Citations

INTRODUCTION: Ongoing surveillance after successful endoscopic eradication therapy for Barrett's esophagus (BE)-related neoplasia is essential to detect and manage recurrence. Despite established surveillance interval recommendations after complete eradication of intestinal metaplasia (CE-IM), patient compliance with repeat endoscopy is frequently suboptimal. Understanding patient drivers to adherence is essential to inform interventions that address the high rates of overdue surveillance and loss to follow-up. METHODS: Patients with BE-related neoplasia who achieved CE-IM were eligible for inclusion and classified as delayed or on-time for endoscopic surveillance. Patients were prospectively enrolled and participated in structured virtual interviews designed to explore barriers and facilitators to on-time care. A rapid qualitative analysis approach was applied, continuing until thematic saturation was reached. RESULTS: Thirty-nine patients were interviewed: 22 (56.4%) were delayed, and 17 (43.6%) were on-time for surveillance. Patients in the delayed group had longer mean BE segment lengths and a higher prevalence of tobacco use. Geographic distance from the treatment center was the most frequently cited barrier to follow-up (n = 17; 43.5%). Other common barriers were access limitations, financial concerns, misunderstanding of disease course, and test-related anxiety. DISCUSSION: Patient-related drivers of delay in postendoscopic eradication therapy surveillance are largely logistical, socioeconomical, and psychological in nature. Solutions to reduce the significant burden on the patient and achieve timely surveillance may include transitioning patients back to their local endoscopists after CE-IM or incorporating nonendoscopic surveillance methods through patient centered approaches.

Background/Objectives: Precocious puberty (PP), defined as the onset of secondary sexual characteristics before 8 years in girls and 9 years in boys, is associated with psychosocial distress, compromised adult height, and long-term metabolic risk. Early identification remains challenging, as current diagnostic approaches are largely reactive and rely on invasive or resource-intensive testing. This narrative review examines how artificial intelligence (AI) can support earlier risk prediction and detection of PP through integration of clinical, hormonal, imaging, lifestyle, and environmental data. Methods: A narrative literature review was conducted using PubMed, Scopus, Embase, Web of Science, and Google Scholar to identify relevant studies published between 2005 and 2025. Eligible studies included original research and high-quality reviews that examined AI-based approaches, such as machine learning and deep learning, in pediatric endocrinology, particularly for the prediction or diagnosis of central or peripheral precocious puberty. Studies incorporating clinical, hormonal, radiological, lifestyle, environmental, or multi-omics data relevant to AI modeling were included. Results: AI models, including XGBoost, random forest, convolutional neural networks, and regression-based approaches, have demonstrated potential utility in predicting central precocious puberty using hormonal, imaging, and growth data. Reported applications include automated bone age assessment, lifestyle and dietary risk stratification, and exploratory use of wearable-derived behavioral data. However, progress is limited by small pediatric datasets, population bias, limited interpretability, and unresolved ethical challenges related to privacy, consent, and equity. Conclusions: Artificial intelligence represents a promising decision-support approach for earlier, non-invasive, and individualized risk assessment in precocious puberty. Future progress will depend on the integration of longitudinal, multimodal data, the development of ethical models, and interdisciplinary collaboration among pediatric endocrinologists, data scientists, and public health stakeholders.

