ADMIRE Trial Confirms Safety and Effectiveness of Pulsed Field Ablation for Paroxysmal AF

USA: The ADMIRE pivotal trial has provided significant insights into using pulsed-field ablation (PFA) for treating paroxysmal atrial fibrillation, demonstrating safety and effectiveness. This innovative approach utilizes a variable-loop PFA catheter, which facilitates shorter procedure times and reduces exposure to fluoroscopy.

“The ADMIRE trial confirmed that the variable-loop PFA catheter is both safe and effective, demonstrating short procedure and PFA application times, along with low levels of fluoroscopy exposure,” the researchers wrote in Circulation.

Atrial fibrillation (AF) is a common cardiac arrhythmia that can lead to severe complications, including stroke and heart failure. Paroxysmal atrial fibrillation, characterized by intermittent episodes, is particularly challenging to manage. Traditional ablation methods have their drawbacks, including longer recovery times and higher radiation exposure for patients and medical staff.

Clinical trials of early PFA systems for treating atrial fibrillation have shown promising potential to minimize complications associated with traditional thermal methods while preserving efficacy. However, the absence of a fully integrated mapping system—commonly used in contemporary electrophysiology procedures—limits lesion creation and workflow efficiency. To address this, a novel variable-loop PFA catheter has been developed, which integrates with an electroanatomic mapping system. This advancement enables real-time nonfluoroscopic procedural guidance, lesion indexing, and feedback on the proximity between tissue and catheter.

In light of this context, Vivek Y. Reddy and colleagues from the Helmsley Electrophysiology Center at Mount Sinai Fuster Heart Hospital in New York, NY, conducted the ADMIRE trial. This multicenter, single-arm study, which received an investigational device exemption from the Food and Drug Administration, evaluated the long-term safety and effectiveness of the integrated pulsed field ablation (PFA) system in a large population of drug-refractory patients with symptomatic paroxysmal atrial fibrillation in the United States.

Using the PFA catheter in conjunction with a compatible electroanatomic mapping system, patients with drug-refractory symptomatic paroxysmal atrial fibrillation underwent pulmonary vein isolation.

The primary safety endpoint was the occurrence of major adverse events within seven days post-ablation. The primary effectiveness endpoint was a composite measure that included 12 months of freedom from documented episodes of atrial tachyarrhythmia (such as atrial fibrillation, atrial tachycardia, and atrial flutter), failure to achieve pulmonary vein isolation, use of a non-study catheter for isolation, repeat procedures (excluding one redo during the blanking period), initiation of a new or previously ineffective class I or III antiarrhythmic drug at a higher dose after the blanking period, or the need for direct current cardioversion after the blanking phase.

Based on the study, the researchers reported the following findings:

  • At 30 centers, 277 patients with paroxysmal atrial fibrillation (61.5±10.3 years of age; 64.3% male) in the pivotal cohort underwent PFA.
  • More than 25% of the procedures were performed without fluoroscopy. Median pulmonary vein isolation procedure, fluoroscopy, and transpired PFA application times were 81.0, 7.1, and 31.0 minutes, respectively.
  • The primary adverse event rate was 2.9%, with the most common complication being pericardial tamponade.
  • The 12-month primary effectiveness endpoint was 74.6%.
  • The 1-year freedom from atrial fibrillation, atrial tachycardia, or atrial flutter recurrence rate after blanking was 75.4%.
  • There were substantial improvements in quality of life as early as three months after the procedure, concurrent with a reduction in multiple healthcare use measures.

In conclusion, the ADMIRE pivotal trial confirms that pulsed field ablation with the variable-loop catheter is a promising treatment option for patients with paroxysmal atrial fibrillation.

“With shorter procedure times and reduced fluoroscopy exposure, this innovative technique could significantly improve patient outcomes and quality of life for those affected by this common cardiac condition,” the researchers wrote.

Reference:

Reddy VY, Calkins H, Mansour M, et al. Pulsed-field ablation to treat paroxysmal atrial fibrillation: safety and effectiveness in the ADMIRE pivotal trial. Circulation. 2024; Epub ahead of print.

