Continuous positive airway pressure is unsafe for radiofrequency ablation of lung cancer under sedation: a randomised controlled trial.

OBJECTIVE: To evaluate the safety of a minimum continuous positive airway pressure of 4 cmH2O (CPAP + 4) during computed tomography (CT)-guided radiofrequency ablation (RFA) for lung malignancies under procedural sedation and analgesia (PSA). METHODS: This was a prospective, randomised, single-blind, parallel-group, placebo-controlled trial with an open-label medical device conducted at a single tertiary university hospital in Barcelona, Spain. Forty-six patients over 18 years of age scheduled for CT-guided RFA of a malignant pulmonary tumour under PSA were randomised to receive either CPAP + 4 or a modified mask for placebo CPAP (Sham-CPAP). Exclusion criteria included contraindications for RFA, refusal to participate, inability to understand the procedure or tolerate the CPAP test, lung biopsy just prior to RFA, intercurrent diseases, or previous randomisation for additional pulmonary RFA. Primary outcomes were the percentage of patients reporting at least one serious adverse event (SAE), classification for complications from the Cardiovascular and Interventional Radiological Society of Europe (CIRSE), and Clavien-Dindo classifications for complications, hospital stay, and readmissions. Secondary outcomes included adverse events (AEs), respiratory parameters, airway management, and the local radiological efficacy of pulmonary ablation. RESULTS: CPAP + 4 prolonged hospital stay (1.5 ± 1.1 vs. 1.0 ± 0 inpatient nights, p = 0.022) and increased the risk of AE post-RFA (odds ratio (95% CI): 4.250 (1.234 to 14.637), p = 0.021 with more pneumothorax cases (n = 5/22, 22.7% vs. n = 0/24, 0%, p = 0.019). Per-protocol analysis revealed more SAEs and CIRSE grade 3 complications in the CPAP + 4 group (23.5% vs. 0%, p = 0.036). No significant differences were found in the effectiveness of oxygenation, ventilation, or pulmonary ablation. CONCLUSION: CPAP is unsafe during CT-guided RFA for lung cancer under PSA even at the lowest pressure setting. TRIAL REGISTRATION: ClinicalTrials.Gov, ClinicalTrials.gov ID NCT02117908, Registered 11 April 2014, https://www. CLINICALTRIALS: gov/study/NCT02117908 CRITICAL RELEVANCE STATEMENT: This study highlights the hazards of continuous positive airway pressure during radiofrequency ablation of lung cancer, even at minimal pressures, deeming it unsafe under procedural sedation and analgesia in pulmonary interventional procedures. Findings provide crucial insights to prioritise patient safety. KEY POINTS: No prior randomised controlled trials on CPAP safety in percutaneous lung thermo-ablation. Standardised outcome measures are crucial for radiology research. CPAP during lung RFA raises hospital stay and the risk of complications. CPAP is unsafe during CT-guided RFA of lung cancer under procedural sedoanalgesia.

Lagrangian tracking of long-lasting plastic tags: From lobster fisheries in the USA and Canada to Macaronesia.

Plastic waste from the fishing industry, particularly lobster trap identification tags from the USA and Canada, poses a significant threat to marine ecosystems due to its resilience. This study unveils a novel link between North American fisheries and the appearance of these plastic tags in Macaronesia. Collected in the Azores and Canary Islands, these tags offer a unique insight into the sources and spatio-temporal scales of marine plastic pollution. Ocean model data indicates the Labrador Current and Gulf Stream as key forces transporting these tags. Virtual particle simulations show a small fraction reaching Macaronesia (4.12 % in the Azores, 0.76 % in the Canary Islands), suggesting real ocean drift. The Azores, with more collected tags, are more susceptible, and tags can reach Macaronesia in under a year. These findings underscore the urgency of better waste management and emphasize the role of citizen science in monitoring and combating marine pollution.

Beneath the water column: Uncovering microplastic pollution in the sublittoral coastal sediments of the Canary Islands, Spain.

Marine ecosystems pollution by microplastics (MPs) is a global problem of special concern. The present study examines the prevalence and distribution of MPs and cellulosic particles in sublittoral coastal sediments of the Canary Islands archipelago (Spain). At twenty-six different locations alongside seven islands, three samples were taken parallel to the shoreline between 1 and 10 m depth (n = 78). Sediment samples were primarily digested with a H2O2 solution followed by four flotations in a saturated NaCl solution. The mean concentration obtained was 3.9 ± 1.6 items/g of dry weight. A similar distribution pattern was observed across all islands concerning particles morphology, color, size and composition: mainly colorless/translucent and blue fibers (60.0%). Additionally, fragments were also found, and to a much lesser extent microbeads, films and tangled messes. MicroFourier Transform Infrared spectroscopy analysis of 12.5% of the fibers, showed that they were mainly cellulosic (54.5%) -either natural or semisynthetic- followed by polyester (22.7%) and acrylic (4.5%). The potential correlation between particle distribution in nearshore sediments and wave intensity was also explored. This work provides the first comprehensive report on the current MPs content of the seabed of the region.

