Faculty Bibliography

Obesity has been associated with non-Hodgkin lymphoma (NHL), but the evidence is inconclusive. We examined the association between genetically determined adiposity and four common NHL subtypes: diffuse large B-cell lymphoma (DLBCL), follicular lymphoma, chronic lymphocytic leukemia, and marginal zone lymphoma, using eight genome-wide association studies of European ancestry (N = 10,629 cases, 9505 controls) and constructing polygenic scores for body mass index (BMI), waist-to-hip ratio (WHR), and waist-to-hip ratio adjusted for BMI (WHRadjBMI). Higher genetically determined BMI was associated with an increased risk of DLBCL [odds ratio (OR) per standard deviation (SD) = 1.18, 95% confidence interval (95% CI): 1.05-1.33, p = .005]. This finding was consistent with Mendelian randomization analyses, which demonstrated a similar increased risk of DLBCL with higher genetically determined BMI (OR_{per SD} = 1.12, 95% CI: 1.02-1.23, p = .03). No significant associations were observed with other NHL subtypes. Our study demonstrates a positive link between a genetically determined BMI and an increased risk of DLBCL, providing additional support for increased adiposity as a risk factor for DLBCL.

STUDY QUESTION/OBJECTIVE:Is there an association between infertility diagnosis and long-term adult-onset psychiatric conditions in women? SUMMARY ANSWER/CONCLUSIONS:Infertility diagnosis in women is linked to higher risks of mood disorders, anxiety- and stress-related disorders, and behavioral syndromes with physical components, but not schizophrenia or other psychotic disorders, particularly notable from 9 years after the first infertility diagnosis. WHAT IS KNOWN ALREADY/BACKGROUND:Infertility, especially in women, is associated with major mental health challenges around the time of diagnosis. However, the long-term connection with a wide range of psychiatric disorders is largely unknown. STUDY DESIGN, SIZE, DURATION/METHODS:This study employed a matched-pair design within the UK Biobank (UKB) cohort, including 3893 females with a diagnosis of infertility and 15 603 matched female controls, totaling 19 496 participants. PARTICIPANTS/MATERIALS, SETTING, METHODS/METHODS:Female UKB participants with a diagnosis of infertility were matched to females without the diagnosis in a 1:4 ratio based on year of birth, index of deprivation of their residency area, and primary care data linkage status. The diagnosis of female infertility was identified by the first occurrence of a primary or secondary diagnosis in either primary care or hospital records. Additional analyses explored interactions between infertility diagnosis and both miscarriage and childbearing status on psychiatric conditions. MAIN RESULTS AND THE ROLE OF CHANCE/RESULTS:Diagnosis of infertility was associated with higher risks of mood disorders, anxiety- and stress-related disorders, and behavioral syndromes with physical components, but not with schizophrenia or other psychotic disorders. The most notable increases in the risk of psychiatric diagnoses were observed 9 years after the first infertility diagnosis. No significant interactions were found between infertility diagnosis and either miscarriage or childbearing status on psychiatric conditions. Sensitivity analysis confirmed the robustness of these associations across different data sources for infertility diagnosis and psychiatric condition ascertainment. LIMITATIONS, REASONS FOR CAUTION/CONCLUSIONS:The study's limitations include the racial homogeneity and the overall healthier status of the UKB cohort compared to the general UK population and the potential underestimation of associations due to misclassification of subfecund women. WIDER IMPLICATIONS OF THE FINDINGS/CONCLUSIONS:These results emphasize the need for integrated mental health support in infertility care and long-term monitoring of infertility patients for psychiatric risks. STUDY FUNDING/COMPETING INTEREST(S)/BACKGROUND:None. No competing interests were declared. TRIAL REGISTRATION NUMBER/BACKGROUND:n/a.

