Faculty Bibliography

The extended care for deceased organ donors can be challenging for resource-constrained hospitals that do not have the staff, equipment, or expertise to manage a donor. Donor care units provide a dedicated space and team for donor management, which allows for efficient and effective care. In 2020, the transplant institute at a New York City hospital established the first hospital-based donor care unit in the city with its local organ procurement organization to help alleviate the organ crisis in the United States. Hospital-based donor care units require a trusting relationship between the organ procurement organization and donor management team to maximize every donor's gift.

UNLABELLED:<p>Introduction: Tremor-predominant Parkinson's disease (TPPD) generally responds favorably to deep brain stimulation (DBS) targeting the subthalamic nucleus (STN). However, traditional stereotactic targeting of the STN does not universally yield the anticipated intraoperative improvement, prompting exploration of additional targets to achieve optimal results prior to permanent implantation of electrodes. The posterior subthalamic area (PSA), including the caudal zona incerta (cZI), have been associated with tremor suppression and can be easily compared to the neighboring STN intraoperatively. METHODS:We retrospectively compared intraoperative and clinical outcomes in tremor-dominant PD patients who prospectively underwent dual trajectory microelectrode monitor targeting the STN and PSA/cZI. We compared the neurophysiology and tremor response of both the central (STN) and posterior (PSA) trajectories in 22 patients and analyzed outcomes in those who ultimately received traditional STN (16) or PSA/cZI lead implantation (12). RESULTS:While both groups achieved substantial overall motor improvement under chronic stimulation, intraoperative test stimulation through the posterior path produced more consistent tremor arrest compared with STN. These findings suggest that positioning the DBS lead further posteriorly to engage the PSA can augment tremor suppression in select cases of TPPD without compromising other parkinsonian symptom relief. CONCLUSION/CONCLUSIONS:Our results emphasize the value of intraoperative physiological feedback in trajectory selection in tremor-predominant patients and are consistent with emerging literature that PSA/cZI DBS is an effective and potentially superior target for management of tremor in PD. </p>.

BACKGROUND:Despite a high incidence of tracheostomy-related airway complications with potentially life-threatening implications, nonsurgical tracheostomy first-responders receive limited formal education on the management of tracheostomy emergencies. While the U.K. has developed multidisciplinary guidelines and education for tracheostomy emergencies, such programs have not been widely implemented in the United States. OBJECTIVE:We evaluated the feasibility and effectiveness of an immersive virtual reality (VR) simulation training as a potential generalizable and scalable approach to tracheostomy-related emergency training. METHODS:Over the academic year 2023-2024, critical care fellows were randomized to participate in tracheostomy emergency training either via immersive VR simulation or via small group discussion sessions facilitated by expert faculty. After each case-based educational intervention, participants were asked to manage four simulated tracheostomy-related emergencies involving common tracheostomy complications. Fellow performance was evaluated using a purpose-built task trainer. Three independent and blinded graders completed fellow scoring using a checklist assessment for which validation evidence was also collected. Fellows received pre- and post-intervention surveys to measure attitudes towards VR training. RESULTS:Nineteen out of 27 eligible fellows participated in the study, managing a total of 76 simulated tracheostomy emergencies. There were 10 fellows in the VR arm and 9 fellows in the Small Group arm. Out of a total possible 26 points on the checklist assessment, fellows in the VR group scored an average of 18.03 ± 3.39 compared to the Small Group score of 16.96 ± 4.41 (P = .558). Surveys indicated improvements in fellow confidence after the training and high levels of acceptance of the VR curriculum. CONCLUSIONS:An immersive VR educational intervention for the management of tracheostomy-related emergencies was feasible and well-received by learners. There was no significant difference in post-training checklist assessment scores between the VR and Small Group participants, suggesting non-inferiority of the VR intervention, and contributing validation evidence to our task trainer simulation assessment. FUNDING/BACKGROUND:This study was funded via the APCCMPD, CHEST, and ATS Education Research Award.

INTRODUCTION/BACKGROUND:Use of the direct anterior approach (DAA) in total hip arthroplasty (THA) has increased, with suggested benefits of faster recovery and less pain. However, consensus regarding the optimal approach is lacking. This study compared post-operative pain, functional recovery, and opioid use between DAA and posterior approach (PA) THA. METHODS:-tests. RESULTS: 0.001), but these small differences do not reflect clinical significance. MME comparison showed a trend towards decreased opioid consumption within the DAA cohort, but the clinical relevance of these differences is unknown. CONCLUSIONS:Pain, function, and opioid use were largely comparable between DAA and PA, with minor statistical differences unlikely to be clinically meaningful.

