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A bstract Alzheimer’s disease (AD) presents with substantial clinical and anatomical heterogeneity, including both typical amnestic and atypical variants such as posterior cortical atrophy and logopenic primary progressive aphasia. Although neurofibrillary tangle (NFT) burden is a defining pathological feature of AD, its regional distribution varies across clinical phenotypes, suggesting that selective neuronal vulnerability may shape disease presentation. However, the cellular and molecular determinants underlying this vulnerability remain incompletely understood. Here, we profiled single-nucleus transcriptomes across multiple brain regions, including hippocampal (CA1) and neocortical (superior temporal gyrus and occipital cortex) regions, from individuals with typical and atypical AD and healthy controls. Integrative analysis identified major cell classes and resolved diverse excitatory and inhibitory neuronal subpopulations that were reproducibly observed across regions and individuals. Using quasi-binomial regression models to assess compositional changes, we quantified subtype-specific vulnerability associated with AD pathology. We identified a distinct excitatory neuronal subpopulation characterized by NRGN and BEX1 expression, which showed reproducible depletion across multiple regions, with the strongest evidence in amnestic AD and in neocortical regions in lvPPA. This vulnerable population showed concordance with previously reported AD-associated excitatory neuron signatures, supporting a conserved transcriptional program of susceptibility. Genes enriched in this population were associated with chemical synaptic transmission and regulation of synaptic plasticity and formed interconnected networks in protein-protein interaction analyses. These findings suggest that intrinsic properties related to synaptic function may predispose specific neuronal populations to degeneration in AD. Together, our results define a conserved, transcriptionally distinct excitatory neuron subpopulation that is selectively vulnerable across AD phenotypes and brain regions. This work provides a framework for linking regional pathology to cell-type-specific susceptibility and highlights synaptic regulatory pathways as potential contributors to neuronal degeneration in Alzheimer’s disease.

OBJECTIVE Anterior cervical discectomy and fusion (ACDF) is commonly performed in both inpatient and outpatient settings. In this study, the authors evaluate the influence of surgical setting on patient-reported outcome measures (PROMs), satisfaction, dysphagia, and complications following ACDF. METHODS A prospectively collected, multi-institutional quality improvement registry was retrospectively reviewed. Patients eligible for study inclusion were those who underwent ACDF without corpectomy or arthroplasty between 2016 and 2023. The patients were stratified by surgery setting, with same-day discharge indicating outpatients and an overnight stay indicating inpatients. PROMs were collected preoperatively and at 3 and 12 months postoperatively. Patient satisfaction was measured using the North American Spine Society (NASS) outcome assessment questionnaire, and dysphagia was measured using the 10-item Eating Assessment Tool (EAT-10). Propensity score overlap weighting (average treatment effect in the overlap population) was used to balance baseline covariates. RESULTS Of the 1514 patients who underwent ACDF, 462 were inpatients and 1052 were outpatients. The outpatient cohort was younger (55.1 ± 10.7 vs 60.5 ± 11.0 years, p < 0.001), had higher rates of private insurance (73% vs 52%, p < 0.001), had a lower mean American Society of Anesthesiologists (ASA) physical status (2.3 ± 0.6 vs 2.6 ± 0.6, p < 0.001), and underwent more single-level surgeries (53% vs 33%, p < 0.001). Propensity weighting resulted in comparable mean ages (58.9, p > 0.9) and ASA classes (2.5, p = 0.8) as well as private insurance rates (56%, p > 0.9) between the cohorts. After weighting, the inpatient cohort had a higher share of single-level fusions (46% vs 37%, p = 0.007). An outpatient status was associated with significantly better 12-month numeric rating scale (NRS) scores for neck pain (2.4 ± 2.7 vs 3.1 ± 3.0, p = 0.006), NRS scores for arm pain (1.7 ± 2.6 vs 2.2 ± 3.0, p = 0.047), and Neck Disability Index (NDI; 7.7 ± 7.8 vs 9.8 ± 9.4, p = 0.004) and greater improvement from baseline to 12 months on the NDI (−12.5 ± 9.7 vs −10.8 ± 10.5, p = 0.017), EQ-5D (0.242 ± 0.220 vs 0.209 ± 0.226, p = 0.047), and EQ visual analog scale (10.6 ± 21.6 vs 7.1 ± 20.8, p = 0.012). Fewer outpatients reported dysphagia at 3 months postoperatively (31% vs 40%, p = 0.010). No differences were observed in readmissions or revision procedures, although fewer outpatients experienced new neurological deficits (1.0% vs 2.6%, p = 0.032) and pneumonia (< 0.1% vs 0.9%, p < 0.001). In terms of the 12-month NASS outcome assessment, a smaller proportion of the outpatient cohort reported the lowest satisfaction score (3.9% vs 8.0%, p = 0.019). CONCLUSIONS Outpatient setting was associated with better PROMs at the 12-month follow-up when patients were weighted by baseline health status. These findings support the efficacy of outpatient ACDF in appropriately selected patients.

