Bill Young

All Publications

• Outcomes After Proximal Humerus Surgery: Does Regional Anesthesia Usage Matter? Journal of hand surgery global online Young, B., Ladd, A. L. 2026; 8 (2): 100920

  Abstract

  Regional anesthesia is commonly used for intraoperative pain control during proximal humerus fracture surgery. We hypothesized that patients undergoing proximal humerus fracture surgery who received regional anesthesia would have increased postoperative emergency department (ED) utilization, increased perioperative opioid prescriptions, and greater incidence of persistent postoperative opioid prescriptions compared with those who received general anesthesia.We retrospectively identified patients ≥18 years of age with a closed proximal humerus fracture undergoing either open reduction internal fixation (ORIF) or shoulder arthroplasty within 21 days of the fracture. We used International Classification of Diseases (ICD) 9/10 codes to identify patients using an administrative claims database. We categorized and then propensity-score matched patients based on receipt of regional anesthesia during surgery. Our first outcome was any instance of an ED visit within 7 and 30 days after surgery. Secondary outcomes included perioperative opioid prescriptions and the incidence of persistent opioid prescriptions. Multivariable regression models were used to assess the risk of an ED visit or persistent opioid usage based on the receipt of intraoperative regional anesthesia, adjusting for demographics and comorbidities.In total, 10,580 (33.3%) ORIF patients and 3,299 (33.6%) shoulder arthroplasty patients received regional anesthesia during surgery. Regional anesthesia was associated with an increased 7-day ED visit incidence compared to no regional anesthesia receipt for ORIF patients (3.3% vs 2.3%) and shoulder arthroplasty patients (2.7% vs 1.9%) (P < .001 for both). In the 30-day postoperative window, regional anesthesia was associated with an increased incidence of an ED visit for ORIF patients (7.1% vs 5.8%) and shoulder arthroplasty patients (6.6% vs 5.2%) (P < .001 for both). Regional anesthesia was also associated with greater perioperative opioid prescriptions across both surgeries (P < .05).Further research should explore interventions for proximal humerus fracture surgery patients who receive regional anesthesia to reduce potentially preventable ED visits and opioid-related adverse events.Therapeutic III.

  View details for DOI 10.1016/j.jhsg.2025.100920

  View details for PubMedID 41584057

  View details for PubMedCentralID PMC12828752

• Evaluating the Safety of Prescription Sleep Medications in Patients Undergoing Total Knee Arthroplasty: A Propensity Matched Analysis. The Journal of the American Academy of Orthopaedic Surgeons Young, B., Zhuang, T., Fernando, N., Manner, P., Kamal, R. N., Hernandez, N. M. 2025

  Abstract

  BACKGROUND: Impaired sleep is reported in over 50% of patients after a total knee arthroplasty (TKA). Clinicians often treat postoperative sleep disturbances with medications; however, the risks associated with the use of sleep medications after TKA are not well understood. We assessed the association between sleep medication use after TKA and postoperative complications.METHODS: Using a national administrative claims database, we identified 101,806 patients undergoing primary TKA from 2011 to 2022 who were taking sleep medications within 90 days after surgery and 509,030 patients who were not, which formed the control group. We further analyzed the effects of standard prescription sleep medications (daridorexant, eszopiclone, lemborexant, suvorexant, temazepam, triazolam, zaleplon, zolpidem) and less potent prescription sleep medications (doxepin, ramelteon). Ninety-day and 365-day outcomes investigated were falls, revision surgery, dislocation, fractures, and emergency department (ED) visits. Multivariable logistic regressions were used to calculate odds ratios, adjusting for age, sex, region, insurance plan, Elixhauser Comorbidity Index, preoperative sleep medication usage, and history of mood and anxiety disorders.RESULTS: Use of any sleep medication was associated with an increased risk of 90-day prosthetic joint dislocations (OR, 1.26; 95% CI, 1.02 to 1.54; P = 0.031), revision surgery (OR, 1.12; 95% CI, 1.02 to 1.24; P = 0.019), falls (OR, 1.10; 95% CI, 1.03 to 1.18; P = 0.008), and ED visits (OR, 1.12; 95% CI, 1.09 to 1.15; P < 0.001). Standard sleep medication usage was correlated with an increased risk of 90-day and 365-day revision surgery, falls, distal radius fractures, and ED visits (P < 0.05).CONCLUSIONS: Use of any prescription sleep medication or only standard sleep medications is associated with increased surgical complications. Additional research is needed to find medications that may be safer for routine postoperative use.

