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What Are the Most Challenging Aspects of Inflammatory Bowel Disease? An International Survey of Gastroenterologists Comparing Developed and Developing Countries.

Inflamm Intest Dis 2021 May 5;6(2):78-86. Epub 2021 Feb 5.

Section of Gastroenterology, Max Rady School of Medicine and University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada.

Background And Aims: As inflammatory bowel disease (IBD) becomes more prevalent, the challenges that gastroenterologists face in managing these patients evolve. We aimed to describe the most important challenges facing gastroenterologists from around the world and compare these between those working in developed and developing countries.

Methods: An online questionnaire was developed, and a link distributed to gastroenterologists. Read More

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Angular Offset Distributions During Fixation Are, More Often Than Not, Multimodal.

J Eye Mov Res 2021 Jun 3;14(3). Epub 2021 Jun 3.

Texas State University, San Marcos, Texas, USA.

Typically, the position error of an eye-tracking device is measured as the distance of the eye-position from the target position in two-dimensional space (angular offset). Accuracy is the mean angular offset. The mean is a highly interpretable measure of central tendency if the underlying error distribution is unimodal and normal. Read More

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Contour Map Point Distribution and Surgeon Experience Level Affect Accuracy of Surgical Navigation in a Pilot Study.

Ann Otol Rhinol Laryngol 2021 Jun 13:34894211005982. Epub 2021 Jun 13.

Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.

Background: Reliable use of surgical navigation depends upon the registration process. The gold standard is paired-point registration with bone-anchored fiducials, but contour-map registration is more practical. Surgeons may employ variable contour maps and less experienced team members often perform this critical step. Read More

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Influence of coronary stenosis location on diagnostic performance of machine learning-based fractional flow reserve from CT angiography.

J Cardiovasc Comput Tomogr 2021 Jun 4. Epub 2021 Jun 4.

Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA. Electronic address:

Background: Compared with invasive fractional flow reserve (FFR), coronary CT angiography (cCTA) is limited in detecting hemodynamically relevant lesions. cCTA-based FFR (CT-FFR) is an approach to overcome this insufficiency by use of computational fluid dynamics. Applying recent innovations in computer science, a machine learning (ML) method for CT-FFR derivation was introduced and showed improved diagnostic performance compared to cCTA alone. Read More

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Physical Activity, Subclinical Myocardial Injury, and Risk of Heart Failure Subtypes in Black Adults.

JACC Heart Fail 2021 Jun 3. Epub 2021 Jun 3.

Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA. Electronic address:

Objectives: This study sought to evaluate the independent associations and interactions between high-sensitivity cardiac troponin I (hs-cTnI) and physical activity (PA) with risk of heart failure (HF) subtypes, HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF).

Background: Black adults are at high risk for developing HF. Physical inactivity and subclinical myocardial injury, as assessed by hs-cTnI concentration, are independent risk factors for HF. Read More

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Evaluation of the utility of early routine computed tomography angiography in subarachnoid hemorrhage patient outcomes.

J Clin Neurosci 2021 Jul 10;89:133-138. Epub 2021 May 10.

Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Electronic address:

Objectives: The role of an early CTA approach in neurologically stable patients with nontraumatic SAH has not been assessed. This study explored the use of CTA in clinically stable SAH patients to pre-emptively identify cerebral vasospasm, to evaluate whether this approach is associated with improved clinical outcomes.

Methods: We conducted a retrospective chart review of SAH patients presenting between July 2007 and December 2016 in a single academic center. Read More

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Selecting software pipelines for change in flortaucipir SUVR: Balancing repeatability and group separation.

Neuroimage 2021 Jun 9;238:118259. Epub 2021 Jun 9.

Department of Radiology, Mayo Clinic and Foundation, 200 First Street SW, Rochester 55905, MN, USA.

Since tau PET tracers were introduced, investigators have quantified them using a wide variety of automated methods. As longitudinal cohort studies acquire second and third time points of serial within-person tau PET data, determining the best pipeline to measure change has become crucial. We compared a total of 415 different quantification methods (each a combination of multiple options) according to their effects on a) differences in annual SUVR change between clinical groups, and b) longitudinal measurement repeatability as measured by the error term from a linear mixed-effects model. Read More

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Novel selection paradigms for endovascular stroke treatment in the extended time window.

J Neurol Neurosurg Psychiatry 2021 Jun 11. Epub 2021 Jun 11.

Neurology, Emory University, Atlanta, Georgia, USA

Background And Purpose: The optimal selection methodology for stroke thrombectomy beyond 6 hours remains to be established.

