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BACKGROUND: Even among other mental disorders, a diagnosis of schizophrenia is associated with an abnormally low employment rate. However, those who can find employment report mental health improvements and diminishing symptoms. AIMS: In this cross-sectional study, we analyzed a variety of sociodemographic factors between groups of schizophrenia-diagnosed employed and unemployed individuals to attempt to determine any causal relationships. METHODS: A group of 52 employed and 48 unemployed individuals from the same outpatient hospital were surveyed. Patients were asked about their sociodemographic background and employment history, as well as subjected to a variety of tests to quantify critical aspects of their symptomatology. These included the Positive and Negative Syndrome Scale (PANSS), Social and Occupational Functioning Assessment Scale (SOFAS), and Personal and Social Performance Scale (PSP). The Calgary Depression Scale for Schizophrenia (CDSS) and Hamilton Anxiety Rating Scale (HAM-A) were administered to assess comorbid depression and anxiety. Lastly, the Simpson Angus Scale (SAS) measured any extrapyramidal side effects caused by the patients' medications. RESULTS: Initial analysis by the Student's t-test and chi-square test revealed correlations between employment status and symptomatology, but upon performing logistic regression, peer support was found to be the only significant predictor of employment status (OR = 0.119, CI [0.40, 0.354], p = .001). Based on these results, the creation of peer support systems at work through fostering inclusive, well-informed, and destigmatized environments should be employers' predominant focus. CONCLUSION: Future studies conducted longitudinally can strengthen the conclusions found and confirm the optimal manners in which to address the matter of aiding the integration of schizophrenic and similarly symptomatic individuals into the labor force.

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OBJECTIVES: This retrospective cohort multicentre study aimed to characterise the signalment, clinicopathologic data, complications and the association between treatment and outcome (the reduction in ionised calcium concentration) in cats with idiopathic or chronic kidney disease-associated ionised hypercalcaemia managed with alendronate and standard treatment or standard treatment alone, and to compare the outcome between the two groups. MATERIALS AND METHODS: Medical records for cats diagnosed with idiopathic or chronic kidney disease-associated ionised hypercalcaemia were retrospectively reviewed. Cats treated with alendronate and standard treatment were assigned to the alendronate group and cats treated with standard treatment alone were assigned to the control group. The standard treatment was defined as dietary modification and/or monitoring of ionised calcium concentrations and management of complications secondary to hypercalcaemia. The follow-up period was selected as 6 months. RESULTS: Twenty-nine cats were enrolled in the study. Nine cats were included in the control group and 20 cats in the alendronate group. A significant reduction in serum ionised calcium was observed in both groups between the baseline and the follow-up visit; however, this reduction did not differ significantly between both groups (the mean change in the ionised calcium concentration in alendronate and control group was -0.18 and -0.17, respectively). Suspected bisphosphate-related osteonecrosis of the jaw was reported in one cat receiving alendronate. CLINICAL SIGNIFICANCE: In this study, similar reduction in serum ionised calcium concentration was observed in cats with ionised hypercalcaemia treated with diet alone and in cats treated with diet and alendronate. These results should be interpreted with caution, as the study was underpowered for meaningful statistical comparison. Cats receiving alendronate should be monitored for the development of adverse reactions, including osteonecrosis of the jaw.

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Patients with hemophilia frequently require supplementary interventions, either invasive (suturing, gel foam, or cauterization) or non-invasive (fibrin sealant/glue), to attain hemostasis post dental procedures. This study aimed to compare the efficacy of fibrin sealant against traditional methods for achieving hemostasis post dental surgery. The medical records of patients with factor VIII or IX deficiency, or von Willebrand disease, who underwent dental procedures in the Department of Dentistry, Seth GSMC and KEM Hospital, were evaluated for inclusion in this retrospective matched cohort study. Cohort-1 included those treated with a fibrin sealant (Tisseel Lyo) with/without traditional hemostatic measures post-procedure, while cohort-2 (controls) included those in whom no fibrin sealant was used. A total of 128 patients, 64 in each group, were evaluated. There was no statistically significant difference in demographics, disease-related variables, dental complaints, or preoperative treatment given between the groups. However, there was a significant reduction (P < 0.001) in the requirement for secondary procedures for hemostasis (suturing, gel foam application, and/or cauterization) and postoperative requirement for factor replacement (P = 0.003) in the fibrin glue group as compared to the controls. In this study, fibrin sealant demonstrated superior efficacy in mitigating the necessity for active hemostasis control.

