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PURPOSE In large B-cell lymphoma (LBCL), use of high-dose methotrexate (HD-MTX) to prevent CNS relapse (so-called CNS prophylaxis) remains controversial. International guidelines continue to recommend HD-MTX in patients deemed ultra high risk (UHR) because of a lack of robust data specific to these subgroups. This study was designed to examine the impact of HD-MTX specifically in UHR patients. METHODS Data from two previous retrospective analyses were combined to produce a cohort of UHR patients (≥1 of the following criteria: CNS international prognostic index score 5-6; testicular, renal/adrenal, or breast involvement; ≥3 extranodal sites), treated with or without HD-MTX. The primary outcome was CNS relapse rate (isolated or concurrent with systemic relapse) measured from diagnosis with additional landmark analysis of all responding patients with no progression event at 6 months. RESULTS Analyses were performed on 1,923 patients meeting UHR criteria. No significant difference in 3-year CNS relapse rate was observed between no HD-MTX (n = 1,051) versus HD-MTX patients (n = 872), including in multivariable analyses adjusting for baseline characteristics (3-year rate, 9.3% v 8.1%; adjusted hazard ratio [HR], 1.13 [95% CI, 0.82 to 1.57]). Analyses restricted to isolated CNS relapse also confirmed no difference (5.9% v 5.7%; adjusted HR, 1.03 [95% CI, 0.69 to 1.53]). In the landmark analysis (no HD-MTX n = 782, HD-MTX n = 773), no difference in 3-year CNS relapse was observed (6.7% v 6.6%, adjusted HR, 0.95 [95% CI, 0.62 to 1.44]). CONCLUSION To our knowledge, this is the largest international comparative data set of patients with LBCL with UHR features showing no significant reduction in CNS relapse with HD-MTX in all UHR or in any individual subgroup. Despite inherent limitations of retrospective analyses, the data strongly support previous studies in suggesting HD-MTX prophylaxis has no meaningful benefit for most patients.

Background and Objective: This study aimed to characterize clinical characteristics and visual outcomes of patients with hemorrhagic choroidal detachments. Patients and Methods: Single-center retrospective case series of patients with hemorrhagic choroidal detachments from January 1, 2003, to December 31, 2020 at Mayo Clinic. Patients were categorized as appositional or non-appositional based on ultra-sonography. Results: Among 39 cases with hemorrhagic choroidal detachments, 15 (38%) were appositional and 24 (62%) were non-appositional. There was a significant difference between the appositional and non-appositional groups in mean initial logMAR visual acuity (VA) (2.8 [ SD = 0.20] vs 2.2 [ SD = 0.78], P < .001). However, no difference was observed in final logMAR VA (1.9 [ SD = 1.2] vs 1.5 [ SD = 1.1], P = .30). Comparison between surgical ( N = 9) versus non-surgical ( N = 5) hemorrhagic appositional choroidal detachments cases revealed no differences in outcomes. Comparison between anticoagulated ( N = 21) versus nonanticoagulated ( N = 18) patients with hemorrhagic choroidal detachments also revealed no differences in outcomes. Conclusion: Patients with appositional and nonappositional hemorrhagic choroidal detachments did not differ significantly with regards to visual outcome. Surgical intervention was not associated with improved final vision in this cohort.

Articles published in Radiology: Cardiothoracic Imaging in 2025 highlight advances in cardiothoracic imaging through technical innovation, quantitative biomarkers, and artificial intelligence applications that support improved diagnosis, risk stratification, and patient-centered management across cardiac, vascular, and thoracic disease.

