APCU25MPB7 Caught in transit: a case of submassive PE, right heart thrombus, and stroke after thrombolysis

CLOT IN TRANSIT: THE ROLE OF POINT-OF-CARE ULTRASOUND IN EARLY DIAGNOSIS AND IMPROVED OUTCOMES

Obesity is a complex condition that is associated with various metabolic disorders and has a significant social impact. Weight loss is primarily achieved through dietary changes, such as reducing calorie intake. Therefore, it is essential to provide patients with effective weight loss programs and recommend a low-calorie diet as soon as possible. In addition to drug therapy for metabolic disorders, it is crucial to educate patients about the importance of a healthy diet and encourage them to adopt a low-calorie approach. Numerous studies have demonstrated the effectiveness of low-calorie and very low-calorie diets for treating obesity. However, compliance with these diets can be challenging, as they require careful attention to nutritional value and the balance of macronutrients and micronutrients. Prolonged adherence to reduced dietary regimens can lead to hypovitaminosis, lack of dietary fiber, or decreased protein intake. In 2024, a new product for balanced low-calorie nutrition, OPTIFAST, was introduced on the Russian market by the Nestlé Health Science company in Germany. This product provides patients with all essential nutrients and allows them to manage their daily calorie intake. It also provides a feeling of fullness that is essential for maintaining adherence to a low-calorie diet and ensuring effective and safe weight loss, primarily through adipose tissue reduction.

Introduction/BackgroundPre-operative Very Low Calorie Diets (VLCDs) can achieve rapid and safe weight loss in patients, yet no studies have evaluated VLCDs in the severely obese endometrial cancer population prior to...

Background: Right heart thrombi and thrombi in transit across a patent foramen ovale (PFO) are uncommonly seen in patients with pulmonary embolism (PE) and are associated with high risk of adverse outcomes. We present a case of bi-atrial thrombi and thrombus in transit in a patient with acute submassive PE. Methods/Case Description/Results: A 31-year-old male with no significant past medical history presented with 8 days of dyspnea on exertion and pleuritic chest pain. Computed tomography angiography showed large volume of bilateral PE with right ventricular (RV) strain and right atrial (RA) thrombus. He was hemodynamically stable. Cardiac biomarkers were elevated. COVID testing was negative. Pulmonary embolism response team (PERT) was activated. Transthoracic echocardiogram revealed severely dilated RV with severely reduced function. A mobile mass was seen in the RA, possibly anchored to the interatrial septum. An emergent transesophageal echocardiogram showed mobile thrombus within both atria and thrombus in transit through a PFO. After multidisciplinary PERT discussion, involving the patient and his family, decision was made to proceed with a surgical approach, including pulmonary artery and bi-atrial embolectomy, and PFO closure. Post-surgical recovery was uneventful, and he was discharged on aspirin and apixaban on postoperative day 6. Follow up TTE 4 weeks after discharge showed recovered RV size and function. The patient is back to normal functional status. Conclusion: Combined biatrial thrombi and thrombi in transit are rare in patients with PE. Multidisciplinary approach to such patients, taking into account risks and benefits of each treatment approach, and patient preferences, is of paramount importance to achieve optimal patient outcome..

Are Sugar-Sweetened Beverage Taxes a Cost-Effective Means of Reducing Weight?

The objective of this case study is to discuss a rare case of proven paradoxical thromboembolism captured in-transit. A 23-year-old female with a diagnosis of right internal jugular deep vein thrombus who developed acute onset chest pain, dyspnea and hypotension, was selected for the study. Sub-massive PE and STEMI were diagnosed. Transthoracic echocardiogram revealed a left ventricular (LV) mass moving across the aortic valve. Soon after, the patient developed numbness of right extremities with non-palpable pulses. A transesophageal echocardiogram revealed absent LV mass, PFO, left atrial mass entering through the PFO and emboli in bilateral pulmonary arteries. We report a case of sub-massive PE and paradoxical proven coronary and upper extremity embolism, captured in-transit, following destabilization of an UEDVT in a patient with PFO.

