Search Results (925)

Prostate cancer remains a major global health challenge, ranking as the second most common malignancy in men worldwide. Advances in diagnostic and therapeutic strategies have transformed its management, enhancing patient outcomes and quality of life. This review highlights recent breakthroughs in imaging, including multiparametric MRI and PSMA-PET, which have improved cancer detection and staging. Biomarker-based diagnostics, such as PHI and 4K Score, offer precise risk stratification, reducing unnecessary biopsies. Innovations in treatment, including robotic-assisted surgery, novel hormone therapies, immunotherapy, and PARP inhibitors, are redefining care for localized and advanced prostate cancer. Artificial intelligence (AI) and machine learning (ML) are emerging as powerful tools to optimize diagnostics, risk prediction, and treatment personalization. Additionally, advances in radiation therapy, such as IMRT and SBRT, provide targeted and effective options for high-risk patients. While these innovations have significantly improved survival and minimized overtreatment, challenges remain in optimizing therapy sequencing and addressing disparities in care. The integration of AI, theranostics, and gene-editing technologies holds immense promise for the future of prostate cancer management. Full article

Background/Objectives: The COVID-19 pandemic has been associated with significant increases in mental-health-related concerns in adolescents, including eating disorders. Disparities in screening, diagnosis, and treatment impact adolescents with eating disorders. This study aimed to describe the patterns in the prevalence and the associations between eating disorder diagnoses and demographic factors in adolescent patients since the start of the COVID-19 pandemic. Methods: We performed a retrospective cohort study examining adolescent patients (aged 12 to 21) with an eating disorder (ED) diagnosis documented between January 2019 and July 2023 using Epic Systems Corporation’s Cosmos, a de-identified dataset aggregated from electronic health record (EHR) data. We examined the differences in demographic factors by utilizing chi-square and Kruskal–Wallis rank sum tests. Results: A total of 82,435 distinct adolescent and young adult patients with eating disorder diagnoses were included in the analytical dataset. The overall prevalence of EDs has increased since 2019. The median age of patients with an ED decreased between 2019 and 2023. There was a decrease in other eating disorder diagnoses and an increase in avoidant-restrictive food intake disorder (ARFID) during the study period. There was a decrease in the proportion of individuals who identified as White and an increase in the proportion of adolescents from historically minoritized racial and ethnic groups (i.e., African American or Black and Hispanic). There was also an increase, during this study period, in the proportion of adolescents with an ED diagnosis who were from more socially vulnerable communities. Conclusions: Our study describes the changes in the prevalence of sociodemographic factors in adolescent patients with EDs since the start of the COVID-19 pandemic. Further studies should address screening, diagnostic, and treatment barriers for EDs in historically underserved communities. Full article

Background: Transportation equity has emerged as a critical area of focus in recent studies. Integrating equity into transportation research is increasingly recognized as essential for developing fair, inclusive, and sustainable transportation systems. The significance of this integration lies in its potential to reduce social and spatial disparities, support economic growth, promote social cohesion, and advance public health. Methods: This literature review synthesizes recent research on the incorporation of equity into transportation studies within transportation planning and frameworks. It examines how equity is conceptualized, measured, and operationalized, focusing on both horizontal equity (the equal treatment of similar groups) and vertical equity (prioritizing disadvantaged populations). This study evaluates various methodologies and tools, such as accessibility indices, affordability metrics, and community engagement approaches, which are used to assess and promote equity in transportation systems. Results: The findings from this review highlight the importance of both horizontal and vertical equity in transportation planning and policy and foundational tools for assessing equity. Conclusions: Integrating equity into transportation research is vital for creating systems that are equitable, inclusive, and responsive to the needs of all communities. Addressing current challenges requires clearer and more consistent frameworks, improved data collection, and more inclusive, community-driven decision-making processes. Full article

