Presbyterian Hospital

To develop a deep learning-based auto-navigation technique for free-breathing golden-angle radial MRI named RANGR (Respiratory Auto-Navigator for Golden-angle Radial free-breathing abdominal MRI). RANGR computes a one-dimensional (1D) respiratory motion signal from 1D projections along the superior-inferior dimension (z) extracted directly from the acquired golden-angle stack-of-stars k-space data. The motion signal is used to retrospectively sort k-space data into different undersampled motion states, which are reconstructed using Movienet, a neural network developed for dynamic reconstruction. RANGR was trained using PCA (Principal Component Analysis) as a reference in cases where PCA was successful. The performance of RANGR is evaluated against PCA using a dynamic phantom with programmable motion waveforms on a 1.5 T MR-Linac system and free-breathing imaging of patients with abdominal tumors. In vivo image quality was qualitatively scored by body radiologists. For phantom studies, RANGR can track motion with less than 1 mm error with respect to the ground-truth. For in vivo studies, RANGR generalizes to cases where PCA failed due to limited liver coverage and/or the presence of high intensity regions outside the liver dome. RANGR outscores PCA on all qualitative image criteria as evaluated on a 5-point Likert scale by two expert body radiologists (p < 0.05). RANGR estimates motion faster than PCA on GPU (1.7 ± 0.3 vs. 168.7 ± 172.4 ms, p < 0.005). The total time from motion estimation to Movienet reconstruction is 2.91 ± 1.07 s. RANGR presents a robust auto-navigation solution based on deep learning for free-breathing MRI using golden-angle radial MRI acquisition.

To investigate longitudinal trends in the American Board of Emergency Medicine (ABEM) Qualifying Examination (QE) performance, identify statistically significant inflection points in pass rates, and determine factors associated with the recent decline observed in 2022. This was a retrospective, observational study conducted in 2 phases. Phase 1 analyzed all QE attempts from 1980 to 2024 (n = 83,254) to identify changepoints using segmented regression and Bayes factor comparisons. Phase 2 focused on QE attempts surrounding the most recent changepoint from 2016 to 2024 (n = 23,784) and used multilevel nonlinear piecewise growth models to examine the association between physician characteristics and QE pass rates before and after the 2022 changepoint. Three statistically significant changepoints were identified: 1988, 2003, and 2022. Although increases in pass rates were noted in 1988 and 2003, 2022 was marked by a decline in pass rates with a steeper drop post-2022 (slope from 2016 to 2022 = -0.17 vs slope 2022 to 2024 = -0.67). From 2016 to 2022, MD graduates had a lesser decline in performance compared with non-MD peers. After 2022, those trained during the COVID pandemic also experienced a lesser decline. ABEM QE pass rates experienced 3 major inflection points since 1980, with the most recent occurring in 2022 and representing a meaningful decline. Physician-level characteristics, particularly medical school degree type and COVID-era training, were significantly associated with this trend.

Perinatal obsessive–compulsive (OC) symptoms are common and distressing, yet their impact on early parenting outcomes such as maternal-infant bonding remains poorly understood. Although prior research links maternal depression and anxiety to bonding difficulties, less is known about how perinatal OC symptoms relate to maternal-infant bonding over time, or the extent to which maternal-partner relationship quality is associated with these outcomes, and whether depressive symptoms explain observed associations. Data were drawn from a longitudinal study of 256 pregnant women recruited from two U.S. sites between 2020 and 2023. Participants completed self-report and clinician-administered assessments at 20 weeks (PGWK20), 34 weeks gestation (PGWK34), and at 6 weeks (PP6WK) and 6 months postpartum (PP6MO). OC symptoms were measured using the Yale-Brown Obsessive–Compulsive Scale (Y-BOCS) and the Perinatal Thoughts and Behaviors Checklist (PTBC), depressive symptoms with the Edinburgh Postnatal Depression Scale (EPDS), maternal-partner relationship quality with the Dyadic Adjustment Scale (DAS), and maternal-infant bonding with the Postnatal Bonding Questionnaire (PBQ). Prenatal OC symptom severity (PGWK34) and OC symptom severity assessed at PP6WK did not directly predict maternal-infant bonding difficulties at PP6WK or PP6MO. Depressive symptoms at PP6WK significantly mediated the association between prenatal OC symptoms and bonding difficulties at PP6MO. Higher maternal-partner relationship quality during pregnancy (PGWK34) predicted fewer bonding difficulties at PP6MO but was not associated with the strength of associations between OC symptoms and bonding outcomes. Perinatal OC symptoms may indirectly influence maternal-infant bonding through co-occurring depressive symptoms, highlighting the importance of mood-focused assessment and personalized intervention during pregnancy. Maternal-partner relationship quality emerged as a general protective factor associated with fewer bonding difficulties but did not moderate associations between OC symptoms and bonding outcomes. Integrated screening and intervention approaches targeting both mood and OC features may enhance maternal well-being and early relational outcomes.

