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Exploring Latent Prostate Cancer: A Forensic Autopsy Study in South India
No full textBACKGROUND: Forensic autopsies offer a unique opportunity to study the natural history of prostate cancer (PCa), especially in individuals who had no prior diagnosis or long-term medical interventions. These examinations provide unbiased data on the true prevalence and progression of latent, asymptomatic prostate cancer. Unlike PSA screening-which often leads to overdiagnosis and unnecessary treatment-autopsy studies reveal clinically silent cases, particularly in older men. This prospective analysis was conducted to explore the prevalence and features of latent PCa in a South Indian population.
METHODS: A study was conducted at a primary hospital in Vellore, Tamil Nadu, from August 2023 to April 2024. A total of 100 whole prostatectomy specimens were collected during forensic autopsies of male decedents aged 40-86 years, who had died under various medicolegal causes. Histopathological analysis was performed to identify the presence of latent prostate cancer. Data collected included basic history, cause of death, location of PCa, and Gleason scores.
RESULTS: Histopathological examination revealed that 9 out of 100 cases were diagnosed with invasive adenocarcinoma, with Gleason scores of 3 + 3 = 6 or 3 + 4 = 7, primarily in individuals aged over 60. The remaining 91 cases exhibited benign prostatic hyperplasia (BPH). These latent malignancies were more frequently found in individuals over the age of 60 years.
CONCLUSIONS: This study highlights the role of forensic autopsies in detecting latent prostate cancer that may have gone undiagnosed during life. By providing insight into the frequency and characteristics of prostate cancer in a defined geographic and demographic context, the findings contribute to the understanding of its natural history. The results emphasize the need for age-specific screening strategies and underscore the importance of comprehensive autopsy evaluations in uncovering hidden disease burdens in the population
The sociocultural ecology of resilience: A comparative study among women in the United Kingdom
No full textResilience is often framed as an internal, individual process. However, this perspective overlooks the complex relationship between individuals and their social and ecological contexts. Drawing on insights from evolutionary anthropology, psychology, and public health, this paper explores how women who use drugs from two regions in the United Kingdom perceive resilience and navigate intricate sociocultural environments of recovery. It also considers factors that promote resilience and those that can cause harm. This study was conducted in two regions of England: Northeast England (n = 14), including Newcastle upon Tyne and Durham, and Greater London (n = 10). Participants, who were actively engaged in recovery services, participated in one-on-one in-depth interviews that included questions about their perceptions of and direct experiences with substance use and recovery. They were also asked to share their journeys into addiction and subsequent recovery while reflecting on the barriers and facilitators to recovery for women in their community. Our findings support a growing body of research that emphasizes recovery as a relational process. Women in Northeast England and London relied on social networks, particularly through peer meetings, to navigate their recovery. Additionally, key themes included the impact of community and institutional harm, particularly in promoting isolation and emotional distress. This study highlights the significance of social learning and relational resilience in addiction recovery, framed within a sociocultural-ecological model. These findings underscore that recovery is not solely an individual process but one deeply embedded in broader sociocultural and relational dynamics
Project #088: Increasing Access to Occupational and Physical Therapy for Postpartum Patients
Full text linkhttps://scholarlycommons.henryford.com/qualityexpo2025/1013/thumbnail.jp
Project #119: Early Conversations, Better Outcomes: Advance Care Planning in Critical Care
No full texthttps://scholarlycommons.henryford.com/qualityexpo2025/1022/thumbnail.jp
Addressing the Diabetes Tsunami Requires Expanded Access to Diabetes Technologies
No full textThe use of continuous glucose monitoring (CGM) and automated insulin delivery (AID) technologies can improve patient outcomes and overall quality of life while helping to reduce the long-term costs. However, current eligibility criteria imposed by many major commercial insurers limit access to these technologies among a large portion of the diabetes population. This narrative review and commentary highlights the evidence supporting the use of CGM and AID in the various diabetes populations, discuss the current eligibility criteria that make these technologies inaccessible to individuals who would benefit, and present recommendations for modifying these criteria
Recurrence of autoimmune hepatitis cholestatic variant syndromes after liver transplantation affects graft and patient survival
No full textBACKGROUND & AIMS: A significant proportion of patients with variant syndromes (VSs), namely autoimmune hepatitis/primary biliary cholangitis or autoimmune hepatitis/primary sclerosing cholangitis, require liver transplantation (LT) despite treatment. The frequency of disease recurrence and the effect on graft survival are yet to be clarified. The aim of this international, multicentric, retrospective study is to evaluate the risk factors associated with recurrence and the impact of the disease recurrence after LT on graft and patient survival.
