Citations

Abstract Background Patients with moderate-to-severe inflammatory bowel disease (IBD) often require immunosuppressive therapy to achieve and maintain remission; however, the impact of these medications on influenza risk and the severity of influenza-related complications remains inadequately characterized. Methods Using the TriNetX U.S. Analytics Network, adults (≥ 18 years) with Crohn’s disease or ulcerative colitis during the 2022–2023 influenza season were identified. Patients were stratified by disease activity into two cohorts: (1) moderate-to-severe/active IBD, defined by elevated inflammatory markers, initiation of corticosteroids or a new biologic or small-molecule agent, or documented IBD-related symptoms or complications within the prior six months; and (2) mild/inactive IBD, defined by the absence of these features and no recent immunosuppressive therapy. Propensity score matching (1:1) was used to balance baseline characteristics, and Cox proportional hazards models were applied to estimate hazard ratios for influenza-related outcomes. Results After propensity score matching, each group had 22,784 patients. The incidence of influenza diagnosis was significantly higher in the moderate-to-severe/active IBD group (HR 1.41; 95% CI, 1.30–1.52). Hospitalization rates were also increased (HR 2.05; 95% CI, 1.89–2.23), as were influenza-related complications (HR 1.36; 95% CI, 1.23–1.51). ICU admissions (HR 1.51; 95% CI, 1.33–1.72) and mechanical ventilation (HR 1.68; 95% CI, 1.32–2.13) were both more frequent in the moderate-to-severe/active IBD group. Use of antiviral medications was higher among those in this cohort (HR 1.60; 95% CI, 1.22–2.10), and overall mortality was modestly increased (HR 1.17; 95% CI, 1.02–1.35). Subgroup analysis revealed the highest risk among patients on corticosteroids, followed by JAK inhibitors and anti–IL-23 agents. Conclusion Patients with moderate-to-severe/active IBD had more severe influenza-related outcomes compared with mild/inactive controls. Improving vaccine uptake and prompt evaluation of upper respiratory symptoms during influenza seasons are key to reducing influenza-related risks in immunosuppressed patients with IBD.

Abstract Repetitive head impacts are common in contact and collision sports and are linked to structural brain changes and an elevated risk of neurodegenerative diseases such as Chronic Traumatic Encephalopathy. Identifying early in vivo structural markers remains challenging. Although diagnosis currently requires post-mortem confirmation, clinical symptoms, including cognitive impairment and behavioural changes, are reflected in the diagnosis of Traumatic Encephalopathy Syndrome. These symptoms align with dysfunction in key brain regions—amygdala, hippocampus and thalamus—which support memory, emotion and behaviour and commonly show tau pathology in Chronic Traumatic Encephalopathy. This study uses shape analysis to examine structural differences in these regions between former American football players and unexposed asymptomatic controls and evaluates the influence of age, head impact exposure and clinical diagnosis on brain structure. We analyzed brain morphology in former American football players (n = 163) and unexposed, asymptomatic controls (n = 53). Structural segmentation was performed with FreeSurfer 7.1, and the shape analysis pipeline was used to generate subregional reconstructions. Vertex-level morphometry, based on the logarithm of the Jacobian determinant and radial distance, quantified local surface area dilation and thickness. Group differences were examined with covariate-adjusted linear regression models contrasting football players and controls, as well as participants with and without a Traumatic Encephalopathy Syndrome diagnosis. Partial correlations examined the influence of age, age of first football exposure and cumulative head impact index metrics, including frequency, linear acceleration and rotational force. Models were adjusted accordingly for age, body mass index, education, race, imaging site, apolipoprotein ϵ4 status and total intracranial volume. Former football players exhibited bilateral surface area contractions in the hippocampus and amygdala, along with reduced amygdala thickness, compared to controls. Older age was associated with widespread surface contractions and thinning across all regions, except for preserved thickness in the left hippocampus. An earlier age of first exposure to football correlated with surface contractions in the thalamus and left hippocampus. Greater cumulative linear acceleration was linked to bilateral hippocampal surface contractions and reduced thickness in the left thalamus, while greater rotational force exposure was associated with hippocampal thinning. No significant structural differences were found between players with and without a diagnosis of Traumatic Encephalopathy Syndrome. These findings extend volume-based research by revealing localized alterations in surface area dilation and thickness and emphasize the roles of age and repetitive head impact exposure in long-term brain changes.

