bluuebunny/crossref_metadata_2025 huggingface dataset:
Brain tumoroids: Treatment prediction and drug development for brain tumors with fast, reproducible, and easy-to-use personalized models
Authors: Soubéran Aurélie , Jiguet-Jiglaire Carine , Toutain Soline , Morando Philippe , Baeza-Kallee Nathalie , Appay Romain , Boucard Céline , Graillon Thomas , Meyer Mikael , Farah Kaissar , Figarella-Branger Dominique , Tabouret Emeline , Tchoghandjian Aurélie
Published: September 2024

Background

The generation of patient avatars is critically needed in neuro-oncology for treatment prediction and preclinical therapeutic development. Our objective was to develop a fast, reproducible, low-cost, and easy-to-use method of tumoroids generation and analysis, efficient for all types of brain tumors, primary and metastatic.

Methods

Tumoroids were generated from 89 patients: 81 primary tumors including 77 gliomas, and 8 brain metastases. Tumoroids morphology and cellular and molecular characteristics were compared with the ones of the parental tumor by using histology, methylome profiling, pTERT mutations, and multiplexed spatial immunofluorescences. Their cellular stability over time was validated by flow cytometry. Therapeutic sensitivity was evaluated and predictive factors of tumoroid generation were analyzed.

Results

All the tumoroids analyzed had similar histological (n = 21) and molecular features (n = 7) to the parental tumor. The median generation time was 5 days. The success rate was 65 %: it was higher for high-grade gliomas and brain metastases versus IDH mutated low-grade gliomas. For high-grade gliomas, neither other clinical, neuro-imaging, histological nor molecular factors were predictive of tumoroid generation success. The cellular organization inside tumoroids analyzed by MACSima revealed territories dedicated to specific cell subtypes. Finally, we showed the correlation between tumoroid and patient treatment responses to radio-chemotherapy and their ability to respond to immunotherapy thanks to a dedicated and reproducible 3D analysis workflow.

Conclusions

Patient-derived tumoroid model that we developed offers a robust, user-friendly, low-cost, and reproducible preclinical model valuable for therapeutic development of all types of primary or metastatic brain tumors, allowing their integration into forthcoming early-phase clinical trials.
Early experience and perioperative risk of GammaTile for upfront brain metastases: Report from a prospective multicenter study
Authors: Zeller Sabrina L , Soldozy Sauson , Busse Shaye , Chen Clark C , Venteicher Andrew , Ferreira Clara , Dusenbery Kathryn , Lee Stuart , Peach Matthew Sean , DiNapoli Vincent , Kotecha Rupesh , Ahluwalia Manmeet S , Bojanowski-Hoang Kimberly , Hanft Simon J
Published: September 2024

Background

GammaTile (GT), a form of brachytherapy utilizing cesium-131 seeds in a bioresorbable collagen tile, has gained popularity for the treatment of recurrent intracranial tumors and more recently for newly diagnosed metastases. This study reports early experience utilizing GT in upfront brain metastases with a focus on clinical applications and perioperative safety.

Methods

The STaRT Registry (NCT04427384) was queried for all patients receiving GT for upfront metastases from August 2021 to August 2023. Data regarding patient demographics, procedure details, and adverse events (AEs) were extracted and analyzed.

Results

Twenty-eight patients, median age 65 years (range 28–81), with 30 treated metastases were reported from 6 institutions. Patients had 2.8 metastases on average (range 1–15) at the time of surgery; however, most patients had a single metastasis (60.7%). The mean diameter of treated metastases was 3.4 cm (range 1.5–4.7). A median of 4.0 tiles (range 1–10) were used per tumor. The median follow-up was 3.0 months (range 1.0–11.2) with 6 attributed AEs (21.4%), including 1 grade ≥ 3 (infection). In the immediate postoperative period (<14 days), 2 patients reported pain or headache, and 1 reported facial edema. One patient developed seizures on postoperative day 8 requiring medication. At 1-month follow-up, there was 1 superficial wound infection, in a previously colonized patient, requiring surgical intervention without explantation of tiles. At 3-month follow-up, 1 patient reported facial pain not requiring treatment. There were no symptomatic hematomas.

Conclusions

GT demonstrates a favorable safety profile in upfront brain metastases with a 3.6% rate of serious AEs (grade ≥ 3) within 90 days of the procedure.
Effects of Different Caloric Restriction Patterns on Blood Pressure and Other Cardiovascular Risk Factors: A Systematic Review and Network Meta-Analysis of Randomized Trials
Authors: Zhang Hui , Du Jinchao , Zhang Mingchen , Li Tingting , Zhang Pingping , Wang Xiaowen , Sun Zhongguang
Published: September 2024

Context

All types of caloric restriction are preventive against cardiovascular risk factors, but the best restriction method and most affected factors have not been identified.

Objective

The objective of this study was to explore the effects of different caloric restriction methods on various cardiovascular risk factors by horizontally comparing program advantages and disadvantages via network meta-analysis.

Data Sources

The PubMed, Web of Science, Cochrane Library, and Embase literature databases were searched (October 2013 to October 2023).

Data Extraction

Eligible randomized controlled trials involving participants who underwent caloric restriction and systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), and high-density lipoprotein (HDL) cholesterol level measurements were included.

Data Analysis

Thirty-six of 13 208 records (0.27%) were included. Two researchers reviewed the articles, extracted data, and assessed article quality.

