Citations

Purpose: To assess chest computed tomography (CT) manifestations of Legionella pneumonia (LP) in a large, well-characterized immunocompetent and immunocompromised patient cohort. Materials and Methods: This retrospective study identified LP patients across a multicenter hospital system over 84-months. Chest CTs were reviewed for presence and distibution of ground-glass opacity (GGO), consolidation, and numerous other findings. CT findings were categorized into lobar, bronchopneumonia, atypical, and mixed patterns. Evolution on follow-up CT was assessed. Results: 311/346 patients (median age 66.6 y [IQR: 55.9, 74.8]; 178 [57.2%] male) had CT examinations available. GGO (98.1%, 305/311) and consolidation (92%, 286/311) were the most prevalent findings, commonly coexisting. The segmental pattern occurred most frequently. The GGO and reverse halo signs occurred in 6.1% (19/311) and 3.5% (11/311), respectively. Follow-up CT occurred in 58.5% (182/311) (median=47.5 d), demonstrating improvement in 84.1% (153/182), worsening in 10.4% (19/182), stability in 5.5% (10/182), and new CT patterns in 12.6% (23/182). Respiratory co-infection occurred in 27.0% (84/311), commonly bacterial. Cavitation occurred in 7.1% (22/311), more frequently among co-infected patients (14.3%, 12/84) than isolated LP (4.4%, 10/227, P =0.005), even more common among immunocompromised patients (12.0% [18/150] vs. 2.5% [4/161], P =0.001), the highest prevalence among co-infected immunocompromised patients (21.3%, 10/47). Co-infection (odds ratio [OR]=3.26, 95% CI=1.33-8.00; P =0.01) and immunocompromise (OR=4.93, 95% CI=1.61-15.1; P =0.005) were independently associated with cavitation. Conclusions: LP presents nonspecifically with a multilobar segmental pattern of GGO and consolidation. Respiratory co-infection was common, often heralded by cavitation. CT findings improve after LP diagnosis.

Background The development and evaluation of anti-amyloid beta monoclonal antibodies (mAbs) for the treatment of Alzheimer’s disease have been accompanied by extensive ethical debate spanning clinical trials, regulatory processes, prescribing practices, and healthcare delivery. This scoping review examined literature published between 2006 and 2026 to identify and clarify the landscape of ethical considerations surrounding the implementation, prescribing, and delivery of anti-amyloid mAbs across both research and clinical settings. Methods We searched PubMed, Scopus, Web of Science, Embase, and Ovid EBM Reviews (including CENTRAL and CDSR) from 2006 to March 2026 using a structured search strategy. Eligible publications focused on ethical issues associated with the clinical translation of anti-amyloid mAbs. Two reviewers independently screened titles, abstracts, and full-text articles, with duplicate extraction performed on an initial subset of publications. The review was conducted using JBI guidance and reported according to PRISMA-ScR. Results We identified 84 publications from 23 countries published between 2014 and 2026, including 12 original research studies, 1 systematic review, and 71 commentaries, narrative reviews, legal analyses, or practice guidelines. Analysis identified 32 subthemes, which were synthesized into 7 overarching themes: (1) beneficence and nonmaleficence, (2) respect for persons, (3) equity and accessibility, (4) evidence and trial integrity, (5) governance and stewardship, (6) relational and social impacts, and (7) health system readiness and sustainability. Among the 32 subthemes, uncertain clinical benefit and risk of harm (both within the beneficence and nonmaleficence theme) were discussed most frequently within the literature, each appearing in 61 publications. Conclusions The biomedical literature documents a broad range of ethical considerations relating to anti-amyloid mAbs. Despite this growing literature, it is primarily based on commentary, with few empirical studies, and even fewer incorporating the perspectives of patients, families, and clinicians. Doing so may add further context and nuance to ethical discussion about mAbs in the years ahead.

