Friday, January 24 , 2025 at 18h30 at BO - 23h30 at BE

ABFL, MAAT, JCAU, HIBN, MACR, GMC, AMA, AAQC

2021 HHP - How many fruits+vegetables do we really need (Circulation).pdf
2021 CIRCULATION - Fruit and Vegetable Intake and Mortality, 2 Prospective Cohort Studies + MA of 26 Studies (wang) [MA]

Codified by ABFL
Codified by ACE ᵗᵉᵃᵐ

Glossary: 

🫁 = lungs, COPD; 🧠 = brain, stroke; 🫀 = heart, cardiovascular disease; WHO = World Health Organization; WCRF = World Cancer Research Fund; NHSE = National Health Service of England

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2021, CIRCULATION, USA ➖ obs_PROS + MA ➕ 2M | pros = >66k in ♀ (1984-2014) – >42k iin ♂ (1986-2014) ▶ MA = 1.8M ➕ 30y ➖ P I C O:
   - P: adults
   - I: pooled self-reported health and diet information
   - C: NA
   - O: MM ➩ Results:
            • 10%. ↓r CA - (0.90)
            • 12%. ↓r 🧠 🫀 (HR 0.88)
            • 13%. ↓r MM (HR 0.87)
            • 15 35%. ↓r 🫁 COPD (0.65)
3. EVIDENCE:
  - Leafy green vegetables: kale + spinach
  - Fruits & vegetables: vitamin C + beta carotene (ANTIOXIDANTS)
  - NO BENEFIT in MM ➩ >5 servings OR starchy veggies OR potatoes OR drinking fruit juices.
  - Veggies only = no ↓ CA (p=0.62)
  - RECCO diver among countries ➩
       * 8.5 servings in AUS
       * 6 servings in DEN
       * 5 servings in WHO, WCRF, NHSE

  - Fruit juices + potatoes = ↑ glycemic load (various DIETARY RECOMM include them)

  - How much you eat in average MATTERS ➩ if NOT achieved THE GOAL, you can

    compensate the day after.

⏳ TIME MANAGEMENT.
01:27:38

Round: 8 00:01:30 The end
Round: 7 06:31:64 Wrap-up
Round: 6 12:09:86 Images + keypoints
Round: 5 37:44:75 ART 1 original
Round: 4 21:01:46 ART 1 prequel
Round: 3 04:19:04 Selection
Round: 2 02:13:15 Past JCRound: 1 03:37:75 Past JC

2024 CC - Comparison of methods to normalize urine output in CIpxs, a multicenter cohort study (monard) [R].pdf

Codified by MAAT

Glossary: 

♾ = kidneys; ABW = actual body weight; AKD = acute kidney disease;

CH = Switzerland; coh = cohort; DE = Germany; h_DIS  =  Hospital discharge; IBW = ideal body weight;

mc = multicentric; UO = urinary output.

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2024, CC, CH + USA ➖ mc_coh ➕ 15,322 + 28,610 (derivation + validation) ➕ CH 2010-2020 ➖ P I C O:
     - P: adults, CI pxs
     - I: CH (Laus’AKI, derivation coh) 🆚 USA (MIMIC-IV, validation coh)
     - C: NA
     - O: best predictor for UO
3. EVIDENCE:
   - Oliguria = <0.5mL/Kg/h in ≥6h
   - Presents in 75% of CI pxs + ↔ MM90
   - Estimation of weight is inaccurate
   - ABW ➩ massive variations (fluid overload + muscle mass loss + obesity + underweight)
   - Types of BW: pre-admission + actual + ideal + adjusted
   - Series (493 pxs = overestimation) + 2 large studies (USA + DE = confirmed)
   - 4th study (S + 569pxs) not influenced by the method (oliguria & MM)
   - The four studies = single center
4. METHODS.
- DEF ➠ Best predictor for UO = most closely ↔ w_mean UO d_UCI
- IN ➠
  * Laus’AKI: ≥18yo, Lausanne, Jan 2010 - Jun 2020
  * MIMIC-IV: Boston, 2008 - 2019
- EX ➠
  * Laus’AKI + MIMIC-IV: refused, u_HD, <6h UO measurement, no sCr, no weight, no height,

    vesical irrigation d_ICU stay.
- RANDOM ➠
- INTERV ➠ 1st. Best predictor was chosen 2nd. Compared OLIGURIA INCIDENCE w_: a. MM90, b. AKD at H+dis ➩ according to ABW or IBW (which normalized better)
6. RESULTS
   - USA cohort: heavier, older, lower in SAPS-II (than CH cohort)
   - Best UO predictor = IBW (‘oliguria incidence’ was constant)

