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Neutrophil-to-Lymphocyte Ratio and Flair Imaging Biomarkers in Vestibular Schwannoma: A Single-Center Retrospective Study
No full textUse of the Ross Procedure in North America: Relation Between Surgical Volume and Operative Mortality.
No full textBACKGROUND: There has been a renewed interest in the Ross procedure as an alternative to conventional aortic valve replacement in young adults.
OBJECTIVES: This study aimed to assess contemporary trends in Ross procedure utilization in adults and examine the relationship between surgical volumes and operative mortality.
METHODS: The Society of Thoracic Surgeons Adult Cardiac Surgery Database was queried for patients who underwent the Ross procedure between 2008 and 2023. We used modified Poisson regression with generalized estimating equations and robust standard errors to assess the relationship between Ross volumes and operative mortality, accounting for clustering by center and year.
RESULTS: A total of 2,268 Ross procedures were reported across 194 centers from 2008 to 2023. The median age was 43 years (Q1-Q3: 32-52 years). The median number of procedures per center over 16 years was 2 (Q1-Q3: 1-7). Ross procedure utilization reached a nadir in 2017 (n = 63) before increasing annually, reaching 531 cases in 2023. Ross procedures represented 0.9% of all aortic valve replacements in adults ≤60 years of age in 2017, increasing to 6.7% by 2023. Operative mortality declined from 4.4% in 2008 to 1.0% in 2020 but rose to 2.5% in 2023. Regression-adjusted modeling demonstrated an association between higher center- and surgeon-level Ross volume and lower operative mortality (P \u3c 0.001), with substantial improvements occurring beyond approximately 10 cases per year.
CONCLUSIONS: The Ross procedure is increasingly utilized in North America. Outcomes appear more favorable in higher-volume centers and surgeons, supporting the view that experience may play a key role in achieving optimal results. These findings highlight important considerations for how Ross programs are developed and implemented
Ergonomic Trends in Endoscopic Skull-Base Surgeons: A Survey to the North American Skull Base Society.
No full textOBJECTIVE: Lack of ergonomic practices in the operating room results in significant musculoskeletal strain. This study obtains a current assessment of self-reported musculoskeletal strain associated with endoscopic endonasal and open skull base surgery as reported by members of the North American Skull Base Society (NASBS).
STUDY DESIGN: Online Survey.
SETTING: Online.
METHODS: A survey assessing current symptoms in endoscopic skull base surgery was distributed to members of the NASBS.
RESULTS: Sixty-six responses were completed and analyzed. 95% of respondents indicated they had musculoskeletal strain at the neck and C-spine. There was no significant difference in average operating time per week and musculoskeletal strain. Prolonged standing during endoscopic cases increased neck/C-spine musculoskeletal strain (OR: 3.96; CI: 1.26, 14.2;
CONCLUSION: The results found that most respondents experience musculoskeletal strain and that factors including surgeon positioning and prolonged standing increase pain. Altering strategies in the operating room, including surgeon and instrument positioning, may help to decrease ergonomic strain amongst skull base surgeons
Demographics and costs of pediatric blepharitis and conjunctivitis seen in California emergency departments over a 10-year period.
No full textBACKGROUND: Every year, thousands of children use the emergency department (ED) for low-acuity conditions. This study aimed to determine the financial impact of ED utilization for the most common nonemergent ocular conditions, blepharitis and conjunctivitis, and to explore the demographics of patients seeking care for these conditions through the ED.
METHODS: All cases of pediatric blepharitis and conjunctivitis between January 1, 2012, and December 31, 2021, were identified using the California Office of Health Care Access Information Database. Cases were analyzed under different billing structures including care rendered in the emergency department (ED) versus outpatient settings using evaluation and management (E&M) and eye visit codes.
RESULTS: Blepharitis and conjunctivitis accounted for 306,417 visits, or 78.2% of all ED eye-related visits among children ≤18 years. The most common self-reported race/ethnicity was Hispanic (56.3%), followed by White (20.1%) and Black (13.0%). Most patients had public insurance (72.7%) or private insurance (19.7%). ED utilization was 17.6% higher during weekends. Estimated costs for ED visits totaled 37,914,508 annually. Estimated annual outpatient costs using new patient E&M codes totaled 2,303,337, and the estimated annual outpatient costs using eye visit codes totaled $1,138,339-1,525,344. This suggests the cost of ED care was 16.5-32.1 times more expensive than equivalent outpatient costs.
CONCLUSIONS: Care provided in the ED for blepharitis and conjunctivitis may be 16.5-32.1 times more expensive than care rendered in outpatient settings. Non-White children and children with public insurance had higher ED utilization compared to their population-level representation. Increasing access to pediatric eye specialists and decreasing ED utilization has the potential to improve efficacy while promoting childhood health outcomes
Multi-Institutional Machine-Learning Predictor of Gross-Total Resection in Skull-Base Chondrosarcoma
No full textFinerenone in People with CKD, Type 2 Diabetes, and History of Nephrectomy.
No full textKEY POINTS: Finerenone reduced albuminuria versus placebo in patients with a history of nephrectomy, similar to those without a history of nephrectomy. Incidences of treatment-emergent adverse events or serious adverse events were generally similar in patients with and without history of nephrectomy. Finerenone may delay kidney disease progression in patients with CKD and type 2 diabetes, irrespective of nephrectomy status.
