Midterm outcomes of aortic valve replacement using a rapid-deployment valve for aortic stenosis: TRANSFORM trial.

Background: The use of rapid-deployment valves (RDVs) has been shown to reduce the operative time for surgical aortic valve replacement (AVR). Long-term core laboratory-adjudicated data are scarce, however. Here we report final 7-year data on RDV use.

Initial multicenter experience using a novel articulating through-the-scope traction device for endoscopic submucosal dissection.

A single-operator, articulating, through-the-scope (TTS) traction device was recently developed to facilitate endoscopic submucosal dissection (ESD). Clinical data on the performance of this device are limited. We report an initial multicenter experience with ESD using this articulating TTS traction device.

Current state of biliary cannulation techniques during endoscopic retrograde cholangiopancreatography (ERCP): International survey study.

Endoscopist techniques affect biliary cannulation success and the risk of adverse events during endoscopic retrograde cholangiopancreatography (ERCP). This survey study aims to understand the current practice of biliary cannulation techniques among endoscopists. Practicing endoscopists were sent an anonymous 28-question electronic survey on biliary cannulation techniques and intraprocedural pancreatitis prophylactic strategies.

Health-Related Quality of Life in Older Patients With Advanced Heart Failure: Findings From the SUSTAIN-IT Study.

Background There is a paucity of research describing health-related quality of life (HRQOL) in older adults considered for advanced heart failure surgical therapies. Using data from our SUSTAIN-IT (Sustaining Quality of Life of the Aged: Heart Transplant or Mechanical Support) study, we aimed to compare HRQOL among 3 groups of older (60-80 years) patients with heart failure before heart transplantation (HT) or long-term mechanical circulatory support (MCS) and identify factors associated with HRQOL: (1) HT candidates with MCS, (2) HT candidates without MCS, or (3) candidates ineligible for HT and scheduled for long-term MCS. Methods and Results Patients from 13 US sites completed assessments, including self-reported measures of HRQOL (EuroQol-5 Dimension Questionnaire, Kansas City Cardiomyopathy Questionnaire-12), depressive symptoms (Personal Health Questionnaire-8), anxiety (State-Trait Anxiety Inventory-state form), cognitive status (Montreal Cognitive Assessment), and performance-based measures (6-minute walk test and 5-m gait speed).

Involved-Field Irradiation in Definitive Chemoradiotherapy for Locoregional Esophageal Squamous Cell Carcinoma: Results From the ESO-Shanghai 1 Trial.

Purpose: To evaluate the feasibility and efficacy of involved-field irradiation in definitive chemoradiation therapy for locoregional esophageal squamous cell carcinoma.

Methods And Materials: Patterns in recurrence and elective nodal failure were analyzed in patients from the previously published ESO-Shanghai 1 trial, who received definitive chemoradiation therapy with involved-field irradiation to 61.2 Gy in 34 fractions using intensity modulated radiation therapy planning.

A novel surgeon credentialing and quality assurance process using transoral surgery for oropharyngeal cancer in ECOG-ACRIN Cancer Research Group Trial E3311.

Purpose: Understanding the role of transoral surgery in oropharyngeal cancer (OPC) requires prospective, randomized multi-institutional data. Meticulous evaluation of surgeon expertise and surgical quality assurance (QA) will be critical to the validity of such trials. We describe a novel surgeon credentialing and QA process developed to support the ECOG-ACRIN Cancer Research Group E3311 (E3311) and report outcomes related to QA.

Effect of Alteplase Administration on International Normalized Ratio in Patients With Acute Ischemic Stroke.

Background/objective: Alteplase may elevate international normalized ratio (INR) results, although the exact rate of elevation occurrence is not firmly established in the literature. The purpose of this study is to determine the occurrence rate of INR elevation following alteplase administration. We also aimed to determine what factors are independently associated with the development of elevated INR following alteplase administration for ischemic stroke.

Recurrent Shoulder Posteroinferior Subluxation Status Post Reverse Remplissage.

Posterior shoulder dislocation is an uncommon injury that typically follows intense contraction of the external rotator muscles, such as from seizure activity, high-velocity trauma, or intense electrical shock. The diagnosis is often missed or delayed, leading to complications such as functional deficits or osteonecrosis of the humeral head. Closed reduction can be utilized following an initial occurrence, however, repeated insult to the glenohumeral joint may lead to posterior instability.

