The SNAPPS model is a learner-centered teaching strategy widely used in clinical specialities. It promotes active participation and enhances diagnostic reasoning. However, its application in pathology residency training remains underexplored. This study aimed to assess the utility of the SNAPPS method in improving the academic performance, diagnostic reasoning, and self-directed learning of pathology residents. A cross-sectional analytical study was conducted in Department of Pathology. 35 residents across three levels of training participated. The study was conducted in four phases: sensitization of preceptors, case writing using the traditional method, sensitization of residents to components of SNAPPS -Summarize, Narrow, Analyze, Probe, Plan, and Self-directed learning; and case presentation under SNAPPS guidance. Residents' performances were evaluated through standardized SNAPPS checklists, multiple-choice question (MCQ) tests (pre- and post-intervention), and structured feedback forms. Data were analysed using Wilcoxon Signed Rank Test. Post-test MCQ scores demonstrated significant improvement across all academic years. First-year residents showed modest but statistically significant gains (p < 0.001). Second-year residents exhibited consistent improvement (p = 0.004), while third-year residents demonstrated the greatest learning gains (p < 0.0001). SNAPPS checklist scores improved from median of 3 to 4 for first five SNAPPS components, while sixth component increased from median of 1 to 2 (p < 0.0001). Feedback analysis showed > 90% positive responses for most items, although time-related concerns were noted. SNAPPS can serve as an effective structured teaching tool in postgraduate pathology education, as it enhances academic performance and clinical reasoning and promotes active participation.
Accurate risk stratification in oncology is essential for guiding treatment decisions, yet current algorithms rely on a narrow set of structured variables, and hence potentially ignore the rich signal in narrative pathology reports. These reports contain nuanced morphological descriptions and expert clinical judgmentThis narrative information remains largely unused in clinical decision-making as it gets lost in "prose" text-based reports. We hypothesized that large language models (LLMs) could extract prognostic information from complete free-text pathology reports and convert it into a binary survival biomarker. We used the open-weight LLaMA 3.3 70B model to generate risk scores directly from publicly available pathology reports across three gastrointestinal cancer types. The model was prompted to synthesize the complete narrative reports into a binary prognostic score. We evaluated associations between the LLM-generated scores and survival outcomes, including overall survival, progression-free survival, and disease-specific survival. In colorectal cancer, LLM-generated risk scores demonstrated significant prognostic value for overall survival (Hazard ratio (HR) = 2.77, 95% confidence interval (CI) = 1.92-3.97, p < 0.001), progression-free survival (HR = 2.93, 95% CI = 2.11-4.08, p < 0.001), and disease-specific survival (HR = 5.85, 95% CI = 3.66-9.36, p < 0.001). Multivariate analysis confirmed the LLM-generated risk score as an independent prognostic factor for progression-free survival. LLMs can turn narrative pathology reports into a single, independent survival biomarker. This approach leverages routinely available free-text documentation without requiring additional tissue analysis or pathologist workload, providing a deployable method to enhance risk stratification for treatment decision-making.
Subjective cognitive decline (SCD) may represent an early stage of Alzheimer's disease (AD), but biomarker studies in this population are limited. Therefore, we compared the performance of a comprehensive panel of novel cerebrospinal fluid (CSF) and blood biomarkers across different platforms for detecting amyloid-β (Aβ) pathology in SCD. 143 individuals with SCD (20% Aβ-positive) from the β-AARC cohort were included. Aβ status was determined by CSF Aβ42/40. CSF and blood biomarkers of Aβ, tau, synaptic function, neurodegeneration, and glial reactivity were measured cross-sectionally. In CSF, novel tau variants (p-tau205, p-tau217, p-tau231, p-tau235, NTA-tau) were elevated in Aβ-positive individuals with SCD. In plasma, p-tau217, p-tau217/Aβ42 (across multiple platforms), as well as p-tau181, p-tau181/Aβ42 and Aβ42/40 (platform-dependent) demonstrated strong discriminatory performance and high negative predictive value, but limited positive predictive value because of the low prevalence of Aβ pathology. In conclusion, several plasma biomarkers can exclude Aβ pathology in SCD, while some CSF and plasma markers indicate early AD-related changes. These plasma biomarkers could serve as accessible, cost-effective tools for early AD detection and risk stratification, and expedite the selection of candidates for disease-modifying treatments or preventive strategies. The research leading to these results has received funding from the Alzheimer's Drug Discovery Foundation (ADDF) grants #RDADB-201906-2018897 and #201809-2016862. Additionally, the study has been funded by the Health Department of the Catalan Government, the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation programme (Grant agreement No. 948677), and PI22/00456, funded by Instituto de Salud Carlos III (ISCIII).