  View details for DOI 10.5435/JAAOS-D-25-00888

  View details for PubMedID 41490393

• Does Traumatic Brain Injury Increase Opioid Utilization after Primary Total Knee Arthroplasty? The Journal of arthroplasty Young, B., Shankar, D., Sabet, C., Leopold, A., Fernando, N., Hernandez, N. M. 2025

  Abstract

  Traumatic brain injury (TBI) is a common neurological injury with widespread systemic effects, leading to increased pain and opioid utilization. In this study, we investigated how a prior TBI affects perioperative opioid utilization in patients undergoing a total knee arthroplasty (TKA) as well as the risk of prolonged opioid usage.Using an administrative claims database, we identified patients undergoing a primary TKA from 2010 to 2022. Following inclusion and exclusion criteria, patients were categorized based on a prior diagnosis of a TBI, leading to a final TBI cohort of 127,369 patients and a control cohort of 1,116,605 patients. Our primary outcome was perioperative opioid utilization, defined as any opioid prescription between 30 days before and after surgery. Our secondary outcome was persistent opioid usage, or continued opioid prescriptions 90 to 180 days after surgery. Multivariate regression models were used to assess the risk of persistent opioid usage based on TBI history, adjusting for demographics and comorbidities.Patients who had a prior TBI had greater perioperative opioid utilization compared to patients who did not have a prior TBI, with 987.5 versus 896.7 morphine milligram equivalents (P < 0.001). The TBI cohort also showed greater rates of persistent opioid usage compared to the control cohort: 22,258 patients (17.5%) versus 162,214 patients (14.5%) (P < 0.001). In the multivariate regression analyses, prior diagnosis of a TBI within one year before a TKA was associated with the greatest risk of persistent opioid usage (odds ratio (OR) 1.20, 95% confidence interval (CI): 1.14 to 1.22, P < 0.001).Prior diagnosis of a TBI is associated with greater perioperative opioid utilization and an increased risk of prolonged opioid utilization after a TKA. Further research should investigate the mechanisms of this association to target interventions for this population and ultimately reduce opioid consumption.

  View details for DOI 10.1016/j.arth.2025.12.018

  View details for PubMedID 41419030

• Comparative performance of the Risk Analysis Index versus traditional frailty measures in predicting outcomes following unicompartmental knee arthroplasty: A national database analysis. The Knee Sabet, C. J., Jain, B., Lawand, J., Prulovic, S., Young, B., Nguyen, D., Hammadeh, B. M., Liu, J. 2025

  Abstract

  BACKGROUND: While multiple frailty assessment tools exist for perioperative risk stratification, their comparative effectiveness in unicompartmental knee arthroplasty (UKA) remains unclear. The Risk Analysis Index (RAI) represents a comprehensive frailty measure, but its performance relative to established indices requires validation. We aimed to compare the predictive accuracy of the RAI against traditional frailty measures including the modified Frailty Index-5 (mFI-5) and Geriatric Nutritional Risk Index (GNRI) for 30-day outcomes following UKA.METHODS: We analyzed 9358 patients undergoing elective UKA from the ACS-NSQIP database (2015-2021). Three frailty indices were calculated: RAI (incorporating age, sex, renal function, dyspnea, cancer, weight loss, and functional status), mFI-5 (five comorbidity domains), and GNRI (nutritional assessment). Primary outcomes were discharge disposition and 30-day readmission. Secondary outcomes included 30-day all-cause mortality, complications, reoperations, and extended length of stay.RESULTS: The RAI demonstrated superior discrimination for discharge disposition (area under the curve (AUC)=0.694) and 30-day readmission (AUC=0.615) compared with mFI-5 (AUC=0.593 and 0.570) and GNRI (AUC=0.521 and 0.558). Progressive increases in adverse outcomes occurred across RAI tiers, with non-home discharge rates of 1.7% in robust patients versus 15.9% in frail patients (P<0.001).CONCLUSIONS: The RAI provides superior risk stratification compared with traditional frailty measures for discharge disposition and 30-day readmission in particular following UKA, supporting its adoption as the preferred perioperative assessment tool.

