Citations

ABSTRACTBackgroundIdiopathic inflammatory myopathies, beyond inclusion body myositis (IBM), have demonstrated an increased risk of adverse cardiovascular outcomes, particularly myocardial infarction (MI). This study evaluated the risk of cardiovascular disease in IBM.MethodsWe conducted a non‐concurrent cohort study utilizing the expanded Rochester Epidemiologic Project, including 50 patients with IBM, matched 1:6 to age‐, sex‐, and calendar year‐matched referents without IBM. Baseline cardiovascular risk factors were recorded. Differences in baseline covariates were adjusted by the inverse probability of treatment weighting method. Participants were followed from the index date forward to determine relative risks (RR) and hazard ratios (HR) for the development of cardiovascular outcomes including MI, ischemic stroke, cardiomyopathy, congestive heart failure (CHF), and peripheral vascular disease (PVD).Results50 patients with IBM and 294 matched population referents were included. Baseline cardiovascular risk factors were similar between groups. Aspirin use was more common (28% vs. 18%, p = 0.03) and statin use less common (26% vs. 38%, p = 0.04) in IBM versus referents. Patients with IBM had an increased hazard of MI compared to referents [HR: 5.79, 95% CI (2.51, 13.36)]. The risk of MI remained consistently elevated across all models, after accounting for potential confounders. For PVD, 16/50 IBM patients versus 16/287 referents were excluded due to pre‐existing PVD at index (p < 0.001). Among remaining participants, RR for PVD was 2.38 (0.82, 6.9). IBM was not associated with an increased risk of ischemic stroke, cardiomyopathy, or CHF.ConclusionsIBM is associated with increased risk of MI compared to population referents. Heightened cardiovascular monitoring and prevention strategies are needed in IBM.

ABSTRACTIntroductionThe diagnosis of antibody‐mediated rejection (AMR) requires input from several transplant professionals. Bringing clinical and laboratory experts together may help standardize care. Yet, little is known about current global practices of multidisciplinary meetings for AMR management.MethodsThe Banff Antibody‐Mediated Injury Working Group approached professional societies worldwide to distribute a survey on the availability, content, participants, perceived value, and barriers to the implementation of multidisciplinary meetings.ResultsFour hundred two transplant professionals from six continents caring for kidney (90.55%), liver (21.14%), pancreas (20.65%), heart (15.17%), and lung (14.18%) transplant recipients participated in the survey, and 302 (75.12%) reported attending multidisciplinary meetings. Multidisciplinary meetings were more prevalent in academic centers, in high‐ versus low‐to‐middle‐income regions (81.03% and 65.99%, respectively; p < 0.001), and in mid‐to‐large size transplant programs compared to smaller programs. Perceived value included continued professional development (97.68%) and trainee education (95.70%). AMR was reported to be discussed at these meetings by 217 respondents with case presentations reviewing patient characteristics, histology, and HLA antibody data. A third of the respondents reviewed non‐HLA/pathogenic autoantibodies and/or molecular diagnostics, with the latter being more frequently applied in high‐ versus low‐to‐middle‐income regions (46.71% and 12.31%, respectively; p < 0.001). AMR case presentations allowed diagnosis revision, actionable management plans and were perceived as improving care. The primary barrier to the implementation of multidisciplinary meetings (63.27%) was the unavailability of transplant professionals (e.g., transplant immunologists).ConclusionFacilitating multidisciplinary meetings through the remote participation of pertinent experts and incentivizing participation through remuneration, protected time, or continued medical education may help standardize AMR diagnosis and harmonize its management.

Abstract Aims Sodium-glucose cotransporter 2 inhibitors (SGLT2-Is) improve heart failure (HF) outcomes but their effects on acute myocardial infarction (AMI) remain poorly characterized. This study aimed to evaluate the 1-year cardiovascular outcomes of SGLT2-Is among patients with AMI. Methods and results We conducted an observational, retrospective cohort study using TriNetX data, including patients aged ≥18 with AMI identified via ICD-10 codes regardless of left ventricular ejection fraction (LVEF), categorized by SGLT2-Is use. Propensity score matching (PSM) was performed to balance baseline demographics, comorbidities, and medication use. Adjusted odds ratios (aORs) were estimated for the primary outcome (recurrent AMI) and the secondary outcomes (acute HF hospitalizations, stroke, all-cause hospitalizations, all-cause mortality, new-onset atrial fibrillation, and cardiac arrest). After PSM, 89 554 patients were analysed (44 777 SGLT2-Is users; 44 777 non-users). The mean age was ∼68 years in both cohorts with a similarly high burden of cardiovascular comorbidities. Mean follow-up duration was 290.854 days for SGLT2-Is users and 284.465 days for non-users. SGLT2-Is use was linked to lower rates of recurrent AMI [aOR: 0.459; 95% confidence interval (CI): 0.367–0.551], all-cause hospitalizations (aOR: 0.782; 95% CI: 0.762–0.803), all-cause mortality (aOR: 0.640; 95% CI: 0.612–0.670), and cardiac arrest (aOR: 0.834; 95% CI: 0.773–0.900). No differences were observed in acute HF hospitalizations, new-onset atrial fibrillation, or stroke. Conclusion SGLT2-Is are associated with improved cardiovascular outcomes in patients with AMI, including reductions in recurrent AMI, all-cause hospitalizations and mortality, and cardiac arrest. These findings emphasize the need for prospective clinical trials involving patients with AMI and other cardiovascular comorbidities, regardless of LVEF, to confirm these results.

