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INTRODUCTION: Pancreatic ductal adenocarcinoma is associated with significant morbidity and mortality as most patients present with advanced disease. The development of ascites has been associated with poor outcomes and further characterization and contemporary management strategies are needed. METHODS: A total of 437 patients enrolled in the Gastrointestinal Biobank at Cedars-Sinai Medical Center who had epithelial pancreatic malignancy were included in the prospective cohort group. Overall, 41.7% of patients included in this study developed ascites. Most patients with ascites (>80%) had high serum-ascites albumin gradient ascites. In both univariate and multivariate analysis, a history of ≥1 form of chemotherapy was significantly associated with ascites. Estimated median overall survival in patients with ascites was significantly lower than in patients without ascites, 473 days vs 573 days, and ascites had a hazard ratio of 1.37. RESULTS: Patients with ascites who received diuretics and indwelling peritoneal catheter had an estimated median survival of 133 days from diagnosis of ascites, and those who received only the indwelling peritoneal catheter without diuretics had an estimated median survival of only 54 days. The estimated median survival from the diagnosis of ascites was 92 days, and the median time to puncture was 7 days. The median time from first tap to death was 45 days. DISCUSSION: The use of diuretics is lower than would be expected for patients with pancreatic ductal adenocarcinoma with elevated serum-ascites albumin gradient. Other therapies such as beta blockers should be investigated in this subset of patients. The etiology of ascites in these patients is poorly understood, and further research is needed to establish treatment guidelines and improve outcomes.

BACKGROUND: The effect of contact force (CF) on lesion formation is not clear during pulsed field ablation (PFA). The aim of this study was to evaluate the impact of CF, PFA, and their interplay through the PFA index (PF index) formula on the ventricular lesion size in swine. METHODS: PFA was delivered through the CF-sensing OMNYPULSE catheter. Predefined PFA applications (×3, ×6, ×9, and ×12) were delivered maintaining low (5-25 g), high (26-50 g), and very high (51-80 g) CFs. First, PFA lesions were evaluated on necropsy in 11 swine to investigate the impact of CF/PFA-and their integration in the PF index equation-on lesion size (study characterization). Then, 3 different PF index thresholds-300, 450, and 600-were tested in 6 swine to appraise the PF index accuracy to predict the ventricular lesion depth (study validation). RESULTS: In the study characterization data set, 111 PFA lesions were analyzed. CF was 32±17 g. The average lesion depth and width were 3.5±1.2 and 12.0±3.5 mm, respectively. More than CF and PFA dose alone, it was their combined effect to impact lesion depth through an asymptotically increasing relationship. Likewise, not only was the PF index related to lesion depth in the study validation data set (r2=0.66; P

Extended reality (XR) technologies are emerging as promising platforms for medical training and procedural guidance, particularly in complex cardiac interventions. This paper presents a high-fidelity methodology to perform real-time 3D catheter tracking and visualization during simulated cardiac interventions. A custom 3D-printed setup with mounted cameras enables biplane video capture of a catheter. A computer vision algorithm processes the biplane images in real-time to reconstruct the 3D catheter trajectory represented by any designated number of points along its length. This method accurately localizes the catheter tip within 1 mm and can reconstruct any arbitrary catheter configuration. The tracked catheter data is integrated into an interactive Unity-based scene rendered on the Meta Quest 3 headset. The visualization seamlessly combines a reconstructed 3D patient-specific heart model with the dynamically tracked catheter, creating an immersive extended reality training environment. Our experimental study, involving six participants, demonstrated that the 3D visualization provided by the proposed XR system significantly outperformed 2D visualization in terms of speed and user experience. This suggests that the XR system has the potential to enhance catheterization training by improving spatial comprehension and procedural skills. The proposed system demonstrates the potential of XR technologies to transform percutaneous cardiac interventions through improved visualization and interactivity. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionUrinary tract infections (UTIs) are prevalent among patients carrying indwelling catheters in the intensive care unit (ICU). This study investigates antibiotic use and bacterial colonisation among ICU patients during the third wave of the COVID-19 pandemic, building on our prior discovery of increased Enterococcus colonisation associated with increased cephalosporin use in early COVID-19.Longitudinal urine samples from COVID-19 patients (n = 109) with transurethral catheterisation were analysed for bacterial prevalence, further identified via MALDI-TOF. Microbiological results were combined with clinical data obtained daily, assessed and compared with COVID-19 waves 1 and 2.Patients in wave 3 exhibited improved outcomes compared to those in waves 1 and 2, alongside a decrease in antibiotic use. Staphylococcus emerged as the primary bacterium and early colonizer of the urinary tract, potentially due to the absence of antibiotic treatment. Our results imply that length of stay (LOS) correlates solely with enteric pathogens and that antibiotic treatment correlates with colonisation by certain uropathogens, whereas the absence of antimicrobial therapy is associated with rapid colonisation of skin flora. Polymicrobial colonisation was common, predominantly involving Gram-positive bacteria.Our findings underscore the complexity of bacteriuria in ICU patients, advocating for targeted surveillance and tailored antibiotic approaches to mitigate UTI risk. Insights into antibiotic use and bacterial colonisation are vital for optimising stewardship practices, combating antimicrobial resistance, and enhancing ICU patient outcomes. [ABSTRACT FROM AUTHOR]

Background: This study was designed to evaluate the clinical benefit of double-lumen port catheters in patients receiving chemotherapy and parenteral nutrition concurrently or in those with vascular access failure. The advantages, complications, indications and duration of use of double port-a-cath were considered. Methods: Thirteen Brazilian patients received a double-lumen port catheter that was implanted under ultrasonographic and fluoroscopic guidance in the radiologic interventional suite. Results: All double-lumen port systems were successfully implanted in all patients without immediate complications. The port-a-cath was removed in two patients due to infection of the reservoir. Three deaths occurred due to underlying disease with no correlation to the port-a-cath. No temporal interference between the administration of chemotherapy and parenteral nutrition was observed. Conclusion: The double-door approach is a safe technique with low complication rates. Indications for use of the dual port are numerous and should be encouraged because of the considerable benefits for critically ill patients. [ABSTRACT FROM AUTHOR]

To evaluate the efficacy of the Aurie System, a preclinical prototype allowing for standardized intermittent catheter (IC) reuse of novel reusable no-touch ICs. Individuals with neurogenic bladder often require single-use ICs to urinate, but urinary tract infection (UTI) is a common cause of morbidity for IC users. Safer no-touch catheters are not easily affordable, and the Aurie System attempts to provide no-touch catheters at a fraction of the price by allowing for standardized and safe IC reuse. Standard ICs were inoculated with Escherichia coli and Pseudomonas aeruginosa and incubated for 48 hours to assess microbial burden and biofilm formation (the latter using infrared fluorescence imaging). This procedure was repeated with Aurie ICs, focusing on evaluating catheter microbial burden after inoculation and reprocessing with the prototype washer-disinfector. This was repeated with up to 100 cycles to evaluate repetitive use. Standard ICs showed bacterial attachment and biofilm development peaking at 24 hours of incubation. The Aurie catheters produced a similar outcome but, after reprocessing, microbial burden was reduced below the level of detection. Repeat cycles showed pathogen clearance to similar levels. One catheter reached 100 cycles and there was no viable pathogen load after reprocessing. Intermittent urinary catheters, when cleaned inappropriately, can harbor viable bacteria and biofilm. The Aurie System, when used to disinfect novel reusable ICs within a prototype reprocessing device, can reduce microbial burden below level of detection even after 100 cycles. This suggests the Aurie System may be a feasible technology for safe IC reuse. [ABSTRACT FROM AUTHOR]

