Citations

Background Sarcopenia is associated with worse outcomes in pancreatic cancer patients, but longitudinal body composition changes during neoadjuvant therapy remain poorly understood. Methods A retrospective review identified patients who underwent pancreatectomy, either upfront or after neoadjuvant therapy, for pancreatic adenocarcinoma between 2011 and 2021. Skeletal muscle area, index, and mean attenuation were calculated from CT images throughout the treatment course to assess sarcopenia. Multivariable generalized linear and logistic regression models were used to assess associations between sarcopenia, neoadjuvant therapy, and postoperative outcomes. Results A total of 72 patients were included: 32 who underwent neoadjuvant therapy and 40 who underwent upfront surgery. Forty-one (57%) patients had sarcopenia at diagnosis (65% upfront surgery vs 47% neoadjuvant, P = 0.154). Post-neoadjuvant therapy, 15.6% developed and 18.8% resolved sarcopenia. Median skeletal muscle mean attenuation increased by 2.4 HU after neoadjuvant therapy ( P = 0.02). Patients receiving neoadjuvant therapy were more likely to undergo nutrition consultation prior to surgery (61% vs 7%, P = 0.003). Neoadjuvant therapy was also associated with higher postoperative albumin levels (β = 0.244; 95% CI 0.041-0.446). Baseline sarcopenia diagnosed by skeletal muscle area was associated with increased postoperative complications (OR 13.696; 95% CI 2.537-73.921), while neoadjuvant therapy did not significantly impact complications (OR 0.384; 95% CI 0.12-1.226). Conclusions Patients who completed neoadjuvant therapy and underwent resection did not have increased rates of sarcopenia and were more likely to receive preoperative nutrition consultation and have higher postoperative albumin levels. The neoadjuvant period may represent an opportunity for sarcopenia assessment, nutritional optimization, and multimodal prehabilitation prior to pancreatectomy.

Cardiovascular disease (CVD) remains the leading cause of death worldwide and is a major driver of critical illness, resulting in admission to cardiac intensive care units (CICUs). Patients with acute, life-threatening CVD often experience episodes of acute decompensation characterized by high symptom burden that may portend progressive loss of function, significantly impair quality of life (QOL), and involve high-intensity, technologically advanced therapies to sustain life. Despite these advances, up to 30% of patients die during CICU hospitalizations, and those who survive may subsequently face persistent functional impairment and psychosocial distress. During critical CVD (CCVD), patients often endure prognostic uncertainty and face complex decisions regarding life-sustaining therapies alongside refractory symptoms. Thus, care that focuses exclusively on disease-directed or life-prolonging therapies is often insufficient to address the full spectrum of patient and caregiver needs. When integrated alongside intensive cardiovascular care, palliative care (PC) offers a complementary and essential approach to the management of CCVD to inform therapeutic decisions, improve QOL, and address psychosocial and spiritual well-being. In this article, a multidisciplinary team featuring PC clinicians (physicians, nurse practitioners, social worker, psychologist, and chaplain), cardiologists, cardiac surgeons, cardiothoracic anesthesiologists, and intensivists present evidence-based guidance in a “Top Ten Tips” format to support PC clinicians caring for CICU patients and their caregivers.