The immune tumor microenvironment (iTME) plays a crucial role in disease biology of plasma cell (PC) dyscrasias, but remains poorly characterized in self-identified Black individuals, a population at increased risk. Mass cytometry and scRNA-seq of 128 bone marrow aspirates revealed significant changes in immune cell composition across the disease spectrum, including shifts from naïve to effector T cells with declines in B cells, MAIT, pDCs, and increases in monocytes with disease progression. Self-identified Black patients had higher relative proportions of terminally differentiated T cells and lower monocytes in newly diagnosed and treated multiple myeloma (MM). ScRNA-seq revealed genes overexpressed in self-identified Black individuals were enriched for E2F targets and G2-M checkpoints, while reduced genes were enriched for TNF-α/NF-kB, interferon and inflammatory responses pathways. These findings were supported by genetic ancestry and validated in an independent dataset of 286 patients with MM from the MMRF Immune Atlas. Self-identified race and African genetic similarity are significantly associated with remodeling the MM iTME, with potential implications for disease biology and treatment response.

Importance Rapid whole-genome sequencing (WGS) has advanced inpatient genetic diagnosis, although most evidence comes from neonatal and pediatric intensive care unit (ICU) populations. Its utility for pediatric neurology inpatients across broader acute settings remains insufficiently established. Objective To assess the diagnostic yield, clinical impact, and factors associated with phenotype-concordant rapid WGS diagnoses. Design, Setting, and Participants This was a retrospective cohort study conducted from June 1, 2022, through January 17, 2026, at a tertiary medical center. Pediatric inpatients in the neonatal ICU, pediatric ICU, or general floor with an unexplained neurologic presentation were included. Those with established nongenetic etiology were excluded from analyses. Exposures Trio (77.8%), duo (9.1%), or singleton (13.1%) rapid WGS. Main Outcomes and Measures The primary outcome was the initial phenotype-concordant diagnostic yield at the point of care. Secondary outcomes were reanalysis yield (new diagnoses from reinterpreting nondiagnostic cases prompted by a new unexplained phenotype or family request), cumulative yield, and management change. Associations were assessed by logistic regression (odds ratios [ORs] and 95% CIs). Results Among 175 children (median [IQR] age, 4 months [1 day-4 years]; 93 male [53.1%]) who met inclusion criteria (82 neonates, 93 nonneonates), initial rapid WGS established a phenotype-concordant diagnosis in 79 (45.1%), higher in nonneonates (49 of 93 [52.7%]) than neonates (30 of 82 [36.6%]). Preliminary results returned at mean (SD) 4.0 (1.6) days and final reports at 10.4 (4.5) days. Positive nonconcordant findings occurred in 33 children (18.9%). Reanalysis of 14 nondiagnostic cases yielded 3 additional diagnoses, for a cumulative yield of 82 of 175 children (46.9%). Most diagnoses were monogenic (63 [76.8%]). Management changed in 54 of 82 phenotype-concordant cases (65.9%; 53 at the point of care, 1 after reanalysis) and 8 of 33 (24.2%) positive nonconcordant cases. Family history was most strongly associated with diagnosis (adjusted OR [aOR], 6.46; 95% CI, 3.23-12.93; P < .001), followed by multisystem involvement (aOR, 2.85; 95% CI, 1.24-6.54; P = .01) and congenital anomaly or dysmorphism (aOR, 2.47; 95% CI, 1.07-5.68; P = .03). Hypotonia was most strongly associated in neonates (OR, 20.63; 95% CI, 5.46-77.87; P < .001); ICU admission (OR, 10.25; 95% CI, 2.79-37.67; P < .001) predominated in nonneonates. Conclusions and Relevance Results of this cohort study suggest that rapid WGS diagnosed nearly half of pediatric neurology inpatients and changed management in two-thirds of diagnosed cases, supporting its potential use as early diagnostic testing. Associated features may guide patient selection, and reanalysis extends yield longitudinally.

