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Comparison of Heart Failure Cardiogenic Shock Patients with Axillary and Femoral Intra-aortic Balloon Pump: Cardiogenic Shock Working Group report.
No full textBACKGROUND: IABPs traditionally are placed via the femoral artery. Single-center studies have shown the utility of axillary placement to promote ambulation. The utility of Ax IABP in CS has not been established. Therefore, we sought to describe the outcomes of patients receiving axillary (Ax) intra-aortic balloon pump (IABP) and compare them with those receiving femoral (Fem) IABP for heart failure-related cardiogenic shock (HF-CS).
METHODS: Data from 2020 to 2023 from the Cardiogenic Shock Working Group, a multicenter academic consortium, were analyzed. We examined the demographic, metabolic, hemodynamic characteristics, and outcomes of patients with HF-CS treated with Ax-IABP and compared them with those who primarily received a Fem-IABP.
RESULTS: Of 6201 CS patients in the registry, 557 (8.9%) patients received an IABP for HF-CS, of whom 244 (43.8%) and 313 (56.2%) received Ax-IABP and Fem-IABP, respectively. Compared with Fem-IABP, patients who received Ax-IABP were more likely to have previous intracardiac defibrillators (42.5% vs 68.9%, P \u3c .001). Time to IABP implant from admission (7.9 ± 10.6 vs 1.8 ± 6.1, P \u3c .01) and duration of support (9.6 ± 14.6 vs 4.0 ± 4.5, P \u3c .01) were longer among Ax-IABP, relative to Fem-IABP. Patients who received Ax-IABP were more likely to undergo heart-replacement therapy (65% vs 21%, P \u3c .001) compared with the Fem-IABP cohort. The rate of reported complications was similar between the 2 groups.
CONCLUSION: Axillary IABP is being used beyond single-center reports to support HF-CS mostly as a bridge to heart-replacement therapies. Its use might provide advantages over fem-IABP
Enhanced Diagnostic Accuracy for Septic Arthritis Through Multivariate Analysis of Serum and Synovial Biomarkers.
No full textBackground: Septic arthritis is an orthopedic emergency. However, optimal biomarkers and diagnostic criteria remain unclear. The study aimed to evaluate the diagnostic performance of routinely used and novel biomarkers, including serum C-reactive protein (CRP), synovial white blood cells (WBC), pentraxin-3 (PTX3), interleukin-6 (IL-6), and presepsin, in distinguishing septic from non-septic arthritis. Methods: Thirty-one patients undergoing arthrocentesis were included. Patients were categorized into septic and non-septic arthritis groups. Synovial fluid and serum samples were analyzed for five biomarkers. Diagnostic performance was assessed by calculating the area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: Synovial WBC demonstrated the highest diagnostic performance among single biomarkers (AUC = 0.837, p = 0.012). Among novel biomarkers, PTX3 showed the highest accuracy and sensitivity. The serum CRP and synovial WBC combination yielded an AUC of 0.853, with 100% sensitivity, 68.0% specificity, 42.9% PPV, and 100% NPV. Adding all three novel biomarkers to this combination increased the AUC to 0.887 (p = 0.004), maintaining 100% sensitivity and NPV. When individually added, PTX3 achieved 100% sensitivity and NPV, while presepsin showed the highest specificity (96.0%), PPV (75.0%), and accuracy (87.1%). Conclusions: Serum CRP and synovial WBC remain essential biomarkers for diagnosing septic arthritis; however, combining them with PTX3, IL-6, and presepsin improved diagnostic accuracy. PTX3 is best suited for ruling out septic arthritis due to its high sensitivity and NPV, whereas presepsin is more useful for confirmation, given its specificity and PPV. These results support a tailored biomarker approach aligned with diagnostic intent
Ivermectin and gynecologic cancer: What\u27s the data?
No full text•Ivermectin is currently approved by the US Food and Drug Administration (FDA) in 1996 as an oral medication for intestinal strongyloidiasis and onchocerciasis.•The data on ivermectin as a gynecologic cancer-fighting compound is lacking.•Clinical studies on ivermectin use in cancer are limited to effects observed in cell lines.•We have not assessed ivermectin\u27s safety and efficacy in gynecologic cancers.•We do not recommend and strongly caution the use of ivermectin in the treatment of gynecologic cancers
Early Reduction of Pulmonary Artery Pressures Is Associated With Improved Mortality Among Medicare Beneficiaries With Heart Failure.
No full textBACKGROUND: The early hemodynamic trajectories of heart failure patients receiving implantable pulmonary artery pressure monitor and the clinical implications of those trajectories are unknown in a contemporary real-world population.
OBJECTIVES: This study aims to determine whether baseline pulmonary artery diastolic pressure (PAD) and its early trajectories predict risk of mortality.
METHODS: Patients in Merlin.net implanted with the CardioMEMS sensor between 2017 and 2022 were linked to Medicare claims. Patients were categorized by PAD being acceptable (≤20 mm Hg) or elevated (\u3e20 mm Hg). Multivariable regression was used to evaluate the impact of baseline PAD (cohort A) and its early changes at 90 days (cohort B) on long-term mortality.
