Baylor University Medical Center Proceedings最新文献

Frontal fibrosing alopecia (FFA) is a clinical variant of lichen planopilaris that presents as a chronic, scarring alopecia. An association between FFA and the autoimmune condition vitiligo has been rarely discussed in the literature, with most cases describing the occurrence of FFA after a long-standing history of vitiligo. We present a patient case of vitiligo developing after a diagnosis of frontal fibrosing alopecia and discuss the potential pathologic link between these two entities.

The high cost of medications in human healthcare remains a pressing concern, particularly for novel therapies such as biologics and Janus kinase (JAK) inhibitors. While these medications have markedly improved the management of chronic dermatologic conditions, their high cost continues to pose a significant barrier to widespread access. In contrast, veterinary JAK inhibitors and biologics are readily accessible at a fraction of the cost. We sought to quantify the price disparities between human and veterinary formulations of dermatologic medications and explore potential reasons for these differences. We collected pricing data for various dermatologic drugs, including antibiotics, antifungals, antiparasitics, antihistamines, antiinflammatory agents, topicals, biologics, and JAK inhibitors. Pricing data for human formulations were obtained using the top five GoodRx listings. Veterinary pricing was sourced from VetRx Direct, Pet VM, and Chewy. Most human formulations were up to two times more expensive than veterinary formulations. However, biologics and JAK inhibitors exhibited extreme discrepancies, costing up to 71 times more than their veterinary counterparts. Our findings highlight the need for increased transparency in drug pricing and policy reforms aimed at reducing excessive markups, particularly for biologics and targeted treatments.

Circumflex humeral artery aneurysms are rare vascular injuries that can lead to disastrous consequences if there is a delay or error in diagnosis. Previously only described in young elite athletes, this case series of eight patients, including a symptomatic 59-year-old man, illustrates the need for its inclusion in the differential in isolated arm ischemia regardless of age. Ligation without revascularization is the most commonly reported intervention; however, this does not address the axillary artery inflammatory thickening associated with the development of these aneurysms. We propose that aneurysm ligation with patch angioplasty of the axillary artery enables treatment of all arteries affected in the quadrilateral space.

Background: Coronary no-reflow is associated with adverse outcomes in patients with myocardial infarction (MI). This study aimed to evaluate the association between the presence of fragmented QRS (fQRS) and no-reflow in MI patients.

Methods: A systematic search was conducted across four databases from inception to July 20, 2024. The inclusion criteria were studies that enrolled MI patients, stratified by the presence of fQRS, and reported at least one of the following outcomes: no-reflow, infarct size, reinfarction, or repeat revascularization during hospitalization. No-reflow was defined as a Thrombolysis In Myocardial Infarction (TIMI) flow grade < 3.

Results: A total of 19 studies with 5840 participants were analyzed using a random-effects model. The presence of fQRS was associated with a higher risk of no-reflow compared to non-fQRS in MI patients, with an odds ratio (OR) of 2.08 (95% CI 1.39 to 3.12), P < 0.01. Subgroup analysis by study design supported this finding. However, there were no significant differences in infarct size, in-hospital reinfarction, or need for repeat revascularization between groups.

Conclusions: The presence of fQRS was associated with a higher risk of no-reflow in MI patients. fQRS could serve as a useful tool for predicting no-reflow and guiding primary prevention strategies in MI patients.

Background: Previous studies have demonstrated disparities in survival outcomes between Black/African American, Asian, and White patients with non-small cell lung cancer (NSCLC). Some studies have suggested that non-White patients have poorer survival outcomes due to socioeconomic factors, while others have reported different findings. Therefore, we performed a comprehensive review and meta-analysis to evaluate the impact of racial disparity on NSCLC survival outcomes.

Method: PubMed, Ovid MEDLINE, Embase, and Google Scholar were searched for articles published until September 2024. Eligible studies with aligned research objectives were included. Two reviewers independently extracted data. Methodological quality was assessed using the Newcastle-Ottawa Scale. The meta-analysis adhered to the PRISMA guidelines.

Result: Fifteen studies with 763,314 patients met the eligibility criteria. Asian and Asian/Pacific Islander (API) patients had significantly better overall survival (OS) compared to White patients (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.79-0.94; P < 0.01 and HR, 0.80; 95% CI, 0.69-0.93; P < 0.01, respectively). In contrast, OS differences were not statistically significant between Black and White (HR, 1.00; 95% CI, 0.94-1.07; P < 0.01) or Hispanic and White patients (HR, 0.93; 95% CI, 0.87-1.00; P = 0.19). Further, the subgroup analyses did not demonstrate any significant difference in OS outcome in any stage when comparing Black to White patients (stage I HR, 1.11; 95% CI, 1.00-1.23; P < 0.01; stage II HR, 1.03; 95% CI, 0.96-1.10; P = 0.26; stage III HR, 1.04; 95% CI, 0.96-1.12; P < 0.01; and stage IV HR, 1.02; 95% CI, 0.97-1.07; P < 0.01).

