Faculty Bibliography

PURPOSE/OBJECTIVE:This study aimed to examine associations of bisphenol and phthalate exposure with arterial stiffness among women of reproductive age. METHODS:Participants include 637 adult women enrolled in the New York University Children's Health and Environment Study (NYU CHES), a prospective pregnancy cohort. The concentrations of eight bisphenols and 22 phthalate metabolites were quantified in up to three spot urine samples. Primary outcomes included brachial artery distensibility (BrachD) and carotid-femoral pulse wave velocity (cfPWV) as measures of peripheral and central arterial stiffness, respectively, along with blood pressure assessed at repeated study visits up to seven years from exposure measures. Associations between averaged, log2-transformed, creatinine-standardized chemical concentrations and subclinical vascular outcomes of interest were examined using linear mixed-effects models. RESULTS:In covariate-adjusted models, a doubling of bisphenol A was positively associated with BrachD (0.09%/mmHg, 95% confidence interval [CI] = 0.02, 0.16), a doubling of bisphenol S was negatively associated with mean arterial pressure (MAP) (-0.52 mmHg, 95% CI = -0.98, -0.05), a doubling of di(2-ethylhexyl) phthalate (DEHP) metabolites was negatively associated with diastolic blood pressure (DBP) (-0.81 mmHg, 95% CI = -1.38, -0.23) and MAP (-0.83 mmHg, 95% CI = -1.45, -0.21), and a doubling of antiandrogenic phthalate metabolites was associated with 0.62 mmHg lower DBP (95% CI = -1.22, -0.03) and 0.66 mmHg lower MAP (95% CI = -1.30, -0.02). CONCLUSION/CONCLUSIONS:These findings suggest that routine exposure to bisphenols and DEHP may be associated with vasorelaxation, potentially related to these chemicals' estrogenic and/or antiandrogenic effects.

INTRODUCTION/BACKGROUND:Patients with a suspected high-consequence infectious disease (HCID), such as Ebola virus disease, may require routine laboratory testing to guide management. We assessed the capabilities of frontline hospitals and the barriers they face performing laboratory testing for patients with a suspected HCID. METHODS:A one-time confidential REDCap survey querying capabilities to safely perform laboratory tests that the Centers for Disease Control and Prevention considers critical for patients with a suspected HCID was sent to 95 institutions in Baltimore, MD, Boston, MA, New York City, NY, and Washington, DC, from January to May 2025. RESULTS:Fifty (53%) institutions responded, mostly teaching hospitals (96%), with 24% reporting prior experience evaluating a patient with suspected Ebola virus disease. While many hospitals could perform on-site blood gas (70%), hemoglobin/hematocrit (68%), and lactate (68%) tests on a suspected HCID patient, fewer could safely perform a chemistry panel (64%), a urinalysis (60%), a complete blood count with differential (56%), and a malaria rapid diagnostic test (RDT) (48%) on a suspected HCID patient. The five tests respondents most often considered extremely or very important were hemoglobin/hematocrit (91%), chemistry panel (90%), CBC with differential and platelet count (89%), malaria RDT (88%), and blood gas (88%). Reported barriers to performing routine laboratory testing included issues related to patient and staff safety, infection control, lack of appropriate space, and funding. CONCLUSIONS:Our survey identified several barriers to implementing safe laboratory testing. The inability to conduct these laboratory tests may result in delays in care when an HCID is suspected.

AIM/OBJECTIVE:The "2026 HRS Expert Consensus Statement Update on Cardiovascular Implantable Electronic Device Lead Management and Extraction" provides updated recommendations to guide clinicians in the management of cardiovascular implantable electronic device (CIED) leads. BACKGROUND:Since the publication of the "2017 HRS Expert Consensus Statement on Cardiovascular Implantable Electronic Device Lead Management and Extraction," the field has evolved quickly. New evidence on CIED lead management and the blooming development of new CIED technologies, including leadless pacing and implantable cardioverter-defibrillator leads implanted outside the vascular system and new lumenless pacing leads and lead extraction tools, have contributed to the field's rapid evolution. METHODS AND RESULTS/RESULTS:A comprehensive literature search was conducted in accordance with the Institute of Medicine standards. The writing committee reviewed evidence gathered through electronic literature searches encompassing clinical trials, original studies, and meta-analyses conducted on human subjects published in English from MEDLINE, PubMed, Embase, and the Cochrane Library up to December 2024. The comprehensive literature review supports each evidence-based recommendation and is compiled in the evidence tables. A predefined threshold of >70% approval for each recommendation was required, with a quorum of two-thirds of the writing committee. The final mean consensus of 108 recommendations was 93.61%. DISCUSSION/CONCLUSIONS:The recommendations from the "2017 Expert Consensus Statement on Cardiovascular Implantable Electronic Device Lead Management and Extraction" have been updated with new evidence to guide clinicians. The new recommendations address the latest CIED technologies with the advantages over transvenous leads; new evidence supporting diagnosis, treatment, and prevention for CIED infection; appropriate lead management in transcatheter tricuspid valve replacement for tricuspid regurgitation; and standardization of transvenous lead extraction approach, protocol, and facilities to improve the outcomes of CIED lead management and extraction.

