JC 2026

1. A JC is an academic session in which we go through a scientific article over 60-90 min.
2. It takes place every Friday via our JC Discord channel – see calendar.
3. Its purpose is to:

- Understand, discuss and dissect relevant elements from the content.
- Appraise whether they apply to or change our clinical practice.
- Identify learning opportunities and potential research questions.

4. The selected article for the week is posted in our dedicated WhatsApp group.

5. We take interactive and pedagogic notes in a shared document, using visual aids, highlighting, underlining, arrows, and conceptual links to connect ideas and facilitate understanding.
6. For each session, we create RECAP key points and publish them on our website.

7. In the following session, we briefly recall the previous JC’s RECAP to reinforce learning through retrieval practice.

Journal CLUBS

JC’s Calendar

JC’s WhatsApp

[2025 JAMA - SOFA-2 (Ranzani) [RCT].pdf]

Codified by MLHG

Glossary:

Glossary: 🧠 = brain, 🫀 = heart, 🫁 = lungs, 🫃🏽 = abdomen = abdominal, 🩸 = blood = hematology, ♾️ = kidneys = renal, ◸ = liver = hepatic, AUROC = area under the receiver operating characteristic, icuMM = ICU mortality

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, JAMA, WW ➖ federated 🤓 ➕ 2M (>1k ICUs, 9 countries) ➕ 2014 - 2023 ➖ P I C O:
- P: P: ICU pxs
- 🅸: SOFA 1 variables 🤓
- 🅲: NA
- O: O: pOC = icuMM
3. EVIDENCE:
a. SOFA-1 in 1996
b. Changes ➩ 30 years

c. SOFA-1 does not capture DRUGS ➕ DEVICES

d. The new one should be GENERALIZABLE ➩ high-, middle-, low- income countries.

4. METHODS.

a. Expert selection (60) ▶︎ mDelphi ➕ sr ➕ internal + external validation

b. 8 stages:

i. 1-3 = identification (variables)➕ management (dysfunction)

ii. Discussions ➩ evidence gaps ➕ clinical relevance

iii. Scoreable construct ➩ defined by:

1. YES operational criteria

2. NOT precise biological truth

3. Priorities: SIMPLICITY + CLINICAL USABILITY + WIDESPREAD APPLICABILITY + - CONTENT VALIDITY.

- 6 domains: reliability ➕ content ➕ construct ➕ criterion ➕ predictive validity

INTERV ➠

- Expert input

- internal + external validation

- mDelphy - STAGE 1-5

- Expert input

- Data-driven component (SOFA-2) - STAGE 6-8

- geographical setting

- resource setting

Validity

- mDelphy ➩ predictive validity w_AUROC curve (1st day of ICU)

5. RESULTS.

1. Same 6 systems 🧠 ➖ 🫁 ➖ 🫀 ➖ ♾️ ➖ ◸ ➖ ♾️ ♾️
2. w_new variables ➕ thresholds
3. SOFA-2 (AUROC 0.79) 🆚 SOFA-1 (AUROC 0.77) 4. Sequential SOFA-2 data ➩ ICU day 1 to 7 = same predictive validity 5. No data + No validity ➩ 🫃🏽 + immune DYSF

⏳ TIME MANAGEMENT.
01:33:02

Round: 10 00:17:92 Close
Round: 9 23:26:56 Wrap-up
Round: 8 05:47:34 Results
Round: 7 01:15:95 Comments
Round: 6 10:32:13 Interpretation
Round: 5 02:18:07 Reading + notes
Round: 4 27:21:39 Interpretation
Round: 3 16:48:65 Reading + notes
Round: 2 03:21:14 ART selection
Round: 1 01:53:22 Past JC

Friday, January 30, 2026 at 17:05:52 in BE

MASP, AAQC

⏳ TIME MANAGEMENT.
01:42:18

Round: 10 00:41:09 Comments
Round: 9 17:17:59 Wrap-up
Round: 8 30:08:20 Identification (interpretation)
Round: 7 04:43:25 Identification (notes)
Round: 6 19:24:49 Definition
Round: 5 00:18:75 Titles + subtitles (4 min)
Round: 4 09:36:83 Interpretation (abstract)
Round: 3 04:52:36 Abstract (reading + notes)
Round: 2 06:28:64 ART selection
Round: 1 08:47:54 PAst JC

[2025 ICM - Cardiogenic shock diagnosis, phenotyping + mm (Moller) [r].pdf]

Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (MASP)

Glossary: ABG w_lactate = arterial blood gas, AMI-CS = acute myocardial infarction with cardiogenic shock, BP = blood pressure, CAT LAB = catheterization laboratory, CRT = capillary refill time, CS = cardiogenic shock, DX = diagnosis, ID = identification, MCS = mechanical circulatory support, PAC = pulmonary artery catheter, TTO = treatment, UO = urine output, ∑ = so, ➰ = pressure, 💨 = flow, 🤓 = analysis, 🗣 = suggestion(s), ★ = recommendation(s).

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, ICM, DN ➖ r ➕ NA ➕ NA

3. DEF.

a. ↓💨 critical → end-organ ▶︎ function

b. primary 🫀 failure ▶︎ cause

c. 🫀 cannot generate → SUFFICIENT OUTPUT ▶︎ consequence

d. despite → adequate preload ▶︎ condition
4. DX can be challenging ➩ ∑ we need HD measurements:

a. ↓ CI ▶︎ ≤2,2 “typically”

b. ↑ PCWP ▶︎ ≥15

c. LVOT-VTI ▶︎ gives SV
5. Identification
a. EARLY recognition + therapy ▶︎ cornerstone

b. Lesson from STEMI ➩ 1st “golden hour”

c. 🚑 + ER deparment

i. ID and TTO ➩ CS ➕ AMI-CS

ii. Transfer directly to CAT LAB w_MCS (STEMI, NSTEMI, CS SCAI ≥class B)

1. Class B = ↓BP ↑HR

2. Class C = ↓💨

d. 🏥 ➩ ECG 12 + tropoinin + lactate (10 min)

i. Score ORBI ➩ 🔗: Orbi Risk Score

ii. Score STOPSHOCK ➩ 🔗: 🤯 [Stop Shock calculator ]

e. SHOCK team ➩ 30min evaluation

f. Therapy ➩ 60 min af_1st medical contact.