OBJECTIVE:Social determinants of health (SDOH) may impact the incidence of Respiratory Syncytial Virus (RSV) infection and the uptake of vaccinations in pregnancy. The objective of this study is to identify contributors to disparities in RSV vaccination in pregnancy. DESIGN/METHODS:This is a retrospective cohort study of patients delivering at term within three hospitals during February and March 2024, comparing pregnant patients identified as receiving vs not receiving RSV vaccinations. This period and gestational age were chosen to include patients who would have qualified for RSV vaccination administration. Vaccination status was extracted from standardized admission templates where these variables were recorded as discrete fields. Patients without RSV vaccination information were excluded. Sociodemographic factors, COVID vaccination status, and delivery campus were evaluated. Outcomes were analyzed using chi-squared, t-test, and McNemar test. RESULT/RESULTS:2181 patients met inclusion criteria and RSV vaccination information was available for 1548 patients (71%) with a 14% vaccination rate. Compared to those not vaccinated (n=1332), RSV vaccinated patients (n=216) were more likely to be older (30.7 vs 34.8, p<0.001), have private insurance (42% vs 85%, p<0.001), speak English (82% vs 95%, p<0.001), and deliver at our regional perinatal center (26% vs 77%, p<0.001). 50% of RSV vaccinated patients had a history of COVID vaccination compared to 33% of those not vaccinated against RSV (p<0.001). CONCLUSIONS:SDOH were associated with differences in RSV vaccination status. In addition, patients without RSV vaccination were less likely to have had COVID vaccination. These findings highlight the need to address SDOH to increase vaccination rates for vulnerable populations.

Increasing the vaginal birth after cesarean (VBAC) rate to 18% was a Healthy People 2020 goal. Detailed data on racial/ethnic differences in VBAC rates is lacking and can inform efforts to equitably increase VBAC rates. This study aimed to assess racial/ethnic variation in VBAC rates and to describe group trends in VBAC rates in California between 2011 and 2021.This retrospective cohort study used a database of birth certificates linked to hospital discharge records. We analyzed singleton, term live births among people who had a history of at least one prior cesarean birth, no identified contraindications to a vaginal birth, and self-identified their racial/ethnic group as Hispanic or non-Hispanic (American Indian-Alaskan Native (AIAN), Asian, Black, Hawaiian/Pacific Islander, or white). VBAC births were identified from birth certificate records. Differences between VBAC rates were assessed using univariable and multivariable Poisson log-linear regression while adjusting for potential confounders.A total of 607,808 birthing people were included (2,234 AIAN, 84,899 Asian, 34,217 Black, 2,559 Hawaiian/Pacific Islander, 334,116 Hispanic, 149,783 white). Over the study period, Hawaiian/Pacific Islander birthing people had the highest average VBAC rate at 11.5% (AIAN, 6.5%; Asian, 8.8%; Black, 8.0%; Hispanic, 7.4%; white, 9.5%). In adjusted models, Black (aRR = 1.06, 95% CI: 1.01-1.11) and Hawaiian/Pacific Islander (aRR = 1.43, 95% CI: 1.27-1.61) birthing people were more likely to have a VBAC compared with white birthing people, while Hispanic birthing people were less likely (aRR = 0.96, 95% CI: 0.93-0.98). VBAC rates increased significantly (p < 0.001) over time for all groups except AIAN birthing people.VBAC rates increased for most racial/ethnic groups in California. With the exception of the Hawaiian/Pacific Islander group, there were small and likely not clinically significant differences in the chances for a VBAC across groups. No group in California met the Healthy People 2020 goal VBAC rate of 18%. · VBAC rates increased for most racial/ethnic groups.. · The VBAC rate for AIAN birthing people did not increase.. · No group met the Healthy People 2020 goal VBAC rate of 18%..

