Citations

Purpose: Fenestrated stent-grafts with proximal bare-metal fixation stent (BMFS) may provide better rotational movement to facilitate vessel catheterization, but novel designs with covered fixation stents (CFSs) have been increasingly utilized with lower profile fabric. This study aimed to evaluate procedural metrics and outcomes of fenestrated endovascular repair (FEVAR) using BMFS and CFS devices. Methods: Clinical data of 502 consecutive patients enrolled in a prospective, non-randomized investigational device exemption (IDE) study were reviewed. Patients with 4-vessel fenestrated stent-grafts with BMFS or CFS for treatment of complex abdominal aortic aneurysms (CAAAs) and Extent IV thoracoabdominal aortic aneurysms (TAAAs) were included. Patients with Extent I-III TAAAs and stent-grafts designed with <4 fenestrations or scallops were excluded. Endpoints were technical success, radiation exposure, major adverse events (MAEs), patient survival, freedom from secondary interventions, and target artery instability (TAI). Results: There were 147 patients (29%; 85% male, median 75 years old) treated by FEVAR using 4-vessel fenestrated stent-grafts with BMFS in 79 patients or CFS in 68 patients. Patients treated with BMFS designs had significantly (p<0.05) higher prevalence of cigarette smoking and peripheral artery disease and less often had Extent IV TAAAs. Use of BMFS designs decreased from 88% (64/73) to 20% (15/74) after 2018 (p<0.001). Technical success was similar in patients treated with or without BMFS designs (99% vs 100%, p=0.47), but total operating time and cumulative air karma were significantly lower (p<0.05) in patients with CFS designs. Overall 30-day mortality was 1%, with no difference in mortality and MAEs among patients treated with or without BMFS (1% vs 1%, p=1.0 and 15% vs 12%, p=0.59), respectively. Patient survival at 1 and 3 years was 95%±2%, and 85%±4% for all patients with no difference between groups (p=0.51). Freedom from secondary interventions was 88%±3.6% for patients with BMFS and 86%±4.6% for those with CFS at 1 year (p=0.71), with also no difference at 3 years (p=0.55). Conclusion: FEVAR for CAAAs and Extent IV TAAAs was performed with high technical success, low mortality, and MAEs, independent of the use of BMFS. There is no difference in patient survival and freedom from secondary interventions in patients treated with or without BMFS. Clinical Impact One hundred forty-seven patients were treated with bare-metal fixation-stent (79) or covered fixation stents (68). Technical success was similar (p=.47). Overall 30-day mortality was 1%, with no difference in major adverse events (MAEs; p=.59). At 1- and 3-year, there was no difference in patient survival (p=.51), freedom from secondary intervention (p=.71). In conclusion, FEVAR for CAAAs and Extent IV TAAAs was performed with high technical success, low mortality and MAEs, independent of the use of bare-metal fixation stent.

BACKGROUND AND OBJECTIVES: Meningiomas are the most common primary central nervous system tumors, with cavernous sinus meningiomas (CSMs) making up a small fraction (1% of intracranial tumors). CSMs are challenging to treat due to their location and potential invasion. Therapy methods have shifted from aggressive resections to less invasive techniques such as stereotactic radiosurgery, reducing morbidity and improving survival. This study reviews the effectiveness and safety of radiosurgery for CSMs, blending historical and contemporary approaches to guide future treatments. METHODS: A search was performed in MEDlINE, Embase, and Cochrane databases, following Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Eligible studies included randomized or observational studies with ≥4 patients reporting on radiosurgery for CSM. The random-effects model was used to calculate a single proportion analysis with 95% CIs. Statistical analyses were performed using RStudio. RESULTS: Twenty seven studies, encompassing 1851 patients, were included in this analysis, with a population median age of 27 years. Outcomes were assessed as follows: the 10-year progression-free survival rate was 87% (323 patients; 95% CI: 73%-100%; I 2 = 89.6%), clinical deterioration occurred in 6% of cases (957 patients; 95% CI: 3%-8%; I 2 = 71.3%), clinical improvement was observed in 35% of patients (1106 patients; 95% CI: 27%-43%; I 2 = 86.6%), major complications rate was 4% (688 patients; 95% CI: 1%-6%; I 2 = 71.8%), and minor complications was 2% (653 patients; 95% CI: 0%-3%; I 2 = 68.6%). CONCLUSION: This study reveals stereotactic radiosurgery as an effective treatment of CSMs, showing high long-term progression-free survival and significant tumor control with few complications.

