American Society Research Articles

Imaging Recommendations for Diagnosis and Management of Primary Parathyroid Pathologies: A Comprehensive Review

Parathyroid pathologies are suspected based on the biochemical alterations and clinical manifestations, and the predominant roles of imaging in primary hyperparathyroidism are localisation of tumour within parathyroid glands, surgical planning, and to look for any ectopic parathyroid tissue in the setting of recurrent disease. This article provides a comprehensive review of embryology and anatomical variations of parathyroid glands and their clinical relevance, surgical anatomy of parathyroid glands, differentiation between multiglandular parathyroid disease, solitary adenoma, atypical parathyroid tumour, and parathyroid carcinoma. The roles, advantages and limitations of ultrasound, four-dimensional computed tomography (4DCT), radiolabelled technetium-99 (99mTc) sestamibi or dual tracer 99mTc pertechnetate and 99mTc-sestamibi with or without single photon emission computed tomography (SPECT) or SPECT/CT, dynamic enhanced magnetic resonance imaging (4DMRI), and fluoro-choline positron emission tomography (18F-FCH PET) or [11C] Methionine (11C -MET) PET in the management of parathyroid lesions have been extensively discussed in this article. The role of fluorodeoxyglucose PET (FDG-PET) has also been elucidated in this article. Management guidelines for parathyroid carcinoma proposed by the American Society of Clinical Oncology (ASCO) have also been described. An algorithm for management of parathyroid lesions has been provided at the end to serve as a quick reference guide for radiologists, clinicians and surgeons.

Analisis Wacana Kritis Norman Fairclough Pada Film Barbie 2023 Sebagai Representasi Budaya Patriarki

Film is part of audio-visual mass media communication and aims to convey social messages to the audience in accordance with the reality that is growing and developing in society. One of the films that has this purpose is the film Barbie Live Action 2023. The purpose of this research is to dissect the discourse in three dimensions, namely textual, discourse practice, and sociocultural practice. In this research, the type of research used is qualitative-descriptive research. The paradigm used in this research is the critical paradigm. The appropriate research method used for this research is Norman Fairclough's Critical Discourse Analysis method. In the textual dimension, the linguistic tools of Diction, Cohesion, Modality and figure of speech metaphor are obtained. In the discourse practice dimension, at the production level the Barbie film is produced with two backgrounds, namely Barbieland and the real world, namely the city of Los Angles, United States with English language dialogue. At a text consumption level, the film is the highest-grossing box office film of all time with earnings of $1.45 billion. Sociocultural practices have 3 levels, namely situational, institutional and social levels. Situational Barbie script was written during the pandemic. For example, the film Barbie was a box office success in almost the entire world and became the hope of the global community regarding the end of the pandemic. Furthermore, at the institutional level, which includes the media, is Greta Gerwig herself as a film filmmaker. Warner Bros. is the production house for the 2023 Barbie Live Action film. Then there is Mattel as the company behind the production of Barbie dolls. Finally, at the social level, this film shows how patriarchy persists in reality, the social and cultural system of American society still adheres to patriarchal culture and neglects women's rights and protection.

Safety and feasibility of single-incision laparoscopic distal gastrectomy in overweight and obese gastric cancer patients: a propensity score-matched analysis.

The technical challenges and safety concerns of single-incision laparoscopic gastrectomy for overweight and obese gastric cancer patients remain unclear. This study aimed to evaluate the safety and feasibility of single-incision laparoscopic distal gastrectomy (SIDG) compared to multiport laparoscopic distal gastrectomy (MLDG) in overweight and obese gastric cancer patients. This study retrospectively analyzed overweight and obese patients (body mass index ≥ 25kg/m2) and pathologic stage T1 primary gastric adenocarcinoma treated with either SIDG or MLDG. The SIDG and MLDG groups were propensity score matched at a 1:2 ratio using age, sex, height, body weight, American Society of Anesthesiologists classification, year of surgery, pathologic N stage, and anastomosis method as covariates. After 1:2 matching, the study included patients who underwent SIDG (n = 179) and MLDG (n = 358). No significant difference in the number of retrieved lymph nodes was found between the SIDG and MLDG groups (52.8 ± 19.3 vs. 53.9 ± 21.0, P = 0.56). Operation times were significantly shorter in the SIDG group (170.8 ± 60.0min vs. 186.1 ± 52.6min, P = 0.004). The postoperative hospital length of stay was comparable between the 2 groups (SIDG: 5.9 ± 3.4days vs. MLDG: 6.3 ± 5.1days, P = 0.23), as was postoperative complication rate (SIDG: 13.4% vs. MLDG: 12.8%, P = 0.89). SIDG was shown to be as safe and feasible as MLDG for overweight and obese gastric cancer patients, with comparable early postoperative complication rates without compromising operation time compared to MLDG.

