Citations

Radiation exposure to the eye during cancer treatment can lead to ocular radiation injury (ORI), a devastating condition that can have a profound and permanent impact on vision-related quality of life. Rodent models do not have adequate ocular anatomy to accurately simulate human ORI, and modeling in non-human primates is limited by logistical and ethical concerns. To improve future translational research investigating ways to treat or prevent ORI, we developed protocols for a tree shrew model of ORI. Northern tree shrews (Tupaia belangeri) were obtained by our laboratory. Custom housing and handling methods were developed, including custom body suits to maintain the tree shrew’s body temperature during procedures. Radiation delivery was optimized to accurately deliver radiation, and imaging was performed to observe fundus changes from ORI. Optimization of tree shrew handling, housing, anesthesia approaches, radiation delivery, and clinically-relevant ocular imaging permitted successful induction and assessment of ORI in tree shrews. With these protocols, tree shrews can be used as a highly relevant model organism with key anatomic features similar to humans to study ORI.

ABSTRACT Telemedicine is a broad term that encompasses all aspects of utilizing information and communication technologies to provide health services at distant sites. The primary goal of telementoring is the education and training of gastrointestinal (GI) endoscopists particularly in areas where there is a shortage of endoscopy trainers. Telementoring in GI endoscopy can help to provide teaching and skills training both in simulator‐based learning, and endoscopic skills training in the context of patient care. This position statement aims to outline the role of telementoring within GI endoscopy, offering a general model for the introduction and evaluation of a telementoring program that incorporates both simulators for junior trainees and skills training for practicing endoscopists. We hope to highlight its utility and implementation in remote locations. WEO recognizes that telementoring is valuable to expand access to high‐quality endoscopy training especially in parts of the world where there is a shortage of endoscopy trainers and this document can serve as a guide in the planning and implementation of telementoring programs.

This paper develops and characterizes an adaptive hybrid Electrodynamic Intelligence (EDI) Neuro-Patch, a biohybrid interface uniting the physical, electrical, and functional dimensions of neural plasticity. Unlike conventional neuromorphic systems that simulate synaptic learning algorithmically, the hybrid EDI approach treats charge-flux interactions within memristive neurons as the substrate of computation itself. In this framework, axonal conduction and synaptic integration occur from continuous electrodynamic evolution, where memory, adaptation, and signal propagation are inseparable physical processes. The hybrid neuro-patch combines a solid-state conductive upper layer for rapid signal modulation with a lower iontronic layer providing slow, adaptive reconfiguration. Controlled programming pulses induce state transitions, allowing path learning through field-mediated adaptation rather than digital feedback. By integrating devicelevel electrodynamics with cortical network dynamics we establish a quantitative framework linking voltage, conductance, and path reconfiguration across scales from nanometers to cortical circuits. The simulations demonstrate emergent network stabilization and adaptive routing, suggesting that hybrid EDI neuro-patch could provide self-organizing implants for restoring and maintaining stable neural function through the intrinsic physics. By demonstrating that memory, adaptation, and signal propagation are inseparable physical processes rather than algorithmic constructs, the hybrid EDI neuro-patch highlights a new framework for self-organizing neural computation. This approach provides a pathway toward adaptive implants able of restoring and maintaining stable neural function through the intrinsic physics of matter with potential applications in epilepsy suppression, spinal injury bridging, and adaptive prosthetic control. Beyond its immediate clinical utility, a modular, scalable design could provide a platform for next-generation biohybrid or synthetic brain architectures, neuromorphic computation, and distributed neural networks with a clear pathway toward advanced brain–machine interfaces.

Abstract Feedback is the transfer of information about an action back to the performing individual in order that the individual can adjust the performance on subsequent actions, allowing for informed learning. In his landmark article, Ende explained that feedback exposes the gap between the actual and intended outcomes. By increasing the learner's awareness of his/her weaknesses and strengths, feedback supports the development of strategies for performance improvement. The focus of this article is on formative feedback in the context of surgical education and practice. As trainees progress through a competency-based curriculum, they observe, participate, and gradually gain independence. The importance of prompt and specific feedback cannot be overstated as it helps trainees track progress, adapt performance and behaviors, and ultimately achieve required competencies. This discussion will explore established feedback models, barriers to giving and receiving feedback, and the unique considerations of feedback to trainees and surgeons.

The emergence of state-of-the-art large language models (LLMs), which hold the ability to generalize to diverse natural language processing tasks, has led to new opportunities in health care. Oncology is especially well-suited to leverage these resources as the journeys of patients with cancer inherently yield extensive, longitudinal data sets comprising clinical narratives, pathology and radiology reports, and genomic sequencing reports. This review begins with an overview of the fundamental concepts behind LLMs, including the definitions, architecture, training paradigm, and performance optimization through prompt engineering and retrieval-augmented generation. We also take a moment to explore the newly emerging paradigm of LLMs in a multiagentic framework. We then synthesize current research on how LLMs may benefit stakeholders within the practice of oncology, including patients, oncologists, researchers, and learners. Finally, we address the limitations and risks of LLMs, including hallucinations, inherent biases, patient privacy, and clinician deskilling. While research thus far shows significant potential for LLMs to transform cancer care, necessary future directions include studies emphasizing patient stakeholder perspectives on LLM incorporation in clinical workflows, the development of relevant clinical benchmarks for LLM evaluation, a greater focus on real-world prospective testing, and deeper exploration of LLM reasoning capabilities.

