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Background: Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy with limited treatment options. Although there have been recent advancements revealing genomic drivers of these tumors, it remains unclear which genomic signatures are associated with recurrence, particularly following R0 resection., Methods: Adrenocortical carcinoma patients treated with adrenalectomy in the Cancer Genome Atlas with recurrence data were identified using cBioPortal. Clinicopathologic variables, genomics, treatment patterns, and outcomes were retrospectively analyzed., Results: Among 92 adrenocortical carcinoma patients, 84 had recurrence data, with 52% experiencing tumor recurrence. Age and sex were not significantly different between recurrent and nonrecurrent groups. Nonrecurrent patients had a significantly longer overall survival (54 months vs 35 months, P = .0036). Adjuvant radiation was administered similarly in both groups (25.0% vs 16.2%, P = .4164). There were no differences in capsular or venous invasion or median tumor size. Sixty-two patients had R0 resection and 40.3% (n = 25/62) recurred. Multivariate logistic regression in this cohort, when controlling for vascular invasion, venous invasion, and capsular invasion, revealed that the WNT (odds ratio 4.43 [1.09-18.0], P = .034), PI3K (odds ratio 7.80 [1.33-45.65], P = .023), and cell cycle (odds ratio 6.81 [1.43-32.30], P = .016) pathways were significantly associated with recurrence. Median time to recurrence was 7.9 months; early recurrence (<7.9 months) was associated with MYC pathway alterations (40.9% vs 9.1%, P = .0339)., Conclusion: This study identified genomic signatures in the PI3K, WNT, and cell cycle pathways associated with adrenocortical carcinoma recurrence, including in those who underwent R0 resection. Investigations regarding the utility of these signatures as a prognostic tool to dictate adjuvant therapies or targeted treatment are warranted., Competing Interests: Conflict of Interest/Disclosure The authors have no relevant financial disclosures., (Copyright © 2024 Elsevier Inc. All rights reserved.) more...

Background: Computed tomography angiography of the head (CTAH) is not routinely obtained during the initial evaluation of patients with traumatic intracranial hemorrhage (ICH); however, it is useful for diagnosing vascular pathologies that may have led to the bleed. The aims of this study were to identify traumatic ICH patient characteristics on presentation that are associated with positive CTAH findings to elucidate which ones should prompt a CTAH and compare outcomes of patients with positive and negative CTAH findings., Methods: This is a retrospective cohort study of 522 patients who had blunt traumatic ICH and subsequently received CTAH between January 1, 2017, and January 1, 2022. Patients were then sorted into two cohorts: positive and negative CTAH findings. The CTAH findings were our primary outcomes and included a spectrum of traumatic vascular injuries as well as nontraumatic vascular pathologies. Secondary outcomes included mortality, intensive care unit admission, intensive care unit length of stay, and neurological intervention rates., Results: A total of 108 patients (20.7%) had positive CTAH findings. Patients with positive CTAH findings were more likely to be older, have lower heart rate, have more neurological deficits at admission, have fewer signs of external injury, and have increased need for cerebral angiogram and neuro-embolization. Patients with no pathologic CTAH findings were 3.9 times more likely to be alive at discharge. Initial heart rate and presence of neurological deficits on arrival were found to be independent predictors of positive CTAH findings., Conclusion: Empiric CTAH is not necessary in all traumatic ICH patients. However, given the increased rates of neurologic procedures and mortality in patients with positive findings on CTAH, we recommend obtaining CTAH in blunt traumatic ICH patients who present with neurological deficits. The presence of external injuries alone should not influence the clinician's decision to obtain a CTAH., Level of Evidence: Prognostic and Epidemiological; Level III., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.) more...

Introduction: Mechanical Cardiac Support and Left Ventricular Assist Devices (LVAD) have been demonstrated to prolong Heart Failure patients' survival and improve their quality of life. LVAD implantation has a considerable effect on patients' body image. Patients find it hard to accept the device as an extension of their body, especially the driveline. The study aimed to examine the relationships between anxiety and depressive symptoms, acceptance of illness, beliefs about pain control, and quality of life with body image among LVAD-implanted patients., Methods: The cross-sectional study included 54 conveniently recruited patients who completed the Body Image Scale, SF-12, Acceptance of Illness Scale, Beliefs about Pain Control Questionnaire, NRS, HADS, and demographic and clinical data. Multiple regression analyses examined the associations between the research variable., Results: The mean Age of the participants was 59.64 (SD=9.63), and 96.3% were men. The mean scores were: Body Image Scale - 28.33 (SD=5,91); Acceptance of Illness Scale - 25.51 (SD=5.92); beliefs about pain control: internal factors - 15.85 (SD=4.96), the influence of physicians - 17.57 (SD=3.15), random events - 14.37(SD=3.32), NRS=2.80(SD=1.86), HADS anxiety - 5.33 (SD=4.12), HADS depression - 4.66 (SD=3.10), SF12MCS-45.49 (SD=6.48), SF-12PCS-41,33 (SD=6.48). The presence of anxiety and depressive symptoms and complications after LVAD significantly predicted low body image concerns., Discussion: Healthcare professionals should be aware of challenges regarding body image faced by LVAD-implanted patients and address related factors, especially anxiety and depression., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2025 Milaniak, Witkowska, Cebula, Tomsia, Wasilewski, Górkiewicz-Kot, Wiśniowska-Śmiałek, Kaleta and Wierzbicki.) more...