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Cardiac Lipomas, accounting for 10% of primary benign cardiac tumours are usually asymptomatic, although they can sometimes be associated with a plethora of manifestations. Our patient was a 16 year old asymptomatic female with marked lipomatous hypertrophy of the interventricular septum protruding into the right ventricle, diagnosed incidentally during the ECHO evaluation for a haemic systolic murmur.

The impact of future climate change on the chickpea productivity was studied using the sequence analysis tool of DSSAT V 4.5 to simulate fallow-chickpea rotation at four locations viz Anantapur, Kurnool, Kadapa and Prakasam of Andhra Pradesh State. The results indicated that as compared to baseline climate, the climate change to be anticipated by 2069 (Mid -century period) would decrease the yield of chickpea by 4.3 to 18.6 per cent across various locations tested. Yield benefits obtained based on the simulation study from various adaptation options revealed that advancing the sowing window by one fortnight and application of one critical irrigation at 60 DAS found to be beneficial in increasing chickpea yields under climate change scenario. [ABSTRACT FROM AUTHOR]

The sustainability of traditional rice (Oryza sativa L.) cultivation in many Asian countries is being questioned due to severe water shortage conditions, envisaging the need for development of water-saving rice production technologies. A 2-year-field study on a typic Haplustalf soil was conducted to compare traditional transplanted rice-maize system with water-saving aerobic rice-maize system, with an overall objective of investigating the fate of fertilizer nitrogen (N) using N-labeled urea. Results from the field experiments showed that the rice plants positively responded to N fertilizer application. The average fertilizer N recovery by rice crop over the 2 years in aerobic rice was 26 kg per 100 kg of applied fertilizer N in the main field and 21 kg per 100 kg of applied N in the microplot, while the recoveries were 41 and 32 kg ha per 100 kg of applied N in traditionally cultivated rice under flooded conditions. The fraction of N that was found in soil after the harvest of rice crop ranged from 11.4 to 47.1 kg ha in aerobic rice and 14.2-51.4 kg ha in flooded rice. Average recovery of N fertilizer in maize after the first growing season was 3.3 %, and the corresponding recovery in soil was 19 %. An additional 1.3 % of the fertilizer was recovered by crops during the two subsequent seasons. This study indicates the need to develop management practices that improve N use efficiency in aerobic rice by reducing losses to improve yields and reduce N export to the environment. [ABSTRACT FROM AUTHOR]

Background: Although robotic surgery has gained popularity, safety concerns remain due to potential delay in addressing intraoperative hemorrhages since the surgeon is not at the bedside. This study aimed to test whether a training program for emergency robotic undocking protocols improved the performance of thoracic operating room (OR) teams., Methods: An emergency undocking protocol and checklists were created for massive hemorrhage during robotic thoracic surgery. In phase I, two OR teams participated in in-situ simulations of the scenarios in the OR without knowledge of the protocols. In phase II, the protocol and checklists were introduced to four different OR teams by either high-fidelity lab simulation or video-based didactic sessions. The teams' performances were tested with in-situ OR simulations. Performance assessments included the number of missed critical steps, participant-reported feedback, and timeliness of crucial steps., Results: All teams successfully converted from robot-assisted to open, with the attending at bedside within five minutes from the decision to convert, regardless of phase or education type. Phase I (control) teams had an average of 2.55 critical misses per team while the average was 0.25 for phase II teams (P=0.08). There was no significant difference between phases in time required for the surgeon to be at the bedside (average 132.2 seconds, P=0.64)., Conclusions: Targeted education can lead to improved team performance. This study shows that high-fidelity simulation and didactic sessions can both be used to effectively teach emergency undocking protocols., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form, except for author Bryce Bludevich, who is deceased (available at https://jtd.amegroups.com/article/view/10.21037/jtd-24-291/coif). K.U. reports grant funding from the Intuitive Foundation to his institution. The other authors have no conflicts of interest to declare., (2024 Journal of Thoracic Disease. All rights reserved.)

