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To compare incidence rates of lower limb muscle injuries (LLMIs) and hamstring muscle injuries (HMIs) in 100 m, 200 m and 400 m sprints disciplines between finals, semi-finals and heats of international athletics championships. Prospective total population study. We analysed in-competition LLMIs and HMIs of female and male athletes during eight championships between 2009 and 2022. LLMI and HMI incidence rates in 100 m finals were significantly higher than in heats and semi-finals for female and male athletes. HMI incidence rates were significantly higher in 200 m finals than heats and semi-finals for male athletes. LLMI and HMI risk was higher in finals compared to previous rounds during international athletics championships. [ABSTRACT FROM AUTHOR]

To explore perceptions and beliefs of elite athletics (track and field) athletes, coaches, and health professionals, towards the use of injury prediction as an injury risk reduction strategy. Cross-sectional study. During the 2022 European Athletics Championships in Munich, registered athletes, coaches, and health professionals were asked to complete an online questionnaire on their perceptions and beliefs of injury prediction use as an injury risk reduction strategy. The perceived level of interest, intent to use, help, potential stress (psychological impact) and dissemination were assessed by a score from 0 to 100. We collected 54 responses from 17 countries. Elite athletics stakeholders expressed a perceived level of interest, intent to use, and help of injury prediction of (mean ± SD) 85 ± 16, 84 ± 16, and 85 ± 15, respectively. The perceived level of potential stress was 41 ± 33 (range from 0 to 100), with an important inter-individual variability in each elite athletics stakeholder's category. This was the first study investigating the perceptions and beliefs of elite athletics stakeholders regarding the use of injury prediction as an injury risk reduction strategy. Regardless of the stakeholders, there was a high perceived level of interest, intent to use and help reported in this potential strategy. • Injury risk prediction could be well accepted by elite athletics stakeholders. • Populations expectations must align with the injury risk reduction strategies. • Injury risk prediction increases stress with high inter-individual variability. • Inter-subject variability is crucial to the implementation of preventive measures. [ABSTRACT FROM AUTHOR]

Despite the significant morbidity associated with gastric variceal bleeding, there is a paucity of high-quality data regarding optimal management. EUS-guided coil injection therapy (EUS-COIL) has recently emerged as a promising endoscopic modality for the treatment of gastric varices (GV), particularly compared with traditional direct endoscopic glue injection. Although there are data on the feasibility and safety of EUS-COIL in the management of GV, these have been limited to select centers with particular expertise. The aim of this study was to report the first U.S. multicenter experience of EUS-COIL for the management of GV. This retrospective analysis included patients with bleeding GV or GV at risk of bleeding who underwent EUS-COIL at 10 U.S. tertiary care centers between 2018 and 2022. Baseline patient and procedure-related information was obtained. EUS-COIL entailed the injection of.018 inch or.035 inch hemostatic coils using a 22-gauge or 19-gauge FNA needle. Primary outcomes were technical success (defined as successful deployment of coil into varix under EUS guidance with diminution of Doppler flow), clinical success (defined as cessation of bleeding if present and/or absence of bleeding at 30 days' postintervention), and intraprocedural and postprocedural adverse events. A total of 106 patients were included (mean age 60.4 ± 12.8 years; 41.5% female). The most common etiology of GV was cirrhosis (71.7%), with alcohol being the most common cause (43.4%). Overall, 71.7% presented with acute GV bleeding requiring intensive care unit stay and/or blood transfusion. The most common GV encountered were isolated GV type 1 (60.4%). A mean of 3.8 ± 3 coils were injected with a total mean length of 44.7 ± 46.1 cm. Adjunctive glue or absorbable gelatin sponge was injected in 82% of patients. Technical success and clinical success were 100% and 88.7%, respectively. Intraprocedural adverse events (pulmonary embolism and GV bleeding from FNA needle access) occurred in 2 patients (1.8%), and postprocedural adverse events occurred in 5 (4.7%), of which 3 were mild. Recurrent bleeding was observed in 15 patients (14.1%) at a mean of 32 days. Eighty percent of patients with recurrent bleeding were successfully re-treated with repeat EUS-COIL. No significant differences were observed in outcomes between high-volume (>15 cases) and low-volume (<7 cases) centers. This U.S. multicenter experience on EUS-COIL for GV confirms high technical and clinical success with low adverse events. No significant differences were seen between high- and low-volume centers. Repeat EUS-COIL seems to be an effective rescue option for patients with recurrent bleeding GV. Further prospective studies should compare this modality versus other interventions commonly used for GV. [Display omitted] [ABSTRACT FROM AUTHOR]

Enhanced recovery after cardiac surgery (ERACS) has been gaining rapid acceptance after multiple studies have demonstrated promising results in improved outcomes of enhanced recovery after surgery in other surgical fields (eg, colorectal, orthopedic, thoracic, etc). Cardiac surgery has several unique challenges, including sternotomy, cardiopulmonary bypass and associated coagulopathy, blood transfusion, and postoperative intensive care requirement. Nonetheless, selective cardiac surgical patients can still benefit from ERACS. Guidelines for perioperative care in cardiac surgery, previously published by the ERACS Society, are weighted heavily in preoperative and postoperative management without much focus on intraoperative care provided by anesthesiologists. To address this gap and to explore anesthesiology's contribution in achieving ERACS, the study authors' cardiac anesthesiology division, in collaboration with cardiac surgery, introduced the ERACS protocol in their institution in February 2020. The cardiac anesthesiology division, in collaboration with cardiac surgery, introduced the ERACS protocol consisting of multimodal opioid-sparing analgesia, including the introduction of regional blocks, hemostasis management protocol, reversal of neuromuscular blockade, and administration of antiemetics in the authors' institution in February 2020. They have conducted a retrospective chart review study comparing patients who have received ERACS measures with a similar historic cohort who underwent cardiac surgery prior to initiation of an ERACS protocol. The primary outcomes of the study were to determine patients' time to extubation, postoperative opioid consumption, intensive care unit (ICU) length of stay (LOS), and incidence of postoperative complications (eg, postoperative nausea vomiting [PONV], bleeding, ICU readmission, delirium. The ERACS patients showed reduced opioid consumption (intraoperative fentanyl; postoperative fentanyl, as well as oxycodone, in the first 6 hours postoperatively), lesser mechanical ventilation (2.5 hours less), shorter ICU stays (5 hours less), shorter hospital LOS (1 day), and lesser incidence of PONV. None of the ERACS patients required blood transfusion. The study authors performed an anonymous survey among the anesthesiologists and ICU providers to assess providers' satisfaction, which showed 92% of survey takers agreed that the ERACS protocol should be continued for future cardiac patients, and 61% of survey takers reported superior pain control in ERACS group of patients while managing those patients. The ERACS is achievable after the careful implementation of a series of measures. It does not signify only fast-track extubation and opioid-sparing analgesia, and must be implemented in the entire perioperative period beginning from preoperative clinic to postoperative rehabilitation. Cardiac anesthesiologists play a vital role in execution of intraoperative ERACS measures. Both providers and patients themselves are key stakeholders. A larger randomized prospective trial is warranted to solidify the inference. [ABSTRACT FROM AUTHOR]

