Citations

Abstract Introduction Ultrasonic vaping devices like SURGE are marketed as safer alternatives to conventional coil-based electronic cigarettes like JUUL due to their lower operating temperatures. However, their impact on cardiovascular health has not been fully characterized. Methods Sprague–Dawley rats were exposed daily for 9 weeks to aerosol generated from SURGE, JUUL, or clean air. Heart rate variability was continuously monitored via implanted telemetry. Cardiac fibrosis was quantified using histological analysis. Temperature profiles of SURGE, JUUL, and Nautilus (a coil-based tank device) were recorded. Aerosol samples were analyzed for carbonyl compounds using high-performance liquid chromatography. Results Both SURGE and JUUL exposures significantly reduced heart rate variability (high frequency and total power) compared with air. JUUL exposure significantly increased cardiac fibrosis; SURGE showed a similar mean fibrosis level but greater variability, resulting in a non-significant difference. SURGE devices operated at lower peak temperatures (~131°C) than JUUL (~239°C) and Nautilus (~160–170°C). Despite having the lowest temperature, SURGE emitted higher levels of carbonyl compounds than JUUL, although still substantially lower than Nautilus. Conclusions Although SURGE operates without coils and at lower temperatures than coiled vaping devices, it generates higher levels of carbonyls than some coiled devices and impairs cardiac autonomic regulation, and it can cause cardiac fibrosis comparable with JUUL although with high variability; that is, SURGE does not reliably avoid the increase in fibrosis caused by conventional electronic cigarettes. These findings suggest that non-thermal mechanisms predominate in mediating cardiovascular toxicity associated with ultrasonic vaping, challenging the assumption that coil-free designs are inherently safer. Implications Despite its lower operating temperature and coil-free design, the SURGE ultrasonic vaping device impaired cardiac autonomic function and promoted fibrosis at a mean level comparable to that of JUUL. These findings challenge claims of reduced harm from coil-less vaping technologies and suggest that non-thermal mechanisms may drive toxicity. Regulatory evaluations should consider device emissions and physiological outcomes—not just hardware features. Physicians and policymakers should be aware that coil-less systems may still pose cardiovascular risks, and marketing these devices as inherently safer may mislead users and undermine tobacco harm reduction efforts.

Abstract Hyperpolarized [1-¹³C]pyruvate MRI provides real-time, radiation-free insight into myocardial pyruvate metabolism and mitochondrial oxidative capacity, yet its utility in patients with severe multivessel coronary artery disease before and after surgical revascularization remains unknown. Here we show, in the first prospective study applying this technique to three-vessel disease, that serial imaging is feasible and safe with no serious adverse events in 22 injections. Healthy myocardium displayed a bicarbonate-to-total hyperpolarized carbon product ratio of 0.66 ± 0.13, indicating that the majority of pyruvate undergoes oxidation. Patients exhibited significantly lower ratios in the inferolateral segment (P = 0.03) with reciprocal increases in lactate, and global ratios correlated with left ventricular ejection fraction (r = 0.695, P = 0.006). Post-revascularization changes were heterogeneous across individuals. These findings establish hyperpolarized 13C MRI as a powerful tool for noninvasive assessment of myocardial metabolism in multivessel coronary artery disease and support its potential for longitudinal therapeutic monitoring.

Chylous effusion is a complication most frequently seen in the iatrogenic setting secondary to thoracic surgery or other intervention. Management of this complication includes conservative measures, surgical exploration/ligation, and percutaneous thoracic duct embolization. This case presents a medically complex patient with persistent chylous effusions after thoracoscopic resection of a fluorodeoxyglucose (FDG) and Cu 64 DOTATATE-avid retrocrural lymph node. Initial conventional fluoroscopic lymphangiogram and thoracic duct embolization were unsuccessful. Subsequent magnetic resonance lymphangiography (MRL) more accurately localized the leak which was then marked with computed tomography-guided needle placement before conversion to fluoroscopically guided embolization. This case demonstrates the utility of MRL as a problem-solving tool for localizing hard-to-treat lymphatic leaks. MRL localized embolization is a safe and effective treatment for lymphatic leaks.

