Citations

Abstract INTRODUCTION We integrate visual and quantitative metrics in white matter and medial temporal lobe to examine relationships with neuropathology in a community cohort. METHODS Postmortem in situ MRI (T1, T2, DWI) was performed in 25 human brains, followed by visual ratings (Fazekas, MTA, ERICA, Koedam). Neuropathology included ADNC, LATE-NC, hippocampal sclerosis, PART, ARTAG, Lewy pathology, and CAA. RESULTS Increased Fazekas score was linked to aging, lower education, hypertension, higher basilar artery wall thickness, and greater Braak NFT stage. WMH volume also correlated with lacunes, Thal phase, and CERAD score that was not observed using Fazekas. Hippocampal volumes were lower in elderly, less educated people and were associated with higher atrophy scores and higher Braak NFT stage. Higher amygdala volume was only associated with higher CERAD score. DISCUSSION Quantitative MRI may detect neuropathologic associations more sensitively than visual ratings. Tau pathology is a key predictor of WMH burden and hippocampal atrophy.

Community engagement and trust are vital to medical education and improving health. The experience of national level, extramural seed grant programs to support faculty in both education and health care delivery with the focus of building trust has not been previously reported. The authors reviewed a total of four cohorts of the “Building Trust: Advancing Health Equity” grant recipients supported by the ABIM Foundation and other funding partners. Over $1.5 million was awarded from 2021 to 2024, which represented 92 grants ranging from $2,500–$40,000 each. The geographic regions receiving the most grants and funding were the middle and south Atlantic, and the Pacific regions in the United States. University programs received more grants and funding than affiliated or community programs. The majority of project types primarily focused on developing educational curricula for internal medicine residents (68%) and engaging with local communities (19%). The approach to implementation often included service-learning and community experts (29%), quality improvement and patient care delivery methods (22%), and traditional curriculum development (21%). The most common education topic themes were health equity and social determinants of health (43%) and addressing bias in care delivery and learning environment (20%). The Building Trust grant program reflects the unique needs of local communities and supported innovative practices and educational techniques. Implementation support was provided to grantees through shared experiences and mentorship. Evaluating outcomes upon completion of grants will be an imperative next step. This serves as a model that can inform institutions and other professional organizations approaching implementation of seed grant funding.

Scattered tubular-like cells (STCs) are dedifferentiated renal tubular cells that repair other damaged kidney cells. This study shows that renovascular disease (RVD) induces site-specific 5-methylcytosine (5mC) and 5-hydroxymethylcytosine (5hmC) modifications in DNA associated with transcriptional changes and impaired proliferative capacity of swine STCs, which could be mitigated in RVD-STCs treated with an epigenetic modulator. Therefore, our observations may contribute to the development of novel approaches to preserve the reparative capacity of STCs in individuals with RVD.

Purpose of Research Lucidity is the transient recovery of abilities and communication that were seemingly lost among people living with dementia (PLWD). This study describes lucid episodes reported by Alzheimer’s dementia (AD) and Lewy Body Dementias (LBD) caregivers. We analyzed survey data from 212 current AD ( n = 191) and LBD caregivers who reported the frequency, duration, and characteristics of 653 lucid episodes witnessed in the past month. Major Findings Most AD caregivers (67%) and LBD caregivers (81%) witnessed a lucid episode within the past month. LBD caregivers reported lucid episodes with greater changes in awareness and communication, compared to AD caregivers. LBD caregivers reported longer lucid episodes and that the PLWD knew about their change in lucidity, compared to AD caregivers. Conclusions Findings suggest that differences in lucid episode intensity, timing, and meta-awareness between AD and LBD are possible and may inform care strategies for PLWD.

Abstract Background Breast cancer chemoprevention is underutilized among high-risk women. We examined whether decision support could increase informed decision making. Methods We conducted a cluster randomized controlled trial to evaluate the effect of a patient-facing decision aid (RealRisks) and provider tool (BNAV) compared with standard education on the number of women with high-risk breast lesions making informed choices. Questionnaires were administered at baseline and 6 and 12 months. The primary outcome was chemoprevention informed choice (defined as adequate knowledge and attitudes congruent with decision) at 6 months. Secondary endpoints included breast cancer risk perceptions, worry, chemoprevention knowledge, decision conflict, and chemoprevention decision. Results Across 31 randomized sites, we enrolled 210 providers, who were primarily breast health specialists. Of these, 24 sites (14 intervention, 10 control) enrolled 412 patients. Among 287 patients evaluable for the primary outcome, there were no statistically significant differences in informed choice between the intervention and control arms at 6 months (35% vs 27%, respectively; P = .20) and 12 months (37% vs 25%, respectively; P = .05). At 6 months, women in the intervention compared with control arm were more likely to have accurate breast cancer risk perceptions (31% vs 21%, respectively; P = .03) and adequate chemoprevention knowledge (33% vs 23%, respectively; P = .04). At 12 months, 52% of women in the control and 50% in the intervention arm self-reported initiating chemoprevention. Conclusion Decision support led to modest improvements in accurate risk perceptions and chemoprevention knowledge but not informed choice. Relatively high chemoprevention uptake was achieved among women with high-risk breast lesions managed mainly by breast health specialists. Trial Registration NCT04496739, https://clinicaltrials.gov/study/NCT04496739?cond=NCT04496739&viewType=Card&rank=1

