Citations

Abstract While the launch of the da Vinci Surgical System catalyzed the expansion of robotic surgery across disciplines, adoption in plastic surgery remains modest. To explore this disconnect, this study surveys plastic surgeons to gauge interest, utilization, and perceived barriers to robotic surgery adoption. A 15-question survey on training, access, interest, and barriers to robotic procedures was developed on Qualtrics and distributed via email to members of the American Society of Plastic Surgeons (ASPS) in May 2024. Descriptive statistics were used to summarize responses. About 123 responses were collected among 3,512 survey recipients. Among respondents, 84.6% reported having access to a surgical robot; however, only 13.8% had training on robotic systems during residency, and only 12.2% utilized the technology for plastic surgery procedures. Interest in robotics was noted among 47.9% of respondents, particularly for deep inferior epigastric perforator (DIEP) flap procedures (65.5%), rectus/Vertical Rectus Abdominis Myocutaneous (VRAM) flap (58.2%), and hernia repairs (27.3%). Key barriers to adoption included training requirements (63.9%), lack of demand (60.2%), increased operative time (54.6%), and financial concerns (26.9%). Additional obstacles cited were credentialing difficulties and skepticism about the necessity of robotics in plastic surgery. The present survey identified inadequate training, high costs, and limited demand as key barriers to the adoption of robotics in plastic surgery, reflecting the current lack of robotic integration into residency curricula, as well as the substantial investment and maintenance costs associated with robotic systems. Nevertheless, the strong interest in robotics highlights the need for expanded training programs, promotion of clinical benefits, and research quantifying potential downstream savings to overcome these barriers.

Abstract Gangliosides are structurally complex glycosphingolipids that regulate cellular signaling via interactions with extracellular binding partners and by influencing protein function within the membrane. Their comprehensive analysis remains analytically challenging, in part due to low endogenous abundance, extensive structural diversity, and the frequent occurrence of isomeric species arising from both glycan and ceramide moieties. Here, we present a hydrophilic interaction liquid chromatography (HILIC) nanoelectrospray ionization tandem mass spectrometry (nanoESI-MS/MS) method specifically designed to achieve isomer-resolved analysis and molecular species-level quantification of gangliosides. To improve characterization of low-abundance fatty acyl fragments, the workflow was extended by combining nanoESI with online fraction collection and subsequent direct infusion. The method demonstrated stable chromatographic performance, high sensitivity, and reproducible quantitative results across ten mouse tissues. Application of the workflow enabled quantification of 80 ganglioside molecular species belonging to 18 subclasses and revealed pronounced tissue-specific differences in subclass distribution and ceramide composition. Overall, this study establishes a robust and sensitive platform for comprehensive ganglioside analysis, providing new opportunities to investigate ganglioside diversity, regulation, and function in complex biological systems.

Abstract INTRODUCTION We integrate visual and quantitative metrics in white matter and medial temporal lobe to examine relationships with neuropathology in a community cohort. METHODS Postmortem in situ MRI (T1, T2, DWI) was performed in 25 human brains, followed by visual ratings (Fazekas, MTA, ERICA, Koedam). Neuropathology included ADNC, LATE-NC, hippocampal sclerosis, PART, ARTAG, Lewy pathology, and CAA. RESULTS Increased Fazekas score was linked to aging, lower education, hypertension, higher basilar artery wall thickness, and greater Braak NFT stage. WMH volume also correlated with lacunes, Thal phase, and CERAD score that was not observed using Fazekas. Hippocampal volumes were lower in elderly, less educated people and were associated with higher atrophy scores and higher Braak NFT stage. Higher amygdala volume was only associated with higher CERAD score. DISCUSSION Quantitative MRI may detect neuropathologic associations more sensitively than visual ratings. Tau pathology is a key predictor of WMH burden and hippocampal atrophy.

Purpose of review Photon-counting detector computed tomography (PCD-CT) represents a major technological advancement in computed tomography, offering improved spatial resolution, reduced image noise, and increased dose efficiency compared with conventional energy-integrating detector CT (EID-CT). Because many clinically relevant structures within the temporal bone are submillimeter in size, the temporal bone represents an ideal region for determining whether these technical improvements translate into meaningful clinical benefits. This review evaluates the emerging literature on PCD-CT in temporal bone imaging and examines whether higher spatial resolution meaningfully impacts clinical decision-making. Recent findings Recent studies demonstrate improved visualization of middle ear anatomy, ossicular prostheses, cochlear implant electrode arrays, and superior semicircular canal dehiscence with PCD-CT compared with conventional CT. Improved spatial resolution and reduced metal artifact have been shown to enhance assessment of prosthesis positioning, cochlear duct measurements, and differentiation of true versus near semicircular canal dehiscence. However, given the recent availability of PCD-CT, most studies to date have focused on cadaveric studies, phantom studies, or patient studies evaluating image quality rather than diagnostic accuracy or clinical outcomes. Summary PCD-CT provides substantially improved visualization of submillimeter temporal bone structures and may improve diagnostic confidence in select clinical scenarios. Nevertheless, evidence demonstrating improved clinical outcomes remains limited, and further clinical studies are needed to define the role of PCD-CT in routine temporal bone imaging.