Background: Post-treatment prognosis and monitoring are critical for determining the timing of salvage treatment in glioblastoma patients but has been challenging due to difficulties differentiating progression from treatment effects in conventional images. This exploratory study aimed to establish the correlation of radiomics image features from time series of amino acid tracer 18F-DOPA PET images, with outcomes, using machine learning and dimension reduction analysis. Methods: 18F-DOPA PET images were collected for a patient cohort with wild-type IDH and unmethylated MGMT who underwent dose-escalated radiation therapy. Quantitative features were derived from the high uptake region (T/N > 2.0) in pre- and post-radiation therapy follow-up 18F-DOPA PET images. A customized workflow was utilized for pre-selecting predictive features, followed by manifold learning. Machine learning algorithms were employed to establish associations between imaging features and remaining survival (RS), defined as the time between a follow-up scan and date of death. Results: The ML models exhibited 81–83% ROC_AUC in predicting RS evaluated on an independent test dataset. A RS map is proposed for monitoring tumor alterations through serial 18F-DOPA PET scans, demonstrating superior sensitivity and better correlation with survival compared to the RANO criteria. Conclusions: Our study demonstrates that ML models utilizing FU 18F-DOPA PET images have the potential to effectively predict future survival outcomes in patients with glioblastoma treated with dose-escalated radiation therapy. The capability to assess changes in tumor over time through imaging can potentially assist in patient stratification and the selection of salvage treatments, while also aiding in distinguishing treatment effects from genuine tumor progression.

Background: Pre-clinical animal studies have demonstrated improved cerebral blood flow and neurological survival with Automated Head Up Position (AHUP) cardiopulmonary resuscitation (CPR) as compared to flat conventional (C) CPR. AHUP CPR consists of 1) automated head and thorax elevation 2) active compression decompression CPR and 3) an impedance threshold device. Subsequently, observational propensity-matched studies of out-of-hospital cardiac arrest (OHCA) patients demonstrated a time-dependent association between survival with intact neurological function (SNF) and application of AHUP CPR. However, comparison of AHUP CPR outcomes with contemporaneous C-CPR controls is lacking. Hypothesis: Use of AHUP CPR for OHCA by first responder agencies will demonstrate a higher incidence of SNF compared to C-CPR outcomes from a national registry Methods: Data from the previous 5 years (2020-2024) from an AHUP-CPR Registry comprised of OHCA patients routinely treated by first responders with AHUP CPR were compared with data from the Cardiac Arrest Registry to Enhance Survival (CARES). Patient demographics, arrest characteristics, ROSC, SHD, and SNF were recorded. SNF was defined as a Cerebral Performance Category 1 or 2 at hospital discharge. A two-sample test of proportions was used for outcome comparisons. Results: Nine AHUP registry sites (MN, FL, TN, IL, OK, VA, AL, IA, MI) were included. Summary 5-year demographics (Table 1) and clinical outcomes (Table 2) are presented. For 2020-2024 AHUP sites, the average time (mm:ss, SD) from 9-1-1 call to start of CPR was 9:09 (4:37) and time to start of AHUP CPR was 12:46 (5:57). The AHUP registry had a higher 5-yr incidence of SNF versus the CARES registry (difference 2.8%, 95% CI 1.8-3.8, p < 0.00001). This difference was consistent year over year (Figure 1). Secondary outcomes of sustained return of spontaneous circulation and survival to hospital discharge in the AHUP registry were also significantly higher than CARES registry data (Table 2). Conclusions: Over a 5-year period, an unadjusted analysis of aggregate data from two OHCA patient registries demonstrated that the incidence of survival with intact neurological function was higher in patients treated with AHUP CPR as part of first responder care versus patients treated with more conventional CPR methods.