Abstract Background N‐methyl‐D‐aspartate receptor antibody encephalitis (NMDAR‐Ab‐E) is an autoantibody‐mediated disorder, characterized by acute development of neuropsychiatric symptoms, seizures, movement disorders, and autonomic instability. Objectives To describe acute seizure semiology and electroencephalogram (EEG) findings in patients with a first episode of NMDAR‐Ab‐E. Methods Medical records and EEG results were retrospectively evaluated from 14 adult patients with definite NMDAR‐Ab‐E, recruited between April 2009 and September 2017, and followed up until October 2024. Results A total of 92.8% (13/14) were women with a mean age of 29.6 years. 85.7% (12/14) patients experienced seizures. Focal and/or generalized seizures were described at presentation or in the first days of the illness in 57% (8/14). EEGs showed diffuse slowing in 13/14 and this coexisted with epileptiform activity in 10/13; fast frequencies in 7/13 (potentially owing to a benzodiazepine effect); and asymmetric focal slowing in 6/13. Six patients had periods of rhythmic slow activity (focal or diffuse), without evolution to electrographic seizures. An extreme delta brush (EDB) pattern was recorded in 2/13 patients, and this was associated with non‐convulsive status epilepticus in one of these individuals. Significance Most patients in this case series of NMDAR‐Ab‐E were young adult females with early focal and/or generalized seizures. Diffuse slowing in theta/delta range was the most common EEG finding, with or without epileptiform discharges, focal slowing, superimposed fast activities, and focal or diffuse rhythmic slowing. An EDB pattern was rare. Even with non‐specific findings, EEG seems to be a sensitive tool to aid diagnosis and decision‐making in NMDAR‐Ab‐E.

Abstract Background Ventricular arrhythmias (VA) are common complications of acute coronary syndromes (ACS) and can cause cardiac arrest and adverse outcomes. However, the prognostic impact of VA according to their timing in relation to percutaneous coronary intervention (PCI) remains unclear. Purpose To assess the prognostic significance of VA in patients with ACS undergoing PCI according to the timing of occurrence (before, during, or after PCI). Methods We performed a systematic review and meta-analysis of observational studies reporting all-cause mortality with and without VA (sustained VT/VF) in ACS patients undergoing PCI. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using random-effects models for short-term (30 days/in-hospital) and long-term (1 year) mortality. Between-study heterogeneity was assessed using the I² statistic. We conducted subgroup analyses for studies that stratified VA according to timing, defined as VA before PCI (prior to arrival in the catheterization laboratory), VA during PCI (in the catheterization laboratory or immediately after reperfusion), VA after PCI (following completion of PCI). Each timing category was compared to patients who did not develop VA within the same time window (before, during or after PCI). Results Twelve studies comprising 49306 patients were included, of whom 4320 (8.76%) experienced VA. The mean age of the patients ranged from 60 to 70 years, and the follow-up ranged from hospital discharge to 8 years. VA was associated with increased short-term (OR 5.02 [3.91-6.44]) and long-term mortality (OR 3.00 [2.86-3.82]). However, in patients alive at discharge/30 days, subsequent long-term mortality risk did not differ between those with and without VA (OR 1.21 [0.70-2.09]) (Figure 1). The subgroup analyses showed that patients with VA were associated with higher short-term mortality compared to patients without VA within each time window: before (OR 4.32 [3.29-5.66]), during (OR 4.29 [2.08-8.84]), and after PCI (OR 9.29 [3.12-27.63]) (Figure 2). VA after PCI was associated with the highest OR for short-term mortality. Conclusions VA significantly worsens short-term outcomes in ACS patients undergoing PCI. Subgroup analysis shows that VA increases mortality in each timing category, before, during and after PCI, with the poorest prognosis observed for arrhythmias developed after reperfusion, in whom reversible acute ischemia may play a lesser role and underlying arrhythmic substrate may predominate.Figure 1Figure 2

Abstract Roux‐en‐Y gastric bypass (RYGB) surgery is a highly effective technique for treating obesity. However, it may result in nutritional deficiencies. Here we report the case of a 55‐year‐old woman presenting with chronic diarrhea lasting 2 years, accompanied by lower limb paresthesia, macrocytic anemia, leukopenia, and thrombocytopenia. Her medical history included hypothyroidism treated with levothyroxine, and RYGB surgery performed in 2014, with intermittent micronutrient supplementation. The patient developed copper and zinc deficiencies. To our knowledge, this is the first report of a patient presenting with both deficiencies simultaneously with pancytopenia 10 years after RYGB. This case underscores the need to verify adherence to existing preoperative screening recommendations involving preoperative micronutrient measurements to assess micronutrient deficiency risks and multidisciplinary postoperative follow‐up, the importance of monitoring micronutrient levels, close follow‐up of both symptomatic and asymptomatic patients and evaluating adherence to supplementation regimens.