Faculty Bibliography

BACKGROUND:Although medications for opioid use disorder (MOUD) improve outcomes for persons with opioid use disorder (OUD), it is unclear whether augmentation with mutual help groups (MHGs), such as 12-Step programs, enhances abstinence following jail release. This study examined how MHG and MOUD together affect abstinence in persons with problematic opioid use in the 6 months post-incarceration. METHOD/METHODS:We subset to 328 adult participants who completed baseline, 3- and 6-month follow-ups. All screened positive for problematic opioid use upon discharge from jail, primarily in Chicago. Participants reported days of MHG and MOUD participation and days abstinent from illicit opioids. Both supports could be accessed in any combination. Beta-binomial models estimated the effects of MHG and MOUD participation at 3 months on abstinent days at 3 and 6 months, adjusting for relevant baseline factors. RESULTS:At 3 months, each day of MHG participation was associated with + 0.4 days of opioid abstinence. MOUD days showed a similar effect (+0.3 abstinent days). At 6 months, 3-month MHG and MOUD days continued to predict greater abstinence to a smaller degree (+0.3 and +0.1 days, respectively). Together, MHGs were associated with greater abstinence only among individuals receiving low levels of MOUD at 3-months. No MHG×MOUD interaction was observed at 6-months. CONCLUSION/CONCLUSIONS:Our findings highlight the benefits of incorporating MHGs and MOUD to support abstinence from illicit opioids while extending prior work to a predominately Black, post-incarceration sample. Further research should examine factors influencing the combined effects of MHG and MOUD participation.

INTRODUCTION/BACKGROUND:Patellar resurfacing in primary total knee arthroplasty (TKA) has been debated for decades. This study aimed to evaluate cost-effectiveness and clinical outcomes of patellar resurfacing in modern TKA at a high-volume arthroplasty center. METHODS:A retrospective study was conducted on 4,534 patients who underwent unilateral, elective, primary TKA from 2021 to 2024 at an urban academic institute. Patients were stratified by patellar resurfacing: resurfaced (n=3,753) or not (n=781). Baseline characteristics, operative costs [implants, anesthesia, operating room time], and postoperative outcomes (revision incidence) were collected. The median follow up was 2.0 years (1.0- 4.8). The individual cost of patellar component was adjusted for implant manufacturer and cementation out of total implant cost. Multivariable regression analysis determined added operating room time (ORT) due to patellar resurfacing, controlling for body-mass index, usage of robotics, navigation and cementation. Relative costs of added ORT and the patellar component were compared to total implant and procedure costs of patellar-resurfacing operations. RESULTS:The patellar component accounted for an average of 7.9% of the total implant cost in patellar-resurfacing operations. Patellar-resurfacing operations had longer operative times (112.2 vs. 105.4 minutes, P<0.001), and multivariable regression determined patellar resurfacing is associated with an added 6.3 minutes of total ORT (P<0.001). The patellar component implant cost and the cost of added ORT due to resurfacing accounted for 4.5% of the total procedure cost in resurfaced group. Resurfaced group had an overall 5% higher total operative cost than the non-resurfaced group. No differences existed in length of stay (LOS), discharge disposition, or all-cause and patella-specific revision incidence. CONCLUSION/CONCLUSIONS:We found that patellar resurfacing was associated with longer operative times and greater implant and procedure costs, although there was no effect on LOS, discharge disposition, or all-cause and patella-specific revision incidence. Ultimately, the decision to resurface the patella in primary TKA should be based on patient-specific indications and clinical judgment. However, it is important to consider the additional cost associated with this procedure.

