Literature Search Research Articles

HPB SO69 - Comparison of radical antegrade modular pancreatosplenectomy with standard pancreatosplenectomy for left sided pancreatic cancer

Abstract Background Long term survival of patients undergoing distal pancreatosplenectomy for left sided pancreatic cancer has not been satisfactory owing to inability to achieve negative resection margins. Radical antegrade modular pancreatosplenectomy (RAMPS) has been designed to achieve better margin resection and better lymph node clearance compared to the standard distal pancreatosplenectomy (SDP) for left sided pancreatic cancer. This results in better oncological outcomes and patient survival rates. The aim of this study was to compare clinical outcomes from RAMPS and SDP. Method Literature search was performed to identify studies published in Pubmed, Embase, Cochrane library and google search. 13 Studies comparing RAMPS versus standard method of distal pancreatecetomy were included in the final meta-analysis. Revman 5.4 was used to perform the analysis and random effects model was used with results shown on forest plot. A total of 1450 patients were enrolled in the meta analysis with 685 in RAMPS and 765 patients in SDP group. R0 resection rate, recurrence rate, better overall survival and number of harvested lymph nodes were taken as primary outcomes. Results RAMPS was associated with better overall survival than SDP (HR-0.62, 95% CI - 0.38-0.91, p=0.03). The recurrence rate (OR-0.68, 95% CI 0.47-0.97, p=0.04) was significantly less. R0 resection rate was higher in RAMPS but did not reach statistical significance (OR-1.47 CI0.93-2.3, p=0.10). Complications notably pancreatic fistula Showed favourable results in RAMPS along with other variables such as hospital stay, operative stay and blood loss but didn’t reach statistical Significance. Conclusion This study clearly signifies the importance of RAMPS being able to achieve higher R0 resection rate as well as less complications which results in better surgical and long term clinical outcomes for the patients. With more expertise and surgical training, this novel procedure promises to be a more safer and feasible technique than the conventional pancreatosplenectomy.

Examining suicidality in relation to the menopause: A systematic review

Suicide is one of the leading causes of deaths worldwide, with an estimated 1 in 100 deaths being attributable to suicide. Whilst rates of suicide are higher in men, evidence suggests that suicide attempts are more frequent in women. Suicidality data indicates that deaths by suicide in women are highest in those in midlife, warranting investigation into the relationship between the menopause and suicidality. The current study aimed to review the existing literature examining the relationship between suicidality and the menopause using a systematic review approach. A systematic literature search of MEDLINE, Cochrane Library, Scopus Web of Science, PsycINFO, and Embase databases was conducted in October 2023. Two authors independently screened the titles and abstracts of identified articles against the eligibility criteria. Any inconsistencies were discussed and resolved. This process was subsequently repeated with the articles’ full-text. Risk of bias was assessed using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD). Relevant data were extracted and summarised in both a tabulated and narrative form. A total of 28 studies met the inclusion criteria, with the findings revealing a complex relationship between the menopause and suicidality. Several studies highlighted that the perimenopause period shows a higher prevalence of suicidal thoughts compared to pre-menopausal and post-menopausal stages. Conversely, some studies indicated increased suicidality during the post-menopausal phase, while others noted elevated suicidality in pre-menopausal individuals and those with primary ovarian insufficiency. Critically, several studies found no link between hormonal status and suicidality. The quality of the studies also varied, with a lack of involvement from individuals with relevant lived experience being a consistent methodological flaw across all the included studies. Overall, the current evidence on menopause and suicidality is mixed. Further research is needed to unravel the relationship between menopause and suicidality.

Therapeutic inertia in the management of patients with moderate to severe psoriasis: A systematic review of cross‐sectional studies

AbstractTherapeutic inertia (TI) is defined as the inability of physicians to intensify or initiate a more aggressive treatment in patients who need it. This study aims to explore the evidence behind TI in the management of patients with moderate to severe psoriasis and to determine the factors that contribute to its occurrence. An extensive literature search was conducted systematically in Cochrane Library, Medline, Epistemonikos, Google Scholar, and HERDIN Plus from their inception up to June 2023. Cross‐sectional studies that looked into TI in patients with moderate to severe psoriasis and discussed the factors that lead to its occurrence were included in the study. The review was limited to peer‐reviewed journals in the English language. Outcomes were presented as counts and percentages, and notable findings from each study were highlighted. Three thousand two hundred and fifty six records were identified but only 4 studies met the inclusion criteria and were included in the analysis. Based on the available evidence, the prevalence of TI in psoriasis varies from 25.4% to 35.6%. Its occurence is largely caused by physician‐related factors (reluctance to escalate treatment due to lack of knowledge and experience) and patient‐related factors (satisfaction with current treatment or refusal to change treatment due to psychological barriers). Healthcare system‐related factors were not directly explored. The limited data on TI in the management of moderate to severe psoriasis presents opportunities to further explore its prevalence, the factors contributing to it, and its effect on treatment outcomes.

