Post-PCI De-escalation of Ticagrelor to Clopidogrel Reduces Bleeding Risk Without Increasing Ischemic Events in CKD Patients: JAMA

A new study published in the Journal of American Medical Association showed that switching from ticagrelor to clopidogrel one month after percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) significantly reduced bleeding risk without increasing ischemic events in patients with chronic kidney disease (CKD).

A major risk factor for ischemic and hemorrhagic sequelae after PCI for acute myocardial infarction is chronic kidney disease. Improving clinical results requires optimizing dual antiplatelet treatment (DAPT). Thus, to determine if an 11-month, unguided deescalation approach from ticagrelor to clopidogrel was linked to decreased bleeding without an increase in ischemic events in stable patients with CKD following AMI, Sang Hyun Kim and colleagues carried out this trial.

A total of 32 major cardiac hospitals in South Korea participated in this clinical study Ticagrelor vs. Clopidogrel in Stabilized Patients With Acute Myocardial Infarction (TALOS-AMI), which was the subject of this post hoc secondary analysis. The trial comprised patients with biomarker-positive AMI who were able to tolerate ticagrelor-based DAPT for one month following PCI.

The patients were enrolled between February 2014 and December 2018, and they were followed up with at 30, 3, 6, and 12 months following PCI. The subgroup of CKD patients was the focus of the current investigation. Analysis of the data took place between July 2023 and October 2024. The main outcome was a composite of bleeding (Bleeding Academic Research Consortium [BARC] categories 2, 3, or 5) and myocardial infarction, stroke, and cardiovascular disease mortality.

Of the trial’s 2646 participants, 305 had chronic kidney disease, whereas 2341 did not have CKD. While there was no change in the risk of bleeding, individuals with CKD were more likely to experience ischemic episodes. Deescalation (n = 160) compared to active control (n = 145) was linked to lower chances of the main end point and BARC 2, 3, or 5 bleeding in CKD patients.

After deescalation, there was no discernible rise in the risk of ischemia episodes. Overall, unguided deescalation from ticagrelor- to clopidogrel-based DAPT in patients with AMI and CKD one month after PCI was linked to a lower risk of bleeding complications without an increased risk of ischemic events. 

Reference:

Kim, S. H., Lee, K. Y., Byeon, J., Sa, Y. K., Hwang, B.-H., Kim, C. J., Choo, E.-H., Lim, S., Choi, I. J., Choi, Y. S., Park, C. S., Park, M.-W., Her, S.-H., Lee, M., Chang, K., & TALOS-AMI Investigators. (2025). Deescalation from ticagrelor to clopidogrel for myocardial infarction with chronic kidney disease: A secondary analysis of a randomized clinical trial. JAMA Network Open, 8(5), e2511297. https://doi.org/10.1001/jamanetworkopen.2025.11297

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Adopting healthy diet may have cardiometabolic benefits regardless of weight loss, suggests study

Nearly one-third of people who adopted and adhered to a healthy diet did not lose any weight, but still reaped many health benefits, according to a new study led by researchers at Harvard T.H. Chan School of Public Health and Ben Gurion University, Israel. Independent of weight reduction, study participants showed significant improvements in cardiometabolic markers, including higher HDL cholesterol (the healthy type of cholesterol), lower levels of leptin (the hormone that signals hunger), and less visceral fat (belly fat found deep inside the abdominal cavity, sometimes wrapping around organs).

“We have been conditioned to equate weight loss with health, and weight loss-resistant individuals are often labeled as failures,” said lead author Anat Yaskolka Meir, postdoctoral research fellow in the Department of Epidemiology at Harvard Chan School. “Our findings reframe how we define clinical success. People who do not lose weight can improve their metabolism and reduce their long-term risk for disease. That’s a message of hope, not failure.”

The study will be published June 5 in the European Journal of Preventive Cardiology.

The researchers analyzed changes in weight and health among 761 individuals with abdominal obesity in Israel who participated in three landmark workplace-based nutrition clinical trials (DIRECT, CENTRAL, and DIRECT-PLUS) with high adherence rates and comprehensive metabolic profiling. At each trial, participants were randomly assigned to adopt and adhere to healthy diets-including low-fat, low-carbohydrate, Mediterranean, and green-Mediterranean diets-for between 18 and 24 months.

