Peroral endoscopic myotomy (POEM) is an effective treatment for esophageal motility disorders. There is limited data regarding the safety and feasibility of same-day discharge after POEM, and postoperative care lacks standardization. This study aims to assess the data on readmission rate, emergency department (ED) visits, and adverse events between same-day discharge (SDD) and admitted patients after POEM. Several databases were reviewed from inception to October 12, 2025. Outcomes of interest were readmissions, emergency department (ED) visits, adverse events, and post-procedural pain. Data were analyzed using a random-effect model. Seven retrospective studies with a total of 637 patients (384 SDD, 253 admitted) were included in the final analysis. There was no significant difference in 30-day readmission rate, OR (95
BACKGROUND:Incidence of acute kidney injury (AKI), reflected by raised serum creatinine level, is a common complication following liver transplant. Dexmedetomidine, an α2-adrenergic agonist, has been proposed as a potential renoprotective agent in the preoperative/perioperative setting. However, its effects on renal outcomes after liver transplantation are relatively understudied. AIM:To assess the outcomes of preoperative/perioperative dexmedetomidine on serum creatinine level following liver transplant. METHODS:This systematic review evaluated studies investigating the outcome of preoperative/perioperative systemic dexmedetomidine on postoperative serum creatinine levels following liver transplant. Meta-analysis was performed using random or fixed effects models depending on the degree of statistical heterogeneity. Risk of bias and overall quality of evidence were assessed using standardized methodologies. RESULTS:A total of four studies involving 535 participants (of whom 270 received dexmedetomidine and 265 served as controls) were included in the meta-analysis. Preoperative/perioperative administration of dexmedetomidine was associated with a statistically significant reduction in postoperative serum creatinine levels (mean difference: -0.06 mg/dL; 95%CI: -0.09 to -0.02; P = 0.002). However, reporting of clinically meaningful renal outcomes was limited, and no consistent reduction in AKI was observed across studies. Heterogeneity among studies was substantial (I 2 = 75%, P = 0.007). CONCLUSION:Preoperative/perioperative administration of dexmedetomidine was linked to a modest yet statistically significant decrease in postoperative serum creatinine levels after liver transplantation. Although these results suggest a possible biochemical effect, the clinical relevance remains uncertain, as no consistent improvement in clinically meaningful renal outcomes was demonstrated.
Using the National Inpatient Sample (2016-2022), we identified adult hospitalizations with cardiogenic shock (ICD-10-CM R57.0) and an Impella procedure code (ICD-10-PCS 5A0221D or 5A0211D), excluding elective admissions, transfers out, postcardiotomy shock, and missing core data. Patients were classified as acute myocardial infarction-cardiogenic shock (AMI-CS) or non-AMI-CS by diagnosis. One-to-one nearest-neighbor propensity-score matching without replacement was performed on 64 covariates using a caliper of 0.2 standard deviations of the logit propensity score, with balance evaluated by absolute standardized mean differences <0.10. Co-primary outcomes were in-hospital all-cause mortality and the Saito composite (death or any major Impella-related complication: bleeding requiring transfusion, acute kidney injury requiring dialysis, stroke, vascular complication, limb ischemia, or access-site infection). Secondary outcomes included individual complications, length of stay, inflation-adjusted charges, and discharge disposition. The final analytic cohort comprised 9866 unweighted Impella-supported CS hospitalizations (7507 AMI-CS; 2359 non-AMI-CS). After 1:1 propensity-score matching, 1917 pairs were retained with excellent postmatch balance (median |standardized mean difference| 0.014; maximum 0.053). In the matched cohort, in-hospital mortality was significantly lower in AMI-CS (43.9%) than in non-AMI-CS (47.4%) (absolute risk difference -3.5%; OR 0.87, 95% CI, 0.76-0.99; P = 0.030), as was the Saito composite (61.1% vs 65.2%; OR 0.84, 95% CI, 0.74-0.96; p=0.010). Within non-AMI-CS, in-hospital mortality varied substantially by etiology, lowest in myocarditis-associated CS (25.0%) and highest in ventricular arrhythmia and pulmonary embolism etiologies. National Impella-supported CS hospitalizations rose progressively in both groups over 2016-2022 (annual percent change +12.0% and +11.1% for AMI-CS and non-AMI-CS, respectively).
BACKGROUND:Prospective studies with a focus on the safety and effectiveness profile of stylet-driven left bundle branch area (LBBA) pacing leads at both implant and chronic stages significantly contribute to a comprehensive perspective of using a stylet-driven lead in this pacing modality. OBJECTIVE:This study aimed to prospectively evaluate the performance and safety of LBBA-placed Solia S leads and the related impact on the patient's quality of life (QOL) through 12 months. METHODS:A multicenter, prospective, nonrandomized trial enrolled patients with standard pacing indications in whom a Solia S lead was implanted in the LBBA. Adverse events and QOL metrics were collected up to 12 months after implant along with threshold, sensing, and lead impedance data. RESULTS:For the 161 patients who experienced a serious adverse device effect (SADE) event or had at least 335 days of follow-up, the associated 12-month SADE-free rate was 0.02 events per subject-year (SADE-free rate 98.1%; 95% confidence interval, 94.7-99.6). The mean threshold was 0.98 V at 0.4 ms (vs 0.84 V at implant), mean sensing was 12.76 mV (vs 9.15 mV at implant), and mean impedance was 521.8 Ω (vs 670.5 Ω at implant). The mean change for the QOL physical function scale was +11.4 ± 24.0 (95% confidence interval, 7.4-15.4; t value = 4.23; P < .001). CONCLUSION:These 12-month results using the Solia S stylet-driven lead demonstrate freedom from LBBA pacing lead-related complications, acceptable lead performance characteristics, and a significant coincident improvement in a patient's physical function.
We investigated the impact of racial/ethnic disparities in therapy initiation on colorectal cancer (CRC) mortality using Surveillance, Epidemiology, and End Results Program (SEER) database. Adults aged 18–84 years with CRC were identified. Cox models for 60-month all-cause and cancer-specific mortality were adjusted for demographics, stage, tumor site, income, and rural–urban residence. Therapy initiation was slower for Hispanics (HR 0.85) and non-Hispanic Black (NHB) patients (HR 0.80) compared with non-Hispanic Whites (p < 0.001). Each additional month of delay was associated with a 3