Risk factors of postoperative urinary retention following total hip and knee arthroplasty.

The aim of this meta-analysis was to determine the pooled incidence of postoperative urinary retention (POUR) following total hip and knee arthroplasty (total joint replacement (TJR)) and to evaluate the risk factors and complications associated with POUR. Two authors conducted searches in PubMed, Embase, Web of Science, and Scopus on TJR and urinary retention. Eligible studies that reported the rate of POUR and associated risk factors for patients undergoing TJR were included in the analysis. Patient demographic details, medical comorbidities, and postoperative outcomes and complications were separately analyzed. The effect estimates for continuous and categorical data were reported as standardized mean differences (SMDs) and odds ratios (ORs) with 95% CIs, respectively. A total of 31 studies were included in the systematic review. Of these, 29 studies entered our meta-analysis, which included 3,273 patients diagnosed with POUR and 11,583 patients without POUR following TJR. The pooled incidence of POUR was 28.06%. Demographic risk factors included male sex (OR 1.81, 95% CI 1.26 to 2.59), increasing age (SMD 0.16, 95% CI 0.04 to 0.27), and American Society of Anesthesiologists grade 3 to 4 (OR 1.39, 95% CI 1.10 to 1.77). Patients with a history of benign prostatic hyperplasia (OR 1.99, 95% CI 1.41 to 2.83) and retention (OR 3.10, 95% CI 1.58 to 6.06) were more likely to develop POUR. Surgery-related risk factors included spinal anaesthesia (OR 1.44, 95% CI 1.19 to 1.74) and postoperative epidural analgesia (OR 2.82, 95% CI 1.65 to 4.82). Total hip arthroplasty was associated with higher odds of POUR compared to total knee arthroplasty (OR 1.10, 95% CI 1.02 to 1.20). Postoperatively, POUR was associated with a longer length of stay (SMD 0.21, 95% CI 0.02 to 0.39). Our meta-analysis demonstrated key risk variables for POUR following TJR, which may assist in identifying at-risk patients and direct patient-centered pathways to minimize this postoperative complication.

Risk of malignancy in effusions according to the International System for Serous Fluid Cytopathology: a review.

The International Serous Fluid Cytopathology Reporting System (TIS) was developed to standardize communication among health professionals reporting analyses of serous fluid samples. The categories include Non-Diagnosis (ND), Negative for Malignancy (NFM), Atypia of Undetermined Significance (AUS), Suspected Malignancy (SFM), and Malignant (MAL). Each category was characterized by a risk of malignancy (ROM). We performed a literature review to analyze studies related to TIS using several sources, including PubMed, followed by a search of relevant cytopathology journal websites (American Cancer Society, Diagnostic Cytopathology, Journal of the American Society of Cytopathology, and Acta Cytologica and Cytopathology). The search included articles published between January 2020 and December 2023, using the terms "international AND serous fluid system." We identified 257 articles, of which 20 addressed the inclusion and exclusion criteria. The overall ROMs for each category were 23.55% for ND, 16.46% for NFM, 50.78% for AUS, 91.34% for SFM, and 98.21% for MAL. Considering the TIS-recommended ROM rates, the ND category was between the suggested intervals, while the SFM category rate was larger than expected. The other categories (NFM, AUS, and MAL) were below expected values. SFM and MAL had a stronger association with malignant results. New studies are needed to determine each category's ROM rate from TIS accurately.

