Citations

Purpose To compare radiographically the concavity depth and slope angle of the congruent‐arc distal tibial allograft (CA‐DTA), harvested from the posterior distal tibia, with the traditional lateral distal tibial allograft (traditional DTA) used for glenoid reconstruction in anterior shoulder instability with bone loss. Methods A convenience sample of 32 ankle computed tomography scans from patients ≤35 years old without prior trauma, arthritis, or ankle pathology were retrospectively reviewed. Using standardized coronal (traditional DTA) and sagittal (CA‐DTA) reconstructions, 2 independent reviewers measured allograft concavity depth (mm) and slope angle. Paired t tests compared traditional versus CA‐DTA measurements. Intraclass correlation coefficients assessed reliability. Significance was set at P < .05. Results The mean age of patients was 25.2 years, with 50% (n = 18) of patients being male. Compared with the traditional DTA, the CA‐DTA showed significantly greater glenoid concavity change (2.9 ± 0.65 mm vs −2.3 ± 0.71 mm; P < .001) and slope angle (22.9°± 4.02 vs −9.78°± 4.07; P < .001). All CA‐DTAs showed positive concavity and slope, whereas all traditional DTAs produced negative values. Conclusions The CA‐DTA consistently increased both concavity and slope, whereas the traditional DTA decreased these measures. By leveraging the posterior tibial surface, the CA‐DTA more reliably recreates the anatomic “half‐pipe” glenoid contour that contributes to bony concavity‐compression‐based stability. Clinical Relevance The CA‐DTA offers a graft alternative that more reliably restores glenoid concavity in anterior shoulder instability with glenoid bone loss. This has potential implications for improved glenohumeral stability and clinical outcomes.

Purpose To evaluate objective return‐to‐sport (RTS) outcomes and limb symmetry index (LSI) data after primary medial patellofemoral ligament reconstruction (MPFLR) in patients with patellar instability. Methods A systematic search of Scopus, PubMed, CINAHL, and Embase (2000‐2024) identified studies reporting RTS outcomes and LSI‐based performance testing in patients undergoing primary MPFLR. Clinical and observational studies reporting objective metrics such as isokinetic strength and hop testing were included. Results Six studies including 243 patients (64% women, mean age 19.4 years) undergoing primary MPFLR were included. Several studies included patients undergoing concomitant bone procedures (41%), such as tibial tubercle osteotomy or trochleoplasty. Objective RTS testing commonly included isokinetic strength (4 studies), hop testing (3 studies), and Y‐Balance testing (2 studies). Follow‐up testing ranged from 6 to 8 months postoperatively. Reported LSI values ranged from 83% to 94% for isokinetic flexion, 70% to 96% for isokinetic extension, 85% to 93% for single hop, and 90% to 97% for triple hop. Time to RTS ranged from 6.1 to 8.1 months across studies, with RTS rates from 85% to 100%. However, only 14% to 40% of patients met all study‐specific RTS criteria when reported. Testing protocols and thresholds varied across studies, contributing to heterogeneity in outcomes. Conclusions Few studies reporting RTS outcomes after MPFLR incorporate LSI measures as part of RTS assessment, and only a minority define explicit RTS criteria based on objective testing. Among studies that reported LSI, quadriceps strength frequently remained below 90% LSI at the time of RTS. Despite high reported RTS rates, substantial variability exists in RTS assessment after MPFLR. Level of Evidence Level IV, systematic review of Level III to IV studies.