6. Special attention.

a. ♀ ➕ old pxs ➩ ATYPICAL symptoms

b. Younger ➩ ↓ likelihood ➩ ∑↑ likelihood to MISS CS DX.

7. Af_DX ➩ monitoring (BP, ECG, ABG w_lactate, UO)

a. response

b. progression

8. ECHO is mandatory ➩ severity ➕ etiology ➕ phenotyping.

9. PAC ➩ IF a) unresponsive to INITIAL therapy, b) DX uncertainty (not supported by RCTs)

10. Clinical tools ➩ mottling ➕ CRT

11. Microcirculation

a. may persist DESPITE NORMAL macrocirculation.

b. Method ➩ sidestream dark field imaging.

c. DAMIS trial ▶︎ sublingual microcirculation in mixed CS population ▶︎ led to mm changes BUT did not correlate w_↑OC.

Friday, January 16, 2026 at 17:15:00 in BE

MASP, AAQC, PFLC, MNVC

January, 2026

February, 2026

Brief scope glossary

- 𝙄𝙌𝘾 BS 🟰 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ brief scope 🟰 Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:

- year (Y), journal (J), country (C) ➖ type of study (T) ➕ patients/sample number (N) ➕ time (t) ➖ population (P), intervention (I), comparison (C), outcome (OC).

Glossary (most used)

⚡️ = cardiac arrest, 🤓 = analysis, 💨 = flow, 📈 = arrhythmia, 🗣 = suggestion(s), 🩸 = blood = hematology, 🪲 = infections, 🧠 = brain, 🫀 = heart, 🫁 = lungs, 🫃🏽 = abdomen = abdominal, ♾️ = kidneys = renal, ◸ = liver = hepatic, ➰ = pressure, 💪🏽 = muscle, ⭕️ = circulation, 🥊 = inflammation, ★ = recommendation(s), ↑ = increase, ↓ = decrease, ↗️ = improve, ↘️ = worsen, 𝗘𝗫 = exclusion, 𝗜𝗡 = inclusion, CIpxs = critically ill patients, DX = diagnosis, h_LOS = Hospital length of stay, icu_LOS = ICU length of stay, inc_ = incident, MA = metaanalysis, mc = multicentric, MM = mortality, MM90 = mortality at 90 days, pOC = primary outcome(s), pxs = patients, RCT = randomized controlled trial, sOC = secondary outcome(s), sr = systematic review, SS = survival, w_ = with, wo_ = without, yo = years old.

Complete glossary here

Friday, February 20, 2026 at 17:08:25 in BE

MASP, AAQC

2025 JAMA - The CDC No Longer Recommends C19 Shots During Pregnancy Now What (rubin) [mn].pdf

Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary: CATE = conditional average treatment effect, cHTA = chronic hypertension, CKD = chronic kidney disease, f = CDC Advisory Committee for Immunization Practices, FRT-CI = Fisher Randomization Test for Confidence Intervals, NE = norepinephrine, RRT = renal replacement therapy, UP = urine output, VP_fd = vasopressor free days.

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:

2. 𝙄𝙌𝘾 BS 🟰 2025, ICM, FR ➖ post-HOC ➕ 776 ➕ Mar 2010 - Dec 2011 ➖ P I C O:
- P: septic shock
- 🅸: MAP 80-85
- 🅲: MAP 65-70
- O: pOC = heterogeneity of treatment effect (HTE) | sOC = variable trajectories (MAP ➕ NE ➕ lactate ➕ mottling ➕ UO)
3. EVIDENCE:
a. 2014 NEJM - SEPSIS PAM (asfar)

i. 2014, NEJM, FR ➖ mc_prag_RCT ➕ 776 ➕ Mar 2010 - Dec 2011 ➖ 🅿️ Septic shock, 🅸 MAP 80-85 🅲 MAP 65-70 🅾️ pOC = MM28 | sOC = MM90 ➕ AKI ➕ sAKI ➕ nRRT 7d➕ RRT ➕ VP_fd.

ii. cHTA in high MAP group = ↓ RRT ▶︎ heterogeneity may exist 🤔
b. SSC 2021 implemented ➩ MAP 65
c. Debate (higher BP better?) ➩ chronic HTA ⌄ CKD
d. Personalized approach ➩ has been repeatedely called out.
e. FRT-CI helps TESTING heterogeneity ▶︎ if substantial heterogeneity, CATE helps

4. METHODS.

- INTERV ➠ during 24h af_ VP start.

- Step 1. Randomization inference ➕ FRT
- Step 2. CATE ➕ HTE variables <10%

- Prespecified trajectories:

- MAP. 80% of hourly MAP values (met 🆚 unmet)
- Lactate. ≥ 🆚 < 2 d_1st 24h
- UO: ≥ 🆚 < 0.5 d_1st 24h
- Mottling. yes 🆚 no d_1st 24h

- Unadjusted ➩ then adjusted ▶︎ logistic regression models ➕ alluvial plots.

- Multi-mediation analyses w_4 randomization components: UO, lactate, mottling, NE ↔ MAP goal responsiveness

5. RESULTS.

1. Not meeting targets ➩ ↑r MM
2. MAP not reached ➕ UO ↓ (24h) ➕ lactaet ↑ (24h) ➕ mottling (24h) 🟰 ↑r MM
3. The indirect effect was driven by NE exposure ➕ mottling.
4. See table 3

⏳ TIME MANAGEMENT.
01:43:52

Round: 9 00:53:23 Comments
Round: 8 42:13:02 Interpretation all
Round: 7 08:52:45 Interpretation
Round: 6 02:51:21 I: read + notes
Round: 5 05:10:92 Structure
Round: 4 19:19:16 Reading + notes + interpretation
Round: 3 06:37:83 ART selection
Round: 2 00:35:50 Comments

