Global Consensus Statement on the Management of Pregnancy in Inflammatory Bowel Disease.

Background & Aims: Pregnancy can be a complex and risk-filled event for women with inflammatory bowel disease (IBD). High-quality studies in this population are lacking, with limited data on medications approved to treat IBD during pregnancy. For patients, limited knowledge surrounding pregnancy impacts pregnancy rates, medication adherence, and outcomes.

Where comfort and nutrition meet: A case series of children with severe neurologic impairment receiving home parenteral nutrition at the end of life.

Home parenteral nutrition (HPN) is a life-sustaining therapy traditionally used as a bridge to enteral autonomy or intestinal transplantation. Increasingly, it is used for intractable feeding intolerance (IFI), which can occur near the end of life (EOL) in children with severe neurological impairment (SNI). In these cases, HPN use differs from its historical role and requires tailored outpatient planning.

Transcatheter edge-to-edge repair for the management of secondary mitral regurgitation - CRT 2025 Beyond the Guidelines.

Secondary mitral regurgitation (SMR) remains a prevalent and challenging complication in patients with heart failure (HF), associated with poor prognosis despite optimal guideline-directed medical therapy (GDMT) and cardiac resynchronization therapy. Current American and European guidelines recommend GDMT as first-line therapy, with transcatheter edge-to-edge repair (TEER) reserved for severe symptomatic SMR patients who remain refractory. However, both guidelines preceded the reporting of pivotal randomized controlled trials (RESHAPE-HF2, MATTERHORN, and EFFORT) and emerging evidence in new clinical scenarios.

Rationale and Design of the Comparative Effectiveness of ICD Versus Non-ICD Therapy in Contemporary Heart Failure Patients at a Low Risk for Arrhythmic Death (CONTEMP-ICD) trial.

Background: Current recommendations for a prophylactic (primary prevention) implantable cardioverter defibrillator (ICD) in patients with both ischemic and non-ischemic heart failure with reduced ejection fraction (HFrEF) originate from clinical trials conducted in selected patients over 20 years ago that showed an overall statistically significant survival benefit associated with a primary prevention ICD in the range of 23%-34%. The recent introduction of angiotensin receptor-neprilysin inhibitors [ARNI] and sodium glucose co-transporter 2 inhibitors [SGLT2i]) was shown to further reduce the risk of sudden cardiac death (SCD) in patients with HFrEF. Thus, there is an unmet need appropriately designed comparative effectiveness clinical trials aimed to reassess the survival benefit of a primary prevention ICD in contemporary patients with HFrEF.

Myocardial Blood Flow Quantification in Patients with an Implanted Cardiodefibrillator during Stress and at Rest using a Wideband Perfusion Pulse Sequence: An Initial Feasibility Study.

Background: Although a recently developed wideband perfusion sequence has shown diagnostically acceptable image quality and accurate myocardial blood flow (MBF) quantification at rest in patients with cardiac implanted electronic devices (CIEDs), its performance during vasodilator stress remains unproven. This study aims to determine whether the sequence produces diagnostically acceptable image quality during stress and is capable of quantitatively detecting abnormal stress MBF and myocardial perfusion reserve (MPR) in patients with implanted cardiodefibrillators (ICDs).

Methods: We enrolled 29 patients with an ICD (mean age = 63 ± 15 years, 17 males, 12 females) and 11 control patients (mean age = 50 ± 17 years, 6 males, 5 females; negative coronary artery disease; negative stress perfusion CMR; and no cardiac event one year post CMR) with an ICD taped below the left clavicle to mimic image artifacts.

Healthy dietary pattern and risk of rheumatoid arthritis: A systematic review and meta-analysis.

Objectives: We aimed to determine the degree to which a healthy dietary pattern is associated with incident rheumatoid arthritis (RA).

Methods: We registered this systematic review and meta-analysis in PROSPERO (CRD42025645056). Inclusion criteria were validated diet (anti-inflammatory, Mediterranean, Dietary Approaches to Stop Hypertension (DASH), and/or healthy eating index [HEI]); validated RA definition; dietary exposure preceding RA; and randomized controlled trial, cohort, or case-control design.

VO Max in Clinical Cardiology: Clinical Applications, Evidence Gaps, and Future Directions.

