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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_459"
                     title="Murtha Dead at 77"
                     score="0.014"
                     href="http://www.medpagetoday.com/Washington-Watch/Washington-Watch/tb/18388?impressionId=1265799982658"
                     
      &lt;p&gt;Representative John P. Murtha (D-Pa.), 77, long-time chairman of the House Appropriations Subcommittee on Defense, died yesterday afternoon from complications following a planned laparoscopic cholecystectomy, according to a statement from the congressman&apos;s office.&lt;/p&gt;
&lt;p&gt;He had been admitted to the intensive care unit at Virginia Hospital Center in Arlington on Jan. 31, days after surgeons at the National Naval Medical Center in Bethesda, Md., accidentally nicked his intestine during the operation, according to a report in &lt;em&gt;The Washington Post&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;In that same report, Rep. Bob Brady (D-Pa.), a close friend of Murtha&apos;s, said the congressman developed an infection and fever.&lt;/p&gt;
&lt;p&gt;Citing a request for privacy from the Murtha family and patient privacy laws, a spokesperson for the National Naval Medical Center declined to provide information on the operation.&lt;/p&gt;
&lt;p&gt;In a statement, Virginia Hospital Center said Murtha died &quot;despite aggressive critical care interventions.&quot;&lt;/p&gt;


  &lt;p&gt;Mark Malangoni, MD, surgeon-in-chief at MetroHealth Medical Center in Cleveland, told &lt;em&gt;MedPage Today&lt;/em&gt; that serious complications, including bowel damage and death, are not common following cholecystectomy. More complicated patients, such as the obese and diabetics, have a greater risk of complications and of a switch to an open procedure.&lt;/p&gt;
    &lt;p&gt;Death is extremely rare in healthy individuals, occurring in no more than one per 1,000 patients, according to the American College of Surgeons (ACS).
    &lt;p&gt;More common, but still infrequent, are bleeding and leakage of bile, both of which can be treated fairly easily, said Malangoni, a regent of the ACS.&lt;/p&gt;


&lt;p&gt;When the bowel is damaged, as reportedly occurred in Murtha&apos;s case, it typically occurs in two ways -- either from a sharp injury when the trocars used for a laparoscopic procedure are inserted or from a cautery burn.
    &lt;p&gt;Both types of injury can go unnoticed by the surgeon and may not become apparent for days after the operation, Malangoni said.&lt;p&gt;
    &lt;p&gt;Although he did not know the details of Murtha&apos;s case, Malangoni said a patient would usually be admitted right away, at least overnight, if the surgeon realized that an injury had occurred. The procedure likely would have switched from a laparoscopic one to an open one as well.&lt;/p&gt;


&lt;p&gt;A 2009 Cochrane Review comparing laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis found no difference in mortality in 38 trials. No patients died in the laparoscopic group and only 0.09% died in the open group.&lt;/p&gt;
&lt;p&gt;Severe complications were reported in 2.2% of the laparoscopic patients and 6.8% of the open patients.&lt;/p&gt;


 &lt;p&gt;Malangoni said most surgeons become experienced with performing laparoscopic cholecystectomies before completing their residency; most will perform 40 or 50 by the end of training.&lt;p&gt;
    &lt;p&gt;&quot;It is a very common operation, so once out into practice, most general surgeons are doing dozens of these each year,&quot; he said. &quot;So your experience comes about pretty quickly.&quot;
    &lt;p&gt;It is unclear how much experience Murtha&apos;s surgeon had.&lt;/p&gt;

&lt;p&gt;Murtha had recently become the longest serving member of Congress in Pennsylvania state history.&lt;/p&gt;
&lt;p&gt;First elected in 1974, Murtha, a former Marine, was the first Vietnam War combat veteran to serve in Congress, and he served as an advocate for the military throughout his career. He was also a prominent critic of the Iraq War.&lt;/p&gt;
