Citations

Background: Nasal and sinonasal findings have been reported in patients with Behçet’s syndrome, but their frequency, clinical significance, and relationship to underlying disease remain unclear. We performed a scoping review to map the published literature on epidemiology, clinical characteristics, and management. Methods: Following PRISMA-ScR guidance, we systematically searched MEDLINE, EMBASE, and Web of Science from inception through June 2026 for peer-reviewed primary studies reporting nasal or sinonasal findings in patients with Behçet’s syndrome. Two reviewers independently screened studies and extracted data. Results: Fifteen eligible studies, including seven case reports and eight observational studies, were identified. Reported frequencies of nasal or sinonasal findings varied substantially across studies. A spectrum of nasal and sinonasal symptoms was noted among the literature, including direct mucosal lesions, sinonasal symptoms and functional abnormalities such as olfactory impairment or delayed mucociliary clearance, and secondary nasal conditions occurring in patients with Behçet’s syndrome. Oral ulcers were consistently reported in the limited studies describing associated systemic features. Treatment data were sparse, and no evidence-based management approach specific to nasal disease was identified. Conclusions: The published literature suggests that a range of nasal and sinonasal findings may occur in patients with Behçet’s syndrome. However, the available evidence is sparse, heterogeneous, and insufficient to determine true prevalence, attribution, or optimal management. Future studies should distinguish direct Behçet-related nasal lesions from secondary or nonspecific findings and use standardized clinical assessment.

Abstract Objective Rituximab causes B‐cell depletion and hypogammaglobulinemia, increasing risk for infections. This study aims to determine the incidence of chronic rhinosinusitis (CRS) in patients following rituximab therapy. Study Design Retrospective cohort study using chart review of patients prescribed rituximab between January 2019 and January 2025. Setting Multisite study across Mayo Clinic Enterprise locations in Arizona, Florida, Minnesota, and Wisconsin. Methods Patients with documented rituximab use were included; those with pre‐existing CRS were excluded. Demographic and clinical data—including timing and duration of rituximab therapy, CRS diagnosis, comorbidities (asthma, allergic rhinitis, GERD), and need for sinus surgery—were collected. Descriptive statistics summarized patient characteristics. Group comparisons were performed using t ‐tests, Mann‐Whitney U , and chi‐square tests. Analyses were conducted using SPSS v28. Results Among 17,851 patients prescribed rituximab (median age 64.0 years, M:F ratio 1.1:1), 1105 (6.2%) developed CRS, with an annual incidence of 1.03% (1032 cases per 100,000 person‐years). The median duration of rituximab therapy for those diagnosed with CRS was 5.9 months (IQR, 0.5‐42.6). Most CRS cases occurred after rituximab discontinuation (62.7%, n = 693) compared to during active treatment (37.3%, n = 412). The median delay between rituximab discontinuation and CRS diagnosis was 17.0 months (IQR, 4.3‐41.7). Conclusions This study demonstrates an annual incidence of 1.03% for CRS diagnoses following rituximab. While prior studies report varying CRS incidences in the general population (0.25%‐0.73%), our findings suggest increased risk among rituximab users. Most CRS diagnoses occurred after rituximab discontinuation, emphasizing the need for a comprehensive medication history review during CRS evaluation.

