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  • Mcpherson posted an update 9 months ago

    BACKGROUND The optimal management of preexisting severe aortic stenosis (AS) in patients undergoing noncardiac surgery (non-CS) remains uncertain. This study aimed to investigate the safety and effectiveness of percutaneous aortic valve intervention (PAVI) in patients with AS before non-CS. METHODS We analyzed pooled data within a multicenter Japanese registry from 118 patients with severe AS who underwent PAVI before non-CS. Sixty patients underwent percutaneous balloon aortic valvuloplasty (BAV) and 58 patients underwent transcatheter aortic valve replacement (TAVR). The groups’ baseline characteristics, perioperative complications, and 30-day mortality and midterm mortality after non-CS were compared. RESULTS The postprocedural mean pressure gradient was higher in the BAV group than in the TAVR group (35.0 ± 11.5 mmHg vs. 11.5 ± 4.8 mmHg, p  less then  0.001). The non-CS operation risk did not differ between the groups (p = 0.69). One patient in each group experienced a noncardiac death (p = 0.74), and the 30-day mortality rate after non-CS was 1.7%. Heart failure occurred in 2 patients in each group (p = 0.68). One patient in the TAVR group experienced a non-disabling stroke, and no myocardial infarctions occurred. Consequently, the combined adverse events were 5.0% and 6.9% in the 2 groups (p = 0.48). The bleeding rates during the non-CS were similar in both groups (33.3% vs. 25.9%, p = 0.25). There were no differences between the groups regarding midterm mortality (p = 0.60), whereas 53.3% of the patients in the BAV group required invasive treatment of their AS during follow-up. CONCLUSIONS Among patients with severe AS, PAVI before non-CS reduces the AS severity and may contribute to procedural safety during non-CS. OBJECTIVE To assess the value of 18F-FDG PET/CT in differentiating between benign and malignant intraductal papillary mucinous neoplasms (IPMN) of the pancreas. SUMMARY BACKGROUND DATA Malignant or high-risk IPMN require surgical resection but surgery should be avoided in patients with IPMN carrying a low risk of malignancy. 18F-FDG PET has been studied mostly in small, single center, retrospective series. METHODS Prospective, non-comparative, multicenter French study. The primary endpoint was the specificity of PET/CT for identifying malignant IPMN (in situ or invasive carcinoma). Final diagnosis was obtained from pathological examination of the resected specimen. RESULTS Among 120 patients analyzed, 99 had confirmed IPMN, including 24 with malignant lesions, namely 9 with carcinoma in situ and 15 with invasive carcinoma. The 18F-FDG PET/CT was positive in 44 and 31 patients in the overall and IPMN populations respectively. In the 99 IPMN patients, PET/CT showed 13 true positive, 18 false positive, 57 true negative and 11 false negative results. The sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) for the diagnosis of malignancy were 54.2%, 76.0%, 83.8% and 41.9% respectively, versus 64.9%, 75.9%, 82.9% and 54.5% in the overall population. We could not identify a cut-off value for SUVmax to distinguish benign from malignant lesions. Recilisib price Conventional imaging included computed tomography, magnetic resonance cholangiopancreatography and endoscopic ultrasound. In IPMN patients who underwent the 3 techniques, sensitivity, specificity, NPV and PPV were 66.7%, 84.4%, 84.4% and 66.7% respectively. CONCLUSIONS In this study, 18F-FDG PET/CT did not perform better than conventional imaging to differentiate malignant from benign IPMN. INTRODUCTION Measuring and comparing the incidence of child maltreatment is challenging. Linkage of statewide birth cohorts with Child Protective Services reports to study incident child maltreatment over the life course are becoming more common. This study compares the reported incidence between 2 states derived from population-based administrative data linkages. METHODS Linked births (2009-2011) with Child Protective Services records (2009-2015) and deaths in each state were used to compare the cumulative incidence of a Child Protective Services report before age 7 years. Given differences in population race structure and documented disparities of race groups in Child Protective Services data, variation was adjusted for using direct standardization. Unadjusted cumulative incidence, race cumulative incidence, and race-adjusted cumulative incidence were compared. Analyses were completed in 2018. RESULTS Before age 7 years, 26.0% of Alaskan children and 19.0% of Californian children were reported to Child Protective Services (RR=1.37, p less then 0.001). Aside from Asian/Pacific Islanders, the cumulative incidence between states was similar for each race. The race-adjusted cumulative incidence indicated that children born in Alaska were 1.10 times as likely to experience a report before age 7 years compared with children in California. CONCLUSIONS Much of the difference in risk for child maltreatment observed between Alaska and California is most likely due to variation in the population structure by race as opposed to modifiable factors. Standardization is a simple method to adjust for population structure differences. This study contributes to the growing body of knowledge regarding the use of linked administrative data to study maltreatment and provides insights into considerations for making comparisons or conducting cross-jurisdictional analyses based on commonly aligned data sets. Educational councils and medical societies recommend that medical students learn to recognize and care for victims of sex trafficking. Previous research has found that healthcare providers are one of the few professionals to interact with sex trafficking victims during exploitation. This review evaluates currently published curricular and extracurricular U.S. medical education resources. A literature review of MEDLINE, PubMed, Embase, MedEdPORTAL, Google Scholar, and Google was conducted in December 2018 to January 2019 using the search terms human trafficking OR sex traffic OR sex violence OR sex work OR sex exploitation OR child prostitution AND education, medical, undergraduate OR students, medical OR medical student or medical education OR education, medical. The inclusion criteria included informational educational materials for medical students on sex trafficking. Studies were excluded for non-English language, empirical research on sex trafficking, nonhealth or nonundergraduate medical students, and resources focused on other sexual health topics.

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