Faculty Bibliography

Young adults (approximately 18-35 years) with inflammatory bowel disease (IBD) represent a distinct demographic with unique developmental and physiological characteristics, yet they are underrepresented in clinical trials. This commentary synthesizes insights from a roundtable discussion facilitated by the Crohn's and Colitis Young Adults Network (CCYAN) between young adult patients with IBD and medical professionals, including physicians, nurses, psychologists, and trainees/medical students. Themes include defining young adults as a distinct demographic in research, improving outcomes for young adults with IBD through age-specific data disaggregation, barriers for participation and post-trial responsibilities, as well as regulatory and legislative policy opportunities to enhance young adult representation in clinical trials.

PURPOSE/OBJECTIVE:Meniscus repair is preferred over meniscectomy when possible due to its ability to preserve meniscal tissue and reduce long-term joint degeneration. However, meniscus repair has a risk of failure, resulting in an increasing number of patients presenting with symptoms following a failed repair. Revision meniscus repair remains an option for symptomatic patients, yet guidance on indications, surgical techniques, and expected outcomes is limited. The purpose of this review is to summarize indications, surgical approaches, and outcomes associated with revision meniscus repair. RECENT FINDINGS/RESULTS:Patient-specific factors such as age, activity level, and modifiable risk factors influence revision repair success. Younger, highly active individuals may be at higher risk of retear due to increased mechanical stress. Tissue quality and vascularity are critical, as degenerative changes and poor perfusion increase failure rates. The gold-standard inside-out technique is often favored for revision repairs due to its superior biomechanical stability. However, all-inside and outside-in techniques remain viable options in specific cases. Biological augmentation, including platelet-rich plasma (PRP) and marrow venting, may enhance healing potential but requires further investigation. Revision meniscus repair demonstrates comparable failure rates and functional outcomes to primary repair, with reported failure rates ranging from 21-33% at mid-term follow-up. Many patients successfully return to high levels of activity following revision repair. Although younger age and high activity levels may predispose to failure, revision meniscus repair remains a viable option for preserving meniscal integrity and optimizing long-term joint health.

INTRODUCTION/UNASSIGNED:A learning health system (LHS) approach is a collaborative model that continuously examines, evaluates, and re-evaluates data eventually transforming it into knowledge. High quantity of high-quality data are needed to establish this model. The purpose of this article is to describe the collaborative discovery process used to identify and standardize clinical data documented during daily multidisciplinary inpatient rehabilitation that would then allow access to these data to conduct comparative effectiveness research. METHODS/UNASSIGNED:CARE4TBI is a prospective observational research study designed to capture clinical data within the standard inpatient rehabilitation documentation workflow at 15 TBI Model Systems Centers in the US. Three groups of stakeholders guided project development: therapy representative work group (TRWG) consisting of frontline therapists from occupational, physical, speech-language, and recreational therapies; rehabilitation leader representative group (RLRG); and informatics and information technology team (IIT). Over a 12-month period, the three work groups and research leadership team identified the therapeutic components captured within daily documentation throughout the duration of inpatient TBI rehabilitation. RESULTS/UNASSIGNED:Data brainstorming among the groups created 98 distinct categories of data with each containing a range of data elements comprising a total of 850 discrete data elements. The free-form data were sorted into three large categories and through review and discussion, reduced to two categories of prospective data collection-session-level and therapy activity-level data. Twelve session data elements were identified, and 54 therapy activities were identified, with each activity containing discrete sub-categories for activity components, method of delivery, and equipment or supplies. A total of 561 distinct meaningful data elements were identified across the 54 activities. DISCUSSION/UNASSIGNED:The CARE4TBI data discovery process demonstrated feasibility in identifying and capturing meaningful high quantity and high-quality treatment data across multiple disciplines and rehabilitation sites, setting the foundation for a LHS coalition for acute traumatic brain injury rehabilitation.

