Objectives Investigate whether or not race is associated with differences in hospitalization and survival to discharge among patients with coronavirus disease-2019 (COVID-19) at the height of the pandemic in New York City (NYC). Methods Single-center retrospective cohort study of COVID-19 patients hospitalized at our university-affiliated NYC hospital from 3/10/20 through 4/13/20 with follow-up to 5/1/20. Our primary endpoint was hospitalization rate among patients with confirmed COVID-19 compared with the regional population based on race. Our secondary endpoint survival to discharge among hospitalized COVID-19 patients. NYC Department of Health data were used to calculate hospitalization odds ratios. Chi-square and t tests were used to compare categorial and continuous variables, respectively. Cox proportional hazards regression and predictive analysis were used to investigate our endpoints further. Results Our cohort of 734 patients included 355 women (48.4%), 372 Blacks (50.7%), 214 Whites (29.2%), and 92 Hispanics (12.5%) in our analysis. Blacks were nearly twice as likely as Whites to require hospitalization for COVID-19 (OR 1.89, 95% CI, 1.59-2.24, p < 0.001). Hispanics were also more likely to suffer in-hospital mortality from COVID-19 compared with Whites (HR 1.84; 95% CI 1.21-2.80; p = 0.005). There was a non-significant increased hazard of in-hospital mortality among Blacks when compared with Whites (HR, 1.30; 95% CI, 0.95-1.78; p = 0.09). Conclusions and Relevance Blacks were more likely than Whites to require hospitalization for COVID-19 while Hispanics were more likely to experience in-hospital mortality. Further investigation into the socioeconomic factors underlying racial disparities in COVID-19 survival and severity requiring hospitalization is needed on a national scale.

Pancreatic malignancy portends poor prognosis with a dismal 5-year survival of 8%. 1 Moreover, the disease burden of pancreatic cancer continues to rise, having the second highest incidence among gastrointestinal tumors in the U.S. 2 Prompt tissue diagnosis allows for early targeted treatment, potentially improving progression-free survival. 3 The advent of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) has permitted minimally invasive tissue acquisition for tissue diagnosis. Unlike FNA needles, the reverse or opposing cutting bevel design of the FNB needle allows for the biopsy of core histopathologic tissue. 4 EUS-FNA and EUS-FNB provide accurate diagnoses of solid pancreatic lesions with a reported sensitivity of 85% and 87%, respectively. 5,6 Previous studies comparing the two needles have yielded conflicting results with no clear superiority. 7-10 There has been a recent increase in randomized con

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Background: Endoscopic ultrasound–guided cystogastrostomy has become the first-line treatment for symptomatic peripancreatic fluid collections. The aim of this study is to analyze the efficacy and safety of cystogastrostomy via a meta-analysis of the literature. Methods: We performed a systematic search of PubMed and Medline databases for studies published from January 2005 to May 2018. We included randomized controlled trials along with retrospective and prospective observational studies reporting endoscopic ultrasound–guided cystogastrostomy stent placement for peripancreatic fluid collections. The primary outcome for our meta-analysis was complete peripancreatic fluid collection resolution on imaging. Our secondary outcomes included comparative efficacy and safety of the procedure for pseudocysts and walled-off pancreatic necrosis using metal and plastic stents. Results: Seventeen articles involving 1708 patients met our inclusion criteria for meta-analysis. Based upon the random effects model, the pooled technical success rate of cystogastrostomy was 88% (95% confidence interval = 83–92 with I 2 = 85%). There was no difference in the technical success rate between pancreatic pseudocysts and walled-off pancreatic necrosis (91% and 86%, respectively p = nonsignificant). The adverse event rates for metal and plastic stents were equivalent (14% and 18%, respectively, p = nonsignificant). Conclusion: Endoscopic ultrasound–guided cystogastrostomy stents are effective in the treatment of pancreatic pseudocysts and walled-off pancreatic necrosis. We found no difference in technical success or adverse event rates of drainage based on peripancreatic fluid collection type or stent used.

ObjectiveOur objective was to report safety and efficacy of stereotactic radiosurgery (SRS) to the surgical bed following resection of brain metastases.MethodsEighty-seven consecutive patients who underwent cavity-directed SRS to the operative bed for the treatment of brain metastases between 2002 and 2010 were evaluated. SRS required a gadolinium-enhanced, high-resolution, T1-weighted magnetic resonance imaging for tumor targeting and delivered a median dose of 18 Gy (14-22 Gy) prescribed to encompass the entire resection cavity. Whole brain irradiation was reserved for salvage. Patients were followed every 3 months with clinical examination and magnetic resonance imaging. Overall survival, local and regional recurrence, and factors affecting these outcomes were evaluated using Kaplan-Meier and log-rank analyses.ResultsThe median imaging follow-up was 7.1 months, with >40% of patients having imaging for ≥1 year. Local control at 1 and 2 years was 82% and 75%, respectively. Cavity recurrence was more common with a tumor diameter >3 cm (P < .020) or resection cavity volume >14 mL (P < .050). One-year local control for tumors <2 cm, 2 cm to 3 cm, and >3 cm were 100%, 86%, and 72%, respectively. Neither subtotal resection nor target margins >2 mm to 3 mm affected local control. The median overall survival was 14.3 months with actuarial 5-year survival of 20%. Actuarial regional central nervous system recurrence was 44% at 1 year. On univariate analysis, only the presence of extracranial disease was associated with survival (P < .001) and central nervous system failure (P < .030).ConclusionsExcellent local control is achievable with cavity-directed SRS in well-selected patients, particularly for lesions with diameter <3 cm and resection cavity volumes <14 mL. Long-term survival is possible for select patients.