Citations

Abstract Black/African American populations, globally, bear the greatest prostate cancer (CaP) burden compared to other racial/ethnic groups. Addressing CaP disparities in Black men is complex, requiring a patient-centered, community-centric and comprehensive approach. This study integrates iCCaRE Consortium findings and broader literature to address unmet needs in survivorship care. The iCCaRE Consortium implemented five complementary pilot studies using mixed-methods designs, including feasibility trials, qualitative research, and observational analyses across the United States and sub-Saharan Africa. Descriptive statistics, subgroup analyses, and qualitative thematic analyses were performed across these studies. Collectively, projects addressed multilevel determinants including social, behavioral, and biological drivers of disparities. Project 1 implemented a Virtual Reality Assistant (ViRA) across clinical and community settings, with ongoing evaluation in pragmatic trials. Project 2 showed strong patient preference for home-based cancer care. Project 3 enrolled demonstrated trends toward improved health-related quality of life. Project 4 identified key themes influencing survivorship experiences. Project 5 identified biological mechanisms linking stress, immune modulation, and symptom burden. The iCCaRE pilot projects demonstrate the feasibility and early impact of a consortium-based, transdisciplinary approach to addressing CaP disparities in Black men. These findings highlight the importance of integrating patient-centered interventions, community engagement, and biological insights to inform scalable strategies aimed at improving survivorship outcomes and advancing health equity. The iCCaRE Consortium demonstrates that a transatlantic, patient-centered, and multidisciplinary approach integrating social, clinical, and biological factors can generate scalable strategies to improve survivorship outcomes and advance equity in CaP care for Black men.

Background Randomized trials have shown equivocal outcomes between a direct aspiration as first-pass technique (ADAPT) and stent retriever (SR) stroke thrombectomy, yet whether specific patient subgroups benefit differentially from one technique over the other remains unknown. Methods In this retrospective multicenter cohort study, patients with large vessel occlusion were included, and those who underwent ADAPT versus SR first-pass thrombectomy (either as standalone or combined with aspiration) were compared. The primary outcome was a composite of first-pass effect (FPE, modified Thrombolysis In Cerebral Infarction (mTICI) 2c or better with one attempt) with no symptomatic intracranial hemorrhage (sICH). A causal forest model was used to estimate the conditional average treatment effect (CATE) for each patient, with larger CATEs indicating that ADAPT is expected to be more advantageous. Patients were stratified by CATEs, and outcomes were compared between treatment groups. Results Among 6700 included patients, ADAPT (n=3695, 55%) was associated with a higher rate of FPE with no sICH (39.9% vs 26.9%; adjusted OR (aOR) 2.07, 95% CI 1.77 to 2.41, P<0.001). The causal forest identified significant treatment effect heterogeneity (interaction P<0.001), where ADAPT was more advantageous in more recent years and among patients with M1 occlusions presenting in earlier time windows. Low-CATE patients showed no statistically significant difference between techniques (aOR 0.91, 95% CI 0.57 to 1.45, P=0.70), while medium- and high-CATE patients demonstrated progressively larger ADAPT advantages (aOR 2.06, 95% CI 1.67 to 2.55, and aOR 2.99, 95% CI 2.24 to 3.98, respectively, both P<0.001). Conclusions ADAPT may be superior to SR for a majority of patients, particularly in recent years, and among patients with M1 occlusions presenting in earlier time windows.

Automated diagnostic report generation lies at the core of clinical diagnosis and can alleviate clinician shortages. Existing diagnostic report generation methods have two major limitations: they rely on unimodal inputs (e.g., images), ignoring textual biomarkers like medical history, and lack proactive dialogue capabilities to elicit personalized clinical information. To address those issues, we propose a ProActive Multimodal Agentic (PAMA) system, which performs comprehensive disease analysis by examining biomarkers in diverse sources, including multi-view medical images, medical histories, and diagnostic conversations. Built upon a knowledge graph and recommendation-based dialogue architecture, PAMA actively initiates adaptive, multi-turn conversations with patients, which is integrated with visual data for robust and reliable report generation. Specifically, PAMA actively generates adaptive multi-turn questions to collect clinically relevant background information, and then fuses the resulting dialogue context with visual representations for robust diagnostic report generation. We validate our approach on two real-world benchmark datasets, MIMIC-CXR and IU-Xray, through extensive quantitative evaluations and comparisons with state-of-the-art baselines. Furthermore, we conduct user studies to assess the realism and clinical quality of the generated reports. Finally, we present real-world case studies to examine the performance of our system across diverse scenarios, demonstrating its robustness on scalability, complexity, and data variability.

