Heart failure is a major cause of global morbidity and mortality. Studies in laboratory animals have shown the direct protective effects of α-klotho on the cardiovascular system although it has limited expression in the heart. The association between α-klotho and cardiovascular disease is still controversial in different clinical studies. We designed a cross-sectional study in order to investigate the association between serum α-klotho level and the prevalence of heart failure in the American general population. The data were obtained from the National Health and Nutrition Examination Survey (NHANES), which included 11 271 participants aged 40-80 years. Serum α-klotho level was examined by enzyme-linked immunosorbent assay and divided into four quartiles for further analysis. Heart failure status was obtained from self-reported questionnaires. To estimate the association between α-klotho level and prevalence of heart failure, multivariate logistic regression analyses were conducted. Interaction and stratified analyses were performed to evaluate the potential modifiers. After adjusting for multiple covariates, a per-standard deviation increase in serum α-klotho level was associated with a decrease in prevalence of heart failure [odds ratio (OR): 0.76, 95% confidence interval (CI): 0.68-0.85). The ORs for participants in quartiles 2 to 4 were 0.77 (95% CI: 0.58-1.01), 0.70 (95% CI: 0.52-0.93) and 0.71 (95% CI: 0.53-0.95), respectively, compared with those in quartile 1. Stratified analysis revealed significant gender and racial differences. We revealed an independent association between serum α-klotho level and the prevalence of heart failure in the American general population. The association was not always consistent and varied according to gender and race.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is common among midlife women. Circulating extracellular vesicles (EVs) carry bioactive cargo that may mediate or reflect disease processes, but their role in hepatic steatosis in postmenopausal women remains unexplored. We conducted liquid chromatography data-independent acquisition-mass spectrometry on serum-derived EVs from 275 postmenopausal women enrolled in the Michigan site of the Study of Women's Health Across the Nation (MI-SWAN). Participants were grouped by hepatic steatosis status (n = 75), assessed via standardized ultrasound at the 2010 follow-up visit. Fasting serum samples were processed using size exclusion chromatography to isolate EVs. Differential EV protein abundance was evaluated by ANCOVA, adjusting for ethnicity and diabetes status, and applying Benjamini-Hochberg correction. Gene Set Enrichment Analysis (GSEA) was performed to identify enriched biological pathways. Among 469 detected EV proteins, 60 differed by hepatic steatosis status (p < 0.05), with two proteins remaining significant after multiple testing correction: complement C4A (C4A) and afamin (AFM). GSEA indicated enrichment in lipid metabolism and innate immune activation pathways. Subgroup analyses revealed racial and disease severity-specific differences in EV protein profiles. In Black women (n = 172), AFM, C4A, and APOA1 were significantly elevated, while in White participants (n = 103), no proteins reached significance, although AFM displayed a nonsignificant trend toward higher abundance. In participants with severe hepatic steatosis (n = 43), subgroup analysis showed increased COL18A1, AFM, PRG4, and INHBE and decreased C4A and APOA1. INHBE was the only protein consistently elevated across all three subgroups, whereas others showed subgroup-specific enrichment, such as immunoglobulins in Black women and complement or coagulation proteins in White participants and those with severe steatosis. Analysis of hepatic transcriptomic datasets demonstrated consistently higher INHBE expression across the MASLD spectrum, including metabolic dysfunction-associated steatohepatitis (MASH), while AFM expression was significantly higher in the MASH vs. steatosis comparison. This study demonstrates that circulating EV proteomes differ by hepatic steatosis status in postmenopausal women. While exploratory, candidate EV proteins such as INHBE and AFM merit validation as biomarkers and potential contributors to MASLD in this high-risk population.

