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In Memoriam: Professor Enio Buffolo (1941 - 2025)
No full textProfessor Enio Buffolo, born on Dezember 9th, 1941, was a pioneer in thoracic and cardiovascular surgery in Brazil. His career spanned over six decades, during which he made groundbreaking contributions to world cardiac surgery, including the development of off-pump coronary artery bypass, endovascular treatment of aortic aneurysms, and the introduction of transcatheter aortic valve implantation in Brazil. He held numerous leadership roles, mentored generations of surgeons, and published extensively. His legacy is defined by visionary leadership, academic excellence, and deep humanistic values that continue to shape cardiovascular medicine in Brazil and beyond. If unanimous opinions are rare, just as rare are those that serve as examples, in their most diverse conducts, for family, friends, and coworkers. Dr. Enio Buffolo has a special place among this category of citizenship and humanism
AquaX: An enhanced and revised AquaMaps framework to model marine species distributions and biodiversity
No full textMarine biodiversity underpins ecosystem health and is critical for the provision of essential ecological services. Global efforts to mitigate biodiversity loss are underway but require comprehensive knowledge on the biogeography of species to be effective. However, key challenges limit comprehensive mapping of species distributions, including the ecosystem complexity and difficulty of sampling the marine realm. Global initiatives such as AquaMaps pioneered large-scale marine species mapping using species distribution models or ecological niche models and provided the knowledge base for effective marine conservation and management. Recently, methodological and data advances have enabled a more modern and robust approach that enables higher resolution outputs more suited to conservation applications at all scales. Building on AquaMaps, we developed a next-generation marine species habitat suitability modelling platform called AquaX, providing a suite of advances that include an ensemble of ten machine learning algorithms, enabling spatial uncertainty assessments, validation indices, and ecological niche representation at a ten-fold improved spatial resolution of 0.05 degrees. Furthermore, AquaX integrates (i) accepted taxonomy from the World Register of Marine Species, (ii) species-specific ecological, physiological, and biogeographical information (D3-Ocean system), (iii) updated occurrence records validated through expert input, and (iv) refined species range maps using expert knowledge and biogeographical divisions. AquaX also projects species' habitat suitability for both present and future conditions based on two time periods and three climate scenarios. This work provides species range maps for numerous species compared to previously available datasets and improves the accurate use of observational data. The approaches described here improve predictive accuracy at scales more relevant to marine biodiversity conservation and offer an openly accessible tool to support marine biodiversity research and conservation planning under accelerating environmental change. AquaX represents an important step forward in species distribution modeling, enabling researchers and policymakers to better understand marine biodiversity patterns and develop more effective conservation strategies.</p
Acute thoracic aortic dissection, A radiological approach from a surgical perspective
No full textThe objective of our study is to describe the most significant radiological findings that influence and guide the preparation for emergency surgery for acute thoracic aortic dissection in the radiology emergency department, based on our knowledge of the surgical technique used. Acute thoracic aortic dissection is the most common urgent aortic pathology, with high morbidity and mortality rates. Radiology plays a key role in proper diagnosis, with CT angiography being the imaging test of choice, performing a multiphase study with image acquisition without and after contrast administration. The radiologist must provide key data useful to the surgeon, answering several questions that aid surgical planning, as well as using uniform terminology and measurement techniques that allow for better communication with other specialists, avoiding misinterpretation of findings. Knowledge of the surgical approach to acute aortic dissection is extremely useful for the emergency radiologist, since, in addition to focusing on describing acute vascular pathology, it can provide further information to aid preoperative planning, allowing for a faster and safer approach.</p
Trauma Training for Emergency Department Physicians in Low- and Middle-Income Countries: A Scoping Review
