Bruton tyrosine kinase (BTK) links the B-cell antigen receptor (BCR) and Toll-like receptors with Nuclear factor kappa B (NF-κB). The role of BTK in primary CNS lymphoma (PCNSL) is unknown. We performed a Phase 1 clinical trial with ibrutinib, the first-in-class BTK inhibitor, for patients with relapsed or refractory CNS Lymphoma. Clinical responses to ibrutinib occurred in 10/13 (77%) PCNSL patients, including five complete responses. The only PCNSL with complete ibrutinib resistance harbored a mutation within the coiled-coil domain of Caspase Recruitment Domain Family Member 11, a known ibrutinib resistance mechanism. Incomplete tumor responses were associated with mutations in the B-Cell Antigen Receptor-associated protein CD79B. CD79B-mutant PCNSLs showed enrichment of mammalian target of rapamycin (mTOR)-related gene sets and increased staining with Phosphatidylinositol 3-kinase (PI3K)/mTOR activation markers. Inhibition of the PI3K-isoforms p110α/p110δ or mTOR synergized with ibrutinib to induce cell death in CD79B-mutant PCNSL cells.
Objective:
The purpose of this study is to investigate the Medicare reimbursement trends for otologic procedures from 2000 to 2020.
Study Design:
Retrospective data analysis using the Physician Fee Schedule Look-Up tool from the Centers for Medicare and Medicaid services.
Setting:
Facility performed procedures of the auditory system.
Patients:
Medicare beneficiaries from 2000 to 2020.
Interventions:
Selected otologic current procedural terminology codes and their respective year-to-year reimbursement data.
Main Outcome Measures:
Assessment of trends in financial reimbursement.
Results:
After adjusting for inflation, the total average reimbursement for all procedures saw an average decrease of –21.2% from 2000 to 2020. The average adjusted percent change per year was –1.3% indicating a slow decline in reimbursement over the study period. There was a difference between the adjusted and unadjusted percent change in reimbursement rate during the study period (–21% versus 20.4%, respectively; p < 0.001). Linear regression analysis of the adjusted average reimbursement across all procedures revealed an overall decline from 2000 to 2020 with an R-squared value of 0.85 indicating a decline in reimbursement over time.
Conclusions:
After adjusting all data for inflation, there has been a reduction in the average Medicare reimbursement for otology procedures from 2000 to 2020. Compared with previous reimbursement studies on the whole field of otolaryngology, otology has a less severe decline in reimbursement. Knowledge of these reimbursement trends is critical for otologic surgeons and leaders within the field to develop more sustainable reimbursement plans.
BACKGROUND:The efficacy of combined aspiration catheter and stent retriever compared with stent retriever alone for the treatment of large-vessel occlusion acute ischemic stroke is unclear. PURPOSE: Our aim was to conduct a systematic literature review and meta-analysis on several metrics of efficacy comparing aspiration catheter and stent retriever with stent retriever alone.DATA SOURCES: MEDLINE and the Cochrane Library Databases were searched. Randomized controlled trials and case-control and cohort studies were included.
STUDY SELECTION:Ten comparative studies were included detailing a combined 1495 patients with aspiration catheter and stent retriever and 1864 with stent retrievers alone.DATA ANALYSIS: Data on first pass effect (TICI 2b/2c/3 after first pass), final successful reperfusion (modified TICI $2b), and 90day functional independence (mRS # 2) were collected. Meta-analysis was performed using a random-effects model.
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