175 Background: BRAF V600E mutations occur in ~8–12% of metastatic colorectal cancer (mCRC) and are linked to poor prognosis, therapy resistance, and limited response to anti-EGFR monotherapy. While the BEACON trial established encorafenib plus cetuximab as standard, the added value of triplet regimens remains unclear. Clarifying the efficacy and toxicity of doublet vs triplet therapies is essential to optimize care in this high-risk group. Methods: Studies published across PubMed, Embase, and Google Scholar from inception till May 2025 with reported outcomes of the desired targeted therapies for BRAF V600E-mutated mCRC were screened and finally 12 studies included in this review. Data on efficacy parameters such as overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR) as well as safety indicators such as adverse events (AEs), and discontinuation rates were extracted and analyzed. Results: In the ≥2nd-line setting, doublet and triplet regimens (doublet plus binimetinib) demonstrated improved outcomes compared with cetuximab plus irinotecan/FOLFIRI, with higher OS (7.2–9.2 vs 5.6 months), PFS (4.2–4.6 vs 1.5 months), DCR (65–75% vs 31%), and a comparable incidence of severe AEs (3–5% vs 4%). Panitumumab plus vemurafenib, also in the ≥2nd-line setting, reported an OS of 7.6 months, PFS of 3.2 months, and a DCR of 27%. In the 1st-line setting, the doublet regimen plus mFOLFOX6 with longer treatment duration (~50 weeks) showed improved outcomes compared with the doublet regimen plus higher-dose cetuximab, with higher OS (30.3 vs 19.5 months), PFS (12.8 vs 6.8 months), ORR (65.7% vs 45.6%), but also a higher incidence of severe AEs (46% vs 30%). Similarly, the cetuximab + vemurafenib + irinotecan regimen outperformed conventional chemotherapy (mFOLFOX6, FOLFOXIRI, or CAPOX) ± bevacizumab, with improved OS (25.3 vs 10–15 months), PFS (11.9 vs 7.5 months), ORR (63.2% vs 37–40%), DCR (94.7% vs 75%), and a lower rate of grade ≥3 AEs (34.2% vs 65%). Conclusions: The survival benefit observed with the doublet regimen was comparable to that of the triplet, but with lower rates of adverse events and treatment discontinuation, supporting current evidence that the doublet remains the preferred option for patients with BRAF V600E–mutated mCRC who have received one or more prior lines of therapy. Although adding conventional agents such as mFOLFOX6 to the doublet in the first-line setting improved OS, PFS, ORR, and DCR, this approach was associated with higher toxicity and discontinuation rates, raising questions about its overall benefit. Emerging data on vemurafenib in combination with cetuximab and conventional agents show promise, but further studies directly comparing encorafenib- versus vemurafenib-based regimens are warranted to optimize outcomes in this patient population.

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Small Cell Lung Cancer provide recommendations for diagnostic workup, staging, and treatment. These NCCN Guidelines Insights highlight recent updates, with a particular focus on changes to systemic therapies and radiation treatment in the NCCN Guidelines for Small Cell Lung Cancer.

ABSTRACT Accurate identification of dysplasia in Barrett's esophagus (BE) remains a challenge. Advanced optical imaging techniques may allow for better localization of dysplasia in BE. Here, we have assessed the potential clinical utility of a previously described multimodal imaging probe combining optical coherence tomography (OCT) with angle‐resolved low coherence interferometry (a/LCI) to prospectively identify dysplasia in BE. Imaging was conducted on 37 patients undergoing endoscopic surveillance of BE, yielding co‐registered biopsies of 50 esophageal sites. The a/LCI nuclear morphology data were compared to a previous decision line to prospectively predict dysplasia, demonstrating 100% sensitivity, 93% specificity, and 94% overall accuracy. The NPV was 100%, comparable to previous a/LCI studies. The addition of OCT imaging markedly improved PPV and specificity, compared to previous studies with a/LCI alone, illustrating the clinical utility of the combined platform. These findings suggest that combining OCT and a/LCI enables better detection of dysplasia by providing better guidance.