The study found that, across all of the clinical trials and all of the diets, 36% of participants achieved clinically significant weight loss (defined as losing more than 5% of their initial body weight); 36% achieved moderate weight loss (losing up to 5% of their initial body weight); and 28% were resistant to weight loss, losing no weight or gaining some. Weight loss was associated with a variety of health improvements: The researchers calculated that each kilogram lost was associated with a 1.44% increase in HDL cholesterol, a 1.37% decrease in triglycerides, a 2.46% drop in insulin, a 2.79% drop in leptin, and a 0.49-unit reduction in liver fat, along with reductions in blood pressure and liver enzymes.

The study also found, however, that participants who were resistant to weight change-who tended to be older and/or women-showed many of the same improvements. They had more good cholesterol; lower levels of leptin, leading to less hunger; and less harmful visceral fat.

“These are deep metabolic shifts with real cardiometabolic consequences,” said Yaskolka Meir. “Our study showed that a healthy diet works, even when weight doesn’t shift.”

The researchers also utilized cutting-edge omics tools and discovered 12 specific DNA methylation sites that strongly predict long-term weight loss.

“This novel finding shows that some people may be biologically wired to respond differently to the same diet,” said corresponding author Iris Shai, principal investigator of the nutrition trials and adjunct professor of nutrition at Harvard Chan School. “This isn’t just about willpower or discipline—it’s about biology. And now we’re getting close to understanding it.”

The study had some limitations, namely that the majority of participants were men. The researchers noted that future similar studies should focus on women.

Reference:

Anat Yaskolka Meir, Gal Tsaban, Ehud Rinott, Hila Zelicha, Dan Schwarzfuchs, Yftach Gepner, Assaf Rudich, Ilan Shelef, Matthias Blüher, Michael Stumvoll, Uta Ceglarek, Berend Isermann, Nora Klöting, Maria Keller, Peter Kovacs, Lu Qi, Dong D Wang, Liming Liang, Frank B Hu, Meir J Stampfer, Iris Shai, Individual response to lifestyle interventions: a pooled analysis of three long-term weight loss trials, European Journal of Preventive Cardiology, 2025;, zwaf308, https://doi.org/10.1093/eurjpc/zwaf308

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Red Blood Cells Linked to Vascular Damage in Type 2 Diabetes: Study

Sweden: A study published in the Journal of Clinical Investigation has revealed that red blood cells (RBCs) in individuals with type 2 diabetes release extracellular vesicles (EVs) loaded with the enzyme arginase-1. These vesicles contribute to oxidative stress and damage to the vascular lining, opening potential pathways for therapeutic intervention to prevent complications commonly associated with diabetes.

Led by Aida Collado Sanchez and her team at the Karolinska Institutet in Stockholm, the research explores how RBCs in type 2 diabetes mellitus (T2DM) contribute to endothelial dysfunction—an early marker for various vascular complications, including heart attacks, strokes, and kidney disease. Despite producing fewer EVs than those from healthy individuals, diabetic RBCs showed increased vesicle uptake by endothelial cells. This uptake impaired the ability of blood vessels to relax, a key feature of healthy vascular function.

The researchers demonstrated that this dysfunction could be significantly reduced by blocking arginase activity or mitigating oxidative stress. Their findings suggest that RBC-derived EVs transfer arginase-1 into the endothelial cells, triggering oxidative mechanisms that disrupt the nitric oxide pathway, which is essential for vascular dilation.

The study challenges the long-held belief that endothelial dysfunction in diabetes is primarily due to intrinsic defects within the endothelial cells. Instead, it positions RBC-derived vesicles as external instigators of vascular injury. A better understanding of the mechanisms involved in EV uptake, particularly changes to proteoglycans like syndecan-4 and CD44 on the EV surface, could help in developing targeted interventions.

Further supporting the findings, proteomic analysis of diabetic RBC-EVs revealed elevated levels of proteins linked to oxidative stress. Treatment with an arginase-1 inhibitor, ABH, prevented the spike in reactive oxygen species and preserved normal vessel relaxation in mouse models, even after exposure to diabetic RBC-EVs.

Genetic studies in mice confirmed that this damaging process stems from externally delivered arginase-1 rather than the endothelial cells’ enzyme. Even when the internal production of arginase-1 was silenced, the vesicle-transferred enzyme was sufficient to provoke oxidative stress.

