Purpose: To highlight the clinical utility of ultra-widefield swept-source optical coherence tomography angiography (SS-OCTA) in evaluating diabetic retinopathy (DR), particularly focusing on its ability to detect peripheral ischemia and neovascularization. Methods: Eyes of 5 participants with varying severity of DR were imaged with expanded-field 12 × 12-mm SS-OCTA scans and ultra-widefield SS-OCTA montages. Montages were created by stitching five 21 × 26-mm scans, offering up to a 200° field of view. Cases were assessed for areas of nonperfusion, intraretinal microvascular abnormalities, and neovascularization extending beyond the posterior pole. Results: Ultra-widefield SS-OCTA imaging demonstrated progressive mid-peripheral and peripheral nonperfusion, intraretinal microvascular abnormalities, and neovascularization in association with increasing DR severity. Peripheral nonperfusion and neovascular changes were detected beyond the scope of standard 12 × 12-mm scan areas. Conclusions: Ultra-widefield SS-OCTA is effective in noninvasively detecting peripheral retinal lesions such as ischemia and neovascularization. This technology offers potential to refine DR staging, improve risk stratification, and guide earlier clinical interventions.
Publications by Year: 2025
2025
BACKGROUND: Reproductive health considerations are critical to patients with IDH-mutant (IDHm) glioma as they are mainly diagnosed during their reproductive years. Given the recent introduction of IDH inhibitors (IDHi) for the treatment of IDHm glioma, we sought to review the current understanding of reproductive implications of IDHi therapy, and report how frequently documented reproductive health conversations take place in the clinic when considering IDHi initiation.
METHODS: We searched the literature for studies evaluating the effects of IDHi therapy on reproductive health. We additionally retrospectively collected clinical data from reproductive-age patients with IDHm glioma treated at the Dana-Farber Cancer Institute and Mass General Brigham who received or were considered for IDHi therapy between 2018 and 2024. Medical records were reviewed for documentation of fertility and contraception discussions at the time of IDHi consideration.
RESULTS: Other than limited preclinical studies described on Food and Drug Administration labels, no other data on the effects of IDHi on reproductive health were found. Of 119 patients considered for IDHi therapy, 54 (45%) had no documented fertility conversation in relation to IDHi, and 92 (77%) had no documented contraception conversation. On univariable analysis, factors significantly associated with not having fertility conversations were older age (OR: 0.94, CI: 0.88-1.0), male sex (OR: 0.50, CI: 0.23-1.07), and prior fertility conversation (OR: 0.41, CI: 0.18-0.88).
CONCLUSIONS: According to our institutional data, conversations regarding IDHi reproductive risks are not generally documented, contrary to guideline recommendations. Future studies are required to better understand the impact of IDHi therapy on fertility and fetal development.
BACKGROUND: BRAF alterations are common in pediatric low-grade gliomas (LGG) and a subset of high-grade gliomas (HGG) in adults and children. BRAF-targeted therapy can be effective at preventing tumor growth, though resistance commonly emerges in HGG. Recently, tovorafenib was FDA approved for recurrent or refractory LGG with BRAFV600 alterations or BRAF rearrangements. While the trial showed it is effective for children with LGG previously treated with BRAF or MEK inhibitors, the safety in adults and efficacy in HGG is unknown.
METHODS: A cohort of appropriate patients was identified through routine clinical care. This research was conducted in accordance with IRB regulations with a waiver of written consent.
RESULTS: Seven adults (5 HGG, 2 LGG) who received tovorafenib were identified. All patients had received prior BRAF-targeted therapy, and all patients with HGG had received prior radiation and temozolomide as well. Three individuals (2 HGG, 1 LGG) experienced stable disease or better for 4 or more months. Median duration of treatment was 8 weeks (range 3 weeks to 10 months). Two individuals experienced CTCAE grade 4 intratumoral hemorrhage (1 HGG, 1 LGG). Two patients remain on therapy at 4 and 10 months of treatment (1 HGG, 1 LGG).
CONCLUSION: Our experience with tovorafenib indicates some limited efficacy in HGG in combination with other standard treatments. These observations demonstrate the need for further clinical trials in patients with HGG to understand potential clinical utility, either earlier in the disease course or in combination with other therapies.
Individuals with Alice in Wonderland syndrome can present with a wide variety of visual symptoms. Most commonly, visual disturbances in size perception such as micropsia or macropsia are observed. However, rarer disturbances such as the visual perception of multiple images, termed polyopia, as well as kinetopsia, a visual illusion in which stationary objects are perceived as moving, have also been described. Previous neuroimaging of different individuals with Alice in Wonderland syndrome has shown the involvement of topographically separate brain regions. Here, we describe an individual who sequentially developed both micropsia and concurrent polyopia with kinetopsia following multi-focal infarction from underlying endocarditis. We show and describe his neuroimaging findings, as well as contextualize this with recent work showing how Alice in Wonderland syndrome may be subserved by a common distributed brain network.