ABSTRACT Purpose Genetic testing is recommended but underutilized in advanced prostate cancer. Given known disparities affecting Black patients, we assessed genetic testing completion rates by race. Methods Henry Ford Health's electronic medical record was queried for new prostate cancer diagnoses (1/1/2017–6/30/2022). The primary outcome was completion of somatic and/or germline testing in stage IV cases. Secondary outcomes included genetic counseling referrals and attendance. Multivariable logistic regression assessed associations with baseline variables. Kaplan‐Meier analysis was used for exploratory survival comparisons. Results Among 452 stage IV patients (150 Black, 302 White), Black patients had higher somatic (30.7% vs. 18.9%, p = 0.00489) and comparable germline testing rates (16.7% vs. 21.2%, p = 0.255). In M1 cases ( N = 297), germline testing was lower among Black patients (14.8% vs. 25.4%, p = 0.0329) despite higher referral rates (32.0% vs 22.2%, p = 0.0241) and similar counseling attendance (45.8% and 43.3%, p = 0.786). No significant racial differences were seen in germline testing for N1 cases ( N = 155, 21.4% vs 14.2%, p = 0.274), or somatic testing for M1 (36.1% vs 25.9%, p = 0.0644) or N1 (16.7% vs 7.1%, p = 0.0728) subgroups. M1 patients that completed testing had improved survival ( p = 0.0352), while no survival difference by testing in N1 disease or race was observed. Conclusions Genetic testing uptake in this advanced prostate cancer cohort was low overall. Notably, Black patients had higher rates of somatic testing, an equitable finding given historically higher prostate cancer‐specific mortality. Germline testing was comparable overall but remained lower among Black patients with metastatic disease, indicating that additional decisional and systemic barriers persist beyond access to care and referrals to genetic counseling. Insurance disparities and lower census tract‐estimated income represent the largest structural differences between cohorts, with observed equity likely supported by broad coverage of commercial testing. Together, these results indicate that equitable testing utilization is achievable through consistent access frameworks, while residual disparities in germline testing warrant targeted intervention at both the patient and healthcare delivery levels.

Development and Validation of a Novel Machine Learning-Based Algorithm to Predict Incident Atrial Fibrillation - A Multicohort Analysis.

Lung cancer is the leading cause of cancer-related death. The incidence and mortality rates are higher for Black men than for White men. Protein arginine methyltransferase 6 (PRMT6) is known to be associated with lung cancer tumorigenesis and prognosis, and different levels of PRMT6 expression by race and sex may explain lung cancer disparity among Black men. To examine differences in PRMT6 by neighborhood violence as social stress, we obtained 88 formalin-fixed paraffin-embedded tissue sections of lung cancer patients. Using immunohistochemistry, samples were stained and scored (H-score) for PRMT6 levels. Logistic regression was used to examine the likelihood of having a high H-score (≥ median) by race and sex, controlling for age, smoking status, tumor type, grade, stage at diagnosis, and neighborhood homicide rate. The odds of having a high H-score were higher for Blacks than Whites, but there was no sex difference, controlling for tumor characteristics. High Homicide was negatively associated with high H-scores. Controlling for all other variables, the odds ratio (OR) of having a high H-score for Black vs. White males was 7.8, and the OR for Black vs. White females was 1.8 for the low homicide group. The ORs for both Black vs. White males and Black vs. White females were more than 3 times higher for the high homicide group. Overexpression of PRMT6 may explain lung cancer disparity in Black men. Exposure to social stress may contribute to higher levels of PRMT6. Social and biological differences affecting race and sex groups need further investigation.

IntroductionBlack patients with systemic lupus erythematosus (SLE) have lower medication adherence than White patients, contributing to worse health outcomes. However, racial differences in reasons for nonadherence and beliefs about medications are not well understood.MethodsWe conducted a cross-sectional analysis of Black and White patients with SLE who completed the Beliefs about Medicines Questionnaire and the SLE-specific Domains of Subjective Extent of Nonadherence survey. We compared scores by race and by adherence level within each racial group.ResultsAmong 123 patients (52% Black, 48% White), adherence was lower in Black patients (44% vs 64%, p = .02). Black patients reported greater concerns about SLE medications and medication overuse and harm than White patients. Nonadherent Black patients reported weaker beliefs in SLE medication necessity and greater concerns about medication overuse and harm than adherent Black patients. Reasons for nonadherence reported by Black patients but not White patients included feeling well (45%), concerns about future fertility (14%), and doubts about their doctors and medicines (8%).ConclusionNonadherence among Black patients was uniquely associated with stronger concerns about medication overuse and harm and weaker beliefs that SLE medicines were necessary, potentially reflecting medical mistrust that may drive skipping doses when feeling well or when concerns arise. These insights can help clinicians more astutely probe and address each patient's needs to enhance medication adherence and SLE management.