Purpose Of Review: VO₂ max is a fundamental marker of cardiorespiratory fitness with substantial prognostic and diagnostic value within the field of cardiology. This review analyzes current and emerging evidence regarding its clinical uses, highlights key evidence gaps, and explores emerging developments poised to broaden its clinical application.

Recent Findings: Evidence supports VO2 max as a powerful independent predictor for heart failure, coronary artery disease, hypertrophic cardiomyopathy, and cardiac amyloidosis, supporting it use in identifying high-risk patients for advanced interventions.

Towards causal inference-based antidepressant selection with brain and blood biomarkers.

This report sought to employ multi-modal integration of pre-treatment brain (electroencephalogram, resting-state functional magnetic resonance imaging) and blood (immune and metabolic) biomarkers to facilitate causal inference-based treatment selection by virtue of establishing predictability of remission to multi-stage antidepressant treatment. Data from two stages of pharmacotherapy in the 'Establishing Moderators and Biosignatures of Antidepressant Response for Clinical Care for Depression' (EMBARC) study from participants with both brain and blood biomarkers were included (N = 197). Participants were initially randomized to sertraline or placebo (Stage 1), and depending on clinical response at week-8, their therapy in Stage 2 was either maintained or switched (to sertraline, if a non-responder to placebo, or to bupropion, if a non-responder to sertraline).

Acute Respiratory Distress Syndrome Phenotypes After Stem Cell Transplantation: A Latent Class Analysis.

Objective: To identify distinct phenotypes of acute respiratory distress syndrome (ARDS) developing after hematopoietic cell transplantation (HCT), using routinely available clinical data at ICU admission.

Design: Multicenter retrospective cohort study using latent class analysis.

Setting: ICUs across three Mayo Clinic campuses (Minnesota, Florida, and Arizona).

Modifying inhibitor specificity for homologous enzymes by machine learning.

Selective inhibitors are essential for targeted therapeutics and for probing enzyme functions in various biological systems. The two main challenges in identifying such protein-based inhibitors lie in the extensive experimental effort required, including the generation of large libraries, and in tailoring the selectivity of inhibitors to enzymes with homologous structures. To address these challenges, machine learning (ML) is being used to improve protein design by training on targeted libraries and identifying key interface mutations that enhance affinity and specificity.

Minimal Changes in Excitation-Contraction Coupling in Spastic Human Muscle.

Spasticity results from upper motor neuron lesions and can create a deforming force, pain, and is often accompanied by contracture. While the origin of spasticity is neural, there is ample evidence of secondary muscle changes. Here we use direct measurement of the force-frequency relationship (FFR) to characterize human muscle's physiological properties.

Covert Transthyretin Amyloidosis Mimicking Advanced Obstructive Hypertrophic Cardiomyopathy Despite Multiple Negative Tc-PYP Radionuclide Scans.

Background: We present the case of a 74-year-old woman diagnosed with obstructive hypertrophic cardiomyopathy.

Case Summary: Amyloidosis was initially considered because she was genotype positive in the transthyretin gene. However, because of 2 negative 99m technetium pyrophosphate radionuclide scans, this diagnosis was considered unlikely, and endomyocardial biopsy was deferred.

Balloon-expandable versus self-expandable stent grafts for endovascular repair of aorto-iliac aneurysms with iliac branch devices: A systematic review and meta-analysis.

Background: To compare the results of internal iliac artery (IIA) incorporation using balloon-expandable (BESG) versus self-expandable stent grafts (SESG) while using iliac branch devices (IBD) for endovascular repair of aorto-iliac artery aneurysms.

Methods: A systematic review and meta-analysis was conducted. PubMed, Embase, and Cochrane databases were searched for studies up to December 2024 that compared BESG and SESG for IBD during endovascular repair of aortoiliac aneurysms.

Late Survival and Self-reported Quality of Life in Octogenarians with Prior Sternotomy Undergoing Valvular Surgery.

Background: Recent advances in transcatheter valvular techniques often compete with open cardiac operations in managing high-risk patients with valvular disease, especially in the elderly. The present study assesses late survival and quality of life following valvular surgery in octogenarians with prior sternotomy.

Methods: We identified octogenarians who underwent cardiac valve reoperations between 2004 and 2023.

Phenotyping and Clinical Utility of Phagocytic Polyploid Giant Cancer Macrophages in Blood.

