Citations

Hepatic resection (HR) and liver transplantation (LT) are curative-intent treatments for hepatocellular carcinoma (HCC). Patients without cirrhosis are typically analyzed as a single group, obscuring potentially important differences between those with histologically normal liver and those with non-cirrhotic parenchymal disease. We aimed to characterize long-term outcomes following HR stratified by underlying parenchymal quality, with a contemporary LT cohort as an external benchmark. Retrospective cohort study of 662 adults undergoing curative-intent surgery for HCC at 2 tertiary centers (2010–2024). Resection patients (n=380) were stratified by non-tumor parenchymal histology into HR-Normal (n=84), HR-Diseased non-cirrhotic (n=159), and HR-Cirrhotic (n=137). A total of 282 LT recipients served as an external reference but were not entered into comparative models. Overall survival (OS) was analyzed by Kaplan–Meier and multivariable Cox regression, and recurrence by Fine–Gray competing-risks regression. Ninety-day mortality was low across resection strata (1.2%–3.2%). OS differed significantly across parenchymal groups (log-rank p =0.01), driven by superior outcomes in HR-Normal patients compared with both HR-Cirrhotic ( p =0.008) and HR-Diseased ( p =0.005). HR-Cirrhotic and HR-Diseased did not differ ( p =0.97). Five-year OS was 74.4%, 59.8% and 57.2%, respectively. On multivariable Cox regression, both cirrhosis (HR 2.03, 95% CI 1.16–3.54, p =0.01) and diseased non-cirrhotic parenchyma (HR 2.04, 95% CI 1.21–3.43, p =0.008) independently predicted death versus normal liver. Fine–Gray analysis confirmed higher recurrence risk in cirrhotic (sHR 2.09, p =0.01) and diseased non-cirrhotic (sHR 1.80, p =0.04) groups. The LT benchmark cohort achieved a 5-year OS of 82.4%. Histologically normal liver identifies a distinct HR subgroup with favorable oncologic outcomes. The conventional cirrhotic/non-cirrhotic dichotomy underestimates the prognostic impact of underlying parenchymal disease.

Abstract More information is needed to better understand the effect of caffeine on sleep quality at the community level. In a population-based, cross-sectional study design, we aimed to assess the effect of caffeine intake on sleep quality by the use of a multivariate exposure-effect model, adjusted for relevant confounders. All Atahualpa residents aged ≥40 years were identified during a door-to-door survey and interviewed with the Pittsburgh Sleep Quality Index (PSQI) and a structured instrument designed to estimate the daily amount of caffeine intake. An exposure-effect model was built using augmented inverse probability weighting taking into account variables that were associated with exposure (using a probit model) and variables that were associated with outcome (in a linear model). Out of 779 eligible individuals, 716 (92%) were included. Consumption of <100 mg/day of caffeine was recorded in 320 (45%) participants, from 100 to 200 mg/day in 299 (42%), and >200 mg/day in 97 (13%). Mean score in the PSQI was 4.5±2.2 points, with 203 (28%) individuals classified as poor sleepers (≥6 points). The exposure-effect model, adjusted for variables associated with the exposure (symptoms of depression, total cholesterol blood levels and smoking) and the outcome (age, symptoms of depression, physical activity and fasting glucose levels), revealed no effect of caffeine intake in sleep quality (average exposure effect: 0.027, 95% C.I.: −0.284 to 0.338, p=0.866). This population-based study shows that caffeine intake has no effect on sleep quality in community-dwelling adults living in a rural village of Ecuador.

Abstract Introduction Underwater endoscopic mucosal resection (uEMR) technique has gained popularity for removal of large non-pedunculated colorectal polyps (LNPCPs) due to high en-bloc resection rates and lower recurrence rates. However, there is no information regarding outcomes of uEMR for giant colorectal polyps. Therefore, we aimed to evaluate the outcomes of uEMR for giant colorectal polyps across multiple centers in North America. Methods We conducted a multicenter retrospective study of adults with giant colorectal polyps undergoing uEMR between January 2019 and November 2025. Giant colorectal polyps were defined as LNPCPs ≥40 mm. Primary outcomes were technical success and rate of recurrent adenoma. Secondary outcomes were severe adverse events (SAEs) and predictors of technical success, recurrence, and SAEs. Results A total of 137 polyps, with mean polyp size 47.6 mm were included. Majority of the lesions were located in right colon (61%, n = 83) with the most common histopathology being high-grade dysplasia (HGD) (31.4%, n = 43). Technical success was achieved in 90.5% (n = 124) with en-bloc resection rate of 11.7% (n = 16). Polyp fibrosis (OR: 0.08) and HGD (OR: 0.15) were independent predictors of inability to achieve technical success. Of 92 (67.1%) patients with follow-up, recurrent polyp was present in 8.7% (n = 8). SAEs were noted in 9.5%, consisting of delayed bleeding (9.5%, n = 13), while no delayed perforation or post polypectomy syndrome was noted. Discussion Our study demonstrates that uEMR is technically feasible for the removal of giant colorectal polyps with an acceptable safety profile and recurrence rate.

