Tag: pubmed

JAMA. 2025 Apr 28. doi: 10.1001/jama.2025.5791. Online ahead of print.

ABSTRACT

IMPORTANCE: Hospitalization of moderately preterm infants may be prolonged while waiting for apnea of prematurity to resolve after discontinuing caffeine.

OBJECTIVE: To evaluate whether extending caffeine treatment reduces the duration of hospitalization.

DESIGN, SETTING, AND PARTICIPANTS: From February 2019 to December 2022, this randomized clinical trial in 29 US hospitals enrolled infants born at 29 to 33 weeks’ gestation who at 33 to 35 weeks’ postmenstrual age were receiving caffeine treatment with plans to discontinue it plus receiving full feeds (≥120 mL/kg/d). Follow-up was completed on March 20, 2023.

INTERVENTIONS: Infants were randomized to oral caffeine citrate (10 mg/kg/d) or placebo until 28 days after discharge.

MAIN OUTCOMES AND MEASURES: The primary outcome was days to discharge after randomization. Secondary outcomes included days to physiological maturity (apnea free for 5 consecutive days, receiving full oral feeds, and out of the incubator for at least 48 hours), postmenstrual age at discharge, all-cause hospital readmissions, all-cause sick and emergency department visits, safety outcomes, and death.

RESULTS: A total of 827 infants (median gestational age, 31 weeks; 414 female [51%]) were randomized (416, caffeine; 411, placebo) out of the 878 planned before reaching the prespecified futility threshold. Days of hospitalization after randomization did not differ between groups (18.0 days [IQR, 10 to 30 days] for caffeine vs 16.5 [IQR, 10 to 27 days] for placebo; adjusted median difference, 0 days [95% CI, -1.7 to 1.7 days]), nor did days to physiological maturity differ (14.0 vs 15.0 days, adjusted median difference, -1 day [95% CI, -2.4 to 0.4 days]). Infants receiving caffeine were apnea free sooner (6.0 vs 10.0 days; adjusted median difference, -2.7 days [95% CI, -3.4 to -2.0 days ]) but had similar days to full oral feeding (7.5 vs 6.0 days, adjusted median difference, 0 days [95% CI, -0.1 to 0.1]). Rates of readmissions and sick visits did not differ between groups. There was no statistically significant difference in adverse events between the 2 groups.

CONCLUSIONS AND RELEVANCE: In moderately preterm infants, continuation of caffeine treatment compared with placebo did not shorten hospitalization.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03340727.

PMID:40294395 | DOI:10.1001/jama.2025.5791

J Comput Assist Tomogr. 2025 Apr 28. doi: 10.1097/RCT.0000000000001761. Online ahead of print.

ABSTRACT

OBJECTIVES: At present, the study of bronchiolar adenoma (BA) mainly focuses on its pathologic characteristics, but there is limited understanding of its clinical manifestations and imaging signs. This article aims to summarize the clinical manifestations and imaging features of 80 cases of BA, with the goal of achieving a comprehensive and systematic understanding of BA.

MATERIALS AND METHODS: We retrospectively analyzed 80 patients with BA confirmed by surgical pathology in our hospital. All subjects underwent thin-slice CT examination. The basic information, tumor history, clinical manifestations, and CT imaging features of the lesions were collected. The subjects’ age, maximum diameter of BA, and shortest distance from the pleura were analyzed by t-test or 1-way ANOVA, while other clinical and radiologic characteristics were compared for differences among different BA types by the χ2 test or Fisher exact probability method.

RESULTS: The majority of the 80 patients were female, with an average age of 59.08±10.16 years. The majority of them do not manifest any clinical symptoms. All lesions are located in the subpleural area, including 63 cases in the lower lobe of the lungs. The average size of the tumors was 10.31±5.01 mm. The majority of the lesions exhibited irregular morphology (53 cases, 66.25%) and predominantly comprised solid nodules (46 cases, 57.50%). There were statistically significant differences in lesion morphology, boundary, and pseudocavity among pure ground-glass nodular BA, mixed ground-glass nodular BA, and solid density nodular BA. Compared with pure ground-glass density BA (1 case, 1.25%) and mixed ground-glass density BA (7 cases, 8.75%), the boundary of solid nodules BA (42 cases, 52.50%) was significantly clearer (P<0.001). The presence of pseudocavity was found to be significantly higher in individuals with solid nodules compared with those with pure ground-glass nodules (P<0.0167). Compared with BA without pseudocavity, BA with pseudocavity exhibited a clearer lung interface (P<0.001), more abnormal vessel signs (P=0.007), and a higher incidence of malignant preoperative diagnosis (P=0.020).

