Faculty Bibliography

INTRODUCTION/BACKGROUND:Hemispherotomy is an effective treatment for children with drug-resistant epilepsy (DRE). While hemispherotomy techniques and indications have evolved, access remains predominantly constrained to high-resource settings. METHODS:We performed a retrospective analysis of children who underwent hemispherotomy from 2011 to 2023 by a hybrid team, including local Panamanian and US neurologists, neurosurgeons, and EEG technicians and analyzed surgical, epilepsy, and quality of life (QoL) parameters. Follow-up data were collected according to the International Consortium for Health Outcomes Measurement (ICHOM) guidelines for children with epilepsy. RESULTS:Twenty-three children underwent hemispherotomy. The median age at surgery was 10 years (range 2-20). The median follow-up time was 6 years (range 1-13). The etiology of DRE included malformations of cortical development in 14 children (60.8%), including 8 (34.8%) with schizencephaly, and secondary causes in 9 children (39.1%). Seizure frequency improved for all 23 children (100%): Engel I was achieved in 15 children (65.2%), Engel II (26.1%) in six children, and Engel III (8.7%) in two children. Patients with seizure freedom had significantly fewer preoperative seizures per day than patients with seizure recurrence. Complications occurred in six children (26.1%): 2 wound infections, 2 meningitis, 1 femoral vein thrombosis, and 1 wound hematoma with return to OR. There were no perioperative mortality and no postoperative hydrocephalus or CSF diversion. QoL-related outcomes were available for 16 children: 16/16 (100%) reported that the surgery was a worthwhile and repeatable choice, 14 (87.5%) reported improved cognitive function, the median QOLCE-16 score was 62.5 ± 21. CONCLUSION/CONCLUSIONS:Hemispherotomy for DRE in selected children is a safe and effective surgery in a public children's hospital in a low-resource setting. At last follow-up, the majority of children were seizure-free, and all children had decreased seizure frequency. Families reported improved cognitive function, improved QoL and high satisfaction with their decision to pursue this surgery.

BACKGROUND:Management of modifiable risk factors is key in the prevention of recurrent stroke. We investigated trends in vascular risk factors (hyperglycemia, hyperlipidemia, hypertension, and smoking) control among US adults with stroke. METHODS:, low-density lipoprotein, and blood pressure and prevalence of meeting each recommended target were calculated for each epoch (1999 through 2002, 2003 through 2006, 2007 through 2010, 2011 through 2014, 2015 through 2020, and 2021 through 2023). RESULTS:-trend=0.002). The prevalence of meeting smoking and blood pressure guidelines was stable. Fewer than 10% of individuals met guidelines for all 4 risk factors over the study. CONCLUSIONS:In this nationally representative sample of US adults with stroke, <10% met guideline recommendations for all risk factors with an overall stable trend. These results suggest that efforts aimed at glycemia, blood pressure, and lipid control and smoking cessation could be improved to reduce the burden of recurrent stroke.

Current CardioMEMS HF System (Abbott) instructions for use recommend against implantation in obese patients (body mass index >35 kg/m²) whose chest circumference exceeds 165 cm, as placement can be technically challenging and remote interrogation can be unreliable. We present a case of successful CardioMEMS implantation in a patient with significant morbid obesity, exceeding previously reported body size limits, with a body mass index of 77.1 kg/m² and chest circumference of 178 cm. Outpatient device interrogation following implantation has been reliable in optimizing diuretic management and preventing readmissions in this patient.

BACKGROUND/UNASSIGNED:Social determinants of health disparities (SDHD), encompassing environmental, health care, social, educational, and economic factors, are known to increase the risk of complications after various orthopaedic procedures. However, their impact on tibial tubercle osteotomy (TTO) outcomes remains undefined. HYPOTHESIS/PURPOSE/UNASSIGNED:This study aimed to compare complication risks and health care utilization within 90 days and 1 year of primary TTO in patients with versus without SDHD. It was hypothesized that SDHD patients would show higher odds of health care utilization and complications. STUDY DESIGN/UNASSIGNED:Cohort study; Level of evidence, 3. METHODS/UNASSIGNED:Adult (>17 years) patients who underwent primary TTO from January 2010 to April 2023 were identified using the PearlDiver M170 database. The exclusion criteria included inactivity within 90 days after TTO or a history of neoplasm or infection within 90 days before the procedure. The overall cohort was divided into SDHD and non-SDHD groups. Patient characteristics-including age, sex, Elixhauser Comorbidity Index, obesity, type 2 diabetes mellitus, tobacco or nicotine use, and substance use disorder-were abstracted. Patients without versus with SDHD were matched (2:1) based on all demographic variables. Moreover, 90-day and 1-year complications were identified and compared using the Pearson chi-square test and multivariable logistic regression, adjusted for demographic variables. RESULTS/UNASSIGNED:< 0.05). CONCLUSION/UNASSIGNED:The present study found that SDHD patients were associated with increased odds of ED visits, readmissions, VTE, and UTI after primary TTO. Additionally, SDHD patients demonstrated higher odds of revision TTO and nonunion. Further research is needed to identify the root causes of these differences, enabling targeted strategies to reduce future outcome inequities associated with SDHD.

