PubMed Scopus Research Articles

Conflict between parents, physicians, and healthcare professionals in medical decision-making: How to address it-A systematic review from the ESPGHAN Ethics Committee.

Medical decisions about pediatric gastroenterology pathologies often involve collaboration between the medical team and the family. On occasions, conflict may arise between the individuals involved in decision making (team-family conflict) causing delays in managing a child's health condition. Little is known on the strategies that can be implemented to address such conflicts. Using the systematic review model by McCullough et al., an electronic literature search was conducted using PUBMED databases and SCOPUS. Studies published between 2001 and 2022 were analyzed to identify high-risk families, the barriers and facilitators involved in the team-family conflict and the circumstances in which healthcare professionals can be ethically justified to override parents' medical decisions and to trigger the state intervention. The present review provides recommendations on the more suitable ways to manage team-family conflict and gives a practical approach using a case vignette.

Benchmarking in pancreatic surgery: a systematic review of metric development and validation.

Benchmarking in healthcare, particularly in the context of complex surgical procedures like pancreatic surgery, plays a pivotal role in comparing and evaluating the quality of care provided to patients. There is a growing body of evidence validating existent metrics and introducing new ones in the pursuit of safety and excellence in pancreatic surgery. A systematic review adhering to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was conducted on metric development and validation across multiple databases, including PUBMED Medline, Scopus, and Web of Science, until February 2024. The extracted data were categorized into three domains according to the Donabedian model: structure, process, and outcomes. Thirty-four studies were deemed eligible for inclusion in this review. Among these articles, 20 contributed to metric development, while 14 studies validated them. A total of 234 metrics were identified across the 34 studies, of which 185 were included in the analysis. Thirty-three of these metrics were relative to structure, 79 to processes, and 73 to outcomes. The distribution of metric domains across the included studies revealed that structure, process, and outcome domains were reported in 12, 26, and 26 studies, respectively. In conclusion, this systematic review underscores the heterogeneity in metric development methodologies and the varying degrees of consensus among different quality indicators, despite the growing interest in benchmarking in pancreatic surgery. This review aims to inform future research efforts and contribute to the ongoing pursuit of excellence in pancreatic surgical care.

Effectiveness of preoperative and perioperative pulmonary rehabilitation nursing program for the management of patients undergoing thoracic surgery: A systematic review and meta-analysis.

Several studies have investigated the effectiveness of preoperative or perioperative pulmonary rehabilitation in thoracic surgery patients, but the results are inconsistent and inconclusive. This study attempts to summarize the existing data on the effect of the preoperative and perioperative pulmonary rehabilitation nursing program for the management of patients undergoing thoracic surgery. Systematic search was done in PubMed Central, SCOPUS, EMBASE, MEDLINE, Google Scholar, and ScienceDirect for papers published until December 2022 and reporting data of postoperative complications and pulmonary health status in patients undergoing thoracic surgery and receiving preoperative or perioperative pulmonary rehabilitation nursing intervention or standard care. Meta-analysis was done by random-effects model and pooled standardised mean differences (SMD) or odds ratios (OR) along with 95% confidence intervals (CIs) were reported. Eighteen studies were included and analysed. Pooled SMD was 0.44 (95%CI: -0.21 to 1.08) for forced expiratory volume (FEV-1), -0.34 (95%CI: -0.94 to 0.26) for peak expiratory flow (PEF), 0.61 (95%CI: -0.60 to 1.81) for forced vital capacity (FVC), 0.42 (95%CI: -0.13 to 0.98) for diffusing capacity of carbon monoxide (DLCO). Pooled SMD for length of hospital stay was -0.64 (95%CI: -1.09 to -0.19). Pooled OR was 0.87 [95%CI: 0.32 to 2.37] for all-cause mortality, 0.35 [95%CI: 0.25 to 0.50] for postoperative pulmonary complications, 0.98 [95%CI: 0.45 to 2.12] for respiratory failure, 0.52 [95%CI: 0.38 to 0.78] for pneumonia and 0.50 [95%CI: 0.33 to 0.76] for atelectasis. Perioperative pulmonary rehabilitation nursing program is effective in reducing the postoperative lung complications and shortening the length of hospital stay in patients undergoing thoracic surgery.

