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“A Bridge-Over-The Bar”: A Novel Strategy to Prevent Paravalvular Regurgitation During Mitral Valve Replacement for Severe Mitral Annular Calcifications
No full textMitral annular calcifications have been known to increase complexity during mitral valve replacement (MVR). Standard procedure requires decalcification followed by reconstruction of the mitral annulus prior to placing the prosthesis. While this is the ideal technique, it is not feasible in every patient due to the associated risks. The mere attempt at valve replacement without proper annular decalcification has been associated with a high incidence of periprosthetic leak which complicates the postoperative course and has been associated with increased morbidity and mortality. With the advances in transcatheter therapy, postoperative periprosthetic regurgitation can be managed with devices and primary transcatheter valve implantation could be alternative to standard valve replacement; however, these alternate strategies are not without its own limitations and drawbacks. In the current report, we present a novel strategy to be used in a select group of patients with severe but non-circumferential annular calcifications to prevent/minimize periprosthetic regurgitation during MVR. This involves placing a patch over the posteriorly located calcium bar, thus minimizing tension on the posterior suture line and contain any periprosthetic regurgitation if to develop. This modification has been performed in a total of nine cases with acceptable early results
Can Standing Replace Upright Tilt Table Testing in the Diagnosis of Postural Tachycardia Syndrome (POTS) in the Young?
No full textPurpose: We compared standing and upright tilt in patients with postural tachycardia syndrome (POTS) and healthy volunteers to determine whether standing accurately tests for POTS in youngsters \u3c 19 years. POTS in adolescents is defined by orthostatic intolerance plus sustained excessive upright tachycardia, without hypotension during upright tilt. We examined whether active standing is a valid classifier for POTS in adolescents compared to tilt. Methods: Patients with POTS (N = 36, 12.2–18.8 years) and healthy volunteers (N = 39, 13.1–18.9 years) performed stand for a minimum of 5-min and were tilted to 70° for 10 min. Receiver operating characteristics analyses (ROC) were performed at 5-min stand, and at 5 and 10 min tilt for optimal threshold for heart rate (HR) increase (ΔHR), and test sensitivity and specificity. Results: Most subjects were unable to stand for 10 min. ΔHRs at 5 min stand were higher in POTS (31 ± 3) compared with control (21 ± 2) and elevated at 5- or 10-min tilt in POTS (51 ± 3 and 51 ± 2) versus control (26 ± 2 and 25 ± 2) compared with standing. ΔHR in POTS and controls for 10 min were not different from 5 min. For 5 min stand ROC threshold was 26 beats per min (bpm), sensitivity of 70.6%, and specificity of 68.2% compared with 39 bpm, 88.2%, and 95.1% for 5 min tilt, and 40 bpm, 94.1%, and 95.1% for 10-min tilt. A precision-recall graph confirmed the superior discriminating ability of 5 min and 10 min tilt compared to 5 min stand. Conclusions: The stand test is relatively non-specific and imprecise compared to tilt and does not satisfactorily distinguish POTS from control in patients aged \u3c 19 years old
The U.S. Radiologist Workforce: Ajr Expert Panel Narrative Review
No full textThe U.S. radiologist workforce has experienced periods of growth as well as stagnation and downturns, with concerns of radiologist oversupply during tight job markets followed by perceived workforce shortages. Major issues facing the radiologist workforce today include the following: the impacts of accumulated policy changes; a mismatch between the demand for radiologist services and the current size of the radiologist workforce; dissatisfaction, turnover, and burnout among radiologists; challenges in radiology resident education due to employment trends; and the promise and challenges of artificial intelligence. To address current and future workforce shortages, radiology as a profession must adapt to ongoing stresses and the changing care ecosystem by promoting appropriate utilization, leveraging all existing workforce reserves, and embracing innovation. In this AJR Expert Panel Narrative Review, we explore the recent history of the U.S. radiologist workforce; examine the political, social, and educational milieus faced by current and future radiologists; and consider the effects of disruptive technology
Identifying a Role for Oxytosis/Ferroptosis in Pde6b-Associated Retinitis Pigmentosa