Competing Interests: Funding Support and Author Disclosures Dr Chen was supported by National Heart, Lung, and Blood Institute grant RO1 3UG1CA189955-08S3. Dr Tamirisa has served as a speaker for Abbott and Sanofi. Dr Ogunniyi has received institutional research support grants from AstraZeneca, Boehringer Ingelheim, Cardurion Pharmaceuticals, and Pfizer, outside the submitted work. Dr Contreras has served as a speaker for Merck and Boehringer Ingelheim; served as a consulting advisor for Alnylam, AstraZeneca, and Lexicon; and has received grant support from Novo Nordisk. Dr Tong has served as a speaker for Bristol Myers Squibb. Dr Kadiyala has served as a consultant for HeartFlow Inc. Dr Tremmel has served as a consultant for Abbott Vascular, Boston Scientific, Shockwave, and Avinger; has served on the advisory board for Abbott Vascular; and has received research support from Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Background: Enhanced recovery after surgery (ERAS) protocols in thoracic surgery have been demonstrated to impact length of stay (LOS), complication rates, and postoperative opioid use. However, ERAS protocols for minimally invasive lung resections have not been well described. Given most lung resections are now performed minimally invasively, there is a gap in the literature regarding the efficacy of ERAS protocols in this setting. In this study, we analyzed patient outcomes following implementation of an ERAS protocol for minimally invasive lung resections., Methods: Outcome data was retrospectively collected for 442 patients undergoing minimally invasive lung resections between January 1 st , 2015 and October 26 th , 2021. Patients were divided into either a pre-ERAS (n=193) or ERAS (n=249) group. Primary outcomes included LOS, postoperative complications, intensive care unit (ICU) admission status, 30-day hospital readmissions, and 30-day mortality. Secondary outcomes included common postoperative complications required for the Society for Thoracic Surgeons (STS) database., Results: We observed an overall decrease in median LOS (4.0 vs. 3.0 days, P=0.030) and ICU admission status (15% vs. 7.6%, P=0.020) after implementation of our ERAS protocol. The difference in LOS was significantly lower for anatomic lung resections, but not non-anatomic resections. There was no difference in 30-day readmissions and a 0% mortality rate in both groups. Overall, there was a low complication rate that was similar between groups., Conclusions: The implementation of an ERAS protocol led to decreased LOS and decreased ICU admission in patients undergoing minimally invasive lung resection. Process standardization optimizes performance by providers by decreasing decision fatigue and improving decision making, which may contribute to the improved outcomes observed in this study., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-23-1500/coif). M.W.M. received lecture fees from Intuitive Surgical, unrelated to the content of this manuscript. The other authors have no conflicts of interest to declare., (2024 Journal of Thoracic Disease. All rights reserved.)

Purpose of Review: Cardiovascular disease (CVD) is the leading cause of death in women. This review highlights contraceptive options and their effects on the cardiovascular system (CVS). It provides guidance to cardiologists to make informed decisions regarding the safety of contraceptive use and cardiovascular risk stratification in the care of women of childbearing age., Recent Findings: Approximately 44% of American women live with some type of CVD. Many women use hormonal contraception during their lifetime. It is imperative that cardiologists have a robust understanding of the forms of contraception in current use and their cardiovascular effects. This contemporary review provides a comprehensive summary of available contraceptive methods to practicing cardiologists and aims to be used as a resource to guide cardiovascular specialists on contraception in the context of cardiovascular disease., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Coronary artery calcium (CAC) scoring is a proven predictor for future adverse cardiovascular events (CVE) in asymptomatic individuals. Data is emerging regarding the usefulness of non-calcified plaque (NCP) assessment on cardiac computed tomography (CCT) angiography in symptomatic patients with a zero CAC score for further risk assessment., Methods: A retrospective review from January 2019 to January 2022 of 696 symptomatic patients with no known CAD and a zero CAC score identified 181 patients with NCP and 515 patients without NCP by a visual assessment on CCT angiography. The primary endpoint was to identify predictors for NCP presence and adverse CVEs (death, myocardial infarction, or cerebrovascular accident) within two years., Results: Based on logistic regression, age (OR 1.039, 95% CI [1.020-1.058], p ​< ​0.001), diabetes mellitus (OR 2.192, 95% CI [1.307-3.676], p ​< ​0.003), tobacco use (OR 1.748, 95% CI [1.157-2.643], p ​< ​0.008), low-density lipoprotein cholesterol level (OR 1.009, 95% CI [1.003-1.015], p ​< ​0.002), and hypertension (OR 1.613, 95% CI [1.024-2.540], p ​< ​0.039) were found to be predictors of NCP presence. NCP patients had a higher pretest probability for CAD using the Morise risk score (p ​< ​0.001∗), with NCP detection increasing as pretest probability increased from low to high (OR 55.79, 95% CI [24.26-128.26], p ​< ​0.001∗). 457 patients (66%) reached a full two-year period after CCT angiography completion, with NCP patients noted to have shorter follow-up times and higher rates of elective coronary angiography, intervention, and CVEs. The presence of NCP (aOR 2.178, 95% CI [1.025-4.627], p ​< ​0.043) was identified as an independent predictor for future adverse CVEs when adjusted for diabetes mellitus, age, and hypertension., Conclusion: NCP was identified at high rates (26%) in our symptomatic Appalachian population with no known CAD and a zero CAC score. NCP was identified as an independent predictor of future adverse CVEs within two years., Competing Interests: Declaration of competing interest All authors deny any conflicts of interest or financial disclosures in creating this manuscript, except for one author (MB) receiving separate private grant funding from General Electric., (Copyright © 2023 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.)

