American Society Research Articles

Meeting Abstracts from the 2025 Annual Scientific Meeting of the American Society of Colon and Rectal Surgeons

Meeting Abstracts from the 2025 Annual Scientific Meeting of the American Society of Colon and Rectal Surgeons

Costs of Academic Engagement in Organized Neurosurgery in the United States.

Organized neurosurgery offers innumerable opportunities for scientific exchange, networking, and continuing medical education (CME). National, regional, and state societies and meetings have rapidly proliferated across neurosurgery, as have neurosurgical-associated publications and journals. This study sought to review individual costs incurred by neurosurgeons seeking engagement in organized neurosurgery to illustrate the costs associated with participation. National, regional, and state neurosurgery societies were identified, and associated annual meetings were recorded. Leading neurosurgery journals, as determined by reputation and impact factor, were selected. Data unavailable online were acquired through direct communication with the respective organization. American Board of Neurological Surgeons board-certification costs were acquired and compared with board-certification costs in comparable specialties (orthopedic surgery (Ortho), plastic surgery (PS), general surgery (GS), neurology). Baseline academic engagement was defined as two general society memberships, two annual meeting registrations, and respective board certification. A CME credit-per-dollar value was created to measure the relative financial value of CME. A total of 31 societies, 23 meetings, and 18 journals were identified. Society membership costs included American Association of Neurological Surgeons ($1100), Congress of Neurological Surgeons ($990), Society of NeuroInterventional Surgery ($775), and Cervical Spine Research Society ($950). Meetings with the greatest registration fees included the Society of Neurological Surgeons ($1800) and the American Society of Pediatric Neurosurgeons ($1675) annual meetings. Individual journal subscription costs included Journal of Neurosurgery ($636), Neurosurgery ($643), Spine ($1188), and World Neurosurgery ($909). In our limited comparison, the specialty of neurosurgery had the greatest baseline academic engagement cost ($11,588; PS: $8105; Ortho: $7013; GS: $5570; neurology: $4640). Costs of nontraditional CME are significantly less compared with traditional, meeting-driven CME opportunities. Organized neurosurgery incurs major individual costs by way of society membership, meeting registration, and journal subscriptions. Rising costs for engagement are substantial and may not be sustainable when contrasted with unchanged CME reimbursement, prompting dialog to identify sources of subsidization.

Invasive Validation of the Echocardiographic Assessment of Left Ventricular Diastology Postacute Coronary Syndrome

ABSTRACTBackgroundDiastolic dysfunction (DD) is a negative predictor in acute coronary syndrome (ACS). The 2016 American Society of Echocardiography (ASE) and the European Association of Cardiac Imaging (EACVI) DD guidelines (2016 ASE/EACVI guidelines) were validated in stable patients. We assessed the effect of implementing the 2016 ASE/EACVI guidelines in a population of patients with high‐risk ACS by correlating invasively measured left ventricular diastolic pressures or pulmonary capillary wedge pressure (PCWP) within 8 h of the echocardiography estimated left ventricle (LV) filling pressures and determined how easily general cardiologists could apply the 2016 ASE/EACVI guideline parameters to see if this affects accuracy.MethodsTwo groups of independent investigators, group FT, full‐time (FT) echocardiography consultants, and group PT, part‐time (PT) board‐certified general cardiologists, blinded to each other and the invasive LV measurements, reviewed digitally stored echocardiography images. The researchers applied the 2016 DD guidelines definitions to 101 (24% females, mean age 57.2 ± 12.5, and a mean BSA 1.8 ± 0.2) high‐risk ACS troponin I‐positive patients admitted to the coronary care unit between December 2007 and February 2018. DD grade assessment using 2009 guidelines was obtained from the echocardiography reports.ResultsThe 2009 ASE/EACVI guideline results showed 0.58 sensitivity and 0.74 specificity. The 2016 ASE/EACVI guidelines in the FT group had 0.46 sensitivity and 0.74 specificity, and in the PT group, 0.45 sensitivity and 0.86 specificity.ConclusionsThe agreement with 2016 ASE/EACVI guideline definitions in high‐risk ACS patients was weak to intermediate. The 2016 ASE/EACVI guidelines classification and the noninvasive left ventricular filling pressure assessment were easy to implement compared to the 2009 ASE/EACVI guidelines. Our study validates the 2016 ASE/EACVI guideline algorithm in patients with high‐risk ACS.