OBJECTIVE Primary malignant osseous tumors of the mobile spine are rare and require complex, multidisciplinary care. Treatment outcomes may differ between academic and community hospitals due to variations in resources, expertise, and infrastructure. This study evaluates demographics, care delivery patterns, and clinical outcomes, including both short- and long-term survival, for patients treated at academic versus community cancer programs using the National Cancer Database. METHODS A retrospective analysis of a prospectively maintained database was performed. Nine hundred forty-three patients diagnosed with primary malignant osseous tumors of the mobile spine between 2004 and 2017 were identified. Patients were stratified by facility type: there were 601 patients treated at academic comprehensive cancer programs (ACADs) and 342 treated at comprehensive community cancer programs (CCCPs). Demographic, treatment, and clinical data were compared using descriptive statistics. Outcomes included inpatient length of stay, time to treatment, 30- and 90-day mortality, vital status at last contact, and overall survival. A multivariable Cox proportional hazards model assessed factors associated with overall survival. RESULTS Patients at ACADs were significantly younger and more likely to have private insurance. The size and histopathological composition of the tumors did not differ significantly between facility types. ACAD patients experienced significantly longer inpatient stays and longer time to radiation initiation among patients receiving radiation with documented start dates. Time to chemotherapy did not significantly differ (p = 0.91). Thirty- and 90-day mortality were comparable between facility types among eligible surgical cases. At last follow-up, a significantly greater proportion of ACAD patients were alive (50.2% vs 38.3%, p < 0.001), and the median time from diagnosis to last contact or death was longer at ACADs (40.8 vs 33.2 months, p = 0.001). In the primary multivariable Cox model, treatment at an academic facility was associated with improved overall survival (hazard ratio [HR] 0.766, 95% CI 0.627–0.937; p = 0.009). In a sensitivity model adjusting for histopathology rather than grade, this association was attenuated and no longer statistically significant (CCCP vs ACAD, HR 1.19, p = 0.081). CONCLUSIONS Patients treated at academic centers had longer inpatient stays and longer time to radiation initiation, yet academic facility treatment was associated with improved overall survival in the primary multivariable model. After accounting for histopathological subtype in sensitivity analysis, the facility-type association was attenuated, suggesting survival differences reflect both tumor biology and system-level care pathways.

Abstract Positron emission tomography (PET)-based molecular imaging is a clinically important tool for the evaluation of dementia and other neurodegenerative disorders, using radiotracers that target specific molecular and pathophysiological processes. Fluorodeoxyglucose brain PET has historically supported neurodegenerative disorder evaluation through detection of characteristic patterns of regional glucose hypometabolism. In recent years, the molecular imaging of protein aggregates has taken on an increasingly important role. This is evident with the widespread clinical adoption of amyloid PET and early use of tau PET to provide diagnostic and prognostic information for patients with suspected Alzheimer’s disease. Additional classes of radiotracers relevant to neurodegenerative diseases are under active investigation, including those targeting neuroinflammation, synaptic density, and α-synuclein aggregates. We review the major classes of PET radiotracers for neurodegenerative diseases, describing their molecular mechanisms, diagnostic performance, and their current and emerging clinical roles in dementia evaluation. Case examples for clinically used tracers illustrate imaging features relevant to diagnosis and characterization of prognosis and treatment effect. Finally, we discuss early developments and current challenges in the development of theranostic approaches and novel radiotracers for neurodegenerative diseases.

Klippel-Trénaunay syndrome (KTS) is a rare congenital vascular-overgrowth disorder within the broader spectrum of PIK3CA -related overgrowth syndromes. Although clinical, radiologic, and orthopedic manifestations are well described, the histologic spectrum of KTS-associated pathology remains under-characterized. Clinicopathologic findings from 21 patients with clinically established KTS were reviewed, including 18 with longitudinal clinical follow-up and 3 consultation cases of rare malignant mesenchymal neoplasms. Cases were identified from institutional pathology and clinical databases, and available hematoxylin and eosin-stained sections and ancillary studies were reviewed. The cohort included 11 males and 10 females. Among the 18 clinically followed patients, 12 had limb length discrepancy or asymmetric limb overgrowth, 9 had documented deep vascular malformations, 4 had intra-articular/synovial malformations, and 10 underwent initial orthopedic evaluation or intervention before age 18. Orthopedic morbidity clustered into mechanical overgrowth-related, vascular malformation-related, and soft tissue/wound-related complications. Histologic findings included superficial and/or deep slow-flow vascular malformations, ulceration and granulation tissue, hemosiderin-laden reactive synovium, and destructive hemorrhagic arthropathy. Intra-articular disease recapitulated a hemophilic arthropathy-like pattern, with hemosiderotic synovitis, papillary synovial hyperplasia, and progressive joint destruction with loss of articular cartilage, exposed subchondral bone destruction and remodeling, all attributable to long-standing intra-articular hemorrhage. Three consultation cases showed malignant mesenchymal neoplasia, including 2 angiosarcomas. Recognition of these patterns is important for pathologists evaluating specimens from patients with known or suspected KTS, particularly when findings mimic hemophilic arthropathy, diffuse-type tenosynovial giant cell tumor, nonsyndromic vascular malformation, and/or end-stage destructive arthropathy.

