Guidelines recommend fasting before catheterization laboratory (cath lab) procedures. However, recent studies question the necessity of fasting, suggesting that fasting may not provide significant clinical benefits. This study aims to evaluate the existing evidence between outcomes for patients with fasting and nonfasting regimens. We conducted a comprehensive search for randomized controlled trials comparing fasting and nonfasting protocols before cath lab procedures. Outcomes included hypoglycemia, aspiration pneumonia, contrast nephropathy, all-cause mortality, and cardiovascular mortality. A random effects meta-analysis was performed to derive odds ratios (ORs) and 95% confidence intervals (CIs). The meta-analysis included 8 randomized controlled trials with a total of 3068 participants: 1544 in the fasting group and 1524 in the nonfasting group. Compared with fasting, nonfasting was not associated with significant differences in hypoglycemia (OR = 0.77, 95% CI, 0.44-1.34), aspiration pneumonia (OR = 1.33, 95% CI, 0.38-4.72), contrast nephropathy (OR = 1.82, 95% CI, 0.88-3.75), all-cause mortality (OR = 1.29, 95% CI, 0.51-3.28), or cardiovascular mortality (OR = 0.94, 95% CI, 0.22-4.05). Nonfasting regimens show no significant differences in safety outcomes compared with fasting, suggesting it may be implemented to improve patient experience without compromising safety. Larger trials are needed to confirm the safety of nonfasting regimens. Summary of outcomes (CEID, cardiac implantable electronic device; PCI, percutaneous coronary intervention; TAVR, transcatheter aortic valve replacement). The design features graphical elements sourced from Servier Medical Art, which are provided by Servier under the Creative Commons Attribution 4.0 unported license.
Publications by Year: 2026
2026
BACKGROUND: Coronary artery disease (CAD), tuberculosis (TB), and HIV are major global health concerns. Individuals affected by one or more of these conditions often exhibit chronic inflammation and immune dysregulation, with monocytes playing a central role. Monocyte subsets are known to expand in individuals with HIV, TB, or CAD, but the mechanisms by which these cells contribute to inflammation and immune responses remain poorly understood.
METHODS: We employed high-dimensional mass cytometry to characterize monocyte heterogeneity in 61 Ugandan adults with varying combinations of HIV, TB, and subclinical or overt CAD. An integrative approach was used, combining manual gating, unsupervised clustering, and machine learning to identify distinct monocyte phenotypes associated with CAD and TB. Monocyte activation markers soluble CD14 (sCD14) and sCD163 were measured in plasma. CAD was diagnosed by coronary computed tomography angiography. TB was determined by a questionnaire and interferon-gamma release assay (IGRA) testing.
RESULTS: Participants' demographics and clinical characteristics were similar by CAD or HIV/TB status. Median age was 61 years; 37.7% were female. People living with HIV and latent TB or prior active TB had higher sCD14 plasma levels compared with HIV/TB-negative individuals. Individuals with CAD showed reduced surface expression of the scavenger receptor CD163 on non-classical monocytes. Unsupervised clustering further revealed 2 distinct non-classical monocyte subsets associated with disease states: A CD86dim CX3CR1dim CD45RA+ GPR56+ CXCR3+ subset significantly depleted in individuals with CAD, and a CD86+ CX3CR1++ CD45RA++ GPR56- CD38- CXCR3- subset enriched in individuals with latent TB.
CONCLUSIONS: These findings underscore the complexity of the monocyte landscape in CAD progression, particularly in regions where HIV and TB are co-endemic. Our study reveals distinct alterations within 2 non-classical monocyte subpopulations associated with CAD and with HIV/TB, offering mechanistic insights that may support the development of precision biomarkers and immune-targeted therapies across these disease contexts.
Kidney organoids derived from human pluripotent stem cells have emerged as promising models for studying kidney disease and therapeutic development. However, the lack of a scalable production system has limited their industrial applications in regenerative medicine. Here, we have developed a cost-effective mass-production method for manufacturing vascularized kidney organoids, which has improved production efficiency by more than 50 times compared to conventional culture systems. The incorporation of a dynamic culture environment in delta-wing stirred bioreactors has significantly enhanced the glomerular vascularization of kidney organoids via mechanosensory integrin α2β1. Single-cell RNA sequencing and functional analyses demonstrated the enhanced maturation in STR nephron epithelia. The large quantities of vascularized kidney organoids enabled the fabrication of a nephron sheet with nephron numbers equivalent to those found in two rat kidneys. Intravital imaging of a nephron sheet implanted in a dorsal skinfold chamber of mice revealed filtration function with size selectability in the organoid glomeruli vascularized with human endothelia. This work may represent a significant step towards bridging the gap between basic research and commercial products, paving the way towards developing bioengineered kidneys for kidney replacement therapy.