Sleep Duration, Disturbances, and Health-Related Quality of Life in Stroke Survivors.

Racial and Ethnic Differences in Rates of Reduction Mammoplasty Among Women with Macromastia: An Analysis of the All of Us Research Program

Variation in Micronutrient Intake and Adequacy by Race, Ethnicity, and Poverty-to-Income Ratio in United States Children and Adults: A Descriptive Analysis of the National Health and Nutrition Examination Survey.

Racial disparities in research productivity among integrated plastic surgery applicants.

Social Determinants of Health in Pediatric Appendicitis: A Systematic Review and Meta-Analysis.

Lower urinary tract symptoms (LUTS), associated with benign prostatic hyperplasia (BPH), are an aging-related disease, with more than 210 million cases worldwide. Estrogen exposure and estrogen regulation have been implicated in a variety of disease processes, with estrogen receptor (ER)-α pathways associated with disease progression and ERβ pathways considered to be disease-protective through enhanced apoptosis and reduced cellular proliferation. Preclinical models of LUTS/BPH have shown that ERα activation contributes to disease initiation and progression. Self-identified African American (AA) men have a high incidence of LUTS/BPH, with increased incidence of non-surgical treatment failure, larger prostates at time of surgery, and surgery occurring at a younger age compared with self-identified European American (EA) men. While circulating estrogen levels are higher in AA individuals, regulation of ERs, particularly ERβ, in normal and LUTS/BPH human prostate has not been well characterized. In this study, we examined differences in ER expression between peripheral zone (PZ) and transition zone (TZ) prostate tissues using multiplex, multispectral imaging. Additionally, we assessed changes in ERs and steroid metabolism genes involved in ERβ signaling between normal and LUTS/BPH prostate samples. Our study revealed underlying differences in steroid metabolism gene expression between normal AA and EA prostates, which were further altered with LUTS/BPH. Importantly, the contribution of ERα to LUTS/BPH was more pronounced in EA prostate samples, whereas AA prostate samples exhibited an overall increase in the expression of both ER and estrogen metabolism-related genes. Although estrogens have also been implicated in collagen deposition in the prostate of LUTS/BPH patients, we did not observe significant differences in collagen deposition between AA and EA samples. These results suggest that racial differences in steroid hormone signaling pathways within the benign prostate represent a promising area for the development of precision-based therapies to reduce LUTS in aging men. © 2025 The Author(s). The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.

Epigenetic differences across racial/ethnic groups can provide insights into health disparities, including likely mechanisms and multifactorial upstream exposures at play. We compared the blood DNA methylome of Native Hawaiian (NatH) women, an understudied group with high chronic disease burden, with that of White women. Blood genome-wide DNA methylation profiling was performed in generally healthy, non-smoking NatH (n = 143) and White (n = 181) postmenopausal women in the Multiethnic Cohort. CpGs showing significant (Bonferroni p < 0.05) and substantial (delta-beta > 0.1) differential methylation in NatH compared to White women (CpGs-NatH) were identified through linear regression of methylation, adjusted for potential confounders. The CpGs-NatH were examined for gene pathways and for associated dietary patterns and metabolic biomarkers. We identified 736 CpGs-NatH, which presented more frequent CpG island hypermethylation than expected. Many corresponding CpGs-NatH genes (61%) were functionally implicated in liver disease etiology, and 15 CpGs-NatH were correlated with MRI-quantified liver fat content. 168 of the 736 CpGs were associated with adherence to the Dietary Approaches to Stop Hypertension (DASH) diet. The CpGs-NatH were also associated with several blood biomarkers of key metabolism, including adiponectin, triglycerides, and sex hormone-binding globulin. Our findings suggest marked racial differences in DNA methylation, suggesting epigenetic mechanisms underlying racial metabolic health disparities, such as the higher propensity for ectopic fat accumulation and higher incidence of liver disease and cancer among NatH, compared to Whites. These results support further investigation of the epigenome across racial and ethnic populations in relation to lifestyle factors and metabolism.

