Citations

The transplant selection process for solid organ recipients relies on committee review and is susceptible to human nature and bias. The current model of selection committees has been under-examined and untested. Few studies exist on transplant selection committees. Barriers to quality decision-making have been studied in other industries. Lessons learned in other industries were explored and how they may be applied to a transplant selection committee. These include appointing an ethical representative or an advocate (pro) and dissenter (against) for discussion, adopting an ideal committee size/composition, and reviewing previous committee decisions (post-mortem). The transplant selection committee can function beyond a singular decision and be an opportunity to identify gaps in patients’ treatment plans and available resources. Looking forward, a transplant selection committee that is more consistent, equitable, and protocolized can reduce bias, moral burden, and missed listings for our patients.

Background The first-pass effect (FPE) refers to the complete or near-complete revascularization with a single pass of mechanical thrombectomy devices. While previous claims suggest a link between larger catheters and the effectiveness of contact aspiration (CA) thrombectomy, no extensive research has confirmed if larger distal inner diameter (ID) catheters achieve higher FPE rates. Methods We searched PubMed, Scopus, and Web of Science to assess the impact of aspiration catheter distal ID size on FPE. The primary outcome was FPE rate, defined as thrombolysis in cerebral ischemia (TICI) grades 2c-3 at first pass, and the secondary outcome was modified FPE (TICI 2b-3 in a single pass). Aspiration catheters were categorized based on distal ID: 0.060–0.069 (medium bore), 0.070–0.074 (large bore), and greater than 0.074 inches (super-large bore). Rates of FPE were pooled using random effect models and compared using a Chi-square test. Results Our study included 34 articles with 4831 patients. FPE rates were 27.7% (95% CI, 15.1–45.3) for medium bore, 46.6% (95% CI, 33.7–59.9) for large, and 58.3% (95% CI, 44.8–70.7) for super-large catheters. The FPE rate was significantly higher for super-large bore catheters compared with other groups (χ² = 7.26, p = 0.03). A similar trend was observed for modified FPE rates, which were 51.1% (95% CI, 45.3–56.8) for medium bore, 60.0% (95% CI, 52.8–66.8) for large bore, and 80% (95% CI, 56.3–94.2) for super-large bore catheters (χ² = 8.14, p = 0.03). Conclusion Our analysis indicates that larger CA catheters are correlated with higher FPE rates.

Background There has been growing interest in transradial procedures over the past decade due to substantial reductions in access site complications as well as improved patient recovery. While several radial-specific neurovascular catheters have come to market, all catheters that are compatible with a 7Fr sheath have small inner diameters (IDs) (0.079″–0.082″), which can limit use of modern intermediate catheters. while larger-ID catheters cannot be used with a radial sheath resulting in complications related to radial artery spasm and entrapment. We report our results using a novel 7Fr-sheath-compatible radial guide catheter with an 0.087″ ID (Piraeus 7Fr 87 NeuGlide catheter) for neurovascular procedures. Methods This is a single center retrospective case series of patients undergoing transarterial transradial neuroendovascular procedures using the Piraeus 7Fr 87 NeuGlide catheter. The primary outcome was delivery of the catheter to the target vessel and successful completion of the procedure without the need to convert to femoral access or an alternative guide. Descriptive statistics are reported. Results Forty patients were included. The most common procedure was middle meningeal artery embolization followed by aneurysm embolization. And 97.5% of procedures were completed successfully without conversion to femoral access; 75% were completed without the need of an intermediate guide catheter. One procedure required conversion to femoral access. There were no access site or neurological complications. Conclusion The Piraeus 7Fr 87 NeuGlide catheter is both safe and effective for neurovascular procedures. The larger ID and 7Fr compatible outer diameter allows for the use of standard 5Fr and 6Fr intermediate/aspiration catheters.

Myoepithelial tumors are typically characterized by distinct molecular profiles that have been shown to correlate with their anatomical locations. EWSR1 or FUS rearrangements are common in cutaneous, soft tissue and bone tumors, whereas salivary gland myoepithelial tumors are frequently associated with PLAG1 and HMGA2 alterations. This apparent molecular divergence led some previous studies to doubt a common pathogenetic relationship between myoepithelial tumors of soft tissue and bone with their salivary gland counterparts. Herein, we present primary intraosseous myoepithelioma harboring HMGA2::WIF1 fusion. This fusion has been previously identified in a range of salivary gland myoepithelial tumors including myoepitheliomas, myoepithelial carcinomas arising from pleomorphic adenomas, and pleomorphic adenomas themselves. Primary myoepithelial tumors of the bone are exceedingly rare, and to our knowledge, HMGA2 rearrangements have not been previously reported in soft tissue or bone myoepithelial neoplasms. Through this report, we aim to enhance the existing literature on myoepithelial neoplasms, while highlighting the importance of recognizing primary bone myoepitheliomas and contributing to a broader understanding of the pathogenetic landscape of myoepithelial tumors across diverse tissue types.

