New York University Langone Orthopedic Hospital

Background:Meniscus tears occur in tandem with other degenerative changes at the knee joint, making interpretation of imaging findings challenging. Meniscus tears, commonly treated by general physicians and musculoskeletal specialists, have significant treatment variability.Purpose/Hypothesis:The purpose of this study was to investigate whether big data analytical tools and natural language processing (NLP) of magnetic resonance imaging reports could identify factors that are predictive of treatment decisions in a large cohort of patients. It was hypothesized that surgical treatment would be associated with specific meniscus tear patterns.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Deidentified electronic health records from approximately 5 million patients, available at Information Commons, were analyzed to identify patients with meniscus tears on knee MRI reports. NLP was used to extract descriptive features from MRI reports. Demographics and clinical and treatment data were recorded. Univariate and multivariate analyses were performed.Results:For 4013 patients with meniscus tears on MRI, physical therapy was the most common treatment (62.4% of patients). Opioid medications were prescribed to 25.6% of patients diagnosed with a meniscus tear. Surgery was performed for 19.6% of patients. A bucket-handle tear was the strongest predictor for receiving surgery. Meniscus tear patterns, the presence of degenerative changes, and demographic factors were independent predictors of treatment received.Conclusion:Meniscus tear types and other findings at the knee joint, along with demographic variables, are associated with treatment for meniscus tears. Bucket-handle and root tears were most likely to undergo surgical treatment, while patients on Medicare and those with arthrosis were more likely to be treated with nonoperative modalities. NLP of big data, including radiology findings, may have a role in providing clinical decision support for interpreting findings on knee MRIs. Prescription of opioid medications in meniscal tears was observed at a higher-than-expected rate.

Abstract Alzheimer's disease (AD) is a multifactorial neurodegenerative disorder that is produced by a network of interdependent pathophysiological processes, such as oxidative stress, neuroinflammation, ferroptosis, pyroptosis, apoptosis, autophagic failure, endocrine dysregulation, and aberrant neuronal signalling. Therefore, multitarget pharmacological natural products have potential therapeutic uses in alleviating this heterogeneity of mechanisms. Saposhnikovia divaricata is a common medicinal herb that contains a wide array of bioactive compounds, which have been reported to exhibit antioxidant, anti-inflammatory, and neuroprotective effects. Eight key terpenoids and coumarins: scopoletin, fraxidin, isofraxidin, 5-O-methylvisamminol, deltoin, anomalin, α-pinene, and panaxydol were chosen in this investigation after ADME filtration to evaluate their suitability in AD. We employed integrative network pharmacology, mechanistic target profiling, protein interaction network construction, identification of hub genes, KEGG pathway enrichment for Alzheimer's disease, and in silico docking to systematically elucidate the mechanistic relevance of each compound. Fraxidin, panaxydol, deltoin, and 5-O-methylvisamminol showed the most significant common targets between them and the main regulatory nodes, including AKT1, MTOR, CASP3, MAPK, INS, and NFKB1. Molecular docking made an emphasis on strong ligand protein interactions, and deltoin, panaxydol, and anomalin binding PTGS2 (ΔG -8.03 kcal mol − 1), MTOR (ΔG -7.65 kcal mol − 1), and INS (ΔG -7.74 kcal mol − 1) were found to have a strong binding affinity. Altogether, these data present several S.divaricata constituents as promising multitarget modulators of AD pathophysiology, which gives a solid foundation in terms of the future experimental validation and emphasizes the therapeutic value of coumarins and terpenoids in the modification of neurodegenerative diseases.

The National Academy of Science Engineering and Medicine (NASEM) developed items to collect sexual orientation and gender identity (SOGI) in healthcare settings to harmonize collection of these data and address disparities often experienced by sexual and gender minorities (SGM) (LGBTQAI+). This study tested wording of SOGI items among the SGM Community. Individuals were recruited to participate in an interview about the NASEM SOGI items. Eligible participants identified as SGM, lived within the catchment area of an NYC academic medical center, had a history of cancer, or were caregivers of a person with cancer. Interviews were audio-recorded, transcribed, and qualitatively coded. Thirty-eight SGM individuals participated. The majority disliked the options for sexual orientation (SO) and gender identity (GI) but did find one they would choose. For SO, participants thought options like queer, pansexual, and asexual were missing, and for GI, participants said non-binary and transgender category (transgender man, transgender woman) were needed. Half said they had no concerns about disclosing SOGI information on medical intake forms and others reported preferring knowing why it was needed and who would have access. Several expressed worry about their safety upon disclosure of SOGI. Respondents cited being less likely to disclose SOGI if there was an offensive question on intake form (e.g., spouse instead of partner) or if there were no privacy assurances. Almost all expected reported SOGI to be reflected in their oncology healthcare. The NASEM questions need improvement. To improve trust and encourage disclosure, clinicians and clinics should improve the options for SOGI data collection and take steps to ensure privacy is addressed.

