Barnes-Jewish Hospital

Evidence supporting prehabilitation before cardiac procedures is growing, but the efficacy of different components remains unclear. The primary aim was to assess the efficacy of prehabilitation on clinical outcomes based on recent randomized controlled trials (RCTs). The secondary aim was to identify effective intervention and which patient subgroups benefit most. We searched Medline, Web of Science, PsycINFO, Embase, Scopus, and Cochrane Central Register of Controlled Trials Library for RCTs comparing prehabilitation with standard care in cardiac patients up to August 2024. Trials were screened by 2 reviewers and meta-analyses were performed using random-effects models. Forty-four RCTs including 3,925 patients were identified. Prehabilitation improved preprocedural functional capacity (6-minute walk distance) and recovery (in-hospital length of stay, intensive care unit stay, and occurrence of postprocedural pneumonia). Six trials (n = 600) showed improved 6-minute walk distance (mean difference [MD] 68.87 m; 95% CI: 12.76-124.98 m; P = 0.020). In 18 studies (n = 1,568), length of stay was shorter (MD -0.95 days; 95% CI: -1.77 to -0.13 days; P = 0.026) and meta-regression showed greater effect in studies including more women (P = 0.015). In 16 trials (n = 1,149), intensive care unit stay was reduced (MD -6.03 hours; 95% CI: -12.01 to -0.06 hours; P = 0.048). In 5 studies (n = 729), postprocedural pneumonia occurred less frequently (OR: 0.33; 95% CI: 0.15-0.72; P = 0.017). The analysis revealed substantial heterogeneity and risk of bias. Analysis of specific components showed no consistent effects. Prehabilitation before cardiac procedures may enhance preprocedural functional capacity and postprocedural recovery, particularly in women. Further multicenter studies are needed.

Loss of community dwelling status is frequent after hospitalization for traumatic injuries in older adults. Arranging placement to a skilled nursing facility or an inpatient rehabilitation facility often causes a delay in discharge after the patient is medically stable, exacerbating bed capacity issues in health systems and unnecessarily exposing patients to hospital-related complications. This study aimed to identify characteristics associated with delayed discharge and to quantify temporal trends in discharge delays at a high-volume trauma center. We retrospectively analyzed all trauma patients from 2018 to 2023 in our Level I trauma registry, excluding in-hospital mortalities. Patients living greater than 70 miles from our trauma center were excluded due to the need for long-distance transport. Patients were stratified by delayed discharge time vs discharge at medical readiness. Of 17,886 patients, 1,091 (6.1%) had a delay in discharge, waiting an average of 4.9 days after medical readiness. Patients with delayed discharge were more likely to be older (65.1 vs 53.2 years, p < 0.001), female (50.1% vs 38.8%, p < 0.001), have a higher Injury Severity Score (12.4 vs 8.6, p < 0.001), and blunt mechanism (92.7% vs 80.4%, p < 0.001). In a multivariate analysis, Medicare beneficiary status and skilled nursing facility placement remained associated with delayed discharge. The time of the week that the patient was medically ready for discharge did not significantly affect the discharge delay duration. Trauma patients with Medicare experience significant delays in discharge. Currently, an average of 5 patients await disposition in our trauma center, which has increased yearly from a low of 0.5 patients in 2018. Further investigation is needed to determine causes of increased delays, including insurance denial of inpatient rehabilitation.

High-grade astrocytoma with piloid features (HGAP) is a recently defined central nervous system (CNS) tumor, first introduced into the 2021 World Health Organization (WHO) classification. While predominantly observed in adults, pediatric cases remain rare and poorly characterized. This study aimed to review the epidemiology, clinical features, and molecular profile of pediatric HGAP. A comprehensive review of studies published from 2018 to 2025 was performed to identify methylation-confirmed HGAP cases in patients aged 18years or younger. Data extracted from studies included subject demographics, tumor location, histological features, molecular alterations, and the implemented treatment sequence. The search identified 17 pediatric cases meeting the inclusion criteria. The median age at diagnosis was 15years (range: 4-18years), and a male predilection of approximately twofold was observed. Tumors most commonly arose in the posterior fossa (56.3%). Recurrent molecular alterations included CDKN2A/B loss (75%), FGFR1 mutations or fusions (55.6%), and ATRX loss (45.5%). This review did not identify definitive clinical or histomolecular differences between pediatric and adult HGAP, underscoring the need for further comparative studies. Pediatric HGAP may represent an underrecognized diagnostic entity within the glioma spectrum, emphasizing the critical role of methylation profiling for accurate diagnosis and classification. Retrospective reclassification of histologically and molecularly ambiguous gliomas is warranted and may reveal additional cases. Larger pediatric cohorts are urgently needed to inform clinical management and refine prognostic stratification.

