Adapting the design of the ongoing RAMPART trial in response to external evidence: An example for trials which take many years to run and report.

Clinical trials to establish the efficacy of new agents in the adjuvant cancer setting typically take many years to complete. During that time, external factors can impact recruitment and reporting plans. An example is a new standard of care becoming available during the recruitment period.

Ischemic Heart Disease in the Cancer Population: Trends, Outcomes, Epidemiology, and Challenges in Diagnosis and Treatment.

Patients with cancer are at increased risk of ischemic heart disease (IHD). The increased risk of IHD in these patients is due to the interaction of shared risk factors, cancer type and stage, and immuno/chemotherapy and radiotherapy regimens. Management of IHD in cancer patients is challenging, due to atypical presentation, increased thrombotic and bleeding risk, and worse outcomes compared to patients without cancer.

Efficacy and Safety of Combination AKT and Androgen Receptor Signaling Inhibition in Metastatic Castration-Resistant Prostate Cancer: Systematic Review and Meta-Analysis.

Background: Metastatic castration-resistant prostate cancer (mCRPC) has a poor prognosis with current treatment options including chemotherapy and androgen receptor signaling inhibitor (ARSI) medications. Poly-ADP ribose polymerase (PARP) inhibitors alone and in combination with ARSI has recently been incorporated in management for mCRPC deficient in BRCA1/2 genes. However, downregulating androgen-receptor signaling using ARSIs can upregulate the PI3K/AKT/mTOR pathway, promoting tumor cell survival.

Generation of TWO iPSC lines (CRICKi009-A; CRICKi010-A) from patients with type 1 von Hippel-Lindau (VHL) and histopathologically confirmed renal cell carcinoma (RCC).

VHL disease is an inherited and autosomal dominant disorder affecting 1 in 36,0000 individuals worldwide. It is caused by von Hippel-Lindau (VHL) gene mutations and can affect both genders and all ethnic backgrounds (Nordstrom-O'Brien et al., 2009; Maher, 2004).

Perioperative pain management for cardiac surgery.

Purpose Of Review: Acute postsurgical pain after cardiac surgery is challenging to treat. Adverse effects related to the high dose opioids which have traditionally been used perioperatively in cardiac surgery have led to the adoption of alternative analgesic strategies. This review aims to highlight current evidence-based approaches to managing pain after cardiac surgery.

Perioperative risk scores: prediction, pitfalls, and progress.

Purpose Of Review: Perioperative risk scores aim to risk-stratify patients to guide their evaluation and management. Several scores are established in clinical practice, but often do not generalize well to new data and require ongoing updates to improve their reliability. Recent advances in machine learning have the potential to handle multidimensional data and associated interactions, however their clinical utility has yet to be consistently demonstrated.

Ethnicity and Socioeconomic Disparities in Clinical Trial Participation for Ovarian Cancer: A Retrospective Observational Study in London.

Background: Ethnic and socioeconomic disparities in cancer outcomes are exacerbated by clinical trial underrepresentation. This study aims to identify inequalities in ethnicity and socioeconomic features among ovarian cancer clinical trial participants in two London cancer centres.

Methods: All ovarian cancer patients treated between 2017 and 2022 were included.

Metformin associates with higher myocardial perfusion reserve and survival in type 2 diabetes mellitus patients.

Metformin is an antihyperglycemic used to treat type 2 diabetes mellitus (T2DM). Patients with T2DM are at increased risk of cardiovascular disease. We explored the association between metformin use and cardiovascular magnetic resonance (CMR) derived stress myocardial blood flow (MBF), myocardial perfusion reserve (MPR) and major adverse cardiovascular events (MACE; all cause death, MI, stroke, heart failure hospitalisation and coronary revascularisation) in patients with T2DM.

Vector field heterogeneity as a novel omnipolar mapping metric for functional substrate characterization in scar-related ventricular tachycardias.

Background: Vector field heterogeneity (VFH) is a novel omnipolar metric to quantify local propagation heterogeneities that may identify functionally critical sites for ablation in scar-related ventricular tachycardia (VT).

Objective: This study aims to assess the diagnostic value of VFH to identify abnormal propagation patterns during ventricular substrate mapping and compare VFH in VT isthmus sites (IS), low-voltage bystander area (LVA) , and normal voltage areas (NVAa).

Methods: Substrate maps acquired with a 16-pole grid catheter in patients with scar-related VT were segmented into sites corresponding to IS, LVA, and NVA (defined as omnipolar voltages > and <1.

Cancer incidence and mortality among patients with new-onset atrial fibrillation: A population-based matched cohort study.

Background: Understanding the risk of cancer after the diagnosis of another condition can present opportunities for earlier diagnosis. We examined the risk of cancer diagnosis conditional on prior diagnosis of atrial fibrillation (AF).

Methods: Linked electronic health records were used to identify patients aged ≥18 with new-onset AF and age-sex-matched controls.

Contemporary epidemiology of hospitalised heart failure with reduced versus preserved ejection fraction in England: a retrospective, cohort study of whole-population electronic health records.

Background: Heart failure is common, complex, and often associated with coexisting chronic medical conditions and a high mortality. We aimed to assess the epidemiology of people admitted to hospital with heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF), including the period covering the COVID-19 pandemic, which was previously not well characterised.

Methods: In this retrospective, cohort study, we used whole-population electronic health records with 57 million individuals in England to identify patients hospitalised with heart failure as the primary diagnosis in any consultant episode of an in-patient admission to a National Health Service (NHS) hospital.

Arrhythmic risk stratification in patients with left ventricular ring-like scar.

Aims: Left ventricular (LV) ring-like scar on cardiac magnetic resonance (CMR) has been linked to malignant arrhythmias in patients with non-ischemic cardiomyopathy. This study aimed to perform a comprehensive evaluation of this phenotype and to identify risk factors for life-threatening arrhythmic events (LAEs), a composite of sudden cardiac death (SCD), aborted SCD, and sustained ventricular tachycardia.

Methods And Results: One-hundred-fifteen patients (median age 39 [IQR 28-52], 42% females) were identified at 6 referral centres.

Aortic arch replacement in patients with previous repair of acute aortic dissection: a systematic review and meta-analysis.

Objectives: Despite the popularity of the frozen elephant technique procedure in recent years, evidence is scarce regarding its utilization for aortic arch replacement following previous acute aortic dissection repair. In this systematic review and meta-analysis, we aimed to analyse clinical outcomes of aortic arch replacement in patients with previous repair of acute aortic dissection.

Methods: A systematic literature search on PubMed, MEDLINE via Ovid, Embase, Scopus, and Web of Science until March 2024 was performed for studies on open aortic arch replacement with or without frozen elephant technique procedure in adult patients after previous acute aortic dissection repair.

Cerebrospinal fluid drain placement and comprehensive strategies for spinal cord protection in open thoracoabdominal aortic aneurysm repair.

Ischaemic spinal cord injury remains a significant challenge in thoracoabdominal aortic repairs. Modern techniques have reduced spinal cord injury rates yet managing patients during and after thoracoabdominal aortic repairs remains complex. This article outlines our comprehensive approach to the prevention of spinal cord injuries in open thoracoabdominal aortic repair operations, focusing on the placement of cerebrospinal fluid drain and intraoperative strategies to enhance spinal cord protection.