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Readmission Trends and Outcomes of Transcatheter Edge-to-Edge Repair of Mitral Regurgitation With and Without Atrial Fibrillation: A Propensity-Matched National Readmission Analysis.
No full textBACKGROUND: The use of transcatheter edge-to-edge repair (TEER) for symptomatic mitral regurgitation is steadily increasing. However, the outcomes of TEER among patients with atrial fibrillation (AF), including readmission trends, remain unknown.
METHODS: The Nationwide Readmissions Database was queried between 2016 to 2020 to identify TEER patients with and without AF. The two groups were then compared using propensity score matching (PSM) and multivariate regression models. The outcomes included in-hospital mortality, acute kidney injury (AKI), heart failure, acute stroke, myocardial infarction (MI), post-procedure bleeding (PPB), and cardiac tamponade.
RESULTS: A total of 39,867 TEER procedure recipients were included over the study period, of which, 24,729 (62%) had AF compared to 15,138 (38%) with no AF diagnosis. On adjusted analysis, the AF group had a higher rate of inpatient mortality, AKI, heart failure (HF), and post-procedural bleeding (PPB). On the contrary, TEER with AF group had lower odds of MI. The risk of stroke and cardiac tamponade were similar between the two groups. The median length of stay (LOS) at index hospitalization was longer in the AF cohort in comparison with those without (2 days (IQR 5-1) vs 1 day (IQR 3-1)).
CONCLUSION: AF in TEER procedure recipients was associated with worse outcomes including a higher rate of inpatient mortality, AKI, and HF compared to the patients without AF. Readmission rates at 30, 90, and 180 days were similar between the two groups
Inconsistency in Physician Orders for Life-Sustaining Treatment (POLST) Documentation, an Opportunity to Improve
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The World Federation of Neurology: Brain health for all ages 2025.
No full textThe World Federation of Neurology (WFN) has used the term brain health for many years and implemented the Brain Health campaign in 2020. This year\u27s World Brain Day continues the WFN\u27s engagement on brain health, emphasizing its relevance for all ages. This continues on prior themes, such as Brain Health for All (2022), Brain Health and Disability (2023), and Brain Health and Prevention (2024). The burden of neurological disease is not evenly distributed worldwide, and significant differences exist across age groups and regions. The disparities reflect broader inequalities in healthcare infrastructure, workforce capacity, public health investment, and social determinants of health. The WFN World Brain Day raises awareness of all these issues as they pertain to brain health with the goal of improving equitable access to neurological care
Bridging the gap: A scoping review of endovascular and microsurgical approaches to anterior ethmoidal dural arteriovenous fistulas.
No full textINTRODUCTION: Dural arteriovenous fistulas (dAVF) are abnormal anastomoses between meningeal arteries and dural venous sinuses. Typically, dAVF treatment involves an endovascular or microsurgical approach. Anterior ethmoidal artery (AEA) dAVFs pose unique challenges due to their anatomy and location. We performed a scoping review to characterize pre and postoperative characteristics of AEA dAVFs and elucidate their optimal management.
METHODS: The authors conducted a comprehensive literature search on PubMed and Embase using Arskey & O\u27Malley\u27s scoping review framework. The search strategy included anterior, ethmoidal, and fistula and excluded review articles and studies with unrelated pathology. Data collected included patient demographics, presentation, angiographic features, treatment modalities, and clinical and radiological outcomes.
RESULTS: One-hundred and two articles describing 273 patients with an average age of 58.79 years were included. Two-hundred and sixty patients had surgery; 127 (49 %) had endovascular embolization and 133 (51 %) had open surgery. Surgical approach was significantly associated with complete dAVF obliteration (p = 0.003, X
DISCUSSION: Surgical techniques and endovascular embolization are commonly used when treating dAVF, and our results highlight that open surgery appears to be superior to endovascular embolization when considering complete AEA dAVF obliteration. Despite advancements in treatment modalities, complications such as stroke, hemorrhage, and recurrence persist, emphasizing the importance of continued research and refinement of therapeutic strategies
Isolated Limb Infusion/Perfusion for Unresectable Acral Versus Non-Acral Melanoma In-Transit Metastases.
No full textBACKGROUND: Acral lentiginous melanoma (ALM) has a worse prognosis than non-ALM subtypes and poorly understood genetic profile, limiting therapy options. This study compares outcomes of isolated limb infusion or perfusion (ILI/ILP) in patients with ALM or non-ALM.
METHODS: A multi-institution retrospective review including patients with unresectable melanoma in-transit metastases (ITM) treated with ILI/ILP from 2002 to 2023.
RESULTS: A total of 364 patients were identified: 55% female; median age 71 years; 84 with ALM; 280 non-ALM. Acral lentiginous melanoma tumors had deeper Breslow thickness (4 mm vs. 2.9 mm, P = .005) and more frequent ulceration (38% vs. 27%, P = .03). On multivariable analysis, there were no differences in complete or overall response rates between ALM vs. non-ALM. Median follow-up was 3 years. On Kaplan-Meier analysis, median progression-free survival (PFS) was shorter for ALM (5.6 vs. 7.7 months, P = .02). Out-of-field PFS was shorter for ALM (9.6 vs. 15.3 months, P = .02). Disease-specific survival was shorter for ALM (3.5 vs. 7.8 years, P = .008). In-field PFS and overall survival were not different for ALM vs. non-ALM. On multivariable analysis, there were no differences in PFS (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.0-1.74; P = .05) or in-field PFS (HR 1.25, 95% CI 0.95-1.65; P = .1). Out-of-field PFS remained shorter for ALM (HR 1.44, 95% CI 1.09-1.91; P = .01).
CONCLUSIONS: Isolated limb infusion or perfusion is equally effective in achieving locoregional disease control in patients with ALM or non-ALM ITM. Disease-specific survival and out-of-field PFS were significantly shorter with ALM, likely reflective of ALM\u27s more aggressive biology, and highlights a potential opportunity for systemic therapy with ILI/ILP to optimize local and distant disease control