19043 research outputs found
Sort by
Lead Extraction–Indications, Procedure, and Future Directions
No full textCardiac implantable electronic device (CIED) implantation has steadily increased in the United States owing to increased life expectancy, better access to health care, and the adoption of updated guidelines. Transvenous lead extraction (TLE) is an invasive technique for the removal of CIED devices, and the most common indications include device infections, lead failures, and venous occlusion. Although in-hospital and procedure-related deaths for patients undergoing TLE are low, the long-term mortality remains high with 10-year survival reported close to 50% after TLE. This is likely demonstrative of the increased burden of comorbidities with aging. There are guidelines provided by various professional societies, including the Heart Rhythm Society, regarding indications for lead extraction and management of these patients. In this paper, we will review the indications for CIED extraction, procedural considerations, and management of these patients based upon the latest guidelines
Review of the Etiology, Diagnosis, and Management of Left Ventricular Thrombus
No full textThe incidence of left ventricular (LV) thrombus following acute myocardial infarction has declined significantly due to recent advancements in reperfusion and antithrombotic therapies. The development of LV thrombus depends on Virchow\u27s triad: endothelial injury following myocardial infarction, blood stasis from LV dysfunction, and hypercoagulability. Diagnostic modalities for LV thrombus include transthoracic echocardiography and late gadolinium enhancement cardiac magnetic resonance imaging. Anticoagulation with direct oral anticoagulants or vitamin K antagonists for 3 months following initial diagnosis of LV thrombus remains the treatment of choice for LV thrombus. However, further evidence is needed to demonstrate the noninferiority of direct oral anticoagulants compared with vitamin K antagonists for the prevention of thromboembolic events
Aortopathy: Effects of Lipid-Lowering Therapy
No full textAortopathies can be congenital or acquired. Aortic atherosclerosis, abdominal aortic aneurysm, and degenerative aortic stenosis are some of the major manifestations of acquired aortopathy. Dyslipidemia, an imbalance of plasma lipid levels, is strongly associated with common aortopathies. A relationship between abdominal aortic aneurysm, degenerative aortic stenosis, and dyslipidemia has been identified in the literature but finding effective preventive strategies has been challenging. Nevertheless, lipid-lowering therapy remains a mainstay of both treatment and prevention. In patients with aortic atheroma, statins were found to be protective through the review of this study. There is currently no place for statins in the treatment or prevention of disease progression in patients with calcific aortic stenosis. Their low cost, widespread availability, and strong safety profile tip the risk-to-benefit ratio toward statins for abdominal aortic aneurysms but more research is needed. A review of proprotein convertase subtilisin/kexin type 9 inhibitors may yield similar benefits for all aortopathy patients; however, those results are not yet available
The Role of Intravenous Selexipag in Managing PAH and Bridging Gaps in Oral Treatment: A Narrative Review
No full textPulmonary arterial hypertension (PAH) is a rare and potentially fatal condition characterized by progressive increases in blood pressure in the arteries of the lungs. Oral selexipag, approved by the Food and Drug Administration (FDA) in 2015 for the treatment of PAH, targets prostacyclin receptors on pulmonary arterial vascular smooth muscle and endothelial cells to improve blood flow through the lungs and reduce pulmonary vascular resistance. Oral selexipag is effective, but may be discontinued due to factors like side effects, emergency conditions, or inability to take oral medication, potentially leading to severe adverse events, such as rebound pulmonary hypertension and right heart failure. To address treatment interruptions, intravenous (IV) selexipag was introduced as an alternative for patients who are temporarily unable to take oral medications. IV selexipag bypasses hepatic metabolism, requiring a 12.5% higher dose compared to the oral form to achieve similar therapeutic effects. It is administered via IV infusion twice daily over 80 minutes, typically for short-term use. However, caution is needed when prescribing selexipag to patients with hepatic or renal issues, and it is contraindicated with strong CYP2C8 inhibitors. A Phase III clinical trial confirmed that switching between oral and IV selexipag was safe, with comparable efficacy and tolerability, though it was limited by small sample size and short duration. Given the risks of treatment interruption and the complexity of managing PAH, this review provides essential insights into the practical use of IV selexipag as a bridging therapy. Furthermore, it calls for larger clinical trials to refine dosing strategies, explore long-term outcomes, and identify patient populations most likely to benefit from IV selexipag