Predicting Outcomes Following Carotid Artery Stenting Using Machine Learning.

Carotid artery stenting (CAS) carries important perioperative risks. Outcome prediction tools may help guide clinical decision-making but remain limited. We developed machine learning (ML) algorithms that predict 30-day outcomes following transfemoral CAS. The National Surgical Quality Improvement Program (NSQIP) targeted vascular database was used to identify patients who underwent transfemoral CAS between 2011 and 2021. Input features included 36 preoperative demographic/clinical variables. The primary outcome was a 30-day major adverse cardiovascular event (MACE; composite of stroke, myocardial infarction [MI], or death). The secondary outcomes were 30-day stroke, MI, death, carotid-related morbidity, other morbidity, non-home discharge, and unplanned readmission. Our data were split into training (70%) and test (30%) sets. Using 10-fold cross-validation, we trained six ML models using preoperative features with logistic regression as the baseline comparator. The primary model evaluation metric was area under the receiver operating characteristic curve (AUROC). Model robustness was evaluated with calibration plot and Brier score. Variable importance scores were calculated to determine the top 10 predictive features. Performance was assessed on subgroups based on age, sex, race, ethnicity, symptom status, stent type, and urgency. Overall, 2093 patients underwent CAS during the study period. Thirty-day MACE occurred in 130 (6.2%) patients. The best-performing prediction model for 30-day MACE was XGBoost, achieving an AUROC (95% CI) of 0.93 (0.92-0.94). In comparison, logistic regression had an AUROC (95% CI) of 0.67 (0.65-0.68), and existing tools in the literature demonstrate AUROCs ranging from 0.58 to 0.74. For secondary outcomes, XGBoost achieved AUROCs between 0.86 and 0.97. The calibration plot showed good agreement between predicted and observed event probabilities with a Brier score of 0.02. The top three predictive features in our algorithm were (1) symptomatic carotid stenosis, (2) age, and (3) American Society of Anesthesiologists classification. Model performance remained robust on all subgroup analyses of specific demographic and clinical populations. Our ML models accurately predict 30-day outcomes following transfemoral CAS using preoperative data. They have the potential for important utility in guiding risk-mitigation strategies for patients being considered for CAS to improve outcomes.Clinical ImpactTransfemoral carotid artery stenting (CAS) carries important perioperative risks. Outcome prediction tools may help guide clinical decision-making but remain limited. Using data from the National Surgical Quality Improvement Program (NSQIP) targeted vascular database, we developed machine learning (ML) models that accurately predict 30-day outcomes following transfemoral CAS using preoperative data, outperforming logistic regression and existing tools in the literature. The models were well-calibrated and remained robust across demographic and clinical subpopulations. These ML algorithms have the potential for important utility in guiding risk-mitigation strategies for patients being considered for transfemoral CAS to improve outcomes.

ASRA pain medicine narrative review and expert practice recommendations for gastric point-of-care ultrasound to assess aspiration risk in medically complex patients undergoing regional anesthesia and pain procedures

Gastric point-of-care ultrasound (POCUS) may offer clinical value in assessing aspiration risk among medically complex patients undergoing regional anesthesia and pain procedures. While the American Society of Anesthesiologists (ASA) preoperative...

Learning curve of augmented reality surgical application for reverse shoulder arthroplasty.