   - IBW ➩ ↗️ association ↔ oliguria w_: MM90 & AKD

   - After correction (sex, SAPS-II): ALL FINDINGS PERSISTED

Friday, January 17 , 2025 at 18h30 at BO - 23h30 at BE

ABFL, MAAT, JCAU, HIBN, MACR, GMC, AMA, AAQC

⏳ TIME MANAGEMENT.
01:18:15
Round: 5 06:07:41 Figures
Round: 4 20:28:69 Content + wu
Round: 3 33:11:79 Article UO

Round: 2 06:06:67 Article choice

Round: 1 12:21:18 Past JC

2025 CC - Changes in pulse pressure variation induced by passive leg raising test to predict preload responsiveness in MV pxs w_low Vt in ICU (mallat) [srMA].pdf

Codified by MAAT

Glossary: 

💨 = flow = perfusion; 🫁 = lungs; 🫀 = heart; FC = fluid challenge; FR = fluid responsiveness; PPV = pulse pressure variation.

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, CC, UAE ➖ srMA ➕ 5 studies (474 pxs) ➕ PROSPERO - publication (1y) ➖ P I C O:
     - P: ↓Vt 
     - I: ∆PPV & ∆PPV% a_PLR following ‘…not a drop of fluid’
     - C: fluid challenge or response to PLR
     - O: ability to predict FR in ↓ Vt MV
3. EVIDENCE:
   - 1st line therapy = fluid administration ➩ tissue hypoperfusion context
   - FC AIM = ↑ preload + CI ➩ 🔝 DO2 + tissue 💨
   - Excessive fluid ➩ peripheral + 🫁 edema + poor OC
   - Deficient fluid ➩ MOF + MM
   - 50% are fluid responsive- PPV accurately predicts FR in MV pxs ➩ only if Vt ≥8 ➩

     OTHERWISE (Vt <8), insufficient to induce changes in THORACIC PRESSURE &

     PRELOAD.

Friday, January 31 , 2025 at 18h30 at BO - 23h30 at BE

AMA, HIBN, AAQC

⏳ TIME MANAGEMENT.
01:28:32
Round: 4 06:18:93 Comments
Round: 3 01:07:40 ART
Round: 2 09:17:00 ART selection
Round: 1 05:16:43 Past JC

Friday, March 14 , 2025 at 18h30 at BO - 23h30 at BE

AMA, MACR, DFM, JQB, MAAT, HIBN, AAQC

2024 JACC - From ST-Segment Elevation MI to Occlusion MI (McLaren) [r].pdf

Codified by ABFL

Glossary: 

ACC = American College of Cardiology, ACO = acute coronary occlusion, Computerized Tomography, Delayed Invasive Intervention in Patients With Non–ST-Segment–Elevation Myocardial Infarction, INT = interpretation, MI = myocardial infarction, OMI = occlusion MI, RIDDLE-NSTEMI = Randomized Study of Immediate Versus, STD = ST-segment depression, STEMI = ST-segment elevation MI, TIMACS = Timing of Intervention in Acute Coronary Syndromes, VERDICT = Very EaRly vs Deferred Invasive evaluation using.

1. Image of non-STEMI = STEMI (occluded) + non-STEMI (nonocclusive thrombus)
2. Clear deviation from actual evidence ➩ real occlusion in non-STEMI
3. ST criteria (age, sex) = Healthy 🆚 CKMB measured MI pxs ➩ DESPITE THIS… REC

    differentiation of MI w_ & wo_ACO
4. NORMAL SCIENCE = persistence of a paradigm (successful in its aim, steady expansion) =

    DOES NOT aim at novelties
5. OCs of STEMI criteria ➩ best reperfuse + ↓ reperfusion delays
6. STEMI paradigm ➩
       * ↗️REPERFUSION strategies & techniques
            - Angiography
            - Stenting
            - Medications
            - Door-to-balloon (time is myocardium)
       * ↗️🫀 ER + INTERdisciplinary collaboration:
            - ⊕ Cath lab
            - Paramedics BYPASSING ER departments
            - Rapid assembling of interventional 🫀 teams
       * 2 quality ↗️:
            - ↓ reperfusion delays
            - ↓ false positives STEMI
       * NOVELTY:
            - No false negatives found ➩ ECG wo_STEMI criteria + ACO = NOT considered a false

              (-) STEMI ➩ “As a result, the patient will be denied emergent reperfusion”
            - McLaren stated this problem in 2023 AJEM, Missing occlusion
       * Evidence
            - Trials have not regarded this type of cases
            - Many non-STEMI trials have reperfusion time limitations ➩ TIMACS 16h (unstable

              angina, non-STEMI) to reperfusion.
            - VERDICT (unstable angina, non-STEMI) = benefit from 4.7h of reperfusion.
            - RIDDLE-NSTEMI = ↓ MM in immediate reperfusion
            - NSTEMI exclude refractory ischemia OR HD/electrical instability

