Citations

This scientific commentary refers to ‘Pure autonomic failure: a natural history study of the Queen Square cohort’ by Chiaro et al. (https://doi.org/10.1093/brain/awaf191).

Sharing research code in an open access version-controlled repository offers significant benefits for both science as a whole and for individual researchers. In this article, we focus on this practice, which is fully aligned with the NIH’s Gold Standard Science (GSS) program as well as FAIR (findable, accessible, interoperable, reusable) and TRUST (transparency, responsibility, user focus, sustainability, technology) principles. Gold Standard Science supports open science by emphasizing transparency, reproducibility, and the use of best practices that enable others to verify and extend research. Pairing a research article’s cited data snapshot with a versioned, environment-specific code release, deposited in a companion code repository, ensures that, upon submission to a medical journal, readers and reviewers can directly verify results. An executable and updatable companion code repository complements, rather than replaces, established research data repositories. When code underlying medical research results is made openly available, then other scientists can inspect, run, and validate analyses. These activities enhance reproducibility, which is a core aim of GSS. Shared code also facilitates collaborative innovation by allowing researchers to extend the utility of the code to new datasets and applications. For researchers, code sharing can increase visibility, credibility, and citation impact. Demonstrating transparency through shared executable and updatable code builds trust with journal readers, peer reviewers, funders, and peers. Shared code in an open access repository signals adherence to high standards of scientific integrity and attracts opportunities for collaboration. A researcher who shares code receives recognition as a leader in reproducible, trustworthy research consistent with NIH’s GSS principles.

BACKGROUND: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome, predominantly affecting women. Psychological distress is common pre- and post-SCAD, yet sex-specific patterns remain understudied. This cross-sectional study aimed to examine sex differences in the psychological distress of patients with SCAD. METHODS: Adult patients diagnosed with SCAD within the past 3 years, confirmed by coronary angiography, were recruited from 6 Canadian hospitals between April 2022 and January 2025. Participants completed questionnaires assessing sociodemographics and validated measures of psychological distress: Patient Health Questionnaire-9 for depression, Generalized Anxiety Disorder-7 for generalized anxiety, Cardiac Anxiety Questionnaire for cardiac-related anxiety, and PTSD Checklist-5 for posttraumatic stress symptoms. Sex differences were analyzed using t tests for continuous variables and χ 2 tests for categorical variables. Multivariable linear regression models assessed the association between sex and psychological distress, adjusting for age, pre-SCAD mental health diagnosis, and employment status. RESULTS: Among 326 patients (92.9% women; mean age=53.3±11.1 years), women reported higher rates of preexisting mental health conditions (29.2% versus 8.7%; P =0.035). Post-SCAD women reported higher mean scores than men on the Patient-Health-Questionnaire-9, Cardiac-Anxiety-Questionnaire, and PTSD Checklist-5 (all P <0.05). Female sex was associated with greater depressive (B=2.94; P =0.010), cardiac anxiety (B=7.09; P =0.008), and posttraumatic stress symptoms (B=5.94; P =0.048) after adjustment. Clinically significant symptoms were more common in women versus men: 25.1% versus 0% (depression), 21.5% versus 4.4% (anxiety), 54.8% versus 26.1% (cardiac anxiety), and 15.5% versus 0% (posttraumatic stress). CONCLUSIONS: Both women and men experience clinically significant cardiac anxiety following SCAD, but women report a greater psychological burden, including more preexisting mental health conditions and twice the distress after SCAD. These results underscore the importance of routine psychological screening and timely intervention to support mental health and recovery outcomes, particularly among women.

