Faculty Bibliography

BACKGROUND/UNASSIGNED:Pneumatic tourniquets are routinely used in upper extremity surgery to create a bloodless operative field, often at a standard pressure of 250 mm Hg. However, high pressures may lead to complications, including tissue damage and increased pain. This study investigates whether tailoring tourniquet pressures to individual systolic blood pressure (SBP) can achieve comparable surgical field visualization while reducing inflation pressure. MATERIALS AND METHODS/UNASSIGNED:-tests. RESULTS/UNASSIGNED: = 0.27). Tourniquet adjustments were rare (2.13%, intervention only). CONCLUSION/UNASSIGNED:SBP-based tourniquet pressures effectively maintain surgical field visualization at lower pressures without compromising safety or increasing pain. These findings support wider adoption of this method and warrant further large-scale studies.

BACKGROUND AND OBJECTIVES/OBJECTIVE:Circumferential minimally invasive surgery (cMIS) techniques in adult spinal deformity (ASD) surgery may reduce physiological burden compared with open technique, but their utility in octogenarians has not been previously assessed. METHODS:Operative ASD patients aged 80 years or older with complete baseline (BL) and 2-year postoperative radiographic and health-related quality of life data were assessed and compared by surgical technique: open vs cMIS. Propensity score matching aligned groups by BL Charlson Comorbidity Index (CCI), C7-S1 sagittal vertical axis, pelvic incidence minus lumbar lordosis mismatch, and C7 plumb line. BL and peri/postoperative factors were assessed using analysis of variance and Bonferroni-adjusted analysis of covariance while controlling for BL CCI and posterior fusion length. RESULTS:Thirty-four octogenarian ASD patients met inclusion criteria, of whom 29.4% underwent cMIS and 70.6% underwent open correction. cMIS patients were less likely to require surgical intensive care unit (10% vs 75%, P < .001) and had shorter hospital stays (4.6 vs 10.1 days, P = .013). Open patients reported higher Scoliosis Research Society-22 Appearance and Mental domain scores (both P < .005) and more frequently reached minimal clinically important difference in both domains by 2 years (P = .025, .024). cMIS patients more often required reoperation for radiographic sagittal imbalance by 2 years when controlling for CCI and levels fused (20.0% vs 8.3%, P < .001). No deaths occurred in either group by 2 years. CONCLUSION/CONCLUSIONS:In octogenarians undergoing ASD surgery, cMIS reduced physiological burden but had higher reoperation rates, whereas open surgery showed greater durability.

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.

The rapid pace of innovation in synthetic biology and genome engineering elicits a need to reevaluate systems of oversight to ensure that biosafety and biosecurity safeguards are keeping up. Accordingly, the regulation of nucleic acid synthesis, an enabling technology for synthetic biology and genome engineering, is a current focus of political debate in the United States. However, to develop appropriate governance that neither under- nor overregulates technological development, policy leaders must also appreciate how advances in synthetic biology and genome engineering are being employed in the interests of biosecurity to support human health, manufacturing, food security, ecosystems and the natural environment. Synthetic biology can support the development of new therapeutics and health technologies, alternative biomanufacturing methodologies, food and agricultural innovations, environmental biosensors for monitoring infectious and toxic agents, and interventions aimed at preserving and restoring our natural environment. This Perspective provides an overview of current and potential benefits of synthetic biology and genome engineering, aiming to balance the broader societal discussion of potential risks-particularly in this special issue of the journal-with potential social, economic, and environmental value to individuals and society at large.

Conventional imaging techniques lack the resolution and sensitivity to adequately characterize cerebral small-vessel abnormalities (CSVA) in vivo. This study aimed to overcome these limitations and evaluate the feasibility of a novel MRI technique called Microvascular In-vivo Contrast Revealed Origins (MICRO), which uses an ultrasmall superparamagnetic iron oxide (USPIO) contrast agent (Ferumoxytol) to resolve the cerebral microvascular architecture with a level of anatomical and physiological detail not previously achievable in vivo. Fifty-nine Parkinson's disease (PD) patients underwent MICRO MRI based on susceptibility-weighted imaging (SWI). Three independent raters identified and categorized CSVAs as large developmental venous anomalies (DVAs), micro DVAs, engorged vessels, and diminished vessels. The location of each CSVAs was documented, and its association with white matter hyperintensities (WMHs) was assessed. The MICRO imaging protocol demonstrated excellent inter-rater agreement for identifying these CSVAs. Our findings show a high prevalence of CSVAs in PD patients, with engorged vessels being the most common type (49.06% of subjects). Both engorged vessels (72.41%) and micro DVAs (81.82%) were highly associated with WMHs. CSVAs were most frequently observed in the periventricular white matter (n=28), deep white matter (n=32), and putamen (n=14), suggesting regional distribution pattern of detectable CSVAs. This work establishes MICRO as a feasible, reliable platform for in vivo microvascular mapping with potential applications in neurovascular research.

