Faculty Bibliography

Therapeutic options for chronic kidney disease (CKD) have expanded substantially in recent years, creating new opportunities to reduce residual kidney and cardiovascular risk through combination therapy. Evidence from large, randomized trials and meta-analyses demonstrates that sodium-glucose co-transporter 2 (SGLT2) inhibitors, non-steroidal mineralocorticoid receptor antagonists (MRAs), and glucagon-like peptide-1 (GLP-1) receptor agonists provide independent and additive benefits, with emerging data showing that select combinations may also improve safety. A risk-based approach, anchored in albuminuria and supported by validated risk equations, can guide treatment intensity, support more timely initiation of multidrug regimens, and improve health system efficiency. Addressing implementation barriers, advancing single-pill combinations, and leveraging adaptive and combination therapy trials will be essential to translate these therapeutic advances into improved long-term outcomes for people with CKD.

BACKGROUND:Poor persistence and adherence to attention-deficit/hyperactivity disorder (ADHD) medication is a significant barrier to effective long-term care, particularly during adolescence, yet age-specific and sex-specific trajectories remain poorly characterised. OBJECTIVE:To characterise medication initiation, discontinuation and long-term adherence patterns for children and adolescents diagnosed with ADHD in a real-world setting. METHODS:A nationwide retrospective cohort study, including 8961 children and adolescents (aged <18 years) with a new ADHD diagnosis in child and adolescent mental health services between 1 January 2010 and 31 December 2012, with follow-up until 31 December 2021. Main outcomes were medication initiation rates; time to first medication discontinuation, analysed using Kaplan-Meier estimates and restricted mean survival time at 1 year and longitudinal adherence, measured by the proportion of days covered over 9 years. FINDINGS/RESULTS:Of the 8961 individuals in the cohort (mean age at diagnosis, 12 years; 69% male), 6661 (74.3%) initiated medication, with a median time from diagnosis to initiation of 106 days (IQR 17-231); 55% initiated within 90 days. Discontinuation increased significantly with age; adolescents aged 15-17 years remained on treatment for 31.9 fewer days (95% CI -40.8 to -23.1; p<0.001) in the first year compared with children aged 5-11 years. Females also discontinued significantly earlier than males (difference -13.2 days; 95% CI -19.8 to -6.5; p<0.001). Longitudinal analysis confirmed that older age at initiation and female sex were associated with a significantly steeper decline in medication coverage over time. CONCLUSIONS:Discontinuation and low adherence to ADHD medication were common and increased substantially through adolescence, with females at higher risk of early cessation. CLINICAL IMPLICATIONS/CONCLUSIONS:Late adolescence warrants closer clinical monitoring and shared decision-making to support appropriate treatment continuation or well-informed discontinuation, particularly for older adolescents and females. Integrating structured transition planning and attention to sex-specific barriers may help reduce avoidable non-adherence during this high-risk period.

Urolithiasis is increasingly common, with rising rates driven by obesity, diabetes and metabolic syndrome. Patients with cancer have additional, unique risks of stone formation owing to effects on fluid and electrolyte balance, systemic cancer therapies, tumour lysis syndrome and anatomical alterations after urinary diversion or nephrectomy. Moreover, urolithiasis itself has been linked to increased rates of renal cell carcinoma, urothelial carcinoma and bladder cancer, potentially mediated by chronic inflammation, recurrent infections and shared metabolic or environmental factors. Management in this setting is complex and must be individualized. Percutaneous nephrolithotomy achieves the highest stone-free rates in patients with altered urinary tract anatomy, whereas retrograde intrarenal surgery and shock wave lithotripsy have more selective roles. Preventive strategies focus on thorough metabolic evaluation, hydration optimization and addressing cancer-specific risk factors such as hypercalcaemia, acidosis and chronic urinary stasis. Despite these insights, data on the epidemiology, mechanistic underpinnings and optimal management of urolithiasis in patients with cancer remain limited. Prospective studies are needed to clarify causal relationships, refine preventive strategies and develop evidence-based treatment algorithms for this growing and complex population.

BACKGROUND:Despite prevalent gender discrimination in medical education, its influence on personal and professional development, foundational competencies in medical training per the Association of American Medical Colleges (AAMC), remains unclear. This retrospective cross-sectional study assesses how experiences of gender discrimination in medical school influence personal and professional identity formation (PPIF) among males and females. METHODS:Deidentified student-level data were procured from the AAMC data warehouse for 37,610 MD students who matriculated in 2014-2015 and took the Graduation Questionnaire (GQ) between 2016-2020. Gender discrimination frequency was categorized as 'Never', 'Isolated', and 'Recurrent' from GQ responses to questions about denial of opportunities, offensive remarks, and lower evaluations due to gender. Students self-reported their sex as male, female or declined to answer. PPIF was assessed using two separate GQ metrics assessing student agreement on a 5-point Likert scale that their medical school fostered and nurtured their development as a person and a future physician, respectively, and dichotomized. RESULTS:Female students experienced higher rates of isolated (12.6%) and recurrent (20.1%) gender discrimination than males (4.3% isolated, 6.2% recurrent). Females reported slightly lower personal (71.2%) but similar professional development (92.2%) rates compared to males (73.4% personal, 91.2% professional). Both sexes experiencing gender discrimination had lower likelihoods of PPIF than their counterparts without these experiences. If recurrent discrimination occurred, the aRR (95%CI) of professional development was 0.89 (0.87-0.90) for females and 0.78 (0.74-0.81) for males, while for personal development, it was 0.69 (0.67-0.71) for females and 0.61 (0.58-0.66) for males. Compared to females, males showed sharper declines in professional development as discrimination frequency increased from never to isolated (aRR = 0.93, 95% CI [0.92-0.94], p < 0.001) and isolated to recurrent (aRR = 0.95, 95% CI [0.93-0.97], p < 0.001). CONCLUSIONS:Gender discrimination negatively influences PPIF for both female and male medical students. Efforts to combat discrimination in medical training and promote holistic student development should be considered. Future work is needed to understand the influence of gender discrimination on the comprehensive development of gender-diverse medical students.

