University Hospital is a large teaching hospital in London, Ontario, Canada, that is affiliated with the University of Western Ontario's Schulich School of Medicine & Dentistry. It is part of the London Health Sciences Centre hospital network and the Lawson Health Research Institute, which manages clinical research across all London hospitals. The hospital was formally opened in September 1972 by Canadian neurosurgeon Wilder Penfield.Neurosurgeon Charles Drake achieved international renown for his innovative surgery for brain aneurysms at University Hospital, which attracted patients and surgeons from around the world to London.
BACKGROUND:Disease control assessment for chronic rhinosinusitis (CRS) remains a challenge. In this study, we develop and psychometrically validate a new patient-reported outcome measure, the Chronic Rhinosinusitis Control Test (CRCT), for assessing CRS control. METHODOLOGY:The CRCT, which includes 8 items and has a score that ranges from 0-31, incorporates the perspectives of key stakeholders (patients and healthcare providers) and was developed incorporating methodologic guidance from the COSMIN initiative and United States Food and Drug Administration. Psychometric validation was performed in line with recommendations from the COSMIN initiative to establish validity, reliability and responsiveness in a sample of 545 CRS patients and with the participation of 23 expert rhinologists. RESULTS:The CRCT has excellent face validity, content validity, concurrent validity, internal consistency, test-retest reliability, and responsiveness. Factor analysis reveals that the CRCT has 2 subdomains: sinonasal and impairment subdomains in addition to a final item related to CRS-related oral corticosteroid usage in the past 3 months. Using a distribution-based and multiple anchorbased methods, the CRCT has a minimal clinically important difference (MCID) of 4 points. After 23 expert rhinologists independently classified all possible combinations of scoring on the CRCT, scores of ≤7 indicate controlled CRS, 8 to 15 (inclusive) partly controlled CRS and ≥16 uncontrolled CRS. CONCLUSION:The CRCT is a psychometrically validated measure of CRS control. CRS may be classified as controlled based on CRCT score ≤7, partly controlled with CRCT score of 8 to 15 (inclusive) and uncontrolled with CRCT score ≥16. The MCIDs for improvement and worsening are both 4.
Accurate visualization of interventional devices, such as medical needles, in relation to the procedural target is critical for the safe and effective guidance of interventional procedures. Ultrasound (US) imaging is widely used for guiding percutaneous needle interventions, but the 2-D nature of most clinical US probes limits accurate 3-D localization, particularly of the needle tip. In this work, we introduce a novel system that combines volumetric US imaging with 3-D needle tracking. The system integrates a fiber-optic hydrophone (FOH) into the needle and employs a 2-D sparse spiral US array with 256 active elements. Real-time volumetric US imaging is achieved using plane-wave imaging with the sparse array, while 3-D needle tip tracking is enabled through communications between the US probe and the FOH. The system achieved spatial resolutions (mean +/- standard deviation) of 2.06 +/- 0.29 mm (lateral), 2.26 +/- 0.23 mm (elevational), and 0.69 +/- 0.12 mm (axial) at depths ranging from 10 to 40 mm. The tracking accuracy was better than 0.30 +/- 0.21 mm. The clinical potential of the system was demonstrated using a nerve block training phantom. This study presents a proof-of-concept for an integrated solution that enables simultaneous volumetric anatomical imaging and precise 3-D needle tip tracking. The proposed system holds strong potential to enhance the efficacy and safety of image-guided interventional procedures by providing real-time 3-D anatomical visualization and accurate needle tracking.
Curative-intent multimodality treatment-combining local treatments such as surgery or radiotherapy with systemic therapy-is the cornerstone of care in stage II-III non-small cell lung cancer (NSCLC). Since 2017, the systemic therapy backbones with multimodality treatment have undergone a dramatic transformation, driven by a series of pivotal, practice-changing clinical trials. Immunotherapy and targeted therapies, previously confined to the advanced/metastatic setting, are now firmly embedded in curative-intent regimens. Maintenance immunotherapy following chemoradiation in unresectable stage III disease, adjuvant tyrosine kinase inhibitors in resected epidermal growth factor receptor/anaplastic lymphoma kinase-positive tumours, neoadjuvant and perioperative chemoimmunotherapy in resectable stage II/III NSCLC and adjuvant chemoimmunotherapy following resection have all become new standards of care.This state-of-the-art review synthesises the key evidence underpinning these developments, highlights their clinical implications and identifies challenges to implementation-particularly the need for redefined clinical pathways, accurate pretreatment staging, timely biomarker testing and coordinated multidisciplinary decision-making. A novel treatment algorithm is proposed to support clinicians in navigating these complex treatment choices.We conclude that immunotherapy and targeted agents have irrevocably altered curative-intent NSCLC care, establishing multiple new standards that sometimes overlap and compete. In the surgical multimodality treatment pathway, neoadjuvant and perioperative chemoimmunotherapy offers the opportunity to increase the uptake of systemic therapy in comparison to adjuvant therapy and is considered by these authors to represent the optimal treatment path for most patients.In this unprecedented era of therapeutic expansion, the greatest challenge is no longer the absence of effective treatments, but the complexity of selecting, sequencing and delivering them, as well as patient optimisation. Lung cancer services must evolve through proactive pathway redesign, integrated diagnostics and new models of multidisciplinary care. High-quality, biomarker-driven and patient-centred care is now achievable for many patients with stage II-III NSCLC-but it will require system-level adaptation to deliver it.
Abstract Introduction Inflatable penile prostheses (IPPs) are a definitive treatment for refractory erectile dysfunction, but infection remains a significant complication. Infection-retardant (rifampicin-minocycline) and hydrophilic polyvinylpyrrolidone coatings, have been developed to mitigate this risk. Antimicrobial solutions like vancomycin-gentamicin (VG) and 0.05% chlorhexidine gluconate (CHG, recently in the form of Irrisept) are commonly used for device dipping and irrigation, yet conflicting in-vitro studies have created uncertainty about their comparative efficacy. Objective This review aims to analyse the microbiological principles and methodological challenges in the currently available pre-clinical studies of antimicrobial solutions for IPPs. Methods A literature review was conducted on PubMed and Embase (January 5, 2025) and Boolean-operators were used to refine the search, with inclusion criteria limited to English-language, full-text in-vitro studies focusing on infection-related properties of prosthetics. Clinical studies and those addressing non-infection-related characteristics were excluded. The review team, including a microbiologist, critically analysed methodologies from studies, including microbial selection, biofilm assessment, and antimicrobial efficacy testing (zone of inhibition assays, colony-forming unit quantification). Special attention was given to the experimental designs of Karpman et al. and Simhalet al., which employed divergent approaches to evaluate CHG and VG solutions. Results A total of 54 studies were reviewed. The review highlighted the polymicrobial nature of IPP infections, with gram-positive bacteria predominating alongside gram-negative pathogens and fungi. Karpman et al. tested Irrisept against seven microorganisms, reporting significant reductions in bacterial load after dipping and irrigation. In contrast, Simhal et al. focused on Methicillin sensitive S.aureus and found VG solutions superior to Irrisept, particularly when implants were pre-treated. Significant methodological differences were found between studies, specifically microbial inoculum quantity, treatment sequence, and assessment techniques thus rendering comparison between studies challenging. Conclusions The contrasting conclusions of the Karpman and Simhal studies underscore the complexity of evaluating antimicrobial solutions for IPPs, but this review highlights the need for a consensus approach as to how such studies are conducted. Disclosure No
