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Background: Pulse pressure variation (PPV) is widely used to guide fluid responsiveness in mechanically ventilated patients, but its accuracy in the prone position remains uncertain. Prone positioning alters respiratory mechanics and venous return, potentially diminishing the respiratory variation in stroke volume that PPV is designed to detect. We conducted a systematic review and meta-analysis to evaluate the diagnostic accuracy of PPV for predicting fluid responsiveness during prone spine surgery. Methods: We searched MEDLINE, Embase, Scopus, and Cochrane through July 2025 for prospective studies evaluating PPV in adults undergoing prone spine surgery. Two reviewers independently screened studies, extracted data, assessed risk of bias using QUADAS-2, and pooled diagnostic performance using a bivariate random-effects model. The protocol was registered with PROSPERO (CRD420251106134). Results: Of 599 records, 34 underwent full-text review, and 10 studies (433 patients) were included. PPV thresholds ranged from 7% to 15%. Most studies were at low risk of bias except for the index test because thresholds were determined post hoc. For predicting fluid responsiveness, PPV had a pooled sensitivity of 68% (95% CI: 61%-75%) and specificity of 76% (95% CI: 65%-84%), with a summary area under the receiver operating characteristic curve of 0.72 (95% CI: 0.64-0.80). Conclusions: PPV showed only moderate diagnostic performance for predicting fluid responsiveness during prone spine surgery. Its performance may have been influenced by threshold variability, heterogeneous reference standards, fluid-challenge protocols, ventilation strategies, and positioning systems. PPV should therefore be interpreted alongside complementary dynamic assessments rather than in isolation, particularly during lung-protective ventilation.

Patients with plasma cell leukemia (PCL) are generally excluded from pivotal T-cell redirecting bispecific antibody (BsAb) trials. We evaluated real-world outcomes in a multicenter retrospective study of 122 patients with primary or secondary PCL across 15 academic centers, categorized as 'active' (≥5% circulating plasma cells within 30 days of BsAb initiation) or 'historical'. In a heavily pretreated population, patients received teclistamab (37%), elranatamab (11%), talquetamab as a line of therapy (Tal LOT, 42%), or talquetamab as bridging therapy to CAR-T (Tal Bridge, 11%). Cytokine release syndrome (CRS) was grade 1-2 in 56% and grade 3-4 in 4%, whereas neurotoxicity was grade 1-2 in 16% and grade 3-4 in 5%. Among 110 evaluable patients, the overall response rate (ORR) was 55%, including 61% with Tal LOT, 58% with Tal Bridge, 46% with elranatamab, and 33% with teclistamab. With a median follow-up of 8.3 months, talquetamab demonstrated superior survival. Tal LOT showed a median progression-free survival (mPFS) of 5.5 months and a median overall survival (mOS) of 11.5 months, and both were unreached in the Tal Bridge cohort. In contrast, teclistamab and elranatamab showed a mPFS of 1.2 and 1.6 months and mOS of 8.1 and 3.6 months, respectively (P=0.007, P=0.023). In active PCL, Tal LOT achieved mPFS/mOS of 6.9/12.2 months versus 0.7/1.4 months with teclistamab and 1.0/3.1 months with elranatamab, respectively (P<0.001, P=0.002). Multivariable analysis associated active PCL with worse survival and Tal LOT with improved outcomes. BsAbs were safe in PCL, with talquetamab showing superior outcomes compared with BCMA-directed BsAbs.

Abstract Objective . Phase gating is a critical technique to mitigate tumor motion during radiotherapy, particularly in spot-scanned particle therapy where internal motion can interfere with dynamic spot scanning patterns and, simultaneously, introducing substantial range uncertainties. However, the current commercial state of the art in real-time phase prediction is challenged by patient-specific breathing variability as well as detection and delivery system latencies. This leads to suboptimal efficiency, mis-timed radiation delivery and requires frequent manual intervention. This study aims to improve phase prediction accuracy using deep learning (DL)-based time series forecasting to enable more accurate dose delivery. Approach . Retrospective breathing waveforms from 69 proton therapy patients, sampled at 30 Hz, were labeled with inspiratory peaks and assigned subjective regularity scores (four levels). DL models with various architectures were trained using waveform amplitude to predict current or future breathing phases. Model performance was evaluated using mean squared error, phase binning accuracy, and timing deviation for radiation on/off events. Bayesian optimization was used for hyperparameter tuning. Results were compared between models and against a commercial algorithm currently in clinical use. Main Results . The curated waveform dataset included 165 242 s for training, 24 057 s for validation, and 30 322 s for testing, with an additional 40 604 s from separate patients for extended validation. The long short-term memory and temporal fusion transformer models significantly outperformed the commercial algorithm, improving phase prediction accuracy by nearly 20% and reducing timing deviations across all regularity levels. Significance . DL-based time series forecasting may substantially improve breathing phase prediction accuracy over current clinically available methods, offering a more precise and reliable approach to phase-gated radiation delivery.