Abstract Background ­The use of labile, weak AmpC-inducing β-lactams (e.g., ceftriaxone (CRO), ceftazidime (CAZ), piperacillin-tazobactam (TZP)) for organisms with moderate risk of inducible AmpC production may lead to treatment failure due to AmpC overproduction. Recent guidance from the Infectious Disease Society of America and Clinical Laboratory Standards Institute state Serratia marcescens is at low risk of significant AmpC production and suggests it is reasonable to treat low-risk organisms with a labile, weak AmpC-inducing β-lactam. Prior to October 2023, S. marcescens isolates were reported as resistant to CRO, CAZ and TZP at our institution; these susceptibilities are now reported as tested.Figure 1.Inclusion-Exclusion FlowchartTable 1.Baseline Characteristics Methods This study evaluated safety, effectiveness, and antibiotic utilization before and after this change in susceptibility reporting. The primary outcome was AmpC stable β-lactam (cefepime or carbapenem) inpatient days of therapy (DOT). This pre-test (October 2022–September 2023), post-test (October 2023–September 2024) quasi-experiment included inpatients at Barnes-Jewish and St. Louis Children’s Hospitals with first-positive S. marcescens culture and at least 48 hours of antibiotic therapy. Exclusions included concomitant Gram-negative infections resistant to CRO, CAZ, or TZP, ocular cultures, and death prior to susceptibility results.Table 2.Days of Gram-Negative Antimicrobial TherapyTable 3.Clinical and Microbiological Outcomes Results A total of 268 patients were screened and 166 patients were included (Figure 1). Baseline characteristics including age, ICU status, immunocompromised status, and no or incomplete source control were well balanced between groups (Table 1). The most common infection source was pneumonia (30%). The median total DOT for AmpC stable β-lactams was 8 in the pre-group vs 5 in the post-group (P &amp;lt; 0.001) (Table 2). In patients treated with ≥ 3 days of AmpC labile β-lactams who had repeat cultures, there was no emergence of resistance (0/26). No statistically significant differences in clinical outcomes were observed (Table 3). Conclusion In conclusion, a change in susceptibility reporting for S. marcescens was associated with a decrease in AmpC stable β-lactam use, with no significant changes in microbiological or clinical outcomes. Disclosures Christine R. Lockowitz, PharmD, BCIDP, AbbVie: Grant/Research Support|Premier Inc.: Honoraria Tamara Krekel, PharmD, BCPS, BCIDP, AbbVie: Advisor/Consultant|AbbVie: Honoraria|Shionogi: Advisor/Consultant|Shionogi: Honoraria David J. Ritchie, PharmD, BCPS (AQ-ID), Shionogi: Honoraria Rebekah Dumm, PhD D(ABMM), BD: Advisor/Consultant|BD: Grant/Research Support|Biomerieux: Advisor/Consultant|Biomerieux: Grant/Research Support|Diasorin: Grant/Research Support|Pattern Biosciences: Grant/Research Support|Qiagen: Grant/Research Support|Roche Diagnostics: Advisor/Consultant|Shionogi: Advisor/Consultant

BackgroundIdentifying significantly mutated genes in tumors aids in understanding disease etiology and survival and may aid in the discovery of new drug targets. We aimed to detect and characterize mutated genes from a large, well-characterized group of colorectal cancers.MethodsIn tumor and paired normal samples from 6,111 colorectal patients, we sequenced 199 genes identified from whole exome sequencing of over 1,100 tumors. Analyses focused on non-silent mutations. We classified significantly mutated genes after stratification by hypermutation status, and estimated associations of mutated genes/pathways with disease-specific (DS)-survival using Cox regression, adjusting for age, sex, mutation burden, hypermutation status, and study while accounting for multiple comparisons (n = 4,874).ResultsWe identified 57 genes that were significantly mutated in colorectal cancer, including 9 that were not previously reported. Among individual genes, only BRAF p.V600E mutations were significantly associated with poorer survival after correction for multiple testing (HR 1.96, P = 2.07 × 10− 10), with a more pronounced association among those with non-hypermutated tumors (HR 2.24, P = 1.79 × 10− 12). We also observed statistically significant associations with survival for four mutated pathways: TP53/ATM (HR 1.24, P = 7.96 × 10− 4), RTK/RAS (HR 1.33, P = 3.81 × 10− 6), TGF-beta (HR 1.25, P = 1.85 × 10− 3), and WNT (HR 0.81, P = 2.52 × 10− 03).ConclusionsWe identified 9 significantly mutated genes, some of which are known drug targets. Among individual genes, only the BRAF p.V600E mutation was significantly associated with DS-survival, suggesting a limited survival impact from mutations driving colorectal cancer development.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12885-025-15440-x.