Faculty Bibliography

OBJECTIVE:Spinal meningiomas (SMs) are common primary spinal tumors for which surgery is considered the first-line treatment when safe and feasible. The ability to extrapolate the tumor grade from preoperative imaging may significantly inform early patient expectation-setting regarding recurrence. Building on radiomics studies in cranial meningiomas, the authors aimed to construct a benchmark radiomics model to preoperatively identify the histological grade of SMs. METHODS:Institutional surgical records from May 2012 to November 2025 were queried for pathology-confirmed meningiomas below the foramen magnum, with preoperative contrast-enhanced imaging available for segmentation. SMs were classified as low-grade (WHO grade 1) and high-grade (WHO grade 2 tumors and grade 1 tumors with atypia). Tumors were manually segmented, and features were extracted using the PyRadiomics software package. An ensemble model of k-nearest neighbors, random forest, and support vector machine classifiers was trained using nested cross-validation on a subset of 10 features to differentiate tumor grades. Clinical data for the cohort were also extracted, and disease control in an adjunctive clinical series was assessed. RESULTS:Seventy-four patients were included in radiomics analysis, with an area under the receiver operating characteristic curve of 0.879 and a mean F1 score of 0.748. The model's top 5 features were all texture features that differed significantly (p < 0.05) across low- and high-grade SMs. These included measures of tumor textural and contrast-enhancement heterogeneity, with overlap with features reported in radiomics models for histological grading of intracranial meningiomas. Fifty-five patients with a median radiographic follow-up of 22.2 (range 1.9-86.4) months remained for clinical analysis after exclusion of patients with less than 1 month of follow-up and syndromic meningiomas. Four recurrences occurred at a median of 20.8 (range 1.8-41.8) months. High-grade tumor pathology did not significantly impact progression-free survival (p = 0.682, log-rank test; Cox regression high vs low grade hazard ratio [HR] 0.62, 95% CI 0.06-6.11, p = 0.685). Subtotal resection was associated with poorer progression-free survival than gross-total resection (p = 0.004, log-rank test; Cox regression subtotal vs gross-total resection HR 10.62, 95% CI 1.46-77.05, p = 0.019). These findings remain contextualized within a relatively limited follow-up window and small recurrence event count, suggesting a need to characterize the interplay between tumor grade and extent of resection as drivers of local disease control in SMs. CONCLUSIONS:A preoperative radiomics model can stratify high-grade SMs using open-source tools applied to single-institution data.

BACKGROUND:Cognitive impairments are consistently associated with the actual number of falls and future fall risk in people with multiple sclerosis (PwMS), but their influence and predictive usefulness regarding fear of falling (FoF) are not well understood. Since FoF can greatly affect a patient's lived experience and is essential for evaluating overall fall risk in PwMS, we aimed to explore how cognitive performance relates to, and forecasts, individuals' perceptions of their fall risk, and whether disease severity impacts this relationship. METHODS:FoF (Modified Falls Efficacy Scale, MFES) and neurocognitive function (NeuroTrax computerized cognitive assessment battery) were assessed in 188 PwMS. The NeuroTrax battery provided index scores for global cognition and specific cognitive domains such as memory, executive function, attention, processing speed, visuo-spatial, verbal function, and motor skills. The predictive value of cognitive performance on FoF was examined through hierarchical regression models. RESULTS: = 9.15, p < 0.001). CONCLUSION/CONCLUSIONS:FoF in PwMS can affect day-to-day planning and quality of life but is often overlooked as a meaningful aspect of the patient's lived experience. Our findings suggest that cognitive deficits are associated with greater FoF, and that the cognitive domain related to FoF varies as a function of disability level. Deficits in executive functioning and motor skills, in particular, may indicate broader disease impact on the patient's perception of their physical capabilities.

BACKGROUND:Palliative care skills are essential in surgical practice, but time constraints and lack of faculty expertise are barriers to implementing palliative care education in surgical training. This study describes and assesses a 5-hour palliative care curriculum designed to fit within demanding residency programs. METHODS:The palliative care curriculum was delivered to general surgery residents at a single institution by faculty surgeons over the course of five 1-hour sessions. Palliative care competence was assessed by a palliative care competence survey completed by residents at baseline and after completion of the palliative care curriculum. The palliative care curriculum survey assessed 3 domains (attitudes, knowledge, and behavior) on a 5-point Likert scale to create a composite score and domain subscores reported as mean (standard deviation). RESULTS:The study included 62 survey respondents, most of whom were in their first year of training (n = 32, 59.7%). Overall survey scores were significantly higher after palliative care curriculum participation (3.92 [0.43]) when compared with baseline (3.56 [0.61]), P = .008; this was also demonstrated in the knowledge domain (3.73 [0.55] vs 3.32 [0.69], P = .011) and the behavior domain (3.44 [0.7] vs 3.28 [0.78], P = .023). The improvement in scores was demonstrated in both univariate and multivariate analyses (P < .05). CONCLUSION/CONCLUSIONS:Participation in this 5-hour palliative care curriculum for surgical residents is associated with improved attitudes, knowledge, and behaviors in palliative care. This palliative care curriculum provides a framework for palliative care education across a variety of residency programs based on available time and faculty resources.