Expert consensus recommendations from 21 academic centers were established for appropriate radiography utilization at 12 potentially low-yield anatomic sites through a multidisciplinary process endorsed by six major American medical societies.

Background: Hepatorenal syndrome–acute kidney injury (HRS-AKI) is associated with high mortality in cirrhosis. Recent FDA approval of terlipressin and updated clinical guidance have expanded management options, but real-world practice patterns remain unknown. Methods: We conducted a nationwide survey of U.S. hepatology providers regarding HRS-AKI management practices. The 33-question survey assessed provider demographics, vasoconstrictor selection, treatment timing, and adherence to guideline recommendations. Results: Among 162 respondents, most were hepatologists (94%) at academic centers (83%). Only 11% obtained a nephrology consultation at AKI detection, with 44% waiting until worsening renal function. Terlipressin was available at 80% of institutions but more commonly at academic centers (84% vs. 53%, p =0.003). Consistent with guideline recommendations, 77% of providers initiate vasoconstrictors only after completing a trial of volume expansion (if no renal improvement), particularly in academic centers (80% vs. 60% non-academic, p =0.03). Terlipressin (49%) and midodrine/octreotide (44%) were preferred first-line treatments, with providers at academic centers more likely to use midodrine/octreotide (46% vs. 30%, p =0.008). Mean arterial pressure was used by 62% of providers to guide vasoconstrictor dosing. Most providers (73%) discontinued vasoconstrictor treatment after 4 days if no improvement. Conclusions: Significant variations exist between guideline recommendations and real-world HRS-AKI management, especially first-line treatment choice, treatment monitoring, and nephrology consultation. These findings highlight opportunities to improve guideline implementation and identify areas where practice patterns might inform provider education and future guidance updates.

Background Cysteine–cysteine chemokine receptors 2 (CCR2) and 5 (CCR5) contribute to immune suppression in tumor microenvironments. CCR2 and CCR5 antagonists have demonstrated antitumor activity in pancreatic ductal adenocarcinoma (PDAC) and colorectal cancer (CRC), respectively. This phase 1b/2, open-label study evaluated BMS-813160, a CCR2/5 dual antagonist, in combination with chemotherapy±nivolumab in advanced PDAC or metastatic CRC. Methods Part 1 included patients with metastatic untreated (first-line (1L)) PDAC, 1L CRC, or previously treated (second or third line (2/3L)) microsatellite stable (MSS) CRC. Patients received 2 weeks of BMS-813160 monotherapy (300 mg two times a day, 600 mg once daily, 300 mg once daily, or 150 mg once daily) and then BMS-813160+chemotherapy (gemcitabine+nab-paclitaxel (gem/nabP; 1L PDAC), 5-fluorouracil+leucovorin+irinotecan (FOLFIRI; 1L CRC)), or nivolumab (2/3L MSS CRC). Part 2 included patients with metastatic 1L PDAC or 2L CRC. Patients received BMS-813160 300 mg two times a day+gem/nabP±nivolumab (1L PDAC), BMS-813160 300 mg two times a day or 150 mg once daily+FOLFIRI (2L CRC), or chemotherapy alone. Primary endpoints were safety and pharmacodynamics (Part 1) and efficacy (Part 2). Results In Part 1, 22 of 75 (29%) and 54 of 72 (72%) patients experienced a treatment-related adverse event during monotherapy lead-in and overall, respectively. Two dose-limiting toxicities (rash and pericardial effusion with pericarditis, both grade 3) occurred. In Part 2, patients with 1L PDAC who received BMS-813160 300 mg two times a day+gem/nabP+nivolumab achieved an overall response rate (ORR) of 37% (13/35); the median duration of response (DOR) was 45 weeks (95% CI 26.1 to not evaluable). ORRs with BMS-813160 300 mg two times a day+gem/nabP and gem/nabP alone were 26% (9/35) and 28% (9/32), respectively; median DORs were 121 and 31 weeks, respectively. Progression-free survival rates at 24 weeks were 56% (BMS-813160 300 mg two times a day+gem/nabP+nivolumab), 56% (BMS-813160 300 mg two times a day+gem/nabP), and 50% (gem/nabP). ORRs in 2L CRC were 19% (6/32; BMS-813160 300 mg two times a day+FOLFIRI), 13% (4/32; BMS-813160 150 mg once daily+FOLFIRI), and 27% (7/26; FOLFIRI). Conclusions In 1L PDAC, BMS-813160 300 two times a day+gem/nabP±nivolumab demonstrated durable antitumor response and was well tolerated. BMS-813160 combination regimens were tolerable in other cohorts, but clinical efficacy was not demonstrated. Trial registration number NCT03184870 .

