Multi-center experience with an off-the-shelf single retrograde thoracic branch endoprosthesis for acute aortic pathology.

Objective: The thoracic branch endoprosthesis (TBE) (W.L. Gore) offers an off-the-shelf single option for thoracic endovascular aortic repair (TEVAR) of aortic arch pathology with sealing in zones 0 to 2.

Nurses' work environment and health promotion in relation to psychological distress symptoms, and sleep disturbance: A structural equation modeling approach.

Background: The healthcare work environment has numerous stressors that can contribute to distress and poor health outcomes among nurses. The impact of distress can be detrimental, resulting in nurses leaving the profession. Thus, it is critical to explore factors in the work environment that contribute to the distress symptoms and behaviors that promote nurses' health.

Effect of Vaginal Prolapse Repair and Midurethral Sling on Urgency Incontinence Symptoms.

Importance: Limited evidence exists on the effect of combined native tissue vaginal prolapse repair with midurethral sling on urgency urinary incontinence (UUI) symptoms.

Objectives: This study aimed to evaluate the effect of combined native tissue vaginal prolapse repair with midurethral sling on UUI symptoms at 12 months postoperatively and identify risk factors for persistent UUI.

Study Design: This secondary analysis utilized data from a randomized trial comparing retropubic versus single-incision slings in women undergoing treatment of stress incontinence and vaginal prolapse with native tissue vaginal repair and midurethral sling.

Phase II Trial of Risk-Enabled Therapy After Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer (RETAIN 1).

Purpose: Cisplatin-based neoadjuvant chemotherapy (NAC) followed by cystectomy is the standard of care for patients with muscle-invasive bladder cancer (MIBC). Mutations in DNA damage repair genes are associated with pathologic downstaging after NAC. We hypothesized that a combination of biomarker selection and clinical staging would identify patients for cystectomy-sparing active surveillance (AS).

Vasoactive Agents in Burn Patients - Perspectives on Angiotensin-II.

Severe burn injury poses significant clinical challenges, often necessitating the use of vasoactive agents to maintain perfusion. This narrative review explores the current landscape of vasoactive agents in acute burn shock resuscitation and severe burn-injured patients who develop septic shock, with a particular focus on the potential role of the novel vasoactive agent, synthetic angiotensin-II (AT-II), in these settings. While catecholamines and vasopressin remain cornerstone therapies, adverse effects, variable patient response, and a new understanding of burn injury pathophysiology highlight the potentially evolving role of vasoactive agents in these clinical scenarios.

Comparison of HEmorrhage on CT versus MRI After ThrombEctomy: The HECATE study.

Background: The characterization of hemorrhage following acute stroke intervention has largely been CT-based. We sought to compare MRI- and CT-based scoring of hemorrhage after acute endovascular therapy (EVT) applying the Heidelberg Bleeding Classification (HBC) to assess inter-modal agreement and quantify inter-rater agreement.

Methods: Consecutive acute stroke patients were included in this retrospective study if they: i) had MRI and CT ≤12 hours of each other OR ii) had CT bracketed by MRI pre- and post-CT [i.

Patient-Reported Outcomes for Low-Risk Ductal Carcinoma In Situ: A Secondary Analysis of the COMET Randomized Clinical Trial.

Importance: Active monitoring (AM) for low-risk ductal carcinoma in situ (DCIS) has been considered as a potential alternative to guideline-concordant care (GCC; inclusive of surgery with or without radiation). Reported data comparing patient-reported outcomes (PROs) between GCC and AM for DCIS are lacking.

Objective: To compare PROs at baseline and over time in patients with low-risk DCIS randomized to receive either AM or GCC.

Active Monitoring With or Without Endocrine Therapy for Low-Risk Ductal Carcinoma In Situ: The COMET Randomized Clinical Trial.

Importance: Active monitoring for low-risk ductal carcinoma in situ (DCIS) of the breast has been proposed as an alternative to guideline-concordant care, but the safety of this approach is unknown.

Objective: To compare rates of invasive cancer in patients with low-risk DCIS receiving active monitoring vs guideline-concordant care.

