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Background: Patients with active cancer and aortic stenosis may be under-referred for valve interventions due to concerns over a prohibitive risk. However, whether active cancer impacts outcomes after transcatheter aortic valve replacement (TAVR) remains unknown., Methods: We searched PubMed, Embase, and Cochrane Library in December 2023 for studies comparing the post-TAVR outcomes of patients with versus without active cancer. We pooled odds ratios (OR) and adjusted hazard ratios (aHR) with 95% confidence intervals (CI) applying a random-effects model. Statistical analyses were performed in R version 4.3.2., Results: We included nine observational studies analyzing 133,906 patients, of whom 9,792 (7.3%) had active cancer. Compared with patients without cancer, patients with active cancer had higher short- (OR 1.33; 95% CI 1.15-1.55; p < 0.001) and long-term mortality (OR 2.29; 95% CI 1.80-2.91; p < 0.001) rates, not driven by cardiovascular mortality (OR 1.30; 95% CI 0.70-2.40; p = 0.40), and higher major bleeding rates (OR 1.66; 95% CI 1.15-2.42; p = 0.008). The higher mortality rate was sustained in an adjusted analysis (aHR 1.77; 95% CI 1.34-2.35; p < 0.001). There was no significant difference in cardiac, renal, and cerebral complications at a follow-up ranging from 180 days to 10 years., Conclusion: Patients with active cancer undergoing TAVR had higher non-cardiovascular mortality and bleeding rates, with comparable incidences of other complications. This highlights the need for a shared decision and appropriate patient selection considering cancer type, staging, bleeding risk, and optimal timing for intervention., (© 2024. The Author(s).)

Donor vessel fractional flow reserve (FFR) usually increases following successful chronic total occlusion (CTO) percutaneous coronary intervention, as documented by pressure wires. In this case, donor vessel physiology changes were assessed using FFR derived from coronary computed tomography angiography (CCTA) and an artificial Intelligence-guided quantitative CCTA ischemia model in combination with pressure wire-based FFR., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Bovine pericardium (BP) is widely used as a biomaterial for tissue engineering. Glutaraldehyde and formaldehyde are commonly employed in the reticulation processes to enhance the material's resistance and preservation. In this study, we assessed the impact of long-term storage in 4% formaldehyde on the quantitative expression of immunophenotypic markers in glutaraldehyde-treated BP. Histologic and immunohistochemical analyses were performed on 2 BP patches, manufactured in 2009 and 2020, respectively. Braile Biomédica provided the BP patches. Sections of BP were stained with H&E, Weigert, and picrosirius red, followed by immunolabeling for vimentin, laminin 5, collagen I, and collagen IV using a standardized protocol. Microscopic images were captured using light and polarized microscopy, and the area of the antibody signal was quantified using Image J Software. Histologic analysis showed no autolysis or significant changes in the patches. Immunohistochemical analysis revealed a diffuse distribution of collagen I and collagen IV throughout the connective tissue of the patches. The 2020 specimen exhibited higher expression levels of collagen I (21.36%) and collagen IV (24.67%) compared with the 2009 specimen (collagen I: 15.87%; collagen IV: 12.02%). Laminin did not show reactivity in either specimen. Notably, vimentin immunopositivity differed significantly between the patches, with a larger area of expression observed in the 2020 patch (54%) compared with the 2009 patch (13%). In summary, there were no substantial differences in immunophenotypic expression between the 2009 and 2020 BP patches, except for the higher vimentin expression in the 2020 BP patch., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

In complex chronic total occlusion (CTO) percutaneous coronary interventions (PCI), a retrograde crossing strategy is often necessary. Recently, the Japanese retrograde (JR) CTO score was developed using a simple 4-item tool. This score showed a good performance in predicting guidewire crossing failure in patients undergoing primary retrograde CTO PCI. We evaluated the JR-CTO score’s performance in patients treated at 44 centers between 2013 and 2024 as part of the Prospective Global Registry for the Study of CTO Intervention (PROGRESS-CTO). In an independent cohort, although the JR-CTO score showed an association with crossing and technical failure, its predictive ability for both outcomes was modest.

