Faculty Bibliography

BACKGROUND:Cannabis use among older adults has increased in recent years. Age-related physiological changes, socio-ecological factors, and medications may exacerbate potential adverse effects of cannabis and complicate the detection of cannabis use disorder (CUD) in older adults. However, current estimates of cannabis use are largely limited to national surveys, which may have age-related surveying challenges. METHODS:We conducted an intercept survey of 315 adults aged ≥ 65 in New York City, primarily in public parks and immediately outside older adult centers. The survey asked primarily about drug use with a focus on past-year cannabis use, reasons for use, adverse effects, and CUD. We examined reported cannabis use and delineated correlates of use and of having CUD. RESULTS:22.2% of participants (n = 70) reported past-year cannabis use, and among them, 11.1% (n = 35) reported past 24-h use. Older [adjusted odds ratio (aOR) = 0.90, 95% CI: 0.84-0.95] and female participants were at lower odds for use (aOR = 0.35, 95% CI: 0.17-0.73), and those who smoked cigarettes were at higher odds (aOR = 3.73, 95% CI: 1.65-8.48). Cannabis was most often used to get high (60.0%), relieve tension (55.7%), sleep (52.9%), or relieve chronic pain (30.0%). Dry mouth (41.4%) and drowsiness (18.6%) were the most reported adverse effects. Nearly a third (32.9%) who used cannabis had CUD, with 5.7% having severe CUD. CONCLUSIONS:Findings suggest that cannabis use among older adults may be more common and clinically significant than suggested by prior evidence. Improved screening, clinician education, and harm reduction strategies are needed to confront emerging risks in this population.

BACKGROUND/UNASSIGNED:late-onset CRC (LOCRC). METHODS/UNASSIGNED:Using the National Inpatient Sample (NIS) (2016-2020), we identified hospitalizations with a primary diagnosis of CRC. Patients were categorized from a hospital-based classification of EOCRC (<50 years) or LOCRC (≥50 years). Multivariate logistic regression assessed associations between body mass index (BMI), demographics, and outcomes including inpatient mortality, length of stay (LOS), and chemotherapy use. RESULTS/UNASSIGNED:Among 246,231 CRC hospitalizations, 13.7% (n=33,662) were EOCRC. Compared to LOCRC, EOCRC patients were more likely to be female [odds ratio (OR): 1.09], Black (OR: 1.17), Hispanic (OR: 1.56), or Asian (OR: 1.29), and more often covered by Medicaid, private insurance, or have no coverage. EOCRC patients had higher rates of tobacco use disorder (OR: 1.26) and depression (OR: 1.13), but lower prevalence of diabetes, coronary artery disease (CAD), and alcohol use disorder. EOCRC hospitalizations had lower inpatient mortality (OR: 0.649). Inpatient chemotherapy was more common in EOCRC (OR: 1.78). Obesity was positively associated with EOCRC for BMI 30-39 (OR: 1.07) and BMI ≥40 (OR: 1.50), while LOCRC showed inverse associations for the same BMI groups. CONCLUSIONS/UNASSIGNED:EOCRC is associated with unique demographic and clinical profiles when compared to LOCRC, highlighting disparities by race, insurance status, and comorbidities. The higher rate of inpatient chemotherapy use in EOCRC warrants further study to evaluate its clinical necessity and outcomes. These findings reinforce the need for targeted screening and inpatient care strategies for younger and underserved patient populations.

BACKGROUND:Despite the frequent late-stage diagnosis of gastric cancer (GC), the U.S. lacks a routine gastric cancer screening program. Liquid biopsy (LB), specifically blood-based tests, has emerged as a potential screening approach, but it is unclear whether such a strategy is cost-effective. We therefore evaluated the cost-effectiveness of liquid biopsy screening for GC in the U.S. METHODS:A Markov model was developed to compare no screening (current standard-of-care) and two liquid biopsy screening strategies. The study used a simulated cohort of 45-year-old individuals with average risk of gastric cancer. Primary model outcomes included life expectancy, quality-adjusted life-years (QALYs), total cost, and incremental cost-effectiveness ratios (ICERs). A strategy was considered cost-effective if the incremental cost-effectiveness ratio was less than the U.S. willingness-to-pay threshold of $100,000 per quality-adjusted-life-year gained. RESULTS:In the base-case analysis, LB screening strategies were not cost-effective, with an incremental cost-effectiveness ratio of $917,826 per QALY gained. Screening became cost-effective for high-risk subpopulations or when the per-test cost was approximately $89. CONCLUSIONS:This economic evaluation of LB for GC screening found that while LB strategies are effective in reducing cancer incidence and mortality, they are not cost-effective due to high test costs. Our findings could help inform the potential planning of future clinical validation studies for LB tests used for GC screening.