Abstract Aim To confirm or refute recent pilot studies showing unexpectedly high rates of undetected heart failure (HF) in cardiology patients. Methods We assessed the prevalence, characteristics, and outcome of undetected HF in a large prospective cohort study of patients referred for non-invasive coronary artery disease (CAD) work-up with cardiac positron emission tomography computed tomography. HF presence and phenotype were centrally adjudicated by an independent cardiologist according to clinical practice guidelines requiring three mandatory criteria: symptoms, elevated natriuretic peptides, and structural/functional cardiac abnormalities. The endpoint was a composite of cardiovascular death and acute HF (AHF) hospitalization through 2-year of follow-up. Results Among 1738 eligible patients (median age 67 years, 30% women), 138 patients (7.9%) had known HF, and 534 of 1600 patients (33.4%) without known HF had adjudicated undetected HF, resulting in a ratio of undetected HF to known HF of 3.9 (95%CI, 3.2–4.7)-to-1 and a number needed to screen to detect one patient with undetected HF of 3.0 (95%CI, 2.9-3.1). In undetected HF, left ventricular ejection fraction (LVEF) was preserved in 72.3%, mildly reduced in 16%, and reduced in 11.7%. Older age, known CAD, atrial fibrillation, previous pacemaker implantation, and ECG abnormalities were associated with a higher likelihood for undetected HF. Undetected HF was associated with an increased cumulative incidence of the composite endpoint (adjusted subdistribution hazard ratio 7.37 [95%CI, 3.87-14.06], p<0.001, versus no HF). Conclusion One-out-of three patients referred for CAD work-up had undetected HF, which was associated with cardiovascular death and AHF hospitalization.

This article describes clinical, serologic, and histopathologic features of the first North American cohort of patients with positive anti-p200 serology identified at Mayo Clinic, Rochester, Minnesota, USA and Beutner Laboratories, Buffalo, New York, USA. Forty-seven patients were identified with positive p200 laminin beta 4 autoantibodies, detected with either immunoglobulin (Ig)G or IgG4 modified indirect immunofluorescence on HEK293 cells transfected with recombinant laminin beta.

Stellate ganglion blockade (SGB) is an uncommon but increasingly relevant therapy used to modulate the autonomic nervous system and reduce the risk of atrial fibrillation (AF). This narrative review focuses specifically on the potential therapeutic role of SGB in new-onset perioperative atrial fibrillation (POAF), a complication associated with adverse long-term outcomes that may diminish the overall benefits of surgery. SGB may reduce AF through several inflammation-mediated mechanisms, including attenuation of direct sympathetic activation and modulation of perioperative inflammatory responses. Because the clinical effects of SGB may persist beyond the expected duration of local anesthetic nerve blockade, we emphasize immunomodulation as a potential mechanism sustaining its beneficial effects and influencing longer-term outcomes. In this review, we examine the immunological effects of SGB in the context of postoperative AF, with particular emphasis on human studies most relevant to clinical practice. Available evidence suggests that, beyond nonspecific inflammation, several less commonly studied cellular components, including mast cells and T cells, may contribute to the initiation and persistence of POAF. These findings support the hypothesis that SGB may reduce POAF by limiting stellate ganglionitis driven by perioperative localized leukocyte activation. Future studies should define the extent, timing, and frequency of this inflammatory process and determine whether specific inflammatory or autonomic phenotypes can identify patients most likely to benefit from SGB.

The effect of induced hypertension (iHTN) on functional outcomes in noncardioembolic acute ischemic stroke (AIS) with early neurological deterioration remains unclear. We performed a systematic review and meta-analysis evaluating the safety and efficacy of iHTN vs medical management. A literature search of PubMed/MEDLINE, Web of Science, Ovid Embase, and Scopus from inception through November 6th, 2025. The protocol was registered in PROSPERO (CRD420261282211). Studies evaluating iHTN within 72 h of AIS onset and reporting 90-day functional independence (modified Rankin Scale [mRS] 0-2) were included. Safety outcome was hemorrhagic transformation. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using random-effects model based on Restricted Maximum-Likelihood (REML) methods. Three studies were included, comprising 366 patients (iHTN, n = 180; control, n = 186). Mean age was 65.8 ± 11.8 years, 60.9% were men, and the mean initial NIHSS was 5.4 ± 3.5. Target systolic blood pressure (SBP) was a 15-25% increase from baseline SBP using phenylephrine. Functional independence at 90-days occurred more often in the iHTN group than in controls (68.8% vs 50.5%; RR = 1.37; 95% CI, 1.09-1.73; P = 0.007). Hemorrhagic transformation was uncommon and did not differ significantly between groups (3.3% vs 0.5%; RR = 2.08; 95% CI, 0.05-88.07; P = 0.70). In our study, phenylephrine-induced hypertension was associated with greater 90-day functional independence in selected AIS subtypes,without a significant increase in hemorrhagic transformation. However, the limited studies, predominance of retrospective designs, exclusively Asian cohorts, and heterogeneity in treatment protocols and populations warrant cautious interpretation and underscore the need for larger multicenter RCTs.