Background: Interstitial lung disease (ILD) involves numerous chronic pulmonary conditions that damage the lung parenchyma and alveolar interstitium. ILD has overlapping clinical and radiological features with other commonly seen cardiac and respiratory conditions. If not identified and treated in a timely manner, it may lead to irreversible fibrosis and a poor prognosis in the patient. The current diagnostic methods are either invasive or reliant on imaging or specialist interpretation, which can lead to diagnostic delay, increased radiation exposure, and healthcare costs. Lung crackles, often under-recognized as a non-specific feature of ILD, may serve as an important diagnostic clue in identifying not only the early stages of ILD but also its subtypes. This review explores the potential of analyzing the lung sounds in ILD through AI-based auscultation. Objective: To provide a comprehensive analysis of the pathophysiological stages of lung injury in ILD, the specific acoustic features, and the location associated with each ILD subtype and to evaluate the current state-of-the-art non-AI and AI methodologies that are used to diagnose ILD. This review aims to analyze the limitations associated with the current modalities and to envision AI-integrated auscultation as a powerful, cost-effective, non-invasive, radiation-free screening tool for early detection of ILD and its subtypes. Content Overview: The review begins with a detailed analysis of the lung sound pathophysiology, exploring the two-stage mechanism of alveolar epithelial injury and fibrosis formation. Existing hypotheses explaining the mechanism behind crackle production and the role of structural anatomy and surface tension in the generation of pathological lung sounds are examined. A tabulated summary of common ILD subtypes is provided, including their inciting events, pathogenesis, anatomical auscultation locations, and prognostic implications. Current diagnostic modalities for ILD, both non-AI and AI-based, are summarized along with their limitations, emphasizing the need for improved diagnostic tools. Discussion: Existing studies suggest that AI-based auscultation can match or exceed the current modalities in its sensitivity and specificity for detecting ILD-related crackles. Clinicians can identify the specific sound pattern and then correlate it with the ILD subtype and understand the prognosis in real time, thereby providing timely intervention to the patient. Additionally, AI-based auscultation can be used in resource-limited settings and can potentially reduce dependence on pulmonology expertise and radiation-based imaging for monitoring the condition. Conclusions: This literature review highlights the clinical potential of AI-based auscultation for early and accurate diagnoses of ILD. Understanding the associated pathological sounds, biomarkers, and genetic mutations linked to different subtypes opens avenues for future development of non-invasive diagnostic panels for ILD in clinical practice.

Abstract Background: Leukemia, a type of cancer of the blood forming tissues, compromises the immune system putting the body at risk of aggressive infections like septicemia. This can not only progress to septic shock but also death. The occurrence of the two conditions makes it almost necessary to understand the epidemiological patterns to increase the rates of survival. This study assesses the trends in mortality in patients with leukemia and septicemia in the United States from 1999-2023. Methods : We analyzed death certificates of adults aged 5 to 84 years' from the CDC-WONDER database with Leukemia (ICD-10 codes: C91, C92) and Septicemia (ICD-10 codes: A40, A41) from 1999-2023. Age-adjusted mortality rates (AAMR) per 100,000 population were stratified by gender, race, census region, year and age. Join-Point analysis was performed to estimate annual percent change (APC) and average annual percent change (AAPC) in mortality trends, along with 95% confidence intervals (CIs). Results : Between 1999 and 2023, Leukemia and Septicemia caused 56,497 deaths in patients aged 5 to 84 years. The total AAMR decreased from 0.78 in 1999 to 0.66 in 2023. Demographically, AAMR among the men decreased significantly from 1.04 to 0.85 (AAPC: -0.65; 95% CI: -0.80 to -0.49). Females experienced a decline in mortality from 0.59 to 0.46(AAPC: -0.44; 95% CI: -0.71 to -0.17). In terms of race, a slight decrease in mortality was witnessed in the mortality of Non-Hispanic (NH) Black or African Americans from 0.91 to 0.7 (AAPC:-1.13 ; 95% CI: -1.43 to -0.82), moreover the AAMR in the Hispanics decreased from 0.8 to 0.63 (AAPC: -0.04; 95% CI: -0.04 to -0.58) while those among the white community decreased from 0.78 to 0.68 (AAPC: -0.39; 95% CI: -0.58 to -0.19). Moreover, the Asian community also experienced a declining death rate. Geographically, regions in the Midwest showed the highest overall AAMR (0.75), followed by the West,Northeast and areas in the South with an overall AAMR of 0.72 . Between the urban and rural areas, rural areas had a higher AAMR as compared to the urban areas with an overall AAMR of 0.17. When stratified according to states, AAMRs varied highly from the highest in Kentucky (0.89) to the lowest in Maine(0.26). Conclusion: The overall mortality rates for leukemia and septicemia decreased between the years 1999-2023. The greatest change was seen in males, regions in the Northeast, racially in NH Blacks and the rural areas.

