Strategies for Well-Being in Interventional Radiology.

Interventional radiologists (IRs) have a massive impact on their patients, communities, and healthcare at large. Yet, IRs have physical and emotional challenges that lead to a high rate of burnout compared with other medical specialties. A Medscape survey in 2013 showed a 37% burnout incidence among radiologists, which increased to 49% in 2015. This ranked radiology 7th out of 26 specialties with respect to burnout. Although the survey did not examine IR specifically, with the increasing demands on those in the profession, this number can only be expected to increase. A survey by Bundy et al demonstrated that interventional radiologists are in the upper range of burnout among physicians with 71.9% presenting with at least 1 manifestation of burnout. This is higher than that reported among surgeons or diagnostic radiologists. We must be proactive in addressing wellness in IR if we are to flourish both individually and as a group. The impact of suboptimal well-being in an IR goes beyond that of the individual, influencing patient care with ripple effects to society at large. At worst, severe burnout can lead to an early exit from medicine, with the cost of recruiting a replacement IR estimated at two to three times an annual physician salary. This is to say nothing of the experience, wisdom, and leadership that are lost when physicians burn out and drop out. Particularly in IR, where the work performed often improves the cost-effectiveness and quality of care, burnout is a threat to the physician workforce and healthcare at large. In this article, our goal is to share some elements of physician well-being and highlight opportunities to support well-being in IR.

Health for All: A Report of the 2020 Association of American Medical Colleges Learn Serve Lead Meeting.

Learn Serve Lead (LSL) is the signature annual conference of the Association of American Medical Colleges (AAMC), which focuses on the most pressing issues facing American medical practice and education. Unsurprisingly, the recent AAMC LSL conference at the end of 2020 centered on the multifaceted impacts of the COVID-19 pandemic and racial inequity upon the medical community. At the LSL meeting, national leaders, practicing physicians from diverse specialties, and medical trainees discussed the impact of these challenges and ongoing strategies to overcome them. These efforts paralleled the AAMC mission areas of community collaborations, medical education, clinical care, and research. Additionally, this focus aligns with the ACR's core purpose: to serve patients and society by empowering members to advance the practice, science, and professions of radiological care. ACR is a member of the AAMC Council of Faculty and Academic Society and seeks to collaborate with other medical specialties to promote interdisciplinary collaboration, contribute to medical education, and voice the value of medical imaging for patient care. We summarize the major insights of this interdisciplinary conference and present tailored recommendations for applying these insights specifically within the radiology community. In addition, we review the parallels between the ACR and the AAMC strategic plans.

Thin flexible lab-on-a-film for impedimetric sensing in biomedical applications.

Microfluidic cytometers based on coulter principle have recently shown a great potential for point of care biosensors for medical diagnostics. Here, we explore the design of an impedimetric microfluidic cytometer on flexible substrate. Two coplanar microfluidic geometries are compared to highlight the sensitivity of the device to the microelectrode positions relative to the detection volume. We show that the microelectrodes surface area and the geometry of the sensing volume for the cells strongly influence the output response of the sensor. Reducing the sensing volume decreases the pulse width but increases the overall pulse amplitude with an enhanced signal-to-noise ratio (~ max. SNR = 38.78 dB). For the proposed design, the SNR was adequate to enable good detection and differentiation of 10 µm diameter polystyrene beads and leukemia cells (~ 6-21 µm). Also, a systematic approach for irreversible & strong bond strength between the thin flexible surfaces that make up the biochip is explored in this work. We observed the changes in surface wettability due to various methods of surface treatment can be a valuable metric for determining bond strength. We observed permanent bonding between microelectrode defined polypropylene surface and microchannel carved PDMS due to polar/silanol groups formed by plasma treatment and consequent covalent crosslinking by amine groups. These experimental insights provide valuable design guidelines for enhancing the sensitivity of coulter based flexible lab-on-a-chip devices which have a wide range of applications in point of care diagnostics.

Circular shaped microelectrodes for single cell electrical measurements for lab-on-a-chip applications.