Background: Safety data of the latest radiofrequency (RF) technologies during atrial fibrillation (AF) ablation in real‐world clinical practice are limited. Objectives: We sought to evaluate the acute procedural safety of the four latest ablation catheters commonly used for AF ablation. Methods: A total of 3957 AF ablation procedures performed between January 2022 and December 2023 at 20 centers with either the THERMOCOOL SMARTTOUCH SF (STSF), TactiCath (TC), QDOT Micro (QDM), or TactiFlex (TF) were retrospectively analyzed. Results: In total, QDM, STSF, TF, and TC were used in 343 (8.7%), 1793 (45.3%), 1121 (28.4%), and 700(17.7%) procedures. Among 2406 index procedures, electrical pulmonary vein isolations were successfully achieved in 99.5%. Despite similar total procedure times in the four groups, the total fluoroscopic time was significantly shorter for QDM/STSF with CARTO than TF/TC with EnSite (18.7 ± 14 vs. 27.6 ± 20.6 min, p <.001) and longest in the TF group. The incidence of cardiac tamponade was 0.7% (0.5% and 0.9% during index and redo procedures, 0.8% and 0.3% for paroxysmal and non‐paroxysmal AF) and was significantly lower for QDM/STSF than TF/TC (0.2% vs. 1.1%, p =.008) and highest in the TF group. The incidence of cardiac tamponade was higher for TF than TC and STSF than QDM. In the multivariate analysis, TF/TC with EnSite was a significant independent predictor of cardiac tamponade during both the index (odds ratio [OR] = 4.8, 95% confidence interval [CI] = 1.3–17.5, p =.02) and all procedures (OR = 3.0, 95% CI = 1.3–7.2, p =.01). Conclusions: The incidence of cardiac tamponade and the fluoroscopic time during AF ablation significantly differed among the latest RF catheters and mapping systems in real‐world clinical practice. [ABSTRACT FROM AUTHOR]

Infantile botulism is a potentially life-threatening neuromuscular disorder. It presents with descending paralysis that can involve the diaphragm and cause respiratory failure. Neurally adjusted ventilatory assist (NAVA) provides synchronized bilevel positive pressure by using electrical diaphragmatic (Edi) signals. Diaphragmatic paresis is thought to be a contraindication for using NAVA. However, the use of a NAVA catheter allows continuous assessment of diaphragm activity in infantile botulism. We discuss a case of infantile botulism in an infant from central Pennsylvania who presented with poor oral feeding, hypothermia, and lethargy and progressed to develop apnea and acute respiratory failure. The infant was intubated and mechanically ventilated. A diagnosis of infantile botulism was confirmed through the detection of botulinum toxin in the infant's stool, and the infant was treated with botulism immune globulin neutralizing antibodies. During his recovery phase, a NAVA catheter was placed, which allowed monitoring of Edi signals to gauge the return of diaphragm activity and to assist with the assessment of extubation readiness. We describe the trends in this infant's Edi signals following administration of globulin neutralizing antibodies and the successful transition to invasive, and subsequently, noninvasive NAVA. Our report demonstrates the clinical utility of monitoring diaphragmatic activity using a NAVA catheter and that NAVA provided adequate respiratory support to an infant during the recovery phase of infantile botulism. [ABSTRACT FROM AUTHOR]

Background: Intravenous therapies are essential for hospitalised patients. The rapid dissemination of portable ultrasound machines has eased ultrasound‐guided intravenous access and facilitated increased use of long peripheral venous catheters (LPCs). This study aimed to evaluate the clinical performance and complications of LPCs. Methods: Retrospective, observational single‐site study. Data from all consecutively inserted LPCs during a period of 18 months was evaluated. The primary endpoint was the all‐cause incidence rate of catheter removal. Secondary endpoints included specific reasons for the catheter removal and the associations between predefined characteristics of the patients, the infusions and the catheters with catheter failure. Results: During the period, 751 PVCs were inserted in 457 patients. The reasons for catheter removal were recorded in 563 cases. The overall incidence rate of catheter removal was 95.8/1000 catheter days (95% CI 88.4–103.8). The median dwell time was 8 days (IQR 5–14), and the total dwell time was 6136 days. Catheter failure occurred in 283 (50.3%) cases, of which the most common cause was phlebitis (n = 101, 17.9%). In multivariable analyses, the use of the cephalic vein was significantly associated with both all‐cause catheter failure (p <.001) and catheter failure due to phlebitis (p <.001). In multivariable analyses, vancomycin infusion was not significantly associated with all‐cause catheter failure (HR 1.15 (0.55–2.42), p =.71) or catheter failure due to phlebitis (HR 1.49 (0.49–4.53), p =.49). Conclusion: The overall incidence rate of catheter removal was 95.8/1000 catheter days, and the most common causes of catheter failure were phlebitis, infiltration and unintended catheter removal. The use of the cephalic vein was significantly associated with catheter failure in multivariable analyses. We did not find an association between vancomycin infusion and catheter failure in multivariable analyses. [ABSTRACT FROM AUTHOR]

Background : Acute ischemic stroke (AIS) following left ventricular assist device (LVAD) implantation is a serious complication associated with device morbidity. AIS development following LVAD placement typically presents between 6- and 24-months post implantation. Case/Results : We report a case of a 67-year-old male who initially presented with reduced ejection fraction and severe coronary vessel disease. Following coronary artery bypass graft surgery, the patient remained in a low output state necessitating placement of an LVAD device. Approximately 4.5 hours following LVAD implantation, a severe acute decrease in mental status revealed new development of ischemic stroke of the basilar artery, which was successfully treated in one pass with catheter endovascular thrombectomy. Conclusion : While embolic stroke management in these cases remains difficult as patients are usually anticoagulated, our case demonstrates the utilization of endovascular thrombectomy as a viable therapeutic option in the setting of an uncommon occurrence of embolic stroke in the hours following LVAD implantation. [ABSTRACT FROM AUTHOR]

Introduction: Traction on the per-urethral catheter is commonly employed after monopolar transurethral resection of the prostate (mTURP) to reduce bleeding. However, its efficacy and impact on postoperative pain remain uncertain. Further, there is limited evidence to suggest any benefit regarding post-operative blood loss. Materials and methods: In a randomized controlled trial, 62 patients undergoing mTURP were assigned to either a traction (n = 30) or non-traction (n = 32) group. Blood loss, postoperative pain, and analgesic requirements were assessed between January 2022 and April 2023. {(IHEC-PGR/2021/DM/M.Ch/Jan/02), CTRI Registration: CTRI/2022/01/039199.} Results: No significant differences were observed between the traction and non-traction groups regarding postoperative blood loss (p -value- 0.632), fall in hemoglobin (p -value- 0.719) and hematocrit (p -value- 0.937) levels, and length of postoperative hospital stay (p -value- 0.797). However, the traction group reported significantly higher postoperative pain scores (p -value < 0.001) and increased analgesic requirements (p -value < 0.001). Conclusion: The study suggests that 12-hours catheter traction after mTURP does not reduce blood loss and is associated with increased postoperative pain. [ABSTRACT FROM AUTHOR]