Methods: Review of a prospectively collected database of thrombectomy patients with anterior circulation strokes, adequate CT perfusion (CTP) maps, National Institute of Health Stroke Scale (NIHSS)≥10 and presenting beyond 6 hours from January 2014 to October 2018. Patients were categorised according to five selection paradigms: DAWN clinical-core mismatch (DAWN-CCM): between age-adjusted NIHSS and CTP core, DEFUSE 3 perfusion imaging mismatch (DEFUSE-3-PIM): between CTP-derived perfusion defect (Tmax >6 s lesion) and ischaemic core volumes and three non-contrast CT Alberta Stroke Program Early CT Score (ASPECTS)-based criteria: age-adjusted clinical-ASPECTS mismatch (aCAM): between age-adjusted NIHSS and ASPECTS, eloquence-adjusted clinical ASPECTS mismatch (eCAM): ASPECTS 6-10 and non-involvement of the right M6 and left M4 areas and standard clinical ASPECTS mismatch (sCAM): ASPECTS 6-10. Read More

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Engineered bridge protein with dual affinity for bone morphogenetic protein-2 and collagen enhances bone regeneration for spinal fusion.

Sci Adv 2021 Jun 11;7(24). Epub 2021 Jun 11.

Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL 60637, USA.

The revolutionizing efficacy of recombinant human bone morphogenetic protein (rhBMP-2) for clinical spinal fusion is hindered by safety issues associated with the high dose required. However, it continues to be widely used, for example, in InFUSE Bone Graft (Medtronic). Here, we developed a translational protein engineering-based approach to reduce the dose and thereby improve the safety of rhBMP-2 delivered in a collagen sponge, as in InFUSE Bone Graft. Read More

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Three dimensional reconstruction of coronary artery stents from optical coherence tomography: experimental validation and clinical feasibility.

Sci Rep 2021 Jun 10;11(1):12252. Epub 2021 Jun 10.

Cardiovascular Biology and Biomechanics Laboratory, Cardiovascular Division, University of Nebraska Medical Center, 982265 Nebraska Medical Center, Omaha, NE, 68198, USA.

The structural morphology of coronary stents (e.g. stent expansion, lumen scaffolding, strut apposition, tissue protrusion, side branch jailing, strut fracture), and the local hemodynamic environment after stent deployment are key determinants of procedural success and subsequent clinical outcomes. Read More

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Short-Term Clinical Outcomes of Transcatheter Tricuspid Valve Repair With the Third-Generation MitraClip XTR System.

JACC Cardiovasc Interv 2021 Jun;14(11):1231-1240

Department of Cardiology, Heart Valve Center, University Medical Center Mainz, Mainz, Germany.

Objectives: The aim of this study was to assess 30-day outcomes of transcatheter edge-to-edge repair with the MitraClip XTR for significant tricuspid regurgitation (TR), relative to baseline coaptation gap sizes (CGS).

Background: Transcatheter edge-to-edge repair using the MitraClip NT for patients with significant TR is safe and efficacious; the utility of the MitraClip XTR is unknown.

Methods: Patients with significant, symptomatic TR treated at a single site between April 2018 and December 2019, with consent and with complete data, were included (n = 50). Read More

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Small Annulus, Hemodynamic Status, and TAVR.

JACC Cardiovasc Interv 2021 Jun;14(11):1229-1230

Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. Electronic address:

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Predictors and Clinical Impact of Prosthesis-Patient Mismatch After Self-Expandable TAVR in Small Annuli.

JACC Cardiovasc Interv 2021 Jun;14(11):1218-1228

Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA.

Objectives: The aim of this study was to define predictors of prosthesis-patient mismatch (PPM) and its impact on mortality after transcatheter aortic valve replacement (TAVR) with self-expandable valves (SEVs) in patients with small annuli.

Background: TAVR seems to reduce the risk for PPM compared with surgical aortic valve replacement, especially in patients with small aortic annuli. Nevertheless, predictors and impact of PPM in this population have not been clarified yet. Read More

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The Impact of Aortic Angulation on Contemporary Transcatheter Aortic Valve Replacement Outcomes.

JACC Cardiovasc Interv 2021 Jun;14(11):1209-1215

Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA. Electronic address:

Objectives: The aim of this study was to investigate whether the degree of aortic angulation (AA) affects outcomes after transcatheter aortic valve replacement (TAVR) using newer-generation transcatheter heart valves (THVs).

Background: AA ≥48° has been reported to adversely influence accurate THV deployment, procedural success, fluoroscopy time, and paravalvular leak (PVL) in patients undergoing TAVR with early generation self-expanding (SE) THVs.

Methods: A retrospective observational study was conducted among 841 patients across all risk strata who underwent transfemoral TAVR using the balloon-expandable (BE) SAPIEN 3 or the SE CoreValve Evolut PRO from 2015 to 2020. Read More

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Development and Validation of a Practical Model to Identify Patients at Risk of Bleeding After TAVR.

