Scripps Clinic

Retrospective cohort study using a multicenter, prospectively collected adult spinal deformity (ASD) database. To determine whether achieving the ideal L1 pelvic angle (L1PA) in minimally invasive surgery (MIS) for ASD correction is associated with reduced mechanical failure and improved clinical outcomes. Prior research has shown that achieving ideal L1PA-defined as (0.5×pelvic incidence)-21-is linked to lower reoperation risk in open ASD correction. Its relevance in MIS has not been well established. A total of 1104 ASD patients across 13 centers were included (criteria: scoliosis ≥20°, SVA ≥5cm, PT ≥25°, or TK ≥60°, with ≥2-year follow-up). Radiographic parameters and patient-reported outcomes (PROs) were collected preoperatively, at six weeks, and at final follow-up. Ideal L1PA was defined as within ±5° of the calculated target. MIS was defined as circumferential MIS (LLIF/ALIF with percutaneous posterior fixation). Associations between alignment and outcomes (reoperation, PROs) were analyzed using linear regression and t tests. Ideal L1PA was achieved in 63% of MIS cases and 61% of open cases ( P =0.342). Among MIS patients, ideal L1PA correlated with lower reoperation rates (15% vs. 33%, P <0.01) and greater improvement in SRS-22 total (Δ0.85 vs. Δ0.40, P <0.01) and SF-36 PCS scores (Δ9.1 vs. Δ4.6, P =0.04). In contrast, ideal L1PA was not associated with reduced reoperation in the open group. Across all patients, each 1° deviation from ideal L1PA increased reoperation risk by 1.8% ( P =0.04). Ideal L1PA is achievable in MIS at similar rates as open surgery. In MIS-treated ASD patients, achieving ideal alignment is associated with reduced reoperation and improved clinical outcomes, supporting its role as a key surgical target.

Background: Large vessel occlusion (LVO) strokes are among the most severe forms of ischemic stroke, requiring rapid identification and transfer to thrombectomy-capable centers for optimal outcomes. The Field Assessment Stroke Triage for Emergency Destination (FAST-ED) score, derived from the NIH Stroke Scale, has shown promise in identifying LVOs. However, most prior studies assessed FAST-ED retrospectively or in hospital settings. This study evaluates the real-time use of FAST-ED by emergency medical services (EMS) personnel in San Diego County and its effectiveness in predicting LVOs during prehospital care. Methods: This observational study analyzed data collected from January 1 to June 30, 2024, involving EMS-transported patients with suspected stroke across San Diego County. Following standardized training, EMS providers calculated the FAST-ED score during field assessment for patients meeting stroke protocol criteria. Data from seven receiving stroke centers were collected, including FAST-ED scores, clinical outcomes, and confirmed LVO status via imaging. These data were de-identified and analyzed by the local EMS authority to evaluate sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the FAST-ED score in identifying LVOs. Results: Among patients assessed, the FAST-ED score demonstrated a high NPV, supporting its utility in effectively ruling out LVOs in the field. While higher FAST-ED thresholds (≥6) were associated with improved PPV, lower score thresholds yielded more false positives, which could lead to overtriage to comprehensive stroke centers. Nonetheless, the tool provided EMS personnel with a standardized, rapid method to assess stroke severity and support early triage decisions in a geographically diverse region with variable access to thrombectomy-capable centers. Conclusions: Implementation of the FAST-ED score by EMS providers in the prehospital setting offers valuable support in identifying and ruling out LVOs, particularly in regions like San Diego County with complex transport logistics. While the tool enhances early stroke severity assessment, its moderate PPV suggests it should be integrated with other clinical findings or triage protocols rather than used as a sole determinant for transport destination. Continued refinement, including regional threshold adjustments and integration with EMS technologies, may enhance its effectiveness and optimize prehospital stroke triage systems.

