Citations

ABSTRACT Background Living kidney donation is a crucial option for addressing the global organ shortage and providing kidney transplantation for patients suffering from end‐stage kidney disease. Ensuring donor safety necessitates a comprehensive preoperative assessment of kidney anatomy and function. This study evaluates the relationship between kidney volumes derived from deep learning‐based MRI volumetry, intraoperative kidney volume measurements, split renal function measured by renal scintigraphy, and post‐donation eGFR. Deep learning‐based MRI volumetry is hypothesized to be a reliable method with good correlation. Methods This retrospective study analyzed 178 living kidney donors. Deep learning MRI volumetry‐based kidney volumes were compared with intraoperative volumes of the explanted donor kidneys obtained using the water displacement method. Additionally, MRI‐based volume ratios were compared with scintigraphy‐based split renal function ratios to determine their ability to predict the kidney with poorer renal function and post‐donation eGFR. Results Deep learning‐based MRI volumetry strongly correlated with intraoperatively measured kidney volumes (Pearson's correlation; r = 0.7671; p < 0.0001), confirming its precision in volume estimation. Although MRI‐based kidney volume ratios demonstrated only a moderate correlation with scintigraphy‐based split renal function ratios ( r = 0.4798), MRI volumetry correlated with 1‐year post‐donation eGFR. It tended to be better than renal scintigraphy ( r = 0.6829 versus r = 0.6191). Conclusion Deep learning‐based MRI volumetry is a reliable, non‐invasive tool for estimating kidney volumes in living donors, offering a radiation‐free alternative for preoperative assessment. While it differs from renal scintigraphy in evaluating split renal function ratios, its correlation with post‐donation eGFR tends to be better, supporting its potential role in living kidney donor assessment.

Abstract The environmental impact of computer-aided diagnosis (CADx) in colonoscopy is unknown. The potential to reduce greenhouse gas emissions by limiting unnecessary polypectomies may be offset by emissions associated with CADx devices. We quantified and compared the carbon footprint of colonoscopy with and without CADx. Life-cycle carbon emissions associated with endoscopic snares, polyp traps, histopathology, and CADx devices were estimated using life-cycle assessment software. The effect of CADx was estimated by the carbon dioxide equivalent (CO2e) emissions related to outcomes from a prospective cohort of patients who underwent colonoscopy with optical diagnosis under a leave-in-situ strategy (i.e. rectosigmoid polyps ≤5 mm predicted as non-neoplastic were not removed) with and without CADx assistance. We analyzed 1134 individuals (median age 67 years, 59% male) with 1716 colorectal polyps. Colonoscopy with CADx reduced the number of snares and polyp traps from 567 to 543 (difference: 24) and histopathology submissions from 1343 to 1278 (difference: 65). However, the total carbon footprint increased from 832 kg CO2e (95%CI 815 to 847) without CADx to 946 kg CO2e (95%CI 927 to 965) with CADx, corresponding to an absolute increase of 114 kg CO2e (95%CI 80 to 150) or 0.10 kg CO2e per colonoscopy. Using CADx under a leave-in-situ strategy increased the environmental burden of colonoscopy.

Withdrawal Statement bioRxiv has withdrawn this manuscript after being contacted by the current corresponding author because they are unable to access the original data for revisions needed to finalize the preliminary results. If you have any questions, please contact the current corresponding author.

