Faculty Bibliography
Searched for:
school:LISOM
Total Results:
14804
Neoadjuvant nivolumab plus gemcitabine-cisplatin followed by postsurgical adjuvant nivolumab versus neoadjuvant gemcitabine-cisplatin in patients with muscle-invasive bladder cancer: final results from the phase III CA017-078 trial
BACKGROUND:Perioperative immune-checkpoint inhibition improves outcomes in muscle-invasive bladder cancer (MIBC). The phase III, randomized CA017-078 (ENERGIZE) trial evaluated perioperative nivolumab plus neoadjuvant gemcitabine-cisplatin (GC) versus neoadjuvant GC alone for previously untreated, resectable MIBC. PATIENTS AND METHODS/METHODS:Adults with previously untreated cT2-T4aN0M0 MIBC eligible for radical cystectomy (RC) and cisplatin were randomized to neoadjuvant nivolumab plus GC followed by RC and adjuvant nivolumab (nivolumab plus GC arm), or neoadjuvant GC followed by RC alone (GC arm). Co-primary endpoints were pathological complete response (pCR; defined as ypT0N0) and event-free survival (EFS). Overall survival (OS) was a secondary endpoint within the prespecified hierarchical testing strategy, and formal testing was contingent on a statistically significant EFS result. RESULTS:At this final analysis with 54.5 months of median follow-up, 325 patients were randomized to the nivolumab plus GC arm, 328 to the GC arm. pCR rates were 39.1% and 29.6%, respectively (adjusted difference 9.5%, 99.91% CI -2.6-21.6). EFS was not improved in the nivolumab plus GC versus GC arm (104 events in each arm; HR 0.94, 95.74% CI 0.71-1.25; P=0.6697). OS was summarized descriptively because EFS did not meet the testing criterion (HR 0.88, 95% CI 0.64-1.21). Grade 3-4 treatment-related adverse events occurred in 50.0% versus 49.5%; one treatment-related death occurred with nivolumab plus GC. Pretreatment ctDNA was positive in 229/416 tested patients (55%) overall, 108/211 (51%) in the GC arm, and 121/205 (59%) in the nivolumab plus GC arm. Clearance by cycle 4 day 1 (C4D1) occurred in 153/199 patients (76.9%) overall, 87/107 (81.3%) with nivolumab plus GC, and 66/92 (71.7%) with GC. ctDNA detection at baseline and at C4D1 was associated with shorter EFS and OS. CONCLUSIONS:The addition of perioperative nivolumab to neoadjuvant GC did not improve outcomes and was associated with predictable toxicity. Exploratory analysis showed ctDNA was strongly prognostic.
PMID: 42918420
ISSN: 1569-8041
CID: 6074927
Disseminated Histoplasmosis Presenting as an Obstructive Mass in Crohn's Disease: A Case Report [Case Report]
INTRODUCTION/UNASSIGNED:Patients with Crohn's disease are at increased risk for both colorectal carcinoma and opportunistic infections due to chronic inflammation and long-term immunosuppressive therapy. Fungal infections such as histoplasmosis may mimic malignancy or inflammatory exacerbation, leading to diagnostic delay. CASE PRESENTATION/UNASSIGNED:, confirmed by polymerase chain reaction. The urinary Histoplasma galactomannan antigen test was negative, while serum 1,3 β-D-glucan was positive. The patient was successfully treated with amphotericin B followed by itraconazole, with complete clinical recovery. Retrospective history revealed travel to Ecuador. CONCLUSION/UNASSIGNED:Gastrointestinal histoplasmosis can closely mimic Crohn's flare or malignancy, especially in immunosuppressed patients. Careful histopathologic evaluation and integration of clinical and laboratory findings are essential for timely diagnosis and effective antifungal therapy.