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Semaglutide effective as add on therapy for patients with hypertension and obesity, finds research

A new study published in the European Heart Journal showed that semaglutide is a helpful additional medication for the individuals who are obese and have high blood pressure.

Even with the availability of efficient medicines, meeting blood pressure objectives is difficult and poses a serious threat to world health. There are several ways in which obesity and hypertension interact. The processes most likely include changes in how the body handles salt, an inflammatory environment, and activation of the sympathetic nervous system. Treatments for hypertension now available focus on pathways that interact with the ones impacted by being overweight. But addressing the obesity illness could be a useful tactic to manage blood pressure, especially for the ones with resistant hypertension (RH). Thereby, determining the impact of semaglutide therapy on systolic BP (SBP) among individuals with hypertension, SBP in individuals with RH, SBP while baseline body mass index (BMI) is taken into account, and modifications to anti-hypertensive drugs were among the objectives of this study.

Individual patient data (IPD) from 3 RCTs that looked at how semaglutide 2.4 mg affected body weight over a 68-week period was included. The trial participants were divided into 3 groups based on the hypertension diagnosis, where the one group had apparent resistant hypertension (RH), other group with baseline SBP > 130 mmHg (HTN130) or > 140 mmHg (HTN140) and the last group was treatment or baseline measurement (HTN). The main comparison was between the semaglutide and placebo groups’ in-trial changes in SBP. Treatment intensity score was used to quantify and compare changes in antihypertensive medication across groups. Analysis of covariance was used in these analyses.

The study found that there was a difference in SBP change of −4.95 mmHg between the treatment (n = 2109) and placebo (n = 1027) groups. The HTN, HTN130, HTN140, and RH had the largest differences, with −4.78 mmHg (95% CI −5.97 to −3.59), −4.93 mmHg, and −4.09 mmHg for HTN140, respectively. Weight loss was a major mediating factor in the reduction in SBP. The anti-hypertensive therapy intensity score dropped for semaglutide users when compared to placebo. Overall, the outcome of this analysis showed a drop in SBP that was equivalent in persons with normotension and hypertension. The weight loss impact of semaglutide acted as a mediator for the decrease in SBP.

Reference:

Kennedy, C., Hayes, P., Cicero, A. F. G., Dobner, S., Le Roux, C. W., McEvoy, J. W., Zgaga, L., & Hennessy, M. (2024). Semaglutide and blood pressure: an individual patient data meta-analysis. In European Heart Journal. Oxford University Press (OUP). https://doi.org/10.1093/eurheartj/ehae564

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Study Links Higher Serum Iron Levels to Lower Insulin Resistance

China: A recent nationwide study has revealed a compelling link between iron status and insulin resistance (IR) among adults in the United States. The research, which examined a large and diverse sample of the adult population, highlights a strong correlation suggesting that variations in iron levels may significantly influence insulin resistance—a key factor in the development of type 2 diabetes.

The study, published in The Journal of Clinical Endocrinology & Metabolism, revealed that higher serum iron (SI) levels might actually protect against insulin resistance.

Among a cohort of 2,900 adults, researchers discovered that elevated serum iron levels were associated with reduced insulin resistance. In contrast, higher iron intake and increased serum transferrin receptor (sTfR) levels were correlated with greater IR. Transferrin saturation was identified as the most reliable predictor of IR, surpassing other iron-related indicators in its predictive accuracy.

Evidence connecting markers of iron status to insulin resistance remains sparse. To fill this knowledge gap, Haiqing Zhang, Shandong University, Jinan, Shandong, China, and colleagues aimed to investigate the relationship between iron status and IR among U.S. adults.

For this purpose, the researchers analyzed data from 2,993 participants of the National Health and Nutrition Examination Survey (NHANES) spanning the periods 2003-2006 and 2017-2020. A HOMA-IR value of ≥2.5 defines insulin resistance.

The team employed weighted linear and multivariable logistic regression analyses to explore the linear relationships between iron status and IR. They utilized restricted cubic splines (RCS) to uncover potential non-linear dose-response associations. Additionally, stratified analyses were conducted based on age, sex, body mass index (BMI), and physical activity (PA). Finally, receiver operating characteristic (ROC) curve analysis assessed the predictive value of iron status for IR.

