Citations

Vaccine hesitancy refers to the delay in accepting or refusing vaccines despite the availability of vaccination services. Well-conducted studies and trials reviewed in this article support methods both to prevent and manage vaccine hesitancy. Clinicians should know which vaccines their patients are due to receive and should use every encounter to address this issue. Research shows clinicians' recommendations increase vaccine uptake. Recommendations that patients perceive as stronger have a greater effect in increasing vaccine uptake. Using presumptive language to phrase the recommendation is more effective than presenting the vaccine conversationally as an option for the patient. When the patient counters the strong recommendation with hesitancy, the clinician should engage the patient with motivational interviewing, perhaps using a four-step process called the "Four A's".

ABSTRACT Background The assessment of gastrointestinal (GI) motility disorders is limited by the invasive, resource‐intensive, and subjective nature of current testing. Artificial Intelligence (AI) is being applied to address these challenges. This review aimed to comprehensively identify, appraise, and synthesize the spectrum of AI applications in GI motility diagnostics. Methods A systematic search of PubMed, Embase, Scopus, Web of Science, and Medline for original studies was conducted in March 2025. Results were narratively synthesized and grouped by anatomic region. Key Results Of 1383 articles, 90 primary studies met the inclusion criteria. In the esophagus ( n = 31), the primary focus was automation of High‐Resolution Esophageal Manometry (HREM), pH impedance, and Functional Luminal Imaging Probe (FLIP) panometry analysis. In the gastroduodenum ( n = 21), studies looked to improve diagnostic accuracy and interpretability of legacy electrogastrography (EGG). In the small and large intestine ( n = 19), AI was used to determine transit time and predict post‐operative ileus. In the anorectum ( n = 9), tools focused on standardizing manometry interpretation. Review of pan‐GI applications ( n = 10) highlighted AI's application to wireless capsule endoscopy and bowel sounds analysis. While promising, all areas need more rigorous research and external validation before widespread deployment. Conclusions and Inferences AI will play an essential role in improving and automating the interpretation of GI motility diagnostics. However, even the most promising models require large‐scale prospective validation before clinical implementation. Trial Registration PROSPERO (ID: 1128662)

Abstract Background: Black men carry a disproportionate prostate cancer (CaP) burden and often experience significant psychosocial distress at the point of prostate cancer diagnosis (PPCD). Many report emotional shock, uncertainty, and limited access to culturally competent guidance, which can negatively affect treatment decisions and long-term survivorship. To address these needs, we developed the PPCD Virtual Reality Assistant (ViRA), an immersive, AI-enabled intervention co-designed with Black CaP survivors. ViRA delivers tailored psycho-oncology support, emotional guidance, and navigation of social determinants of health (SDOH) within virtual reality environments. This study evaluated the feasibility, acceptability, and usability of the PPCD ViRA (NCT06535802). Methods: ViRA was developed through a structured, seven-step co-design process with survivors, integrating mobile immersive technologies, SDOH navigation, and culturally grounded psycho-oncology content. Personalization was enabled through AI-driven predictive analytics and a recommendation engine. Alpha testing assessed initial usability and acceptability among 10 participants (seven team members and three Black CaP survivors). Beta testing with 24 Black men in Florida examined feasibility and preliminary efficacy. Results: A demonstration of ViRA is available (https://www.youtube.com/watch?v=1mI-HS5R6sk). Alpha testing indicated strong usability, positive emotional engagement, and clear promise for enhancing support at the PPCD. In Beta testing, participants varied in age; most were married (58.3%), held a bachelor’s degree (45.8%), were retired (45.8%), and had a family history of cancer (83.3%). ViRA use was associated with increased engagement and reduced distress across participants. Overall, 74% rated ViRA as “excellent,” while the remainder rated it as “good” or “very good.” More than 90% reported being “very satisfied,” with the rest indicating satisfaction. Conclusions: Findings demonstrate high feasibility, acceptability, and cultural relevance of the PPCD ViRA for supporting Black men at diagnosis. Lessons learned highlight the need for culturally embedded design, emotional timing, community co-creation, flexible delivery formats, and strong community partnerships to advance digital health equity. The refinement and larger-scale validation to establish clinical utility and readiness for implementation is ongoing (NCT07126548). Citation Format: Folakemi T. Odedina, Che Ngufor, Christopher Williams, Mary Ellen Young, Floyd Willis, Adam M. Kase, Arnold Merriweather, Emelina Asto-Flores, Dee M. Glaser-Boivin, Jada Melton, Monica L. Albertie, Michelle Fudge, Quincy Wimberly, Inclusive Cancer Care Research Equity (iCCaRE) Consortium, Prostate Cancer Transatlantic Consortium (CaPTC). Novel application of the iCCaRE consortium virtual reality assistant (ViRA) to support Black men at the point of prostate cancer diagnosis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 6306.

