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Transcatheter aortic valve replacement (TAVR) has become the standard of care for patients with severe aortic stenosis (AS) who are at elevated surgical risk. Although generally well tolerated, TAVR can be associated with uncommon but potentially serious complications, including acute mitral regurgitation (MR) following valve deployment. We present the case of a 94-year-old woman with symptomatic severe AS who developed acute, new-onset severe MR immediately after TAVR. Preprocedural imaging had shown no significant MR. The patient experienced acute hemodynamic compromise with pulmonary edema and hypotension, necessitating prompt medical intervention with vasopressors, diuretics, and noninvasive ventilation. Postoperative imaging excluded structural mitral valve (MV) damage and suggested impaired leaflet coaptation. The severity of MR improved markedly over the subsequent days, and at 1-year follow-up, only trace MR was observed. The likely mechanism was transient ischemic dysfunction of the posteromedial papillary muscle due to hypotension. New-onset severe MR following TAVR is an uncommon yet clinically significant complication that necessitates prompt identification and intervention. In cases where intraprocedural hypotension occurs, transient papillary muscle dysfunction should be considered as a potential underlying mechanism, particularly when the MR is reversible and not associated with structural MV abnormalities or evidence of myocardial ischemia.

416 Background: Variable anatomy, prompted by bowel filling and respiratory motion, necessitates larger margins for planning target volumes (PTV) in radiotherapy for gastric lymphoma patients, leading to higher doses to organs at risk (OAR). The deep inspiratory breath-holding (DIBH) technique during radiotherapy has emerged as a protective method that improves OAR sparing. Therefore, this systematic review aims to systematically evaluate the benefits of DIBH compared to free breathing (FB) techniques during radiotherapy for gastric lymphomas, along with the physiological mechanisms involved. Methods: This systematic review included three comparative studies following a comprehensive search across PubMed, Google Scholar, and the Cochrane Library, involving a total of 33 patients with gastric lymphomas, in whom radiotherapy was planned under both DIBH and FB. The radiotherapeutic techniques assessed were intensity-modulated radiotherapy (IMRT), 3D-conformal radiotherapy (3D-CRT), step-and-shoot IMRT (SIMRT), volumetric-modulated arc therapy (VMAT), and tomotherapy. The dosimetric parameters included Gy (Gray), mean dose (Dmean), maximum dose (Dmax), etc. Results: Median heart dose (MHD) showed a consistent and significant reduction with DIBH across all techniques, including IMRT: 4.9→2.6 Gy; 3D: 8.54→4.46 Gy; SIMRT: 6.97→3.63 Gy; VMAT: 6.83→3.42 Gy; and tomotherapy: 7.06→3.80 Gy (all p<0.001). An additional study reported a decline from 7.1 Gy (FB 1.5 cm PTV) to 3.2 Gy (DIBH 1 cm PTV) (p<0.001). Kidney doses showed modest changes, with Dmean reduced from 4.3 Gy with FB 1 cm to 3.8 Gy with DIBH. For the left kidney, only one study demonstrated a significant reduction (p = 0.01). Spinal cord doses were also lower with DIBH; Dmax decreased from 19.79 to 17.56 Gy (VMAT), and Dmean from 8.7 Gy (FB 1.0 cm) and 9.7 Gy (FB 1.5 cm) to 7.9 Gy (DIBH) (p=0.02 and p=0.001). Findings in the lung were inconsistent: one study reported lower Dmean with DIBH, while others noted slight increases, e.g., left lung 3.0 vs. 2.6 Gy for FB 1 cm; 3.3 vs. 3.0 Gy for FB 1.5 cm. Liver outcomes were non-significant primarily, with reported reductions from 9.4 to 8.3 Gy and 13.91 to 12.64 Gy, although one study showed a higher Dmean with DIBH compared to FB 1 cm (p = 0.04). Conclusions: In conclusion, based on the current literature, DIBH significantly improves organ at risk (OAR) sparing, especially for the heart, right kidney, and spinal cord, during radiotherapy for gastric lymphomas. While results for the liver and lungs are mixed, no significant differences have yet been reported for the small bowel. These findings support the routine use of DIBH to minimize cardiac and critical organ radiation during radiotherapy, thereby facilitating safer clinical and patient practices.

