Faculty Bibliography

Pathogens infecting humans continue to emerge or reemerge to cause outbreaks and widespread disease. The National Institute of Allergy and Infectious Diseases has funded Vaccine Treatment and Evaluation Units (VTEUs) for more than 50 years. VTEUs perform clinical studies to assess the safety and immunogenicity of candidate vaccines and other interventions to mitigate the impact of emerging and ongoing infectious diseases. Here, we review clinical studies conducted in the VTEUs since 2000 that have addressed emerging pathogens and other infectious agents with pandemic potential or of bioterrorism concern. The studies conducted range from phase 1 to phase 3 clinical trials, and they have included vaccines, therapeutics, and epidemiological studies. The results of the trials have guided national and often international recommendations for treatment and prevention of many of the evaluated pathogens, culminating in coronavirus disease 2019 studies that began within three months of severe acute respiratory syndrome coronavirus 2 identification. The VTEU network continues to be a critical public health resource for addressing emerging pathogens and expediting the development of safe and effective vaccines and treatments to protect at-risk populations.

PURPOSE/OBJECTIVE:The purpose of this study was to evaluate the effect that associated glenohumeral dislocations have on outcomes following surgical treatment of proximal humerus fractures. METHODS:This IRB-approved study reports on 301 patients, who underwent operative treatment for proximal humerus fractures at an academic medical center from January 2006 to January 2023. Fractures were classified according to the Neer system. Patients were separated into two cohorts based on whether a glenohumeral dislocation was present at the time of initial injury. Outcomes measured included the Disabilities of the Arm, Shoulder, and Hand (DASH) score, shoulder range of motion (forward elevation, external rotation, internal rotation), readmission rates, complications, hardware removal, and need for revision surgery. Independent samples t-tests and chi-squared analysis were used for continuous and categorical variables, respectively. A binary logistic regression was performed to analyze the influence of these factors on complication rate. RESULTS:230 patients sustained an isolated fracture (PHF) and 71 sustained a fracture-dislocation (FD). Significant differences were observed between the FD and PHF groups in all measured outcomes. The FD group had a poorer DASH score (24.38 ± 19.09 vs 10.54 ± 13.67; P < 0.001) and reduced range of shoulder motion in forward elevation (114° ± 40° vs 162° ± 19°; P < 0.001), external rotation (40° ± 19° vs 66° ± 19°; P < 0.001), and internal rotation (57° ± 26° vs 82° ± 21°; P < 0.001). Readmission rates were higher in the FD group (0.28 ± 0.85 vs 0.05 ± 0.28; P < 0.001). The FD cohort also had a higher rate of complications (25.35% vs 6.52%; P < 0.001), need for removal of hardware (14.08% vs 3.04%; P = 0.002), and overall revision surgery (11.27% vs 1.30%; P < 0.001). The FD cohort demonstrated a greater incidence of AVN (12.68% vs 4.35%; P = 0.012). No significant difference was observed regarding rates of fracture healing and recurrent dislocation. Multivariate analysis in the form of binary logistic regression indicated that fracture-dislocation significantly increased the complication risk (OR = 3.310, 95% CI = 1.42-7.70; P = 0.005). CONCLUSION/CONCLUSIONS:Proximal humerus fracture-dislocations are associated with worse functional outcomes and higher complication rates compared to those without dislocations. These findings highlight the potential need for specialized treatment strategies to mitigate the impact of dislocation on recovery.

Labetalol and nifedipine are first-line antihypertensives for hypertensive disorders of pregnancy. However, there is limited research comparing their effectiveness based on hemodynamic profiles seen in preeclampsia, such as high cardiac output (CO) and high systemic vascular resistance (SVR). This study assesses whether concordance of antihypertensive treatment with the hemodynamic status on echocardiogram reduces time to achieve target postpartum blood pressure (BP) before discharge.This retrospective cohort study included patients with preeclampsia with severe features who received a postpartum echocardiography, excluding patients with cardiac etiology. Antihypertensive choices were provider-dependent. The CO and SVR were calculated retrospectively from the echocardiogram in collaboration with cardiology. Concordance was defined as patients with high CO (>6 L/min) started on labetalol and high SVR (>1,200 dynes·sec·cm⁵) started on nifedipine; opposite pairings were discordant. The primary outcome was time to achieve target BP, defined as the period from the start of antihypertensive therapy to when no titration was needed to sustain BPs of less than 140/90 mm Hg. Chi-square and Fisher's tests were used for categorical variables, and Mann-Whitney U test for continuous variables.Of 298 patients, 155 (52%) received concordant therapy and 143 (48%) discordant. Of the cohort, 229 (76.8%) had high SVR and 69 (23.2%) had high CO. Median time to target BP was not significantly different (concordant: 32 hours [interquartile range, IQR: 0-61], discordant: 41 hours [IQR: 4-75], p = 0.13). The concordant group needed fewer titrations to achieve target BP (1 [IQR: 0-2] vs. 2 [IQR: 1-3]; p = 0.008) and were less likely to be discharged home on multiple antihypertensive medications compared with the discordant group (28.9 vs. 42.7%, p = 0.014). Maternal demographics were similar between groups.While time to target BP did not differ, concordance of antihypertensive therapy to postpartum hemodynamics in patients with severe preeclampsia reduced medication adjustments and increased the likelihood of discharge on a single-agent regimen. · Echocardiography can be used to assess maternal hemodynamics.. · Aligning BP meds to hemodynamics cuts the need for a second agent.. · Aligning BP meds to hemodynamics reduces dose adjustments..

