Faculty Bibliography

Subjective cognitive decline (SCD) is associated with preclinical Alzheimer's disease (AD). Suboptimal sleep is also a risk factor for cognitive decline, but with unclear relationship to SCD. We conducted a retrospective cross-sectional study in a biracial research cohort of 148 cognitively normal older adults who underwent quantification of SCD (Cognitive Change Index; CCI), sleepiness (Epworth Sleepiness Scale; ESS), depression (Geriatric Depression Scale; GDS), and amyloid/tau PET. ESS score was associated with total, amnestic, and non-amnestic CCI scores, after adjustment for GDS, amyloid/tau burden, and race. This supports future longitudinal work on how sleepiness impacts SCD outcomes.

The continuity of a species depends on germ cells. Germ cells are different from all the other cell types of the body (somatic cells) as they are solely destined to develop into gametes (sperm or egg) to create the next generation. In this review, we will touch on 4 areas of embryonic germ cell development in Drosophila melanogaster: the assembly and function of germplasm, which houses the determinants for germ cell specification and fate and the mitochondria of the next generation; the process of pole cell formation, which will give rise to primordial germ cells (PGCs); the specification of pole cells toward the PGC fate; and finally, the migration of PGCs to the somatic gonadal precursors, where they, together with somatic gonadal precursors, form the embryonic testis and ovary.

This scientific commentary refers to 'Fatigue in early multiple sclerosis: MRI metrics of neuroinflammation, relapse and neurodegeneration', by Meijboom et al. (https://doi.org/10.1093/braincomms/fcae278).

BACKGROUND:Reports suggest neurotization can help restore sensation in patients undergoing implant-based breast reconstruction (IBBR) following nipple-sparing mastectomy (NSM). There is a dearth of information regarding the outcomes and cost associated with neurotization of the nipple-areola complex (NAC). The objective of this study is to determine perioperative complications of performing NAC neurotization in IBBR and analyze the added cost of performing this procedure. METHODS:A retrospective chart review was performed of patients who underwent NSM with IBBR. Breasts undergoing neurotization of the NAC were compared to breasts that did not undergo neurotization using 2:1 propensity score matching on age, reconstruction type, and BMI. Primary endpoints included 30-day complications and cost. Statistical analysis included descriptive statistics, t tests, and chi-square tests where applicable with a predetermined level of significance of P < 0.05. RESULTS:A total of 15 patients (26 breasts) were in the neurotized cohort and matched to 30 patients (52 breasts) in the nonneurotized cohort. Mean follow-up period was 10 months and significantly lower in neurotized group (P < 0.001). Rates of major and minor complications did not vary by neurotization (P > 0.05). Cases of neurotization added a mean cost of $7839 per breast. CONCLUSIONS:As NAC neurotization introduces increased complexity from coordination with the oncologic surgeons, use of microsurgical instruments, and additional implantable devices, it is important to compare perioperative outcomes to standard breast reconstruction. As our institution begins to offer this new technique, we have identified no increased risk of perioperative complications with NAC neurotization.

BACKGROUND/OBJECTIVES/UNASSIGNED:Myocardial and liver iron overload can be assessed through T2* in magnetic resonance imaging (MRI). It is unclear, how T2* measurements are associated with systolic and diastolic left ventricular function assessed by novel feature tracking (FT) strain. METHODS/UNASSIGNED:Consecutive patients with suspected iron overload undergoing MRI T2* were retrospectively included. T2* was studied continuously and in categories: normal myocardial iron status (T2* ≥ 20 ms), myocardial iron overload (T2* < 20 ms), normal liver iron status (T2* ≥ 15.4 ms) and liver iron overload (T2* < 15.4 ms). Multivariable regression models were used to assess associations between T2* and FT strain. RESULTS/UNASSIGNED: = 0.008]. No associations of T2* values with systolic function were found. CONCLUSION/UNASSIGNED:Liver and a combination of myocardial and liver iron overload were associated with increased early diastolic filling and increased e/a ratio respectively, which may serve as markers of diastolic dysfunction. Impaired diastolic function, even in the absence of myocardial iron overload was associated with liver iron metabolism and may indicate early cardiac involvement, while left ventricular systolic function is still preserved.

