A43was to assess the association of the depression as a risk factor for coronary heart disease (CHD) based on prospective studies included in published systematic reviews. Methods: A systematic review to identify systematic reviews was conducted in MEDLINE, Cochrane library and Embase databases, with no limit on the start date until December 2015, using keywords for depression, coronary events and risk factors. The selection of the reviews that included prospective studies was realized by two researchers independently; primary data from prospective studies analyzing the relationship of depression and CHD were extracted. The Hazard Ratios (HRs) were pooled using random effects model. The subgroup analysis was carried out considering fatal CHD, myocardial infarction, gender, and follow-up duration. Results: It was selected twenty one systematic reviews comprising thirty five prospective studies that were extracted. The number of people included in the studies was 900,226. The main differences among the studies were the age, gender, measurement of depression, length of follow-up and CHD fatality. The meta-analysis found that the depression behavior is a risk factor for CHD, although the heterogeneity is substantial. The analysis by subgroup found low heterogeneity for myocardial infarction and fatal CHD. The analysis suggested that depression increases the risk for fatal CHD AND myocardial infarction (HR 1.13 95%CI: 1.06-1.20 and HR 1.29 95%CI: 1.19-1.39, respectively). In the subgroup analysis by length of follow-up, the HR of CHD was 1.24 (95%CI 1.01-1.47) for the studies with less than 15 years of follow-up and 1.18 (95%CI 1.12-1.24) for those with more than 15 years of followup. ConClusions: The results of meta-analysis suggest that depression increases the risk of CHD significantly, although the evidence has substantial heterogeneity. PCV24CardioVasCular risks of ExogEnous TEsTosTEronE usE among mEn: a sysTEmaTiC rEViEw and mETa-analysis

Many surgeons do not routinely discuss advanced directives preoperatively and more than one half reported they would decline to operate on patients whose directives limit postoperative care. This practice may limit the expression of patient preferences during decision making for high-risk operations.

Drake and colleagues in several hundred patients with Grade I aneurysm. 1 ' 6 In the present study, 4 new postoperative deficits appeared after rupture with forced vascular clipping, vasospasm, or edema. These postoperative deficits might have been exacerbated by hypotension, which was sometimes protracted.In this study, EEG did not identify intraoperative local ischemia in 3 patients with immediate postoperative focal deficits. Several reasons may explain the failure of EEG to predict these deficits. Most importantly, infarction caused by hypotension was not identified in these patients, and thus we lacked a clear-cut hypotensive stress for detection by EEG surveillance. Moreover, standard EEG electrodes could be placed only in the area over the unoperated scalp and, therefore, the area of potential maximum vulnerability was not monitored.EEG with scalp electrodes near but outside the surgical site does not seem helpful for monitoring cerebral function in the region of aneurysm surgery. Preliminary studies in our operating room suggest that electrocorticography over the operative area will be more revealing.

Background Frequently used fluoroquinolones have been subject to increasing safety concerns and regulatory alerts. This study characterized ambulatory fluoroquinolone utilization in the United States and evaluated the impact of 2016 FDA safety advisories on its use. Methods We used IQVIA’s National Disease and Therapeutic Index (NDTI) to quantify adult outpatient fluoroquinolone use (“treatment visits”). Descriptive statistics and segmented-regression were used to report trends and quantify the varied use before and after FDA’s 2016 alerts. Results Between 2015 to 2019, fluoroquinolone use decreased by 36.5% (18.7 million treatment visits in 2015 to 13.7 million treatment visits in 2019). Annual use declined by 78%, 31%, 31% for respiratory, urogenital, and gastrointestinal conditions, respectively; and by 191% among providers <44 years-old versus negligible decline among > 65 years-old. Before 2016 FDA advisories, there were ~ 4.8 million fluoroquinolone treatment visits/quarter which had a statistically significant immediate drop by 641,035 visits (p-value=0.000, 95%CI:-937,368 to -344,702) after FDA’s 2016 advisories. A statistically significant difference of ~45,000 visits/quarter (p-value=0.036,95%CI:-85,956 to -3,122) was observed after the advisories. Conclusions Large reductions in ambulatory fluoroquinolone use in the United States have coincided with increasing evidence of safety concerns and FDA advisories. However, fluoroquinolone use varies significantly based on patient and provider characteristics, suggesting heterogeneous effects of emerging risks on clinical practice.