The Effect of Lifestyle Interventions on Anxiety, Depression and Stress: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Background/Objectives: Depression, anxiety, and stress are common mental health issues that affect individuals worldwide. This systematic review and meta-analysis examined the effectiveness of various lifestyle interventions including physical activity, dietary changes, and sleep hygiene in reducing the symptoms of depression, anxiety, and stress. Using stress as an outcome and conducting detailed subgroup analyses, this study provides novel insights into the differential effects of lifestyle interventions across diverse populations. Methods: Five databases were systematically searched: PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar, for gray literature searches. Keywords were used to search each database. The search period was from the conception of the databases until August 2023 and was conducted in English. For each analysis, Hedges’ g was reported with a 95% confidence interval (CI) based on the random-effects method. Subgroups were analyzed and heterogeneity and publication bias were examined. Results: Ninety-six randomized clinical trial studies were included in this meta-analysis. Lifestyle interventions reduced depression (Hedges g −0.21, 95% confidence interval −0.26, −0.15; p < 0.001; I2 = 56.57), anxiety (Hedges g −0.24, 95% confidence interval −0.32, −0.15; p < 0.001; I2 = 59.25), and stress (−0.34, −0.11; p < 0.001; I2 = 61.40). Conclusions: Lifestyle interventions offer a more accessible and cost-effective alternative to traditional treatments and provide targeted benefits for different psychological symptoms.

Evaluating the current methodological practices and issues in existing literature in pooling complex surveys: a systematic review.

Pooling data from complex survey designs is increasingly used in the health and medical sciences. However, current methodological practices are not well documented in theliterature while performing the pooling strategy. We aimed to review related pooling studies and evaluate the quality of pooling within the framework of specific methodological guidelines, particularly when combining complex surveys such as Demographic & Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS). We performed a systematic literature search focusing on studies utilizing the pooling method with DHS and MICS survey data. These studies were selected from those published between 2010 and 2021 and were retrieved from electronic databases (PubMed and Scopus) in accordance with pre-defined inclusion criteria. Then, we extracted355 studies for the final review and evaluated the reporting quality of the pooling strategy while considering some methodological issues. The majority of studies (81.4%) reported using a pooled (one-stage) approach, while 11.8% used a separate (two-stage) approach, and 6.8% used both approaches. Approximately 63.3% of studies did not clearly describe their pooling strategy. Only 3.4% of the studies mentioned the variable harmonization process, while 66.9% addressed dealing with heterogeneity between surveys. All studies that used the separate (two-stage) approach conducted a meta-analytic procedure, while 38.1% of studies using the pooled approach employed a multilevel model. More than half of the studies (55.6%) mentioned the use of clustered standard errors. The Delta method, Bootstrap, and Taylor linearization were each applied in 11.1% of the studies for variance estimation. Survey weights, primary sampling unit (PSU) or cluster, and strata were used together in 30.5% of the studies. Survey weights were employed by 69.8%, PSU or cluster by 43.8%, and the strata variable by 31.7%. Sensitivity analysis was conducted in 16% of the studies. Our study revealed that fundamental methodological issues associated with pooling complex survey databases, such as the selection of pooling procedures, data harmonization, accounting for cycle effects, quality control checks, addressing heterogeneity, selecting model effects, utilizing survey design variables, and dealing with missing values, etc., were inadequately reported in the included studies. We recommend authors, readers, reviewers, and editors examine pooling studies more attentively and utilize the customized checklist developed by our study to assess the quality of future pooling studies.

