SUNY Downstate Health Sciences University (Downstate) is a public medical school and hospital in Brooklyn, New York. It is the southernmost member of the State University of New York (SUNY) system and the only academic medical center for health education, research, and patient care serving Brooklyn's 2.5 million residents. As of Fall 2018, it had a total student body of 1,846 and approximately 8,000 faculty and staff.Downstate Medical Center comprises a College of Medicine, Colleges of Nursing and Health Related Professions, Schools of Graduate Studies and Public Health, and University Hospital of Brooklyn. It also includes a major research complex and biotechnology facilities.SUNY Downstate ranks eighth nationally in the number of alumni who are on the faculty of American medical schools. More physicians practicing in New York City graduated from Downstate than from any other medical school. With 1,040 residents (young physicians in training), Downstate's residency program is the 16th largest in the country.SUNY Downstate Medical Center is the fourth largest employer in Brooklyn. Eighty-six percent of its employees are New York City residents; 68 percent live in Brooklyn. The medical center's total direct, indirect, and induced economic impact on New York State is in excess of $2 billion. SUNY Downstate Medical Center attracted close to $100 million in external research funding in 2011, which includes $26 million from federal sources. It ranks fourth among SUNY campuses in grant expenditures, and second among SUNY's academic health centers.
AbstractCyclin-dependent kinase 4/6 (CDK4/6)-specific inhibitors, such as palbociclib, have shown clinical efficacy, but primary or secondary resistance has emerged as a problem. To develop more effective therapeutic approaches, investigation is needed into the mechanisms of resistance or adaption. Here, it is demonstrated that CDK2 compensates for loss of CDK4 activity to rescue palbociclib-arrested breast cancer cells, suggesting that inhibition of both kinases is required to achieve durable response. In addition, a novel strategy is described to inhibit tyrosine phosphorylation of p27Kip1 (CDKN1B) and simultaneously inhibit both CDK2 and CDK4. p27Kip1 is a required assembly factor for cyclin–CDK4 complexes, but it must be phosphorylated on residue Y88 to open or activate the complex. The Brk-SH3 peptide, ALT, blocks p27 Y88 phosphorylation, inhibiting CDK4. Nonphosphorylated p27 is no longer a target for ubiquitin-mediated degradation and this stabilized p27 now also inhibits CDK2 activity. Thus, ALT induction inhibits both the kinase that drives proliferation (CDK4) and the kinase that mediates resistance (CDK2), causing a potent and long-lasting cell-cycle arrest. ALT arrests growth of all breast cancer subgroups and synergizes with palbociclib to increase cellular senescence and to cause tumor regression in breast cancer xenograft models. The use of ALT demonstrates that both CDK4 and CDK2 need to be inhibited if long-term efficacy is to be achieved and represents a novel modality to inhibit breast cancer cells.Implications: Modulating tyrosine phosphorylation of p27 impacts both proliferative (CDK4) and resistance (CDK2) mechanisms in breast cancer and suggests that phospho-p27 status may serve as a biomarker for patients that are responsive to CDK4/6 inhibition. Mol Cancer Res; 16(3); 361–77. ©2018 AACR.
