Tele-Critical Care, Severity of Illness, and 30-Day Mortality Risk: A Retrospective, Cohort Analysis.

Studies have shown that tele-critical care (TCC) improves outcomes in intensive care unit (ICU) settings with low baseline performance. Evidence also suggests that TCC outcomes may be modified by heterogenous baseline severity of illness. We examined the association of admission Acute Physiology and Chronic Health Evaluation IV (APACHE IV) score quartiles (APQ1-APQ4) and TCC exposure with 30-day mortality.

Teaching Ethics Consultation Using a Tabletop Exercise.

Drawing on pedagogical tools utilized in clinical scenario simulation and emergency preparedness training, the authors describe an innovative method for teaching clinical ethics consultation skills, which they call a "tabletop" exercise. Implemented at the end of a clinical ethics intensive course, the tabletop enables learners to implement the knowledge and practice the skills they gained during the course. The authors highlight the pedagogical tools on which the tabletop exercise draws, describe the tabletop exercise itself, offer how to best operationalize such an exercise, reflect on the method's strengths and weaknesses, and provide insights for others who may want to implement their own tabletop for ethics consultation education.

Post-esophagectomy patients presenting for general anesthesia induction: a survey of practice among US anesthesiologists (PESO-GAIN-S).

Purpose: Following esophagectomy, annually several thousand patients in the United States (US) reach a stable post-esophagectomy status. Such patients may require general anesthesia (GA) for elective procedures, but no generally accepted guidelines exist for the induction of GA in post-esophagectomy patients.

Methods: A national survey describing a post-esophagectomy patient was emailed to 23,524 attending anesthesiologists who were members of the American Society of Anesthesiologists.

Effects of Tirzepatide on the Clinical Trajectory of Patients with Heart Failure, a Preserved Ejection Fraction, and Obesity.

Background: Patients with heart failure, a preserved ejection fraction (HFpEF), and obesity have significant disability and suffer frequent exacerbations of heart failure. We hypothesized that tirzepatide, a long-acting agonist of glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptors, would improve a comprehensive suite of clinical endpoints, including measures of health status, functional capacity, quality of life, exercise tolerance, patient well-being, and medication burden in these patients.

Methods: 731 patients in class II-IV heart failure, ejection fraction ≥50%, and body mass index ≥30 kg/m were randomized(double-blind) to tirzepatide(titrated up to 15mg subcutaneously weekly)(n=364) or placebo(n=367), added to background therapy for a median of 104 weeks (Q1=66, Q3=126 weeks).

Tirzepatide for Heart Failure with Preserved Ejection Fraction and Obesity.

Background: Obesity increases the risk of heart failure with preserved ejection fraction. Tirzepatide, a long-acting agonist of glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptors, causes considerable weight loss, but data are lacking with respect to its effects on cardiovascular outcomes.

Methods: In this international, double-blind, randomized, placebo-controlled trial, we randomly assigned, in a 1:1 ratio, 731 patients with heart failure, an ejection fraction of at least 50%, and a body-mass index (the weight in kilograms divided by the square of the height in meters) of at least 30 to receive tirzepatide (up to 15 mg subcutaneously once per week) or placebo for at least 52 weeks.

Return to sports following arthroscopic Bankart repair in collision athletes: A systematic review.

Background: The purpose of this study was to systematically review the rate and time frame to return to sports in collision athletes following arthroscopic Bankart repair.

Methods: A systematic literature search based on Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, utilizing the EMBASE, MEDLINE, and The Cochrane Library Databases was performed. Manuscripts were included if they studied collision or contact athletes, reported on return to play rates or percentages, underwent arthroscopic Bankart repair, published in a peer-reviewed journal, and published in English.

Oncofertility Research: A Review of the Literature.

To examine publication trends pertaining to fertility-sparing management in patients of reproductive age with gynecological malignancies. Ovid MEDLINE was used to aggregate all publications on gynecological cancers and fertility between 1946 and 2022. Original research, reviews, case series/reports, and editorials were included.

The Multifaceted Role of Bilirubin in Liver Disease: A Literature Review.

Bilirubin, the primary breakdown product of hemoproteins, particularly hemoglobin, plays a key role in the diagnosis, prognosis, and monitoring of liver diseases. In acute liver diseases, such as acute liver failure, drug-induced liver injury, and viral hepatitis, bilirubin serves as a biomarker reflecting the extent of hepatocyte loss and liver damage. Chronic liver diseases, including alcohol-related liver disease, chronic hepatitis C virus infection, metabolic dysfunction-associated fatty liver disease, and autoimmune liver diseases, are marked by persistent liver injury and inflammation.

Advantage of Log Odds of Metastatic Lymph Nodes After Curative-Intent Resection of Gallbladder Cancer.

