The 16th Acromegaly Consensus Conference in September 2024 updated recommendations on diagnosis and treatment of acromegaly comorbidities. Since the 2020 acromegaly comorbidity management guideline was published, new evidence has emerged on novel and known comorbidities and new treatment approaches. Forty-three experts in the management of acromegaly reviewed the current literature and assessed changes in clinical practice standards and management. Current outcome goals were considered and updated, with a focus on the impact of current and emerging treatments of these comorbidities. Participants assessed factors that determine pharmacological choices, as well as use of specific agents in the management of the most relevant acromegaly comorbidities. We present consensus recommendations highlighting optimization of evidence-based acromegaly comorbidities management.
This manuscript reviews the clinical spectrum and management of Fontan-associated liver disease (FALD) and protein-losing enteropathy (PLE), examining how chronic venous hypertension leads to multisystem injury. Liver fibrosis is now recognized as an early and nearly universal complication after the Fontan procedure, with cirrhosis affecting approximately 43
Peritoneal carcinomatosis (PC) represents a complex manifestation of intra-abdominal malignancies. Its resistance to systemic therapy and diagnostic challenges has limited treatment options and resulted in poor survival outcomes. This review synthesizes current evidence on the pathophysiology, diagnosis, patient selection, surgical techniques, outcomes, and emerging therapies in PC. Advances in the understanding of peritoneal tumor biology, coupled with the development of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), have significantly transformed the management landscape, enabling carefully selected patients to achieve meaningful survival outcomes. The diagnostic work-up has evolved to incorporate multimodal imaging, laparoscopy, serum and peritoneal biomarkers, and standardized scoring systems such as the Peritoneal Cancer Index (PCI) and Completeness of Cytoreduction (CC) score, which guide patient selection and surgical planning. Experimental approaches such as intraperitoneal immunotherapy, targeted therapies, nanoparticle drug delivery, and mucolytics are being actively investigated to expand treatment options for patients with unresectable or high-burden disease. Despite these advances, challenges persist, including heterogeneity in HIPEC protocols, and limited tumor-specific evidence. Peritoneal carcinomatosis is no longer universally considered a terminal condition, with CRS and HIPEC offering significant survival benefit in appropriately selected patients. However, outcomes remain highly dependent on tumor biology, disease burden, and completeness of cytoreduction. Future progress will require improved patient selection, standardization of HIPEC protocols, and integration of emerging therapies.
Intimate partner homicide is one of the leading causes of death for women, disproportionately affecting Black women. To investigate the severity of lethality risk and its relationship with individual characteristics, experiences of discrimination, and mental health among urban Black women in Wisconsin since the start of COVID-19. This analysis was part of a larger mixed-methods study. Women were recruited from community agencies in Wisconsin. Eligible participants could participate either in person, by phone call, or via Teams. Lethality was assessed using the Lethality Assessment Protocol (LAP). The experiences of discrimination were measured by the Experiences of Everyday Discrimination (EDS). Mental health and all other demographic variables were self-reported. The data collection was conducted between 2023 and 2025. Analyses were conducted using descriptive analysis, simple linear regression, and multiple regression. All analyses were conducted in SPSS version 29. Data from 185 urban Black women were analyzed, with an overall mean weighted LAP score of 17.29. The overall regression was significant, accounting for approximately 5
Vertebral end plates (EP) are essential for disc homeostasis due to their dual role of structural load distributor and a nutritional interface. Focal EP defects are frequently observed clinically, but their true biomechanical significance in vivo is unknown. Finite Element (FE) analysis offers a unique opportunity to simulate specific anatomical changes and can quantify the consequences of the mechanical disruption. We employed a validated FE Model of L4-L5 functional unit and investigated the effects of physiological compression and pure moments on models simulating: (1) Healthy discs with intact EP, (2) Four EP defect models, and (3) Graded anatomical EP damage based on Integrated Total Endplate Score (I-TEPS). Stress distribution on cartilage end plate (CEP), bony end plate (BEP), annulus fibrosus (AF), nucleus pulposus (NP), and subchondral bone was documented. In the intact healthy model, stress was uniformly distributed without focal concentrations. In contrast, all EP defect models demonstrated significant, non-linear stress elevation across the motion segment. Incremental analysis based on I-TEPS revealed a ‘mechanical tipping point’ phenomenon: stresses remained relatively stable until score three but increased sharply once the score reached four, coinciding with the onset of BEP involvement. Focal EP defects, irrespective of their location, cause stress extensions beyond the defect zone, causing cascading mechanical disruption of the disc environment. Combined CEP and BEP defects (I-TEPS ≥ 4) represent synergistic mechanical failure, characterized by abnormal NP pressure, annular tension, and subchondral bone stress. These findings demonstrate that EP integrity is one of the primary determinants of segmental spine stability.
