Citations

Abstract Background Spinal cord stimulation (SCS) is an important modality for treating chronic pain in patients who have failed conservative therapy and a substantial portion of the population rely on fee-for-service Medicare or Medicaid for coverage. We aimed to determine physician professional fee reimbursement rates and the ratio of Medicaid to Medicare professional fee reimbursement (MMI) for three common Current Procedural Terminology (CPT) codes related to SCS therapy (63650, 63685, and 63655) across states. Secondarily, we explored trends in utilization and reimbursement of these procedures by Medicare at the national level between 2013 and 2023. Methods Medicaid professional fee reimbursement data were extracted from publicly available fee schedules where available for individual states, while Medicare reimbursement data were extracted from the Centers for Medicare and Medicaid Services (CMS) Physician Fee Schedule. Baseline and wage-adjusted MMI values were calculated for each state. Results Medicaid reimbursed 11.5–21.0% less than Medicare across the evaluated CPT codes after wage adjustment, with differences of 11.8% for CPT 63650 (facility), 18.0% for CPT 63650 (non-facility), 11.5% for CPT 63685 (facility), and 21.0% for CPT 63655 (facility). Medicaid MMI values ranged from 0.397–1.87 across codes and settings. State-level Medicaid professional fee reimbursement varied substantially, ranging from $194.52–$639.38 for CPT 63650 (facility), $978.72–$2,781.65 for CPT 63650 (non-facility), $160.82–$558.00 for CPT 63685 (facility), and $375.97–$1,045.15 for CPT 63655 (facility); Medicare reimbursement was substantially less variable. From 2013–2023, Medicare utilization, rendering providers, beneficiaries, and standardized payments generally increased, although trends varied by CPT code and site of service. Conclusions Medicare physician professional fee reimbursement largely exceeds Medicaid physician professional fee reimbursement for three of the most common SCS procedural codes, suggesting potential access barriers to chronic pain procedures. Medicaid reimbursement shows considerable variation across states and among procedural codes, suggesting substantial interstate heterogeneity in Medicaid rate-setting that may reflect differences in state policy priorities or other factors not analyzed in this study.

Purpose To evaluate the association between myocardial infarction (MI) timing within 2 years prior to arthroscopic rotator cuff repair (aRCR) and postoperative cardiac, medical, and surgical complications. Methods The PearlDiver Mariner Database (2010‐2022) was queried to identify patients undergoing aRCR (CPT‐29827). Patients with an MI within 2 years before surgery were propensity matched 1:4 to controls without MI based on demographics and comorbidities. Subgroup analyses evaluated MI timing (0‐6, 6‐12, 12‐18, and 18‐24 months), MI type (type 1 vs type 2, ST‐elevation MI vs non‐ST‐elevation MI), percutaneous coronary intervention (PCI) status, guideline‐directed medical therapy, and infarct location. Primary outcomes included 90‐day medical and 2‐year surgical complications. Odds ratios with 95% confidence intervals were calculated. Results A total of 2886 patients with prior MI were matched to 10,613 controls. Prior MI increased the odds of postoperative MI (odds ratio, 3.48; 95% confidence interval, 2.13, 8.32). The highest risk of postoperative MI occurred when aRCR was performed within 6 months of MI (odds ratio, 7.55; 95% confidence interval, 4.38, 13.01), with no significant elevation beyond this window. Type 1 MI was associated with postoperative MI and mortality, whereas type 2 MI was associated with acute kidney injury, pneumonia, and readmission. Both ST‐elevation MI and non‐ST‐elevation MI were linked to increased postoperative MI risk. Patients without PCI showed broader postoperative complications, including mortality, acute kidney injury, and stiffness, compared with those who underwent PCI. Conclusions Recent MI is associated with increased postoperative risk of MI after aRCR, particularly when surgery is performed within 6 months. Patients without PCI experience additional vulnerability. Level of Evidence Level III, retrospective comparative study.

