Faculty Bibliography

BACKGROUND:Chronic axial spinal pain is a major contributor to disability and healthcare expenditures, with facet joints recognized as one of the established sources of pain. OBJECTIVE:To provide evidence-based guidance in performing diagnostic and therapeutic facet joint interventions. METHODS:A multidisciplinary panel of experts from various medical and pharmaceutical disciplines, convened by the American Society of Interventional Pain Physicians (ASIPP), reviewed the available evidence, considered patient perspectives, and formulated recommendations for facet joint interventions in the management of chronic pain.The methodology included the development of key questions with evidence-based statements and recommendations. Grading of the evidence and recommendations followed a modified approach described by ASIPP, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, and the Agency for Healthcare Research and Quality (AHRQ) methods for grading strength of recommendations. The evidence review included existing guidelines, systematic reviews, comprehensive reviews, randomized controlled trials (RCTs), and observational studies evaluating the effectiveness and safety of facet joint interventions in chronic pain management.In the development of consensus statements and guidelines, a modified Delphi technique was utilized to minimize bias related to group interactions. Panelists without a primary conflict of interest voted on approval of specific guideline statements. Each panelist was permitted to suggest revisions to guideline wording and provide additional qualifying remarks or comments regarding implementation of the guidelines in clinical practice. To achieve consensus and inclusion in the final guidelines, each guideline statement required at least 80% agreement among eligible panel members without a primary conflict of interest. RESULTS:A total of 48 authors participated in the development of these guidelines, of whom 39 participated in the voting process. A total of 37 recommendations were developed, with 100% acceptance for all items. The Summary of Recommendations is presented separately. These recommendations addressed diagnostic, therapeutic, and special considerations related to facet joint interventions. For diagnostic and therapeutic interventions, the level of evidence ranged from II to III, with moderate to strong recommendations. For special considerations and safety assessments, the level of evidence ranged from II to V. The evidence provided recommendations regarding diagnosis, treatment, sedation, concurrent antithrombotic therapy, and precautions required in special clinical circumstances. LIMITATIONS/CONCLUSIONS:The limitations of these guidelines include a paucity of high-quality studies in some aspects of diagnosis and therapy. CONCLUSION/CONCLUSIONS:These guidelines for facet joint interventions were developed through a comprehensive review of the literature, including methodologic quality assessment and determination of the level of evidence and strength of recommendations. DISCLAIMER/CONCLUSIONS:These guidelines are based on the best available evidence and do not constitute inflexible treatment recommendations. Due to the changing body of evidence, this document is not intended to be a "standard of care."

OBJECTIVES/OBJECTIVE:To assess efficacy and adverse outcomes of misoprostol 200mcg versus 400mcg every three hours buccal or vaginal for medication abortion (MAb) from 24-27 weeks' gestation. STUDY DESIGN/METHODS:This retrospective cohort study included MAbs from 24 0/7-27 0/7 weeks' gestation at Bellevue Hospital from 7/2022-6/2025. All patients received digoxin 2mg intraamniotic injection and mifepristone 200mg oral followed at 24-48hrs by misoprostol 200mcg or 400mcg every three hours buccal or vaginal based on hospital policy at time of admission. The primary outcome was time from first misoprostol dose to placental expulsion. Secondary outcomes were procedural complications. Primary statistical analysis was performed with Fisher's exact and Wilcox rank-sum tests. RESULTS:Of 55 patients, 27 (49%) received 200mcg doses of misoprostol and 28 (51%) received 400mcg doses of misoprostol. Median time to expulsion was 13hrs in the 200mcg group versus 9.5hrs in the 400mcg group (p=0.144). More patients in the 200mcg group versus the 400mcg group had blood loss ≥500mL (11.1% vs 0%, p=0.11) and retained placenta at four hours (3.7% vs 0%, p=0.49). No patients in either group had uterine rupture. CONCLUSIONS:Misoprostol 200mcg versus 400mcg every three hours buccal or vaginal for MAb from 24-27 weeks' gestation had overall similar outcomes. Although this single site retrospective study is underpowered to significantly differentiate between the two regimens, we observe that 200mcg dosing may be associated with higher risk of complications. Larger studies are needed to clarify optimal misoprostol dosing for 24-27 week MAb. IMPLICATIONS/CONCLUSIONS:For medication abortion from 24-27 weeks' gestation, serial doses of misoprostol 200mcg versus 400mcg every three hours have similar rates of complications, though there is a signal that 200mcg dosing may be associated with longer time to expulsion, higher blood loss, and more incidences of retained placenta.

