Baylor University Medical Center Proceedings最新文献

Background: Spinal tumors present complex clinical challenges due to their proximity to vital neurological structures. Conventional open surgery may be associated with notable complications, contributing to a growing interest in minimally invasive approaches. This systematic review explored the role, safety, and effectiveness of full-endoscopic spine surgery in managing spinal tumors.

Methods: A thorough literature search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines across PubMed, EMBASE, and CINAHL databases. Recent studies describing full-endoscopic spinal tumor procedures and clinical outcomes, including pain relief, neurological improvement, surgical complications, and recovery metrics, were selected.

Results: Ten studies involving 65 patients, all retrospective case series or case reports, met the inclusion criteria. Most of the procedures involved gross total tumor resection with various endoscopic approaches. Postoperative outcomes demonstrated significant reductions in pain scores and improvement or stability in neurological function across nearly all patients. The average surgery duration was 121 minutes, estimated blood loss ranged from minimal to 100 mL, and hospital stays averaged 71 hours. Complication rates following full-endoscopic spinal surgeries were low and primarily transient, and no tumor recurrences or reoperations were noted within the follow-up period averaging 16.4 months.

Conclusions: Full-endoscopic spine surgery appears to be a relatively safe and effective minimally invasive technique that is being increasingly adopted for selected spinal tumors. Preliminary evidence suggests a favorable safety profile, including reduced surgical trauma, decreased blood loss, shortened hospital stays, as well as accelerated recovery. Nevertheless, its broader use remains limited by the steep learning curve for spine surgeons, the rarity of spinal tumors, and a lack of larger prospective studies.

Background: Asthma remains a major public health concern, with marked mortality disparities by sex and race and related mortality trends among US young adults aged 25 to 54 from 1999 to 2020.

Methods: Age-adjusted mortality rates (AAMR) from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) were stratified by demographics and geography. Trends were assessed using Mann-Kendall test, t test, and analysis of variance.

Results: The overall AAMR was 1.886 per 100,000, higher in females than males (2.085 vs 1.655, P < 0.001). Male mortality rose (P = 0.002); female rates nonsignificantly declined (P = 0.18). Nonmetropolitan areas showed a rising trend (P < 0.001), but the rates were not higher than in metropolitan areas (P = 0.20). The Northeast (1.979) and Midwest (1.954) had the highest regional rates, with rising male mortality in the Midwest (P = 0.005) and West (P = 0.04). Black populations had the highest mortality (5.164), though declining (P = 0.004); White rates rose (P < 0.001), especially in males. State-level disparities were evident, highest in the District of Columbia (3.202) and lowest in New Hampshire (1.167).

Conclusions: Asthma mortality in young US adults reveals persistent disparities and troubling trends in historically lower-risk groups. These findings signal critical gaps in early diagnosis, access to care, and exposure management. Without timely, equity-focused public health action, preventable asthma deaths may rise.

Background: In the United States, hepatocellular carcinoma (HCC) mortality is disproportionately high in the US-Mexico border region. This study examined disparities in hepatitis C virus (HCV)-related HCC mortality between border and nonborder regions.

Methods: We queried the CDC WONDER Multiple Cause of Death database from 2000 to 2020 for deaths with ICD-10 codes B18.2 (chronic HCV) and C22.0 (HCC). Age-standardized mortality rates (ASMRs) per 100,000 were compared across border and nonborder regions. Significant differences were determined by nonoverlapping 95% confidence intervals.

Results: The border region had a 1.6-fold higher overall ASMR (95% CI = 1.5-1.7) than nonborder regions (0.8 vs 0.5 per 100,000). All ethnic groups in the border region had a higher ASMR than their nonborder counterparts, with pronounced risk ratios (RR) in White (RR = 2.0, 95% CI = 1.9-2.1), American Indian (RR = 1.9, 95% CI = 1.2-2.8), and Black/African American (RR = 1.6, 95% CI = 1.3-2.0) people. Within the border region, Black people had the highest risk compared to White people (RR = 2.0, 95% CI = 1.6-2.6), followed by American Indian people (RR = 1.6, 95% CI = 1.1-2.5). Hispanic people also had an increased risk (RR = 1.3, 95% CI = 1.2-1.4) compared to non-Hispanic people.

Conclusion: HCV-related HCC mortality is significantly higher in the US-Mexico border region, particularly among Black and American Indian/Alaska Native populations.

Background: Rural patients are significantly underrepresented in cancer clinical trials. A proper understanding of the barriers and facilitators to rural patient participation in cancer clinical trials is essential, especially in states like Texas where rural-urban disparity is prominent.

Methods: EBSCO Medline, Embase, CINAHL, Cochrane, and PsycInfo were systematically searched for articles. A total of 2663 articles were screened, yielding 20 articles for study.

Results: A systematic review of the literature revealed that barriers and facilitators to cancer clinical trial participation by rural populations are present at the patient, physician, and healthcare system levels. Notable barriers found in this review include the burden of travel, lack of patient knowledge about clinical trial participation, insufficient provider communication and awareness of current trials, and strict eligibility criteria. Promising facilitators include caregiver support, close physician support and contact, and programs to increase patient understanding of clinical trials.

Conclusion: Further elucidating barriers to ascertain why rural patients have less participation in clinical trials, and exploring which facilitators need to be further explored, could allow for effectively harnessing the power of facilitators in the pursuit of lessening disparities and improving cancer outcomes for rural patients.

Background: Infective endocarditis is commonly associated with Staphylococcus aureus bacteremia. While various guidelines regarding the need for echocardiography imaging exist, few studies directly compare transthoracic echocardiography (TTE) with transesophageal echocardiography (TEE).

Methods: We performed a single institution retrospective study from January 1, 2015, through December 31, 2022, that compared the sensitivity of TTE and TEE in patients admitted with a diagnosis of S. aureus bacteremia.

Results: A total of 196 patients were included in the final analysis. Blood culture results revealed positivity for methicillin-susceptible S. aureus in 62.2% of cases and for methicillin-resistant S. aureus in 34.2% of cases. Thirty-six patients were excluded due to indeterminate imaging findings, leaving a subset of 160 for final analysis. Of this subset, 30 patients were found to have positive imaging findings on TTE and/or TEE. TEE detected 26 cases (87%), while TTE detected 7 cases (23%). TEE was significantly more sensitive than TTE (P = 0.0003).

Conclusion: In patients with S. aureus bacteremia who underwent sequential TTE followed by TEE, TEE was significantly more sensitive than TTE for detecting imaging evidence of infective endocarditis.

Iliac artery aneurysms (IAAs) represent a small percentage of intra-abdominal aneurysms but pose a significant risk for progression and possible rupture. IAA repair has traditionally been achieved through open intervention, although endovascular repair has shown good successes. Endovascular repair of IAAs with concomitant venous outflow obstruction is poorly described. We present two IAAs with venous obstruction managed via endovascular repair and subsequent venous stenting.