Citations

Heart rate variability (HRV) is a widely utilized approach for investigating cardiovascular health and human performance. Methodological approaches, analyses, and interpretations of HRV can vary extensively, and scientific debates on HRV reliability and utility remain. These debates have been amplified in recent years by the rapid growth and ubiquity of wearable devices, and their incorporation into scientific research studies. The present guidelines paper takes an evidence-based approach to propose more consistent and rigorous measurement and interpretation of HRV within human cardiovascular research and application. First, HRV has some utility as a cardiovascular risk stratification tool, but is not appropriate to employ as a specific marker of cardiac sympathetic outflow or sympathovagal balance. While time-domain and spectral analysis can more accurately reflect respiratory modulation of cardiac vagal (parasympathetic) activity, caution is necessary to avoid overinterpretation, particularly with respect to the concept of “vagal tone”. Numerous experimental, demographic, and environmental factors influence HRV assessment, interpretation, and reliability. Specifically, it is critical to account for non-modifiable (age, sex, race/ethnicity, etc.) and modifiable (i.e., exercise, physical fitness, etc.) factors within participant samples. Furthermore, technical approaches such as the HRV input signal (e.g., electrocardiography vs. photoplethysmography), length of recording, location of recordings (i.e., laboratory vs. field), respiratory rate and depth, and analytical approaches (i.e., time vs. frequency domain) can all impact rigor, reliability, and study interpretations. Finally, with respect to the rapid advancements of HRV assessment using wearable technology, investigators should interpret and contextualize findings within the limitations outlined in this guideline review.

Purpose: To compare the safety and efficacy of gonioscopy-assisted transluminal trabeculotomy (GATT) combined with phacoemulsification in eyes with high myopia versus non-high myopia with open-angle glaucoma. Methods: This retrospective comparative study included 76 eyes with open-angle glaucoma. Eyes were stratified into high myopia (Group 1; axial length ≥26.5 mm, n = 36) and non-high myopia (Group 2; axial length <26.5 mm, n = 40). Baseline parameters including intraocular pressure (IOP), best-corrected visual acuity, and number of anti-glaucoma medications (AGMs) were compared at 2 weeks, 1 month, and 3, 6, and 12 months. Surgical success was defined as IOP ≤21, ≤18, or ≤15 mmHg with a ≥20%, ≥25%, or ≥30% reduction from baseline, respectively. Postoperative complications, secondary interventions, and surgical risk factors were analyzed. Results: The mean (SD) IOP (mmHg) decreased from 20.56 ± 4.71 to 13.32 ± 5.02 in Group 1 and 19.33 ± 4.15 to 12.94 ± 3.48 in Group 2 at 12 months, with no significant difference between groups ( P = 0.92). AGM reduced from 2.11 ± 0.89 to 0.36 ± 0.95 in Group 1 and 1.98 ± 0.89 to 0.06 ± 0.24 in Group 2 at 12 months ( P = 0.07). There was no significant difference in success rate between groups by all criteria at the end of 12 months ( P = 0.77, 0.54, 0.14). Transient hyphema and IOP spikes were common complications. Five eyes required anterior chamber wash (3 in Group 1, 2 in Group 2). Conclusion: GATT with phacoemulsification is a safe and effective procedure in high myopia with open-angle glaucoma, with comparable outcomes to non-high myopia eyes at 12 months.

Overall, our findings expand current understanding of SDRIFE by highlighting both well-recognized and underappreciated medication classes, underscoring the importance of ongoing pharmacovigilance.

Abstract Background Opportunistic bilateral salpingectomy (OBS), the removal of fallopian tubes during hysterectomy or instead of tubal ligation, is recommended to reduce ovarian cancer risk. However, data on the effectiveness of prophylactic OBS is limited. Methods This population-based retrospective cohort included individuals aged 18–80 in Ontario, Canada, who underwent OBS or comparator surgeries (hysterectomy with ovarian and tubal conservation or tubal ligation) from 2011 to 2023. Individuals with gynecologic cancer before or within six months of surgery were excluded. Hazard ratios and 95% confidence intervals were estimated using Cox proportional hazards regression. Sensitivity analyses varied the time between surgery and cancer diagnosis to account for pre-existing serous tubal intraepithelial carcinomas. Results Among 196,839 individuals, 57,941 underwent OBS and 138,898 underwent comparator surgeries. 142 epithelial ovarian cancers were diagnosed (19 in the OBS group and 123 in the comparator surgery group). OBS was associated with reduced risk of any ovarian carcinoma, with an adjusted hazard ratio (aHR) of 0.60 (95% CI, 0.36 to 0.98). For serous ovarian carcinoma (high- and low-grade combined due to missing grade data), the aHR was 0.47 (95% CI, 0.22 to 0.99). Sensitivity analyses with 12- and 18-month intervals showed aHRs of 0.59 (95% CI, 0.35 to 0.99) and 0.60 (95% CI, 0.35 to 1.01) for all ovarian carcinomas, and 0.49 (95% CI, 0.23 to 1.01) and 0.47 (95% CI, 0.22 to 0.99) for serous ovarian carcinoma, respectively. Conclusions OBS was associated with reduced risk of ovarian carcinoma, supporting its role as a primary prevention strategy.

