Faculty Bibliography

BACKGROUND:Abnormalities in Autonomic Nervous System activity are well described in psychosis but their peripheral versus CNS origins remains unresolved. However, the purely peripheral component of the sudomotor sweat reflex can be quantified using the Quantitative Sudomotor Axon Reflex Test (Q-SWEAT), in which local postganglionic fibers are stimulated by applying acetylcholine to the skin. METHOD/METHODS:This study assessed Q-SWEAT, psychiatric symptoms (PANSS; HAMD) and cognition (MATRICS) in 33 participants with psychosis, 17 with nonpsychotic affective disorders, and 23 healthy controls. Statistical analyses included ANOVA, GENLIN ordinal logistic regression, and Spearman correlations. RESULTS:(2)=9.75, p = 0.008). Specifically, the psychosis group was 5.37-fold more likely to have sudomotor dysfunction compared to healthy controls (95% CI 1.86, 15.45) and this remained significant when controlling for anticholinergic burden. The NP-affective group did not differ from those with psychosis or healthy controls. Across the overall sample, sudomotor dysfunction was significantly associated with greater cognitive impairment and increased psychiatric symptom severity. DISCUSSION/CONCLUSIONS:This first of its kind study shows abnormal sudomotor sweat reflexes in psychosis are independent of CNS input and not fully explained by anticholinergic medications but are associated with symptoms and cognition. We propose that muscarinic M3 acetylcholine receptors, which occur in eccrine sweat glands and in the CNS, may be relevant, although microvascular and inflammatory pathologies can impact the PNS and CNS. Sudomotor dysfunction could also underlie the abnormal thermoregulation in psychosis. More research is needed to confirm and extend these observations implicating a novel biomarker for psychosis.

In 1954, William Athol McElmoyle described an approach to the difficult gallbladder that reframed operative incompleteness as a deliberate strategy for preventing injury. When inflammation obscured the cystic duct and adjacent structures, he advocated removing only the safely separable gallbladder while preserving adherent tissue over vulnerable anatomy as a protective "shield." Although partial gallbladder resection predated McElmoyle, his distinctive contribution was the explicit rationale that tissue too hazardous to separate could be intentionally retained for protection. This principle anticipates the judgment underlying contemporary subtotal cholecystectomy and bailout strategies when the critical view of safety cannot be safely achieved. McElmoyle's operation should not be considered technically equivalent to modern subtotal cholecystectomy, nor does the available historical record establish that his report directly influenced its later development. Rather, the continuity is conceptual: when inflammation destroys reliable anatomic planes, operative completeness should become subordinate to avoidance of injury. Recovering McElmoyle's contribution therefore restores an overlooked historical articulation of a principle that remains central to safe cholecystectomy and surgical judgment more broadly-knowing when deliberate restraint is safer than continued dissection.

The da Vinci 5 (DV5) system has purported advantages over existing platforms, including forced feedback. We compare perioperative safety, operative efficiency and early oncologic quality between DV5 and Xi robotic platforms for anatomic lung resection. A total of 419 robotic lung resections were performed between January 2025 and August 2026. Propensity-score overlap weighting balanced and matched 294 patients (47 DV5, 247 Xi) for age, sex, ASA class, BMI, forced expiratory volume in 1 s, tumor size, clinical T and N category, resection type and laterality. Effects were reported with robust and bootstrap 95% confidence intervals. Sensitivity analyses included 1:1 and 1:3 propensity matching comparisons and E-value assessment. From January 2025 to August 2026, 294 patients (47 DV5, 247 Xi) had balanced baseline characteristics (SMD < 0.01). Operative time was shorter with DV5 (96.4 vs. 118.7 min; 95% CI, - 36.2 to - 8.5). Lymph node yield was comparable (DV5 29.9 vs. Xi 31.6; [- 7.2 to + 3.7]). Blood loss (p < 0.01), length of stay (1.05 vs. 1.28 days; [- 0.53, + 0.06]) and stapler loads (8.5 vs. 9.6; [- 2.81 to + 0.55]) were numerically lower with DV5. Major complications were numerically lower with DV5 (1/47 [2.0%] vs. 20/247 [8.2%]; -16.0 to + 3.6). Both had 100% R0 resections and no conversion. There was no 30- or 90-day mortality. In this first clinical comparison of da Vinci 5 and Xi for robotic anatomic lung resection, DV5 preserved the safety and oncologic quality of Xi while being associated with shorter operative times. Prospective multi-institutional studies are required to confirm these findings.

