Citations

Introduction: Gastroesophageal reflux disease (GERD) plays an important role in lung transplant (LT) outcomes. This study aims to evaluate the impact of a novel sleep positioning device (SPD) on lung function in LT recipients with GERD. Methods: In this single-center cohort study, LT recipients (2014 to 2019) with GERD who were prescribed an SPD within 2 years of LT were included. A historical control group of LT recipients with GERD on PPI only (2011 to 2013) was selected to compare forced expiratory volume in 1 second (FEV1) as a marker of lung function. Results: Twenty LT recipients using SPD (cases) and 54 patients in the historical control group with proven GERD were included. Mean (SD) interval between LT and SPD prescription was 8.6 (5.7) months. Mean % predicted FEV1 was higher in SPD users than controls post-LT at 6 months (80% vs. 69%) and 1 year (80% vs. 71%), respectively. Among SPD users, post-SPD FEV1 was higher than pre-SPD FEV1 (82% vs. 70%). Conclusion: Use of a novel SPD can stabilize or improve pulmonary function in patients with GERD after LT. SPD may be a safe and cost-effective adjunctive therapy for the management of GERD after LT.

Background and Aims: Sarcopenia (SP) is increasingly recognized as a poor prognostic factor for patients with Crohn’s disease (CD). We aimed to use radiographically-measured SP to determine a disease-specific definition and measure its association with CD-related outcomes. Methods: This retrospective study included adults with CD seen at our outpatient tertiary center between 2019 and 2021 who underwent a CT scan within 3 months of visit. Using axial cross-sectional measurements at the L3 vertebral level, skeletal muscle area was indexed to height to derive skeletal muscle index (SMI). Demographics, comorbidities, CD phenotype, and outcomes, including hospitalization at 1 year, were analyzed in univariate and multivariate models. Results: One hundred twenty-four patients with CD were included, with a mean age of 52.2±16.6 years and 53.2% (66/124) women. Overall, 33.1% (41/124) had SP based on sex-specific cutoffs with men representing 75.6% (31/41) of the sarcopenic population. In bivariate analysis, patients with SP had a higher likelihood of hospitalization (43.9% vs. 22.9% for non-SP, P =0.02) and penetrating CD phenotype (20.0% vs. 2.3% for non-SP, P <0.05). On multivariate regression, higher SMI was associated with decreased hospitalization, with each 10-unit increase in SMI conferring 0.54 lower odds (OR: 0.54 [95% CI: 0.32-0.92], P =0.02). Patients with higher SMI trended towards lower use of biologics (OR: 0.70 [95% CI: 0.45-1.09], P =0.12). Our novel SP definition derived from an IBD population performed similarly to definitions from the literature. Conclusion: Our study demonstrates the application of an automated algorithm for the quantification of body composition based on CT scan in patients with CD. SP and low SMI were associated with increased hospitalization at 1 year.

ABSTRACT Background While immune checkpoint inhibitors (ICIs) have shown significant efficacy, a common side effect is cutaneous immune‐related adverse events (irAEs). This study focuses on exploring the association between specific human leukocyte antigen (HLA) alleles and the development of cutaneous irAEs in melanoma patients undergoing ICI monotherapy and combination therapy. As certain HLA types are indicative of susceptibility to autoimmune diseases, it was hypothesized that HLA typing could serve as a potential screening tool for identifying patients at increased risk for developing irAEs. Methods A retrospective chart review was performed of 515 patients with melanoma who underwent ICI therapy, either as monotherapy or in combination, and had HLA typing available. This analysis spans from 2003 to 2023 with a focus on cutaneous irAEs. Statistical analyses were conducted to assess the association between HLA alleles and irAEs. Results Our analysis revealed that the HLA‐B*51:01 allele was associated with a higher risk of cutaneous irAEs after adjusting for ICI regimen (hazard ratio: 1.71 [95% CI, 1.12–2.61], p = .013.) Conclusion This is the largest study to link an HLA allele with ICI‐induced cutaneous irAEs. The findings may support the use of HLA typing as an initial screen for developing irAEs, providing a simple, straightforward metric that can be rapidly performed on patients prior to initiation of ICIs. However, further research is needed across different cancer and toxicity types.

