Citations

Background The optimal imaging guidance for percutaneous coronary intervention (PCI) in complex coronary lesions remains a matter of debate. This meta-analysis compares the efficacy and safety of optical coherence tomography (OCT)-guided PCI versus angiography-guided PCI. Methods Following PRISMA guidelines, we systematically searched PubMed, Embase, Cochrane, and ClinicalTrials.gov from inception to December 2024. Randomized controlled trials (RCTs) comparing OCT-guided PCI to angiography-guided PCI were included. Data analysis was performed using RevMan 5.4, with risk ratios (RR) and 95% confidence intervals (CI) calculated for dichotomous outcomes using a random-effects model. Risk of bias was assessed using the Cochrane RoB 2.0 tool. Results Eleven RCTs involving 6432 participants were included. OCT-guided PCI showed no statistically significant reduction in all-cause mortality compared to angiography-guided PCI (RR 0.72, 95% CI 0.51–1.01, P = 0.06, I 2 = 0%). However, OCT-guided PCI was associated with a significant reduction in cardiac death (RR 0.52, 95% CI 0.30–0.90, P = 0.02, I 2 = 0%), major adverse cardiovascular events (MACE) (RR 0.70, 95% CI 0.55–0.89, P = 0.003, I 2 = 0%), stent thrombosis (RR 0.53, 95% CI 0.33–0.87, P = 0.01, I 2 = 0%), and major edge dissection (RR 0.47, 95% CI 0.34–0.65, P < 0.00001, I 2 = 0%). Upon stratification of studies on the basis of follow-up duration, similar results were noted. Conclusion OCT-guided PCI demonstrated significant benefits in reducing cardiac death, MACE, and procedural complications compared to angiography-guided PCI. These findings support the integration of OCT in complex PCI, although further studies are warranted to assess its impact on long-term mortality.

OBJECTIVE Ruptured, large pediatric arteriovenous malformations (AVMs) pose a significant management challenge due to high rerupture risk and the morbidity of conventional treatments. Volume-staged stereotactic radiosurgery (VS-SRS) has emerged as an alternative; however, evidence for its use in this specific population is limited. This study aimed to evaluate the long-term efficacy and safety of VS-SRS for ruptured, large AVMs in a dedicated pediatric cohort. METHODS This international, multicenter, retrospective cohort study from 21 centers analyzed outcomes for 42 pediatric patients (age < 18 years) with previously ruptured, large AVMs treated with VS-SRS. The primary outcome was complete AVM obliteration, and secondary outcomes included post-SRS hemorrhage, radiation-induced changes (RICs), and favorable outcome. Favorable outcome in this study was defined as obliteration without post-SRS hemorrhage or permanent RIC. RESULTS At the initial SRS, the median patient age was 14.5 years, and the median AVM volume was 15.0 cm 3 ; most AVMs were high grade (Spetzler-Martin grades IV and V). With a median follow-up of 41.5 months, complete AVM obliteration was achieved in 21 patients (50.0%). The cumulative obliteration rate was 37% at 5 years and 56% at 10 years. Patients with a nidus volume of ≤ 10 cm 3 had significantly higher cumulative obliteration rates than those with a nidus volume > 10 cm 3 (log-rank test, p = 0.021). Similarly, patients treated with a prescription dose > 17 Gy showed significantly higher cumulative obliteration rates compared to those treated with a dose ≤ 17 Gy (log-rank test, p = 0.012). The cumulative 5-year incidences of hemorrhage and RICs following VS-SRS were 19% and 7%, respectively. In multivariable analysis, only larger total AVM volume was an independent predictor of a lower likelihood of favorable outcome (hazard ratio 0.89, 95% CI 0.80–0.99; p = 0.036). CONCLUSIONS In this multicenter pediatric cohort, VS-SRS for ruptured, large AVMs provides a reasonable chance of long-term obliteration, but generally acceptable risks of post-SRS hemorrhage and RICs exist. VS-SRS should be considered as an option for pediatric patients with large, ruptured AVMs.

