Long Island Jewish Medical Center

ABSTRACT Background Freezing of gait (FoG) is a debilitating motor feature that affects individuals with Parkinson's disease (PD). The mechanism underlying FoG is not entirely understood, which poses a challenge in finding effective treatment. The goal of this study is to advance the understanding of FoG pathophysiology. This study aims to assess the differences in structural connectivity (SC) and functional connectivity (FC) patterns among PD patients with freezing of gait (FoG+), gait disturbances other than freezing (FoG−), and no gait disturbances (NGD). Methods Diffusion‐weighted MRI (dwMRI) and resting‐state functional MRI (rs‐fMRI) were obtained from 9 FoG+, 13 FoG−, and 10 NGD patients. The FC data was processed by a region of interest (ROI)‐to‐ROI analysis using the default preprocessing pipeline from the MATLAB‐based CONN toolbox. SC analysis was performed via diffusion‐based tractography and subsequent connectome reconstructions in MRtrix3. Results Compared to the FoG− and NGD groups, the FoG+ group showed substantial involvement, in both SC and FC, of the limbic system, putamen, parietal lobes, and cerebellum. Furthermore, our results reveal FC alteration between the cerebellum and the median raphe nuclei, which is part of the pontomedullary reticular formation. Conclusions Our results confirmed previous research regarding the alterations in multiple brain areas in those with FoG, particularly the limbic system, putamen, parietal lobe, and cerebellum. We further establish unique FC between the cerebellum and the median raphe nucleus in those with FoG. This finding highlights the role of the cerebellum in regulating posture, gait, and locomotive signals, potentially through serotonergic projections.

Induction of labor (IOL) and hospitalist coverage are becoming more common. While hospitalist coverage has been associated with improved maternal outcomes and lower cesarean delivery rates, its impact on IOL remains unclear. The objective of this study was to compare the induction time to vaginal delivery across three obstetric coverage models: hospitalists, faculty generalists, and private practice generalists.This single-site retrospective cohort study analyzed singleton, term (≥39 weeks), vertex patients undergoing IOL at NYU Langone Hospital-Long Island from January 1, 2022, to September 30, 2022. Hospitalists at this institution managed high-risk obstetric patients, including those under maternal-fetal medicine care, resident clinic, and unregistered patients who presented to labor and delivery, along with serving as labor and delivery safety officer on the labor floor. Faculty and private practice generalists managed their respective groups. Outcomes included induction time to vaginal delivery, mode of delivery, induction methods, and maternal and neonatal complications. Statistical analyses included chi-square, ANOVA, and multivariable linear regression. A p-value of < 0.05 was statistically significant.Among 403 patients, 92 (22.8%) were managed by hospitalists, 115 (28.5%) by faculty, and 196 (48.6%) by private generalists. Median (IQR) induction-to-delivery times were similar across groups: hospitalists 20.5 (15.3-27.5) hours, faculty 23.4 (16.5-31.1) hours, and private 19.7 (14.1-25.6) hours (p = 0.004). However, when limited to vaginal deliveries, no significant difference was observed in induction-to-vaginal-delivery time (p = 0.17). Private generalists had the shortest induction-to-cesarean time and time to membrane rupture leading to cesarean. There were no differences in intrapartum or postpartum complications. Hospitalists had more NICU admissions after vaginal delivery, mostly unrelated to labor.Induction-to-vaginal delivery times and complication rates were similar across coverage models, but differences in NICU admissions and cesarean delivery times highlight care variations. Collaboration and evidence-based standardized induction protocols may optimize outcomes across coverage models. · Induction to vaginal delivery time can be similar across obstetric groups.. · Labor and delivery units with high induction rates may benefit from hospitalists.. · An evidence-based induction protocol may optimize maternal and fetal outcomes..

En bloc spondylectomies are essential for controlling malignant spinal tumors, but existing classification systems are often complex and impractical. This study introduces the Column, Line-of-Sight, Margins, Ring (CLiMR) framework, a novel system simplifying and standardizing en bloc spondylectomy planning and classification. A retrospective review of patients who underwent single- or multistage en bloc spinal tumor resections was conducted at a single academic center (October 2019-December 2024). The CLiMR framework assigns scores to 4 components: Column (osteotomies/diskectomies for tumor release), Line-of-Sight (approach for circumferential access), Margin (adjacent structures sacrificed), and Ring (size of the vertebral ring window for safe delivery of neural tissue). Scores were applied using operative notes and imaging. Column scores ranged from 0.5 to 4.5. Of the patients included, 40.9% underwent sagittal split osteotomies, 22.7% radical diskectomies, 18.2% horizontal osteotomies, and the remaining 18.2% combinations of previous osteotomies . A posterior-only approach (Line-of-Sight score = 1) was used in 45.4% of cases, whereas 45.4% required a multistage approach (score = 2). Margin scores reflected increasing morbidity: 31.8% (n = 7) involving chest wall/pleura resection (grade 3), 40.9% (n = 9) requiring eloquent nerve sacrifice (grade 6), and 9.1% (n = 2) necessitating limb sacrifice (grade 7). The majority (86.4%, n = 19) of ring scores were grade 1, requiring laminectomies/facetectomies. The mean CLiMR score was 9.36 ± 2.43, with higher scores correlating with longer hospital stays (R = 0.64, P = .0012), longer case durations (R = 0.61, P = .0023), and increased blood loss (R = 0.40, P = .067). Patients with local recurrence, positive margins, or complications trended toward greater CLiMR scores. The CLiMR framework provides a novel, user-friendly method for planning and communicating en bloc spondylectomies. By addressing technical complexities and morbidity, CLiMR enables standardized assessment, facilitates surgical decision-making, and supports future research. This study demonstrates feasibility and lays the foundation for future validation studies.

