Citations

Background: Fecal immunochemical tests (FITs), fecal occult blood tests (FOBTs), and multitarget stool DNA (mt-sDNA) tests are convenient, noninvasive colorectal cancer (CRC) screening strategies. However, delays in or failure to complete follow-up colonoscopy (FU-CY) after a positive noninvasive test are associated with higher CRC incidence, complications, and mortality. We sought to evaluate FU-CY rates, time to colonoscopy, and compliance predictors. Patients and Methods: This retrospective cohort study linked 2 data sources: Komodo Health Data with Exact Sciences Laboratories. Data were collected from January 2016 to June 2023 and analyzed in 2024. Study participants (ages 45–75 years) were individuals with positive stool-based CRC screening tests (FIT, guaiac-based FOBT, or mt-sDNA tests). FU-CY compliance was assessed at 30-day intervals up to 365 days, and logistic regression was used to identify predictors of FU-CY. Results: Among 362,646 participants, colonoscopy compliance was 77.1% for mt-sDNA and 45.1% for FIT/FOBT ( P <.001). Overall FU-CY compliance was lowest among Asian and Black populations, but was significantly higher in these subgroups for mt-sDNA versus FIT (Asian: 74.2% vs 41.1%; Black: 71.3% vs 44.6%). The strongest predictor of compliance was use of mt-sDNA (odds ratio, 3.98; P <.001). More than half of participants across all race groups who completed FU-CY after mt-sDNA did so within the first 120 days, whereas none of the FIT/FOBT racial subgroups reached 50% completion within 365 days. Conclusions: Timely completion of colonoscopy after a noninvasive test is critical, as failure to undergo colonoscopy or delays in completion are associated with increased CRC incidence and more advanced-stage disease. These findings demonstrate that mt-sDNA use may help close CRC screening disparity gaps compared with FIT testing. FU-CY adherence is higher, and time to colonoscopy is shorter following a positive mt-sDNA test versus FIT across all racial and ethnic subgroups.

The Philadelphia chromosome-negative myeloproliferative neoplasms (MPN) are a group of heterogenous hematologic malignancies characterized by the proliferation of blood cells and consist of myelofibrosis, polycythemia vera, and essential thrombocythemia. The NCCN Guidelines for MPN were developed as a result of meetings convened by a multidisciplinary panel with expertise in MPN, with the aim of providing recommendations for the comprehensive care of adults with these diseases. The panel of experts convenes at least once a year to discuss requested changes to the Guidelines and to evaluate emerging data. These Guideline Insights focus on some of the recent updates for myelofibrosis.

The NCCN Clinical Practice Guidelines for Breast Cancer include recommendations for clinical management of patients with carcinoma in situ, invasive breast cancer, Paget’s disease, Phyllodes tumor, inflammatory breast cancer, and management of breast cancer during pregnancy. The panel convenes annually to update recommendations based on a review of recently published clinical trials. This selection from the NCCN Guidelines for Breast Cancer focuses on the recommendations for the management of recurrent or stage IV (M1) metastatic breast cancer. It summarizes the treatment strategies stratified by tumor biology, including hormone receptor status and HER2 expression, as well as clinical factors such as prior therapy and disease-free interval. Throughout all treatment lines, supportive care, quality of life preservation, toxicity minimization, and clinical trial participation are emphasized as integral components of patient care.

Moderate traumatic brain injury (TBI) is a prevalent entity with a wide, dynamic, and heterogeneous injury spectrum. It has its own characteristics. However, it does not receive enough attention, as evidenced by the scarce representation in the literature and the absence of specific guidelines. Its changing epidemiological profile allows us to predict an increase in its incidence in the future, especially in the fragile population. Moderate TBI is not adequately categorized, and the risk of neuroworsening is elevated. The mortality of moderate TBI is not negligible and its functional outcomes are poor. Non-invasive neuromonitoring tools may have a key role in the initial evaluation and categorization of moderate TBI. Moderate TBI has cloudy, dark, and sunny aspects. To analyze these aspects and to propose management strategies constitute the main objective of this narrative review.

Abstract Purpose This study evaluated and compared the marginal fit of CAD–CAM zirconia crown copings with and without a 3D‐printed control model. Materials and Methods This prospective in vitro trial involved 30 zirconia crown copings made from the same STL file. These were divided into two groups. Half of them had their own 3D‐printed control model made from the same STL file (With‐Printed‐Model group), whereas the other half lacked any control model (No‐Printed‐Model group). Both groups underwent manual adjustments in a systematic way. Their marginal gaps were evaluated using a digital optical microscope from eight zones: buccal, mesiobuccal, mesial, mesiopalatal, palatal, distopalatal, distal, and distobuccal. Results The mean values with standard deviations for the With‐Printed‐Model and No‐Printed‐Model groups were 15.18 ± 14.49 and 12.46 ± 14.09 µm, respectively. All crown copings from both groups were below 75 µm. Statistical analysis showed a significant difference between the two groups. Conclusion The No‐Printed‐Model group demonstrated superior marginal fit compared to the With‐Printed‐Model group. However, the largest marginal gaps from each group were still within the clinically acceptable range below 75 µm. Although the 3D‐printed control model did not improve marginal fit, its primary function is to effectively identify major manufacturing errors.

