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Optical Coherence Tomography Risk Factors for Progression to Late-Stage Age-related Macular Degeneration in the Amish Eye Study
No full textTo characterize the prevalence of some critical optical coherence tomography (OCT) biomarkers-including cuticular drusen and acquired vitelliform lesions (AVLs)-and to identify their relative risk for progression to late age-related macular degeneration (AMD) over two years in subjects with early or intermediate AMD in the Amish Eye Study.
Prospective, observational, longitudinal, population-based cohort study.
This study included 276 eyes from 171 subjects with early or intermediate AMD at baseline who completed the two-year follow-up.
Baseline OCT scans were evaluated for the presence of: cuticular drusen, AVLs, subretinal drusenoid deposits (SDD), high drusen volume (defined as ≥0.2mm
within the central 5mm), intraretinal hyperreflective foci (IHRF), hyporeflective drusen cores (hDC), thick/thin double-layer sign, and incomplete retinal pigment epithelium and outer retinal atrophy (iRORA). Subfoveal choroidal thickness (SFCT) was also measured.
Incidence of late AMD (geographic atrophy or macular neovascularization) at two years as determined by multimodal imaging (OCT, color fundus photography (CFP), and confocal fundus autofluorescence (FAF)).
By 2-years of follow-up, 26 eyes (10.7%) progressed to late AMD. The most prevalent baseline features in this cohort, in descending order, were cuticular drusen (52.3%), IHRF (17.3%), hDC (16.0%), thin DLS (11.9%), SDD (8.2%), iRORA (7.8%), AVL (7.0%), and high drusen volume (2.5%). The mean SFCT was 243.23 ± 75.45 μm. Univariate analysis demonstrated that the presence of thick DLS, iRORA, AVL, SDD, IHRF, hDC, and SFCT were associated with increased risk of progression. In multivariate regression, however, only the presence of iRORA (OR: 29.60; 95% CI: 6.86-127.84; p < 0.001) and AVL (OR: 15.90; 95% CI: 3.24-78.00; p < 0.001) remained significant, while the presence of IHRF showed borderline significance (OR: 4.71; 95% CI: 1.00-22.16; p = 0.050).
In this cohort, the presence of iRORA and AVL was independently associated with progression to late AMD over 2 years. Although cuticular drusen were highly prevalent, their presence, as assessed in this study, was not significantly associated with an increased risk of progression to late AMD
Age-disparate experiences and incidence of gender-based violence victimization of transgender women: findings from a cohort study in eastern and southern United StatesResearch in context
No full textBackground: Gender-based violence (GBV) is a threat to health and human rights and experiences may vary with age. We estimated the incidence and correlates of GBV in transgender women in the United States. Methods: From March 2018–August 2020, we enrolled a cohort (N = 1312) of transgender women without HIV in eastern and southern US. Participants were followed for 24–48 months via site-based and digital modes. We measured lifetime and recent (past 3 or 6 months) psychological, physical, and sexual GBV over follow-up. We calculated frequencies and incidence rates (IR) of each form of violence, stratified by age at enrollment (18–24 vs. ≥ 25 years). We used modified Poisson regression models to identify predictors of incident GBV and calculate adjusted relative risk (aRR) and 95% confidence intervals. Findings: Participants were a mean age of 31years (standard deviation: 11) and 60% identified as White race (793/1312), 15% as Black (196/1312), and 19% as Hispanic/Latine (242/1312). At baseline, 88% (1140/1312) reported any lifetime GBV and 42% (546/1312) recent GBV. Psychological violence was most common (39% [507/1312] recent, 85% [1101/1312] lifetime), followed by physical (12% [151/1312] recent, 65% [843/1312] lifetime) and sexual (7% [94/1312] recent, 43% [557/1312] lifetime). Perpetrators were most frequently family members, partners, and strangers. Incidence of GBV was higher among young adults (IR = 119·4/100 person-years, 95% CI = 107·0–132·9) compared to adults (IR = 88·5/100 person-years, 95% CI = 81·7–95·6). Among young adults, online versus site-based participants had elevated GBV risk (aRR = 1·14, 95% CI = 1·03–1·26). Among adults, food insecurity (aRR:1·13, 95% CI:1·04–1·23), higher discrimination scores (aRR:1·01, 95% CI: 1·01–1·02), psychological distress (aRR:1·08, 95% CI:1·00–1·17), and drug use disorder symptoms (aRR:1·09, 95 CI:1·01–1·18) were associated with increased GBV risk. Other predictors were observed in age-specific models for incident psychological, physical, and sexual violence. Interpretation: GBV is exceptionally high among US transgender women. Survivor services, protective policies, and interventions must explicitly address transgender women's needs, including age-specific GBV contexts. Funding: NIH
Abstract TP069: Role of Lifestyle Factors and Cognitive Function on the Association of Educational Attainment with Incident Hypertension in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)
No full textIntroduction: Hypertension is one of the most important determinants of cardiac and brain health. We previously showed that higher educational attainment is associated with a lower risk of incident hypertension. The factors that mediate such an association have not been described.