Beyond vascular damage, the study touches upon broader implications of RBC-EVs in diabetes-related complications. These vesicles carry pro-thrombotic markers like tissue factor and phosphatidylserine, which may contribute to increased clotting risk in heart attack patients. Additionally, EVs containing the protein α-synuclein, which plays a role in neurodegenerative diseases, could pass into the brain and trigger inflammation, possibly explaining the higher risk of dementia in diabetics.

“This study suggests that the problem may not lie within the blood vessels themselves, but rather in the blood,” the authors noted. Their work clarifies the cellular mechanisms behind diabetes-induced vascular damage and paves the way for novel therapies aimed at blocking EV uptake or neutralizing their harmful cargo.

Reference:

Erythrocyte-derived extracellular vesicles induce endothelial dysfunction through arginase-1 and oxidative stress in type 2 diabetes. Aida Collado, … , Zhichao Zhou, John Pernow. Published March 20, 2025. Citation Information: J Clin Invest. 2025;135(10):e180900. https://doi.org/10.1172/JCI180900.

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Dietary Supplements Promising in Preventing Kidney Stones by Targeting Crystal Formation and Growth: Study Finds

Thailand: New research presented at NUTRITION 2025, the annual meeting of the American Society for Nutrition, has revealed that several commonly used dietary supplements may help prevent the formation and progression of calcium oxalate kidney stones—the most prevalent type of kidney stone worldwide.

Led by Dr. Visith Thongboonkerd from Siriraj Hospital, Mahidol University, Bangkok, Thailand, the study explored how five dietary supplements—caffeine, epigallocatechin-3-gallate (EGCG), N-acetylcysteine (NAC), resveratrol, and trigonelline—interact with calcium oxalate (CaOx) crystals. These crystals are a key component in kidney stone development. The investigation aimed to understand how these supplements influence crystal formation, growth, and aggregation, which are critical steps in kidney stone formation.

“Preventing kidney stone disease (KSD) and reducing its recurrence remains a significant challenge,” according to Dr. Thongboonkerd. “We explored whether these dietary compounds could interfere with the crystallization process at physiologically relevant concentrations.”

The research team conducted a series of laboratory experiments using concentrations of each supplement that reflect typical levels found in human urine (1, 10, and 100 μM).

The key findings of the study were as follows:

  • The study showed that each dietary supplement influenced different stages of calcium oxalate (CaOx) crystal development.
  • Caffeine was observed to inhibit crystal formation.
  • EGCG, present in green tea, prevented both the formation and growth of CaOx crystals.
  • N-acetylcysteine (NAC) effectively reduced crystal aggregation, a crucial factor in stone enlargement.
  • Resveratrol inhibited crystal growth but, paradoxically, promoted aggregation, indicating a dual role depending on the stage of stone formation.
  • Trigonelline, found in coffee and fenugreek, blocked both the growth and aggregation of crystals.
  • Among all the supplements, EGCG was the most effective in preventing crystal formation.
  • Resveratrol was the strongest inhibitor of crystal growth.
  • NAC was the only supplement that significantly curbed crystal aggregation.

The findings align with previous observations by Dr. Thongboonkerd’s team, who reported that while normal urinary proteins generally hinder CaOx crystallization, oxidative changes in these proteins among kidney stone formers may actually encourage stone formation. This study aimed to assess whether dietary antioxidants could counteract such pro-stone effects.

While the results are encouraging, Dr. Thongboonkerd emphasized the need for caution before translating these findings into clinical recommendations. “Further research, particularly in clinical settings, is needed to confirm these effects in humans and to ensure that these supplements are safe and effective for long-term use in kidney stone prevention,” he said.

The study adds to the growing body of evidence suggesting that targeted nutritional strategies could play a supportive role in managing and preventing kidney stone disease.

Reference: https://nutrition2025.eventscribe.net/fsPopup.asp?PresenterID=1797305&mode=posterPresenterInfo

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Genetic Link Found Between Early-Onset AF and Risk of Cardiomyopathy or Heart Failure: Study

Researchers have found in a cohort study that there is a significant prevalence of CMP-PLP genetic variants in patients with early-onset atrial fibrillation (AF) which is linked with higher risk of developing cardiomyopathy or heart failure. The research published in JAMA cardiology highlights the potential value of genetic testing in AF patients.

