Publications by Year: 2026

BACKGROUND: Peripheral nerve block (PNB) usage in breast reconstruction (BR) improves post-operative pain with minimal risks. This study examined outcomes of patients receiving PNB for post-operative analgesia in BR.

METHODS: A retrospective analysis using the ACS-NSQIP database identified women that underwent BR from 2012-2021. Patients who received regional anesthesia in addition to general anesthesia were included. Patients that received other forms of anesthesia were excluded. Post-operative complications were compared between PNB and non-PNB groups, as well as among BR timing, modality, operative time and ASA class. Group differences assessed via t-tests and Fisher's Exact tests. Multivariate logistic regression assessed whether complications were independently associated with receiving PNBs.

RESULTS: Out of 25,188 patients, 9,429 patients (37.4%) received PNB for perioperative BR analgesia. Patients that received PNBs had longer operative times, more wound complications, reoperations and readmissions. PNB usage was associated with increased likelihood of SSI even when BR modality, timing, operative time and ASA classification were isolated (p<0.05). Further, sub-group analysis revealed PNB use was associated with SSI for all BR modalities and timing.

CONCLUSIONS: The decision to use PNBs in BR should be made with awareness of the associated risk of increased wound complications. Despite that, benefits of PNBs may still very well outweigh these risks for all our patients. However, based on our findings we still suggest increased surveillance and more comprehensive consultation. Further research into the association of PNB usage and wound complications should be performed such that our patients can obtain maximal benefit and minimize unwanted side-effects.

BACKGROUND: Stroke is a sexually dimorphic disease, with different risk factors, incidence, outcomes, and treatment responses in men and women. While sex differences have been documented in preclinical studies, these findings often come from single-site studies with small sample sizes and require validation across diverse research settings.

METHODS: We used data from the SPAN (Stroke Preclinical Assessment Network), a randomized, placebo-controlled, blinded, multilaboratory trial, to determine if sex differences in neurological outcomes are present in preclinical stroke models. We analyzed data from 665 stroke animals treated with saline, including young mice, diet-induced obese mice, aging mice, young rats, and spontaneously hypertensive rats. We compared the corner test index and brain morphology between the sexes using linear random effect models and assessed the mortality rate using Cox proportional hazard regression models.

RESULTS: No significant sex differences were found in neurological outcome measured with the corner test on either day 7 or day 30 after stroke, regardless of the mouse or rat stroke model used. Additionally, female and male mice exhibited similar infarct sizes on day 2 magnetic resonance imaging and on brain atrophy measures on day 30 after stroke, indicating a lack of sex differences in brain injury. Similarly, no sex differences were observed in acute or chronic sensorimotor or tissue outcomes in young rats. In 1 subanalysis, sex differences were seen in the spontaneously hypertensive rats cohort. Female rats exhibited a higher corner test index on day 30 than males, indicating more severe sensorimotor injury.

CONCLUSIONS: In this multicenter preclinical study, we did not detect sex differences in stroke outcomes in mice, although sex differences in behavioral outcomes were observed in spontaneously hypertensive rats. These findings highlight that sex differences may be model-specific and subtle, emphasizing the need for methodological consistency and thoughtful inclusion of diverse animal models in translational stroke research to better understand if sex-specific responses contribute to stroke outcomes.