Diagnostic Accuracy of Four-Dimensional Computed Tomography in Preoperative Localization of Primary Hyperparathyroidism After Negative or Inconclusive Sestamibi: A Systematic Review and Meta-analysis

Objective The aim of the study is to assess the diagnostic accuracy of 4-dimensional computed tomography (4D-CT) scans for patients with primary hyperparathyroidism (pHPT) after negative or inconclusive Technetium-99m sestamibi single-photon emission computed tomography scan. Methods A literature search of several databases was conducted from inception to August 2023. Eligible studies reported adult patients (>18 years old) who underwent 4D-CT after negative or inconclusive sestamibi results. The pooled proportions were analyzed using a random-effects model. This review was registered in PROSPERO (CRD42023446285). Results From 208 initial studies screened, 10 met the eligibility criteria, with a total of 335 patients with a diagnosis of pHPT who underwent 4D-CT scans and subsequent surgical exploration. Nine of the studies reported a pooled sensitivity of localization of 71% (0.71; 95% confidence interval [CI]: 0.610, 0.811, I 2 = 72%). The pooled specificity of localization across 5 studies was calculated at 47% (0.47; 95% CI: −0.111, 1.059, I 2 = 99%). Seven of the included studies reported a pooled positive predictive value of 81% (0.81; 95% CI: 0.708, 0.917, I 2 = 70%), and 6 of the studies reported a negative predictive value of 28% (0.28; 95% CI: −0.114, 0.683, I 2 = 98%). Conclusions For pHPT patients with inconclusive sestamibi scans, 4D-CT demonstrates promising results with good diagnostic accuracy for the localization of pHPT. Additional studies evaluating larger groups of patients may provide further support for the use of 4D-CT in this population.

Effect of therapeutic exercise on peak oxygen consumption in oncological population: a systematic review with meta-analysis

Abstract Introduction Cancer is amongst the leading causes of death worldwide. A total of 19.3 million new cases were diagnosed in 2020. Cardiovascular impairment is the second leading cause of death in patients undergoing cancer treatment. By measuring the maximum rate of oxygen consumption (VO2max) in cancer patients, it is possible to estimate their cardiorespiratory health. This study aims to show how participants’ VO2max increases with a therapeutic physical exercise programme. Methods Four databases were used for the literature search. Twenty-eight studies were analysed using the inclusion and exclusion criteria. The quality of these studies was analysed with the PEDRO scale. The structural characteristics of the articles and the study variable (VO2max) were studied. Results The VO2max of the 2558 patients studied presents some variations by gender, intervention and moment of measurement. For male-associated cancer, the increased VO2max ranged between 1.5 and 4.2% after the intervention. The increase in the maximum VO2max in female-associated cancer was between 0.3 and 53%. Different types of cancer for both genders presented an oscillation between 0.5 and 3.47%. Conclusions Therapeutic physical exercise is an efficient intervention to improve the VO2max in oncology patients. The results show that a therapeutic physical exercise intervention lasting 12 weeks, 3 days per week with a moderate-vigorous intensity, increases the VO2max in oncology patients.

Wolbachia in Antarctic terrestrial invertebrates: Absent or undiscovered?

Interactions between a host organism and its associated microbiota, including symbiotic bacteria, play a crucial role in host adaptation to changing environmental conditions. Antarctica provides a unique environment for the establishment and maintenance of symbiotic relationships. One of the most extensively studied symbiotic bacteria in invertebrates is Wolbachia pipientis, which is associated with a wide variety of invertebrates. Wolbachia is known for manipulating host reproduction and having obligate or facultative mutualistic relationships with various hosts. However, there is a lack of clear understanding of the prevalence of Wolbachia in terrestrial invertebrates in Antarctica. We present the outcomes of a literature search for information on the occurrence of Wolbachia in each of the major taxonomic groups of terrestrial invertebrates (Acari, Collembola, Diptera, Rotifera, Nematoda, Tardigrada). We also performed profiling of prokaryotes based on three marker genes and Kraken2 in available whole genome sequence data obtained from Antarctic invertebrate samples. We found no reports or molecular evidence of Wolbachia in these invertebrate groups in Antarctica. We discuss possible reasons underlying this apparent absence and suggest opportunities for more targeted future research to confirm bacteria's presence or absence.

Adaption of a trigger tool to identify harmful incidents, no harm incidents, and near misses in prehospital emergency care of children.