Results

Alternate-day fasting (ADF) reduced SBP (4.88 mmHg; CI, 2.06-7.15) and DBP (5.10 mmHg; CI, 2.44-7.76). Time-restricted eating reduced SBP (2.46 mmHg; CI, 0.16-4.76) but not DBP. Continuous energy restriction (CER) significantly reduced BMI (1.11 kg/m2; CI = 0.16, 2.06) and waist circumference (3.28 cm; CI, 0.62-5.94).

Conclusions

This meta-analysis confirmed the preventive effect of CER and ADF on various cardiovascular risk factors. Additionally, CER is more likely to reduce obesity, and ADF is more likely to reduce blood pressure (BP). Based on this meta-analysis, CER is recommended to control obesity only for people who are obese and do not have elevated BP or other abnormal indicators. Additionally, ADF for early control or prevention is recommended for patients who have abnormal BP or other cardiovascular risk factors.

Systematic Review Registration

PROSPERO registration no. CRD42023455889.
Bridging Echinocandin With Azole Antifungal Therapy on Prevention of Invasive Candidiasis Post–Lung Transplantation
Authors: Pasley Taylor , Baladad Christopher , DeSear Kathryn , Karimi Solmaz , Rubido Eric , El Helou Guy , Converse Maureen
Published: September 2024

Background

Invasive candidiasis (IC) is a significant factor for lung transplant recipient (LTR) mortality, especially in the immediate postoperative phase. Receipt of antifungal prophylaxis has demonstrated lower all-cause mortality.

Methods

This was a single-center, retrospective cohort study of LTRs between August 2017 and August 2020. Included patients were adult LTRs with positive Candida cultures preoperatively (donor or recipient) or within 6 weeks postoperatively. Patients were divided into 2 cohorts—bridged and unbridged. The bridged cohort received micafungin in the postoperative period until therapeutic azole concentrations were achieved or up to 2 weeks, whichever was sooner. The primary outcome was a composite of proven or probable invasive candidiasis.

Results

A total of 117 patients were included in the study, with 68 in the unbridged cohort and 49 in the bridged cohort. There were more cases of IC in the bridged cohort than in the unbridged cohort (P = .011).

Conclusions

In combination with an azole antifungal, micafungin did not prevent IC in postoperative LTRs with cultures positive for Candida species in this cohort. Larger prospective studies are needed to determine the ideal combination and duration of antifungal prophylaxis.
Estimated Deaths Averted in Adults by COVID-19 Vaccination in Select Latin American and Caribbean Countries
Authors: Savinkina Alexandra , Weinberger Daniel M , Toscano Cristiana M , De Oliveira Lucia H
Published: September 2024

Background

The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on global health, with millions of lives lost worldwide. Vaccination has emerged as a crucial strategy in mitigating the impact of the disease. This study aims to estimate the number of deaths averted through vaccination in Latin America and the Caribbean region (LAC) during the first year and a half of vaccination rollout (January 2021–May 2022).

Methods

Publicly available data on COVID-19 deaths and vaccination rates were used to estimate the total number of deaths averted via vaccination in LAC. Using estimates for number of deaths, number of vaccinated, and vaccine effectiveness, a counterfactual estimated number of deaths observed without vaccination was calculated. Vaccine effectiveness estimates were obtained from published studies. The analysis focused on 17 countries in LAC and considered adults aged 18 years and older.

Results

After accounting for underreporting, the analysis estimated that >1.49 million deaths were caused by COVID-19 in the selected countries during the study period. Without vaccination, the model estimated that between 2.10 and 4.11 million COVID-19 deaths would have occurred. Consequently, vaccination efforts resulted in ∼610 000 to 2.61 million deaths averted.

Conclusions

This study represents the first large-scale, multicenter estimate of population-level vaccine impact on COVID-19 mortality in LAC. The findings underscore the substantial impact of timely and widespread vaccination in averting COVID-19 deaths. These results provide crucial support for vaccination programs aimed at combating epidemic infectious diseases in the region and future pandemics.
Chirality and odd mechanics in active columnar phases
Authors: Kole S J , Alexander Gareth P , Maitra Ananyo , Ramaswamy Sriram
Published: September 2024

Chiral active materials display odd dynamical effects in both their elastic and viscous responses. We show that the most symmetric mesophase with 2D odd elasticity in three dimensions is chiral, polar, and columnar, with 2D translational order in the plane perpendicular to the columns and no elastic restoring force for their relative sliding. We derive its hydrodynamic equations from those of a chiral active variant of model H. The most striking prediction of the odd dynamics is two distinct types of column oscillation whose frequencies do not vanish at zero wavenumber. In addition, activity leads to a buckling instability coming from the generic force-dipole active stress analogous to the mechanical Helfrich–Hurault instability in passive materials, while the chiral torque-dipole active stress fundamentally modifies the instability by the selection of helical column undulations.
Written Mobility Communication in Acute Care Medical Wards: An Observational Study of Physical Therapists’ and Nurses’ Documentation Practice
Authors: Harvey Emily , Adsett Julie , Mudge Alison , Steele Michael , McRae Prue
Published: September 2024

Objective

Low inpatient mobility is associated with poor hospital outcomes. Poor communication between clinicians has been identified as a barrier to improving mobility. Understanding how mobility is communicated within the multidisciplinary team may help inform strategies to improve inpatient mobility. The aim of this study was to describe written mobility communication by physical therapists and nurses in acute care medical wards.

