Citations

Abstract Objectives Emotional impairments in people with dementia can be taxing for family caregivers. However, caregivers differ in their resilience to these challenges. We previously found that, compared to healthy controls and people with Alzheimer’s disease, people with frontotemporal lobar degeneration (FTLD) have smaller physiological responses when anticipating upcoming emotional stimuli. This impairment may leave these people with FTLD unprepared for upcoming emotional stimuli because they cannot mount responses needed for appropriate behaviors, which may create stress and difficulties for caregivers. We examined (a) whether smaller preparatory physiological responses in people with dementia are associated with lower emotional well-being and physical functioning in caregivers; and (b) whether these associations are moderated by the dyads’ relationship quality. Methods A total of 158 individuals with FTLD or Alzheimer’s disease and their family caregivers participated. Preparatory physiological responses in people with dementia were quantified as decreases in cardiac interbeat intervals from baseline to an instruction period, during which they were told they would be watching an upcoming emotional film. Caregivers self-reported their emotional well-being, physical functioning, and relationship quality with the people with dementia. Results Smaller preparatory physiological responses in people with dementia were associated with lower emotional well-being (but not physical functioning) in caregivers. This association was moderated by relationship quality (i.e., weakened for caregivers in higher-quality relationships). Discussion Findings advance understanding of risk and resilience factors for negative caregiver outcomes. Positive interpersonal processes in high-quality relationships (e.g., positive appraisal of aberrant behaviors) may buffer caregivers from the impact of emotional impairments in people with dementia.

ABSTRACT Background and Aims Clinically significant portal hypertension (CSPH; hepatic venous pressure gradient (HVPG) ≥ 10 mmHg) is a severe complication of chronic liver disease, with increased risk of variceal bleeding and liver decompensation (at HVPG ≥ 12 mmHg). This study evaluated the performance of multiparametric (mp)MRI for diagnosing CSPH and predicting liver decompensation, compared to ultrasound‐based shear wave elastography (SWE) and blood tests. Methods In this prospective single‐centre study (2018–2022), 59 patients (M 30, mean age 52.7 years) underwent mpMRI and HVPG measurement, with an average interval of 32 ± 31 days. The mpMRI protocol included 2D/3D MR elastography (MRE), T 1 /proprietary iron‐compensated T 1 (cT 1 )/T 1ρ mapping, gadoxetate‐enhanced dynamic contrast‐enhanced MRI (DCE‐MRI) of the liver and spleen, SWE and blood tests. Statistical analyses included Mann–Whitney U tests, ROC analysis, logistic regression and Cox proportional hazards models. Results CSPH was present in 13 patients (22%). Several MRI parameters showed high diagnostic performance for CSPH (AUC ≥ 0.8), with spleen stiffness‐2D MRE (AUC 0.88, 95% confidence interval (CI) 0.78–0.98) and liver uptake on DCE‐MRI (AUC 0.83, 95% CI 0.70–0.96) performing best, while SWE had AUCs of 0.63 (95% CI 0.45–0.81) for liver and 0.67 (95% CI 0.44–0.89) for spleen. Combining spleen stiffness‐2D MRE and liver uptake achieved an AUC of 0.93 (95% CI 0.86–1.00) for diagnosing CSPH. For predicting decompensation, spleen stiffness‐3D MRE and liver uptake rate had AUCs of 0.83 (95% CI 0.68–0.99) and 0.83 (95% CI 0.70–0.95), respectively, outperforming SWE. Conclusions Spleen stiffness measured with MRE combined with gadoxetate liver uptake (measured with DCE‐MRI) can diagnose CSPH and predict liver decompensation, with superior performance compared to SWE. Trial Registration ClinicalTrials.gov identifier: NCT03436550