OBJECTIVE:Interest in psychedelic medicine is increasing, yet psychiatry trainees report limited education in this area. The authors developed a standardized curriculum and evaluated its impact on trainee knowledge and attitudes toward psychedelic medicines. METHODS:A 6-h psychedelic medicine course was delivered across four psychiatry residency programs in the Northeast United States in 2025-2026. The curriculum included six modules covering foundational concepts and evidence, as well as clinical considerations. Anonymous pre- and post-course surveys assessed knowledge, interest, and confidence in counseling. Statistical comparisons were used to evaluate pre-post changes. RESULTS:Forty trainees participated across institutions; 34 completed a pre-course survey and 22 completed a post-course survey. Most trainees reported minimal prior didactic exposure to psychedelic medicine. Self-assessed knowledge as well as scores on a knowledge quiz improved significantly following the course. Self-rated understanding of both the rationale for psychedelic treatments and limitations of evidence increased. Most substantially, confidence in counseling patients about clinical research, harm reduction, and treatment risks improved across domains. Baseline interest in psychedelic medicine was high at the start of the course and did not change significantly following its completion. CONCLUSIONS:A multi-site curriculum in psychedelic medicine was associated with increased knowledge and counseling confidence in trainees. The curriculum did not significantly impact interest or plans to pursue opportunities in psychedelic medicine, suggesting the course did not overinflate enthusiasm for the field. Standardized curricula in residency education may help address gaps in psychiatric training as clinicians increasingly encounter questions about these emerging treatments.

Glucagonomas are a rare hormone-producing pancreatic neuroendocrine tumor (panNET), with an estimated incidence of 1 to 2 cases per million persons. They typically present at diagnosis as large, metastatic panNET and are characterized clinically by diabetes mellitus, weight loss, thromboembolic complications and necrolytic migratory erythema. The diagnosis of glucagonoma syndrome requires the presence of both elevated fasting plasma glucagon levels and glucagonoma symptoms. Staging relies on cross-sectional imaging with computed tomography (CT) or magnetic resonance imaging (MRI), complemented by somatostatin receptor positron emission tomography (PET) imaging. Initial management of glucagonoma includes supportive therapy with supplementation of amino acids, essential fatty acids, zinc, and other micronutrients as well as glycemic control and anticoagulation. Surgical resection is the only curative treatment. For unresectable or metastatic disease, palliative management parallels that of nonfunctioning panNET and includes somatostatin analogues, targeted therapies, peptide receptor radionuclide therapy with radiolabeled somatostatin analogues, and cytotoxic chemotherapy. Prognosis depends on tumor stage and grade, with reported 10-year survival rates approaching 100% for localized disease and approximately 50% for metastatic glucagonoma. A rare hereditary cause of hyperglucagonemia due to glucagon receptor mutations is glucagon cell hyperplasia and neoplasia, also termed Mahvash disease. These patients develop alpha cell hyperplasia and panNET but lack the classical glucagonoma symptoms. In conclusion, fasting glucagon levels should be measured in patients with typical features such as necrolytic migratory erythema, an advanced panNET associated with cachexia and new-onset or worsening diabetes mellitus or diffuse alpha cell hyperplasia.

STUDY DESIGN/METHODS:Retrospective analysis of a multicenter series of deformity patients undergoing thoracolumbar instrumentation to the pelvis. OBJECTIVE:Introduce the C2 coronal angle (C2C) as a novel metric, assess its association with quality-of-life and neck-specific outcomes, and compare the strength of this association with the traditional linear C7-CSVL offset. SUMMARY OF BACKGROUND DATA/BACKGROUND:While assessment of the sagittal plane incorporates vertebropelvic angles for surgical planning, angular coronal measurements have not been evaluated as predictors of patient-reported outcomes following adult spinal deformity (ASD) surgery. METHODS:Demographics, comorbidities, and radiographic parameters were collected preoperatively and at 2-year follow-up. Coronal angles were measured between CSVL and the center of the C2 body (C2C). Primary endpoints were patient‑reported outcomes at two years (SRS‑22, SF‑36, NDI) and whether patients achieved the minimal clinically important difference (MCID). Univariable and multivariable regression models examined the relationship between C2C and PROMs. An ROC analysis with Youden's Index identified optimal C2C thresholds for predicting NDI >20. RESULTS:Among 328 patients (mean age 64.0 years, 12.6 levels fused), postoperative absolute C2C was independently associated with PROMs. Each 1° increase in C2C was associated with decreased 2-yr SRS-Total (P=0.014) and activity (P=0.024), pain (P=0.033), and mental health (P=0.029) subdomains. Each 1° increase reduced odds of achieving NDI MCID by 34% (OR=0.66, P=0.022). ROC identified an optimal C2C threshold of 3.5°. Patients exceeding this had nearly twice the odds of neck disability (OR=1.90, P=0.049) and significantly lower SF-36 Physical Component (P=0.004) and Physical Functioning (P=0.011) scores. C2C was more strongly associated with SRS-Total than C7-CSVL (AIC=657 vs. 660; adj. R²=0.058 vs.0.048). CONCLUSIONS:Achieving postoperative C2C ≤3.5° is independently associated with reduced neck disability and optimized quality of life after ASD surgery. C2C was more strongly associated with SRS-Total than C7-CSVL and could be considered as a complementary measure of coronal alignment.

