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Factors Influencing Match Success in Integrated Vascular Surgery Residency Programs From 2019 to 2023
No full textINTRODUCTION: Integrated vascular surgery residency (IVSR) programs have grown increasingly competitive. However, the factors influencing successful matching remain unclear. This study evaluates the impact of medical school and applicant characteristics on IVSR match outcomes.
METHODS: A list of ACGME-accredited IVSRs was obtained from the Society for Vascular Surgery, and resident data from the 2019-2023 match cycles were collected from publicly available sources. Applicant characteristics consisted of additional graduate degrees, Alpha Omega Alpha (AOA) status, and research productivity. Medical school characteristics consisted of ranking, research funding, vascular surgery interest group (VSIG) presence, and vascular surgery faculty size. Logistic regression models were employed to identify predictors of matching into top 10, top 25, and top 50 IVSR programs.
RESULTS: The final analysis included 374 residents from 120 unique U.S. medical schools across 69 IVSR programs. Most graduated from institutions with a VSIG (70.9%), and 16.0% were members of AOA. Significant predictors (p \u3c 0.05) of matching into a top 50 or top 25 program include VSIG presence (Top 50 odds ratio [OR] = 1.80; Top 25 OR = 2.24), having more than 5 PubMed articles (Top 50 OR = 2.62; Top 25 OR = 2.41). Graduation from a Tier 1 medical school (OR = 5.90) or Tier 2 (OR = 2.82) significantly influenced matching into a top 50 program. Having more than 5 PubMed articles was the only significant predictor for matching into a top 10 program (OR = 3.18, 95% CI = 1.25-8.16).
CONCLUSIONS: Applicant and medical school characteristics significantly influence IVSR match outcomes, particularly institutional ranking, VSIG presence, and research productivity. These findings highlight the role of early vascular surgery exposure and institutional reputation in residency placement. Encouraging VSIG development and fostering mentorship opportunities may enhance applicant competitiveness
Clinical, Imaging and Blood Biomarker Outcomes in a Phase 3 Clinical Trial of Tau Aggregation Inhibitor Hydromethylthionine Mesylate in Mild Cognitive Impairment and Mild to Moderate Dementia Due to Alzheimer’s Disease
No full textBACKGROUND: Hydromethylthionine mesylate (HMTM) targets tau pathology and has tau-independent symptomatic activity.
OBJECTIVES: To evaluate the safety and efficacy of HMTM in participants with mild cognitive impairment (MCI) and mild to moderate dementia due to Alzheimer\u27s disease (AD).
SETTING: 82 centres in Canada, European Union, United Kingdom and United States of America.
PARTICIPANTS: A total of 598 amyloid β-PET positive participants were included; 44% (263) met clinical criteria for MCI due to Alzheimer\u27s disease and 56% (335) were diagnosed with mild to moderate dementia due to AD.
INTERVENTION: HMTM 16 mg/day and 8 mg/day were compared with methylthioninium chloride (MTC) 4 mg twice weekly, intended as an inactive urinary colourant to preserve blinding with respect to possible urinary discolouration caused by HMTM.
MEASUREMENTS: HMTM and MTC were compared on cognitive and functional endpoints for the first 52 weeks followed by all receiving HMTM 16 mg/day to 104 weeks in a modified delayed-start trial design. Biomarker outcomes included change in plasma levels of neurofilament light chain (NfL), pTau217 and MRI measures of grey matter atrophy.
RESULTS: It was not possible to demonstrate significant differences on the co-primary clinical endpoints (ADAS-cog11 and ADCS-ADL23) at 52 weeks due to symptomatic activity in the control arm. In participants with MCI, statistically significant differences in cognitive decline (ADAS-cog13) emerged at 78 weeks (p = 0·0291) and 104 weeks (p = 0·0308) between early- and delayed-start HMTM 16 mg/day in analyses specified prior to the 24-month database lock. Statistically significant cognitive improvement over baseline score was sustained for 78 weeks in the early start MCI group, with no significant cognitive or functional decline to 104 weeks. There was a significant reduction in progression of neurodegeneration measured by NfL change (p = 0·0291) at 52 weeks in the whole population, consistent with significant reductions in progression of grey matter atrophy at 52 and 104 weeks, and a reduction in progression of tau pathology (pTau217, p = 0·0165) in MCI. Headache (1·5%) and diarrhoea (1·2%) were the most frequent adverse effects.