Round: 1 17:19:20 Past JC

2025 ICM - Echocardiography guided management of AFib (Balik) [nr].pdf

Codified by YAPG

Glossary: 📈 = arrhthmias, 🗣 = suggestion(s), 🫀 = heart, 🫀 SØ = cardiogenic shock, 🫁 = lungs, AF = Atrial fibrilation, AL = afterload, antiCOA = anticoagulation, CCE = critical care echocardiography, DISF = disfunction, HD = hemodynamic, HR = heart rate, IVC = inferior vena cava, LVSF = left ventricular systolic function, LVF = Left ventricular filling, mm = management, MV = mechanical ventilated, NOAF = new onset atrial fibrillation, PH = pulmonary hypertension, RAP = right atrial pressure, r = risk, S&D = systolic and diastolic

1. EVIDENCE:

a. AF ➩ ↑ incidence
b. In the ICU is MORE impactful ➩ aggravated by illness severity
c. NOAF ➩ independent predictor MM
d. 🫀 GL ▶︎ MAJOR TRIALs:

i. ambulatory pxs
ii. different DEGREES ventricular S&D DYSF.
iii. Variable dependences of LVF on ATRIAL SYSTOLE.

e. Rate control ➕ antiCOA ➕ LIMITING any 🫀 depression in structural DIS scenarios (🗣) 🟰 emphasis

2. CCE:

a. Diagnosis + monitoring. ➩ in HD unstable pxs
b. ID risk factors
c. ID parameters ↔ 📈 chronicity
d. Guides therapy (sinus rhythm return) ➩ rhythm control
e. Decide: rhythm 🆚 rate CONTROL
f. Monitors ➩ left atrial recovery post cardioversion
g. Conflicting mm goals ➩ **anticoagulation** (especially in significant r of bleeding)

3. LIMITED DATA ➩ ACUTE benefits of rhythm OVER rate control ▶︎ long-term seems to be the same.

4. RCTs failed to CONSIDER the **degree** of “pre-existing LV S&D DYSF” (important for acutely decompensated pxs)
5. Rhythm control might be useful in certain populations ➩ PHYSIOLOGICAL RATIONALE.
6. CCE ➩ structure + function + risk stratification + mm guidance
7. LVSF ➩ ↑ incidence 📈: atrial ➕ ventricular. Prevalence:

a. 10-15% = AF w_moderate ↓ LVEF
b. 49% = AF w_severe ↓ LVEF

8. NOAF ↔ LVEF <35% ➩ non 🫀 CIpxs
9. RIght ventricule + PH

a. RV Dilatation ↔ 📈
b. AF prevalence 26-31% in all forms of PH
c. 📈 INDICATE (harginger) of clinical deterioration w_RV failure (context: PH)
d. RA change ➩ spherical remodelling ➕ ↑ RAP ▶︎ ↔ ↑ AF prevalence
e. MV pxs w_SØ ➩ PH (SPAP ≥51) after cardioversion ↔ MULTIPLE AF RECURRENCES.
f. 🫀 GL ▶︎ use PEAK TRICUSPID PRESSURE GRADIENT wo_RAP (IVC diameter + respiratory variation) ➩ although CVC is present (RAP is feasible)

10. Cor pulmonale

a. May TRIGGER AF ➩ ↑ HD instability
b. Chronic PH ➩ RV develops adaptaive wall hypertrophy ➩ ↑ systolic pressure to counteract the AL.
c. IF ↪︎ ↓ RV contractility, ↪︎ RV failure ➕ 🫀 SØ [NOAF or ↑HR]

Friday, February 13, 2026 at 17:08:15 in BE

MASP, AAQC, PFLC, MNVC

⏳ TIME MANAGEMENT.
01:39:50

Round: 11 01:09:41 Comments
Round: 10 40:00:54 Wrap-up
Round: 9 14:52:95 Interpretation
Round: 8 02:56:81 Reading + notes
Round: 7 08:52:19 Interpretation
Round: 6 04:12:06 REading + notes
Round: 5 11:53:50 Interpretation
Round: 4 03:10:69 Reading + notes
Round: 3 04:19:05 ART selection
Round: 2 00:55:75 Comments

Round: 1 07:27:80 Past JC

Friday, February 27, 2026 at 17:05:25 in BE

MASP, AAQC, PFLC, MNVC

⏳ TIME MANAGEMENT.
01:29:16

Round: 10 01:59:19 Comments
Round: 5 15:02:89 Wrap-up
Round: 4 07:09:52 Interpretation
Round: 3 05:49:09 Reading + notes
Round: 2 03:07:86 ART selection
Round: 1 07:57:68 Past JC + 10min

2026 FPHYS - Real-time change in Dynamic CAR af_acupuncture at GB34 Yanglingquan, a self-controlled study (ZHANG) [R].pdf

Codified by YAPG

Glossary: ABP = arterial blood pressure, AdvEve = adverse events, af_ = after, BMI = body mass index, BP = blood pressure, CA = cerebral autoregulation, CBF = cerebral blood flow, dCA = dynamic cerebral autoregulation, DIS = disease, DM = diabetes mellitus, EtCO₂ = End-tidal carbon dioxide, GAD = generalized anxiety disorder, HR = heart rate, LF = low frequency, MCA = middle cerebral artery, MIN = minimum, NO DIFF = no difference, PV = phase value, SAH = subarachnoid hemorrhage, VRBPAC = FDA’s Vaccines and Related Biological Products Advisory Committee, ↑THY = hyperthyroidism, 🥃 = alcohol consumption, 🚬 = tabaquism, 🧠 = brain

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:

2. 𝙄𝙌𝘾 BS 🟰 2026, FP, CH ➖ sef-con_INT cross-over ➕ 20 healthy ➕ Sep — Dec 2021 ➖ P I C O:

- P: Healthy volunteers
- 🅸: 2 acupunture interventions (active)
- 🅲: Sham acupuncture
- O:pOC = ←→phase levels af_GB34 | sOC = other CA parameters, MCA velocity, mean BP, HR af_GB34.
3. EVIDENCE:
a. CA ➩ 🧠 maintains CBF despite ABP changes.
b. dCA ➩ transient response of CBF to rapid changes of BP ▶︎ compromised:

1. Stroke
2. SAH

3. Parkinson
4. Panic disorder

5. DM
6. Depression

c. 3. Few 🅸 ↑ CA function.
d. Acupuncture ➩ popular in China ➩ ✔︎ clinical effects ➕ ↓ AdvEve
e. GB34 = Yanglingquan ➩ common function TTO in the clinic ▶︎ used for:

i. Stroke
ii. Parkinson

f. GB34 ➩ ↑ CO2 reactivity in the ipsilateral MCA ➩ ↗️ vasodilatory potential of 🧠 vasculature.