&lt;p&gt;Murtha is survived by his wife, Joyce, and three children.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_331"
                     title="Physicians Must Treat Transplant Tourists"
                     score="0.005"
                     href="http://www.medpagetoday.com/Gastroenterology/LiverTransplantation/tb/18203?impressionId=1265799982658"
                     
      &lt;p&gt;Patients who travel to foreign countries for organ transplants may return with more problems than they left with  --  and physicians here have a moral responsibility to treat them, researchers asserted in a transplant journal.&lt;/p&gt;
&lt;p&gt;&quot;Medical tourism&quot; has been on the rise as demand for organs outpaces supply and U.S. healthcare costs skyrocket, Thomas D. Schiano, MD, and Rosamond Rhodes, PhD, of Mount Sinai School of Medicine, reported in &lt;em&gt;Liver Transplantation&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Researchers have estimated that 300 medical tourism transplants occurred between 2004 and 2006, with more than 40% of transplant tourists residing in New York or California, which have only 18% of the total U.S. population. (See &lt;a href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/HealthPolicy/12564&quot; mce_href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/HealthPolicy/12564&quot; target=&quot;_blank&quot;&gt;International Medical Trade Turns Big Business&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;Yet physicians have had little guidance on delivering care to these patients, and some transplant centers may turn them away, based on their actions, Schiano and Rhodes wrote.&lt;/p&gt;
&lt;p&gt;Their questions about treatment arose with a 46-year-old Chinese patient who had been put on a waiting list for a liver transplant here because of end-stage liver disease.&lt;/p&gt;
&lt;p&gt;The patient waited on the list for a year as his disease progressed from 18 points to 21 points on a 40-point severity scale.&lt;/p&gt;
&lt;p&gt;Rather than wait any longer, the patient flew to China and had a liver transplant there.&lt;/p&gt;
&lt;p&gt;Many transplanted organs in China come from executed prisoners, raising concerns about disease. Also, foreign transplants may be compromised by poor organ matching, unhealthy donors, and post-transplant infections, while some transplant centers abroad may use substandard surgical techniques, the researchers said.&lt;/p&gt;
&lt;p&gt;Foreign centers are also less likely to send patients home with adequate records and education than centers here, they asserted.&lt;/p&gt;
&lt;p&gt;Three months after his transplant in China, the patient came back to the clinic at Mount Sinai for follow-up care because he was about to run out of imunosuppressive medication.&lt;/p&gt;
&lt;p&gt;Two months after that, the patient developed sepsis due to diffuse intrahepatic biliary stricturing related to hepatic artery thrombosis.&lt;/p&gt;
&lt;p&gt;He required three additional hospitalizations for biliary sepsis, and at that point, retransplantation was the only viable option, Schiano said.&lt;/p&gt;
&lt;p&gt;However, members of the medical team had conflicting views about giving the patient another new liver.&lt;/p&gt;
&lt;p&gt;&quot;He was a medically suitable candidate,&quot; Schiano and Rhodes wrote, &quot;but there was disagreement about whether it was morally right to provide him with a transplant.&quot;&lt;/p&gt;
&lt;p&gt;The clinicians had few ethical guidelines to refer to in making their decision because many deal solely with moral issues related to donors and foreign medical standards.&lt;/p&gt;
&lt;p&gt;For example, the International Society for Heart and Lung Transplantation issued a statement against accepting organs from prisoners in April 2007, and the American Association for the Study of Liver Diseases and the International Liver Transplant Society endorsed similar policies.&lt;/p&gt;
&lt;p&gt;The American Medical Association&apos;s guidelines on medical tourism focus on best practices  --  for example, the procedure must be voluntary, it can&apos;t limit the alternatives offered to patients, and patients should only be referred to accredited institutions.&lt;/p&gt;
