Faculty Bibliography

PURPOSE/OBJECTIVE:Knee dislocations (KDs) can be limb-threatening injuries that may require a temporising knee-spanning external fixator (KSEF) for stabilisation. Precise indications for this commonly utilised invasive immobilisation technique remain controversial and poorly defined. The purpose of this study was to establish consensus-driven indications for temporising KSEF use in the initial management of KDs. METHODS:A working group of fellowship-trained orthopaedic surgeons generated clinical scenarios reflecting commonly debated indications for temporising KSEF application. Utilising a modified Delphi technique, 23 surgeons from the International Knee Dislocation Study Group completed two anonymous online survey rounds. Consensus was defined a priori as ≥70% agreement or disagreement. RESULTS:Response rates were 100% for Round 1 and 96% for Round 2. Four scenarios achieved unanimous consensus: (1) KD without post-reduction instability (100% disagreement), (2) inability to maintain tibiofemoral reduction in the sagittal/coronal plane with non-invasive knee immobilisation (NIKI) after initial reduction (i.e., redislocation/subluxation) (100% agreement), (3) tibial plateau fracture-dislocation with post-reduction subluxation (100% agreement), and (4) in bilateral closed KDs where one limb is indicated and the other is NOT, span ONLY the indicated limb (100% agreement). Two scenarios achieved strong positive consensus (90%-99.9% agreement): (1) morbid obesity (BMI ≥ 40) without NIKI of sufficient size (91.3% agreement), and (2) extensor mechanism injury with post-reduction subluxation (91.3% agreement). Four and one additional scenarios achieved positive and negative consensus, respectively. CONCLUSIONS:This modified Delphi study established consensus-driven indications for temporising KSEF application in the initial management of KDs, which advocate for more selective use than what is demonstrated in the literature. LEVEL OF EVIDENCE/METHODS:Level V.

The guest editors introduce the Biomedical Optics Express feature issue "Optics and the Brain." This issue highlights a range of important neuroscientific questions and clinical needs, and illustrates novel optical methodologies being developed to address them by this research community.

PURPOSE/OBJECTIVE:To develop a novel single-shot radial echo planar imaging (ss-rEPI) technique for rapid, distortion-free brain imaging in functional MRI experiments. METHODS:* mapping and QSM. Visual BOLD fMRI experiments were conducted and evaluated against Cartesian EPI measurements. RESULTS:* measurements. CONCLUSION/CONCLUSIONS:modeling is critical for ss-rEPI performance. Advanced reconstruction techniques and self-calibration methods could further enhance its speed, performance, and applicability across diverse MRI techniques.

BACKGROUND:The frequency of residual angina and its impact on health status and death following anatomic complete revascularization in symptomatic patients with chronic coronary disease are unknown. METHODS:Data were analyzed from ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) trial participants randomized to invasive management with baseline angina (Seattle Angina Questionnaire Angina Frequency score <100), no prior coronary artery bypass graft surgery, and anatomic complete revascularization within 90 days of randomization. The primary outcome was frequency of residual angina after revascularization, defined as a Seattle Angina Questionnaire Angina Frequency score <100 within 6 months of randomization. Secondary outcomes included 6-month health status and medication use and 5-year all-cause and cardiovascular death. RESULTS:=0.006). Five-year all-cause and cardiovascular death did not differ significantly between groups. CONCLUSIONS:Residual angina is common (>40%) following anatomic complete revascularization for chronic coronary disease and is associated with reduced quality of life and greater antianginal medication use but no increase in death. REGISTRATION/BACKGROUND:Unique Identifier: NCT01471522.

