Citations

Abstract Object Transdermal biosensors may provide an alternative to conventional blood-based biomarker measurement. Our purpose was to determine the binary correlation between transdermal (Infrasensor™; RCE, Inc, Carlsbad, CA) and conventional blood-based measurements. Methods This was a secondary analysis from a previously published observational cardiac troponin I (cTnI) study performed to establish the upper reference level of cTnI, at 10 US hospitals. After obtaining informed consent, 2 cohorts of patients were enrolled: 1) those who completed a health assessment questionnaire and appeared healthy, and 2) those with a known elevated cTnI per the local hospital standard assay. All blood lab analyses were performed at the University of Maryland Medical Center, Baltimore, MD. Normal was defined as cTnI <53.48 ng/L (male) or 34.11 ng/L (female) using the Siemens Atellica IM assay (Siemens Medical Solutions, Mountain View, CA), NT-proBNP <450 pg/mL (>75 years) or <124 pg/mL (<75 years), creatinine >1.17 mg/dL (male) or >0.95 mg/dL (female), and HbA1c <6.4%. The Infrasensor was placed on the patient’s wrist for measurement and blood drawn for analysis at approximately the same time. Results Of 840 enrolled patients, the median (IQR) age was 46 (30,57), 416 (49.5%) were female, 10.36% Hispanic, 6.7% Asian, 12.9% African American, and 69.1% White. Elevated lab tests were 102 hscTnI’s, 156 NTproBNP’s, 37 HbA1C’s, and 163 creatinine’s. Significant binary correlations were found between all transdermal signals and the corresponding lab blood levels Conclusion Infrasensor transcutaneous measurement demonstrates similar results as that obtained from blood testing in the central laboratory. Capsule The Infrasensor (RCE, Inc, Carlsbad, CA, USA) is rapid point of care transcutaneous biomarker measurement device. This study evaluated its ability to provide qualitative results for troponin I, NTproBNP, creatinine, and HbA1c levels in 840 patients. Significant correlations were found between all transdermal signals and the corresponding binary lab blood levels.

Background: Knee injuries are among the most common injuries in female basketball players. Despite the growing popularity of professional women's basketball, particularly the Women's National Basketball Association (WNBA), there are limited recent data evaluating the incidence of and risk factors for knee injuries in WNBA athletes. Hypothesis: Older age, minutes played per game, number of games played, and player usage rate would be significantly associated with having a knee injury in WNBA players from the 2017 to 2022 seasons. Study Design: Descriptive epidemiology study. Methods: Publicly available data on the injury history and player records of active WNBA players between the 2017 and 2022 seasons were reviewed to identify players with a knee injury resulting in ≥1 games missed. The primary outcome was the incidence of knee injuries reported per 1000 minutes-exposures (MEs). Player demographics, statistics, and injury characteristics were recorded. Secondary analysis was conducted using bivariate and multivariable logistic regression to investigate risk factors associated with having a knee injury. Results: A total of 87 players (10.8% of all players) sustained a combined 104 knee injuries between the 2017 and 2022 seasons, indicating a rate of 6.03 knee injuries per 1000 MEs. Accounting for potential confounders, having a knee injury was significantly associated with older age (OR, 1.11; 95% CI, 1.05-1.18; P = .0002) and higher usage rate (OR, 1.06; 95% CI, 1.02-1.11; P = .02). Conclusion: This study showed that knee injuries occurred in 10.8% of players, with an overall rate of 6.03 injuries per 1000 MEs. The most significant risk factors associated with having a knee injury in WNBA athletes were older age and higher player usage rate. Implementing targeted load management strategies for players with higher usage rates or advanced age may help reduce the incidence of knee injuries among female basketball athletes.

Bone scintigraphy is a valuable adjunct to cross-sectional imaging and can be used to evaluate disease extent in multifocal processes such as blastic osseous metastatic disease, provide diagnostic information to aid in problem solving in challenging cases, and serve as the primary diagnostic modality for diseases that manifest with pathognomonic scintigraphic appearances.

Background: This systematic review examined differences in learner outcomes between traditional learning models (TLMs) and dedicated education units (DEUs) in undergraduate nursing programs. Method: Six databases were searched to identify peer-reviewed literature published between 2000 and 2025. Fifteen articles informed this review. Results: Included studies focused on various student outcomes including evaluation of students' perceptions and student performance. Themes around student perception included learning environment, learning opportunities, and learning performance. Themes around performance included standardized exams, course exams, competency exams, and preceptor evaluation of competency development. Conclusion: Main findings indicate the DEU model for clinical education enhances student satisfaction with the learning environment, increases learning opportunities, and improves self-perceived learning performance. The effects of DEUs on student performance outcomes require additional research, but preliminary research suggests a positive relationship between the DEU and competency development.

Abstract Objectives To comprehensively evaluate the validity of International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes for both prevalent diagnoses and less common diseases, and to assess the performance of a large language model (LLM)-based system in validating these codes. Materials and Methods This retrospective study analyzed hospital admissions from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. We developed a validated LLM-based system using GPT-4o, refined through iterative prompt engineering, to assess ICD-10-CM code validity. We measured the positive predictive value (PPV) of ICD-10-CM codes, PPV of principal and secondary diagnoses, and the performance of an LLM-based system in code validation. Results Among 865 079 assigned codes, the PPV was 84.6% (95% CI, 84.5%-84.6%). Principal diagnoses had a PPV of 93.9% (95% CI, 93.7%-94.1%), while secondary diagnoses had a PPV of 83.8% (95% CI, 83.7%-83.9%). The LLM system demonstrated high performance in validating ICD codes, achieving 93.6% accuracy, 95.4% sensitivity, and 85.2% specificity. Among correctly assigned secondary diagnoses, the majority (67.9%) represented historical or baseline conditions, while 32.1% reflected active conditions that deviated from baseline status; 22.3% of these emerged after hospital admission. PPV decreases with later diagnosis positions, with the largest decline occurring between principal and secondary diagnoses. Discussion and Conclusion In this large-scale evaluation, ICD-10-CM codes exhibited generally high accuracy, though variability existed by position and condition type. A validated LLM system performed comparably to physician review and offers a scalable means to improve coding accuracy. These findings support the potential for integrating LLM-based auditing into routine workflows to strengthen the quality of administrative and research data.