Single ventricle (SV) patients with pulmonary vascular disease (SV-PVD) are considered poor surgical candidates for Glenn or Fontan palliation. Given limited options for Stage 1 (S1) and Stage 2 (S2) SV patients with SV-PVD, we report on the use of subcutaneous treprostinil (TRE) to treat SV-PVD in this population. This single-center, retrospective cohort study examined SV patients who were not candidates for subsequent surgical palliation due to SV-PVD and were treated with TRE. The primary outcome was ability to progress to the next surgical stage; secondary outcomes included changes in hemodynamics after TRE initiation. Between 3/2014 and 8/2021, 17 SV patients received TRE for SV-PVD: 11 after S1 and 6 after S2 (median PVR 4.1 [IQR 3.2–4.8] WU*m2 and 5.0 [IQR 1.5–6.1] WU*m2, respectively). Nine of 11 (82%) S1 progressed to S2, and 2 (18%) underwent heart transplant (HTx). Three of 6 (50%) S2 progressed to Fontan, 1 underwent HTx and 2 are awaiting Fontan on TRE. TRE significantly decreased PVR in S1 patients with median post-treatment PVR of 2.0 (IQR 1.5–2.6) WU*m2. TRE can allow for further surgical palliation in select pre-Fontan patients with SV-PVD, obviating the need for HTx. Improvement in PVR was significant in S1 patients and persisted beyond discontinuation of therapy for most patients. [Display omitted] [ABSTRACT FROM AUTHOR]

Currently there are no immunosuppression regimens FDA-approved to prevent rejection in pediatric heart transplantation (HT). In recent years, everolimus (EVL) has emerged as a potential alternative to standard tacrolimus (TAC) as the primary immunosuppressant to prevent rejection that may also reduce the risk of cardiac allograft vasculopathy (CAV), chronic kidney disease (CKD) and cytomegalovirus (CMV) infection. However, the 2 regimens have never been compared head-to-head in a randomized trial. The study design and rationale are reviewed in light of the challenges inherent in rare disease research. The TEAMMATE trial (IND 127980) is the first multicenter randomized clinical trial (RCT) in pediatric HT. The primary purpose is to evaluate the safety and efficacy of EVL and low-dose TAC (LD-TAC) compared to standard-dose TAC and mycophenolate mofetil (MMF). Children aged <21 years at HT were randomized (1:1 ratio) at 6 months post-HT to either regimen, and followed for 30 months. Children with recurrent rejection, multi-organ transplant recipients, and those with an estimated glomerular filtration rate (eGFR) <30 mL/min/1.73m2 were excluded. The primary efficacy hypothesis is that, compared to TAC/MMF, EVL/LD-TAC is more effective in preventing 3 MATEs: acute cellular rejection (ACR), CKD and CAV. The primary safety hypothesis is that EVL/LD-TAC does not have a higher cumulative burden of 6 MATEs (antibody mediated rejection [AMR], infection, and post-transplant lymphoproliferative disorder [PTLD] in addition to the 3 above). The primary endpoint is the MATE score, a composite, ordinal surrogate endpoint reflecting the frequency and severity of MATEs that is validated against graft loss. The study had a target sample size of 210 patients across 25 sites and is powered to demonstrate superior efficacy of EVL/LD-TAC. Trial enrollment is complete and participant follow-up will be completed in 2023. The TEAMMATE trial is the first multicenter RCT in pediatric HT. It is anticipated that the study will provide important information about the safety and efficacy of everolimus vs tacrolimus-based regimens and will provide valuable lessons into the design and conduct of future trials in pediatric HT [ABSTRACT FROM AUTHOR]

The Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs), supported by The Society of Thoracic Surgeons, provides detailed information on pediatric patients supported with ventricular assist devices (VADs). From September 19, 2012, to December 31, 2021, there were 1355 devices in 1109 patients (<19 years) from 42 North American Hospitals. Cardiomyopathy was the most common underlying cause (59%), followed by congenital heart disease (25%) and myocarditis (9%). Regarding device type, implantable continuous (IC) VADs were most common at 40%, followed by paracorporeal pulsatile (PP; 28%) and paracorporeal continuous (PC; 26%). Baseline demographics differed, with the PC cohort being younger, smaller, more complex (ie, congenital heart disease), and sicker at implantation (P <.0001). At 6 months after VAD implantation, a favorable outcome (transplantation, recovery, or alive on device) was achieved in 84% of patients, which was greatest among those on IC VADs (92%) and least for PC VADs (69%). Adverse events were not uncommon, with nongastrointestinal bleeding (incidence of 14%) and neurologic dysfunction (11% [stroke, 4%]), within 2 weeks after implantation being the most prevalent. Stroke and bleeding had negative impacts on overall survival (P =.002 and P <.001, respectively). This Sixth Pedimacs Report demonstrates the continued evolution of the pediatric field. The complexity of cardiac physiologies and anatomic constraint mandates the need for multiple types of devices used (PC, PP, IC). Detailed analyses of each device type in this report provide valuable information to further advance the care of this challenging and vulnerable population. [ABSTRACT FROM AUTHOR]

To evaluate whether the prescription of SGLT2-inhibitors in primary care patients with type 2 diabetes (T2DM) and a very high risk was according to the newest updated Dutch general practitioners' practice guidelines on T2DM. This observational study with routine care data was conducted in a primary care setting in the Netherlands. The very high-risk population size was identified and analyzed via descriptive statistics. In this high-risk group the percentage of patients treated with SGLT2-inhibitors was assessed. Of the 1492 T2DM patients managed in primary care, 475 (31.8%) were classified as very high-risk based on (a history of) ischemic cardiovascular disease, chronic kidney disease, and/or heart failure. Of the very high-risk patients, 49 (10.3%) received SGLT2-inhibitors conform the guidelines. Of the remaining 426 high-risk patients 334 (70.3%) had no contraindication (eGFR <30 ml/min/1.73 m2 or HbA1c <53 mmol/mol) for initiating SGLT2-i prescription according to the guidelines. None of these patients received an GLP-1 agonist as alternative. The vast majority of very high-risk type 2 diabetes patients were not prescribed SGLT2-I. There is substantial room for improvement in the management of these critical T2DM patients because most of them had no contraindications for initiating SGLT2-I prescription. • In a type 2 diabetes population care 31.8% were classified as having very high risk. • High risk was based on cardiovascular disease, chronic kidney disease and/or heart failure. • Only 10.3% of the very high risk patients used a SGLT2-I. • There is room for improvement of managing these high risk patients. [ABSTRACT FROM AUTHOR]