Treatment of Acute Heart Failure With Acetazolamide
No full textThe primary treatment for acute heart failure includes the use of intravenous loop diuretics to reduce congestion. Successful decongestion at the time of hospital discharge improves mortality and prevents rehospitalization in these patients. Loop diuretic therapy alone may not be enough for adequate decongestion, especially as diuretic resistance becomes more common. Other therapies include the addition of thiazide diuretics, though increasing evidence might suggest a better alternative to add-on therapy. In this review, we will discuss the new evidence for the use of the diuretic acetazolamide in acute heart failure
Safety and Efficacy of Transarterial Therapies for Pancreatic Acinar Cell Carcinoma Metastases
No full textPurpose: To evaluate the safety and efficacy of transarterial therapy, including hepatic arterial embolization (HAE) and transarterial radioembolization (TARE), for patients with hepatic metastases secondary to pancreatic acinar cell carcinoma (PACC). Methods: This retrospective, single-center study included patients with PACC liver metastases treated with transarterial therapy between 11/2013 and 2/2023. Nine patients with PACC were treated in a total of 18 sessions [HAE (n = 14), and TARE (n = 4)]. Patient demographics, tumor characteristics, and radiographic response were recorded. Local tumor progression-free survival (LTPFS) and overall survival (OS) were assessed via Kaplan-Meier analysis. Adverse events were graded according to Common Terminology Criteria for Adverse Events (CTCAE) v5. Results: Median LTPFS was 6.77 months (95 % CI: 3.23–26.33 months) after first treatment. Median assisted LTPFS in the six patients with multiple treatment sessions was 22.33 months (95 % CI: 3.67–31.93 months). Median OS was not reached (95 % CI: 0.17-NR). One-year OS from first treatment was 66.67 % (95 % CI: 28.17–87.83 %). Adverse events within one month of treatment occurred in 5/18 (27.8 %) sessions. Three of the five (60 %) reported complications were grade 1 and included mild post-embolization syndrome. One grade 3 complication occurred; pulmonary embolism associated with hypoxia and treated with anticoagulation. There was one death, grade 5, five days after treatment in a patient with a history of pancreaticoduodenectomy who developed a hepatic abscess complicated by sepsis. Conclusion: This small retrospective study suggests that transarterial therapies for PACC provide acceptable local control and safety
Intersection of Foreign-Birth (FB) Status, Preferred Language & Ethnicity on Intention to Breastfeed (ITBF)
No full textIntroduction: Preferred language other than English is associated with preventable adverse health outcomes. While Foreign-Birth status is linked to higher odds of breastfeeding, limited research examines how Foreign-Birth status, language preference, and self-identified ethnicity intersect to influence intention to breastfeed (ITBF).
Problem Statement & Purpose: Breastfeeding disparities exist across Foreign-Birth status, race/ethnicity, and preferred language, with a limited understanding of how these factors are linked. The Theory of Planned Behavior proposes that intention predicts behavior and is influenced by attitudes, subjective norms, and perceived behavioral control (Ajzen, 1991). This study evaluates ITBF and the impact of Foreign-Birth status, accounting for language preference, race/ethnicity, clinical conditions, and social determinants of health (SDOH).
Methods:
This was a cross-sectional analysis (2016-2025) of birth certificates merged with self-reported survey data administered to all consenting mothers (≥18 years) of singleton live-born infants in the Hudson Valley, NY Region. The primary outcome was ITBF. The preferred language (English or Spanish) was defined as the language in which the survey was completed. Subgroup analyses included 1. Self-reported Hispanic mothers & 2. Self-reported Non-Hispanic mothers.
Bivariate & multivariate regression analyses were performed examining ITBF in relation to Foreign-Birth status for the entire population as well as the two subgroups. Models were adjusted for maternal demographics, language, clinical conditions, and social determinants of health.