METHODS: We evaluated 166 patients undergoing LT for VS in 33 centers in North America, South America, Europe, and Asia. Clinical data before and after LT, biochemical data within the first 12 months after LT, and immunosuppression after LT were analyzed to identify patients with a higher risk of recurrence of autoimmune disease based on a histological and radiological diagnosis. Cumulative probabilities of graft and overall survival after LT were calculated using a semi-Markov model.
RESULTS: The autoimmune pattern of recurrence resembled the original VS in 19 cases (61%). Recurrence of autoimmune liver disease (rALD) after LT was observed in 23% and 33% of patients after 5 and 10 years, respectively. Increased alkaline phosphatase (hazard ratio [HR] 1.60, 95% confidence interval [CI] 1.13-2.25, p \u3c 0.01) and alanine aminotransferase (HR 1.25, 95% CI 1.01-1.53, p = 0.03) at 12 months after LT and acute rejection (HR 3.58, 95% CI 1.60-7.73, p \u3c 0.01) were associated with a higher risk of VS recurrence, whereas the use of predniso(lo)ne was associated with a reduced risk (HR 0.30, 95% CI 0.14-0.64, p \u3c 0.01). After adjusting for alanine aminotransferase and alkaline phosphatase at 12 months, the use of predniso(lo)ne was found to be independently and negatively associated with recurrent disease. The rALD was found to be significantly associated with graft loss and patient survival in the multivariate Cox regression analysis with a time-dependent covariate. The 5- and 10-year probabilities of graft survival were 68% and 41% in patients with recurrent VS compared with 83% and 60% in patients without recurrent disease, respectively (p = 0.01). The overall survival was significantly reduced in patients with recurrent disease (p = 0.01), with event probability at 5 and 10 years of 75% and 49% vs. 84% and 60% in patients without recurrence, respectively.
CONCLUSIONS:
: rALD after LT is frequent and is associated with elevation in liver enzymes within the first year after LT and rejection episodes. According to our data, VS recurrence appears to be associated with poorer graft and patient survival. Further studies are needed to explore strategies that can prevent VS recurrence or mitigate its potential impact.
IMPACT AND IMPLICATIONS: This study investigated the recurrence of autoimmune liver diseases (rALD) in patients transplanted for variant syndromes (VSs) and its effect on graft and patient survival. The findings reveal a significant association between rALD and poorer graft and overall survival, highlighting the need for preventive strategies. This research is crucial for transplant physicians and healthcare providers, as it underscores the impact of early liver enzyme monitoring and tailored immunosuppressive therapy on long-term outcomes. These insights can inform more effective post-LT management protocols, potentially improving patient prognosis
Treatment of imperforate submandibular duct: A systematic literature review and case report
No full textBACKGROUND: Imperforate submandibular ducts are rare with a broad differential including lymphatic malformation, congenital ranula, and thyroglossal duct cyst. Prompt evaluation is important as treatment differs based on the diagnosis. This systematic review aimed to characterize treatments and outcomes for management of imperforate submandibular ducts while describing 2 new cases.
METHODS: The following systematic review was performed using PubMed and EMBASE: imperforate submandibular duct or congenital atresia submandibular duct. All associated papers were also included. Demographics, birth history, symptoms, treatment, and outcomes were collected.
RESULTS: Sixteen articles were included with 22 patients presenting with imperforate submandibular ducts. Most patients were male (67 %), half of them were born at term (50 %), and 15 (62 %) had unilateral imperforate ducts. Eight patients had bilateral presentation. The mean age for initial treatment was 3.5 months. Treatment varied from 11 (48 %) patients undergoing simple incision only, 3 (13 %) underwent incision and ductoplasty, 4 (17 %) underwent marsupialization and ductoplasty, 3 (13 %) underwent marsupialization only, and 2 (9 %) underwent incision and marsupialization. Mean follow-up without recurrence was 20 months. One complication was reported, restenosis after incision only. Two patients presented to our health system a month apart, one male and one female, and both with unilateral cysts. One patient underwent incision and ductoplasty with no recurrence at the 1-week postoperative visit. The second patient is pending incision and ductoplasty.
