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Objective: To evaluate treatment trends and compare outcomes following fenestrated-branched endovascular aortic repair (FB-EVAR) versus open surgical repair (OSR) of thoracoabdominal aortic aneurysms (TAAA). Background: FB-EVAR has been increasingly utilized as a less invasive alternative to OSR for treatment of TAAAs. Methods: We studied patients who underwent elective FB-EVAR or OSR of TAAAs (2008-2020), since the initiation of an Advanced Endovascular Aortic Program. Primary endpoints were early major adverse events (MAE) and early and late all-cause mortality. Propensity score overlap weighting analysis was performed to adjust for measured confounders between groups. Results: There were 357 (70.8%) patients treated by FB-EVAR and 147 (29.2%) with OSR. The use of FB-EVAR increased from 16.7% in 2008 to >80% since 2017 ( P <0.001). Incidences of early MAEs were 25.8% and 49.0%, respectively; early mortality rates for FB-EVAR and OSR were 2.5% and 6.8%, respectively. In the weighted cohort, FB-EVAR patients had decreased early MAEs (weight-adjusted odds ratio [aOR], 0.28; 95% confidence interval [CI], 0.18-0.41; P <0.001) and mortality (aOR, 0.35; 95% CI, 0.17-0.73; P =0.005) versus OSR patients. Five-year survival estimates were 52.2% (95% CI, 45.2-60.4%) and 78.0% (95% CI, 70.6-86.2%), respectively. In the weighted cohort, there was no significant difference in late survival between groups (weight-adjusted hazard ratio, 1.33; 95% CI, 0.74-2.39; P =0.34). Conclusions: This study confirmed the change in practice from OSR to FB-EVAR for treatment of TAAAs over the past decade. Incidences of early MAEs and mortality were lower with FB-EVAR, with no significant difference in late survival in the weighted cohort.

Comparative analysis of fibrin sealant and recombinant thrombin hydrogels reveals distinct microarchitectures and cellular responses, emphasizing recombinant thrombin’s potential to enhance cellular activity and enable vesicle delivery.

Abstract INTRODUCTION African American (AA) individuals are underrepresented in biomarker studies for Alzheimer's disease (AD). Biomarkers that reflect the heterogeneity of AD and achieve the greatest accuracy across populations are sorely needed. METHODS Untargeted proteome measurements were obtained using the SomaScan 7k platform to identify novel plasma biomarkers for AD in AA participants with clinical diagnoses of AD dementia ( n = 181) and cognitively unimpaired (CU, n = 142). Machine learning was used to identify a set of plasma proteins that yielded the best classification accuracy. RESULTS A set of 36 proteins achieved an area under the curve (AUC) of 0.94 to classify AD dementia versus CU, a 16% improvement over age, sex, and apolipoprotein E ( APOE) . This finding was replicated in multiple plasma and brain datasets (AUCs 0.73–0.97). Our findings underscore the importance of matrisome and cerebrovascular dysfunction in AD pathophysiology. DISCUSSION This study demonstrates the potential of biomarker discovery through untargeted plasma proteomics and machine learning. Highlights Conducted large‐scale plasma proteomics in Alzheimer's disease (AD) versus cognitively unimpaired controls. Machine learning biomarker discovery was replicated in an independent cohort. Novel set of proteins distinguishes AD versus controls with high accuracy (area under the curve [AUC] = 0.94). Achieved reproducibility across multiple replication cohorts (AUC = 0.73–0.97). Network analyses implicates matrisome biology and cerebrovascular dysfunction.

ABSTRACTObjectiveTo conduct an economic evaluation of a group mindfulness program compared to an education support program for breast cancer survivors (BCS).MethodsThe cost‐utility analysis (cost per quality‐adjusted life year [QALY]) was performed from a single‐center randomized controlled trial in the United States. Data from 181 BCS were included in the analysis (91 from the mindfulness‐based stress reduction for breast cancer, MBSR(BC) and 90 from the Breast Cancer Education Support, (BCES)). Analyses were conducted from two perspectives: societal and healthcare system. The EuroQol EQ‐5D‐5L was used to measure quality of life and the Client Service Receipt Inventory (CSRI) was used to measure health services utilization from baseline through 26 weeks. The impact of MBSR(BC) on health services utilization and costs was estimated with generalized linear models.ResultsIn the reference case analyses (societal perspective), the average total cost in the MBSR(BC) group was $5744 compared with $6140 in the BCES group. At the end of follow‐up, the MBSR(BC) group dominated BCES in terms of Incremental Cost Utility Ratio (ICUR), with MBSR(BC) providing an incremental cost of −$541 (95% CI: −$3400, $2318) and a 0.021 QALY (95% CI: −0.014, 0.055). Net monetary benefit (NMB) analysis showed that MBSR(BC) has a higher probability of achieving positive NMB across a range of possible societal willingness‐to‐pay for improving quality of life.ConclusionsOur findings suggest that MBSR(BC) is likely to be cost‐effective for breast cancer survivors over 6 months. Cost savings primarily resulted from reduced ER and hospital admissions and tests.

Abstract Background: Understanding of the diagnosis and treatment of adults with community-acquired pneumonia (CAP) has evolved thanks to new evidence, experience, and emerging technologies. This document updates evidence-based clinical practice guidelines on four key questions for the diagnosis and management of adult patients with CAP. Methods: A multidisciplinary panel integrated systematic reviews of comparative evidence with other relevant research and clinical experience, then applied Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology to produce recommendations using the Evidence to Decision Framework. Results: The panel formulated clinical recommendations that address questions related to CAP, including lung ultrasound for diagnosis, empiric antibacterial therapy if a test for a respiratory virus is positive, antibiotic duration, and the use of systemic corticosteroids. Conclusions: The panel formulated and provided the rationale for recommendations on selected diagnostic and treatment strategies for adult patients with CAP.

