Clinical features and outcomes in patients with cardiogenic shock complicating acute myocardial infarction: early vs recent experience with impella.

Objectives: To compare clinical features and outcomes in patients with acute myocardial infarction complicated by cardiogenic shock (AMICS) treated in the early experience with Impella percutaneous ventricular assist device and patients treated recently.

Background: Since pre-market approval (PMA) of Impella device as treatment for AMICS, use of the device has grown considerably.

Methods: We retrospectively analyzed 649 AMICS patients treated with perioperative Impella, with 291 patients treated from 2008 to 2014 comprising the early experience cohort and 358 patients treated from 2017 to 2019 comprising the recent experience cohort.

Neuroform Atlas Stent for Treatment of Middle Cerebral Artery Aneurysms: 1-Year Outcomes From Neuroform Atlas Stent Pivotal Trial.

Background: Heterogeneous effect of endovascular aneurysm therapy has been observed across different anatomic locations. There is a paucity of data for stent-assisted coiling of middle cerebral artery (MCA) aneurysms.

Objective: To present the results of the MCA aneurysm group from the Neuroform Atlas (Stryker Neurovascular) investigational device exemption (IDE) trial.

A quality improvement project to address the challenges surrounding zoledronic acid use in children.

Introduction: Zoledronic acid (ZA) is an intravenous bisphosphonate used to treat pediatric osteoporosis. Adverse events including hypocalcemia and acute phase reaction (APR) are common following first-infusion. The purpose of this report is to describe implementation of a ZA clinical practice guideline and the subsequent process changes to improve adherence to aspects of the protocol related to safety and efficacy.

Large Sheath Management in Patients with Poor Peripheral Access.

Despite the evolution of device technology and increasing operator experience, vascular and bleeding complications remain a major source of perioperative morbidity and mortality, particularly in patients with peripheral arterial disease. These complications may be compounded with the use of large bore access sheaths for mechanical support, which may be required to be left in the vessels for a prolonged period of time. Through this article, the authors demonstrate the importance of assessment for peripheral arterial disease before insertion of large bore sheaths.

Orbital compartment syndrome: Pearls and pitfalls for the emergency physician.

Orbital compartment syndrome (OCS) is a rare, vision-threatening diagnosis that requires rapid identification and immediate treatment for preservation of vision. Because of the time-sensitive nature of this condition, the emergency physician plays a critical role in the diagnosis and management of OCS, which is often caused by traumatic retrobulbar hemorrhage. In this review, we outline pearls and pitfalls for the identification and treatment of OCS, highlighting lateral canthotomy and inferior cantholysis (LCIC), a crucial skill for the emergency physician.

Pivotal trial of the Neuroform Atlas stent for treatment of posterior circulation aneurysms: one-year outcomes.

Background: Stent-assisted coiling of wide-necked intracranial aneurysms (IAs) using the Neuroform Atlas Stent System (Atlas) has shown promising results.

Objective: To present the primary efficacy and safety results of the ATLAS Investigational Device Exemption (IDE) trial in a cohort of patients with posterior circulation IAs.

Methods: The ATLAS trial is a prospective, multicenter, single-arm, open-label study of unruptured, wide-necked, IAs treated with the Atlas stent and adjunctive coiling.

Prehospital Ketamine Use for Rapid Sequence Intubation: Are Higher Doses Associated With Adverse Events?

Objective: Ketamine for rapid sequence intubation (RSI) is typically dosed at 1 to 2 mg/kg intravenously. The need to ensure dissociation during RSI led some to administer ketamine at doses greater than 2 mg/kg. This study assessed associations between ketamine dose and adverse events.

Benefit of endovascular thrombectomy for M2 middle cerebral artery occlusion in the ARISE II study.

Background: The benefit of endovascular thrombectomy for acute ischemic stroke with M2 segment middle cerebral artery occlusion remains controversial, with uncertainty and paucity of data specific to this population.

Objective: To compare outcomes between M1 and M2 occlusions in the Analysis of Revascularization in Ischemic Stroke with EmboTrap (ARISE II) trial.

Methods: We performed a prespecified analysis of the ARISE II trial with the primary outcome of 90-day modified Rankin Scale score of 0-2, which we termed good outcome.

Newer generation of proximal tibia locking plates demonstrate large variability in their ability to capture the posteromedial fragment in bicondylar tibial plateau fractures.

Introduction: The early generations of proximal tibial locking plates demonstrated inferior results when compared to dual plating in bicondylar tibial plateau fractures with posteromedial fragments (PMF). Modern plates have multiple rows of locking screws and variable angle technology -which tote the ability to capture the PMF. The purpose of this study was to determine if the modern plates could capture the PMF in a large series of bicondylar tibial plateau fractures.

Risk of Depression in the Adolescent and Adult Offspring of Mothers With Perinatal Depression: A Systematic Review and Meta-analysis.

Importance: Maternal depression during pregnancy is associated with emotional and behavioral difficulties of offspring during childhood that can increase the risk of depression in adolescence and adulthood.

Objective: To investigate the association between perinatal maternal depression and an increased long-term risk of depression in their adolescent and adult offspring.

Data Sources: A systematic search of the electronic databases of PubMed and PsycINFO was conducted from May 2019 to June 2019.

Pivotal Trial of the Neuroform Atlas Stent for Treatment of Anterior Circulation Aneurysms: One-Year Outcomes.

Background And Purpose: Stent-assisted coil embolization using the new generation Neuroform Atlas Stent System has shown promising safety and efficacy. The primary study results of the anterior circulation aneurysm cohort of the treatment of wide-neck, saccular, intracranial, aneurysms with the Neuroform Atlas Stent System (ATLAS trial [Safety and Effectiveness of the Treatment of Wide Neck, Saccular Intracranial Aneurysms With the Neuroform Atlas Stent System]) are presented.

