Citations

Purpose Aneurysmal rupture and subarachnoid hemorrhage (SAH) have an exceptionally high mortality and morbidity burden. The aim of this study was to develop interpretable machine learning models for predicting short-term poor outcomes defined by the National Inpatient Sample Subarachnoid Hemorrhage Outcome Measure (NIS-SOM). Methods The National Inpatient Sample (NIS) database was queried from 2008 to 2018 to identify patients diagnosed with SAH who had undergone endovascular coiling or clipping for intracranial aneurysm. Demographic, comorbidity, risk factor, and hospital characteristic variables were recorded. Variables were preprocessed, and the feature space was reduced to include the most important features. To predict poor outcomes, machine learning models were trained and cross-validated before being evaluated on a separate testing set. Shapley Additive exPlanations of the best performing model was used for general and local model interpretation. Results Among 18,149 admissions (mean age 55 ± 14 years, 68.8% women), 52.9% had a poor outcome. Test-set AUCs ranged 0.74–0.80; a multilayer perceptron performed best (AUC 0.80, precision 0.74, recall 0.82). SHAP ranked the ten most influential variables: age, neurological comorbidity, paralysis, Medicare insurance, smoking status, Elixhauser burden, fluid-electrolyte disorders, weight loss, arrhythmia, and heart failure. Conclusions The modeling predicted nationwide aSAH prognosis with decent accuracy and highlighted clinical, socioeconomic, and system-level drivers of determinants of poor short-term outcome. These results support the potential of explainable ML tools as complementary tools for early risk stratification, guiding resource allocation, and informing prospective multi-center validation and implementation studies.

Background: Postoperative failure to wean from ventilator support is associated with poor outcomes. This study characterizes patients requiring prolonged ventilation after head-and-neck reconstructive surgery and their outcomes. Methods : Patients who underwent head-and-neck reconstructive surgery were identified in the National Surgical Quality Improvement Program (NSQIP) database using CPT codes, ICD-10 codes, and free-text search. Hypothesis testing and regression analysis was utilized to compare patient characteristics and peri/postoperative complication rates between those with and without extended ventilation. Results : NSQIP contained 4661 patients who underwent free flap surgery; 180 experienced prolonged ventilation. Patients with primary oral cavity/sinonasal malignancy, preoperative ventilator dependence, and preoperative open wound/wound infection were more likely to experience prolonged ventilation. Prolonged ventilation patients experienced double the overall hospital stay, and increased rates of wound disruption, reoperation, and mortality. (p<0.05). Conclusion : Prolonged mechanical ventilation can significantly affect outcomes of free flap patients, including longer hospital stays, and higher 30-day mortality.

ABSTRACTBackground and ObjectiveSeladelpar is an oral, once‐daily medication that improves cholestasis through its selective peroxisome proliferator‐activated receptor (PPAR‐δ) agonism. It shows promising efficacy in treating primary biliary cholangitis (PBC) patients.MethodsA systematic review and meta‐analysis synthesizing evidence from randomized controlled trials (RCTs) obtained from PubMed, Cochrane, Scopus, and WOS until July 19th, 2025. Dichotomous outcomes were reported using risk ratio (RR) and continuous outcomes using mean difference (MD), with a 95% confidence interval (CI).ResultsThree RCTs with 499 patients were included. Seladelpar was significantly associated with an increased ALP normalization (RR: 21.12 with 95% CI [4.14, 107.58], p < 0.01), biochemical response (RR: 3.06 with 95% CI [2.00, 4.70], p < 0.01), and decreased pruritus NRS score change (MD: −1.47 with 95% CI [−2.73, −0.21], p = 0.02). Seladelpar was also significantly associated with a decreased incidence of pruritus (RR: 0.54 with 95% CI [0.31, 0.94], p = 0.03) but with an increased incidence of headache (RR: 3.37 with 95% CI [1.11, 10.23], p = 0.03). However, there was no significant difference between seladelpar and placebo regarding the incidence of any adverse events (RR: 0.96 with 95% CI [0.87, 1.06], p = 0.43).ConclusionSeladelpar improved liver biomarkers of cholestasis and reduced pruritus in patients with PBC without significantly increasing the adverse effects. This makes seladelpar a promising addition to the treatments available for PBC.Trial Registration: PROSPERO: CRD42024521208

