Neera M Patel

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This two-part review examined how artificial intelligence is changing colorectal surgery across the full spectrum from screening to postoperative care. AI-enhanced colonoscopy meaningfully increases polyp detection rates, and machine learning models now outperform traditional risk scores in predicting surgical complications. AI has achieved regulatory approval for specific applications and is beginning to reduce documentation burden and detect complications earlier than clinical observation alone.

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Children with public insurance waited significantly longer for surgery after a first-time patellar dislocation with a loose body, with a median 55 days to surgery versus 38.5 days for those with private insurance. Publicly insured patients were 2.3 times more likely to have surgery delayed beyond 30 days, and delayed treatment made it less likely that the loose fragment could be fixed rather than removed. These disparities risk worsening outcomes in an already vulnerable population.

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A surgical residency program reviewed a decade of resident life events requiring schedule changes and found that the number and complexity of such events grew steadily from 1-2 per year to as many as 8. Births were the most common event, and the variety of disruptions expanded after 2020. The program shifted from reacting to individual crises toward proactive team-based scheduling and cultural reframing of life events as expected, normal parts of surgical training.

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Across three Mayo Clinic sites, shape-sensing robotic-assisted bronchoscopy sampled 2,115 peripheral lung lesions with a strict diagnostic yield of 76.9% and sensitivity for malignancy of 85%. Early lung cancer detection rose from 46% to 69% of diagnoses over the 5-year experience, while complication rates requiring intervention remained low at 2.8%. The technology is improving early cancer diagnosis at scale with acceptable safety.

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Researchers compared macrophage populations in contractured muscles of children with cerebral palsy to those in typically developing children with ACL injuries. In contractured cerebral palsy muscles, macrophages, muscle stem cells, capillary density, and fiber characteristics were all positively correlated with each other, a pattern also seen in ACL-injured muscles. These findings suggest that the contractured muscles of children with cerebral palsy are in a chronic state of active repair similar to injury-driven inflammation.

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This study directly compared two neighborhood-level deprivation metrics, the Child Opportunity Index (COI) and the Area Deprivation Index (ADI), in predicting disparities in ACL reconstruction timing and joint damage in children. The COI outperformed the ADI, identifying more associations with delayed surgery and meniscal injury. When studying pediatric sports medicine disparities, the COI appears to be a more sensitive tool than the ADI.

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In a multicenter prospective study, researchers measured quality of life in 212 patients at 90 days after stroke thrombectomy using validated questionnaires. Over 40% reported at least mild problems in each quality-of-life domain, and quality-of-life scores correlated strongly with standard disability scores. Quality-of-life measurement captures patient experience beyond what functional scales alone convey and should be used alongside the modified Rankin Scale in thrombectomy research.

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This study traced exactly where in the preoperative pathway disparities arise for children with ACL injuries based on insurance and race. Publicly insured children had higher odds of delayed initial evaluation, delayed MRI, delayed surgeon evaluation, and surgery beyond 90 days at every step of the preoperative process. Non-White Hispanic patients independently experienced delays in MRI, surgeon evaluation, and surgery, pointing to disparities that persist even after accounting for insurance.

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This multicenter retrospective study followed 439 sepsis patients to determine whether left ventricular strain measured during hospitalization predicted long-term heart problems. Abnormal left ventricular global longitudinal strain (LV GLS) was independently associated with major adverse cardiovascular events after discharge, while ejection fraction was not. LV GLS is a better long-term cardiac risk marker than ejection fraction in sepsis survivors.

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An international expert panel reviewed what is and is not understood about what happens to mesenchymal stromal cells (MSCs) after they are given to patients. While mechanisms of immune clearance have been identified, how these processes relate to MSC therapeutic effect remains unclear. The panel identified urgent research questions around biodistribution, functional persistence, and delivery context to move the field beyond cell tracking toward understanding what MSCs actually do in patients.

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Children undergoing ACL reconstruction with a 2-limb lateral extra-articular procedure (LEAP) were compared to those with ACL reconstruction alone for early complications. Adding the LEAP did not increase rates of stiffness, infection, or reoperation, though cosmetic concerns were more common in the LEAP group (6.1% vs 0.5%). Surgeons can add this procedure to reduce ACL re-tear risk without meaningfully increasing early complication risk.