PMCID:13695535
PMID: 42927153
ISSN: 1662-0631
CID: 6074712
Distinct phenotype or confounder? Interpreting placenta accreta spectrum severity after in vitro fertilization [Letter]
PMID: 42951137
ISSN: 2589-9333
CID: 6074779
Assessing inflammation and predicting relapse in ulcerative colitis is more accurate when performed by IBD specialized gastroenterologists [Letter]
BACKGROUND/UNASSIGNED:Ulcerative colitis is monitored through clinical, laboratory, endoscopic, and histologic measures. Persistence of histologic inflammation despite clinical and endoscopic remission is associated with disease flare. METHODS/UNASSIGNED:We compared the identification of clinically significant histologic inflammation by general and IBD-specialized gastroenterologists (GI) using a simplified binary scoring system and looked at associations with disease relapse. RESULTS/UNASSIGNED:Both general and IBD-specialized GIs identified significant inflammation associated with relapse, though IBD-specialized GIs scoring had stronger correlations with relapse. CONCLUSIONS/UNASSIGNED:Our findings suggest simple histologic assessment can inform risk stratification, and further work is needed to optimize monitoring patients with histologic inflammation despite endoscopic remission.
PMCID:13682846
PMID: 42904013
ISSN: 2631-827x
CID: 6074887
Global, Regional, and National Burden of Heart Failure, 1990-2023: A Systematic Analysis for the Global Burden of Disease Study 2023
IMPORTANCE/UNASSIGNED:Heart failure (HF) is a common condition with substantial geographical variation in its prevalence and underlying etiologies. Consistent and comparable data on the burden of HF within populations are needed to inform health system priorities. OBJECTIVE/UNASSIGNED:To estimate the global burden of HF. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This cross-sectional study estimates disease burden using Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) methodologies to integrate multiple information sources. Data come from 204 countries and territories from 1990 to 2023 representing the global population with prevalent HF. EXPOSURE/UNASSIGNED:HF and underlying etiologies. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Estimates with 95% uncertainty intervals (UIs) for the prevalence and years lived with disability (YLDs) for HF by age, sex, location, year, and underlying etiology. RESULTS/UNASSIGNED:Globally, there were 56.0 million (95% UI, 49.9-62.2 million) estimated cases of HF in 2023. The estimated prevalence of HF generally increased with age for all locations. While ischemic heart disease and hypertensive heart disease were the 2 most common etiologies globally among older adults, there was substantial variation in etiological pattern by location and age. Congenital heart anomalies and rheumatic heart disease (RHD) were common etiologies in children and young adults, while the proportion of HF due to alcohol use peaked in middle adulthood. Location-specific estimates highlighted regions with higher burden of HF due to specific etiologies, including RHD (south Asia, east Asia, Oceania, southeast Asia, central sub-Saharan Africa, eastern sub-Saharan Africa, southern sub-Saharan Africa, and western sub-Saharan Africa), alcohol use (eastern Europe, Australasia, the Caribbean, and central Europe), and Chagas disease (southern, Andean, tropical, and central Latin America). CONCLUSIONS AND RELEVANCE/UNASSIGNED:Heart failure is a significant global public health burden, and the impact is likely to increase as populations age. However, most HF etiologies can be prevented by interventions that reduce exposure to modifiable risk factors, such as elevated blood pressure, excessive alcohol consumption, and tobacco use. Etiology- and location-specific estimates can provide necessary information for public health officials to determine how best to prioritize interventions to reduce HF disease burden.