Abstract Topic Benign Disease: Other Background Lichen planus is a chronic immune-mediated skin disease that may involve the esophagus. Esophageal lichen planus (ELP) is considered rare, but likely underdiagnosed. Lack of published guidelines for ELP results in significant treatment variability. Given heterogeneous practice patterns and emerging treatments, further outcome data are needed. Methods A retrospective cohort of ELP patients was assembled from 3 academic centers. Patients ≥ 18 years old were identified by ICD10 code search (L43.8) in the electronic health record, from 2006 to 2025. Patients were included if they had initial endoscopy, histology, and follow-up endoscopy showing features of LP, and excluded if there was diagnostic uncertainty, unavailable procedural documentation, or other esophageal diseases. Endoscopic findings were assessed qualitatively by manual review of reports. Data abstracted included demographics, presenting symptoms, endoscopic/histologic findings, treatment, and clinical outcomes. Statistical analysis was performed in R. Results 193 patients met inclusion criteria. Mean age at index endoscopy was 65 years, 86% were female, 98% were non-Hispanic Caucasian, 39% were ever smokers, and mean BMI was 26. Dysphagia was the most common presenting symptom (90%). Strictures were common (73%), 58% underwent dilation during initial endoscopy. Endoscopic findings included presence of sloughing (20%), exudate (22%) and friability (23%). Histology showed lymphocytic infiltrate (47%), parakeratosis/dyskeratosis (42%) and Civatte bodies (17%). Topical steroids (71%) and PPIs (63%) were used most frequently for treatment. Immunosuppressives (tacrolimus, systemic steroids, mycophenolate, methotrexate, hydroxychloroquine, cyclosporine, azathioprine, JAK inhibitor) were used in 54% of patients. Endoscopic improvement was seen in 66%, with highest response rates in tacrolimus (100%), hydroxychloroquine (100%), and a JAK inhibitor (100%). Symptom improvement was seen in 63%, with the greatest benefit seen in patients treated with a JAK inhibitor (100%) and hydroxychloroquine (86%). Conclusion In this large, multisite cohort, ELP demonstrated significant morbidity, with high rates of dysphagia, strictures, and inflammatory changes. Dilation appeared to be safe, with only a single iatrogenic perforation identified. Esophageal squamous cell cancer risk was low but present, at 4%. Despite heterogeneous treatment practices, several therapies – tacrolimus, hydroxychloroquine, and JAK inhibitors – were associated with marked endoscopic and symptomatic improvement. Prospective studies are needed to clarify the optimal approach to pharmacological management of ELP.

Abstract Purpose Validate the semiquantitative (SQ)-MRI score for chronic pancreatitis (CP) diagnosis in an independent, multicenter cohort. Methods We analyzed MRIs performed at baseline in 337 participants with acute (AP) or recurrent AP (RAP) and 67 with non-calcific chronic pancreatitis (NCCP) enrolled in the PROCEED study from 6/2017 to 3/2023. MRIs were performed at multiple clinical centers using site-specific clinical protocols and a variety of MRI vendors to evaluate the SQ-MRI score in a real-world setting. The SQ-MRI score was calculated using the T1 signal intensity ratio of the pancreas to the spleen (T1 score), arteriovenous enhancement ratio (AVR), and pancreatic body diameter (PBD). We adjusted for confounding by participant characteristics via propensity score weighting. Results Median AVR was higher in AP/RAP (1.18, IQR: 0.97–1.44) than in the NCCP group (1.03, IQR: 0.78–1.22, p = 0.007). Pancreatic body diameters were larger in AP/RAP than in the NCCP group − 7–14 mm (10% vs 25%), 14–20 mm (40% vs 54%), and > 20 mm (50% vs 21%), respectively ( p < 0.01). Median T1 score was higher in AP/RAP (1.18, IQR: 0.96–1.40) than in the NCCP group (1.04, IQR: 0.86–1.32, p = 0.10). Median SQ-MRI score in the AP/RAP group was significantly lower, 1.91 (IQR: 0.97, 2.95), than in the NCCP group, 2.74 (IQR: 2.04–4.03) ( p < 0.001). The propensity score-adjusted AUC for SQ-MRI to distinguish AP/RAP from NCCP was 0.64, which was higher than for individual parameters. Conclusion We have validated the SQ-MRI score in a multicenter cohort using an independent, real-world MRI dataset.

This study examines the patient- and hospital-level variation in time to initiation of inpatient management among patients admitted to general medical services.

Lay Summary Glioblastoma is an aggressive brain cancer, and it can be difficult to tell whether changes seen on scans after radiation treatment represent tumor growth or treatment-related effects. The authors of this study wanted to evaluate whether a specialized imaging test called PSMA PET could help define tumor boundaries for radiation planning and distinguish tumor progression from treatment-related changes. To do this, they performed PSMA PET scans in 27 patients with high-grade gliomas, including patients undergoing radiation planning and patients being evaluated for possible tumor recurrence. They found that tumors showed higher PSMA PET signal than surrounding tissue, that PSMA PET sometimes identified tumor beyond what was visible on standard MRI, and that it correctly distinguished tumor progression from treatment-related changes in most patients.