Abstract Background Climate-related stressors such as heat, wildfires, and extreme weather are increasingly recognized as determinants of cardiovascular and oncologic health. However, their joint impact on overlapping cancer–cardiovascular disease (CVD) burdens remains unknown. We developed a Cardio-Oncology Burden Index (COBI) to quantify the co-prevalence of cancer and CVD at the community level and examined its association with climate vulnerability across U.S. census tracts. Methods We conducted a cross-sectional ecological analysis of 82,679 census tracts (328,683,841 residents) using the CDC PLACES database. COBI was derived using principal component analysis of age-adjusted prevalence of cancer, coronary artery disease, and stroke. The Climate Burden Index (CBI, 0–1 percentile) integrates multiple climate-related exposures, including extreme temperature, wildfire frequency, and severe weather events. Population-weighted mixed-effects regression models with county-level random effects estimated associations between CBI and COBI, adjusting for region, rurality, and environmental justice indicators. β coefficients represent percentage-point differences in COBI per unit (or category) increase in climate burden. Exposure–response relationships were examined using restricted cubic splines (RCS). Robustness was assessed via geographically matched (&lt;50 km) and fully matched (region, rural–urban commuting area, and environmental justice) analyses. Results Marked spatial heterogeneity was observed in both CBI and COBI across the U.S. (Fig. A–B). Higher climate burden was consistently associated with greater cardio-oncology burden (Fig. C), demonstrating a dose–response relationship: second vs lowest quartile β=0.92 (95% CI, 0.61–1.24); third vs lowest quartile β=1.61 (95% CI, 1.30–1.92); highest vs lowest quartile β=3.44 (95% CI, 3.11–3.76). The RCS model revealed a significant non-linear association (p_non-linear&lt;0.001), with a plateau at moderate exposures and a steep rise at the highest CBI levels (Fig. D). Results remained robust in sensitivity analyses (β=4.17 [95% CI, 3.62–4.71] for geographically matched; β=4.39 [95% CI, 4.10–4.69] for fully matched tracts; Table). Conclusions Greater climate burden is independently associated with higher cardio-oncology burden across U.S. communities, with disproportionate effects in the most climate-vulnerable areas. This novel, population-level linkage between climate stress and onco-cardiovascular disease burden, highlights an emerging syndemic at the intersection of environment, cancer, and CVD. Targeted mitigation and prevention strategies integrating environmental resilience into chronic disease prevention are urgently needed.For image description, please refer to the figure legend and surrounding text.

Abstract Background Lipomatous atrial septal hypertrophy (LASH) is generally viewed as a benign anatomical finding. Although extracardiac fat depots have been linked to adverse cardiometabolic outcomes, the prognostic implications of LASH have not been well defined. Purpose To evaluate whether LASH thickness is independently associated with long-term all-cause mortality. Methods We reviewed adult patients who underwent diagnostic transesophageal echocardiography at our Clinic sites from 2010–2017. LASH was identified by a dumbbell-shaped interatrial septum with maximal thickening ≥5 mm in the bicaval midesophageal view. All-cause mortality through January 1, 2024, served as the primary endpoint. Septal thickness was evaluated using restricted cubic splines and Cox proportional hazards models adjusted for age, sex, body mass index, Charlson Comorbidity Index, and left ventricular ejection fraction. Results Among 1,397 patients (mean age 69±12 years; 60% male), median LASH thickness was 14.2±4.4 mm. LASH severity was classified as mild (&lt;15 mm; n=763), moderate (15-20 mm; n=522), or severe (&gt;20 mm; n=112). During 7.5±4.0 years of follow-up, 586 deaths (42%) occurred. Mortality was higher with increasing septal thickness (37%, 46%, and 56%; p &lt; 0.001). Each 1-mm increase in LASH-thickness was associated with higher adjusted mortality (adjusted-hazard-ratio 1.03; 95%-confidence-interval 1.01-1.05). Spline modeling suggested a risk increase beginning near 16 mm; thickness &gt;16 mm carried a 26% higher mortality risk (adjusted-hazard-ratio 1.26; 95%-confidence-interval 1.06-1.50). Conclusions LASH was associated with long-term mortality independent of BMI and other clinical factors. Septal fat accumulation may provide a useful, noninvasive marker that complements broader cardiac risk assessment.Risk for all-cause mortality across LASHFor image description, please refer to the figure legend and surrounding text.