INTRODUCTION: Growing demand for liver transplantation (LTx) has increased the use of elderly donors. In Argentina, however, data on the clinical impact of donor age on post-transplant outcomes remain limited.
OBJECTIVE: To evaluate the effect of donor age on clinical, functional, and molecular outcomes after LTx at Hospital Universitario Fundación Favaloro Buenos Aires, Argentina.
METHODS: We performed a retrospective cohort study of 494 LTx conducted between 2009 and 2020. Patients were stratified into two age groups: 18-59 years (Younger) and ≥60 years (Elderly). Overall and graft survival (OS and GS) were assessed using Kaplan-Meier and Cox regression analyses adjusted for recipient age, donor age, recipient gender, donor gender, transplant year, MELD score, disease etiology, donor BMI, DRI, CIT, WIT, Total Bilirubin (TBIL) and INR. Early postoperative complications including early allograft dysfunction (EAD) and early renal replacement therapy (RRT) were evaluated. Post-transplant liver function was assessed by routine biochemical tests. Gene expression of pro-inflammatory and senescence markers was quantified by qRT-PCR, and lipofuscin deposition was measured using ImageJ.
RESULTS: After applying exclusion criteria, 267 LTx were included (Younger donors: n = 222; Elderly donors: n = 45). Recipients of elderly donor grafts showed significantly lower OS and GS (p < 0.05). In the multivariable analysis, donor age and TBIL remained independent predictors of GS, whereas donor age, recipient age, and TBIL were associated with OS. In contrast, neither the incidence of EAD nor early RRT differed between recipients of elderly versus young donor grafts. Early postoperative biochemical profiles were also similar between groups, with no significant differences in ALT, AST, ALP, or TBIL levels. Molecular analyses demonstrated that elderly donor livers exhibited significantly higher expressions of IL-1β, IL-6, TNF-α, p21 and CCND1, Elderly donor livers displayed higher baseline lipofuscin accumulation (p < 0.05), consistent with age-associated cellular senescence, and trends toward higher rejection rates.
CONCLUSION: Donor liver aging, characterized by increased inflammatory and senescence signatures, is associated with reduced patient and graft survival. These findings underscore the clinical relevance of considering donor biological age, beyond chronological age, in organ allocation and selection strategies.
BACKGROUND: People with HIV (PWH) may have a higher risk of heart failure (HF) due to traditional and HIV-related factors. Incidence and risk prediction of HF in PWH are not well characterized. We aimed to quantify the risk of HF events in a global population of PWH with low-to-moderate estimated atherosclerotic cardiovascular disease risk.
METHODS: HF incidence (events/1000 person years) was described overall and by demographic, HIV-specific, and HF factors, including estimated Predicting Risk of Cardiovascular Disease Events 10-year risk of HF. Confirmed HF events included adjudicated HF hospitalization and adverse events identified via a standardized Medical Dictionary for Regulatory Archives HF query.
RESULTS: We analyzed 7769 REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) participants from 5 global regions (median, 50 years; 31% female). Over a median follow-up of 5.6 years (interquartile range, 4.3-5.9), HF incidence was higher in women, among Black participants in high-income regions, participants in sub-Saharan Africa, and among those with preexisting hypertension and obesity compared with the absence of these factors. Current and nadir CD4+T-cell count, and HIV-1 RNA level were not related to the incidence of HF events. Median (Q1-Q3) Predicting Risk of Cardiovascular Disease Events HF score was 1.66% (1.01-2.62). HF incidence was 1.65/1000 person-years (95% CI, 1.30-2.09). Expected number of HF events by Predicting Risk of Cardiovascular Disease Events HF (n=73) was consistent with observed (n=67).
CONCLUSIONS: Select demographics, clinical factors, and global regions contribute to a higher incidence of HF events among PWH. In PWH, the observed overall number of HF events aligned with the estimated Predicting Risk of Cardiovascular Disease Events HF risk rates.
