Jacobi Medical Center

657 Background: Bladder cancer typically presents after age 60, but cases diagnosed before age 60 (early-onset) may show distinct demographic and socioeconomic profiles. Using NIH All of Us, we characterized disparities in early- vs late-onset bladder cancer. Methods: Cross-sectional analysis of 1,669 adults with incident bladder cancer in All of Us (Registered Tier) (early-onset &lt;60, n=222; late-onset ≥60, n=1,447). We compared age at diagnosis, sex, simplified race/ethnicity (White, Hispanic, Black, Asian, Other), and neighborhood-level socioeconomic z-scores (median income, high-school completion, poverty, assisted-income reliance, uninsured rate, vacant housing, deprivation index, composite SES). Categorical variables were analyzed with χ² tests; continuous (age and SES z-scores) with Welch t-tests. Results: Early-onset patients were younger (mean age 52.3 vs. 71.4 years; p&lt;0.001), more often female (38.3% vs. 26.7%; p = 0.0012), and more Hispanic (16.7% vs. 5.7%; p&lt;0.001), Black (17.1% vs. 5.3%; p &lt; 0.001), and Asian (3.2% vs. 0.7%; p&lt;0.001), with fewer White (57.2% vs. 80.4%; p&lt;0.001). Neighborhood deprivation (deprivation index +0.22 vs. –0.03; p&lt;0.001), uninsurance (+0.21 vs. –0.03; p = 0.0015), and poverty (+0.17 vs. –0.03; p = 0.0074) z-scores were higher, while median income (–0.14 vs. +0.02; p = 0.024) and high-school completion (–0.20 vs. +0.03; p = 0.002) were lower. Conclusions: Early-onset bladder cancer is enriched for women and racial/ethnic minorities and clusters in disadvantaged areas. These differences implicate social determinants–limited health care access, occupational/environmental exposures, and economic hardship, may accelerate onset in vulnerable populations, underscoring targeted prevention and earlier detection. Demographic, race/ethnicity, and socioeconomic characteristics of early- vs late-onset bladder cancer, All of Us research program (N = 1,669). Category Feature Early_Onset (n = 222) Late_Onset (n = 1447) p-value Ethnicity/Race Hispanic 16.7% 5.7% &lt; 0.001 White 57.2% 80.4% &lt; 0.001 Other or unknown 5.9% 7.9% &lt; 0.001 Black 17.1% 5.3% &lt; 0.001 Asian 3.2% 0.7% &lt; 0.001 Demographics Female 38.3% 26.7% 0.001 Other or unknown 1.30% 1.10% 0.001 Male 60.4% 72.2% 0.001 Socioeconomic No health insurance 0.21 ± 1.08 -0.03 ± 0.98 0.001 SES composite index 0.12 ± 0.63 -0.02 ± 0.61 0.001 High School education -0.20 ± 1.03 0.03 ± 0.99 0.001 Assisted income 0.19 ± 1.05 -0.03 ± 0.99 0.01 Poverty 0.17 ± 1.03 -0.03 ± 0.99 0.01 Median income <jats:td colspan="1" rows

