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BACKGROUND:Chemotherapy-induced thrombocytopenia (CIT) is a common complication of chemotherapy that is associated with bleeding, reduced relative dose intensity, and potentially worse outcomes. No widely available therapies are approved for CIT. METHODS:We conducted a phase 3, international, double-blind, randomized, placebo-controlled trial involving patients with persistent CIT (platelet count, ≤85×109 per liter on trial day 1) who were receiving oxaliplatin-based multiagent cytotoxic chemotherapy for gastrointestinal cancers. Patients were randomly assigned in a 2:1 ratio to receive romiplostim or placebo for three chemotherapy cycles. The primary end point was the absence of CIT-induced modifications of the chemotherapy dose (reduction, delay, omission, or discontinuation) in both the second and third chemotherapy cycles. RESULTS:Of the 165 patients who underwent randomization (109 in the romiplostim group and 56 in the placebo group), 75% had colorectal cancer, 13% had gastroesophageal cancer, and 12% had pancreatic cancer; 72% of the patients in the romiplostim group and 61% of those in the placebo group had stage 4 disease. The percentage of patients with no CIT-induced modifications of the chemotherapy dose was 84% (92 of 109 patients) with romiplostim and 36% (20 of 56 patients) with placebo, which corresponded to an odds ratio of 10.16 (95% confidence interval [CI], 4.44 to 23.72; P<0.001) and a risk ratio of 2.77 (95% CI, 1.78 to 4.30; P<0.001). Adverse events of grade 3 or higher occurred in 37% of the patients who received romiplostim and in 22% of those who received placebo, which primarily reflected chemotherapy effects. Adverse events that were considered by the investigator to be related to romiplostim or placebo occurred in 12% of patients who received romiplostim and in 7% who received placebo, with the most frequent being nausea (2% in each group) and headache (2% in the romiplostim group); none were serious or led to death or discontinuation of romiplostim, placebo, or chemotherapy. Thromboembolic events occurred in 2% of patients who received romiplostim and in no patients who received placebo. CONCLUSIONS:In this phase 3, placebo-controlled trial, romiplostim was efficacious in treating CIT. (Funded by Amgen and the Biomedical Advanced Research and Development Authority; RECITE ClinicalTrials.gov number, NCT03362177.).
Hepatic artery dissection means a tear in the wall of the hepatic artery, allowing blood to accumulate between arterial layers, leading to fatal or major sequelae, including ischemia and hepatic injury, pseudoaneurysm, or rupture. Spontaneous hepatic artery dissection is rare, especially in patients without any recent hepatobiliary surgery or trauma. It is a nonspecific and often subtle presentation that can delay diagnosis, leading to major/fatal consequences, including hepatic injury due to ischemia, pseudoaneurysm, and rupture leading to death, which highlights the need for clinical awareness. We report on a 54-year-old man with hypertension, type 1 diabetes mellitus, hyperlipidemia, and a remote motor vehicle accident 12 years prior to our case presentation. He presented with acute epigastric pain. Computed tomography angiography (CTA) demonstrated an isolated dissection of the common and proper hepatic arteries without involvement of the aorta or celiac trunk. He was managed conservatively with anticoagulation and close follow-up. Repeat CTA at one month showed interval remodeling and partial recanalization of the hepatic artery. Although a few cases have been reported, they offer insights into risk factors, clinical presentation, and the range of management strategies. Our report underscores the importance of considering vascular causes in patients with unexplained upper abdominal pain. Early diagnosis and a tailored treatment plan can help prevent serious complications.