Vocal Self-Perception of Singers During COVID-19 Pandemic.

to compare the self-perception of vocal fatigue and use of singing voice during the COVID-19 pandemic between professional and amateur singers and to relate this self-perception with vocal use characteristics during this period. Participants were 121 singers divided into professional singers group (PSG) (12 men and 20 women) comprising singers who depended exclusively on singing as a profession and an amateur singers group (ASG) (37 men and 52 women) of singers who did not depend exclusively on singing for their livelihood. All answered online questionnaires through Google Forms ®. Sociodemographic and vocal characteristics were investigated before and during the pandemic; symptoms of vocal fatigue were assessed through the vocal fatigue index (VFI); and self-perception of use of singing voice through the evaluation of the ability to sing easily protocol for Brazil (EASE-Br). In the comparison between groups, the PSG presented higher scores of vocal fatigue in fatigue and vocal limitation (P=0.045), vocal restriction (P=0.002), and recovery with vocal rest (P=0.008) domains than did the ASG. There was no difference between the groups regarding the use of singing voice. Based on the relationship between self-perception and vocal use characteristics during the pandemic, it was observed that the presence of vocal complaint was the only factor associated with self-perception of fatigue symptomatology in both groups. Regarding the self-perception of the current status of the singing voice, singing time, the presence of vocal complaints, the need to increase visual concentration, and the perception of vocal worsening during the pandemic were considered predictive for amateur singers. For professional singers, vocal complaints and vocal training were predictors for self-perception of the current status of the singing voice. Professional singers presented with higher scores of vocal fatigue than did amateur singers. The symptomatology of vocal fatigue was associated with the presence of vocal complaints in both groups. However, self-perception of the current status of the singing voice was different between the groups and was associated with vocal training for professional singers and characteristics of vocal demand of singing voice during the pandemic period for amateur singers.

Development of a Multi-site Curriculum for Inequities in Newborn Care (CINC) Informed by Pediatric Resident and Community Engagement.

Inequities in health care are a well-identified contributor to adverse outcomes in neonates of vulnerable populations. 1 2022 March of Dimes Report Card. Accessed March 8, 2023. 〈https://www.marchofdimes.org/report-card〉 Google Scholar , 2 Warren M.D. Hirai A.H. Lee V. Accelerating Upstream Together: Achieving Infant Health Equity in the United States by 2030. Pediatrics. Published online January. 2022; 3e2021052800https://doi.org/10.1542/peds.2021-052800 Crossref Scopus (2) Google Scholar , 3 Sigurdson K. Morton C. Mitchell B. Profit J. Disparities in NICU quality of care: a qualitative study of family and clinician accounts. Journal of Perinatology. 2018; 38: 600-607https://doi.org/10.1038/s41372-018-0057-3 Crossref PubMed Scopus (61) Google Scholar Societal and institutional inequities rooted within implicit biases and racism result in variable quality of care in the nursery, such as differences in time spent skin-to-skin with infants, clinical resource allocation based on racial background, and a lack of motivation to establish a therapeutic alliance with families who have differing social and cultural needs. 3 Sigurdson K. Morton C. Mitchell B. Profit J. Disparities in NICU quality of care: a qualitative study of family and clinician accounts. Journal of Perinatology. 2018; 38: 600-607https://doi.org/10.1038/s41372-018-0057-3 Crossref PubMed Scopus (61) Google Scholar Most significantly, this inequitable care results in the increased mortality of non-Hispanic black and Hispanic infants as compared to infants of non-Hispanic white backgrounds. 4 National Vital Statistics Reports Volume 69, Number 7 July 16, 2020, Infant Mortality in the United States, 2018 : Data From the Period Linked Birth/Infant Death File. Google Scholar In light of these inequities, the Academic Pediatrics Association (APA) implemented initiatives rooted in active anti-racism to dismantle oppressive power structures across pediatric organizations. 5 Cohen A. et al. Changing Who Has a Seat and Voice at the Table: How the Academic Pediatric Association is Responding to Systemic Racism. Academic Pediatrics. 2022; 22: 352-355https://doi.org/10.1016/j.acap.2022.01.002 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar This urgent commitment to action is further supported by the Association of Pediatric Program Directors (APPD) which maintains that anti-racism involves actively dismantling racism in all that we do. 6 Blankenburg B. et al. Dismantling Racism: Association of Pediatric Program Directors’ Commitment to Action. Academic Pediatrics. 2020; 20: 1051-1053https://doi.org/10.1016/j.acap.2020.08.017 Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar Focus groups of trainees at 4 Bay Area academic medical centers explored gaps in education on newborn health inequities to best understand how to support providers in actively practicing anti-racism in clinical care. Trainees spotlight inequities in their rotations, but feel helpless to address them given a lack of action-based tools, education on inequities, protected time for reflection, and faculty role-modeling. 7 Hume P. , Bowers K. , Robertson L. , et al. Residents’ Perspectives on Neonatal Health Inequities to Guide an Innovative Curriculum. Poster Presentation presented at: APPD; March 2023; Atlanta, Georgia. Google Scholar Given these highlighted gaps, we sought to provide our pediatrics faculty and trainees with action-oriented education to address inequities.

