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Importance Currently, there are no standardized outcome domains or measures in clinical trials for facial aging. Heterogeneity in outcome domains and measurement instruments across clinical trials creates difficulty in directly comparing interventions, determining superior therapies, and developing high-quality meta-analyses. Objective To develop a core outcome set (COS) of essential domains to be reported in clinical trials evaluating the efficacy of interventions for facial aging. Evidence Review PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials, and CINAHL were searched from September 2005 to September 2015. An updated search of the same databases was performed from September 2015 to February 2026. Studies were included if (1) they were randomized clinical trial or controlled clinical trial in design, (2) they assessed the efficacy or safety of an intervention for facial aging, (3) they were published in English, and (4) they involved human participants. Complementary sources, including patient interviews, were used to capture further relevant outcomes. Two rounds of Delphi surveys, followed by consensus meetings, were used to identify outcome domains considered most important by both patient and physician stakeholders. Findings The final COS consists of 6 outcome domains: (1) overall convenience of treatment; (2) time to return to normal work and social activity; (3) overall assessment of focused area of treatment (at the point in time when treatment is expected to provide peak benefit); (4) duration of treatment effect; (5) severity of persistent local or systemic adverse events, including pigmentary change, skin texture change, delayed healing, scarring, and serious adverse events; and (6) patient satisfaction with treatment. Conclusions and Relevance The 6 outcome domains identified through a Delphi consensus are recommended for reporting in future facial aging trials to ensure that outcomes that matter most to patients and clinicians are measured and that results are comparable across interventions.

Syndesmotic injuries are complex and often require a longer return to play as compared with lateral ankle sprains. As common as they are, they can be difficult to diagnose owing to the complex biomechanics of the ankle joint as well as their varying degrees of stability. A careful physical examination and dedicated imaging can assist with the diagnosis. Weightbearing ankle X-rays should be obtained to assess for fractures or gross instability with anteroposterior, lateral, and mortise views. If these are inconclusive but there is high clinical suspicion, stress views can be added. Advanced imaging also plays a role. Classification systems attempt to distinguish a stable, dynamically unstable, and unstable injury, as this guides management. Stable injuries can be treated conservatively and unstable injuries warrant surgical intervention. It is the diagnosis and treatment of unstable injuries that can be particularly challenging.

ABSTRACT Primary plasma cell leukemia (pPCL) is a rare and aggressive plasma cell disorder with inferior outcomes compared with multiple myeloma (MM). However, studies describing outcomes after first progression and subsequent lines of therapy remain limited. We retrospectively analyzed 104 patients with pPCL who progressed after first‐line therapy treated at one comprehensive cancer center between 2006 and 2024. Clinical characteristics, treatments, time to next treatment (TTNT), and overall survival (OS) were assessed using Kaplan–Meier methods. All pPCL patients received novel agent–based induction. At the time of analysis, 63% had died; median OS was 39 months. High‐risk cytogenetics were present in 71%. The median TTNT after first‐line therapy was 10 months. Symptomatic progression occurred in 29% of patients and was associated with significantly inferior subsequent OS (13 vs. 34 months) compared with those experiencing asymptomatic biochemical progression. The TTNT progressively shortened with subsequent lines of therapy (3rd line: 6 months; 4th line: 4 months; 5th line: 3 months). Notable exceptions included pPCL patients with t (11;14) treated with anti‐BCL‐2‐based regimens, who achieved a median TTNT of 13 months. Additionally, 24 patients received anti‐BCMA CAR T‐cell therapy. With a median follow‐up of 21 months, their median TTNT was 32 months. pPCL is characterized by frequent disease progression and diminishing response duration with successive therapeutic lines. Symptomatic progression portends particularly poor outcomes. Anti‐BCL‐2‐based therapy in t (11;14) disease and anti‐BCMA CAR T‐cell therapy appear to provide more durable disease control and represent important advances for the management of progressed pPCL.

