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Liver transplantation (LT) provides the best long-term survival outcomes for patients with liver cancer. As a result, the field of transplant oncology has grown greatly over the past few decades, and many centers have expanded their criteria to allow increased access to LT for liver malignancies. Center-level guidelines and practices in transplant oncology significantly vary across the world, leading to debate regarding the best course of treatment for this patient population. An international consensus conference was convened by the International Liver Transplantation Society and the International Liver Cancer Association on February 1-2, 2024, in Valencia, Spain, to establish a more universal consensus regarding LT for oncologic indications. The conference followed the Delphi process, followed by external expert review. Consensus statements were accepted regarding patient assessment and waitlisting criteria, pretransplant treatment (including immunotherapy) and downstaging, living donor LT, post-LT patient management, and patient- and caregiver-related outcomes. The multidisciplinary participants in the consensus conference provided up-to-date recommendations regarding the selection and management of patients with liver cancer being considered for LT. Although participants deferred to center protocols in many cases, there was great interest in safely expanding access to LT for patients with larger tumor burden and biologically amenable lesions.

Loneliness and social isolation are increasingly recognized as critical public health issues, linked to adverse outcomes such as cardiovascular disease, cognitive decline, depression, and increased healthcare utilization. Despite their significance, these factors are underrepresented in medical education curricula. This Perspective advocates for the integration of loneliness and social isolation into undergraduate medical education (UME), emphasizing their roles as social determinants of health and their disproportionate impact on marginalized populations. We propose a multifaceted curricular framework encompassing foundational knowledge, clinical skills, innovative interventions, interprofessional education, and reflective practice. We provide strategies for addressing social isolation and social connection in medical education curricula using literature-based tools and experiential learning activities. By equipping future physicians with the competencies to address social disconnection, medical education can play a pivotal role in advancing health equity and improving patient outcomes.

We aimed to compare early perioperative and functional outcomes of holmium laser enucleation of the prostate (HoLEP) performed with the 30-amp MOSES system and MOSES 2.0 technology. We retrospectively compared 65 patients who underwent HoLEP with the 30-amp MOSES system and 210 with MOSES 2.0 between June 2023 and April 2025.Intraoperative and perioperative outcomes were collected and analyzed at 1, 3, and 6 months postoperatively. The two groups had comparable preoperative characteristics, with median prostate volumes of 105 and 111&#xa0;cc in the MOSES 2.0 and 30-amp MOSES groups, respectively (p&#x2009;=&#x2009;0.22). Intraoperatively, the MOSES 2.0 group demonstrated an 8-minute shorter median enucleation time (p&#x2009;=&#x2009;0.007), a 3-minute shorter median hemostasis time (p&#x2009;<&#x2009;0.001), and lower energy use (75.7 vs. 92.1&#xa0;kJ, p&#x2009;<&#x2009;0.001). Additionally, MOSES 2.0 demonstrated superior enucleation efficiency compared to 30-amp MOSES (2.2 vs. 2&#xa0;g/min, p&#x2009;=&#x2009;0.047). Other operative parameters were comparable between the two groups. Both technologies achieved comparable successful same-day trial of void rates of 94% in the MOSES 2.0 group and 93.4% in the 30-amp MOSES group (p&#x2009;=&#x2009;0.88). Postoperative functional outcomes, including IPSS, QoL, Qmax, PVR, and PSA, were comparable between groups up to 6 months of follow-up. HoLEP with 30-amp MOSES technology is a safe and effective option for treating benign prostatic obstruction. Both MOSES systems support same-day discharge with comparable safety and functional outcomes. The 30-amp MOSES system may offer a practical alternative for institutions without a dedicated 50-amp power supply. Large randomized controlled trials with longer follow-up are warranted.