Abstract Objective Otolaryngology–Head and Neck Surgery (OHNS) residency remains highly competitive, with persistent disparities in applicant representation. This study presents a cross‐sectional analysis of OHNS residency and faculty demographics using 2025 program rosters, evaluating degree type (MD vs DO), geographic distribution, and leadership influence. Study Design A cross‐sectional review. Setting All US ACGME‐accredited OHNS residency programs, with data collected in 2024 to 2025. Methods Demographic data were collected on OHNS faculty and residents, including post‐graduate year (PGY) 1 through PGY5 trainees at the time of data collection, corresponding to entry years from 2020 to 2024 across all US ACGME‐accredited residency programs. Data was extracted from official program websites, FREIDA, ACGME, NRMP, and social media. Programs with incomplete data, those using the military match, and non‐accredited sites were excluded. Descriptive statistics, χ 2 tests, and correlation analyses were performed ( p < .05). Results Of 131 programs, 125 were analyzed at the program level and 121 at the faculty level. DO residents were concentrated in Michigan (59%), Ohio (50%), and Oklahoma (50%). DO representation correlated with DO faculty ( r = .82, p < .0001), DO program director ( r = .95, p < .0001), and former AOA program designation ( r = .92, p < .0001). A negative correlation existed between program size and DO resident ( r = –.4, p < .0001). Conclusion Despite growing diversity following the single accreditation system, disparities persist in OHNS. DO residents remain underrepresented and geographically concentrated, with representation strongly associated with osteopathic faculty presence, program leadership, and prior AOA affiliation.

Introduction The World Health Organization (WHO) endorses male circumcision as an effective human immunodeficiency virus (HIV) prevention intervention in settings where the expected impact is greatest, including Sub-Saharan Africa. Data on cost implications of early infant male circumcision (EIMC) are limited. The ShangRing (SR) is a WHO pre-qualified device for circumcision. We sought to perform a comprehensive cost assessment alongside a randomized controlled trial (RCT) of the SR versus the standard of care Mogen clamp (MoC) for EIMC to enable future scale-up towards a cost-effective HIV prevention strategy. Methods We collected resource utilization and economic data as part of an RCT of infants aged 0–60 days old undergoing EIMC in Kenya, Tanzania, and Uganda. Cost data for both the SR and MoC included baseline facility costs, direct costs, and indirect costs. The Decision Makers Program Planning Tool v1.0 was used to perform a direct cost comparison of these two devices. The Goals model was used to compare the costs of EIMC in 2023 using the present value of money to circumcise an adolescent male 15 years from now. Results A total of 1,378 infant males underwent circumcision, 689 via SR and 689 via MoC. The overall cost of a single EIMC in Kenya, Tanzania, and Uganda were 61.30 United States Dollars ($), $47.14, and $64.59 respectively for the SR, and $56.38, $50.43, and $58.57 respectively for the MoC. In Kenya, EIMC would be less expensive based on nominal present costs in 2023 compared to waiting for adolescent circumcision at age 15 years in 2038. This finding is reversed in Tanzania and Uganda. Conclusions The overall cost of EIMC via SR versus MoC is comparable in an RCT. With scale-up utilizing lower level personnel, the cost of SR may be further reduced. The SR is an attractive alternative for future EIMC initiatives in Sub-Saharan Africa to further reduce HIV burden.

