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Hemocompatibility Outcomes With Pharmacological Therapy Following LVAD Implantation: Insights From the ARIES-HM3 Trial.
No full textBACKGROUND: The ARIES-HM3 (Antiplatelet Removal and Hemocompatibility Events With the HeartMate 3 Pump) trial demonstrated safety and decreased bleeding in eliminating aspirin from the antithrombotic regimen of patients implanted with a HM3 left ventricular assist device (LVAD). Whether pharmacologic therapies impact hemocompatibility-related adverse events (HRAEs) remains uncertain.
OBJECTIVES: In this trial analysis, the authors investigated associations between pharmacologic therapy and hemocompatibility outcomes.
METHODS: Among 547 of 589 randomized patients who were discharged, non-inotrope-dependent, and completed 1-month of follow-up, the study explored the influence of pharmacotherapy (renin-angiotensin-aldosterone system [RAAS] inhibitors, heart failure [HF]-related and other cardiovascular drugs) on blood pressure control and on survival free of major nonsurgical HRAE (stroke, pump thrombosis, bleeding, and arterial thromboembolism) at 12 months.
RESULTS: In 547 eligible patients, 65% received RAAS inhibitors, 89% received other HF-related therapy, and 82% received another cardiovascular drug at 1 month. No statistically significant interaction between RAAS inhibitors (P = 0.08), other HF-related therapies (P = 0.65), or other cardiovascular drugs (P = 0.92) on aspirin use and primary endpoint success was observed. Patients receiving RAAS inhibitors at 1 month had greater primary endpoint success (78.9% vs 69.3%, HR: 0.61 [95% CI: 0.37-1.01]; P = 0.14). Other HF-related therapies and cardiovascular drugs were not associated with primary event success either on or off prescription (HF-related therapy: 75.4% vs 76.7%; other cardiovascular drugs: 74.3% vs 81.3%). Pharmacologic therapy did not have a significant interaction with blood pressure control (RAAS inhibitors: P = 0.69; other HF-related therapy: P = 0.40).
CONCLUSIONS: Background pharmacologic therapy did not modify the effect of aspirin on HRAE; however, the use of a RAAS inhibitor was independently associated with a reduction in HRAE. These exploratory observations may potentially point to opportunity for enhancing hemocompatibility in patients receiving LVAD therapy. (Antiplatelet Removal and Hemocompatibility Events With the HeartMate 3 Pump [ARIES-HM3]; NCT04069156)
Content and Readability Analysis of Patient-Reported Outcome Measures for Gynecomastia: A Systematic Review.
No full textGynecomastia, characterized by the benign enlargement of male breast tissue, has a lifetime prevalence of 65% and can significantly impact quality of life and psychosocial well-being. Although most cases resolve spontaneously within 1 to 3 years, surgical intervention is often necessary for patients experiencing persistent symptoms or distress. Understanding patient perspectives via patient-reported outcome measures (PROMs) is critical for evaluating the success of medical or surgical interventions in addressing aesthetic concerns, psychosocial functioning, and health-related quality of life (HRQOL). However, a systematic review of available PROMs specific to gynecomastia is lacking. This study aims to identify and analyze existing PROMs used for patients with gynecomastia and to assess PROM content and readability. This systematic review followed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines, and searches were performed across 4 databases: PubMed, EMBASE, CINAHL, and Scopus. The search strategy resulted in 22 studies and 23 unique PROMs. Following a structured domain framework with field definitions, content comparison was performed for 908 PROM items across 5 domains: objective appearance, self-perception, HRQOL, social outcomes, and intervention satisfaction. Readability was assessed using the Simple Measure of Gobbledygook and Flesch-Kincaid indices. Results indicated that although some PROMs adequately address key domains such as objective appearance and self-perception, significant gaps remain in comprehensively capturing the full spectrum of HRQOL and social outcomes among patients with gynecomastia. Additionally, readability indices for nearly all PROMs exceed the recommended grade level for the general population, thereby highlighting the need for a new gynecomastia-specific instrument that can be used for pediatric, adolescent, and adult populations
Bilateral venous sinus stenting for idiopathic intracranial hypertension: a single center series
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The effect of aspirin use following woven endobridge treatment: a multicenter study with propensity score-matching
No full textDelayed Bilateral Internal Carotid Artery Occlusion in a Pediatric Patient Following Traumatic Injury: Insights on Management and Interventional Approach.
No full textCarotid artery dissection is a rare but significant cause of pediatric stroke, often associated with trauma or underlying collagen vascular disorders. The management of these cases, both medical and surgical, is complex, particularly in bilateral dissections where collateral circulation may be insufficient. We describe a case of bilateral internal carotid artery occlusion that developed 10 days after an initial traumatic fall. The progression of ischemic stroke burden and fluctuating neurologic status, despite therapeutic anticoagulation and optimal medical management, led to the decision for endovascular intervention involving balloon angioplasty and stenting. Following the procedure, a rapid improvement in neurologic function was observed, with the patient exhibiting only mild deficits at discharge. This case highlights the complexities in managing pediatric carotid dissections, especially in unusual presentations. Our experience underscores the necessity for tailored treatment strategies, rigorous monitoring, and a multidisciplinary approach to optimize outcomes in pediatric stroke patients
Pilot Evaluation of a Host-Protein Test in Emergency Department Patients Who Trigger a Sepsis Alert
No full textNeuroimmune modulation in patients with active rheumatoid arthritis with an inadequate response to TNF inhibitors (TNFi)
No full textLiver transplantation for colorectal metastasis -selection criteria, outcomes, and management recurrence: a systematic review and meta-analysis.
No full textBACKGROUND: Despite advances in systemic therapies, the prognosis for non-resectable colorectal liver metastases (nCRLM) remains poor, with a 5-year survival rate of only 10%. Liver transplantation (LT) has emerged as a potential curative option for select patients. This study evaluated survival outcomes, recurrence rates, prognostic factors, and quality of life (QoL) following LT for nCRLM.
METHODS: A comprehensive search was performed through PubMed, Scopus, and the Cochrane Library for studies available up to 4 October 2024. Eligible studies reported survival, recurrence, or QoL following LT for nCRLM. Risk of bias was evaluated using ROBINS-I and RoB 2. A random-effects model pooled overall survival (OS), disease-free survival (DFS), and recurrence rates. Heterogeneity and publication bias were examined using Cochran\u27s Q and Egger tests.
RESULT: Out of 549 patients, 20 studies with 377 unique patients were selected. OS at 1, 3, and 5 years were 91%, 67%, and 54%. DFS: 65%, 38%, and 16%. Recurrence occurred in 52%. Favorable pre-transplant factors were linked to better OS. QoL varied, with fatigue, pain, and dyspnea reported post-transplantation.
CONCLUSION: LT offers strong survival benefits in nCRLM. However, high recurrence rates highlight the need for strict selection using Oslo score and Metabolic Tumor Volume (MTV)
