Renal denervation for hypertension.

Innovative therapies for hypertension are desperately needed given the rising prevalence and falling rates of control of hypertension despite an abundance of available medical therapies. Procedural interventions lower blood pressure without depending on adherence to medications, and endovascular renal denervation (RDN) is the interventional procedure with the best evidence base for the treatment of hypertension. After nearly two decades of study, with major refinements to devices, technique and trial design, two different systems for RDN received approval from the FDA in late 2023 for the treatment of hypertension.

Plasma phospho-tau217 as a predictive biomarker for Alzheimer's disease in a large south American cohort.

Background: Blood-based Alzheimer's disease (AD) biomarkers have been increasingly employed for diagnostic, prognostic, and therapeutic monitoring purposes, due to accuracy in distinguishing AD pathophysiologic process. Compared to other p-tau isoforms, plasma p-tau217 exhibits stronger associations with AD hallmarks in CSF and brain. However, most studies have been conducted in non-Hispanic Whites, limiting our understanding of the performances and utility of these biomarkers across ethnicities.

The efficacy of revascularization in ischemic cardiomyopathy.

Ischemic cardiomyopathy (ICM) is characterized by myocardial dysfunction due to myocardial ischemia, associated with the presence of significant coronary artery disease (CAD). We provide a comprehensive review of the current evidence for coronary revascularization in ICM, including consideration of the different modalities of coronary artery bypass grafting and percutaneous coronary intervention . In addition to a contemporary assessment of the literature, we aim to provide real-world insights and perspectives to guide clinical decision-making in this heterogeneous and complex patient population.

Can Grading of Mild Cardiac Allograft Vasculopathy be Further Refined? An angiographic and physiologic assessment of heart transplant recipients with ISHLT CAV 1.

Background: Cardiac allograft vasculopathy (CAV) results in impaired blood flow in both epicardial vessels and the microvasculature and is a leading cause of poor outcomes in heart transplant (HT) recipients. Most patients have mild (ISHLT CAV 1) disease. This study examined outcomes amongst those with ISHLT CAV 1 and investigated the value of physiologic assessment via cardiac positron emission tomography/computed tomography (PET/CT) for added risk stratification.

Rapid identification and phenotyping of nonalcoholic fatty liver disease patients using a machine-based approach in diverse healthcare systems.

Nonalcoholic fatty liver disease (NAFLD) is the most common global cause of chronic liver disease and remains under-recognized within healthcare systems. Therapeutic interventions are rapidly advancing for its inflammatory phenotype, nonalcoholic steatohepatitis (NASH) at all stages of disease. Diagnosis codes alone fail to recognize and stratify at-risk patients accurately.

A phase I study using bortezomib (Velcade), cladribine, and rituximab in treating patients over 50 years old with mantle cell lymphoma.

Unlabelled: Cladribine indirectly downregulates methylation of DNA, RNA, and histones by blocking the transfer of methyl groups from -adenosyl-methionine. The cladribine and rituximab combination showed a synergetic effect in treating B-cell lymphomas. Bortezomib (Velcade) is a Food and Drug Administration (FDA)-approved proteasome inhibitor for treating mantle cell lymphoma (MCL).

Physician inpatient handoffs-Patient and physician outcomes: A systematic review.

Background: Prior reviews have shown that interventions to improve inpatient handoffs are inconsistently associated with improvement in patient outcomes. This systematic review examines the effectiveness of inpatient handoff interventions on outcomes affecting patients and physicians, including objective measures when reported (PROSPERO ID: CRD42022309326).

Methods: Pubmed, Embase, and Cochrane Central Register of Controlled Trials were searched on January 13th, 2022.

Endoscopic ultrasound-guided fine-needle aspiration and fine-needle biopsy in the diagnosis of gastrointestinal lymphomas.

Introduction: The role of endoscopic ultrasound-guided fine-needle aspiration and fine-needle biopsy (EUS-FNA/B) in the clinical management of gastrointestinal lymphoma has not been extensively studied. This study investigates the use of EUS-FNA/B in the diagnosis of first-time and recurrent gastrointestinal lymphomas at a large academic institution.

Materials And Methods: A total of 40 patients who had final diagnosis of lymphoma according to the World Health Organization (WHO) classification of tumors of hematopoietic lymphoid tissues who underwent EUS-FNA/B were included in the study.

The Historical and Clinical Foundations of the Modern Neuroscience Intensive Care Unit.

The subspecialty of neurocritical care has grown significantly over the past 40 years along with advancements in the medical and surgical management of neurological emergencies. The modern neuroscience intensive care unit (neuro-ICU) is grounded in close collaboration between neurointensivists and neurosurgeons in the management of patients with such conditions as ischemic stroke, aneurysmal subarachnoid hemorrhage, intracerebral hemorrhage, subdural hematomas, and traumatic brain injury. Neuro-ICUs are also capable of specialized monitoring such as serial neurological examinations by trained neuro-ICU nurses; invasive monitoring of intracranial pressure, cerebral oxygenation, and cerebral hemodynamics; cerebral microdialysis; and noninvasive monitoring, including the use of pupillometry, ultrasound monitoring of optic nerve sheath diameters, transcranial Doppler ultrasonography, near-infrared spectroscopy, and continuous electroencephalography.

