Faculty Bibliography

Surgical repair of extracapsular hip fractures is associated with a higher rate of successful healing compared to intracapsular fractures; however, a small subset of patients may still experience complications or treatment failure. Potential modes of failure include nonunion, peri-implant fracture, malalignment, cortical impingement or perforation and hardware failure with or without lag screw cutout. Factors determining salvage method include physiologic age, functionality, bone quality, and fracture stability. In this review, potential complications of extracapsular hip fracture repair are described with proposed solutions and supporting literature, when available.

BACKGROUND:Minimally invasive surgery (MIS) chevron osteotomy has emerged as an alternative to the traditional open chevron (OC) osteotomy for hallux valgus correction, aiming to achieve similar deformity correction with reduced soft-tissue trauma and faster recovery. However, the relative clinical and radiographic outcomes of these techniques remain debated. METHODS:A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. PubMed, EMBASE, and Cochrane databases were searched through June 2025 for randomized controlled trials (RCTs) and cohort studies comparing MIS and OC osteotomies in patients with hallux valgus. Only studies explicitly describing a percutaneous, burr-based V-shaped Chevron osteotomy were included. Primary outcomes included American Orthopaedic Foot & Ankle Society (AOFAS) scores, Visual Analog Scale (VAS) pain scores, radiographic parameters: hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) and complication rates. Random-effects meta-analyses were performed, with subgroup analyses at early (≤6 months), mid-term (6-12 months), and long-term (>12 months) follow-ups. RESULTS:=23 %). CONCLUSION/CONCLUSIONS:This systematic review and meta-analysis demonstrate that MIS Chevron osteotomy provides clinical and radiological outcomes comparable to those of open Chevron osteotomy. Differences in pain scores, angular correction, and complication rates were small and not clinically meaningful. These findings suggest that MIS Chevron is a safe and effective alternative to open Chevron osteotomy.

Monitoring intracellular calcium is central to understanding cell signaling across nearly all cell types and organisms. Fluorescent genetically encoded calcium indicators (GECIs) remain the standard tools for in vivo calcium imaging, but require intense excitation light, leading to photobleaching, background autofluorescence and phototoxicity. Bioluminescent GECIs, which generate light enzymatically, eliminate these artifacts but have been constrained by low dynamic range and suboptimal calcium affinities. Here we show that CaBLAM ('calcium bioluminescence activity monitor'), an engineered bioluminescent calcium indicator, achieves an order-of-magnitude improvement in signal contrast and a tunable affinity matched to physiological cytosolic calcium. CaBLAM enables single-cell and subcellular activity imaging at video frame rates in cultured neurons and sustained imaging over hours in awake, behaving animals. These capabilities establish CaBLAM as a robust and general alternative to fluorescent GECIs, extending calcium imaging to regimes where excitation light is undesirable or infeasible.

BACKGROUND:Arrhythmogenic cardiomyopathy (ACM) is a genetic disorder marked by fibrofatty myocardial replacement, leading to ventricular dysfunction and life-threatening arrhythmias. Historically identified as a right ventricular disease, advances in cardiac magnetic resonance imaging (CMR) have revealed left ventricular involvement in some cases, underscoring the need for refined diagnostic criteria. Conventional echocardiographic methods lack sensitivity, particularly for early disease detection, while strain imaging holds promise for identifying subclinical dysfunction. OBJECTIVE:This review explores the advancements in echocardiographic strain imaging techniques for ACM diagnosis and prognosis, focusing on recent developments in right and left ventricular assessment, differentiation from athletic remodeling, and integration with CMR findings. METHODS:An extensive review of contemporary literature was conducted, analyzing diagnostic thresholds, prognostic significance, and the utility of echocardiographic strain imaging compared to standard measures. FINDINGS/RESULTS:Echocardiographic right ventricular strain assessment offers enhanced diagnostic sensitivity, identifying ACM in cases that fail to meet traditional echocardiographic criteria. Strain provides superior prognostic discrimination, correlating with risk of ventricular arrhythmias and disease progression. Left ventricular strain, particularly global longitudinal strain (GLS), detects subclinical dysfunction and predicts adverse outcomes, emphasizing its importance in left-dominant ACM phenotypes. Strain-based mechanical dispersion metrics also facilitate early disease detection and risk stratification. CONCLUSION/CONCLUSIONS:Echocardiographic strain imaging is a valuable, non-invasive tool for ACM, addressing gaps in traditional echocardiographic diagnostic criteria. Standardization of thresholds and broader integration into clinical practice are required to maximize its utility. Future directions include leveraging machine learning and multimodal imaging for comprehensive ACM characterization.

BACKGROUND/UNASSIGNED:While extremes of body mass index (BMI) are known to influence surgical risks, their distinct impacts on short- and long-term outcomes following hip fracture remain poorly defined. This study compared outcomes in severely underweight, normal weight, and obese elderly patients. METHODS/UNASSIGNED:A retrospective cohort study was conducted using a prospectively collected hip fracture database (2014-2024) at a single academic medical center. Patients with BMI ≤16.5 (severely underweight) or ≥35 (class 2+ obesity) were compared to a randomly selected cohort of normal-weight controls (BMI 18.5-25.0). Outcomes included complications, discharge disposition, mortality, and functional recovery. RESULTS/UNASSIGNED:A total of 282 patients were included. Obese patients had significantly higher odds of intensive care unit (ICU) admission compared to normal weight patients (OR 5.75 [2.00-16.39], p = .001) and were less likely to be discharged home (OR 0.31 [0.14-0.66], p = .003). In contrast, underweight status was significantly associated with increased six-month mortality compared to normal weight (OR 4.95 [1.34-18.18], p = .016). No significant differences were found in healing or functionality across groups. CONCLUSION/UNASSIGNED:Obese patients were more likely to require ICU admission but did not face increased long-term mortality. Severely underweight patients demonstrated the opposite pattern, with minimal short-term morbidity but significantly higher risk of death at six months. These findings suggest that short- and long-term risks after hip fracture diverge at the extremes of BMI and highlight the need for tailored perioperative strategies based on metabolic status.