4. METHODS.

- 𝗘𝗫 ➠ mental diseases + cerebrovascular DIS + TBI + HTA + 📈 + DM + ↑THY + GAD + depression + insomnia ➕ 🥃 ⌄ 🚬 ➕ poor cooperation, bone window.

- INTERV ➠ each par = 2 acupuncture 🅸

- sterile, single-use needle
- 20mm depth
- Deqi sensation = needle reaction
- 20s stimulation
- 1 week interval ↔ acupuncture 🅸
- Sequence of stimulus ➩ active, sham.
- dCA measurements ➩ quiet room, controlled room, same technician.
- Par AVOIDED ▶︎ ↑ caloric meals (4h MIN), mod-vig exercise (12h MIN), coffee + 🚬 + chocolate + 🥃 (12h MIN).
- 15-min rest.

- TCD + photoplethysmography + EtCO2
- dCA recording for 30 min ▶︎ including 10min ← acupuncture + 10min → needle removal.
- TFA for CBFV + BP [page 3 detailed]

5. RESULTS.

1. NO DIFF age ➕ BMI
2. NO changes 🟰 mean MCA + BP + EtCO2
3. Left & right PV in LF band af_GB34 🟰 🅸 ↑ than baseline.
4. Other dCA af_GB34 🟰 NO DIFF than baseline
5. No real-time changes in dCA ➩ in SHAM.
6. Real-time changes in HR af_GB34. ➩ ↓ hrvCAR mentioned

March, 2026

Friday, March 27, 2026 at 17:05:30 in BE

LH, EQO, HIBN, MASP, AAQC

2026 AIC - Subphenotyping hypotension in early S•, A physiology-guided therapeutic approach (sanchez) [ed].pdf

Codified by YAPG

GLOSSARY: ★ = recommendation(s), DAP = diastolic arterial pressure, DSI = diastolic shock index, HD = hemodynamics, Mech = mechanism, PP = pulse pressure, SAP = systolic arterial pressure, SV = stroke volume, artT = arterial tone, vT = vascular tone, venT = venous tone, 💨 = perfusion, 🫀 DYSF = cardiac dysfunction

1. Continuation…
2. Subphenotypes (3)

a. ↓VOL

i. Mech ▶︎ ABSOLUTE ↓VOL ↔ INF ➕ preserved vT
ii. HD ▶︎

1. ↓CO secondary to ↓SV ➩ ↓PP ➩ ↓MAP
a. PP = SAP - DAP
2. HR ↑ as a compensatory mech
3. DAP not ↓ (if vT is preserved)

iii. TTO response ▶︎

1. When ↓BP + ↓ peripheral 💨 ➩ FR is needed, to ↑:

a. Stressed 🩸 volume
b. venous return
c. SV

b. ↓ vT

i. Mech ▶︎

1. ↓ artT + venT
2. Venous DILATION ➩ relative ↓VOL (redistribution: stressed → unstressed 🩸VOL)

ii. HD ▶︎

1. Causes: ↓ DAP + ↑ DSI (DSI = HR/DAP)
2. MAP is ↓
3. CO is variable, depending: DEGREE of “relative ↓ VOL” → ↓ vT
4. TTO response ▶︎

a. IF “↓BP + peripheral ↓💨” , NE is the TTO.

i.. alfa 1 - adrenergic
ii. ↑ artT ➩ ↑DAP + MAP
iii. ↑ venT ➩ moves 🩸 → stressed compartment.

c.🫀 DYSF

i. Mech ▶︎

1. 🫀 depression ↔ S•
2. Impaired CONTRACTILITY

ii. HD ▶︎

1. ↓ SV
2. ↓ PP
3. ↓ MAP
4. DAP preserved
5. DIFFICULT to distinguish FROM ↓VOL, so consider other factors:

a. context
b. previous 🫀 DIS
c. CV comorbidities
d. Clinical findings (🫁 edema)

6. ECHO is needed.

iii. TTO response ▶︎

1. Inotropic.

d. MIXED

⏳ TIME MANAGEMENT
02:29:16

Round: 10 01:59:19 Comments
Round: 9 11:47:81 Wrap-up
Round: 8 12:03:26 Interpretation
Round: 7 03:32:76 Reading + notes
Round: 6 01:17:72 Comments
Round: 5 15:02:89 Wrap-up
Round: 4 07:09:52 Interpretation
Round: 3 05:49:09 Reading + notes
Round: 2 03:07:86 ART selection
Round: 1 07:57:68 Past JR + 10min

2026 AIC - Subphenotyping hypotension in early S•, A physiology-guided therapeutic approach (sanchez) [ed].pdf

Codified by YAPG

Glossary: ACIP = CDC Advisory Committee for Immunization Practices, cHTA = chronic hypertension, CRT = capillary refill time, DAP = diastolic arterial presssure, DM = diabetes, DSI = diastolic shock index, DYSF = dysfunction, PP = pulse pressure, SAP = systolic arterial pressure, SI = shock index, VRBPAC = FDA’s Vaccines and Related Biological Products Advisory Committee

1. ↓ MAP ➩ poor OC

2. S• induced ↓BP ▶︎

a. ↓ VOL ➩ preload
b. ↓ vascular tone ➩ afterload
c. 🫀 DYSF ➩ contractility
d. Combination
3. Vasoplegia does NOT allow ↑ tissue perfusion

4. FLUID ACCUMULATION ➩ worse OC
5. Concerns ▶︎ need for early subphenotype-tailored therapeutic strategy.
6. Bedside variables to guide therapy:
a. CRT. Does not define ↓AP subphenotype alone, but CENTRAL to decision-making

i. Prolonged = need for therapy.

ii. Normal = correction of ↓➰ unnecessary UNLESS other signs of ↓💨 (altered mental status)

iii. Its RESPONSE helps identify the underlying mech and the plan (continue ⌄ change ).
b. PP.

i. ↓PP = ↓SV
ii. Arterial stiffness 🚨
iii. Elderly + cHTA + DM ▶︎ “apparently” normal (40-50 mmHg) 🟰 ↓SV

c. DAP.

i. Except ↓HR, ↓ DAP (<45-50) 🟰 ↓ vascular tone
d. DSI

i. HR / DAP.
ii. ↑DSI (>3) ▶︎ severe VASODILATION
iii. More reliably than ↓DAP
iv. ≠ SI ▶︎ HR / SAP.

