A woman in her mid-50s with Lynch syndrome and a history of malignant neoplasms was found to have a superior vena cava (SVC) thrombus and a necrotic mediastinal mass on surveillance imaging. The initial biopsy yielded necrotic debris, and the procedure was complicated by a mediastinal hematoma. Due to concern for possible infection, the patient was empirically treated with antibiotics while planning further workup. A broad-range 16S polymerase chain reaction (BRPCR) was performed on a formalin-fixed paraffin-embedded (FFPE) tissue, which was negative for fungi and mycobacteria but revealed DNA from normal oral flora. Subsequently, she developed SVC syndrome, raising concern about a mediastinal abscess. A repeated biopsy confirmed the suspected carcinoma with necrosis. This case underscores the importance of proper interpretation of BRPCR results in FFPE (non-sterile) tissue and emphasizes the need to use these results in an appropriate clinical context.

Delayed mass effect (DME) is a rare yet significant long-term complication following endovascular coiling of intracranial aneurysms, often mimicking intracranial neoplasms and leading to diagnostic challenges. This report presents a distinctive case of DME that occurred 3 years after coiling of a posterior inferior cerebellar artery (PICA) aneurysm, characterized by a prolonged latency period, imaging findings suggestive of an evolving mass lesion, and concurrent pulmonary pathology that compounded diagnostic complexity. A 59 year-old female underwent microcatheter-assisted coiling for a PICA aneurysm. Two-year post-procedural angiographic follow-up revealed aneurysm neck recanalization. At 3 years post-embolization, organized intra-aneurysmal thrombosis resulted in a prominent peribrainstem mass effect, manifesting as progressive brainstem compression symptoms. This case highlights that DME, as a rare but serious long-term complication of aneurysm coiling, warrants heightened clinical awareness. Its management necessitates early detection and personalized treatment strategies based on a comprehensive assessment of the patient's overall condition and the specific morphological features of the aneurysm.

Papillary thyroid carcinoma (PTC) is the most common malignant thyroid neoplasm. Its solid/trabecular subtype (STPTC) is rare, and its aggressiveness remains controversial. We describe the clinical, histopathological, and immunohistochemical characteristics of three STPTC cases, highlighting their biological behavior and impact on current classification. Two patients exhibited aggressive clinical courses with extensive lymphatic metastases and possible distant spread, while the third case showed a more indolent progression. Immunohistochemistry revealed positivity for cytokeratin 7, cytokeratin 19, thyroglobulin, TTF-1, and PAX8, with negativity for CD56, synaptophysin, and p63, among others. Although the 2022 WHO classification does not consider STPTC an aggressive subtype, the literature and our findings suggest reconsideration. Immunohistochemistry and the Ki-67 proliferation index may be key tools for differential diagnosis and prognosis. STPTC can exhibit aggressive behavior, particularly in young patients. Early diagnosis and individualized therapeutic approaches are essential to improve clinical outcomes.

Vestibular schwannomas (VSs) are benign neoplasms commonly located in the cerebellopontine angle and are increasingly managed with stereotactic radiosurgery (SRS), particularly Gamma Knife radiosurgery (GKRS). The integration of artificial intelligence (AI), encompassing machine learning (ML) and deep learning (DL) algorithms, into GKRS has emerged as a promising strategy to enhance diagnostic accuracy, automate treatment planning, and predict treatment response. This systematic review evaluates the current applications and clinical utility of AI in the stereotactic radiosurgical management of VSs. A systematic search was conducted on July 31, 2024, across Medline (PubMed), Embase, Scopus, and the Cochrane Library, in accordance with PRISMA guidelines. Studies were selected if they investigated the use of AI at any stage of stereotactic treatment or follow-up of VSs. Articles were excluded if they focused solely on microsurgical interventions or were review articles. Eligibility was independently assessed by two reviewers, with discrepancies resolved by a third observer. A total of 22 original studies were included in the final qualitative synthesis. AI applications were categorized into three domains: (1) pre-treatment tumor characterization and segmentation, (2) radiosurgical treatment planning, and (3) post-treatment response prediction. Multiple studies demonstrated the efficacy of convolutional neural networks (CNNs) and federated learning for automated and accurate segmentation of VSs, often achieving performance metrics comparable to expert manual annotations. In treatment planning, AI-driven models enabled improved target delineation, dosimetric optimization, and reduced inter-planner variability. In the post-treatment phase, radiomic-based AI models accurately predicted pseudoprogression and long-term tumor response, while automated volumetric assessment tools reliably tracked tumor changes over time. Collectively, these AI applications showed potential to streamline clinical workflows, enhance precision, and support individualized decision-making. AI has shown significant promise in enhancing various aspects of stereotactic radiosurgical care for VSs, from diagnosis and planning to longitudinal monitoring. While current findings are encouraging, challenges such as data standardization, model generalizability, and integration into clinical practice remain. Further prospective multicenter studies and regulatory oversight are warranted to validate AI tools and facilitate their widespread clinical adoption. With continued refinement, AI is likely to augment the capabilities of radiosurgeons and improve outcomes for patients with VS.

