Preparation and in vitro evaluation of 111In-CHX-A"-DTPA-labeled anti-VEGF monoclonal antibody bevacizumab

Bevacizumab is a humanized monoclonal antibody that binds to vascular endothelial growth factor (VEGF) and prevents tumor angiogenesis. Radionuclide imaging using radiolabeled bevacizumab might be useful for selection of patients for anti-VEGF therapy. This study describes preparation of a potential imaging agent, 111In-CHX-A"-DTPA-bevacizumab, and evaluation of specificity of its binding to three tumor cell lines, SKOV3, LS174T and DU 145. Bevacizumab was conjugated with CHX-A"-DTPA and radiolabeled with 111In with high yield and excellent stability. Specificity of cellular binding was examined by a saturation assay using 100-fold excess of non-radiolabeled antibody. SKOV3 and LS174T tumor cell lines showed significantly specific binding, while DU 145 cells did not showed any specific binding. The specific binding is dependent to type of cell lines, which it is important for selection of tumor model for scintigraphic imaging of the VEGF expression.     

Influence of diabetes on cardiac resynchronization therapy with or without defibrillator in patients with advanced heart failure

ObjectivesWe performed a post hoc analysis to determine the influence of cardiac resynchronization therapy with a defibrillator (CRT-D) or without a defibrillator (CRT-P) on outcomes among diabetic patients with advanced heart failure (HF).BackgroundIn patients with systolic HF, diabetes is an independent predictor of morbidity and mortality. No data are available on its impact on CRT-D or CRT-P in advanced HF.MethodsThe database of the Comparison of Medical Therapy, Pacing and Defibrillation in Heart Failure trial was examined to determine the influence of CRT (CRT-D and CRT-P) on outcomes among diabetic patients. All-cause mortality or hospitalization, all-cause mortality or cardiovascular hospitalization, all-cause mortality or HF hospitalization, and all-cause mortality were analyzed among diabetic patients (n = 622). A Cox proportional hazard model, adjusting for age, gender, New York Heart Association, ischemic status, body mass index, left ventricular ejection fraction, heart rate, QRS, left or right bundle branch block, blood pressure, comorbidities (renal failure, carotid artery disease, peripheral vascular disease, hypertension, coronary artery bypass grafting, and atrial fibrillation), medications, and device (with or without defibrillator), was used to estimate hazard ratios (HRs) and significance.ResultsThe overall outcome of diabetic patients was similar to that of nondiabetic patients in the optimal pharmacologic therapy arm. With CRT, diabetic patients experienced a substantial reduction in all-cause mortality or all-cause hospitalization (HR = 0.77, 95% confidence interval [CI] 62–0.97), all-cause mortality or cardiovascular hospitalization (HR = 0.67, 95% CI 0.53–0.85), all-cause mortality or HF hospitalization (HR = 0.52, 95% CI 0.40–0.69), and all-cause mortality (HR = 0.67, 95% CI 0.45–0.99) compared with optimal pharmacologic therapy. Procedure-related complications and length of stay were identical in diabetic and nondiabetic patients.ConclusionIn diabetic patients with advanced HF, there is a substantial benefit from device therapy with significant improvement in all end points.     

Electrophysiological study prior to planned pulmonary valve replacement in patients with repaired tetralogy of Fallot

Aim

Ventricular arrhythmias (VAs) are the most common cause of death in patients with repaired Tetralogy of Fallot (rTOF). However, risk stratifying remains challenging. We examined outcomes following programmed ventricular stimulation (PVS) with or without subsequent ablation in patients with rTOF planned for pulmonary valve replacement (PVR).

Methods

We included all consecutive patients with rTOF referred to our institution from 2010 to 2018 aged ≥18 years for PVR. Right ventricular (RV) voltage maps were acquired and PVS was performed from two different sites at baseline, and if non-inducible under isoproterenol. Catheter and/or surgical ablation was performed when patients were inducible or when slow conduction was present in anatomical isthmuses (AIs). Postablation PVS was undertaken to guide implantable cardioverter-defibrillator (ICD) implantation.

Results

Seventy-seven patients (36.2 ± 14.3 years old, 71% male) were included. Eighteen were inducible. In 28 patients (17 inducible, 11 non-inducible but with slow conduction) ablation was performed. Five had catheter ablation, surgical cryoablation in 9, both techniques in 14. ICDs were implanted in five patients. During a follow-up of 74 ± 40 months, no sudden cardiac death occurred. Three patients experienced sustained VAs, all were inducible during the initial EP study. Two of them had an ICD (low ejection fraction for one and important risk factor for arrhythmia for the second). No VAs were reported in the non-inducible group (p < .001).

Conclusion

Preoperative EPS can help identifying patients with rTOF at risk for VAs, providing an opportunity for targeted ablation and may improve decision-making regarding ICD implantation.     

The role of human resource management and governance in addressing bullying,burnout and the depersonalization of junior and senior psychiatric nurses in Saudi Arabia

This study examined the level of perceived responsibility junior and senior psychiatric nurses have for human resources and governance in Saudi Arabia. Bullying is a significant issue in nursing and an entrenched cultural practice that highlights a failure in governance and human resource responsibilities. A total of 90 responses (43.1%) to a 5-point Likert Scale survey that sought respondent perceptions on leadership, governance and human resources. This study is reported using EQUATOR network recommendations (SQUIRE 2.0). This survey revealed that junior and senior nursing respondents weakly agree with all statements. Neither nurse rank, educational status nor nationality affected the answers of the respondents; there were age, gender and experience effects. There is a significant correlation between all responses to the statements implying there is a social desirability bias to the responses. If bullying, and its derived consequence of burnout, is to be addressed there needs to be a cultural shift in the attitudes of junior and senior nurses towards more acceptance of their HR and governance responsibilities. Furthermore, there needs to be an increased focus on shared leadership responsibilities, with greater nurse-manager interaction and cooperation on transformational practices that will bring cultural change to the clinical space.     

Aortic dissection presenting as stroke with focal neurologic deficits: A case report

Aortic dissection is a relatively uncommon and potentially misdiagnosed disease. Early and accurate diagnosis and appropriate treatment are imperative for patient survival. In this case, we present a 55-year-old male who presented to the Emergency Department with severe abdominal pain and acute neurological deficits who was triaged for stroke protocol. After unexpected findings on physical examination, other diagnostic hypotheses were evaluated, culminating in the diagnosis of aortic dissection. The purpose of this article is to exemplify a patient who presents with noteworthy neurologic clinical features who ultimately was diagnosed with Type B aortic dissection, to help benefit the rapid diagnosis and subsequent treatment for future patients with similar presentations.     

Primary muscular hydadit cyst: Case report

Primary hydatid disease of the skeletal muscle without systemic involvement is rare. Since the infection appears on clinical examination to be a soft-tissue tumor. It is important to have a preoperative radiological evaluation, particularly with magnetic resonance imaging (MRI) to avoid biopsy or improper cyst management during surgery. We present a unique case of a primary hydatid cyst manifesting as an expanding soft-tissue mass in a 31-year-old woman''s left thigh with magnetic resonance imaging revealed a very suggestive aspect of hydatid cyst in the adductor muscles and shows the interaction between cysts and nearby structures. The cyst was surgically removed, and macroscopic and microscopic histopathological examinations confirmed the diagnosis of muscular hydatidosis.