Astrocytes differentiate and mature during postnatal development, but the molecular mechanisms linking their maturation to neuronal function remain unclear. We investigated the role of Wnt/β-catenin signaling and its effector, the transcription factor TCF7L2, in postnatal astrocytes using single-nucleus RNA sequencing, imaging, morphometric analysis, microdialysis, and electrophysiology in Tcf7l2 conditional knockout (cKO) mice. Loss of Tcf7l2 caused widespread transcriptional dysregulation in astrocytes, particularly in genes related to amino acid and ion transport, as well as membrane potential regulation. These mice showed disrupted amino acid homeostasis, astrocyte swelling, and impaired extracellular potassium clearance in the somatosensory cortex. These astrocytic changes were accompanied by altered gene expression in cortical pyramidal neurons, reduced excitability, and a hyperpolarized resting membrane potential. Our results suggest that astrocytic TCF7L2 is crucial in coordinating ion and amino acid transport in adulthood, thereby contributing to maintaining extracellular homeostasis and supporting neuronal function. This study identifies TCF7L2 as a key regulator of astrocyte-mediated neurophysiological support and underscores the importance of its role in astrocyte maturation during postnatal development.

METHODS:We analyzed the Nuclear Regulatory Commission event notifications related to brachytherapy events that occurred between January 1, 2005, and December 31, 2024. The events were categorized and their distribution and time evolution analyzed. RESULTS:A total of 818 events (227 LDR, 203 HDR, 21 intravascular, 367 microsphere) were identified, excluding events that related purely to shipping. We analyzed the events for the whole period and in consecutive 5-year intervals. The total number of events rose by 27% from the first to the last interval (2005-09:179, 2020-24:227), with the LDR events decreasing by 81% (2005-2009:98, 2020-24: 19) and microsphere events increasing by 588% (2005-09:25, 2020-24:172). HDR events decreased by 15% (2005-09:53, 2020-24:45), while intravascular events increased (2005-09:3, 2020-2024:7) but stayed very rare. . For HDR, the three most frequent categories were treatment planning error (26%), transfer tube issues (13%) and other/unknown issues (13%); the frequency of treatment planning events decreased with time (2005-09: 38%, 2020-24: 18%). For LDR, the three most frequent categories were lost or leaking source (39%), other/unknown issues (24%) and permanent implant sources implanted into wrong tissue (18%). For microspheres, most events were related to the sphere remaining in the delivery apparatus and for intravascular brachytherapy, to the source not retracting. The radioisotopes of LDR events were I-125 (72%), Pd-103 (11%), Cs-137 (8%), Ir-192 (4%), Cs-131 (3%) and Sr-90 (2%); no events relating to Ir-192 or Cs-137 occurred in 2020-24. CONCLUSION/CONCLUSIONS:The reduction in the LDR events is probably explained by the decreased frequency of prostate implants and LDR gynecological procedures. Microspheres now account for most event reports.

Hepatic encephalopathy (HE) is a common complication of decompensated cirrhosis that can be reversed with treatment. Frequent episodes of recurrence are common, impacting patients, caregivers and healthcare systems, increasing morbidity and mortality statistics and resulting in grave financial consequences. Uptake and adherence to formal recommendations for HE diagnosis and management are low. There is an unmet need to advocate for the use of these recommendations in a more pragmatic form. Clinicians from multiple disciplines, dedicated to raising liver disease awareness, convened in a roundtable format to review and discuss the latest HE guidelines and relevant peer-reviewed literature on HE. The result was this clinical care publication on the screening, diagnosis and management of HE which seeks to facilitate clinicians' recognition and diagnosis of HE, apply a pathway of care for HE that addresses steps for initial management, long-term maintenance and prevention; it also addresses practical recommendations concerning situations encountered in HE. Resources are provided to address the different needs of the three key players in HE: patients, caregivers, and healthcare professionals.

PURPOSE/OBJECTIVE:To introduce mtrk, a new open-source tool based on modern software-engineering principles that simplifies pulse-sequence design, implementation, and dissemination. METHODS:The mtrk framework is vendor-agnostic and relies on a compact and human-readable descriptive language. Users can design pulse sequences using either a Python-based programming interface or an intuitive graphical interface. The graphical interface also allows for visualizing pulse-sequence diagrams. A driver sequence was developed to run mtrk sequences on MR scanners. A spin-echo sequence was designed with mtrk and converted to Pulseq for comparison. Both versions were compared to an equivalent vendor sequence in phantom and in vivo experiments. RESULTS:Images from the mtrk and Pulseq versions were nearly identical and showed over 90% similarity compared to the vendor sequence, despite minor unavoidable design differences. Phantom images matched corresponding synthetic images simulated using the same pulse sequences. CONCLUSION/CONCLUSIONS:The mtrk framework simplifies the development of pulse sequences by providing an intuitive descriptive language and compatibility with the Pulseq format. Users can design and simulate pulse sequences using the graphical interface without any programming experience.