Citations

Three pediatric oncology patients received isavuconazole concurrently with vincristine across 15 days to approximately 23 months, spanning 32 vincristine doses. No severe adverse effect including neurotoxicity or paralytic ileus was attributed to the combination.

Objective: To compare patient and provider experiences and opinions regarding auditory training in adult cochlear implant (CI) recipients. Study Design: Narrative review and comparison of patient and provider surveys. Setting: Tertiary referral center and email distribution list of the American Cochlear Implant Alliance. Participants: CI recipients and care providers. Interventions/Methods: We examined and performed a narrative review of two independently developed and published surveys looking at auditory training practices and habits from the perspectives of CI recipients and CI providers, respectively. Main Outcome Measure: Comparison of overlapping topics between patient and provider reports on their experiences with respect to auditory training for CI recipients. Results: Topics for comparison included how auditory training was performed, the timing or logistics of training, and barriers to utilization of training. Findings revealed that auditory training is considered a valuable resource by both CI patients and providers, with similar reports from the 2 groups on the use, timing, and perceived benefits of auditory training. However, we also noted discrepancies between patients and providers with regard to the use of specific types of training and concerns regarding reimbursement for auditory training services. Conclusion: Both CI patients and providers consider auditory training a useful and affordable resource to maximize CI outcomes. However, utilization remains inconsistent. Further study and effort are needed to address key knowledge gaps and better standardize this aspect of peri-CI care.

BACKGROUND AND OBJECTIVES: Surgery for cervical spondylotic myelopathy improves quality of life but remains expensive. We conducted a cost-effectiveness analysis of patients treated with anterior cervical diskectomy/fusion (ACDF), posterior cervical decompression/fusion (PCDF), and laminoplasty (LP) in the Cervical Spondylotic Myelopathy Surgical (CSM-S) Trial, a randomized trial comparing surgical approaches for cervical spondylotic myelopathy. METHODS: In the trial, patients were randomized (2:3) to anterior (ACDF) or posterior surgery (LP or PCDF, at surgeon's discretion). A cost-effectiveness analysis was performed from a societal perspective with a 1-year time horizon, including only US patients as-treated. Cumulative costs were estimated using patient data on utilization and lost productivity using a human capital approach. Direct costs were calculated using 2022 Medicare rates for professional fees and cost-to-charge ratios for hospital services. Quality-adjusted life-years (QALYs) were calculated from patient responses to the EuroQol-5-Dimensions instrument at baseline and 3, 6, and 12 months postoperatively. Incremental cost-effectiveness ratio analysis was performed with bootstrapping to address uncertainty. RESULTS: Of 163 total patients enrolled in the CSM-S Trial, 153 from the United States (mean age, 62 years; 80 (52%) female) were included as-treated (ACDF = 61, PCDF = 64, LP = 28) in a cost-effectiveness analysis. Economic data were not available for 9 patients. The remaining 144 patients treated (ACDF = 55, PCDF = 61, LP = 28) had cost data through a 1-year follow-up. Mean hospitalization costs were higher after PCDF than ACDF and LP ($33 410 vs $26 468 vs $25 550; P < .001). Mean total costs were higher after PCDF than ACDF and LP ($62 383 vs $53 074 vs $47 426; P = .017). LP yielded greater QALY gains than ACDF (0.792 vs 0.732; P = .08) and PCDF (0.792 vs 0.698; P = .01). At a willingness-to-pay threshold of $150 000/QALY-gained, the probability that LP was cost-effective compared with PCDF was 99.7% and the probability compared with ACDF was 96%. CONCLUSION: In the CSM-S Trial, LP yielded greater 1-year quality-of-life improvements at lower costs than PCDF and ACDF.

