Myelin-weighted imaging with inversion-recovery ultrashort-echo-time (IR-UTE) is highly motion-sensitive, yet extra hardware or longer scans are impractical. We evaluated whether a 1D superior–inferior (SI) navigator with bit-reversed spoke-angles mitigates motion artifacts without extending acquisition. Dual-echo IR-UTE was implemented at 3T. After an adiabatic inversion pulse, 21 spokes were acquired per segment around the white-matter null point, and dual-echo subtraction suppressed residual long-T2 signals. Adding SI-navigators at the end of each segment allows motion detection without lengthening TR. And bit-reversal is used to pseudo-randomize the spoke-angles. Bloch simulations of a 2D synthetic brain removed 10% of spokes to mimic gating. Three volunteers were scanned: (i) sequential-ordering, no-motion; (ii) bit-reversed, no-motion; (iii) bit-reversed with deliberate head nods. The navigator rejected 1,280 of 12,000 spokes (10.7%) during nodding, and the same gating was reconstructed on motion-free data. Simulation showed coherent streaks for sequential ordering but an isotropic point-spread function for bit-reversal. In vivo, gating degraded only the sequential dataset. bit-reversal preserved subcortical and deep-white-matter detail. During intentional nodding, gating with bit-reversal enhanced myelin contrast, outperforming the image reconstructed from the ungated data. The SI-navigator plus bit-reversal enables effective motion gating without hardware or time penalty, supporting routine motion-robust myelin mapping.
Publications by Year: 2026
2026
OBJECTIVE: To determine whether frailty, as quantified using the Five-Item Modified Frailty Index (mFI-5), independently predicts postoperative complications in patients undergoing surgery for diabetic foot ulcers (DFUs), and to assess its utility as a clinical risk stratification tool.
APPROACH: A retrospective cohort analysis was conducted using the American College of Surgeons National Surgical Quality Improvement Program database (2015-2021). Adults with type 2 diabetes and International Classification of Diseases, 10th Revision-coded DFUs (E11.621) undergoing elective surgery were identified and stratified into frail (mFI-5 >2) and prefrail (mFI-5 ≤2) groups. Preoperative variables, perioperative characteristics, and 30-day postoperative outcomes were compared using univariate tests, followed by multivariable logistic regression adjusting for clinically relevant confounders. The study design, reporting, and analysis followed the Strengthening the Reporting of Observational Studies in Epidemiology guidelines for observational cohort studies.
RESULTS: Among 2,819 patients, 714 (25.3%) were classified as frail. Frail patients had significantly higher rates of overall complications (50.6% vs. 32.9%), mortality (4.1% vs. 1.6%), and medical complications, including reintubation and urinary tract infection. In adjusted models, frailty independently predicted any postoperative complication (odds ratio [OR] = 1.34, 95% confidence interval [CI] 1.05-1.70, p = 0.02) and medical complications (OR = 1.53, 95% CI: 1.12-2.07, p = 0.007).
INNOVATION: This is the first large-scale study applying the mFI-5 to DFU surgery, demonstrating that frailty provides prognostic information beyond traditional comorbidity-based assessments and offers a rapid, objective tool for perioperative risk evaluation.
CONCLUSION: Frailty, as measured by the mFI-5, independently predicts postoperative morbidity and mortality after DFU surgery. Incorporating preoperative frailty screening may improve surgical decision making, resource allocation, and enhance outcomes in this high-risk population.
CONTEXT: Oncocytic cells can occur in benign and malignant thyroid nodules, posing a diagnostic challenge. This has reduced the diagnostic performance of molecular testing for indeterminate oncocytic thyroid nodules.
OBJECTIVE: To evaluate the performance of Afirma Genomic Sequencing Classifier (GSC) in thyroid nodules with Bethesda III or IV cytology and oncocytic predominance.
DESIGN, SETTING, PATIENTS, AND INTERVENTION: A multicenter retrospective study was conducted in adults with Bethesda III and IV thyroid nodules showing oncocytic predominance who underwent a fine-needle aspiration biopsy and Afirma GSC testing between July 2017 and December 2023. Variables included presence of Hashimoto's thyroiditis and Thyroid Imaging Reporting and Data System (TIRADS) classification.
MAIN OUTCOME MEASURES: Outcomes included benign call rate (BCR), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of Afirma GSC testing.
RESULTS: Of 359 nodules (57% Bethesda III, 43% Bethesda IV) tested with Afirma GSC, the mean nodule size was 2.0 cm. BCR was 81% and 74% for Bethesda III and IV nodules, respectively. GSC sensitivity, specificity, PPV, and NPV were 89%, 86%, 24%, and 99% for Bethesda III nodules and 94%, 87%, 50%, and 99% for Bethesda IV nodules, respectively. A concurrent diagnosis of Hashimoto's thyroiditis significantly reduced the specificity and PPV in Bethesda III nodules. TIRADS classification did not affect the BCR or PPV in Bethesda III or IV nodules.