PURPOSE: To report a rare case of an anteriorly enlarged giant bleb following Ahmed ClearPath 350 glaucoma drainage device implantation, successfully treated with compression sutures.
OBSERVATIONS: A 50-year-old man with a history of primary open angle glaucoma and multiple prior glaucoma procedures presented with a progressively enlarging inferonasal conjunctival bleb in the right eye, six months after Ahmed ClearPath 350 implantation. Examination revealed visual acuity (VA) of 20/40, intraocular pressure (IOP) of 6 mmHg, and a large, elevated, fluid-filled conjunctival bleb. While bleb formation is a desired outcome following glaucoma drainage device (GDD) implantation and trabeculectomy, the increasingly large size of this bleb caused discomfort, worsening vision, and difficulty closing the eye. Due to its rare nature, there was little consensus available regarding treatment. Compression sutures were placed in attempt to flatten the bleb. At one-week follow-up, vision and discomfort improved and slit-lamp examination revealed a markedly flatter bleb. Sutures were sequentially removed via slit-lamp during the one-month and two-month postoperative visits. At one-year follow-up, VA was 20/25, IOP was 6 mmHg, and slit lamp examination revealed a completely flattened inferonasal bleb.
CONCLUSIONS AND IMPORTANCE: This case highlights a rare presentation of a giant inferonasal conjunctival bleb developing several months after Ahmed ClearPath 350 implantation. The successful use of compression sutures suggests they may be a viable treatment option for similar post-GDD implantation bleb complications.
BACKGROUND: Patients with osseous metastatic breast cancer receive bone-modifying agents (BMAs) as part of their standard care. Medication-related osteonecrosis of the jaw (MRONJ) is one of the most important toxicities of this class of drugs. MRONJ heavily impacts patients' quality of life and represents a major medical burden necessitating a discontinuation of treatment. Currently, the diagnosis of MRONJ is established upon the manifestation of clinical symptoms like exposed necrotic jawbone, pain, swelling or signs indicative of infection of the jaw. The objective of this study was to assess the potential of imaging modalities, specifically FDG-PET/CT (positron emission tomography with computed tomography) in the early detection of MRONJ.
METHODS: This cohort study in Austria included all patients with metastatic breast cancer who were receiving denosumab and regular PET/CTs, diagnosed with MRONJ between 2000 and 2022 at the Department of Obstetrics and Gynecology Innsbruck. For each of the patients in the study cohort, two control patients with comparable clinical characteristics were matched to serve as a control group. Control patients with metastasized breast cancer did not develop MRONJ but did receive denosumab and regular FDG-PET/CTs. Imaging data were independently assessed by two experienced nuclear medicine physicians.
FINDINGS: Baseline characteristics were well balanced. Patients received 120 mg denosumab once per month subcutaneously without de-escalation of therapy. The median time to develop MRONJ was 23 months (range 5-71, lower Quartile (Q1), upper Quartile (Q3) 16, 40 months). Nuclear medicine physicians detected jaw alterations in 91% (19/21) of MRONJ cases (sensitivity, 95% CI: 70%-98.8%) and in 29% (12/42) of controls, corresponding to a specificity of 71% (30/42; 95% CI: 55%-84%). Median lead time of imaging by demonstrating lesion in the jaw was 238 days (range 11-1118, Q1, Q3 106,494) prior to MRONJ diagnosis. In 68% (13/19) of MRONJ cases the nuclear medicine physicians were able to predict the exact tooth location of MRONJ with a deviation of no more than two teeth.
INTERPRETATION: The high sensitivity and negative predictive value of imaging for early detection of MRONJ underscore its significance for clinical practice. Given that the majority of patients receive regular PET/CTs, our results provide an excellent opportunity for early intervention when MRONJ is detected with a considerable lead time.
FUNDING: This study received no external funding.
