UI Hospitals and Clinics is part of University of Iowa Health Care, a partnership that includes the University of Iowa Roy J. and Lucille A. Carver College of Medicine and the University of Iowa Physicians group practice.It is located on the University campus in Iowa City, Iowa at Melrose Avenue and Hawkins Drive near Kinnick Stadium. At times during televised Hawkeye football games, the hospital can be seen in the background. The hospital is one of three in Iowa City, the others being Mercy Hospital and the Iowa City VA Health Care System, a VA medical center.UI Hospitals and Clinics employs over 7,100 people and is overseen by the Iowa Board of Regents. It is Iowa's only comprehensive, tertiary-level center and also its premier medical facility. In addition to taking care of local patients, people throughout the state and region are often referred to the University's hospitals for treatment of serious or complex illnesses or injuries.
PURPOSE:Large bore catheters are increasingly used in mechanical thrombectomy (MT) for large vessel occlusions (LVOs). OBJECTIVE:To evaluate the efficacy and safety of the super-large bore Cereglide 0.092" (C-92) catheter, featuring the largest inner diameter available. METHODS:A multicenter observational study was conducted across 12 comprehensive stroke centers in the United States. Efficacy outcomes included the first pass effect (FPE) and successful reperfusion. FPE was defined as a first MT pass achieving a modified Treatment in Cerebral Infarction (mTICI) score of ≥2c. Successful reperfusion was defined as final mTICI score ≥2c. Safety outcomes involved device-related complications, symptomatic intracranial hemorrhage (sICH), and inpatient mortality. Functional outcomes included modified Rankin Scale (mRS) score at discharge and delta National Institutes of Health Stroke Scale (NIHSS) score. RESULTS:Fifty patients were included. The most common LVO was the first segment of the middle cerebral artery in 31/50 cases (62%). The C-92 reached the thrombus in 41 patients (82%). Median puncture-to-thrombus and puncture-to-reperfusion times were 15 min (IQR 10-25) and 26 min (IQR 15-49), respectively. FPE was achieved in 25/50 (50%) cases, and in 25/41 (61%) cases when the C-92 reached the thrombus. Successful reperfusion occurred in 36/41 patients (88%). There were no vessel perforations, or sICH. Distal embolization occurred in 4/50 (8%) cases, and 4/50 (8%) died. The mRS score at discharge was 3 (IQR 2-6), and the delta NIHSS score was 8 (IQR 5-12). CONCLUSION:The C-92 catheter demonstrated a safe profile achieving an overall FPE rate of 50%, and favorable functional outcomes in 88% of cases.
BACKGROUND:To systematically review published reports of standalone bland embolization for intracranial meningioma and summarize clinical, radiographic, and safety outcomes. METHODS:A systematic PubMed search was performed from inception through December 2025 in accordance with PRISMA guidelines. Eligible studies included intracranial meningiomas treated with embolization as the primary therapy without planned immediate surgery or radiation. Data on patient characteristics, tumor features, embolic materials, complications, and longitudinal outcomes were extracted and synthesized descriptively. RESULTS:Twelve studies comprising 30 patients met inclusion criteria. Patients were typically older or high-risk surgical candidates, and tumors were most commonly convexity or parasagittal with predominant external carotid artery supply. The middle meningeal artery was embolized in 27/30 cases. Particles (polyvinyl alcohol or tris-acryl gelatin microspheres) were the most commonly used embolic agents, with multiple studies also reporting liquid embolics. Quantitative volumetric follow-up was available in 18 patients and demonstrated a mean tumor volume reduction of 37% over a mean follow-up of 13 months. Durable symptomatic improvement was reported in all cases with available clinical follow-up. Treatment-related complications included two patients with transient edema, one requiring steroids. Two patients underwent delayed additional tumor-directed therapy. CONCLUSIONS:This review is limited by low-quality evidence of the existing literature. Nevertheless, the evidence suggests that standalone bland embolization appears technically feasible and may provide symptom improvement and moderate tumor control in selected intracranial meningiomas, without precluding subsequent surgery or radiation. These findings provibaseline outcome data, establish a precedent for possible pragmatic trials, and may inform the design and interpretation of future endovascular therapy studies for meningioma.
