Beebe Healthcare

Colorectal cancer with peritoneal metastases (PM) presents a significant therapeutic challenge. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is one option to prolong survival. While completeness of cytoreduction (CC) score 0 is associated with improved outcomes, the clinical value of near-complete CC-score 1 versus open-close laparotomy (CC-3) remains unclear. This retrospective study evaluates overall survival (OS) in patients with colorectal cancer PM scheduled for CRS and HIPEC from 23 global peritoneal-surface oncology centers from 2006 to 2023. A propensity score matching was performed using tumor location (colon/rectum), lymph node status, liver metastases, signet-ring histology, preoperative chemotherapy, peritoneal cancer index, and treatment year. Matching was performed using the nearest neighbor method with a caliper of 0.1, chosen after several iterations to optimize intergroup balance. Balance was assessed using standardized mean differences. Sensitivity analyses with alternative calipers and multivariable Cox regression in the unmatched cohort were considered to test the robustness of the findings. The study time-period was divided into 4 equal quartiles for analysis. In the unmatched cohort (n=284), patients with CC-1 had significantly longer median OS compared to those with CC-3 (22.2 vs. 9.4 months, p<0.001). After 1:1 matching (n=172), the OS advantage of CC-1 persisted, with a median OS of 18.9 months (95% CI: 14.2-24.7) versus 10.5 months (95% CI: 9.4-12.3) for CC-3, p<0.0001, HR 0.4 (95% CI:0.27-0.56). Multivariable Cox regression confirmed CC-1 as a significant predictor of survival (HR: 0.15, 95% CI: 0.08-0.26). The CC-1 proportion went from 55 to 65% in time-periods 1 & 2-39% in period 3, to 11% in period 4; leading to significantly reduced survival rates in the latter time-periods 3 & 4. Near complete cytoreduction is associated with improved overall survival compared to open-close laparotomy. Prospective or standardized multicenter analyses will be required to confirm the clinical value of a near complete cytoreduction.

Background: Inflammatory bowel disease (IBD) represents a growing health challenge in regions undergoing socioeconomic transition. This study characterized IBD epidemiology across Gulf Cooperation Council (GCC) countries, forecasted future burden, and identified country-specific determinants to inform targeted health policy interventions. Methods: IBD data from the Global Burden of Disease study (1990–2021) were analyzed for all six GCC countries using descriptive epidemiology, temporal trend analysis, three forecasting models (Age-Period-Cohort, Joinpoint regression, Bayesian age-standardized rate modeling), and regression analyses to identify socioeconomic, environmental, gender-specific, and healthcare system factors associated with IBD burden variation. Results: Age-standardized IBD prevalence rates varied across GCC countries (28.92–42.93 per 100,000), with Qatar and the United Arab Emirates (UAE) showing the highest rates and fastest increases (967% and 898% since 1990). Kuwait uniquely demonstrated stable or slightly declining trends. Significant female predominance emerged in most countries (male ratio 0.70–0.91) with strong birth cohort effects (1970s cohorts showing 18–48% higher risk than 1950s cohorts). IBD manifested primarily as disability rather than a mortality burden. Projections indicate continued increases through 2030, potentially reaching 55–59 per 100,000 in Qatar and the UAE. Fast food outlet density, processed food imports, antibiotic consumption, and female vitamin D deficiency were the most significant modifiable risk factors. Conclusions: The GCC region faces a growing IBD epidemiological profile characterized by rising burden, female predominance, and generational differences in risk observations. Identification of modifiable determinants provides actionable targets for intervention, while country-specific projections offer a foundation for healthcare planning to address this challenge.

There is limited published information on outcome adjudication in heart failure (HF) trials, particularly in heart failure with preserved ejection fraction (HFpEF). The study sought to compare investigator reports with clinical events committee (CEC) adjudication and assess the impact of the SCTI (Standardized Data Collection for Cardiovascular Trials) criteria. In the EMPEROR-Preserved (EMPagliflozin outcome tRial in Patients with chronic heart Failure With Preserved Ejection Fraction) trial, we compared investigator reports with CEC for concordance, treatment effect on primary composite outcome events and components (first event primary heart failure hospitalization [HHF] or cardiovascular [CV] mortality), prognosis after first HHF, total HHF, and trial duration with and without SCTI criteria. The CEC confirmed 67.4% investigator-reported events for the primary outcome (CV mortality 82.7%, HHF 66.3%). The HR for treatment effect did not differ between adjudication methods for the primary outcome: investigator reports (HR: 0.77; 95%CI: 0.69-0.87), CEC (HR: 0.79; 95%CI: 0.69-0.90), its components, or total HHFs. The prognosis after the first HHF for all-cause mortality and CV mortality also did not differ between investigator reports and the CEC, nor did investigator reports and HHFs with a different CEC cause. SCTI criteria were present in 92% of CEC HHFs with a similar treatment effect to non-SCTI criteria. The investigator-reported primary events reached the protocol target number 6months earlier than the CEC (7months with full SCTI criteria). Investigator adjudication is an alternative to a CEC with similar accuracy and faster event accumulation in HFpEF. The use of granular (SCTI) criteria did not improve trial performance. Our data suggest that a broader definition of an HHF event could be particularly beneficial in HFpEF clinical trials. (EMPagliflozin outcome tRial in Patients with chronic heart Failure With Preserved Ejection Fraction; NCT03057951).