Assessing T-cell receptor clonality by next-generation sequencing in atypical cutaneous lymphoid infiltrates and cutaneous T-cell lymphoma: A scoping review.

The diagnosis of cutaneous T-cell lymphoma (CTCL) remains challenging. Demonstration of a clonal T-cell population using T-cell receptor (TCR) gene rearrangement studies by next-generation sequencing (NGS) has been explored in several studies. This review summarizes the current literature on NGS-based sequencing methods for the assessment of TCR clonality in the evaluation of atypical cutaneous lymphoid infiltrates and CTCL on behalf of the American Society of Dermatopathology Appropriate Use Criteria Committee (lymphoproliferative subgroup). PubMed was searched for relevant articles, including CTCL and NGS, for clonality from 1967 to 2022. Thirteen studies were included in the analysis. The skin was the most commonly assayed compartment with TCR NGS. Sensitivity for TCR NGS in the skin ranged between 69% and 100%, compared to 44%-72% for polymerase chain reaction (PCR)-capillary electrophoresis. Specificity for TCR NGS in the skin ranged from 86% to 100%, compared to 77%-88% for PCR capillary electrophoresis. TCR NGS was also reported to have potential prognostic value in CTCL and can also be used to detect relapse and/or minimal residual disease after treatment.

Consensus Statement: Technical Standards for Thoracoabdominal Normothermic Regional Perfusion

BackgroundThoracoabdominal normothermic regional perfusion (TA-NRP) has emerged as a powerful technique for optimizing organ procurement from donation after circulatory death donors. Despite its rapid adoption, standardized guidelines for TA-NRP implementation are lacking, prompting the need for consensus recommendations to ensure safe and effective utilization of this technique. MethodsA working group composed of members from The American Society of Transplant Surgeons, The International Society of Heart and Lung Transplantation, The Society of Thoracic Surgeons, and The American Association for Thoracic Surgery was convened to develop technical guidelines for TA-NRP. The group systematically reviewed existing literature, consensus statements, and expert opinions to identify key areas requiring standardization, including predonation evaluation, intraoperative management, postdonation procedures, and future research directions. ResultsThe working group formulated recommendations encompassing donor evaluation and selection criteria, premortem testing and therapeutic interventions, communication protocols, and procedural guidelines for TA-NRP implementation. These recommendations aim to facilitate coordination among transplant teams, minimize variability in practice, and promote transparency and accountability throughout the TA-NRP process. ConclusionsThe consensus guidelines presented herein serve as a comprehensive framework for the successful and ethical implementation of TA-NRP programs in organ procurement from donation after circulatory death donors. By providing standardized recommendations and addressing areas of uncertainty, these guidelines aim to enhance the quality, safety, and efficiency of TA-NRP procedures, ultimately contributing to improved outcomes for transplant recipients.

90-Day Emergency Department Utilization and Readmission Rate After Full-Endoscopic Spine Surgery: A Multicenter, Retrospective Analysis of 821 Patients.

Emergency department (ED) utilization and readmission rates after spine surgery are common quality of care measures. Limited data exist on the evaluation of quality indicators after full-endoscopic spine surgery (FESS). The objective of this study was to detect rates, causes, and risk factors for unplanned postoperative clinic utilization after FESS. This retrospective multicenter analysis assessed ED utilization and clinic readmission rates after FESS performed between 01/2014 and 04/2023 for degenerative spinal pathologies. Outcome measures were ED utilizations, hospital readmissions, and revision surgeries within 90 days postsurgery. Our cohort includes 821 patients averaging 59 years of age, who underwent FESS. Most procedures targeted the lumbar or sacral spine (85.75%) while a small fraction involved the cervical spine (10.11%). The most common procedures were lumbar unilateral laminotomies for bilateral decompression (40.56%) and lumbar transforaminal discectomies (25.58%). Within 90 days postsurgery, 8.0% of patients revisited the ED for surgical complications. A total of 2.2% of patients were readmitted to a hospital of which 1.9% required revision surgery. Primary reasons for ED visits and clinic readmissions were postoperative pain exacerbation, transient neurogenic bladder dysfunction, and recurrent disk herniations. Our multivariate regression analysis revealed that female patients had a significantly higher likelihood of using the ED (P = .046; odds ratio: 1.77, 95% CI 1.01-3.1 5.69% vs 10.33%). Factors such as age, American Society of Anesthesiologists class, body mass index, comorbidities, and spanned spinal levels did not significantly predict postoperative ED utilization. This analysis demonstrates the safety of FESS, as evidenced by acceptable rates of ED utilization, clinic readmission, and revision surgery. Future studies are needed to further elucidate the safety profile of FESS in comparison with traditional spinal procedures.