Background The management of osteochondral lesions of the talus (OLT) is challenging, with 2 main options being conservative and surgical management. Orthobiologic therapies come to bridge the gap between these 2 options; however, inconsistencies in indication, composition, and heterogeneous evidence limit clinical decision-making. To address these challenges, 3 International Congress Meetings on Cartilage Repair of the Ankle were convened in Pittsburgh, USA (2017), Dublin, Ireland (2019), and New York, USA (2025) to establish agreement on the role of conservative management and injectable orthobiologic strategies in the treatment of OLT. Methods Seventy-five multidisciplinary experts from over 25 countries and 1 territory participated in a structured Delphi-based consensus process. Blinded surveys, structured questionnaires, and in-person discussions were used to develop and refine statements, supported by literature review and graded evidence (A1–E). Consensus strength was defined as consensus (51%-74%), strong consensus (75%-99%), or unanimous (100%) Results In total, 29 consensus statements were achieved across the 3 meetings. Strong agreement was reached regarding indications and expected outcomes of conservative management, including the role of immobilization and appropriate timing for surgical intervention. Orthobiologic injections, including platelet-rich plasma, concentrated bone marrow aspirate, and hyaluronic acid, were considered appropriate in select patients with persistent symptoms, although no superiority was demonstrated among formulations, preparation methods, or injection strategies. When used as adjuncts to surgical procedures, orthobiologics may improve radiological outcomes, with limited evidence for improvement in clinical outcomes. Technical considerations, including preferred harvest sites and a lack of standardized preparation protocols, were identified, along with key principles for patient counseling Conclusion These international consensus statements establish a standardized framework for the conservative management and use of injectable orthobiologic therapies in OLT. By clarifying indications, technical considerations, and current limitations, this work aims to improve consistency in clinical practice, guide treatment decision-making, and inform future research.

ABSTRACT Part I of our three‐part series outlines the essential technical and operational components required for successful digital pathology implementation including hardware, software, and IT infrastructure. It reviews the rationale for digitization, highlighting improvements in workflow efficiency, diagnostic collaboration, and preparedness for computational applications. Key components of Whole Slide Imaging (WSI) systems are discussed, including practical considerations for scanner selection, scanning modalities, and performance trade‐offs relevant to dermatopathology. The article also examines image compression strategies and pyramid image representation, with attention to balancing image quality and storage efficiency. Finally, we review DICOM standards and storage infrastructure options, including cloud, on‐premises, and hybrid models, and associated network bandwidth requirements.

ABSTRACT Distinguishing atypical parkinsonian disorders (APS) from Parkinson's disease (PD) remains challenging due to overlapping clinical features, yet accurate differentiation is critical for prognosis and treatment. Here, we employed multimodel diffusion MRI (dMRI) analysis to characterize microstructural alterations across corticobasal syndrome (CBS), progressive supranuclear palsy‐Richardson syndrome (PSP‐RS), and PD, with the aim of identifying which dMRI model and regional metrics show the strongest group‐level separation. We analyzed 25 CBS, 42 PSP‐RS, and 21 PD participants compared to 35 age and sex‐matched controls. Using a clinically feasible 3‐shell high angular resolution diffusion imaging (HARDI) protocol, we applied 11 metrics from five complementary dMRI models—diffusion tensor imaging (DTI), free‐water‐eliminated model of DTI (FWE), neurite orientation dispersion and density imaging (NODDI), tissue‐weighted NODDI, and fixel density (FD) in fixel‐based analysis (FBA)—to comprehensively assess regional white and gray matter integrity. Group differentiation was quantified using covariate‐adjusted Cohen's d effect sizes and spearman correlations were assessed between dMRI metrics and clinical scales. Distinct microstructural signatures were observed across disorders, and the sensitivity of the dMRI models differed. In group contrasts, DTI and NODDI‐derived metrics consistently captured the strongest effects in midbrain and peduncular pathways for PSP‐RS, whereas precentral and corticospinal alterations in CBS were most prominent using NODDI and FBA measures. Free‐water‐corrected metrics showed attenuated group differences. Across clinical‐diffusion analyses, NODDI metrics exhibited the most robust associations with disease severity, while DTI and FWE measures detected more limited, regionally constrained effects. Together, these findings highlight complementary yet distinct sensitivities of tensor, free‐water, multicompartment, and fixel‐based models to APS‐related neurodegeneration.

Radiation oncology is poised for a decade of unusually rapid technological and biological change. Six innovations are converging on the clinic: FLASH radiotherapy, adaptive radiotherapy with advanced imaging, artificial intelligence and machine learning in treatment planning, theranostics with targeted radionuclide therapy, spatially fractionated radiotherapy using GRID and LATTICE techniques, and continuing enhancements in particle therapy with protons and heavy ions. Each is biologically compelling, but they will not reach patients at the same speed or in equal numbers. This review proposes an evidence-and-capital framework for evaluating these innovations along four axes – physical principle, biological rationale, current clinical evidence, and dominant adoption barrier – and ranks them by anticipated population-level impact over the next five years. Capital intensity emerges as the principal determinant of diffusion: innovations layered onto existing linear accelerators (artificial intelligence, spatially fractionated radiotherapy) or onto existing nuclear medicine infrastructure (theranostics) will scale globally, whereas innovations requiring new bunkers, magnetic-shielded vaults, or dedicated accelerators (adaptive radiotherapy, FLASH, particle therapy) will remain concentrated in well-resourced centres. A low anticipated diffusion ranking is not a judgement on intrinsic clinical value: several capital-intensive modalities deliver substantial benefit for selected patients even where population-level reach is limited, and the framework distinguishes throughout between intrinsic efficacy and expected accessibility. The resulting equity gap is not primarily a scientific problem but an infrastructural one. Recognising this asymmetry should inform departmental investment, training curricula, multinational cooperative-group trial design, and health-system policy on capital subsidy and consortium models. The framework is intended for radiation oncologists, medical physicists, and cancer scientists evaluating where to invest finite institutional resources.