Cell motility, characterized by random walk and exploratory search movement, enables effector CD8+ T cells to search for sparse antigen-specific cancer targets within a tumor. This is of special relevance for treatment of solid cancers with adoptive T-cell receptor (TCR) T-cell therapy, where administered effector CD8+ T cells recognize specific MHC-I-presented antigens. Cell motility requires cytoskeleton remodeling to facilitate shape changes and movement. Herein, we show that increased mitochondrial Ca2+ levels are essential to reduce cytoskeleton stiffness of effector CD8+ T cells, leading to acquisition of a polarized shape and high motility. IL-21, but not IL-7 or IL-15, was able to raise mitochondrial Ca2+ levels in effector CD8+ T cells and increase their motility without affecting survival and proliferation. This increase in mitochondrial Ca2+ levels triggered by IL-21 was driven by sustaining mitochondrial membrane potential through mitochondrial STAT3, independently of its transcriptional activity. Enhanced motility of effector CD8+ T cells led to a superior killing efficacy of antigen-specific melanoma cells in vitro. Furthermore, enhanced mitochondrial Ca2+-mediated motility of adoptive TCR-specific effector CD8+ T cells resulted in a superior antitumor efficacy of this treatment against solid tumors in vivo. Thus, enhancing effector CD8+ T-cell motility is a promising strategy to boost efficacy of adoptive T-cell therapies against solid tumors.

BACKGROUND:Soft tissue sarcoma (STS) is a rare and heterogeneous malignancy with more than 100 histologic subtypes that can arise in virtually any part of the body. Although surgical resection is the standard of care, complete surgical resection is often limited by involvement of critical anatomy, and most subtypes are resistant to systemic therapies. Histotripsy uses microsecond length, high-pressure ultrasound (US) pulses delivered externally to generate cavitation inside the target tumor to mechanically liquefy tissue to acellular homogenate. This study tested the effect of histotripsy in a variety of soft tissue tumors (STTs) including benign tumors and sarcomas. METHODS:Histotripsy was delivered to 45 surgically excised ex vivo human samples with a custom 1 MHz 8-element US transducer guided by US imaging. RESULTS:Histotripsy was successful in creating an identifiable treatment effect across all subtypes including adipocytic tumors, benign myxoid and nerve sheath tumors, aggressive fibrous sarcomas, and high-grade sarcomas. Immediately after histotripsy, B-mode and shear-wave elastography US imaging was shown to effectively evaluate the treatment. Tissue structure heterogeneity among the tumor subtypes dictated the variation in histologic treatment effects. CONCLUSIONS:The data demonstrate effective US-guided histotripsy ablation on a robust cohort of ex vivo STTs. The variable treatment effects observed across tumor subtypes highlight the need for histotripsy parameter optimization, with support for its potential as a promising non-invasive treatment modality for sarcoma patients who currently have limited therapeutic options.

DESCRIPTION/UNASSIGNED:A work group representing the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) prepared a new VA/DoD clinical practice guideline (CPG) for tobacco use treatment. This article provides a synopsis of the 2026 CPG, which addresses use of commercially available tobacco and nicotine products. METHODS/UNASSIGNED:A multidisciplinary work group developed 19 key questions on clinical topics of highest priority for the VA and DoD populations. Published literature from 1 January 2014 to 10 December 2024 was systematically reviewed using the PICOTS (population, intervention, comparator, outcomes, timing of outcomes measurement, and setting) framework. Recommendations were made by consensus and informed by evaluation using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method, which assesses quality of evidence and balances benefits and harms, patient preferences, and feasibility. The final document incorporated input from peer review by an external group of experts. RECOMMENDATIONS/UNASSIGNED:The 2026 guideline includes 32 recommendations across 10 topic areas. Key recommendations for increasing abstinence from combustible tobacco include recommending motivational interviewing to increase engagement in treatment of tobacco and nicotine use (strong) and use of U.S. Food and Drug Administration-approved pharmacotherapies (strong), with varenicline recommended over monotherapy with other agents (strong), combination nicotine replacement therapy ([NRT] for example, patch plus lozenge) recommended over NRT monotherapy (single agent) (strong), and extending use of bupropion sustained release beyond 12 weeks (weak). Other key recommendations include varenicline for increasing abstinence from smokeless tobacco (strong) and electronic nicotine delivery systems (weak) and use of NRT or varenicline to increase quit attempts and abstinence in patients not ready to quit in the next 30 days (weak).