Faculty Bibliography

PURPOSE/UNASSIGNED:Orbital fractures are a major reason for ophthalmologic consultation in the emergency department. In this study, we studied ocular signs associated with intervention and compared 4 previously published protocols to identify which best identified higher risk patients in need of consultation. METHODS/UNASSIGNED:We performed a retrospective cross-sectional study of patients from the BALCITE (BALtimore Consultation, Inpatient, and Trauma of the Eye) database who received ophthalmologic consultation. Our primary outcomes were the ocular and orbital signs associated with receiving intervention. Our secondary outcome identified the most sensitive and specific screening algorithm for orbital fractures by comparing four existing protocols (HOPE+CT, STOP, MEE, and UTH) to our large independent cohort. RESULTS/UNASSIGNED: < 0.001). The STOP tool had the highest sensitivity of 96.3%, demonstrating a potential 29% reduction in hospital fracture consults, followed by MEE, with a sensitivity of 93.1%. The HOPE+CT tool had the highest specificity of 95.6%. CONCLUSION/UNASSIGNED:The presence of an APD and periorbital laceration are strong indicators of urgent ophthalmologic treatment in the setting of acute orbital fractures. Supportive implementation of the STOP and MEE algorithms can effectively screen orbital fracture patients to help triage in the acute setting, improve resource utilization, and reduce healthcare costs.

Xenotransplantation has been iteratively improved over the last decade in pre-clinical models, with first-in-human clinical trials underway. The 2025 IXA Congress in Geneva was held in parallel with meetings involving World Health Organization leaders to support the development of new guidance on xenotransplantation in this rapidly evolving field. Key scientific themes of the meeting included the introduction of multiple-gene edited pigs for xenotransplantation research and clinical trials, better characterization of innate and adaptive immune responses and xenograft preservation that optimizes ramifications of ischemia-reperfusion injury during implantation. This comes at a time when gene-edited pig organs are being used for human xenotransplantation, a development that demands safety, reproducibility, durability, and a clear mechanistic understanding of rejection and tolerance.

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.

The American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee provides reviews of existing, new, or emerging endoscopic technologies that have an impact on the practice of GI endoscopy. Evidence-based methodology is used, with a MEDLINE literature search to identify pertinent clinical studies on the topic and a MAUDE (U.S. Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported adverse events of a given technology. Both are supplemented by accessing the "related articles" feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Controlled clinical trials are emphasized, but in many cases, data from randomized, controlled trials are lacking. In such cases, large case series, preliminary clinical studies, and expert opinions are used. Technical data are gathered from traditional and Web-based publications, proprietary publications, and informal communications with pertinent vendors. Technology Status Evaluation Reports are drafted by 1 or 2 members of the ASGE Technology Committee, reviewed and edited by the committee as a whole, and approved by the Governing Board of the ASGE. When financial guidance is indicated, the most recent coding data and list prices at the time of publication are provided. For this review, the MEDLINE database was searched through August 2024 for articles related to endoscopic submucosal dissection. Technology Status Evaluation Reports are scientific reviews provided solely for educational and informational purposes. Technology Status Evaluation Reports are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment or payment for such treatment.

BACKGROUND:Transcatheter aortic valve replacement (TAVR) has become a cornerstone in the management of aortic valve disease. However, delayed complications after hospital discharge and readmission remain in an issue following TAVR. We aimed to evaluate the impact of remote monitoring systems on clinical outcomes after TAVR. METHODS:All patients who underwent TAVR from September 2014 through January 2019 were included retrospectively. Additionally, all patients, clinically indicated for TAVR from 9/1/2018 through 8/30/2021, were screened, and patients who agreed were prospectively enrolled. Medtronic Care Management Service (MCMS) was used to monitor patients following TAVR after discharge (Medtronic, Minneapolis, MN). RESULTS:A total of 1078 patients were included. Among them, 843 (78.2 %) patients were discharged with MCMS (MCMS group) and 235 (21.8 %) patients were discharged without (non-MCMS group). Overall, the mean age was 81.5 years, and mean STS-PROM was 5.53 %. Baseline conduction defect was observed in 427 (39.6 %). Peripheral artery disease was more common in the MCMS group while a history of myocardial infarction was more likely seen in the non-MCMS group. After propensity-score matching, length of hospital stays was significantly shorter in the MCMS group (1.42 days vs. 1.82 days in the non-MCMS group, p < 0.001). Readmission rates and new permanent pacemaker insertion rates were similar between the two groups. All-cause mortality, 30-day and 90-day mortality were comparable between the groups. CONCLUSIONS:MCMS was easily applicable to a clinical practice and may reduce length of hospital stays in patients undergoing TAVR without increasing readmission or mortality.

