Faculty Bibliography

BackgroundThrombosis is the second leading cause of death in cancer patients and treatment for thrombosis and prevention for secondary prophylaxis is anticoagulation. Low-molecular-weight heparin (LMWH) is more effective than vitamin K antagonists for the treatment of cancer-associated thromboembolism (CAT). Direct oral anticoagulants (DOACs) are non-inferior to dalteparin in treating CAT with similar major bleeding risks. Major guidelines recommend DOACs for CAT; however, data comparing individual DOACs to enoxaparin is lacking. The purpose of this study is to evaluate the efficacy and safety of DOACs compared to LMWH for CAT.MethodsA multi-site retrospective review was conducted in adult cancer patients with a CAT history who received either a DOAC (apixaban or rivaroxaban) or LMWH (enoxaparin). Primary efficacy and safety endpoints were recurrent thromboembolism and major bleeding occurrences. Secondary endpoints included time to subsequent CAT occurrence, time to first bleed event post initial CAT, and incidence of clinically relevant non-major and minor bleeding.ResultsA total of 102 patients were included in the study. There was no significant difference among the groups with respect to time to subsequent CAT (p = 0.5625). However, patients who received apixaban and rivaroxaban had a 2.39 times and 3.26 times higher risk of subsequent CAT respectively compared to those who received enoxaparin. Major bleeding rates were also not statistically significant (p = 0.465), despite enoxaparin having the highest rate at 8.8% and no rivaroxaban patients experiencing major bleeding.ConclusionNo differences were observed between rivaroxaban, apixaban, and enoxaparin in rates of recurrent venous thromboembolism (VTE) and bleeding.

INTRODUCTION/BACKGROUND:Wound care is an essential discipline in plastic surgery, especially as the prevalence of chronic wounds, such as pressure injuries, is increasing. The escalating volume of patient data and the numerous variables influencing wound outcomes are making traditional manual chart reviews in wound care and research increasingly complex and burdensome. The emergence of Natural Language Processing (NLP) software based on large language models (LLMs) such as ChatGPT presents an opportunity to automate the data extraction process. This study harnesses the capabilities of ChatGPT, hosted by our medical center's secure, private Azure OpenAI service, to automatically extract and process variables from patient charts following sacral wound visits. We assess ChatGPT's potential to revolutionize chart review through improved data retrieval accuracy and efficiency. METHODS:We evaluated the use of the medical center's internal ChatGPT in chart review. ChatGPT and a Python script were integrated into the existing chart review process for patients with sacral wounds from 2 hospital cohorts to extract and format variables related to wound care. Metrics include time taken for review, accuracy of extracted information, and assessment of ChatGPT-generated insights. RESULTS:ChatGPT reduced the average time per chart review from 7.56 minutes with the manual method to 1.03 minutes using ChatGPT. Furthermore, it achieved a 0.957 overall accuracy rate compared to manual chart review, ranging from 0.747 to 0.986 across extracted data elements. ChatGPT was also able to synthesize accurate narrative descriptions of patient wounds. CONCLUSIONS:We highlight ChatGPT's potential to enhance speed and precision of chart review in the context of both clinical care and wound care research, offering valuable implications for integration of artificial intelligence in healthcare workflows.

BACKGROUND:Near-infrared autofluorescence (NIRAF) spectroscopy is an emerging adjunct for intraoperative parathyroid identification. However, its ability to differentiate between normocellular, hyperplastic, or adenomatous parathyroids remains unexplored. We hypothesize that parathyroid adenomas have lower NIRAF ratios than normocellular parathyroids since the likely fluorophore is the calcium-sensing receptor (CaSR), which is downregulated in adenomas. METHODS:In vivo NIRAF ratios for each identified parathyroid gland were recorded for patients undergoing thyroidectomy or parathyroidectomy from 08/2023 to 12/2023 at a single institution. Parathyroids were categorized as normocellular by visual inspection and hyperplastic or adenomatous by final histology. RESULTS:Of the 44 patients included (66% underwent parathyroidectomy and 34% underwent thyroidectomy), 137 parathyroids were identified intraoperatively with 66 resected and analyzed histologically. A total of 71 (52%) parathyroids were normocellular, 45 (33%) were hyperplastic, and 21 (15%) were adenomatous. Among the resected parathyroids, there was moderate agreement (81%) between visual categorization and final histology for hyperplasia versus adenoma (κ = 0.6). Parathyroid adenomas had lower median NIRAF ratios than normocellular parathyroids (p = 0.0005). Median NIRAF ratios were not significantly different between normocellular and hyperplastic parathyroids (p = 0.35) nor between hyperplastic parathyroids and adenomas (p = 0.04). The performance of NIRAF spectroscopy in differentiating parathyroid pathology is poor based on receiver operator characteristics analysis. CONCLUSION:Parathyroid adenomas have lower NIRAF ratios than normocellular parathyroids. However, the performance of using NIRAF ratios to differentiate between parathyroid pathology is poor. Therefore, the differences in NIRAF ratios are unlikely to be sufficient at point-of-care use to distinguish between various parathyroid pathologies. As NIRAF ratios are highest in normocellular parathyroid glands, NIRAF appears to be most useful in detecting normal parathyroid glands.

