Myocarditis presents with heterogenous clinical manifestations and remains diagnostically challenging due to nonspecific biomarkers and limitations of endomyocardial biopsy. This review evaluates the role of multimodality cardiac imaging in the diagnosis, phenotyping, and longitudinal management of myocarditis, and proposes a practical clinical integration pathway. Cardiac magnetic resonance has emerged as the reference noninvasive modality, with parametric mapping and updated Lake Louise Criteria improving diagnostic sensitivity and prognostic stratification. Echocardiographic strain imaging enhances detection of subclinical dysfunction. Positron emission tomography enables assessment of active inflammation, particularly in sarcoidosis and immune checkpoint inhibitor-associated myocarditis. Advances in photon-counting CT, hybrid PET/MR, and artificial intelligence are expanding tissue characterization and risk prediction capabilities. A stepwise imaging strategy integrating echocardiography, CMR, PET, and CT improves diagnostic confidence and guides tailored management. Ongoing research focused on imaging biomarker standardization, validation, and outcome prediction will further refine precision care in myocarditis.
Bruton tyrosine kinase inhibitors (BTKis) and BCL2 inhibitor (BCL2i)-containing regimens significantly improve survival outcomes in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). Results from randomized clinical trials have demonstrated that time-limited treatment with BCL2i-containing regimens resulted in higher rates of undetectable measurable residual disease (uMRD) than BTKi monotherapy or chemoimmunotherapy (CIT). Pirtobrutinib (a noncovalent BTKi) and lisocabtagene maraleucel (CD19-directed CAR T-cell therapy) are newer options for relapsed or refractory disease after prior therapy with BTKi and BCL2i-contining regimens. Histologic transformation of CLL/SLL to diffuse large B-cell lymphoma (Richter transformation) is associated with a poor prognosis. Molecular analysis to determine whether there is clonal relationship between CLL/SLL and transformed diffuse large B-cell lymphoma is useful to select an appropriate treatment option. These NCCN Guideline Insights highlight significant updates to the NCCN Guidelines for the treatment of CLL/SLL and Richter transformation.
Biomarkers are needed to characterize mechanistic endophenotypes after neurotrauma and inform prognosis and therapy. Vascular endothelial growth factor-A (VEGF-A) is associated with inflammation and vascular permeability, which are implicated in secondary brain injury. We describe changes in plasma VEGF-A levels at injury (D1) and 2 weeks (W2) postinjury, and their associations with traumatic brain injury (TBI) severity and 6-month (M6) Glasgow Outcome Scale-Extended (GOSE) scores in a subset of Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) participants with TBI (n = 317), orthopedic trauma controls (OTC, n = 82), and healthy controls (HC, n = 69). D1 VEGF-A levels were higher in TBI (median [IQR] = 175.8 [114.2-273.1]) compared with OTC (134.3 [97.4-200.6], p = 0.001) and HC (133.6 [89.2-188.2], p = 0.003). VEGF-A levels for both Glasgow Coma Scale (GCS) 3-12 (187.1 [131.7-271.6], p < 0.001) and GCS 13-15 with CT lesions (167.6 [111.4-273.9], p = 0.04) were significantly higher than control groups. This was not the case for GCS 13-15 without CT findings (160.5 [99.2-255.7], p = 0.11, p = 0.09 vs. HC and OTC, respectively). D1 levels did not significantly differ between GCS 3-12 and GCS 13-15 (p = 0.09), but W2 VEGF-A levels remained elevated for GCS 3-12 (231.6 [120.2-511.5], p < 0.0001 vs. HC) while GCS 13-15 returned to HC levels. VEGF-A levels were higher in all TBI participants with intracranial pathology on CT compared with those without (D1: p = 0.024; W2: p < 0.0001). VEGF-A levels for all TBI returned to HC values by M6. D1 VEGF-A levels did not differ by M6 GOSE, but W2 levels were higher in those with moderate functional disability (GOSE 1-6; p = 0.04) and with unfavorable outcomes (GOSE 1-4; p < 0.0001). W2 VEGF-A was associated with increased odds of unfavorable outcome (GOSE 1-4) at M6 (aOR = 1.44 per log unit increase, 95% CI: 1.02-2.05) after accounting for demographic and clinical variables, but D1 levels were not. Our findings suggest that VEGF-A is a candidate biomarker of traumatic vascular injury and may hold promise for identifying and monitoring of a potentially treatable endophenotype after TBI.
This article provides a focused update to the clinical practice guideline on the treatment and management of patients with coronavirus disease 2019, developed by the Infectious Diseases Society of America. The guideline panel presents a recommendation on the use of the anti-severe acute respiratory syndrome coronavirus 2 neutralizing antibody pemivibart as pre-exposure prophylaxis. The recommendation is based on evidence derived from a systematic review and adheres to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Information on pemivibart is included in the U.S. Food and Drug Administration Emergency Use Authorization for this agent.
Abstract Psychedelics have robust effects on acute brain function and long-term behavior but whether they also cause enduring functional and anatomical brain changes is largely unknown. In an exploratory, placebo-controlled, within-subjects, electroencephalography (EEG), and magnetic resonance imaging (MRI) study in 28 healthy, entirely psychedelic-naive participants, anatomical and functional brain changes are detected from one-hour to one-month after a single high-dose (25 mg) of psilocybin. Increases in cognitive flexibility, psychological insight, and well-being are seen at one-month. Diffusion tensor imaging (DTI) done before and one-month after 25 mg psilocybin reveals decreased axial diffusivity bilaterally in prefrontal-subcortical tracts that correlate with decreases in brain network modularity (fMRI) over the same month. Enduring functional brain changes are largely absent, but network modularity change (numerical decrease) negatively correlates with well-being change (significant increase), in line with previous findings in depression. Increased cortical signal entropy (EEG) at 1- and 2-hours post-dosing predicts improved psychological well-being at one-month. Next-day psychological insight mediates the entropy to well-being relationship. All effects are exclusive to 25 mg psilocybin; no effects occur with a 1 mg psilocybin placebo.
