Citations

Purpose White matter hyperintensity (WMH) is associated with heterogeneous pathologies. In neurodegeneration, the prevailing hypothesis is that WMH primarily reflects vascular pathology, exerting an additive effect in AD. Alternatively, a subset of WMH may arise secondary to AD‐related pathophysiology. APOE4 genotype, the greatest genetic risk factor for late‐onset AD, impacts the blood‐brain barrier and WMH burden. Herein, we investigate the association between regional WMH burden and APOE4 allelic dosage in cognitively normal individuals. Methods We used deep learning to automatically segment WMH from T2‐FLAIR MRI from 154 cognitively intact individuals older than 50. We mapped WMH to 4 specific brain regions (lobar, periventricular, basal ganglia and infratentorial, further parcellated into sub‐regions, Table 1) using atlas‐based registration and FastSurfer. WMH volumes were adjusted for total intracranial volume and normalized using log transformation. The APOE4 groups were compared for WMH burden using linear regression, controlling for age and vascular risk factors (hypertension, diabetes, hypercholesterolemia, cigarette smoking). For brain regions where more than 20% of participants had no WMH, a two‐part hurdle model was applied. Results We included 13 APOE4 homozygotes, 50 heterozygotes (ε4/ ε3) and 91 non‐carriers. Compared to non‐carriers, APOEε4 homozygotes exhibited significantly greater WMH burden in the whole brain, periventricular (posterior) and lobar regions (Figure 1a). Homozygotes exhibited a significantly greater WMH burden in the whole brain and posterior periventricular region, when compared to heterozygotes (Figure 1b). No significant whole‐brain or region‐specific differences were observed between heterozygotes and non‐carriers (Figure 1c). Conclusion In cognitively intact individuals at risk for AD, APOE4 homozygosity is associated with significantly greater WMH burden, particularly in the posterior periventricular space, after controlling for age and vascular risk factors. The relationship between regional‐specific WMH burden and neurodegeneration warrants further investigation. image image

Background The Woven EndoBridge (WEB) device is an effective treatment for wide‐neck aneurysms (WNA). This study aims to identify and compare anatomical and procedural factors that predicts the aneurysm occlusion, both adequate and inadequate after WEB device treatment. Methods A systematic review and meta‐analysis were conducted using PubMed, Embase, Scopus, and Web of Science, including studies up to October 25, 2024. Data on angiographic outcomes of WEB occlusion were extracted and analyzed using R version 4.4.2 Results Nine studies (790 patients) were included. Female patients were 1.64 times more likely to achieve adequate occlusion than males (OR: 1.64, 95% CI: [1.06, 2.52], p = 0.026). Regular‐shaped aneurysms had a 2.44‐fold higher likelihood of adequate occlusion compared to irregular ones (OR: 0.41, 95% CI: [0.23, 0.74]). Aneurysm neck size was significantly smaller in the adequate occlusion group (3.9 mm vs. 4.4 mm, MD: ‐0.48 mm, 95% CI: [‐0.78, ‐0.18], p = 0.002). Maximum aneurysm diameter was also smaller in the adequate occlusion group (5.7 mm vs. 6.8 mm, MD: ‐1.13 mm, 95% CI: [‐1.69, ‐0.57], p < 0.001). Aneurysm height was also significantly lower than the inadequate occlusion group (5.4 mm vs. 6.3 mm, MD: ‐0.92 mm, 95% CI: [‐1.55, ‐0.29], p = 0.004). Conclusion Smaller aneurysm dimensions, regular shape, and female gender were associated with higher adequate occlusion rates after WEB treatment. These findings may guide patient selection strategies for optimizing aneurysm occlusion. Further high‐quality studies are needed to confirm these associations. image image

Three previously uncharacterized bacterial species, designated strains BD586 T , BD613 T and BD626 T , isolated from human clinical specimens, were identified at Mayo Clinic, Rochester, Minnesota, USA. Initial identification efforts using matrix-assisted laser desorption ionization-time-of-flight MS and partial 16S rRNA gene sequencing proved inconclusive. Comprehensive analysis involving phenotypic characterization, biochemical assays and whole-genome sequencing was undertaken. The isolates were Gram-negative, motile, facultatively anaerobic rods, occurring singly, in pairs and in short chains; BD613 T additionally formed small aggregates. The isolates tested positive for catalase and negative for oxidase. Their colonies appeared smooth, white, opaque and non-haemolytic. Growth was observed at 35 °C under aerobic, anaerobic and CO₂-enriched conditions, as well as in media with NaCl concentrations up to 10% and at pH 7-9. Phylogenetic relationships were inferred from core gene alignments, average nucleotide identity and digital DNA–DNA hybridization comparisons. Results confirmed the placement of BD586 T , BD613 T and BD626 T within the recently established Dryocola genus, while also indicating their novelty as distinct species. The major cellular fatty acids were C 16:0 and C 17:0 cyclo. Based on these findings, a formal description of three new species, Dryocola mayonis sp. nov. (type strain BD586 T =TSD 474 T , =NCTC 15089 T , =DSM 119465 T ), Dryocola sharpae sp. nov. (type strain BD613 T =TSD 475 T , =NCTC 15090 T , =DSM 119466 T ) and Dryocola baronae sp. nov. (type strain BD626 T =TSD 476 T , =NCTC 15091 T , =DSM 119479 T ), is proposed, and the genus description of Dryocola is emended to refine its genomic, morphological and chemotaxonomic boundaries.

