The Carle Illinois College of Medicine is the graduate medical school of the University of Illinois at Urbana Champaign. Called the "World's First Engineering-Based College of Medicine," the school trains physician-innovators by integrating several engineering and entrepreneurship approaches to healthcare into its medical training, and awards the degree of M.D. upon graduation.
This review summarizes considerations within the existing recent literature that guide the practice of interval appendectomy (IA) after initial non-operative management (NOM) of complicated appendicitis (CA) in children. A systematic review of English language articles published from 2000 to 2025 was conducted in Medline, Embase, and Cochrane Central Register of Controlled Trials to address four elements which could impact the decision for IA after NOM of CA: (1) the incidence of recurrent appendicitis; (2) the time period in which recurrence occurs; (3) the patient or disease-related risk factors which increase recurrence; and (4) the incidence of appendiceal neoplasms identified by IA. Of the 3,022 articles initially reviewed, 46 met inclusion criteria. Recurrence was reported in 2–50
Purpose/Objective(s) In metastatic breast cancer (MBC), brain metastases (BM) are frequently detected only after neurologic symptom onset, often necessitating craniotomy or whole-brain radiotherapy. However, routine MRI screening is not endorsed by consensus guidelines due to the low point prevalence in unselected patients. We present a novel clinicogenomic risk stratification strategy to enable targeted CNS surveillance and earlier detection of clinically significant BM. Materials/Methods We analyzed MBC patients without known BM at metastatic diagnosis who underwent genomic sequencing of a non-CNS specimen within one year of metastatic diagnosis. An ensemble time-dependent LASSO machine learning approach was used to develop a clinicogenomic risk model integrating baseline clinical, pathologic, and genomic features to estimate BM risk. The primary endpoint for this analysis was symptomatic brain metastasis–free survival (sBMFS), defined as time from metastatic diagnosis to first BM diagnosed in the setting of neurologic symptoms. Competing-risk and cause-specific time-to-event models were evaluated, and patients were stratified into low-, intermediate-, and high-risk groups. Results Among 1,594 patients with MBC, the model demonstrated robust stratification for sBMFS, with pronounced separation between risk groups. At 2 years, sBMFS was 91%, 77%, and 46% for patients classified as low-, medium-, and high-risk, respectively (log-rank p<0.001). Correspondingly, the 2-year cumulative incidence of any BM and symptomatic BM was 2.3% and 0.76%, 11% and 5.2%, and 32% and 20%, for low-, intermediate-, and high-risk patients, respectively (Gray's test p<0.001 and p<0.001, respectively). Across all risk strata, most patients who developed symptomatic brain metastases required craniotomy or whole-brain radiotherapy at initial presentation. These findings were independently validated in external cohorts, including a phase II clinical trial dataset evaluating MRI surveillance in patients with MBC. Conclusion Clinicogenomic risk stratification identifies patients with MBC at increased risk for symptomatic CNS progression. These findings support the development of risk-adapted CNS surveillance strategies. Earlier identification may enable intervention before the onset of neurologic compromise, when focal radiotherapy or systemic therapy alone may be sufficient, thereby reducing the need for WBRT or craniotomy.
Introduction: Stroke remains the second leading cause of death worldwide and a major cause of long-term disability. Approximately 87% of strokes are ischemic, and 30% of these are large vessel occlusions (LVOs). Early recognition of LVOs and rapid transport to a comprehensive stroke center (CSC) capable of MT are critical to improving outcomes. Accurately predicting LVOs in prehospital settings remains chall29enging. Several triage scales have been developed to aid early detection, but their diagnostic accuracy varies across studies. This study compares the performance of commonly used prehospital LVO scales by pooling published data to identify which tools best support emergency medical services (EMS) in optimizing triage and improving outcomes. Methods: A systematic search, following the Cochrane Library, of PubMed, Scopus, and Web of Science identified studies evaluating prehospital LVO triage scales using standardized search terms. Diagnostic accuracy measurements were extracted, and a pooled analysis was completed to compare scores. Results: From 743 unique articles, 15 studies evaluating prehospital large vessel occlusion (LVO) triage scales were included. Pooled log diagnostic odds ratios (DORs) indicated that RACE demonstrated the highest discriminative performance (2.367 [1.943–2.792]), followed by LAMS (2.228 [1.987–2.470]). The lowest scores were from the PASS (1.992 [1.758–2.227]) and C-STAT (1.886 [1.652–2.119]) scales. Conclusions: Among prehospital triage scales, RACE demonstrated the highest accuracy for LVO detection, followed by LAMS and G-FAST. Variation in scores may indicate inconsistency in performing the tests or the complexity of the questions. These findings support a personalized approach to choosing an LVO identification scale based on the resources available.
BACKGROUND:Medical malpractice contributes to an estimated $55.6 billion in overall medical liability system costs per year. The rise of medspas has resulted in an increase in complications and litigation. In this study, we identified all publicly indexed litigation against medical spas and medical spa practitioners using the Westlaw legal database and characterized trends in these findings. METHODS:A retrospective analysis of litigation against medical spas and medical providers performing care at medical spas was performed. Cases were indexed from 2006 to 2024 using the Westlaw legal database. Case documents were reviewed for the following datapoints: Patient characteristics (age, sex), legal case characteristics (state in which litigation occurred, reason for litigation, outcome, monetary payments, expert witness involvement), and medical procedure characteristics (type of procedure, location on the body in which the procedure was performed, complication, credentials of person who performed the procedure). RESULTS:Twenty legal cases met inclusion criteria, ranging in date from May 2006 to October 2024. The average patient age was 36 years old (SD 12.570). All plaintiffs were listed as female (n=20). 4 cases sued only the medspas, 15 sued only a medical practitioner, and in one case both the practitioner and medspa were sued. Each of the 20 cases were decided by jury decision at trial. 7 cases were won by the defendants (35%), whereas the remaining 13 cases were won by the plaintiffs. The average jury award was $2,489,128.69. CONCLUSIONS:Our findings highlight the importance of properly managing patient expectations and thorough discourse regarding the risks of the procedure to better align patient presurgery expectations with the final result. Our findings also emphasize the positive impact that tighter regulation of medical spas will have on patient safety. Our data is limited by the small sample size that was indexed on Westlaw legal database and descriptive in nature, so future studies analyzing larger cohorts of data may provide additional data to further benefit patient safety.