Abstract Objective&#xD;X-ray angiography and fluoroscopy systems are used to diagnose and treat congenital heart disease in pediatric patients. Among the substantial variabilities in this clinical patient population is that patient weight ranges from <1 kg premature infants to large adolescents. The primary aim of this work was to assess whether an air gap or antiscatter grid is more efficient to mitigate the detrimental influence of scatter radiation on pediatric image quality.&#xD;Approach&#xD;The experimental approach was guided by a 2 year review of pediatric patient imaging conditions. Uniform density water-equivalent phantoms with thickness in the range 6-24 cm were used. For each phantom thickness, the X-ray technique was manually set to mimic the technique selected by automatic dose rate control. The influence of four combinations of air gap and ratio 15:1 antiscatter grid on test object SNR was measured. The air gap was varied by changing the X-ray source to detector distance from 107 to 120 cm. The analytical methods estimated pixel-specific snr2 contributions to object SNR2, thus providing for the use of iodine disks and pediatric implantable devices as test objects.&#xD;Main results&#xD;Patient weight ranged from 0.5 to 134 kg. The relationship between patient water equivalent thickness and weight was demonstrated. For all phantom thicknesses, object SNR was highest using a long air gap, non-grid technique. Decreasing the air gap between the phantom and detector and use of the anti-scatter grid both degraded SNR. These major findings were consistent between iodine disks and clinical devices as test objects.&#xD;Significance&#xD;The findings of this phantom study suggest that a long air gap, non-grid imaging technique may improve radiation dose efficiency of fluoroscopy and angiography imaging across a broad range of pediatric patient sizes.&#xD;

Background: Metacarpophalangeal (MCP) arthroplasty is an established surgical option for end-stage MCP arthritis. We analyzed trends in case volumes and 30-day perioperative outcomes after MCP arthroplasty performed for rheumatoid arthritis (RA) and osteoarthritis (OA). Methods: We used the National Surgical Quality Improvement Program database to identify all MCP arthroplasties performed for RA (n = 216) or OA (n = 452) between 2010 and 2023. Bivariate analysis was used to compare patient demographics, operative characteristics, and 30-day outcomes. We analyzed temporal trends in case volumes using Poisson regression models and trends in patient characteristics using linear regression. Results: Patients with RA were more likely to be female (85% vs 54%) and have a history of smoking (22% vs 10%) and chronic steroid use (58% vs 4%). Patients with OA had more prevalent comorbidities including obesity, diabetes, and hypertension. Patients with RA more frequently required multi-joint replacement, concomitant soft tissue balancing procedures, plastic surgery involvement, and inpatient admission. The annual case volume for OA increased at +5.9% per year ( P < .001), whereas the volume for RA remained steady. The outpatient case volume grew at a rate of +4.6% per year ( P < .001). Both groups had similarly low rates of 30-day complications (0.9% RA, 1.8% OA), readmission (0.5% RA, 1.5% OA), and reoperation (0% RA, 0.9% OA). Conclusions: Despite distinct patient profiles and operative complexity, both OA and RA patients experience low rates of perioperative adverse events after MCP arthroplasty. Osteoarthritis is a growing indication for this procedure, which is increasingly being performed in the outpatient setting.

BACKGROUND: Pulsed field ablation is now widely used for atrial fibrillation (AF) ablation, but atrial tachyarrhythmia recurrence remains common and postablation risk tools are limited. We assessed whether a validated sinus‑rhythm artificial intelligence— enabled ECG AF probability score, and its early postablation change, predicts recurrence after pulsed field ablation. METHODS: We studied consecutive patients undergoing index pulsed field ablation across 3 Mayo Clinic sites (February 2024–March 2025) with ≥1 sinus‑rhythm ECG within 180 days preprocedure. Baseline artificial intelligence—enabled ECG AF score (range 0–1) was the mean across baseline ECGs. Recovery indices (RI30/60/90), defined as mean postprocedure artificial intelligence—enabled ECG score within days 1–30/60/90 minus baseline, predicted post‑blanking recurrence using corresponding 30‑, 60‑, and 90‑day blanking windows. The primary outcome was time to first documented AF/atrial flutter/atrial tachycardia episode >30 seconds, ascertained via clinic ECGs, ambulatory monitoring, and device interrogations. Cox regression adjusted for prespecified clinical and echocardiographic covariates assessed associations; Harrell C‑statistic quantified discrimination. RESULTS: Among 1052 patients (67±10 years; 33% women), median baseline score was 0.35; 320 (30%) recurred over 188 days. Higher baseline score independently predicted recurrence (hazard ratio per 0.1 increase, 1.08 [95% CI, 1.03–1.14]). Scores rose on day 0 after ablation, then declined over subsequent weeks, with persistently higher, less‑improving trajectories among patients who recurred (time×recurrence interaction P <0.001). Day 0 score was not independently associated with recurrence after adjustment. Attenuated early recovery (higher recovery index) was independently associated with recurrence, most robustly for RI-90 (hazard ratio per 0.1 increase, 1.15 [95% CI, 1.07–1.24]), and improved discrimination beyond baseline and covariates (C‑statistic, 0.63–0.67; ΔC=0.04). Findings were consistent in a historical thermal ablation cohort. CONCLUSIONS: Baseline and early postablation dynamics of a sinus‑rhythm artificial intelligence—enabled ECG AF probability score are associated with pulsed field ablation recurrence and may aid multivariable risk stratification; prospective validation is warranted.

