George Washington University Hospital

Purpose: Kidney cancer mortality in the United States exhibits persistent racial, ethnic, and geographic disparities, yet regional patterning of these disparities over time remains incompletely characterized. We conducted a retrospective analysis using national mortality data to examine differences in kidney cancer mortality between U.S. Mexico border and non-border regions from 2000 through 2020.Materials and Methods: Death records were obtained from CDC WONDER, and kidney cancer deaths were identified using ICD 10 code C64 as the underlying cause of death. We evaluated C64 to C65 in sensitivity analyses, including C65 separately. We compared demographics, age adjusted mortality rates, and temporal trends by border residence. Multivariable logistic regression assessed demographic patterning of deaths across regions, and Joinpoint regression evaluated changes in age adjusted mortality trends over time.Results: A total of 279,117 kidney cancer related deaths were recorded nationally. Hispanic decedents were disproportionately represented among border state deaths (22.9% vs 2.8% in non-border states). Border states accounted for 67.4% of Hispanic C64 deaths. Age distribution and racial composition of decedents differed between border and non-border regions (all p<0.001). In multivariable analyses, Hispanic ethnicity was strongly associated with border state residence among decedents, independent of age and race. Joinpoint regression identified multiple periods of change in mortality trends, with statistically significant increases in non-border regions and less precise segment estimates in border regions.Conclusion: Kidney cancer deaths among Hispanic decedents show substantial geographic concentration in U.S. Mexico border states. These findings support surveillance strategies and interventions that incorporate geographic context in efforts to reduce kidney cancer mortality disparities.

Pediatric mental health prevalence rates have increased in recent years, while gaps remain in the number of available providers. Ongoing evaluation and understanding of treatment progress and engagement are critical to psychiatric care, and these details are often documented in the electronic health record (EHR). Given the utility of retrospective chart review (RCR) as a tool for psychiatrists, we developed a coding system examining common comorbid conditions (anxiety and attention-deficit/hyperactivity disorder [ADHD]) and adherence and evaluated interrater reliability. We created a coding system with a comprehensive manual and coding instructions that explore both symptom severity domains (anxiety, ADHD, and global) and adherence to medication. Codes were rated using Likert scales, and two independent raters coded all data. RCR was completed for 142 patients with a total of 1139 visits over 2 years. Weighted linear kappa statistics ranged between 0.77 and 0.95, and weighted quadratic kappa statistics ranged between 0.74 and 0.96, suggesting substantial to almost perfect agreement. Interrater agreement was highest for anxiety severity. We created a novel coding system for RCR and found substantial to almost perfect interrater reliability for assessing ADHD severity, anxiety severity, global severity, and medication adherence using psychiatry encounter notes documented in an EHR. Our coding system explores conditions that are often heterogeneous and have waxing and waning presentations, using a continuum that captures the complexity of symptoms. Future directions include utilization of coding systems to explore emotion and behavior change over time to optimize treatment.

Endotoxic septic shock, a subset of septic shock with high endotoxin activity and multiorgan failure, is associated with high risk of death. We sought to identify the effect of endotoxin removal from the blood with polymyxin B haemoadsorption on mortality. We conducted an open-label, randomised, controlled, phase 3 trial at 19 US hospitals, enrolling adults (aged ≥18 years) with septic shock requiring vasopressors, with multiple organ dysfunction, and with endotoxin activity between 0·60 and 0·89 units. Patients were randomly assigned (2:1) to receive two sessions of polymyxin B plus standard of care or standard of care alone (control), with block randomisation stratified by site. Study personnel were masked to treatment allocation. Polymyxin B haemoadsorption was given via haemodialysis at a blood flow rate of 80-120 mL/min for 90-120 min per session, 22 h apart. The primary outcome was 28-day mortality in the intention-to-treat cohort. The safety cohort included all participants exposed to any amount of study treatment. Design and analysis followed a Bayesian framework, using a prior for the treatment effect based on a subgroup of the earlier EUPHRATES trial. 90-day mortality was the key secondary outcome. The trial was registered at ClinicalTrials.gov and is completed (NCT03901807). Between Sept 30, 2019, and April 10, 2025, we screened 14 890 patients, of whom 157 were enrolled (106 assigned to polymyxin B and 51 to control; 66 [42%] women and 91 [58%] men). At 28 days, 41 (39%) patients in the polymyxin B group and 23 (45%) in the control group had died, yielding a posterior probability of benefit of 95·3% (APACHE-II adjusted odds ratio 0·67 [95% credible interval 0·39-1·08]). At 90 days, the posterior probability of benefit was 99·4% (0·54 [0·32-0·87]). Of 100 patients in the polymyxin B group assessed for safety, 30 (30%) had a serious adverse event compared with 11 (22%) of 51 patients in the control group (difference -8 percentage points [95% CI -22 to 6]). Two (2%) serious adverse events in the polymyxin B group were treatment-related, one related to polymyxin B and one to catheter placement. In patients with endotoxic septic shock defined by high endotoxin activity and multiorgan failure, polymyxin B haemoadsorption was associated with a high probability of lower mortality at 28 days and 90 days. Spectral Medical.

