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Endovascular Management of Severe Peripheral Artery Disease Isolated to the Popliteal Artery Shows Comparable Outcomes Regardless of Treatment Modality
No full textBackground: While the use of endovascular intervention for peripheral artery disease has expanded in recent years, there remains relatively few studies focused on the endovascular treatment of isolated popliteal artery occlusive disease. The popliteal artery presents a particular challenge for endovascular intervention due to the constant flexion at the knee. We sought to assess the outcomes for endovascular management of isolated popliteal artery occlusive disease based on type of intervention performed. Methods: The Vascular Quality Initiative (VQI) database was queried for patients with isolated popliteal artery occlusive disease who underwent endovascular intervention from January 2011 to December 2019. Patients were excluded from analysis if they did not have Medicare Fee-For-Service entitlement, had a history of prior intervention in the ipsilateral limb, or had vessels treated in addition to the popliteal artery. Patients were stratified into groups based on their initial presenting symptom (claudication versus chronic limb-threatening ischemia (CLTI)) and were analyzed by endovascular procedure performed (plain old balloon angioplasty (POBA) versus adjunctive stent/atherectomy). The POBA group underwent only plain balloon angioplasty, whereas the adjunctive stent/atherectomy group underwent any type of balloon angioplasty and adjunctive stenting or atherectomy or both. The primary outcome was amputation-free survival, a composite outcome of freedom from major amputation and/or death. Results: A total of 1,740 patients met criteria for analysis who underwent endovascular intervention for isolated popliteal artery occlusive disease. Among patients with claudication, the amputation-free survival rate was significantly higher at 1 year and 3 years for patients treated with adjunctive stent/atherectomy than POBA (1 year: 94.2% vs. 88.9%, P = 0.03; 3 years: 83.0% vs. 76.6%, P = 0.04). This difference appeared to be driven by mortality, as mortality was significantly better for adjunctive stent/atherectomy than POBA (1 year: 4.6% vs. 10.2%, P = 0.01; 3 years: 15.4% vs. 23.3%, P = 0.02), whereas major amputation rates were not significantly different. However, multivariable analysis showed that use of adjunctive stent/atherectomy was not independently associated with improved amputation-free survival (adjusted hazard ratio 0.74, 95% confidence interval 0.48–1.16, P = 0.19). In the CLTI group, amputation-free survival rates were not significantly different for patients treated with adjunctive stent/atherectomy compared to POBA (1 year: 65% vs. 64.6%, P = 0.78; 3 years: 47.1% vs. 42.6%, P = 0.30). Reintervention rates were not statistically different when stratified by use of adjunctive therapies in either the claudication or CLTI groups. Conclusion: Our results suggest that across all patients with isolated popliteal artery occlusive disease, amputation-free survival rates were comparable regardless of endovascular treatment modality. As expected, amputation-free survival for patients presenting with claudication was favorable compared to those with CLTI and was driven primarily by mortality. Reintervention rates were similar across all patients regardless of treatment modality. This study underscores the clinical challenge of treating isolated popliteal artery occlusive disease and stresses the need for further study of adjunctive modalities in treating complex lesions
Cerebral Cavernous Malformation Surgery: National Trends in Volume, Complications, and Costs
No full textBackground and Objectives: Cerebral cavernous malformations (CCMs) are vascular anomalies that can lead to significant neurological complications, such as hemorrhage or lesion progression. This study analyzes trends in CCM resections across the United States, focusing on morbidity, mortality, and associated costs. Methods: A retrospective analysis was conducted on the National Inpatient Sample who underwent CCM resections from 2016 to 2020. Data were collected from a national database, including patient demographics, outcomes, and costs. Statistical analysis was performed to identify factors associated with in-hospital mortality, complications, length of stay (LOS), and cost. Results: The patient cohort identified 3,300 patients with a mean age of 42.8 years, with a slight female predominance (53.5 %) and a majority identifying as white (66.5 %). Complications occurred in 8.5 % of cases, with acute bleeding significantly increasing the risk of complications (OR = 2.15, p \u3c 0.001), non-home discharge (OR = 2.52, p \u3c 0.001), and extended LOS (OR = 3.21, p \u3c 0.001). Non-elective admissions were associated with higher rates of complications (17.0 % vs. 3.4 %, p \u3c 0.001) and extended LOS (OR = 2.84, p \u3c 0.001). Independent factors for poor outcomes included higher Charlson Comorbidity Index (CCI) scores (OR = 1.417, p \u3c 0.01) and patient demographics such as age and race, with Black race (OR = 6.84, p = 0.0199) and lower household income (OR = 2.17, p \u3c 0.01) being significant predictors of in-hospital mortality. Conclusion: This study highlights the significant impact of acute bleeding and non-elective admissions on complications and outcomes following CCM resection. Further research is warranted to analyze socio-economic factors in improving CCM resection outcomes and explore possible pharmacological treatment approaches in high-risk surgical patients
The Good, the Bad, and the Ugly: Ethical Considerations Regarding Artificial Intelligence Assistance in Administrative Physician Tasks
No full textArtificial intelligence is a powerful tool that can potentially transform the diagnostic, therapeutic, and administrative practice of dermatology. Physicians are expected to complete electronic health record documentation in a timely fashion, prepare and submit previous authorizations, code for billing accurately, compose physician consultation letters, create patient education handouts, and communicate with our patients via the electronic health record. Streamlining and automating these time-intensive administrative responsibilities and tasks would likely reduce physician burnout and augment physician satisfaction at work, and enhance access to care by creating more time to care for patients. Herein we discuss the ethical issues of autonomy, informed consent, privacy, accuracy and safety regarding the use of artificial intelligence to assist us in these tasks