BACKGROUND:Methylene blue (MB), a phenothiazine dye with antimicrobial activity, is used to stain soft tissues and guide thoroughness of debridement during revision total knee arthroplasty (rTKA) for periprosthetic joint infection (PJI). The purpose of this study was to determine if instillation of MB prior to arthrotomy impacts culture yield in TKA PJI. METHODS:We retrospectively reviewed 266 patients diagnosed with TKA PJIs according to the 2018 International Consensus Meeting (ICM) criteria from January 2018 - March 2023 at a single academic hospital. Demographics, perioperative outcomes, and preoperative and intraoperative culture positivity were compared between patients who received intraoperative MB (MB group; n = 26) and those who did not (nMB group; n = 241). A record of detected organisms was included in the analysis. RESULTS:There was no difference in preoperative aspiration culture positivity between groups. However, the MB group had a higher percentage of preoperative to intraoperative culture concordance (89.5 vs. 69.9%; P = 0.04). Although the overall rate of intraoperative culture positivity did not differ significantly between groups, the MB group had more intraoperative cultures obtained per patient (4.9 vs. 4.5; P = 0.02) and higher numbers of positive intraoperative cultures per patient. Concordance rates for patients in both groups with positive preoperative and negative intraoperative cultures were similar (10.5 vs. 16.5%, P = 0.50). Among patients with negative preoperative cultures, intraoperative culture positivity was more discordant in the MB group (0 vs. 18.8%; P = 0.03). There was no difference in the number of patients that received antibiotics following aspiration (68.4 vs. 49.6%; P = 0.12). CONCLUSION/CONCLUSIONS:While MB use did not affect overall culture positivity, it could interfere with intraoperative pathogen detection in patients with negative preoperative cultures. In these cases, MB should be avoided to decrease inaccuracies in intraoperative culture yield. If preoperative cultures are positive, MB may improve surgical debridement and likelihood of infection eradication.

Stenosing tenosynovitis/tendinitis of the flexor hallucis longus (FHL) tendon is a relatively common occurrence in dancers. When nonoperative management fails, surgical tenolysis/tenosynovectomy has been shown to successfully reduce pain and restore function. In this study, we present the case of a professional contemporary dancer with FHL stenosing tenosynovitis/tendinitis who underwent a z-lengthening of the FHL proximal to the intact tendon sheath which resulted in a rupture of the FHL upon return to dance. He subsequently underwent a FHL reconstruction with tendon allograft. He returned to unrestricted professional dance at 11 months postoperative, which has been maintained at 4-year clinical and MRI follow-up.Level of evidence: V.

Soft tissue sarcomas (STSs) are a diverse group of malignant tumors derived from mesenchymal tissues [...].

BACKGROUND:Lymphovascular invasion (LVI) is regarded as a high-risk feature of cutaneous squamous cell carcinoma (CSCC) but is currently absent from CSCC staging systems. OBJECTIVE:To assess whether LVI serves as an independent predictor of major poor outcomes in CSCC. METHODS:Twelve centers contributed to a multinational CSCC database. Clinical and pathologic risk factors, treatment, and patient outcomes were retrospectively collected. CSCCs were stratified based on LVI status. Tumors that developed major poor outcomes defined as nodal metastasis, in-transit metastasis, distant metastasis, and disease-specific death were identified. RESULTS:A total of 23,166 CSCCs were identified, 179 were LVI+ tumors (0.8%). LVI+ tumors had a higher cumulative incidence of major poor outcomes than those without LVI (33.5% vs. 3.2% at 3 years; overall cumulative incidence function p < 0.001). In an adjusted analysis, LVI+ tumors had an 82% increase in the rate of developing major poor outcomes when compared to LVI- tumors (subdistribution hazard ratio (SHR) = 1.82; p = 0.002). Notably, LVI+ low-stage BWH tumors (T1 or T2a) had a greater cumulative incidence of major poor outcomes compared to LVI- BWH low-stage tumors (20.7% vs. 1.61% at 3 years, overall cumulative incidence function p < 0.001). LIMITATIONS/CONCLUSIONS:Retrospective study design CONCLUSION: The presence of LVI in CSCC is a high-risk feature that is an independent predictor of metastasis and disease-specific death in both low and high BWH stage tumors.