Abstract Pain is a common postpartum complaint, yet data suggest that approaches to postpartum pain management vary widely. Given the goal of improving quality and equity in postpartum pain management, we aimed to examine whether and how clinicians' perspectives on postpartum pain management differed by clinician roles. This is a qualitative study at a large, tertiary, and academic medical center. From November 2021 to June 2022, obstetric clinicians, including attending physicians, trainee physicians, and advanced practice providers (APPs), were recruited to complete in-depth interviews regarding their clinical experience managing postpartum pain using a semi-structured interview guide. Participants were asked to reflect both on their own role and that of the other clinician types. Purposive sampling was used to enroll a cohort representative of the institutional workforce in terms of clinician type and demographics. Data were analyzed using the constant comparative method. Of 46 participants, 47.8% (n = 22) were attending physicians, and 91% (n = 42) were female. Emergent themes were both self-reflected and externally directed. Data demonstrated that postpartum pain management differs by clinician type and level of experience. Themes related to the role of attending physicians included responsibilities as teachers for trainees, supervisory roles, and perceptions that attendings have greater comfort with prescribing opioids. Themes related to the role of trainee physicians included the impact of patient load on trainees' management, limitations of morning rounds, familiarity with emerging data, and perceptions of hesitancy to prescribe opioids. Themes related to the role of APPs included less reliance on opioids for postpartum pain management and emphasis on nonpharmacological approaches. Perspectives on postpartum pain management vary by clinician role. Consideration of these differences and the interplay between roles is essential when examining opioid prescribing patterns and developing interventions to improve postpartum pain management.

Bridging locoregional therapy (LRT) is widely used in liver transplant (LT) candidates with hepatocellular carcinoma (HCC) to minimize waitlist dropout and evaluate tumor biology. While transarterial chemoembolization (TACE) has historically been the predominant approach, the role of transarterial radioembolization (TARE) is expanding. Comparative effectiveness data for these 2 modalities as bridging strategies remain limited. This study assessed the trends, factors influencing therapy selection, and outcomes of transarterial bridging LRT. We conducted a retrospective cohort study of adult LT candidates with HCC listed in the Organ Procurement and Transplantation Network (OPTN) between 2016 and 2024 who received TACE or TARE as their sole bridging LRT. Inverse probability weighting (IPW) was applied to balance baseline covariates. Multivariable Fine–Gray competing risk regression and stratified Cox proportional hazards and logistic regression models were used to assess waitlist dropout, complete pathological necrosis (CPN), recurrence, and overall survival. Among 8367 patients, 5472 (65%) received TACE, and 2895 (35%) received TARE. TARE use increased significantly from 22.5% to 51.7% over the study period. TARE was more likely to be used among patients with MASLD, older age, and high tumor burden, and less likely in those with lower socioeconomic status. TARE recipients had a significantly lower risk of waitlist dropout (sHR 0.83, p <0.001) and a higher likelihood of achieving CPN (aOR 2.24, p <0.001). The overall survival did not differ significantly between groups (aHR 0.94, p =0.19). The use of TARE as bridging therapy in HCC LT candidates has surged and is influenced by socioeconomic factors, comorbidities, and tumor burden. TARE effectiveness has been demonstrated by its advantages in waitlist retention and tumor necrosis. Further studies are warranted to evaluate its impact on post-LT recurrence and to validate the cost-effectiveness among transarterial therapies.

Background: Venous malformations can cause substantial morbidity and long-term complications. There are no Food and Drug Administration (FDA)-approved therapies for the treatment of venous malformations. However, off-label use of sirolimus has demonstrated clinical benefit in these patients. This systematic review evaluates the efficacy and safety of sirolimus in the management of venous malformations. Methods and Results: A systematic literature search identified 26 studies comprising 98 patients treated with sirolimus for venous malformations. Most studies were case reports or case series (77%), with 15% prospective trials and 8% retrospective analyses. Sirolimus, primarily administered orally, yielded some level of clinical improvement in 72% of reported patients, with consistent symptomatic relief observed in coagulopathy, bleeding, anemia, pain, and improved function. However, reduction in the size of the malformation varied and treatment-limiting side effects were observed. Conclusions: Oral sirolimus is a promising treatment option for venous malformations, especially for those with deep venous malformations. A direct, targeted topical treatment could provide clinical benefit for the cutaneous manifestation without the risk of off-target effects as occur with oral sirolimus. Further prospective, controlled studies are warranted to elucidate sirolimus’s role in managing venous malformations.

Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death in the United States and worldwide. HCC screening among patients at elevated risk is associated with improved early detection and overall survival, but current ultrasound-based screening strategies are challenged by low adherence and suboptimal sensitivity. Blood-based screening tests have the potential to enhance adherence and improve early-stage HCC detection if they can demonstrate favorable performance compared with ultrasound-based screening. Here we present the design and rationale for ALTUS (A lternative to Ultrasound), a prospective, longitudinal, multicenter study in the United States to investigate the performance of the multi-target HCC blood test (mt-HBT) for the detection of HCC in a screening population. Methods: Adults with liver cirrhosis or chronic hepatitis B infection will be enrolled to undergo standard-of-care screening imaging and concurrent blood collection for the mt-HBT. All participants will undergo contrast-enhanced CT or MRI imaging with central radiology LI-RADS assessment as the reference method to determine HCC status. Participants without an identified malignancy will undergo a second screening visit and blood collection, and longitudinal clinical and imaging data will be collected up to 18 months from enrollment. The primary study objectives are to demonstrate that the mt-HBT is non-inferior to ultrasound for early-stage HCC sensitivity and to assess mt-HBT HCC specificity. The secondary objective is to assess mt-HBT overall sensitivity. Results: ALTUS is in progress with readout of the primary analysis expected in 2025. Conclusions: This prospective head-to-head comparison of the mt-HBT versus ultrasound will provide novel data regarding the performance and utility of the mt-HBT for HCC screening.

PURPOSE This analysis aimed to contextualize the symptoms of peripheral neuropathy (PN) experienced by patients with triple-class refractory (TCR) multiple myeloma (MM) treated with elranatamab in the MagnetisMM-3 clinical trial with those experienced by patients with TCR MM receiving a new line of physician's choice of therapy in the real-world MagnetisMM-14 study. METHODS MagnetisMM-3 included 123 patients and MagnetisMM-14 included 35 who had TCR MM and were enrolled under the same eligibility criteria. Patient-reported symptoms of PN were collected monthly using the Chemotherapy-Induced Peripheral Neuropathy-20 item (CIPN20) questionnaire and compared for clinically meaningful differences across sensory, motor, and autonomic domains. Higher scores indicated worse patient-reported PN symptoms. RESULTS Baseline demographics and clinical characteristics for patients in MagnetisMM-3 and MagnetisMM-14 were generally similar. Patients in MagnetisMM-3 had a median of five ( v four in MagnetisMM-14) prior lines of therapy. In MagnetisMM-14, common index therapies included elotuzumab + pomalidomide (23%), carfilzomib + pomalidomide (19%), or carfilzomib + cyclophosphamide (19%), all with corticosteroids. Mean scores for sensory (15.8 v 14.8) and motor (14.4 v 12.2) domains of the CIPN20 were similar between MagnetisMM-3 and MagnetisMM-14 at baseline. Mean scores for the autonomic domain were 14.0 versus 21.3 at baseline, respectively. No clinically meaningful differences for any domain were found between month 6 scores or changes in scores from baseline to month 6 between MagnetisMM-3 and MagnetisMM-14 populations. CONCLUSION These findings suggest that elranatamab treatment was not associated with a worsening of patient-reported PN symptoms across the sensory, motor, and autonomic domains of the CIPN20. Moreover, PN symptoms reported with elranatamab treatment were similar to those reported with other common therapies used in real-world clinical practice for the management of MM. MagnetisMM-3 ClinicalTrials.gov identifier: NCT04649359 .

Abstract For occlusion experiments of 9 dogs [1], the infarcted and not-infarcted regions of left ventricular cross sections have been investigated by application of a plane-strain finite-element method to determine the change in the wall passive stiffness, or, Young’s modulus E [2]. The present paper reports how the instantaneous strain equation derived from the myocardium-blood composite model [3,4] can be utilized to obtain a formula for calculation of the ratio of extended myocardial fiber length in the infarcted (IN) region and that in the not-infarcted (NI) region of left ventricular cross section during the diastole phase of cardiac cycle. This formula uses the blood volume fraction (f) data [5] listed in Table 1 and the ventricular wall thickness (t) directly measurable from the LV walls as visualized in short-axis tomographic images of the LV.