Faculty Bibliography

The prevalence of vitamin D deficiency among intensive care unit (ICU) patients is potentially associated with an increased risk of mechanical ventilation, sepsis, prolonged hospital stays, and mortality. Although ICU patient care has significantly improved in recent years, the role of vitamin D supplementation remains under investigation. A literature review was conducted using PubMed, Web of Science, Embase, and Cochrane databases, focusing on randomized controlled trials published in the past five years on vitamin D supplementation in adult ICU patients. Patients' baseline vitamin D levels, administration routes, doses, biomarker changes, mechanical ventilation duration, length of hospital stay, and mortality were analyzed. Although vitamin D supplementation appears safe and may reduce ICU stay duration and mechanical ventilation time and improve SOFA scores, its impact on overall mortality remains uncertain. Routine supplementation for all ICU patients is not currently recommended; clinical decisions should consider individual baseline vitamin D levels, patient characteristics, severity of illness, doses, and administration methods.

Neoadjuvant therapy (NAT) is the standard of care for borderline-resectable and locally advanced pancreatic ductal adenocarcinoma (PDAC). It can be used to treat resectable PDAC. This study aimed to investigate how NAT remodels the tumor immune microenvironment (TIME) and whether this remodeling translates into survival benefits. We performed spatial and digital pathology analysis of 27 upfront resection patients (naïve group) and 39 age-, gender-, and stage-matched patients who had surgery after NAT (NAT group). AI-assisted digital pathology was used to annotate cancer cells and CD8 + T lymphocytes. Spatial correlation between CD8 + T lymphocytes and cancer cells for each case was assessed using spatial point pattern analysis, followed by generalized linear modeling (GLM) of quadrat counts of CD8 + T cells, with the quadrat counts of cancer cells as the independent variable. The regression coefficient was used to quantify the strength of their spatial correlation and then further assessed for association with patient survival. The analyses showed that the NAT group, compared with the naïve group, had increased spatial correlation of CD8 + T cells with cancer cells, suggesting enhanced effector T cell-cancer cell engagement in the NAT patients. Additionally, patients with a higher degree of spatial correlation between the two cells showed improved after-surgery survival. Through a new methodological framework that takes advantage of AI-assisted digital pathology and spatial point pattern analysis, our study has successfully captured the subtle effects of NAT-induced TIME remodeling and assessed its impact on prognosis of PDAC patients.

BACKGROUND/UNASSIGNED:High-dose (HD) tigecycline is often required for severe multidrug-resistant gram-negative infections in liver failure patients, despite package recommendations to halve the dose for those with severe liver impairment. This study evaluated the efficacy and safety of different tigecycline doses in this population. RESEARCH DESIGN AND METHODS/UNASSIGNED:A retrospective cohort of 192 patients with Child-Pugh grade C liver failure was divided into label-dose (LD), standard-dose (SD), and HD groups. Primary and secondary outcomes included microbial eradication, mortality, and adverse effects. RESULTS/UNASSIGNED: = 0.062). Optimal microbial eradication and minimized adverse effects occurred with the SD group at 7 days of treatment. CONCLUSIONS/UNASSIGNED:Standard-dose tigecycline offers a balanced approach to microbial eradication and safety, making it preferable in liver failure patients.

Diagnosing and characterizing biliary strictures (BS) remains challenging. Artificial intelligence (AI) applied to digital single-operator cholangioscopy (D-SOC) holds promise for improving diagnostic accuracy in indeterminate BS. This multicenter study aimed to validate a convolutional neural network (CNN) model using a large dataset of D-SOC images to automatically detect and characterize malignant BS. D-SOC exams from three centers-Centro Hospitalar Universitário de São João, Porto, Portugal (n = 123), Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain (n = 18), and New York University Langone Hospital, New York, USA (n = 23)-were included. Frames were categorized based on histopathology. The CNN's performance in detecting tumor vessels, papillary projections, nodules, and masses was assessed. The dataset was split into 90% training and 10% validation sets. Performance metrics included AUC, sensitivity, specificity, PPV, and NPV. Analysis of 96,020 images from 164 D-SOC exams (50,427 malignant strictures and 45,593 benign findings) showed the CNN achieved 92.9% accuracy, 91.7% sensitivity, 94.4% specificity, 95.1% PPV, 93.1% NPV, and an AUROC of 0.95. Accuracy rates for morphological features were 90.8% (papillary projections), 93.6% (nodules), 93.2% (masses), and 78.1% (tumor vessels). AI-driven CNN models hold promise for enhancing diagnostic accuracy in suspected biliary malignancies. This multicenter study contributes diverse datasets to ongoing research, supporting further AI applications in this patient population.

