Faculty Bibliography

BACKGROUND:There is little data on the relationship between socioeconomic factors and immunotherapy in advanced cutaneous squamous cell carcinoma of the head and neck (cSCCHN). METHODS:Our study analyzed patients with Stage IV cSCCHN diagnosed between 2018-2026 using the EPIC Cosmos database. Socioeconomic status was measured based on the social vulnerability index (SVI) and corresponding themes. Immunotherapy receipt was evaluated with Robust Poisson models. RESULTS:A total of 1140 patients were identified with Stage IV cSCCHN, with 338 (29.6%) of whom received immunotherapy. Higher SVI was associated with a lower likelihood of receiving immunotherapy (incidence rate ratio = 0.96). Patients in the most vulnerable overall SVI quintile had a 29% lower rate of receiving immunotherapy compared to the least vulnerable quintile (p = 0.018). Participants' race/ethnicity, insurance status, and urbanicity were not significantly associated with immunotherapy receipt. CONCLUSION/CONCLUSIONS:Increased social vulnerability is associated with reduced likelihood of treatment with immunotherapy among patients with Stage IV cSCCHN.

Systemic lupus erythematosus (SLE) frequently presents joint pain and stiffness, yet clinicians lack an objective, rapid method to quantify joint inflammation at the point of care. We introduce the Lupus Optical Tomography Imaging System (LOTIS), a wearable near-infrared (NIR) device that performs real-time three-dimensional tomographic imaging of hemodynamic changes in finger joints. LOTIS was developed to address key limitations of our earlier Flexible Optical Imaging System (FOIS), including mechanical fragility, high noise levels, single-joint acquisition, and slow reconstruction times. The new system integrates modular, mechanically robust optical patches with on-sensor digitization and a computationally efficient, non-iterative multispectral reconstruction algorithm to produce frame-by-frame maps of hemoglobin concentration. In a preliminary study using a standardized venous-occlusion protocol, LOTIS differentiated SLE-affected joints from those of healthy controls. Diseased joints exhibited blunted and spatially diffuse hemodynamic responses, whereas healthy joints showed localized and robust changes. These results demonstrate that LOTIS provides an operator-independent, patient-friendly method for quantifying joint-specific hemodynamic changes in real time, offering strong potential as a clinical tool for objective assessment and longitudinal monitoring of lupus arthritis.

BACKGROUND:Astroblastomas are rare brain tumors predominantly affecting children and young adults, for which molecular subtypes and clinical management remain undefined. METHODS:We analyzed tumor samples, molecular profiles, and clinical data from 200 patients, classified as "Astroblastoma, MN1-altered" under WHO criteria, using DNA methylation profiling, DNA/RNA profiling/sequencing, and survival analyses. RESULTS:DNA methylation analyses identified 3 groups: Group A (n = 143, characterized by MN1::BEND2 fusions, predominantly supratentorial location, with striking female predominance and favorable survival); Group B (n = 37, epigenetically and transcriptionally closely related to Group A, but characterized by EWSR1::BEND2 fusions, with spinal and infratentorial locations and poor prognosis); and Group C (n = 20, epigenetically and transcriptionally distinct, characterized by MN1::CXXC5 fusions, exclusively supratentorially located, with favorable survival). Progression-free and overall survival were significantly shorter in Group B (5-year PFS 14%; 10-year OS 54%) compared to A (5-year PFS 47%; 10-year OS 89%) and C (5-year PFS 75%; 10-year OS 89%). Radiotherapy improved PFS in Group B (hazard ratio 0.25), while no clear benefit was identified for Groups A and C. CONCLUSIONS:Astroblastoma, MN1-altered, comprises 3 molecularly and clinically distinct groups, characterized by different fusion genes, including those without MN1. These new insights, including the identification of potential predictive biomarkers like 14q/16q loss, provide a framework for the development of risk-stratified therapeutic approaches. Importantly, we identified a molecularly defined high-risk group that benefits from radiation therapy. Our findings redefine Astroblastoma as a molecularly diverse tumor type, propose a refined classification, support the development of risk-adapted therapeutic strategies and provide a rational standard of care.