Methods: ATLAS IDE trial (Investigational Device Exemption) is a prospective, multicenter, single-arm, open-label study of wide-neck (neck ≥4 mm or dome-to-neck ratio <2) intracranial aneurysms in the anterior circulation treated with the Neuroform Atlas Stent and approved coils.

The impact of clinical crisis management on trauma team outcomes following a prolonged strike by nursing, technical, and support staff.

There is a paucity of literature describing the preparation of hospital institutions prior to a nursing strike and the quality outcomes during and after a prolonged nursing strike. No published study was found describing the effects of a prolonged strike on quality outcomes specific to trauma patients. The American College of Surgeons (ACS) suggests specific critiques and complications data that each trauma program may choose to track as quality indicators, and those metrics are submitted to regional, state and national databanks and closely examined during site accreditations.

Regadenoson Cardiac Stress Test-Induced Takotsubo Cardiomyopathy: A Case Report.

A 79-year-old female presented with acute left-sided chest pain with shortness of breath; she was afebrile and vitally stable. She had a mildly elevated troponin (0.11 ng/mL).

Exebacase for patients with Staphylococcus aureus bloodstream infection and endocarditis.

BACKGROUNDNovel therapeutic approaches are critically needed for Staphylococcus aureus bloodstream infections (BSIs), particularly for methicillin-resistant S. aureus (MRSA). Exebacase, a first-in-class antistaphylococcal lysin, is a direct lytic agent that is rapidly bacteriolytic, eradicates biofilms, and synergizes with antibiotics.

Curcumin Preparations Can Improve Flow-Mediated Dilation and Endothelial Function: A Meta-Analysis.

Introduction: Endothelial dysfunction is an early marker of atherosclerosis. Flow-mediated dilation (FMD), measured by ultrasonography, is used to noninvasively assess endothelial dysfunction. Preparations of curcumin, a naturally occurring pigment found in turmeric, may improve FMD and thus endothelial dysfunction.

A Look at Genetic Linkage between Clozapine-induced Agranulocytosis, Malignant Hyperthermia, Neuroleptic Malignant Syndrome, and Statin-induced Myopathy.

Clozapine-induced agranulocytosis, malignant hyperthermia (MH), statin-induced myopathy, and neuroleptic malignant syndrome (NMS) are all serious drug reactions with significant overlap in terms of clinical symptomatology. The use of clozapine can lead to neutropenia, as well as the development of NMS; thus, it seemed logical to explore a possible common genetic background for the development of these two adverse effects. Furthermore, due to the overwhelming clinical resemblance between NMS, MH, and statin-induced myopathy, we decided specifically to search for a common genetic background in the development of these conditions.

Defining the Correlation Between Heroin Overdose and Length of Hospital Admissions.

Heroin has had an overwhelming impact on public welfare and health resources. National surveillance data indicate a 25% increase in drug overdose deaths in Ohio between 2012 and 2017, ranking the state second in terms of drug overdose deaths associated with opioids. The primary objective of this evaluation was to determine the length of hospital stay in suspected or confirmed heroin overdose.

Systematic Review and Proportional Meta-Analysis of Endarterectomy and Endovascular Therapy with Routine or Selective Stenting for Common Femoral Artery Atherosclerotic Disease.

Introduction: Common femoral endarterectomy (CFE) has been the therapy of choice for common femoral artery atherosclerotic disease (CFA-ASD). In the past, there was inhibition to treat CFA-ASD endovascularly with stents due to fear of stent fracture and compromise of future vascular access site. However, recent advances and new evidence suggest that CFA may no longer be a 'stent-forbidden zone'.

Sweet hydrothorax: a common presentation of a rare condition.

Sweet hydrothorax is a known, yet rare, complication of peritoneal dialysis. It can be life-threatening. This case is about a 70-year-old lady who presented with acute respiratory failure due to massive right-sided hydrothorax that developed insidiously over 3 months of starting peritoneal dialysis.

Site Experience and Outcomes in the Trevo Acute Ischemic Stroke (TRACK) Multicenter Registry.

Background and Purpose- It remains unclear how experience influences outcomes after the advent of stent retriever technology. We studied the relationship between site experience and outcomes in the Trevo Acute Ischemic Stroke multicenter registry. Methods- The 24 sites that enrolled patients in the Trevo Acute Ischemic Stroke registry were trichotomized into low-volume (<2 cases/month), medium-volume (2-4 cases/month), and high-volume centers (>4 cases/month).

Concurrent Cardiac Tamponade and Superior Vena Cava Syndrome: A Concerning Situation.

Diffuse large B-cell lymphoma (DLBCL) is the most commonly diagnosed lymphoma; as per the Surveillance, Epidemiology, and End Results (SEER) database 2006-2015, incidence of DLBCL is 7.0/100,000 per year. Superior vena cava (SVC) syndrome and cardiac tamponade are life-threatening oncological emergencies with an overlap in clinical manifestations.

Meta-analysis of fractional flow reserve guided complete revascularization versus infarct related artery only revascularization in patients with ST-elevation myocardial infarction and multivessel coronary artery disease.

Background: Multivessel coronary artery disease is found in 30-50% of patients with ST-elevation myocardial infarction (MI) and is associated with adverse outcomes. It is not yet clear if outcomes are improved by utilizing fractional flow reserve (FFR) guided percutaneous coronary intervention (PCI) of noninfarct related artery (non-IRA) along with primary PCI.

Methods And Results: To evaluate this, we performed a metanalysis of published randomized controlled trials by performing systematic search of PubMed, Medline, Google Scholar and Cochrane Central.