Gynecologic oncology patients are ready for telemedicine in routine care: Results from a pre-COVID survey.

OBJECTIVES: To assess telemedicine readiness of gynecologic oncology patients, particularly those at risk for care access disparities (increased distance to care, rural populations.). METHODS: Patients at all disease/treatment stages completed an anonymous survey during in-person outpatient appointments at an academic comprehensive cancer center from 1/6/2020 to 2/28/2020, conducted prior to the COVID-19 pandemic, before the introduction of telemedicine in this practice. RESULTS: Of 180 patients approached, 170 completed the survey (94.4%). Mean age was 59.6 years; 73.4% identified as White, 23.7% Black, and 2.9% other race. Ovarian cancer was most common (41.2%), followed by endometrial (27.1%), cervical (20.6%), and vaginal/vulvar (7.1%). Most patients traveled > 50 miles for appointments (63.8%); they were more likely from rural counties with significantly higher travel costs/visit ($60.77 vs $37.98, p = 0.026.) The majority expressed interest in using telemedicine (75.7%) or a smartphone app (87.5%) in their care. The majority of patients with difficulty attending appointments (88.9 vs 70.2%, p = 0.02) or from rural counties (88.7% vs 69.6%, p = 0.03) were interested in telemedicine; those with both characteristics reported 100% interest. The majority in both urban and rural counties had home internet access, and reported similarly high rates of daily use (79% vs 75%). Race and age were not associated with differences in internet access or use or telemedicine interest. CONCLUSIONS: Telemedicine is attractive to the majority of patients and may offer financial/logistical advantages. Patients have high internet use rates and comfort with using technology for healthcare. Telemedicine should be incorporated into standard practice beyond the COVID-19 pandemic to reduce healthcare access disparities.

[Standardization of spirometry: 2015 update. Published by German Atemwegsliga, German Respiratory Society and German Society of Occupational and Environmental Medicine]. / Leitlinie zur Spirometrie. Leitlinie der Deutschen Atemwegsliga, der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin und der Deutschen Gesellschaft für Arbeitsmedizin und Umweltmedizin zur Spirometrie.

Spirometry is a simple test and considered the gold standard in lung function. An obstructive ventilatory defect is a disproportionate reduction of maximal airflow from the lung in relation to the maximal volume that can be displaced from the lung. It implies airway narrowing and is defined by a reduced FEV1/FVC ratio below the 5th percentile of the predicted value (lower limit of normal, LLN). A restrictive disorder may be suspected when vital capacity (FVC) is reduced and FEV1/FVC is normal. It is definitely proven, however, only by a decrease in TLC below the 5th percentile of predicted value (LLN). The measurement of TLC by body plethysmography is necessary to confirm or exclude a restrictive defect or hyperinflation of the lung when FVC is below the LLN. 2012 a task force of the ERS published new reference values based on 74,187 records from healthy non-smoking males and females from 26 countries. The new reference equations for the 3-95 age range are now available that include appropriate age-dependent mean values and lower limits of normal (LLN). This presentation aims at providing the reader with recommendations dealing with standardization and interpretation of spirometry.

Effect of eicosapentaenoic acid, protein and amino acids on protein synthesis and degradation in skeletal muscle of cachectic mice.

Atrophy of skeletal muscle reduces both the quality and quantity of life of patients with cancer cachexia. Loss of muscle mass is thought to arise from a reduction in protein synthesis combined with an enhanced rate of protein degradation, and few treatments are available to counteract this process. Eicosapentaenoic acid (EPA) has been shown to attenuate the enhanced protein degradation, but to have no effect on protein synthesis. This study examines the effect of EPA combined with a protein and amino-acid supplementation on protein synthesis and degradation in gastrocnemius muscle of mice bearing the cachexia-inducing MAC16 tumour. Muscles from cachectic mice showed an 80% reduction in protein synthesis and about a 50-fold increase in protein degradation compared with muscles from nontumour-bearing mice of the same age and weight. Treatment with EPA (1 g kg(-1)) daily reduced protein degradation by 88%, but had no effect on protein synthesis. Combination of EPA with casein (5.35 g kg(-1)) also had no effect on protein synthesis, but when combined with the amino acids leucine, arginine and methionine there was almost a doubling of protein synthesis. The addition of carbohydrate (10.7 g kg(-1)) to stimulate insulin release had no additional effect. The combination involving the amino acids produced almost a doubling of the ratio of protein synthesis to protein degradation in gastrocnemius muscle over that of EPA alone. No treatment had a significant effect on tumour growth rate, but the inclusion of amino acids had a more significant effect on weight loss induced by the MAC16 tumour than that of EPA alone. The results suggest that combination therapy of cancer cachexia involving both inhibition of the enhanced protein degradation and stimulation of the reduced protein synthesis may be more effective than either treatment alone.