Objectives: To analyse the association between pre-participation health status and in-championships injuries in a large dataset from seven international athletics championships, and to determine the health status of athletes during the four weeks before the start of international athletics championships.Design: Prospective cohort study.Methods: We used data collected from athletes of national teams with medical staff who participated i) in a pre-participation health survey (retrospective data collection) and ii) in an in-championships injury surveillance (prospective data collection) during seven international athletics championships (2013-2018). We performed a binomial logistic regression with in-championship injury (yes/no) as the dependent variable and sex, age, discipline (explosive/endurance), type of championships (outdoor/indoor) and pre-participation injury complaint (yes/no) and pre-participation illness complaint (yes/no) as independent variables, with odds ratios (OR) and 95% confidence intervals (95% CI).Results: Out of the 1095 athletes included 31.2% reported an injury complaint during the 4 weeks before the championships and 21.6% an illness complaint. The univariate model showed that discipline, type of championships and pre-participation injury complaints (OR = 2.57, 95%CI: 1.66 to 3.97) were significantly associated with in-championships injuries, and the multivariable model showed that type of championships and pre-participation injury complaints (OR = 2.64, 95%CI: 1.60 to 4.36) remained significantly associated with in-championships injuries.Conclusions: Our present study shows that an injury complaint during the four weeks before an international athletics championship significantly increased risk of sustaining an injury during the following championship, which was reported by about one third of athletes with differences between sex and disciplines. [ABSTRACT FROM AUTHOR]

Background: Sudden cardiac arrest (SCA) is a prevailing cause of mortality after pediatric heart transplant (HT) but remains understudied. We analyzed the incidence, outcomes, and risk factors for SCA at our center.Methods: Retrospective review of all pediatric HT patients at our center from January 1, 2009 to January 1, 2021. SCA was defined as an abrupt loss of cardiac function requiring cardiopulmonary resuscitation and/or mechanical circulatory support (MCS). Events that occurred in the setting of limited resuscitative wishes, or while on MCS were excluded. Patient characteristics and risk factors were analyzed.Results: Fourteen of 254 (6%) experienced SCA at a median of 3 (1, 4) years post-HT. Seven (50%) events occurred out-of-hospital. Eleven (79%) died from their initial event, 2 (18%) after failure to separate from extracorporeal membrane (ECMO). In univariate analysis, black race, younger donor age, prior acute cellular rejection (ACR) episode, pacemaker and/or ICD in place, and pre-mortem diagnosis of allograft vasculopathy were associated with SCA (P = .003-0.02). In multivariable analysis, history of ACR, younger donor age, and black race retained significance. [OR = 6.3, 95% CI: 1.6-25.4, P = .01], [OR = 0.9, 95% CI: 0.8-1, P = .04], and [OR = 7.3, 95% CI: 1.1-49.9, P = .04], respectively. SCA occurred in 3 patients with a functioning ICD or pacemaker, which failed to restore a perfusing rhythm.Conclusions: SCA occurs relatively early after pediatric HT and is usually fatal. Half of events happen at home. Those who received younger donors, have a history of ACR, or are of black race are at increased risk. ICDs/pacemakers may offer limited protection. [ABSTRACT FROM AUTHOR]

It is not yet established whether additional orbicularis oculi muscle excision leads to better patient-reported aesthetic outcomes (PRO) compared to a skin-only resection blepharoplasty. A double-blind randomized controlled trial of upper blepharoplasty, with or without muscle excision, was performed on 54 White European patients who assessed the procedure via PRO. FACE-Q questionnaires covering eyes in general, upper eyelids, forehead and eyebrows, overall face, age appearance appraisal, age appraisal, social functioning, satisfaction with the outcome, and adverse effects were completed preoperatively and at 6 and 12 months after upper blepharoplasty. The Patient and Observer Scar Assessment Scale was used to assess scarring. The FACE-Q scores for skin-only and skin/muscle upper blepharoplasty were similar regarding the upper eyelids, forehead and eyebrows, overall face, patient perceived aging and age, social functioning, and satisfaction with the results, and also increased for both procedures with time. The FACE-Q score regarding the eyes in general was higher in the skin-only group at the 12-month follow-up. Scarring and adverse effects did not differ between the groups. Additional muscle resection does not seem to influence patient satisfaction. Thus, when performing an upper blepharoplasty, there is no need for additional muscle resection as a routine procedure to improve patient satisfaction. [ABSTRACT FROM AUTHOR]

Optimal treatment for an adult patient with hyperdivergent facial morphology, Class III malocclusion, bilateral posterior crossbite, and skeletal disharmony usually requires comprehensive orthodontics combined with extractions, orthognathic surgery, or both. However, treatment becomes more challenging when the patient rejects surgery because of fear or cost. This case report presents the orthodontic treatment of a 24-year-old woman with a Class III malocclusion and bilateral posterior crossbite without surgery using orthopedic and comprehensive orthodontic approaches. The extraoral evaluation showed a hyperdivervent pattern, paranasal deficiency, a slightly protrusive lower lip, and an obtuse labiomental angle with a chin deviated to the left. Intraorally, she exhibited a severe Angle Class III malocclusion bilaterally with edge-to-edge to -1 mm overjet, canting of the occlusal plane up to the left with mandibular midline 5.3 mm to the left of the maxillary and facial midlines, and bilateral posterior crossbite with 5.7 mm of arch width discrepancy. Therefore, the patient was diagnosed with skeletal and dental Class III relationship, hyperdivergent pattern, a deviation of the mandible to the left, bilateral posterior crossbite, mild to moderate maxillary and mandibular crowding, slightly proclined maxillary incisors and upright mandibular incisors. After 15 months of treatment, all treatment objectives were achieved, and the appliances were removed. Teeth were well leveled and aligned, ideal overbite and overjet were established with premolars and canines in a Class I relationship, bilateral posterior crossbite was corrected, vertical dimension was controlled, and the smile was improved with a slight improvement in the profile; however, bilaterally, the molar occlusion was not completely settled and remained in a Class III relationship. This case report demonstrates the successful nonsurgical treatment of an adult with Class III malocclusion, hyperdivergent facial morphology, and bilateral posterior crossbite using a midfacial skeletal expander and facemask for orthopedic correction. With reduced costs and fewer risks than surgical treatment options, this treatment protocol offers an alternative to adult patients. [ABSTRACT FROM AUTHOR]

Although EUS is highly accurate for the evaluation of common bile duct (CBD) dilation, the yield of EUS in patients with incidental CBD dilation is unclear. Serial patients undergoing EUS for incidental, dilated CBD (per radiologist, minimum of >6 mm objectively) from 2 academic medical centers without active pancreaticobiliary disease or significantly elevated liver function test results were evaluated. Multivariable logistic regression identified predictors of EUS with significant findings and a novel prediction model was derived from one center, internally validated with bootstrapping, and externally validated at the second center. Of 375 patients evaluated, 31 (8.3%) had significant findings, including 26 choledocholithiasis, 1 ampullary adenoma, and 1 pancreatic mass. Predictors of significant findings with EUS included age of ≥70 years (odds ratio [OR], 3.7; 95% confidence interval [CI], 1.5-10.0), non–biliary-type abdominal pain without chronic pain (OR, 6.1; 95% CI, 2.3-17.3), CBD diameter of ≥15 mm or ≥17 mm with cholecystectomy (OR, 6.9; 95% CI, 2.7-18.7), and prior ERCP (OR, 6.8; 95% CI, 2.1-22.5). A point-based novel clinical prediction model was created: age of ≥70 years = 1, non–biliary-type abdominal pain without chronic pain = 2, prior ERCP = 2, and CBD dilation = 2. A score of <1 had 93% (development) and 100% (validation) sensitivity and predicted a <2% chance of having a significant finding in both cohorts while excluding the need for EUS in ∼30% of both cohorts. Conversely, a score of ≥4 was >90% specific for the presence of significant pathology. Less than 10% of patients undergoing EUS for incidental CBD dilation had pathologic findings. This novel, externally validated, clinical prediction model may reduce low-yield, invasive evaluation in nearly one-third of patients. [Display omitted] [ABSTRACT FROM AUTHOR]