RESULTS: In cohort A (N = 9,579), baseline PAD was elevated in 64.1%. The 2-year risk of mortality was lower for those with acceptable vs elevated PAD at baseline (HR: 0.68 [95% CI: 0.62-0.73]; P \u3c 0.001). In cohort B (N = 8,452), 63.3% had elevated PAD at baseline; of those, 24.0% improved to having acceptable PAD (Δ: -6.5 ± 4.3 mm Hg), and 76.0% remained persistently elevated at 90 days despite experiencing a reduction (ΔPAD: -1.6 ± 4.3 mm Hg). Those with improved PAD (acceptable at 90 days from elevated at baseline) had lower mortality compared with those with persistently elevated PAD (HR: 0.72 [95% CI: 0.64-0.81]; P \u3c 0.001). Lower baseline PAD and no history of chronic obstructive pulmonary disease or atrial arrhythmia were associated with higher odds of improved PAD.
CONCLUSIONS: Among Medicare beneficiaries, CardioMEMS-guided management was associated with a reduction in PAD. Achieving acceptable PAD within 90 days of implant was associated with better survival. Our study highlights the need to develop novel strategies, including standardization of management algorithms that target elevated PAD
Cervical Sagittal Alignment Revisited on the Path to Personalized Spine Surgery: A Big Picture Perspective Through Bibliometric Analysis and Visualization.
No full textOBJECTIVE: Spinal alignment has become a focal point of spine deformity surgery amid an increased emphasis on global balance. Following a strong focus on thoracolumbar alignment, the cervical spine has recently emerged as a key area for further investigations. We applied formal bibliographic analytic techniques to assess trends regarding cervical sagittal alignment over time.
METHODS: Data was collected from the Clarivate Web of Science, PubMed, and Scopus databases on 08/02/2025 utilizing the keyword search ( cervical OR cervical spine ) AND ( sagittal imbalance OR sagittal balance OR sagittal alignment OR sagittal malalignment ). Excel was used to create the publication years, citations per year, publishing journals, countries, author figures. VosViewer was used to create the network visualizations of keyword co-occurrence, cocitation, country copublication, and coauthorship analyses.
RESULTS: We identified an over ten-fold increase every fifteen years in cervical sagittal alignment-related publications, starting with one study published in 1994 rising to 161 published in 2023. This trend outpaces global increases in spine publications by over sixfold. Notable jumps occurred from both 2012-2013 and 2016-2017, with over 50% increases in publications year over year. In the last five years, there has been an increasing focus on deformity, laminectomy, and motion.
CONCLUSIONS: Cervical sagittal alignment has received a rapid and disproportionate increase in publications in the last ten years which may reflect increased interest in personalized surgery through deformity correction and motion preservation. Our study provides a graphic perspective on this topic and reflects the importance of spinal alignment in all sections of the spinal column
Correction: Natural killer cell infiltration in prostate cancers predict improved patient outcomes.
No full textSpontaneous Improvement of Hypogonadotropic Hypogonadism in a Patient with
No full textKallmann syndrome (KS) is a form of hypogonadotropic hypogonadism (HH) characterized by gonadotropin-releasing hormone (GnRH) deficiency and anosmia due to defective neuronal migration. While traditionally considered irreversible, cases of spontaneous improvement of HH have been reported, suggesting residual GnRH neuronal function in some individuals. We present a case of a 29-year-old man with KS who exhibited spontaneous recovery of endogenous testosterone production following the cessation of long-term androgen therapy without the use of alternative hormonal agents. After ceasing testosterone therapy for several months, the patient\u27s total testosterone levels normalized (407-424 ng/dL), accompanied by increased secondary sexual characteristics, stable gonadotropin levels, and normal testicular volume. Persistent anosmia was noted, suggesting that restoration of reproductive endocrine function can occur independently of olfactory recovery. Genetic testing identified heterozygous mutations in PCSK1 and HS6ST1, genes implicated in GnRH regulation and KS pathogenesis. This case highlights the potential role of genetic variation in spontaneous HH improvement and underscores the need for individualized management strategies, including periodic reassessment of gonadal function and fertility potential. Further research is needed to elucidate the mechanisms driving spontaneous HH improvement, identify predictive biomarkers of reversibility, and explore therapeutic strategies that may promote endogenous GnRH activity in select patients with KS
GRAPPA 2024: Key Project Advances.
No full textSignificant progress toward several key initiatives was presented during the Project Key Advances session of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2024 annual meeting. Highlights included advancements from the Collaborative Research Network (CRN), with contributions from the Health Initiatives in Psoriasis and Psoriatic Arthritis Consortium European States (HIPPOCRATES) and developments in the complex-to-manage (C2M)/difficult-to-treat (D2T) psoriatic arthritis project. The presentation also included an update on the GRAPPA educational slide library. These activities underscore GRAPPA\u27s continued dedication to fostering collaboration that advances psoriatic disease education and research toward improved patient outcomes
