Anatomy of Risk: Decoding the Predictors of Vascular Access Complications in Transcatheter Aortic Valve Replacement.

Background: Despite advancements in valve implantation devices, vascular access complications (VAC) remain a significant cause of morbidity and mortality for those undergoing transcatheter aortic valve replacement (TAVR). We describe pre-operative imaging analysis of the aortoiliac and femoral arterial beds using the TransAtlantic intersociety consensus (TASC) score, ilio-femoral tortuosity, and procedural characteristics to identify anatomic risk factors predictive of VAC in TAVR.

Methods: Consecutive patients undergoing TAVR from 2012 to 2022 at a single North Dakota hospital were retrospectively reviewed.

Transcatheter Aortic Valve Replacement in Patients With Geographic and Socioeconomic Vulnerabilities.

Background: Transcatheter aortic valve replacement (TAVR) is an established treatment for patients with severe aortic stenosis (AS). It remains unclear whether disparities exist in rural or socially vulnerable populations undergoing TAVR. This study assessed whether outcomes differ based on geographic location or vulnerability of patients undergoing TAVR.

WRAD core perturbation impairs DNA replication fidelity promoting immunoediting in pancreatic cancer.

It is unclear how cells counteract the potentially harmful effects of uncoordinated DNA replication in the context of oncogenic stress. Here, we identify the WRAD (WDR5/RBBP5/ASH2L/DPY30) core as a modulator of DNA replication in pancreatic ductal adenocarcinoma (PDAC) models. Molecular analyses demonstrated that the WRAD core interacts with the replisome complex, with disruption of DPY30 resulting in DNA re-replication, DNA damage, and chromosomal instability (CIN) without affecting cancer cell proliferation.

The Ws of Parental Help-Seeking: When, Where, and for What Do Parents Seek Help for Child Mental Health.

Parental help-seeking preferences may help explain the treatment gap in child mental health. This study examined mothers' and fathers' help-seeking behaviors for child mental health to further understand their individual preferences for treatment. A total of 394 mothers and fathers completed questionnaires assessing the types of help sought for mental health concerns for a target child (age 3-7 years), as well as measures representing illness profile, predisposing characteristics, and barriers/facilitators proposed to influence help-seeking.

Clonal dominance defines metastatic dissemination in pancreatic cancer.

Tumors represent ecosystems where subclones compete during tumor growth. While extensively investigated, a comprehensive picture of the interplay of clonal lineages during dissemination is still lacking. Using patient-derived pancreatic cancer cells, we created orthotopically implanted clonal replica tumors to trace clonal dynamics of unperturbed tumor expansion and dissemination.

Efficacy of Guardian Cap Soft-Shell Padding on Head Impact Kinematics in American Football: Pilot Findings.

Sport-related concussion prevention strategies in collision sports are a primary interest for sporting organizations and policy makers. After-market soft-shell padding purports to augment the protective capabilities of standard football helmets and to reduce head impact severity. We compared head impact kinematics [peak linear acceleration (PLA) and peak rotational acceleration (PRA)] in athletes wearing Guardian Cap soft-shell padding to teammates without soft-shell padding.

Underutilization of Transcatheter Aortic Valve Replacement in Northern Plains American Indians with Severe Aortic Stenosis.

Introduction: Transcatheter aortic valve replacement (TAVR) has overtaken surgical aortic valve replacement and revolutionized the treatment strategy for aortic valve replacement. Little is known on the disparities among minorities, especially American Indians (AI), undergoing this procedure. We explore TAVR outcomes to identify disparities at our institution.

Society for cardiovascular magnetic resonance recommendations for training and competency of CMR technologists.

The Society for Cardiovascular Magnetic Resonance (SCMR) recommendations for training and competency of cardiovascular magnetic resonance (CMR) technologists document will define the knowledge, experiences and skills required for a technologist to be competent in CMR imaging. By providing a framework for CMR training and competency the overarching goal is to promote the performance of high-quality CMR and to foster the increased adoption of CMR into clinical care.