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Introduction: Fixed flexion deformity (FFD) following total knee arthroplasty occurs in approximately 4% of patients undergoing primary total knee arthroplasty. Treatment modalities for significant disabling FFD post-arthroplasty encompass manipulation under anesthesia, osteophyte resection, soft tissue release, peroneal nerve decompression, and revision knee replacement. Case Report: A 43-year-old lady, a known case of rheumatoid arthritis and psoriasis, presented with fixed flexion contracture of the left knee following total knee arthroplasty. The range of motion (ROM) at the left knee was 60°-110°. With the help of the plastic surgery team, the patient underwent an extensive posterior soft tissue release. Intra-operatively, the ROM achieved was 5°-110°. After 3 weeks, the patient was mobilized with full weight bearing with a knee brace. But unfortunately, there was a gradual recurrence of deformity at 3-month follow-up in spite of adequate and aggressive rehabilitation. Conclusion: Patients with FFD for more than 2 years following a total knee arthroplasty may not benefit from extensive radical posterior soft tissue release. Revision knee replacement may be the better option.

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Per-oral pancreatoscopy (POP) is a pancreas-preserving modality that allows for targeted pancreatic duct interventions, particularly in cases where standard techniques fail. POP specifically has an emerging role in the diagnosis, risk stratification, and disease extent determination of main duct intraductal papillary mucinous neoplasms (IPMNs). It has also been successfully used for laser ablation of IPMNs in poor surgical candidates, lithotripsy for complex stone disease, and laser stricturoplasty. As experience with POP increases beyond select referral center practices, further studies validating POP efficacy with long-term follow-up will help clarify when POP-guided intervention is most beneficial in relation to surgical intervention.

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Enfermedades Pancreáticas , Humanos , Enfermedades Pancreáticas/terapia , Enfermedades Pancreáticas/cirugía , Endoscopía del Sistema Digestivo/métodos , Conductos Pancreáticos/cirugía , Conductos Pancreáticos/patología , Neoplasias Pancreáticas/terapia , Neoplasias Pancreáticas/cirugía , Neoplasias Intraductales Pancreáticas/terapia , Neoplasias Intraductales Pancreáticas/cirugía

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The discovery and replacement of lung surfactant have helped increase survival rates for neonatal respiratory distress syndrome in extremely premature infants.

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Recien Nacido Prematuro , Surfactantes Pulmonares , Síndrome de Dificultad Respiratoria del Recién Nacido , Humanos , Recién Nacido , Recien Nacido Extremadamente Prematuro , Surfactantes Pulmonares/metabolismo , Historia del Siglo XX

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We have reported previously that during hypoxia exposure, the expression of mature miR-17∼92 was first upregulated and then downregulated in pulmonary artery smooth muscle cells (PASMC) and in mouse lungs in vitro and in vivo. Here, we investigated the mechanisms regulating this biphasic expression of miR-17∼92 in PASMC in hypoxia. We measured the level of primary miR-17∼92 in PASMC during hypoxia exposure and found that short-term hypoxia exposure (3% O2, 6 h) induced the level of primary miR-17∼92, whereas long-term hypoxia exposure (3% O2, 24 h) decreased its level, suggesting a biphasic regulation of miR-17∼92 expression at the transcriptional level. We found that short-term hypoxia-induced upregulation of miR-17∼92 was hypoxia-inducible factor 1α (HIF1α) and E2F1 dependent. Two HIF1α binding sites on miR-17∼92 promoter were identified. We also found that long-term hypoxia-induced suppression of miR-17∼92 expression could be restored by silencing of p53. Mutation of the p53-binding sites in the miR-17∼92 promoter increased miR-17∼92 promoter activity in both normoxia and hypoxia. Our findings suggest that the biphasic transcriptional regulation of miR-17∼92 during hypoxia is controlled by HIF1/E2F1 and p53 in PASMC: during short-term hypoxia exposure, stabilization of HIF1 and induction of E2F1 induce the transcription of miR-17∼92, whereas during long-term hypoxia exposure, hyperphosphorylation of p53 suppresses the expression of miR-17∼92.NEW & NOTEWORTHY We showed that the biphasic transcriptional regulation of miR-17∼92 during hypoxia is controlled by two distinct mechanisms: during short-term hypoxia exposure, induction of HIF1 and E2F1 upregulates miR-17∼92. Longer hypoxia exposure induces hyperphosphorylation of p53 at ser15, which leads to its binding to miR-17∼92 promoter and inhibition of its expression. Our findings provide novel insights into the spatiotemporal regulation of miR-17∼92 that may play a role in the development of human lung diseases including pulmonary hypertension (PH).