Patients with atrial fibrillation (AF), a common morbid arrhythmia, are more likely to carry rare genetic variants associated with inherited cardiomyopathies. Prior studies on rare pathogenic variants in AF relied on small, hospital referral populations, and knowledge on clinical outcomes remains limited. A study was done to evaluate the prevalence and prognostic implications of cardiomyopathy-associated pathogenic or likely pathogenic (CMP-PLP) genetic variants in patients with AF. In 2 prospective cohort studies, the prevalence of CMP-PLP variants was assessed in the population of patients with AF and early-onset AF. The association between carrying a CMP-PLP variant and the risk of incident cardiomyopathy or heart failure (CMP/HF) after AF diagnosis was evaluated. Finally, the joint contributions of CMP-PLP variants, clinical risk, and polygenic risk were assessed. Included in this study were 2 large longitudinal cohort studies, the UK Biobank (UKB) (data 2006-2023) and the All of Us Research Program (AllofUs) (2018-2022). The UKB and AllofUs cohorts, respectively, contained 393 768 and 193 232 unrelated genotyped participants. Results In the UKB cohort, 32 281 participants (8%) had AF (mean [SD] age, 62 [6] years; 20 459 male [63.4%]). In the AllofUs cohort, 11 901 participants (6%) had AF (mean [SD] age, 67 [12] years; 6576 male [55.3%]). Compared with the biobank populations, CMP-PLP variants were twice as prevalent in patients with AF (UKB, 2.04%; 95% CI, 1.89%-2.20%; AllofUs, 2.52%; 95% CI, 2.25%-2.82%) and 5 times as prevalent in AF with onset before age 45 years (UKB, 4.99%; 95% CI, 3.07%-7.91%; AllofUs, 4.66%; 3.40%-6.32%). Cumulative incidence of CMP/HF was high in patients with AF (18%) compared with patients without AF (3%). Still, among patients with AF without prior CMP/HF (UKB, 20 226; AllofUs, 8330), carrying a CMP-PLP variant was associated with 1.6-fold risk of incident CMP/HF (meta-analysis, 95% CI, 1.32-1.90). Finally, CMP-PLP variants, a polygenic score, and clinical risk factors were independent estimators of CMP/HF. Results of this cohort study suggest that the prevalence of CMP-PLP variants was substantial in patients with early-onset AF. Patients with AF carrying a CMP-PLP variant had an associated increased risk of future CMP/HF, independent of clinical and polygenic risk. These results indicate that genetic testing in patients with AF may identify individuals at higher risk for developing CMP/HF.

Reference:

Wijdeveld LFJM, Ajufo E, Challa SP, et al. Cardiomyopathy-Associated Gene Variants in Atrial Fibrillation. JAMA Cardiol. Published online April 30, 2025. doi:10.1001/jamacardio.2025.0460

Keywords:

Wijdeveld LFJM, Ajufo E, Challa SP,Genetic, Link, Found, Between, Early-Onset AF, Risk, Cardiomyopathy, Heart Failure

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Sleep Bruxism Linked to Higher TMD Recurrence Post-Treatment: Study

Researchers have found in a new study that sleep bruxism significantly increases the risk of temporomandibular disorder (TMD) recurrence within six months after treatment. It was that despite notable improvements in pain, jaw function, and mouth opening following physical therapy, 25% of patients experienced recurrence. Daytime oral behaviors improved, but nocturnal bruxism persisted. The analysis identified bruxism as an independent risk factor, with an odds ratio (OR) of 4.41.

Oral behaviours are risk factors for temporomandibular disorder (TMD), but the associations between oral behaviours and TMD prognosis remain unclear. A study was to assess the effect of oral behaviours on TMD prognosis. This single-centre retrospective study included 99 TMD patients (12 males and 87 females, median age: 28 years) who received physical therapy between January and August 2022 and completed a 6-month follow-up. Pain intensity, mouth opening, jaw function and oral behaviours were assessed at baseline. At follow-up, disease recurrence and the abovementioned indicators were assessed. Paired-samples t tests were used to compare pain, mouth opening and jaw function before and after treatment. Chi-squared tests were used to assess changes in oral behaviours. Multivariate logistic regression analyses were used to identify risk factors for TMD recurrence. p < 0.05 indicated statistical significance. TMD recurrence was reported by 25 patients, yielding a recurrence rate of 25%. After physical therapy, the patients’ pain, mouth opening and jaw function significantly improved (p < 0.001). The oral behaviour during waking hours was effectively corrected (p < 0.05); however, it was difficult to improve nocturnal oral behaviour (p > 0.05). Multivariate logistic regression analysis revealed that sleep bruxism was an independent risk factor for TMD recurrence (OR = 4.411, p = 0.023). Sleep bruxism is a significant risk factor for TMD recurrence. Close attention should be given to whether TMD patients have a habit of sleep bruxism.

