Citations

Introduction: Systemic racism continues to shape maternal health care in the United States, contributing to higher rates of adverse outcomes for Black women and other women of color. Doulas have emerged as important advocates, yet little is known about how doulas’ own racial identities influence their work in challenging inequities. Methods: This qualitative study used a phenomenological approach to explore doulas’ perspectives on racism in maternal health care. Ten doulas in Northeast Florida participated in in-depth interviews and focus groups between 2021 and 2022. Data were transcribed verbatim and analyzed thematically using established qualitative methods. Results: Four major themes were identified: (1) challenging differential racial treatment, (2) leveraging privilege, (3) anti-racist doula training, and (4) advocating for Black doula recruitment and engagement. White doulas described using their privilege to support clients of color, while Black doulas described navigating heightened scrutiny and exclusion. Across participants, there was consensus that current training inadequately prepares doulas to address racism and that greater racial diversity within the profession is essential. Discussion: Findings highlight how doulas both confront and adapt to systemic racism in maternal health care. Their accounts point to gaps in training and structural barriers to equitable practice, while also illustrating how advocacy can both protect clients and, at times, reproduce inequities through unequal access to power and privilege. Health Equity Implications: Addressing how race and privilege shape advocacy pathways, reforming training to include racial justice, expanding recruitment and support for Black doulas, and integrating doulas into perinatal care models are important strategies for advancing maternal health equity and advocating for Black racial justice in health.

Background Lewy body disease (LBD) is a progressive neurodegenerative a-synucleinopathy, whereas isolated REM sleep behavior disorder (iRBD) is recognized as a prodromal stage of LBD. Although growing evidence implicates the gut–brain axis in neurodegeneration, the taxonomic and functional roles of the gut microbiome across the prodromal-to-symptomatic LBD continuum remain poorly defined. Methods Here, we performed shotgun metagenomic sequencing on stool samples from 25 patients with LBD (10 mild cognitive impairment due to LBD [MCI-LB] and 15 dementia with Lewy bodies [DLB]), 10 individuals with iRBD, and their household matched cohabitant controls to characterize disease-associated microbial alterations while minimizing environmental confounding. Results Despite no significant differences in global microbial diversity, we identified convergent shifts in microbial taxa, metabolic pathways, and gene families across disease stages. Both LBD and iRBD showed increased abundance of microbial taxa potentially associated with gut barrier disruption, as well as higher abundance of functional pathways related to lipopolysaccharide biosynthesis. LBD showed lower abundance of pathways related to complex carbohydrate fermentation, and both groups showed lower abundance of pathways associated with neurotransmitter-related metabolism. In particular, pathways and gene families associated with starch degradation were reduced in LBD, and those associated with histidine-to-glutamate/ GABA metabolism were reduced in both groups. Discussion These exploratory findings represent the first high-resolution, shotgun metagenomic characterization of gut microbiome alterations across the LBD continuum, highlighting functional patterns that may serve as candidate markers of disease progression in future longitudinal and mechanistic studies.