Background: The impact of peripheral artery disease (PAD) on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is not well studied., Methods: We analyzed the association of PAD with CTO-PCI outcomes using data from the PROGRESS-CTO registry of procedures performed at 47 centers between 2012 and 2023., Results: The prevalence of PAD among 12 961 patients who underwent CTO PCI during the study period was 13.9% (1802). PAD patients were older, more likely to be current smokers, and had higher rates of dyslipidemia, diabetes, cerebrovascular disease, hypertension, prior myocardial infarction, PCI, and coronary artery bypass graft surgery. Their PROGRESS-CTO (1.35 vs 1.22; P < .001) and J-CTO (2.63 vs 2.33; P < .001) scores were higher, lesion length was longer, and angiographic characteristics were more complex. Their access site was more likely to be bifemoral (33.6% vs 30.9%; P = .024) compared with patients with no PAD. Technical (82.9% vs 87.7%; P < .001) and procedural (80.5% vs 86.6%; P < .001) success rates were lower in patients with PAD, while the incidence of major adverse cardiovascular events (MACE) was higher (3.1% vs 1.8%; P < .001), with higher mortality (0.8% vs 0.4%; P = .034), acute myocardial infarction rate (0.9% vs 0.4%; P = .010), and perforations rate (6.6% vs 4.5%; P < .001). In multivariable analysis, PAD was associated with higher MACE (odds ratio [OR]: 1.53; 95% CI, 1.01-2.26; P = .038) and lower technical success (OR: 0.82; 95% CI, 0.69-0.99; P = .039)., Conclusions: PAD patients undergoing CTO PCI have higher comorbidity burden, more complex CTOs, higher MACE, and lower technical success.

Background: The efficacy and safety of adjunctive low-voltage area (LVA) ablation on outcomes of catheter ablation (CA) for atrial fibrillation (AF) remains uncertain., Methods: PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were searched for randomized controlled trials (RCTs) comparing CA with versus without LVA ablation for patients with AF. Risk ratios (RR) with 95% confidence intervals (CI) were pooled with a random-effects model. Our primary endpoint was recurrence of atrial tachyarrhythmia (ATA), including AF, atrial flutter, or atrial tachycardia. We used R version 4.3.1 for all statistical analyses., Results: Our meta-analysis included 10 RCTs encompassing 1780 patients, of whom 890 (50%) were randomized to LVA ablation. Adjunctive LVA ablation significantly reduced recurrence of ATA (RR 0.76; 95% CI 0.67-0.88; p < .01) and reduced the number of redo ablation procedures (RR 0.54; 95% CI 0.35-0.85; p < .01), as compared with conventional ablation. Among 691 (43%) patients with documented LVAs on baseline substrate mapping, adjunctive LVA ablation substantially reduced ATA recurrences (RR 0.57; 95% CI 0.38-0.86; p < .01). There was no significant difference between groups in terms of periprocedural adverse events (RR 0.78; 95% CI 0.39-1.56; p = .49)., Conclusions: Adjunctive LVA ablation is an effective and safe strategy for reducing recurrences of ATA among patients who undergo CA for AF., (© 2024 Wiley Periodicals LLC.)