Background/Objectives: Dizziness is a symptom of many disorders across a wide range of etiologies. If dizzy patients are seen for vestibular evaluation with an audiologist and no vestibular reason for the patient’s dizziness is found, the medical referral pathway can become convoluted. This can leave patients feeling discouraged and unable to manage their symptoms. Clinically symptomatic chronic respiratory alkalosis (CSCRA) is an acid–base disorder that typically presents with dizziness but is unfamiliar to practitioners in vestibular and balance care settings. Methods: In a retrospective chart review deemed exempt by the Mayo Clinic Institutional Review Board, 74 patients at Mayo Clinic Arizona were included. All had consultations with both Audiology and Aerospace Medicine to assess their dizzy symptoms. Results: After completing vestibular testing, arterial blood gas (ABG) testing, and a functional test developed at Mayo Clinic Arizona called the Capnic Challenge test, 40% of patients were found to have CSCRA contributing to their dizzy symptoms. Many of these patients also had common comorbidities of CSCRA, like postural orthostatic tachycardia syndrome (POTS), migraines, and sleep apnea. Fewer than one-fourth of these patients had measurable vestibulopathies causing their dizziness. Half of the patients referred by the vestibular audiologist to Aerospace Medicine had a diagnosis of CSCRA. Conclusions: Assessment for CSCRA should be considered as a next step for patients presenting with dizziness without a vestibular component. Being aware of the prevalence of CSCRA and its comorbidities may help balance providers offer quality interprofessional referrals and improve patient quality of life.

Complement-mediated hemolytic uremic syndrome (CM-HUS), commonly referred to as atypical HUS, is a rare thrombotic microangiopathy caused by uncontrolled activation of the alternative complement pathway, typically triggered by a “two-hit” mechanism. It is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and end-organ damage, most commonly affecting the kidneys. While our understanding of the complement system has advanced significantly, CM-HUS remains a complex, heterogeneous disorder influenced by a spectrum of genetic variants, risk haplotypes, and acquired factors such as anti-factor H autoantibodies. This review highlights the current knowledge of CM-HUS pathogenesis, focusing on genetic variants in regulatory and activating proteins of the complement system. We also discuss the diagnostic complexity posed by incomplete penetrance, overlapping phenotypes, and limitations of genetic and functional assays. Emerging ex-vivo assays and complement biomarkers are explored as tools for refining diagnosis and risk stratification. The use of complement inhibitors such as eculizumab and ravulizumab has significantly improved renal outcomes and survival. This review provides a comprehensive, clinically grounded update on the genetics, pathophysiology, diagnostics, and therapeutic considerations in CM-HUS, aiming to provide clinicians and researchers with a deeper understanding of this complex, complement-driven disease.

TPS646 Background: SSTR-targeted RPT has transformed the treatment landscape for NETs, significantly improving clinical outcomes in phase 3 studies versus other targeted therapies. Nevertheless, disease progression and renal toxicity after treatment highlight the need for further improvement. Use of the α-emitter 225 Ac as the radioactive component has shown promising results in clinical studies: initial data from ACTION-1 suggest promising efficacy for RYZ101, a first-in-class, highly potent α-emitting RPT, in patients with SSTR+ GEP-NETs progressing after 2–4 cycles of 177 Lu-somatostatin analogs. RYZ401 is a cyclic 6-amino acid SSTR-targeting peptide agonist conjugated to a DOTA chelator bound to 225 Ac. Preclinical data have shown an improved therapeutic window versus DOTATATE. RYZ401 has the potential to deliver higher radiation doses to tumors, with improved renal clearance and lower kidney absorbed dose, potentially eliminating the need for amino acid infusion. Methods: RYZ401-101 is a global, multicenter, phase 1, first-in-human, dose-escalation/-expansion study designed to determine the recommended phase 2 dose (RP2D) and optimal treatment regimen, safety and tolerability, and preliminary efficacy of RYZ401 in patients with NETs and other selected solid tumors expressing SSTRs. Key eligibility criteria: histologically confirmed metastatic or unresectable well-differentiated NETs; WHO grade 1–3 (Ki-67 ≤55%); ≥1 SSTR PET-positive measurable lesion; and disease progression after ≥1 prior treatment line. In dose escalation, 6–18 patients will receive escalating doses of RYZ401 (2.0–11.1 MBq IV Q6W × 2–4 cycles); no amino acid co-infusion is planned. In dose expansion, approximately 80 patients will receive RYZ401 at the RP2D, 40 patients with well-differentiated GEP-NETs (cohort A) and 40 with other SSTR+ tumors including non-GEP-NETs (cohort B). Primary endpoints: dose-limiting toxicities in weeks 1–4 of treatment (dose escalation) and safety (dose expansion). Secondary endpoints: safety, pharmacokinetics, and efficacy outcomes (dose escalation and expansion). RYZ401 dosimetry will be evaluated in a sub-study of 10−16 patients. Enrollment is ongoing in the USA. Clinical trial information: NCT07165132 .