OBJECTIVE Endovascular thrombectomy (EVT) for acute large-vessel occlusion stroke is well established, yet its role in patients presenting with minor stroke symptoms (National Institutes of Health Stroke Scale [NIHSS] score < 6) remains unclear. Prior studies have not accounted for intraprocedural factors that may influence outcomes in this subgroup. METHODS The authors analyzed 5693 patients from the STAR (Stroke and Thrombectomy and Aneurysm Registry), including 398 with low NIHSS scores, to evaluate the association between procedure time (PT) and outcomes. Among patients with low NIHSS scores, propensity score matching was used to compare outcomes between those with PT ≤ 35 versus > 35 minutes, a cutoff defined using receiver operating characteristic curve analysis. The authors performed a meta-analysis of studies reporting best medical management (BMM) outcomes in patients with low NIHSS scores. To compare these with EVT-treated patients, a matched BMM comparator cohort using stratification on pooled baseline characteristics was constructed. Outcomes included 90-day functional independence (modified Rankin Scale [mRS] scores 0–2), intracranial hemorrhage, and mortality. RESULTS PT had a stronger negative effect on outcomes in patients with low NIHSS scores compared with those with high scores, with a steeper decline in functional independence per minute of PT (slope: –0.45% vs –0.21%; p = 0.03 for interaction). Among patients with low scores, PT ≤ 35 minutes was associated with higher 90-day functional independence compared with the propensity score–matching cohort with PT > 35 minutes (82.6% vs 59.0%, p < 0.001). When benchmarked against BMM (75.2% mRS scores 0–2), patients undergoing EVT within 35 minutes had superior outcomes (85.1%, p = 0.047). In contrast, EVT with PT > 35 minutes resulted in worse outcomes than BMM (mRS scores 0–2: 59.8%, p = 0.008). The number needed to treat for PT ≤ 35 minutes was 10, whereas PT > 35 minutes yielded a number needed to harm of 6. CONCLUSIONS PT critically modulates the benefit of EVT in minor stroke. While efficient EVT yields better outcomes than BMM, prolonged procedures are associated with harm. These findings may explain prior inconsistent evidence on EVT in patients with low NIHSS scores and underscore the need to individualize procedural thresholds in this population.

Abstract Glioblastoma (GBM) remains a deadly cancer driven in part by invasion of tumor cells into the brain. Transcriptomic analyses have identified distinct molecular subtypes, but mechanistic differences that account for clinical differences are not clear. In this study, we show that, as predicted by the motor-clutch model of cell migration, mesenchymal glioma cells are more spread, generate larger traction forces, and migrate faster in brain tissue compared with proneural cells. Despite their rapid migration and comparable proliferation rates in vitro, mice with mesenchymal tumors survive longer than those with proneural tumors. This improved survival correlated with an immune response in mesenchymal tumors, including T cell–mediated. Consistently, inducing mesenchymal tumors in immunodeficient mice resulted in shorter survival, supporting a protective immune role in mesenchymal tumors. Thus, mesenchymal tumors have aggressive migration but are immunologically “hot,” which suppresses net proliferation. These two features counteract each other and may explain the lack of a strong survival difference between subtypes clinically, while also opening up new opportunities for subtype-specific therapies. Significance: This study highlights new mechanical and immunologic insights into GBM molecular subtypes using an integrated modeling–genome engineering strategy, which can potentially facilitate GBM subtype-specific therapeutic strategies.

Objectives: To evaluate the association of a templated interhospital transfer (IHT) note on transfer appropriateness and clinical outcomes. Methods: We conducted a retrospective, single-center study of 100 IHTs to the Department of Medicine services between May and June 2023. The exposure was the type of documentation at the time of transfer, categorized as templated note, nontemplated note, or no note. The primary outcome was appropriateness of transfer, determined by 2 independent adjudicators using a standardized framework developed as part of the POINT Study. Documentation type by clinical specialty and reason for transfer were assessed, with statistical analyses of clinical outcomes limited to those with an incidence >5% (ie, escalation/downgrade in level of care within 24 h of transfer and 30 d mortality). Results: Among 100 transfers, 81 (81%) were deemed appropriate and 19 (19%) were deemed inappropriate. Documentation was present in 59%, including templated (35%) and nontemplated notes (24%). IHTs without documentation had the highest appropriateness rate (87.8%, 36/41), compared with templated notes (29/35, 82.9%; P =0.15) and nontemplated notes (66.7%, 16/24; P =0.042). Downgrades were more common in inappropriate transfers with nontemplated notes (50.0%, 4/8) than in appropriate transfers with templated notes (10.3%, 3/29; P =0.012). Conclusions: Structured IHT documentation was inconsistently used and did not predict the appropriateness of transfer. Transfers without documentation were most often appropriate, suggesting straightforward cases may not require formal notes. In contrast, nontemplated notes in inappropriate transfers showed high downgrade rates, implying that unstructured documentation may inflate perceived acuity. Further evaluation of documentation strategies is needed to support appropriate transfer decision-making.

