Citations

Abstract The all‐inside anterior cruciate ligament reconstruction technique has gained popularity because of its ability to preserve bone stock, accommodate shorter graft lengths, and reduce postoperative pain. Traditionally, this technique uses metallic cortical suspensory buttons for graft fixation, which are reliable but may cause soft‐tissue irritation and hardware prominence. A recent modification to traditional all‐inside suspensory fixation uses all‐suture cortical buttons, eliminating the need for metallic or screw‐based implants while maintaining secure fixation. This Technical Note describes an all‐inside anterior cruciate ligament reconstruction technique that uses an all–soft tissue quadriceps tendon autograft, secured with only suture‐based buttons (no metal, no plastic) on both the femoral and tibial sides. Technique Video video See video under supplementary data.

Objective This survey study assessed trainee attitudes and perceptions of the longitudinal public speaking curriculum at Mayo Clinic Pediatric and Adolescent Residency Program. Methods This 3-part survey of Mayo Clinic pediatric residents was conducted from 2013 to 2017 and utilized yes/no questions, Likert scales, and open-ended questions. Code book content analysis was used to analyze open-ended questions. Results A total of 121 participants (96.8%, n = 121/125) completed the survey. Most respondents (93.3%, n = 111/119) either agreed or strongly agreed that the public speaking requirement enabled them to be more effective in delivering information to large groups. Most respondents (89.2%, n = 107/120) agreed or strongly agreed that they incorporated feedback from previous public speaking feedback sessions into subsequent presentations. The 2 activities that respondents found most useful for preparing later presentations were setting goals for future presentations in a feedback session and discussing performance in a feedback session. Conclusions There was a perceived effectiveness of a longitudinal public speaking curriculum among pediatric residents at our program. Multidimensional feedback seems to be a critical aspect of a public speaking curriculum in graduate medical education.

Background. Metabolic dysfunction–associated steatotic liver disease (MASLD) is increasingly recognized as a significant indication for liver transplantation (LT) in North America. Yet data on its impact in other countries, such as Spain, remain limited. This study aimed to evaluate the prevalence and trajectory of MASLD-related LT in Spain and compare these findings with broader national data and international data sets. Methods. Multicenter retrospective cohort study including adults (18 y and older) undergoing LT for MASLD between 2010 and 2023 in 5 large Spanish centers. Additional data were obtained from the Spanish Transplant Registry (Organización Nacional de Trasplantes) and high-prevalence LT centers in the United States (n = 7) and Canada (n = 1). Results. Among 3448 LTs performed in the 5 Spanish centers, 3.4% (n = 117) were MASLD-related. An increasing trajectory of MASLD-related LT was observed, with predictions suggesting a rise to 5.4%–10.8% of LTs for MASLD by 2028. These trends were consistent with Organización Nacional de Trasplantes data. Compared with North American data, the growth trajectory in Spain showed a less steep increase. Hepatocellular carcinoma rates were higher in the Spanish MASLD-LT recipients, yet metabolic comorbidities were frequent in all populations. Conclusions. The burden of MASLD-related LT in Spain is growing, yet at a less pronounced rate than in the United States/Canada. Whether this slower increase will persist or decline in the future as newer antiobesity and MASLD-related drugs are increasingly used is still unknown. In the meantime, our results highlight the need for tailored approaches to management and prevention in the Spanish population and underscore the importance of continued monitoring and research into the evolving impact of MASLD on LT in Spain and beyond.