Abstract Genetic studies have significantly advanced our understanding of tauopathies, yet the genetic aetiology of Pick’s disease, a rare 3-Repeat tauopathy, remains unclear. The MAPT p.A152T variant has been identified as a risk factor for Alzheimer’s disease and progressive supranuclear palsy, but its role in Pick’s disease is unknown. In this study, we examined the prevalence of MAPT p.A152T in the largest series of neuropathologically confirmed Pick’s disease cases to date (n = 401). Through genotyping, we identified a single mutation carrier in the Pick’s disease cohort (minor allele frequency = 0.12%). We previously reported MAPT p.A152T at a 0.20% frequency in healthy controls (n = 2456), suggesting that it does not associate with 3-Repeat tauopathy risk. To further investigate the effect of the variant on MAPT transcript expression, we used bulk RNA sequencing in Alzheimer’s disease and progressive supranuclear palsy A152T mutation carriers. We did not detect significant differences in 4-Repeat tau levels, though preliminary trends may indicate more nuanced effects that need to be examined with long-read sequencing in a larger series. Overall, our study suggests that MAPT p.A152T does not increase Pick’s disease risk and may instead be linked to 4-Repeat or mixed tau pathologies, warranting further functional investigation.

Exercise and physical activity are recognized as essential tools to optimize fitness and longevity, improve overall health, and reduce the risk of cardiovascular disease and other major comorbidities. However, there are inherent risks associated with participation in sports and exercise, regardless of the level of competition or skill required. As such, there is a need for cardiologists to understand the unique aspects of competitive and recreational athletics, as well as sport and exercise science, as it relates to overall heart health and cardiovascular risk. In this article, we provide an overview of the essential aspects of sports and exercise cardiology. We describe the roles and responsibilities of a sports and exercise cardiologist as a member of a comprehensive team of experts who provide care of athletes at all levels of sport, emphasize the importance of risk stratification and prevention of sudden cardiac arrest, the role of exercise for maintaining and optimizing overall health in the general population, describe the growing field of sports electrophysiology and also discuss unique aspects of sports cardiology applied to environmental health and care of the tactical athlete. Knowledge gaps and directions for future clinical and research investigation are reviewed.

ABSTRACT Background Olfactory neuroblastoma (ONB) exhibits variable recurrence patterns, with significant late recurrences occurring years after treatment. We investigated cutoff periods to define late recurrence and identified predictors that distinguish patients at risk of late recurrence from those considered cured. Methods From a multi‐institutional cohort of 219 ONB patients treated at nine centers, we analyzed 77 patients with documented recurrence. Using a 48‐month cutoff to define early (< 48 months) versus late (≥ 48 months) recurrence, we evaluated 35 clinical, anatomic, and treatment variables using Firth penalized logistic regression across three comparisons: (1) late versus early recurrence timing, (2) late recurrence versus no recurrence, and (3) early recurrence versus no recurrence. Results Thirty‐four of the 77 (44.2%) recurrences were classified as late. Among the 77 patients who recurred, smaller tumor volume (OR 0.243, p = 0.035) and lower novel Dulguerov staging (OR 0.802, p = 0.038) were associated with late, rather than early recurrence. When patients with late recurrence were compared to those who remained disease‐free, radiographic skull base bone involvement was the strongest independent predictor (OR 2.90, 95% CI 1.14–8.64, p = 0.025), and this effect strengthened after adjusting for tumor volume (OR 3.80, p = 0.029). Pathologic dural invasion (OR 3.29, p = 0.013), Kadish stage (OR 2.02, p = 0.026), and T‐stage (OR 1.32, p = 0.040) were also significant. Conclusions A 48‐month cutoff effectively stratifies ONB recurrence risk. Skull base bone involvement independently predicts recurrence when compared to nonrecurrent cases and uniquely persists as a risk factor for late recurrence. These findings establish skull base bone involvement as a novel biomarker for risk‐stratified surveillance protocols.

Aims Testicular sex cord‐stromal tumours (TSCSTs) are rare neoplasms that arise from (or show differentiation to) elements derived from the sex cords or intertubular stroma. The current classification (World Health Organization, 2022) is based almost entirely on morphology, with many tumour types such as granulosa cell tumours being defined based on their resemblance to ovarian counterparts. Recent studies have uncovered new clinicopathological, molecular and biological nuances within this group of tumours, underscoring differences with ovarian homologues. Methods and results Considering the new data, a group of genitourinary pathology experts (Testicular Sex Cord‐Stromal Tumour [TESST] group) has proposed a revised ‘TESST classification’ that incorporates the best available evidence. This classification is structured and hierarchical, composed of the following tiers: (1) group, (2) category, (3) entity and (4) histological pattern. ‘Group’ refers to the histological compartment a specific tumour belongs to (sex cords, stroma or both), whereas ‘category’ is defined by the phenotype of the tumour, taking non‐neoplastic elements of the ovary and testis as a reference. The third tier, ‘entity’, refers to neoplasms with shared clinicopathological and/or molecular features that justify classifying them as distinct types. Lastly, ‘histological patterns’ are recurrent morphological variations within entities that are not linked to distinct clinicopathological or molecular features. Conclusions We propose a classification that will provide a framework to improve current clinical management and guide future research in the field.