The impedimetric sensing techniques for single cell characterization have witnessed growing interest due to their high sensitivity and widespread applications. However, adapting the method to different biological measurements in microfluidic environments under various input conditions can result in feeble signal detection leading to a drastic decrease in the sensor sensitivity. The reduced signal-to-noise ratio (SNR) hinders the signal differentiation, sensor accuracy and prohibits fully integrated point-of-care applications. Here, we address the sensitivity enhancement for microfluidic impedimetric sensing of micron and submicron-sized microparticles by exploring novel circular shape electrodes in a simulation study. The influence of radial electrode parameters on differential electrical signal is systematically analyzed in COMSOL Multiphysics using spherical particles ranging from 0.75 µm to 5 µm in diameter. Detailed analysis revealed the strong impact of the circular shape microelectrode geometry and the electrode gap on the signal strength, resulting SNR, and device sensitivity for multiple bioparticles detection. Specifically, ˃ 50 dB improvement in SNR was enabled by optimizing the circular electrode geometrical parameters. Our proposed sensing modality can be adapted for nanoparticles detection by further optimizing the microfluidic device parameters.

Biochip with multi-planar electrodes geometry for differentiation of non-spherical bioparticles in a microchannel.

A biosensor capable of differentiating cells or other microparticles based on morphology finds significant biomedical applications. Examples may include morphological determination in the cellular division process, differentiation of bacterial cells, and cellular morphological variation in inflammation and cancer etc. Here, we present a novel integrated multi-planar microelectrodes geometry design that can distinguish a non-spherical individual particle flowing along a microchannel based on its electrical signature. We simulated multi-planar electrodes design in COMSOL Multiphysics and have shown that the changes in electrical field intensity corresponding to multiple particle morphologies can be distinguished. Our initial investigation has shown that top-bottom electrodes configuration produces significantly enhanced signal strength for a spherical particle as compared to co-planar configuration. Next, we integrated the co-planar and top-bottom configurations to develop a multi-planar microelectrode design capable of electrical impedance measurement at different spatial planes inside a microchannel by collecting multiple output signatures. We tested our integrated multi-planar electrode design with particles of different elliptical morphologies by gradually changing spherical particle dimensions to the non-spherical. The computed electrical signal ratio of non-spherical to spherical particle shows a very good correlation to predict the particle morphology. The biochip sensitivity is also found be independent of orientation of the particle flowing in the microchannel. Our integrated design will help develop the technology that will allow morphological analysis of various bioparticles in a microfluidic channel in the future.

Exceedingly Sensitive Restructured Electrodes Design for Pathogen Morphology Detection using Impedance Flow Cytometry.

The cellular morphology is a vital biological characteristic for determining explicit information about its physiological state. Monitoring real-time cell shape is of great importance in infectious pathogen detection. Here, we designed a highly sensitive coplanar electrode sensing system and merged it with planar electrodes for simultaneous impedance signals in two dimensions. We simulated the proposed design in this study for the detection of different single cell pathogens based on their morphology. The optimized design has a great potential to monitor and characterize different bacteria based on their sizes and shapes. In this report, spherical and rod shaped particles were used to illustrate the device performance. This simple and extremely sensitive modified electrode design is very promising for bacterial detection and will serve as a future guiding tool for discriminating different morphologies of singular cells.

Intravitreal Aflibercept for Neovascular Polypoidal Choroidal Vasculopathy in a Predominantly Non-Asian Population: RIVAL Results.

BACKGROUND AND OBJECTIVE: To evaluate safety and efficacy of intravitreal aflibercept (Eylea; Regeneron, Tarrytown, NY) injection (IAI) for the treatment of neovascular polypoidal choroidal vasculopathy (PCV) in a predominantly non-Asian population. PATIENTS AND METHODS: This was an open-label, prospective, unmasked, nonrandomized clinical trial. Twenty eyes with neovascular PCV received monthly 2.0 mg IAI for 3 months followed by mandatory IAI every 2 months for 12 months. RESULTS: The mean change in ETDRS best-corrected visual acuity from baseline to 1 year was +11 letters in the treatment-naïve group, +5 letters in the treatment non-naïve group, and +9 letters overall. There was an overall mean reduction of 70 µm from baseline central subfield thickness (CST) at 1 year. Patients received a mean of 6.2 mandatory and 0.7 additional IAI injections overall during the course of 1 year. No serious ocular adverse events were reported. CONCLUSION: At 1 year, neovascular PCV in a predominantly non-Asian population treated with IAI demonstrated favorable visual, anatomic, and safety outcomes. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:34-44.].