Lysosomal phospholipid degradation produces two types of metabolites, either 2-lysophospholipids with saturated fatty acids in sn-1 position or 1-lysophospholipids with unsaturated fatty acids in sn-2 position. They may either be degraded further or re-used for phospholipid synthesis. We found that LPLAT7 (LPGAT1), an acyltransferase of the endoplasmic reticulum, re-acylates specifically lysosome-derived 1-lysophospholipids that carry an unsaturated chain. The enzymatic activity of LPLAT7 was specific for stearoyl-CoA and 1-lyso-2-acyl positional isomers of unsaturated lysophospholipids. In Huh7 cells, Lplat7 knockout prevented the reacylation of 1-lysophospholipids generated by the lysosomal degradation of exogenous ²H-phosphatidylcholine. Inhibition of lysosomal phospholipid degradation reduced the abundance of 1-stearoyl-2-unsaturated PC in Huh7 cells. Lplat7 knockout blunted the loss of unsaturated lysophosphatidylcholine (LPC) in response to lysosomal inhibition, suggesting that LPLAT7 consumes unsaturated LPC formed by lysosomes. In mice, Lplat7 knockout increased the concentration of unsaturated lysophospholipids, reduced the abundance of 1-stearoyl-2-unsaturated species of phosphatidylcholine, phosphatidylethanolamine, and phosphatidylserine, and inhibited the regeneration of cellular membranes. It also triggered the accumulation of triglycerides, confirming earlier reports that unsaturated lysophospholipids induce lipid droplet formation. Thus, by re-acylating unsaturated 1-lysophospholipids, LPLAT7 shifts lipid metabolism from the biogenesis of lipid droplets to the biogenesis of membranes.

BACKGROUND:Using high-frequency jet ventilation (HFJV) to improve catheter stability with conventional energy sources during atrial fibrillation (AF) ablation is associated with higher ablation success and improved arrhythmic outcomes. The utility of HFJV with pulsed field ablation (PFA) for AF is unclear. We investigated the utility of HFJV vs. standard ventilation in PFA for AF. METHODS:We studied consecutive cases of patients with AF undergoing PFA between 5/6/24 to 10/10/24. Procedural data collected included total procedure time and major periprocedural complications. Clinical data collected included atrial tachyarrhythmia (ATA) recurrence, stroke, and major bleeding at one-year follow-up. Outcomes were compared in cases where HFJV was used vs. standard ventilation. RESULTS:A total of 512 patients were included in this study (307 standard ventilation, 205 HFJV). There was no difference in ATA recurrence by Kaplan-Meier survival analysis between standard ventilation and HFJV groups (log rank test p = 0.59). When comparing standard ventilation vs. HFJV groups, there was no difference in ATA recurrence at one year (23% vs. 26%; p = 0.43), AF burden on continuous monitoring (9 ± 5% vs. 8 ± 24%; p = 0.85), total procedure time (114 ± 38 vs. 115 ± 33 min; p = 0.78), or major periprocedural complications (3% vs. 2%; p = 0.64). There was no difference in arrhythmic outcomes when patients were stratified by AF type and whether patients presented for first-time or redo ablation. CONCLUSION/CONCLUSIONS:Using HFJV in PFA for AF produces similar sinus rhythm maintenance overall and when stratified by AF type without affecting procedure times or complication rate.

