Citations

We report the rare coexistence of extensive coronary-cameral fistulas (CCFs) with aneurysmal dilatation of coronary arteries and an incidental left ventricular papillary fibroelastoma (PFE) in a female in her early 70s who presented with chest pain and lower extremity oedema. Multimodality imaging, including transoesophageal echocardiography, cardiac CT and coronary angiography, confirmed the diagnosis. The PFE was surgically resected to prevent embolic complications, while the CCFs were managed conservatively due to their haemodynamic insignificance. This case demonstrates that even extensive CCFs may be haemodynamically insignificant, while a small PFE can pose a significant embolic threat, justifying disparate management strategies guided by multimodality imaging and haemodynamic assessment.

Abstract Background Dual‐contrast imaging of iodine and bismuth has shown promise in previous phantom and animal studies utilizing spectral CT. However, these studies often employed Pepto‐Bismol containing bismuth subsalicylate with dosages exceeding the recommended limits for human consumption, limiting their clinical applicability. Purpose The purpose of this study was to improve iodine–bismuth dual‐contrast imaging on a clinical photon‐counting CT (PCCT) system using a noise‐optimized virtual monoenergetic imaging (VMI) approach. Methods Four bismuth samples (0.6, 1.3, 2.5, and 5.1 mg/mL) and three iodine rods (1.0, 2.0, and 5.0 mg/mL) were inserted into a multi‐energy CT phantom and scanned on a PCCT system at 140 kV. VMIs were generated from 40 to 190 keV in 10 keV increments. Iodine and bismuth maps were computed for all possible keV pairs using a generic image‐based three‐material decomposition method and compared with maps generated from the original low‐/high‐energy PCCT images. Mass concentrations, noise levels, and individual as well as joint root‐mean‐square error (RMSE) for iodine and bismuth were measured to determine the optimal keV pair. The contrast‐to‐noise ratios (CNRs) of low concentration samples (bismuth: 0.6 and 1.3 mg/mL; iodine: 1.0 mg/mL) were calculated at the optimal keV pair and compared to the values determined with the original PCCT images. In an IRB‐approved feasibility study, a research patient was administered two doses of Pepto‐Bismol prior to a routine abdomen‐pelvis CT scan. Material decomposition was performed using both the original low‐/high‐energy images and the optimal VMI pair identified in the phantom study. Bismuth signals in the stomach and proximal small bowel were assessed qualitatively and quantitatively. Results The VMI pair of 110 and 190 keV was determined to be optimal, achieving the lowest joint RMSE of 0.49 mg/mL, compared to 1.42 mg/mL for the original low‐/high‐energy pair. It also yielded the highest CNR, representing a 190–318% improvement over the original low/high‐energy decomposition. Qualitatively, both phantom and patient studies demonstrated improved iodine–bismuth separation and reduced noise using the optimized VMI pair. Conclusions These findings suggest that noise‐optimized VMI selection can enhance dual‐contrast material decomposition performance on clinical PCCT, supporting its potential for translation into gastrointestinal imaging applications.

Abstract Background Red blood cell (RBC) transfusion may be lifesaving, however transfusion-transmitted infections (TTI) and transfusion-associated graft-versus-host disease (TA-GVHD) still pose a threat despite current donor selection and testing requirements. Amustaline (S-303)/glutathione (GSH) pathogen reduction (PR) is designed to inactivate infectious microbes and leukocytes in RBCs. The RedeS study evaluates the safety and efficacy of amustaline/GSH PR-RBCs compared to conventional RBCs in a broad spectrum of patients requiring acute and/or repeated RBC transfusion support. Methods RedeS is a Phase 3, prospective, multi-center, randomized, double-blind, active-controlled, parallel-design study, with a 6-month extension option to evaluate patients requiring repeated transfusions including red cell exchange (RCE).Eligible subjects will be stratified according to site, baseline bleeding status and participation in the extension period. The study arms include a transfusion period of 28-days for anemia with any bleeding or non-bleeding patients or a 28-day+6-month extension for non-bleeding patients with chronic anemia requiring repeated simple transfusions, or for patients with sickle cell disease (SCD) expected to receive three RCE procedures. The study will seek to enroll 600-800 subjects in the overall safety analysis, including ~140 repeatedly-transfused subjects in the 6-month extension including up to 30 subjects receiving three RCE procedures. The primary safety endpoints are the proportion of patients with any treatment-emergent adverse events (TEAEs) related to study RBC transfusion through 28 days after the last study transfusion, and the proportion of patients with treatment-emergent antibodies with confirmed specificity to PR-RBCs. The primary efficacy endpoint is the hemoglobin (Hb) increment in subjects who are non-bleeding at baseline, adjusted for the grams of Hb transfused and averaged over multiple transfusions. With 352 evaluable transfused non-bleeding subjects (176 per treatment group) from either arm, the study will have 80% power to demonstrate non-inferiority, defined as a Hb increment treatment difference of no more than 15% of the Control group mean, assuming a Control arm coefficient of variation of 50%. Discussion RedeS will characterize the safety of amustaline/GSH PR-RBCs and is designed to demonstrate the non-inferiority of PR-RBCs to conventional RBCs with respect to Hb increment, a common pragmatic clinical assessment of RBC transfusion effectiveness.