CONCLUSIONS: BA mostly occurs in middle-aged and elderly women without any clinical symptoms. The imaging manifestations of BA are diverse, mainly presenting as irregular solid nodules. The interface between the tumor and lung is clear, and pseudocavity formation is common. In addition, BA with pseudocavity often exhibits abnormal vascular signs, which can lead to misdiagnosis as malignancy before surgery.

PMID:40294372 | DOI:10.1097/RCT.0000000000001761

JCO Glob Oncol. 2025 Apr;11:e2400589. doi: 10.1200/GO-24-00589. Epub 2025 Apr 28.

ABSTRACT

PURPOSE: This study aimed to identify the concerns and needs of radiation oncology residents in Turkey regarding their efforts to stay current with advancements in this highly competitive discipline.

MATERIALS AND METHODS: A cross-sectional anonymous survey of 20 questions was designed by the Turkish Society for Radiation Oncology (TROD)-Young Radiation Oncologists Group (GROG) and distributed to radiation oncology residents across Turkey. Data were collected and analyzed using descriptive analyses to identify common themes and specific needs and stratified according to junior and senior residents. Statistical analysis was performed using the Statistical Package for Social Sciences Statistics 21.0 (SPSS Inc, Chicago, IL).

RESULTS: Sixty-four residents participated in the survey, with an overall response rate of 20%. The majority of participants, 55 (85.9%), had a regular training program in their clinic. However, only 28 (51%) felt that this program was sufficient to stay up to date. Consequently, almost all participants (98.4%) reported making individual efforts to stay current, with 87.3% encountering difficulties. Notably, junior residents experienced a higher rate of difficulty than senior residents did (93.1% v 70%, respectively). All the participants expressed the need for a new platform to easily access the results of significant new studies.

CONCLUSION: The traditional radiation oncology curriculum needs to be updated to include modern methods of obtaining information in the current Internet era. In addition, new platforms should be provided to residents for easier access to information. As TROD/GROG, we have planned to address this issue with the GROG News project. Further efforts should be made to develop solutions to alleviate residents’ concerns.

PMID:40294365 | DOI:10.1200/GO-24-00589

JCO Precis Oncol. 2025 Apr;9:e2400459. doi: 10.1200/PO-24-00459. Epub 2025 Apr 28.

ABSTRACT

PURPOSE: Although estrogen receptor is well studied in breast cancer (BC), the role of androgen receptor (AR) in prognosis and therapy response is less understood. Here, we characterized the clinicopathologic and molecular features of AR gene expression in BC subtypes.

METHODS: Ten thousand seven hundred twenty-eight BC samples were tested by next-generation DNA sequencing, whole-transcriptome sequencing, and immunohistochemistry at Caris Life Sciences (Phoenix, AZ). Tumors with AR-high and AR-low RNA expression were stratified by top and bottom quartiles, respectively. Treatment-associated survival was obtained from insurance claims and calculated from treatment start to last contact using Kaplan-Meier estimates. Statistical significance was determined by chi-square and Mann-Whitney U test with P values adjusted for multiple comparisons (q < .05).

RESULTS: AR-low was associated with basal-like tumors. AR-high tumors were associated with increased mutation rates in several genes-namely PIK3CA and CDH1-across all subtypes, while other associations such as RB1 and MAP3K1 were subtype-dependent. The immune landscape was differentially affected by AR expression in each subtype, but these differences did not correspond to differential responses to immune checkpoint blockade. Patients with AR-high tumors had a longer therapy response for most subtypes, but those with AR-high tumors that were human epidermal growth factor receptor 2-enriched and luminal B trended toward worse chemotherapy or hormone therapy response, respectively.

CONCLUSION: Our data suggest a unique molecular profile of AR-high BC that is subtype-specific and generally associated with improved outcomes. Exploration of specific mutations and immune-oncology markers associated with AR-high may aid in molecularly selected clinical trial design for patients with advanced BC.

