Faculty Bibliography

BACKGROUND:Physician workforce diversity improves access to care, outcomes, and workforce productivity. Yet, women and sexual minorities remain underrepresented in anesthesiology, while representation for low-income trainees remains poorly characterized. How interest in anesthesiology evolves among these groups during medical school remains unclear. METHODS:This retrospective cohort study of U.S. MD-granting medical school matriculants from 2014-2017 used Association of American Medical Colleges data on self-reported sociodemographic characteristics and anesthesiology interest. Students were grouped by interest evolution from matriculation to graduation: never interested (no-no), cultivated (no-yes), lost (yes-no), sustained (yes-yes). Chi-square tests characterized sociodemographic differences across interest paths. Firth logistic regression models assessed odds of cultivated vs never interested and sustained vs lost paths across sociodemographic groups. RESULTS:Among 39,910 students in the cohort, 295 (0.7%) sustained, 2,007 (5.0%) cultivated, 494 (1.2%) lost interest, and 37,114 (93.0%) were never interested in anesthesiology. Women were less likely than men to have initial interest (1.5% vs 2.5%, p < .001), whereas initial interest among low-income (2.1% vs 1.9%, p = .087) and sexual minority (1.8% vs 2.0%, p = .505) students did not significantly differ from majority counterparts. Sustained interest did not differ significantly between women and men (OR: 0.85, 95% CI: 0.63-1.14), according to low-income (OR: 0.89, 95% CI: 0.65-1.22), or sexual minority status (OR: 0.77, 95% CI: 0.41-1.45). Women (OR: 0.50, 95% CI: 0.45-0.55) and sexual minority students (OR: 0.79, 95% CI: 0.65-0.96) were less likely to cultivate interest than men and heterosexual students, respectively. Low-income students had greater (OR: 1.27, 95% CI: 1.16-1.40) odds of cultivating interest compared to non-low-income peers. CONCLUSIONS:Women's underrepresentation in anesthesiology is associated with lower initial and cultivated interest. Sexual minority students also demonstrated lower cultivated interest. These disparities identify time points in training where interest diverges by demographic group and may help prioritize where future research - including studies of targeted interventions - is most needed.

We present an uncharacterized laryngotracheal agenesis variant with esophageal airway continuity, highlight limitations of existing classification systems, and demonstrate the possibility of primary crico-tracheal anastomosis. As awareness of these anomalies increases, careful anatomic description and individualized surgical reconstruction will be essential to advance the field and improve outcomes for these challenging patients.

BackgroundCartilaginous non-structural allografts have emerged as biologic adjuncts for the treatment of osteochondral lesions and focal cartilage pathology in the foot and ankle, particularly for lesions that fail bone marrow stimulation (BMS) yet may not warrant osteochondral transplantation. These allografts may serve as an intermediary treatment strategy between BMS and more invasive restorative procedures.MethodsA scoping review of the currently available literature regarding cartilaginous non-structural allografts used in foot and ankle pathology was performed, with a focus on BioCartilage, DeNovo NT, and CartiMax.ResultsBioCartilage may improve radiographic defect fill when used as an adjunct to marrow stimulation procedures, although superior functional outcomes have not been consistently demonstrated. In contrast, DeNovo NT has demonstrated mixed clinical and radiographic outcomes, including persistent postoperative marrow edema, inconsistent graft incorporation, and relatively high complication and failure rates in current studies. Available evidence for BioCartilage and DeNovo NT consists primarily of small clinical studies with heterogeneous methodologies, whereas evidence for CartiMax remains limited to preclinical and industry-supported investigations without published peer-reviewed human clinical outcome studies.ConclusionAlthough these allografts demonstrate potential as biologic adjuncts for cartilage repair, currently available evidence remains limited by heterogeneous study designs, inconsistent outcome reporting, limited comparative data, small cohort sizes, and short-term follow-up. Cost-effectiveness remains an important consideration, given the limited evidence demonstrating long-term functional superiority over traditional marrow stimulation techniques. Further high-quality comparative studies are necessary to determine the long-term efficacy, safety, durability, and cost-effectiveness of cartilaginous non-structural allografts in foot and ankle pathology.Level of Evidence:V: Scoping Review.