Iron chelating agents for treating malaria.

BACKGROUND: Researchers are exploring the effects of adding treatments to the main antimalarial regimens in an attempt to reduce mortality from Plasmodium falciparum. Iron chelation is one potential chemotherapeutic adjuvant treatment. Before advocating adjunctive therapy, the effects of iron chelators in improving patient outcomes need to be examined. OBJECTIVES: To assess the effects of iron-chelating agents combined with antimalarial drugs, or iron chelators alone, for treating Plasmodium falciparum malaria in adults and children, in relation to mortality, coma recovery time, parasite clearance, and adverse effects. SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group trials register (up to January 2003), the Cochrane Central Register of Controlled Trials (Cochrane Library, Issue 1, 2003), MEDLINE (January 1966 to January 2003), EMBASE (January 1980 to November 2002), and reference lists of retrieved studies. We also contacted organisations, experts and researchers in the field. SELECTION CRITERIA: All randomised controlled trials comparing iron chelating agents with placebo, or comparing iron chelating agents in conjunction with other antimalarials with antimalarial treatment alone in adults or children with falciparum malaria. DATA COLLECTION AND ANALYSIS: Two reviewers independently applied inclusion criteria and assessed trial quality. One reviewer (HS) extracted data from included studies. Study authors were contacted for missing and additional data. MAIN RESULTS: Seven trials involving 570 participants were included. Two trials involving 435 children compared the iron chelator DFO with placebo and standard treatment. No evidence of benefit or harm was shown in relation to mortality, but studies were small. The risk of experiencing persistent seizures was lower with DFO compared to placebo treatment (RR 0.80, 95% CI 0.67 to 0.95), but adverse effects were more common in the DFO group. One trial involving 45 adults and children compared the orally active iron chelator (deferiprone) with placebo and standard treatment; coma recovery (WMD -27 hrs; 95%CI -34.20 to -19.80) and parasite clearance (WMD -24 hrs; 95%CI -35.27 to -12.73) were significantly faster in the deferiprone group compared to placebo, but clinical significance cannot be assumed from this small trial. The authors reported no side effects during the study. REVIEWER'S CONCLUSIONS: There are insufficient data for any conclusions for both agents tested. There are non-significant trends towards harm (death) and potential benefit (fewer seizures) with DFO. With deferiprone, results suggest possible benefit (shorter coma recovery and parasite clearance). If this topic is considered a priority for further research, larger trials are needed to detect an effect on clinical outcomes; and these trials should also include carefully evaluate adverse effects.

Inhibitors of human and rat testes microsomal 17beta-hydroxysteroid dehydrogenase (17beta-HSD) as potential agents for prostatic cancer.

In a screening programme for inhibitors of human testis 17beta-hydroxysteroid dehydrogenase (17beta-HSD type 3), as potential agents for the treatment of hormone-dependent prostatic cancer, we have used crude human testis microsomal 17beta-hydroxysteroid dehydrogenase as a convenient source of the enzyme. Crude human enzyme was shown to have a similar substrate profile to recombinant Type 3 17beta-HSD from the same source as determined by the low Km/Vmax ratio for the reduction of androstenedione compared to the oxidation of testosterone, and a low level of activity in reduction of oestrone. Screening of a wide range of compounds of different structural types as potential inhibitors of the microsomal enzyme in the reduction step revealed that certain p-benzoquinones and flavones/isoflavones were potent inhibitors of the enzyme, diphenyl-p-benzoquinone (2.7 microM), phenyl-p-benzoquinone (5.7 microM), 7-hydroxyflavone (9.0 microM), baicalein (9.3 microM) and biochanin A (10.8 microM). Some structure-activity relationships within the flavone/isoflavone series are discussed. Studies with rat testis microsomal 17beta-HSD showed that it differed from the human enzyme mainly in its greater ability to accept oestrone as substrate and the pH-optimum for oxidation of testosterone. It was found to be much less sensitive to inhibition by the compounds studied so negating it use as a more readily available tissue for the screening of potential inhibitors.

