Citations

Abstract Aims Left ventricular hypertrophy (LVH) regionality carries diagnostic and prognostic importance. Mean absolute deviation of maximum segmental wall thickness (MadWT) is a novel left ventricular wall thickness (LVWT) heterogeneity biomarker from cardiovascular magnetic resonance imaging (CMR). Objectives To compare MadWT to indexed LV mass (LVMi), maximum (MaxWT) and mean (MeanWT) wall thickness to predict incident cardiovascular disease (CVD) and differentiate physiological from pathological LVH in highly physically active individuals. Methods and results Deep learning-assisted analysis of 44 930 UK Biobank CMR scans produced WT indices. Cox regression modelled major adverse cardiovascular events (MACE), heart failure (HF), arrhythmia, and all-cause death against LVWT indices. In the top 1% most physically active biomarker differences between propensity score matched hypertensive and non-hypertensive groups were compared. Over median (Q1, Q3) follow-up of 5.7 (4.9, 7.1) years, MadWT, MaxWT, MeanWT, and LVMi were associated with greater risk of MACE, HF, arrhythmia (P < 0.05), but not all-cause death (P > 0.05). After adjusting for CMR biomarkers, including LVMi, MadWT remained independently prognostic of the greatest number of endpoints, including MACE, HF, and arrhythmia [HR 1.13 (1.04–1.23); HR 1.15 (1.01–1.32); and HR 1.26 (1.18–1.35) respectively]. In the top 1% most physically active by three metrics, MadWT was the only significantly different biomarker between hypertensive and non-hypertensive participants (P < 0.05). Conclusion MadWT is important prognostically beyond LV mass and may be useful when differentiating physiological from hypertensive LVH. Although findings require confirmation in athletic and diseased cohorts, MadWT is readily translatable to deep learning-assisted clinical CMR reporting, especially in early unexplained LVH.

Balloon-assisted dilation (BAD) of paranasal sinus ostia is a Food and Drug Administration (FDA)-approved minimally-invasive procedure used to treat medically refractory chronic rhinosinusitis. Several large cohort studies have reported relatively-low complication rates with BAD. Thus, users of this technology may perceive this to be a safer alternative to formal dissection of the frontal and sphenoid sinus and perform these as office-based procedures. Here, we present 2 patients who underwent BAD of the sphenoid sinus and developed cerebrospinal fluid leak (CSF) leaks with pneumocephalus. Both patients had thinning of the planum sphenoidale in generously-pneumatized sphenoid sinuses. Although BAD is considered safe, review of the current literature demonstrates that serious complications can occur. These case reports demonstrate the potential for skull base injury, particularly in hyper-pneumatized sphenoid sinuses with dehiscent bone. Preoperative anatomic evaluation is crucial to identify at-risk patients. During BAD, trauma to critical structures may cause CSF leak and result in pneumocephalus. This knowledge is important for improving surgical decision-making and patient counseling. Level of Evidence: III.

Abstract Objective Perimenopause is an under-recognized transition poorly measured by existing tools, which often overlook symptoms characteristic of this phase. To address this, we developed and validated the Perimenopause Symptom Scale (Peri-SS): a concise, phase-specific, psychometrically robust instrument for digital self-assessment and research use among U.S. women aged 35-59 who self-reported in perimenopause. Methods We conducted a longitudinal validation study with 1,255 U.S. women aged 35-59 (633 identified as perimenopausal) recruited via Prolific. Participants completed the Peri-SS, Menopause Rating Scale (MRS), and EuroQol 5-Dimension, 5-Level (EQ-5D-5L) at baseline and 7-14 days later. Following COSMIN guidelines, we assessed structural validity, internal consistency, test-retest reliability, criterion and construct validity, and responsiveness to change. Results The Peri-SS demonstrated strong psychometric performance. Confirmatory factor analysis confirmed a four-domain structure (vasomotor, psychological, sexual, physical), with excellent model fit (CFI = 0.932, RMSEA = 0.069). Internal consistency was excellent (α = 0.90 overall; domain range 0.73-0.86), and test-retest reliability was high (ICC = 0.82). Criterion validity was strong, with Peri-SS scores highly correlated with MRS (r = 0.88). Construct validity was supported through moderate correlations with EQ-5D-5L utilities (ρ = -0.50) and effective discrimination between groups by age, menopausal status, and hormone therapy use. The scale was also responsive to symptom changes over time (η² = 0.277). Conclusions The Peri-SS is a reliable, valid, responsive tool for assessing perimenopausal symptom burden. Its concise format and strong psychometric performance make it well-suited for research, clinical care, and digital health applications. Two sentence summary The Perimenopause Symptom Scale (Peri-SS) is a novel 16-item instrument developed to measure symptom burden during perimenopause across four domains. In a validation study among U.S. women aged 35-59 years, the Peri-SS demonstrated strong reliability, validity, and responsiveness, supporting its use in research, clinical care, and digital health settings.

