Faculty Bibliography

PURPOSE/OBJECTIVE:Obesity is increasingly encountered among patients requiring extracorporeal membrane oxygenation (ECMO) for severe respiratory or cardiac failure. It alters respiratory and cardiovascular physiology and drug pharmacokinetics and introduces technical and logistical challenges that may complicate patient selection, ECMO initiation, cannulation, anticoagulation, and monitoring. This review summarizes current evidence regarding the epidemiology, physiological implications, outcomes, and management of obesity in patients supported with veno-venous (VV) or veno-arterial (VA) ECMO. RESULTS:Available evidence, largely retrospective and based on body mass index classifications, suggests that obesity should not be considered a contraindication to VV-ECMO, with outcomes comparable to or potentially better than those of patients without obesity. However, obesity-related respiratory mechanics may exaggerate the apparent severity of lung injury, emphasizing the need for optimized conventional ARDS management, including appropriate ventilatory strategies and prone positioning, before ECMO initiation. In contrast, outcomes during VA-ECMO are more heterogeneous, particularly in extracorporeal cardiopulmonary resuscitation (ECPR), and may be influenced by patient selection, comorbidities, and timing of support. Obesity also creates important technical challenges requiring individualized cannulation, anticoagulation, and perfusion strategies. CONCLUSION/CONCLUSIONS:Obesity alone should not preclude access to ECMO, particularly VV-ECMO. Successful management requires anticipation of obesity-related challenges, appropriate infrastructure, and structured multidisciplinary protocols. Further prospective studies are needed to clarify obesity-specific risks, optimize management strategies, and evaluate long-term outcomes.

MRI is central to evaluation of the post-operative knee, providing a comprehensive assessment of reconstructions, repairs, and cartilage restoration procedures. Accurate interpretation requires familiarity with operative techniques, graft biology, and the expected temporal evolution of post-operative imaging findings. This review presents a practical, imaging-based approach to contemporary knee surgery. Emphasis is placed on anterior cruciate ligament reconstruction, the renewed interest in primary repair, and common mechanisms of failure. Meniscal surgery, including repair, root repair, centralization, and transplantation, is discussed with attention to expected post-operative MRI appearances and findings suggestive of recurrent or failed repair. Finally, cartilage resurfacing and restoration techniques are reviewed using a systematic framework to assess graft infill, integration, surface congruity, and subchondral bone response. By integrating surgical context with time-dependent MRI findings, this review aims to provide radiologists with a practical framework to distinguish expected post-operative changes from complications, improving diagnostic confidence and clinical relevance of post-operative knee MRI interpretation.

BACKGROUND/UNASSIGNED:Aspirin-exacerbated respiratory disease (AERD) is a distinct asthma endotype marked by asthma, nasal polyposis, and respiratory reactions to COX-1 inhibitors. Early and accurate identification of AERD remains clinically challenging. OBJECTIVE/UNASSIGNED:We sought to develop and externally validate an artificial intelligence (AI)-based diagnostic model that uses nasal epithelial mRNA expression profiles to accurately identify AERD. METHODS/UNASSIGNED:cohort. RESULTS/UNASSIGNED:(Charcot-Leyden crystal protein), which are known to be important to AERD pathogenesis. CONCLUSIONS/UNASSIGNED:Nasal transcriptomics can predict AERD diagnosis accurately and may improve disease understanding, enabling earlier and more precise endotype-based diagnosis and management.

BACKGROUND:People with multiple sclerosis (PwMS) frequently experience invisible symptoms, including cognitive impairment, fatigue, depression, anxiety, and psychosocial factors such as stigma, which can substantially affect social role participation (SRP). These factors are often under-recognized in clinical care despite their functional impact. OBJECTIVE:To examine the unique contributions of invisible MS-related symptoms to SRP after accounting for demographic characteristics and objective cognitive performance. METHODS:A cross-sectional sample of 434 PwMS was recruited from a large outpatient neurology clinic specializing in MS care. The sample was predominantly female (75%), largely white (85%), and middle-aged (M = 51.0, SD = 11.7), with mild-to-moderate disability. Participants completed a computerized cognitive battery and validated patient-reported outcome measures assessing disease impact, mood, fatigue, stigma, and SRP. Hierarchical regression models evaluated the variance explained by demographics, cognitive performance, and patient-reported symptoms. RESULTS:Demographic variables were not significant predictors of SRP. Cognitive performance accounted for 13.3% of the variance. Adding patient-reported outcomes increased explained variance to 70.6%. Depression, disease impact, fatigue, and executive functioning remained significant predictors, whereas stigma did not. CONCLUSIONS:Patient-reported symptom burden showed strong associations with SRP and explained more variance than demographic factors and most cognitive measures, while executive functioning also contributed independently.

