Faculty Bibliography

PURPOSE/OBJECTIVE:The purpose of this study was to evaluate the short-term postoperative outcomes of patients undergoing patella open reduction internal fixation procedures based on the type of anesthesia administered. METHODS:A retrospective review was conducted of patients who were surgically treated for displaced patella fractures from 2012 to 2024 at a single multi-site academic institution. Patients were included if they were > 18 years of age, sustained an isolated patella fracture, and had a minimum of 6-month follow-up. Patients were divided into groups based on the anesthetic modality used during their surgery: regional anesthesia only (RA), general/neuraxial anesthesia (NR), and a combination of these methods (CA). Comparisons of statistics were performed using Pearson chi-squared tests, one-way ANOVA tests, and linear regression tests as appropriate. RESULTS:There were no complications associated with the administration of anesthesia within each cohort. There was no significant difference in fracture healing rates (p = .210) nor complication rates between the anesthesia groups (p = .088). The RA and CA groups had significantly shorter operating room (wheels in to wheels out) times than the NR group (p < .001), significantly greater 3-month (p = .001) and 6-month knee ROM (p = .016) than the NR group when controlling for age, fracture pattern, and repair method. CONCLUSION/CONCLUSIONS:This study demonstrates the efficacy of the use of regional anesthesia only for repair of a patella fracture. This technique is associated with greater early range of knee motion in patients after surgery and a shorter surgical time with no increase in intra or postoperative complications.

BACKGROUND:Despite evidence supporting the efficacy of culturally tailored interventions in reducing stigma, such approaches are lacking for women living with HIV/AIDS (WLWHAs) in China. We conducted this study to determine the efficacy of the culturally tailored Helping Overcome Perceived Stigma (HOPES) intervention in reducing perceived stigma among WLWHAs in China. METHODS:A single-blinded, two-arm parallel-group randomized clinical trial was conducted from 2023 to 2024 in South and Southwest China. WLWHAs from four hospitals were assigned using a WeChat-embedded randomization application to the control group (usual care) or the HOPES intervention. Data analysts remained blinded. Interventions were conducted virtually using Leave No One Behind (LNOB) platform for 3 months. The primary outcome, perceived stigma score, was assessed at baseline, immediately after the intervention and at 3 months post-intervention using 7 items from the HIV/AIDS Stigma Experience Questionnaire (HASEQ), with data analyzed through repeated measures analysis. RESULTS:Of 136 WLWHAs screened, we randomized 101 WLWHAs (50 HOPES; 51 controls). The HOPES group demonstrated a statistically significant reduction in perceived stigma scores immediately after the intervention (-3.86 points, 95 % CI: 5.34 to -2.38, P < .001) and at three months post-intervention (-5.83 points, 95 % CI: 7.20 to -4.47, P < .001) compared to the control group. CONCLUSION/CONCLUSIONS:The findings demonstrate HOPES' efficacy in reducing perceived stigma in WLWHA. However, the clinical significance of these changes needs further investigation. Future research should focus on defining meaningful patient-reported thresholds, assessing long-term impact, and optimizing delivery methods.

SUMMARY OF BACKGROUND DATA/UNASSIGNED:Facet joint degeneration is a known source of chronic axial low back pain, and intra-articular steroid injections (IASI) have been used as a treatment. OBJECTIVES/UNASSIGNED:To systematically review the evidence of the effectiveness of fluoroscopically guided lumbar IASI for the treatment of lumbar facet joint pain. METHODS/UNASSIGNED:The primary outcome was ≥50 % pain reduction at ≥ 1 month, measured by Visual Analog Scale and/or Numeric Rating Scale. Secondary outcomes included ≥30 % functional improvement on a validated functional scale. Studies including group mean improvements in pain/function without categorical reporting were also considered. Two reviewers independently screened Embase, Cochrane, PubMed Medline, Ovid Medline, Web of Knowledge, and Google Scholar. The risk of bias was assessed using the Cochrane Risk of Bias Tool, and evidence quality was evaluated using Grades of Recommendation, Assessment, Development, and Evaluation (GRADE). RESULTS/UNASSIGNED:Of the 701 publications screened, 21 met the inclusion criteria. Success rates for clinically significant pain reduction (≥50 % pain relief) ranged from 13 to 74 %, and functional improvement (≥30 % improvement) was 29 % at ≥ 1 month, based on only one study. Overall, mean improvement ranged from 11 to 59 % for pain relief and 8-58 % for function at ≥ 1 month. In the seven studies selecting patients with facet or medial branch blocks, success rates for clinically significant pain reduction (≥50 % pain relief) are reported as 13-74 % at ≥ 1 month. In this subgroup, mean pain improvement rates ranged from 23 to 67 % and functional improvement from 15 to 58 % at ≥ 1 month. According to GRADE, the overall quality of the evidence is very low due to the high risk of bias, study heterogeneity, and inconsistent methodologies. DISCUSSION/CONCLUSION/UNASSIGNED:Pragmatic and observational studies suggest IASI may reduce pain and disability, while sham-controlled trials have not demonstrated efficacy. Given the very low quality of evidence, the true effect of IASI is highly uncertain. Further high-quality, placebo-controlled studies using standardized diagnostic criteria are needed.