Medical device-associated infections are a pervasive global healthcare concern, often leading to severe complications. Bacterial biofilms that form on indwelling medical devices, such as catheters, are significant contributors to infections like bloodstream and urinary tract infections. This study addresses the challenge of biofilms on medical devices by introducing a portable antimicrobial catheter insert (PACI) designed to be efficient, biocompatible, and anti-infective. The PACI utilizes nitric oxide (NO), known for its potent antimicrobial properties, to deter bacterial adhesion and biofilm formation. To achieve this, a photoinitiated NO donor, S -nitroso- N -acetylpenicillamine (SNAP), is covalently linked to a polydimethylsiloxane (PDMS) polymer. This design allows for higher NO loading for long-term impact and prevents premature donor leaching, a common challenge with SNAP-blended polymers. The SNAP-PDMS material was applied to a side-glowing fiber optic and connected to a wearable light module emitting 450 nm light, creating a functional antimicrobial insert. Activation of the fiber optic, accomplished with a one-click mechanism, enables real-time NO release, maintaining controlled NO levels for a minimum of 24 hours. The therapeutic levels of NO released via photocatalysis from the PACI demonstrated remarkable efficacy, with >90 % reduction in bacterial viability against S. aureus , S. epidermidis , and P. mirabilis without any cytotoxic impact on mammalian cells. This study underscores the potential of the NO-releasing insert in clinical settings, providing a portable and adaptable solution for preventing catheter-associated infections. Photoactivated nitric oxide (NO)-release levels can be achieved using a wireless and Portable Antimicrobial Catheter Insert (PACI) at the medical device interface. The covalent attachment of the NO donor to the base PDMS polymer enables higher NO loading and prevents premature leaching, ensuring maximum efficiency in eradicating catheter-associated infections. [Display omitted] [ABSTRACT FROM AUTHOR]

This study was conducted to determine the levels of Patients' spiritual well-being (SWB) and self-care agency (SCA) of patients receiving chemotherapy with a port catheter. It was a correlational and observational study. Data were collected between December 2021 and March 2022. The sample was 88 people. Of the participants; 59.1% were women, 88.6% were married, 38.6% were primary school graduates, 47.7% were unemployed, and 51.1% had income equal to their expenses. Furthermore, 38.6% patients had breast cancer diagnosis and 52.3% did not have any chronic diseases. Both scale scores were affected by different variables and there was a positive correlation between SCA and SWB. Better SWB positively affected SCA. Patient age and duration after cancer diagnosis affected SCA and SWB. Notably, SCA and SWB levels of the patients may change with age and disease progression, and patients should also be monitored in this respect. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 17-year-old patient with cystic fibrosis experiencing persistent air leaks and empyema following unresolved pneumonia. Topics discussed include the use of endobronchial valves to reduce airflow through alveolopleural fistulas, the management challenges associated with pleuropulmonary infections, and the effectiveness of nonsurgical interventions like tunneled pleural catheters in minimizing hospital stays and promoting outpatient care.

Introduction Methods Results Conclusion Currently, there are two approved single chamber leadless pacemakers (LP) in the United States (US), Micra VR™; approved since 2016 and AVEIR VR™; approved in 2022. A potential complication of LPs is dislodgement and/or embolization (D/E) during or after implant. According to the IDE trials, there appears to be a significant difference in D/E rates between the two LPs that have different fixation mechanisms; Micra uses nitinol tines, while AVEIR uses an active screw helix. The aim of this study was to determine if the AVEIR VR LP has continued to exhibit D/E in the United States since it was approved by the Food and Drug Administration (FDA) in April 2022.The FDA Manufacturer and User Facility Device Experience (MAUDE) database was searched for US D/E reports communicated by the manufacturers of both LP devices. For AVEIR VR we reviewed reports from approval till December 2023, and for Micra VR we looked at reports from approval to April 2024. Excluded were reports based on information indirectly obtained from registries, journals, social media, or volunteers. Total number of US implants was acquired from the manufacturers' product performance reports.During a period of 21 months, 5990 AVEIR VR implants had been registered in the United States, of which 53 (0.88%) encountered D/E both during and after the procedure. More D/E (32; 60.4%) occurred during the implantation procedure, with device release problems being the most prominent procedural issue involved with these events. Within a 8‐year period, 72 237 Micra VR implants have been registered in the United States, of which 211 (0.29%) showed D/E. The rate of D/E since the US approval of both devices was significantly higher for AVEIR VR compared to Micra VR (0.88% vs 0.29%; p < .0001).AVEIR VR implants may be complicated by dislodgement with or without embolization. Currently, the estimated incidence is about 0.9%, which is significantly higher than Micra VR. Fixation issues and separation problems of the device from the delivery catheter appear to be responsible for most of these D/E events. [ABSTRACT FROM AUTHOR]

Introduction Methods and Results Conclusion It remains unclear if pacing induced cardiomyopathy (PICM) may be minimized by standard pacing of the right ventricle (RV) at sites other than the RV apex. The purpose of this study is to compare the relative frequency of PICM in a population of patients paced at either the superficial RV mid septum (RVMS) or RV apex (RVA), and other outcomes that may differ between these sites.A retrospective evaluation was performed on all patients undergoing pacemaker implantation between 2011 and 2022. Potential study patients were those with Medtronic 3830 superficial RVMS leads placed with septal specific guidance catheters, and any with RVA leads. Patients were included if they had ≥20% RV pacing, available baseline and follow‐up measurements of left ventricular ejection fraction (LVEF) at least 6 months postimplantation, and a baseline LVEF ≥50%. PICM was defined as a decline in the LVEF of at least 10%, resulting in LVEF <50%. Patients were excluded for Biventricular devices, and for alternative causes of cardiomyopathy. The study criteria were met in 324 patients, with 220 RVMS and 104 RVA paced patients. PICM occurred in 4.5% of RVMS patients, and 22.1% of RVA patients (p < .001). Additional differences were demonstrated in paced QRS duration (144 ± 15.5 ms in RVMS, 166 ± 19.4 ms in RVA; p < .001); QRS axis (2.3 ± 64.9 in RVMS, −65.2 ± 49.5 in RVA; p < .001), and various qualitative QRS morphologic characteristics.Patients with normal LVEF experienced significantly less PICM with superficial RVMS pacing performed via septal specific guidance catheters than similar counterparts with RVA pacing. Narrower paced QRS duration and less left axis deviation was also demonstrated. [ABSTRACT FROM AUTHOR]

Purpose: The study aimed to evaluate the efficacy of the Biologically Transparent Illumination (BTI) device for confirming the correct placement of nasogastric (NG) tubes in children, as an alternative to X-ray, which exposes patients to radiation. Methods: In this prospective observational study, 106 pediatric patients (ages 0–16) undergoing NG-tube insertion after general anesthesia were evaluated. The BTI catheter was used to emit bio-permeable red light from the NG tube, which was then visually confirmed in the cervical, thoracic, and epigastric regions. X-ray confirmed NG-tube placement in all patients. The ethics committee approved the study. Results: The average patient age was 3.8 years, with a male-to-female ratio of 72:34. BTI was successfully detected in the epigastric area in 105 of 106 patients, with one 9-year-old patient having unclear BTI visibility. X-ray confirmed NG-tube placement in the stomach for all patients, resulting in a BTI sensitivity of 99%. The mean NG-tube insertion time was 38 s, and the mean abdominal thickness was 9.8 mm. Conclusions: The BTI device proved to be a safe and effective method for NG-tube placement in children, offering a radiation-free alternative with 100% successful placement when BTI was detected in the epigastric area. [ABSTRACT FROM AUTHOR]