PURPOSE/OBJECTIVE:The purpose of this study was to report minimum 10-year survivorship, patient-reported outcomes (PROs), clinically significant outcome achievement and predictors of outcomes and failure in patients with structurally stable femoroacetabular impingement syndrome (FAIS) who underwent primary hip arthroscopy with interportal capsulotomy without capsular repair. METHODS:A retrospective review was conducted of patients undergoing primary hip arthroscopy for FAIS from 2010 to 2013 with a minimum 10-year follow-up. Exclusion criteria included hip dysplasia, Tönnis Grade >1, prior ipsilateral hip surgery and unavailable preoperative radiographs. All patients underwent interportal capsulotomy without capsular repair. Outcomes included modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), minimal clinically important difference (MCID) achievement, survivorship and predictors of PROs and failure. RESULTS:A total of 150 patients were included (62.7% female), with mean follow-up of 11.7 ± 1.1 years and mean age of 38.3 ± 12.1 years. Ten-year survivorship was 90.7%; 7 patients (4.7%) underwent total hip arthroplasty and 7 (4.7%) underwent revision arthroscopy. mHHS improved from 52.0 ± 11.7 to 87.9 ± 16.7 (p < 0.001), and NAHS improved from 49.5 ± 11.4 to 86.2 ± 18.0 (p < 0.001). Patient Acceptable Symptom State (PASS) was achieved by 76.0% of patients for mHHS and 65.3% for NAHS. Female sex and higher body mass index (BMI) were associated with worse 10-year PROs, whereas Tönnis Grade 1 (p = 0.003) and lower preoperative NAHS (p = 0.034) were associated with failure. CONCLUSION/CONCLUSIONS:Primary hip arthroscopy for structurally stable FAIS performed with interportal capsulotomy and without capsular repair demonstrated favourable 10-year outcomes, high PASS achievement and 90.7% survivorship. Clinically, these findings provide long-term benchmarking data for counselling appropriately selected patients with structurally stable hips. Higher BMI and female sex were associated with worse 10-year PROs, while Tönnis Grade 1 and lower preoperative NAHS were associated with increased failure risk, supporting their use in preoperative risk stratification and shared decision-making. LEVEL OF EVIDENCE/METHODS:Level IV, retrospective case series (single-surgeon, without comparison group).

BACKGROUND:Large-bore aspiration catheters are integral to mechanical thrombectomy (MT) for large vessel occlusions (LVOs), offering potential for improved first pass success and faster recanalization. OBJECTIVE:To assess the clinical performance, efficacy, and safety profile of the Broadway 8 system as a primary aspiration device in MT of LVOs. METHODS:This is a multicenter observational study conducted across 8 US comprehensive stroke centers. Efficacy outcomes included first pass effect (FPE), defined as a single-pass modified Treatment In Cerebral Infarction (mTICI) score ≥2c, and successful reperfusion (final mTICI ≥2b). Safety outcomes included device-related complications, symptomatic intracranial hemorrhage (sICH), and inpatient mortality. Functional outcomes included modified Rankin Scale (mRS) at discharge and delta National Institutes of Health Stroke Scale (NIHSS) score. Logistic regression was used to assess predictors of thrombus access and intermediate catheter use. RESULTS:49 patients were included. The Broadway 8 system reached the thrombus in 44 (89.8%). Median puncture-to-thrombus and puncture-to-reperfusion times were 11 min (IQR 9-18) and 20 min (14-31), respectively. FPE was achieved in 20 (40.8%). Successful reperfusion was achieved in 46/49 (93.8%), with 35 (71.4%) using Broadway 8. sICH occurred in 2 patients (4.1%). Median mRS at discharge was 3.0 (IQR 1.0-4.0); delta NIHSS was 8 (IQR 5-12). Regression analysis showed faster reperfusion when Broadway 8 was used without an intermediate catheter. CONCLUSION/CONCLUSIONS:The Broadway 8 system appears to be a safe and effective frontline aspiration device, demonstrating a safety and efficacy profile comparable to other large-bore aspiration systems that incorporate delivery-assist technology.

