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Impact of Subsequent Fellowship on Urology Chief Resident Case Log Volumes
No full textOBJECTIVE: To characterize the impact of subsequent fellowship on the case log experience of trainees throughout their residency and specifically their chief resident year.
MATERIALS AND METHODS: Urology resident case logs from 2010 to 2022 were obtained from 13 institutions for total residency and chief years. Five categorized index procedures were included for analysis: General Urology; Endourology; Reconstructive Urology; Urologic Oncology; and Pediatric Urology. Subsequent fellowship data (yes/no and type) were available for 338. Regression models analyzed the interactions of case log volumes and subsequent fellowship.
RESULTS: Of the 338 residents, 141 (42%) went onto practice and 197 (58%) completed a fellowship including 53 in oncology, 44 in reconstruction, 43 in endourology, 29 in pediatric, and 28 in another nonindexed domain. A total of 419,353 cases were logged during training, including 125,319 (30%) during the chief resident year. The median number of total cases completed per resident increased irrespective of subsequent fellowship. Conversely, the median number of total cases completed during chief year declined with the slope of decline being significant in those residents not completing a fellowship [slope = -2.44, CI: (-4.66, -0.23), p-value = 0.031]. Temporal trends demonstrated that absence of subsequent fellowship was associated with decrease in chief resident cases across all index domains (p for all \u3c 0.001). The specific type of fellowship, however, had no association with chief year trends.
CONCLUSIONS: The median number of chief resident cases has declined, most significantly in those trainees not pursuing a fellowship, possibly reflecting a focus on urology encounters which are not captured in ACGME logs
The impact of race and socioeconomical status on the conditional graft and patient survival after 5-year in liver transplantation
No full textBackground: Race and socioeconomic status have been reported to affect graft survival in adult liver transplant recipients, but there are few reports on the effects on long-term survivors. We hypothesized that impact of socioeconomic status on patient outcomes might persist even in very long-term. In this study, we assessed possible impact of race and socioeconomic status on their very-long term outcomes. Method: Adult liver transplant alone performed from 2003-2013 were evaluated to compare 10-year survivals using the United Network for Organ Sharing database. To minimize prognostic impacts of early post-transplant complications, the conditional survival was evaluated which was defined as the probability of survival after 5 years in those who survived for the first 5 years. (10-year survivals in 5 years survivors) Socioeconomic factors included patient education level and employment status at transplant. The impact of race and socioeconomical factors on 10-year conditional graft/patient survival in 5 years survivors was evaluated by Cox proportional hazard model. Result: In total, 71,679 adult LT were performed from 2003-2013, of which 46,659 recipients survived at 5 years post-transplant. In this population, Kaplan-Meier analysis showed that Hispanic and Asian had better 10-year conditional graft survival as compared with Black and White (p\u3c0.01) in 5 years survivors. (Figure 1) Multivariable Cox hazard model revealed that Hispanic, Asian (reference; white), and employment status at transplant improved 10-year conditional graft survival, independent of age, gender, diabetes mellitus, and MELD score. The lower education level (high school or lower, reference; postcollege graduate degree) was independently associated with worse 10-year conditional graft survival. (HR1.26, 95%CI 1.11-1.42, p\u3c0.01, HR1.14, 95%CI 1.01-1.30, p\u3c0.01) Similarly, in multivariable Cox hazard model for 10-year conditional patient survival, Hispanic, Asian, and employment status at transplant were related to better 10-year conditional patient survival. The lower education level increased the risk of 10-year mortality. (HR1.33, 95%CI 1.18-1.51, p\u3c0.01, HR1.19, 95%CI 1.05-1.35, p=0.01) Conclusion: In liver transplantations, race and socioeconomic status significantly impacted very long-term outcomes, even after minimizing prognostic impacts of early post-transplant complications. [Formula presented] DISCLOSURES: A. Nishimagi: None. R. Oki: None. I. Rocha: None. S. Al- Juburi: None. L. Rajendran: None. E. Kerby: None. A. Mohamed: None. A. Nassar: None. A. Al-Kurd: None. A. Yoshida: None. M. Abouljoud: None. S. Nagai: None
A Systematic Analysis of Coronary to Pulmonary Artery Fistula and Its Associated Aneurysm in Adults
No full textOBJECTIVES: We conducted a systematic review to evaluate the clinical features, diagnosis, and treatment of coronary artery to pulmonary artery fistula (CPAF) and its associated aneurysms.