857 Background: Lymphovascular invasion (LVI) critically guides neoadjuvant therapy, cystectomy timing, and surveillance in bladder cancer, yet it is rarely known preoperatively. We developed and externally validated lymphovascular invasion radiomics–deep learning signatures (LRDs) to noninvasively predict LVI and provide a clinicopathologic+LRDs nomogram. Methods: Retrospective two-center cohort of 302 bladder cancer patients with preoperative contrast-enhanced CT and pathologic LVI reference. QLYY split 7:3 (train/internal); TCIA external. CTs standardized; radiomics+DL features stacked. Performance (AUC, calibration, DCA) and survival (KM/Cox) evaluated. Results: 302 patients (training/internal/external 174/75/53; male 76%/87%/81%). Baseline features were comparable; the external cohort was older (69.3 y; SMD_age≈0.30) with higher LVI (54.7% vs 41–43%), more MIBC (54.7% vs 37–41%) and N+ disease (34% vs 19–25%), forming a tougher validation set. Among single-source models, radiomics-MLP outperformed DL-only (AUC 0.856/0.859/0.832 train/internal/external vs 0.758/0.746/0.773 for DL-LR). The stacked LRDs improved discrimination to 0.859 (95%CI 0.806–0.913) in training, 0.872 (0.792–0.952) internally, and 0.872 (0.773–0.972) externally, with ΔAUC vs radiomics +0.003/+0.013/+0.040 and vs DL +0.101/+0.126/+0.099. DeLong favored LRDs over DL and showed gains over radiomics (largest externally). DCA showed highest net benefit at pt = 0.20–0.60 with near-ideal calibration; results were stable in NMIBC/MIBC. Clinically: ≤0.20 rule-out (bladder-sparing), ≥0.60 rule-in (early RC/NAC). NRI confirmed incremental value (LRDs vs DL +0.159/+0.200/+0.075; vs radiomics +0.015/+0.044/+0.055 for train/internal/external). A clinicopathologic+LRDs nomogram achieved AUC 0.912 (95%CI 0.871–0.954) in training and 0.886 (0.808–0.965) internally. In multivariable analysis, MIBC, nodal positivity, HER2 overexpression, and LRDs (per-SD) were independently associated with LVI (all p &lt; 0.05). LRDs generated clinically meaningful probabilities (e.g., 0.28 in pathologic LVI−, 0.65 in LVI+), aligning with the rule-out/rule-in cut points above. Prognostically, high LRDs predicted worse outcomes (PFS HR 2.35, 95%CI 1.55–3.57; OS HR 3.10, 1.90–5.06; both p &lt; 0.001), with time-dependent AUCs 0.698/0.718/0.724 (PFS) and 0.730/0.741/0.781 (OS) at 1/3/5 years. Conclusions: The integrated CT-based LRDs accurately estimates preoperative LVI, is externally validated in a harder cohort, and adds independent value beyond pT/pN/HER2. With strong calibration and higher net benefit than single-source models, and deployable from routine CT via a clinicopathology+LRDs nomogram, it enables individualized counseling, guides perioperative planning, and stratifies PFS/OS risk.

Breast cancer screening, while vital for reducing mortality, faces significant limitations in sensitivity and specificity, particularly in dense breasts. Current modalities primarily detect anatomical changes, often missing biologically aggressive tumors at their earliest stages. The altered metabolism of cancer cells establishes a characteristic inverted pH gradient that drives tumor invasion, metastasis, and treatment resistance. This makes tumor acidity a compelling, functional biomarker for early detection. This review synthesizes the emerging role of pH as a diagnostic biomarker and provides a critical evaluation of advanced imaging techniques for its non-invasive or minimal measurement. We detail the biological underpinnings of tumor acidosis, emphasizing its regulation through glycolytic reprogramming and dysregulated proton transport. Our analysis encompasses a broad spectrum of pH-sensitive imaging modalities, including magnetic resonance methods such as Chemical Exchange Saturation Transfer (CEST) MRI for extracellular pH mapping and multi-nuclear Magnetic Resonance Spectroscopy (MRS) using 1H, 31P, and 19F nuclei to probe various cellular compartments. Furthermore, we examine hyperpolarized 13C MRI for real-time metabolic flux imaging, where metrics such as the lactate-to-pyruvate ratio demonstrate significant predictive value for treatment response. The review also assesses optical and photoacoustic imaging techniques, which offer high sensitivity but are often constrained to superficial tumors. Imaging tumor pH provides a powerful functional window into the earliest metabolic shifts in breast cancer, far preceding macroscopic anatomical changes. The ongoing development and evidence support the role of the pH-sensitive imaging techniques in diagnosis, lesion characterization, and therapy. Additionally, it holds promise for supplementing breast cancer screening by enabling earlier, more specific detection and personalized risk stratification, ultimately aiming to improve patient outcomes.

SummaryThe effective treatment of bladder cancer depends on early evaluation through cystoscopy. Given the clinical importance of distinguishing the tumor grade, we report the application of the AI-assisted NBI Cystoscopy Diagnostic System (AINCDS). The AINCDS consists of (1) dual-channel feature extraction module, (2) lesion segmentation module based on feature pyramids, and (3) a multi-task classification module. AINCDS achieved an accuracy for identifying bladder cancer of 0.919 (95% CI = 0.896 to 0.938). For the prediction of tumor grade, the accuracy was 0.764 (95% CI = 0.714 to 0.810). The AINCDS demonstrates similar ability comparable to urologists with over 10 years’ experience. With the assistance of AINCDS, the tumor grade prediction accuracy of urologists with 1–3 years’ experience improved from 0.667 to 0.793. AINCDS can assist in the diagnosis of bladder cancer and prediction of tumor grade, offering the potential to improve the accuracy of lesion assessment and reduce the workload of urologists.