Reference:

Yang Y, Qin JX, Yao Y, Liu SS, Zeng H, Fang ZY, Xu LL, Cai B. Sleep Bruxism Is a Significant Risk Factor for the Recurrence of Temporomandibular Disorder: A Single-Center Retrospective Study. J Oral Rehabil. 2025 May 2. doi: 10.1111/joor.13991. Epub ahead of print. PMID: 40317789.

Keywords:

Sleep, Bruxism, Linked, Higher, TMD, Recurrence, Post-Treatment, Study, oral behaviour; physical therapy; recurrence; sleep bruxism; temporomandibular disorder, Yang Y, Qin JX, Yao Y, Liu SS, Zeng H, Fang ZY, Xu LL, Cai B

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Zibotentan–Dapagliflozin Combo Shows Promising Results in CKD Patients With and Without Diabetes: Study

Denmark: A recent post hoc analysis from the ZENITH-CKD trial suggests that combining zibotentan, a selective endothelin receptor antagonist, with dapagliflozin, a sodium-glucose cotransporter-2 (SGLT2) inhibitor, may offer consistent therapeutic benefits for patients with chronic kidney disease (CKD), irrespective of whether they have type 2 diabetes. The findings were published in Diabetes, Obesity and Metabolism by Dr. Victor Wasehuus and colleagues from the Steno Diabetes Center Copenhagen, Denmark.

The analysis aimed to explore whether type 2 diabetes influences the efficacy and safety of zibotentan when added to dapagliflozin therapy in CKD patients. Data were from a multicenter, double-blind, randomized, active-controlled phase 2b study that enrolled 447 individuals—261 with type 2 diabetes and 186 without.

Participants were assigned to receive either 0.25 mg or 1.5 mg of zibotentan in combination with 10 mg of dapagliflozin or a placebo alongside dapagliflozin. The primary parameter assessed was the change in urinary albumin-to-creatinine ratio (UACR), a marker of kidney function. Researchers also evaluated changes in body weight and B-type natriuretic peptide (BNP), indicators of fluid retention.

The study revealed the following findings:

  • Low-dose zibotentan (0.25 mg) combined with dapagliflozin reduced UACR by 37.7% in patients without diabetes.
  • The same combination led to a 17.9% reduction in UACR in patients with diabetes.
  • The stronger response in non-diabetic patients was not statistically significant.
  • High-dose zibotentan (1.5 mg) with dapagliflozin resulted in similar UACR reductions (~34%) in diabetic and non-diabetic patients.
  • There was no significant interaction between diabetes status and treatment effect at the higher dose.
  • No notable differences were observed in body weight or BNP changes based on diabetes status.
  • Fluid retention occurred only in diabetic patients receiving the higher zibotentan dose.
  • No cases of fluid retention were seen in non-diabetic patients receiving zibotentan.
  • The combination therapy was generally well-tolerated across all patient groups.

Despite these promising findings, the authors emphasized that this was a post hoc analysis of a trial not specifically designed to compare patients based on diabetes status. Therefore, they suggest that the results be interpreted cautiously and viewed as hypothesis-generating. Moreover, the trial’s 12-week duration limits any conclusions about long-term outcomes.

To address these limitations, ongoing trials like ZENITH-HP and ZODIAC are expected to offer further clarity. The ZENITH-HP trial has recruited over 1,500 CKD patients with and without diabetes, while the ZODIAC study is evaluating the individual and combined effects of zibotentan and dapagliflozin in greater detail.

“The analysis supports the potential utility of zibotentan-dapagliflozin combination therapy in CKD management across diverse patient groups, offering a promising approach that appears unaffected by diabetes status,” the researchers concluded.