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Factor de Transcripción E2F1 , Subunidad alfa del Factor 1 Inducible por Hipoxia , MicroARNs , Arteria Pulmonar , Proteína p53 Supresora de Tumor , MicroARNs/genética , MicroARNs/metabolismo , Proteína p53 Supresora de Tumor/metabolismo , Proteína p53 Supresora de Tumor/genética , Subunidad alfa del Factor 1 Inducible por Hipoxia/metabolismo , Subunidad alfa del Factor 1 Inducible por Hipoxia/genética , Fosforilación , Humanos , Animales , Factor de Transcripción E2F1/metabolismo , Factor de Transcripción E2F1/genética , Arteria Pulmonar/metabolismo , Arteria Pulmonar/patología , Transcripción Genética , Hipoxia de la Célula/genética , Miocitos del Músculo Liso/metabolismo , Regiones Promotoras Genéticas/genética , Ratones , Hipoxia/metabolismo , Hipoxia/genética , Serina/metabolismo , Regulación de la Expresión Génica , Células Cultivadas

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In this research, the performance pertaining to tire crumb obtained from scrap tire processing plants is discussed. These tire crumbs are blended with soil at a 30% ratio. When subjected to seismic load, the performance of the 30% tire crumb combination is superior to the 0% tire crumb combination. The investigation is classified into two phases. Phase 1 of the study involves conducting an experimental investigation by applying cyclic loads to a model footing that was resting on the soil with and without tire crumbs. This study reveals that a 30% tire crumb combination achieves optimum energy absorption and minimal footing stiffness, which is a crucial component needed for base isolation. Additionally, using the PLAXIS 2D software package, finite element analysis was carried out during the second phase of the study. For this study, a three-story residential building close to the border between India and Nepal is used. Three different disastrous seismic excitations are applied to the building. From this analytical analysis, it is reported that a 60-70% reduction in acceleration is attained for 30% tire crumb combination with soil. Therefore, from the two phases, it is evaluated that the inclusion of tire crumbs with soil is an excellent seismic base isolation material.

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BACKGROUND: Endoscopic papillectomy (EP) offers a safe and effective method for resection of ampullary adenomas. Data regarding the long-term resolution of adenoma following EP are limited. The aim of this study therefore was to examine the timing of recurrence after EP of ampullary adenomas. METHODS: This was a single-center retrospective study including patients who received EP for ampullary adenomas from 8/2000 to 1/2018. Patients with confirmed complete eradication of adenoma were included in the recurrence analysis with recurrence defined as finding adenomatous histology after 1 negative surveillance endoscopy. Kaplan-Meier estimates were calculated to determine recurrence rates. RESULTS: Of the 165 patients who underwent EP, 136 patients (mean age 61.9, 51.5% female) had adenomatous histology with a mean lesion size of 21.2 mm. A total of 124 (91.2%) achieved complete eradication with a follow-up of 345.8 person-years. Recurrence occurred in 20 (16.1%) patients at a mean of 3.2 (± 3) years (range 0.5-9.75 years) for a recurrence rate of 5.8 (95% CI 3.6-8.8) per 100 person-years. Nine (45%) recurrences occurred after the 1st 2 years of surveillance. Recurrence rate did not differ by baseline pathology [low-grade dysplasia: 5.2 (95% CI 3.0-9.0), high-grade dysplasia: 6.9 (95% CI 2.3-15.5), adenocarcinoma: 7.7 (95% CI 0.9-25.1)]. CONCLUSION: Recurrence remains a significant concern after EP. Given the timing of recurrence, long surveillance periods may be necessary. Larger multicenter studies are needed, however, to determine appropriate surveillance intervals.