Abstract Background : Type 2 diabetes and Multiple myeloma are becoming a growing cause of worry among aging populations. Type 2 diabetes and Multiple myeloma share many risk factors like age, obesity, and chronic inflammation. It is also found that diabetes may influence the worsening of multiple myeloma. Hence it becomes crucial to understand the epidemiological intersections between the two conditions in order to optimise treatment and lower death rates. This study assesses the trends in mortality in patients with Type 2 diabetes and Multiple myeloma in the United States from 1999-2023. Methods : We analyzed death certificates of adults aged>45 years' from the CDC-WONDER database with Type 2 diabetes (ICD-10 codes: E10-14) and Multiple myeloma (ICD-10 codes: C90) from 1999-2023. Age-adjusted mortality rates (AAMR) per 100,000 population were stratified by gender, race, census region, year and age. Join-Point analysis was performed to estimate annual percent change (APC) and average annual percent change (AAPC) in mortality trends, along with 95% confidence intervals (CIs). Results: Between 1999 and 2023, Type 2 diabetes and Multiple myeloma caused 22,467 deaths in patients aged>45 years. The overall AAMR increased from 0.647 in 1999 to 0.886 in 2023. Demographically, AAMR among the men increased significantly from 0.827 to 1.205 (AAPC: 1.22; 95% CI: -1.02 to 3.52). Although experiencing a lower mortality as compared to males, females also experienced a surge in mortality from 0.563 to 0.633(AAPC: 0.90; 95% CI: -0.11 to 1.93). In terms of race, mortality increased among the Non-Hispanic (NH) Black or African Americans from 1.942 to 2.158 (AAPC:0.60 ; 95% CI: -0.06 to 1.26), moreover the AAMR in the Hispanics increased from 0.986 to 1.099 (AAPC: 0.84; 95% CI:-0.05 to 1.73) while those among the white community increased from 0.493 to 0.679 (AAPC: 0.87; 95% CI -1.13 to 2.91). Geographically, regions in the South showed the highest overall AAMR (0.760) followed by the West (0.748), followed by the Midwest(0.731), and the Northeast (0.617). Between the urban and rural areas, rural areas had a higher AAMR as compared to the urban areas with an overall AAMR of 0.809. When stratified according to states, AAMRs varied highly from the highest in Columbia to the lowest in California. Conclusion: The overall mortality rates for Type 2 diabetes and Multiple myeloma increased between the years 1999-2023. The greatest change was seen in males, regions in the Northeast, racially in NH Blacks and the rural areas.

Abstract Disclosure: M. Kakakhel: None. S. Cheema: None. R. Haider: None. R. Noor: None. S. N.l: None. S.M. Irshad: None. A. Ullah: None. H. Jawad: None. A. Nawaz: None. M. Khawar: None. A. Qadeer: None. H. Ahmad: None. R. Alcaraz: None. F. Ahmed: None. Background: Bone density and structure-related disorders, such as osteoporosis and related fractures, significantly contribute to morbidity and mortality, particularly among aging populations. Monitoring temporal trends and geographic variations in mortality is essential to inform targeted public health interventions. In this study, we aimed to examine temporal and geographic variations in mortality associated with bone density and structure-related disorders in the United States from 1999 to 2022. Methods: Using ICD-10 codes M80-M85, this retrospective ecological study utilized mortality data extracted from the CDC WONDER database for the years 1999-2022. Age-adjusted mortality rates (AAMRs) were calculated and stratified by demographic variables (age, sex, and race/ethnicity) and geographic regions. Temporal trends were analyzed using Joinpoint regression to estimate annual percent changes (APCs). Geographic variations were visualized using choropleth maps, and subgroup analyses were performed to explore disparities. Statistical significance was set at p < 0.05. Results: Age-adjusted mortality rates (AAMRs) for bone density and structure-related disorders decreased overall from 1999 to 2019, with a subsequent rise observed in 2020 and 2022. Joinpoint regression revealed a significant negative trend from 2007-2016 (APC = -7.46%, p < 0.000001), followed by a positive reversal from 2019-2022 (APC = 3.78%, p = 0.013). Both males and females experienced declines in mortality, but females had a slightly higher APC of -3.10% compared to -2.82% for males. Asian/Pacific Islander groups exhibited the most pronounced decrease in mortality (APC = -11.92%, p < 0.000001) from 2009-2015, with a positive rebound in recent years. Black or African American populations had the smallest decline (APC = -1.35%). The Southern U.S. experienced the steepest decline in mortality from 2010-2016 (APC = -10.92%, p < 0.000001), followed by a strong positive trend from 2019-2022 (APC = 6.61%, p < 0.000001). Conversely, the West and Northeast regions showed milder trends with less pronounced reversals. Older age groups (65-74, 75-84) showed significant decreases in mortality, particularly the 65-74 group, which reversed to a positive trend (APC = 6.97%) from 2019-2022. The highest number of deaths occurred at the decedent’s home (3,330 in 2022). Subgroup analyses indicated significant temporal shifts in the mortality patterns across different racial/ethnic groups and geographic regions. Hispanic/Latino and Asian/Pacific Islander populations exhibited an increase in mortality rates post-2019, particularly in 2020. Conclusion: From 1999 to 2022, mortality from bone density and structure-related disorders in the U.S. exhibited significant temporal and geographic variations. These findings highlight the need for targeted public health strategies. Presentation: Monday, July 14, 2025