Objective: To assess the feasibility and clinical impact of sideline telemedicine for real-time injury assessment during high school athletic events in rural communities and to determine its potential effect on emergency department (ED) utilization. Design: Prospective, observational cohort study. Setting: Three rural high schools in southeast Minnesota without on-site athletic trainer or emergency medical services coverage. Participants: High school athletes and attendees injured during school-sponsored athletic events during the 2021 to 2022 school year. Intervention: Sideline telemedicine consults were initiated by school officials using tablets to connect with on-call dual board-certified emergency and sports medicine physicians. Consults included video-based assessment, triage, return-to-play guidance, and follow-up recommendations. Main Outcome Measures: Disposition after consultation (return to play, outpatient follow-up, ED referral), satisfaction scores using the 10-item Telehealth Satisfaction Scale, and patient-reported intent to seek ED care if telemedicine were unavailable. Results: Telemedicine was activated 15 times. Most (53%) injuries were musculoskeletal. Two (13%) patients were referred to the ED, where time-sensitive diagnoses (NSTEMI, testicular torsion) were confirmed. Thirteen patients were treated without ED referral; 6 (46%) reported they would have otherwise visited the ED. All diagnoses were confirmed by outpatient follow-up. Telehealth Satisfaction Scale scores were high: interpersonal communication (mean 4.00), respectfulness (3.96), and technical quality (3.99). Conclusions: Sideline telemedicine is a feasible and well-received model for acute injury evaluation at rural athletic events lacking on-site medical providers. It may reduce unnecessary ED use while preserving care quality and satisfaction, offering scalable support for resource-limited sports settings.

Abstract Background: Hepatocellular carcinoma (HCC) is largely refractory to immune checkpoint blockade due to immune exclusion, stromal barriers, and aberrant vasculature. We evaluated whether multimodal therapy - external beam radiotherapy (EBRT) for antigen release, intratumoral dendritic cell (DC) vaccination for antigen presentation, PD-L1 blockade for immune activation, and VEGF inhibition for vascular normalization - could convert “cold” HCC tumors into sustained immune-inflamed states. Methods: Serial biopsies (baseline, post-EBRT, end-of-treatment [EOT], and progression [PD] when available) from three patients enrolled in an ongoing phase II trial (NCT03942328) underwent multiplex immunofluorescence, spatial neighborhood analysis, and transcriptomic profiling. Longitudinal changes in cellular composition, immune-stromal architecture, spatial contact networks, and pathway activity were compared. Results: Baseline tumor microenvironments (TMEs) were strongly immune-excluded, dominated by tumor (PanCK+60-70%) and stroma (SMA+/Vimentin+25-30%) with sparse immune infiltration (<10-15%). Post-therapy, immune complexity and spatial connectivity increased 2-3-fold in all patients. Patient 1 showed robust cold-to-hot conversion with CD8+(3x), CD4+(2.2x), and DC (2.3x) expansion, increased CD8-DC interactions (2.5x), and reduced tumor fraction (-40%). Transcriptomics showed marked upregulation of IFN-γ (↑3.4x), HLA-DRA (↑2.7x), and reductions in VEGFR2 (↓50%) and HIF1A (↓40%), consistent with vascular normalization. Patient 2 exhibited stromal/vascular remodeling and improved T-cell infiltration but restricted immune diversity, with CD4+/CD8+ dyads (↑2.2x) and B/NK cells(↓ 60%). Neighborhood diversity rose (3→7 communities) and immune-tumor proximity improved (distance ↓ 35%). Patient 3 showed transient inflaming with CD8+(↑3x), DC(↑2x), and new CD4-CD20/CD4-CD56 interactions, followed by relapse marked by stromal/myeloid re-expansion (SMA+↑1.8x, CD14+↑2.5x), angiogenic resurgence (VEGFR2/CD34+↑2.2x), contraction of immune networks, and genomic shift from activating CTNNB1 mutation loss to ATM gain. DCs accumulated but localized mainly to DC-DC or DC-myeloid niches, indicating non-productive antigen presentation. Conclusions: Multimodal EBRT+DC+PD-L1/VEGF blockade induces four-sided synergistic TME reprogramming - antigen release, immune priming, checkpoint release, and vascular normalization - promoting cold-to-hot conversion in HCC. Durable inflaming correlates with sustained T-cell/DC expansion and vascular remodeling, whereas relapse reflects stromal/myeloid reinforcement and genomic adaptation. These findings define mechanistic trajectories of TME remodeling and highlight actionable barriers to sustained immunotherapy response in HCC. Citation Format: Lionel Aurelien Kankeu Fonkoua, Christopher L. Hallemeier, Basim Salem, Arina Tkachuk, Kaitlynn McCay, Panwen Wang, Ying Li, Thomas D. Atwell, Krishan R. Jethwa, Caitlin Conboy, Nguyen H. Tran, Leslie A. Washburn, Melody Wu, Chen Wu, Andre De Menezes Silva Corraes, Rondell P. Graham, Jose Caetano Villasboas, Kevin Regan, Zuoyi Shao, Rayaan Kamal, Nathan R. Foster, Haidong Dong, Sean Park, Yi Lin, Lewis R. Roberts. Multimodal immunotherapy remodels the tumor microenvironment in hepatocellular carcinoma: Integrative spatial and transcriptomic profiling from a Phase II trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 7935.

