University of Rochester Medical Center

Although endocrinologists specialize in the management of hormones, they often lack sufficient training in the appropriate use of the diverse array of available contraceptive options. All medical providers should possess a fundamental understanding of contraceptive methods for pregnancy prevention, but endocrinologists should have a deeper understanding of birth control possibilities due to the useful role of hormone-containing contraception in managing endocrine and metabolic disorders. This manuscript outlines the history of contraception and then evaluates both existing and emerging birth control options for women and men. Delving further, this review also explores the impact of individual sex steroids—estrogens, progestins, and androgens—used in hormonal contraceptive methods. In addition to their role as contraceptives, the influence of these exogenous hormones on the hypothalamic-pituitary-gonadal axis warrants careful consideration. These effects extend beyond pregnancy prevention and can be instrumental in regularizing menses, sex steroid replacement, and androgen suppression. Finally, this review provides tailored suggestions for contraceptive usage in patients with endocrine disorders, ensuring comprehensive care and informed decision-making in clinical practice.

OBJECTIVE Assessing pediatric subspecialty fellows using entrustable professional activities (EPAs) to determine readiness for graduation has not been described. We aimed to determine whether graduating pediatric fellows are meeting the minimum supervision level at graduation previously identified by program directors for the clinical EPAs and the relationship between meeting these levels and initial subspecialty board certification. METHODS Pediatric fellows in 14 subspecialties were assessed by clinical competency committees in the spring before graduation in 2019 to 2022 on 3 EPAs common to all subspecialties that involve direct patient care and the subspecialty-specific EPAs. Publicly available board certification data were obtained from the American Board of Pediatrics. RESULTS EPA supervision levels were collected on 1480 fellows, representing approximately 27% of all graduating fellows. A total of 117 (7.9%) fellows did not meet the minimum supervision level for at least 1 EPA, with some requiring direct supervision. Of fellows who did not achieve the expected level at graduation, 83 (70.9%) were certified. Those who met the minimum level for all clinical EPAs had a higher certification rate compared with those who did not meet the minimum for at least 1 EPA (80.6% vs 70.9%; P = .01). CONCLUSIONS Almost 10% of pediatric fellows are not meeting the expected supervision level for the clinical EPAs at graduation, and yet over 70% of them passed their subspecialty certification examination. This study provides support for using EPAs to determine readiness for graduation and demonstrates that some fellows may need additional training or continued supervision after completion of their fellowship.

Purpose Lesbian, Gay, Bisexual, Transgender, Queer, Plus (LGBTQ+) cancer survivors are at risk of financial hardship due to multilevel factors amplified by anti-LGBTQ+ stigma. Transgender and gender diverse (TGD) cancer survivors may experience greater financial hardship than cisgender lesbian, gay, and bisexual (LGB) individuals, but data on LGBTQ+ individuals is often reported in aggregate. We describe differences in crowdfunding experiences between TGD and LGB cancer crowdfunding campaigns to address this gap in TGD cancer-related financial hardship literature. Methods We used a mixed methods approach to evaluate LGBTQ+ cancer crowdfunding campaigns from GoFundMe’s website, coded as TGD or LGB. Campaign data (amount raised, funding goal, etc.) were compared using summary statistics and independent t-tests. Qualitative content analysis described campaign text. Quantitative and qualitative findings were integrated by theme. Results A total of N = 470 LGBTQ+ cancer campaigns were included for this analysis, of which 175 (32.5%) were TGD campaigns and 295 (54.8%) were LGB. TGD campaigns raised 39% less than LGB campaigns ($7782 [$5842–$9723] vs.$12,724 [10,525–14,924], p < 0.0001). TGD campaigns had more mentions of perceived stigma in healthcare spaces and fewer mentions of caregiver support. Conclusions TGD cancer campaigns earned significantly less money than LGB campaigns, suggesting that TGD cancer survivors may face more challenges in using community-based financial support mechanisms to mitigate financial hardship. Structural stigma and transphobia may be impacting the amount of funds raised by TGD cancer survivors through crowdfunding.

