Baylor University Medical Center Proceedings最新文献

Background: Lipoprotein(a) (Lp(a)) is an low-density lipoprotein (LDL)-like particle whose elevation is considered a causal risk factor for atherosclerotic cardiovascular disease (ASCVD) and calcific aortic valve stenosis. Currently, there are no published clinical trials showing whether Lp(a) lowering in conjunction with optimal LDL cholesterol control reduces ASCVD risk.

Methods: Clinicaltrials.gov, an online database for clinical research studies, was used to identify ongoing clinical trials studying targeted Lp(a) lowering pharmacotherapy as of May 2025. Twelve clinical studies met the criteria and were included in this summary.

Results: The three large, multicenter phase 3 outcome trials evaluating clinical cardiovascular disease endpoints of major adverse cardiac event (MACE) are Lp(a)HORIZON (NCT04023552), OCEAN(a) (NCT05581303), and ACCLAIM-Lpa(a) (NCT06292013), which investigate pelacarsen, olpasiran, and lepodisiran, respectively. Other phase 2 and phase 3 trials are also under way.

Conclusion: Results from upcoming trials will inform us whether Lp(a) reductions translate to improved cardiovascular clinical outcomes.

Objective: To compare cardiovascular disease (CVD) attributable to environmental, metabolic, and behavioral risk factor trends in Pakistan and globally.

Methods: We used the Global Burden of Disease 2019 to determine the number of deaths, disability-adjusted life years, age-standardized mortality rates (ASMR) per 100,000, and age-standardized disability-adjusted life years (ASDRs) per 100,000 by age, sex, year, sociodemographic index, regions, and countries.

Results: In Pakistan, the ASMR per 100,000 (329 to 358; estimated annual percentage change [EAPC] 0.09) and ASDR per 100,000 (7327 to 7989; EAPC 0.09) for CVD remained stable with an inverted U-shaped trend. On the other hand, the global ASMR per 100,000 (354 to 240; EAPC -0.32) and ASDR per 100,000 (7085 to 4864; EAPC -0.31) for CVD decreased. Both globally and in Pakistan, the highest ASMR and ASDR of CVD were attributable to high systolic blood pressure followed by dietary risks. Out of 204 countries and territories worldwide, Pakistan ranked 49th for SBP and 33rd for dietary risks in terms of ASMR attributable to these risk factors in 2019.

Conclusion: CVD disease burden in Pakistan remains prominent, with CVD ASMR and ASDR trends attributable to various risk factors displaying unfavorable patterns compared to global trends.

Objective: This study assessed the ability of a real-time artificial intelligence (AI) tool to correctly align early during hospitalization with the discharge status of inpatient versus observation.

Methods: This retrospective case-control study at Baylor Scott & White Medical Center - Temple involved patients on 11 randomly chosen calendar days between August 2023 and October 2024. A real-time AI care level score (CLS) and machine learning likelihood (MeL) recommendations for inpatient versus observation discharge status were developed. Receiver operating characteristic curves were used to compare CLS, MeL, and commercial screening tool criteria with actual inpatient versus observation discharge status.

Results: The receiver operating characteristic curve for CLS-based prediction of the MeL recommendation for inpatients had the highest area under the curve (AUC) of 0.9954 (95% confidence interval [CI] = 0.9954, 0.9998). The AUC for only CLS for predicting inpatient discharge was 0.8949 (95% CI = 0.8692, 0.9206). A CLS score ≥76 resulted in the highest correct classification rate of 86%. For CLS and the commercial screening tool, the AUC was the lowest at 0.8419 (95% CI = 0.8121, 0.871).

Conclusions: Patients with a real-time AI CLS ≥76 had an 86% correct assignment of inpatient discharge status.

Background: This study sought to assess the outcomes of pulmonary embolism (PE) admissions at teaching and nonteaching hospitals in the month of July, when new trainees begin their training in the United States.

Methods: During 2016-2021, adult (≥18 years) nonelective admissions with PE, admitted to urban teaching hospitals in the months of May and July, were identified using the National Inpatient Sample and compared to nonteaching admissions. Outcomes of interest included in-hospital mortality, complications, variations in management, total hospitalization costs, and hospitalization duration.

Results: From January 1, 2016, to December 31, 2021, 164,244 PE admissions were identified in May and July to teaching (76.5%) and nonteaching (23.5%) hospitals. The May and July cohorts had comparable baseline characteristics at both teaching and nonteaching hospitals. The rates of organ failure, noncardiac and cardiac organ support, cardiogenic shock, and cardiac arrest were comparable across all four cohorts. Use of systemic thrombolysis (3.8% vs 3.1%; P = 0.002) and catheter-directed therapies (4.1% vs 3.8%; P = 0.05) were higher in the teaching hospitals in July than in May, but there were no differences in nonteaching hospitals. The cohorts of teaching (3.0% vs 3.3%, P = 0.30) and nonteaching hospitals (2.7% vs 2.2%, P = 0.15) had comparable adjusted in-hospital mortality in May and July. Hospitalization duration, total hospitalization costs, and discharge disposition were comparable in all four cohorts.

Conclusion: In this large 6-year US analysis, there were no differences in the outcomes of PE admissions to teaching and nonteaching hospitals in the months of May and July, arguing against the 'July effect.'

Background: Individuals with Lynch syndrome face up to a 60% lifetime risk of developing endometrial and gastrointestinal cancer. Established guidelines recommend colonoscopies every 1 to 2 years beginning at age 20 to 25 and endometrial biopsy every 1 to 2 years beginning at age 30 to 35. We evaluated the patient experience with a combined endometrial biopsy and gastrointestinal cancer screening procedure for patients with Lynch syndrome.

Methods: Patients with Lynch syndrome undergoing combined colon and endometrial screening from June 2021 to September 2023 were prospectively enrolled. Patients had both procedures during a single session using propofol sedation. Appropriate patients also underwent upper endoscopy. Patient satisfaction was assessed by questionnaire. Surveys were distributed to patients via email 1 day after their procedure. Twenty patients were enrolled, and 18 completed the survey (90%).

Results: None of the patients reported pain during the procedure. The average combined procedure duration was 42 minutes (range 27-59) and average total operating room time was 54 minutes (range 37-93). One patient was found to have complex atypical endometrial hyperplasia and had a hysterectomy for stage 1 A uterine clear cell carcinoma. There were no cases of colon or gastric cancer. A total of six adenomatous polyps and five serrated polyps were removed.

Conclusion: Patients with Lynch syndrome undergoing One-Stop Colon and Endometrial Screening (ONCE) reported high satisfaction with the combined procedure. To maximize patient care, physicians and health care systems should consider support for and investment in the implementation of combined screening approaches.