Incidence and risk factors of immediate hypersensitivity reactions associated with low-osmolar iodinated contrast media: a longitudinal study based on a real-time monitoring system

OBJECTIVES: We investigated the incidence of immediate hypersensitivity reaction (HSR) caused by different types of low-osmolar contrast media (LOCM) and cumulative exposure to LOCM. METHODS: This cohort study included all consecutive patients who underwent LOCM-enhanced computed tomography from 2012 through 2014. We assessed 5 LOCM (iobitridol, iohexol, iomeprol, iopamidol, and iopromide). All patients were monitored for adverse events, and new symptoms and signs were recorded in real time using the Contrast Safety Monitoring and Management System (CoSM2oS). RESULTS: The overall incidence of immediate HSR to LOCM was 0.97% (2004 events resulting from 205 726 exposures). Incidence differed significantly depending on whether the patient had a previous history of HSR to LOCM (0.80% in patients with no history and 16.99% in patients with a positive history of HSR to LOCM, P=.001). The incidence of HSR to individual LOCM ranged from 0.72% (iohexol) to 1.34% (iomeprol), although there were no significant differences across the 5 LOCM. A longitudinal analysis demonstrated that the incidence of HSR increased gradually with more frequent previous exposure to LOCM (HR=2.006 [95%CI, 1.517-2.653], P<.001). However, this cumulative increase in risk was observed in patients who had experienced HSR to LOCM, but not in those who had not. CONCLUSION: The incidence of HSR did not differ significantly across the 5 LOCM assessed in the study. Repeated exposure to LOCM did not increase the risk of HSR among patients who had never experienced HSR to LOCM

OBJETIVOS: Estudio de la incidencia de reacciones de hipersensibilidad inmediata frente a diferentes medios de contraste de baja osmolaridad, así como la incidencia global de dichas reacciones con estos contrastes yodados. MÉTODOS: Estudio de cohortes en el que se incluyó de forma consecutiva a todos los pacientes a los que se realizó TAC con contraste yodados de baja osmolaridad durante los años 2012 a 2014. Se emplearon 5 contrastes yodados: iobitridol, iohexol, iomeprol, iopamidol, y iopromide. En todos los pacientes se valoró la presencia de efectos adversos. La aparición de cualquier síntoma fue registrada en el mismo momento de su aparición en el Contrast Safety Monitoring and Management System (CoSM2oS) en tiempo real. RESULTADOS: La incidencia global de reacciones de hipersensibilidad inmediata a medios de contraste yodados de baja osmolaridad fue de 0,97% (2.004 reacciones en 205.726 exploraciones con contraste). La incidencia fue significativamente mayor en los pacientes con historia previa de reacción adversa (16,99%) frente a tan solo 0,80% en los pacientes sin historia previa de reacción (p=.001). La incidencia de estas reacciones osciló desde el 0,72% con iohexol al 1,34% con iomeprol, sin alcanzar diferencias significativas entre los cinco contrastes. Un análisis longitudinal mostró que la incidencia de reacciones inmediatas de hipersensiblidad se incrementa de forma gradual en los pacientes con historia de reacciones previas con medios de contraste yodados (CR=2,006 (1.517-2.653), p<.001). este incremento solo se observaba en los pacientes con historia de reacciones previas, pero no en los sujetos sin historia previa de estas reacciones. CONCLUSIÓN: La incidencia de las reacciones de hipersensibilidad inmediata no fue significativamente diferente entre ninguno de los 5 contrastes utilizados en el estudio. Exposiciones repetidas a estos medios de contraste no aumentan el riesgo de este tipo de reacciones de hipersensibilidad inmediata en los pacientes que no habían presentado previamente este tipo de reacciones

Reactive atmospheric pressure plasma for highly efficient removal of structure-directing agents from zeolite thin films.

We present a novel approach to remove the structure-directing agent (SDA) from as-synthesized zeolites using an atmospheric pressure plasma jet (APPJ). This reduces the time required to less than 60 seconds as compared to the existing thermal calcination, whose durations range from hours to days. The highly reactive plasma also results in a pronounced Q(3)-to-Q(4) transformation in the pure-silica zeolite MFI.

A comparative study of two- versus one-lung ventilation for needlescopic bleb resection.

This prospective study was conducted to evaluate the feasibility of two-lung (TL) ventilation with low tidal volume anaesthesia compared with one-lung (OL) ventilation for needlescopic bleb resection. Patients with spontaneous pneumothorax that underwent bleb resection with a 2-mm thoracoscope were enrolled. During the operation, the tidal volume was set at 4.0 mL·kg⁻¹ in the TL group and 8.0 mL·kg⁻¹ in the OL group; the respiration rate was set at 23 and 12 breaths·min⁻¹, respectively, at the same inspiratory oxygen fraction (50%). A total of 108 patients (55 patients in the TL group and 53 in the OL group) were included in this study. Airway pressure was significantly lower in the TL group (mean ± sd 8.0 ± 3.3 versus 24.0 ± 3.9 mmHg in the OL group; p<0.001). The time from endotracheal intubation to the incision was 17.1 ± 4.0 min in the TL group and 35.3 ± 7.6 min in the OL group, which was significantly different (p<0.001). However, the operation time was not different in comparisons between the two groups. Therefore, the total anaesthesia time was significantly longer in the OL group (77.9 ± 21.6 versus 64.9 ± 14.7 min in the TL group; p = 0.002). Needlescopic bleb resection using TL ventilation anaesthesia with low tidal volume was technically feasible, cost-effective and time-saving compared with OL ventilation anaesthesia.

Needlescopy-assisted resection of pulmonary nodule after dual localisation.

The aim of this study was to evaluate the feasibility of dual localisation with hookwire and lipiodol before needlescopy-assisted resection for pulmonary nodule. Computed tomography-guided dual marking was performed on 36 pulmonary nodules of 32 patients and needlescopy-assisted resection was performed monitored by C-arm fluoroscopy. The mean age of the patients was 58 ± 12 (range 12-77) yrs. The mean size of the nodules was 7.5 ± 3.7 (3-17) mm. Their mean distance from the pleural surface was 7.3 ± 7.5 (0-35) mm. There were nine pure ground-glass opacity lesions, five semi-solid lesions and 22 solid lesions. The time of the dual localisation procedure was 13.1 ± 4.8 (7-23) min. Complications of the marking were pneumothorax in nine patients, and intrapulmonary bleeding in three. One hookwire dislodged during the operation. All nodules were successfully resected under needlescopy without conversion to a conventional thoracoscopy (5 mm or 10 mm thoracoscopy) or a minithoracotomy. There was no complication related to needlescopy-assisted resection. Dual marking with hookwire and lipiodol is a safe and none time consuming procedure, and needlescopy-assisted lung resection for small nodules is technically feasible and useful for histological diagnosis and treatment.