Importance The prevalence of cardiovascular disease differs substantially across neighborhoods. However, few studies have examined the contribution of neighborhood-level structural racism to inequities in cardiovascular health. Objective To investigate the association between neighborhood-level manifestations of structural racism and the prevalence of cardiovascular clinical and behavioral risk factors and cardiovascular diseases. Design, Setting, and Participants This cross-sectional study consisted of 71 915 US census tracts. The Structural Racism Effect Index (SREI) was appended to the 2020 Centers for Disease Control and Prevention’s PLACES dataset. Race and ethnicity were self-reported and obtained from the 2019 American Community Survey 5-year estimates. Data analysis was conducted from June 2024 to October 2024. Exposure The SREI is a composite score of census tract measures within 9 domains affected by structural racism (built environment, criminal justice, education, employment, housing, income and poverty, social cohesion, transportation, and wealth). The SREI scores were categorized into distribution-based quintiles, where higher quintiles represented greater neighborhood structural racism. Main Outcomes and Measures Neighborhood-level prevalence of cardiovascular clinical (high blood pressure, high cholesterol, obesity, and diabetes) and behavioral (current cigarette smoking and no leisure-time physical activity) risk factors and cardiovascular disease (coronary heart disease and stroke). Multilevel-linear mixed models, adjusting for confounders, were used to estimate adjusted prevalence rate ratios (aPRR). Results Among 71 915 census tracts, neighborhoods in the highest quintiles of structural racism were more likely than neighborhoods in the lowest quintile to be in the southern region (quintile 1, 19.9% vs quintile 5, 56.8%). The proportion of the population that was Black was largest in neighborhoods in the highest quintile of structural racism (quintile 1, 2.2% vs quintile 5, 23.0%). After adjustment, compared with the lowest quintile of structural racism, the highest quintile had significantly higher prevalence rates of cardiovascular clinical risk factors, including high blood pressure (aPRR, 1.37; 95% CI, 1.37-1.38), obesity (aPRR, 1.40; 95% CI, 1.39-1.40), and diabetes (aPRR, 1.80; 95% CI, 1.79-1.81). Similarly, for cardiovascular behavioral risk factors, the highest quintile of structural racism had significantly higher prevalence rates of current cigarette smoking (aPRR, 1.84; 95% CI, 1.83-1.85) and no leisure-time physical activity (aPRR, 1.88; 95% CI, 1.87-1.89). Additionally, for cardiovascular diseases, the highest quintile of structural racism had higher prevalence rates of coronary heart disease (aPRR, 1.80; 95% CI, 1.79-1.82) and stroke (aPRR, 1.99; 95% CI, 1.98-2.00). Conclusions and Relevance In this cross-sectional study, structural racism was associated with inequities in neighborhood cardiovascular health, highlighting opportunities for place-based prevention efforts.

Aims Lymphangioleiomyomatosis (LAM) is a PEComa that primarily affects premenopausal women and is associated with the cystic destruction of the lung. Although smooth muscle and melanocytic markers can be helpful, histologic diagnosis of LAM remains challenging, especially in small biopsies. Glycoprotein non‐metastatic melanoma protein B (GPNMB) expression has recently been identified as a highly specific and sensitive immunohistochemical marker for PEComas. Nevertheless, only a few LAM cases have been studied so far. The aim of this study was to assess the utility of GPNMB immunohistochemistry as an ancillary marker in a larger cohort of LAM samples. Methods and results Immunohistochemistry for GPNMB was performed on cases of LAM ( N = 15), potential differential diagnostic mimics ( N = 30) and normal lung tissue ( N = 2). Immunohistochemistry was assessed using the H‐score method; an H‐score above 100 was considered ‘high’. All LAM cases showed strong cytoplasmic expression, with cell membrane accentuation in some areas. In contrast, differential diagnostic mimics were either negative or only weakly positive. Normal lung parenchyma was negative for GPNMB; however, weak‐to‐moderate expression was seen in alveolar macrophages in both the normal and diseased lung tissues in most cases. Considering only ‘high’ positivity, GPNMB immunohistochemistry showed 100% sensitivity and specificity for the diagnosis of LAM in our cohort. Conclusions Based on its 100% sensitivity and specificity, GPNMB appears to be a highly valuable immunohistochemical marker for the diagnosis of pulmonary LAM. Besides its diagnostic value, the membrane positivity of GPNMB on LAM cells may predict a response to glembatumumab vedotin, an antibody‐drug conjugate targeting GPNMB.

