Faculty Bibliography

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.

STUDY DESIGN/METHODS:Retrospective cohort study. OBJECTIVES/OBJECTIVE:This study aimed to determine whether substance abuse among adolescent idiopathic scoliosis (AIS) patients is associated with increased odds of subsequent new-onset mental health disease (MHD). SUMMARY OF BACKGROUND DATA/BACKGROUND:MHD prevalence in patients with a substance abuse history has been well-described. However, the impact of current or historical substance abuse/dependence in AIS patients on the risk of subsequent development of new-onset MHDs is unknown. METHODS:The New York SPARCS database was reviewed to identify all 10-25-year-old AIS patients and stratified by prior or concurrent substance abuse (AIS-Sub) versus no history of substance abuse (AIS-NoSub). Cohorts were 1:1 propensity score-matched, and various comparisons were made, including incidence of subsequent MHDs. Binary stepwise logistic regressions were utilized to calculate odds ratios (OR) of developing any MHDs based on baseline substance abuse. RESULTS:386 AIS patients were included (193 AIS-Sub and 193 AIS-NoSub). At baseline, there were no significant differences between patient cohorts in demographic factors. AIS-Sub patients had higher rates of new-onset subsequent overall MHDs (16.1% vs. 3.6%, P<0.001), with only depressive disorder showing a significantly higher incidence when examining individual MHDs (10.9% vs. 0.5%, P<0.001). Logistic regression analyses revealed that baseline substance abuse was independently associated with subsequent diagnosis of either any MHD (OR=6.8, 95% CI: 2.6-17.3, P=0.001), or new-onset depressive disorder (OR=47.0, 95% CI: 3.9-568.7, P=0.002); but was not associated with the development of anxiety, stress, sleep, or eating disorders. CONCLUSIONS:AIS patients with prior or current substance abuse/dependence were at increased 2-year risk of developing any new-onset MHD, specifically depressive disorders. This data may guide preoperative screening and optimization efforts for surgeons, as MHDs have been associated with poor outcomes following spine surgery. LEVEL OF EVIDENCE/METHODS:Level III-retrospective cohort study.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with marked clinical heterogeneity and a multifactorial pathogenesis. Environmental and lifestyle factors, including obesity, tobacco exposure, microbiome dysbiosis, dietary patterns, and plastic-associated endocrine disruptors, have all been linked to HS risk or disease severity. However, these exposures alone do not fully explain why only some individuals develop HS, why age at onset and severity vary substantially, or why disease occurs in patients without major identifiable environmental burden. In parallel, genetic studies have demonstrated that inherited susceptibility is a central component of HS pathogenesis. Rare loss-of-function variants in γ-secretase complex genes cause a small subset of familial, autosomal dominant HS, while genome-wide association studies have shown that population-level risk implicates pathways involved in epithelial differentiation, follicular biology, immune signaling, and cutaneous inflammation. Recent work further suggests that common and rare genetic risk may converge on shared biological mechanisms, including γ-secretase-related signaling. While nature vs. nurture arguments dichotomize genetic constitution and environmental exposures, current evidence supports a model in which genetic susceptibility interacts with environmental exposures to shape HS risk, clinical expression, and disease progression. In this review, we examine the evidence supporting both exposomic and genomic contributions to HS and argue that the disease is best understood as arising from their intersection rather than from either domain alone.

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.

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 Studies have reported the value of contrast-enhanced mammography (CEM) for screening women at increased risk for breast cancer, based on prevalence ("baseline") screening. Purpose To compare the performance of CEM between prevalence and incidence screens in women at increased risk for breast cancer. Materials and Methods This retrospective study included CEM screens from January 2015 through December 2021. Screens were categorized as prevalence if there was no prior breast MRI in the past 3 years or no prior CEM; all others were incidence screens. Performance metrics, including cancer detection rate (CDR), incremental CDR (cancers found through enhancement on recombined images with negative low-energy [26-30 kVp] images), sensitivity, specificity, positive predictive value, negative predictive value, and accuracy, were compared between prevalence and incidence screens. Reference standards for malignant and benign results were biopsy or negative imaging follow-up in 1 year. P values were estimated using a generalized estimating equation model. Results Of 6911 screens in 2756 women (median age, 52 years [IQR, 46-58 years]), 1575 (22.8%) were prevalence screens and 5336 (77.2%) were incidence screens. Adjusting for the number of screens per individual, there was no evidence of a difference in CDR between prevalence and incidence screens (19 cancers per 1000 prevalence screens vs 11.6 cancers per 1000 incidence screens; P = .65) or in incremental CDR (11.4 per 1000 prevalence screens vs 6.7 per 1000 incidence screens; P = .10). Incidence CEM had higher specificity than prevalence CEM (91.5% [95% CI: 90.7, 92.2] vs 83.4% [95% CI: 81.6, 85.4]; P = .008), and higher accuracy (91.4% [95% CI: 90.6, 92.2] vs 83.5% [95% CI: 81.7, 85.4]; P = .01). Contrast enhancement alone helped detect 18 of 30 (60%) cancers during prevalence screening and 36 of 62 (58%) during incidence screening. Conclusion CEM continues to help detect cancers during incidence screening with improved specificity compared with prevalence screens. © RSNA, 2026 Supplemental material is available for this article. See also the editorial by Freitas in this issue.