Frontline daratumumab-based triplet and quadruplet standard-of-care regimens have demonstrated improved survival outcomes in newly diagnosed multiple myeloma (NDMM). For patients with transplant-ineligible NDMM, triplet therapy with either daratumumab plus lenalidomide and dexamethasone (D-Rd) or bortezomib, lenalidomide and dexamethasone (VRd) is the current standard of care. This phase 3 trial evaluated subcutaneous daratumumab plus VRd (D-VRd) in patients with transplant-ineligible NDMM or for whom transplant was not planned as the initial therapy (transplant deferred). Some 395 patients with transplant-ineligible or transplant-deferred NDMM were randomly assigned to eight cycles of D-VRd or VRd followed by D-Rd or Rd until progression. The primary endpoint was overall minimal residual disease (MRD)-negativity rate at 10^-

BACKGROUND:Despite widespread use of Roux-en-Y gastric bypass (RYGB), there are no standardized limb lengths in the United States. METHODS:A multi-center retrospective cohort study was conducted from 2020 to 2023. Eligible patients who had undergone RYGB were divided into subgroups based on BP limb lengths: short (50-75 cm), intermediate (80-125 cm), and long (150-175 cm). Primary outcomes were total weight loss (TWL) and % TWL at 1 and 2 years. Secondary outcomes were post-operative BMI and % BMI change at 1 and 2 years, micronutrient deficiencies, hypothyroidism, acute kidney injury (AKI) requiring treatment, and remission in associated medical problems. Subgroups were compared using multivariate analysis. RESULTS:Two hundred twenty-eight patients received a long BP limb, 194 patients received an intermediate BP limb, while 152 patients received a short BP limb. Primary outcomes TWL and % TWL were significantly different between the groups at 1 year: TWL and % TWL were greater in patients with long BP limbs. The difference between the long and short BP limb groups increased at the 2-year mark. Patients who had long BP limbs had higher rates of DM remission (12.3% vs 11.9% 6.6%), HTN (8.8% vs 5.7% vs 7.9%), GERD symptoms (14.5% vs 9.8% vs 5.3%), and OSA (8.8% vs 7.7% vs 5.3%). Vitamin A deficiency rates were higher in the long BP limb group. CONCLUSIONS:The results suggest that longer BP limb lengths are conducive to TWL and overall treatment of obesity-related problems without severe rates of complications. Additional longer longitudinal studies are needed to assess the impact of long BP limbs on nutrition and weight loss in the long term.

Stercoral colitis is an inflammatory reaction secondary to fecal impaction and almost always occurs in the setting of chronic constipation. Luminal distention caused by dense and dehydrated stool compresses the vascular supply of the distal colon, resulting in bowel ischemia and ulceration. Stercoral colitis primarily affects elderly patients, but it can be seen in any patient with decreased bowel motility, with risk factors including neurodegenerative disorders, chronic medical diseases, malignancy, immobility, and the use of narcotic or anticholinergic medications. Patients most often present with abdominal pain and tenderness. However, the presentation is often nonspecific and can include nongastrointestinal symptoms. Due to the common presence of comorbidities, a thorough history and physical examination findings may be difficult to obtain. Imaging, especially CT, plays a vital role in the diagnosis of stercoral colitis, demonstrating hallmark features such as fecal impaction and a large colorectal stool burden. Mural thickening (>3 mm) and other CT signs of inflammation aid in diagnosis, although findings including perirectal fat stranding can be nonspecific. Signs of perforation, including mural discontinuity, extraluminal air, and extraluminal stool collections, can also be identified. Other potential complications include obstruction, bleeding, fistulas, and urinary tract involvement secondary to mass effect. The overlap of findings between stercoral colitis and other colonic diseases, particularly diverticulitis and malignancy, can sometimes make diagnosis challenging. Identification of fecal impaction and associated inflammatory changes helps in distinguishing stercoral colitis from other pathologic conditions. Prompt diagnosis of stercoral colitis and its complications allows appropriate management, which can range from preventive measures to emergent surgical treatment. ^©RSNA, 2025 Supplemental material is available for this article.