Abstract Objectives Patients referred for specialized care often arrive with outside medical records (OMRs) compiled into multi-report PDFs that include imaging, pathology, and clinical notes in unstructured formats. Reviewing these records is time consuming and mentally taxing, increasing the risk of delayed care, clinician frustration, and missed information affecting quality of care. This study aimed to automate the segmentation, classification, and date extraction of scanned OMRs, with a focus on records relevant to breast cancer care. Materials and Methods We used optical character recognition (OCR) to extract machine-readable text from 1303 scanned PDF documents from 116 distinct external institutions. Gemini 1.5, a large language model (LLM), was then used to segment multi-report files into individual documents, classify them into clinically meaningful categories such as mammograms and pathology reports, and extract study dates to build diagnostic timelines. Document categories were informed by clinical workflows in a breast cancer center. Results The system achieved an F1 score of 0.95 for segmentation, 0.96 for classification, and 0.90 for date extraction. In a pilot of 45 records reviewed by clinicians, only 2 classification errors and 1 date error were reported. Clinicians estimated that the tool reduced OMR review time by 40%, improved workflow efficiency, and increased satisfaction. Discussion Our findings demonstrate that combining OCR with LLMs can significantly enhance the processing of unstructured medical records, reducing manual burden and supporting timely clinical decision-making. Conclusion This study demonstrates the successful application of OCR and LLMs for organizing scanned OMRs within a specialty clinic. By automating a previously manual process, the approach supports scalable review of incoming outside records and has potential for adaptation to other clinical workflows. Future work will focus on evaluating the system across additional specialties and institutions.

Abstract Background and Aims Stroke and systemic embolism are recognized but poorly characterized complications of atrial fibrillation (AF) and left atrial flutter (AFL) catheter ablation. Their incidence, outcomes, and procedural associations remain insufficiently defined. Methods Retrospective global registry was initiated by the European Heart Rhythm Association Scientific Committee. A secure database captured data from ablation centres worldwide on general AF and left AFL ablation activity, as well as detailed information on patients with symptomatic embolic events between 2017 and 2024. Results Overall, 204 centres reported 335 743 ablation procedures and 550 embolic events (incidence 0.16%). Centre-level rate ranged from 0% to 3.1%. Most events were cerebral (94%), followed by peripheral (5%), and combined (1%). Coronary air embolism accounted for 62% of all peripheral events. Intraprocedural events occurred in 93 patients (17%), within 72 h in 357 (78%) and beyond 72 h in 100 (22%); 128 cases (23%) were diagnosed after hospital discharge. Nonparoxysmal AF (0.23% vs 0.15%; P &lt; .001), centre experience, and ablation energy source (radiofrequency, 0.16%; cryoballoon, 0.16%; pulsed field ablation, 0.25%; laserballoon, 0.88%; P &lt; .001) were associated with embolic risk. Median NIHSS score after stroke was 4 (interquartile range, 2–9). Three-month follow-up was available for 518 patients with embolism (95%): 181 (35%) had sequelae and 16 (3%) died. Conclusions Symptomatic embolic events are infrequent but associated with significant morbidity and mortality. Most events occur early, though a substantial proportion arise later. Higher event rates were observed with laser and possibly with pulsed field ablation. A greater centre experience was associated with a lower embolism incidence.

ABSTRACT Introduction and Methods Cancer therapy–related cardiac dysfunction (CTRCD) is a well established and potentially life‐threatening complication of contemporary oncologic treatment. Although comprehensive cardio‐oncology guidelines have been developed, their integration into routine hematology and oncology practice remains inconsistent. This consensus statement, developed by a multidisciplinary panel of cardio‐oncology experts, aims to provide practical, case‐based guidance to help oncology providers recognize, assess, and manage CTRCD across a spectrum of malignancies and cardiovascular presentations. Clinical Scenarios and Discussion We present representative clinical scenarios that illustrate real‐world challenges in cardio‐oncology and apply evidence‐based recommendations from current guidelines, including those from the European Society of Cardiology (ESC) and the International Cardio‐Oncology Society (ICOS)—to support informed decision‐making. Key areas of focus include baseline cardiovascular risk stratification prior to initiating potentially cardiotoxic therapies, with an emphasis on biomarker and imaging surveillance strategies tailored to individual risk profiles. Also, this document outlines the application of guideline‐directed medical therapy (GDMT) for cancer patients with heart failure. Conclusion By offering a structured, user‐friendly framework, this document seeks to bridge the implementation gap between oncology and cardiology disciplines. Our goal is to equip oncology providers with accessible tools that facilitate early recognition, consistent surveillance, and timely referral, thereby preserving cancer treatment intensity while minimizing cardiovascular morbidity.