Purpose: Total knee arthroplasty (TKA) is associated with severe postoperative pain. Continuous adductor canal blockade provides analgesia while preserving quadriceps muscle strength. Nevertheless, uncertainty still exists as to the optimal adductor canal catheter placement approach. We sought to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the analgesic effects of proximal vs distal adductor canal catheters in patients undergoing TKA., Source: We systematically searched PubMed, EMBASE, and Cochrane for RCTs comparing distal and proximal adductor canal catheters for TKA regarding critical clinical outcomes in adult patients. Statistical analysis was performed using R version 4.1.2 (R Foundation for Statistical Computing, Vienna, Austria). Heterogeneity was assessed using the Cochran Q test and I 2 statistics. Trial sequential analysis (TSA) was performed to evaluate the risk of random errors and the uncertainty of our results. The risk of bias was appraised according to the RoB-2 tool., Principal Findings: Six RCTs and 352 patients were included, of whom 151 (42.9%) were male, and 175 (49.7%) were randomized to undergo proximal adductor canal catheter placement. Due to the randomized nature of the studies, baseline characteristics were similar between groups. There were no statistical differences between proximal and distal adductor canal catheters regarding cumulative opioid consumption in the first 24 hr (mean difference [MD], -4.86; 95% confidence interval [CI], -15.19 to 5.47; P = 0.36; four RCTs; 240 patients); pain scores at rest (MD, 0.41; 95% CI, -1.23 to 0.40; P = 0.32; six RCTs; 350 patients); and pain scores with movement for the first 24 hr (MD, -0.25; 95% CI, -0.85 to 0.35; P = 0.42; four RCTs; 246 patients). In the TSA, the required information size was not reached, and the Z-curve did not cross the monitoring boundaries in any of the endpoints., Conclusion: These findings suggest that proximal vs distal adductor canal catheter placement in patients undergoing TKA may be equally effective for the outcomes of opioid consumption in the first 24 hr, pain scores at rest, and pain scores with movement in the first 24 hr. Nevertheless, TSA findings suggest insufficient power to definitively conclude no differences between the two techniques., Study Registration: PROSPERO (CRD42022353576); registered 25 August 2022., (© 2023. Canadian Anesthesiologists' Society.)

Objective: To verify the impact of preoperative levosimendan on patients with severe left ventricular dysfunction (ejection fraction <35%) undergoing isolated coronary artery bypass grafting., Design: A meta-analysis., Setting: Hospitals., Participants: The authors included 1,225 patients from 6 randomized controlled trials., Interventions: None., Measurements and Main Results: The authors performed a meta-analysis of trials that compared preoperative levosimendan with placebo or no therapy, reporting efficacy and safety endpoints. Statistical analyses used mean differences and risk ratios (RR), with a random effects model. Six studies were included, comprising 1,225 patients, of whom 615 (50.2%) received preoperative levosimendan, and 610 (49.8%) received placebo/no therapy. Preoperative levosimendan showed a lower risk of all-cause mortality (RR 0.31; 95% CI 0.16-0.60; p < 0.01; I 2 = 0%), postoperative acute kidney injury (RR 0.44; 95% CI 0.25-0.77; p < 0.01; I 2 = 0%), low-cardiac-output syndrome (RR 0.45; 95% CI 0.30-0.66; p < 0.001; I 2 = 0%), and postoperative atrial fibrillation (RR 0.49; 95% CI 0.25-0.98; p = 0.04; I 2 = 85%) compared to control. Moreover, levosimendan significantly reduced the need for postoperative inotropes and increased the cardiac index at 24 hours postoperatively. There were no differences between groups for perioperative myocardial infarction, hypotension, or any adverse events., Conclusion: Preoperative levosimendan in patients with severe left ventricular dysfunction undergoing isolated coronary artery bypass grafting was associated with reduced all-cause mortality, low-cardiac-output syndrome, acute kidney injury, postoperative atrial fibrillation, and the need for circulatory support without compromising safety., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: There is a lack of up-to-date estimates about the prevalence of Chagas disease (ChD) clinical presentations and, therefore, we aimed to assess the prevalence of clinical forms of ChD among seropositive adults, pooling available data., Methods: A systematic review was conducted in Medline, Embase, Biblioteca Virtual em Saúde and Cochrane databases looking for studies published from 1990 to August 2023, which investigated the prevalence of ChD clinical forms among seropositive adults, including: (i) indeterminate phase, (ii) chronic Chagas cardiomyopathy (CCM), (iii) digestive and (iv) mixed (CCM + digestive) forms. Pooled estimates and 95% confidence intervals (CI) were calculated using random-effects models. Studies quality and risk of bias was assessed with the Leboeuf-Yde and Lauritsen tool. Heterogeneity was assessed with the I 2 statistic. The study was registered in the PROSPERO database (CRD42022354237)., Findings: 1246 articles were selected for screening and 73 studies were included in the final analysis (17,132 patients, 44% men). Most studies were conducted with outpatients (n = 50), followed by population-based studies (n = 15). The pooled prevalence of the ChD clinical forms was: indeterminate 42.6% (95% CI: 36.9-48.6), CCM 42.7% (95% CI: 37.3-48.3), digestive 17.7% (95% CI: 14.9-20.9), and mixed 10.2% (95% CI: 7.9-13.2). In population-based studies, prevalence was lower for CCM (31.2%, 95% CI: 24.4-38.9) and higher for indeterminate (47.2%, 95% CI: 39.0-55.5) form. In meta-regression, age was inversely associated with the prevalence of indeterminate (β = -0.05, P < 0.001) form, and directly associated with CCM (β = 0.06, P < 0.001) and digestive (β = 0.02, P < 0.001) forms. Heterogeneity was overall high., Interpretation: Compared to previous publications, our pooled estimates show a higher prevalence of CCM among ChD seropositive patients, but similar rates of the digestive form., Funding: This study was funded by the World Heart Federation, through a research collaboration with Novartis Pharma AG., Competing Interests: The authors have no conflicts of interest to disclose regarding this manuscript. Yvonne Geissbu¨hler, Caroline Demacq, and Monica Quijano are Novartis employees and declare stocks of the company., (© 2024 The Author(s).)

