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Executive Summary of the American Radium Society Appropriate Use Criteria for Management of Early Glottic Cancer: A Review
No full textIMPORTANCE: Stage I squamous cell carcinoma (SCC) of the glottic larynx carries a favorable prognosis after treatment with endoscopic surgery or radiation therapy (RT). In addition to tumor control, goals of therapy include preservation of voice quality, swallow function, and breathing. Multidisciplinary consensus guidelines are needed to assist clinicians in treatment selection and the appropriate use of both surgical and radiation-based techniques.
OBSERVATIONS: Treatment of clinical T1N0 glottic SCC has evolved over time, with advances in both transoral laser microsurgery and RT designed to become more targeted and reduce the overall treatment burden for patients. When selecting a treatment option, consideration should be given to patient-specific factors, including tumor position/extent, age, and medical and psychosocial factors. This 16-member multidisciplinary American Radium Society (ARS) Head and Neck Cancer Appropriate Use Criteria (AUC) expert panel performed a review of the English-language medical literature from 2000 to 2022 to inform consensus guidelines. Clinical case variants were developed to represent commonly encountered clinical scenarios, and the RAND/UCLA appropriateness method was used to rate the appropriate use of various treatments. The modified Delphi method was used to reach consensus recommendations, which were approved by the ARS Executive Committee and subject to public comment per established ARS procedures.
CONCLUSIONS AND RELEVANCE: Given the range of treatment options available, early glottic SCC management should be done in a multidisciplinary fashion including otolaryngologists and radiation oncologists. The ARS Head and Neck AUC expert panel created an appropriate-use consensus document by performing a literature review of the current treatment strategies for stage I glottic SCC, providing recommendations regarding the appropriateness of surgery or RT for various clinical scenarios and highlighting areas of controversy and uncertainty
Orchiectomy and scrotectomy as genital gender-affirming surgery: novel surgical technique and patient-reported outcomes
No full textBACKGROUND: Gender-affirming orchiectomy is well described; however, a subset of patients may also seek scrotectomy to alleviate dysphoria related to the scrotum. Techniques and outcomes of gender-affirming orchiectomy and scrotectomy (GAOS) have not been described to date.
METHODS: We retrospectively reviewed all patients who had undergone GAOS from 2021 to 2024 at our institution. The World Professional Association for Transgender Health criteria for surgical treatment were met preoperatively, and patients understood vaginoplasty was not recommended post-scrotectomy. Two approaches were offered: excision of a majority of scrotal tissue and primary closure of the perineal wound, or excision of all rugated skin with mons and groin (Y-flap) advancement. Patient-reported outcomes questionnaires from the PROMIS(®) Sexual Function and Satisfaction Measures, version 2.0, along with questions specific to post-scrotectomy anatomy, were sent postoperatively.
RESULTS: Eight patients, median age 31 years, underwent GAOS with a preoperative hormone duration of 26.5 months. All patients reported dysphoria related to the scrotum and testes, and wished to preserve the phallus. Five elected for primary closure, three for Y-flap perineoplasty. At median 97-day follow-up, all reported satisfaction and dysphoria relief. One patient with Y-flap experienced wound dehiscence requiring operative revision. Four reported sexual activity with the ability to achieve erection and orgasm.
CONCLUSIONS: GAOS is a well-tolerated procedure that can address dysphoria related to the scrotum and testes. Longer-term study of this emerging procedure is warranted. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12894-025-01867-8
A structured training curriculum for robot-assisted radical nephroureterectomy: a Delphi consensus study
No full textOBJECTIVES: To develop an internationally validated, structured robot-assisted radical nephroureterectomy (RARNU) training programme through expert consensus.
MATERIALS AND METHODS: A RARNU-specific questionnaire was developed/adapted from previously published, validated questionnaires for robot-assisted urological procedures. This included five key domains and 11 surgical steps. In all, 30 upper tract urothelial carcinoma experts were invited to participate. A two-stage modified Delphi approach was employed. Consensus was defined as ≥ 80% agreement. Modifications and additional statements were proposed during the second round following qualitative/quantitative feedback from the initial round.