The following were the key findings of the study:

  • In weighted linear analyses, serum iron exhibited a negative correlation with HOMA-IR (β = -0.03).
  • In weighted multivariate logistic analyses, iron intake and serum transferrin receptor (sTfR) were positively correlated with IR (OR =1.02; OR =1.07).
  • Also, SI and transferrin saturation (TSAT) were negatively correlated with IR (OR =0.96; OR =0.98) after adjusting for confounding factors.
  • RCS depicted a nonlinear dose-response relationship between sTfR and TSAT and IR. This correlation remained consistent across various population subgroups.
  • ROC curve showed that TSAT performed better than iron intake, SI, sTfR, and TSAT in ROC analyses for IR prediction.

“All biomarkers showed a significantly reduced risk of insulin resistance as iron levels increased. These findings enhance our understanding of the relationship between iron status and IR, offering a robust foundation for further investigation into the mechanisms driving this connection,” the researchers concluded.

Reference:

Liu, X., Zhang, Y., Chai, Y., Li, Y., Yuan, J., Zhang, L., & Zhang, H. Iron status correlates strongly to Insulin Resistance among U.S. Adults: A nationwide population-base study. The Journal of Clinical Endocrinology & Metabolism. https://doi.org/10.1210/clinem/dgae558

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Study highlights Dental Safety Concerns: Anaphylaxis Linked to PEG-Infused Endodontic Materials in dental Patients

Norway: Recent case reports in the Journal of Endodontics have highlighted the rare but serious risk of anaphylaxis following treatment with endodontic materials containing polyethylene glycol (PEG). Two patients experienced severe allergic reactions after dental procedures involving these materials, raising important concerns within the dental community.

“While rare, clinicians should be aware that PEG in endodontic filling materials can trigger anaphylaxis. It is important to conduct a PEG allergy assessment when anaphylaxis is suspected,” the researchers wrote.

Anaphylaxis is a life-threatening allergic reaction that can occur rapidly, making early recognition and treatment critical. While anaphylactic reactions to PEG are uncommon, they are likely underreported and can lead to severe consequences for patients, especially those who remain undiagnosed. These cases emphasize the need for heightened awareness among dental professionals regarding the potential for PEG to trigger such reactions.

Marie Alnæs, Department of Clinical Medicine, University of Bergen, Bergen, Norway, and colleagues report two cases of anaphylaxis following the use of an endodontic temporary filling material that contains polyethylene glycol.

The first case involved a healthy man in his 30s who developed generalized itching, nausea, and cold sweats after undergoing endodontic treatment. He subsequently lost consciousness, with a blood pressure reading of 70/40 mm Hg when assessed in the ambulance. Fortunately, he recovered after receiving emergency medical care. The second case involved a patient around 50 years old, who also experienced skin itching following treatment. Tragically, this patient lost consciousness and suffered cardiac arrest upon arrival at the hospital, leading to his death.

The authors emphasize that these case reports highlight the need for increased awareness regarding the potential for endodontic materials containing polyethylene glycol (PEG) to cause anaphylaxis. They recommend that PEG allergy assessments be included in evaluations of patients experiencing anaphylaxis related to endodontic treatment. Confirmed PEG allergies can have significant implications for patients, particularly those who remain undiagnosed, as they face the risk of further anaphylactic reactions upon re-exposure.

Given the associated risks, the authors advise against using endodontic filling materials containing PEG, suggesting that alternative materials without PEG should be preferred. In cases where the benefits of using PEG-containing materials outweigh the risks, they recommend a 30-minute observation period post-treatment. Furthermore, they advocate for clear labeling in the instructions, explicitly stating that PEG in endodontic materials can trigger anaphylactic reactions.

“Thorough investigations were required to identify the source of the allergic reactions. Reports of allergies to polyethylene glycol are on the rise and can have serious consequences for patients,” the researchers concluded.