Background: Lymph node metastasis (LNM) is among the most important predictors of poor prognosis after surgery for gallbladder cancer (GBC). Traditionally, staging has been based on the raw count of LNM, with a high risk of understaging patients who undergo inadequate lymph node dissection (LND). The log odds of metastatic lymph nodes (LODDS) may represent an alternative staging approach to stratify patients more accurately after resection of GBC.

Posterior and Transforaminal Lumbar Interbody Fusion: Recent Advances in Technique and Technology.

Posterior approach interbody fusion techniques such as posterior lumbar interbody fusion and transforaminal interbody fusion are known as the workhorse procedures for lumbar spinal fusion. Over the years, advancements in procedural steps, technique, and technology have sought to improve patient outcomes. Within the last 2 decades, considerable emphasis has been placed upon minimally invasive techniques utilizing tubular retractors and conscious sedation.

Postmenopausal Endometriosis: Clinical Insights and Imaging Considerations.

Endometriosis is a chronic systemic condition characterized by the presence of ectopic endometrial-like tissue outside of the uterus. It occurs most often in reproductive-aged patients and less frequently in postmenopausal women. In postmenopausal patients, endometriosis is more common in those undergoing hormone replacement therapy or taking tamoxifen.

Performance of Polygenic Risk Scores for Primary Open-Angle Glaucoma in Populations of African Descent.

Importance: Primary open-angle glaucoma (POAG) polygenic risk scores (PRSs) continue to be evaluated in primarily European-ancestry populations despite higher prevalence and worse outcomes in African-ancestry populations.

Objective: To evaluate how established POAG PRSs perform in African-ancestry samples from the Genetics in Glaucoma Patients of African Descent (GIGA), Genetics of Glaucoma in Individuals of African Descent (GGLAD), and Million Veteran Program (MVP) datasets and compare these with European-ancestry samples.

Design, Setting, And Participants: This was a multicenter, cross-sectional study of POAG cases and controls from Tanzania, South Africa, Nigeria, Ghana, and the US.

Frontal Lobe Epilepsy: Bermuda's Triangle.

Despite great progress in imaging, genetics, surgery, and therapeutics, frontal lobe epilepsy (FLE) continues to be a challenge for neurologists and epileptologists. This manuscript summarizes the latest advancements in FLE discussed at the 2023 Epilepsy Specialist Symposium during the American Epilepsy Society Annual meeting. Correlation between stereoelectroencephalography and clinical symptoms has reinvigorated symptomatology literature in FLE, allowing for more precise aura anatomical localization.

Replacement of the main bile duct by bioprosthesis in an experimental porcine model (24-month results).

Background: Cholecystectomy for conditions like iatrogenic injury during cholecystectomy can lead to complications such as bile duct injuries, necessitating alternative options like bioprosthesis.

Methods: This study evaluated a bioprosthesis's efficacy in maintaining bile duct continuity over 24 months in 16 male pigs.

Results: The bioprosthesis was implanted in the common bile duct of three-month-old animals, with follow-ups at 1, 6, 12, 18, and 24 months.

Development of a deep learning algorithm for Paneth cell density quantification for inflammatory bowel disease.

Background: Alterations in ileal Paneth cell (PC) density have been described in gut inflammatory diseases such as Crohn's disease (CD) and could be used as a biomarker for disease prognosis. However, quantifying PCs is time-intensive, a barrier for clinical workflow. Deep learning (DL) has transformed the development of robust and accurate tools for complex image evaluation.

Endovascular abdominal aortic aneurysm repair (EVAR) outcomes of unibody and single/double docking limb endografts in Medicare beneficiaries between 2012 and 2018.

Objective: The evaluation of perioperative and long term outcomes for endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAA) using anatomic (unibody) and proximal neck fixated (docking limbs) endografts across consecutive time cohorts.

Design: This study compares the outcomes of EVAR in Medicare patients stratified by mode of fixation.

Methods: All patients who underwent EVAR between 2012 and 2018 were identified in the Medicare database.

Rare Metastasis of Prostate Cancer in a Man With Ulcerative Colitis After Creation of an Ileal Pouch.

Prostate cancer is one of the most common globally diagnosed cancers in men. It most frequently metastasizes to bones, lymph nodes, lungs, or the liver. There are limited data investigating the impact of prostate cancer on patients who have undergone ileal pouch-anal anastomosis.

The role of chemotherapy in the management of pancreatic acinar cell carcinoma.

Introduction: Pancreatic acinar cell carcinoma (pACC) is a rare malignancy with unique clinical and molecular features. The role of chemotherapy in pACC management is not well established.

Methods: The National Cancer Database (NCDB) for pACC was used.