OBJECTIVE:Mood disturbances-including depressed mood, irritability, anxiety, and mental exhaustion-are common during the menopause transition, affecting up to 68% of women. While menopausal hormone therapy (HT) is FDA-approved for vasomotor and genitourinary symptoms, its role in managing mood symptoms remains less well understood. This retrospective, comparative study evaluated the impact of systemic HT on mood in a cohort of HT-naive individuals. METHODS:We included 260 patients presenting to an urban, academic menopause center between 2023 and 2025 who completed the Menopause Rating Scale (MRS) before and after initiating systemic HT for FDA-approved indications. MRS psychological subdomain scores covering depressive mood, irritability, anxiety, and mental exhaustion were analyzed. Most patients (96.5%) received transdermal estradiol, had an average age of 52.1 years, and a mean follow-up of 4.5 months. Notably, 51% had a history of anxiety or depression, and 24% were on antidepressant therapy at baseline. RESULTS:Results showed a significant reduction in MRS psychological subdomain scores from baseline to follow-up (P<0.001). The proportion of patients with severe mood symptoms (score ≥7) decreased from 62.3% to 24.6%. Improvement was greatest in those with severe baseline symptoms (mean change: -3.85, SE: 0.223). Treatment response did not differ by psychiatric history, age, menopausal stage, or antidepressant use. CONCLUSIONS:These findings suggest systemic HT may improve mood symptoms in midlife, especially among those with elevated baseline severity, independent of prior mental health diagnosis, antidepressant use, or menopause stage. These findings support further investigation of HT's impact on mood in midlife women.

Enteric hyperoxaluria (EH) results from increased oxalate bioavailability in the gastrointestinal (GI) tract, often affecting patients with inflammatory bowel disease (IBD). We investigated the pathophysiology of EH in an ileitis mouse model, hypothesizing that fat malabsorption, increased gut permeability, and microbial shifts collectively contribute to the hyperoxaluric phenotype in the setting of GI tract inflammation. SAMP1/YitFc (SAMP1) mice and their parental AKR controls were fed one of three diets varying in fat content (10%, 45%, or 60% kcal), each supplemented with 1% oxalate, for 6 weeks. Plasma (P), urine (U), oxalate (Ox), and creatinine (Cr) levels were measured, while stool lipid species were analyzed using mass spectrometry. Intestinal permeability was assessed using sucralose and ¹³C₂ oxalate gastric gavage in SAMP1 and AKR mice. Histology, qPCR, and Western blotting were performed on kidney, liver, and GI tissues. Microbial DNA was analyzed at the community, genus, and functional levels. Changes in bacterial metabolic pathways were investigated in the mice fed the highest fat content. The oxalobiome of SAMP1 and AKR mice was characterized using our bioinformatics pipeline. On high-fat diets, SAMP1 mice had higher UOx, POx, and PCr levels than AKR mice. Increased levels of diacylglycerols and free fatty acids in SAMP1 stool samples suggested fat malabsorption. A decrease in ZO1 and occludin intestinal expression, coupled with significantly increased urinary sucralose and oxalate levels, indicated increased intestinal permeability. Microbiome analysis revealed the enrichment of Lactobacilli and Bacteroides in SAMP1 mice, with bacterial pathways favoring lipid synthesis and glyoxylate metabolism. Ileal SLC26A6 protein expression was significantly reduced in SAMP1 mice. SAMP1 mice also developed progressive kidney injury with interstitial inflammation. These findings highlight fat malabsorption as a central pathophysiologic disturbance in EH that reduces luminal calcium availability for oxalate binding, is associated with enhanced intestinal permeability, and accompanies microbiome and enzymatic pathway alterations.

BackgroundThe evaluation of osteochondral lesions of the talus (OLT) has long been limited by variability in imaging protocols, lesion measurement techniques, and clinical utility of radiographic classification systems. To address these challenges, 3 International Congress Meetings on Cartilage Repair of the Ankle were convened in Pittsburgh, USA (2017), Dublin, Ireland (2019), and New York, USA (2025) to establish agreement on the work-up, diagnostic imaging, and radiographic classification systems for OLT.MethodsSeventy-five multidisciplinary experts from over 25 countries and 1 territory participated in a structured Delphi-based consensus process. Blinded surveys, structured questionnaires, and in-person discussions were used to develop and refine statements, supported by literature review and graded evidence (A1-E). Consensus strength was defined as consensus (51%-74%), strong consensus (75%-99%), or unanimous (100%).ResultsIn total, 19 consensus statements were achieved across the 3 meetings. Strong agreement was reached for first-line use of weight-bearing radiographs and complementary use of magnetic resonance imaging (MRI) and computed tomography for lesion characterization. Standardized assessment of lesion size in 3 planes and localization using a 9-zone grid were endorsed. Diagnostic arthroscopy was considered to have limited routine value in the setting of advanced imaging. Post-treatment imaging recommendations clarified indications for radiographs and cross-sectional imaging and emphasized the limited correlation between imaging findings and clinical function. Computed tomography-based classification systems were considered more useful for guiding treatment decisions than plain radiographic or MRI-based systems.ConclusionThese international consensus statements establish a standardized imaging-based framework for the evaluation and classification of OLT, improving consistency in diagnosis, treatment planning, and clinical reporting.

