Publications by Year: 2026

BACKGROUND: Stabilizers/silencers limit new transthyretin amyloid formation, whereas emerging agents aim to clear existing deposits. Cardiovascular magnetic resonance (CMR) extracellular volume (ECV) reflects myocardial amyloid and may provide a quantitative framework for therapeutic planning OBJECTIVES: The aim was to define calibrated ECV thresholds, evaluate their diagnostic and prognostic value, and explore how CMR-ECV could provide a quantitative framework for disease staging and therapeutic planning.

METHODS: We studied 1,541 subjects undergoing CMR for transthyretin amyloidosis (ATTR) classified as TTR-variant carriers (n = 123), extracardiac ATTR (n = 41), early-stage ATTR-CM (n = 70), or overt ATTR-CM (n = 1,308). The endpoint was all-cause mortality.

RESULTS: ECV was similar in carriers and extracardiac ATTR but rose from early-stage to ATTR-cardiomyopathy (CM). Associations with biomarkers, National Amyloidosis Centre (NAC) stage, Perugini grade, and echocardiographic measures were modest, with wide overlap. Diagnostic performance was excellent: ECV <30% excluded and ≥40% confirmed cardiac involvement, whereas 30% to 39% indicated early infiltration. Over a median follow-up of 2.8 years (IQR: 1.4-4.3 years), 612 patients (40%) died. Prognostically, ECV independently predicted mortality (HR: 1.22 per 10% increase; 95% CI: 1.10-1.34 per 10% increase; P < 0.001) after multivariable analysist. Stratifying patients by ECV categories (degree of infiltration: none <30%; mild = 30%-39%; moderate = 40%-49%; moderate-to-severe = 50%-59%; severe ≥60%) showed monotonic risk increase across categories. ECV retained prognostic value across hs-troponin and N-terminal pro-B-type natriuretic peptide (NT-proBNP) strata, Perugini grades 1 to 3, and left ventricular mass index (LVMI) tertiles, with steeper gradients in low-biomarker/low-LVMI strata.

CONCLUSIONS: ECV directly quantifies myocardial amyloid load and, for the first time, defines reproducible thresholds that stratify burden and refine risk prediction beyond stage, biomarkers, and imaging, providing a quantitative framework for staging and therapeutic planning in ATTR amyloidosis.

BACKGROUND: The rapid integration of Large Language Models (LLMs) into healthcare necessitates a rigorous evaluation of their performance in specialized medical fields. In metabolic bariatric surgery (MBS), LLMs have the potential to revolutionize education and clinical support, yet their accuracy and reliability are not well-established. This study provides a critical assessment of the capabilities of current LLMs in the context of MBS.

METHODS: This cross-sectional validation study assessed the performance of six LLMs (ChatGPT-3.5, ChatGPT-4o, Gemini, Copilot, GROK, and DeepSeek) in answering 100 evidence-based binary and multiple-choice questions related to MBS. Questions were constructed from international guidelines and categorized into six thematic domains. Expert consensus answers served as the reference standard, with inter-rater reliability measured using Fleiss’ κ. Model outputs were scored for accuracy. Comparisons across LLMs were first assessed using an overall test for differences between multiple related groups. Pairwise comparisons were then conducted between LLMs to identify specific differences in performance.

RESULTS: Across the dataset, the mean number of correct LLM responses per question was 3.9 (SD = 1.8). ChatGPT-4o achieved the highest accuracy (66.0%), while DeepSeek recorded the lowest (60.0%). Accuracy varied across domains, highest for indications/contraindications (78.7%) and complications/management (68.0%), and lowest for preoperative preparation (52.0%) and postoperative care (58.4%). Binary questions yielded higher accuracy (69.1%) than multiple-choice questions (62.0%). Inter-expert reliability was substantial (κ = 0.742, 95% CI: 0.71–0.77). Agreement between LLMs and experts ranged from fair (DeepSeek κ = 0.349) to moderate (ChatGPT-4o κ = 0.446). No significant accuracy differences were detected across models (Friedman test, p = 0.662).

CONCLUSION: LLMs represent a promising, yet imperfect, adjunct in MBS education. Their utility is currently limited by inconsistencies in accuracy, particularly in areas requiring nuanced clinical judgment. While these models can supplement traditional learning resources, they are not yet a substitute for expert clinical guidance. This study underscores the need for continued refinement and validation of LLMs to ensure their safe and effective integration into clinical practice.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11695-025-08418-y.

BACKGROUND: The aim of this study is to explore how neutrophil extracellular traps (NETs) and phosphatidylserine exposure contribute to hypercoagulability in periodontitis with type 2 diabetes (T2D).

METHODS: Ninety-six participants were divided into groups with periodontitis (CP), T2D, periodontitis with type 2 diabetes (DP), and a healthy control (CTR). Coagulation profiles were assessed using coagulation time and fibrin generation tests. Confocal microscopy and flow cytometry measured phosphatidylserine (PS)-exposed cells and NETs in blood samples. The impact of NETs on endothelial cells was evaluated through Western blot, confocal microscopy, and angiogenesis tests. We evaluated the NETs levels in patients before and after treatment through blood glucose control or periodontitis treatment.

