Publications by Year: 2026

Limited information on the business practices of liver transplant (LT) centers worldwide has been published. Characterizing this data could help identify best practices as well as opportunities for improvement. As such, the International Liver Transplant Society (ILTS) Business Practice Committee conducted a global online survey of LT centers, which was sent to the ILTS membership. Questions focused on 5 main domains: transplant practice and volumes, workforce, finances, quality assessment and performance improvement, and overall program function. Data was compared across program geographic regions and transplant volume. A total of 89 discrete centers were represented, of which 76.4% were academic/university-affiliated, and about one-third each were from Europe (36.0%) and North America (31.5%). The top 3 problems programs reported were finances/funding (60.7%), adequate program support/guidance (48.3%), and transplant volumes (43.8%). In all, 59.6% of respondents felt their salary was undercompensated, consistent across geographic regions. In addition, 69.7% felt their center was not adequately funded to meet program goals, with programs in Europe (N=28/32, 87.5%) and Oceania (N=2/3, 66.7%) most impacted. Transplant surgeon retainment was noted as more difficult for lower volume programs (<50 liver transplants/year, N=13/31). Nearly half (42.7%) of all programs felt under-resourced to provide high-quality care, and the majority (80.9%) felt there was room for growth and improvement under their current model. While international concerns varied widely among LT centers, inadequate salary and center funding, low transplant and referral volumes, and staff retainment were persistent themes. Focusing on adopting region-specific best practices and developing transplant systems of care that focus on these elements is critical to provide optimal care to LT patients worldwide.

PURPOSE: Biomarkers, or specific somatic alterations, are increasingly required for clinical trial eligibility. Finding and enrolling patients with these biomarkers is essential not only for continuous progress in the treatment of disease but also for democratizing clinical trial participation. Here, we use data from the National Cancer Institute Clinical Trials Reporting Program (NCI CTRP), combined with large language model applications, to survey the current landscape of cancer clinical trials.

METHODS: We extracted 20,894 trials from Cancer.gov from the application programming interface (API) of the NCI CTRP. We quantified biomarker rates in cancer subtypes, described the geographic distribution of trial sites, and identified failure causes for these trials. Finally, we built an application from this API to match patients with clinical trials.

RESULTS: We showed that 5,044 of the 20,894 interventional clinical trials contained biomarker eligibility data and trials tended to cluster around large academic centers and cities. We identified 630 biomarkers in 36 cancer subtypes and show that most biomarkers are used as eligibility criteria for multiple cancer subtypes. We highlight that the difficulties with accrual and sponsorship were the most common reason for discontinuing clinical trials. Finally, we demonstrate a novel method to automatically match natural language queries with eligible clinical trials, NCI Clinical Trials Navigator.

CONCLUSION: A survey of our clinical genomics showed that many individuals likely have mutations that would make them eligible for biomarker-driven trials. We used the NCI Clinical Trials database to show that the distribution of biomarker trials across the United States limits access for many patients and likely leads to the frequent trial termination because of inadequate accrual. Finally, we built an automated publicly available tool that can improve patient-to-trial biomarker-based matching.

BACKGROUND: Rates of drug-resistant tuberculosis (DR-TB) are increasing worldwide. Tuberculosis preventive treatment (TPT) for contacts of people with active TB is essential to halt infection progression and transmission. While newer TPT regimens for exposure to drug-susceptible and rifampin (R)-resistant strains (MDR-TB/RR-TB) are expanding, optimal treatment for contacts exposed to fluoroquinolone-resistant strains of TB (pre-XDR- or XDR-TB) remains unclear. In 2019-2020, Vladimir City, Russia, introduced moxifloxacin (Mfx)- and bedaquiline (Bdq)-based TPT regimens to prevent disease development in contacts exposed to MDR/RR-TB and pre-XDR-TB.

METHODS: We conducted a retrospective cohort study of adult TB contacts, people experiencing homelessness, and people with HIV who received TPT in Vladimir between 2019 and 2020. Those without TB disease but with indications for TPT were offered 1 of 6 regimens, based on drug-susceptibility testing results of the index patient: rifapentine/isoniazid (3HP), isoniazid (6H), rifabutin/isoniazid (3HRb), 4R, 4Mfx, or 3Bdq. Adverse drug reactions (ADRs) were monitored with monthly lab tests and electrocardiogram (ECGs). Outcome measures included ADRs, TPT completion, and TB disease incidence during the 12-month follow-up period.