Hypothesis: Higher education attainment reduces risk of incident hypertension both directly and indirectly through higher global cognitive scores and improved health behaviors.
Methods: Data from the Hispanic Community Health Study/Study of Latinos were analyzed. Education attainment was grouped into 3 categories: Less than High School (HS), HS, or greater than HS. Global cognition (GC) of non-hypertensive participants at Visit 1 was derived by averaging the z scores across four neurocognitive tests (Brief Spanish-English Verbal Learning Test Sum and Recall; Word Fluency; and Digit Symbol Substitution Test). Sociodemographic characteristics and unhealthy behaviors (smoking, obesity, sedentary life, lower diet quality, and presence of sleep apnea) were ascertained at Visit 1. Incident hypertension was investigated at Visit 2, conducted, in average, 6 years later. The association of education attainment at Visit 1 with incident hypertension at Visit 2 (defined as BP ≥130/80 mmHg or on treatment) was investigated using logistic regression analyses adjusted for sociodemographic characteristics and time between visits. We used multimodal analyses to assess whether unhealthy behaviors and GC were pathway variables between education attainment and incident hypertension.
Results: A total of 8,482 hypertension free participants (mean [IQR] age, 41[40-41] years; 62% female) were included. At Visit 2, 39% of individuals developed hypertension. In our final model, achieving greater than HS for education, was associated with lower odds of incident hypertension (OR=0.86; 95% CI 0.74- 0.99). In the pathway analysis, each level increase in the education attainment was associated with lower odds of incident hypertension, either directly or through higher global cognitive scores, which in turn led to lower rates of sedentarism, obesity, and sleep apnea (Figure).
Conclusions: Higher education attainment was associated with lower odds of incident hypertension six years later. Global cognitive scores were an important mediator between education attainment and unhealthy behaviors, which were pathways variables in the development of hypertension
Abstract DP041: Proteomics of Ischemic Stroke Thrombi: Optimizing Minimum Sample Input Requirements from Rat Models to Human Clots
No full textBackground: Proteomics of clots retrieved during mechanical thrombectomy (MT) enables biomarker discovery, insight into clot composition and formation, clot etiology differentiation, and development of clot removal or resolving treatments targeted to molecular signatures. Because clots are heterogeneous and tissue availability is limited, strategic allocation is essential. Establishing minimum protein input for proteomics is critical to reduce heterogeneity, prevent sample waste, and maximize clot samples for parallel omics investigations.
Objective: To define minimum clot sample input for robust thrombus proteomics using protein estimation and mass spectrometry of rat blood thrombi, creating a standardized workflow for optimal sample prep and use.
Methods: Blood from male Sprague Dawley rats (8-10 wk) was collected from cardiac puncture under approved ACUC protocol. Thrombi were formed in centrifuge tubes by mixing blood with 0.06% CaCl2, incubated at 37°C for 5 h, and stored at 4°C overnight, followed by storage in -80°C in RNA solution until use. Rat thrombi are stratified by weight with rat thrombi smaller than human thrombi, so we employed: small 15 mg. Samples are homogenized and lysed using a detergent-containing buffer, followed by centrifugation for protein extraction. Protein concentration was estimated by densitometry against a BSA standard curve, enzymatically digested, followed by detergent removal and iTRAQ mass spectrometry (MS). Adequacy thresholds are defined a priori based on protein yield, signal-to-noise ratios, and reproducibility metrics.