Introduction: Blood transfusions are often necessary to control bleeding and maintain hemodynamic stability during cardiac surgery. However, using blood products may be associated with poor postoperative outcomes, such as arrhythmias, gastrointestinal bleeding, prolonged ventilation, and higher mortality. This study aimed to investigate the correlation between the intraoperative administration of specific blood products and 30-day postoperative mortality in adult patients undergoing cardiac surgery. Methods: We conducted a retrospective analysis of patients from our institutional Society of Thoracic Surgeons Adult Cardiac Surgery Database. We included adults undergoing cardiac surgery. To isolate the effect of intraoperative transfusion, patients who received postoperative blood products were excluded. The primary outcome was 30-day mortality. Univariate comparisons assessed differences in complication rates between intraoperative transfusions and those who did not. A multivariable logistic regression model within the transfused cohort evaluated the association between 30-day mortality and the type and quantity of intraoperative blood products administered. Results: A total of 503 patients met the inclusion criteria, 93 (18.5%) had intraoperative transfusion. The 30-day mortality rates were markedly elevated in transfused patients relative to non-transfused individuals (8.6% vs. 0.2%, p < 0.001). Increased red blood cell (RBC) transfusion volumes were found to be independently linked to higher 30-day mortality risks within the transfused group (odds ratio 5.44, 95% CI 1.94–24.65, p = 0.009), according to multivariable analysis. No significant associations were observed between mortality and intraoperative administration of FFP, platelets, or cryoprecipitate. Conclusions: Intraoperative RBC transfusion was significantly correlated with an elevated risk of mortality within 30 days post-cardiac surgery. These results support the cautious use of blood products during cardiac surgery, although transfusion probably reflects the severity of the illness and the complexity of the procedure. More prospective research is needed to determine causality and guide transfusion practices in this high-risk population.

BackgroundEffects of antenatal Lyme disease (LD) exposure on the pregnant patient, placenta, and fetus and subsequent child outcomes are not well known. To date, there have been no obstetrical pathology and long-term neurodevelopmental follow-up studies of infants exposed to LD during pregnancy. A first-of-its-kind pilot study (NCT06026969) is being conducted at Children’s National Hospital in Washington, DC.MethodsThis study aims to assess the feasibility of recruiting pregnant patients with LD and following their pregnancy outcomes and children’s neurodevelopment through age 18 months. Pregnant adults in the U.S. or Canada can participate if they have met CDC criteria for acute LD during their current pregnancy or post-treatment Lyme disease syndrome (PTLDS) within 5 years.ResultsAs of May 2025, 9 participants (4 with acute LD, 5 with PTLDS) have enrolled in the study. Successful recruitment methods have included posting in LD-focused social media groups and partnering with trusted stakeholders (doctors, nonprofit organizations) to share details about the study. All enrolled participants have learned about the study online. Fifty additional people have completed an interest screener; reasons for non-enrollment include not meeting CDC criteria for LD/PTLDS (n=15) or diagnosis outside of the eligibility window (n=7), not being pregnant at the time of eligibility assessment (n=5), them declining participation (n=6), or eligibility assessment in progress (n=17).Eight participants have given birth to date; 100% have completed neurodevelopmental follow-up and a qualitative interview about their experience with LD/PTLDS during pregnancy. Four have completed prenatal and/or postnatal imaging. Placentas have been successfully processed by all birth hospitals in preparation for further analysis.ConclusionWhile recruitment/enrollment are complex, there is robust interest from the pregnant LD/PTLDS patient population in contributing to research. Reducing financial barriers (e.g., travel costs), early communication with birth hospitals about placenta collection, partnering with trusted stakeholders, and using targeted marketing strategies have contributed to success in enrolling participants at this infrequent intersection of LD and pregnancy.DisclosuresRoberta L. DeBiasi, MD, MS, Pfizer: Grant/Research Support Sarah B. Mulkey, MD, PhD, Pfizer: Advisor/Consultant

