Methodist Hospital

Air pollution has long been recognized as a threat to human health. There is growing evidence that exposure to air pollution increases the risk of upper airway inflammatory disease including allergic and non-allergic rhinitis, and chronic rhinosinusitis. Recent improvement in air pollution measurement, including wearable pollution monitors, may improve our understanding of patient exposures. In this piece, we summarize salient literature and interventions.

Among patients receiving ongoing intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy who experience stroke or myocardial infarction (MI), evidence is limited on the systemic safety of continuing injections and whether treatment should be paused or modified. To evaluate whether, among patients receiving intravitreal anti-VEGF therapy who experience cardiovascular events (CVE), there exist associations between anti-VEGF treatments administered shortly before or after CVE (peri-CVE) and mortality or major functional outcomes, and to evaluate whether systemic outcomes differ by anti-VEGF agents. This was a retrospective cohort study of TriNetX network deidentified electronic health records (EHR) from 2005 to 2025. This study setting was a multicenter, EHR-based network analysis including individuals with stroke or MI with established anti-VEGF history (≥3 months pre-CVE), matched between those receiving 1 or more anti-VEGF injections within 14 days before or up to 6 weeks after CVE and those with no anti-VEGF from 3 months before to 3 months after. Propensity score matching (PSM) balanced demographics, comorbidities, procedures, systemic medications, laboratory values, and anti-VEGF agent history. Exposures included intravitreal anti-VEGF during the peri-CVE window vs no peri-CVE anti-VEGF. Sensitivity analyses restricted exposure to 14 days or fewer pre-CVE and compared aflibercept, bevacizumab, or ranibizumab with other agents. The primary outcomes were 3-month and 1-year all-cause mortality, poststroke neurologic deficits, and post-MI heart failure. Data were expressed in relative risks (RRs) with 95% CIs. A total of 6073 and 5381 individuals with stroke or MI, respectively, were included before PSM. After PSM (1526 pairs with stroke; exposure [received peristroke anti-VEGF], mean [SD] age, 72.1 [12.9] years; 822 female [53.9%]; control [did not receive peristroke anti-VEGF], 72.7 [13.3] years; 840 female [55.0%]; and 1523 pairs with MI, exposure [received peri-MI anti-VEGF], 71.4 [13.5] years; 809 male [53.1%]; control [did not receive peri-MI anti-VEGF], 71.5 [13.3] years; 798 male [52.4%]), peristroke anti-VEGF was associated with lower mortality at 3 months (RR, 0.39; 95% CI, 0.29-0.53) and 1 year (RR, 0.52; 95% CI, 0.43-0.63) and fewer neurologic deficits at 3 months (RR, 0.64; 95% CI, 0.46-0.89) but not 1 year (RR, 0.79; 95% CI, 0.62-1.01). Peri-MI exposure was associated with lower mortality at 3 months (RR, 0.34; 95% CI, 0.26-0.43) and 1 year (RR, 0.58; 95% CI, 0.49-0.68) and lower heart failure at 3 months (RR, 0.65; 95% CI, 0.46-0.93) but not 1 year (RR, 0.87; 95% CI, 0.68-1.11). Timing-restricted analyses showed similar mortality findings without differences in neurologic deficits or heart failure. In agent-specific comparisons, there were no differences across aflibercept, bevacizumab, or ranibizumab for any outcome. Results of this cohort study reveal that peri-CVE anti-VEGF was not associated with increased mortality or morbidity. Outcomes did not differ among commonly used agents, supporting the safety of continuing intravitreal anti-VEGF therapy without modification during the peri-CVE period.

Lymph node dissection has been a component of surgical staging for endometrial cancer, with more recent change to sentinel lymph node biopsy as standard of care. However, comparisons of any lymph node assessment with no nodal assessment is limited. We conducted a systematic review of literature published between June 2015 and July 5, 2025, searching Medline and Embase. Eligible studies compared sentinel lymph node biopsy to no nodal assessment and reported on: (1) peri-operative outcomes (2) oncologic outcomes (3) adjuvant treatment (4) patient-reported outcomes (5) lymphoedema outcomes, or (6) cost. Peer-reviewed publications in English, reporting on adult women who underwent sentinel lymph node biopsy or no nodal assessment for endometrial cancer were included. Studies reporting fewer than 10 patients, and reviews, commentaries, editorials, letters, protocol papers, conference proceedings, guidelines, and clinical trial registrations were excluded. Screening was performed in Covidence by 2 independent reviewers. Eight observational studies were eligible for inclusion. Considerable heterogeneity existed in study design and reporting. Evidence was too inconsistent to detect meaningful differences in peri-operative outcomes (blood loss, length of stay, intra-operative complications, conversion to laparotomy) or oncologic outcomes (recurrence, overall survival). Adjuvant treatment findings varied-1 study found no difference in adjuvant treatment between sentinel lymph node biopsy compared to no nodal assessment; another study found that patients who did not have nodal assessment were less likely to receive adjuvant treatment. Lymphoedema outcomes were inconsistent-2 studies suggested lower rates with sentinel lymph node biopsy, while another found no difference. Cost data were limited; 1 study reported no nodal assessment as attracting the lowest charges. There were no studies comparing patient-reported outcomes between sentinel lymph node biopsy and no nodal assessment. Comparative evidence between sentinel lymph node and no nodal assessment in endometrial cancer remains limited. Gaps are greatest in patient-reported outcomes, lymphoedema, and cost outcomes.

Conclusions: aSCC shows a myeloid enriched, developed T cell milieu vs HSIL/NDE.Stratifying SCC by T cell inflammation reveals tighter epithelial-T cell and myeloid-T cell coupling in Hot tu

Introduction: Emergency department (ED) overcrowding remains a pervasive issue across the U.S., contributing to delays in care, prolonged boarding times, and worse clinical outcomes. Telehealth has emerged as a potential strategy to reduce ED strain, but evidence at the population level remains limited. This study investigates whether higher telehealth utilization at each state level is associated with three primary outcomes, i.e, reduced ED congestion, inpatient boarding time, and improved health outcomes, particularly age-adjusted mortality rates. Methods: This cross-sectional ecological study included data from all 50 U.S. states and Washington, D.C., for the year 2022. Telehealth utilization rates (% of outpatient visits via telehealth) were obtained from the Kaiser Family Foundation. ED visit rates and boarding times were sourced from the CDC and the Agency for Healthcare Research and Quality (AHRQ). Finally, mortality data came from the CDC WONDER data (links are available in the references of actual manuscript). Pearson correlation coefficients were used to assess associations between telehealth use and the three outcome measures. Results: Across all states, average telehealth utilization was 14.7% (range: 5.8%–27.3%). ED visit rates ranged from 265 to 719 per 1,000 population, while boarding times varied from 98 to 265 minutes. Age-adjusted mortality ranged from 614 to 1,036 per 100,000 residents. A significant inverse correlation between telehealth utilization and ED visit rates (r = -0.43, p = 0.001). Also, a significant inverse correlation with ED boarding times (r = -0.37, p = 0.006) and a moderate inverse correlation with age-adjusted mortality (r = -0.31, p = 0.02). However, given the study’s cross-sectional design, causality cannot be inferred. Limitations include the exclusion of confounders such as broadband access and healthcare infrastructure variability. Conclusions: Higher telehealth utilization was significantly associated with lower ED visit volumes, shorter boarding times, and reduced age-adjusted mortality. These findings suggest that a robust telehealth infrastructure may improve outcomes. Future studies should explore longitudinal and interventional designs to confirm associations and guide policies. Investment in equitable telehealth expansion, particularly in underserved areas.