Left Ventricular Energetics in Patients Receiving Veno-Arterial Extracorporeal Membrane Oxygenation for Extracorporeal Cardiopulmonary Resuscitation.

Introduction: The haemodynamic effects veno-arterial extracorporeal membrane oxygenation (VA-ECMO) remain inadequately understood. We investigated invasive left ventricular (LV) haemodynamics in patients who underwent treatment with an intensive care strategy involving extracorporeal cardiopulmonary resuscitation (ECPR).

Methods: We conducted invasive haemodynamic assessments on 15 patients who underwent ECPR and achieved return of spontaneous circulation.

Artificial intelligence in radiation therapy treatment planning: A discrete choice experiment.

Introduction: The application of artificial intelligence (AI) in radiation therapy holds promise for addressing challenges, such as healthcare staff shortages, increased efficiency and treatment planning variations. Increased AI adoption has the potential to standardise treatment protocols, enhance quality, improve patient outcomes, and reduce costs. However, drawbacks include impacts on employment and algorithmic biases, making it crucial to navigate trade-offs.

A technology-enabled collaborative learning model (Project ECHO) to upskill primary care providers in best practice pain care.

Background The South Australian (SA) Chronic Pain Extension for Community Healthcare Outcomes (ECHO) Network was established to upskill primary care providers in best practice pain care aligned to a patient-centred, biopsychosocial approach using didactic and case-based virtual mentoring sessions. The aims of this study were to assess: (a) participation, satisfaction (relevance, satisfaction with format and content, perceptions of the mentorship environment), learning (perceived knowledge gain, change in attitudes), competence (self-confidence) and performance (intention to change practice, perceived practice change) of the ECHO Network clinician participants; and (b) self-perceived barriers at the clinical, service and system level to applying the learnings. Methods A mixed methods, participatory evaluation approach was undertaken.

Association between osteoarthritis-related serum biochemical markers over 10-13 years and knee symptoms in middle-aged adults.

Objectives: To describe the associations between OA-related biochemical markers and knee symptoms in middle-aged adults followed up over 10-13 years.

Methods: Blood samples were collected during the Childhood Determinants of Adult Health (CDAH)-1 study (year: 2004-06) and 10-13 year follow-up at CDAH-3. Serum samples from baseline (n=156) and follow-up (n=167) were analyzed for three OA-related biomarkers [cartilage oligomeric matrix protein (COMP), matrix metalloproteinase (MMP)-3, and hyaluronan (HA)] using non-isotopic enzyme-linked immunosorbent assay (ELISA).

Emergency department management of primary headache disorders in pediatric patients.

Headaches are a common reason for pediatric visits to the emergency department. Emergency clinicians must distinguish between common and dangerous secondary causes of headache and primary headache disorders such as migraine and tension-type headaches. This issue discusses the diagnosis of primary headaches by history and physical examination, the options for first-line treatment of primary headache and for severe or refractory migraines, and procedural interventions that may be considered when other therapies have failed.

Balanced Electrolyte Solutions Versus 0.9% Saline for Kidney Transplantation: An Updated Systematic Review and Meta-analysis.

Background: Perioperative intravenous fluids are administered to kidney transplant recipients to maintain hemodynamic stability and graft perfusion; however, the ideal fluid remains uncertain. Although 0.9% saline (saline) is commonly used, its high chloride content causes hyperchloremic metabolic acidosis and may increase the risks of delayed graft function (DGF) and hyperkalemia.

Second Generation I-Body AD-214 Attenuates Unilateral Ureteral Obstruction (UUO)-Induced Kidney Fibrosis Through Inhibiting Leukocyte Infiltration and Macrophage Migration.

Kidney fibrosis is the common pathological pathway in progressive chronic kidney disease (CKD), and current treatments are largely ineffective. The C-X-C chemokine receptor 4 (CXCR4) is crucial to fibrosis development. By using neural cell adhesion molecules as scaffolds with binding loops that mimic the shape of shark antibodies, fully humanized single-domain i-bodies have been developed.

Designing and Validating a Hereditary Spastic Paraplegia-Specific Quality of Life Rating Scale (HSPQoL).

Patients with Hereditary Spastic Paraplegia (HSP) report reduced quality of life (QoL) compared to the general population. Generic QoL measures do not address disease-specific aspects such as spasticity, access to specialty HSP clinics, and bladder symptoms. We designed and validated a HSP-specific QoL scale (HSPQoL), intended for use in standard clinical settings and clinical trials.

Avoiding prostate bed radiation for the PSMA-PET detected nodal recurrence patient post prostatectomy.

Background: Nodal only recurrence post radical prostatectomy (RP) is increasingly recognised in the PSMA scan era. Management is controversial with a curative approach usually incorporating prostate bed and nodal irradiation (PB + NRT) in combination with long-term hormonal therapy. It is unknown whether omitting prostate-bed irradiation (PBRT) is safe in a subgroup of these patients.

