Citations

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.

ABSTRACT Background Unknown primary cancer in the head and neck presents a difficult surgical treatment dilemma. Patients with squamous cell carcinoma of unknown primary (SCCUP) typically present with an enlarging neck mass found on biopsy but with no indication of primary site on diagnostic exams such as flexible laryngoscopy, CT, MRI, and/or PET/CT. Failure to identify primary sites eliminates surgical treatment as an option, pushing patients toward definitive chemoradiation with associated side effects. Methods Indocyanine green (ICG) has been used to identify primary carcinoma in known oropharyngeal squamous cell carcinoma while using transoral robotic surgery (TORS). In this case, we injected ICG intraoperatively in a patient with SCCUP to help with the real‐time localization of ICG in the tumor. Results ICG fluorescence successfully identified a previously undetected primary lesion within the oropharynx during TORS, which enabled precise surgical excision of the tumor. Conclusions This case demonstrates the potential of ICG‐guided TORS to localize primary tumors in SCCUP patients, offering a pathway to surgical treatment and potentially reducing reliance on chemoradiation.

Abstract Background Radiomics extracts quantitative imaging features from computed tomography (CT) data for clinical decision‐making. However, variations in acquisition parameters—particularly x‐ray tube voltage (kV)—introduce non‐biological variability in attenuation values, limiting the reproducibility of radiomic features across scanners, protocols, and institutions. Purpose To develop and evaluate a CT dAta harmoNiZAtion framework based on deep learNed vIrTual monoEnergetic imaging (TANZANITE), which leverages the keV flexibility of virtual monoenergetic images (VMIs) to enable cross‐kV scan translation and radiomics harmonization. Methods TANZANITE is a model hub consisting of multiple pre‐trained convolutional neural networks (CNNs), each designed to translate VMIs from 1 keV level to another. Phantom‐based calibration was first used to determine energy‐equivalent (Eff_E) keV levels corresponding to each tube potential (e.g., Eff_E(A) keV for source kV and Eff_E(B) keV for target kV). A CNN trained using 69 120 patches from seven patient cases to map VMIs from Eff_E(A) to Eff_E(B) was selected from the TANZANITE hub and applied directly to clinical CT images acquired at the source kV. This harmonized the images to match the attenuation characteristics of the target kV setting. Evaluation was conducted on independent dual‐energy CT datasets acquired at 100/Sn150 kV. Regions of interest (ROIs) were placed in the kidney, liver, and spine to assess CT number consistency and radiomic feature reproducibility. The concordance correlation coefficient (CCC) was calculated across 93 non‐shape radiomic features. Results After TANZANITE processing with 100 kV images, CT numbers in evaluated organs closely matched the Sn150 kV reference values in four testing patient cases. For example, mean kidney CT numbers changed from 320 HU (100 kV) to 156 HU (TANZANITE), approximating the Sn150 kV value of 160 HU. Similar changes were observed in the liver (157–105 HU vs. 104 HU reference) and spine (45–22 HU vs. 19 HU reference). Radiomic reproducibility improved substantially across organs: mean CCC increased from 0.590 to 0.995 in the liver, 0.300 to 0.970 in the kidney, and 0.630 to 0.968 in the spine. Post‐TANZANITE, over 98% of features exceeded the stability threshold (CCC ≥ 0.900) in all three representative organs. Conclusion TANZANITE provides a flexible, image‐domain harmonization framework by learning the keV‐to‐keV translation in the VMI domain and applying pre‐trained CNNs to clinical kV images. It improves CT number consistency and organ‐specific radiomic reproducibility without requiring raw projection data or scanner‐specific training. This approach supports consistent quantitative imaging across multiple‐kV acquisition protocols, enhancing radiomics reliability in clinical settings.

ABSTRACT Candida auris is an emerging pathogen known for causing invasive, multidrug-resistant infections and healthcare-associated outbreaks. Measuring the relatedness of C. auris strains is critical for detecting and preventing healthcare-associated transmission. Whole genome sequencing (WGS) and analysis of single-nucleotide polymorphisms (SNPs) offer high-resolution assessments of genetic relatedness and antifungal susceptibility; however, interpretation requires an understanding of inter- and intra-patient C. auris diversity and genotypic markers of resistance, respectively. This study aimed to define SNP thresholds for assessing C. auris relatedness in healthcare-associated outbreak investigations, predict antifungal resistance via genotypic markers, and evaluate patient risk factors to inform future surveillance strategies. WGS was performed on 68 C. auris isolates (clades I and III) obtained from 31 hospitalized patients across a healthcare system between 2021 and 2024. Using MycoSNP analysis, we observed a maximum intra-patient variation of 14 SNPs. Five probable transmission clusters were identified based on epidemiologic links, with patient isolates differing by a median of 5 SNPs (range: 0−12). Analysis with a commercial pipeline (refMLST, BugSeq) showed similar clustering patterns. All new detections occurring more than 1 month after admission were linked to a cluster, representing a highly specific indicator of healthcare-associated infection. WGS detected known genotypic markers for fluconazole (ERG11 Y132F, F126L, and MRR1 N647T) and micafungin (FKS1 F635C) resistance, with the latter emerging during antimicrobial therapy. In addition, putative FUR1 mutations (G207R and Q16::STOP) associated with flucytosine resistance were identified. These findings emphasize the utility of WGS for identifying healthcare-associated clusters of C. auris and predicting antifungal resistance. IMPORTANCE Candida auris is a difficult-to-treat yeast that causes invasive infections in vulnerable patient populations. Healthcare exposure is a key risk factor for becoming colonized or infected with C. auris , and infection prevention groups focus on curbing the spread of this organism within the healthcare environment. Whole genome sequencing approaches are key for supporting these efforts, as they can help define clusters of C. auris transmission and can also provide insight into antifungal resistance. Our work provides practical guidance for interpreting genomic data in this setting, helping infection prevention teams respond more effectively to outbreaks and expanding the use of genotypic predictions for antifungal resistance.

