Faculty Bibliography

OBJECTIVE:To describe a novel surgical technique utilizing the placement of an apical ground electrode to facilitate intracochlear current modulation in patients with cochlear ossification and incomplete electrode array insertion. PATIENTS/METHODS:Patients with incomplete standard electrode array insertion due to cochlear ossification. INTERVENTION/METHODS:Standard cochlear implant (CI) electrode array insertion, in addition to the placement of the extracochlear ground electrode into the cochlear apex to enable current steering through areas of cochlear ossification and towards the cochlear apex. MAIN OUTCOME MEASURES/METHODS:Procedural safety and patient-reported perceptual differences between programming configurations utilizing the apical ground. RESULTS:Placement of an apical ground electrode was safe and feasible in 3 patients with complex ossified cochlea and was able to augment sound perception, and improve performance, after adjustments to device programming. CONCLUSIONS:Apical ground electrode placement represents a technically achievable adjunct in selected patients with ossified cochlea and incomplete electrode array insertion. This approach may expand the functional stimulation field utilizing intracochlear current modulation to improve patient performance.

BACKGROUND/UNASSIGNED:"Never Events" (<1/1000) likely never occur without a breach in the standard of care (SOC), while "Near Never Events" (<1/100) are typically not far behind. METHODS/UNASSIGNED:"Never Events" are described as "Harmful hospital-acquired conditions that the Center for Medicare and Medicaid Services identified in 2008." Here, we focused on wrong-site spine surgery (WSSS)/wrong-level spine surgery (WLSS), 3 select cases of Caspar Distraction Screws causing hematomas, and one medicolegal case involving multiple simultaneous "Never Events." RESULTS/UNASSIGNED:The spine literature documented the following frequencies of wrong-site spine surgery WSSS/"Never Events" as occurring in 4.5/10,000 lumbar, 6.8/10,000 cervical, and 2.2/10,000 cranial procedures; other series focused on the incidence of wrong-level spine surgery (WLSS). Three "Never Events" consisting of cervical epidural hematomas were attributed to Caspar Distraction Screws. A medicolegal case is also presented in which a spine surgeon caused multiple simultaneous "Never Events" (i.e., ipsilateral surgical errors) during an anterior cervical fusion. Finally, the definition of "Never Events" was newly expanded to better assess "Near Never Events", as the latter applied to varied frequencies of esophageal perforations, plate/screw migration/erosions/displacement, cerebrospinal fluid leaks, infection, and other factors. CONCLUSION/UNASSIGNED:"Never Events" (<1/1000) likely never occur without a breach in the SOC, while "Near Never Events" (<1/100) are typically not far behind.

BACKGROUND:in participants with relapsed or refractory follicular lymphoma after at least one previous line of chemoimmunotherapy. METHODS:for up to 12 cycles. Epcoritamab was administered weekly in cycles 1-3 and every 4 weeks in cycles 4-12, lenalidomide once daily during cycles 1-12 (days 1-21), and rituximab weekly during cycle 1 and monthly in cycles 2-5. The dual primary endpoints were overall response rate and progression-free survival by independent review committee. The data reported here are from a planned interim analysis carried out after 78% of progression-free survival events had occurred. This study is registered with ClinicalTrials.gov, NCT05409066, and EudraCT, 2021-000169-34, and is ongoing (closed to recruitment). FINDINGS/RESULTS:(grade 1 in 28 [21%] participants and grade 2 in seven [5%] participants) and manageable, and all events were resolved. INTERPRETATION/CONCLUSIONS:as a new standard of care for second-line or subsequent treatment of follicular lymphoma. FUNDING/BACKGROUND:AbbVie and Genmab.

BACKGROUND:Linkage to medical services enables timely diagnosis and treatment, yet racial/ethnic minority older adults with limited English proficiency (LEP) face substantial barriers. We tested Preparing Healthy Aging through Dementia Literacy Education and Navigation (PLAN), a language-concordant community health worker (CHW)-led intervention, to improve dementia linkage among Korean American (KA) older adults with undiagnosed probable dementia and to assess caregiver outcomes. METHODS:In a community-based randomized trial, 287 older adult-caregiver dyads were followed for 6 months. Trained Korean-speaking CHWs delivered a 1-h dementia literacy education session plus phone navigation. The primary outcome was linkage to medical services, verified through clinic documentation. Secondary outcomes included caregiver psychosocial measures. RESULTS:PLAN increased linkage to medical services versus control (16.7% vs 0%, chi-squared [df = 1] = 24.05, p < 0.001). Caregiver outcomes were largely unchanged, with self-efficacy favoring control. DISCUSSION/CONCLUSIONS:This language-concordant CHW model achieved verified community-to-clinic linkage at 6 months. Longer follow-up and testing across diverse LEP communities are needed to assess diagnosis, treatment initiation, and caregiver trajectories.

