Faculty Bibliography

BackgroundPeople with subjective cognitive decline (SCD) are at increased risk of Alzheimer's disease. Prior research has suggested that amygdala volume may be more sensitive than hippocampal volume in detecting differences between SCD and age-matched controls, as well as in predicting SCD conversion to mild cognitive impairment. However, the microstructure underlying this volumetric change remains unclear.ObjectiveThis study evaluated amygdala microstructural differences in SCD versus control participants as well as associations between amygdala microstructure and volume, age, memory performance, anxiety, and depression using diffusion imaging.MethodsDiffusion tensor imaging, diffusion kurtosis imaging, and neurite orientation dispersion and density imaging were fit to diffusion MRI images. Group differences and correlations between diffusion metrics, age, memory, anxiety, and depression were assessed in 123 SCD versus 194 age-matched controls over age 55.ResultsIn the left amygdala, SCD participants had significantly lower fractional anisotropy (FA), lower kurtosis fractional anisotropy (KFA), and higher free water fraction (FWF). KFA was lower in the right amygdala in SCD. There were no significant group differences in the amygdala volume. Bilateral KFA negatively correlated with FWF, a marker of neuroinflammation and neurodegeneration. Left FA negatively correlated with orientation dispersion index, a marker of neuritic branching. Right KFA correlated with age only in SCD, while left FA correlated with anxiety only in controls.ConclusionsKFA is sensitive to group differences between SCD and controls in bilateral amygdala. KFA may reflect neuroinflammation and increased sensitivity to aging in the amygdala in SCD.

BACKGROUND/UNASSIGNED:Nontuberculous mycobacteria pulmonary disease (NTM PD) has been increasing in the United States, and New York City is an important hotspot, with a high burden of disease. RESEARCH QUESTION/UNASSIGNED:We assessed how neighborhood-level risk factors influenced NTM PD prevalence in New York City. STUDY DESIGN AND METHODS/UNASSIGNED:We used outpatient claims data from hospitals participating in the Patient-Centered Outcomes Research Institute network, compiled by the INSIGHT Clinical Research Network at Weill Cornell Medicine. NTM PD period prevalence (referred to here as 'prevalence') was estimated by New York City neighborhood for the study period 2012 through 2022. A case was defined as someone with at least one claim for NTM PD. De-identified NTM PD case data and demographic data were analyzed by neighborhood of residence at diagnosis. Using prevalence estimates, we detected high- and low-prevalence regions within New York City and associated these estimates with demographic, clinical, socioeconomic, and environmental neighborhood-level factors using Poisson regression and backward elimination of covariates. RESULTS/UNASSIGNED:Overall, 6,169 NTM PD cases were identified among persons receiving care across 17 private New York City hospitals. The mean age was 67.5 years, 68.7% were female, and 57.3% were White. Over the study period, NTM PD prevalence increased throughout New York City, and median year built of housing units, median income, and median age of residents were significant neighborhood-level risk factors. The highest prevalence neighborhoods were in Manhattan, while the lowest prevalence neighborhoods were in Brooklyn and Staten Island. INTERPRETATION/UNASSIGNED:Our findings indicate that neighborhood-level access to care may explain the heterogeneity in NTM PD prevalence among New York City neighborhoods, as higher income, newer neighborhoods exhibited the highest NTM PD prevalences. Future studies should examine the extent of undetected NTM PD in New York City, particularly in low-income areas.

Telehealth may help maintain access to care for individuals with chronic conditions, particularly during periods of disruption. This study examined the association between telehealth use and health care utilization, continuity, and quality in primary care. We used a difference-in-differences design (2019-2021) to compare outcomes for patients attributed to practices with high versus low telehealth uptake before and after the onset of the COVID-19 pandemic across three clinical research networks. Outcomes included evaluation and management visits, preventable emergency department visits, avoidable hospitalizations, Bice-Boxerman and Usual Provider of Care continuity indices, and disease-specific quality measures. Among 383,570 Medicare fee-for-service patient-quarters with chronic conditions, telehealth use was not associated with changes in preventable emergency department visits or hospitalizations. Continuity of care, measured by the Bice-Boxerman Index, increased by 0.01 (95% CI, 0.002 to 0.017), corresponding to an 8.3% greater increase relative to the pre-period mean in high versus low telehealth practices. However, telehealth use was associated with declines in selected disease-specific quality measures, including beta-blocker use among patients with heart failure (-0.04; 95% CI, -0.08 to -0.002) and controlled blood pressure among patients with hypertension (-0.10; 95% CI, -0.14 to -0.06). These findings suggest that telehealth may support continuity of care without increasing acute care utilization, although its implications for chronic disease management quality remain uncertain.

