Citations

ABSTRACT Aims Common genetic variants have been linked to an increased risk of non-ischaemic cardiomyopathy (NICM). The primary objective of this study was to evaluate the significance of these variants in a general population. Methods and results Thirteen NICM risk alleles, previously validated by meta-analyses of case-control genetic association studies, were used to determine genetic risk (GR) in a large, unselected cohort (n = 1897) of Olmsted County residents aged >45 years. Clinical and echocardiographic data, with biomarkers, were correlated with this NICM-GR over a median of 16 years of follow-up (interquartile range [IQR] 15–17). There were no significant differences between the study population quartiles, based on NICM-GR, in terms of age (median 61.6 [IQR 53.6–70.4]), sex (48% male), and cardiovascular risk factors. A significant correlation was detected by specific linear-regression models between NICM-GR and left ventricular (LV) ejection-fraction (beta [standard error]: −2.68 [0.68], p < 0.001), LV end-systolic-diameter (0.22 [0.06], p < 0.001), and LV end-diastolic-diameter (0.14 [0.06], p = 0.01). During follow-up, 46 subjects developed NICM. Using a 3:1 matched-cohort of non-NICM versus NICM patients, linear-regression analysis found a significant correlation between NICM-GR and NICM development (odds ratio 2.27, 95% confidence interval 1.06–4.85, p = 0.03). There was no significant association between these variants and heart failure biomarkers (aldosterone, natriuretic peptides, ST2, galectin-3). Conclusions The NICM-GR correlates with LV function and dimension, and subsequent development of NICM in the general population. The lack of correlation of these variants with cardiovascular risk factors and the renin–angiotensin–aldosterone axis or natriuretic peptides suggest different biological mechanisms involved. These findings support the need to explore newer pathophysiologic pathways in the development of NICM.

Background: Plantar vein thrombosis (PVT) is a rare cause of unilateral plantar foot pain not commonly assessed during sonographic scans for venous thromboembolic evaluation. The present study aims to increase awareness of PVT when evaluating musculoskeletal conditions and to discuss the utility and characteristic imaging findings of PVT on magnetic resonance imaging (MRI). Methods: This is a retrospective chart review identifying patients with suspected PVT via search of a single institution’s radiology reports. Twelve patients had an available lower extremity MRI. These 12 MRIs were independently reviewed by 2 fellowship-trained musculoskeletal radiologists for common imaging characteristics. Of note, only 7 of the 12 available imaging studies contained MRI findings consistent with PVT as determined by the radiology reviewers. For these 7 patients, clinical characteristics were also recorded. Results: Between both radiology reviewers, there was 100% agreement confirming, localizing, and describing the findings of PVT. Of the 7 cases of MRI-confirmed PVT, 6 of 7 studies were performed without contrast and 1 of 7 was performed with and without contrast. The lateral plantar vein was the predominant vein involved in 85.7% (6/7). All 7 cases showed signs of intraluminal signal change, venous enlargement, and muscle edema. Two cases (28.6%, 2/7) displayed collateralization and/or enlargement of surrounding veins. In the only MRI performed with contrast, perivascular enhancement and a filling defect were noted. Conclusion: In the evaluation of a painful foot, an MRI can be used to diagnose PVT reliably and may have several advantages over compression ultrasonography (US) because of its ability to identify other unsuspected etiologies of a painful foot and elimination of technical limitations of compression US in the plantar foot region.

Abstract Introduction The new preference-informed allocation (PIA) system introduced for the 2024 UK cohort Foundation Programme (UKFPO) marks a shift away from the traditional meritocratic ‘ranking’ used in previous years. Instead of appointment to Foundation Programme places, PIA is a computer-generated allocation and deanery preferencing system. This change has raised numerous concerns among both students and clinicians. Aims To investigate the opinions of medical students on the new UKFPO PIA system. Methodology An online questionnaire was distributed to medical students graduating in 2024, 2025, or 2026 across the UK. Results In total, 2297 responses were collected and 2288 were included in the study. Overall, 51.6% (n = 1183) of respondents felt the PIA system was unfair, 76.3% (n = 1746) felt they had lost control of their application, and 46.3% (n = 1049) had noticed a negative effect on their physical or mental health. Notably, 48.2% (n = 1094) of students who responded are now considering a career outside the National Health Service (NHS). Conclusions Overall, the PIA system falls short of students’ expectations and has led to record numbers of students considering careers outside the NHS. Further changes to this system are needed and should aim to address fairness and equity while rewarding students for their hard work. According to these data, the PIA system risks further deteriorating workforce morale and attrition rates.

Acute right ventricular failure (ARVF) is commonly seen in the intensive care unit and constitutes a significant clinical challenge, with associated high in-hospital mortality. Recently, the treatment of ARVF has significantly changed, with the progressive implementation of mechanical circulatory support devices that now represent important tools for clinicians in treating this condition. However, despite recent advancements, the optimal approach for ARVF remains elusive, and precise treatment algorithms and comprehensive management protocols are still lacking. In the present review, we explore the pathophysiology of ARVF, highlighting the different mechanisms that may lead to this clinical entity and emphasizing the left and right heart’s complex interplay. We analyze the different therapeutic options that are now available for short- and long-term management of ARVF, with a particular focus on the advantages and disadvantages of the mechanical circulatory support devices actually used. Furthermore, we propose future directions in the field and a possible flowchart for the treatment of this condition.