Introduction: The sheathless transradial (TR) technique is a novel approach that may offer potential benefits over the conventional TR approach. We aim to comprehensively investigate the safety and efficacy of sheathless versus conventional TR percutaneous coronary interventions (PCIs). Methods: We conducted comprehensive searches across PubMed, CENTRAL, Web of Science (WOS), Scopus, and EMBASE until July 2023. Pooled data were reported using risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, along with a 95% confidence interval (CI). PROSPERO ID: CRD42023443834. Results: We included 11 studies with 15,392 patients. The radial artery spasm (RAS) (RR: 0.26, 95% CI: [0.09, 0.77], p = 0.02) and cross‐over to the femoral site (RR: 0.28, 95% CI: [0.10, 0.81], p = 0.02) were significantly lower in the sheathless group. However, radial artery occlusion (RAO) (RR: 2.84, 95% CI: [1.78, 4.54], p < 0.0001) and success rate (RR: 1.011, 95% CI: [1.004, 1.019], p = 0.002) were significantly higher in the sheathless group. Also, we did not find a significant difference between both groups in all‐cause mortality (RR: 0.41, 95% CI: [0.16, 1.04], p = 0.06). Conclusion: The sheathless TR approach showed lower rates of RAS and femoral conversion. Sheathless has a higher success rate; however, it also increased RAO. Thus, more trials are needed to confirm this technique's long‐term outcomes and complications. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion Complete isolation of the left atrial posterior wall (LAPW) is challenging owing to overlapping epicardial conduction. Peak frequency (PF) is a novel parameter that focuses on near‐ and far‐field electrogram components. In this study, we aimed to determine whether transmural block completion is related to the ablation site PF.We analyzed 44 consecutive patients undergoing initial LAPW isolation (LAPWI) between June 2023 and February 2024. Pre‐LAPWI and PF maps were obtained using an HD‐Grid catheter. In 17 of the 44 patients (Group‐1), LAPWI was performed conventionally. In the remaining 27 patients (Group‐2), PF‐guided LAPWI was applied based on Group‐1 results.In Group‐1, the left atrial (LA) roof and floor line success rates were 58.8% and 76.5%, respectively. The average PF value in the roof lines of patients with a completed block line was significantly higher than that of the remaining patients (286.6 ± 29.3 Hz vs. 236.1 ± 40.9 Hz, p = .012), but the floor lines were similar. In Group‐2, relatively high PF values were targeted to achieve complete block of the LA roof and floor lines, following the results obtained in Group‐1. The LA roof line success rates (92.6% vs. 58.8%, p = .007), total number of radiofrequency (RF) applications (22.7 ± 5.6 vs. 27.6 ± 8.5, p = .03), and procedural time (32.6 ± 18.3 vs. 47.9 ± 25.6 min, p = .03) differed between Group‐1 and Group‐2.Using a PF map for determining the optimal ablation line for LAPWI by RF catheter ablation is feasible. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusion Cuff extrusion of tunneled dialysis catheter (TDC) leads to catheter dysfunction, leading to loss of vascular access and the need for new catheter. Definitive management is to remove TDC and reinsert new catheter by new venous puncture and tunnel, which may not be possible in all cases. The study evaluated the surgical experience and early outcomes of a novel “Catheter Exchange with Elongation of Tunnel (CEET)” procedure for cuff extrusion.The retrospective study included all cases of hemodialysis with TDC with partial or complete cuff extrusion and excluded complete catheter dislodgement, tunnel infection, or any catheter related infection. All patients also underwent the CEET procedure under fluoroscopy guidance, and the clinical details and outcomes were analyzed.Eleven cases of TDC cuff extrusion underwent the CEET procedure of which three (27.2%) had previous and four (36.4%) had partial cuff extrusion, and seven cases (63.6%) had short tunnel length, which likely predisposed to cuff extrusion. CEET procedure was successful in 10 cases (success rate 90.1%) with desired position of catheter tip and good blood flow. Study population was divided into early and late cuff extrusion (≥1 month). Short tunnel length was associated with late extrusion (p = 0.05), whereas premature removal of TDC anchor sutures was associated with early cuff extrusion (p = 0.04).CEET procedure is a successful alternative technique for correction of cuff extrusion of TDC with good success rate. Premature removal of anchor sutures was associated with early cuff extrusion, whereas short tunnel length was associated with late cuff extrusion. [ABSTRACT FROM AUTHOR]

AbstractThe application of balloon dilation catheters in the management of intracranial arterial stenosis has been gradually increasing. However, studies on the feasibility and effectiveness of different types of balloons remain relatively scarce. In this study, catheter models of three different materials were designed to simulate balloon crimping,splitting, and dilatation processes. A compliant balloon produces large deformations with poor dilatation and a stress concentration phenomenon. During dilatation, the shear stress generated in the intima and lesion area by the semi-compliant balloon was smaller than that generated by the non-compliant balloon. These results demonstrate the feasibility of using semi-compatible balloons. [ABSTRACT FROM AUTHOR]

Objective: Knowing factors that impact catheter stay duration is important since removing drainage catheters too early or late can have significant consequences. We present a single center retrospective study that analyzes multiple variables, including abscess size, white blood cell count, and patient age, to see if a correlation between them and duration of catheter stay exists. The inclusion criteria were patients that had abdominal abscesses treated with percutaneous abscess drainage using a pigtail catheter, ≥ 18 years of age, and had available medical images and records. 44 patients were included. Results: Among white blood cell count, patient age, and abscess volume, the only significant relationship with duration of catheter stay was abscess size (R = 0.42, p-value = 0.0049). [ABSTRACT FROM AUTHOR]

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) impact morbidity and mortality in burn patients, exacerbated by extensive fluid resuscitation required for more than 20% of total body surface area burns. We report a case of a 28-year-old male with severe burns and a TBSA of 49% who presented after a fire incident. The trauma team managed the patient's fluid resuscitation, followed by early burn debridement. A TraumaGuard catheter was used for continuous intra-abdominal pressure (IAP) monitoring. On the second day of admission, a critical IAP of 20 mm Hg was detected, indicative of impending ACS. Immediate intervention with cistracurium and increased sedation reduced the IAP to 9 mm Hg, preventing the progression to ACS. This case demonstrates the importance of routine IAP monitoring in severely burned patients to prevent ACS. Early identification and management of elevated IAP can avert the progression to ACS and reduce the need for more invasive interventions. [ABSTRACT FROM AUTHOR]

Objective: This study aims to evaluate ultrasound-guided radial artery cannulation versus conventional digital palpation techniques in terms of first-trial success, number of attempts, intervention time, and complication rates. Methods: The study was designed as a prospective, randomized, controlled study. The study included 44 patients and divided into two groups: Group US (ultrasound guided cannulation group) and Group P (palpation cannulation group). Demographic data and clinical characteristics of the patients were recorded. Procedure time, number of cannulas used, success rate on the first attempt, complications and number of attempts were analyzed in both groups. Results: Demographic and clinical characteristics of the patients were similar between the groups. In the ultrasound-guided cannulation group, the cannulation time was significantly shorter (p=0.023), the success rate on the first attempt was higher (p=0.042), the number of cannulas used was lower (p=0.030), and the number of attempts was lower (p=0.039) compared to the palpation method. However, complication rates were similar between both groups. Conclusion: This study demonstrates that ultrasound-guided radial artery cannulation is superior to digital palpation with higher first-trial success, shorter procedure time, and less cannula use. The results support the standardization of ultrasound-guided cannulation in larger populations. [ABSTRACT FROM AUTHOR]

Objective: This study examined postoperative urinary retention (POUR) rates in patients who had transvaginal or transabdominal morcellation for large fibroids or adenomyotic uteri. Materials and Methods: This retrospective, observational cohort study was conducted, from January 2015 to April 2021, in a multicenter health care system, in Calgary and Southern Alberta, Canada. The patients were women, ≥18 years, who had total laparoscopic hysterectomy with morcellation. Women with preexisting urinary retention were excluded. POUR was urinary retention needing an indwelling or in-and-out catheter postoperatively before discharge. Results: There were no differences in POUR for transvaginal (29/139; 20.9%) and transabdominal (12/56; 21.4%) morcellation. There were also no differences in time to first postoperative void (5.5 hours [range: 3.5–8] versus 5.75 hours [range: 4–7.125]); length of stay (23 hours [range: 20.875–25.625] versus 22 hours [range:18.5–24.5]); postoperative urinary tract infections (5.1% versus 3.6%); or visits to the emergency department for POUR postdischarge (1.4% versus 1.8%) for transvaginal and transabdominal morcellation, respectively. The vaginal-morcellation group trended toward increased complication rates during morcellation (7% versus 0%) and urinary complaints at postoperative follow-ups (9.4% versus 0%). Conclusions: Either morcellation type produces similar rates of POUR. Surgeon and patient preferences guide decisions on preferred morcellation routes. Larger prospective trials are needed to further assess POUR, potential for increased complications, and postoperative urinary complaints induced by transvaginal morcellation. (J GYNECOL SURG 20XX:000) [ABSTRACT FROM AUTHOR]