To study the long-term cause of death following percutaneous coronary intervention (PCI) in patients from a contemporary data set undergoing dialysis.

We evaluated successive patients who underwent PCI from September 30, 2009, to October 31, 2023, and categorized them according to the MDRD (Modification of Diet in Renal Disease) equation into group 1 (normal renal function), group 2 (mild-moderate renal dysfunction; chronic kidney disease stage 1 to 3a), group 3 (moderate to severe renal disease; chronic kidney disease stage 3b to 5), and group 4 (patients undergoing dialysis). Multivariable Cox proportional hazards models were fit to examine the effect of dialysis on 10-year all-cause/cardiac mortality and major adverse cardiac events. Cause of death was determined via telephone interviews, medical records, autopsy reports, and death certificates.

Overall, 15,403 patients underwent PCI during our study period, 369 of whom were receiving dialysis and 1659 who had moderate to severe renal dysfunction. Group 4 patients were younger (median age group 4: 66 years vs group 1-3: 69 years) with a higher comorbid burden (Charlson Comorbidity Index score for group 4 was 8 vs 4 for group 1). After multivariable adjustment, group 4 as compared with group 1 had the worst all-cause mortality (hazard ratio [HR], 3.84; 95% CI, 3.16 to 4.66), cardiac mortality (HR, 4.95; 95% CI, 3.53 to 6.95), major adverse cardiac events (HR, 2.32; 95% CI, 1.99 to 2.70), repeat revascularization (HR, 1.29; 95% CI, 0.92 to 1.82), and recurrent hospitalization (HR, 2.14; 95% CI, 1.86 to 2.45). Long-term cause of death was dominantly noncardiovascular. However, cardiovascular mortality accounted for 38.9% of deaths in group 4 (65 of 167) as compared with 24.3% in group 1 (82 of 338) (P<.001).

Patients on dialysis had worse outcomes, including 10-year all-cause and cardiac mortality compared with patients with normal renal function.

Recent studies have confirmed the feasibility and safety of cavotricuspid isthmus (CTI) ablation using either a pentaspline or a focal monopolar pulsed-field ablation catheter. However, no documented cases have reported irreversible heart block as a potential complication.

A 62-year-old woman with persistent atrial fibrillation underwent CTI ablation using a pentaspline pulsed-field catheter after pulmonary vein isolation. Immediately postablation, third-degree atrioventricular block occurred, transiently recovering to 2:1 block before reverting to complete heart block. A permanent pacemaker was subsequently implanted given irreversible conduction impairment.

We report to our knowledge the first case of irreversible heart block after CTI ablation using a pentaspline pulsed-field ablation catheter, necessitating permanent pacemaker implantation after 13 hours of observation. This case underscores the need for caution when employing this technology for CTI ablation.

Irreversible heart block is a novel, albeit rare, complication of CTI ablation with a pentaspline pulsed-field catheter.

