Buras, Matthew

Sex and gender influence disease mechanisms and outcomes, yet their integration into medical curricula remains limited. Faculty knowledge and confidence are essential for effective incorporation. This study assessed baseline sex- and gender-specific health (SGSH) knowledge, attitudes, and comfort among medical school educators and delivered a multi-format faculty development intervention. A survey adapted from prior SGSH assessments was distributed to medical school block leaders before the intervention, measuring SGSH knowledge, comfort differentiating sex and gender, awareness of SGSH resources, and readiness to integrate SGSH content. The intervention included virtual and in-person grand rounds, distribution of How Sex and Gender Impact Clinical Practice , and a screening of Ms. Diagnosed . Of the 103 invited to participate, 68 educators (66% response rate) completed the baseline survey. Forty percent reported no prior SGSH training, and only 13.2% felt very comfortable with SGSH concepts. Although 94.1% correctly identified gender as a social construct and sex assignment at birth, 22% remained uncomfortable distinguishing the two. More than 80% were neutral or uncomfortable identifying SGSH resources. Comfort with curriculum integration varied: 45.6% felt comfortable, 32.4% neutral, and 22.1% uncomfortable, with differences observed across specialties. These findings reveal significant gaps in medical educators’ SGSH knowledge and comfort regardless of experience, with SGSH content narrowly confined to reproductive health topics. Simply providing resources is insufficient; educators need structured guidance on integration. By outlining baseline gaps and an intervention model, this study offers a framework for institutions seeking to enhance SGSH integration through interactive, longitudinal, multi-format faculty development approaches.

ABSTRACT Background Eosinophilic esophagitis is associated with epithelial barrier dysfunction. Epidemiologic studies suggest environmental factors promote disease pathogenesis. The common household detergent sodium dodecyl sulfate (SDS) induces epithelial barrier dysfunction and eosinophilic inflammation in mice. We hypothesized that acute SDS exposure would compromise the esophageal mucosal barrier in humans. Methods Healthy adults brushed with 2 g of an SDS‐containing toothpaste. Esophageal impedance was measured continuously pre‐/post‐toothbrushing to assess the effect of toothpaste on epithelial barrier function. SDS was measured in saliva using a methylene blue anionic substances assay. Participants completed 1‐h esophageal string tests (ESTs) pre‐/post‐toothbrushing and protein isolates from EST eluates from the proximal and distal esophagus were analyzed by tandem mass tag mass spectrometry. Results Ten of twelve subjects completed the clinical study. SDS in the initial expectorate measured immediately after toothbrushing varied markedly (median: 321.40 μg/mL; range: 169.90–1243.00 μg/mL) and was detectable in saliva in 80% of subjects (median: 9.55 μg/mL; range: 0–123.40 μg/mL) at 60 min post toothbrushing. Esophageal mucosal impedance decreased within 30 min of toothbrushing ( p < 0.01). Toothbrushing increased salivary viscosity and proteins associated with mucosal defense in EST eluates. The tight junction pathway was downregulated while the salivary secretion and complement and coagulation cascades pathways were upregulated in the proximal esophagus. Conclusion In healthy individuals, SDS remained detectable in saliva for a prolonged period after toothbrushing at concentrations previously shown to disrupt esophageal epithelial barrier function in vitro. Toothbrushing with an SDS‐containing toothpaste was associated with reduced esophageal mucosal impedance, altered salivary properties, and activated mucosal immune responses.

ABSTRACT The coexistence of obesity and insulin resistance is associated with elevated plasma amino acid concentrations. However, it remains unclear whether adiposity or insulin resistance is the stronger determinant of plasma amino acid dysregulation in this setting. Twenty-two adults (10 women, 12 men) spanning a broad range of body mass index (BMI) and insulin resistance underwent a 75-g oral glucose tolerance test (OGTT) after an overnight fast. Plasma glucose, insulin, and amino acid concentrations were measured serially, and insulin resistance/sensitivity was estimated from OGTT-derived glucose and insulin responses, using the homeostasis model assessment of insulin resistance (HOMA-IR) and the Matsuda insulin sensitivity index (Matsuda-ISI). Principal component analysis (PCA) of fasting plasma amino acid concentrations showed no clear separation by obesity or insulin resistance classifications. In contrast, PCA of OGTT-stimulated plasma amino acid concentrations revealed clearer clustering by BMI, fat mass, and waist circumference, whereas separation by HOMA-IR and Matsuda-ISI was less distinct. Importantly, regression analyses showed that BMI, fat mass, and waist circumference were significant predictors of OGTT-stimulated, but not fasting, amino acid responses, with waist circumference accounting for the greatest proportion of the variance in branched-chain amino acid responses during the OGTT (R 2 = 0.54). In conclusion, measures of adiposity, particularly total fat mass and waist circumference, accounted for a greater proportion of the variance in plasma amino acid responses under physiologically stimulated conditions than indices of insulin resistance. These findings support the view that plasma amino acid concentrations reflect adiposity-related metabolic alterations more strongly than insulin resistance.