Abstract Background Molecular breast imaging (MBI) has shown utility as a supplement to mammography in women with dense breasts. Background parenchymal uptake (BPU), which describes the level of Tc-99m sestamibi in fibroglandular tissue on MBI, varies among women with similar density. Higher BPU is associated with greater breast cancer risk. The goal of this work is to investigate the histological correlations of BPU that may explain this association with risk. Methods We compared histologic features of prospectively collected benign breast tissue biopsies from healthy women who had a region of dense tissue on mammography exhibiting one of the extreme categories of BPU on MBI: either photopenic or marked. Tissue composition of specimens was assessed by measuring area of epithelium, stroma, and fat and counting lobules. Lobular involution status was assessed by an expert pathologist as either none, partial, or complete. Ki-67 index and estrogen receptor-alpha expression were also assessed. Results Biopsies were performed in 48 women (mean age 54.9 years [SD 11.1 years]), including 20 with marked BPU and 28 with photopenic BPU. Women with marked BPU were younger (mean age 49.9 vs. 58.4 years, p = 0.004), had higher body mass index ( p = 0.01), and were more likely premenopausal ( p = 0.005). Marked BPU specimens had a higher proportion of epithelium (14.5% vs. 2.2%, p < 0.001), lower stromal content (44.8% vs. 84.2%, p = 0.005), similar fat (18.9% vs. 12.9%, p = 0.41), and greater lobule counts (15.5 vs. 6.3, p < 0.001) compared to photopenic specimens. Complete lobular involution was less frequent in marked tissue than in photopenic tissue (10.5% vs. 76%, p < 0.001). Ki-67 index was higher in marked BPU tissues (5.4% vs. 1.6%, p = 0.006), though the difference was attenuated after adjustment for epithelial area (p = 0.26). Estrogen receptor-alpha expression did not differ between marked and photopenic groups (25.6% vs. 28.4%, p = 0.12). Conclusions Marked BPU on MBI is associated with greater epithelial content, less lobular involution, and higher proliferative activity—features characteristic of tissue at elevated risk for malignant transformation. These findings suggest that BPU provides functional information beyond mammographic density, supporting its role as an imaging biomarker for breast cancer risk in women with dense breasts. Trial Registration: NCT01240278 and NCT01588834

BACKGROUND AND OBJECTIVES: While many trials of the last decade have shifted the paradigm of stroke care toward endovascular therapy, a lack of timely access to centers with neurointerventional capabilities for many patients has remained a significant barrier to care. Endovascular robotic systems are poised to address this need for expanded access through telerobotic procedures, while also benefiting clinical team safety and raising the possibility of improved procedural precision. METHODS: A telerobotic setup consisting of a magnetic field generator and a mechanical advancer was placed with a silicone vascular phantom in an interventional suite in Switzerland and connected by wireless internet to an operator console in Arizona. From the operator console, the neurosurgeon navigated a guidewire and aspiration catheter to simulated middle cerebral artery (MCA) (n = 10) and basilar artery (n = 10) clots in consecutive timed procedural trials in evaluation of system feasibility and operator learning curve. RESULTS: From over 5700 miles away, the neurosurgeon navigated an aspiration catheter to 10 MCA and 10 basilar artery simulated large vessel occlusions. Clot aspiration was attempted in 4 trials and successful in each. Endovascular navigational time over 10 procedural trials to the M1 segment of the MCA and 10 trials to the basilar artery were completed on average in 114 seconds (SD 44.4 seconds) and 134 seconds (SD 65.8 seconds), respectively. Sufficient operator mastery was demonstrated in 20 procedural iterations with an average 77% reduction in navigational time from aortic arch initial to final trials. CONCLUSION: To our knowledge, we present the first intercontinental aspiration thrombectomy in the preclinical setting in comparable time to the clinical practice and demonstrate the early potential of telerobotic navigation. A lack of haptic feedback did not pose a hindrance, and the potential for intuitive operation offers to drive future research and adoption of this telesurgery system.

Abstract The environmental impact of computer-aided diagnosis (CADx) in colonoscopy is unknown. The potential to reduce greenhouse gas emissions by limiting unnecessary polypectomies may be offset by emissions associated with CADx devices. We quantified and compared the carbon footprint of colonoscopy with and without CADx. Life-cycle carbon emissions associated with endoscopic snares, polyp traps, histopathology, and CADx devices were estimated using life-cycle assessment software. The effect of CADx was estimated by the carbon dioxide equivalent (CO2e) emissions related to outcomes from a prospective cohort of patients who underwent colonoscopy with optical diagnosis under a leave-in-situ strategy (i.e. rectosigmoid polyps ≤5 mm predicted as non-neoplastic were not removed) with and without CADx assistance. We analyzed 1134 individuals (median age 67 years, 59% male) with 1716 colorectal polyps. Colonoscopy with CADx reduced the number of snares and polyp traps from 567 to 543 (difference: 24) and histopathology submissions from 1343 to 1278 (difference: 65). However, the total carbon footprint increased from 832 kg CO2e (95%CI 815 to 847) without CADx to 946 kg CO2e (95%CI 927 to 965) with CADx, corresponding to an absolute increase of 114 kg CO2e (95%CI 80 to 150) or 0.10 kg CO2e per colonoscopy. Using CADx under a leave-in-situ strategy increased the environmental burden of colonoscopy.

