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Biocompatibility of the InSpace Subacromial Balloon Spacer: An In Vivo Murine Pouch Model Cytokine Analysis
No full textBACKGROUND: There are several methods of treating massive rotator cuff tears in patients without severe glenohumeral arthritis. Subacromial balloon spacers have emerged as one solution to this problem. Previous studies identified a lasting film in the subacromial space well after the balloon should have dissolved, and there is limited information regarding the biocompatibility and reactivity of the resorbable implant. This study sought to characterize the inflammatory response to the balloons histologically and via cytokine production using an established in-vivo animal model.
METHODS: Forty-two BALB/c mice were randomized into two groups: control (no balloon device, n=4/time point) and experimental (balloon device implanted, n=10/time point). Time points were 1, 4, and 12 weeks creating 3 subgroups that contained 4 controls and 10 experimental mice. One subacromial balloon spacer (InSpace; Stryker, Mahwah, NJ, USA) was sectioned into equally sized 3mm diameter sections. Subcutaneous mouse air pouches were created and one 3mm diameter sample was implanted into each mouse pouch. No implants were placed in control pouches. Sacrifice occurred at the noted timepoints. Bead array assay was used to measure cytokines TGF-B1, IL-13, IL-1B, IL-4, IL-6, IL-10, and TNF-α. Histologic analysis was also performed for hematoxylin and eosin (H&E) stained sections.
RESULTS: Cytokine analysis: Cytokines analysis curves correlated appropriately to the array standards. At 1 week and 4 weeks, all cytokines besides TGF-B1 remained within the standard curve and were therefore undetectable. At 12 weeks all cytokines were undetectable.
HISTOLOGIC ANALYSIS: No differences were seen between the control and experimental groups histologically. When characterizing the pouch histology: At 1 week, pouch membranes were dense and infiltrated with inflammatory neutrophils and few macrophages. At 4 weeks the membranes were less densely populated with cells, consisting of mostly fibroblasts, few neutrophils, and no macrophages or lymphocytes. At 12 weeks, the pouch membranes had few cell layers showing mostly fibroblasts.
CONCLUSION: While a thin film may remain after resorption of balloons, the inflammatory response appeared minimal. Further studies using human subjects and/or insufflated balloons may be helpful in better defining the biocompatibility profile of subacromial balloon spacers.
LEVEL OF EVIDENCE: Basic Science Study; In-vivo Animal Model; Histology and Microbiology
Circulating microRNA profiles in early-stage osteoarthritis and rheumatoid arthritis.
No full textOsteoarthritis (OA) and rheumatoid arthritis (RA) are prevalent joint diseases, yet early diagnosis remains challenging with existing methods. Circulating microRNAs are promising biomarkers for detection and differentiation of arthritis subtypes. This study aimed to profile plasma microRNAs from early OA (N = 22), early RA (N = 12), and non-OA/RA (N = 50) individuals using microRNA-sequencing. Principal component analysis revealed distinct clustering of early OA from both early RA and non-OA/RA, but not for early RA and non-OA/RA. A total of 170 differentially expressed microRNAs were identified in early OA versus the other groups, with no significant differences found between early RA and non-OA/RA. Stepwise filtering followed by RT-qPCR validation in independent samples identified six microRNAs: miR-16-5p and miR-29c-3p were upregulated in early OA compared to both early RA and non-OA/RA, while miR-744-5p, miR-382-5p, miR-3074-5p, and miR-11400 were upregulated in early RA compared to the other two groups. Additionally, three novel microRNAs were identified using bioinformatic tools-one enriched in early OA and two in early RA. Target prediction and pathway analyses revealed that early OA microRNAs were linked to extracellular matrix degradation pathways, and early RA microRNAs were linked to immune signaling. These findings highlight six known and three novel circulating microRNAs with potential as biomarkers to distinguish early OA from early RA
Uniting disciplines against antimicrobial resistance (AMR): highlights from a multidisciplinary inaugural AMR summit
No full textAntimicrobial resistance (AMR) poses a significant global health threat, projected to cause 10 million deaths annually by 2050. Addressing AMR requires a coordinated, multidisciplinary approach encompassing infectious disease (ID) clinicians, pharmacists, microbiologists, infection preventionists, and policymakers. The inaugural AMR Summit, hosted by bioMérieux in collaboration with Tampa General Hospital and the University of South Florida Morsani College of Medicine in November 2024, convened experts from various fields to explore innovative strategies for combating AMR. Key topics discussed included the role of multidisciplinary teams in antimicrobial stewardship programs, advancements in rapid diagnostic tests and antimicrobial susceptibility testing, the application of implementation science in AMR, and the integration of next-generation sequencing in ID diagnostics. The summit underscored the importance of diagnostic innovation, interdisciplinary collaboration, policy, advocacy, and public engagement in advancing efforts against AMR
Prognostic Impact of Adjuvant Immunotherapy in Patients with High-Risk Upper Tract Urothelial Cancer: Results from the ROBUUST 2.0 Collaborative Group
No full textBackground/Objective: The impact of adjuvant immunotherapy (IO) on the prognosis of patients with upper tract urothelial carcinoma (UTUC) remains unclear. This study examines the association of adjuvant IO with oncologic outcomes in patients with high-risk UTUC.
