Central Michigan University

Introduction: Intracranial aneurysms (IAs) are focal dilatations of cerebral arteries that carry a significant risk of rupture and subarachnoid hemorrhage (aSAH). Advances in basic science have improved understanding of vascular wall biology, hemodynamic stress, inflammation, and genetic contribution to aneurysm rupture. Rapid progress in neurovascular therapeutics highlights the need to evaluate emerging molecular and pharmacologic strategies targeting IAs. Methodology: This narrative review synthesizes evidence from 2015 to 2025 on the cellular, molecular, and biomechanical mechanisms underlying IA pathophysiology. A structured search of PubMed, Scopus, and Embase identified studies examining molecular pathways, genetic determinants, and therapeutic approaches. Discussion: Aneurysm initiation involves endothelial responses to abnormal shear stress, activating NF-κB, MAPK, and calcium-dependent pathways that promote inflammation, smooth-muscle cell apoptosis, and extracellular matrix degradation. Pharmacologic candidates including MCP-1 antagonists, PPARγ agonists, and IL-6/STAT3 inhibitors reduce inflammatory remodeling, while doxycycline and cathepsin inhibitors preserve matrix integrity. Emerging strategies like microRNA modulation, tyrosine-kinase inhibition, and gene-based delivery offer potential for localized, durable stabilization with minimal systemic toxicity. Conclusions: Integrating surgical and biologic therapies may shift IA management from reactive repair to rupture prevention.

The neutrophil-to-lymphocyte ratio (NLR) is a novel inflammatory marker predicting cardiovascular mortality (CVM) and all-cause mortality (ACM). To investigate the association between the NLR and CVM and ACM in patients with peritoneal dialysis (PD). We reviewed articles from PubMed, Google Scholar, and Scopus until May 2024 for the association of ACM and CVM in patients with NLR following PD. We used a fixed effects model and I 2 statistics to pool hazard ratio (HR) and measure heterogeneity. Leave-one-out sensitivity analysis assessed the robustness of our study. Multivariate meta-regression (MMR) was utilized to identify influencing confounding factors. Joanna Briggs Institute (JBI) tool was used for quality assessment. Out of 160 articles screened, seven studies from 2011 to 2024 with 4350 patients, a mean age of 49.9 years ± 15 years, and a median follow-up of 4 years were included. We found that higher NLR (> 3) was significantly associated with ACM [adjusted HR (aHR): 1.18, 95%CI: 1.03-1.36, P = 0.016]. However, there was no significant association of NLR (> 3) with CVM (aHR: 1.16, 95%CI: 0.68-1.98, P = 0.59) in patients following PD. Sensitivity analysis showed no variations. JBI tool revealed low bias among the studies. MMR revealed a significant relationship between age and ACM (coefficient: 0.14, P = 0.04). Our meta-analysis identifies a significant association between NLR (> 3) and ACM outcome, which can help prevent deaths in the elderly and optimize resource use. Caution is needed when predicting mortality in this group as age significantly confounds ACM in patients undergoing PD.

This article examines the institutional, technical, and ontological consequences of plagiarism detection platforms on contemporary academic writing. It argues that services like Turnitin and Grammarly do not simply detect plagiarism but actively reconfigure what counts as authorship, originality, and intellectual integrity. Drawing on historical and media-theoretical perspectives, the article traces plagiarism’s emergence as a culturally contingent offense, showing how its definition has shifted from oral cultures all the way to algorithmically processed patterns. In this transformation, plagiarism detection becomes less a neutral evaluative tool than a form of infrastructural governance that translates interpretive judgment into machinic legibility. Drawing on theorists such as Foucault, Chun, Kittler, Flusser, and Byung-Chul Han, the article situates plagiarism detection within a broader shift from expressive authorship to operational formatting. The article argues that plagiarism detection tools function as psychopolitical instruments, reshaping academic labor through anticipatory compliance and rendering originality as machinic compatibility.