  View details for DOI 10.1016/j.knee.2025.10.015

  View details for PubMedID 41219082

• A Complete Infrapatellar Fat Pad Resection is Associated with New Postoperative Patella Baja and Persistent Pain, but a Lower Risk of Manipulation Under Anesthesia after Primary Total Knee Arthroplasty. The Journal of arthroplasty Young, B., McGovern, A., Tantikosol, P., Sodhi, N., Koltsov, J. C., Wong, H. J., Maloney, W. J., Amanatullah, D. F. 2025

  Abstract

  Patella baja after total knee arthroplasty (TKA) is associated with postoperative stiffness, and there is conflicting evidence regarding the patellar fat as a source of pain. We hypothesized that a complete infrapatellar fat pad resection during primary TKA does not increase the incidence of new postoperative patella baja while reducing the incidence of persistent pain and improving postoperative function. Specifically, we evaluated the odds of 1) new patella baja, 2) persistent pain, 3) Knee Society Score (KSS), 4) range of motion, and 5) manipulation under anesthesia.The primary outcome of this single-institution retrospective study was the incidence of new patella baja comparing pre- and postoperative lateral knee radiographs using the Insall-Salvati ratio of patients who underwent a primary TKA with either a complete or partial infrapatellar fat pad resection from 2014 to 2025. The final cohort included 592 patients who had either a complete (n = 351) or partial (n = 241) infrapatellar fat pad resection. The secondary outcomes included KSS, persistent pain, and range of motion. Differences in outcomes between complete and partial fat pad resection were assessed via risk-adjusted multivariable binomial and linear regression models.A complete infrapatellar fat pad resection nearly tripled the odds of new patella baja compared to a partial resection [2.92 (confidence interval (CI): 1.12 to 9.15); P = 0.041; number needed to harm [NNH] = 26]. Complete resection also more than doubled the odds of persistent pain [2.45 (CI: 1.17 to 5.54); P = 0.022; NNH = 19]. The Knee Society scores (KSS) were lower by 2.9 (CI: 1.2 to 4.7) points with complete resection (P = 0.001). After adjustment, no differences were noted in the range of motion.Our study highlights that infrapatellar fat pad resection may be a potential risk factor for developing new patella baja and persistent pain after primary TKA.

  View details for DOI 10.1016/j.arth.2025.10.046

  View details for PubMedID 41138994

• ChatGPT Can Provide Satisfactory Answers to Assessments of Mock Clinical Photos Following Anterior Cruciate Ligament Reconstruction and Rotator Cuff Repair. Arthroscopy, sports medicine, and rehabilitation Hollyer, I., Schroeder, G. G., Young, B., Sholtis, C., Hunt, A., Koltsov, J., Sherman, S. L., Safran, M. R. 2025; 7 (5): 101212

  Abstract

  To evaluate the ability of ChatGPT-4o to provide clinical assessments of mock photos of knees and shoulders that had undergone arthroscopic or open surgery and answer common questions related to anterior cruciate ligament reconstruction and rotator cuff repair.The authors created a series of mock postoperative knee and shoulder photos and common questions about anterior cruciate ligament reconstruction and rotator cuff repair. These clinical photos and questions were presented to GPT in isolated chat windows and without prior training, and its responses were graded by orthopaedic surgeons, physician assistants, and residents using a previously established 4-point grading system.When grading ChatGPT's assessments of mock clinical photos, raters gave 18.8% to 75.0% total excellent grades and 0% to 25.0% unsatisfactory grades. When grading ChatGPT question answers, raters gave 4.5% to 77.3% total excellent grades and 0% to 9.1% unsatisfactory grades. Mean grades ranged from excellent to satisfactory, requiring moderate clarification, depending on the photo or question. There was wide variability in rater grading agreement, with attendings being the most critical graders.ChatGPT-4o can provide some satisfactory assessments of simple postoperative clinical photos and responses to common questions after orthopaedic knee and shoulder surgery, as graded by orthopaedic surgeons, residents, and physician assistants. While this study highlights how ChatGPT could serve as a tool for generating draft responses to patient concerns after undergoing orthopaedic knee and shoulder surgery, it cannot yet provide reliable, independent clinical advice.As digital interactions in health care continue to expand, large language models could play a role in enhancing communication between patients and the orthopaedic care team, potentially improving patient engagement and access to information.

