Comparison of 24-Month Clinical Outcomes after Prostatic Artery Embolization in Prostate Glands Larger versus Smaller than 80 mL: A Systematic Review.

PURPOSE: This review was undertaken to compare the clinical outcomes of prostatic artery embolization (PAE) in patients with >80 versus <80 mL prostatic volume (PV) at the 24-month follow-up to determine whether PV predicted the effectiveness or durability of PAE. MATERIALS AND METHODS: The PubMed/MEDLINE database was searched for articles published between 2010 and 2022 using the search term "(prostat∗ artery embolization) AND (long term OR follow-up OR 24-month)." Articles were included if they discussed PAE for benign prostatic hyperplasia (BPH) and reported a minimum follow-up of 24 months. Articles with <10 patients were excluded. A subgroup analysis was performed to evaluate for any difference in clinical outcomes at the 24-month post-PAE follow-up between studies with a mean PV of >80 mL and those with a mean PV of <80 mL. RESULTS: A total of 14 studies with 2,260 patients were included, all of which demonstrated significant reduction in symptoms at the 24-month follow-up after PAE. Four studies were included as part of the >80-mL PV subgroup (n = 467), and 10 studies were included as part of the <80-mL PV subgroup (n = 1,793). There was a statistically significant difference between the mean preprocedural PV (128.5 vs 64.0 mL; P = .015). At the 24-month follow-up, there were no significant differences between groups across any of the compared parameters. The collective incidence of major adverse events reported in the studies within this review was <1%. CONCLUSIONS: PAE is both safe and durable for patients suffering from BPH and can be effective across a wide range of baseline PVs.

A systematic review of current trends in pharmacologic management after stent placement in nonthrombotic iliac vein lesions.

OBJECTIVE: Stenting of the iliac vein is increasingly recognized as a treatment for chronic venous insufficiency (CVI). However, the pharmacologic management after stent placement is unclear. This review was conducted to illustrate recent trends in anticoagulation and antiplatelet regimens following stent placement for nonthrombotic iliac vein lesions (NIVL). METHODS: The MEDLINE database was searched using the term "iliac vein stent." Retrieval of articles was limited to studies conducted on humans and published in English between 2010 and 2020. Studies were included that described iliac vein stent placement. Studies were excluded that contained fewer than 25 patients, performed procedures other than stent placement, did not specify the postoperative anticoagulant used, or treated lesions of thrombotic origin. RESULTS: 12 articles were included in this review, yielding a total of 2782 patients with a male-to-female ratio of 0.77. The predominant CEAP classification encountered was C3. The most common stent used in the included studies was the Wallstent (9/12), and the most common pharmacologic regimen was 3 months of clopidogrel (6/12). Warfarin, aspirin, cilostazol, and rivaroxaban were among other agents used. Primary stent patency ranged from 63.1 to 98.3%. There was no apparent correlation between pharmacologic agent used and stent patency or subjective patient outcomes. CONCLUSION: Multiple different approaches are being taken to pharmacologically manage patients following stent placement for NIVL. There is no consensus on which agent is best, nor is there a formal algorithmic approach for making this decision. Additionally, the findings in this study call into question whether anticoagulation following stenting for NIVL is necessary at all, given the similar outcomes among the different agents utilized. This review underscores the potential value of undertaking a multi-institutional prospective study to determine what is the best pharmacologic therapy following venous stent placement for NIVL.

Analyzing the cost of medical student virtual conference registration by specialty during the COVID-19 pandemic.

CONTEXT: Medical student involvement in research is an important metric used by residency programs across most specialties to better assess the candidates' commitment to advancing medicine as well as their specialty of interest. One strategy is presentation of research work at national conferences in the specialty of interest; another is simply attending these events for networking purposes with program directors. However, attending these conferences carries cost. OBJECTIVES: To investigate the cost incurred by medical students to attend the premier annual scientific meeting of each major medical specialty in 2020, during the novel coronavirus 2019 (COVID-19) pandemic, and to evaluate whether "research intensive" specialties carried greater conference registration costs. METHODS: Potential medical specialties to which students can apply upon graduation were identified in the National Residency Match Program (NRMP). "Research intensive" specialties were defined as those with a mean number of abstracts, presentations, or publications ≥10 per matched applicant in the 2020 NRMP. The premier conference for each specialty was determined by membership in the American Medical Association House of Delegates in the NRMP. The cost to be a member of each conference's parent organization and attend the annual meeting were determined by internet search. Subgroup analysis was conducted to compare cost between research intensive and non research intensive specialties. RESULTS: The registration cost of 19 virtual conferences held in 2020 were analyzed in this study. The average cost to attend as a medical student member of the hosting organization for all conferences was $49.82 (range, $0-$331; SD±$92.18), while the average cost to attend as a nonmember across all conferences was $188.16 (range, $0-$595; SD±$176.35; p<0.001). Seven of 19 (36.8%) meetings had free registration for medical students who are members of the hosting organization. The premier meetings affiliated with the seven research intensive specialties had a significantly higher mean cost for medical students who were members of the parent organization than the meetings of the other specialties ($125.60 vs. $49.20; p=0.031). There was no significant difference in mean registration cost between research intensive and non research intensive specialty conference registration for nonmember medical students (p=0.85). Vascular surgery, radiation oncology, and emergency medicine were the three specialties with the most expensive medical student member registration fees overall ($331, $200, and $195, respectively). CONCLUSIONS: Medical student attendance and presentation at national scientific meetings was found to be significantly more costly for research intensive specialties, although all meetings were held in an online format due to the COVID-19 pandemic. Overall, this reflects an increased financial burden to an already indebted medical student population and compounds the stresses brought on by the pandemic. More national medical societies might consider free meeting registration to reflect support for medical students and encourage their continued participation in research to advance their specialty of interest.