ABSTRACTObjectiveTo build consensus from different stakeholders on the content and digital interactivity of a shared decision making (SDM) tool to guide patient‐clinician collaborative conversations about treatment for bipolar depression.Patients and MethodsThis study was conducted between September 2022 and September 2023. In the first phase, we conducted a narrative review on pharmacological, neuromodulatory, and psychotherapeutic treatments available for bipolar depression. For each option, we assessed treatment effectiveness, side effects, need for clinical monitoring, clinical considerations, and cost. In the second phase, committees comprised of mental health clinicians and people with lived experience with bipolar disorder from a national mood disorders advocacy group identified key features and content to be included in the SDM tool. A thematic analysis of these data then contributed to populate the SDM tool.ResultsTwenty‐one evidence‐based treatment options identified from the narrative review were presented to the four convened committees (clinical, lived experience, peer council, and integrated steering committees) in five meetings. After discussions and thematic analysis, 12 outcomes of interest for each of the therapeutic interventions were delineated for inclusion in a web‐based SDM tool. A detailed description of the development process and SDM tool is provided.ConclusionThis is the first partnership between clinicians and persons with bipolar disorder lived experience charged with the development of a patient‐centered SDM tool to integrate clinical evidence with real‐world clinical practice and patient preferences for use during clinical encounters. Human‐centered design and testing in real clinical encounters will now contribute to refining the instrument and readying it for rigorous evaluation and implementation in practice.

Hyperdiploid multiple myeloma (Hy‐MM) is a common (50% of MM cases), but frequently under‐recognized subtype of MM. Hy‐MM is characterized by the presence of multiple trisomies of the odd numbered chromosomes (with the exception of chromosomes 13 and 17), leading to an average chromosome count of 53. Despite its prevalence, Hy‐MM tends to receive less attention compared to high‐risk subtypes. Thus, gaps in our understanding of Hy‐MM remain underscoring the need for continued research ultimately to aid in targeted therapies and personalized treatment strategies to improve outcomes in this subgroup.

Abstract Aim Growing evidence suggests that immune/inflammatory pathways play a crucial role in the persistence of symptoms in diverticular disease (DD). We hypothesize that chronic diverticulitis triggers a self‐sustained inflammatory status which can be detected by measuring the levels of tumor necrosis factor‐α (TNF‐α) and interleukin‐6 (IL‐6). The aim of this study was to investigate the systemic levels of TNF‐α and IL‐6 before and after elective surgery in patients with DD, and their relationship with the gastrointestinal quality of life index (GIQLI) score. Method This prospective multicentric study enrolled patients from the Diverticular Disease Registry (DDR‐Trial, NCT04907383). All adult patients diagnosed with symptomatic uncomplicated diverticular disease (SUDD), uncomplicated recurrent diverticulitis (URD) and smouldering diverticulitis (SmD) between 1st December 2022 and 31st December 2023 were included in this study. Exclusion criteria were as follows: no surgery, a concurrent chronic immunomodulated systemic disease, a SARS‐CoV‐2‐positive test in the previous 12 months, a history of cancer in the previous 5 years, patients treated with immunomodulators, an American Society of Anesthesiologists category of class IV, and complicated acute diverticulitis. Results Seventy‐two patients were included: 52 (72%) with URD, 11 (15%) with SUDD, and nine (13%) with SmD. The median postsurgery – presurgery (Δ)IL‐6 and ΔTNF‐α levels were −16.8 and −17.3 pg/mL, respectively ( p < 0.001 for both; Wilcoxon test). Spearman correlation revealed a significant, negative association between the ΔGIQLI and the ΔIL‐6, as well as the ΔTNF‐α ( p < 0.001 for both). Greater reduction in the levels of IL‐6 and TNF‐α following surgery are associated with higher GIQLI scores postoperatively. Conclusion Patients with chronic diverticulitis may experience persistent systemic inflammation driven by a colonic trigger. Surgical removal of this trigger appears to enhance GIQLI outcomes reducing IL‐6 and TNF‐α across surgery.

Abstract Background Geographic cohorting (GCh) is a popular model of care that localizes physician teams to a single hospital unit. Objectives We conducted a scoping review identifying the aims, implementation strategies, study methods, and measured outcomes of GCh. Methods We searched the medical literature analysis and retrieval system online, Embase, and Scopus databases. Eligible citations included English language reports of interventions including GCh in adult patients. Included studies were screened for their aim, GCh implementation strategy, study method, and outcomes measured. Results Of 1863 identified citations, 30 met inclusion criteria, representing 27 interventions. Implementation aims varied from specific goals measured by a single metric to multiple outcomes intended to capture wide‐ranging effects of GCh. A majority of studies ( n = 13, 48.1%) used a pre‐post cohort design. GCh was implemented in one of four ways: (1) as a stand‐alone intervention, (2) bundled with accountable care unit elements, (3) bundled with care components that did not include all ACU elements, (4) GCh bundled with ACU elements and additional components (“enhanced” ACU). The measured outcomes sorted to eight different categories: patient outcomes, patient safety, patient experience, work flow, workload, clinician experience, communication/team work, and cost. Conclusions The current literature on GCh describes implementation as both a stand‐alone intervention and bundled with other care elements. Current research has not delineated whether the degree to which GCh is implemented matters, nor what impact it has as part of a bundled care intervention. Future work would benefit from a prospective design that clarifies these questions, facilitating care models tailored to the needs of the practice ecosystem.