PMID: 42814432
ISSN: 2380-6591
CID: 6074692
Heart and Brain: Linking Obesity-Related Inflammation, Cardiovascular Disease and Cognitive Function
The heart and brain are interconnected, and risk factors that impact the heart can negatively affect the brain and cognition. Among the underlying features that foster both poor brain health and poor heart health are obesity, diabetes, physical inactivity and low sleep quality. Obesity and type 2 diabetes are associated with an increased likelihood of cognitive impairment and dementia. Further, obesity is a causal factor in obstructive sleep apnea, leading to intermittent hypoxemia, neuroinflammation and cognitive dysfunction. Cerebrovascular disease with reduced cerebral blood flow brings on stroke and elevates dementia risk. Like cardiovascular disease, cerebrovascular disease is also accelerated in the setting of obesity, likely through the same mechanisms involving endothelial dysfunction and damage to macrovasculature and microvasculature from hypertension, dyslipidemia and inflammation. Obesity is considered a risk factor for recurrent stroke. The protracted low-grade chronic elevation of inflammatory markers found with excess adiposity leads to oxidative stress and promotes both endothelial dysfunction and a pro-thrombotic state. Greater loss of brain volume has been documented in middle-aged and older adults with obesity compared with young adults with obesity. Obesity poses a threat to the cardiovascular and cerebrovascular health and well-being of individuals worldwide. Unfortunately, treatments directed at reducing caloric intake are of limited effectiveness. This review will focus on the latest research into the link between excess adipose tissue and cardiac and brain health, with attention to dietary and lifestyle interventions that may be protective of the integrity and function of the vasculature and brain.
PMCID:13705137
PMID: 42930873
ISSN: 2308-3425
CID: 6074718
Beyond the Surface: AI-Assisted Basal Cell Carcinoma Detection via Optical Coherence Tomography
OBJECTIVES/OBJECTIVE:To determine whether integrating an artificial intelligence (AI) decision-support system (VivoAID) into optical coherence tomography (OCT) interpretation improves diagnostic accuracy and efficiency for novice users evaluating basal cell carcinomas (BCCs). METHODS:Two dermatology research fellows completed a structured OCT training module for BCC identification using the VivoSight Dx system. Each independently reviewed 45 de-identified OCT scans (31 BCC-positive and 14 BCC-negative, negative ones included squamous cell carcinomas, keratoacanthomas, actinic keratoses and scar tissue), with ground truth established by expert clinical interpretation and histopathology, in two sessions: one unassisted and one AI-assisted. Session order was counterbalanced between learners, and scans were re-randomized for AI sessions. In unassisted sessions, learners manually classified scans; in AI-assisted sessions, they reviewed AI-annotated scans, recorded agreement/disagreement, and noted additional findings. Time-to-decision per scan was measured. A linear mixed-effects model in SAS assessed the effect of AI on decision time while accounting for scan difficulty. RESULTS:Without AI, correct BCC identification was 62% for Learner 1% and 64% for Learner 2 (combined 63%). With AI assistance, accuracy increased to 78% and 76%, respectively (combined 77%), reflecting relative improvements of 25% and 17% (combined +21%). Mean decision time decreased from 45 to 28 s for Learner 1 and from 35 to 22 s for Learner 2, yielding a combined reduction from 40 to 25 s (~38% faster). AI use significantly reduced decision time by an average of 15.1 s per image (p < 0.0001). AI standalone accuracy versus expert opinion was 64%, comparable to novice baseline performance. CONCLUSIONS:AI-enhanced OCT with VivoAID significantly improved novice users' diagnostic accuracy and efficiency, despite AI performance alone being similar to baseline novice interpretation. These data support VivoAID's role as a decision-support and potential educational tool in dermatology. Findings are limited by small sample size, single-institution design, and repeated review of the same scans. TRIAL REGISTRATION/BACKGROUND:None.