&lt;p&gt;While the United Network for Organ Sharing (UNOS)&apos;s statement on medical tourism does maintain that the medical community has an obligation to provide care for these patients, it stops short of offering further direction to transplant programs.&lt;/p&gt;
&lt;p&gt;&quot;Little guidance is provided for dealing with the specific problems of patients who choose to become transplant tourists,&quot; Schiano and Rhodes wrote.&lt;/p&gt;
&lt;p&gt;Instead, they created some ethical guidance for the &quot;moral quandary.&quot;&lt;/p&gt;
&lt;p&gt;Physicians have a &quot;professional obligation to promote the good of patients&quot; as well as a &quot;professional responsibility to adhere to medicine&apos;s commitment to nonjudgmental regard,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;&quot;Taken together, the moral principles of beneficence and nonjudgmental regard direct us to treat potential or returning transplant tourists as we would treat other patients under our care by focusing on providing the medical treatment and support they need,&quot; they continued.&lt;/p&gt;
&lt;p&gt;Physicians shouldn&apos;t deny patients post-transplantation care, and they ought to provide emergent care at the very least. They may refer the patient to another transplant center for long-term follow-up if they regard it as unethical to continue treatment.&lt;/p&gt;
&lt;p&gt;Patients should also be informed about the possibility of transplant tourism when they are not eligible for a transplant in the U.S. or when they are likely to die before reaching the top of the transplant list, Schiano and Rhodes wrote.&lt;/p&gt;
&lt;p&gt;&quot;Patients should not be threatened with abandonment by a center&apos;s refusal to provide care upon their return,&quot; they added.&lt;/p&gt;
&lt;p&gt;As for the 46-year-old patient who was transplanted in China, the Mount Sinai team decided a transplant program must treat all patients on the basis of their need &quot;regardless of what they might have done or how they secured their transplant organ.&quot;&lt;/p&gt;
&lt;p&gt;&quot;Although [the patient] had a long, complicated transplantation course,&quot; they wrote, &quot;he is currently doing well.&quot;&lt;/p&gt;
&lt;p&gt;Mount Sinai has seen a total of nine patients who pursued transplants in China. Three of those had post-transplant problems but had been turned away elsewhere &quot;because several transplant centers in our region do not render care to transplant tourists,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;Seven of those nine patients have hepatitis B. Another three had had a renal transplant in India, and subsequently developed liver failure, the authors reported.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_295"
                     title="STS: Aorta Repair Done at Warmer Temperatures (CME/CE)"
                     score="0.002"
                     href="http://www.medpagetoday.com/MeetingCoverage/STS/tb/18156?impressionId=1265799982658"
                     
      &lt;p&gt;FORT LAUDERDALE  --  Doctors here suggest it is safe to perform aortic arch surgery using moderate hypothermia  --  cooling the body to about 26 degrees C rather than 18 degrees C  --  without jeopardizing cerebral protection.&lt;/p&gt;
&lt;p&gt;Researchers at Emory University in Atlanta said their aortic arch repair techniques have been evolving over the past decade, including performing the surgery at higher body temperatures.&lt;/p&gt;
&lt;p&gt;&quot;The optimal management during aortic arch surgery is controversial,&quot; Emory&apos;s Bradley Leshnower, MD, noted in his oral presentation at the annual meeting of the Society of Thoracic Surgeons here. &quot;The main issue is cerebral protection during the period of circulatory arrest.&quot;&lt;/p&gt;
&lt;p&gt;Since modern aortic surgery was first performed in 1975, body temperatures have traditionally been lowered to about 18 degrees Celsius (64.4 degrees Fahrenheit) in order to protect organs from damage once circulatory arrest has been achieved.&lt;/p&gt;