Abstract Background and Aims EUS-guided gastroenterostomy (EUS-GE) is an effective option to palliate symptoms of gastric outlet obstruction (GOO). While the jejunum is conventionally targeted (EUS-GJ), targeting the duodenum (EUS-GD) may offer clinical advantages. Outcomes were compared for EUS-GJ and EUS-GD. Methods Adult patients who underwent EUS-GE for GOO between 2020 and 2024 were included and categorized as an EUS-GD if the stent entered the transverse or ascending duodenum or an EUS-GJ if the stent entered more distally. The primary outcome was clinical success (soft diet tolerance at 7 days). Secondary outcomes included adverse events (AEs), stent misdeployment, and unplanned endoscopic reintervention. Baseline demographic variables and outcomes were compared with statistical significance at p < 0.05. Results Of the 139 included patients (median age 67 years (IQR 61–74); 41% female), 105 underwent EUS-GJ and 34 underwent EUS-GD. Clinical success was 98% for EUS-GJ and 94% for EUS-GD (p = 0.25). The misdeployment rate was 7% for EUS-GJ and 0% for EUS-GD (p = 0.19). The AE rate was 22% for EUS-GJ and 12% for EUS-GD (p = 0.23). There were no significant differences for stent obstruction (EUS-GJ 12% vs. EUS-GD 6%), bleeding (2% vs. 6%), perforation (4% vs. 0%), stent migration (1% vs. 0%), infection (3% vs. 0%), and unplanned reintervention (14% vs. 9%). Conclusion Both EUS-GJ and EUS-GD demonstrate high clinical success with no significant differences in adverse event rates. These data can support intraprocedural decision-making for endoscopists performing EUS-GE.

Abstract Obesity has emerged as one of the most significant health challenges, with prevalence rates exceeding 30% in many regions and contributing substantially to the burden of cardiovascular disease (CVD). This review synthesized findings from clinical trials, systematic reviews, and narrative reviews. Key outcomes assessed included heart failure symptoms, echocardiographic parameters, incidence of atrial fibrillation (AF), inflammation biomarkers, and overall cardiovascular morbidity and mortality. Across studies, obesity was consistently linked with elevated risk of coronary heart disease, AF, stroke, and heart failure with preserved ejection fraction (HFpEF). Central adiposity and ectopic fat depots, especially epicardial fat, emerged as critical mediators of CVD progression. Semaglutide, tirzepatide, and other agents have demonstrated robust effects in reducing weight, improving functional capacity, and attenuating cardiac remodeling, with additional benefits in lowering inflammation markers and natriuretic peptides independent of weight loss. Notably, patients with AF and obesity-related HFpEF appeared to experience greater symptomatic and functional improvements with semaglutide compared with those without AF. Conversely, evidence on the obesity paradox and metabolically healthy obesity revealed heterogeneity, with some subgroups demonstrating preserved or even improved survival despite excess adiposity, though these effects may be confounded by differences in cardiorespiratory fitness and lead time biases. Obesity remains a powerful risk factor for CVD, mediated through both metabolic and structural pathways. The advent of anti-obesity pharmacotherapies represents a watershed moment for cardiology, offering disease-modifying potential in obesity-related heart failure and beyond. Future research should refine the understanding of obesity phenotypes, and the role of fat distribution and cardiorespiratory fitness.