RESULTS: Over 24 months, 403 people started TPT. No life-threatening ADRs or deaths occurred. The lowest ADR rate and highest completion were seen with 3Bdq (95.2%) compared to 3HP (75.9%, Mid-P exact = .03). Tuberculosis incidence per 1000 person-years was 4 times higher among eligible individuals who declined TPT versus those initiating it.

CONCLUSIONS: Preventive therapy for drug-resistant TB, including fluoroquinolone-resistant strains, is acceptable, safe, and effective. Implementation of comprehensive TPT programs in high-burden DR-TB settings can protect contacts and reduce transmission.

BACKGROUND: Stroke is a sexually dimorphic disease, with different risk factors, incidence, outcomes, and treatment responses in men and women. While sex differences have been documented in preclinical studies, these findings often come from single-site studies with small sample sizes and require validation across diverse research settings.

METHODS: We used data from the SPAN (Stroke Preclinical Assessment Network), a randomized, placebo-controlled, blinded, multilaboratory trial, to determine if sex differences in neurological outcomes are present in preclinical stroke models. We analyzed data from 665 stroke animals treated with saline, including young mice, diet-induced obese mice, aging mice, young rats, and spontaneously hypertensive rats. We compared the corner test index and brain morphology between the sexes using linear random effect models and assessed the mortality rate using Cox proportional hazard regression models.

RESULTS: No significant sex differences were found in neurological outcome measured with the corner test on either day 7 or day 30 after stroke, regardless of the mouse or rat stroke model used. Additionally, female and male mice exhibited similar infarct sizes on day 2 magnetic resonance imaging and on brain atrophy measures on day 30 after stroke, indicating a lack of sex differences in brain injury. Similarly, no sex differences were observed in acute or chronic sensorimotor or tissue outcomes in young rats. In 1 subanalysis, sex differences were seen in the spontaneously hypertensive rats cohort. Female rats exhibited a higher corner test index on day 30 than males, indicating more severe sensorimotor injury.

CONCLUSIONS: In this multicenter preclinical study, we did not detect sex differences in stroke outcomes in mice, although sex differences in behavioral outcomes were observed in spontaneously hypertensive rats. These findings highlight that sex differences may be model-specific and subtle, emphasizing the need for methodological consistency and thoughtful inclusion of diverse animal models in translational stroke research to better understand if sex-specific responses contribute to stroke outcomes.

BACKGROUND: Peripheral nerve block (PNB) usage in breast reconstruction (BR) improves post-operative pain with minimal risks. This study examined outcomes of patients receiving PNB for post-operative analgesia in BR.

METHODS: A retrospective analysis using the ACS-NSQIP database identified women that underwent BR from 2012-2021. Patients who received regional anesthesia in addition to general anesthesia were included. Patients that received other forms of anesthesia were excluded. Post-operative complications were compared between PNB and non-PNB groups, as well as among BR timing, modality, operative time and ASA class. Group differences assessed via t-tests and Fisher's Exact tests. Multivariate logistic regression assessed whether complications were independently associated with receiving PNBs.

RESULTS: Out of 25,188 patients, 9,429 patients (37.4%) received PNB for perioperative BR analgesia. Patients that received PNBs had longer operative times, more wound complications, reoperations and readmissions. PNB usage was associated with increased likelihood of SSI even when BR modality, timing, operative time and ASA classification were isolated (p<0.05). Further, sub-group analysis revealed PNB use was associated with SSI for all BR modalities and timing.

CONCLUSIONS: The decision to use PNBs in BR should be made with awareness of the associated risk of increased wound complications. Despite that, benefits of PNBs may still very well outweigh these risks for all our patients. However, based on our findings we still suggest increased surveillance and more comprehensive consultation. Further research into the association of PNB usage and wound complications should be performed such that our patients can obtain maximal benefit and minimize unwanted side-effects.

In the FMR1 gene, expansion of the CGG triplet beyond 200 repeats triggers DNA methylation, resulting in the Fragile X Syndrome (FXS). There exist rare individuals who carry a CGG expansion >200 that remains unmethylated, rescuing them from expressing the FXS phenotype. We tested the hypothesis that active FMR1 transcription regulates DNA methylation of the locus through the binding of its mRNA to DNMT1 enzyme. Our results show that DNMT1 binds FMR1-mRNA in transcriptionally active cells preventing them from being methylated, whereas it binds to the FMR1 locus in FXS cells, resulting in gene silencing. DNMT1 binds to the transcript or to the locus after reactivating or blocking FMR1 transcription using specific drugs, respectively. As proof of concept, aptamers capable of binding and inhibiting DNMT1 were shown to reactivate the silenced FMR1 gene. We propose that DNMT1 represents a specific molecular target to reactivate the FMR1 gene expression.