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Tricuspid valve surgery in transposition of the great arteries with a systemic right ventricle.
No full textBACKGROUND: Adults with transposition of the great arteries (TGA) and systemic morphologic right ventricle (SRV) have a high prevalence of SRV failure with accompanying tricuspid valve regurgitation (TR). It is unknown if tricuspid valve surgery (TVS) impacts clinical outcomes in this setting.
METHODS: Data were gathered from an international cohort of patients with TGA and SRV. From this group, patients who had previously undergone tricuspid valve surgery (TVS) were propensity matched with patients who had not undergone surgery and followed for 10.5 ± 4.6 years. The impact of surgery on the probability of the combined endpoint of death/transplant/MCS was investigated. Variables associated with favorable outcomes were explored.
RESULTS: Among 2562 patients with TGA and SRV, 140 patients with prior TVS were propensity matched to 140 controls without previous TVS. In the TVS group, primary end point was noted in 20 cases with 15 deaths (10.7 %), 3 transplant listings (2.1 %) and 5 MCS implants (3.6 %). Among controls, primary end point occurred in 23 patients (16.4 %) with 15 deaths (10.7 %), 7 transplant listings (5.0 %) and 2 MCS implants (1.4 %). There was no difference between groups in event free survival. Lower rates of combined endpoint were observed in TVS group with moderate-severe TR and mild-moderate SRV dysfunction. Sensitivity analyses to address potential immortal-time bias were performed in the subset who underwent surgery during the observation period and produced similar results. Among patients with severe SRV dysfunction there was no difference in primary outcome between groups. Similarly, no difference in outcomes was observed between congenitally corrected (ccTGA) and atrial corrected transposition of the great arteries (acTGA) patients.
CONCLUSIONS: For acTGA and ccTGA patients with SRV and moderate-severe TR, surgical intervention prior to development of severe RV dysfunction is recommended. More data are required to determine those with severe SRV dysfunction who may benefit most
Cancer care disparities among patients with limited English proficiency: challenges and strategies for equity.
No full textAs the population of individuals with limited English proficiency (LEP) continues to rise in the United States, language barriers have become an increasingly important yet underrecognized driver of disparities in cancer care. This review aims to synthesize current evidence on how LEP affects the cancer care continuum and to offer actionable strategies to promote equity. We conducted a comprehensive review of the literature spanning communication, diagnosis, treatment, outcomes, prevention, research participation, and policy related to LEP populations in oncology. LEP is associated with poorer cancer outcomes, including delayed diagnosis, lower treatment adherence, decreased access to supportive services, and reduced quality of life. These disparities stem from multilevel communication barriers, underuse of professional interpretation, cultural discordance, and limited institutional support for language-concordant care. LEP patients are also underrepresented in cancer research due to language-based exclusion criteria, inadequate translation resources, and provider burden. A multifaceted framework is needed to address LEP-related disparities in oncology. Key strategies include expanding language-concordant care teams, improving interpreter and translation services, designing inclusive research protocols, and embedding language equity into institutional safety culture and policy. Addressing these disparities is a clinical, ethical, and public health imperative requiring systemic investment and leadership
Intersection of Payer Coverage Policies and Clinical Care: Striking the Right Balance in Cardiovascular Medicine.
No full textSolutions for Increased Adoption of Patient Portal Shared Access: A Human-Centered Design Approach Using the Double Diamond Model.
No full textAchieving digital health equity and proper use of identity credentials is crucial as reliance on electronic modalities increases. Proxy access-now increasingly referred to as shared access-is a widely available functionality that offers identity credentials to care partners who assist loved ones in navigating the electronic care delivery demands of patients with complex care needs. However, adoption of these tools has been hindered by complicated user interfaces and low awareness.Drawing on frameworks and principles rooted in human-centered design (HCD), we conducted an evaluation of a multisite quality improvement study designed to increase the awareness and adoption of shared access to patient portals for older adults and their care partners. Through feedback gathered from key informants, we identified barriers to the adoption of materials created for the parent quality improvement project, and synthesize additional implementation strategies from informant feedback to improve shared access.We employed the Double Diamond Model (DDM) of HCD to guide our research. The DDM includes engaging a diverse group of community partners-older adults, care partners, health care system leaders, communications professionals-through focus groups and individual interviews. Our process involved identifying pain points related to registration for shared access, then synthesizing these insights through inductive coding and affinity mapping to generate solutions.An analysis of our community partner feedback revealed several themes, including the necessity for simplified patient portal registration, standardized terminology about shared access, and clear messaging strategies. A step-by-step video tutorial was developed as a prototype. The prototype was then implemented at a partner health system and received positive feedback, suggesting its potential for broader use.These findings emphasize the importance of involving end users (patients, care partners, health care system leaders, communications professionals) in the evaluation and implementation of digital health tools. Approaching challenges with an HCD mindset helped our team identify barriers to shared access adoption and led to the development of a tangible resource (prototype and video). This project highlights the potential for HCD to drive improvements in digital health equity.This research demonstrates a practical application of HCD methods in developing effective solutions for enhancing shared access for older adults, and all people using patient portals
Mining the gaps: Deciphering Alzheimer\u27s biology through AI-driven reconciliation.