OBJECTIVE:Amnioinfusions in anhydramnios aim to promote fetal lung development, but currently used fluids (Normal Saline [NS], Lactated Ringer's [LR]) fail to mimic the intrauterine environment and increase reactive oxygen species (ROS). We developed a synthetic amniotic fluid (Amnio-well, AW) designed to reduce intrauterine ROS. This study evaluated the pulmonary and gastrointestinal effects of 2 formulations of AW compared with those of NS and LR in a pre-clinical model. METHOD:At gestational age E17.5, pregnant rats underwent amniotic fluid replacement with NS, LR, AW, AW plus epidermal growth factor and transforming growth factor-β (AW++), or sham control. Fetal lungs were harvested at E20.5 for histology, fractional airspace, and blinded pathological evaluation. Surfactant protein (SP-A, SP-B, SP-C) expression and inflammatory gene panels were assessed in lungs and gastrointestinal (GI) tissue. RESULTS:NS and LR lungs demonstrated edema, macrophage infiltration, and reduced airspace (p < 0.001). AW improved SP-B and SP-C relative to control, whereas AW++ suppressed SP-B and SP-C (p < 0.05). Lung gene profiling showed NS/LR induced alterations in histamines, annexins, and immune recruitment, while AW closely resembled control. GI histology was similar across groups, though NS/LR altered TNF, prostaglandin, and adhesion pathways (p < 0.05). CONCLUSION:AW reduced lung inflammation and enhanced surfactant expression compared with NS or LR, with minimal GI effects.

BACKGROUND:Artificial intelligence (AI)-enabled "ambient" documentation may reduce clinician administrative burdens and improve care delivery, but implementation in clinical practice is complex. AIM/OBJECTIVE:To evaluate the implementation of commercially available ambient documentation tools in multi-specialty ambulatory clinical workflows at an academic medical center. SETTING/METHODS:A large urban academic health system in New York City. PARTICIPANTS/METHODS:Ninety-seven ambulatory clinicians across specialties. PROGRAM DESCRIPTION/METHODS:A multidisciplinary team conducted a 6-month proof-of-concept structured evaluation of two commercially available ambient documentation tools through initial vendor evaluations, technical review and integration with the electronic health record (EHR), clinician training and onboarding, implementation and technical support, and structured evaluation based on objective and key results (OKR) metrics. A single-group, pre-post evaluation of the impact of the tools on clinician EHR-based efficiency was conducted on a subset of participating clinicians. PROGRAM EVALUATION/RESULTS:Compared to the 3-month period immediately prior to initiating the ambient trial, clinicians experienced a 0.35-min-per-note and a 2.07-min-per-day reduction in documentation time. "Vendor B" showed higher utilization rates and superior user experience compared to "Vendor A." Implementation challenges included workflow integration, training resource requirements, data interoperability and analytics, and ongoing technical support needs. DISCUSSION/CONCLUSIONS:Ambient documentation shows promise in reducing documentation burden, but its success depends on technical stability and integration, product fit and support for clinicians, and adequate implementation resourcing. A multidisciplinary approach with clear metrics, strong vendor partnership and executive sponsorship, and ongoing technical support enables scalability.

