Prevalence, mortality, cost, and disparities in transcatheter mitral valve repair and replacement in cancer patients: Artificial intelligence and propensity score national 5-year analysis of 7495 procedures.

INTRODUCTION: We conducted the first comprehensive evaluation of the therapeutic value and safety profile of transcatheter mitral edge-to-edge repair (TEER) and transcatheter mitral valve replacement (TMVR) in individuals concurrently afflicted with cancer. METHODS: Utilizing the National Inpatient Sample (NIS) dataset, we analyzed all adult hospitalizations between 2016 and 2020 (n = 148,755,036). The inclusion criteria for this retrospectively analyzed prospective cohort study were all adult hospitalizations (age 18 years and older). Regression and machine learning analyses in addition to model optimization were conducted using ML-PSr (Machine Learning-augmented Propensity Score adjusted multivariable regression) and BAyesian Machine learning-augmented Propensity Score (BAM-PS) multivariable regression. RESULTS: Of all adult hospitalizations, there were 5790 (0.004%) TMVRs and 1705 (0.001%) TEERs. Of the total TMVRs, 160 (2.76%) were done in active cancer. Of the total TEERs, 30 (1.76%) were done in active cancer. After the comparable rates of TEER/TMVR in active cancer in 2016, the prevalence of TEER/TMVR was significantly less in active cancer from 2017 to 2020 (2.61% versus 7.28% p < 0.001). From 2017 to 2020, active cancer significantly decreased the odds of receiving TEER or TMVR (OR 0.28, 95%CI 0.13-0.68, p = 0.008). In patients with active cancer who underwent TMVR/TEER, there were no significant differences in socio-economic disparities, mortality or total hospitalization costs. CONCLUSION: The presence of malignancy does not contribute to increased mortality, length of stay or procedural costs in TMVR or TEER. Whereas the prevalence of TMVR has increased in patients with active cancer, the utilization of TEER in the context of active cancer is declining despite a growing patient population.

Coronary Revascularization in Patients With Cancer.

Purpose of review: The treatment of coronary artery disease (CAD) in cancer patients is an evolving landscape. Recent data emphasizes the importance of aggressive management of cardiovascular risk factors and diseases in improving cardiovascular health in this unique group of patients regardless of cancer type or stage. Recent findings: Novel cancer therapeutics such as immune therapies and proteasome inhibitors have been associated with CAD. Recent stent technologies may safely allow for shorter duration (< 6 months) of dual antiplatelet therapy post-percutaneous coronary interventions. Intracoronary imaging may be useful in the decision making process in terms of stent positioning and healing. Summary: Large registry studies have partially filled a gap left by the lack of randomized controlled trials in the treatment of CAD in cancer patients. Cardio-oncology is gaining traction as a major sub-specialty in the cardiology field given the release of the first European Society of Cardiology - Cardio-oncology guidelines in 2022.

Single Radial Access Simultaneous Left Ventricular and Ascending Aortic Pressure for the Evaluation of Aortic Stenosis: The "Double-Barrel" Technique.

The use of simultaneous left ventricular and ascending aortic pressure tracings by cardiac catheterization is the gold standard of care for accurate hemodynamic assessment of aortic stenosis severity in patients with equivocal echocardiogram. We describe the first-in-man single radial access "double-barrel" technique for the evaluation of aortic stenosis. A 7-Fr Glidesheath Slender hydrophilic-coated introducer sheath (Terumo) was placed in the right radial artery. Two 4-Fr pigtails, 1 in the left ventricle and 1 in the ascending aorta, were advanced through the single sheath. The single radial access "double-barrel" technique is a simple way to accurately evaluate patients with aortic stenosis, avoiding multiple access sites or femoral access.

Single-access dual-injection technique (SADIT) for high-risk PCI with Impella CP.

The use of two arterial vascular accesses is now the standard of care in chronic total occlusion (CTO) percutaneous coronary interventions (PCI). When Impella support is needed, an additional vascular access may be necessary. We describe the first-in-man single-access, dual injection technique (SADIT). The Impella CP device was inserted in the left ventricle in the standard fashion. Subsequently, a 6 French sheath was placed at the "10 o clock" position and a second 4 French sheath was at the "5 o clock" position. This technique obviates the need for additional arterial access sites and potentially risk of complications. The SADIT technique is a simple way to perform high-risk, Impella-assisted coronary revascularization procedures necessitating dual coronary injections like CTO interventions. This strategy avoids unnecessary vascular complications from multiple access sites.

Lophomoniasis pulmonar / Pulmonary lophomoniasis / Lophomoniase pulmonar

Resumen: La lophomoniasis pulmonar es una infección por un protozoario sumamente rara, está asociada con enfermedades crónicas que comprometen la respuesta inmune; sus manifestaciones son erráticas en muchos de los casos, por lo que se retrasa el diagnóstico y el tratamiento oportuno, lo que lleva a complicaciones graves. Presentamos a paciente obstétrica complicada con síndrome de preeclampsia-eclampsia que fue expuesta a corticoide como madurador pulmonar fetal, la cual desarrolló neumonía con SIRA grave, y se documentó en frotis de secreción bronquial Lophomonas spp., recibió tratamiento específico con recuperación clínica.

Abstract: Pulmonary lophomoniasis is an extremely rare protozoan infection, it is associated with chronic diseases that compromise the immune response, its manifestations are in many cases erratic, which delays the diagnosis and timely treatment, leading to complications serious. We present obstetric patient complicated with preeclampsia eclampsia syndrome that was exposed to corticoids as fetal pulmonary maturing, developing pneumonia with severe ARDS, documented in smear of bronchial secretion Lophomonas ssp., received specific treatment with clinical recovery.

Resumo: A lophomoniase pulmonar é uma infecção protozoária extremamente rara, está associada a doenças crônicas que comprometem a resposta imune, suas manifestações são em muitos casos erráticas, por isso o diagnóstico e o tratamento oportuno são tardios levando a complicações sérias. Apresentamos uma paciente obstétrica complicada com síndrome de eclâmpsia pré-eclâmpsia que foi exposta ao corticóide como um madurador pulmonar fetal, desenvolvendo pneumonia com SIRA grave, documentada com frotis de secreção brônquica Lophomonas ssp, recebeu tratamento específico com recuperação clínica.

Puentes continuos pretensados con vigas prefabricadas

Contenido: 1.- Introduccion. 2.- Efectos de fluencia y retraccion. 3.- Ensayos ejecutados por la Portland Cement Association. 4.- Conclusiones obtenidas de los ensayos y teoria de calculo resultante. 5.- Aplicacion: proyecto de la superestructura de un puente carretero de 155 mts., continuo para carga viva sobre el río Sacramento. 6.- Ventajas con relacion a los puentes con tramos simples y a los puentes totalmente continuos de hormigon pretensado.