Comparative effectiveness of ultrathin vs. standard strut drug-eluting stents: insights from a large-scale meta-analysis with extended follow-up.

BACKGROUND: Newer generation ultrathin strut stents are associated with less incidence of target lesion failure (TLF) in patients undergoing percutaneous coronary intervention (PCI) in the short term. However, its long-term effect on different cardiovascular outcomes remains unknown. OBJECTIVES: We aim to identify the effects of newer-generation ultrathin-strut stents vs. standard thickness second-generation drug-eluting stents (DES) on long-term outcomes of revascularization in coronary artery disease. METHODS: We searched PubMed, Web of Science, Cochrane Library databases, and Scopus for randomized controlled trials (RCTs) and registries that compare newer-generation ultrathin-strut (< 70 mm) with thicker strut (> 70 mm) DES to evaluate cardioprotective effects over a period of up to 5 years. Primary outcome was TLF, a composite of cardiac death, target vessel myocardial infarction (TVMI) or target lesion revascularization (TLR). Secondary outcomes included the components of TLF, stent thrombosis (ST), and all-cause death were pooled as the standardized mean difference between the two groups from baseline to endpoint. RESULTS: We included 19 RCTs and two prospective registries (103,101 patients) in this analysis. The overall effect on the primary outcome was in favor of second-generation ultrathin struts stents in terms of TLF at ≥ 1 year, ≥ 2 years, and ≥ 3 years (P value = 0.01, 95% CI [0.75, 0.96]), P value = 0.003, 95% CI [0.77, 0.95]), P value = 0.007, 95% CI [0.76, 0.96]), respectively. However, there was no reported benefit in terms of TLF when we compared the two groups at ≥ 5 years (P value = 0.21), 95% CI [0.85, 1.04]). Some of the reported components of the primary and secondary outcomes, such as TLR, target vessel revascularization (TVR), and TVMI, showed the same pattern as the TLF outcome. CONCLUSION: Ultrathin-strut DES showed a beneficial effect over thicker strut stents for up to 3 years. However, at the 5-year follow-up, the ultrathin strut did not differ in terms of TLF, TLR, TVR, and TVMI compared with standard-thickness DES, with similar risks of patient-oriented composite endpoint (POCE), MI, ST, cardiac death, and all-cause mortality.

An important finding for differential diagnosis in thymic cyst mimicking pericardial cyst: punctate calcification.

Mediastinal cysts are usually congenital but present in adulthood. A pericardial cyst is usually localized in the right cardiophrenic region. Thymic cysts are less common and are located in the cervical region or anterior mediastinal region. While thoracoscopic excision or aspiration can be applied in pericardial cysts, excision is recommended in thymic cysts. We present a case of a thymic cyst located in the localization of the pericardial cyst and radiologically containing wall punctate calcification.

Cardiac calcified amorphous tumour: an unusual aetiology for recurrent cardioembolic strokes.

We report an elderly woman with vascular risk factors and recurrent cardioembolic strokes in whom the stroke aetiology was finally ascertained to be a calcified amorphous tumour of the heart after repeated negative investigations for embolic aetiology over 2 years. This report discusses the clinical and imaging characteristics of calcified amorphous tumours of the heart with emphasis of recent advances in cardiac imaging.

Extracorporeal membrane oxygenation in paediatric cardiac surgery: 5-year single centre experience.

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has become an integral part of paediatric cardiac surgery. We report the experience of a well-established ECMO service over 5 years. METHODS: This retrospective study analysed all paediatric patients who required ECMO support following cardiac surgery from April 2015 to March 2020. Inclusion criteria were age less than 18 years and post-operative ECMO support. Patients were analysed dividing into groups according to the urgency for ECMO support (extracorporeal cardiopulmonary resuscitation (ECPR) and cardiac ECMO) and according to age (neonatal and paediatric ECMO groups). They were followed for 30-day, 6-month mortality, long-term survival, postoperative morbidity and the need for reintervention. RESULTS: Forty-six patients were included who had a total of venoarterial (VA) 8 ECMO runs. The 5-year incidence of the need for VA ECMO after cardiac surgery was 3.3% (48 of the overall 1441 cases recorded). The median follow-up period was 3.5 (interquartile ranges, 0.8-4.7) years. Thirty-day, 6-month and follow-up survival rate was 85%, 65% and 52% respectively. At the 6-month follow-up, the ECPR group showed a trend towards worse survival compared with the cardiac ECMO group (47% vs. 55%) but with no statistical significance (p = 0.35). Furthermore, the survival rates between paediatric (60%) and neonatal (46%) ECMO groups were similar, with no statistical significance (p = 0.45). The rate of acute neurological events was 27% (13/48). CONCLUSION: ECPR and neonatal ECMO groups had higher mortality. VA ECMO 30-day and 6-month survival rates were 85% and 65% respectively. Major neurological injury resulting in ECMO termination occurred in 3 patients. Accumulated experiences and protocols in ECMO management can improve mortality and morbidity.