Lower limbs can play a major compensating role for sagittal malalignment; however, little is known about the different types of compensation. This study aimed to identify different patterns of lower limb compensation and to determine which parameters may affect the recruitment of knee flexion versus hip extension. This study included adult spinal deformity (ASD) patients with full-body X-rays in erect position from a multicentric prospective database. All parameters were measured at baseline: demographics, clinical scores and radiographic parameters: pelvic parameters, pelvic incidence-lumbar lordosis (PI-LL) mismatch, T1 pelvic angle (TPA), sacro-femoral angle (SFA), knee flexion angle (KA), ankle dorsi-flexion angle (AA), pelvic shift (PSh), hip and knee osteoarthritis (OA) grade.A K-means cluster analysis was conducted to identify patterns of lower limb compensation based on SFA and KA. The optimal number of clusters was determined using the silhouette score. The different parameters were then compared across clusters. 871 ASD patients were included, of whom 66.9% were females. Mean age was 62.3±14.6 years, mean BMI was 27.7±5.5 kg.m-2. Four patterns of lower limb compensations were identified: "No compensators", "Recliners" (mainly hip extension), "Squatters" (mainly knee flexion) and "Mixed compensators" (both)."Mixed" and "Squatters" had significantly larger BMI. The proportion of females was the least in the "Squatters" cluster (47.0%) while it was the highest in the "Recliners" group (79.3%) (p<0.001). The proportion of patients with severe hip OA was the lowest in the "Recliners" (38.5%) while it was the highest in the "Squatters" group (71.9%). Knee OA rate was the highest in the"Squatters" group (72.7%). "Mixed compensators" had the greatest PI-LL mismatch (30.4±20.0°) and "No compensators" the lowest (5.3±21.3°). Pelvic incidence values were the highest in "Recliners" and "Mixed compensators" (59.2±13.1° and 57.0±14.1° respectively). TPA values were the highest in the "Mixed compensators" and the lowest in the "No compensators" (33.3±11.7° versus 16.1±11.5°). The "Squatters" presented the significantly poorest values for disability, frailty, and SRS score. Cluster analysis determined four types of lower limb compensation:"Recliners" using only hip extension, "Squatters" using only knee flexion,"Mixed compensators" and "No compensators". Lower limb compensatory mechanisms recruitment is multifactorial and varies with age, sex, BMI, frailty, knee and hip OA, pelvic incidence, and spinal alignment.

Precision medicine demands a shift from static, single-analyte diagnostics toward dynamic, systems-level understanding of health and disease. This review explores how the convergence of systems biology, multiomics, and artificial intelligence (AI) redefines biomarker discovery to drive early disease detection and personalized intervention. We highlight pioneering efforts that use longitudinal, multimodal data to map individual health trajectories and uncover early disease signals. Advances in AI, including machine learning and contextualization using knowledge graphs and digital twins, are accelerating clinical translation by enabling predictive, context-aware analyses. Real-world applications, including omics-informed diagnostics and digital health monitoring, demonstrate the potential of this approach to transform health care from reactive treatment to proactive wellness. These technologies also inform the development of targeted therapeutics that intervene earlier, personalize treatment, and potentially halt or reverse disease progression. We outline challenges, emerging solutions, and future directions that position AI-driven systems biology at the center of next-generation precision health.

Abstract This prospective, multicenter, real-world evidence study evaluates the 12-month safety and effectiveness of standalone cyclodialysis with AlloFlo™ cleft reinforcement for intraocular pressure (IOP) reduction in open-angle glaucoma (OAG). AlloFlo represents the world’s first acellular, allogenic scleral tissue implant, and data from this CREST Study cohort ( NCT05506423 ) contribute critical long-term safety and effectiveness knowledge to the field of extracellular matrix biomaterials research, in addition to describing a novel procedure for surgical management of OAG. Eyes with investigator-confirmed inadequately controlled OAG were treated with standalone cyclodialysis using a microsurgical cannula (CycloPen™), followed by uveoscleral cleft reinforcement with AlloFlo. Eyes were followed prospectively for 12 months. Key outcomes included changes in medicated IOP, number of glaucoma medications, adverse events, and progression to subsequent glaucoma procedures. Forty-one eyes of 38 patients were included. Most eyes (66%) were considered treatment-refractory, defined as having any of: failed ≥ 1 incisional surgery or cilioablative procedure; condition in which incisional surgery would be more likely to fail than in eyes with uncomplicated OAG. At 12 months, mean IOP decreased 31% to 14.7 ± 6.9 mmHg (within the normal IOP range of 10-20 mmHg, p &lt; 0.001); mean number of glaucoma medications decreased 32% to 1.9 ± 1.6 (p &lt; 0.001). Seventy-one percent of eyes achieved ≥ 20% IOP reduction (a clinically meaningful benchmark set by the FDA). More than half of eyes (53%) achieved ≥ 20% IOP reduction without increasing medication. Three eyes (7.2%) progressed to incisional glaucoma surgery. Postoperative IOP elevations ≥ 10 mmHg occurred in 17% of eyes, most of which resolved within 30 days of the procedure. No persistent inflammation, implant rejection, clinically significant hyphema, or scaffold migration occurred. These findings suggest that uveoscleral outflow enhancement with AlloFlo provides a safe, conjunctiva-sparing option for IOP reduction in OAG, including eyes with prior surgical interventions.