In this case report, we illustrate the contemporary use of multi-modality cardiac imaging and three-dimensional (3D)-printing in the diagnosis and precise surgical planning of a large ventricular aneurysm with an extensive thrombus burden after myocardial infarction. We further discuss an integrated multimodality approach in the evaluation of ventricular outpouchings., (© 2023 Wiley Periodicals LLC.)

Background: Degenerative lumbar spondylolisthesis is one of the most common pathologies addressed by surgeons. Recently, data demonstrated improved outcomes with fusion in conjunction with laminectomy compared to laminectomy alone. However, given not all degenerative spondylolistheses are clinically comparable, the best treatment option may depend on multiple parameters. Specifically, the impact of spinopelvic alignment on patient reported and clinical outcomes following fusion versus decompression for grade I spondylolisthesis has yet to be explored., Purpose: This study assessed two-year clinical outcomes and one-year patient reported outcomes following laminectomy with concomitant fusion versus laminectomy alone for management of grade I degenerative spondylolisthesis and stenosis. The present study is the first to examine the effect of spinopelvic alignment on patient-reported and clinical outcomes following decompression alone versus decompression with fusion., Study Design/setting: Retrospective sub-group analysis of observational, prospectively collected cohort study., Patient Sample: 679 patients treated with laminectomy with fusion or laminectomy alone for grade I degenerative spondylolisthesis and comorbid spinal stenosis performed by orthopaedic and neurosurgeons at three medical centers affiliated with a single, tertiary care center., Outcome Measures: The primary outcome was the change in Patient-Reported Outcome Measurement Information System (PROMIS), Global Physical Health (GPH), and Global Mental Health (GMH) scores at baseline and post-operatively at 4-6 and 10-12 months postoperatively. Secondary outcomes included operative parameters (estimated blood loss and operative time), and two-year clinical outcomes including reoperations, duration of postoperative physical therapy, and discharge disposition., Methods: Radiographs/MRIs assessed stenosis, spondylolisthesis, pelvic incidence, lumbar lordosis, sacral slope, and pelvic tilt; from this data, two cohorts were created based on pelvic incidence minus lumbar lordosis (PILL), denoted as "high" and "low" mismatch. Patients underwent either decompression or decompression with fusion; propensity score matching (PSM) and coarsened exact matching (CEM) were used to create matched cohorts of "cases" (fusion) and "controls" (decompression). Binary comparisons used McNemar test; continuous outcomes used Wilcoxon rank-sum test. Between-group comparisons of changes in PROMIS GPH and GMH scores were analyzed using mixed-effects models; analyses were conducted separately for patients with high and low pelvic incidence-lumbar lordosis (PILL) mismatch., Results: 49.9% of patients (339) underwent lumbar decompression with fusion, while 50.1% (340) received decompression. In the high PLL mismatch cohort at 10-12 months postoperatively, fusion-treated patients reported improved PROs, including GMH (26.61 vs. 20.75, p<0.0001) and GPH (23.61 vs. 18.13, p<0.0001). They also required fewer months of outpatient physical therapy (1.61 vs. 3.65, p<0.0001) and had lower 2-year reoperation rates (12.63% vs. 17.89%, p=0.0442) compared to decompression-only patients. In contrast, in the low PLL mismatch cohort, fusion-treated patients demonstrated worse endpoint PROs (GMH: 18.67 vs. 21.52, p<0.0001; GPH: 16.08 vs. 20.74, p<0.0001). They were also more likely to require skilled nursing/rehabilitation centers (6.86% vs. 0.98%, p=0.0412) and extended outpatient physical therapy (2.47 vs. 1.34 months, p<0.0001) and had higher 2-year reoperation rates (25.49% vs. 14.71%,p=0.0152)., Conclusions: Lumbar laminectomy