&lt;p&gt;&quot;Since that time, two additional methods of surgery with protection have evolved and are used in conjunction with hypothermia: retrograde cerebral perfusion and selective antegrade cerebral perfusion,&quot; Leshnower said.&lt;/p&gt;
&lt;p&gt;&quot;At Emory we use a strategy of cerebral protection that we call unilateral selective antegrade reperfusion,&quot; he explained. &quot;Our hypothesis was that by using adjunctive selective antegrade perfusion, we could safely perform arch reconstruction using more moderate levels of hypothermia and thereby avoid the adverse effects of deep hypothermia.&quot;&lt;/p&gt;
&lt;p&gt;Matthew Williams, MD, of the University of Louisville, noted that temperature is critical because &quot;the deeper the hypothermia, the more problems occur in clotting.&quot;&lt;/p&gt;
&lt;p&gt;&quot;Even the tiniest pinpricks in the aorta that would immediately clot off at normal temperatures will bleed profusely among hypothermia patients,&quot; he said.&lt;/p&gt;
&lt;p&gt;In their retrospective study, Leshnower and colleagues identified 412 aortic arch procedures performed between January 2004 and December 2009.&lt;/p&gt;
&lt;p&gt;All cases involved hypothermia circulatory arrest and unilateral selective antegrade reperfusion. The mean age of the patients was 57, and about two-thirds were male. About 10% had a history of renal failure and the same proportion had a history of stroke. Among the cases were 85 reoperations.&lt;/p&gt;
&lt;p&gt;&quot;About three-fourths of the cases were done electively, and the remaining 24% were done for emergent Type 1 aortic dissections,&quot; Leshnower said.&lt;/p&gt;
&lt;p&gt;The procedures included 344 hemiarch reconstructions and 68 total arch replacements. Among them were 175 aortic root replacements.&lt;/p&gt;
&lt;p&gt;Overall, the average temperature for circulatory arrest was 25.7 degrees Celsius (range 19 - 30). The average circulatory arrest time was 30 minutes.&lt;/p&gt;
&lt;p&gt;In the safety analysis the researchers found: &lt;ul&gt; &lt;li&gt;Overall mortality was 7%, but &quot;as we gained experience with this procedure, our results improved and our mortality was reduced to 4.8% in the latter half of the series,&quot; Leshnower said.&lt;/li&gt; &lt;li&gt;Permanent neurological dysfunction  --  a focal stroke  --  occurred in 3.6%.&lt;/li&gt; &lt;li&gt;Temporary neurological dysfunction  --  cognitive deficits observed postoperatively  --  occurred in 5.1%. &quot;These deficits are considered to be a sign of inadequate cerebral protection,&quot; Leshnower explained.&lt;/li&gt; &lt;li&gt;Renal failure requiring dialysis as a measure of lower body, end organ ischemia occurred in 4.6%&lt;/li&gt; &lt;li&gt;There were no cases of paraplegia.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;In a subgroup analysis, Leshnower and colleagues observed a mortality rate of 14.4% in the emergent cases, compared with 4.8% in the elective group.&lt;/p&gt;
&lt;p&gt;&quot;There was also a significantly higher percentage of permanent neurologic dysfunction and renal failure requiring dialysis in the dissection group. However, there was no difference in our temporary neurologic dysfunction rate,&quot; he said.&lt;/p&gt;
&lt;p&gt;He noted that a multivariate analysis failed to show that higher temperatures were related to adverse outcomes.&lt;/p&gt;
&lt;p&gt;&quot;We feel that the use of moderate hypothermia with selective antegrade cerebral reperfusion is an effective method of cerebral protection as evidenced by our low rate of permanent and temporary neurologic dysfunction,&quot; he said.&lt;/p&gt;
&lt;p&gt;&quot;We feel that the use of this technique avoids the adverse effects of deep hypothermia and is an effective strategy for circulation management in the aortic arch surgery in both the emergent and elective settings.&quot;&lt;/p&gt;
&lt;p&gt;Randall Griepp, MD, of Mount Sinai School of Medicine in New York City, who pioneered the technique back in 1975, praised the report from the floor of the session but added a caution.&lt;/p&gt;