Abstract ICLB03 - The Labral Reconstruction Masterclass: Autografts, Allografts, and Technical Frontiers, Session Room 12 (BMCC Level 3), October 8, 2026, 10:30 - 12:30 Purpose The purpose of this study was to compare patient-reported outcomes and incidence of revision surgery based on tear location, size, and number of anchors placed at minimum 10-year follow-up in patients undergoing hip arthroscopy. Methods A retrospective cohort study was conducted of patients undergoing primary hip arthroscopic labral repair between January 2011 and December 2014 at a single academic institution. Patients with revision procedures, prior ipsilateral hip surgery, labral debridement, or <10-year follow-up were excluded. Tear arc size and number of anchors were recorded from operative reports. Patient-reported outcome measures (PROMs) included modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports (HOS-Sports), Tegner, Visual Analog Score (VAS), and satisfaction (0-10). Associations between number of anchors and tear size with PROMs were assessed with univariate and multivariate linear regression. Multivariate logistic regression was used to evaluate predictors of reoperation or conversion to total hip arthroplasty (THA). Results Seventy-three hips were included (mean age 36.2±10.8 years; 72.6% female) with mean follow-up 10.9±0.7 years (range: 10.0-13.0). At ≥10 years, mean mHHS was 79.6±17.2, HOS-ADL 83.4±17.1, HOS-Sports 72.8±25.5, Tegner 3.8±1.5, VAS 2.4±2.7 (rest) and 2.7±2.7 (use), and satisfaction 8.5±2.4. Tear arc was not associated with any PROMs on regression analysis. In multivariable analysis, each additional anchor was associated with lower HOS-ADL (β=-5.6, p=0.048) and HOS-Sports (β=-8.5, p=0.044) and higher VAS pain at rest (β=0.8, p=0.048). No association was observed between anchor number or tear arc size and subsequent surgery. Conclusions After 10 years following arthroscopic labral repair, tear arc size was not associated with PROMs or revision/THA risk. Higher anchor number was associated with modestly lower PROMs but did not increase reoperations rates. Repairs of both small and large tears, when appropriately stabilized, demonstrate durable long-term benefit.

ABSTRACT Background Atrial fibrillation (AF) has been observed in adults with anomalous pulmonary venous return (APVR), but data on catheter ablation outcomes in this population remain limited to case reports and small series. Methods We retrospectively reviewed 14 adult patients with confirmed APVR who underwent catheter ablation for AF at three tertiary academic centers in the United States between July 2003 and May 2025. Baseline, procedural, electroanatomic mapping, and outcome data were collected. Freedom from atrial arrhythmia recurrence was estimated by Kaplan-Meier analysis. Results Mean age was 56 ± 13 years and 79% were male. Heart failure was present in 64%, and hypertension and coronary artery disease in 43% each. Most had partial APVR (86%), and 57% had prior surgical correction. Radiofrequency ablation was used in all patients, combined with pulsed-field ablation in one. Acute success was achieved in all patients, although areas with residual pulmonary vein or SVC electrical activity were left untreated in 3 (21%). Non-pulmonary-vein electrical activity was more common in patients with prior surgical correction than in those without (43% vs 17%). Median follow-up was 3.4 years (IQR, 2.0-9.6). Freedom from arrhythmia recurrence was 78.6% at 1 year and 53.9% at 5 years. Two patients (14%) required reablation; complications occurred in 3 (21%) without long-term sequelae. Conclusions Catheter ablation was acutely successful in all patients in this largest reported APVR cohort, despite substantial comorbidity burden and anatomic complexity. The arrhythmogenic substrate often extended beyond the anomalous vein, particularly in surgically corrected patients, supporting individualized, substrate-guided ablation in this population. CLINICAL PERSPECTIVE What Is Known Atrial fibrillation has been reported in adults with anomalous pulmonary venous return (APVR), but data on catheter ablation outcomes in this population are limited to case reports and small series. What the Study Adds In the largest reported cohort of patients with APVR undergoing catheter ablation for atrial fibrillation, pulmonary vein isolation achieved acute success in all patients despite substantial comorbidity burden and anatomic complexity. Non-pulmonary-vein sites of electrical activity were more common among patients with prior surgical correction, and postsurgical scar and epicardial venoatrial connections were also arrhythmogenic, indicating that the arrhythmogenic substrate in APVR often extends beyond the anomalous vein itself. These findings support individualized, substrate-guided mapping in patients with APVR, particularly those with a surgical history, and suggest a role for pulsed-field ablation near critical structures such as the phrenic nerve.