PURPOSE STELLAR (ClinicalTrials.gov identifier: NCT02796261 ) was a phase III, randomized, open-label trial of eflornithine + lomustine versus lomustine monotherapy in patients with recurrent grade 3 astrocytoma. METHODS At trial initiation, eligibility criteria included: age ≥18 years, anaplastic astrocytoma (2016 WHO CNS Tumor classification [WHO CNS4]), first recurrence ≥6 months after radiation and temozolomide (TMZ), Karnofsky performance status ≥70, and no imaging findings consistent with grade 4 glioblastoma. Random assignment (1:1) was stratified by isocitrate dehydrogenase ( IDH ) mutation, age, resection extent, and geography. Patients received eflornithine (2.8 g/m 2 orally, every 8 hours [2 weeks on, 1 week off]) + lomustine (90 mg/m 2 orally, once every 6 weeks), or lomustine monotherapy (110 mg/m 2 once every 6 weeks). The primary end point was overall survival (OS). RESULTS Among 343 patients randomly assigned across 74 sites in eight countries, there was no difference in survival between eflornithine + lomustine and lomustine monotherapy (median OS 23.4 v 20.3 months, hazard ratio [HR], 0.94). Following changes in classification and grading in the 2021 WHO CNS5, a subset analysis of patients with IDH- mutant, grade 3 astrocytoma (n = 196), defined in 2024, before unblinding, showed clinically meaningful improvements in median OS with eflornithine + lomustine versus lomustine monotherapy (34.9 v 23.5 months, HR, 0.64) and median progression-free survival (PFS, 15.8 v 7.2 months, HR, 0.57). No differences were observed among patients with CNS grade 4 disease. Grade ≥3 treatment-emergent adverse events of relevance were related to reversible myelosuppression (eflornithine + lomustine 42% v lomustine monotherapy 29% of patients) and hearing impairment (24% v 0%). No new safety signals were identified. CONCLUSION Clinically meaningful improvements were observed; eflornithine + lomustine doubled PFS and improved OS in patients with recurrent IDH -mutant, grade 3 astrocytoma, but not grade 4 tumors, after prior radiotherapy and TMZ, consistent with its cytostatic mechanism of action.

ABSTRACT The Mayo Foundation Special Purpose Processor Development Group has been supporting a serial link development effort. In order to characterize serial link performance, two versions of a multi-chip module (MCM) test vehicle were assembled to study the effects of the substrate and the integrated circuit input/output buffer technologies on basic signal integrity performance parameters at data rates of 2.5 GHz. The difference between the test vehicles was the substrate technology used: ceramic and laminate. This paper describes the steps taken to develop an assembly process for the ceramic version of the test vehicle. The ceramic test vehicle consisted of a high thermal coefficient of expansion ceramic substrate, 2 CMOS chips with IBM high lead content (hereafter: “high lead”) bumps, 16 surface mount (SMT) capacitors, and an interposer. Assembly processes needed to be developed for SMT attach of the capacitors, flip-chip attach of the chips, and ball grid array (BGA) attach of the interposer. Based on Mayo's suite of assembly equipment, three process flows could have been used to attach the capacitors and the chips to the substrate: High lead attach of the capacitors and chips; Eutectic attach of capacitors, high lead attach of chips; Eutectic attach of the capacitors and chips. Assembly process flow 1 required the least number of steps. Therefore, it was initially selected as the process flow. However, this process flow was found to be unsatisfactory due to problems with flux charring around the capacitors and a high incidence of chip to substrate opens. Assembly process flow 2 was then evaluated. Assembly process flow 3 was considered the least desirable because eutectic solder paste had to be coated on the substrate die pads and Mayo did not have capability to do this. In order to develop the capacitor and die attach processes and to set up the interposer attach process, two assembly test vehicles were built on glass substrates. A capacitor attach process was devised that involved stenciling the eutectic solder paste, placing the capacitors, and then reflowing the assembly. The flip-chip attach process development required greater effort. Experimental matrices were run that allowed an assessment of bond strength as a function of flux quantity, bond force, and reflow temperature and time. Water-soluble flux was used for the chip attach process, so a de-fluxing process had to be developed. The chips then needed to be underfilled. The underfill dispense pattern and substrate heating were evaluated. The interposer was attached using eutectic solder paste stenciled on the back of the substrate. A BGA style attach process was set up to do this. The result of this process development activity was the successful assembly of 21 modules with no defects. Lessons were learned during the assembly process development regarding the difficulties associated with attaching components with high lead solder.