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Examining the impact of time-to-treatment on disease-specific survival in pediatric pilocytic astrocytoma: A multi-institutional retrospective cohort analysis
No full textHistory of bronchoscopy: From inception to the modern era of interventional pulmonology
No full textPurpose of review: This review traces the historical evolution of bronchoscopy, from its origins in the late nineteenth century to its current role as a central tool in interventional pulmonology. It highlights major technological and clinical milestones and considers how early innovations continue to shape modern practices. As bronchoscopy enters the era of robotics and artificial intelligence, this reflection offers a timely perspective on its future trajectory.
Recent findings: Advances in both rigid and flexible bronchoscopy have enhanced visualization, navigation, and therapeutic precision. Interventions such as airway stenting, cryotherapy, endobronchial valve placement, and nonthermal ablation are now routine. These developments build on historical foundations and support a more targeted, minimally invasive approach to pulmonary intervention.
Summary: The evolution of bronchoscopy reflects a legacy of innovation driven by clinical need and technological advancement. Rigid and flexible techniques remain vital, while recent advances in robotics, artificial intelligence navigation, and image-guided interventions signal a new era. A deep appreciation of its historical development informs current practice and shapes the integration of emerging technologies into the future of interventional pulmonology
Relationship between aerobic fitness and adipose tissue insulin resistance
No full textObjective: Aerobic fitness is associated with greater skeletal muscle insulin sensitivity with regards to glucose uptake. Whether fitness is associated with an improvement in the insulin36 regulation of adipose tissue lipolysis is unknown.
Methods: We collated adipose insulin sensitivity, body composition and fitness data from six of our previously published and two of our unpublished studies. ADIPO- IRpalmitate data was available for 340 volunteers and the insulin concentration resulting in a 50% suppression of palmitate rate of appearance (FFApalmitate IC50) measured using the insulin clamp technique was available for 108 volunteers. Pearson correlation and multiple linear regression analysis were performed to assess the relationship between the independent variables of aerobic fitness (VO2 peak, mL•kg FFM-1•min-1), age, sex, BMI, visceral adipose tissue (VAT), body fat, percent body fat and the dependent variables ADIPO-IRpalmitate and FFApalmitate IC50.
Results: Factors that were univariately correlated (ppalmitate and FFApalmitate IC50 were BMI, percent body fat, body fat and VAT. Fitness correlated negatively with ADIPO- IRpalmitate and FFApalmitate IC50. Stepwise regression analysis showed that fitness independently predicted ADIPO- IRpalmitate and FFApalmitate IC50 after adjusting for the other significant factors.
Conclusions: These findings suggest that aerobic fitness may promote metabolic health through positive effects on adipose tissue
Tucatinib plus trastuzumab for chemotherapy-refractory, HER2+, RAS wild-type metastatic colorectal cancer (MOUNTAINEER): Final analysis
No full textMOUNTAINEER was a multicenter, open-label, phase 2 trial (NCT03043313) that evaluated the efficacy and safety of tucatinib plus trastuzumab, a dual HER2-targeted chemotherapy-free regimen. Patients were included if they had chemotherapy-refractory, HER2+, RAS wild-type unresectable or metastatic colorectal cancer. This final analysis reports updated efficacy and safety after a median follow-up of 32.4 months. Of the 84 patients who received tucatinib plus trastuzumab, the confirmed objective response rate was 39.3%; median duration of response was 15.2 months. Median progression-free survival was 8.1 months and overall survival was 23.9 months. Efficacy was relatively similar across central HER2+ testing methods. No clear association of treatment response with co-occurring biomarker alterations was seen. Few patients discontinued treatment due to adverse events; no treatment-emergent deaths occurred. Tucatinib plus trastuzumab showed clinically meaningful efficacy and favorable safety. Efficacy was observed irrespective of central HER2+ testing methods and in patients with heterogeneous tumor biomarker profiles
Leadless versus transvenous dual-chamber pacemakers: Real-world evidence from AVEIR DR coverage with evidence development study
No full textBackground: AVEIR DR, an industry-first dual-chamber leadless pacemaker (LP), provides continuous atrioventricular synchrony through implant-to-implant (i2i) communication between atrial and ventricular LP devices. It is important to evaluate the early real-world comparative safety of AVEIR DR LP.
Objective: To compare complications and mortality between AVEIR DR LP and dual-chamber transvenous pacemakers (TP).
Methods: De novo LP and TP patients were identified in Medicare Fee-for-Service claims (October 2023 and December 2024). Outcomes were 30-day and 6-month complications, reinterventions, heart failure hospitalizations, and all-cause mortality. Comparisons were adjusted for demographics, comorbidities, and hospital encounter characteristics.
