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  • 1
    In: European Journal of Clinical Investigation, Wiley, Vol. 53, No. 10 ( 2023-10)
    Abstract: Cancer is a well‐known risk factor for venous thromboembolism (VTE). A combined strategy of D‐dimer testing and clinical pre‐test probability is usually used to exclude VTE. However, its effectiveness is diminished in cancer patients due to reduced specificity, ultimately leading to a decreased clinical utility. This review article seeks to provide a comprehensive summary of how to interpret D‐dimer testing in cancer patients. Methods In accordance with PRISMA standards, literature pertaining to the diagnostic and prognostic significance of D‐dimer testing in cancer patients was carefully chosen from reputable sources such as PubMed and the Cochrane databases. Results D‐dimers have not only a diagnostic value in ruling out VTE but can also serve as an aid for rule‐in if their values exceed 10‐times the upper limit of normal. This threshold allows a diagnosis of VTE in cancer patients with a positive predictive value of more than 80%. Moreover, elevated D‐dimers carry important prognostic information and are associated with VTE reoccurrence. A gradual increase in risk for all‐cause death suggests that VTE is also an indicator of biologically more aggressive cancer types and advanced cancer stages. Considering the lack of standardization for D‐dimer assays, it is essential for clinicians to carefully consider the variations in assay performance and the specific test characteristics of their institution. Conclusions Standardizing D‐dimer assays and developing modified pretest probability models specifically for cancer patients, along with adjusted cut‐off values for D‐dimer testing, could significantly enhance the accuracy and effectiveness of VTE diagnosis in this population.
    Type of Medium: Online Resource
    ISSN: 0014-2972 , 1365-2362
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2004971-7
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  • 2
    In: European Journal of Clinical Investigation, Wiley
    Abstract: To investigate the potential of radiomic features and dual‐source dual‐energy CT (DECT) parameters in differentiating between benign and malignant mediastinal masses and predicting patient outcomes. Methods In this retrospective study, we analysed data from 90 patients (38 females, mean age 51 ± 25 years) with confirmed mediastinal masses who underwent contrast‐enhanced DECT. Attenuation, radiomic features and DECT‐derived imaging parameters were evaluated by two experienced readers. We performed analysis of variance (ANOVA) and Chi‐square statistic tests for data comparison. Receiver operating characteristic curve analysis and Cox regression tests were used to differentiate between mediastinal masses. Results Of the 90 mediastinal masses, 49 (54%) were benign, including cases of thymic hyperplasia/thymic rebound ( n  = 10), mediastinitis ( n  = 16) and thymoma ( n  = 23). The remaining 41 (46%) lesions were classified as malignant, consisting of lymphoma ( n  = 28), mediastinal tumour ( n  = 4) and thymic carcinoma ( n  = 9). Significant differences were observed between benign and malignant mediastinal masses in all DECT‐derived parameters ( p  ≤ .001) and 38 radiomic features ( p  ≤ .044) obtained from contrast‐enhanced DECT. The combination of these methods achieved an area under the curve of .98 (95% CI, .893–1.000; p   〈  .001) to differentiate between benign and malignant masses, with 100% sensitivity and 91% specificity. Throughout a follow‐up of 1800 days, a multiparametric model incorporating radiomic features, DECT parameters and gender showed promising prognostic power in predicting all‐cause mortality (c‐index = .8 [95% CI, .702–.890], p   〈  .001). Conclusions A multiparametric approach combining radiomic features and DECT‐derived imaging biomarkers allows for accurate and noninvasive differentiation between benign and malignant masses in the anterior mediastinum.
    Type of Medium: Online Resource
    ISSN: 0014-2972 , 1365-2362
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2004971-7
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  • 3
    In: Fundamental & Clinical Pharmacology, Wiley, Vol. 37, No. 3 ( 2023-06), p. 519-529
    Abstract: Upcoming experimental and epidemiological data have identified the endogenous non‐proteinogenic amino acid L‐homoarginine (L‐hArg) not only as a novel biomarker for cardiovascular disease but also as being directly involved in the pathogenesis of cardiac dysfunction. The association of low L‐hArg levels with adverse cardiovascular events and mortality has proposed the idea of nutritional supplementation to rescue pathways inversely associated with cardiovascular health. Subsequent clinical and experimental studies contributed significantly to our knowledge of potential effects on the cardiorenal axis, acting either as a biomarker or a cardiovascular active agent. In this review article, we provide a comprehensive summary of the L‐hArg metabolism, pathophysiological aspects, and current developments in the field of experimental and clinical evidence in favor of protective cardiovascular effects. Establishing a reliable biomarker to identify patients at high risk to die of cardiovascular disease represents one of the main goals for tackling this disease and providing individual therapeutic guidance.