Background: Patients undergoing nasal reconstruction with the paramedian forehead flap (PMFF) can lead to scalp hair transfer and brow distortion. To minimize this, we have adopted the low median forehead flap (LMFF). Objectives: To compare the hypothetical flap reach of the LMFF with the PMFF and measure flap viability and hair transfer amongst patients undergoing nasal reconstruction. Materials and Methods: A multi-institutional retrospective chart review of patients undergoing the LMFF collected demographics, flap viability, brow distortion, and hair transfer. Photograph measurements compared the hypothetic flap reach between an LMFF or PMFF design. Results: Eighty patients (mean age 65 ± 13 [SD] years, 56.3% female) met inclusion after LMFF for nasal defects, mostly from skin cancer resection (93.8%) involving the tip (67.1%) and ala (73.4%); with ≥3 involved subunits (63.8%). Transferred scalp hair (n = 1, 1.3%), and no flap compromise occurred. In photograph analysis, the LMFF showed an 11.6% increase in flap reach as compared to the PMFF (p < 0.0001). Intra-rater and inter-rater variances were nonsignificant. Conclusions: The LMFF is a viable modification to the PMFF for nasal reconstruction, especially in patients with short hairline and/or distal nasal tip/alar defects where increased flap reach and minimal hair transfer are desired.
Background: Serious illness conversations are an iterative, interprofessional, team-based process that includes recommendations about medical care. Yet, it is not clear how clinicians in different role groups work together in this process. Objectives: We sought to examine how interprofessional clinicians in the medical intensive care unit (MICU) who were trained in the serious illness care program (SICP) document recommendations after serious illness conversations. Design: This is a retrospective chart review and inductive content analysis. Settings/Subjects: We reviewed the charts of patients admitted to the MICU of an academic hospital with a long history of palliative care (PC) in the northeastern United States between January 1 and December 31, 2019, who had at least one documented serious illness conversation. Results: Of the 207 conversations identified, 177 (85.5%) included a recommendation: 44.6% (79/177) were documented by registered nurses, 36.7% (65/177) by physician trainees (internal medicine residents and pulmonology/critical care fellows), and 18.6% (33/177) by PC consultants (physicians, nurse practitioners, and PC fellows). Recommendations were categorized into several domains: (1) code status (2) treatment interventions, (3) psychosocial support, and (4) communication. The recommendations textbox was also used to document general updates and patient education. The most common domains documented were code status and treatment interventions, respectively: Registered nurses (40.5%; 20.3%), physician trainees (52.3%; 36.4%), and PC clinicians (42.4%; 32.3%). Clinicians used the direct/active voice to document recommendations concordant with their scope of practice and the reporter/passive voice to document recommendations given by others. Conclusions: SICP-trained interprofessional MICU clinicians commonly give and document recommendations on a range of domains and flexibly use direct/active and reporter/passive voice to signal their scope of practice.
BACKGROUND: Deficiencies in non-technical skills (NTS) such as leadership and communication can lead to intraoperative inefficiency and error. However, the relationship between these skills and patient-level outcomes has yet to be synthesized. The aim of this study was to systematically review the evidence examining the relationship between intraoperative NTS and clinical outcomes.
METHODS: The PubMed, Embase, CENTRAL, CINAHL, and PsycINFO databases were searched for relevant studies published between inception and 1 November 2024. Eligible studies assessed NTS of operating room personnel, were conducted in non-simulated environments, and reported clinical outcomes. NTS were categorized into five core domains including leadership and communication. Patient-level outcomes comprised eight clinical measures including mortality and postoperative complications.
RESULTS: Of 6313 screened studies, 21 met the inclusion criteria. Included studies represented 8536 participants performing 251 180 procedures across 13 specialties. Eleven observational studies assessed NTS of surgical personnel via study participants or observers. Ten interventional studies introduced NTS team training initiatives. Twelve of 21 studies (57%) incorporating 247 036 of all procedures (98.4%) reported significant improvements in clinical outcomes. Nine of 11 observational studies (82%) reported significant improvement in clinical outcomes compared with 3 of 10 interventional studies (30%). No studies demonstrated a significant deterioration in clinical outcomes associated with improved NTS.
CONCLUSION: Published evidence shows a significant link between intraoperative NTS and patient-level outcomes. These findings reinforce the value of behavioural assessment in surgery, support evidence-based team training, and underscore the need to embed NTS into regulatory frameworks to improve surgical quality and safety worldwide.
The medical device regulation (MDR) was adopted in 2017 to replace the medical device directive (MDD). Key changes included more rigorous clinical evidence requirements, increased scrutiny of notified bodies, and improved traceability of medical devices, with the overarching aim to improve their safety and quality. For chronic haemodialysis, the impact of the MDR on devices has been substantial, resulting in niche devices being no longer available, and critical shortages, especially in paediatric nephrology. The Eudial board discussed these developments and concluded that the MDR has had a clear negative impact on innovation. In conjunction with other emerging economic macro-trends, this development heightens the potential for disruptions within critical supply chains. We offer actionable recommendations to optimise the benefits of the MDR and to minimise unintended consequences.