The medical school to residency transition remains challenging for learners and educators. Within pediatrics, the effectiveness of medical school activities intended to ease this transition remains unclear, and little is known about the intern perspective. We sought to (1) describe new pediatric interns’ perspectives on areas they felt least and most prepared for and (2) elucidate the educational interventions interns found valuable during the transition. From 2/2024 to 4/2025, we conducted a qualitative study consisting of 1:1 semi-structured interviews with pediatric interns from an academic, tertiary-care medical center guided by a phenomenological approach. We utilized self-determination theory to develop our interview guide and reflexive thematic analysis to analyze transcripts. Sixteen interviews were conducted with interns from 14 unique medical schools. Four themes were identified: (1) Interns felt most comfortable with medical knowledge and patient presentations, yet struggled with autonomy and counseling families in the outpatient setting; (2) Undergraduate Medical Education (UME) experiences e.g., sub-internships and Transition To Residency (TTR) courses that were pediatric specific were most valuable; (3) Early Graduate Medical Education (GME) programming should prioritize teaching institution-specific skills e.g., Electronic Medical Record (EMR) best practices; (4) A supportive environment with close peer mentoring best fosters intern growth through clinical learning. Themes informed a novel conceptual model with actionable recommendations for medical school and residency educators. By interviewing interns who graduated from multiple medical schools, we benefited from learners with diverse experiences. Our model should guide educators in facilitating a smoother transition to pediatric residency through programming aligned with intern needs.

A 21-year-old male presented with chronic left-sided rhinosinusitis and was found to have a left frontal sinus mass on maxillofacial computed tomography (CT). The mass measured approximately 1.9 × 1.3 × 2.3 cm in size and was contiguous with the intrasinus septum and anterior table of the frontal sinus. Imaging features were consistent with osteoma. An endoscopic endonasal approach resulted in subtotal resection of the mass. Eleven months later, the patient underwent a combined left transorbital and endoscopic surgical resection with oculofacial plastic surgery and otolaryngology. The mass was resected in its entirety, and histopathology confirmed an osteoma. This is one of the few reports of a unilateral transorbital frontal sinus osteoma resection and highlights the utility of the transorbital approach for minimally invasive access to the far-lateral frontal sinus.

IntroductionClonal hematopoiesis (CH) is a common age-related phenomenon associated with an increased risk of hematologic malignancies and cardiovascular disease. Its prognostic significance in patients with solid tumors remains unclear. The aim of this meta-analysis was to evaluate the association between CH and clinical outcomes, including overall survival (OS), progression-free survival (PFS), cardiovascular events, and all-cause mortality in patients with solid tumors.MethodsWe conducted a meta-analysis according to PRISMA guidelines, including 21 studies comprising 4845 patients with CH and 63557 patients without CH. Hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals were pooled using random-effects or fixed-effects models as appropriate, based on assessments of between-study heterogeneity.ResultsCH was not significantly associated with OS in patients with solid tumors (HR: 1.10, 95% CI: 0.92–1.32, p = 0.30). The pooled analysis using a random-effects model suggested a trend toward improved PFS in patients with CH compared with those without CH, although statistical significance was not reached (HR: 0.83, 95% CI: 0.67–1.02, p = 0.08). However, CH was associated with an increased mortality in patients with solid tumors, with nearly a twofold higher risk compared to those without CH (OR = 1.70, 95% CI: 1.34-2.16, p < 0.00001). Furthermore, CH was significantly associated with an increased risk of cardiovascular events (OR = 2.75, 95% CI: 1.38 to 5.47, p = 0.004).ConclusionOur meta-analysis indicated that CH mutations have a prognostic value and are associated with a clinically meaningful increased risk of overall mortality and cardiovascular events in patients with solid tumors.