JACC Cardiovasc Interv 2021 Jun;14(11):1196-1206

Department of Diagnostic and Interventional Cardiology, Gabriele Monasterio Tuscany Foundation, G. Pasquinucci Heart Hospital, Massa, Italy.

Objectives: No standardized algorithm exists to identify patients at risk of bleeding after transcatheter aortic valve replacement (TAVR). The aim of this study was to generate and validate a useful predictive model.

Background: Bleeding events after TAVR influence prognosis and quality of life and may be preventable. Read More

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Transcatheter Versus Surgical Aortic Valve Replacement in Young, Low-Risk Patients With Severe Aortic Stenosis.

JACC Cardiovasc Interv 2021 Jun;14(11):1169-1180

Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA. Electronic address:

Transcatheter aortic valve replacement (TAVR) is approved for all patient risk profiles and is an option for all patients irrespective of age. However, patients enrolled in the low- and intermediate-risk trials were in their 70s, and those in the high-risk trials were in their 80s. TAVR has never been systematically tested in young (<65 years), low-risk patients. Read More

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Ending Gender Inequality in Cardiovascular Clinical Trial Leadership: JACC Review Topic of the Week.

J Am Coll Cardiol 2021 Jun;77(23):2960-2972

Michael E. DeBakey Veterans Affairs Medical Center and Winters Center for Heart Failure Research, Cardiovascular Institute, Cardiology, Baylor College of Medicine, Houston, Texas, USA.

Women are under-represented as leaders of cardiovascular randomized controlled trials, representing 1 in 10 lead authors of cardiovascular trials published in high-impact journals. Although the proportion of cardiovascular specialists who are women has increased in recent years, the proportion of cardiovascular clinical trialists who are women has not. This gap, underpinned by systemic sexism, has not been adequately addressed. Read More

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Refining the Approach to Risk Stratification in Patients With Dilated Cardiomyopathy.

J Am Coll Cardiol 2021 Jun;77(23):2906-2908

Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.

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Renal denervation in patients with versus without chronic kidney disease: results from the global SYMPLICITY Registry with follow-up data of 3 years.

Nephrol Dial Transplant 2021 Jun 9. Epub 2021 Jun 9.

Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-, Nürnberg, Germany.

Background: Activity of the sympathetic nervous system is increased in patients with hypertension and chronic kidney disease (CKD). Here we compare short- and long-term blood pressure (BP) lowering effects of renal denervation (RDN) between hypertensive patients with or without CKD in the Global SYMPLICITY Registry.

Methods: Office and 24-hour ambulatory BP (ABP) were assessed at pre-specified time-points after RDN. Read More

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Republished: Multiplug flow control technique as a novel transarterial curative approach for the endovascular treatment of cerebrovascular malformations.

J Neurointerv Surg 2021 Jun 9. Epub 2021 Jun 9.

Radiology Department, Private Koru Hospital, Ankara, Turkey.

Herein, we describe the use of a novel multiplug flow control technique for the curative transarterial embolisation of cerebrovascular malformations using liquid embolic agents (LEAs). The idea behind the use of this technique is to substantially control or arrest flow during LEA injection, with multiple plugs simultaneously formed from microcatheters that are placed within all or multiple feeders, so that the penetration of LEAs is facilitated, with flow control decreasing the washout of a malformation. This technique enables the complete occlusion of a vascular malformation in a shorter injection time than that in other methods because penetration is achieved faster. Read More

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Infectious and lifestyle modifiers of immunity and host resilience.

Immunity 2021 Jun;54(6):1110-1122

Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Internal Medicine I, University Hospital Wuerzburg, Wuerzburg, Germany. Electronic address:

The interindividual heterogeneity of the immune system likely determines the personal risk for acquiring infections and developing diseases with inflammatory components. In addition to genetic factors, the immune system's heterogeneity is driven by diverging exposures of leukocytes and their progenitors to infections, vaccinations, and health behavior, including lifestyle-related stimuli such as diet, physical inactivity, and psychosocial stress. We review how such experiences alter immune cell responses to concurrent and subsequent challenges, leading to either improved host resilience or disease susceptibility due to a muted or overzealous immune system, with a primary focus on the contribution of innate immune cells. Read More

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An overview of lurbinectedin as a new second-line treatment option for small cell lung cancer.

Ther Adv Med Oncol 2021 29;13:17588359211020529. Epub 2021 May 29.

Thoracic Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215, USA Department of Medicine, Harvard Medical School, Boston, MA, USA.

