Harbin Clinic

TAVI is a widely accepted treatment for patients with severe aortic stenosis (AS). Despite the adoption of diverse therapies, opportunities remain to develop technologies tailored to provide optimal acute and potential long-term benefits, particularly around haemodynamics, flow and durability. We aimed to evaluate the safety and feasibility of the DurAVR transcatheter heart valve (THV), a first-in-class biomimetic valve, in the treatment of patients with symptomatic severe AS. This was a first-in-human (FIH), prospective, non-randomised, single-arm, single-centre study. Patients with severe, symptomatic AS of any surgical risk and who were eligible for the DurAVR THV prosthesis were recruited; they were assessed at baseline, 30 days, 6 months, and 1 year post-procedure for implant success, haemodynamic performance, and safety. Thirteen patients (73.9±6.4 years old, 77% female) were enrolled. The DurAVR THV was successfully implanted in 100% of cases with no device-related complications. One access site complication, one permanent pacemaker implantation, and one case of moderate aortic regurgitation occurred. Otherwise, no deaths, stroke, bleeding, reinterventions, or myocardial infarction were reported during any of the follow-up visits. Despite a mean annulus size of 22.95±1.09 mm, favourable haemodynamic results were observed at 30 days (effective orifice area [EOA] 2.00±0.17 cm2, and mean pressure gradient [MPG] 9.02±2.68 mmHg) and were sustained at 1 year (EOA 1.96±0.11 cm2, MPG 8.82±1.38 mmHg), resulting in zero patients with any degree of prosthesis-patient mismatch. Additionally, new valve performance measures derived from cardiovascular magnetic resonance displayed restoration of laminar flow, consistent with a predisease state, in conjunction with a mean coaptation length of 8.3±1.7 mm. Preliminary results from the FIH study with DurAVR THV demonstrate a good safety profile with promising haemodynamic performance sustained at 1 year and restoration of near-normal flow dynamics. Further clinical investigation is warranted to evaluate how DurAVR THV may play a role in addressing the challenge of lifetime management in AS patients.

<div>AbstractPurpose:<p>Preclinical and clinical data suggest that downstream inhibition with an MEK inhibitor, such as binimetinib, might be efficacious for <i>NRAS</i>-mutated cancers.</p>Patients and Methods:<p>Patients enrolled in the NCI-MATCH trial master protocol underwent tumor biopsy and molecular profiling by targeted next-generation sequencing. Patients with <i>NRAS</i>-mutated tumors, except melanoma, were enrolled in subprotocol Z1A, a single-arm study evaluating binimetinib 45 mg twice daily. The primary endpoint was objective response rate (ORR). Secondary endpoints included progression-free survival (PFS) and overall survival (OS). A <i>post hoc</i> analysis examined the association of <i>NRAS</i> mutation type with outcome.</p>Results:<p>In total, 47 eligible patients with a refractory solid tumor harboring a codon 12, 13, or 61 <i>NRAS</i> mutation were treated. Observed toxicity was moderate, and 30% of patients discontinued treatment because of binimetinib-associated toxicity. The ORR was 2.1% (1/47 patients). A patient with malignant ameloblastoma harboring a codon 61 <i>NRAS</i> mutation achieved a durable partial response (PR). A patient with <i>NRAS</i> codon 61–mutated colorectal cancer had an unconfirmed PR, and two other patients with <i>NRAS</i> codon 61–mutated colorectal had stable disease for at least 12 months. In an exploratory analysis, patients with colorectal cancer bearing a <i>NRAS</i> codon 61 mutation (<i>n</i> = 8) had a significantly longer OS (<i>P</i> = 0.03) and PFS (<i>P</i> = 0.007) than those with codon 12 or 13 mutations (<i>n</i> = 16).</p>Conclusions:<p>Single-agent binimetinib did not show promising efficacy in <i>NRAS</i>-mutated cancers. The observation of increased OS and PFS in patients with codon 61 <i>NRAS</i>-mutated colorectal cancer merits further investigation.</p></div>

Colonoscopy is routinely used for the diagnosis and treatment of colorectal diseases. Bowel perforation is a rare but severe complication that significantly increases the morbidity and mortality. Tension pneumothorax is an uncommon complication of colonic perforation. We present a case of the successful treatment of a patient with tension pneumothorax, following colonoscopy, by using tube thoracostomy and Hartman-type resection of the rectosigmoid junction and proximal sigmoid. Surgeons, anesthesiologists, and endoscopists should consider the possibility of pneumothorax as a rare complication of colonoscopy. Early detection and urgent treatment is the key to successful management.