Comparing Capitonnage and Uncapitonnage Techniques for Pulmonary Hydatid Cysts: A Systematic Review and Meta-analysis.

Surgery is the primary treatment for pulmonary hydatid cysts. This systematic review and meta-analysis aimed to compare the results of capitonnage and uncapitonnage techniques for the surgery of pulmonary hydatid cysts. Descriptive Boolean queries were used to search PubMed, Scopus, and Web of Science for articles published up to June 2022 to evaluate the outcomes of pulmonary hydatid cysts in terms of mortality, postoperative complications, and hospital stay. A total of 12 studies were included. An analysis of the total side effects revealed that there was a statistically significant difference between the capitonnage and uncapitonnage groups (odds ratio=3.81, 95% confidence interval=[1.75-8.31], P < .001). The results showed that more side effects were observed in the uncapitonnage group than in the capitonnage group. The risk of side effects in the uncapitonnage group is 3.81 times higher than in the capitonnage group. The results showed that more prolonged air leak was seen in uncapitonnage group than in the capitonnage group (odds ratio=4.18, 95% confidence interval=[1.64-10.64], P=.003). The results show that more empyema was observed in uncapitonnage group than in the capitonnage group (odds ratio=4.76, 95% confidence interval=[1.29-17.57], P =0.020). An analysis of atelectasis and mean hospital stay revealed that there was no statistically significant difference between the capitonnage and uncapitonnage groups. The results reveal the advantages of capitonnage in the treatment of pulmonary hydatid cysts and that the capitonnage method is quite effective in reducing complications compared to the uncapitonnage method.

Microsievert Wide-Volume Versus Spiral Computed Tomography Using an Automatic Exposure Control System in the Diagnosis of Foreign Body Aspiration in Children.

BACKGROUND: Foreign body aspiration (FBA) in childhood is a life-threatening condition that necessitates prompt management to prevent devastating complications. Different imaging methods are used in the diagnosis of FBA. OBJECTIVE: The aim of this study was to compare the diagnostic value and dose of microsievert wide-volume computed tomography (µSv-WV-CT) with multidetector computed tomography using an automatic exposure control system (MDCT-AEC) in children with FBA. MATERIAL AND METHODS: In this single-center cross-sectional study, 102 cases diagnosed with FBA between September 2013 and September 2021 were retrospectively evaluated. The patients were divided into 2 groups according to the diagnostic modality used: group A, µSv-WV-CT (2016-2021) and group B, MDCT-AEC (2013-2021). The diagnostic performance and radiation dose of the 2 groups were statistically compared. RESULTS: The diagnostic performance (sensitivity, specificity, positive predictive value, negative predictive value, and accuracy) of the 2 groups was similar. The mean effective radiation dose of group A was 34.89 ± 0.01 µSv, which was significantly lower than that of group B (179.75 ± 114.88 µSv) ( P < 0.001). CONCLUSION: In children with suspected FBA, µSv-WV-CT at a lower radiation dose had similar diagnostic performance to MDCT-AEC.

Numerical simulation of the nanofluid flow consists of gyrotactic microorganism and subject to activation energy across an inclined stretching cylinder.

The current study examines the numerical simulation of the nanoliquid boundary layer flow comprising gyrotactic microbes with mass and energy transmission across a stretching inclined cylinder. The consequences of chemical reaction, heat generation/absorption, buoyancy force and Arrhenius activation energy is also considered on the nanofluid flow. The flow mechanism has been modeled in the form of system of nonlinear partial differential equations (PDEs). That system of PDEs is further transform into the dimensionless set of ordinary differential equations (ODEs) through the similarity substitutions. The obtained set of differential equations are numerically computed through the parametric continuation method (PCM). The effects of the distinct physical constraints on the energy, velocity, mass and the motile microbe profiles are discoursed and evaluated through Tables and Figures. It has been noticed that the velocity curve drops with the influence of inclination angle and Richardson number, while enhances against the variation of curvature factor. Furthermore, the energy field boosts with the upshot of inclination angle and heat source term, while declines with the influence of Prandtl number and Richardson number.

