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Key Points Increased protein expression of tissue inhibitor of metalloproteinase-3, glypican 6, synuclein γ , apolipoprotein A-4, and Ecto-5′-nucleotidase was observed in old adults compared with young adults. In old adults, overexpressed proteins were enriched in mitochondrial processes while under expressed proteins enriched in RNA metabolism. Validated differentially expressed proteins were not significantly correlated with kidney pathology after adjusting for age. Background Kidney aging is characterized by a loss of glomeruli, predominantly in the superficial cortex, with a resultant decline in GFR and an increased risk of various kidney-related diseases. The early molecular alterations in glomeruli associated with the aging process are not well studied. Methods We combined laser capture microdissection and mass spectrometry–based unbiased proteomic analysis of nonsclerosed, nonischemic glomeruli in the superficial cortex from young and old adults who underwent a radical nephrectomy for a tumor to understand the age-related molecular changes in glomeruli. Twenty-four young and 30 old adults were used for the discovery dataset, and the significant differentially expressed proteins were further validated using an independent set comprising six young and eight old adults. Results Kidneys from old adults had lower eGFR, less kidney parenchyma on computed tomography imaging, and more glomerulosclerosis and arteriosclerosis on histology. Quantitative proteomic analysis of nonsclerosed, nonischemic glomeruli identified increased expression of tissue inhibitor of metalloproteinase-3, glypican 6, synuclein γ , apolipoprotein A-4, and Ecto-5′-nucleotidase in old adults that were further validated in an independent set. Pathway analysis indicated that proteins with increased expression in old adults were enriched in mitochondrial translational processes, aerobic respiration, and TCA cycle, whereas proteins with decreased expression in old adults were enriched in mRNA splicing, mRNA processing, and nonsense mediated decay. Furthermore, validated differentially expressed proteins did not show any significant correlation with the kidney pathology independent of age group. Conclusions Overall, this study identified proteins that are specifically associated with the aging process in otherwise normal-appearing glomeruli.

BACKGROUND: The use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has significantly increased in recent years. GLP-1 RAs delay gastric emptying, resulting in early satiety and weight loss. This may increase the risk of pulmonary aspiration of residual gastric contents (RGC) during anesthesia delivery. Evidence is urgently needed to guide perioperative anesthesia management for patients taking GLP-1 RAs. This study evaluated preoperative factors that may be associated with high RGC. METHODS: Adult patients who were taking GLP-1 RAs and scheduled to receive anesthesia at 3 hospitals between June 30, 2023, and August 15, 2024, were evaluated via preoperative point-of-care gastric ultrasonography (GUS). The primary outcome was high RGC, defined by the presence of solids food or >1.5 mL/kg of clear liquids on GUS, and its association with preoperative factors (eg, existing medical conditions, indication and route of taking GLP-1 RAs, length of taking GLP-1 RAs, days of withholding GLP-1 RAs before surgery, and preoperative fasting periods). Data are presented as median (interquartile range [IQR]). RESULTS: Among the 316 patients (60.9 years [52.1–68.9] of age; 167 [52.8%] females) included in the study, 113 (35.8%) had high RGC. A higher percentage (5.3%; 6/113) of patients in the high RGC group had an opioid prescription for pain management within 3 months of the GUS assessment compared to the low RGC group (1.0%; 2/203; P = .027). No statistical difference was found between the groups in other existing medical conditions, indication and route of taking GLP-1 RAs, and length of taking GLP-1 RAs. Of the 294 patients taking weekly injections, there were 187 (63.6%) with low RGC and 107 (36.4%) with high RGC. Patients with low RGC withheld their GLP-1 RAs for 8 days [5–10], while patients with high RGC withheld for 6 days [3–9] ( P = .003). Receiver operating characteristic (ROC) analysis found ≤7.5 days of withholding the medication as cutoff for increased prevalence of high RGC in patients taking GLP-1 RA injections. Patients with low RGC fasted from solid food for 20.0 hours [14.8–40.8], and patients with high RGC fasted from solid food for 15.0 hours [12.8–19.0] ( P < .001). ROC found ≤21.3 hours of fasting from solid food as the cutoff for increased prevalence of high RGC. CONCLUSIONS: GLP-1 RA usage may delay gastric emptying. In preoperatively fasting adults, ≤7.5 days of withholding injections and ≤21.3 hours of fasting from solid food are associated with high RGC.

This JAMA Insights explores the management of severe refractory asthma, including medications, access to specialists, and managing environmental triggers.

In this video, the authors present the microsurgical treatment of a superior petrosal dural arteriovenous fistula (dAVF) associated with a symptomatic hemorrhagic brainstem cavernous malformation in a 38-year-old male. The patient underwent a retrosigmoid craniotomy for cavernoma evacuation and fistula disconnection. Intraoperative indocyanine green angiography revealed cortical venous reflux not evident on catheter angiography, prompting reclassification to a higher-grade fistula. Postoperatively, the patient returned to neurological baseline, and follow-up imaging confirmed complete fistula obliteration, cavernoma resection, and new appearance of a developmental venous anomaly (DVA). This case highlights the dynamic nature of dAVF venous drainage and illustrates the rare co-occurrence of dAVF, DVA, and brainstem cavernoma. The video can be found here: https://stream.cadmore.media/r10.3171/2025.7.FOCVID2553

Background: Timely intervention and effective control of Alzheimer’s disease (AD) have been shown to limit memory loss and preserve cognitive function and the ability to perform simple activities in older adults. In addition, magnetic resonance imaging (MRI) scans are one of the most common and effective methods for early detection of AD. With the rapid development of deep learning (DL) algorithms, AD detection based on deep learning has wide applications. Methods: In this research, we have developed an AD detection method based on three-dimensional (3D) convolutional neural networks (CNNs) for 3D MRI images, which can achieve strong accuracy when compared with traditional 3D CNN models. The proposed model has four main blocks, and the multi-layer fusion functionality of each block was used to improve the efficiency of the proposed model. The performance of the proposed model was compared with three different pre-trained 3D CNN architectures (i.e., 3D ResNet-18, 3D InceptionResNet-v2, and 3D Efficientnet-b2) in both tasks of multi-/binary-class classification of AD. Results: Our model achieved impressive classification results of 91.4% for binary-class as well as 80.6% for multi-class classification on the Open Access Series of Imaging Studies (OASIS) database. Conclusions: Such results serve to demonstrate that multi-stage feature fusion of 3D CNN is an effective solution to improve the accuracy of diagnosis of AD with 3D MRI, thus enabling earlier and more accurate diagnosis.