4. P-PHY subphenotypes

a. ↓VOL
b. ↓ vascular tone
c. 🫀 DYSF

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
- 🅸: preg hALT
- 🅲: preg non-hALT
- O: pOC = hALT impact on LBW, SGA, SPTB | sOC = magnitude LBW

3. EVIDENCE.
4. METHODS.

- 𝗜𝗡 ➠
- 𝗘𝗫 ➠
- RANDOM ➠
- INTERV ➠

5. RESULTS.
6. RATIONALE.7. LIMITATIONS.

Friday, March 13, 2026 at 16:31:12 in BE

MASP, AAQC, PFLC, MNVC

⏳ TIME MANAGEMENT.
01:01:21

Round: 6 03:29:58 Comments
Round: 5 28:48:61 Interpretaion
Round: 4 09:56:25 Reading + notes
Round: 3 07:27:69 ART selection
Round: 2 01:37:51 Comments

Round: 1 10:01:43 Past JC

2026 BMJ - Careful ventilation in ARDS (Coudroy) [RCT].pdf

Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (MASP)

Glossary: c-ARDS = COVID ARDS, d_ = duration, d_MV = duration of mechanical ventilation, EFF = efforts, hLOS = hospital length of stay, icuLOS = ICU length of stay, inspE = inspiratory effort, oDYS = organ dysfunction, Paw = airway pressure, Pinsp = inspiratory pressure, PSILI = patient self-induced lung injury, s&s = stress and strain, SOC = standard of care, s-t = short-term, VILI = ventilator- induced lung injury

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:

2. 𝙄𝙌𝘾 BS 🟰 2026, BMJo, ARG + CA + CL + FR + IT + ES + NL + US ➖ invest-led_mc_ol_RCT (basket) ➕ 740 ➕ 6y (Nov 2020 - Jul 2026) ➖ P I C O:

🅿: ARDS & c-ARDS

🅸: 2 ventilatory strategies

🅲: SOC

🅾: pOC = MM60 | sOC = d_MV ➕ d_icuLOS & hLOS

3. EVIDENCE

a. 10% of ICU admissions is ARDS
b. 23% of ventilated pxs is ARDS
c. s-t MM is 40% 😳
d. Causes: 🫁 , S•, TRAUMA, pancreatitis
e. 🫁 ➩ inflamed + edematosos ➩ ↓ volume + compliance ▶︎ difficult ventilation
f. MV can cause VILI ➩ adverse HD consequences
g. c-ARD ➩ severe form ➕ complex physiology ➕ varies widely ➕ ★ uncertain. ▶︎ ↑ ↑ ↑ MM
h. NO TTO for the alveolar-capillary leak
i. YES supportive TTO ➩ MV ➕ NMB ➕ prone
j. RCT ▶︎ GL ▶︎ ↓r VILI w_: ↓Vt ➕ ↓Paw ➩ ↓ stress & strain
k. Other STUDIES ▶︎ contemporary strategies are NOT SUFFICIENTLY protective.
l. PEEP is not used properly:

i. ↓ atelectrauma 🟰 opening + closing of alveoli
ii. ↑ recruitment 🟰 ↑ aerated 🫁 →∑ ↓ s&s

m. ↑ ↑ ↑ PEEP ➩ ↑MM [when alveoli NOT recruitable]
n. Authos described a technique to measure ALVEOLAR RECRUITABILITY
o. Spontaneous breathing & assisted MV ➩ PSILI
p. 🫁 DRIVE ▶︎ ⊕ 🫁 ➕ systemic INFLAMMATION ➕ unmyelinated afferent fibres ➕ slow & rapid adaptive receptors (nociceptive stimuli + blunted ⊖ response).

i. ↑ in ARDS pxs
ii. ↑ ↑ in c-ARDS pxs
iii. ↔ ↑d_MV
iv. ↑ MM

q. 🫁 inspE ▶︎ ↑ distending (transpulmonary) pressure ▶︎ 🫁 🥊 ➕ oDYS
r. HYPOTHESIS: 🫁 injury ↓ ➕ SS ↑

i. individualizing PEEP
ii. ↓ MAX Pinsp
iii. ↓ magnitude spontaneous breathing EFF

s. PEEP

i. Set wo_knowledge of the potential of recruit – only set on O2
ii. ← RCTs compared 2 levels of PEEP ➩ BUT, none looked at 🫁 recruitment.
iii. Noncrecuitable 🟰 r_overdistention
iv. Recruitable 🟰 repetitive 🫁 open-close
v. ★ ➩ ↑ PEEP but individual ★ vary.

vi. List

4. SOURCE: https://pubmed.ncbi.nlm.nih.gov/41730551/

⏳ TIME MANAGEMENT.
02:29:16

Friday, April 24, 2026 at 18:35:53 in BE

TGA, MASP, AAQC, HIBN

2026 AIC - Subphenotyping hypotension in early S•, A physiology-guided therapeutic approach (sanchez) [ed].pdf

Codified by YAPG

Glossary: d_ = during, FR = fluiid responsiveness, hLOS = hospital lenght of stay, iFR = fluid responsiveness indices, ivT-R = indices of vascular tone responsiveness, r⌄i = responsiveness or intolerance, SUPP = support, VA = vasoactives, µCIR = microcirculatory, 🫀 = heart, 🫁 = lungs