Objectives: It has been claimed that analyses of large datasets from publicly accessible, open-collaborated ("citizen science-based") online databases may provide additional insight into the epidemiology of injuries in professional football. However, this approach comes with major limitations, raising critical questions about the current trend of utilizing citizen science-based data. Therefore, we aimed to determine if citizen science-based health data from a popular online database on professional football players can be used for epidemiological research, i.e. in providing results comparable to other data sources used in previously published studies.Design: Retrospective database analysis.Methods: Transfermarkt.com (Transfermarkt; Hamburg; Germany) is a publicly accessible online database on various data of professional football players. All information provided in the section "injury history" of football players from the top five European leagues over a period of ten seasons (2009/10-2018/19) was analyzed. Frequency, characteristics, and incidence of injuries were reported according to seasons and countries, and results compared with three previously published databases (a scientific injury surveillance, a media-based study, and an insurance database).Results: Overall, 21,598 injuries of 11,507 players were analyzed from the Transfermarkt.com database. Incidence was 0.63 injuries per player-season (95% confidence interval 0.62 to 0.64) but significant differences between subgroups (countries, years) were found. In comparison to other databases, citizen science-based data was associated with lower injury incidences and higher proportions of severe injuries.Conclusions: With few exceptions (e.g., severe injuries), the use of citizen science-based health data on professional football players cannot be recommended at present for epidemiological research. [ABSTRACT FROM AUTHOR]

Background: Among patients with acute dyspnea, concentrations of N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T, and insulin-like growth factor binding protein-7 predict cardiovascular outcomes and death. Understanding the optimal means to interpret these elevated biomarkers in patients presenting with acute dyspnea remains unknown.Methods and Results: Concentrations of NT-proBNP, high-sensitivity cardiac troponin T, and insulin-like growth factor binding protein-7 were analyzed in 1448 patients presenting with acute dyspnea from the prospective, multicenter International Collaborative of NT-proBNP-Re-evaluation of Acute Diagnostic Cut-Offs in the Emergency Department (ICON-RELOADED) Study. Eight biogroups were derived based upon patterns in biomarker elevation at presentation and compared for differences in baseline characteristics. Of 441 patients with elevations in all 3 biomarkers, 218 (49.4%) were diagnosed with acute heart failure (HF). The frequency of acute HF diagnosis in this biogroup was higher than those with elevations in 2 biomarkers (18.8%, 44 of 234), 1 biomarker (3.8%, 10 of 260), or no elevated biomarkers (0.4%, 2 of 513). The absolute number of elevated biomarkers on admission was prognostic of the composite end point of mortality and HF rehospitalization. In adjusted models, patients with one, 2, and 3 elevated biomarkers had 3.74 (95% confidence interval [CI], 1.26-11.1, P = .017), 12.3 (95% CI, 4.60-32.9, P < .001), and 12.6 (95% CI, 4.54-35.0, P < .001) fold increased risk of 180-day mortality or HF rehospitalization.Conclusions: A multimarker panel of NT-proBNP, hsTnT, and IGBFP7 provides unique clinical, diagnostic, and prognostic information in patients presenting with acute dyspnea. Differences in the number of elevated biomarkers at presentation may allow for more efficient clinical risk stratification of short-term mortality and HF rehospitalization. [ABSTRACT FROM AUTHOR]

• Male team sport players have more overall, upper extremity, hip/groin, thigh and foot injuries than female players. • Female team sport players have more anterior cruciate ligament injuries but do not differ significantly from males in the concussion, ankle sprain, Achilles tendon rates. • Sex appears to be no general risk factor but should be considered in interaction with the type of sport. • Non-football team sports were underrepresented in this meta-analysis indicating the need of further injury surveillance studies including elite athletes of both sexes. Team-sport players have a particularly high injury risk. Although female sex is considered a risk factor, it is still unknown whether female and male team-sport players, in fact, differ in their injury rates. We aimed to compare injury rates between female and male players by systematically reviewing and meta-analyzing injury surveillance studies of both sexes in order to evaluate sex-specific differences in team-sport injuries. Studies that prospectively collected injury data for high-level female and male players (age ≥16 years) in basketball, field hockey, football (soccer), handball, rugby (union and sevens), and volleyball were included. Two reviewers (AZ and ALR) independently assessed study quality and extracted data for overall, match, training, and severe injuries (>28 days' time loss) as well as data regarding injury locations and types. Incidence rate ratios (IRRs) were pooled in a meta-analysis, and meta-regression analysis was performed when 10 or more studies were available. Of 20 studies, 9 studies reported injury data from football, 3 studies from rugby, 3 studies from handball, 1 study from basketball, 1 study from field hockey, 2 studies from volleyball, and 1 study from basketball and field hockey. For overall injuries, the pooled IRR = 0.86 (95% confidence interval (95%CI): 0.76−0.98) indicated significantly more injuries in male than in female players. For injury location, the pooled IRR showed higher injury rates in male athletes than in female athletes for upper extremity, hip/groin, thigh, and foot injuries. Female players had a significantly higher rate of anterior cruciate ligament injuries (IRR = 2.15, 95%CI: 1.27−3.62) than male players. No significant sex-specific differences in IRR were found for match, training, severe injuries, concussions, or ankle sprains. Our meta-analysis provides evidence for sex-specific differences in the injury rates in team sports. Further epidemiological studies including both sexes in sports other than football are needed in order to strengthen the evidence. [Display omitted] [ABSTRACT FROM AUTHOR]

The Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) provides detailed information on pediatric patients supported with ventricular assist devices (VADs). From September 19, 2012, to December 31, 2020, 1229 devices in 1011 patients were reported to the registry from 47 North American Hospitals in patients aged younger than 19 years. Cardiomyopathy was the most common underlying etiology (58%), followed by congenital heart disease (CHD; 25%) and myocarditis (10%). The most common devices implanted were implantable continuous (IC; 419 [41%]), followed by paracorporeal pulsatile (PP; 269 [27%]), paracorporeal continuous (PC; 263 [26%]), and percutaneous (53 [5%]). Overall, at 6 months after VAD implantation, 83% had a positive outcome (transplant, explant, or alive on device). The freedom from stroke at 3 months was highest in IC VADs (93%), compared with PP VADs (84%) and with PC VADs (75%). There were differences in survival by device type, with patients on IC VADs having the best overall survival and those on PC having the lowest overall survival, though the patient populations being supported by each VAD type differed significantly from each other. This Fifth Pedimacs Report demonstrates the continued robust growth of VADs in the pediatric community, now with more than 1000 patients reported to the registry. The multiple available device types (PC, PP, IC) serve different populations with different pre-VAD risk profiles, which may account for differences in survival and adverse events between device types. [ABSTRACT FROM AUTHOR]