Objective. Preoperative imaging is vital for cochlear implant surgeries, aiding diagnosis, and surgical planning. This study evaluated global practices and the value of preoperative imaging through an international survey. Methods. A cross-sectional survey was conducted among international cochlear implantation experts using a 112-item questionnaire. The study explored imaging modalities, anatomical targets, evaluated parameters, and different imaging approaches' perceived value and risks. Participants were recruited from a global consortium of otolaryngology, otology, neurotology, and cochlear implant surgery professionals. Results. Thirty-nine practitioners from 36 centers in 16 countries completed the survey (95.1% response rate). All used computed tomography (CT) and magnetic resonance imaging (MRI) for preoperative evaluation; MRI was deemed more valuable for diagnosis and candidacy assessment, while CT was preferred for surgical planning. Nearly half utilized additional imaging modalities, with functional MRI being the most common (20.5%). Additionally, 79.5% of respondents reported using image-based surgical planning software. Discussion. Results show a universal reliance on CT and MRI for cochlear implant evaluations, with MRI aiding diagnosis and CT focusing on surgical planning. Advanced imaging techniques may emerge in specific clinical cases. Implications for practice. Modern imaging practices and their potential changes can enhance protocol development and improve preoperative evaluations, ultimately boosting patient safety and outcomes in cochlear implantation.
Toxicology testing for drugs associated with scenarios such as recreational use or substance use disorder can be performed in support of the emergency department (ED) for specific patient populations such as pediatrics and trauma. These compounds were historically referred to as drugs of abuse (DOA); although the word "abuse" is recognized as potentially stigmatizing, no replacement terminology for DOA has emerged in current guidelines. This document refers to these compounds as drugs or substances of misuse, and acknowledges the need for less-stigmatizing language that more fully encompasses the range of uses for these drugs. This literature-driven, consensus guidance document provides recommendations primarily targeted to US hospital-based laboratories performing urine drug testing (UDT) in support of the ED. Indications for ordering UDT and related testing in both pediatric and adult populations are summarized. Further, recommendations are made for testing that should be available at all facilities with rapid turnaround, and how to perform and report testing. The advantages and disadvantages of immunoassays and mass spectrometry, as well as common challenges, are reviewed. Indications for mass-spectrometry assays and more extensive testing (e.g., novel psychoactive substances) are also provided. Future directions for improvements in laboratory technology to improve the utility of this testing are outlined. All laboratories should collaborate with ED leadership, medical toxicologists and poison control centers to optimize and update test menus to reflect local drug use patterns, ensure test methodologies and results meet clinical needs, and educate clinical staff regarding assay limitations and accurate test interpretation.
The WHO 2019 classification of digestive tract tumors introduced a high-grade (G3) category for well-differentiated neuroendocrine tumors (NETs). These neoplasms appear to have a better prognosis than poorly differentiated neuroendocrine carcinomas (NECs) and may not respond to platinum-based chemotherapy, which is the treatment of choice for NECs, justifying the creation of this new category. Most existing data on G3 NETs are derived from pancreatic neuroendocrine neoplasms, as the majority of G3 neuroendocrine neoplasms (NENs) arise there. G3 NETs are rare at extrapancreatic sites, and their prognosis and behavior are not well studied. We collected and analyzed a multi-institutional cohort of 24 extrapancreatic primary gastrointestinal G3 NETs based on mitotic rate and/or Ki67 index (5 gastric, 13 small bowel, 6 colorectal/anal). Mean Ki67 index was 29.3% (range: 10.5% to 50.2%). Cases generally showed typical well-differentiated NET morphology. Nodal metastases were present in 17/17 (100%) patients; 13/24 (45%) had distant metastases at initial presentation, and 7 patients developed them on follow-up. With a median of 29 months of follow-up, only 2 patients (8%) were alive without disease. Outcomes of G3 NETs were compared with a separate cohort of 125 extrapancreatic G1/G2 gastrointestinal NETs. G3 tumors presented at a higher pT-category stage ( P <0.001) and overall stage ( P =0.002), and patients with G3 disease were more likely to die than those with G1/G2 disease ( P <0.001). Our data show that, like pancreatic G3 NETs, rare extrapancreatic gastrointestinal G3 NETs exhibit aggressive behavior compared with their G1/G2 counterparts (although small bowel NETs tend to recur irrespective of grade). In most cases, the G3 designation is driven by Ki67 index, though exceptions exist, emphasizing the need for reviewing mitotic count in every case.