Background: Rheumatic mitral stenosis (MS) leads to LA remodeling with disordered electrical activation that may revert with valve intervention. This study aimed to assess the acute and late impact of percutaneous mitral balloon valvuloplasty (PMBV) on LA volume and function in patients with atrial fibrillation (AF) compared with sinus rhythm., Methods: A total of 167 patients with severe MS undergoing PMBV were prospectively enrolled. LA volumes and function were measured by three-dimensional echocardiography (3DE) pre PMBV, within 24 to 48 h after PMBV, and at 1 year., Results: Mean age was 43.5 ± 11.8 years old, and 142 (85%) patients were women. At baseline, 46 patients (27.5%) were in permanent AF, and 62 (37.1%) classified as New York Heart Association functional class III or IV. In sinus rhythm population, LA volumes decreased immediately after PMBV and continue to decrease at 1-year follow-up. LA emptying fraction increased from 23.6 ± 10.4% to 33.8 ± 11.9% acutely after the procedure (p < 0.001), and to 37.2 ± 13.2% at 1-year follow-up (p = 0.028). Patients with AF only had a significant decrease in LA minimum volume immediately after PMBV, with no significant changes in maximum volume either immediately or at follow-up. In these patients, LA emptying fraction increased immediately after the procedure from 15.8 ± 9.9% to 22.8 ± 9.8 (p = 0.001) with no evidence for additional improvement at the 1-year follow-up. Age, and post-procedural mean gradient were identified as the most significant factors associated with the absolute changes in LA function between baseline and the 1-year follow-up., Conclusions: In patients with severe MS, the impact of PMBV on LA volume and function varies according to cardiac rhythm. In patients in sinus rhythm, the procedure leads to improvement of LA volumes and function both acutely and at 1-year follow-up. Patients with AF had a lesser improvement in LA function immediately after the procedure, without further improvement over time despite adequate relief of valve obstruction., Competing Interests: Declaration of competing interest The authors have no relevant conflicts of interest to disclose regarding this study., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: The optimal antithrombotic therapy following left atrial appendage occlusion (LAAO) in patients with nonvalvular atrial fibrillation (AF) remains uncertain., Objectives: In this study, the authors sought to compare the efficacy and safety of various antithrombotic strategies after LAAO., Methods: We searched the Medline, Cochrane, EMBASE, LILACS, and ClinicalTrials.gov databases for studies reporting outcomes after LAAO, stratified by antithrombotic therapy prescribed at postprocedural discharge. Direct oral anticoagulants (DOACs), vitamin K antagonists (VKAs), single antiplatelet therapy (SAPT), dual antiplatelet therapy (DAPT), DOAC plus SAPT, VKA plus SAPT, and no antithrombotic therapy were analyzed. We performed a frequentist random effects model network meta-analysis to estimate the OR and 95% CI for each comparison. P-scores provided a ranking of treatments., Results: Forty-one studies comprising 12,451 patients with nonvalvular AF were included. DAPT, DOAC, DOAC plus SAPT, and VKA were significantly superior to no therapy to prevent device-related thrombosis. DOAC was associated with lower all-cause mortality than VKA (OR: 0.39; 95% CI: 0.17-0.89; P = 0.03). Compared with SAPT, DAPT was associated with fewer thromboembolic events (OR: 0.50; 95% CI: 0.29-0.88; P = 0.02), without a difference in major bleeding. In the analysis of P-scores, DOAC monotherapy was the strategy most likely to have lower thromboembolic events and major bleeding., Conclusions: In this network meta-analysis comparing initial antithrombotic therapies after LAAO, monotherapy with DOAC had the highest likelihood of lower thromboembolic events and major bleeding. DAPT was associated with a lower incidence of thromboembolic events compared with SAPT and may be a preferred option in patients unable to tolerate anticoagulation., Competing Interests: Funding Support and Author Disclosures Dr Darmon has served as a consultant for Boston Scientific and Bayer; and has received research grants from Abbott and Alvimedica. