Citations

ABSTRACT Objective Falls are a leading cause of morbidity and loss of independence in adults. The association between overactive bladder (OAB) and fall risk has not been thoroughly investigated. This study evaluated the association between OAB and fall history in a nationally representative sample of US adults aged 20−69 years. Methods We performed a cross‐sectional analysis of adults aged 20−69 years from the 2021−2023 National Health and Nutrition Examination Survey (NHANES). OAB was classified using a composite symptom severity score that assessed urge urinary incontinence and nocturia. Fall history was assessed by self‐reporting (only in participants aged 20−69 years), where a recent fall was defined as experiencing at least one fall within the past year. Survey multivariable logistic regression was used to estimate adjusted odds ratios (aOR) for the association between fall history and OAB after controlling for sociodemographic and clinical covariates. Results Among 4118 participants, the population‐weighted prevalence of OAB was 19.6% (standard error [SE]: 1.1%), and the prevalence of a recent fall was 28.3% (SE: 1.3%). The prevalence of a recent fall was higher among those with OAB (39.7% [SE: 1.6%] vs. 25.7% [SE: 1.5%]). The prevalence of a recent fall increased progressively with OAB symptom severity (24.3% in those with no symptoms vs. 52.4% in those with severe symptoms). In the fully adjusted model controlling for sociodemographic and clinical covariates, OAB was independently associated with a 42% higher odds of experiencing a recent fall (aOR, 1.42; 95% CI, 1.10 to 1.83; p = 0.01). Conclusion OAB is independently associated with an increased risk of a recent fall in US adults aged 20‐69 years, with a strong positive relationship between OAB severity and fall risk. These findings suggest that screening for OAB may be a useful adjunct to fall risk assessment. Future studies are needed to determine whether OAB management reduces the risk of falls.

Abstract INTRODUCTION Cognitive impairment in hospitalized older adults without delirium is often undiagnosed. We evaluated the diagnostic accuracy and prognostic value of two brief bedside screening tools—the 10‐point Cognitive Screener (10‐CS) and Short Portable Mental Status Questionnaire (SPMSQ). METHODS Multicenter prospective cohort of 2003 patients ≥65 years of age without delirium, admitted to 43 hospitals in five countries of the Creating a Hospital Assessment Network in Geriatrics (CHANGE) Study. Screening was completed within 48 h of admission. Dementia was defined as informant‐based Clinical Dementia Rating ≥1. RESULTS Dementia prevalence was 22%, with 35% undiagnosed. Both tools showed good accuracy for detecting dementia, with the 10‐CS slightly more accurate than SPMSQ (area under the curve [AUC] = 0.87 vs 0.85; p = 0.02). After adjustment, cognitive impairment detected by either tool was associated with increased risk of incident delirium, hospital‐associated disability in self‐care activities, and 90‐day mortality, but not prolonged stay. DISCUSSION Brief bedside screening identified dementia and predicted adverse outcomes, supporting its integration into routine hospital care.

Abstract Background Lumbar puncture is a routinely performed procedure, yet it presents significant challenges in patients with abnormal spinal anatomy, such as severe scoliosis or obesity. Conventional ultrasound-assisted neuraxial techniques, while superior to landmark-based methods, are constrained by two fundamental limitations: inaccurate projection of the probe’s geometric center onto the skin when the probe is tilted or rocked, and the difficulty of consistently replicating the exact probe angle during needle insertion. These limitations contribute to multiple needle passes, prolonged procedure time, and increased patient discomfort and complication risk. To address these issues, we developed a novel angle-free ultrasound-assisted technique designed to eliminate the need for replicating probe angulation during needle insertion. Case presentation: This angle-free approach was utilized for serial lumbar punctures in two patients with spinal muscular atrophy requiring repeated intrathecal nusinersen administration. Both patients presented with extreme anatomical complexity, including high body mass index (30 and 35.1 kg/m²) and severe scoliosis (Cobb angles 90° and 83°). The technique follows a three-step protocol: (1) Preprocedural imaging to select the optimal interlaminar space; (2) Ultrasound-guided postural adjustment until the probe could be held perpendicular to the bed edge and parallel to the floor while maintaining target visualization; (3) Needle insertion along this orthogonal trajectory. All 22 procedures (11 per patient) were completed successfully without persistent neurological complications. Procedural outcomes demonstrated a first-attempt success rate of 81.8% (Case 1) and 100% (Case 2), with first-pass success rates of 45.5% and 54.5%, respectively. Longitudinal analysis across sequential procedures revealed a consistent reduction in both the number of needle passes and needling time, reflecting a favorable learning curve. Conclusions The angle-free ultrasound-assisted neuraxial technique offers a valuable alternative for patients with complex spinal anatomy. By using real-time postural adjustments to achieve a needle trajectory, it enhances procedural precision and eliminates the technical hurdle of replicating probe angulation. The structured "4P" framework (Planning, Positioning, Perpendicular, Parallel) offers a practical guide for clinical adoption. The observed learning curve suggests that clinicians can readily acquire and apply this technique to manage such challenging cases.