Nationally, there is increased investment in interventions that address diet-related chronic diseases however few studies and interventions are developed to reflect the values and lifestyles of many communities, presenting a barrier to participation. This study aims to better understand the motivators and barriers for the Bangladeshi American community in Brooklyn, New York to participate in diet-related interventions. Formative qualitative interviews were conducted in English and Bangla with Bangladeshi adults (n = 12) to understand current shopping/cooking behaviors, access and usage of food programs, awareness and interest in food programs, and future program preferences. Participants reported three key themes: centrality of community behaviors for program acceptability, creating opportunities to leverage community and social motivations, and addressing logistical concerns during program development. Gardening emerged as a promising program offering to increase access to fresh produce, strengthen community bonds, and foster cross-cultural understanding. Using community feedback, Harvest Share Seedlings, a community-informed home gardening program, was co-developed and implemented with farming and community partners to increase access to fresh produce for the Bangladeshi community. The findings highlight the need to understand and center community-specific considerations when designing and implementing food programs and interventions. Adopting a community-informed approach increases uptake and acceptability from the community, and ensures sustainability in the long run.

High-riding vertebral artery (HRVA) is an important anatomical variant of the vertebral artery that poses significant challenges during cervical spine surgery, particularly at the C1-C2 level, where it reduces the safe corridor for pedicle screw placement and increases the risk of arterial injury. This narrative review summarizes current evidence regarding the definition, prevalence, imaging identification, and surgical implications of HRVA, along with risk mitigation strategies. Radiographically, HRVA is most commonly defined by reduced C2 isthmus height (C2IsH) (≤5 mm) and/or internal height (C2InH) (≤2 mm) on computed tomography (CT) scans. Reported prevalence varies widely across populations, typically ranging from 10% to 25%, with higher rates observed in selected patient cohorts. The presence of HRVA necessitates careful perioperative planning, including comprehensive imaging and modification of surgical techniques, such as the use of alternative fixation strategies, including pars screws, laminar screws, navigation-assisted instrumentation, and artery mobilization. Advances in CT angiography (CTA), alternative fixation strategies, surgical navigation, and emerging predictive models may further improve risk stratification and operative safety. Recognition of HRVA and tailored surgical planning are essential to minimize the risk of vertebral artery injury (VAI) and to optimize patient outcomes in cervical spine surgery and instrumentation.

Leucine-rich repeat kinase 2 (LRRK2) plays a central role in the pathogenesis of Parkinson's disease (PD), with pathogenic mutations leading to increased kinase activity. Consequently, LRRK2 has become a key therapeutic target in PD research. Although several candidate PET radioligands have been investigated for imaging brain LRRK2, only a few have shown good brain permeability and even these have exhibited limited specific binding to the target. In our search for an improved radioligand candidate, we identified GNE-0877 (28) as a highly potent and selective inhibitor for LRRK2 (K _i = 0.7 nM) with physicochemical properties favorable for brain penetration. We, therefore, synthesized an N-Boc-protected precursor (22) for labeling 28 with carbon-11 (t _1/2 = 20.4 min) at the N-methyl position, which yielded [¹¹C]28 in a two-step radiosynthesis with high isolated yields (∼12-15%), excellent radiochemical purity (≥97%), and high molar activity (260-330 GBq/μmol). We evaluated [¹¹C]28 as a potential PET radioligand for imaging brain LRRK2 in rodent and monkey. The radioligand showed excellent stability in vitro and desirably moderate lipophilicity (measured logD _7.4, 2.92). Following intravenous administration in rodents or monkey, [¹¹C]28 entered the brain rapidly reaching high peak uptake (∼4.0 SUV). In monkey, however, [¹¹C]28 showed slightly higher brain uptake and higher total volume of distribution (V _T) under preblocking of LRRK2 with 28 than at baseline, indicating an absence of measurable specific binding to LRRK2, possibly due to low LRRK2 density in vivo or to insufficient radioligand affinity.

