• Inpatient ACS improves MOUD initiation and links patients to follow-up care. • Bridge clinics and peer navigation enhance continuity of care posthospital discharge. • Structured discharge planning and addiction consult services significantly boost outpatient treatment engagement. • Persistent disparities in MOUD access highlight the need for equitable policy innovations.

Aldosterone escape refers to the spontaneous and compensatory diuresis that occurs in primary aldosteronism to correct and rebalance fluid homeostasis during conditions of sodium retention. Although widely observed in humans and animals, the precise mechanisms underpinning aldosterone escape remain unclear. The escape phenomenon is clinically relevant as primary aldosteronism affects nearly one in ten hypertensive adults and is associated with a two-fold higher risk of stroke and atrial fibrillation. Studying the phenomenon provides additional insights into the intricate physiology of renal sodium handling that may inform future development of novel therapeutics. This review is a modern account of the complex interplay of renal hemodynamics, hormonal signaling, paracrine modulation, and tubular adaptations underlying aldosterone escape. By re-examining classical and emerging mechanisms, including the With-No-Lysine (WNK) kinase system as a potassium-sensitive distal homeostasis mechanism, we suggest a general framework for this remarkable phenomenon.

Stem cells are essential for tissue maintenance, repair, and regeneration, yet their dysregulation gives rise to cancer stem cells (CSCs), which drive tumor progression, metastasis, and therapy resistance. Despite extensive research on stemness and oncogenesis, a critical gap remains in our understanding of how the transcriptomic landscapes of normal somatic stem cells (SSCs) diverge from those of CSCs to enable malignancy. This review synthesizes current knowledge of the key signaling pathways (Wnt, Notch, Hedgehog, TGF-β), transcription factors (Oct4, Sox2, Nanog, c-Myc, YAP/TAZ), and epigenetic mechanisms (chromatin remodeling, DNA methylation, microRNA regulation) that govern stemness in SSCs and are hijacked or dysregulated in CSCs. We highlight how context-specific modulation of these pathways distinguishes physiological regeneration from tumorigenesis. Importantly, we discuss the role of epithelial–mesenchymal transition (EMT), cellular plasticity, and microenvironmental cues in reprogramming and maintaining CSC phenotypes. By integrating transcriptomic and epigenetic insights across cancer biology and regenerative medicine, this review provides a framework for identifying vulnerabilities specific to CSCs while still preserving normal stem cell function. Understanding these distinctions is essential for the development of targeted therapies that minimize damage to healthy tissues and advance precision oncology.

Background: While decortication is well-established for empyema or malignancy, its role in chronic sterile, non-malignant pleural effusions (CSNMPE) remains unclear. Given the high mortality rate among patients with CSNMPE, further longitudinal studies are warranted to assess the long-term efficacy and survival outcomes associated with decortication in this population. This study assesses long-term outcomes of decortication in CSNMPE and considers implications for future management. Methods: Between January 1, 2012, and December 31, 2022, a total of 25 patients underwent pleural decortication for CSNMPE at a single institution. Results: Median age was 67 years, with male predominance (84%) and right-sided effusions (64%). Etiologies were cardiac (28%), multifactorial (20%), hepatic (16%), renal (16%), unknown (12%), and autoimmune (8%). The median time from initial detection of pleural effusion to decortication was 6.6 months. Minimally invasive approach was used in 52% (thoracotomy, 48%). Radiographic improvement with significant lung re-expansion (>75%) was observed in 80%, and 72% experienced symptom relief. Postoperative complications occurred in 36%. Median overall survival was 65.3 months, with 1-, 3-, and 5-year survival rates of 80.0%, 63.8%, and 50.1%, respectively. Factors associated with decreased survival included a history of cancer treatment (P<0.01), prolonged pleural effusion duration (P=0.01), and increased intraoperative blood loss (P<0.01). Conclusions: Pleural decortication may benefit selected CSNMPE patients unresponsive to conservative therapy, offering symptom relief and survival. Findings are exploratory, and potential advantages of early intervention require further prospective validation.

Background: Improvements in imaging and technique have led to a greater role for renal mass biopsy (RMB) to risk‐stratify localized renal masses. We sought to assess the contemporary diagnostic accuracy of RMB for identifying renal cell carcinoma (RCC) based on concordance with final surgical pathology. Materials and Methods: Consecutive patients undergoing RMB between 2013 and 2023 across an 11‐hospital health system were identified. Concordance between RMB and final pathology for patients receiving partial or radical nephrectomy was compared. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of RMB for identifying RCC among patients who underwent surgery. Results: A total of 733 patients underwent RMB with an overall non‐diagnostic rate of 11% and most biopsies (67%) identified RCC. A total of 243 patients with surgical pathology were analysed, and 229 (94%) had RCC on surgical pathology. Excluding non‐diagnostic cases, RMB had a 98% concordance with surgical pathology for RCC; RMB had 94% sensitivity, 71% specificity, 98% PPV and 42% NPV for identifying RCC with non‐diagnostic cases considered as benign biopsies. For the nine RMB oncocytic cases receiving surgery, six (66%) were RCC and only two (22%) were confirmed oncocytomas. For patients with biopsy grade reported, 100% of high‐grade RCC were confirmed while 26% of low‐grade RCC were upgraded at nephrectomy (overall 80% concordance). Conclusions: In a large, contemporary cohort of patients, RMB had high PPV and sensitivity for identifying RCC and high concordance for specific histology at nephrectomy. However, upgrading was common, and oncocytic lesions selected for surgery due to clinical suspicion often harboured RCC.

Objectives: The objective of this study is to evaluate whether prior Holmium laser enucleation of the prostate (HoLEP) affects the diagnostic accuracy of multiparametric prostate MRI (mpMRI) with PI‐RADS scoring for detecting clinically significant prostate cancer (csPCa) on biopsy. Patients and Methods: We queried the Northwestern Electronic Data Warehouse for all patients who underwent mpMRI followed by prostate biopsy. Demographic information, mpMRI data including PI‐RADS score and biopsy data including Gleason grade (GG) were collected. Patients were stratified based on prior HoLEP and highest PI‐RADS score of index lesion on MRI. The outcome of interest was detection of csPCa (GG ≥ 2) on biopsy. Logistic regression was performed to assess the impact of prior HoLEP on the detection of csPCa at time of biopsy. Results: A total of 8937 patients met inclusion criteria, of which 97 patients (1.1%) had prior HoLEP. HoLEP specimen revealed benign pathology in 38 patients (39.2%), GG1 in 32 patients (33.0%), GG2 in 25 patients (25.8%) and GG3 in 2 patients (2.1%). Average time from HoLEP to mpMRI was 11.5 months. The post‐HoLEP group had lower prostate volumes (median 25.0 vs. 47.0 cc; p < 0.001) and PSA density (median 0.06 vs. 0.12 ng/ml ² ; p < 0.001). Rates of csPCa detection based on highest PI‐RADS score were comparable between control and HoLEP groups. Prior HoLEP did not significantly affect the detection of csPCa on multivariable analysis adjusting for age, race, PI‐RADS, family history of PCa, and PSA density (OR = 0.97; 95% CI: 0.60–1.57). Conclusion: PI‐RADS remains a reliable predictor of csPCa after HoLEP despite anatomic alterations. mpMRI should continue to guide biopsy and risk stratification in this population, though larger validation is warranted.