Abstract Colorectal cancer develops through a normal-adenoma-carcinoma sequence, yet only 5-10% of adenomas progress to malignancy, and the cellular programs governing that sequence remain poorly defined. Here we generate a spatial multi-omics atlas of human colon adenomas, combining Visium CytAssist and protein co-detection across 24 nonadvanced and advanced tubular adenomas with single-cell resolution Xenium Prime 5K profiling of 101 patient-matched normal, adenoma, and carcinoma cores from 16 patients. Integrating whole-transcriptome and 31-plex protein data identifies nine spatial clusters and two dysplastic epithelial populations that co-express stemness, proliferation, and senescence programs. These programs occupy a shared, spatially confined epithelial niche that expands from adenoma to carcinoma. Spatial analysis revealed GDF15, a senescence-associated secretory factor, mediated the coupling between senescence and stemness in advanced adenomas, and that GDF15-high epithelium locally excludes CD8+ T cells in adenoma and, more broadly, in carcinoma. These findings position senescence as a spatially instructive rather than merely tumor-suppressive program during colorectal carcinogenesis and suggest GDF15 might be a potential candidate target for cancer prevention and interception in the colon.

Background Randomized trials have shown equivocal outcomes between a direct aspiration as first-pass technique (ADAPT) and stent retriever (SR) stroke thrombectomy, yet whether specific patient subgroups benefit differentially from one technique over the other remains unknown. Methods In this retrospective multicenter cohort study, patients with large vessel occlusion were included, and those who underwent ADAPT versus SR first-pass thrombectomy (either as standalone or combined with aspiration) were compared. The primary outcome was a composite of first-pass effect (FPE, modified Thrombolysis In Cerebral Infarction (mTICI) 2c or better with one attempt) with no symptomatic intracranial hemorrhage (sICH). A causal forest model was used to estimate the conditional average treatment effect (CATE) for each patient, with larger CATEs indicating that ADAPT is expected to be more advantageous. Patients were stratified by CATEs, and outcomes were compared between treatment groups. Results Among 6700 included patients, ADAPT (n=3695, 55%) was associated with a higher rate of FPE with no sICH (39.9% vs 26.9%; adjusted OR (aOR) 2.07, 95% CI 1.77 to 2.41, P<0.001). The causal forest identified significant treatment effect heterogeneity (interaction P<0.001), where ADAPT was more advantageous in more recent years and among patients with M1 occlusions presenting in earlier time windows. Low-CATE patients showed no statistically significant difference between techniques (aOR 0.91, 95% CI 0.57 to 1.45, P=0.70), while medium- and high-CATE patients demonstrated progressively larger ADAPT advantages (aOR 2.06, 95% CI 1.67 to 2.55, and aOR 2.99, 95% CI 2.24 to 3.98, respectively, both P<0.001). Conclusions ADAPT may be superior to SR for a majority of patients, particularly in recent years, and among patients with M1 occlusions presenting in earlier time windows.

ABSTRACT In 567 PH‐COPD patients from the PVRI GoDeep Meta‐Registry, ACE inhibitor use was associated with improved survival only in severe PH (PVR > 5 WU), supporting prospective trials targeting this high‐risk subgroup.

Primary enlargement of the cerebrospinal fluid (CSF)–filled brain ventricles, known as congenital cerebral ventriculomegaly (CCV), is a hallmark of congenital hydrocephalus. CCV is also enigmatically but frequently associated with autism and other neurodevelopmental disorders. To gain insight into the developmental genetic regulation of the human CSF-ventricular system, we conducted an integrated, multiomic study of about 2700 trio-based exomes from patients with primary CCV. We found that about 25% of cases were associated with rare, damaging de novo variants in mutation-intolerant genes, many of which are linked to other dominant Mendelian disorders. Thirty-five exome-wide significant CCV genes and dozens of other high-confidence CCV genes converged on pathways involved in ATP-dependent Brahma-related gene 1/Brahma-associated factor chromatin remodeling, histone H3 lysine 4 methylation, and phosphoinositide 3-kinase signaling. Knockout of selected CCV genes in mouse models supported that de novo variants in CCV genes caused ventriculomegaly by impairing both CSF dynamics and cortical cytoarchitecture through dysregulation of neuroprogenitor cell growth and maturation in the ventricular and subventricular zones. These findings indicated that genetic and epigenetic programs coordinate the “hand-in-glove” development of the CSF-ventricular system with that of the cerebral cortex and establish a genetic connection between CCV and neurodevelopmental disorders, potentially explaining why some patients with hydrocephalus continue to exhibit CCV and neurodevelopmental disorders despite CSF shunting. We suggest that combined brain imaging and whole-exome sequencing could enable early detection of, and intervention for, autism and other neurodevelopmental disorders.