Microplastic pollution in sublittoral coastal sediments of a North Atlantic island: The case of La Palma (Canary Islands, Spain).

In this work, the microplastic content of sediments collected in July 2020 between 5 and 7 m depth was studied in four locations of La Palma island (Canary Islands, Spain). At each sampling location, three samples were taken parallel to the shoreline. The microplastic content in each sampling corer was studied every 2.5 cm depth after digestion with a H2O2 solution followed by flotation in a saturated NaCl solution. Visualization of the final filtrates under a stereomicroscope revealed that all the sediment samples evaluated contained mostly microfibers (98.3%) which were mainly white/colorless (86.0%) and blue (9.8%), with an average length of 2423 ± 2235 (SD) mm and an average concentration of 2682 ± 827 items per kg of dry weight, being the total number of items found 1,019. Fourier Transform Infrared microscopy analysis of 13.9% (n = 139) of the microfibers also showed that they were mainly cellulosic (81.3%). No significant differences were found between the depths of the sediment. However, significant differences were found between the number of fibers from the sampling sites at the east and west of the island. Such variability could be driven by the winds and ocean mesoscale dynamics in the area. This study confirms the wide distribution of microfibers in sediments from an oceanic island like La Palma, providing their first report in marine sediments of the Canary Islands.

Distribution and transport of microplastics in the upper 1150 m of the water column at the Eastern North Atlantic Subtropical Gyre, Canary Islands, Spain.

Nowadays it is widely known that pollution by microplastics (MP) at the open ocean covers immense areas. Buoyant plastics tend to accumulate in areas of convergence at the sea surface such as subtropical gyres, while non-buoyant plastics accumulate at the seafloor. However, previous studies have revealed that the total amount of plastic in the different oceans is not well correlated with the concentrations measured at the sea surface and the sea floor, evidencing a significant amount of missing plastic in the oceans. This deviation could be related to an underestimation of the role played by small fragments of plastic and fibers in the oceans. Furthermore, microplastic fragments with a density lower than the density of seawater have been gathered hundreds of meters below the sea surface in the Pacific Ocean due to their size and shape. The main objective of this study is to carry out, for the first time, an equivalent analysis along the water column for the Atlantic Ocean. In that sense, a total number of 51 samples were collected during four different oceanographic cruises between February and December 2019, from the sea surface down to 1150 m depth at the open ocean waters of the Canary Islands region (Spain). For each sample, 72 l of seawater were filtered on board with a mesh size of 100 µm, where the presence of microplastics has been clearly observed. Our results reveal the presence of microplastics at least up to 1150 m depth, at the Northeastern Atlantic Subtropical Gyre with noticeable seasonal differences. The spatial distribution of these small fragments and fibers at the water column is mainly related to the oceanic dynamics and mesoscale convective flows, overcoming the MP motion induced by their own buoyancy. Moreover, these microplastics have being transported by the ocean dynamics as passive drifters.

Intraventricular hemorrhage after dural fistula embolization / Hemorragia intraventricular após embolização de fístula dural

Abstract Background and objectives: Dural arteriovenous fistulas are anomalous shunts between dural arterial and venous channels whose nidus is located between the dural leaflets. For those circumstances when invasive treatment is mandatory, endovascular techniques have grown to become the mainstay of practice, choice attributable to their reported safety and effectiveness. We describe the unique and rare case of a dural arteriovenous fistula treated by transarterial embolization and complicated by an intraventricular hemorrhage. We aim to emphasize some central aspects of the perioperative management of these patients in order to help improving the future approach of similar cases. Case report: A 59-year-old woman with a previously diagnosed Cognard Type IV dural arteriovenous fistula presented for transarterial embolization, performed outside the operating room, under total intravenous anesthesia. The procedure underwent without complications and the intraoperative angiography revealed complete obliteration of the fistula. In the early postoperative period, the patient presented with clinical signs of raised intracranial pressure attributable to a later diagnosed intraventricular hemorrhage, which conditioned placement of a ventricular drain, admission to an intensive care unit, cerebral vasospasm and a prolonged hospital stay. Throughout the perioperative period, there were no changes in the cerebral brain oximetry. The patient was discharged without neurological sequelae. Conclusion: Intraventricular hemorrhage may be a serious complication after the endovascular treatment of dural arteriovenous fistula. A close postoperative surveillance and monitoring allow an early diagnosis and treatment which increases the odds for an improved outcome.