There is growing interest in developing risk assessment tools/metrics to improve treatment, management, and outcomes for pulmonary arterial hypertension (PAH). This study investigated the association of the pulmonary artery pulsatility index (PAPi) with patient characteristics, hospitalization, and mortality. Data collected from the US-based Registry to Evaluate Early and Long-Term PAH Disease Management were stratified/analyzed according to baseline PAPi quartiles (36-month follow-up). In total, 2,711 patients were included. Baseline demographic/clinical characteristics were similar; however, the lowest quartiles (< 3.55; &#x2265; 3.55 to < 5.5) had higher New York Heart Association/World Health Organization functional class, while those in the highest quartiles (&#x2265; 5.5 to < 9.0; &#x2265; 9.0) had longer 6-min walk distance. Of 2,414 patients assessed for hospitalization, 1,326 (54.9%) were hospitalized. Lower PAPi correlated with increasing hospitalization probability (&#x2265; 9.0 quartile, n = 291 (48.0%); &#x2265; 5.5 to < 9.0 quartile, n = 333 (54.8%); &#x2265; 3.55 to < 5.5 quartile, n = 340 (57.2%); and < 3.55 quartile, n = 362 (59.7%)). Of 681 (28.1%) patients who died, 150 (24.1%) were in the &#x2265; 9.0 quartile, 154 (25.5%) the &#x2265; 5.5 to < 9.0 quartile, 157 (26.7%) the &#x2265; 3.55 to < 5.5 quartile, and 220 (35.9%) the < 3.55 quartile (P < 0.001). Compared with the < 3.55 quartile, there was a 35.6%, 25.8%, and 23.3% reduction in mortality in the &#x2265; 9.0, &#x2265; 5.5 to < 9.0, and &#x2265; 3.55 to < 5.5 quartiles, respectively. PAPi may be a useful prognostic tool and long-term predictor of clinical events in PAH.

Despite more complex procurement logistics under Continuous Distribution (CD), lung transplant (LT) outcomes appear better. The current analysis sought to investigate the potential contributors to these trends observed under the CD framework. This study compared LT recipients from the CAS era (Mar 9, 2023-Mar 31, 2025) and the LAS era (Jan 1, 2021-Mar 8, 2023; n=12,287). Recipients in the CAS era were more often female, Black, and non-O blood type, with a higher proportion of obstructive lung disease and fewer restrictive or vascular diseases. Although pre-transplant recipient profile varied between the two eras, CAS era involved greater use of older and extended-criteria donors, longer procurement distances, and higher ischemic time. Cox regression demonstrated an independent association between transplantation during the LAS era and higher one-year post-transplant mortality. Waitlist time did not affect one-year mortality, and transplant center volumes were comparable between eras. Favorable one-year survival during the continuous distribution era was observed across several exploratory subgroups, including recipients aged 56-63 years and those not hospitalized at the time of transplant. Overall, transplantation during the continuous distribution era was associated with improved early morbidity and 1-year post-transplant survival despite substantial changes in donor characteristics and procurement logistics.

Intracardiac echocardiography (ICE) is widely used during electrophysiology and structural heart procedures; however, image interpretation remains operator-dependent and procedural views are not standardized. Although artificial intelligence has been increasingly applied to transthoracic and transesophageal echocardiography, applications to ICE remain limited. The objective of the study was to develop and evaluate Auto-Contour, a deep-learning pipeline for multistructure semantic segmentation of ICE anatomy and assess its feasibility for real-time procedural guidance. In this retrospective multicenter study, 5,496 deidentified ICE cine loops from 249 procedures of unique patients, including routine clinical cases and the ViewFlex&#x2122; X first-in-human study, were analyzed. ICE experts classified each cine into 1 of 20 procedural views and annotated key anatomic structures, including the left atrium, left atrial appendage, pulmonary vein ostia, valves, cusps, papillary muscles, and left ventricle, at end-systole, and end-diastole, yielding 65,117 segmentations. A deep-learning segmentation model was trained using patient-level splits, standard augmentations, and early stopping. Segmentation performance was highest for larger cardiac chambers, with Dice scores of 0.94 for the left atrium and 0.82 for the left ventricle, and corresponding 95th-percentile Hausdorff distance values of 1.18 mm and 3.27 mm. Smaller structures also demonstrated acceptable performance, including the left atrial appendage, pulmonary veins, papillary muscles, and aortic cusps. The mean per-frame inference time was <0.03 seconds. Auto-Contour demonstrated robust multistructure segmentation of ICE anatomy with real-time inference, supporting prospective evaluation of artificial intelligence-assisted ICE for procedural standardization, efficiency, and safety.