Asthma is a chronic inflammatory disease characterized by airway hyperresponsiveness, variable airflow obstruction, and persistent inflammation. While its pathophysiology is well established, growing evidence highlights significant sex-based differences in its prevalence, severity, and treatment response. Epidemiological studies indicate that asthma is more common in prepubertal boys but shifts toward a female predominance after puberty, with adult women experiencing higher morbidity and greater healthcare utilization. These disparities suggest a crucial role for sex hormones, genetic predisposition, and epigenetic regulation in asthma pathogenesis. Sex hormones modulate immune responses, contributing to disease progression. Estrogen enhances type 2 inflammation, increases eosinophilic infiltration, and upregulates IL-4 and IL-13 expression, leading to greater airway hyperreactivity in women. Additionally, progesterone fluctuations correlate with perimenstrual asthma exacerbations, while testosterone appears to exert a protective effect by dampening Th2-driven inflammation and airway remodeling. These hormonal influences contribute to sex-specific asthma phenotypes and treatment responses. Genetic and epigenetic factors further shape sex-related differences in asthma. The X chromosome harbors immune-regulatory genes, including TLR7 and TLR8, which amplify inflammatory responses in females. The sex-dependent expression of IL13 and ORMDL3 influences eosinophilic inflammation and airway remodeling. Epigenetic modifications, such as DNA methylation and microRNA regulation, further impact immune activation and corticosteroid responsiveness. For instance, Let-7 miRNAs modulate IL-13 expression, contributing to sex-specific inflammatory profiles. Environmental factors, including air pollution, obesity, and diet, interact with hormonal and genetic influences, exacerbating sex disparities in asthma severity. Obesity-related metabolic dysfunction promotes systemic inflammation, airway remodeling, and steroid resistance, disproportionately affecting women. Given these complex interactions, sex-specific approaches to asthma management are essential. Personalized treatment strategies targeting hormonal pathways, immune regulation, and metabolic health may improve outcomes for both men and women with asthma. Future research should focus on sex-based therapeutic interventions to optimize disease control and mitigate healthcare disparities. Full article

Papillary thyroid cancer (PTC) is the most common thyroid malignancy, with significant racial/ethnic disparities in incidence and survival. Asians have the highest incidence, and recurrence, while African Americans experience the lowest survival rates, suggesting contributions from genetic, environmental, and healthcare-related factors. While socioeconomic disparities play a role, emerging evidence highlights genetic and molecular mechanisms underlying these differences. This study examines differentially expressed genes (DEGs) to identify potential molecular drivers of PTC disparities. Bulk RNA-sequencing (RNA-seq) data from 20 PTC tumors (5 White, 5 African American, 5 Hispanic, and 5 Asian) were analyzed using the UseGalaxy platform. Preprocessing included quality control, adapter trimming, and genome alignment. Differential expression analysis identified genes with p < 0.01 and fold change ≥ 2.5. Volcano plots visualized significant DEGs. Gene Set Enrichment Analysis (GSEA) via eVITTA identified enriched pathways. TCGA data analysis validated racial/ethnic differences in gene expression. Ethnic groups exhibited distinct gene expression profiles. GSEA revealed differences in cell proliferation, immune regulation, and thyroid hormone metabolism. African Americans showed immune suppression and reduced tumor suppressor activity, while Asians exhibited enriched cell cycle and DNA repair pathways. Significant differences were confirmed in some of the genes in TCGA data analysis. This study identifies genetic factors contributing to racial disparities in PTC, emphasizing the need for further validation in larger cohorts and functional studies. Understanding these molecular differences may inform personalized treatment strategies and improve PTC outcomes across diverse populations. Full article

Background: Women with a lower socioeconomic status (SES) have an increased risk of dying from breast cancer (BC) than those with a higher SES. The association of SES with BC survival may be partially mediated by factors such as Oncotype DX (ODX) testing and stage at diagnosis. This study aims to examine SES disparities in survival among HR+/HER2- BC women and to quantify the mediating effects of the ODX test and stage. Methods: We used data from the Louisiana Tumor Registry to identify women aged 20–90 years diagnosed with stage I–II in 2011–2014 and stage I–III in 2015–2017 HR+/HER2- BC who underwent BC surgery. The follow-up cutoff date was 31 December 2020. Cox proportional hazard regression and generalized mediation analysis were both performed. Results: Of 8931 BC women, 41.4% underwent ODX testing. After adjusting for sociodemographic, tumor characteristic, and treatment variables, low SES women had a higher hazard of overall death (HR = 1.16, 95% CI: 1.02–1.32) and BC-specific death (HR = 1.37; 95% CI: 1.01–1.87) compared to high SES women. The ODX test and stage explained 9.0% and 11.2% SES differences in the hazard of overall death and 4.4% and 13.3% in BC-specific death, respectively. Conclusions: Low SES is associated with higher hazard rates of overall and cause-specific death among women with breast cancer, even after adjustment. Differences in Oncotype DX (ODX) testing and stage at diagnosis explained part of these disparities. Targeted interventions are needed to improve access to genomic testing and early detection to reduce SES-related disparities in breast cancer outcomes. Full article

