Citations

Abstract Transgender and gender-diverse (TGD) individuals face unique challenges in accessing affirming, evidence-based breast imaging care because of longstanding disparities in provider education, institutional practices, and imaging guidelines. Gender-affirming hormone therapy and gender-affirming surgeries, such as chest masculinization or breast augmentation, impact breast tissue composition and cancer risk, necessitating individualized imaging approaches. Through multiple clinical vignettes, this article illustrates potential pitfalls and key considerations in breast imaging for TGD patients, including appropriate imaging recommendations, inclusive system-level changes, and navigating patient encounters. Education of breast imaging radiologists, technologists, and front-desk staff is critical to bridge the known knowledge gap and improve outcomes for this patient population. By adopting inclusive, culturally competent, and trauma-informed practices, breast imaging professionals can help reduce disparities and improve the experience and health outcomes of TGD patients.

ABSTRACT Background Recent data show increased ventricular tachycardia (VT) related mortality. We aimed to investigate the trends and disparities of VT‐related mortality according to cardiomyopathy subtypes. Methods Mortality and demographic data were obtained from the CDC Wide‐ranging Online Data for Epidemiologic Research database between 1999 and 2020. VT‐related mortality was defined as the underlying cause of death and ischemic cardiomyopathy (ICM) or nonischemic cardiomyopathy (NICM) as the contributing cause of death. The direct method of standardization was utilized to estimate age‐adjusted mortality rates (AAMRs). Temporal trends were evaluated using log‐linear regression models. Results A total of 15 888 deaths were related to both VT and ICM, and 16 777 were due to both VT and NICM. There was a significant increase in VT and ICM‐related mortality between 2006 and 2020 with an APC of +1.38% ( p < 0.05). Similarly, VT and NICM‐related mortality increased between 2008 and 2020 with an APC of +0.60% ( p < 0.05). ICM had a higher AAMR in males [6.23 (6.12–6.34)], Whites [3.49 (3.43–3.54)], Hispanics [2.11 (1.95–2.26)], and the Midwest region [3.73 (3.61–3.85)] compared to NICM. In contrast, NICM had a higher AAMR in females [1.57 (1.52–1.61)], Black or African Americans [5.02 (4.84–5.20)], and the South region [3.10 (3.03–3.18)]. p for all trend < 0.05. Conclusions Real‐world data show significant differences in VT‐related mortality according to cardiomyopathy subtypes with prominent sex, race, and regional disparities. Clinical and public health strategies are needed to address inequities and improve outcomes.

Background: Substance use disorders (SUDs) are highly prevalent, affecting over 48.5 million Americans. Available treatments for SUD remain insufficient, and many patients do not respond to existing interventions despite adequate adherence to treatments. While novel therapies for SUD are urgently needed, the use of psychedelic drugs for the treatment of SUDs has shown promise. Objectives: This overview of systematic reviews summarizes existing evidence on hallucinogens—serotonergic psychedelics and ketamine—for the treatment of SUD. Methods: A comprehensive search of the literature was conducted to identify relevant evidence for using serotonergic and non-serotonergic psychedelics for the treatment of SUDs. After initial screening (n = 468 studies), 62 studies were retrieved and assessed for eligibility, and a total of 16 systematic reviews were included. Conclusions: Although preliminary, evidence suggests that the use of serotonergic and non-serotonergic psychedelics for the treatment of SUD may provide advantages over traditional therapeutics, and these compounds may eventually become part of the next generation of treatments for SUD under specific circumstances. Research with these drugs has faced significant challenges, though, and caution when interpreting results is warranted, given high risk of bias and several other methodological limitations from the studies to date. Furthermore, risks associated with these drugs are not negligible. For now, the use of psychedelic drugs for the treatment of SUDs remains experimental, and existing evidence is insufficient to support its use in clinical practice.

Abstract With the rapid advancements in large language model technology and the emergence of bioinformatics‐specific language models (BioLMs), there is a growing need for a comprehensive analysis of the current landscape, computational characteristics, and diverse applications. This survey aims to address this need by providing a thorough review of BioLMs, focusing on their evolution, classification, and distinguishing features, alongside a detailed examination of training methodologies, datasets, and evaluation frameworks. We explore the wide‐ranging applications of BioLMs in critical areas such as disease diagnosis, drug discovery, and vaccine development, highlighting their impact and transformative potential in bioinformatics. We identify key challenges and limitations inherent in BioLMs, including data privacy and security concerns, interpretability issues, biases in training data and model outputs, and domain adaptation complexities. Finally, we highlight emerging trends and future directions, offering valuable insights to guide researchers and clinicians toward advancing BioLMs for increasingly sophisticated biological and clinical applications.