The objective of this review article is to examine and describe the literature on training speech-language pathology students on the principles of evidence-based practice (EBP). A scoping literature review was undertaken in order to identify studies related to the research question. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol extension for scoping reviews, the author conducted a search of peer-reviewed literature and extracted relevant data from the selected papers. Twenty-five papers were identified that reported information about how academic programs in speech-language pathology train students on EBP. This literature review revealed 11 different instructional approaches. Commonly utilized methods included case-based learning; integration of EBP training into clinical practicum and coursework; and training delivered via seminars, workshops, or modules. However, most papers reported that programs used multiple approaches in their instruction, so it is difficult to parse out which methods are most effective. Additionally, much of the evidence is based on student self-report measures without rigorously collected objective outcome data. This review presents several options that speech-language pathology educators may use for training students about EBP. Findings reveal a lack of empirical evidence in this area. Future research should focus on direct assessment of student learning outcomes in order to establish data-based efficacy.
Schizophrenia in adolescence severely impairs quality of life (QoL) and disrupts critical social, academic, and neurodevelopmental periods. Beyond symptom remission, functional recovery and subjective well-being have become central therapeutic goals; however, the specific contributions of pharmacogenetic, social-cognitive, and residual clinical factors to QoL in early-onset schizophrenia remain largely unexplored. This study investigated the contribution of CYP2D6 metabolizer status, social cognition (theory of mind and empathy), residual psychopathology, and family factors to subjective QoL in adolescents with schizophrenia. A cross-sectional study of 52 adolescents with DSM-5 schizophrenia (PAT-SCZ) and 51 matched healthy controls. QoL was measured with the Pediatric Quality of Life Enjoyment and Satisfaction Questionnaire (PQ-LES-Q). Social cognition was assessed using the revised Reading the Mind in the Eyes Test (RMET). Residual symptoms were rated with the Positive and Negative Syndrome Scale (PANSS). CYP2D6 genotyping classified patients as normal metabolizers (NMs) or reduced-function metabolizers (RM: intermediate/poor). Two multivariable OLS regression models examined predictors of QoL. Patients showed markedly lower QoL, impaired theory of mind, lower empathy, and higher residual symptoms than controls (all p < 0.0001). Within patients, reduced-function metabolizer (RM) status was associated with poorer QoL, weaker social cognition, higher negative/general psychopathology, and lower IQ. Two multivariable regression models explained 84.2-84.3% of the variance in QoL (adjusted R2). Social cognition (RMET scores) and CYP2D6 reduced-function metabolizer status emerged as the strongest predictors (β = 0.363 and β = -0.362, respectively, both p < 0.0001), followed by negative symptom severity and dysfunctional family relationships (all p < 0.05). Pharmacogenetic (CYP2D6), social-cognitive, and clinical factors strongly determine QoL in adolescent schizophrenia. Routine CYP2D6 genotyping, social-cognition remediation, and family interventions should be integrated into early treatment to improve long-term well-being.
