Publications by Year: 2026

Interventional oncology has gained a lot of traction as an attractive alternative treatment for various musculoskeletal tumours by offering minimally invasive image-guided therapies. In this domain, thermal ablation is increasingly being used malignant tumours, including bone metastatic disease. Thermal ablation therapies such as radiofrequency ablation, microwave ablation, cryoablation and high intensity focused ultrasound therapy achieve excellent local tumour control and pain palliation, whilst structural stability is ensured through the combination with bone augmentation techniques such as standard or reinforced osteoplasty. Many factors are affecting the results including the biology of the disease the treatment intent (curative or palliative) as well as the potential for complications, like thermal injury to surrounding tissues, highlight the need for meticulous procedural planning. This review highlights the pathophysiology, the current repertoire of thermal ablation techniques, clinical outcomes and the future directions for the treatment of metastatic bone disease.

BACKGROUND: Dual antiplatelet therapy (DAPT) is recommended around carotid artery stenting (CAS) to reduce periprocedural stroke risk. Clopidogrel is widely used, but response variability related to pharmacokinetics and CYP2C19 polymorphisms may limit its effectiveness. Ticagrelor is a more potent, direct acting P2Y12 inhibitor, but its comparative effectiveness in CAS remains uncertain.

METHODS: We conducted a retrospective cohort study in the TriNetX database, identifying adults with carotid artery stenosis who underwent CAS between January 2016 and August 2025 and received either ticagrelor or clopidogrel. Primary outcomes at 180 days included ischemic stroke, major hemorrhage, intracranial hemorrhage, and all cause mortality. Secondary outcomes included inpatient readmission and emergency department (ED) visits. Propensity score matching (1:1), Kaplan-Meier survival, and Cox proportional hazards analysis were used.

RESULTS: Among 6996 patients, 378 received ticagrelor and 6618 received clopidogrel; aspirin co-use was similar (89.7% vs 91.7%). After matching, 377 patients remained in each cohort. Ischemic stroke (2.7% vs 4.2%; HR 0.56, 95% CI 0.25 to 1.27; P=0.159) and major hemorrhage (2.9% vs 4.8%; HR 0.61, 95% CI 0.29 to 1.30; P=0.197) were numerically lower with ticagrelor. Rates of intracranial hemorrhage were similar (2.7% vs 2.7%; HR 0.61, 95% CI 0.14 to 2.53; P=0.488). Mortality was numerically higher with ticagrelor (3.4% vs 2.7%; HR 1.64, 95% CI 0.68 to 3.97; P=0.263). ED visits were similar (14.3% vs 14.6%; HR 0.97, 95% CI 0.67 to 1.42; P=0.895). Inpatient readmission was numerically lower with ticagrelor (15.9% vs 19.1%; HR 0.81, 95% CI 0.57 to 1.14; P=0.223).

CONCLUSION: Ticagrelor and clopidogrel showed comparable safety and effectiveness following CAS. Future prospective genotype informed trials are warranted to confirm these findings.

Cerebrovascular dysfunction is associated with aging and the progression of neurodegenerative diseases. Optical coherence elastography (OCE) is an emerging technique for measuring the stiffness of arteries nondestructively with high spatial resolution. In this study, we employed wave-based OCE to measure the shear modulus of human anterior cerebral arteries (ACA). Surface elastic waves were excited on ACA across a wide frequency range (2 to 100 kHz), at intra-vessel pressures ranging from 20 to 140 mmHg. Lamb wave theory was applied to analyze the propagation speeds of dispersive elastic waves guided along the arterial walls and determine shear modulus. The measured shear modulus increases linearly with pressure, reflecting the hyper-elastic properties of arterial walls. The data were compared with stiffness values derived from conventional biaxial extension-inflation mechanical testing. The shear modulus determined from high frequency OCE measurements are much higher when compared to those from the quasi-static mechanical tests. Nevertheless, both measurements demonstrated a consistent trend of cerebral artery stiffening with aging.

INTRODUCTION: Patients undergoing colorectal surgery with fecal ostomy experience biopsychosocial challenges during recovery. We aimed (1) to describe clinician's perceived challenges with biopsychosocial recovery after ostomy surgery and (2) to examine current solutions to address patient psychosocial challenges while recovering.

METHODS: We conducted qualitative focus groups evaluating clinician perspectives using a semistructured interview guide. Colorectal surgeons, gastrointestinal psychologists, colorectal surgery nurse practitioners, and ostomy nurses were included.

RESULTS: Five interview sessions were performed including focus groups and individual interviews. Clinicians were 73% female, all White, and with varied experience (2-40 y in practice). All participants reported ostomy-related emotional distress occurs after surgery and impacts patient recovery and adaptation. Participants reported distress was mitigated when the ostomy relieved functional symptoms and in patients with time to cope with needing an ostomy due to chronic diseases. Patients with permanent ostomies were felt to adapt faster. Emotional distress increased dependence on caregivers, prolonged hospital stays, and delayed adaptation to daily life. Ostomy nurses reported they spent significant time addressing patient distress in clinical encounters. Participants reported a lack of training, time, and resources to help manage patients' emotional distress.

CONCLUSIONS: Clinicians treating colorectal surgery patients with ostomy frequently note clinically significant emotional distress. This distress hinders patients' ability to adapt to life with an ostomy. An ostomy specific distress management intervention is needed to improve biopsychosocial outcomes during surgical recovery and adaptation.