39 Background: Prostate cancer is a leading cause of cancer-related death among men in the United States (U.S). Despite therapeutic advances, racial disparities persist, with African American men experiencing higher incidence and poorer survival. Data on racial differences in inpatient outcomes, particularly in-hospital mortality, remain limited. This study evaluated racial and ethnic variations in in-hospital mortality among patients hospitalized with malignant prostate cancer (MPC) in the U.S. Methods: The U.S National Inpatient Sample (NIS) from 2016 to 2020 was queried for patients diagnosed with MPC. We used International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) code “C61” to identify patients who were hospitalized for MPC. The study was exempt from institutional review board approval as the NIS database contains deidentified patient information. Multivariable regression analysis was performed to determine the odds of in-hospital mortality among patients with MPC. Multivariable logistic regression followed by marginal effects was used to plot yearly trends in in-hospital mortality. All the outcomes were adjusted for age, gender, Charlson comorbidity index (CCI) and hospital characteristics. All Statistical analyses were conducted using STATA 19 software. Results: The current retrospective study analyzed 98,000 patients hospitalized for MPC between 2016 to 2020. The racial distribution among study patients included: Whites (68,000; 69.4%), African Americans (17,738; 18.1%), Hispanics (7,154; 7.3%), and other minorities (5,098; 5.2%). African Americans were more likely to be hospitalized at a relatively younger age, and with a higher co-morbidity burden (mean age: 69.4 years; mean CCI: 5.5; p<0.01) when compared to Whites (mean age: 73 years; mean CCI: 4.8), Hispanics (mean age: 71.1 years; mean CCI: 5.1) and other minorities (mean age: 71.5 years; mean CCI: 5.0). A total of 3,626 (3.7%) patients died during the study period. On multivariable analysis, a higher absolute in-hospital mortality was observed in African Americans (OR: 1.14, 95% CI: 1.07 – 1.22, p <0.01) and other minorities (OR: 1.19, 95% CI: 1.06 – 1.34, p <0.01), when compared to Whites (OR: reference). Similarly, an increasing trend of in-hospital mortality was observed in African Americans (from 1.6% mortality per annum in 2016 to 2.0% in 2020; trend p <0.01) and Hispanics (from 1.1% mortality per annum in 2016 to 1.6% in 2020; trend p = 0.02). No change in mortality was observed among Whites (trend p = 0.171) and other minorities (trend p = 0.479) during the study period. Conclusions: Racial disparities persist in in-hospital outcomes among patients with MPC in the U.S. African American and Hispanic patients experienced increasing in-hospital mortality over time, highlighting the need for targeted interventions to address inequities in access, comorbidity management, and inpatient care.

Medical specialty camps provide short-term positive psychosocial benefits for participants (McAuliffe-Fogarty et al., 2007), while more long-term benefits appear to be fleeting (Dawson, 2017). In studies of participation in life after spinal cord injury (SCI), a commonality among responses emphasized the importance of finding a support network post injury (Amsters et al., 2021). Medical specialty camps may be one way to provide support, yet criticism on diminishing effects after camp participation ends remains a concern (Plante et al., 2001). Few studies have utilized qualitative means to examine possible reasons for lack of carry over psychosocial impact. This study utilized a general inductive qualitative analysis of 11 adults with SCI 2-5 years post camp participation. Interviews were conducted with individuals with differing levels of spinal cord injury. Qualitative analyses yielded 3 major themes from campers with SCI: 1) Nuances of the Camp Social Inoculation Experience, 2) Facilitators to a Successful SCI Specific Camp, and 3) Challenges of Returning Home After Camp Ends. Discussion focuses on perceived benefits of camp participation, positive structure of camp, and issues related to lack of carry over impact after camp ends. It is recommended that future practices and research focus on improving access to the SCI community social networks made at camp after returning to home communities.

Beyond legal requirement, why should physicians obtain parental permission to treat a pediatric patient? Children are not the property of their parents, physicians have the relevant medical expertise, and a physician's primary responsibility is to the child, not the parents. In response, scholars have provided several instrumental reasons grounded in the parent-child relationship beyond legal obligation (e.g., parents know their child best; parents can resist substandard care; doing so fosters parental buy-in). While I agree with these reasons, they are not enough to support parental permission in every case in which it should be obtained. Accordingly, I defend a further reason: physicians should obtain parental permission as part of their role responsibility in the physician-parent relationship. I delineate this largely neglected but morally significant relationship and explain why it helps account for physician responsibilities toward parents in pediatric care.