No full textInherited retinal diseases (IRDs) are a large heterogeneous group of diseases that lead to visual impairment and complete vision loss. Retinitis pigmentosa (RP) is an IRD with progressive degeneration of photoreceptors and has been associated with mutations in over 80 genes. In this study, we investigated the mechanism of retinal degeneration caused by an inherited mutation in the Pde6b gene in the rd10 mouse model of RP, with a focus on alternative programmed cell death pathways. RNA-seq analysis was used to identify changes in gene expression in rd10 mice, using C57BL/6J mice as non-degenerating genetic background controls. The functional role of differentially expressed genes was investigated using pharmacological treatments and visual acuity was assessed using optomotor kinetic tracking assay. We found increased expression of genes involved in inflammatory response, while expression of genes involved in photoreceptor function and homeostasis were decreased. We also demonstrated increased expression of genes that regulate oxytosis/ferroptosis, a type of regulated necrosis that can promote inflammatory responses. We found no significant changes in expression of genes controlling other types of regulated necrosis. Treating rd10 mice with oxytosis/ferroptosis inhibitors led to significant improvements in visual acuity. Therefore, these findings suggest that disruption of Pde6b activity results in photoreceptor death via oxytosis/ferroptosis, contributing to inflammatory responses in the retina. Our results identify for the first time a possible role of oxytosis/ferroptosis in a model of inherited retinal degeneration and provide a foundation for further studies exploring oxytosis/ferroptosis inhibitors as a potential therapeutic strategy for RP
Artificial Intelligence for Drug Discovery: An Update and Future Prospects
No full textArtificial intelligence (AI) has become a pivotal tool for medical image analysis, significantly enhancing drug discovery through improved diagnostics, staging, prognostication, and response assessment. At a high level, AI-driven image analysis enables the quantification and synthesis of previously qualitative imaging characteristics, facilitating the identification of novel disease-specific biomarkers, patient risk stratification, prognostication, and adverse event prediction. In addition, AI can assist in response assessment by capturing changes in imaging “phenotype” over time, allowing for optimized treatment plans based on real-time analysis. Integrating this emerging technology into drug discovery pipelines has the potential to accelerate the identification and development of new pharmaceuticals by assisting in target identification and patient selection, as well as reducing the incidence, and therefore cost, of failed trials through high-throughput, reproducible, and data-driven insights. Continued progress in AI applications will shape the future of medical imaging, ultimately fostering more efficient, accurate, and tailored drug discovery processes. Herein, we offer a comprehensive overview of how AI enhances medical imaging to inform drug development and therapeutic strategies
Dual Immunomodulator Therapy With Adalimumab and Upadacitinib to Treat Recalcitrant Hidradenitis Suppurativa
No full textTolerability and Effectiveness of Low-Dose Oral Minoxidil for Alopecia in Patients With Breast Cancer: A Retrospective Cohort Study
No full textImpact of the COVID-19 Pandemic on the HIV Care Continuum and Associated Factors in Middle-Income Countries: A Mixed-Methods Systematic Review
No full textIntroduction: The HIV care continuum during the COVID-19 era faced specific challenges. The pandemic, affecting the delivery of HIV care, exacerbated existing healthcare inequities and vulnerabilities in middle-income countries with limited financial resources. This study aims to set the stage for the systematic review, focusing on the impact of COVID-19 on HIV care in middle-income countries with a focus on barriers and facilitators. Methods: A systematic search of relevant literature, including electronic databases and manual assessment of references, was done. The review included quantitative, qualitative and mixed-methods studies conducted in middle-income countries, with no age or gender restrictions. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for reporting the results. Results: In the course of our systematic review, a comprehensive examination of the pertinent literature published between 2020 and 2024 yielded a total of 76 studies. This adverse impact was prominently attributed to an amalgamation of factors intrinsically associated with pandemic-induced restrictions, fear of contracting the COVID-19 and fear of disclosing HIV status. Moreover, an emergent theme observed in select studies underscored the enduring trend of HIV treatment continuity, which was facilitated by the burgeoning utilization of telemedicine within this context. Discussion: The pandemic negatively affected income and increased vulnerability to HIV across all phases of the HIV care continuum, except for viral suppression. Prevention measures, such as pre-exposure prophylaxis (PrEP), were compromised, leading to increased risky behaviours and