RESULTS: Response rates for the first and second Delphi rounds were 80% (24/30) and 92% (22/24), respectively. All agreed that adoption of a standardised training curriculum can improve clinical outcomes during the RARNU learning curve. There was ≥ 92% agreement on all proposed RARNU steps. Five RARNU clinical modules of increasing complexity were defined using individual step difficulty and number of prior RARNU cases required, with ≥ 96% agreement among respondents. Respondents unanimously agreed that the final assessment should be based on a procedure-specific scale focusing on the hilar dissection, ureteric dissection, and bladder cuff excision steps. No consensus was reached for the annual minimum RARNU volume required for eligibility as a RARNU curriculum host centre.
CONCLUSION: This is the first structured training curriculum for RARNU using international expert consensus. This will help guide surgical educators and trainees toward independent completion of a full RARNU
GLP-1RA comparative effectiveness against dementia onset relative to other antidiabetic medications in a large, multi-site cohort of patients with type 2 diabetes
No full textINTRODUCTION: To address gaps in current research, this study aims to compare the impact of exposure to glucagon-like peptide-1 receptor agonists (GLP-1RA) versus sodium-glucose cotransporter 2 inhibitors (SGLT2i), dipeptidyl peptidase 4 inhibitors (DPP4i), and sulfonylureas (SU) on reducing the risk of dementia, using a rigorous targeted learning causal inference approach.
METHODS: Using clinical and claims data from four diverse US health-care systems, we emulated three two-arm trials contrasting sustained treatment with GLP-1RA versus SGLT2i, DPP4i, and SU on dementia diagnosis. We included diabetes patients aged ≥ 60 years who initiated medication between 2014 and 2022. We estimated cumulative risk differences at 2.5 years.
RESULTS: In Cohort 1, there was no evidence of differential dementia risk between sustained exposure to GLP1-RA versus SGLT2i (adjusted risk difference [aRD] -0.001, 95% confidence interval [CI] -0.004, 0.001). In Cohorts 2 and 3, GLP-1RA was associated with reduced risk of dementia diagnosis compared to DPP4i and SU, respectively (aRD -0.013, 95% CI -0.017, -0.009; aRD -0.016, 95% CI -0.018, -0.015).
DISCUSSION: Rigorous causal inference analysis suggests that sustained exposure to GLP-1RA may modestly reduce risk of dementia, compared to DPP4i or SU exposure-but not compared to SGLT2i.
HIGHLIGHTS: We researched the comparative effects of diabetes medications on dementia. We studied a large, diverse observational cohort of patients with diabetes in the United States. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) may modestly reduce risk of dementia compared to dipeptidyl peptidase 4 inhibitor or sulfonylurea exposure. GLP-1RAs do not show evidence of dementia risk reduction compared to sodium-glucose cotransporter 2 inhibitors. Physicians may consider this when making prescription decisions with patients
Estrogen-containing contraceptive use and blood lead concentrations in a cohort of premenopausal individuals
No full textAfter exposure, toxic metal lead is stored in the skeleton and is mobilized to systemic circulation with bone turnover. Given the bone-conserving properties of estrogen, we investigated whether current use of estrogen-containing contraception is associated with lower blood lead concentrations. We conducted a cross-sectional analysis using enrollment data from the Study of Environment, Lifestyle & Fibroids (SELF), a cohort of 1693 Black women ages 23-35 years enrolled in years 2010-2012. The study population was restricted to non-users of injectable hormonal contraception with questionnaire data on hormonal contraceptive use and laboratory data on whole blood lead concentrations (n = 1549). The geometric mean blood lead concentrations for current users of estrogen-containing contraception and non-users were 0.41 μg/dl (95 % CI: 0.39-0.43) and 0.51 μg/dl (95 % CI: 0.50-0.52), respectively. After adjusting for age, education, current smoking status, alcohol consumption, recency of injectable contraceptive hormone use, and recent birth using a multivariable linear regression model to estimate the percent difference in blood lead concentrations, current use of estrogen-containing contraception was associated with an 11 % lower blood-lead concentrations (95 % CI: -16 %, -5 %). In exploratory analyses considering contraceptive type, current combined oral contraceptive users (n = 187) had 10 % lower blood lead concentrations (95 % CI: -16 %, -4 %) and contraceptive vaginal ring/transdermal patch users (n = 33) had 18 % lower blood lead concentrations (95 % CI: -29 %, -5 %) compared with non-users. Given the known toxic effects of lead and the common use of estrogen-containing contraception, further research is warranted to confirm our observation of lower blood lead concentrations with current use of estrogen-containing contraception
Role of universal and targeted recommendations for vaccines for sexually transmitted infections in the USA, China and Indonesia: a cross-sectional study.