Background: Macromastia causes significant physical and psychological distress in adolescents. Although reduction mammaplasty alleviates these symptoms, the mental health impact of macromastia in younger populations remains underexplored. This systematic review and meta-analysis aimed to evaluate mental health and quality of life outcomes in adolescents/young women undergoing reduction mammaplasty. Methods: A systematic search of PubMed, Embase, and the Cochrane Central Register of Controlled Trials was conducted from inception to September 2024. Studies reporting mental health or quality of life outcomes through the BREAST-Q, Short Form-36, Rosenberg Self-Esteem Scale, and Eating Attitudes Test were included. Odds ratios and mean difference with 95% confidence intervals were pooled using a random-effects model. Heterogeneity was assessed with I 2 statistics. The Risk of Bias in Nonrandomized Studies of Interventions tool was used to assess study quality. Meta-analysis was performed on 4 BREAST-Q domains. Results: Of 701 articles identified, 8 observational studies involving 660 patients were included. Pooled BREAST-Q scores postsurgery showed significant improvements across all 4 domains. Improvement in Short Form-36, Rosenberg Self-Esteem Scale, and Eating Attitudes Test scores was noted in individual studies, though meta-analysis was limited by incomplete data. Conclusions: These results indicate that reduction mammaplasty significantly improves the physical, psychosocial, and sexual well-being of adolescents/young women with macromastia.

Introduction: Diastolic dysfunction is a hallmark of heart failure with preserved ejection fraction, yet echocardiographic grading is challenging in patients with hypertrophic or amyloid cardiomyopathies due to variable structural and functional remodeling. Consequently, there is a need for additional diagnostic tools to identify patients at increased risk of diastolic dysfunction and enhanced filling pressure. Research Question: What is the accuracy of an artificial intelligence (AI)-enabled electrocardiogram (ECG) model to predict diastolic dysfunction in hypertrophic and amyloid cardiomyopathy? Methods: We included patients with diverse phenotypes of hypertrophic cardiomyopathy (HCM) and cardiac amyloidosis and validated Mayo Clinic's AI-enabled ECG model to grade diastolic function (normal: grade 0/1; abnormal: grade 2/3). Echocardiographic analysis of systolic (LVEF) and diastolic function was performed within 14 days of ECG recording. Diastolic function was graded based on E/e’ (>14), left atrial volume index (>34 mL/m2), pulmonary venous atrial reversal flow duration (≥30 ms), and peak tricuspid regurgitation velocity (>2.8 m/s). Filling pressure was considered increased if ≥3 parameters were abnormal, inconclusive if 2 were abnomal, and normal if ≥3 were normal. Echocardiograms with severe mitral regurgitation were excluded. Results: We identified and matched 840 ECGs from non-obstructive HCM patients (n=125, age 58±19y, 70% male), 145 ECGs from obstructive HCM patients (n=29, age 56±18y, 66% male), 225 ECGs from apical HCM patients (n=33, age 66±14y, 61% male), and 382 ECGs from cardiac amyloidosis patients (n=49, age 70±13y, 57% male). The AI-enabled ECG model predicted diastolic dysfunction with an accuracy of 65% (non-obstructive HCM), 67% (obstructive HCM), 65% (apical HCM), and 75% (cardiac amyloidosis), with sensitivities of 94% and 97% for obstructive HCM and cardiac amyloidosis, respectively, and high positive and negative predictive values for cardiac amyloidosis. Systolic dysfunction (LVEF≤40%) was more common in cardiac amyloidosis (29%) than in all HCM patients (5%). Conclusion: The AI-enabled ECG model demonstrates moderate accuracy but high sensitivity for detecting diastolic dysfunction and increased filling pressure, especially in obstructive HCM and cardiac amyloidosis. The AI-enabled ECG is a useful, widely scalable, and low cost tool to identify patients at increased risk for diastolic dysfunction.

