Estimating the Risk of Cardiovascular Events in U.S. Veterans Using the SMART Risk Score.

Background: Estimation of long-term risk for cardiovascular events using the SMART (Secondary Manifestations of Arterial Disease) risk score can be potentially valuable in devising risk mitigation strategies.

Objectives: The objective of this study was to apply the SMART risk score to compute the risk for major adverse cardiovascular events (MACE) in the U.S.

The Pelvic Floor Disorders Network: Evolution Over Two Decades of Female Pelvic Floor Research.

Importance: This review aimed to describe research initiatives, evolution, and processes of the Eunice Kennedy Shriver National Institute of Child Health and Human Development-supported Pelvic Floor Disorders Network (PFDN). This may be of interest and inform researchers wishing to conduct multisite coordinated research initiatives as well as to provide perspective to all urogynecologists regarding how the PFDN has evolved and functions.

Study Design: Principal investigators of several PFDN clinical sites and Data Coordinating Center describe more than 20 years of development and maturation of the PFDN.

Pneumatosis Intestinalis and Concurrent Focal Diaphragmatic Pneumatosis Cystoides Presenting With Pneumoperitoneum in a 20 Year-Old Male: A Case Report.

Pneumatosis cystoides intestinalis can present with concurrent diaphragmatic cysts, a previously undocumented phenomenon. Surgical management may be required, but further investigation is needed to understand the pathogenesis and optimize management in atypical and chronic cases, such as this case with a history of corrected intestinal malrotation.

Modified Approach to Segmental Maxillary Surgery: Midline Osteotomy and Parasagittal Soft Tissue Incisions.

Traditional surgical techniques for segmental maxillary surgery include a combination of interdental osteotomies with paramidline bony cuts while keeping the palatal soft tissue intact. Besides surgical complexity, segmental maxillary procedures have been associated with higher incidence of relapse and complications. We present our experience with specific hard- and soft-tissue modifications (midline bony osteotomy and reflection of palatal soft tissue with carefully designed incisions) which will allow surgeons to perform larger expansions with a low incidence of complications and decreased relapse.

PSCA-targeted BPX-601 CAR T cells with pharmacological activation by rimiducid in metastatic pancreatic and prostate cancer: a phase 1 dose escalation trial.

Here we report results of a phase 1 multi-institutional, open-label, dose-escalation trial (NCT02744287) of BPX-601, an investigational autologous PSCA-directed GoCAR-T® cell product containing an inducible MyD88/CD40 ON-switch responsive to the activating dimerizer rimiducid, in patients with metastatic pancreatic (mPDAC) or castration-resistant prostate cancer (mCRPC). Primary objectives were to evaluate safety and tolerability and determine the recommended phase 2 dose/schedule (RP2D). Secondary objectives included the assessment of efficacy and characterization of the pharmacokinetics of rimiducid.

Factors Associated with Pediatric Drowning-Associated Lung Injury.

Objective: To identify risk factors for clinically-important drowning-associated lung injury (ciDALI) in children.

Study Design: This was a cross-sectional study of children (0 through18 years) who presented to 32 pediatric emergency departments (EDs) from 2010 through 2017. We reviewed demographics, comorbidities, prehospital data, chest radiographs reports, and ED course from emergency medical services, medical, and fatality records.

Evaluation of methotrexate Pharmacogenomic variation to predict acute neurotoxicity in children with acute lymphoblastic leukemia.

Background: Methotrexate is an important component of curative therapy in childhood acute lymphoblastic leukemia (ALL), but the role of genetic variation influencing methotrexate clearance and transport in toxicity susceptibility in children with ALL is not well established. Therefore, we evaluated the association between suspected methotrexate pharmacogenomic variants and methotrexate-related neurotoxicity.

Methods: This study included children (aged 2-20 years) diagnosed with ALL (2005-2019) at six treatment centers in the southwest United States.

Tramadol as a fentanyl adulterant: Prevalence and management in a ToxIC Fentalog study prospective cohort.

Background: Tramadol is an adulterant of illicit opioids. As it is a serotonin-norepinephrine reuptake inhibitor as well as a μ-opioid agonist, tramadol adulteration may worsen overdose signs and symptoms or affect the amount of naloxone patients receive.

Methods: This is a multicenter, prospective cohort of adult patients with suspected opioid overdoses who presented to one of eight United States emergency departments and were included in the Toxicology Investigators Consortium's Fentalog Study.

Empagliflozin in acute myocardial infarction in patients with and without type 2 diabetes: A pre-specified analysis of the EMPACT-MI trial.

Aims: In the EMPACT-MI trial, empagliflozin reduced heart failure (HF) hospitalizations but not mortality in acute myocardial infarction (MI). Contemporary reports of clinical event rates with and without type 2 diabetes mellitus (T2DM) in acute MI trials are sparse. The treatment effect of empagliflozin in those with and without T2DM in acute MI is unknown.

In Obesity, Esophagogastric Junction Fat Impairs Esophageal Barrier Function and Dilates Intercellular Spaces via HIF-2α.

Background & Aims: Dilated intercellular space (DIS) in esophageal epithelium, a sign of impaired barrier function, is a characteristic finding of GERD that also is found in obese patients without GERD. We have explored molecular mechanisms whereby adipose tissue products might impair esophageal barrier integrity.