BACKGROUND:Studies have not explored consciousness during deep hypothermic circulatory arrest (DHCA). However, as studies in cardiac arrest have identified a spectrum of consciousness, we sought to establish the feasibility of studying consciousness during DHCA. METHODS:This was a prospective study across 10 hospitals with 36 DHCA patients undergoing thoracic aortic aneurysm repair or pulmonary endarterectomy. A tablet computer delivered audiovisual stimuli (images and names of three fruits) using headphones during each procedure as a potential test of implicit learning and explicit recall. We also established electroencephalography (EEG) and near-infrared spectroscopy (NIRS) to measure electrocortical markers of consciousness and cerebral oxygenation. Post-procedure interviews were carried out to test patients' ability to recall the audiovisual stimuli as well other explicit memories. PRIMARY OUTCOMES/METHODS:1) Feasibility of establishing tests of explicit recall and implicit learning, 2) Electroencephalography testing during DHCA. SECONDARY OUTCOMES/RESULTS:1) Signs of explicit recall of memories or implicit learning, and 2) identification of electrocortical biomarkers of consciousness during DHCA. RESULTS:Overall, 29/36 (81%) had the tablet set up. All 36 had NIRS and EEG set up, but 9 (25%) had useable EEG data, and 23 (66%) NIRS data. Delta EEG waves were observed during circulatory arrest in 3/9 (33%) patients, while 1/9 (11%) had theta waves just prior to circulatory arrest. All others showed isoelectric pattern. 35/36 (97%) agreed to follow up interviews. None had explicit recall of the names of the three fruits, but 3/36 (9%) correctly guessed them as a potential sign of implicit learning and 3 (9%) recalled other memories including events around the procedure and themes consistent with a recalled experience of death. CONCLUSIONS:A spectrum of consciousness and awareness, including signs of implicit learning and electrocortical biomarkers of consciousness may be present during DHCA, despite absence of visible signs of consciousness. This can be further used to help explain the negative psychological outcomes that cardiac arrest survivors face.

INTRODUCTION/BACKGROUND:Delayed Emergency Medical Services (EMS) response and transport (time from injury occurrence to hospital arrival) are associated with increased injury mortality. Inequities in accessing EMS care for injured patients are not well characterized. We sought to evaluate the association between the area deprivation index (ADI), a measure of geographic socioeconomic disadvantage, and timely access to EMS care within the United States. METHODS:The Homeland Infrastructure Foundation Level Data open-source database from the National Geospatial Intelligence Agency was used to evaluate the location of EMS stations across the United States using longitude and latitude coordinates. The ADI was obtained from Neighborhood Atlas at the census block group level. An ambulance desert (AD) was defined as populated census block groups with a geographic center outside of a 25-minute ambulance service area. The total population (urban and rural) located within an AD and outside an AD (non-ambulance desert [NAD]) and the ADI index distribution within those areas were calculated with their statistical significance derived from χ2 testing. Spearman correlations between the number of EMS stations available within 25-minutes service areas and ADI were calculated, and statistical significance was derived after accounting for spatial autocorrelation. RESULTS:A total of 42,472 ground EMS stations were identified. Of the 333,036,755 people (current US population), 2.6% are located within an AD. When stratified by type of population, 0.3% of people within urban populations and 8.9% of people within rural populations were located within an AD (p < 0.01). When compared with NADs, ADs were more likely to have a higher ADI (ADIAD, 53.13; ADINAD, 50.41; p < 0.01). The number of EMS stations available per capita was negatively correlated with ADI (rs = -0.25, p < 0.01), indicating that people living in more disadvantaged neighborhoods are likely to have fewer EMS stations available. CONCLUSION/CONCLUSIONS:Ambulance deserts are more likely to affect rural versus urban populations and are associated with higher ADIs. The impact of inequities in access to EMS care on outcomes deserves further study. LEVEL OF EVIDENCE/METHODS:Prognostic and Epidemiological; Level III.