BACKGROUND/UNASSIGNED:As one of the non-communicable diseases, cancer will overtake communicable, maternal, neonatal and nutritional diseases combined as the leading cause of mortality by 2040. Gastrointestinal (GI) cancers are predicted to increase by over 50% in the next 20 years, with a higher incidence in developing countries. In this study, we describe the national GI cancer trends in Zimbabwe using the annual reports from the Zimbabwe National Cancer Registry (ZNCR) from 2009 to 2018. METHODS/UNASSIGNED:Demographic data and incidence of GI cancer subtypes were collected and analysed from the ZNCR annual reports from 2009 to 2018. Age standardised rates (ASRs) for each GI cancer subtype were calculated and simple trend analysis was performed over the 10-year study period. RESULTS/UNASSIGNED:In total, 10,859 new GI cancer cases were reported during the study period, accounting for 17.2% of all cancers in Zimbabwe and 55% of these were males. The most prevalent GI cancers were oesophageal, liver, gastric, colon and rectal malignancies. In males, on average the incidence of ASR of oesophageal, liver and gastric cancer increased annually by 14.7%, 17% and 16%, respectively. In females, on average the ASR of oesophageal, liver and gastric cancer increased annually by 27.2%; 18% and 13%, respectively. Overall, one in ten new cases of oesophageal cancer were diagnosed in patients under 45 years of age and for liver cancer, one in four new male cases were diagnosed below the age of 45 years. CONCLUSION/UNASSIGNED:Zimbabwe faces an increasing trend in all GI cancer subtype incidence over the decade reviewed. The rate of increase in oesophageal and gastric cancers in females was particularly high and the male-to-female ratio observed requires further etiological studies. The increasing rate of young GI cancer patients requires both education regarding risk factors and national screening policies that are tailored to the Zimbabwean population's characteristics and context.

BACKGROUND:Computed tomography (CT) offers a detailed assessment of the shoulder for preoperative shoulder arthroplasty planning; however, this technique exposes the patient to ionizing radiation. The purpose of this study was to prospectively evaluate the practicality of reducing the CT radiation dose compared to conventional dose levels for manual and preoperative planning software measurements for shoulder arthroplasty. METHODS:A total of 10 shoulder CT examinations were performed for preoperative planning purposes on a dual x-ray source CT scanner. A specialized dose-split scan technique was utilized to reconstruct CT images corresponding to 100%, 70%, and 30% radiation dose relative to our institution's standard of care imaging protocol. Glenoid version, inclination, and humeral head subluxation were measured manually by 3 authors and by commercially available software platforms. These measurements were analyzed for agreement among the 100%, 70%, and 30% dose levels for each patient. Tolerances of 5° of glenoid version, 5° of glenoid inclination, and 10% humeral head subluxation were used as equivalent for preoperative planning. RESULTS:Automated measurements of 70% dose images were within 5° of version, 5° of inclination, and 10% subluxation in 95.0% of cases. Manual measurements of 70% RD images were within 5° of version for 90.0% of cases, 5° of inclination in 86.7% of cases, and 10% subluxation in 100% of cases. Automated measurements from the 30% dose images were within 5° of version, 5° of inclination, and 10% subluxation for 100% of cases. Manual measurements from the 30% dose images were within 5° of version for 86.7% of cases, 5° of inclination in 76.7% of cases, and 10% subluxation in 100% of cases. The mean absolute difference in software measurement of glenoid version (P = .96), glenoid inclination (P = .64), or humeral head subluxation (P = .09) or in aggregated manual mean absolute difference of version (P = .22), inclination (P = .31), or humeral head subluxation (P = .56) was not significant. Good to excellent reliability was determined by interclass correlation coefficients among the manual observers and automatic software platforms for measurements at all doses (P < .001) CONCLUSIONS: The results indicate that both preoperative planning software platforms and human observers produced similar measurements of glenoid version, inclination, and humeral head subluxation from reduced-dose images compared to standard of care doses. By implementing reduced dose techniques in preoperative shoulder CT, the potential risks associated with radiation exposure could be reduced for patients undergoing shoulder arthroplasty.