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This cross-sectional study of 96 chronic kidney disease patients found that 84% had mild anxiety and half had mild to moderate depression. All quality-of-life domains were negatively correlated with anxiety and depression severity, and advanced CKD stage independently predicted higher odds of both conditions. Routine psychiatric screening is warranted in CKD patients given the high prevalence and its direct impact on quality of life.

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A comparative analysis of mental health system indicators across 10 countries found dramatic differences between high-income and lower-income nations. High-income countries allocated 6-11% of health budgets to mental health with treatment gaps under 32%, while lower-income countries allocated under 1% with gaps exceeding 75%. Economic capacity and political commitment are the dominant drivers of mental health system capacity globally.

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This review covered the genetic and environmental causes of cleft lip and palate, the most common craniofacial birth defect. Multiple specific genes and molecular pathways involved in facial development were described, along with the most common syndromes associated with clefting. A clearer understanding of these mechanisms is expected to enable standardized genetic screening and future advances in treatment.

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A qualitative study of 25 surgical trainees across 9 teaching hospitals identified four barriers and three facilitators to psychological safety in training. Public humiliation, fear of questioning, and faculty culture were the main barriers, while intentional faculty behaviors, trust, and normalizing vulnerability were the key facilitators. These findings provide concrete targets for programs aiming to build psychologically safer learning environments.

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Researchers identified a new pathway by which the GIP receptor, a diabetes and obesity drug target, is internalized from the cell surface. The receptor engages myosin VI through a specific binding motif, and this motor protein works together with the better-known beta-arrestin pathway to control receptor trafficking and signaling. Blocking myosin VI activity enhances insulin release from pancreatic beta cells, revealing a potential new angle for targeting metabolic disorders.

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A systematic review of clinical trials on pediatric knee injuries found that outcomes measured across 15 trials were highly variable, with 83 distinct outcomes covering 35 WHO functional domains. No trials used a standardized core outcome set, and primary outcomes were not defined in nearly half the studies. The field urgently needs a consensus on which outcomes to measure so trial results can be compared and combined.

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School-aged children with type 1 diabetes using a hybrid closed-loop insulin pump were compared during the school year and summer for sleep and blood sugar control. There were no statistically significant differences in sleep duration or glycemic outcomes between seasons. Automated insulin delivery may help eliminate the seasonal variation in diabetes control typically seen in children.

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This multicenter study of 369 children with tibial tubercle fractures found that surgery delayed more than 24 hours after presentation and postoperative immobilization lasting more than 4 weeks were each associated with roughly 10 times higher odds of persistent knee stiffness at 3 months. Overall stiffness affected 3% of patients. Early fixation and prompt mobilization after surgery are the most modifiable factors for preventing this complication.

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A surgical residency program embedded a licensed psychiatrist into its graduate medical education structure using debriefs, confidential group sessions, and individual care. The program now reaches over 150 residents annually, with residents reporting reduced stigma and increased mental health service utilization. Group sessions served as an entry point to individual care, and early exposure during orientation was key to engagement.

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Using a modified Delphi process, the Pediatric Orthopaedic Society of North America identified the top 16 clinical research priorities for pediatric orthopedics from 116 submitted questions. The highest-scoring topics included surgical treatment for cerebral palsy and indications for residual hip dysplasia. The resulting research agenda is intended to direct surgeon efforts, study group collaboration, and funding toward the most critical gaps in evidence.

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Real-world outcomes were analyzed for 59 patients meeting large core infarction criteria treated with stroke thrombectomy. Twenty percent achieved functional independence at 90 days, matching rates from the SELECT2 trial, while 53% of those who achieved recanalization had devastating neurological outcomes despite successful treatment. Atrial fibrillation was the only independent predictor of futile recanalization.

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This narrative review summarized the types and rates of complications from linear endobronchial ultrasound (EBUS), which is now widely used to diagnose lung diseases. Overall complication rates range from 0.04% to 17%, with infectious complications most common at 0.04-4%, and mortality extremely rare at 0.01-0.04%. As EBUS use grows, clinicians need to recognize the full spectrum of potential complications to diagnose and treat them quickly.

