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BACKGROUND AND OBJECTIVES: Meningiomas are the most common primary central nervous system tumors, with cavernous sinus meningiomas (CSMs) making up a small fraction (1% of intracranial tumors). CSMs are challenging to treat due to their location and potential invasion. Therapy methods have shifted from aggressive resections to less invasive techniques such as stereotactic radiosurgery, reducing morbidity and improving survival. This study reviews the effectiveness and safety of radiosurgery for CSMs, blending historical and contemporary approaches to guide future treatments. METHODS: A search was performed in MEDlINE, Embase, and Cochrane databases, following Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Eligible studies included randomized or observational studies with ≥4 patients reporting on radiosurgery for CSM. The random-effects model was used to calculate a single proportion analysis with 95% CIs. Statistical analyses were performed using RStudio. RESULTS: Twenty seven studies, encompassing 1851 patients, were included in this analysis, with a population median age of 27 years. Outcomes were assessed as follows: the 10-year progression-free survival rate was 87% (323 patients; 95% CI: 73%-100%; I 2 = 89.6%), clinical deterioration occurred in 6% of cases (957 patients; 95% CI: 3%-8%; I 2 = 71.3%), clinical improvement was observed in 35% of patients (1106 patients; 95% CI: 27%-43%; I 2 = 86.6%), major complications rate was 4% (688 patients; 95% CI: 1%-6%; I 2 = 71.8%), and minor complications was 2% (653 patients; 95% CI: 0%-3%; I 2 = 68.6%). CONCLUSION: This study reveals stereotactic radiosurgery as an effective treatment of CSMs, showing high long-term progression-free survival and significant tumor control with few complications.

BACKGROUND AND OBJECTIVES: The Patient-Generated Subjective Global Assessment (PG-SGA) is a standardized tool for assessing malnutrition in patients with cancer. The primary aim of this study was to assess the impact of preoperative nutritional status as measured by PG-SGA on survival in patients requiring surgical intervention and/or radiotherapy for spinal metastases. METHODS: Patients with spinal metastases who underwent surgery and/or radiation therapy for symptomatic spinal metastases were enrolled in the AO Spine Metastatic Tumor Research and Outcomes Network, a prospective international multicenter research registry, between September 2017 and August 2022. Using the PG-SGA, nutritional status was classified into 3 categories: A, well nourished; B, moderately malnourished; and C, severely malnourished. RESULTS: A total of 589 patients met the inclusion criteria; 362 were classified as well nourished (61%), 159 were moderately malnourished (27%), and 68 were severely malnourished (12%). The median survival was 491 days, 328 days, and 117 days for well-nourished, moderately malnourished, and severely malnourished patients, respectively. In the multivariate analyses, severe malnourishment (HR 2.5 95% CI 1.4-4.3, P < .01) and an ECOG performance status of 3 or 4 (HR 2.7 95% CI 1.2-6.0) remained associated with significantly worse survival. CONCLUSION: Malnutrition as measured by the PG-SGA demonstrated to be significantly and independently associated with postoperative survival. The PG-SGA is a simple and useful tool to identify spinal metastases patients at risk of early postoperative mortality, and inclusion in the preoperative evaluation of these patients should be considered.

Background: Internalized HIV stigma (IHS) is associated with reductions in antiretroviral therapy (ART) adherence and HIV viremia mediated through depression. However, there is still a need to quantify the direct impact of IHS on ART adherence to inform interventions to improve medication adherence. Methods: The Center for AIDS Research Network of Integrated Clinical Systems is a longitudinal, US-based, multisite cohort of people with HIV who complete patient-reported outcome assessments as part of HIV-care visits. Patient-reported outcome data include IHS items, ART adherence, depression assessments, substance use, and other outcomes. We examined associations between IHS and ART adherence using generalized linear latent and mixed models with a nonparametric random effects intercept to accommodate repeated measures. Results were compared with analyses using generalized estimating equations and marginal structural models. Results: Among 13,119 people with HIV, the mean age was 47.4 years, 17.6% were women, and 59.3% were non-White. Across 33,139 observations, controlled for repeated measures on individuals, HIV medication adherence was reduced by 1.07% for every point increase in IHS after controlling for age, sex, ethnicity, geographic location, and substance use, and 0.58% when additionally adjusted for depression score. Marginal structural models and generalized estimating equations provided similar results. Conclusions: Our study demonstrates that IHS has a direct association with reductions in ART adherence, which could affect other comorbid health outcomes that are influenced by unsuppressed viremia over time. Developing a thorough understanding of the mechanisms through which IHS affects ART adherence is critical for developing interventions to mitigate IHS and improve health outcomes across the lifespan.