INTRODUCTION/BACKGROUND:Patient-reported outcome measures (PROMs) are an important component of evaluating patient health and are increasingly utilized in orthopedics. However, their use remains inconsistent among orthopedic subspecialties, with only 21% of orthopedic trauma surgeons reporting regular use of PROMs in their practice. While tools for quantifying patient distress in response to pain have been developed, they are often difficult to apply due to extensive questioning and the need for prospective implementation. The purpose of this study was to propose a novel retrospective technique to measure the Pain Distress Index (PDI) using two common PROMs: the visual analog scale (VAS) and the short musculoskeletal functional assessment (SMFA). METHODS:A total of 797 patients who underwent operative repair of a tibial plateau fracture or revision of long bone nonunion were included. To quantify PDI, a linear trend line was calculated from a scatter plot of SMFA Bothersome Index (BI) vs. VAS pain scores at three months postoperatively. Reported SMFA BI was compared to predicted SMFA BI, and patients were stratified into three cohorts: "limited," "adequate," and "excellent" PDI. RESULTS:In both cohorts, SMFA Function Index scores at 6 and 12 months postoperatively differed significantly among the limited, adequate, and excellent PDI levels (p < 0.0005, p < 0.0005). Worse PDI (indicating greater distress from pain) was associated with poorer SMFA Function Index scores. CONCLUSIONS:The combination of SMFA BI and VAS scores may serve as a useful tool to quantify PDI without requiring an additional questionnaire. "Limited" PDI was associated with poorer functional outcomes at 6 and 12 months postoperatively. This method may help predict which patients are at risk for worse functional outcomes and could serve as a retrospective proxy for resilience in future research.

Ultrasound (US) is a valuable tool in the evaluation of arthritis both for diagnosis and treatment response. Pertinent findings such as joint effusions, synovitis, bursitis, bone erosions, tenosynovitis, and enthesitis can all be readily evaluated sonographically. In this article, we describe specific considerations in the US evaluation of rheumatoid arthritis, psoriatic arthritis, juvenile idiopathic arthritis, crystalline arthritis (gout, calcium pyrophosphate deposition disease, and hydroxyapatite deposition disease), septic arthritis, and osteoarthritis with attention to certain differentiating features. The potential role of US in the diagnosis of specific arthritides is discussed, together with an overview of newer technologies and future directions.

BACKGROUND/UNASSIGNED:Myocardial injury detected after percutaneous coronary intervention (PCI) is associated with increased mortality. Predictors of post-PCI myocardial injury are not well established. The long-term prognostic relevance of post-PCI myocardial injury remains uncertain. METHODS/UNASSIGNED:Consecutive adults aged ≥18 years with stable ischemic heart disease who underwent elective PCI at NYU Langone Health between 2011 and 2020 were included in a retrospective, observational study. Patients with acute myocardial infarction or creatinine kinase myocardial band (CKMB) or troponin concentrations >99% of the upper reference limit before PCI were excluded. All patients had routine measurement of CKMB concentrations at 1 and 3 hours post-PCI. Post-PCI myocardial injury was defined as a peak CKMB concentration >99% upper reference limit. Linear regression models were used to identify clinical factors associated with post-PCI myocardial injury. Cox proportional hazard models were generated to evaluate relationships between post-PCI myocardial injury and all-cause mortality at long-term follow-up. RESULTS/UNASSIGNED:<0.001). After adjustment for demographics and clinical covariates, post-PCI myocardial injury was associated with an excess hazard for long-term mortality (hazard ratio, 1.46 [95% CI, 1.20-1.78]). CONCLUSIONS/UNASSIGNED:Myocardial injury defined by elevated CKMB early after PCI is common and associated with all-cause, long-term mortality. More complex coronary anatomy is predictive of post-PCI myocardial injury.