BACKGROUND/UNASSIGNED:Predominantly Dorsal Thoracic Spinal Arachnoid Webs (DAW/SAW: 90%-100%), attributed to arachnoidal scarring obstructing cerebrospinal fluid (CSF) dynamics, typically cause dorsal cord compression. Their multiple etiologies include; trauma, idiopathic/post-surgical, inflammatory/infection, subarachnoid hemorrhage, and/or congenital defects. METHODS/UNASSIGNED:Patients with DAW/SAW are typically in their early/mid-fifties, and present with; back pain (i.e., 41.2%-88.9%), motor deficits (i.e. 59%-77.8%), sensory loss (i.e., numbness 65%-66.7%), and/or sphincter dysfunction (i.e., 33.3%). RESULTS/UNASSIGNED:MR and Myelo-CT studies for DAW/SAW classically demonstrate the positive scalpel sign (i.e., single or multilevel dorsally compressive "fluid" collections often containing multiple loculations/fenestrations usually accompanied by Syrinxes (i.e., 44 - 83%), and/or Spinal Arachnoid Cyst (SAC) formation. Conservative treatment is rarely effective. Alternatively, surgery consisting of laminectomy/decompression, resection/ lysis, marsupialization and/or fenestration of loculated collections including attendant SAC resections, and decompression/shunting of Syrinxes, results in postoperative improvement in up to 91% of patients. CONCLUSION/UNASSIGNED:Patients with DAW/SAW typically present with MR/Myelo-CT studies that demonstrate the dorsal thoracic positive scalpel sign in conjunction with Syrinxes, and/or SAC. Surgery typically includes laminectomy/ decompression, lysis/resection of arachnoidal adhesions with marsupialization/fenestration, and/or shunting, to achieve up to a 91% incidence of postoperative neurological improvement.

BACKGROUND:Robotic-assisted total joint arthroplasty (RTJA) is increasingly used to improve patient outcomes and reduce revision rates in total joint arthroplasty (TJA). With robotic-assisted total knee arthroplasty (RTKA) projected to exceed 70% of cases by 2030, concern exists about whether orthopaedic residents are being adequately trained. METHODS:Orthopaedic arthroplasty fellows between 2023 and 2025 completed an anonymous electronic survey assessing exposure to RTJA and conventional TJA (CTJA), impact on fellowship selection, and projected future use. Incomplete responses and non-fellows were excluded. RESULTS:Of 60 respondents, 78% were exposed to RTKA, 52% to robotic-assisted unicompartmental knee arthroplasty (RUKA), and 48% to robotic-assisted total hip arthroplasty (RTHA). Satisfaction with training was higher for conventional procedures: 82 versus 53% (TKA), 97 versus 32% (THA), and 23 versus 31% (UKA). Most felt comfortable performing conventional TKA (CTKA) and THA (CTHA) independently; among robotic procedures, only RTKA had similar comfort levels. Fellowship selection was influenced by a desire for balanced robotic and manual experience (66.7%). While 42% did not believe robotics should be required in residency, most agreed it improved understanding and performance (68% RTKA, 61% RUKA, and 75% RTHA respondents). Robotic exposure during residency was associated with higher satisfaction and preparedness (P < 0.001) and increased support for requiring training in RUKA (P = 0.015) and RTHA (P = 0.006). Regional differences in exposure and satisfaction were also observed. Fellows planning to use robotics in greater than 50% of future cases were more likely to choose robotics-focused fellowships (P = 0.003). CONCLUSION/CONCLUSIONS:Arthroplasty fellows reported high satisfaction with conventional arthroplasty training, whereas satisfaction and self-reported preparedness for robotic-assisted procedures were lower. Prior robotic exposure during residency was associated with higher satisfaction and preparedness, and fellows expressed interest in balanced robotic and manual fellowship experiences. These findings provided a baseline of current trainee perceptions.

IMPORTANCE/UNASSIGNED:Transvaginal pelvic imaging is an integral and sensitive aspect of gynecologic care that individuals find both invasive and burdensome. At-home transvaginal imaging provides an opportunity to navigate these barriers to care. OBJECTIVE/UNASSIGNED:To evaluate the use of at-home transvaginal ultrasonography for gynecologic assessment, as measured by diagnostic imaging quality and participant satisfaction, in a broad sampling of women aged 22 to 50 years. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:Prospective, interventional, single group nonrandomized clinical trial with blinded review of collected images from premenopausal women aged 22 to 50 from Florida, Massachusetts, Maryland, Maine, Minnesota, New Hampshire, Texas, Utah, Virginia, Vermont, and Washington, DC. Images were gathered between July 2022 and July 2023, and data were analyzed from April to September 2025. INTERVENTION/UNASSIGNED:At-home pelvic ultrasonography guided by verbal communication with a fully trained remote sonographer who had real-time access to study images. Cine clips were used to capture standard views of the uterus, ovaries, cervix, and posterior cul-de-sac. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Primary outcomes were image quality and participant net promoter score (NPS), reflecting participants' likelihood of recommending the procedure, with higher scores indicating greater likelihood. Secondary outcomes included minor pain or discomfort, sonographer reported experience and/or pain, and all other adverse events. RESULTS/UNASSIGNED:A total of 265 participants (mean [SD] age, 32 [6.7] years; mean [SD] body mass index, 27.0 [5.6]) enrolled in the trial, and 263 ultrasonographic scans were completed. Image quality showed that 253 at-home ultrasonographic scans (96.2%) met diagnostic quality while 10 (3.8%) did not. NPS was significantly higher with use of the at-home ultrasonography (59) compared with in-clinic scans (24), with an adjusted difference of 33.7 (95% CI, 23.3-44.0; z = 6.35; P < .001). No adverse events were reported. CONCLUSIONS AND RELEVANCE/UNASSIGNED:This nonrandomized clinical trial of at-home pelvic ultrasonography in premenopausal women demonstrated that broad use of at-home gynecologic ultrasonography technology is feasible, safe, and preferred by participants and sonographers compared with in-clinic ultrasonography. At-home ultrasonographic imaging presented an innovative and clinically acceptable alternative to in-clinic care, providing opportunities for improved access to and decreased burden of gynecologic and reproductive care. REGISTRATION/UNASSIGNED:ClinicalTrials.gov NCT05443698.