BACKGROUND:) is associated with age, sex, and cardiorespiratory comorbidities. Frequency and timing of nocturnal arousals and respiratory events also display age, sex, and comorbidity-based differences. Hence, it is plausible that resaturation parameters may present an alternative avenue for the assessment of nocturnal arousals. METHODS:events and defined temporally as pre-event (arousal terminated ≤ 10 s prior to desaturation onset) or within-event (arousal began within the desaturation event or ≤ 5 s after desaturation offset). RESULTS:5,484 participants (49% female, median age 63 years) were included with 235,996 saturation events. 1.2% of events had pre-event arousals (n = 2,850), while 47.6% had within-event arousals (n = 112,271). Pre-event arousals were associated with faster desaturation rates (standardized effect: 0.54-0.58) and shorter desaturation durations (by 25-36%). Within-event arousals were associated with lower nadirs, longer desaturation durations, and larger desaturation areas (standardized effects: 0.24-0.51). Both arousal types increased resaturation rates, but through different mechanisms: pre-event arousals shortened resaturation durations while within-event arousals increased resaturation height. These effects were amplified with respiratory events, with the strongest associations observed during apnoeas. CONCLUSIONS:event architecture, with differential changes seen between desaturation and resaturation parameters.

BACKGROUND/UNASSIGNED:In-stent restenosis (ISR) remains an important cause of repeat revascularization despite advances in drug-eluting stent technology. Contemporary adoption patterns and outcomes of adjunctive plaque-modification strategies for ISR are incompletely characterized. We evaluated national trends and in-hospital outcomes of ISR percutaneous coronary intervention treated with adjunctive plaque-modification devices versus conventional plain old balloon angioplasty. METHODS/UNASSIGNED:All ISR percutaneous coronary intervention procedures in the National Cardiovascular Data Registry CathPCI Registry from July 2009 to June 2024 were analyzed. Adjunctive ISR therapy was defined as use of excimer laser atherectomy, intravascular lithotripsy, cutting/scoring balloon angioplasty, or rotational/orbital atherectomy with or without stent implantation. Conventional plain old balloon angioplasty included balloon angioplasty with or without stent placement and no adjunctive devices. Multivariable logistic regression clustered by operator was used to assess adjusted in-hospital outcomes. RESULTS/UNASSIGNED:Among 1 065 354 ISR admissions (1 182 599 lesions), adjunctive devices were used in 26.5% of cases, increasing from 20.8% in 2018 Q1 to 40.7% by 2024 Q2. Intravascular lithotripsy showed the most rapid adoption, reaching 16.1% of ISR cases within 4 years of US introduction. Adjunctive therapy was associated with higher odds of in-hospital mortality (odds ratio, 1.25 [95% CI, 1.19-1.31]), myocardial infarction (odds ratio, 1.30 [95% CI, 1.24-1.35]), bleeding (odds ratio, 1.29 [95% CI, 1.26-1.33]), and stroke (odds ratio, 1.11 [95% CI, 1.02-1.22]). Recurrent ISR (14.3%) was more often managed with adjunctive therapy (34.2% versus 25.0% for initial ISR) yet had lower absolute complication rates. CONCLUSIONS/UNASSIGNED:ISR remains a major contributor to percutaneous coronary intervention volume. Use of adjunctive plaque-modification devices, especially intravascular lithotripsy, has risen sharply. Adjunctive therapy was associated with higher in-hospital event rates, likely reflecting lesion complexity.

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.

Classic models of the French flag problem depict sharp cell type boundaries emerging from threshold responses to morphogen gradients. How discrete cell type boundaries arise from morphogen signals that vary continuously across developing tissues remains incompletely understood. We use hair follicle dermal condensate (DC) formation to study a sharp developmental transition in which proliferative progenitors undergo cell cycle exit concurrent with molecular differentiation. Using genetic and genomic approaches, we show that Wnt and Hedgehog signaling coordinate separable cellular events during DC commitment. Elevated Wnt signaling promotes cell cycle exit through reduced chromatin binding of the Hedgehog mediator GLI3, while Hedgehog signaling induces differentiation genes in a Wnt-dependent manner and simultaneously elevates Wnt activity. When these responses coincide, differentiation and cell cycle exit occur together, limiting the duration and abundance of intermediate states and producing a sharp boundary. When they do not, intermediate states persist and expand, producing a graded boundary. Thus, a sharp boundary can emerge from a continuous transition that is compressed in time and space.