Abstract Aims Patients with end-stage renal disease (ESRD) and atrial fibrillation present a challenge for thromboembolic prevention, given their elevated risks of both thromboembolism and bleeding. Anticoagulants carry a higher bleeding risk in this population without clear evidence of thromboembolic benefit. This study aims to define the role of left atrial appendage occlusion (LAAO) as a preventive strategy for patients with ESRD. Methods and results A systematic literature review was conducted to identify studies reporting outcomes in patients with ESRD who underwent LAAO. Meta-analyses of aggregate and individual patient data were performed to evaluate acute and long-term outcomes and compare them with those of patients without ESRD. Seventeen studies reporting data from 24 127 patients, including 1047 with ESRD, were included. Procedural complications were more common in patients with ESRD (RR 2.23; P = 0.02), with a pooled rate of 4% (95% CI, 1–9%). There was no significant difference in thromboembolic event rates during follow-up between the groups (IRR 1.44; P = 0.16), but major bleeding incidence was higher among patients with ESRD (IRR 1.84; P &lt; 0.01). Individual patient-level data from seven studies comprising 4745 patients (268 with ESRD) were obtained and analysed. Similarly, there was no significant association between ESRD and stroke/TIA incidence (HR, 1.22; 95% CI, 0.66–2.26), but major bleeding was higher on patients with ESRD (HR, 1.65; 95% CI, 1.01–2.69). Conclusion LAAO represents a feasible option for thromboembolic prevention in patients with ESRD, although these patients have an increased risk of complications and bleeding.

Abstract Objectives Effective communication is crucial in healthcare, and for patients with a non-English language preference (NELP), professional interpreters are recognized as the gold standard in supporting bidirectional communication. However, interpreters are not always readily available, prompting the exploration of other options for translation and interpretation. The recent developments in artificial intelligence-based neural network translation tools, namely neural machine translation (NMT) may enable robust interpretation and translation. Materials and Methods We conducted a systematic review (SR) to evaluate the literature on NMT for this purpose. We did a comprehensive search of several databases with guidance from a professional librarian. The search was limited to the year 2000 onwards and English language. Title and abstract screening and full-text review were independently conducted by two reviewers with conflicts resolved by a third reviewer Results 2867 studies were identified with 10 studies included in the final analysis. Among these, six evaluated interpretation in real or simulated clinical settings and four examined translation of discharge materials. Google Translate and ChatGPT were assessed in several studies. Accuracy differed by language, with low-resource languages performing worse. Discussion NMT technologies in healthcare have several advantages including broad language accessibility and potential cost savings for institutions. Despite improved accuracy of these novel tools, due to possible critical errors NMT tools are not yet ready for widespread clinical use. Conclusion Future studies should focus on optimizing evaluation methods as well as how best to integrate these technologies into real-time clinical settings.

Introduction: Mitral valve transcatheter edge-to-edge repair (M-TEER) has emerged as a minimally invasive option for high-risk surgical candidates with severe and symptomatic mitral regurgitation (MR), but post-procedure residual mitral valve (MV) dysfunction remains a significant concern. This study evaluates the clinical utility of combining artificial intelligence applied to electrocardiograms (ECG-AI) for diastolic dysfunction (DD) grading and the echocardiography-derived velocity time integral of the MV and left ventricular outflow tract ratio (VTIMV/LVOT) in predicting prognosis in patients post-M-TEER. Methods: A retrospective analysis of patients who underwent M-TEER between 2014 and 2021 was conducted. Patients were categorized based on VTIMV/LVOT and ECG-AI scores into three groups: both normal parameters, either abnormal parameter, or both abnormal parameters to compare outcomes (mortality, major adverse cardiovascular events [MACE], and the need for subsequent MV reintervention) using Kaplan–Meier analysis, multivariable Cox regression models, and net reclassification improvement. Results: Overall, 250 patients were included; the median age was 79.5 (IQR: 73.1, 84.6) and 66.4% were male. The combined abnormal VTIMV/LVOT (≥2.5) and ECG-AI score for DD (>1) was associated with higher risk of one-year mortality (adjusted HR: 4.56 [1.04–19.89], p = 0.044) and MACE (adjusted HR: 3.72 [1.09–12.72], p = 0.037) compared to patients with both normal parameters. Conclusions: This study highlights the potential additive value of integrating VTIMV/LVOT and ECG-AI scores as a prognostic tool for a personalized approach to the post-operative evaluation and risk stratification in M-TEER patients.