Abstract Background Iliopsoas impingement (IPI) is a known cause of persistent anterior hip pain following total hip arthroplasty (THA). Management of IPI has often relied on an 8mm anterior acetabular overhang threshold to guide operative treatment, favoring acetabular revision for greater prominence and iliopsoas tenotomy for lesser prominence. These thresholds were initially established based on the outcomes of open tenotomy, and now with improved understanding of IPI and the advent of arthroscopic iliopsoas fractional lengthening (IPFL), a review of the 8 mm threshold is warranted. Materials A retrospective review was performed to identify patients who underwent arthroscopic IPFL following primary THA between 2017 and 2024, with a minimum of one year of follow-up. Acetabular overhang was measured for all patients using cross-table lateral radiograph and patients were stratified into <8mm and ≥8mm cohorts. Patient-reported outcome measures (PROMs), reoperations, revisions, and complications were collected and analyzed based on both the classic 8 mm threshold using continuous statistical methods. Results Eighty-six hips undergoing IPFL in 83 patients (30 male, 53 females, age: 63.0 ± 11.2) were evaluated. Sixty-seven hips had <8mm of overhang and nineteen had ≥8 mm. Mean follow-up was 2.5 ± 1.6 years (range: 1- 7.5 years). When comparing patients with <8mm and ≥8mm acetabular overhang, there were no significant differences (p ≥0.06) observed between pre- and postoperative VAS pain scores, modified Harris Hip Score, SANE score, Tegner activity level, subjective groin pain improvement, subjective hip flexion strength, and overall satisfaction. Reoperation (2.9 vs. 10.5%, p = 0.210) and acetabular revision rates (1.5 vs. 5%, p = 0.387) were not significantly different between overhang groups. Conclusions Arthroscopic IPFL provides satisfactory outcomes for patients with IPI, independent of degree of acetabular overhang. IPFL should be considered for first-line surgical management of IPI refractory to conservative management, even in the setting of substantial acetabular overhang, given positive outcomes and low rates of subsequent acetabular revision.

Abstract Purpose To evaluate patient-reported outcome measures at a minimum of 5-years of follow-up and return to sport (RTS) in dancers with femoroacetabular impingement (FAI) after primary hip arthroscopy with labral repair. Methods Dancers diagnosed with FAI and labral tears undergoing primary hip arthroscopy with labral repair from 2010 to 2020 were included. Modified Harris Hip Score (mHHS), Hip Outcome Score Activities of Daily Living (HOS-ADL), HOS Sports-Specific Subscale (HOS-SSS), Tegner Activity Score, Visual Analogue Scale (VAS) for pain, and surgery satisfaction were collected. Results Twenty-six dancers (25 female and 1 male; mean age, 22 ± 7; mean body mass index (BMI), 23.9 ± 4.6) were followed for a mean of 8.2 years. At final follow-up, the mean and 95% CI for VAS pain with rest was 1.8 (0.9-2.6), VAS pain with use was 3.3 (2.2-4.4), Tegner Activity Scale was 5.0 (4.2-5.9), mHHS Total was 82.4 (75.9-88.9), HOS-ADL was 90.0 (85.2-94.7), and HOS-SSS was 78.4 (69.1-87.6). All outcome scores significantly improved postoperatively (p ≤ 0.027), and MCID achievement was 91.0% for mHHS total, 85.7% for HOS-ADL, and 91.0% for HOS-SSS. One patient (4%) underwent revision hip arthroscopy and labral repair for a re-tear of the labrum. Nineteen (76%) returned to sport, of which 17 (89%) returned to the same or higher level. Seven patients (37%) had subsequently stopped for reasons unrelated to hip symptoms, while four (21%) stopped for hip related reasons. Conclusion Treatment of FAI with hip arthroscopy in dancers leads to improvement in outcomes with a high rate of satisfaction at mean follow-up of 8.2 years. Seventy-six percent of dancers ultimately returned to dance, of which 89% returned to the same level, and majority subsequently discontinuing for non-hip related reasons. These results support a high rate of RTS in dancers after hip arthroscopy with labral repair for the treatment of FAI with maintained level of dance competition and improvement in PROMs at mid-term follow-up.

