Citations

Nutritional supplement use is common among athletes aiming to enhance performance, recovery, and health. However, variable regulatory frameworks and limited safety oversight create risks for inadvertent doping violations. This article provides a global overview of supplement use, relevant authorities, legislation, and safety measures, with a focus on third-party testing (TPT) as a risk-mitigation strategy. Data from six global regions—Africa, Asia, Australia/New Zealand, Europe, Latin America, and North America—were synthesized from peer-reviewed studies, governmental sources, and regional expert contributions. Reported supplement use ranged from 7% to 100% among athletes (variability within regions), with protein powders, vitamins/minerals, creatine, caffeine, and sports drinks being most prevalent. High-risk products (potential anti-doping rule violations), including certain herbal blends, preworkouts, and weight-management supplements, were reported across all regions. While some countries have robust regulatory systems, most lack harmonized or enforceable safety frameworks. TPT programs, which independently verify products for prohibited substances, remain concentrated in the global northwest (Europe, North America, and Australia/New Zealand); awareness and use of TPT certification vary widely, and even in regions with established systems, athlete adherence is inconsistent. Barriers to low-risk supplement use are limited TPT availability, cost, differences in labeling (including language), and cultural factors. Firsthand experiences and perceptions highlight widespread misconceptions about supplement safety and certification. The authors recommend expanded athlete and team-around-the-athlete education, improved global access to TPT low-risk supplements, and policy initiatives to harmonize safety standards. This work emphasizes the need for coordinated international efforts to protect athlete health and integrity while allowing access to evidence-based supplementation.

Objective: To evaluate the ethical implications, clinical benefits, and challenges associated with centralizing the surgical care of vestibular schwannoma (VS) care. Databases reviewed: PubMed, Embase, CINAHL, Web of Science, Cochrane, Scopus. Methods: A scoping review was conducted per the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A comprehensive search of 6 electronic databases yielded 1,231 articles using keywords related to vestibular schwannoma, centralization of care, centers of excellence, and ethical considerations. After removing duplicates (n=344) and screening titles and abstracts (n=887), 17 full-text articles were reviewed. Two additional articles were identified through manual screening. A total of 15 studies were included in the final analysis. Results: Hospitals were categorized by surgical case volume (high, medium, low) to compare patient demographics and clinical outcomes. Patients seen at low-volume hospitals (LVHs) were generally older and more racially diverse, and more likely to have public insurance (Medicare or Medicaid), whereas high-volume hospitals (HVHs) served a younger, predominantly White, and privately insured population. Of the 14 studies evaluating outcomes, 12 demonstrated a positive association between higher surgical volume and improved outcomes, including reduced complications, lower mortality, shorter length of stay, and decreased hospitalization costs. High-volume hospitals also had significantly higher rates of routine discharge. Conclusion: Centralization of vestibular schwannoma care to high-volume centers is associated with improved clinical outcomes and reduced health care costs. However, these benefits must be carefully weighed against potential ethical concerns, including disparities in access related to socioeconomic status, insurance coverage, and geographic location.

Abstract The Mayo Clinic Center for Clinical and Translational Science Rural Health Research Core emphasizes community engagement to address healthcare access and delivery. In 2023, the Midwest Rural Health Research Community Advisory Board (CAB) was established to guide research. Eleven of 13 researchers presenting to the CAB in 2023 completed a survey assessing influence of CAB feedback across seven domains. All reported >1 domain influenced by CAB feedback, most commonly on study design, pre-research activities and implementation. CAB feedback shaped many aspects of the rural health research process. CAB members valued seeing how their input contributed to the research process.

Abstract Effective communication in the intensive care unit (ICU) is essential, particularly for patients with non-English language preference, yet timely access to professional interpreters remains limited. While artificial intelligence (AI)-based translation tools have been explored in outpatient and nonacute care settings, studies evaluating their use in acute care, environments such as the ICU remain limited. To address this gap, we developed AI-TransLATE (AI-enhanced Transition to Language-Agnostic Transcultural Engagement), a speech-based translation tool designed for multilingual communication in critical care settings. This study aimed to assess the interpretation quality of AI-TransLATE across four languages—Spanish, Chinese, Arabic, and Turkish—using scripted ICU scenarios. We created ICU communication scripts and recorded bilingual research team members simulating clinical interactions. Two independent bilingual evaluators assessed interpretation quality using a 5-point Likert scale across fluency, adequacy, meaning preservation, and severity of errors. Clarity and cultural appropriateness were also rated. Percentage agreement was used to assess interrater agreement. AI-TransLATE achieved acceptable composite scores (≥16/20) across all languages. Spanish and Turkish performed consistently well; Chinese and Arabic showed variability due to omissions and terminology errors. AI-TransLATE shows promise as a clinical communication tool, but further evaluation in real-world, unscripted ICU settings is needed.