CONCLUSIONS: Although HMTM 16 mg/day arrested progression of neurodegeneration and reduced grey matter atrophy at 52 weeks, symptomatic activity in the control arm precluded separation of treatment arms at 52 weeks on primary clinical endpoints. In participants with MCI, significant clinical separation was seen only at 78 and 104 weeks. This effect has been confirmed in a further study. HMTM was well tolerated and has the potential to offer an accessible oral treatment option with a benign safety profile which could be delivered with minimal patient/physician burden
Trends in the Implementation of the Cyberchondria Severity Scale: Bibliometric Analysis
No full textBACKGROUND: Cyberchondria, a combination of the words cyber and hypochondriasis, is a condition that is receiving increasing attention from clinicians and researchers globally. Researchers are currently using multiple instruments to quantify it. Furthermore, the instruments have been translated into multiple languages.
OBJECTIVE: This study aimed to examine the extent to which researchers are measuring cyberchondria using the 33-item Cyberchondria Severity Scale (CSS) and its 12-item abbreviated version, the CSS-12. It also examined the relative use of cyberchondria instruments in different languages.
METHODS: PubMed and PsycInfo were searched for articles published between May 1, 2019, and December 31, 2024, featuring the term cyberchondria in the title. Included articles mentioned the CSS, were empirical studies, and were in English. Each article was categorized by the CSS version, publication year, and language of instrument implementation. Fisher exact tests were used to assess associations, and the Spearman rank correlation coefficient was used to evaluate trend monotonicity.
RESULTS: Among the 117 articles included in the analysis, 42 (35.9%) used the CSS, 38 (32.5%) used the CSS-12, and the remaining 37 (31.6%) used unknown or modified versions. Although CSS-12 use began with its introduction in 2019, there was no significant association between publication year and instrument choice (P=.84). Unadjusted analysis found that the relationship between year and the percentage of articles using the CSS-12 showed a statistically significant monotonic trend (ρ=0.89; P=.02). This finding was not significant after applying a Bonferroni correction. However, there was a significant association between the language of the instrument and the CSS version used (P\u3c .001).
CONCLUSIONS: From 2019 to 2024, both the CSS and CSS-12 continued to be used. The CSS-12 offers benefits such as brevity and the removal of reverse-keyed items, while the original CSS remains useful for studies that require the mistrust of medical professionals subscale. The significant association between language and instrument choice suggests that cultural and linguistic factors impact selection, and instrument choice should be guided by the study\u27s objectives and the constructs of interest
Accuracy of Frozen Section for Hpv-Associated Squamous Cell Carcinoma of Unknown Primary
No full textINTRODUCTION: Current guidelines for the management of metastatic squamous cell carcinoma of unknown primary (SCCUP) recommend submission of suspicious primary sites for frozen section analysis (FSA). This study aims to investigate the diagnostic accuracy of FSA for identification of HPV-associated SCCUP.
METHODS: A retrospective cohort study of patients with biopsy-proven p16-positive SCCUP who underwent diagnostic operation at two tertiary care institutions was performed. Sensitivity, specificity, PPV, and NPV of diagnostic FSA were assessed.
RESULTS: 77 patients were included in analysis. 66 patients underwent definitive TORS (diagnostic TORS operation with subsequent neck dissection after identification of the occult primary tumor), 7 patients underwent diagnostic TORS (TORS to identify occult primary tumor, no neck dissection), and 4 patients underwent direct laryngoscopy and biopsy only. Primary tumors were identified in 63 patients (82%) with a mean tumor size of 1.1 cm. There was no significant difference in size between patients whose tumor was identified on FSA (mean 1.1 cm) and on permanent only (mean 0.9 cm) (p = 0.26). The sensitivity, specificity, PPV, and NPV of FSA for SCCUP was 86%, 100%, 100%, and 86%, respectively. Diagnostic frozen specimens included 52 direct laryngoscopy biopsies and 69 TORS excisions. In the biopsies, sensitivity was 100% and NPV was 100%, whereas in the TORS-excised specimens, sensitivity was 77% and NPV was 77%.
CONCLUSIONS: In this case series of 77 patients with SCCUP, the sensitivity and NPV of FSA for identification of the primary tumor was over 85%. FSA is valuable during diagnostic operation for SCCUP
A Phase 1, First-In-Human, Dose Escalation Study of JNJ-80038114, a PSMAxCD3 Bispecific Antibody, in Participants With Metastatic Castration-Resistant Prostate Cancer
No full textPURPOSE: Prostate-specific membrane antigen (PSMA) has been identified as a therapeutic target for metastatic castration-resistant prostate cancer (mCRPC). The recent success of radioligands targeting PSMA spurred development of new PSMA-targeting agents including immunotherapy. JNJ-80038114 is a bispecific antibody that binds PSMA on tumor cells and CD3 on T cells to induce anti-tumor activity.
