Faculty Bibliography

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..

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.

Transformed follicular lymphoma (tFL) is typically associated with chemotherapy resistance and a poor prognosis. There are limited data regarding outcomes after CD19-directed chimeric antigen receptor T-cell (CAR T) therapy in relapsed/refractory (R/R) tFL. A total of 923 adult patients with R/R tFL who received commercial CD19 CAR T therapy between 2017 and 2023 were identified in the Center for International Blood and Marrow Transplant Research registry. Median age was 64 years (range: 30-86) and median prior lines of therapy was 4 (range: 1-18). Most patients (78%) received axicabtagene ciloleucel, with 67% of patients having resistant disease at the time of CAR T infusion. At a median follow-up of 25 months (range: 1-72) from CAR T infusion, the 2-year overall survival (OS) was 57% (95% CI: 53-60) and progression-free survival (PFS) was 43% (95% CI: 40-47). The 2-year cumulative incidences of relapse or progression (rel/prog) and non-relapse mortality (NRM) were 47% (95% CI: 44-51) and 9% (95% CI: 7-11), respectively. The overall response rate to CAR T was 76%, with a complete response rate of 63%. Grade ≥ 3 cytokine release syndrome (CRS) was observed in 7.1% and grade ≥ 3 immune effector cell-associated neurologic syndrome (ICANS) in 21.6% of patients. Multivariable analysis suggested that resistant disease status at the time of CAR T, use of bridging therapy, and high comorbidity index ≥ 3 were associated with inferior PFS and OS. Older age ≥ 60 significantly increased the risk of NRM. Our study suggests that CD19 CAR T is effective and safe for tFL.

Capiversatib is a pan-Ak strain transforming inhibitor used in combination with fulvestrant for the treatment of hormone receptor-positive advanced breast cancer and has a known adverse effect of hyperglycemia. We present 3 cases of severe hyperglycemia, 2 of which presented as diabetic ketoacidosis, in patients being treated with capivasertib. These cases demonstrate the severity of hyperglycemia that can result from capivasertib use, as well as highlight treatment regimens and patient outcomes.

BACKGROUND:Drug-coated balloons (DCBs) represent a novel treatment option for coronary in-stent restenosis (ISR). The AGENT DCB (Boston Scientific, Marlborough, MA) demonstrated superior efficacy in treating ISR compared to uncoated balloons in randomized controlled trials. However, real-world data on AGENT DCB safety remains limited. AIMS/OBJECTIVE:This study sought out to evaluate post-marketing adverse event reports related to the AGENT DCB. METHODS:This study analyzed post-marketing adverse event reports submitted to the FDA Manufacturer and User Facility Device Experience (MAUDE) database between March 1, 2024, and March 1, 2025, specifically focusing on coronary interventions utilizing the AGENT DCB. Reports were independently reviewed and categorized by device-related complications, patient injuries, and device failures. Data were summarized descriptively, and limitations inherent to the MAUDE database were considered. RESULTS:After screening and excluding duplicates, 155 reports on the AGENT DCB were included. Among all reports, device malfunctions without injury were most common (56.77%), followed by patient injury (30.97%) and death (12.26%). Of the total reported device problems, balloon rupture (33.55%) and shaft breakage (10.32%) were predominant. Injuries reported included angina (32.84%), acute myocardial infarction (29.85%), and coronary perforation (8.95%). Notably, 30 MAUDE reports described off-label treatment of de novo lesions; these off-label cases exhibited similar injury rates compared to ISR-treated lesions (53.33% vs. 57.89%). CONCLUSION/CONCLUSIONS:Real-world analysis of FDA MAUDE reports revealed frequent device malfunctions, mainly balloon rupture and shaft breakage, and patient complications such as angina, myocardial infarction, and coronary perforation. The off-label use for de novo lesions highlights the need for caution and further clinical investigation.