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Impact of intraoperative dexmedetomidine on clear cell renal cell carcinoma progression: a retrospective cohort study
No full textBACKGROUND: Dexmedetomidine, an α-2 adrenoreceptor agonist, is commonly administered during cancer surgery as an adjuvant sedative because of its general anaesthetic agent-sparing effects. We investigated the association between ADRA2 gene expression and dexmedetomidine on oncological outcomes after surgery for clear cell renal cell carcinoma (RCC).
METHODS: We conducted an in silico analysis using a publicly available database and a retrospective study in patients with clear cell RCC. The associations between ADRA2A expression and recurrence-free survival and overall survival were analysed. The same outcomes were investigated in a cohort of patients who underwent partial or total nephrectomy and received dexmedetomidine or not. A propensity score matching strategy was utilised to account for selection bias, and a multivariable analysis was performed to control for variables implicated in survival.
RESULTS: Expression of the ADRA2A gene at the tumour level was not associated with recurrence-free survival; however, higher levels of expression were significantly associated with shorter overall survival. A total of 1766 patients with clear cell RCC were included in the retrospective study. Dexmedetomidine administration was not associated with higher rates of recurrence or mortality or with a significant impact on recurrence-free survival or overall survival.
CONCLUSIONS: Intraoperative administration of dexmedetomidine was not associated with a significant impact on cancer progression and survival. The role of ADRA2A as a prognosis biomarker for clear cell RCC warrants further study
Predictors of extracorporeal membrane oxygenation utilization and survival during cardiopulmonary resuscitation in out and in-hospital cardiac arrest
No full textINTRODUCTION: Extracorporeal membrane oxygenation during cardiopulmonary resuscitation (ECPR) has shown promise in managing both out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA).
METHODS: We analyzed hospital discharge records from the National Inpatient Sample of adult individuals who underwent ECPR between 2016 and 2020. Multivariable regression analyses were conducted to identify factors influencing ECPR utilization and survival.
RESULTS: Among 1,585,960 patients (901,470 OHCA, 684,490 IHCA), ECPR utilization rates were 1 % for OHCA and 1.4 % for IHCA, with inpatient mortality rates of 52 % and 67 %, respectively. In OHCA, ECPR was more likely in patients from higher-income areas, those with Medicaid/private insurance, systolic heart failure, shockable rhythms, and Hispanic/other races but less likely in those over 65, with patients with history of atrial fibrillation, diabetes, cerebrovascular accident, or COPD. In IHCA, ECPR was more common in larger hospitals, higher-income areas, and those with private insurance but less frequent in Black patients, those over 65, or with prior cerebrovascular accidents, COPD, diabetes, or end-stage renal disease. In OHCA ECPR, Asian race (aOR: 2.31), diabetes (aOR: 1.29), and liver disease (aOR: 1.77) predicted mortality, while shockable rhythms (aOR: 0.75), systolic heart failure (aOR: 0.67), and treatment in southern states (aOR: 0.72) predicted survival. In IHCA ECPR, acute myocardial infarction (aOR: 0.73) and private insurance (aOR: 0.63) were associated with improved survival, whereas liver disease (aOR: 1.59) predicted higher mortality.
CONCLUSION: We highlight the selective nature of ECPR utilization between OHCA and IHCA and the distinct survival predictors in each setting. Further research is needed to refine selection criteria and optimize patient outcomes
Dissection Techniques in Chronic Total Occlusion Percutaneous Coronary Intervention
No full textBACKGROUND: There is limited data on dissection strategies in chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
AIMS: To study the differences in the baseline characteristics and procedural outcomes of antegrade CTO PCIs that used dissection strategies.
METHODS: We performed a comparative analysis of antegrade dissection and re-entry CTO PCIs from the PROGRESS-CTO registry from 50 centers (2012-2024). Three dissection strategies were compared: (a) knuckle wiring: knuckle wire(s) without Carlino technique or CrossBoss catheter; (b) the CrossBoss technique: use of the CrossBoss catheter; and (c) the Carlino technique: use of the Carlino technique. In-stent CTO PCIs were excluded from the analysis.
RESULTS: In total, 1575 (74.6%) cases used knuckle wiring, 427 (20.2%) the CrossBoss, and 110 (5.2%) the Carlino technique. Knuckle wiring was the most frequent strategy with increasing utilization over time (p \u3c 0.001). The CrossBoss catheter was more common in lesions with lower J-CTO scores (CrossBoss: 2.91 vs. Knuckle wiring: 3.07 vs. Carlino: 3.18; p = 0.015), and was associated with higher technical success (CrossBoss: 84.0% vs. Knuckle wiring: 74.2% vs. Carlino: 64.2%; p \u3c 0.001) and similar major adverse cardiac events rates, but lower perforation rates. Time to crossing was longer when Carlino was used (CrossBoss: 93 [70, 133] min vs. Knuckle wiring: 97 [63, 136] min vs. Carlino: 133 [84, 166] min, p = 0.001). Use of different types of knuckle wires (Pilot 200, Gladius Mongo, and Fielder XT) was associated with similar success rates.