OBJECTIVE:To report updated patient-reported (PRO) health-related quality of life (HRQOL) findings and evaluate the effect of disease progression on HRQOL using data from the final analysis of the PRIMA/ENGOT-OV26/GOG-3012 trial. METHODS:Patients were randomized 2:1 to niraparib first-line maintenance or placebo. Longitudinal HRQOL was a prespecified secondary endpoint assessed via European Organisation for Research and Treatment of Cancer QOL-Core Questionnaire (EORTC QLQ-C30) and -Ovarian Cancer module (EORTC QLQ-OV28), Functional Assessment of Cancer Therapy Ovarian Cancer Symptom Index (FOSI), and EuroQol 5-dimension 5-level questionnaire with visual analog scale (EQ-VAS). Post hoc analyses evaluated least-squares mean change from baseline or last on-treatment visit before disease progression (clinical cutoff: April 8, 2024). RESULTS:Questionnaire completion rates exceeded 89% through cycle 24 and were 80% at end of treatment. Early differences in gastrointestinal symptom scores between arms resolved over time, and no differences in overall HRQOL were observed. Disease progression reduced overall HRQOL across arms, with marked reductions in EORTC QLQ-C30 overall HRQOL, FOSI, and EQ-VAS scores that never recovered to pre-progression levels. Progression also resulted in sustained deterioration across all EORTC QLQ-C30 and QLQ-OV28 functional scales and worsening symptom scores, particularly for fatigue, dyspnea, pain, and appetite loss. Similar results were observed when patients were evaluated by homologous recombination deficiency status. CONCLUSION/CONCLUSIONS:In the final PRIMA PRO analysis, results confirmed that niraparib first-line maintenance did not negatively affect HRQOL versus placebo. Disease progression caused sustained HRQOL deterioration across arms, emphasizing the clinical importance of extending progression-free survival to preserve patient HRQOL. CLINICAL TRIAL REGISTRATION NUMBER/BACKGROUND:NCT02655016.

PURPOSE/UNASSIGNED:Vesicourethral anastomotic stenosis (VUAS) occurs after 1 to 3% of robotic-assisted radical prostatectomies (RARPs). Pelvic fascia-sparing techniques preserve more native anatomy and may reduce stenoses, but evidence is lacking. The aim of this study was to compare stenosis incidence, management, and outcomes after standard vs pelvic fascia-sparing RARP. MATERIALS AND METHODS/UNASSIGNED:We conducted a multi-institutional retrospective study of 910 standard, 409 Retzius-sparing, and 272 hood RARP during February 2012-September 2025. Standard and hood techniques used 18Fr urethral catheters, and the Retzius-sparing technique used 18Fr suprapubic catheters. The primary end point was cystoscopically confirmed VUAS requiring intervention within 12 months. Urinary continence was assessed using the validated Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP). Multivariable logistic regression assessed factors associated with VUAS. RESULTS/UNASSIGNED:= .046). CONCLUSIONS/UNASSIGNED:There were no VUAS after Retzius-sparing RARP, and Retzius-sparing vs standard approach was associated with lower odds of stenosis. Endoscopic management with structured self-catheterization achieved high success without worsening incontinence. Prospective studies are needed to validate our findings.

Bacterial keratitis (BK) is a common subtype of infectious keratitis, the most common cause of corneal blindness globally. While antibiotics are the mainstay of treatment for BK, numerous nonantibiotic treatments and adjuncts have emerged in recent years. These include, but are not limited to, collagen cross-linking, phototherapy, immunomodulators, and various forms of transplantation. The purpose of this work is to provide a comprehensive summary of the current literature, highlight promising areas of progress, and identify gaps and areas for further work in the management of BK. With rising resistance to antibiotics, this review echoes and emphasizes the call to study and establish alternative and adjunctive strategies for BK treatment.