Methods

This cross-sectional observational study was conducted across 4 hospitals in an Australian health service. A survey of physical therapists and nurses identified preferred sources and content of written mobility communication. An audit described and compared written mobility communication in the most strongly preferred documentation sources. Findings were described and compared graphically between discipline and site.

Results

Questionnaires were completed by 85 physical therapists and 150 nurses. Twenty-two sources of documentation about mobility were identified. Preferences for sources and content varied between disciplines. Physical therapists nominated several preferred information sources and sought and documented broader mobility content. Nurses often sought nursing documents that focused on current mobility assistance and aids, with limited communication of mobility level or mobility goals. Audits of 104 patient records found that content varied between sources and sites, and content was variably missing or inconsistent between sources.

Conclusion

Written mobility communication focused on mobility assistance and aids, rather than mobility levels or mobility goals, with poor completion and inconsistency within documentation. More complete and consistent documentation might improve progressive mobilization of hospital inpatients.

Impact

Physical therapists and nurses seek and document different content in a wide range of locations, leading to incomplete and inconsistent written documentation. Understanding and resolving these practice differences offers potential to improve mobility communication and practice.
Trust and delegated investing: a Money Doctors experiment
Authors: Germann Maximilian , Mertes Lukas , Weber Martin , Loos Benjamin
Published: September 2024

The more trust investors place in a money manager, the more confident they are to take risk. We test this theory in a laboratory experiment using the amount returned from a trust game as measure of trustworthiness. Investors increase the share invested in risky assets with high-cost money managers compared to those with low costs when the high-cost money managers are more trustworthy than the low-cost ones. The willingness to take more risk with high-cost money managers is increasing in the difference in trustworthiness. Up to a third of the difference in trustworthiness translates into an increasing risky share. Vice versa, investors are willing to accept higher costs for investments made through more trustworthy money managers. Our findings are robust to alternative explanations, demonstrating that the risk-aversion channel can be sufficient for trust to influence behavior.
Increased sensitivity to social hierarchy during social competition versus cooperation
Authors: Su Yaner , Martens Sander , Aleman André , Zhou Jiali , Xu Pengfei , Luo Yue-Jia , S. Goerlich Katharina
Published: September 2024

Social hierarchy is a typical feature of social organization. The ability to quickly recognize social hierarchy information is crucial for adapting to social contexts. Here, we adopted fast periodic visual stimulation with electroencephalography to assess the neural responses to social hierarchy during social competition and cooperation, respectively. Participants first learned hierarchical faces from a competitive game versus a cooperative game. We then sequentially presented the learned hierarchical faces with a specific frequency in a set of faces. Results showed that participants rated the inferior player as lower in the social hierarchy in the cooperative context compared to the competitive context, indicating that social context affects the judgment of others’ rank. Moreover, higher neural responses to high and low-hierarchy faces versus medium-hierarchy faces were observed, suggesting rapid discrimination of social hierarchy from faces. Interestingly, rank-specific neural responses were more pronounced in the competitive context than in the cooperative context, indicating increased sensitivity to social hierarchy during social competition versus social cooperation. This study provides behavioral and neural evidence for rapid, automatic processing of social hierarchy information and for an increased sensitivity to such information in competitive versus cooperative social contexts.
Genome-Wide Association Study of Bacterial Blight Resistance in Soybean
Authors: Zhao Fangzhou , Wang Yanan , Cheng Wei , Antwi-Boasiako Augustine , Yan Wenkai , Zhang Chunting , Gao Xuewen , Kong Jiejie , Liu Wusheng , Zhao Tuanjie
Published: September 2024

Bacterial blight caused by Pseudomonas syringae pv. glycinea (Psg) is a widespread foliar disease. Although four Resistance to Pseudomonas syringae pv. glycinea (Rpg) 1 to 4 (Rpg1∼4) genes that have been observed to segregate in a Mendelian pattern have been reported to confer resistance to Psg in soybean, the genetic basis of quantitative resistance to bacterial blight in soybean remains unclear. In the present study, the Psg resistance of two soybean association panels consisting of 573 and 213 lines, respectively, was phenotyped in multiple environments in 2014 to 2016. Genome-wide association study was performed using two models, FarmCPU and BLINK, to identify Psg resistance loci. A total of 40 soybean varieties with high level of Psg resistance were identified, and 14 quantitative trait loci (QTLs) were detected on 12 soybean chromosomes. These QTLs were identified for the first time. The majority of the QTLs were detected only in one or the other association panels, while qRPG-18-1 was detected in both association panels for at least one growing season. A total of 46 candidate Psg resistance genes were identified from the qRpg_13_1, qRPG-15-1, and qRPG-18-1 loci based on gene function annotation. In addition, we found the genomic region covering rpg1-b and rpg1-r harbored the synteny with a genomic region on chromosome 15 and identified 16 nucleotide binding site–leucine-rich repeat (NBS-LRR) genes as the candidate Psg resistance genes from the synteny blocks. This study provides new information for dissecting the genetic control of Psg resistance in soybean.
Mitigation of Almond Leaf Scorch by a Peptide that Inhibits the Motility of Xylella fastidiosa
Authors: Moll Luis , Badosa Esther , De La Fuente Leonardo , Montesinos Emilio , Planas Marta , Bonaterra Anna , Feliu Lidia
Published: September 2024