Ranibizumab 0.3 mg for Persistent Diabetic Macular Edema After Recent, Frequent, and Chronic Bevacizumab: The ROTATE Trial.

BACKGROUND AND OBJECTIVE: To evaluate the safety and efficacy of 0.3 mg ranibizumab (Lucentis; Genentech, South San Francisco, CA) in eyes with persistent diabetic macular edema (DME) after recent, chronic, and frequent bevacizumab (Avastin; Genentech, South San Francisco, CA). PATIENTS AND METHODS: Open-label, prospective study of 0.3 mg ranibizumab for eyes with persistent DME after bevacizumab. Thirty eyes randomized to a sustained group or a pro re nata (PRN) dosing group. RESULTS: The mean change in ETDRS best-corrected visual acuity from baseline to 1 year was +6.7 letters in the sustained group, +6.4 letters in the PRN group, and +6.5 letters overall. There was an overall mean reduction of 116 µm from baseline central subfield thickness at 1 year, with -92 µm and -127 µm decreases in the sustained and PRN groups, respectively. Adverse events included two deaths; one patient with multiple cardiopulmonary comorbidities, myocardial infarction, stroke, osteomyelitis; and mild posterior subcapsular cataracts in two eyes. CONCLUSION: Ranibizumab 0.3 mg demonstrated improved visual and anatomic outcomes in patients with persistent DME following bevacizumab. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:1030-1037.].

Sensitivity of staurosporine-induced differentiated RGC-5 cells to homocysteine.

PURPOSE: Homocysteine is implicated in ganglion cell death associated with glaucoma. To understand mechanisms of homocysteine-induced cell death, we analyzed the sensitivity of the RGC-5 cell line, differentiated using staurosporine, to physiologically-relevant levels of the excitotoxic amino acid homocysteine. METHODS: RGC-5 cells were differentiated 24 hr using 316 nM staurosporine and tested for expression of Thy 1.2 via immunodetection, RT-PCR, and immunoblotting. The sensitivity of staurosporine-differentiated RGC-5 cells to physiological levels of homocysteine (50, 100, 250 microM) and to high levels of homocysteine (1 mM), glutamate (1 mM), and oxidative stress (25 microM:10 mU/ml xanthine:xanthine oxidase) was assessed by TUNEL assay and by immunodetection of cleaved caspase-3. The sensitivity of undifferentiated RGC-5 cells to high (1, 5, and 10 mM) homocysteine was also examined. RESULTS: Undifferentiated RGC-5 cells express Thy 1.2 mRNA and protein. Staurosporine-differentiated RGC-5 cells extend neurite processes and express Thy 1.2 after 24 hr differentiation; they express NF-L after 1 and 3 days differentiation. Treatment of staurosporine -differentiated RGC-5 cells with 50, 100, or 250 microM homocysteine did not alter neurite processes nor induce cell death (detected by TUNEL and active caspase-3) to a level greater than that observed in the control (non-homocysteine-treated, staurosporine-differentiated) cells. The 1 mM dosage of homocysteine in staurosporine-differentiated RGC-5 cells also did not induce cell death above control levels, although 18 hr treatment of non-differentiated RGC-5 cells with 5 mM homocysteine decreased survival by 50%. CONCLUSIONS: RGC-5 cells differentiated for 24 hr with 316 nM staurosporine project robust neurite processes and are positive for ganglion cell markers consistent with a more neuronal phenotype than non-staurosporine-differentiated RGC-5 cells. However, concentrations of homocysteine known to induce ganglion cell death in vivo and in primary ganglion cells are not sufficient to induce death of RGC-5 cells, even when they are differentiated with staurosporine.