OBJECTIVES/UNASSIGNED:Outside of the association of SS-A antibody with congenital heart block, little is known about adverse maternal and neonatal outcomes, in patients with Sjogren's disease (SjD). Our study involved collaboration with maternal-fetal medicine (MFM). METHODS/UNASSIGNED:-test and Fisher's exact test. RESULTS/UNASSIGNED:48 patients were included: 12 SjD patients and 36 controls. APO was significantly increased in SjD with one preterm birth, one fetal growth restriction, and one limb anomaly; non-SjD had one cardiac anomaly. There were no cases of CHB. SjD patients were more likely to be delivered by cesarean delivery. CONCLUSION/UNASSIGNED:There was an increased risk of APO in SjD patients compared with controls. No significant difference in neonatal outcomes was found. We speculate that placental pathology may play a role in pathophysiology and future studies should be performed. KEY POINTS/UNASSIGNED:There was an increased risk of APO in SjD patients compared with controls.No significant difference in neonatal outcomes was found.We speculate that placental pathology may play a role in pathophysiology, prompting future studies.

The psychosocial evaluation plays an essential role in the multidisciplinary assessment of pediatric patients for thoracic organ transplantation or ventricular assist device (VAD) placement. However, there is considerable practice variation with regard to the content and process of the evaluation, with no known recent published guidelines. Furthermore, the pediatric evaluation necessarily differs from the adult evaluation in a number of substantive ways, including caregiver roles and decision-making. A writing committee of 25 multidisciplinary experts in pediatric cardiothoracic transplantation/VAD was established, who conducted a comprehensive literature review which resulted in the development of this consensus-based framework. This framework, which is a collaborative effort of the International Society for Heart and Lung Transplantation (ISHLT), the International Pediatric Transplant Association (IPTA), the Pediatric Heart Transplant Society (PHTS), the Advancing Cardiac Therapies Improving Outcomes Network (ACTION), and Transplant Families, represents the first known framework specific to both the content and process of the psychosocial evaluation for pediatric cardiothoracic transplantation/VAD. Attention was paid to relevant ethical, cultural and health equity considerations inherent in the pediatric evaluation process. Rather than provide a proscriptive evaluation process, the goal was to create a flexible framework to encourage consistency across centers, while also acknowledging the complexities inherent in evaluating children and their families for cardiothoracic transplant and VAD.

OBJECTIVE:Recent guidelines suggest that non-invasive prenatal screening (NIPS) should be offered to all patients with singleton and twin pregnancies. Accurate determination of fetal fraction in cell-free DNA (cfDNA) is vital for reliable NIPS outcomes. We propose a methylation-based approach using droplet digital PCR (ddPCR) and methylation-sensitive restriction enzyme (MSRE) digestion for fetal fraction quantification as an affordable and fast solution. METHOD/METHODS:Following biomarker discovery using early pregnancy placental genomic DNA (gDNA) and cfDNA from non-pregnant female individuals, we designed assays targeting MSRE-compatible regions based on contrasting methylation patterns between maternal and fetal cfDNA. We established a proof-of-concept ddPCR workflow on the Bio-Rad Droplet Digital PCR QX600 instrument. RESULTS:Testing the fetal fraction assay multiplex on 137 prospective clinical samples demonstrated high concordance with NGS results for both female and male pregnancies as well as with chromosome Y-based calculations for samples with a male fetus. Reproducibility analysis indicated lower variability compared to previously reported NGS performance. CONCLUSION/CONCLUSIONS:This study showcases the potential of this novel, 6-color, high-multiplex methylation ddPCR panel for accurate measurement of fetal fraction in cfDNA samples. It presents opportunities to integrate such methodology as a standalone measurement to assess the quality of samples undergoing NIPS.