Abstract Hepatocellular carcinoma (HCC) mortality is increasing globally, partly due to the growing prevalence of nonviral liver diseases. Genome‐wide association studies (GWAS) have identified genetic variants associated with HCC development. Leveraging GWAS summary statistics and linkage disequilibrium score regression (LDSR), we investigated disease co‐development with hepatitis C virus‐negative (HCV‐negative) HCC to provide unique insights into HCC etiology and prioritize relationships for further causal inquiry. We utilized the LDSR statistical framework to estimate the genetic correlation and heritability between HCV‐negative HCC with 901 epidemiologic, behavioral, and clinical traits from the United Kingdom Biobank (UKBB). First, we set the threshold for observed scale heritability of each trait at 0.02 to ensure reliable inferences with adequate study power. Next, we observed significant positive genetic correlations between HCV‐negative HCC and blood‐based biomarkers of liver injury (ALT, GGT) and allostatic load (including glycated hemoglobin, blood pressure, and total albumin). We also identified a positive genetic correlation between HCV‐negative HCC and diseases associated with metabolic dysfunction‐associated steatotic liver disease (MASLD), including diabetes, hypertension, chronic ischemic heart disease, and others. Taken together, our results help to identify polygenic and pleiotropic signals related to different phenotypic traits associated with HCC and support further exploration of the predictive power of blood‐based biomarkers identified in this study for inferring HCC development among HCV‐negative individuals.

Background Sexual and gender diverse (SGD) individuals comprise nearly 10% of the United States’ population but remain underrepresented in cancer research, particularly in intimate partner violence (IPV) studies. Although IPV rates are comparable or higher in SGD individuals than in non-SGD individuals, the literature on IPV in SGD patients with cancer remains sparse. Methods This qualitative study was conducted within a Mayo Clinic IRB-approved parent database on SGD patients with cancer. Eligible patients were adults who self-identified as non-heterosexual or non-cisgender, had an invasive cancer diagnosis, and reported IPV via a four-question screening tool. A detailed medical review was performed to extract qualitative data related to IPV and other violence. Two investigators employed thematic analyses to understand these qualitative data. Results Among 258 SGD patients whose medical records were screened, 13 (5%) reported IPV. Six key themes emerged: (1) IPV co-occurred with other violence (childhood, workplace, sexual violence); (2) IPV was associated with mental health conditions (depression, PTSD, suicidality); (3) Unhealthy coping mechanisms (substance use, risky behaviors) were common; (4) Social isolation and lack of support exacerbated challenges; (5) Internalized stigma influenced self-perception, relationships, healthcare experiences; (6) Chronic stress from cumulative trauma negatively impacted cancer care. Conclusion IPV was reported by a small proportion of SGD cancer patients, and cause and effect associations been IPV and the above themes have not been demonstrated. These findings suggest a need for trauma-informed, culturally competent interventions to address IPV and its broader psychosocial effects in these underserved populations.

Abstract Background: Spatial Reasoning AI (SRAI) systems are emerging as a transformative class of clinical artificial intelligence, enabling real-time interpretation of complex anatomy in imaging, surgery, and chronic disease management. Unlike traditional AI approaches constrained to tabular or 2D inputs, SRAI models incorporate geometric priors, multimodal fusion, and 3D anatomical reasoning to support high-impact tasks such as volumetric segmentation, lesion localization, intraoperative guidance, and prognostic modeling. Objective: This scoping review aimed to (1) map the emerging landscape of SRAI in healthcare, (2) assess its clinical performance across diagnostic, prognostic, and workflow applications, and (3) identify opportunities and barriers for safe translation into practice. Methods: Following PRISMA 2020 guidelines, we systematically searched PubMed, Springer Nature, and IEEE Xplore (including CVPR, ICCV, ISBI, and EMBC) for original studies implementing spatially aware AI models with clinical validation or workflow relevance. Data extraction captured model architecture, input modality, anatomical scope, application domain, and performance outcomes. Results: We identified eligible studies spanning oncology, neurology, cardiology, surgery, and infectious diseases. SRAI systems consistently outperformed conventional methods in segmentation, lesion classification, and risk stratification. A paradigm shift is underway from task-specific CNNs to foundation-level models, including MedSAM and MedCLIP for zero-shot segmentation and retrieval, and NeRF-based pipelines for anatomically faithful 3D reconstruction. Randomized evidence shows that SRAI can improve workflow efficiency without compromising diagnostic accuracy. Conclusion: SRAI models demonstrate strong potential to advance diagnostic precision, prognostic accuracy, and workflow integration across multiple clinical domains. Their safe adoption will require standardized evaluation metrics, prospective multi-institutional validation, and interpretable outputs. As foundation models evolve to better encode spatial priors, SRAI is poised to become a cornerstone of workflow-integrated precision medicine.

