NCOG-35. Neuropsychological outcomes in patients with IDHm lower grade gliomas who underwent awake craniotomy

Neuro-Oncology · 2025-11-01

Abstract BACKGROUND Lower-grade IDHm gliomas (LGG) commonly occur in, or close to, eloquent brain areas; leading to higher risks of neurocognitive impairments from surgery. Awake craniotomy is aimed at reducing this risk, whilst seeking to maximise tumour resection. This study aims to evaluate the outcomes from peri-operative neuropsychological assessment in patients with LGG undergoing awake craniotomy. METHODS Data (2020-24) were collected retrospectively from patients who underwent awake craniotomy for IDHm LGG at Leeds Teaching Hospitals NHS Trust, UK. To avoid selection-bias (negative or positive outcome, surgeon-specific referral), only patients with routinely planned pre- and post-operative neuropsychological assessments were included. Domains assessed included intellectual function, processing speed, executive functioning, attention and memory. Reliable change indices (RCIs) were calculated for each domain. Statistical significance was determined as an RCI greater than 1.96 or less than -1.96. RESULTS Twenty-six patients (18 male, 8 female) were included, with 28 surgeries performed. Mean age (years) at diagnosis and operation were 39.5+/-9.5 and 41.1+/-10.1, respectively. 19/22 (86.4%) presented with seizures and 4/26 (15.4%) were incidental. 50% (13/26) of the lesions were in the left hemisphere. There was an equal split between WHO Gr2 IDHm astrocytoma and oligodendroglioma (13/26 respectively). Mean age at pre- and post-operative assessment completion were 40.9+/-9.3 and 42.1+/-9.8. The average pre-operative IQ fell between the average range. For each domain; working memory: 24/26 (92.3%) patients remained unchanged or improved; executive functioning: 10/11 (90.9%) patients remained unchanged or improved; intellectual function: 5/8 (62.5%) and 4/7 (57.1%) patients remained unchanged or improved in vocabulary and perceptual reasoning respectively. There were no statistically significant changes in speed of information processing. CONCLUSION Our findings demonstrate that good neurocognitive outcomes are achievable with awake surgery for LGG. Routine, non-selective, neuropsychological assessment pre- and post-operatively in patients undergoing awake craniotomy for LGG is therefore important in confirming objective neurocognitive outcomes.

Adult heart transplantation in the USA and Western Europe: state of the art review

European Heart Journal · 2025-11-10 · 2 citations

Heart transplantation has made remarkable strides since its inception in the 1960s. While the transplant volume in the USA has steadily increased over the last decade, significant disparities exist in Europe, fuelled by cultural and legislative differences. Recent advancements such as donation after circulatory death and use of hepatitis C positive donors are embraced to differing degrees among countries. This review serves to summarize the current state and ongoing challenges of heart transplantation in the USA and Europe.

Single cell RNA sequencing of haematopoietic cells in fresh and frozen human atheroma tissue

Cardiovascular Research · 2025-02-01 · 4 citations

AIMS: Single-cell RNA sequencing (scRNA-seq) is a powerful method for exploring the cellular heterogeneity within human atheroma but typically requires fresh tissue to preserve cell membrane integrity, limiting the feasibility of large-scale biobanking for later analysis. The aim of this study was to determine whether cryopreservation of fragile and necrotic atheroma tissue affects the viability and transcriptomic profiles of haematopoietic cells in subsequent scRNA-seq analysis, enabling the use of cryopreserved atheroma samples for future research. METHODS AND RESULTS: We performed scRNA-seq on five paired fresh and cryopreserved atheroma samples-three from coronary arteries and two from carotid arteries. Each sample was enzymatically digested, sorted for CD45+ haematopoietic cells, and processed using the 10× Genomics scRNA-seq workflow. Half of each sample was processed immediately, while the other half was cryopreserved in liquid nitrogen for an average of 5 weeks before thawing and processing. In carotid artery samples, we noted the absence of LYVE1+ macrophages, likely due to the loss of the adventitial layer during endarterectomy procedures. Our results indicated that cryopreservation modestly affected cellular integrity, leading to an increase in the relative abundance of mitochondrial RNA in frozen samples. Minimal differences were observed between fresh and cryopreserved samples in uniquely detected transcripts, cell clustering, or transcriptional profiles within haematopoietic populations. CONCLUSIONS: Our study demonstrates that cryopreserved human atheroma samples can be successfully profiled using scRNA-seq, with comparable transcriptomic data to that obtained from fresh samples. These findings suggest that cryopreservation is a viable method for biobanking atheroma tissues, facilitating large-scale studies without the need for immediate sample processing.

