Faculty Bibliography

Chronic pelvic pain, which persists longer than 6 months by definition, is a common condition which affects women of all ages with causes differing by age group. This document will focus on gynecologic origins of chronic pelvic pain, etiologies including chronic pelvic inflammatory disease, postsurgical changes, vaginal or vulvar cysts, and pelvic venous congestion disorder. Ultrasound is the initial imaging modality of choice with MRI or CT of the pelvis may be used in select cases when initial ultrasound is inconclusive. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Breast cancer disparities in outcomes remain a persistent challenge in the USA, with survival influenced by neighborhood context, access to resources, and the applicability of existing scientific evidence across populations. These disparities arise from complex, intersectional factors spanning social, structural, and biologic domains. While social determinants of health (SDOH) are strongly associated with breast cancer incidence and outcomes, the causality of biologic mechanisms underlying these associations remain incompletely understood. This review examines breast cancer disparities at the societal level and highlights emerging research that links social epidemiology with tumor biology, emphasizing the need for continued investigation using advanced genomic and epigenetic approaches to better understand and ultimately reduce inequities in breast cancer outcomes.

CONTEXT/BACKGROUND:More health systems are establishing outpatient palliative care (PC) programs, increasing demand for ambulatory PC clinicians. However, existing outpatient training during hospice and palliative medicine (HPM) fellowship remains limited and suboptimal. Little is known about the outpatient-specific knowledge and skills PC trainees should acquire for competent outpatient practice. OBJECTIVES/OBJECTIVE:To identify and prioritize outpatient-focused educational topics for HPM fellows and clinicians new to ambulatory practice. METHODS:A cross-sectional survey of United States (U.S.) outpatient PC clinicians (physicians, advanced practice practitioners [APPs]). Using a list of 51 educational topics, respondents selected a maximum of 20 topics they would prioritize as essential to prepare learners for outpatient practice. RESULTS:Of 247 clinicians, 136 (55%) responded, including 115 physicians and 21 APPs from all U.S. regions. Seven of 51 topics were prioritized by more than two-thirds of respondents (n = 92-119, 68%-86%). Four focused on outpatient application of core PC skills (pain management [n = 113, 83%], nonpain symptom management [n = 117, 86%], depression/anxiety [n = 107, 79%], goals of care [n = 92, 68%]). The remaining three covered discrete topics related to pain and opioid management, including best practices for caring for patients with comorbid pain and substance use disorder (n = 104, 76%). CONCLUSION/CONCLUSIONS:This national survey identified foundational outpatient-focused educational topics for HPM learners and suggests that outpatient curricula prioritize deliberate education on the unique application of core PC skills in outpatient settings. This prioritized list provides education leaders a roadmap to enhance existing curricula and informs the development of outpatient educational resources that can be shared across institutions.

BACKGROUND:Bronchopulmonary Dysplasia (BPD) is the most common complication associated with prematurity. Caffeine citrate is a commonly used medication in the neonatal intensive care unit (NICU) for apnea of prematurity (AOP). In the Caffeine Therapy for Apnea of Prematurity study, or CAP trial, infants who received caffeine at 5 mg/kg had reduced rates of BPD compared to the placebo group. Recently, there have been questions regarding the optimal dose of caffeine and if higher doses may have increased benefit on decreasing rates of BPD. OBJECTIVE:The objectives of this study were to determine if infants who received a higher maintenance dose of caffeine have decreased rates of BPD, decreased severity of BPD and improved neurodevelopmental outcomes compared to those who received a lower maintenance dose of caffeine. DESIGN/METHODS/METHODS:This was a retrospective, observational cohort study at a level IV NICU including infants less than 28 weeks gestational age (GA) receiving caffeine. Maternal and infant demographics and clinical data from the infant's hospital course were collected. Infants were assigned to low-dose (n = 62) or high-dose (n = 111) cohorts based on average daily caffeine dose. The low-dose cohort received an average daily dose of ≤6 mg/kg/day, while the high-dose cohort received an average daily dose of >6 mg/kg/day. BPD rates and severity were then evaluated for each subject. Neurodevelopmental follow-up Bayley scores were assessed at 6, 12, 18, and 24-month follow-up visits. Chi-square test, T test, Mann-Whitney U Test, Logistic regression, and Linear regression statistics were completed to evaluate data. RESULTS:Demographics and clinical characteristics were similar between the low and high-dose caffeine groups. The duration of caffeine in each group was similar as well. The percentage of individuals requiring invasive ventilation was similar between the two groups, however, infants in the high-dose group required less intense forms of ventilation and were on invasive ventilation for a shorter time than the low-dose group (Table 1). The rates of BPD were similar in the two groups (79% vs 78%, p = 0.92), however the severity of BPD based on Jensen Criteria was significantly different between the two groups, with lower rates of severe BPD in the high-dose group (p < 0.001) (Tables 2 and 3). Patients in the higher-dose caffeine group had higher Bayley composite scores at 6 months (p < 0.02). No significant differences were noted at later follow-up (Table 3). CONCLUSIONS:The decreased rates of severe BPD in the high-dose group, along with improved Bayley scores at 6-month follow-up suggest the potential benefit of high-dose maintenance caffeine in the extremely premature and extremely low birth weight population. Additional large, prospective studies are required to evaluate the efficacy of high-dose caffeine in preventing BPD and improving long-term outcomes in this most vulnerable population.

