Citations

Summary CD19 chimeric antigen receptor T‐cell (CAR‐T) therapy is a pivotal part of the treatment algorithm for large B‐cell lymphoma (LBCL) in the second‐ and third‐line settings based on numerous clinical trials. However, these studies included very few patients with a diagnosis of high‐grade B‐cell lymphoma, not otherwise specified (HGBCL‐NOS) and it is unclear if outcomes are similar to those observed with more common LBCL histologies. Using the Center for International Blood and Marrow Transplant Research (CIBMTR) registry, we identified 111 HGBCL‐NOS patients who received CAR‐T therapy. The cytokine release syndrome (CRS) rate was 74% (7.7% grade 3+), median onset was 4 days (1–17) and immune effector cell‐associated neurotoxicity syndrome rate was 45.2% (22.6% grade 3+), median onset was 7 days (1–17). At 2 years post‐CAR‐T infusion, the probability of overall survival and progression‐free survival were 41.6% and 28.7% respectively. The 2‐year non‐relapse mortality and relapse/progression were 3.1% (95% confidence interval [CI]: 0.6–7.6) and 68.1% (95% CI: 57.9–77.6) respectively. Our analysis illustrates that patients with HGBCL‐NOS represent a particularly difficult group to treat, even with CAR‐T therapy. We observed that one third of patients achieved a durable response; however, the overall results were less favourable, with lower overall response rate, overall survival and progression‐free survival as compared to published reports on LBCL.

ABSTRACT Determining an appropriate sample size in human cadaveric studies remains a long‐standing and unresolved challenge. Unlike other basic science fields, anatomical research is constrained by factors such as limited human donor availability, cultural considerations, and ethical restrictions. Despite these limitations, researchers are often asked to justify sample sizes, yet no standardized guidelines currently exist. To quantitatively assess sample sizes in recent human cadaveric studies and propose evidence‐based recommendations for future research, a PubMed search was conducted on February 26, 2024, using the term human cadaveric study . The articles published in 2023 and 2024 were screened, yielding 770 eligible studies. Data extracted included the total sample size, number of classified groups, and journal impact factor (IF). Descriptive statistics, linear regression, and correlation analyses were performed. Continuous variables were summarized using medians and interquartile ranges (IQR). The median sample size was 11.5 (IQR: 7–20), and 47.9% of studies used 10 or fewer specimens. The median number of classified groups was 3 (IQR: 2–4). Linear regression showed that studies dividing specimens into 2–6 groups often failed to meet the recommended sample size per group based on regression modeling. No significant correlation was found between sample size and journal IF ( r = −0.062, p = 0.115). Most cadaveric studies rely on small sample sizes due to inherent constraints, yet many still attempt a subgroup analysis without sufficient statistical power. Although flexibility is essential in anatomical research, we recommend a minimum total sample size of 10 for basic studies and at least five samples per group for those involving classification. Cadaveric sample size alone does not predict journal impact, highlighting the importance of methodological rigor over quantity.

ResumenSi bien el papel del complejos volar escafolunar en la estabilidad de la muñeca es cada vez más reconocido la literatura sobre sus técnicas de reparación y resultados sigue siendo limitada. Este artículo ofrece una visión general completa de la anatomía la biomecánica y la importancia clínica del complejo escafolunar volar junto con las técnicas de reparación artroscópica más actualizadas. Al presentar los avances y los desafíos de estos abordajes mínimamente invasivos buscamos fomentar la investigación y el desarrollo para abordar este aspecto aunque poco reconocido crucial de la inestabilidad escafolunar.

Abstract Background In the context of competency-based medical education, more research is needed to define point-of-care ultrasound (POCUS) competency and validate learner assessment. To address noted gaps in the currently validated assessment instruments, we developed the Observed Structured POCUS Readiness Examination (OSPRE). The purpose of this study is to demonstrate evidence of validity and reliability of the OSPRE in Physician Assistant (PA) students. Methods A prospective cohort study was designed to demonstrate evidence of validity and reliability for the OSPRE instrument at one PA program. Students completed a hands-on skills assessment utilizing a simulated patient scenario involving a traumatic injury. Student performance was assessed in real time by one reviewer and asynchronously by a second reviewer blinded to the scoring of the initial reviewer. Inter-rater reliability was calculated for overall score and for each criterion of the OSPRE. Results Intraclass correlation coefficient for the final percentage score between the independent reviewers utilizing the OSPRE instrument was noted to be 0.86 (95% CI 0.56–0.95, p < 0.001), demonstrating overall good reliability. Level of agreement for inter-rater reliability for the specific individual criterion ranged between fair and substantial. Conclusion The OSPRE instrument provides a valid and reliable assessment of POCUS skills in PA students. When compared to previously validated assessment instruments, scores on the OSPRE had a wider range, suggesting that the OSPRE might have a greater discriminatory value for POCUS skillset.