ABSTRACT Persistent gaps in anatomical knowledge among incoming residents have raised concerns about clinical preparedness, especially in surgical and interventional disciplines. Conventional anatomy instruction and limited cadaveric exposure and learning opportunities in medical curricula have prompted calls for innovative, clinically focused anatomical curricular integration in clinical training. This article describes the development, implementation, and impact of a tailored Year 4 Clinical Anatomy Elective in the Department of Clinical Anatomy at Mayo Clinic, designed to reinforce competency in clinically relevant anatomical understanding and support learners' perceived preparedness during transitions to residency. A 4‐week elective was designed for fourth‐year medical students interested in pursuing a specific residency program. The course was personalized for students' clinical interests and incorporated fresh tissue dissection, simulation, procedural skills training, and imaging using an immersive learning platform. The elective was structured within the experiential learning model using a guided, self‐directed format within a multicapability laboratory and instructional environment, grounded in constructivist theory. A 5‐year review of elective records and informal thematic analysis of student feedback were conducted. Most participants pursued surgically related specialties, with orthopedic surgery being the most common. Exploratory thematic analysis identified six core themes: Professional Identity Formation, Educational Benefits, Learning Challenges, Connection to Clinical Practice, Patient Care Implications, and Future Preparation and Transferability. These students perceived gains in areas aligned with ACGME milestones: increased confidence, greater preparedness for residency, and improvement in their ability to apply anatomical knowledge in clinical settings. This perception may be indicative of lifelong learning and early educator identity formation. A specialty‐specific, clinically integrated anatomy elective may support learners' perceived preparedness for residency, reinforce clinically relevant anatomical understanding, and support the development of educational and professional competencies. Such targeted interventions may help address perceived gaps in anatomical preparedness during the transition to residency and contribute to postgraduate training within a competency‐based medical education framework.

Abstract Historically, the study of cellular metabolism and the cellular proteome have largely focused on specific proteins and metabolites in certain cellular pathways. With the advent of new “omics” technologies, researchers have been able to probe disruptions and alterations in cellular homeostasis on a near proteome-wide and metabolome-wide basis. Yet the truly interconnected and interdependent nature of the cellular metabolome and proteome has only become more evident with the discovery of proteome-wide protein post-translational modifications (PTMs) such as lysine acylation by acetyl-CoA or succinyl-CoA. Such PTMs link proteome function to fluctuating concentrations of tricarboxylic acid (TCA) cycle metabolites. Tumorigenesis in TCA cycle-defective tumors that upregulate acylating agents such as succinyl-CoA and acetyl-CoA provides a relevant context for understanding the breadth of protein acylation in disease. In particular, succinate dehydrogenase (SDH)-loss chromaffin cells can be transformed to the neuroendocrine tumors pheochromocytoma and paraganglioma (PPGL), but sensitive diagnostic and effective therapeutic options for metastatic disease remain limited. Interrogating cell models of SDH-loss PPGL provides a unique opportunity to capture the effects of SDH loss on cellular metabolism and protein acylation while exploring new avenues for improved diagnostics and novel therapeutic targets in these rare diseases.