Faculty Bibliography

BACKGROUND/UNASSIGNED:Many overhead athletes, both amateur and professional, experience an increasing number of injuries to the ulnar collateral ligament (UCL) as a result of overuse or trauma. As a result of this increasing frequency, multiple techniques have been developed to reconstruct or repair the UCL with success and faster return to sports (RTS) for athletes who are ideal candidates for a repair. However, a large proportion of UCL tear patients cannot undergo repair due to chronic injury, leading to poor tissue quality, midsubstance tears, or older age, which predispose them to slower healing and a more difficult path to total rehabilitation. The senior author's "hybrid" reconstruction combines a palmaris longus autograft for reconstruction with a repair-style suture brace augmentation that allows for increased load-to-failure strength that parallels the native UCL, while allowing for native anatomic motion of the ligament when ranging the elbow. INDICATIONS/UNASSIGNED:This technique is indicated for patients with a UCL tear confirmed by magnetic resonance imaging, poor to moderate UCL tissue quality, midsubstance tears, and older patients who have a palmaris longus tendon to harvest and persistent ulnar nerve paresthesias. TECHNIQUE DESCRIPTION/UNASSIGNED:This video demonstrates the senior author's technique of harvesting a palmaris autograft, drilling proximal and distal UCL graft passage tunnels, augmenting the graft with an internal suture brace, fixation of the graft, and finally an ulnar nerve transposition to alleviate ulnar nerve paresthesia. RESULTS/UNASSIGNED:Outcomes of retrospective studies demonstrate good to excellent outcomes of UCL hybrid reconstructions with suture brace augmentation and RTS rates of at least 85%. Complication rates are low, with the most common complication being graft failure (14%) and the next most common being temporary ulnar nerve paresthesia. DISCUSSION/CONCLUSION/UNASSIGNED:Overall, this video demonstrates a highly effective technique at restoring native-like biomechanics and function for patients with UCL tears that are too complex to repair. Patients have good to excellent outcomes and RTS rates, although time to RTS may take 12 months or longer. PATIENT CONSENT DISCLOSURE STATEMENT/UNASSIGNED:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

PURPOSE/OBJECTIVE:This study aimed to examine associations of bisphenol and phthalate exposure with arterial stiffness among women of reproductive age. METHODS:Participants include 637 adult women enrolled in the New York University Children's Health and Environment Study (NYU CHES), a prospective pregnancy cohort. The concentrations of eight bisphenols and 22 phthalate metabolites were quantified in up to three spot urine samples. Primary outcomes included brachial artery distensibility (BrachD) and carotid-femoral pulse wave velocity (cfPWV) as measures of peripheral and central arterial stiffness, respectively, along with blood pressure assessed at repeated study visits up to seven years from exposure measures. Associations between averaged, log2-transformed, creatinine-standardized chemical concentrations and subclinical vascular outcomes of interest were examined using linear mixed-effects models. RESULTS:In covariate-adjusted models, a doubling of bisphenol A was positively associated with BrachD (0.09%/mmHg, 95% confidence interval [CI] = 0.02, 0.16), a doubling of bisphenol S was negatively associated with mean arterial pressure (MAP) (-0.52 mmHg, 95% CI = -0.98, -0.05), a doubling of di(2-ethylhexyl) phthalate (DEHP) metabolites was negatively associated with diastolic blood pressure (DBP) (-0.81 mmHg, 95% CI = -1.38, -0.23) and MAP (-0.83 mmHg, 95% CI = -1.45, -0.21), and a doubling of antiandrogenic phthalate metabolites was associated with 0.62 mmHg lower DBP (95% CI = -1.22, -0.03) and 0.66 mmHg lower MAP (95% CI = -1.30, -0.02). CONCLUSION/CONCLUSIONS:These findings suggest that routine exposure to bisphenols and DEHP may be associated with vasorelaxation, potentially related to these chemicals' estrogenic and/or antiandrogenic effects.