PURPOSE/OBJECTIVE:Peer review is an integral process in the field of radiation oncology to ensure that radiation plans meet appropriate clinical and dosimetric standards. We report a pilot quality assessment of our peer review process and a model for utilizing the results of this pilot project for resident education. METHODS:This study prospectively tracked peer review in our department over the course of 9 months and tracked all plans that were not approved. Reasons for lack of approval were recorded. Plans that did not pass peer review were anonymized and imported to a shared folder for future educational use. Eight cases were used in a mock peer review didactics session with the residents. The session was led by two residents, a dosimetrist, and attending physician while the remaining residents were tasked with finding the error or reason for lack of approval. Pre-and post-session surveys were conducted to evaluate the value of the session. RESULTS:Out of 2,209 total cases presented during peer review, 37 treatment plans (2%) were not approved. The most common reasons for disapproval included contours (24%), dose (22%), and workflow (22%). Breast and skin cases had the highest numbers of not approved plans, 19% and 16% respectively. Relative to the total number of cases presented for each disease site, skin had the highest rate of disapproval at 5.4% followed by gynecologic treatments at 4.3%. All residents found the mock peer review didactics session to be "helpful" or "very helpful" on the post-session survey and would want additional sessions in the future. CONCLUSION/CONCLUSIONS:Overall, our study showed a low rate of disapproval during peer review, and our resident survey results indicated that a mock peer review didactics session would be a valuable addition to training.

PURPOSE/OBJECTIVE:Herpes simplex virus (HSV) and varicella zoster virus (VZV) are known causes of chronic and recurrent interstitial keratitis. Determination of active corneal inflammation is important for appropriate management. This study aimed to investigate features of clinically active herpetic interstitial keratitis (HIK) by anterior segment optical coherence tomography (AS-OCT). METHODS:Twenty-seven patients with active HIK (17 with HSV, 10 with VZV) and AS-OCT imaging were retrospectively identified. Five patients also had stromal scarring (SS), presumably from prior HIK episodes. An additional 4 patients with SS, but without a history of HIK, were also identified. The AS-OCT images were analyzed qualitatively, followed by an automated segmentation analysis. Deidentified images were shown to 3 masked graders after a training module, and their diagnoses were compared with slit-lamp diagnoses. RESULTS:Qualitative analysis of AS-OCT images of active HIK revealed anterior stromal hyperreflectivity, often with a hazy border and convex posterior contour comparable with "posterior bowing" historically seen on slit lamp. Borders were sharper and typically more linear for SS. Automated segmentation analyses identified that epithelium overlying the stromal area of interest was thicker in SS than HIK. Survey results revealed a high degree of correlation with slit-lamp diagnoses. CONCLUSIONS:AS-OCT may be a useful adjunct to slit-lamp examination in the evaluation of active inflammation in patients with a history of HIK. Hyperreflectivity, hazy borders, convex contour, and epithelial thickness may be informative. Future studies could elucidate a role for deep learning algorithms in diagnosing active HIK.

Mucous membrane pemphigoid (MMP) is an autoimmune blistering disorder that can involve the esophagus, potentially leading to complications such as stricture or stenosis. Diagnosis of MMP is challenging owing to overlapping clinical features with other subepithelial blistering diseases and limitations of current diagnostic techniques. Although direct immunofluorescence (DIF) remains the gold standard, it requires fresh tissue samples, which are not always available, particularly in cases without active mucosal or cutaneous lesions. Complement fragment 4d (C4d) immunohistochemistry (IHC) on formalin-fixed tissue has demonstrated diagnostic utility in bullous pemphigoid but has been less explored in MMP. This case highlights that C4d IHC may serve as a useful ancillary test to support MMP diagnosis, especially for mucosal or esophageal biopsies received in formalin, offering a potential diagnostic pathway when fresh biopsy samples are unavailable.

BACKGROUND:Replication-repair-deficiency is associated with increased risk of developing malignant gliomas. The aim of this study was to investigate primary mismatch repair deficient gliomas (PMMRDGs), a group of IDH-wildtype and H3-wildtype gliomas that is enriched among patients with CMMRD and Lynch syndrome. METHODS:We investigated how PMMRDGs differ from other gliomas with respect to DNA methylation profile, genomic alterations, histopathology, and clinical outcomes. RESULTS:PMMRDGs occur in pediatric, adolescents and the elderly, falling in two related methylation clusters and are characterized by a high frequency of replication repair deficiency. Histology showed multinucleated giant cells, and immunohistochemistry demonstrated loss of MMR protein expression. Survival analysis revealed long-term survival in patients with high mutational burden (>50 mut/Mb) and an intact chromosome 9p region, which was validated in an independent reference cohort. CONCLUSIONS:Overall, our findings indicate that PMMRDGs represent a distinct type of IDH-wildtype gliomas with potential for long-term survival likely driven by immune activation.