PURPOSE/OBJECTIVE:Neuro-oncology generates complex clinical, imaging, and molecular data, yet datasets remain relatively small and fragmented across modalities and institutions. While "big data" is traditionally defined by large sample size, neuro-oncology datasets are often characterized instead by high dimensionality. This study aims to provide an overview of the landscape of major U.S. neuro-oncology data resources and evaluate how these datasets are used in contemporary research. METHODS:A selection of neuro-oncology datasets was evaluated, including population registries, clinical data networks, federal and consortium research cohorts, institutional datasets, specialized resources, and artificial intelligence benchmarking resources. Analytical use was assessed through a large language model-assisted review of PubMed-indexed studies published over the past ten years referencing these datasets. Titles and abstracts were screened using a predefined classification schema, and structured data extraction identified study characteristics, analytical tasks, outcomes, modalities, validation strategies, and longitudinal modeling approaches. RESULTS:Of 11,651 screened publications, 3,608 met inclusion criteria. Analytical use was concentrated in a small number of datasets, particularly TCGA (~ 65%), SEER (~ 14%), and BraTS (~ 13%). Most studies modeled survival or tumor characteristics, whereas fewer than 1% examined functional or quality-of-life outcomes. Approximately 90% relied on a single dataset, and external validation and longitudinal modeling were rare. CONCLUSION/CONCLUSIONS:Big data in neuro-oncology is characterized by rich diversity. Expanding multimodal data capture, improving coverage of underrepresented populations and tumor types, strengthening longitudinal data collection, and enabling cross-dataset integration will be essential for translating high-dimensional datasets into clinically actionable insights.

OBJECTIVE:Patients with stage IV non-small cell lung cancer (NSCLC) often present with substantial symptom burden that impairs quality of life and tolerance of systemic therapy. Quad Shot (QS), a cyclical hypofractionated radiotherapy (RT) regimen, could provide effective symptom palliation while allowing concurrent systemic therapy. We evaluated the safety, feasibility, and patient-reported outcomes (PROs) of delivering up to three cycles of QS concurrently with systemic therapy. METHODS:This prospective phase I dose-escalation trial enrolled patients with stage IV NSCLC from June 2020 to February 2024. Allowable systemic therapy included immunotherapy alone, immunotherapy plus chemotherapy, or chemotherapy alone at the treating medical oncologist's discretion. Each QS cycle consisted of 14.8 Gy in 4 fractions delivered twice daily over 2 consecutive days within 1 week of systemic therapy. The primary endpoint was to determine the maximum tolerated number of QS cycles (MTD) using a modified 3+3 design, defined as a dose-limiting toxicity (DLT) rate ≤17% (1 of 6 patients). Secondary endpoints included feasibility, systemic therapy disruptions, RT-related toxicities, and PROs. RESULTS:Forty-five patients were enrolled in this study. One DLT occurred in the two-cycle cohort, and none occurred with three cycles, establishing three cycles as the MTD. In the expansion cohort, three patients developed grade 3 RT-related toxicities. All systemic therapies were administered without any interruptions. Among symptomatic patients, PROs demonstrated improvement in dyspnea (67%), cough (62%), and hemoptysis (100%). CONCLUSIONS:Three cycles of QS were associated with limited high-grade toxicities, no disruption of systemic therapy, and high rates of patient-reported symptom improvement, supporting its use as a palliative option within multidisciplinary care for advanced NSCLC.

BACKGROUND:Agitation is a common clinical presentation associated with up to 2.6% of emergency department (ED) visits per year. The science of identifying, predicting, and managing agitation has rapidly progressed over the past decade, leading to broad recommendations about initial approaches and management strategies. OBJECTIVE:The purpose of this clinical review is to review existing literature on the etiology, recognition, and management of agitation to help clinicians and staff who care for these patients. METHODS:A narrative review was performed of articles published from 1984 to 2026. DISCUSSION/CONCLUSIONS:Standardized approaches to agitation management are discussed, highlighting both existing literature and research gaps. There is broad agreement on 5 main objectives of the approach to the agitated patient in the ED: address safety issues for the patient and ED staff, an expedited clinical assessment, identifying a presumptive etiology of agitation in order to guide treatment, verbal de-escalation as an initial management strategy, and judicious medication administration. CONCLUSIONS:This review shows that practices like verbal de-escalation, therapeutically-indicated medication administration, and multidisciplinary teamwork are imperative to improving care and reducing mistrust, longer hospital stays, use of restraints, and physical assaults on ED staff and ultimately, workplace violence. In particular, verbal de-escalation should be a first-line treatment. There is agreement that the etiology of agitation should guide management, but less agreement on particular drug combinations if medication is needed. Recommendations are given but further research is necessary.