OBJECTIVES Postoperative pain remains a burden for patients after minimally invasive anatomic lung resection. Current guidelines recommend the intraoperative placement of intercostal catheters to promote faster recovery. This trial aimed to determine the analgesic efficacy of continuous loco-regional ropivacaine application via intercostal catheter and establish this method as a possible standard of care. METHODS Between December 2021 and October 2023, patients were randomly assigned to receive ropivacaine 0.2% or a placebo through an intercostal catheter with a flow rate of 6–8 ml/h for 72 h after surgery. Patients were undergoing anatomic VATS lung resection under general anaesthesia for confirmed or suspected stage I lung cancer (UICC, 8th edition). The sample size was calculated to assess a difference in numerical rating scale associated with pain reduction of 1.5 points. RESULTS Fourteen patients were included in the ropivacaine group, whereas the placebo group comprised 18 participants. Patient characteristics and preoperative pain scores were similar in both groups. There was no statistically significant difference in postoperative pain scores and morphine consumption between the 2 groups. The mean numerical rating scale when coughing during the first 24 h postoperatively was 4.9 (SD: 2.2) in the ropivacaine group and 4.3 (SD: 2.4); P  = 0.47 in the placebo group. We were unable to determine any effect of administered ropivacaine on the postoperative pulmonary function (FEV1, PEF). CONCLUSIONS Our preliminary results suggest that continuous loco-regional ropivacaine administration via surgically placed intercostal catheter has no positive effect on postoperative pain scores or morphine requirements. CLINICAL REGISTRATION NUMBER NCT04939545 [ABSTRACT FROM AUTHOR]

Key Clinical Message: Patients with intrathecal catheters for pain medication infusion should be aware of the possible complication of acute flaccid paralysis. While exceedingly rare, it should prompt immediate medical attention to rule out compressive pathology requiring intervention. [ABSTRACT FROM AUTHOR]

Background: Ventricular assist devices (VADs) are used to bridge pediatric patients to heart transplantation. Paracorporeal VADs require the placement of cannulas, which can create an environment for infections. We examined cannula infections in pediatric VAD patients and the role of nutritional status. Methods: This retrospective study (2005–2021) included patients <20 years old on VAD support using Berlin Heart EXCOR® cannulas. Cannula infections were defined by a positive culture and need for antibiotic therapy. Malnutrition was defined using the American Society of Parenteral and Enteral Nutrition guidelines as well as the Michigan MTool. Results: There were 76 patients with a median age at implant of 0.9 years (IQR 0.4, 3.6), 50% male, with 73.7% having non‐congenital heart disease. More than one‐quarter (26.3%) of patients developed a cannula infection. Higher pre‐implant weight (OR = 1.93, p = 0.05), creatinine (OR = 1.02, p = 0.044), and pre‐albumin (OR = 15.79, p = 0.025), as well as duration of VAD support (OR = 1.01; p = 0.003) were associated with increased odds of developing a cannula infection. There was no difference in the malnutrition parameters between those with and without an infection. Conclusions: Further exploration in a larger cohort is needed to see whether these associations remain and if the incorporation of objective measures of nutritional status at the time of infection are predictive. [ABSTRACT FROM AUTHOR]

Background: STW5 is an herbal medicinal product that, in previous studies, reduced abdominal pain in irritable bowel syndrome (IBS). The effect of STW5 on gas‐related abdominal symptoms is unknown. Aim: To determine the effects of STW5, compared to placebo, on the responses to colonic gas in IBS. Methods: Using a cross‐over design, two gas challenge tests were performed in 10 patients with IBS and bloating after 2‐weeks treatment with (a) STW5 and (b) placebo. The challenge test consisted in continuous infusion of gas into the colon (24 mL/min for 60 min), followed by a 30‐min free evacuation period. Gas evacuation, symptom perception, and abdominal distension were continuously registered. Results: Colonic gas filling was associated to a significant rise in abdominal symptom perception, that was significantly greater when patients were on‐placebo (score increment 4.0 ± 0.3) compared with on‐STW5 (score increment 3.2 ± 0.4; p = 0.035). Gas filling was associated to a progressive abdominal distension that was similar with both treatments. Opening of the rectal cannula produced a massive gas evacuation, similar after both treatments, associated to a return of abdominal perception and distension to basal levels when patients were on‐STW5 (score increment −0.1 ± 0.4; distension 0.3 ± 0.2 cm; p = 0.399, and p = 0.112 vs. basal), whereas both remained increased on‐placebo (score increment 0.5 ± 0.3; distension 0.8 ± 0.3 cm; p = 0.048, and p = 0.016 vs. infusion start). Conclusions: STW5 improves colonic gas tolerance in IBS patients with bloating without a significant effect on gas retention and evacuation. This medicinal product can be beneficious for treatment of gas‐related abdominal symptoms in patients with bloating. EudraCT: 2019‐003976‐38. [ABSTRACT FROM AUTHOR]

Given the benefits of neuroendovascular simulation to resident education, this study aimed to assess the efficacy of simulation-based training for neuroendovascular intervention with primary and secondary catheters using a transradial approach (TRA). Five neurosurgical residents (PGY 1–3) from our institution enrolled in a standardized pilot training protocol. Trainees used the Mentice (Gothenburg, Vastra Gotaland, Sweden) Visit G5 simulator with a type II arch using a right TRA. All participants improved their total time to complete the task from the first trial to the last trial. Residents improved the overall time required to complete the task by 111.8 ± 57 seconds (52% improvement; P = 0.012). Participants reported improved knowledge of Simmons catheter formation from 1.6 ± 0.8 to 2.8 ± 1 (P = 0.035) and improved knowledge of transradial vessel selection technique from 1.6 ± 0.9 to 2.8 ± 1.1 (P = 0.035). All residents were able to illustrate a bovine arch and types 1–3 arches post-simulation. Residents rated the simulation usefulness as 4.6 ± 0.548 (scale 1 [not useful] to 5 [essential]) with 4 of the 5 residents (80%) identifying this exercise as essential. All residents rated the hands-on component of the training exercise as the most important. Residents demonstrated proficiency at Simmons catheter formation and vessel selection in a type II arch over a short time period (4 attempts and <1 hour total). Residents can use simulator-based training to increase their proficiency of vessel selection using a primary or secondary catheter for a TRA. [ABSTRACT FROM AUTHOR]

In this paper, we present the design and fabrication of a novel chip-on-tip catheter, which uses a microcamera and optical fibres to capture in vivo images in a beating porcine heart thanks to a saline flush to clear the blood field. Here, we demonstrate the medical utility and mechanical robustness of this catheter platform system, which could be used for other optical diagnostic techniques, surgical guidance, and clinical navigation. We also discuss some of the challenges and system requirements associated with developing a miniature prototype for such a study and present assembly instructions. Methods of clearing the blood field are discussed, including an integrated flush channel at the distal end. This permits the capture of images of the endocardial walls. The device was navigated under fluoroscopic guiding, through a guiding catheter to various locations of the heart, where images were successfully acquired. Images were captured at the intra-atrial septum, in the left atrium after a trans-septal cross procedure, and in the left ventricle, which are, to the best of our knowledge, the first images captured in an in vivo beating heart using endoscopic techniques. [ABSTRACT FROM AUTHOR]