Xylella fastidiosa is a xylem-limited plant pathogenic bacterium that is a menace to the agriculture worldwide, threating economically relevant crops such as almond. The pathogen presents a dual lifestyle in the plant xylem, consisting of sessile microbial aggregates and mobile independent cells that move by twitching motility. The latter is essential for the systemic colonization of the host and is mediated through type IV pili. In previous reports, it has been demonstrated that peptides can affect different key processes of X. fastidiosa, but their effect on motility has never been assessed. In the present work, peptides previously identified and newly designed analogs were studied for their effect in vitro on the motility of X. fastidiosa, and their protective effect against almond leaf scorch was determined. By assessing the twitching fringe width in colonies and using microfluidic chambers, the inhibitory effect of BP100 on twitching motility was demonstrated. Interestingly, type IV pili of BP100-treated cells were similar in frequency and length and presented no morphological differences when compared with the nontreated control. The application of BP100 by endotherapy in almond plants inoculated with X. fastidiosa under greenhouse conditions significantly reduced population levels and showed less affected xylem vessels, which correlated with decreased disease symptoms. Therefore, BP100 is a promising candidate to manage almond leaf scorch caused by X. fastidiosa.

[Formula: see text] Copyright © 2025 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Effects of Post-Hospital Arrival Factors on Out-of-Hospital Cardiac Arrest Outcomes During the COVID-19 Pandemic
Authors: Kawai Yasuyuki , Yamamoto Koji , Miyazaki Keita , Asai Hideki , Fukushima Hidetada
Published: September 2024

IMPORTANCE:

The relationship between post-hospital arrival factors and out-of-hospital cardiac arrest (OHCA) outcomes remains unclear.

OBJECTIVES:

This study assessed the impact of post-hospital arrival factors on OHCA outcomes during the COVID-19 pandemic using a prediction model.

DESIGN, SETTING, AND PARTICIPANTS:

In this cohort study, data from the All-Japan Utstein Registry, a nationwide population-based database, between 2015 and 2021 were used. A total of 541,781 patients older than 18 years old who experienced OHCA of cardiac origin were included.

MAIN OUTCOMES AND MEASURES:

The primary exposure was trends in COVID-19 cases. The study compared the predicted proportion of favorable neurologic outcomes 1 month after resuscitation with the actual outcomes. Neurologic outcomes were categorized based on the Cerebral Performance Category score (1, good cerebral function; 2, moderate cerebral function).

RESULTS:

The prediction model, which had an area under the curve of 0.96, closely matched actual outcomes in 2019. However, a significant discrepancy emerged after the pandemic began in 2020, where outcomes continued to deteriorate as the virus spread, exacerbated by both pre- and post-hospital arrival factors.

CONCLUSIONS AND RELEVANCE:

Post-hospital arrival factors were as important as pre-hospital factors in adversely affecting the prognosis of patients following OHCA during the COVID-19 pandemic. The results suggest that the overall response of the healthcare system needs to be improved during infectious disease outbreaks to improve outcomes.
Efficacy and safety of avatrombopag in the treatment of thrombocytopenia after umbilical cord blood transplantation
Authors: Huang Aijie , Sun Guangyu , Tang Baolin , Han Yongsheng , Wan Xiang , Yao Wen , Song Kaidi , Cheng Yaxin , Wu Weiwei , Tu Meijuan , Wu Yue , Pan Tianzhong , Zhu Xiaoyu
Published: September 2024

Background:

Delayed platelet engraftment is a common complication after umbilical cord blood transplantation (UCBT), and there is no standard therapy. Avatrombopag (AVA) is a second-generation thrombopoietin (TPO) receptor agonist (TPO-RA) that has shown efficacy in immune thrombocytopenia (ITP). However, few reports have focused on its efficacy in patients diagnosed with thrombocytopenia after allogeneic hematopoietic stem cell transplantation (allo-HSCT).

Methods:

We conducted a retrospective study to evaluate the efficacy of AVA as a first-line TPO-RA in 65 patients after UCBT; these patients were compared with 118 historical controls. Response rates, platelet counts, megakaryocyte counts in bone marrow, bleeding events, adverse events and survival rates were evaluated in this study. Platelet reconstitution differences were compared between different medication groups. Multivariable analysis was used to explore the independent beneficial factors for platelet implantation.

Results:

Fifty-two patients were given AVA within 30 days post-UCBT, and the treatment was continued for more than 7 days to promote platelet engraftment (AVA group); the other 13 patients were given AVA for secondary failure of platelet recovery (SFPR group). The median time to platelet engraftment was shorter in the AVA group than in the historical control group (32.5 days vs. 38.0 days, Z = 2.095, P = 0.036). Among the 52 patients in the AVA group, 46 achieved an overall response (OR) (88.5%), and the cumulative incidence of OR was 91.9%. Patients treated with AVA only had a greater 60-day cumulative incidence of platelet engraftment than patients treated with recombinant human thrombopoietin (rhTPO) only or rhTPO combined with AVA (95.2% vs. 84.5% vs. 80.6%, P <0.001). Patients suffering from SFPR had a slightly better cumulative incidence of OR (100%, P = 0.104). Patients who initiated AVA treatment within 14 days post-UCBT had a better 60-day cumulative incidence of platelet engraftment than did those who received AVA after 14 days post-UCBT (96.6% vs. 73.9%, P = 0.003).

