Epistaxis Versus Nonepistaxis Bleeding in Anticoagulated Patients With Atrial Fibrillation: Results From the ENGAGE AF-TIMI 48 Trial.

Background: Epistaxis is common with antithrombotic therapy and is often troublesome to patients, yet its frequency, severity, and outcomes are poorly characterized.

Methods And Results: Effective Anticoagulation with Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction 48 (ENGAGE AF-TIMI 48) randomized 21 105 patients with atrial fibrillation and CHADS2 risk score ≥2 to higher-dose edoxaban regimen (60 mg daily, dose-reduced to 30 mg), lower-dose edoxaban regimen (30 mg, dose reduced to 15 mg, daily), or warfarin. Bleeds were adjudicated using International Society on Thrombosis and Haemostasis criteria.

Enhancing quality of care for older adults: The age-friendly health system (4Ms framework) and the role of general medicine physicians as system-based complexologists.

The aging population presents critical challenges to global healthcare systems, with Japan expected to have 35% of its population aged 65 or older by 2040. Older adults often experience multimorbidity, cognitive impairments, and physical frailties, increasing healthcare utilization and costs. Traditional medical approaches that focus on organ-specific diagnoses are insufficient for addressing these multifaceted needs.

Effectiveness of the educational training program for Japanese chief residents: A one-year pilot study.

Background: Multi-institutional faculty development programs for chief residents were lacking in Japan. This study evaluated the effectiveness of the program for enhancing the knowledge and behaviors of chief residents at the national level.

Methods: Six participants completed self-assessment questionnaires at three points: before, immediately after, and 6 months post-program.

Precision Medicine for Pulmonary Vascular Disease: The Future Is Now (2023 Grover Conference Series).

Pulmonary vascular disease is not a single condition; rather it can accompany a variety of pathologies that impact the pulmonary vasculature. Applying precision medicine strategies to better phenotype, diagnose, monitor, and treat pulmonary vascular disease is increasingly possible with the growing accessibility of powerful clinical and research tools. Nevertheless, challenges exist in implementing these tools to optimal effect.

Relationship between physical activity and biomarkers of pathology and neuroinflammation in preclinical autosomal-dominant Alzheimer's disease.

Objective: Physical activity (PA) has been linked to reduced Alzheimer's disease (AD) risk. However, less is known about its effects in the AD preclinical stage. We aimed to investigate whether greater PA was associated with lower plasma biomarkers of AD pathology, neural injury, reactive astrocytes, and better cognition in individuals with autosomal-dominant AD due to the presenilin-1 E280A mutation who are virtually guaranteed to develop dementia.

Treatment of symptomatic bipartite patella in patients <21 years of age: A systematic review and treatment algorithm.

Purpose: The purpose of this study is to develop an evidence-based algorithm for the management of symptomatic bipartite patella in the pediatric and adolescent population based on a systemic review of the published literature.

Methods: A systematic review of the literature was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines on PubMed and Embase, selecting for studies discussing the management of symptomatic bipartite patella.

Results: Five studies met criteria, involving 315 knees (314 patients, average age 15.

Days at Home After Transcatheter Mitral Valve Repair Versus Medical Therapy Alone in Heart Failure.

Background: Transcatheter edge-to-edge repair of the mitral valve (mTEER) reduced a hierarchical end point that included death and heart failure hospitalization in COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation Trial). However, the magnitude to which mTEER increases the number of days a patient spends at home (DAH) in the first few years after treatment, a patient-centered end point not captured routinely in clinical trials, has not been evaluated. We compared 1- and 2-year DAH among patients with functional mitral regurgitation and heart failure randomized to mTEER plus medical therapy versus medical therapy alone (control) by linking the COAPT trial to comprehensive health care claims data.

Echocardiographic Changes Following Surgical Myectomy in Severely Symptomatic Obstructive Hypertrophic Cardiomyopathy: Insights From the SPIRIT-HCM Study.

Background: In obstructive hypertrophic cardiomyopathy, myectomy improves symptoms, quality of life, and left ventricular (LV) outflow tract gradients. We prospectively evaluated the temporal changes in various echo parameters after myectomy.

Methods And Results: In 173 adults with obstructive hypertrophic cardiomyopathy (53±10 years, 63% men) who underwent myectomy between March 2017 and June 2020, clinical and blinded echo assessment (before and at 12±6 months follow-up) was performed prospectively (SPIRIT-HCM [Quality of Life and Functional Capacity Following Septal Myectomy in Obstructive Patients With Hypertrophic Cardiomyopathy]).

Generalizability of consensus regarding standardized letters of evaluation competitiveness: A validity study in a national sample of emergency medicine faculty.

Background: Standardized letters of evaluation (SLOEs) are an important part of residency recruitment, particularly given the limited availability of other discerning factors in residency applications. While consensus regarding SLOE competitiveness has been studied within a small group of academic faculty, it remains unexplored how a more diverse group of letter readers interpret SLOEs in terms of competitiveness.

Methods: A sample of 50 real SLOEs in the new SLOE format (2022 eSLOE 2.

ChatG-PD? Comparing large language model artificial intelligence and faculty rankings of the competitiveness of standardized letters of evaluation.

Background: While faculty have previously been shown to have high levels of agreement about the competitiveness of emergency medicine (EM) standardized letters of evaluation (SLOEs), reviewing SLOEs remains a highly time-intensive process for faculty. Artificial intelligence large language models (LLMs) have shown promise for effectively analyzing large volumes of data across a variety of contexts, but their ability to interpret SLOEs is unknown.

Objective: The objective was to evaluate the ability of LLMs to rate EM SLOEs on competitiveness compared to faculty consensus and previously developed algorithms.

