Faculty Bibliography

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.

The integrated stress response (ISR) coordinates cellular adaptation to diverse stress conditions. In Drosophila, two bZIP transcription factors, Xrp1 and crc (ATF4 homolog), are induced during ISR. Crc protein can dimerize with two CEBP factors in vitro, but the in vivo relevance of those interactions remained unknown. Here, we report that the CEBPG homolog, Irbp18, is an essential partner of crc during ISR. Specifically, Irbp18 is broadly required for the transcriptional induction of ISR target genes in the photoreceptors of ninaE^G69D, a Drosophila model of retinitis pigmentosa. Moreover, CUT&RUN analysis indicates that Irbp18 loss reduces or abolishes crc binding to target DNAs in photoreceptors and impairs crc's ability to induce target transcripts upon overexpression. Functionally, Irbp18 loss causes retinal degeneration and suppresses ISR signaling in parkin mutants, a model of Parkinson's disease. Together, these findings identify Irbp18 as a cofactor for crc, impacting pathological outcomes in Drosophila models of degeneration.

INTRODUCTION/BACKGROUND:Vascularized Composite Allotransplantation (VCA) is a reconstructive technique that restores form and function in patients with severe tissue loss from trauma, burns, tumors, or congenital anomalies. Despite improving clinical outcomes, public understanding and acceptance remain barriers to widespread public acceptance. This systematic review examines global public perceptions of VCA, focusing on demographic, cultural, religious, and educational influences on donation. METHODS:A PRISMA-guided systematic review was conducted in June 2025 across PubMed, Embase, MEDLINE, Scopus, and Web of Science. Eligible studies included original surveys or mixed-methods research involving nonexpert participants who reported willingness to donate to VCA. Excluded were studies limited to experts, discussion articles, reviews, abstracts, or commentaries. RESULTS:Twenty studies met the inclusion criteria, representing 19,023 respondents from 8 countries. Overall, there was a lower pooled willingness to donate facial VCA than hand VCA, with pooled willingness estimates of 47.9% and 54.8%, respectively. In contrast, willingness to receive VCA was higher overall, with pooled willingness estimates of 65.6% for facial transplantation and 72.4% for hand transplantation. Religious differences were evident: Christian and agnostic respondents were generally more willing to donate, whereas Muslim respondents were less willing. Racial differences were also noted, with White respondents more likely to donate. In contrast, Black and Asian respondents were less likely to indicate willingness to donate. CONCLUSIONS:This systematic review provides the first comprehensive synthesis of global survey data on public perceptions of VCA. Nearly half of the respondents reported willingness to donate, with higher acceptance of hand donation than of face donation. Racial, ethnic, and religious factors shape attitudes, underscoring the need for culturally tailored educational strategies to improve donation acceptance.

Newly practicing early career radiologists face significant challenges as they onboard into their first attending role. One of the most difficult challenges is often aligning their expectations of their roles and responsibilities in the workplace with those of the institution or practice to which they now belong. This perspective will discuss some of these challenges and suggest potential approaches to assist new faculty in overcoming this alignment barrier to seamlessly integrate into their new work environment.

OBJECTIVE:To assess the perceived clinical impact of radiologist staffing shortages across the U.S. and identify potential short- and long-term solutions. METHODS:A 26-question survey on breast imaging staffing shortages was distributed to active Society of Breast Imaging physician members from May 31, 2024, to June 28, 2024. Questions regarding the impact on patient care and radiologist wellbeing, as well as potential solutions, were included. Bivariable analysis (chi-squared) was performed between the survey demographics and survey response questions of interest. RESULTS:Of 226 respondents who felt understaffed in their practice due to an insufficient number of radiologists, the most frequently reported impact on patients was delayed diagnostic imaging (171/226, 75.7%) and procedures (155/226, 68.6%). The most frequently reported impacts on radiologists were increased stress (198/226, 87.6%), working hours (173/226, 76.6%), and burnout (173/226, 76.6%). As a perceived consequence, 56.2% (127/226) of respondents reported colleagues transitioning to part-time and 35.8% (81/226) reported colleagues switching practice types. To mitigate effects of understaffing, the most frequently reported short-term strategy was offering moonlighting (100/226, 44.2%), whereas offering part-time employment was the most frequently reported long-term strategy for retaining (86/226, 38.1%) and recruiting (120/226, 53.1%) radiologists. Over one-third (77/226, 34.1%) of respondents reported using advanced practice providers, most often for procedural support and patient navigation. CONCLUSION/CONCLUSIONS:Understaffed breast radiologists often perceived delays in patient care and increased levels of physician burnout. Moonlighting and part-time opportunities may mitigate these effects in the short and long-term, respectively.

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.

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.