Faculty Bibliography

INTRODUCTION/BACKGROUND:In recent years, there has been growing concern over the wellbeing and mental health of medical students in the United States, driven by the academic, personal, and professional challenges inherent in medical school. Recent data indicates that medical students experience higher rates of psychological stress, anxiety, and depression compared to the general population, with the COVID-19 pandemic exacerbating these challenges. Medical student suicide, linked to burnout and depression, highlights the urgent need for effective wellbeing support. Despite the documented barriers to mental wellbeing, such as self-imposed pressures, imposter syndrome, stigma around help-seeking, and financial difficulties, medical student wellbeing programs remain understudied at the structural and design level. METHODS:This is a multi‑phase qualitative study (sequential-exploratory) that combines a web-based environmental scan and content analysis with key informant interviews and focus groups, using methodological triangulation to develop a framework for evaluating wellbeing programs. First, we will conduct a web-based content analysis of publicly available resources across medical school websites. We will identify key characteristics of wellbeing programs, such as mental health resources, structural well-being components, and culturally integrated approaches. Then, we will conduct key informant interviews with medical school administrative staff to discuss wellbeing programs in detail and hold focus group interviews with medical students to gather their perspectives on how to improve their health and wellbeing. Based on the findings from these three components, we will develop a comprehensive and standardized framework for evaluating medical school wellbeing programs that can be used across institutions. ETHICS AND DISSEMINATION/BACKGROUND:Human Research Ethics Approval was obtained from the NYU Langone Health Institutional Review Board (IRB ID: i25-00965). The content analysis results and qualitative themes extracted from key informant and focus group interviews will be made available to all study participants. They will also be disseminated in a peer-reviewed journal.

BACKGROUND:Apical aneurysms in hypertrophic cardiomyopathy (HCM) have been linked to sudden cardiac death (SCD) and a nidus for thromboembolism. Uncertainty remains regarding the level of risk and significance of aneurysm size. OBJECTIVES/OBJECTIVE:The objective of the study was to determine the rate of SCD events and prevalence of apical thrombus or embolic events by size (maximum transverse dimension). METHODS:Apical aneurysms were identified in 510 patients from 10 centers, followed a median of 4.1 years for SCD events (SCD, appropriate implantable cardioverter defibrillator therapy, and resuscitated SCD) or development of apical thrombus/thromboembolism. Relationship between size and SCD events was analyzed using multivariable Cox proportional hazard models. RESULTS:In 510 HCM patients: 19% had small aneurysms (<10 mm), 39% medium (10-19 mm), 39% large (20-39 mm), and 3% very large (≥40 mm). SCD event rate was 2.1%/year, with risk increasing with increasing aneurysm size: 0.2%/year in small, 2.3%/year in medium, 3.0%/year in large and 8.2%/year in very large (P < 0.001). On multivariable analysis, greater size was associated with SCD events, independent of other risk markers or European Society of Cardiology-SCD score. Either an embolic event (3.6% of patients) or apical thrombus (10% of patients) occurred in 13% of patients and was independently associated with greater aneurysm size, 3% in small to 25% in very large aneurysms (P < 0.001). CONCLUSIONS:In a large cohort of HCM patients with apical aneurysms, rates of SCD events were high, with continuous relationship between size and risk. Small aneurysms (<10 mm) were associated with low risk for SCD events (0.2%/year), whereas aneurysms ≥10 mm with high risk (>2%/year). Although embolic events were uncommon, increasing aneurysm size was associated with the prevalence of apical thrombi.

PURPOSE/OBJECTIVE:To report perioperative and short-term outcomes of single-port (SP) robotic vascular-preserving (non-transecting) Y-V flap pyeloplasty with stricturoplasty for ureteropelvic junction obstruction (UPJO). The most commonly performed pyeloplasty technique is the dismembered Anderson-Hynes technique; however, transection of the ureter compromises its blood supply and makes revision surgery more complex. Non-transecting pyeloplasty preserves the longitudinal ureteral blood supply and serves as an alternative to transecting techniques. METHODS:All patients who underwent SP robotic-assisted non-transecting Y-V flap pyeloplasty with stricturoplasty for primary UPJO between December 2020 and December 2024 were retrospectively reviewed. Surgical success was defined as the absence of secondary intervention (endoscopic or surgical), resolution or improvement of symptoms, and stable or improved postoperative imaging findings. RESULTS:A total of 21 cases met the inclusion criteria. Median operative time was 109 min. Median follow-up was 73 weeks. Overall surgical success was achieved in 95% of patients. There were no intraoperative complications, and the median estimated blood loss was 15 mL. Most patients were discharged the same day (18/21, 86%), with no Clavien-Dindo grade ≥ III complications. Postoperative renal scintigraphy was obtained in 8 patients, all of whom demonstrated improved drainage (T½ <20 min). The remaining patients were followed with clinical assessment and postoperative imaging. One patient developed recurrent obstruction after stent removal and was successfully managed with secondary endopyelotomy. CONCLUSIONS:SP robotic non-transecting Y-V flap pyeloplasty with stricturoplasty appears feasible and safe in selected patients with primary UPJO, with favorable short-term outcomes in this single-surgeon retrospective series. Further study with standardized functional follow-up is needed to define durability and appropriate patient selection.

