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Carotid artery stenosis remains a major cause of ischemic stroke worldwide, and its management continues to evolve in parallel with advances in surgical, endovascular, and medical therapies. Carotid endarterectomy (CEA) was established as the standard of care for symptomatic high-grade stenosis following landmark randomized trials, while carotid artery stenting (CAS) subsequently emerged as a less invasive alternative for appropriately selected patients. This review aims to summarize the historical evolution of carotid artery stenting, critically appraise evidence from major clinical trials comparing CAS and CEA, and examine contemporary practice patterns in the era of intensive medical therapy. A comprehensive review of randomized trials, registries, guideline statements, and recent literature was performed to synthesize current evidence regarding procedural outcomes, patient selection, and emerging technologies, including transcarotid artery revascularization (TCAR). Large, randomized trials have demonstrated comparable long-term composite outcomes between CAS and CEA in selected patients, although peri-procedural risk profiles differ, with higher stroke risk observed after CAS and higher myocardial infarction rates after CEA. Technological advancements in embolic protection devices, stent platforms, and alternative access strategies have further refined endovascular approaches. Concurrently, improvements in intensive medical therapy—including lipid-lowering, antiplatelet therapy, blood pressure control, smoking cessation, and lifestyle modification—have substantially reduced overall stroke risk, particularly in asymptomatic patients. In the contemporary era, optimal stroke prevention requires individualized, multidisciplinary decision-making that integrates symptom status, anatomical complexity, comorbid conditions, procedural expertise, and sustained long-term vascular risk factor management following revascularization.

Background With increasing healthcare demands for acute illness in patients especially in the times of pandemic, healthcare organizations require modern solutions. Hospital at home (HaH) is one such tool that has the potential to solve these problems without compromising the care of the patients. Main body Hospitals have been the conventional setting for managing acute sickness patients; however, it could be a very challenging environment for a few patients, especially for the older population who are highly susceptible to hospital-acquired infections. Health care in a hospital setting can also be very expensive, as it often involves a lot of healthcare professionals providing care. HaH service can provide the same quality of care expected in traditional settings. Conclusions The median length of stay and the rate of readmissions were lower in people under HaH care. Compared with patients in a hospital setting, patients in HaH had better clinical outcomes. HaH unit provides an integrated, flexible, easy-to-scale platform that can be cost-effectively adapted to high-demand situations.

Bronchogenic cysts are closed sac-like cystic lesions resulting from abnormal budding of the primitive foregut during the early development of the alimentary and respiratory systems. We describe the case of a 54-year-old man who presented to the emergency department with complaints of fever, chills, shortness of breath, and a productive cough with intermittent hemoptysis for the past two to three months. Initial workup revealed a right lung hydropneumothorax with complete atelectasis of the right lung and a mass effect on the left lung. During intercostal drainage, pleural fluid analysis revealed empyema with treated with antibiotics. However, the symptoms persisted after five days of antibiotic treatment and drainage. A multidisciplinary team of thoracic surgeons, anesthesiologists, and pulmonologists was assembled due to the non-resolving nature of the lung abscess. The patient underwent a right middle lobe lobectomy with decortication via open thoracotomy, and a bronchogenic cyst, an uncommon cause of the lung abscess, was suggested by histopathological analysis.

Prolonged hospital stays can significantly impede patients' recovery, negatively affecting anything from physical health via issues like hospital-acquired infections and increased complications due to immobility to psychological health. Several studies investigated the psychosocial impact of prolonged hospital stays, revealing a variety of patient perspectives, such as feeling uncertain and frustrated about their conditions, which can erode their trust in healthcare providers. Delayed discharges not only affect patients but also have multifaceted effects on healthcare providers, potentially reducing physician efficiency and contributing to higher rates of burnout among healthcare professionals. This article investigates the consequences of delayed versus early discharge on physicians, patients, and the overall hospital system. We conducted an extensive search through PubMed and Google Scholar using the keywords \"delayed discharge,\" \"hospital discharge,\" and \"bed blocking\" to identify all the recent studies highlighting the dynamics of patient discharge. Our results support the hypothesis that reducing delayed discharge rates will not only improve patient outcomes but also have widespread fiscal impacts. This review also outlines measures to reduce delayed discharges, ultimately leading to a significant enhancement in the healthcare system.