No full textBACKGROUND: Vaccines for sexually transmitted infections (STIs) are in development and little is known about their future acceptance. The type of recommendations released by National Immunisation Technical Advisory Groups could influence vaccine uptake. This study aims to understand how universal and targeted wording affects theoretical acceptance to vaccines for four common STIs (chlamydia, gonorrhoea, syphilis and genital herpes) in the USA, China and Indonesia. We also aim to understand how universal and targeted wording may influence acceptance among those who engage in high-risk sexual behaviours.
METHODS: A total of 1941 adults between the ages of 18 and 45 were included in the final sample. For each country, the sample was stratified by sexual behaviours, then the proportion of those who accepted each vaccine under universal or targeted wording was reported. χ(2) tests were used to assess differences, and the likelihood of vaccine acceptance was represented using prevalence ratios (PRs) from Poisson regression models.
RESULTS: Overall, vaccine acceptance for each STI and in every country sampled tended to be lower among those who received targeted wording compared with universal wording. Previous knowledge of STIs significantly affected vaccine acceptance. In the USA, there was significant interaction between recommendation wording type and having heard of the STI; individuals who had previously heard of STIs were more likely to accept an STI vaccine, and that this acceptance varied significantly based on whether they received a universal (PR: 1.30, 95% CI: 1.05 to 1.62) versus targeted recommendation (PR: 2.45, 95% CI: 1.69 to 3.56).
CONCLUSIONS: Our results are important for future vaccine recommendations as vaccine hesitancy and refusal are on the rise globally. Thus, wording and education surrounding sexual health and STIs are factors that influence decision-making. Our research also highlights the importance of appealing to certain high-risk groups and providing informative language when releasing vaccine recommendations
The common cold is associated with protection from SARS-CoV-2 Infections.
No full textBACKGROUND: Adults and children often respond differently to SARS-CoV-2 infection, with adults facing a higher risk of symptomatic and severe illness. We hypothesize that children\u27s protection from symptomatic SARS-CoV-2 may be due to more frequent respiratory viral infections, which prime their airway antiviral defenses.
METHODS: Using case-cohort and case-control analyses in the Human Epidemiology and Response to SARS-CoV-2 cohort, we evaluated whether infection with common respiratory viruses protects against SARS-CoV-2 infections and investigated airway molecular mechanisms by which this protection is achieved. We tested 10,493 longitudinal nasal swabs from 1,156 participants for 21 respiratory pathogens. We performed RNA-sequencing on 147 swabs (N=144 participants) collected prior SARS-CoV-2 infection and 391 swabs (N=165 participants) during and before rhinovirus infection.
RESULTS: Participants with rhinovirus infection in the previous 30 days were at 48% lower risk of SARS-CoV-2 infection (aHR:0.52, p=0.034). Among participants with SARS-CoV-2 infection, recent rhinovirus infection was associated with 9.6-fold lower SARS-CoV-2 viral load (p=0.0031). Higher pre-infection expression of 57 genes was associated with lower SARS-CoV-2 viral load, including 24 antiviral defense genes; 22 of these were induced by rhinovirus infections. Relative to adults, children expressed higher levels of the antiviral gene signature (p=0.014) and were at 2.2-fold increased risk for rhinovirus infections.
CONCLUSIONS: Rhinovirus infections, which trigger increased expression of antiviral airway genes, are linked to a lower risk of SARS-CoV-2 infection. Frequent rhinovirus infections may enhance this protective gene profile, partially explaining why children experience milder SARS-CoV-2 infections compared to adults.