The emergency medical service (EMS) addresses all chief complaints across all ages in various contexts. Children in EMS present a particular challenge due to their unique anatomical and physical properties, which require specific training that EMS clinicians often report lacking. This combination exposes children to incidents threatening patient safety. The most common method to highlight incidents is the incident reporting system. Studies have shown underreporting of such incidents, highlighting the need for multiple methods to measure and enhance patient safety in EMS for children. Thus, the aim of this study was to modify and adapt the current Ambulance TT for road-based EMS (ATT) to a pediatric version (pATT) with a guide containing definitions of triggers. The adaption of the ambulance trigger tool to a version suitable for children followed a stepwise manner, including (1) a review of previous literature to pinpoint areas of risk regarding patient safety among children in EMS. (2) Three sessions of expert panel discussions via video meetings were held to evaluate each trigger of the ATT in terms of clinical relevance, comprehensibility, language and areas of risk regarding patient safety among children in EMS. (3) Clinical use of the pATT along with Retrospective Record Review (RRR). (4) Calculation of Item-level validity index and positive predictive value (PPV) for each trigger. (5) calculate inter-rater reliability between two independent record reviewers. The literature search revealed 422 respective 561 articles in Cinahl and Medline where headlines and abstracts were read to identify areas posing risks to patient safety in EMS for children. During the structured discussions, one trigger was added to the existing 19 derived from the ATT, and the trigger definitions were modified to suit children. The three most common triggers identified in the 900 randomly selected records were deviation from treatment guidelines (63.9%), incomplete documentation (48.3%), and the patient is non conveyed after EMS assessment (41.1%). The positive triggers were categorized into near miss (54.6%), no harm incident (5.8%), and harmful incident (0.4%). Inter-rater reliability testing showed excellent agreement. This study demonstrates the adaptation of an existing trigger tool (ATT) to one suitable for children. It also shows that the trigger tool, along with retrospective record review, is a feasible method to evaluate patient safety in EMS, thus complementing existing methods.

BN SO22 - Magnetic sphincter augmentation in the management of gastro-esophageal reflux disease: A systematic review and meta-analysis

Abstract Background Magnetic sphincter augmentation (MSA) through placement of the LINX device is an alternative to fundoplication in the management of gastro-esophageal reflux disease (GERD). This systematic review and meta-analysis aimed to assess efficacy, quality of life and safety in patients that underwent MSA, with a comparison to fundoplication. Method A literature search of MEDLINE, Embase, Emcare, Scopus, Web of Science and Cochrane library databases was performed for studies that reported data on outcomes of MSA, with or without a comparison group undergoing fundoplication, for GERD from January 2000 to January 2023. Meta-analysis was performed using random-effect models and between-study Results Thirty-nine studies with 8,075 patients were included: 6,983 patients underwent MSA and 1,092 a fundoplication procedure. More individuals discontinued proton-pump inhibitors (P<0.001; WMD 0.83) and had higher rates of satisfaction (P<0.001; WMD 0.85) following MSA compared to fundoplication. Functional outcomes including ability to belch (P<0.001; WMD 0.96) and emesis (P<0.001; WMD 0.92), and bloating (P=0.003; WMD 0.20) were better after MSA than after fundoplication, although MSA had higher rates of dysphagia (P=0.001; WMD 0.41). The overall erosion and removal rate following MSA was 0.24% and 3.9% respectively, indicating no difference in re-intervention rates between MSA and fundoplication (P=0.446; WMD 0.001). Conclusion MSA is a safe and effective procedure at reducing symptom burden of GERD and can potentially improve patient satisfaction and functional outcomes. However, randomized controlled trials directly comparing MSA with fundoplication are necessary to determine where MSA precisely fits in the management pathway of GERD.

Abstract 4128519: Performance of a Popular Large Language Model in Answering Cardiovascular Related Queries: A Systematic Review and Pooled-Analysis