The National Education Policy (NEP) 2020 calls for a multidisciplinary, flexible and outcome-oriented approach to education in India. Responding to this pivotal policy framework, the Rehabilitation Council of India (RCI) has come up with a revised syllabus (2024) for Audiology and Speech- Language Pathology courses. This investigation was a systematic mapping of the newly propagated undergraduate and postgraduate syllabi of B. ASLP, MSc (SLP), and MSc (Aud) against the central directions of the NEP 2020 namely, goals of holistic integration, structural flexibility and digital pedagogy. A qualitative structure of document analysis was used as set out by Bowen, in the analysis of the three syllabi for RCI 2024. Through a deductive strategy, the contents were coded into three domains: philosophical orientation, structural features and pedagogical strategies. Alignment in each domain was evaluated through the Theory of Change (ToC) framework to examine how elements of the curriculum could lead to long term transformations in professional training. The analysis showed strengths especially in the structural dimensions such as the introduction of a modular credit system and the explicit articulation of competencies. However, there remain major gaps in terms of explicit pedagogic strategies, multilingual provision and interdisciplinary linkages. Although the structural framework is consistent with national policy objectives, the operational pathways of digital integration and learner autonomy are not adequately outlined. The RCI syllabi exhibit promising structural congruence with the NEP 2020. However, pedagogical innovation and incorporating philosophical foundations are limited. Recommendations include incorporating graduate attributes into learning outcomes, operationalising the Academic Bank of Credit (ABC) and formalising digital teaching strategies. This study represents a first step in the reflexive process of the translation of education policy into clinical curriculum practice.
Patient-based real-time quality control (PBRTQC) is an attractive addition to a laboratory's quality assurance program. However, implementation for clinical chemistry analytes has been lacking. To assist with broader implementation, provided is PBRTQC protocols from a large hospital laboratory along with over 7 years of tabulated experience. PBRTQC was initialized and monitored for 17 clinical chemistry analytes utilizing Data Innovations middleware. Gathered results include total alerts, true alerts, and true alert rates by year and analyte. Overall, there were 623 total alerts and 160 true alerts resulting in true alert rate of 25.7%. The true alert rates ranged from 0 to 100%, depending upon the analyte. PBRTQC provides a low/no cost tool providing real-time detection of systemic bias. Implementation assists the laboratory in providing high-quality results.
Autoimmune gastritis (AIG) is characterized by well-described histologic features, yet diagnostic thresholds and reporting practices vary in routine pathology practice. This study aimed to characterize variability in evaluation, ancillary testing, and reporting of AIG across diverse pathology practice settings and training backgrounds. We conducted a national, anonymized, cross-sectional online survey for practicing pathologists who routinely sign out gastric biopsies. The survey assessed diagnostic criteria for AIG, use of ancillary studies, reporting practices, and approaches to overlapping Helicobacter pylori gastritis. Associations between respondent characteristics and diagnostic behaviors were evaluated using χ2 tests and multivariable logistic regression. A total of 163 pathologists completed the survey. Diagnostic thresholds for AIG varied widely, ranging from strict criteria requiring oxyntic gland atrophy, intestinal metaplasia, and enterochromaffin-like-cell hyperplasia to broader approaches recognizing atrophy alone. Only 22% of respondents reported AIG in the main report, while 43% reported in the comments and only one-third routinely subtyped intestinal metaplasia. In all, 52% of respondents routinely ordered gastrin immunohistochemistry in random gastric biopsies. Academic settings were associated with greater reporting detail, while gastrointestinal pathology fellowship training was associated with the use of qualifying terminology such as "early" or "suspicious" AIG (P = .01). Approaches to cases with concurrent H pylori gastritis and oxyntic gland atrophy also showed substantial variability. Diagnostic evaluation and reporting of AIG remain highly variable and are associated with subspecialty training, practice environment, and years of experience. These findings highlight the need for consensus-based guidance to improve consistency, communication, and clinical integration of AIG diagnoses.
