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Superficial temporal artery retrograde access for the treatment of chronic subdural hematomas.
No full textOBJECTIVE: Middle meningeal artery (MMA) embolization for chronic subdural hematoma (cSDH) has ushered in a treatment paradigm shift. The objective of this study was to determine whether the superficial temporal artery (STA) could be used consistently and just as effectively compared to conventional femoral and radial artery access.
METHODS: The authors retrospectively reviewed a series of consecutive cases from January 1, 2024, to February 28, 2025, where the STA was used to treat cSDH. The 90-day readmission, retreatment, and death rates were collected and compared against a set of internal comparison cases that underwent similar treatment, though via femoral or radial artery puncture.
RESULTS: The study included 40 patients with STA retrograde (STAR) access and 50 patients who had traditional transfemoral or radial artery approaches. In the STA group, there was significantly reduced radiation exposure (p \u3c 0.001) and less contrast administration (p \u3c 0.001). There were no differences between the groups in terms of the 90-day readmission (p = 0.82), retreatment (p = 0.93), or death rates (p = 0.42). One access site complication was observed after a transfemoral intervention.
CONCLUSIONS: STAR access is an alternative for MMA embolization in cSDH. This innovative approach can potentially rival the results achieved by traditional techniques
GRAPPA 2024 Annual Meeting: An Update on Major Project Milestones.
No full textAt the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2024 annual meeting, members were updated on several ongoing activities during the key project update session. These activities included the Biomarker Project, the Axial Psoriatic Arthritis Molecular and Clinical Characterization study, the Diagnostic Ultrasound Enthesitis Tool (DUET) study, the Sex- and Gender-Based Analysis of the Effectiveness of Advanced Therapies in Psoriatic Arthritis (SAGE-PsA) study, the Early Recognition of PsA (COMPOSITION) study, and the GRAPPA treatment recommendations
Clinical Experience with URO17(®) in the Diagnosis and Surveillance of Bladder Cancer
No full textObjective: To describe the clinical use of URO17®, a noninvasive, urine-based immunocytochemistry assay targeting Keratin 17 (K17), as an adjunct to conventional diagnostic methods for urothelial carcinoma. Materials and Methods: These illustrative cases summarize the real-world use of URO17® in diagnostic workflows for patients presenting with hematuria and those undergoing surveillance for non-muscle invasive bladder cancer (NMIBC). Urine samples were processed via standard immunocytochemistry and interpreted alongside cystoscopic, cytological, and radiographic findings. Discussion: URO17® was used as a complementary diagnostic tool to help guide clinical management. Negative results supported deferral of invasive procedures in selected patients, while positive findings prompted further evaluation when standard tests were inconclusive. Conclusions: In the seven illustrative cases presented, URO17® aided clinical decision-making as part of routine diagnostic and surveillance workflows. The test\u27s integration with existing cytology processes supports its potential role as a noninvasive adjunct for evaluating patients with suspected or recurrent urothelial carcinoma
Long COVID trajectories in the prospectively followed RECOVER-Adult US cohort.
No full textLongitudinal trajectories of Long COVID remain ill-defined, yet are critically needed to advance clinical trials, patient care, and public health initiatives for millions of individuals with this condition. Long COVID trajectories were determined prospectively among 3,659 participants (69% female; 99.6% Omicron era) in the National Institutes of Health Researching COVID to Enhance Recovery (RECOVER) Adult Cohort. Finite mixture modeling was used to identify distinct longitudinal profiles based on a Long COVID research index measured 3 to 15 months after infection. Eight longitudinal profiles were identified. Overall, 195 (5%) had persistently high Long COVID symptom burden, 443 (12%) had non-resolving, intermittently high symptom burden, and 526 (14%) did not meet criteria for Long COVID at 3 months but had increasing symptoms by 15 months, suggestive of distinct pathophysiologic features. At 3 months, 377 (10%) met the research index threshold for Long COVID. Of these, 175 (46%) had persistent Long COVID, 132 (35%) had moderate symptoms, and 70 (19%) appeared to recover. Identification of these Long COVID symptom trajectories is critically important for targeting enrollment for future studies of pathophysiologic mechanisms, preventive strategies, clinical trials and treatments
Identifying domains for CNO and SAPHO: A scoping review to create domains from existing outcomes by the OMERACT CNO and SAPHO working group.
No full textINTRODUCTION: Chronic nonbacterial osteomyelitis (CNO) and synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome are autoinflammatory bone diseases of unknown etiology that present with bone pain and varying degrees of extraosseous manifestations such as skin, intestinal and joint involvement. Currently, there are no validated outcome measurement sets that represent the input from all collaborating groups.
METHODS: The OMERACT CNO & SAPHO working group performed a scoping review to identify domains previously used in CNO and SAPHO clinical studies. The list of potential domains was narrowed through a process of binning and winnowing.
RESULTS: A scoping review included 260 observational studies published from 1978 -2020 and 220 domains were initially identified. Domains were reduced to 25 through a binning and winnowing process. Domains cover each of the OMERACT core with most domains mapped to life impact and pathophysiological manifestations.