The mucosal-associated lymphoid tissue (MALT)-International Prognostic Index (IPI) is widely applied to estimate outcomes in patients with extranodal marginal zone lymphoma (EMZL) of MALT. Although it was developed in the context of the IELSG-19 trial exclusively in patients treated with chlorambucil, rituximab, or their combination, it is commonly used across virtually all disease settings. However, its applicability beyond contexts resembling the IELSG-19 trial remains debated, and several studies have proposed modifications to improve prognostic precision in EMZL. Here, we retrospectively analyzed 498 patients with newly diagnosed EMZL at the Medical University of Vienna with the dual objective of evaluating the prognostic performance of the MALT-IPI across clinical subgroups, and to assess whether incorporation of autoimmunity could refine risk stratification. Stratification by the MALT-IPI revealed significantly longer progression-free survival (PFS) and overall survival (OS) in patients who were low-risk compared with intermediate- and high-risk groups (P< .001) in unselected patients. However, in subgroup analyses, its discriminatory capacity was restricted to patients with extragastric disease, particularly patients with EMZL of the ocular adnexa or the parotid gland or intestinal EMZL, as well as those receiving systemic therapy. On the contrary, patients with gastric EMZL or those managed with Helicobacter pylori eradication, local therapy, or watch-and-wait approaches did not derive consistent prognostic separation. Incorporation of autoimmunity identified a small subgroup with inferior PFS and OS, but provided limited incremental prognostic power beyond the established index in most patients. Our results support context-specific applicability of the MALT-IPI, and highlight autoimmunity as a prognostically relevant factor in a small cohort of patients.

Minimally invasive surgery (MIS) has revolutionized foot and ankle care by emphasizing delicate tissue handling, reduced postoperative pain, and faster recovery through small incisions and precise instrumentation. The evolution of MIS spans 4 distinct historical "seasons," from its early development in the mid-20th century to its global resurgence in the 2010s, driven by improved techniques, education, and international collaboration. Today, MIS extends beyond hallux valgus correction to include complex procedures such as first metatarsophalangeal joint, subtalar joint, tibiotalar joint, and tibiotalocalcaneal arthrodesis, with evidence demonstrating comparable or superior outcomes to open approaches. This review details the history of MIS in foot and ankle orthopedics and how this paradigm shift continues to redefine standards and improves outcomes in foot and ankle surgery.

BACKGROUND/UNASSIGNED:Traumatic brain injury (TBI) is a pervasive and important public health concern. TBI can range from mild, resulting in headache, dizziness, and imbalance, to severe resulting in coma and death. Diffusion tensor imaging (DTI) offers the ability to assess tissue microstructure at a level inaccessible to classical neuroimaging methods, such as CT and structural MRI. This systematic review aims to explore studies using DTI in mild TBI (mTBI) during the 2012-2022 decade, which is the second decade of reported use. The use of DTI in moderate-severe TBI (msTBI) during this time period is discussed in our companion systematic review. METHODS/UNASSIGNED:A systematic literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched the electronic databases PubMed/MEDLINE, Embase, Cochrane Library, and Web of Science from 2012 through September 28, 2022. RESULTS/UNASSIGNED:A total of 325 studies on mild TBI were included, which encompassed 26,287 participants. There were more longitudinal studies in 2012-2022 compared to the prior decade (29.85 vs. 13%). Fractional anisotropy (FA) and mean diffusivity (MD) were the most commonly used DTI measures. Regardless of acquisition techniques and analysis methods, the majority of studies that compared FA between those with mTBI and controls, found lower FA in mTBI patients compared to controls, but less consistently than in msTBI. Lower FA was associated with worse cognitive outcomes across domains, but associations with clinical post-concussive symptoms were more mixed. CONCLUSION/UNASSIGNED:Since its first decade (2002-2012) of reported use, DTI applications to mTBI have continued to expand in both quantity and scope, including notable increases in the proportions of larger and longitudinal studies, those employing whole brain analyses and those addressing clinical and cognitive outcomes. The most salient feature of the study results remains that low FA is the most common finding identified in mTBI patients compared to controls, however the direction of the FA effect is more variable for mTBI compared to msTBI. SYSTEMATIC REVIEW REGISTRATION/UNASSIGNED:Prospero [CRD42022361318], https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=361318.