PURPOSE/UNASSIGNED:We report long-term follow-up on participants in the QUILT-3.032 study in BCG-unresponsive non-muscle-invasive bladder cancer (NMIBC) carcinoma in situ (CIS) +/- papillary disease utilizing nogapendekin alfa inbakicept (NAI) approved by the FDA (ANKTIVA) in combination with BCG. MATERIALS AND METHODS/UNASSIGNED:Participants received 400 mcg NAI in combination with 50 mg BCG via intravesical instillation weekly for six weeks, with optional re-induction if complete response (CR) was not achieved at month 3. Primary endpoints were CR rate at any time; secondary endpoints were duration of CR (DOR), progression-free survival (PFS), overall survival (OS), disease-specific survival (DSS), and time to cystectomy. RESULTS/UNASSIGNED:The CR rate (n=100) was 71% (95% CI, 61.1, 79.6) with a median DOR of 26.6 months (range, 0.03-53.62). The cystectomy-free rate (CFR) in the 71 responders at 24- and 36-months was 90.3% (95% CI 79.7, 95.6) and 84.2% (95% CI 69.6, 92.1), respectively. DSS was 100% (95% CI 100.0, 100.0) at 12-months, and 98.2% (95% CI 88.2, 99.8) at 36-months. Treatment-related adverse events (TRAE) were largely grade 1 to 2 (61%), with 3% grade 3 and no grade 4 or 5 TRAE observed with this biological combination. CONCLUSIONS/UNASSIGNED:The CR rate and durability of responses that surpass 53 months reveal the efficacy of NAI in combination with BCG for treating BCG-unresponsive NMIBC with CIS +/- Ta/T1 disease. The high CFR of 84% and DSS of 98% at 36-months suggest that NAI plus BCG is a safe and efficacious option for NMIBC with CIS +/- Ta/T1 disease.

BACKGROUND/UNASSIGNED:Retained foreign bodies (RFB), or those left behind following spine surgery, are considered "Never Events (NE < 1/1000: they should never happen)," or "Near Never Events (NNE < 1/100; they should nearly never happen)", but are not just "Adverse Events (AE >/= 1/100)." The vast majority of NE/NNE are due to cotton sponges, cottonoids, or residual cotton strands (i.e., collectively called Textilomas or Gossypibomas). However, RFB additionally included; fractured needles, guidewires, fractured screws/implants/drains, and/or broken instruments (i.e., scalpels). Notably, the spine surgeon of record, as captain of the ship, is primarily liable for RFB and is central to ensuing medicolegal suits. However, secondarily liable are the adjunctive surgical/medical personnel, (i.e., physicians, Physician Assistants, Nurses, Nurse Practitioners, Physical Therapists, Occupational Therapists), and others who are independent or work full-time for hospitals. METHODS/UNASSIGNED:Patients with RFB may present with acute, subacute, or chronic/delayed pain and suffering. Additional complaints include; lost wages, sustained physical disability and/or injury attributed to these objects. Most RFB are diagnosed on plain X-rays, followed by MR and/or CT studies. RESULTS/UNASSIGNED:RBS's may include; retained drain fragments, broken needles, fractured guidewires, broken scalpel blades, fractured screws, and/or instruments. Retrieval procedures warrant a wide variety of different techniques, some of which fail. Notably, RFB's largely occur due to the performance of; emergent procedures, doing an unfamiliar operation, encountering anatomical variants, or operating on patients with elevated body mass indexes (BMI). Additionally these include; surgeons' failure to order and/or radiologists' failure to correctly read intraoperative X-rays/fluoroscopic images, and/or nurses' failures to correctly perform end of surgery counts. CONCLUSION/UNASSIGNED:RFBs, or foreign bodies left behind following spine surgery, are considered "Never Events (< 1/1000)" or "Near Never Events (< 1/100)," and are not just "Adverse Events (> 1/100)". When they do occur, the operating surgeon bears primary responsibility, but the nursing/adjunctive staff and hospital are also liable.