BACKGROUND/UNASSIGNED:Recent observational studies have suggested that early treatment (<12 hours from diagnosis) of intermediate risk pulmonary embolism (PE) with catheter-based therapies may reduce morbidity and mortality. However, the effect of early versus late mechanical thrombectomy on acute pulmonary hemodynamics and right ventricular mechanics is less well defined. METHODS/UNASSIGNED:Patients enrolled in SYMPHONY-PE were divided into one of 2 groups based on the time from baseline CT pulmonary angiography to mechanical thrombectomy: Early <12 hours versus late ≥12 hours. The primary safety end point was the rate of major adverse events within 48 hours, as adjudicated by an academic independent safety board. The primary efficacy end point was the core-lab assessed mean change in right ventricle-to-left ventricle ratio from baseline to 48 hours. RESULTS/UNASSIGNED:=0.431) between groups, and there were no mortalities. The differences in efficacy outcomes were greatest in higher-risk patients per the Composite Pulmonary Embolism Shock score. CONCLUSIONS/UNASSIGNED:Early mechanical thrombectomy was associated with larger reductions in right ventricle-to-left ventricle ratio and mean pulmonary artery pressure, with no significant differences in safety event rates compared with patients who underwent late thrombectomy. Randomized trials are needed to test these associations. REGISTRATION/UNASSIGNED:URL: https://www.clinicaltrials.gov; Unique identifier: NCT06062329.

BACKGROUND:Crisis Standards of Care (CSC) may require rationing of life-sustaining resources, such as mechanical ventilation, during public health emergencies. Simulation modeling offers a scalable, transparent method to evaluate triage frameworks before implementation. While ventilator triage frameworks vary in their use of exclusion criteria, comorbidity adjustments, and reassessment frequency, few have been rigorously compared using real-world data under realistic surge conditions. Robust platforms that simulate both front-end (initiation) and back-end (reassessment or reallocation) triage are critical for evaluating clinical, operational, and ethical performance. METHODS:We developed a computational simulation platform using retrospective real-world data from intubated adults during the Spring 2020 COVID-19 surge across a large New York City health system. The simulated surge cohort included all patients mechanically ventilated between March 1 and June 30, 2020. A crisis cohort was defined as those patients receiving ventilation once 95% of the health system's pre-pandemic ventilator supply was in use. Eight CSC strategies were evaluated, including policies from New York, Pennsylvania, Maryland, Canada, two academic frameworks, a lottery-based system, and first-come first-served. Strategies varied in their use of exclusion criteria, comorbidity modifiers, reassessment intervals, and prioritization for special populations. Daily ICU census and ventilator availability were used to simulate resource strain and drive triage decision-making. Patients simulated for ventilator rationing were simulated to expire. Manual abstraction of comorbidities and structured rules for imputing missing SOFA subscores were applied uniformly. RESULTS:The platform simulated 10,000 iterations per strategy and included 2,365 intubated patients. Final analyses will be published separately. CONCLUSION:This platform provides a scalable, reproducible framework for evaluating ventilator triage strategies under pandemic-like conditions. By integrating both initial triage and serial reassessment (front- and back-end) logic, operational constraints, and clinical trajectories, it enables detailed comparisons of survival, resource utilization, and prognostic accuracy. The simulation also supports ethical evaluation by testing the practical impact of exclusion and comorbidity-based criteria. Such models can assist governments, health systems, and public health agencies in designing triage protocols that are evidence-informed, ethically defensible, and operationally feasible. This work demonstrates how computational modeling can strengthen health system preparedness and support public trust.

This multinational cone-beam computed tomography (CBCT) study evaluated the root canal morphology of mandibular first premolars (M1Ps) from 21 countries and compared how well the Ahmed and Vertucci classification systems represented these patterns. A total of bilateral mandibular first premolars from eligible CBCT scans were assessed using both systems, and the data were analyzed with a hierarchical probabilistic approach to account for population and imaging-related variation. Across the overall dataset, a simple single-canal configuration was the dominant pattern, and this remained the most common finding in all populations despite limited but structured variation in less frequent subclasses. The Ahmed system classified all observed configurations, whereas the Vertucci system left approximately 10.2% of cases without an equivalent category. In addition, Ahmed preserved more anatomical detail, while Vertucci compressed several distinct configurations into broader groups. Demographic and imaging-related factors had modest effects, with voxel size showing the clearest technical influence on the detection of more complex patterns. Overall, M1P morphology showed a stable global pattern with secondary heterogeneity, and the Ahmed system provided a more complete and informative representation for CBCT-based morphology assessment across diverse populations.