Accurate positioning of the glenoid component in reverse total shoulder arthroplasty is important since it reduces prosthesis-related complications. Conventional instrumentation is still the gold standard. However, patient-specific instrumentation using 3-D printed guides, as well as computer-assisted navigation, is gaining more and more importance. Augmented reality has been established to enable the surgeon to have more precision in the positioning and inclination of the glenoid component. A new technique called "NextAR" (©Medacta) supports the surgeon during operation by guidance on bone preparation, instrument navigation, and implant placement, using virtual reality goggles or displays. The aim of this study was to determine a learning curve for reversed total shoulder arthroplasty by a high-volume single shoulder surgeon using the NextAR system. We performed retrospective data analysis of the first 20 cases of one high-volume single shoulder surgeon performing reversed total shoulder arthroplasty using the NextAR system. Parameters such as anesthesia time, surgical time, length of hospital stay, classification of the American Society of Anesthesiologists, body mass index, intraoperative blood loss, and complications were analyzed. We found significant decreases in measures like surgery time (p = 0,001), amount of blood loss during surgery (p = 0,005), and anesthesia time (p = 0,08). A remarkable turning point of blood loss occurs within the fifteenth surgery. A significant reduction of the operation time is shown at the fourteenth operation. Looking at blood loss and operation time together using a standardized cumulative curve, a significant reduction of the cumulative score is found within the fifteenth surgery. Significance was found in surgery time as well as in the amount of blood loss. However, these results may not be generalizable since they depend on further conditions. Future studies could provide information about other outcome parameters and learning curves of several surgeons performing reversed total shoulder arthroplasty with augmented reality applications.

Risk Factors of 90-Day Unplanned Readmission After Lumbar Spine Surgery for Degenerative Lumbar Disk Disease: A Systematic Review and Meta-Analysis.

With the increasing aging population, the number of patients undergoing lumbar spinal surgery for degenerative changes is rising. In the United States, spinal fusion surgery ranked sixth in operating room procedures, accounting for 3.2% of all such procedures, with an aggregate cost for stays amounting to $14.1 billion, making it the most expensive operating room procedure in 2018. The aim of this study was to identify valid risk factors of 90-day unplanned readmissions after lumbar spine surgery through a meta-analysis, with the goal of saving insurance finances and improving patient clinical outcomes. We searched PubMed, Embase, Web of Science, and Cochrane Library databases using the search terms "90-day readmission" and "lumbar spine surgery." Eleven eligible studies were included. Characteristic differences between readmitted and nonreadmitted patients were identified and analyzed using Review Manager software. This meta-analysis included 11 studies with a total of 648 415 patients; 50 047 were readmitted unplanned after lumbar spine surgery. The incidence of unplanned readmission after lumbar spine surgery was 7.72%. Among demographic risk factors, older age and higher body mass index were significantly associated with unplanned readmission after lumbar spine surgery. Patient characteristics, such as depression, diabetes mellitus, hypertension, renal failure, and an American Society of Anesthesiologists grade greater than 2 were also significantly associated with unplanned readmission after lumbar spine surgery. The meta-analysis revealed a 7.72% incidence of unplanned readmission after lumbar spine surgery. These findings suggest the need for enhanced preoperative optimization and careful patient selection for lumbar spine surgery, particularly in elderly patients and those with multiple comorbidities. Implementation of targeted preventive strategies for high-risk patients may help reduce unplanned readmissions and improve healthcare resource utilization.

The combined effect of nutritional status and body mass index on 90-day adverse events following long-segments fusion for adult spinal deformity: a propensity score-matched analysis.

The aim of this study was to investigate the individual and combined effects of PNI (prognostic nutritional index) and BMI (body mass index) on 90-day adverse events (AEs) following adult spinal deformity (ASD) surgery. A retrospective analysis was conducted on prospectively collected data from patients who underwent open long-segment fusion surgery for ASD. Patients were stratified into four groups based on BMI and PNI: low BMI with low PNI (LBLP), high BMI with low PNI (HBLP), low BMI with high PNI (LBHP), and high BMI with high PNI (HBHP). The primary outcome was the incidence of postoperative AEs within 90 days of ASD surgery. The LBLP group had a significantly higher risk of overall AEs (58.7% vs. 33.3%, p = 0.004) and infectious complications (20.6% vs. 7.9%, p = 0.042) compared to the LBHP group. The HBHP group exhibited a higher rate of major AEs (28.1% vs. 12.3%, p = 0.036) and infectious complications (15.6% vs. 3.5%, p = 0.026) within 90 days postoperatively than the LBHP group. Multivariate logistic regression analysis identified male, higher American Society of Anesthesiologists class, increased intraoperative blood loss, and HBHP status (compared to LBHP) as independent predictors of 90-day major AEs. In patients with low PNI, those with low BMI had a significantly higher risk of overall adverse events and infectious complications. Conversely, among patients with high PNI, those with high BMI were more prone to major adverse events and infectious complications within 90 days postoperatively.