Cornea Oculomics: A Clinical Blueprint for Extending Corneal Diagnostics and Artificial Intelligence in Systemic Health Insights
No full textOculomics is an emerging field that leverages ophthalmic imaging data to identify biomarkers of systemic disease, facilitating early diagnosis and risk stratification. Despite its growing recognition, gaps remain in the literature regarding the clinical applications of oculomics. Various systemic diseases—including metabolic disorders (e.g., diabetes mellitus), infectious diseases (e.g., COVID-19), neurodegenerative diseases (e.g., dementia), hematologic disorders (e.g., thalassemia), autoimmune conditions (e.g., rheumatoid arthritis), and genetic syndromes (e.g., Fabry disease)—exhibit ocular manifestations detectable through in vivo confocal microscopy and anterior segment optical coherence tomography, among other imaging modalities. Increasing evidence supports the role of corneal imaging in identifying systemic disease biomarkers, a process further enhanced by artificial intelligence-driven analyses. This review synthesizes the current findings on corneal biomarkers of systemic disease, their ophthalmic imaging correlates, and the expanding role of corneal oculomics in translational medicine. Additionally, we explore future directions for integrating oculomics into clinical practice and biomedical research
Melatonin From Plants: Going Beyond Traditional Central Nervous System Targeting—A Comprehensive Review of Its Unusual Health Benefits
No full textMelatonin is indispensable for the homeostasis of plants and animals. In humans, it can help prevent or be an adjuvant treatment for several diseases mainly related to the immune system, inflammation, and oxidative stress. Moreover, a melatonin-rich diet is linked to several health benefits, such as regulation of circadian rhythm, regulation of the immunological system, epilepsy control, delaying the aging process, and diminishing hormones related to cancer. This review aimed to show the effects of melatonin in diseases beyond its traditional use. The results showed it can present scavenging of free radicals, reducing inflammatory cytokines, and modulating the immune system. Moreover, it can improve insulin resistance, blood pressure, LDL-c, adipose tissue mass, adhesion molecules, endothelial impairment, and plaque formation. These effects result in neuro- and cardioprotection, improvement of liver diseases, rheumatoid arthritis, dermatitis, COVID-19, polycystic ovaries, and sepsis. We conclude that plant melatonin can benefit patients with many diseases besides sleep problems and neurodegeneration. Plant melatonin may be more cost-effective and present fewer adverse events than synthetic. However, more clinical trials should be performed to show adequate doses, formulation, and treatment time
Evolution
No full textSparked by a Microbiology II lecture on plague, this piece reflects on the evolution of medicine across centuries. From herbs and leeches to vaccines and antibiotics, our tools have changed, but the plague doctor and the modern scientist are united by a shared desire to help and heal
Strategies to Reduce Hospital Length of Stay: Evidence and Challenges
No full textHospital length of stay (HLOS) is a critical healthcare metric influencing patient outcomes, resource utilization, and healthcare costs. While reducing HLOS can improve hospital efficiency and patient throughput, it also poses risks such as premature discharge, increased readmission rates, and potential compromise of patient safety. This literature review synthesizes current evidence on the determinants of HLOS, including patient-specific factors such as demographics, comorbidities, and socioeconomic status, as well as hospital-related factors like admission route, resource allocation, and institutional policies. We also examine the relationship between HLOS and key clinical outcomes, including mortality, readmission rates, and healthcare-associated infections. Additionally, we evaluate predictive modeling approaches, including artificial intelligence and machine learning, for forecasting HLOS and guiding early intervention strategies. While interventions such as enhanced recovery after surgery (ERAS) protocols, multidisciplinary care teams, and structured discharge planning have demonstrated efficacy in reducing HLOS, their success varies based on healthcare setting, patient complexity, and resource availability. Predictive analytics, incorporating clinical and non-clinical variables, offer promising avenues for improving hospital efficiency, yet may carry risks related to data quality and model bias. Given the impact of HLOS on clinical and economic outcomes, targeted interventions and predictive models should be applied cautiously, with future research focusing on refining personalized discharge strategies and addressing disparities across diverse patient populations
CAR-NK\u27s Balancing Act: When Scfv Affinity Is Not Too Tight, Not Too Loose... but Just Right?
No full textChimeric antigen receptor (CAR) therapies have revolutionized cancer treatment by enabling immune cells to target tumor cells with high specificity. While extensive research has focused on optimizing single-chain variable fragment (scFv) affinity in CAR-T cells, its impact on CAR-natural killer (NK) cell function remains less understood. A recent study by Rahnama et al, published in the Journal for ImmunoTherapy of Cancer, addresses this gap by investigating how fine-tuning scFv affinity influences CAR-NK efficacy against acute myeloid leukemia. The study demonstrates that lower-affinity 7G3-based CAR-NK cells exhibit superior antigen discrimination, prolonged persistence, and enhanced tumor control compared with their high-affinity counterparts. However, findings with 26292-based CAR-NK cells reveal a more complex, context-dependent relationship between scFv affinity and cytotoxic function. These results highlight the need for individualized optimization of CAR designs, considering factors such as epitope accessibility, ligand-binding kinetics, and cellular context. Future studies incorporating real-time kinetic analyses and tumor microenvironment modeling will be crucial for refining CAR-NK therapies. Striking the right balance between binding affinity, dwell time, and serial killing capacity could enhance CAR-NK therapeutic potential while minimizing toxicity risks