Hadassah Medical Center (Hebrew: מֶרְכָּז הָרְפוּאִי הֲדַסָּה) is an Israeli medical organization established in 1934 that operates two university hospitals in Jerusalem – one in Ein Karem and one in Mount Scopus –, as well as schools of medicine, dentistry, nursing, and pharmacology affiliated with the Hebrew University of Jerusalem. Its declared mission is to extend a "hand to all, without regard for race, religion or ethnic origin."The hospital was founded by the Hadassah Women's Zionist Organization of America, which continues to underwrite a large part of its budget today. The Medical Center ranks as the sixth-largest hospital complex in Israel. Across its two campuses, Hadassah Medical Center has over 1,000 beds, 31 operating theaters and nine special intensive care units, and runs five schools of medical professions.
There is limited data available on short-term outcomes on a cut-block positioning robotic system. The purpose of this study was to compare 12-month clinical outcomes between robotic-assisted (raTKA) and conventional total knee arthroplasty (cTKA) with multiple outcomes and surgical centers. This was a non-randomized controlled trial of patients who received either raTKA (n = 120) or cTKA (n = 101) at 6 different surgical centers. Variables of interest included occurrence of soft tissue release, complications and revisions at minimum one-year follow-up. Satisfaction, pain (numeric rating scale [NRS]), 5-dimensional European Quality of Life (EQ-5D-5 L) questionnaire (index and visual analog scale [VAS]), Oxford Knee Score (OKS), and the Forgotten Joint Score (FJS-12) were collected pre-operatively, and at six weeks, three months, and 12 months post-operative. There were significantly less soft tissue releases with raTKA (28/120, 23.3
Strenuous physical exercise causes a massive elevation in the concentration of circulating cell-free DNA (cfDNA), which correlates with effort intensity and duration. The cellular sources and physiological drivers of this phenomenon are unknown. Using methylation patterns of cfDNA and associated histones, we show that cfDNA in exercise originates mostly in extramedullary polymorphonuclear neutrophils. Strikingly, cardiomyocyte cfDNA concentration increases after a marathon, consistent with elevated troponin levels and indicating low-level, delayed cardiac cell death. Physical impact, low oxygen levels, and elevated core body temperature contribute to neutrophil cfDNA release, while muscle contraction, increased heart rate, β-adrenergic signaling, or steroid treatment fail to cause elevation of cfDNA. Physical training reduces neutrophil cfDNA release after a standard exercise, revealing an inverse relationship between exercise-induced cfDNA release and training level. We speculate that the release of cfDNA from neutrophils in exercise relates to the activation of neutrophils in the context of exercise-induced muscle damage.
Binge eating (BE) and addictive-like eating behaviors, as assessed by the Yale Food Addiction Scale (YFAS) may change following metabolic bariatric surgery (MBS), yet their long-term trajectories and relationship with weight recurrence remain unclear. We examined their prevalence, longitudinal course, and associations with weight outcomes seven years following sleeve gastrectomy (SG). Women who underwent primary SG (n = 62) were evaluated prospectively at baseline and at 3, 6, 12, and 24 months, and 7 years post-surgery. Addictive-like eating behaviors and BE were assessed using the YFAS and Binge Eating Scale (BES), respectively. Longitudinal changes and associations with 7-year weight recurrence from nadir were examined. Thirty women completed the 7-year follow-up. At baseline, addictive-like eating behaviors and BE were identified in 40.0
BACKGROUND:For patients with atrial fibrillation, the use of oral anticoagulant therapy to prevent stroke is limited by the risk of bleeding. Left atrial appendage closure is considered for patients who are unsuitable candidates for long-term anticoagulation, but its role in patients who are eligible for anticoagulants has not been established. METHODS:In this ongoing, prospective, international, randomized trial involving patients with atrial fibrillation who were suitable candidates for anticoagulation, we randomly assigned patients in a 1:1 ratio to receive either device-based left atrial appendage closure (device group) or non-vitamin K antagonist oral anticoagulant (NOAC) therapy (anticoagulation group). The primary efficacy end point - a composite of death from cardiovascular causes, stroke, or systemic embolism - was tested for noninferiority (noninferiority margin, 4.8 percentage points) after 3 years of follow-up. The primary safety end point, non-procedure-related bleeding, was tested for superiority. RESULTS:Of the 3000 patients who underwent randomization, 1499 were assigned to the device group and 1501 to the anticoagulation group. The mean (±SD) age of the patients was 71.7±7.5 years, 31.9% of the patients were women, and the mean CHA2DS2-VASc score was 3.5±1.3. At 3 years, a primary efficacy end-point event had occurred in 81 patients (Kaplan-Meier estimate, 5.7%) in the device group and in 65 patients (Kaplan-Meier estimate, 4.8%) in the anticoagulation group (difference, 0.9 percentage points; 95% confidence interval [CI], -0.8 to 2.6; P<0.001 for noninferiority). Non-procedure-related bleeding occurred in 154 patients (Kaplan-Meier estimate, 10.9%) in the device group and in 260 patients (Kaplan-Meier estimate, 19.0%) in the anticoagulation group (hazard ratio, 0.55; 95% CI, 0.45 to 0.67; P<0.001 for superiority). CONCLUSIONS:Among patients with atrial fibrillation who were candidates for anticoagulation, device-based left atrial appendage closure was noninferior to NOAC therapy with respect to a composite of death from cardiovascular causes, stroke, or systemic embolism and was superior to NOAC therapy for non-procedure-related bleeding at 3 years. (Funded by Boston Scientific; CHAMPION-AF ClinicalTrials.gov number, NCT04394546.).
BACKGROUND:As Parkinson's disease (PD) progresses, motor fluctuations become increasingly difficult to manage with oral medications. Foslevodopa/foscarbidopa (LDp/CDp), delivered as a continuous 24-h/day subcutaneous infusion, offers continuous levodopa delivery and stable plasma levodopa levels that reduce motor fluctuations. LDp/CDp has been widely utilized since becoming commercially available. OBJECTIVES:To provide practical guidance for clinicians on the real-world use of LDp/CDp, including information on patient selection, treatment initiation, dose adjustments, and long-term management. METHODS:This narrative review included investigator experience from studies of LDp/CDp and insights from clinicians with real-world experience with LDp/CDp, addressing many critical questions that clinicians may have when initiating and managing patients on therapy. RESULTS:Continuous 24-h infusion enables consistent, individualized symptom control, with improvements in motor fluctuations and quality of life. LDp/CDp therapy can be initiated, adjusted, and maintained in outpatient settings without hospitalization. While infusion site events are common, they are typically mild to moderate and manageable. Early detection and intervention are important for managing infusion site events. Systemic adverse events associated with dopaminergic therapies (eg, psychosis, hallucinations, nightmares), may require infusion rate adjustment, particularly at night. Setting clear expectations is key to successful therapy adoption and maintenance. It is essential to educate patients, care partners, and clinical teams. CONCLUSIONS:LDp/CDp is a new treatment option for advanced PD (aPD). Treatment success depends on education, selecting appropriate patients, setting patient expectations, implementing individualized dosing strategies, and managing adverse effects.