Background. Chronic kidney disease (CKD) is a common complication of nonrenal transplantation, influencing recipients’ morbidity and mortality. The incidence of CKD varies depending on the transplanted organ. Recipients of vascularized composite allotransplantation (VCA) need lifelong immunosuppression similar to that of solid organ transplantation. This study investigated renal function in VCA recipients. Methods. We studied 70 recipients from 17 centers (median follow-up: 8 y): 59 upper extremity, 10 face, and 1 penis transplant. Pretransplant and posttransplant clinical data and sera were collected to calculate the estimated glomerular filtration rate (eGFR) using the CKD Epidemiology collaboration 2021 formula. Results. Pretransplantation, the median eGFR was 105.36 mL/min (range, 71.39–155.39 mL/min). By 3 mo posttransplant, the eGFR had significantly decreased to 78.42 mL/min (range, 32.49–130.74 mL/min; P = 0.001) before stabilizing. Despite higher tacrolimus levels at 3 mo, no correlation with eGFR was found. During follow-up, 17.1% of patients experienced a ≥50% eGFR decline, 10.9% progressed to CKD, and 4.7% developed end-stage kidney disease. Some risk factors were identified, but their responsibility could not be established with certainty because of the low number of severe renal outcomes. Conclusions. Renal function declines in the majority of VCA recipients, but the function loss is lower compared with nonrenal solid organ transplantation recipients. Although no statistically significant correlation could be established between tacrolimus exposure and renal function decline, strategies aiming at minimizing calcineurin inhibitor exposure and avoiding other nephrotoxic causes are recommended to preserve long-term kidney function.

Abstract Objective Genicular nerve radiofrequency (gRF) treatment is a widely used intervention for chronic pain from knee osteoarthritis (KOA). This systematic review and meta-analysis focuses on RCTs utilizing image guidance to address inconsistencies in previous reviews and provide higher-quality evidence. Design, Setting, and Methods This study included RCTs that compared gRF techniques (conventional, cooled, pulsed, bipolar) to non-gRF treatments, including sham procedures, intra-articular injections, ozone therapy, and oral medications. Primary and secondary outcomes were changes in pain and total WOMAC scores at 3, 6, and 12 months post-gRF treatments. Subgroup analyses explored differences by lesion size, use of prognostic blocks, industry sponsorship, and study location. Statistical heterogeneity was assessed via I 2 statistics. Results Eleven RCTs with 868 knee osteoarthritis patients (435 gRF, 433 non-gRF) were included. At 3 months, gRF significantly reduced pain (SMD -1.65, 95% CI: -3.20 to -0.10, I 2 = 98%, P = 0.040), but not at 6 months or 12 months. Secondary analyses showed no significant differences in total WOMAC scores between the gRF and control groups at 3, 6, and 12 months. Subgroup analysis showed that industry-sponsored studies reported significant 3-month pain reduction, whereas non-sponsored studies did not. This effect was independent of study location. Conclusions GRF provides short-term pain relief (up to 3 months) but neither functional improvement nor sustained pain reduction compared to non-gRF treatments. Our findings do not support the routine use of gRF for long-term chronic pain due to KOA.

Abstract Background Central venous catheterization (CVC) is a fundamental procedural competency in pulmonary and critical care medicine (PCCM). Although commercially available task trainers are effective for teaching CVC placement, their high cost and logistical requirements can limit access to repeated practice. Objective To evaluate learner and faculty perceptions and usability of a newly developed CVC simulation model compared with a standard commercial task trainer and detail the technical report of the novel model’s construction. Methods We conducted a prospective educational evaluation during the PCCM CVC workshop. Participants practiced CVC placement with both the standard commercial trainer and a locally constructed simulation model developed at our institution. Teaching faculty were asked to evaluate both models from an instructional standpoint. Results Eighteen participants (15 PCCM 1st year fellows and 3 faculty instructors) evaluated the novel CVC simulation model. All fellows (n = 15, 100%) preferred the new model over a standard commercial model, with 14 (93%) reporting improved understanding of CVC insertion steps and 11 (73%) noting ease of ultrasound landmark identification. All fellows (n = 15, 100%) endorsed inclusion of the model in future workshops. Additionally, faculty instructors preferred the novel model for teaching (n = 3, 100%). All faculty supported future use of the model. The initial model development cost was approximately $288.96 with most materials’ reusable. Conclusions The novel task-aligned CVC simulation model offers a realistic, reusable, and cost-effective alternative to commercial simulators, with high learner and faculty preference and strong educational value. Its functional alignment supports integration into fellowship training, with future studies needed to assess objective skill acquisition and retention.

