Citations

Abstract Background: With over 1 billion individuals affected globally, obesity and obesity related diseases is now a leading cause of death. Metabolic and bariatric surgery (MBS) has emerged as a cornerstone intervention for severe obesity and its associated comorbidities. Despite its efficacy, postoperative care and follow-up after MBS remains highly variable worldwide. Objective: The PARTNER study aimed to evaluate global clinical practices in the postoperative management following MBS by surveying multidisciplinary healthcare professionals . Methods: This study was an international online survey conducted between October 2024 and January 2025. A multidisciplinary team developed the questionnaire based on existing literature and international guidelines. The survey assessed five domains: follow-up care, postoperative treatment, dietary management, patient support, and measurement of surgical outcomes. Responses were analysed descriptively. Results: A total of 262 responses were received from 62 countries. Most respondents were bariatric surgeons (72.1%) working in public healthcare systems (73.3%). While 78.7% reported conducting three-month postoperative reviews, only 23.7% offered indefinite follow-up. Hybrid models of care (virtual and in-person) were common (56.9%). VTE prophylaxis and postoperative PPI use were recommended by 64.1% and 84.3% respectively. Nearly all respondents (98.1%) provided dietary advice, with protein and micronutrient supplementation widely endorsed. Only 56.1% routinely referred patients for psychological follow-up. Definitions of surgical success and failure varied widely, with inconsistent objective outcome measures. Conclusion: The PARTNER study reveals significant international variation in postoperative management practices following MBS. These findings underscore the need for more standardized, evidence-based guidelines to improve long-term outcomes and equity of care worldwide.

Background While rapid response teams (RRT) are widely implemented to address clinical deterioration in hospitalized patients, their impact on goals of care (GOC) discussions remains underexplored. Aims We aimed to evaluate whether RRT activations were associated with subsequent goals of care discussions, code status changes, and clinical outcomes. Methods We conducted a retrospective single-center review of hospitalized adult patients admitted to medicine services who had RRT activations between January and December 2023. The primary outcome was GOC discussion within 72 h of RRT. GOC discussions were identified through EMR documentation of conversations, code status changes, and ACP notes. Secondary outcomes included code status change, transition to comfort care, and 30- and 90-day mortality. Analyses were adjusted using inverse probability of treatment weighting. Results 1823 RRTs among 1677 patients were analyzed; 47% of patients were female and 88% identified as white. Those transferred to the ICU had higher odds of goals of care discussions (OR 1.52, P < 0.001), code status change (OR 2.43, P < 0.001), and transition to comfort care (OR 1.47, P = 0.026) compared to those who remained on the floor. ICU transfer was also associated with increased 30- (OR 1.39, P = 0.006) and 90-day mortality (OR 1.30, P = 0.014). Conclusions ICU transfer following RRT activation is strongly associated with downstream goals of care discussions, changes in code status, comfort-focused care, and higher mortality. This demonstrates the importance of initiating goals of care discussions early and often, regardless of whether clinical decompensation is anticipated.

Abstract Background Proton therapy offers precise tumor targeting while minimizing damage to surrounding healthy tissue, making it especially valuable for treating tumors near critical organs and in pediatric patients. However, its success depends on accurate beam delivery, requiring rigorous quality assurance (QA) to maintain treatment precision and effectiveness. Purpose This study aims to standardize the measurement of key aspects of proton therapy delivery, such as gantry and couch isocentricity, spot position accuracy, and spot size consistency. The goal is to enhance the delivery accuracy of proton therapy across various clinical settings, improving patient outcomes. Methods The QA framework uses the Octopoint phantom, Gafchromic film, and spot position monitor (SPM) log data to evaluate proton beam isocentricity, spot position, and spot size. The Octopoint phantom, made from acrylic, was used with Gafchromic films at various gantry and couch angles to measure isocentricity. MATLAB tools were used to analyze spot positions, and SPM logs provided verification. Sensitivity tests were conducted to assess the system's response to intentional shifts and errors, ensuring alignment with clinical QA standards. Results The Octopoint phantom's stepwise two‐dimensional (2D) fitting process, validated against film‐measured dose profiles, accurately identified beam and ball bearing (BB) centroid locations. Isocentricity tests conducted over 8 months across four gantries demonstrated consistent beam‐to‐BB radial offsets. The phantom showed excellent repeatability, with a maximum standard deviation of 0.1 mm across various couch‐gantry combinations. Sensitivity testing across all axes revealed a strong alignment between intended shifts and measured values. Over the course of a year, film measurements tracked spot position and size consistency, with deviations remaining within acceptable clinical limits. Comparisons with SPM data further confirmed the system's reliability in maintaining beam accuracy across different gantry angles and energy levels. Conclusions This study presents a reliable QA framework for ensuring precision in proton therapy delivery. By combining the Octopoint phantom, Gafchromic film analysis, and SPM log file evaluation, we effectively measured isocentricity, spot position accuracy, and spot size stability. The framework demonstrated adaptability across various clinical QA tasks, enhancing the accuracy and safety of proton therapy treatments.