Objectives: Current standard of care after a First-Time patellar instability event is non-operative management, with exceptions for patients with osteochondral fracture or loose body requiring immediate surgical intervention, patients with significant pathoanatomy, or contralateral patellar instability. For recurrent patellar instability, there is controversy as to when isolated medial patellofemoral ligament reconstruction (MPFL-R) is enough. The purpose of this study is to determine (1) the comparative outcomes of isolated MPFL-R after first-time patellar instability (FTPI) and recurrent patellar instability (RPI) and (2) the impact of osteochondral injury on outcomes after surgical treatment of FTPI. Methods: A prospective, multicenter cohort study (JUPITER: Justifying Patellar Instability Treatment by Results) database was queried for patients who underwent patellar stabilization surgery (PSS) between December 2016 and September 2022. Patients were included if they underwent a medial patellofemoral ligament reconstruction (MPFL-R) for FTPI or RPI. Those with less than 2 years of clinical follow-up, revision PSS, or concomitant bony procedures at the time of MPFL-R were excluded. Independent t-tests were performed to compare means for continuous variables, and chi-squared tests were performed to compare frequency for categorical variables, between groups. Results: A total of 739 patients met inclusion criteria with a mean age of 15.6 ± 3.3 years, and 59.9% female sex. FTPI occurred in 216 (27.2%) patients, and of these 104 (48.1%) sustained an operative chondral or osteochondral lesion. Those with FTPI had a significantly greater trochlear depth (2.9 mm vs. 2.6 mm; P = .048), but a significantly lower rate of pathological trochlear bump > 5 mm (52.3% vs. 67.8%; P = .008) than those with RPI (Table 1). Among the FTPI cohort, those with treatment of a chondral lesion were less likely to have patella alta (Caton-Deschamps Index > 1.3) (14.9% vs. 41.3%, P = .006), and less frequently had a mild or severe J-sign (25.0% vs. 42.7%, p = .016) than those without a chondral intervention (Table 2). Postoperatively, there were no differences with rates of recurrent instability (8.3% vs. 12.3%; P = .130) or return to sport (90.4% vs. 94.5%; P = .182) between FTPI and RPI, respectively (Table 3). There were no differences with rates of recurrent instability (7.6% vs. 9.1%; P = .807) or return to sport (89.1% vs. 91.7%; P = .755) between those with or without a chondral intervention, respectively (Table 4). Conclusions: This study demonstrates no difference in rates of recurrent post-operative instability between FTPI and RPI with rates consistent with the current literature. MPFL reconstruction remains as a durable surgical treatment option for patients presenting with either FTPI or RPI with relatively low rates of recurrent instability. In this patient population, patella alta was found to be protective of osteochondral injury which is also consistent with existing literature. Continued, long-term investigation is needed to understand outcomes for First-Time patellar instability and to better define the indications for surgical interventions in this population.

Objectives: To evaluate return-to-sport (RTS) rates and patient reported outcome measures (PROMs) following hip arthroscopy for femoroacetabular impingement (FAI) in active football players with a minimum of 5-years follow-up. Methods: All active football players who underwent hip arthroscopy for FAI from 2010-2019 were identified. Preoperative radiographic measures including lateral center edge angle, Tönnis angle, alpha angle, and acetabular depth were obtained. Patients were evaluated for post-operative RTS and revision surgery data at final follow-up. Modified Harris Hip Score (mHHS), Hip Outcome Score (HOS), HOS Activities of Daily Living (HOS-ADL), HOS Sports Specific Subscale (HOS-Sports), Tegner Activity Scores, Visual Analogue Scale (VAS) for pain, and surgery satisfaction were collected at a minimum 5-year follow-up. Descriptive and comparative statistical analysis was performed using R software (version 4.4.1). Results: Sixty-six hips from 53 male patients were included. The mean age was 20.4 ± 6.4 years and mean BMI was 27.3 ± 6.6 kg/m² (Table 1). Mean follow-up was 8.7 ± 2.8 years. The majority (60%) were high school players and 19% were college players. Figure 1 displays the most commonly affected positions which included wide receiver (32%), defensive lineman (26%), and tight end or offensive lineman (16%). There were 11 bilateral cases and 2 revisions. The mean lateral center edge angle was 31.6º ± 6.4, the mean Tönnis angle was 5.0º ± 5, and the mean alpha angle was 63.2º ± 12.7. There was significant improvement in all PROMs from baseline to a minimum 5-year follow-up (p<0.04). Fifty-four percent of athletes returned to football postoperatively and the average overall surgery satisfaction rating was 8.1/10. Among those who didn’t return, 14% cited hip-related reasons, while 67% cited non-hip related reasons such as priorities changing or graduating (Figure 2). Athletes who returned to football had significantly higher mean HOS-ADL (p=0.049), HOS-Sport (p=0.042), and Tegner level before surgery (p=0.023) compared to those who did not return (Table 2). Conclusions: Football players undergoing hip arthroscopy for FAI demonstrate significant improvements in outcome scores at a minimum 5-year follow-up with a moderate return-to-sport rate. Athletes who are able to return to football report higher patient reported outcomes compared to those who do not. Player position may also influence incidence and outcomes. Although football players demonstrate significant improvements following hip arthroscopy, the moderate RTS rates highlights the demanding nature of the sport and need for improved perioperative counseling.

