Citations

Abstract Rural health disparities in the United States remain poorly understood, in part due to inconsistent definitions of “rurality” and the failure to integrate both geographic and socially constructed dimensions of place. This commentary draws from insights shared during the panel “Addressing Diversity in Cancer Prevention, Control, and Survivorship Within Rural Communities” at the 2024 Transforming Community and Rural Healthcare (TCRH) conference. Panelists emphasized the limitations of current rural-urban classification systems, which often overlook the intersectional identities, cultural heterogeneity, and lived experiences of rural populations. They advocated for integrating community-based participatory research (CBPR) and identity-based approaches to define rurality more holistically. Such methods prioritize self-identification, social determinants of health (SDOH), and localized knowledge, allowing for a more accurate assessment of cancer disparities and the development of equitable interventions. The commentary outlines how geophysical and census-based metrics, although convenient, can misrepresent rural communities and inadvertently perpetuate disparities in cancer care access, outcomes, and policy. The authors argue for an identity- and community-centered conceptualization of rurality that is dynamic, inclusive, and responsive to the complexity of rural life.

Abstract Background The associations between different types of diabetes, characterized by distinct pathophysiology and genetic architecture, and pancreatic ductal adenocarcinoma (PDAC) risk are not understood. Methods We investigated associations of genetic susceptibility to type 2 diabetes (T2D), 8 T2D mechanistic clusters, type 1 diabetes (T1D), and maturity-onset diabetes of the young (MODY) with PDAC risk. We used genome-wide association study (GWAS) summary-level statistics for T2D (242 283 cases, 1 569 734 controls), T1D (18 942 cases, 501 638 controls), and PDAC (10 244 cases and 360 535 controls) in individuals of European ancestry. Results Two-sample Mendelian randomization (MR) using the Robust Adjusted Profile Score (MR-RAPS) method indicated that genetically predicted T2D was associated with PDAC risk (OR = 1.10; 95% CI = 1.05 to 1.15), particularly the T2D obesity (OR = 1.28; 95% CI = 1.15 to 1.42) and lipodystrophy (OR = 1.25; 95% CI = 1.03 to 1.51) clusters. No association was observed for T1D with PDAC risk (OR = 1.01; 95% CI = 0.99 to 1.02). Pathway/gene-set analysis using the summary-based Adaptive Rank Truncated Product (sARTP) method revealed a significant association between the MODY gene-sets and PDAC risk (P = 1.5 × 10−8), which remained after excluding 20 known PDAC GWAS loci (P = 7.6 × 10−4). HNF1A, FOXA3, and HNF4A were the top contributing genes after excluding the previously identified GWAS loci regions. Conclusions Our results from this genetic association study support that T2D, particularly the obesity and lipodystrophy mechanistic clusters, and MODY genomic susceptibility regions play a role in the etiology of PDAC.

Yao syndrome (YAOS) is a NOD2-associated autoinflammatory disease marked by periodic fevers, dermatitis, polyarthritis, distal extremity swelling, and nearly universal gastrointestinal symptoms. A recent study was the first to comprehensively assess the gastrointestinal symptoms and manifestations of YAOS, finding that most testing is normal, without gastrointestinal mucosal inflammation, and many patients have constipation and rectal evacuation disorders. Building on this foundation, this paper highlights future directions and research priorities in furthering the understanding of YAOS. These draw heavily from the literature on Crohn disease, which is also associated with NOD2 variants. These future research priorities include detailed genotype-phenotype correlation focusing on specific NOD2 variants, prospective, comprehensive gastrointestinal phenotyping, and multi-omics approaches to investigate genetic, microbiome, epigenetic, and environmental interactions underlying YAOS pathogenesis. Insights gained from such investigation may guide improved diagnostic criteria and targeted, personalized therapeutic development for patients with YAOS.

ABSTRACT Background Microbial overgrowth (MO) in the small intestine can cause gastrointestinal symptoms and may arise from stasis, such as dysmotility. Microtypes of MO include small intestinal bacterial overgrowth (SIBO) and intestinal methanogen overgrowth (IMO). Dyssynergic defecation (DD) is associated with constipation and slow colonic transit (STC). Our aim was to assess the relationship between DD and MO. Methods We retrospectively identified patients who underwent both anorectal manometry (ARM) and balloon expulsion testing (BET) for DD, and MO testing using either small intestinal aspirate culture or breath testing. SIBO was analyzed using two culture thresholds: ≥ 10 5 CFU/mL and ≥ 10 3 CFU/mL. Chi‐square tests compared positive vs. negative results. Key Results 436 patients underwent culture of SB aspirates. At the ≥ 10 5 CFU/mL threshold, 41.7% were diagnosed with SIBO, and 87.4% at ≥ 10 3 CFU/mL. At ≥ 10 5 CFU/mL, percent anal relaxation was significantly lower in SIBO‐positive patients. SIBO patients were more likely to have reduced anal relaxation ( p = 0.032), but no other ARM parameters or BET > 60 s. At ≥ 10 3 CFU/mL, a more negative recto‐anal pressure differential (RAPD) was observed, along with a combination of RAPD < −45 mmHg and resting anal pressure > 90 mmHg. 637 patients underwent breath testing for MO, with 174 positive results, predominantly showing IMO (73%). In this group, BET was significantly longer, and anal relaxation was significantly lower. SIBO at ≥ 10 3 CFU/mL was more prevalent in DD than STC (85.5% vs. 64.7%, p = 0.002). IMO was more common in DD than STC ( p = 0.021). Conclusion/Inferences DD may be a risk factor for MO, often with evidence of methanogenesis.