The University of Wisconsin Running Injury and Recovery Index (UWRI) was developed as an evaluative patient-reported outcome measure of perceived running ability and recovery after running-related injuries. To date, the questionnaire was not translated into German language and studies on its clinical feasibility and validity are sparse. Prospective cohort study. Outpatient sports medicine clinic. The UWRI questionnaire was translated to German language using a state-of-the art back-translation method including three translators and two back-translators. Clinical feasibility and validation were assessed in 14 injured runners. UWRI total score, running volume. The translation process was completed without major discrepancies. Feasibility and preliminary evaluation were demonstrated in a cohort of 14 injured runners. The UWRI total score significantly improved throughout 12 weeks of recovering from running-related injuries (p < 0.001). Relative running volume significantly correlated with UWRI score (p < 0.001). The University of Wisconsin Running Injury and Recovery Index was successfully translated into the German language. Its usage may hold promise for better rehabilitation surveillance following running-related injuries. • The UWRI provides information on the recovery from a running-related injury. • This patient-reported outcome measure can be successfully translated and culturally adapted. • This study indicates its feasibility and validity in a clinical setting. • Usage of the UWRI may hold promise for better rehabilitation surveillance. [ABSTRACT FROM AUTHOR]

Gastrointestinal (GI) bleeding in patients with calcific aortic valve stenosis (AVS), termed Heyde syndrome, was first described by Edward C. Heyde. The strong association between valvular replacement and the eradication of clinically significant GI bleeding confirmed an underlying pathophysiologic relationship. The rheologic stress created by AVS increases proteolysis of von Willebrand factor (VWF), resulting in loss of predominantly high-molecular-weight VWF (Hmw VWF). Angiodysplastic vessels present in patients with AVS, coupled with the lack of functioning Hmw VWF, increase the risk for GI bleeds. Aortic valve replacement, both surgical and transcatheter-based, is often a definitive treatment for GI bleeding, leading to recovery of Hmw VWF multimers. Perioperative management of patients involves monitoring their coagulation profiles with relevant laboratory tests and instituting appropriate management. Management can be directed in the following two ways: by improving internal release of VWF or by administration of external therapeutics containing VWF. It is important for perioperative physicians to obtain an understanding of the pathophysiology of this disease process and closely monitor the bleeding pattern so that targeted therapies can be initiated. [ABSTRACT FROM AUTHOR]

Background: Surgical site infections (SSI) are the second commonest healthcare-associated infections. Active SSI surveillance can help inform preventative measures and assess the impact of these measures.Aim: We aimed to describe the evolution in trends over fourteen years of prospective active SSI surveillance and implementations of SSI prevention measures in a French Teaching Hospital.Methods: We monitored and included in the study all surgical procedures performed from 2003 to 2016 in eight surgical units. The semi-automated surveillance method consisted in weekly collection of SSI declaration forms (pre-filled with patient and procedure administrative data and microbiology laboratory data), filled-in by surgeons and then monitored by the infection control practitioners.Findings: 181,746 procedures were included in our analysis and 3,270 SSIs recorded (global SSI rate 1.8%). The SSI rate decreased significantly from 3.0% in 2003 to 1.1% in 2016. This decrease was mainly in superficial SSIs and high infectious risk procedures. Higher SSI rates were observed for procedures associated with the usual risk factors. During this fourteen-year period, several evolutions in surgical practices occurred that might have contributed to this decrease.Conclusion: With an overall decrease in SSI rate throughout the surveillance, our results revealed the benefits of an active and comprehensive hospital SSI surveillance programme for understanding the SSI rate trends, analysing local risk factors and assess effectiveness of prevention strategies. These findings highlighted also the importance of the collaboration between surgeons and infection control practitioners. [ABSTRACT FROM AUTHOR]

• HFNC is a potential feasible rescue respiratory treatment strategy for frail elderly COVID-19 patients. • Using HFNC in fragile COVID-19 patients in the wards results in a survival rate of 25%. • For fragile COVID-19 ICU and frail HFNC patients in the wards mortality is comparable. Invasive mechanical ventilation is the treatment of choice in COVID-19 patients when hypoxemia persists, despite maximum conventional oxygen administration. Some frail patients with severe hypoxemic respiratory failure are deemed not eligible for invasive mechanical ventilation. To investigate whether High-flow nasal cannula (HFNC) in the wards could serve as a rescue therapy in these frail patients. This retrospective cohort study included frail COVID-19 patients admitted to the hospital between March 9th and May 1st 2020. HFNC therapy was started in the wards. The primary endpoint was the survival rate at hospital discharge. Thirty-two patients with a median age of 79.0 years (74.5–83.0) and a Clinical Frailty Score of 4 out of 9 (3–6) were included. Only 6% reported HFNC tolerability issues. The overall survival rate was 25% at hospital discharge. This study suggests that, when preferred, HFNC in the wards could be a potential rescue therapy for respiratory failure in vulnerable COVID-19 patients. [ABSTRACT FROM AUTHOR]

A working group was established to develop a core domain set (CDS) for Chronic Nonbacterial Osteomyelitis (CNO) and Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis (SAPHO) following the OMERACT filter 2.1. A scoping review to identify disease-related manifestations was performed, followed by a special interest group (SIG) session at OMERACT2020 to begin the CNO/SAPHO CDS framework. Candidate items were identified from the scoping review and most fell under Life Impact and Pathophysiology Manifestation core areas. A SIG agreed on the need to develop a CDS for CNO and SAPHO (100%) and for children and adults (91%). Based on candidate items identified, qualitative research and Delphi surveys will be performed as next steps. [ABSTRACT FROM AUTHOR]

The Yale-Brown Obsessive-Compulsive Scale modified for Body Dysmorphic Disorder (BDD-YBOCS) is a semi-structured interview designed to assess the severity of current BDD. The aim of the study was to examine the factor structure and construct validity of the BDD-YBOCS. The sample included 366 adults with BDD who completed the BDD-YBOCS and other measures of BDD severity/impairment, psychiatric distress (i.e., anxiety and depression) and quality of life. Exploratory factor analysis supported two factors that were weakly correlated with each other (r = 0.21) (1) Severity (i.e., time, distress, interference, and avoidance; 31.6% of the variance): and (2) Resistance/Control (i.e., reduced effort to resist symptoms and lack of control over symptoms; 16.7% of the variance). The Severity factor had good internal consistency (α = 0.82) and good construct validity (rs = 0.69-0.81 with BDD severity/impairment; rs = 0.38-0.56 with depression and anxiety; and rs = 0.48-0.53 with functional impairment and quality of life). The Resistance/Control factor had acceptable internal consistency (α = 0.74) but more limited construct validity (rs = 0.27-0.28 with BDD severity/impairment (rs = 0.04-0.20 with depression and anxiety and rs = 0.05-0.14 with functional impairment and quality of life). Implications for the conceptualization and assessment of BDD severity are discussed. • Examined the factor structure of the BDD-YBOCS among individuals with BDD. • Exploratory factor analysis supported two factors: Severity and Resistance/Control. • The two factors had small correlation with each other (r = 0.21). • The Severity factor had good construct validity. • The Resistance/Control factor had more limited construct validity. [ABSTRACT FROM AUTHOR]