BACKGROUND:Documentation of goals-of-care conversations (GOCC) in the electronic health record (EHR) is considered a cornerstone of high-quality cancer care. When done well, it can support treatment decisions that are informed by patients' values, preferences, and priorities and serve as a critical communication tool across the health care team. Although inpatient and palliative care settings have been studied extensively, less is known about GOCC documentation in outpatient oncology. AIM/OBJECTIVE:We examined the prevalence of GOCC documentation among older adults with advanced cancer in the outpatient setting and identified patient-level factors related to documentation. DESIGN/METHODS:tests for continuous variables and chi-square tests for categorical variables. SETTING/SUBJECTS/METHODS:The cohort included older adults aged >65 years with advanced cancer who received outpatient treatment at an academic cancer center in Boston, MA, between 2016 and 2019. RESULTS:< 0.001). No significant differences were observed by gender, race, or Hispanic ethnicity. CONCLUSIONS:Fewer than half of older adults with advanced cancer had documented GOCC in outpatient oncology. This gap underscores the need for scalable interventions to ensure that values and preferences are initiated and documented in routine care.

OBJECTIVE:Masked hypertension [nonhigh office blood pressure (BP) and high out-of-office BP] is associated with cardiovascular risk. Obstructive sleep apnea (OSA) is associated with high office BP, but few data exist on its association with masked hypertension, especially in Black adults who have a high prevalence of both conditions. METHODS:We analyzed pooled data from 1078 Black adults, 713 in the Jackson Heart Study and 365 in the Coronary Artery Risk Development in Young Adults study, with office BP less than 140/90 mmHg, who completed 24-h ambulatory BP monitoring. Masked hypertension was defined as mean awake BP at least 135/85 mmHg, asleep BP at least 120/70 mmHg, or 24-h BP at least 130/80 mmHg. A high likelihood of OSA was defined using sleep questionnaires and physical measurements. Poisson regression was used to estimate prevalence ratios, adjusting for demographics, lifestyle behaviors, and comorbidities. Analyses were stratified by antihypertensive medication use. RESULTS:Overall, 34% of participants had a high likelihood of OSA; 53.3% had masked hypertension. Among participants not taking antihypertensive medication (n = 505), adjusted prevalence ratios comparing those with versus without a high likelihood of OSA were 1.31 [95% confidence interval (CI) 1.06-1.61], 0.88 (95% CI 0.59-1.29), 1.37 (95% CI 1.09-1.73), and 1.35 (95% CI 1.00-1.83) for any, awake, asleep, and 24-h masked hypertension. Among those taking antihypertensive medication (n = 573), the adjusted prevalence ratios were 1.15 (95% CI 0.99-1.32), 1.04 (95% CI 0.83-1.31), 1.14 (95% CI 0.97-1.33), and 1.19 (95% CI 0.96-1.47), respectively. CONCLUSION/CONCLUSIONS:A high likelihood of OSA was associated with a higher prevalence of masked hypertension among participants not taking antihypertensive medication.

Despite comprising one-fifth of the population, individuals living in rural areas are underrepresented in clinical trials on substance use disorders (SUD). The inclusion of rural residents is critical to reducing disparities in health outcomes and improving adoption of evidence-based interventions for SUDs. The current commentary provides five guiding principles to assist researchers in including rural populations in trials. These principles emphasize including rural communities in the study design phase and throughout the research process, understanding the local rural context, consideration of operationalization of rural in research, suggested adaptions for research, and embracing opportunities for bi-directional and sustainable partnerships. When approached thoughtfully, research funding can catalyze rural capacity, foster durable partnerships, and enrich scientific inference to assist in establishing the evidence-base for SUD research.