No full textAlzheimer\u27s disease remains one of the most complex and contested domains in biomedicine, characterized by fragmented findings, competing hypotheses, and limited translational success. We propose that AI can offer not just technical acceleration but a deeper epistemic contribution: reconciliation. Rather than optimizing predictive performance or replicating existing assumptions, the goal is to align disparate data, methods, and mechanistic insights into coherent models that explain how the disease emerges, progresses, and can be treated. This approach centers on digital twins, not as monolithic models, but as flexible, testable architectures grounded in homeostasis, destabilization, and multiscale coherence. Through an iterative, interoperable AI architecture, digital twins integrate evidence, resolve contradictions, and highlight where critical gaps remain. This framework moves beyond incremental progress within the prevailing model to catalyzing a paradigm shift in how Alzheimer\u27s is understood. Reconciliation, in this sense, is not a method but a guiding principle for transforming both the science and its applications
Jeanne Cady Solis: an early woman academic neurologist and an avid mentor of women.
No full textWhen she accepted an unsalaried position as Assistant to the Professor of Nervous Diseases and Electrotherapeutics at the University of Michigan in 1892, Jeanne Cady Solis became possibly the first women to take a faculty position in any neurology department-but she had other important contributions to medicine and science. She encouraged and supported other women in research and academia, with leadership roles in the medical sorority Alpha Epsilon Iota and the Women\u27s Research Club of the University of Michigan. For 7 years, she offered a prize from her own funds for the best published research in medicine or science done during the year by a woman at the University of Michigan-won notably in 1926 by neuroanatomist Elizabeth Crosby. As president of the Women\u27s Research Club, she created a loan funding program for women\u27s research. These small efforts made meaningful differences in the careers of women in the early 1900s, allowing them to mentor and inspire generations of women
Provision of up-to-date magnetic resonance imaging conditionality for current peripheral nerve stimulation and spinal cord stimulation systems in pain management.
No full textBackground: Magnetic resonance imaging (MRI) safety with implanted neuromodulation devices presents a critical challenge in modern medicine. While spinal cord stimulation (SCS) and peripheral nerve stimulation (PNS) devices are increasingly utilized for pain management, the scattered nature of manufacturer-specific MRI safety information creates substantial challenges for healthcare providers in making informed clinical decisions. Furthermore, despite the public availability of this information, a comprehensive review of the literature reveals no centralized repository of data regarding SCS and PNS.
Objective: To synthesize comprehensive MRI safety data from multiple manufacturers of SCS and PNS devices into a centralized resource for clinicians, thereby streamlining the decision-making process for MRI scanning in patients with implanted neuromodulation devices.
Methods: We collected MRI safety data for devices from 10 major neurostimulation companies (Abbott, Biotronik, Boston Scientific, Curonix, Mainstay, Medtronic, Nalu, Nevro, Saluda, and SPR Therapeutics) through December 2024. Data collection involved direct communication with manufacturers and analysis of technical documentation to extract specific MRI-related parameters.
Results: Full-body MRI safety at 1.5 T is standard across most SCS systems, with select devices permitting 3.0 T imaging. Specific limitations vary by manufacturer, including restrictions on spatial gradient magnetic fields (1000-4000 Gauss/cm), specific absorption rates, and active scan times (15-60 minutes). PNS systems show similar safety patterns.