Evaluating the impact of attention shift intervention on human evacuation behavior in virtual environment

Developments in the Built Environment · 2025-03-01 · 1 citations

Traditional auditory evacuation cues, such as fire alarms, frequently fail to capture individuals' attention, particularly when they are using handheld devices. This study investigates the effectiveness of attention shift interventions delivered via emergency text messages displayed on these devices to improve evacuation responses. Participants in a virtual reality simulation of a metro station were exposed to emergency cues through auditory broadcasts or visual text messages. The findings show that visual attention shift interventions reduce the likelihood of re-engaging in pre-evacuation activities while improving evacuation performance when compared to auditory cues. Continuous visual cues were more effective than auditory cues in keeping attention during evacuation. These results highlight the potential for personalized visual communication to improve emergency response strategies in environments where handheld devices are widely used, providing critical insights into developing more effective emergency communication systems for improved evacuation behavior and overall safety during emergencies. • Evaluated impact of attention shift interventions on evacuation behavior • VR experiment with participants engaged in pre-evacuation tasks using smartphones • Visual attention shift reduced re-engagement from 78% to 45% after info-seeking • Continuous visual attention shifts improved evacuation delay and route compliance • Personalized visual cues lower pre-evacuation task re-engagement and boost response

An axis-specific mitral annuloplasty ring eliminates mitral regurgitation allowing mitral annular motion in an ovine model

Communications Medicine · 2025-02-12 · 2 citations

Current mitral annuloplasty rings fail to restrict the anteroposterior distance while allowing dynamic mitral annular changes. We designed and manufactured a mitral annuloplasty ring that demonstrated axis-specific, selective flexibility to meet this clinical need. The objectives were to evaluate ex vivo biomechanics of this ring and to validate the annular dynamics and safety after ring implantation in vivo. Healthy human mitral annuli (n = 3) were tracked, and motions were isolated. Using the imaging data, we designed and manufactured our axis-specific mitral annuloplasty ring. An ex vivo annular dilation model was used to compare hemodynamics and chordal forces after repair using the axis-specific, rigid, and flexible rings in five porcine mitral valves. In vivo, axis-specific (n = 6), rigid (n = 6), or flexible rings (n = 6) were implanted into male Dorset sheep for annular motion analyses. Five additional animals receiving axis-specific rings survived for up to 6 months. Here we show the axis-specific, rigid, and flexible rings reduced regurgitation fraction to 4.7 ± 2.7%, 2.4 ± 3.2%, and 17.8 ± 10.0%, respectively. The axis-specific ring demonstrated lower average forces compared to the rigid ring (p = 0.046). Five animals receiving axis-specific rings survived for up to 6 months, with mitral annular motion preserved in vivo. Mature neoendocardial tissue coverage over the device was found to be complete with full endothelialization in all animals. The axis-specific mitral annuloplasty ring we designed demonstrates excellent capability to repair mitral regurgitation while facilitating dynamic mitral annular motion. This ring has tremendous potential for clinical translatability, representing a promising surgical solution for mitral regurgitation. If a person has a leaky heart valve and it remains untreated, it can lead to death. One treatment is to insert a special type of ring called an annuloplasty ring around the heart valve to prevent leakage. We designed and manufactured an annuloplasty ring and tested its effectiveness in a heart simulator and in sheep. We found that our ring was able to reduce leakage from the heart valve, while preserving the natural movement of the part of the heart where it was implanted. Our annuloplasty ring could potentially be used in the future to improve the treatment of people with leaky heart valves. Zhu et al. designed and manufactured a mitral annuloplasty ring based on human high-resolution cardiac magnetic resonance imaging exams, demonstrating axis-specific flexibility and rigidity. This ring demonstrates excellent ex vivo hemodynamics and biomechanics while allowing mitral annulus dynamic changes in a survival in vivo large animal model.

Dual Contrast‐Enhanced Microcomputed Tomography Uncovers Leaflet‐Dependent Patterns of Macrocalcification, Fibrous Extracellular Matrix Remodeling, and Adipocyte Degeneration in Calcific Aortic Stenosis