Aging is unavoidable and driven, at least in part, by the biologic process termed senescence. Senescence is characterized by cell cycle arrest incurred by one or more stressors wherein there is cellular upregulation of cyclin-dependent kinase inhibitors, p16 Ink4a and/or p21 Cip1 . Senescent cells are metabolically active and resistant to apoptosis, have increased β -galactosidase activity, and express a senescence-associated secretory phenotype (SASP). The SASP produces an array of inflammatory, cytotoxic, fibrotic, and vasoactive factors. Senescence is a diffusible process as, largely through the SASP, a focus of senescent cells can recruit adjacent cells and cells in distant organs, thereby expanding its scope way beyond its original focus. Senescence predisposes not only to chronic diseases (including CKD) but also acute processes (including AKI). This review provides evidence that age increases the risk of human AKI and summarizes clinical factors that predispose older individuals to AKI. It provides an overview of the biology of senescence, and it discusses the role of intrarenal senescent cells in the pathogenesis of AKI, the significance of the extrarenal milieu and distant organs in predisposing to AKI with age, heme as a prosenescent species, and the role of senescence in the AKI to CKD transition. The risk for AKI with aging, in large part, reflects the fact that virtually all processes implicated in AKI, irrespective of age, occur as the kidney ages. Processes discussed include senescent cells, vascular responses, diabetes, impaired NAD + content, sirtuin expression, mitochondrial dysfunction, impaired autophagy, epigenetic changes, telomere shortening, impaired nephroprotectant expression, inflammaging, and immunosenescence. The review concludes by discussing the basis for senolytics (agents that kill senescent cells), senomorphics (agents that block SASP factors), and other aspects of senotherapies.

BACKGROUND AND OBJECTIVES: Stereotactic radiosurgery (SRS) for brain arteriovenous malformations (AVMs) can cause radiation-induced changes (RIC), but its interactions with AVM embolization are not well established. The aim of this study was to assess the effect of previous embolization on RIC in SRS-treated AVM patients. METHODS: Data of AVM patients treated with single-session SRS from 1987 to 2018 were retrieved from the International Radiosurgery Research Foundation. Univariable and stepwise backward logistic regression models were used to identify RIC predictors. Patients were stratified into those who received pre-SRS embolization (E + SRS) vs those who did not (SRS-only). Radiologic RIC (rRIC) was the primary end point. Secondary outcomes included symptomatic RIC (sRIC) and permanent symptomatic RIC (pRIC). RESULTS: Among 1187 AVM patients, the mean age was 36.4 years (SD 16.8), with 50.4% female patients. AVMs had a mean untreated AVM volume of 5.2 cm 3 . A total of 130 patients (11%) underwent neoadjuvant embolization (E + SRS). The overall rRIC and sRIC rates were 32.8% and 12.1%, respectively, with time to rRIC and sRIC being significantly longer in the E + SRS vs SRS-only cohorts (103.6 ± 339.4 vs 11.3 ± 12.5 and 60.4 ± 262.9 vs 9.5 ± 9.0 months, respectively). Seizures at presentation and ≥3-cm untreated AVM volume significantly correlated with a higher likelihood of rRIC (adjusted odds ratio [aOR] 2.32 [1.25-4.30] and aOR 2.77 [1.24-6.16], respectively). Age and pre-SRS embolization were associated with a significantly lower risk of rRIC (aOR 0.97 [0.96-0.99] and aOR 0.32 [0.13-0.74], respectively). The E + SRS cohort had significantly reduced odds of rRIC (aOR = 0.37 [0.15-0.89]) and pRIC (aOR = 0.04 [0.00-0.30]) after adjusting for significant covariates. CONCLUSION: Seizures at presentation and larger untreated AVM volume were independently associated with an increased risk of rRIC, whereas older age and pre-SRS embolization were protective. Notably, patients who underwent embolization before SRS had lower odds of rRIC and pRIC, with delayed onset of complications compared with SRS-only.

Circulating tumor DNA (ctDNA) is increasingly being used to monitor minimal residual disease (MRD) in various solid tumors, including urothelial carcinoma (UC). It has emerged as a promising biomarker for MRD and may serve as a valuable tool to guide treatment decisions, particularly in patients at high risk of recurrence after definitive therapy or those experiencing favorable responses to systemic therapy in the setting of locally advanced or metastatic disease. ctDNA technology is largely agnostic to the type of tumor, which can be either hematologic or solid organ malignancies. Its clinical utility requires validation across different tumor types as ctDNA release kinetics and threshold values for testing often vary. Moreover, it is essential to evaluate ctDNA testing across a range of clinical scenarios, including screening, diagnosis, prognosis, and therapeutic decision making. The optimal frequency and duration of testing also need to be defined, particularly in settings such as postdefinitive therapy and ongoing chemotherapy for metastatic disease. In this study, we will summarize the current literature on the role of ctDNA in urothelial cancer. We will discuss the data that inform us of current clinical practice. Furthermore, we will explore evolving developments in the field from other tumor types and potential future directions in UC. Finally, we will highlight selected clinical scenarios for applications of ctDNA testing and its interpretation.