BACKGROUND:Studies have shown that use of immunomodulators during the acute phase of SARS-CoV-2 infection may decrease development of post-acute sequelae of SARS-CoV-2 (PASC) or long COVID; however, such studies have not been conducted in children. OBJECTIVE:Evaluate the effectiveness of steroid use during the acute phase of SARS-CoV-2 infection in preventing long COVID in children. METHODS:We conducted a retrospective cohort study using target trial emulation methodology to compare children and youth who did and did not receive dexamethasone, prednisone, prednisolone or methylprednisolone within 12 days of SARS-CoV-2 infection. Inverse propensity of treatment weighting was used to balance covariates between treated and untreated patients in hospitalized and outpatient groups. The primary outcome was the development of PASC in the 1-6 months following acute infection using a computable phenotype definition. Secondary outcomes included respiratory, musculoskeletal, gastrointestinal and neurological subphenotypes and the PASC ICD-10-CM diagnosis code. We calculated hazard ratios from Cox proportional models with 95% confidence intervals. RESULTS:From a starting cohort of 854,128 children/youth, of whom 768,845 (90.0%) were outpatients and 85,283 (10.0%) were inpatients at the time of SARS-CoV-2 infection, the weighted outpatient cohort included 22,085 steroid-treated children and 20,373 in the non-steroid group. Following weighting, the hospitalized cohort included 11,250 steroid-treated children and 10,340 untreated children. In hospitalized patients, there were no significant treatment differences in the development of PASC in the 1-6 months following acute SARS-CoV-2 infection except for a lower risk of gastrointestinal PASC in treated patients (HR: 0.58; [95% CI: 0.39-0.85], p = 0.01). In outpatients, no treatment differences were observed in the development of PASC subphenotypes. CONCLUSIONS:Steroids administered during acute SARS-CoV-2 infection did not lead to a decreased risk of PASC, with the exception of gastrointestinal presentations. Additional studies are needed to confirm the benefit of steroids and other immunomodulators in preventing long COVID.

BACKGROUND:Cardiac dysfunction is more common in people with HIV (PWH) than those without HIV (PWoH), with mitochondrial dysfunction implicated in pathogenesis. We investigated whether variations in mitochondrial DNA (mtDNA) and certain dideoxynucleoside analogs (D-drugs) relate to left ventricular diastolic dysfunction (LVDD) in PWH. METHODS:We included individuals with echocardiograms from the Multicenter AIDS Cohort Study and Women's Interagency HIV Study. LVDD was defined using characterizing heart function on antiretroviral therapy criteria. mtDNA haplogroups were inferred using HaploGrep. Separate exploratory multivariable logistic regressions examined associations between LVDD and African (L0L1, L2, L3, or "other") or European haplogroups (UK, H, JT, or "other"), D-drugs, and their interactions. No adjustments were made for multiple comparisons. RESULTS:Among 842 men (455 PWH and 387 PWoH) and 898 women (620 PWH and 278 PWoH), LVDD prevalence was 29% in women and 24% in men. Among non-Hispanic White men with HIV, European haplogroup H was associated with lower odds of LVDD (odds ratio [OR], 0.50; 95% CI, 0.26-0.93), while haplogroup clade JT was associated with increased odds (OR, 2.09; 95% CI, 1.00-4.36). In men with HIV, D-drug exposure was associated with increased odds of LVDD (OR, 1.94; 95% CI, 1.21-3.13). No significant associations were observed between haplogroups and LVDD in women. HIV serostatus modified the association of haplogroup L2 (pinteraction = 0.036) and L3 (pinteraction = 0.045) with LVDD in women. CONCLUSIONS:Mitochondrial genetic variation and D-drug use were associated with altered LVDD risk in men with HIV, highlighting potential biological mechanisms that may be targeted for surveillance or therapeutic strategies.

AIMS/OBJECTIVE:We aimed to develop a multistage schema to stratify diabetes risk using continuous plasma glucose (PG) values (fasting and 1 h) in combination with clinical variables. METHODS:In 962 Brazilian adults, we initially estimated the probability of developing diabetes with the Finnish Diabetes Risk Score (FINDRISC). We then stratified participants with a FINDRISC score of 9 or higher into three progressive high-risk stages based on their probability of developing diabetes. We evaluated the schemás ability to predict the incidence of diabetes using robust Poisson regression with a time offset, employing bootstrap resampling for internal validation. RESULTS:to scores produced little change. CONCLUSIONS:A staging schema based on scores derived from continuous FPG and 1 h PG values along with clinical variables, applied after a FINDRISC screening, offers a nuanced and practical approach to identifying individuals for diabetes prevention.