Results: Minimum protein yield and tissue mass for reproducible proteomic coverage were established. Average protein concentrations for small, medium, and large samples were 3.39 mg/mL, 8.82 mg/mL , and 10.30 mg/mL, respectively. iTRAQ MS confirms minimal concentration and thresholds for proteome depth, spectral match reproducibility, and signal-to-noise ratios across varying input sizes. These findings will provide the first input-output curve for clot proteomics establishing reproducibility applicable to human samples.
Conclusions: Establishing minimum input requirements enables reproducible clot proteomics and preserves material. We will shortly apply this standardized protocol to our current human clot library (retrieved via MT from ~20 varied etiology stroke patients) ensuring reproducible proteomics and biomarker discovery with optimal sample use for multi-omics
Medicolegal Implications and Current Landscape of Artificial Intelligence in Plastic Surgery
No full textArtificial intelligence (AI) is increasingly integrated into plastic and reconstructive surgery. It supports preoperative prediction and imaging analysis, intraoperative visualization, and postoperative monitoring. While these advancements demonstrate AI's growing potential across the surgical continuum, their adoption also presents ethical, legal, and regulatory challenges. Concerns surrounding algorithmic bias, data privacy, and informed consent are particularly relevant in fields shaped by individualized anatomy, aesthetic nuance, and patient-specific goals. This analysis reviews the current landscape of AI in plastic surgery and medicolegal frameworks shaping its use. Existing legal doctrines, ranging from antidiscrimination and privacy protections to common-law informed consent, offer partial guidance for AI use in plastic surgery. Traditional liability models struggle to accommodate adaptive algorithms. Early litigation has focused largely on insurance decision-making rather than procedural use of AI. In the absence of clear precedent, regulatory efforts remain fragmented. The EU imposes strict oversight for high-risk medical AI, and US federal and state policies emphasize transparency and human oversight. However, there remains limited direction on liability or intraoperative use. These gaps highlight the need for more comprehensive, procedure-specific regulation as AI integrates into surgical care and plastic surgery more broadly. This analysis proposes a decision-making framework. We emphasize transparent informed consent, patient privacy protections, and clinician awareness of algorithmic bias, to guide safe integration of AI tools into active clinical practice. While AI may meaningfully enhance plastic surgery, its limited generalizability and susceptibility to bias reinforce its current role as an adjunct to, rather than a substitute for, a surgeon's expertise
Abstract Th0028: Transcriptomic Dynamics of Mouse Arteriovenous Fistulas via Single-Cell RNA Sequencing Analysis
No full textAbstract WP184: The Impact of the Advanced Stroke Life Support® Simulation-Enhanced Course on Knowledge, Diagnosis, and Management of Stroke Patients
No full textIntroduction: Stroke is the second leading cause of death worldwide (7.3 million/year). Early detection and effective management are critical for survival and neurological recovery. Comprehensive stroke education for healthcare providers in prehospital and hospital settings can lead to improved outcomes. Advanced Stroke Life Support (ASLS®) is a simulation-based interprofessional course consisting of interactive instruction, including standardized patient-based cases where learners diagnose strokes and develop a management plan for the patients. This study evaluated the course's effect on participants' knowledge of stroke diagnosis and management, translation to patient care, and clinical outcomes.
Methods: We conducted an observational, mixed-methods study of participants completing the 11th ASLS version (2015-2022) at U.S. and international sites. All learners received the same educational intervention. A total of 40,434 prehospital and hospital providers participated. Outcomes were evaluated using the Kirkpatric model: Level 1 (Reactions), Level 2 (Learning), Level 3 (Application), and Level 4 (Impact). Knowledge was measured by validated 25-item pre-and post-course assessments. We used a comprehensive questionnaire to determine translation to clinical practice (Level 3) and its impact on outcomes (Level 4).
