Citations

ABSTRACT Background Interpretation of urodynamic studies (UDS) is central to diagnosing lower urinary tract dysfunction, but it is often complex, time‐consuming, and subject to interobserver variability. Recent advances in artificial intelligence (AI), particularly machine learning (ML) and deep learning (DL), have enabled automated analysis of multichannel pressure–flow data and may improve objectivity and efficiency in UDS interpretation. Objective To critically review current applications of ML and DL for interpretation of multichannel UDS data and to evaluate their performance, clinical targets, and limitations. Methods A literature search of PubMed, Scopus, and Web of Science was performed through September 2, 2025, without language or date restrictions. A narrative review was conducted of peer‐reviewed studies applying ML or DL techniques to invasive UDS signals, including vesical, abdominal, and detrusor pressures as well as urinary flow. Studies limited to uroflowmetry or non‐UDS inputs were excluded. Model design, input features, validation strategies, and clinical outcomes were systematically assessed. Results A total of 12 studies met inclusion criteria. AI models were applied to a range of UDS tasks, including detection of detrusor overactivity, classification of bladder outlet obstruction and detrusor underactivity, multi‐feature UDS pattern recognition, severity grading, and real‐time event detection. Reported diagnostic performance was generally high, with many models achieving accuracies or AUCs between 80% and 95% for primary outcomes. However, study designs were heterogeneous, most datasets were retrospective and single‐center, and external validation was limited. Conclusions ML and DL approaches can extract clinically meaningful information from multichannel UDS recordings and demonstrate strong technical performance across several diagnostic tasks. However, variability in methodology, limited generalizability, and lack of prospective validation currently limit clinical adoption. AI‐based UDS interpretation remains an emerging research area requiring standardized data, robust validation, and integration with clinical workflows.

Abstract Background Fibroblast growth factor receptors inhibitors (FGFRi) are approved treatments for various malignancies. FGFRi-associated retinopathy is a class effect of FGFRi, including erdafitinib, pemigatinib, infigratinib, and rogaratinib. Patients and Methods We summarized FGFRi-associated retinopathy with erdafitinib across 5 clinical studies in patients with metastatic urothelial cancer (mUC pooled studies) and one study in patients with advanced solid tumors (RAGNAR). We also present changes in visual acuity, retinal pigment epithelial elevation, and subretinal fluid in RAGNAR. Results One hundred and three (21.5%) of 479 patients in the mUC pooled studies and 43/314 (13.7%) patients in RAGNAR experienced FGFRi-associated retinopathy. Most FGFRi-associated retinopathy were Grade 1/2 events. Grade 3 FGFRi-associated retinopathy were infrequent (mUC pooled studies, 11/479 [2.3%]; RAGNAR, 3/314 [1.0%]). No Grade 4 events occurred. Most FGFRi-associated retinopathy events (mUC pooled studies, 81/103 [78.6%]; RAGNAR, 30/43 [70.0%]) occurred within 90 days of treatment initiation and were managed with erdafitinib dose interruption (mUC pooled studies, 41/479 [8.6%]; RAGNAR, 23/314 [7.3%]) or reduction (mUC pooled studies, 58/479 [12.1%]; RAGNAR, 21/314 [6.7%]); few required treatment discontinuation (mUC pooled studies, 14/479 [2.9%]; RAGNAR, 3/314 [1.0%]). By the data cutoff, 63.1% (65/103) patients in the mUC pooled studies and 65.1% (28/43) patients in RAGNAR had their FGFRi-associated retinopathy events resolve. Most unresolved FGFRi-associated retinopathy events were persistent Grade 1 events. In RAGNAR, 92.0% of patients had their visual acuity return to baseline and 78.5% of patients had their retinal pigment epithelial elevation resolve. Conclusions FGFRi-associated retinopathy with erdafitinib can be managed with dose reductions, interruptions, or discontinuations. Proactive collaboration between oncologists and ophthalmologists is required to ensure that erdafitinib delivers clinical benefit to patients while managing their potential adverse symptoms of FGFRi-associated retinopathy.

Case: A right-hand dominant, 38-year-old man presented to clinic with atraumatic left wrist pain of 1 year duration in the setting of bilateral bipartite lunate. Both wrists ultimately became symptomatic and were treated with proximal row carpectomy. The patient had durable pain relief in both wrists after proximal row carpectomy. Conclusion: Bipartite lunate is a rare developmental anomaly that is usually asymptomatic. Operative intervention directed at treating involved osteoarthritic joints is warranted in the rare symptomatic patient. Clinicians should be aware of the pathology given its high rate of misdiagnosis.