BACKGROUND:Idiopathic clubfoot is a complex congenital foot and ankle anomaly commonly treated with the Ponseti method. While gross motor function and activity level are similar in children with clubfoot treated with this method compared with children without clubfoot, data are lacking on sports participation following this treatment. This study aimed to describe the prevalence of sports participation among children with idiopathic clubfoot treated with the Ponseti method. METHODS:This was a multicenter retrospective cross-sectional study. Patients aged 5 to 17 years were included if they had been diagnosed with idiopathic clubfoot and treated with the Ponseti method during infancy. Parents of subjects were asked to complete a 1-time REDCap survey that included basic demographic questions, 2 validated activity scores (PROMIS Physical Activity Short Form and PACE+), and questions relating to sports participation. The comparison group consisted of the siblings of patients with clubfoot. RESULTS:One hundred fifty-one patients with clubfoot and 45 siblings without clubfoot were included from 4 institutions. In the clubfoot group, 72.2% of participants were male compared with 60% in the sibling group ( P =0.12). Median PROMIS-PA t-scores were 53.3 [interquartile range (IQR) 8.6] and 56.3 (IQR 13.2) in the clubfoot and sibling groups, respectively ( P =0.016). The median PACE+ scores were 4 (IQR 3.5) in the clubfoot group and 4.75 (IQR 2.75) ( P =0.261) in the sibling group. Sports participation was reported in 120 (79.5%) patients with clubfoot and 43 siblings (95.6%) ( P =0.006). Soccer, baseball, basketball, football, and swimming were the most commonly played sports in both groups. CONCLUSIONS:Children treated for idiopathic clubfoot with the Ponseti method remain active and participate in sports similar to their siblings. Further prospective studies examining sports participation and injury prevalence are needed to better understand long-term clinical and functional outcomes in patients treated with the Ponseti method for idiopathic clubfoot. STUDY DESIGN/METHODS:Retrospective. LEVEL OF EVIDENCE/METHODS:Level IV.

PURPOSE OF REVIEW/OBJECTIVE:To describe the relationship between reflux and bronchiectasis and to appraise recent literature on reflux characterization, clinical outcomes, and management strategies in patients with bronchiectasis. RECENT FINDINGS/RESULTS:Reflux is common in bronchiectasis and has been linked to worse respiratory symptoms and quality of life, more exacerbations and healthcare use, lower lung function, and higher mortality. These associations are seen across several cohorts, but nearly all data are observational, use variable reflux definitions, and cannot determine whether reflux contributes to bronchiectasis progression or simply identifies patients with more severe disease. Proposed pathways include microaspiration-related airway injury, reflex-mediated cough amplification, and microbial dysbiosis. No randomized bronchiectasis-specific trial has shown improved respiratory outcomes with reflux-directed therapy, and acid suppression alone is unlikely to address nonacid reflux, microaspiration, cough-reflex pathways, or airway dysbiosis. SUMMARY/CONCLUSIONS:In bronchiectasis, reflux should be separated into clinically relevant phenotypes, including typical gastroesophageal reflux disease, proximal or nonacid reflux, laryngopharyngeal symptoms, dysphagia, and aspiration. Management should be guided by the suspected reflux or aspiration pattern because acid suppression alone may not address airway-relevant reflux. Future studies should pair objective reflux and swallowing measures with bronchiectasis-specific outcomes.

BACKGROUND AND OBJECTIVES/UNASSIGNED:Patients with neurologic disease have a variety of unmet palliative care needs. Both the Accreditation Council for Graduate Medical Education and Academy of Neurology have emphasized the need for neuropalliative care education in recent years. Neurology training programs have widely variable practices in teaching neuropalliative care. This study aims to characterize current practices in providing neuropalliative care education across graduate neurology training and to identify barriers to its delivery. METHODS/UNASSIGNED:We surveyed program directors (PDs) of neurology residency and fellowship training programs in the United States regarding their current methods of teaching neuropalliative care topics, perceived importance of these topics, relevant subspecialty resources, and perceived barriers to providing neuropalliative care education. RESULTS/UNASSIGNED:Our survey was emailed to 777 PDs and fellowship directors. In total, 118 responses were included in the analytic sample (response rate 15.2%). Program directors generally perceived neuropalliative care education as important, with a median rank of 7 of 10. 91% of adult neurology residency programs and 66% of fellowship programs included palliative care topics in their didactics curricula. Topics emphasized varied depending on the training program's subspecialty. Respondents highlighted barriers to implementing neuropalliative care training, including inadequate trainee and faculty time and lack of adequate teaching faculty. DISCUSSION/UNASSIGNED:Neurology training programs continue to exhibit considerable variability in palliative care education curricula. Although most programs reported a presence of palliative care in their institutions, variability exists in the amount of palliative care education taught, the topics emphasized, and the teaching methods. Notably, there is an opportunity for fellowship programs to increase the amount of neuropalliative care topics taught in their curricula. Neurology residency and fellowship directors may benefit from using existing neuropalliative care curricula to enhance this area of education, partnering with local non-neurology faculty to teach palliative topics, and integrating palliative care topics into subspecialty training.