Lifetime management considerations to optimise transcatheter aortic valve implantation: a practical guide.

Transcatheter aortic valve implantation (TAVI) is a safe and effective procedure for the treatment of aortic stenosis. With the recently broadened indications, there is a larger cohort of patients likely to outlive their first transcatheter heart valve (THV). This review discusses relevant lifetime planning considerations, focusing on the utility of preprocedural computed tomography imaging to help implanters future-proof their patients who are likely to outlive their first valve.

Strength training with electrical stimulation has no or little effect on the very weak muscles of patients with spinal cord injury: a randomised trial.

Question: Is electrical stimulation (ES) combined with strength training and usual care more effective than usual care alone in increasing the strength of very weak muscles in people with recent spinal cord injury (SCI)?

Design: A randomised controlled trial with concealed allocation, intention-to-treat analysis and blinded outcome assessors.

Participants: Sixty participants with recent SCI were recruited from three SCI units in Australia and Bangladesh.

Interventions: Participants were randomised to either a treatment or control group.

The potential for reducing greenhouse gas emissions through disease prevention: a secondary analysis of data from the CREDENCE trial.

Background: The health-care sector is responsible for 5·2% of global emissions, however, little data exist regarding the environmental impact of disease management strategies. SGLT2 inhibitors are now widely used to reduce the risk of hospital admission and kidney failure in people with type 2 diabetes and chronic kidney disease. This study aimed to estimate the impact of SGLT2 inhibitors on greenhouse gas emissions using data from the CREDENCE trial.

Intra-thoracic thyroid rests: an updated classification and case series.

Background: Thyroid rests are common and arise during embryological development, with aberrant descent of thyroid tissue along the thyro-thymic tract. These give rise to a range of pathologies, including goitre formation and malignancy. Thyroid rests have been graded I-IV based on their connection to the thyroid gland proper - grade I is a short protuberance, grade II & III are connected via a pedicle and fibrous band respectively, and grade IV is completely disconnected.

Infective Endocarditis in Patients Receiving Hemodialysis: A Current Review.

Background: Cardiovascular and infective complications are commonly observed in patients receiving hemodialysis (HD) with cardiovascular events and infection-related complications being the first and second leading causes of death. Infective endocarditis (IE) is characterized by inflammation of the endocardium caused by infection, typically affecting the cardiac valves and can be in acute, subacute, or chronic forms. It is a serious complication within the HD population due to their predisposition for both infection and valvular damage.

Insufficient structure and reporting of process evaluations of complex interventions for musculoskeletal conditions in randomised controlled trials: a systematic review.

Objectives: To explore how process evaluation of complex interventions alongside randomised clinical trials (RCTs) in musculoskeletal conditions are conducted.

Study Design: Systematic review.

Methods: We searched the MEDLINE, SCOPUS, CINAHL, PsycINFO, Embase, Web of Science, and Cochrane databases.

Clinical significance of intra-thoracic and intra-abdominal sentinel lymph nodes detected on lymphoscintigraphy in truncal melanoma patients.

Background: Although most melanomas drain to the more common major lymph node basins (axilla, groin, neck), rarely they drain to deep SLN locations such as intra-abdominal and intra-thoracic (including intercostal and internal mammary) sites, which pose a higher surgical risk and complexity for procurement. Our study is aimed at determining the rate of positivity and likelihood of recurrence in these nodal sites to guide management decisions for patients with truncal melanomas which drain to these 'deep' SLN locations.

Methods: Retrospective data collected between May 2008 and May 2022 including all patients with truncal melanomas who underwent lymphoscintigraphy resulting in the identification of deep SLNs in intra-abdominal and intra-thoracic sites were included.

Gene Expression Profiling of Pancreatic Ductal Adenocarcinoma Arising From Intraductal Papillary Mucinous Neoplasms of the Pancreas.

Introduction: Intraductal papillary mucinous neoplasms (IPMNs) are diverse premalignant tumors of the pancreas. They progress stepwise from adenoma to carcinoma and offer an opportunity for intervention prior to malignant transformation into pancreatic ductal adenocarcinoma (PDAC). The current study aimed to identify differentially expressed genes (DEGs) in invasive PDAC-associated IPMN vs.

Stapled Arterial Divestment in Surgery for Locally Advanced Pancreatic Cancer.

Background: Pancreatic adenocarcinoma has a predisposition to invade the neural tissue surrounding the superior mesenteric artery (SMA). Before the advent of neoadjuvant chemotherapy (NAC), any invasion of this tissue was often considered as unresectable disease. Currently, patients who respond favourably to NAC have potentially resectable disease.

Impact of frailty, malnutrition and socioeconomic status on perioperative outcomes.

Background: Frailty, malnutrition and low socioeconomic status may mutually perpetuate each other in a self-reinforcing and interdependent manner. The intertwined nature of these factors may be overlooked when investigating impacts on perioperative outcomes. This study aimed to investigate the impact of frailty, malnutrition and socioeconomic status on perioperative outcomes.