Variations in Revascularization Strategies for Chronic Limb-Threatening Ischemia: A Nationwide Analysis of Medicare Beneficiaries.

Background: Recent data support both surgical-first and endovascular-first revascularization approaches for chronic limb-threatening ischemia (CLTI), but hospital-based practices are poorly described.

Objectives: This aim of this study was to characterize contemporary variations and outcomes associated with each strategy among U.S.

Improving the Robustness of Deep-Learning Models in Predicting Hematoma Expansion from Admission Head CT.

Background And Purpose: Robustness against input data perturbations is essential for deploying deep-learning models in clinical practice. Adversarial attacks involve subtle, voxel-level manipulations of scans to increase deep-learning models' prediction errors. Testing deep-learning model performance on examples of adversarial images provides a measure of robustness, and including adversarial images in the training set can improve the model's robustness.

Facilitating a More Diverse Workforce: The Value of Mentorship in Cardiothoracic Surgery.

Background: Cardiothoracic surgery (CTS) is one of the least diverse surgical specialties in both gender and race. Aside from the inherent benefits of a diverse working environment, mitigating this diversity gap improves patient care. Mentorship is important for creating a diverse, nurturing environment for trainees.

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.

Managing Adverse Skin Reactions Associated With Central Line Dressings in Children: A Survey of Dermatologists.

Central line dressings (CLDs) may be associated with adverse skin reactions in hospitalized children. Currently, standardized protocols to guide the management of cutaneous CLD reactions are unavailable at our children's hospital and in the pediatric literature. We surveyed dermatologists at multiple institutions who routinely perform pediatric consults to assess their management practices and/or the use of standardized protocols for addressing adverse cutaneous reactions to CLDs.

Elevated Donor-Derived Cell-Free DNA Levels Are Associated With Reduced Myocardial Blood Flow but Not Angiographic Cardiac Allograft Vasculopathy: The EVIDENT Study.

Background: Cardiac allograft vasculopathy (CAV) leads to impaired myocardial blood flow (MBF), increasing the risk of cardiovascular death or retransplant among heart transplantation (HT) recipients. Data on elevation in donor-derived cell-free DNA (dd-cfDNA) and CAV in the absence of rejection are mixed. We sought to test the hypothesis that CAV with reduced MBF (RMBF) is associated with elevated dd-cfDNA.

The Essential Role of Ongoing Reassessment of Patients With Secondary Tricuspid Regurgitation.

This case report describes a patient diagnosed with severe secondary tricuspid regurgitation (TR) and pulmonary hypertension. Initial improvement with heart failure therapy was followed by a worsening of TR despite optimal medical management. Transcatheter edge-to-edge repair successfully addressed TR, resulting in marked clinical improvement.

Implementation of an Outpatient Clinical Pharmacy Service at an Adult Cystic Fibrosis Center.

Background: High treatment burden can adversely impact health outcomes in people with cystic fibrosis (PwCF). There is a continued need for medication adherence education and further research to evaluate impact of CF pharmacist interventions in an ambulatory care setting.

Objective(s): To evaluate whether pharmacist integration into an outpatient adult CF clinic can positively impact patient satisfaction and medication adherence through various pharmacist-based interventions.

The Association of Statin Use With Survival Outcomes in Patients With Metastatic Castration-Resistant Prostate Cancer (mCRPC) Treated With Androgen Receptor Targeted Therapies (ART).

Background: Statins may provide a compounded effect on ART by decreasing cholesterol levels thus decreasing de novo androgen synthesis and tumor cell viability. We investigated the clinical efficacy of concurrent statin use on outcomes of patients with mCRPC taking ART.

Methods: A single-institution retrospective analysis of patients with mCRPC receiving ART from 2010 to 2021 was performed.

CAV Trajectories Among Patients With No or Mild CAV at 10 Years Posttransplant.