Background The management of unruptured intracranial aneurysms (UIA) requires a balance between procedural risks and the potential benefit of rupture prevention. Objective The aim of this study is to evaluate the clinical and anatomical results of endovascular treatment for UIAs at our institution, to benchmark our practice and potential areas for improvement, and enable transparent communication with patients by providing accurate, evidence-based information. Methods We reviewed all patients treated for an UIA between January 2017 and July 2022. Patients were grouped according to treatment technique: simple or balloon-assisted coiling; stent-assisted coiling; or flow-diverter stent placement. Clinical outcomes included perioperative mortality, transient (<3 months), and permanent morbidity (>3 months). Anatomical results were graded with the Raymond-Roy or the O’Kelly-Marotta scales. Retreatment rates, length of hospitalization, readmissions, irradiation time, and total radiation dose were assessed. Results In total, 169 patients with 201 UIAs underwent 187 endovascular procedures without death, 1% permanent morbidity, 8% transient morbidity, and 4% retreatment. The treatment subgroups analysis shows an absence of permanent morbidity associated with flow-diverter stenting and stent-assisted coiling. Simple/balloon-assisted coiling suffered 2.6% permanent morbidity. Transient morbidity was observed in 9%, 9.5%, and 6.6% of flow-diverter stenting, stent-assisted coiling, and simple/balloon-assisted coiling, respectively. Conclusions In our hospital, about one in a hundred procedures caused lasting problems, while about one in 25 aneurysms needed a second treatment. These results reflect our case selection and multidisciplinary approach. Reporting them transparently helps patients understand what outcomes to expect at our hospital.

OBJECTIVE While endonasal transsphenoidal surgery (ETS) is the standard treatment for nonfunctioning pituitary adenomas (NFPAs), the postoperative recovery rates of secondary adrenal insufficiency and their predictive factors remain poorly understood. The authors investigated the relationship between the tumor resection rate and adrenal function recovery in patients with NFPAs. METHODS This retrospective study included 450 patients with NFPAs who underwent ETS between January 2013 and November 2023. The rates of preoperative hypopituitarism and postoperative recovery rates of secondary adrenal insufficiency and their associated factors were analyzed. Recovery was defined as normalization of serum cortisol levels without replacement therapy for at least 24 hours, accompanied by symptom resolution. The tumor resection rate was calculated as the percentage of the tumor volume resected. RESULTS The median follow-up period for the entire cohort was 52 months (range 1–131 months). A total of 246 (55%) patients had dysfunction in one or more pituitary axes. Fifty-three (47%) of 114 patients with preoperative adrenal insufficiency showed postoperative adrenal insufficiency recovery. The cumulative adrenal insufficiency recovery rates were 12% at 1 month, 19% at 3 months, 32% at 6 months, and 41% at 12 months. Among the 114 patients with preoperative adrenal insufficiency, the factors associated with postoperative adrenal insufficiency recovery were investigated. Patients with smaller tumor sizes of < 20 mm (log-rank test, p = 0.001) and those with tumor resection rates of more than 85% (log-rank test, p = 0.032) demonstrated better postoperative adrenal insufficiency improvement. Bivariate Cox proportional hazards analysis demonstrated that smaller tumor sizes (continuous, HR 0.97, 95% CI 0.93–0.98; p = 0.043) and higher tumor resection rates (HR 1.03, 95% CI 1.01–1.07; p = 0.001) were significantly associated with better postoperative adrenal insufficiency recovery. Multivariable analysis confirmed that only higher tumor resection rates were significantly associated with better postoperative adrenal insufficiency recovery (HR 1.03, 95% CI 1.01–1.06; p = 0.019). CONCLUSIONS Nearly half of the patients with preoperative adrenal insufficiency achieved recovery after ETS for NFPAs. The enhanced extent of tumor removal was an independent factor associated with better postoperative recovery, indicating that optimizing safe maximal resection procedures may be crucial in enhancing adrenal function.

Abstract Selective myectomy has gained popularity for treating facial synkinesis. We examined the combined effectiveness of depressor anguli oris (DAO), partial buccinator, and platysma myectomies. Retrospective case series. Pre- and postoperative botulinum toxin-A (BTX-A) treatments of selective myectomy patients were collected. Facial photographs were analyzed using Emotrics + . Facial Asymmetry Index (FAI) and electronic facial paralysis assessment (eFACE) scores were calculated. Twenty patients underwent myectomies. Improvements (mean ± standard error) were seen in several smile metrics, including FAI by 2.80 ± 0.68 mm, nasolabial fold angle by 4.78 ± 1.83 degrees, and smile angle by 4.43 ± 1.18 degrees (all p < 0.05). Postoperative FAI was 2.79 mm. Total BTX-A decreased by 10.85 ± 4.48 units (p = 0.03). eFACE revealed improved oral commissure movement and platysmal synkinesis (p < 0.05 for both). Combined myectomies of the DAO, partial buccinator, and platysma clinically and statistically improve smile in facial synkinesis.