Penicillin allergy labels affect 1 in 10 people but are uncommonly reflective of true, IgE-mediated allergy. Penicillin allergy labeled patients have increased exposure to broad-spectrum antibiotics that increase the risk for treatment failures, antimicrobial resistance, and adverse events. De-labeling of penicillin allergy is an evidence-based strategy to support access to optimal antibiotics and reduce antimicrobial resistance. To assess the association of race with penicillin allergy de-labeling prevalence. We used a retrospective cohort of primary care patients at Mass General Brigham and Tufts Medicine health systems receiving care from June 2019 - 2022 with any active or inactive (i.e., deleted, inactivated) penicillin allergy record in their electronic health record. We assessed penicillin allergy de-labeled as the primary outcome, defined as no active penicillin allergy record in the electronic health record using a validated algorithm. The primary exposure was self-reported race in the electronic health record. We also assessed age, sex, language preference, documented allergies, healthcare visits, and Charlson comorbidity index as potential associated factors and mediators. Black patients were less likely to have penicillin allergy de-labeling overall (aOR 0.73 [95%CI 0.64-0.84]), but the prevalence and mediation differed across the two healthcare systems. Asian patients had lower penicillin allergy de-labeling prevalence (aOR 0.76 [95%CI 0.65-0.88]), which was mediated in both systems by non-English language preference and specific healthcare utilization. Racial differences were identified in penicillin allergy de-labeling, in Black and Asian patients, but with inconsistencies between healthcare systems. Further studies identifying the clinician, institution, and structural-level barriers to penicillin allergy de-labeling are necessary to advance equitable penicillin allergy de-labeling and antibiotic stewardship.

ABSTRACTBackgroundWhile mothers have an important role in shaping their children's physical activity (PA) behaviours, their participation in PA with their young child is limited. This study aimed to understand mothers' perceptions of co‐participation of PA (co‐PA) with their young child and compared these perceptions between White and Black, Indigenous, and people of colour (BIPOC) mothers.MethodsThirty mothers (White: n = 14; BIPOC: n = 16) with a 2‐to‐5‐year‐old child were interviewed about their current co‐PA interactions with their child. A thematic analysis approach was used to determine themes and subthemes for all mothers and by racial category.ResultsCo‐PA was important within a technological society as it allowed for bonding time, educational opportunities and healthier lifestyles. Mothers' thoughts about co‐PA before the activity were negative, but positive afterwards. A unique barrier was adapting to the child's age and mood. Mothers also noted the availability of places to be active as a barrier and facilitator. A novel theme discussed by the mothers was the social aspect that co‐PA provided. A few differences in the importance of subthemes emerged between the racial categories. White mothers, more often described co‐PA as providing learning opportunities, whereas BIPOC mothers often said co‐PA allowed them to model that PA was important to do. Regarding co‐PA barriers, White mothers noted distractions due to screens, whereas BIPOC mothers mentioned inadequate resources. Finally, regarding the social aspects of co‐PA, more BIPOC mothers highlighted the importance of co‐PA for motivating others to be active.ConclusionOverall, the perceptions regarding co‐PA in this diverse group of mothers were similar; however, some key differences in the importance of co‐PA existed between White and BIPOC mothers. Co‐PA's social aspect and the differences between racial groups should be considered when aligning interventions to fit the needs and preferences of subgroups of mothers to improve co‐PA.