Results:
Of 1390 mothers, 932(67%) Domestic-Born mothers, 832 (89%) preferred English and 1011 (0.11%) preferred Spanish. Of the 307 (33%) Hispanic Domestic-Born mothers, 229 (75%) intended to breastfeed, and of the 625 (67%) non-Hispanic Domestic-Born mothers, 406 (65%) intended to breastfeed. Of the 458 (33%) Foreign-Born, 356 (78%) preferred English, and102 (22%) preferred Spanish. Of the 294 (64%) Hispanic Foreign-Born mothers, 298 (81%) intended to breastfeed. Of the 164 (36%) non-Hispanic Foreign-Born mothers, 125 (77%) intended to breastfeed. Among all mothers, those who were Foreign-Born exhibited higher ITBF rates than Domestic-Born (85% vs 71% respectively, p\u3c 0.001). In both subgroup analyses, Foreign-Born mothers compared with Domestic-Born exhibited higher rates of ITBF, whether among Hispanic mothers (84% vs 76%, p\u3c 0.010) or among Non-Hispanic mothers (87% vs 69% respectively, p\u3c 0.001). Preferred language was not associated with ITBF among all mothers (76% English, 77% Spanish, p=0.580), mothers who only identified as Hispanic (80% English, 82% Spanish, p=0.637), and not with mothers who identified as Non-Hispanic (73% English, 70% Spanish, p=0.689). Logistic regression demonstrated Foreign-Born mothers had higher adjusted odds of ITBF compared to Domestic-Born mothers (OR 1.92, 95% CI 1.29-2.85), irrespective of preferred language. Similarly, among Non-Hispanic mothers, Foreign-Birth status was associated with higher adjusted odds of ITBF compared to Domestic-Born mothers (OR 2.48, 95% CI 1.35-4.55). However, among Hispanic mothers, nativity was not associated with ITBF.
Conclusions: This study is among the first to examine the relationship between Foreign-Birth status, race/ethnicity, preferred language, and ITBF while accounting for SDOH. We found Foreign-Birth status is associated with higher odds of ITBF among all mothers as well as among the Non-Hispanic subgroup. Yet, Foreign-Birth was not associated with ITBF among the Hispanic subgroups. These results suggest cultural influences, either by Foreign-Birth status/Non-U.S. country of origin or related ethnicity, may influence ITBF. These cultural influences may exert a more direct effect on ITBF than language or SDOH. We speculate nativity does not influence ITBF in our analysis among the Hispanic population because there may be commonalities and cultural norms related to breastfeeding across countries which denote Hispanic origin. In contrast, we surmise that among Non-Hispanic, Foreign-Born, cultural norms related to Breastfeeding may differ significantly compared to the United States, potentially explaining our findings. Culturally appropriate education and support, regardless of preferred language, may improve ITBF rates.
Keywords: Intent to Breastfeed, Breastfeeding, Foreign-Birth, Preferred language, Social Determinants of Health, Health Disparities, Maternal Health, Neonatal Nutritio
Risk of Postoperative Complications Following Total Knee or Hip Arthroplasty Associated with Patients Who Consume Alcohol: A Systematic Review Protocol
No full textInTouch Week of November 3, 2025
No full textNYMC Expands Recreational Facilities with New Multi-Sport Courts October 22 is Proclaimed New York Medical College Day BioInc@NYMC Welcomes Applied Biological Laboratories A Legacy of Giving: Endowed Scholarships at NYMC TCDM Students Present at the Academy of Laser Dentistry Annual Conference TCDM Walks for Wishes Alumni Spotlight: Odaelys Pollard, Ph.D. \u2715, Champions STEM and Empowers Future Scientistshttps://touroscholar.touro.edu/in_touch/1379/thumbnail.jp
Differentiation Driver Gene HOXD4 as a Potential Prognostic Marker and Therapeutic Target in Anaplastic Thyroid Cancer
No full textAnaplastic thyroid cancer (ATC) is a rare and highly aggressive subset of thyroid cancer, characterized by its refractory nature and poor prognosis. Conventional cancer treatment modalities, including chemotherapy and radiotherapy, have proven ineffective in managing ATC. At the same time, targeted therapies show limited promise due to the absence of identifiable targetable genetic alterations, culminating in a dismal five-year survival rate of approximately 4%.