CONCLUSIONS: Although an exceedingly rare condition, imperforate submandibular duct cysts more often present in males, unilaterally, and can be managed via multiple methods; however, marsupialization has shown no reported recurrences
Patient Simulation-Based Primary Care Training to Increase Evidence-Based COPD Care and Value-Based Success: Real-World Cost and Quality Impact Analysis
No full textAdverse childhood experiences and multisite pain among adolescents in the United States
No full textINTRODUCTION: Childhood adversity can have a lasting negative impact throughout one\u27s life. Youth with pain conditions consistently report a higher rate of adverse childhood experiences (ACEs) when compared with their healthy peers. Adolescents experiencing pain in more than 1 region tend to have greater symptom burden and reduced quality of life. Research on the association between ACEs and multisite pain in adolescents is sparse.
OBJECTIVES: The objective of our study was to investigate the association between cumulative ACEs and self-report of multisite pain in early adolescence using data from the Adolescent Brain Cognitive Development study.
METHODS: We used a 19-region body map to evaluate the presence of regional pain (1-2 regions) and multisite pain (≥3 regions). We analyzed data using multinominal logistic regression, adjusting for sociodemographic factors including pubertal status, sex, race/ethnicity, and income-to-needs ratio.
RESULTS: We included a total of 7582 children aged 12 to 13 years, with 33.4%, 24.0%, 13.2%, and 8.6% reporting 1, 2, 3, and 4+ ACEs, respectively. Moreover, 30.7%, 24.2%, 15.2%, and 10.1% of children with multisite pain reported 1, 2, 3, and 4+ ACEs, respectively. Those with 4+ ACEs (adjusted odds ratio 1.62, 95% confidence interval 1.24-2.12) and 3 ACEs (adjusted odds ratio 1.44, 95% confidence interval 1.14-1.82) were more likely to report multisite pain compared with the children with no ACEs.
CONCLUSION: We showed a potential dose-response relationship between cumulative ACEs and multisite pain, suggesting that the impact of ACEs on pain, particularly multisite pain, may emerge earlier than previously documented
Correlation of American Board of Surgery In-Training Exam Metrics in a Post-Percentile Reporting Era
Full text linkBackground: The American Board of Surgery In-Training Exam (ABSITE) is an annual exam for all surgical residents that functions as a formative assessment to guide learning. Historically, it has been used as summative tool to guide program directors to identify struggling learners at risk of failing the American Board of Surgery (ABS Qualifying Examination. Failure of the Qualifying Exam has been associated with ABSITE scores below the 30th percentile. Starting in 2025, the ABSITE score reports will eliminate percentile rankings by program year, providing only percent correct and a scaled standard score. This study aims to develop and validate predictive targets for standard scores and percent correct to effectively identify residents at risk of scoring below the 30th percentile. Methods: Retrospective data were collected from a community based general surgery program in Michigan between 2012 and 2024. The program year, percentile, percent correct, and standard score were collected to correlate those metrics with future board passage rate. Linear regression analysis was used to determine standard score and percent correct targets for each program year. Target scores were compared to predict performance below the 30th percentile for each program year. Results: 148 tests taken by 42 residents were included in the analysis. Standard score targets were set at 350, 445, 210, 535, 545 for program year 1 through 5, respectively. These standard score targets had an overall sensitivity of 0.87 and specificity of 0.93. Percent correct targets were set at 55%, 64%, 70%, 72%, 73% for program year 1 through 5, respectively. These percent correct targets had an overall sensitivity of 0.87 and specificity of 0.99. Conclusions: The predicted targets for standard score and percent correct were effective in identifying resident performance under the 30th percentile, an evidence-based cutoff for identifying struggling learners. Further investigation is needed to validate these results.https://scholarlycommons.henryford.com/hfjhrs2025/1004/thumbnail.jp