Alzahra’A Al Matairi

1. Intraosseous (IO) access is a technique for obtaining vascular access by infusing fluids and medications directly into the bone marrow cavity, thereby achieving access to the venous circulation ...

Cerebral palsy (CP) is a group of non-progressive neuromotor disorders resulting from early brain injury, and it is the most common cause of chronic physical disability in children [1]. The motor i...

Background Heart failure (HF) is a common comorbidity in patients undergoing carotid artery stenting (CAS), but its impact on outcomes by HF phenotype is unclear. This is the first study to compare short-term CAS outcomes between patients with heart failure with reduced ejection fraction (HFrEF) and those with preserved ejection fraction (HFpEF). Methods This multicenter, prospective observational study started by screening 889 patients from the CASSH registry. After applying predefined criteria, 105 patients with heart failure undergoing CAS were included (69 HFpEF, 36 HFrEF). Baseline demographics, comorbidities, and procedural details were compared. The primary outcome was a composite of 30-day procedure-related mortality, stroke, or myocardial infarction. Secondary outcomes included disability, measured by the modified Rankin Scale (mRS), at 30 days and at 90 days. Multivariable ordinal regression was used to assess the independent association between HF phenotype and poor functional outcome. Results Baseline characteristics were similar between groups. The primary outcome occurred in 5.6% of HFrEF patients versus 1.4% of HFpEF patients (p = 0.561). However, functional outcomes were significantly worse in the HFrEF group, with higher mean mRS scores at 30 days (2.7 vs. 1.6, p = 0.003) and 90 days (2.7 vs. 1.4, p = 0.001). All-cause mortality was 11.1% in HFrEF vs. 1.4% in HFpEF (p = 0.085). After adjustment for age, sex, atrial fibrillation, and preprocedural mRS, HFrEF was independently associated with a higher risk of poor functional outcome at 30 days (β = 0.89, p = 0.018) and 90 days (β = 1.05, p = 0.006). Conclusion HFrEF, but not HFpEF, independently predicts poorer functional recovery following CAS. These findings highlight the importance of incorporating heart failure phenotype into risk stratification and clinical guidelines to improve patient selection and peri-procedural management.

Background/Objectives: Radiation therapy for left-sided breast cancer exposes the heart and lungs to incidental radiation, increasing long-term risk of cardiopulmonary morbidity. This study evaluated the dosimetric impact of DIBH compared with free breathing (FB) and explored patient- and treatment-related predictors of benefit. Methods: We retrospectively analyzed 90 patients with left-sided breast cancer or chest wall irradiation planned under both FB and DIBH. Dosimetric parameters included mean heart dose (MHD), mean lung dose (MLD), heart V5, and lung V20. Univariable analyses assessed associations between dose reductions (Δ%) and clinical factors (age, BMI, fractionation, boost, nodal fields, and smoking). Multivariable regression identified independent predictors. Results: DIBH significantly reduced mean doses to the heart (FB 4.25 ± 1.47 Gy vs. DIBH 2.64 ± 1.28 Gy; Δ −1.60 Gy, p < 0.001, and Cohen’s d = 2.46) and lung (FB 14.00 ± 3.45 Gy vs. DIBH 11.64 ± 3.32 Gy; Δ −2.36 Gy, p < 0.001, and Cohen’s d = 2.73). Similarly, heart V5 (median Δ −10.5%, p < 0.001) and lung V20 (median Δ −5.5%, p < 0.001) were significantly improved. Higher BMI was independently associated with smaller relative reductions in MHD (−1.4% per unit, p < 0.001) and MLD (−0.31% per unit, p = 0.019). Hypofractionation was linked to greater MHD and MLD reductions (+8.9%, p = 0.007), (3.7%, p = 0.035), respectively. Supraclavicular field irradiation increased lung exposure, while internal mammary chain fields elevated both lung and heart doses. Age showed no significant influence. Conclusions: DIBH provides robust and consistent reductions in cardiac and pulmonary radiation doses during left-sided breast irradiation. The degree of sparing is modulated by BMI, fractionation, and nodal field inclusion.

