m
T
, and far from both the Gaussian case of
α
=
2
or the conjectured value at the critical endpoint,
α
=
0.5
. The radius scale parameter
R
shows a slight decrease in
m
T
, which can be explained as a signature of transverse flow. Finally, an approximately constant trend of the intercept parameter
λ
as a function of
m
T
was observed, similar to previous NA44 S + Pb results (obtained with a Gaussian approximation, but unlike RHIC results).
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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