compromised mental health among people living with HIV. HIV testing and diagnosis faced challenges, with reduced access and frequency, particularly among key populations. The pandemic also disrupted linkage and retention in care, especially in urban areas, exacerbating barriers to accessing necessary HIV treatment. Additionally, this review highlights the complex and multifaceted landscape of the pandemic\u27s impact on HIV medical appointments, adherence and treatment engagement, with various barriers identified, including fear of COVID-19, economic constraints and disruptions in healthcare services. Conclusions: The coexistence of pandemics has had negative effects on the HIV care continuum, with restrictions on services, an increase in care gaps and a break in the transmission chain in middle-income countries
Lower Extremity Osseointegration Postoperative Rehabilitation Protocols: A Scoping Review
No full textObjective. Lower-extremity transcutaneous osseointegration is a rehabilitation alternative to socket-suspended prostheses. The rehabilitation process, philosophies, and routines remain under-described. This review, primarily, identifies commonalities and differences among protocols. Secondarily, strategies are proposed to streamline future research of post-osseointegration surgery rehabilitation. Methods. Two differently-phrased queries of Google Scholar, Pubmed, Embase, and Web of Science were performed. First using either “osseointegration” or “osseointegrated” or “bone anchored prosthesis” AND [last name]. Second, replacing author name with “physical therapy” or “rehabilitation”. Six hundred eighty-eight articles were identified describing lower-extremity rehabilitation following osseointegration. Following software-based deduplication, manual abstract and full-text review, article reference evaluation, and use of Google Scholar’s “Cited by” feature, 35 studies were fully analyzed. First, a consolidated summary was made of protocols focusing on stages, timing, and other descriptions of postoperative rehabilitation. Subsequently, strengths and limitations of protocols were considered to propose potential strategies to investigate and optimize postoperative rehabilitation. Results. All articles describe rehabilitation having this same order of goal progression: from surgery to gradual weight bearing and final goal of independent ambulation. The most impactful difference influencing the stated final goal of independent ambulation was whether one or two surgical stages were performed. No articles reported patient success rate achieving proposed goals and timing, or challenges during rehabilitation. Therefore, the first research suggestion is to investigate actual success rates achieving proposed goals and timing. Second, to further explore rehabilitation of performance deficits, beyond unaided ambulation. Finally, to incorporate technology such as mobility trackers to more objectively understand prosthesis use and mobility. Conclusion. All lower-extremity osseointegration rehabilitation literature recommends identical goal progression order. No studies evaluate patient challenges or variation. Understanding and addressing such challenges may enhance postoperative rehabilitation. Impact. This article consolidates published rehabilitation protocols post-osseointegration surgery. Specific analysis and experimentation of the protocols may enhance the uniformity and potential of patient rehabilitation
The Association Between Female Sex and Depression Following Traumatic Brain Injury: A Systematic Review and Meta-Analysis
No full textWhile women tend to experience more severe psychiatric and neurobehavioral symptoms following traumatic brain injury (TBI), the connection between sex and post-TBI depression remains poorly understood. To explore the potential association between sex and post-TBI depression, we conducted a systematic review and meta-analysis, including studies with participants who had no prior diagnosis of depression. Thirteen studies met the criteria for inclusion, collectively investigating a cohort of 449,471 individuals with TBI. The median age of the subjects was 49.9 years (≥7 years old). All participants were observed across a spectrum of TBI severities, encompassing mild, moderate, and severe cases. A pooled analysis of 449,471 subjects, revealed a statistically significant difference in the risk of developing post-TBI depression between male and female patients, with females at a significantly higher risk compared to males (RR = 1.4 [95 % CI, 1.29–1.52], P \u3c.0001; I2 = 90.8 %, P \u3c.0001). This significance also appeared in mild TBI/concussion cases (RR = 1.44 [95% CI, 1.36−1.52], P \u3c.0001; I2 = 0%, P =.9), and in depression after a longer period (≥ 24 months) following the TBI (RR = 1.6 [95% CI, 1.59−1.66], P \u3c.0001; I2 = 0%, P = 1). These findings identify TBI as a consistent risk factor for depression, regardless of its severity or type