Cardiac allograft vasculopathy (CAV) is a major cause of morbidity and mortality following heart transplantation (HT). Prior studies identified distinct CAV trajectories in the early post-HT period with unique predictors, but the evolution of CAV in later periods is not well-described. This study assessed the prevalence of late CAV progression and associated risk factors in HT recipients with ISHLT CAV 0/1 at 10 years post-HT.

Cytologic testing for mismatch repair deficiency/microsatellite instability and NTRK gene fusion is not routinely indicated in primary pancreaticobiliary carcinoma cell block material.

Introduction: Pancreaticobiliary carcinomas rarely harbor targetable genetic alterations, including microsatellite instability (MSI) or neurotrophic tyrosine receptor kinase (NTRK) gene fusions. As these malignancies are typically present at an advanced stage and have suboptimal response to chemotherapy, the discovery of an actionable genomic alteration provides an additional avenue of treatment for chemotherapy-refractory cases.

Materials And Methods: In this study, we evaluate 319 cases of pancreaticobiliary carcinoma diagnosed on fine-needle aspiration biopsy or biliary brushing for DNA mismatch repair (MMR) protein deficiency and pan-TRK overexpression by immunohistochemistry (IHC) and compare these results to MSI and NTRK gene fusion molecular testing.

3-Year Outcomes of Balloon-Expandable Valves: 20-mm vs Larger Valves (≥23 mm).

Background: A prior Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry-based analysis reported similar 1-year clinical outcomes with small (20-mm) vs large (≥23-mm) balloon-expandable valves (BEV).

Objectives: The aim of this study was to describe mid-term 3-year clinical outcomes for small vs large BEV and the relationship between discharge echocardiographic mean gradient (MG) and different definitions of prothesis-patient mismatch (PPM) with clinical outcomes.

Methods: Using the TVT Registry with Centers for Medicare and Medicaid Services linkage, a propensity-matched analysis of patients receiving 20- vs ≥23-mm BEVs was performed.

Surgical and Endovascular Therapies for Below-the-Knee Peripheral Arterial Disease: A Contemporary Review.

Peripheral arterial disease (PAD) represents one of the most prevalent cardiovascular disease processes and carries a high burden of morbidity and mortality. Patients with chronic limb-threatening ischemia (CLTI), the most severe manifestation of PAD, have the highest rates of cardiovascular morbidity and mortality of the overall PAD population. Patients with below-the-knee (BTK) PAD have an increased propensity toward CLTI due to small-vessel caliber and the frequently comorbid conditions of end-stage renal disease and diabetes mellitus, which tend to affect small artery beds preferentially.

Diffusion tensor imaging shows increased physis organization after growth hormone initiation in hypophosphatasia.

Hypophosphatasia is a rare heritable disorder of bone mineralization, with a spectrum of severity based on age of initial presentation. We describe the case of a 14-year-old boy with gene-confirmed inherited hypophosphatasia and growth hormone deficiency, who presented with short stature, unremarkable radiographs, and only minor physeal and metaphyseal changes on magnetic resonance (MR) imaging. Diffusion tensor imaging (DTI) before growth hormone initiation revealed abundant, non-parallel tracts in the physes and metaphyses with loss of the typical columnar organization.

Age-based disparities in hearing loss diagnosis and treatment in the United States population.

Objective: To investigate age-related disparities in the diagnosis and treatment of borderline/mild hearing loss (HL) in the United States.

Study Design: A cross-sectional epidemiologic study.

Setting: The National Health and Nutrition Examination Survey (NHANES).

Managing the Intricacies of Coronary Revascularization: A Close Look at the Complete Versus Culprit-Only Approach and its Implications in Elderly Patients.

Coronary heart disease is the leading cause of mortality in the United States, and data indicates that 805,000 Americans will face a new or recurrent myocardial infarction (MI) attack every year. Frailty, a conceptual syndrome categorized by a functional decline that occurs with aging, has been linked to adverse health outcomes in cardiovascular disease and all cardiac-related procedures in general. It is therefore reasonable to deliberate that more conservative medical therapy or medical management should be considered in the frail population when managing acute coronary syndrome.