Baylor University Medical Center Proceedings最新文献

Background: Factors affecting outcomes in patients with abdominal compartment syndrome (ACS) associated with acute pancreatitis (AP) have not been well studied.

Methods: All patients admitted with a diagnosis of AP or ACS between 2016 and 2022 were selected by using the relevant International Classification of Disease (ICD)-10 codes from the National Inpatient Sample. Multivariate binary logistic regression was used to assess the odds of mortality in the setting of ACS secondary to AP.

Results: A total of 708 patients with AP and ACS were identified. Age and additional ICD-10 diagnoses, including sepsis, acute renal failure, malnutrition, intestinal obstruction, and ileus, were found to have statistically significant odds ratios. Older patients and those with sepsis and acute renal failure had greater odds of experiencing inpatient mortality. Conversely, those with malnutrition, ileus, and intestinal obstruction were found to have lower odds of inpatient mortality.

Conclusions: Our results suggest a higher mortality in patients with older age, sepsis, and acute renal failure in the setting of ACS. It also seems that readily treated factors such as malnutrition, intestinal obstruction, and ileus are associated with lower odds of mortality.

Background: Endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) are minimally invasive alternatives to surgery for gastrointestinal tumors, differing in technique, indications, and outcomes. This meta-analysis compared the efficacy and safety of ESD vs EMR.

Methods: Following PRISMA guidelines, PubMed, Cochrane, Google Scholar, and Scopus were searched. Binary outcomes were pooled as odds ratios (ORs) and continuous outcomes as standardized mean differences (SMDs), with 95% confidence intervals (CIs), using a random-effects model. Analyses were performed in R (v4.4.1), with significance set at P < 0.05.

Results: Twenty-five studies with 5283 patients (2234 ESD, 3049 EMR) were included. ESD achieved higher complete resection (OR, 5.77; 95% CI, 2.18-15.26; P < 0.001; I ² = 91%) and en bloc resection rates (OR, 13.46; 95% CI, 5.91-30.64; P < 0.001; I ² = 82%). It required longer procedural time (SMD, 1.73; 95% CI, 1.26-2.19; P < 0.01) but had lower piecemeal resection (OR, 0.06; 95% CI, 0.01-0.38; P = 0.003). Postendoscopic resection coagulation syndrome (PECS) was more frequent with ESD (OR, 2.40; 95% CI, 1.25-4.61; P = 0.008). No significant differences were found in delayed bleeding (P = 0.06) or recurrence (P = 0.61).

Conclusions: ESD provides superior complete and en bloc resection compared with EMR but involves longer procedures and higher PECS risk. Large-scale trials are needed to refine comparative outcomes.

Background: This study evaluated a system-level quality improvement initiative designed to increase colorectal cancer (CRC) screening completion rates within the HealthTexas Provider Network, an employed primary care group affiliated with Baylor Scott & White Health.

Methods: We implemented a series of stepwise interventions between 2015 and 2025 to enhance screening uptake. Interventions included blinded and unblinded physician performance feedback, incentive alignment, and recognition of alternative screening modalities.

Results: CRC screening rates improved from 65.1% in 2018 to 76.0% in 2025. Adoption of stool-based and noncolonoscopy screening increased from 2-4% to 22-25% of total screenings.

Conclusion: Structured accountability and inclusion of alternative screening methods substantially improved CRC screening rates across a large primary care network. This initiative demonstrates the power of data transparency, performance incentives, and flexibility as successful tactics to increase screening options to improve CRC screening and, by extension, set up the potential to reduce preventable CRC deaths.

Objective: Hyperkalemia is a potentially life-threatening electrolyte imbalance that contributes to increased morbidity and mortality in patients with heart failure (HF) and chronic kidney disease (CKD). Novel potassium binders (NPBs) have been shown to prevent hyperkalemia; however, their efficacy and safety have not been fully established.