Methods: We established cultures of visceral fat obtained during foregut surgery from obese and non-obese patients.

Challenges to innovation arising from current companion diagnostics regulations and suggestions for improvements.

A companion diagnostic is a diagnostic test that provides information essential for the safe and effective use of a corresponding therapeutic product. To obtain marketing approval, the companion diagnostic must demonstrate acceptable analytical and clinical performance. Companion diagnostic regulations are intended to protect patients by ensuring quality and consistency of treatment-guiding biomarker testing in clinical trials and clinical practice.

Over 100 Fontan Patients on Systemic Ventricular Assist Device Support: An ACTION Update.

As the Fontan population grows, understanding successful strategies for ventricular assist device (VAD) support of the failing Fontan circulation is needed. We performed a retrospective analysis of patients with Fontan circulation and systemic VAD support in the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) registry. Competing outcomes and Kaplan-Meier estimated survival methods were used.

Integrated Analysis of Vonoprazan Safety for Symptomatic Gastro-Oesophageal Reflux Disease or Erosive Oesophagitis.

Background: Patients with erosive oesophagitis, and those with persistent symptomatic non-erosive gastro-oesophageal reflux disease, require long-term maintenance treatment with acid-suppressing agents.

Aim: To evaluate the safety of vonoprazan, a potassium-competitive acid blocker, in an integrated analysis of data from clinical trials in adults.

Methods: We included 14 clinical trials of vonoprazan conducted in multiple countries.

Clinical Characteristics and Outcomes of Patients With Heart Failure With Preserved Ejection Fraction and With Reduced Ejection Fraction According to the Prognostic Nutritional Index: Findings From PARADIGM-HF and PARAGON-HF.

Background: The importance of nutritional status is underappreciated in patients with heart failure (HF). This study aimed to describe the range of the prognostic nutrition index (PNI), and the clinical characteristics and outcomes according to PNI, in patients with HF with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF). The primary outcome was the composite of HF hospitalization or cardiovascular death.

Ensuring safety and optimization in total joint arthroplasty of cancer patients: A comprehensive analysis of complication risks and modifiable risk factors.

Aims & Objectives: The primary objective of this study is to determine whether an active cancer diagnosis results in an increased risk of perioperative TJA complications and postoperative mortality. The secondary objective is to analyze the effects of demographic factors on perioperative complication rates in cancer patients undergoing TJA.

Materials & Methods: Patients with active cancer diagnoses undergoing total joint arthroplasty from 2014 to 2020 were included in this retrospective analysis.

The use of exoskeleton robotic training on lower extremity function in spinal cord injuries: A systematic review.

Objective: To perform a systematic review of the utility of exoskeleton robotic therapy on lower extremity recovery in Spinal Cord Injury (SCI) patients.

Methods: We used the Embase, Cochrane, and PubMed databases and searched from to December 2023 for studies on exoskeleton robotic assist devices used in working with SCI patients. Only articles published in English were evaluated, and the retrieved articles were screened via our inclusion/exclusion criteria.

HIPPO artificial intelligence: Correlating automated radiographic femoroacetabular measurements with patient-reported outcomes in developmental hip dysplasia.

Background: Hip dysplasia (HD) is characterized by insufficient acetabular coverage of the femoral head, leading to a predisposition for osteoarthritis. While radiographic measurements such as the lateral center edge angle (LCEA) and Tönnis angle are essential in evaluating HD severity, patient-reported outcome measures (PROMs) offer insights into the subjective health impact on patients.

Aim: To investigate the correlations between machine-learning automated and manual radiographic measurements of HD and PROMs with the hypothesis that artificial intelligence (AI)-generated HD measurements indicating less severe dysplasia correlate with better PROMs.

Respiratory failure in a patient with exhaled nitric oxide >300 ppb and subsequent response to dupilumab.

Multiple biologic agents are approved for the treatment of severe persistent asthma not controlled by inhaled corticosteroid/beta-agonist therapy. Appropriate phenotyping can aid in picking the right biologic for the right patient. Here is a unique case of a patient with severe asthma and respiratory arrest, with fraction of exhaled nitric oxide >300 ppb whose asthma became completely controlled with dupilumab.

Esophageal perforation following anterior cervical discectomy and fusion.

Anterior cervical discectomy and fusion (ACDF) is one of the most common spinal surgeries performed in the US but is associated with various morbidities. Esophageal perforation is one of the rarest complications of ACDF, but it is potentially fatal, therefore requiring timely detection and treatment. We present three cases of esophageal perforation after ACDF.

Managing medical and surgical error: an emotional survival guide.

Medical errors are common and often lead to feelings of self-doubt, helplessness, and guilt. Society thinks of physicians as healers, and physicians who see their role as offering a cure will always feel as if they haven't done enough. This article discusses five steps in the management of medical and surgical error: (1) care for the patient and family, (2) report to appropriate sources, (3) review the incident, (4) manage legal issues, and (5) engage in self-care.

Intragastric balloon adverse events: a comprehensive MAUDE database review.

Background: Endoscopic bariatric interventions are viable alternatives to traditional weight loss surgeries for patients with a body mass index between 30 and 40 kg/m. While studies have explored the impact of intragastric balloons on obesity and weight reduction, comprehensive data on real-world device-related complications and failures are limited. This study aimed to investigate mechanical failures leading to patient adverse events reported to the US Food and Drug Administration.