Citations

Abstract Background Onco-hypertension, the interplay between cancer and hypertension, is an emerging specialty highlighting the bidirectional relationship between carcinogenesis, anticancer therapies, and blood pressure regulation. In Pakistan, data on physicians’ awareness and management of onco-hypertension are limited, yet critical given the rising global burden of cancer (24.5 million new cases; 9.6 million deaths in 2017) and hypertension (7.6 million annual deaths) worldwide. Methods A cross-sectional survey was conducted from May to October 2023 among physicians in oncology, internal medicine, cardiology, and allied specialties across tertiary hospitals, private clinics, and teaching institutions in Pakistan. A self-structured questionnaire, covering sociodemographic, knowledge, attitudes, and clinical practices, was distributed online and in person. Descriptive statistics summarized respondent characteristics, and inferential tests (t-tests, ANOVA) examined associations (p < 0.05). Results Mean respondent age was 37.5 ± 7.8 years; 58% male. Specialty distribution: internal medicine (45%), oncology (16%), cardiology (17%), nephrology (8%), pulmonology (13%), and others (1%). Nearly half (49%) rated their onco-hypertension knowledge as “average,” and 62% reported challenges managing hypertensive cancer patients. Key perceived causes in previously normotensive patients were anxiety (48%) and corticosteroid use (40%). Sixty-three percent sometimes adjusted antihypertensive regimens based on cancer therapies, and 80% endorsed the necessity of interdisciplinary coordination for optimal management. Conclusion Pakistani physicians demonstrate moderate understanding of onco-hypertension with prevalent management challenges. Findings underscore the need for targeted educational initiatives, validated clinical guidelines, and structured interdisciplinary collaboration to improve cardiovascular outcomes in cancer care.

Background Immune‐checkpoint inhibitors (ICI) are associated with adverse cardiac events. Although troponin elevation is a diagnostic criterion for ICI‐related myocarditis (ICIrM) and myocardial infarction, data on other causes of troponin elevation and their outcomes in ICI‐treated patients are limited. Methods All patients treated with ICI who had hs‐TnT (high‐sensitivity troponin T) measured at a multicenter institution from 2011 to 2022 were included. Clinical data, outcomes (cardiac death, heart failure (HF), major adverse cardiovascular events [myocardial infarction, stroke, heart failure]), and cause of hs‐TnT elevation were assessed. Risks of cardiac events were compared across hs‐TnT elevation causes. Results Of 5423 patients treated with ICI, 1669 had post‐ICI hs‐TnT measurement (mean age 68.7±11.3 years, 58.3% male), with 1‐year follow‐up. Hs‐TnT elevation in patients with ICIrM (n=59) was associated with the highest risk for cardiac death (hazard ratio [HR], 52.7 [95% CI, 11.7–238.0], P <0.001), followed by hs‐TnT elevation due to heart failure (HR, 15.9), myocardial infarction/type 2 ischemia (HR, 11.6), and infection/sepsis (HR, 5.7), compared with those with no hs‐TnT elevation. ICIrM also carried highest risk for major adverse cardiovascular events (HR, 8.2, [95% CI, 4.4–15.3], P <0.001), followed by myocardial infarction/type 2 ischemia (HR, 8.1), heart failure (HR, 7.6), pulmonary embolus (HR, 5.1), infection/sepsis (HR, 4.1), and indeterminate cause (HR, 2.4). Among ICIrM, HsTnT value >576 ng/L best predicted risk for cardiac death and >319 ng/L for major adverse cardiovascular events. Conclusions Hs‐TnT elevation after ICI therapy is associated with increased risk of cardiac events, particularly in ICIrM, and a graded prognostic association depending on the cause of hs‐TnT elevation. Identifying the underlying cause and troponin thresholds may guide risk stratification and management.

The field of radiology is experiencing rapid adoption of large language models (LLMs), yet their tendency to generate hallucinations (plausible but incorrect information) remains a significant barrier to trust. This comprehensive review evaluates emerging agentic artificial intelligence (AI) approaches, including multi-agent role-based systems, retrieval-augmented generation (RAG), and uncertainty quantification, to assess their potential for reducing hallucinations in radiology workflows. Evidence from 2024 to 2025 demonstrates that agentic AI can improve diagnostic accuracy and reduce error rates, though these methods remain computationally demanding and lack comprehensive clinical validation. Multi-agent frameworks enable cross-validation through role-based specialization and systematic workflow orchestration, while RAG strategies enhance accuracy by grounding responses in verified medical literature. Within multi-agent systems, uncertainty quantification enables agents to communicate confidence levels to one another, allowing them to appropriately weigh each other’s contributions during collaborative analysis. While multi-agent frameworks and RAG strategies show significant promise, practical deployment will require careful integration with human oversight, robust evaluation metrics tailored to medical imaging tasks, and regulatory adaptation to ensure safe clinical use in diverse patient populations and imaging modalities.