Background/Objectives: Esaxerenone, a novel non-steroidal mineralocorticoid receptor antagonist, has shown promising results in the treatment of essential hypertension (HTN). This study aims to comprehensively analyze the effectiveness of esaxerenone to control BP in patients with essential HTN. Methods: A systematic search was performed on PubMed, Scopus, Web of Science (WOS), and Cochrane Library from inception until January 2025 for randomized controlled trials (RCTs) comparing esaxerenone with standard HTN usual care. The primary outcome of interest was mean changes in sitting systolic (SBP) and diastolic blood pressure (DBP). Other secondary outcomes were mean changes in 24 h-SBP and 24 h-DBP, and target BP achievement. Safety outcomes, such as adverse events and increased levels of potassium/uric acid, were also assessed. Results: Our meta-analysis included four studies with a total of 1981 patients, all conducted in Japan. Esaxerenone demonstrated dose-dependent blood pressure reductions. At 5 mg, sitting DBP decreased by 4.22 mmHg (95% CI −8.72 to 0.29; p = 0.07) and SBP by 9.07 mmHg (95% CI −17.69 to −0.45; p = 0.04), while the 1.25 mg dose showed smaller, non-significant reductions. For 24 h measurements, only the 5 mg dose achieved significant reductions. Target BP achievement increased by 48% overall (RR 1.48, 95% CI 1.11 to 1.96; p = 0.007), with stronger effects at 5 mg (RR 2.05, 95% CI 1.03 to 4.08; p = 0.04). Esaxerenone significantly reduced nocturnal SBP by 10.62 mmHg (95% CI −14.01 to −7.23; p < 0.001). Conclusions: In patients with essential HTN, esaxerenone was shown to be safe and well-tolerated compared with usual care. Long-term data on safety is warranted.

Abstract Objective Autoimmune encephalitis is a cause of brain inflammation characterized by auto‐antibodies, which target cell surface neuronal proteins and lead to neuronal dysfunction. The most common form is associated with auto‐antibodies to leucine‐rich glioma‐inactivated 1 (LGI1) protein, the presentation of which includes frequent focal seizures. The exact cause of these auto‐antibodies remains unknown, but established predispositions include overrepresented human leukocyte antigen ( HLA ) alleles. Yet, these HLA alleles are themselves common in the healthy ancestry‐matched population. One potential etiological hypothesis is that an environmental trigger, such as the gut microbiome, interacts with a genetically predisposed individual. Methods To investigate this, we studied 42 patients with LGI1‐antibody encephalitis (LGI1‐Ab‐E) and 27 familial/environmentally matched controls, and performed metagenomic shotgun sequencing, to describe the compositional and functional differences in the gut microbiome. Results We observed that LGI1‐Ab‐E gut microbiomes exhibited a significant reduction in the ratio of Firmicutes (or Bacillota) and Bacteroidetes phyla, which is associated with the dosage of HLA susceptibility allele count in patients with LGI1‐Ab‐E. Furthermore, we identified differences in functional gene profiles in the gut microbiome that led to a reduction of neuroinflammatory protective short‐chain fatty acids (SCFAs) in LGI1‐Ab‐E patients. Significance Taken together, our results suggest that a compositional shift in the gut microbiome of LGI1‐Ab‐E associates with a neuroinflammatory state, possibly through the reduction of SCFA production. Our study highlights the potential of the gut microbiome to explain some of the complex condition and unravel etiological questions. Validation studies with greater sample sizes are recommended.