Advanced multimodal diagnostic approaches for detection of lung cancer

Introduction: Lung cancer (LC) emerges as a principle cause of death among smokers and is also one of the most lethal forms of cancer in nonsmokers. LC is mainly classified as non-small cell lung cancer (NSCLC), small cell LC, and lung carcinoid tumor. NSCLC is the most prevalent form of LC and its early stage diagnosis is essential to reduce mortality rate of patients and provide specific therapy. The field of LC diagnostics witnessed a gradual escalation with advancement in technology.

Areas covered: This comprehensive review focuses on classification of LC and advanced diagnostics for LC detection like biosensors, biomarkers, nanotechnology-based diagnostics, wearable devices, mobile health, artificial intelligence (AI), aptamers, and molecularly imprinted polymers (MIPs).

Expert opinion: Liquid biopsy and breath analysis developments are the most promising and advanced technologies for the detection of biomarkers associated with LC. Wearable devices and AI are two niche areas that require development and standardization for commercialization. The upcoming technology based on nanosystems includes robots, fibers, and particles for sensitive detection of LC. In the near future, nanotechnology-based theranostics, aptamers, and MIPs will emerge in early-stage diagnosis of LC.     

A prospective audit of patient experiences in colonoscopy using the Global Rating Scale: a cohort of 1,187 patients

BACKGROUND:

The Global Rating Scale (GRS) comprehensively evaluates the quality of an endoscopy department, providing a patient-centred framework for service improvement.

OBJECTIVE:

To assess patient experiences during colonoscopy and identify areas that need service improvement using the GRS.

METHODS:

Consecutive outpatients undergoing colonoscopy were asked to complete a pre- and postprocedure questionnaire. Questions were based on GRS items and a literature review. The preprocedure questionnaire addressed items such as patient characteristics and information provision. The postprocedure questionnaire contained questions regarding comfort, sedation, the attitude of endoscopy staff and aftercare.

RESULTS:

The preprocedure questionnaire was completed by 1187 patients, whereas the postprocedure part of the questionnaire was completed by 851 patients (71.9%). Fifty-four per cent of patients were first seen in the outpatient clinic. The indication for colonoscopy was explained to 85% of the patients. Sixty-five per cent of the patients stated that information about the risks of colonoscopy was provided. Sedation was used in 94% of the patients; however, 23% judged the colonoscopy to be more uncomfortable than expected. Ten per cent of patients rated the colonoscopy as (very) uncomfortable. Preliminary results of the colonoscopy were discussed with 87% of patients after the procedure. Twenty-one per cent of the patients left the hospital without knowing how to obtain their final results. Being comfortable while waiting for the procedure (OR 9.93) and a less uncomfortable procedure than expected (OR 2.99) were important determinants of the willingness to return for colonoscopy.

CONCLUSIONS:

The present study provided evidence supporting the GRS in identifyng service gaps in the quality of patient experiences for colonoscopy in a North American setting. Assessing experiences is useful in identifying areas that need improvement such as the provision of pre- and postprocedure information.     

The management of atrial fibrillation in heart failure

Opinion statement The development of atrial fibrillation (AF) can greatly complicate the course of heart failure (HF). Although recent trials have indicated the nonsuperiority of a rhythm control strategy in the general population with AF, this may not apply to patients with HF. We feel strongly that AF be treated aggressively in patients with HF, defaulting toward an initial rhythm control strategy, to avoid the hemodynamic detriment of irregular rapid ventricular response and the development of tachycardia-related myopathy. The index episode is treated with cardioversion and antiarrhythmic therapy. If significant benefit is demonstrated, the rhythm control strategy is maintained, to the point of catheter ablation for AF if necessary. If there is no change in cardiac performance or symptoms after cardioversion, strict rate control is enforced, to the point of atrioventricular node ablation and pacing if necessary.     

Neuroprotective and Anti-ageing Effects of Curcumin in Aged Rat Brain Regions

This study investigated the influence of chronically administered curcumin on normal ageing-related parameters: lipid peroxidation, lipofuscin concentration and intraneuronal lipofuscin accumulation, activities of the enzymes superoxide dismutase (SOD), glutathione peroxidase (GPx), and Na⁺, K⁺, -adenosine triphosphatase (Na⁺, K⁺, -ATPase) in different brain regions (cerebral cortex, hippocampus, cerebellum and medulla) of 6- and 24-month-old rats. In normal ageing, lipid peroxidation and lipofuscin concentration were found to increase with ageing, the activities of SOD, GPx and Na⁺, K⁺, -ATPase, however, decreased with ageing. Chronic curcumin treatment of both 6 and 24 months old rats resulted in significant decreases in lipid peroxide and the lipofuscin contents in brain regions, the activities of SOD, GPx and Na⁺, K⁺, -ATPase however, showed significant increase in various brain regions. The present study, thus, demonstrated the antioxidative, antilipofusinogenesic and anti-ageing effects of curcumin in the brain.     

Cardiac perforation and tamponade: a potentially fatal complication during transjugular intrahepatic portosystemic shunt placement

Transjugular intrahepatic portosystemic shunt (TIPS) is a low-resistance channel between the hepatic vein and the intrahepatic portion of the portal vein. This is an important addition to the therapeutic armamentarium against portal hypertension. Complications are either technical or due to the creation of a shunt. Procedure-related mortality is about 0 to 2%. Cardiac perforation, one of the rarest complications during TIPS, can occur while traversing the catheter from the jugular vein past the right atrium to enter the hepatic vein. We are reporting the case of a 50-year-old woman who became acutely hypotensive with cardiovascular compromise during the TIPS procedure. A stat echocardiogram confirmed cardiac tamponade and emergency pericardiocentesis resulted in improvement of hemodynamic status with complete recovery.