Providence St. Joseph Health Digital Commons
Not a member yet
12290 research outputs found
Sort by
Sex and Racial Differences in Prescription Patterns to Guideline-directed Medical Therapy Among STEMI Patients
No full text
Readmission rates and hospital charges: a comparative study of surgical interventions in degenerative spondylolisthesis and spinal canal stenosis.
No full textOBJECTIVE: Degenerative spondylolisthesis and spinal canal stenosis are some of the more common clinical conditions associated with low back pain, with various surgical techniques available, ranging from standalone decompression to fusion. Interspinous spacer devices (ISD) have emerged as an intermediary surgical option. The aim was to compare 90-day all-cause readmission rates between techniques, with secondary outcomes including total hospital charges and postoperative complications.
METHODS: Utilizing the 2020 Nationwide Readmissions Database (NRD), adult patients (\u3e 18 years) were selected by primary diagnosis ICD-10 code for spondylolisthesis and/or spinal stenosis. Patients were categorized by surgical treatment: ISD, decompression, or single-level posterior fusion. Treatment techniques were compared using a multivariable logistic and linear regression while adjusting for potential confounding factors. Propensity score adjustments were performed as a sensitivity analysis.
RESULTS: In total 37,503 patients met our inclusion criteria, with (81.2%) having received a decompression, 18.3% a fusion and 0.49% an ISD. The 90-day all-cause readmission rates were 8%, 9%, and 9% respectively (p= 0.85). ISD had the lowest mean raw hospital charges at 205,024. Early c omplication rates were similar across all groups, except for neurological and gastrointestinal complications.
CONCLUSION: ISD had comparable readmission and early postoperative complication rates versus decompression or fusion surgeries, with lower raw charges compared to fusion. Our results suggest that ISD may be a viable option for some patients compared to more traditional surgical techniques for spondylolisthesis or spinal stenosis. Further research into the long-term cost-effectiveness and clinical outcomes will be needed
Retrospective Study Supports that Pharmacologic Venous Thromboembolism Prophylaxis After Intracerebral Hemorrhage is Safe, Underused.
No full textBACKGROUND: Patients with spontaneous non-traumatic intracerebral hemorrhage (ICH) have a heightened risk for venous thrombosis (VTE). The Stroke 2022 Guidelines suggest initiating pharmacologic prophylaxis after hemorrhage stabilization, as measured on repeat imaging within the first 24 hours of admission. However, pharmacologic prophylaxis is underutilized and there remain concerns that initiation of pharmacologic prophylaxis could increase hemorrhage size. This study examines the safety of initiating pharmacologic prophylaxis after hemorrhage stabilization.
METHODS: This was a retrospective study of patients discharged with nontraumatic spontaneous ICH. The study population was from Providence Medical Centers in Washington, Oregon, and California. Patients, 18 years or older, presenting to a hospital between January 2018 and December 2021 with a primary diagnosis at discharge of ICH were included.
RESULTS: Among the 228 included, 65.4% (n = 149) received mechanical prophylaxis only and 34.6% (n = 79) received any pharmacologic prophylaxis (with or without mechanical prophylaxis). Of those patients who received any pharmacologic prophylaxis, 55.7% (44) were administered pharmacologic prophylaxis within 48 hours of stabilization. There were no significant differences in age, sex, medical history, hemorrhage type, severity, or mortality in-hospital or at 30 days.
CONCLUSION: There were no significant differences in VTE events and hemorrhage expansion for spontaneous ICH patients who had pharmacologic with or without mechanical prophylaxis or mechanical only, consistent with previous literature. For patients who received pharmacologic prophylaxis after stabilization, none had hemorrhage expansion; our data support the 2022 guidelines that it is safe to administer pharmacologic prophylaxis after hemorrhage stabilization
In-depth analysis of endogenous retrovirus expression in glioblastoma.
No full textBACKGROUND: Human endogenous retroviruses (HERVs) are remnants of ancient viral infections and comprise 6-8% of the human genome. Their biological functions in cancer remain poorly understood, especially in glioblastoma, the most common and deadly primary brain cancer in adults. Prior studies on HERV expression in glioblastoma have yielded conflicting results. Here, we employed orthogonal computational pipelines to address these limitations.
