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In-hospital and long-term outcomes in spontaneous coronary artery dissection with concurrent cardiac arrest: Systematic review and meta-analysis
No full textBACKGROUND: Our understanding of factors predisposing patients with spontaneous coronary artery dissection (SCAD) to worse outcomes, such as concurrent sudden cardiac arrest (CA) and secondary prevention of sudden cardiac death in those patients, is limited.
OBJECTIVE: We conducted the largest systematic review of studies assessing clinical outcomes in SCAD with concurrent CA.
METHODS: This study was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Cochrane, and Scopus were searched using relevant search terms including Spontaneous Coronary Artery Dissection, Ventricular Tachycardia, Ventricular Fibrillation, Sudden Cardiac Death, and Cardiac Arrest. The search was conducted from database inception to January 2025.
RESULTS: Out of 269 studies that underwent screening, 10 were included (n = 3978). In-hospital mortality, postdischarge mortality, recurrent myocardial infarction (MI) and recurrent SCAD occurred in 20%, 3%, 12%, and 9% of patients with SCAD and CA, respectively. When compared with patients with SCAD without CA, patients with SCAD and CA were at significantly higher risk of in-hospital mortality (risk ratio [RR] 6.7, 95% confidence interval [CI] 4.5–10.1, P \u3c .00001), postdischarge mortality (RR = 5.9, 95% CI 1.7–19.9, P = .005), recurrent MI (RR = 3.3, 95% CI 2.0–5.4, P \u3c .00001), and recurrent SCAD (RR = 1.9, 95% CI 1.1–3.3, P = .02). Out of a pooled 35 implanted cardiac defibrillators (ICDs) and wearable cardiac defibrillators (WCDs), there was only 1 appropriate and 1 inappropriate defibrillator discharge recorded over the follow-up period.
CONCLUSION: SCAD with concurrent CA is associated with worse in-hospital and long-term outcomes, although long-term rate of administered defibrillator therapies was low, supporting a conservative approach
FIP1L1-PDGFRA Positive Chronic Eosinophilic Leukemia Presenting With Vestibular Neuritis
No full textMyeloproliferative neoplasms are disorders of stem cells that result in excessive proliferation of one or more myeloid progenitors. We report a rare finding of chronic eosinophilic leukemia with a rearrangement of the PDGFRA gene in a 53-year-old male patient presenting with symptoms suggestive of vestibular neuritis
Trapezius Myocutaneous Flap Reconstruction for the Head and Neck
No full textINTRODUCTION: The trapezius myocutaneous flap is a valuable option for reconstructing defects in the head and neck region requiring a sizeable skin paddle. This study assessed surgical outcomes of the trapezius myocutaneous flap in head and neck reconstruction, specifically focusing on defects of the lateral temporal bone, lateral neck, and scalp or posterior midline neck.
METHODS: This retrospective study analyzed patients grouped by site of defect within the head and neck. Subgroup analysis was performed.
RESULTS: Overall rates of complication for the lateral temporal bone and lateral neck were 14.5% and 21.1%, respectively. The odds of complications in the scalp and midline posterior neck site were significantly higher (2.94 times higher) than in patients with a temporal bone defect site (odds ratio=2.94, P=0.027).
CONCLUSIONS: The trapezius flap is useful when reconstructing the lateral temporal bone and lateral neck defects, likely due to a more favorable arc of rotation
Pre and postnatal exposure to glyphosate-based herbicides and potential neurodevelopmental outcomes: a systematic review of animal and epidemiological studies
No full textEmerging evidence indicates potential adverse effects on infant neurodevelopment from exposure to glyphosate during prenatal and postnatal periods. This systematic review examines the scientific literature to explore links between prenatal/postnatal glyphosate exposure and neurodevelopmental abnormalities in humans and non-humans. Twenty-five original articles were reviewed, focusing on the following descriptors: glyphosate-based herbicides, pre and postnatal exposure, and neurodevelopmental outcomes. Risk of bias assessment was conducted to quality of studies. Experimental studies commonly used tests such as open field and novel object recognition, while epidemiological studies relied on medical records for diagnoses of conditions like depression and autism-like behavior. Surprisingly, only one experimental study directly measured glyphosate levels, and one of the epidemiological studies included a biomarker measure. In rodents, GLY exposure was associated to impaired cognition, motor function, memory, as well as ASD and anxiety-like behavior. In fish models, impairment of swimming activity was predominant. Overall, findings suggest possible associations between glyphosate exposure and neurodevelopmental deficits, emphasizing the need for further research to comprehend the extent of glyphosate\u27s impact on developmental functioning