Abstract Background: Black men across the African Diaspora experience a disproportionate burden of prostate cancer (CaP). The Inclusive Cancer Care Research Equity (iCCaRE) Consortium aims to eliminate CaP burden through global scientific collaboration, innovative research, community-engaged interventions, and next-generation workforce development. The primary objective for this Consortium was to optimize CaP diagnosis, treatment, and survivorship through research, research training and education, community engagement and community outreach. The Consortium integrates digital health technologies, community navigation, precision communication and precision science. Methods: Five full projects and one pilot project were launched across partner institutions in North America and Africa. Supported by multiple cores and services, the research activities included (1) implementation of a Point of Prostate Cancer Diagnosis Virtual Robot Assistant (PPCD-ViRA); (3) initiation of a cancer care at home trial; (4) migrant health studies of Caribbean and Sub-Saharan African immigrants; (5) expansion of genomic and metabolomic research; and (6) digital, psychosocial, and survivorship intervention development. Training and dissemination activities were deployed through iCCaRE TV, webinars, and community engagement programs including the Global Prostate Health Dialogue (Glo-PHD). Results: In one year, accomplishments included 45 presentations, 17 publications, 16 grant submissions, and 3 awards. The consortium delivered 408 live webinar engagements and reached more than 400 men globally through Glo-PHD. PPCD-ViRA was fully developed and prepared for clinical deployment (see https://www.youtube.com/watch?v=1mI-HS5R6sk). The African cohort expansion for genomic and metabolomic profiling was activated across several countries, with biospecimen collection underway. Media dissemination generated more than 15,000 views across platforms, including high-impact educational videos (see: www.youtube.com/@iCCaREConsortium). Training achievements included 13 early-career investigators and 7 trained prostate cancer advocates. Conclusions: In just one year, the iCCaRE Consortium Phase 2 made substantial progress toward transforming CaP equity globally. Through multidisciplinary science, digital innovation, and community partnerships, the consortium is building scalable infrastructure to address diagnosis experiences, treatment quality, and survivorship among Black men. Ongoing efforts will continue to advance precision medicine, culturally grounded interventions, and global capacity building. Citation Format: Folakemi T. Odedina, Arnold Merriweather, Roxana S. Dronca, Ernest T. Kaninjing, Solomon Rotimi, Gerardo Colon-Otero, Kimlin Ashing, Ademola A. Popoola, Gladys Asiedu, Opeyemi Bolajoko, Ewan COBRAN, Emelina Asto-Flores, Floyd Willis, Christopher Williams, Monica L. Albertie, Michelle Fudge, Oluwaseyi Toye, Collisa Mahin, Jada Melton, Inclusive Cancer Care Research Equity (iCCaRE) Consortium, Prostate Cancer Transatlantic Consortium (CaPTC). Achieving prostate cancer equity globally: Multinational advances from the iCCaRE consortium [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 2382.

