Faculty Bibliography

Imaging-based staging is a key component of renal cell carcinoma (RCC) management, yet anatomic labels alone do not fully capture tumor biology. This review highlights key aspects of RCC staging using computed tomography (CT) and magnetic resonance imaging (MRI), compares their use across major guidelines, and explores how integrating imaging-based prognostic markers can refine preoperative risk assessment. We summarize the pragmatic use of multiphase CT and MRI for T-staging, highlight pitfalls, and outline indications for chest and ancillary imaging based on American Urological Association, European Association of Urology, and National Comprehensive Cancer Network guidelines. We also discuss imaging-based prognostic biomarkers, including central non-enhancement and enhancement heterogeneity, diffusion metrics, and radiomic signatures, and we describe how they correlate with outcomes such as tumor grade, stage, molecular features, and survival. In addition, we dive into future directions, focusing on the potential integration of advanced technologies (e.g., photon counting CT, ⁸⁹Zr-Girentuximab positron emission tomography/CT), integration with liquid biopsy, and development of standardized reporting systems focusing on cancer likelihood and aggressiveness (e.g., Kidney Imaging Reporting and Data System). By bridging staging descriptors with prognostic phenotypes, we aim to standardize reports, better inform management, and improve decision-making for patients with RCC.

PURPOSE/OBJECTIVE:We aimed to determine time trends in incidence, treatment and survival of patients with adrenocortical carcinoma in the Netherlands. METHODS:All 685 adult patients with adrenocortical carcinoma diagnosed between 1993 and 2020 in the Netherlands were included, using the nation-wide prospective Netherlands Cancer Registry. RESULTS:The median age-adjusted incidence rate based on the European Standard Population was 1.62 per million person-years [0.83-2.11] and was stable over time. We saw a gradual increase in stage III on diagnosis (13 to 25%) with a stable proportion of stage IV (40%). The five-year survival remained stable over time for stage I-II at 65% and stage III at 35%, while the survival for stage IV increased from 3% in 1993-1996 to 11% in 2017-2020. Since the Dutch Adrenal Network was founded in 2004, more patients were referred to an expert center (p<0.001), which was associated with increased survival (adjusted HR 0.70, 95%CI[0.57-0.85]). Multivariate cox-regression showed increased survival in all stages when treated with adrenalectomy (adjusted HR 0.53, 95%CI[0.43-0.65]) and mitotane therapy (adjusted HR 0.73, 95%CI[0.55-0.98]). In stage IV disease, adrenalectomy, surgical control of disease, chemotherapy and mitotane therapy were associated with increased survival. However, only 58% of mitotane users reached a therapeutic drug level and 59.5% discontinued treatment prematurely. CONCLUSIONS:The incidence of adrenocortical carcinoma is stable over time. The five-year survival for stage I-III remained stable, while the survival for stage IV increased. Factors associated with increased survival are centralization of care, adrenalectomy, surgical control of disease, chemotherapy and mitotane therapy.

We address an ethical challenge in climate change adaptation and global health research. The challenge stems from two pairs of intuitions about justice and responsibility in climate change and health. One pair assigns responsibility for adaptation research to high-income countries given their historical emissions, disproportionate share of resources and capacity to intervene. The other pair assigns responsibility to low- and middle-income countries given their agency, right to self-determination, local authority and legitimacy, and disproportionate burden of climate and health risks. The intuitions create conflicting views: obligation and assistance pull in one direction, and agency and authority pull in another. To resolve the tension, we distinguish two forms of responsibility: (i) adaptation-enabling responsibilities; and (ii) adaptation-enacting responsibilities. The resulting division of labour reflects different forms of justice and aligns with the principle of subsidiarity's core elements, namely: non-abandonment, non-absorption, and cooperation and coordination. We thus propose a framework that ascribes adaptation-enabling responsibilities to high-income countries, including adaptation financing, capacity-building and other forms of support; and adaptation-enacting responsibilities to low- and middle-income countries, including priority-setting in local adaptation research, and creation and implementation of their adaptation plans and policies. Our framework also suggests a third form of responsibility: shared adaptation responsibilities, which are jointly assigned to high-income countries, low- and middle-income countries and agents at multiple levels within them. We conclude that genuine collaboration in adaptation research, where high-income countries enable without dominating and low- and middle-income countries act without being abandoned, will be essential for just and effective adaptation to climate change.

INTRODUCTION/BACKGROUND:This community-led research study protocol emphasises placing black youth impacted by the legal system, their families and their communities at the forefront of substance use treatment development research and decision-making. The study, the Cultural Adaptation of a Substance Use Treatment (CAST) Project, challenges traditional top-down approaches to treatment creation, advocating for a grassroots model that centres community knowledge, values and active participation. METHODS AND ANALYSIS/METHODS:The CAST project is a US-based mixed-methods study with an exploratory design that examines the impact of racial discrimination on substance use in black youth impacted by the legal system. The study participants are black youth impacted by the legal system (N=15), parents of black youth impacted by the legal system (N=10) and community members who serve black youth (N=10) (total N=35 study participants). Study participants from each group (youth, parents and community members) will participate in three separate focus groups, respectively, to provide feedback on the culturally responsive content needed to best support black youth impacted by the legal system around substance use and mental health. The eight-step Assess, Decision, Adaptation, Production, Topical Expert, Integration, Training, Testing framework will be used as a guide to inform adaptations to the Motivational Enhancement Therapy and Cognitive Behavioural Therapy (MET/CBT12) for black youth impacted by the legal system. Once the cultural adaptation process has been completed, the study will conclude with an open feasibility and accessibility trial of the culturally adapted MET/CBT12 manual. The primary outcomes of this study are the feasibility and acceptability of the culturally adapted manual, measured by treatment attendance and participant feedback. Secondary outcomes include reductions in substance use and discrimination distress, and improvements in mental health symptoms. ETHICS AND DISSEMINATION/BACKGROUND:This study was approved by the Institutional Review Board (IRB) at the University of California, San Francisco (IRB Protocol Number: 23-40126). All study procedures will be conducted in accordance with the ethical standards outlined by the institutional review board. The results from this study will be shared through peer-reviewed publications, academic conferences, community forums and policy briefs to support broader implementation of culturally adapted adolescent substance use interventions that address discrimination-related stress and substance use among black individuals impacted by the legal system. TRIAL REGISTRATION NUMBER/BACKGROUND:NCT06003725.

