Faculty Bibliography

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.

Chronic hepatitis B virus (HBV) infection remains a serious global public health concern and a leading cause of liver cirrhosis and hepatocellular carcinoma. Although currently available oral therapies can effectively suppress HBV DNA, there is no approved regimen that has shown to reliably achieve a functional cure. In recent years, various classes of novel therapy for HBV infection have undergone considerable research and advanced to clinical trials, targeting multiple stages of the viral life cycle and systemic immunomodulatory pathways. This article discusses the complex HBV life cycle and highlights emerging therapeutic advances on the horizon for HBV treatment.

SUMMARYThe traditional landscape of dermatophyte infections has changed over the past decade. The emergence and global expansion of Trichophyton indotineae have highlighted the impact of irrational and uncontrolled antifungal and topical corticosteroid use, presented treatment challenges, and highlighted the deficiencies of currently available diagnostic methods. Trichophyton mentagrophytes genotype VII, which has until recently been associated with animal reservoirs, is now associated with human-to-human transmission and is frequently related to sexual transmission. Infections associated with emerging dermatophytes are notable for atypical presentations that may include widespread, inflamed lesions, terbinafine resistance, and frequent relapse. The classic presentation of tinea lesions is frequently obscured by the application of topical corticosteroids, leading to delays in clinical recognition, diagnosis, and appropriate treatment, perpetuating further misuse of topical medications. Deep or invasive dermatophytoses, including Majocchi's granuloma, may occur in immunocompromised patients. The introduction of matrix-assisted laser desorption/ionization-time of flight mass spectrometry and molecular detection of dermatophytes has improved the diagnostic landscape for dermatophytes. However, currently, most assays do not specifically detect T. indotineae or T. mentagrophytes genotype VII, hindering the diagnosis and surveillance. Sequencing of the internal transcribed spacer (ITS) region is required for definitive identification. Terbinafine and azole resistance is common in T. indotineae and increasingly being reported for other species. While nomenclatural changes have been introduced and debated over many decades, the last decade has seen the introduction of new genera, e.g., Nannizzia, Paraphyton, and Lophophyton. An overview of currently recognized dermatophyte species, complexes, and genera is presented here, describing phylogenetic, ecological, and biochemical relatedness. The ethical conundrum of the name Trichophyton indotineae is also discussed.

OBJECTIVE:Mitotane is e first-line medical treatment for adrenocortical carcinoma (ACC). Mitotane has substantial dr awbacks, including severe toxicity and contralateral gland destruction, whilst effective in only 25-30% of ACCs. To improve patient selection for mitotane therapy, this study aimed to identify tissue biomarkers associated with in vitro mitotane response. DESIGN/METHODS:Retrospective cohort study. METHODS:We performed transcriptomic and proteomic analyses on fresh-frozen human ACC tissues classified as responders (n=13), partial responders (n=10), or non-responders (n=7) based on in vitro mitotane-induced inhibition of cell proliferation. RESULTS:Responders showed distinct transcriptomic and proteomic signatures compared with partial and non-responders, whereas fewer differences were found between the latter groups. Integrating transcriptomic and clinicopathological data indicated that responders frequently had cortisol-producing ACC with metastases or nodal involvement. Furthermore, their transcriptomes aligned with aggressive, proliferative ACC subtypes described previously. Differential expression analysis identified 718 genes and 60 proteins that distinguished responders from non-responders. Pathway and network analyses revealed upregulation of cell cycle and collagen related genes and downregulation of mitochondria related genes and proteins in responders. CONCLUSIONS:In summary, transcriptomic and proteomic profiling offers promise to predict mitotane response in ACC. Our findings suggest that responders exhibit features of aggressive ACC, with distinct molecular characteristics that could serve as biomarkers for treatment selection.

The scale and pace of evidence generation in digital psychiatry increasingly exceed the capacity of traditional systematic literature review (SLR) methods. Large language models (LLMs) are gaining traction in evidence synthesis, yet limited guidance exists for integrating generative AI into transparent, reproducible SLR workflows. To develop and evaluate a prompt-driven, modular decision-making framework for adaptable SLR workflows in digital psychiatry, and to compare stage-matched performance relative to a consensus-based human reference process. We conducted a mixed-methods, stage-matched comparative evaluation of three GPT-5 mode variants (Auto, Agent, and Deep Research) against a consensus-based human-led SLR workflow using a registered digital psychiatry review (PROSPERO CRD42025648122) as a case example. Nine SLR tasks were implemented within the ChatGPT interface using structured RISEN prompts: preliminary searches; research question, eligibility criteria, and search strategy development; article screening; data extraction; article summarization; critical appraisals; and descriptive results synthesis. Performance was evaluated using task-specific assessments of accuracy, sensitivity, specificity, inter-rater agreement, reporting compliance, hallucination monitoring, and workflow feasibility. All GPT-5 mode variants were feasible across SLR stages, although performance varied by task and mode. No fabricated study-level content was identified during structured hallucination auditing. Auto mode performed best for structured rule-based tasks requiring efficiency and implementation-ready outputs (e.g., eligibility criteria). Agent mode excelled in conceptual integration and interpretive tasks (e.g., research question generation, critical appraisals, descriptive synthesis). Deep Research mode most closely approximated human reasoning for higher-order synthesis tasks, performing best in full-text article screening, article summarization, and narrative synthesis. Prompt-driven LLM workflows are feasible and semi-efficacious for selected SLR tasks in digital psychiatry when deployed within a modular, human-in-the-loop decision-support framework. Findings support task-specific deployment of an adaptable modular framework, enabling healthcare researchers and clinicians to modify LLM workflows according to methodological appropriateness, confidence in performance, and institutional review practices.

Disparities in deceased donor liver transplantation (DDLT) may be due to geographic imbalances of organ supply-to-demand ratios and/or center organ acceptance practices. We evaluated the relative contribution of centers versus broader geographic units (DSAs/States/OPTN regions/census divisions) to variability of DDLT rate. Using SRTR data on adult, first-time, non-Status1A, period-prevalent waitlist candidates, we conducted multilevel Poisson regression with center-level and donor service area (DSA)-level intercepts to model DDLT rates across three eras: pre-acuity circles (AC)(5/1/2017-4/30/2019), initial post-AC (2/4/2020-2/3/2022), and recent post-AC (02/04/2022-12/31/2024), adjusting for candidate factors. We calculated center-level and DSA-level median incidence rate ratios (MIRRs) and their relative contributions to total geographic variation. DSA-level MIRR declined from _1.471.52_1.58 to _1.321.37_1.42 to _1.171.23_1.28 from pre-AC to initial post-AC to recent post-AC. The center-level, within-DSA MIRR increased from _1.561.61_1.64 to _1.761.82_1.84 to _1.921.96_2.05 across eras. The DSA-level contribution to total center-level variation declined from 43.7% to 21.5% to 8.4% across eras. Similarly, the contribution of other broad, geographic units (States/OPTN regions/census divisions) to total geographic variation in DDLT rates decreased after AC. Further allocation changes are unlikely to substantially reduce geographic disparities because DDLT rate variation is predominantly driven by center-level differences, which were associated with highly variable advanced preservation practices.

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.