Seagrasses are marine flowering plants found in both temperate and tropical coastal environments, that offer vital ecosystem services and adaptations. However, due to their proximity to the shore, they are heavily impacted by human activities and climate change, endangering seagrasses and their services. To manage seagrass meadows effectively and sustainably, detailed monitoring and data on distribution and extent are essential. Unfortunately, past under-prioritization of reliable baseline data impedes understanding of ecosystem dynamics and rapid response to declines. This study employs satellite imagery, coupled with ground truthing, to comprehensively report seagrass coverage along Tanzania's mainland coast and Zanzibar islands. By utilizing machine-learning technologies, the study achieves 84.2% accuracy, and found that Tanzania has 2817 km2 of seagrass coverage, which is five times higher than previously reported. In addition, the results also provide coverage of additional benthic habitats, such as corals, rocks/rubble, and sand. This study provides the first comprehensive overview of seagrass coverage in Tanzania and will function as a valuable tool and baseline for understanding and managing these habitats. The findings suggest that seagrasses in Tanzania are still relatively abundant, but due to a number of threats, including pollution, coastal development, and climate change, these habitats require improvement in management strategies including regular monitoring to understand their status and trends in their area coverage. The study highlights the significance of remote sensing and machine learning in mapping and monitoring coastal habitats across extensive geographical areas. We aspire for the presented results to be utilized among stakeholders and researchers to develop more effective conservation measures for seagrasses in Tanzania and the Western Indian Ocean. [ABSTRACT FROM AUTHOR]

Objective: To analyse the rates of lower limb muscle injuries in athletics disciplines requiring different running velocities during international athletics championships.Design: Prospective total population study.Methods: During 13 international athletics championships (2009-2019) national medical teams and local organizing committee physicians daily reported all newly incurred injuries using the same study design, injury definition and data collection procedures. In-competition lower limb muscle injuries of athletes participating in disciplines involving running (i.e. sprints, hurdles, jumps, combined events, middle distances, long distances, and marathon) were analysed.Results: Among the 12,233 registered athletes, 344 in-competition lower limb muscle injuries were reported (36% of all in-competition injuries). The proportion, incidence rates and injury burden of lower limb muscles injuries differed between disciplines for female and male athletes. The most frequently injured muscle group was hamstring in sprints, hurdles, jumps, combined events and male middle distances runners (43-75%), and posterior lower leg in female middle distances, male long distances, and female marathon runners (44-60%). Hamstring muscles injuries led to the highest burden in all disciplines, except for female middle distance and marathon and male long distance runners. Hamstring muscles injury burden was generally higher in disciplines requiring higher running velocities, and posterior lower leg muscle injuries higher in disciplines requiring lower running velocities.Conclusions: The present study shows discipline-specific injury location in competition context. Our findings suggest that the running velocity could be one of the factors that play a role in the occurrence/location of muscle injuries. [ABSTRACT FROM AUTHOR]

Palliative care is the turn from cure as the priority of care to symptom relief and comfort care. Although very little is published in the burn literature on palliative care, guidelines can be gleaned from the general literature on palliative care, particularly for acute surgical and critical care patients. This second article discusses practical issues around palliative care for burn patients, such as pain and fluid management, withdrawal of ventilator support and wound care, as well as spiritual and family issues. This paper forms part two, of two narrative reviews on the topic of palliation, end-of-life care and burns. The first part considered concepts, decision-making and communication. It was published in volume 10, issue 2, June 2020, pages 95–98. • Mortality of burns presented to a burns unit in Africa is about 10%. • Resources in Africa to manage burn patients are scarce and patients with massive burns may not be offered curative burn care. • There are no guidelines for palliative care in burn patients. [ABSTRACT FROM AUTHOR]

Given poor outcomes, strategies to improve ventricular assist devices (VADs) for single-ventricle patients with bidirectional Glenn (BDG) palliation are needed. This retrospective review describes an institutional experience with VAD support for patients with BDG from April 2011 to January 2019. Surgical strategies, complications, and causes of death are described. Survival to heart transplantation for various strategies are compared. A total of 7 patients with BDG (weights, 5.6 to 28.8 kg; ages, 7 months to 11 years) underwent VAD implantation. Three patients underwent implantation of Berlin Heart EXCOR devices (Berlin Heart, Inc, Spring, TX), 2 had HeartWare HVADs (Medtronic, Minneapolis, MN) implanted, and 2 patients underwent implantation of paracorporeal continuous flow devices. Four patients underwent ventricular inflow cannulation, and 3 underwent atrial inflow cannulation. At the time of VAD implantation, the BDG was left intact in 3 patients, taken down in 3 patients, and created de novo in 1 patient. Over a total of 420 VAD support days, 2 patients survived to heart transplantation, 1 patient with HeartWare ventricular cannulation and intact BDG (after 174 days) and another with Berlin Heart atrial cannulation and BDG take-down (after 72 days). There were 3 deaths within 2 weeks of VAD implantation (2 from respiratory failure, 1 from infection) and 2 deaths after 30 days as a result of strokes. The surgical strategy and postoperative management of VAD with BDG are still evolving. Successful support can be achieved with (1) both pulsatile and continuous flow pumps, (2) atrial or ventricular cannulation, and (3) with or without BDG take-down. Surgical strategy should be determined by individual patient anatomy, physiology, and condition. [ABSTRACT FROM AUTHOR]