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: Tirzepatide is a dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist approved for type 2 diabetes. We performed a meta-analysis to assess tirzepatide's weight reduction efficacy and safety., Methods: We searched PubMed, Embase, and Cochrane for randomized controlled trials published from inception to July 2022, comparing tirzepatide with placebo for the co-primary endpoints of absolute and percent change in weight. Mean difference (MD) and odds ratio (OR) were calculated for continuous and binary outcomes, respectively. Review Manager 5.4.1 and RStudio were used for the statistical analysis, and RoB-2 (Cochrane) to assess the risk of bias., Results: Of 397 search results, 6 studies (4036 participants) ranging from 12 to 72 weeks were included. Pooled analysis showed that tirzepatide 5 mg, 10 mg, and 15 mg were more effective than placebo, with MD in body weight of -7.7 kg (95% CI -11.0, -4.4; p < 0.001), -11.6 kg (95% CI -18.8, -4.3; p = 0.002), and -11.8 kg (95% CI -17.4, -6.2; p < 0.001), respectively, and MD in percent change in weight of -8.1% (95% CI -11.0, -5.2; p < 0.001), -11.9% (95% CI -18.1, -5.6; p < 0.001), and -12.4% (95% CI -17.2, -7.5; p < 0.001), respectively. Tirzepatide also reduced BMI and waist circumference. Adverse events were more common with tirzepatide with respect to nausea (OR 4.2; 95% CI 2.4, 7.5; p < 0.001), vomiting (OR 7.0; 95% CI 4.3, 11.4; p < 0.001), and diarrhea (OR 2.8; 95% CI 1.6, 4.9; p < 0.001) (15 mg dose), when compared with placebo., Conclusions: The results support that tirzepatide leads to substantial weight reduction and constitutes a valuable therapeutic option for weight management, despite an increase in gastrointestinal symptoms., Protocol Registration: CRD42022348576., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: We sought to compare cardiovascular outcomes, renal function, and diuresis in patients receiving standard diuretic therapy for acute heart failure (AHF) with or without the addition of SGLT2i., Methods and Results: Systematic search of three electronic databases identified nine eligible randomized controlled trials involving 2,824 patients. The addition of SGLT2i to conventional therapy for AHF reduced all-cause death (odds ratio [OR] 0.75; 95% CI 0.56-0.99; p = 0.049), readmissions for heart failure (HF) (OR 0.54; 95% CI 0.44-0.66; p < 0.001), and the composite of cardiovascular death and readmissions for HF (hazard ratio 0.71; 95% CI 0.60-0.84; p < 0.001). Furthermore, SGLT2i increased mean daily urinary output in liters (mean difference [MD] 0.45; 95% CI 0.03-0.87; p = 0.035) and decreased mean daily doses of loop diuretics in mg of furosemide equivalent (MD -34.90; 95% CI [- 52.58, - 17.21]; p < 0.001) without increasing the incidence worsening renal function (OR 0.75; 95% CI 0.43-1.29; p = 0.290)., Conclusion: SGLT2i addition to conventional diuretic therapy reduced all-cause death, readmissions for HF, and the composite of cardiovascular death or readmissions for HF. Moreover, SGLT2i was associated with a higher volume of diuresis with a lower dose of loop diuretics., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Background: Pretreatment with oral P2Y12 inhibitors is a standard practice for ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI). However, the efficacy and safety of P2Y12 inhibitors pretreatment remain unclear., Objectives: We conducted a meta-analysis to investigate the impact of P2Y12 inhibitor pretreatment on thrombotic and hemorrhagic endpoints in STEMI patients., Methods: We searched multiple databases for studies that compared P2Y12 inhibitor pretreatment