Conclusion:

In summary, compared with those in the historical control group, our results indicate that AVA could effectively promote platelet engraftment and recovery after UCBT, especially when used in the early period (≤14 days post-UCBT).
Research progress on platelets in glioma
Authors: Zuo Mingrong , Li Tengfei , Wang Zhihao , Xiang Yufan , Chen Siliang , Liu Yanhui
Published: September 2024

Gliomas are the most common primary neuroepithelial tumors of the central nervous system in adults, of which glioblastoma is the deadliest subtype. Apart from the intrinsically indestructible characteristics of glioma (stem) cells, accumulating evidence suggests that the tumor microenvironment also plays a vital role in the refractoriness of glioblastoma. The primary functions of platelets are to stop bleeding and regulate thrombosis under physiological conditions. Furthermore, platelets are also active elements that participate in a variety of processes of tumor development, including tumor growth, invasion, and chemoresistance. Glioma cells recruit and activate resting platelets to become tumor-educated platelets (TEPs), which in turn can promote the proliferation, invasion, stemness, and chemoresistance of glioma cells. TEPs can be used to obtain genetic information about gliomas, which is helpful for early diagnosis and monitoring of therapeutic effects. Platelet membranes are intriguing biomimetic materials for developing efficacious drug carriers to enhance antiglioma activity. Herein, we review the recent research referring to the contribution of platelets to the malignant characteristics of gliomas and focusing on the molecular mechanisms mediating the interaction between TEPs and glioma (stem) cells, as well as present the challenges and opportunities in targeting platelets for glioma therapy.
Outcomes of Surgical Versus Transcatheter Aortic Valve Replacement in Obese Patients: A Systematic Review and Meta-Analysis
Authors: Domondon Ileana Anika A. , Jeyakumar Deepapriya , Raake Mohammed , Halaharvi Savitri Poornima , Zafar Fabeha , Contreras Vazquez Samantha A. , Abarca Yozahandy A. , Goli Snehitha Reddy , Rohra Divya , Shah Farah , Sikander Mohammed , Al-Tawil Mohammed
Published: September 2024

Transcatheter aortic valve implantation (TAVI) has been increasingly preferred over surgical aortic valve replacement (SAVR) for treating patients with severe aortic stenosis and intermediate to high surgical risk. Recent studies have indicated that obesity may confer protective benefits in cardiac surgery, known as the obesity paradox. We conducted a systematic review and meta-analysis to explore how obesity influences outcomes of TAVI versus SAVR. We searched and reviewed relevant studies comparing TAVI and SAVR in obese patients with aortic stenosis indexed in PubMed, Embase, and Scopus databases. Data from 5 studies with 16,161 patients (TAVI, n = 2951; SAVR, n = 13,210) were included. There was a lower incidence of postprocedural in-hospital mortality [risk ratio (RR), 0.64; 95% confidence interval (CI), 0.41–0.98; P = 0.04], acute kidney injury (RR, 0.53; 95% CI, 0.38–0.73; P = 0.0001), and shorter duration of in-hospital stay (mean difference: −3.35; 95% CI, −4.93 to −1.76; P = 0.0001) in TAVI versus SAVR. There was no significant difference in the risk of postoperative stroke (RR, 0.93; 95% CI, 0.29–3.02; P = 0.91), major bleeding (RR, 0.71; 95% CI, 0.47–1.07; P = 0.10), and myocardial infarction (RR, 0.64; 95% CI, 0.39–1.06; P = 0.08) between TAVI and SAVR. Higher incidences of PPM implantation (RR, 2.0; 95% CI, 1.38–2.90; P = 0.0003) and major vascular complications (RR, 1.51; 95% CI, 1.01–2.27; P = 0.05) were observed with TAVI. In obese patients, TAVI offers similar results as in the general population when compared with SAVR, except for increased vascular complications. An individualized approach can lead to optimal outcomes in this subpopulation.
Hematological Complications From Transcatheter Aortic Valve Replacement (TAVR): Recognition and Treatment
Authors: Bhargava Sahil , Maheta Darshilkumar , Agrawal Siddharth Pravin , Raval Maharshi , Frishman William H. , Aronow Wilbert S.
Published: September 2024

Transcatheter aortic valve replacement (TAVR) has emerged as a pivotal intervention for patients with severe aortic stenosis who are at high or prohibitive surgical risk. Although TAVR is a minimally invasive procedure, it is linked to serious hematological problems, most notably thrombosis and bleeding. Numerous factors, such as procedural features, patient comorbidities, and anticoagulation management techniques, contribute to these complications. Bleeding complications can be major, minor, or life-threatening. They can be caused by problems with the vascular access site, anticoagulation medication, or coexisting conditions like renal dysfunction and frailty. Hemoglobin drop, overt bleeding, and hematoma signs must all be closely watched to identify bleeding. Careful selection and modification of anticoagulation medication, the use of vascular closure devices, and timely attention to bleeding sites are examples of management techniques. Thrombotic consequences, which include cerebrovascular accidents and valve thrombosis, are caused by endothelial injury, stent implantation, and patient hypercoagulability. Imaging modalities such as computed tomography and transesophageal echocardiography are used in the crucial process of detection. The goal of preventive care is to maximize anticoagulation regimens that are customized to each patient’s risk profile, frequently striking a balance between the risk of thrombosis and bleeding. A multidisciplinary strategy that integrates surgical, hematological, and cardiology expertise is necessary for the effective management of these hematological complications. To improve patient outcomes, ongoing research attempts to improve risk stratification and create safer anticoagulation protocols. This review emphasizes how critical it is to identify bleeding and thrombotic events as soon as possible and treat them promptly to reduce the risk of negative outcomes for TAVR patients.
Robotic mitral surgery: recent advances and outcomes
Authors: Hibino Makoto , Murphy Douglas A. , Halkos Michael E.
Published: September 2024

Purpose of review

This review explores recent advancements in robotic cardiac surgery, specifically focusing on its application in diverse mitral valve surgeries. The aim is to provide an overview of current clinical practices and supporting evidence in this evolving field.