Typical carotid webs are nonatherosclerotic shelf-like projections of fibromyxoid tissue extending from the posterior wall of the proximal internal carotid artery (ICA). Carotid webs may precipitate acute embolic stroke, especially in younger patients. We describe our experience with pathology-proven carotid webs of atypical appearance, or atypical carotid webs (ACWs), a subset of carotid webs exhibiting abnormal location, morphology, or association with atherosclerotic changes. Our electronic medical record database was queried for all imaging impressions containing "carotid web," "shelf," or "protrusion" from 2018-2024. Imaging was reviewed by an experienced neuroradiologist and neurosurgeon. Patients with typical carotid webs or those with different diagnoses (e.g. dissection/thrombus) were excluded. Twenty-seven patients were treated for typical carotid webs; 24 were treated with carotid endarterectomy (CEA) and had pathology-confirmed webs. Five patients (three male) were identified to have ACWs and included in this report. Mean age was 43.6 years. All ACWs were identified by computed tomography angiography (CTA). All patients presented with acute ischemic stroke or transient ischemic attack (TIA). One web was located on the anterior ICA wall, three were of abnormal morphology different from a "shelf-like" projection, and one was associated with atherosclerotic change. No patients experienced a further stroke or TIA following CEA. ACWs may precipitate ischemic stroke and can be treated and definitively diagnosed with CEA. Due to their unusual appearance, ACWs may evade radiographic identification or be misdiagnosed. As ACWs have not been previously reported in the literature, awareness of their existence must be raised to increase their detection and treatment.

PURPOSE/OBJECTIVE:Immune checkpoint inhibitors (ICIs) have revolutionized the care of patients with cancer, but use among hospitalized patients is controversial as a result of questionable benefit and high costs. To evaluate the role of ICIs in the inpatient (IP) setting, we conducted the Inpatient Immunotherapy Outcomes Study (IIOS) to describe characteristics and outcomes of patients who received IP ICIs. METHODS:IIOS is a retrospective study of patients treated with ICIs during hospitalization between 2012 and 2021 at five academic institutions. Data collection was performed using each institution's electronic medical record. We estimated overall survival (OS) from the first administration of ICI using the Kaplan-Meier method and used adjusted Cox proportional hazards models to explore associations between clinicodemographic variables and OS. RESULTS:Two hundred fifteen patients received IP ICIs (median age 60 years; 55% White; 14% Black; 13% Hispanic). Thoracic and head and neck (24%), GI (21%), and hematologic (19%) malignancies were most common. Most of the patients were ICI-naïve (75%), had stage IV solid malignancies (75%) at the time of IP ICI initiation, and had no radiographic response to ICI therapy (88%). Median OS from the first IP ICI dose was 1.55 months (95% CI, 1.08 to 1.81) for all patients and 1.28 months (95% CI, 0.95 to 1.80) for patients with advanced solid malignancies. Multivariable Cox proportional hazards model analysis found no clinicodemographic variables associated with improved OS after IP ICI administration. CONCLUSION/CONCLUSIONS:IIOS is the largest multi-institutional effort to describe outcomes after IP ICI administration. Clinical outcomes are poor after IP ICI use and IP ICIs should be used with caution.

INTRODUCTION/BACKGROUND:Ballistics is the science that studies the trajectory, range, and effects of projectiles. Knowledge of the principles of wound ballistics is of particular importance to the surgeon because they allow the optimization of the diagnosis and treatment of those injured by firearms. This review focuses on the updated knowledge of wound ballistics as it pertains to the diagnosis and treatment of gunshot wounds. METHODS:A literature review was performed using PubMed, Scopus, and Embase databases. The search was limited to observational articles pertaining to wound ballistics and its relationship to patient management in English and Spanish published between January 2014 and March 2024. Studies about weapon design, patients with lethal injuries, experimental, forensic, historical studies, and those reports on pediatric population were excluded. RESULTS:Eleven articles from twenty-eight publications meeting the inclusion criteria were reviewed. CONCLUSIONS:The understanding of wound ballistics enhances the ability to identify potential injuries and to optimize the treatment of gunshot wounds in adults.

BACKGROUND:Cognitive impairment is linked with increased risk of falls in people with multiple sclerosis (pwMS), but it is not clear whether cognitive performance may help to account for the discordance between fall-risk due to actual physiological functioning and the individual's perception of their fall-risk. This study examined the relationship between cognitive performance and the concordance/discordance of physiological and perceived fall-risk in pwMS. METHODS:) fall-risk. Cognitive performance was evaluated using the NeuroTrax computerized cognitive battery, which generates a global cognitive score (GCS) as well as scores for individual cognitive domains. RESULTS:group. CONCLUSION/CONCLUSIONS:In this study, one in 4 pwMS had a discordance between their physiological and perceived fall-risk. This discordance was not explained by cognitive performance.