Background: The integration of large language models (LLMs) such as ChatGPT into healthcare can have significant implications for patient education and clinical decision-making. Aims: This systematic review and pooled analysis aim to evaluate the accuracy of ChatGPT 3.5 and 4 in answering simple queries across cardiovascular (CV) medicine disciplines. Methods: Literature searches were conducted in PubMed, Embase, and Cochrane Central in May 2024. Keywords included “ChatGPT”, “LLMs”, and “Chat-based artificial intelligence models”. Cross-sectional, peer-reviewed studies published in 2023 and 2024 investigating ChatGPT’s performance in CV medicine-related queries (Table/Figure) were extracted and included. All queries were evaluated by expert physicians in the corresponding fields within each study (and not by our readjudication), and a standardized grading system was employed for pooled analysis using an "accurate" and "inaccurate" grading scale for each answer. Results: Out of 127 identified and screened peer-reviewed studies, fourteen studies involving 542 CV-related queries were included. Pooled analysis revealed an overall accuracy of 84.5% (458/542) (95% CI [81.5, 87.6]). Stratification by model (ChatGPT-4 vs. ChatGPT-3.5) did not show a significant difference in accuracy (p=0.32). Furthermore, no significant differences in accuracies were seen between answers in 2023 and 2024 (p=0.07). The accuracies across the various topics were statistically comparable, except in the field of cardio-oncology, which showed significantly lower accuracy at 68% (p=0.02). Detailed performances per topic are included in the table and figure. Conclusion: ChatGPT demonstrated consistently high accuracy in answering CV-related queries with no significant differences across model versions or years. These results support the potential use of online-chat based LLMs as an informational tool in cardiology.

Local Treatment of Wound Infections: A Review of Clinical Trials from 2013 to 2024.

Significance: Management of infection is a critical aspect of wound care. It involves the application of various interventions to treat the wound and prevent the infection from spreading to other parts of the body, which may lead to serious complications, including sepsis. Local treatment of skin wound infections is the favored route of administration, reducing the risk of adverse systemic effects while providing very high therapeutic concentrations at the target site. The purpose of this article was to review clinical trials from 2013 and onward, focusing on local treatment of acute wounds and burns as well as chronic wounds as their primary outcome measurement. Recent Advances: Based on our literature search, 49 clinical trials were focusing on treating infected chronic wounds, and 6 trials studied infection as their primary outcome in acute wounds during the last 10 years. Critical Issues: Currently commercially available local treatments do not prevent the onset of invasive infection. Therefore, there is a need for more effective local therapies. Future Directions: Despite multiple preclinical studies introducing novel and promising strategies in terms of novel antimicrobial agents and delivery methods to prevent and treat skin wound infections locally, many have yet to be tested in a clinical setting. These preclinically tested approaches could still be valuable additions to today's care of infected skin wounds.

Determinants of Child Marriage in Indonesia : A Systematic Review

Early marriage is an ongoing phenomenon and is becoming more prevalent. The lack of public knowledge and lack of awareness of early child marriage leaves children deeply traumatized. More than 1 million (1.2 million) women aged 20-24 were married for the first time before the age of 18. The purpose of this study was to provide an overview of the causal characteristics of child marriage in Indonesia. The method used in this study was a systematic review conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) rules. The literature search was performed across multiple journal sites or online articles such as Google Scholar, PubMed, and Science Direct by entering the keywords 'Determinants of child marriage AND Indonesia'. There is a prevalent belief among parents and youth is that marrying off young girls preserves family honor. Additionally, poverty and economic instability make child marriage more socially acceptable. Other contributing factors include limited access to education and societal norms that promote marriage after puberty and within the same ethnic group. Despite existing laws regulating the minimum age for marriage, enforcement remains problematic. The review of nine articles indicated that child marriage in Indonesia is influenced by beliefs, limited access to education, culture, environmental factors, and gaps in legal enforcement.

Short- and Long-Term Effects of Inhaled Ultrafine Particles on Blood Pressure: A Systematic Review and Meta-Analysis

Background: Air pollution contributes to up to 60% of premature mortality worldwide by worsening cardiovascular conditions. Ultrafine particles (UFPs) may negatively affect cardiovascular outcomes, and epidemiological studies have linked them to short- and long-term blood pressure (BP) imbalance. Methods: We conducted a systematic review and meta-analysis of the short- and long-term effects of UFP exposure on systolic (SBP) and diastolic (DBP) blood pressure. Eligibility criteria were established using the Population, Exposure, Comparator, Outcome, and Study Design (PECOS) model, and literature searches were conducted in Web of Science, PubMed, Embase, and Scopus for studies published between 1 January 2013 and 9 October 2024. Risk of Bias (RoB) was assessed following World Health Organization (WHO) instructions. Separate meta-analyses were performed for the short- and long-term effects of UFP exposure on SBP and DBP. Additionally, we analyzed SBP and DBP imbalances across different timespans following short-term exposure. Results: The results showed an increase in BP during short-term UFP exposure, which returned to baseline values after a few hours. Changes in SBP were greater than in DBP following both short- and long-term exposure. Prolonged exposure to UFPs is associated with increased SBP and concurrently low DBP values. Chronic exposure to UFPs may lead to a persistent increase in SBP, even without a concurrent increase in DBP. Conclusions: The findings presented here highlight that UFPs may contribute to worsening cardiovascular outcomes in vulnerable populations living in air-polluted areas.