[Magnetic tomography--new imaging techniques and future perspectives]. / Magnettomografi--nyere bildeteknikker og fremtidsperspektiver.

BACKGROUND: From the very introduction of MRI into medicine, the modality has presented the user a long list of theoretical tissue contrast parameters. The development of MRI has been aimed at turning these theoretical possibilities into practical options. MATERIAL AND METHODS: We give an overview of the new MRI techniques and perspectives for the future based on a literature search and our own experience. RESULTS: Today, the modality offers state-of-the-art anatomical details as well as visualisation of several functional parameters such as perfusion, diffusion, blood oxygen saturation, and tissue temperature. In the near future, MRI may provide absolute quantification of regional perfusion and rate of oxygen consumption in a clinical setting. New vascular and gastrointestinal contrast media will further increase the sensitivity and specificity of MRI. A continuous increase in imaging speed has made MRI capable of providing adequate "fluoroscopic" guidance during interventional procedures, and real-time diagnostic imaging is only few years ahead. INTERPRETATION: The spread of MRI installations will increase as a result of increasing demand for the best and least harmful diagnostic procedure. The main challenge to the MRI community will be to exploit the vast diagnostic possibilities.

Iron chelating agents for treating malaria.

BACKGROUND: Mortality from Plasmodium falciparum malaria remains high; death and sequelae occur in even in patients treated with antimalarial drugs. Researchers are exploring the effects of adding treatments to the main antimalarial regimens in an attempt to reduce mortality. Iron chelation is one potential chemotherapeutic adjuvant treatment. Before advocating adjunctive therapy, the effects of iron chelators in improving patient outcomes needs to be examined. OBJECTIVES: To assess the effects of iron-chelating agents combined with antimalarial drugs, or iron chelators alone, for treating Plasmodium falciparum malaria in adults and children, in relation to mortality, coma recovery time, parasite clearance, and adverse effects. SEARCH STRATEGY: Electronic searches of the Cochrane Library, MEDLINE, and EMBASE, using the standard Cochrane search strategy. Bibliographies of retrieved studies were scrutinized in order to identify further relevant trials. Organisations, experts and other individuals in malaria research were contacted for unpublished studies. SELECTION CRITERIA: All randomised controlled trials of adults or children with P.falciparum malaria. DATA COLLECTION AND ANALYSIS: Trials were identified and extracted by a single reviewer (HS) and checked by a second (MM). Inclusion criteria were applied, and data were extracted independently by both reviewers. Authors were contacted for missing and additional data. Meta-analysis used Relative Risk (RR) and 95% Confidence Intervals. MAIN RESULTS: No evidence of benefit or harm were shown in relation to mortality, but studies were small, and one trial was tending towards more deaths with the intervention when it was stopped. The risk of experiencing persistent seizures was significantly lower with desferrioxamine compared to placebo treatment (RR 0.80, 95% CI 0.67 to 0.95). Many adverse effects were more common in participants treated with desferrioxamine. REVIEWER'S CONCLUSIONS: Trends suggestive of both harm (death) and potential benefit (fewer seizures) are demonstrated in this review. It is not possible to comment on time to event outcomes that include coma recovery or parasitaemia as we are clarifying data with the trialists. Whether to conduct further trials will depend on a judgement about potential benefit.

The diagnostic capacity of forced oscillation and forced expiration techniques in identifying asthma by isocapnic hyperpnoea of cold air.

The measurement of forced expiratory volume in one second (FEV1) is often used to assess the effect of bronchial provocations, and deep inspiration is required beforehand. This may briefly alter the bronchial tone in a variable way in some subjects. The forced oscillation technique (FOT) is a test used to characterize the mechanical impedance of the respiratory system, and prior deep inspiration is not required. We tested the hypothesis that measurable bronchoconstriction would occur in all asthmatic subjects stimulated with isocapnic hyperventilation of dry cold air (IHCA). Twenty patients with mild asthma and nine healthy controls were exposed to IHCA, at 70% of their maximal voluntary ventilatory capacity for 4 min and the results were assessed both by applying the FOT and by measuring FEV1. Optimal cut-off levels were defined by receiver operating characteristic (ROC) curve analyses of the changes in respiratory resistance and reactance at 5-35 Hz, resonant frequency (fres) and FEV1. A positive result was present in the asthmatics when measured by FOT, and using ROC analyses the discriminative capacity to correctly diagnose asthma was greatest for responses in fres; the sensitivity was 89% and the specificity 100%. The sensitivity of FEV1 to correctly diagnose asthma was only 73%, and the specificity 88%. In conclusion, the results of this study suggest that the use of forced expiratory volume in one second for bronchial provocation tests by isocapnic hyperventilation of dry cold air may be misleading and that the bronchoconstriction thus elicited is measured with greater sensitivity and specificity by the forced oscillation technique than by forced expiratory volume in one second.