Health Equity in the Neonatal Intensive Care Unit Rounds: A Multidisciplinary Educational Conference.

Despite improving pregnancy-related morbidity and mortality in other high-income countries, birthing people and infants in the United States have disparate and worsening outcomes influenced by structural, political, and moral determinants of health including racism. 1 2021 Annual Report. America's Health Rankings, United Health Foundation. 〈https://www.americashealthrankings.org/learn/reports/2021-annual-report/international-comparison〉. Published 2021. Accessed2022. Google Scholar , 2 Clark A. Wescott P. Mitchell N. Mahdi I. Crear-Perry J. Centering equity: Addressing structural and social determinants of health to improve maternal and infant health outcomes. Semin Perinatol. 2022; 46151661 Crossref PubMed Scopus (3) Google Scholar As clinicians in the neonatal intensive care unit (NICU), we are professionally obligated to enact structural and individual changes to mitigate disparities. 3 Cohen A. Montez K. Orr C. et al. Changing Who Has a Seat and Voice at the Table: How the Academic Pediatric Association is Responding to Systemic Racism. Acad Pediatr. 2022; 22: 352-355 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar Therefore, recognizing and understanding how structural determinants of health (SDoH) and racism affect our patients is paramount.

Improving Diversity, Equity, and Inclusion Content in Pediatrics Grand Rounds.

Grand rounds (GR) is a quintessential component of medical education across the spectrum from undergraduate medical education to continuing medical education for established physicians with a goal of enhancing knowledge, changing physician behavior, and improving patient outcomes. The purpose and scope of GR has undergone many iterations over the hundreds of years of its practice and previous work has aimed to enhance its educational impact, 1 Van Hoof, Thomas MD, EdD, J. Monson, Robert PhD, J. et al. A Case Study of Medical Grand Rounds: Are We Using Effective Methods?. Academic Medicine. 2009; Volume 84 (August): 1144-1151https://doi.org/10.1097/ACM.0b013e3181ad1c0e Crossref Scopus (33) Google Scholar including innovations that seek to educate about the origin and ongoing consequences of the health crises of systemic racism and other structural inequities. 2 Perdomo J. Tolliver D. Hsu H. et al. Health Equity Rounds: An Interdisciplinary Case Conference to Address Implicit Bias and Structural Racism for Faculty and Trainees. MedEdPORTAL. 2019; 15: 10858https://doi.org/10.15766/mep_2374-8265.10858 Crossref PubMed Scopus (39) Google Scholar A primary audience for GR is established mid- and late-career faculty, an educational target group perhaps more in need of DEI pedagogy than our earliest medical career learners. 3 Rosenkranz Kari M. Arora Tania K. Termuhlen Paula M. et al. Diversity, Equity and Inclusion in Medicine: Why It Matters and How do We Achieve It?. Journal of Surgical Education. 2021; Volume 78 (ISSN 1931-7204): 1058-1065https://doi.org/10.1016/j.jsurg.2020.11.013 Crossref Scopus (34) Google Scholar Previous work on improving anti-racist content in medical education recognizes this group as in need of particular focus. 4 Blankenburg R. et al. Dismantling racism: Association of Pediatric Program Directors’ Commitment to Action. Academic Pediatrics. 2020; 20: 1051-1053 Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar Development of presentations that consistently and specifically address aspects of DEI is essential to sustainably re-orienting medical education to address health equity.

