Kettering Health Dayton, formerly known as Grandview Medical Center, is a 317-bed teaching hospital located on the north side of Dayton, Ohio, United States, in the Five Oaks part of the larger area of Dayton View. Founded in 1926, Kettering Health Dayton is a part of the Kettering Health network. It is also the parent hospital to Kettering Health Washington Township in Centerville, Ohio. Kettering Health Dayton is one of the largest osteopathic teaching hospitals in the United States, operating several residency training and fellowship programs.The hospital is accredited by the Healthcare Facilities Accreditation Program (HFAP) and by the Commission on Accreditation of Rehabilitation Facilities (CARF).The last year data was made available, the hospital had 12,585 admissions, performed 2,777 inpatient surgeries and 17,481 outpatient surgeries, and its emergency department had 47,164 visits. According to the Dayton Business Journal in 2013, the then-Grandview Medical Center had 203 beds and employed over 1,200 people.
BACKGROUND:Pulsed field ablation (PFA) using a variable loop circular catheter (VLCC) is increasingly adopted for atrial fibrillation (AF) ablation. Early experience suggests a favorable safety profile, yet outcomes from complex procedures remain limited. OBJECTIVE:This study aimed to evaluate the safety profile of the VLCC from a large, multicenter, real-world registry. METHODS:Consecutive ablations performed with the VLCC in the prospective, multicenter Real-world Experience of Catheter Ablation for the Treatment of Symptomatic Paroxysmal and Persistent Atrial Fibrillation (REAL AF) registry were evaluated for safety events through 3 months follow-up. Events were categorized by investigator-assessed relationship to procedure and/or VLCC. RESULTS:In 1014 index ablation cases, the procedure-attributed complication rate was 0.6% (6/1014). Complications included cardiac tamponade/pericardial effusion attributed to a concomitant left atrial appendage closure device, sinoatrial block after accessory pathway ablation, iliac artery dissection, fluid overload, blurred vision with normal magnetic resonance imaging, and transient ischemic attack. Half of the events occurred in cases involving adjunctive radiofrequency ablation. No strokes, coronary spasm, or deaths were reported. Complication rates were low in all AF types and ablation strategies. Same-day discharge occurred in 86.5% of cases, and short-term pulmonary vein isolation was achieved in 99.6%. CONCLUSION:In a multicenter real-world cohort that included persistent AF and more complex strategies, the VLCC indicated a favorable early safety profile with no catheter-attributed adverse events and very low procedure-attributed complications. These findings support the feasibility of efficient, outpatient-focused PFA workflows whereas ongoing accrual will enable more granular assessment of rare events.
Abstract Background and Objectives The distinction between benign and neoplastic bile duct strictures remains challenging. Pathologic assessment of ERCP-obtained specimens has limited sensitivity, particularly among patients with primary sclerosing cholangitis (PSC). Next-generation sequencing (NGS) of bile duct specimens provides a promising diagnostic approach; but a prospective, multi-institutional, and comprehensive DNA/RNA analysis is lacking. Method A 6-year, prospective, multi-institutional study was conducted using BiliSeqV2 (28 cancer-associated genes and 167 fusion genes) and BiliSeqV3 (161 cancer-associated genes and 763 fusion genes) for 2908 ERCP-obtained brushings, biopsies, and bile from 2116 patients at 28 medical institutions across the United States. Molecular results were compared to clinical, imaging, and pathologic parameters including diagnostic pathology and/or at least 1-year follow-up. Results BiliSeqV2N3 testing was performed for 2865 (99%) specimens from 2080 (98%) patients. Based on follow-up from 1979 (95%) patients, BiliSeqV2N3 demonstrated 82% sensitivity and 98% specificity for a neoplastic stricture. In comparison, pathologic assessment had a sensitivity of 44% and a specificity of 99%. Combining BiliSeqV2N3 testing with pathologic assessment improved the sensitivity to 88% and maintained a high specificity of 97%. High-risk populations, such as Hispanic, germline carrier, and PSC patients, also showed improvement in sensitivity with BiliSeqV2N3 (74% to 86%) compared to pathologic assessment (26% to 50%). Further, actionable molecular alterations were identified in 20% of BiliSeqV3-positive neoplasms and modified patient management in 30% of these cases. Conclusions Applying BiliSeqV2N3 testing to ERCP-obtained specimens improved the diagnostic evaluation of bile duct strictures, achieving higher sensitivity, especially for PSC, and maintained high specificity compared to traditional methods. This study highlights the importance of NGS for precise diagnosis and therapeutic intervention.
In the present case report, we have described the incidental finding of a gastrointestinal stromal tumor (GIST) in the appendix following surgical evaluation of a possible closed loop small bowel obstruction in the right lower quadrant. Upon exploration inside the abdomen, the distal ileum and proximal cecum appeared dusky with chronic strictures. An ileocecectomy was performed, and pathology returned with an incidental GIST of the appendix with a T1N0 classification.
BACKGROUND:Strategies for persistent atrial fibrillation (PsAF) ablation remain limited. OBJECTIVE:This study aimed to determine optimal PsAF ablation strategies. METHODS:REAL-AF (NCT04088971) is a multicenter, prospective, observational registry enrolling patients undergoing de novo ablation for atrial fibrillation. Between January 2018 and August 2024, 746 patients with PsAF were treated with radiofrequency ablation (RFA); 3 ablation methods were analyzed: group 1, pulmonary vein isolation (PVI) only; group 2, PVI + substrate modification (SM) + vein of Marshall (VoM) by RFA; and group 3, PVI + SM + VoM by ethanol (EtOH). RESULTS:Of the overall 746 patients, 564 patients (75.6%) were treated with PVI only (group 1), 94 (12.6%) with PVI + SM + VoM RFA (group 2), and 88 (11.8%) with PVI + SM + VoM EtOH (group 3). Scar burden was higher in group 2 than groups 1 or 3 (20%, 1.0%, and 11%, respectively; P < .001). Procedure times were higher in group 3 (147 minutes; interquartile range 125.0-171.0) than groups 1 (81.0 minutes; 64.0-104.0) and 2 (90.5 minutes; 64.8-119.3). Acute complication rates were low in all groups, lowest in group 3 (0%; P = .438), and 12-month rates remained lowest in group 3 (2.3%; P = .896). Arrhythmia recurrence was reduced in group 3 through 12 months (15.3%) vs groups 1 (24.4%) and 2 (35.3%) (P = .023). Repeat ablations through 12 months trended lowest in group 3 (3.4%) vs groups 1 (5.3%) and 2 (6.4%) (P = .654). CONCLUSION:VoM EtOH ablation for PsAF seems safe and efficacious as an adjunctive strategy for the treatment of PsAF. Findings are not based on cohort size, but on comparative effectiveness and safety across distinct ablation strategies in real-world practice.
