Zhiguo Zhao

Objectives: To report long‐term oncological outcomes for men with clinically localised prostate cancer (PCa) treated with contemporary modalities in a population‐based United States cohort. Patients and Methods: The Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study prospectively enrolled men with clinically localised PCa from 2011 to 2012. Patients were stratified into two groups: favourable prognosis (clinical T stage [cT]1–T2a/bN0M0, prostate‐specific antigen [PSA] level ≤ 20 ng/mL, Grade Group 1–2) and unfavourable prognosis (cT2cN0M0, PSA level 20–50 ng/mL, or Grade Group 3–5). Main outcomes were PCa‐specific mortality (PCSM), composite progression to advanced disease (metastasis, PCSM event, or systemic therapy), and overall survival (OS). Cox regression models adjusted for demographic and clinical covariates. Results: Of the 2604 men included, 73% were White, 15% Black, and 7% Hispanic. All hazard ratios (HRs) were adjusted for demographic and clinical covariates using multivariable Cox and Fine‐Gray models. In the favourable group, compared with surgery, external beam radiotherapy (EBRT; HR 1.5, 95% confidence interval [CI] 1.1–2.1, P < 0.01), brachytherapy (HR 2.1, 95% CI 1.3–3.3, P < 0.01), and active surveillance (HR 1.5, 95% CI 1.1–2.1, P = 0.02) were associated with higher all‐cause mortality; the 10‐year cumulative incidence of PCSM was ≤1.5% for all five strategies, and progression did not differ. In the unfavourable group, EBRT was associated with worse OS (HR 2.8, 95% CI 1.9–4.3, P < 0.01), with no adjusted differences in PCSM (10‐year cumulative incidence 3.5% after surgery vs 8.8% after EBRT) or progression across treatments. Conclusion: In this population‐based cohort treated with contemporary modalities, the 10‐year risk of PCa death was low across all treatment strategies, including active surveillance. OS differences favouring surgery likely reflect residual confounding from baseline health and treatment selection. These findings underscore the importance of patient values and comorbidities in shared decision‐making for localised PCa.

The reliability of methicillin-resistant Staphylococcus aureus (MSRA) polymerase chain reaction (PCR) nasal swab testing in the context of mupirocin nasal decolonization has been questioned. This study investigated whether the negative predictive value (NPV) of MSRA PCR nasal swab testing following mupirocin decolonization was non-inferior to testing prior to decolonization. This retrospective cohort study included adult inpatients admitted to intensive care units (ICUs) from February 2023 - August 2024 who underwent both MRSA PCR nasal swab testing and universal mupirocin decolonization. Patients were divided into 3 groups based on timing of PCR testing: prior to receiving any doses of topical mupirocin, no more than 7 days after, or greater than 7 days after a first dose. The primary outcome was the NPV of MRSA PCR nasal swab testing. 1034 patients were included in the primary analysis; 508 (49.1%) had a MRSA PCR nasal swab collected prior to the start of decolonization and 388 (73.8%) and 138 (26.2%) received nasal swabs > 0 to ≤7 days and >7 days after the start of mupirocin decolonization, respectively. The differences between the NPV of MRSA PCR testing in patients with swabs collected prior versus in patients with swabs collected >0 to ≤7 days and >7 days after the start of mupirocin were 0.3% and –0.4% (1-sided 95% CI –0.9% and CI –2.3%), respectively. The NPV of MRSA PCR nasal swabs is not diminished after mupirocin decolonization. MRSA PCR testing within 7 days of initiation of decolonization is non-inferior to testing prior to decolonization.

People living with HIV-1 (PLWH) have an increased risk of cardiovascular disease (CVD), influenced by chronic inflammation, immune dysregulation, and antiretroviral therapy (ART). B cells regulate immune responses, but their contribution to HIV-associated atherosclerosis remains poorly defined. In a cross-sectional study, we enrolled 40 PLWH and 60 people without HIV (PWoH) in Uganda, matched 1:1.5 for age and CVD risk. Peripheral blood mononuclear cells were profiled by mass cytometry to define immune cell subsets. Coronary computed tomography angiography quantified coronary artery disease using the segment stenosis score (SSS). We used multivariable hurdle regression to estimate the effect sizes of immune clusters, atherosclerotic cardiovascular disease (ASCVD) risk score, HIV status, and gender. Median age was 60 years, with no difference by HIV status. People living with HIV had a lower proportion of CCR7⁻ naïve B cells than PWoH (median 1.5% vs 1.8%; P-value adjusted [padj] = .03). Across all participants, higher CCR7⁻ naïve B cells (ratio = 0.55, P = .02), CXCR3⁺CX3CR1⁺ B cells (ratio = 0.54, P = .03), and plasmablasts (ratio = 0.57, P = .003) were associated with lower SSS. HIV-positive status was linked to nearly 3-fold higher SSS (P < .01). In stratified analyses, classical monocytes (CD14⁺CD16⁻) correlated with higher SSS among PLWH. When classical monocytes were held at the median, higher CCR7⁻ naïve B cells were protective in PLWH (ratio = 0.55, P = .02). This exploratory study suggests that lower frequencies of naïve B cells in PLWH are associated with differences in subclinical atherosclerosis. However, the mechanisms cannot be inferred from this study. This graphical abstract is also available at Tidbit: https://tidbitapp.io/tidbits/associations-between-b-cell-subsets-and-subclinical-coronary-artery-disease-in-ugandans-with-and-without-hiv