An Equity Response to COVID-19 in Allegheny County, Pennsylvania: The Development and Work of the Black Equity Coalition.

From the onset of the pandemic in the United States, racial disparities in COVID-19 outcomes have been evident. In April 2020, several events prompted a concerned group of colleagues to form the Black Equity Coalition (BEC), a Black-led coalition in Allegheny County, Pennsylvania, which brings together professionals from multiple sectors who aim to ensure an equitable response to the COVID-19 pandemic. Several significant milestones have been achieved, and this article describes the development, functioning, and outcomes of the Coalition in the first 15 months of operation (April 2020-June 2021).

Latiglutenase Protects the Mucosa and Attenuates Symptom Severity in Patients With Celiac Disease Exposed to a Gluten Challenge.

Background & Aims: Gluten ingestion in patients with celiac disease can lead to gastrointestinal symptoms and small intestinal mucosal injury.

Methods: This gluten challenge phase 2 trial was double blind and placebo controlled, and it assessed the efficacy and safety of a 1200-mg dose of IMGX003 in patients with celiac disease exposed to 2 g of gluten per day for 6 weeks. The change in the ratio of villus height to crypt depth was the primary endpoint.

Day-to-day blood pressure variability predicts poor outcomes following percutaneous coronary intervention: A retrospective study.

Background: For patients with cardiovascular disease, blood pressure variability (BPV), distinct from hypertension, is an important determinant of adverse cardiac events. Whether pre-operative BPV adversely affects outcomes after percutaneous coronary intervention (PCI) is to this point unclear.

Aim: To investigate the relationship between blood pressure variability and outcomes for patients post-PCI.

Procedural and anthropometric factors associated with musculoskeletal injuries among gastroenterology endoscopists.

Background And Aims: Musculoskeletal (MSK) injuries among gastroenterologists are common. Our study describes risk factors and consequences of injury by comparing provider-specific anthropometric and objective procedural data to self-reported injury patterns.

Methods: A validated MSK symptom survey was sent to gastroenterologists to gauge prevalence, distribution, and severity of active injury.

The Future of Cardiac Magnetic Resonance Clinical Trials.

Over the past 2 decades, cardiac magnetic resonance (CMR) has become an essential component of cardiovascular clinical care and contributed to imaging-guided diagnosis and management of coronary artery disease, cardiomyopathy, congenital heart disease, cardio-oncology, valvular, and vascular disease, amongst others. The widespread availability, safety, and capability of CMR to provide corresponding anatomical, physiological, and functional data in 1 imaging session can improve the design and conduct of clinical trials through both a reduction of sample size and provision of important mechanistic data that may augment clinical trial findings. Moreover, prospective imaging-guided strategies using CMR can enhance safety, efficacy, and cost-effectiveness of cardiovascular pathways in clinical practice around the world.

Plasma IL-2 and Symptoms Response after Acute Gluten Exposure in Subjects With Celiac Disease or Nonceliac Gluten Sensitivity.

Introduction: Treated patients with celiac disease (CeD) and nonceliac gluten sensitivity (NCGS) report acute, transient, incompletely understood symptoms after suspected gluten exposure. To determine whether (i) blinded gluten exposure induces symptoms, (ii) subjects accurately identify gluten exposure, and (iii) serum interleukin-2 (IL-2) levels distinguish CeD from NCGS subjects after gluten exposure.

Methods: Sixty subjects (n = 20 treated, healed CeD; n = 20 treated NCGS; n = 20 controls) were block randomized to a single, double-blind sham (rice flour) or 3-g gluten challenge with 72-hours follow-up.

Effectiveness of Digital Interventions for Reducing Behavioral Risks of Cardiovascular Disease in Nonclinical Adult Populations: Systematic Review of Reviews.