Reference:

Alnæs, M., Storaas, T., Vindenes, H. K., Guttormsen, A. B., Brudevoll, S., & Björkman, L. (2024). Anaphylaxis after treatment with an endodontic material containing polyethylene glycol. Journal of Endodontics. https://doi.org/10.1016/j.joen.2024.09.002

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Droxidopa Effective as Adjunct Therapy for Vasopressor Weaning in ICU Patients, finds study

USA: A recent multicenter, retrospective, single-arm observational study has unveiled promising results for the use of droxidopa in critically ill patients experiencing persistent hypotension.

The study, published in the Journal of Intensive Care Medicine, suggested that droxidopa may be a valuable adjunct therapy for facilitating vasopressor weaning, with comparable effects observed in patients receiving the medication through feeding tubes.

Persistent hypotension is a significant challenge in the management of critically ill patients, often leading to prolonged reliance on vasopressor agents. These medications can have adverse effects and complications, underscoring the need for alternative strategies to facilitate safe withdrawal.

According to the study authors, persistent reliance on vasopressors is a frequent factor contributing to delays in patient discharge from the intensive care unit (ICU). They note that adjunct oral agents can accelerate the timeline for discontinuing vasopressor treatment. Considering this, Andrew J Webb, Department of Pharmacy, Massachusetts General Hospital, Boston, USA, and colleagues sought to examine the application of droxidopa for facilitating vasopressor weaning in critically ill patients experiencing prolonged hypotension.

For this purpose, this retrospective, single-arm observational study focused on adult patients admitted to ICUs at two academic centers between June 2016 and July 2023 who received droxidopa for vasopressor weaning. Patients who had received droxidopa before admission or for other indications were excluded from the analysis.

The primary outcome measured was the time to vasopressor discontinuation, defined as the duration for which vasopressors were stopped and remained off for at least 24 hours. Secondary outcomes included the rates of tachycardia and hypotension following the initiation of droxidopa, norepinephrine equivalents before and after treatment, concomitant use of oral agents, and dosing details. Additionally, a subgroup analysis was performed on patients receiving droxidopa via feeding tubes.

The following were the key findings of the study:

  • A total of 30 patients met the inclusion criteria for the study. The median age was 62 years, with 12 patients being female, and 73% of participants were admitted to a cardiac or cardiac surgical ICU.
  • Before the initiation of droxidopa, patients had been on vasopressors for a median of 16 days.
  • The median time to vasopressor discontinuation was 70 hours, and norepinephrine equivalents showed a significant decrease immediately after droxidopa initiation (0.08 versus 0.02 mcg/kg/min).
  • Mean arterial pressure (MAP) increased following the start of droxidopa (68.8 versus 66.5 mm Hg), while heart rates remained stable (86 versus 84 BPM).
  • Patients who successfully weaned off vasopressors within 72 hours of initiating droxidopa had lower norepinephrine equivalents before treatment than those who took longer than 72 hours (0.05 versus 0.12 mcg/kg/min).
  • The method of administration via feeding tubes did not significantly affect the time to vasopressor discontinuation.

“The findings indicate that droxidopa could serve as an effective adjunct therapy for vasopressor weaning in critically ill patients. Further prospective studies are needed to assess this intervention comprehensively,” the researchers concluded.

Reference:

Webb, A. J., Casal, G. L., Newman, K. A., Culshaw, J. R., Northam, K. A., Solomon, E. J., Beargie, S. M., Johnson, R. B., Lopez, N. D., Hayes, B. D., & Roberts, R. J. (2024). Droxidopa for Vasopressor Weaning in Critically Ill Patients with Persistent Hypotension: A Multicenter, Retrospective, Single-Arm Observational Study. Journal of Intensive Care Medicine. https://doi.org/10.1177/08850666241270089

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Early postoperative exposure of skin to water safe, may not increase risk of infection or other complications: Study

Researchers in a study found that moisture on surgical wounds in the chosen 24-h postoperative period was not associated with an increase in the incidence of infection or other wound complications. It thereby rejects the conventional doctrine, which is the dry and undisturbed principle of the dressings in the time frame 24-72 hours post-surgery, unless there is a heightened possibility of moisture associated with most daily activities. Christen S. and colleagues reported it in the Journal of the American Academy of Dermatology.