Conclusions: This manuscript addresses the urgent need for centralized safety information. As device technology continues to evolve, this resource will require ongoing updates to maintain its utility in supporting informed clinical decision making and patient care
Cutaneous Phosphorylated Alpha-Synuclein in Lewy Body Dementia.
No full textObjective: To determine the test performance of cutaneous phosphorylated alpha-synuclein (P-SYN) in dementia with Lewy bodies (DLB), individuals with reduced Montreal Cognitive Assessment (MoCA) and healthy controls.
Methods: This is the first subgroup analysis of the Synuclein-One study, a prospective, blinded study evaluating P-SYN detection from skin biopsies in 218 subjects with a referral diagnosis of control (N = 151) and DLB (N = 67). All subjects completed detailed examinations, questionnaires, and had skin biopsies for detection of P-SYN. DLB patients were included if meeting the 4th DLB consensus probable criteria. Control subjects, aged 40-99, had no history, examination findings, or symptoms suggestive of a synucleinopathy or neurodegenerative disease. An expert review panel, blinded to pathological data, determined the final diagnosis. Controls with reduced MoCA (MoCA \u3c 26, N = 26) at screening were analyzed separately.
Results: After expert panel review, only 50/67 patients met consensus criteria for DLB, 26/151 controls had a reduced MoCA, and 120/151 controls had a normal MoCA. The proportions of subjects with cutaneous P-SYN detected by skin biopsy were 96.0% (48 of 50) of the DLB group, 31% (8 of 26) of the controls with reduced MoCA, and 3.3% (4 of 120) of the controls with normal MoCA.
Interpretation: In this prospective, blinded, cross-sectional study, a high proportion of subjects meeting clinical consensus criteria for DLB had P-SYN detected in skin biopsies. Almost 1/3 of subjects with reduced MoCA testing also had P-SYN detected. These results support a role for skin biopsy detection of P-SYN in patients with DLB.
Trial registration: NCT04700722
Multicenter Study on the Safety of Pulsed Field Ablation in Over 40,000 Patients: MANIFEST-US.
No full textBACKGROUND: Pulsed field ablation (PFA) is emerging as the preferred energy source for atrial fibrillation ablation, largely because of its promising safety profile, including lower risks of esophageal injury, pulmonary vein stenosis, and phrenic nerve injury. However, rare complications may only emerge after treating many thousands of patients.
OBJECTIVES: This study sought to determine the real-world utilization and safety profile of the pentaspline PFA catheter in the United States.
METHODS: In this retrospective analysis, invitations were sent to U.S. centers performing PFA with the pentaspline catheter. Centers submitted data on patient demographics, procedural details, and adverse events (AEs). The main outcomes included the incidence of major and minor procedure-related AEs.
RESULTS: Of the 435 centers contacted, 102 participated, averaging 5.1 operators per center (range 1-16 operators per center). Each center treated a median of 412 patients (range 26-1,961 patients), totaling 41,968 patients between February 2024 and July 2025. The median patient age was 68 years (range 17-99 years), and 56% were male. Most patients underwent first-time ablation (73%), primarily for paroxysmal (54%) or persistent atrial fibrillation (37%). Pulmonary vein isolation was performed in 93% of patients, with extravenous lesions on the posterior wall (57%), cavotricuspid isthmus (31%), or mitral isthmus (14%). Major AEs occurred in only 0.63% of patients, including cardiac tamponade (0.16%), vascular injury requiring intervention (0.18%), and stroke (0.10%). Importantly, no cases of esophageal fistula, persistent phrenic nerve paralysis, or pulmonary vein stenosis occurred. Mortality at 30 days was rare (0.04%), but there was a potential signal for rare (0.019%) unexplained sudden death/cardiac arrest. Rare AEs included coronary spasm (0.10%) and acute renal failure requiring dialysis (0.02%). Minor complications were reported in 2.05%, mainly vascular issues (0.96%), pericarditis (0.52%), and self-limited esophageal dysmotility (0.04%).
CONCLUSIONS: In a real-world setting of unselected U.S. patients, PFA demonstrated a safety profile consistent with preferentiality to functional myocardial tissue ablation, without evidence of esophageal fistula or pulmonary vein stenosis. The major complication rate was ∼0.6%-mostly vascular AEs and pericardial tamponade. Stroke (∼1 in 1,000) and death (∼1 in 2,000) were rare. These data indicate that the initial implementation of pentaspline PFA has been overall safe
