There is an exponential growth in the numbers of procedures requiring large-bore access. InSeal vascular closure device (VCD) is a novel device that seals the puncture with a biodegradable membrane, which is supported by a self-expanding nitinol frame. The current study suggests that the InSeal VCD is safe and effective in achieving hemostasis after transcatheter aortic valve replacement.Transfemoral (TF) transcatheter aortic valve replacement (TAVR) has evolved dramatically. Improvements in technique, devices, operator's experience, and patient selection have resulted in markedly lower rates of procedural complications, thus allowing further technical simplification at every step of the procedure. Implementing a minimalist approach for TF TAVR (including transradial secondary access, angio-guidewire-ultrasound guidance for femoral puncture, and left ventricle guidewire pacing) may improve outcomes and reduce complications without compromising patient safety in contemporary clinical practice. Although this simplified approach is applicable for most patients undergoing TF TAVR, careful patient selection remains of paramount importance.The "pre-close" technique is a widely established technique to achieve vascular closure after TAVI or TAAR, with most centers utilizing two suture-mediated vascular closure devices (ProGlide) to pre-close the arteriotomy site.  https://www.selleckchem.com/products/gne-049.html  In this study, the authors provided new data on the safety and efficacy of utilizing a single ProGlide based strategy for closure during TAVI with good clinical outcomes. These information may be very useful pending that randomized data from multicenter trials will be collected in order to confirm safety and efficacy of the technique.If you have transitioned to the radial artery as the preferred approach, congratulations. If you are in training or currently transitioning, good for you, too. Your patient satisfaction scores are going to rise, and complications will be less frequent. If you are still a femoral first, you are as old or older than me, and you should master this approach soon before you retire. Left radial approach is pretty much just like femoral, but with fewer complications.One-third of interventionalists still use dedicated left and right coronary catheters for diagnostic angiography with radial access, despite some evidence that a single "universal" catheter strategy is superior. This meta-analysis of seven randomized controlled studies of one- versus two-catheter strategies with radial access showed no differences in procedural time, fluoroscopy time, or contrast use. Use of an additional catheter was more frequent with the one-catheter strategy but radial spasm was more common with a two-catheter strategy. This meta-analysis did not address cost, complication rates, or radial occlusion rates. Differences in these factors, if found in future studies, may yet prove one strategy or the other to be superior.
  The incidence of fetomaternal complications during pregnancy is high for women with sickle cell disease (SCD), which is the most common hematologic genetic disorder worldwide. Prophylactic red blood cell exchange (pRBCX) has been shown to be efficient, safe, and feasible for preventing complications. The aim of this study was to observe maternal, perinatal, and neonatal outcomes of pregnancies in which pRBCX was.
 
  This was a single-center, retrospective, cross-sectional study, which recruited 46 consecutive adult pregnant women with SCD between January 2012 and June 2019. Obstetric features, SCD-related complications, and fetomaternal outcomes were compared between the 27 patients who received prophylactic exchange and the 19 who did not (therapeutic exchange was performed in 7 and was not performed in 12 cases).
 
  Painful crises, preeclampsia, and preterm birth rates were significantly higher in the group that did not receive prophylactic exchange (control group; P = .001, P = .024, and P = .027, respectively). There was one maternal mortality in the control group (P = .41). Incidence of adverse fetal or maternal complications was significantly higher in the control group (P = .044 and P = .007, respectively).
 
  Our center's experience over a 7.5-year period, as described above, demonstrates that pRBCX in SCD affects the course of pregnancy positively by ameliorating negative fetomaternal outcomes.
 Our center's experience over a 7.5-year period, as described above, demonstrates that pRBCX in SCD affects the course of pregnancy positively by ameliorating negative fetomaternal outcomes.
  Acute soft tissue injuries are common and costly. The best drug treatment for such injuries is not certain, although non-steroidal anti-inflammatory drugs (NSAIDs) are often recommended. There is concern about the use of oral opioids for acute pain leading to dependence. This is an update of a Cochrane Review published in 2015.
 
  To assess the benefits or harms of NSAIDs compared with other oral analgesics for treating acute soft tissue injuries.
 
  We searched the CENTRAL, 2020 Issue 1, MEDLINE (from 1946), and Embase (from 1980) to January 2020; other databases were searched to February 2019.
 
  We included randomised or quasi-randomised controlled trials involving people with acute soft tissue injury (sprain, strain, or contusion of a joint, ligament, tendon, or muscle occurring within 48 hours of inclusion in the study), and comparing oral NSAIDs versus paracetamol (acetaminophen), opioid, paracetamol plus opioid, or complementary and alternative medicine. The outcomes were pain, swelling, function, adversmall increase in gastrointestinal adverse events and may make no difference in neurological adverse events compared with paracetamol. Compared with opioids, NSAIDs probably make no difference to pain at one hour, and may make no difference at days four or seven. NSAIDs probably result in fewer gastrointestinal and neurological adverse effects compared with opioids. The very low-certainly evidence for all outcomes for the NSAIDs versus paracetamol with opioid combination analgesics means we are uncertain of the findings of no differences in pain or adverse effects. The current evidence should not be extrapolated to adults older than 65 years, as this group was not well represented in the studies.