ABSTRACT Background Few studies have examined pretransplant CD4 count and risk of post‐kidney transplant (KT) infection in persons with HIV (PWH). Methods This multi‐center, retrospective cohort study included adult PWH undergoing KT from 2004 to 2019. The primary outcome was infection in the first year post‐KT in PWH with pretransplant CD4 < 350 cells/µL versus CD4 ≥ 350 cells/µL. Relative risk was assessed using modified Poisson modeling. Restricted mean survival time analysis was used to assess 5‐year posttransplant outcomes. Results Of the 75 patients included, 27% had a pretransplant CD4 < 350 cells/µL. Those with CD4 < 350 versus CD4 ≥ 350 were more likely to be hospitalized for infection in the first year (55% versus 16%, p = 0.001). There were no significant differences in relative risk of infection in the first‐year posttransplant (RR: 1.31, p = 0.053), 5‐year overall survival (87.5% vs. 93%, p = 0.49) or 5‐year graft loss (29.4% vs. 23.1%, p = 0.61) betweengroups. Conclusion These findings suggest that pretransplant CD4 count alone may not reflect the true risk of post‐KT infection in PWH.

Background General practitioners (GPs) have limited tools for chest pain patients to identify (non-)obstructive coronary artery disease (OCAD). This trial evaluates whether GP access to the coronary artery calcium score (CACS) improves diagnostic efficiency and cardiovascular risk management (CVRM). Methods COroNary Calcium scoring as fiRst-linE Test to dEtect and exclude coronary artery disease in GP patients with stable chest pain (CONCRETE) is a pragmatic, non-blinded implementation study that cluster-randomised 101 Dutch GP offices into CACS or standard of care (SOC). Patients aged ≥40 (men) or ≥45 (women) years, without known CAD, with possible cardiac or non-cardiac chest pain were included. The primary outcome was the proportional 2-year increase in CVRM registrations at GP office level. Patient-level secondary outcomes included cardiologist referral rate, OCAD diagnosis and CVRM enrolment. Results At GP office level, no significant difference in CVRM registration increase was seen for CACS versus SOC (46 CACS practices: +0.3%, 45 SOC practices: +0.2%, p=0.77). Per protocol analysis for patient-level outcomes included 583 patients (57.5% women, mean age 60.6±9.1 years) (CACS arm: 466; SOC arm: 117), recruited between January 2019 and October 2023. The CACS arm showed 47.1% relative reduction in cardiologist referrals compared with SOC (42.5% vs 80.3%; modelled difference 31.3% (95% CI 14.8% to 47.8%)). OCAD detection rates were not significantly different (CACS: 4.9, SOC: 7.7%, p=0.14). Patients with higher CACS had a higher probability of cardiologist referral (from 8.4% for CACS 0 to 94.2% for CACS ≥400, difference +85.7% (95% CI 79.4% to 91.9%)) and of OCAD diagnosis (0% for CACS 0 to 21.2% for CACS ≥400, OR 9.08 (95% CI 4.20 to 19.67)). Compared with SOC, more CACS patients were enrolled in CVRM (36.3% vs 17.0%, p<0.01). Conclusions In this pragmatic, primary-care implementation and proof-of-concept trial, CACS was an effective diagnostic test for stable chest pain patients with (very) low likelihood of OCAD. CACS reduced unnecessary cardiology referrals and enhanced individual preventive care, without demonstrable practice-level impact on CVRM registrations. Registration The CONCRETE study is registered under CCMO Register NL66821.042.18 and closed for enrolment.