Abstract Background Glioblastoma (GBM) is the most common high-grade primary malignant brain tumor, characterized by a notably poor prognosis. Current treatments for GBM have shown limited effectiveness in improving patient survival, highlighting the urgent need for novel therapeutic strategies. Combination therapy offers significant potential in overcoming resistance by targeting multiple signaling pathways; however, it often comes with increased toxicity compared to monotherapy. Co-encapsulating multiple therapeutic agents into a tumor-targeted drug delivery platform holds promise for overcoming these limitations and improving treatment outcomes. Methods We developed a tumor-targeted liposomal nanoformulation (TTL) using phospholipids, cholesterol, DSPE-(PEG)2000-OMe, and a proprietary tumor-targeting peptide (TTP). The TTL was loaded with everolimus (TTL-E), vinorelbine (TTL-V), rapamycin (TTL-R), a combination (TTL-EV), or (TTL-RV). These formulations were tested in vivo on orthotopic GBM mice, combined with temozolomide and radiation. RNA sequencing was performed to identify molecular and transcriptome changes post-treatment. Results TTL demonstrated tumor-specific uptake, effectively delivering drugs to GBM tumors. TTL-EV and TTL-RV outperformed single-drug formulations. Radiation combined with TTL-EV/RV improved tumor growth inhibition and survival, while temozolomide provided minimal benefit. Transcriptome analysis revealed differentially expressed genes (DEGs) linked to DNA damage repair, cell cycle, metabolism, and extracellular matrix pathways. Conclusion TTL crossed the blood-brain barrier, targeting tumors effectively. Radiation plus TTL-EV/RV enhanced tumor suppression and survival in GBM models. Gene expression analysis identified DEGs related to DNA damage and cell death. Mechanistic studies suggest TTL-EV plus radiation inhibits mTOR/MAPK pathways and sensitizes tumors to radiation. These findings offer a potential approach for improving GBM treatment.

Abstract The incidence of venous thromboembolism (VTE) in patients with acute lymphoblastic leukemia (ALL) receiving asparaginase-based induction is high despite primary thromboprophylaxis. Our aim was to derive and externally validate a VTE risk prediction model in patients with ALL receiving asparaginase-based induction. We conducted a multicenter retrospective cohort study of patients (aged ≥18 years) with newly diagnosed ALL receiving asparaginase-based induction. The derivation and external validation cohorts included 306 and 94 patients, respectively. Primary outcome was VTE at any site. A cause-specific Cox proportional hazards model stratified by thromboprophylaxis and center was performed to identify VTE risk factors in the derivation cohort. A risk prediction model for VTE at 30 days was derived using variables with P value < .05 in the multivariable model and was tested in the validation cohort. VTE risk factors on multivariable analysis in the derivation cohort included D-dimer ≥1 μg fibrinogen equivalent unit per mL (hazard ratio [HR], 2.64; 95% confidence interval [CI], 1.07-6.5) and hemoglobin (HR for each 1 g/dL increment, 1.19; 95% CI, 1.06-1.34) at ALL diagnosis. A VTE risk score based on these variables distinguished between a 4% (95% CI, 0.72-12) and 20% (95% CI, 14-27) 30-day cumulative incidence of VTE in the derivation cohort, with similar findings in the validation cohort (area under the curve, 0.56). The negative predictive value for VTE at 30 days was 96% and 93% in the derivation and validation cohorts, respectively, and the positive predictive value was 20% in both. We derived and validated a model using D-dimer and hemoglobin, which stratifies VTE risk in patients with ALL receiving asparaginase-based induction.

Abstract Objective Microscopic surgery assessment tools vary in objectivity and requirements for determining surgical proficiency. Artificial intelligence methods for objective microsurgical analysis have become more common, but their applications to mastoidectomy have not been reconciled with earlier efforts. This scoping review aimed to (1) compile and compare objective features and assessment targets of microscopic surgery analysis tools and (2) inform the development of a standardized annotation framework for mastoidectomy. Data Sources Ovid MEDLINE®, Embase (Ovid), Cochrane Central Register of Controlled Trials (CENTRAL, Ovid), Cochrane Database of Systematic Reviews (Ovid), and Scopus. Review Methods A scoping review of English‐language, full‐text articles describing any objective analysis tool for microscopic surgery performed by participants of any level. Extracted data included procedure type, evaluation modality, and classification into five domains: checklist/rating‐based, instrument motion analysis, error identification, workflow modeling, and artificial intelligence‐assisted feedback. Results Of 2203 screened studies, 52 met the inclusion criteria across otolaryngology, ophthalmology, and neurological surgery. Manual assessments (n = 42, 80.8%) primarily used checklists, rating scales, or end‐product evaluations. Automated assessments (n = 10, 19.2%) incorporated motion tracking and artificial intelligence‐assisted feedback. Otolaryngology contributed 28 tools, 22 of which evaluated mastoidectomy, cochlear implantation, or temporal bone dissection. Virtual reality was the most commonly reported training platform (n = 13). Conclusion Although instrument tracking and artificial intelligence‐assisted feedback have been explored, evaluation of microscopic surgery remains largely manual and subjective, with limited adoption of automated assessment tools. The lack of a standardized framework for automated mastoidectomy assessment represents a potential area for future development.