ABSTRACT Background In healthy individuals, exercise and amino acid availability act synergistically to stimulate muscle anabolism. However, this interaction may be impaired in individuals with obesity. Objective We examined whether acute aerobic exercise alters amino acid-stimulated muscle protein synthesis during immediate postexercise recovery in adults with obesity. Methods Sixteen sedentary adults with a body mass index >30 kg/m 2 underwent a stable-isotope tracer infusion to measure mixed-muscle protein fractional synthesis rate (FSR) in the basal/fasted state and during an amino acid infusion, either with or without prior aerobic exercise. Participants were randomly assigned to receive either amino acid infusion alone (AA) or 45 min of cycling exercise at ∼65% heart rate reserve immediately before amino acid infusion (EX + AA). Results Amino acid infusion increased muscle protein FSR in the AA group ( P < 0.0001) but not in the EX + AA group ( P > 0.05), and the amino acid-stimulated increase in FSR was 78% lower in EX + AA than in AA ( P < 0.01). The amino acid infusion increased ( P < 0.05) plasma amino acid concentrations in both groups. However, during the amino acid infusion, plasma concentrations of essential and branched-chain amino acids, including leucine, were lower in EX + AA than in AA ( P < 0.05). Moreover, across participants, absolute changes in muscle protein FSR were positively associated with plasma leucine concentrations during the amino acid infusion ( P < 0.05). Conclusions These findings show that, in individuals with obesity, acute aerobic exercise markedly attenuates amino acid-stimulated muscle protein synthesis during early postexercise recovery. These findings have important implications for designing nutritional strategies to optimize muscle anabolism in this population.

8045 Background: Surgical resection is the primary therapy for stage I-II NSCLC but not performed in a subset of patients due to comorbidities or self-election, who instead undergo radiation with or without systemic therapy (RT±ST). Little is known about the demographic, tumoral, therapeutic, and quality-of-life (QOL) characteristics of this non-surgical group. Understanding their differences from the surgical group is essential for developing precision treatment strategies and tailored survivorship guidelines. Methods: In a prospectively enrolled (1997-2016) and followed (through 2025) cohort of 20,951 primary lung cancer patients, 6,486 (31%) had stage I-II NSCLC, including 5,359 (83%) treated surgically (Surgical) and 1,113 (17%) otherwise (Non-surgical). Preexisting diseases were grouped into cancer, lung, and other comorbidities. QOL data were available for 40% of all patients. Descriptive analysis of demographics, tumor features, treatment patterns, and QOL metrics, as well as survival analysis (median years and overall survival [OS] rates) were conducted. QOL measures, on overall and 15 symptom and functional domains, were scored 0 (worst) to 10 (best), with 1-unit difference considered clinically and statistically meaningful. Results: At time of diagnosis, compared to the Surgical, the Non-surgical patients were older (median 73 v 68 years), more likely to have smoked cigarettes (91% v 83%), squamous cell and unspecified NSCLC (53% v 28%), stage IIB (19% v 12%), and preexisting lung comorbidities (71% v 58%). Non-surgical patients more frequently received RT±ST than the Surgical (70% v 21%) and had shorter median survival (2.5 v 7.8) years. Within the Non-surgical, 28% had no cancer treatment (No-Tx), 44% RT-only, 7% ST-only, and 19% both (RT+ST); their respective median diagnosis ages were 74, 76, 68, 70 years; median survival were 1.7, 2.7, 2.2, 3.2 years; 5-year OS (95%CI) at 25% (21-31), 25% (21-29), 26% (17-38), 30% (25-37); and 10-year OS at 9% (7-14), 7% (5-10), 10% (5-21), 9% (6-14), respectively. RT-only group had highest rates of comorbidities (37-84%) and the No-Tx the lowest (31-66%). Although the overall QOL scored the same for all groups, RT-only patients reported the worst scores on multiple symptoms burden, and the No-Tx reported the least pain and lung cancer symptoms but the worst on mental well-being and social activities. Conclusions: Non-surgically managed stage I-II NSCLC cases present clinically distinct patients with the shortest median survival in No-Tx group and highest 5-year survival in RT+ST. RT-only patients were oldest, had the most comorbidities, and reported the worst symptom burdens. These differences highlight the need for more in-depth analyses and studies (considering age, histology, comorbidity, QOL, etc.) to support tailored therapeutic strategies and survivorship care for patients who decline or are not suitable for surgery.