Background: EUS-guided gastroenterostomy (EUS-GE) is an effective option for the management of gastric outlet obstruction (GOO). Due to the poor prognosis of patients undergoing it, data on its long-term adverse events (AE) is scarce. Herein, we describe a cohort of patients with gastro-entero-colic fistula (GECF) as a late AE of previously successful EUS-GE. Methods: Patients who developed a GECF after EUS-GE from 10 high-volume centers were analyzed. Information collected included demographic characteristics, indications, clinical and technical success rates, stent type and size, fistula characteristics, management, and outcomes. Results: Sixteen cases were identified. The mean interval from index EUS-GE to the diagnosis of GECF was 4 to 8 weeks. The most common cause of GOO was pancreatic adenocarcinoma (PDAC). The transverse colon was the most common site for the GECF (14 patients). A 20×10 mm lumen apposing metal stent (LAMS) was utilized in 10 patients. Endoscopic management with a variety of modalities was successful in 13 cases. Follow-up interval after endoscopic management of the fistula averaged 2 to 4 weeks. At the time of the manuscript elaboration, 10 patients had died, 5 were alive, and 1 was lost to follow-up. Conclusions: This is the first description of a cohort of patients with GECF after EUS-GE. The exact mechanisms leading to GECF in these cases are unknown. Possible explanations include inadvertent colon puncture during the index procedure and/or entrapment of mesocolon. More data is needed to further characterize this AE.

ImportanceCancer imposes a substantial economic burden on patients that may be worse in patients with higher-stage disease due to the need for more therapy.ObjectiveTo investigate the out-of-pocket costs (OOPCs) attributable to the initial treatment of common cancers among privately insured individuals diagnosed at different stages.Design, Setting, and ParticipantsThis retrospective cohort study used administrative claims data of a large national insurer in the US linked to the Surveillance, Epidemiology, and End Results (SEER) cancer registry to compare OOPCs of individuals diagnosed with breast, colorectal, and lung cancer at different stages with OOPCs of similar individuals without cancer using difference-in-differences methods. Individuals living in the US between 2008 and 2022, aged younger than 65 years, insured through a large national private health insurer, and with 6 or more months of continuous enrollment were included. Data were analyzed from June 2024 through February 2025.ExposureThe presence or absence of an incident cancer diagnosis and disease stage from the SEER registry diagnosed from 2008 to 2019.Main Outcomes and MeasuresThe primary outcome was OOPCs among individuals with breast, colorectal, and lung cancer diagnosed at different disease stages compared with those with no cancer diagnosis.ResultsThe cohort consisted of 46 158 patients (mean [SD] age at diagnosis, 46 [12] years; 30 733 female [66.6%]; 2543 Asian [5.5%], 4114 Black [8.9%], 3590 Hispanic [7.8%], and 31 099 White [67.4%]), including 19 656 patients with cancer and 26 502 patients without cancer in the control group. Among patients with cancer, 14 581 patients had breast cancer, 2842 patients had colorectal cancer, and 2233 patients had lung cancer. An incident cancer diagnosis was associated with a mean increase in OOPCs of $592.53 per month (95% CI, $528.01-$627.04 per month) for the 6 months after the diagnosis. Cost monotonically increased with stage at diagnosis (mean OOPC increase range, $462.01 per month [95% CI, $417.92-$506.11 per month] for stage 0 to $719.97 per month [95% CI, $626.11-$813.83 per month] for stage 4).Conclusions and RelevanceIn this study of individuals with private insurance, patients faced high OOPCs after an incident diagnosis of cancer, with patients with more advanced cancer having the highest OOPCs. Further research is needed to determine the clinical and financial effects of increased OOPCs for patients with cancer.

Background and Goals: Ulcerative colitis (UC) readmissions to the hospital pose a burden to patients and health care systems. Preventing readmissions is important for the quality of care and quality of life of patients with UC. We aimed to identify the incidence of 30 and 90-day readmissions and its predictors in patients with UC. Study: Retrospective review of the 2018 National Readmission Database (NRD) of adult patients readmitted after an index admission (IA) of UC. ICD-10CM/PCS codes were used to identify patients with UC, other comorbidities, and procedures. We identified the most common causes for readmission and independent risk factors for readmission were identified using Cox regression analysis. Results: The 30 and 90-day readmission rates for UC in 2018 were 16.6% and 28.3%. In-hospital mortality and mean length of stay were higher in patients readmitted within both 30 and 90 days. Independent predictors of 30-day readmission were higher Charlson Comorbidity Index (CCI), undergoing ileostomy, increasing length of stay, malnutrition and opioid use disorder at IA. In the 90-day readmission cohort, independent predictors were CCI score of 2 or ≥3, developing shock, admission to large bed size hospitals, undergoing colectomy, increasing length of stay and opioid use disorder at IA. The number one readmission cause at 30 and 90 days was sepsis of unspecified organism. Conclusion: Readmission is associated with higher mortality and is associated with risk factors such as malnutrition, undergoing ileostomy during IA and opioid use disorder. Readmissions in UC continue to pose a high burden to patients and our health care system.