Antioxidant Therapies in the Treatment of Aminoglycoside-Induced Ototoxicity: A Meta-Analysis.

A feared complication of aminoglycoside treatment is ototoxicity, which is theorized to be attributed to the production of aminoglycoside-induced reactive oxygen species. Previous studies using animal models have suggested that numerous therapies targeting reducing oxidative stress may prevent ototoxicity from aminoglycosides. However, few clinical studies have been conducted on these antioxidants. This systematic review and meta-analysis examines the effectiveness of antioxidant therapies in the treatment of aminoglycoside-induced ototoxicity. PubMed, Embase, Web of Science, and ClinicalTrials.gov. A literature search was conducted in August 2024. This review sought randomized controlled trials to be conducted on humans to examining otologic outcomes in aminoglycoside-induced ototoxicity following administration of medications intended to reduce oxidative stress. A systematic review yielded 2037 results, of which seven studies met inclusion criteria. N-acetylcysteine (NAC) was investigated in four studies, aspirin in two studies, and vitamin E in one study. Six studies examined the benefit of antioxidant treatments for up to 8 weeks after administration while one study tested subjects' hearing after 1 year. In pooled analysis, two studies assessing NAC showed the greatest reduction in ototoxicity (RR 0.112, 95% CI, 0.032-0.395; p = 0.0007; I2 = 18%), followed by two studies examining aspirin (RR 0.229, 95% CI, 0.080-0.650; p = 0.0057; I2 = 0%). One study performed with vitamin E did not find a reduction in ototoxicity compared to the placebo (RR 0.841, 95% CI, 0.153-4.617; p = 0.8416). Multiple studies have shown that NAC and aspirin are effective in reducing ototoxicity from treatment with aminoglycosides. However, there is a lack of high-quality evidence. Additional studies should examine whether aspirin and N-acetylcysteine provide long-term benefit, and which of the other promising antioxidants translate from animal models. N/A Laryngoscope, 2024.

Abstract 4136969: Empagliflozin's Role in Post-Myocardial Infarction Management: Insights from a Meta-Analysis

Background: Empagliflozin, a Sodium Glucose Cotransporter 2 (SGLT2) Inhibitor, is used to treat type 2 diabetes mellitus and heart failure. Its safety and efficacy in patients with Myocardial Infarction (MI) have been studied recently. Research Questions/Hypothesis: What is the role of Empagliflozin in post-myocardial infarction management by preventing cardiovascular deaths, reducing hospitalization due to heart failure, and minimizing adverse events? Goals/Aims: Role of Empagliflozin in post-myocardial infarction management by preventing cardiovascular deaths, reducing hospitalization due to heart failure, and minimizing adverse events Methods: A literature search was done on PubMed, Medline, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials from inception until May 2024. All Randomized Control Trials (RCT) reporting the safety and efficacy of Empagliflozin in MI management were selected. Outcomes were pooled as Mean Difference (MD) or Risk Ratio (RR) with 95% Confidence Intervals (CI) in this meta-analysis using Revman 5.4. Results: Data from ten RCTs, with a combined sample size of 10,560 patients was pooled, and showed that Empagliflozin is superior to placebo in terms of Cardiovascular death (RR=0.75, 95% CI [0.64, 0.88],p < 0.0004) and hospitalization due to heart failure (RR=0.70, 95% CI [0.59, 0.82], p < 0.0001). However, the results were non-significant for both groups in terms of adverse events (RR=1.00, 95% CI [0.96, 1.03], p < 0.78). Conclusion: Empagliflozin significantly lowers the risk of cardiovascular events in patients with MI who are at a high risk of death due to cardiovascular causes.