Asunto(s)

Adenocarcinoma , Adenoma , Ampolla Hepatopancreática , Neoplasias del Conducto Colédoco , Neoplasias Duodenales , Neoplasias Hepáticas , Neoplasias Pancreáticas , Humanos , Femenino , Masculino , Ampolla Hepatopancreática/cirugía , Ampolla Hepatopancreática/patología , Estudios Retrospectivos , Adenoma/cirugía , Adenoma/patología , Endoscopía Gastrointestinal , Adenocarcinoma/cirugía , Neoplasias Pancreáticas/cirugía , Neoplasias Hepáticas/patología , Neoplasias del Conducto Colédoco/cirugía , Recurrencia Local de Neoplasia/cirugía , Neoplasias Duodenales/cirugía , Resultado del Tratamiento

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BACKGROUND & AIMS: Chronic pancreatitis (CP) causes an abdominal pain syndrome associated with poor quality of life. We conducted a clinical trial to further investigate the efficacy and safety of camostat, an oral serine protease inhibitor that has been used to alleviate pain in CP. METHODS: This was a double-blind randomized controlled trial that enrolled adults with CP with a baseline average daily worst pain score ≥4 on a numeric rating system. Participants were randomized (1:1:1:1) to receive camostat at 100, 200, or 300 mg 3 times daily or placebo. The primary end point was a 4-week change from baseline in the mean daily worst pain intensity score (0-10 on a numeric rating system) using a mixed model repeated measure analysis. Secondary end points included changes in alternate pain end points, quality of life, and safety. RESULTS: A total of 264 participants with CP were randomized. Changes in pain from baseline were similar between the camostat groups and placebo, with differences of least squares means of -0.11 (95% CI, -0.90 to 0.68), -0.04 (95% CI, -0.85 to 0.78), and -0.11 (95% CI, -0.94 to 0.73) for the 100 mg, 200 mg, and 300 mg groups, respectively. Multiple subgroup analyses were similar for the primary end point, and no differences were observed in any of the secondary end points. Treatment-emergent adverse events attributed to the study drug were identified in 42 participants (16.0%). CONCLUSION: We were not able to reject the null hypothesis of no difference in improvements in pain or quality of life outcomes in participants with painful CP who received camostat compared with placebo. Studies are needed to further define mechanisms of pain in CP to guide future clinical trials, including minimizing placebo responses and selecting targeted therapies. CLINICALTRIALS: gov, Number: NCT02693093.

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Ésteres , Guanidinas , Pancreatitis Crónica , Calidad de Vida , Adulto , Humanos , Resultado del Tratamiento , Dolor Abdominal/tratamiento farmacológico , Dolor Abdominal/etiología , Pancreatitis Crónica/complicaciones , Pancreatitis Crónica/diagnóstico , Pancreatitis Crónica/tratamiento farmacológico , Método Doble Ciego

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Video 1Successful removal of impacted cholangiopancreatoscopy-guided retrieval basket.