Comparison of Lidocaine Versus Nifedipine for Attenuation the Cardiovascular Response to Direct Laryngoscopy and Intubation during General Anesthesia

Background: Laryngoscopy and Endo-tracheal intubation are gold standard for securing the airway and giving positive pressure ventilation. Drugs like Lidocaine, Fentanyl citrate and Nifedipine are used frequently to attenuate presser response to laryngoscopy and intubation, Single drug or technique is not satisfactory. Different methods of attenuation of response to laryngoscopy and intubation are still to be studied with new drugs tried every once a while. Aim: To compare the lidocaine and nifedipine effect on the cardiovascular response to direct laryngoscopy and intubation during general anesthesia Methods: Following the approval of the Institutional Review Board of AL jala Teaching hospital and written informed consent from patients undergoing elective surgery under general anesthesia, fifty patients between 18 and 60 years old, American Society of Anesthesiologist (ASA) Grades I and II, were randomized to one of the following groups, Group A: Lidocaine group 1.5 mg/kg IV bolus 3 minutes prior to laryngoscopy and intubation, Group B: Nifedipine group. 10 mg SL 15 minutes prior to induction. The induction protocol was standard for all patients. Intraoperative vitals were monitored using ECG, Pulse Oxymeter and NIBP. HR, SBP, DBP and MAP were recorded & RPP was calculated in all patients inside the operation theater just before induction (baseline), immediate after laryngoscopy and intubation, every 2 minutes after intubation during which no stimulus was given to patient for the next 10 minutes after laryngoscopy and intubation. Results: Patients' characteristics of age, gender and were comparable in the two groups. There was no significant difference between the groups regarding the type of the surgery. Statistically there was no significant difference (p=0.66) in the two groups in terms of ASA grading. No significant difference was observed between Lignocaine group and Nifedipine group values (P> 0.05), in any parameters at pre anaesthetic check-ups. the first significant change between the two groups , in which significant drop (p <0.05 ) in MAP occurred 4 minutes after intubation in group received Nifedipine sublingually, Once again , 6 minutes after intubation we recorded significant drop in SBP and MAP in Nifedipine group compared to Lidocaine group, No significant changes in parameters between two groups , 8and 10 minutes after intubation. The HR reached its maximum value immediately after intubation, after that the recording of HR became fluctuant in both groups. The percentage of rise in HR was less significant in Lidocaine group immediately after intubation and after that except for the reading 2 minutes, which was less significant in Nifedipine group. Both drugs failed to bring the HR to pre-operative value even after 10 minutes; the highest SBP was recorded at the pre-anaesthetic check-up. After that the SBP started to decline in both groups, this decline reached its maximum 4 minutes after intubation. After that the SBP started to gradually rise until 10 minutes without reaching the pre-anaesthetic basal value. The percentage of decline was more pronounced in Lidocaine group immediately and after 2 minutes of intubation and more pronounced in Nifedipine group after that, The highest DBP was recorded at the pre-anaesthetic check-up. After that the DBP started to decline in both groups, this decline reached its maximum 4 minutes after intubation. After that the DBP started to gradually rise until 10 minutes without reaching the pre-anaesthetic basal value. The percentage of decline was more pronounced in Lidocaine group immediately after intubation and more pronounced in Nifedipine group after that, The highest MAP was recorded at the pre-anaesthetic check-up. After that the MAP started to decline in both groups, this decline reached its maximum 4 minutes after intubation. After that the MAP started to gradually rise until 10 minutes without reaching the pre-anaesthetic basal value. The percentage of decline was more pronounced in Lidocaine group immediately after intubation and more pronounced in Nifedipine group after that. The Pressure Rare Product reached its maximum value immediately after intubation, the highest decrease in Pressure Rare Product occurred 4 minutes after intubation in both groups Conclusion: Both drugs in our study ( Lidocaine and Nifedipine ) has been shown to be effective in attenuating and preventing the increase in haemodynamic stress response to direct laryngoscopy and intubation during general anaesthesia in our patients. However, Nifedipine is more effective than Lidocaine in preventing the hypertensive response and attenuating the increase in RPP, and Lidocaine is more effective in attenuating the tachycardia response than Nifedipine. Recommendation: Based on the results of this study, it is recommended to consider the use of iv Lidocaine and sublingual Nifedipine to reduce the presser effect of laryngoscopy and intubation.