Fall Risk Prevention in Obstetric and Newborn Patients

Estimation of wall properties and wall strength of aortic aneurysms using modern imaging techniques. One more step towards a patient-specific assessment of aneurysm rupture risk

Chronic postoperative pain has been identified as amajor medical and socioeconomic problem. A prevention of the chronification processes is potentially possible and preventive treatment could start early (e.g. preoperatively). So far, however, evidence for the effectiveness of preventive strategies is basically low. Important reasons for this dilemma are the lack of appropriate risk assessment as well as effective and mechanism-based preventive (procedure-sepcific) strategies for the chronification process, a lack of stratification of treatment approaches and a so far barely investigated combination of various treatment approaches. In this review article recent findings on the appropriate identification of patients at risk for developing postoperative chronic pain are presented, predictive models for the valid estimation of the individual risk of patients are assessed and studies on pharmaceutical and regional analgesia techniques influencing the pain chronification process are discussed. As achronification process is, however, extremely complex and dynamic and also necessitates adaptation of the prevention during the course of the process, only combinations of treatment, interdisciplinary and if necessary even longer term approaches might be successful. Future studies are needed to address with which preventive treatment strategies and in which patients chronic pain after surgery can effectively be prevented.

To conduct a systematic review to investigate risk factors, incidence, and preventive strategies for perioperative pressure injuries (PIs). The authors reviewed four databases for literature published from January 2001 to December 2017. Selected articles included primary quantitative studies with prospective, descriptive, and longitudinal design or randomized controlled trials that evaluated risk factors, incidence, and preventive strategies for perioperative PIs. The studies included were evaluated for methodological quality using the Edwards Method Score. The authors used a standardized extraction form to extract inclusion and exclusion criteria, participant demographics, methodology, PI risk instrument and classification systems, type of surgery and anesthesia, PI risk factors, incidence, preventive strategies, and outcomes evaluation. Of the 115 publications identified, 11 met the inclusion criteria. The risk assessment and PI classification instruments used differed in every study. Incidence of PI varied throughout the studies and was reduced by warming therapy and by a skin care intervention program. Further studies are necessary to develop a standard risk assessment instrument and preventive strategies and to clarify some contradictions evident in the literature.

Our friend and colleague Wayne Fenton asked to write this article for the Journal because of his desire to educate other psychiatrists about the treatment of schizophrenia, including what he recognized to be a growing problem with the metabolic syndrome. This lifelong passion, which he pursued from his psychiatry residency at Yale, through his directorship of Chestnut Lodge, to his position at NIMH as Director of the Division of Adult Translational Research and Associate Director for Clinical Affairs, ended tragically with his killing during an evaluation of a psychotic young man. Wayne had worked tirelessly to secure support for new drug discovery in the NIMH programs that he directed. The Journal will be initiating in 2007 a series of articles on the discovery of new mental illness treatments. We will dedicate this series to Wayne's memory and include with it a memorial of his life and contributions to the treatment of mental illness.

This review study aimed to investigate the definition, etiology, risk factors (RFs), management strategy, and prevention of insufficient weight loss (IWL) and weight regain (WR) following bariatric metabolic surgery (BMS). Electronic databases were searched to retrieve relevant articles. The inclusion criteria were English articles with adult participants assessing the definition, prevalence, etiology, RFs, management strategy, and prevention of IWL/WR. Definition: The preferred definition for post-BMS IWL/WR are the terms "Lack of maintenance of total weight loss (TWL)>20%" and "weight change in percentage compared to nadir weight or weight loss". Prevalence: The exact prevalence of IWL/WR is still being determined due to the type of BMS and various definitions. Etiology: Several mechanisms, including hormonal/metabolic, dietary non-adherence, physical inactivity, mental health, and anatomic surgical failure, are possible etiologies of post-BMS IWL/WR. Risk factors: Preoperative body mass index (BMI), male gender, psychiatric conditions, comorbidities, age, poor diet, eating disorders, poor follow-ups, insufficient physical activity, micronutrients, and genetic-epigenetic factors are the most important RFs. Management Strategy: The basis of treatment is lifestyle interventions, including dietary, physical activity, psychological, and behavioral therapy. Pharmacotherapy can be added. In the last treatment line, different techniques of endoscopic surgery and revisional surgery can be used. Prevention: Behavioral and psychotherapeutic interventions, dietary therapy, and physical activity therapy are the essential components of prevention. Many definitions exist for WR, less so for IWL. Etiologies and RFs are complex and multifactorial; therefore, the management and prevention strategy is multidisciplinary. Some knowledge gaps, especially for IWL, exist, and these gaps must be filled to strengthen the evidence used to guide patient counseling, selection, and improved outcomes.