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PURPOSE: Pediatric pulmonary hypertension (PH) is a condition characterized by elevated pulmonary arterial pressure, which has the potential to be life-limiting. The etiology of pediatric PH varies. When compared with adult cohorts, the etiology is often multifactorial, with contributions from prenatal, genetic, and developmental factors. This review aims to provide an up-to-date overview of the causes and classification of pediatric PH, describe current therapeutics in pediatric PH, and discuss upcoming and necessary research in pediatric PH. METHODS: PubMed was searched for articles relating to pediatric pulmonary hypertension, with a particular focus on articles published within the past 10 years. Literature was reviewed for pertinent areas related to this topic. FINDINGS: The evaluation and approach to pediatric PH are unique when compared with that of adults, in large part because of the different, often multifactorial, causes of the disease in children. Collaborative registry studies have found that the most common disease causes include developmental lung disease and subsets of pulmonary arterial hypertension, which includes genetic variants and PH associated with congenital heart disease. Treatment with PH-targeted therapies in pediatrics is often guided by extrapolation of adult data, small clinical studies in pediatrics, and/or expert consensus opinion. We review diagnostic considerations and treatment in some of the more common pediatric subpopulations of patients with PH, including developmental lung diseases, congenital heart disease, and trisomy 21. IMPLICATIONS: The care of pediatric patients with PH requires consideration of unique pediatric-specific factors. With significant variability in disease etiology, ongoing efforts are needed to optimize treatment strategies based on disease phenotype and guide evidence-based practices.

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Cardiopatías Congénitas , Hipertensión Pulmonar , Hipertensión Arterial Pulmonar , Embarazo , Adulto , Femenino , Niño , Humanos , Hipertensión Pulmonar/diagnóstico , Hipertensión Pulmonar/etiología , Hipertensión Pulmonar/terapia , Cardiopatías Congénitas/complicaciones , Cardiopatías Congénitas/diagnóstico , Fenotipo

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Considering the unique properties of magnesium and its alloy, it has a vast demand in biomedical applications, particularly the implant material in tissue engineering due to its biodegradability. But the fixing spares must hold such implants till the end of the biodegradation of implant material. The composite technology will offer the added benefits of altering the material properties to match the requirements of the desired applications. Hence, this experimental investigation is aimed at developing a composite material for manufacturing fixing spares like a screw for implants in biomedical applications. The matrix of AZ63 magnesium alloy is reinforced with nanoparticles of zirconium (Zr) and titanium (Ti) through the stir casting-type synthesis method. The samples were prepared with equal contributions of zirconium (Zr) and titanium (Ti) nanoparticles in the total reinforcement percentage (3%, 6%, 9%, and 12%). The corrosive and tribological studies were done. In the corrosive study, the process parameters like NaCl concentration, pH value, and exposure time were varied at three levels. In the wear study, the applied Load, speed of sliding, and the distance of the slide were considered at four levels. Taguchi analysis was employed in this investigation to optimize the reinforcement and independent factors to minimize the wear and corrosive losses. The minimum wear rate was achieved in the 12% reinforced sample with the input factor levels of 60 N of load on the pin, 1 m/s of disc speed at a sliding distance was 1500 m, and the 12% reinforce samples also recorded a minimum corrosive rate of 0.0076 mm/year at the operating environment of 5% NaCl-concentrated solution with the pH value of 9 for 24 hrs of exposure. The prediction model was developed based on the experimental results.

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Cáusticos , Titanio , Titanio/química , Circonio/química , Magnesio , Cloruro de Sodio , Materiales Dentales , Aleaciones/química

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OBJECTIVES: To describe antibiotic prescription by veterinarians in general practices in the United Kingdom before referral and analyse if UK antibiotic stewardship guidelines were followed. MATERIALS AND METHODS: The clinical records from dogs and cats referred to the Internal Medicine and Oncology departments of two referral hospitals were retrospectively reviewed. RESULTS: There were 917 cases included, of which 486 (53.0%) had been prescribed antibiotics for the presentation they were subsequently referred for. Bacterial culture or cytology to guide antibiotic prescription had been performed in 43 of 486 (8.8%) and nine of 486 cases (1.8%) respectively. In four cases, both cytology and culture were performed. For those animals who had received antibiotics, 344 of 486 (70.8%) prescriptions did not comply with UK antibiotic stewardship guidelines. Following investigations at a referral centre, a bacterial aetiology was found or suspected in 17.9% of the cases that received antibiotics. CLINICAL SIGNIFICANCE: Use of diagnostics, including culture and cytology, to prove or determine the likelihood of a bacterial aetiology was infrequently performed before referral and may have contributed to overprescription of antibiotics. Encouraging veterinarians to undertake appropriate diagnostics, in combination with education around compliance with antibiotic stewardship guidelines, might reduce antibiotic prescription.