Abstract Mitochondrial creatine kinase (MtCK) is a key enzyme in energy buffering and homeostasis in cells. It catalyzes transfer of phosphoryl group from ATP to creatine. Overexpression of MtCK occurs in many cancer cells to meet elevated energy demands, which is associated with poor prognosis. This suggests that MtCK may be a promising target for cancer therapeutics. We sought to discover first-in-class selective inhibitors of MtCK with diverse mechanisms of action using high-throughput screening, biochemical characterization and cryo-EM studies. Through these studies, we identified diverse types of compounds that modulate activity of MtCK in vitro , including fast-equilibrium and time-dependent orthosteric and allosteric inhibitors. Select hits were subjected to in vitro enzymatic and binding assays to assess MtCK inhibition and binding. A subset of inhibitors was advanced into structural studies using cryo-EM resulting in the molecular structure of MtCK with and without bound substrates in complex with an allosteric uncompetitive inhibitor that we discovered. These studies identified compound’s unique binding pocket on MtCK and established the molecular steps manifesting in the apparent uncompetitive mode of inhibition. We demonstrate that the compound stabilizes an active site loop in a closed conformation restricting access of the creatine substrate to and the release of phosphocreatine product from its binding pocket. These findings establish chemical tools suitable for validation of MtCK as a promising breast cancer target with high therapeutic potential and build a foundation for future structure-guided optimization of the hit compounds of MtCK we identified and de novo rational design of novel MtCK inhibitors. Abstract Figure

ABSTRACT Real time, chronic electrochemical detection of neurotransmitters will provide a positive step in the treatment and understanding of neurological disease. However, current electrodes using carbon fibers (CF) fail to perform chronically. While diamond‐based coatings show promise in improving their longevity, achieving a uniform layer of such coatings on CFs is challenging, and the electrodes often lose sensitivity after coating. In this work, a complete and uniform boron‐doped nanocrystalline material grown in a diamond reactor (B‐NCD) was developed to coat CF microelectrodes for neurochemical sensing. The coating was characterized electrically, optically, mechanically, and chemically. The B‐NCD coated CF electrodes were able to detect phasic dopamine at a sensitivity comparable to the most widely used alternatives (uncoated and PEDOT:Nafion coated CFs). During biofouling testing, the B‐NCD coated CF electrodes demonstrated better stability than uncoated CFs and comparable performance to PEDOT:Nafion coated CFs. Moreover, B‐NCD exhibited no signs of degradation during consecutive FSCV applications, while uncoated and PEDOT:Nafion coated CF electrodes degraded significantly over time. Furthermore, the B‐NCD coating supported the survival and development of neurons and astrocytes in vitro, exhibited excellent adhesion and durability during mechanical bending testing, and enabled successful in vivo recording of phasic dopamine release in the rat brain. Overall, B‐NCD coated CFs present as an ideal candidate for chronic, flexible neural implantable electrodes for long‐term neurochemical monitoring.