Abstract Introduction: Liver cancer remains a leading cause of cancer mortality globally with limited treatment options for patients (pts) with unresectable hepatocellular carcinoma [HCC] and intrahepatic cholangiocarcinoma [iCCA][1,2,3,4]. We hypothesize that combining the intratumoral dendritic cell (DC) vaccination after external beam radiotherapy (EBRT) without (phase I) and with (phase II) systemic atezolizumab and bevacizumab (atezo/bev for HCC) would enhance tumor-specific immunity and improve clinical outcomes, and present preliminary results from our phase I/II trial (NCT03942328). Methods: Peripheral blood mononuclear cells (PBMCs) were collected at baseline (PRE), after radiation (EBRT), and after completion of DC without or with atezo/bev (POST). Single-cell RNA sequencing with TCR sequencing were analyzed using CellRanger v7.0.1, Immunopipe, Seurat v5.3.0, & Gene-set enrichment analysis (GSEA). Long EFS (EFS-L) is defined as >=12 months (mo) for phase I and >=18mo for phase II, and short EFS (EFS-S) below that. Results: Seventeen patients have been analyzed to date (Phase I: n=8 [4 HCC, 4 iCCA]; Phase II: n=9 HCC). 674,106 cells were sequenced (146,843 PRE; 168,838 EBRT; 114,437 POST). GSEA for EFS-L vs EFS-S were comparable at PRE, EBRT and POST between phase I and phase II. EFS-S was associated with enrichment of interferon alpha (IFNα; B naïve, monocytes, pDC, cDC2, NK, Treg, CD8 Tcm and Tem at PRE and POST; B intermediate, CD4 Tem and NK at EBRT) and reactive oxygen species (ROS; PRE: pDC, CD8 Tcm, Tem. EBRT: CD4 Tem. POST: CD8 T naïve Tem, CD4 Tcm & Tem, cDC2) pathways. In contrast, EFS-L was associated with enrichment of WNT-β-catenin (WNT; CD14 mono at EBRT & POST, B intermediate at EBRT), TGFb (PRE: NK; EBRT: B intermed, CD4 Tem; POST: monocytes, CD4 naïve & Tem, pDC, cDC2), and angiogenesis (EBRT: NK; POST: monocytes, cDC2) pathways. Interestingly, enrichment of protein secretion pathway in NK cells was associated with EFS-L, but among other cells were associated with EFS-S (PRE: CD16 mono, Treg; POST: CD16 mono, CD4 & D8 Tem). Compared to phase I, addition of atezo/bev in phase II pts was associated with a significant increase in Gini coefficient (p<0.0001), suggesting expansion of certain TCR clones, along with a trend for increased Gini coefficient from Pre to Post in both phase I and II. Conclusions: Preliminary analysis of this study combining EBRT with intratumoral DC vaccination +/- PD-L1/VEGF blockade identified distinct treatment-related changes in systemic cellular immune profiles. Enhanced TCR clonal diversity in phase II suggests added immunologic benefit from PD-L1/VEGF blockade. As accrual continues, integrated analyses will identify systemic immune correlates of clinical benefit and resistance to this multimodal immunotherapy approach. Citation Format: Melody Wu, Panwen Wang, Chen Wu, Ying Li, Christopher L. Hallemeier, Thomas D. Atwell, Nguyen H. Tran, Andre de Menezes Silva Corraes, Kevin Regan, Zuoyi Shao, Rayaan Kamal, Haidong Dong, Lewis R. Roberts, Sean Park, Yi Lin, Lionel Aurelien Kankeu Fonkoua. Radiation-dendritic cell combination therapy drives systemic cellular immune shifts in liver cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 3741.

INTRODUCTION: Safety and effectiveness of treating to target mucosal healing in older patients with Crohn's disease (CD) is unknown. METHODS: We analyzed CD-related complications by 24 months in the randomized evaluation of an algorithm for Crohn's treatment—study 2-2 trial that randomized practices to an enhanced-care or step-care algorithm to determine whether patient age modifies the effect of treatment. Data were analyzed using marginal Cox regression and modified Poisson regression. RESULTS: There was no difference in treatment between younger and older patients in at 24 months. DISCUSSION: Enhanced-care was effective and not associated with increased risk compared with step-care in older patients with CD.