INTRODUCTION AND HYPOTHESIS/OBJECTIVE:Patients with stage 3 or 4 pelvic organ prolapse (POP) may concurrently have hydronephrosis. Consequences of hydronephrosis, such as acute kidney injury and chronic kidney disease, have significant costs to patients and healthcare facilities. In this study, we evaluate the cost-effectiveness of renal ultrasound to screen for hydronephrosis in patients with stage 3 or 4 POP. METHODS:We designed a decision tree model comparing screening renal ultrasound versus usual care for patients with stage 3 or 4 POP. In the screening strategy, patients undergo ultrasound and subsequently proceed with pessary or surgery should they screen positive for hydronephrosis or proceed with expectant management, pessary, or surgery should they screen negative. In the non-screening strategy, patients choose treatment as they normally would and those with underlying hydronephrosis either continue to have hydronephrosis or have resolution of hydronephrosis. We modeled a time horizon of 5 years, with a 3% discount rate annually for future costs and quality-adjusted life-years (QALY). This was an IRB-exempt study. RESULTS:At a willingness to pay threshold of $150,000/QALY, renal ultrasound was cost-effective when the majority of patients who screen positive for hydronephrosis choose pessary instead of surgery. Screening renal ultrasound is cost-effective if less than 36.3% of patients with hydronephrosis choose surgery. At 5 years, screening renal ultrasound was cost-effective regardless of the prolapse treatment chosen by patients with hydronephrosis. CONCLUSION/CONCLUSIONS:Routine renal ultrasound screening of patients with stage 3 or 4 POP is a cost-effective strategy to identify hydronephrosis and guide treatment that mitigates risk of permanent renal damage.

The rapid evolution of generative artificial intelligence (AI) is poised to transform medicine and medical education. Large language models (LLMs) have begun to demonstrate capabilities in reasoning, diagnosis, documentation, and patient communication that can rival or exceed those of clinicians. In medical education, AI is reshaping how students learn and how faculty teach-offering individualized, context-sensitive guidance at scale. This article outlines the current state of AI integration in health care, examines how systems can responsibly implement it to enhance patient care and education, and raises critical questions about ethics and safety as we harness its transformative potential.

This Society of Gynecologic Oncology review synthesizes updated data from pivotal trials of poly-ADP-ribose polymerase inhibitors (PARPi) in ovarian cancer. Multiple phase III trials established PARPi as effective maintenance therapy, demonstrating substantial progression-free survival across biomarker-defined subgroups, particularly for patients with BRCA-mutated and homologous recombination-deficient (HRD) ovarian cancer. However, mature overall survival analyses and safety signals prompted the US Food and Drug Administration to narrow indications, while the broader indications were maintained by the European Medicines Agency. We review the current FDA approvals that now prioritize patients with BRCA-mutated and HRD ovarian cancers, underscoring the importance of biomarker stratification and careful patient selection. We discuss the evolving regulatory landscape and potential mechanisms of PARPi resistance.

OBJECTIVE:To describe the current state of AAGL-FMIGS fellowship programs, assessing case volume, case types, and differences among programs. DESIGN/METHODS:Retrospective cohort study. SETTING/METHODS:Fellowships in Minimally Invasive Gynecologic Surgery (FMIGS) in the United States. PARTICIPANTS/METHODS:All fellows who started and completed an AAGL-FMIGS fellowship in the U.S. between 2020 to 2024. INTERVENTIONS/METHODS:n/a RESULTS: During the study period, 130 fellows completed a 2 or 3-year fellowship from start to finish among 52 fellowships. The median number of total cases completed in a 2-year fellowship was 510 [IQR 428-586]. The most common procedure was hysterectomy (median 210 [IQR 174-255]), followed by peritoneal procedures, which included retroperitoneal dissection and adhesiolysis (median 125 [IQR 91-167]), and endometriosis procedures (median 89 [IQR 56-132]). The medians for other case types were as follows: myomectomies (including hysteroscopic) 62 [IQR 40-95], adnexal surgeries 39 [IQR 25-67], and hysteroscopies (excluding hysteroscopic myomectomy) 45 [IQR 35-77]. Among the 130 fellows, 67% (n= 87) had FMIGS-trained Program Directors and 33% (n= 43) had non-FMIGS-trained Program Directors. Fellows from programs with FMIGS-trained Program Directors had greater surgical volume compared to fellows with non-FMIGS-trained Program Directors (median number of cases per fellow of 537 [IQR 468-620] vs 464 [IQR 367-551], p=.03). Furthermore, fellows from programs with FMIGS-trained Program Directors compared to those with non-FMIGS-trained Program Directors, completed a median of 108 vs. 58 endometriosis surgeries (p=.01), 71 vs. 44 myomectomies (p = .01), 52 vs. 39 hysteroscopies (p=.06), and 215 vs. 187 hysterectomies (p=.27), respectively. CONCLUSION/CONCLUSIONS:Adopting the ACGME case log system provided greater insight into the volume and types of cases completed in AAGL-FMIGS programs. Overall, AAGL-FMIGS programs have robust surgical volume with Program Director training affecting volume and case types. Fellows from programs with FMIGS-trained Program Directors have significantly greater total case volume, myomectomies, and endometriosis surgeries.

