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Towards Better Response Assessment of Cutaneous Chronic Graft-Versus-Host Disease: A Report from the National Institutes of Health Consensus Project Task Force
No full text•NIH Task Force refines response criteria for chronic cutaneous graft-versus-host disease•Body surface area scoring separated for epidermal vs sclerotic skin involvement•Two new clinician scales measure sclerosis severity and qualitative features•Revised sclerosis assessments improve sensitivity to clinically meaningful change
The National Institutes of Health (NIH) chronic graft-versus-host disease (cGVHD) Consensus Project established response criteria that enabled clinical trials and facilitated regulatory approval of multiple therapies. Nonetheless, organ-specific assessments have limitations, particularly for severe sclerotic skin involvement. Cutaneous manifestations occur in approximately half of patients with chronic GVHD but are difficult to evaluate due to heterogeneous clinical features. To address these challenges, the NIH Consensus Skin Task Force convened in 2024–2025 to refine skin response measures for use in clinical trials. This report (a) summarizes current diagnosis and scoring of skin chronic GVHD, (b) reviews existing response assessments, (c) identifies gaps in their performance, (d) proposes refinements to the 2014 NIH skin response criteria, and (e) outlines future directions incorporating patient-reported outcomes, novel technologies, and biomarker research. Current NIH scoring relies on a 4-point body surface area (BSA) scale and a 3-point sclerosis features scale. While standardized, these measures have limited sensitivity to clinically meaningful change. Proposed refinements include: (i) separate BSA assessments for epidermal involvement and sclerotic features; (ii) modification of sclerosis descriptors, with removal of impaired mobility and specification of GVHD-related ulceration, and addition of sclerosis-associated edema with or without erythema; and (iii) replacement of the exploratory severity scale with two new clinician instruments. The Sclerosis Quality and Physical Signs (SQPS) scale (0–10) captures qualitative physical changes, while the Sclerosis Daily Function Impact (SDFI) scale (0–4) evaluates functional compromise. These proposed refinements aim to improve the accuracy, reproducibility, and clinical relevance of skin chronic GVHD assessments, strengthening trial endpoints and patient care
Efficacy of Low-Dose Adjunctive Methylphenidate Extended-Release on Cognition and Functioning in Individuals With Schizophrenia: A Randomized Open-Label Trial
No full textCognitive impairment severely disrupts functioning and recovery in schizophrenia. Methylphenidate extended-release (ER) shows promise for cognition in attention-deficit/hyperactivity disorder but has limited, inconsistent evidence in schizophrenia. This study investigates low-dose methylphenidate ER's effects on cognitive and functional outcomes in schizophrenia, addressing a critical therapeutic gap.
In an 8-week, open-label, randomized crossover trial, 24 stable adults with Diagnostic and Statistical Manual of Mental Disorders, 5th edition, diagnosis of schizophrenia spectrum disorder received 4 weeks of methylphenidate ER or treatment-as-usual (TAU), with crossover at week 4, and follow-up at week 12. The primary outcome was improvement in functional capacity, measured by the Virtual Reality Functional Capacity Assessment Tool (VRFCAT), while secondary outcomes included cognitive performance, assessed by the Brief Assessment of Cognition in Schizophrenia (BACS), and symptom severity evaluated by Positive and Negative Symptoms Scale (PANSS).
VRFCAT scores improved significantly over time; in the first period (baseline to week 4), the medication-first arm showed improvement versus the TAU-first arm, with overall gains from baseline to week 8 of 303.47 seconds and 159.91 seconds , respectively, sustained post medication. BACS showed significant improvements in the TAU-first arm during the medication phase for Symbol Coding and Tower of London. PANSS-6 improved significantly while on study medication, notably in delusions and social withdrawal, without psychosis exacerbation. At 2-month follow-up, 75% resumed methylphenidate ER.
While results are interpreted cautiously due to the open-label design and small sample size, this trial suggests low-dose methylphenidate ER may enhance functional capacity, specific cognitive domains, and symptoms in schizophrenia without exacerbating psychosis
Prognostic Value of Non-nodal Regional Metastases in Predicting Sentinel Lymph Node Status in Cutaneous Melanoma: Multicenter Analysis of the Sentinel Lymph Node Working Group Database
No full textNon-nodal regional metastases, including microsatellite lesions, satellites, and in-transit metastases, are an uncommon but aggressive entity in cutaneous melanoma. We evaluated their association with clinicopathological features, sentinel lymph node (SLN) status, and prognosis.