Abstract Background The use of collared femoral stems are becoming increasingly popular in total hip arthroplasty (THA) due to improved axial stability and decreased periprosthetic femoral fractures. However, the effect of the initial collar–calcar relationship on femoral remodeling is poorly understood. Methods A retrospective review of 700 primary THAs using triple-tapered collared stems with a minimum 2-year radiographic follow-up was performed. Radiographic imaging was analyzed to determine the collar–calcar relationship, measured as the distance between the medial edge of the collar and the medial calcar on antero-posterior radiographs at time zero and ≥2-year follow-up. The collar-calcar relationship was classified into three distinct groups: overhang, flush, and underhang. Overhang was defined as the collar extending medial to the calcar, flush as the collar sitting directly on top of the calcar, and underhang as the medial portion of the collar lateral to the medial calcar. The change in the collar–calcar relationship over time was analyzed as calcar remodeling. Furthermore, a linear regression model was used to determine how baseline position predicted 2-year collar position, with the goal to identify an ideal relationship at implantation to achieve a flush collar at two-year follow-up. Results At implantation, 370 (52%) of stems demonstrated a underhang, 56 (8%) were flush, and 274 (39%) showed overhang. For the entire cohort, the mean collar-calcar relationship changed from −0.68 ± 2.5 mm at implantation to 1.9 ± 1.9 mm at final follow-up (p < 0.001). Collared stems with underhang demonstrated the greatest remodeling (3.5 ± 1.9 mm), followed by flush (2.1 ± 1.4 mm) and overhang (1.5 ± 1.4 mm) (p < 0.001). Pairwise comparison demonstrated statistically significant difference between all three groups (p <0.001). Each 1 mm increase in baseline overhang was associated with a decrease of 0.5 mm change in calcar remodeling (95% CI −0.55 to −0.46; p < 0.001). To achieve a flush collar at two years a baseline underhang of −4.52 mm (95% CI −4.97 to −4.15) was required. Reoperation rates were low and did not differ between all three groups. Conclusions The collar–calcar relationship evolves predictably over time, with baseline position impacting final collar prominence. Immediate implant position does not reflect the final construct, however it does plays a role in calcar remodeling.

Abstract Background The THA-10 Score is a risk stratification tool to help predict 10-year conversion to total hip arthroplasty (THA) following hip arthroscopy (HA) for femoroacetabular impingement (FAI). It is intuitive that the score demonstrated predictive accuracy on the original cohort utilized to create the metric. However, external validation has not yet been conducted. The purpose of the present study was to externally validate the THA-10 Score using a large single-institution cohort with long-term follow-up. Methods A retrospective review was conducted of patients who underwent primary HA with labral repair and capsular repair between 2011 and 2015. Inclusion criteria required a minimum of 10-year follow-up. Exclusion criteria included revision surgery, Tonnis grade ≥2, lateral center-edge angle <18°, or periacetabular osteotomy. The THA-10 Score was calculated by assigning points for body mass index (BMI) ≥25 kg/m2 (1 point), Tonnis grade 1 (1 point), age ≥47 years (2 points), and high-grade (Outerbridge grade 3 or 4) acetabular and femoral head chondral defects (3 points each). Discrimination was assessed using receiver operating characteristic (ROC) analysis and calibration was evaluated using the Brier score. Results The final cohort consisted of 215 patients (74.0% female, mean age 33.6 ± 13.0 years, mean BMI 26.9 ± 6.4 kg/m2). At a mean follow-up of 11.1 years (range 10.0-13.9 years), 23 patients (10.7%) underwent conversion to THA. The THA-10 Score demonstrated sufficient discrimination with an area under the curve (AUC) of 0.763. Calibration analysis demonstrated a Brier score of 0.078 with a p-value of 0.115, which is consistent with appropriate model calibration. Patients with THA-10 Scores ≥4 had 10.4-times greater odds of conversion to THA compared to those with scores <4 (p<0.001). Conclusions The THA-10 Score demonstrated sufficient discrimination and appropriate calibration for predicting 10-year THA conversion after HA for FAI. These findings support the use of the THA-10 Score as a counseling and risk-stratification tool in patients undergoing HA.