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The Impact of Extended Procedure Duration on Nasal Morbidity after Endoscopic Endonasal Transsphenoidal Resection of Pituitary Macroadenomas
No full textStrabismus surgery charges at ambulatory facilities across the United States.
No full textPURPOSE: To identify factors associated with variation in strabismus surgery charges at hospital-owned facilities across the United States.
METHODS: This cross-sectional study included all strabismus-related patient encounters in the National Ambulatory Surgery Sample over a 5-year period (January 2016 to December 2020). The primary outcome was total charge per encounter. Multivariable linear regression was used to estimate the association of charge per encounter with patient, hospital, and regional characteristics, adjusting for procedure complexity and inflation. Sampling weights were used to generate nationally representative estimates and appropriate standard errors.
RESULTS: We included 154,005 patient encounters. Most surgeries were performed on pediatric patients (69.9%) and at teaching facilities (91.8%). The median charge per encounter was 8,840 to $17,573). Compared with the Midwest, charges were higher in the Northeast by 20.0% (95% CI, 8.4%, 32.9%; P = 0.0004) and South by 15.9% (95% CI, 4.8%-28.1%; P = 0.004). Nonteaching hospitals had 35.0% higher charges (95% CI, 17.6%-55.0%; P \u3c 0.0001) compared with teaching hospitals. Rural hospitals had 26.6% (95% CI, 19.4%-33.1%; P \u3c 0.0001) lower charges compared to urban hospitals. Patients residing in ZIP codes within the lowest income quartile had on average 6.8% (95% CI, 1.8%-12.2%; P = 0.008) higher charges than those in the highest income quartile.
CONCLUSIONS: Our findings highlight substantial variation nationwide in charges for strabismus surgeries, raising important questions about how these differences may influence subspecialty geographic distribution of care and affect treatment access for patients with strabismus
Timing of Antithrombotic Initiation and Risk of Reocclusion After Mechanical Thrombectomy
No full textExercise-based cardiac rehabilitation after transcatheter aortic valve replacement: a systematic review and meta-analysis of randomized controlled trials.
No full textBACKGROUND: Many patients remain functionally limited after transcatheter aortic valve replacement (TAVR) despite successful correction of aortic stenosis. Exercise-based cardiac rehabilitation (EBCR) is effective in other cardiac populations, but its benefits after TAVR remain uncertain. This study evaluated the impact of EBCR on functional capacity, cardiac function, quality of life, and safety outcomes in post-TAVR patients.
METHODS: A systematic review and meta-analysis of randomized controlled trials (RCTs) published through February 2025 was conducted using major databases. Outcomes were pooled using mean differences or risk ratios with 95% confidence intervals.
RESULTS: Six RCTs with 272 patients were included. No significant difference was found between EBCR and usual care for peak VO
CONCLUSION: EBCR did not significantly improve outcomes after TAVR; however, near-significant trends in functional capacity warrant further large-scale investigation.
PROTOCOL REGISTRATION: PROSPERO ID CRD420250652719
Antimuscarinic Delirium in a Pediatric Patient Reversed with Transdermal Rivastigmine: A Case Report
No full textMaternal Cardiac Arrest During Cesarean Section in the Setting of Severe Preeclampsia and Uncontrolled Type 1 Diabetes: A Case Report.
No full textMaternal cardiac arrest is an uncommon but life-threatening complication of pregnancy. Several maternal, social, and obstetric factors have been associated with increased risk, including older maternal age, underlying medical comorbidities, and hypertensive disorders of pregnancy. We present a case of maternal cardiac arrest during cesarean section in a patient with preeclampsia with severe features and uncontrolled type 1 diabetes. This case raises awareness for maternal morbidity and suggests cardiovascular risk and preconception counseling in high-risk obstetrical patients. A 31-year-old G2P1001 at 32 weeks and 1 day of gestation presented with preeclampsia with severe features and uncontrolled type 1 diabetes. On hospital day 2, the patient developed pulmonary edema. Because of this, magnesium sulfate for seizure prophylaxis was discontinued, and delivery via repeat cesarean section was performed. During surgery, the patient became agitated, which persisted despite sedation. She had an episode of oxygen desaturation followed by bradycardia to 36 beats per minute. The patient was intubated, and asystole was recognized. Advanced cardiac life support was initiated, and the patient was resuscitated. The bedside echocardiogram showed an ejection fraction of 25-30%. She was diagnosed with cardiogenic shock and treated with vasopressors and insertion of an Impella device. The patient\u27s condition was most likely exacerbated by her morbidities: preeclampsia with severe features and uncontrolled diabetes. Preeclampsia with severe features and diabetes can be considered as independent risk factors for maternal cardiac arrest. Diabetes and hypertension are known risk factors for heart disease, which can be amplified in the setting of physiologic changes that occur during pregnancy. This case demonstrates the role of cardiometabolic disease in peripartum cardiovascular collapse and emphasizes the importance of cardiovascular risk stratification, preconception counseling, and multidisciplinary surveillance in high-risk patients
PARP inhibitors elicit distinct transcriptional programs in homologous recombination competent castration-resistant prostate cancer.
No full textProstate cancer (PCa) is the second most lethal cancer in men in the US. African American (AA) men have twice the incidence and death rate of European American (EA) men. Advanced PCa shows increased expression and activity of the DNA damage/repair pathway enzyme, poly (ADP-ribose) polymerase 1 (PARP1). PARP1 inhibitors (PARPi) are FDA-approved for advanced PCa tumors with mutations in the homologous recombination repair (HRR) pathway. However, PARPi can provide benefit in model systems without HRR deficiencies. PARPi have distinct biochemical mechanisms, potencies, and toxicity profiles. While there is emerging evidence of differences in DNA damage/repair pathway enzyme expression between EA and AA men, PARP1 expression has not been fully explored in the context of race. This study hypothesized: (a) AA and EA PCa may respond differently to PARPi and (b) different PARPi may uniquely impact the transcriptome, irrespective of HRR status. Study results indicate a link between racial background and PARP1 expression/activity and define unique and overlapping transcriptional responses downstream of all five PARPi. These findings may lead to refined personalized recommendations for use of specific PARPi