with fusion was superior to laminectomy in health-related quality of life and reoperation rate at two years postoperatively only for patients with sagittal malalignment, represented by high PILL mismatch. In contrast, the addition of fusion for patients with low-grade spondylolisthesis, spinal stenosis, and spinopelvic harmony (low PILL mismatch) resulted in worse quality of life outcomes and reoperation rates., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Breast arterial calcification (BAC), which may be detected during screening mammography, is hypothesized to be a noninvasive imaging marker that may enhance cardiovascular risk assessment. Materials and Methods: In this systematic review and meta-analysis, we sought to assess the association between BAC and coronary artery disease (CAD) by conducting a meta-analysis. We conducted a literature search of PubMed, Scopus, Cochrane library, ClinicalTrials.gov, and conference proceedings, from inception through December 24, 2019. The outcome of interest was the presence of CAD in patients with BAC. This was reported as crude and adjusted odds ratio (OR). Results: A total of 18 studies comprising 33,494 women (mean age of 60.8 ± 3.7 years, 25% with diabetes, 57% with hypertension, and 21% with history of tobacco smoking) were included in the current meta-analysis. The prevalence of BAC among study participants was 10%. There was a statistically significant association between BAC and CAD (unadjusted OR 2.14; 95% confidence interval [CI] 1.63-2.81, p  < 0.001, I 2  = 76.5%). Moreover, adjusted estimates were available from 10 studies and BAC was an independent predictor of CAD (OR 2.39; 95% CI 1.68-3.41, p  < 0.001, I 2  = 61.7%). In the meta-regression analysis, covariates included year of publication, age, hypertension, diabetes mellitus, and history of tobacco smoking. None of these study covariates explained the heterogeneity across studies. Conclusions: BAC detected as part of screening mammography is a promising noninvasive imaging marker that may enhance CAD risk prediction in women. The clinical value of BAC for cardiovascular risk stratification merits further evaluation in large prospective studies.

Background/purpose: Device-related thrombosis (DRT) is one of the greatest challenges of transcatheter left atrial appendage device occlusion. Due to the invasive nature of transesophageal echocardiography (TEE), cardiac computed tomography angiography (CCTA) is being increasingly utilized in several centers for assessing adequate left atrial appendage closure and monitoring for DRT. There is a paucity of data regarding the standardized definition of DRT on CCTA for the WATCHMAN FLX™ device., Methods/materials: A retrospective review was conducted on 43 patients receiving WATCHMAN FLX™ device implantation with CCTA performed at the first follow-up at our institution. A comparative review of DRT predictors was performed on 10 patients who had both CCTA and TEE at the time of follow-up., Results: Hypoattenuated thickening (HAT) was a common finding on CCTA and was noted to be present in 95.35% of the patients. The combination of a large device size, peridevice gap >4 mm, and HAT located on the device gutter and 1 shoulder were characteristics present on CCTA observed in 2 patients with confirmed DRT on TEE., Conclusion: CCTA is a noninvasive imaging modality for DRT monitoring, with guidelines still in development. We report potential predictors of DRT on CCTA. Additional studies are needed to further determine standardized parameters for DRT detection on CCTA and the significance of HAT with multimodality correlation., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Partho P Sengupta, MD reports a relationship with HeartSciences that includes: equity or stocks. Dr. Partho P Sengupta, MD reports a relationship with Ultromics that includes: equity or stocks. Dr. Partho P Sengupta, MD reports a relationship with Kencor Health that includes: equity or stocks., (Published by Elsevier Inc.)