A Randomized Trial of Erythropoietin for Neuroprotection in Preterm Infants.

Background: High-dose erythropoietin has been shown to have a neuroprotective effect in preclinical models of neonatal brain injury, and phase 2 trials have suggested possible efficacy; however, the benefits and safety of this therapy in extremely preterm infants have not been established.

Methods: In this multicenter, randomized, double-blind trial of high-dose erythropoietin, we assigned 941 infants who were born at 24 weeks 0 days to 27 weeks 6 days of gestation to receive erythropoietin or placebo within 24 hours after birth. Erythropoietin was administered intravenously at a dose of 1000 U per kilogram of body weight every 48 hours for a total of six doses, followed by a maintenance dose of 400 U per kilogram three times per week by subcutaneous injection through 32 completed weeks of postmenstrual age.

A Pharmacotherapy Scholars Program to Provide Intensive Training to Enhance Pharmacy Students' Postgraduate Readiness.

To design, integrate the curriculum for, and evaluate an innovative program to facilitate placement of students into postgraduate pharmacy residency training programs involving direct patient care. The Pharmacotherapy Scholars Program (PSP) was designed to prepare fourth-professional year students to become highly proficient in a direct patient care role and to successfully match with postgraduate residency training programs. The following elements were included in the year-long curriculum: integrated synchronous advanced pharmacy practice experiences with personal advising, team-based mentoring, peer-to-peer learning, longitudinal research, and professional development.

Atrial Fibrillation and Atrial Flutter Ablation - an Unconventional Approach.

Background: Radiofrequency cathether ablation (RFCA) of Atrial Fibrillation (AFib) and typical atrial flutter (AF) is traditionally performed via femoral vein approach and all devices are designed to be delivered via inferior access. In rare cases of congenital or iatrogenic obstruction of inferior vena cava (IVC), RFCA of arrhythmias is performed via transhepatic approach.

Case Report: 87 year old male patient with history of IVC filter placement for recurrent deep venous thrombosis and AFib on amiodarone developed symptoms with worsening Afib burden resulting in deterioration of left ventricular ejection fraction.

Statement for gastroesophageal reflux disease after peroral endoscopic myotomy from an international multicenter experience.

It has been 10 years since peroral endoscopic myotomy (POEM) was reported for the first time, and POEM has currently become the standard treatment for achalasia and related disorders globally because it is less invasive and has a higher curative effect than conventional therapeutic methods. However, there are limited studies comparing the long-term outcomes of POEM with those of conventional therapeutic methods, particularly in the occurrence of gastroesophageal reflux disease (GERD) after therapy. With this background, we held a consensus meeting to discuss the pathophysiology and management of GERD after POEM based on published papers and experiences of each expert and to discuss the prevention of GERD and dealing with anti-acid drug refractory GERD.

Calciphylaxis due to metastatic well-differentiated neuroendocrine carcinoma.

A 70-year-old man with history of metastatic well-differentiated neuroendocrine carcinoma was presented to the hospital with a painful left lower extremity ulcer which started around 3 months prior to presentation. He was treated with antibiotics for cellulitis on multiple occasions with no improvement in his symptoms. On initial laboratory evaluation, he was found to have acute kidney injury and a normal calcium level.

Herpes Simplex Esophagitis in Immunocompetent Patients: A Rare But Easily Managed Condition.

Herpes simplex (HS) is an opportunistic infection, primarily in immunocompromised patients, caused by herpes simplex virus. Oral and genital mucosa are the most commonly involved sites; it is rare for HSV to invade the esophagus and cause esophagitis, especially in immunocompetent patients. Here, we present a case where an immunocompetent patient presented with HS esophagitis, which had evolved into esophageal ulcers.

Comparative Clinical Characteristics of Rheumatic Heart Disease Patients Undergoing Surgical Valve Replacement.