Abstract Background: Rural/nonmetropolitan (nonmetro) counties face known barriers to comprehensive cancer care compared with metropolitan (metro) counties, which may impact the outcomes for lymphoma patients. We evaluated the impact metro vs nonmetro status on outcomes after a diagnosis of non-Hodgkin lymphoma (NHL) in the context of clinical, demographic, and lifestyle factors. Methods: Of 7724 participants enrolled in the prospective LEO cohort study from 2015-2020, 7610 (98.5%) had their county of residence at diagnosis assigned a RUCC (2013) code. We compared outcomes of participants from metro (defined as RUCC 1-3, which are central counties with ≥1 urban areas of ≥50,000) vs nonmetro counties (RUCC 4-9, which are counties with smaller urban areas as well as completely rural). We estimated hazard ratios (HRs) and 95% confidence intervals (CI) from univariable and multivariable Cox models for associations of metro status with overall survival (OS). Cause of death (lymphoma [including treatment related], non-lymphoma, unknown) was assessed using a competing risk approach. Results: Compared with metro counties (N=6096), LEO participants from nonmetro counties (N=1514) were older (median age 64 vs 62 years; p<0.001), more likely to be non-Hispanic white (94% vs 75%; p<0.001) and married (84% vs 75%; p<0.001), and less likely to have completed graduate or professional school education (16% vs 27%; p<0.001). There were no notable differences (>5%) by metro status for sex, employment status, NHL subtype, stage, performance status, abnormal lactate dehydrogenase (LDH), international prognostic index (IPI), number of comorbidities, time from diagnosis to treatment interval (DTI) or participation in a clinical trial. Compared with LEO participants from metro counties, those from nonmetro counties had inferior OS at 5 years (74.5% vs 78.4%; HR=1.23, CI 1.10-1.37; p<0.001). The OS association only slightly attenuated after adjustment for age, sex, race/ethnicity and NHL subtype (HR=1.20, CI 1.07-1.34; p=0.002), and held in models that adjusted for clinical prognostic factors (stage, NHL subtype, IPI, DTI), socioeconomic status (SES; education, marital status), health status (comorbidity, frailty), or lifestyle factors (smoking, body mass index). Using a competing risk model, the cumulative incidence of death at 5 years due to lymphoma (16.9% vs 14.1%; p=0.002) and non-lymphoma (5.9% vs 3.9%; p=0.002) was higher for participants from nonmetro vs metro counties, respectively. For participants <65 years, nonmetro vs metro status had inferior OS (HR=1.40, CI 1.17-1.67; p<0.001). This association remained after adjustment for age, sex, race/ethnicity and NHL subtype (HR=1.36, CI 1.14-1.63; p<0.001), as well as after adjustment for clinical prognostic, SES, health status, or lifestyle factors. The cumulative incidence of death at 5 years due to lymphoma was higher in participants from nonmetro vs metro counties (15.1% vs 11.5%; p=0.002), while there was no difference by metro status for non-lymphoma related deaths (2.1% vs 1.7%; p=0.47). In contrast, for participants age 65+ years, there was no differences by metro status for OS (HR=1.04, CI 0.91-1.20; p=0.56). After adjustment for age, sex, race/ethnicity and NHL subtype, participants from nonmetro areas had inferior OS (HR=1.12, 0.97-1.29) although this was not statistically significant (p=0.13), and was attenuated in models adjusting for clinical, health status, or lifestyle factors. The cumulative incidence of death at 5 years due to lymphoma was no different in participants from nonmetro vs metro counties (18.9% vs 18.0%; p=0.37), while non-lymphoma related deaths were higher in nonmetro counties (9.9% vs 6.8%; p=0.017). Conclusion: LEO participants from nonmetro vs metro counties had inferior OS overall, although this was predominately observed for younger (<65 years) participants. These associations did not appear to be explained by demographic, NHL subtype, clinical, SES, health status, or lifestyle factors. Of particular note, the risk of death due to lymphoma was higher in nonmetro areas for participants <65 years but not those 65+ years, while the risk of death due to other causes was higher in nonmetro areas for participants 65+ years but not those <65 years. These findings require further study, particularly related to barriers to care, and suggest the potential need for age-specific strategies to optimize outcomes for NHL patients from nonmetro/rural areas.