Glioblastoma (GBM), the most common primary malignant brain tumor in adults, has a median survival of 14–15 months despite aggressive treatment. Monitoring relies on MRI, but differentiating tumor progression from pseudo-progression or radiation necrosis remains difficult. Plasma extracellular vesicles (EVs) are emerging as promising non-invasive biomarkers due to their molecular cargos and accessibility. This review evaluates studies that specifically isolated plasma EVs for molecular profiling in GBM diagnosis and monitoring. Biomarkers (miRNA, RNA, DNA, proteins), EV characterization methods, and advancements in enriching tumor-derived EV subpopulations and assessing their diagnostic and prognostic potential are highlighted. Plasma EVs carry diverse cargos, including miRNAs (e.g., miR-21, miR-15b-3p), mRNAs (e.g., EGFRvIII), circRNAs, and proteins (e.g., CD44, GFAP). Composite molecular signatures have achieved sensitivities of 87–100% and specificities of 73–100% for GBM diagnosis. Tumor-derived EVs, enriched using techniques like SEC-CD44 immunoprecipitation, microfluidic platforms, or 5-ALA-induced PpIX fluorescence, enhance biomarker detection. Non-tumor-derived EVs may also reflect GBM’s systemic effects. Challenges include EV heterogeneity, non-EV contamination, and variable biomarker expression across studies. Plasma-EV-based liquid biopsies offer significant potential for GBM monitoring, with advanced enrichment methods improving tumor-specific biomarker detection. Standardizing isolation protocols and validating biomarkers in larger cohorts are critical for clinical translation.

Abstract Social Determinants of Health (SDoH), such as education level, housing status, lived environment, and socioeconomic status, can create obstacles to accessing healthcare services, particularly for minoritized people and individuals with chronic health conditions. While previous research shows that addressing SDoH can lead to positive health outcomes, no studies have investigated the role of SDoH in genetic counseling. This mixed‐methods study aimed to clarify if genetic counselors (GCs) are aware of SDoH, and if knowing a patient's specific SDoH would prompt GCs to change their approach to that patient's care. An online survey was sent to GCs, consisting of scenario‐based questions to explore whether knowledge of a patient's SDoH information prompts changes in approaches to care. Nearly 45% of respondents reported only somewhat to no familiarity with SDoH. However, respondents with moderate to extreme familiarity with SDoH were 1.58 times more likely to modify patient care to address SDoH than those with little to no familiarity ( p = 0.003). However, nearly half of the respondents reported that their electronic medical record (EMR) system does not display SDoH information. Qualitative analysis demonstrated that GCs would use SDoH information to make specific changes in counseling content, identify resources, provide referrals to services such as local resources or social work, and offer alternative service delivery methods. These preliminary findings suggest that GCs can leverage SDoH data to help patients overcome obstacles stemming from SDoH and highlight areas for improvement within healthcare systems and education. Healthcare institutions should consider effective workflows to accurately capture and display SDoH within the EMR and increase efforts surrounding SDoH education. An earlier introduction to SDoH through GC training programs could promote higher familiarity with SDoH. Together, increased SDoH awareness and easier access to information about patient‐specific barriers may lead to an increase in GC‐initiated interventions to address disparities stemming from SDoH.