Background: The comparable long-term benefits of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in patients with multivessel disease remains limited in underrepresented populations, particularly in patients with multivessel coronary artery disease and heart failure with severely reduced left ventricular ejection fraction (LVEF <35%). Research Question: Among patients with HF and LVEF < 35% which revascularization strategy (CABG or PCI) provides superior long-term clinical outcomes? Methods: We conducted a systematic review and meta-analysis of observational studies involving patients with ischemic heart disease (IHD), HF and LVEF < 35% undergoing PCI or CABG with a minimum follow-up duration of five years. PubMed, Embase, and Cochrane databases were searched for studies published up to April 15, 2025. We computed hazard ratios (HR) from propensity score matched results. We used Cochrane Review Manager version 9.2.1 for statistical analysis. The primary endpoints of interest included all-cause mortality at 5 to 10 years, repeat revascularization, and all-cause mortality at 10 or more years. Results: We included 8 studies with 12,697 patients (6,187 PCI vs 6,510 CABG). Median follow-up duration ranged from 3.8 to 5.2 years, with the longest reported follow-up up to 13 years. The cumulative, propensity adjusted, incidence of all-cause mortality was significantly lower in the CABG group compared to PCI in 5 to 10 years of follow-up (HR 0.61; 95% CI 0.54-0.69; p<0.001) and ≥ 10 years (HR 0.63; 95% CI 0.53-0.74; p<0.001). Additionally, CABG was associated with a reduced need for repeat revascularization in the 5 to 10 year time frame, with a HR of 0.42 (95% CI 0.22-0.81; p=0.01). Conclusion: In this systematic review and meta-analysis of patients with IHD and an ejection fraction ≤ 35% undergoing revascularization, CABG was associated with a reduction in all-cause mortality at ≥ 5 and ≥ 10 years of follow-up, as compared to PCI.

ABSTRACT Suicidality contributes substantially to global morbidity and mortality, yet despite its heritability, its biological etiology remains largely elusive. We conducted multi-ancestry genome-wide association study meta-analyses of suicidal ideation (259,747 cases), suicide attempt (64,993 cases), suicide death (9,197 cases), and suicidal behavior (suicide attempt/ death, 75,300 cases), across 54 cohorts (e.g., the Psychiatric Genomics Consortium, Million Veteran Program, UK Biobank). We identified 77 significant loci across meta-analyses, including 59 previously unreported for suicidality. SNP-based heritability ranged from 2.0-6.7% and there were strong, yet incomplete, genetic correlations between suicidality phenotypes (0.70-0.88). Fine-mapping prioritized putative causal SNPs and 20 credible genes. Enrichment analyses implicated synaptic pathways and neuronal populations predominantly in subcortical brain regions (e.g., amygdala excitatory, medium spiny, hippocampal CA1-3). Together, these findings establish suicidality as a polygenic set of traits with both shared and distinct genetic influences, providing a foundation for future studies of suicide biology and etiology.