INTRODUCTION/BACKGROUND:Vascularized Composite Allotransplantation (VCA) is a reconstructive technique that restores form and function in patients with severe tissue loss from trauma, burns, tumors, or congenital anomalies. Despite improving clinical outcomes, public understanding and acceptance remain barriers to widespread public acceptance. This systematic review examines global public perceptions of VCA, focusing on demographic, cultural, religious, and educational influences on donation. METHODS:A PRISMA-guided systematic review was conducted in June 2025 across PubMed, Embase, MEDLINE, Scopus, and Web of Science. Eligible studies included original surveys or mixed-methods research involving nonexpert participants who reported willingness to donate to VCA. Excluded were studies limited to experts, discussion articles, reviews, abstracts, or commentaries. RESULTS:Twenty studies met the inclusion criteria, representing 19,023 respondents from 8 countries. Overall, there was a lower pooled willingness to donate facial VCA than hand VCA, with pooled willingness estimates of 47.9% and 54.8%, respectively. In contrast, willingness to receive VCA was higher overall, with pooled willingness estimates of 65.6% for facial transplantation and 72.4% for hand transplantation. Religious differences were evident: Christian and agnostic respondents were generally more willing to donate, whereas Muslim respondents were less willing. Racial differences were also noted, with White respondents more likely to donate. In contrast, Black and Asian respondents were less likely to indicate willingness to donate. CONCLUSIONS:This systematic review provides the first comprehensive synthesis of global survey data on public perceptions of VCA. Nearly half of the respondents reported willingness to donate, with higher acceptance of hand donation than of face donation. Racial, ethnic, and religious factors shape attitudes, underscoring the need for culturally tailored educational strategies to improve donation acceptance.

IMPORTANCE/UNASSIGNED:The decision to transfuse a patient with myocardial infarction (MI) and anemia at a higher vs lower hemoglobin threshold must consider the potential benefit of reduced risk of 30-day death or MI and the potential risk of heart failure. OBJECTIVES/UNASSIGNED:To estimate bayesian posterior risk differences and posterior probabilities that a liberal vs restrictive transfusion strategy is associated with reduced risk of 30-day death or MI and whether the probabilities exceed predefined thresholds. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:The Myocardial Ischemia and Transfusion (MINT) trial recruited adults from April 26, 2017, to April 14, 2023, who were hospitalized with MI and anemia at 144 sites in 6 countries. Statistical analysis was performed from July 31, 2024, to February 18, 2026. INTERVENTION/UNASSIGNED:The MINT trial randomized participants to a restrictive (transfuse if hemoglobin is <7 to 8 g/dL) or liberal (maintain hemoglobin at >10 g/dL) transfusion strategy. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Bayesian posterior risk differences were estimated for 30-day death or MI and for heart failure using 3 prior beliefs regarding the treatment strategies: noninformative, liberal strategy superiority, or restrictive strategy superiority. RESULTS/UNASSIGNED:The mean (SD) age of the 3504 participants was 72.1 (11.6) years and 1911 (54.5%) were men. Compared with the restrictive strategy, the risk of 30-day death or MI with the liberal strategy was 1.4% (95% credible interval, -0.8% to 3.5%) to 2.4% (95% credible interval, 0.3%-4.6%) lower, depending on prior beliefs. The probability that the liberal strategy was associated with a lower risk of 30-day death or MI ranged from 89.1% to 98.8%, and the probability that a liberal strategy was associated with at least 1 less death or MI per 100 treated was between 62.7% and 90.4%. Conversely, the risk of heart failure with the liberal strategy was 0.2% (95% credible interval, -1.6% to 1.2%) to 0.6% (95% credible interval, -2.0% to 0.8%) higher compared with the restrictive strategy, depending on prior beliefs. The probability that the liberal strategy was associated with a higher risk of heart failure ranged from 60.6% to 80.0%, and the probability that a liberal strategy was associated with at least 1 more heart failure event per 100 treated was between 13.3% and 29.3%. CONCLUSIONS AND RELEVANCE/UNASSIGNED:This post hoc analysis of a randomized clinical trial of patients with MI and anemia suggests that a liberal transfusion strategy was associated with a lower risk of 30-day death or MI, outweighing the increased risk of heart failure. Consistent with guideline recommendations and according to patients' values and clinician risk assessment, a liberal transfusion strategy may be reasonable. TRIAL REGISTRATION/UNASSIGNED:ClinicalTrials.gov Identifier: NCT02981407.