Background To assess the prevalence patterns of isolated/mixed rheumatic valvular lesions and associated risk factors among rheumatic heart disease (RHD) patients undergoing surgical valve replacement. Methods An analytical cross-sectional design was used. Purposive sampling was used to select 87 RHD patients who underwent a first-time valve replacement for mitral, aortic, or both valves between April 1 and October 20, 2016, at Punjab Institute of Cardiology, Lahore, Pakistan.

Superficial and Deep Cutaneous Involvement by RAS-Associated Autoimmunne Leukoproliferative Disease (RALD Cutis): A Histologic Mimicker of Histiocytoid Sweet Syndrome.

RAS-associated autoimmune leukoproliferative disease (RALD) is a recently described noninfectious and nonmalignant clinical syndrome characterized by autoimmune disorders, massive splenomegaly, modest lymphadenopathy, and monocytosis. On the molecular level, RALD is defined by somatic mutations of either NRAS or KRAS gene in a subset of hematopoietic cells. To date, there is a dearth of well-documented histopathologic description of cutaneous involvement by RALD in the literature.

Rapid detection of bacille Calmette-Guérin-associated mycotic aortic aneurysm using novel cell-free DNA assay.

Intravesical instillation of bacille Calmette-Guérin (BCG), an attenuated strain of , is an adjuvant immunotherapy for bladder carcinoma. Typical complications include fever, malaise, and dysuria. However, more severe complications have been reported, including granulomatous pneumonitis, BCG sepsis, and vascular infections.

Ventriculoperitoneal Shunt Infection Caused by in a Pediatric Patient: A Case Report.

is a common colonizer of the gastrointestinal tract that expresses intrinsic vancomycin resistance. This case report describes an ventriculoperitoneal (VP) shunt infection in a pediatric patient. A 4-year-old female patient presented with cerebrospinal fluid (CSF) cultures from a VP shunt significant for .

Diagnosis and Management of Isolated Superior Mesenteric Artery Dissection: A Systematic Review and Meta-Analysis.

The objective of this study was to analyze the three different management modalities for isolated superior mesenteric artery (SMA) dissection. We did a comprehensive literature search and found 703 articles on the initial search, out of which 111 articles consisting of 145 patients were selected for analysis. The mean age was 55.

CE: Original Research: Work-Related Stress and Positive Thinking Among Acute Care Nurses: A Cross-Sectional Survey.

Unlabelled: : Background: Acute care nurses work in highly taxing environments, and as such are vulnerable to work-related stress, burnout, and attrition. Yet some nurses appear to flourish even in the presence of such stress, perhaps because of differences in their cognitive processes. Positive thinking, a set of skills that can be learned, has been linked to increased well-being, physical health, and longevity.

Heparin-Induced Fever: A Case Report and Literature Review.

Burn patients are often plagued by fever due to the inflammatory nature of their injuries as well as the normal postoperative systemic inflammatory response syndrome. One etiology for fever, often not initially considered, is drug-induced fever. A rare cause of drug-induced fever is heparin with only one documented case reported in the literature.

Imaging Manifestations of Creutzfeldt-Jakob Disease and Case Series.

Sporadic Creutzfeldt-Jakob disease (CJD) is the most common prion disease, resulting in rapid neurocognitive decline, and is universally lethal. CJD has a confounding clinical presentation with similarities which overlap with many other neurodegenerative disorders. Brain biopsy is the current gold standard; however, less-invasive initial screening tests are also utilized.

Cryopreserved amniotic membrane and umbilical cord for a radiation-induced wound with exposed dura: a case report.

An 87-year old male received surgical excision of scalp melanoma and subsequent radiotherapy due to metastasis to the skull. A radiation-induced wound developed with osteoradionecrosis that required necrotic bone excision resulting in a 7.5x8.

Esthesioneuroblastoma: An Unusual Presentation with Intractable Headache.

Esthesioneuroblastoma, also known as olfactory neuroblastoma, is a malignant tumor of the upper nasal cavity. This report illustrates the case of a 63-year-old woman who presented with intractable headaches. Subsequent radiologic evaluation and correlation with histopathologic analysis confirmed esthesioneuroblastoma.

Funny Lumps, Flaming Pheo, and a Broken Heart: A Rare Case of Pheochromocytoma.

Pheochromocytoma is the underlying etiology in 0.1% of hypertensive cases. However, it may be present in up to 5.