851 Background: Diffuse idiopathic skeletal hyperostosis (DISH) has been associated with increased risk of vertebral fractures in elderly men with prostate cancer. However, its potential role in the development of malignancies is poorly defined. In particular, the relationship between DISH and gastrointestinal (GI) cancers—including esophageal, gastric, colorectal, liver, biliary system, and pancreatic cancers—has not been examined. This study aimed to explore the risk of GI cancers among patients with DISH compared to those without DISH. We also assessed survival and incidence of vertebral fractures in these groups. Methods: Using the Mayo Clinic Platform (Full AMC1 dataset), we identified patients with and without a documented history of DISH. Outcomes included (1) prevalence and risk of GI cancers, (2) survival among GI cancer patients, and (3) vertebral fracture incidence. Relative risks (RRs) and hazard ratios (HRs) were calculated using SPSS20.0 and platform-based statistical tools, respectively. Kaplan–Meier survival analyses were performed to evaluate cancer survival outcomes. Results: A total of 6,189,860 patients were included, of whom 2,802 (0.05%) had DISH and 6,187,058 (99.95%) did not. Patients with DISH had a significantly higher prevalence of GI cancers compared with those without (RR = 1.63, 95% CI: 1.377–1.930). Survival analysis suggested worse outcomes among GI cancer patients without DISH (HR = 1.72, 95% CI: 1.25–2.35). Vertebral fracture incidence appeared lower among DISH patients, although low event numbers limit the reliability of this observation. Conclusions: DISH is associated with increased risk of GI cancers, while GI cancer patients without DISH may experience poorer survival. The observed trend toward lower vertebral fracture incidence among DISH patients should be interpreted cautiously due to limited event numbers. These findings highlight the importance of integrating musculoskeletal and oncologic perspectives in patient management and warrant further mechanistic and interventional studies. Survival analysis. Statistic Without DISH With DISH Patient Count 214,180 109 1 Month Survival 95.3% 98.2% 5 Month Survival 82.2% 87.9% 10 Month Survival 72.4% 85.1% 30 Month Survival 54.3% 74.1% 60 Month Survival 44.9% 60.6% Log-Rank 11.90 P-Value 0.00056 Hazard Ratio 1.72 (95% CI: 1.25 - 2.35)

331 Background: The relationship between plant-based dietary patterns and upper gastrointestinal (GI) cancers remains unclear. The Healthful Plant-Based Diet Index (hPDI) is a tool that measures adherence to plant-based diet and generates “scores” for clinical comparison. We conducted a systematic review and meta-analysis to examine the association between hPDI and the risk of esophageal and gastric cancers. Methods: A PubMed search identified relevant studies reporting on the association between hPDI and upper GI cancers. Reference lists were manually searched for additional studies. Study selection followed PRISMA guidelines, and quality was assessed using the Newcastle–Ottawa Scale (NOS). Pooled risk estimates were calculated using inverse-variance fixed-effects models, with subgroup analyses by cancer type. Sensitivity analyses were conducted using leave-one-out approach and by switching between fixed- and random-effects models. Forest plots and funnel plots were generated with RevMan 5.4, while Begg’s and Egger’s tests for publication bias were performed using Stata 15. Results: A total of four studies were included, all with high NOS scores. Overall, higher hPDI scores were associated with a significantly lower risk of upper GI cancers (RR = 0.64, 95% CI: 0.56–0.75). In subgroup analyses, the inverse association was consistent for both esophageal cancer (RR = 0.66, 95% CI: 0.54–0.79) and gastric cancer (RR = 0.63, 95% CI: 0.50–0.79). Between-study heterogeneity was low (I² = 35%, P = 0.16). Publication bias assessment indicated no evidence of small-study effects, as Begg’s test was non-significant (P = 0.88) and Egger’s test showed no significant bias (P = 0.76). Sensitivity analyses confirmed the robustness of the findings, with consistent results after sequential exclusion of individual studies and when using random-effects models. Conclusions: Higher hPDI scores were associated with a significantly reduced risk of esophageal and gastric cancers, indicating that adherence to a healthy plant-based diet may reduce upper GI cancer risk. These findings highlight the potential role of dietary modification in upper GI cancer prevention.

Abstract Background Revaccination is required for patients who receive a hematopoietic cell transplant (HCT) to reduce vaccine preventable illness. Revaccination requires an individualized plan due to differences in immunosuppressive therapy, immune reconstitution, age, and other challenges such as graft versus host disease. A structured approach is required to ensure prompt initiation of re-vaccinations and completion of the re-vaccination schedule. This study sought to evaluate the re-vaccination process at our center as a baseline for quality improvement. Methods We conducted a retrospective chart review of pediatric patients who received an autologous or allogeneic HCT between January 2019 and March 2024 to assess time to starting re-vaccination after post-HCT medical clearance and percentage of patients up to date within each series of vaccinations per internal protocol. Results A total of 64 patients were evaluated, of whom 23 were female and 35 underwent allogeneic stem cell transplant. For analysis, 13 were excluded due to death prior to clearance for vaccination. Among those included, 42 patients were cleared for restarting vaccines, and 37 (88%) of those have received at least one vaccine, while only 25 (59%) have completed the first series of recommended vaccines. The average time from transplant to administration of the first vaccine was 431 days for autologous HCT and 459 days for allogeneic HCT. The average time from medical clearance to the first vaccine was 66 days. The mean interval between the first and second vaccine doses was 97 days. Conclusion The majority of eligible patients initiated re-vaccination after transplant, but rates for the receipt of full recommended initial series remained suboptimal, with notable delays with notable delays between transplant and the day of clearance as well as clearance and the first vaccine administered. These findings highlight significant gaps in post-transplant immunization practices and underscore the need for targeted interventions to optimize protection for this vulnerable population. Disclosures All Authors: No reported disclosures