Comparative efficacy and safety of nalbuphine and hydromorphone in painless colonoscopy techniques: a randomized controlled trial

BackgroundColonoscopy is essential for diagnosing colon lesions but is often associated with discomfort. Painless colonoscopy techniques are being increasingly used to improve the patient experience."However, in the case of painless colonoscopy, anesthesia is performed outside the operating room, which requires more significant peri-examination of hemodynamic changes and adverse postoperative reactions. This requires a more careful selection of narcotic analgesics, and there needs to be optimal analgesic drug guidance in clinical practice. This study compared the efficacy and safety of nalbuphine and hydromorphone in improving patient comfort and maintaining hemodynamic stability during elective colonoscopy.MethodsThis prospective, randomized, double-blinded controlled trial included 72 adult patients (aged 18–65) who underwent sedation colonoscopy. The 72 patients were randomly divided into two groups using a computer-generated random sequence. Body mass index 18.5–28.0 kg/m2; American Society of Anesthesiologists (ASA) grade I to II. Then, the nalbuphine group was given 0.13 mg/kg nalbuphine, the hydromorphone group was given 0.016 mg/kg hydromorphone, and during the operation, 10–20 mg/time propofol could be appropriately injected according to the patient's examination and cooperation. All patients were continuously monitored for oxygen saturation, heart rate, and noninvasive mean arterial blood pressure. The colonoscopy time and anesthesia time were recorded. Adverse reactions such as hypotension, decreased oxygen saturation, nausea, and vomiting were recorded. Anesthesiologist satisfaction, gastroenterologist (operator), and patient satisfaction were recorded.ResultsBoth nalbuphine and hydromorphone effectively maintained hemodynamic stability, with no significant differences in vital signs observed between the groups (P > 0.05). However, nalbuphine significantly reduced the incidence of postoperative nausea, vomiting, dizziness, and headache compared to hydromorphone (P < 0.05). The reduced side effects of nalbuphine were marked, suggesting a better postoperative comfort profile.ConclusionsWhile nalbuphine and hydromorphone effectively maintain intraoperative vital signs, nalbuphine offers superior postoperative comfort. This makes nalbuphine a preferable analgesic choice in outpatient colonoscopy settings. Further research is warranted to determine the optimal dosages for both drugs and to explore their mechanisms of action in procedural pain management.Register NumberChiCTR2300077446,November 9, 2023.

Shooting Movies: Effects of Gun and Firearm Exposure in Popular Films on Gun Use Self-Efficacy and Gun Attitudes/Beliefs

Gun violence in the United States is a public health crisis with debates raging about the role of guns in American society. The current study examined how exposure to guns in movies may shape attitudes/beliefs about guns and the mediating role of gun use self-efficacy as a potential mechanism for effects, using a retrospective survey with 612 undergraduates. Increased exposure to guns in movies was correlated with less support for gun control and stronger beliefs that guns make society safer. Importantly, gun use self-efficacy was a significant mediator between movie exposure and gun control.

Effect of bilateral intranasal transmucosal sphenopalatine ganglion block on intraoperative fentanyl requirement in children undergoing palatoplasty under general anaesthesia – A randomised, double-blinded, comparative study

Background and Aims: Palatoplasties are extremely painful surgeries commonly performed in children; hence, providing excellent analgesia for these surgeries is crucial. This study aims to evaluate the effect of bilateral intranasal transmucosal sphenopalatine ganglion (SPG) block on intraoperative fentanyl requirement in children undergoing palatoplasty under general anaesthesia (GA). Methods: Thirty American Society of Anesthesiologists physical status (PS) I and II patients, aged 6 months–12 years, scheduled to undergo palatoplasty, were randomised to two groups. After induction of anaesthesia, patients in Group T received bilateral SPG block using 0.5% bupivacaine-soaked cotton-tip applicators, while patients in Group C received standard anaesthesia care. The primary outcome was intraoperative fentanyl requirement, and secondary outcomes were intraoperative haemodynamics and post-extubation Paediatric Anaesthesia Emergence Delirium (PAED) scale scores at 5 and 10 min, respectively. Results: The mean intraoperative fentanyl consumption was 26.73 [standard deviation (SD): 10.19)] [95% confidence interval (CI): 20.38, 33.08] μg in Group T compared to 34.47 (SD: 12.73) (95% CI: 27.20, 41.74) μg in Group C (P = 0.008). Heart rate and mean arterial pressure were lower in Group T as compared to that in Group C (P &lt; 0.05). PAED scale scores were recorded to be 7.33 (SD: 1.50) (95% CI: 6.47, 8.19) and 6.00 (SD: 1.31) (95% CI: 5.30, 6.70) for Group T, and 15.53 (SD: 0.74) (95% CI: 15.13, 15.93) and 14.07 (SD: 0.59) (95% CI: 13.75, 14.39) for Group C at 5 and 10 min, respectively (P &lt; 0.001). Conclusion: SPG block causes a significant reduction in intraoperative fentanyl consumption, stabilises haemodynamics, and facilitates smoother recovery of children undergoing palatoplasty under GA.