CONCLUSIONS: Afirma GSC has a high BCR and improved performance over earlier generation molecular tests in oncocytic thyroid nodules, particularly for Bethesda IV. However, the PPV in Bethesda III nodules remains low, especially in the presence of Hashimoto's thyroiditis.
OBJECTIVES: To examine whether unionized nursing homes in New York State show different levels of resident voice-measured through formal complaints-and how ownership relates to these patterns.
DESIGN: Cross-sectional analysis of 2022 facility-level data.
SETTING AND PARTICIPANTS: A total of 511 New York State nursing homes categorized by union status and ownership type.
METHODS: Resident voice was defined as complaints per 100 residents submitted to the New York State Department of Health Complaint Hotline. Key predictors were union status and ownership, with covariates including facility size, payer mix, occupancy, hospital admissions, and quality rating.
RESULTS: Of the 511 facilities, 361 (70.6%) were unionized. Unionized homes had fewer complaints on average (57.9 vs 64.4 per 100 residents; P = .04). Among unionized facilities, higher Medicaid (β = 0.885; P < .001) and Medicare shares (β = 0.567; P = .003) were positively associated with complaints and higher overall quality ratings were inversely associated (β = -6.77; P < .001).
CONCLUSIONS AND IMPLICATIONS: Nursing homes with unionized workforces display distinct patterns of resident voice. These findings suggest that workforce organization may influence the institutional environment in ways that either facilitate or constrain residents' ability to advocate for improved care. Understanding how labor structures intersect with ownership and quality conditions can inform future policy efforts aimed at strengthening resident-centered care and guide research on mechanisms linking workforce organization to resident advocacy behaviors.
Clear cell morphology is an uncommon finding in human tumors and reflects the distinctive appearance of the cytoplasm under standard histopathologic examination. Granular cell morphology appears to be a closely related phenomenon and reflects an abundant eosinophilic cytoplasm. Accumulating evidence suggests a central role for the MITF/TFE family of transcription factors in diverse clear cell and granular cell neoplasms. A principal function of these transcription factors concerns cytoplasmic organellar biogenesis: TFEB is the master regulator of lysosome biogenesis while MITF controls the biogenesis of lysosome-related organelles known as melanosomes, which are responsible for melanin pigment production. This article reviews the role of MITF/TFE pathway activation in a variety of benign and malignant tumors, with an emphasis on the diverse oncogenic mechanisms that activate this pathway and the resulting altered cell biology that contributes to the distinctive histomorphologic features.
BACKGROUND: Adipocyte hypertrophy, the unique capacity of adipocytes to enlarge in response to energy surplus, is a crucial determinant of metabolic health during obesity. Nonetheless, the molecular mechanisms governing this adaptive growth remain incompletely characterized.
METHODS: Super-enhancer landscapes in adipocytes were mapped via H3K27ac chromatin immunoprecipitation sequencing analysis of adipocyte nuclei from mice fed either a standard chow diet or high-fat diet (HFD) to identify transcriptional regulators activated under obesogenic conditions. Functional validation was conducted through both in vitro and in vivo experiments, including adipocyte-specific gene deletion mouse models, followed by single-nucleus RNA sequencing.
RESULTS: Super-enhancer profiling identified Serum Response Factor (SRF) as a critical driver of actin cytoskeletal remodeling in adipocytes during obesity. SRF was shown to be both necessary and sufficient for regulation of actin cytoskeletal gene expression in 3T3-L1 adipocytes. Adipocyte-specific SRF ablation in mice led to reduced expression of actin cytoskeletal genes, disruption of actin filament organization, and impaired adipocyte enlargement under HFD feeding. Despite comparable body weight, SRF-deficient mice developed exacerbated insulin resistance and ectopic lipid accumulation in the liver and brown adipose tissue, indicative of compromised lipid storage within adipocytes. Single-nucleus RNA-seq further revealed that cell-intrinsic actin cytoskeletal defects in adipocytes propagated to tissue-level dysfunction, impairing vascularization and increasing inflammation.
CONCLUSION: These findings establish SRF as a central regulator of actin cytoskeletal organization that promotes healthy adipocyte hypertrophy and adipose tissue remodeling. Enhancing SRF-dependent cytoskeletal remodeling in adipocytes may offer a therapeutic strategy to preserve metabolic health in obesity.
PURPOSE: To report on the presentation, treatment, and visual outcome of stromal keratitis (SK) in the Zoster Eye Disease Study (ZEDS).
DESIGN: Secondary analysis of SK end point of randomized clinical trial.
SUBJECTS: Patients with herpes zoster ophthalmicus (HZO) were randomized in a double-masked clinical trial of oral valacyclovir 1 g daily or placebo for 1 year. They were followed prospectively every 3 months for 18 months for end points of SK, iritis (IR), endothelial keratitis (EK), or dendritiform epithelial keratitis (DEK).
