Citations

Objectives: Examining the effect of demographics and social vulnerability on diagnosis and management of patients with vestibular and balance disorders. Design: Retrospective review of a database of patients presenting with vestibular symptoms to a multidisciplinary tertiary vestibular clinic between January and October 2021. Main outcomes included odds ratios of final diagnosis, treatment response, time to presentation by demographic variable, insurance status, residence, and social vulnerability factors according to the 2018 Centers for Disease Control Social Vulnerability Index. Results: Five hundred thirty-six patients with definitive vestibular diagnoses and treatment outcome data were included. Mean age at presentation was 60.4 ± 16.5 years. Women (n = 389, 72.6%) outnumbered men (n = 147, 27.4%). Most patients self-identified as White (n = 440, 82.1%) and non-Hispanic (n = 521, 97.2%). Overall, 17.4% of participants belonged to a minority group. Socioeconomic status, household composition, geographic location, and insurance status were associated with patient diagnoses received. Patients from the lowest socioeconomic class were more likely to be diagnosed with Meniere’s disease. In addition, patients with private insurance were more likely to be diagnosed with Meniere disease or vestibular migraine than those with Medicare insurance. Geographic distance greater than 60 miles from the clinic was associated with a higher likelihood to present >90 days since initial symptom onset. Housing and transportation vulnerabilities were associated with decreased treatment response. Conclusions: Diagnostic classification, time to presentation, and treatment outcomes differed according to demographic and social vulnerability factors. There was no single unifying theme among vulnerabilities, but the results of this study offer preliminary data to design future investigations on regional and national levels to understand and mitigate the effects of social vulnerability factors on access to specialty vestibular care and outcomes of treatment.

OBJECTIVE Mechanical thrombectomy (MT) is well established for large-vessel occlusion (LVO) strokes, but its safety in distal and medium-vessel occlusions (DMVOs) requires further investigation. This study analyzed the relationship between procedural approaches, petechial hemorrhage (PetH), and clinical outcomes in DMVO thrombectomy, with particular attention to technical considerations and the complex interplay between tissue injury and hemorrhagic complications. METHODS A retrospective cohort study was conducted on DMVO stroke patients treated with MT at 37 stroke centers worldwide from 2016 to 2024. Patients were categorized based on follow-up imaging into those with or without PetH. Four logistic regression models analyzed the association of PetH with favorable functional outcomes (modified Rankin Scale score ≤ 2) at 90 days, early neurological improvement (≥ 4-point National Institutes of Health Stroke Scale score decrease at 24 hours), all-cause mortality, and independent determinants of PetH. Adjusted odds ratios (aORs), 95% confidence intervals, and p values were reported. RESULTS Of 1428 patients, 439 (30.7%) developed PetH. Factors independently associated with PetH were multiple thrombectomy passes (aOR 1.58, 95% CI 1.21–2.06; p = 0.001), IV thrombolysis (aOR 1.31, 95% CI 1.01–1.69; p = 0.04), and the combined use of a stent retriever with aspiration as the first-line method compared with aspiration alone (aOR 1.66, 95% CI 1.15–2.38; p = 0.007). Conversely, general anesthesia (aOR 0.55, 95% CI 0.40–0.77; p < 0.001), higher Alberta Stroke Program Early CT Scores (aOR 0.76, 95% CI 0.69–0.83; p < 0.001), and successful recanalization (aOR 0.56, 95% CI 0.39–0.80; p = 0.002) were significantly associated with a lower odds of PetH. PetH was associated with a decreased odds of favorable functional outcomes (aOR 0.51, 95% CI 0.36–0.73; p < 0.001), reduced early neurological improvement (aOR 0.59, 95% CI 0.44–0.79; p < 0.001), and increased all-cause mortality (aOR 1.84, 95% CI 1.23–2.76; p < 0.001). CONCLUSIONS PetH is a frequent sequela following MT in DMVO strokes and is associated with poorer outcomes, likely reflecting underlying ischemic injury rather than direct causation. Procedural factors influence PetH risk, suggesting medical treatment as first-line therapy for DMVOs, with MT reserved for refractory cases using less aggressive approaches.

Three-dimensional radiomic analysis of digital breast tomosynthesis outperformed two-dimensional measures in breast cancer risk assessment.

Ketones, which are key biomarkers of fat oxidation, are relevant for metabolic health maintenance and disease development, making continuous monitoring essential. In this study, we introduce a novel colorimetric sensor designed for potential continuous acetone detection in biological fluids. The sensor features a polydimethylsiloxane (PDMS) shell that encapsulates a sensitive and specific liquid-core acetone-sensing probe. The microsphere sensors were characterized by evaluating their size, PDMS shell thickness, colorimetric response, and sensitivity under realistic conditions, including 100% relative humidity (RH) and CO2 interference. The microsphere size and sensor sensitivity can be controlled by modifying the fabrication parameters. Critically, the sensor showed high selectivity for acetone detection, with negligible interference from CO2 concentrations up to 4%. In addition, the sensor displayed good reproducibility (CV < 5%) and stability under realistic storage conditions (over two weeks at 4 °C). Finally, the accuracy of the microsphere sensor was validated against a gold standard gas chromatography-mass spectrometry (GC-MS) method using simulated and real breath samples from healthy individuals and type 1 diabetes patients. The correlation between the microsphere sensor and GC-MS produced a linear fit with a slope of 0.948 and an adjusted R-squared value of 0.954. Therefore, the liquid-core microsphere-based sensor is a promising platform for acetone body fluid analysis.