No full textBackground Trauma is a leading cause of morbidity and mortality globally, and a disproportionate burden falls on low- and middle-income countries (LMICs). Proper triage and prompt resuscitation are critical to providing life-saving care for these patients. Emergency Medicine (EM) is a rapidly growing field, and Emergency Department (ED) physicians often manage the immediate care for trauma patients. However, given a lack of EM residencies and EM-specialized physicians in many LMICs, EDs are often staffed by general practitioners who may have limited formal trauma training. This review assesses the scope of published literature on trauma-specific training for ED physicians in LMICs.Methods A literature search was conducted in April 2025 using PubMed, EMBASE, and Scopus databases for publications about trauma training efforts for ED physicians in LMICs. Titles and abstracts were screened by two independent reviewers with discrepancies resolved by a third reviewer. Full-text articles in English were included. Secondary literature and articles addressing pre-hospital settings were excluded. Full-text review and data extraction were performed by two independent reviewers.Results 261 unique articles were identified in the search and 14 articles from 12 LMICs were included. Studies primarily assessed the impact of short trauma courses averaging 2.65 days. Ten articles studied their impact on provider knowledge and confidence, three assessed clinical impact, and one detailed the process of creating a trauma course. Overall, articles were limited by small sample sizes and heterogeneous participant cohorts.Conclusions ED physicians play a critical role in trauma care, yet in LMICs their trauma-specific training is limited. This review identified various short trauma courses demonstrating promising, yet limited, results in LMICs. Longitudinal assessment of knowledge retention, evaluation of skill application in clinical practice, and measurement of training effectiveness through clinical outcomes are opportunities to ensure adequate trauma education for ED physicians and strengthen trauma systems globally.</p
Chagas disease in Florida: An emerging one health challenge in the United States
No full textChagas disease, caused by Trypanosoma cruzi, poses an underrecognized public health risk in the United States, especially in states like Florida with both imported and potential for autochthonous transmission. Florida's ecological, demographic, and climatic factors—along with the presence of infected vectors and animal reservoirs—make it a high-risk region. However, limited surveillance, diagnostic infrastructure, and clinical awareness have led to significant underdiagnosis. Drawing on a One Health framework, this article highlights Florida's vulnerability in the national Chagas disease landscape by comparing its risk profile to other U.S. states such as Texas. It calls for integrated surveillance across human, animal, and environmental health sectors, improved diagnostic access, and mandatory disease reporting. By closing these gaps, Florida can serve as a model for proactive public health intervention and help prevent the silent emergence of endemic Chagas disease in the southeastern United States
Efficacy and safety of relacorilant for the treatment of patients with Cushing's syndrome (GRACE): a multicentre, phase 3, double-blind, placebo-controlled, randomised-withdrawal study
No full textRelacorilant is a selective glucocorticoid receptor modulator designed to reduce excess cortisol activity by competing with cortisol for glucocorticoid receptor binding, mitigating the clinical manifestations of endogenous hypercortisolism (Cushing's syndrome). The aim of this study was to assess the efficacy and safety of relacorilant in adults with endogenous hypercortisolism.
This multicentre, phase 3, double-blind, placebo-controlled, randomised-withdrawal study enrolled adults with endogenous hypercortisolism and hypertension, hyperglycaemia, or both and was conducted at 77 study centres across 11 countries. Key inclusion criteria included being aged 18–80 years with at least two clinical signs or symptoms of hypercortisolism. In the open-label phase, patients received oral, once-daily relacorilant (escalation from 100 mg up to 400 mg) for 22 weeks. Patients who met response criteria were randomly assigned (1:1) by the interactive web response system to continue relacorilant 400 mg (or highest tolerated dose) or placebo for 12 weeks in the randomised-withdrawal phase. Participants and investigators were masked to treatment assignment. The primary outcome was the proportion of patients who lost hypertension response during the randomised-withdrawal phase compared between relacorilant and placebo at week 12. As per protocol, this outcome was assessed in all participants who received at least one dose of study drug in the study period (intention-to-treat population). Missing randomised-withdrawal week 12 values were considered a loss of response. Safety was assessed in all enrolled patients who received at least one dose of study drug in that period. This study is registered with ClinicalTrials.gov, NCT03697109.