Abstract The progression of osteoarthritis (OA) is fundamentally characterized by the aberrant transformation of chondrocytes into a fibrotic phenotype, although the precise molecular mechanisms involved remain inadequately understood. In this study, the interplay between epigenetic modifications and metabolic reprogramming during the activation of fibrocartilage cells in osteoarthritis was investigated. The findings demonstrate that FSTL1 markedly upregulates key glycolytic enzymes, including LDHA, HK2, and PKM, in chondrocytes, triggering a “glycolytic burst” that results in elevated intracellular lactate levels. This accumulated lactate acts as a precursor for epigenetic modifications, specifically promoting the lactylation of histone H3 lysine 18 (H3K18la) in fibrocartilage cells, thereby facilitating the transcriptional activation of critical fibrosis‐related genes such as Itga6, Cxcl10, and Parp16. Notably, pharmacological inhibition of the PI3K/mTOR pathway or lactate dehydrogenase significantly diminishes H3K18la levels and markers of chondrocyte fibrosis, while exogenous lactate supplementation can counteract this effect. In summary, this study unveils the core mechanism by which FSTL1 reshapes the epigenetic landscape of chondrocytes and drives the fibrotic process through the activation of the “glycolysis‐lactate‐H3K18la” cascade axis, offering a dual‐target intervention strategy for OA involving metabolic reprogramming and epigenetic modification.

The breadth of medical practice for a physical medicine and rehabilitation (PM&R) physician is quite extensive. Not only are practice areas quite different among PM&R physicians, but practice settings, procedures, and salary models also vary significantly. For PM&R residents and fellows who are making career decisions regarding specialization versus general practice and/or in the process of negotiating contracts, salary is a significant influence in their decision of clinical practice. Physician payment models may create inadvertent bias against women, those seeking less than full time clinical employment, and those interested in an academic career. In this review and commentary, we will discuss the more common payment models encountered, with a focus on a fixed salary payment model. We will also discuss our experiences as pediatric and adult PM&R providers in a salaried payment model at a not-for-profit academic institution.

In 2023, the American Congress of Rehabilitation Medicine Brain Injury Interdisciplinary Special Interest Group (ACRM BI-ISIG) Mild Traumatic Brain Injury (TBI) Task Force published updated diagnostic criteria for mild TBI. These criteria were developed in collaboration with a panel of 32 subject matter experts in mild TBI using the Delphi method. The 2023 ACRM diagnostic criteria marked the first update since 1993, incorporating three decades of research advancements in our understanding of mild TBI. To facilitate the consistent use of the new diagnostic criteria, the ACRM BI-ISIG Mild TBI Task Force initiated a special project in September 2023 to develop a structured interview to apply the ACRM diagnostic criteria for mild TBI in clinical and research settings. The purpose of this article is to describe the development of the ACRM Structured TBI Interview and the accompanying documents. The ACRM Structured TBI Interview was developed in four phases: (1) initial development of a draft interview by two project leads, (2) review and revision over three rounds by 17 members of the ACRM BI-ISIG Mild TBI Task Force, (3) external review by 19 subject matter experts in mild TBI, and (4) field testing of the ACRM Structured TBI Interview by 11 interviewers who completed 25 diagnostic interviews. In addition to the ACRM Structured TBI Interview, three other documents were developed to help facilitate the administration of the interview (Administration Guide) and to apply the diagnostic criteria (Diagnostic Coding Form and Diagnostic Flow Diagram). A Short Form was also developed for use in contexts where administering the full structured interview is not feasible due to time constraints.

Stroke is the second-largest cause of death and disability worldwide, and many patients require intensive care for airway compromise, hemodynamic instability, cerebral edema, or systemic complications. This review summarizes key aspects of ICU management in both acute ischemic stroke (AIS) and hemorrhagic stroke (HS). Priorities are airway protection, oxygenation, individualized blood pressure targets, and strict control of temperature and glucose. Neurological monitoring and prompt management of intracranial pressure (ICP), together with timely surgical interventions (hemicraniectomy or hematoma evacuation), are central to acute care. Seizures are treated promptly, while routine prophylaxis is not recommended. Prevention of aspiration pneumonia, venous thromboembolism, infections, and other intensive care unit (ICU) complications is essential, along with early nutrition, mobilization, and rehabilitation. Prognosis and decisions about intensity of care require shared discussions with families and involvement of palliative services, when appropriate. Many practices remain based on observational data or extrapolation from other populations, underlining the need for stroke-specific clinical trials. Outcomes are consistently better when patients are managed in specialized stroke or neurocritical care units with a multidisciplinary treatment approach

Abstract Computational analysis of speech enables precise, objective measurements of a behavioral signal closely linked to manic episodes. In a prospective cohort study conducted in Rochester, MN ( ClinicalTrials.gov Identifier: NCT05956340 ) , eighteen English-speaking adults voluntarily hospitalized for a manic episode of Bipolar I Disorder between August 2023 and September 2024 were enrolled. Participants completed semi-structured research interviews during both acute episodes and remission, with manic symptom severity assessed at each session using the Young Mania Rating Scale (YMRS). Across 57 recorded interviews, temporal prosodic features were extracted using automated computational algorithms. After adjusting for individual differences and moderating effects, participant articulation rate (β = 0.24, p = 0.0038), speech rate variability (β = 0.23, p = 0.0041), floor transfer offset (β = -0.31, p = 0.007), and speaking duration (β = 0.54, p < 0.001) were significantly associated with manic symptom severity. These temporal elements classified manic (CV AUC = 0.85) and remission (CV AUC = 0.83) status, highlighting their potential as monitoring and prognostic biomarkers for manic episodes.