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This is an erratum correcting a previously published article on health equity research in orthopedic surgery. The correction addresses errors in the original article without presenting new findings.

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Robotic-assisted bronchoscopy was compared to CT-guided biopsy for diagnosing peripheral lung cancer in 407 and 556 patients respectively using propensity-matched analysis. The robotic approach diagnosed significantly more early-stage cancers (OR 3.02), with dramatically lower pneumothorax rates (3.4% vs 44.6%) and far fewer hospitalizations. Robotic bronchoscopy offers a safer diagnostic path that catches lung cancer earlier.

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A scoping review of 86 sports medicine disparities articles from 2013 to 2022 found that the field is growing but methodologically limited. Two-thirds of studies were published after 2019, but 64% were retrospective, none used a community-engaged approach, and only one study focused on an intervention. Disparities research in sports medicine is documenting problems without yet designing or testing solutions.

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A systematic review characterized 855 health equity publications in orthopedic surgery from 2013 to 2022, finding rapid growth concentrated after 2019. Ninety-two percent were observational or experimental, 73% retrospective, and only 8 studies evaluated original interventions. Federal funding was nearly absent, and qualitative methods and community engagement were almost nonexistent despite being essential for understanding and addressing disparities.

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This study of 375 children with first-time patellar dislocation found that those from low-opportunity neighborhoods and those with public insurance waited significantly longer for orthopedic evaluation, MRI, and physical therapy. Time to MRI was nearly twice as long for those in the lowest-opportunity neighborhoods compared to the highest. These delays likely have downstream functional consequences and reflect structural barriers that need targeted intervention.

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Researchers analyzed procalcitonin (PCT) as a predictor of severe COVID-19 outcomes in 7,851 hospitalized patients. Elevated PCT was independently associated with higher odds of ICU admission, mechanical ventilation, and in-hospital death, and combining PCT with other biomarkers (NLR, LDH, D-dimer) produced the strongest predictive model with an AUC of 0.826. Biomarker panels including PCT can meaningfully improve early risk stratification in hospitalized COVID-19 patients.

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A bibliometric study of 69 pediatric orthopedics disparities articles published from 2013 to 2022 found nearly three-quarters published after 2019, but the field is still almost entirely descriptive. No studies used qualitative methods, community engagement, or federal funding, and not one published an original intervention. The pediatric orthopedics field is documenting disparities but has not yet moved toward addressing them.

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Researchers compared knee anatomy between children who sustained ACL tears, tibial spine fractures, or had no injury. A steep lateral tibial slope was a common risk factor for both ACL tears and tibial spine fractures, while a narrower intercondylar notch was specific to ACL tears. These morphological differences suggest that knee geometry partly determines which injury a child sustains when the ACL is stressed.

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Among 957 anterior circulation thrombectomy patients, those aged 80 or older had 1-year functional independence rates of 18.6% compared to 45.9% in younger patients. In the elderly, key predictors of functional independence included presenting stroke severity, collateral blood flow, and achieving recanalization in a single pass. One-year outcomes in octogenarians were similar to previously reported 90-day outcomes, suggesting slower but continued recovery.

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This trial protocol describes a randomized, double-blind study of nintedanib versus placebo in 170 patients with subacute lung injury following COVID-19. The primary endpoint is change in forced vital capacity at 180 days, with secondary endpoints including diffusing capacity, walk test, CT changes, and mortality. The trial tests whether nintedanib can prevent subacute COVID-19 lung injury from progressing to permanent fibrosis.

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Tibial tubercle osteotomy with distalization was compared to anteromedial transfer alone in 76 young patients with patellar instability. Overall complication rates were 27% for distalization and 19% for anteromedial transfer, but the difference was not statistically significant. Surgeons can use distalization in young patients when anatomy requires it without a significant increase in complications.

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A 22-year-old with metastatic follicular variant papillary thyroid carcinoma developed unusual tracheal nodularity and a paratracheal soft tissue nodule one year after radioactive iodine ablation. Bronchoscopic sampling identified mucinous material without malignancy or infection in multiple submucosal tracheal nodules. This appears to represent the first described pathologic correlation with post-radioactive iodine treatment changes in the trachea.