• Coccidioidomycosis meningitis can cause aneurysms, hemorrhage, and vasospasm. • Coccidioidomycosis-induced cerebral aneurysms are surgically/endovascularly treatable. • Coccidioidomycosis-induced intracranial hemorrhage has a mortality rate of over 80%. • Coccidioidomycosis-induced cerebral vasospasm is treatable with balloon angioplasty. • Coccidioidomycosis-induced transient ischemic attacks are medically treatable. Coccidioidomycosis exposure is common in the southwest United States and northern Mexico. Dissemination to the meninges is the most severe form of progression. Although ischemic strokes are well-reported in these patients, other cerebrovascular complications of coccidioidomycosis meningitis (CM), as well as their treatment options and outcomes, have not been systematically studied. We present a uniquely severe case of CM with several cerebrovascular complications. We also systematically queried PubMed and EMBASE databases, including articles published before April 2020 reporting human patients with CM-induced cerebrovascular pathology other than ischemic infarcts. Sixteen articles met inclusion criteria, which describe 6 patients with aneurysmal hemorrhage, 10 with non-aneurysmal hemorrhage, one with vasospasm, and one with transient ischemic attacks. CM-associated aneurysms invariably presented with hemorrhage. These were universally fatal until the past decade, when advances in surgical clipping and/or combined surgical and endovascular treatment have improved outcomes. We found that non-aneurysmal intracranial hemorrhages were limited to male patients, involved a diverse set of intracranial vasculature, and had a mortality rate surpassing 80%. Vasospasm was reported once, and was treated with percutaneous transluminal angioplasty. Transient ischemic attacks were reported once, and were successfully treated with fluconazole and dexamethasone. This review suggests that CM can present with a wide array of cerebrovascular complications, including ischemic infarcts, aneurysmogenesis, non-aneurysmal intracranial hemorrhage, vasospasm, and transient ischemic attacks. Mortality has improved over time due to advances in surgical and endovascular treatment modalities. The exception is non-aneurysmal intracranial hemorrhage, which remains associated with high mortality rates and few targeted therapeutic options. [ABSTRACT FROM AUTHOR]

Palliative care is the turn from cure as the priority of care to symptom relief and comfort care. Although very little is published in the burn literature on palliative care, guidelines can be gleaned from the general literature on palliative care, particularly for acute surgical and critical care patients. Palliative care may be started because of futility, on request of the patient, or because of limited resources. The SPIKES acronym is a useful guide to avoid errors in communication with terminal patients and their relatives. [ABSTRACT FROM AUTHOR]

Although upper blepharoplasty is a common cosmetic surgical intervention, a better scientific understanding of the aesthetic results and the preferred surgical technique to achieve the best aesthetic results is still needed. A systematic search using four search engines (PubMed, Embase, CINAHL, and Cochrane) was performed to identify any study on the aesthetic outcome of a solitary upper blepharoplasty; these were subjected to quality assessment for possible inclusion. Eligible studies were randomized controlled trials, controlled trials, cohort studies, and case series (n ≥ 10). A total of 4043 studies were assessed, of which 26 were included. Aesthetic outcomes included patient-reported outcome measures, scarring, eyebrow height, tarsal platform show, and panel or expert evaluation. Meta-analysis was not possible. Patients were generally satisfied with the aesthetic result and scar formation after an upper blepharoplasty. The amount of tarsal platform show increases, which positively affects the aesthetics. The eyebrow seems to move down slightly. The surgical technique used (skin only or skin/muscle removal) did not influence patient satisfaction or the physician-assessed aesthetic outcomes. Patients are generally satisfied after an upper blepharoplasty. The optimal design of the skin excision is still a matter of debate, especially when addressing lateral hooding. Further objective research is advised. [ABSTRACT FROM AUTHOR]

Foam Rolling (FR) is currently used by athletes at all levels. It is not known whether FR is more effective being used as a warm up to aid performance or more effectively used as a cool-down for recovery. Therefore, the purpose of this systematic review was to determine the effects of FR on performance and recovery. A customized search strategy was conducted to search seven electronic databases: Google Scholar; Science Direct; Pubmed Central; Pubmed; ISI Web of Science; Medline and Scopus. The database search was limited to journals published in English between January 2006 and June 2019. Any study design, for example, cross-over, repeated measures, randomized-control trials, was considered, as long as one of the interventions was using a FR. Studies that tested FR combined with other techniques were also considered, as long as one of the conditions was FR only. A total of 49 articles met the inclusion criteria. FR may reduce muscle stiffness and increase ROM and should be used in combination with dynamic stretching and active warm-up before a training session. Furthermore, the optimum dosage to achieve these flexibility benefits seems to be a total 90s–120s of FR. FR reduced DOMS and increased PPT, and therefore may optimize recovery from training. Future studies on the effects of FR should include true controls or sham groups, and consider the FR experience of the athlete. PROSPERO – CRD42017064976. [ABSTRACT FROM AUTHOR]

Developing air filters with biocidal ability is important to protect the public from infectious respiratory diseases. A simple spray-coating approach was devised to fabricate antimicrobial air filters to remove bioaerosols. The commercial antimicrobial agent Goldshield 75 was coated on the air filters through covalent immobilization, endowing the fabricated filter with long-lasting biocidal ability. All coated filters significantly inhibited both Gram-positive bacteria (Micrococcus luteus) and Gram-negative bacteria (Escherichia coli). The antibacterial ability of the coated filters is similar to the commercial AeraSafe antibacterial filter. The coated filter showed over 99.9 % antibacterial efficiency 3 months after the application of the coating. Both bacterial and virus filtration efficiencies of coated charged polypropylene filter were higher than 99.9 %. The coating did not have much effect on the NaCl aerosol filtration efficiency of the filters. This simple spray-coating strategy is a practical method for producing antimicrobial air filters for the prevention of infectious respiratory diseases. [Display omitted] • An antimicrobial polypropylene filter was prepared using spray coating. • The antimicrobial filter had high filtration efficiency against particles, bacteria, and viruses. • The antimicrobial filter maintains its high antibacterial ability after three months. • This study provides a simple strategy for developing antibacterial filters to improve indoor air quality. [ABSTRACT FROM AUTHOR]

Background: Syncope is a common chief complaint among older adults in the Emergency Department (ED), and orthostatic vital signs are often a part of their evaluation. We assessed whether abnormal orthostatic vital signs in the ED are associated with composite 30-day serious outcomes in older adults presenting with syncope.Methods: We performed a secondary analysis of a prospective, observational study at 11 EDs in adults ≥ 60 years who presented with syncope or near syncope. We excluded patients lost to follow up. We used the standard definition of abnormal orthostatic vital signs or subjective symptoms of lightheadedness upon standing to define orthostasis. We determined the rate of composite 30-day serious outcomes, including those during the index ED visit, such as cardiac arrhythmias, myocardial infarction, cardiac intervention, new diagnosis of structural heart disease, stroke, pulmonary embolism, aortic dissection, subarachnoid hemorrhage, cardiopulmonary resuscitation, hemorrhage/anemia requiring transfusion, with major traumatic injury from fall, recurrent syncope, and death) between the groups with normal and abnormal orthostatic vital signs.Results: The study cohort included 1974 patients, of whom 51.2% were male and 725 patients (37.7%) had abnormal orthostatic vital signs. Comparing those with abnormal to those with normal orthostatic vital signs, we did not find a difference in composite 30-serious outcomes (111/725 (15.3%) vs 184/1249 (14.7%); unadjusted odds ratio, 1.05 [95%CI, 0.81-1.35], p = 0.73). After adjustment for gender, coronary artery disease, congestive heart failure (CHF), history of arrhythmia, dyspnea, hypotension, any abnormal ECG, physician risk assessment, medication classes and disposition, there was no association with composite 30-serious outcomes (adjusted odds ratio, 0.82 [95%CI, 0.62-1.09], p = 0.18).Conclusions: In a cohort of older adult patients presenting with syncope who were able to have orthostatic vital signs evaluated, abnormal orthostatic vital signs did not independently predict composite 30-day serious outcomes. [ABSTRACT FROM AUTHOR]

