Physician Payment Incentives and Active Surveillance in Low-Risk Prostate Cancer.

Importance: Active surveillance in men with less aggressive prostate cancer is inconsistently used despite clinical guidelines. Renumeration generally favors treatment over conservative management and may contribute to the variable adoption of active surveillance, which suggests that value-based payment incentives may promote guideline-concordant care.

Objective: To describe the adoption of active surveillance in low-risk prostate cancer, following the initiation of a novel payment incentive sponsored by a commercial payer to support its use.

The 340B Drug Pricing Program and Management of Advanced Prostate Cancer.

Introduction: Oral targeted therapies are a standard of care for men with advanced prostate cancer. However, these therapies are expensive, which may be a barrier to some, particularly the most economically disadvantaged. Through investment in programs to assist this population, savings generated from the 340B program have the potential to mitigate barriers to initiating treatment with targeted therapies in these men.

Improved Adherence to Lipid Screening in the Pediatric Cardiology Clinic: A Quality Improvement Project.

Introduction: Lipid screening identifies at-risk patients to facilitate cardiovascular risk reduction. National pediatric guidelines recommend universal lipid screening between 9-11 and 17-21 years of age. We aimed to improve adherence to lipid screening for all age-appropriate outpatient pediatric cardiology visits from a baseline of 35% to 90% between November 2021 and July 2023.

Cryopreserved sperm among patients with Oligoasthenoteratozoospermia.

Objectives: This study investigates sperm utilization and disposal patterns in Oligoasthenoteratozoospermia (OAT) patients undergoing long-term sperm storage. OAT is a major contributor to male infertility. Cryopreservation is a common practice as a "fertility insurance" in case of further deterioration until azoospermia.

Kratom: A Narrative Review of the Possible Clinical Uses and Dangers of This Opioid-Like Plant.

The term "kratom" refers to a plant species formally known as  Kratom is composed of over 40 alkaloids, a type of organic compound that contains nitrogen. These compounds work primarily via binding to opioid receptors expressed on neurons, where they stimulate signal transduction mechanisms involving the activation of G proteins. Kratom has been shown to cause both a stimulant-like effect and a sedative effect in humans.

Commercial Prices and Care for Medicare Beneficiaries With Prostate Cancer.

Objective: To examine the relationship between market dynamics, in the form of commercial prices paid to urologists, and utilization of services, as measured by Medicare spending, in men with newly diagnosed prostate cancer.

Methods: We performed a retrospective national cohort study of Medicare beneficiaries with newly diagnosed prostate cancer between 2014 and 2019, with follow-up through 2020. The primary exposure was the commercial price index (ie, the ratio of commercial prices to Medicare prices for a common set of services performed by urologists).

Long-Term Quality of Life Among Patients Undergoing Endoscopic Pituitary Gland Surgery.

The endoscopic approach to skull base lesions is widely regarded as less invasive and associated with reduced morbidity, offering favorable outcomes, particularly in terms of short-term quality of life (QOL). However, to date, long-term assessments of both nasal function and tumor-related QOL remain limited. To evaluate patients' long-term nasal- and tumor-related QOL after endoscopic endonasal resection of pituitary tumors and to detect predictors for poor postoperative QOL.

Commercial prices and their influence on urology practices: Prostate cancer care among men with Medicare.

Background: For men with prostate cancer, there is substantial variation in the use of conservative management, such as active surveillance. Commercial prices, which vary across urology practices, may afford incentives that foster physician behaviors associated with utilization. Such behaviors may "spillover" to the Medicare population and affect quality.

Implementing Best Practice When Screening Birthing People for a Substance Use Disorder.

Screening for substance use disorder (SUD) is an essential part of antepartum care. Best practice for screening requires the use of a validated tool early in pregnancy to identify those at risk and to connect them with counseling and treatment. In many health systems and practices, urine toxicology testing is erroneously employed as a SUD screening tool despite consistent recommendations against its routine use.

The 340B Program and High-Risk Prescribing of Oral Targeted Therapies for Advanced Prostate Cancer.

Introduction: The use of expensive oral targeted agents for advanced prostate cancer can be influenced by those who stand to gain from their use. The 340B drug pricing program allows eligible hospitals to purchase medications at steep discounts, generating millions of dollars in savings. The extent to which hospitals engage in higher-risk prescribing due to program incentives is unclear.

Innate and Adaptive Immune Responses in Intestinal Transplant Rejection: Through the Lens of Inflammatory Bowel and Intestinal Graft-Versus-Host Diseases.

Intestinal transplantation is a life-saving procedure utilized for patients failing total parenteral nutrition. However, intestinal transplantattion remains plagued with low survival rates and high risk of allograft rejection. The authors explore roles of innate (macrophages, natural killer cells, innate lymphoid cells) and adaptive immune cells (Th1, Th2, Th17, Tregs) in inflammatory responses, particularly inflammatory bowel disease and graft versus host disease, and correlate these findings to intestinal allograft rejection, highlighting which effectors exacerbate or suppress intestinal rejection.