What happens to patients after upper and lower gastrointestinal tract barium studies?

We investigated the occurrence of new constipation, diarrhea, nausea, vomiting, visible blood in stool, abdominal pain, black stools, belching, and flatus in 324 outpatients following upper or lower gastrointestinal tract barium procedures. We also evaluated the roles of age, sex, patient mobility, and types of barium enema (single- or double-contrast). At least one new symptom was reported after 51% of all examinations. Constipation was the most frequently reported single symptom after barium meal or small bowel examinations. Fifty percent of all constipation occurred following upper gastrointestinal examinations. Abdominal pain was common in patients of the seventh decade, especially following barium enema. Nausea typically followed barium swallow or upper gastrointestinal series. Belching and passage of flatus were the most frequently reported symptoms after barium enema, both single- and double-contrast. No significant relationship between the frequency of symptoms and patient age, sex, or the type of barium enema was established.

Performance of barium examinations after acute myocardial infarction: report of a survey.

A survey of members of the Society of Gastrointestinal Radiologists was conducted to ascertain the standards of practice and timing for elective barium studies of the gastrointestinal tract in patients recovering from acute myocardial infarction. Sixty-two percent of respondents do not have cardiac monitoring apparatus readily available in the fluoroscopy suite. When readily available, such equipment is rarely (42%) or never (58%) used during routine barium examinations. Twenty-four percent of respondents take special precautions when performing examinations on these patients by reducing patient movement, the length of the examination, and the number of radiographs exposed, and by employing cardiac monitoring. Seventy-two (89%) of 81 respondents noted at least one adverse cardiovascular reaction. This was most often chest pain, but there were 10 deaths from cardiac causes. Two-thirds of respondents delay elective barium examinations of any kind for at least 4 weeks after acute myocardial infarction. The remaining one-third perform these studies earlier than 4 weeks. The latter typically limit their studies to the upper gastrointestinal tract (82%), 42% of which are single-contrast; the rest are equally divided between double-contrast and biphasic studies. This minority of radiologists is twice as likely to perform a single-contrast barium enema than a double-contrast barium enema during this period. No such preference for single-contrast (47%) over double-contrast (53%) barium enema is revealed by the majority who delay their elective barium enemas 4 or more weeks. The data indicate a strong preference to defer elective barium examinations a minimum of 4 weeks after acute myocardial infarction. A sizable minority (one-third) of radiologists, however, feel comfortable performing a single-contrast upper gastrointestinal examination at an earlier time.

High dose urography in patients with renal failure. A double blind investigation of iohexol and metrizoate.

The new non-ionic contrast medium iohexol 350 mg I/ml was compared with the ionic contrast medium metrizoate 350 mg I/ml in a double blind, two-group urographic study performed on 20 patients with stable, impaired renal function. A dose of contrast medium of 500 mg I/kg body weight was given to each patient. Iohexol resulted in significantly fewer subjective adverse reactions than metrizoate. A similar image quality was obtained with the two contrast media. No clinically significant difference existed between the two contrast media with respect to influence on blood pressure, pulse or clinical chemical parameters. A tendency to deterioration of renal function after urography was found in both groups, but no difference of statistical significance existed between the two contrast media with respect to possible nephrotoxicity. Inadequate hydration may have been partly responsible for the nephrotoxic effect of the urographic procedure.

Benign (solitary) ulcer of the rectum -- another cause for rectal stricture.

Benign rectal ulcer syndrome is an uncommon cause of lower gastrointestinal bleeding. Patients may present with mild, often recurrent, rectal bleeding frequently ascribed to hemorrhoids. Barium enema may be normal during the early, nonulcerative phase of proctitis. Single (or multiple) ulcers with or without rectal stricture are the hallmarks of the radiographic diagnosis. Radiologic demonstration of the ulcer(s) is not required, however, for the diagnosis. Benign rectal ulcer should be included in the differential diagnosis of benign-appearing rectal strictures.