Between Oct 16, 2018, and April 15, 2024, 404 patients were screened, 152 were enrolled, and 95 completed the open-label relacorilant phase. 62 patients met response criteria and were randomly assigned to relacorilant (30 total participants [21 met hypertension response criteria]) or placebo (32 total participants [22 met hypertension response criteria]). In the 30 participants in the relacorilant group, the mean age was 46·6 years (SD 11·0), 22 (73%) were female, and eight (27%) were male. In the 32 participants in the placebo group, the mean age was 48·8 years (SD 14·4), 26 (81%) were female, and six (19%) were male. During the randomised-withdrawal phase, significantly more patients with baseline hypertension who were randomly assigned to placebo lost hypertension control compared with those who continued relacorilant (proportion difference 34%; odds ratio 0·17 [95% CI 0·04–0·77]; p=0·022). In the randomised-withdrawal phase safety population, the most common adverse events in the 30 participants given relacorilant and the 32 participants given placebo were back pain (5 [17%] vs 6 [19%]), acne (3 [10%] vs 0), arthralgia (3 [10%] vs 3 [9%]), bursitis (3 [10%] vs 0), headache (3 [10%] vs 4 [13%]), and insomnia (0 vs 4 [13%]). There were no cases of excessive glucocorticoid receptor antagonism, adrenal insufficiency, vaginal bleeding associated with endometrial hypertrophy, drug-induced hypokalaemia, or drug-induced QT interval prolongation.
Patients treated with relacorilant were more likely to maintain hypertension control compared with patients treated with placebo. The findings support consideration of relacorilant as a therapeutic option to reduce the harmful and debilitating effects of endogenous hypercortisolism.
Corcept Therapeutics
Editorial: Advancing HIV treatment and prevention for cisgender women: approaches to optimize health outcomes
Get PDFHormone Replacement Therapy and Hair: A Review for Trichologists Treating Menopausal Women
No full textHormones exert complex regulatory effects on the hair follicle and local follicular environments. Hormonal replacement therapy (HRT) is recommended to treat vasomotor symptoms in menopausal and post-menopausal women and is also used off-label to manage low sexual function. Given the increasing prevalence of HRTs, there is a growing interest in understanding their impact on hair. This review summarizes the role of key hormones (estrogen and androgen) in hair biology, the types of HRTs and their clinical indications, and current evidence regarding HRT's effects on hair. HRT such as estrogen-based therapies, testosterone-based therapies, and bioidentical hormones are being utilized to provide relief for undesirable vasomotor and sexual symptoms, although the risks and benefits have been debated over the years. Despite its increasing clinical relevance, HRT's impact on hair remains poorly understood due to the complex interplay of hormones, hair follicles, and local follicular environment.Hormones exert complex regulatory effects on the hair follicle and local follicular environments. Hormonal replacement therapy (HRT) is recommended to treat vasomotor symptoms in menopausal and post-menopausal women and is also used off-label to manage low sexual function. Given the increasing prevalence of HRTs, there is a growing interest in understanding their impact on hair. This review summarizes the role of key hormones (estrogen and androgen) in hair biology, the types of HRTs and their clinical indications, and current evidence regarding HRT's effects on hair. HRT such as estrogen-based therapies, testosterone-based therapies, and bioidentical hormones are being utilized to provide relief for undesirable vasomotor and sexual symptoms, although the risks and benefits have been debated over the years. Despite its increasing clinical relevance, HRT's impact on hair remains poorly understood due to the complex interplay of hormones, hair follicles, and local follicular environment
Percentages of Surgical Procedure Combinations That Were Performed Just Once or Twice at Florida Hospital and Ambulatory Surgery Centers During Each Quarter From 2010 Through 2024