            - 6.4% of VERY-HIGH NSTEMI ➩ angio in 2h

⏳ TIME MANAGEMENT.
01:24:22
Round: 4 00:50:82 Comments
Round: 3 23:33:13 wrap-up
Round: 2 47:53:53 JC
Round: 1 12:05:49 Past 2 JCs

⏳ TIME MANAGEMENT.
01:25:47
Round: 7 07:25:35 Comments
Round: 6 11:46:41 Results
Round: 5 30:00:94 Methods
Round: 4 16:27:26 INTRO
Round: 3 11:42:31 JC, abstract
Round: 2 03:16:61 ART selection
Round: 1 05:08:43 past JC

2024 JACC - From ST-Segment Elevation MI to Occlusion MI (McLaren) [r].pdf

Codified by ABFL

Glossary: 

ACC = American College of Cardiology, ACO = acute coronary occlusion, INT = interpretation, MI = myocardial infarction, OMI = occlusion MI, STEMI = ST-segment elevation MI.

1. SHIFT ➩ scope + precision change OR stay when PARADIGM is more successful (few

    problems resolved) - acute ones
2. STEMI criteria as SURROGATE of ACO = limited in scope + precision
3. 1994 MA ➩ “ECG w_STEMI criteria = emergent reperfusion”
      - Suspected MI
      - w_limited or NO ECG
      - Treated w_streptokinase
      - MI determined by CK-MB
      - CRUDE separation = poor definition
      - 4 studies ➩ no ECG requirements for enrollment
      - cautioned about denying reperfusion in patients without STE.
      - Few deaths + data-dependent emphasis could be misleading
4. Kuhn ➩ paradigms start FLEXIBLE… and then become RIGID
5. GLs:
      1. 1996 ➩ advised THROMBOLYTICS for hyper acute T or ST-seg depression V1-V4 from

           POSTERIOR MI (experienced expertise is needed)
      2. 1999 ➩ advised CLASSIFY “w_STE or LBBB” + “nonDx ECGs” (even being posterior

           infarctions)
      3. ∑ STEMI paradigm emerged w_2 ≠ entities: STEMI 🆚 non-STEMI

Friday, March 07 , 2025 at 18h30 at BO - 23h30 at BE

MAAT, HIBN, AAQC

2025 ICM - How we use ultrasound in the mm of weaning from MV (Tuinman) [ed].pdf

Codified by ABFL

Glossary: 

🫁  = lungs, 🫀 = heart,🫃🏽 = abdomen = abdominal, AbP = abdominal pressure, af_ = after, antiISCHE = anti-ischemic, CCUS = critical care ultrasound, DE = diaphragm excursion, Di = diaphragm, DIS = disease, DYSF = dysfunction, DW = difficult weaning, HTA = hypertension, IAP = intraabdominal pressure, iFunction = impaired function, MIP = maximal inspiratory effort = maximal inspiratory pressure, MV = mechanical ventilation, PSIC = parasternal intercostal, PSLA = parasternal long axis, PSSA = parasternal short axis, SBT = spontaneous breathing trial, TECHS = techniques, TFdi = thickening fraction of the diaphragm, WF = weaning failure.

1. DW ➩ ↑ adverse clinical OCs➕ resources (limited healthcare)
2. DW = failure SBT ➩ causes of WF ▶ iFunction: 🫁 🫀 Di
3. CCUS ➩ valuable DX tool ➩ MV, weaning, readiness for weaning, causes of WF, 🫀–🫁 function, TTO response.
4. ABCDE-US ➩ pathophysioly of WF ➩ DX ➕ monitoring = CAUSE oF WF
       1. ABCDE ➩
              - it is an ADJUNCT to clinical parameter + physical examination
              - Timing: MV > 48h
              - Frequency: follow-up determined by a. Cause, b. Course DIS     
        2. 🫀:
              - DYSF ➩ MOST frequent causes of WF
              - 1st. TTE. views (PSLA, PSSA, apical 2, 3, 4, 5 chamber, subcostal) ➩ eye-balling: to

                 estimate SIZE + FUNCTION both ventricles ➕ wall abnormalities OR 🫀 effusion
              - 2nd. TTE by educated in ECHO. If CAUSE not clear
              - 3rd. TEE. Diastolic function (E/A and E/e’ ratios) when FAILING an SBT. Wall motion

                abnormalities + 🫀 valves (stenosis + regurgitation)
              - TTO ➩ fluid removal ➕ antiHTA ➕ antiISCHE
        3. 🫁 :
              - Aeration score + P.eff.
                  * QUALITATIVE ▶ 6 views DX cause of ARF (sliding, pleural abnormalities, lung