Abstract Background The implications of poor sleep for cardiovascular disease risk are increasingly recognised. Although previous research has focused on clinical sleep disorders, emerging evidence highlights the relevance of subclinical sleep aspects for cardiovascular health. Sleep midpoint, an index of sleep timing and a proxy of circadian phase, has been shown to be associated with markers of cardiometabolic risk, including obesity, in the general population. Purpose We aimed to assess whether sleep midpoint was related to body composition measures in patients with coronary heart disease enrolled in cardiac rehabilitation (CR). Methods Study participants were recruited from the patient population referred to our CR center for acute coronary syndrome or coronary revascularisation. Shift work was exclusionary. Participants underwent sleep testing prior to entering the CR program, including completion of one week of wrist actigraphy and sleep log. Using actigraphy-derived sleep metrics, sleep midpoint was calculated as the middle time (hh:mm) between bedtime and wake up time for each individual night, and averaged across the monitoring week. Based on the median sleep midpoint of the sample, participants were categorised as having early (before 2:42) or late (after 2:42) sleep midpoint. Body composition and regional fat distribution were determined by whole-body dual-energy absorptiometry (DEXA). Between-group characteristics were compared using independent t-test, Mann-Whitney U test and Chi-square statistics as appropriate. Linear regression was used to test the association between sleep midpoint and body fat measures. Results Thirty-one participants (26 males, 64.7±12.5 years) completed both actigraphy and DEXA assessments. Demographics, lifestyle, and clinical characteristics were similar between patients with early sleep midpoint (n=15; sleep midpoint, hh:mm: 2:00, range 0:57 to 2:41) and patients with late sleep midpoint (n=16; sleep midpoint 3:18, range 2:42 to 4:17). Despite comparable body mass index between groups (p=0.21), patients with late sleep midpoint had significantly higher total body fat percentage (p=0.017), android fat percentage (p=0.015), and gynoid fat percentage (p=0.045). Late sleep midpoint remained significantly associated with adiposity measures in age- and sex-adjusted analysis (total body fat percentage, beta = 0.371, 95% CI 0.063 to 0.68; android fat percentage, beta = 0.394, 95% CI 0.078 to 0.71; gynoid fat percentage, beta = 0.301, 95% CI 0.007 to 0.596). Conclusions Late sleep midpoint was associated with excess adiposity in patients with coronary heart disease enrolled in CR. These findings support the predictive value of sleep timing for cardiometabolic risk and emphasise the importance of objective sleep assessment for secondary prevention.

Abstract Objective Invasive presurgical evaluation plays a key role in pediatric epilepsy surgery, particularly in magnetic resonance imaging (MRI)‐negative cases, by guiding resective, disconnective, or ablative procedures. This International League Against Epilepsy (ILAE) Pediatric Epilepsy Surgery Taskforce study provides an updated global overview of current invasive evaluation practices. Methods Group‐level data were collected from 61 epilepsy surgery programs (49 pediatric‐only) in 29 countries across six continents. Included were children and adolescents who underwent presurgical evaluation and epilepsy surgery in 2023. The study was designed to enable comparison with the similar ILAE survey conducted in 2004. Results A total of 2427 patients were included. Invasive evaluations were performed in 21.1% of cases, most frequently in North America (33.7%, higher than Europe: 18.0%, p = .003). Among invasive cases, 32.3% had no detectable MRI abnormalities. The main indication for invasive evaluation was seizure onset localization (88.1%), followed by motor or sensory mapping (17.2%) and language mapping (14.2%). Stereoelectroencephalography (SEEG) was the predominant technique (19.8% overall, 93.6% of invasive cases), more common in North America (30.0%, p = .021) and less common in South America (7.4%, p < .001). Subdural electrodes were used in only 3.2% of invasive cases, and combined depth and subdural approaches in 3.2%. SEEG‐guided radiofrequency thermocoagulation (RF‐TC) was performed in 40.9% of SEEG cases, most commonly in Asia (63.8%). In 16.2% of invasive evaluations, patients did not proceed to resection, disconnection, or ablation, with the highest rate in Europe (28.5%). Significance This global survey provides the first broad overview of invasive evaluation practices in pediatric epilepsy surgery across participating centers worldwide. It highlights the widespread adoption of SEEG, declining use of subdural electrodes, and increasing application of SEEG‐guided RF‐TC. The high proportion of MRI‐negative cases and the considerable proportion of patients not proceeding to resection, disconnection, or ablation underscore the complexity of contemporary surgical candidates and the need for further refinement of selection strategies.

Accurate assessment of renal function is fundamental to dosing renally eliminated drugs. For decades, serum creatinine–based estimating equations have been used to approximate glomerular filtration rate (GFR) for this purpose. While these equations perform reasonably well at the population level, they exhibit substantial individual‐level imprecision and inaccuracy. Simultaneously, recent efforts to remove race from estimating equations addressed important ethical concerns but did not resolve the core limitation of population‐based estimation for individual drug dosing. In this perspective, we argue that personalized dosing requires a shift away from demographic surrogates toward direct measurement of renal clearance and clarify when incremental therapeutic complexity is warranted. We review the limitations of endogenous biomarkers, discuss the role of cystatin C, and propose exogenously measured GFR using iohexol integrated within a Bayesian pharmacometric framework as a clinically actionable approach to individualized drug dosing. Practically, this framework can be implemented by administering a small iohexol dose, collecting sparse timed samples, estimating absolute mGFR and its uncertainty with Bayesian software, and using that posterior estimate to refine renal dose selection.