Many standard patient instructions after surgical wound care include keeping the initial dressings clean and dry and free of contamination, and maintained for 24 to 72 hours to avoid the development of infection and to promote healing of the wound, which is in sharp contrast to the energetic levels required to meet daily activities like bathing, leisure, and optimum levels of functioning. The randomized controlled trial comparatively assessed standard keeping of wounds dry and covered for the period of 48 hours to early post-operative (6 hours) water exposure.

This was a randomized controlled, investigator-blinded, comparative study to assess infection rates and other outcomes. In total, 437 patients were randomized to early water exposure (6 hours post-operatively, n = 218) and standard care (48 hours post-operatively, n = 219). Primary outcome: Culture-proven infection. Other outcomes that were measured: bleeding rate, bruising rate, and scar assessment according to the Patient and Observer Scar Assessment Scale.

The key findings of the study were:

• The incidence of culture-proven infection was comparable between the early water exposure group, (1.8%), and the standard care group, (1.4%); this difference was not significant with (p > 0.99).

• There were no differences between groups in rates of bleeding or bruising.

• The scar results, recorded with the POSAS, did not reveal any significant differences between both groups, thus showing similar cosmetic results.

The study has revealed that allowing surgical wounds to get wet as early as six hours after surgery does not increase the rate of complications or infections. Hence, this increases flexibility in the post-operative care routine for patients, hence helping them to return back to normal activities earlier than thought.

This study was conducted in a single academic center. Generalizability of the results is therefore limited, and further studies are required in different clinical settings for the confirmation of these findings.

Surgical wounds can be safely exposed to water immediately after the operation without increasing the risk of infections or compromising the final cosmetic outcome. Evidence suggesting that post-operative care recommendations should be revised to allow greater patient convenience and comfort.

Reference:

Samaan, C., Kim, Y., Zhou, S., Kirby, J. S., & Cartee, T. V. (2024). Early post-operative water exposure does not increase complications in cutaneous surgeries: A randomized, investigator-blinded, controlled trial. Journal of the American Academy of Dermatology. https://doi.org/10.1016/j.jaad.2024.05.098

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Study Links Hormone Dosage in Intrauterine Systems to Increased Depression Risk in First-Time Users

Denmark: A recent study has highlighted a concerning association between the dosage of hormones in levonorgestrel-releasing intrauterine systems (LNG-IUS) and the risk of developing depression among first-time users. The research, published in the American Journal of Psychiatry, reveals that the likelihood of experiencing depression increases with higher dosages of the hormone, suggesting a dose-dependent relationship.

The findings revealed that the first-time use of an LNG-IUS was associated with an increased risk of developing depression in a dose-dependent manner across low, medium, and high-dose options. 

“While the observational nature of the study does not allow for causal conclusions, the identified dose-response relationship adds to the growing body of evidence indicating a link between levonorgestrel exposure and depression risk,” the researchers wrote.

Levonorgestrel, a synthetic progestin commonly used in various contraceptive methods, has been the subject of scrutiny regarding its mental health implications. Søren Vinther Larsen, Psychiatric Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark, and colleagues compared the risk of developing incident depression among first-time users of low-, medium-, and high-dose levonorgestrel-releasing intrauterine systems.

The national cohort study utilized Danish register data on first-time users of LNG-IUSs aged 15 to 44 between 2000 and 2022. To calculate the 1-year average absolute risks, risk differences, and risk ratios for incident depression—defined as either starting an antidepressant or receiving a depression diagnosis—Cox regression and a G-formula estimator were employed.

The analysis was standardized for factors such as calendar year, age, education level, parental history of mental disorders, endometriosis, menorrhagia, polycystic ovary syndrome, dysmenorrhea, leiomyoma, and postpartum initiation.