  View details for DOI 10.1016/j.asmr.2025.101212

  View details for PubMedID 41583817

  View details for PubMedCentralID PMC12827220

• Incidence and Risk Factors for Soft Tissue Hand and Wrist Conditions in Pregnancy and Postpartum. Journal of hand surgery global online Smith, G. B., Young, B., Titan, A. L., Kenney, D. E., Ladd, A. L. 2025; 7 (5): 100778

  Abstract

  This study aimed to identify the incidence of and risk factors associated with soft tissue hand conditions in pregnancy and postpartum. We hypothesized that the incidence of de Quervain tenosynovitis (DQT) and possibly carpal tunnel syndrome (CTS) and trigger finger would be higher in pregnancy and postpartum and that gestational diabetes would be a risk factor for these conditions.Using the PearlDiver administrative claims database, we identified pregnant females undergoing vaginal or Cesarean delivery from 2011 to 2022. This cohort was propensity score matched based on age and Elixhauser comorbidity index to females who were not pregnant. We identified pregnant females with a diagnosis of gestational diabetes. Multivariate regression models were used to assess the risk of developing a hand condition within the first year postpartum, adjusting for age, geographical region, insurance plan, comorbidity index, and inflammatory arthritis or diabetes diagnosis. We applied these models to evaluate the risk of developing a hand condition in gestational diabetes patients.We identified a cohort of 357,534 postpartum patients and 357,803 control patients. We observed a 1.5% incidence of hand conditions postpartum compared to 1.3% in the control population (P < .001). Pregnancy was associated with an increased risk of diagnosis with DQT (odds ratio [OR], 5.11; 95% confidence interval [CI], 4.47-5.85; P < .001). Gestational diabetes was also associated with an increased risk of a hand condition diagnosis (OR, 1.34; 95% CI, 1.26-1.42; P < .001), specifically increased odds of CTS (OR, 1.40; 95% CI, 1.29-1.51; P < .001) and DQT (OR, 1.23; 95% CI, 1.12-1.34; P < .001).Pregnancy is a significant risk factor for hand conditions and was associated with increased odds of DQT. Gestational diabetes is a significant risk factor for CTS and DQT. Our findings can inform screening and patient education efforts for high-risk pregnant patients.Prognostic IIIb.

  View details for DOI 10.1016/j.jhsg.2025.100778

  View details for PubMedID 40746749

  View details for PubMedCentralID PMC12312026

• Does Traumatic Brain Injury Increase Surgical and Medical Complications After Total Hip Arthroplasty? The Journal of arthroplasty Young, B., Shankar, D., Fernando, N., Manner, P., Chansky, H., Hernandez, N. M. 2025

  Abstract

  Traumatic brain injuries (TBIs) are a common neurological injury and can cause impaired cognition and fatigue. However, it is unknown how these systemic effects may influence surgical recovery following a total hip arthroplasty (THA). In this study, we asked whether a prior TBI was associated with a higher risk of postoperative medical and surgical complications.Using a national claims database, we examined adult patients undergoing a primary THA, excluding those who had a hip infection, hip fracture, or incomplete demographic information. This resulted in 81,586 (10.5%) patients who had a prior TBI diagnosis and 697,562 (89.5%) patients who did not. We examined the incidence of postoperative complications, including revision surgery, acute kidney injury (AKI), pulmonary embolism (PE), pneumonia, and urinary tract infection (UTI). Multivariate regression models were used to assess the risk of 90- and 365-day complications based on prior TBI diagnosis.We found that a prior diagnosis of a TBI was associated with greater rates of 90- and 365-day revision surgery and certain medical complications, including AKI, PE, pneumonia, and UTI (P < 0.05). In the multivariable regression analysis, the association between prior diagnosis of a TBI and greater risk of 90-day all-cause revision surgery persisted. This was greatest among patients who have a 1-year history of a TBI (OR [odds ratio] 1.28, 95% CI [confidence interval]: 1.07 to 1.51; P = 0.005). For 365-day medical complications, prior TBI was associated with a greater risk of AKI, pulmonary embolism, pneumonia, and UTI (P <0.05 for all).Our findings highlight a prior TBI diagnosis as a potential risk factor for increased surgical and medical complications following a THA. Further research is needed to explore the impact of a TBI on the physiological post-THA state to inform preoperative interventions and reduce the risk of TBI-related adverse events.