CONCLUSIONS: Knuckle wiring is the most commonly used antegrade dissection strategy. The CrossBoss catheter was used in less complex cases and was associated with higher success, whereas the opposite was true for the Carlino technique
Left Atrial Veno-Arterial Extracorporeal Membrane Oxygenation In Valvular Cardiogenic Shock
No full textBACKGROUND: Treatment of valvular cardiogenic shock (VCS) is challenging as the options for mechanical cardiocirculatory support are limited. Left atrial veno-arterial extracorporeal membrane oxygenation (LAVA-ECMO) is a mechanical cardiocirculatory support strategy that provides cardiocirculatory support and simultaneous left ventricular unloading, compared to traditional VA-ECMO.
METHODS: This is a single-center retrospective analysis of patients with VCS who underwent LAVA-ECMO between 2018 and 2023. During LAVA-ECMO, the ECMO venous cannula is placed transeptally in the LA, therefore providing active biventricular unloading.
RESULTS: A total of 18 patients who had VCS and underwent LAVA-ECMO cannulation were included. Among patients with VCS, 10 were related to the aortic valve (55.6%), 7 to the mitral valve (38.9%), and 1 to the tricuspid valve (5.6%). Four patients (22.2%) had multivalvular disease. The median age was 65 years, most were men (66.7%) and most were in Society for Cardiovascular Angiography & Interventions cardiogenic shock stage D or E (89%). LAVA-ECMO was associated with substantial improvement in hemodynamics, including lower right atrial pressure (-8 mm Hg; 95% CI, 7.0-9.5; P = .004), mean pulmonary artery systolic pressure (-18.5 mm Hg; 95% CI, 14.3-21.7; P = .026), pulmonary capillary wedge pressure (-14.5 mm Hg; 95% CI, 12.8-12.3; P = .003), and left ventricular end-diastolic pressure (-20.0 mm Hg; 95% CI, 16.5-21.0; P \u3c .001). These effects were consistent across VCS types. There were no complications from transeptal cannulation. Survival to a transcatheter or surgical procedure was 69.1%, and survival to hospital discharge was 44.4%.
CONCLUSIONS: LAVA-ECMO appears to be feasible, safe, and associated with improved hemodynamics in patients with VCS. Further research is needed to evaluate whether LAVA-ECMO as a bridge treatment strategy to intervention is beneficial in VCS
Response to Barbieri, Response to Veenstra et al\u27s \u27Benzoyl peroxide acne treatment shows no significant association with benzene-related cancers: A multicenter retrospective analysis\u27
No full textMicroRNA-17-92 Regulates Skin Langerhans Cell Embryonic Development by Targeting Cell Proliferation Pathways
No full textEpigenetic Control of Alveolar Macrophages: Impact on Lung Health and Disease
No full textAlveolar macrophages (AMs) are immune cells located in the alveoli-the tiny air sacs in the lungs where gas exchange occurs. Their functions are regulated by various epigenetic mechanisms, which are essential for both healthy lung function and disease development. In the lung\u27s microenvironment, AMs play critical roles in immune surveillance, pathogen clearance, and tissue repair. This review examines how epigenetic regulation influences AM functions and their involvement in lung diseases. Key mechanisms, such as DNA methylation, histone modifications, and non-coding RNAs, regulate gene expression in response to environmental signals. In healthy lungs, these modifications enable AMs to quickly respond to inhaled threats. However, when these processes malfunction, they could contribute to diseases such as pulmonary fibrosis, COPD, and pulmonary hypertension. By exploring how epigenetic changes affect AM polarization, plasticity, and immune responses, we can gain deeper insights into their role in lung diseases and open new avenues for treating and preventing respiratory conditions. Ultimately, understanding the epigenetic mechanisms within AMs enhances our knowledge of lung immunology and offers potential for innovative interventions to restore lung health and prevent respiratory diseases
Efficacy and safety of ruxolitinib cream in children aged 2 to 11 years with atopic dermatitis: Results from TRuE-AD3, a phase 3, randomized double-blind study
No full textBACKGROUND: Ruxolitinib (Janus kinase 1 and Janus kinase 2 inhibitor) cream demonstrated efficacy and safety in adolescents and adults with mild-to-moderate atopic dermatitis (AD).