ABSTRACTCatheter‐directed intervention (CDI) in patients presenting with pulmonary embolism (PE) is suggested to improve in‐hospital outcomes. We aimed to compare the effect of early versus late initiation of CDI on in‐hospital outcomes. A systematic review and meta‐analysis were conducted according to PRISMA guidelines. A comprehensive search of PubMed, Scopus, Web of Science, and Embase databases was performed from inception to May 2025. Data extraction was conducted independently by multiple reviewers. Statistical analysis was performed using R software version 4.3.2, and odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) were combined using a random‐effects model. Six studies, including 53,472 patients, were included. Early intervention before 24 h significantly reduced mortality (OR 0.61, 95% CI [0.44–0.84]; I² = 0%). Moreover, Early intervention before 24 h significantly reduced the all‐cause readmission in patients with acute PE (OR = 0.81 (95% CI: [0.73, 0.89]; I² = 0%). There was no significant difference in risk of major bleeding in early vs late intervention (OR = 0.82; 95% CI: [0.48, 1.39]; I² = 69.3%). Also, early intervention before 24 h significantly reduced the length of hospital stay (LOS) (MD = –3.11 days (95% CI: [–4.33, –1.89]; I² = 0%). This meta‐analysis showed that early CDI, particularly within 24 h of presentation, is associated with a significant reduction in both mortality and all‐cause readmission in patients with acute PE, without increasing the risk of bleeding. These findings support the concept of “time‐is‐myocardium” and reinforce the need for structured protocols that enable early therapeutic intervention. Further randomized controlled trials are needed to confirm these findings and to establish the optimal timing for this potentially life‐saving therapy.

This meta-analysis aims to compare chest compression-only cardiopulmonary resuscitation (CO-CPR) with standard CPR (sCPR), which includes mouth-to-mouth ventilation, as potential strategies for managing out-of-hospital cardiac arrest (OHCA). We systematically searched various databases and registries such as MEDLINE, Embase, The Cochrane Library, and Clinicaltrials.gov to retrieve relevant studies. We used the revised Cochrane "Risk of Bias" tool for randomized trials (RoB 2.0) to assess the risk of bias in included studies. Revman 5.4 was used to pool dichotomous outcomes under a random effects model. A total of 4 randomized controlled trials were included in our meta-analysis. Our results indicate that CO-CPR was associated with a significantly increased survival to hospital discharge compared to sCPR [relative risk (RR) 1.22, 95% confidence interval (CI): 1.01 to 1.46] with minimal heterogeneity (I2=0%). No significant difference was observed between the two groups regarding 1-day survival (RR 1.07, 95% CI: 0.94 to 1.23), survival to hospital admission with a good neurological outcome (cerebral performance category 1 or 2) (RR 1.10, 95% CI: 0.80 to 1.51), return of spontaneous circulation (RR 1.05, 95% CI: 0.95 to 1.17), and survival to hospital admission (RR 1.08, 95% CI: 0.93 to 1.25). This meta-analysis found that chest CO-CPR significantly improves survival to hospital discharge compared to sCPR for managing OHCA, while yielding comparable results for other resuscitation outcomes.

Acute heart failure (AHF) is a serious medical condition with considerable morbidity and mortality ranging from 20%-30% within the first month following hospital admission. We aimed to evaluate the efficacy and safety of sodium-glucose cotransporter-2 (SGLT2) inhibitors administered within the first five days of hospitalization for AHF. We utilized various electronic resources such as MEDLINE, Embase, and the Cochrane Library to retrieve relevant randomized controlled trials (RCTs). The meta-analysis was performed using Revman, where the risk ratio (RR) and mean difference (MD) with a 95% confidence interval (CI) were used for dichotomous and continuous variablesrespectively. A total of seven trials were included in this review. SGLT2 inhibitors were associated with decreased all-cause mortality (RR = 0.61, 95% CI = 0.40, 0.95; P = 0.03), worsening of HF (RR = 0.59, 95%CI = 0.36, 0.97;P = 0.04), and GFR (MD: 1.05, 95% CI = 0.68, 1.43; P < 0.00001) compared with the control group. There were no significant differences between the two groups regarding readmission for HF, cardiovascular mortality, AKI, hypoglycemia, hypotension, and diuretic efficiency. SGLT2 inhibitors were associated with improved KCCQ-CSS scores (MD: -3.82, 95% CI = -7.51, -0.13; P = 0.04). SGLT2 inhibitors demonstrate overall clinical benefits and a favorable safety profile in acute heart failure, although their impact on readmission rates is limited. Further research is needed to refine patient selection and optimize treatment strategies. https://www.crd.york.ac.uk/PROSPERO/view/CRD42024571563, PROSPERO (CRD42024571563).

Continuous positive airway pressure (CPAP) is a standard treatment for children with moderate to severe respiratory distress; however, ventilators are often unavailable in developing countries. Bubble CPAP (bCPAP) is considered a simple, cost effective and less invasive alternative to CPAP, however, its efficacy has not been assessed for children with pneumonia until recently. This meta-analysis aims to compare the effectiveness of bCPAP with low-flow oxygen for treating severe pneumonia and hypoxemia in children. PubMed, EMBASE, Cochrane Library, Web of Science, and CENTRAL were searched to identify eligible randomized controlled trials reported up to March 23, 2024. Outcomes were reported as risk ratios (RRs) or mean difference (MD) and confidence intervals (CIs) using Review Manager software. P value < 0.05 was considered statistically significant. Three studies with 2030 patients were included and revealed no significant difference between bCPAP and control in overall mortality [RR (95% CI) 0.46 (0.09, 2.32); P = 0.348], death during hospital stay [0.48 (0.02, 9.09), P = 0.619], composite primary outcome [0.48 (0.12, 1.97), P = 0.301], pneumothorax [1.94 (0.16, 23.11), P = 0.601], leaving hospital against medical advice [0.63 (0.16, 2.39), P = 0.489], and length of hospital stay [MD (95%CI) 0.15days (- 0.66, 0.96), P = 0.706]. Children on bCPAP had significantly fewer events of severe hypoxemia [RR (95% CI) 0.22 (0.10, 0.49), P < 0.001], and less requirement for mechanical ventilation [RR (95% CI) 0.38 (0.15, 0.99), P = 0.048]. bCPAP is not superior to low-flow oxygen for improving survival and reducing hospital stay in children with pneumonia, albeit the need for mechanical ventilation decreases.

