Faculty Bibliography

PURPOSE/UNASSIGNED:The purpose was to identify the 100 most-cited scientific publications in ankle cartilage and provide an analysis of their main characteristics. METHODS/UNASSIGNED:The Web of Science (Clarivate) database was searched in April 2025 to obtain data and metrics on ankle cartilage research. The search list was sorted by the number of citations, and articles were included or excluded based on their relevance to ankle cartilage research. The information extracted for each article included the publication year, citation count, author's name, country of origin, journal name, article type, citation density and the level of evidence. RESULTS/UNASSIGNED:The 100 studies generated a total of 17,208 citations, with an average of 172 citations per article. The most-cited article was cited 489 times. The 100 studies included in this analysis were published between 1979 and 2018. In total, these articles represented 13 different countries of origin. The United States represented 38 of the 100 articles. The Netherlands, Italy and Germany followed with nine articles, and South Korea with seven articles. The most prevalent study designs were case series, and the most prevalent level of evidence was Level IV (69 studies). CONCLUSIONS/UNASSIGNED:The present research concludes that the 100 most-cited publications in cartilage lesions of the ankle research were cited a total of 17,208 times. Case series and cohort studies were among the most frequently used study designs with an overall relatively low-level of evidence. The present work may function as a reference standard to help direct orthopaedic providers to the 100 most-cited studies in cartilage lesions of the ankle. LEVEL OF EVIDENCE/UNASSIGNED:N/A.

Food assistance recipients have high smoking rates. Mental health factors that may affect their smoking are understudied. This study examined psychological distress and mental health service use among food assistance recipients enrolled in a smoking cessation trial. The trial sample comprised N = 352 adults aged ≥18, earning below 200% of the federal poverty level, smoking ≥5 cigarettes daily, and receiving public food assistance (e.g. SNAP). Psychological distress was assessed via the Kessler-6. Recent mental health service use (yes/no), therapeutic satisfaction (scale of 1-10), and potential usefulness of mental health services (scale of 1-10) were also assessed. Overall, 23% of participants had severe distress, 53% moderate distress, and 24% no/mild distress. Severe psychological distress was associated with younger age, high levels of financial stress, and food insecurity, but not with tobacco behaviors or motivations. Recent mental health service use was more common among individuals with severe distress, while therapeutic satisfaction was high across all distress levels. Participants who had not received mental health services reported a high level of potential usefulness if they were to receive services, especially among participants with severe distress. Results suggest that food assistance recipients who smoke may have unmet mental health care needs.

PURPOSE/OBJECTIVE:To develop Trainee Attributable & Automatable Care Evaluations in Real‑Time (TRACERs) for inpatient diabetes management, collect validity evidence for their use in formative assessment, and explore performance variation across residents and institutions. METHOD/METHODS:In 2023, a multi‑institutional team created two TRACERs based on type 2 diabetes guidelines-discourage bolus‑only insulin (TRACER #1) and encourage basal (± bolus) insulin (TRACER #2)-for internal medicine residents at three large residency programs. Residents were attributed to inpatient admissions based on placing the most medication orders in the first 12 hours. Structured queries extracted 35 discrete variables from the electronic health record (EHR). Two experts per institution reviewed random admissions (July-August 2022) to establish criterion validity. A retrospective cohort (July 2020-June 2023) added validity evidence. RESULTS:Automated extraction achieved ≥96% sensitivity and ≥95% specificity when compared to manual review. Among 615 residents attributed to 6,192 admissions of patients with type 2 diabetes at high risk for hyperglycemia, TRACER #1 occurred in 42.6% (1,689/3,965) of admissions at Program A, 28.9% (408/1,410) at Program B, and 26.7% (218/817) at Program C. TRACER #2 occurred in 44.9% (367/817) of Program C admissions versus 24.2% (959/3,965) at Program A and 28.2% (397/1,410) at Program B (all P < .001). Four resident-level insulin‑ordering profiles were identified-consistent basal-bolus insulin use (most guideline-concordant), basal-predominant, bolus-predominant, and bolus-only (most guideline-discordant)-with between‑resident variation exceeding between‑program differences. Longitudinally, cohort-level trends masked opposing individual trajectories-some residents improved with exposure while others worsened-and performance tertiles were distinguishable early in training. CONCLUSIONS:TRACERs revealed substantial institution‑ and resident‑level variation in insulin‑ordering practices, including guideline deviations, demonstrating potential for real‑time formative feedback. Multi‑institutional implementation highlighted scalability barriers, including EHR heterogeneity and workflow‑dependent attribution, underscoring the need for continued refinement and broader validation.

