An intensivist-led ECMO accreditation pathway and safety data over the first 4 years.

Objective: To describe the training and accreditation process behind an intensivist-led extracorporeal membrane oxygenation (ECMO) cannulation program, and identify the rate of complications associated with the ECMO cannulation procedure.

Design: A narrative review of the accreditation process, and a retrospective review of complications related to cannulation during the first four years of the intensivist program.

Setting: Royal Prince Alfred Hospital, a quaternary referral hospital in Sydney.

KSR1 regulates small-cell lung carcinoma tumor initiation and cisplatin resistance.

Small-cell lung cancer (SCLC) is designated a recalcitrant cancer due to its five-year relative survival rate of less than 7%. First line SCLC treatment has changed modestly in the last 40 years. The NeuroD1 subtype of SCLC (SCLC-N) commonly harbors MYC amplifications and other hallmarks of aggressive behavior.

SOS1 and KSR1 modulate MEK inhibitor responsiveness to target resistant cell populations based on PI3K and KRAS mutation status.

KRAS is the most commonly mutated oncogene. Targeted therapies have been developed against mediators of key downstream signaling pathways, predominantly components of the RAF/MEK/ERK kinase cascade. Unfortunately, single-agent efficacy of these agents is limited both by intrinsic and acquired resistance.

Prevalence of Transthyretin Amyloid Cardiomyopathy in Heart Failure With Preserved Ejection Fraction.

Importance: Heart failure (HF) with preserved ejection fraction (HFpEF) is common, is frequently associated with ventricular wall thickening, and has no effective therapy. Transthyretin amyloid cardiomyopathy (ATTR-CM) can cause the HFpEF clinical phenotype, has highly effective therapy, and is believed to be underrecognized.

Objective: To examine the prevalence of ATTR-CM without and with systematic screening in patients with HFpEF and ventricular wall thickening.

Characterization of Aerosol Generation During Various Intensities of Exercise.

Background: Characterization of aerosol generation during exercise can inform the development of safety recommendations in the face of COVID-19.

Research Question: Does exercise at various intensities produce aerosols in significant quantities?

Study Design And Methods: In this experimental study, subjects were eight healthy volunteers (six men, two women) who were 20 to 63 years old. The 20-minute test protocol of 5 minutes rest, four 3-minute stages of exercise at 25%, 50%, 75%, and 100% of age-predicted heart rate reserve, and 3 minutes active recovery was performed in a clean, controlled environment.

Mitigation of Aerosols Generated During Exercise Testing With a Portable High-Efficiency Particulate Air Filter With Fume Hood.

Background: The role of portable high-efficiency particulate air (HEPA) filters for supplemental aerosol mitigation during exercise testing is unknown and might be relevant during COVID-19 pandemic.

Research Question: What is the effect of portable HEPA filtering on aerosol concentration during exercise testing and its efficiency in reducing room clearance time in a clinical exercise testing laboratory?

Study Design And Methods: Subjects were six healthy volunteers aged 20 to 56 years. In the first experiment, exercise was performed in a small tent with controlled airflow with the use of a stationary cycle, portable HEPA filter with fume hood, and particle counter to document aerosol concentration.

Federal Employees' Compensation Act and Mandating the Use of X-ray for Chiropractic Management of Federal Employees: An Exploration of Concerns and a Call to Action.

Objective: The purpose of this article is to explore concerns regarding sections of the federal workers' compensation law that apply to the treatment and management of work-related injuries of federal employees by chiropractors, and to offer a call to action for change.

Discussion: A 1974 amendment to the Federal Employees' Compensation Act (FECA) stipulates that chiropractic services rendered to injured federal workers are reimbursable. However, the only reimbursable chiropractic treatment is "manual manipulation of the spine to correct a subluxation as demonstrated by X-ray to exist.

Impact of the Commercial Introduction of Transcatheter Mitral Valve Repair on Mitral Surgical Practice.

Background There has been uncertainty regarding the effect of transcatheter mitral valve repair (TMVr) with MitraClip on cardiac surgical practice. Our aim was to examine the impact of the commercial introduction of TMVr to a comprehensive mitral program. Methods and Results We evaluated 875 patients (aged 69±14 years; 58% men) who underwent transcatheter or mitral surgical procedures over a 6-year period at our institution.

Bioprosthetic Aortic Valve Leaflet Thickening in the Evolut Low Risk Sub-Study.

Background: Subclinical leaflet thrombosis has been reported after bioprosthetic aortic valve replacement, characterized using 4-dimensional computed tomographic imaging by hypoattenuated leaflet thickening (HALT) and reduced leaflet motion (RLM). The incidence and clinical implications of these findings remain unclear.