Realizing Inclusion and Systemic Equity in Medicine: Upstanding in the Medical Workplace-A Curriculum Update.

Racism is a public health crisis. Bias towards patients adversely affects health outcomes 1 FitzGerald C. Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics. 2017; 18 (Mar 1) (PMID: 28249596; PMCID: PMC5333436.): 19https://doi.org/10.1186/s12910-017-0179-8 Crossref PubMed Scopus (984) Google Scholar and access to care while structural racism in medicine has led to decreased diversity of the healthcare workforce, burnout, and negative career outcomes. 2 Filut A. Alvarez M. Carnes M. Discrimination Toward Physicians of Color: A Systematic Review. J Natl Med Assoc. 2020; 112 (Apr): 117-140https://doi.org/10.1016/j.jnma.2020.02.008 Crossref PubMed Scopus (46) Google Scholar Growing evidence shows that curricula addressing racism within medical education can increase providers’ perceived capacity to address racism and limit its impact on patients and staff. 3 Jindal M. Mistry K.B. McRae A. Unaka N. Johnson T. Thornton R.L.J. "It Makes Me a Better Person and Doctor": A Qualitative Study of Residents' Perceptions of a Curriculum Addressing Racism. Acad Pediatr. 2022; 22 (Mar): 332-341https://doi.org/10.1016/j.acap.2021.12.012 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar

FOSTERING COMMUNITY ENGAGEMENT TO ADDRESS RACISM: DEVELOPMENT AND IMPLEMENTATION OF A SERVICE-LEARNING CURRICULUM FOR PEDIATRIC RESIDENTS.

In recent years, there has been a call for Academic Health Centers to increase community engagement to address racism. 1 Blanchard A.K. Blanchard J.C. Suah A. et al. Reflect and reset: Black academic voices call the graduate medical education community to action. Acad Med. 2022; 97: 967-972 Crossref PubMed Scopus (6) Google Scholar Alongside didactic education and building a diverse learning environment, community engagement allows trainees to better understand the structural underpinnings of inequities and better recognize their own biases to create a framework for how to improve care for marginalized populations. 2 Khazanchi R. Keeler H. Strong S. et al. Building structural competency through community engagement. Clin Teach. 2021; 18: 535-541 Crossref PubMed Scopus (8) Google Scholar Community-based service learning (CBSL), a teaching strategy that combines community service with “explicit learning objectives, preparation, and reflection,” 3 Seifer S.D. Hermanns K. Lewis J. Creating community-responsive physicians: Concepts and models for service-learning in medical education. American Association for Higher Education, 2000〈https://files.eric.ed.gov/fulltext/ED449734.pdf〉 Google Scholar is one methodology that can be used to give participants the opportunity to engage with the local community while also learning about the context in which the service is provided.

2023 CCS/CSE Standards for Physician Training and Maintenance of Competence in Adult Echocardiography: Executive Summary.