CONCLUSION: We identified 25 potential domains covering health concepts of function, disease manifestations, pain, and impact on mental health and societal participation to be included in the final core domain set. The next step will be to reach a consensus on the final CNO & SAPHO core domain set and begin instrument selection
Team-Based Versus Technology-Based Supportive Cancer Care: A Mixed Methods Study of Multi-Site Implementation.
No full textBACKGROUND: Supportive cancer care (SCC), defined as advance care planning and symptom management, is nationally recommended for people with cancer. However, barriers persist in its delivery. To address these barriers, we launched a cluster-randomized, multisite clinical trial to evaluate team-based SCC approaches led by lay health educators versus technology-based delivery of SCC education. This mixed methods study aimed to identify implementation barriers and facilitators impacting comparative effectiveness, implementation, adoption, and sustainability of these approaches.
METHODS: Study staff at 26 cancer clinics participated in a 45-minute semistructured interview and a 71-question survey developed using the Consolidated Framework for Implementation Research (CFIR) and Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. We employed a convergent parallel mixed methods analysis approach: interviews were qualitatively coded and analyzed using content analysis methods, and surveys were analyzed using descriptive statistics. Synthesized interview findings were merged with survey findings for final interpretation.
RESULTS: Participants unanimously agreed that SCC is essential for patients with cancer. All highlighted infrastructural and cultural barriers to implementation, including funding constraints, limited organizational prioritization, stigma related to advance care planning, and varying needs of diverse patient populations. There was broad support for team-based approaches and shared concern that technology-based approaches implemented alone could worsen cancer disparities. The impact of these approaches on total costs of care was emphasized as an important outcome, given that such data could potentially convince payer organizations to reimburse for these supportive care services.
CONCLUSIONS: Findings from this study reveal significant infrastructural, organizational, and policy factors influencing adaptability and sustainability of SCC in practice. Such findings may influence the comparative effectiveness of the SCC approaches in the ongoing, multisite cluster randomized trial
Cardiac resynchronisation therapy among adults with a systemic right ventricle: a multicentre experience.
No full textBACKGROUND: Cardiac resynchronisation therapy (CRT) is a key treatment for heart failure (HF) in acquired heart disease, but its benefits in adults with congenital heart disease and a systemic right ventricle (sRV) remain unclear. This study aimed to assess whether CRT improves outcomes in patients with sRV.
METHODS: This is an international, retrospective study including patients \u3e18 years from 33 centres with transposition of the great arteries (TGA) following atrial switch operation and congenitally corrected TGA. The primary endpoint included overall survival and survival free from HF. The secondary endpoint was a composite of death, hospitalisation for HF, heart transplant, mechanical support and ventricular tachycardia/implantable cardioverter-defibrillator therapies.
RESULTS: We identified 105 out of 1721 patients (3.5%) who underwent CRT. Median follow-up after CRT implant was 4.6 (1.6-8) years. QRS improvement was limited to those with previous pacing (167±35 vs 154±28 ms; p=0.002). Following CRT, there was no significant change in B-type natriuretic peptide values, peak VO
CONCLUSION: In this retrospective study in the largest population thus far described with an sRV, CRT implant was not associated with improved survival, even after controlling for key confounders
The impact of gender balance in medical subspecialties on microaggressions and discrimination faced by Asian American women healthcare workers.
No full textOBJECTIVE: This study investigates experiences of Asian American women healthcare workers (HCWs) in various medical specialties, especially those in men-dominated ones, with the goal of identifying key factors that underlie barriers to workplace satisfaction and professional advancement for this group of healthcare professionals.
DESIGN: We conducted a qualitative study of self-identified Asian American women HCWs in the Pacific Northwest. Semi-structured interviews were conducted via videoconference and transcribed. Interviews were coded, then analyzed for themes with an inductive, iterative approach to thematic analysis.
MAIN OUTCOMES AND MEASURES: Participants in men-dominant fields, including surgical specialties, reported frequent instances of gender-based microaggressions and discrimination. Major themes such as bias against motherhood, unequal access to mentorship, and underestimation of competence were associated with barriers to career advancement for women HCWs, particularly in men-dominated specialties
Clinical Utility of [F18]-Fluciclovine PET/MRI for Differentiating True Progression from Treatment-Related Changes in Patients with Glioblastoma.
No full textBACKGROUND AND PURPOSE: Differentiating true progression from treatment-related changes in patients with glioblastoma (GBM) remains a major diagnostic challenge. Amino acid PET tracers such as [F18]-Fluciclovine provide biologically specific information, but clinical real-world validation across institutions is limited. We aimed to evaluate the clinical diagnostic performance of [F18]-Fluciclovine PET/MRI for distinguishing true progression from treatment-related change in patients with presumed GBM progression across 2 academic centers.