Background and study aimsData on colorectal endoscopic mucosal resection (C-EMR) training during advanced endoscopy fellowship remain limited. We aimed to determine the number of procedures required by an “average” advanced endoscopy trainee (AET) to achieve competence in cognitive and technical C-EMR skills.MethodsAETs from advanced endoscopy training programs (AETPs) were graded on every C-EMR using a standardized assessment tool. Cumulative sum (CUSUM) analysis was used to generate individual and aggregate learning curves to estimate the minimum number of cases required to achieve competence for overall, technical, and cognitive components of C-EMR. AETs completed a self-assessment questionnaire on C-EMR competence at the end of their training.ResultsA total of 22 AETs among 16 AETPs participated in this study. Nineteen AETs (86%) reported formal training in C-EMR with a mean number of 32 ± 22 cases prior to their AETP. In aggregate, 637 C-EMRs were performed (median of 32 per AET; interquartile range 17–45). Learning curve analyses revealed substantial variability in minimum volume of procedures needed to attain competence across different C-EMR skills (range: 19–39). A minimum of 19 cases were required to achieve overall competence using the global assessment score. All AETs reported feeling comfortable performing C-EMR independently at the end of AETP, yet only three (14%) achieved competence in their overall performance.ConclusionsThe relatively low number of C-EMRs performed by many AETs may be insufficient to achieve competence. The estimated thresholds for an average AET to achieve competence in C-EMR provide a framework for AETPs in determining the minimal standards for case volume exposure during training.

With continued improvements in systemic cancer therapies, there has been an increase in the survivorship of patients with spinal metastases. However, many patients with spinal metastases are frail and may not be able to tolerate the morbidity of open surgery. For these patients, percutaneous ablation techniques offer a minimally invasive approach that can facilitate local tumor control and pain relief. Here we describe the currently employed modalities—radiofrequency ablation (RFA), microwave ablation (MWA), cryoablation, and laser interstitial thermal therapy (LITT)—summarize the clinical support for their use, and overview the relative risks and benefits for each. All these technologies offer to help improve local tumor control and improve oncologic pain associated with vertebral metastases, and they have become a staple of multidisciplinary spine metastasis care at many centers. As clinical experience with these technologies continues to grow, their use will likely become more widely adopted, and so understanding of their indications, risks, and benefits will become increasingly important to the practicing spine oncologist.

Among people with cystic fibrosis (CF), health behaviors and mental health have been associated with general social support. We used egocentric network analysis to assess the specific impact of social network variables on treatment adherence, depression, anxiety, and perceived stigma among adults with CF. Our goal is to identify the social network factors which may be driving adherence, anxiety, depression, and perceived stigma among adults with CF toward developing targeted network-based interventions. Our primary outcome, adherence to individual-level treatment regimens, was assessed using composite prescription refill history (cMPR), self-reported airway clearance therapy (ACT), and consumption of all prescriptions. Secondary outcomes were assessed via patient completion of the Patient Health Questionnaire-9 (PHQ-9) for depression, the General Anxiety Disorder-7 (GAD-7) for anxiety, and the CF Stigma Scale for perceived stigma. Participants also completed a social network interview to collect data on personal-level networks. Controlling for participant age, sex, race, relationship status, work status, and CF disease severity, we explored the impact of network variables on our primary and secondary outcomes using regression analysis. All models were run twice to assess both core and strong network ties. Regression analysis of 104 participants showed that strong network ties serving as health discussants and health regulators were positively associated with stronger adherence, while financial dependence and network density were associated with decreased adherence. Network alters having higher education levels, strong trust in doctors, and support for daily activities were associated with lower depression, anxiety, and perceived stigma. Participants having a higher proportion of network members who hassled them and had lower trust and/or greater variability in trust in doctors experienced higher depression, anxiety, and perceived stigma. Findings show that network-based variables including close ties to health discussants, network members' education levels, and health beliefs, as well as having network members providing support for daily activities may be driving specific aspects of adherence, symptoms of depression and anxiety, and perceived stigma among adults with CF. These findings may thus allow us to leverage social networks in the development of novel interventions to improve adherence and mental health and reduce perceived stigma for people with CF.