Background: Massive weight loss after bariatric surgery (BS) often results in excess skin, leading to physical discomfort and impaired quality of life (QoL). Body contouring surgery (BCS) addresses these issues by restoring body image, improving function, and enhancing overall QoL, but its added value on patient-reported outcome measures (PROMs) remains underexplored. Methods: A systematic search of PubMed, Scopus, Embase, Web of Science, and Cochrane databases was conducted from inception to March of 2025. Studies comparing PROMs between patients undergoing BS alone and those undergoing BS + BCS were included. Retrieved studies were assessed using the Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) tool. Outcomes were pooled using random effects models. Results: Fifteen non-randomized studies involving 7339 patients were included (BS, 4339 [59.1%]; BS + BCS, 3000 [40.9%]). Patients undergoing BS + BCS had a significantly greater percentage of total weight loss (mean difference [MD], 4.40% [95% CI, 1.69, 7.10]; P < 0.01). BODY-Q improvements favored the BS + BCS group in body image, physical, psychological, sexual, and social function (MD, 16.07 [95% CI, 12.14, 20.0]; P < 0.01). Among patients receiving only BS, those desiring BCS reported lower body satisfaction (MD, −0.40 [95% CI, −0.70, −0.10]; P < 0.01) and lower appraisal of excess skin scores (standardized MD, −1.09 [95% CI, −1.83, −0.36]; P = 0.02) than those without desire for BCS. Conclusions: BCS after BS yields substantial improvements in overall QoL. These findings highlight the importance of BCS as a fundamental element of comprehensive postbariatric care that significantly enhances long-term patient satisfaction and drives durable multidimensional recovery.

Importance The effect of cornea donor diabetes on endothelial cell density (ECD) and morphometry after Descemet membrane endothelial keratoplasty (DMEK) is not known. Objective To determine whether endothelial cell loss (ECL) and morphometric changes 1 year after successful DMEK are related to cornea donor’s diabetes status. Design, Setting, and Participants This was a multicenter, double-masked, randomized clinical trial conducted from February 2022 to July 2024 at 28 US clinical sites (46 surgeons) and 13 eye banks. Included in the trial were the eyes of recipients (some of whom received tissue from donors without diabetes and others who received tissue from donors with diabetes) who underwent successful DMEK, primarily for Fuchs endothelial corneal dystrophy, and had at least 1 analyzable postoperative endothelial image. Intervention DMEK performed with a cornea from a donor without or with diabetes, assigned using a minimization procedure to achieve an approximate 2:1 distribution. Main Outcomes and Measures ECD, ECL, coefficient of variation in cell area (CV), and percentage of hexagonal cells (HEX) at 1 year from eye bank and postoperative specular central endothelial images. Results A total 1274 eyes of 982 recipients (mean [SD] age, 70 [8] years; 569 female [57.9%]; 816 [64.1%] with tissue from donors without diabetes and 458 [35.9%] with tissue from donors with diabetes) were included in the study. Preoperatively, mean (SD) central ECD in tissue from donors without diabetes and with diabetes were 2676 (290) cells/mm 2 and 2671 (286) cells/mm 2 , respectively. At 1 year, mean (SD) ECL was 28.3% (16.1%) and 28.0% (17.0%), in the donor groups without and with diabetes, respectively (adjusted mean difference = −0.4%; 95% CI, −2.3% to 1.4%), resulting in a mean (SD) 1-year ECD of 1927 (498) cells/mm 2 and 1920 (496) cells/mm 2 , respectively (adjusted mean difference = 10 cells/mm 2 ; 95% CI, −36 to 56; P = .95). No difference in ECD at 1 year associated with diabetes severity was noted ( P = .97). Mean (SD) CV did not differ at 1 year between the 2 groups of eyes (31.5% [4.1%] vs 31.4% [4.1%]; adjusted mean difference = −0.4%; 95% CI, −0.9% to 0.1%; P = .51), and mean (SD) HEX did not differ at 1 year between the 2 groups of eyes (57.7% [5.8%] vs 57.2% [5.8%]; adjusted mean difference = 0.1%, 95% CI, −0.8% to 0.9%; P = .33). Conclusions and Relevance This randomized clinical trial found that ECL and morphometry 1 year after DMEK were not affected by cornea donor diabetes status. With comparable 1-year graft success with tissue from donors with and without diabetes demonstrated in this trial, these findings support the use of corneas from donors with diabetes for endothelial keratoplasty procedures. Trial Registration ClinicalTrials.gov Identifier: NCT05134480