BACKGROUND: Finerenone significantly reduced the risk of cardiovascular and kidney outcomes in patients with CKD and type 2 diabetes (T2D) in FIDELITY, a prespecified pooled analysis of two phase 3 trials. This
METHODS: Patients in FIDELITY were randomized to receive finerenone or placebo and were on optimized renin–angiotensin system inhibition. We identified nephrectomy status using patients\u27 medical history and assessed CKD progression in patients by nephrectomy status at baseline by modeling change in urine albumin-to-creatinine ratio from baseline to months 4–24. Safety outcomes included treatment-emergent adverse events and incident hyperkalemia.
RESULTS: Of 12,990 patients, 108 had a history of nephrectomy at baseline; 101 of 108 had radical nephrectomy, 55 received finerenone, and 53 received placebo. Baseline mean eGFR were numerically lower in patients with a history of nephrectomy (48±17 ml/min per 1.73 m
CONCLUSIONS: Finerenone reduced albuminuria compared with placebo and demonstrated a safety profile consistent with the overall FIDELITY population in patients with and without a history of nephrectomy at baseline. Finerenone may delay CKD progression and associated morbidity in patients with CKD and T2D, irrespective of nephrectomy status.
CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER:: FIDELIO-DKD (NCT02540993); FIGARO-DKD (NCT02545049)
Efavirenz treatment improves retinal vaso-obliteration and pathological neovascularization in a mouse model of retinopathy of prematurity.
No full textOBJECTIVES: Previous studies have shown the metabolic and regulatory significance of CYP46A1 in the adult retina; however, its role in the developing retina is unknown. Here, we evaluate CYP46A1 expression and the impact of its activation in the developing mouse retina under normal and pathological conditions.
METHODS: Seven-day-old (P7) C57BL/6 J mice maintained in room air (controls) or subjected to oxygen-induced retinopathy (OIR) were treated with/without 20 mg/kg efavirenz (EFV), a CYP46A1 activator administered intraperitoneally from P7 to P17.
RESULTS: Retinal cross sections and flat mounts were prepared to study retinal vasculature morphology, Müller and microglia activation, and ganglion cell viability. EFV treatment significantly reduced pathological neovascularization and the size of avascular and hypoxic areas in OIR mice retinas. EFV treatment additionally limited reactive gliosis and microglia activation and improved retinal ganglion cell survival in OIR mice.
CONCLUSION: The current study demonstrates the developmental regulation of CYP46A1 and the dysregulated expression and levels of the downstream metabolite 24-Hydroxycholesterol (24HC) in OIR mice. The study further suggests that EFV treatment (in part via CYP46A1 activation) may improve key pathological features associated with pathological neovascularization in OIR mice
Neonatal neurocritical care considerations for prenatally identified neurological disorders.
No full textWith increased access to advanced prenatal neuroimaging and genetic testing, neurological disorders such as brain malformations, brain injuries, and genetic disorders, are increasingly being diagnosed during pregnancy. In this review, we address neonatal neurocritical care considerations for the population with prenatally identified neurological disorders. We identify antenatal considerations, including planning location of delivery, as well as postnatal considerations, including clinical phenotyping, neuromonitoring, neuroimaging, and genetic testing. The importance of interdisciplinary collaboration between obstetrics, maternal-fetal medicine, neonatology, pediatric neurology, neuroradiology, genetics, palliative care, early intervention and habilitative services is emphasized. We outline high-priority research gaps, and highlight the need for large, multicenter studies that capture diverse geographies, populations, care practices and settings longitudinally. IMPACT: Fetal neurology is a rapidly evolving field owing to the increased prenatal diagnosis of neurological disorders; however, the natural history of many fetal neurological disorders is not well known. We identify interdisciplinary neonatal neurocritical care considerations for newborns with prenatally diagnosed neurological disorders, such as neuroimaging, neuromonitoring, and family support. We outline high-priority research gaps in fetal neurology relevant to neurocritical care, including the need to prioritize large-scale longitudinal studies on the etiologies, short- and long-term outcomes of fetal neurologic disorders across diverse geographies and populations to improve counseling and care
Spontaneous breathing trials as predictors of extubation outcomes in neurocritical care: insights from the ENIO study.
No full textPURPOSE: In critically ill patients, extubation readiness is typically assessed using a spontaneous breathing trial (SBT). Among patients with acute brain injury (ABI), the optimal SBT method remains uncertain.
METHODS: We conducted a post-hoc analysis of the ENIO study (NCT03400904), including mechanically ventilated ABI patients with available SBT data, undergoing extubation attempt. SBTs were classified as T-piece, pressure support ventilation (PSV), or continuous positive airway pressure (CPAP). The primary outcome was extubation failure within 5 days. Associations between SBT modality and extubation failure were assessed using multivariable logistic regression and inverse probability of treatment weighting.
RESULTS: Of 1,512 patients enrolled in ENIO, 839 met the inclusion criteria, of whom 270 (32.2%) were female and 396 (47.2%) had traumatic brain injury as the cause of admission. SBTs were performed with PSV in 430 (51.3%), T-piece in 329 (39.2%), and CPAP in 80 (9.5%). SBT median duration was 60 min in PSV and T-piece, while 120 min in CPAP. Extubation failure occurred in 177 (21.1%) cases. In multivariable analyses, there was no significant association between SBT modality or duration and extubation outcome. Results were similar in ABI subgroup analyses. After inverse probability weighting, vigorous cough remained the only significant predictor of extubation success.
CONCLUSIONS: In this large international ABI cohort, neither SBT mode nor duration was associated with extubation failure