Faculty Bibliography

While there have been great advancements in total knee arthroplasty (TKA) over the past 50 years, anterior knee pain (AKP) remains the most common concern among patients postoperatively. Despite exhausting evidence supporting no clinical difference in AKP with resurfaced vs. unresurfaced patellae in TKA, 87% of TKAs are resurfaced in the United States, compared with 2% in other countries. These large practice variations underscore a lack of consensus regarding the role of the patella and the approach to the anterior compartment of the knee in TKA. The aim of this review was to go beyond patellar resurfacing and describe the effects that surgical technique and implant design may have on AKP in current TKA.

BACKGROUND:Delayed abdominal wound healing remains a common complication following abdominally based autologous breast reconstruction. We hypothesized that the type of umbilical inset incision impacts the incidence of delayed wound healing due to differential disruption of abdominal wall vascularity, particularly in the infraumbilical region. METHODS:A retrospective review was conducted of all patients undergoing abdominally based autologous breast reconstruction at a single center between 2014 and 2021. The primary outcome was delayed abdominal wound healing, classified as major (requiring readmission or reoperation), minor (managed with outpatient care, antibiotics, or debridement), or both. Umbilical inset incision type was evaluated as a predictor using univariate and multivariate analysis. RESULTS:. The most used umbilical incision was an elliptical incision (193, 40%) followed by vertical (141, 29%), inverted-U (30, 6%), other (39, 8%), and unknown (81, 17%). Abdominal wound healing complications occurred in 63 (13%) patients. The incidence of abdominal wound healing complications was lowest with elliptical incisions (p < 0.001). In a multivariate regression model controlling for age, BMI, diabetes, smoking history, and flap weight, umbilical incision predicted abdominal wound healing complications, with inverted-U and vertical incisions conferring higher odds of abdominal wound healing complications (OR 5.9, 95% CI [1.6, 20.8] and OR 4.6, 95% CI [2.0, 11.4], p < 0.05) as compared to elliptical incisions. CONCLUSION/CONCLUSIONS:Abdominal wall vascularity likely plays a critical role in donor site healing following autologous reconstruction. In this large cohort, inverted-U and vertical umbilical inset incisions were associated with the highest rates of wound healing complications.

BACKGROUND/UNASSIGNED:Differentiated service delivery (DSD) is increasingly available for HIV treatment. DSD has been shown to improve treatment retention, but DSD modalities incur higher costs than the clinic-based standard-of-care (SoC). We conducted a cost-effectiveness (CE) analysis to assess what DSD modalities, in what settings, would constitute an efficient use of limited HIV program resources. METHODS/UNASSIGNED:) to project HIV trends (incidence, prevalence, mortality), disability-adjusted life years (DALYs), and costs (2021 USD) arising from DSD versus SoC over 2022-2062 in four settings: South Africa, Malawi, Zambia, and a collective representation of African low- and middle-income countries (LMICs). We compared three DSD modalities: healthcare worker-managed community adherence groups (CAG), client-managed urban adherence group (UAG), and home ART delivery (HomeART). We calculated incremental cost-effectiveness ratios (ICERs) of DSD versus SoC from the health system perspective using country-specific CE thresholds, and performed one-way sensitivity analyses for key assumptions. RESULTS/UNASSIGNED:Community adherence groups (ICER: $274-$604/DALY averted) and UAG (ICER: $590-$720/DALY averted) were cost-effective for all country/model settings. HomeART was dominated by UAG in all settings. In nearly all settings, CE estimates of CAG were robust to uncertainty in DSD effectiveness (except Zambia), DSD costs, CE threshold (except South Africa), HIV-associated disability weights, and discount rates. Cost-effectiveness of UAG was highly sensitive to uncertainty in DSD effectiveness in all settings. CONCLUSIONS/UNASSIGNED:Community adherence groups and UAG can provide cost-effective alternatives to the clinic-based SoC in multiple African settings.

