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BACKGROUND: Mantle field radiotherapy has been known to cause cardiovascular complications even years after therapy. Complications include pericardial disease, coronary artery disease, and conduction abnormalities. CASE SUMMARY: We present a case series of two patients who developed cardiovascular complications years after receiving mantle radiation. Patient 1 is a 52-year-old man who presented with symptoms of heart failure. He had a neurostimulator which precluded him from cardiac magnetic resonance imaging. Haemodynamic findings on right heart catheterization raised suspicion for constrictive pericarditis and pericardiectomy was performed. Histopathological analysis reported dense, sclerotic fibrous tissue consistent with radiation-related changes. Patient 2 is a 37-year-old man with a 2-month history of chest pain and exertional dyspnoea who was admitted for management of coronary artery disease. Coronary angiography demonstrated bilateral subclavian artery stenosis and an elevated left ventricular end-diastolic pressure (50 mmHg). He had bilateral percutaneous subclavian artery stenting. Both patients had complete resolution of symptoms on follow-up. DISCUSSION: Our case series emphasizes the need for an index of suspicion for radiation-related cardiovascular changes in patients who have a history of mantle radiation, especially in younger patients. This was especially pertinent in the case of our first patient who presented a diagnostic challenge due to certain patient factors. Our second patient is a case of subclavian artery stenosis which is less frequently reported as a complication of mantle radiation in the literature.
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BACKGROUND: Oseltamivir is recommended in the treatment of influenza illness in high-risk populations, including those with chronic heart and lung diseases. OBJECTIVES: We conducted a systematic review and meta-analysis to determine the rate of use and effectiveness of oseltamivir in these groups of patients. METHODS: The protocol for the systematic review was registered on PROSPERO (CRD42019125998). Medline, EMBASE, Cochrane CENTRAL, and CINAHL were searched for observational studies and randomized controlled trials published up to 16 February 2020. Quality appraisal of final studies was conducted using GRADE guidelines. Data were extracted using a predeveloped template. Main outcomes measured included the rate of use of oseltamivir for influenza-like-illness and its effectiveness in reducing disease severity in patients with cardiopulmonary diseases. Outcomes measured for effectiveness were influenza-related complications (respiratory infections and asthma exacerbations), hospitalization rates, and time to freedom from illness. Risk of bias was assessed using Cochrane's Risk of Bias 2.0 tool for randomized trials and Cochrane's Risk of Bias in nonrandomized Studies of Interventions tool for nonrandomized trials. Where data were available, pooled analyses were conducted. Dichotomous variables were evaluated using the Mantel-Hansel method. A random effect model was applied. Summary measures were reported as risk ratios where relevant. RESULTS: Our systematic review identified nine studies. Oseltamivir use ranged from 25% to 100%. When oseltamivir group was compared to placebo, rates of respiratory tract infections reduced by 28% (RR = 0.72, 95% CI = 0.59-0.90), hospitalization reduced by 52% (RR = 0.48, 95% CI = 0.28-0.80) and median time to illness alleviation decreased by 10.4 to 120 hours. There was no significant reduction in asthma exacerbation rates. CONCLUSIONS: Our systematic review suggests that the use of oseltamivir is beneficial in reducing disease severity, however, its use in high-risk population remains suboptimal.
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We report on the compatibility of various nanowires with hippocampal neurons and the structural study of the neuron-nanowire interface. Si, Ge, SiGe, and GaN nanowires are compatible with hippocampal neurons due to their native oxide, but ZnO nanowires are toxic to neuron due to a release of Zn ion. The interfaces of fixed Si nanowire and hippocampal neuron, cross-sectional samples, were prepared by focused ion beam and observed by transmission electron microscopy. The results showed that the processes of neuron were adhered well on the nanowire without cleft.