Recurrent health events often involve complex inter-relationships between longitudinal biomarkers and time-to-event outcomes, further complicated by sparse, irregular data collection and time-dependent correlations among events. Traditional statistical methods frequently struggle with these complexities, resulting in biased estimates and suboptimal modeling performance. To address these challenges, we propose the Functional Regression with AutoregressIve fraiLTY (FRAILTY) method, a novel framework designed to jointly model longitudinal measurements and recurrent events, accommodating both scalar and functional covariates while capturing time-dependent correlations among events. The FRAILTY method employs a two-step estimation procedure. First, functional principal component analysis through conditional expectation (PACE) is applied to extract key temporal features from sparse and irregular longitudinal data. Second, the obtained scores are incorporated into a dynamic recurrent frailty model with an autoregressive structure to account for within-subject correlations across recurrent events. Simulation studies demonstrated that the FRAILTY method outperformed existing methods, such as those relying on B-spline basis functions and Bayesian joint modeling, by achieving lower integrated mean squared errors, higher concordance indices, and greater statistical power in detecting functional parameters. Its practical utility was further validated through applications to two datasets: the Systolic Blood Pressure Intervention Trial study and the Multicenter Collaboration to Study Treatment Outcomes in Nephrolithiasis Evaluation cohort.

Particulate matter &#x2264;2.5&#x3bc;m (PM2.5) air pollution is a leading global environmental risk factor. We investigated the impact of PM2.5 on cardiovascular risk with lifetime genetic predisposition to low-density lipoprotein cholesterol (LDL-C) and systolic blood pressure (SBP). We conducted a Mendelian Randomization (MR) study of participants from the UK Biobank study (n&#x2009;=&#x2009;412,446) over 13.85 years. Polygenic Risk Scores (PRS) for LDL-C and SBP were used as instrument variables to estimate association and causal effects with major adverse cardiovascular events (MACE). The interaction between exogenous PM2.5 exposure with individual or combined LDL-C, SBP PRS, and clinical phenotypes was assessed using adjusted survival regression, causal inference, and machine learning models. A significant negative interaction was observed between PM2.5 and PRS on MACE incidence for both SBP and LDL-C. The association of 1-SD PRS increase for SBP (&#x2248; 10&#x2005;mm Hg) and LDL-C (&#x2248;38.6&#x2005;mg/dl) with MACE was attenuated at higher PM2.5 levels (HR&#x2009;=&#x2009;0.947, p&#x2009;=&#x2009;0.039, HR&#x2009;=&#x2009;0.943, p&#x2009;=&#x2009;0.025, respectively). Analyses with phenotype showed a similar trend for SBP, further confirmed by causal effects interactions (HR&#x2009;=&#x2009;0.9979, p&#x2009;<&#x2009;0.001, HR&#x2009;=&#x2009;0.9995, p&#x2009;=&#x2009;0.093, respectively). Absolute risk analysis showed that predicted risk remained highest in the high-PRS groups across PM2.5 levels. Higher-genetic-risk groups for SBP and LDL-C carried the greatest absolute cardiovascular risk when exposed to air pollution, even though PM2.5 conferred lower relative risk, perhaps related to high baseline risk. These findings support a gene-environment interaction between air pollution exposure and genetically proxied cardiovascular risk factors. Air pollution, especially fine particulate matter (PM2.5), is the world&#x2019;s leading environmental risk factor. Does it change cardiovascular risk related to inherited tendency for higher systolic blood pressure (SBP) or low-density lipoprotein cholesterol (LDL-C)? In Mendelian randomization analyses of 412,446 UK Biobank participants, genetic variants linked to higher tendency for LDL-C and SBP were confirmed to be independently associated with higher risks of major adverse cardiovascular events (MACE). Air pollution-related risk appeared relatively smaller among people with higher genetic risk for SBP and LDL-C than among lower-genetic-risk groups, most likely because these individuals already were saturated with baseline risk. However, these higher-genetic-risk individuals still carried the greatest predicted cardiovascular risk burden when exposed to air pollution risk. Air pollution interacts with genetic risk for LDL-C and SBP supporting a gene by environment interaction. The findings reinforce that air pollution remains an important cardiovascular hazard and support the consensus that environmental and genetic risks are synergistic. These findings underscore the importance of ongoing air quality regulation, especially for people at higher baseline risk.