Abstract Molecular characterization of high-grade B-cell lymphoma, not otherwise specified (HGBCL-NOS), is hindered by its rarity, evolving definition, and poor diagnostic reproducibility. To address this challenge, we analyzed 92 HGBCL-NOS tumors collected across Lymphoma/Leukemia Molecular Profiling Project sites. Leveraging comparison cohorts of diffuse large B-cell lymphoma, NOS (DLBCL-NOS) and Burkitt lymphoma (BL), and molecular frameworks described in these entities, our analysis revealed a heterogenous molecular landscape, reminiscent of DLBCL-NOS but with an enrichment of BL features. By cell-of-origin classification, 59% were germinal center B-cell–like (GCB), and 25% were activated B-cell–like (ABC). LymphGen, a genetic classifier for DLBCL-NOS, assigned a genetic subtype to 34% of HGBCL-NOS. Although classification rate was lower than in DLBCL-NOS (66%), assigned subtypes spanned the spectrum of LymphGen classes, including 31% of ABCs classified as MCD. Features differentiating HGBCL-NOS from DLBCL-NOS included MYC rearrangement (47% vs 6%); dark zone signature (DZsig) expression (45% vs 7%); and more frequent mutation of ID3, MYC, CCND3, and TP53, all common to BL. A genetic classifier that differentiates DLBCL-NOS from BL classified 53% of DZsig+ tumors as BL-like, and those classified as DLBCL-like were frequently BCL2-rearranged. Among DZsig− GCB tumors, 95% were DLBCL-like. Centralized pathology review reclassified almost half of tumors as DLBCL-NOS but did not identify a more homogenous HGBCL-NOS population, with no difference in features between confirmed and reclassified tumors. In conclusion, molecular testing enables a subset of HGBCL-NOS to be assigned to established categories. Based on rarity and diagnostic challenges, broader inclusion of HGBCL-NOS should be considered in biomarker-driven DLBCL trials.

Objective: Obesity is thought to negatively affect outcomes of in-vitro fertilization (IVF), however its impact on minimal stimulation (MiST) cycles is unclear. This study aims to explore the effect of elevated body mass index (BMI) on blastulation rate (BR) and clinical pregnancy rate (CPR) in patients undergoing MiST. Design: Retrospective cohort analysis of patients who underwent MiST at a single academic fertility center over four years. Patients were grouped by BMI to assess associations between BR and CPR. Materials and Methods: Patients aged 18-44 were identified who underwent MiST at Mayo Clinic between 10/1/2020, and 12/1/2024. BR was calculated as each patient’s total blastocysts divided by total 2PN embryos; embryos and blastocysts were pooled in those with multiple cycles. CPR was calculated as each patient’s total number of clinical pregnancies divided by total embryo transfers. Patients were stratified into two BMI groups: underweight/normal (BMI <25, n=58) and overweight/obese (BMI ≥25, n=76). Quasibinomial logistic regression evaluated the association between BMI (per 5-unit increase) and both BR and CPR. Results: 134 patients were identified. 58 patients in the normal BMI group underwent 117 stimulation cycles and 67 transfers. 76 patients in the elevated BMI group underwent 139 stimulation cycles and 81 transfers. Age and anti-mullerian hormone levels were similar between groups. In the normal BMI group, BR 59.6%, CPR 45.6%, and cumulative pregnancy rate 45.6%. In the elevated BMI group, BR 62.3%, CPR 45.8%, and cumulative pregnancy rate 58.8%. BR and CPR did not differ significantly between BMI groups (BR p=0.652; CPR p=0.982). Per logistic regression, increasing BMI was not significantly associated with BR (95% CI: 0.77-1.07, p = 0.25) or CPR (95% CI: 0.76-1.30, p = 0.94). Conclusions: In this cohort, high BMI was not associated with significantly lower BR or CPR in patients undergoing MiST. Support: Institutional research funding.

Abstract: Papillary eccrine adenoma/tubular apocrine adenoma (PEA/TAA) is a rare sweat gland neoplasm. Because PEA/TAA shares morphologic features with other sweat gland tumors, including digital papillary adenocarcinoma, histologic diagnosis may be challenging. We report a case of PEA/TAA presenting as a nodule on the left foot of a 43-year-old man. Histopathologic examination revealed a well-circumscribed dermal proliferation of variably sized glands composed of ductal cells with an outer layer of myoepithelial cells. By immunohistochemistry, the ductal tumor cells showed strong, diffuse expression of BRAF V600E, and the myoepithelial cells were positive for p63. This case illustrates the utility of immunohistochemistry in the diagnosis of this rare neoplasm. Particularly when PEA/TAA is located on an acral site, distinction from digital papillary adenocarcinoma is critical, because these tumors show significant differences in clinical behavior.

Case: An upper trunk brachial plexus injury patient underwent ulnar motor fascicular to biceps motor nerve transfer. At 6 months postoperative, the patient had trace biceps firing but was diagnosed with an unrecognized rupture of the distal biceps tendon, requiring reconstruction. Another patient with C5-T1 injury was noted to have distal biceps tendon rupture at the time of gracilis muscle transfer. Both patients had gravity-assisted elbow flexion at 1-year follow-up. Conclusion: Biceps rupture is an uncommon concomitant injury with brachial plexus trauma and challenging to diagnose in the context of a paretic limb. Thorough history and intraoperative biceps tendon palpation will ensure these injuries are identified.