BACKGROUND/UNASSIGNED:The aging and caregiving population is becoming increasingly diverse in the United States, leading to a growing need for culturally adapted interventions to address the unique needs of underrepresented groups, such as Asian Americans. However, interventions targeting Asian Americans and exploring cultural adaptation strategies remain limited in dementia caregiving research. OBJECTIVE/UNASSIGNED:This study aimed to describe the cultural adaptation process of an evidence-based intervention for Chinese and Korean American dementia caregivers, called the New York University Caregiver Intervention-Enhanced Support. METHODS/UNASSIGNED:We conducted a deductive content analysis and categorized our adaptation strategies into 5 elements: content, context, relationship fidelity and core elements, engagement, and cultural competence. Timing and types of responses to each adaptation strategy were also observed. Two authors conducted the initial analysis, and additional team members finalized the synthesis through discussion. The Template for Intervention Description and Replication (TIDieR) checklist was used to guide the methodological rigor. RESULTS/UNASSIGNED:Twenty-four major adaptations were identified and categorized. For content, we translated materials, used culturally relevant terms, incorporated ethnic-specific surveys and resources, created social media support groups on platforms widely used by the targeted population, and extended the time allocated to complete the 6 counseling sessions. Context adaptation included expanding the range of individuals eligible for family counseling sessions to include fictive kin, using online and social media apps for communication, cultural matching and training of staff, and partnerships with relevant community organizations. Relationship fidelity and core elements involved consulting with community experts, conducting focus group interviews with caregivers, having regular meetings with the developer of the original intervention and an experienced New York University Caregiver Intervention-Enhanced Support clinician as well as experts in Chinese and Korean culture, and continuing regular counseling supervision. To enhance engagement, we provided clear explanations of the study procedure, which emphasized the benefits in participants' native languages and matched participants with social workers who shared the same cultural backgrounds. We also used a step-by-step contact approach and prolonged communication, explained staff roles to build rapport, and offered participant compensation. Finally, cultural competence was reflected in tailoring counseling techniques with respect for cultural beliefs, the use of euphemistic language for taboo subjects, and culturally appropriate refreshments to show respect and build interpersonal relationships. CONCLUSIONS/UNASSIGNED:We systematically adjusted a counseling-based intervention, an approach less familiar among Asian Americans, to fit the cultural characteristics of the target population. A contribution of this study is using an integrated, theory-driven approach that combines 2 cultural adaptation frameworks while also capturing real-time adaptations informed by external feedback and self-reflection. This work provides a practical model for adapting evidence-based interventions to serve Chinese and Korean American dementia caregivers and may inform future adaptations for other East Asian populations.

BACKGROUND:Lumbar spinal stenosis (LSS) is a prevalent cause of pain and disability in elderly individuals, characterized primarily by neurogenic claudication resulting from narrowed spinal canals. Traditional treatment for LSS spans from conservative approaches to decompressive surgery, the latter of which poses significant complication risks. Minimally Invasive Lumbar Decompression® (MILD®, Vertos Medical) offers a less invasive alternative, with its efficacy supported by preliminary studies such as the MiDAS ENCORE. OBJECTIVE:This retrospective study evaluates the real-world outcomes of the MILD® procedure in managing LSS accompanied by hypertrophied ligamentum flavum (HLF) in 300 patients who have failed conservative management. STUDY DESIGN/METHODS:A single-center observational study. METHODS:We conducted a retrospective review of 300 patients treated with MILD® at a single center in Northern New Jersey. Patients had documented cases of central LSS with HLF and persistent symptoms despite being treated with conventional therapies. The procedure involved percutaneous lumbar decompression using fluoroscopic guidance. Outcomes measured included scores on the Numeric Pain Rating Scale (NPRS) and patient-reported improvement percentages at intervals of up to one year. RESULTS:MILD® significantly reduced NPRS scores at all follow-up points, with the most substantial improvements noted within 3 months after the operation and sustained benefits up to a year. The average patient-reported improvement in pain and function was robust, beginning as early as 2 weeks after the procedure. No serious adverse events were reported, affirming the procedure's safety. LIMITATIONS/CONCLUSIONS:The absence of a control group and the study's single-center nature might have limited the generalizability of results. These factors highlight the necessity for multicenter controlled trials to validate findings across diverse populations. CONCLUSION/CONCLUSIONS:The MILD® procedure is a safe and effective treatment for LSS, providing significant and sustained improvements in pain and function, making the technique particularly suitable for patients ineligible for surgery or at higher risk of experiencing complications from it.

PURPOSE OF REVIEW/OBJECTIVE:Recent high-quality outcomes research shows that anesthetic technique in nonoperating room anesthesia influences procedural performance, intraprocedural stability, and recovery. RECENT FINDINGS/RESULTS:In gastrointestinal endoscopy, noninvasive oxygenation strategies reduce hypoxemia, and remimazolam provides improved cardiopulmonary stability compared with propofol. Sedation depth may also affect the detection of serrated polyps. In bronchoscopy and interventional pulmonology, remimazolam and regional analgesic strategies improve respiratory and hemodynamic tolerance. In neurointerventional radiology and electrophysiology, general anesthesia does not consistently improve major outcomes and may prolong procedures or increase complications. In electroconvulsive therapy, processed electroencephalogram-guided timing and anesthetic dose reduction may reduce airway interventions while preserving effectiveness. SUMMARY/CONCLUSIONS:Recent evidence across a diverse selection of nonoperating room anesthesia environments demonstrates outcomes that have advanced the field and inform anesthetic decisions.