There is an idea misattributed to Freud that a certain "race" (e.g., the Irish) cannot be analyzed. One of the problems of this statement is its particularity. Thinking a certain race cannot be analyzed not only accepts the perniciousness of categorical racial difference, but also overlooks a more central idea Freud investigated in clinical work: that an unconscious antagonism inherent to subjectivity is the motivation and resistance to know oneself. This is the premise of this paper, which illustrates samples of Filipino American experiences in the psychoanalytic consulting room. Several vignettes are presented, in which fantasies of the author's identity are conjured to facilitate and hinder the analysis. The intrapsychic, interpersonal and sociohistorical conflicts featured in these cases reflect not only how the Philippines can be positioned in American and Asian imaginations, but also how investments in the identities of self and other reveal how we relate to our constitutive lack. It finally reflects on the jouissance (enjoyment) taken in identity's rewards, exclusions and impossibility.

Advances in cancer management have improved oncologic outcomes, but the extent of these improvements and disparities across demographic and socioeconomic groups over the past two decades remains unclear. We identified patients diagnosed with primary cancer at eight sites (lung and bronchus, liver and intrahepatic bile ducts [IHBD], esophagus, colon, kidney, pancreas, rectum, and stomach) between 2000 and 2019 from the Surveillance, Epidemiology, and End Results (SEER)-17 database. Kaplan-Meier curves were used to evaluate cancer-specific survival (CSS) across different diagnostic periods, and Cox proportional hazards models were employed to adjust for confounding factors. We found that CSS for eight cancers improved significantly between 2000 and 2019, but the extent of improvement varied by population characteristics. Elderly patients, unmarried individuals, those with low income, and rural residents showed poorer relative CSS improvement across all eight cancers. Relative CSS improvement differences by sex were present across the eight cancers but remained small. Black patients exhibited less relative CSS improvement than White patients only in pancreatic cancer. Absolute 5-year CSS differences by race (White vs. Black) decreased in six cancers except pancreatic and gastric cancers. In summary, the extent of improvement in CSS for the eight cancers varied by demographic characteristics between 2000 and 2019. Absolute survival differences by age, marital status, income, and place of residence widened for most cancers, while racial differences (White vs. Black) narrowed for most cancers. This provides potential recommendations for further adjustments in medical resources.

To assess racial and ethnic differences in gestational diabetes mellitus (GDM) prevalence and perinatal outcomes among U.S. women with normal prepregnancy body mass index (BMI). Retrospective, population-based cohort study using 2021-2023 US National Vital Statistics System data. Included singleton live births to women aged 18-44 years with BMI 18.5-24.9 kg/m2. Exclusions were preexisting hypertension or diabetes, multiple gestations, missing covariates, or implausible data. Race/ethnicity: White, Black, Asian, and Other (Native American/Alaska Native, Native Hawaiian/Pacific Islander, and multiracial). Primary outcome: GDM prevalence by race. Logistic regression estimated adjusted odds ratios (aORs) with White women as the reference. preterm delivery macrosomia, NICU admission, and neonatal respiratory failure. A total of 3,754,684 women, GDM prevalence was highest in Asians (12.5%). Compared with White women, Asians had nearly threefold higher odds of GDM (aOR, 2.95; 95% CI, 2.91-3.00). GDM was associated with preterm delivery (aOR, 1.23; 95% CI, 1.22-1.25), NICU admission (aOR, 1.26; 95% CI, 1.24-1.28), and neonatal respiratory failure (aOR, 1.27; 95% CI, 1.22-1.32), in all racial groups. Macrosomia was increased only in Black (aOR, 1.55; 95% CI, 1.43-1.68) and Other (aOR, 1.21; 95% CI, 1.08-1.34). Among women with normal BMI, substantial racial disparities in GDM prevalence and outcomes exist, with Asian women at the highest risk. Our results support earlier and ethnicity-tailored GDM screening among women with normal BMI-particularly Asian women-plus proactive counseling on glucose monitoring and culturally adapted lifestyle interventions during pregnancy.