Coronary artery spasm (CAS) is a dynamic vasomotor disorder characterized by transient, intense constriction of epicardial coronary arteries, leading to myocardial ischemia in patients with and without obstructive coronary artery disease. CAS plays a central role in vasospastic angina, ischemia with nonobstructive coronary arteries and myocardial infarction with nonobstructive coronary arteries, malignant arrhythmias, and sudden cardiac death. Its pathophysiology is multifactorial, involving endothelial dysfunction, vascular smooth muscle hyperreactivity, inflammation, oxidative stress, autonomic imbalance, and genetic susceptibility, with notable ethnic and sex-related differences. Diagnosis relies on integration of clinical features, electrocardiographic changes, and invasive coronary provocation testing using acetylcholine or ergonovine, supported by advanced imaging and functional assessment when microvascular involvement is suspected. Management is centered on calcium channel blockers and nitrates, aggressive risk factor modification, particularly smoking cessation, and individualized strategies for refractory or high-risk patients. Improved recognition and standardized diagnostic pathways are essential to optimize outcomes and reduce life-threatening complications associated with CAS.

Shock is a life-threatening state of circulatory failure characterized by inadequate tissue oxygen delivery and cellular hypoxia. Lactate has emerged as a central biomarker in the diagnosis, risk stratification, and management of shock, yet its interpretation is complex and context dependent. Although traditionally viewed as a marker of anaerobic metabolism and tissue hypoperfusion, hyperlactatemia in distributive shock, particularly sepsis, frequently reflects multifactorial mechanisms, including increased aerobic glycolysis, adrenergic stimulation, mitochondrial dysfunction, and impaired hepatic clearance. This review examines the pathophysiology and classification of shock, the biochemical basis of lactate production and clearance, and the prognostic significance of both static lactate levels and lactate kinetics. We synthesize evidence supporting lactate as a robust prognostic marker while highlighting limitations of lactate-targeted resuscitation strategies. Emerging data favor multimodal approaches integrating lactate trends with complementary perfusion markers such as capillary refill time and central venous oxygen saturation. Lactate should be interpreted as one component of a comprehensive physiological assessment rather than an isolated therapeutic target.

Importance The Surgery as Needed for Oesophageal Cancer (SANO) trial introduced active surveillance as a noninferior alternative to esophagectomy for patients with esophageal cancer who achieve a clinical complete response (cCR) after neoadjuvant chemoradiation (nCRT). However, concerns remain about recurrence risk, long-term survival, and quality-of-life trade-offs with organ-preserving strategies. Objective To evaluate the long-term comparative effectiveness of active surveillance vs standard esophagectomy in patients with cCR following nCRT for locally advanced esophageal cancer, using updated data from the SANO trial. Design, Setting, and Participants This decision analytical model used Markov modeling and probabilities and utility inputs derived from the SANO trial and existing literature. The base case was a 60-year-old male with good functional status and cT3N1M0 esophageal cancer achieving cCR after nCRT. Exposures Standard routine esophagectomy vs active surveillance after neoadjuvant chemoradiation. Main Outcomes and Measures The primary outcome was quality-adjusted life-years (QALYs); the secondary outcome was life-years. Additional model scenarios explored (1) quality-of-life impacts of esophagectomy modeled as a time-varying covariate and (2) 2-year outcomes to align with the SANO trial time horizon. Sensitivity analyses evaluated recurrence probabilities and surgery-related quality-of-life trade-offs. Results At 5 years, standard surgery yielded greater QALYs (1.74 vs 1.34; incremental gain of 0.40 QALYs or ~4.8 months in perfect health) and life-years (3.11 vs 2.41; incremental gain of 0.70 life-years or ~8.4 months) compared with active surveillance. However, at a 2-year horizon, active surveillance was preferred for QALYs (incremental gain of ~15 days), consistent with the SANO trial. Sensitivity analyses revealed the model favored active surveillance when the recurrence probability was less than 43%, the likelihood of local/resectable recurrence was greater than 94%, or the negative quality-of-life impact of esophagectomy was substantial. Modeling esophagectomy’s quality-of-life impact as time limited further strengthened surgery’s long-term QALY benefit. Conclusions and Relevance This study found that while active surveillance offers short-term quality-of-life benefits and may be appropriate in select patients, particularly those at low recurrence risk or with high surgical risk, esophagectomy remains the preferred strategy for maximizing long-term survival and QALYs. These findings support a nuanced, individualized approach to post-nCRT management, balancing organ preservation with long-term oncologic outcomes.