2021 American Society of Acupuncturists Survey on Acupuncturists’ Backgrounds, Interests, and Attitudes toward Conducting Research

2021 American Society of Acupuncturists Survey on Acupuncturists’ Backgrounds, Interests, and Attitudes toward Conducting Research

GLP1-RA use prior to endoscopy is associated with low retained gastric contents: a multicenter cross-sectional analysis.

While ubiquity of glucagon-like peptide receptor agonists (GLP1-RAs) is rising, guidance from the gastroenterology societies and American Society of Anesthesiologist (ASA) remains in conflict on recommendations regarding preoperative holding prior to endoscopy. This study aims to address this by evaluating the effect of GLP1-RAs on gastric retention during upper endoscopy. This multicenter cross-sectional study included patients on confirmed GLP1-RAs receiving an endoscopy from 2021-2023. Demographics, prescribing practices, and procedure outcomes were captured. GLP1-RA management of preoperative holding was retroactively classified per ASA guidance. Multivariable logistic regression was performed to assess factors influencing retained gastric contents. Of 815 patients, 70 (8.7%) had retained gastric contents on endoscopy of whom 65 (93%) had type 2 diabetes mellitus (T2DM). Only 1 (1.4%) of these patients required unplanned intubation and none had aspiration events. Those with GLP1-RA held per ASA guidance (406, 49.8%) were less likely to have retained contents (4.4 vs 12.7%, p<0.001), but there were no significant differences to intubation (0% vs 2%, p=0.53) or aborting procedure rates (28% vs 18%, p=0.40) due to gastric retention. On multivariable analysis, likelihood of food retention increased 36% (95%CI 1.15-1.60) for every 1% increase in HbA1C after adjusting for GLP1-RA type and preoperative medication hold. In this multicenter study, very low rates of retained gastric contents were seen during endoscopy in patients on GLP1-RAs and most were in patients with T2DM. Our findings suggest an individualized approach rather than universal pre-operative holding of medications prior to endoscopy.

Artificial intelligence and clinical guidance in male reproductive health: ChatGPT4.0's AUA/ASRM guideline compliance evaluation.

Male infertility is defined as the inability of a male to achieve a pregnancy in a fertile female by the American Urological Association (AUA) and the American Society for Reproductive Medicine (ASRM). Artificial intelligence, particularly in language processing models like ChatGPT4.0, offers new possibilities for supporting clinical decision-making. This study aims to assess the effectiveness of ChatGPT4.0 in responding to clinical queries regarding male infertility, which is aligned with AUA/ASRM guidelines. This observational study employed a design to evaluate the performance of ChatGPT4.0 across 1073 structured clinical queries categorized into true/false, multiple-choice, and open-ended. Two independent reviewers specializing in reproductive medicine assessed the responses using a six-point Likert scale to evaluate accuracy, relevance, and guideline adherence. In the true/false category, the initial accuracy was 92%, which increased to 94% by the end of the study period. For multiple-choice questions, accuracy improved from 85% to 89%. The most significant gains were seen in open-ended questions, where accuracy rose from 78% to 86%. Initially, some responses did not fully align with the AUA/ASRM guidelines. However, by the end of the 60 days, these responses had become more comprehensive and clinically relevant, indicating an improvement in the model's ability to generate guideline-conformant answers (p<0.05). The depth and accuracy of responses for higher difficulty questions also showed enhancement (p<0.01). ChatGPT4.0 can serve as a valuable support tool in managing male infertility, providing reliable, guideline-based information that enhances the accuracy of clinical decision-making tools and supports patient education.