Recent findings

A literature review indicates a 30% surge in robotic mitral valve repair from 2015 to 2021, paralleled by a decline in sternotomy-based repair per the STS database. Robotic mitral valve repair consistently shows effective and safe outcomes, with comparable mortality but lower morbidity risks than sternotomy and thoracotomy. The robotic approach exhibits lower conversion to valve replacement, shorter ICU stays, and reduced 30-day readmissions. For experienced programs, robotic techniques prove versatile in various pathologies, including rheumatic heart valve disease, infective endocarditis, ischemic cardiomyopathy, and mitral annular calcification necessitating valve replacement. Literature supports their selective use in high-risk scenarios, including redo surgeries and elderly patients.

Recent evidence supports the growing use of robotic approaches in mitral valve surgery, highlighting their efficacy with comparable mortality rates but lower morbidity risks. Robotic techniques consistently yield positive outcomes across various pathologies and patient profiles, signaling a potential paradigm shift in mitral valve interventions.
Expanding revascularization trials to women and underserved minorities and shifting to patient-centered outcomes: RECHARGE trials program
Authors: Redfors Bjorn , Spertus John A. , Yancy Clyde , Masterson-Creber Ruth , Stone Gregg W. , Gaudino Mario F.L.
Published: September 2024

Purpose of review

We review the limited available evidence informing coronary revascularization decisions in women and minorities, and introduce the RECHARGE trial program, which consists of two separate but integrated parallel multicenter, randomized trials comparing coronary artery bypass grafting (CABG) to percutaneous coronary intervention (PCI), one exclusively enrolling women (RECHARGE:Women) and one exclusively enrolling Black or Hispanic patients (RECHARGE:Minorities).

Recent findings

The extensive evidence base supporting coronary revascularization suffers from under-representation of women, minorities and minoritized populations, and the use of heterogeneous primary composite outcomes whose components have varying strengths of association with prognosis and quality-of-life (QOL). In RECHARGE, participants will be followed for up to 10 years, with QOL assessments at baseline, 30 days, 3 months, every 6 months for 3 years, and annually thereafter. The primary endpoint is the hierarchical composite of time to all-cause mortality, time-averaged change from baseline in the physical component of the SF-12v2 physical summary score, and time-averaged change from baseline in the mental component of the SF12v2 summary score, evaluated using a win ratio. Independently adjudicated major adverse cardiovascular and noncardiovascular events and disease-specific QoL will be secondary endpoints.

The RECHARGE trials are the first revascularization trials to enroll exclusively women and minority patients and to use patient-centered outcomes as their primary outcome.
Predictors of long-term clinical outcomes after TIPS: An ALTA group study
Authors: Nobel Yael R. , Boike Justin R. , Mazumder Nikhilesh R. , Thornburg Bartley , Hoffman Rachel , Kolli K. Pallav , Fallon Michael , Lai Jennifer C. , Morelli Giuseppi , Spengler Erin K. , Said Adnan , Desai Archita P. , Paul Sonali , Goel Aparna , Hu Kelly , Frenette Catherine , Gregory Dyanna , Padilla Cynthia , Zhang Yuan , VanWagner Lisa B. , Verna Elizabeth C. ,   Advancing Liver Therapeutic Approaches (ALTA) Study Group
Published: September 2024

Background and Aims:

While TIPS is traditionally considered a bridge to liver transplant (LT), some patients achieve long-term transplant-free survival (TFS) with TIPS alone. Prognosis and need for LT should not only be assessed at time of procedure, but also re-evaluated in patients with favorable early outcomes.

Approach and Results:

Adult recipients of TIPS in the multicenter advancing liver therapeutic approaches retrospective cohort study were included (N=1127 patients; 2040 person-years follow-up). Adjusted competing risk regressions were used to assess factors associated with long-term post-TIPS clinical outcomes at the time of procedure and 6 months post-TIPS. MELD-Na at TIPS was significantly associated with post-TIPS mortality (subdistribution hazards ratio of death 1.1 [p=0.42], 1.3 [p=0.04], and 1.7 [p<0.01] for MELD-Na 15–19, 20–24, and ≥25 relative to MELD-Na <15, respectively). MELD 3.0 was also associated with post-TIPS outcomes. Among the 694 (62%) patients who achieved early (6 mo) post-TIPS TFS, rates of long-term TFS were 88% at 1 year and 57% at 3 years post-TIPS. Additionally, a within-individual increase in MELD-Na score of >3 points from TIPS to 6 months post-TIPS was significantly associated with long-term mortality, regardless of initial MELD-Na score (subdistribution hazards ratio of death 1.8, p<0.01). For patients with long-term post-TIPS TFS, rates of complications of the TIPS or portal hypertension were low.