Background: Colorectal cancer (CRC) is the second leading cause of cancer-related mortality worldwide, accounting for approximately 10% of all cancer cases. Despite the proven effectiveness of conventional screening modalities such as colonoscopy and fecal immunochemical testing (FIT), their invasive nature, high cost, and limited patient compliance hinder widespread adoption. Recent advancements in artificial intelligence (AI) and bowel sound-based signal processing have enabled non-invasive approaches for gastrointestinal diagnostics. Among these, bowel sound analysis—historically considered subjective—has reemerged as a promising biomarker using digital auscultation and machine learning. Objective: This review explores the potential of AI-powered bowel sound analytics for early detection, screening, and characterization of colorectal cancer. It aims to assess current methodologies, summarize reported performance metrics, and highlight translational opportunities and challenges in clinical implementation. Methods: A narrative review was conducted across PubMed, Scopus, Embase, and Cochrane databases using the terms colorectal cancer, bowel sounds, phonoenterography, artificial intelligence, and non-invasive diagnosis. Eligible studies involving human bowel sound-based recordings, AI-based sound analysis, or machine learning applications in gastrointestinal pathology were reviewed for study design, signal acquisition methods, AI model architecture, and diagnostic accuracy. Results: Across studies using convolutional neural networks (CNNs), gradient boosting, and transformer-based models, reported diagnostic accuracies ranged from 88% to 96%. Area under the curve (AUC) values were ≥0.83, with F1 scores between 0.71 and 0.85 for bowel sound classification. In CRC-specific frameworks such as BowelRCNN, AI models successfully differentiate abnormal bowel sound intervals and spectral patterns associated with tumor-related motility disturbances and partial obstruction. Distinct bowel sound-based signatures—such as prolonged sound-to-sound intervals and high-pitched “tinkling” proximal to lesions—demonstrate the physiological basis for CRC detection through bowel sound-based biomarkers. Conclusions: AI-driven bowel sound analysis represents an emerging, exploratory research direction rather than a validated colorectal cancer screening modality. While early studies demonstrate physiological plausibility and technical feasibility, no large-scale, CRC-specific validation studies currently establish sensitivity, specificity, PPV, or NPV for cancer detection. Accordingly, bowel sound analytics should be viewed as hypothesis-generating and potentially complementary to established screening tools, rather than a near-term alternative to validated modalities such as FIT, multitarget stool DNA testing, or colonoscopy.

ABSTRACT Squid sucker ring teeth proteins (suckerins) have recently been shown to exhibit higher molecular‐level adhesion than mussel adhesive proteins–a well‐known class of wet‐resistant adhesive proteins–and can also assemble into nanoparticles in aqueous conditions. Herein, we present recombinant suckerin‐12 colloids and hydrogels as bioadhesives with strong wet adhesion and excellent in vivo biocompatibility. These colloids and hydrogels displayed low cytotoxicity, minimal immunogenicity, and negligible hemolysis, while outperforming fibrin glue in hemostasis, skin cell proliferation and migration, wound closure, and healing. Suckerin hydrogels formulated via riboflavin‐mediated di‐tyrosine crosslinking preserved β‐sheet content and elasticity at an optimal crosslinking density, resulting in enhanced adhesion, hemocompatibility, and in vivo wound closure. Transcriptomic analysis further revealed regulation of genes associated with hemostasis, angiogenesis, proliferation, and re‐epithelialization, with minimal immune activation. Together, these findings establish suckerin‐based adhesives as promising next‐generation biomedical materials that combine scalability, stability under oxidative conditions, and superior performance for external wound repair.