Objectives: The aim of this study was to determine the frequency, predictors, and hemodynamic and clinical correlates of HALT and RLM after aortic bioprosthetic replacement.

Post-synthetic anion exchange in iron(ii) 1,2,4-triazole based spin crossover materials via mechanochemistry.

A facile method for post-synthetic exchange of anions in an iron(ii) spin crossover material using mechanochemistry is described. Dry grinding of the [Fe(atrz)3]Cl2 complex (atrz = 4-amino-1,2,4-triazole) in the presence of an excess of sodium halide salt results in the complete exchange of anions and formation of [Fe(atrz)3]Br2 and [Fe(atrz)3]I2 in a solid-state metathesis reaction. The method represents a new strategy for tuning active switching properties such as the transition temperature in spin crossover systems.

Stress Testing in the Evaluation of Stable Chest Pain in a Community Population.

Objective: To evaluate the use of stress testing in a community population with de novo stable chest pain, a normal resting electrocardiogram (ECG), and the ability to exercise.

Patients And Methods: We identified eligible patients by searching the electronic medical record of all outpatients seen at Mayo Clinic Rochester from January 1, 2010, through December 31, 2013. We determined the frequency of initial exercise stress testing, computed tomography coronary angiography, and invasive coronary angiography, as well as the use of subsequent second procedures (including percutaneous coronary intervention [PCI] and coronary artery bypass grafting) within 90 days.

Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients.

Background: Transcatheter aortic-valve replacement (TAVR) is an alternative to surgery in patients with severe aortic stenosis who are at increased risk for death from surgery; less is known about TAVR in low-risk patients.

Methods: We performed a randomized noninferiority trial in which TAVR with a self-expanding supraannular bioprosthesis was compared with surgical aortic-valve replacement in patients who had severe aortic stenosis and were at low surgical risk. When 850 patients had reached 12-month follow-up, we analyzed data regarding the primary end point, a composite of death or disabling stroke at 24 months, using Bayesian methods.

Causes and Clinical Outcomes of Patients Who Are Ineligible for Transcatheter Mitral Valve Replacement.

Objectives: The aim of this study was to gain insight into the causes and outcomes of patients who do not qualify for transcatheter mitral valve replacement (TMVR).

Background: Despite the increasing availability of TMVR, patients with severe mitral regurgitation may not be eligible. Thus far, no investigation has examined ineligible patients and their clinical outcomes.

Splice-altering variant in COL11A1 as a cause of nonsyndromic hearing loss DFNA37.

Purpose: The aim of this study was to determine the genetic cause of autosomal dominant nonsyndromic hearing loss segregating in a multigenerational family.

Methods: Clinical examination, genome-wide linkage analysis, and exome sequencing were carried out on the family.

Results: Affected individuals presented with early-onset progressive mild hearing impairment with a fairly flat, gently downsloping or U-shaped audiogram configuration.

Anticoagulation and Antiplatelet Strategies After On-X Mechanical Aortic Valve Replacement.

Background: The burden oral anticoagulation is a limitation of mechanical valve prostheses.

Objectives: The aim of this study was to test whether patients could be safely managed with dual-antiplatelet therapy (DAPT) (aspirin 325 mg and clopidogrel 75 mg) or lower warfarin after On-X mechanical aortic valve replacement (mAVR).

Methods: PROACT (Prospective Randomized On-X Anticoagulation Trial) (n = 576) is a multicenter (41 sites) noninferiority trial.

Use of echocardiography in outpatients with chest pain and normal resting electrocardiograms referred to Mayo Clinic Rochester.

Objectives: To determine how often unnecessary resting echocardiograms that are "not recommended" by clinical practice guidelines are performed in patients with stable chest pain and normal resting electrocardiograms (ECGs).

Background: There are scant data to indicate how often Class III recommendations are ignored in clinical practice.

Patients And Methods: We searched electronically all medical records of referral outpatients seen at Mayo Clinic Rochester from January 1, 2010, through December 31, 2013, to identify patients with stable chest pain and known or suspected coronary artery disease who underwent resting echocardiography and had normal resting ECGs and no other indication for echocardiography.

Mechanochemical synthesis of cooperative spin crossover materials.

We describe the synthesis of switchable spin crossover materials via mechanochemistry for the first time. Three chemically diverse spin crossover materials have been produced using solvent-free grinding. Crucially, cooperative spin transition behavior and crystallinity is retained, presenting exciting opportunities for the discovery of new materials with switchable magnetic, optical and structural properties.