Citations

Advances in plaque imaging have transformed cardiovascular diagnostics through detailed characterization of atherosclerotic plaques beyond traditional stenosis assessment. This review outlines the clinical applications of varying modalities, including dual-layer spectral CT, photon-counting CT, dual-energy CT, and CT-derived fractional flow reserve (CT-FFR). These technologies offer improved spatial resolution, tissue differentiation, and functional assessment of coronary lesions. Additionally, artificial intelligence has emerged as a powerful tool to automate plaque detection, quantify burden, and refine risk prediction. Collectively, these innovations provide a more comprehensive approach to coronary artery disease evaluation and support personalized management strategies.

ABSTRACT Background Chronic neurogastroduodenal disorders are challenging to manage, with therapy often initiated on a trial and error basis. Prokinetics play a significant role in management, but responses are variable and have been associated with adverse events, impacting widespread use. We investigated whether body surface gastric mapping (BSGM) biomarkers (using Gastric Alimetry) could inform patient selection for prokinetic therapy. Methods Patients with chronic gastroduodenal symptoms taking oral prokinetic agents, regardless of gastric emptying status, were prospectively recruited and underwent BSGM (30 m baseline, 482 kcal standardized meal, 4 h postprandial recording) while off‐prokinetic agents. Patients were followed up with daily symptom diaries. A subset was compared to matched patients not taking prokinetic agents. Prokinetic responders were defined based on symptom improvement greater than a minimum clinically important difference methodology. Key Results Forty‐two patients (88% female; median age 36; median BMI 26) taking prokinetics were analyzed. Prokinetic prescribing, compared to matched patients, was independent of BSGM metrics ( p > 0.15). In patients on existing prokinetics (withheld for BSGM), lower amplitudes predicted reduced symptom burden, whereas low rhythm stability predicted a worse symptom burden ( p < 0.05). In prokinetic‐naive patients (i.e., started on a prokinetic during the study), a lower postprandial amplitude predicted responders (mean 37.5 ± 10.6 uV in responders [ n = 5] vs. mean 54.8 ± 6.6 uV among nonresponders [ n = 3], p = 0.047). Conclusions Gastric Alimetry biomarkers may help in the prediction of prokinetic response in patients with chronic gastroduodenal symptoms. Lower postprandial amplitudes, indicating a reduced meal response, appear to predict benefit, while impaired rhythm stability predicted poorer therapeutic response.

Pelvicalyceal invasion (PCI) is a relatively novel pT3a staging parameter for renal cell carcinoma (RCC) nephrectomies. While interobserver reproducibility staging studies of sinus/vascular invasion in RCC exist, a similar evaluation for PCI has not been performed. Moreover, in our experience, there is also diagnostic variability in how pathologists interpret PCI. Herein, we explore interobserver reproducibility among genitourinary (GU) pathologists. Twenty hematoxylin and eosin-stained digitized slides from RCCs (all grossly approaching the renal pelvis) were distributed to 31 GU pathologists to classify each as PCI or not PCI based on their respective clinical practices; slides with concomitant sinus/fat/vascular invasion were excluded. Slides were then evaluated for the following 4 morphologic features: tumor abutting renal pelvis, tumor pushing/indenting into the renal pelvis, polypoid configuration of tumor into the renal pelvis, and tumor eroding through renal pelvic urothelium. Interobserver reproducibility was assessed, and the morphologic features were correlated with PCI. Relationships between pathologists’ interpretations, morphologic features, and PCI were evaluated using hierarchical clustering. Although the diagnosis of PCI was relatively uniform with a majority agreement (>67%) reached in 16/20 slides, overall interobserver reproducibility was only moderate (kappa=0.601). While all 4 morphologic features were sensitive for PCI, polypoid configuration of the tumor into the renal pelvis and the tumor eroding through the renal pelvic urothelium were most specific (90%, 100%, respectively). Although we show general consensus among genitourinary pathologists on PCI assessment, clarifying the diagnostic guidelines with specific criteria should be included in pathologic staging systems.

