Faculty Bibliography

IMPORTANCE/UNASSIGNED:Currently, there are no standardized outcome domains or measures in clinical trials for facial aging. Heterogeneity in outcome domains and measurement instruments across clinical trials creates difficulty in directly comparing interventions, determining superior therapies, and developing high-quality meta-analyses. OBJECTIVE/UNASSIGNED:To develop a core outcome set (COS) of essential domains to be reported in clinical trials evaluating the efficacy of interventions for facial aging. EVIDENCE REVIEW/UNASSIGNED:PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials, and CINAHL were searched from September 2005 to September 2015. An updated search of the same databases was performed from September 2015 to February 2026. Studies were included if (1) they were randomized clinical trial or controlled clinical trial in design, (2) they assessed the efficacy or safety of an intervention for facial aging, (3) they were published in English, and (4) they involved human participants. Complementary sources, including patient interviews, were used to capture further relevant outcomes. Two rounds of Delphi surveys, followed by consensus meetings, were used to identify outcome domains considered most important by both patient and physician stakeholders. FINDINGS/UNASSIGNED:The final COS consists of 6 outcome domains: (1) overall convenience of treatment; (2) time to return to normal work and social activity; (3) overall assessment of focused area of treatment (at the point in time when treatment is expected to provide peak benefit); (4) duration of treatment effect; (5) severity of persistent local or systemic adverse events, including pigmentary change, skin texture change, delayed healing, scarring, and serious adverse events; and (6) patient satisfaction with treatment. CONCLUSIONS AND RELEVANCE/UNASSIGNED:The 6 outcome domains identified through a Delphi consensus are recommended for reporting in future facial aging trials to ensure that outcomes that matter most to patients and clinicians are measured and that results are comparable across interventions.

BACKGROUND AND IMPORTANCE/UNASSIGNED:Closed reduction is an important adjunct in the surgical management of traumatic cervical facet dislocations, particularly jumped and locked facets. By restoring normal spinal alignment, successful closed reduction allows the surgeon to proceed with surgical stabilization via an anterior-first approach, obviating the need to rotate a dislocated, biomechanically unstable cervical spine, thereby minimizing the risk of iatrogenic spinal cord injury. While closed reduction has traditionally been achieved with Gardner-Wells tongs and weights, this reduction method requires the patient to remain bedbound for prolonged periods of time, is not MRI-compatible, and is associated with inconsistent results. CLINICAL PRESENTATION/UNASSIGNED:We present two patients with bilaterally jumped and locked cervical facets, in whom a closed manual reduction technique was used, allowing rapid spinal realignment prior to surgical stabilization. We provide a detailed video illustration of this technique, emphasizing the steps involved and relevant technical nuances. While this technique might have been previously used and rarely reported, it has not, to the best of our knowledge, been described in a detailed, step-by-step fashion. CONCLUSION/UNASSIGNED:Closed manual reduction of traumatic cervical facet dislocations can be performed safely and effectively in the operating room prior to definitive surgical stabilization of the spine. This technique should not be attempted in patients with severe spinal cord compression or neurologic compromise. The importance of adequate muscle relaxation provided by general anesthesia and continuous intraoperative feedback provided by live fluoroscopy and neurophysiologic monitoring cannot be overemphasized.

This study evaluates the repeatability of a 3D simultaneous

INTRODUCTION/UNASSIGNED:Medicaid spent over 129 billion dollars on home- and community-based services (HCBS) in 2022. However, complex financing structures obscure which services are used, who uses them, and how use varies across states. METHODS/UNASSIGNED:Using 100% of national Medicaid claims data from 2021, we characterize HCBS use among dual-eligible adults aged 65 and older, distinguishing between direct care services (services that provide hands-on assistance with functional needs) and non-direct care services (eg, transportation and case management), which are often grouped together in the literature. RESULTS/UNASSIGNED:We find that 38% of older duals used any Medicaid-funded HCBS in 2021, and 26% used direct care, with direct care users being older, sicker, and more likely to have dementia than non-users. We also find that the share of older duals using direct care varies more than 4-fold between the lowest and highest utilization states, with states that finance personal care as a State Plan benefit, rather than exclusively through waiver programs, generally having greater utilization. CONCLUSION/UNASSIGNED:In light of potential funding cuts, our findings highlight the large but uneven role that Medicaid plays in financing direct care for a vulnerable population of older adults, which can be critical for them to remain in their homes and communities.