A woman in her 70s with a history of metastatic squamous cell carcinoma (SCC) of the anus in systemic remission presented with a new splenic metastasis on surveillance CT imaging consistent with the primary site of the anus as confirmed by histology. The patient consented to surgical management via laparoscopic splenectomy, which was facilitated by a combination of laparoscopic and hand-assist ports. Mobilisation of the spleen revealed local tumour invasion into the diaphragm, requiring resection and resulting in capnothorax, which was appropriately repaired. Final pathology showed a well-circumscribed 7.9×6.8×5.2 cm mass exhibiting microscopic morphology and nuclear markers consistent with poorly-differentiated SCC of the anus, confirming metastatic disease. Splenic metastases are a rare finding that may require surgical management. Splenectomy can be feasibly managed using minimally invasive techniques, such as laparoscopy, with or without hand assistance.

Abstract Background Cryoprecipitated antihemophiliac factor (cryo) is primarily used to replenish fibrinogen in acquired coagulopathy. Little has been reported about its usage patterns within hospitals with respect to patient population, frequency of use, and dosing. Study design and methods Cryo production and usage data were collected over 5 years from July 1, 2016, to June 30, 2021, from nationally based blood collection centers in the United States (U.S. n = 2) and Canada ( n = 2) and from eight large academic hospitals, respectively. Usage data for a similar product, purified fibrinogen concentrate were also collected from four hospitals. Results Two U.S. blood collectors reported increases in cryo production normalized to total whole blood collections from 17.4% in 2016 to 22.3% in 2021 and from 16.4% in 2016 to 20.2% in 2021. In contrast, in Canada cryo manufacturing increased slightly in one region (11.3%–12.9%) and decreased (8.0%–2.0%) in the other. Cryo utilization, defined as numbers of patients treated normalized to the inpatient census, and dose administered per patient did not consistently increase and differed significantly between hospitals participating in the study ( p < .0001). Likewise, the departments that most frequently transfused cryo varied between hospitals. Similarly, variations in practice were observed for fibrinogen concentrate usage. Conclusion While much of Canada and Europe have moved towards using fibrinogen concentrate, two large U.S. collectors have increased cryo distribution. The lack of standardization and variability in the clinical practice regarding the use of cryo and fibrinogen concentrate reported by study sites may be attributable to practitioner preference, availability, and/or cost rather than adherence to published evidence or guidelines.

Abstract Background Spatially fractionated radiation therapy (SFRT) is a technique that delivers heterogenous dose distributions consisting of alternating regions of high dose “peaks” and low dose “valleys”. Current delivery methods for SFRT using megavoltage x‐rays usually treat large and bulky tumors with brass grid or volumetric modulated arc therapy (VMAT) lattice techniques. The size and spacing of high dose regions in these approaches are typically on the order of centimeters. However, multiple studies have suggested that decreasing these dimensions may improve the therapeutic ratio. Furthermore, a more compact approach to SFRT would allow for a greater number of high dose regions within the tumor, as well as application to smaller and more irregularly shaped targets thereby increasing the number of patients that could benefit from SFRT. Purpose This study describes the commissioning and first patient treatment using mini‐lattice radiation therapy (MLRT). MLRT uses a clinical linear accelerator and decreases the size and spacing of standard lattice SFRT by using individual multileaf collimator (MLC) leaves to deliver 5 mm wide high dose regions. Methods MLRT plans were created in the Varian Eclipse treatment planning system for a Varian Truebeam equipped with Millennium 120 MLCs. MLRT uses 6 MV Flattening Filter Free high dose rate and the width of individual MLCs to define 5 mm by 5 mm openings separated by closed MLCs to deliver alternating opened and blocked regions. Dynamic conformal arcs were used to conform MLCs to 4 mm spherical mini‐lattice structures in the gross tumor volume (GTV). A MLRT‐specific beam model was commissioned to accurately model the small MLRT fields. Film measurements were performed to assess the accuracy of MLRT plans calculations. Plans for seven treatment sites in different parts of the body for retrospective patient candidates were created with varying numbers of mini‐lattices and separation distances to assess the impact of varying these parameters on treatment dose metrics. MLRT was used for the first time to treat a patient with two fractions of MLRT. Results The AcurosXB calculation algorithm with modified x and y spot sizes, dosimetric leaf gap, transmission factor, and output factor table was used to generate a beam model for accurate MLRT calculations. The MLRT‐specific beam model resulted in gamma passing rates (1%/0.5 mm criteria) of 90%–99% for retrospective patient MLRT film measurements. Dose volume histogram statistics, equivalent uniform dose, and mean dose showed a higher number of mini‐lattices with smaller separation increased the dose to the GTV and surrounding tissue. Separation distances between mini‐lattices did not impact plan heterogeneity as measured by D10%/D90%. The first patient treated with the MLRT technique reported pain relief, had stable disease, and no acute toxicities following both fractions. Conclusions MLRT is feasible using clinical linear accelerators and existing radiation oncology infrastructure. It enables targeting smaller tumors with SFRT, allows for a greater number of high dose regions within the target compared to standard VMAT lattice techniques, and may be a useful technique for challenging treatment scenarios.