with no pretreatment in STEMI patients and reported endpoints of interest. Random effects model was used for the meta-analysis., Results: Our meta-analysis included 3 randomized controlled trials and 14 observational studies, comprising 70,465 patients assigned to either P2Y12 inhibitor pretreatment (50,328 patients) or no pretreatment (20,137 patients). Compared to no pretreatment, P2Y12 inhibitor pretreatment did not result in significant reductions in all-cause mortality (risk ratio [RR] 0.73; 95% confidence interval [CI]: 0.52-1.03; p = 0.07), myocardial infarction (RR 0.75; 95% CI: 0.53-1.07; p = 0.11), or major bleeding (RR 0.80; 95% CI: 0.56-1.16; p = 0.22) at 30 days. However, our subgroup analysis revealed that P2Y12 inhibitor pretreatment administered in the pre-hospital setting was associated with a significant reduction in the incidence of myocardial infarction compared to no pretreatment (RR 0.73; 95% CI: 0.56-0.91; p < 0.01)., Conclusion: Our analysis suggests that pretreatment with oral P2Y12 inhibitors before PCI in patients with STEMI was not associated with reduced all-cause mortality, myocardial infarction, or major bleeding. However, pretreatment with P2Y12 inhibitors in the pre-hospital setting appears to be beneficial in reducing reinfarction., (© 2023 Wiley Periodicals LLC.)

Background: Hyperkalemia leads to suboptimal use of evidence-based therapies in patients with heart failure (HF). Therefore, we aimed to assess whether new potassium binders are effective and safe to promote medical optimization in patients with HF., Methods: MEDLINE, Cochrane, and Embase were searched for randomized controlled trials (RCTs) that reported outcomes after initiation of Patiromer or Sodium Zirconium Cyclosilicate (SZC) versus placebo in patients with HF at high risk of hyperkalemia development. Risk ratios (RR) with 95% confidence intervals (CI) were pooled with a random effects model. Quality assessment and risk of bias were performed according to Cochrane recommendations., Results: A total of 1432 patients from 6 RCTs were included, of whom 737 (51.5%) patients received potassium binders. In patients with HF, potassium binders increased the use of renin-angiotensin-aldosterone inhibitors (RR 1.14; 95% CI 1.02-1.28; p = 0.021; I 2  = 44%) and reduced the risk of hyperkalemia (RR 0.66; 95% CI 0.52-0.84; p < 0.001; I 2  = 46%). The risk of hypokalemia was significantly increased in patients treated with potassium binders (RR 5.61; 95% CI 1.49-21.08; p = 0.011; I 2  = 0%). There was no difference between groups in all-cause mortality rates (RR 1.13; 95% CI 0.59-2.16; p = 0.721; I 2  = 0%) or in adverse events leading to drug discontinuation (RR 1.08; 95% CI 0.60-1.93; p = 0.801; I 2  = 0%)., Conclusion: The use of new potassium binders Patiromer or SZC in patients with HF at risk for hyperkalemia increased the rates of medical therapy optimization with renin-angiotensin-aldosterone inhibitors and reduced the incidence of hyperkalemia, at the cost of an increased prevalence of hypokalemia., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Purpose: To investigate if Antibiotic Prophylaxis (AP) can prevent wound and/or systemic infection in pediatric patients who underwent Percutaneous Endoscopic Gastrostomy (PEG)., Methods: PubMed, Embase, and Cochrane databases were searched for Randomized Controlled Trials (RCT) and Observational Studies that compared AP vs. no Intervention (NI) in children submitted to PEG. Odds ratios (OR) with 95% confidence intervals (CI) were pooled with random-effect models. Quality assessment and risk of bias were performed as outlined by Cochrane recommendations., Results: Four studies, including one RCT, with a total of 568 patients were included, in which 230 (40.5%) individuals received AP. The use of AP during PEG reduced the incidence of systemic infection (OR 0.46; 95% CI 0.24-0.90; p = 0.02; I 2  = 0). However, no statistical difference was found for wound infection (OR 0.85; 95% CI 0.43-1.69; p = 0.64; I 2  = 12%) and for the composite outcome of any kind of infection (OR 0.74; 95% CI 0.13-4.06; p = 0.73; I 2  = 67%)., Conclusion: In this pooled analysis of 568 infants who underwent PEG, the use of AP reduced the incidence of systemic infection. Our results were compatible with findings obtained in the adult population. No differences were found regarding wound infection or the composite outcome of any kind of infection., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: The efficacy and safety of percutaneous coronary interventions (PCI) relative to coronary artery bypass grafting (CABG) in patients with diabetes and unprotected left main coronary artery disease (LMCAD) are not well established., Objectives: To perform a meta-analysis evaluating the long-term outcomes after PCI with drug-eluting stents (DES), as compared with CABG, in patients with diabetes and unprotected LMCAD., Methods: MEDLINE, Cochrane, and Embase were searched for randomized controlled trials (RCTs) that reported outcomes after PCI with DES versus CABG in unprotected LMCAD among patients with diabetes. To evaluate the long-term effects of these interventions, we restricted this analysis to studies with a minimum follow-up period of 3 years. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled with a random-effects model. Quality assessment and risk of bias were performed according to Cochrane recommendations., Results: Four RCTs with a total of 1080 patients were included, 553 (51.2%) of whom underwent PCI. There was no difference for individual outcomes of all-cause mortality (RR: 1.21; 95% CI: 0.86-1.71; p = .27; I 2  = 28%), cardiovascular death (RR 1.29; 95% CI: 0.76-2.18; p = .34; I 2  = 0%), or myocardial infarction (MI) (RR: 0.94; 95% CI: 0.61-1.45; p = .79; I 2  = 0%). However, the risk of stroke was reduced with PCI relative to CABG (RR: 0.41; 95% CI: 0.18-0.94; p = .04; I 2  = 0%), whereas the risk of any repeat revascularization was higher in the PCI group (RR: 1.99; 95% CI: 1.44-2.75; p < .001; I 2  = 0%). The risk of the composite outcome of all-cause mortality, MI, stroke, or repeat revascularization was higher after PCI compared with CABG (RR: 1.30; 95% CI: 1.09-1.56; p = .004; I 2  = 0%)., Conclusion: In this meta-analysis with more than 1000 patients with diabetes and unprotected LMCAD followed for a minimum of 3 years, the incidence of repeat revascularization was higher among those treated with PCI, whereas the risk of stroke was higher in patients treated with CABG., (© 2022 Wiley Periodicals LLC.)

The COVID-19 pandemic affected almost all aspects of our lives, including the education sector and the way of teaching and learning. In March 2020, health authorities in Brazil imposed social isolation and the interruption of on-site activities in schools and universities. In this context, the Federal University of Minas Gerais (UFMG), one of the largest universities in Brazil and Latin America, developed an emergency remote learning (ERL) plan that allowed the return of classes in an online format and supported students to obtain access to equipment and internet network. Within this new perspective, the Undergraduate Teaching Assistant (UTA) program of the Department of Physiology and Biophysics (DFIB) explored strategies to minimize the impact of the absence of face-to-face classes. Using different available tools in online platforms and social media such as Microsoft Teams, YouTube animated video classes, and Instagram, the UTA program assisted >500 undergraduate students and strongly supported professors during ERL. In just over a year, our video classes on YouTube Channel reached ∼40,000 views. Most of the students reported that their questions were fully and quickly solved by the UTA program. Collectively, our results indicate that the strategies implemented by the UTA program helped the undergraduate students and professors to adapt to a remote learning format.