Echocardiography is an imaging modality essential to the provision of contemporary cardiovascular care. Since the publication of the 2010 CCS/CSE Guidelines, 1 Burwash IG, Basmadjian A, Bewick D, Choy JB, Cujec B, Jassal DS, MacKenzie S, Nair P, Rudski L, Yu E, Tam JW. 2010 Canadian Cardiovascular Society/Canadian Society of Echocardiography Guidelines for Training and Maintenance of Competency in Adult Echocardiography. Can J Cardiol 2010;27:862-864. Google Scholar clinical echocardiography has expanded with respect to both technologies and applications. At the same time there has been a shift in emphasis away from quantity of training (duration and case volumes) to actual demonstration of competency to determine successful completion of training. 2 Royal College of Physicians and Surgeons of Canada “Competency by Design: Reshaping Medical Education” 2014 https://www.royalcollege.ca/rcsite/documents/educational-strategy-accreditation/royal-college-competency-by- design-ebook-e.pdf Accessed 8 March 2023. Google Scholar Concurrently, there is growing evidence of considerable variability in echocardiography competence among general cardiology trainees. 3 Nair P. Siu S.C. Sloggett C.E. Biclar L. Sidhu R.S. Yu E.H.C. The assessment of technical and interpretative proficiency in echocardiography. J Am Soc Echocardiogr. 2006; 19: 924-931 Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar , 4 Bierowski M.J. Qureshi U. Ramedani S. Grewal S. Shah R. Park B. Peterson B.R. Variable exposure to echocardiography core competencies when applying minimum recommended procedural numbers of cardiology fellows in training. Cardiovasc Ultrasound. 2022; 20: 24-32 Crossref Scopus (0) Google Scholar , 5 Yu C.C.W. Pendrith C. Chun S. Echocardiographic interpretation skills of graduating cardiology trainees. Can J Cardiol. 2022; 38: 1304-1306 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar

Phosphorylated Ataxia Telangiectasia Mutated (pATM) Enzyme-Linked Immunosorbent Assay (ELISA) for Predicting Radiation Induces Normal Tissue Toxicity in Radiotherapy Patients: A Systematic Review

Background: An adverse normal tissue response, such as normal tissue toxicity (NTT), is present in radiotherapy (RT) patients and can limit the effectiveness of the RT treatment. Identifying patients with adverse tissue responses before RT had clinical benefits and individual radiosensitivity (IRS) is considered an important factor in NTT incidences. Therefore, this systematic study aimed to determine the possibility of using phosphorylated Ataxia Telangiectasia Mutated (pATM) Enzyme-Linked Immunosorbent Assay (ELISA) to predict NTT in RT patients.Methods: A comprehensive data search was conducted in three electronic databases, namely PUBMED CENTRAL, ScienceDirect, and SCOPUS. The quality of relevant publications was independently evaluated using the PICO (participants, intervention/exposure, comparison, and outcome) approach.Results: : A total of 47 articles were retrieved, 41 of which were assessed based on the titles and abstracts. Furthermore, 39 articles were excluded, and 2 were included in this study.Conclusions: The phosphorylated ATM ELISA on lymphocytes showed promising results for IRS prediction in RT patients. However, these assumptions should be validated on a larger RT patient cohort.

Chronic or recurrent Campylobacter enteritis in primary immunodeficiency: a UK national case-series and review of the literature.

Chronic or recurrent Campylobacter enteritis in primary immunodeficiency: a UK national case-series and review of the literature.

Open reconstruction of severe superior vena cava syndrome with right internal jugular-Superior vena cava bypass using femoral vein.