Artificial intelligence (AI) has rapidly emerged as a transformative force in radiology, offering enhanced diagnostic accuracy, workflow optimization, and the potential to alleviate rising imaging demands. As radiology remains inherently dependent on pattern recognition and high-volume data interpretation, it represents an ideal domain for AI integration. This narrative review synthesizes current evidence on the clinical impact of AI across multiple dimensions of radiologic practice, including diagnostic performance, workflow efficiency, patient perspectives, and trainee education. AI systems have demonstrated performance approaching or exceeding that of radiologists in high-prevalence tasks, particularly in chest imaging and breast cancer screening, while also improving triage and reducing report turnaround times. However, these benefits are accompanied by significant challenges. Automation bias, over-reliance on algorithmic output, and anthropomorphic framing may compromise clinical judgment. Additionally, AI integration may paradoxically increase workload and contribute to radiologist burnout when poorly implemented. Patient-centered studies consistently indicate a preference for AI-augmented, rather than autonomous, diagnostic models, underscoring the enduring importance of physician oversight and communication. Among trainees, concerns regarding job security persist, though these are mitigated by increased AI literacy and structured educational initiatives. Ultimately, AI is best conceptualized not as a replacement for radiologists, but as a complementary tool. Thoughtful integration, combined with robust training, validation, and human oversight, will be essential to ensure that AI enhances rather than diminishes the quality of radiologic care.

PURPOSE/OBJECTIVE:To determine the association between labral width as measured on preoperative magnetic resonance imaging (MRI) and patient-reported outcomes, achievement of clinically significant thresholds, and reoperation rates in hip arthroscopy for femoroacetabular impingement syndrome (FAIS) at minimum 10-year follow-up. METHODS:A retrospective review of a prospectively gathered database of hip arthroscopy patients from August 2012 to June 2014 was conducted. Inclusion criteria were patients ≥18 years with clinically and radiographically confirmed FAIS and labral tearing who underwent primary hip arthroscopy with labral repair or debridement and had ≥10 years of follow-up. MRI labral width measurements were performed by 2 blinded musculoskeletal radiologists at standardized clockface locations using a validated technique. Outcomes were assessed using the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS). Patients were classified as hypoplastic if they had a labral width below the mean on 2 or more views. Outcomes and reoperation rates were compared between groups using independent samples t-tests for continuous variables and chi-square tests for categorical variables. RESULTS:were included, with a mean follow-up of 11.30 ± 0.47 years. Patients were categorized into hypoplastic (n = 42) and nonhypoplastic (n = 41) groups. There was no significant difference between hypoplastic and nonhypoplastic groups with respect to age, sex, smoking status, or intraoperative procedures. Additionally, there were no significant intergroup differences in mHHS or NAHS improvement at 5 or 10 years postoperatively. Both groups showed high achievement of the mHHS minimal clinically important difference threshold at 10-year follow-up with no significant difference (nonhypoplastic: 90.3% vs hypoplastic: 85.2%, P = .549). There was also no difference achievement of the patient acceptable symptom state (nonhypoplastic: 64.5% vs. hypoplastic: 70.4%, P = .636). However, the hypoplastic group had a significantly higher rate of revision arthroscopy (28.6% vs 9.8%, P = .030) and conversion to total hip arthroplasty (21.4% vs 4.9%, P = .026) when compared with the nonhypoplastic group. CONCLUSIONS:Hypoplastic labral width on preoperative MRI was associated with an increased risk of revision hip arthroscopy and conversion to total hip arthroplasty at 10 year follow-up in patients with FAIS. LEVEL OF EVIDENCE/METHODS:Level III, retrospective comparative case series.

BACKGROUND:People with multiple sclerosis (PwMS) frequently experience invisible symptoms, including cognitive impairment, fatigue, depression, anxiety, and psychosocial factors such as stigma, which can substantially affect social role participation (SRP). These factors are often under-recognized in clinical care despite their functional impact. OBJECTIVE:To examine the unique contributions of invisible MS-related symptoms to SRP after accounting for demographic characteristics and objective cognitive performance. METHODS:A cross-sectional sample of 434 PwMS was recruited from a large outpatient neurology clinic specializing in MS care. The sample was predominantly female (75%), largely white (85%), and middle-aged (M = 51.0, SD = 11.7), with mild-to-moderate disability. Participants completed a computerized cognitive battery and validated patient-reported outcome measures assessing disease impact, mood, fatigue, stigma, and SRP. Hierarchical regression models evaluated the variance explained by demographics, cognitive performance, and patient-reported symptoms. RESULTS:Demographic variables were not significant predictors of SRP. Cognitive performance accounted for 13.3% of the variance. Adding patient-reported outcomes increased explained variance to 70.6%. Depression, disease impact, fatigue, and executive functioning remained significant predictors, whereas stigma did not. CONCLUSIONS:Patient-reported symptom burden showed strong associations with SRP and explained more variance than demographic factors and most cognitive measures, while executive functioning also contributed independently.