Abstract Background and aims Acute ischemic stroke remains a leading cause of mortality. Reperfusion therapies have transformed acute stroke management. To evaluate clinical characteristics, treatment patterns, and in-hospital outcomes among acute ischemic stroke patients receiving mechanical thrombectomy, intravenous thrombolysis, or combined therapy at a regional stroke center in Ireland. Methods A retrospective cohort study of acute ischemic stroke admissions at St. Luke's Hospital was conducted from Jan 1, 2022, till Sep 30, 2025. Data were extracted from the Hospital In-Patient Enquiry reporting database. Patients were stratified by reperfusion treatment: mechanical thrombectomy alone, intravenous thrombolysis alone, combined therapy, or no reperfusion therapy. Primary outcomes included demographics, comorbidities, length of hospital stay, and in-hospital complications. Results 663 patients with acute Ischameic Stroke were included (mean age 73.1 ± 13.7 years; 57.5% male), 19 (2.9%) received mechanical thrombectomy, 23 (3.5%) received intravenous thrombolysis, 10 (1.5%) received combined therapy, and 611 (92.2%) received no reperfusion treatment. Patients receiving mechanical thrombectomy alone were younger (67.8 ± 10.3 years) and predominantly male (78.9%). Combined therapy patients were oldest (78.0 ± 9.4 years) with highest atrial fibrillation prevalence (60.0%). Hemorrhagic transformation occurred in 26.3% of thrombectomy-alone patients, 13.0% of thrombolysis-alone patients, and 20.0% of combined-therapy patients. Conclusions At this regional Irish stroke center, reperfusion therapy utilization remained low (7.8% overall), reflecting patient selection, transfer logistics, and contraindications. Patients receiving reperfusion therapies demonstrated distinct clinical profiles, with hemorrhagic transformation rates consistent with published literature. These findings highlight opportunities to optimize stroke systems of care and expand access to evidence-based reperfusion strategies. Conflict of interest Mohammad Bilal Khan Nothing to disclose
Purpose Instagram is a highly popular social media platform, which has been implemented as a teaching modality of several disciplines. We performed a literature review of its use for anatomy and histology teaching, given the lack of reviews with this purpose. Methods We searched PubMed, Scopus, ERIC, and Cochrane library to find articles with the aim to explore the use of Instagram for anatomy or histology teaching. From each included paper, we extracted the following data: author(s), number of participants, way of Instagram implementation in anatomy or histology teaching, educational outcomes (effectiveness or perceptions about the educational usefulness), and their level according to Kirkpatrick hierarchy. Results Eight articles were included, of which five concerned anatomy and three were about histology. Three articles investigated students’ examinations scores (Kirkpatrick level 2b), while five contained only participants’ perceptions (Kirkpatrick level 1). The use of Instagram for anatomy and histology teaching has been rated highly positively in all studies, which assessed participants’ perceptions. Also, the three studies of level 2b showed significant knowledge acquisition, yet without evidence of long-term retention. There is lack of data about specific factors related to Instagram that could play a role in these educational outcomes. Conclusions Anatomy and histology educators may be encouraged to incorporate Instagram into their teaching toolkit. This platform could deliver knowledge in small pieces and within limited time. This educational strategy, which is known as microlearning, seems to be promising and warrants further investigation.
e16157 Background: Liver cancer mortality remains a major public health burden in the United States despite advances in prevention and treatment. Psychoactive substance use disorder (PSUD) is an increasingly prevalent comorbidity; however, national trends and disparities in liver cancer mortality among adults with PSUD remain poorly characterized. Methods: We conducted a retrospective analysis of liver cancer-related deaths among U.S. adults aged 25 years and older with PSUD from 1999 to 2023 using Centers of Disease Control (CDC) Wide Ranging Online Data for Epidemiological Research (WONDER) mortality database. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 population and stratified by census region, state, urban–rural status, sex, and race/ethnicity. Temporal trends were assessed using Joinpoint regression to estimate average annual percent change (AAPC). Statistical significance was determined using p-value (<0.05). Results: Overall liver cancer related AAMR per 100,000 among adults with PSUD significantly increased from 0.15 in 1999 to 1.02 in 2023 (AAPC: 7.47; 95% CI: 6.33 to 8.61; p < 0.000001). The overall mortality burden was higher in males. However, females experienced larger rises in mortality (AAPC: 10.03; 95% CI: 8.85 to 11.24; p < 0.000001) as compared to males (AAPC: 7.30; 95% CI: 5.78 to 8.84; p < 0.000001). Marked racial disparities were observed, with non-Hispanic Black and non-Hispanic White individuals experiencing the highest mortality rates with persistent increases over time, while Hispanic/Latino populations exhibited modest and variable trends. A substantial geographic variability was observed, with the greatest increases in the Midwest and the South. State-level analysis revealed higher mortality rate in Oregon (1.27) followed by Washington (1.12) and Texas (1.06) respectively. Both rural and urban areas experienced a sharp rise in mortality with AAPC being slightly higher in rural areas (AAPC: 10.34) as compared to urban areas (AAPC: 9.67). Conclusions: Liver cancer mortality among U.S. adults with PSUD has risen markedly over the past two decades, with substantial demographic and geographic disparities. These findings highlight the need for integrated liver cancer screening and substance use disorder interventions targeting high-risk populations. Variables AAMR (95% CI) in 2023 AAPC (95% CI) Overall 1.02 (0.98 –1.05) 1999-2023: 7.47* (6.33 – 8.61) Female 0.42 (0.39 – 0.46) 1999-2023: 10.03* (8.85 – 11.24) Men 1.69 (1.62 –1.76) 1999-2023: 7.30* (5.78 – 8.84) White 1.05 (1.0 –1.09) 1999-2023: 9.52* (8.08 – 10.98) Black / African Americans 1.22 (1.09 – 1.35) 1999-2023: 6.59* (5.50 – 7.68) Hispanics / Latinos 0.75 (0.65 – 0.84) 1999-2023: 1.26 (-1.01 – 3.60) AAMR (95% CI) in 2020 AAPC (95% CI) Rural 1.51 (1.39 – 1.62) 1999-2020: 10.34* (5.05 – 15.90) Urban 0.92 (0.82 – 0.95) 1999-2020: 9.67* (7.32 – 12.06)