American Society of Transplant Surgeons Normothermic Regional Perfusion Standards: Abdominal.

Normothermic regional perfusion (NRP) has emerged as a vital technique in organ procurement, particularly in donation after circulatory death (DCD) cases, offering the potential to optimize organ utilization and improve posttransplant outcomes. Recognizing its significance, the American Society of Transplant Surgeons (ASTS) convened a work group to develop standardized recommendations for abdominal NRP in the United States. The workgroup, comprising experts in NRP, DCD, and transplantation, formulated recommendations through a collaborative process involving revisions and approvals by relevant committees and the ASTS council. Four key areas were identified for standardization: Preprocedure communication, NRP procedure, Terminology and documentation, and Mentorship/credentialing. The recommendations encompass a range of considerations, including preprocedure communication protocols to facilitate informed decision-making by transplant centers and organ procurement organizations, procedural guidelines for NRP teams, uniform terminology to clarify the NRP process, and standards for mentorship and credentialing of NRP practitioners. Specific recommendations address logistical concerns, procedural nuances, documentation requirements, and the importance of ongoing quality assurance. The standardized recommendations for abdominal NRP presented in this article aim to ensure consistency, safety, and efficacy in the organ procurement process. By establishing clear protocols and guidelines, the ASTS seeks to enhance organ utilization, honor donor wishes, and uphold public trust in the donation process. Implementation of these recommendations can contribute to the advancement of NRP practices and improve outcomes for transplant recipients.

Prevalence of frailty and associated factors in coronary artery bypass graft surgery patients

Abstract Background Frail patients are at increased risk for postoperative delirium, complications, delayed recovery, prolonged hospital and intensive care unit stay, morbidity and mortality. The number of studies examining frailty in cardiovascular surgery patients is limited (1,2). In this context, it is important to determine the prevalence of frailty in cardiac surgery patients (3,4). Purpose This research was conducted to examine the prevalence of frailty in coronary artery bypass graft surgery patients and associated factors with frailty. Methods The research was descriptive cross-sectional type. It was conducted between 18.02.2021 and 18.02.2022 at the cardiovascular surgery department of a training and research hospital in Turkey. A total of 96 patients who had undergone coronary artery bypass graft (CABG) were included. The "Sociodemographic and Clinical Data Form" which was prepared in accordance with the literature, the "Modified Fried Frailty Index", the "Mini Nutritional Assessment Test-Short Form", the "Barthel Daily Living Activities Index", the "Charlson Comorbidity Index", and the "Montreal Cognitive Assessment Scale" were used to collect data. The data were analyzed using the SPSS 23.0 package program. Descriptive statistics, Kolmogorov-Smirnov test, Chi-square test, One Way ANOVA, Kruskal Wallis test and multinomial logistic regression analysis were used in the evaluation of the data. Results As a result of the study, the mean age of the patients was 65.65±8.72 years (min:40-max:85), 62.5% consisted of males. The majority of patients (94.8%) had comorbid diseases, most of whom had hypertension (66.7%) and diabetes mellitus (63.5%). The mean ejection fraction of the patients was normal (54.59±8.70) according to the European Society of Cardiology and the majority (80.2%) were in the preserved LVEF group. The mean EuroSCORE was intermediate (4.79±2.40) and 49% of the patients were at intermediate risk for mortality. The majority of the patients (94.8%) were in the ASA III class according to the American Society of Anaesthesiologists. Of the patients. 14.6% were determined as ‘non-frail’, 45.8% as ‘pre-frail’ and 39.6% as ‘frail’. Age, educational status, income level, beta-blocker use, nutritional status, daily living activities, cognitive status, number of comorbidities, and level of potassium, procalcitonin and creatinine were found to be associated with frailty (p&amp;lt;0.05). Malnutrition, decreased daily living activity, cognitive impairment and creatinine elevation were found to be predictors of frailty (p&amp;lt;0.05). Sociodemographic and Clinical Characteristics by Frailty Status was presented in Table 1. Conclusions More than a third of CABG patients were frail. Malnutrition, decreased daily living activity, impaired cognitive status and high creatinine levels increased the risk. It is important to assesment frail cardiac surgery patients and provide them with appropriate nursing management.