TRIAL REGISTRATION NUMBER: NCT04375761
Is Shorter Better in Oncology Patients, Too? A Retrospective Cohort Study of Short- Versus Long-Course Antibiotic Therapy for Uncomplicated Infections in Solid Tumor Patients Receiving Care in Ambulatory Oncology Clinics
No full textThis retrospective cohort study evaluated short- versus long-course antibiotics for uncomplicated infections in ambulatory solid tumor patients. Among 303 patients, outcomes were similar between groups, including infection recurrence, treatment delays, and adverse events. Short-course therapy was not associated with worse outcomes, suggesting it may be a viable alternative
Incidence and survival trends in early-onset colorectal cancer
No full textBackground: Early-onset colorectal cancer (EOCRC) is colorectal cancer that occurs in people under the age of 50 and represents an emerging public health concern with increasing incidence rates worldwide. The incidence of colorectal cancer in young adults has been rising globally over the past two decades. This study analyzes demographic patterns, risk factors, and survival trends in a cohort of 413 EOCRC patients. Methods: This study retrospectively analyzed 413 patients diagnosed with EOCRC from TriNetX database. Clinical data included disease stage, treatment modalities, and survival outcomes, with an event rate of 40% and a median followup time of approximately 26 months. Age-stratified survival analysis revealed distinct patterns across the three age groups examined. Statistical analyses were conducted using Kaplan-Meier methods for survival outcomes and multivariable Cox proportional hazards models to identify prognostic factors. All analyses complied with ethical guidelines and institutional review board requirements. Results: An analysis of 413 patients with early-onset colorectal cancer (EOCRC, ages 21-50, mean: 44 years, SD: 5) revealed distinct age-dependent patterns in incidence, molecular features, and survival. The cohort showed a male predominance (60.29%). HER2 testing was the most common molecular assessment (76%, with 75% undergoing ISH dual probe ratio testing), while KRAS mutation and hormone receptor/PDGFRA analyses were conducted in 4% and 2%, respectively. Testing rates were highest in the youngest ( \u3c35 years) and oldest (43-50 years) cohorts, suggesting potential age-specific molecular phenotypes. Survival analysis revealed an age-related gradient: younger patients (\u3c35 years) had the highest survival rate (64.65%), followed by 57.58% in the middle age group (35-42 years) and 54.31% in the older group (43-50 years). A critical two-year post-diagnosis period showed an initial decline in survival, followed by stabilization. These findings highlight an age-dependent survival advantage in younger EOCRC patients, despite the aggressive nature of the disease. Conclusions: Key learning points include the age-dependent survival advantage observed in younger patients, the importance of comprehensive molecular profiling for personalized treatment, and identifying a critical two-year post-diagnosis period for intervention and monitoring. Future research should focus on elucidating the underlying biological mechanisms driving EOCRC in younger populations, developing targeted prevention strategies, and optimizing treatment protocols to improve long-term outcomes. Additionally, large-scale, multicenter studies are needed to validate these findings and explore the role of emerging therapies in this unique patient population
Where you live and who you are: The unequal face of cancer and diabetes mortality in the United States
No full textBackground: Cancer and diabetes represent leading causes of mortality in the United States, with considerable disparities in rates across demographic and geographic factors. Despite advancements in medical research and healthcare interventions, mortality rates for both conditions remain persistently high, particularly among certain populations. These variations are influenced by multiple factors, including gender, race, socioeconomic status, and geographic location. The findings aim to inform public health strategies to address these disparities and improve health outcomes. Methods: Mortality data from the CDC WONDER database were retrospectively analyzed for adults aged 25 years and older who died with cancer and diabetes between 1999 and 2020. Temporal and demographic trends were assessed using the Joinpoint Regression Program (Version 5.3.0.0), providing insights into changes over time by age, gender, race, and geographic location. Results: From 1999-2020, the age-adjusted mortality rate (AAMR) rose from 157.3 to 189.4, with a significant surge from 2015-2020. Males consistently exhibited higher AAMRs than females, with both genders experiencing notable increases in recent years. Racial disparities were stark, as non-Hispanic Black populations had the highest AAMRs, followed by non-Hispanic American Indian/Alaskan Natives and Hispanics, with substantial increases from 2018-2020. Non-metropolitan areas displayed persistently higher mortality rates than metropolitan regions, with a marked surge between 2016-2020. Across all age groups, the 25-44 year old cohort showed the steepest AAMR increase, particularly from 2018-2020. Conclusions: This study highlights the growing burden of cancer and diabetes mortality in the U.S. and underscores widening demographic and geographic disparities. Addressing these inequities requires targeted public health strategies, improved healthcare access, and resource prioritization to support high-risk populations and underserved regions. Efforts should focus on health equity and reducing disparities to mitigate the rising mortality trends effectively