1. Mixed subphenotypes:

a. SEPSIS ➩ combinations:

i. ↓VOL + ↓vT

1. ↓ PP + ↓ DAP

2. TTO ➩ fluids + NE

3. Delaying NE is RISKY ▶︎

a. fluids may worsen VASODILATION.

b. early NE movilizes VENOUS BLOOD

ii. 🫀DYSF + ↓vT ⌄ 🫀DYSF + ↓VOL. Before DOBUTAMINE:

1. Dx 🫀 DYSF should be WELL STABLISHED.

2. ANY ↓VOL ➕ ↓vT SHOULD BE corrected. If Dobuta:

a. Poorly tolerated.

b. ↘️ ↓vT

iii. MIXED 3 mechs ➩ varying proportions (emerging + receding + combining to ≠ degrees)

2. Beyond early subphenotyping
a. Subphenotying is not all.
b. Additional considerations:
i. MAP targets

ii. FR r⌄i

iii. VP r⌄i

iv. Evolving µCIR behavior

v. need ongoing ADJUSTMENT

c. Advanced clinical TOOL

i. ScvO2
ii. ∆CO2
iii. iFR
iv. ivT-R
v. VExUS

d. More invasive HD monitoring ➩ in COMPLEX CASES

i. unresponsive to initial therapy
ii. fluid benefit-risk assessment (e.g. ARDS)

e. Integration of all ➩ implementation of a PESRONALIZED, PX TAILORED APPROACH.

3. CLIINICAL IMPLICATIONS

a. Subphenotyping is a KEY STEP → precision resuscitation.
b. When combined w_CLINICAL CONTEXT ➕ SIMPLE BEDSIDE MARKERS 🟰 ID mechs ▶︎ administer fluids, VP, INO, ⌄ combination.
c. Recent evidence ▶︎ ANDROMEDA-SHOCK-2

i. ↑ OC
ii. 🅸 CRT-PHR = personalized hemodynamic resuscitation protocol
targeting capillary refill time
iii. pOC = combined: MM ➕ d_vital SUPP (VA, MV, RRT) ➕ hLOS 28d
iv. 🅸 (better) 🆚 usual care

⏳ TIME MANAGEMENT.
01:48:07

Round: 7 01:11:38 Comments
Round: 6 21:12:56 Wrap-up
Round: 5 41:46:90 Interpretation
Round: 4 03:56:96 Reading + notes
Round: 3 00:14:59 Same topic
Round: 2 37:30:69 Continue wrap-up
Round: 1 02:13:96 Past JC

Friday, April 10, 2026 at 18:15:06 in BE

SR, HBN, EQO, MASP, AAQC

April, 2026

2026 ICM - Temporary mechanical support in fulminant myocarditis, prognostic factors + clinical implications, FULLMOON study (Schmidt) [R].pdf

Codified by YAPG

Glossary: AdvOC = adverse outcomes, EMB = endomyocardial biopsy, FM = fulminant myocarditis, HTx = heart transplantation, LVAD = left-ventricular assist device, t-MCS = temporary mechanical circulatory support, wOC = worse outcome.

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:

2. 𝙄𝙌𝘾 BS 🟰 2026, ICM, 15C ➖ cohort FULMOON (int_mc_retro_”registry”) ➕ 295/419 pxs (36 centers)➕ Jan 2008 - Jan 2020 (12y) ➖ P I C O:

🅿: FM + V-A ECMO ± impella

🅸: NA

🅲: NA

🅾: pOC = MM 1y ⌄ HTx ⌄ LVAD

3. EVIDENCE

a. FULLMOON ▶︎ EHJ 2023, Huang et al. ➩ DX made by:

i. histologically = 50%
ii. autopsy = 28%
iii. MRI = 23%

b. t-MCS ▶︎ ↑ used in FM ➩ OC + rf are POORLY DEFINED.

4. METHODS.

Multivariate Cox regression ➩ predictors of AdvOC
Propensity score-weighted 🤓 ➩ EMB:
- early ≤2d
- delayed >2d
- none

5. RESULTS.

a. Age 39y (55% ♀)

b. Confirmed 69% (histological + MRI)

c. Causes:

i. HTA
ii.🩸 hh
iii. SSØ

d. UNIVARIATE

i. diastolic HTA (RR 2,7. p=0.0001) AUROC 0,58. p=0.003
ii. severe bleeding > 1000mL (RR 11. p=0.0001) AUROC 0,56. p=0.03
iii. CRT > 3,5s (RR 14,2. p=0.0001) AUROC 0,72. p=0.001

e. MULTIVARIATE

i. severe bleeding > 1000mL
ii. CRT > 3,5s

f. Better RR with CRT.

Friday, May 29, 2026 at 18:14:30 in BE

TGA, KYEC, MLHG, HIBN, AAQC,

⏳ TIME MANAGEMENT.
01:25:51

Round: 6 02:13:52 Comments
Round: 5 25:07:88 RECAP
Round: 4 36:11:17 Interpretation
Round: 3 09:30:58 Reading + notes
Round: 2 05:32:34 JR selection
Round: 1 07:16:23 Past JR

Friday, May 29, 2026 at 18:14:30 in BE

TGA, KYEC, MLHG, HIBN, AAQC,

6. RATIONALE

a. Pregnancy is related to microcirculation derangements.

b. Sublingual alterations shown.
c. Strong prolonged CRT ↔ sublingual µCIR ➩ SSØ
d. Current TTO might MODULATE this network.