406 Background: Anxiety is highly prevalent among oncology patients, often arising from uncertainty around diagnosis, treatment options, and prognosis. Elevated anxiety can impair decision-making, reduce treatment adherence, and diminish overall quality of life. Effective second opinion consultations may help mitigate anxiety and increase patients’ confidence in recommending healthcare services to others. Our study evaluates the impact of oncology second opinion (OSO) consultations on anxiety level (AL) and confidence in the organization (CIO) providing the second opinion, i.e., Cincinnati Cancer Advisors (CCA) and Naples Cancer Advisors (NCA). Methods: The study included patients with cancer diagnoses, age ≥18 years, who were served in person for OSO at CCA and NCA. A survey was used before and after consultation, measuring AL (scale 1- 10) and CIO level (scale 1 - 10), assessed by asking patients how likely they would refer loved ones to the organization. After the content and face validation, patients completed the survey anonymously, put it in a sealed envelope, and dropped it in a dedicated box. Data was analyzed using paired t-tests to compare the change from pre- to post-consultation scores. Spearman’s correlation test was used to assess the relation between the changes in AL and CIO. Statistical significance was assessed using an alpha-level of 0.05. Analyses were conducted via R and R Studio (version 2025.5.1.513). Results: Overall, 46 consecutive patients participated (45 completed AL pre and post visit survey and 43 completed the CIO pre and post visit survey). The mean pre-consultation anxiety score was 5.92 (SD = 2.58), and the post-consultation score was 3.87 (SD = 2.10), demonstrating a significant reduction (mean paired difference = -2.05; p < 0.0001). The mean pre-consult CIO was 8.21 (SD = 2.03), increasing to 9.73 post-consultation (SD = 0.53), indicating a significant improvement (mean paired difference = 1.66; p < 0.0001). The correlation between changes in AL and CIO was not statistically significant, which may be attributed to the high baseline CIO scores (ceiling effect) and the small sample size. Conclusions: Oncology second opinion was associated with a marked decrease in patient AL and a significant increase in CIO. The patient survey will continue to recruit additional participants to increase the sample size and explore the correlation between changes in AL and CIO. Studying the downstream impact on patient experience and outcome is warranted.

In women with dense breasts, adding molecular breast imaging to digital breast tomosynthesis (DBT) increased both overall and invasive cancer detection rates, while modestly raising the recall rate compared with DBT alone.

ImportancePatients with kidney failure (KF) receiving long-term dialysis have increased incidence of atrial fibrillation (AF). Patients with KF and AF have increased risk of stroke, death, and bleeding compared with age-matched cohorts. In KF, the use of oral anticoagulants (OACs) increases hemorrhage risk, offsetting potential benefits and making left atrial appendage occlusion (LAAO) a potentially promising solution for risk reduction in AF.ObjectivesTo compare the outcomes and safety of OACs and LAAO for risk reduction of AF in patients with KF.Design, Setting, and ParticipantsThis retrospective cohort study assessed patients with KF enrolled in the US Renal Data System registry between January 1, 2015, and December 31, 2018, who were diagnosed with AF after initiation of long-term dialysis. On average, patients met inclusion criteria for 22 months. Data analysis was completed in May 2024.ExposureMedicare claims were used to identify patients who received OACs and LAAO after AF diagnosis. A propensity-matched cohort was created based on the CHA2DS2-VASc score and year of treatment.Main Outcomes and MeasuresDeath, nonfatal bleeds, and nonfatal strokes.ResultsThe final cohort included 2344 patients with KF and a new AF diagnosis (median [IQR] age, 66.0 [57.0-73.0] years; 1341 [57.2%] male). Of these patients, 293 received LAAO and 2051 received OACs. A total of 2194 patients (93.6%) were receiving hemodialysis, with the remaining 150 (6.4%) receiving peritoneal dialysis. In the LAAO group, 79 deaths (27.0%) and 21 nonfatal strokes (7.2%) occurred, and 117 patients (39.9%) experienced 234 bleeding events. In the OAC group, 729 deaths (35.5%) and 163 strokes (8.0%) occurred, and 687 patients (33.5%) experienced 1114 bleeding events. After accounting for correlation between bleeds and death, the joint frailty model showed evidence of a treatment association of LAAO compared with OACs on recurrent bleeding events (hazard ratio [HR], 0.74; 95% CI, 0.56-0.98) and death (HR, 0.47; 95% CI, 0.30-0.72). There was a reduced risk of nonfatal stroke in the LAAO group (HR, 0.55; 95% CI, 0.32-0.94), but this finding was not significant after adjustment (HR, 1.18; 95% CI, 0.76-1.81).Conclusions and RelevanceIn this cohort study, LAAO compared with OACs was associated with improved survival and reduced bleeding risk in patients with KF and AF. These findings suggest that these data should be considered in shared decision-making in consideration of LAAO for patients with KF and AF.