The study led to the following findings:

  • A total of 149,200 women started using an LNG-IUS, among whom 22,029 started a low-dose one (mean age, 22.9 years), 47,712 a medium-dose one (mean age, 25.2 years), and 79,459 a high-dose one (mean age, 30.2 years).
  • The associated subsequent 1-year adjusted absolute risks of incident depression were 1.21%, 1.46%, and 1.84%, respectively.
  • For the users of high-dose LNG-IUSs, the risk ratios were 1.52 and 1.26 compared with users of the low- and medium-dose LNG-IUSs, respectively.
  • For users of medium-dose LNG-IUSs, the risk ratio was 1.21 compared with users of low-dose LNG-IUSs.

The researchers suggest that clinicians should advise patients that there is a modest yet elevated risk of depression linked to first-time LNG-IUS use. While this association is not causal, it can provide valuable information to help patients make informed choices regarding their contraceptive options.

“These findings should be considered within the context of the limitations inherent to an observational study design, including the potential for residual confounding. When offering personalized contraceptive counseling, it’s important to balance the observed risk differences against potential benefits and other side effects associated with LNG-IUS use,” the researchers concluded.

Reference:

Larsen SV, Mikkelsen AP, Ozenne B, Munk-Olsen T, Lidegaard Ø, Frokjaer VG. Association Between Intrauterine System Hormone Dosage and Depression Risk. Am J Psychiatry. 2024 Sep 1;181(9):834-841. doi: 10.1176/appi.ajp.20230909. Epub 2024 Jul 10. PMID: 38982827.

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Extended Lymphadenectomy fails to Improve Survival in Muscle-Invasive Bladder Cancer Patients: NEJM

A recent study published in the New England Journal of Medicine and found no significant survival benefit of extended lymphadenectomy over standard lymphadenectomy in patients with localized muscle-invasive bladder cancer undergoing radical cystectomy. The randomized trial enrolled a total of 658 patients to compare the outcomes of extended lymphadenectomy, involving the removal of additional lymph nodes with standard lymphadenectomy and to focus on survival and safety outcomes.

The trial included patients with clinical stage T2 to T4a bladder cancer (cancer confined to muscle or invading adjacent organs) and up to 2 positive lymph nodes. They were randomly assigned to either undergo standard lymph node dissection (involving pelvic nodes) or extended lymphadenectomy (removal of common iliac, presciatic, and presacral nodes). The primary focus was disease-free survival, with overall survival and safety being secondary outcomes.

The results of this study showed no significant improvement in disease-free or overall survival for patients who underwent extended lymphadenectomy at a median follow-up of 6.1 years. Also, recurrence or death occurred in 45% of patients in the extended group and 42% in the standard group. The estimated 5-year disease-free survival was 56% in the extended-lymphadenectomy group and 60% in the standard group, yielding a hazard ratio for recurrence or death of 1.10 (95% CI, 0.86–1.40; P=0.45). The overall survival at 5 years was 59% for the extended group and 63% for the standard group, with a hazard ratio for death of 1.13 (95% CI, 0.88–1.45).

In terms of safety, adverse events were more common in the extended-lymphadenectomy group, where 54% of patients experienced grade 3 to 5 complications when compared to 44% in the standard-lymphadenectomy group. Post-operative mortality within 90 days was also higher in the extended group where 7% of patients succumbed to complications than the 2% in the standard group.

The findings suggest that extended lymphadenectomy does not offer a significant survival advantage over the standard approach and comes with increased risks of perioperative complications. Further research may be needed to refine surgical guidelines and identify subgroups of patients who may benefit from extended procedures.

Reference:

Lerner, S. P., Tangen, C., Svatek, R. S., Daneshmand, S., Pohar, K. S., Skinner, E., Schuckman, A., Sagalowsky, A. I., Smith, N. D., Kamat, A. M., Kassouf, W., Plets, M., Bangs, R., Koppie, T. M., Alva, A., La Rosa, F. G., Pal, S. K., Kibel, A. S., Canter, D. J., & Thompson, I. M., Jr. (2024). Standard or Extended Lymphadenectomy for Muscle-Invasive Bladder Cancer. In New England Journal of Medicine (Vol. 391, Issue 13, pp. 1206–1216). Massachusetts Medical Society. https://doi.org/10.1056/nejmoa2401497

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CHEST releases Guideline on handling endobronchial ultrasound transbronchial needle samples

The American College of Chest Physicians (CHEST) recently released a new clinical guideline on endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) specimen processing and handling. Published in the journal CHEST, the guideline contains nine evidence-based recommendations to identify best practices for collection, processing, and handling of EBUS-TBNA specimens.