BACKGROUND:Chronic kidney disease (CKD) is associated with cardiovascular disease (CVD). Exceptional parental longevity protects against CVD. We examined whether exceptional parental longevity modified the associations of kidney function and kidney aging with CVD in older adults. METHODS:We used data from LonGenity (2008-2023), a cohort of Ashkenazi Jewish adults aged 65-95, comparing the offspring of parents with exceptional longevity to the offspring of parents with usual survival. Exceptional longevity was defined as living beyond 95 years. Kidney function was estimated using glomerular filtration rate (eGFR); CKD was defined as eGFR < 60 mL/min/1.73m2. Kidney aging was assessed using kidney age gap-the difference between proteomic kidney age and chronological age. Logistic and Cox regression tested associations between eGFR and kidney aging with prevalent and incident CVD, respectively. Effect modification was tested using interaction terms and stratified analyses. RESULTS:Among 1180 participants (mean age 76 ± 7 years), 23% had CKD; median kidney age gap was -0.04 years (IQR: -0.67, 0.66); 15% had baseline CVD. eGFR and kidney aging were associated with prevalent CVD, but not incident CVD. Exceptional parental longevity did not modify the association of eGFR with prevalent or incident CVD. However, it did modify the association of kidney age gap with incident, but not prevalent, CVD. In the offspring of parents with exceptional longevity, higher kidney age gap was associated with increased incident CVD hazard (HR: 1.90; 95% CI: 1.23, 2.94), but not in the offspring of parents with usual survival (HR: 0.79 95% CI: 0.59, 1.05). CONCLUSIONS:Kidney age gap may reflect early CVD risk in biologically resilient populations, thus warranting prospective studies.

We present MelOD (Melanoma Omics Dashboard), a free, web-based interactive platform integrating preprocessed data from 16 melanoma studies, including eight bulk transcriptomics, six single-cell RNA-seq, and two proteomics datasets. MelOD provides user-friendly visualization and analysis tools, differential expression, dimensionality reduction, clustering, correlation, and survival analysis without requiring local computational resources. Several datasets include annotations for immunotherapy response, facilitating exploration of resistance and response signatures. Built on RShiny with optimized handling of large datasets, MelOD supports real-time hypothesis generation, cross-study validation, and community dataset contributions. Freely accessible online, MelOD lowers barriers to multi-omics research in melanoma and related fields.

INTRODUCTION/UNASSIGNED:Chronic hepatitis B infection affects an estimated 258 million people globally. Mother-to-child transmission (MTCT) accounts for over one-third of new cases in endemic regions and almost invariably results in lifelong infection if acquired at birth. Over the past four decades, universal vaccination, hepatitis B immunoglobulin (HBIG), and maternal antiviral prophylaxis have substantially reduced MTCT. However, limited access to antiviral therapy and HBIG in resource-constrained settings continues to hinder elimination efforts. AREAS COVERED/UNASSIGNED:This review focuses on HBV in pregnancy and breastfeeding, with emphasis on maternal antiviral prophylaxis. It outlines epidemiology, maternal risk factors, and the limitations of vaccination and HBIG. Evidence supporting tenofovir disoproxil fumarate (TDF) and tenofovir alafenamide (TAF) is evaluated, alongside HBIG-free strategies and novel vaccine delivery platforms. Postpartum management, including hepatitis flares and the safety of breastfeeding during antiviral therapy, is also addressed. EXPERT OPINION/UNASSIGNED:Maternal antiviral prophylaxis with TDF, and increasingly TAF, is central to preventing mother-to-child transmission of hepatitis B. HBIG-free strategies, earlier treatment initiation, and improved vaccines may further reduce transmission, particularly in resource-limited settings. Achieving WHO 2030 elimination goals will require policy commitment, affordable access, and integration of HBV prevention into routine maternal - child health care.

PURPOSE/OBJECTIVE:Emotion Dysregulation (ED) in children with ASD are linked to behavioral challenges, such as aggression, self-injurious behaviors, and anxiety. Parenting stress, often elevated in families of autistic children, also significantly influences child behavioral outcomes. However, little is known about the dynamics among parenting stress, child ED, and behavioral problems in ASD, especially during the early developmental period. The primary aim of the study was to examine the mediating role of child ED in the association between parenting stress and future child behavioral outcomes in toddlers/preschoolers with ASD. METHODS:The sample included 51 autistic young children aged 18-53 months and their caregivers. Parenting stress (PSI-SF), child ED (BRIEF-ECI), and behavioral problems (CBCL) were assessed, with 30 participants completing a 12-month follow-up. Analyses were conducted starting with Pearson correlations, followed by mediation analyses using the PROCESS macro to examine the mediating role of ED. RESULTS:Higher parenting stress was correlated with more severe ED and increased behavioral challenges in children. Mediation analyses revealed that child ED fully mediated the relation between parenting stress and child behavioral challenges. A significant mediation effect of child ED was found on the association between PSI-SF Parental Distress subdomain and child internalizing behaviors. CONCLUSIONS:Child ED may play a key role mediating the association between parenting stress and child internalizing behavioral problems in autistic toddlers/preschoolers. Interventions targeting both parental well-being and child ED development could improve behavioral outcomes.