The Sentinel Lymph Node Working Group (SLNWG) database was used to examine the clinicopathological associations of non-nodal regional metastases, their prognostic significance in relation to SLN status, and their impact on clinical outcomes, including in patients with negative SLN status, using multivariable logistic regression and Cox regression models, respectively.
Of 13,474 patients in the SLNWG database, 12,644 underwent SLN biopsy, and 3.4% (n = 426) had non-nodal regional metastases at diagnosis. These were associated with adverse clinicopathological features, higher odds of SLN positivity (OR 2.75; 95% CI 2.18-3.47; P < 0.001), and worse relapse-free survival (RFS: HR 1.47, 95% CI 1.07-2.02, P = 0.02), melanoma specific survival (MSS: HR 1.72, 95% CI 1.06-2.78, P = 0.03), overall survival (OS: HR 1.49, 95% CI 1.01-2.21, P = 0.05). Adverse prognostic associations were also observed in the SLN negative subgroup (RFS: HR 1.93; 95% CI 1.58-2.36, P < 0.001; MSS: HR 2.24; 95% CI 1.58-3.17, P < 0.001, and OS: HR 1.51; 95% CI 1.17-1.95, P = 0.002).
Non-nodal regional metastases independently predict SLN involvement and adverse prognosis, and outcomes remain poor even when SLN is negative. These findings reinforce the risk stratification and prognostic relevance of SLN assessment in clinically node-negative patients with non-nodal regional metastases
P-2081. Lessons Learned from Diverse Community Screenings and Client, Clinician, and Stakeholder Education to Improve HIV Detection in Priority Populations
No full textBackground In the United States, HIV disproportionately affects individuals in Southern states and those from historically marginalized groups, including people who are Black, formerly incarcerated, or facing food or housing insecurity. Community engagement is essential to ending the HIV epidemic in the US. Black men who have sex with men (MSM) are less likely to receive HIV testing in clinical settings than White MSM (65% vs 82%) and Black MSM are most likely to be tested in nonclinical settings (eg, HIV outreach program, syringe exchange program). The rate of new HIV diagnoses after testing in nonclinical settings is highest among Black individuals. We aimed to engage community stakeholders, implement community-based approaches to improving HIV detection in priority populations, educate healthcare clinicians, and identify lessons learned during the implementation of community-based approaches. Methods We developed several multidimensional programs targeted towards priority populations identified in Ending the HIV Epidemic jurisdictions, each including three components: (1) accredited medical education for clinicians about the prevalence of HIV in the specific priority population and strategies to identify, prevent and treat HIV; (2) education for clients and partners/stakeholders related to that population; and (3) screening for HIV and other conditions at community events with incentives (eg, gift cards). Each programs’ components were determined in conjunction with stakeholders. We assessed population and provider reach by collecting the number of people screened and number of clinicians who participated in the education, respectively. Educational outcomes were measured by assessing knowledge, confidence and competence before and after participation in the clinician education. Results To date, 1625 clinicians have been educated and 745 HIV screenings have been completed across five community events. See Table 1 for description of events, key populations, and stakeholders. Educational outcomes are shown in Table 2. Lessons learned, identified by the program planners and community partners, are shown in Table 3. Conclusion Programs that incorporate client, clinician and partner education along with client incentives can promote HIV testing in priority populations. Disclosures Lesley Simon, BA, Gilead Sciences: Independent medical education grant Dean Beals, BA, Gilead: CME Grants Stan Pogroszewski, JD, Gilead Sciences: Unrestricted CME Grant Tabitha Washington, MHA, Gilead Sciences, Inc.: independent medical education grant from Gilead Sciences Dovie L. Watson, MD, MSCE, Gilead Sciences: Honorari
Acquired Progressive Kinking of the Hair: A Narrative Review of the Androgen‐Dependent Phenotype
No full textAcquired progressive kinking of the hair (APKH) is an underrecognized hair disorder characterized by a gradual change in hair texture, often manifesting as increased curliness, frizziness, and darkening of the shafts. While various systemic triggers and congenital conditions can induce similar phenotypes, a subset of cases—particularly those involving the frontal and temporal scalp in young males—appears to be linked to androgen‐mediated mechanisms. This narrative review focuses on the androgen‐dependent phenotype of APKH, integrating clinical, trichoscopic, and histopathological findings and presenting a representative case. We also propose a conceptual framework for distinguishing between androgen‐dependent and non–androgen‐dependent subtypes. A detailed analysis of all published cases meeting criteria for androgen‐sensitive APKH is provided, highlighting patterns of progression, diagnostic clues, and therapeutic implications. Recognizing this presentation as a potential early manifestation of androgenetic alopecia may inform clinical decisions and prompt timely intervention
