Baystate Health is a not-for-profit integrated health system headquartered in Springfield, Massachusetts, serving Western Massachusetts and the Knowledge Corridor Region of Massachusetts and Connecticut. The system has 5 hospitals, over 80 medical practices, and 25 reference laboratories. With 12,000 employees including 1,600 physicians, it is one of Massachusetts' largest employers. Baystate also owns the for-profit insurer Health New England.
Background Analysis of the National Inpatient Sample database for the safety of procedures that are primarily outpatient in nature can be biased due to the selective hospitalization of patients who have complications during these procedures. Methods This is a retrospective cross‐sectional analysis of hospitalized patients in the National Inpatient Sample data set who underwent an atrial fibrillation catheter ablation between 2016 and 2022. Patients were divided into 2 groups based on the day of hospitalization on which the ablation was performed: day 1 of admission or before (group 1), versus day 2 of admission or later (group 2). Patient baseline characteristics and procedural complication rates were compared. Results The analysis included 47 925 weighted hospitalizations of patients who underwent atrial fibrillation catheter ablation. Group 1 had significantly fewer octagenerians (6.9% versus 10.4%), lower rates of renal disease (12.6% versus 20.0%), heart failure (28.3% versus 45.8%), and ischemic heart disease (16.0% versus 20.5%), P<0.001 for all, compared with group 2. The rate of complication was higher in group 1 (9.5% versus 6.6%; P<0.001). Multivariate analysis showed study group 1 to be an independent predictor of complications (odds ratio, 1.54 [95% CI, 1.30–1.83]; P<0.001). Conclusions Patients undergoing procedures on the day of admission or before were younger and had fewer comorbidities. Despite this, these patients had a significantly higher rate of procedural complications. The likely explanation for these results is selection bias, where patients undergoing outpatient procedures who are at higher risk or develop complications are admitted as inpatients, thus falsely inflating the complication rate of patients in the National Inpatient Sample data set.
Cutaneous and subcutaneous lumps are frequently encountered in the pediatric population and are usually benign. Although some lesions can be diagnosed clinically, ultrasound plays a pivotal role in evaluation by delineating lesion morphology, depth, extent, internal composition, and vascularity. Technological advances in high-frequency transducers and image resolution have significantly improved visualization of superficial soft tissues, enhancing diagnostic confidence. Despite substantial overlap in sonographic appearance among different lesions, specific imaging characteristics can help narrow the differential diagnosis and guide management. This review summarizes both common and uncommon pediatric superficial soft tissue masses, emphasizing their tissue of origin, key ultrasound features, and distinguishing findings that assist in accurate characterization and appropriate clinical decision-making. Conditions covered include epidermal inclusion cysts, sebaceous cysts, hair follicle lesions (hidradenitis suppurativa, pilonidal sinus disease, pilomatricomas, trichilemmal cysts), juvenile xanthogranulomas, dermatofibromas, subcutaneous granuloma annulare, and cutaneous leukemia/lymphoma.
Abstract Background and aims Current treatment of symptomatic carotid stenosis relies on data that are more than 30 years old. There is limited reliable information on the stroke rate with modern, intensive medical therapy (IMT). The aim of this pragmatic registry was to provide an estimate of the ipsilateral stroke rate for patients with 50-99% symptomatic carotid stenosis who have at least one feature suggesting reduced stroke risk. Methods IMT was provided to all participants. IMT consists of dual antiplatelet therapy (short-term), high potency statins, blood pressure control, and lifestyle modification with risk factor education. Criteria for enrollment include any one of three clinical or radiologic markers. Clinical 1) Women 2) Retinal ischemic event only 3) Last symptomatic event >1 week ago. Radiologic: 1) TCD negative for emboli 2) MRI negative for intraplaque hemorrhage 3) High risk TIA with negative DWI. The primary endpoint is ipsilateral ischemic stroke within 12 months of enrollment. Results The registry completed enrollment in Sept 2025 with 114 patients (53% women), recruited from 18 centers in N America. 70% of patients qualified with stroke, 30% with TIA. All patients completed 6 month follow-up, with the ipsilateral stroke rate being 4.4%. Eight patients have died (7%). Information on stroke severity will be presented. Conclusions SCORE Registry data will allow clinicians to refine carotid stenosis decision making in symptomatic patients with >50% stenosis and potentially justify a future phase III RCT. With 6 months of follow-up in all patients, the stroke rate appears reduced compared to historical controls. Conflict of interest
BACKGROUND: CPT valuation historically treated open and minimally invasive (MIS) abdominopelvic operations as interchangeable services performed on similar patients. As MIS has become the dominant approach, open operation may now represent a distinct and more complex clinical scenario. This study characterized contemporary open operation for common abdominopelvic procedures. STUDY DESIGN: The 2023 American College of Surgeons NSQIP database was analyzed for appendectomy, cholecystectomy, right colectomy, low anterior resection, and Hartmann’s procedure. Cases were categorized as MIS, straight to open, or conversion to open. Patient characteristics, operative time, length of stay, and 30-day complications were compared across approaches using binomial regression models. RESULTS: Among 105,085 operations, MIS predominated for appendectomy (98%), cholecystectomy (98%), low anterior resection (84%), and right colectomy (72%), whereas Hartmann’s procedures were primarily open (77%). Conversions represented approximately half of open appendectomies and cholecystectomies and had the longest operative times, exceeding MIS operations by 147% for appendectomy and 116% for cholecystectomy. Compared with MIS, straight-to-open appendectomy was associated with increased length of stay (incident rate ratio 2.92) and higher complication odds (odds ratio 4.02), with conversion-to-open appendectomy showing further stepwise increases (incident rate ratio 4.85; odds ratio 7.07). Similar stepwise patterns from MIS to straight-to-open to conversion-to-open were observed across procedures. CONCLUSIONS: In contemporary practice, open abdominopelvic operations are uncommon and frequently represent conversion from MIS, identifying a subgroup with longer operations, longer hospitalization, and higher complication rate. Current CPT coding and work relative value units may not reflect the greater clinical complexity and effort associated with these cases, supporting reconsideration of open procedure valuation.
The endoplasmic reticulum (ER) serves as a key hub for protein homeostasis, maintaining a strict quality-control system that ensures only properly folded proteins reach their destinations, while misfolded proteins are degraded via ER-associated degradation (ERAD) or selective ER-phagy. JKAMP, which encodes an ER-resident transmembrane protein involved in ERAD, has not previously been associated with human disease. Here, we report bi-allelic loss-of-function variants in JKAMP in 14 affected individuals from 10 unrelated families presenting with a neurodevelopmental syndrome characterized by intellectual disability, developmental delay, seizures, hypotonia, microcephaly, and dysmorphic features. An in vivo zebrafish model lacking jkamp recapitulated key aspects of the human disorder, including developmental abnormalities and impaired myelin production, further corroborating its pathogenic role. Mechanistic studies identified GPR37, a brain-enriched orphan G protein-coupled receptor (GPCR) and known JKAMP interactor, as a critical downstream effector. GPR37 plays essential roles in dopaminergic signaling, inflammatory pain regulation, neuroprotection, and myelination. Loss of JKAMP resulted in defective folding and degradation of GPR37, leading to its accumulation within the ER and impaired trafficking to the plasma membrane, likely due to impaired ER quality control. These findings establish JKAMP as a previously unrecognized contributor to human neurodevelopment and uncover a pathogenic mechanism linking ER protein quality control to GPCR regulation and neurological disease.