Abstract Introduction The International Prognostic Index (IPI, NEJM, 1993) has guided risk stratification in large B-cell lymphoma (LBCL) for over three decades. Its simplicity and clinical utility have driven its widespread adoption, even in the era of precision medicine. However, the prognostic value of the IPI and its components may not be uniform across the age spectrum of LBCL patients. We evaluated the contemporary prognostic performance of the IPI in a large international cohort, focusing on age-stratified performance and the relative contributions of its individual components, grouped as patient- and disease-related factors. Methods We harmonized and pooled data from 6,941 patients with newly diagnosed systemic LBCL treated with R-CHOP-like regimens (R-CHOP, R-miniCHOP, DA-EPOCH-R, R-CHOEP, R-CHOP+X) with complete IPI data from three prospective cohorts: NiHiL (Czech Republic, n=4,590; 2010–2023), LEO (USA, n=1,789; 2015–2020), and MER (USA, n=562; 2010–2015). IPI components included age, ECOG performance status (PS) as patient-related, and Ann Arbor clinical stage, serum lactate dehydrogenase (LDH), and extranodal (EN) involvement as disease-related factors. Prognostic performance was evaluated using multivariable Cox regression models and C-statistics. Age-stratified analysis was performed for: ≤40 years (7%; n=492), 41–60 years (28%; n=1,909), 61–80 years (59%; n=4,080), and >80 years (7%; n=460). The primary endpoint was overall survival (OS). Results In the pooled cohort, the median age was 66 years (range 18–95). Compared to the original IPI cohort (n=3,273), our cohort was older (age >60 years: 66% vs 41%) but otherwise comparable: ECOG PS 2–4 (25% vs 24%), clinical stage III–IV (63% vs 66%), elevated LDH (60% vs 52%), and >1 EN involvement (32% vs 30%). In multivariable analysis, age (≤60 vs >60 years) was the strongest predictor of OS (HR=2.78; vs HR=1.96 in original IPI report), followed by ECOG PS (HR=2.07; vs 1.80), clinical stage (HR=1.50; vs 1.47), LDH (HR=1.41; vs 1.85, all P<0.01); EN involvement was not significant (P=0.50, HR=1.03 vs 1.48). Risk group distribution shifted from the original IPI: 28% were low-risk (0–1 factor; vs 35%), 23% low-intermediate (2; vs 27%), 24% high-intermediate (3; vs 22%), and 25% high-risk (4–5; vs 16%). Corresponding 2-year OS rates were 95%, 86%, 78%, and 63%, superior to those of the original IPI cohort (87%, 67%, 55%, 44%; pre-rituximab era). Age was associated with an increasing risk of mortality, with a more pronounced rise beyond 60 years. In a piecewise Cox model, the HR per year was 1.04 for ages ≤60 (linear), 1.05 for 61–69 (accelerated), and 1.06 for ≥70 years (exponential, all P<0.01). ECOG PS retained prognostic significance across age groups: HRs were 1.87 (P=0.06) for ≤40 years, 1.63 (P<0.01) for 41–60, 2.22 (P<0.01) for 61–80, and 1.43 (P<0.01) for >80 years. The strength of other IPI components declined with age. Clinical stage showed decreasing impact: HR 2.08 (P=0.09), 1.97 (P<0.01), 1.49 (P<0.01), and 1.31 (P=0.05). LDH was significant only up to age 80 years: HRs were 2.07 (P=0.04), 1.96 (P<0.01), 1.32 (P<0.01), and 1.21 (P=0.13). EN involvement was non-significant across all groups: HRs were 1.37 (P=0.34), 1.26 (P=0.05), 0.98 (P=0.74), and 1.06 (P=0.67). The IPI C-statistics was 0.676 overall and declined with age: ≤40 years (0.708), 41–60 years (0.683), 61–80 years (0.641), and >80 years (0.598). We next stratified the IPI factors into patient- (age, ECOG PS) and disease-related (clinical stage, LDH, EN involvement). In patients ≤40 years, disease-related factors outperformed patient-related (C-index 0.693 vs 0.602), as in the 41–60 group (C-index 0.677 vs 0.589). In patients aged 61–80, predictive values were comparable (0.613 vs 0.622). In >80-year-olds, both declined substantially (0.580 vs 0.568). Conclusion The IPI remains a valuable prognostic tool in LBCL, particularly among younger patients. However, its overall predictive accuracy declines with age. In patients ≤60 years old, prognosis is primarily driven by disease-related factors, suggesting a role for molecular classifiers to enhance risk stratification. In older patients, incorporation of additional patient-level factors, such as comorbidities and nutritional status could be considered. These findings underscore the need for more individualized prognostic tools for LBCL patients. Funding: NU21-03-00411, P50 CA97274, U01 CA195568, Charles University Haematology-Oncology Cooperatio Program.