BACKGROUND AND OBJECTIVES: The Congress of Neurological Surgeons (CNS) Leadership Institute developed the first structured leadership program designed specifically for neurosurgeons. Led by the experts in neurosurgery, health care administration, and business, the program provides formal leadership training and mentorship aimed at advancing neurosurgeons' professional development at local, regional, national, and international levels. METHODS: The CNS Leadership Institute offers 2 curricula tailored for junior and senior faculty. Training begins with assigned readings, webinars, and online lectures that establish essential leadership principles. Core learning occurs during 2 in-person courses featuring interactive lectures, feedback sessions, and a longitudinal leadership project guided by national mentors. Program outcomes were assessed through a 40-question survey of alumni evaluating training effectiveness, skill application, and career advancement. RESULTS: Since 2016, 195 neurosurgeons have completed the CNS Leadership Institute. Among the 77 survey respondents, 70.1% reported significant professional advancement (new leadership role or job transition), and 64.8% directly attributed their advancement in skills and insights acquired through the program. Overall program effectiveness was rated 4.4 of 5, and the mean likelihood-to-recommend was 8.95 (95% CI: 8.70-9.20), yielding a Net Promoter Score of +63 (95% CI: +49 to +77). Alumni have assumed prominent roles including 16 Residency Program Directors, 3 Department Chairs, 1 Vice Dean, 4 Service Line Leaders, 13 CNS Executive Committee members, and over 100 committee or editorial board appointments critical to the specialty. CONCLUSION: The CNS Leadership Institute equips neurosurgeons with structured leadership training, mentorship, and practical tools to enhance their effectiveness as leaders. Survey results confirm that the program has a measurable impact on participants' career trajectories and professional growth. This initiative provides a reproducible model for cultivating the next generation of neurosurgical leaders and advancing the specialty's capacity for strategic, transformational leadership.

Background Mortality in adults with congenital heart disease (CHD) is strongly driven by disease complexity. Social determinants of health (SDOH) influence adult CHD (ACHD) health outcomes but their impact on mortality is unclear. This study examined the influence of clinical factors and SDOH on all‐cause mortality in patients with ACHD. Methods Single‐center retrospective cohort study of patients with ACHD in the Mayo ACHD Registry who had a verifiable residential address between January 1, 2004 and December 31, 2023. Clinical and SDOH indicators were extracted, including insurance type, language, rural–urban commuting area code, and a housing‐based socioeconomic index, an individual‐level measure of socioeconomic status derived from 4 objective housing characteristics and categorized into quartiles (Q1–Q4). Cox proportional‐hazards models were fitted to evaluate associations with mortality, incorporating CHD severity, arrhythmias, SDOH indicators, and other comorbidities. County of residence was included as a random effect, and model discrimination was assessed using the concordance statistic. Results Among 6134 patients with ACHD, the mean age was 38±16 years; 51% were male; 78.7% were White and 44.9% had rural residence. Independent predictors of mortality included cyanotic CHD (adjusted hazard ratio [aHR], 5.70 [95% CI, 2.90–11.23]), Fontan palliation (aHR, 4.98 [95% CI, 2.56–9.70]), ventricular tachycardia (aHR, 1.71 [95% CI, 1.16–2.52]), older age at first visit (aHR, 1.05 per year [95% CI, 1.04–1.05]), male sex (aHR, 1.19 [95% CI, 1.03–1.39]), public insurance (aHR, 1.60 [95% CI, 1.35–1.90]), rural residence (aHR, 1.25 [95%, CI 1.06–1.47]), and non‐English language (aHR 1.75 [95% CI 1.38–2.23]). The housing‐based socioeconomic index quartile was not associated with mortality. The final model achieved a concordance statistic of 0.77. Conclusions Mortality in patients with ACHD is strongly influenced by both clinical factors and SDOH, independent of socioeconomic status. Addressing barriers to care such as language, insurance, and geography is essential for improving ACHD survival particularly in those at increased mortality risk.

Abstract We aim to compare the benefits, harms, and costs of multiple plastic stents (MPS) versus covered self-expandable metallic stents (CSEMS) in the treatment of benign biliary strictures (BBS). A comprehensive database search through June 6, 2024 identified randomized controlled trials (RCT) involving adult patients with BBS comparing MPS to CSEMS in terms of stricture resolution, recurrence, technical success, number of required procedures and stents, treatment duration, all-cause mortality, adverse events, and stent migration. We utilized the Cochrane Risk of Bias (RoB) tool2 for study quality assessment. Meta-analysis following the random effects model was performed. After screening 365 references, we included 7 RCTs (high RoB) involving 594 patients. Most reported stricture etiology is chronic pancreatitis (52.4%), followed by orthotopic liver transplant (40.5%). Compared with MPS, CSEMS achieved similar efficacy and safety. However, CSEMS required fewer procedures (mean difference [MD]: −1.84 [−2.56 to −1.11]; I2 = 76%) and stents (MD: −6.04 [−9.55 to −2.52]; I2 = 93%), amounting for shorter duration of treatment (MD: −119.02 days [−137.41 to −100.62]; I2 = 96%) and savings in costs between 41 and 57% with absolute savings of 4,019$ to 9,192$ favoring CSEMS. All outcomes had a low to very low certainty of evidence (CoE), except for technical success and stricture resolution (moderate CoE). Our analysis suggests that CSEMSs are comparable to MPSs in terms of efficacy and safety. However, it shows that CSEMSs are more cost-effective. Sample size calculations from our analyses can guide the design of future studies to validate the safety profiles and determine the feasibility of the two modalities.