Journal of the American Heart Association · 2025-11-03

Background Clinical imaging studies of calcific aortic stenosis have suggested interleaflet pathological differences in patients. In this cross‐sectional study, we sought to investigate interleaflet differences in calcification, fibrous extracellular matrix remodeling, and adipocyte degeneration in explanted human aortic valves. Methods Diseased (n=45) and control (n=39) tricuspid aortic valve leaflets obtained from patients with aortic stenosis and normal aortic valves on echocardiography were assessed for calcification, fibrous extracellular matrix remodeling, and adipocyte degeneration using contrast‐enhanced microcomputed tomography in conjunction with scanning and transmission electron microscopy, with interleaflet differences analyzed by fractional response regression. Results In diseased leaflets, the calcification volume fraction was significantly greater in the noncoronary cusp than the left coronary cusp (LCC; β=0.313 [95% CI, 0.048–0.579], P =0.021) but not than the right coronary cusp (RCC; β=0.196 [95% CI, −0.107 to 0.499], P =0.204), with no difference between the RCC and LCC (β=0.117 [95% CI, −0.150 to 0.385], P =0.390). However, the fibrous extracellular matrix volume fraction was significantly greater in the RCC and LCC than the noncoronary cusp (β=0.502 [95% CI, 0.300–0.704], P <0.001; β=0.388 [95% CI, 0.188–0.589], P <0.001), with the RCC also greater than the LCC (β=0.114 [95% CI, 0.065–0.163], P <0.001). The volume fraction of osmium‐labeled inclusions observed on microcomputed tomography—confirmed to be predominantly adipocytes (95.4 [IQR, 72.4–99.0]%) and occasionally membranous fat necrosis (4.6 [IQR, 1.0–27.6]%) on electron microscopy—was significantly less in the noncoronary cusp than the LCC (β=−0.269 [95% CI, −0.441 to −0.096], P =0.002) but not than the RCC (β=−0.185 [95% CI, −0.409 to 0.038], P =0.104), with no difference between the RCC and LCC (β=−0.083 [95% CI, −0.348 to 0.182], P =0.538). Conclusions Valvular calcification diverges from fibrous extracellular matrix remodeling but converges with adipocyte degeneration in terms of preferential impact on the noncoronary cusp versus, in particular, the LCC. Future mechanistic studies to elucidate the intimate relationship between adipocyte degeneration and valvular calcification may provide opportunities for further therapeutic development.

Stromal cell-derived factor-encapsulated nanoparticles target ischemic myocardium and attenuate myocardial injury via proangiogenic effects

Biomaterials · 2025-02-04

Lipid bilayer nanoparticles (NPs) with and without stromal cell-derived factor (SDF) were created to target and treat ischemia/reperfusion (I/R)-injured myocardium. Male Wistar rats were subjected to myocardial I/R insult and, at reperfusion, randomized to receive systemic injections of 5 mL/kg PBS, 6 μg/kg of NPs, SDF, or SDF-NPs. Four days after treatment, SDF-NPs circulated and accumulated selectively in the ischemic myocardium, with an SDF concentration roughly three times that of the other three treatments. SDF- N P-treated rats had more endothelial progenitor cells (EPCs) in the blood and preserved capillaries and arterioles in the ischemic border myocardium four weeks post-treatment, which improved microvascular perfusion, reduced fibrosis, and preserved heart function. Notably, hearts treated with SDF-NPs retained left ventricular function at four weeks compared to 1-day post-treatment, with a 2.7 ± 1.2 % increase in the ejection fraction. The other three treatments decreased left ventricular function at four weeks (PBS: −7.8 ± 1.2 %, P < 0.001; empty NPs: −3.9 ± 1.3 %, P = 0.004; SDF solution: −5.1 ± 1.3 %, P = 0.001). Hence, systemically injected SDF-NPs selectively accumulate in ischemic cardiac tissue, shielding the myocardium from I/R injury via angiogenic effects through increased EPC migration. This novel cardioprotective drug may be clinically translatable. • Lipid nanoparticles with stromal cell-derived factor (SDF-NP) for myocardial injury. • SDF-NPs selectively accumulate at the injured myocardium. • SDF-NPs increased recruitment of the endothelial progenitor cells and preserved vasculature. • SDF-NPs improved microvascular perfusion and preserved heart function. • SDF-NPs shield myocardium from ischemic/reperfusion injury via angiogenic and anti-apoptotic effects.

Ex-vivo heart perfusion attenuates early post-transplant risk after prolonged agonal period in DCD heart transplantation

The Journal of Heart and Lung Transplantation · 2025-11-17 · 3 citations

Outcomes after fractional flow reserve-guided percutaneous coronary intervention versus coronary artery bypass grafting (FAME 3): 5-year follow-up of a multicentre, open-label, randomised trial

The Lancet · 2025-04-01 · 38 citations

Design and evaluation of valve interventions using ex vivo biomechanical modeling: the Stanford experience

General Thoracic and Cardiovascular Surgery · 2025-03-27