Chinesization of the quality of life assessment, venous device-port, and its reliability and validity tests for patients with breast cancer.

OBJECTIVE: To translate the assessment item sets of the Canadian version of the quality of life assessment, venous device-port for breast cancer patients with chest and arm ports (i.e. different implanting sites) into Chinese version, and to conduct a test of reliability and validity for it. METHODS: According to the Brislin translation model, quality of life assessment, venous device-port underwent literal and back translations, and the Chinese version of quality of life assessment, venous device-port was preliminarily revised by consulting an expert and a preliminary test. A total of 270 cancer patients undergoing chemotherapy were assessed during the use of ports, and the reliability and the validity of the Chinese version of quality of life assessment, venous device-port scale were then tested. RESULTS: The scale consisted of 23 yes/no items and seven numerical rating scales. The total Cronbach's α coefficient of the scale was 0.829, and each item ranged from 0.812 to 0.845. The item-level content validity index was 0.67-1.00, and the scale-level content validity index/average and the scale-level content validity index/universal agreement were 0.98 and 0.90, respectively. The correlation coefficient of the repeated measurement results of the scale was 0.554 (p < 0.01). Exploratory factor analysis showed that the cumulative explained variance of five common factors was 64.197%. CONCLUSION: The Chinese version of quality of life assessment, venous device-port scale is an effective assessment tool for quality of life with good reliability and validity in breast cancer patients with different implantation sites for totally implanted venous access devices in northern China.

Preclinical Evaluation of Pulsed Field Ablation: Electrophysiological and Histological Assessment of Thoracic Vein Isolation.

BACKGROUND: Pulsed field ablation (PFA) is a uniquely tissue-selective, nonthermal cardiac ablation modality. Delivery parameters such as the electrical waveform composition and device design are critical to PFA's efficacy and safety, particularly tissue specificity. In a series of preclinical studies, we sought to examine the electrophysiological and histological effects of PFA and compare the safety and feasibility of durable pulmonary vein and superior vena cava (SVC) isolation between radiofrequency ablation and PFA waveforms. METHODS: A femoral venous approach was used to gain right and left atrial access under general anesthesia in healthy swine. Baseline potentials in right superior pulmonary and inferior common vein and in SVC were assessed. Bipolar PFA was performed with monophasic (PFAMono) and biphasic (PFABi) waveforms in 7 and 7 swine sequentially and irrigated radiofrequency ablation in 3 swine. Vein potentials were then assessed acutely, and at ≈10 weeks; histology was obtained. RESULTS: All targeted veins (n=46) were successfully isolated on the first attempt in all cohorts. The PFABi waveform induced significantly less skeletal muscle engagement. Pulmonary vein isolation durability was assessed in 28 veins: including the SVC, durability was significantly higher in the PFABi group (18/18 PFABi, 10/18 PFAMono, 3/6 radiofrequency, P=0.002). Transmurality rates were similar across groups with evidence of nerve damage only with radiofrequency. Pulmonary vein narrowing was noted only in the radiofrequency cohort. The phrenic nerve was spared in all cohorts but at the expense of incomplete SVC encirclement with radiofrequency. CONCLUSIONS: In this chronic porcine study, PFA-based pulmonary vein and SVC isolation were safe and efficacious with demonstrable sparing of nerves and venous tissue. This preclinical study provided the scientific basis for the first-in-human endocardial PFA studies.

Detection of thoracic vascular structures by electrical impedance tomography: a systematic assessment of prominence peak analysis of impedance changes.

OBJECTIVE: Electrical impedance tomography (EIT) is a non-invasive and radiation-free bedside monitoring technology, primarily used to monitor lung function. First experimental data shows that the descending aorta can be detected at different thoracic heights and might allow the assessment of central hemodynamics, i.e. stroke volume and pulse transit time. APPROACH: First, the feasibility of localizing small non-conductive objects within a saline phantom model was evaluated. Second, this result was utilized for the detection of the aorta by EIT in ten anesthetized pigs with comparison to thoracic computer tomography (CT). Two EIT belts were placed at different thoracic positions and a bolus of hypertonic saline (10 ml, 20%) was administered into the ascending aorta while EIT data were recorded. EIT images were reconstructed using the GREIT model, based on the individual's thoracic contours. The resulting EIT images were analyzed pixel by pixel to identify the aortic pixel, in which the bolus caused the highest transient impedance peak in time. MAIN RESULTS: In the phantom, small objects could be located at each position with a maximal deviation of 0.71 cm. In vivo, no significant differences between the aorta position measured by EIT and the anatomical aorta location were obtained for both measurement planes if the search was restricted to the dorsal thoracic region of interest (ROIs). SIGNIFICANCE: It is possible to detect the descending aorta at different thoracic levels by EIT using an intra-aortic bolus of hypertonic saline. No significant differences in the position of the descending aorta on EIT images compared to CT images were obtained for both EIT belts.

Quality-of-life assessment: arm TIVAD versus chest TIVAD.

INTRODUCTION: Venous access devices are essential for the provision of care for patients requiring chemotherapy. Totally implanted venous access devices (TIVADs), also known as ports, are an option for infusion care. Medical devices have an impact upon patient quality of life. We assessed the impact on quality of life and satisfaction with their venous device, for patients with a chest TIVAD versus an upper arm TIVAD. MATERIALS AND METHODS: Sequential subjects were administered a questionnaire, "Quality of Life Assessment, Venous Device - Port (QLAVD-P)" at the time of their TIVAD removal. All subjects consented to complete the questionnaire and volunteered for this assessment. The TIVADs were all implanted and removed in the medical imaging department. RESULTS: Between March 1, 2014 and August 30, 2015, 127 subjects completed the QLAVD-P. At the time of their port removal, 51 had chest ports while 76 had arm ports. There were some negative features of the chest ports that were statistically significant in comparison to the arm ports. Most of the subjects felt that their port had a positive impact upon their treatment and they would have another port inserted if required for future treatment. DISCUSSION: Quality of life for those requiring intravenous chemotherapy is very important. This should be considered when selecting an infusion device. Venous ports were positively received by the subjects in our study and there were fewer negative impacts upon subject satisfaction and quality of life for those with upper-arm devices.

Thorax: new millennium vascular imaging.

In recent years the technological development of computed tomography (CT) and magnetic resonance (MR) has promoted new improvements in diagnosis by means of imaging. In particular the introduction of multislice CT and MR angiography (MRA) has broadened the non-invasive diagnostic possibilities in the vascular study of the thorax. The new technological developments of CT and MR enable functional studies as well. Recent studies have demonstrated that CT and MR are as accurate in finding the vascular anomalies as digital subtraction angiography, while they are more precise in recognising possible associated pathologies which modify therapeutic treatment (for example of the trachea, bronchi, oesophagus etc.). There are many vascular structures in the thorax which need to be considered (aorta, pulmonary and coronary arteries, pulmonary veins, vena cava). The field of associated pathologies is also broad, and includes congenital vascular anomalies, vascular malformations, aorta dissection, vascular compression syndromes, atherosclerotic stenosis or occlusions, and pulmonary embolism. In pulmonary embolism some authors have demonstrated the utility of CT, in showing pulmonary segmental perfusion defects, and MRA, in identifying sub-segment pulmonary embolism. In this paper we analyse the most important CT and MR applications for the study of vascular thoracic diseases and compare them with other diagnostic techniques. We also evaluate the morpho-functional capabilities of CT and MR in this field.