Our objective was to compare 3 different therapeutic particles used for radioembolization in locally advanced intrahepatic cholangiocarcinoma.
Y-glass,
Y-resin, and
Ho-labeled poly(l-lactic acid) ...microsphere prescribed activity was calculated as per manufacturer recommendations. Posttreatment quantitative
Y PET/CT and quantitative
Ho SPECT/CT were used to determine tumor-absorbed dose, whole-normal-liver-absorbed dose, treated-normal-liver-absorbed dose, tumor-to-nontumor ratio, lung-absorbed dose, and lung shunt fraction. Response was assessed using RECIST 1.1 and the
FFDG PET-based change in total lesion glycolysis. Hepatotoxicity was assessed using the radioembolization-induced liver disease classification.
Six
Y-glass, 8
Y-resin, and 7
Ho microsphere patients were included for analysis. The mean administered activity was 2.6 GBq for
Y-glass, 1.5 GBq for
Y-resin, and 7.0 GBq for
Ho microspheres. Tumor-absorbed dose and treated-normal-liver-absorbed dose were significantly higher for
Y-glass than for
Y-resin and
Ho microspheres (mean tumor-absorbed dose, 197 Gy for
Y-glass vs. 73 Gy for
Y-resin and 50 Gy for
Ho; mean treated-normal-liver-absorbed dose, 79 Gy for
Y-glass vs. 37 Gy for
Y-resin and 31 Gy for
Ho). The whole-normal-liver-absorbed dose and tumor-to-nontumor ratio did not significantly differ between the particles. All patients had a lung-absorbed dose under 30 Gy and a lung shunt fraction under 20%. The 3 groups showed similar toxicity and response according to RECIST 1.1 and
FFDG PET-based total lesion glycolysis changes.
The therapeutic particles used for radioembolization differed from each other and showed significant differences in absorbed dose, whereas toxicity and response were similar for all groups. This finding emphasizes the need for separate dose constraints and dose targets for each particle.
Since its first suggestion as possible option for liver radioembolization treatment, the therapeutic isotope holmium-166 (
166
Ho) caught the experts’ attention due to its imaging possibilities. ...Being not only a beta, but also a gamma emitter and a lanthanide,
166
Ho can be imaged using single-photon emission computed tomography and magnetic resonance imaging, respectively. Another advantage of
166
Ho is the possibility to perform the scout and treatment procedure with the same particle. This prospect paves the way to an individualized treatment procedure, gaining more control over dosimetry-based patient selection and treatment planning. In this review, an overview on
166
Ho liver radioembolization will be presented. The current clinical workflow, together with the most relevant clinical findings and the future prospective will be provided.
The diagnosis of recurrent ipsilateral deep vein thrombosis (DVT) with compression ultrasonography (CUS) may be hindered by residual intravascular obstruction after previous DVT. A reference CUS, an ...additional ultrasound performed at anticoagulant discontinuation, may improve the diagnostic work-up of suspected recurrent ipsilateral DVT by providing baseline images for future comparison.
To evaluate the cost-effectiveness of routinely performing reference CUS in DVT patients.
Patient-level data (
= 96) from a prospective management study (Theia study; NCT02262052) and claims data were used in a decision analytic model to compare 12 scenarios for diagnostic management of suspected recurrent ipsilateral DVT. Estimated health care costs and mortality due to misdiagnosis, recurrent venous thromboembolism, and bleeding during the first year of follow-up after presentation with suspected recurrence were compared.
All six scenarios including reference CUS had higher estimated 1-year costs (€1,763-€1,913) than the six without reference CUS (€1,192-€1,474). Costs were higher because reference CUS results often remained unused, as 20% of patients (according to claims data) would return with suspected recurrent DVT. Estimated mortality was comparable in scenarios with (14.8-17.9 per 10,000 patients) and without reference CUS (14.0-18.5 per 10,000). None of the four potentially most desirable scenarios included reference CUS.