A BSTRACT An adolescent boy presented with a history of penetrating trauma from a bicycle handlebar injury to the left lower abdomen. A computed tomography (CT) scan and a diagnostic laparoscopy showed extraperitoneal bladder rupture, which was repaired. In the postoperative period, a micturating cystourethrogram revealed a rectovesical fistula (RVF), which was managed conservatively with a Foley catheter. This case depicts a rare complication of RVF in a case of penetrating trauma abdomen managed conservatively with a unique mechanism of injury.

ABSTRACT Background Preparation of the right ventricular outflow tract (RVOT) using covered stent placement is a common preparatory step for transcatheter pulmonary valve replacement (TPVR) to reduce the risk of disruption associated with dilating calcified RVOT conduits. Aim We present a novel method employing a self‐expanding covered aortic endoprosthesis and discuss its advantages as an alternative strategy. Methods Patients with congenital heart disease undergoing RVOT conduit preparation with the GORE TAG Thoracic Branch Endoprosthesis Extender (W.L. Gore & Associates, Newark, DE) followed by TPVR, were prospectively enrolled in a dedicated database. To date, 14 patients have been included. Data on demographics, diagnoses, procedural details, hemodynamic parameters, and outcomes were analyzed. Results Fourteen patients (median age: 35 years [range: 18–79]; 57% female) successfully underwent endograft placement immediately before TPVR. Treated conduits included pulmonary homografts ( n = 8), surgical bioprostheses ( n = 2), Hancock conduit ( n = 1), Contegra conduit ( n = 1), native RVOT ( n = 1), and Melody valve within a surgical bioprosthesis ( n = 1). Most patients presented with mixed stenosis and regurgitation ( n = 9), with the remaining having stenosis ( n = 4) or regurgitation ( n = 1). Valves implanted post‐preparation included the Sapien S3 valve (Edwards Lifesciences, Irvine, CA) ( n = 10) and the Melody valve (Medtronic, Minneapolis, MN) ( n = 5). Significant reductions in RVOT systolic gradient were observed (median 34 mmHg pre‐procedure to 3 mmHg post‐procedure), along with marked conduit expansion (median diameter 13 mm pre‐procedure to 25.5 mm post‐procedure). No complications were reported. Conclusions This study highlights the feasibility of a self‐expanding aortic endoprosthesis for RVOT preparation before TPVR. Further comparative study is warranted. Procedural success was achieved in all cases.

Abstract INTRODUCTION Mitochondrial dysfunction is implicated in Alzheimer's disease (AD), but whether it drives AD‐associated changes is unclear. We assessed transcriptomic alterations in the brains of Ndufs4 −/− mice, a model of mitochondrial complex I (mtCI) deficiency, and evaluated the therapeutic effects of the neuroprotective mtCI inhibitor CP2. METHODS Cortico‐hippocampal tissue from Ndufs4 −/− and wild‐type mice was subjected to transcriptomic analysis, followed by cross‐species comparisons to human late‐onset AD and familial AD mouse datasets. RESULTS Knockout of Ndufs4 ‐mediated mtCI deficiency disrupted mitochondrial homeostasis, energy metabolism, and synaptic gene expression, recapitulating transcriptomic signatures of AD. CP2 treatment partially reversed these changes, with female Ndufs4 −/− mice showing greater compensatory adaptations and treatment responses. DISCUSSION Loss of mtCI activity alone is sufficient to induce AD‐like molecular changes in the brain, independent of amyloid beta or phosphorylated tau. CP2‐mediated rescue highlights the potential of targeting mitochondria as a therapeutic strategy for AD. Sex‐specific responses suggest important considerations for personalized therapeutics. Highlights Activity of mitochondrial complex I (mtCI) affects broad mitochondrial and neuronal transcriptional networks. A reduction of mtCI activity is sufficient to induce transcriptomic changes reminiscent of those observed in late‐onset Alsheimer's disease (AD) patients and familial mouse models of AD. Pharmacological targeting of mtCI mediates neuroprotective signaling. Male and female mice have differential responses to the loss of mtCI activity and to the mitochondria‐targeted therapeutics. Mitochondria play a key role in AD development and treatment.