Brain arteriovenous malformations (bAVMs) are vascular anomalies characterized by direct arterial to venous shunting without an intervening capillary bed, predisposing patients to intracranial hemorrhage and subsequent neurological morbidity and mortality. Evidence suggests that development and evolution of bAVMs are influenced by ongoing molecular and inflammatory processes. Chronic inflammation within the AVM microenvironment has emerged as a key driver of dysregulated angiogenesis, vascular instability, and hemorrhage risk. The objective of this review is to examine the molecular and cellular mechanisms through which inflammatory pathways contribute to AVM development, rupture, and treatment response. A comprehensive search of the Web of Science database was performed from database inception through September 2024. Following removal of duplicate articles, titles and abstracts were screened and full texts were reviewed for relevance. Experimental, translational, and clinical studies investigating inflammatory signaling pathways, immune cell involvement, molecular biomarkers, and therapeutic implications in AVMs were included. A total of 342 studies were included in the final review. Current evidence demonstrates that inflammatory signaling plays a central role in AVM pathobiology. Pro-inflammatory cytokines including interleukin-1β, interleukin-6, and tumor necrosis factor-α promote endothelial activation, leukocyte recruitment, and abnormal angiogenesis within the AVM nidus. Dysregulation of signaling pathways such as VEGF, TGF-β/BMP, NF-κB, Notch, and KRAS/MAPK-ERK contributes to extracellular matrix degradation, vascular remodeling, and vessel fragility. Infiltration by macrophages and neutrophils further amplifies inflammatory cascades through the release of matrix metalloproteinases and reactive oxygen species, increasing rupture risk. In addition to its pathogenic role, inflammation also contributes to success of AVM obliteration using stereotactic radiosurgery through radiation-induced endothelial injury, immune cell recruitment, and progressive vascular fibrosis. Inflammation is a fundamental component of AVM formation, progression, and therapeutic response. Targeting these pathways, in combination with surgical or radiosurgical interventions, may offer new opportunities for improving AVM management and improving approaches in cerebrovascular neurosurgery.

Inflammation is a pivotal driver of the progression from metabolic dysfunction-associated steatotic liver disease (MASLD) to metabolic dysfunction-associated steatohepatitis (MASH), an aggressive form associated with substantial liver-related mortality. However, the molecular mechanisms underlying the initiation and persistence of liver inflammation remain poorly defined. Here, we demonstrated a previously unrecognized role for hepatic acetyl-CoA synthetase short-chain family member 2 (ACSS2) in MASH, showing that ACSS2 upregulation in patients exacerbates MASH progression by functioning as an epigenetic regulator, independent of its canonical lipogenic role. Mechanistically, ACSS2, in complex with lysine acetyltransferase 5 (KAT5), upregulates allograft inflammatory factor-1 (AIF1) transcription via histone crotonylation, thereby inducing liver inflammation and subsequently resulting in the aberrant accumulation of senescent hepatocytes, which further enhances proinflammatory cytokine production. This ultimately initiates a vicious cycle of chronic inflammation, which directly promotes the progression from simple steatosis to MASH. Thus, our work reveals a mechanistically defined and pivotal role for ACSS2 in promoting the MASLD-to-MASH transition, highlighting its potential as a compelling therapeutic target.

The subcutaneous (SC) injection route is a commonly used and important method for therapeutic delivery of a wide range of compounds, and needle characteristics have a significant influence on patient pain, anxiety, safety, and other outcomes. This systematic review evaluates the evidence on how needle-specific characteristics (e.g. gauge, length, tip design, wall thickness, concealment) and administration- or device-related factors can affect patient-reported outcomes and clinical safety indicators during and following SC injections. A comprehensive search was conducted in MEDLINE, PubMed, Embase, and ClinicalTrials.gov in June 2024. Studies were included if they assessed the relationship between needle characteristics and pain, anxiety, safety, or related outcomes in individuals receiving SC injections. A dual-reviewer process was used for study selection, data extraction, and quality assessment. Sixty-two studies met inclusion criteria. Evidence consistently indicated that thinner and shorter needles reduced patient-reported pain and adverse events such as bruising and bleeding. Tapered and lubricated needles, hidden or retractable needle designs, and use of autoinjectors or prefilled syringes also contributed to reduced anxiety and improved user satisfaction. However, results were heterogeneous, and many studies lacked sufficient power or single-variable evaluation of individual needle parameters, limiting definitive conclusions. Needle characteristics significantly influence patient experience and safety with SC delivery. While both clinical evidence and practical experience clearly favor thinner, shorter, and concealed needles, further standardized, high-quality research is needed to isolate and quantify the specific contributions of individual needle characteristics to optimize injection practices and support patient-centered device design.

OBJECTIVE/UNASSIGNED:Timely use of sodium-glucose cotransporter-2 inhibitors (SGLT2is) is vital for managing type 2 diabetes (T2DM) and preventing cardiovascular and renal complications. However, socioeconomic barriers and prescribing inertia may disproportionately affect disadvantaged populations. We examined racial and ethnic differences in the initiation of SGLT2i among Medicaid patients with T2DM. METHODS/UNASSIGNED:Adult participants 18-64 with T2DM and prescribed with metformin were drawn from MarketScan Multistate Medicaid Database (2015-2022) for this retrospective cohort study. We used a Cox proportional hazards model, adjusted for age, sex, type of Medicaid coverage, and comorbidities, to assess time to SGLT2i initiation. RESULTS/UNASSIGNED:Among 13 744 Medicaid patients, non-Hispanic Black patients had an 18% lower rate of SGLT2i initiation compared with non-Hispanic White patients (hazard ratio [HR] = 0.82; 95%CI: 0.75-0.90). This disparity was most pronounced among patients without pre-existing atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease (HR = 0.79; 95%CI: 0.71-0.87). No significant racial/ethnic differences were observed among patients with these conditions. CONCLUSIONS/UNASSIGNED:Significant delays in SGLT2i initiation among Black Medicaid patients-particularly in early stage of diabetes-may increase their risk for long-term complications. Addressing structural barriers through targeted interventions is essential to promote equity in diabetes care.