OBJECTIVE:This study was conducted to identify patient characteristics and medication factors associated with perceived comfort with migraine treatments and control of migraine symptoms. BACKGROUND:Patient perceptions of migraine treatment influence adherence and outcomes, yet little is known about their underlying drivers. Our study objective was to identify clinical features of migraine associated with comfort and perceived control of symptoms, and medication classes associated with higher patient comfort and efficacy. METHODS:Participants in the Headache Assessment via Digital Platform in United States (HeAD-US) study completed a cross-sectional survey on demographics, migraine burden, mood, disability, and medication use between September and November 2023. Comfort and control were defined using corresponding items from the Migraine Treatment Optimization Questionnaire and categorized as "high" or "low." We compared patient characteristics, clinical features, and medication classes by reported comfort and control. RESULTS:Among 5717 participants (mean age, 41.7 ± 13.0 years; 92.1% female), 58.5% reported high comfort with migraine treatments, whereas only 27.5% reported high control of migraine symptoms. High comfort was associated with fewer monthly headache days (mean, 9.9 vs. 14.2; p < 0.001), lower migraine symptom severity (median Migraine Symptom Severity Score 18 vs. 19; p < 0.001), and lower disability (Migraine Disability Assessment Score, severe: 72.7% vs. 91.2%; p < 0.001) and mood symptom scores (Patient Health Questionnaire-4 severe: 9.5% vs. 21.0%; p < 0.001), as well as income, education, and employment status. High perceived control showed similar associations with monthly headache days (mean, 9.0 vs. 12.7; p < 0.001), migraine severity (median Migraine Symptom Severity Score, 18 vs. 19; p < 0.001), disability (severe: 66.0 vs. 85.8; p < 0.001), and mood symptoms (severe: 7.6 vs. 16.9; p < 0.001), and was associated with employment status but not income or education. Among those on monotherapy, gepants and triptans were associated with higher comfort and efficacy than over the counter medications or opioids/barbiturates/ergots. For preventive therapy, β blockers and botulinum toxin were associated with the lowest perceived comfort and efficacy. CONCLUSION/CONCLUSIONS:Perceived comfort and control were linked to headache frequency, severity and disability, and mood symptoms. Medication class use influenced perceptions, with gepants and triptans rated most favorably. These findings underscore the importance of incorporating patient perspectives into treatment planning, with particular attention to mood, disability, and choice of medication.

Platelets, classically defined by their hemostatic function, are increasingly recognized as immune effectors that shape chronic inflammation and vascular pathology in immune-mediated inflammatory diseases. In conditions such as systemic lupus erythematosus, rheumatoid arthritis, and psoriasis, immune activation skews platelet adhesion, secretion, and procoagulant activity, while persistent interferon signaling and immune complex engagement (via receptors such as FcγRIIA) amplify thromboinflammation. Platelets orchestrate leukocyte recruitment and endothelial activation through P-selectin/PSGL-1 (P-selectin glycoprotein ligand-1) interactions, CD40 ligand, interleukin-1β, and the release of extracellular vesicles carrying cytokines and RNAs. Platelet involvement manifests differently across immune-mediated inflammatory diseases. In systemic lupus erythematosus, they promote type I interferon priming, neutrophil extracellular trap formation, and endothelial dysfunction. In rheumatoid arthritis, they generate abundant synovial microparticles and systemic vascular changes. In psoriasis, they accumulate within skin lesions, enhance platelet-leukocyte aggregation and activate proatherogenic endothelial responses. These pathways promote, independent of traditional cardiovascular risk factors, atherothrombosis including myocardial infarction, stroke, and venous thromboembolism. Limited translational data suggest that hydroxychloroquine may attenuate platelet activation and improve endothelial function. P2Y₁₂ inhibition may blunt interferon-linked platelet RNA signatures and leukocyte-platelet interactions. However, some therapies targeting inflammation, such as Janus kinase inhibitors, may promote thrombosis, the mechanisms of which are not fully known. Advances in multiomics, single-cell and spatial profiling, and in vivo models are delineating targets for intervention and enabling biomarker-driven risk stratification. Collectively, platelets function as central translators between autoimmunity and atherothrombosis. Defining and modulating platelet-immune crosstalk holds the potential to reduce cardiovascular risk in rheumatologic populations.