Working memory (WM), the transient storage and manipulation of information, is a cognitive function that can improve with training. Accumulating evidence suggests that sleep, particularly slow oscillations (SOs) that occur during nonrapid eye movement sleep, supports this improvement. Yet, how sleep and SOs in particular relate to neural processes supporting WM remains poorly understood. In this study, we investigated how WM-related neural activity evolves across nocturnal sleep and how these changes relate to neural processing during SOs. Participants performed a WM task during fMRI before and after sleep, with simultaneous EEG-fMRI capturing neural activity during the first 2.5 hr of sleep. Our results showed significant overnight changes in WM-related activity, characterized by reduced recruitment of the dorsal precuneus during WM encoding/maintenance phases and frontal regions during the retrieval phase of WM. In addition, sleep increased item-specific reinstatement in a sensory processing region during WM. This pattern of results suggests a combined influence of sleep on enhancing sensory reinstatement while reducing potential top-down control (i.e., reduced parietal and frontal activity). Critically, SO-related activity was directly linked to overnight activity changes: Stronger SO activation in the premotor cortex and ventromedial pFC predicted greater overnight reductions in WM-related activity, and multivoxel analyses in the ventral attention network revealed a parallel relationship. These findings suggest that SOs play a critical role in WM function by facilitating the reorganization of WM-related processing.

INTRODUCTION/BACKGROUND:Patients with a suspected high-consequence infectious disease (HCID), such as Ebola virus disease, may require routine laboratory testing to guide management. We assessed the capabilities of frontline hospitals and the barriers they face performing laboratory testing for patients with a suspected HCID. METHODS:A one-time confidential REDCap survey querying capabilities to safely perform laboratory tests that the Centers for Disease Control and Prevention considers critical for patients with a suspected HCID was sent to 95 institutions in Baltimore, MD, Boston, MA, New York City, NY, and Washington, DC, from January to May 2025. RESULTS:Fifty (53%) institutions responded, mostly teaching hospitals (96%), with 24% reporting prior experience evaluating a patient with suspected Ebola virus disease. While many hospitals could perform on-site blood gas (70%), hemoglobin/hematocrit (68%), and lactate (68%) tests on a suspected HCID patient, fewer could safely perform a chemistry panel (64%), a urinalysis (60%), a complete blood count with differential (56%), and a malaria rapid diagnostic test (RDT) (48%) on a suspected HCID patient. The five tests respondents most often considered extremely or very important were hemoglobin/hematocrit (91%), chemistry panel (90%), CBC with differential and platelet count (89%), malaria RDT (88%), and blood gas (88%). Reported barriers to performing routine laboratory testing included issues related to patient and staff safety, infection control, lack of appropriate space, and funding. CONCLUSIONS:Our survey identified several barriers to implementing safe laboratory testing. The inability to conduct these laboratory tests may result in delays in care when an HCID is suspected.

OBJECTIVE:To assess the perceived clinical impact of radiologist staffing shortages across the U.S. and identify potential short- and long-term solutions. METHODS:A 26-question survey on breast imaging staffing shortages was distributed to active Society of Breast Imaging physician members from May 31, 2024, to June 28, 2024. Questions regarding the impact on patient care and radiologist wellbeing, as well as potential solutions, were included. Bivariable analysis (chi-squared) was performed between the survey demographics and survey response questions of interest. RESULTS:Of 226 respondents who felt understaffed in their practice due to an insufficient number of radiologists, the most frequently reported impact on patients was delayed diagnostic imaging (171/226, 75.7%) and procedures (155/226, 68.6%). The most frequently reported impacts on radiologists were increased stress (198/226, 87.6%), working hours (173/226, 76.6%), and burnout (173/226, 76.6%). As a perceived consequence, 56.2% (127/226) of respondents reported colleagues transitioning to part-time and 35.8% (81/226) reported colleagues switching practice types. To mitigate effects of understaffing, the most frequently reported short-term strategy was offering moonlighting (100/226, 44.2%), whereas offering part-time employment was the most frequently reported long-term strategy for retaining (86/226, 38.1%) and recruiting (120/226, 53.1%) radiologists. Over one-third (77/226, 34.1%) of respondents reported using advanced practice providers, most often for procedural support and patient navigation. CONCLUSION/CONCLUSIONS:Understaffed breast radiologists often perceived delays in patient care and increased levels of physician burnout. Moonlighting and part-time opportunities may mitigate these effects in the short and long-term, respectively.