Obesity is a prevalent metabolic condition that is strongly associated with the development of cardiovascular disease. Adipose arteries exhibit robust endothelial dysfunction in diet-induced obese mice. Obesity is also associated with elevated plasma long chain fatty acids (LCFAs), well-established contributors to endothelial dysfunction, which require a receptor to facilitate their uptake. CD36, facilitates LCFA uptake which when in excess contributes to endothelial dysfunction. Our previous work demonstrated that global CD36 ablation restores endothelium-dependent dilations to flow. Therefore, to determine if an upregulation in CD36 expression was driving these differences, we first assessed if obesity alters endothelial CD36 expression using flow cytometry and immunofluorescence imaging. For flow cytometry experiments mesenteric arteries were digested and sorted to identify the endothelial cell population (i.e., CD45-CD31+ cells). En face preparations were stained for VE-cadherin to locate the endothelial cell layer using confocal microscopy. In both experiments, an antibody that detects an extracellular epitope of CD36 was used to detect membrane expression. Obesity did not alter the expression of CD36 in endothelium of mesenteric arteries relative to lean counterpart controls in WT mice. We next aimed to determine if obesity influences the functional capacity of endothelial CD36. First, we measured LCFA uptake in mesenteric arteries from lean and obese WT mice. Arteries were exposed to a fluorescent palmitic acid analogue, BODIPYC-16, and internalized endothelial LCFA uptake was assessed at different time points using confocal microscopy. Arteries from obese mice had elevated endothelial LCFA uptake and lipid accumulation relative to lean controls. To determine if the effects of obesity on LCFA uptake were mediated by endothelial CD36, we repeated the fluorescent LCFA uptake experiments using the Tie2eCreCD36 fl/fl model. First, to determine if endothelial cell CD36 was driving obesity induced endothelial dysfunction, mesenteric arteries were isolated from lean and diet-induced obese Tie2eCreCD36 fl/fl mice. Arteries from Tie2eCreCD36 fl/fl diet induced obese mice exhibited attenuated fatty acid uptake, compared to their lean and obese genotype controls. Next, we measured endothelial function ex vivo via pressure myography. Mesenteric arteries from obese Tie2eCreCD36 fl/fl mice exhibited a restored response to flow induced vasodilation relative to respective controls suggesting a role for endothelial cell CD36 in mediating endothelial dysfunction perhaps through promoting lipid accumulation in obesity. Ongoing work within our lab is aimed at determining the mechanism underlying obesity-induced alterations to endothelial CD36 and how the observed increase in LCFAs may be contributing to reduced endothelial function. Center of Biomedical Research Excellence in Cardiovascular Health (COBRE): 5P20GM113125-08, University of Delaware Research Fund (UDRF) This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.

Background. Ex vivo machine perfusion (MP) has transformed organ preservation, offering significant benefits in liver transplantation (LT), particularly with high-risk donor grafts. However, adoption in the United States has been limited. We aimed to examine early adoption trends, surgeon perceptions, and barriers to implementing MP in the United States after Food and Drug Administration approval of MP platforms. Methods. A 23-question electronic survey was distributed to members of the American Society of Transplant Surgeons between October and November 2022, capturing attitudes and practices related to MP adoption. Responses from 96 surgeons representing 77 LT centers across 11 Organ Procurement and Transplantation Network regions were analyzed. Results. Forty-four respondents (48%) reported having an MP program at their institution. Adoption of MP was significantly more common in high-volume centers and those performing ≥20 donation after circulatory death (DCD) transplants annually (P < 0.001). MP utilization received strong support, with 88% endorsing its use for DCD liver allografts and 82% for donation after brain death allografts. Respondents cited MP’s ability to reduce ischemic cholangiopathy, enable graft repair, and facilitate viability assessment as key benefits. Normothermic MP was preferred for high-risk donor profiles, including DCD grafts, older donors, and steatotic livers, and was associated with an increased willingness to accept medically complex grafts compared with static cold storage. Barriers to MP utilization included program costs, personnel demands, and logistical complexities. Centers with higher proportions of privately insured patients were more likely to adopt MP. Despite these challenges, 84% of respondents expressed interest in future MP adoption. Conclusions. MP enhances graft utilization and outcomes, particularly for complex and high-risk donor livers, but widespread US adoption requires addressing financial and logistical barriers. Future efforts should focus on refining cost-effectiveness analyses, collaboration with organ procurement organizations and device companies, and developing standardized training to optimize MP integration and maximize its clinical impact on LT.