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Enfermedades de los Gatos , Enfermedades de los Perros , Medicina General , Gatos , Perros , Animales , Estudios Retrospectivos , Enfermedades de los Gatos/tratamiento farmacológico , Enfermedades de los Perros/tratamiento farmacológico , Antibacterianos/uso terapéutico , Reino Unido

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BACKGROUND: Intra-articular hyaluronic acid (IAHA) has been commonly used in the management of knee osteoarthritis (OA). This study sought to assess patient-reported outcomes (PRO) following different formulations of hyaluronic acid injections for patients who have knee OA. METHODS: A retrospective analysis was performed on patients who have knee OA and received IAHA knee injections from October 2018 to May 2022 in sports medicine (SM) and adult reconstructive (AR) clinics. Patients completed PRO measures including the Patient-Reported Outcome Measurement Information System (PROMIS) Mobility, Pain Interference, and Pain Intensity at baseline, 6-week, 6-month, and 12-month follow-up. Univariate and multivariate analyses were used to evaluate changes in PRO measures between baseline and follow-up periods and to evaluate differences between the SM and AR divisions. A total of 995 patients received IAHA for knee OA and completed PRO assessments. RESULTS: There was no difference in the PROMIS measures based on molecular weight at 6 weeks, 6 months, and 12 months. Except for 6-month Mobility scores between the SM and AR patients (-0.52 ± 5.46 versus 2.03 ± 6.95; P = .02), all other PROMIS scores were similar. Mobility scores at 6 months were significantly different based on Kellgren and Lawrence grade (P = .005), but all other PROMIS scores were similar. CONCLUSION: Average change in PROMIS scores were significantly different only for 6-month Mobility scores based on divisions and Kellgren and Lawrence grade but did not achieve minimally clinical important difference at most timepoints. Further studies are needed to investigate whether improvement is observed in specific patient populations.

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Ácido Hialurónico , Osteoartritis de la Rodilla , Adulto , Humanos , Ácido Hialurónico/uso terapéutico , Osteoartritis de la Rodilla/tratamiento farmacológico , Osteoartritis de la Rodilla/cirugía , Estudios Retrospectivos , Resultado del Tratamiento , Inyecciones Intraarticulares , Medición de Resultados Informados por el Paciente

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OBJECTIVE: We evaluated a protocolized endoscopic necrosectomy approach with a lumen-apposing metal stent (LAMS) in patients with large symptomatic walled-off pancreatic necrosis (WON) comprising significant necrotic content, with or without infection. SUMMARY BACKGROUND DATA: Randomized trials have shown similar efficacy of endoscopic treatment compared with surgery for infected WON. DESIGN: We conducted a regulatory, prospective, multicenter single-arm clinical trial examining the efficacy and safety of endoscopic ultrasound -guided LAMS with protocolized necrosectomy to treat symptomatic WON ≥6 cm in diameter with >30% solid necrosis. After LAMS placement, protocolized WON assessment was conducted and endoscopic necrosectomy was performed for insufficient WON size reduction and persistent symptoms. Patients with radiographic WON resolution to ≤ 3 cm and/or 60-day LAMS indwell had LAMS removal, then 6-month follow-up. Primary endpoints were probability of radiographic resolution by 60 days and procedure-related serious adverse events. RESULTS: Forty consecutive patients were enrolled September 2018 to March 2020, of whom 27 (67.5%) were inpatients and 19 (47.5%) had clinical evidence of infection at their index procedure. Mean WON size was 15.0 ± 5.6 cm with mean 53.2% ± 16.7% solid necrosis. Radiographic WON resolution was seen in 97.5% (95% CI, 86.8%, 99.9%) by 60 days, without recurrence in 34 patients with 6-month follow-up data. Mean time to radiographic WON resolution was 34.1 ± 16.8 days. Serious adverse events occurred in 3 patients (7.5%), including sepsis, vancomycin-resistant enterococcal bacteremia and shock, and upper gastrointestinal bleeding. There were no procedure-related deaths. CONCLUSIONS: Endoscopic ultrasound-guided drainage with protocolized endoscopic necrosectomy to treat large symptomatic or infected walled-off necrotic pancreatic collections was highly effective and safe. Clinicaltrials.-gov no: NCT03525808.