BACKGROUND AND AIMS/UNASSIGNED:Pancreatic cystic lesions (PCLs) are increasingly detected because of the widespread use of imaging techniques. Among them, mucinous PCLs carry a higher malignancy risk, with intraductal papillary mucinous neoplasms (IPMNs) being the most frequent subtype. Accurate stratification based on the degree of dysplasia-low-grade dysplasia (LGD) versus high-grade dysplasia or carcinoma (HGD/C)-is essential to guide clinical management and avoid unnecessary surgical interventions. This study aimed to develop and evaluate a deep learning model for stratifying IPMNs into HGD/C and LGD using endoscopic ultrasound (EUS) images. METHODS/UNASSIGNED:This multicenter study included EUS images collected from 5 centers across Spain, Brazil, and the United States. Ground truth classification of IPMNs was established through cytologic and biochemical analysis of cyst fluid, EUS-guided through-the-needle biopsy, or surgical specimens. A deep learning model was trained to distinguish LGD from HGD/C. Model performance was assessed on the basis of sensitivity, specificity, accuracy, and area under the precision-recall curve. RESULTS/UNASSIGNED:A total of 51,046 EUS images were extracted from 30 examinations performed at 5 centers in Portugal, Spain, Brazil, and the United States. The model distinguished IPMNs with HGD/C from those with LGD with a sensitivity of 95.7%, a specificity of 88.7%, and an overall accuracy of 87.2%. The area under the receiver operating characteristic curve was 0.951. CONCLUSIONS/UNASSIGNED:To our knowledge, this is one of the first studies to evaluate the potential of an artificial intelligence model for dysplasia grading of IPMNs. Prospective validation of our model is necessary to ensure clinical benefit.

From 2014 to 2025, accelerated 3-year MD programs (A3YP) have expanded significantly, such that 20% of allopathic medical schools offer a program to earn the MD degree in three years. While maintaining rigorous and comparable educational standards as traditional 4-year programs, A3YPs aim to address physician workforce shortages, reduce student debt, and provide individualized education pathways into specific specialties. Among the thirty-two A3YPs in existence, twenty-two medical schools have graduated 1141 students to date, with numbers increasing annually. Nineteen programs are linked to a residency program, though six of these programs consistently match students outside their linked program. As more medical schools implement A3YPs and an increasing number of graduates enter the National Residency Matching Program (NRMP), residency program directors will encounter A3YP applicants more frequently. The proliferation of A3YPs presents both challenges and opportunities for residency program directors in evaluating applicants. Despite the differences in their applications, including limited extracurricular activities and time for visiting rotations, these applicants have been found to perform similarly in standardized testing and residency milestones, and have similar well-being and satisfaction as traditional students. This perspective outlines key considerations for PDs and provides a foundation for contextually evaluating the increasing numbers of these applicants graduating from A3YPs.

Pediatric autoimmune hemolytic anemia (AIHA) is a heterogeneous disease with significant morbidity due to the underlying condition and its treatment. Evidence-based guidelines for evaluation and management are lacking. Data from 399 patients with AIHA followed at 15 pediatric centers were collected to identify factors associated with secondary diagnoses, recurrent/chronic course, therapeutic efficacy, and mortality. Most had AIHA associated with secondary diagnoses including Evans syndrome (37%, 142/385), other autoimmunity (22%, 86/392), and inborn errors of immunity (IEI, 18%, 68/379). Of 305 patients tested, 82% had abnormal functional immune results. Genetic testing for an IEI was sent in 31% (109/348) with pathogenic findings identified in 32% of those tested. Patients with IEI or other autoimmunity more frequently had abnormal immunoglobulin and complement testing. Prevalence of IEI was not different between those presenting with or without infection. The median number of treatments for the first AIHA episode was 2 (range: 0-17). Of those with warm AIHA, 31% received steroid-sparing therapy during the first episode. Patients with recurrent AIHA (42%) had a higher rate of abnormal immune tests (OR=2.29, p=0.012), Evans syndrome (OR= 4.85; p<0.001), IEI (OR=3.88, p<0.001), and other autoimmune disorders (OR=3.29; p<0.001). With median follow up of 4.9 years (range: 0-19.4 years), 72/257 (28%) with warm AIHA continued to have active disease on treatment. Of the 399 patients, 10 died, all of whom had secondary diagnoses. Expansive immune evaluation, monitoring, and targeted treatments directed at immune diagnoses are needed for pediatric AIHA, highlighting the need for evidence-based pediatric AIHA guidelines.