The document is an author index from the BJOG: An International Journal of Obstetrics & Gynaecology, featuring a diverse range of authors and their corresponding presentation codes. Researchers interested in obstetrics and gynaecology can use this index to locate specific authors and their work within the journal. The list includes names from different cultural backgrounds, reflecting a global perspective in research and academia. The authors cover a wide range of topics and research areas, showcasing diverse perspectives and contributions to the field. [Extracted from the article]

Background: Bicaval dual lumen cannula (DLC) is gaining popularity in veno-venous extracorporeal membrane oxygenation (V-V ECMO) for having less recirculation and facilitating mobilization. It is usually inserted under fluoroscopic or transesophageal echocardiographic guidance to prevent potentially fatal complications. Thus, their utilization was limited during the COVID-19 outbreak due to stringent quarantine policy and manpower shortage, especially when emergency insertion was required. Purpose: To describe our experience on DLC insertion using transthoracic echocardiography alone during the pandemic, with a focus on safety considerations by using detail step-by-step procedural guide. Outcome: Four patients were performed V-V ECMO using the transthoracic echocardiographic-guided DLC cannulation technique during the fifth wave of the COVID-19 outbreak, with no cannulation-related complications. Conclusion: Transthoracic echocardiographic guidance for DLC insertion is feasible and probably safe with a detailed guide, which can be adopted as a supplementary tool during future endemic outbreaks. [ABSTRACT FROM AUTHOR]

Introduction: A minimally invasive alternative to surgery for treating pneumothorax has been developed, aiming to reduce risks while maintaining efficacy. This study conducted basic experiments using ex vivo and in vivo pig lung employing a super-thin catheter for treatment. This new device injects fibrin glue directly into the responsible lesion to close the air leak, which has two features: thin design and double-lumen. Methods: The experimental setup involved utilizing trachea and both lung specimens from pigs under positive pressure ventilation. To simulate pneumothorax, artificial fistulas were created on the lung surfaces. The super-thin catheter, guided through a bronchoscope near the fistula, was used to embolize the peripheral bronchus by injecting a fibrin preparation. Then, an air leak test was conducted afterward to assess the efficacy of the treatment. Additionally, a similar pneumothorax model was induced in alive pig under general anesthesia to evaluate its curability. Results: In the extracted pig lungs, embolization was performed in 21 cases, resulting in the cessation of air leaks in 19 cases, corresponding to a 90.5% cure rate. Notably, no major adverse events occurred with the treatment devices. Similarly, in living pigs, pneumothorax was successfully treated, with no recurrence observed up to the seventh postoperative day. Conclusion: The novel treatment device utilizing a super-thin catheter offers a minimally invasive and highly curative option for pneumothorax. These promising results suggest the potential for further development and human clinical trials, which could revolutionize the treatment of pneumothorax, reducing risks and improving outcomes. [ABSTRACT FROM AUTHOR]

Background: Carotid artery stenting (CAS) is a key treatment option for moderate to severe carotid artery stenosis. Carotid stent thrombosis (CST), a rare complication of CAS, has gained significant attention because of its catastrophic nature. More evidences are needed to guide the diagnosis and treatment of CST. Case presentation: This study reports a rare case of sub-acute CST following CAS in a 50-year-old male patient who had experienced repeated cerebrovascular events on the premise of taking antiplatelet drugs. He also suffered an occlusion of the left middle cerebral artery (MCA) in the M2 segment, likely caused by an embolus detached from the stent thrombus. The cause of CST in this patient was presumed to be dual antiplatelet resistance (AR), as indicated by genetic testing. After treated with guide catheter-directed thrombolysis, thrombus aspiration, and a second round of thrombolysis, his in-stent thrombus was basically cleared. His M2 occlusion was resolved by mechanical thrombectomy using the Solitaire FR/Stent with Intermediate Catheter Assisting technique. The patient recovered well after replacement of antiplatelet drugs, and no new thromboembolic event occurred during the 13-month follow-up period. Conclusions: The occurrence rate of AR-related CST may be underestimated as the cause of majority CST cases remains unclear. Implementation of genetic test for aspirin and clopidogrel resistance may be helpful to find the possible cause of CST and to avoid future repeated cerebrovascular events by replacement of antiplatelet drugs. [ABSTRACT FROM AUTHOR]

Background: Atrial septal defect (ASD) is a common congenital heart disease, and currently, transcatheter intervention is the most common clinical treatment method. However, certain complications still occur during the percutaneous process, among which occluder loss and displacement are rare but serious complication. Although the probability of occluder loss and displacement is low, severe cases can endanger life. Case presentation: Here, we report the case of a patient who underwent ASD closure in which the occluder fell off into the aortic arch, the detached occluder was recovered through catheter intervention, and the patient underwent ASD closure again. Conclusions: In this case report, we highlight that although percutaneous closure of an ASD is regarded as a routine procedure, clinicians should remember the possibility of complications, especially occluder loss and displacement. Therefore, interventionist should carefully evaluate the situation before intervention closure, establish standardized interventional treatment procedures, and provide timely treatment follow-up. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Our study aimed to assess the efficacy and durability of holmium laser enucleation of the prostate (HoLEP) in managing acute urinary retention (AUR), neurogenic chronic urinary retention (NCUR), and non-neurogenic chronic urinary retention (NNCUR). We also sought to compare outcomes in patients with preoperative urinary retention (UR) to those without. METHODS: We conducted a retrospective analysis using prospectively gathered data from men who underwent HoLEP at our institution between October 2017 and July 2022. Patient demographics and outcome measures were recorded, including indications for the procedure, median urinary volume drained, or median postvoid residual urine volume (PVR) before catheterization or HoLEP. Chronic urinary retention (CUR) was defined as PVR >300 mL in males able to void; and initial catheter drainage >1000 mL in males unable to void, in the absence of pain. NCUR and NNCUR were differentiated based on the presence of any significant illness or injury with a neurologic impact on the bladder. All patients had postoperative followup visits at one, three, six, and 12 months. Our evaluation included the International Prostate Symptom Score (IPSS), quality of life (QoL) assessment, maximum urinary flow rate (Qmax), PVR, and catheter-free status. RESULTS: Three hundred sixty-eight males who underwent HoLEP were included in our study. The UR group consisted of 189 patients (70 AUR, 42 NCUR, and 77 NNCUR), and the lower urinary tract symptoms (LUTS) group was comprised of 179 individuals. There were no statistically significant differences between the NCUR and NNCUR subgroups regarding demographics and outcomes. At 12 months postoperative, the AUR group had a higher catheter-free rate than the CUR group (p=0.04), and other outcome variables were comparable between the two cohorts. The UR group had a significantly lower QoL score at one month (p=0.01) and a significantly lower IPSS score at one and 12 months (p=0.034 and p=0.018, respectively) than the LUTS cohort. During all followup visits, the UR group had a significantly higher PVR than the LUTS cohort. The successful first trial of void (TOV) rate for the UR and LUTS groups was 81% and 83.2%, respectively. At 12 months postoperative, the catheter-free rate for the UR and LUTS cohorts was 96.3% and 99.4%, respectively. [ABSTRACT FROM AUTHOR]

Background: Given the significant increase in the quantity of cosmetic procedures utilizing hyaluronic acid fillers, including in the nasal region, the initial evaluation of patients using high frequency ultrasound becomes a crucial instrument in evaluating and handling nonsurgical rhinoplasty. Aims: The aim of this article is to introduce an assessment methodology for nasal filling guided by high frequency ultrasound. Patients/Methods: A prospective and single‐center study was conducted with 12 Latin American patients. The patients underwent nasal filling with hyaluronic acid following high power ultrasound mapping. Results and Conclusions: In the evaluation of the GAIS scale, all patients reported improvement with the treatment. No infections, nodules, ischemia, or other relevant adverse effects were noted. Real‐time ultrasound‐guided filler techniques have been developed to reduce the risk of vascular compromise, confirming the distribution pattern of blood vessels. It's also crucial to visualize the cannula at the same moment as the vessels, even if the previous vascular mapping was performed. Therefore, the utilization of high frequency ultrasound can act as a pivotal tool in augmenting procedure safety. [ABSTRACT FROM AUTHOR]