Current status of ultrasound training in obstetrics and gynecology: a scoping literature review

IntroductionAs a widely accessible, cost-effective, and safe imaging tool, obstetric and gynecologic (OB/GYN) ultrasound (ULS) plays a vital role in diagnostics and patient care. With its growing relevance, the demand for comprehensive education in this field increases. The objective of this work was to outline the current state of OB/GYN ULS education.MethodsA scoping literature search was performed until May 2023 using the medical database PubMed according to PRISMA guidelines. Using specific keywords, relevant publications were filtered. Subsequently, abstracts were independently reviewed by two authors and the inclusion of each publication was assessed against pre-defined key search terms. Full-text versions of the included publications were scrutinized and pertinent information was extracted.ResultsIn this review, 126 articles from the literature search matched the inclusion criteria and were investigated. Our findings revealed a diverse range of course concepts and programs, a lot of them not meeting the expectations of trainees and international guidelines. OB/GYN ULS training primarily targets residents, yet opportunities for early exposure and continuing education are underexplored. International organizations, such as the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and the German Society for Ultrasound in Medicine (DEGUM) have proposed guidelines and curricula for standardized training. However, adoption remains varied. There is an emergent need to innovate teaching methods.ConclusionThere is consensus that standardizing OB/GYN ULS curricula could enhance training quality and streamline the creation of new programs, ultimately improving patient care. Further research is needed to define the most effective strategies for curriculum development and implementation.

Abstract 4124532: A Meta-Analysis on the Effect of Chronic Total Occlusion of Coronary Arteries on Cardiovascular Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement

Background and Aims: Transcatheter aortic valve replacement (TAVR) has revolutionized the management of severe aortic stenosis, particularly prevalent in elderly patients. These patients often present with coexisting coronary artery disease (CAD) due to shared risk factors. There is evidence suggesting that underlying CAD may result in poorer outcomes for patients undergoing TAVR. Chronic total occlusion (CTO), representing a severe manifestation of CAD, could therefore be hypothesized to worsen prognosis in TAVR patients, although data supporting this hypothesis are limited. Our meta-analysis aims to consolidate all available data concerning patients undergoing TAVR with concurrent CTO. Methods: We conducted a thorough literature search across major bibliographic databases, including PubMed, Embase, Cochrane Library, and SCOPUS, from their inception until May 15, 2024, to identify studies comparing outcomes of TAVR in patients with and without CTO. Pooled odds ratios (OR) with 95% confidence intervals (CIs) were calculated using the random-effects model via Comprehensive Meta-Analysis Software. The primary outcome assessed was in-hospital mortality, with several secondary endpoints also evaluated. Statistical significance was determined at p<0.05. Results: Eight studies, encompassing a total of 540,910 patients undergoing TAVR (11,679 with CTO; 529,231 without CTO), were included in this meta-analysis. TAVR in patients with CTO was associated with significantly increased odds of in-hospital mortality (OR: 1.25; 95% CI: 1.05, 1.49; p=0.011; I 2 =0%) and acute myocardial infarction (periprocedural) (OR: 1.68; 95% CI: 1.48, 1.91; p<0.001; I 2 =0%). However, no significant difference was observed in all-cause mortality (OR: 1.18; 95% CI: 0.71, 1.96; p=0.525; I 2 =59.37%), acute kidney injury (OR: 1.32; 95% CI: 0.94, 1.85; p=0.11; I 2 =72.12%), and stroke (OR: 1.06; 95% CI: 0.89, 1.28; p=0.509; I 2 =0%) (see Figures 1 and 2). Conclusion: CTO emerges as a substantial risk factor for patients undergoing TAVR, elevating the risk of in-hospital mortality and acute myocardial infarction. Considering a heart team's multidisciplinary approach in patients with underlying CTO may be advisable during TAVR, allowing for a comprehensive assessment of the benefits versus risks of revascularization prior to TAVR.