Comparison of the cost-effectiveness and safety between staged bilateral total knee arthroplasty and simultaneous bilateral total knee arthroplasty: a retrospective cohort study between 2001 and 2022.

A substantial proportion of Hong Kong's aging population suffers from osteoarthritis in both knees. Bilateral total knee arthroplasty (BTKA) is a surgical option for addressing this condition and can be performed via two approaches: simultaneous (SimBTKA) and staged (StaBTKA) bilateral TKAs. We compared the cost-effectiveness and safety of these two methods in our institution. We retrospectively reviewed 2,372 patients (SimBTKA, 772; StaBTKA, 1,600; female, 1,780; male, 592; mean age at SimBTKA, 70.4 ± 7.99 years; mean age at StaBTKA, 66.4 ± 7.50 years; p < 0.001) who underwent bilateral TKA in our institution from 2001 to 2022. Patients were categorized according to surgical approach. Patients undergoing BTKA in our institution were included. Particularly for SimBTKA, patients were assessed by anesthetists to be medically fit before undergoing SimBTKA according to their age, American Society of Anesthesiologists status, and osteoarthritis severity. Primary outcome was the length-of-stay (LOS) after surgery. Secondary outcomes were the 30-day unintended readmission, intensive care unit (ICU) admission, and death. SimBTKA had a short mean total LOS (acute hospital + rehabilitation center; SimBTKA, 13.09 days; StaBTKA, 18.12 days; p < 0.001) and mean LOS in acute hospital (SimBTKA, 7.70 days; StaBTKA, 10.42 days; p < 0.001). However, no significant difference was found in mean LOS in rehabilitation centers (SimBTKA, 5.47 days; StaBTKA, 6.32 days; p > 0.05) between the two approaches. The 30-day unintended readmission rate was low in SimBTKA (SimBTKA, 2.07%; StaBTKA, 3.30%; OR = 1.60; p > 0.05) but statistically insignificant. SimBTKA was less costly than StaBTKA by US$8,422.22. per patient. No significant differences in ICU admission and death rates were found (p > 0.05) between the two groups. SimBTKA had a shorter LOS and lower cost than StaBTKA and comparable complication rates. Therefore, SimBTKA should be indicated in medically stable patients.

Real-world clinical outcomes with fostamatinib for the treatment of refractory chronic immune thrombocytopenia: a single-center experience.

Fostamatinib is a spleen tyrosine kinase inhibitor indicated for the treatment of chronic immune thrombocytopenia (ITP) unresponsive to a previous treatment. Real-world studies evaluating the utilization and effectiveness of fostamatinib outside the context of a clinical trial are lacking. The objective of this analysis was to evaluate the effectiveness of fostamatinib for the treatment of ITP in a real-world cohort. We conducted a single-center, retrospective, observational study to evaluate the effectiveness of fostamatinib for the treatment of ITP. The primary endpoint was durable response as defined by the American Society of Hematology ITP response criteria. Secondary endpoints included overall response rate, time to response, and safety. Subgroup analysis was performed to assess frequency of durable response in key subgroups of patients based on prior therapies. Thirty-one patients treated with fostamatinib for ITP were included in our analysis. Patients had received a median of four prior lines of therapy. Ten patients (32%) achieved a durable response. Most durable responders maintained their response at 24 months (n = 7; 70%). The median time to response was 9 days. Four patients (13%) discontinued fostamatinib due to an adverse event. Subgroups who had higher rates of durable responses included those who had received two to three prior lines of therapy (40%), splenectomized patients (50%), and those who had not received prior rituximab (55%). Fostamatinib therapy in a real-world population of patients with heavily pretreated ITP led to a durable response in a third of patients, which was maintained for most responders.