PMID: 42960626
ISSN: 1096-9101
CID: 6074806
Approaches to teaching and assessing the communication of uncertainty in the health professions: a scoping review
PURPOSE/OBJECTIVE:Uncertainty is inherent to clinical practice and impacts diagnostic reasoning, patient safety, and trust. Despite its ubiquity, health professions education has not adequately prepared learners to communicate uncertainty to patients, families, and care teams. Training remains variable and unevenly assessed. The authors examined how uncertainty communication is taught and assessed across the health professions and identified gaps to inform curricular development and scholarship. METHOD/METHODS:The authors conducted a scoping review guided by Arksey and O'Malley's framework and reported according to PRISMA-ScR guidelines. Eligible studies included learners from any health profession and addressed communication of uncertainty with patients and/or clinicians. Commentaries and reviews were excluded. Searches were conducted in PubMed, Ovid MEDLINE, Scopus, ERIC, CINAHL, and MedEdPORTAL beginning in March 2024 through August 2026. Data were analyzed using inductive and deductive analysis informed by Han's uncertainty taxonomy. Study quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI). RESULTS:Searches identified 18,810 records. After screening, 213 full-text articles were reviewed and 21 were included in the final analysis. Most were conducted in the U.S. and published after 2019. Learners were predominantly physicians-in-training, with most studies focused on undergraduate and graduate medical education; fewer addressed continuing education or interprofessional learners. Diagnostic uncertainty was the most frequently addressed uncertainty type. Educational approaches were primarily experiential, including simulation, standardized patients, OSCEs, and role-playing. Fewer than half of studies involved patients in design, development, or assessment. Twenty studies assessed learners using self-reported surveys, faculty observations, or standardized patient evaluations. MERSQI scores ranged from 6.5 to 15.5 (mean 10.4). No study evaluated clinical practice or patient outcomes. CONCLUSIONS:Educational approaches to uncertainty communication are emerging but remain limited in scope, learner populations, and outcome evaluation. Future work should prioritize interprofessional, longitudinal curricula and rigorous assessment strategies linking education to clinical and patient-level outcomes.
PMID: 42949089
ISSN: 1938-808x
CID: 6074766
Defying Gravity: Strategies for Reducing the Impact of Falls - AAST Virtual Grand Rounds
Injuries from falls and their sequelae represent a significant source of morbidity and mortality. This impact is predominantly felt by patients with pre-existing health conditions and poor health. For these patients, comorbidities, frailty, use of anticoagulation, and other factors result in the development of severe injuries after relatively low-impact falls. Many strategies exist to counter the negative effects of falls-both thinking about how to reduce the incidence of falls by engaging in fall prevention strategies and techniques for reducing trip hazards or finding ways to minimize the potential impact of falls on vulnerable populations. These efforts can be combined to create local and regional fall-prevention networks, which have been highly successful and effective in addressing fall risk. This publication summarizes the contents of an American Association for the Surgery of Trauma's Virtual Grand Rounds that highlighted the epidemiology of falls, the effects of falls, and strategies for countering these effects at individual and locoregional levels.
PMCID:13691809
PMID: 42920948
ISSN: 2397-5776
CID: 6074938
Provider Knowledge and Utilization of Anal Cancer Screening: A Single Institution Cross-Sectional Survey Study
In 2024, the International Anal Neoplasia Society (IANS) published the first consensus guidelines for anal cancer screening, outlining recommendations for patients who are most impacted by anal cancer. This study assesses provider knowledge and practice of these guidelines. A 37-item cross-sectional survey was distributed electronically to physicians, nurse practitioners, and physician assistants across ten specialties within a single health system. The survey assessed familiarity with anal cytology, guideline knowledge, screening practices, and barriers to screening. Descriptive statistics and bivariate analyses compared primary care providers (PCPs) to subspecialists. 87 providers completed the survey (62% physicians, 21% nurse practitioners, 17% physician assistants); 60% were Primary Care Physicians (PCPs) and 40% subspecialists. 55% had never heard of the IANS guidelines, and 76% had never performed an anal Pap test. Among the 70 providers completing the knowledge assessment, the median score was 10/20 (Inter Quartile Range (IQR) 8-12). Providers performed worst when identifying screening recommendations for solid organ transplant recipients (7% correct) and cisgender women with HIV (13% correct). No significant differences were found between PCPs and subspecialists across any measure. Qualitative responses identified scope of practice uncertainty (78%), lack of training (20%), and limited access to high-resolution anoscopy (9%) as primary barriers. Provider knowledge and utilization of anal cancer screening guidelines remain critically low across specialties. These findings highlight the urgent need for institution-wide education, standardized ordering pathways, and clear referral processes to improve screening rates.
PMID: 42907613
ISSN: 1543-0154
CID: 6074903