Passing the American Society for Clinical Pathology Board of Certification (ASCP BOC) exam is a key milestone, and this study examined its association with academic performance at Qatar University. For 228 graduates attempting the ASCP BOC exam, use used χ2 tests to assess relationships between (1) performance in ASCP domains and overall exam result (pass/fail) and (2) course grades (C or above vs below C) and ASCP BOC domain performance. The correlation between grade point average (GPA) and ASCP BOC exam score was assessed using the Pearson coefficient. Passing any ASCP BOC domain was statistically significantly associated with passing the overall exam (all P < .001). Students who passed the overall exam demonstrated high pass rates across domains, particularly in chemistry (95.5%), hematology (84.1%), microbiology (86.0%), and blood banking (73.9%). Achieving a grade of C or higher in courses at the university was statistically significantly associated with passing the corresponding ASCP BOC domains in most cases. Graduation GPA was positively correlated with total ASCP BOC score (r = 0.652, P < .001). Academic performance at the university level is strongly associated with ASCP BOC certification success, along with other factors that influence student success. Higher graduation GPA and passing grades in core courses are strong predictors of improved ASCP BOC exam outcomes, providing early indicators by which to identify students who may benefit from targeted academic support.
Alzheimer's disease (AD) is a growing problem in our society and the most common form of dementia. This neurodegenerative disease is characterized by neuroinflammation and the accumulation of amyloid-β (Aβ) and tau. Previous studies have found associations between the oral microbiome and AD. This review aims to elucidate the role of the oral microbiome in AD, through neuroinflammation, and reviews the relationship between AD and bacteria and fungi. Studies have found bacteria (e.g., Porphyromonas gingivalis) and fungi (e.g., Candida albicans) in postmortem AD brains. Moreover, mice models have shown that oral microbes are able to cross the blood-brain barrier (BBB), and were correlated with activated microglia, neuroinflammation, and Aβ load. This review introduces a mechanistic framework that describes how oral microbes cause an inflammatory response resulting in AD pathology. Specifically, oral dysbiosis causes oral pathogens to disseminate into the bloodstream, this triggers an inflammatory response, subsequently activating microglia, ultimately resulting in AD pathology. This process can follow two pathways: First, there is a direct response of the immune system in the brain to oral pathogens that migrate through the bloodstream and cross the BBB, which causes neuroinflammation and activates microglia, leading to AD pathology. Second, an early-life systemic inflammation causes microglia to get into a "hyperactive" state, in which they respond in an exaggerated way to normal stimuli triggering immune responses throughout a person's life that result in AD pathology. This mechanistic framework provides new line of thought for future research on the question of causality of AD.
Bladder cancer (BLCA) is a prevalent malignancy characterized by high recurrence and poor prognosis, particularly muscle-invasive bladder cancer (MIBC). Histopathology, the gold standard for assessing muscle invasion, often suffers from sampling errors and operator dependency, underscoring the need for non-invasive, accurate preoperative assessment methods. This study aimed to develop and validate a hybrid artificial intelligence (AI) model based on computed tomography (CT) radiomics and deep learning (DL) to predict MIBC and overall survival (OS) preoperatively in BLCA patients. A total of 1370 patients from 6 academic medical centers were retrospectively included. Preoperative contrast-enhanced CT scans were analyzed to extract handcrafted radiomic features using PyRadiomics and DL features using ResNet101, followed by machine learning (ML)-based modeling for prediction. A hybrid model combining radiomic and DL features was constructed and validated in internal and external cohorts. Model performance was evaluated using metrics such as the area under the curve (AUC) and Cox proportional hazards analysis for OS prediction. The DL radiomics nomogram (DLRN) model demonstrated superior diagnostic performance, achieving an AUC of 0.807 in the internal validation cohort and 0.783 in the external multi-center validation cohort for predicting muscle invasion. The DLRN generated an imaging-derived risk score (DLRN score), which was subsequently incorporated as one covariate into a multivariable Cox proportional hazards model together with clinicopathological variables to evaluate OS. Using this approach, patients were effectively stratified into high- and low-risk groups for OS, showing robust generalizability across diverse clinical settings. AI-assisted diagnostics significantly improved the sensitivity and accuracy of urologists, particularly among less experienced clinicians. The DLRN model provides a reliable, non-invasive tool for preoperative assessment of muscle invasion and prognosis in BLCA. Addressing histopathology limitations, it offers valuable insights for personalized treatment strategies, paving the way for precision oncology in real-world clinical applications.