ABSTRACT Purpose Despite 5‐year survival rates of over 90% among children and adolescents/young adults (CAYAs) with classic Hodgkin lymphoma (cHL), 15%–20% relapse after frontline therapy. Prior analysis of frontline Children's Oncology Group (COG) clinical trials demonstrated that, despite similar rates of relapse, non‐Hispanic Black (NHB) and Hispanic (vs. non‐Hispanic White [NHW]) patients experienced higher post‐relapse mortality. It is unknown whether post‐relapse disparities persist when second‐line treatment is delivered in a cooperative group trial setting. We examined overall survival (OS) by race and ethnicity in CAYAs enrolled in COG trials for relapsed/refractory (r/r) cHL. Methods A pooled analysis of individual‐level data from CAYAs (≤ 29 years) receiving therapy for r/r cHL on COG clinical trials (2001–2016) was conducted. The Kaplan–Meier method estimated 3‐year OS by racial and ethnic groups. Cox regression models examined associations of race and ethnicity and OS, adjusted for age, insurance, first versus ≥2 relapse, and time from initial diagnosis to relapse trial enrollment. Results Among 175 CAYAs treated on COG trials for r/r cHL (5.7% Asian or Pacific Islander, 14.9% Hispanic, 14.3% NHB, 61.7% NHW, 3.4% other), at median follow‐up of 4.9 years, 3‐year OS was 82.1% (95% confidence interval [CI], 75.3%–87.1%) and did not differ by race and ethnicity ( p = 0.36). In multivariable analyses, shorter time from diagnosis to relapse trial enrollment ( p = 0.01) and ≥2 relapses (vs. first, p = 0.004) conferred worse OS, with no significant effect of race and ethnicity ( p = 0.43). Conclusion Post‐relapse survival did not differ by race and ethnicity among CAYAs enrolled in COG trials for r/r cHL, suggesting access to clinical trials may mitigate OS disparities.

Objective To investigate sex differences in Alzheimer's disease (AD) related pathology among autopsy-confirmed Parkinson's disease (PD) cases. Background AD and PD frequently co-occur in older adults, yet the influence of sex on AD pathology in the context of PD remains unexplored. Methods All subjects were enrolled in the Arizona Study of Aging and Neurodegenerative Disorders (AZSAND) and Brain and Body Donation Program (BBDP) and had annual standardized research clinical assessments by neuropsychologists, subspecialty behavioral and movement disorders neurologists, as well as comprehensive neuropathological examinations after death. Results Among 230 autopsy-confirmed PD cases, females exhibited greater amyloid plaque pathology burden than males, regardless of a co-occurring AD diagnosis. Specifically, females with PD had significantly higher mean cortical total plaque scores (mean 6.5/15 vs. 4.9/15, p = 0.045) and greater CERAD neuritic plaque density (mean 1.7/3 vs. 1.3/3, p = 0.035). Females were also more likely to have a higher cortical plaque burden (plaque total ≥ 5: 56.8% vs. 39.7%, p = 0.015). In multivariable logistic regression models, female subjects showed greater than twice the odds of having an amyloid plaque burden ≥5 compared to males (OR = 2.18; 95% CI = 1.17–4.06; p = 0.014), when controlling for ApoE ε4 status, Lewy body density score, and age at death. Conclusions Female sex is associated with increased amyloid plaque pathology in PD, independent of ApoE ε4 status. These findings highlight a sex-specific vulnerability to AD pathology in PD patients and support the need for sex-informed approaches to reseach in mixed neurodegenerative disease.