  View details for DOI 10.1016/j.arth.2025.08.025

  View details for PubMedID 40835014

• Utilization of Surgical Fixation for Distal Radius Fractures in the United States: A Population-Based Cohort Study. The Journal of hand surgery Zhuang, T., Young, B., Shapiro, L. M., Kamal, R. N. 2024

  Abstract

  In contrast to younger adult populations, clinical practice guidelines state that there is no difference in long-term functional outcomes in surgically versus nonoperatively treated distal radius fractures in patients ≥65 years old. In this study, we asked the following questions: (1) has treatment for distal radius fractures in younger and older adult populations changed over time? (2) What patient and surgeon factors are associated with treatment trends?Using a national administrative claims database, we identified patients aged ≥18 years with isolated, closed distal radius fractures, subdivided by age (18-64 years, ≥65 years old). We characterized the proportion of patients who underwent open reduction and internal fixation (ORIF) over time. We stratified our analysis by surgeon subspecialty, region, and mean area income. Changes in ORIF utilization over time were evaluated using linear regression models.The proportion of distal radius ORIF, including in patients aged ≥65 years, increased from 10.4% in 2012 to 15.1% in 2020. Of the ORIF procedures performed, hand surgeons accounted for an increasing proportion over time, with a corresponding decrease in those performed by general orthopedic surgeons. The proportion of ORIF increased over time in all US regions, with the largest rate of increase in the Midwest for patients aged ≥65 years and Northeast for patients aged 18-64 years. Patients living in areas with mean family income ≥$65,000 were more likely to undergo ORIF.The proportion of distal radius ORIF including in older adult populations is increasing in all US regions, and an increasing proportion is performed by hand surgeons.Further analysis of the drivers of these trends is warranted, given the rising incidence of surgical treatment in older patients, which could reflect evolving patient activity demands and suggest a need to further evaluate conventional treatment algorithms based on age.

  View details for DOI 10.1016/j.jhsa.2024.09.014

  View details for PubMedID 39488766

• Wide-ranging genetic variation in sensitivity to rapamycin in Drosophila melanogaster. Aging cell Harrison, B. R., Lee, M. B., Zhang, S., Young, B., Han, K., Sukomol, J., Paus, V., Tran, S., Kim, D., Fitchett, H., Pan, Y. C., Tesfaye, P., Johnson, A. W., Zhao, X., Djukovic, D., Raftery, D., Promislow, D. E. 2024; 23 (11): e14292

  Abstract

  The progress made in aging research using laboratory organisms is undeniable. Yet, with few exceptions, these studies are conducted in a limited number of isogenic strains. The path from laboratory discoveries to treatment in human populations is complicated by the reality of genetic variation in nature. To model the effect of genetic variation on the action of the drug rapamycin, here we use the growth of Drosophila melanogaster larvae. We screened 140 lines from the Drosophila Genetic References Panel for the extent of developmental delay and found wide-ranging variation in their response, from lines whose development time is nearly doubled by rapamycin, to those that appear to be completely resistant. Sensitivity did not associate with any single genetic marker, nor with any gene. However, variation at the level of genetic pathways was associated with rapamycin sensitivity and might provide insight into sensitivity. In contrast to the genetic analysis, metabolomic analysis showed a strong response of the metabolome to rapamycin, but only among the sensitive larvae. In particular, we found that rapamycin altered levels of amino acids in sensitive larvae, and in a direction strikingly similar to the metabolome response to nutrient deprivation. This work demonstrates the need to evaluate interventions across genetic backgrounds and highlights the potential of omic approaches to reveal biomarkers of drug efficacy and to shed light on mechanisms underlying sensitivity to interventions aimed at increasing lifespan.