Reference:

https://doi.org/10.1111/dom.16468

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Talc or Minocycline Pleurodesis May Aid managing malignant pleural effusion Management in Lung Cancer with ILD: Study

Researchers have found in a new study that Pleurodesis using talc or minocycline had potential as a treatment option for managing malignant pleural effusion (MPE) in patients with lung cancer complicated by interstitial lung disease (ILD).

What is known and what is new?

• The efficacy rate of pleurodesis with talc and minocycline is about 70%. Acute respiratory distress syndrome (ARDS) after pleurodesis with talc is a concern. The partially expanded lung before pleurodesis is known as the predictor of pleurodesis failure. The efficacy and safety of pleurodesis against MPE complicated with ILD have not been elucidated.

• In this study, excluding the cases of partially expanded lung, the efficacy rate of pleurodesis against MPE complicated with ILD was comparable to that of previous reports. Presenting ground glass opacity and consolidation treated with systemic prednisolone within 6 months before pleurodesis might be the risk factor for developing ARDS.

What is the implication, and what should change now?

• Pleurodesis against MPE might be the therapeutic option for patients complicated with ILD. However, two cases of ARDS were observed in the patients administered systemic prednisolone against ILD within 6 months before pleurodesis. The clinicians should carefully consider the indication for pleurodesis.

Reference:

Hirokazu Iso, Akihiko Miyanaga, Yozo Sato, Yukari Shirakura, Kaoruko Shinbu, Tomoyasu Inoue, Atsuhiro Nagano, Kazuhito Misawa, Takehiro Tozuka, Akari Murata, Efficacy and safety of pleurodesis for lung cancer patients with interstitial lung disease, Journal of Thoracic Disease, DOI: 10.21037/jtd-24-1541.

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Obstructive Sleep Apnea Doubles Risk of Severe Glaucoma Progression, Study Finds

USA: Patients diagnosed with obstructive sleep apnea (OSA) may be at a significantly higher risk of rapid glaucoma progression, according to a new study that evaluated the long-term outcomes of primary open-angle glaucoma (POAG) in those with and without OSA. The research, published in Ophthalmology Glaucoma, emphasizes the need for early and potentially more aggressive intervention to help mitigate vision loss in this high-risk group.

Led by Dr. Pranav Vasu from the Department of Medicine at Creighton University School of Medicine, Phoenix, Arizona, the study analyzed data from the TriNetX US Collaborative Network using electronic health records spanning from January 2004 to October 2024. The retrospective cohort included 5,277 patients with OSA and 5,277 without, all of whom had mild to moderate POAG at baseline.

The investigators examined the risk of progressing to severe POAG over 3-, 5-, and 10-year follow-up periods.

The study led to the following findings:

  • Patients with obstructive sleep apnea (OSA) had significantly higher odds of progressing to severe glaucoma after adjusting for baseline characteristics, comorbidities, and medication use.
  • The risk of progression to severe glaucoma was nearly 2.8 times higher at 3 years for patients with OSA compared to those without.
  • At 5 years, the odds of disease progression were 2.3 times higher for the OSA group.
  • After 10 years, the risk remained elevated, with just over 2.1 times higher odds of severe glaucoma among those with OSA.
  • There was no significant difference in the rates of minimally invasive glaucoma surgeries (MIGS) or trabeculectomy procedures between patients with and without OSA.
  • Laser treatments and tube shunt surgeries were significantly more common in patients with OSA at all follow-up time points.

“These findings suggest that while OSA patients face a markedly greater risk of glaucoma progression, surgical interventions such as MIGS and trabeculectomy are not necessarily used more frequently,” the authors noted. “Instead, there is greater reliance on laser therapies and tube shunt procedures, which may reflect the need to address more advanced or rapidly progressing disease in this group.”

The study highlights the importance of recognizing OSA as a potential accelerator of POAG and suggests that standard management strategies may not be sufficient for this subset of patients. Clinicians are encouraged to consider early screening and timely interventions tailored to individuals with coexisting OSA and glaucoma to help prevent irreversible vision loss.

In light of these findings, the authors advocate for greater clinical vigilance and suggest revisiting current treatment algorithms for POAG patients with OSA. Proactive management, they argue, could help alter the course of disease and preserve visual outcomes over time.