METHODS: Our search encompassed MEDLINE/PubMed, Scopus, Google Scholar, and the Cochrane Collaboration Database from 1970 to 2025.
RESULTS: A total of 461 cases were analysed. The volume of publications steadily increased after 2010. The left anterior descending coronary artery was the most common site of origin for CPAF. A total of 457 cases underwent coronary angiography confirming CPAF, with computed tomography coronary angiography being the most frequently used non-invasive imaging modality (190 cases, 41.2%). Stress tests were conducted in 78 cases (16.9%), revealing a coronary steal phenomenon associated with CPAF. Particularly, when comparing aneurysm CPAF to non-aneurysm CPAF, we found that older age is an independent risk factor for developing an aneurysm. For interventions, the symptomatic patients were more likely to close the fistula. We identified that 218 cases (49.7%) underwent surgical treatment, while 121 cases (27.6%) received percutaneous embolization. There were 8 reported deaths, resulting in a mortality rate of 1.8%.
CONCLUSIONS: The clinical presentations of CPAF are often non-diagnostic. Computed tomography coronary angiography is the preferred method for visualizing the fistulas and their surrounding structures. Surgical treatment is beneficial in cases of aneurysm CPAF or with other surgical indications. Transcatheter closure of CPAF may be considered for selected individuals with favourable anatomy (PROSPERO Number CRD42025643603).
CLINICAL REGISTRATION NUMBER: PROSPERO Number CRD42025643603
Synchronizing the Beat: The Art and Science of Intracardiac Device Implantation
No full textThis is the case report of a 90-year-old woman with multiple prior valvular interventions and severe tricuspid regurgitation who underwent successful percutaneous tricuspid valve replacement with an EVOQUE bioprosthesis (Edwards Lifesciences). Despite initial success, she developed a right bundle branch block and high-degree atrioventricular block resulting in a traumatic syncopal episode, necessitating leadless pacemaker insertion. This case highlights the advancements in valvular interventions and intracardiac devices and the impact they have had in transforming the field of structural heart disease. We discuss the new challenges for interventionalists and electrophysiologists in device selection and the potential benefits of leadless pacemakers in patients with complex cardiac histories
Atrioventricular Block After EVOQUE Transcatheter Tricuspid Valve Replacement
No full text•Based on a real-world study of 106 Evoque transcatheter tricuspid valve replacement (TTVR) recipients, a total of 14 (25%) cases of new atrioventricular (AV) block occurred after Evoque implantation in the 55 patients without prior pacemakers who met study inclusion criteria. This incidence is similar to that reported in the TRISCEND II clinical trial.•New AV block occurred in a median of 26 hours after Evoque TTVR (interquartile range: 5-60 hours), but there were cases of new AV block that occurred as late as 7 days after the procedure.•Of the 14 new cases of AV block, 12 were treated successfully with implantation of a leadless pacemaker (Micra) under fluoroscopic guidance without procedural complications or compromising the valve implantation.•The institutional strategy of 48-hour post-Evoque inpatient monitoring for all patients followed by mobile cardiac outpatient telemetry identified 11 of 14 cases of new AV block as before discharge from the hospital and 1 case as an outpatient before symptom onset
Fluoroscopic radiation induced skin reactions: Radiation dermatitis and radiation-induced morphea
No full textGiven the rise of radiation based medical procedures, cutaneous radiation reactions are increasing in frequency. Diagnosis of fluoroscopic radiation-related cutaneous injuries are challenging, as patients are often unaware of or cannot recall radiation exposure. It is important to maintain clinical suspicion of radiation induced skin injuries in patients with persistent morpheaform areas and localized areas of dermatitis or ulceration. Several cutaneous radiation induced injuries have overlapping clinical presentations. Histopathology may be required to help differentiate between these distinct disorders. Treatment of cutaneous radiation reactions may vary, dictated by a variety of factors, including the disease process, the severity of the lesions, and the presence of comorbidities. Herein, we present two cases to highlight the spectrum of fluoroscopic radiation induced cutaneous injuries