Purpose To quantify and evaluate gait spatiotemporal and kinematic parameters in patients with symptomatic lumbar degeneration disc disease(LDD) with unilateral radiculopathy and/or neurogenic claudication. Methods Seventy-eight pre-operative patients with LDD and 27 healthy adult volunteers were identified at a single institution. Participants were fitted with a full-body external reflective marker set for gait analysis using a three-dimensional motion capture system. Participants performed a series of over-ground walking trials at a self-selected speed. Spatiotemporal and kinematic parameters of gait were compared between cohorts using linear mixed-effects regression models. Results Compared with healthy participants, LDD patients had reduced cadence (101.3 steps/min vs. 110.9 steps/min, p < 0.001), step width (0.2 m vs. 0.1 m, p < 0.019), and step length (0.6 m vs. 0.7 m, p < 0.001). During the stance (ST) and swing (SW) phases of the gait cycle, LDD patients had significantly reduced hip extension (ST: 0.7° vs. 12.2° and SW: -7.6° vs. 3.8°) and sagittal plane hip range of motion (ST: 36.1° vs 42.5° and SW: 30.2° vs. 35.8°) on the symptomatic side compared to healthy subjects (p < 0.001). Furthermore, LDD patients had significantly greater anterior and posterior pelvic tilt when compared to healthy controls in both the swing and stance phases of the gait cycle. Conclusion Patients with LDD demonstrate significantly altered gait including reduced cadence and step-specific gait parameters compared to healthy controls. Additionally, LDD patients experienced modified hip excursion during both the swing and stance phases compared to healthy participants on the symptomatic side. This study comprehensively assesses clinically measurable spatiotemporal and kinematic gait parameters in patients with LDD and may provide further insight into disease-specific effects and compensatory mechanisms associated with symptomatic LDD.

Background Pediatric central nervous system (CNS) tumors are the most common solid cancers and the leading cause of cancer-related morbidity and mortality in children. The global demographic and epidemiological trends indicate a significant increase in childhood and adolescent cancers, including pediatric brain tumors, in low- and middle-income countries, particularly in Sub-Saharan African countries necessitating the dire need of multidisciplinary Pediatric Neuro-Oncology (PNO) teams to improve outcomes. Objective The primary objective of the study was to evaluate the patterns, clinical presentations, time to diagnosis (TD), and treatment provided to pediatric and adolescent patients with central nervous system tumors who were discussed at the pediatric neuro-oncology tumor board and treated by the neuro-oncology team at Tikur Anbessa Specialized Hospital in Ethiopia. Methods and materials This retrospective cross-sectional study was conducted in the Pediatric Hematology and Oncology (PHO) unit at Tikur Anbessa Specialized Hospital in Ethiopia. It included all pediatric patients under 15 years old with primary central nervous system (CNS) tumors from December 2021 to May 2024. The study aimed to provide an overview of the sociodemographic characteristics of the children, clinical presentation, time to diagnosis, histopathology of the tumors, and treatment modalities recommended by the PNO tumor board. Results A total of two hundred ten patients with pediatric CNS tumors were discussed and reviewed at the Pediatric Neuro-Oncology (PNO) Tumor Board during the study period. More than half of the patients (54.8%, n = 114) were males. The median age at diagnosis was 7 years, and nearly half of the patients (48.6%) were between 5 and 10 years old. The most common clinical presentations were headache (66.2%), vomiting (64.3%), visual symptoms (44.8%), and cerebellar symptoms (43.8%). The median time to diagnosis was 90 days (IQR 60–210), and 60% of the patients presented after three months of symptom onset of the disease. The most common pediatric CNS tumors were medulloblastoma and embryonal CNS tumors, accounting for 32.9% (n = 69), followed by astrocytic tumors; 30.0% (n = 63), craniopharyngiomas (14.0%), and ependymal tumors (11.4%). The main treatments offered by the PNO Tumor Board were a combination of surgery, radiotherapy, and systemic chemotherapy (33.8%), surgery alone (23.8%), and surgery with radiotherapy (21.4%). The PNO Tumor Board was primarily attended by pediatric hematology-oncology fellows, pediatric oncologists (90%), and neurosurgeons (86%). Conclusion This study focused on analyzing the age distribution, clinical presentation, time to diagnosis, burden, and patterns of pediatric primary CNS tumors at the largest tertiary referral center in Ethiopia. It is imperative to prioritize educating healthcare professionals about the symptoms and signs of CNS tumors in children, promoting early diagnosis, facilitating timely referrals, and enhancing the effectiveness of the PNO tumor board. These measures should be considered essential aspects of care for children with CNS tumors.