Regeneration of cartilage defects using engineered extracellular vesicles
No full textIn recent years, the number of adults with diagnosed cartilage defects has increased significantly, and various modes of treatment have been sought. However, traditional cartilage repair strategies have been proven inefficient, with limited success. Recently, regenerative treatment options have become more routinely used for specific indications, but they still have major limitations. Cell-derived extracellular vesicles (EVs) are becoming increasingly attractive for regenerative purposes because they provide several regenerative factors. In addition, they can be engineered to function as delivery agents for proteins, nucleic acids, and other molecules. Recently, EVs were explored for cartilage tissue engineering, with varying results. Unlike other cell-based therapies, this approach will lead to the avoidance of problems associated with immunogenic reactions against allogenic cells and easier approval of the therapy by regulatory bodies, which is expected to stimulate wider clinical application. Because of its broad interest and importance, this review was developed to discuss published works, their outcomes, and limitations and outline future research directions
Paranasal Sinus and Nasal Cavity Cancers: Systematic Review and Executive Summary of the American Radium Society Appropriate Use Criteria
No full textTumors of the paranasal sinus and nasal cavity (PNS/NC) are rare and exhibit diverse histology, anatomic subsite, and malignant potential. Early-stage disease is typically managed with surgery, and locally advanced disease is treated with a combination of surgery, radiotherapy, and chemotherapy. Clinical decision-making is commonly guided by limited retrospective evidence. To address this limitation, we performed a systematic review to inform evidence-based consensus for the management of common clinical scenarios, including the potential roles of radiation and systemic therapy to promote structural preservation, elective neck management, and radiation technique considerations. A librarian-mediated literature search identified 39 studies of adult patients with PNS/NC tumors treated with curative intent that met the study inclusion criteria. Search results were reported using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) methodology. A modified-Delphi process was used to guide consensus for the appropriate use of various management strategies. Strong consensus existed for the appropriateness of primary surgery for early-stage disease, approaches to locally advanced disease with minimal periorbital fat invasion, and the use of induction chemotherapy with response-directed local therapy. Consensus regarding nodal treatment and the use of proton therapy in the adjuvant setting was less robust. The rarity and diversity of PNS/NC tumors limit randomized phase III trials to guide management. As such, this systematic review and appropriate-use consensus statements provide clinical guidance for the management of this challenging disease spectrum
A Mechanistic study assessing difficulty discontinuing chronic hypnotic use
No full textRATIONALE: The abuse liability of chronic hypnotic use remains a clinical concern.
OBJECTIVES: This study assessed 1) whether there would be greater difficulty discontinuing chronic hypnotic use for people with insomnia and hyperarousal vs those with insomnia but without hyperarousal and 2) whether those seeking to discontinue chronic hypnotic use of the receptor non-specific hypnotic eszopiclone would have more difficulty than those discontinuing the receptor specific zolpidem XR.
METHODS: DSM-V diagnosed insomnia participants, aged 23-61 yrs, (n = 41, 36 females), with no other sleep disorders, unstable medical or psychiatric diseases or drug dependency completed the trial. Following a screening nocturnal polysomnogram (NPSG) participants were randomized to zolpidem XR (12.5 mg), eszopiclone (3 mg), or placebo nightly for 6 months. After 6 months nightly use, over a 2-week discontinuation, they were instructed to discontinue their hypnotic use, but, if necessary, to self-administer before sleep either 1, 2, or 3 capsules, each packaged separately in envelopes labeled 1, 2, and 3, containing their assigned blinded medication or placebo.
RESULTS: Over the 14 nights 21 participants took zero (51%) capsules and among the 20 taking capsules the median total number chosen was 3. Those people with insomnia and hyperarousal vs those with insomnia but not hyperarousal had more difficulty discontinuing chronic hypnotic use (aim 1) as did those using eszopiclone vs zolpidem or placebo (aim 2).