BACKGROUND: The impact of life-course blood pressure (BP) trajectories on later-life focal left ventricular (LV) fibrosis by late gadolinium enhancement (LGE) remains elusive. METHODS: MyoFit46 prospectively recruited ≈500 participants from a 1946 birth cohort for a cardiovascular magnetic resonance scan at 77 years, assessing LV LGE calculated using the 3-SD method or 5-SD method. Systolic BP (SBP) and diastolic BP were recorded at 36, 43, 53, 63, 69, and 77 years. For each participant, annual rates of BP change (steepness) and area under the BP trajectory (cumulative burden) for each age interval were calculated using mixed-effects models. Associations between life-course BPs and LGE were tested using generalized linear models, adjusted for antihypertensives, demographics, lifestyle, and comorbidities. Time-to-event associations between LGE and incident major adverse cardiovascular event (hospitalizations for coronary artery disease, stroke, heart failure, and atrial/ventricular arrhythmias; n=29) were also evaluated. RESULTS: Among 472 participants (54% male), each 10 mm Hg greater individual SBPs at 36 to 69 years were associated with 6% to 11% greater LV LGE calculated using the 3-SD method (all P ≤0.033), whereas each 10 mm Hg sustained greater SBPs on any age interval from 36 to 69 associated with 16% to 24% greater LGE calculated using the 3-SD method at 77(all P ≤0.005), independent of SBP at 77 years. Each 1 mm Hg/y steeper SBP rise during age intervals 36 to 43, 43 to 53, and 53 to 63 was associated with 6% to 12% greater LGE calculated using the 3-SD method at 77 years. LGE presence was associated with greater major adverse cardiovascular event rates (hazard ratio, 2.5 [95% CI, 1.2–5.2]). CONCLUSIONS: Higher life-course BPs, cumulative burden, and steeper increases were associated with greater older-age LV LGE, which was linked to incident major adverse cardiovascular events. BP trajectories, beyond single-point BP measurements, warrant further investigation as tools to guide BP management strategies.

BACKGROUND: Pulsed field ablation is now widely used for atrial fibrillation (AF) ablation, but atrial tachyarrhythmia recurrence remains common and postablation risk tools are limited. We assessed whether a validated sinus‑rhythm artificial intelligence— enabled ECG AF probability score, and its early postablation change, predicts recurrence after pulsed field ablation. METHODS: We studied consecutive patients undergoing index pulsed field ablation across 3 Mayo Clinic sites (February 2024–March 2025) with ≥1 sinus‑rhythm ECG within 180 days preprocedure. Baseline artificial intelligence—enabled ECG AF score (range 0–1) was the mean across baseline ECGs. Recovery indices (RI30/60/90), defined as mean postprocedure artificial intelligence—enabled ECG score within days 1–30/60/90 minus baseline, predicted post‑blanking recurrence using corresponding 30‑, 60‑, and 90‑day blanking windows. The primary outcome was time to first documented AF/atrial flutter/atrial tachycardia episode >30 seconds, ascertained via clinic ECGs, ambulatory monitoring, and device interrogations. Cox regression adjusted for prespecified clinical and echocardiographic covariates assessed associations; Harrell C‑statistic quantified discrimination. RESULTS: Among 1052 patients (67±10 years; 33% women), median baseline score was 0.35; 320 (30%) recurred over 188 days. Higher baseline score independently predicted recurrence (hazard ratio per 0.1 increase, 1.08 [95% CI, 1.03–1.14]). Scores rose on day 0 after ablation, then declined over subsequent weeks, with persistently higher, less‑improving trajectories among patients who recurred (time×recurrence interaction P <0.001). Day 0 score was not independently associated with recurrence after adjustment. Attenuated early recovery (higher recovery index) was independently associated with recurrence, most robustly for RI-90 (hazard ratio per 0.1 increase, 1.15 [95% CI, 1.07–1.24]), and improved discrimination beyond baseline and covariates (C‑statistic, 0.63–0.67; ΔC=0.04). Findings were consistent in a historical thermal ablation cohort. CONCLUSIONS: Baseline and early postablation dynamics of a sinus‑rhythm artificial intelligence—enabled ECG AF probability score are associated with pulsed field ablation recurrence and may aid multivariable risk stratification; prospective validation is warranted.

Abstract Historically, the study of cellular metabolism and the cellular proteome have largely focused on specific proteins and metabolites in certain cellular pathways. With the advent of new “omics” technologies, researchers have been able to probe disruptions and alterations in cellular homeostasis on a near proteome-wide and metabolome-wide basis. Yet the truly interconnected and interdependent nature of the cellular metabolome and proteome has only become more evident with the discovery of proteome-wide protein post-translational modifications (PTMs) such as lysine acylation by acetyl-CoA or succinyl-CoA. Such PTMs link proteome function to fluctuating concentrations of tricarboxylic acid (TCA) cycle metabolites. Tumorigenesis in TCA cycle-defective tumors that upregulate acylating agents such as succinyl-CoA and acetyl-CoA provides a relevant context for understanding the breadth of protein acylation in disease. In particular, succinate dehydrogenase (SDH)-loss chromaffin cells can be transformed to the neuroendocrine tumors pheochromocytoma and paraganglioma (PPGL), but sensitive diagnostic and effective therapeutic options for metastatic disease remain limited. Interrogating cell models of SDH-loss PPGL provides a unique opportunity to capture the effects of SDH loss on cellular metabolism and protein acylation while exploring new avenues for improved diagnostics and novel therapeutic targets in these rare diseases.