Background Tuberous Sclerosis Complex (TSC) is a rare multi-system genetic disorder characterised by benign growths in multiple body systems. TSC-Associated Neuropsychiatric Disorders (TAND) are very common in individuals with TSC, but families often struggle to access appropriate clinical care. To address this gap, the new TAND-SQ Checklist allows individuals with TSC or their caregivers to self-report and quantify characteristics of TAND. The 33 items make up seven natural TAND clusters and an eighth cluster reflecting psychosocial difficulties in individuals with TSC and their caregivers. Respondents rate items as having ever been present to generate cluster scores (CS), and rate item severity (over the last month) on a 10-point scale to generate cluster severity scores (CSS mean ) and a total TAND severity score (TTSS mean ). The purpose of this study was to determine the reliability and validity of the CS, CSS mean and TTSS mean of the TAND-SQ. Methods A descriptive group design was used. Two convenience samples with existing clinical data were recruited from the TSC Alliance Natural History Database (NHD) in the USA (n = 69), and from the Developmental Synaptopathies Consortium Rare Diseases Clinical Research Network (RDCRN) study based at Boston and Cincinnati Children's Hospitals (n = 23), totalling 92 participants. Results Analyses showed good internal consistency for CS (Cronbach’s alphas: 0.67–0.89) and CSS mean (0.76–0.95) with the exception of the eat/sleep cluster. Within the TAND-SQ, most CS and all CSS mean were significantly correlated to corresponding self-reported clinical diagnoses, and the TTSS mean was significantly correlated to a global self-rating of TAND burden (ρ = 0.75; p < .001). Significant correlations were observed between the CS and CSS mean and a range of relevant standardised behavioural measures in the RDCRN cohort. The TTSS mean was significantly correlated with global measures of adaptive behaviour (ρ = − 0.75; p < .001) and emotional/behavioural difficulties (ρ = 0.71; p = .001). All CS were significantly correlated with corresponding diagnoses of autism, ADHD, anxiety disorder, depressive disorder, scholastic difficulties, and neuropsychological difficulties where reported in the RDCRN and NHD cohorts. Conclusions Findings provide support for the reliability and validity of the CS, CSS mean and TTSS mean of the TAND-SQ and support their use in clinical decision-making for TAND management and in further research.

Resection of liver metastases is considered the only treatment with curative potential for patients with metastatic colorectal cancer to the liver (CRLM). However, only a minority of patients with CRLM are eligible for up-front resection of liver metastases. Despite advances in systemic chemotherapy, long-term survival is rare without resection of liver metastases. This highlights the unmet need for alternative localized treatment options for patients with unresectable colorectal liver metastases (uCRLM). Liver-directed therapies include hepatic artery infusion pump (HAIP) therapy and nonsurgical locoregional approaches including image-guided ablation, Y90 radioembolization (TARE), and stereotactic body radiation therapy. More recently, emergent data support the use of liver transplantation (LT) in select patients with uCRLM. In this chapter, we review the data for various liver-directed therapies revolutionizing the treatment approach and improving clinical outcomes for patients with uCRLM.