Background: The depressed volume of the forehead and temple is resolved by filler injection. However, the current method has the potential to cause pain and side effects in patients, depending on the skill of the clinician. Therefore, this study proposes a new method for safer and simpler injection using only one injection entry point. Methods: Using the novel injection method, the filler was injected into the forehead and temple regions in three unembalmed cadavers and two healthy Korean volunteers. The cannula and filler locations were identified using dissection, ultrasonography, and three‐dimensional (3D) scanning. Results: Ultrasonographic images and dissection results showed that the filler injected into the cadavers was in the target layer. The cannula and filler were located on the layer as the supraperiosteal layer on the forehead and the supra deep temporal fascia layer in the temple. Finally, 3D scanning images showed that the filler was injected precisely and effectively into the forehead and temples of the volunteer who underwent the procedure. Conclusions: This method can reduce pain and minimize externally visible wounds caused by injections. The injected filler was naturally connected from the forehead to the temple and maintained for around 3 months. Additionally, it is possible to inject fillers into the forehead and temple at a constant and safe depth without requiring specific skills. It is expected that this method will become a universal method because it minimizes the burden on both patients and clinicians. [ABSTRACT FROM AUTHOR]

Ni Eochagain and colleagues report that programmed intermittent bolus and continuous infusion regimens in continuous erector spinae plane (ESP) block catheters produced similar quality of recovery (QoR-15) scores, pain scores, and use of rescue opioids after video-assisted thoracic surgery. This is a reassuring finding for practitioners without access to pumps with programmed intermittent bolus functionality. Nevertheless, it remains plausible that the benefit of one regimen over another might vary depending on the specific infusion parameters. There continues to be scope for research into optimising programmed intermittent bolus delivery and dosing regimens and identifying the most appropriate clinical applications for this mode of infusion. [ABSTRACT FROM AUTHOR]

Rhinoplasty is one of the most common plastic surgeries and is commonly associated with postoperative edema, ecchymosis, and pain which play a role in patients' dissatisfaction. In this randomized comparative study, we discuss the effect of cannula drainage in the reduction of postoperative periorbital edema, ecchymosis, pain, and nasal obstruction after open structural septorhinoplasty. The study was conducted at a tertiary referral center from April to November 2022. We performed internal lateral osteotomy on all patients using the lateral saw and aided by lateral osteotome. At the end of the procedure, a cannula drain is prepared and inserted in the subperiosteal tunnel on the left side only. Patients were examined on the 1st, 3rd, 7th, 14th, and 21st days for periorbital edema, ecchymosis, pain, and nasal obstruction, and each side is scored separately. A total of 40 patients (80 sides in total) were recruited, 22 females (55%) and 18 males (45%), all of whom were adults (18–44 years old; mean age 29 years). The most frequent age group is those younger than 20 years representing 35% of the sample and the males forming 33.3%. The reduction in edema and pain was statistically significant in the drained sides (p = 0.000) during all the postoperative days. On the other hand, ecchymosis was lower on the drained side but statistically insignificant (p = > 0.29). Nasal obstruction was reduced significantly only on the seventh postoperative day (p = 0.000). The postoperative morbidities associated with rhinoplasty could have important functional and psychological effects on patients. This study demonstrates that inserting a cannula in the subperiosteal tunnel for drainage in rhinoplasty yields a significant clinical and statistical decrease in postoperative periorbital edema and pain with little effect on ecchymosis and nasal obstruction. [ABSTRACT FROM AUTHOR]

Hypertension is a leading risk factor for cardiovascular morbidity and mortality. Despite the widespread availability of both pharmacological and lifestyle therapeutic options, blood pressure control rates across the globe are worsening. In fact, only 23% of individuals with high blood pressure in the United States achieve treatment goals. In 2023, the US Food and Drug Administration approved renal denervation, a catheter-based procedure that ablates the renal sympathetic nerves, as an adjunctive treatment for patients in whom lifestyle modifications and antihypertensive medications do not adequately control blood pressure. This approval followed the publication of multiple randomized clinical studies using rigorous trial designs, all incorporating renal angiogram as the sham control. Most but not all of the new generation of trials reached their primary end point, demonstrating modest efficacy of renal denervation in lowering blood pressure across a spectrum of hypertension, from mild to truly resistant. Individual patient responses vary, and further research is needed to identify those who may benefit most. The initial safety profile appears favorable, and multiple ongoing studies are assessing longer-term efficacy and safety. Multidisciplinary teams that include hypertension specialists and adequately trained proceduralists are crucial to ensure that referrals are made appropriately with full consideration of the potential risks and benefits. Incorporating patient preferences and engaging in shared decision-making conversations will help patients make the best decisions given their individual circumstances. Although further research is clearly needed, renal denervation presents a novel treatment strategy for patients with uncontrolled blood pressure. [ABSTRACT FROM AUTHOR]

Objective: This study aims to evaluate the differences between The balloon catheter method and End-hole Catheter Method in measuring hepatic venous pressure gradient (HVPG) among cirrhosis patients. Methods: From October 2017 to January 2024, patients who underwent HVPG measurements using both methods were consecutively included. HVPGs obtained from both methods were compared with the portal vein pressure gradient (PPG) obtained via transjugular intrahepatic portosystemic shunt (TIPS) using paired comparisons. Additionally, the consistency and predictive ability for bleeding risk of the two methods, as well as the impact of intrahepatic veno-venous shunt (IHVS), were analyzed. Results: The study enrolled 145 patients, each of whom had HVPG measured by both methods. PPG was measured in 61 patients. There was a statistically significant difference between the PPGs and HVPGs measured by both the balloon catheter method and the end-hole catheter method (P < 0.001), with the HVPG mean values obtained by the end-hole catheter method being closer to the PPGs. In the non-IHVS group, no significant statistical difference was found between the two methods (P = 0.071). In contrast, the IHVS group showed a significant difference (P < 0.001), with a mean difference of 2.98 ± 4.03 mmHg. When IHVS was absent, the measurement results from the end-hole catheter method and the balloon catheter method were found to be highly correlated. The end-hole catheter method has a higher screening capability for patients at risk of bleeding compared to the balloon catheter method (75.90% vs. 72.86%). Conclusion: HVPG measurements using either the balloon catheter method or end-hole catheter method showed significant difference with the PPG. The end-hole catheter method has a higher screening capability for patients at risk of bleeding, and IHVS could lead to lower HVPG measurements with The balloon catheter method. [ABSTRACT FROM AUTHOR]

Background Collateral blood supply of distal vessels has been linked to clinical outcome, infarct volume and recanalization rates in patients with large vessel occlusion. Our study aimed to explore the effects of catheterization during mechanical thrombectomy in collaterals. Methods We quantified the flow diversion effect secondary to arterial occlusions in an in vitro model which was connected in a flow-loop setup with a saline reservoir and a pump supplying pulsatile flow. Clot analogs were embolized to the middle cerebral artery (MCA) M1 or M2 segments. We used the same model with a clamped anterior communicating artery (AComA) to simulate its absence. An ultrasound flow sensor was placed at the vessel of interest. Flow rates and pressures were evaluated according to the following catheter locations: baseline (1) before and (2) after the occlusion; (3) 8F guiding catheter at the internal carotid artery (ICA) bulb; (4) at the cavernous segment; (5) at the cavernous segment a 0.071" distal access catheter at proximal M1; (6) 8F balloon guide catheter inflated. Results Collateral blood flow measured at distal anterior cerebral artery (ACA) (M1-MCA occlusion) and M2-MCA (M2-MCA occlusion) was progressively reduced as catheters were advanced through the ICA and MCA. In the lacking AComA model, the flow was further diminished as compared with the model with a patent AComA. Conclusion Our in vitro study showed a progressive reduction of collateral blood flow due to the advance of catheters during mechanical thrombectomy. [ABSTRACT FROM AUTHOR]