Bicuspid aortic valve (BAV) and thoracic aortic aneurysms and dissections (TAAD) are recognized in syndromic connective tissue diseases (CTD), but most cases occur sporadically. The extent to which non-syndromic BAV or TAAD predisposes to additional arteriopathies, particularly in younger individuals, remains unclear. We retrospectively analyzed 1438 patients (mean age = 48.0, 67.7% female), excluding those with CTDs. Participants were ≤60 years old and categorized by the presence of BAV and/or TAAD. We examined co-existing arterial pathologies, including fibromuscular dysplasia, spontaneous coronary artery dissection, abdominal aortic aneurysms (AAA), mesenteric, peripheral extremity, and carotid/cerebral arteriopathies. Overall, 44.6% had either BAV or TAAD, and 27.2% had multiple arteriopathies. While vascular diseases were frequently noted, odds ratios demonstrated no significantly increased risk of extra-aortic arteriopathies in the BAV or TAAD cohorts. AAA exhibited a non-significant trend toward higher prevalence in TAAD patients. These findings support current guidelines recommending targeted imaging (transthoracic echocardiography of the aortic root and ascending aorta) over comprehensive “head-to-pelvis” screening for non-syndromic BAV or TAAD patients without additional risk factors. Ongoing genetic analyses may elucidate whether particular variants predispose to multi-site aneurysms or dissections. Consequently, targeted surveillance remains appropriate, with broader imaging reserved for patients with genetic or clinical indicators of higher risk.

ABSTRACTIntraluminal infection of central venous catheters, used for long‐term treatment, can result in central line‐associated bloodstream infection (CLABSI). These infections can be challenging to prevent and treat due to formation of biofilms within catheter lumens, which shield bacteria from the human immune response and conventional antimicrobial therapies. Preventing bacterial colonization of catheter hubs is a strategy to prevent CLABSI. To address this, we developed a nonantibiotic, animal‐ready electrochemical catheter hub (e‐catheter hub), operated by a wearable, battery‐powered micropotentiostat (MP), that internally generates tunable hypochlorous acid (HOCl) for preventing intraluminal infection. The design evaluated three different electrode materials—titanium, platinum, and gold—for HOCl generation and biocidal activity, using working and counter electrodes of the same materials and a silver/silver chloride‐plated wire as a quasi‐reference electrode. e‐catheter hubs operated by MPs at 1.5 VAg/AgCl for 3 h generated HOCl, reducing Acinetobacter baumannii ATCC‐17978 below the detection limit (average reduction of 4.40 ± 0.05 log10 CFU/mL). The efficacy of e‐catheter hubs operated by MPs in generating HOCl and achieving biocidal activity is comparable to that of a commercial potentiostat. This study represents the first step in developing a localized, nonantibiotic strategy to mitigate CLABSI risk.

Background: Total mesorectal excision (TME) remains the gold standard for the resection of rectal cancer regardless of the modality: open, laparoscopic, or robotic. The transanal TME (TaTME) approach has been utilized to overcome the difficulties encountered with the dissection of tumors in the distal pelvis. Recently, a single-port robotic approach (rSPa) was introduced, where three arms and a camera emanate from a 2.5 cm diameter port. This report presents the first experience in the United States combining those two approaches (rSPa TaTME) in rectal cancer, evaluating its safety and oncologic outcomes. Methods: This is a retrospective review of our prospectively maintained rectal cancer database. Patient demographics, tumor characteristics, neoadjuvant treatment, and oncologic and surgical outcomes were recorded. Results: Between May 2022 and August 2024, ten patients (six females, four males) with a median age at surgery of 53 years (range: 38–85) and a mean BMI of 26 (±5) kg/m2 were included for analysis. The median distance of tumors from the anorectal junction was 3.2 cm (range: 2–5.3 cm). All patients had negative margins, with eight complete TME specimens, one near complete, and one incomplete. The mean number of lymph nodes harvested was 24 (±11). The average operative time was 351 (243–411) min. The average length of stay was four days. The ileostomy was reversed in nine out of ten patients. Six patients experienced complications within 30 days of surgery. There were no local or distal recurrences, with a mean follow-up of 20 months (range: 4–30). Conclusions: rSPa TaTME is a unique and innovative method of combining two minimally advanced approaches for the resection of distal rectal cancers, with acceptable surgical and oncologic outcomes.

Abstract Lineage switch (LS), defined as the immunophenotypic transformation of acute leukemia, has emerged as a mechanism of relapse after antigen-targeted immunotherapy, which is associated with dismal outcomes. Through an international collaborative effort, we identified cases of LS after a host of antigen-targeted therapies (eg, CD19, CD22, CD38, and CD7), described how LS was diagnosed, reviewed treatment approaches, and analyzed overall outcomes for this form of postimmunotherapy relapse. Collectively, 75 cases of LS were evaluated, including 53 (70.7%) cases of B-cell acute lymphoblastic leukemia (B-ALL) transforming to acute myeloid leukemia (AML), 17 (22.7%) cases of B-ALL transforming to mixed phenotypic acute leukemia (MPAL)/acute leukemias of ambiguous lineage (ALAL), and 5 (6.7%) cases of rare LS presentation (ie, T-cell ALL to AML). An additional 10 cases with incomplete changes in immunophenotype, referred to as “lineage drift” were also described. With a primary focus on the 70 cases of LS from B-ALL to AML or MPAL/ALAL, LS emerged at a median of 1.5 months (range, 0-36.5) after immunotherapy, with 81.4% presenting with LS within the first 6 months from the most proximal immunotherapy. Although most involved KMT2A rearrangements (n = 45, 64.3%), other rare cytogenetic and/or molecular alterations were uniquely observed. Treatment outcomes were generally poor, with remission rates of &lt;40%. The median overall survival after LS diagnosis was 4.8 months. Outcomes were similarly poor for those with rare immunophenotypes of LS or lineage drift. This global initiative robustly categorizes lineage changes after immunotherapy and, through enhanced understanding, establishes a foundation for improving outcomes of LS.