INTRODUCTION: Acute pancreatitis is a relatively common condition in the hospital. About 75% of cases are associated with excessive alcohol use or gallstones, and only 0.1 to 2% are drug-induced. The clinical and pathologic findings are similar regardless of the inciting cause. We have suspicion that metronidazole-induced pancreatitis occurs at a significantly higher incidence, or maybe exclusively, in females. CASE DESCRIPTION/METHODS: A 68-year-old Caucasian female with history of hyperlipidemia, cardiomyopathy and hypothyroidism presents to the ED with chief complaint of epigastric pain. Symptoms started few days prior with back pain that progressed to epigastric tenderness and fullness. Associated symptoms include nausea and vomiting. She denies fever, chest pain, hematemesis, hematochezia, melena or recent injury. She denies alcohol or tobacco use. About 2 weeks ago, patient underwent upper endoscopy for ongoing epigastric pain and family history of sister who passed away in her 50s from gastric cancer. EGD showed numerous pedunculated and sessile hyperplastic appearing gastric polyps in the fundus and body; biopsy was obtained. Pathology report revealed no dysplasia or malignancy. She completed a short course of metronidazole for abdominal bloating and diarrhea 4 days prior to hospital presentation. On admission, lipase was 10,347 with normal triglyceride and calcium levels. CT imaging demonstrated stranding around the pancreatic head and uncinate process. She was placed on bowel rest, IV hydration and supportive care. MRCP was performed to assess the pancreatic duct; it revealed acute pancreatitis, but no cholelithiaisis, choledocholithiasis or other complicating features. Repeat lipase was 2,533. Patient recovered well and was discharged home. DISCUSSION: Metronidazole-induced acute pancreatitis has been reported in prior English literature; in which all 8 cases involved female patients (O'Halloran E, et al. HPB Surgery, pp. 1–4, 2010). Proposed mechanisms include free radical production and immune-mediated inflammatory response. In a population-based case control study, there was a significantly increased risk of acute pancreatitis within 30 days exposure to metronidazole, especially when used in combination with other agents for H. pylori eradication (Barbulescu A, et al. Clinical Epidemiology, pp. 1573–1581, 2018). Physicians should maintain a high index of suspicion when prescribing metronidazole and avoid rechallenge. Further investigation may help reduce morbidity related with this phenomenon.

e18651Background: Clinical trials promote excellence in cancer care but only 2 – 3 % of patients enroll on trials. 1Minorities who experience the greatest cancer burden are least likely to enroll, ...

BackgroundThe study was a collaboration between Lifting The Burden (LTB) and the European Headache Federation (EHF). Its aim was to evaluate the implementation of quality indicators for headache care Europe-wide in specialist headache centres (level-3 according to the EHF/LTB standard).MethodsEmploying previously-developed instruments in 14 such centres, we made enquiries, in each, of health-care providers (doctors, nurses, psychologists, physiotherapists) and 50 patients, and analysed the medical records of 50 other patients. Enquiries were in 9 domains: diagnostic accuracy, individualized management, referral pathways, patient’s education and reassurance, convenience and comfort, patient’s satisfaction, equity and efficiency of the headache care, outcome assessment and safety.ResultsOur study showed that highly experienced headache centres treated their patients in general very well. The centres were content with their work and their patients were content with their treatment. Including disability and quality-of-life evaluations in clinical assessments, and protocols regarding safety, proved problematic: better standards for these are needed. Some centres had problems with follow-up: many specialised centres operated in one-touch systems, without possibility of controlling long-term management or the success of treatments dependent on this.ConclusionsThis first Europe-wide quality study showed that the quality indicators were workable in specialist care. They demonstrated common trends, producing evidence of what is majority practice. They also uncovered deficits that might be remedied in order to improve quality. They offer the means of setting benchmarks against which service quality may be judged. The next step is to take the evaluation process into non-specialist care (EHF/LTB levels 1 and 2).Electronic supplementary materialThe online version of this article (doi:10.1186/s10194-016-0707-9) contains supplementary material, which is available to authorized users.

81 Background: The Georgia Cancer Control Consortium’s Survivorship Working Group conducted a needs assessment to understand physical, psychological, practical, and spiritual needs of adult survivors. Results were used to assess survivors’ level of distress and how effectively their needs were being met. Methods: Cross-sectional online and paper-based surveys developed using NCCN and Commission on Cancer (CoC) guidelines. Surveys were distributed through survivorship programs of CoC hospitals (n = 40) and cancer organizations via email, social media and mail. 740 responses received September-December 2014. Results: Respondents were primarily female (78%) married (65%), college-educated (55%) and insured (97%). 83% were White,16% were African American and 3% were Hispanic. 36% of respondents were within 1 year of treatment; 45% were 1 - 5 years post treatment. Survivors reported positive experiences with provider communication. Responses of ‘often’ or ‘very often’ were: provider gave them a chance to ask questions (90.6%); provider involved them in healthcare decisions (84.7%), provider spent enough time with them (78.5%) and provider helped with feelings of uncertainty about health issues or treatment (75.7%). Physical and emotional needs were not as effectively met as spiritual or practical needs. A higher proportion of survivors reported moderate to extreme levels of emotional distress with: depression (32.7%), anxiety (32.1%), stress (30.2%), fear of recurrence (28.2%) and defining a “new normal” (25.9%). 81% of survivors found information and assistance online (56%), in print materials (41%) and from providers/cancer centers (41%). 37% received a survivorship care plan (SCP); 98% reported the SCP was helpful. Conclusions: Results demonstrate the need for providers in Georgia to be educated about and responsive to survivors’ unmet needs and levels of distress. Survivors report positive communication with providers but lower levels of having physical and emotional needs addressed. Survivors actively seek resources and benefit from SCPs. Providers can contribute to addressing needs and reducing distress by maintaining strong communication, guiding survivors to evidence-based resources and implementing SCPs.