ObjectiveTo assess the incidence of Robin Sequence in the United States and evaluate predictors of early morbidity and mortality.DesignRetrospective cohort study.SettingEpic Cosmos database.Patients, ParticipantsPatients with Robin Sequence diagnosed within the first year of life from January 2015 to December 2024.InterventionsVariables including prenatal drug exposure (PDE), prematurity, intrauterine growth restriction (IUGR), concomitant airway diagnoses, genetic syndromes, and anomalies of the cardiopulmonary, gastrointestinal, or central nervous system (CNS) were captured.Main Outcome Measure(s)Incidence across a 10-year period and associations with admission to the neonatal intensive care unit (NICU) and length of stay (LOS), 30-day readmission and ED visit, and one-year mortality through a multivariate logistic regression.Results3863 patients were identified, for an incidence of 1 in 3713 live births. NICU admission was significantly associated with PDE, prematurity, IUGR, tracheomalacia, laryngomalacia, cleft palate, and presence of a cardiopulmonary or CNS anomaly. NICU LOS was associated with prematurity, bronchomalacia, and the presence of a gastrointestinal anomaly. 30-day readmission was associated with PDE, prematurity, tracheomalacia, laryngomalacia, cleft palate, cardiopulmonary anomalies, and CNS anomalies. 30-day ED visit was associated with prematurity, tracheomalacia, cleft palate, cardiopulmonary anomalies, and CNS anomalies. One-year mortality was associated with prematurity, IUGR, cardiopulmonary anomalies, and CNS anomalies.ConclusionsSignificant associations were identified between morbidity and mortality and perinatal factors, concomitant airway diagnoses, and the presence of cardiopulmonary and CNS anomalies. These findings underscore the importance of an early comprehensive evaluation for patients with Robin Sequence.

Neurons undergo extensive metabolic reprogramming during differentiation; this reprogramming leads to specific changes in the kinetics and concentrations of metabolites. We developed an in-cell NMR-based method that monitors this metabolic transformation with subminute time resolution. Undifferentiated SH-SY5Y human neuronal precursor cells were encapsulated into alginate gel beads and differentiated inside the gel. Real time pulse chase (RTPC) in-cell NMR was used to measure relative steady state concentrations of glycolysis and TCA cycle metabolites and the kinetics of metabolite production and clearance in differentiated and undifferentiated cells. Neuronal differentiation slowed glycolysis, increased TCA cycle activity and glutamate production. Fructose 1,6 bisphosphate and glutathione were identified as major biomarkers of undifferentiated and differentiated cells, respectively. The results demonstrate that RTPC-NMR analysis of neuronal cells is an effective method for studying changes in metabolite profiles induced by stress and drug-induced stimuli.