Chronic hepatitis C infection has been linked to chronic kidney disease. Despite availability of all oral highly curative direct acting antiviral treatment for more than a decade, impact of HCV cure on extrinsically measured iohexol glomerular filtration rate (iGFR), a marker of kidney function, has not been rigorously evaluated. Over two recruitment periods (October 14, 2010 – July 23, 2012 and December 15, 2015 – September 12, 2019), we enrolled 208 participants with chronic HCV infection, 63% of whom were co-infected with HIV. We conducted linear mixed effects modeling to evaluate the change in iGFR slope among participants who were and were not cured from chronic HCV. Secondary outcomes included albuminuria (urine albumin-creatinine-ratio ≥30 mg/g). At baseline, the median age was 51 years (interquartile range: 47–56), most of whom were Black (85%), and male (71%). In the multivariable-adjusted model, including baseline iGFR and other covariates, the adjust difference in iGFR slope was 2.37 mL/min/1.73 m² per year (95% CI: 0.72, 4.03, p = 0.0051) higher among HCV treated participants compared to untreated. HCV treatment status was not associated with probability of albuminuria. Among participants chronically infected with HCV, we identified a significant positive impact of HCV cure on kidney function over time. While iGFR declined overall, declines were attenuated among participants treated for HCV compared to participants who remained untreated.

This commentary highlights the importance of understanding mental health in deaf populations within the context of language development and access. The authors, who are all Deaf professionals, emphasize that language deprivation—not hearing loss directly—is a primary cause of many mental health issues in deaf communities, and advocate for the inclusion of deaf experts in research and publications concerning deaf individuals' mental health.

We describe here the initial creation and validation of a tool designed to quantify certain unique life experiences of deaf individuals. The Deaf Childhood Experiences Scale (DCES) aims to provide empirical data on uniquely deaf life factors with the long-term goal of better understanding education, health, and quality of life outcomes among deaf populations. The methodology involved a mixed-methods approach of qualitative interviews with deaf community members to inform the creation of a quantitative assessment. This first version of the DCES comprises two main constructs—Language and Access, and Belonging—and was validated against Adverse Childhood Experiences questions, revealing a weak but significant correlation (r(568) = .18, p = < .001). The DCES offers a novel approach to better measure, and eventually understand the impact of, childhood experiences of deaf people that are likely salient for quality of life outcomes. Future work includes more validation efforts, plans for American sign language translation, parent and teacher versions, and further item revisions.

This study compares the range of motion (ROM) in all three planes in patients with Scheuermann kyphosis (SK) to healthy controls using surface topographic (ST) scanning. SK patients and healthy controls between 11–21 years old were recruited prospectively. Patients underwent ST scanning in maximal forward bend, twist to the right and left, and side-bend to the right and left. Sagittal, axial, and coronal ROM were computed using an automated pathway. An analysis of variance was used to determine significant differences in the ROM (coronal, axial, and sagittal) and asymmetry (coronal and axial) of SK patients versus controls. Scoliosis Research Society (SRS) 22r total, self-image, pain and function, as well as Patient-Reported Outcome Measurement Information System (PROMIS) mobility, physical activity and pain interference scores, and HSS Pedi-FABS were collected for all patients. 23 patients with SK and 98 controls were analyzed. SK group was 78.3% male with BMI of 24.1 kg/m2, average thoracic kyphosis angle of 75.0°. Control group was 55.1% male with a BMI 20.9 kg/m2. Compared to controls, patients with SK had 18.0° less sagittal, 12.0° less coronal ROM, and 15.5° less axial ROM. Controlling for age, sex, BMI, HSS Pedi-FABS did not change significance except for axial asymmetry index when controlling for sex. Patients with SK had lower SRS22r pain scores (4.1 vs. 4.4, p = 0.023), SRS22r self-image scores (3.5 vs. 4.5, p < 0.001) and SRS22r total scores (3.9 vs. 4.4, p < 0.001) compared to controls. Patients with SK have reduced ROM in all three planes measured by ST, compared to controls. The restriction in motion is accompanied by lower SRS22r pain and total scores, indicating that motion may play an important role in a patient’s quality of life. This study is limited by the lack of evaluation of extension when assessing sagittal range of motion, which has previously been documented to be compromised by SK.