PURPOSE/OBJECTIVE:The National Academy of Science Engineering and Medicine (NASEM) developed items to collect sexual orientation and gender identity (SOGI) in healthcare settings to harmonize collection of these data and address disparities often experienced by sexual and gender minorities (SGM) (LGBTQAI+). This study tested wording of SOGI items among the SGM Community. METHODS:Individuals were recruited to participate in an interview about the NASEM SOGI items. Eligible participants identified as SGM, lived within the catchment area of an NYC academic medical center, had a history of cancer, or were caregivers of a person with cancer. Interviews were audio-recorded, transcribed, and qualitatively coded. RESULTS:Thirty-eight SGM individuals participated. The majority disliked the options for sexual orientation (SO) and gender identity (GI) but did find one they would choose. For SO, participants thought options like queer, pansexual, and asexual were missing, and for GI, participants said non-binary and transgender category (transgender man, transgender woman) were needed. Half said they had no concerns about disclosing SOGI information on medical intake forms and others reported preferring knowing why it was needed and who would have access. Several expressed worry about their safety upon disclosure of SOGI. Respondents cited being less likely to disclose SOGI if there was an offensive question on intake form (e.g., spouse instead of partner) or if there were no privacy assurances. Almost all expected reported SOGI to be reflected in their oncology healthcare. CONCLUSIONS:The NASEM questions need improvement. To improve trust and encourage disclosure, clinicians and clinics should improve the options for SOGI data collection and take steps to ensure privacy is addressed.

Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal and infant mortality and morbidity worldwide. This prospective cohort study investigated the association of racial and ethnic disparities in HDP and explored the potential mediation effect of environmental chemical exposures on excess HDP risk among non-Hispanic Black pregnant people. A total of 3,279 pregnant people were included from 11 cohorts across the United States in the Environmental influences on Child Health Outcomes (ECHO) Program. We analyzed 20 environmental chemicals detected in over 70 % of biospecimens collected during pregnancy. Among Hispanic, non-Hispanic White, and non-Hispanic Black participants, 11.8 %, 10.8 %, and 16.6 % were diagnosed with HDP, respectively. Compared with non-Hispanic White participants, non-Hispanic Black participants had a higher risk of HDP (aRR = 1.48; 95 % CI 1.13-1.94) and higher levels of traditional phthalate metabolites, but lower levels of phthalate alternative metabolites and perfluorooctanoic acid. Hispanic participants had a lower risk of gestational hypertension (aRR = 0.62; 95 % CI 0.40-0.98) and lower levels of perfluoroalkyl substances than non-Hispanic White participants. Critically, despite these race/ethnicity-specific exposure patterns, individual chemical exposures did not mediate the association between racial/ethnic group and HDP. These findings highlight the need to investigate cumulative chemical mixtures and non-chemical environmental and social determinants as potential drivers of HDP disparities.