Background: Heart transplantation remains definitive therapy for children with heart failure, but the burden of acute graft rejection remains. While adult data has shown cardiac magnetic resonance (CMR) offers reliable, non-invasive identification of graft rejection1-3, endo-myocardial biopsy (EMB) continues to be the gold-standard in children. Hypothesis: CMR can establish the presence/absence of rejection, guiding need for EMB and rejection therapy. Aims: To assess the (1) strength of CMR parametric mapping in discriminating presence of rejection (defined as need for new therapy), and (2) the ability of CMR to identify patients without rejection, negating the need for EMB. Methods: Pediatric heart transplant patients referred for EMB underwent concurrent noncontrast CMR with volumetry, flows, MOLLI T1 and T2 parametric mapping at 1.5T. Average and peak segmental native T1 and T2 were measured in 6 slices, and regions of sub-segmental ‘hotspot’ elevation (3 continuous voxels T1&gt;1050 ms or T2&gt;60 ms) were identified. Rejection treatment was per institutional protocol, blinded to CMR results, categorized as (A)new IV therapy, (B)oral augmentation of maintenance, or (C) no change. Sensitivity, specificity and ROC analyses were performed. Results: 95 encounters in 34 patients (median age 13.1y (IQR 7.5-16.3), BSA 1.37 m2 (1.1-1.6), 47% female) were completed, with treatment groups A 13%, B 5%, and C 82%. Significantly higher T1 and T2 values were found in the rejection groups. ROC curve analysis identified elevated peak T1 levels as the strongest predictor of rejection (AUC = 0.848, 95% CI: 0.746, 0.950, p&lt;0.001), with optimal cutoff T1 &gt;1099 ms. Subsegmental hotspots were present in all encounters with rejection requiring new therapy (100% sensitivity), however the type/ number of hotspots did not correlate with rejection. New rejection therapy was not initiated in any patient encounter without hotspots (NPV 100%). Conclusions: Elevated segmental T1 CMR values can identify children with graft rejection, and absence of subsegmental hotspot elevations can reliably identify patients without rejection. CMR is a promising non-invasive test to aid in graft surveillance and direct invasive testing and therapy.

Proces poznania społecznego oraz zachowania interpersonalne są ze sobą nierozerwalnie związane i obejmują wszystkie obszary życia społecznego, m.in. edukację, co przybliżam w niniejszym artykule. Poznanie społeczne, dotyczące sposobu, w jaki ludzie myślą o sobie oraz o otaczającym świecie społecznym, jest procesem odgrywającym niezwykle istotną rolę w życiu każdego człowieka. Umożliwia nabywanie wiedzy i doświadczenia, a także orientację w codziennej rzeczywistości. Jest konieczny do formułowania sądów oraz podejmowania decyzji, będących warunkiem skutecznego działania. Wiedza o prawidłowościach kierujących poznaniem społecznym jest ważna w pracy wychowawczej, która opiera się na relacjach.

The use of fentanyl and its analogs is the primary driver of deaths related to the opioid overdose crisis. In fall 2021, the U.S. Drug Enforcement Administration issued its first public safety alert in 6 years to raise awareness of the escalating prevalence of fentanyl in counterfeit pills and in other opioids, such as heroin, and nonopioids, such as methamphetamine. In addition to increased public awareness, specific actions are needed to remediate the risk for fentanyl overdose. The authors endorse four principles to address the opioid overdose crisis and provide guidance for remediating its impacts: an incremental approach to behavior change or harm reduction; engagement strategies for individuals with substance use disorder; an integrated care approach to ensure better access to treatment programs and effective interventions; and vigilance among clinicians, program staff, and patients to the threat of fentanyl-adulterated drugs. The authors offer specific recommendations on how to apply these principles effectively within health care systems, communities, and law enforcement agencies across the United States.