Abstract Disclosure: M. Kakakhel: None. S. Cheema: None. R. Haider: None. F. Saleem: None. A. Ullah: None. M. Shah: None. A. Qadeer: None. M. Khawar: None. H. Jawad: None. H. Ahmad: None. F. Ahmed: None. S. N.l.: None. R. Alcaraz: None. Background: Diabetes mellitus (DM) is a global health burden, contributing significantly to mortality and comorbidities, including chronic kidney disease (CKD), which remains a leading cause of morbidity and mortality, especially in type 1 and type 2 diabetes. Methods: This retrospective cohort study examined mortality data from the United States from the CDC WONDER database, which gathers data from death certificates. Particularly, deaths from renal problems (ICD-10 codes E10.2-E14.2) linked to diabetes were the emphasis. Sex, age, race/ethnicity, and geographic location were among the important demographic factors that were used to stratify the data for the analysis. Temporal trends were examined using linear regression, while geographic disparities were assessed through chi-square tests and regression analysis. A significance level of p<0.05 was used for all tests. Results: According to the data, the death rate from diabetes increased significantly between 1999 and 2020. Between 1999 and 2020, the number of deaths from diabetes rose from 2,325 to 74,296. From 13.12 per 100,000 in 1999 to 276.92 per 100,000 in 2020, the age-adjusted death rate increased significantly, indicating a fivefold rise in mortality rates over the 21 years. After 2010, the pace of increase became especially steep, with notable yearly increases, especially in the years after 2013. In the Hispanic population alone, the number of deaths from diabetes more than quadrupled between 2013 and 2020, rising from 5,378 in 2013 to 10,395 in 2020. Male mortality rates were consistently greater than female death rates, indicating gender-based inequities as well. By 2020, there were 41,225 male deaths from diabetes (AAMR: 351.07). Notably, the death rate for men was almost 60% greater than that for women in 2020, with rates rising more sharply for men, particularly from 2010 onward. Significant differences in diabetes-related mortality were also observed by geography. Florida, Texas, and California had the largest mortality burdens; in California alone, 73,185 deaths, or 13.8% of all deaths, occurred. Lastly, more deaths were found to occur in medical facilities, especially inpatient settings, as well as at home or in hospice care, indicating a change in the place of death. Conclusions: The study shows a significant rise in diabetes-related mortality in the US over the past two decades, with males experiencing a higher mortality rate. Geographic disparities are also evident, with Southern states and large states like California, Texas, and Florida contributing disproportionately. The shift in death places suggests increased reliance on medical facilities, home care, and hospice care. The study calls for targeted public health interventions to address the growing burden of diabetes-related mortality, particularly in high-risk regions. Presentation: Sunday, July 13, 2025