Conclusions:

Among patients with early post-TIPS TFS, prognosis and need for LT should be reassessed, informed by postprocedure changes in MELD-Na and clinical status. For selected patients, “destination TIPS” without LT may offer long-term survival with freedom from portal hypertensive complications.
Association of HDV infection and HCC, hepatic decompensation, and all-cause and liver-related death in a national cohort
Authors: John Binu V. , Bastaich Dustin , Amoli Mahmoud Manouchehri , Wong Robert J. , Evon Donna M. , Rogal Shari S. , Ross David B. , Morgan Timothy R. , Spector Seth A. , Villada Gabriel , Chao Hann-Hsiang , Dahman Bassam ,   on behalf of the Veterans Analysis of Liver Disease (VALID) group of investigators
Published: September 2024

Background and Aims:

HDV infection is the most severe form of chronic hepatitis. However, studies on outcomes and causes of death in a US-born population, with primarily horizontal transmission of HDV, are lacking. The aim of this study was to conduct a national study of patients with hepatitis D to understand the natural history and outcomes compared to patients with HBV infection.

Approach and Results:

In a national cohort of 4817 veterans infected with HBV tested for HDV (99.6% US-born, 3.3% HDV-positive) over a 23-year period, we used multivariable models to identify the factors associated with a composite outcome of HCC, decompensation, and liver-related mortality, and all-cause mortality of patients with HDV compared to HBV mono-infection. HDV coinfection (vs. HBV mono-infection) was associated with a significantly higher incidence of composite liver-related outcomes at both 5 (23.84 vs. 7.98,p< 0.001) and 10 years (19.14 vs. 10.18,p< 0.001), respectively. The most common cause of death was liver-related (33.8% for HDV vs. 24.7% for HBV), followed by nonhepatic malignancies (15.6% vs. 14.8%), cardiac (11.7% vs. 15.2%), and lung disease (5.2% vs. 3.7%). In multivariable models, HDV was associated with an increased risk of composite liver outcomes (adjusted hazard ratio: 2.57, 95% CI: 1.87–3.52,p< 0.001) and all-cause mortality (adjusted hazard ratio: 1.52, 95% CI: 1.20–1.93,p< 0.001).

Conclusions:

In a predominantly US-born cohort of veterans, HDV coinfection was associated with an increased risk of liver-related outcomes and all-cause mortality. Our findings support widespread testing for early identification of HDV.
Twelve hot questions in the management of hypertension in patients aged 80+ years and their answers with the help of the 2023 European Society of Hypertension Guidelines
Authors: Bahat Gulistan , Ribeiro Heloisa , Sheppard James P. , Bogaerts Jonathan M.K. , Camafort Miguel , Dallmeier Dhayana , De Backer Tine , Desideri Giovambattista , Olszanecka Agnieszka , Persu Alexandre , Protogerou Athanase , Rajzer Marek , Virdis Agostino , Ungar Andrea , Weber Thomas , Benetos Athanase ,   ESH Working Group on Hypertension in older adults
Published: September 2024

Arterial hypertension is a major risk factor for cardiovascular morbidity and mortality, and highly prevalent in older age, underscoring the importance of its appropriate management. The population is ageing at an increasing rate, with those aged 80+ years being the fastest growing population characterized by high heterogeneity in terms of functionality and autonomy. The prevalence of hypertension rises with increasing age, due to a significant increase in SBP largely as a result of age-related stiffening of the aorta and other large arteries, affecting almost 80% of those aged 80+ years. Appropriate management of blood pressure in this population is a priority for clinicians. Frailty is a condition characterized by marked vulnerability to adverse health outcomes and is common among older adults including those with hypertension. Hypertension increases frailty level and at the same time, individuals with increasing frailty present with more drug-related adverse effects meaning they are less tolerant to blood pressure lowering by medication. Thus, frailty is a factor that should be integrated when treating hypertension in this population. The European Society of Hypertension 2023 Guidelines on the management of Hypertension are the first international guidelines to integrate the concept of adapting blood pressure management in older adults according to their frailty/functionality level, and to propose practical tools for the application of this concept in the daily practice of physicians and other healthcare professionals. The present article prepared by the European Society of Hypertension Working Group on Hypertension in Older Adults aims to further address some important aspects mentioned concisely in the 2023 European Society of Hypertension guidelines, in order to help physicians and other healthcare professionals including those practicing in primary care. To this end, this study discusses 12 ‘hot questions’ which are answered with the help of the 2023 European Society of Hypertension Guidelines. We hope the present article and Working Group's actions will contribute to understanding and applying the ideal management of hypertension in this most vulnerable population.
The History and Impact of Prescribing Orthokeratology for Slowing Myopia Progression
Authors: Lipson Michael J. , Koffler Bruce H.
Published: September 2024

