Research Spotlight

Roberts, W. C. and S. Ilyas (2020). “Examining One’s Own Heart.” Am J Cardiol 127: 41-51.

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At Baylor University Medical Center (BUMC) in Dallas, we began showing heart transplantation recipients their hearts in 2010. Since that time, we have shown 157 patients their own hearts (through March 2020). The exercise was initiated not by me or another physician but by a heart transplant recipient, Mr. Marvin Jones. I was walking in the corridor near the cardiac catheterization waiting room and next to me was Mr. Jones. He leaned over and asked if I was Dr. Roberts. “Yes,” I answered. He said, “I understand that you have my heart.” I invited him to our weekly cardiovascular pathology conference so that several physicians could observe a person examining their own heart.1 Subsequently, the heart transplant cardiologists, surgeons, their nurses and coordinators have gotten on board to encourage their heart transplant patients to “Call Dr. Roberts” to make the arrangements to view their own hearts. Some of the patients had their heart transplants many years earlier. Fortunately, BUMC has provided us with a heart storage facility and all transplant and autopsy hearts have resided there since 1993. Thus, all heart transplant recipients who want to see their hearts since that time can have their requests fulfilled. [No abstract; excerpt from article].

Rizkalla, J. M., T. Lines, Y. Daoud and J. Zide (2020). “Instagram and Pilon Fractures: An Analysis of Social Media and Its Relationship to Patient Injury Perception.” Foot Ankle Spec Jul 20;1938640020940837. [Epub ahead of print.].

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Background: The purpose of this study was to investigate social media posts regarding pilon fractures and its relationship to patient injury perception. We evaluated Instagram media posts in patients who have suffered pilon fractures for the following variables: gender, tone, discussion of rehabilitation, activities of daily living (ADL) reference, incision/scar reference, pain, post of radiograph/imaging, external fixation reference, discussion of bracing/splinting, pre- or postoperative swelling, and need for reoperation. Results were determined by comparing each variable to gender and tone of the post to study patient injury perception. Methods: Public Instagram posts from within a 1-year time period were isolated and evaluated using the hashtag “#pilonfracture.” Individual posts were analyzed by authors. In total, 241 patient posts were included for investigation and analysis of patient injury perception via social media. Results: Of all included posts, 88% of posts had a positive tone. A majority of the posts (66.8%) mentioned rehabilitation and postoperative progress. There were significant associations between positive tone and rehabilitation (P = .0001), as well as positive tone and ADLs (P = .0361). Conclusion: Reported outcomes after surgical management of pilon fractures are generally poor. Nonetheless, this analysis of patients sharing their experience on social media after open reduction internal fixation of pilon fractures demonstrates a mostly positive attitude toward the injury and recovery. A positive tone of the post was significantly associated with mentions of rehabilitation and ADLs.Levels of Evidence: Level III: Retrospective comparative study.

Rizkalla, J. M., B. P. Gladnick, A. A. Bhimani, D. S. Wood, K. J. Kitziger and P. C. Peters, Jr. (2020). “Triaging Total Hip Arthroplasty During the COVID-19 Pandemic.” Curr Rev Musculoskelet Med 13(4): 416-424.

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PURPOSE OF REVIEW: The purpose of this review was to evaluate the available literature to determine what may be considered urgent indications for total hip arthroplasty, in the unprecedented setting of the worldwide COVID-19 pandemic. RECENT FINDINGS: SARS-CoV-2 is a novel coronavirus currently presenting in the form of a global pandemic, referred to as COVID-19. In this setting, multiple states have issued executive orders prohibiting “elective” surgery, including arthroplasty, in order to preserve healthcare resources. However, during this unprecedented reduction in elective surgery, there is likely to be some controversy as to what constitutes a purely “elective” procedure, versus an “urgent” procedure, particularly regarding hip arthroplasty. We reviewed the available literature for articles discussing the most commonly encountered indications for primary, conversion, and revision hip arthroplasty. Based upon the indications discussed in these articles, we further stratified these indications into “elective” versus “urgent” categories. In patients presenting with hip arthroplasty indications, the decision to proceed urgently with surgery should be based upon (a) the potential harm incurred by the patient if the surgery was delayed and (b) the potential risk incurred by the patient in the context of COVID-19 if surgery was performed. The authors present a decision-making algorithm for determining surgical urgency in three patients who underwent surgery in this context. Urgent total hip arthroplasty in the setting of the COVID-19 pandemic is a complex decision-making process, involving clinical and epidemiological factors. These decisions are best made in coordination with a multidisciplinary committee of one’s peers. Region-specific issues such as hospital resources and availability of PPE may also inform the decision-making process.

Rinchai, D., B. Syed Ahamed Kabeer, M. Toufiq, Z. Tatari-Calderone, S. Deola, T. Brummaier, M. Garand, R. Branco, N. Baldwin, M. Alfaki, M. C. Altman, A. Ballestrero, M. Bassetti, G. Zoppoli, A. De Maria, B. Tang, D. Bedognetti and D. Chaussabel (2020). “A modular framework for the development of targeted Covid-19 blood transcript profiling panels.” J Transl Med 18(1): 291.

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BACKGROUND: Covid-19 morbidity and mortality are associated with a dysregulated immune response. Tools are needed to enhance existing immune profiling capabilities in affected patients. Here we aimed to develop an approach to support the design of targeted blood transcriptome panels for profiling the immune response to SARS-CoV-2 infection. METHODS: We designed a pool of candidates based on a pre-existing and well-characterized repertoire of blood transcriptional modules. Available Covid-19 blood transcriptome data was also used to guide this process. Further selection steps relied on expert curation. Additionally, we developed several custom web applications to support the evaluation of candidates. RESULTS: As a proof of principle, we designed three targeted blood transcript panels, each with a different translational connotation: immunological relevance, therapeutic development relevance and SARS biology relevance. CONCLUSION: Altogether the work presented here may contribute to the future expansion of immune profiling capabilities via targeted profiling of blood transcript abundance in Covid-19 patients.

Probe, R. A. and T. Britten (2020). “Correction of Lateral Tibial Plateau Malunion.” J Orthop Trauma 34 Suppl 2: S31-s32.

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The results of open reduction and internal fixation for tibial plateau fractures are generally favorable when articular morphology and stability are restored. When these goals of treatment are not achieved, limited function often results. The patient presented in this video complained of pain and an inability to resume his previous work. Evaluation suggested that root causes of these difficulties included widening of the plateau, significant depression of the articular surface, resultant valgus instability, and a displaced nonfunctioning lateral meniscus. This video demonstrates the planning and correction of a long-standing intraarticular malunion of a lateral tibial plateau fracture.