The low mutational burden observed in ATC prompted exploration of differential gene expression patterns through analysis of publicly available transcriptomic datasets from the National Center for Biotechnology Information (NCBI) Gene Expression Omnibus (GSE33630, GSE85457). Bioinformatic analysis was conducted using GEO2R software, comparing ATC tissue samples to PTC tissues or normal thyroid tissues. Strikingly, the differentiation-associated gene Homeobox D4 (HOXD4) was significantly upregulated in ATC patient tissue samples compared to papillary thyroid cancer (PTC) and normal tissues. Immunohistochemistry analysis of ATC, PTC, and normal thyroid tissues obtained from the National Institute of Health: Cooperative Human Tissue Network confirmed that HOXD4 expression was significantly elevated in ATC patient tissues. Kaplan-Meier survival analysis indicated that ATC patients with high levels of HOXD4 expression exhibited significantly reduced survival rates. ATC is unique because it lacks differentiation, resulting in the loss of thyroid-like morphology and function. Thus, the marked upregulation of HOXD4, a gene typically associated with differentiation, warranted further in vitro exploration. HOXD4 RNA and protein expression were significantly upregulated in ATC cell line T238 and SW1736 compared to PTC cell line K1 and immortalized “normal” thyroid epithelial cell line Nthy-ori-3-1. Bioinformatic analysis of predicted HOXD4 binding partners revealed six binding partners that were concurrently upregulated in ATC, revealing the ATC-associated
HOXD4 protein interactome. This protein interactome is associated with the main hallmarks of ATC that contribute to its highly aggressive nature: loss of thyroid functional genes, loss of thyroid signaling (including Notch signaling), and loss of adherens junctions, characteristic of epithelial- to-mesenchymal transition.
To assess the functional role of HOXD4 in ATC, a CRISPRi knockdown was employed to transcriptionally repress HOXD4 expression in both T238 and SW1736 ATC cell lines, generating HOXD4 knockdown cell lines (T238-HOX and SW1736-HOX) as well as a control cell line treated with NS oligonucleotides. Functional assays revealed a significant reduction in cell proliferation, increased cellular senescence, and reduced self-renewal capacity in the HOXD4 knockdown lines. HOXD4 was found to mediate differentiation in ATC, as knockdown cells had increased thyroid functional gene expression and increased Notch signaling, both of which contribute to the refractory nature of this malignancy. Repression of HOXD4 resulted in reduced invasion, migration, and epithelial-to-mesenchymal transition in ATC cells in both two- dimensional and three-dimensional contexts. Considering that ATC is a highly metastatic and treatment-refractory disease, repression of HOXD4 presents as a potential therapeutic avenue.
To address the hypothesis of HOXD4 repression as a potential therapeutic target in ATC, an inducer of differentiation, all-trans retinoic acid (ATRA), was investigated to determine its potential to abrogate ATC’s aggressive phenotype. ATRA significantly reduced HOXD4 expression at the RNA and protein levels in ATC cell lines T238 and SW1736 while not affecting NThy-ori-3-1 HOXD4 levels. The modulation of HOXD4 using ATRA treatment was related to the classical retinoic acid pathway, leading to the subsequent induction of differentiation in ATC cells. Thus, the restoration of thyroid functional genes and Notch signaling suggests the potential for successful radioiodine therapy. ATC cells treated with ATRA displayed a significant reduction in proliferation, cellular senescence, and self-propagation capacity. Furthermore, ATRA-treated T238 and SW1736 cells exhibited a significant decrease in invasion and migration capacities in both two-dimensional and three-dimensional contexts as well as a reversal of epithelial-to- mesenchymal signatures. By contrast, NTHY-ori-3-1 cells demonstrated no significant alteration in proliferation, senescence, invasion, or migration following ATRA administration, indicating that ATRA treatment is specific to ATC cells.
These findings highlight the novel role of HOXD4 as a putative oncogenic driver in ATC, underscoring its potential as both a diagnostic and prognostic biomarker for the disease. Additionally, these data suggest that HOXD4 may serve as a viable therapeutic target in future treatments for ATC. Considering the efficacy of the differentiation-inducing agent all-trans retinoic acid in mitigating this deadly malignancy, it may prove useful as a standalone treatment or in combination with other therapeutic strategies to develop more effective clinical applications for ATC