Objectives: Periacetabular osteotomy (PAO) is utilized for the treatment of hip dysplasia, with a growing trend towards hip arthroscopy at the time of PAO or in a planned, staged manner prior to PAO in order to address intra-articular pathology such as labral tears. For patients with persistent or new pain following isolated PAO, a subset undergo unplanned, primary hip arthroscopy. To date, there is a paucity of available evidence regarding the risk factors for and outcomes of unplanned hip arthroscopy for persistent or new pain after PAO. The purpose of this study was to determine demographic and radiographic characteristics of patients undergoing hip arthroscopy for persistent pain after PAO and also to compare radiographic parameters, surgical characteristics, and postoperative PROMs between patients that underwent hip arthroscopy following PAO and a demographically similar group of controls without acetabular dysplasia that underwent primary hip arthroscopy. Methods: An institutional database of 3014 hip arthroscopies performed between 1988 and 2022 was reviewed for patients having undergone unplanned (i.e. non-staged) first-time hip arthroscopy after PAO. These patients were propensity-matched on a 1:2 ratio with demographically similar, non-dysplastic patients undergoing primary hip arthroscopy with labral repair. All patients were contacted at final-follow-up to collect outcomes including subsequent procedures, progression to THA, and patient-reported outcome measures (PROMs), including modified Harris Hip Score (mHHS), Hip Outcome Score (HOS), International Hip Outcome Tool (iHOT), Tegner Activity Scores, Visual Analogue Scale (VAS) for pain, and surgery satisfaction. Demographics, radiographic characteristics, and postoperative outcomes were compared. All statistical analysis and Kaplan-Meier survival curve analysis was performed using R software (version 4.4.1). Results: We identified 22 hips in 21 patients (17 female, 4 male; age: 24.6 ± 8.5 years; BMI: 29.3 ± 7.4 kg/m²) who underwent first-time arthroscopy after ipsilateral PAO and were followed for a mean of 7.2 ± 2.8 years (Table 1). The median post-PAO LCEA was 28° (IQR: 24.6 – 31.7) and the mean Tönnis angle was 4.2° ± 5.9. The median time from the date of PAO to date of subsequent hip arthroscopy was 1.6 years (IQR: 1.1 - 3.4). Compared to the control group, there was a significantly lower rate of femoral osteochondroplasty (50% vs, 86%, p < 0.01), as well as trends towards lower rate of labral repair (77% vs. 95% p = 0.11), and higher rate of capsular repair (64% vs. 75%, p = 0.34). No differences were found between the PAO and control groups in any of the postoperative PROMs (Table 2). Among the PAO patients, 3 (20%) progressed to total hip arthroplasty (THA) compared to 1 (9%) in the control group (p=0.62). Conclusions: Hip arthroscopy after prior PAO was associated with postoperative improvements in pain and moderate rates of conversion to THA. When patients undergoing hip arthroscopy following PAO were compared to a demographically similar matched cohort of nondysplastic hips who underwent primary hip arthroscopy without a prior PAO, similar postoperative outcome scores were observed. This data provides valuable counselling information for clinicians discussing hip arthroscopy in the setting of patients with persistent pain following PAO.