AbstractDocumentation burden contributes to health professional burnout and negatively impacts health professional well-being and patient care quality. Yet, there is a gap in the literature regarding an effective measure to assess the perceived documentation burden of health professionals in a wide range of care settings over time.We developed and administered a pulse survey to trend, with subsequent administrations, the perceived documentation burden of health professionals in all care settings in the United States over time.A multimethods approach was used which included conducting a scoping review of the literature to identify and then curate a set of potential survey items based on scoping review results. Next, a modified Delphi approach was used with clinical informatics experts for consensus-driven item selection and pulse survey development. Finally, we administered the pulse survey nationally using snowball sampling through professional listservs and networks of organizations.The scoping review helped to identify constructs and items to include on the pulse survey. After four iterations of the modified Delphi approach, consensus was reached on five final items for the pulse survey, labeled “TrendBurden.” The first administration of “TrendBurden” was completed by 1,253 healthcare professionals in April 2024. Most respondents (73.26%) disagreed that the time and effort spent documenting patient care is appropriate, with 77.42% reporting finishing work later or needing to work from home due to excessive documentation tasks. Seventy-four point three-eight percent agreed that the effort or time required to complete documentation tasks impedes patient care, and less than one-third (31.76%) agreed that the EHR is easy to use.The “TrendBurden” Pulse Survey was developed through a scoping review of the literature and expert consensus. The resulting five-question pulse survey was administered nationally and provided insight into current perceptions of documentation burden among healthcare professionals.

The use of temporary mechanical circulatory support in refractory heart failure cardiogenic shock (HFCS) has risen, leading to potential complications. Post-Cardiac Injury Syndrome (PCIS) from Impella insertion is rare but may result from subclavian artery manipulation and aortic irritation. We report the first case of pericarditis (PCIS) caused by Impella 5.5 insertion in an HFCS patient awaiting heart transplantation. The patient developed chest pain, tachycardia, and hypotension post-Impella insertion. Laboratory results and electrocardiograms confirmed PCIS. Treatment with Ibuprofen and Colchicine was successful. He received a heart transplant 14 days later. This case emphasizes recognizing iatrogenic pericarditis after Impella insertion and the need to avoid additional myocardial strain.

Background: Diabetic patients experience carpal tunnel syndrome (CTS) at high rates, have increased symptom severity, and experience prolonged recovery after carpal tunnel release (CTR). This study assessed the association of glucagon-like peptide-1 receptor agonist (GLP-1) therapy with postoperative outcomes after CTR in type II diabetic patients with CTS. Methods: Using the PearlDiver database, 25 229 diabetic patients with CTS who underwent CTR and were prescribed GLP-1 therapy were identified and exact matched to 25 229 controls based on age, sex, Elixhauser comorbidity index, tobacco use, obesity, hypothyroidism, and body mass index where available. Demographic variables and comorbidities were compared between groups using Kruskal-Wallis analyses for continuous variables and chi-square tests for categorical variables. Bivariate logistic regression analysis was conducted for 90-day outcomes and 2-year CTR revision. Results: Patients on GLP-1 therapy had decreased risk of 90-day medical complications (odds ratio [OR] = 0.90; 95% confidence interval [CI], 0.84-0.96) and hospital readmission (OR = 0.85; 95% CI, 0.77-0.94) of 0.5% and 0.4%, respectively, compared with controls. No significant differences were found in 90-day surgical complications or 2-year revision rates between cohorts. There were no cases of aspiration pneumonia. The GLP-1 cohort had increased odds of higher 90-day total costs of care (OR = 2.42; 95% CI, 1.88-3.15). Conclusions: GLP-1 therapy is associated with reduced risk of 90-day medical complications and hospital readmission following CTR in diabetic patients, suggesting these medications may optimize comorbidity profiles via glucose control preoperatively. Future studies may examine whether GLP-1 therapy is associated with minimum clinically important difference in patient-reported outcome measures for CTS in diabetic patients.

Background: To evaluate the safety of Aliya pulsed electric field (PEF) ablation in lung lesions at the time of biopsy before first-line standard of care (SOC) therapy in patients with metastatic cancer. Methods: Eligible patients requiring diagnostic biopsy for suspected metastatic lung lesions were enrolled. Treatment-naive lesions ≤5 cm were PEF ablated bronchoscopically or percutaneously. Procedure and/or device-related adverse events (AE) or serious adverse events (SAEs) and their effects on subsequent therapy were assessed from PEF ablation through 30 days. Results: Forty-four lesions from 30 enrolled patients were ablated using PEF with 3-dimensional image guidance immediately following diagnostic biopsy under general anesthesia. Ninety percent (27/30) were ablated bronchoscopically with robotic navigation. One to 3 lesions (range: 0.4 to 2.4 cm longest diameter) were ablated per patient, including 17 within 1 cm of the pleura or a fissure. One procedure-related SAE (pneumothorax) occurred at the time of percutaneous biopsy and PEF ablation and resolved without sequelae. No AE impacted planned therapy initiation. Limited changes to the lung parenchyma in and around the PEF ablation zone were observed on CT scans 30 days post-PEF ablation. Conclusion: This study demonstrates PEF ablation of lung lesions at the time of diagnostic biopsy is safe. One PEF-related SAE occurred within 30 days of PEF and resolved without sequelae. Ablation adjacent to sensitive structures was feasible, safe, and without impact on subsequent therapy.