Results: ASLS course completion improved outcomes at all evaluation levels. Paired-samples t-tests showed significant knowledge gains (pretest mean 64.66, SD 13.17; posttest mean 89.51, SD 7.55; p < .001) (Image 1). Of 21,945 eligible survey recipients emailed 750 responded. Most (96%) reported applying ASLS skills in clinical practice. On a 5-point scale, 64% said participation improved stroke care and outcomes "a lot" or "a great deal." Hospital-based respondents estimated a 76.14% reduction in door-to-needle time (Images 2&3).
Conclusions: This large study demonstrates that a structured, simulation-based stroke curriculum significantly enhances providers' knowledge, skills, and application in patient care. Over eight years, data from 40,434 learners across 31 U.S. states and eight countries confirmed the ASLS course's impact on stroke diagnosis, management, and outcomes. Participants consistently reported using acquired skills and perceiving substantial improvements in patient care. Future work includes a multicenter analysis of tangible and intangible outcomes, including cost-benefit evaluation of ASLS implementation for stroke training
Abstract Tu0068: The Microanatomy of the Human Hemodialysis Fistula Maturation and Failure
No full textRescue versus First-Line Intracranial Stenting during Thrombectomy for Acute Ischemic Stroke: A Propensity-Weighted Analysis of the RESISTANT Registry
No full textWhile rescue stenting (RS) is a recognized bailout strategy following failed endovascular thrombectomy (EVT) for acute ischemic stroke with large vessel occlusion (AIS-LVO), first-line stenting (FLS) has emerged as a potential alternative to avoid vascular injury and improve outcomes. However, direct comparisons between these strategies remain limited. We conducted a comparative analysis of FLS versus RS using data from a large, multicenter international registry to evaluate their relative safety and effectiveness.
We conducted a comparative analysis of FLS versus RS using data from the RESISTANT registry, a multicenter, international, retrospective cohort of AIS patients treated with intracranial stenting during EVT (2016-2023). Patients were categorized by stenting strategy: FLS (stent placed without prior thrombectomy) or RS (stent placed after failed thrombectomy). The primary effectiveness outcome was functional independence (modified Rankin Scale [mRS] 0-2) at 90 days; the primary safety outcome was symptomatic intracranial hemorrhage (sICH). Propensity score inverse probability of treatment weighting (IPTW) was used to adjust for baseline differences.
Among 827 patients, 723 were in the RS cohort (median age 67 years [IQR 59-77], 64.2% male) and 104 in the FLS cohort (median age 65.5 years [IQR 58.8-77], 72.1% male). Using FLS as the reference strategy, IPTW=adjusted analyses did not detect significant differences in functional independence (OR=0.64; 95% CI 0.38-1.07) or sICH (OR=0.93; 95% CI 0.34-2.59). No significant differences were observed in secondary outcomes including successful reperfusion, mortality, or procedural complications. In the anterior circulation cohort (n=589), outcomes were likewise comparable (functional independence: OR=0.62; 95% CI 0.60-1.25; sICH: OR=0.81; 95% CI 0.30-2.18). Similarly, in the posterior circulation cohort (n=234), no significant differences were found (functional independence: OR=0.82; 95% CI 0.32-2.10; sICH: OR=0.81; 95% CI 0.30-2.18).
In this study, no significant differences in safety or effectiveness were detected between FLS and RS strategies during EVT for AIS. Prospective, randomized trials are needed to better define optimal treatment approaches
Contemporary Management Strategies for Peyronie's Disease: A Comprehensive Review
No full textPeyronie's disease (PD) is an acquired fibrotic condition of the tunica albuginea that is characterized by penile curvature, deformity, pain, and impaired sexual function. PD is prevalent among all ages and is responsible for significant psychological distress. This review summarizes the current knowledge on PD, covering its epidemiology, risk factors, and natural history, along with a comprehensive overview of the medical, intralesional, and surgical options. While the traditional treatments are well-described in previous publications, the focus of the current review is on new biologic and regenerative treatments. Increasing attention to therapies such as platelet-rich plasma and stem cells is representative of the larger trend toward attempts at modifying the underlying fibrotic process, as opposed to merely correcting deformity. By integrating evolving regenerative strategies with proven therapeutic options and prioritizing patient-centered counselling, future PD care may become increasingly individualized, effective, and less invasive