Faculty Bibliography

Geriatric assessment (GA) may identify vulnerabilities and promote risk-stratification in older adults predisposed to toxicities after autologous (auto), allogeneic (allo) hematopoietic cell transplantation (HCT) and chimeric antigen T-cell therapies (CAR T). With increased utilization cellular therapies for older adults the American Society for Transplantation and Cellular Therapy (ASTCT) Committee on Practice Guidelines and its Special Interest Group for Aging (SIG) conducted an online cross-sectional survey between April 2023 and August 2023 to determine transplantation and cellular therapy physicians' practice patterns regarding GA in older patients receiving HCT and CAR T-cell therapies. E-mail surveys were sent to 1168 ASTCT physician members and only 96 (8.2%) respondents completed the survey. Most (86%) were affiliated with university/teaching centers and 70% had a combined HCT and cellular therapy practice. More than 50% of respondents were interested in pursuing GA but 68% described barriers. The top two recognized barriers to GA were lack of time (96%) and clinical support staff (90%). Despite interest, only 15% respondents reported to know the domains of GA 'well'. Among those using GA, the minimum age used for routine GA was 65 years for allo-HCT and CAR T in over 91% respondents. Taken together, we recommend the HCT community leadership and GA experts combine efforts to address the gap in GA uptake and implementation.

Despite continued advancement in thrombectomy devices and techniques, a small proportion, approximately 10%, of thrombectomy attempts result in failed reperfusion due to technical difficulties with reaching the clot or recanalizing the occluded vessel. Technically challenging thrombectomy cases are often longer, with more thrombectomy passes, resulting in poorer clinical outcomes and higher rates of complications. Factors causing difficulty during thrombectomy include tortuous vasculature preventing access, challenging clot location (tandem or distal occlusions), underlying vessel abnormality, and hard-to-retrieve clots. Anticipating potentially challenging or refractory thrombectomy cases allows one to plan appropriate procedural strategies with the goal of maximizing technical success and favorable clinical outcome. We review these challenging situations and discuss specific procedural techniques that can be employed in each scenario to overcome the barriers and achieve fast and successful reperfusion.

BACKGROUND:Phrenic nerve injury is a serious complication of radiofrequency catheter ablation (RFA), potentially leading to diaphragmatic paralysis. CASE SUMMARY/METHODS:A 42-year-old woman was admitted for an electrophysiological study and RFA for symptomatic supraventricular tachycardia using minimal conscious sedation. During the electrophysiological study, atrial tachycardia was induced, showing early activation at the crista terminalis of the posterior right atrium. Persistent phrenic nerve capture with diaphragmatic stimulation was noted with pacing, which correlated with respiration and disappeared during inspiratory breath hold. A quadripolar catheter placed in the right subclavian vein was used to maintain phrenic nerve capture. RFA was successfully performed at the end of inspiration with careful monitoring of diaphragmatic stimulation facilitated by verbal commands. Postablation, atrial tachycardia was no longer inducible, and no complications occurred after the procedure or during outpatient follow-up. DISCUSSION/CONCLUSIONS:Proximity of the phrenic nerve to right-sided atrial structures can complicate ablation for atrial tachycardia. This was managed by deep inspiration and displacement of right atrium away from the phrenic nerve, facilitating successful RFA. TAKE-HOME MESSAGE/CONCLUSIONS:Performing ablation during end inspiration with phrenic nerve displacement was effective and safe.

We present a case of a 43-year-old female with a rare congenital quadricuspid aortic valve (QAV) leading to severe aortic regurgitation (AR) and acute decompensated systolic heart failure. This case highlights the diagnostic challenges associated with QAV, particularly when using transthoracic echocardiography (TTE), and emphasizes the importance of advanced imaging techniques like transesophageal echocardiography (TEE) and cardiac magnetic resonance (CMR) imaging in confirming the diagnosis. Prompt diagnosis and surgical intervention are crucial in preventing the progression of heart failure and improving outcomes.

The gastrointestinal tract is subjected to extensive mechanosensory stimulation during food ingestion. However, the identities of mechanosensory receptors in the enteric nervous system remain largely unknown. The pharynx of C. elegans is structurally and functionally analogous to the vertebrate foregut, but it contains only 20 neurons embedded among the muscles and epithelial cells of the organ. Here, we report that the DEG/ENaC family ion channel DEGT-1 is a proprioceptor of pharynx movement. DEGT-1 protein is expressed in four pharyngeal neurons (MI, M3, I4, and M5) and localized to their neuronal soma in direct contact with the collagenous pharyngeal basement membrane. degt-1 mutants display abnormally rapid feeding in the presence of food, causing global changes in lipid accumulation. degt-1 mutants also pump rapidly when pumping is induced by the presence of serotonin alone, suggesting that DEGT-1 is required for proprioception of pharyngeal pumping itself rather than for sensing ingested food. DEGT-1 is required in only two pharyngeal neurons (I4 and M5) to control pumping rate. I4 and M5 neurons show a DEGT-1-dependent calcium response. Taken together, these results suggest that DEGT-1 modulates pharyngeal pumping rate by relaying proprioceptive feedback generated by the shear force of the pharynx against its own basement membrane. Thus, mechanosensors in the enteric nervous system modulate organ function by detecting not only the forces from ingested contents but also the movements of the organ itself.