Faculty Bibliography

BACKGROUND/UNASSIGNED:Hallux varus is an uncommon pathology with no consensus regarding outcomes following the various surgical techniques available for its management. The purpose of this systematic review was to evaluate clinical outcomes, radiographic parameters, and complications following surgical management of hallux varus. METHODS/UNASSIGNED:During August 2025, the PubMed, Embase, and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following surgical management of hallux varus. RESULTS/UNASSIGNED:Eleven studies comprising 152 patients (159 feet) were included. Among patients treated with soft-tissue procedures, the weighted mean age was 53.5 ± 5.1 years with a weighted mean follow-up time of 35.3 ± 11.1 months. The weighted mean American Orthopedic Foot and Ankle Society (AOFAS) score improved 25.6 points, with corresponding improvements in hallux valgus angle (HVA) of 17.5°. The complication and failure rates were 18.9% and 11.3%, respectively. In the osteotomy cohort, the weighted mean age was 52.4 ± 6.0 years and the weighted mean follow-up time was 44.3 ± 15.6 months. The weighted mean AOFAS score improved 23.7 points, with improvements in of 24.5°. The complication and failure rates were 1.7% and 3.3%, respectively. In the arthrodesis cohort, the weighted mean age was 63.3 ± 0.7 years and the weighted mean follow-up time was 44.2 ± 30.1 months. The mean AOFAS improved 51 points, with improvements in HVA of 25.2°. The overall complication and failure rates were 10.7% and 3.6%, respectively. CONCLUSIONS/UNASSIGNED:Surgical management of hallux varus is associated with meaningful improvements in clinical outcomes and radiographic alignment across a range of operative techniques. No technique could be definitively identified as superior given the absence of comparative studies and variability in reported outcomes. Future studies should prioritize prospective, comparative designs with standardized outcome measures and long-term follow-up to better establish optimal management strategies for hallux varus. REGISTRATION/UNASSIGNED:CRD420261280842 (Prospero identifier). LEVEL OF EVIDENCE/UNASSIGNED:IV, systematic review.

Sports cardiology has emerged as a critical subspecialty within cardiovascular medicine, focusing on the prevention, diagnosis, and management of cardiovascular conditions in athletes and physically active individuals. As participation in both competitive and recreational sports continues to grow globally, physicians increasingly encounter physiologic adaptations to exercise that may mimic pathology. Cardiac magnetic resonance (CMR) has emerged as a cornerstone in the evaluation of athletes with suspected or diagnosed cardiovascular disease. Its ability to provide comprehensive tissue characterization, functional and morphologic assessment makes it uniquely suited for distinguishing physiologic cardiac remodeling from pathologic conditions.

OBJECTIVES/OBJECTIVE:The National Surgical Quality Improvement Program-Pediatric (NSQIP-P) recommends reducing computed tomography (CT) scan use to <25% in children with suspected appendicitis. Our multidisciplinary team developed a pediatric appendicitis clinical pathway that emphasizes the use of ultrasound as first-line imaging and reserves CT for patients with both non-diagnostic ultrasounds and agreement from pediatric emergency medicine and surgery teams. METHODS:For this local study, all cases of patients aged younger than 19 years who were diagnosed with appendicitis from 2021 to 2023 were reviewed, with emergency department (ED) length of Stay (LOS) as a balancing measure. A series of Plan-Do-Study-Act cycles was used to implement the clinical pathway and to involve multiple teams. A Statistical Process Control chart was generated and possible special cause variations were analyzed using Six Sigma rules. RESULTS:Ultrasound was the first-line imaging in over 90% of total cases. However, CT utilization steadily decreased from 39% to 22% by the end of our initiative. This was paralleled by a sharp increase in surgical consults before CT scan order from 21% to 41%, and a decrease in non-diagnostic ultrasounds from 35% to 20% across the 3 years of the study. ED LOS decreased from 538 to 435 minutes on average. In addition, 2 patients underwent an MRI in quarter 4 of 2023, demonstrating its potential in the workflow. CONCLUSIONS:Overall, by implementing a clinical pathway this team was able to significantly reduce CT scan utilization in the diagnosis of pediatric appendicitis. STUDY TYPE AND EVIDENCE LEVEL/UNASSIGNED:Cohort study, level III.