Context.— The Goldman criteria are widely used to categorize diagnostic discrepancies in autopsy reports for hospital quality assurance. Despite their adoption, little is known about how consistently they are applied across institutions. Objective.— To evaluate the interrater reliability among academic pathologists applying the Goldman criteria to classify missed diagnoses in autopsy cases. Design.— Thirty autopsy cases from 2 academic hospitals were reviewed by 5 experienced autopsy pathologists. Each reviewer independently assigned Goldman classification scores (class I–IV) to missed diagnoses based on the original 1983 definitions. Consensus was defined as at least 60% agreement (≥3 of 5 raters). Fleiss κ and Gwet AC1 were calculated to assess interrater reliability. Results.— A total of 196 missed diagnoses were identified by at least 1 rater. Only 26% (51 of 196) achieved a consensus Goldman classification, and just 4% (8 of 196) had unanimous classification agreement. Most diagnoses (65%; 127 of 196) were not identified by at least 3 raters. Among consensus classification ratings, 49% (25 of 51) were class IV. Fleiss κ was 0.176 (slight agreement) while Gwet AC1 was 0.390 (fair agreement). Collapsing major (classes I–II) and minor (classes III–IV) categories modestly improved agreement. Conclusions.— Interrater agreement in applying the Goldman criteria is only fair to moderate, suggesting significant subjectivity in their application. As the criteria are used for institutional comparison and quality metrics, efforts to standardize definitions and provide reviewer training are warranted to improve reproducibility and utility.

Purpose To use publicly available injured list (IL) data to 1) describe Major League Baseball injury trends from 2010 to 2024; 2) analyze injury types and body regions affected to report the highest impact injuries; and 3) report the financial implications of time lost due to injury over this 15‐year period. Methods IL data for every Major League Baseball player (pitchers and position players) from the 2010 to 2024 regular seasons were collected using publicly available sources, including player demographics, IL placements, body part injured, and length of each IL stay. Player salaries were compiled to determine the “financial loss” per injury. Results Across 15 seasons, 8078 players were placed on the IL, totaling 478,085 days. The mean IL placements/year was 634, and the annual number increased by an additional 27 injuries/year ( P < .001). Mean total IL days/season was 31,872, and this increased year‐over‐year ( P = .008). Shoulder injuries represented the most IL placements (n = 1555), followed by elbow (n = 1344) and upper leg (n = 769). Elbow injuries averaged the most days missed/IL placement (mean: 93, median: 74) and the greatest total days missed (129,610), followed by shoulder (95,189). Pitchers comprised 55% of IL placements and most commonly injured their shoulder or elbow. Infielders and outfielders accounted for 21% and 16% of IL placements, respectively. A total financial loss of $9,636,753,291 was accumulated over 15 seasons. Financial loss increased season‐to‐season (+$32,309,178/year, P = .002). Elbow injuries accounted for the highest financial loss at $1,932,048,168 ($1,379,049 lost/injury). In 2024, $2,220,432 was lost/elbow injury, $1,110,573/shoulder injury, $1,397,322/any injury, and $952,973,760 total for the season. Conclusions This study observed that the number of players, IL placements, days spent on the IL, and financial loss due to injury increased steadily each year. Pitchers were the most frequently injured players with shoulder and elbow injuries being most common. Over the 15‐season study period, there was a total financial loss of nearly $9.7 billion due to salary paid to injured players, with elbow injuries contributing the highest loss at just under $2 billion. Clinical Relevance Injury trends and financial data from Major League Baseball highlight the growing burden of shoulder and elbow injuries, particularly in pitchers. These findings underscore the need for orthopaedic surgeons to focus on prevention, early intervention, and optimized surgical management of high‐impact injuries to reduce long‐term morbidity and associated financial costs at the elite level.