Conclusion: Asian and API patients with NSCLC exhibited superior OS outcomes compared to White patients. In contrast, racial disparities in survival outcomes were statistically insignificant for Black and Hispanic patients. Additionally, staging disparities in OS were not observed between Black and White patients with NSCLC.

Background: While insulin resistance (IR) and metabolic dysfunction-associated steatotic liver disease (MASLD) are well established in obese individuals, their connection in lean populations remains underexplored.

Methods: This cross-sectional study investigated the relations of IR with MASLD and advanced liver fibrosis based on data from the 2017-2020 US National Health and Nutrition Examination Surveys. The subjects were lean adults (non-Asian body mass index [BMI] < 25 kg/m², Asian BMI <23 kg/m²) with transient elastography data, free from viral hepatitis, human immunodeficiency virus, excessive alcohol use, and diabetes. Multivariable generalized linear and logistic regression models were used to relate IR measures to hepatic fat content and visceral adiposity. The IR measures included homeostasis model assessment of insulin resistance (HOMA-IR), the quantitative insulin sensitivity check index (QUICKI), and homeostasis model assessment of β-cell function (HOMA-β).

Results: Among 860 lean adults (median age 53 years; 48% female; 38% White; mean BMI 22.5 kg/m²), the age-adjusted prevalence of MASLD was 8.9%. Among individuals with MASLD, 84% had a high visceral adiposity index (>1.92). The percent change in controlled attenuation parameter associated with HOMA-IR, QUICKI, and HOMA-β was 11.62 (95% confidence interval [CI]: 6.31, 16.93), 0.76 (95% CI: 0.26, 1.26), and -162.72 (95% CI: -260.94, -64.50), respectively. HOMA-IR (adjusted odds ratio [aOR]: 2.60, 95% CI: 1.36, 4.98), QUICKI (aOR: 1.06, 95% CI: 1.01, 1.11), and HOMA-β (aOR: 0.04, 95% CI: 0.01, 0.56) were each associated with MASLD. HOMA-IR was associated with advanced liver fibrosis (aOR: 1.51, 95% CI: 1.19, 2.15).

Conclusion: MASLD and advanced liver fibrosis in lean individuals are linked to IR, independently of excess adiposity. Assessing IR could aid in identifying lean individuals at high risk of MASLD and liver fibrosis, regardless of diabetes status.

Introduction: Research productivity is an important component of the fellowship application for vascular surgery and is a criterion identified by program directors as important in the general surgery fellowship match. Bibliometric methods have been developed to standardize and quantify scholarly productivity. This study evaluated the research of general surgery residents who successfully matriculated into an independent vascular surgery fellowship.

Methods: A list of the independent vascular surgery fellowships for the 2021-2022 academic year was first identified on the Society for Vascular Surgery website. Programs that displayed vascular fellows were selected for analysis. The names of all first- and second-year fellows were entered into Scopus, Google Scholar, and ResearchGate to obtain various bibliometric variables including number of total publications, number of vascular surgery publications, and number of citations upon matriculation into fellowship. Regression models were created to assess factors associated with publications.

Results: Among independent vascular surgery fellowships, 83% were in academic training centers, 8% were in community training centers, and 9% were in university-affiliated training centers. Two-thirds of independent vascular surgery fellowship websites displayed fellow names; 17% of fellowships had one fellow, 49% had two fellows, 19% had three fellows, and 15% had four fellows (2.32 ± 0.93 fellows on average). The average number of publications upon matriculation for independent vascular fellows was 5, with an average of 3 publications within vascular surgery journals. On average, an incoming independent vascular fellow had 22 total citations. A larger number of fellows in the program (3 or 4) was observed to strongly correlate with publications (P < 0.01), number of vascular surgery publications (P < 0.01), and number of citations (P = 0.04). The geographic region of the fellowship did not correlate with research output. There was also no significant difference in research productivity among vascular surgery fellows coming from academic versus community versus affiliated general surgery residencies.

Conclusion: Most independent vascular surgery fellowships are academic training centers with, on average, two fellows. Vascular surgery publications account for more than 50% of general surgery residents' research output upon vascular surgery fellowship matriculation. Larger independent vascular fellowships may attract candidates with greater scholarly productivity.

Metastatic prolactinomas are an extremely rare type of neuroendocrine tumors, comprising <0.2% of all pituitary tumors. These tumors are typically associated with poor prognosis, with an average survival of 10 months. Temozolomide, an alkylating chemotherapy agent, has previously been shown to be effective in treating these rare cases once first-line medical and surgical therapies have failed. We present a patient with metastatic prolactinoma to the cerebellopontine angle, thoracic spine, and lumbar spine who has achieved 12 years of survival with clinical improvement and stabilization after 4 years of temozolomide therapy.