BackgroundGreater Trochanteric Pain Syndrome (GTPS) is a common cause of chronic lateral hip pain, often refractory to conservative medical management (CMM). Combined percutaneous ultrasound-guided tenotomy (PUT) of the gluteus medius (GMed) and iliotibial band (ITB) has shown promising one-year results, but data on long-term outcomes remain limited. This study evaluates two-year clinical outcomes in patients undergoing combined GMed and ITB PUT for recalcitrant GTPS.MethodsThis retrospective cohort study included 69 patients (79 hips) treated with combined GMed and ITB PUT between January 2022 and August 2023. Baseline and follow-up data, collected for an average of 2-year, were obtained through chart review and structured phone interviews. The primary outcome was ≥50 % reduction in Numeric Rating Scale (NRS) pain scores. Secondary outcomes included side-lying tolerance, sitting-to-standing ability, responder rate and need for additional hip interventions. Responder status required both pain reduction and complete side-lying tolerance. Statistical significance was evaluated using paired t-tests with p < 0.05.ResultsMedian baseline Numeric Rating Scale (NRS) pain score was 10 interquartile range (IQR 9–10), decreasing significantly to 2 (IQR 1–4) at 1, 6, and 12 months, then increasing to 6 (IQR 4–10) at 24 months (p < 0.001 vs. baseline). Rates of ≥50 % improvement in NRS were 88.6 % at 1 month, 89.6 % at 6 months, 83.0 % at 12 months, and 59.5 % at 24 months. Side-lying tolerance improved from 21.5 % hips at baseline to 88.9 % reporting improvement at 1 month and 55.7 % at 24 months (p < 0.001). Sitting-to-standing ability showed sustained improvement at 81.0 % at 24 months. Composite responder rate declined from 88.6 % at 1 month to 57.0 % at 24 months. Subsequent invasive interventions were required in a minority of cases (2.5 % total hip arthroplasty; 11.4 % repeat TENEX).ConclusionCombined PUT of the GMed and ITB provides durable pain relief and functional improvement in patients with refractory GTPS at two years post-procedure. Despite declining responder rates over time, this minimally invasive dual-target technique demonstrates a favorable safety profile and may delay or reduce the need for more invasive surgery. Further prospective studies are warranted to optimize patient selection and validate long-term efficacy.

Antiretroviral therapy (ART) adherence behavior is heterogeneous among adolescents and young adults (AYAs) with HIV and influenced by individual and interpersonal psychosocial factors. The primary objective of this study is to characterize ART adherence phenotypes and psychosocial symptom clusters, as related to ART adherence and HIV viral load suppression. This analysis included 60 AYAs with HIV enrolled in an ART adherence support clinical trial. Self-reported ART adherence at baseline, 12-weeks, and 24-weeks was used to define four ART adherence phenotypes: consistently high adherence (YY), early-only adherence (YN), late-only adherence (NY), and consistently low adherence (NN). Symptom clusters were empirically derived from baseline psychosocial measures, including adherence self-efficacy, ART knowledge, HIV stigma, psychological distress (depression, anxiety, trauma), and social support. Linear mixed-effects models were used to examine psychosocial symptom outcomes at three timepoints (baseline, 12-weeks, and 24-weeks) and across groups with different adherence or viral load phenotypes. Using hierarchical clustering, four distinct clusters were identified, underscoring heterogeneity of psychosocial symptoms and patterns of ART and viral suppression. Findings from this analysis are among the first known characterizations of ART adherence phenotypes and psychosocial symptom clusters among AYAs with HIV. Heterogeneity in clusters underscores the need to examine other factors, such as resilience, not captured in the present study. Overall, these study findings contribute to improved understanding of the multi-level psychosocial influences of ART adherence and viral load suppression.

Abdominal surgeries make up a significant portion of all surgical procedures performed worldwide. Despite advances in surgical techniques, there is significant morbidity and mortality associated with abdominal surgeries. Cardiopulmonary complications in the postoperative period play an important part in the elevated risk associated with these surgeries. Preoperative medical assessments have therefore become the standard of care to evaluate the risk of surgery, optimize a patient's medical conditions, and mitigate the perioperative risk. While there has been increasing utilization of lung point of care ultrasound (POCUS) in the immediate preoperative setting, the use of lung POCUS at the preoperative medical assessment clinic visit has not been studied. While using risk stratification tools is common in current practice, the role of adjunctive office-based techniques like lung POCUS have not been studied in this setting. We conducted an observational prospective pilot study to evaluate the association of lung POCUS findings in the preoperative visit on the risk of adverse cardiopulmonary outcomes in the 30-day postoperative period after major abdominal surgery. A standardized scoring system called integrated lung ultrasound score (iLUS) is used for objective assessment. Our study attempted to determine whether the addition of lung POCUS can be used to better stratify the risk for postoperative complications.