METHODS: This was a phase 1, open-label, multicenter study of JNJ-80038114 in participants with mCRPC and ≥ 1 prior systemic therapy. JNJ-80038114 was administered subcutaneously every 3 weeks (Q3W), starting at 0.1 mg. The primary endpoint was safety. Secondary endpoints included pharmacokinetics (PK), immunogenicity, and prostate-specific antigen (PSA).
RESULTS: At final analysis, 39 participants received 0.1–180 mg JNJ-80038114 across 11 dose-escalation cohorts for a median of 9.3 weeks (range, 0.1–31.1). The most common treatment-related adverse events (TRAEs; ≥20%) included cytokine release syndrome (CRS, 51.3%, all Grade 1–2), injection-site reactions (46.2%), and fatigue (30.8%). Related Grade ≥ 3 TRAEs occurred in 51.3% of participants; dose-limiting toxicities occurred in 3 (7.7%). Four participants (10.3%) developed clinically significant neuropathies. In 37 PK-evaluable participants, mean exposure (Cmax, AUC) increased with increas- ing doses. Anti-drug antibodies (ADA) were reported in 56.8% (21/37) participants. One participant had confirmed PSA decrease ≥ 50%. Three participants had radiological responses in the context of rapidly rising PSA. Following a review of data, the study was terminated.
CONCLUSIONS: This first-in-human study of JNJ-80038114 was discontinued early due to its lack of preliminary clinical activity, neurologic toxicities, high rates of CRS, and the development of ADAs impacting PK.
GOV INFORMATION: NCT05441501, Registered July 1, 2022
Somatosensory Realignment Following Single and Dual Force-Field Adaptation
No full textEvidence that adaptive motor learning coincides with a realignment of somatosensory perception has led to hypotheses that a shared mechanism underlies both processes. This implies that these two phenomena should exhibit similar properties. However, studies of somatosensory realignment with visuomotor adaptation have shown mixed support, possibly due to a confounding coactivation of sensory prediction errors and multisensory integration. Although the former is thought to drive adaptation, both processes may contribute to somatosensory realignment. Here, we examined somatosensory realignment following force-field adaptation, which is not confounded by multisensory integration. Across two experiments, we tested whether somatosensory realignment mimics three canonical properties of adaptation in this paradigm. Our first experiment examined whether sensory realignment (for the perception of movement or static position) correlated with adaptation across individuals and generalized beyond the trained reach direction. The results showed that force-field adaptation coincided with a selective realignment of somatosensory perception of movement in the direction of the perturbing force, but this realignment did not correlate with the magnitude of adaptation or generalize beyond the reach direction of the adaptation task. In a second experiment, we tested whether context-dependent dual adaptation to opposing force-field perturbations coincides with a context-dependent dual realignment of somatosensory perception. The results showed no evidence of context-dependent somatosensory realignment after dual adaptation. Overall, our results indicate that somatosensory realignment and adaptation exhibit different properties and are therefore unlikely to rely on the same underlying mechanism, although realignment does display some coherence with the nature of the perturbation
Jefferson Heart Health (JHH): A Successful Student-delivered Motivational Interviewing Pilot Program to Lower Cardiovascular Disease (CVD) Risk
No full textPurpose: The Jefferson Heart Health (JHH) program utilizes student health coaching by trained undergraduate and medical students supporting patients to sustain lifestyle changes and subsequently determine: how can we effectively educate patients by improving adherence to lifestyle recommendations? Also, what is the effectiveness of student-delivered health coaching for reducing patient cardiovascular risk? With our unique student-delivered program, we promote cost-effective lifestyle interventions for lowering overall cardiovascular disease (CVD) burden.
Methods: We successfully completed a four-week pilot with consistent patient attendance. Certified student JHH coaches, supervised by the certified obesity-management specialist and principal investigator, met weekly with 23 patients: 82.6% female/17.4% male, a mean age of 56, and a mean BMI of 34. Our program involves interactive 15-20 minute lessons based on the American Heart Association (AHA) “Life’s Essential Eight.” These group lessons are then supplemented by the novel PennDitti app that tracks real-time adherence as patients listen to three minute audio summaries of each lesson. Patient CVD risk was assessed at the beginning and end of the program using Framingham and PREVENT equations along with metabolic endpoints, including blood pressure, cholesterol, and A1C levels. Data analysis is ongoing.
Results: We will report our final data analysis in the poster that I hypothesize will demonstrate lower CVD risk burdens for JHH patient participants.