Methods: This retrospective study reviewed patients with high-risk UTUC treated with adjuvant IO using the ROBotic surgery for Upper tract Urothelial cancer STudy (ROBUUST) database. Propensity-score-matched analysis (nearest-neighbor algorithm, caliper 0.1) was conducted to compare patients receiving adjuvant IO versus those who did not, with matching based on pathologic T and N category and receipt of neoadjuvant chemotherapy. Associations between adjuvant IO and urothelial recurrence-free survival (URFS), non-urothelial recurrence-free survival (NRFS), and overall survival (OS) were estimated using a Cox proportional hazards model.
Results: Seventy-five patients received adjuvant IO following nephroureterectomy (median four cycles, including eleven (14.7%) nivolumab, thirty-one (41.3%) pembrolizumab, four (5.3%) atezolizumab, and twenty-nine (38.6%) other agents. These patients were matched to 68 patients without adjuvant therapy. Median follow-up times were 17 (IQR, 10-29) months and 20 (9-44) months for IO and no adjuvant therapy, respectively. Multivariable analysis revealed that adjuvant IO was not associated with URFS, NRFS, or OS. Pathologic nodal involvement (HR 7.52, p \u3c 0.001) was the only independent predictor of worse OS.
Conclusions: In this real-world retrospective data set, adjuvant IO does not have an impact on oncologic outcomes of UTUC patients following extirpative surgery
Results of Open and Endovascular Repair of Complex Aortic, Iliac, and Femoral Anastomotic Aneurysms
No full textAnastomotic aneurysms (AA) manifest as late complications of aortic-iliac-femoral reconstruction with a prosthetic graft. We studied open and endovascular repair of complex aortic iliac and femoral AA was performed for (A) Rupture, (B) Large symptomatic aneurysms, (C) Recurrent, (D) Femoral AA requiring simultaneous arterial reconstruction for critical limb ischemia in two teaching hospitals. Between 1990 and 2024, 100 aorto-femoral-iliac AA were repaired with 32 representing complex AA involving aorta (n = 6), iliac (n = 3), femoral (n = 23). Aortic and iliac anastomotic aneurysms underwent endovascular repairs in 5 patients and open repair in 4 patients with satisfactory outcomes in all. All 23 patients presenting with complex femoral anastomotic aneurysms were repaired via open technique, including five presenting with rupture with mortality in two, and one mortality among those presenting with large aneurysms. Complex femoral AA take longer to present after index operative, showed greater operative time, intra-operative blood loss but had similar mortality to patients with non-complex AAs. Most aortic and iliac AA can be repaired with endovascular and open techniques with satisfactory results, while complex femoral AA required open repair
Project #010: Influencing Outcomes through an Evidence-based Nurse-Driven Telemetry Discontinuation Protocol
Full text linkhttps://scholarlycommons.henryford.com/qualityexpo2025/1000/thumbnail.jp
Project #067: Expanded Alcohol Use Disorder Care for Patients with Advanced Liver Disease
Full text linkhttps://scholarlycommons.henryford.com/qualityexpo2025/1007/thumbnail.jp
Project #154: The Flow of Impact: CHWs Uncovering Needs, Unlocking Support
No full texthttps://scholarlycommons.henryford.com/qualityexpo2025/1030/thumbnail.jp
Fibrinogen depletion and the risk of intracerebral hemorrhage following endovascular mechanical thrombectomy
No full textBackgroundIntravenous thrombolysis (IVT) and mechanical thrombectomy (MT) are the standard of care for select stroke patients with acute large vessel occlusion (LVO). Fibrinogen levels may drop after IVT, and a significant decrease in fibrinogen is associated with an increased risk of intracranial hemorrhage (ICH). Our pilot study aimed to explore the relationship between fibrinogen levels and the development of ICH in MT-treated patients and whether bridging with IVT further increases that risk.MethodsThis is a prospective pilot study that enrolled adults presenting with a diagnosis of LVO stroke and eligible to