7. SOURCE: Monares Zepeda et al. Critical Care https://doi.org/10.1186/s13054-025-05404-9 (2025) 29:231

2026 BMJ - CAVIARDS, careful ventilation in ARDS (Coudroy) [RCT].pdf

Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (MASP)

Glossary: c-ARDS = COVID ARDS, d_ = duration, d_MV = duration of mechanical ventilation, EFF = efforts, hLOS = hospital length of stay, hPEEP = high PEEP, icuLOS = ICU length of stay, inspE = inspiratory effort, NRD = neural respiratory drive ✩, oDYS = organ dysfunction, Paw = airway pressure, Pinsp = inspiratory pressure, Pplat = plateau pressure, PSILI = patient self-induced lung injury, Ptp = transpulmonary pressure, REC = recruitability, rf = risk factors, s&s = stress and strain, SOC = standard of care, s-t = short-term, VILI = ventilator- induced lung injury

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:

2. 𝙄𝙌𝘾 BS 🟰 2026, BMJo, ARG + CA + CL + FR + IT + ES + NL + US ➖ invest-led_mc_ol_RCT (basket) ➕ 740 ➕ 6y (Nov 2020 - Jul 2026) ➖ P I C O:

🅿: ARDS & c-ARDS

🅸: 2 ventilatory strategies

🅲: SOC

🅾: pOC = MM60 | sOC = d_MV ➕ d_icuLOS & hLOS

3. EVIDENCE

a. 2 criteria to set PEEP (for this study):

i. R/I ratio → for predicting alv_REC
ii. «One-breath decremental PEEP» → distinguishes: recruitable 🆚 non-recruitable
iii. <5min
iv. It should:

1. avoid harm of hPEEP (when not recruitable)
2. allow hPEEP only when recruitable

v. This happens when R/I >0.5.

b. Airway closure

i. Complete closure is >5 cmH2O ➩ 30-40% ➩ defines the minimum PEEP.
ii. Humans and animal might have the same damage.
iii. Pressure-time curve helps detecting it. (low-flow inflation)
iv. PRO: (due to better understanding of the alveoli than Paw)

1. avoiding repeated opening-closure.
2. corrects assessment of plateau + driving P

v. Necessary step BEFORE measuring recruitability.

c. Maximal inp distending P

i. Assessed by Pplat → to titrate Vt
ii. GL ▶︎ limits Vt + Paw + PEEP

d. 🫁 drive ➕ spontaneous breathing effort

i. D_SPONTANEOUS breathing: ↑ resp drive ➕ large resp efforts 🟰 PSILI + diaphragm DYS
ii. 2018 ICM, Brochard… 2020 BLUE, Rittayamai ➩ P0.1

1. simple tool on ventilator
2. Reflects: NRD ➩ guide level os assistance + sedation.
3. ∑ ↓r: excessive Ptp ➩ ↓ rPSILI

iii. MECHS assessment CONTROLS the 3rf (underlined above)
iv. MECHS:

1. alveoli recruitability
2. R/I ratio
3. total PEEP
4. Pplat
5. ∆P
6. resp system COMPLIANCE

7. P0.1

e. HYPOTHESIS. individualizing ventilator setting based on RESP MECHS → more effective ✔︎

⏳ TIME MANAGEMENT.
01:22:05

Round: 7 02:33:44 Comments
Round: 6 29:57:18 RECAP
Round: 5 11:17:01 Interpretation
Round: 4 01:13:60 Reading + notes
Round: 3 23:06:18 Evidence (2nd part)
Round: 2 13:21:09 JC continuation
Round: 1 00:37:39 PAst JC

Friday, May 8, 2026 at 18:30:59 in BE

SC, TGA, RCH, BAR, DEPZ, YAPG, HIBN, AAQC,

May, 2026

June, 2026

2025 JAMA - BICARICU-2, Sodium Bicarbonate for Severe Metabolic Acidemia + AKI (jung) [RCT].pdf

Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (MASP)

Glossary:
🧠 = brain
🫁 = lungs
🫀 = heart
🫃🏽 = abdomen = abdominal

◸ = liver = hepatic
♾️ = kidneys = renal
🩸= blood = hematology
🪲 = infections
💨 = flow
➰ = pressure
🤓 = analysis;
⚡️ = cardiac arrest;
📈 = arrhythmia;
🗣 = suggestion(s)

★ = recommendation(s)

AF = atrial fibrillation;

VRBPAC = FDA’s Vaccines and Related Bio-
logical Products Advisory Committee

ACIP = CDC Advisory Committee for Immunization Practices

sev = severe

MeAc = metabolic acidemia

OS = organ suport

VP = vasopressors

iMV = invasive mechanical ventilation

FLU = fluid balance

MAKE = major adverse kidney events

NO DIFF = no difference

imp_ = impairment

DYS = dysfunction

OF = organ failure

S• = sepsis

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:

2. 𝙄𝙌𝘾 BS 🟰 2025, JAMA, FR ➖ ol_ii_mc_RCT ➕ 640 → 627 (313 🆚 314) [43 ICUs] ➕ -Oct 2019 - Dec 2023 | ƒ-up 90d (last 2024) ➖ P I C O:

🅿: Adults (sev_MeAc ➕ sev&mod_AKI)

🅸: HCO3

🅲: no HCO3

🅾:

pOC = MM90
sOC = MM28 + MM180 ➕ OS therapy ➕ VP ➕ iMV ➕ “icu_ & h_” LOS ➕ icu_INF ➕ FLU ➕ SOFA 7 ➕ MAKE 90 (they are 18 sOC)

3. EVIDENCE

a. Effects of HCO3 in 🅿 are ❓

b. pH ≤ 7,2:

i. = 🫀
1. imp_contractility
2. 📈
ii. 🩸: systemic vasodilation
iii. ♾️: imp_ blood 💨
iv. 🧠: edema
v. 🫁: diaphragmatic DYS

c. CAUSES (MeAc), d_AKI:

i. ↑Cl acidosis
ii. ↑ Lac
iii. ↑ endogenous anion

d. BICARICU-1

i. ✔︎ Na HCO3 4,2% 🅸 🆚 ✖︎ Na HCO3 🅲
ii. 🅿 sev_MeAc
iii. pOC = MM28 ⌄ OF 7d ⌄ both ➩ 𝗡𝗢 𝗗𝗜𝗙𝗙

iv. Preplanned 🤓

e. OBSERVATIONAL

i. Benefits 🅸:

1. sev_MeAc + sev_AKI ➕ very sev_MeAc (pH < 7,15) ▶︎ ICM 2018 ➕ CCM 2019 2. >60yo ➕ S• ➕ mod_Ac ▶︎ Front Pharmacol.2023

f. TARGET TRIAL EMULATION

i. >6k pxs
ii. HCO3 ↔ ↓ MM30
g. STUDIES

i. AKIKI (NEJM 2016)
ii. AKIKI-2 (LANCET 2021)

iii. CRICS TRIGGERSEP (NEJM 2018)

iv. STARRT-AKI (NEJM 2020)