INTRODUCTION: Evidence on the comparative real-world effectiveness of terlipressin vs midodrine plus octreotide (MO) for hepatorenal syndrome-acute kidney injury (HRS-AKI) in the United Kingdom and the United States is limited. METHODS: Using individual-level chart review data for patients across the United Kingdom (2013–2017) and the United States (2016–2019), an indirect treatment comparison was conducted comparing the efficacy of terlipressin (UK cohort) with MO (US cohort). Covariate balancing propensity scoring matched the cohorts on baseline serum creatinine (SCr), presence of encephalopathy and/or ascites, albumin use and duration, age, and sex. The primary endpoint was HRS reversal, defined as achieving SCr ≤1.5 mg/dL by the last day of treatment. RESULTS: At treatment initiation, 90.2% of UK patients received terlipressin (194/215), while 89.2% of US patients received MO (140/157). Concomitant albumin was administered in 67.9% of UK and 98.7% of US patients. In a covariate balancing propensity score-adjusted cohort, HRS reversal was achieved in 53.2% of terlipressin-treated patients (the United Kingdom, weighted effective sample size of 75) compared with 16.9% of MO-treated patients (the United States, n = 89) (adjusted mean difference (95% CI) 36.3% (22.4, 50.2), P < 0.0001). In adjusted analysis, individuals treated with terlipressin experienced an overall reduction in SCr at completion of treatment (SCr decrease 1.00 mg/dL vs increase of 0.08 mg/dL for MO-treated patients, P < 0.0001). DISCUSSION: HRS-AKI treatment and outcomes differ between the United Kingdom and the United States, attributed to the historical standard of care MO in the United States. In adjusted analyses, real-world use of terlipressin was more effective than MO at improving kidney function and achieving HRS-AKI reversal.

Abstract Background OnabotulinumtoxinA (BoNT‐A) is an established preventive treatment for chronic migraine but involves 31 to 40 injections per session, often causing discomfort and post‐procedural headaches. Remote electrical neuromodulation (REN) is a noninvasive therapy with efficacy in migraine treatment via conditioned pain modulation but has not been evaluated for procedural pain. This study evaluated REN's effectiveness in reducing acute procedural pain and postprocedural headache associated with BoNT‐A injections. Methods This was an investigator‐initiated single‐center, randomized, single‐blind, sham‐controlled crossover study enrolled 80 adults (aged 22 to 74 years) with chronic migraine undergoing routine BoNT‐A treatment. Each participant received one injection session without a device, followed by sessions using active REN and sham in randomized order. REN was applied to the upper arm 10 min prior to injections and removed after injection completion. Pain intensity was measured using a visual analog scale (0 to 100) at pre‐procedure, intra‐procedure, and post‐procedure time points. The primary outcome was procedural pain intensity, and secondary outcomes included post‐procedural headache incidence and adverse events. Due to clear benefit, the study was terminated early based on predefined stopping criteria. Results Final analysis of 60 participants (mean age 48.0 years; 49/60, 82% female) demonstrated that pre‐procedural pain levels were not significantly different between baseline and the active REN or sham ( p > 0.999 and p = 0.485, respectively). However, during and after BoNT‐A administration, the active REN group reported significantly lower pain scores compared to both the sham and baseline conditions. At intra‐procedure, the REN group experienced a mean pain reduction of 15.0 points ( p < 0.001), and at post‐procedure experienced a 19.1‐point reduction ( p < 0.001). Sham treatment did not result in significant pain reduction compared to baseline ( p > 0.999 for both intra‐procedure and post‐procedure). Additionally, REN lowered the incidence of headache as an adverse event, with only 15% (8/52) of participants experiencing post‐procedural headache compared to 55% (29/53) in the sham group and 39% (23/59) at baseline (odds ratio = 0.28, 95% confidence interval: 0.10 to 0.69, p = 0.008). No additional adverse events were reported. Conclusions REN significantly reduces procedural pain and post‐procedural headache associated with BoNT‐A injections for chronic migraine and may serve as a noninvasive, easily implemented pain management strategy for acute procedural pain. REN represents a promising approach to improving patient comfort during routine migraine treatment as well as reducing post‐procedural headache.