Late complications of repaired congenital heart disease are increasingly common, including tricuspid stenosis and regurgitation. We present a case of a 36-year-old female with tetralogy of Fallot, 1.5 ventricle repair, and prior tricuspid repair using homograft tissue without an annuloplasty ring, who developed worsening congestive heart failure. Transesophageal echocardiogram revealed severe tricuspid stenosis and regurgitation. We performed transcatheter tricuspid valve replacement with a SAPIEN S3 Ultra RESILIA valve within a CP-covered stent. To our knowledge, this is the first implantation of the SAPIEN S3 Ultra RESILIA valve in the tricuspid position without an annuloplasty ring, and the first implantation of a balloon-expandable valve in a native tricuspid valve without extracorporeal membrane oxygenation support.

Accurate assessment of coronary plaque burden is essential for risk stratification in coronary artery disease (CAD). The Coronary Artery Disease – Reporting and Data System (CAD-RADS) 2.0 classification incorporates P-scores derived from coronary artery calcium (CAC) and segment involvement scores (SIS) to semi-quantitatively characterize plaque burden. However, limited data exist on the concordance and clinical implications of these two plaque characteristics. We retrospectively analyzed 461 coronary CT angiography (CCTA) studies using a commercial AI-based quantitative CT (AI-QCT) plaque analysis platform (CLEERLY). CAC scores were extracted using prompt-based natural language processing, and SIS were determined by AI quantification. Unilateral P-scores for CAC (PCAC) and SIS (PSIS) were calculated according to CAD-RADS 2.0 thresholds. Agreement between PCAC and PSIS was assessed using Cohen’s kappa, Wilcoxon signed-rank test, and McNemar’s test. Subgroup analyses evaluated distribution of P-score categories, sex and age in CAC = 0 patients, and the impact of symptom status using Wilcoxon rank-sum, chi-square, Fisher’s exact test, and ordinal logistic regression. The median patient age was 67 years, and 38.7% were female. CAC and SIS produced concordant P-scores in 23% of cases, with discordance in 77%. SIS determined the final P-score in 75.5% and CAC in only 1.5%. Cohen’s kappa indicated modest agreement (κ = 0.40, p < 0.01), while Wilcoxon signed-rank and McNemar’s tests revealed significant discordance, with SIS tending to assign higher P-score categories (p < 0.01). Among patients with CAC = 0 (n = 97; median age 62; 65% female), 95% had non-calcified plaque by AI-QCT, and only 4 had both CAC and SIS of zero. P-score, PCAC, and PSIS distributions did not differ significantly by symptom status (all p > 0.05), although a significant difference was detected for PSIS on chi-square and Fisher’s exact tests but not by ordinal regression or Wilcoxon rank-sum. Further analysis demonstrated that discordance was most prominent in higher P-score categories and was primarily driven by non-calcified plaque. Our study demonstrates frequent discordance between CAC and SIS in CAD-RADS 2.0 plaque burden classification, particularly due to the detection of non-calcified plaque by SIS. Reliance on either CAC or SIS alone may result in risk misclassification, especially for patients with CAC = 0, the majority of whom had non-calcified plaque by AI-QCT. These findings highlight the need for standardized criteria and integration of both measures in automated plaque quantification to improve cardiovascular risk assessment, especially in discordant populations.