Background/Objectives: The persistent health disparities affecting Black men in the US healthcare system reflect systemic inequities that impact their health outcomes. This qualitative study employs thematic analysis to examine how Black men’s interactions with medical providers shape their healthcare experiences and to identify key factors influencing their quality of care. Methods: Through in-depth interviews with 25 Black men throughout the United States, our thematic analysis identified patterns in their reported healthcare experiences. Results: Our analysis revealed four main themes: (1) inadequate clinician communication and information, (2) clinician dismissiveness and failure to listen, (3) experiences of interpersonal racial bias in healthcare interactions, and (4) facilitators of positive, patient-centered healthcare encounters. Black men’s narratives illuminate how communication barriers, dismissive treatment, and racial bias manifest in healthcare settings, while also highlighting elements that facilitate successful patient–clinician relationships. Conclusions: The findings suggest specific approaches for improving these interactions, including clinician active listening and bias training, anti-racism medical education, accountability policies, increased clinician diversity, and patient self-advocacy strategies to address systemic factors affecting Black men’s healthcare experiences and outcomes. Full article

Background: Despite advances in glioblastoma (GBM) management, median overall survival (mOS) remains poor, and multi-modal disparities persist. We sought to evaluate trends in GBM treatment and survival outcomes from 2005–2020, with a focus on sociodemographic and geographic disparities. Methods: We conducted a retrospective US-based cohort study using the National Cancer Database (NCDB), stratifying study period into four intervals (2005–2008, 2009–2012, 2013–2016, and 2017–2020). Logistic regression was used to identified predictors of receipt of combination surgery, radiation, and chemotherapy (Sx+RT+Chemo). Kaplan–Meier and multivariable Cox proportional hazards approaches were used to assess mOS. Results: A total of 111,955 adults with GBM were included. From 2005–2008 to 2017–2020, mOS increased from 7.8 to 9.5 months, with geographically unequal gains in survival across the US. In multivariable logistic regression model adjusting for known confounders, combined Sx+RT+Chemo was less likely to be received by female patients (OR 0.90, 95% CI 0.88–0.92) vs. male, non-White patients (OR 0.90, 95% CI 0.86–0.94) vs. White, patients treated at community hospitals (OR: 0.78, 95% CI 0.76–0.80) vs. academic centers, publicly-insured patients (OR 0.74, 95% CI 0.71–0.76) or uninsured patients (OR 0.54, 95% CI 0.50–0.58) vs. privately-insured, and patients living in the South (OR 0.88, 95% CI 0.85–0.91), Midwest (OR 0.83, 95% CI 0.80–0.86), and West (OR 0.85, 95% CI 0.81–0.88) compared to the Northeast. In multivariable Cox regression, significantly poorer survival was seen amongst non-metropolitan patients, community-based hospital patients, and publicly-insured and uninsured patients (vs. privately-insured), despite adjusting for prognostic factors. Conclusions: Only modest improvement in mOS of GBM patients has occurred across 2005–2020, with persistent disparities linked to sociodemographic and structural factors, whose redressal warrants multi-pronged efforts. Full article

Colorectal cancer (CRC) remains a major health burden in Japan, with precision medicine playing an increasingly critical role in treatment optimization. Key biomarkers, including RAS, BRAF, microsatellite instability/mismatch repair, and human epidermal growth factor receptor 2, can be used as a guide for molecularly targeted therapies and immunotherapy. Advances in molecular diagnostics, including comprehensive genomic profiling, have enabled more precise treatment selection such as RET and NTRK fusions. Nationwide initiatives, such as c-CAT and SCRUM-Japan, can leverage real-world data to refine clinical strategies. Recent developments in circulating tumor DNA analysis have led to novel approaches for minimal residual disease monitoring, as demonstrated by the CIRCULATE-Japan GALAXY study. However, certain challenges persist, including the time required for genetic testing, the limited availability of targeted therapies, and disparities in access to molecular tumor boards. This review summarizes the current landscape of precision medicine in CRC in Japan, emphasizing key biomarkers, genetic testing strategies, targeted therapies, and emerging technologies. Future research should focus on expanding clinical trial access, accelerating drug approvals, and integrating real-world data into clinical practice to further advance precision medicine. Full article

