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Cardiovascular system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Echocardiography offers detail of the cardiac structure including the state of the valves, and functional information such as cardiac muscle contractility (cardiac output and ejection fraction) and blood flow across the valves including detection and quantification of reflux (leakage). As a non-invasive test it is often the first investigation of suspected cardiac conditions either alone or in combination with other tests. Its uses include diagnosis and assessment of heart failure and cardiomyopathy, valve diseases and in children, detection and assessment of congenital diseases. Intravascular ultrasound (IVUS) may be used in conjunction with the interventional techniques of thrombectomy and rotablation, to restore the lumen of occluded coronary arteries.
Peripheral Vascular Disease
Published in Andrew Stevens, James Raftery, Jonathan Mant, Sue Simpson, Health Care Needs Assessment, 2018
The main non-invasive test now used commonly to assess the location of disease is Duplex scanning. The test is good at identifying occlusions and discriminating between large (> 50%) and small (< 50%) stenoses. In a review of evidence comparing Duplex with arteriography, Duplex was found to be 71–98% sensitive and 91–100% specific in discriminating stenoses of greater or less than 50%.76 Discrimination of more precise degrees of stenosis is less good but may improve with technological developments. In practice, the advent of Duplex scanning has reduced but not eliminated the need for arteriography in the management of patients requiring an interventional procedure.
Tachyarrhythmias
Published in Ian Mann, Christopher Critoph, Caroline Coats, Peter Collins, The Junior Doctor’s Guide to Cardiology, 2017
Ian Mann, Christopher Critoph, Caroline Coats, Peter Collins
This is an invasive test in which catheters are placed inside the heart. An electrical map is created to identify areas of abnormal conduction (seeFigure 10.4). Drugs may be given to precipitate arrhythmias.
Neuromuscular disorders in women and men with spinal cord injury are associated with changes in muscle and tendon architecture
Published in The Journal of Spinal Cord Medicine, 2023
Larissa Santana, Emerson Fachin-Martins, David Lobato Borges, Jonathan Galvão Tenório Cavalcante, Nicolas Babault, Frederico Ribeiro Neto, João Luiz Quagliotti Durigan, Rita de Cássia Marqueti
Invasive electromyography has identified neuromuscular electrophysiological disorders (NED) in individuals with complete and incomplete SCI.16–19 The most significant effect on nerve waveform amplitude suggests a predominant axonal involvement. However, there are no definitive findings on neuromuscular function changes observed in individuals with chronic SCI.17,18 Among the modalities used to evaluate peripheral nerve lesions, the Stimulus Electrodiagnosis Test (SET) is a non-invasive examination that quantifies nerve and muscle evoked responses using specific parameters of neuromuscular electrical stimulation (NMES) to measure the rheobase, chronaxie, accommodation, and accommodation index.20–22 Invasive electromyography has been indicated as a relevant test to determine peripheral nerve injury level and severity.23 However, the feasibility of this test may be limited due to its considerable cost, need for a skilled physician, and the inherent risk of an invasive test.24 NED can also be diagnosed by SET, which presents sensitivity ranging from 88% to 100% compared to needle electromyography.21 The chronaxie needs to be considered in the proposal of NMES protocols for experimental and rehabilitation purposes.21,24,25 In addition, a possible mechanism for non-responsivity to NMES parameters has not yet been elucidated after SCI.
Diagnostic value of non-coding RNAs in ovarian cancer
Published in Journal of Obstetrics and Gynaecology, 2022
Ningxia Sun, Shiguo Liu, Aiping Chen
Although an increasing number of miRNAs have been confirmed to be differentially expressed in ovarian cancer tissues, a limited number of studies exist on the diagnostic value of miRNAs in ovarian cancer. This may be attributed to the method of obtaining ovarian cancer tissues for testing being an invasive test. Oliveira et al. (2019) analysed the expression profile of miRNAs, and the diagnostic accuracy of miR-200c-3p and miR-221-3p combined with CA125 was AUC = 0.96, providing important information for the diagnosis of advanced OC. Members of the miR-200 family (miR-141 and miR-200a) are considered as potential non-invasive biomarkers because their expression in tissue samples is correlated with the value in blood samples. Braicu et al. (2017) observed miR-141 overexpression in ovarian cancer tissues. Its AUC is 0.87. Supplementary Table 2 summarises the diagnostic value of the few differentially expressed miRNAs reported.
Optimization of the vancomycin administration regimen by clinical pharmacists based on a population pharmacokinetics model: a prospective interventional study
Published in Journal of Chemotherapy, 2022
Haodi Lu, Lufen Duan, Yanxia Yu, Jingjing Li, Lu Shi, Sudong Xue, Qian Zhang, Qin Zhou, Chenqi Zhu, Erning Shang, Xinxin Yan, Lian Tang
The correct sampling time of the vancomycin TDM is important to the rational application of vancomycin. An inappropriate sampling time for TDM will lead to inaccurate TDM results and affect the decision regarding the dosage regimen adjustment. In a 13-month retrospective study at a large academic medical center, data on vancomycin trough concentrations were obtained from 2597 samples, and 41.3% of samples were taken too early, resulting in significantly higher concentrations than those in samples taken at the right time [28]. Regarding the early intervention time of our study, most of the early sampling times were approximately 6 a.m.; however, the administration time of vancomycin was generally approximately 9 a.m. There were three main reasons for this: first, the sampling time was not indicated to the nurse when the clinician prescribed the determination of the trough concentration; second, the nurse routinely took blood from the patient at 6 a.m. to assess other laboratory indicators, so the sample for the vancomycin trough concentration measurement was taken together with the samples for these indicators; and third, some patients were reluctant to undergo an additional invasive test for vancomycin TDM. After intervention by clinical pharmacists, the rational rate of the TDM sampling time increased from 49.85% to 60.45%, and the difference was statistically significant. However, further efforts are still needed to improve the rate of correct sampling times. Clinical pharmacists need further training on providing TDM operation specifications to doctors and nurses.