  View details for DOI 10.1111/acel.14292

  View details for PubMedID 39135281

  View details for PubMedCentralID PMC11561674

• The interactions of macrophages, lymphocytes, and mesenchymal stem cells during bone regeneration. Bone & joint research Murayama, M., Chow, S. K., Lee, M. L., Young, B., Ergul, Y. S., Shinohara, I., Susuki, Y., Toya, M., Gao, Q., Goodman, S. B. 2024; 13 (9): 462-473

  Abstract

  Bone regeneration and repair are crucial to ambulation and quality of life. Factors such as poor general health, serious medical comorbidities, chronic inflammation, and ageing can lead to delayed healing and nonunion of fractures, and persistent bone defects. Bioengineering strategies to heal bone often involve grafting of autologous bone marrow aspirate concentrate (BMAC) or mesenchymal stem cells (MSCs) with biocompatible scaffolds. While BMAC shows promise, variability in its efficacy exists due to discrepancies in MSC concentration and robustness, and immune cell composition. Understanding the mechanisms by which macrophages and lymphocytes - the main cellular components in BMAC - interact with MSCs could suggest novel strategies to enhance bone healing. Macrophages are polarized into pro-inflammatory (M1) or anti-inflammatory (M2) phenotypes, and influence cell metabolism and tissue regeneration via the secretion of cytokines and other factors. T cells, especially helper T1 (Th1) and Th17, promote inflammation and osteoclastogenesis, whereas Th2 and regulatory T (Treg) cells have anti-inflammatory pro-reconstructive effects, thereby supporting osteogenesis. Crosstalk among macrophages, T cells, and MSCs affects the bone microenvironment and regulates the local immune response. Manipulating the proportion and interactions of these cells presents an opportunity to alter the local regenerative capacity of bone, which potentially could enhance clinical outcomes.

  View details for DOI 10.1302/2046-3758.139.BJR-2024-0122.R1

  View details for PubMedID 39237112

• Opioid Use After Robotic-Assisted Versus Conventional Total Hip Arthroplasty: A National Database Analysis ORTHOPEDICS Zhuang, T., Young, B., Hooper, J., Amanatullah, D. F., Shapiro, L., Kamal, R. N. 2024; 47 (5): 289-+

  Abstract

  In this study, we tested the null hypothesis that robotic-assisted total hip arthroplasty (THA) vs conventional THA was not associated with (1) the amount of postoperative opioid use and (2) the incidence of new, persistent opioid use.We used a large, national administrative database to identify patients 50 years and older undergoing primary robotic or conventional THA. Patients with hip fractures or a history of malignancy, hip infection, or opioid use disorder were excluded. Patients who filled an opioid prescription within 1 year to 30 days preoperatively or who underwent a subsequent procedure within 1 year after THA were excluded. Outcomes included the morphine milligram equivalents (MMEs) filled within the THA perioperative period and the incidence of new, persistent opioid use. Multivariable logistic regression models were used to evaluate associations between robotic-assisted THA and new, persistent opioid use, adjusting for age, sex, insurance plan, region, location of surgery, and comorbidities.In the postoperative period, robotic-assisted THA, compared with conventional THA, was associated with a lower mean total MMEs filled per patient (452.2 vs 517.1; P<.001) and a lower mean MMEs per patient per day (71.53 vs 74.64; P<.001). Patients undergoing robotic-assisted THA had decreased odds of developing new, persistent opioid use compared with patients undergoing conventional THA (adjusted odds ratio, 0.82 [95% CI, 0.74-0.90]).Robotic-assisted THA is associated with lower postoperative opioid use and a decreased odds of developing new, persistent opioid use compared with conventional THA. For the purposes of reducing opioid use, our results support the adoption of robotic-assisted THA. [Orthopedics. 2024;47(5):289-294.].