Lay Summary In this study we evaluated the effectiveness of vedolizumab (anti-integrin) vs ustekinumab/risankizumab (anti-interleukin) therapy for isolated small-bowel Crohn’s disease using a real-world, multicenter national database. We found that anti-interleukin therapy was more effective for inducing steroid-free remission and reducing hospitalizations.

ABSTRACT Pulmonary hypertension (PH) is a common complication in interstitial lung disease (ILD), but the additional burden it imposes on patients and healthcare systems is not well characterized. This retrospective analysis of claims data from the US Merative MarketScan database assessed hospitalization rates and costs over 2 years in patients with connective tissue disease‐related ILD (CTD‐ILD) and non‐CTD‐ILD with or without PH (between January 2017 and December 2019). Index was the date of first ILD claim; baseline was the 12‐month preindex period. In total, 16,129 patients with non‐CTD‐ILD (1502 [9%] with PH) and 4545 patients with CTD‐ILD (663 [15%] with PH) were identified. A higher proportion of patients with non‐CTD‐ILD with PH, compared with patients without PH, had all‐cause and heart failure (HF)‐related hospitalizations during baseline (all‐cause, 37.0% vs. 22.3%; HF‐related, 14.2% vs. 3.1%), 0–12 months (62.4% vs. 43.0%; 29.0% vs. 7.0%), and 13–24 months (44.7% vs. 18.3%; 21.5% vs. 3.2%) follow‐up ( p < 0.0001 for all). A significantly higher proportion of patients with CTD‐ILD with PH, compared with patients without PH, had all‐cause and HF‐related hospitalizations during baseline (all‐cause: 30.0% vs. 20.6%; HF‐related: 9.1% vs. 1.9%), 0–12 months (41.9% vs. 29.1%; 15.5% vs. 3.9%), and 13–24 months (37.9% vs. 18.9%; 13.9% vs. 2.5%) follow‐up ( p < 0.0001 for all). In both cohorts, total all‐cause and HF‐related costs were significantly higher in patients with PH at baseline, 0–12 months, and 13–24 months follow‐up ( p < 0.05 for all). PH substantially increased hospitalization risks and costs in both types of ILD, underscoring the importance of improving outcomes in patients with ILD‐PH.

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.

Abstract Background Adolescent and young adult (AYA) patients remain underrepresented in neuro-oncology research. Despite being the second most common primary brain tumor in this population, meningiomas have not been studied using age-specific molecular analyses. DNA methylation-based classification and prognostic tools have transformed meningioma care. This study aimed to evaluate the performance of these tools across age groups. Methods We analyzed 1,568 meningiomas with DNA methylation and clinical data, including 18 pediatric patients (&lt;15 years), 195 AYA patients (15-39 years), and 1,355 adult patients (&gt;39 years). Pediatric and AYA (P/AYA) tumors were combined and compared with adult tumors. The performance of established molecular classifiers and recurrence predictors, as well as differences in chromosomal copy number alterations were compared across age groups. Results While histologic grading was comparable between cohorts, P/AYA tumors displayed significantly fewer aggressive molecular groups and lower frequencies of chromosomal arm losses, including 1p, 6q, and 14q. The adult-trained recurrence predictor failed in the P/AYA population (AUC 0.57), despite similar score distributions. Retraining the model on an age-specific cohort using an identical analytic framework improved performance (AUC 0.79) and enabled effective stratification of progression-free survival (P = 0.00054). Importantly, 1p loss retained prognostic significance within the P/AYA group, supporting its clinical utility. Conclusions Molecular tools developed in adult-dominant cohorts do not generalize to younger patients due to both biological divergence and exclusion from model development. These findings underscore the need for age-specific molecular frameworks and highlight the imperative of including P/AYA populations in precision neuro-oncology research to ensure lifespan-equitable care.

