20966 research outputs found
Sort by
Angiomatoid fibrous histiocytoma occurring at distal/acral extremity sites: clinicopathological and molecular study of 26 cases highlighting frequent myxoid histology and site-dependent genotypic variation
No full textAngiomatoid fibrous histiocytoma (AFH) is a rare mesenchymal neoplasm of borderline malignancy (locally recurring, rarely metastasizing), most often involving the limbs, trunk, and head/neck. Rarely, AFH may involve unusual locations. Herein, we characterize the clinicopathologic features of 26 AFH of the distal extremities, including acral sites. The tumors occurred in 19 females and 7 males ranging in age from 12 to 76 years (median, 23 years). Tumors involved the upper (n = 19) and lower (n = 6) distal extremity; one affected an unspecified digital site. Twenty-two cases occurred in acral locations (hands and feet). Subsets of cases showed the following morphologic features: multinodular architecture (26/26), lymphoid cuffs (23/26), prominent stromal myxoid change (11/25), angiomatoid features (9/26), and cytologic pleomorphism (8/26). The average mitotic count was 1/10 HPF; 3 cases showed brisk mitotic activity (\u3e 10 mitoses/10 HPF). Immunohistochemistry revealed variable expression of desmin (16/25), EMA (14/21) and ALK (5/8). Molecular testing revealed EWSR1 rearrangements in 17/18 cases (94%). Among 12 tumors with known fusion partners, the fusions partner was CREB1 in 6 cases (50%), CREM in 4 tumors (33%), ATF1 in one tumor (8%) and PBX3 (8%) in another tumor. Prominent myxoid features were noted in 75% CREM versus 33% of CREB1 versus 0% of ATF1-fused tumors. AFH occurring in distal extremity/acral locations have a predilection for females, upper extremity locations, frequent unusual (solid, non-angiomatoid and myxoid) morphology and higher frequency of CREM over ATF1 fusions. Awareness of the morphologic spectrum of these rare neoplasms is essential for correct classification
Protocol for robotic-assisted bronchoscopy versus electromagnetic navigation bronchoscopy for the diagnosis of peripheral pulmonary nodules: a randomized trial (ARTICULAtE study)
No full textBACKGROUND: Electromagnetic navigation bronchoscopy (ENB) and shape-sensing robotic-assisted bronchoscopy (ssRAB) are the two dominant bronchoscopic technologies for the diagnosis of peripheral pulmonary nodules (PPNs). However, data directly comparing ENB and ssRAB are limited. We designed a randomized controlled trial to compare the diagnostic performance of these two technologies. The primary objective is to evaluate if ssRAB is superior to ENB for the diagnosis of PPNs.
METHODS: It is a multicenter, open-label, superiority randomized controlled trial. Patients with PPNs suspicious for lung cancer with a long-axis 8 to 30 mm are being approached for enrollment. The first 90 patients are being recruited as lead-in cases to allow the investigators to become familiar with the ssRAB system. A total of 264 patients will be enrolled in the randomized stage. The primary outcome is the diagnostic yield at the 6-month post-procedure follow-up. The secondary outcomes include diagnostic yield using a strict definition, diagnostic sensitivity of malignancies, the incidence of pneumothorax that requires chest tube placement and/or re-hospitalization or extended hospitalization within 1 month post-procedure, and the incidence of intraoperative severe airway bleeding. Enrollment for the study began in 20 March, 2024 and is currently in progress.
DISCUSSION: The results of this study will provide evidence to directly compare ssRAB and ENB in terms of diagnostic yield of PPNs and guide the selection of appropriate diagnostic techniques for different nodules.
TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT06308120
Integration of Respiratory Care Experts and Emerging Technologies in Critical Care Simulation
No full textRespiratory Therapists (RTs) are indispensable members of the critical care team, yet their participation in the design and facilitation simulation-based training (SBT) remains significantly underrepresented. SBT provides healthcare professionals a risk-free environment to develop and maintain clinical and team skills, prepare for uncommon, high-risk scenarios and receive real-time feedback. This review examines critical contributions of RTs, encompassing their expertise in invasive procedures, mechanical ventilation management, and the burgeoning role of Advanced Practice Respiratory Therapists (APRTs). We explore the professional evolution of critical care and the parallel advancements in simulation technology, creating opportunities to enhance the training of all healthcare professionals. RTs possess unique clinical and technical skills ideally suited for the design and facilitation of critical care simulations. Their inclusion offers a powerful means to improve team training and patient outcomes. Integrating RTs into simulation programs has proven challenging. Resource limitations and staffing constraints require a multifaceted solution including dedicated full-time equivalents (FTEs) in simulation programs, specialized training in simulation pedagogy, and fostering robust interprofessional collaboration opportunities for RTs. Research demonstrating the return on investment (ROI) of integrating RTs into simulation is lacking, but remains crucial to securing the necessary resources and support. Research should focus on quantifiable improvements in trainee performance, team dynamics, and patient safety metrics. By fully integrating RTs into SBT, healthcare institutions can significantly enhance the quality of critical care training, fostering improved interprofessional teamwork, leading to better patient outcomes. This strategic investment in RT participation in SBT will yield substantial returns in improved healthcare delivery
Phase 3 Trial of Dose-Escalated Radiation Therapy and Standard Androgen Deprivation Therapy Versus Dose-Escalated Radiation Therapy and Enhanced Androgen Deprivation Therapy With Orteronel for Men With High-Risk Prostate Cancer (NRG/RTOG 1115)
No full textPURPOSE: NRG/RTOG 1115 was a phase 3 trial evaluating the addition of orteronel, a CYP17A1 inhibitor, to radiation therapy (RT) plus androgen deprivation therapy (ADT) in men with high-risk prostate cancer.