American Society of Transplant Surgeons Normothermic Regional Perfusion Standards: Ethical, Legal, and Operational Conformance.

The American Society of Transplant Surgeons convened a multidisciplinary working group to address operational, ethical, and legal considerations surrounding normothermic regional perfusion (NRP) procurement. The working group, comprising members from American Society of Transplant Surgeons and AST across various disciplines including transplant surgery, hepatology, critical care, and bioethics, collaborated to formulate recommendations and guidance for NRP procurement. The following topics were identified by the group as essential standards that need to be addressed for ethical, legal, and operational conformance: terminology; conceptualization of death in the context of NRP; and communication, logistics, and training and competency. Fourteen recommendations that support the ethical and legal acceptability of NRP in the United States and set expectations for the conduct of NRP procedures are provided.

Consensus Statement: Technical Standards for Thoracoabdominal Normothermic Regional Perfusion.

Thoracoabdominal normothermic regional perfusion (TA-NRP) has emerged as a powerful technique for optimizing organ procurement from donation after circulatory death donors. Despite its rapid adoption, standardized guidelines for TA-NRP implementation are lacking, prompting the need for consensus recommendations to ensure safe and effective utilization of this technique. A working group composed of members from The American Society of Transplant Surgeons, The International Society of Heart and Lung Transplantation, The Society of Thoracic Surgeons, and The American Association for Thoracic Surgery was convened to develop technical guidelines for TA-NRP. The group systematically reviewed existing literature, consensus statements, and expert opinions to identify key areas requiring standardization, including predonation evaluation, intraoperative management, postdonation procedures, and future research directions. The working group formulated recommendations encompassing donor evaluation and selection criteria, premortem testing and therapeutic interventions, communication protocols, and procedural guidelines for TA-NRP implementation. These recommendations aim to facilitate coordination among transplant teams, minimize variability in practice, and promote transparency and accountability throughout the TA-NRP process. The consensus guidelines presented herein serve as a comprehensive framework for the successful and ethical implementation of TA-NRP programs in organ procurement from donation after circulatory death donors. By providing standardized recommendations and addressing areas of uncertainty, these guidelines aim to enhance the quality, safety, and efficiency of TA-NRP procedures, ultimately contributing to improved outcomes for transplant recipients.

Life with pets study: lower income veterinary clients' perception of pets' quality of life

Perception of quality of life for cats and dogs of low-income Spanish and English-speaking veterinary clients attending problem focused or routine veterinary visits is an important area of focus for community based veterinary service providers. Using a qualitative approach, 50 New York City based American Society for the Prevention of Cruelty to Animals (ASPCA) veterinary clients completed semi-structured interviews as well as a survey about their perception of life with their pets. Veterinary clients shared both human-animal bond (HAB) related and quality of life (QoL) related factors in their daily experience of life with their pets. Results indicated that this demographic perceives QoL similarly to previous QoL research that either does not report sample demographics or reports sample demographics with more affluence. Moreover, 60% of qualitative excerpts included both HAB and QoL themes and 40% were discretely HAB or QoL. An analog single item 10-point scale measuring veterinary client perception of their pets QoL did not differentiate between sample demographics at a statistically significant level. Finally, pet QoL literature has not traditionally reflected diverse demographic identities of veterinary clients or widely included reliable and valid measures of the human-animal bond (HAB). These results support the importance of measuring the HAB when researching pet QoL and provide evidence that lower-income Spanish and English-speaking veterinary clients are similarly bonded and attentive to their pets as other demographics.

Navigating Bias When Using AI in Oncology

OPTIMISING patient care and survival with AI is a rapidly advancing field of medical research. During the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting, a symposium titled “Using ‘Artificial’ Intelligence to Achieve ‘Real’ Improvements in Cancer Care” explored the use of innovative AI algorithms in oncology. Experts presented breakthroughs in diagnostic and predictive AI, whilst increasing awareness of inherent bias in AI models that can perpetuate into clinical outcomes.