INTRODUCTION: Advanced therapies infrequently achieve complete fistula closure in patients with Crohn's disease (CD). The primary objective of the STOMP2 clinical trial was to determine whether the implantable autologous cell therapy AVB-114 is effective in inducing remission of persistent Crohn's perianal fistulas versus standard of care. METHODS: Eligible patients had a single perianal fistula tract and had failed previous treatment or had documented medication intolerance to biologic or conventional CD therapy. All enrolled subjects underwent surgical fistula optimization and adipose tissue biopsy collection (to manufacture AVB-114) followed by 1:1 randomization to either standard of care (repeat fistula optimization including seton replacement) or AVB-114 implantation. The primary end point was combined fistula remission at 36 weeks, defined as closure of the external opening, no drainage of fluid despite gentle finger compression, and no collections >2 cm in at least 2 of the 3 dimensions on MRI. RESULTS: Subjects at 14 US sites were equally randomized to SoC (N = 24) or AVB-114 (N = 24). Week 36 combined remission was 8.3% and 45.8% for subjects randomized to SoC and AVB-114, respectively (38% difference, 95% CI 11%–60%; P = 0.0078). At week 36, MRI revealed no subjects with collections >2 cm, radiological improvement (≥50% decrease in the Magnetic Resonance Novel Index for Fistula Imaging in Crohn's Disease (MAGNIFI-CD) score from baseline) in 1 SoC subject and 3 AVB-114 subjects, and radiological healing (complete resolution of T2-weighted hyperintensity in fistula tract) in 2 SoC subjects and 5 AVB-114 subjects. Through week 36, there were 40 and 56 treatment emergent adverse events for SoC and AVB-114, respectively. There were no serious treatment emergent adverse events in the AVB-114 group through week 36. DISCUSSION: A significantly higher proportion of patients treated with AVB-114 achieved combined remission vs SoC, and the treatment was well tolerated. These data support the safety and efficacy of AVB-114 in persistent Crohn's perianal fistulas.

Objective This study evaluates the impact of international observerships organized by Help Ukraine Group (HUG) on professional development, knowledge transfer, and clinical practice improvement in radiation oncology in Ukraine. Methods A total of 50 observerships were facilitated for Ukrainian medical professionals at 14 institutions across the USA, Canada, Europe, and Australia from 2022 to 2024, including 31 radiation oncologists and medical physicists. A survey assessed their impact on oncology care, focusing on knowledge gained, lessons learned, and challenges in implementing new techniques. The primary outcome was the success score, defined as a composite score of implementing new procedures, initiating improvement projects, and knowledge dissemination efforts. Descriptive and comparative analyses examined satisfaction and success outcomes. Results A total of 43 respondents participated in the survey (response rate 86.0%). Twenty-eight of the responders were radiation oncology professionals (67.8% radiation oncologists, 32.1% medical physicists). The median observership duration for radiation oncology professionals was four weeks, with 96.4% also attending a professional conference. Overall satisfaction was high (mean 9.5 out of 10, median 10.0, IQR 9.0-10.0) while the success score was substantial (mean 6.1 out of 10, median 7.0, IQR 5.0-8.0). Time since certification influenced success, with ≥10 years’ experience associated with higher success scores (7.4 vs. 4.7, p=0.01). Importantly, 100% of respondents learned new procedures, 89.3% reported shifts in their clinical perspective, and 60.7% successfully implemented new techniques. Subsequent knowledge dissemination in Ukraine was substantial: 82.1% provided informal training, 60.7% delivered institutional or national presentations, 39.3% incorporated materials into lectures, and 10.7% engaged in all activities. Continued mentorship with host institutions was reported by 82.1%. Conclusions Amid the war, international observerships advanced clinical practice, education, and procedures in Ukraine, demonstrating the resilience of its medical community and providing a model that other LMICs/UMICs can follow.

Objective: To examine the benefit of cochlear implantation (CI) in pediatric patients with a history of temporal bone fracture resulting in single-sided deafness (SSD). Study design: Retrospective chart review. Setting: Two tertiary academic centers. Patients: Pediatric patients less than 18 years of age with SSD secondary to temporal bone fracture who underwent CI from 2012 to 2022. Intervention(s): CI. Main outcome measure(s): Postoperative audiometric testing. Results: Seven subjects were identified (median age: 10 years (y); Q1 to Q3: 5 to 16 y). Median time from temporal bone trauma to CI was 7 months (mo) (Q1 to Q3: 3 to 7 mo) and 85% had otic capsule involvement. Subjects were followed for a median length of 12 months (Q1 to Q3: 6 to 24 mo) after CI. All patients achieved full electrode insertion, though 2 required scala vestibuli insertion due to ossification of the scala tympani (one of whom had a history of meningitis after temporal bone fracture). Postoperative audiometric testing revealed variable speech perception outcomes with 4 of 7 obtaining open or closed set speech perception and 3 of 7 obtaining only sound awareness. No postoperative complications occurred. Conclusions: CI is a feasible intervention for SSD following pediatric temporal bone fractures, but outcomes are variable. Early evaluation and timely CI, ideally within 6 months of temporal bone fracture, may optimize outcomes. Cochlear ossification, either as a result of otic capsule fracture or subsequent meningitis, may lead to suboptimal outcomes.