Salvage chemotherapy and autologous stem cell transplantation (ASCT) offer the opportunity to cure eligible patients with relapsed diffuse large B-cell lymphoma (DLBCL). Epigenetic alterations such as aberrant DNA methylation patterns have been linked to chemotherapy resistance in DLBCL. Oral Azacitadine (AZA) is a hypomethylating agent that inhibits DNA methyltransferase and has provided evidence of chemotherapy sensitization in DLBCL. In this phase I trial the safety and feasibility of two dose levels of AZA were investigated in combination with standard cytotoxic chemotherapy rituximab, ifosfamide, carboplatin, and etoposide (R-ICE) in relapsed DLBCL patients who were candidates for ASCT.

Occupational exposure to commercial cooking emissions has not been comprehensively studied, particularly in a Western context. This investigation measured the concentration and composition of volatile organic compounds (VOCs), polycyclic aromatic hydrocarbons (PAHs), particulate matter (PM), carbon monoxide (CO), and black carbon (BC) in 18 New York City restaurants. Eight-hour gravimetric PM_1,2.5,10 mass concentrations were measured in kitchen and dining areas, and PM₁ was speciated using X-ray fluorescence. Evacuated canisters and XAD-2 sorbent tubes collected VOCs and PAHs, respectively, and were speciated using gas chromatography/mass spectrometry (GC/MS). Lastly, spatial concentration gradients for PM_2.5 and day-of-the-week effects were considered in eight additional restaurants. A median PM_2.5 concentration of 79.6 μg/m³ was found in kitchens, with real-time values spiking into the thousands of micrograms per cubic meter in some restaurants─values below the Occupational Safety and Health Administration 8 h permissible exposure limit of 5 mg/m³ for particles not otherwise regulated (respirable fraction), but well above the 24 h World Health Organization recommended ambient exposure limit of 15 μg/m³ for 2021. Benzene, a known carcinogen, was frequently detected in the kitchen areas, while PAHs were often undetected. These data warrant further investigation into the cardiopulmonary health of restaurant workers.

Recurrent patellar instability is a complex condition influenced by both soft tissue insufficiency and a spectrum of bony abnormalities. Although medial patellofemoral ligament reconstruction is the cornerstone of treatment, it may not address all contributing factors-particularly in patients with malalignment, trochlear dysplasia, or abnormal patellar height. This study explores the indications, techniques, and outcomes of adjunctive bony procedures including tibial tubercle osteotomy, trochleoplasty, and derotational distal femoral osteotomies. Ultimately, the goal is to integrate soft tissue and bony procedures in a patient-specific manner to reduce recurrence and preserve long-term joint function. This synthesis aims to offer an up-to-date framework for approaching a challenging condition with growing treatment complexity.

BACKGROUND/UNASSIGNED:The practice of living donor kidney transplantation has evolved through innovations in logistics, technology, and clinical practice. In the United States, Good Samaritan donation, a historical label exclusive to nondirected donors, now incorporates voucher-based models. METHODS/UNASSIGNED:To determine how voucher-based nondirected living kidney donation has influenced the volume and practice of Good Samaritan living kidney donation in the United States, we analyzed living donor kidney transplants from 2000 to 2024 using data from the National Kidney Registry (103 transplant centers) and the Scientific Registry of Transplant Recipients. Temporal trends were derived by linear regression. RESULTS/UNASSIGNED:We identified 4662 Good Samaritan living donor kidney transplants, defined as historical nondirected and novel voucher-based nondirected donations. Of 2131 Good Samaritan living donor kidney transplants facilitated by the National Kidney Registry, donors had a median age of 43 y, were predominantly of White race (93%), and were women (60%). Recipients had a median age of 52 y and were racially and ethnically diverse (63% White, 14% Black, and 10% Hispanic). Annual Good Samaritan donation counts in the United States increased from 17 in 2000 to 439 in 2024, corresponding to a growth rate of 14.5%. Voucher-based nondirected donations increased from 2 in 2015 to 314 in 2024, comprising 72% of all Good Samaritan donations in that year. CONCLUSIONS/UNASSIGNED:The advent of voucher-based nondirected donation correlated with growth in Good Samaritan donation volume. Given the prevalence of voucher-based donations, connecting local kidney paired donation practices to voucher-based nondirected donation may improve access to and participation in living kidney donation.