Risk for development of vancomycin resistant enterococci bacteremia among colonized or infected patients, a multiple center, retrospective study in Palestine

Vancomycin-Resistant Enterococcus (VRE) is one of the key antibiotic-resistant pathogens that challenges the health system with its threat to human health. Most VRE infections occur in hospital settings as these pathogens are known to colonize hospital environments and maintain their viability for long periods. Without good infection control measures, these pathogens can spread in the hospital setting and cause hospital-acquired infections including bacteremia. In this study, we report the isolation of VRE from patient samples hospitalized in four Palestinian hospitals. The American Society for Microbiology proceedings were utilized to culture and identify VRE. During the 5-year study period between December 2020 and March 2024, 736 VRE isolates were detected, and 30 (4.76%) patients with bacteremia were reported. Excellent infection control measures including active surveillance swabs, contact precaution and following strict isolation protocols were important to limit the spread of these pathogens, as well as limiting the consumption of antibiotics, especially Vancomycin. In this research article, we discuss the detection of VRE in the different hospitals located in West Bank and East Jerusalem. We also analyze the prevalence of VRE in other body sites including anal surveillance swab, urine, wound and stool cultures that may be associated with developing VRE bacteremia. The cumulative average of VRE causing bacteremia was of urinary origin, followed by wound and stool positive cultures, respectively. Hospital number 2 had the highest risk of developing bacteremia in patients with other VRE positive culture or swab with a percentage of 11.3%.

Quality of recovery (QoR-15) following opioid-free versus opioid anaesthesia for elective endoscopic nasal surgeries: A randomised, open-label comparative trial

Background and Aims: Newer modalities like opioid-free analgesia overcome the opioid-related side effect profile and are equally efficacious. This study aims to compare the clinical outcomes between opioid-free anaesthesia (OFA) and opioid-based anaesthesia (OA) in elective nasal endoscopic surgeries. Methods: A randomised, open-label trial was conducted to evaluate the quality of recovery (QoR). The study included 64 patients with American Society of Anesthesiologists physical status I and II, of either gender, aged between 18 and 60 years, scheduled for elective endoscopic nasal surgery at a tertiary care centre. The patients were randomised into two groups: Group OA (patients receiving opioid anaesthesia) and Group OFA (patients receiving opioid-free anaesthesia). The primary outcome was the effects of OFA versus OA on the QoR-15 in patients undergoing endoscopic nasal surgeries under general anaesthesia. Secondary outcomes included intraoperative haemodynamics, respiratory depression, nausea/vomiting, pruritus, postoperative analgesia, and length of stay in the post-anaesthesia care unit. An independent sample t-test and Chi-squared test were employed for between-group comparisons. Results: Patients undergoing OFA showed higher postoperative QoR-15 scores compared to the opioid group. Intraoperatively, the OFA group demonstrated a better haemodynamic profile at 15, 30, 60, 90, and 120 min, with lower mean arterial pressure values compared to the opioid group. Notably, the OFA group experienced reduced nausea/vomiting and pruritus. Postoperative analgesia requirements and length of stay in recovery were also lower in the OFA group. Conclusion: OFA in elective nasal endoscopic surgeries results in higher QoR-15 scores, better postoperative analgesia and fewer adverse effects associated with opioids.

Comparison of Procedural Sedation Outcomes inChildren With and Without Autism SpectrumDisorder.