CONCLUSIONS: Most subjects discontinued hypnotic use and among the few continuing to use their use declined from week one to week two of the discontinuation period
Investigation of relationship between occupational exposure to aerosol and sleep problems: A systematic review and meta-analysis
No full textThere are various occupational and industrial activities that are associated with the production of suspended particles. Little is known about sleep disturbance caused by exposure to aerosol exposure. Presented systematic review and meta-analysis study aimed to investigate the impact of various aerosols during occupational exposure on sleep. A systematic search in Scopus, Web of Science, PubMed, Embase, and Medline databases was performed until 20 February 2024. Three sets of keywords and their possible combinations were used in the search algorithm. To evaluate the quality and risk of bias in studies, the Joanna Briggs Institute (JBI) tools and risk of bias in non-randomized studies of exposure (ROBINS-E) instruments were applied, respectively. The pooled values were also computed by meta-analysis. Based on inclusion/exclusion criteria, 23 articles were entered into the review. 9 out of 11 articles with high quality (81.82 percent), 8 out of 9 articles with moderate quality (88.89 percent), and 2 out of 3 articles with low quality (66.67 percent) indicated that aerosol exposure had a meaningful negative effect on sleep among workers in various occupations. Among articles, 69.6% (N = 16) were given a high risk of bias rating, 13.0% (N = 3) were rated as moderate risk of bias, and 17.4% (N = 4) were rated as low risk of bias. The results of the meta-analysis indicated that the pooled value of the prevalence in the cross-sectional, cohort, and case control studies was 42.35 (95%CI [34.55, 50.16]), 10.82 (95%CI [6.76, 14.87]), and 35.70 (95%CI [13.96, 57.45]), respectively. Also, the results of the meta-analysis showed that the pooled values of the odds ratio in the cross-sectional and cohort studies were 1.82 (95% CI [1.43, 2.21]) and 1.73 (95% CI [1.49, 1.96]), respectively. Totally, most studies indicated that various sources of occupational aerosol exposure significantly affected sleep among employees
Opioid Prescribing Patterns and Post-prostatectomy Readmission: Data From a Statewide Quality Collaborative
No full textOBJECTIVE: To explore whether post-radical prostatectomy (RP) opioid prescription is associated with hospital readmission, given that this may represent a potential means of reducing unplanned health service utilization.
METHODS: The Michigan Urological Surgery Improvement Collaborative registry was queried for patients undergoing RP between May 2018 and October 2024 who completed a questionnaire on number of post-RP opioid pills prescribed. Multivariable models were constructed to evaluate the relationship between either (1) the number of pills prescribed or (2) the provider\u27s default prescribing practice and hospital readmissions.
RESULTS: Of 2656 patients with opioid prescription data, 77 were readmitted (rate: 2.9%). Unadjusted readmission rate by opioid prescription count was 2.1% for those receiving no pills, 3.0% for 1-6 pills, and 4.2% for \u3e6 pills. Multivariable models demonstrated a significant association of opioid prescription (overall P=.041; 0 pills [vs. \u3e6 pills]: odds ratio [OR] 0.45, 95% confidence interval [CI] 0.24-0.84, P=.012) and provider default prescribing practice (after switch to opioid-free [vs. before]: OR 0.53, 95% CI 0.29-1.00, exact P=.0495) with readmission.
CONCLUSION: Omission of post-RP opioid prescription is significantly associated with lower odds of readmission; a change in prescribing habits to opioid-free is associated with a decrease in readmission rate. Post-RP opioid prescription is an actionable target in the reduction of unplanned health service utilization
Active Surveillance for Prostate Cancer in Real-World Setting: Exploring Racial Disparities
No full textINTRODUCTION AND OBJECTIVES: Active surveillance (AS) is a safe management strategy for low-risk prostate cancer (PCa), but limited real-world data exist outside trial cohorts. This study investigates racial disparities in progression to treatment, upgrading, and prostate cancer-specific mortality (PCSM) in a real-world AS population, aiming to improve healthcare quality.
METHODS: We retrospectively analyzed data from the Henry Ford Health System (1995-2023) for men diagnosed with PCa (Gleason Grade ≤ 2, ≤ cT2c, N0-M0, PSA ≤ 20 ng/ml, age \u3c 76 years) and enrolled in AS with ≥ 1 post-diagnosis PSA or biopsy and ≥ 1 year follow-up. Non-Hispanic Blacks (NHBs) and Non-Hispanic Whites (NHWs) were included. Surveillance adequacy was defined as ≥ 1 PSA/year and ≥ 1 biopsy every 4 years. Competing-risk cumulative incidence and regression assessed disparities in progression to treatment, upgrading, and PCSM.
RESULTS: Among 864 patients (38% NHBs, 62% NHWs), NHBs presented with more advanced disease, including higher rates of GG2 (29% vs. 18%, p \u3c 0.001) and intermediate-risk PCa (39% vs. 32%, p = 0.04). Surveillance adequacy was lower in NHBs (38% vs. 50%, p \u3c 0.001). NHBs progressed to treatment more frequently (45% vs. 36%, p \u3c 0.001), with a 1.46-fold higher risk (95% CI: 1.14-1.87, p = 0.003). NHBs had no higher odds of upgrading but showed higher 10-year PCSM (5.6% vs. 1.4%) and 5.9-fold higher odds of PCSM (95% CI: 1.38-25.37, p = 0.01).
CONCLUSIONS: NHBs under AS face more advanced disease, lower follow-up adequacy, higher progression to treatment, and elevated PCSM odds. Targeted strategies are needed to address these disparities and improve equitable PCa care