&lt;p&gt;&quot;These are terrific results. But you should do some postoperative cognitive testing. The perfusion of the distal aorta does become an issue somewhere around an hour or so. There have been reports of injury, including paraplegia, when higher temperatures are used. You have not seen it in your series but you are beginning to flirt with the limits of depriving the lower body of blood flow.&quot;&lt;/p&gt;
&lt;p&gt;He said that the estimation of temporary neurologic dysfunction may not appear until six weeks to a year after surgery for those patients who go beyond 25 to 30 minutes with circulatory arrest.&lt;/p&gt;
&lt;p&gt;Leshnower also noted that his study could not prove that bleeding times were reduced, because a proper historical control group using similar surgical and protection techniques is not available.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Leshnower had no disclosures but one of the co-authors revealed financial relationships with Terumo. Williams and Griepp had no disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_284"
                     title="STS: Leg Artery Access Linked to Dissection (CME/CE)"
                     score="0.002"
                     href="http://www.medpagetoday.com/MeetingCoverage/STS/tb/18139?impressionId=1265799982658"
                     
      &lt;p&gt;FORT LAUDERDALE  --  Avoiding femoral artery cannulization during cardiac surgery might eliminate some of the rare but potentially catastrophic aortic dissections that occur during the procedure, researchers said here.&lt;/p&gt;
&lt;p&gt;Doctors identified the femoral location as an increased risk factor in an analysis of records from the Society of Thoracic Surgeons&apos; national database of more than 2.2 million cardiac surgeries. That search yielded 1,294 incidents of aortic dissection.&lt;/p&gt;
&lt;p&gt;&quot;Prevention is the key,&quot; Matthew Williams, MD, of the University of Louisville, said at the annual meeting of the Society of Thoracic Surgeons here.&lt;/p&gt;
&lt;p&gt;Williams and colleagues reported that aortic dissection occurs in only 0.06% of cardiac surgeries but accounts for almost one percent of perioperative deaths.&lt;/p&gt;
&lt;p&gt;&quot;Aortic dissection is a low frequency but catastrophic event,&quot; Williams said, noting that 48% of aortic dissections during surgery prove fatal. Some 9% of the survivors suffer strokes and 14% experience kidney failure.&lt;/p&gt;
&lt;p&gt;He recalled becoming interested in the research after one of his patients, a woman, experienced aortic dissection during a procedure. &quot;She walked out of the hospital,&quot; he said.&lt;/p&gt;
&lt;p&gt;He told &lt;em&gt;MedPage Today&lt;/em&gt; that &quot;the incidence of these aortic dissections is so small that only a large database project such as this one could possibly get at these cases.&quot;&lt;/p&gt;
&lt;p&gt;According to his presentation materials, researchers created a logistic regression model based on 2004-2007 STS data. The analysis turned up nine significant risk factors, including femoral cannulization, preoperative steroids, and Asian race. Diabetes appeared to be protective.&lt;/p&gt;
&lt;p&gt;When aortic dissection occurs during surgery, Williams said, doctors generally stop the operation and attempt to restart it by cannulization in another area.&lt;/p&gt;
&lt;p&gt;He said he has considered femoral access as a last resort and prefers either central aortic cannulization or axial cannulization.&lt;/p&gt;
&lt;p&gt;He said improving outcomes and identifying what causes aortic dissection in these surgical cases may require changes and updates in the information captured by the database. He said a clinical trial would require so many patients that it would not be practical.&lt;/p&gt;
&lt;p&gt;Aubrey Galloway, MD, of the New York University School of Medicine, who was the discussant for Williams&apos; talk, said that the imprecise nature of the way the data are gathered might have misidentified the femoral access point as a culprit procedure.&lt;/p&gt;
&lt;p&gt;&quot;It may be that femoral access was employed in response to another dissection site,&quot; he said.&lt;/p&gt;