    Type of Medium: Online Resource
    ISSN: 0767-3981 , 1472-8206
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2006242-4
    SSG: 15,3
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  • 4
    In: NMR in Biomedicine, Wiley, Vol. 36, No. 2 ( 2023-02)
    Abstract: Whole‐body magnetic resonance imaging (MRI) has become increasingly popular in oncology. However, the long acquisition time might hamper its widespread application. We sought to assess and compare free‐breathing sequences with conventional breath‐hold examinations in whole‐body MRI using an automated workflow process. This prospective study consisted of 20 volunteers and six patients with a variety of pathologies who had undergone whole‐body 1.5‐T MRI that included T1‐weighted radial and Dixon volumetric interpolated breath‐hold examination sequences. Free‐breathing sequences were operated by using an automated user interface. Image quality, diagnostic confidence, and image noise were evaluated by two experienced radiologists. Additionally, signal‐to‐noise ratio was measured. Diagnostic performance for the overall detection of pathologies was assessed using the area under the receiver operating characteristics curve (AUC). Study participants were asked to rate their examination experiences in a satisfaction survey. MR free‐breathing scans were rated as at least equivalent to conventional MR scans in more than 92% of cases, showing high overall diagnostic accuracy (95% [95% CI 92–100]) and performance (AUC 0.971, 95% CI 0.942–0.988; p   〈  0.0001) for the assessment of pathologies at simultaneously reduced examination times (25 ± 2 vs. 32 ± 3 min; p   〈  0.0001). Interrater agreement was excellent for both free‐breathing (ϰ = 0.96 [95% CI 0.88–1.00]) and conventional scans (ϰ = 0.93 [95% CI 0.84–1.00] ). Qualitative and quantitative assessment for image quality, image noise, and diagnostic confidence did not differ between the two types of MR image acquisition (all p   〉  0.05). Scores for patient satisfaction were significantly better for free‐breathing compared with breath‐hold examinations ( p  = 0.0145), including significant correlations for the grade of noise (r = 0.79, p   〈  0.0001), tightness (r = 0.71, p   〈  0.0001), and physical fatigue (r = 0.52, p  = 0.0065). In summary, free‐breathing whole‐body MRI in tandem with an automated user interface yielded similar diagnostic performance at equivalent image quality and shorter acquisition times compared to conventional breath‐hold sequences.
    Type of Medium: Online Resource
    ISSN: 0952-3480 , 1099-1492
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2002003-X
    detail.hit.zdb_id: 1000976-0
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  • 5
    In: European Journal of Clinical Investigation, Wiley, Vol. 53, No. 4 ( 2023-04)
    Abstract: D‐dimer testing is known to have a high sensitivity at simultaneously low specificity, resulting in nonspecific elevations in a variety of conditions. Methods This retrospective study sought to assess diagnostic and prognostic features of D‐dimers in cancer patients referred to the emergency department for suspected pulmonary embolism (PE) and deep vein thrombosis (DVT). In total, 526 patients with a final adjudicated diagnosis of PE ( n  = 83) and DVT ( n  = 69) were enrolled, whereas 374 patients served as the comparative group, in which venous thromboembolism (VTE) has been excluded. Results For the identification of VTE, D‐dimers yielded the highest positive predictive value of 96% (95% confidence interval (CI), 85–99) at concentrations of 9.9 mg/L and a negative predictive value of 100% at .6 mg/L (95% CI, 97–100). At the established rule‐out cut‐off level of .5 mg/L, D‐dimers were found to be very sensitive (100%) at a moderate specificity of nearly 65%. Using an optimised cut‐off value of 4.9 mg/L increased the specificity to 95% for the detection of life‐threatening VTE at the cost of moderate sensitivities (64%). During a median follow‐up of 30 months, D‐dimers positively correlated with the reoccurrence of VTE ( p  = .0299) and mortality in both cancer patients with VTE ( p   〈  .0001) and without VTE ( p  = .0008). Conclusions Although D‐dimer testing in cancer patients is discouraged by current guidelines, very high concentrations above the 10‐fold upper reference limit contain diagnostic and prognostic information and might be helpful in risk assessment, while low concentrations remain useful for ruling out VTE.
    Type of Medium: Online Resource
    ISSN: 0014-2972 , 1365-2362
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2004971-7
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  • 6
    In: Journal of Applied Clinical Medical Physics, Wiley, Vol. 24, No. 2 ( 2023-02)
    Abstract: This prospective study sought to evaluate potential savings of radiation dose to medical staff using real‐time dosimetry coupled with visual radiation dose feedback during angiographic interventions. For this purpose, we analyzed a total of 214 angiographic examinations that consisted of chemoembolizations and several other types of therapeutic interventions. The Unfors RaySafe i2 dosimeter was worn by the interventionalist at chest height over the lead protection. A total of 110 interventions were performed with real‐time radiation dosimetry allowing the interventionalist to react upon higher x‐ray exposure and 104 examinations served as the comparative group without real‐time radiation monitoring. By using the real‐time display during interventions, the overall mean operator radiation dose decreased from 3.67 (IQR, 0.95–23.01) to 2.36 μSv (IQR, 0.52–12.66) (−36%; p  = 0.032) at simultaneously reduced operator exposure time by 4.5 min ( p  = 0.071). Dividing interventions into chemoembolizations and other types of therapeutic interventions, radiation dose decreased from 1.31 (IQR, 0.46‐3.62) to 0.95 μSv (IQR, 0.53‐3.11) and from 24.39 (IQR, 12.14‐63.0) to 10.37 μSv (IQR, 0.85‐36.84), respectively, using live‐screen dosimetry ( p  ≤ 0.005). Radiation dose reductions were also observed for the participating assistants, indicating that they could also benefit from real‐time visual feedback dosimetry during interventions (−30%; p  = 0.039). Integration of real‐time dosimetry into clinical processes might be useful in reducing occupational radiation exposure time during angiographic interventions. The real‐time visual feedback raised the awareness of interventionalists and their assistants to the potential danger of prolonged radiation exposure leading to the adoption of radiation‐sparing practices. Therefore, it might create a safer environment for the medical staff by keeping the applied radiation exposure as low as possible.
    Type of Medium: Online Resource
    ISSN: 1526-9914 , 1526-9914
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2010347-5
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