OBJECTIVE:To evaluate the feasibility of same-day (postoperative day 0; POD0) physical therapy (PT) following lumbar fusion and to identify factors associated with failure to participate. METHODS:This retrospective study analyzed prospectively collected data from patients undergoing single-level posterior spinal fusion (PSF), with or without anterior (ALIF) or lateral (LLIF) interbody fusion, between January and December 2024 at a single institution. A standardized POD0 PT protocol was implemented for eligible patients. Patients were categorized into two groups: successful POD0 PT (ambulatory on POD0) and unable to participate. Demographic and surgical variables were compared between groups. Reasons for inability to participate were recorded and categorized. RESULTS:Among 129 patients in whom POD0 PT was attempted, 84 (65%) successfully participated, while 45 (35%) were unable. There were no significant differences in age, sex, BMI, ASA class, operative time, estimated blood loss, or surgical approach between groups. Patients who successfully completed POD0 PT had a significantly shorter hospital length of stay compared to those who did not (3.4 ± 1.6 vs 5.8 ± 2.9 days, P < 0.001), with no differences in complication rates, discharge disposition, emergency department visits, or reoperation rates. The most common barriers to POD0 PT were postoperative pain, medical issues (e.g., orthostatic hypotension, nausea, dizziness), and anesthesia-related somnolence. Less common factors included postoperative restrictions and logistical issues such as brace availability. CONCLUSIONS:POD0 PT following lumbar fusion is feasible in the majority of patients and is associated with a shorter hospital stay without increased complications. Failure to participate was not associated with the baseline patient or surgical characteristics evaluated in this study. Instead, the most common barriers were postoperative pain, transient medical issues, and anesthesia-related somnolence, suggesting that optimization of modifiable perioperative factors may improve the implementation of POD0 PT.

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 systematically review and meta-analyse the available evidence comparing perioperative outcomes between small- (≤6.3/7.5 F) and large-calibre (≥7.5/9.8 F) ureteroscopes. METHODS:A literature search of MEDLINE/PubMed, and Scopus was performed prior to March 2026 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The endpoints of interest were stone-free rates (SFRs), overall complications, and operative time. Study quality and risk of bias were evaluated using the Newcastle-Ottawa Scale and the Revised Cochrane Risk of Bias Tool for Randomised Trials for non-randomised and randomised studies. Sensitivity analyses were completed on studies reporting flexible ureteroscopes only, 7.5- vs >7.5-F ureteroscopes, and on randomised controlled trials (RCTs). RESULTS:Eight studies were included in the meta-analysis. Of those, four were RCTs while four were retrospective. Specifically, three studies compared 6.3- vs 7.5-F ureteroscopes, one 6.3- vs 8.5-F ureteroscopes, one 6- vs 7.5-F ureteroscopes, while three compared 7.5- vs >7.5-F ureteroscopes. Within the meta-analysis comparing 6.3- vs 7.5-F ureteroscopes, the small-calibre ureteroscopes were associated with a risk ratio [RR] for SFR of 0.99 (95% confidence interval [CI] 0.92-1.06), of 1.08 (95% CI 0.77-1.51) for overall complications, and a standardised mean difference in operative time of -14.5 min (95% CI -33.4 to 3.3 min). These results were virtually confirmed by all sensitivity analyses. No differences in the above outcomes were recorded for the comparison between 7.5- vs >7.5-F ureteroscopes. CONCLUSIONS:Within the present meta-analysis, the small-calibre ureteroscopes achieved comparable outcomes to large-calibre ureteroscopes. To overcome the substantial heterogeneity and residual confounding across studies, well-designed and adequately powered RCTs are required.