Even though adult degenerative scoliosis (ADS) is an increasingly relevant pathology in the aging spine, its pathophysiology has yet to be fully understood. As some previous studies have shown degeneration of the paraspinal muscles to be associated with ADS, this study aimed to examine side-specific degeneration of the erector spinae (ES), multifidus (MF), and psoas (PS) along the concave and convex aspects of the curvature. This retrospective study included patients with adult degenerative scoliosis (Cobb > 10°) and a defined apex at L3 who underwent spinal fusion surgery of at least 2 levels at a tertiary academic center. Paraspinal muscle morphology was assessed on preoperative axial T2-weighted MRIs, including fatty infiltration (FI) and height-adjusted functional cross-sectional area (fCSA). Measurements were performed bilaterally from L1/2 to L5/S1 using standardized segmentation and Otsu thresholding. Spinopelvic parameters, including Cobb angle, sagittal vertical axis (SVA), lumbar lordosis (LL), and sacral slope (SS), were measured on standing radiographs. Differences between the concave and convex sides were assessed using Wilcoxon signed-rank tests. Associations with spinopelvic alignment were analyzed using multivariable linear regression adjusted for age, sex, and BMI. A total of 51 patients with median age of 82 (IQR 72 - 85) and 70.6% posterior-only surgery were included. Marked asymmetries in paraspinal muscle composition were observed, particularly at and around the apex. The mean Cobb angle was 18.4° (15.1° - 24.3°). FI was higher and fCSA lower on the concave side, with the strongest differences in the MF at L2/3 and L3/4 (15.53, IQR 4.71-26.65, p < 0.001). Greater asymmetry in MF FI (β: 0.22, 95% CI: - 0.40- - 0.05, p = 0.014, η2 = 0.147) and ES FI (β: 0.45, 95% CI: - 0.69- - 0.21, p < 0.001, η2 = 0.268) was significantly associated with an increased Cobb angle. In contrast, increased erector spinae fCSA on both sides was significantly associated with greater SVA (β: 11.52, 95% CI: 3.28-19.77, p = 0.008, η2 = 0.193). Our results show a significant asymmetry in muscle degeneration with more pronounced changes on the concave curve side, as well as an association of increased asymmetry with an increasing Cobb angle. In contrast, greater sagittal imbalance was linked to increased muscle mass, indicating a potential hypertrophic adaptation rather than muscle atrophy as the principal contributor to sagittal decompensation. Although our cohort is predominantly geriatric and limited to patients with moderate Cobb angles, our results should be taken into consideration for further research and when developing novel treatment strategies for these patients.
Patients with clinical Stage II or III rectal cancer routinely receive neoadjuvant radiotherapy and chemotherapy. But pelvic magnetic resonance imaging may identify patients who can safely avoid neoadjuvant treatments. We evaluated 2-year oncologic outcomes for patients with "margin-clear" Stage II or III rectal cancer going directly to a planned low anterior resection. This prospective, non-randomized, phase II trial was performed at 12 high-volume hospitals across Canada. Patients proceeded directly to a planned low anterior resection if they met the staging magnetic resonance imaging (MRI) criteria for "good prognosis" rectal cancer, including distance > 1 mm between primary tumor, tumor nodule, or positive mesorectal lymph node and the mesorectal fascia. Primary outcomes were 2-year rates of local recurrence, disease free survival, and overall survival. From 30 September 2014 to 31 December 2019, 139 patients met the inclusion criteria and were recruited for the study. Final pathology was Stage 1 in 59 (42%) patients and Stage II/III in 80 (58%). For the 80 Stage II or III patients, 2-year rates for local recurrence, disease free and overall survival were 1% (95% confidence interval [CI] 0-6.8), 85% (95% CI 75.3-92.0), and 99% (95% CI 93.2-100), respectively. Only 8% (6/80) (95% CI 2.8-15.6) received adjuvant radiotherapy. Preoperative staging MRI findings over-staged 30 of 59 pathology-confirmed Stage I patients (51%) (95% CI 37.5-64.1) to a clinical Stage II or III status. Among patients planned for a low anterior resection and with MRI criteria predicting margin-clear Stage II or III rectal cancer, a direct-to-surgery approach was associated with excellent 2-year oncologic outcomes and low use of radiation. ISRCTN.com Identifier: ISRCTN05107772.