Methods: We searched various electronic databases, including MEDLINE (via PubMed), Embase, the Cochrane Library, and ClinicalTrials.gov, to retrieve randomized controlled trials comparing NPB to placebo in patients with chronic hyperkalemia due to HF or CKD.

Results: Our meta-analysis, including 12 studies involving 2517 patients, showed that NPBs, including patiromer and sodium zirconium cyclosilicate, were associated with significant mineralocorticoid receptor antagonist (MRA) optimization (relative risk [RR]: 1.28; 95% confidence interval [CI]: 1.14-1.43) as compared to placebo. The results were consistent for subgroups of sodium zirconium cyclosilicate, patiromer, CKD, and HF. NPBs also significantly reduced the incidence of hyperkalemia (RR: 0.37; 95% CI: 0.22-0.6). Additionally, NPBs reduced the mean serum potassium level from baseline as compared to placebo (mean difference: -0.46; 95% CI: -0.77 to -0.15) and MRA optimization at less than the target dose (RR: 0.62; 95% CI: 0.42-0.85). The risk of adverse events, serious adverse events, and all-cause mortality remained comparable between the two groups.

Conclusion: This meta-analysis highlights the potential of NPBs to facilitate MRA optimization, reduce hyperkalemic episodes, and maintain serum potassium levels in patients with hyperkalemia, without a corresponding increase in adverse events. However, further research through large-scale studies is needed to confirm the sustained clinical benefits of NPBs, establish standardized treatment protocols, and evaluate their effectiveness across diverse patient populations with CKD and HF.

Purpose: Barrett's esophagus (BE) is the main precursor to esophageal adenocarcinoma, a cancer with a significantly rising incidence. While proton-pump inhibitors (PPIs) are the standard therapy for managing BE, the chemopreventive role of aspirin is an area of growing interest with inconclusive evidence, particularly regarding its use in combination with PPIs. This study aimed to assess whether adding aspirin to PPI therapy reduces the incidence of esophageal cancer in patients with BE more than PPIs alone.

Methods: A nationwide retrospective cohort study was conducted using the TriNetX database. Adult patients with BE were divided into two cohorts: those receiving aspirin plus a PPI and those receiving a PPI only. Propensity score matching was used to balance baseline demographics and clinical comorbidities. The primary outcome was the incidence of malignant neoplasm of the lower third of the esophagus. Subgroup analyses were also performed for low-dose (81 mg) and high-dose (300-325 mg) aspirin.

Results: After matching, each cohort included 88,184 patients. The cohort receiving aspirin and PPIs had a lower risk of developing esophageal cancer compared to the PPI-only cohort (odds ratio [OR] 0.799, 95% CI: 0.679-0.941). The protective association was observed in both high-dose (OR 0.643) and low-dose (OR 0.664) aspirin subgroups, suggesting a potential dose-dependent effect.

Conclusion: This large, real-world analysis suggests that the concurrent use of aspirin with PPIs is associated with a reduced risk of esophageal cancer in patients with BE.

Objective: The primary aim of our study was to report the dose of spinal hyperbaric bupivacaine 0.75% used for patients who had removal of an indwelling labor epidural catheter followed by a single injection spinal (SIS) or combined spinal-epidural (CSE) anesthetic technique for cesarean delivery anesthesia.

Methods: Patients who had removal of an indwelling labor epidural catheter and performance of SIS or CSE anesthesia from January 1, 2020, through December 31, 2022, with complete data on height, weight, and spinal anesthetic dose were included in our study.

Results: There were 56 and 212 patients who had SIS and CSE anesthesia, respectively, following removal of an indwelling labor epidural catheter. Patients received a median spinal dose of 9.8 and 10.5 mg for CSE and SIS anesthesia, respectively (P = 0.004). The spinal bupivacaine dose generally increased with increasing height and decreased with increasing weight. The observed incidence of high spinal block was 1:134 (95% confidence interval 1:37 to 488).

Conclusion: Height and weight can be utilized to determine dosing of spinal bupivacaine following removal of an indwelling labor epidural catheter.

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.