INTRODUCTION/UNASSIGNED:Few populations face more disadvantage than those with lifelong intellectual and developmental disabilities (IDD) and those with serious mental illness (SMI). People with IDD may face unique challenges in the manifestation and treatment of SMI; little is known about these challenges during the widespread expansion of telehealth mental health services during the COVID-19 pandemic which disrupted service availability. METHODS/UNASSIGNED:Using Medicaid claims from Kansas, Massachusetts, New York and South Carolina, mental health service utilization patterns for three cohorts of people ages 1-45 years were studied: those with IDD, those with SMI, and those with SMI and IDD. Utilization was examined before (2018-2019) and during (2020-2021) the emergence of telehealth services for each cohort. Meta-analysis was used to compare odds of mental health service utilization by demographic subgroups. RESULTS/UNASSIGNED:The prevalence of mental health service utilization was approximately 75% for the IDD/SMI cohort, 60% for the SMI cohort, and 30% of the IDD cohort in 2018. Teens 13-17 years and young adults tended to have the highest levels of service utilization. Service utilization was driven by different diagnoses for the groups. The SMI cohort utilized services significantly more for mood and anxiety disorders, and the IDD cohort utilized services significantly more for comorbid neurodevelopmental conditions, anxiety, and trauma-related disorders. The IDD/SMI cohort utilized services more bipolar and related disorders and had a younger median age of service utilizers for trauma- and stress-related disorders than the SMI cohort. DISCUSSION/UNASSIGNED:The IDD/SMI cohort had the highest mental health service utilization rates compared to the other two cohorts, with minimal urban-rural differences, suggesting mental health services may be reaching those at the highest levels of risk for adverse outcomes. People with IDD demonstrated substantially lower rates of telehealth utilization for mental health needs; however, people in the cohort with IDD and SMI demonstrated similar or higher rates (in adults) of telehealth utilization compared to people with SMI only. Even with expanded telehealth services, the COVID-19 pandemic appeared to partially disrupt utilization across all cohorts and age groups. Findings suggest that people with IDD and SMI experience trauma- and stressor-related disorders that require treatment at younger ages than people with SMI only.

In presynaptic nerve terminals, the endocytic apparatus rapidly restores synaptic vesicles after neurotransmitter release. Many endocytic proteins localize to the periactive zone, a loosely defined area adjacent to active zones. A prevailing model posits that recruitment of these endocytic proteins to the periactive zone is activity-dependent. We show that periactive zone targeting of endocytic proteins is largely independent of active zone machinery and synaptic activity. At mouse hippocampal synapses and Drosophila neuromuscular junctions, pharmacological or genetic silencing resulted in unchanged or increased levels of endocytic proteins including Dynamin, Amphiphysin, Nervous Wreck, Endophilin A, Dap160/Intersectin, PIPK1γ, and AP-180. Similarly, disruption of active zone assembly via genetic ablation of active zone scaffolds at each synapse did not impair the localization of endocytic proteins. Overall, our work indicates that endocytic proteins are constitutively deployed to the periactive zone and supports the existence of independent assembly pathways for active zones and periactive zones.

PURPOSE/OBJECTIVE:This study evaluates radiographic outcomes and reoperations in patients undergoing anterior vertebral body tethering (VBT) of the lumbar spine. METHODS:A retrospective review of an EOS database identified pediatric patients who underwent lumbar VBT. Demographic and surgical data were collected, as well as radiographic and clinical outcomes including complications, reoperations, and conversion to posterior spinal fusion (PSIF). Analyses included paired t-tests, Wilcoxon signed-rank tests and chi-square. RESULTS:Thirty-two patients with idiopathic scoliosis who underwent thoracolumbar VBT with 2-year follow-up were included. Mean age at surgery was 13.7 ± 1.8 years (mean follow-up 2.0 ± 0.2 years); median Sanders score was 3 (50% ≤ 3). Lumbar Cobb decreased from 48° ± 12 to 20° ± 10 postoperatively (p < 0.001) with correction loss to 29° ± 12 at 2 years (p < 0.001). Tethered Cobb decreased from 46° ± 8 to 13° ± 9 postoperatively (p < 0.001), with correction loss to 17° ± 12 at 2 years (p = 0.284). At 2 years, 31% had > 5° of correction loss and 84% had a tethered Cobb < 30°. Correction loss did not differ by Sanders stage (p = 0.92). Seven patients (23.3%) demonstrated > 5° of additional curve correction postoperatively. Four patients (12.5%) had unplanned reoperation and five others (15.6%) required PSIF: 28.1% total reoperation rate. CONCLUSIONS:Lumbar VBT provided substantial initial correction with maintenance of correction across the tethered levels at 2-year follow-up. While most patients maintained a tethered Cobb angle < 30° at 2 years, 28.1% of patients underwent reoperation (12.5% UPROR; 15.6% PSIF conversion). Longer follow-up in larger multicenter cohorts is required to more accurately define lumbar VBT durability and conversion-to-fusion risk. LEVEL OF EVIDENCE/METHODS:IV.