Citations

Objective During open chondral defect preparation, audible debridement sound changes mark the transition from deep cartilage to the calcified cartilage layer. We developed a novel curette microphone to characterize these audio feature differences during arthroscopic defect preparation. Design A piezoelectric curette microphone was used to transmit and record debridement sound from 12 defect preparations (6 deep cartilage, 6 CCL) using human osteochondral allograft remnants. Live audio from the device was used to stop each debridement at the intended level, which was verified histologically. Spectrograms and power-spectral density plots were used to describe the audible transition from deep cartilage to CCL. We compared 22 audio features describing loudness, frequency, and complexity between the two tissue levels. Results Curette strokes against the deep cartilage were louder, higher frequency, and more acoustically complex than strokes against the CCL (p < 0.001). Cartilage debridement generated acoustically complex frequency bands above 2.5 kHz that diminished upon reaching the CCL. Debridement of the CCL produced a simpler audio profile that was predominant below 350 Hz. Conclusion The novel curette microphone presented here transmits high-fidelity debridement audio that can be used to accurately distinguish tissue depth based on the distinct audio profiles of the deep cartilage and CCL.

Purpose The purpose of this study was to identify risk factors and evaluate clinical outcomes associated with incidental left common iliac vein compression on CT imaging. Methods This is a retrospective study that reviewed venous-phase abdomen and pelvis CT scans to identify patients with incidental extrinsic compression of the left common iliac vein due to an overlying right common iliac artery. A total of 726 patients were included (364 females, 362 males; mean patient age: 61.9 ± 15.9 years). Board-certified radiologists reviewed all CT scans. Significant left iliac vein compression was defined as >50% luminal narrowing. Results Significant iliac vein compression was identified in 114 (15.7%) patients and was more common in females (19.5%) versus males (11.9%) ( p < 0.01). Patients with iliac vein compression >50% had significantly lower BMI than those without compression (24.8 ± 6.2 vs 28.7 ± 7.2 kg/m 2 , p < 0.01). Patients with incidental left iliac vein compression had a higher rate of prior left lower extremity DVT ( p = 0.02). Conclusion Incidental left common iliac vein compression was present in approximately 16% of patients and was more frequent among females. Compression was associated with lower BMI and more than twice the rate of ipsilateral DVT, despite no prior diagnosis of MTS. These findings suggest that incidental iliac vein compression could have more clinical significance than previously recognized.

Background: The limb symmetry index (LSI) is a measure comparing strength and functional movement between the surgical and nonsurgical limbs, used after anterior cruciate ligament reconstruction (ACLR) to guide rehabilitation and assess return-to-sport readiness. With increasing use of the quadriceps tendon autograft (QT-ACLR), limited data exist on whether the LSI score correlates with patient-reported outcome measures (PROMs). Hypothesis/Purpose: To evaluate the predictive value of postoperative strength and functional LSI tests at 3, 6, and 9 months for short-term PROMs, determine Patient Acceptable Symptom State (PASS) thresholds, and assess differences based on PASS achievement. It was hypothesized that quadriceps strength LSI score would more strongly predict 2-year PROMs than hamstring strength LSI score, and that higher 9-month isokinetic quadriceps LSI scores would be associated with higher International Knee Documentation Committee (IKDC) and Lysholm scores. Study Design: Case series; Level of evidence, 4. Methods: Patients undergoing primary QT-ACLR from 2021 to 2024 with LSI testing during rehabilitation (isometric and isokinetic lower extremity strength, Y-Balance, hop testing) and no revision or additional knee surgery were included. The LSI score was assessed at 3, 6, and 9 months, and PROMs, including Lysholm and IKDC scores, were collected at a mean follow-up of 2.0 ± 0.7 years. Multivariable linear regression was used to evaluate associations between LSI measures and PROMs after adjusting for age, sex, and body mass index (BMI). Receiver operating characteristic analysis was used to determine PASS thresholds. Results: A total of 100 knees in 100 patients (mean age, 25.3 ± 11.2 years; BMI, 25.9 ± 6.5 kg/m 2 ; 52% male) were included. Quadriceps and hamstring strength and functional performance progressively improved from 3 to 9 months, with the LSI score reaching 77% to 81% for quadriceps strength and 98% to 100% for hamstring strength by 9 months postoperatively. At a mean follow-up of 2.0 ± 0.7 years, the mean satisfaction score was 8.4 of 10, the Lysholm score was 90.7, and the IKDC score was 77.8. Linear regression, adjusted for age, sex, and BMI, demonstrated that 3-month isometric quadriceps LSI score had a strong effect on IKDC score, explaining substantial variance (β = 3.9; adjusted R 2 [Adj R 2 ] = 0.36; P < .03); 6-month isokinetic quadriceps and hamstrings showed moderate but significant effects (β = 2.9-3.7; Adj R 2 = 0.13-0.17; P < .05) on IKDC score; and 9-month fast quadriceps had a strong effect explaining substantial variance in Lysholm and IKDC scores (β = 3.9-4.7; Adj R 2 = 0.34-0.35; P ≤ .003). Lysholm and IKDC scores correlated with satisfaction and accurately discriminated PASS thresholds (area under the curve, 0.927-0.937; P < .001). Patients achieving the IKDC PASS demonstrated higher LSI scores across time points and all PROMs. Conclusion: After QT-ACLR, strength-associated LSIs were independently associated with PROMs at a mean 2-year follow-up, after adjusting for age, sex, and BMI. Early isometric quadriceps strength at 3 months predicted higher 2-year IKDC scores, with PASS achievers generally attaining a 60% to 70% LSI score by 3 months. Isokinetic quadriceps strength at 9 months predicted both IKDC and Lysholm scores. These findings highlight the importance of early quadriceps strength recovery and the value of LSI measures in predicting PROMs and informing early rehabilitation.