Outpatient gynecologic surgeries are very common; in 2014 alone, 500,000 procedures were performed with 70% and 85% of hysterectomies and oophorectomies, respectively, performed in the outpatient setting. Although risk factors for overnight or prolonged admission after outpatient hysterectomy have been studied, less is known about the postoperative emergency department (ED) burden generated by other outpatient gynecologic surgeries. The objective of this retrospective cohort study was to identify the incidence of ED visits within 30 days of outpatient gynecologic surgery and to identify risk factors for these visits. This study included all adult patients undergoing scheduled outpatient gynecologic surgery for a benign condition at the Vanderbilt University Medical Center (VUMC), a tertiary academic medical institution, between January 2018 and September 2019. Demographic data, as well as comorbidities, surgical history, and surgical outcomes data, were obtained from the electronic medical record. Primary procedure performed was characterized into 1 of 4 categories: hysterectomy, other intra-abdominal nonprolapse surgery, prolapse surgery without hysterectomy, or other nonprolapse vulvovaginal procedure. The primary study outcome was evaluation in the VUMC ED within 30 days of surgery. Logistic regression models were used to evaluate associations between potential risk factors and the risk of an ED visit. A total of 2373 surgeries met the inclusion criteria, with 109 patients (5%) visiting the VUMC ED for a total of 125 visits within 30 days of surgery. After adjustment for potential confounders, younger age (adjusted odds ratio [aOR], 1.2; 95% confidence interval [CI], 1.1–1.3; P < 0.001), history of abdominal surgery (aOR, 1.7; 95% CI, 1.1–2.6; P = 0.02), cardiopulmonary comorbidities (aOR, 1.9; 95% CI, 1.2–3.0; P = 0.004), undergoing hysterectomy (aOR, 2.0; 95% CI, 1.1–3.8; P = 0.03), and a vulvovaginal surgical route as opposed to abdominal surgical route (aOR, 2.4; 95% CI, 1.2–5.1; P = 0.02) were all related to an increased risk of visiting the emergency room. Patients who visited the ED were more likely to have undergone hysterectomy (26% vs 20%, P = 0.05) and less likely to have undergone prolapse surgery (4% vs 12%, P = 0.05). The median time to first ED presentation was 7 days following surgery and surgical site pain (n = 52 [42% of visits]), nausea and/or vomiting (n = 18 [14%]), and fever (n = 15 [12%]) were the most common chief complaints. Of the 125 visits, 45 (36%) resulted in admission, and 36 of these (80%) were surgery related. The results of this study demonstrate that although ED visits after outpatient gynecologic surgery are uncommon, younger patients with underlying cardiopulmonary comorbidities and/or a history of abdominal surgery are at greater risk.

Clinical and molecular characteristics of PD-L1 staining cohort.

Non‐invasive prenatal screening (NIPS) using cell‐free DNA is a screening test for fetal aneuploidy offered by a variety of prenatal healthcare providers. Guidelines for genetic screening consistently recommend that providers facilitate informed choices, which have been associated with better psychological and clinical outcomes than uninformed choices. The multidimensional measure of informed choice (MMIC) is a widely used and theory‐based measure that combines knowledge, values, and behavior to classify decisions as either informed or uniformed. We implemented a previously validated version of the MMIC for women offered NIPS to describe the choices made by women receiving prenatal care at the Vanderbilt University Medical Center. The survey included the Ottawa Decisional Conflict scale, an outcome measure used for validation of choice categorization. We found that most women (87%) made an informed choice about NIPS. Of the women categorized as uninformed, 67% had insufficient knowledge, and 33% had an attitude discordant with their decision. The vast majority of respondents (92.5%) underwent NIPS and had a positive attitude toward screening (94.3%). Ethnicity (p = 0.04) and education (p = 0.01) were found to be significantly associated with informed choice. Decisional conflict was extremely low among all participants, with only 5.6% of all participants demonstrating any form of decisional conflict, and all being categorized as having made an informed choice. This study suggests that pre‐test counseling by a genetic counselor results in high rates of informed choice and low‐decisional conflict amongst women offered NIPS by genetic counselors, though more research is required to determine if rates of informed choice remain high when NIPS is offered by other prenatal providers.