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Pancreatitis Aguda Necrotizante , Humanos , Drenaje/métodos , Endosonografía , Metales , Necrosis/etiología , Necrosis/cirugía , Pancreatitis Aguda Necrotizante/diagnóstico por imagen , Pancreatitis Aguda Necrotizante/cirugía , Estudios Prospectivos , Estudios Retrospectivos , Stents/efectos adversos , Resultado del Tratamiento

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BACKGROUND AND AIMS: Fully covered self-expandable metal stents (FCSEMSs) may offer a treatment option for pain associated with a dilated pancreatic duct (PD) in chronic pancreatitis (CP), but optimal patient selection and FCSEMS design, efficacy, and safety remain uncertain. We studied an investigational pancreatic FCSEMS for treatment of CP-associated pain. METHODS: Patients with painful CP, a dominant distal PD stricture, and PD dilation upstream were enrolled in a prospective, multicenter, single-arm trial studying 6-month indwell of a 4- to 6-cm-long soft pancreatic FCSEMS. Primary efficacy and safety endpoints were pain reduction 6 months after FCSEMS indwell (performance goal ≥53%) and PD stenting-related serious adverse events (SAEs), respectively (performance goal <32%). The primary efficacy endpoint was assessed in patients with sufficiently severe and frequent pain at FCSEMS placement as a first stent or in exchange of a plastic stent. RESULTS: Among 67 patients (mean age, 52.7 ± 12.5 years; mean time since CP diagnosis, 6.4 ± 6.4 years), 34 (50.7%) had plastic stent placement within 90 days of FCSEMS placement, and 46 patients were eligible for the primary efficacy endpoint analysis. Technical success was 97.0% (65/67). The observed primary efficacy (26.1%, 12/46) and safety endpoints (31.3%, 21/67) failed to meet the a priori study hypotheses. Study stent migration occurred in 47.7% of patients (31/65). CONCLUSIONS: Six-month treatment with an FCSEMS did not lead to an expected degree of pain reduction, and migrations and SAEs were common. Further study is needed to clarify optimal decompressive strategy, FCSEMS design, and patient selection. (Clinical trial registration number: NCT02802020.).

Asunto(s)

Enfermedades Gastrointestinales , Pancreatitis Crónica , Stents Metálicos Autoexpandibles , Humanos , Adulto , Persona de Mediana Edad , Anciano , Conductos Pancreáticos , Constricción Patológica/terapia , Constricción Patológica/complicaciones , Estudios Prospectivos , Resultado del Tratamiento , Stents Metálicos Autoexpandibles/efectos adversos , Pancreatitis Crónica/complicaciones , Stents/efectos adversos , Enfermedades Gastrointestinales/etiología , Dolor/etiología , Plásticos , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos

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OBJECTIVE: To characterize distinct comorbidities, outcomes, and treatment patterns in children with Down syndrome and pulmonary hypertension in a large, multicenter pediatric pulmonary hypertension registry. STUDY DESIGN: We analyzed data from the Pediatric Pulmonary Hypertension Network (PPHNet) Registry, comparing demographic and clinical characteristics of children with Down syndrome and children without Down syndrome. We examined factors associated with pulmonary hypertension resolution and a composite outcome of pulmonary hypertension severity in the cohort with Down syndrome. RESULTS: Of 1475 pediatric patients with pulmonary hypertension, 158 (11%) had Down syndrome. The median age at diagnosis of pulmonary hypertension in patients with Down syndrome was 0.49 year (IQR, 0.21-1.77 years), similar to that in patients without Down syndrome. There was no difference in rates of cardiac catheterization and prescribed pulmonary hypertension medications in children with Down syndrome and those without Down syndrome. Comorbidities in Down syndrome included congenital heart disease (95%; repaired in 68%), sleep apnea (56%), prematurity (49%), recurrent respiratory exacerbations (35%), gastroesophageal reflux (38%), and aspiration (31%). Pulmonary hypertension resolved in 43% after 3 years, associated with a diagnosis of pulmonary hypertension at age <6 months (54% vs 29%; P = .002) and a pretricuspid shunt (65% vs 38%; P = .02). Five-year transplantation-free survival was 88% (95% CI, 80%-97%). Tracheostomy (hazard ratio [HR], 3.29; 95% CI, 1.61-6.69) and reflux medication use (HR, 2.08; 95% CI, 1.11-3.90) were independently associated with a composite outcome of severe pulmonary hypertension. CONCLUSIONS: Despite high rates of cardiac and respiratory comorbidities that influence the severity of pulmonary hypertension, children with Down syndrome-associated pulmonary hypertension generally have a survival rate similar to that of children with non-Down syndrome-associated pulmonary hypertension. Resolution of pulmonary hypertension is common but reduced in children with complicated respiratory comorbidities.

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Síndrome de Down , Reflujo Gastroesofágico , Cardiopatías Congénitas , Hipertensión Pulmonar , Niño , Humanos , Lactante , Hipertensión Pulmonar/epidemiología , Hipertensión Pulmonar/etiología , Hipertensión Pulmonar/terapia , Estudios Retrospectivos , Síndrome de Down/complicaciones , Cardiopatías Congénitas/cirugía , Sistema de Registros , Reflujo Gastroesofágico/complicaciones

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OBJECTIVE: To evaluate the safety and efficacy of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using a lumen-apposing metal stent (LAMS). BACKGROUND: For patients with acute cholecystitis who are poor surgical candidates, EUS-GBD using a LAMS is an important treatment alternative to percutaneous gallbladder drainage. METHODS: We conducted a regulatory-compliant, prospective multicenter trial at 7 tertiary referral centers in the United States of America and Belgium. Thirty consecutive patients with mild or moderate acute cholecystitis who were not candidates for cholecystectomy were enrolled between September 2019 and August 2021. Eligible patients had a LAMS placed transmurally with 30 to 60-day indwell if removal was clinically indicated, and 30-day follow-up post-LAMS removal. Endpoints included days until acute cholecystitis resolution, reintervention rate, acute cholecystitis recurrence rate, and procedure-related adverse events (AEs). RESULTS: Technical success was 93.3% (28/30) for LAMS placement and 100% for LAMS removal in 19 patients for whom removal was attempted. Five (16.7%) patients required reintervention. Mean time to acute cholecystitis resolution was 1.6±1.5 days. Acute cholecystitis symptoms recurred in 10.0% (3/30) after LAMS removal. Five (16.7%) patients died from unrelated causes. Procedure-related AEs were reported to the FDA in 30.0% (9/30) of patients, including one fatal event 21 days after LAMS removal; however, no AEs were causally related to the LAMS. CONCLUSIONS: For selected patients with acute cholecystitis who are at elevated surgical risk, EUS-GBD with LAMS is an alternative to percutaneous gallbladder drainage. It has high technical and clinical success, with low recurrence and an acceptable AE rate. Clinicaltrials.gov, Number: NCT03767881.

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Colecistitis Aguda , Vesícula Biliar , Humanos , Vesícula Biliar/diagnóstico por imagen , Vesícula Biliar/cirugía , Estudios Prospectivos , Resultado del Tratamiento , Colecistitis Aguda/diagnóstico por imagen , Colecistitis Aguda/cirugía , Endosonografía , Drenaje/efectos adversos , Stents , Ultrasonografía Intervencional

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Video 1The case report is presented in the video, with a description of the patient's clinical presentation and course along with a set of endoscopic interventions, including different stent retrieval devices and the ultimate use of pancreatoscopy with a Spyglass Retrieval Snare (Boston Scientific, Marlborough, Mass, USA) to remove the migrated pancreatic duct stent after serial dilations of the pancreatic duct.