Impact of clinical factors and surgical treatments on sebaceous carcinoma patients with and without Muir-Torre syndrome
No full textUtilization of Adipose-Derived Stem Cells in Cranial Nerve Regeneration: A Comprehensive Review
No full textLarge peripheral nerve injuries may require surgical reconnection. Cell-based therapies have also been investigated for nerve regeneration. Within the context of this modern treatment paradigm for peripheral nerve injuries, we investigated the role of adipose-derived stem cells (ADSCs) in the regeneration of cranial nerves. PubMed and Embase databases were used to search for primary studies reporting the use of ADSCs in the regeneration of cranial nerves. A total of 12 studies were included, all of which presented data on specific neural injury, therapy, and functional outcomes. Eight studies focused on the facial nerve (66.7%), two on the optic nerve (16.7%), one on the olfactory nerve (8.3%), and one on the hypoglossal nerve (8.3%). One study applied ADSCs to human cranial nerve injuries, while the remainder studied animal models. In these studies, ADSC groups had higher numbers of myelinated fibers, increased myelin thickness, and diameter of muscle fibers, as well as greater magnitude of compound muscle action potentials (CMAP) when compared to controls. In studies focused on optic nerve regeneration, significant improvements across visual tests were observed. ADSCs demonstrate potential utility in regard to their ability to facilitate functional recovery of cranial nerves in humans and animal models. As such, this therapy merits further investigation so that its true clinical applications can be determined
Primary and metastatic cellular landscapes in human pancreatic cancer
No full textPancreatic ductal adenocarcinoma (PDAC) is characterized by a complex tumor microenvironment (TME). We utilized single cell RNA sequencing to compare the TMEs of metastatic sites and primary tumors. We detected increased prevalence of exhausted CD8(+) T cells in metastases, as well as the enrichment of complement pathway encoding genes in immunosuppressive tumor-associated macrophages, consistent with profound immunosuppression in metastatic disease. In cancer-associated fibroblasts, we identified a unique upregulation of metabolic genes, including UPP1, in metastasis. In cancer cells, we uncovered a specific gene signature upregulated in liver metastases; this signature was present in a proportion of primary tumors in the TCGA dataset, where it correlated with worse survival. Overall, our analysis of primary and metastatic PDAC defines a high-risk gene signature, metabolic reprogramming, and increased immune suppression in metastasis
Maternal vulnerability to insomnia: Relationship with poor newborn sleep and peripartum psychopathology
No full textPURPOSE: Sleep reactivity, defined as the degree to which sleep is disrupted due to exposure to stress, serves as a distinctive trait and an indicator of an individual\u27s vulnerability to insomnia. While insomnia may be a risk factor for maternal psychopathology, we aimed to study maternal insomnia vulnerability and its relationship with perinatal psychopathology and newborn sleep.
METHOD: Pregnant women were recruited during their last routine assessment before being hospitalized for delivery at the Gynecological Unit of the University Hospital of Ferrara and Udine, Italy. The assessment included baseline evaluation (T0), and evaluations at 1 months (T1) in the postpartum period with specific questionnaires for insomnia vulnerability such as the Ford Insomnia Response to Stress Test (FIRST), Insomnia Disorder such as Sleep Condition Indicator (SCI), mood and anxiety symptoms such as Edinburgh Postnatal Depression Scale (EPDS), Mood Disorder Questionnaire (MDQ), State-Trait Anxiety Inventory (STAI) and newborn sleep Disturbance Scale for Children (SDSC).
RESULTS: At T0, 151 pregnant women were included. Elevated sleep reactivity affected the 36.4 % at T0. Women with elevated prenatal sleep-reactivity were significantly more affected by prenatal, insomnia, anxiety and mood symptoms. Prenatal elevated sleep reactivity predicted post natal insomnia (OR 4.50,p = 0.014), anxiety (OR 3.44, p = 0.002) and depressive symptoms (OR. 4.45, p = 0.008), It also predicted poor newborn sleep (OR 3.43, p = 0.032).
CONCLUSIONS: Maternal vulnerability to insomnia is an important prenatal factor that may contribute to concurrent and postpartum psychopathology and to poor newborn sleep. Findings may suggest a potential hereditary aspect of insomnia in newborns born to women with insomnia disorder and exhibiting elevated sleep reactivity