RESULTS: DP patients showed shorter coagulation times, higher fibrinogen levels, and more blood cells (e.g., platelets and neutrophils) with PS exposure, along with increased NETs release. Activated platelets were found to stimulate NETs release more than microparticle-poor plasma. NETs damage vascular endothelial cells, leading to increased vascular cell adhesion molecule-1 (VCAM-1), decreased vascular endothelial cadherin (VE-cadherin), actin reorganization, reduced tube formation, and higher procoagulant activity in endothelial cells. After periodontal treatment or blood sugar control, the levels of NETs decreased significantly in patients with DP.

CONCLUSIONS: In patients with DP, activated platelets trigger neutrophils to release excess NETs, which create a pro-thrombotic state by damaging endothelial cells. Small-scale clinical trials underscore the value of controlling local infection and hyperglycemia as first-line "NET-modulating" strategies.

PLAIN LANGUAGE SUMMARY: The hypercoagulability of DP patient can be partially explained by the activated platelet-promoted excess NETs providing a scaffold for clotting factors, damaging endothelial cells intercellular connections, converting of endothelial cells to pro-coagulant phenotype, and impairing of endothelial cells tube formation capacity. Blood sugar control and periodontal treatment can regulate the levels of NETs which represents the generation of new promising DP treatment options. In the future, efforts should be made to develop therapeutic strategies targeting NETs or PS.

We present a 62-year-old male with end-stage kidney disease and a high-flow brachiocephalic arteriovenous fistula (3.3 L/min). Revascularization using distal inflow was performed with a naturally developed retrograde cephalic vein branch in the ipsilateral arm anastomosed to the distal radial artery. The original anastomosis was ligated. The patient could use the revised forearm portion of the autogenous moderate-flow fistula at 2-month follow-up. This case demonstrates the use of naturally augmented veins to facilitate revascularization using distal inflow rather than a prosthetic graft or saphenous vein conduit, offering a unique approach to flow reduction and creation of autogenous forearm conduits for cannulation.

INTRODUCTION: Brown adipose tissue (BAT) contributes to thermogenesis and has been proposed as a therapeutic target for metabolic disease. Thyroid hormones (THs) regulate thermogenic activity, but the relationship between circulating and local TH concentrations and their associations with thermogenic gene and pathway expression in human adipose tissue remain unclear.

METHODS: We obtained paired deep neck and subcutaneous adipose tissue samples from adults undergoing thyroid surgery, which represent BAT and white adipose tissue, respectively. Serum and local adipose tissue TH concentrations (T3, T4, TSH) were measured. Bulk RNA-sequencing was performed on adipose tissue samples. Associations between hormone concentrations and thermogenic gene expression and pathway activation were analyzed, with false discovery rate correction for multiple testing.

RESULTS: Both serum and local T4 concentrations were positively associated with thermogenic pathway activation in deep neck adipose tissue. Although serum T3 was also positively associated, local T3 was inversely associated with thermogenic pathways in deep neck adipose tissue. However, circulating TH concentrations did not correlate with local tissue hormone levels. No significant associations were observed between serum or local TH concentrations and individual thermogenic gene expression after correction for different clinical covariates and multiple comparisons.

CONCLUSION: Local regulation of THs may play a role in human adipose tissue thermogenic activity. Pathway-level transcriptomic analysis may better capture these effects than single-gene approaches. Deep neck adipose tissue can serve as a practical model for studying BAT function and endocrine regulation in humans.

OBJECTIVES: In the United States, training for physicians who manage critically ill adult patients (intensivists) evolved through parallel subspecialty critical care medicine (CCM) pathways with significant commonality. The Society of Critical Care Medicine Adult Critical Care Physician Core Knowledge and Skills Task Force aimed to delineate the common core knowledge and skills required of all intensivists.

DESIGN: A master list of content areas and procedural skills was compiled from all CCM subspecialty program requirements and blueprints of the certification examinations. Using a modified Delphi approach, participants were asked to categorize the knowledge items as "advanced knowledge is essential," "general, but not advanced, knowledge is essential," or "knowledge is not essential." Procedures were categorized as "intensivist performs routinely," "intensivist only performs in an emergency," or "intensivist knows" about the procedure.

SETTING: Representatives from CCM stakeholder organizations, including accreditation and certification organizations, critical care societies, and program directors' societies, were invited to participate.

SUBJECTS: Members of the Adult Critical Care Physician Core Knowledge and Skills Task Force of the Society of Critical Care Medicine.

INTERVENTIONS: For the first two rounds of the modified Delphi process, Research Electronic Data Capture was used. For the third and fourth rounds, the process was completed through online meetings with Zoom (Zoom Video Corporations, San Jose, CA) utilizing Zoom's polling feature.

MEASUREMENTS AND MAIN RESULTS: A total of 541 items were determined to be essential, with 145 requiring advanced knowledge and 323 requiring general knowledge. For 73 items, consensus regarding advanced vs. general could not be achieved, but they remained essential. Only eight items were felt to be nonessential. Of the 16 procedures, most were categorized as "intensivist performs."

CONCLUSIONS: The large number of items included in the list of essential knowledge and skills demonstrates the complexity of modern CCM. Utilization of a common framework across the subspecialties of CCM could lead to greater harmonization among the fellowship program requirements and certification examinations.