ABSTRACT Background Atrial fibrillation (AF) has been observed in adults with anomalous pulmonary venous return (APVR), but data on catheter ablation outcomes in this population remain limited to case reports and small series. Methods We retrospectively reviewed 14 adult patients with confirmed APVR who underwent catheter ablation for AF at three tertiary academic centers in the United States between July 2003 and May 2025. Baseline, procedural, electroanatomic mapping, and outcome data were collected. Freedom from atrial arrhythmia recurrence was estimated by Kaplan-Meier analysis. Results Mean age was 56 ± 13 years and 79% were male. Heart failure was present in 64%, and hypertension and coronary artery disease in 43% each. Most had partial APVR (86%), and 57% had prior surgical correction. Radiofrequency ablation was used in all patients, combined with pulsed-field ablation in one. Acute success was achieved in all patients, although areas with residual pulmonary vein or SVC electrical activity were left untreated in 3 (21%). Non-pulmonary-vein electrical activity was more common in patients with prior surgical correction than in those without (43% vs 17%). Median follow-up was 3.4 years (IQR, 2.0-9.6). Freedom from arrhythmia recurrence was 78.6% at 1 year and 53.9% at 5 years. Two patients (14%) required reablation; complications occurred in 3 (21%) without long-term sequelae. Conclusions Catheter ablation was acutely successful in all patients in this largest reported APVR cohort, despite substantial comorbidity burden and anatomic complexity. The arrhythmogenic substrate often extended beyond the anomalous vein, particularly in surgically corrected patients, supporting individualized, substrate-guided ablation in this population. CLINICAL PERSPECTIVE What Is Known Atrial fibrillation has been reported in adults with anomalous pulmonary venous return (APVR), but data on catheter ablation outcomes in this population are limited to case reports and small series. What the Study Adds In the largest reported cohort of patients with APVR undergoing catheter ablation for atrial fibrillation, pulmonary vein isolation achieved acute success in all patients despite substantial comorbidity burden and anatomic complexity. Non-pulmonary-vein sites of electrical activity were more common among patients with prior surgical correction, and postsurgical scar and epicardial venoatrial connections were also arrhythmogenic, indicating that the arrhythmogenic substrate in APVR often extends beyond the anomalous vein itself. These findings support individualized, substrate-guided mapping in patients with APVR, particularly those with a surgical history, and suggest a role for pulsed-field ablation near critical structures such as the phrenic nerve.

ABSTRACT Aims This study aimed to describe how emergency nurses (ENs) experience secondary traumatic stress (STS) within their practice environments, focusing on the strategies they use to cope and the supportive resources they draw upon to manage its impact on their lives. Design This paper presents the qualitative findings from a larger mixed‐methods survey study on STS among ENs. Methods A geographically diverse U.S. sample of ENs was recruited through social media to participate in an online survey. All participants ( n = 275) were asked to respond to open‐ended survey questions, and 118 of these participants provided answers to at least one open‐ended question. A self‐selected sample of 20 ENs completed semi‐structured interviews. Inductive content analysis was used to analyse open‐ended survey responses and interview transcripts. Results Three themes reflected ENs' experiences with STS: STS Is Real—It's Going to Affect Your Life; Something Must Be Wrong With Me: A Culture of Disconnection; and It's a Systems Issue, but We're in It Together. Participants described individual, unit, and organizational factors that influenced their experiences of STS and their access to and use of coping strategies and supportive resources. Conclusion ENs and nurse leaders acknowledged the impact of STS on their personal and professional lives and emphasized how the practice environment shaped their experiences. They perceived the accessibility of organizational resources, leadership behaviours, and team culture as influencing the individual strategies ENs use to manage the effects of repeated exposure to others' traumatic experiences. STS is a predictable occupational hazard for ENs; thus, healthcare organizations must invest in nurse‐identified supports to preserve workforce well‐being and clinical expertise. Implications for the Profession Assessing organizational readiness to address STS is recommended to ensure ENs receive effective, timely support. In response to these assessments, healthcare organizations should develop and implement policies that prioritize the mental health and well‐being of ENs, including proactive support systems and accessible mental health resources. Impact This study identifies participant‐perceived individual, team, leadership, and organizational conditions that may hinder or support ENs' management of STS. These findings identify potential targets for organizational assessment and support strategies intended to foster healthier practice environments and promote safe, high‐quality care. Reporting Method Consolidated Criteria for Reporting Qualitative Research (COREQ). Patient or Public Contribution This study did not include patient or public involvement in its design, conduct, or reporting.