Research Spotlight

Michelena, H. I., A. D. Corte, A. Evangelista, J. J. Maleszewski, W. D. Edwards, M. J. Roman, R. B. Devereux, B. Fernández, F. M. Asch, A. J. Barker, L. M. Sierra-Galan, L. De Kerchove, S. M. Fernandes, P. W. M. Fedak, E. Girdauskas, V. Delgado, S. Abbara, E. Lansac, S. K. Prakash, M. M. Bissell, B. A. Popescu, M. D. Hope, M. Sitges, V. H. Thourani, P. Pibarot, K. Chandrasekaran, P. Lancellotti, M. A. Borger, J. K. Forrest, J. Webb, D. M. Milewicz, R. Makkaar, M. B. Leon, S. P. Sanders, M. Markl, V. A. Ferrari, W. C. Roberts, J. K. Song, P. Blanke, C. S. White, S. Siu, L. G. Svensson, A. C. Braverman, J. Bavaria, T. M. Sundt, G. El Khoury, R. De Paulis, M. Enriquez-Sarano, J. J. Bax, C. M. Otto and H. J. Schäfers (2021). “International Consensus Statement on Nomenclature and Classification of the Congenital Bicuspid Aortic Valve and Its Aortopathy, for Clinical, Surgical, Interventional and Research Purposes.” Radiol Cardiothorac Imaging 3(4): e200496.

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This International Consensus Classification and Nomenclature for the congenital bicuspid aortic valve condition recognizes 3 types of bicuspid valves: 1. The fused type (right-left cusp fusion, right-non-coronary cusp fusion and left-non-coronary cusp fusion phenotypes); 2. The 2-sinus type (latero-lateral and antero-posterior phenotypes); and 3. The partial-fusion (forme fruste) type. The presence of raphe and the symmetry of the fused type phenotypes are critical aspects to describe. The International Consensus also recognizes 3 types of bicuspid valve-associated aortopathy: 1. The ascending phenotype; 2. The root phenotype; and 3. Extended phenotypes.

Ramsay, M. (2021). “Ventilation Monitoring.” Anesthesiol Clin 39(3): 403-414.

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Ventilation or breathing is vital for life yet is not well monitored in hospital or at home. Respiratory rate is a neglected vital sign and tidal volumes together with breath sounds are checked infrequently in many patients. Medications with the potential to depress ventilation are frequently administered, and may be accentuated by obesity causing airway obstruction in the form of sleep apnea. Sepsis may adversely affect ventilation by causing an increase in respiratory rate, often a very early sign of infection. Changes in ventilation may be early signs of deterioration in the patient.

Vadhan, J. D., K. M. Raj and S. D. Raj (2021). “Is there a doctor on the plane? A review of in-flight emergencies for the on-board radiologist.” Clin Imaging 76: 265-273.

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In-flight medical emergencies (IFME) are the acute on-service events involving illness or injury to a passenger with the potential for long-term health compromise. With the continuously rising number of flights available, both domestically and internationally, it is conceivable that the number of IFMEs will similarly continue to rise. Although most of these instances are relatively self-limited, the rare instance of a severe occurrence justifies preparation, both from in-flight staff and healthcare providers traveling on these flights. Given these events’ sporadic nature and the variable availability of medical support, all physicians need to understand their in-flight ethical and legal capabilities, the available medical supplies, and the most likely etiologies to manage such situations successfully. Most radiologists rarely utilize the hands-on, clinical skills developed in medical school or internship for emergencies beyond allergic contrast reactions. Therefore, they may not be adept in caring for patients during an IFME. As such, we present a thorough overview and literature review for the radiologist regarding the management of various acute IFMEs, with consideration for ethical and legal precedence and a review of medical equipment available on-board.