“Endobronchial ultrasound-guided transbronchial needle aspiration has become the standard for initial lung cancer diagnosis and staging, but there is little guidance available on handling and processing specimens during and after acquisition to help optimize both diagnostic yield and specimen preservation for downstream ancillary testing,” says Christopher Gilbert, DO, MS, FCCP, lead author on the guideline. “In [the panel’s] experience, sample collection varies widely between institutions. This guideline seeks to leverage learned experiences of both pulmonologists and pathologists to standardize the process.”

Evidence of the handling and processing of EBUS-TBNA specimens varies in strength but is satisfactory in some areas to guide clinicians in certain aspects of specimen handling. The guideline authors conclude that additional research in many aspects of specimen handling and processing is needed to help improve the knowledge base.

The recommendations of the guideline include:

  • In patients with suspected malignant disease undergoing EBUS-TBNA, we recommend performing four or more needle passes over three or less needle passes. (Strong Recommendation)
  • In patients with suspected malignant disease undergoing EBUS-TBNA, we suggest utilizing rapid on-site evaluation over usual care. (Conditional Recommendation)
  • In patients with suspected malignant disease undergoing EBUS-TBNA, we suggest using a smaller needle (21 gauge or 22 gauge) over a larger needle (19 gauge). (Conditional Recommendation)

The entire list of recommendations included in the new guideline can be accessed through the CHEST journal website.

Reference:

Gilbert, Christopher R. et al.,Acquisition and Handling of Endobronchial Ultrasound Transbronchial Needle Samples – An American College of Chest Physicians Clinical Practice Guideline, CHEST Journal, DOI:10.1016/j.chest.2024.08.056.

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Faster Weight Loss on Anti-Obesity Medication Correlated With Lower Risk of Gout, finds research

Faster Weight Loss on Anti-Obesity Medication Correlated With Lower Risk of Gout suggests a new study published in the Arthritis Rheumatology.

Weight loss is conditionally recommended for gout management; however, its impact on incident gout and recurrent gout flares among overweight and obese individuals remains unknown. We aimed to investigate the relationship between weight loss rate following the initiation of anti-obesity medications and the risk of incident gout and recurrent gout flares among overweight/obese individuals. Using data from The Health Improvement Network, we selected individuals aged 18 and older who were overweight or obese and started anti-obesity medication. We emulated a target trial to examine the association of different weight loss rates, slow (2-5%), moderate (5-10%), or fast (≥10%), within the first year of treatment with incident gout and recurrent gout flares during a 5-year follow-up period. Results: Among 131,000 participants without gout starting orlistat, the 5-year risk of incident gout was 1.6% for those with weight gain/stable, compared with 1.5%, 1.3%, and 1.2% for those with slow, moderate, and fast weight loss, respectively. Compared with the weight gain/stable arm, the hazard ratios were 0.91 (95% confidence interval [CI]: 0.81 to 1.01), 0.82 (95%CI: 0.72 to 0.92), and 0.73 (95%CI: 0.62 to 0.86) for slow, moderate and fast rate of weight loss arms, respectively. Similar results were observed for the recurrent gout flares among 3,847 overweight or obese individuals with gout starting orlistat. A higher rate of weight loss after initiating orlistat within 1-year was associated with lower risks of incident gout and lower rates of recurrent gout flares among overweight or obese people.

Reference:

Wei J, Wang Y, Dalbeth N, et al. Weight loss after initiating anti-obesity medications and gout among overweight and obesity individuals: a population-based cohort study. Arthritis Rheumatol. Published online September 19, 2024. doi.org/10.1002/art.42996

Keywords:

Faster, Weight Loss, Anti-Obesity, Medication, Correlated, Lower Risk, Gout, Wei J, Wang Y, Dalbeth N

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