Background The prevalence and clinical correlates of extra-aortic vascular disease in Marfan syndrome remain incompletely defined, and current surveillance strategies primarily target the thoracic aorta. Methods We conducted a multicentre retrospective cohort study of 783 patients with Marfan syndrome across three tertiary centres, with systematic chart and imaging adjudication to define aneurysm and dissection distribution. Results Extra-aortic aneurysms were identified in 32% of patients, most commonly involving the iliac, carotid and subclavian arteries. Extra-aortic dissections occurred in 5.2%. Extra-aortic aneurysms clustered strongly with markers of advanced aortic disease, including abdominal aortic aneurysm (adjusted OR 3.48), prior aortic dissection (OR 3.39) and extra-aortic dissection (OR 4.44), as well as age >40 years and male sex. Genetic confirmation status was not associated with extra-aortic aneurysm presence. Conclusions Extra-aortic vascular involvement is common in Marfan syndrome and closely linked to advanced aortic pathology. These findings support risk-stratified vascular imaging beyond the thoracic aorta in higher-risk patients.

ABSTRACT Attending conferences is a foundational component of professional growth in transplant infectious diseases (TIDs), yet trainees and early‐career faculty often face an overwhelming array of meeting options and limited guidance on how to maximize the experience. This report outlines practical strategies for selecting the most impactful conferences, preparing effectively, engaging with poster sessions, cultivating meaningful professional connections, and incorporating rest and reflection into conference travel. Unlike previous discussions hosted by the TID Early Career Network (TxIDECN), which typically occurred over social media, this was a live expert panel with audience participation at the 2025 Fred Hutch Symposium on Infectious Diseases in the Immunocompromised Host on May 13, 2025, in Seattle, Washington. Here, we summarize that discussion with actionable tools to navigate conferences intentionally and translate these experiences into sustained academic and career development for emerging TID professionals. image

Background The optimal management of biochemical recurrence (BCR) after radical prostatectomy (RP) remains controversial, particularly in the absence of clinical or radiographic evidence of disease. Salvage radiotherapy (SRT) remains standard of care, but it is unclear whether SRT benefits patients when modern imaging with a multiparametric magnetic resonance imaging (mpMRI) and prostate‐specific membrane antigen‐positron emission tomography/computed tomography (PSMA‐PET/CT) are negative for local recurrence. Retrospective data comparing SRT to observation for such patients is fraught with selection bias, underscoring the need for a prospective randomised controlled trial. Study Design and Methods The Biochemical Recurrence Irradiation or Observation (BRIO) is a randomised study under the DIVINE trial framework (NCT06378866) enrolling men with BCR (prostate‐specific antigen [PSA] level ≥0.2, up to 1.5 ng/mL) after RP with no radiographic evidence of recurrence on mpMRI and PSMA‐PET/CT. Major inclusion criteria include age ≥18 years, biochemically recurrent prostate cancer after RP with a PSA level between 0.2 and 1.5 ng/mL, and no local or metastatic recurrence on imaging. A total of 312 patients will be enrolled. Participants are randomised 1:1 to standard‐of‐care SRT followed by surveillance (Group A), or initial observation with subsequent image‐guided therapy at radiographic progression (Group B). Based on historical analysis, a total of 30 metastasis events provides 80% power to detect a significant improvement (hazard ratio 0.5 corresponding to a 5‐year metastasis‐free proportion of 80.7% in the control group and 89.8% in the experimental group with one‐sided type I error rate of 0.15). All participants undergo baseline blood collection to measure prostate cancer‐extracellular vesicles and cell‐free DNA for biomarker development. Participants are followed in a 16‐week cycle with serial PSA measurements, repeat imaging if PSA doubles, safety assessment, and patient‐reported outcomes. Endpoints The primary endpoint is distant recurrence‐free survival at 5‐years using a 12‐month landmark to mitigate bias arising from differing assessment schedules for patients receiving optional 6 months of androgen deprivation therapy. Key secondary outcomes include time to hormone therapy, quality of life measures, adverse effects, and novel blood and urine biomarkers. Conclusion The BRIO study will clarify the clinical benefit of immediate SRT vs observation with image‐guided intervention in mpMRI and PET‐negative BCR after RP.