Small cell lung cancer (SCLC) is a highly proliferative, aggressive form of lung cancer that carries a poor prognosis. Recent approvals with new therapeutic options represent the first in more than a decade for SCLC. Lurbinectedin, a newly approved second-line option, is a synthetic alkaloid that covalently binds DNA, generating double-strand breaks, and disrupts DNA-protein interactions and RNA transcription. Read More

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Multicenter Retrospective Review of Safety and Efficacy of a Novel Minimally Invasive Lumbar Interspinous Fusion Device.

J Pain Res 2021 31;14:1525-1531. Epub 2021 May 31.

Center for Interventional Pain and Spine, Lancaster, PA, USA.

Introduction: Several treatment options exist for those with spinal stenosis, as well as degenerative changes. This series evaluates the use of an interspinous fixation (ISF) device as performed by interventional pain physicians.

Methods: This is a retrospective analysis identifying 32 patients with the diagnosis of lumbar degenerative disc disease with secondary diagnosis of lumbar spinal stenosis being treated with ISF with Aurora Spine Zip Interspinous Spacer. Read More

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Can Paclitaxel Coated Balloons Have a Deep Impact on Critical Limb Ischemia?

JACC Basic Transl Sci 2021 May 24;6(5):428-430. Epub 2021 May 24.

Center for Interventional Vascular Therapy, Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA.

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Therapeutic versus prophylactic anticoagulation for patients admitted to hospital with COVID-19 and elevated D-dimer concentration (ACTION): an open-label, multicentre, randomised, controlled trial.

Lancet 2021 06 4;397(10291):2253-2263. Epub 2021 Jun 4.

Brazilian Research in Intensive Care Network, São Paulo, Brazil; BP-A Beneficência Portuguesa de São Paulo, São Paulo, Brazil.

Background: COVID-19 is associated with a prothrombotic state leading to adverse clinical outcomes. Whether therapeutic anticoagulation improves outcomes in patients hospitalised with COVID-19 is unknown. We aimed to compare the efficacy and safety of therapeutic versus prophylactic anticoagulation in this population. Read More

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Downstream Paclitaxel Released Following Drug-Coated Balloon Inflation and Distal Limb Wound Healing in Swine.

JACC Basic Transl Sci 2021 May 31;6(5):416-427. Epub 2021 Mar 31.

CRF Skirball Center for Innovation, Orangeburg, New York, USA.

The authors evaluated the presence of paclitaxel and healing of distal hind limb wounds created in 27 swine using biopsy punches followed by paclitaxel-coated balloon (PCB) use in the iliofemoral arteries of healthy swine. After 14 and 28 days, no differences were seen in time course, appearance, and histopathology of wound healing between the single or triple PCB and uncoated balloon treatment despite clinically relevant paclitaxel concentrations in the skin adjacent to the healing wounds. Presence of paclitaxel downstream from the PCB treatment site does not impair the wound healing response of preexisting distal cutaneous lesions in healthy swine. Read More

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Radiologic Measurements in the Assessment of Patellar Instability: A Systematic Review and Meta-analysis.

Orthop J Sports Med 2021 May 20;9(5):2325967121993179. Epub 2021 May 20.

Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.

Background: Numerous diagnostic imaging measurements related to patellar instability have been evaluated in the literature; however, little has been done to compare these findings across multiple studies.

Purpose: To review the different imaging measurements used to evaluate patellar instability and to assess the prevalence of each measure and its utility in predicting instability. We focused on reliability across imaging modalities and between patients with and without patellar instability. Read More

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Near-infrared spectroscopy device selection affects intervention management for cerebral desaturation during cardiopulmonary bypass surgery.

Gen Thorac Cardiovasc Surg 2021 Jun 6. Epub 2021 Jun 6.

Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0375, Japan.

Objective: Currently, several near-infrared spectroscopy oximetry devices are used for detecting cerebral ischemia during cardiopulmonary bypass (CPB) surgery. We investigated whether two different models of near-infrared spectroscopy oximetry devices affect the assessment of cerebral ischemia and its management during CPB.

Methods: From January 2017 to August 2017, 70 adult cardiovascular surgery cases were randomly assigned to 1 of 2 different near-infrared spectroscopy oximetry devices. Read More

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Leveraging a statewide quality collaborative to understand population-level hernia care.

Am J Surg 2021 May 30. Epub 2021 May 30.

Department of Surgery, University of Michigan, Ann Arbor, MI, USA; Division of Minimally Invasive Surgery, Department of Surgery, Ann Arbor, MI, USA. Electronic address:

Background: Although ventral hernia repair (VHR) is extremely common, there is profound variation in operative technique and outcomes. This study describes the results of a statewide registry capturing hernia-specific variables to understand population-level practice patterns.

Methods: Retrospective analysis of adult patients in a new statewide hernia registry undergoing VHR in 2020. Read More

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