Interdisciplinary decision-making significantly influences both the therapeutic potential and clinical outcomes, shaping clinical attitudes and management strategies. As the integration between endodontic and restorative-prosthetic considerations becomes increasingly prevalent, it is essential to understand how different dental specialists, particularly general dental practitioners, prosthodontists and endodontists, approach clinical decision-making and collaborate to optimize patient care. Objectives: This study aims to identify practice disparities in post-endodontic crown placement to inform national policy reforms, including standardised timing protocols and interdisciplinary referral criteria. Methods: A structured questionnaire was distributed to dentists practicing in Romania, yielding 238 collected responses. Results: Substantial variability was found in clinical approaches: diagnostic imaging preferences indicated frequent use of periapical radiography (83.49%) and CBCT (53.67%). Over 70% expressed high confidence in CBCT’s diagnostic precision, significantly higher than periapical radiography (Wilcoxon Signed-Rank test, p < 0.00001). A statistically significant majority (69.3%, binomial test, p < 0.001) preferred delaying definitive crown placement until radiographic healing of periapical lesions. Logistic regression analysis showed endodontists were significantly less likely to choose invasive treatments compared to other specialists (p = 0.027). Although clinicians widely recognize the significance of prosthetic planning, its early integration into the overall treatment strategy has been inconsistent. Conclusions: This study points out the necessity for standardised guidelines that clearly integrate prosthetic planning into endodontic decision-making, enhancing predictability and tooth preservation. Full article

While biomarker testing can provide various benefits for cancer patient outcomes, numerous challenges persist that cause inequities in access across Canada. An online survey consisting of 51 questions was disseminated to evaluate biomarker testing and precision medicine knowledge and experiences from Canadian patients and caregivers. Responses were recorded between June 2023 and January 2024 and assessed various aspects of the biomarker testing experience including the expectations and challenges of patients. Quantitative and qualitative analyses were conducted using Microsoft Excel and R for descriptive and correlative data analysis, respectively. Among the 74 responses, patients reported an overall moderate experience with positive outcomes for those who underwent biomarker testing, including changes to treatment plans and the shrinking of tumours. The main challenges identified included knowledge gaps, a lack of testing availability, turnaround time for results, and financial constraints, all of which contribute to the disparities in biomarker testing access. Qualitative analysis of responses further emphasized a strong patient desire for patient-centred care and collaborative decision-making for biomarker testing options and treatment planning. Addressing these challenges through increased education, policy advocacy, and advancing infrastructure can help to reduce interprovincial inequities in biomarker testing and contribute to improving cancer patient outcomes. Full article

Background: Rare cancers, defined as those with an incidence rate of fewer than 6 cases per 100,000 individuals, contribute to a substantial portion of the global cancer burden. Despite their impact, they receive less attention than more common malignancies, leading to challenges in early detection, treatment strategies, and research funding. This study aims to assess the global incidence and mortality patterns of rare cancers in 2022 to better understand their contribution to the overall cancer burden and regional disparities. Methods: We conducted a comprehensive analysis using 2022 GLOBOCAN estimates to assess the global incidence and mortality of rare cancers. The study included 24 major rare cancers, such as bladder cancer, leukemia, non-Hodgkin lymphoma, esophageal cancer, and pancreatic cancer. Age-standardized rates (ASRs) were calculated to compare cancer burden across continents, and absolute case and death counts were reported. Results: In 2022, rare cancers accounted for 26.7% of all new cancer cases (5,347,784 cases) and 30% of all cancer-related deaths (2,959,369 deaths) worldwide. Bladder cancer was the most common rare cancer, with an incidence rate of 5.58 per 100,000, followed by non-Hodgkin lymphoma (5.57) and leukemia (5.26). Mortality rates were highest for pancreatic, esophageal, and brain cancers, reflecting their aggressive nature and limited treatment options. Significant regional disparities were observed, with Europe and North America reporting the highest incidence rates for bladder cancer and leukemia, while Asia bore the largest absolute burden of rare cancers. Conclusions: Rare cancers represent a considerable share of the global cancer burden, with notable geographic variations in incidence and mortality. These findings underscore the need for improved early detection, expanded treatment access, and targeted research efforts to address disparities and improve outcomes for patients with rare cancers worldwide. Full article