BACKGROUNDPlasma heparan sulfate, a glycosaminoglycan released during endothelial glycocalyx degradation, predicts sepsis mortality. Chondroitin sulfate is a circulating glycosaminoglycan not specific to glycocalyx degradation; its relevance to sepsis is unknown.METHODSWe studied the associations of plasma chondroitin sulfate with (a) mortality in patients with sepsis-associated hypotension and (b) the relative effectiveness of a randomly assigned liberal versus restrictive intravenous fluid resuscitation strategy. We selected 574 patients enrolled in the Crystalloid Liberal or Vasopressors Early Resuscitation in Sepsis trial using an outcome-enriched sampling strategy. We used liquid chromatography-mass spectrometry to quantify plasma chondroitin sulfate. In comparison, we measured hyaluronic acid as a glycocalyx degradation marker and IL-6 as an inflammatory biomarker. We conducted Cox proportional hazards regression analyses to examine associations of baseline biomarker concentrations with mortality and resuscitation strategy effectiveness. We used inverse probability of selection weights and generalized raking to account for the nonrepresentative sampling design.RESULTSPlasma chondroitin sulfate, hyaluronic acid, and IL-6 were associated with mortality within 90 days. As baseline chondroitin sulfate increased, subsequent randomization to a restrictive strategy was increasingly beneficial (P = 0.022): treatment effect hazard ratio (restrictive versus liberal) for mortality was estimated as 1.49 (95% CI, 0.98-2.27), 1.30 (95% CI, 1.00-1.69), 1.09 (95% CI, 0.82-1.44), 0.88 (95% CI, 0.66-1.16), and 0.71 (95% CI, 0.52-0.97) for 10th, 25th, 50th, 75th, and 90th percentiles of baseline chondroitin sulfate.CONCLUSIONPlasma chondroitin sulfate predicts sepsis mortality and may modify the response to a subsequent liberal versus restrictive intravenous fluid resuscitation strategy.TRIAL REGISTRATIONClinicalTrials.gov NCT03434028.FUNDINGNIH grants R01HL149422 and R01HL094786.

BACKGROUND: One-third of persons age 60 y+ have hearing loss, and hearing loss is a leading preventable risk factor for dementia. We estimated the number of age-associated dementia cases attributable to hearing loss in 2022.

METHODS: We used DeciBHAL, a validated microsimulationøf hearing loss that includes age- and sex-specific annual probabilities of incident hearing loss (0·1-10·4%) and dementia (0·3-7·1%). Utility decrements are incorporated yearly, based on hearing loss (-0·13 to -0·31) and dementia severity (-0·04 to -0·42), to calculate quality-adjusted life-years (QALYs). We estimated dementia incidence for persons with and without hearing loss by removing the estimated proportion attributable to hearing loss (adjusted incidence risk ratio, 2·0 [range: 1·5-2·5]). We projected two cohorts: the general US population and a hypothetical US population without hearing loss (counterfactual). We applied model-projected dementia incidence and utility among both cohorts to the 74,190,000 US adults >60 y and without dementia in 2022.

RESULTS: Model-projected incident cases of dementia are 412,000/year (males) and 523,000/year (females). In the simulation without hearing loss, dementia cases/year fall to 339,000 for males and 455,000 for females projecting that 141,000 new dementia cases in 2022 would be attributable to hearing loss. In probabilistic sensitivity analysis, 95% of simulations projected the proportion of dementia cases attributable to hearing loss were 11·5-23·6% for males and 6·7-18·7% for females. Hearing loss and associated dementia reduced life-time QALYs by 1.38 for females and 1.69 for males.

CONCLUSION: Model-projected estimates support that hearing loss prevention could substantially reduce new dementia cases and should be a priority.

PURPOSE: Routinely collected administrative data provide insights into health care utilization and outcomes but lack detailed clinical information, such as the specific site and intent of radiation therapy (RT). This study aimed to validate claims-based algorithms to accurately identify thoracic RT (TRT) and curative-intent RT in administrative databases.

METHODS: Patients at our institution with lung cancer and any RT Current Procedural Terminology (CPT) code from October 2015 to January 2024 were analyzed. RT claims were organized by treatment episode, and RT details were manually abstracted from the electronic health record to classify episodes as TRT or non-TRT and curative or noncurative. A priori algorithms were defined as the presence of respiratory motion management codes, >14 treatment codes (except for stereotactic body RT [SBRT] courses), with or without exclusive thoracic malignancy diagnosis codes. Positive predictive value (PPV) was computed for each episode, stratified by modality (three-dimensional conformal RT [3DCRT], intensity-modulated RT [IMRT], and SBRT). Algorithms were considered acceptable if the lower bound of the Clopper-Pearson 95% CI for PPV exceeded 70%.

RESULTS: A total of 3,846 RT episodes were analyzed. The primary a priori TRT algorithm achieved a PPV of 97% (95% CI, 96 to 98) for IMRT, 99% (95% CI, 97 to 99) for SBRT, and 87% (95% CI, 81 to 92) for 3DCRT. Performance declined when exclusive thoracic malignancy diagnosis codes were excluded. For curative-intent RT, PPVs were 87% for IMRT, 90% for SBRT, and 55% for 3DCRT.