BackgroundCore CSF and plasma biomarkers of Alzheimer's Disease (AD) Aβ40, Aβ40, total tau and Ptau‐217 exhibit a diurnal pattern, being higher in the evening vs morning in most, but not all reports. The mechanisms underlying this pattern remain unknown. We recently showed that diurnal∆ (7PM ‐ 7AM levels) in plasma total tau levels in older adults correlated with core body temperature (Tc) diurnal change (Tdrop), consistent with temperature‐dependent tau secretion shown in vivo and in vitro (Canet et al., 2025, JCI, in press). Here, we extend this analysis to plasma Aβ40, Aβ42, and Ptau‐217 levels, and examine sex differences.MethodWe recorded Tc in 44 older adults aged 65±5.24 years (40 cognitively normal, 4 MCI) with ingestible telemetry during 48 hours including two nights in the sleep lab. Blood was sampled at 7 pm and 7 am (four occasions total), creating three plasma diurnal∆ outcomes. Tdrop (Tc during wake ‐ T during sleep on night 2) was calculated for multiple clock intervals (3 hours either side of Tmax and Tmin) to explore correlations with diurnal∆ for target plasma levels quantified with SIMOA quanterix assays.ResultFemales (n = 25) vs males (n = 19) showed higher Tc (by ∼0.25°C) from 6 am – 6 pm, and a larger Tdrop, p < 0.05. Tdrop was significantly correlated with diurnal∆ for all four biomarkers and for all three diurnal∆ outcomes for multiple (>10) clock intervals as follows: Aβ42 (r=0.64–0.82, n = 17), Aβ40 (r=0.59–0.73, n = 17), Aβ42/Aβ40 ratio (r=0.65–0.83, n = 17), and pTau‐217 (0.54–0.92, n = 11, with the exception of plasma diurnal∆3, p > 0.05). While PM levels were not significantly higher compared to AM levels for Aβ40, Aβ42 and Ptau217, a median split by Tdrop showed that this was the case in the larger Tdrop group, p < 0.05 all comparisons. Females vs males tended to have larger plasma diurnal∆, which was significant for diurnal∆2 for Aβ42, tau and p‐tau217, p < 0.05, all comparisons.ConclusionCore body temperature (Tc) diurnal change correlates with that in core plasma biomarkers of AD and may be a mechanism underlying this diurnal pattern. Measuring Tc will inform variability between sexes, subjects and study outcomes.

The aim of this study was to determine the rate of postoperative new-onset sacroiliac joint pain (SIJP) following adult spinal deformity (ASD) surgery with pelvic fixation. Patients undergoing ASD surgery with pelvic fixation, without baseline SIJP, and with a minimum 1-year follow-up were included. Patients were screened for SIJP by self-reported buttock/groin pain and/or posterior superior iliac spine (PSIS) pain scores ≥ 4. Patients with positive results on questionnaires were indicated for an SIJ examination consisting of 5 provocative maneuvers with ≥ 3 positive examination findings considered to be indicative of SIJP. Types of pelvic fixation were then compared for rates of postoperative SIJP. A total of 346 patients were identified, with mean age of 65 (SD 10) years and BMI of 28 (SD 5); 71% of patients were female. Thirteen patients (4%) underwent SIJ fusion at the index procedure. At the 1-year follow-up, 82 patients (24%) had positive screening responses for SIJP on the questionnaire; 63 underwent an SIJ examination and only 3 patients (1%) had a positive result. At the 2-year follow-up, 138 patients were administered the SIJP screening questionnaire; 31 (22%) had a positive questionnaire response for SIJP, 17 underwent an SIJ examination, and only 2 patients (1%) had a positive result. There was no difference in SIJP between patients with traditional iliac fixation (n = 162, 0% at 1 and 2 years) and S2-alar-iliac screws (n = 184), where 2% developed SIJP by 1 (p = 0.25) and 2 (p = 0.52) years, respectively. There was also no difference in SIJP between patients with 4 points of pelvic fixation (n = 85, 0% at 1 and 2 years) and patients with fewer than 4 points of pelvic fixation (n = 261), where 1% (p = 0.57) and 2% (p > 0.99) developed SIJP at 1 and 2 years, respectively. Of the 79 patients with iliac crest harvesting, none developed SIJP at the 1- or 2-year follow-up. Based on examination, the incidence of de novo SIJP following ASD surgery with pelvic fixation is low: only 1% at the 1- and 2-year follow-ups. The large discrepancy between at least moderate regional reported pain but a negative provocative examination warrants further investigation as to the source of substantial pain in nearly one-quarter of ASD patients postoperatively.

As orthopedic surgeons navigate the complexities of selecting their first positions, or established surgeons seek changes in employment, understanding the evolving financial and structural landscape of surgical practices is crucial. The rising influence of private equity (PE) in health care has added another dimension to this decision, as investment firms increasingly acquire stakes in practices to drive consolidation and profitability. Between 2015 and 2022, PE transactions in health care surged dramatically, reflecting the growing trend of practice consolidation in response to declining reimbursements, rising operational costs, and regulatory burdens. PE firms use leveraged buyouts to acquire and restructure practices, often forming management services organizations to streamline operations. Although PE partnerships offer benefits, including access to capital and corporate expertise, they also raise concerns about reduced autonomy, increased procedural volumes, and potential impacts on care quality and costs. This article provides an overview of PE's role in orthopedic practices, including its history, investment strategies, and the anatomy of typical deals. It explores the implications of PE partnerships on financial and clinical outcomes and highlights the importance of physicians staying informed about these developments. By understanding the benefits and risks, orthopedic surgeons can make more informed decisions in the context of a rapidly changing health care environment.