Citations

Introduction Infectious intracranial aneurysms (IIAs) are rare but serious complications of systemic infections, particularly infective endocarditis. These aneurysms are prone to rupture, leading to significant morbidity and mortality. Management strategies lack consensus due to the rarity of the condition and reliance on small case series. This study examines the clinical management of IIAs using data from a large multicenter cohort. Methods A retrospective registry-based cohort study was conducted across 11 tertiary care centers in the USA between 2018 and 2023. Patients with IIAs were identified based on clinical and radiographic criteria. The primary outcome was treatment failure defined as persistence, growth, or rupture of the aneurysm. Secondary outcomes were mortality and the modified Rankin Scale (mRS) score at 90 days and 1 year. Multivariate logistic regressions were used to identify outcome predictors. Results A total of 104 patients with 166 aneurysms were included, with a median age of 43 years. Medical management was successful in 56% of cases, with failure often within 18 days of initiation. Predictors of failure included younger age, larger aneurysm size, and rupture at presentation. Surgical and endovascular interventions achieved higher success rates with better outcomes. At 90 days, 57% of patients achieved functional independence (mRS 0–2), while the mortality rate was 24%. Conclusion This study highlights the limitations of medical management for IIAs and underscores the need for early surgical or endovascular intervention in high-risk patients. Outcome predictors aid clinical decision-making, optimizing patient management. Further research is needed to standardize management guidelines for IIAs.

Importance Nontraumatic subarachnoid hemorrhage (SAH) represents the third most common stroke type with unique etiologies, risk factors, diagnostics, and treatments. Nevertheless, epidemiological studies often cluster SAH with other stroke types leaving its distinct burden estimates obscure. Objective To estimate the worldwide burden of SAH. Design, Setting, and Participants Based on the repeated cross-sectional Global Burden of Disease (GBD) 2021 study, the global burden of SAH in 1990 to 2021 was estimated. Moreover, the SAH burden was compared with other diseases, and its associations with 14 individual risk factors were investigated with available data in the GBD 2021 study. The GBD study included the burden estimates of nontraumatic SAH among all ages in 204 countries and territories between 1990 and 2021. Exposures SAH and 14 modifiable risk factors. Main Outcomes and Measures Absolute numbers and age-standardized rates with 95% uncertainty intervals (UIs) of SAH incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) as well as risk factor–specific population attributable fractions (PAFs). Results In 2021, the global age-standardized SAH incidence was 8.3 (95% UI, 7.3-9.5), prevalence was 92.2 (95% UI, 84.1-100.6), mortality was 4.2 (95% UI, 3.7-4.8), and DALY rate was 125.2 (95% UI, 110.5-142.6) per 100 000 people. The highest burden estimates were found in Latin America, the Caribbean, Oceania, and high-income Asia Pacific. Although the absolute number of SAH cases increased, especially in regions with a low sociodemographic index, all age-standardized burden rates decreased between 1990 and 2021: the incidence by 28.8% (95% UI, 25.7%-31.6%), prevalence by 16.1% (95% UI, 14.8%-17.7%), mortality by 56.1% (95% UI, 40.7%-64.3%), and DALY rate by 54.6% (95% UI, 42.8%-61.9%). Of 300 diseases, SAH ranked as the 36th most common cause of death and 59th most common cause of DALY in the world. Of all worldwide SAH-related DALYs, 71.6% (95% UI, 63.8%-78.6%) were associated with the 14 modeled risk factors of which high systolic blood pressure (population attributable fraction [PAF] = 51.6%; 95% UI, 38.0%-62.6%) and smoking (PAF = 14.4%; 95% UI, 12.4%-16.5%) had the highest attribution. Conclusions and Relevance Although the global age-standardized burden rates of SAH more than halved over the last 3 decades, SAH remained one of the most common cardiovascular and neurological causes of death and disabilities in the world, with increasing absolute case numbers. These findings suggest evidence for the potential health benefits of proactive public health planning and resource allocation toward the prevention of SAH.

