RocScholar (Rochester Regional Health)
Not a member yet
3788 research outputs found
Sort by
Comparative efficacy and safety of microwave ablation versus open surgical resection in colorectal liver metastases: A systematic review and meta-analysis
No full textImpact of Timing of Atrial Fibrillation Ablation on AF Recurrence and Clinical Outcomes in Patients With HFpEF and HFrEF
No full textBackground: Early catheter ablation for atrial fibrillation (AF) improves outcomes, but the optimal timing, especially in heart failure (HF) subtypes, remains unclear.
Objective: To evaluate the impact of ablation timing on outcomes in patients with HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF).
Methods: We used the TriNetX database (2010-2024) to identify HF patients with AF who underwent ablation. Patients were classified as early ablation (≤ 1 year of first AF diagnosis) or delayed ablation (1-3 years), with propensity score matching (PSM) applied to balance the baseline characteristics. The primary outcome was AF recurrence, defined by repeat ablation, direct current cardioversion (DCCV), or antiarrhythmic drug (AAD) use after a 3-month blanking period. Secondary outcomes included stroke, hospitalization, and mortality over 5 years.
Results: After PSM, delayed ablation was associated with higher AF recurrence in both HFrEF (HR = 1.28, p \u3c 0.001) and HFpEF (HR = 1.21, p = 0.02), as seen in multivariate analysis. In HFrEF, delayed ablation was associated with higher incidence of re-do ablation, AAD use, and DCCV, while in HFpEF, higher recurrence with delayed ablation was associated with increased AAD use. Both cohorts had similar stroke and mortality rates between early and delayed ablation.
Conclusions: Delayed ablation in HFrEF and HFpEF was linked to higher AF recurrence, driven by increased redo ablations, DCCV, AAD use in HFrEF, and higher AAD use in HFpEF. Stroke, HF hospitalization and mortality rates were similar, suggesting earlier ablation may enhance rhythm control over other outcomes
Combination therapy with TNF inhibitors plus biologics targeting type 2 inflammatory conditions in patients with rheumatoid arthritis: a case series
No full textObjectives: Patients with RA treated with TNF inhibitors (TNFis) may experience type 2 inflammatory conditions such as asthma, atopic dermatitis or urticaria. Multiple biologic agents targeting type 2 inflammation are available. Combination biologic therapy targeting types 1 and 2 inflammation is not well described. We present a series of patients on a combination TNFi and biologic agent targeting type 2 inflammation.
Methods: A retrospective case series of RA patients on TNFi receiving a biologic agent for type 2 inflammatory conditions was compiled. Descriptive data, duration of biologic use, incident bacterial infections and corticosteroid used 6 months before and after combination biologic agent use was collected.
Results: Twelve patients were included. The mean overlap of combination biologic therapy was 83.7 weeks (95% CI 56.0, 111.4) and the median was 92.6 weeks [interquartile range (IQR) 36.4-109.8]. The mean corticosteroid cumulative dose 6 months prior to dual biologic agents was 463 mg prednisone equivalent (95% CI 131, 795) and the median was 265 mg (IQR 75-570). The mean corticosteroid cumulative dose 6 months after dual biologic agents was 241 mg prednisone equivalent (95% CI -21, 503) and the median was 0 mg (IQR 0-275). Six bacterial infections occurred prior to combination biologic therapy compared with five after initiating dual biologics.
Conclusion: This case series demonstrates that adding a second biologic agent to target type 2 inflammatory conditions in RA patients on TNFi did not increase incident bacterial infections and may decrease corticosteroid use
When an Adrenal Mass Isn\u27t Cancer: A Rare Case of Mycobacterium genavense Mimicking a Neuroendocrine Tumor
No full textAn adrenal mass is an abnormal growth or tumor that develops in one or both adrenal glands. These can be benign or malignant. They are common, with a prevalence of 1% to 6% in the general adult population. While opportunistic infections such as histoplasmosis and cryptococcosis are known to rarely cause adrenal masses (\u3c 1%), with histoplasmosis presenting as an adrenal mass in 0.85% of cases in HIV patients, the incidence of Mycobacterium species causing adrenalitis is even lower, making it an infrequent clinical entity. We present a case of a patient without any obvious immunocompromise who presented with a unilateral adrenal mass initially thought to be a neuroendocrine tumor due to markedly elevated pancreatic polypeptide. He underwent a right adrenalectomy due to the increasing size of the mass and was diagnosed with an adrenal Mycobacterium infection. The differential diagnosis of an adrenal mass is discussed, and the role of endocrinologists in diagnosing and managing this case is highlighted
P-1399. Medication Event Reminder Monitors For Tuberculosis Patients: A Systematic Review
No full textExtended Outcomes At 1-year In Future-hf2: Evidence For Effective Remote Ambulatory Management Of Heart Failure Patients Using A Novel Ivc Sensor
No full textPathophysiology of Chronic Rhinitis and Chronic Sinusitis With and Without Nasal Polyposis
No full textThis article covers the pathophysiology of chronic rhinitis and chronic rhinosinusitis (CRS), focusing on both phenotypic and endotypic distinctions. It highlights how genetic and environmental factors contribute to disease development, emphasizing the roles of epithelial barrier dysfunction and microbiome disruption. The article categorizes CRS into forms with and without nasal polyps, each involving unique immune responses and inflammation types. Specific endotypes are also discussed, highlighting the complexity and heterogeneity of these conditions
Medium distances to specialized care models at tertiary hospitals and socioeconomic neighborhood-related factors do not influence the quality of care for patients with liver cirrhosis
No full textBackground: The treatment of liver cirrhosis requires a multidisciplinary approach at expert centers. Given the disease\u27s complexity and serious consequences, care quality significantly impacts patient survival. Specialized care models at tertiary hospitals are thought to improve treatment outcomes and quality of life. This study evaluates whether proximity to an expert center influences care quality and patient outcomes and investigates the role of socioeconomic factors and social support in Germany.
Methods: A retrospective evaluation was conducted on 299 patients with liver cirrhosis treated at Medical Faculty Mannheim, Heidelberg University, with 43% at Child-Pugh B stage. The analysis considered various distances to the hospital (10 and 20 km by car, straight-line distance and public transportation usage) and correlated these with patient survival.
Results: The analysis showed that neither car travel distance (P = 0.221, P = 0.1894), straight-line distance (log-rank P = 0.221, cox regression P = 0.1894), nor public transportation usage (P = 0.363, P = 0.1845) up to over 50 km or more than 120 min traveling by public transportation significantly affected survival. Geographical accessibility and differing socioeconomic conditions did not impact treatment quality or survival rates. Known risk factors such as age (P = 0.007, P \u3c 0.0001), gender (P = 0.019, P = 0.0207) and Child-Pugh stage (P = 0.003, P = 0.0155) significantly influenced survival.
Conclusion: Specialized care models at tertiary hospitals offer consistent high-quality care to rural populations not facing disadvantages in survival due to longer travel distances to expert hepatology centers. Socioeconomic backgrounds do not affect care quality in this care model