Results: Compared to TP (N = 77 422, age = 79.6 ± 7.5), LP patients (N = 759, age = 78.5 ± 7.8) had a higher comorbidity index, more dialysis dependence, end-stage renal disease, and atrial fibrillation. Adjusted 30-day overall complications (7.9% vs. 9.2%; odds ratio [OR] 0.85, p = 0.36) and mortality (1.8% vs. 1.5%; hazard ratio [HR] 1.21, p = 0.47) were comparable, while device-related complications (2.0% vs. 3.9%; OR 0.50, p \u3c 0.01) were lower with LP. Adjusted 6-month overall complications (4.1% vs. 6.9%; HR 0.59, p \u3c 0.01), device-related complications (2.8% vs. 5.9%; HR 0.48, p \u3c 0.01), and device reinterventions (2.1% vs. 4.3%; HR 0.49, p \u3c 0.01) were reduced with LP, with no difference in mortality (6.6% vs. 5.6%; HR 1.18, p = 0.43) and heart failure hospitalizations (3.8% vs. 4.1%; HR 0.91, p = 0.65).
Conclusion: Despite a higher comorbidity burden, AVEIR DR LP had significantly fewer device-related complications, overall 6-month complications, and device reinterventions compared to TP, with similar overall 30-day complications, mortality, and heart failure hospitalizations
Timing of renal and bladder ultrasound after first febrile urinary tract infection: A hospitalist dilemma
No full textImproving the communication of urgent and significant unexpected diagnoses in anatomic pathology
No full textObjective: To identify challenges, opportunities, and best practices for improving the communication of urgent and significant unexpected diagnoses in anatomic pathology, to enhance diagnostic excellence and patient safety.
Methods and results: The American Society for Clinical Pathology convened a group of eleven pathologists from diverse practice settings who discussed the challenges, opportunities, and best practices for improving communication of urgent and significant unexpected findings in anatomic pathology. Through structured discussions, the group identified the challenges such as variability in definitions of urgent and significant unexpected diagnoses and lack of standardized protocols. The group developed a set of best practices and strategies to support timely notification, clear documentation, and standardized communication processes within the healthcare teams to ensure appropriate patient management based on the communicated diagnoses.
Conclusions: Timely and effective communication of urgent and significant unexpected findings in anatomic pathology is essential for patient safety. Standardized definitions and protocols, combined with collaborative strategies, can improve diagnostic accuracy and clinical outcomes. Future research should focus on building an evidence base to support these practices and evaluate their impact on patient care
In reply to: Pretransplant conditioning for haematopoietic cell transplants: The past is prologue
No full textPost-approval study 3-year outcomes of the Neuroform Atlas stent for the treatment of wide-necked intracranial aneurysms
No full textINTRODUCTION: The ATLAS trial was a prospective, multicenter, single-arm, investigational device exemption (IDE) study to evaluate the safety and effectiveness of the Neuroform Atlas Stent System for the treatment of wide-necked bifurcation aneurysms. This analysis presents the 36-month follow-up data for the anterior and posterior cohorts. METHODS: Of the 182 patients in the IDE anterior cohort, 146 consented to participate in the post-approval study (PAS) and, of the 116 patients in the IDE posterior cohort, 101 consented to participate in the PAS. The primary effectiveness endpoint was core laboratory adjudicated (Raymond-Roy 1; RR1) without retreatment or parent artery stenosis (\u3e50%) at 36 months post-procedure. The primary safety endpoint was Clinical Event Committee-adjudicated major ipsilateral stroke or neurological death through 36 months. RESULTS: There were 146 patients in the anterior cohort and 101 patients in the posterior cohort. At 24 months the composite effectiveness endpoint was 77.3% (34/44) in the anterior cohort and 65.5% (19/29) in the posterior cohort and at 36 months these rates were 92.3% (24/26) and 75.0% (18/24), respectively. RR1 rates at 24 months were 84.1% (37/44) in the anterior cohort and 70.0% (21/30) in the posterior cohort; at 36 months they were 96.3% (26/27) and 79.2% (19/24), respectively. By 36 months the primary safety endpoint occurred in 4.1% (6/146) of patients in the anterior cohort and 5.0% (5/101) in the posterior cohort. CONCLUSION: The results of the long-term assessment of the Neuroform Atlas Stent System demonstrate favorable safety and effectiveness in the treatment of wide-necked bifurcation aneurysms without a single treated target aneurysm rupture beyond 12 months post-procedure
Inside Aurora Sinai Medical Center, 2002 May
No full textAurora Sinai Medical Center, Milwaukee, WI: Internal employee newsletter with workplace anniversaries, news, and events.https://institutionalrepository.aah.org/alldocuments/2241/thumbnail.jp