INTRODUCTION AND OBJECTIVES/OBJECTIVE:Transperineal (TP) prostate biopsy offers reduced infection risk compared to transrectal (TR) methods, but patient discomfort remains a concern, especially under local anesthesia. This study evaluated the discomfort from a TP prostate biopsy under local anesthesia and strategies to decrease pain. METHODS:This prospective study included 500 consecutive patients undergoing TP prostate biopsy between June 2023 and November 2024. Pre-biopsy magnetic resonance imaging was used to identify target lesions, followed by TP magnetic resonance imaging/ultrasound (ultrasound) fusion biopsy using the Artemis device. A survey questionnaire was administered immediately following the procedure to assess pain scores related to probe insertion, skin infiltration, deep periprostatic block, and overall discomfort, using the Visual Analog Scale (VAS). RESULTS:< 0.001). No association was found between pain and race, prostate size, number of lesions, lesion location, or grade group. The median duration of hematuria was 5 days (IQR 4-8). Two (0.4%) patients in the local anesthesia group developed urinary retention, and two (0.4%) experienced a vasovagal episode. No patients developed sepsis. CONCLUSIONS:TP prostate biopsy with local anesthesia is a well-tolerated outpatient procedure when optimized pain control techniques are implemented. Tactile stimulation, ethyl chloride spray, and the use of NaHCO3-buffered lidocaine significantly enhance patient comfort by reducing pain. These strategies enhance patient experience, making TP biopsy a viable outpatient option.

The heat shock protein 70 (Hsp70) family consists of ATP-driven molecular chaperones essential for maintaining protein homeostasis (proteostasis) across all cell types, however, modulation of chaperone activity by small molecules remains challenging. In bacteria, a major Hsp70 called DnaK represents a putative antibacterial target, as it plays essential roles in growth, antibiotic resistance, and stress response. While Hsp70 inhibitors are in development as potential cancer and neurodegenerative disease treatments in humans, we lack generalizable methods to target Hsp70s across species. Here, we address how peptidomimetic scaffolds designed to inhibit proteases, exemplified by the drug telaprevir, interact with two different bacterial DnaKs to disrupt chaperone function. We perform extensive structure-function studies of telaprevir analogs against DnaK to inform the design of synthetic unnatural peptide sequences with a range of inhibitory potencies. X-ray crystallography analysis of telaprevir and several synthetic peptidomimetics reveal interactions with DnaK's substrate binding domain via ligand side chain recognition reminiscent of that observed in protease active sites, but in two orientations. These co-complexes inspire the synthesis of shorter peptidomimetics capable of allosterically inhibiting DnaK's ATPase activity. Overall, this work demonstrates that chemical scaffolds devised for protease inhibition may be modified to disrupt Hsp70 chaperone activities.

Young adults with hip pathology present a therapeutic challenge requiring careful consideration of treatment options that will affect decades of future function. Historically, the orthopedic community has maintained a strong preservation bias, often pursuing multiple preservation attempts before considering arthroplasty because of concerns about implant longevity. This narrative review critically examines current evidence regarding hip preservation surgery and total hip arthroplasty in young adults to inform evidence-based decision making. The literature reveals that successful hip preservation requires a narrow therapeutic window defined by preserved articular cartilage, accurate structural diagnosis, and appropriate patient selection. Clinical and imaging predictors, including joint space narrowing below 2 mm, Tönnis grade 2 or higher osteoarthritis, bipolar chondral damage, and mechanical symptoms, reliably identify patients unlikely to benefit from preservation. Concurrently, advances in bearing surfaces-particularly highly cross-linked polyethylene and ceramics-have dramatically improved arthroplasty outcomes, with contemporary data demonstrating 10-year survivorship exceeding 90% in patients younger than 55 years. Modern total hip arthroplasty delivers consistent pain relief and functional improvement that often exceeds preservation outcomes in appropriately indicated patients. This review proposes a decision-making framework emphasizing that treatment selection should be guided by objective disease characteristics rather than age-based algorithms, optimizing long-term outcomes while minimizing unnecessary morbidity.

Rotator cuff disease (RCD) is the leading cause of shoulder disability, characterized by progressive degeneration of tendon structure and function. Despite advances in surgical techniques that optimize repair biomechanics, biological healing remains a major challenge, leading to high rates of repair failure. Augmentation strategies, including biologic adjuvants, grafts, and bioinductive implants, aim to improve the healing environment and reduce re-tear rates. Although augmentation reliably reduces structural failure, its clinical benefits remain under investigation. Continued advancements in biologic therapies, graft technologies, and long-term clinical studies are needed to optimize outcomes and define best practices for augmentation in rotator cuff repair. This review summarizes the current understanding of RCD pathophysiology, natural history, treatment strategies, surgical repair techniques, healing mechanisms, and the role of augmentation.