Get PDFIntroduction: Data-intensive machine learning is suitable for predicting the case durations of common surgical procedures. In contrast, Bayesian methods (e.g., applying the surgeon/scheduler’s estimate) often perform well for uncommon procedures. Uncommon procedures dramatically affect case duration predictions, necessary for scheduling cases days to weeks before surgery. Procedure coding systems have changed over time, as has their disparate use, due to the large increase in ambulatory surgery. However, the current epidemiology of uncommon procedures is based on datasets from 25 years ago. We calculated contemporaneous incidence proportions for rare procedure combinations, those performed at facilities only once or twice per quarter.Methods: The retrospective cohort study used de-identified, publicly available data from the 2010-2024 Florida ambulatory surgery databases, comprising distinct combinations of 20,014,189 cases distributed across 5,106,524 combinations of quarter, facility, and Current Procedural Terminology codes. There were also 11,643,813 cases in the 2009-2024 inpatient databases across 4,772,566 combinations of quarter, facility, and distinct combinations of International Classification of Diseases (ICD) procedure codes.Results: The incidence proportions of procedures performed once or twice at each facility during the quarter performed, “doubletons,” became progressively less common. In contrast, the change from ICD-9 to the more granular ICD-10-PCS in 2015 made singletons and doubletons more common for inpatient surgery. In 2024, approximately 66%, 78%, and 87% of procedures were observed just once or twice each quarter at the ambulatory surgery center, hospital outpatient department, and inpatient surgical suite where observed. These doubleton procedures accounted for approximately 18% of cases at ambulatory surgery centers, 36% at hospital outpatient departments, and 55% at inpatient surgical suites. Pooling hospital estimates, approximately 84% of procedures and approximately 44% of cases were among procedures performed just once or twice during the quarter.Conclusions: Although surgical procedure(s) are the most important predictors of operating room time, many procedures are performed rarely, resulting in little historical case duration data for case duration estimation. Freestanding ambulatory surgery centers have, for more than 10 years, remained different from hospitals in performing more common procedures. Hospitals should plan, when scheduling cases, that approximately 84% of distinct combinations of procedures and 44% of cases will have little to no procedure-specific historical data, and even less so by the combination of procedure and surgeon. Machine learning models for predicting case durations should therefore account for these uncommon procedures, for which Bayesian methods are well suited
Accuracy and safety of acetabular cup placement in total hip arthroplasty using mixed-reality navigation: A prospective trial
No full textSafe and accurate placement of the acetabular component is critical in total hip arthroplasty (THA). Fluoroscopy helps with cup positioning in the direct anterior approach (DAA) but increases radiation exposure. Augmented and mixed-reality (MR) systems may improve precision while decreasing reliance on fluoroscopy. This study assessed the accuracy, safety, and impact on radiation exposure of MR navigation in anterior and posterior THA.
From July 2023 to May 2024 at a single tertiary level institution, 33 patients underwent unilateral THA with MR by either the anterior (16) or posterior (17) approach. Operative time, patient demographics, pre-operative plan and post-operative positioning measures (center of rotation, leg length discrepancy, anteversion, and inclination) were compared between cohorts.
There were no demographic differences between cohorts, though operative time was significantly longer in the anterior group (106.30 vs 94.12 min, p < 0.001). Evidence of a learning curve was observed in the anterior cohort, with significantly higher radiation dose (187.40 vs 119.30 uGym2, p = 0.03) and reference air kerma (4.17 vs 2.60 mGy, p = 0.02) in the initial 20% of cases. While cup placement accuracy was comparable between groups for center of rotation, leg length discrepancy, and anteversion, inclination differed significantly (2.88 vs −6.71°, p = 0.0003). Within-group analyses showed significant deviations from the preoperative plan for all measured variables in both cohorts. Despite this, all patients met clinical thresholds for LLD (<18 mm) and anteversion (15° ± 10°), with 100% of anterior and 88.2% of posterior cases within the target inclination range (40° ± 10°), and 72.7% achieving a center of rotation within ≤5 mm of the plan.
MR-navigated THA can safely produce accurate acetabular cup placement in both anterior and posterior total hip arthroplasty, validating safe use in THA. The observed learning curve suggests MR reduces reliance on fluoroscopy while enhancing surgical precision