The objective of this study was to characterize the neurodevelopment and risk factors for impairment at age 5 to 6 years after acute provoked neonatal seizures. Multicenter study of neonates with acute provoked seizures. Wechsler Preschool and Primary Scale of Intelligence IV (WPPSI-IV), Vineland-3 Adaptive Behavior Scales, Behavior Assessment System for Children, Behavior Rating Inventory of Executive Function, Social Responsiveness Scale, cerebral palsy (CP), and epilepsy were assessed at age 5 to 6 years. Latent class analysis defined outcome profiles. Least absolute shrinkage and selection operator (LASSO) was used to determine outcome predictors. We characterized 3 latent classes among 164 children: (1) Typical Development (63%); (2) Behavioral Dysregulation (13%; low likelihood of physical impairment or severely impaired cognition, high likelihood of attention deficit hyperactivity disorder [ADHD]); and (3) Multi-Domain Impairment (24%; high likelihood of epilepsy and impairment across all domains). Among 144 children with standardized testing, mean WPPSI-IV was 91 ± 25 and Vineland-3 Adaptive Behavior Composite 90 ± 20. Twenty-nine percent had ADHD or elevated attention/hyperactivity scores; 19% had autism or elevated Social Responsiveness scores; 20% had epilepsy, and 19% had CP. Risk factors for Multi-Domain Impairment were abnormal neonatal neurologic examination (odds ratio [OR] = 3.94, 95% confidence interval [CI] = 1.74-8.95), impaired functional development at age 24 months (OR = 3.82, 95% CI = 1.25-11.66), and CP (OR = 3.71, 95% CI = 1.74-7.90). No neonatal or infant characteristics were significantly associated with Behavioral Dysregulation. Nearly two-thirds of 5 to 6-year-old children with provoked neonatal seizures had typical development. Yet, executive and behavioral dysregulation were prevalent, even with preserved cognitive and physical function. These findings can inform outcome discussions and interventions to promote neurodevelopment. ANN NEUROL 2026;99:777-791.

Abstract Objective Prenatal surgical interventions for neural tube defects have been shown to improve fetal outcomes but are associated with previously poorly quantified maternal risk, which is inherently dependent on the surgical approach used. We hypothesized that a meta‐analysis would enable objective quantitation of maternal risk and safety, stratified by which antenatal neural tube defect surgical approaches were employed. Study design We conducted a meta‐analysis by searching PubMed, Scopus, Embase, and Web of Science databases. We included all studies that performed prenatal intrauterine neural tube defect repair, regardless of the surgical technique. Our primary safety measure outcomes were maternal mortality and severe maternal morbidity (inclusive of uterine rupture or dehiscence, blood transfusion, and pulmonary edema). A total of 26 studies published between 2010 and 2024 were selected, prioritizing larger sample sizes and relevant outcomes when populations overlapped. The meta‐analysis was conducted using random‐effects models to account for between‐study heterogeneity, which was quantified using the I 2 statistic; sensitivity analyses and meta‐regression were performed to assess robustness and explore sources of heterogeneity. Analyses were conducted using R software (version 4.0.5). Results Our meta‐analysis included a total of 1485 patients. No occurrence of maternal mortality was reported in any included studies (0/995). Some studies provided comprehensive data for all complications, while others only reported specific outcomes, leading to variation in case denominators: uterine rupture or dehiscence was observed in a pooled proportion of 4% (95% confidence interval [CI], 1%–11%), occurring in 7.4% of open surgery cases (53/710), 3.1% of mini‐hysterotomy cases (6/192), and 0% of fetoscopic cases (0/157). Among 872 reported cases, maternal pulmonary edema occurred in 3% (pooled estimate: 0.03; 95% CI, 0.02–0.06). The lowest rate of pulmonary edema was seen with open surgical approaches (20 of 661 cases, 3%), followed by mini‐hysterotomy (2 of 55 cases, 3.6%) and fetoscopic surgeries (15 of 159 cases, 9.4%). Model‐adjusted pooled proportions demonstrated an overall low rate of maternal blood transfusion at 0.03 (95% CI, 0.01–0.05) among 971 cases. Conclusion This study highlights the need for standardized and comprehensive reporting of maternal outcomes in fetal surgery in order to reliably counsel patients on anticipated and acceptable maternal risk. However, despite limited data, our findings suggest that maternal mortality is rare and that severe maternal complications occur infrequently; however, the potential for serious morbidity underscores the need for careful patient selection, counselling, and standardized outcome reporting.