Ophthalmic complaints account for a substantial proportion of presentations to emergency and acute eye care services, yet initial assessment or referral is frequently performed by non-ophthalmologist healthcare professionals. Previous single-centre studies suggest that one-third of referrals are incorrectly diagnosed, potentially delaying appropriate management of vision-threatening conditions. However, the overall magnitude of diagnostic error and patterns of misdiagnosis across healthcare settings remain unclear. This study aims to systematically review and synthesise the evidence on the diagnostic concordance of ophthalmic referral diagnoses made by non-ophthalmologists in acute eye care. A systematic review and meta-analysis will be conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols) guidance and registered with PROSPERO. MEDLINE (Ovid), Embase (Ovid) and the Cochrane CENTRAL database will be searched from inception to April 2025. Studies evaluating the diagnostic accuracy of referrals made by non-ophthalmologist healthcare professionals in emergency or acute eye care settings will be included. Two reviewers will independently screen studies, extract data and assess risk of bias using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) framework adapted for referral-diagnosis studies. The primary outcome will be diagnostic concordance between referral and final ophthalmologist diagnosis. Where appropriate, pooled concordance proportions will be synthesised using a random-effects meta-analysis. Condition-specific 2×2 diagnostic accuracy analyses will only be undertaken where valid binary target conditions and sufficient denominators are reported. Heterogeneity will be assessed using Cochran's Q test and the I² statistic with subgroup analyses exploring differences by referring clinician type and anatomical location of ophthalmic pathology. Ethical approval is not required for this study as it will synthesise data from previously published studies; findings will be disseminated through publication in a peer-reviewed journal and presentation at relevant academic conferences. CRD420261352717.
Poly-ADP-ribose-polymerase inhibitors (PARPi) are often used as maintenance therapy in advanced epithelial ovarian cancer following primary treatment. The objective of this study was to evaluate whether the degree of response to chemotherapy (measured by the pathology-based Chemotherapy Response Score (CRS) at interval debulking surgery) is associated with a survival benefit from PARPi maintenance. Retrospective cohort study of patients with high-grade epithelial ovarian cancer who received neoadjuvant chemotherapy followed by interval debulking surgery between January 2016 and September 2022 at one high-volume academic center. Demographic, clinical, and treatment data were retrieved from hospital records. Of 213 eligible patients, CRS was reported for 169. 47 patients received PARPi maintenance, with dose reductions required in 53.2%. Baseline characteristics were similar between CRS 1 (minimal/no response) and CRS 2-3 (moderate/marked response) groups. CRS 1 was associated with lower rates of complete cytoreduction (44.1% vs 69.3%, p < 0.0001) and inferior PFS, irrespective of PARPi maintenance (p = 0.017). Among patients with CRS 2-3, PARPi maintenance improved PFS (20 vs 15 months, p = 0.029), whereas no benefit was observed in CRS 1 patients (p = 0.27). Multivariable analysis adjusting for BRCA status and surgical outcome yielded similar results. In patients demonstrating substantial response to neoadjuvant chemotherapy (CRS 2-3), PARPi maintenance was associated with improved PFS, whereas no benefit was observed for CRS 1. The score may aid counseling regarding PARPi initiation, particularly in BRCA-wildtype patients or where homologous recombination deficiency (HRD) testing access is limited.