METHODS: Presentation of recurrent, new, or worsening SK was evaluated retrospectively by treatment assignment, randomization strata, and use of topical steroids. Investigators had been allowed discretionary treatment of end points including open-label valacyclovir and topical steroids. Visual outcome and treatment with open-label oral valacyclovir and topical steroids were evaluated.
MAIN OUTCOME MEASURES: Use of open-label valacyclovir and topical steroid treatment of recurrent, new, or worsening SK, and visual acuity at 12 months.
RESULTS: Recurrent, new, or worsening SK occurred in 105 of 527 participants (20%). The randomization group was not associated with this complication. Mean best-corrected visual acuity at enrollment was logMAR 0.10 ± 0.14 with no difference at 1 year, logMAR 0.13 ± 0.2, and no difference between valacyclovir and placebo groups at enrollment or at 1 year. Among the 105 instances of SK, 79 (75%) were recognized at scheduled study visits rather than at episodic visits. In only 11 of 105 (10%) of recurrent, new, or worsening SK did masked investigators opt to treat with open-label oral antiviral. At the time of SK complication, 52 of 105 participants (50%) were receiving topical steroids, but 47 of 52 participants (90%) receiving topical steroids were using 1× daily or less, 21 of 47 participants (45%) were using high potency, and 26 of 47 participants (55%) were using low potency (P = .47). Of 48 of 105 participants (47%) receiving no topical steroids at recurrent, new, or worsening SK, 18 of 48 (38%) had discontinued steroids in the prior 3 months. A total of 38 of 48 participants (75%) receiving no topical steroids at complication SK were subsequently treated with high-potency steroids 2× daily or more. Of 26 of 52 participants (50%) receiving low-potency steroids at SK complication, 23 of 26 (88%) were treated with increase in frequency only.
CONCLUSIONS: Individuals with ocular complications of HZO who develop SK generally maintain very good vision without the use of oral antiviral therapy when monitored closely and SK is recognized and treated. Low-potency topical steroids should be considered for treatment and ongoing suppression of SK in HZO.
BACKGROUND: Spironolactone is widely used in dermatology. While routine potassium monitoring is no longer recommended in young, healthy females taking spironolactone for acne, hyperkalemia incidence, risk factors, and monitoring necessity in older females is unclear.
OBJECTIVE: To determine hyperkalemia incidence in females aged ≥45 taking spironolactone for dermatologic conditions.
METHODS: In this retrospective cohort study, 1197 Mass General Brigham medical records from January 1, 2015 through February 25, 2025 were reviewed; 398 cases were analyzed.
RESULTS: Hyperkalemia incidence was 10.1% (40/398) and more commonly observed in older patients (age ≥65: 22.4% versus ages 45-64: 7.9%) and those with ≥1 predisposing comorbidity (medically complex: 14.7% versus healthy: 7.3%). Healthy females aged 45-64 were least affected (6.3%). Patients age ≥65 with ≥1 predisposing comorbidity had the highest incidence (28.1%). Hyperkalemia was generally mild (97.5%), asymptomatic (85%), and did not impact clinical management (62.5%).
LIMITATIONS: Limitations include retrospective design and lack of comparator group.
CONCLUSION: Overall hyperkalemia risk in females aged ≥45 is higher than in younger patients and increased further in specific subpopulations. Hyperkalemia is generally mild and prescription modification is uncommon. While spironolactone use is safe for most patients, monitoring guidelines should be clarified to ensure optimal management in this population.
Large portions contribute to excess consumption. We tested whether a portion size labeling intervention influenced consumers to select smaller lunch portions. Two cafés introduced a reduced-sized main course (half the original size and ∼30% lower in price), January-May 2024. Cafés were randomized to a portion labeling intervention or control. During the baseline and follow-up periods, the reduced size was called "Small" and the original "Large" in both cafés. During the intervention period, labels remained unchanged in the control; the intervention café relabeled the reduced size "Standard" and retained "Large" for the original size. The primary outcome was average kcal per main course purchased. Secondary outcomes were: 1) average kcal per transaction; 2) number of main courses purchased; and 3) gross sales. We also examined whether introducing a reduced-sized main course irrespective of the labeling intervention was associated with 1) average kcal per transaction, and 2) sales during the study compared to 2023. Cafés sold 2940 reduced-sized and 8587 original-sized main courses. Average kcal per main course purchased (DID -7.5 kcal [95%CI: 25.8, 10.7]) and kcal per transaction (DID -21.6 kcal [95%CI: 46.6, 3.3]) did not significantly differ compared to the control during the intervention. Regardless of portion labels, transactions with a reduced-sized vs. original-sized main course had 405 fewer kcal (95%CI: 414.7, -396.1). Average weekly gross sales increased by $3131 (95%CI: 2,098, 4164) in 2024 vs. 2023. The labeling intervention did not reduce kcal purchased, but offering reduced sizes regardless of labeling lowered kcal per transaction and did not harm sales.