INTRODUCTION/UNASSIGNED:Effective clinical research training is crucial for advancing medical science and improving patient care. However, current evaluation systems in China often focus on theoretical knowledge, neglecting practical skills and innovation. This study aimed to develop a comprehensive evaluation framework for clinical research training programs using the Delphi consensus method. METHOD/UNASSIGNED:A 2-round Delphi method was employed, involving healthcare professionals and educators from top tertiary hospitals and leading academic institutions in China. The first round included 15 participants, and the second round included 19 participants. The evaluation framework was based on the Kirkpatrick model, covering Reaction, Learning, Behavior, and Results dimensions. Indicators were evaluated using a 5-point Likert scale, with consensus defined as a mean significance score ≥3.50 and a coefficient of variation ≤0.25. RESULTS/UNASSIGNED:In the first round, 9 indicators were excluded and 5 added. In the second round, 26 indicators met consensus criteria. Key indicators included "Relevance of training content" (mean = 4.89, CoV = 0.06), "Degree of knowledge mastery" (mean = 4.58, CoV = 0.13), and "Impact on career development" (mean = 4.53, CoV = 0.15). Other significant indicators were "Timeliness of training information" (mean = 4.84, CoV = 0.08) and "Success rate of applying for scientific research funds" (mean = 4.05, CoV = 0.21). DISCUSSION/UNASSIGNED:This study developed a comprehensive evaluation framework for clinical research training in China, emphasizing the importance of relevant training content, strong learning outcomes, and long-term professional impact. This framework provides a robust tool to assess and enhance clinical research training programs, ultimately contributing to improved healthcare and medical research. Future work should focus on validating this framework through empirical studies and refining it based on ongoing feedback.

Data on the use of Woven EndoBridge (WEB) devices in the treatment of narrow-neck intracranial aneurysms (NNA) are limited. We compared the efficacy and safety of single-layer (SL) and single-layer spherical (SLS) WEB devices in treating NNA. We conducted a multicenter retrospective analysis of adult patients with NNA (neck ≤ 4 mm and width-to-neck ratio ≥ 2) treated with SL or SLS WEB devices between January 2011 and December 2022. Patients with fusiform or blister aneurysms, adjunctive treatments, or devices other than SL or SLS were excluded. Propensity score matching was used to adjust for confounding variables. Outcomes included procedural complications, angiographic occlusion rates using the Raymond Roy classification, major device compaction, need for retreatment, and functional outcomes assessed by the modified Rankin Scale (mRS). After matching, resulting in 101 patients in each group, baseline characteristics were well-balanced. Thromboembolic complications occurred in 2.0% of the SLS group and 5.9% of the SL group (P = 0.28). Hemorrhagic complications occurred in 1.0% of the SLS group and 6.4% of the SL group (P = 0.062). Adequate occlusion rates (Raymond Roy grades I and II) were similar between groups (96% in SLS vs. 91% in SL; P = 0.20). Major device compaction was significantly less frequent in the SLS group compared to the SL group (0% vs. 7.6%; P = 0.024). The need for retreatment trended to be lower in the SLS group (1.1% vs. 6.6% in SL; P = 0.12). Functional outcomes (mRS 0–1) at last follow-up were comparable (82% in SLS vs. 86% in SL; P = 0.41). In the treatment of narrow-neck intracranial aneurysms, the SLS WEB device was associated with significantly lower rates of major device compaction compared to the SL device. Reduced compaction may lead to a lower need for retreatment. Overall imaging outcomes and safety profiles were similar between the two devices.

OBJECTIVES/OBJECTIVE:Silicosis is one of the most common forms of pneumoconiosis worldwide. In Rwanda, there is a lack of data on the silicosis burden and occupational risk among underground miners. METHODS:We conducted a cross-sectional study among all miners from eight cassiterite (tin ore) mining sites in Kayonza district, eastern Rwanda. Questionnaire data and chest radiography were collected at Rwinkwavu District Hospital. Two radiologists reviewed all the chest radiographs using International Labour Organization (ILO) criteria, with a third radiologist reviewing films with ILO rating discrepancies. Logistic regression was performed to investigate risk factors associated with radiographic silicosis. RESULTS:In total, 1021 mine workers were included in the primary outcome (risk) analysis. The median age was 32 years (IQR 26-40), and 948 participants (93%) were male. Of all participants, 94 (9%) were diagnosed with silicosis in the primary analysis. Increased odds of silicosis were associated with working in a blasting station (adjusted OR (aOR) 3.30; 95% CI 1.68 to 6.45), excavation station (aOR 2.77; 95% CI 1.09 to 7.04), drilling station (aOR 2.51; 95% CI 1.34 to 4.70), exposure to tobacco (aOR 1.92; 95% CI 1.14 to 3.24) and increased time of working in mining (aOR 1.05 per year spent in mining; 95% CI 1.01 to 1.09). CONCLUSIONS:High-risk mining tasks, tobacco use and duration of mining employment were significantly associated with increased risk of having a silicosis diagnosis. Our results indicate that screening and preliminary occupational risk analysis in a rural mining cohort is technically feasible.