Objective To characterize regional brain atrophy patterns, evaluate their association with regional leucine‐rich glioma‐inactivated‐1 ( LGI1 ) gene expression, and identify clinical predictors of hippocampal atrophy in LGI1 autoimmune encephalitis (AE). Methods This study compared regional brain volumes in LGI1‐AE patients versus age‐ and sex‐matched healthy controls (HC) and Alzheimer's disease (AD) patients. LGI1 gene expression was derived from the Allen Human Brain Atlas. Multivariable linear regression and generalized linear models were utilized. Results A total of 55 LGI1‐AE patients were included. Median age was 68 years (IQR 62.5–74.2 years) at volumetric analysis, after 19 months (IQR 11–45 months) from symptom onset. Compared with HC ( n = 55) and AD patients ( n = 55), LGI1‐AE patients had greater regional atrophy of the hippocampus, insula, caudate, and putamen ( p < 0.002). Longitudinal analyses demonstrated hippocampal and pallidal atrophy after covariate adjustment. Among those who did not fulfill limbic encephalitis criteria and/or had non‐lesional magnetic resonance imaging, limbic and striatal atrophy were identified compared with HC ( p < 0.01). Regions with the greatest differential atrophy corresponded to higher LGI1 gene expression (Spearman ρ = 0.7, p = 0.005). Severe cognitive deficits at diagnosis ( β = −0.56; p = 0.002) and longer disease duration ( β = −0.01; p = 0.001) independently predicted total hippocampal volume ( R 2 = 0.31). Interpretation LGI1‐AE demonstrates a distinct pattern of limbic and striatal atrophy that differs from AD and aligns with regional LGI1 expression, supporting a model of selective network vulnerability. Greater baseline cognitive impairment and longer disease duration independently associated with hippocampal atrophy, underscoring the potential importance of early diagnosis and treatment to limit structural brain injury. ANN NEUROL 2026

Purpose To evaluate the agreement between a simple magnetic resonance imaging‐based measurement method for determining the patellar tendon‐to‐lateral trochlear ridge (PT‐LTR) distance using an external adhesive marker and a previously validated conventional measurement technique. Methods Patients diagnosed with patellofemoral instability before undergoing primary patellar stabilization surgery at a single institution between 2020 and 2024 were eligible for inclusion. PT‐LTR distances were measured in a blinded fashion by 2 musculoskeletal‐trained radiologists using the conventional technique and by an orthopaedic group using the simple technique. Interrater reliability between the musculoskeletal‐trained radiologists and between the orthopaedic groups was calculated using intraclass correlation coefficients (ICCs) and concordance correlation coefficients (CCCs) and subsequently intermethod reliability between the 2 groups. The measurements were plotted on concordance correlation graphs. Results One hundred knees (38 right, 62 left) from 97 patients (37 men, 60 women; mean age 22 ± 9 years) were included. The average distance for PT‐LTR measured by the radiologists using the conventional technique was 10.9 ± 7.5 mm and by the orthopaedic group using the simple technique was 9.3 ± 6.8 mm. Excellent interobserver agreement was noted for the radiologist group (ICC 0.941, 95% confidence interval [CI], 0.914‐0.960; CCC 0.941, 95% CI, 0.915‐0.959) and orthopaedic group (ICC 0.976, 95% CI, 0.964‐0.985; CCC 0.976, 95% CI, 0.965‐0.984). Excellent intermethod agreement was noted between the 2 techniques (ICC 0.903, 95% CI, 0.775‐0.942; CCC 0.902, 95% CI, 0.861‐0.932). Conclusions There was excellent interobserver reliability for measuring PT‐LTR distance using both the conventional radiologist‐based technique and the external adhesive marker technique. Excellent intermethod agreement was also shown between the 2 techniques, with comparable mean measurements between groups; thus, the simple technique can be used as a reproducible alternative for PT‐LTR distance. Level of Evidence Level III, retrospective comparative study.