Children with autism spectrum disorder (ASD) often have comorbidities predisposing them to higher risk for sedation-related adverse events (AEs). Our objective was to compare sedation-related AEs in children with and without ASD. We conducted a multicenter study of children aged 3-18years with and without ASD who underwent sedation outside the operating room from May 1, 2022, to April 30, 2023, using the Pediatric Sedation Research Consortium database. The primary exposure was ASD diagnosis. We compared AEs in children with and without ASD after matching for age, sex, procedure, and American Society of Anesthesiologists classification. Of 64 708 children analyzed, 4421 (6.8%) had an ASD diagnosis. A higher proportion of children with ASD were male (75.4% vs 54.7%), obese (6.0% vs 2.9%), and had a comorbid condition (93.5% vs 40.3%). Matched analysis showed no significant difference in critical AEs (odds ratio [OR], 0.63; 95% CI, 0.23-1.49). However, children with ASD had greater odds of high risk (OR, 1.52; 95% CI, 1.26-1.83) and low-risk AEs (OR, 1.39; 95% CI, 1.25-1.55) compared with children without ASD. Specifically, children with ASD had greater odds of hypoxia (OR, 1.31; 95% CI, 1.10-1.56) and complete (OR, 1.89; 95% CI, 1.27-2.81) or partial (OR, 1.43; 95% CI, 1.25-1.63) airway obstruction. Children with ASD are at a higher risk for sedation-related airway AEs and significant respiratory interventions, although the incidence of critical AEs was low.

RETRACTION: Effect of Mechanical Tension on Fibroblast Transcriptome Profile and Regulatory Mechanisms of Myocardial Collagen Turnover.

M. Shiraishi, K. Suzuki, and A. Yamaguchi, "Effect of Mechanical Tension on Fibroblast Transcriptome Profile and Regulatory Mechanisms of Myocardial Collagen Turnover," FASEB Journal 37, no. 4 (2023): e22841. https://doi.org/10.1096/fj.202201899R. The above article, published online on 01 March 2023, in Wiley Online Library (wileyonlinelibrary.com), and its erratum (https://doi.org/10.1096/fj.202301989), have been retracted by agreement between the authors; the journal Editor-in-Chief, Dr. Loren E. Wold, the Federation of American Societies for Experimental Biology, and Wiley Periodicals LLC. This retraction follows a previous erratum to correct image duplications in Figures2 and 3 as well as Supplementary Figures1, 3, and 5. The authors contacted the journal and requested retraction of their article following an investigation by Jichi Medical University, which has concluded that there was a lack of primary research data and corroborating evidence which could confirm the source of the errors and whether the experiments had been performed as described. The retraction was agreed to because the investigation performed by the university confirmed a lack of evidence to support the published erratum, and as such the errors in the article fundamentally compromise the editor's confidence in the conclusions presented.

Exploring Unconscious Bias at International Kidney Conference: A Retrospective Analysis.

The impact of unconscious biases on academic interactions has gained increasing attention across several disciplines, including the field of medicine. We explored the possible manifestation of these biases by analyzing presenters' introductions by moderators at the American Society of Nephrology (ASN) Kidney Week Conferences. We analyzed 1534 archived sessions from ASN Kidney Weeks 2019, 2021, and 2023. Moderator and speaker gender, academic rank, session type, and presence of formal titles in introductions were documented. Multivariable logistic regression was conducted to evaluate the relationship between these characteristics and the frequency of formal title usage by moderators. Female moderators used formal titles more frequently than their male counterparts across all years (estimate 0.60, Standard Error (SE) = 0.18, p <0.05). Title usage was higher in 2021 (virtual format) compared to in 2019 and 2023 (est. 0.76, SE = 0.25, p <0.001). However, there was a significant increase from 2019 to 2023 (est. 0.74, SE = 0.24, p <0.001). With respect to rank interactions, full Professors introducing Associate Professors (est. 0.82, SE = 0.35, p <0.05) and vice versa (est. 0.62, SE = 0.40, p <0.05) both had higher probabilities of formal title usage. On the other hand, Assistant Professors introducing other Assistant Professors showed a lower likelihood of using a full title (est. -0.83, SE = 0.35, p <0.05). Basic science sessions exhibited the lowest rates across all years (p <0.001). Our findings suggest that unconscious bias may exist in peer-to-peer interactions in nephrology academic circles. Further investigation is warranted to explore the interplay of additional variables such as geographic and cultural characteristics to more clearly understand the extent of this issue and develop interventions that mitigate bias and promote equity in academic settings.