Accurate risk adjustment in total knee arthroplasty (TKA) is essential for outcome prediction and quality assessment. Most existing prediction models rely solely on patient demographics and comorbidities and do not account for joint-specific pathology. This study evaluated whether incorporating radiographic and clinical joint-specific parameters improves machine learning (ML)-based risk adjustment and prediction of postoperative complications and residual pain following TKA. A retrospective analysis was performed on 1207 primary TKA procedures conducted at a single academic centre between 2018 and 2022. Three outcomes at 1 year were analysed: residual pain (Visual Analogue Scale [VAS] ≥ 4), any complications and major complications. Predictor variables included patient-related factors (e.g., age, body mass index, American Society of Anesthesiologists score, comorbidities) and joint-specific parameters (e.g., limb alignment, range of motion) derived from preoperative radiographs and clinical assessment. Binary classification models were developed using a stacked gradient-boosting ensemble combining XGBoost and CatBoost. For each outcome, models using patient-specific variables alone were compared with models incorporating both patient- and joint-specific variables. Model performance was evaluated using accuracy, sensitivity, specificity and area under the receiver operating characteristic curve (AUC). Incorporating joint-specific parameters significantly improved prediction of complications. For major complications, the combined model achieved an AUC of 0.74 compared with 0.66 using patient variables alone. For any complications, the AUC increased from 0.64 to 0.72. No improvement was observed for predicting residual pain. The most influential joint-specific predictors included prior septic surgery, large bone defects, Kellgren-Lawrence Grade < 3, prior ligament reconstruction and preoperative knee flexion < 70°. Inclusion of joint-specific features improved ML-based prediction of postoperative complications following TKA, but did not improve prediction of residual pain. These findings suggest that joint-specific parameters may enhance risk adjustment for postoperative complications in TKA. Level III, retrospective cohort study.
Stereotactic body radiotherapy (SBRT), most commonly delivered in 5 fractions, is an established treatment option for patients with localized prostate cancer. While efforts to further reduce treatment to fewer than 5 fractions are ongoing, the efficacy and tolerability of single high-dose SBRT remain to be established. To determine in men with localized prostate cancer whether a single-fraction SBRT can be a valid treatment option in terms of biochemical disease control and safety. This multicenter, single-arm, prospective, phase 1/2 nonrandomized clinical trial included men with localized prostate cancer at low or intermediate risk, with International Society of Urological Pathology grade group 1 or 2, and without significant tumor in the transitional zone. Participants were recruited between 2017 and 2022 in 5 academic centers in Europe and the US. Data were analyzed between February and May 2026. Participants were treated with a 19-Gy single-fraction prostate SBRT with urethra-sparing and intrafraction motion control. The primary end point was biochemical relapse-free survival (bRFS) at 3 years (expected value of 96% included in the 95% CI). Secondary end points included occurrence of genitourinary (GU), gastrointestinal (GI), and sexual adverse events (AEs) and quality of life (QOL) assessment. Among the 45 patients recruited (median age, 72 [range, 60-82] years), 43 were treated per protocol. After a median follow-up of 55.3 (IQR, 49.9-60.7) months, the estimated 3-year bRFS was 92.9% (95% CI, 85.4%-100%), meeting the primary end point. At 3 years, grade 2 GU and GI AEs were observed in 4 (9.8%) and 2 (4.9%) participants, respectively, with only a grade-3 proctitis observed in 1 patient at month 12. Grade 2 or higher erectile dysfunction increased from 9 of 42 patients (21.4%) at baseline to 15 of 39 (38.4%) at 3 years. A significant minimally clinically important change in Expanded Prostate Cancer Index Composite scores was observed in 6 (14%) and 12 (28%) participants for GU and sexual scores, respectively. The impact in GI bother scores was minimal. In this multicenter phase 1/2 trial, a single-fraction 19-Gy urethra-sparing SBRT met the primary end point, achieving a 3-year bRFS of 92.9%, with grade 2 GU and GI AEs remaining below 10% and 5%, respectively, at 3 years. Longer follow-up is warranted to assess long-term disease control. ClinicalTrials.gov Identifier: NCT03294889.