Abstract Background and Aims Decrease in pulmonary vascular resistance (PVR) during exercise confers favourable prognosis in biventricular physiology, but its role in Fontan circulation remains unknown. This study aimed to evaluate the prognostic value of PVR index (PVRI) response to exercise in adults post-Fontan palliation. Methods Retrospective cohort of 88 adults (age ≥18 years) post-Fontan undergoing exercise (supine cycling) cardiac catheterization. Patients were categorized into absence (n = 23) or presence (n = 65) of exercise-induced reduction in PVRI. The clinical endpoint was a composite of death or transplantation. Results Age at catheterization was 32.2 ± 8.8 years, and 45.5% were female. Resting and exercise PVRI were 1.9 ± 0.9 and 1.2 (interquartile range [IQR] 0.8–2.1) WU·m2, respectively. Clinical, biochemical and echocardiographic parameters were not associated with PVRI response to exercise. During a follow-up of 2.2 ± 1.4 (IQR 1.2–2.6) years, resting PVRI was not associated with the clinical endpoint (hazard ratio [HR] 0.95 per WU·m2, 95% confidence interval [CI] 0.52–1.74; P = 0.86), whereas exercise PVRI was (HR 2.15 per WU·m2, 95% CI 1.24–3.73; P = .007). Exercise PVRI remained predictive of outcomes after adjusting for exercise pulmonary artery wedge pressure (HR 2.08 per WU·m2, 95% CI 1.19–3.62; P = .01) or clinical risk factors individually. Two-year event-free survival was lower in the no PVRI reduction than in the reduction group (67% vs 95%; P &lt; .001). Conclusions In adults post-Fontan, PVRI response to exercise is a robust predictor of clinical outcomes and offers additive prognostic information beyond resting invasive haemodynamic data and clinical risk factors, underscoring the importance of invasive exercise testing in this population.

BACKGROUND: The first total pancreatectomy (TP) resulting in survival past the immediate postoperative period was performed at Mayo Clinic in 1944. Although still uncommonly performed, indications have recently fluctuated. We aimed to evaluate trends in TP use and outcomes over four decades. STUDY DESIGN: Patients who underwent single-stage TP at Mayo Clinic Rochester from 1988 to 2024 were analyzed in two cohorts: early era (EE, 1988 to 2009) and modern era (ME, 2010 to 2024). RESULTS: In total, 437 patients were identified: 118 during EE (mean 8 per year) and 319 during ME (mean 21 per year). Primary indications were adenocarcinoma (42% EE vs 60% ME), intraductal papillary mucinous neoplasm (31% EE vs 17% ME), and chronic pancreatitis (11% EE vs 13% ME; p < 0.001). Concurrent vascular resection was performed in 9.3% (EE; all venous only) vs 53% (ME; venous alone in 20% and arterial with or without venous in 33%; p < 0.001). Multivisceral resection was performed in <1% (EE) vs 24% (ME; p < 0.001). Major complications occurred in 13% (EE) vs 27% (ME; p = 0.018), and 90-day mortality was 3.4% (EE) vs 6.3% (ME; p = 0.35). For adenocarcinoma, 5-year median overall survival from both surgery and diagnosis was significantly improved in ME (p = 0.009 and p < 0.001, respectively). Median last HbA1c was 7.7 (EE) vs 7.3 (ME; p < 0.001). Among patients surviving more than 1 year, insulin pumps were used in 12% (EE) vs 49% (ME; p < 0.001). Conclusions: The use of TP has dramatically increased in recent years, primarily for adenocarcinoma alongside increased use of neoadjuvant therapy and ever-expanding criteria for anatomic resectability. Operative complexity has significantly increased with resultant increased perioperative morbidity. TP remains a higher-risk procedure, specifically with en bloc vascular resections, emphasizing the importance of appropriate patient selection, preoperative patient education, and thoughtful postoperative and long-term management.