Competing Interests: Conflict of Interest None.

Introduction: With the advancement of robotic surgery, some thoracic surgeons have been slow to adopt to this new operative approach, in part because they are un-scrubbed and away from the patient while operating. Aiming to allay surgeon concerns of intra-operative emergencies, an insitu simulation-based clinical system's test (SbCST) can be completed to test the current clinical system, and to practice low-frequency, high-stakes clinical scenarios with the entire operating room (OR) team., Methods: Six different OR teams completed an insitu SbCST of an intra-operative pulmonary artery injury during a robot-assisted thoracic surgery at a single tertiary care center. The OR team consisted of an attending thoracic surgeon, surgery resident, anesthesia attending, anesthesia resident, circulating nurse, and a scrub technician. This test was conducted with an entire OR team along with study observers and simulation center staff. Outcomes included the identified latent safety threats (LSTs) and possible solutions for each LST, culminating in a complete failure mode and effects analysis (FMEA). A Risk Priority Number (RPN) was determined for each LST identified. Pre- and post-simulation surveys using Likert scales were also collected., Results: The six FMEAs identified 28 potential LSTs in four categories. Of these 28 LSTs, nine were considered high priority based on their Risk Priority Number (RPN) with seven of the nine being repeated multiple times. Pre- and post-simulation survey responses were similar, with the majority of participants (94%) agreeing that high fidelity simulation of intra-operative emergencies is helpful and provides an opportunity to train for high-stakes, low-frequency events. After completing the SbCST, more participants felt confident that they knew their role during an intra-operative emergency than their pre-simulation survey responses. All participants agreed that simulation is an important part of continuing education and is helpful for learning skills that are infrequently used. Following the SbCST, more participants agreed that they knew how to safely undock the da Vinci robot during an emergency., Conclusions: SbCSTs provide an opportunity to test the current clinical system with a low-frequency, high-stakes event and allow medical personnels to practice their skills and teamwork. By completing multiple SbCSTs, we were able to identify multiple LSTs within different OR teams, allowing for a broader review of the current clinical systems in place. The use of these SbCSTs in conjunction with debriefing sessions and FMEA completion allows for the most significant potential improvement of the current system. This study shows that SbCST with FMEA completion can be used to test current systems and create better systems for patient safety., (Copyright © 2022 Elsevier Inc. All rights reserved.)

The quantitative assessment of mitral regurgitation (MR) by echocardiography has limitations. Cardiac magnetic resonance (CMR) imaging has an emerging role in the quantitation of MR, and preliminary studies indicate that CMR assessment may more accurately quantify MR and better correlate with postsurgical left ventricular reverse remodeling. The authors here report a case of MR in which multimodality imaging with CMR and transesophageal echocardiography was crucial in accurately diagnosing the severity of MR when transthoracic and provocative supine bike echocardiography underestimated the degree of MR in a unique variant known as "garden-hose" MR., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Ischemia with non-obstructive coronary artery disease (INOCA), a common cause of angina, can occur due to coronary vasospasm, microvascular dysfunction, endothelial dysfunction, atherosclerosis or a combination of these mechanisms. We describe a case of adenosine-associated paradoxical coronary vasospasm and Takotsubo-like apical ballooning in a postmenopausal woman with underlying mild coronary atherosclerosis and microvascular dysfunction., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Madhavi Kadiyala reports financial support was provided by American Heart Association. Madhavi Kadiyala reports a relationship with National Institutes of Health that includes: funding grants. This case is part of a research study conducted by Dr. Kadiyala and Dr. Reichek at Saint Francis Hospital, Roslyn, NY funded by AHA grant award 0885055N: Plaque Morphology on coronary CT angiography: Relationship to perfusion reserve by quantitative stress CMR. Dr. Kadiyala has funding from NIH/NIGMS award number 2U54GM104942-02: Quantitative myocardial blood flow assessment by Adenosine stress CMR in perimenopausal women with Hormone replacement therapy. Dr. Michos is partially funded by the Amato Fund for Women's Cardiovascular Health research at Johns Hopkins University, Baltimore, MD., (© 2022 The Author(s).)