As clinicians progress in their careers, they are often tasked with projects and responsibilities that require additional education, knowledge, and training in leadership and management. In the past, they were expected to pick up these skills along the way; current expectations, however, are different. Today, several avenues are available to clinicians to acquire and refine these competencies. This narrative review provides a structured overview of the education and training available—both with and without formal credentials—and outlines potential opportunities and pathways for developing leadership and management skills, particularly among critical care physicians.
Obesity is a complex, multifactorial disease that contributes to a broad range of cardiometabolic, reproductive, and psychological disorders. Representing a major global health challenge, obesity can be addressed by lifestyle modifications such as reduced calorie intake, physical activity, adequate sleep, and stress management to help achieve sustainable weight loss and improve metabolic health in the long term. Glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) are the two naturally produced incretin hormones in the gastrointestinal tract. Incretin analogues were initially approved for type 2 diabetes mellitus but were later found to exhibit weight-reducing properties. Liraglutide, semaglutide, and tirzepatide are the three incretin analogues approved for obesity in non-diabetic patients. This narrative review presents detailed comparisons of the three approved incretin analogues for obesity, their cost-effectiveness, and trends in the clinical setting.
Traditional coronary artery disease (CAD) risk scores offer limited precision, often failing to capture the complex, multifactorial nature of the disease. The proliferation of multimodal data from imaging, genomics, electronic health records (EHRs), and wearables offers a transformative opportunity for more individualized risk prediction. This narrative review systematically maps and critically evaluates the landscape of multimodal data fusion for CAD risk prediction. Following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, we synthesized 39 empirical studies published from 2009 to 2025 to identify key methodological patterns, informatics challenges, and future directions. Our synthesis reveals consistent methodological patterns: (1) integrating imaging biomarkers (e.g. coronary computed tomography angiography, coronary artery calcium scoring) with clinical data robustly enhances risk discrimination and reclassification; (2) adding polygenic risk scores provides incremental value, typically via late-fusion models; and (3) leveraging longitudinal EHR data with machine learning captures dynamic risk trajectories, outperforming static scores. Advanced machine learning architectures, particularly deep and graph neural networks, are pivotal for enabling automated feature extraction and modeling complex cross-modal interactions. Despite these advances, significant informatics hurdles persist, including data heterogeneity, algorithmic bias, the need for robust external validation, and challenges in clinical workflow integration. Multimodal data fusion is a cornerstone of precision cardiology, but realizing its clinical potential requires a concerted focus on developing fair, interpretable, and scalable methodological frameworks to translate complex data into improved patient outcomes.
This paper presents a halakhic-ethical analysis of a 2025 case involving A.S., a brain-dead pregnant woman who was maintained on somatic support to enable fetal maturation and delivery. The case raises profound questions at the intersection of Jewish law and contemporary medical practice, particularly regarding the halakhic definition of death—brain versus cardiac cessation—and the moral status of the fetus. The paper explores divergent rabbinic opinions on whether sustaining a brain-dead body for fetal viability is halakhically permissible or obligatory. Key halakhic parameters examined include the principle of pikuach nefesh (saving life), the fetus as a potential nefesh, and the permissibility of delaying burial to perform a Cesarean section. We argue that Halakhah offers nuanced and compassionate responses to unprecedented bioethical dilemmas. Moreover, the paper affirms that Jewish law is ethically responsive, evolving through dialogue with changing human circumstances while remaining rooted in balancing reverence for life with the dignity of death. It underscores the importance of interdisciplinary collaboration between halakhic authorities and medical professionals to navigate ethically complex and medically novel scenarios with both compassion and rigor. This case illustrates that the moral courage of Halakhah’s heartbeat compels rabbinical scholars to navigate its boundaries with empathy, wisdom, and fidelity to tradition.
To the Editor,
We thank Thakur and Bhatia for their insightful letter, “Home-based Pulmonary Rehabilitation in COPD: Bridging Evidence and Practice for Comprehensive Patient-centered Care,” and for their gracious recognition of our study, “From Breathless-ness to Better Living: Transforming COPD Care with Home-based Pulmonary Rehabilitation.”
The evolving landscape of metastatic prostate cancer (mPCa) necessitates a redefinition of the urologist’s role, extending beyond diagnosis to active participation in therapeutic and surgical management. This review outlines evidence-based approaches to biopsy and surgical interventions across the disease spectrum. Prostate biopsy remains fundamental for diagnosis, treatment stratification, and molecular profiling, with targeted and metastatic lesion sampling improving precision oncology. For symptom relief, surgical management of bladder outlet obstruction through transurethral resection of the prostate and holmium laser enucleation of the prostate remains essential, with emerging data suggesting possible oncologic benefits when combined with systemic therapy. GreenLight photoselective vaporization may represent an alternative option, though evidence remains limited. Cytoreductive radical prostatectomy in carefully selected patients with metastatic hormone-sensitive disease may provide improved local control and delayed progression, supported by growing biological rationale but constrained by the retrospective nature of current evidence. Collectively, these findings underscore the expanding multidisciplinary role of the urologist in mPCa care, emphasizing the need for prospective studies to validate the integration of surgical approaches within systemic treatment frameworks.