BACKGROUND AND AIMS/OBJECTIVE:Growing evidence suggests that the gut microbiome plays a role in carcinogenesis for early-onset colorectal cancer (EOCRC). The novel Ring Finger Protein 213 (RNF213) gene has broad antimicrobial properties. Our study aimed to compare RNF213 mutation rates in EOCRC and late-onset colorectal cancer using data from the cBioPortal for Cancer Genomics. METHODS:All participants from the cBioPortal with CRC samples that profiled the RNF213 gene were included. Multivariable logistic regression was used to assess the association between EOCRC and primary tumor RNF213 mutation. Cox proportional hazards models were used to evaluate the influence of RNF213 mutation on all-cause mortality risk. All tests were two-sided. RESULTS:OR 1.61, 95% CI 0.72, 3.22). There was no significant difference in all-cause mortality risk by RNF213 mutation status. CONCLUSIONS:Primary tumor mutations in exon 29 of the RNF213 gene are associated with significantly increased odds of EOCRC diagnosis in a multicohort sample of participants with CRC. Future studies of germline and precancerous RNF213 mutations are needed to elucidate its possible role in EOCRC tumorigenesis.

BACKGROUND/UNASSIGNED:The Standard of Care (SOC) for treating significant spinal epidural abscesses (SEA) is STAT surgery for patients with the new-onset of neurological deficits following STAT contrast MR studies confirming significant neural (i.e. mild/moderate, moderate, or marked cord/nerve root) compression. Too many health care professionals, including physicians, and select spine surgeons still wrongly believe delaying "acute" spinal decompressions in patients with SEA for up to 8, 12, and even 24 hours is acceptable even in paralyzed patients. METHODS/UNASSIGNED:Here we review the fact that the standard of care for treating SEA is STAT surgery for patients demonstrating the new-onset of neurological deficits following STAT contrast MR scans confirming significant neural compression. RESULTS/UNASSIGNED:STAT surgery for newly neurologically symptomatic patients with SEA following STAT contrast MR scans documenting significant neural compression yields the best results. Notably, select patients without neural deficits or significant MR neural compression may be considered for non-surgical treatment. The "gold standard" for diagnosing SEA is the contrast MR, while non-contrast CT studies almost uniformly fail to diagnose SEA, and Myelogram-CT studies have significant limitations (i.e. risk of causing meningitis, and may fail to document cephalad extent of SEA if there is a distal total block to intrathecal contrast). CONCLUSION/UNASSIGNED:STAT surgery is the SOC and treatment of choice for patient with SEA demonstrating significant new-onset neurological deficits with significant STAT contrast MR findings of neural compression. Further, STAT means STAT, no waiting period is acceptable (i.e. 8, 12 or up to < 24 hours) particularly in paralyzed patients.

Characterizing the relationship between DNA methylation and circulating proteins is critical to understanding the epigenetic regulation of the human plasma proteome. Here, we performed an epigenome-wide association study (EWAS) of 5,032 circulating proteins in 1,449 White and 315 Black participants from the Atherosclerosis Risk in Communities (ARIC) cohort. We identified 12,500 significant protein quantitative trait methylation (pQTM)-protein associations involving 1,647 proteins. Among 7,796 unique pQTMs, 14.7% were classified as cis-pQTMs, which were enriched for fundamental cellular processes, whereas trans-pQTMs were predominantly linked to immune-related functions. Trans-pQTMs also exhibited stronger associations with demographic, lifestyle, and clinical traits compared with cis-pQTMs. We identified proteins such as GM2A and EPHB6 whose expression appears to be strongly associated with DNA methylation, suggesting potential as targets for epigenetic-based therapeutic interventions. Together, these findings demonstrate the extensive impact of DNA methylation on the circulating proteome through cis- and trans-regulatory mechanisms and underscore the influence of population-level traits on epigenetic regulation. These findings highlight a broad impact of DNA methylation on circulating proteins through both cis- and trans-regulatory mechanisms and the roles of population-level phenotypes.