Kaplan-Meier analysis of time to first all-cause readmission over 12 months among older adults with ischemic heart disease randomized to 3 months of mobile health cardiac rehabilitation (mHealth-CR) or usual care. There was no significant difference in time to first readmission between groups (log-rank P = 0.26).

INTRODUCTION/BACKGROUND:Obtaining adequate informed consent is a fundamental component of surgical care, often conducted by trainees at academic medical centers. However, the quality of trainees' informed consent remains unclear. To guide future instruction, this study assessed trainees' confidence and performance with the informed consent process, stratified by postgraduate year and previous consent education. METHODS:An objective structured clinical examination (OSCE) was developed to assess informed consent discussions between housestaff trainees and standardized patients undergoing primary total knee arthroplasty. A total of 18 orthopaedic residents (six each in postgraduate years [PGYs] 1, 3, and 5) and five clinical fellows in adult reconstruction (PGY-6) participated. Quality of informed consent was assessed with an objective rubric, scored 0 to 2 ("not addressed," "attempted," and "completed"). Trainees completed a post-OSCE survey assessing their confidence and previous training in obtaining informed consent. RESULTS:All 23 trainees considered informed consent "extremely important," and 96% thought that formal training would be "very" or "extremely beneficial." Yet, only 30% recalled receiving consent education, and 39% had never received clinical feedback on their consent process. Average OSCE performance was 16.2/20 (range: 11-19). Common deficiencies were assessing patient comprehension (13% completed) and facilitating shared decision making (39% completed). Only 35% of trainees identified assessing patient comprehension as critical. Performance did not differ significantly by training level. Previous consent education significantly improved trainees' ability to explain procedures (1.7/2.0 vs. 1.2/2.0; P = 0.013) and was associated with better shared decision-making facilitation (1.4/2.0 vs. 1.0/2.0; P = 0.255), although not statistically significant. CONCLUSION/CONCLUSIONS:Orthopaedic trainees value formal informed consent training but lack structured education and informal feedback. While overall performance was strong, consistent deficiencies in assessing comprehension and shared decision making were noted. Seniority alone did not improve performance, while previous formal education improved procedure explanations. These findings support the implementation of structured informed consent curricula across all levels of orthopaedic training.

BACKGROUND:Cholecystectomy (CCY) is one of the most commonly performed abdominal surgeries in the USA. However, limited population-level data are available that evaluate the long-term risk of colorectal cancer (CRC) following CCY. In this study, we aimed to assess the association between CCY and the risk of developing CRC. METHODS:We conducted a retrospective cohort study using the TriNetX research network. We identified adult patients (≥ 18 years) with a history of CCY between 2010 and 2024. These patients were matched using propensity score matching with adult patients without a history of CCY. Matching was based on demographics, comorbidities, and CRC risk factors. The primary outcome was the risk of first diagnosis of CRC that occurred after the index event (cholecystectomy). Secondary outcomes assessed included colon cancer, rectal cancer, and subsite-specific cancers involving the right-sided, transverse, and descending/sigmoid colon. Subgroup analyses were performed by gender and age categories. With censoring applied, Kaplan-Meier analysis with adjusted hazard ratios (aHRs) and 95% CIs was used to compare time-to-event rates at daily time intervals. RESULTS:A total of 613,396 patients with a history of CCY were matched 1:1 to controls (mean age 48.5 ± 18.1 years; 68.1% female; 71.2% White). CRC was more common in the CCY group (1.11 vs 0.61%; aHR 2.16, 95% CI 2.08-2.25; p < 0.001). CRC risk was elevated in both sexes, with a stronger association in males (aHR 2.57, 95% CI 2.41-2.73; p < 0.001) than females (aHR 1.93, 95% CI 1.83-2.04; p < 0.001). CRC risk following CCY was elevated across all age groups, with the highest overall CRC risk observed in patients aged 18-45 years (aHR 2.41, 95% CI 2.01-2.87), with a notably elevated risk for right-sided colon cancer (aHR 4.08, 95% CI 2.91-5.74). DISCUSSION/CONCLUSIONS:Our study showed an association between CCY and increased CRC risk, especially right-sided colon cancer. This risk was higher in males and younger adults, but elevated across all age and sex subgroups.