Alzheimer disease blood-based biomarkers are a cost-effective method for early detection. Few studies provide long-term follow-up of cognition in Black participants. We assessed biomarker association with cognitive decline and dementia risk in Black and White participants. Plasma biomarkers (neurofilament light chain, glial fibrillary acidic protein [GFAP], amyloid-β 42/40 ratio, phosphorylated tau at threonine 217 [pTau217]) were measured in participants from a community-based Chicago cohort without dementia at the time of blood draw. They were evaluated annually for up to 15 years for cognition and dementia. Data included medical history, blood tests (e.g., kidney function), Mini-Mental State Examination (MMSE) score, and APOEε4. Associations of biomarkers with comorbidities, cognitive decline, and risk of dementia were examined within racial groups. To examine racial differences, we repeated the analysis using a Mahalanobis-balanced 1:1 match on biological sex, age, education, Latino/non-Latino status, longitudinal data availability, and clinical status (hypertension, diabetes, glomerular filtration rate, body mass index [BMI], and heart disease). Biomarkers were measured in 431 Black and 583 White participants (mean age of 77 and 80 years and 17% and 21% of men, respectively), generating a balanced sample of 366:366. Biomarker levels were similar across races. Within racial groups, the associations of biomarkers with multiple comorbidities (especially kidney dysfunction and BMI) remained after controlling for demographics, APOEε4 status, and dementia or death within 5 years. Men had lower GFAP than women (all p < 0.001). Within racial groups, pTau217 was associated with a decline in global cognition and domains (all p < 0.001), and between races, pTau217 was associated with a faster decline in global cognition (β = -0.03, SE = 0.012, p = 0.018) and semantic memory (β = -0.068, SE = 0.016, p < 0.001) in Black individuals. The discrimination of dementia by pTau217 (area under the curve [AUC]3-year, Black 0.81, 95% CI 0.74-0.89; AUC3-year, White 0.77, 95% CI 0.71-0.83) was good relative to age (AUC3-year, Black 0.69, 95% CI 0.58-0.79; AUC3-year, White 0.68, 95% CI 0.62-0.75) and MMSE score (AUC3-year, Black 0.81, 95% CI 0.74-0.89; AUC3-year, White 0.72, 95% CI 0.65-0.80). The discrimination by pTau217 did not improve when adding other biomarkers or MMSE score. pTau217 was highly associated with dementia risk and cognitive decline. The association of biomarkers with cognitive decline in Black and White participants was similar. Higher pTau217 was, however, associated with global and semantic memory decline in Black adults. Generalizability is a limitation.

To investigate the clinical features of nivolumab-induced isolated adrenocorticotropin deficiency and to provide a reference for the diagnosis, treatment and rational use of nivolumab, clinical reports of nivolumab induced isolated adrenocorticotropin deficiency were collected by searching the database until August 31, 2025. Clinical data were collected and retrospectively analyzed. Seventy-one patients were enrolled, with a median age of 66 years (range: 26-87), and 73.2% of whom were male and 67.6% from Japan. Melanoma (36.6%) was the main indication for nivolumab. The median time from initiation of nivolumab to the onset of isolated adrenocorticotropin deficiency was 24 weeks (range: 3-60) and the median was 8 cycles (range: 2-33). Fatigue (76.1%), anorexia (66.2%) and nausea (23.9%) were the most common symptoms of isolated adrenocorticotropin deficiency. Laboratory tests revealed hyponatremia (50.7%) and eosinophilia (28.2%). Pituitary magnetic resonance imaging showed no abnormality in most patients (71.8%). Thyroid dysfunction (26.8%) often coexists with isolated adrenocorticotropin deficiency. These patients had a good prognosis after receiving a physiological dose of hydrocortisone. Nivolumab-induced isolated adrenocorticotropin deficiency is a rare disorder with possible racial differences. The possibility of isolated adrenocorticotropin deficiency should be considered in patients with fatigue and fatigue during treatment. Serum sodium and eosinophil ratios should also be closely monitored. The prognosis is good after hydrocortisone replacement therapy.