Law, R. J., V. Chandrasekhara, A. Bhatt, J. C. Bucobo, A. P. Copland, K. Krishnan, N. A. Kumta, R. Pannala, M. A. Parsi, E. F. Rahimi, M. Saumoy, G. Trikudanathan, A. J. Trindade, J. Yang and D. R. Lichtenstein (2021). “Lumen-apposing metal stents (with videos).” Gastrointest Endosc 94(3): 457-470.

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BACKGROUND AND AIMS: Lumen-apposing metal stents (LAMSs) are a novel class of devices that have expanded the spectrum of endoscopic GI interventions. LAMSs with their dumbbell configuration, short saddle length, and large inner luminal diameter provide favorable stent characteristics to facilitate anastomosis formation between the gut lumen and adjacent structures. METHODS: The MEDLINE database was searched through April 2021 for articles related to LAMSs by using additional relevant keywords such as “walled-off pancreatic necrosis,” “pseudocysts,” “pancreatic fluid collection,” “cholecystitis,” “gastroenterostomy,” in addition to “endoscopic treatment” and “endoscopic management,” among others. RESULTS: This technology review describes the full spectrum of LAMS designs and delivery systems, techniques for deployment, procedural outcomes, safety, training issues, and financial considerations. CONCLUSIONS: Although LAMSs were initially introduced for drainage of pancreatic pseudocysts and walled-off necrosis, the versatility of these devices has led to a variety of off-label uses including gallbladder drainage, enteric bypass with the creation of gastroenterostomies, and treatment of luminal GI strictures.

Powers, M. B., E. Carl, A. Levihn-Coon, M. Van Veldhuizen, A. Caven, J. Pogue, M. Fresnedo, E. D. Turner, M. Adams, K. Leonard, H. Conroy, C. Lantrip, T. Caven, C. Isbell, J. Regner, E. Garmon, M. Foreman, W. Miller, L. A. Fares, P. Carlbring, M. W. Otto, D. N. Weiss, J. Hughes, J. M. Bernhardt, R. Roy, J. Oh, R. Copt, J. MacClements, A. M. Warren, B. Rosenfield, D. Rosenfield, S. Minns, M. J. Telch and J. A. J. Smits (2021). “Nonpharmacologic Pain Management Among Hospitalized Inpatients: A Randomized Waitlist-Controlled Trial of Standard Virtual Reality (CGI VR) Versus Video Capture VR (360 degrees 3D/Stereoscopic Video Capture VR).” Clin J Pain 37(9): 678-687.

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OBJECTIVES: Nonpharmacologic pain management strategies are needed because of the growing opioid epidemic. While studies have examined the efficacy of virtual reality (VR) for pain reduction, there is little research in adult inpatient settings, and no studies comparing the relative efficacy of standard animated computer-generated imagery (CGI) VR to Video Capture VR (360 degrees 3D/stereoscopic Video Capture VR). Here, we report on a randomized controlled trial of the relative efficacy of standard CGI VR versus Video Capture VR (matched for content) and also compared the overall efficacy of VR to a waitlist control group. MATERIALS AND METHODS: Participants (N=103 hospitalized inpatients reporting pain) were randomized to 1 of 3 conditions: (1) waitlist control, (2) CGI VR, or (3) Video Capture VR. The VR and waitlist conditions were 10 minutes in length. Outcomes were assessed pretreatment, post-treatment, and after a brief follow-up. RESULTS: Consistent with hypotheses, both VR conditions reduced pain significantly more relative to the waitlist control condition (d=1.60, P<0.001) and pain reductions were largely maintained at the brief follow-up assessment. Both VR conditions reduced pain by ∼50% and led to improvements in mood, anxiety, and relaxation. Contrary to prediction, the Video Capture VR condition was not significantly more effective at reducing pain relative to the CGI VR condition (d=0.25, P=0.216). However, as expected, patients randomized to the Video Capture VR rated their experience as more positive and realistic (d=0.78, P=0.002). DISCUSSION: Video Capture VR was as effective as CGI VR for pain reduction and was rated as more realistic.