Abstract Aims Endogenous endophthalmitis (EE) is a rarely reported complication of infective endocarditis (IE). In an international series, we sought to determine the clinical and microbiological profile, treatment, and outcome of patients presenting with IE-related EE. Methods and results Cases recorded from 2014 to 2023 in nine centres in Europe and the United States were collected. Results were compared to a matched control group. Conclusion Sixty-six patients with EE were reported, mean age of 65.2 ± 14.9 years, 71% (n = 47) male. Blood cultures were positive in 97% (64 cases) of patients, with a predominance of streptococci (46%, n = 30). As compared with the control group (n = 264), the EE group presented with more frequent diabetes (35% vs. 21%, P = 0.02), history of cirrhosis (9% vs. 3%, P = 0.04), glomerulonephritis (15% vs. 0.4%, P &lt; 0.001), embolism before admission (92% vs. 55%, P &lt; 0.001), and Janeway lesions (9% vs. 1%, P = 0.002). Streptococcal infection (46% vs. 26%, P = 0.001) was more frequent and Enterococcal infection (0% vs. 18%, P &lt; 0.001) less frequent in the EE group. The main ocular symptoms were a decrease in visual acuity (96%), red eye (55%), and ocular pain (55%). Treatment of EE consisted of intravitreal antibiotic injection in 55 (83%) patients and vitrectomy in 17 (26%). Improvement of visual acuity was observed in 36 (55%) patients. Conclusion EE is a serious complication of IE with severe residual vision impairment. Patients with IE should be evaluated for ocular complications, since early detection of EE is crucial to prevent delays in management and to preserve visual function.

262 Background: According to the American Cancer Society, nearly half (47%) of cancer patients and survivors incurred medical debts to pay for cancer care, although most (98%) had health care coverage (2024 Survivor Views Survey). The financial toxicity from high cost of cancer care is itself a risk factor for cancer mortality – hazard ratio of 1.8 among those requiring bankruptcy protection (Ramsey SD, J Clin Oncol 2016). Charity care, also known as financial assistance, plays a vital role in alleviating the medical debt for low-income patients. The Affordable Care Act requires non-profit hospitals to publish charity care policies to maintain their tax-exempt status. We studied the criteria for hospital charity care among NCI-designated cancer centers in the US. Methods: We included all NCI-designated cancer centers with a clinical program as of December 1, 2024. We searched their cancer center websites for charity care eligibility policies in 2024 and obtained the following information: income limit as percentage of the federal poverty guidelines (FPG), eligibility criteria beyond income, and supporting documents required for charity care application. Cancer centers were grouped into the following regions based on US Census classification: Northeast, Midwest, South, and West. Results: We found 64 NCI-designated clinical cancer centers - all non-profit institutions. Charity care policies were readily available. The median income cutoffs for free and discounted care were 200% of the FPG (range, 100%-600%) and 400% of the FPG (range, 200%-800%), respectively. These income cutoffs were similar among the four geographic regions. Most centers (52%) allowed not only uninsured but also underinsured or insured patients experiencing hardship. A minority of the policies (13%) applied different rules for insured patients. Majority of the centers (52%) allowed financial assistance when medical bills exceed a certain hardship limit even if income cutoffs were not met. Only 3 centers (5%) required medical bills to exceed a minimum threshold for eligibility. Residency requirements included US citizenship or permanent residency (27%), state (33%), service area (14%), county (2%), not necessary (11%) or not stated (34%). Most policies (64%) mentioned investigating a patient's assets. Specific documents required for submission included income (98%), pay stub (88%), tax return (84%), asset (73%), proof of residency/citizenship (44%), and bank account (61%). Conclusions: NCI-designated cancer centers apply a relatively uniform range of financial eligibility criteria for free and discounted charity care. Approximately 1 in 4 centers require evidence of US citizenship or permanent residency while 1 in 2 centers restrict eligibility to in-state residents. Future studies into the awareness, accessibility, and utilization of charity care will provide insight into how to optimize this resource for the neediest population.