PMID:40294352 | DOI:10.1200/PO-24-00459

Pediatr Infect Dis J. 2025 Apr 28. doi: 10.1097/INF.0000000000004835. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to develop and validate a clinical score for the prediction of critical care entrance in children with dengue.

METHODS: We conducted a retrospective cohort study using admissions from January 2019 to August 2021, at Hospital Infantil Napoleón Franco Pareja, in Cartagena, Colombia. We included all children 18 years or younger, with a positive immunoglobulin M or nonstructural protein 1 laboratory test and admitted for follow-up at the emergency department. We selected variables retrospectively collected on emergency admission for feature selection. We assessed discrimination and calibration in the development dataset, using 1000 bootstrap replications for internal validation. Data from 2019 to 2020 were used for development and 2021 for temporal validation. We report the c-statistic for discrimination with 95% confidence intervals (CIs), as well as the calibration intercept and slope.

RESULTS: One thousand three hundred eighty-five patients were included for development and internal validation. In temporal validation with 519 additional patients, the c-statistic was 0.82 (95% CI: 0.77-0.87), with a calibration slope of 0.98 (95% CI: 0.77-1.18). We selected the 50th percentile of the distribution of predicted probability of critical care entrance (5%) as a threshold value for increased alert at emergency admission, missing 10% of all cases that need to enter critical care (sensitivity of 90% with 95% CI of 82-95, and specificity of 48% with 95% CI of 41-50).

CONCLUSIONS: Our validated model can be useful to predict critical care entrance in children with dengue. We recommend the validation and potential recalibration of our score in other clinical settings.

PMID:40294334 | DOI:10.1097/INF.0000000000004835

ASAIO J. 2025 Apr 28. doi: 10.1097/MAT.0000000000002450. Online ahead of print.

ABSTRACT

Extracorporeal cardiopulmonary resuscitation (ECPR) requires advanced skills for induction and management. This study evaluated whether the outcomes of ECPR differ by institutional volume. Using the Japanese Association for Acute Medicine-Out-of-Hospital Cardiac Arrest (JAAM-OHCA) registry, we analyzed adult patients (aged ≥18 years) who received ECPR between 2014 and 2020, focusing on 30 day in-hospital survival and favorable neurologic prognosis at 30 days defined as Cerebral Performance Category (CPC) 1-2. Facilities were categorized into tertiles by annual ECPR volume. Multivariable logistic regression examined outcomes across low (≤4.7 cases/year), medium (4.8-7.8 cases/year), and high (≥7.9 cases/year) volume groups. A total of 1,759 patients from 83 centers were included, with an overall 30 day survival of 21.1% and CPC 1-2 rate of 10.1%. We observed no statistically significant differences in the respective rates of 30 day survival and neurologic outcomes in the medium ECPR volume group (adjusted odds ratios 1.09 [95% confidence interval {CI}, 0.82-1.47] and 0.85 [0.56-1.26]) and higher ECPR volume group (adjusted odds ratios 1.27 [95% CI, 0.95-1.70] and 1.11 [0.75-1.63]) compared with the lower ECPR volume group. These findings suggest that ECPR outcomes for out-of-hospital cardiac arrest are not significantly affected by institutional ECPR volume.

PMID:40294333 | DOI:10.1097/MAT.0000000000002450

Pediatr Infect Dis J. 2025 Apr 29. doi: 10.1097/INF.0000000000004836. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to determine the incidence and clinical characteristics of infants evaluated and treated with a prolonged course of antibiotics for culture-negative sepsis in a quaternary Neonatal Intensive Care Unit (NICU) over a 4-year period.

STUDY DESIGN: Retrospective chart review of patients in the NICU at Children’s Hospital of Philadelphia who had negative blood cultures and received ≥5 days of antibiotics. Data collection included demographics, clinical and laboratory data, and underlying diagnoses. Statistical analysis included Mann-Whitney and chi-square tests, and multivariable logistic regression.