Abstract Background Lower extremity compression therapy has been proposed as an adjunct to mitigate diuretic resistance during acute decompensation of heart failure (ADHF). We evaluated the effect of lower leg compression with elastic bandages on diuretic efficiency in patients with diuretic-resistant ADHF. Methods Historical cohort study enrolling adult cardiac ICU admissions with ADHF who used elastic bandages (EB) at Mayo Clinic in Minnesota from 2007 to 2017. The diuretic efficiency before and after applying EB was the primary outcome. Results A total of 176 patients with heart failure who received elastic bandages were included. The in-hospital mortality rate, the median hospital length of stay, and 30-day hospital readmission were 9.7%, 11.4 days (IQR 7.1–19.0), and 11%, respectively. When EB was applied, the average daily loop diuretic dosage was decreased by a mean difference of 1.19 mg per 40 mg furosemide equivalent (95% CI: 0.22 to 2.2; p = 0.016). The average post-EB diuretic efficiency was 1,355 mL (IQR 1,119, 1,590) per 40-mg furosemide, which was significantly higher than before EB application, with a mean difference of 340 mL per 40-mg furosemide equivalent (95% CI: -554, -125; p = 0.002). A higher diuretic efficiency led to lower diuretic doses. Average daily urine output before and after EB application was not different (2,642 pre-EB vs. 2,792 post-EB mL/day; 95% CI: -455 to 154; p = 0.33). Conclusion EB use enhances diuretic efficacy during ADHF. Further studies are needed to determine the potential clinical benefits and risks of applying EB compression treatment in ADHF.

Précis: In this randomized multicenter trial, both TRAB and CPC lowered IOP at 12 months as primary glaucoma surgeries, with TRAB yielding lower final IOP with fewer medications, while both procedures demonstrated meaningful clinical effectiveness. Purpose: To compare the efficacy and safety of trabeculectomy (TRAB) and slow-burn transscleral cyclophotocoagulation (CPC) as primary surgical treatments for glaucoma. Methods: Prospective, randomized, multicenter trial including one eye per patient from July 2020 to July 2023, with 12-month follow-up. Participants were allocated to TRAB (GI) or CPC (GII). The primary endpoint was surgical success at 12 months, defined by intraocular pressure (IOP) between 6 and 18 mm Hg without non-protocol glaucoma surgery or serious complications. Results: Eighty-six eyes were included; nine were excluded (four in GI; five in GII). Baseline demographics were similar between groups. Both significantly reduced IOP at 12 months (GI: 22.97±8.23 mm Hg to 10.14±2.89 mm Hg; GII: 23.47±6.34 mm Hg to 14.58±3.66 mm Hg; P <0.001 for both). Medication use decreased significantly in both groups, with a lower mean number of medications per year in GI ( P <0.001). An IOP of 6–14 mm Hg was achieved in 91.4% of GI and 39.4% of GII ( P =0.007). Final IOP between 6 and 18 mm Hg was reached by 97.1% of GI and 90.9% of GII ( P =0.708). Qualified success rates were high and comparable (GI: 97.4%; GII: 86.8%; P =0.08), while complications were infrequent (four in GI; one in GII; P =0.3). Quality of life improved after TRAB (EQ-5D: 0.71±0.19 to 0.78±0.14; P =0.031) but remained unchanged after CPC ( P =0.424). Conclusions: Both procedures reduced IOP at 12 months as primary glaucoma surgeries. TRAB achieved lower final IOP, required fewer medications, and was associated with improved quality of life, whereas CPC required more adjunctive medication and retreatment in some eyes.

Establishing the chief complaint requires identifying the patient’s main symptoms or concerns. This information is essential for triage and subsequent clinical assessment. However, patients may struggle to describe their symptoms or leave important concerns unspoken. Also, clinicians have limited time to ask further questions during intake. Generative AI could help by asking patients what is troubling them, when their symptoms began, and what other concerns they have. It could prepare a short summary for patients to correct and clinicians to review. Clinical studies of AI-assisted intake have reported shorter physician consultations and more complete recorded histories. These findings do not show whether AI helps clinicians establish the chief complaint more accurately. We propose an evaluation framework centered on the proportion of patients whose main symptoms or concerns are missing or incorrectly described after AI-assisted intake. Studies should compare what patients wanted to discuss with what the AI agent asked about and included in its summary. They should also examine whether concerns requiring urgent assessment were missed. The clinical goal is a clear description of the patient’s main symptoms and concerns that helps clinicians judge urgency and decide what needs attention.