This paper discusses the history and impact of orthokeratology on slowing the progression of myopia. It discusses the origins and evolution of orthokeratology from polymethymethaccrylate lenses worn during the day to its current prescribing of highly permeable, innovative reverse-geometry designs worn only while sleeping. Technological advances in corneal topography, lens design, lens materials, and manufacturing have facilitated growth of orthokeratology to a precise and predictable procedure. More recently, significant interest in orthokeratology has been stimulated by its efficacy in slowing axial elongation in myopic children. Safety of children wearing contact lenses while sleeping has been an ongoing concern. The potential of serious complications exists, but long-term studies and clinical experience have shown that risks of those events can be minimized with strict compliance with lens cleaning, disinfection, and hand hygiene. Because no correction is required during waking hours, patients using orthokeratology report higher vision-related quality of life, less activity restrictions, and more comfortable eyes compared with spectacles or contact lenses worn during the day. The future growth of orthokeratology will be fueled by the prescribing of orthokeratology as a modality to slow axial elongation and an alternative modality to spectacles, traditional contact lenses, and refractive surgery to correct refractive error.
Risk Factors for Bacterial Keratitis and Severe Disease in Hydrogel Contact Lens Users: A Multicenter Case–Control Study and Case-Only Analysis
Authors: Szczotka-Flynn Loretta B. , Raghupathy Sangeetha , Shah Soham , Suri Kunal , Briggs Farren , Iyengar Sudha K.
Published: September 2024

Purpose:

To assess risk factors for contact lens (CL)-related bacterial keratitis, cases and high-risk controls were enrolled. Using high-risk controls can help elucidate whether certain CL types or modalities are attributable to disease burden if risky wear patterns are similar between the cases and controls. This analysis identified whether such CL factors were associated with the occurrence of bacterial keratitis. In addition, a case-only analysis determined CL factors associated with severe disease.

Methods:

From 2018 to 2021, 158 controls were enrolled at University Hospitals of Cleveland Eye Institute, and 153 bacterial keratitis cases were enrolled across 14 sites in the United States. Cases were soft CL wearers with either culture-proven bacterial keratitis or a corneal infiltrate with an overlying epithelial defect within the central 4 mm of the cornea, uveitis, or significant pain. Fungal, protozoan, or nonsoft CL wear-related microbial keratitis cases were excluded. Controls were recruited from high-risk CL wearers with no history of disease. All participants completed a questionnaire related to demographics, type of CL used, wearing schedule, lens handling practices, and storage case handling. Cases with ulcer/infiltrate size ≥2 mm in size, presence of hypopyon, or had fortified antibiotics prescribed were classified as severe keratitis. Univariate and multivariable logistic regression was used to assess association of CL variables with the occurrence of bacterial keratitis as well as occurrence of severe disease among the cases only.

Results:

Compared with the control cohort, cases were older (mean age 45.6 vs. 38.9 years), had more males (42.5% vs. 23.6%), and had more current or former smokers (41.7% vs. 12.9%). There were no significant associations between CL material (silicone hydrogel vs. not) or CL type (daily disposable vs. reusable) and occurrence of bacterial keratitis. More than two-thirds (67.3%) of cases were classified as severe. Among cases only, univariate analyses found current smokers to have increased risk of severe disease (OR=2.87; 95% CI 1.13–7.26, P=0.03). Adjusting for age, sex, and smoking among the cases only, daily disposable lenses were protective against severe disease (OR=0.32; 95% CI 0.11–0.89, P=0.03). Reusable lenses increased risk of severe microbial keratitis between 3.0- and 4.4-fold compared with compliant daily disposability.

Discussion/Conclusion:

Compared with a high-risk control cohort, no specific lens factors were associated with occurrence of CL-associated bacterial keratitis. Among cases only, current smokers and patients wearing reusable lenses are at increased risk of severe keratitis. Daily disposable lenses were protective even when noncompliance to daily disposability was considered.
Periorbital Intravenous Lobular Pyogenic Granulomas: A Case Report and Literature Review of This Peculiar Pathology
Authors: Saffari Persiana S. , Glasgow Ben J. , Lucarelli Katherine M. , Roelofs Kelsey A.
Published: September 2024

Intravenous lobular pyogenic granuloma (ILPG) is a seldom-documented pathology in oculoplastic and orbital literature. This study aims to elucidate the clinical presentation and histopathologic findings surrounding periorbital ILPG through a case presentation and literature review. We describe a 42-year-old male with a palpable periorbital subcutaneous nodule that was subsequently diagnosed as ILPG on immunohistochemistry. A literature review was performed by searching articles in the PubMed/MEDLINE database using the keywords “periorbital intravenous lobular pyogenic granuloma,” “periorbital intravenous pyogenic granuloma,” or “periorbital intravenous capillary hemangioma.” The literature review identified 6 patients presenting with similar subcutaneous nodules that were diagnosed as periorbital ILPGs. All patients, including the one in this study, were treated with local excision. Only 1 patient (1/7; 14.3%) noted pain while 5 experienced swelling or fluctuance (5/7; 71.4%). In patients with documented pathology reports, all ILPGs involved the angular vein (6/6; 100%). Of the 3 patients who had follow-ups at 2 to 7 years postexcision, none had recurrence. Histopathologic findings demonstrate an intravascular lobular tumor composed of capillaries with endothelial cells and pericytes. Marked reactivity to anti-Wilms tumor type 1 (WT-1) and anti-Smooth muscle actin was noted in the capillary structure. ILPG can be included on the differential for well-circumscribed, subcutaneous periocular masses. While the etiology of periorbital ILPG is unknown, most cases are managed with surgical excision, and recurrence appears to be uncommon. In sharing these cases and histopathologic underpinnings of periorbital ILPG, we endeavor to describe this peculiar pathology for oculoplastic and reconstructive surgeons.