Sepsis is characterized by life-threatening organ dysfunction due to dysregulated host response to infection. It can progress to cause circulatory and cellular/metabolic abnormalities, resulting in septic shock that may significantly increase mortality. The pathophysiology of sepsis involves a complex interplay of invading pathogens and the body's immune defense, causing alteration in normal homeostasis, eventually leading to derangements in the cellular, humoral, circulatory, and metabolic functions. Several scoring systems have been developed to rapidly predict or suspect sepsis, such as Sequential Organ Failure Assessment (SOFA), modified SOFA (mSOFA), quick SOFA (qSOFA), shock index (SI), and modified SI (mSI). Each of these scores has been utilized for triaging patients with sepsis, and as per medical advancements these scoring systems have been modified to include or exclude certain criteria to improve their clinical utility. This review aims to compare the individual scores and their usage for sepsis that may be used for laying the foundation for early recognition and prediction of sepsis and for formulating more precise definitions in the future.

Pulmonary Langerhans cell histiocytosis (PLCH) is an uncommon lung disease that affects young adults aged 20 to 40 years with current or prior history of smoking. The pathologic cell type in PLCH is a dendritic cell of the monocyte-macrophage line that resembles cutaneous Langerhans cells. This report presents the case of a 42-year-old woman with PLCH. We discuss her clinical symptoms, diagnostic tests, and treatment plan, with a specific focus on the radiologic features. The patient exhibited a radiologic appearance similar to that of lymphangiomyomatosis with histologic evidence of PLCH.

BackgroundPost-treatment depression among patients and caregiver burnout is a phenomenon that manifests with stress, fatigue, and exhaustion. It is characterized as ‘a triad of depersonalization, emotional exhaustion, and decreased self-care’ related to self or caregiving activities. It’s a common and emerging problem among cancer patients and caregivers. Previous meta-analyses have shown higher suicide rates compared to gender and age-matched individuals in the general population. Music has been known to relieve stress and produce an environment of peace and harmony. Our study aims to study the impact of a full-time live harp player in the hospital in improving patients‘ and caregivers’ well-being.MethodsWe studied patients‘ and caregivers’ responses on the oncology floor to having a full-time live harp player in the hospital. Several aspects were studied, including stress, overthinking, interpersonal relationships, self-care, and fatigue. These responses were analyzed to understand the impact of having a live musician in a hospital setting.ResultsOur study shows that having a full-time live musician in the hospital who plays the harp at a different location throughout the day on the oncology floors brings a sense of hope and peace among the patients and caregivers (figure 1). Harp has been known to induce meditation, and its massive presence with the aura of a live musician mitigates to relieve stress. There was an overall decrease in fatigue, with less emotional exhaustion and less depersonalization improving interpersonal relationships and self-care.ConclusionsAdding several new and innovative interventions, such as a full-time live musician or harp player, will likely improve the overall well-being and efficacy of the patients and caregivers. A persistent focus on a supportive and inclusive environment will enhance the trend toward significance that has already been demonstrated. Recognizing caregivers’ burnout protective factors allows us to work on them and prevent their effects. Interventional and preventative measures should be adapted and adopted, and longitudinal studies on the same topic be conducted for monitoring and evaluation. Implementing this at other hospitals and studying its impact in a controlled environment is imperative in moving towards better emotional outcomes among cancer patients and caregivers in all hospitals across the US.Abstract 908 Figure 1

Background Guidelines show that for metastatic colorectal cancer (mCRC), a combination of three‐drug regimens, fluorouracil, leucovorin, and oxaliplatin and bevacizumab (BVZ), is one of the first‐line standard therapies. BVZ is generally well tolerated; however, it is associated with infrequent, life‐threatening side effects such as severe hypertension (HTN) (5%–18%), Grade ≥3 arterial thromboembolism (ATE) (2.6%), Grade ≥3 hemorrhagic events (1.2%–4.6%), and gastrointestinal perforation (0.3%–2.4%). This meta‐analysis aims to evaluate the additive risk of BVZ‐induced severe HTN and thromboembolism when BVZ is combined with a standard chemotherapy regime in patients with mCRC. Methods Our search was conducted from January 29, 2022, to February 22, 2022, through databases of PubMed, clinicaltrial.gov, EMBASE, Web of Science, and Cochrane Library. Data analysis from randomized controlled trials (RCTs) and clinical trials was conducted using Review Manager V.5.4, comparing BVZ‐chemotherapy to chemotherapy only, focusing on cardiovascular AE such as HTN and arterial and venous thromboembolism. Results The analysis from 26 clinical trials and RCTs showed that the odds of HTN were about four times higher, and ATE subgroup analysis of 11 studies showed over two times higher odds of ATE in patients being treated with BVZ compared to the chemotherapy‐only group. Conclusion BVZ, when added to the standard chemotherapy regimen for mCRC, was associated with higher odds of developing HTN and thromboembolism, specifically ATE, than the chemotherapy‐only group. Our findings are significant as they provide vital information in analyzing the risk–benefit ratio of adding BVZ to the standard chemotherapy regime in patients with mCRC, especially in patients with vascular comorbidities.