The Cardiovascular-Kidney-Metabolic (CKM) framework recognizes the interconnected biological, clinical, and societal drivers of cardiovascular disease, chronic kidney disease, diabetes, and obesity. To advance an integrated perspective, aligned with the kidney community focus, the International Society of Nephrology (ISN) convened an International Expert Forum bringing together a global and multidisciplinary team of leaders in this field. This meeting report synthesizes key discussions spanning CKM risk stratification, lifestyle interventions, guideline-directed medical therapies, emerging late-stage therapeutics, and models of care delivery. Participants emphasized the importance of early, integrated case-finding; long-term, joint kidney-cardiovascular risk assessment; and timely use of evidence-informed therapies to reduce kidney disease progression, kidney failure, and cardiovascular events. Persistent gaps including therapeutic inertia, fragmented care, and global inequities in access to care were highlighted, alongside promising multidisciplinary and system-level care models. Emerging therapies targeting residual risk further underscore the need for adaptive implementation strategies. Aligned with ISN's mission, this forum represents a foundational step toward connecting disciplines, bridging evidence-to-practice gaps, and building global capacity to improve equitable CKM outcomes.

Mistreatment of trainees in graduate medical education (GME) persists despite Accreditation College of Graduate Medical Education (ACGME) standards. Mistreatment disproportionately affects minoritized trainees and undermines their well-being and abilities to provide empathic patient care. The authors conducted a scoping review to identify existing structures-education/trainings and programs/policies-to mitigate harm from and address perpetrators of mistreatment, and to map gaps to guide practice and research. They searched PubMed and Embase for US-based, English-language studies (January 2015-July 2025). References were screened independently and in duplicate. Included studies described educational/training interventions or programs/policies, or proposed a structural approach focused on addressing mistreatment of trainees. Of 856 records, 71 studies (41 articles, 30 abstracts) were included: 56 education/trainings and 15 programs/policies. Trainings reached 3909 learners, were predominantly single-session, and commonly used case-based discussion, role-play, and simulation. Assessments relied largely on immediate self-report of knowledge, skills, or attitudes; few used objective measures or longitudinal follow-up. Programs and policies encompassed real-time reporting tools, communication campaigns, co-created protocols, and task forces all focused on addressing mistreatment after the fact. Outcomes included increased reporting volume of mistreatment, characterization of perpetrators, and identification of concentrated areas of mistreatment within the health system, trainee perceptions, and feedback loops. Mapping of the literature revealed many education/training interventions and fewer programs/policies. A significant gap remains because too strong a focus exists on teaching trainees-the targets of mistreatment-to manage the mistreatment after the fact, rather than implementing trainings and programs to proactively prevent learner mistreatment. The authors suggest opportunities including perpetrator-focused, non-punitive trainings, longitudinal skills reinforcement in the clinical learning environment, transparent measurement, and a continuous quality improvement approach to both preventing and recovering from mistreatment. Addressing mistreatment will require institutional policies and comprehensive, equity-informed structures with objective assessment, shifting focus from resilience after harm to prevention at its source.

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.

BACKGROUND/UNASSIGNED:Re-recurrent rectal cancer (RRRC) represents a highly complex disease following curative-intent treatment of recurrent rectal cancer (RRC). While management principles for primary and locally recurrent rectal cancer (RRC) have been defined by expert collaborations, no specific guidelines currently outline the perioperative management of RRRC. This systematic review aimed to appraise the reported perioperative strategies and oncological outcomes of patients undergoing curative-intent treatment for RRRC. METHODS/UNASSIGNED:Eligibility criteria, Studies reporting perioperative management and outcomes of adult patients undergoing curative-intent treatment for RRRC were included. Non-English articles, letters, abstracts, and studies lacking surgical or oncological data were excluded. Information sources, The review was conducted according to PRISMA guidelines and registered in PROSPERO (CRD420251244390). MEDLINE (PubMed), Cochrane Library, Web of Science, and Scopus were searched for relevant articles. Risk of bias, Methodological quality was assessed using the Newcastle-Ottawa Scale for cohort studies. Synthesis of results, Given heterogeneity in treatment strategies and outcome reporting, results were synthesized narratively. RESULTS/UNASSIGNED:Included studies, Three retrospective cohort studies comprising 169 patients treated with curative intent surgery for RRRC were included. Synthesis of results, Neoadjuvant therapy was administered in 20-92% of included patients, depending on the previous cumulative radiation dose. Pelvic exenteration was frequently required, with total exenteration performed in 6-20% and sacrectomy in up to 15% of cases; reconstructive procedures were reported in less than 16%. IORT was used in 44-77% of patients in centers where it was available. R0 resection rates ranged from 33% to 62%, with oncological outcomes directly associated with margin status. DISCUSSION/UNASSIGNED:Limitations of evidence, Evidence was limited to retrospective observational studies with small sample sizes, heterogeneous management, and varied institutional resources, precluding meta-analysis. Interpretation, Curative-intent surgery for RRRC is feasible in highly selected patients, with R0 being the principal prognostic determinant of oncological outcome. However, significant variability in perioperative pathways, margin definition, MRI-based classification, and reconstructive strategies underlines the necessity for the development of standardized, consensus-based recommendations to optimize multidisciplinary treatment. SYSTEMATIC REVIEW REGISTRATION/UNASSIGNED:https://www.crd.york.ac.uk/PROSPERO/view/CRD420251244390, identifier CRD420251244390.