One-year health care costs of diagnostic strategies for suspected recurrent ipsilateral DVT including reference CUS are higher compared to strategies without reference CUS, without mortality benefit. These results can inform policy-makers regarding use of health care resources during follow-up after DVT. From a cost-effectiveness perspective, the findings do not support the routine application of reference CUS.
Summary
Background
The physical appearance of psoriasis can be cosmetically disfiguring, resulting in a substantial social burden for patients. An important aspect of this burden is the experience of ...stigmatization. While stigmatization is known to be disabling and stressful for patients, little is known about its correlates, and effective interventions are lacking.
Objectives
To examine predictor variables for perceived stigmatization in psoriasis.
Methods
Questionnaires were administered to 514 patients with psoriasis in a cross‐sectional study. Zero‐order correlation and multiple‐regression analyses were conducted including sociodemographic, disease‐related, personality, illness cognitions and social support predictor variables.
Results
Stigmatization was experienced by 73% of patients to some degree, and correlated with all five categories of predictor variables. In multiple‐regression analyses, stigmatization was associated with higher impact on daily life; lower education; higher disease visibility, severity and duration; higher levels of social inhibition; having a type D personality; and not having a partner.
Conclusions
The results indicate that perceived stigmatization is common in psoriasis, and can be predicted by sociodemographic, disease‐related and personality variables. These predictor variables provide indications of which patients are especially vulnerable regarding perceived stigmatization, which might be used in treatment.
What's already known about this topic?
Perceived stigmatization is common and distressing in patients with psoriasis.
Some of its predictors have been examined in small samples.
What does this study add?
This large study of 514 patients with psoriasis examined a combination of potential predictor variables, both previously examined and never before studied.
Sociodemographic, disease‐related and previously unstudied type D personality variables were found to be predictive of perceived stigmatization.
What are the clinical implications of this work?
These results provide an understanding of which patients may be especially vulnerable to stigmatization‐related problems, which may warrant special attention during treatment.
Recent studies have revealed that, in critically ill patients, lung microbiota are altered and correlate with alveolar inflammation. The clinical significance of altered lung bacteria in critical ...illness is unknown.
To determine if clinical outcomes of critically ill patients are predicted by features of the lung microbiome at the time of admission.
We performed a prospective, observational cohort study in an ICU at a university hospital. Lung microbiota were quantified and characterized using droplet digital PCR and bacterial 16S ribosomal RNA gene quantification and sequencing. Primary predictors were the bacterial burden, community diversity, and community composition of lung microbiota. The primary outcome was ventilator-free days, determined at 28 days after admission.
Lungs of 91 critically ill patients were sampled using miniature BAL within 24 hours of ICU admission. Patients with increased lung bacterial burden had fewer ventilator-free days (hazard ratio, 0.43; 95% confidence interval, 0.21-0.88), which remained significant when the analysis was controlled for pneumonia and severity of illness. The community composition of lung bacteria predicted ventilator-free days (
= 0.003), driven by the presence of gut-associated bacteria (e.g., species of the Lachnospiraceae and Enterobacteriaceae families). Detection of gut-associated bacteria was also associated with the presence of acute respiratory distress syndrome.
Key features of the lung microbiome (bacterial burden and enrichment with gut-associated bacteria) predict outcomes in critically ill patients. The lung microbiome is an understudied source of clinical variation in critical illness and represents a novel therapeutic target for the prevention and treatment of acute respiratory failure.