receive MT with or without IVT between April 2020 and May 2023. Fibrinogen levels were drawn before treatment with IVT or MT and immediately following MT.ResultsForty-one patients were enrolled. Median age was 68 years [interquartile range 56-79], 58.5% were females and 56.1% were black. Nineteen patients (46.3%) were treated with MT + IVT, and 22 (53.6%) were treated with MT-only. There was no difference in baseline characteristics between the two groups. Baseline fibrinogen levels were similar between MT + IVT and MT-only groups [391 vs. 352 mg/dL, p = 0.4]. Post MT, the MT + IVT group had lower fibrinogen levels compared to the MT-only group [224 vs. 303 mg/dL, p \u3c 0.001]. Similarly, there was a significant change between baseline and follow-up levels in the MT + IVT vs. MT-only group [106 vs. 39.5 mg/dL, p = 0.001]. Eight patients (19.5%) developed ICH; 5 (26.3%) in the MT + IVT group and 3 (13.6%) in the MT-only group. No significant differences were seen in baseline, follow-up, or change in fibrinogen levels between patients who developed ICH and those who did not. However, when stratified by treatment group, postintervention fibrinogen levels were significantly lower in patients who developed an ICH in the MT + IVT group compared to those without ICH in the MT group (200 vs. 301 mg/dL, p = 0.006). There was also a negative correlation between the change in fibrinogen levels and the rate of first-pass recanalization (Spearman CC -0.33, p = 0.03).ConclusionThis pilot study\u27s preliminary data showed an association between fibrinogen depletion and hemorrhagic transformation in MT-treated patients. Since intracerebral hemorrhage is the most dire side effect in stroke treatment, fibrinogen monitoring in patients undergoing MT after IVT may help identify patients with an increased risk of ICH. Larger, prospective, and multicenter studies are needed to confirm these findings and if fibrinogen repletion should be considered for dysfibrinogenemia
Triage of Patient Messages Sent to the Eye Clinic via the Electronic Medical Record: A Comparative Study on AI and Human Triage Performance
No full textBackground/Objectives: Assess the ability of ChatGPT-4 (GPT-4) to effectively triage patient messages sent to the general eye clinic at our institution. Methods: Patient messages sent to the general eye clinic via MyChart were de-identified and then triaged by an ophthalmologist-in-training (MD) as well as GPT-4 with two main objectives. Both MD and GPT-4 were asked to direct patients to either general or specialty eye clinics, urgently or nonurgently, depending on the severity of the condition.
Main Outcomes: GPT-4s ability to accurately direct patient messages to (1) a general or specialty eye clinic and (2) determine the time frame within which the patient needed to be seen (triage acuity). Accuracy was determined by comparing percent agreement with recommendations given by GPT-4 with those given by MD.
Results: The study included 139 messages. Percent agreement between the ophthalmologist-in-training and GPT-4 was 64.7% for general/specialty clinic recommendation and 60.4% for triage acuity. Cohen\u27s kappa was 0.33 and 0.67 for specialty clinic and triage urgency, respectively. GPT-4 recommended a triage acuity equal to or sooner than ophthalmologist-in-training for 93.5% of cases and recommended a less urgent triage acuity in 6.5% of cases.
Conclusions: Our study indicates an AI system, such as GPT-4, should complement rather than replace physician judgment in triaging ophthalmic complaints. These systems may assist providers and reduce the workload of ophthalmologists and ophthalmic technicians as GPT-4 becomes more adept at triaging ophthalmic issues. Additionally, the integration of AI into ophthalmic triage could have therapeutic implications by ensuring timely and appropriate care, potentially improving patient outcomes by reducing delays in treatment. Combining GPT-4 with human expertise can improve service delivery speeds and patient outcomes while safeguarding against potential AI pitfalls