Aseptic Revision Total Knee Arthroplasty in Octogenarians: A Matched Cohort Comparison of Early Clinical Outcomes.

Aseptic Revision Total Knee Arthroplasty in Octogenarians: A Matched Cohort Comparison of Early Clinical Outcomes.

An era of immunological discoveries heralded by molecular biology.

An era of immunological discoveries heralded by molecular biology.

Diagnostic value of lung ultrasound B-lines for evaluating left ventricular filling pressure

BackgroundThe assessment of left ventricular (LV) diastolic function based on the American Society of Echocardiography and the European Association of Cardiovascular Imaging (ASE/EACVI) guidelines requires measurement of several echocardiographic indices. However, these assessments often yield inconclusive results owing to the absence of measurable parameters. Multiple B-lines on lung ultrasound have been proposed as a method for evaluating pulmonary congestion. We aimed to evaluate the association between B-lines and LV diastolic function and to examine whether B-lines show potential as an alternative to conventional indices for assessing LV diastolic function.MethodsThis prospective study included 172 patients with pre-heart failure (HF) or HF. We investigated (i) the relationship between B-lines and LV diastolic function using echocardiography, (ii) the diagnostic accuracy of B-lines compared to echocardiography indices for estimating LV filling pressures and (iii) the relationship between B-lines and risk of hospitalisation for HF.ResultsAmong patients for whom the ASE/EACVI guideline algorithm for LV diastolic dysfunction was available (n = 89), the number of B-lines typically increased with the severity of diastolic dysfunction grade. In patients who underwent left heart catheterisation (n = 20), the LV filling pressure was significantly correlated with B-lines (r = 0.690, P < 0.001). The diagnostic accuracy of B-lines for detecting high LV filling pressure was comparable to that of tricuspid regurgitation peak gradient (TRPG). When TRPG was replaced with B-lines to diagnose grade II or III diastolic dysfunction using the ASE/ESCVI algorithm, sensitivity remained comparable (0.80); however, specificity improved (0.80 vs. 0.50). In patients who underwent lung ultrasound while they were hemodynamically stable and were followed up for prognosis (median, 730 days; n = 75), 14 hospitalisations for HF were observed. Kaplan–Meier analysis revealed that the high B-line group had a significantly higher incidence of hospitalisation events for HF (P = 0.036, log-rank test).ConclusionB-lines have shown potential as an alternative to conventional indices for assessing LV diastolic dysfunction.Graphical

Left ventricular hypertrophy among adults in a population-based cohort in Haiti

Left ventricular hypertrophy (LVH) is one of the strongest predictors of cardiovascular disease (CVD) and mortality; yet the means to diagnose LVH in resource-constrained settings remain limited. The objectives of this study were to determine LVH prevalence by transthoracic echocardiography (TTE) in a high-risk group, and compare TTE vs. electrocardiography (ECG-LVH) for LVH detection. We analyzed enrollment data from the Haiti cardiovascular disease cohort study on adults (≥ 18 years, n = 3,005) in Port-au-Prince between 2019 and 2021. All participants underwent questionnaires, vital signs, physical exams, and 12-lead ECGs. TTEs were acquired on those with hypertension or exhibiting CVD symptoms (n = 1040, 34.7%). TTE-LVH was defined according to the American Society of Echocardiography guidelines and ECG-LVH by Sokolow-Lyon, Cornell, and Limb-Lead Voltage criteria. The prevalence of TTE-LVH was 39.0% (95% CI 36.6–41.5%) and associated with older age. Only 26% of those with TTE-LVH and elevated blood pressure were on antihypertensives. Prevalence of ECG-LVH ranged from 1.9 to 5.0%, and compared to TTE-LVH had low agreement (κ < 0.20), low sensitivity (< 10%) and high specificity (> 90%). These findings indicate a high prevalence of TTE-LVH among high-risk Haitian adults, and poor detection using ECGs compared to TTEs. For those with TTE-LVH, treatment with antihypertensives may reduce the risk of adverse CVD outcomes.