The current study evaluated Sonic Augmentation Technology&#x2122; (SAT), a novel, Polyvagal-informed probe that incorporates continuously varying and acoustic features modeled on patterns of autonomic regulation into musical soundscapes. Specifically, the study examined whether SAT led to improvements in self-reported biobehavioral state (e.g. relaxation, breathing slowly, interoceptive clarity), and whether individuals with poorer baseline functioning (i.e., increased autonomic reactivity and anxiety/depression symptoms) reported greater improvements in biobehavioral state following SAT. It also sought to determine whether there would be changes in endogenous oxytocin level, and whether individuals who exhibit larger gains in biobehavioral state would show greater increases in oxytocin. The current study examined data obtained from four samples, with 72 participants providing data virtually and 41 participants providing data in-person. Participants completed self-report measures of biobehavioral state, autonomic reactivity, and psychiatric symptomatology (i.e. anxiety and depression). Salivary oxytocin (pg/mL) was assessed via enzyme immunoassay in the participants who completed the study in person, with samples collected pre-and post-SAT. Following SAT, participants reported significant improvements in total biobehavioral state and the low and high arousal subscales. We also found that participants scoring above the cutoff for autonomic reactivity, anxiety, and depression reported greater increases in total biobehavioral state and decreases in the high arousal subscale. Greater decreases in the low arousal subscale were observed in the participants with increased anxiety. The subset of participants with salivary oxytocin samples exhibited increases in salivary oxytocin. Thus, our results support the potential of SAT as a low-cost, non-invasive auditory probe for improving wellbeing, especially for clinical populations experiencing autonomic dysregulation and psychiatric difficulties, such as anxiety and depression. ClinicalTrials.gov, identifiers NCT06710886, NCT06902506, NCT06580119, and NCT07065227.

To investigate the impact of radiotherapy (RT) for brain tumors on circulating lymphocyte populations and understand this from a dosimetric perspective. This prospective study enrolled primary brain tumor patients treated with either photon or proton RT. To specifically study the effect of RT, only patients without concurrent chemotherapy were eligible. For each patient, blood samples were collected before, during and after RT, as well as at the first follow-up, for flow cytometry analysis of blood cells. We used a stochastic model to compute blood dose distributions from treatment plans and patient-specific blood flow simulations. Dose to the lymph nodes in the head and neck region was also assessed. Dose distributions and lymphocyte trends from patients treated with photon versus proton therapy were compared. Thirty-five patients with a median age of 50 were included: 27 patients with benign tumors (mostly meningiomas) and 8 with malignant tumors (mostly gliomas). There were no significant RT-induced changes in either the total lymphocyte count or its subpopulations in this patient cohort. In line with this finding, dosimetric analyses showed that total blood doses were &#x223c;0.1-0.2 Gy and that most lymph nodes in the head-and-neck area are spared. Proton RT was associated to a greater dosimetric sparing of both blood and lymph nodes. In this exploratory analysis, we found no evidence that RT alone results in significant changes in peripheral lymphocyte counts in primary brain tumor patients treated to limited intracranial volumes. The lack of apparent RT-induced cytotoxicity is consistent with the limited dose received by either the blood or the regional lymph nodes.

Intracardiac hemodynamics plays a crucial role in the onset and progression of cardiac and valvular diseases. Simulations of blood flow in the left ventricle (LV) have proven valuable for elucidating LV hemodynamics. While fully coupled fluid-solid modeling of the LV remains challenging due to the complex passive-active behavior of the LV myocardial wall, integrating imaging-driven quantification of structural motion with computational fluid dynamics (CFD) modeling in the LV holds promise for feasible and personalized characterization of LV hemodynamics. In this study, we propose developing individualized LV models by integrating two magnetic resonance imaging (MRI) modalities with a moving-boundary CFD method to characterize patient-specific intracardiac LV hemodynamics. Our method uses standard cine cardiac magnetic resonance (CMR) images to assess four-dimensional endocardial motion via non-rigid image registration (NRIR), eliminating the need for complex myocardial material modeling to produce LV wall behavior. In addition, phase-contrast MRI (PC-MRI) was used to obtain time-resolved mitral inflow rates, applied as a spatially and temporally varying inflow velocity at the mitral orifice in the CFD simulations. CFD flow patterns, including velocity streamlines, vortex rings, and kinetic energy, were computed and compared to the available clinical data. Moreover, leveraging the NRIR framework, relationships between LV wall kinematic markers and flow characteristics were determined. The fidelity of the simulation was quantitatively evaluated by comparing the flow rate at the aortic outflow tract with the corresponding PC-MRI measurements. The proposed methodology offers a novel, feasible approach that leverages standard PC-CMR protocols to improve patient-specific clinical assessment of LV characteristics for prognostic studies and surgical planning.