RESULTS: Locus-specific analysis revealed marked heterogeneity of transcription among HERVs within the same clade. We found that individual HERV proviruses are more than twice as likely to be underexpressed in glioblastoma than overexpressed and that most differentially expressed HERVs are exonized within transcripts. These HERVs are enriched in the 3\u27-terminal exons of transcripts, associated with alternative polyadenylation and contribute conserved polyadenylation signals. We identified HERV expression patterns associated with glioblastoma subtypes and anatomic features. We also identified three proviruses or proviral fragments of particular interest including one associated with survival and one exonized within a currently unannotated cancer-specific transcript. Among the most recently integrated clade of HERVs, excluding solo-LTRs, only the HML-2 provirus at 1q22 is overexpressed in glioblastoma. We report previously undescribed transcripts incorporating this provirus that may encode several proteins.
CONCLUSIONS: This study represents the first systematic exploration of the heterogeneity of HERV expression between anatomic features of any cancer. It shows that exaptation of HERV polyadenylation signals and HERV-associated APA are widespread in the human transcriptome and identifies critical structural information regarding the HML-2 1q22 provirus transcript, which has been the focus of several recent analyses. Our findings underscore the importance of locus-specific and anatomic feature-specific HERV analysis and suggest structural and functional roles for HERVs in glioblastoma-associated transcripts
Association of baseline ctDNA EGFR mutation detection with clinical outcome in the phase II RAMOSE trial assessing ramucirumab plus osimertinib versus osimertinib in EGFR mutant non-small cell lung cancer
No full textAmivantamab in Participants With Advanced NSCLC and MET Exon 14 Skipping Mutations: Final Results From the CHRYSALIS Study.
No full textINTRODUCTION: Amivantamab is an EGFR-MET bispecific antibody with immune cell-directing activity. We assessed the safety and efficacy of amivantamab in participants with advanced NSCLC harboring primary MET exon 14 skipping mutations (METex14).
METHODS: CHRYSALIS enrolled participants with METex14 NSCLC who progressed after or declined standard-of-care therapy. Participants received intravenous amivantamab weekly for 4 weeks and biweekly thereafter. Objective response rate, duration of response (DoR), clinical benefit rate, progression-free survival, overall survival, safety, and circulating tumor DNA were analyzed.
RESULTS: Among 97 participants, 16 were treatment naive, 28 received prior treatment without MET therapies, and 53 received prior MET therapies. Objective response rate was 32% overall, 50% in treatment-naive participants, 46% in participants without prior MET therapies, and 19% in participants with prior MET therapies. In participants without prior MET therapies, amivantamab activity was observed regardless of co-occurring genomic alterations. Clinical benefit rate was 69% overall, 88% in treatment-naive participants, 64% in participants without prior MET therapies, and 66% in participants with prior MET therapies. Median DoR was 11.2 months; 61% (19/31) of the responders had DoR greater than or equal to 6 months. Median progression-free survival was 5.3 months (95% confidence interval, 4.3-7.0); median overall survival was 15.8 months (95% confidence interval, 14.6-not estimable). Most common adverse events were rash (79%) and infusion-related reactions (72%), most being grades 1 to 2 (52%).
CONCLUSIONS: The safety profile was consistent with previous reports of amivantamab in EGFR-mutant NSCLC. Amivantamab demonstrated clinically meaningful and durable antitumor activity in participants with METex14 advanced NSCLC, including those who progressed on prior MET therapies
Manual therapy considerations for adhesive capsulitis in the breast cancer population: a clinical perspective.
No full textAdhesive capsulitis (AC) is common in women aged 40-60, overlapping with the population at higher risk for breast cancer. Many breast cancer survivors develop shoulder dysfunction, including AC, due to cancer treatments such as surgery, chemotherapy, and radiation, leading to pain, limited mobility, altered biomechanics, and soft tissue contracture. Despite the prevalence of AC in this population, clinical guidelines for its management remain underexplored. Manual therapy can play a key role in improving quality of life for these individuals.Understanding the pain mechanisms - nociceptive, neuropathic, and nociplastic - can inform appropriate treatment strategies for breast cancer survivors with AC. This clinical perspective integrates manual therapy principles into the evaluation and management of AC in this population. As breast cancer cases continue to rise, clinicians must recognize the impact of cancer treatment sequelae on orthopedic conditions to optimize patient care