Abstract: Background: Extended patch testing beyond the standard series is commonly performed in patients with allergic contact dermatitis. This broader testing allows for more precise and complete allergen identification, ultimately leading to improved clinical outcomes. Objective: To report the Mayo Clinic Contact Dermatitis Group (MCCDG) patch testing results using a custom extended series from 2010 to 2023. Methods: A retrospective review of patch testing results using the MCCDG extended standard series at the Mayo Clinic was conducted. Data from 2010 to 2023 were analyzed. Results: Patch testing with the extended standard series was performed in 3,767 unique patients, with a total of 3834 extended standard patch tests administered (81.8% in women, 18.2% in men). The top 5 allergens eliciting positive reactions were gold (I) sodium thiosulfate (10.4%), benzisothiazolinone (10.4%), carmine (9.4%), thimerosal (9.3%), and hydroperoxides of linalool (8.8%). Conclusions: The extended standard series expands the diagnostic scope for patients in whom the standard series incompletely identifies relevant allergens. Preservatives and fragrances remain among the most common sensitizers, emphasizing the need for ongoing allergen surveillance, periodic review, and updates to patch test series to enhance diagnostic accuracy and patient care.

Perioperative health inequities remain a critical issue, contributing to unequal patient outcomes and financial costs despite increasing awareness and efforts to address these disparities. This systematic review evaluated anesthesiology literature from 2010 to 2023 on perioperative health care disparities related to race, ethnicity, gender, and socioeconomic status. The review aimed to identify gaps and propose research and opportunities for intervention. A comprehensive literature search was conducted using PubMed, Embase, Scopus, and Web of Science, with studies included if they focused on perioperative disparities in the United States, were published in anesthesiology journals, and met criteria for methodological rigor. The review was registered with International Prospective Register of Systematic Reviews (PROSPERO); data extraction followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and study quality was assessed with the Newcastle-Ottawa scale. Out of 1050 abstracts screened, 116 articles were reviewed for full text, with 59 studies meeting inclusion criteria. Included studies comprised retrospective cohort studies, cross-sectional analyses, a case-control study, and a randomized controlled trial, covering various surgical procedures and sample sizes from 100 to over 21 million patients. Disparities were noted in peripartum management (n = 14), mortality (n = 12), complications (n = 8), regional anesthesia use (n = 6), and pain management (n = 3), with evidence of poorer outcomes in Black and Hispanic women, older adolescents, and patients who were uninsured or on Medicaid. This review highlights the persistence of significant perioperative disparities and identifies gaps, such as limited exploration of the causes of these disparities, limited examination of disparities during the preoperative and intraoperative period, and few interventions to address these identified disparities. Reducing these disparities requires stakeholder engagement, multifaceted approaches, culturally agile training for health care teams, enhanced decision support tools, and a more diverse health care workforce. Continued research and targeted interventions at individual, community, and societal levels are essential for improving perioperative outcomes.

Abstract Glioblastoma is highly vascularized with increased perfusion and prognosis remains dismal, despite improved diagnosis and aggressive multimodal treatment. The current standard of care is maximal surgical resection when feasible, followed by adjuvant radiation with concurrent chemotherapy, temozolomide. However, treatment resistance and tumor recurrence pose a considerable challenge for stratifying patients for optimal treatment planning. Current radiological assessment of glioblastoma therapy response predominantly relies on morphological measures; that may not accurately capture early microscopic changes or therapeutic efficacy. We have developed and validated an advanced imaging method, Arterial Spin Labeling (ASL) MRI that enable noninvasive spatial assessment of the entire tumor. ASL-MRI uses water within the blood as an endogenous tracer and measures perfusion without the need for exogenous gadolinium-based contrast agent. The objective of this study was to investigate ASL measured quantitative perfusion after surgery to predict survival in glioblastoma patients undergoing the standard of care chemoradiation treatment. In this prospective, IRB-approved study, twenty-three adults with glioblastoma participated for longitudinal MRI. Progression-free survival (PFS) and overall survival (OS) were recorded for each patient. A baseline MRI scan was performed prior to chemoradiation treatment and after surgery utilizing a 3D ASL sequence. All structural images were co-registered to T1 post-contrast images. Tumor regions of interest (ROIs) such as enhancing tumor (ET), tumor core, whole tumor, and necrosis were manually segmented. Cerebral blood flow maps were calculated and mean perfusion values (MPV) within ET ROIs were extracted. Scatter plot of MPV and Kaplan-Meier graphs were generated using GraphPad Prism. Based on median survival of 420 days, patients were categorized into short (≤420 days) or long (>420 days) survival. A threshold ASL measured perfusion value of 30 mL/100g/min distinguished survival groups; hyper-perfusion correlated with shorter OS, while hypo-perfusion linked to longer OS. The mean±SD of PFS and OS for patients with shorter survival were 119±42 days and 230±117 days respectively, while for longer survival were 624±285 and 726±210 days respectively, and the values were statistically different (P<0.001for both). Kaplan-Meier curves showed significant OS and PFS differences (p<0.015, Hazard Ratio=3.056). Our data indicate that ASL measured baseline perfusion, after surgery and before chemoradiation treatment can benefit in predicting survival and treatment stratification in glioblastoma patients. ASL measured perfusion can be performed during radiation treatment and could provide valuable information that can be incorporated into emerging treatment strategies such as adaptive radiation. Citation Format: Durga Udayakumar, Limin Zhou, Marco Pinho, Yiming Wang, Ben Wagner, Michael Youssef, Joseph Maldjian, Ananth Madhuranthakam. Noninvasive magnetic resonance imaging measured quantitative perfusion as predictive and prognostic biomarker in glioblastoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 7163.