BACKGROUND/UNASSIGNED:Many overhead athletes, both amateur and professional, experience an increasing number of injuries to the ulnar collateral ligament (UCL) as a result of overuse or trauma. As a result of this increasing frequency, multiple techniques have been developed to reconstruct or repair the UCL with success and faster return to sports (RTS) for athletes who are ideal candidates for a repair. However, a large proportion of UCL tear patients cannot undergo repair due to chronic injury, leading to poor tissue quality, midsubstance tears, or older age, which predispose them to slower healing and a more difficult path to total rehabilitation. The senior author's "hybrid" reconstruction combines a palmaris longus autograft for reconstruction with a repair-style suture brace augmentation that allows for increased load-to-failure strength that parallels the native UCL, while allowing for native anatomic motion of the ligament when ranging the elbow. INDICATIONS/UNASSIGNED:This technique is indicated for patients with a UCL tear confirmed by magnetic resonance imaging, poor to moderate UCL tissue quality, midsubstance tears, and older patients who have a palmaris longus tendon to harvest and persistent ulnar nerve paresthesias. TECHNIQUE DESCRIPTION/UNASSIGNED:This video demonstrates the senior author's technique of harvesting a palmaris autograft, drilling proximal and distal UCL graft passage tunnels, augmenting the graft with an internal suture brace, fixation of the graft, and finally an ulnar nerve transposition to alleviate ulnar nerve paresthesia. RESULTS/UNASSIGNED:Outcomes of retrospective studies demonstrate good to excellent outcomes of UCL hybrid reconstructions with suture brace augmentation and RTS rates of at least 85%. Complication rates are low, with the most common complication being graft failure (14%) and the next most common being temporary ulnar nerve paresthesia. DISCUSSION/CONCLUSION/UNASSIGNED:Overall, this video demonstrates a highly effective technique at restoring native-like biomechanics and function for patients with UCL tears that are too complex to repair. Patients have good to excellent outcomes and RTS rates, although time to RTS may take 12 months or longer. PATIENT CONSENT DISCLOSURE STATEMENT/UNASSIGNED:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

BACKGROUND:Magnetic resonance (MR) imaging-linear accelerator-based real-time adaptive planning for delivering ultra-hypofractionated stereotactic body radiotherapy (SBRT) has advanced clinical accuracy yet added complexity to the radiotherapy workflow. We retrospectively evaluated whether the addition of a Parallel Automated Contouring module with Enhancement of AI (PACE-AI) reduced contouring time and overall SBRT duration, and its impact on intra-fractional target motion. METHODS:This study included 250 fractions from 90 prostate cancer patients from which fraction time were tracked. All patients received definitive SBRT to the prostate on the 1.5-Tesla Unity (Elekta©) system, through the Adapt-To-Shape (ATS) workflow, which required real-time re-contouring of the normal tissues by the dosimetrists and target contouring by the physician for each of the fractions. We compared the fraction durations for 125 consecutive fractions treated with the incorporation of PACE-AI with 125 fractions previously treated without PACE-AI to determine whether PACE-AI improved efficiency and reduced treatment session duration. RESULTS:For the cohort treated without PACE-AI, the overall median duration was 67.6 min, including 23.9 min contouring time. With the incorporation of PACE-AI, the overall median duration was 51.2 min, representing a 24.3% reduction. The average contouring time was reduced by 55% to 10.8 min. In addition, the extent of positional shifts prior to beam delivery was significantly reduced from an average of 1.8 mm to 1.3 mm (p < 0.001) in both superior/inferior (range reduced from 0 to 6.3 mm to 0-4.2 mm) and anterior/posterior directions (range reduced from 0 to 6.6 mm to 0-5.0 mm). CONCLUSIONS:The incorporation of PACE-AI improved workflow efficiency during SBRT. The reduction in treatment duration also helped reduce organ motion during real-time adaptive planning.

Anaphylaxis is a rapid-onset, potentially life-threatening systemic allergic reaction that remains a significant clinical concern in pediatric practice. Food allergies are the most common trigger in children, and a substantial proportion of affected patients experience severe reactions. This review provides a practical, evidence-based framework for the diagnosis and management of IgE-mediated allergy in the pediatric setting, emphasizing recognition, treatment, and preparedness. Anaphylaxis is a clinical diagnosis based on established criteria, with age-specific presentations that may complicate recognition, particularly in infants and young children. Epinephrine is the cornerstone of treatment and the only therapy capable of reversing life-threatening respiratory and cardiovascular manifestations. Early epinephrine administration improves outcomes, yet real-world use remains suboptimal due to barriers such as needle aversion, device complexity, and access challenges. Pediatricians play a critical role in identifying at-risk patients, prescribing epinephrine, and reinforcing preparedness through education and individualized action plans across care settings. Integrating evolving therapeutic options with established best practices may help to address persistent gaps in care and improve outcomes for children at risk of anaphylaxis.