INTRODUCTION:10 randomized controlled trials (RCTs) have compared general anesthesia (GA) with non-GA sedation for endovascular thrombectomy (EVT) in patients with emergent large vessel occlusion (ELVO). We performed an updated meta-analysis of the existing trials. METHODS:Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, all RCTs comparing GA versus non-GA during EVT for ELVO published between May 2022 and October 2025 were identified. Two meta-analyses were performed. The primary meta-analysis included all trials, whereas the secondary analysis included only those trials with inclusion criteria similar to those used in the pivotal thrombectomy trials. RESULTS:10 RCTs were identified, of which six were included in the secondary analysis. Across all 10 trials, GA significantly increased the odds of successful revascularization compared with non-GA (n=1584; pooled OR 1.79, 95% CI 1.35 to 2.36; P<0.001; I²=0%), but no significant difference was observed in the resulting functional independence of treated patients. In the secondary analysis of six trials, GA was associated with a significant improvement in functional independence (n=648; pooled OR 1.58, 95% CI 1.15 to 2.18; P=0.005; I²=0%), in addition to higher revascularization rates. Mortality at 90 days and hemorrhagic complications did not differ significantly between the groups in either analysis. CONCLUSIONS:GA significantly improved successful revascularization rates in patients undergoing EVT. In RCTs that enrolled patients based on established EVT inclusion criteria, the rate of good functional outcome at 90 days was significantly higher in patients undergoing EVT with GA compared with non-GA.
Thyroid nodules are extremely common with a prevalence of up to 70% in the general population. While the majority of these are benign, 5–10% harbor a malignancy. Fine-needle aspiration has been widely implemented to stratify the cancer risk of thyroid nodules. Standardized diagnoses using the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) have aided in the triaging of nodules. While many cases are categorized with a definite diagnosis of benign (Bethesda II) or malignant (Bethesda VI) results, approximately 25% of cases are diagnosed as atypia of undetermined significance (AUS) (Bethesda III) or follicular neoplasm (Bethesda IV). These cytological categories imply an intermediate risk of malignancy ranging from 16 to 48%. These nodules, collectively defined as indeterminate thyroid nodules, pose diagnostic and management challenges. In recent years, several commercial molecular testing (MT) methods have become available to improve risk stratification, successfully helping to reduce unnecessary surgeries. In this review, we provide an overview of MT methods, present practical guidance on interpreting test results, and conclude with a discussion on future directions in the field.
INTRODUCTION:While testosterone replacement therapy (TRT) is generally effective in restoring testosterone levels and improving quality of life, its dermatological adverse effects are underreported compared to cardiovascular and oncologic risks. OBJECTIVE:This review aims to synthesize existing evidence on cutaneous complications associated with TRT to better inform clinical practice. METHODS:A scoping review was conducted using PubMed, Scopus, and Cochrane databases to identify studies reporting dermatologic adverse events related to TRT in adult men. Inclusion criteria focused on original studies documenting skin-related side effects in TRT recipients. Ten studies met eligibility: eight prospective clinical trials and two retrospective chart reviews published between 2006 and 2025. Data were extracted and summarized narratively. RESULTS:Across all included studies, dermatologic adverse events were consistently reported. Acne was the most frequent, affecting 0.6%-9.1% of participants, with the lowest incidence in oral formulations. Pruritus occurred in up to 10.0%, rashes in up to 5.3%, and abnormal hair growth in up to 5.3%. Injectable formulations were generally associated with higher rates of acne and systemic reactions than topical or oral preparations. Despite the prevalence of these effects, most studies lacked standardized reporting or detailed management strategies. CONCLUSIONS:Dermatologic side effects of TRT, though often considered non-severe, can significantly impact patient satisfaction, adherence, and quality of life. Acne and other cutaneous reactions vary by delivery method and patient susceptibility, emphasizing the need for clinician awareness, patient counseling, and better adverse event reporting. Future research should standardize dermatologic outcome measures and explore effective prevention and management strategies to improve the safety and tolerability of TRT.
The United States is experiencing a high societal burden of pregnancy-related and infant morbidity and mortality during the postnatal year. These trends are inherently linked because the 2 members of the parent-infant dyad are interdependent for their well-being. Several systemic factors contribute to suboptimal health outcomes, including health care siloes under the medical specialization paradigm, multiple care transitions, and lack of care coordination during the postnatal year. Despite the clear positive impact of breastfeeding on parent and child health outcomes, as a dyadic specialty, lactation care does not have an obvious home within the siloed United States health care system. The objective of this article is to propose implementation of a comprehensive dyadic care model for birthing parents and infants during the postnatal year, including a focus on provider-level lactation management. Practical issues, such as clinic workflows, financial sustainability, workforce development solutions, and scope of practice issues are discussed. Midwives are ideally positioned to be leaders in the provision of dyadic perinatal care during the postnatal year, with long-term implications for parent and infant health.
Abstract Introduction Nighttime digital media can adversely impact sleep through sleep displacement and/or disruption. One potential mechanism causing nighttime use is that “usage begets usage:” media use prior to bedtime may prime an individual to use their smartphone again during the nighttime. To test this hypothesis, we examined whether objectively measured smartphone use prior to bedtime predicted a higher likelihood of late-night smartphone use at the daily, within-person level among a national, diverse sample of adolescents. Methods Adolescents who owned or were the primary user of a personal smartphone from across the U.S. (n=229; 47%F, 46%M, 7% other) were recruited into the Stony Brook University Measuring Electronic Devices in Adolescents (MEDiA) Study. Participants answered a survey querying sociodemographic characteristics and sleep timing and then installed RealityMeter, which passively measured objective smartphone use (M±SD=16.8±13.7 days). Multilevel logistic models with random intercepts nested within individuals assessed whether person-mean-centered total (M=18.51m), social media (e.g., TikTok, Instagram, Facebook, YouTube; M=8.53m), and non-social media (e.g., messaging, gaming, streaming videos/movies; M=9.99m) smartphone use ≥30 minutes in the hour before the sample-mean of self-reported bedtime ("pre-bedtime," defined as 22:24-23:23 for school nights; 23:24-0:23 for non-school nights) predicted higher likelihood of ≥30 minutes of usage during the night (0:00-5:00 school nights; 1:00-6:00 non-school nights; M=46.74m) at the within-person, nightly level (≥30 minutes of usage: pre-bedtime total=28.5%, social media=10.0%, non-social media=11.6% of evenings; nighttime total=40% of nights). Results Within-person findings demonstrated that on evenings when adolescents engaged in ≥30 minutes of pre-bedtime smartphone use compared to when they did not engage in ≥30 minutes pre-bedtime use, likelihood of ≥30 minutes nighttime smartphone use was higher, with overlapping confidence intervals for the three categories of pre-bedtime media use: total pre-bedtime media (OR=1.45; 95%CI=1.19-1.77), social media (OR=1.23; 95% CI 0.92-1.65), and non-social media (OR=1.38; 95%CI=1.04-1.84) use. Conclusion After evenings when adolescents used their smartphone prior to sleeping, they had a higher likelihood of using their smartphone later that same night, which increases the risk of later bedtimes and opportunity for sleep disruption. Reducing pre-bedtime smartphone use may serve as a strategy to reduce nighttime use and improve sleep, health, and wellbeing. Support (if any) Della Pietra Family Foundation