Background: Chemotherapy-induced peripheral neuropathy (CIPN) and cancer-related myelopathy often cause pain, numbness, and mobility impairment. While treatments such as medications typically target positive sensory symptoms (eg, burning or tingling), negative symptoms such as numbness and proprioceptive loss remain difficult to manage and significantly affect balance and gait. This study evaluated the feasibility of using textured insoles as a noninvasive approach to improve these symptoms. Methods: A prospective feasibility study was conducted with adult patients with cancer experiencing negative sensory symptoms due to CIPN or myelopathy. Participants were provided with textured insoles designed to enhance plantar sensory input and instructed to wear them during daily activities for 1 month. Outcomes were measured pre- and postintervention using the 4-Stage Balance Test, Timed Up and Go test, and patient-reported assessments of balance and mobility. Results: Twenty participants were enrolled: 70% reported numbness, 45% gait impairment, 40% balance impairment, and 35% pain. Objective improvements in balance and gait were observed with the use of insoles, with significant Timed Up and Go gains at both initial ( P < .001) and follow-up ( P = .01) visits, adjusting for additional therapy. Sixteen participants reported improved stability and confidence after 1 month. Adherence was high, and no adverse events occurred. Conclusion: Textured insoles are a feasible, well-tolerated supportive intervention for patients with negative sensory symptoms from CIPN or cancer-related myelopathy. By enhancing sensory feedback, insoles may improve balance, mobility, and quality of life. Larger controlled trials are warranted to confirm efficacy and long-term outcomes.

Members of the type 2 histone lysine methyltransferase family (KMT2s) are key drivers of enhancer activation and are the most mutated group of epigenetic regulators in different cancer types. Within this family, KMT2C and KMT2D have the highest mutational incidence across various cancers. To evaluate their role in gastric cancer, Wang et al. developed a Pten deficiency–driven genetically engineered mouse model with inducible loss of Kmt2c and Kmt2d in gastric epithelial cells. Through extensive in vitro, in vivo, and in silico analyses, the authors revealed that the concomitant loss of Kmt2c and Kmt2d promotes gastric carcinogenesis while enhancing antigen presentation and sensitivity to immunotherapy and targeted approaches like mTOR inhibition, highlighting the tumor-suppressive roles of KMT2C/D in gastric cancer and uncovering a vulnerability for this dismal condition.

Abstract Clinical empathy is essential for patient care, but physicians need continually balance emotional warmth with factual precision under the cognitive and emotional constraints of clinical practice. This study investigates how large language models (LLMs) can function as empathy editors, refining physicians’ written responses to enhance empathetic tone while preserving underlying medical information. More importantly, we introduce novel quantitative metrics, an Empathy Ranking Score and a MedFactChecking Score to systematically assess both emotional and factual quality of the responses. Experimental results show that LLM-edited responses significantly increase perceived empathy while preserving factual accuracy compared with fully LLM-generated outputs. These findings suggest that using LLMs as editorial assistants, rather than autonomous generators , offers a safer, more effective pathway to empathetic and trustworthy AI-assisted healthcare communication.

Abstract Frontotemporal dementia (FTD) is characterized by selective neuronal vulnerability, yet the features that predispose specific neuron types to degeneration remain unclear. We performed single-nucleus RNA sequencing of frontoinsular cortex, a region affected early in behavioral variant FTD, across individuals with C9orf72 -associated and sporadic FTD-MND spectrum disease. By enriching for large projection neurons, we resolved molecular subtypes of layer 5 extratelencephalic neurons, including von Economo neurons, and identified selective depletion of specific layer 2/3 and layer 5 neuron subtypes, convergent across genotypes. Despite selective neuronal loss, disease-associated transcriptional changes were convergent across excitatory neuron populations, suggesting that they reflect upstream pathophysiology or shared responses to local neurodegeneration. By relating neighborhood-level depletion in disease to gene expression in controls, we found that baseline cellular respiration and ATP synthesis predict neuronal vulnerability in disease. These findings define molecular correlates of selective neuronal vulnerability in FTD and provide a framework linking cell type and state to neurodegeneration.