Poxvirus infections, particularly those caused by the monkeypox virus, have emerged as significant public health threats. Ocular manifestations constitute a severe potential clinical complication associated with these infections, potentially resulting in permanent visual impairment in afflicted patients. This review aimed to examine the clinical spectrum of ocular manifestations associated with mpox and other poxvirus infections and to evaluate current management strategies alongside emerging therapeutic interventions and prevention strategies. A comprehensive literature search was performed across major databases to identify studies reporting ocular involvement in poxviral infections. Ocular involvement in poxviral infections ranges from mild conjunctivitis and eyelid lesions to severe keratitis with potential vision loss. Mpox-related ocular manifestations are more prevalent in unvaccinated and immunocompromised individuals. Although early antiviral intervention and supportive care are critical, clinical outcomes vary considerably across viral clades. Emerging evidence indicates that tecovirimat may reduce lesion severity, although its impact on accelerating recovery remains limited. Moreover, vaccine strategies, particularly the MVA-BN (JYNNEOS) vaccine, appear to decrease ocular complications, despite regional disparities in access and implementation. Ocular complications pose a significant clinical challenge in mpox and related poxviral infections. This review highlights the need for early diagnosis and integrated treatment approaches that combine antiviral therapy, supportive care, and targeted vaccination. Further research is essential to refine treatment protocols and assess the long-term outcomes in diverse patient populations. Full article

Soil microorganisms are increasingly recognized as critical regulators of farmland soil fertility and crop productivity. However, the impacts of spatial heterogeneity in soil microbial communities on bioindicators for evaluating agricultural practices remain poorly understood and warrant further validation. Through field experiments, this study investigated the differential effects of agricultural practice treatments on soil properties and bacterial communities between two main farmland soil compartments: intra-row and inter-row. Additionally, we explored the potential correlations between key taxa and soil properties, as well as maize biomass. Results revealed marked disparities in soil properties, bacterial community compositions, and co-occurrence network patterns between intra-row and inter-row soils. Agricultural practice treatments exerted significant impacts on bacterial community structures and network topological features in both intra-row and inter-row soils. Subsequent correlation analysis demonstrated strong relationships between soil properties and most keystone species. In addition, 42 and 41 indicator species were identified in intra-row and inter-row soils, respectively, including shared genera such as Solirubrobacter, Blastococcus, Iamia, Conexibacter, and Lysobacter. Notably, 22 key indicator species in intra-row soils displayed significant positive/negative correlations with maize biomass, whereas only 4 key indicator species showed negative correlations in inter-row soils. These findings highlight differential responses of bacterial communities to agricultural practices in distinct soil compartments. The intra-row soils harbored more bacterial taxa significantly associated with maize biomass, while the inter-row soils better reflected the effects of agricultural interventions. This study confirms the spatial variability of microbial communities as effective bioindicators for evaluating agricultural practice strategies. Identification of compartment-specific indicators provides novel microbiological insights into supporting precision agriculture practices. Full article

Objective: This systematic review and meta-analysis aims to evaluate the temporal changes in Helicobacter pylori antibiotic resistance in Russia based on studies published over the past 15 years. Materials and Methods: We conducted a comprehensive literature search in MEDLINE/PubMed, EMBASE, the Russian Science Citation Index, and Google Scholar, following the PRISMA 2020 guidelines. Our meta-analysis was pre-registered in PROSPERO (CRD 420251025636). The inclusion criteria included original research, published in English or Russian in 2011–2024, involving antibiotic susceptibility testing in treatment-naive Russian adults using validated diagnostic methods. Two independent researchers selected studies and extracted data using standardized procedures, with methodological quality assessed via the Newcastle–Ottawa Scale. Pooled resistance rates were calculated using fixed/random-effects models in MedCalc 23.1.5 and Python 3.9.21, with meta-regression investigating temporal trends and subgroup analyses examining regional and methodological variations. Results: We identified 16 studies comprising 1206 H. pylori isolates. The pooled analysis of studies (2011–2025) revealed an overall clarithromycin resistance rate of 15.236%, with a significant temporal increase from 11.903% pre-2015 to 21.024% in 2020–2024 (p = 0.0049). Metronidazole showed consistently high pooled resistance (33.309%), while amoxicillin (1.828%), levofloxacin (19.014%), tetracycline (1.328%), and rifampicin (5.803%) maintained low resistance rates, and dual clarithromycin–metronidazole resistance was observed in 2.793% of isolates. Regional disparities were notable in the two largest cities of Russia, with 18.763% clarithromycin resistance in Moscow versus 28.540% in Saint-Petersburg. Conclusions: Russia surpasses the Maastricht VI Consensus resistance threshold for clarithromycin (15%), necessitating revision of empirical treatment strategies. The significant increase in clarithromycin resistance, potentially exacerbated by antibiotic use during the COVID-19 pandemic, underscores the urgent need for resistance-guided therapies and ongoing national surveillance programs to optimize H. pylori management. Full article