Abstract Background PET visual reads for multi‐center studies are conducted centrally by one or a few experts. In CLARiTI, a broader network of raters will perform the reads, necessitating methods to ensure their accuracy and reliability. Method All ADRC sites ( N = 37) will prospectively acquire amyloid PET scans for 800 cognitively unimpaired and 1200 cognitively impaired participants. Each site can use one of four amyloid PET tracers ([ 18 F]florbetaben, [ 18 F]florbetapir, [ 11 C]PIB, [ 18 F]NAV4694). PET scans will be visually interpreted by ten PET neuroimaging experts located across eight ADRCs, using their preferred hardware, software, and file format (DICOM, NIFTI). Calibration requires readers to perform blinded, independent visual interpretation of 180 amyloid PET scans (30 unique and 15 duplicate scans per tracer), previously read and selected by an expert (Table 1). An even mix of visually non‐elevated and elevated scans were selected, with quantitation spanning ‐26‐123 Centiloids (Figure 1), and 15% were visually borderline (similar proportion to ADNI4), with quantitation spanning 4‐48 Centiloids (mean 21). Kruskal‐Wallis H test showed no significant difference in the distribution of Centiloid values for scans in each tracer group, Χ 2 (3)=2.133, p = 0.545. Result Calibration scans were read by a second expert not serving in CLARiTI. There was 97% concordance and almost perfect agreement between readers (κ=0.932, p <0.001; Figure 2). Discordantly read scans were visually borderline elevated ( N = 2), borderline non‐elevated ( N = 1), and negative ( N = 1), with quantitation of 8‐21 Centiloids (mean 14). Intra‐rater reads were 98% concordant and had almost perfect agreement (κ=0.966, p <0.001). These findings hold promise for scaling‐up visual reads in CLARiTI, and we expect ≥80% concordance and substantial to almost perfect agreement (κ≥0.7) for inter/intra‐rater reliability. Conclusion Calibration is essential for accurate/reliable amyloid PET visual reads in large multi‐center studies with multiple raters. Through the calibration process, we will develop methods to improve the adjudication of borderline/challenging scans and formalize methods for visual reads of amyloid PET tracers that are investigational (i.e., [ 11 C]PIB, [ 18 F]NAV4694). Involving multiple raters across different sites, who use diverse hardware/software/file format combinations, will mirror the natural heterogeneity present in real‐world clinical practice. This calibration set can also serve as a standardized training tool for other studies incorporating amyloid PET visual reads.

Background/objectives: Improvements in esophageal adenocarcinoma (EAC) treatment have reduced mortality. While chemoradiation before surgery was previously a standard of care, updated guidelines recommend peri-operative chemotherapy without chemoradiation. Continued investigation into optimal non-operative treatment paradigms for patients who defer surgery or are not candidates for surgery and certain chemotherapy regimens is needed. The impact of induction chemotherapy prior to chemoradiation on survival and surgical outcomes remains unclear. This study assessed survival and surgical outcomes in a real-world cohort of EAC patients receiving induction chemotherapy before chemoradiation. Methods: This single-institution, IRB-approved, retrospective cohort study included patients with newly diagnosed stage II-IVb (oligometastatic for IVb) EAC who received definitive chemoradiation (radiation ≥ 40 Gy and two cycles of chemotherapy) +/− esophagectomy from 2007 to 2022. Patients receiving induction chemotherapy were compared to those who did not. Endpoints included survival and surgical outcomes. Results: A total of 141 EAC patients received definitive chemoradiation; 83 received induction chemotherapy before chemoradiation. Patients receiving induction chemotherapy were younger (p < 0.01) with slightly lower performance status (p = 0.27) and presented at a more advanced stage (p < 0.001). Median OS was 3.5 years in the induction chemotherapy group compared to 2.2 years (p = 0.10). There was no difference in pathologic complete response (p = 0.81), esophagectomy frequency (p = 0.87), or surgical downstaging between treatment groups (p = 0.84). Conclusions: In this real-world, single-institutional patient cohort investigating induction chemotherapy prior to chemoradiation in EAC, patients receiving induction chemotherapy did well but did not have a statistically significant improvement in survival outcomes or surgical outcomes. This study showed that significant numbers of real-world patients may not receive esophagectomy. Thus, prospective, randomized clinical trials are warranted to better delineate the efficacy and selection of patients for induction chemotherapy when non-operative approaches are favored.