BACKGROUND/UNASSIGNED:Citation analysis is a useful bibliometric tool to identify impactful publications and trace the evolution of a specialty or a technique. In the past three decades, the research on vascularized composite allotransplantation (VCA) has grown exponentially but very few studies have examined the most influential papers in this field. METHODS/UNASSIGNED:The Web of Science Core Collection database was searched for articles published from inception to August 4th, 2025. Titles, full authors' names, years of publication, source journals, regions of origin, and numbers of citations were recorded. VCA anatomical location, main topics, and citation density were determined. Articles were ranked based on number of citations and citation density; they were then categorized based on methodology, study design, and main topic. RESULTS/UNASSIGNED: = 51) were classified as level 4. DISCUSSION/UNASSIGNED:This list of the top 100 most-cited articles highlights seminal and influential papers in VCA. It also demonstrates the relative novelty of this field with ongoing efforts in immunological research to allow its further expansion. The present study provides an understanding of VCA evolution while directing future clinical and preclinical studies.

The 2025 Evaluation Special Interest Group (SIG) meeting at the Association for Clinical and Translational Science conference brought together clinical and translational science (CTS) professionals to address evolving challenges in translational science evaluation. The meeting presentations and discussions addressed concept mapping for commonly used metrics, continuous quality improvement (CQI) practices, translational science impact evaluation, and evaluator toolkit development. Key themes and lessons learned included the tension between institution-specific and network-wide evaluation goals, the need for standardized yet flexible evaluation frameworks, and persistent barriers including limited staffing capacity and data ownership challenges. Facilitators identified included diverse CQI approaches, the evolving frameworks, and collaborative evaluation practices. Convened during a time of increasing research funding uncertainty and accountability, the meeting underscored the urgency of strengthening evaluation capacity to sustain the impact of CTS, highlighting both the enduring value of heterogeneous evaluation approaches and the critical need for coordinated CTS evaluation strategies to demonstrate impact and secure continued funding support.

BACKGROUND:Tranexamic acid (TXA) has reduced, but not eliminated, blood transfusions surrounding total knee arthroplasty (TKA). Identifying risk factors for transfusion remains important for risk reduction and type and screen (T and S) optimization. METHODS:We retrospectively reviewed 7,254 patients who underwent primary, unilateral TKA and 307 patients who underwent primary bilateral TKA between January 2014 and January 2023, who received perioperative TXA and had preoperative hemoglobin (Hgb) values. We compared demographics, baseline Hgb levels, and surgical details between patients who were and were not transfused. Data were analyzed utilizing multivariate regressions and receiver operating characteristic (ROC) analyses. A total of 172 unilateral TKA patients (2.4%) received perioperative transfusions, with 170 (2.3%) receiving postoperative transfusions and two (0.03%) receiving intraoperative transfusions. There were 26 bilateral TKA patients (8.5%) who received postoperative transfusions with no documented intraoperative transfusions. RESULTS:For unilateral TKA, the risk of transfusion demonstrated an inverse correlation with preoperative Hgb levels, a bimodal association with body mass index (BMI), and a direct correlation with American Society of Anesthesiologists (ASA) class and estimated blood loss (EBL) on multivariate testing. The ROC analyses demonstrated an optimal Hgb cutoff of 12.1 g/dL for predicting transfusion. The transfusion rate below Hgb of 12.1 g/dL was 6.6%, compared to a rate of 1.4% above this Hgb threshold. Below Hgb of 11 g/dL, the transfusion rate was 11.1%, while for Hgb between 11 and 12 g/dL, the transfusion rate was 4.6%. CONCLUSION/CONCLUSIONS:Transfusion is rare in unilateral TKA when TXA is used and preoperative Hgb is ≥ 12.1 g/dL, challenging universal T and S. Patients who have Hgb less than 11.0 g/dL and bilateral TKA patients remain at higher risk. Risk factors such as Hgb between 11 and 12 g/dL, BMI, ASA and EBL may predict transfusion risk and need for T and S.