Abstract Purpose The female waist and torso remain fundamental aesthetic elements in body contouring, yet empirical data describing public preferences for waist-to-hip ratio (WHR) and abdominal muscle definition are limited. Misalignment between patient perceptions and actual aesthetic preferences may influence body dissatisfaction, drive unnecessary procedures, and shape unrealistic surgical goals. This study aimed to (1) evaluate how females perceive their own waist shape and ideal appearance using standardized manipulated images, (2) quantify male preferences for female WHR and abdominal definition, and (3) assess the discrepancy between what women believe men find attractive and men’s actual preferences. Methods An anonymous online survey was distributed internationally and collected 900 responses from adult participants. Two digitally manipulated, standardized female torso images were created: one varying waist-to-hip ratio across five levels (WHR 0.60 to 0.80) and one varying abdominal muscle definition. Male participants rated which WHR and abdominal definition they found most attractive. Female participants reported (1) which WHR and definition most resembled their current appearance, (2) which represented their ideal, and (3) which they believed men found most attractive. Additional demographic and body image variables were collected. Descriptive statistics were generated, and comparative analyses (chi-square tests) were conducted to evaluate differences in preference distributions and female perception versus male reality. Results A total of 900 respondents participated, including 41% men and 59% women. Male respondents showed a clear preference for smaller waist-to-hip ratios (WHR). The lowest WHR (0.60) was the most frequently selected option (38%), with steadily decreasing selections as WHR increased. Men also most preferred mild abdominal definition (Option B). Female responses revealed notable perception gaps: women most often perceived themselves as having midrange WHRs (0.70) but selected lower WHRs (0.65) as ideal, and they substantially overestimated men’s preference for the smallest WHR. Subgroup analyses showed that male WHR preferences varied significantly by continent (p &lt; 0.05), with Europe, North and South America favoring smaller WHRs, while Africa, Australia, and Asia preferred larger ones. Higher male physical activity was associated with selecting smaller WHRs (r = –0.220, p &lt; 0.05) and slightly greater abdominal definition (r = 0.169, p &lt; 0.05). Social media use did not influence male preferences. Among women, physical activity strongly predicted desired abdominal muscularity (r = 0.236, p &lt; 0.05) but not ideal WHR. Perceived social media influence significantly shaped ideal WHR (r = 0.202, p &lt; 0.05), such that women who reported more negative influence selected smaller, more exaggerated WHRs. Time spent on social media did not significantly affect female aesthetic preferences. Conclusion This study provides quantitative evidence describing public preferences for female waist and torso aesthetics, revealing important divergences between perception and reality. Men strongly prefer smaller waist-to-hip ratios and mild abdominal definition, but not to the extreme levels that women commonly assume. Women’s own ideal waist shape aligns directionally with male preferences, yet women significantly overestimate the degree to which men favor the smallest possible WHR. This misperception may contribute to body dissatisfaction, drive interest in unnecessary procedures, or set unrealistic surgical expectations. For aesthetic surgeons, these findings highlight the need for patient-centered counseling that addresses perception gaps, corrects inaccurate beliefs about male preferences, and reinforces natural, proportionate outcomes rather than extreme contouring. The data support a trend toward moderate enhancement rather than highly exaggerated WHR reduction or aggressive abdominal definition in female body contouring. Incorporating these insights may improve patient satisfaction, promote psychological well-being, and guide surgical planning grounded in evidence-based aesthetics.

ABSTRACT Background Babesia microti , a parasite transmitted by the Ixodes scapularis tick, can cause infections ranging in presentation from asymptomatic to fulminant, life-threatening disease. Ocrelizumab, an anti-CD20 B-lymphocyte monoclonal antibody used to treat multiple sclerosis, increases the risk of severe or relapsing infections with tick-borne pathogens. In rare cases, babesiosis may trigger hemophagocytic lymphohistiocytosis (HLH). Case Summary We report a case of babesiosis manifesting in a subacute fashion with secondary HLH in a 51-year-old female on B cell-depleting therapy. She presented in December with generalized weakness and fever and was found to have pancytopenia, transaminitis, and hyperinflammatory markers consistent with HLH. A microbial cell-free DNA next-generation sequencing test detected Babesia microti , with subsequent confirmation by blood PCR and smear demonstrating <0.01% parasitemia. The patient improved following treatment with atovaquone and azithromycin, along with corticosteroids for HLH. Conclusion This case highlights the heterogeneity of babesiosis and its potential to present with minimal parasitemia, yet severe systemic inflammation in immunocompromised hosts. Additionally, this case underscores the importance of maintaining a broad differential in patients on B cell-depleting agents who present with new pancytopenia and systemic inflammatory symptoms. Early utilization of microbial cell-free DNA next-generation sequencing tests may aid in timely diagnosis and treatment.