Nonmedical stimulant use (NMSU) among adolescents poses significant public health concerns. Using cross-sectional design, this study examined risk and protective factors for NMSU among 20,576 Florida high school students using the 2020 Florida Youth Substance Abuse Survey, with 925 students reporting NMSU. Guided by Hawkins and Catalano’s Social Development Model, we employed multivariate logistic regression analyses to estimate adjusted odds ratios while controlling for demographics. Students engaged in extracurricular activities were 50% less likely to report NMSU. Higher academic performance was associated with lower NMSU likelihood. Students with friends who used stimulants nonmedically were significantly more likely to engage in NMSU (AOR, 7.60; 95% CI: 6.35, 9.10), as were those living with relatives who used substances (AOR, 3.54; 95% CI: 2.94, 4.26). Findings highlight the importance of extracurricular involvement and positive social networks in mitigating NMSU. Interventions addressing family, peers, and extracurricular involvement are crucial for prevention and evidence-based policies.

Background While rapid response teams (RRT) are widely implemented to address clinical deterioration in hospitalized patients, their impact on goals of care (GOC) discussions remains underexplored. Aims We aimed to evaluate whether RRT activations were associated with subsequent goals of care discussions, code status changes, and clinical outcomes. Methods We conducted a retrospective single-center review of hospitalized adult patients admitted to medicine services who had RRT activations between January and December 2023. The primary outcome was GOC discussion within 72 h of RRT. GOC discussions were identified through EMR documentation of conversations, code status changes, and ACP notes. Secondary outcomes included code status change, transition to comfort care, and 30- and 90-day mortality. Analyses were adjusted using inverse probability of treatment weighting. Results 1823 RRTs among 1677 patients were analyzed; 47% of patients were female and 88% identified as white. Those transferred to the ICU had higher odds of goals of care discussions (OR 1.52, P < 0.001), code status change (OR 2.43, P < 0.001), and transition to comfort care (OR 1.47, P = 0.026) compared to those who remained on the floor. ICU transfer was also associated with increased 30- (OR 1.39, P = 0.006) and 90-day mortality (OR 1.30, P = 0.014). Conclusions ICU transfer following RRT activation is strongly associated with downstream goals of care discussions, changes in code status, comfort-focused care, and higher mortality. This demonstrates the importance of initiating goals of care discussions early and often, regardless of whether clinical decompensation is anticipated.

Objective: To determine the impact of modifiable surgical factors on ossiculoplasty outcomes after controlling for ear environment risk. Study Design: Multi-institutional retrospective review. Setting: Six tertiary care centers from 2011 to 2019. Patients Adults and children. Interventions: Ossiculoplasty, including synthetic ossicular replacement prosthesis, autograft interposition, bone cement repair, and mobilization. Main Outcome Measure: Correlation between modifiable surgical factors and pure-tone average air-bone gap (ABG) at most recent audiogram after controlling for preoperative risk using the statistically validated Ear Environment Risk (EER) score. Results: A total of 1,679 cases were included with a median follow-up time of 20 months (IQR, 5–51). After controlling for EER score, malleus engagement of prosthesis yielded favorable ABG versus direct contact to tympanic membrane without malleus engagement (beta = −2.4 dB [−3.8, −1.1], p < 0.001). For total ossicular replacement prostheses (TORP), use of a footplate prosthesis yielded favorable ABG as compared with no footplate prosthesis (−3.6 dB [−6.1, −1.1], p = 0.005). For synthetic prostheses, polyethylene prostheses had a less favorable ABG compared with full titanium or titanium with hydroxyapatite prostheses ( p < 0.05). In cases where the malleus was not engaged in reconstruction, amputation of the malleus head yielded worse ABG (+3.9 dB [1.2, 6.7], p = 0.005). There was no significant difference ( p > 0.05) in ABG for single-stage versus multistaged approach, use of a cartilage cap over the prosthesis versus no cartilage, use of bone cement to secure a PORP to the stapes versus no cement, mastoid cavity obliteration versus no obliteration, and incudostapedial joint reconstruction with joint prosthesis/bone cement versus synthetic PORP. Conclusions: With statistical correction for ear environment risk, several modifiable surgical factors are noted to impact ossiculoplasty hearing outcomes. Level of Evidence: 4.