BACKGROUND: The CASONI study (Carotid Artery Stenting Outcomes by Neurointerventional Surgeons) showed that proceduralist experience significantly reduces complications in carotid artery stenting. The CASSH study (Carotid Artery Stenting Outcomes in Comprehensive Stroke Hospitals) prospectively evaluates real-world carotid artery stenting outcomes by fellowship-trained neurointerventionalists at comprehensive stroke centers across the United States to validate and expand on CASONI’s findings. METHODS: CASSH is a multicenter, prospective observational study conducted across 15 US comprehensive stroke centers from January 2023 to December 2024. Adults with symptomatic ≥50% or asymptomatic ≥70% carotid stenosis undergoing carotid artery stenting by fellowship-trained neurointerventionalists were included. The primary outcome was a 30-day composite of procedure-related death, stroke, or myocardial infarction. Secondary outcomes included nonprocedural mortality, access site complications, stent thrombosis, and other adverse events. Logistic regression identified predictors of adverse outcomes. RESULTS: Among 889 patients (mean age 70.3±9.9 years; 61.4% male), 87.1% had hypertension and 63.1% were symptomatic. The 30-day composite primary outcome occurred in 1.2% (mortality 0.8%, ischemic stroke 0.3%, hemorrhagic stroke 0.2%, myocardial infarction 0.2%). Composite secondary outcome occurred in 5.4%, most commonly access site complications (1.7%) and nonprocedural mortality (1.5%). Higher preprocedural modified Rankin Scale (odds ratio [OR], 1.42), National Institutes of Health Stroke Scale score (OR, 1.09), and longer fluoroscopy times (OR, 1.02) were associated with increased complication risk. Mortality was independently predicted by elevated modified Rankin Scale (OR, 1.72), higher National Institutes of Health Stroke Scale score (OR, 1.15), older age (OR, 1.05 per year), and lower ejection fraction (OR, 0.96). Postprocedural antiplatelet therapy was protective, reducing both complications (OR, 0.03) and mortality (OR, 0.07). CONCLUSIONS: Carotid artery stenting performed by fellowship-trained neurointerventionalists at comprehensive stroke centers is associated with low rates of periprocedural stroke, myocardial infarction, and death. These outcomes align with the landmark CREST-2 trial (Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial), particularly in asymptomatic patients, and are strongly influenced by preprocedural disability, stroke severity, age, and cardiac function, underscoring the importance of patient selection and optimized perioperative care.

Background/Objectives: To explore the prognostic potential of gross tumor volume (GTV)-based delta-radiomic features from CT simulation scans in patients with locally advanced unresectable vulvar cancer. Methods: A total of 21 patients (between 2019 and 2024) undergoing definitive radiotherapy were included, with baseline and post-phase I (after 25 fractions) CT simulation scans analyzed. Radiomic features (n = 107) were extracted from GTVs using PyRadiomics, and delta features were calculated as the relative change between scans. A multi-step selection pipeline (univariable Cox screening (p < 0.10), correlation filtering, and Lasso–Cox) was applied for each endpoint: local control (LC), regional control, distant metastasis-free survival, progression-free survival, and overall survival (OS). Model discrimination was assessed via 500-iteration bootstrapped concordance index (C-index), and calibration was plotted at 24 months. Results: Median follow-up was 50.0 months. The 2-year LC and OS rates were 56.2% and 55.9%, respectively. Final multivariable models retained a sole texture Δ feature for LC (HR = 2.62, 95% CI = 1.05–6.52, p = 0.039; C-index = 0.748) and six Δ features for OS (C-index = 0.864). No features were retained for other endpoints. For LC, increased run-length non-uniformity after phase I predicted poorer control. For OS, increased texture/shape complexity predicted worse survival, whereas increased uniformity predicted better survival. Conclusions: CT-based delta-radiomic features, particularly shape and texture metrics, may predict LC and OS in unresectable vulvar cancer. Despite the small sample size, these findings highlight the potential for delta-radiomics as a noninvasive biomarker for risk stratification. Validation in larger cohorts and exploring potential in adaptive radiotherapy are warranted.