Adverse events in men with advanced prostate cancer treated with androgen biosynthesis inhibitors and androgen receptor inhibitors.

Background: The use of androgen biosynthesis and second-generation androgen receptor inhibitors for advanced prostate cancer is increasing. Because these therapies alter the androgen pathway, they have been associated with cardiometabolic and neurocognitive toxicities. Although their safety profiles have been assessed in clinical trials, real-world data are limited.

Late Identification of Perinatal Transmission of HIV in an Infant at High Risk.

The focus of this case study is the delayed diagnosis of a perinatal HIV transmission, which was identified when the infant reached 4 months of age, and the social conditions and structural determinants that contributed to the increased transmission risk. Despite adhering to the diagnostic testing protocols and neonatal antiretroviral (ARV) guidelines of the New York State Department of Health, this transmission still occurred. This transmission event prompted strategies to address criminalization of substance use during pregnancy and a reevaluation of the HIV testing and treatment protocols, including the timing of testing.

Teaching Hospitals and Textbook Outcomes After Major Urologic Cancer Surgery.

Objective: To assess textbook outcomes by hospital teaching status following major surgery for urologic cancers.

Methods: We used 100% national Medicare Provider Analysis and Review files from 2017-2020 to assess rates of textbook outcomes in patients undergoing bladder (ie, radical cystectomy), kidney (ie, radical or partial nephrectomy), and prostate (ie, radical prostatectomy) surgery for genitourinary malignancies. The extent of integration of learners into each hospital's workforce-defined as major, minor, and non teaching hospitals-was the primary exposure.

Cryopreserved testicular spermatozoa among patients with azoospermia.

Purpose: To investigate cryopreserved testicular spermatozoa among patients with azoospermia.

Methods: In this retrospective study spanning from October 1993 to December 2021, we examined men diagnosed with azoospermia who underwent testicular spermatozoa cryopreservation. Data from medical records included utilization and disposal of sperm samples, age at initial cryopreservation.

Prevalence of Repeat Prenatal HIV Screening in New York State.

New York State Department of Health (NYSDOH) recommends that all pregnant patients receive human immunodeficiency virus (HIV) screening during pregnancy. This study assessed the prevalence of repeat prenatal HIV testing and factors associated with receipt of the recommended tests. Data from the NYSDOH newborn screening program were used to randomly select pregnant persons without HIV who delivered a liveborn infant in 2017.

Evaluation of pediatric patients for intestinal transplantation in the modern era.

Objectives: To review recent evaluations of pediatric patients with intestinal failure (IF) for intestinal transplantation (ITx), waiting list decisions, and outcomes of patients listed and not listed for ITx at our center.

Methods: Retrospective chart review of 97 patients evaluated for ITx from January 2014 to December 2021 including data from referring institutions and protocol laboratory testing, body imaging, endoscopy, and liver biopsy in selected cases. Survival analysis used Kaplan-Meier estimates and Cox proportional hazards regression.

Discovery of Potent, Selective, and Orally Available IRE1α Inhibitors Demonstrating Comparable PD Modulation to IRE1 Knockdown in a Multiple Myeloma Model.

The lack of selective and safe in vivo IRE1α tool molecules has limited the evaluation of IRE1α as a viable target to treat multiple myeloma. Focus on improving the physicochemical properties of a literature compound by decreasing lipophilicity, molecular weight, and basicity allowed the discovery of a novel series with a favorable in vitro safety profile and good oral exposure. These efforts culminated in the identification of a potent and selective in vivo tool compound, , that was well tolerated following multiday oral administration of doses up to 500 mg/kg.

Practitioner Experiences of the Death of an Equine in an Equine-Assisted Services Program.

Given the nature of horse-human interactions in equine-assisted services (EAS), death of a horse may have significant impacts. In this study, an online survey was distributed to EAS practitioners. The goal of the study was to explore the experiences of practitioners and identify the socioemotional processes that occur upon the death of an equine within an EAS program.

Two redundant transcription factor binding sites in a single enhancer are essential for mammalian sex determination.

Male development in mammals depends on the activity of the two SOX gene: Sry and Sox9, in the embryonic testis. As deletion of Enhancer 13 (Enh13) of the Sox9 gene results in XY male-to-female sex reversal, we explored the critical elements necessary for its function and hence, for testis and male development. Here, we demonstrate that while microdeletions of individual transcription factor binding sites (TFBS) in Enh13 lead to normal testicular development, combined microdeletions of just two SRY/SOX binding motifs can alone fully abolish Enh13 activity leading to XY male-to-female sex reversal.