Current treatment of chronic benign superior vena cava syndrome (SVCS) is endovascular with angioplasty/stenting1Rizvi A.Z. Kalra M. Bjarnason H. Bower T.C. Schleck C. Gloviczki P. Benign superior vena cava syndrome: Stenting is now the first line of treatment.J Vasc Surg. 2008; 47: 372-380Abstract Full Text Full Text PDF PubMed Scopus (153) Google Scholar,2Wilson L.D. Detterbeck F.C. Yahalom J. Clinical practice. Superior vena cava syndrome with malignant causes.N Engl J Med. 2007; 356: 1862-1869Crossref PubMed Scopus (355) Google Scholar. Open surgical bypass is typically considered for patients who fail endovascular therapy3Picquet J. Blin V. Dussaussoy C. Jousset Y. Papon X. Enon B. Surgical reconstruction of the superior vena cava system: Indications and results.Surgery. 2009; 145: 93-99Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar,4Kalra M. Sen I. Gloviczki P. Endovenous and Operative Treatment of Superior Vena Cava Syndrome.Surg Clin North Am. 2018; 98: 321-335Abstract Full Text Full Text PDF Scopus (20) Google Scholar. This report illustrates the surgical treatment of symptomatic SVCS. The patient consented to the publication. A 31-year-old male patient presented with recurrent edema and dilated veins of the upper extremities, head, neck, and chest, with concomitant severe headache. His history was significant for previous left lower extremity osteomyelitis six years before, being treated with antibiotics through a left upper extremity peripherally inserted central catheter (PICC). Symptoms of SVCS developed three years later. He was treated with bilateral subclavian and innominate vein stenting extending into the superior vena cava (SVC). Despite oral anticoagulation since the first intervention, the patient had multiple in-stent reocclusions and seven reinterventions with only temporary symptom improvement. Physical examination evidenced facial edema, plethoric facies, and dilated veins in the chest and abdomen. Computed tomography venogram (CTV) demonstrated occlusion of all stents. The right internal jugular vein (RIJV) was patent at the upper-neck level, close to the carotid bifurcation and the SVC was also patent caudally to the azygos vein. A left upper extremity and central venogram were performed and attempts were made to cross the occluded stents, without success. The patient then agreed to proceed with an open reconstruction. A RIJV to SVC bypass was performed using the patient´s right femoral vein, which had 8 mm in diameter, via a median sternotomy and a right neck incision (01:39). The suitable diameter of the vein-graft relies upon the main vessels’ diameter and patient´s anatomy, although a minimum dimeter of 6 mm is generally accepted. After the SVC anastomosis, a Valsalva maneuver was performed, and the clamp was opened with the patient in Trendelenburg position to minimize the risk of air embolism. At the two-year follow-up, a patent bypass was demonstrated with symptoms resolution. Annual follow-up with duplex ultrasound will be pursued. Open surgical treatment of SVC syndrome is associated with long-term symptoms relief and is an excellent option for patients who fail endovascular treatment. The femoral vein-graft was an excellent conduit with a good size-match to the RIJV, durable results and symptoms resolution. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI3OTBmNTRkMDM4ODYxZjBkNTkxYTBlMWZlNDc5OGU3NyIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjg3NTk5NzY2fQ.cmFN_OFbjDH4lOiwl1zKkjrgnyVQ2yXQnj_hVfumqU1CX0DvODIdqDnFjP8WKhsd08e_hL8cEQf62356emnlqTr0YQ3Taf7QzqEzXDSXdshLabCLWCJSBJImuFBTwhSNEbChKp9VtQEQaGgQFyoxmim8ywtDZOp91FbZKEyqSzPRGpQZ1TaQTnYdofXOPWy6HWHwpA7L72nUSdtDa6DKZAo-7fV2qqKuAhpR-b2_-TYFZ5QDsM4894KbXMoSfpiuH1MyYN3E2RcS1dja_5IiR_wUucRBjC65wTnhE2xRmiUL_0CZXxMNdfGKpq8bBaTg1GNl69QgdXWvXJkmViQ8Mw Download .mp4 (86.14 MB) Help with .mp4 files

Isolated IgG4-related cholecystitis mimicking an advanced gallbladder cancer: Don't fall into the trap.

A 59-year old women developed spontaneous jaundice without fever and after a progressive loss of 10 kg in 6 months. Iconography showed an enlarged gallbladder with gallstones and thickening walls responsible for an intrahepatic bile duct dilatation with infiltration of the hepatic pedicle and a portal stenosis (Fig. 1). Jaundice spontaneously resolved but cholestasis remained. Surgical and radiological guided biopsy were performed twice without contributive histology. We decided to proceed to a right portal vein embolization in the aim to proceed to an extended right hepatectomy. Fortunately, definitive histology of the last biopsy revealed inflammatory condition with a high IgG4-plasmocytes rate although the patient's serum concentration of IgG4 was moderate (1.39 g/L, normal rate: 0.86–1.35 g/L) and initially considered as not significant. A complete check up was performed and concluded that it was the unique location of an IgG4-related disease [ [1] Lanzillotta M. Mancuso G. Della-Torre E. Advances in the diagnosis and management of IgG4 related disease. BMJ. 2020; 369: m1067https://doi.org/10.1136/bmj.m1067 Crossref PubMed Scopus (97) Google Scholar ]. Corticotherapy was introduced.