Hereditary Breast/Ovarian Cancer Syndrome: A Primer for Obstetricians/Gynecologists

BackgroundParticulate air pollution in lung epithelial cells induces pathogenic endpoints like proliferation, apoptosis, and pro-inflammatory reactions. The activation of the epidermal growth factor receptor (EGFR) is a key event responsible for signalling events involving mitogen activated protein kinases specific for these endpoints. The molecular events leading to receptor activation however are not well understood. These events are relevant for the toxicological evaluation of inhalable particles as well as for potential preventive strategies in situations when particulate air pollution cannot be avoided. The current study therefore had the objective to elucidate membrane-coupled events leading to EGFR activation and the subsequent signalling cascade in lung epithelial cells. Furthermore, we aimed to identify the molecular target of ectoine, a biophysical active substance which we described to prevent carbon nanoparticle-induced lung inflammation.MethodsMembrane signalling events were investigated in isolated lipid rafts from lung epithelial cells with regard to lipid and protein content of the signalling platforms. Using positive and negative intervention approaches, lipid raft changes, subsequent signalling events, and lung inflammation were investigated in vitro in lung epithelial cells (RLE-6TN) and in vivo in exposed animals.ResultsCarbon nanoparticle treatment specifically led to an accumulation of ceramides in lipid rafts. Detailed analyses demonstrated a causal link of ceramides and subsequent EGFR activation coupled with a loss of the receptor in the lipid raft fractions. In vitro and in vivo investigations demonstrate the relevance of these events for carbon nanoparticle-induced lung inflammation. Moreover, the compatible solute ectoine was able to prevent ceramide-mediated EGFR phosphorylation and subsequent signalling as well as lung inflammation in vivo.ConclusionThe data identify a so far unknown event in pro-inflammatory signalling and contribute to the understanding of particle cell interaction and therefore to risk identification and risk assessment of inhalable xenobiotics. Moreover, as this cellular reaction can be prevented by the well tolerated substance ectoine, a molecular preventive strategy for susceptible persons against airway inflammation is proposed.

Funding Acknowledgements Type of funding sources: None. Background. Contrast-induced acute kidney injury remains one of the dangerous complications of percutaneous coronary interventions, in spite of the evolution of contrast media and prevention strategies. Many researchers assume that this syndrome is not as frequent as it used to be and its clinical importance is overestimated. Purpose. The aim of the study was to assess the rates of contrast-induced acute kidney injury in a prospective study in patients with chronic coronary syndromes after percutaneous coronary interventions in 2012 and 2017 respectively. Methods. 1023 patients with chronic coronary syndromes and indications for the interventions with intra-arterial contrast media administration were included in the prospective open cohort study. 561 patients were enrolled in 2012 and 462 in 2017 respectively. The contrast media remained the same both in 2012 and 2017. Preventive measures included the administration of 0,9% saline 1 ml/kg/h intravenously and 0,5 kg/ml/h for the patients with heart failure before and after procedure. The primary endpoint was the development of contrast-induced acute kidney injury. Results. The incidence of contrast-induced acute kidney injury decreased more than 3 times in 2017 than in 2012 (6% vs. 18,5%, 28 patients vs 104 patients respectively). The difference was statistically significant (p < 0,0001). The patients included in the study in 2017 were older, had higher body mass index and had more risk factors, than the ones enrolled in 2012. We organised several conferences for all the cardiologist involved in the treatment of patients undergoing percutaneous coronary intervention, as well as were printing materials describing the risk assessment and preventive measures that should be done in patients with chronic coronary syndromes before percutaneous coronary interventions (eg, stopping metformin and nephrotoxic drugs). Conclusion. The prevalence of contrast-induced acute kidney injury is decreasing not only due to the evolution of contrast media and preventive strategies, but also due to the higher level of education of all the doctors about the syndrome and its prognosis, as well as available preventive measures and treatment options.