Background and Objectives: Ureteral reconstruction is aimed at maintaining ureteral patency without the need for long-term catheters like ureteral stents or percutaneous nephrostomies. Different surgical strategies are adopted based on the etiology, the location of the injury, and the severity of the injury. We aimed to analyze the parameters that can predict which patients might not be free from further catheterization after reconstruction. Materials and Methods: This study included patients who underwent ureteral reconstruction from January 2007 to December 2021. The success of ureteral reconstruction was defined as being free from further catheterization after the operation. Results: A total of 184 patients underwent ureteral reconstruction. Malignant disease with ureteral invasion and iatrogenic injuries accounted for 79.9% of the cases. The majority (79.3%) did not have to undergo subsequent interventions. Predictors for a failed result of ureteral reconstruction included a history of radiotherapy (OR = 2.75, p = 0.01), chronic kidney disease (CKD) (OR = 3.42, p < 0.001), and an upper ureteric location of the injury (OR = 5.68, p = 0.042). Conclusions: A history of radiation therapy, an upper third ureteric location of the injury, and CKD were identified as predictors of a failed ureteral reconstruction. Malignant diseases, surgical methods, and repair techniques did not significantly affect the outcome of the operation. [ABSTRACT FROM AUTHOR]

Background: Catheter-related bladder discomfort (CRBD) commonly occurs in patients who have indwelling urinary catheters while under general anesthesia. And moderate-to-severe CRBD can lead to significant adverse events and negatively impact patient health outcomes. However, current screening studies for patients experiencing moderate-to-severe CRBD after waking from general anesthesia are insufficient. Constructing predictive models with higher accuracy using multiple machine learning techniques for early identification of patients at risk of experiencing moderate-to-severe CRBD during general anesthesia resuscitation. Methods: Eight hundred forty-six patients with indwelling urinary catheters who were resuscitated in a post-anesthesia care unit (PACU). Trained researchers used the CRBD 4-level assessment method to evaluate the severity of a patient's CRBD. They then inputted 24 predictors into six different machine learning algorithms. The performance of the models was evaluated using metrics like the area under the curve (AUC). Results: The AUCs of the six models ranged from 0.82 to 0.89. Among them, the RF model displayed the highest predictive ability, with an AUC of 0.89 (95%CI: 0.87, 0.91). Additionally, it achieved an accuracy of 0.93 (95%CI: 0.91, 0.95), 0.80 sensitivity, 0.98 specificity, 0.94 positive predictive value (PPV), 0.92 negative predictive value (NPV), 0.87 F1 score, and 0.07 Brier score. The logistic regression (LR) model has achieved good results (AUC:0.87) and converted into a nomogram. Conclusions: The study has successfully developed a machine learning prediction model that exhibits excellent predictive capabilities in identifying patients who may develop moderate-to-severe CRBD after undergoing general anesthesia. Furthermore, the study also presents a nomogram, which serves as a valuable tool for clinical healthcare professionals, enabling them to intervene at an early stage for better patient outcomes. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusion The treatment of the medial infraorbital region also termed the tear trough has become increasingly popular by the use of soft tissue fillers in a minimally invasive approach using a cannula.A total of 246 tear troughs were injected and investigated originating from 123 study participants. The clinical outcome was evaluated 6 months after the treatment by independent observers based on standardized frontal images and the procedure was documented by ultrasound imaging.On average, 0.26 (0.1) cc [range: 0.08–0.32] of soft tissue filler material was injected per tear trough. Tear trough depth was before the treatment rated as 2.12 (0.4), whereas after the treatment it was 1.15 (0.4) (p < 0.001). Hyperpigmentation score was 2.19 (0.4) before the treatment, whereas after the treatment it was 1.31 (0.5) (p < 0.001). Intraorbital fat pseudo‐prolapse severity was rated before the treatment 1.88 (0.7), whereas it was rated after the treatment 1.14 (0.3) (p < 0.001). Wrinkle severity of the lower eyelid was rated before the treatment 1.51 (0.6), whereas it was rated after the treatment 1.12 (0.3) (p < 0.001).The results of this retrospectively investigated case series revealed that the conducted injection technique for treating the tear trough for medial infraorbital hollowing with a cannula provided statistically significant clinical improvement with a limited adverse events profile. The technique utilized an injection approach which was perpendicularly oriented to the longitudinal axis of the tear trough thereby “bridging the gap instead of filling the entire valley.” [ABSTRACT FROM AUTHOR]

ABSTRACT The importance of treating non‐pulmonary vein (PV) foci is increasing with improvements in the durability of PV isolation. We describe two cases wherein non‐PV foci were induced by mechanical irritation and conventional induction in the same area, which was impossible to induce after ablation, suggesting a relationship between mechanical irritation and induction of non‐PV foci. In a recurrent case of non‐PV foci, atrial fibrillation (AF) was induced only by mechanical irritation. No recurrence has been observed since the ablation of the area. Thus, treatment of the AF induction site with mechanical irritation could be considered an effective therapy for non‐PV foci. [ABSTRACT FROM AUTHOR]

Catheter-based embolization has become a widely adopted minimally-invasive treatment for a broad range of applications. However, assessment of embolization endpoints requires x-ray fluoroscopic monitoring, exposing patients and physicians performing embolization procedures to harmful ionizing radiation. Moreover, x-ray fluoroscopy assessment of embolization endpoints is low sensitivity, subjective, and may not reflect the actual physiology of blood flow reduction, thus providing little oversight of the embolization procedure. Inspired by the observation that the dielectric properties of blood differ from those of fluids injected during the embolization procedure, a customized angiographic catheter was created with embedded electrodes for catheter-based electrochemical impedance spectroscopy as a way to monitor embolization. Real-time electrochemical impedance spectroscopy was performed in a phantom and compared to visual and videographic monitoring. Electrochemical impedance spectroscopy was able to sense endpoints of embolization, including stasis, reflux, and persistent flow. This new technique offers a label-free method of sensing embolization progress with potentially higher sensitivity and reproducibility compared to x-ray, as well as offer substantial reduction in x-ray exposure to patients and physicians. [ABSTRACT FROM AUTHOR]

Purpose: Robot-assisted laparoscopic radical prostatectomy (RARP) is the most common robotic procedures performed in urologic oncology. The Hugo Robot-Assisted Surgery (RAS) System (Medtronic, USA©) has recently been launched on the market and is characterized by the modularity of four different independent arm carts. The aim of this study is to describe and evaluate safety and feasibility of three-arms setting for RARP using the Hugo RAS™ System in a large case series. Methods: Between October 2022 and December 2023, a large case series of patients from two tertiary referral center who underwent RARP through HUGO™ RAS were prospectively enrolled. Informed written consent was obtained before the procedure and a three-arms setting was used in every case. Follow-up was scheduled according to EAU guidelines. Results: A total of 86 patients were included in this study and underwent RARP with Hugo™ RAS System. Median Console time time was 114 min (IQR, 75–150), median docking time 4 min (IQR, 3–5). Lymphadenectomy was successfully performed when indicated in 19 patients (22.1%). A vesicourethral anastomosis using the modified Van Velthoven technique was successfully achieved in all cases. No post-operative complications > Clavien II up to 30 post-operative days were reported. In all patients, catheter was removed on the 7th postoperative day. Conclusion: We conducted the first large case series of RARP through the novel Hugo™ RAS System using a three-arms configuration. This innovative robotic platform showed an easily accessible docking system, providing excellent perioperative outcomes. [ABSTRACT FROM AUTHOR]