Abstract Introduction Revascularization to prevent limb loss is not feasible or represents a very high risk in a significant proportion of patients with chronic limb-threatening ischaemia (CLTI). No standard definition currently exists to define this population of patients. The aim of this study was to develop a consensus-based, multidomain definition to improve clinical assessment and reporting of studies in people with ‘no option’ (NO) or ‘poor option’ (PO) CLTI. Methods A modified Delphi process was conducted with 164 specialists from 30 countries. Two iterative survey rounds were used to reach consensus, defined as ≥70% agreement with a score of ≥7 on a nine-point scale. Results Some 164 international vascular specialists participated in the study, averaging 19 years of experience. A multidomain framework including arterial disease anatomy, biology, risk, function, and context (ABRFC) achieved 83% consensus. A ‘desert foot’ was defined as the absence of distal arterial revascularization targets on advanced non-invasive imaging, invasive digital subtraction angiography, and at least one failed endovascular revascularization attempt (81.6% agreement). Inadequate autogenous bypass conduit was defined as the lack of usable autologous vein across all four limbs (85% agreement). Patients were classified as NO for revascularization if they present with ‘desert foot’, prohibitive medical risk, a non-functional limb, or in those patients who refused arterial revascularization. PO revascularization patients combined factors such as severe infection, lack of autologous vein, or treatment non-compliance (72.1% agreement). Conclusion This consensus study established a structured, expert-validated definition of no option or poor option for revascularisation of patients with CLTI. The multidomain ABRFC framework provides a foundation for standardized clinical assessment, trial design, and future guideline development.

Abstract Background: Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related mortality worldwide. Prognostic models for HCC primarily rely on tumor burden and liver function, with limited consideration of inherited genetic contributions to survival variability. Identifying germline variants associated with survival could refine prognosis and reveal biological mechanisms underlying disease progression. Methods: We conducted a genome-wide association study (GWAS) of overall survival among 864 patients with HCC from the M.D. Anderson Cancer Center cohort. Genotyping, quality control, and imputation procedures followed previously described protocols (PMID: 38381705). Associations between genetic variants and overall survival were assessed using Cox proportional hazards models adjusted for age, sex, and the first five principal components. Genome-wide significance was defined as P < 5×10-8. Functional annotation and pathway enrichment analyses (MAGMA) were employed to investigate the biological relevance of the identified loci. Results: After quality control, 8,525,017 single-nucleotide polymorphisms (SNPs) were analyzed. We identified seven new loci associated with HCC survival at the genome-wide significance level. Five out of seven loci are associated with anthropometric traits and hematological measurement traits, reflecting metabolism, hematopoiesis, immune function, and inflammation. A variant in the 3′ untranslated region (UTR3) of STX7 showed a genome-wide significant association with overall survival (HR = 3.23; P = 2.56 ×10-8). Carriers of the risk allele had significantly shorter survival times compared with noncarriers. Pathway analysis revealed enrichment in biologically relevant processes, including liver growth and regeneration (growth hormone and Interleukin-6 (IL-6) signaling pathway), implicating hepatocyte proliferation and IL-6/STAT3-mediated inflammatory signaling. Immune-related pathways, such as regulation of T cell activation and myeloid leukocyte migration, highlight the role of germline variation in immune surveillance. Moreover, pathways governing vascular remodeling and metabolic stress response (e.g., JAK activation, mitochondrial dynamics) suggest that inherited determinants of microenvironmental structure and hepatocyte resilience influence patient outcomes. Conclusion: This germline GWAS of HCC survival identifies seven new genome-wide significant loci and implicates pathways involved in liver regeneration, inflammation, and tissue remodeling. These findings support a role for inherited genetic variation in shaping HCC prognosis and underscore the potential of integrating germline genetics into prognostic modelling and therapeutic target discovery. Citation Format: Younghun Han, Jinyoung Byun, Lewis R. Roberts, Katherine A. McGlynn, Manal M. Hassan, Christopher I. Amos. Identification of survival-associated germline variants in hepatocellular carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 3606.