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Background: Health systems across Europe are facing a workforce crisis, with some experiencing severe shortages of doctors. In response, many are exploring greater task-sharing, across established professions, such as doctors, nurses, and pharmacists, with patients and carers, and with new occupational groups, in particular ones that can assist doctors and relieve their workload.

Case Presentation: In the early 2000s the United Kingdom created a new occupational role, that of physician assistant.

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Transcatheter Aspiration of Tricuspid Vegetation.

JACC Case Rep

December 2024

Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.

Objective: This study sought to present the endovascular approach of transcatheter aspiration using the FlowTriever (Inari Medical) aspiration system for high surgical risk patients with right-sided infective endocarditis.

Key Steps: General anesthesia and transesophageal echocardiogram guidance; ultrasonography-guided femoral vein access, preclosure sutures, and insertion of a 24-F sheath; insertion of straight 24-F aspiration cannula over a stiff wire, parked in the superior vena cava; introduction of a 20-F curved cannula inside the 24-F cannula to create a telescopic assembly; accurate positioning using the right ventricle inflow/outflow projection in biplane mode; adjustment of the curved cannula radius by sliding the inner cannula in and out inside the mother cannula; manual aspiration of the vegetation; Postaspiration transesophageal echocardiogram assessment.

Potential Pitfalls: Avoid leaflet and annular injury and account for potential embolization.

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The histologic differential diagnosis between intracranial hemangioblastoma (HB) and metastatic clear cell renal cell carcinoma may be challenging, especially considering that both tumors exhibit clear cell morphology and can be associated with vHL mutation and/or Von Hippel-Lindau syndrome. As the execution of immunohistochemical analyses is often mandatory, the expression of PAX8 has been traditionally considered a reliable marker of metastatic clear cell renal cell carcinoma, being consistently negative in intracranial HB. However, as in recent years, some cases of PAX8-positive HBs have been reported in the literature; we studied the expression of this antibody on a series of 23 intracranial HB, showing that about 40% of these tumors may express PAX8 and that this immunoreactivity is often focal and weak.

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A practical guide for nephrologist peer reviewers: understanding and appraising Mendelian randomization studies.

Ren Fail

December 2025

Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.

Identifying risk factors for disease onset and progression has been a core focus in nephrology research. Mendelian Randomization (MR) has emerged as a powerful genetic epidemiological approach, utilizing genome-wide association studies (GWAS) to establish causal relationships between modifiable risk factors and kidney disease outcomes. MR uses genetic variants as instrumental variables to infer causal relationships between exposures and disease outcomes.

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