  View details for DOI 10.3928/01477447-20240702-03

  View details for Web of Science ID 001348283400017

  View details for PubMedID 38976847

• Evaluating surgeon communication of pancreatic cancer prognosis using the VitalTalk ADAPT framework. Journal of surgical oncology Dickerson, L. K., Lipson, T. A., Chauhan, S. S., Allen, G. I., Young, B., Park, J. O., Pillarisetty, V. G., O'Connell, K. M., Sham, J. G. 2024; 130 (3): 476-484

  Abstract

  Few data exist to guide optimal communication practices for surgical oncologists. VitalTalk, an evidence-based communication skills training model for clinicians, offers the five-step ADAPT tool for discussing prognosis. This study aimed to characterize surgeon communication of pancreatic cancer prognosis using VitalTalk's ADAPT framework.Contemporaneous audio recordings from 12 initial surgeon-patient encounters for borderline resectable pancreatic cancer were transcribed. Directed qualitative content analysis based on ADAPT (Ask, Discover, Anticipate, Provide, and Track) was used to deductively code transcripts.All encounters contained at least one ADAPT step while only one (8%) incorporated four or five steps. Surgeons provided prognostic information (Provide) in all but one encounter (92%); most was qualitative and clustered into themes: serious illness, surgical candidacy, prognostic ambiguity, and cancer recurrence. Surgeons elicited understanding (Ask), requested information preferences (Discover), anticipated ambivalence (Anticipate), and responded to emotion (Track) in a minority of encounters (25%-42%); of 15 patient emotional cues, six were not addressed by surgeons.During an initial encounter for pancreatic cancer, surgeons focus heavily on providing information but omit critical prognostic communication steps. Future studies are needed to investigate if surgeon training in palliative care-based communication is feasible and impacts patient-perceived quality of communication.

  View details for DOI 10.1002/jso.27777

  View details for PubMedID 38990255

• Ccl2 Enhances Macrophage Migration And Osteogenesis In Rabbits More Than Mice Shinohara, I., Chow, S. K., Toya, M., Murayama, M., Gao, Q., Susuki, Y., Lee, M. L., Young, B., Tsubosaka, M., Goodman, S. B. MARY ANN LIEBERT, INC. 2024: S241-S242

  View details for Web of Science ID 001434953602106

• T cells and macrophages jointly modulate osteogenesis of mesenchymal stromal cells. Journal of biomedical materials research. Part A Murayama, M., Shinohara, I., Toya, M., Susuki, Y., Lee, M. L., Young, B., Gao, Q., Chow, S. K., Goodman, S. B. 2024

  Abstract

  Approximately 5%-10% of fractures go on to delayed healing and nonunion, posing significant clinical, economic, and social challenges. Current treatment methods involving open bone harvesting and grafting are associated with considerable pain and potential morbidity at the donor site. Hence, there is growing interest in minimally invasive approaches such as bone marrow aspirate concentrate (BMAC), which contains mesenchymal stromal cells (MSCs), macrophages (Mφ), and T cells. However, the use of cultured or activated cells for treatment is not yet FDA-approved in the United States, necessitating further exploration of optimal cell types and proportions for effective bone formation. As our understanding of osteoimmunology advances, it has become apparent that factors from anti-inflammatory Mφ (M2) promote bone formation by MSCs. Additionally, M2 Mφ promote T helper 2 (Th2) cells and Treg cells, both of which enhance bone formation. In this study, we investigated the interactions among MSCs, Mφ, and T cells in bone formation and explored the potential of subsets of BMAC. Coculture experiments were conducted using primary MSCs, Mφ, and CD4+ T cells at specific ratios. Our results indicate that nonactivated T cells had no direct influence on osteogenesis by MSCs, while coculturing MSCs with Mφ and T cells at a ratio of 1:5:10 positively impacted bone formation. Furthermore, higher numbers of T cells led to increased M2 polarization and a higher proportion of Th2 cells in the early stages of coculture. These findings suggest the potential for enhancing bone formation by adjusting immune and mesenchymal cell ratios in BMAC. By understanding the interactions and effects of immune cells on bone formation, we can develop more effective strategies and protocols for treating bone defects and nonunions. Further studies are needed to investigate these interactions in vivo and explore additional factors influencing MSC-based therapies.