Fine particulate matter (PM2.5) remains a major contributor to environmental health burden in the United States. Its concentrations vary across space and time due to the combined influence of local temporal persistence and regional transport processes. Many existing modeling approaches represent spatial and temporal dependencies within a single predictive structure, limiting the ability to distinguish site-specific temporal persistence from regional transport and emission-related influences. In this study, we develop a spatiotemporal modeling strategy that explicitly separates temporal dynamics from spatial predictors by integrating a bidirectional long short-term memory (BiLSTM) network with Kolmogorov-Arnold Networks (KAN). The BiLSTM component captures forward and backward temporal dependencies in site-level PM2.5 time series, while two spline-based KAN layers represent nonlinear spatial gradients using distance-weighted PM2.5 and ancillary predictors. This structure enables independent modeling of temporal persistence and spatial transport processes while retaining flexibility in nonlinear feature representation. Using Texas as a case study, the proposed model reduced RMSE by 39.6% and MAE by 41.9%, and increased R2 by 16.7% relative to a conventional LSTM, while more accurately capturing high-concentration episodes. Site-level predictions were further aggregated to support county-scale next-day exceedance assessment, achieving precision of 0.93 and recall of 0.96 across six major counties. By separating temporal persistence from spatial transport influences, this approach provides improved characterization of short-term PM2.5 variability and provides a modeling framework applicable to regions with heterogeneous monitoring coverage.

Testing for sexually transmitted infections (STIs) is a routine component of prenatal care. Treating partners is challenging and the inconsistency contributes to maternal reinfection and neonatal morbidity. This study evaluated documentation of partner treatment among pregnant women diagnosed with different STIs. This retrospective cohort study included pregnant women who received care at two safety-net hospitals in Harris County, TX, between 2019 and 2022. Electronic health records were reviewed for documented partner treatment among patients with chlamydia, gonorrhea, hepatitis B infection (HBV), or syphilis during pregnancy. Patients with chlamydia and gonorrhea are typically offered expedited partner therapy by physicians, whereas the local health department coordinates partner treatment of HBV and syphilis. Gaps in hospital and health department records were supplemented through brief patient interviews. Multivariable Poisson regression models with robust error variance examined associations between STI and physician counseling on partner treatment, adjusting for age, race and ethnicity, marital status, preferred language, and substance use. Adjusted relative risk (aRR) with 95% confidence intervals (CI) were calculated. P<0.05 was considered statistically significant. Among 369 eligible patients, physician documentation of partner treatment was highest for patients with chlamydia only (54%), followed by gonorrhea only (46%), syphilis (43%), and lowest for HBV (1%). Documented barriers to partner treatment included lack of partner contact (gonorrhea only 75%, chlamydia only 43%, syphilis 34%) and partner refusal (HBV 43%). Physician counseling on partner treatment was documented for &#x2265;80% of patients with STIs except HBV (56%, aRR=0.68 compared to chlamydia only, 95% CI 0.51-0.91). Sufficient prenatal care was associated with higher partner treatment for chlamydia only (67% vs. 45%, p=0.023). Partner treatment and physician counseling vary by STI. Physician reliance on public health-managed partner treatment may hinder completion and sustain high rates of STIs during pregnancy.

BackgroundAlthough several studies have examined gait changes associated with continuous intrathecal baclofen (CITB) infusion for spasticity in ambulatory patients with acquired brain injury (ABI), none has included a control group.ObjectiveTo assess long-term changes in gait kinematics associated with CITB infusion for post-ABI spasticity.MethodsForty-three consecutive ABI patients underwent gait evaluations during an ITB bolus trial, with follow-up gait data available in 17 pump recipients (re-evaluated 24&#x2009;&#xb1;&#x2009;17 months after implantation, dose range 95-590&#x2005;&#xb5;g/day) and 8 non-recipients (re-evaluated 30&#x2009;&#xb1;&#x2009;19 months after screening). Temporospatial gait parameters and lower extremity joint range of motion (ROM) were analyzed.ResultsChanges in temporospatial gait parameters from baseline to follow-up did not differ significantly between pump recipients and non-recipients. Likewise, there were no significant between-group differences in changes in ROM over time except for a 7.5&#xb0; increase in more-affected (MA) knee ROM during swing in pump recipients, compared with a 2.4&#xb0; decrease in non-recipients (ANOVA group&#xd7;time interaction, P&#x2009;=&#x2009;0.027). Secondary analyses showed that baseline average Ashworth score in the MA leg correlated significantly with changes in MA stance time and less-affected initial double support time (r&#x2009;&#x2265;&#x2009;|0.56|, P&#x2009;&#x2264;&#x2009;0.029) in pump recipients only.ConclusionsThe modest improvements in gait kinematics in pump recipients appeared to have limited clinical significance, considering no concurrent improvements in average gait speed and the study limitations. The overall results suggest that gait speed may be useful for goal setting, but it should not be considered the sole measure of CITB efficacy.