Reference:

Vasu, P., Wagner, I. V., Lentz, P. C., Gumaste, P., Abubaker, Y., Ang, B. C., Ahuja, A. S., Dorairaj, E., Qozat, I., Miller, D. D., & Dorairaj, S. (2025). Obstructive Sleep Apnea as a Potentiator of Primary Open Angle Glaucoma and Necessity for Interventional Therapy. Ophthalmology Glaucoma. https://doi.org/10.1016/j.ogla.2025.05.005

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Beyond the Skin: Study Assesses Subcutaneous Emphysema Risk in Laparoscopic Surgery

Subcutaneous emphysema, a common complication of laparoscopic surgery, has garnered increased attention due to its variability in incidence and clinical outcomes. Recently published historical cohort study involving 1,642 adult patients who underwent laparoscopic procedures at Kagoshima University Hospital examined the incidence, outcomes, and risk factors associated with this complication. The study found that 600 patients (37%) developed postlaparoscopic subcutaneous emphysema, with varying degrees of severity categorized as mild (72%), moderate (23%), and severe (6%). Several independent risk factors were identified through multivariable logistic regression analysis. These included female sex, with an odds ratio of 1.82; peak end-tidal carbon dioxide (EtCO2) levels exceeding 45 mm Hg (OR, 2.07); and use of the AirSeal Intelligent Flow System (OR, 3.37). A lower body mass index (BMI) was also associated with increased risk, with a statistically significant trend noted (p < 0.001). Notably, the study highlighted that, despite the high incidence of subcutaneous emphysema, there were no significant complications linked to this condition, reaffirming its relatively benign clinical course. Data collection encompassed demographic information, comorbidities, surgical specifics, and postoperative outcomes, revealing no significant differences in preexisting conditions across patient groups. Moreover, postoperative complications were present in only 20% of patients with subcutaneous emphysema, showing no statistically significant relationship with other postoperative events.

Diagnosis Methodology

The methodology of diagnosing postlaparoscopic subcutaneous emphysema relied on radiological findings, specifically digital chest and abdominal radiographs. This study confirmed that, although the clinical features of postlaparoscopic subcutaneous emphysema are often mild, detailed monitoring is essential for detection through imaging techniques. A significant finding was the interaction between pneumoperitoneum time and type of surgery, with longer operative times correlating only with specific surgical groups, suggesting that procedural characteristics may influence complications. Furthermore, the use of the AirSeal Intelligent Flow System raised considerations regarding its design, potentially increasing the incidence of subcutaneous emphysema due to the method of CO2 insufflation. Overall, this investigation into postlaparoscopic subcutaneous emphysema underscores the importance of recognizing risk factors, particularly in female patients and those with lower BMI, to enhance preventive strategies and ensure timely clinical responses. Enhanced awareness could improve both patient management and outcomes in laparoscopic surgery settings.

Key Points

– A historical cohort study of 1,642 adult patients who underwent laparoscopic procedures indicated that 37% developed postlaparoscopic subcutaneous emphysema, classified into mild (72%), moderate (23%), and severe (6%) cases.

– Independent risk factors associated with the development of subcutaneous emphysema included female sex (odds ratio of 1.82), peak end-tidal carbon dioxide (EtCO2) levels exceeding 45 mm Hg (OR of 2.07), and the use of the AirSeal Intelligent Flow System (OR of 3.37). Additionally, lower body mass index (BMI) was linked to a heightened risk, demonstrating a statistically significant trend (p < 0.001).

– Despite the high incidence of subcutaneous emphysema, the study found no significant complications related to the condition, indicating a relatively benign clinical course, with only 20% of patients experiencing postoperative complications and no significant relationship to other postoperative events.

– Diagnosis of postlaparoscopic subcutaneous emphysema relied on digital chest and abdominal radiographs, highlighting the necessity for thorough monitoring through imaging techniques, as clinical features are often mild.

–  Interaction between pneumoperitoneum time and type of surgery was observed, with longer operative times linked to specific surgical groups, implying procedural characteristics may affect complication rates.

– The study emphasizes the need for heightened awareness of risk factors, particularly in female patients and those with lower BMI, to improve preventive strategies and timely clinical responses in laparoscopic surgery.

Reference –

Onitsuka, K., Godai, K., Tanoue, S. et al. Incidence, outcomes, and risk factors of postlaparoscopic subcutaneous emphysema: a historical cohort study. Can J Anesth/J Can Anesth 72, 152–161 (2025). https://doi.org/10.1007/s12630-024-02859-2

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