Minimizing for Maximum Benefit: An Illustrative Case-Series of Atrial Only Leadless Pacing.

Leadless pacing technology now includesdedicated atrial helix-fixation leadless pacemakers (LPs), expanding theapplication of leadless devices for patients with sinus node dysfunction andatrioventricular block during sinus rhythm. This first reportedcase-series of atrial LPs describes and discusses the potential use-casescenarios of recently approved helix-fixation atrial LPs. The article highlights important concepts regarding their use, including implantationtechniques, programming, battery conservation, and the low rate of progressionof AV block in patients implanted with AAI(R) pacemakers.

The Use of Robotics in Implant Dentistry.

The integration of robotics in medicine and surgery marks a pivotal shift in the way modern health care delivers care. Robotics technology is not only capable of augmenting human capabilities but also improving the quality of surgical interventions. Initially designed to enhance precision in complex surgeries, robotics has made significant advancements in orthopedics, soft tissue surgery, and, more recently, implant dentistry.

Current Approaches to Optimize Donor Heart for Transplantation.

Heart transplantation remains a critical therapy for patients with end-stage heart failure, offering incremental survival and improved quality of life. One of the key components behind the success of heart transplantation is the condition and preservation of the donor heart. In this review, we provide a comprehensive overview of ischemic reperfusion injury, risk factors associated with primary graft dysfunction, current use of various preservation solutions for organ procurement and recent advancements in donor heart procurement technologies.

Immediate postpartum contraceptive implant placement and breastfeeding success in postpartum people at risk for low milk supply: a randomized non-inferiority trial.

Objectives: Our goal was to measure the impact of postpartum implant insertion timing on breastfeeding success and duration in a population at high-risk for low milk supply.

Study Design: We conducted a three-armed randomized non-inferiority study of postpartum people who plan to breastfeed and have known risk factors for low milk supply. Participants were randomized to one of three groups for the timing of implant placement: within 30 minutes of placental delivery, 24-72 hours postpartum, or 6+ weeks postpartum.

Impact of Hospital Lead Extraction Volume on Management of Cardiac Implantable Electronic Device-Associated Infective Endocarditis.

Background: Utilization of transvenous lead extraction/removal (TLE) for the management of cardiac implantable electronic device (CIED)-associated infective endocarditis (IE) remains low.

Objective: To examine the impact of hospital TLE procedural volume on TLE utilization and outcomes for patients with CIED-associated IE.

Methods: Using the Nationwide Readmissions Database, we evaluated 21,545 admissions for patients (mean age 70, 39% female) with CIEDs hospitalized with IE at TLE centres.

Impact of Bifurcation Lesions on Outcomes After FFR-Guided PCI or CABG.

Background: In the era of first-generation drug-eluting stents and angiography-guided percutaneous coronary intervention (PCI), the presence of a bifurcation lesion was associated with adverse outcomes after PCI. In contrast, the presence of a bifurcation lesion had no impact on outcomes following coronary artery bypass grafting (CABG). Therefore, the presence of a coronary bifurcation lesion requires special attention when choosing between CABG and PCI.

Transjugular Intrahepatic Portosystemic Shunt (TIPS) Check and Revision in a Freestanding Outpatient Facility: Safety and Efficacy.

Aim This study aims to evaluate the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) check and revision procedures performed in a freestanding interventional radiology (IR) outpatient facility. Methodology A total of 40 patients (male 31:female 9, median age 60 years old) underwent a TIPS check and/or revision at a freestanding IR outpatient facility between 2009 and 2017. Procedures were performed using a mobile C-arm unit under intravenous (IV) moderate sedation, with the patient discharged home on the same day.

Associations of the Korean patient placement criteria matching among individuals with alcohol-related problems with treatment completion and abstinence: an observational study.

Background: The American Society of Addiction Medicine Patient Placement Criteria (ASAM PPC) are guidelines for matching addiction patients to an optimal level of care (LOC). South Korea lacked a systematic approach to assigning alcohol use disorder patients to suitable treatment. To address this, Park et al.

Over 100 Fontan Patients on Systemic Ventricular Assist Device Support: An ACTION Update.

As the Fontan population grows, understanding successful strategies for ventricular assist device (VAD) support of the failing Fontan circulation is needed. We performed a retrospective analysis of patients with Fontan circulation and systemic VAD support in the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) registry. Competing outcomes and Kaplan-Meier estimated survival methods were used.

Improving Procedural Pain Management for Newborns in a Level 3 Neonatal Intensive Care Unit: A Quality Improvement Initiative.

Introduction:  Neonatal pain has been associated with numerous adverse outcomes, making pain management essential in the neonatal intensive care unit (NICU). Our specific, measurable, actionable, realistic, and timely (SMART) aim was to increase the proportion of neonates receiving pain management interventions during painful procedures from a baseline of less than 30% to above 50% within six months.

Methods: The Plan-Do-Study-Act (PDSA) model for improvement methodology was employed to improve pain management in the NICU between August 2022 and July 2023.