RESULTS: We identified 774 culture-negative sepsis evaluations where antibiotic treatment was continued ≥5 days. While the majority were attributed to a focal etiology, 146 had negative blood cultures and no focal source. Infants with no focal source were younger at the time of sepsis evaluation, of greater gestational age, and more frequently required extracorporeal membrane oxygenation (P < 0.001). In multivariable analysis, evaluations for early-onset disease and need for extracorporeal membrane oxygenation were increased among infants with no focal source (P < 0.01). Although rates of invasive ventilation, and central venous catheters were similar, length of stay and mortality were significantly higher in late-onset episodes (P < 0.001 and P = 0.029, respectively). Consultation with the infectious disease team increased during the study period (P = 0.002).

CONCLUSIONS: Although it is challenging to limit the initiation of antibiotics in infants with complex underlying disease processes with concern for sepsis, minimizing antibiotic use can be achieved by timely discontinuation when cultures are negative. A robust antimicrobial stewardship program can identify valid reasons for prolonged antibiotic administration and suggest approaches to minimize antibiotic exposure.

PMID:40294328 | DOI:10.1097/INF.0000000000004836

Cancer Control. 2025 Jan-Dec;32:10732748251339248. doi: 10.1177/10732748251339248. Epub 2025 Apr 28.

ABSTRACT

IntroductionOvarian cancer remains a leading cause of gynecologic cancer-related mortality worldwide. Identifying perioperative factors that influence survival outcomes is essential for optimizing care. This study evaluates the impact of perioperative factors such as intraoperative blood transfusions and hospital length of stay (LOS) on survival rates in ovarian cancer patients undergoing surgical debulking.MethodsThis retrospective study analyzed charts of 314 patients who underwent ovarian cancer surgery at a single institution between 2010 and 2018. Patients were grouped based on survival status: “Live” or “Death”. Variables included demographics, tumor size, comorbidity, anesthesia time, surgery time, estimated blood loss, transfusion, readmission, hospital stay length, and survival. Statistical analyses included log-rank tests and mean survival estimations: chi-square tests and Mann-Whitney U-test. Significance was set at P < .05.ResultsThe mean follow-up was 50.5 months (95% CI, 47.8-53.2). Prolonged LOS (>3 days) was significantly associated with reduced survival (47.4 vs 52.4 months, P = .015). Patients requiring intraoperative blood transfusions had poorer survival outcomes (42.0 months 95% CI, 36.3-47.7 vs 53.1 months 95% CI, 50.3-55.9, P < .001). The “Death” group experienced greater blood loss, longer surgical/anesthesia times, and higher intraoperative fluid requirements.ConclusionProlonged hospital stays and intraoperative blood transfusions are associated with worse survival outcomes in ovarian cancer patients undergoing surgery. These findings underscore the importance of perioperative optimization strategies, including minimizing transfusion requirements and reducing LOS through enhanced recovery protocols.

PMID:40294239 | DOI:10.1177/10732748251339248

J Cogn Neurosci. 2025 Apr 28:1-13. doi: 10.1162/jocn_a_02339. Online ahead of print.