Conclusion: With students serving as medical extenders, our pilot JHH coaching program demonstrates successful implementation of an accessible and low-cost methodology to deliver evidence-based knowledge that improves health outcomes for underserved patients in Philadelphia.https://jdc.jefferson.edu/aoa_research_symposium_posters/1024/thumbnail.jp
Clinical Outcomes of Patients Hospitalized for Conventional Pacemaker Implantation With Protein-Energy Malnutrition
No full textINTRODUCTION: The impact of protein-energy malnutrition (PEM) on patients hospitalized for conventional pacemaker implantation remains poorly understood.
METHODS: We utilized the 2020 U.S. National Inpatient Sample (NIS) database to evaluate the impact of PEM on the in-hospital outcomes of patients who underwent conventional pacemaker implantation. Patients aged 18 and older were identified by ICD-10 CM and PCS codes. Multivariable survey logistic and linear regression analyses were employed to examine in-hospital outcomes, including in-patient mortality, system-based outcomes, and post-procedural complications.
RESULTS: A total of 108 020 patients were identified with 4315 (3.99%) diagnosed with PEM. The mean age of the cohort was 76 years, and 47.5% were female. The overall mortality rate among patients undergoing pacemaker implantation was 1.07%. After adjusting for various patient and hospital confounding factors, PEM was significantly associated with an increased risk of in-hospital mortality (aOR 3.30, 95% CI 2.33-4.88, p \u3c 0.001), prolonged hospital stay (βLOS 7.89, 95% CI 6.88-8.90, p \u3c 0.001), and an increased risk of various complications such as sepsis (aOR 2.56, 95% CI 1.56-4.19, p \u3c 0.001) along with other post-procedural complications including bleeding/anemia (aOR 2.48, 95% CI 1.98-3.10, p \u3c 0.001), pneumothorax (aOR 2.47, 95% CI 1.71-3.58, p \u3c 0.001), and pericardial complications (aOR 1.65, 95% CI 1.14-2.40, p = 0.008).
CONCLUSION: PEM was associated with an increased risk of in-hospital mortality, extended hospital stays, and various post-procedural complications in patients undergoing conventional pacemaker implantation. Hence, prompt identification and effective management of PEM are essential for improving post-procedural outcomes in these patients
Post-Traumatic Rupture of Primary Solid Pseudopapillary Epithelial Neoplasm (SPEN) of the Pancreas in a Male Adolescent: A Case Report
No full textIntroduction Solid pseudopapillary epithelial neoplasm (SPEN) is a rare pancreatic tumor that typically presents in adult women and is usually asymptomatic. Case presentation A 12-year-old male presented to the emergency department with worsening abdominal pain one day after suffering mild abdominal trauma during a soccer match. Physical exam showed diffuse abdominal tenderness and guarding. CT abdomen with IV contrast showed a heterogeneous, round structure adjacent to the pancreatic tail with mass effect upon the spleen. MRI abdomen revealed a “claw sign” of pancreatic tissue surrounding the structure, suggesting a an underlying pancreatic mass with capsular rupture measuring 8.3 x 8.1 × 8cm. This finding indicated the need for open distal pancreatectomy. Intraoperatively, safe separation of the splenic vasculature from the mass proved impossible and splenectomy was performed. A drain was left in place. Postoperatively, the patient recovered without complication. At one month follow-up, the patient was seen doing well. A drain amylase did not show evidence of a pancreatic leak and was removed. Histopathology later confirmed the diagnosis of SPEN of the pancreas. Conclusion Traumatic rupture of SPEN of the pancreas is a rare initial presentation. Distal pancreatectomy shortly after presentation appears to be safe and may require splenectomy if the splenic vasculature appears inseparable from the tumor
Selective Deletion of slc2a1 From the RPE Reveals That Rods but Not Cones Depend on Glucose Transport Across the Outer Blood-Retinal Barrier
No full textGLUT1 facilitates a continuous flow of glucose across the inner and outer blood-retinal barriers (BRBs) to support vision. To understand the extent to which photoreceptors rely on glucose transport across the outer BRB, we generated a tamoxifen-inducible conditional knockout of Slc2a1 in the retinal pigment epithelium (RPE) (RPE-iΔGlut1). In the RPE-iΔGlut1 mice, rod photoreceptors exhibited impaired outer segment renewal and decreased the expression of proteins involved in phototransduction and ciliary transport. Proteins regulating the retinal stress response increased. Cone photoreceptors were functional and viable 15 months post-tamoxifen treatment in the RPE-iΔGlut1 mice, while 70% of the rods died. When Slc2a1 was genetically deleted from rods (Rod-iΔGlut1 mice), rod degeneration was faster than in the RPE-iΔGlut1 mice. These findings suggest that rods are more dependent on glucose than cones, and that glucose from the deep vascular plexus may support cone function and viability and slow the rate of rod death