INTRODUCTION: Computed tomography enterography (CTE) is a noninvasive cross-sectional imaging modality routinely used for diagnosis of Crohn's disease (CD) strictures. However, CTE is limited in individually defining the severity of inflammation, fibrosis, or smooth muscle hyperplasia/hypertrophy (SMH) within such strictures. We developed and internally validated a radiomics-based machine learning model for separately characterizing the degree of histopathological inflammation, fibrosis, and SMH in CD strictures and compared it with centrally read visual radiologist scoring of CTE. METHODS: This single-center, cross-sectional study included 100 patients with CD (n = 66 for discovery; n = 34 for validation) with terminal ileal strictures confirmed on diagnostic CTE within 15 weeks of intestinal resection. Histopathological specimens were scored for inflammation, fibrosis, and SMH and spatially linked with corresponding pre-surgical CTE sequences. Annotated stricture regions on CTE were scored visually by radiologists as well as underwent three-dimensional radiomics-based machine-learning analysis; both evaluated against histopathology scoring. RESULTS: Three distinct sets of radiomic features capturing textural heterogeneity within strictures were separately linked with severe inflammation, fibrosis, and SMH across both discovery (accuracy = 0.74, 0.71, 0.71, respectively) and validation (accuracy = 0.74, 0.68, 0.68, respectively) cohorts. Radiologist visual scoring was limited, with accuracy of 0.51 for identifying severe inflammation, 0.48 for severe fibrosis, and 0.58 for severe SMH. Augmenting radiologist scoring with radiomic features yielded improved performance in identifying severe inflammation, fibrosis, or SMH compared to radiologist scoring alone. DISCUSSION: Radiomic features of CD strictures on CTE can identify severe histopathological fibrosis, inflammation, and smooth muscle hyperplasia and perform better than radiologist visual scoring in stricture characterization.

Abstract Background Cumulative head trauma, encompassing repetitive head impacts (RHI) and traumatic brain injury (TBI), has been associated with later‐life neurodegenerative disease. Studies on parkinsonism/Parkinson's disease (PD) have evaluated RHI and TBI in isolation, yielding mixed results. Cumulative head trauma may better predict PD risk. Objective To examine independent and cumulative effects of RHI through soccer participation and TBI history on PD diagnosis and age at diagnosis. Methods We used a cross‐sectional cohort design with data from the Fox Insight study. Participants completed self‐report questionnaires on PD diagnosis, TBI (no TBI, TBI with loss of consciousness [LOC], TBI without LOC), and sport participation. Multivariable logistic regressions examined the effects of soccer, TBI group, and their interaction on PD diagnosis. Cox proportional hazards examined associations with time to PD diagnosis. Covariates included age, sex, race, education, income, body mass index, heart disease/diabetes, and family PD history. Results Among 1231 participants (mean[SD] age = 66.12[10.60]), 278 played soccer (953 non–contact and collision sport [CCS] athletes). Participants reported no TBI (390[33%]), TBI without LOC (495[43%]), or TBI with LOC (258[23%]). Overall, 768(62%) reported a PD diagnosis (mean[SD] age at diagnosis = 59.02[9.86]). A significant soccer × TBI interaction indicated that soccer players with TBI with LOC had 2.6× higher odds of PD compared to non‐CCS athletes without TBI (OR [95% CI] = 2.600[1.085–6.305], P = 0.033). Former soccer players with TBI with LOC had a 15.6% higher hazard of early PD diagnosis (HR = 1.469, P = 0.027) compared to non‐CCS athletes with no TBI. Conclusion Cumulative head trauma (RHI + TBI) increased PD risk and lowered age at onset. © 2026 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Background. Pancreas transplantation (PT), historically limited to patients with type 1 diabetes (T1D), is currently performed successfully in selected patients with type 2 diabetes (T2D). However, contemporary practice patterns and eligibility criteria for PT in T2D remain incompletely characterized. Methods. The International Pancreas and Islet Transplant Association Pancreas Transplant Interest Group developed an electronic survey to assess center-level approaches to patient phenotyping, candidacy, and peri- and posttransplant management for PT in patients with T2D. The survey was distributed to international transplant professionals during an International Pancreas and Islet Transplant Association Pre-Congress meeting on June 15, 2025. Results. Thirty-seven participants completed the survey. Most respondents’ programs offer PT for T2D only when a kidney transplant is also indicated. Fewer respondents’ programs also offer PT alone (10%), evaluate T2D candidates on a case-by-case basis (3%), or do not offer PT to patients with T2D (10%). Total daily insulin requirement and body mass index (BMI) were the most selected factors in determining eligibility. Considerable variability existed in metabolic thresholds: 62% of programs reported no C-peptide cutoff, whereas nearly half required a BMI of <30 kg/m 2 for C-peptide-positive candidates. Respondents frequently recommend weight-optimization strategies, including lifestyle modification, glucagon-like peptide-1 receptor agonists, and bariatric surgery for candidates exceeding acceptable BMI thresholds. Surgical technique, induction, and maintenance immunosuppression and early posttransplant glycemic management were largely uniform between T2D and T1D recipients. Conclusions. International practice reflects broad but heterogeneous adoption of PT for T2D, with most participants restricting its use to candidates requiring kidney transplantation and emphasizing integrated clinical phenotyping approaches.