The Hospital of the University of Pennsylvania (HUP) is the flagship hospital of Penn Medicine and is located in the University City section of West Philadelphia. It is consistently ranked as one of the top hospitals in the United States..
Glioblastoma (WHO grade 4), defined by IDH-wildtype status and associated molecular features, carries poor prognosis, and real-world survival models incorporating molecular and immunologic variables remain limited. Severe radiation-induced lymphopenia (sRIL) is a proposed prognostic factor, but its independent effect in molecularly defined glioblastoma has not been established in the modern era. We retrospectively identified 832 adults with glioblastoma, defined as WHO 2021 grade 4 IDH-wildtype diffuse glioma treated with maximal safe resection and adjuvant radiotherapy (RT) with or without chemotherapy between 2014 and 2024. A trial-eligible subgroup was defined using Stupp criteria. Clinical, molecular, and hematologic variables were analyzed. sRIL was defined as CTCAE grade ≥ 3 lymphopenia within 4 months of RT. Multivariable Cox models incorporated LASSO for variable selection and spline regression for non-linearity. Median overall survival (OS) was 13.0 months. On multivariable analysis, sRIL (HR 1.37, 95
Hernia repairs have differences in outcomes based on hernia type. Information regarding hernia burden in the emergency setting is lacking. Among older adults, who have the greatest prevalence of hernia and the need for emergent repair, little data on the impact of multimorbidity on outcomes exist. We aim to define the burden of emergency hernia on hospitals and to compare outcomes of older adults with and without multimorbidity. This was a nationwide retrospective cohort study of Medicare beneficiaries admitted emergently from 2015–2018 with a principal diagnosis of an umbilical, ventral, parastomal, femoral, or inguinal hernia. The primary outcome was all-cause inpatient mortality. Multivariable logistic regression was performed. Among 47,687 hospitalized patients, there were 4,612 (9.7
Xylazine is a veterinary sedative increasingly detected as an adulterant in illicit opioids that is associated with severe skin and soft-tissue wounds. This study aimed to characterize the musculoskeletal imaging manifestations of xylazine-associated tissue injury in individuals with recreational use and to increase radiologic awareness of this emerging public health problem. This institutional review board–approved retrospective study identified patients with documented recreational xylazine use who underwent musculoskeletal imaging. Demographic data, wound location, clinical characteristics, and photographic documentation were extracted from the electronic medical record and correlated with findings on radiography, CT, MRI, and ultrasound. A total of 120 patients were included. Wounds most commonly involved the lower (48
BACKGROUND AND AIMS:The biological pathways leading to elevated blood pressure (BP) and subsequent cardiovascular diseases (CVDs) remain incompletely understood. Investigating the proteomic landscape of BP and its overlap with CVD could provide critical insights into the molecular determinants and pathways involved in BP regulation and its subsequent effect on CVD. METHODS:A proteome-wide Mendelian randomization (MR) study was conducted by leveraging genetic instruments from 2007 plasma proteins to assess their causal effects on BP (systolic and diastolic BP). Proteins showing strong associations with BP were further analyzed for potential causal effects on coronary artery disease (CAD) and stroke subtypes. Network MR was performed to estimate the proportion of CVD risk mediated through BP. Bayesian colocalization was applied to determine whether identified associations share common causal variants. Observational associations were examined in UK Biobank participants to assess associations between proteins, BP, and incident CVD events using linear regression and Cox proportional hazard models. RESULTS:Proteome-wide MR identified 242 proteins associated with BP, of which 48 were also linked to CAD or stroke, with four (ACOX1, FGF5, FURIN, MST1) also supported by genetic colocalization analyses (FDR 5% and PP ≥70%). Genetically predicted FURIN and FGF5 were strongly associated with BP and stroke risk, while ACOX1, FGF5, and MST1 exhibited potential causal effects on CAD. Network MR suggested that a substantial proportion of their effect on CAD and stroke (30.5%-77.2%) was mediated through BP regulation. Observational analyses further supported these findings. CONCLUSIONS:This study identifies key plasma proteins with potential causal roles in BP regulation and CVD risk, highlighting BP as a major mediator of their effects on CAD and stroke. These findings provide novel insights into the molecular mechanisms underlying hypertension-related CVD and identify promising protein targets for further investigation.
A quantification technique for costal cartilage calcification using 18F-sodium fluoride-positron emission tomography/computed tomography (18F-NaF-PET/CT) has yet to be established, and the effects of aging and other demographic variables on costal cartilage calcification remain understudied. This study aims to introduce a quantification methodology for assessing costal cartilage calcification using 18F-NaF-PET/CT, assess age-related changes in its 18F-NaF uptake in females and males, and examine the relationship between its 18F-NaF uptake and CT attenuation as well as 18F-NaF uptake and coronary artery calcification. In this retrospective study, we analyzed subjects from the Cardiovascular Molecular Calcification Assessed by 18F-NaF PET/CT (CAMONA) clinical trial. This study evaluated 130 subjects (mean age 48.7 ± 14.5 years; n = 67 females). We manually generated regions of interest overlying the costal cartilages from ribs 8 to 10 on the left side, carefully avoiding osseous uptake from adjacent ribs and sternum, to measure cartilaginous 18F-NaF uptake. Non-parametric statistical analyses (Spearman correlations, Mann-Whitney U tests, Kruskal-Wallis tests) and receiver operating characteristic analysis were performed to evaluate sex-specific age-related changes in uptake, correlations between imaging parameters, and associations with coronary artery calcium (CAC) score. In females, the mean 18F-NaF uptake (as assessed by average SUVmean) was 0.69 ± 0.38 while the corresponding mean Hounsfield Unit (HU) was 108.0 ± 40.0. In males, the mean 18F-NaF uptake (as assessed by average SUVmean) was 0.63 ± 0.22, and the mean HU was 104.0 ± 24.0. There was a significant correlation between 18F-NaF uptake and age in both females (p = 0.003, r = 0.36) and males (p < 0.0001, r = 0.63). The correlation was significantly stronger in males than females (Fisher's z-test, p = 0.040). There was a significant correlation between CAC score and costal cartilage SUVmean in both females (r = 0.26, p = 0.036) and males (r = 0.51, p < 0.0001). This study introduces a quantification technique to assess costal cartilage calcification using 18F-NaF-PET/CT and demonstrates that the calcification increases with age, more strongly in males than in females, and 18F-NaF uptake is correlated with CAC score. This technique can be applied to other cartilages of interest, in both physiological and pathological conditions, to assess the effects of aging and various demographic variables on cartilage calcification.