  View details for DOI 10.1002/jbm.a.37771

  View details for PubMedID 38963690

• Flavonoid-Rich Fruit Intake in Midlife and Late-Life and Associations with Risk of Dementia: The Framingham Heart Study JPAD-JOURNAL OF PREVENTION OF ALZHEIMERS DISEASE Lyu, C., Jacques, P. F., Doraiswamy, P. M., Young, B., Gurnani, A. S., Au, R., Hwang, P. H. 2024: 1270-1279

  Abstract

  Fruits are an important source of flavonoids, and greater intake of dietary flavonoids in older adults has been shown to be associated with decreased risk of dementia. It is unclear whether this relationship is similar or different between younger adults and older adults.We examined for associations between midlife and late-life intake of flavonoid-rich fruits and incident dementia. We hypothesized that greater total cumulative intake of flavonoid-rich fruits in midlife and late-life adults would be associated with reduced risk of all-cause dementia.Longitudinal, cohort study design.Framingham Heart Study, which is a longitudinal, multi-generational community-based cohort based in Framingham, Massachusetts, USA.Participants from the Framingham Heart Study Offspring cohort were included (n = 2,790) who attended the fifth core exam between 1991 to 1995, and were dementia-free and at least 45 years of age at that time, as well as had valid food frequency questionnaires from the fifth to ninth core exams.Consumption of fruits with high flavonoid content or are important contributors to overall flavonoid intake was collected via food frequency questionnaire. Flavonoid-rich fruits from the food frequency questionnaire included raisins or grapes, prunes, bananas, fresh apples or pears, apple juice or cider, oranges, orange juice, grapefruit, grapefruit juice, strawberries, blueberries, and peaches, apricots, or plums. Dementia ascertainment was based on a multidisciplinary consensus committee, and included all-cause dementia and Alzheimer's disease dementia diagnoses based on research criteria. Cox models were used to examine associations between cumulative fruit intake and incident dementia, stratified by midlife (45-59 years; n = 1,642) and late-life (60-82 years; n = 1,148).Greater cumulative total fruit intake in midlife, but not late-life, was significantly associated with a 44% decreased risk of all-cause dementia (HR = 0.56; 95% CI = 0.32 - 0.98; p = 0.044). Decreased risk of all-cause dementia was also associated with higher intake of apples or pears in midlife and late-life, as well as higher intake of raisins or grapes in midlife only, and higher intake of oranges, grapefruit, blueberries, and peaches, apricots, or plums in late-life only.Among participants from the Framingham Heart Study, greater overall consumption of flavonoid-rich fruits in midlife was associated with reduced risk of dementia, though intake of specific fruits in midlife and late-life may have a protective role against developing dementia. These findings may help to inform future recommendations on when dietary interventions may be most beneficial to healthy brain aging across the life course.

  View details for DOI 10.14283/jpad.2024.116

  View details for Web of Science ID 001251084400002

  View details for PubMedID 39350372

  View details for PubMedCentralID PMC11436402

• Understanding Tendon Fibroblast Biology and Heterogeneity. Biomedicines DiIorio, S. E., Young, B., Parker, J. B., Griffin, M. F., Longaker, M. T. 2024; 12 (4)

  Abstract

  Tendon regeneration has emerged as an area of interest due to the challenging healing process of avascular tendon tissue. During tendon healing after injury, the formation of a fibrous scar can limit tendon strength and lead to subsequent complications. The specific biological mechanisms that cause fibrosis across different cellular subtypes within the tendon and across different tendons in the body continue to remain unknown. Herein, we review the current understanding of tendon healing, fibrosis mechanisms, and future directions for treatments. We summarize recent research on the role of fibroblasts throughout tendon healing and describe the functional and cellular heterogeneity of fibroblasts and tendons. The review notes gaps in tendon fibrosis research, with a focus on characterizing distinct fibroblast subpopulations in the tendon. We highlight new techniques in the field that can be used to enhance our understanding of complex tendon pathologies such as fibrosis. Finally, we explore bioengineering tools for tendon regeneration and discuss future areas for innovation. Exploring the heterogeneity of tendon fibroblasts on the cellular level can inform therapeutic strategies for addressing tendon fibrosis and ultimately reduce its clinical burden.

  View details for DOI 10.3390/biomedicines12040859

  View details for PubMedID 38672213

  View details for PubMedCentralID PMC11048404

• Surgeon Communication of Prognosis in Pancreatic Cancer: A Single-institution Pilot Study Using the VitalTalk ADAPT Framework Dickerson, L. K., Allen, G. I., Chauhan, S. B., Lipson, T. A., Young, B., O'Connell, K. M., Sham, J. G. SPRINGER. 2024: S178

  View details for Web of Science ID 001185577500393