The abundance of compact, massive, early-type galaxies (ETGs) provides important constraints to galaxy formation scenarios. Thanks to the area covered, depth, excellent spatial resolution and seeing, ...the ESO Public optical Kilo Degree Survey (KiDS), carried out with the VLT Survey Telescope, offers a unique opportunity to conduct a complete census of the most compact galaxies in the Universe. This paper presents a first census of such systems from the first 156 deg2 of KiDS. Our analysis relies on g-, r- and i-band effective radii (R
e), derived by fitting galaxy images with point spread function (PSF)-convolved Sérsic models, high-quality photometric redshifts, z
phot, estimated from machine learning techniques, and stellar masses, M
⋆, calculated from KiDS aperture photometry. After massiveness (
${M_{\star }}\gtrsim 8 \times 10^{10}\, \rm {\text{M}_{\odot }}$
) and compactness (
${R_{\rm e}}\lesssim 1.5 \, \rm kpc$
in g, r and i bands) criteria are applied, a visual inspection of the candidates plus near-infrared photometry from VIKING-DR1 are used to refine our sample. The final catalogue, to be spectroscopically confirmed, consists of 92 systems in the redshift range z ∼ 0.2–0.7. This sample, which we expect to increase by a factor of 10 over the total survey area, represents the first attempt to select massive supercompact ETGs (MSCGs) in KiDS. We investigate the impact of redshift systematics in the selection, finding that this seems to be a major source of contamination in our sample. A preliminary analysis shows that MSCGs exhibit negative internal colour gradients, consistent with a passive evolution of these systems. We find that the number density of MSCGs is only mildly consistent with predictions from simulations at z > 0.2, while no such system is found at z < 0.2.
Context. The Kilo-Degree Survey (KiDS) is an ongoing optical wide-field imaging survey with the OmegaCAM camera at the VLT Survey Telescope. It aims to image 1500 square degrees in four filters ...(ugri). The core science driver is mapping the large-scale matter distribution in the Universe, using weak lensing shear and photometric redshift measurements. Further science cases include galaxy evolution, Milky Way structure, detection of high-redshift clusters, and finding rare sources such as strong lenses and quasars. Aims. Here we present the third public data release and several associated data products, adding further area, homogenized photometric calibration, photometric redshifts and weak lensing shear measurements to the first two releases. Methods. A dedicated pipeline embedded in the Astro-WISE information system is used for the production of the main release. Modifications with respect to earlier releases are described in detail. Photometric redshifts have been derived using both Bayesian template fitting, and machine-learning techniques. For the weak lensing measurements, optimized procedures based on the THELI data reduction and lensfit shear measurement packages are used. Results. In this third data release an additional 292 new survey tiles (≈300 deg2) stacked ugri images are made available, accompanied by weight maps, masks, and source lists. The multi-band catalogue, including homogenized photometry and photometric redshifts, covers the combined DR1, DR2 and DR3 footprint of 440 survey tiles (44 deg2). Limiting magnitudes are typically 24.3, 25.1, 24.9, 23.8 (5σ in a 2′′ aperture) in ugri, respectively, and the typical r-band PSF size is less than 0.7′′. The photometric homogenization scheme ensures accurate colours and an absolute calibration stable to ≈2% for gri and ≈3% in u. Separately released for the combined area of all KiDS releases to date are a weak lensing shear catalogue and photometric redshifts based on two different machine-learning techniques.
We report the discovery of two extremely low luminosity globular clusters in the Milky Way halo. These objects were detected in the Sloan Digital Sky Survey Data Release 5 and confirmed with deeper ...imaging at the Calar Alto Observatory. The clusters, Koposov 1 and Koposov 2, are located at similar to 40-50 kpc and appear to have old stellar populations and luminosities of only unk similar to -1 mag. Their observed sizes of -3 pc are well within the expected tidal limit of similar to 10 pc at that distance. Together with Palomar 1, AM 4, and Whiting 1, these new clusters are the lowest luminosity globular clusters orbiting the Milky Way, with Koposov 2 the most extreme. Koposov 1 appears to lie close to distant branch of the Sagittarius stream. The half-mass relaxation times of Koposov 1 and 2 are only similar to 70 and similar to 55 Myr respectively (2 orders of magnitude shorter than the age of the stellar populations), so it would seem that they have undergone drastic mass segregation. Since they do not appear to be very concentrated, their evaporation timescales may be as low as similar to 0.1t sub(Hubble.) These discoveries show that the structural parameter space of globular dusters in the Milky Way halo is not yet fully explored. They also add, through their short remaining survival times, significant direct evidence for a once much larger population of globular clusters.
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