Inferior vena cava (IVC) pathology is often underrecognized on non-dedicated imaging examinations, yet it carries significant diagnostic and clinical implications, particularly in acute emergency settings. This review highlights the complementary roles of ultrasound (US) and computed tomography (CT) in the assessment of IVC abnormalities. The US provides real-time, bedside evaluation of IVC patency, caliber, and hemodynamics, whereas CT offers detailed anatomic and structural characterization critical for diagnosis and management. The review aims to systematically discuss congenital variants, thrombotic, traumatic, systemic conditions, and neoplastic involvement of the IVC, emphasizing their imaging features and clinical relevance.

Objective: To gain firsthand accounts from female physician leaders in academic medicine to better understand the challenges and success factors they have encountered in order to provide insights to early-career female physicians and inform organizations about the challenges faced by female physicians to build better systems and processes to support them in achieving more satisfying and fulfilling careers within an academic setting. Method: This qualitative research study is based on interviews with female physician leaders. Participants were selected based on their scores in multi-rater leadership assessments taken within the past three years, all ranking in the top 30% across four capabilities: Inspiring Values, Engaging Colleagues, Bold and Forward Thinking, and Driving Results. Coding and thematic analysis were used to categorize the challenges and success factors. Results: Data analysis revealed challenges experienced by these female physician leaders, including gender bias, time constraints, family responsibilities, change and innovation, self-doubt, and exclusion from networking. The strategies identified for navigating these challenges and achieving high performance included support from family and colleagues, building relationships and networking, maintaining a positive attitude, making powerful choices, seizing opportunities, finding value, meaning, and purpose, continuous learning, strategic planning, and gaining recognition. Conclusion: Challenges for female leaders in academic medicine are prevalent and evolve alongside changes in health care. Success factors can be generated at an individual level, such as attitudes, making powerful choices, and networking. However, societal and organizational support, including assistance with family responsibilities and providing opportunities, feedback, and mentorship, has also been identified as crucial.

Abstract Background Gastrointestinal (GI) cancer remains a major global health challenge. This study provides updated 2022 estimates of GI cancer incidence and mortality worldwide, along with projections of incident cases and deaths through 2050 to inform cancer control strategies. Methods In this population‐based study, data from the GLOBOCAN 2022 database were used to examine incidence and deaths associated with GI cancer. By using global demographic projections, this study estimated the projected number of incident cases and deaths until the year 2050. Results By 2050, the global burden of GI cancer is projected to reach 9.06 million incident cases (+85%) and 6.42 million deaths (+93%) from 2022. Increases in incidence are projected for both females (+87%) and males (+83%), as are increases in mortality for both females (+97%) and males (+91%). Whereas the Western Pacific region will have the highest absolute burden, with 3.88 million new cases and 2.79 million deaths, the greatest relative increase is expected in Africa, with incidence and deaths rising by 157% and 160%, respectively. As measured by the Human Development Index (HDI), the steepest increases are projected in low (+151% incidence; +152% deaths) and medium (+112% incidence; +114% deaths) HDI countries. Overall, all GI cancer types are projected to increase, led by pancreatic cancer in incidence (+95%) and colorectal cancer in deaths (+103%). Conclusions GI cancer incidence and deaths are expected to nearly double by 2050, with increases across sexes, cancer types, and regions, especially in lower HDI countries.