Baylor University Medical Center Proceedings最新文献

Background: Prostatic leiomyosarcoma is a rare and aggressive malignancy with limited prognostic data. We performed a pooled analysis of 143 cases from 82 published reports to identify key prognostic markers.

Results: The median age at diagnosis was 57 years (interquartile range [IQR] 22.5 years), and the median tumor size was 8 cm (IQR 7 cm). Spindle cell morphology was the predominant histologic subtype, observed in 48.3% of cases, with 80.1% of tumors classified as high-grade. Metastasis was present in 37.2% of patients, recurrence was present in 25.9%, and the overall mortality rate was 57.2%. Kaplan-Meier survival analysis demonstrated significantly reduced survival in patients with metastasis (13 vs 32 months, P = 0.04), mixed histology (5 vs 27 months, P = 0.04), positive surgical margins (15 vs 29 months, P = 0.02), and elevated prostate-specific antigen levels (>4 ng/mL) (3 vs 27 months, P = 0.04). The median overall survival was 25 months (95% confidence interval [CI]: 14.96-35.04). Multivariate Cox regression analysis identified metastasis as a significant predictor of mortality (hazard ratio [HR] = 3.66, P = 0.02). Additionally, multivariate logistic regression analysis revealed tumor recurrence as an independent predictor of mortality (odds ratio [OR] = 3.41, P = 0.01). Chi-square/Fisher's exact tests indicated a significant association between metastasis and recurrence (P = 0.002) and between spindle morphology and metastatic risk (P = 0.04). Moreover, recurrence was strongly associated with mortality (P = 0.002).

Conclusion: Metastasis and tumor recurrence are key predictors of mortality in prostatic leiomyosarcoma.

Background: Diabetes mellitus (DM) and liver cirrhosis are highly co-occurring conditions contributing significantly to global mortality over the past two decades. We aimed to examine nationwide mortality patterns for DM and liver cirrhosis from 1999 to 2023.

Methods: Trends in DM and liver cirrhosis mortality were analyzed using death certificates from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. Crude and age-adjusted mortality rates (AAMRs) per 100,000 people and annual percent changes (APCs) in AAMR were obtained with their 95% confidence intervals (CIs) and measured across different demographic and geographic subgroups.

Results: Overall, 112,644 deaths were attributed to DM and liver cirrhosis among adults aged ≥45. The total AAMR increased twofold from 1999 (2.8) to 2023 (5.2) while peaking in 2021 (13.71, P < 0.05), followed by a post-COVID decline by 2023. Demographic groups with the highest AAMRs included males (4.2), non-Hispanic American Indians (7.7), those in nonmetropolitan areas (3.8), and those in the West region (3.9).

Conclusions: The rising mortality rates across different demographic characteristics and regions highlight the need for targeted interventions and resource distribution among high-risk populations, such as males and nonmetropolitan residents, to address these persistent disparities.

Background: The increased use of glucagon-like peptide 1 receptor antagonists (GLP1RAs), associated with the increasing prevalence of obesity and type 2 diabetes mellitus, has raised concerns for delayed gastric emptying and increasing risks of complications during endoscopic procedures. This study aimed to determine the prevalence of retained gastric content (RGC) and related complications in patients taking GLP1RAs undergoing upper endoscopies.

Methods: A retrospective cohort study was performed involving 218 adults on GLP1RAs undergoing esophagogastroduodenoscopy between June 2013 and June 2023 in the Baylor Scott & White Health system, with analysis of frequency of RGC and related adverse events among this population.

Results: RGCs were seen in 20.6% of the patients, with nine procedures terminated prematurely, one aspiration event, and one intraprocedural intubation.

Conclusion: These findings suggest that there is a high prevalence of RGCs in patients taking GLP1RAs, although a low incidence of severe complications or adverse outcomes during endoscopy.