Pancreatic ductal adenocarcinoma (PDAC) is a devastating cancer with increasing incidence and a dismal prognosis. Here, we uncover serine protease inhibitor Kazal type 1 (SPINK1) as a putative determinant of PDAC progression with a previously unrecognized role in epigenomic regulation. We show that SPINK1 expression, which is highly dynamic across PDAC progression, is associated with key aggressive cancer phenotypic states and regulates cancer cell stemness and plasticity in both in vitro and patient samples. Mechanistically, our results suggest a new signaling axis where SPINK1 interacts with COL18A1 to promote its cleavage into endostatin, which then induces histone H3 modifications. These results reveal a new function of SPINK1 in PDAC and highlight the SPINK1-COL18A1-endostatin signaling axis as a potential therapeutic target to combat PDAC aggressiveness.

Longitudinal causal inference is concerned with defining, identifying, and estimating the effect of a time-varying intervention on a time-varying outcome that is indexed by a follow-up time. In an observational study, Robins's generalized g-formula can identify causal effects induced by a broad class of time-varying interventions. Various methods for estimating the generalized g-formula have been posed for different outcome types, such as a failure event indicator by a specified time (e.g. mortality by 5 year follow-up), as well as continuous or dichotomous/multi-valued outcomes measures at a specified time (e.g. blood pressure in mmHg or an indicator of high blood pressure at 5-year follow-up). Multiply-robust, data-adaptive estimators leverage flexible nonparametric estimation algorithms while allowing for statistical inference. However, extant methods do not accommodate pooling estimation across time points when multiple outcomes are measured over time, which can lead to substantial loss of precision. We propose a novel multiply-robust estimator of the generalized g-formula that accommodates pooled estimation over numerous available outcome measures, which we refer to as time-smoothing. Our approach accommodates any intervention that can be described as a Longitudinal Modified Treatment Policy, a flexible class suitable for binary, multi-valued, and continuous longitudinal treatments. Our method produces an estimate of the effect curve: the causal effect of the intervention on the outcome at each measurement time, taking into account censoring and non-monotonic outcome missingness patterns. In simulations we find that the proposed algorithm outperforms extant multiply-robust approaches for effect curve estimation in scenarios with high degrees of outcome missingness and when there is low covariate overlap. We apply the method to study longitudinal effects of union membership on wages. The proposed estimator is available in the LMTP package at https://github.com/lmtp/tree/curve .

OBJECTIVE:To demonstrate laparoscopic identification and treatment of aberrant superior gluteal vein-related intrapelvic sciatic nerve compression using a targeted neurovascular decompression approach. DESIGN/METHODS:Video article SUBJECTS: A 33-year-old woman presented with noncyclical right-sided sciatica radiating from the buttock to the heel, requiring a cane several times weekly, along with chronic pelvic pain and cyclic bowel and bladder symptoms consistent with peritoneal endometriosis with suspected neuropathic involvement. Her surgical history included multiple endometriosis excision procedures, hysterectomy, and adnexal surgery. Computed tomography and magnetic resonance imaging of the lumbosacral plexus was unremarkable. The patient provided written consent for publication and online distribution of the video (including social media, the journal website, and scientific databases). EXPOSURE/METHODS:Laparoscopic excision of peritoneal implants was followed by stepwise retroperitoneal dissection with ureterolysis, mapping of the obturator nerve, and targeted exploration of the proximal sciatic nerve with. a lateral approach. A markedly dilated aberrant superior gluteal vein crossing and compressing the proximal sciatic nerve was identified and treated with clip ligation and precise transection. MAIN OUTCOME MEASURES/METHODS:Completion of decompression without complications and improvement in neuropathic pain at 6- and 12-month follow-up. RESULTS:Decompression restored normal nerve contour with meticulous hemostasis. At 6 months, the patient reported substantial improvement in right-sided sciatica and mobility without new neurologic deficits. CONCLUSION/CONCLUSIONS:Aberrant pelvic venous anatomy can cause clinically significant intrapelvic sciatic nerve compression even in the absence of imaging findings; however, this single-case surgical demonstration, performed in a highly specialized setting, requires expertise. It is worth acknowledging that permanent metal clips were used for venous ligation in this case. Bipolar energy devices or absorbable polymeric clips may be preferable alternatives in future applications, may reduce the risk of long-term nerve-related complications.