INTRODUCTION/BACKGROUND:Contemporary abdominal wall reconstruction places a strong emphasis on optimizing extraperitoneal mesh placement. When the posterior layer is insufficient for closure, adjuncts such as hernia sac, omentum, or Vicryl mesh have been described. The outcomes of various posterior layer supplementation (PLS) materials, both autologous and non-autologous, have not been well examined. We aim to evaluate the outcomes of patients undergoing ventral hernia repair with extraperitoneal mesh placement who undergo PLS and compare how PLS materials impact these outcomes. METHODS:All patients who underwent a retromuscular hernia (RM) repair with PLS between Jan 2021 and Jan 2025 at a single center were reviewed. Patient demographics, preoperative characteristics, intraoperative factors, and postoperative outcomes were evaluated. Descriptive statistics and comparative tests including Mann-Whitney U test, Student's t-test, and Fisher's exact test were utilized. RESULTS:Sixty-seven patients underwent RM repair with PLS. Supplement materials used included hernia sac, omentum, falciform ligament, prior mesh, new biologic, and biosynthetic coated mesh. Fifty-two percent (n = 35) of the repairs were retrorectus only and 48% (n = 32) were transversus abdominus releases. The average length of follow-up was 189 days with a recurrence rate of 3%. Sixty percent of PLS was performed with autologous material with 40% utilizing new biologic or biosynthetic coated meshes. SSI, SSO, and SSOPI were similar between the autologous and non-autologous supplementation groups (p = 1, p = 0.16, p = 0.29, respectively). There were more postoperative bowel obstructions in the non-autologous group (n = 4) as compared to the autologous group (n = 0) (p = 0.02). All the bowel obstructions were managed nonoperatively. DISCUSSION/CONCLUSIONS:Our findings suggest that outcomes are acceptable with minimal morbidity when comparing autologous tissue to biologic and biosynthetic coated mesh for PLS. The low recurrence rates observed, regardless of the material used, support the continued adoption of this approach. Proactive supplementation of the visceral sac may decrease need for lateral myofascial release.

Thirty-three panelists from 23 institutions participated in a three-round Delphi consensus process to establish interdisciplinary guidelines for reporting knee MRI findings on 11 meniscus topics: MRI criteria for tears, possible tears, tear patterns, tear descriptors, intrameniscal descriptors, meniscal roots, posteromedial meniscocapsular junction, meniscus extrusion, assessment of the postoperative meniscus, retear descriptors, and ancillary findings. All panelists completed all Delphi rounds. In round 1, 350 free-text entries (mean, 31.8 entries per topic ± 2.2 [SD]) were submitted. In round 2, 32 statements (mean, 2.9 entries per topic ± 1.6) were collected from 11 teams (one orthopedic surgeon and two musculoskeletal radiologists per team), with 75% (24 of 32 panelists) achieving consensus using a 9-point Likert scale. Consensus was defined as a score of at least 7 (≥80% of panelists) and a median score of at least 7 (IQR ≤3). In round 3, all statements achieved consensus. Between rounds 2 and 3, agreement significantly increased (P < .05) among all panelists on the topics of possible tears (to express uncertainty) and tear descriptors (for treatment planning), among orthopedic surgeons on MRI criteria for tear and the assessment of the postoperative meniscus (specifically on reporting equivocal findings and the use of MR arthrography), and among radiologists on tear patterns, intrameniscal descriptors, meniscal roots, and retear descriptors.

Underdiagnosis of cardiometabolic risk factors (CMRFs) may represent an unrecognised biological pathway contributing to dementia risk; yet remains poorly characterised in African and African diaspora populations. We quantified the prevalence and determinants of underdiagnosed hypertension and abnormal glycaemia across four cohorts comprising up to 7000 adults aged ≥40 years from Nigeria, Kenya, and The United States: Indianapolis, and North Texas. Underdiagnosis was defined as absence of self-reported diagnosis despite elevated systolic blood pressure ( ≥130 mmHg) or fasting blood glucose ( ≥100 mg/dL). Cohort-stratified analyses examined demographic, socioeconomic, cognitive, Alzheimer's genetic, and blood-based biomarker correlates. Underdiagnosis was pervasive in African cohorts. Elevated fasting glucose was associated with cognitive impairment in Kenya and North Texas, while severe hypertension and diabetes were linked to Alzheimer's disease-related biomarkers [pTau217/181, NFL and Aβ42/40] in North Texas (all p ≤ 0.05). These findings identify context-specific diagnostic gaps in populations at high dementia risk and highlight cardiometabolic detection as a mechanistic target for prevention.