BackgroundAfrican Americans (AA), who have the highest colorectal cancer (CRC) incidence and mortality rates of all racial groups in the US, have a 20% higher likelihood of getting CRC and a 40% higher death rate.1 In 2018 the American Cancer Society (ACS) modified its guidelines to recommend beginning CRC screening at age 45. In October 2020, the USPSTF adapted these ACS guidelines. We aim to study CRC disparities and precision cancer prevention in bringing awareness and addressing CRC disparities.MethodsA comprehensive staged literature search utilizing the PRISMA guidelines was performed on PubMed, Web of Science, and Cochrane Library, using relevant Medical Subject Headings (MeSH) keywords. After full-text analysis, all papers were screened and included only relevant articles on CRC Disparity.ResultsWe found that genetic factors contribute 35% to the overall risk of CRC. Genetic and biological differences like tumor microenvironment between White and AA communities play a crucial role in developing an aggressive tumor and its progression. For AA communities, an increased expression of cytokines and tumor-expressed macrophages in the tumor environment has a significant role in unchecked CRC progression. Currently, AA are more likely to be diagnosed later and have higher mortality rates at any age of diagnosis than Whites.2 AA typically experiences delays or ends the treatment early, in addition to the specific disparities within chemotherapy administration.2–4 Among Native Americans, CRC is the second most common cancer and the second leading cause of cancer death. Other minority groups, including Ashkenazi Jews, are at a higher risk for CRC due to specific gene mutations.2 ConclusionsGermline genetics and tumor phenotype can be correlated to racial identity and are one of the reasons why AA has higher mortality rates. The tumor microenvironment is impacted by non-genetic risk factors such as tobacco consumption and differences in the gut microbiome. In addition, communities of low socioeconomic status are impacted by discrepancies in CRC treatment and poorer medical care for AA, adding another aspect to the racial disparities in CRC diagnosis and management.5 Precision cancer prevention is the key to addressing CRC disparity. It will be helpful to improve access to CRC screening programs via state funding.6 Promoting CRC education about justice, equity, diversity, and inclusion awareness among PCPs and community workers in high-risk areas outside the catchment area of existing National Cancer Institutes (NCI) will be beneficial.7 ReferencesAbigail Silva, Nazia Sayad, Fernando De Maio, Maureen Benjamins; Abstract B137: Colorectal cancer mortality and disparities in America’s 30 most populous cities. Cancer Epidemiol Biomarkers Prev 1 June 2020;29(6_Supplement_2):B137. https://doi.org/10.1158/1538–7755.DISP19-B137Soneji S, Iyer SS, Armstrong KA, Asch DA, Baron JA. Racial disparities in stage-specific colorectal cancer mortality: 1960–2005. American journal of public health, 2015;105(11):2199–2205.Doubeni CA, Gabler NB, Wheeler CM, McCarthy AM, Castle PE, Halm EA, ... Wender RC. Timely follow-up of positive cancer screening results: A systematic review and recommendations from the PROSPR consortium. CA: A Cancer Journal for Clinicians, 2018;68(3):199–216.Shavers VL, Brown ML. Racial and ethnic disparities in the receipt of cancer treatment. Journal of the National Cancer Institute, 2002;94(5):334–357.Doubeni CA, Laiyemo AO, Major JM, Schootman M, Lian M, Park Y, Zauber AG. Socioeconomic status and the risk of colorectal cancer: an analysis of more than a half million adults in the National Institutes of Health-AARP Diet and Health Study. Cancer, 2013;119(23):4230–4236.Sabatino SA, Lawrence B, Elder R, Mercer SL, Wilson KM, DeVinney B, ... Melillo S. Effectiveness of interventions to increase screening for colorectal cancer: a systematic review and meta-analysis. American journal of preventive medicine, 2012;43(1):97–118.Patel SS, Burns R, Shulman LN. Health disparities in the management of colorectal cancer in the United States: a national survey of oncologists. Journal of clinical oncology, 2016;34(22):2618–2625.