PURPOSE: 1) To review the evidence whether "testosterone drives prostate cancer"; 2) to dissect the arguments supporting this belief; and 3) to present the new framework of androgen adequacy versus inadequacy to explain the relationship of testosterone and prostate cancer.

MATERIALS AND METHODS: A MEDLINE review of the literature was performed.

RESULTS: The belief that testosterone (T) drives prostate cancer (PCa) originated with Charles Huggins in 1941, led to a near-complete prohibition against T therapy (TTh) for 60 years, and persists today in regulatory warnings, guideline restrictions, and widespread clinical concerns. However, the evidence is now overwhelming that T does not drive PCa. Biopsy studies show PCa risk is unrelated to endogenous androgen concentrations. Large RCTs reveal identical PCa rates in men receiving TTh versus placebo. TTh in men with known PCa has not shown increased rates of recurrence or progression. While androgens are required for PCa growth, PCa growth also requires other chemicals, e.g., calcium. What is unique to androgens is it is the only required chemical that does not cause loss of life with severe deprivation. The key concept to understand the relationship of androgens and PCa is adequacy versus inadequacy. Adequate T concentrations for optimal PCa growth occur at a low concentration called the saturation point. Below this, cellular metabolism is compromised and cell death may occur depending on degree of deprivation.

CONCLUSIONS: Testosterone does not drive prostate cancer. Androgen adequacy versus inadequacy provides a scientifically sound framework to understand the relationship of testosterone and prostate pathophysiology.

BACKGROUND: Given their emphasis on holistic, patient-centered care, nurse practitioners (NPs) and physician assistants (PAs) play an increasingly critical role in the care of patients with gastrointestinal conditions, including irritable bowel syndrome (IBS).

OBJECTIVES: To review key clinical considerations for the diagnosis and management of IBS, focusing on IBS with diarrhea (IBS-D), alongside 2 case presentations.

DATA SOURCES: PubMed and Google Scholar searches of English-language articles published between January 1, 2009, and April 2, 2025, were conducted to identify publications on the burden, diagnosis, and treatment of IBS-D.

RESULTS: Data indicate that IBS-D impairs quality of life, daily activities, and work productivity and imposes a substantial socioeconomic burden. A positive diagnostic approach involving a detailed medical history and physical examination, with limited laboratory testing in the absence of alarm features, is recommended to facilitate timely and accurate diagnosis. Effective ongoing management relies on a patient-provider relationship that uses shared decision making, patient education and empowerment, and a personalized treatment strategy targeting the IBS subtype and most bothersome symptoms. Treatments considered for IBS-D include dietary management, over-the-counter agents, United States Food and Drug Administration-approved medications, neuromodulators, and gut-brain behavioral therapies.

CONCLUSIONS: Positive diagnosis of IBS-D and an evidence-based, symptom-targeted therapeutic approach are recommended to minimize disease burden.

IMPLICATIONS FOR PRACTICE: Both NPs and PAs are well positioned to provide individualized, compassionate, and competent care to patients with IBS-D. Communicating a confident, positive diagnosis and collaborating on a treatment plan that considers symptom presentation and most bothersome symptoms can improve patient outcomes.

BACKGROUND: The effects of smoking on outcomes after spinal spondylodesis remain unclear due to conflicting findings in the existing literature. This meta-analysis aimed to evaluate the association between smoking and clinical as well as radiological outcomes following instrumented spinal fusion, and to examine differences based on smoking status, spinal region, and surgical extent.

METHODS: PubMed, Embase, and Cochrane were searched up to August 2024 for comparative studies reporting outcomes in smokers and non-smokers undergoing spinal fusion. Extracted outcomes included clinical scores (Oswestry Disability Index [ODI], Neck Disability Index [NDI], Visual Analog Scale [VAS] for pain), fusion rates, pseudoarthrosis, and complications. Pooled percent mean change from baseline and weighted incidences with 95% confidence intervals (CI) were calculated using a random-effects model. Subgroup analyses were performed by spinal region, number of operated levels, and smoking history (current, former, never).

RESULTS: Twenty-nine studies involving 6,687 patients were included. In most outcome measures, smokers showed smaller percent improvements than non-smokers. For instance, NDI improved by 42.8% (95% CI: 25.4-60.1%) in smokers vs. 49.7% (32.4-64.0%) in non-smokers; ODI improved by 48.6% (34.7-62.5%) vs. 56.5% (42.6-70.3%); and VAS back pain by 55.0% (29.7-80.2%) vs. 60.5% (35.2-85.7%). Fusion rates were lower in smokers (86.8%) than in non-smokers (95.1%), while pseudoarthrosis was more common in smokers (17.2% vs. 7.3%). Subgroup analyses revealed similar trends across spinal regions and surgical scope. A hierarchical pattern was observed, with never-smokers experiencing the most favorable outcomes, followed by former smokers.

CONCLUSION: In most instances, smokers appeared to experience worse outcomes following instrumented spinal procedures compared to non-smokers, and a hierarchical pattern was notable, with current smokers experiencing the worst outcomes, followed by former smokers compared to never-smokers. Future well-designed studies with proper adjustment for confounding are needed to further confirm these findings.