Contemporary bioethics treats autonomy as the governing principle in decisions involving euthanasia, abortion, and end-of-life care. Yet the operative moral reasoning in these debates frequently depends not on autonomy but on implicit judgments about the value of human life based on functional capacity, suffering, or perceived quality of life. This paper identifies and analyzes this conceptual inconsistency. It argues that functional valuations of life, not autonomy, are doing the decisive moral work in contemporary clinical ethics, and that this hidden reliance on conditional assessments of human worth creates an unstable foundation for protecting vulnerable persons. Drawing on the Christian theological tradition, particularly the doctrine of the imago Dei, Augustinian and Thomistic moral anthropology, and the work of Edmund D. Pellegrino, the paper proposes an alternative framework in which human dignity is intrinsic and inviolable, and autonomy is understood not as sovereign self-determination, but as responsible moral stewardship exercised within the created order. Three case studies in euthanasia, abortion, and advance care planning illustrate the practical consequences of this reorientation. The paper concludes with implications for clinical ethics consultation, institutional policy, and the role of Christian bioethics in pluralistic healthcare discourse.

PURPOSE/OBJECTIVE:To develop imaging-based measures for disease assessment in noninfectious posterior uveitis (NIPU). DESIGN/METHODS:A mixed-methods design, beginning with a review of previously developed imaging recommendations formulated by separate subcommittees of the multimodal imaging in uveitis (MUV) initiative, followed by a structured consensus process using the nominal group technique (NGT), facilitated by an independent expert committee. METHODS:An expert committee reviewed and extracted all consensus-based imaging recommendations from the MUV subcommittee manuscripts focused on five major NIPU entities. The primary objective was to categorize imaging features as suggestive of active disease (SAD), suggestive of inactive disease (SID), or equivocal. This process was conducted using the NGT to reach consensus-based imaging measures. These recommendations were further voted upon by members of the full task force. RESULTS:A total of 49 imaging statements were deliberated using two rounds of NGT and independent voting. For the five included diseases, a total of 21 statements qualified as features of SAD, whereas 12 statements were classified as SID. The remaining 16 statements were categorized as equivocal features that need further investigation to determine whether the disease is active. CONCLUSIONS:This study builds upon the multinational efforts of the MUV initiative to extend the standardization of uveitis nomenclature (SUN) work through the integration of additional multimodal imaging information. Defining clear imaging-based outcome measures for NIPU, it establishes a structured framework supporting objective disease assessment. These standardized imaging measures are expected to enhance the utility of multimodal imaging in both routine uveitis care and future clinical trials.

BACKGROUND AND OBJECTIVE/UNASSIGNED:Non-small cell lung cancer (NSCLC) accounts for approximately 85% of lung carcinoma cases and is often diagnosed at an advanced stage, leading to poor prognosis. Local tumor ablation is an emerging treatment option; however, thermal ablation techniques, such as radiofrequency ablation (RFA) or microwave ablation (MWA), can have many adverse events, such as a negative impact on the extracellular matrix (ECM) architecture, promoting tumor progression. Pulsed electric field (PEF) therapy is a non-thermal modality that induces electrostimulatory pulses, which can preserve the ECM architecture while stimulating anti-tumor immune responses. This narrative review evaluates the safety, efficacy, and immunomodulatory potential of PEF therapy in NSCLC. METHODS/UNASSIGNED:A comprehensive literature search was conducted in Google Scholar, MEDLINE, Embase, Scopus, PubMed, Web of Science, UpToDate, and the Cochrane Library through October 1, 2025. Eligible studies included adult patients (≥18 years) with histologically confirmed NSCLC treated with PEF. Two independent reviewers screened studies and extracted data on patient demographics, tumor characteristics, treatment modalities, adverse events, and outcomes. KEY CONTENT AND FINDINGS/UNASSIGNED:33%) compared with standard systemic therapy. CONCLUSIONS/UNASSIGNED:PEF may play a role in stimulating an anti-tumor response and represents a promising, safe, non-thermal ablation modality for NSCLC treatment. It preserves ECM integrity while inducing local and systemic immunomodulatory effects. Early clinical evidence suggests potential efficacy. Nevertheless, randomized controlled trials are required to confirm clinical benefit and identify the patient populations most likely to benefit from PEF therapy.