Abstract Background: The standard first line therapy for cholangiocarcinoma (CCA), gemcitabine and cisplatin +/- immunotherapy, only induces disease control in approximately 75% of patients (KEYNOTE-966 Trial). While several candidate single genes that predict gemcitabine and cisplatin resistance have been proposed, the overall molecular landscape that leads to resistance is not well understood. Predicting response based on molecular characteristics would benefit the clinical decision-making process when selecting appropriate chemotherapy regimens for CCA patients. Methods: Fifty-five Mayo Clinic CCA patients who underwent whole transcriptome RNA sequencing were included. Forty-eight patients had TempusXR sequencing and 7 patients used institutional labs. Normalized transcript-level data was converted to KEGG pathway-level data using overrepresentation ranking. Patient oncology notes were manually reviewed for response to gemcitabine plus cisplatin therapy, with or without concurrent pembrolizumab or durvalumab. Oncologists used a mixture of formal RECIST criteria and expert opinion to determine whether the response to gemcitabine and cisplatin +/- immunotherapy was progressive disease (PD), stable disease (SD), partial response (PR), or complete response (CR). The binary outcome of PD vs SD/PR/CR based on KEGG pathway overrepresentation was modelled using a Tabular Prior-data Fitted Network (TabPFN). Validation was performed using leave-one-out cross-validation. External model testing was performed on RNA sequencing data from 11 patient-derived xenografts that were treated with gemcitabine and cisplatin and underwent ultrasound measurements of tumor size. Results: There were 34 patients with SD/PR/CR and 21 patients with PD as the best response while receiving gemcitabine and cisplatin +/- immunotherapy. TabPFN cross-validation accuracy was 0.73, recall 0.94, precision 0.71, and F1 score 0.81. External validation accuracy was 0.70, with one xenograft exhibiting mixed response. In contrast, the best trained model using a 14-gene subset previously published for gemcitabine resistance prediction in pancreatic adenocarcinoma had accuracy 0.58. Conclusions: Machine learning models like TabPFN can capture relationships in high-dimensional transcriptomic information in novel ways that enhance our ability to predict chemotherapy response. Integrating machine learning to understand the complex molecular landscape of CCA will be a valuable tool for therapeutic regimen selection. Citation Format: Ellen L. Larson, Erik Jessen, Dong-Gi Mun, Amro Abdelrahman, Jennifer Tomlinson, Danielle Carlson, Hojjat Salehinejad, Caitlin Conboy, Rory Smoot. Machine learning models of RNA expression landscapes help predict overall tumor response to chemotherapy in cholangiocarcinoma [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Artificial Intelligence and Machine Learning; 2025 Jul 10-12; Montreal, QC, Canada. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(13_Suppl):Abstract nr A020.