BACKGROUND: Early recognition of postoperative ileus remains difficult. OBJECTIVE: To determine whether myoelectric activity recorded by a noninvasive, wireless patch system correlated with the onset of postoperative ileus/bowel dysfunction. DESIGN: Single-arm, prospective study. The surgeon was blinded to myoelectric bowel activity until study completion. SETTINGS: Single surgeon, tertiary referral center. PATIENTS: Consecutive adult patients undergoing abdominal colorectal surgery. INTERVENTIONS: Three wireless patches acquiring myoelectrical GI activity were placed on the abdomen after surgery and removed before hospital discharge/reoperation. All patients followed an enterprise-specific enhanced recovery protocol. MAIN OUTCOME MEASURES: Ileus (nausea, vomiting, abdominal distention requiring nasogastric tube placement) or bowel dysfunction (similar symptoms without nasogastric tube needed) detected clinically within 30 postoperative days. Daily gut activity prints (histograms of the frequencies of all peaks detected in 10-minute time windows) were created for each patient for every 4-hour period after surgery, and activity was averaged and plotted for each group. Peaks in the 8 to 12 cycles per minute range were assigned to intestinal activity, and the energy under the peaks was summed through day 1, day 2, and day 3 and compared among patients. RESULTS: Patch application on 46 enrolled cases undergoing abdominal colorectal surgery (open in 17, robotic in 11, laparoscopic in 18) was not associated with any adverse events. Hyperactive intestinal activity was significantly higher in 12 patients who developed postoperative ileus/bowel dysfunction within 16 hours postoperatively ( p = 0.041), with a more pronounced difference at 20 and 24 hours ( p = 0.016 and p = 0.013, respectively). LIMITATIONS: Data were collected blindly during standard postoperative care; therefore, the integration of technology into clinical practice remains to be tested. CONCLUSIONS: Noninvasive measurement of intestinal myoelectrical activity allowed early identification of postoperative ileus/bowel dysfunction. Future studies will assess the possible advantages deriving from the integration of this system into clinical practice. See Video Abstract . LOS PICOS INTESTINALES HIPERACTIVOS OBSERVADOS POCAS HORAS DESPUÉS DE LA CIRUGÍA COLORRECTAL IDENTIFICAN A LOS PACIENTES QUE DESARROLLAN ÍLEO POSOPERATORIO ANTECEDENTES: El reconocimiento precoz del íleo posoperatorio sigue siendo difícil. OBJETIVO: Determinar si la actividad mioeléctrica registrada por un sistema de parches inalámbricos no invasivos se correlacionaba con la aparición de íleo posoperatorio/disfunción intestinal. DISEÑO: Estudio prospectivo de un solo grupo. El cirujano desconocía la actividad mioeléctrica intestinal hasta la finalización del estudio. ENTORNO: Un solo cirujano, centro de referencia terciario. PACIENTES: Pacientes adultos consecutivos sometidos a cirugía colorrectal abdominal. INTERVENCIONES: Se colocaron tres parches inalámbricos que registraban la actividad mioeléctrica gastrointestinal en el abdomen después de la cirugía y se retiraron antes del alta hospitalaria o la reintervención. Todos los pacientes siguieron un protocolo de recuperación mejorada específico de la empresa. PRINCIPALES MEDIDAS DE RESULTADO: Íleo (náuseas, vómitos, distensión abdominal que requiere la colocación de una sonda nasogástrica) o disfunción intestinal (síntomas similares sin necesidad de sonda nasogástrica) detectados clínicamente en los 30 días posteriores a la operación. Se crearon GutPrints (histogramas de frecuencias de todos los picos detectados en intervalos de 10 minutos) de la actividad intestinal diaria para cada periodo de 4 horas tras la cirugía, se promediaron y se representaron gráficamente para cada uno de los grupos. Los picos en el rango de 8 a 12 cpm (ciclos por minuto) se asignaron a la actividad intestinal y la energía bajo los picos se sumó a lo largo del día 1, el día 2 y el día 3 y se comparó entre los pacientes. RESULTADOS: La aplicación del parche en 46 casos inscritos sometidos a cirugía colorrectal abdominal (abierta en 17, robótica en 11 y laparoscópica en 18) no se asoció con ningún evento adverso. La actividad intestinal hiperactiva fue significativamente mayor en 12 pacientes que desarrollaron íleo postoperatorio/disfunción intestinal en las 16 horas posteriores a la operación ( p = 0,041), con una diferencia más pronunciada a las 20 y 24 horas ( p = 0,016 y p = 0,013, respectivamente). LIMITACIONES: Los datos se recopilaron de forma ciega durante la atención posoperatoria estándar, por lo que aún queda por comprobar la integración de la tecnología en la práctica clínica. CONCLUSIONES: La medición no invasiva de la actividad mioeléctrica intestinal permitió la identificación temprana del íleo/disfunción intestinal posoperatoria. En futuros estudios se evaluarán las posibles ventajas derivadas de la integración de este sistema en la práctica clínica. ( AI-generated translation )