Cardiolipin (CL), the signature phospholipid of mitochondria, carries four fatty acids that are remodeled after de novo synthesis. In yeast, remodeling is accomplished by the joint action of Cld1, a lipase that removes a fatty acid from CL, and Taz1, a transacylase that transfers a fatty acid from another phospholipid to monolyso-CL. While taz1 homologues have been identified in all eukaryotes, cld1 homologues have remained obscure. Here we demonstrate that ABHD18, a highly conserved protein of plants, animals, and humans, is functionally homologous to Cld1. Knockdown of Abhd18 decreased the concentration of monolyso-CL in murine, Taz-knockout myoblasts. Inactivation of Abhd18 in Drosophila substantially increased the abundance of CL. Abhd18 inactivation also reversed the increase in the rate of CL degradation, as measured with ¹³C isotopes, and the accumulation of deacylated CLs, such as monolyso-CL and dilyso-CL, in TAZ-deficient flies. CL species with more than 5 double bonds were resistant to ABHD18. Our data demonstrate that ABHD18 is the elusive lipase that hydrolyzes CL in mice and flies and presumably in other organisms. Rather than removing just one fatty acid, we show that ABHD18 deacylates CL further. Thus, ABHD18 catalyzes the breakdown of CL whereas TAZ protects CL from degradation.

OBJECTIVES/OBJECTIVE:To examine the efficacy of regional only anesthesia for arthroplasty surgery following displaced femoral neck fractures. METHODS:Design: Retrospective study. SETTING/METHODS:A single academic medical center and Level 1 Trauma Center. PATIENT SELECTION CRITERIA/UNASSIGNED:Patients with displaced femoral neck fracture (AO/OTA 31B1.3) treated with either hemi- or total hip arthroplasty were identified. Patients who had general (GA) and Spinal (SA) anesthesia were each matched 2:1 to those who underwent Lateral Femoral Cutaneous and Over the Hip (LOH),based on the Score for Trauma Triage in the Geriatric and Middle Aged (STTGMA) risk score and arthroplasty type. OUTCOME MEASURES AND COMPARISONS/UNASSIGNED:Patient demographics, injury characteristics, and surgical history were compared. Outcomes included postoperative complications, 90-day readmission rates, 1-year mortality and discharge location. Significance was p>0.05. RESULTS:145 patients were analyzed: 58 GA, 58 SA, and 29 Regional. Cohorts were similar in demographics: mean age was 79.9 +9.9 for LOH, 79.8+11.00 for GA and 82.2+8.6 for SA (p=0.3), with 72% female patients in the LOH, 67% female in the GA and 76% female in SA (p=0.585). GA patients had the highest BMI (25.3±5.3 kg/m2, p=0.004). SA patients had the highest ASA score (2.9±0.7, p=0.036). GA patients had the longest anesthesia (2:55 hours, p=0.013) and operating room time (3:35, p=0.009). Regional anesthesia had the shortest anesthesia (2:26, p=0.013) and operating room time (2:54, p=0.009). GA had a higher complication rate (56.9%, p=0.039), including major complications (20.7%, p=0.025) and post-operative anemia (34.5%, p=0.049). GA had a longer length of stay (6.4±2.9 days, p=0.022). Patients operated on under regional only were discharged to home (62%, p=0.003) while more GA (79%) and SA (71%) patients were discharged to SNF (p<0.001). LOH patients ambulated sooner following surgery (1.03±0.2 days, p=0.001). No post-operative complications, blood transfusions (p=0.321), mortality (p=0.089), 30-day readmission (p=0.819), and post-operative delirium (p=0.514) were significantly different. CONCLUSION/CONCLUSIONS:Regional only anesthesia (LOH Block) was safe and effective for hemi and total hip arthroplasty for a displaced femoral neck fracture as compared to spinal and general anesthesia. This anesthetic approach allowed for successful procedures and yielded lower associated rates of post-operative complications and operative time in addition to improved quality measures. LEVEL OF EVIDENCE/METHODS:Prognostic Level III.

Barth syndrome is a mitochondrial disorder with hallmarks of cardiac and skeletal muscle weakness. Barth syndrome is caused by mutation of the X-linked gene Taz, required for cardiolipin remodeling. Previously described germline and conditional Taz knockout models are not ideal for therapeutic development because they lack the combination of robust survival to adulthood, cardiomyopathy, and skeletal muscle weakness. We characterized a cardiac and skeletal muscle-specific Taz knockout model (TazmKO) in which Cre recombinase is expressed from the muscle creatine kinase promoter (mCK-Cre). TazmKO mice survived normally. Cardiolipin composition was abnormal in both heart and skeletal muscle. TazmKO had reduced heart function by 2 months of age, and function progressively declined thereafter. Reduced treadmill endurance and diminished peak oxygen consumption were evident by three months of age, suggesting reduced skeletal muscle function. Electron microscopy showed abnormalities in mitochondrial structure and distribution. Overall, TazmKO mice display diminished cardiac function and exercise capacity while maintaining normal survival. This model will be useful for studying the effects of Taz deficiency in striated muscles and for testing potential therapies for Barth Syndrome.