ABSTRACT

In the past decade, studies have shown that attention fluctuates at ∼8 Hz, alternating between intervals of increased and decreased visual performance [Re, D., Karvat, G., & Landau, A. N. Attentional sampling between eye channels. Journal of Cognitive Neuroscience, 35, 1350-1360, 2023; Re, D., Inbar, M., Richter, C. G., & Landau, A. N. Feature-based attention samples stimuli report feature-based attention samples stimuli rhythmically. Current Biology, 1-7, 2019; Helfrich, R. F., Fiebelkorn, I. C., Szczepanski, S. M., Lin, J. J., Parvizi, J., Knight, R. T., et al. Neural mechanisms of sustained attention are rhythmic. Neuron, 99, 854-865, 2018; VanRullen, R. Perceptual cycles. Trends in Cognitive Sciences, 20, 723-735, 2016; Fiebelkorn, I. C., Saalmann, Y. B., & Kastner, S. Rhythmic sampling within and between objects despite sustained attention at a cued location. Current Biology, 23, 2553-2558, 2013; Landau, A. N., & Fries, P. Attention samples stimuli rhythmically. Current Biology, 22, 1000-1004, 2012]. This modulation of performance, which has been observed primarily in the visual modality, also manifests in behavior and has been termed “attentional sampling.” In this study, we investigate whether sampling goes beyond vision and serves as a domain general mechanism shared by other perceptual systems. Specifically, we examined the auditory modality, in which there is contradicting evidence for endogenous sampling at similar frequencies [see VanRullen, R., Zoefel, B., & Ilhan, B. On the cyclic nature of perception in vision versus audition. Philosophical Transactions of the Royal Society of London, Series B: Biological Sciences, 369, 20130214, 2014]. In addition, we sought to investigate a putative role for visual experience in sampling in audition. To this end, sighted (n = 21), sighted blindfolded (n = 26), individuals with acquired blindness (n = 13), and individuals with congenital blindness (n = 12) detected a brief target (an intensity decrement) within an ongoing white noise stimulus. We observed 8- to 10-Hz sampling in the congenitally blind group only. We discuss this finding within the context of two possible, and even compatible, accounts. The first is that brain plasticity in the congenitally blind brings about attentional sampling in audition. It is possible that the lack of early visual experience drives the recruitment of “visual” cortices for auditory inputs, resulting in the same attentional sampling dynamics typically observed in vision, for audition. The second is that auditory sampling also exists in the sighted brain but might be obscured by visual inputs and other reflexive visual processes or might unfold at an entirely different rhythm. In fact, the acquired blind and the two sighted samples exhibited a significant low-frequency fluctuation at 2 Hz in their auditory performance. Although the study was not designed to investigate sampling at delta, this finding is consistent with a role for delta-band activity in audition as well as in temporal expectation mechanisms due to the temporal statistics of the utilized target times [e.g., Herbst, S. K., & Obleser, J. Implicit temporal predictability enhances pitch discrimination sensitivity and biases the phase of delta oscillations in auditory cortex. Neuroimage, 203, 116198, 2019; Wilsch, A., Henry, M. J., Herrmann, B., Maess, B., & Obleser, J. Slow-delta phase concentration marks improved temporal expectations based on the passage of time. Psychophysiology, 52, 910-918, 2015; Stefanics, G., Hangya, B., Hernádi, I., Winkler, I., Lakatos, P., & Ulbert, I. Phase entrainment of human delta oscillations can mediate the effects of expectation on reaction speed. Journal of Neuroscience, 30, 13578-13585, 2010]. Interestingly, delta band sampling was absent in the congenitally blind group. To further substantiate a role for delta band sampling, it would be important to design paradigms better suited to study lower frequencies in behavior, both in sighted individuals and under different degrees of visual input processing.

PMID:40294234 | DOI:10.1162/jocn_a_02339

Global Spine J. 2025 Apr 28:21925682251339621. doi: 10.1177/21925682251339621. Online ahead of print.

ABSTRACT

Study DesignRetrospective cohort study.ObjectivesThis study aims to evaluate the impact of hospital volume on postoperative outcomes following single-level cervical disc arthroplasty (CDA), focusing on non-routine discharge rates, length of stay (LOS), and hospital costs.MethodsAfter applying the appropriate exclusion criteria, the National Inpatient Sample (NIS) was queried to identify 14,315 weighted cases of patients undergoing single-level CDA between 2016 and 2020. Patients were stratified by hospital volume into low, intermediate, and high categories based on annual case numbers. Multivariate logistic regression evaluated odds of non-routine discharge and complications, while linear regression analyzed LOS and hospital costs. Models were adjusted for age, sex, and comorbidities. Statistical significance was set at P < .05.ResultsPatients in high-volume hospitals had significantly lower odds of non-routine discharge compared to both intermediate-volume (OR: 0.63, 95% CI: 0.44-0.91, P = .014) and low-volume hospitals (OR: 0.66, 95% CI: 0.45-0.98, P = .040). Patients in high-volume hospitals also incurred significantly higher costs compared to low-volume hospitals (coefficient: $1,232.22, 95% CI: $189.05-$2,275.38, P = .021), while length of stay did not differ significantly across volume categories.ConclusionsHigh-volume hospitals are associated with improved discharge outcomes, but also increased costs following single-level CDA. These findings underscore the need to disseminate high-volume center practices to lower-volume hospitals while addressing cost management. Further research should explore the impact of outpatient settings and long-term outcomes to enhance care delivery for CDA patients.

PMID:40294232 | DOI:10.1177/21925682251339621