BACKGROUND AND OBJECTIVES: Healthcare policies have seen significant reforms, with a marked transition toward a patient-centered approach. This shift emphasizes the use of subjective patient-reported outcome measures as key metrics. However, these measures often face limitations, particularly in identifying clinically meaningful changes over time. To address this challenge, the concept of the minimal clinically important difference (MCID) was introduced. This study aims to evaluate the predictive effectiveness of relative change and its associated threshold, the minimal clinically important relative change (MCIRC), as a potential alternative to absolute differences and the MCID. METHODS: Data prospectively collected between 2006 and 2021 from the Swedish Spine Registry (Swespine) were analyzed. Patient-reported outcome measures included the Numeric Rating Scale (NRS) for neck and arm pain, the EQ5D index, EQ VAS, and the Neck Disability Index (NDI). Anchor-based methods were used to calculate the MCID and MCIRC. The predictive performance of absolute differences and relative changes was compared using the area under the receiver operating characteristic curve. RESULTS: 1756 patients were included. The selected MCID values were −3 for NRS neck pain intensity, −2 for arm pain intensity, 0.09 for the EQ5D index, 7 for EQ VAS, and −12 for NDI scores. For MCIRC, the chosen values were −47% for NRS neck pain intensity, −40% for arm pain intensity, 386% for the EQ5D index, 52% for EQ VAS, and −32% for NDI scores. On area under the ROC curve, relative change was superior for NRS neck and arm pain scores and NDI, while absolute difference was superior for EQ5D and EQ VAS scores. CONCLUSION: Relative change, along with its associated minimal clinically important value (MCIRC), proved to be a more suitable indicator of subjective satisfaction for NRS and NDI scores. By contrast, absolute differences and the MCID were better suited for evaluating the EQ5D index and EQ VAS scores.

The NCCN Guidelines for Thyroid Carcinoma address the management of different types of thyroid carcinoma, including papillary, follicular, oncocytic, medullary, and anaplastic carcinoma. The NCCN Thyroid Carcinoma Panel meets at least annually to review comments from reviewers within their institutions, examine relevant new data from publications and abstracts, and reevaluate and update their recommendations. These NCCN Guidelines Insights focus on the panel’s most recent recommendations regarding systemic therapies for thyroid carcinoma as well as the supporting clinical data.

Deep brain stimulation (DBS) is an established therapeutic intervention for a range of neurological disorders, including Parkinson’s disease, essential tremor, and epilepsy. The efficacy of DBS is predicated on the modulation of dysfunctional neural circuits through the application of electrical pulses. Recent advancements in MRI technology have facilitated the visualization of brain nuclei and their associated networks, which is critical for proper patient-specific targeting of electrodes in surgical procedures. This advancement aims to personalize surgical planning and postoperative programming by integrating patient-specific anatomical and connectivity models. The advent of clinical ultrahigh-field MRI, particularly 7T MRI, significantly enhances the targeting of DBS by improving spatial resolution, signal-to-noise ratio, and tissue contrast. Compared with lower field strengths, 7T MRI provides superior visualization of deeply situated brain nuclei and their extensive cortical projections, including the subthalamic nucleus, globus pallidus internus, and thalamus. This review synthesizes a multi-institutional consensus regarding the technical and clinical applications of 7T MRI, drawing on experience from more than 1000 procedures using 7T DBS. It encompasses both imaging acquisition and postprocessing techniques aimed at optimizing image quality. Our extensive clinical experience informs best practices for correcting distortions, mitigating image artifacts, and employing specific imaging sequences that enhance the visualization of common DBS targets. The insights and recommendations presented are intended to promote the safe and effective utilization of 7T MRI in DBS.

ABSTRACT Background This study aims to assess how Watchman FLX (Boston Scientific) and Amplatzer Amulet (Abbott) devices for left atrial appendage occlusion (LAAO) impact the flow dynamics in the LA and the risk of device‐related thrombosis (DRT). Methods Flow simulations were carried out for 12 AF patients before and after undergoing LAAO. Six patients had Watchman FLX while the other six had Amulet devices, of which three in each group had DRT. The flow parameters investigated included the LA velocities, pressure, time averaged wall shear stress (TAWSS), oscillatory shear index (OSI), and relative residence time (RRT). Low TAWSS and high OSI and RRT are generally associated with flow stasis and thrombosis. Results LA flow dynamics differed significantly between the two groups. On average, after LAAO, the Amulet patients exhibited a 25% increase in TAWSS and 24% decrease in RRT while the Watchman FLX patients exhibited, on average, a 24% decrease in TAWSS and a 23% increase in RRT. Both populations experienced an increase in LA pressure (~10% for Amulet patients and 16% for Watchman FLX patients). Increased DRT volume seems to be correlated with low TAWSS and elevated RRT. Conclusion This preliminary study suggests that the Amulet device might be associated with improved LA flow dynamics and a potentially lower incidence of DRT compared with the Watchman. However, a larger clinical study is needed to confirm these findings.