Background: Ampullary neuroendocrine tumors (NETs) are extremely rare, representing 0.3%–1% of gastrointestinal NETs and less than 2% of periampullary cancers. Due to their rarity, there is limited data on their natural history, management, and outcomes. Current European Neuroendocrine Tumor Society guidelines (2023) recommend pancreaticoduodenectomy (PD) as the standard treatment. However, this approach is invasive and associated with high morbidity and mortality. Emerging evidence suggests that endoscopic papillectomy (EP) could be a viable alternative in selected cases. This retrospective multicenter study aimed to evaluate the feasibility and outcomes of endoscopic resection for ampullary NETs.
Methods: This retrospective case series included 14 patients who underwent EP for ampullary NETs between 2011 and 2022 across three Italian tertiary centers. Pre-procedural evaluation was performed following European Society of Gastrointestinal Endoscopy guidelines. Endoscopic papillectomy was performed under monitored sedation, using standard snares for en bloc resection. Follow-up endoscopy was conducted at a median of 3 months. Primary outcomes included complete resection (R0) and recurrence rates; secondary outcomes focused on adverse events.
Results: Fourteen patients (median age: 62.5 years; 50% male) were included. Median tumor size was 18 mm. In 12 out of 14 cases, ampullary NETs were diagnosed only after endoscopic resection. Post-resection histology identified 8 G1 NETs (Ki-67 1%) and 6 G2 NETs (Ki-67 5%). Complete resection was achieved in 11 cases (78.6%). Among 3 incomplete resections, 2 were managed surgically, while 1 was followed up without recurrence. Residual disease was detected in 3 patients: 2 were managed endoscopically, and 1 required surgery. No recurrences occurred during a median follow-up of 14.5 months. Adverse events occurred in 42.9% of patients, including 5 cases of bleeding and 1 case of mild pancreatitis, all resolved without major sequelae. Median hospital stay was 2.5 days.
Conclusions: Our findings suggest that EP offers a promising alternative to surgery in selected patients with ampullary NETs. Endoscopic resection was associated with high rates of R0 and favorable short-term outcomes, with effective endoscopic management of residual disease and procedure-related adverse events. Consistent post-procedural surveillance remains essential to detect residual or recurrent disease. Larger prospective studies are warranted to refine patient selection criteria, optimize protocols, and establish the long-term efficacy.
Immunotherapy using immune checkpoint inhibitor (ICI) has been increasingly used in the oncology treatment field. Although ICIs could help suppress cancer and improve survival rates, it could also lead to certain adverse events, including immune-mediated liver injury caused by ICIs (ILICI). The manifestation of ILICI ranged greatly from asymptomatic disease to liver failure and even death. In this review article, we will discuss the pathogenesis, manifestation, and clinical approach of ILICI.
To the Editor,
We thank Dr Vijayasimha and colleagues for their thoughtful analysis of our work and their proposal for prospective validation of the Padua × D-dimer (PaDd) score. Their roadmap provides a rigorous framework that addresses critical gaps in our single-center retrospective design. We welcome this opportunity to clarify key methodological considerations and invite the global research community to collaborate on next-generation studies.
We address the critical diagnostic challenge of IgG4-related mastitis (IgG4-RM), a rare tumor-like condition that may represent an isolated breast involvement or be the initial manifestation of systemic IgG4-related disease. IgG4-RM presents a significant diagnostic pitfall in the context of core needle biopsies (CNBs) because it frequently mimics malignancy, clinically presenting as a firm mass with skin changes or lymphadenopathy. Accurate diagnosis is often hindered by several factors: the nonspecific nature of the histopathology (fibrosis and lymphoplasmacytic infiltrate), significant overlap with inflammatory entities like Granulomatous Lobular Mastitis, limited tissue yield from CNBs, and the under-utilization of definitive IgG4 immunohistochemical staining. Furthermore, the lack of in-house IgG4 immunohistochemistry at many facilities restricts its use. Given that IgG4-RM is a medically managed condition, primarily treated with systemic corticosteroids, the underdiagnosis of this entity leads to unnecessary, costly, and morbid surgical excisions. We advocate for pathologists to maintain a high index of suspicion and routinely employ supplementary IgG4 staining in suspicious CNB cases to ensure correct non-surgical patient management.