MATERIALS AND METHODS: In this retrospective, multi-institutional, IRB-approved study, we analyzed [F18]-Fluciclovine PET/MRI scans performed in patients with presumed GBM progression. All PET/MRI examinations were clinically indicated and performed as part of routine standard-of-care imaging. Clinical classification was based on histopathology or imaging and clinical follow-up. SUVmax was measured in enhancing lesions. Group comparisons were assessed with Mann-Whitney U tests. Diagnostic performance was evaluated using receiver operating characteristic (ROC) analysis, including derivation of an optimal cutoff using Youden\u27s index and validation of the previously published diagnostic threshold of 4.66 (Nabavizadeh
RESULTS: Thirty-six patients with presumed GBM progression (Institution 1, n = 17; Institution 2, n = 19) provided 22 examinations classified as true tumor progression and 14 as treatment-related change. There were no significant differences in clinical or demographic study population characteristics between the two institutions. SUVmax was significantly higher in true tumor progression than in treatment-related change (median [interquartile range], 8.73 [5.86 -10.83] versus 3.71 [1.70 -4.67], p\u3c .01). Combined ROC analysis demonstrated excellent diagnostic performance (AUC=0.90; 95% CI, 0.79-0.98). The optimal threshold of 5.7 yielded 86% sensitivity (0.70-0.99) and 86% specificity (0.64-0.99). Applying the published threshold of 4.66 produced similar results (AUC=0.90), with 91% sensitivity (0.71-0.99) and 71% specificity (0.42-0.92). A stratified analysis demonstrated comparable diagnostic performance across both institutions.
CONCLUSIONS: [F18]-Fluciclovine PET/MRI demonstrated high diagnostic accuracy for differentiating true GBM progression from treatment-related changes, with consistent SUVmax thresholds across 2 institutions. These findings support the generalizability of [F18]-Fluciclovine PET as a biologically specific adjunct to conventional MR imaging for patients with presumed GBM progression.
ABBREVIATIONS: [F18]-FACBC and [F18]-Fluciclovine＝ Trans-1-amino-3-[F18]-fluorocyclobutane-1-carboxylic acid; GBM＝glioblastoma; IDH＝Isocitrate Dehydrogenase; SUVmax＝maximum standardized uptake value
Rationale, Design, and Baseline Clinical Characteristics of the Ziltivekimab Cardiovascular Outcomes Trial: Interleukin-6 Inhibition and Atherosclerotic Event Rate Reduction.
No full textIMPORTANCE: Cardiovascular inflammation is a major determinant of atherosclerotic disease, and inhibition of the central signaling cytokine, interleukin 6 (IL-6), is a promising target for intervention. Patients with chronic kidney disease (CKD) commonly have plasma elevations of inflammatory biomarkers, such as high-sensitivity C-reactive protein (hsCRP) and IL-6, and are at high risk for life-threatening atherosclerotic events as well as loss of kidney function and might therefore benefit from IL-6 inhibition.
OBSERVATIONS: The Ziltivekimab Cardiovascular Outcomes Trial (ZEUS; NCT05021835) will determine the safety and efficacy of IL-6 inhibition with ziltivekimab among patients with atherosclerotic cardiovascular disease (ASCVD), CKD, and systemic inflammation. ZEUS is a multinational, double-blind, placebo-controlled, event-driven, randomized clinical trial inclusive of 6376 participants with ASCVD, CKD, and an hsCRP level greater than or equal to 2 mg/L who were randomized in a 1:1 fashion to receive either ziltivekimab, 15 mg, administered subcutaneously every month or matching placebo. At randomization, mean age was 69.5 years, 27.5% were female, 92.0% had hypertension, 65.7% had diabetes, and 41.3% had heart failure. At baseline, the mean estimated glomerular filtration rate (eGFR) was 44.5 mL/min/1.73 m2, mean low-density lipoprotein cholesterol level was 77.7 mg/dL, median hsCRP level was 4.5 mg/L, and median IL-6 level was 4.9 pg/mL. At enrollment, sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists were being used by 36.8% and 11.3% of the cohort, respectively. The primary outcome is 3-point major adverse cardiovascular events. Secondary cardiovascular outcomes include (1) an expanded major adverse cardiovascular event outcome including hospitalization for unstable angina requiring urgent coronary revascularization, (2) hospitalizations for heart failure or urgent heart failure visits or cardiovascular death, and (3) all-cause mortality. The secondary kidney outcome is a composite of greater than 40% decline in eGFR, eGFR less than 15 mL/min/1.73 m2, dialysis, kidney transplant, death from kidney disease, or cardiovascular death.
CONCLUSIONS AND RELEVANCE: The ZEUS randomized clinical trial will formally test the hypothesis that IL-6 inhibition with ziltivekimab will lower incident cardiovascular event rates and potentially slow kidney decline among participants with known ASCVD, CKD, and elevated hsCRP. If successful, the ZEUS trial would provide a fully novel approach for prevention of myocardial infarction, stroke, cardiovascular death, and kidney function decline among high-risk patients with CKD