Granulomatous inflammation of the skin can arise in patients with inflammatory disorders, malignancy, infections, and in reactions to medications or foreign bodies. Granulomatous disorders describe a group of diseases marked by the presence of granulomatous inflammation in the dermis and can be categorized into infectious and non-infectious causes. Inflammatory, non-infectious granulomatous disorders including granuloma annulare (GA), necrobiosis lipoidica, rheumatic nodules, cutaneous sarcoidosis, reactive granulomatous dermatitis (RGD), and necrobiotic xanthogranulomas (NXG) can occur in the setting of underlying systemic disease, and some cutaneous granulomatous disorders, including including GA, RGD and NXG, may rarely be associated with malignancy. Due to the varied clinical and histologic presentations of granulomatous infiltrates, and given rare presentations and ongoing debates regarding strength of disease associations, potential for confusion may arise among clinicians when approaching the diagnosis, differentiation and systemic evaluation of granulomatous disorders. Given the potential of certain granulomatous disorders to herald a new diagnosis of a malignancy, it is imperative that dermatologists approach granulomatous inflammation systemically in order to ensure best patient outcomes. We review clinical presentations and histologic findings of GA, RGD, and NXG and discuss the associations of these granulomatous disorders with malignancy. Further, we provide a framework for clinicians to pursue additional diagnostic evaluation for underlying malignancy in these conditions.

Background A landmark study of 1,600 Italian-Americans in Roseto, PA, challenged the prevailing view that high saturated fat intake was a major cause of myocardial infarction (MI). Despite similar rates of cigarette smoking and obesity, and even higher levels of saturated fat consumption compared to neighboring towns, Rosetans experienced far lower MI death rates. More than 50 years later, it remains uncertain whether Roseto's residents had better heart health than the average American and, if so, what protective factors may have been responsible. Methodology We compared MI deaths in Roseto and neighboring towns to the contemporaneous Framingham Heart Study cohort matched for age and sex. Results We found no evidence that MI deaths were lower in Roseto, PA, than in Framingham, MA when controlling for age and sex. While the role of social support in health has been established in subsequent studies, methodological issues, confounding factors, and biases challenge the validity of the Roseto study. Conclusions The dramatically lower MI and MI mortality rates among males in Roseto reflect biases in sampling and comparison populations, which also impacted the contrasting Diet-Heart Hypothesis that saturated fats cause heart disease. Although social support enhances health outcomes, the Roseto study neither supported nor refuted this connection.

BACKGROUND:Respiratory failure frequently complicates cardiogenic shock (CS), yet the optimal initial ventilatory strategy remains uncertain. Whether a noninvasive ventilation (NIV)-first approach is associated with worse outcomes compared to direct invasive mechanical ventilation (IMV) is unclear. METHODS:We performed a cohort study using a multicenter, nationally representative database including adults with CS who received NIV or IMV on the first hospital day. Patients were categorized as NIV only, direct IMV, or NIV before IMV. Inverse probability of treatment weighting balanced baseline characteristics. The primary outcome was in-hospital mortality. Sensitivity analyses excluded mechanical circulatory support and out-of-hospital cardiac arrest and additionally incorporated lactate adjustment and entropy weighting. RESULTS:Among 81,892 patients with CS, 13.7% received NIV alone, 81.9% direct IMV, and 4.4% NIV before IMV on the first day of admission. In-hospital mortality was 37.2%, 57.7%, and 52.1%, respectively. After adjustment, IMV and NIV before IMV had higher mortality than NIV (absolute risk difference 11.8%, 95% CI 10.4-13.3, and 12.9%, 95% CI 10.6-15.1; both p<0.001). Mortality did not differ between direct IMV and NIV before IMV (risk difference 1.0%, 95% CI -1.0-3.0; p=0.279). Notably, sensitivity analyses including lactate and when stratified by SCAI D shock showed higher mortality with NIV before IMV compared to direct IMV. CONCLUSIONS:Direct IMV and NIV before IMV were associated with worse outcomes than NIV alone. Results for direct IMV compared to NIV before IMV were not consistent between analyses and support the urgent need for a prospective study of respiratory support strategies.