Abstract Solitary bone plasmacytoma (SBP) and SBP with minimal marrow involvement (SBPmm) are treated similarly with definitive radiation therapy (RT) followed by observation. However, differences in the natural disease course after RT between the two, are not well described. We performed a multicenter study assessing outcomes after RT in 141 patients with SBP and 102 with SBPmm diagnosed between January 2010 and December 2024. About 92% of patients with SBPmm progressed to multiple myeloma (MM) vs 76% of those with SBP (P = .01). Among patients with SBP, 21% progressed with a second solitary bone lesion vs 4% with SBPmm (P< .01). Patients with longer time to progression (TTP) after initial RT could achieve durable responses with RT to a second solitary plasmacytoma in the absence of other myeloma-defining events (MDE). Multifocal lytic bone lesions were the most common MDE, occurring in 89% and 81% of patients with SBPmm and SBP, respectively. Patients with SBPmm had a median TTP of 15 months (95% confidence interval [CI], 14-21) compared to 43 months (95% CI, 34-55) for those with SBP (P< .0001); 67% with SBPmm progressed within 2 years of diagnosis. Del(17p) and 1q+ (gain or amplification) were associated with shorter TTP to MM in SBPmm, with 2-year progression rates of 100% and 82%, respectively. We report significant differences in risk and modes of progression between SBP and SBPmm. Patients with SBPmm are at particularly high risk for early progression to MM, with most developing bone disease as the MDE. These findings support prospective studies incorporating frontline systemic therapy for SBPmm.

Introduction Sleep is routinely assessed in the management of mental health conditions. Wearable technologies like smartwatches offer a non-intrusive method to quantitatively measure sleep. However, there are limited empirical benchmarks for sleep duration and sleep quality measured by wearables against user reports. This study aims to evaluate the concordance between user-reported and smartwatch-measured hours of sleep and sleep quality. Methods Participants were recruited from two decentralized digital health well-being studies and completed a 7-day sleep diary while simultaneously wearing their smartwatch to sleep (November 7, 2023 - June 30, 2024). Participants self-reported sleep timestamps and perceived sleep quality using the Sleep Quality Scale. Sleep timestamps and quality were also derived from their smartwatches (Garmin Vívoactive 4 2019, Garmin Venu 2 Plus 2022, and Garmin Venu 3/3S 2023). Statistical analyses included paired t-tests, equipercentile linking, and chi-square tests to assess agreement between smartwatch and self-reported sleep parameters. Exploratory analyses established the difference between reported and recorded sleep duration in healthcare shift workers. Results From 841 sleep instances reported by 130 participants wearing three different generation smartwatches, the mean difference in sleep duration between smartwatch-recorded and participant-reported was 21.22 (Garmin Vívoactive), 11.67 (Garmin Venu 2 Plus), and 6.58 (Garmin Venu 3/3S) minutes, respectively. There were statistically significant between-group differences in mean sleep durations assessed by participant self-report vs. Vívoactive 4 smartwatches, but not self-report vs. Venu 2 Plus or Venu 3/3S smartwatches. Equipercentile linking revealed concordance between smartwatch sleep scores and self-reported sleep quality using the Sleep Quality Scale (SQS) between 4 and 7, with disagreements observed at the SQS ranges from 0–4 and 7-10. Conclusions These results suggest that wearables can reliably measure sleep duration, and future research warrants improvements in algorithms that estimate sleep quality with validations across different wearable vendors.

BACKGROUND: The metabolic mechanisms underlying right ventricular (RV) dysfunction are poorly understood, particularly outside of group 1 pulmonary hypertension (PH). We aimed to identify metabolites and pathways associated with RV systolic function and explored whether associations differed by pulmonary vascular resistance, PH group 1 status, and sex. METHODS: We analyzed data from the multicenter PVDOMICS (Pulmonary Vascular Disease Phenomics) cohort. RV systolic function metrics included fractional area change (echo), global longitudinal strain (echo), and ejection fraction (cardiac magnetic resonance). We used linear regression adjusted for age, sex, body mass index, and PH group to assess associations between metabolites and RV function. Pathway enrichment analyses were used to identify pathways significantly associated with RV function. Interaction terms were assessed to determine whether metabolite associations were modified by pulmonary vascular resistance, group 1 PH status, or sex. Least absolute shrinkage and selection operator regression was used to develop metabolite-based scores for RV function, and prognostic performance was assessed. RESULTS: There were 979 participants with plasma metabolomics and RV function data. Linear regression identified 170 metabolites that were significantly associated with all 3 RV metrics. Androgenic steroid, gamma-glutamyl amino acid, polyamine, vitamin A, fatty acid, and sterol pathways are most strongly associated with RV systolic function. Two metabolites interacted with group 1 PH status, and 6 interacted with pulmonary vascular resistance. Four androgenic steroids are associated more strongly with RV systolic function in women compared with men. Metabolite-based scores were prognostically equivalent to RV systolic function metrics and less accurate than REVEAL Lite 2 scores. CONCLUSIONS: We provide a blueprint of metabolites and metabolic pathways associated with RV systolic function across the spectrum of PH. Novel links to vitamin A and glutathione metabolites were observed. We detected few metabolites that associated with RV systolic function differentially by group 1 PH status or degree of pulmonary vascular resistance elevation. Androgenic steroids may associate more strongly with RV systolic function in women compared with men.