Andexanet Alfa Should Be Used to Reverse Factor Xa Inhibitors in the Setting of Life-Threatening Bleeding.

Andexanet alfa was approved by the Food and Drug Administration for reversal of factor Xa inhibitors, apixaban and rivaroxaban, in the setting of acute major bleeding. 1 Connolly S.J. Crowther M. Eikelboom J.W. et al. Full study report of andexanet alfa for bleeding associated with factor Xa inhibitors. N Engl J Med. 2019; 380: 1326-1335 Crossref PubMed Scopus (454) Google Scholar ,2 Siegal D.M. Curnutte J.T. Connolly S.J. et al. Andexanet alfa for the reversal of factor Xa inhibitor activity. N Engl J Med. 2015; 373: 2413-2424 Crossref PubMed Scopus (786) Google Scholar Andexanet alfa and prothrombin complex concentrate have been studied for factor Xa inhibitor reversal. The andexanet alfa is the preferred reversal agent for factor Xa inhibitor bleeds because of its targeted pharmacology for reversal, hemostatic efficacy, mortality outcomes, and its endorsement by numerous guidelines as the preferred agent.

Diagnostic accuracy of positron emission tomography/computerized tomography for periprosthetic joint infection of hip: systematic review and meta-analysis

BackgroundAmerican Academy of Orthopaedic Surgeons (AAOS) has provided the guidelines for diagnosing a patient with periprosthetic joint infection including the use of positron emission tomography/computed tomography (PET/CT). Systematic evidence focussing on periprosthetic joint infection (PJI) of hip is limited, which also contains limited number of studies. Hence, the current study aims to perform a pooled analysis of all studies that have assessed the diagnostic accuracy of PET/CT for PJI of hip.MethodsSearches were done in PubMed Central, EMBASE, MEDLINE, SCOPUS and Cochrane library until December 2022. Meta-analysis was carried out using random-effects model. With 95% confidence intervals (CIs), pooled sensitivity and specificity were reported.ResultsTwenty-six studies met the inclusion criteria. The pooled sensitivity of PET/CT was 89% (95% CI 84–93%), while the pooled specificity was 86% (95% CI 79–91%). The AUROC was 0.94 (95% CI 0.72–0.99). There was statistically significant heterogeneity (p < 0.001) with I2 value of 96%. The diagnostic odds ratio was 52 (95% CI 26–106). Likelihood ratio positive was 6.5 (95% CI 4.1–10.3) and negative was 0.13 (95% CI 0.08–0.19).ConclusionOur study found that PET/CT was found to have higher level of accuracy in terms of sensitivity and specificity. Further large-scale research can help to find answers for such questions and provide final conclusive evidence on the inclusion of the imaging modality into the routine clinical practice guidelines for suspected periprosthetic joint infection patients.

Obesity wars: hypothalamic sEVs a new hope.

There are currently several pharmacological therapies available for the treatment of obesity, targeting both the central nervous system (CNS) and peripheral tissues. In recent years, small extracellular vesicles (sEVs) have been shown to be involved in many pathophysiological conditions. Because of their special nanosized structure and contents, sEVs can activate receptors and trigger intracellular pathways in recipient cells. Notably, in addition to transferring molecules between cells, sEVs can also alter their phenotypic characteristics. The purpose of this review is to discuss how sEVs can be used as a CNS-targeted strategy for treating obesity. Furthermore, we will evaluate current findings, such as the sEV-mediated targeting of hypothalamic AMP-activated protein kinase (AMPK), and discuss how they can be translated into clinical application.

Efficacy of a novel self-assembling peptide gel for hemostasis in refractory neoplastic bleeding.

Video 1Outline of how self-assembling peptide gel can be used exvivo.

Tunneling-free peroral endoscopic septotomy for Zenker diverticulum.

Video 1Tunneling-free peroral endoscopic Zenker myotomy.

Cone repair after tricuspid valve replacement in Ebstein anomaly.

Cone repair after tricuspid valve replacement in Ebstein anomaly.