Importance Transvaginal pelvic imaging is an integral and sensitive aspect of gynecologic care that individuals find both invasive and burdensome. At-home transvaginal imaging provides an opportunity to navigate these barriers to care. Objective To evaluate the use of at-home transvaginal ultrasonography for gynecologic assessment, as measured by diagnostic imaging quality and participant satisfaction, in a broad sampling of women aged 22 to 50 years. Design, Setting, and Participants Prospective, interventional, single group nonrandomized clinical trial with blinded review of collected images from premenopausal women aged 22 to 50 from Florida, Massachusetts, Maryland, Maine, Minnesota, New Hampshire, Texas, Utah, Virginia, Vermont, and Washington, DC. Images were gathered between July 2022 and July 2023, and data were analyzed from April to September 2025. Intervention At-home pelvic ultrasonography guided by verbal communication with a fully trained remote sonographer who had real-time access to study images. Cine clips were used to capture standard views of the uterus, ovaries, cervix, and posterior cul-de-sac. Main Outcomes and Measures Primary outcomes were image quality and participant net promoter score (NPS), reflecting participants' likelihood of recommending the procedure, with higher scores indicating greater likelihood. Secondary outcomes included minor pain or discomfort, sonographer reported experience and/or pain, and all other adverse events. Results A total of 265 participants (mean [SD] age, 32 [6.7] years; mean [SD] body mass index, 27.0 [5.6]) enrolled in the trial, and 263 ultrasonographic scans were completed. Image quality showed that 253 at-home ultrasonographic scans (96.2%) met diagnostic quality while 10 (3.8%) did not. NPS was significantly higher with use of the at-home ultrasonography (59) compared with in-clinic scans (24), with an adjusted difference of 33.7 (95% CI, 23.3-44.0; z = 6.35; P < .001). No adverse events were reported. Conclusions and Relevance This nonrandomized clinical trial of at-home pelvic ultrasonography in premenopausal women demonstrated that broad use of at-home gynecologic ultrasonography technology is feasible, safe, and preferred by participants and sonographers compared with in-clinic ultrasonography. At-home ultrasonographic imaging presented an innovative and clinically acceptable alternative to in-clinic care, providing opportunities for improved access to and decreased burden of gynecologic and reproductive care. Registration ClinicalTrials.gov NCT05443698

Importance Tofersen is a disease-modifying antisense oligonucleotide therapeutic for people living with SOD1 –amyotrophic lateral sclerosis ( SOD1 -ALS). Autopsy tissue donors have provided the first opportunity to study the distribution of intrathecally administered tofersen in human central nervous system tissues. Objectives To determine the tissue distribution of tofersen and to provide the first estimates of SOD1 reduction in human somatic motor systems tissues. Design, Setting, and Participants This was a cross-sectional autopsy tissue case series conducted between 2018 and 2026. Autopsies were performed at 3 US academic medical institutions. Tissue samples from 8 deceased patients who lived with SOD1 -ALS, participated in tofersen clinical trials (ClinicalTrials.gov Identifiers NCT02623699 [An Efficacy, Safety, Tolerability, Pharmacokinetics and Pharmacodynamics Study of BIIB067 (Tofersen) in Adults With Inherited Amyotrophic Lateral Sclerosis (ALS)] and NCT03070119 [Long-Term Evaluation of BIIB067 (Tofersen)]) or the Expanded Access Program, and whose families authorized autopsies were eligible for this study. All autopsy tissue donors known at the time of this study were included (none were excluded). Analyses were conducted between August 2020 and January 2026. Exposures Participants received multiple intrathecal 20- to 100-mg tofersen doses. Main Outcomes and Measures Tofersen tissue concentrations were measured using hybridization enzyme-linked immunosorbent assay (ELISA). SOD1 messenger RNA (mRNA) and protein reduction estimates, defined as percentage SOD1 levels in this study’s recently treated autopsy tissue donors compared to a cohort of samples from tofersen-naive SOD1 -ALS autopsy tissue donors, were measured using quantitative reverse transcription polymerase chain reaction (PCR) and ELISA. Histological localization of tofersen and SOD1 transcripts were studied using immunohistochemistry and in situ hybridization assays. Results In 8 tofersen-treated autopsy tissue donors (5 male and 3 female donors; age range, 42-66 years), spinal cord and motor cortical tissue tofersen concentrations strongly correlated with predictions based on individual dosing histories and a preclinical pharmacokinetic model. For 3 recently treated autopsy tissue donors, reductions in lumbar spinal cord tissue SOD1 mRNA and protein levels ranged from 45% to 84% despite not having been administered 1 to 2 scheduled doses before autopsy. Residual somatic motor neurons demonstrated tofersen transduction and low SOD1 mRNA probe hybridization. Misfolded SOD1 protein inclusions were detected in residual motor neurons of tofersen-naive SOD1- ALS tissue donor controls and tofersen-treated tissue donors. Meningeal and perivascular lymphocytic immune responses were observed in 5 recently treated tissue donors but were not apparent in tissue donors with remote final tofersen doses. Conclusions and Relevance This case series presents the first emerging autopsy tissue data confirming the predicted distribution of tofersen and robust SOD1 protein reduction in human somatic motor systems tissues.