Intensive care units (ICU) produce numerous progress notes that may contain stigmatizing language that perpetuate negative biases and punitive approaches against patients. Patients with substance use disorders are particularly vulnerable to stigma. This study examined the performance of Large Language Models (LLMs) in the identification of stigmatizing language. We annotated a dataset with over 77,000 stigmatizing and non-stigmatizing notes from the MIMIC-III database. We utilized Meta's Llama-3 8B Instruct LLM to run the following experiments for stigma detection: zero-shot; in-context learning; in-context learning with a selective retrieval; supervised fine-tuning (SFT); and keyword search. All approaches were evaluated on a held-out test set and external validation (University of Wisconsin Health System). SFT had the best performance with 97.2% accuracy, followed by in-context learning. The LLMs with in-context learning and SFT provided appropriate reasoning for false positives during human review. Both approaches identified clinical notes with stigmatizing language that were missed during annotation. SFT achieved 97.9% accuracy on external validation dataset. LLMs, particularly SFT and in-context learning, effectively identify stigmatizing language in ICU notes with high accuracy while explaining their reasoning in an asynchronous fashion and demonstrated the ability to identify novel stigmatizing language, not explicitly in training data nor existing guidelines.
BACKGROUND: Distal biceps tendon ruptures often require surgical repair to restore elbow flexion and forearm supination. However, the reinsertion procedure may be complicated by postoperative posterior interosseous nerve palsy caused by iatrogenic injury to the deep branch of the radial nerve (DBRN). While safe drilling trajectories for distal biceps tendon repair have been extensively studied, the potential influence of a bony gap between the insertion sites of the supinator muscle layers, referred to as the bare area of the proximal radius, has not been adequately addressed.
PURPOSE: To determine the frequency, morphometrics, and topography of the bare area and to propose a safe bicortical drilling trajectory for single-incision distal biceps tendon repair that minimizes the risk of injury to the DBRN in the context of the bare area.
STUDY DESIGN: Descriptive laboratory study.
METHODS: A cadaveric dissection of 100 formalin-fixed upper limbs was conducted. Additionally, 1000 dry radii were examined for an osseous groove corresponding to the bare area. Furthermore, 10 fresh-frozen elbows were used for assessment of safe bicortical drilling trajectories in the presence of the bare area.
RESULTS: The bare area was present in 56.0% of cases, with no significant side or sex predominance. The bare area was 13.7 ± 5.2 mm long and 5.1 ± 1.6 mm wide, and occupied an area of 58.7 ± 33.8 mm2. Direct contact between the DBRN and the periosteum of the radius was noted in 28.6% of specimens. The extent of an osseous groove corresponding to the bare area overlapped with the radial tuberosity in 28.5% of the cases. Experimentally, bicortical drilling directed 30° ulnarly and 45° proximally ensured a safe distance from both the DBRN and the bare area.
CONCLUSION: The frequent occurrence of the bare area should be a critical consideration during bicortical drilling for distal biceps tendon repair. Drilling angles directed ulnarly and proximally are recommended to minimize the risk of neural injury.
CLINICAL RELEVANCE: This study highlights the increased risk of DBRN injury during distal biceps tendon repair in individuals with the bare area and provides safe drilling trajectories to guide surgeons in reducing the likelihood of this neural injury.
Childhood-onset movement disorders are clinically and genetically heterogeneous, with over 500 implicated genes. Standard clinical genetic testing, including exome sequencing, has limited sensitivity for certain variants, including repeat expansions, structural variants (SVs), copy number variants (CNVs), and deep intronic changes. We evaluated the diagnostic utility of short-read whole genome sequencing (srWGS) and, in selected cases, long-read genome sequencing (lrWGS) in a real-world cohort of children and young adults with early-onset progressive movement disorders and prior nondiagnostic genetic testing. One hundred individuals (<30 years) with progressive movement disorders with a suspected genetic etiology were recruited from a tertiary pediatric movement disorders program. All had prior nondiagnostic testing. SrWGS (Illumina NovaSeq 6000) assessed single nucleotide variants (SNVs), CNVs, SVs, and repeat expansions; lrWGS (Pacific Biosciences) was applied to select unsolved trios. Variants were reviewed by a multidisciplinary team using standard variant interpretation guidelines and phenotype correlation. A molecular diagnosis was achieved in 27% (27/100) of cases, and candidate variants were identified in an additional 33% (33/100). Among solved cases, 81.5% (22/27) were identified from exome-level data, while 18.5% (5/27) required genome-level analysis to detect variants such as repeat expansions in HTT and FXN, an intragenic duplication in MECP2, an Alu insertion in ATM, and a deletion in FA2H. Genome-level analysis contributed an additional diagnostic yield of 5% (5/100) only. Notably, in 33.3% (9/27) of solved cases, variants had been previously reported but not recognized as diagnostic. LrWGS of 14 unsolved trios did not yield additional diagnoses. SrWGS provided a modest incremental yield over exome sequencing in early-onset movement disorders, with most diagnoses achieved through reanalysis of exome-level data. Findings highlight the importance of iterative variant interpretation and the need for improved analytic pipelines to fully realize the potential of genome sequencing.