Abstract AI-powered pathology foundation models provide general-purpose representations of histopathological images by encoding image tiles into numerical embeddings. However, these embeddings are not directly interpretable in biological or clinical terms and must be translated into biologically meaningful features, such as cell-type composition or gene expression, to enable downstream clinical applications. To bridge this gap, we developed STpath, a framework that integrates histopathology image embeddings derived from existing pathology foundation models with matched, spatially resolved transcriptomics data. STpath consists of cancer-specific XGBoost models trained to infer cell-type compositions and gene expression from histopathology image tiles. We evaluated STpath in colorectal and breast cancer datasets and showed that it provides accurate estimates of the composition of major cell types and the expression of a subset of genes, with further performance gains achieved by combining embeddings from multiple foundation models. Finally, we demonstrated that STpath inferred features that can be used in downstream studies to evaluate their associations with clinical outcomes.

Abstract Genome-wide association studies (GWAS) have linked more than a hundred non-coding genomic loci to Parkinson’s disease (PD) risk. Deciphering their functional impact on gene regulation requires cell type-aware modeling approaches to assess the effects of sequence variation on enhancer function and target gene expression. To address this challenge, we generated a comprehensive matched dataset from 190 human donors (115 controls and 75 PD), comprising long-read whole-genome sequencing alongside single nucleus multiome atlases (snATAC-seq and snRNA-seq for 3.1 and 1.1 million nuclei respectively) of the anterior cingulate cortex and substantia nigra. By integrating chromatin accessibility quantitative trait loci (caQTL), DNA methylation QTL (meQTL), and allele-specific chromatin accessibility (ASCA), we identified 53,841 high-confidence cis -acting genetic variants that modulate cell type-specific enhancer accessibility in one or both brain regions. We further demonstrate that sequence-to-function models can accurately predict the impact of these variants directly from the genomic sequence. Novel explainability approaches allowed stratifying these variants according to their regulatory function, with the majority disrupting specific transcription factor binding sites in a cell type specific manner. Integrating these “enhancer variants” (EV) with eQTL mapping and gene locus modeling linked a subset of EVs to their target genes. Finally, we applied these models to prioritize regulatory variants at known PD GWAS loci, bypassing statistical limitations in rare disease-relevant populations like dopaminergic neurons. All together, we establish a unique resource and new sequence modeling strategies to interpret functional non-coding variation in the human brain.

Background: ASCO recommends extended venous thromboembolism (VTE) prophylaxis with low-molecular-weight heparin (LMWH) or direct oral anticoagulants (DOACs) following cancer surgery. However, these recommendations were based on trials using routine venography, which detects asymptomatic VTEs, and real-life efficacy is not well studied. We aimed to assess the association of extended VTE prophylaxis with the incidence of clinically significant VTE after elective cancer surgery. Patients and Methods: In this retrospective, population-based cohort study, we identified patients who underwent surgical resection for lung, breast, esophageal, gastric, pancreas, and colon cancer from 2010 to 2017 using the SEER–Medicare linked dataset. Patients were divided into 1 of 2 main groups for comparative analyses: those who received extended VTE prophylaxis after cancer surgery and those who did not. Patients who received extended VTE prophylaxis after cancer surgery were identified as those prescribed prophylactic doses of LMWH or a DOAC within 7 days of discharge, as captured in Medicare Part D files. Results: A total of 113,739 Medicare beneficiaries were identified, of whom 1,570 (1.4%) received extended VTE prophylaxis. There was a year-over-year increase in the use of extended VTE prophylaxis during the study period, rising from 0.6% in 2010 to 3.3% in 2017. The overall incidence of VTE was 1.6% at 1 month, 4.3% at 6 months, 5.7% at 12 months, with significant differences observed across cancer types ( P <.001). However, patients who received extended VTE prophylaxis had a higher 1-year cumulative incidence of postoperative VTE compared with those who did not (11.4% vs 5.3%; P <.001), an association that was consistent across cancer sites. In adjusted analyses, extended VTE prophylaxis was independently associated with an increased risk of VTE (hazard ratio, 1.6; 95% CI, 1.3–2.0; P <.001). Extended prophylaxis was also associated with a higher 1-year incidence of bleeding events compared with patients who did not receive prophylaxis (12.0% vs 8.5%; P <.001). Conclusions: The utilization of extended VTE prophylaxis after cancer surgery remains low, although it has increased every year. Paradoxically, patients who received extended VTE prophylaxis had higher incidences of clinically significant VTE and bleeding compared with those who did not, likely reflecting patient selection and surveillance bias after surgery. In light of these findings, national guidelines recommending postoperative extended VTE prophylaxis, and its use as a surrogate for quality of care, should continue to be re-examined.