                     profiles ABC, pleural effusion, consolidation w_or wo_ air bronchograms) ➖

                     careful w_deterministic fashion interpretation
                  * QUANTITATIVE ▶ 12 views ➩ calculare 🫁 aeration score ➩ monitor 🫁

                     pathology over time
                  * r_extubation failure ▶ 8 views ➩ ← → SBT ➩
                  * ≥5 B-lines = extubation failure (independent fro LV filling presssures)
                  * OCs ▶ weaning readiness + WF cause + monitor DIS progression & TTO

                     response.
         4. 🫃🏽:
               - ↑ AbP ➩ can affect MECHS ∑ weaning
               - US ▶ screen aspect FREE FLUID (↓ anechoic) 🆚 heterogenous (↑ echoic) +

                  septum (useful for the cause of free fluid)
               - Paracentesis DX and TTO
           5. Di:
               - Highly prevalent ➩ DYSF of Di
               - US: to exclude Di DYSF ➩ af_FAILED initial SBT
               - DE = subcostal OR subxiphoid (liver OR spleen as acoustic windows)
                  * IF not clear ▶ use  INTERCOSTAL (zone of apposition to DISPLACEMENT of

                     liver

                     OR spleen) = qualititve alternative.
                  * Measured d_spontaneous breathing wo_ventilator support.
                  * In cooperative PXS ➩ MIP to assess MAX excursion
               - Contractility: TFdi (via INTERCOSTAL) ▶
                  * ↑ = edema ➖ fibrosis (careful)
                  * ↓ = atrophy
                  * DYSF = DE <20mm
                  * WF (predictive) = TFdi <30-35% ➕ DE <10-15mm
            6. Extra-Di
                - ExtraDi muscles help Di weakness ➩ successful SBT BUT potential WF
                - Expiratory muscle atrophy = impairment of airway clearance ➩ WF
                - US: PSIC + rectus abdominis muscle + external oblique, internal oblique &

                  transversus abdominis (same window).
                - Consider always IAP (due to GEOMETRY + MOBILITY)
                - Thickening fraction of INTERCOSTAL MUSCLES >10% = ↑r_WF
7. FUTURE DIRECTIONS
                - CLINICAL trials ▶↗️  predictive performance of 🫁 + Di
                - DX continuous data ▶ ↗️ predictive performance of 🫁 + 🆕 indications
                - Advanced TECHS ▶ speckle tracking (quantification of perfusion + better function

                  estimation).

8. These measurements can be used to form a definition of diaphragm dysfunction, although

    there is variation in this definition: It has been defined as a thickening fraction of less than

    20% or a tidal excursion of less than 10 mm – 2019 UJ - A narrative review of diaphragm

    ultrasound to predict weaning from MV, where are we and where are we heading (turton) [r]

Friday, March 28 , 2025 at 18h30 at BO - 23h30 at BE

AMA, AHO, GMC, HIBN, AAQC

⏳ TIME MANAGEMENT.
02:13:08
Round: 5 06:52:74 Comments
Round: 4 58:27:56 Wrap-up
Round: 3 46:41:93 ART
Round: 2 06:47:19 ART selection
Round: 1 14:19:46 past JC

2021 Intl J Gynecology Obste - Fetal growth and spontaneous preterm birth in high‐altitude pregnancy (grant) [srMA].pdf

Codified by AAACC

Glossary: 

👶🏼 = infants = infancy, bW = birth weight, hALT = high altitude, LBW = Low Birth Weight, Preg = pregnant, SGA = Small for Gestational Age, sPTB = Spontaneous Preterm Birth

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2021, IJGO, UK ➖ srMA ➕ 2524, 59 IN ➕ -Nov 11, 2020 ➖ P I C O:
      - P: hALT pregnant
      - I: preg hALT
      - C: preg non-hALT
      - O: pOC = hALT impact on LBW, SGA, SPTB | sOC = magnitude LBW
3. EVIDENCE:
      - hALT physiological changes ➩ pregnancy adaptations + hypobaric hypoxia
      - 👶🏼 born at hALT = "lighter” (LBW)
      - LBW ↔ short/long-term uOC
      - https://www.floodmap.net
4. METHODS.
      - 𝗜𝗡 ➠
      - 𝗘𝗫 ➠
      - RANDOM ➠
      - INTERV ➠
6. RESULTS
7. RATIONALE
8. LIMITATIONS

Friday, April 04 , 2025 at 18h30 at BO - 23h30 at BE

AMA, AHO, BAH, HIBN, AAQC

⏳ TIME MANAGEMENT.
01:48:53
Round: 7 04:24:00 Finish
Round: 6 37:28:01 Results
Round: 5 14:58:50 Methods + Inclusion
Round: 4 09:53:45 Introduction
Round: 3 07:54:63 ART abstract
Round: 2 10:10:66 ART selection
Round: 1 24:04:51 Past JC