METHODS AND MATERIALS: The study was designed to evaluate overall survival for 900 men with high-risk prostate cancer (Gleason 9-10, prostate specific antigen (PSA) \u3e 20, or clinical stage T2 or higher with Gleason ≤ 8). Patients were randomized 1:1 to standard of care (SOC) therapy (RT plus 2 years of ADT) or SOC plus 2 years of orteronel. RT entailed image guided conventionally fractionated dose-escalated external beam RT to the prostate and pelvis to 45 Gy using intensity modulated RT with either intensity modulated RT (to 79.2 Gy) or brachytherapy boost. Health-related quality of life (HRQOL) was measured using the Expanded Prostate cancer Index Composite (EPIC), Patient-Reported Outcome Measurement Information System (PROMIS) fatigue, and EQ-5D. Accrual was halted early because of discontinuation of orteronel development and the trial redesigned to focus on a composite biochemical failure endpoint.
RESULTS: There were a total of 231 eligible randomized patients. Only 29% in the orteronel arm received ≤ 80% of the planned dose. With median follow-up of 6.2 years, the cumulative incidence of grade 3+ adverse events was higher on orteronel than on the standard arm (P \u3c .001; hazard ratio [HR], 2.32; 95% CI, 1.52-3.47) with 5-year estimates of 59.0% and 35.1%, respectively. No significant differences in overall survival (P = .28; HR, 0.71; 95% CI, 0.39-1.32) or biochemical failure (P = .56; HR, 0.84; 95% CI, 0.47-1.51) were observed. Use of orteronel had a transient negative impact on all prostate cancer-specific QOL domains of the EPIC, but did not increase the magnitude of decline once RT started and had minimal impact on other HRQOL measures.
CONCLUSIONS: The addition of orteronel to RT and ADT did not result in significant improvement in any efficacy outcomes, although information was limited by poor drug tolerance and early termination of accrual, thus limiting statistical power
Infectious Complications in a Patient Receiving Immunomodulatory Therapy for Gout
No full textPegloticase is a recombinant uricase enzyme used in the treatment of refractory and severe tophaceous gout, often administered in combination with an immunomodulator such as mycophenolate mofetil and accompanied by pre-infusion medications, including corticosteroids and antihistamines to reduce hypersensitivity reactions. While this regimen is effective for managing gout, it may also increase the risk of opportunistic infections, particularly in patients with significant comorbidities. We present the case of a 75-year-old female patient with multiple comorbidities, including diabetes and chronic kidney disease, who developed a significant gluteal abscess that progressed to pelvic osteomyelitis and methicillin-resistant Staphylococcus aureus (MRSA) bacteremia while undergoing treatment for refractory gout with pegloticase (Krystexxa) and mycophenolate mofetil (CellCept). The patient has recovered from the infection; however, a 2.5 × 1.5 × 7.3 cm wound persists. The wound has remained clean with healthy granulation tissue and no exposed bone or signs of an active infection. This case highlights the importance of assessing infection risk in patients receiving immunomodulatory treatments for gout and demonstrates the need for close monitoring and multidisciplinary care, particularly in those with underlying comorbidities
A case report of recurrent endometrial cancer invading the rectum and bladder with concurrent primary rectal cancer treated with total neoadjuvant therapy and pelvic exenteration
No full textEndometrial cancer, the fourth most common cancer affecting women in the USA, typically recurs locally or can invade regional lymph nodes and the peritoneum. A 66-year-old female with history of Stage 1b endometrial adenocarcinoma was found to have rectal adenocarcinoma on surveillance colonoscopy. Cross-sectional imaging demonstrated a vaginal cuff mass with bladder wall thickening and unilateral hydronephrosis. A bladder mass was identified and partially resected on cystoscopy; pathology was indicative of urothelial carcinoma. The final surgical specimen demonstrated endometrial cancer as the primary culprit in all three organs, confirmed by additional immunohistochemical staining of the previous bladder resection specimen. The rarity of hollow organ involvement in locoregional endometrial cancer recurrence can engender misdiagnosis, potentially leading to discordant treatment and suboptimal outcomes. A high index of suspicion in conjunction with multidisciplinary discussion may have prompted additional immunohistochemical testing to obtain the correct diagnosis earlier in the patient\u27s clinical course
Prototype design of porous Ti6Al4V intraosseous implant for use in mandibular reconstruction
No full textThe design of patient-specific implants often requires computer simulations for the characterization of mechanical properties before manufacturing. We previously developed numerical models to predict the mechanical properties of porous Ti6Al4V constructs built using laser powder bed fusion (LPBF). Here, we developed a patient-specific porous intraosseous mandibular implant based on the models and techniques described in our previous research. The implant model used a simple cubic porous design with an average unit cell size of 1 mm and strut thicknesses between 350 and 450 μm. Finite element analysis was used to simulate right molar clenching on the mandible with and without the implant, under static and dynamic loading. The simulation showed that the implant would remain intact during right molar clenching and should not cause stress shielding. The fatigue numerical models predicted that the implant would remain functional under cyclic masticatory forces (50-100 N) for a period ranging between 4 and 119 years. Given that, within one year, bone ingrowth and osseointegration are complete, the implant is predicted to remain intact long-term under physiological loading conditions. These findings demonstrate the potential of computational modelling in developing patient-specific designs for porous implants built through LPBF
Project #080: Optimizing Neonatal Outcomes: Improving Early HIV Detection and Intervention in Newborns. A Quality Improvement Initiative.
Get PDFhttps://scholarlycommons.henryford.com/qualityexpo2025/1010/thumbnail.jp
Project #160: STOP the line for Safety: Safety STOP
No full texthttps://scholarlycommons.henryford.com/qualityexpo2025/1032/thumbnail.jp