4. METHODS.

𝗜𝗡 ➠
𝗘𝗫 ➠:
RANDOM ➠ 1:1
INTERV ➠
- Target → pH ≥ 7,30
DEFINITIONS ➠
sev_MeAc = pH ≤ 7,20

5. RESULTS.

a. 67yo ➖ 59% ♂︎

b. 62% 🅸

c. MM90 (p = 0.91)

i. 62,1% → 🅸
ii. 61,7% → 🅲

d. acMM 28 & 180 → NO DIFF

e. RRT (-23.1 to -7.8)

i. 35% → 🅸
ii. 50% → 🅲

f. Others → NO DIFF

6. RATIONALE.

7. LIMITATIONS.

8. SOURCE:

Friday, June 26, 2026 at 18:49:35

EQO, OWGG, BAR, SLDC, HIBN, AAQC,

⏳ TIME MANAGEMENT.
01:39:58

Round: 8 00:41:90 Comments
Round: 7 30:02:31 Intepretation + RECAP
Round: 6 03:10:67 Introduction (reading + notes)
Round: 5 37:26:06 Interpretation + RECAP
Round: 4 03:57:56 Reading + notes
Round: 3 10:39:32 ART selection
Round: 2 00:53:33 Comments
Round: 1 13:07:48 Last JC

⏳ TIME MANAGEMENT.
01:49:10

Round: 8 00:29:27 Comments
Round: 7 26:27:83 Article
Round: 6 43:03:47 RECAP
Round: 5 13:15:33 Interpretation
Round: 4 03:41:82 Reading + notes
Round: 3 13:02:43 ART selection
Round: 2 00:36:18 CommentsRound: 1 08:33:92 Past JC

6. RATIONALE.

a. The benefit was seen since 2y
b. NNT 1 = 35 (95% CI, 24 5o 53)
c. PROGRESS pxs who participated = 660

i. perindopril ± indapamide 🆚 placebo
ii. 4y
iii. ↓BP 11/4 ↔ ↓r S† (49%)

d. ol_T:

i. 🅸: more intensive 🆚 🅲: less intensive
ii. ®: **↓**r_rec_IH = 🅸 ➩ in pxs w_prev_”iS† ⌄ IH”

e. Cohort + mendelian RAN

i. BP ↔ IH

7. SOURCE: Trident Research Group, Anderson CS, Chow CK, et al. Three Low-Dose Antihypertensive Agents in a Single Pill after Intracerebral Hemorrhage. N Engl J Med. 2026;394(16):1571-1582. doi:10.1056/NEJMoa2515043

5. RESULTS.

a. 58yo

b. Recurrent S† (p=0.02) →

i. 4,6% → 🅸
ii. 7,4% → 🅲

c. SBP (mmHg) (p<0.001)

i. 127 → 🅸
ii. 138 → 🅲

d. MACE (p=0.04)

i. 6.6% → 🅸
ii. 9.8% → 🅲

e. Æ

i. 23,2% → 🅸
ii. 26% → 🅲

f. Discontinuation

i. 13,6% → 🅸
ii. 6% → 🅲
iii. most common Æ → ↑ crea ≥20%

g. MM 🫀 (p=0.21)

i. 2% → 🅸
ii. 3% → 🅲

h. pOC incidence:

2026 NEJM - TRIDENT, three Low-Dose Antihypertensive Agents in a Single Pill af_icHH (anderson) [R].pdf

Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (TGA)

Glossary: ⛔️ = contraindication, MI = myocardial infarction, MACE = major cardiovascular events, ol = open label, RAN = randomization studies, rec = recurrent, SBP = systolic blood pressure, S† = stroke, T = trials, IH = intracerebral hemorrhage, ♾️ = kidneys = renal, ◸ = liver = hepatic, 🧠ache = headache

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:

2. 𝙄𝙌𝘾 BS 🟰 2026, NEJM, 12C (AU, BR, GE, MY, NL, NG, SG, LK, CH, TW, GB, VN) ➖ mn_db_RCT ➕ 1670pxs (833 🆚 837) ➕ Sep 2017 - Nov 2024 | f-up 2,5y ➖ P I C O:

- 🅿: pxs w_history spontaneous icHH (inpxs or outpxs)

- 🅸: once-daily pill w_3 antiHTA agents ➕ usual TTO

- 🅲: placebo ➕ usual TTO only

- 🅾: pOC = 1st rec_S† | sOC = BP control + MACE + MM 🫀 causes + safety

3. EVIDENCE

a. ↓ BP ➩ only proven TTO for S†
b. Does a pill (combination of 3 antiHTA) ↓BP ➕ ↓r recurrent S† ❓

4. METHODS.

𝗜𝗡 ➠ SBP 130-160 ➕ stable condition ➕ no ⛔️ to the pill content
𝗘𝗫 ➠ ACE ⊖ not replaceable ➕ abnormal tests: ♾️ + ◸ ⌄ both.
RANDOM ➠ 1:1
INTERV ➠
- 2-week active run-in phase → pill administration to ALL
- PILL = telmisartan 20 mg, amlodipine 2.5 mg, and indapamide 1.25 mg.
- 72 months of total f-up
DEFINITIONS ➠
- BP control = SBP < 130 at 6m af_RAN
- MACE = nonfatal myocardial infarction ± nonfatal stroke ± death
  from cardiovascular causes; whichever occurred 1st.
- Other OC = recurrent icHH + iS† + S† unknown type + nonfatal MI + MM_S† + MM_anyC + other measures of BP control.
- Adherence = missing doses (1 in 1-7days in the pre-week) + pill counts
- Safety = serious Æ + Æ of special interest (↓AP, syncope, 🧠ache, ↓Na, ↑K, falls, AKI)

Friday, June 12, 2026 at 18:02:19 in BE

TGA, SARG, KSQV, KYEC, DEPZ, HIBN, AAQC,