To evaluate a new device for obtaining endometrial biopsies which combines global endometrial disruption using a brush with a built-in suction process.Endometrial biopsies were collected, using the GDP-Tao device, from fresh uteri hysterectomy specimens after completion of surgery. Results were compared to final hysterectomy pathology. Specificity and sensitivity and positive and negative predictive values were calculated.Based on a sample size calculation, 42 patients were included in this study. Endometrial tissue adequate for diagnosis was obtained in 93% (39/42) of biopsies. Classifying atypia as a positive result, the sensitivity of the new device was 96% (23/24), with specificity of 87% (13/15). The positive predictive value was 92% (23/25) and the negative predictive value, 93% (13/14). There were 2 nondiagnostic (ND) samples from GDP-Tao with final pathology of benign endometrium. One specimen was ND on both GDP-Tao and final pathology due to absence of tissue after prior endometrial ablation. When stratified by uterine size, benign or malignant, the results were similar.Our validation study showed encouraging results for the GDP-Tao, which combines tissue disruption and aspiration into a single process. The device provides a reliable means of obtaining adequate samples to accurately detect endometrial cancer with a high negative and positive predictive value.
Background: Health equity and the reduced socioeconomic gap between communities are the main objectives of healthcare delivery in the US with a shifting focus towards social determinants of health. We aimed to compare stroke hospitalizations and outcomes in young patients with low median household income (LMHI) across two national cohorts a decade apart (2007 vs. 2017). Methods: We used National Inpatient Sample (2007 & 2017) to identify young-onset stroke hospitalizations (18-44 years, YOS) belonging to LMHI (0-25th quartile) using relevant codes. Demographics, comorbidities, adjusted risk of YOS and outcomes were compared between two cohorts. Results: Of 34249 LMHI YOS admissions, 13749 belonged to 2007 and 20500 to 2017 (median age 39 vs 38 years, p<0.001). The risk of YOS was 30% higher in 2017 young LMHI admissions than in 2007 when adjusted for socio-demographics and comorbidities (aOR 1.30, 95%CI:1.27-1.34, p<0.001) (Table 1). Gender distribution was comparable for YOS between 2007 and 2017. The 2017 YOS cohort often consisted of white (38.4 vs 33.3%), non-elective admissions (94.9 vs 91.1%) and often had cardiovascular comorbidities and concomitant smoking (42.4 vs 26.9%); whereas lower rates of alcohol (5.5% vs. 8.7%) and drug abuse (12.1 vs. 16%) than in 2007 (p<0.001). Though adjusted all-cause mortality was comparable between the two cohorts (aOR 0.91, 95%CI:0.82-1.00, p=0.054) with shortened stay (5 vs. 4 days) and fewer transfers in 2017; adjusted hospital costs were higher in 2017 (p<0.001). Conclusion: There was an alarming 30% higher risk of YOS admissions in patients from the LMHI quartile across 2 national cohorts a decade apart in the US without any significant improvement in mortality odds when controlled for confounders. Our analysis indicates the need for the adoption and propagation of preventive measures and vigilance to lessen CVD and YOS risk, improve health outcomes and decrease healthcare costs among young patients from LMHI quartile.
•First case report of successfully treating severe paclitaxel and docetaxel hypersensitivity reaction with nab-paclitaxel•We demonstrated that nab-paclitaxel is a safe taxane chemotherapy treatment option for patients who could not tolerate paclitaxel or docetaxel.
Background: The scarcity of large-scale trends data on young-onset stroke prompted us to explore the difference in stroke hospitalization and inpatient outcomes among young adults from two nationwide cohorts 10 years apart. Methods: The National Inpatient Sample (2007 & 2017) was utilized to identify stroke admissions among young adults(18-44 years). We compared demographics, comorbidities, inpatient outcomes and gender/racial disparities in frequency of stroke admissions and mortality between the two cohorts 10-years apart. Results: There was an increase in stroke admissions of young adults in 2017 (0.7%, n=58965/8,568,874, aOR: 1.48, 95%CI:1.46-1.5, p<0.001) compared to 2007 (0.4%, n=41379/10,330,126) [Table 1] . The 2017 cohort often included female (49.0% vs 48.4%), non-elective admissions (94.0% vs 90.9%), Medicaid beneficiary (35% vs 23.4%) and urban teaching hospitalizations (81% vs 61.6%)(p<0.05) vs. the 2007 cohort. Cardiovascular comorbidities like hypertension, hyperlipidemia, obesity, peripheral vascular disorders, congestive heart failure and atrial fibrillation/flutter were significantly more prevalent in the 2017 cohort vs. 2007. Reassuringly, with advanced medical and interventional therapeutics in the last decade, the odds of in-hospital mortality decreased in 2017 (aOR 0.84, 95%CI: 0.79-0.89) vs. 2007. Females, Caucasians and Hispanics witnessed a higher relative increase in stroke hospitalizations in 2017. In addition, compared to 2007, a significant decline in mortality was noticed among both sexes but Hispanics and Asians did not show an improvement in survival odds in2017 vs 2007. Conclusion: Comparison of two young stroke cohorts a decade apart shows an alarming rise in stroke hospitalizations (nearly 50% higher) with cardiovascular disease risk factors, particularly in the female gender, with declining in-hospital mortality. Persistent racial disparities warrant an inclusive approach in preventive care.
Background: D-dimer has been evaluated as an independent marker of ischemic stroke. The non-existence of a clear consensus and pooled data about the use of D-dimer as a predictive biomarker for assessing the risk of stroke recurrence led us to perform this systematic review and meta-analysis. Methods: Studies reporting the risk of stroke recurrence with varying degrees of high D-dimer levels were screened through August 2021 using PubMed/Medline, Scopus, EMBASE and Web of Science databases and relevant keywords. Random effects models by Dersimonian & Laird were used for meta-analysis and subgroup analysis. I 2 statistics were used for heterogeneity assessment. The leave-one-out method was used for sensitivity analysis. Results: This systematic review included 5040 patients from 9 studies consisting of >60% males. There was a high burden of cardiovascular comorbidities, smoking and diabetes in stroke patients with or without associated diagnoses and high D-dimer levels. Compared to low D-dimer levels, higher plasma D-dimer levels were associated with ~80% (aOR 1.79, 95% CI: 1.24-2.59) increased risk of stroke recurrence. The odds of stroke recurrence were significantly high in the stroke cohorts including patients with mean age <70 years (OR 2.44, 95%CI:1.00-5.94, p<0.05) with high D-dimer levels (Fig. 1) . In addition, elevated D-dimer levels showed a robust association for stroke recurrence in studies with higher sample size (n>500 vs. n<500: OR 2.48, 95%CI:1.18-5.19, p<0.05) and studies reporting late recurrence (vs. early recurrence: ≥1 month vs <1 month: OR 2.07, 95%CI:1.23-2.55, p<0.01). Conclusion: This meta-analysis showed that high D-dimer levels were associated with nearly 80% higher odds of stroke recurrence irrespective of the etiology of index stroke events. Stronger associations were seen in studies with a mean age <70 years and a higher sample size. Late-onset recurrence had a stronger association with high D-dimer levels compared to early-onset.