ABSTRACT Thogotoviruses are arthropod-borne viruses belonging to the genus Thogotovirus within the family Orthomyxoviridae . Like other orthomyxoviruses, such as the influenza A viruses (IAV), thogotoviruses replicate in the nucleus. As a result, progeny viral ribonucleoprotein complexes (vRNPs) must be exported to the cytoplasm prior to virion assembly and budding at the plasma membrane. In IAV, this export depends on binding of the viral nuclear export protein (NEP) to the cellular exportin chromosomal maintenance 1 (CRM1). In contrast, the mechanism of vRNP nuclear export, including identification of a protein with NEP functionality, has not been characterized for any thogotoviruses. Here, we characterized vRNP nuclear export in Dhori virus (DHOV), a prototypic member of the Thogotovirus genus. DHOV replication and nuclear export of the viral nucleoprotein were inhibited by the canonical CRM1 inhibitor leptomycin B (LMB), suggesting that DHOV vRNP export also utilizes CRM1. Interestingly, LMB treatment led to nuclear retention of the DHOV matrix (M) protein in both infected and transfected cells. Using a mammalian two-hybrid system, we found that DHOV M interacts with CRM1 through a nuclear export sequence (NES) located between amino acids 111 and 128. Mutation of hydrophobic residues within this NES reduced M-CRM1 interaction, abolished the NES phenotype when fused to a fluorescent protein, and impaired rescue of recombinant DHOV by reverse genetics. Together, our results reveal that DHOV vRNP nuclear export is CRM1-dependent and mediated by the M protein rather than a dedicated NEP-like protein, providing the first mechanistic insight into vRNP egress in the genus Thogotovirus . IMPORTANCE Dhori virus (DHOV) is a pathogenic tick-borne virus in the genus Thogotovirus , in the family Orthomyxoviridae. Despite evidence of DHOV exposure in various mammals, including humans, its basic biology is not well understood. We investigated how DHOV’s progeny genome and protein complexes—viral ribonucleoprotein complexes (vRNPs)—are transported out of the nucleus. Our findings show that DHOV, like the influenza viruses, uses the cellular protein chromosomal maintenance protein 1 (CRM1) for vRNP export. We found that chemically inhibiting CRM1 completely blocked DHOV vRNP export, preventing the production of progeny viruses from infected cells. Screening of all known DHOV proteins revealed that the matrix protein, which forms the virus’ scaffold, interacted with CRM1, suggesting it may link CRM1 to the vRNPs. These results advance our understanding of DHOV replication and suggest that chemically inhibiting vRNP export could be a way to treat thogotovirus infections.

BACKGROUND: Cavotricuspid isthmus (CTI) ablation is frequently performed either as a standalone procedure or in combination with pulmonary vein isolation. With the rapid adoption of pulsed field ablation for atrial fibrillation, it is essential to delineate the utility of this modality in treating CTI-dependent atrial flutter (AFL). This study aims to evaluate the procedural and clinical outcomes of CTI ablation using pulsed field energy. METHODS: We conducted a retrospective analysis of consecutive patients who underwent pulsed field ablation for CTI-dependent AFL between January 2024 and March 2025. The primary end points were acute procedural success, periprocedural complications, and CTI-dependent AFL recurrence during follow-up. RESULTS: A total of 132 patients underwent CTI nonthermal ablation. The median age was 69.5 years, and 27.3% were female. The Farawave catheter was used in 93.9% of cases, PulseSelect in 4.5%, and Sphere-9 in 1.5%. Acute block was achieved in 99.2% of patients, although 8 required adjunctive radiofrequency ablation to complete the line. Periprocedural complications included transient ST-segment elevation in 2 patients and transient conduction disturbances in 3. During a median follow-up of 114 days (n=131), 5 patients (3.8%) experienced recurrence of typical AFL. The 6-month typical AFL-free survival estimate was 93.6%. CONCLUSIONS: Pulsed field ablation appears to be a feasible and effective strategy for CTI-dependent AFL. However, anatomic variability may limit its universal applicability with current catheter designs. Although acute procedural success is high, the long-term durability of the CTI block and its comparative efficacy versus conventional thermal ablation remain areas requiring further investigation.

Background The efficacy of EVOKE therapy, a closed-loop spinal cord stimulation (SCS) system, has been demonstrated in a double-blinded randomized controlled trial (RCT). RCT evidence, however, may not be generalizable to clinical practice, while limitations of real-world evidence may affect its validity. The aim of this study was to evaluate the effectiveness of EVOKE therapy in routine clinical practice employing a rigorous data collection approach. Methods The ECAP study was a prospective, multicenter, single-arm, pragmatic study that enrolled SCS candidates with chronic, intractable trunk and/or limb pain in 22 US investigational sites. PROMIS-29 questionnaire and objective neurophysiological metrics were collected, and minimal clinically important differences (MCIDs) were used to characterize baseline dysfunction and response to EVOKE therapy both at trial end and maximal analgesic effect post-implant visit. Pre-specified subgroup analyses were conducted based on diagnosis. Results EVOKE therapy observed included a dose ratio of 1.3 and neural dose accuracy of 2.8 μV. Improvements of >1 MCID were observed for all domains and improvements of ≥2 MCIDs were observed for six of the seven domains. Improvements observed at trial end were maintained or improved at post-implant visit, with statistically significant improvement in holistic MCID (MD 0.2, 95% CI 0.1 to 0.4, p=0.004), and a significantly greater proportion of patients considered holistic MCID responders (p=0.047). Subgroup analysis by diagnosis showed similar outcomes. Conclusions EVOKE therapy was associated with clinically meaningful improvements in a real-world chronic pain population across different subgroups and disease pathologies, with effects observed at trial end reproduced at post-implant visit.