Abstract Background: Specialised knowledge in adult congenital heart disease is crucial but often lacking, particularly in resource-limited settings. The Global Conversations in Adult Congenital Heart Disease webinar series was initiated to provide accessible, global education via virtual platforms. Objective: This study evaluates the attendance patterns, participant demographics, knowledge outcomes, and audience feedback of the Global Conversations in Adult Congenital Heart Disease webinar series , analysing 19 monthly sessions conducted from October 2023 to April 2025. Methods: Registration data, session viewership, and total series reach were recorded. Demographics were collected per session. Pre- and post-session quizzes were used to assess changes in knowledge; scores from these independent groups were compared using the Mann–Whitney U test. Post-webinar surveys collected improvement suggestions. Results: Out of 1,956 registrants from 89 countries, 54.6% attended the sessions, representing 1,068 participants from 64 nations: mainly Colombia (30.9%), Peru (18%), the USA (14.1%), and Mexico (9.9%). Median quiz scores improved from 50% pre-session ( n = 120) to 100% post-session ( n = 108), a statistically significant gain ( p = 0.035). Notably, 29% had no prior adult congenital heart disease education. Most post-webinar survey respondents rated case presentations and discussions as excellent (75.0%) or good (20.1%). Qualitative feedback suggested areas for improvement included audiovisual quality, audience engagement, content delivery, and language accessibility. Conclusion: The Global Conversations in Adult Congenital Heart Disease webinar series successfully engaged a diverse international audience and showed significant differences in quiz scores between pre- and post-session independent groups, demonstrating the potential benefit and feasibility of virtual education in bridging gaps in adult congenital heart disease training, particularly in resource-limited countries.

Abstract Background Immigrants to the United States often face challenges from limited healthcare access and less healthy environments which contribute to rising obesity and cardiovascular risk. Purpose To assess the feasibility and effectiveness of a community-based social network intervention for cardiovascular risk reduction among Hispanic and Somali adults. Methods A social network-informed, community-based participatory research-derived health promotion intervention was delivered by Hispanic and Somali lay health promoters (HPs) to members of their social networks over 1 year (12 biweekly sessions in months 0-6; 12 biweekly check-ins in months 7-12). Using a closed-cohort stepped wedge cluster randomized design, social networks were randomly assigned to receive the intervention immediately or after a delay of 1 year. Measurements at baseline, 6 months, and 12 months were derived from 6 of the American Heart Association’s “Life’s Simple 7”: BMI, blood pressure, fasting glucose, cholesterol, physical activity and dietary quality (range 0-12, with higher values indicating lower cardiovascular risk). Waist circumference and proportion of participants who achieved >5% body weight loss were also assessed. Results Four hundred seventy-five participants were enrolled among 51 HPs (29 Hispanic; 22 Somali). There was a statistically significant improvement in cardiovascular risk in the intervention group (n = 246) compared with controls (n = 229) at 6 months (0.4 [1.8] vs. −0.1 [1.7]; P = .03) that was not sustained at 12 months (0.5 [1.9] vs. 0.3 [1.8]; P = .38). There was a statistically significant higher proportion of participants who lost >5% of body weight in the intervention group compared with controls at 12 months (37% [15] vs. 18% [7.9]; P = .02). Reductions in weight and waist circumference in the intervention group compared with controls did not achieve statistical significance. Conclusion A social network intervention, delivered by lay HPs was feasible and resulted in a modest improvement of cardiovascular risk and clinically significant weight loss. Clinical Trial Identification Number NCT05136339.