Design, Setting, And Participants: Prospective, randomized noninferiority trial enrolling 995 women aged 40 years or older with a new diagnosis of hormone receptor-positive grade 1 or grade 2 DCIS without invasive cancer at 100 US Alliance Cancer Cooperative Group clinical trial sites from 2017 to 2023.

Medical language matters: impact of clinical summary composition on a generative artificial intelligence's diagnostic accuracy.

Objectives: Evaluate the impact of problem representation (PR) characteristics on Generative Artificial Intelligence (GAI) diagnostic accuracy.

Methods: Internal medicine attendings and residents from two academic medical centers were given a clinical vignette and instructed to write a PR. Deductive content analysis described the characteristics comprising each PR.

Adverse Events and Failure Modes Related to Impella RP/RP Flex: Insights From FDA MAUDE Database.

Background: Impella RP and RP Flex can provide right ventricular (RV) support in numerous clinical situations. Notably, the redesigned RP Flex allows for an internal jugular approach compared to the femoral venous approach with RP.

Aims: We investigated the type and frequency of device-related complications as reported in the US Food and Drug Administration (FDA) Manufacturer and User Facility Experience (MAUDE) for both Impella RP and RP Flex to see if there are any differences.

Prevalence of Arrhythmias in Patients With Coronary Microvascular Dysfunction.

Background: Coronary microvascular dysfunction (CMD) is an important cause of angina with nonobstructive coronary arteries (ANOCA). It is unclear whether CMD is associated with arrhythmia.

Aims: This study aimed to evaluate the prevalence of arrhythmias in patients with ANOCA and CMD compared to those in patients with ANOCA without CMD.

Enoxaparin 40mg Twice Daily with Peak Anti-Xa Adjustments is Safe and Necessary to Achieve Therapeutic Chemoprophylaxis in Burn-Injured Patients.

Burn injury results in hypercoagulability and an increased venous thromboembolism risk. However, the most effective chemoprophylaxis for burn-injured patients has yet to be elucidated. Therefore, this study aims to identify the safety and efficacy of a burn center's venous thromboembolism protocol modification which increased the dose of enoxaparin from 40mg daily to 40mg twice daily with peak anti-Xa level adjustments.

Creating a plasma coordination center to support COVID-19 outpatient trials across a national network of hospital blood banks.

Introduction: In response to the COVID-19 pandemic, we rapidly implemented a plasma coordination center, within two months, to support transfusion for two outpatient randomized controlled trials. The center design was based on an investigational drug services model and a Food and Drug Administration-compliant database to manage blood product inventory and trial safety.

Methods: A core investigational team adapted a cloud-based platform to randomize patient assignments and track inventory distribution of control plasma and high-titer COVID-19 convalescent plasma of different blood groups from 29 donor collection centers directly to blood banks serving 26 transfusion sites.

Implementing Precision Medicine for Dilated Cardiomyopathy: Insights from The DCM Consortium.

Background: Clinical genetic evaluation of dilated cardiomyopathy (DCM) is implemented variably or not at all. Identifying needs and barriers to genetic evaluations will enable strategies to enhance precision medicine care.

Methods: An online survey was conducted in June 2024 among cardiologist investigators of the DCM Consortium from US advanced heart failure/transplant (HF/TX) programs to collect demographics, training, program characteristics, genetic evaluation practices for DCM, and implementation needs.

Proteomics in Acute Heart Transplant Rejection, On Behalf of the GRAfT Investigators.

Background: Proteomic phenotyping can provide insights into rejection pathophysiology, novel biomarkers, and therapeutic targets.

Methods: Within the prospective, multicenter Genomic Research Alliance for Transplantation study, 181 proteins were evaluated from blood drawn at the time of endomyocardial biopsy; protein fold change, logistic regression, and pathway analyses were conducted, with protein discovery adjusted for a 5% false discovery rate.

Results: Among 104 adult heart transplant patients (31% female sex, 53% Black race, median age 52 y), 74 had no rejection, 18 developed acute cellular rejection (ACR), and 12 developed antibody-mediated rejection (AMR).