The integrated stress response (ISR) coordinates cellular adaptation to diverse stress conditions. In Drosophila, two bZIP transcription factors, Xrp1 and crc (ATF4 homolog), are induced during ISR. Crc protein can dimerize with two CEBP factors in vitro, but the in vivo relevance of those interactions remained unknown. Here, we report that the CEBPG homolog, Irbp18, is an essential partner of crc during ISR. Specifically, Irbp18 is broadly required for the transcriptional induction of ISR target genes in the photoreceptors of ninaE^G69D, a Drosophila model of retinitis pigmentosa. Moreover, CUT&RUN analysis indicates that Irbp18 loss reduces or abolishes crc binding to target DNAs in photoreceptors and impairs crc's ability to induce target transcripts upon overexpression. Functionally, Irbp18 loss causes retinal degeneration and suppresses ISR signaling in parkin mutants, a model of Parkinson's disease. Together, these findings identify Irbp18 as a cofactor for crc, impacting pathological outcomes in Drosophila models of degeneration.

OBJECTIVE:To estimate the cumulative probability of achieving at least one live birth (LB) after up to six sequential single euploid embryo transfers (euploid SET) and characterize per-transfer outcomes to inform evidence-based counseling for patients undergoing in vitro fertilization (IVF) with preimplantation genetic testing for aneuploidy (PGT-A). DESIGN/METHODS:Retrospective cohort study. SETTING/METHODS:University-affiliated fertility center. SUBJECTS/METHODS:Patients who underwent IVF with PGT-A followed by euploid SET between January 2014 and December 2024. EXPOSURE/METHODS:Up to six sequential euploid SETs until a live birth was achieved, or the patient discontinued additional transfers. MAIN OUTCOME MEASURES/METHODS:Estimated cumulative probability of achieving ≥1 LB and per-transfer rates of live birth, spontaneous abortion, biochemical pregnancy, and non-pregnant. RESULTS:Among 5811 patients undergoing 7763 euploid SETs attempts, the estimated cumulative probability of a LB increased from 63.1% after one SET to 92.0% after three, 98.3% after five, and 98.8% after six SETs. Per-transfer live birth rate declined from 63.1% at the first euploid SET to 54.0% at the second, then remained stable across subsequent attempts. Rates of spontaneous abortion, biochemical pregnancy, and non-pregnant followed a similar trend. Fewer than 5% of patients met criteria for recurrent implantation failure after three euploid SETs, and fewer than 2% remained without live birth after five SETs. CONCLUSION/CONCLUSIONS:Continued sequential transfer of euploid embryos is supported as the primary management strategy after early transfer failure. For patients able to generate an adequate euploid embryo inventory aligned with their individual risk tolerance, persistence with treatment is associated with a high likelihood of achieving a live birth.

PURPOSE/OBJECTIVE:Optical coherence tomography angiography (OCTA) has enabled detailed in vivo imaging of macular neovascularization (MNV) in neovascular age-related macular degeneration (nAMD), leading to a proliferation of morphological descriptive terms. This scoping review aimed to systematically map the existing literature on OCTA-based MNV morphology and evaluate its correlation with disease activity. METHODS:A systematic literature search covering publications through 2025 was performed. After screening 2,445 titles and obtaining 60 full texts, 43 studies were included. Data on morphological terminology, study design, and correlation with disease activity were extracted and synthesized. RESULTS:The included studies, encompassing a total of 2,712 eyes, identified a vast and heterogeneous lexicon of qualitative descriptors, including terms such as "medusa," "sea-fan," and "glomerulus", characterized by significant terminological overlap and inconsistent definitions across studies. Inconsistent, low-certainty associations between specific OCTA morphologies and MNV activity were identified across studies, with findings limited by significant methodological heterogeneity. The evidence for these patterns as reliable biomarkers of disease activity is weak and often contradictory, and several studies were found to use OCTA features to define activity, creating circular arguments that undermine their conclusions. CONCLUSION/CONCLUSIONS:The current terminology for OCTA morphology in nAMD is fragmented and inconsistently applied. The link between these patterns and disease activity is poorly established, severely limiting their clinical utility. These findings highlight a need for a standardized, consensus-based framework for describing and interpreting OCTA findings in nAMD.