Prediction of low birth weight from fetal ultrasound and clinical characteristics: a comparative study between a low- and middle-income and a high-income country.

Introduction: Adverse perinatal outcomes (APO) pose a significant global challenge, particularly in low- and middle-income countries (LMICs). This study aims to analyse two cohorts of high-risk pregnant women for APO to comprehend risk factors and improve prediction accuracy.

Methods: We considered an LMIC and a high-income country (HIC) population to derive XGBoost classifiers to predict low birth weight (LBW) from a comprehensive set of maternal and fetal characteristics including socio-demographic, past and current pregnancy information, fetal biometry and fetoplacental Doppler measurements.

Research trends in pediatric splenic trauma in Brazil: how much has changed in the last two decades?

Purpose: Research in high-income countries has extensively documented the non-operative management of spleen injuries in children, resulting in low splenectomy rates (5%). However, there is a lack of literature on this topic in low- and-middle-income countries (LMICs), including Brazil. This scoping review analyzed pediatric spleen trauma research trends in Brazil and the United States of America (USA).

Brazilian authorship gender trends on academic surgery: a bigdata analysis.

Purpose: To evaluate the gender distribution of first and last authors with Brazilian surgical affiliations in PubMed-indexed surgical journals.

Methods: Data from eligible surgical journals were retrieved using Scimago Journal & Country Rank 2021 and manually reviewed. Manuscripts published from 2018 to 2022 were included if at least one author was affiliated with a Brazilian institution and a surgical specialty.

Adipose tissue around the knee; A pictorial review of normal anatomy and common pathologies.

The periarticular adipose tissues play a crucial role in knee biomechanics, yet they are often overlooked in daily radiology practice. As the primary mechanical shock absorbers of the knee, intra-articular fat pads reduce the friction between intra-articular structures during joint movement. They also contribute to inflammatory regulation, endocrine secretion, and pain detection.

Comparison of 3D facial photographs and clinical documentation in patients with craniofacial morphea.

Diagnosis of craniofacial morphea (CM) relies upon clinical examination of progressive craniofacial changes. We assess the utility of 3D stereophotogrammetry in documenting asymmetry of the face compared to clinical notetaking. This retrospective study of 3D images and clinical documentation included 32 patients (mean age 15.

Using a computational cognitive model to simulate the effects of personal and social network experiences on seasonal influenza vaccination decisions.

Introduction: Seasonal influenza poses significant societal costs, including illness, mortality, and reduced work productivity. Vaccination remains the most effective strategy for preventing the disease, yet vaccination rates in the United States fall below 50% for adults. Understanding the factors influencing vaccination decisions is crucial for designing interventions to improve uptake.

Identifying parentally perceived barriers for children with celiac disease to participate in elementary school meal programs.

Several states have recently enacted laws permanently granting all public school students access to free breakfast and lunch. However, children with dietary restrictions, such as celiac disease (CeD), may encounter barriers to participation in these meal programs. We surveyed caregivers of school-aged children with CeD to study barriers to universal school meals.

Endoscopic diagnosis of asymptomatic appendicitis in a pediatric patient.

Incidental diagnosis of asymptomatic appendicitis is exceptionally rare, even more so when identified endoscopically. This is among the first reported cases of appendicitis incidentally diagnosed during colonoscopy in a pediatric patient. Most notably, the identification of subclinical appendicitis allowed for early referral to pediatric surgery for management, which in turn may have prevented progression to acute symptomatic appendicitis.

Clonal Hematopoiesis in Chronic Thromboembolic Pulmonary Hypertension.

Background: The cause of chronic thromboembolic pulmonary hypertension (CTEPH) remains largely unknown. Recently, clonal hematopoiesis (CH) has been reported to be associated with cardiovascular and thromboembolic diseases. Here, we investigated the prevalence and clinical impact of CH in patients with CTEPH.

Exploring patient perspectives on shared decision making about bariatric surgery in two healthcare systems.

Objective: To assess patient perspectives on the level of shared decision making (SDM) experienced related to bariatric surgery.

Background: Severe obesity is common and has serious health implications. Yet, few eligible patients pursue bariatric surgery.

Staging Heart Failure with Preserved Ejection Fraction by Assessing Cardiac Chamber Involvement.

The management of heart failure with preserved ejection fraction (HFpEF) remains largely unresolved due to our limited understanding of the underlying mechanisms of the pathology and the challenges in accurately phenotyping this heterogeneous syndrome. A paradigm shift is required to personalise care and unify our approaches to HFpEF patients for future clinical trials. Accordingly, we propose a staging classification for HFpEF based on the identification of the involved cardiac chambers by echocardiography.

Sensory white noise in clinical ADHD: Who benefits from noise, and who performs worse?

Background: Experimental research has shown the benefits of auditory white noise on cognitive performance in children with attention problems. However, little is currently known about individual differences in noise response amongst children with a clinical diagnosis of attention deficit hyperactivity disorder (ADHD). In addition, no research has so far tested the effects of visual white noise on children with ADHD.

Microbubble Contrast Agents Improve Detection of Active Hemorrhage.

Assessment of trauma-induced hemorrhage with ultrasound is particularly challenging outside of the clinic, where its detection is crucial. The current clinical standard for hematoma detection - the focused assessment with sonography of trauma (FAST) exam - does not aim to detect ongoing blood loss, and thus is unable to detect injuries of increasing severity. To enhance detection of active bleeding, we propose the use of ultrasound contrast agents (UCAs), together with a novel flow phantom and contrast-sensitive processing techniques, to facilitate efficient, practical characterization of internal bleeding.