Faculty Bibliography

BackgroundManagement of moderate-to-large (1-2.9 cm²) osteochondral lesions of the talus (OLT) remains challenging due to the transition from reparative to replacement surgical strategies and the absence of high-level comparative evidence guiding treatment selection.MethodsAn international panel of experts participated in a modified Delphi consensus process during the International Congress on Cartilage Repair of the Ankle (ICCRA) meetings held in 2017 and 2025. Survey rounds and structured discussions were used to generate and refine consensus statements. Consensus strength was categorized as consensus (51%-74%), strong consensus (75%-99%), or unanimous (100%), and levels of evidence were graded according to established criteria.ResultsConsensus statements were developed for autologous osteochondral transplantation (AOT), osteochondral allograft transplantation (OCA), scaffold-based cartilage restoration techniques, and emerging extracellular matrix and juvenile cartilage allograft strategies. Autologous osteochondral transplantation was supported as a primary treatment option for cystic, uncontained, and revision lesions, with emphasis on graft continuity and appropriate depth. Osteochondral allograft transplantation was recommended for larger or uncontained lesions and in cases where autograft is contraindicated, with preference for fresh, size-matched grafts used within 28 days. Scaffold-based techniques were identified as viable alternatives in select primary and revision settings, although not superior to AOT for larger lesions. Extracellular matrix cartilage allograft (ECMA) and particulate juvenile cartilage allograft transplantation (PJCAT) potentially enhance cartilage restoration.ConclusionThe ICCRA consensus provides a structured, evidence-informed framework for the surgical management of moderate-to-large OLT. Although multiple treatment strategies demonstrate clinical utility, the current literature remains heterogeneous with limited high-level evidence. Further prospective and comparative studies are warranted to better define optimal indications and long-term outcomes for each approach.Level of Evidence:V, Expert consensus.

UNLABELLED:Structured exercise (SE) and physical therapy (PT) are integral components of disease management. Older adults with inflammatory bowel disease (IBD) represent a growing proportion of patients, and are at disproportionate risk of functional decline due to the combined effects of aging, chronic inflammation, malnutrition, and inactivity. Despite the well-established benefits of SE and PT, most gastroenterologists report feeling inadequately equipped to counsel and refer patients with physical function limitations, and thus these therapies remain underutilized. The purpose of this review is to synthesize the existing evidence and provide practical, actionable guidance for gastroenterologists to incorporate SE and PT into IBD care. RECENT FINDINGS/UNASSIGNED:Initial studies suggest complementary SE and PT may significantly improve IBD-related musculoskeletal extraintestinal manifestations (EIMs), such as joint pain, fatigue, sarcopenia, frailty, and improve exercise confidence as compared with standard care alone. Additionally, multimodal prehabilitation strategies may significantly reduce severe postoperative complications and shorten hospital stays in older patients undergoing IBD-related surgery. SUMMARY/UNASSIGNED:SE and PT are low-cost, low-risk interventions with benefits spanning multiple domains of physical function and morbidity in older adults with IBD. This article highlights pertinent SE and PT literature in the aging IBD population, including underlying pathophysiology, interventions, and scope of practice. Gastroenterologists are provided evidence-based, condition-specific assessments and PT referral pathways that can be implemented in routine practice. Integrating this into the multidisciplinary IBD care team may improve patients' physical function and quality of life.

Asian and Latina survivors of international criminal sex trafficking often face profound mental health challenges, yet research on this group remains limited. This study examines mental health outcomes and correlates among 94 survivors in New York City using a Community-Based Participatory Research approach. Multivariable logistic regression identified factors associated with depression, posttraumatic stress disorder (PTSD), and comorbid symptoms. Survivors reported high rates of depression (41.9%), PTSD (41.3%), and co-occurring symptoms (26.6%). Pain and forced abortion were significantly associated with PTSD and comorbidity. Findings highlight the need for trauma-informed, culturally appropriate mental health interventions addressing pain and reproductive coercion to support survivor recovery.

BACKGROUND:Magnetic resonance (MR) imaging-linear accelerator-based real-time adaptive planning for delivering ultra-hypofractionated stereotactic body radiotherapy (SBRT) has advanced clinical accuracy yet added complexity to the radiotherapy workflow. We retrospectively evaluated whether the addition of a Parallel Automated Contouring module with Enhancement of AI (PACE-AI) reduced contouring time and overall SBRT duration, and its impact on intra-fractional target motion. METHODS:This study included 250 fractions from 90 prostate cancer patients from which fraction time were tracked. All patients received definitive SBRT to the prostate on the 1.5-Tesla Unity (Elekta©) system, through the Adapt-To-Shape (ATS) workflow, which required real-time re-contouring of the normal tissues by the dosimetrists and target contouring by the physician for each of the fractions. We compared the fraction durations for 125 consecutive fractions treated with the incorporation of PACE-AI with 125 fractions previously treated without PACE-AI to determine whether PACE-AI improved efficiency and reduced treatment session duration. RESULTS:For the cohort treated without PACE-AI, the overall median duration was 67.6 min, including 23.9 min contouring time. With the incorporation of PACE-AI, the overall median duration was 51.2 min, representing a 24.3% reduction. The average contouring time was reduced by 55% to 10.8 min. In addition, the extent of positional shifts prior to beam delivery was significantly reduced from an average of 1.8 mm to 1.3 mm (p < 0.001) in both superior/inferior (range reduced from 0 to 6.3 mm to 0-4.2 mm) and anterior/posterior directions (range reduced from 0 to 6.6 mm to 0-5.0 mm). CONCLUSIONS:The incorporation of PACE-AI improved workflow efficiency during SBRT. The reduction in treatment duration also helped reduce organ motion during real-time adaptive planning.