ObjectiveTo evaluate the longer‐term efficacy of 10 kHz spinal cord stimulation (SCS) in managing painful diabetic neuropathy (PDN) in a routine clinical setting after the transition from the 24‐month SENZA‐PDN study.MethodsWe contacted 142 participants who completed 24 months of postimplantation follow‐up in the former randomized controlled trial (SENZA‐PDN). Of these, 57 consented and responded to this longer‐term post‐study survey. Outcomes assessed included pain relief, health‐related quality of life (HRQoL) measured using the EuroQol 5‐Dimensional 5‐Level (EQ‐5D‐5L) instrument, Patient Global Impression of Change (PGIC), HbA1c, and weight.ResultsOur survey captured patient‐reported outcomes at a median of 4.1 years after implantation of a permanent 10 kHz SCS system. Among the surveyed participants, 76.8% (43 of 56) reported clinically meaningful pain relief (≥2 points), and 84.6% (44 of 52) achieved a clinically meaningful improvement in their EQ‐5D‐5L index score, with a final mean EQ‐5D‐5L index score of 0.825. Additionally, 74.5% (38 of 51) reported being “Better” or “A great deal better” on the PGIC scale. The surveyed participants reported a mean HbA1c level decrease of 0.4% (p = 0.027), with a more substantial improvement of 1.6% (p < 0.001) among those with type 2 diabetes (T2D) and a higher preimplantation HbA1c (>8%). Significant weight loss was also observed, with a mean reduction of 7.0 kg (p < 0.001) in the overall cohort and 8.7 kg (p < 0.001) in the subgroup with T2D and a higher BMI at preimplantation (≥35 kg/m2).ConclusionsHigh‐frequency SCS at 10 kHz provided sustained and clinically meaningful improvements in pain and HRQoL for PDN patients at 4.1 years postimplantation, with no explants in the cohort due to inefficacy. Alongside these benefits, participants experienced metabolic changes that included reductions in body weight and HbA1c beyond that achieved at 24 months, although changes in lifestyle and medication were not accounted for in this analysis. Notably, the cohort's final mean EQ‐5D‐5L index score was comparable to the US norm. These findings support 10 kHz SCS as a durable and effective treatment option for PDN in routine clinical practice.

BackgroundThere is conflicting evidence regarding the impact of chronic hepatitis B virus (HBV) on SARS-CoV-2 outcomes. Additionally, the impact of SARS-CoV-2 vaccination and variant periods on outcomes in HBV/SARS-CoV-2 coinfection remain unexplored.MethodsWe utilized the TriNetX database to compare adults with HBV/SARS-CoV-2 (vs SARS-CoV-2 alone) across 97 US healthcare systems from 2020 to 2023. We assessed the odds of all inpatient hospitalizations, intensive care unit admissions, mechanical ventilation, 30-day, 90-day, and overall mortality. In sensitivity analyses, we excluded HIV, hepatitis C virus, and transplant cases and stratified the HBV/SARS-CoV-2 cohort by cirrhosis status. We applied propensity score matching to address confounding and reported odds ratios (OR) with 95% confidence intervals (CI).ResultsOf 4 206 774 individuals with SARS-CoV-2, about 0.2% (8293) were HBV/SARS-CoV-2. Individuals with HBV/SARS-CoV-2 (vs SARS-CoV-2 alone) had higher odds of intensive care unit admissions (OR, 1.18; 95% CI, 1.02–1.36), 90-day (OR, 1.22; 95% CI, 1.01–1.41) and overall mortality (OR, 1.18; 95% CI, 1.06–1.33). In sensitivity analyses, those with HBV/SARS-CoV-2 and cirrhosis had a 2.0- to 2.50-fold higher odds of adverse outcomes. Notably, even individuals with HBV/SARS-CoV-2 without cirrhosis had higher odds of mortality. Vaccinated (vs unvaccinated) individuals with HBV/SARS-CoV-2 had 57%, 54%, and 29% reduction in 30-day, 90-day, and overall mortality, respectively. The pre-Delta variant period was associated with higher odds of hospitalization compared to the Omicron but not the Delta period.ConclusionsChronic HBV was associated with worse SARS-CoV-2 outcomes, whereas SARS-CoV-2 vaccination reduced the likelihood of adverse outcomes.