Abstract 4132498: Hemodynamic and Clinical Outcomes with Balloon-Expandable Valves Versus Self-Expanding Valves in Patients with Small Aortic Annulus Undergoing Transcatheter Aortic Valve Implantation: A Meta-Analysis of Randomized Controlled Trials and Propensity Score Matched Studies

Background: Transcatheter aortic valve implantation (TAVI) is thought to be more effective than surgery for patients with small aortic annulus (SAA), however, the comparative efficacy of different transcatheter heart valves (THVs) remains uncertain. The objective of this meta-analysis was to compare the effects of balloon-expandable valves (BEVs) and self-expanding valves (SEVs) on hemodynamic parameters and clinical outcomes in patients with SAA who underwent TAVI. Methods: A thorough literature search was performed across PubMed/MEDLINE, Embase, and the Cochrane Library from their inception until May 2024 to identify eligible randomized controlled trials (RCTs) and propensity-score matched (PSM) studies. Clinical outcomes were evaluated using a random-effects model to pool risk ratios (RRs) with 95% confidence intervals (CIs). Results: The analysis included 8 studies; 2 RCTs and 6 PSM studies, with a total of 2,180 patients with SAA. BEVs were associated with a smaller indexed effective orifice area (MD: -0.18, 95% CI: -0.31 to -0.05) and a higher transvalvular mean pressure gradient (MD: 5.23, 95% CI 3.44 to 7.02) than SEVs. The risk for prosthesis-patient mismatch (PPM) (RR= 1.82, 95% CI: 1.27 to 2.60) and severe PPM (RR= 2.77, 95% CI: 1.93 to 3.98) was significantly higher for patients receiving BEVs than those receiving SEVs. However, no significant difference was observed between BEVs and SEVs regarding the risk of paravalvular leak (RR= 0.98, 95% CI: 0.57 to 1.69) and the permanent pacemaker implantation (RR= 0.78, 95% CI: 0.50 to 1.23). Although patients receiving BEVs showed a slightly lower risk of major bleeding events (RR= 0.69, 95% CI: 0.49 to 0.99), BEVs were associated with a significantly increased risk of 1-year cardiovascular mortality (RR= 1.61, 95% CI: 1.05 to 2.47) compared to those receiving SEVs. However, no significant differences were observed between BEVs and SEVs regarding 30-day all-cause mortality (RR= 1.19, 95% CI: 0.57 to 2.49), 1-year all-cause mortality (RR= 1.17, 95% CI: 0.89 to 1.53), stroke rates (RR= 0.83, 95% CI: 0.52 to 1.31) and any vascular complication (RR= 1.13, 95% CI: 0.72 to 1.75). Conclusion: In patients with SAA, SEVs showed reduced risks of PPM and severe PPM compared to BEVs, along with a larger indexed effective orifice area. Moreover, SEVs were associated with a lower risk of 1-year cardiovascular mortality.

The Potential Health Risks and Benefits of Progesterone in the Transgender Woman Population—A Narrative Review

Introduction: Currently, progesterone is notably absent from conventional feminizing hormone therapies for transgender women. Anecdotal reports indicate the potential for health advantages following the incorporation of progesterone into treatment regimens. The primarily female hormone, progesterone naturally surges in women during the menstrual luteal phase. When administered exogenously, it may expedite bodily changes that are pivotal for gender transition. Progesterone holds promise as a potential remedy for various health conditions prevalent in the transgender woman population. Methods: This narrative review synthesizes existing literature and presents a comprehensive account of the administration of exogenous progesterone in transgender women. A literature search was conducted using the PubMed, Embase, ScienceDirect, and ResearchGate databases. The following keywords were used in the search: progesterone, transgender, breast neoplasms, lactation, prostate, testicular neoplasms, and thrombosis. These terms were combined using Boolean operators. The results of the initial search were screened by three independent reviewers based on their relevance to the topic under study. Results: A total of 104 studies were initially identified as meeting the criteria for inclusion. Following an assessment based on the contents of the title, abstract, and full text, 39 studies were deemed eligible for inclusion. A critical examination of health outcomes was conducted across key sections, including breast development, mental health, lactation, cancer risk (breast and prostate), thrombosis, and nervous and other systems. Discussion: The use of progesterone in the transgender woman population is a topic that has yet to be sufficiently researched. The limited sample size, short follow-up periods, and lack of randomization restrict the potential for achieving a robust scientific evidence base. In order to gain a fuller understanding of this topic, findings from studies on contraception, hormone replacement therapy, and animal models were considered. Conclusions: Progesterone may have a beneficial effect on the bodies of transgender women without significant adverse health effects. Further investigation through well-designed studies is recommended. Randomized controlled trials that include various dosages, broad and long-term effects, and precise demographics are needed. There is an immediate need for more knowledge to create appropriate patent and clinical practice guidelines.