Haemorrhage and blood product usage are common in venoarterial extracorporeal membrane oxygenation (VA ECMO) and associated with increased mortality. A prospective, investigator-initiated, longitudinal observational cohort study on major haemorrhagic events in 12 ECMO centres from 3 continents for three predefined subgroups (VA ECMO initiated during cardio-pulmonary resuscitation (ECPR), after cardiothoracic surgery (CTS), for cardiogenic shock (CS)). The aim was to describe haemorrhagic complications as well as transfusion practice and anticoagulation for the whole population as well as the subgroups. In addition, independent baseline predictors for red blood cell (RBC) transfusions were evaluated. 545 prospective patients were included between 2019 and 2022 (ECPR 149, CTS 169, CS 227). Hospital mortality was 46%. Over 2796 days 406 major haemorrhage events in 286 (52%) patients were recorded. CTS and ECPR patients had more frequent events occurring earlier in their course. 88% received RBC transfusions (1.27 (95%CI 1.22 – 1.31) units/day) with significantly more transfusions for CTS and ECPR patients. Platelet transfusion rates were highest in the CTS group (0.58 (95%CI 0.53–0.64) units/day). Haemoglobin and platelet count prior to transfusion were independent of subgroups and averaged (78 g/L (IQR 73, 84), 58 × 10^9/L (IQR 37, 85), respectively). However, platelet count prior transfusion was only marginally higher on days with major haemorrhage (74 × 10^9/L (IQR 50, 104). Systemic anticoagulation was started within the first 24 h in 83% (95% CI 80–87%) of patients, most frequently in CS patients (90%, CI 85–95%). Independent baseline predictors for RBC transfusion were ECPR (IRR 1.50, 95%CI 1.19–1.89) and prior use of antiplatelets (IRR: 1.43, 95%CI 1.13–1.80). Myocarditis and pulmonary embolism were associated with a lower rate of transfusion when compared to myocardial infarct (IRR: 0.57 (0.37–0.89), IRR: 0.67 (0.45–1.00, respectively). Haemorrhagic complications differ in clinical subgroups and RBC transfusion exposure is by far higher than in other critically unwell populations. We identified ECPR and antiplatelet therapy as additional predictors. Transfusion practice for RBC and platelets is variable and does not always follow international guidelines.

Objectives Afro-Caribbean patients are underrepresented in acute myeloid leukemia (AML) outcomes research, and the impact of socioeconomic and structural barriers on survival in this population remains poorly defined. We aimed to characterize clinicopathologic features, treatment utilization, and outcomes among Afro-Caribbean adults with AML treated at an urban safety-net hospital. Methods We conducted a retrospective cohort study of adults diagnosed with AML and treated at a large urban safety-net hospital in Brooklyn, New York, between 2012 and 2022. Demographic, clinical, and treatment variables were abstracted from electronic medical records. Outcomes were summarized descriptively, including treatment intensity, transplant eligibility and receipt, and survival. Results Among 47 patients (median age 66 years), 85% identified as Afro-Caribbean. At presentation, 38% were uninsured. Ten patients (21%) received supportive care only. Among treated patients (n = 37), 78% received intensive anthracycline+cytarabine–based induction chemotherapy. Twenty-seven patients (57%) were considered appropriate candidates for allogeneic transplantation based on disease risk and performance status; however, only 3 (11%) ultimately underwent the procedure. Complete remission was achieved in 51%, with 58% subsequently relapsing. Median progression-free survival was 8 months, and median overall survival was 9 months. Three-year progression-free and overall survival were 12.8% and 17.0%, respectively. Conclusions In this single-center safety-net cohort, long-term survival was limited and receipt of allogeneic transplantation was low despite documented eligibility in more than half of the patients. These findings provide descriptive insight into post-remission therapy patterns in an understudied population and identify areas for further investigation.