Background: Young-adult heart transplant recipients transferring to adult care are at risk for poor health outcomes. We conducted a pilot randomized controlled trial to determine the feasibility of and to test a transition intervention for young adults who underwent heart transplantation as children and then transferred to adult care.Methods: Participants were randomized to the transition intervention (4 months long, focused on heart-transplant knowledge, self-care, self-advocacy, and social support) or usual care. Self-report questionnaires and medical records data were collected at baseline and 3 and 6 months after the initial adult clinic visit. Longitudinal analyses comparing outcomes over time were performed using generalized estimating equations and linear mixed models.Results: Transfer to adult care was successful and feasible (ie, excellent participation rates). The average patient standard deviation of mean tacrolimus levels was similar over time in both study arms and < 2.5, indicating adequate adherence. There were no between-group or within-group differences in percentage of tacrolimus bioassays within target range (> 50%). Average overall adherence to treatment was similarly good in both groups. Rates of appointment keeping through 6 months after transfer declined over time in both groups.Conclusions: The feasibility of the study was demonstrated. Our transition intervention did not improve outcomes. [ABSTRACT FROM AUTHOR]

Surveillance endoscopy is recommended after endoscopic eradication therapy (EET) for Barrett's esophagus (BE) because of the risk of recurrence. Currently recommended biopsy protocols are based on expert opinion and consist of sampling visible lesions followed by random 4-quadrant biopsy sampling throughout the length of the original BE segment. Despite this protocol, some recurrences are not visibly identified. We aimed to identify the anatomic location and histology of recurrences after successful EET with the goal of developing a more efficient and evidence-based surveillance biopsy protocol. We performed an analysis of a large multicenter database of 443 patients who underwent EET and achieved complete eradication of intestinal metaplasia (CE-IM) from 2005 to 2015. The endoscopic location of recurrence relative to the squamocolumnar junction (SCJ), visible recurrence identified during surveillance endoscopy, and time to recurrence after CE-IM were assessed. Fifty patients with BE recurrence were studied in the final analysis. Seventeen patients (34%) had nonvisible recurrences. In this group, biopsy specimens demonstrating recurrence were taken from within 2 cm of the SCJ in 16 of these 17 patients (94%). Overall, 49 of 50 recurrences (98%) occurred either within 2 cm of the SCJ or at the site of a visible lesion. Late recurrences (>1 year) were more likely to be visible than early (<1 year) recurrences (P =.006). Recurrence after EET detected by random biopsy sampling is identified predominately in the distal esophagus and occurs earlier than visible recurrences. As such, we suggest a modified biopsy protocol with targeted sampling of visible lesions followed by random biopsy sampling within 2 cm of the SCJ to optimize detection of recurrence after EET. (Clinical trial registration number: NCT02634645.) [ABSTRACT FROM AUTHOR]

To determine the association between continuous flow ventricular assist devices and the incidence of vasoplegia following orthotopic heart transplant in children. Moreover, to propose a novel clinical definition of vasoplegia for use in pediatric populations. This is a single-center, retrospective cohort study set in the cardiovascular intensive care unit of a tertiary children's hospital. All patients aged 3 years and older who underwent orthotopic heart transplant at Stanford University between April 1, 2014, and July 31, 2017, were included. Vasoplegia was defined by the use of vasoconstrictive medication, diastolic hypotension, preserved systolic heart function, and absence of infection or right atrial pressure or central venous pressure <5 mm Hg. Of 44 eligible patients, 21 were supported using a continuous flow ventricular assist device. Following heart transplant, 14 patients (32%) developed vasoplegia by the study definition. Development of vasoplegia was associated with pretransplant use of a continuous flow ventricular assist device (52% vs 13%) with a relative risk of 4.02 (95% confidence interval, 1.30-12.45; P =.009). No other variables were predictive of vasoplegia in univariable analysis. Presence of vasoplegia was not associated with adverse outcomes, although there were trends towards higher incidence of acute kidney injury and increased length of hospital stays. Children receiving continuous flow ventricular assist device support are at increased risk for vasoplegia following orthotopic heart transplant, using a novel definition of vasoplegia. Anticipation of this complication will allow for prompt intervention, thereby minimizing hemodynamic instability and impact on patient outcomes. [ABSTRACT FROM AUTHOR]

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Sleeve gastrectomy is the most commonly performed bariatric surgery in the United States. Leaks after sleeve gastrectomy (SGL) occur in 1% to 3% of patients. Endoscopic therapies are increasingly used for treatment of SGLs, but few data exist on their outcomes. The aim of this study was to assess technical success, leak resolution, and reoperation rates of patients undergoing endoscopic therapy for repair SGLs. Eight high-volume academic endoscopy centers. Patients undergoing endoscopic therapy for SGLs from 2007 to 2017 were identified. Patients were excluded if the index endoscopic therapy for SGL was performed elsewhere or if no follow-up data were available. Leaks were classified as acute (≤7 d of SG), early (1–6 wk), late (7–12 wk), and chronic (>12 wk). Leak resolution was defined as lack of extraluminal air, extravasation on oral contrast radiography, cross-sectional imaging, or resolution of percutaneous drain output. Demographic and procedural data were recorded as rates of additional therapy, adverse events, and surgical revision. A total of 85 patients met criteria for analysis (70 women, age 42.6 ± 10.8 yr). A total of 295 endoscopic sessions (median 3, range 1–14) were performed across the cohort. SGLs resolved after index endoscopic therapy in 43 (50.1%) patients. The primary outcome of endoscopic resolution of SGL was observed in 62 patients (72.9%). There were 34 (11.5%) PRAE (the majority occurring with self-expandable metal stents), all but 1 of which were managed endoscopically. Surgical revision was required in 23 (21.7%) patients. On univariate analyses independent variables associated with the need for surgical revision included both acute and chronic SGLs (P =.028), loculated subphrenic collections/abscesses (P =.03), and intraabdominal sepsis (P =.03). On multivariable logistic regression using statistically significant predictors from the univariate analyses, acute SGLs were significantly associated with a need for surgical revision (odds ratio 4.8, 95% confidence interval 1.2–18.9, P =.025). Endoscopic therapy for SGLs is associated with good clinical success, avoiding the need for surgical revision in 73% of patients, with an acceptable adverse event profile. Patients with acute or chronic SGLs and those with loculated abscesses or intraabdominal sepsis are more likely to undergo surgical revision. Endoscopic therapy is an appropriate first-line modality for the management of SGLs, especially those not classified as acute or chronic. • The clinical success rate for resolution of leaks after sleeve gastrectomy with endoscopic therapy is 73%. • The presence of an acute or chronic leak is associated with significantly higher rates of surgical revision. • Patients with loculated abscesses or fluid collections and those with intra-abdominal sepsis are also significantly more likely to undergo surgical revision. • Procedure related adverse events occurred in 11.5% of cases but were mostly mild and all but one were managed nonoperatively. [ABSTRACT FROM AUTHOR]