BACKGROUND:=344 placebo). METHODS:A secondary analysis was performed to evaluate veliparib treatment on primary and secondary outcomes in individual subgroup models. RESULTS:=0.008) days. These effects were independent of sex. Treatment had no effect on magnetic resonance imaging-determined lesion volume. The survival was similar with placebo and veliparib treatments across subgroups, although mortality was high in aging mice. CONCLUSIONS:Veliparib improved functional outcome in aging mice. Because ischemic stroke predominantly occurs in the aging population, further research into the benefit of PARP inhibitors in aged animal models of stroke is warranted.

Trauma during pregnancy presents a clinical challenge because the health and survival of both the mother and fetus are key clinical concerns. Given the prevalence of trauma in pregnancy, affecting an estimated 5%-7% of pregnancies, knowledge of the appropriate treatment of such patients is crucial for emergency and general radiologists. Although US is the default imaging modality during pregnancy, urgent and accurate diagnosis frequently requires the use of CT, despite the potential risk of exposure to ionizing radiation and contrast media. As such, the radiologist must be familiar with both obstetric-specific injuries and how pregnancy may complicate otherwise familiar traumatic presentations. The authors discuss the general treatment of the pregnant trauma patient, with an emphasis on radiologic evaluation. They provide an overview of various imaging modalities available for evaluation of pregnant patients with traumatic injuries, emphasizing their potential risks, benefits, and limitations. The relative role of imaging assessment versus electronic fetal monitoring in a patient with suspected placental abruption is discussed. Proposed grading methods and management pathways for placental abruption, with respect to fetal age and maternal stability, are reviewed. Relevant cases are presented, demonstrating key obstetric abnormalities that may be seen in patients with pregnancy-related trauma. ^©RSNA, 2025 Supplemental material is available for this article. See the invited commentary by Mellnick and Raptis in this issue.

BACKGROUND:Mutations in DICER1 are uncommon, poorly understood, and infrequently found in thyroid nodules. METHODS:The objective of this study was to investigate category III/IV thyroid nodules according to The Bethesda System for Reporting Thyroid Cytopathology with DICER1 gene mutations detected in fine-needle aspiration cytology samples using ThyroSeq v3 molecular testing, with a focus on an exploration of the clinical and histopathologic outcomes of these nodules. In this multicenter study spanning more than 6 years, nodules were retrospectively analyzed for patient demographics, clinical course, cytologic features, and histopathology, where available. RESULTS:In total, 88 patients with somatic DICER1 mutations were included, with a mean age of 39.6 years and a female predominance. All mutations were in the somatic hotspot region, most commonly at the codon 5437 site. Most excised nodules showed benign histologic features (65.9%). Interestingly, the rate of malignancy was higher in this cohort compared with that in the national average. CONCLUSIONS:DICER1 mutations appear to confer a higher risk of malignancy, but are not associated with any specific cytological or histopathological distinguishing features.

INTRODUCTION/UNASSIGNED:Hypertensive disorders in pregnancy, including chronic and pregnancy-induced hypertension, pose significant risks to maternal health. This study evaluated the association of New York State (NYS)'s Paid Family Leave (PFL) law, implemented in 2018, with postpartum healthcare utilization among women with hypertensive disorders in pregnancy. METHODS/UNASSIGNED:Using commercial claims data (2017-2022) for 312 470 employed women aged 15-45 years with live births, we assessed postpartum outpatient visits, hospital admissions, and medication adherence. RESULTS/UNASSIGNED:< 0.001). CONCLUSION/UNASSIGNED:Study findings suggest that PFL laws may enhance postpartum hypertension management, providing useful insights for policymakers aiming to improve maternal health outcomes through workplace policies.

OBJECTIVE:To assess the effectiveness, technical considerations, and long-term outcomes of the Z-plasty technique for correcting pediatric penile and scrotal anomalies. METHODS:A retrospective analysis of 100 consecutive Z-plasty procedures across various pediatric urological conditions was conducted. These included bifid scrotum reconstruction, chordee correction, penoscrotal webbing repair, and complex hypospadias reconstruction. Technical variations, including classic Z-plasty, multiple Z-plasties, and double-opposing Z-plasty configurations were evaluated. Patients were followed for a minimum of one year (range: 1-2 years), with 97% completing all scheduled follow up visits. RESULTS:Z-plasty successfully addressed a spectrum of penile and scrotal abnormalities including 41 hypospadias revisions, 28 primary hypospadias repairs, 10 chordee corrections, and 21 other reconstructive procedures, through strategic modification of the number and angles of incisions. Primary skin flap healing was achieved in 98% of procedures. Only one case (1%) required healing by secondary intention due to suture line separation, and one (1%) developed a hypertrophic scar managed with local steroid application. All patients with complete follow-up (97%) demonstrated stable corrections with minimal visible scarring at final evaluation. CONCLUSIONS:Z-plasty is a highly effective, versatile, and safe technique for pediatric genital reconstructive surgery. This adaptable approach enables optimal resurfacing and correction of diverse penoscrotal abnormalities with minimal morbidity. By minimizing linear scarring and redistributing tissue tension, Z-plasty simultaneously improves cosmetic outcomes and provides durable functional benefits. Future studies should focus on establishing standardized outcome measures and evaluating long-term results into adulthood.