Abstract While the launch of the da Vinci Surgical System catalyzed the expansion of robotic surgery across disciplines, adoption in plastic surgery remains modest. To explore this disconnect, this study surveys plastic surgeons to gauge interest, utilization, and perceived barriers to robotic surgery adoption. A 15-question survey on training, access, interest, and barriers to robotic procedures was developed on Qualtrics and distributed via email to members of the American Society of Plastic Surgeons (ASPS) in May 2024. Descriptive statistics were used to summarize responses. About 123 responses were collected among 3,512 survey recipients. Among respondents, 84.6% reported having access to a surgical robot; however, only 13.8% had training on robotic systems during residency, and only 12.2% utilized the technology for plastic surgery procedures. Interest in robotics was noted among 47.9% of respondents, particularly for deep inferior epigastric perforator (DIEP) flap procedures (65.5%), rectus/Vertical Rectus Abdominis Myocutaneous (VRAM) flap (58.2%), and hernia repairs (27.3%). Key barriers to adoption included training requirements (63.9%), lack of demand (60.2%), increased operative time (54.6%), and financial concerns (26.9%). Additional obstacles cited were credentialing difficulties and skepticism about the necessity of robotics in plastic surgery. The present survey identified inadequate training, high costs, and limited demand as key barriers to the adoption of robotics in plastic surgery, reflecting the current lack of robotic integration into residency curricula, as well as the substantial investment and maintenance costs associated with robotic systems. Nevertheless, the strong interest in robotics highlights the need for expanded training programs, promotion of clinical benefits, and research quantifying potential downstream savings to overcome these barriers.

Abstract The human pancreas contains diverse endocrine and exocrine cell populations whose spatial organization is essential for tissue physiology. While single-cell and spatial transcriptomics revealed molecular heterogeneity across pancreatic cell types, linking these states to physiological activity in situ has remained challenging. Here, we combined single-nucleus RNA sequencing, spatial transcriptomics, and functional calcium imaging across pancreatic samples in health and metabolic disease. We identified heterogeneous endocrine and exocrine cell states associated with obesity and diabetes, including inflammatory remodeling of acinar and ductal populations. To directly couple tissue physiology with molecular state, we developed Slice-seq, which integrates calcium imaging with spatial transcriptomics in acute pancreatic slices. Slice-seq linked local endocrine composition and transcriptional programs with β cell activity and identified extra-islet β cells with reduced glucose responsiveness and mitochondrial oxidative metabolism. Together, our study provides a framework for linking pancreatic cell states to tissue organization and physiological activity in health and disease.

Abstract Aims Transcatheter mitral valve replacement (TMVR) with the Tendyne Mitral Valve System is a treatment option for patients with severe symptomatic mitral regurgitation (MR) unsuitable for conventional mitral valve surgery or transcatheter edge-to-edge repair (TEER). This study sought to evaluate the safety and effectiveness of TMVR through 5-year follow-up. Methods and Results The Tendyne Expanded Clinical Study is a prospective, single-arm, multicentre study that enrolled patients between November 2014 and June 2020. The study enrolled 191 patients (mean age 74.1 ± 8.0 years, 62.8% male, 70.2% New York Heart Association Class (NYHA) class III/IV, 88.5% secondary MR), of whom 186 (97.4%) underwent TMVR with Tendyne. MR grade decreased from ≥3+ in 99.5% patients at baseline to grade ≤1+ in 95.3% at 5 years. In those patients surviving to 5 years (n = 49), durable symptomatic improvement was evidenced by 73.5% patients being in NYHA class I/II at 5 years. The Kansas City Cardiomyopathy Questionnaire overall summary score increased from 48.5 ± 22.5 points at baseline to 67.6 ± 21.5 points at 5 years. Serious adverse events that occurred through 5 years included life-threatening bleeding (11.5%), fatal bleeding (2.6%), renal insufficiency/failure (28.8%), endocarditis (7.3%), device thrombosis (5.8%), and new onset atrial fibrillation (13.1%). No structural device degeneration or device embolism occurred through 5 years. Conclusions The Tendyne TMVR was effective at achieving immediate and sustainable elimination of MR, which was associated with symptomatic improvement and absence of structural valve degeneration in a high-risk cohort over 5 years. These findings support TMVR with the Tendyne System as an alternative for patients with appropriate mitral valve anatomy and symptomatic secondary MR unsuitable for mitral surgery or TEER.

ABSTRACT In a population-based study conducted in rural Ecuador, 635 stroke-free persons aged Z40 years were interviewed with the Epworth sleepiness scale and screened to assess their cardiovascular health (CVH) status. Excessive daytime somnolence was present in 22% persons and a poor CVH status in 69%. In a generalized linear model after adjusting for age and sex, excessive daytime somnolence was not associated with a poor CVH status or with any of the individual metrics in the poor range. Excessive daytime somnolence may not be linked to cardiovascular risk factors at the rural level.