Development and Evaluation of Knowledge-Based Treatment Plans for Chest Wall and Regional Lymph Node Irradiation
No full textDefining Clinically Interpretable Glycemic Profiles Using Continuous Glucose Monitoring in Type 2 Diabetes
No full textCorrection: Accounting for Ocean Waves and Current Shear in Wind Stress Parameterization
No full textPatient-reported outcomes as prognostic indicators for overall survival and progression-free survival in brain tumor patients - a systematic review and meta-analysis of randomized clinical trials
No full textBackground Patient-reported outcomes (PROs) are increasingly recognized as essential endpoints in neuro-oncology, yet their prognostic value for survival across brain tumor trials remains incompletely defined. We conducted a systematic review and meta-analysis to quantify the association between key PRO domains and overall survival (OS) and progression-free survival (PFS)in patients with glioma. Methods Following PRISMA 2020 guidelines, we included randomized controlled trials that reported baseline PROs using the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 or European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Brain Neoplasm-20 questionnaires, with corresponding survival outcomes. Hazard ratios (HRs) per 10-point increase in each PRO domain were extracted. Random-effects models generated pooled HRs. Heterogeneity, risk of bias (ROB 2), and certainty of evidence (GRADE) were assessed. Results Eight trials comprising 6,846 patients were included. Higher baseline cognitive functioning was significantly associated with improved OS (HR = 0.94, 95% CI [0.91-0.97]), as was physical functioning (HR = 0.97, 95% CI [0.94-1.00]). Pooled functional domains showed a protective association (HR = 0.96, 95% CI [0.93-1.00]), while BN-20 domains showed no association with overall survival. Pooled analysis of studies reporting EORTC QLQ-C30 scales was associated with improved PFS (HR = 0.99, 95% CI [0.99-0.99]). Subgroup analysis of physical functioning showed an association with improved PFS (HR = 0.99, 95% CI [0.97-1.0]), and the pooled analysis of all functional scales showed the same direction (HR = 0.99, 95% CI [0.99-0.99]). Conclusions Functional and cognitive PRO domains appear to have potential to be robust prognostic markers of survival in glioma trials, and these findings support the complementary role of PROs alongside clinical, radiographic, and molecular measures. Our findings support integrating PROs into response assessment selection in future neuro-oncology trials.</p
Valorization of Waste Eggshell as a Limestone Alternative for High-Volume Incorporation into Portland Cement
No full textThe incorporation of waste eggshell powder into portland cement presents an innovative strategy for decarbonizing the cement industry. Eggshell powder exhibits properties similar to limestone; however, its effectiveness in portland cement is often hindered by organic impurities and heterogeneous surface characteristics. This study investigates the heat treatment of waste eggshell powder to enhance its performance to a level comparable to limestone powder. Characterization revealed that eggshell powder contains approximately 6% organic impurities by mass from the egg membrane. These organic components impart superhydrophobic properties, inhibiting the interaction between mixing water and the blended cement, which can compromise paste flow, cement hydration, and mortar strength. Rheological measurements showed that pastes incorporating unincinerated eggshell powder exhibited higher static yield stress, which indicate more difficulties in pumping, spreading, and compacting. At the same time, the paste has a lower dynamic yield stress due to delayed hydration. Heat treatment effectively denatured the organic content, mitigating these limitations. Beyond 300°C, mortars with eggshell powder demonstrated compressive strength comparable to those containing limestone powder. At 500°C, all organic impurities were eliminated, rendering the eggshell powder hydrophilic, similar to limestone powder. Scaling heat treatment to an industrial level would incur minimal costs and carbon emissions compared to portland cement production. Thus, waste eggshells can be effectively valorized for blended cement, achieving a 35% portland cement replacement