Backround: Atrial fibrillation (AF) is a common complication following veno-venous extracorporeal membrane oxygenation (VV-ECMO), leading to further complications from anticoagulation or stroke. The Artificial Intelligence AF Prediction Dashboard developed at Mayo Clinic generates two predictive outputs: (1) a continuous probability score and (2) a binary threshold-based signal to predict the likelihood of AF at an individual level after 12-lead electrocardiogram (ECG) is obtained. Using both continuous risk (%) and binary (yes/no) likelihood, we present a novel method to understand AF risk after VV-ECMO cannulation based on pre-ECMO 12-lead ECG. Methods: We reviewed a total of 147 patients on ECMO between 2018 and 2024, from which 85 VV-ECMO patients with complete data were included. AI Dashboard outputs were quantified as binary (1/0) or percent likelihood for AF. R was utilized for statistical analysis. Results: 85 patients met our inclusion criteria from which AF after cannulation occurred in 31 (36%). 17 patients had a history of AF prior to VV-ECMO initiation. The mean age of our cohort was 49 years with a mean BMI of 29.3. Baseline AI Dashboard continuous assessment identified 39 patients (46%) compared to the binary assessment identifying 31 patients (36%). Logistic regression in the binary assessment demonstrated an odds ratio of 1.08 (95% CI 1.04 – 1.12) with a p value of &lt;0.001. The binary AF Prediction yielded a 58% sensitivity, 76% specificity, 58% PPV, and 76% NPV, with an accuracy of 67%. The continuous AF Probability score achieved 72% balanced accuracy with sensitivity 74%, specificity 70%, PPV 59% and NPV 83%, indicating fair overall performance and suggesting good utility for ruling out AF in low-risk patients. Although both outputs provided moderate predictive accuracy, the continuous score reported before ECMO cannulation demonstrated stronger overall performance with fewer false negatives and higher rule-out value. Conclusions: We demonstrate the novel use of an AI predictive model in the VV-ECMO population for the prediction of AF risk with both continuous and binary risk cutoffs from baseline ECG. This data highlights the need for further development in ECMO-specific AI models to help mitigate risk after the onset of atrial arrhythmias. As AI-driven tools become increasingly integrated into care, their performance must be continuously validated and recalibrated for specific populations to ensure their safe and effective use.

Background: Drug-coated balloon angioplasty is an established treatment strategy for coronary in-stent restenosis (ISR). While paclitaxel-coated balloons (PCB) have been studied most extensively, limus-coated balloons—including sirolimus- (SCB) and biolimus-coated balloons (BCB)—offer potential advantages due to their antiproliferative effects and pharmacokinetic profiles. However, direct comparisons remain limited. Objectives: To compare the efficacy of SCB, BCB, and PCB for the treatment of coronary ISR using a pairwise and network meta-analysis of randomized controlled trials (RCTs). Methods: A systematic search of PubMed, Scopus, and Cochrane was performed to identify RCTs comparing any combination of SCB, BCB and PCB angioplasty for ISR lesions. Outcomes of interest include target lesion failure (TLF), a composite of cardiac death, target-vessel myocardial infarction (TV-MI), and target lesion revascularization (TLR), as well as these individual outcomes. A pairwise and frequentist network meta-analysis with random-effects models was used to estimate risk ratios (RR) and 95% confidence intervals (CIs) for each comparison. Treatments were ranked with P-scores. Results: Five RCTs with 977 patients with ISR were included in the analysis (SCB 25.8%; BCB 27.6%; PCB 46.6%). In pairwise comparisons, limus-coated balloons demonstrated similar efficacy to PCB across all endpoints. Network meta-analysis revealed no significant differences among SCB, BCB, and PCB in the risk of TLF, TV-MI, cardiac death, or TLR (Figure 1) . P-score rankings indicated that PCB was most favorable for reducing TLF and TLR, while SCB and BCB ranked highest for reducing cardiac death and TV-MI, respectively. Conclusions: In this network meta-analysis of RCTs, limus-coated balloons and PCB demonstrated comparable efficacy profiles for the treatment of coronary ISR. P-score rankings suggest potential outcome-specific differences that warrant further investigation in adequately powered head-to-head trials.