OBJECTIVE: To evaluate 8-week efficacy and safety of ruxolitinib cream in children with mild-to-moderate AD.
METHODS: This phase 3 study (TRuE-AD3; NCT04921969) enrolled children aged 2-11 years with an Investigator\u27s Global Assessment (IGA) score of 2 or 3 and 3% to 20% affected body surface area. Patients were randomized 2:2:1 to twice-daily ruxolitinib cream (0.75% or 1.5%) or vehicle for 8 weeks. The primary endpoint was the proportion of patients achieving IGA treatment success (IGA-TS; score of 0/1 with ≥2-grade improvement from baseline) at Week 8.
RESULTS: Children (N = 330) were randomized to vehicle (n = 65), 0.75% ruxolitinib cream (n = 134), or 1.5% ruxolitinib cream (n = 131). At Week 8, significantly more patients achieved IGA-TS with 0.75%/1.5% ruxolitinib cream (36.6%/56.5%) versus vehicle (10.8%; P = .0001/P \u3c .0001). Improvements in itch and quality of life were also observed. The safety profile was consistent with that observed in adults and adolescents.
LIMITATIONS: Enrollment was limited to patients in North America.
CONCLUSION: Ruxolitinib cream provided superior improvements versus vehicle in AD signs and symptoms in children with mild-to-moderate AD and was well tolerated
Utility of Combining a Simulation-Based Method with Lecture for Retinopathy Training in Emergency Medicine Residency
No full textINTRODUCTION: Funduscopic examination is a critical skill for diagnosing eye-related pathologies but has witnessed a decline in proficiency over recent decades. Simulation-based training is proposed as a solution to enhance emergency medicine residents\u27 funduscopic examination skills. We hypothesized that a combination of lecture and simulation would improve residents\u27 diagnostic abilities, with senior residents potentially outperforming junior counterparts.
METHODS: This study aimed to assess the effectiveness of simulation-based training in improving the funduscopic examination skills of emergency medicine residents and whether factors such as seniority or prior ophthalmology rotation influenced the results. Residents participated in a 10-question image-based exam, with alternating pairs viewing images and answering questions. Simulation equipment, including digital eye examination retinopathy trainers, was utilized for the study. A lecture covering possible answers was provided, followed by a second round of testing.
RESULTS: A total of 20 participants in this pilot study took both the pre- and post-lecture tests. Test scores significantly improved after supplemental education, indicating the effectiveness of simulation-based training in enhancing funduscopic diagnostic skills. Interestingly, resident year and prior completion of an ophthalmology rotation did not significantly impact test scores, underscoring the importance of supplemental education. Notably, participants demonstrated high accuracy in identifying Normal Fundus and several specific pathologies post-training.
CONCLUSION: Simulation-based training, supplemented by lectures, offers a promising avenue for improving funduscopic examination proficiency among emergency medicine residents. This study\u27s findings highlight the potential for standardized training methods to benefit residents across different levels of experience. Future research could explore the long-term retention of these skills and their translation into clinical practice. In an era where technological advancements are reshaping medical education, simulation-based training offers a promising avenue for ensuring that essential clinical skills are not lost but rather strengthened among medical professionals
Treatment of pruritus in primary sclerosing cholangitis: Analysis of the consortium for autoimmune liver disease registry.
No full textBACKGROUND: Cholestasis from primary sclerosing cholangitis (PSC) frequently causes pruritus. However, the prevalence of pruritus and its management have not been well studied. Investigating the Cholestatic Pruritus of Primary Sclerosing Cholangitis (ItCh-PSC) includes a retrospective medical record review to determine the prevalence, severity, and treatment patterns of pruritus.
METHODS: Data was collected at 5 academic medical centers in the United States. Medical records were searched for the terms itch and pruritus and data abstracted related to itch severity, number of encounters, and treatment.
RESULTS: Among 724 patients with PSC, 359 (50%) of patients had a documented history of pruritus, including 40%, 39%, and 21% with mild, moderate, or severe itch. Itch was less common in those with small ducts compared to large duct PSC (p=0.02) and more frequent in those of Hispanic versus non-Hispanic ethnicity (p=0.001). Compared to patients with mild itch, patients with moderate or severe itch were younger, and had more elevated liver biochemistries, more encounters with itch, and more frequently prescribed 2 or more anti-pruritic medications. Bile acid-binding resins were prescribed in 36%, hydroxyzine in 23%, rifampin in 11%, and fenofibrate in 4% of patients with any itch. The prevalence and severity of pruritus were not affected by cirrhosis, hepatic decompensation, or inflammatory bowel disease.
CONCLUSION: Itch is common in patients with PSC and is often associated with multiple prescriptions of antipruritic agents. Effective treatments for pruritus in patients with PSC remain an unmet need