Mesenteric fibrosis (MF) is an extensive fibrotic reaction common in small intestine neuroendocrine tumours (SI-NETs), which develops around mesenteric metastasis. While primary SI-NETs can remain asymptomatic for years, mesenteric metastasis (MM) and the resulting MF frequently leads to serious complications. Despite its clear impact on quality of life, MF pathophysiology remains poorly understood and treatment options are currently limited to surgical interventions. This review summarizes the literature on MF in SI-NET patients, emphasizing gaps in knowledge and potential research directions. Clinical research confirms that MF is a frequent complication, often causing severe morbidity, including mesenteric ischaemia and obstruction. Addressing these issues requires further research into MF pathogenesis and contributory factors, such as Elastic Vascular Sclerosis (EVS), which are currently underexplored. Advancing this field will necessitate collaboration, supported by clear definitions and standardized diagnostic and grading systems for MF linked to clinical data, which are presently lacking. While MF-directed translational research remains scarce, recent studies focusing on tumour microenvironment have begun to uncover possible pathways involved in MF. Serotonin, pro-fibrotic growth factors and cytokines may play a role in activating cancer-associated fibroblasts and immune cells within the tumour microenvironment, aggravating extracellular matrix protein deposition and possibly creating positive feedback loops which promote fibrosis. Recently classified as an organ, the mesentery may harbour unique properties for stimulating the establishment of MF. Emerging research is paving the way for new MF treatment options which are urgently needed.

Current oral food challenge (OFC) protocols for food protein-induced enterocolitis syndrome (FPIES) exhibit significant variability, creating potential for inconsistent diagnostic outcomes and severe reactions. Based on the published evidence and our clinical experience, we propose a practical, standardized OFC dosing protocol that emphasizes patient safety, goals based on age-appropriate servings (AASs), and clinical monitoring. A recent systematic review reported that most patients with persistent FPIES who underwent OFCs reacted to just 25% of an AAS, with low rates of severe reactions. Thus, we recommend that most patients undergoing a medically supervised FPIES OFC receive a cumulative dose of 25% AAS, followed by observation for a minimum of 4 hours. Supervised challenges should be followed by gradual up-titration to an AAS at home. A lower dose may be considered for patients with a history of severe FPIES symptoms to trace amounts of food. For patients with atypical FPIES, we recommend a slightly modified protocol, using graded dosing per IgE-mediated food allergy protocols, followed by extended FPIES OFC monitoring. Anticipated outcomes from implementation of this standardized OFC protocol include improved diagnostic accuracy, enhanced patient safety, and a structured approach to food reintroduction. Standardizing practices for FPIES OFCs will also permit harmonization of data to advance research.

Advances in targeted therapies, immunotherapy, and early detection have revolutionized lung cancer treatment and extended survival. Nonetheless, lung cancer remains highly fatal. Here, we identify knowledge gaps and propose critical areas of future research, aligning with the mission of the AACR Lung Cancer Task Force. We delineate research priorities, including advancing prevention initiatives, enhancing early detection strategies, developing novel treatments, and refining patient stratification. Addressing disparities and increasing efforts on relatively neglected lung cancer subtypes are also essential. Finally, international collaboration, centralized clinical trial databases, novel clinical trial designs, and artificial intelligence-driven analytics should accelerate precision medicine and aid in elucidating drug resistance mechanisms. Together, these efforts promise to improve patient outcomes.

Accelerated 30 min cardiac magnetic resonance (CMR) examinations combining cutting-edge acquisition, reconstruction, and workflow methods have the potential to expand democratization to CMR, increase throughput, enhance patient experience, and maintain diagnostic quality. At the same time, the integration of artificial intelligence into CMR workflow offers additional opportunities to improve planning, acquisition, reconstruction, and post-processing, further enhancing efficiency without compromising quality. Here, we review the rationale, design, implementation, and impact of a streamlined 30 min CMR protocol developed at our institution for ventricular ablation and hypertrophic cardiomyopathy indications.

The CD30 antibody-drug conjugate, brentuximab vedotin, and PD-1 inhibitors, nivolumab and pembrolizumab have transformed the care of patients with Hodgkin lymphoma and have been incorporated into earlier lines of therapy. However, there are limited treatment options for patients with relapsed/refractory disease whose disease has progressed after brentuximab vedotin and checkpoint inhibitors. Novel immunotherapies for patients with relapsed/refractory Hodgkin lymphoma include CAR-T products, EBV-specific T cells, bispecific antibodies, and checkpoint inhibitor combinations. We review the rationale for each and summarize safety, efficacy, and progress in clinical development.

Leptomeningeal disease (LMD) or leptomeningeal metastases (LM) occurs when tumor cells invade the leptomeningeal and cerebrospinal fluid (CSF) space. Melanoma is the most common cancer causing LMD (M-LMD). Its biology and pathophysiology are very poorly understood. Research efforts are being made to explore the mechanisms underlying the immune landscape and antitumor response in LMD. The significant advances in immunocellular and targeted therapies in unresectable or metastatic melanoma in the last decade have not translated to patients with LMD and the prognosis for these patients remains dismal. While several reviews in LMD have provided an overview including challenges in diagnosis and treatment, herein we highlight evidence-based findings with a focus on immunocellular and radiation therapies, as well as the challenges that we need to overcome to help breach the existing gap in research and treatments in M-LMD. This could potentially guide additional research avenues and a better understanding of the needs and challenges of M-LMD to find novel therapies and improve patient survival.