Advances in cancer treatment by chemotherapy, radiation, and personalized targeted therapy have significantly improved cancer survivorship. Life extension from chemotherapy is arguably the most accessible non-surgical treatment strategy, but it is accompanied by neurotoxic sequelae that are detrimental to cognitive function in survivors. Using the platinum-based drug cisplatin to model chemotherapy induced cognitive impairments (CICI; also called chemobrain) in mice, we recently identified that elevated hippocampal adenosine A 2A receptor (A 2A R) levels are causally associated with CICI. Although neuroinflammation is a major pathological mechanism underlying CICI, it remains unclear whether A 2A R mediates cisplatin-induced neuroinflammation. To address this knowledge gap, we demonstrate for the first time that cisplatin increases microglial process extension and branching complexity, consistent with a primed, hyper-surveillant morphological phenotype. Remarkably, caffeine, a non-specific A 2A R antagonist and known cognitive enhancer, attenuated the primed microglial morphology caused by cisplatin. Furthermore, we show that caffeine mitigates cisplatin-induced body-weight loss, accelerates physical recovery, and protects against motor dysfunction. We also show that caffeine confers protection against cisplatin potentiated impairments in hippocampal dendritic spine density, neurogenesis, and confers modest memory benefits. Collectively, these results suggest that A 2A R-mediated microglial priming is associated with cognitive dysfunction in chemobrain and A 2A R inhibition by caffeine may represent a strategy to ameliorate the physical and cognitive impairments caused by cisplatin.

ABSTRACT Background and Purpose White matter hyperintensities (WMH) are a core neuroimaging marker of cerebral small vessel disease (CSVD). Sleep apnoea (SA) is a recognized vascular risk factor, but its associations with regional WMH burden, short‐interval WMH change and cognitive performance in population‐based cohorts remain incompletely defined. We examined these associations in the UK Biobank imaging cohort. Methods We conducted cross‐sectional analyses with an exploratory longitudinal subset in propensity score–matched cohorts excluding major neurologic and cerebrovascular disease before imaging. SA was identified from hospital records and self‐reports prior to brain magnetic resonance imaging (MRI). Head‐size–normalized WMH volumes were analysed on the log1p scale using multivariable linear regression with robust standard errors. Total WMH was the primary outcome; periventricular WMH (PWMH), deep WMH (DWMH) and cognitive measures were secondary outcomes. Mediation analyses evaluated WMH as a mediator of SA–cognition associations. Results In cross‐sectional analyses ( N = 12,890; mean age, 67.4 years; 27.2% women), SA was associated with greater WMH burden. Total WMH volume was 10.7% higher among participants with SA (95% CI, 5.0%–16.6%; p < 0.001). PWMH and DWMH volumes were 10.0% (95% CI, 4.7%–15.7%; q < 0.001) and 15.7% (95% CI, 7.1%–25.1%; q < 0.001) higher, respectively. SA was associated with modestly worse cognitive performance, with effect estimates attenuated after adjustment for WMH burden and cardiometabolic conditions. Mediation analyses indicated that WMH burden, particularly PWMH, mediated associations between SA and cognitive performance. In the longitudinal subset ( N = 698; median follow‐up, 2.26 years), no significant between‐group differences were observed in annualized WMH change. Conclusions In this large population‐based imaging cohort, SA was associated with higher WMH burden, a key neuroimaging marker of CSVD. Cognitive differences were modest, but WMH burden, particularly PWMH, consistently mediated associations between SA and cognitive performance. Longer term studies are needed to clarify temporal relationships and potential treatment effects.

Introduction The unproven stem cell intervention (SCI) industry markets stem cell products to patients navigating chronic and serious conditions who seek alternative options when conventional treatments no longer offer relief or improvement. This market is often characterized by providers using deceptive advertising to misinform potential consumers to seek stem cells that have not been shown to be safe and/or effective through clinical studies. Objective This study examines how patients describe interpersonal and institutional trust in relation to their interest in and decisions about unproven SCIs among two distinct and divergent chronic disease patient groups: patients with little or no interest in unproven SCIs (low seekers) and those with high interest or have undertaken an unproven SCI (high seekers). Methods A semi-structured interview guide was developed deductively and modified inductively based on the Unified Theory of Health Behavior. Qualitative interviews among 36 patients and carers were conduct and transcripts were analyzed using constant comparison based on the principles of grounded theory. Results Trust varies across social contexts as low seekers expressed strong reservations about the commercialization elements of the SCI industry placing greater confidence in conventional medicine. In contrast, high seekers questioned the advice of conventional providers and motives of medical regulators. Across both, personal relationships were commonly described as influential in how participants evaluated unproven SCIs. Conclusion These findings suggest that communication efforts in clinical settings should account for the relational and emotional dimensions of trust. Interventions aimed at countering misleading information and promoting informed choices should engage trusted messengers and address the broader social and psychological contexts in which patients may seek unproven SCIs.