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This 7-center study of 475 children who underwent screw fixation for tibial tubercle fractures found that implant irritation occurred in 12.8%, with 10.7% ultimately requiring removal. White patients had 3.2 times higher odds of symptomatic hardware, and patients weighing less than 70 kg had twice the odds. Screw size, configuration, and washer use were not significant factors, but this information can still guide preoperative counseling.

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The International Society for Cell and Gene Therapy commented on the December 2024 FDA approval of Mesoblast's allogeneic bone marrow MSC therapy for pediatric steroid-refractory graft-versus-host disease. This was the first US approval of an MSC product after many years without such approvals, achieved through close collaboration between the sponsor and FDA to address concerns about efficacy and potency. The approval is expected to revive investment in MSC therapies and pave the way for further approvals.

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This review examined flavopiridol, a synthetic CDK inhibitor with anticancer properties that has faced clinical limitations due to toxicity and drug resistance. Flavopiridol blocks cancer cell division, promotes cell death, and inhibits transcription across multiple cancer types, with chemical modifications that can enhance its potency. Combination therapies and identification of predictive biomarkers are the most promising strategies for overcoming its current clinical limitations.

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This large meta-analysis covering 230 studies and nearly 4 million oncologic procedures compared da Vinci robotic-assisted surgery to laparoscopic and open approaches. Robotic surgery had longer operative times but shorter hospital stays, less blood loss versus open surgery, fewer conversions, transfusions, complications, readmissions, and deaths compared to both approaches. The data provide cross-specialty evidence that robotic-assisted oncologic surgery offers meaningful clinical benefits.

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This multicenter case series compared operative versus nonoperative treatment for knee arthrofibrosis after tibial spine fracture fixation in children. Both approaches achieved similar final ranges of motion at last follow-up, with final flexion around 130° and minimal extension deficits in both groups. Nonoperative management may be appropriate for milder stiffness, with surgical intervention reserved for greater deficits.

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This review comprehensively covered available diagnostic tools for mediastinal disease, from chest X-ray and CT through minimally invasive bronchoscopic techniques. Endobronchial ultrasound with needle aspiration has become the standard of care for many mediastinal diagnoses given its high yield and low complications. Emerging technologies including confocal endomicroscopy, optical coherence tomography, and AI are likely to further transform bronchoscopic diagnosis.

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This review summarized evidence of disparities in care for children with knee injuries including ACL tears, meniscal injuries, osteochondritis dissecans, and tibial spine fractures. Disparities along lines of sex, race, insurance, and socioeconomic status influence evaluation timing, treatment choices, and outcomes across multiple knee conditions. Addressing these inequities requires research that goes beyond documenting them to designing and testing interventions.

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Researchers identified myosin VI as a previously unknown driver of dopamine receptor internalization that works independently of beta-arrestin. The motor protein accesses the receptor through an adaptor protein that binds a specific C-terminal motif, and its activity shapes receptor trafficking and signaling in ways distinct from the canonical beta-arrestin pathway. This discovery opens a new target for altering dopamine receptor biology through the cytoskeleton rather than through traditional receptor pathways.

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Robotic-assisted bronchoscopy with mobile cone-beam CT was evaluated for its ability to biopsy cystic and cavitary lung lesions, which are challenging targets. Diagnostic yield was 83% and sensitivity for malignancy was 97%, with a low pneumothorax rate of 4% and no procedural deaths in 52 patients. The technique is a safe and accurate alternative to CT-guided biopsy for air-filled lung lesions.

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Researchers studied 118 patients with large core stroke infarctions treated with thrombectomy to identify who is most likely to have poor outcomes despite successful vessel opening. Higher stroke severity, elevated blood glucose, lack of IV thrombolysis, and incomplete recanalization were independent predictors of poor 90-day function. The CLEOS score identified high-risk patients, with 95% of those scoring above 675 having poor outcomes.

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This multicenter retrospective propensity-matched study tested whether inhaled nitric oxide (iNO) improves outcomes in COVID-19 patients requiring respiratory support. Spontaneously breathing patients on iNO had lower in-hospital mortality in time-to-event analysis, while intubated patients did not benefit. Both groups had short-term improvement in oxygenation, but iNO was associated with longer ICU stays and more kidney injury.