MHD flow of nanofluid over moving slender needle with nanoparticles aggregation and viscous dissipation effects.

The study of boundary layer flows over an irregularly shaped needle with small horizontal and vertical dimensions is popular among academics because it seems to have a lot of uses in fields as different as bioinformatics, medicine, engineering, and aerodynamics. With nanoparticle aggregation, magnetohydrodynamics, and viscous dissipation all playing a role in the flow and heat transmission of an axisymmetric TiO2-C2H6O2 nanofluid via a moving thin needle, this article provides guidance on how to employ a boundary layer for this purpose. In this case, we utilized the similarity transformation to change the dimensional partial differential equation into the dimensionless ordinary differential equation. We utilize MATHEMATICA to include shooting using RK-IV methods after identifying the numerical issue. Several characteristics were measured, leading to the discovery of a broad variety of values for things like skin friction coefficients, Nusselt numbers, velocity profiles, and temperature distributions. Velocity profile decreases with increasing values of ϕ,M,e and increases against ε. Temperature profiles enhances with increasing values of ϕ,M,e,ε, and Ec. The reduction in skin friction between a needle and a fluid can be observed when the values of M and ϕ are boosted. Furthermore, it was also noticed an increase in heat transfer on needle surface dramatically when ϕ,e, and M were raised, whereas Ec displayed the opposite effect. The findings of the current study are compared with prior findings for a particular instance in order to confirm the findings. Excellent agreement between the two sets of results is found.

Cross-Sectional Content Evaluation of Spinal Cord Injury Medicine Fellowship Websites.

This study evaluated the quality and accessibility of the websites of the Spinal Cord Injury Medicine (SCIM) fellowship programs to identify potential areas for improvement for future applicants. Twenty-four SCIM fellowship program websites were analyzed based on 44 predetermined criteria: website accessibility, education, research, recruitment, and incentives. This study found that many evaluated websites needed more information on didactics, educational resources, evaluation criteria, call requirements, schedules, and expected caseloads, which could lead to an incomplete understanding of the fellowship program. Additionally, more information on education and research can be needed for applicants to adequately compare programs and make informed decisions about which programs to apply to. Information about the selection process, current board pass rates, mentorship opportunities, technology/simulation, and alumni was limited across several evaluated websites. Incentives, fellow wellness, and harassment policies were also found to be insufficient or absent. The study emphasizes that SCIM fellowship programs should provide comprehensive and accurate information on their websites to facilitate applicants in choosing the program that aligns best with their professional goals. Including detailed and accurate information regarding general program qualities, educational and research opportunities, recruitment, and incentive data will provide prospective applicants with a holistic understanding of the program. By providing detailed and transparent information on their websites, SCIM fellowships can attract more qualified applicants and enhance the applicant pool, ultimately improving the quality of their program.

Long-Term Efficacy and Safety of Left Atrial Appendage Occlusion (LAAO) vs Direct Oral Anticoagulation (DOAC) in Patients with Atrial Fibrillation: A Systematic Review and Meta-Analysis.

Background: Prevention of stroke by anticoagulation is essential in patients with Atrial fibrillation (AF); with direct oral anticoagulants (DOACs) being preferred over warfarin in most patients. The Long-term efficacy and safety of DOACs vs. Left Atrial Appendage Occlusion (LAAO) remain unknown. Methods: Electronic databases (PubMed, Embase, Scopus) were searched from inception to February 10th, 2021. The primary endpoint was cardiovascular mortality. Secondary outcomes included incidence of ischemic stroke/transient ischemic attack (TIA) and systemicembolism. The safety endpoint was clinically relevant bleeding (a composite of major or minor clinically relevant bleeding). Results: A total of three studies with 3039 participants (LAAO = 1465; DOACs = 1574) were included. Mean age was 74.2 and 75.3 years in the LAAO and DOAC group respectively. Average follow-up period was 2 years. There was no difference in terms of cardiac mortality (RR 0.90, 95% CI 0.40-2.03; p = 0.81), ischemic stroke/TIA (RR 1.15, 95% CI 0.80-1.65; p = 0.46; I 2 = 0) and clinically significant bleeding (RR 0.77, 95% CI 0.50-1.17; p = 0.22; I 2 = 69) between the groups. Conclusions: Among patients with AF, LAAO was comparable to DOACs with similar efficacy and safety profiles.