CONCLUSION: Clinically informed algorithms can accurately identify TRT in claims data, achieving high PPVs particularly for IMRT and SBRT courses. These algorithms can be applied in claims databases to assess RT toxicity and effectiveness. External validation across diverse data sets will be important to confirm generalizability.

Large language models (LLMs) have transformative potential in radiology, including textual summaries, diagnostic decision support, proofreading, and image analysis. However, the rapid increase in studies investigating these models, along with the lack of standardized LLM-specific reporting practices, affects reproducibility, reliability, and clinical applicability. To address this, reporting guidelines for LLM studies in radiology were developed using a two-step process. First, a systematic review of LLM studies in radiology was conducted across PubMed, IEEE Xplore, and the ACM Digital Library, covering publications between May 2023 and March 2024. Of 511 screened studies, 57 were included to identify relevant aspects for the guidelines. Then, in a Delphi process, 20 international experts developed the final list of items for inclusion. Items consented as relevant were summarized into a structured checklist containing 32 items across six key categories: general information and data input; prompting and fine-tuning; performance metrics; ethics and data transparency; implementation, risks, and limitations; and further/optional aspects. The final FLAIR (Framework for LLM Assessment in Radiology) checklist aims to standardize reporting of LLM studies in radiology, fostering transparency, reproducibility, comparability, and clinical applicability to enhance clinical translation and patient care. © The Author(s) 2026. Published by the Radiological Society of North America under a CC BY 4.0 license. Supplemental material is available for this article.

We found that PSMD1, a key subunit of the 19S proteasome regulatory particle, was overexpressed and correlated with poor prognosis in multiple myeloma (MM). Genetic depletion of PSMD1 decreased cancer cell viability, induced polyubiquitinated protein accumulation, and promoted apoptosis. Proteomic analysis revealed the activation of immune-related pathways, suggesting the potential for immune modulation. Targeting PSMD1 with siRNA, delivered via lipid nanoparticles (LNPs), reduced tumor growth in MM cell lines and primary patient samples while sparing normal cells. It also overcame proteasome inhibitor resistance and the protective effects of the bone marrow milieu. In MM xenograft mouse models, PSMD1 siRNA LNPs significantly reduced tumor growth and prolonged survival. In addition, PSMD1 depletion had similar effects on other types of cancer cell lines. These findings position PSMD1 as a critical target in cancer therapy, with broad implications for overcoming drug resistance, improving therapeutic outcomes, and potentially impacting immune responses across various cancers. These findings provide a foundation for the clinical development of PSMD1-targeted therapies in myeloma and other malignancies.

Study DesignRetrospective multicenter cohort study.ObjectivesSpine surgery for multiple myeloma (MM) is associated with an increased intraoperative blood loss. Therefore, this study aims to examine prognostic factors for higher intraoperative blood loss in spine surgery for patients with MM.MethodsIn total, 158 adult patients with MM undergoing spine surgery between May 2001 and December 2021 were included. The main outcome for intraoperative blood loss was the Bleeding Index (BI), next to the visually estimated blood loss (EBL). Two separate multivariable generalized linear models (GLMs) were utilized to assess the associations between the predictors and these two outcomes.ResultsThe average BI was 4.4 and average EBL was 750 mL. Compared to corpectomy with stabilization, other types of surgery (decompression with stabilization, sole decompression, sole stabilization) were associated with a lower expected BI, ranging from a 26.5% to 39% decrease. A cervical location of surgery was associated with a 40.3% reduction of expected BI compared to a lumbar location (P = 0.006). Lower platelet count (P = 0.003) and longer duration of surgery (P < 0.001) were associated with a higher expected BI. For EBL, ECOG score, surgery type, and duration of surgery were found as independent predictors.ConclusionsThis study identified lower platelet count, type of surgery, location of operated spinal levels, and a longer duration of surgery as independent predictors of higher intraoperative BI in MBD-related spine surgery. These outcomes can be relevant for preoperative screening, shared decision making, and perioperative blood transfusion deliberation or planning.