Background: Digital health interventions are increasingly being used as a supplement or replacement for face-to-face services as a part of predictive prevention. They may be offered to those who are at high risk of cardiovascular disease and need to improve their diet, increase physical activity, stop smoking, or reduce alcohol consumption. Despite the popularity of these interventions, there is no overall summary and comparison of the effectiveness of different modes of delivery of a digital intervention to inform policy.

Early implementation of Fundamentals of Endoscopic Surgery training using a simulation-based mastery learning curriculum.

Background: After the American Board of Surgery announcement of the Flexible Endoscopy Curriculum requirement in 2014, we implemented a dedicated endoscopy rotation at the post graduate year (PGY)2 level including a simulation curriculum for Fundamentals of Endoscopic Surgery skills. Here we evaluate the outcomes of this implementation.

Methods: Beginning in 2015, we developed a clinical endoscopy and simulation-based rotation to prepare for Fundamentals of Endoscopic Surgery testing.

Pulmonary Artery-Tracheal Fistula After Coil Implantation for Behcet's Disease.

Behcet's disease (BD) is a rare autoimmune disorder that results in diffuse full-thickness vasculitis. Pulmonary artery aneurysms (PAAs) and hemoptysis are known complications of this disease process, with high morbidity and mortality for affected patients. Although medical, endovascular, and surgical treatment strategies have all been described in the literature, there are little data to describe the long-term outcomes of these various treatment modalities and there continues to be a lack of clearly defined algorithms for the management of these patients.

How do parole board members in England and Wales construct decisions about whether to release perpetrators of intimate partner violence from prison?

Background: Existing research explores Parole Board decision-making, but not specifically for perpetrators of intimate partner violence (IPV), a special case due to the gendered and secretive nature of IPV and the role of control in predicting reoffending.

Aim: To identify associations between case variables in England and Wales Parole Board decisions regarding perpetrators of IPV and explore how these variables help construct the decision.

Methods: Logistic regressions regarding decisions in a sample of all 137 male prisoners who had abused women and applied for release or progression to open conditions in England and Wales from April 2018 to September 2019, developed into latent class analyses.

Piloting the FIRE: A Novel Error Management Training Simulation Curriculum for Fasciotomy Instruction.

Background: Multiple studies have demonstrated poor performance of lower extremity fasciotomy (LEF), highlighted by missed and/or inadequately released compartments. Incorporating error management training (EMT) into surgical simulation has been promoted as a way to gain deeper understanding of procedural errors and overall performance. The purpose of this study was to evaluate LEF performance using a Fasciotomy Improvement through Recognition of Errors (FIRE) simulation training curriculum to train novice surgical trainees.

Fact or Fiction? Practice on a Simulator is Not Required to Pass the Fundamentals of Endoscopic Surgery (FES) Skills Exam.

Purpose: Initial work on the validity evidence used to support the Fundamentals of Endoscopic Surgery (FES) performance exam as a measure of technical competency showed a strong relationship to clinical experience. Despite this evidence, there is a perception among some program directors that the exam cannot be successfully passed without practice on a simulator. We assess the validity of this perception.

Comparison of Anticoagulants for Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting: A Pilot Study.

Background: Direct-acting oral anticoagulants are indicated for the treatment of nonvalvular atrial fibrillation, but their use in patients after undergoing cardiac surgery is poorly defined despite a high prevalence of postoperative atrial fibrillation in this population.

Methods: Patients diagnosed with postoperative atrial fibrillation were prospectively randomized to warfarin or apixaban. Safety, efficacy, and economic outcomes were evaluated until their 4- to 6-week postoperative appointment.

Incisional hernia incidence following laparotomy for combat trauma: Investigating 15 years of US war surgery.

Background: While the incidence of incisional hernia (IH) following elective laparotomy has been well described, incidence following emergent laparotomy for combat trauma has been much less studied. This retrospective cohort investigates the latter to better describe the burden IH represents for the injured warfighter.

Methods: Data were obtained from the Expeditionary Medical Encounter Database for service members who survived a combat-related injury between January 2002 and December 2016 and underwent abdominal surgery in the first 30 days after injury.