Metabolic dysfunction-associated steatohepatitis (MASH) is an increasingly significant contributor to primary liver cancer in the Asia-Pacific region, with substantial regional variation. To quantify the burden and temporal trends of MASH-related liver cancer across countries and subregions from 1990 to 2023. Using the Global Burden of Disease (GBD) 2023 dataset, we analysed age-standardized prevalence, deaths, and disability-adjusted life years (DALYs) for MASH-related liver cancer, assessing temporal trends, regional variation and associations with the Socio-demographic Index (SDI). Decomposition analysis estimated the contributions of ageing, population growth and epidemiological changes. In 2023, the high-income Asia-Pacific region had the highest age-standardized prevalence of MASH-related liver cancer (1.19 per 100&#x2009;000), followed by Oceania (0.98 per 100&#x2009;000) and Australasia (0.88 per 100&#x2009;000), with Central Asia the lowest (0.56 per 100&#x2009;000). Across the Asia-Pacific region, prevalence, mortality and DALYs generally increased with SDI, though patterns varied by subregion. The high-income Asia-Pacific region showed a distinct 'increase-peak-decline' pattern in both mortality and DALYs, whereas low- and middle-income regions (i.e., South Asia, South-east Asia and Central Asia) showed steady increases in prevalence. Pacific island nations experienced disproportionately higher DALYs despite their smaller populations. Decomposition analyses showed that ageing and population growth accounted for the largest proportions of the observed changes in East Asia (44.8% and 41.4%, respectively) and South Asia (41.1% and 30.1%, respectively), whereas epidemiological change was the largest contributor in Australasia (58.4%). MASH-related liver cancer is rising across the Asia-Pacific region, with substantial regional variation, underscoring the need for region-specific public health strategies. The burden of liver cancer related to metabolic dysfunction&#x2010;associated steatohepatitis (MASH) has been increasing in the Asia&#x2010;Pacific region over the past decades, with clear differences between countries. While some high&#x2010;income countries have seen improvements in outcomes, many low&#x2010; and middle&#x2010;income countries and Pacific island nations continue to experience a growing disease burden driven by obesity, diabetes and limited access to healthcare. These findings highlight the need for better prevention and early detection strategies to reduce future disease impact.

Nutrition influences cancer outcomes, yet access to Registered Dietitian Nutritionists (RDNs) remains inconsistent. Patient-centered data can reveal gaps in care, unmet needs, and disparities, providing real-world insight into oncology nutrition services. The objective of this study was to characterize cancer survivors' experiences with professional nutrition care since diagnosis, including sources, met and unmet needs, timing, and priority areas, and to examine variation by sociodemographic and clinical characteristics. The cross-sectional study analyzed online surveys from the Cancer Experience Registry, an online patient-reported outcomes registry of cancer survivors in the United States and Canada, collected between November 2022 and November 2024; analyses of this study were restricted to U.S. Participants included 1,427 cancer survivors, predominantly women (76.5%), older adults (45.5% aged &#x2265;65 years), and non-Hispanic White (85.5%), with smaller proportions identifying as non-Hispanic Black (5.6%), Hispanic (3.2%), and non-Hispanic other race (4.3%) (1.5% missing). The most common cancers were breast (32.6%), blood (29.6%), and gastrointestinal (10.5%). Primary outcomes included receipt of nutrition care since cancer diagnosis (any nutrition care and care from an RDN and patient-reported nutrition care need, categorized as met (wanted and received support), unmet (wanted but did not receive support), no perceived need (did not want support), or unsure. Descriptive statistics summarized receipt of nutrition services, expressed need, timing, and priority areas. Bivariate and multivariable regression analyses examined differences in nutrition care need and RDN engagement across patient characteristics. Since diagnosis, 53.6% reported receiving nutrition care, with 39.3% from an RDN. Need was met in 41.0%, unmet in 13.4%, no perceived need in 33.2%, and unsure in 12.5%. Among participants desiring nutrition care, demand peaked during treatment and post-treatment. Unmet need was more common after treatment and linked to increasing energy level (p=.002), emotional health (p<.001), intentional weight loss (p<.001), and cancer worry (p<.001). Endorsement of symptom management (p=.008) and intentional weight gain (p=.001) as reasons for nutrition support was higher among participants who saw a provider (RDN or non-RDN) compared with those who did not. Participants with unmet need were more often younger, women, food-insecure, lacking caregiving support, and had higher symptom burden, while no perceived need was associated with rural residence, lower education, lacking caregiving support, and private practice care (all p values <.05). Unmet nutrition care needs were observed among cancer survivors and varied by sociodemographic and clinical characteristics. Future research should evaluate the impact of systematic malnutrition screening and referral pathways on access to RDN services and examine how nutrition care needs and engagement evolve from diagnosis through survivorship. Additional work is needed to understand and address disparities across population subgroups and care settings.