Background: Preliminary evidence examining ibogaine in neuropsychiatric and substance use disorders is accumulating. As patient interest and off-label use grow, clinicians require an understanding of emerging dosing strategies, investigational protocols, and reported adverse effects to appropriately counsel patients and contextualize potential risks and benefits. Methods: Databases were searched for human studies of ibogaine, noribogaine, or 5-MeO-DMT with relevant clinical outcomes, prioritizing randomized controlled trials (RCTs), microdosing paradigms, and sequential protocols. Results: Only three RCTs were identified. First, a double-blind pilot study in 20 cocaine-dependent adults found that a single 1800 mg dose of ibogaine was associated with reduced craving versus placebo over follow-up of up to 24 weeks. Second, an ascending-dose trial in 36 healthy volunteers showed that noribogaine doses of 3–60 mg were safe and well-tolerated, without opioid-agonist effects. Third, a randomized crossover trial in 27 opioid-dependent patients receiving noribogaine 60–180 mg demonstrated dose-dependent heart rate-corrected QT interval (QTc) prolongation with non-significant reductions in withdrawal symptoms. Thus, two RCTs enrolled substance-dependent populations, while one focused on safety and pharmacokinetics in healthy volunteers. Microdosing and escalating sequential protocols remain experimental, lack standardized definitions, and are supported only by preliminary observational data. Adverse effects include neurologic, psychiatric, and cardiac events, including QTc prolongation; fatalities have occurred in the presence of medical and substance use comorbidities. Conclusions: The available evidence is confined to case reports, observational analyses, and small early-phase or proof-of-concept studies. Given ibogaine’s cardiotoxicity and narrow therapeutic margin, clinical use cannot be recommended without confirmation from larger, well-controlled trials.

Background: Complex repairs of radial meniscal tears have shown increased fixation strength compared to conventional sutures. A simplified 2-suture hybrid and a novel dual tie-grip repair with interconnected vertical mattress sutures spanning the tear were tested and compared to all-inside double-horizontal and tie-grip repairs. Hypothesis: The dual tie-grip repair would increase the initial compression load across the tear and show the least cyclic displacement and highest failure strength. Study Design: Controlled laboratory study. Methods: A total of 40 porcine medial menisci were assigned to 4 repair groups: double-horizontal, hybrid, tie-grip, and dual tie-grip (10 per group). Results from tie-grip repairs were used to assess the effect of vertical mattress suture interconnection. After suture placement according to the described technique and fixation, the initial compressive load, stiffness, and relief displacement were measured. The repaired specimens underwent cyclic loading between 5 and 30 N over 1000 cycles (0.75 Hz), while cyclic stiffness and displacement were measured. Ultimate stiffness and load-to-failure were analyzed at 3.15 mm/s. Results: Analysis of variance revealed that dual tie-grip and hybrid repairs showed higher initial compressive load and relief displacement than the other techniques, with dual tie-grip repair reaching the highest values for both metrics (load: 19.3 ± 2.3 N [ P < .001]; displacement: 0.75 ± 0.19 mm [ P < .001]). The double-horizontal repair had the lowest initial stiffness ( P < .001). Cyclic displacement was lowest for the dual tie-grip repair and highest for the double-horizontal repair (both P < .001). All repaired specimens stiffened during cycling without intergroup differences. Analysis of covariance for stiffness over displacement revealed higher stabilization ( P < .040) with dual tie-grip repair and reduced stabilization ( P < .001) with double-horizontal repair. Despite comparable ultimate stiffness across groups, the dual tie-grip repair failed predominantly by suture rupture at the highest ultimate load (275.5 ± 26.2 N; P < .001), whereas the double-horizontal repair failed by tissue rupture the earliest (127.2 ± 15.9 N; P < .001). Conclusion: The dual tie-grip repair provided the highest initial compression across the radial meniscal tear, the lowest cyclic displacement, and the greatest load-to-failure among all techniques in a porcine cadaveric model. The simplified 2-suture hybrid repair showed higher initial compression than other repairs and comparable cyclic stability to the tie-grip repair. Clinical Relevance: The dual tie-grip repair provided high compression across the radial tear and strong resistance to cyclic displacement. Future clinical series assessing differences in healing rates among different repair groups are warranted.