This multicenter, prospective, randomized controlled trial (NCT03285152) evaluates the primary endpoint of feasibility of a very-low carbohydrate diet (VLCD) in 19 women with obesity/overweight and endometrial cancer, who are randomized 2:1 to either a VLCD or a standard diet for 21-28 days. Fifteen participants complete the study, with 91 ± 4% of VLCD meals consumed, 5.5 ± 0.8% weight lost, and no grade 3/4 adverse events. Secondary endpoints include assessments of tumor biology and circulating metabolic biomarkers. Fasting glucose and insulin fall 22 ± 5.9% and 60 ± 3.8%, while total cholesterol and low-density lipoprotein (LDL) rise 6 ± 2.7% and 17.8 ± 8.9%. In a pre-specified exploratory outcome, RNA-Seq shows enrichment of CD8 + T-cells (q < 0.034; NES > 1.75), confirmed by immunohistochemistry (IHC) showing CD8 + T-cells infiltration of the tumor margins (q = 0.034; NES = 1.75). We conclude that VLCD is feasible and well-tolerated.

PURPOSE/OBJECTIVE:The goal of this work is to introduce an automated method to assess the quality of under-sampled MRI reconstructions. THEORY AND METHODS/METHODS:We propose a general framework for pixel-wise uncertainty quantification in accelerated MRI reconstructions, enabling automatic identification of unreliable regions without using ground-truth fully-sampled reference images. Our method integrates conformal quantile regression with learning-based image reconstruction methods to estimate statistically rigorous pixel-wise uncertainty intervals. We trained and evaluated our model on Cartesian undersampled brain and knee data obtained from the fastMRI dataset using acceleration factors ranging from 2 to 10. An end-to-end Variational Network was used for image reconstruction. RESULTS:Quantitative experiments demonstrate strong agreement between predicted uncertainty maps and true reconstruction error. Using our method, the corresponding Pearson correlation coefficient was higher than 90% at acceleration levels at and above four-fold; whereas it dropped to less than 70% when the uncertainty was computed using a simpler heuristic notion (magnitude of the residual). Qualitative examples further show the uncertainty maps based on quantile regression capture the magnitude and spatial distribution of reconstruction errors across acceleration factors, with regions of elevated uncertainty aligning with pathologies and artifacts. CONCLUSION/CONCLUSIONS:The proposed framework enables evaluation of reconstruction quality without access to fully-sampled ground-truth reference images. It represents a step toward adaptive MRI acquisition protocols that may be able to dynamically balance scan time and diagnostic reliability.

Mutations in the gene encoding the microtubule-associated protein tau (MAPT) that are causal for frontotemporal dementia result in nuclear envelope deformation and disrupted nucleocytoplasmic transport when expressed in human neurons. A small-molecule inhibitor of the acetyltransferase NAT10 has been shown to correct similar nuclear membrane defects in Hutchinson-Gilford progeria syndrome, primarily by modulating microtubule dynamics. We report here that NAT10 inhibition and loss of function correct nuclear membrane abnormalities in human MAPT-mutant neurons. Similarly, NAT10 inhibition and haploinsufficiency correct neuronal nuclear shape defects and extend lifespan in vivo in a Drosophila model of tauopathy. NAT10 inhibition changes microtubule dynamics and corrects aberrant nucleocytoplasmic transport, and NAT10 directly interacts with regulators of microtubule dynamics in human MAPT-mutant neurons. We conclude that NAT10 mediates neuronal pathologies in tauopathies and is a potential therapeutic target in these diseases.

INTRODUCTION/BACKGROUND:Neonatal jaundice (hyperbilirubinemia) affects over half of term infants. Although most cases are benign, some progress to severe hyperbilirubinemia, causing acute bilirubin encephalopathy or kernicterus. Early detection is essential. Total serum bilirubin (TSB) is the diagnostic standard, but invasive. Transcutaneous bilirubin (TcB) provides a reliable non-invasive screening tool. The 2022 American Academy of Pediatrics (AAP) guidelines define phototherapy thresholds but do not specify safe discharge bilirubin margins. Understanding outcomes for infants discharged near, but below, these thresholds may help guide follow-up and reduce readmissions. OBJECTIVE:To evaluate hospitalization rates for phototherapy among neonates discharged with TcB values >5.5 mg/dL versus ≤5.5 mg/dL below the AAP phototherapy threshold and assess associations with ethnicity and feeding type. DESIGN/METHODS/METHODS:A retrospective cohort study of 1,848 term and near-term infants discharged from a single birth center (September 2022-September 2024) was conducted. The difference between TcB and the AAP phototherapy threshold was calculated, and infants were categorized as >5.5 mg/dL or ≤5.5 mg/dL below the threshold. The primary outcome was rehospitalization for phototherapy within one week. Analyses included chi-square and t-tests. RESULTS:=53.0, p<0.001). Infants discharged closer to the threshold were nearly seven times more likely to be readmitted. Asian and Hispanic infants had higher bilirubin levels and readmission rates (p<0.05). Exclusive breastfeeding showed a trend toward higher rehospitalization rates (3.3%) than formula (1.4%) or mixed feeding (1.6%) (p=0.061). CONCLUSION/CONCLUSIONS:Infants discharged within 5.5 mg/dL of the phototherapy threshold have a significantly higher risk of rehospitalization for phototherapy. Ethnicity and feeding type may influence risk. Maintaining a discharge margin >5.5 mg/dL and ensuring closer follow-up for higher-risk groups may reduce preventable readmissions and improve management of neonatal jaundice.