Abstract Purpose Bibliometric indicators are widely used to evaluate faculty productivity, yet these metrics change with career stage, evolving authorship practices, and technological shifts in how science is produced. This study examines patterns of scholarly output among radiation therapy medical physics faculty at leading cancer centers and provides a framework and quantitative metrics for managing career age‐ and era‐based effects. Methods Peer‐reviewed articles (1969–2025) were collected from Scopus for 397 Ph.D. medical physics faculty at the 20 U.S. cancer centers most highly ranked by US News and World Report in 2025. The bibliometric measures included annual rates of authorships (), first/last authorships (), monograph‐equivalents (), as well as the cumulative h‐index and contribution‐normalized ha‐index. Career age was defined by year of first publication. Productivity distributions were evaluated by career age using empirical cumulative distribution functions derived from 2016–2025 data. Era‐dependent fluctuations (1990–2025) were examined using age‐normalized metrics and trends in authorship team size. Tabulated bibliometrics as a function of career age are provided for evaluation of individual performance. Results Productivity increased substantially with career age, peaking in late career. Senior faculty produced approximately two‐fold higher annual output than early‐career peers. At career ages of 1, 10, 20, 30, and 40 years, the median bibliometric rates were = (1.2, 1.6, 2.5, 2.5,1.8) year −1 , = (0.4, 0.4, 0.5, 0.5,0.2) year −1 , = (0.2, 0.2, 0.3, 0.3,0.3) year −1 , h‐index = (0, 7, 15, 23,43), and ha‐index = (0, 3.3, 6.0, 9.4,15.0). Era‐based effects were substantial. Between 1990 and 2025, median authors per paper increased from 4 to 10, inflating authorship‐based metrics. In contrast, contribution‐weighted measures (FL, ME, ha‐index) demonstrated greater temporal stability. Conclusions Scholarly productivity in radiation therapy medical physics is strongly dependent on career age, with peak output occurring near the end of a typical career before declining modestly near retirement. Career‐age‐based percentile benchmarks provide a more balanced framework for evaluating academic performance than unadjusted bibliometric comparisons, especially for early‐career investigators. Due to changes in authorship norms over time, first/last authorships, monograph equivalents, and ha‐index may provide more accurate and equitable assessments of research performance than authorships or h‐index.

Introduction: Ureteral stones are a common cause of emergency presentations. Definitive stone removal at the index encounter can reduce delays and repeat interventions. It is unknown whether fellowship-trained endourologists are more likely to perform definitive management than general/other subspecialist urologists. This multicenter retrospective cohort study evaluated the influence of endourology subspecialty training on the choice between upfront definitive stone treatment and initial ureteral decompression at first presentation. Patients managed with medical expulsive therapy alone were not included. Methods: Adults (≥18 years) presenting at 2022 to seven North American academic centers with symptomatic, noninfected, computed tomography-confirmed ureteral stones were included. Patients with infection, sepsis, positive nitrites, or intraoperative pyelonephritis were excluded from the study. Variables included demographics, stone size and location, subspecialty of the on-call urologist, and management type (definitive [ureteroscopy or shockwave lithotripsy] vs deferred [(initial stent]). Multivariate logistic regression was used to identify the predictors of definitive treatment. Results: Among the 395 patients, 190 (48.0%) underwent definitive management and 205 (52.0%) underwent deferred treatment. Distal stones were treated definitively more often than proximal stones were (51.1% vs 36.6%). An endourologist was on call for 150 encounters (38.0%); 64.7% of these patients received definitive treatment, compared with 38.0% under general/other subspecialist urologists. On multivariate analysis, endourologist on-call remained independently associated with definitive management (odds ratio [OR] 3.46, 95% confidence interval [CI] 2.19–5.47, p < 0.0001), as did distal stone location (OR: 2.46, 95% CI: 1.21–5.00, p = 0.013). Severe complications are rare, and none of the patients developed sepsis. Conclusions: Endourologists were more than three times more likely to perform definitive interventions for symptomatic, noninfected ureteral stones at initial presentation. Subspecialty expertise and timely operative access enable safe, efficient, single-stage management.