&lt;p&gt;Williams responded that by tweaking the information acquired by the database it might be possible to better determine these associations.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Williams listed no relevant disclosures; Galloway disclosed financial relationships with Medtronic and Edwards Life Sciences and Estech.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_226"
                     title="ASCO GI: Blood Test Detects Colorectal Cancer"
                     score="-0.003"
                     href="http://www.medpagetoday.com/MeetingCoverage/ASCOGI/tb/18079?impressionId=1265799982658"
                     
      &lt;p&gt;ORLANDO  --  A novel blood test that measures CD24 protein levels may detect early colorectal cancer and precancerous adenomas, researchers found.&lt;/p&gt;
&lt;p&gt;The investigational assay had 78.4%% sensitivity and 86.8% specificity for distinguishing patients with colorectal adenoma or cancer from healthy controls in a study led by Sarah Kraus, PhD, of Tel Aviv Souraski Medical Center in Israel.&lt;/p&gt;
&lt;p&gt;Further validation for the biomarker would be needed before considering clinical use in surveillance, they cautioned here at the ASCO Gastrointestinal Cancers Symposium.&lt;/p&gt;
&lt;p&gt;But the results were exciting and could represent &quot;a very significant advance,&quot; commented Robert P. Sticca, MD, of the University of North Dakota in Grand Forks.&lt;/p&gt;
&lt;p&gt;&quot;It looks like it may be a very reliable marker for not only the early detection of colon cancer and even precancerous conditions, but also could be used for follow-up for patients who previously had cancer for recurrence,&quot; he said as moderator of a press briefing at which the results were discussed.&lt;/p&gt;
&lt;p&gt;Colorectal cancer screening is effective, with early detection and treatment shown to improve survival.&lt;/p&gt;
&lt;p&gt;However, colorectal cancer is often diagnosed at a late stage with poor prognosis, in part because of &lt;a href=&quot;http://www.medpagetoday.com/Gastroenterology/ColonCancer/10115&quot; mce_href=&quot;http://www.medpagetoday.com/Gastroenterology/ColonCancer/10115&quot; target=&quot;_blank&quot;&gt;poor uptake of colonoscopy&lt;/a&gt;, Kraus said at the press briefing.&lt;/p&gt;
&lt;p&gt;Unfortunately, there are no sufficiently accurate blood-based screening tests, he noted, although there have been &lt;a href=&quot;http://www.medpagetoday.com/MeetingCoverage/ECCO-ESMO/16057&quot; mce_href=&quot;http://www.medpagetoday.com/MeetingCoverage/ECCO-ESMO/16057&quot; target=&quot;_blank&quot;&gt;attempts&lt;/a&gt; to develop them.&lt;/p&gt;
&lt;p&gt;Her group had previously found that the CD24 protein  --  expressed on the cell surface, where it plays a role in cell adhesion and metastasis  --  was associated with development of colorectal cancer in a gene expression study.&lt;/p&gt;
&lt;p&gt;So, with two independent cohorts, they tested whether CD24 could be a good biomarker for colorectal cancer.&lt;/p&gt;
&lt;p&gt;The first cohort included 63 patients with colorectal cancer, 19 with adenoma, and 68 controls with a clean bill of health on colonoscopy. Of these 150 individuals, 143 were externally evaluated by a blinded investigator.&lt;/p&gt;
&lt;p&gt;CD24 expression was nearly six-fold higher among adenoma and colorectal cancer cases than among controls, a significant difference. Levels were similar between the cancer and adenoma groups.&lt;/p&gt;
&lt;p&gt;The second cohort included 73 subjects: 38 normal controls, 24 with colorectal adenoma, and 11 with colorectal cancer.&lt;/p&gt;
&lt;p&gt;The test could distinguish colorectal cancer cases from controls with &quot;relatively high&quot; sensitivity and specificity (92.3% and 83.8%, respectively), Kraus said.&lt;/p&gt;
&lt;p&gt;Its performance in detecting adenoma versus normal colonoscopy results was lower, 75.0% sensitivity and 89.2% specificity.&lt;/p&gt;
&lt;p&gt;Kraus said her group is now testing this CD24 approach in a larger sample and developing an enzyme-linked immunosorbent assay (ELISA) that could be more widely used.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The researchers reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>