To compare venous thromboembolism (VTE) events in patients undergoing open reduction and internal fixation (ORIF) of acetabular fractures who did and did not receive weight-based dosing of prophylactic enoxaparin. This retrospective cohort study included patients with acetabular fractures treated with ORIF between 2013 and 2020 at a single level-1 trauma center. Patients with pre-existing VTE, allergy, no enoxaparin use, or receipt of other prophylactic agents were excluded. Patients were categorized as having received appropriate or inappropriate weight-based enoxaparin dosing based on institutional BMI-tiered protocol. The primary outcome was incidence of VTE, including deep vein thrombosis (DVT) and pulmonary embolism (PE). Group comparisons were performed with Pearson’s Chi-square, and binomial logistic regression was used to adjust for additional VTE risk factors. Among 363 patients, 198 (54.5
Hangman’s fracture, defined as a bilateral pars interarticularis fracture of C2, is a common cervical spine injury treated either conservatively or surgically depending on fracture stability and displacement. Conservative immobilization often provides satisfactory fusion in stable patterns, whereas operative fixation is increasingly used in unstable injuries. Despite widespread use of both approaches, evidence comparing long-term outcomes and complication profiles remains inconsistent. This study aimed to compare surgical versus conservative management of Hangman’s fractures with respect to union and treatment-related complications through a meta-analysis of comparative studies. A systematic review was conducted in accordance with PRISMA and Cochrane Collaboration standards. PubMed, Scopus, Cochrane Library, and Google Scholar were searched through November 2025. Comparative clinical studies evaluating adult patients with traumatic Hangman’s fractures treated operatively or nonoperatively were included. Methodological quality and risk of bias were assessed using the ROBINS-I tool. Six retrospective studies comprising 197 adults (11–62 per study) met eligibility criteria. All included studies had an overall moderate risk of bias. Surgical and conservative management did not differ significantly in rates of nonunion (RR = 4.33; p = 0.09), treatment failure including conversion or revision (RR = 2.19; p = 0.18), posttreatment stiffness (RR = 0.98; p = 0.95), infection (RR = 0.42; p = 0.21), neurologic complications (RR = 1.03; p = 0.97), or one-year mortality (RR = 1.64; p = 0.65). Conservative management demonstrated significantly fewer miscellaneous complications such as delirium, DVT, and dysphagia (RR = 0.46; p = 0.002). Based on observational evidence, nonoperative treatment of Hangman’s fractures achieves outcomes comparable to surgical fixation regarding union, neurological preservation, and functional recovery, with fewer treatment-related complications in appropriately selected, stable patients, whereas surgical stabilization remains necessary for unstable fractures or in patients for whom prolonged immobilization is unsuitable. Additional prospective randomized studies are needed to refine patient selection and enhance individualized management strategies.
Robot-assisted and navigation-guided spinal instrumentation technologies have transformed spine surgery by improving precision and intraoperative safety. Despite widespread adoption, their relative performance across perioperative efficiency, radiographic accuracy, and complication profiles remains insufficiently clarified. A systematic search of PubMed, Scopus, Cochrane Library, and Google Scholar was conducted through December 2025. Sixteen comparative studies involving 59,474 patients (robot-assisted = 11,059; navigation-guided = 48,787) were included. Extracted outcomes included operative time, blood loss, length of stay, radiation exposure, fluoroscopy duration, screw deviation, endplate breach, facet violation, Cobb angle correction, and intra- and postoperative screw revision and complication rates. Pooled effect estimates were calculated for continuous and dichotomous variables. Subgroup analyses were performed according to underlying spinal pathology (degenerative lumbar fusion, thoracolumbar posterior instrumentation, and spinal deformity). Robot-assisted surgery demonstrated significantly shorter fluoroscopy time (MD − 3.44 s; p = 0.03), lower pedicle screw deviation (MD − 0.16 mm; p = 0.003), and fewer intraoperative screw revisions (RR 0.42; p = 0.009). Navigation-guided surgery showed lower endplate breach rates (RR 2.32; p = 0.007). No significant differences were observed in operative time, blood loss, length of stay, total radiation exposure, facet violation, Cobb angle correction, or overall complication rates (all p > 0.05). Subgroup analyses showed overall consistency across pathology types: in degenerative lumbar fusion cohorts, robotic assistance was associated with reduced radiation exposure (MD − 5.27 mSv; p < 0.001) and fewer intraoperative screw revisions (RR 0.41; p = 0.02), whereas in deformity cohorts, navigation-guided techniques demonstrated shorter operative time (MD 11 min; p = 0.01) and lower radiation exposure (MD 11.42 mSv; p < 0.001). Most other outcomes remained comparable across subgroups. Current evidence suggests broadly comparable short-term outcomes between robotic-assisted and navigation-guided spinal surgery. However, while each modality demonstrated selective technical advantages, the overall strength of evidence remains insufficient to support definitive comparative conclusions. High-quality randomized trials are warranted.