Abstract Background and Aims Classification and risk stratification in aortic (AR), mitral (MR), and tricuspid regurgitation (TR) remains a significant clinical challenge. This study aimed to develop an artificial intelligence (AI) system to assess valvular regurgitation and stratify MR-progression risk. Methods Using transthoracic echocardiograms (TTEs) at two sites (internal development/test, external test), the DELINEATE-Regurgitation system was developed to classify AR, MR, and TR severity using colour Doppler videos. Methods of summating video-level classifications into study-level predictions were tested, comparing single-view with multiview approaches integrating predictions across multiple videos. Model agreement with cardiologists was assessed by weighted kappa. A separate AI system (DELINEATE-MR-Progression) analysing colour Doppler videos was developed to predict which patients with mild, mild–moderate, and moderate MR were most likely to progress to moderate–severe or severe MR with analysis by Kaplan–Meier and Cox proportional hazards models. Results A total of 71 660 TTEs with 1 203 980 colour Doppler videos were included. The weighted kappa in internal/external test sets for regurgitation classification was 0.81/0.76 for AR, 0.76/0.72 for MR, and 0.73/0.64 for TR using a multiview approach taking all colour Doppler videos in a study, demonstrating substantial agreement with cardiologist interpretation with superiority of multiview over single view approaches. In the progression analysis, the AI score stratified MR-progression risk even when controlled for clinical factors known to be associated with MR progression [internal test set hazard ratio 4.1 (95% confidence interval 2.5–6.6)]. Conclusions An AI system can accurately classify AR, MR, and TR and predict MR progression beyond currently known risk factors.

ABSTRACT Alzheimer's disease (AD) is the leading cause of dementia in the elderly, marked by abnormal protein buildup (beta‐amyloid and tau) resulting in neuronal loss, especially in the medial temporal lobe and other limbic regions. The presence of transactive response DNA binding protein 43 (TDP‐43) immunoreactive inclusions in medial temporal lobe regions has also been associated with neuroimaging changes in limbic regions. It has been proposed that hypometabolism in limbic regions on [ 18 F] fluorodeoxyglucose positron emission tomography (FDG‐PET) in a patient with a slowly evolving amnestic syndrome may be a signature of the presence of TDP‐43. In this context, we observed an 86‐year‐old Caucasian female with dementia characterized by a slowly evolving amnestic syndrome, along with focal medial temporal atrophy evident on MRI and hypometabolism in limbic regions on FDG‐PET. The patient subsequently died and underwent an autopsy. We performed detailed neuroimaging and digital neuropathological analyses of the hippocampal subfields to better understand the relationship between clinico‐imaging findings and histopathology. In addition to TDP‐43, we identified three other pathological processes in the medial temporal lobe: sequestosome‐1/p62, argyrophilic grain disease (AGD), and primary age‐related tauopathy (PART). Hippocampal subfield volumes and rates of atrophy were no different from those of matched healthy controls, except for the atrophy rate in cornu ammonis 1 (CA1). Digital histopathology revealed the relative highest burden of pathology for p62, followed by TDP‐43, AGD, and PART in CA1. Multiple pathological processes appear to have contributed to the hippocampal atrophy and hypometabolism in our patient with a slowly progressive amnestic syndrome.