Resumo Justificativa e objetivos: Fístulas arteriovenosas durais (FAVD) são comunicações anômalas entre os canais venosos e arteriais da dura-máter cujo centro está localizado entre os folhetos da dura-máter. Para as circunstâncias nas quais o tratamento invasivo é obrigatório, as técnicas endovasculares se tornaram os pilares da prática, escolha atribuível a relatos de sua segurança e eficácia. Descrevemos o caso único e raro de uma FAVD tratada por embolização transarterial (ETA) e complicada por uma hemorragia intraventricular (HIV). Nosso objetivo foi destacar alguns aspectos centrais do manejo perioperatório desses pacientes para ajudar a melhorar uma futura abordagem de casos semelhantes. Relato de caso: Paciente do sexo feminino, 59 anos, com diagnóstico prévio de FAVD tipo IV (Cognard), apresentou-se para ETA, realizada fora da sala de cirurgia soBanestesia venosa total. O procedimento transcorreu sem complicações, e a angiografia intraoperatória revelou obliteração completa da fístula. No período pós-operatório imediato, a paciente apresentou sinais clínicos de aumento da pressão intracraniana (PIC) atribuíveis a uma HIV posteriormente diagnosticada, o que condicionou a colocação de um dreno ventricular, internação em Unidade de Terapia Intensiva (UTI), vasoespasmo cerebral e internação hospitalar prolongada. Durante todo o período perioperatório, não houve alterações na oximetria cerebral. A paciente recebeu alta sem sequelas neurológicas. Conclusão: HIV pode ser uma complicação grave após o tratamento endovascular de FAVD. A observação e o monitoramento cuidadosos no pós-operatório permitem o diagnóstico precoce e o tratamento que aumenta as chances de um resultado melhor.

Intraventricular hemorrhage after dural fistula embolization.

BACKGROUND AND OBJECTIVES: Dural arteriovenous fistulas are anomalous shunts between dural arterial and venous channels whose nidus is located between the dural leaflets. For those circumstances when invasive treatment is mandatory, endovascular techniques have grown to become the mainstay of practice, choice attributable to their reported safety and effectiveness. We describe the unique and rare case of a dural arteriovenous fistula treated by transarterial embolization and complicated by an intraventricular hemorrhage. We aim to emphasize some central aspects of the perioperative management of these patients in order to help improving the future approach of similar cases. CASE REPORT: A 59-year-old woman with a previously diagnosed Cognard Type IV dural arteriovenous fistula presented for transarterial embolization, performed outside the operating room, under total intravenous anesthesia. The procedure underwent without complications and the intraoperative angiography revealed complete obliteration of the fistula. In the early postoperative period, the patient presented with clinical signs of raised intracranial pressure attributable to a later diagnosed intraventricular hemorrhage, which conditioned placement of a ventricular drain, admission to an intensive care unit, cerebral vasospasm and a prolonged hospital stay. Throughout the perioperative period, there were no changes in the cerebral brain oximetry. The patient was discharged without neurological sequelae. CONCLUSION: Intraventricular hemorrhage may be a serious complication after the endovascular treatment of dural arteriovenous fistula. A close postoperative surveillance and monitoring allow an early diagnosis and treatment which increases the odds for an improved outcome.

[Intraventricular hemorrhage after dural fistula embolization]. / Hemorragia intraventricular após embolização de fístula dural.

BACKGROUND AND OBJECTIVES: Dural arteriovenous fistulas are anomalous shunts between dural arterial and venous channels whose nidus is located between the dural leaflets. For those circumstances when invasive treatment is mandatory, endovascular techniques have grown to become the mainstay of practice, choice attributable to their reported safety and effectiveness. We describe the unique and rare case of a dural arteriovenous fistula treated by transarterial embolization and complicated by an intraventricular hemorrhage. We aim to emphasize some central aspects of the perioperative management of these patients in order to help improving the future approach of similar cases. CASE REPORT: A 59-year-old woman with a previously diagnosed Cognard Type IV dural arteriovenous fistula presented for transarterial embolization, performed outside the operating room, under total intravenous anesthesia. The procedure underwent without complications and the intraoperative angiography revealed complete obliteration of the fistula. In the early postoperative period, the patient presented with clinical signs of raised intracranial pressure attributable to a later diagnosed intraventricular hemorrhage, which conditioned placement of a ventricular drain, admission to an intensive care unit, cerebral vasospasm and a prolonged hospital stay. Throughout the perioperative period, there were no changes in the cerebral brain oximetry. The patient was discharged without neurological sequelae. CONCLUSION: Intraventricular hemorrhage may be a serious complication after the endovascular treatment of dural arteriovenous fistula. A close postoperative surveillance and monitoring allow an early diagnosis and treatment which increases the odds for an improved outcome.