Cases of levamisole overdose without coingestants in human subjects are rare. Existing knowledge of human toxicity depends in part on records of adverse events of therapeutic use such as nausea, vomiting, headache, and rarer central nervous system effects. Much of our knowledge also comes from levamisole's role as an adulterant in cocaine, where it is known to have immune modulatory properties and is associated with vasculitis. The few cases of levamisole-only toxicity are either non-fatal or lack clinical details. We present the first case of a fatal, oral ingestion of levamisole in a patient who presented alive with clinical symptoms and had treatment documented. The patient's early symptoms included nausea, vomiting, tremors, and visual changes. Following this, the patient experienced bradycardia followed by pulseless electrical activity cardiac arrest. This presentation was consistent with what would be expected of the pharmacodynamic effects of levamisole as a nicotinic agonist. Levamisole's presence was confirmed by post-mortem confirmatory testing, with a recorded femoral blood concentration of 19,000&#x2009;ng/mL. The clinical picture and post-mortem testing were consistent with the cause of death as levamisole overdose.

Recent advances in inherited retinal disease (IRD) management, including genetic testing and emerging therapies, have increased complexity in clinical decision- making. This study examined IRD-related practice patterns among U.S. retina specialists. An 18-item questionnaire developed by a combination of retina and IRD specialists (KCF, CCW, HK) was distributed electronically via email to retinal specialists at 35 non-university-based practices and 37 combined university-based/VA practices across the US. All retinal specialists at each institution were included and were assessed regarding their practice patterns for genetic testing, genetic counseling and education, referral to subspecialists or certified genetic counselors, and overall comfort level in assessing IRD patients. A total of 116 surveys were completed out of 481 distributed. 101 out of 116 (87.1%) indicated they actively manage IRD patients and were eligible to complete the survey in its entirety. Overall, most respondents were between the ages of 40-60 years old (58.6%). 54% were non-university employed, while 46% were university-employed. 60% reported comfort >3 (scale 1-5) in evaluating IRD patients. 92% of providers regularly send genetic tests, while 55% provide pretest counseling. Of the respondents, 92% performed post-test counseling. In-house genetic counselors were available to 40%. For post-test counseling, while almost all respondents actively see IRD patients, 51% stated they felt confident (>3, scale 1-5) interpreting genetic testing results. Over 90% of surveyed retinal specialists were involved in managing IRDs, but wide variation in practice and limited confidence highlight the need for clearer IRD care guidelines.

The assessment of left ventricular diastolic function started with invasive pressure measurements and is currently primarily based on echocardiographic imaging. The current approach to the diagnosis of diastolic function relies on mitral inflow velocities, tissue Doppler early diastolic velocity of the mitral annulus, peak velocity of tricuspid regurgitation, pulmonary vein flow, left atrial size and function, and the noninvasive estimation of right atrial pressure. The recommended algorithm in the 2025 American Society of Echocardiography guidelines for estimation of mean left atrial pressure has been validated in a large multicenter study that included 951 patients. Further, that algorithm has shown incremental value to triaging clinical scores in achieving accurate heart failure with preserved ejection fraction diagnosis, against the invasive gold standard. Newer promising approaches have been developed over the past few years to study left ventricular diastolic function, including shear wave propagation velocity, left atrial conduit volume, and timing of mitral and tricuspid valve opening in the apical 4-chamber view. Artificial intelligence has been applied to this field as a rule-based decision tree algorithm, and as deep-learning neural networks to train models for diagnosing and grading diastolic dysfunction, and for diagnosing heart failure with preserved ejection fraction.