Historically, polyploid giant cancer cells (PGCCs) within tumors have been ignored as superfluous inflammatory refuse with no intrinsic clinical or biological relevance. However recently, multiple studies have described the existence PGCCs in solid tumor masses that appear to correlate with tumor progression, and can also appear in blood circulation as cancer associated macrophage like cells (CAMLs). In an effort to understand the clinical and biological role of CAMLs (i.

Risk Factors in Predicting Radiologically Occult Metastatic Disease from Pancreatic Ductal Adenocarcinoma: A Single-Institution Experience with Routine Preoperative Magnetic Resonance Imaging.

Background: Limited data exists regarding the incidence of aborted pancreatic surgery due to radiologically occult metastatic disease (ROMD). This study presents a single-institution experience aimed at identifying potential risk factors associated with ROMD of patients undergoing routine preoperative magnetic resonance imaging with pancreatic ductal adenocarcinoma (PDAC) METHODS: Patients with PDAC taken for curative intent pancreatic surgery between January 2012 and December 2022 following preoperative imaging MRI protocol were retrospectively reviewed, and those who had aborted surgery due to ROMD were identified. Binary logistic regression analysis was performed to identify potential predictors of ROMD.

The Association of Premature Atherosclerosis with Ischemic Stroke in Young People with HIV in Lusaka, Zambia.

Background: Premature atherosclerosis has been observed among people with HIV (PWH) with high risk of cerebrovascular disease. The aim of this study was to evaluate premature atherosclerosis in young PWH with and without ischemic stroke.

Methods: We conducted a prospective case-control study at the University Teaching Hospital in Lusaka, Zambia between March 2022 and October 2024, comparing young PWH with non-cardioembolic ischemic stroke (cases) with PWH without a history of stroke (controls) matched (1:2) for age, sex and race.

Extracoronary Arterial Pathologies in Patients With Spontaneous Coronary Artery Dissection (SCAD).

Background/objective: Spontaneous coronary artery dissection (SCAD) is increasingly recognized as a cause of acute coronary syndrome and has been associated with extracoronary arteriopathies, such as fibromuscular dysplasia (FMD), aneurysms, and dissections across other vascular beds. However, these associations remain understudied in the literature. This study aims to characterize the prevalence and distribution of extracoronary arteriopathies in a large cohort of SCAD patients.

Long Term Outcomes after Re-Irradiation With Spine Stereotactic Body Radiation Therapy: Single Institutional Retrospective Experience.

Re-irradiation of spinal metastases using stereotactic body radiotherapy (SBRT) presents clinical challenges, with limited patient outcomes data to guide decision-making. We report a retrospective, single-institutional experience of 107 lesions treated in 91 patients. 88 (72%) lesions were initially irradiated with conventional radiotherapy (median equivalent dose of 33Gy to the target, interquartile range, IQR: 23-35 Gy) with a median time to re-irradiation of 12 months (IQR: 4-21 months).

Activity performance in patients with traumatic brachial plexus injuries after elective amputation and myoelectric hand prosthetic fitting.

Objective: The role of amputation and myoelectric prosthetic fitting for hand function in traumatic pan-brachial plexus injury (pBPI) continues to evolve. This study evaluated the function and activity performance of patients with traumatic pBPI who underwent amputation and prosthetic fitting with a myoelectric prosthesis (MEP) for hand function.

Methods: A retrospective analysis of adult patients who underwent elective amputation after sustaining a pBPI followed by MEP for hand function was performed.

Spinal fractures in patients with versus without ankylosing spinal disorders: a nationwide propensity score-matched study on survival and health-related quality of life.

Objective: The evidence on ankylosing spinal disorders (ASDs), including ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH), in the context of spinal fracture stems from studies with relatively small sample sizes. There are no studies addressing the patient-reported outcome measures (PROMs) and health-related quality of life (HRQOL) outcomes associated with spinal fracture in this population. The aim of this study was to investigate differences in complications, mortality, PROMs, and HRQOL in patients with and without ASD who had been treated for spinal fracture.

A comparative assessment of laser interstitial thermal therapy and open resective surgery for drug-resistant epilepsy: a meta-analysis of 3873 patients.

Objective: Open resective surgery (ORS) has become the standard of care for focal drug-resistant epilepsy (DRE). However, minimally invasive surgical alternatives, such as laser interstitial thermal therapy (LITT), have also been shown to be safe and effective. A meta-analysis comparing both treatments is warranted to assess the benefits of each modality for focal DRE.