Wellens\u27 Syndrome on Electrocardiogram, A Highly Specific Indicator of Critical Stenosis of the Left Anterior Descending Coronary Artery

An 85-year-old male with a past medical history of hyperlipidemia presented to his primary care physician with chest pain. The patient had experienced an acute episode of substernal chest pain that resolved spontaneously three days prior to presentation. An electrocardiogram (ECG) was obtained in the office which showed inverted and biphasic T-waves throughout the precordial chest leads (Panel A, arrows). The patient was sent to the emergency department and underwent an emergent cardiac catheterization which revealed a 99% proximal left anterior descending (LAD) artery occlusion (Panel B, arrow). A drug-eluting stent was placed with successful revascularization (Panel C, arrow). Wellens syndrome is characterized by a history of recent chest pain accompanied by biphasic or deeply inverted T-waves in V2-V3 on ECG. Clinicians must remain vigilant for this presentation of acute coronary syndrome as the finding is highly sensitive for a critical LAD stenosis and impending myocardial infarction

Incidental Coronary Artery Calcification: A Low-Hanging Fruit with Life-Prolonging Potential

Background Problem Statement: Incidental coronary artery calcium (CAC) seen on ungated computerized tomography (CT) scans obtained for various clinical reasons can serve as an excellent opportunity for screening of patients with previously undiagnosed coronary artery disease (CAD). Despite this, studies have shown that these findings are rarely reported in final impressions of radiology reports. Project AIM: To propose the use of a natural language processing (NLP) algorithm to identify incidental CAC noted in radiology reports and an electronic alert to notify primary care clinicians of such findings

LAAO Device Mass: A Classic Condition Involving a Not - So - Classic Device

Current evidence suggests Class 2a recommendation for a left atrial appendage occlusion with a closure device in patients with atrial fibrillation who have moderate to high risk of stroke (CHA2DS2-VASc score ≥2) and a contraindication to long-term oral anticoagulation due to a nonreversible cause.1 Watchman device (WD) related infection is infrequent due to complete endothelialization of the device in a few weeks.2 We report a highly challenging case of possible WD-related infection that involved complex decision-making

Fatty-acid uptake in prostate cancer cells using dynamic microfluidic raman technology

It is known that intake of dietary fatty acid (FA) is strongly correlated with prostate cancer progression but is highly dependent on the type of FAs. High levels of palmitic acid (PA) or arachidonic acid (AA) can stimulate the progression of cancer. In this study, a unique experimental set-up consisting of a Raman microscope, coupled with a commercial shear-flow microfluidic system is used to monitor fatty acid uptake by prostate cancer (PC-3) cells in real-time at the single cell level. Uptake of deuterated PA, deuterated AA, and the omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) were monitored using this new system, while complementary flow cytometry experiments using Nile red staining, were also conducted for the validation of the cellular lipid uptake. Using this novel experimental system, we show that DHA and EPA have inhibitory effects on the uptake of PA and AA by PC-3 cells

Increasing the rate of excisional lymph node biopsies at easily accessible sites when ruling out lymphoma

The aim of this study is to increase the rate of excisional lymph node biopsies from 78% to 95% in patients presenting to the Center City campus with lymphadenopathy at easily accessible sites by September 2021

Introduction to debriefing

time. This manuscript serves as an introduction to debriefing, covering a range of topics that include a brief review of its origin, the structure and process of debriefing-specifically in the context of simulation-based medical education, and factors that facilitate effective, successful debriefing. An approach to debriefing immediately after real clinical events will be presented, as well as an evidence-based approach to evaluating debriefing skills of healthcare simulation instructors

Knee Loading Due to Varus and External Rotation in Gait Supports Medial Compartment Wear in Total Knee Arthroplasty

Malalignment of the lower extremity may be a cause for gonarthrosis and failure of total knee prosthetic components. Neutral lower limb alignment is considered straight alignment of the axes formed from the center of the femoral head to the center of the knee and from the center of the knee to the center of the ankle joint (the mechanical axes of the thigh and shank). Malalignment of the mechanical axis (measured by δv, the angle between the femoral and the tibial mechanical axes) occurs when varus moves the line of action farther medially from the knee joint center. Malalignment due to varus results in increases in medial compartment loading and has been attributed to medial compartment articular cartilage degeneration. External rotation of the hip and knee compared to the direction of gait is another form of malalignment. In external rotation, the knee displaces from the midline at stance phase. Knee loading and the consequences of external rotation on cartilage degeneration are not well understood. The purpose of our study was to develop a mathematical model that would calculate forces and moments in knees for gait and study how they vary with varus and external rotation malalignment. An additional objective was to develop a finite element model of total knee replacement to study stress patterns on the polyethylene insert during malaligned gait. We hypothesized that medial compartment loads would be increased by both varus and external rotation alignment of the knee compared to the direction of gait. We also hypothesize that stress patterns on total knee replacement (TKR) inserts under conditions related to malaligned gait will correlate with wear patterns observed in retrieval studies. It was found that for varus and external rotation, there is a shift towards adduction moment, which resulted in an increase in medial compartment loads, supporting our hypothesis. It was also found that the malalignment in gait results in alterations in tibial tray load magnitudes and load distribution that support elevated wear in the medial compartment as observed clinically

Summary Recommendations for Responsible Monitoring and Regulation of Clinical Sofware Systems

A b s t r a c t , the FDA called for discussions on regulation of clinical software programs as medical devices. In response, a consortium of organizations dedicated to improving health care through information technology has developed recommendations for the responsible regulation and monitoring of clinical software systems by users, vendors, and regulatory agencies. Organizations assisting in development of recommendations, or endorsing the consortium position include the American Medical Informatics Association, the Computer-based Patient Record Institute, the Medical Library Association, the Association of Academic Health Sciences Libraries, the American Health Information Management Association, the American Nurses Association, the Center for Healthcare Information Management, and the American College of Physicians. The consortium proposes four categories of clinical system risks and four classes of measured monitoring and regulatory actions that can be applied strategically based on the level of risk in a given setting. The consortium recommends local oversight of clinical software systems, and adoption by healthcare information system developers of a code of good business practices. Budgetary and other constraints limit the type and number of systems that the FDA can regulate effectively. FDA regulation should exempt most clinical software systems and focus on those systems posing highest clinical risk, with limited opportunities for competent human intervention