The term "clinical anatomy" is widely used in education and research, yet its conceptual boundaries continue to be interpreted in various ways. Prior consensus-based efforts have emphasized integration, collaboration, and clinical relevance as central features of the field and have provided an important foundation for interdisciplinary engagement. At the same time, ongoing changes in academic structure, medical education, and interdisciplinary biomedical science raise important questions regarding how clinical anatomy can sustain its scientific identity and long-term relevance. Building upon prior discussions, this article argues that the continued maturation of clinical anatomy depends on the integration of conceptual frameworks with the sustained production of rigorous, reproducible, and clinically meaningful scholarly contributions. Historical and contemporary examples alike demonstrate that the influence of clinical anatomy has been shaped through contributions that directly advanced clinical science and practice. Accordingly, continued emphasis on methodological rigor, reproducibility, clinically meaningful contribution, and educational accountability may be essential to the field's future development and relevance.
Cancer disproportionately impacts low- and middle-income countries (LMICs), where 70% of cancer-related deaths occur. Oncology providers are needed in global health, but significant barriers limit participation. This study explores challenges impacting global oncology engagement among cancer-oriented trainees and faculty at an academic medical center with strengths in global health and cancer care. A cross-sectional survey was distributed to residents, fellows, and faculty in oncology and oncology-related specialties between May and November 2025. The 33-question survey assessed demographics, prior oncology and global health experiences, interests and barriers impacting participation, and institutional support. Descriptive analysis was performed. There were 46 and 45 eligible responses from trainees and faculty, respectively. Only 16 (34.8%) trainees and 25 faculty (55.6%) knew about global oncology, with only four trainees (8.7%) having prior experience. Most trainees (80.4%) and faculty (80%) expressed interest in learning more and participating. However, scheduling conflicts and limited funding prevented engagement, along with absent mentorship for trainees and family obligations for faculty. Most trainees felt global oncology involvement would build their cross-cultural competence (73.9%) and strengthen clinical knowledge and research skills (65.2%). However, only 8.7% felt that current institutional support was adequate (8.7%). Significant interest in global oncology exists among trainees and faculty, but limited prior exposure, along with absent funding, time, and institutional support, limit engagement. Expanding structured training opportunities and institutional investment could motivate increased global oncology involvement and train more oncology leaders to address cancer disparities globally.
Atypical Spitz tumors (AST) represent a diagnostically challenging and biologically heterogeneous group of intermediate melanocytic tumors in children. Although recent expert consensus guidelines recommend narrow margin excision, objective outcome data supporting narrow excision margins remain limited. This study evaluates surgical management practices and clinical outcomes of AST treated at a tertiary academic center. A retrospective, IRB-approved chart review was performed on patients < 18 years diagnosed with AST and treated surgically from 2012 to 2025 at Children's Wisconsin. Lesions demonstrating spitzoid morphology with atypical histopathologic features were included. Demographics, clinical features, surgical margins, molecular studies, and clinical outcomes were assessed. Narrow excision was defined as ≤ 3 mm. Forty-three patients were included. Twenty patients (46.5%) were female, 23 (53.5%) were male. Mean age was 7.4 years (range 1-15). Mean follow-up was 53.3 months. Thirty-seven patients (86.0%) underwent narrow excision and 6 (14.0%) underwent wider excision with mean surgical margins of 2.1 mm and 6.0 mm, respectively. Four patients in the narrow excision group (10.8%) required re-excision, including 1 (2.7%) due to clinical recurrence; no re-excisions occurred after wide excision. Surgical complications occurred in 50% of patients following wide excision compared to 5.4% following narrow excision. No local or distant metastases or deaths were observed during the study period. In our cohort, narrow excision of AST was commonly employed and associated with excellent short- to mid-term oncologic outcomes and low surgical morbidity. These findings provide supportive clinical outcome data aligning with current consensus recommendations favoring more narrow surgical management of AST in children.