Early diagnosis of cardiovascular diseases requires precise detection of multiple biomarkers, yet simultaneous analysis of these biomarkers without cross-talk remains a major challenge. To overcome this limitation, we developed a novel dual-zone biosensing platform capable of generating independent multimode signals for the parallel detection of cardiac troponin I (cTnI, the gold-standard biomarker) and interleukin-6 (IL-6, a key inflammatory marker). This platform features two spatially resolved zones, Zone I integrates rhodamine B (RhB) with a cadmium sulfide@bismuth tungstate (CdS@Bi₂WO₆) composite, allowing dual-signal detection of cTnI via photoelectrochemical (PEC) and smartphone-based fluorescent (FL) methods. Zone II is functionalized with dsDNA/methylene blue (MB), enabling dual-signal detection of IL-6 through PEC and electrochemical (EC) techniques. The biosensor exhibits excellent analytical performance, including high specificity against interfering species, a broad dynamic range covering clinically relevant concentrations, and high detection sensitivity (cTnI: 1 ∼ 50,000 pg mL^-1 for PEC, 10 ∼ 50,000 pg mL^-1 for FL; IL-6:1 ∼ 20,000 pg mL^-1 for PEC, 1 ∼ 20,000 pg mL^-1 for EC.) with low limits of detection (cTnI: 0.27 pg mL^-1 for PEC, 0.86 pg mL^-1 for FL; IL-6:0.57 pg mL^-1 for PEC, 0.65 pg mL^-1 for EC.). Importantly, it maintains robust functionality in human serum and shows strong correlation with established clinical methods. This work provides a generalizable framework for developing multiplexed biosensors that combine orthogonal detection principles, effectively addressing key challenges in multicomponent bioanalysis, which is a significant advancement in the field of clinical diagnostics.

Proton pump inhibitors (PPIs) may potentially reduce clopidogrel's antiplatelet effect and increase cardiovascular risk. The degree of CYP (cytochrome P450) 2C19 inhibition varies among PPIs. Few studies have evaluated individual PPIs by CYP2C19 inhibition strength across countries. This study aimed to compare the incidence of cardiovascular events between strong CYP2C19-inhibiting potency and weak CYP2C19-inhibiting potency (weak or non-CYP2C19-inhibiting PPIs) in patients receiving clopidogrel.

We conducted an international observational cohort study using 14 databases from the United States, South Korea, and Taiwan. We included patients aged ≥18 years who received clopidogrel with PPIs from 1985 to 2023. PPIs were classified into strong CYP2C19-inhibiting PPIs and weak or non-CYP2C19-inhibiting PPIs based on CYP2C19 inhibition. We compared the hazard ratios and 95% CIs for major adverse cardiovascular events, including myocardial infarction, stroke, and cardiovascular mortality, using the Cox proportional hazards model after 1:1 propensity score matching. Secondary outcomes included cardiovascular mortality, myocardial infarction, stroke, and all-cause mortality. A random-effects model calculated pooled hazard ratios and 95% CIs. Only databases meeting all diagnostic criteria were included in the meta-analysis.

Large-scale propensity score matching identified 166 005 patient pairs. During the 365-day follow-up, the risk of major adverse cardiovascular events did not differ significantly between patients receiving clopidogrel plus strong CYP2C19-inhibiting PPIs and those receiving clopidogrel plus weak or non-CYP2C19-inhibiting PPIs (17.63 per 1000 person-years versus 16.82 per 1000 person-years; calibrated hazard ratio, 1.00 [95% CI, 0.79-1.26]). No significant difference was observed in the risk of secondary outcomes (calibrated hazard ratio, cardiovascular mortality 1.10 [95% CI, 0.87-1.39], myocardial infarction 0.98 [95% CI, 0.81-1.19], stroke 1.05 [95% CI, 0.87-1.27], and all-cause mortality 1.18 [95% CI, 0.93-1.50]).

Concomitant use of clopidogrel and strong CYP2C19-inhibiting PPIs was not associated with a higher cardiovascular risk compared with concomitant use of clopidogrel and weak or non-CYP2C19-inhibiting PPIs. This large-scale study does not support the clinical significance of potential interactions between PPIs and clopidogrel.