Research Spotlight

Dutton, R. P., T. M. McLoughlin, Jr., F. V. Salinas and L. C. Torsher (2019). “Anesthesia Practice on the Rise.” Adv Anesth 37: xix-xxi.

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Welcome to Advances in Anesthesia! We are pleased to present you with 11 articles covering topics across the spectrum of perioperative care. These include traditional clinical science articles on management of hemodynamics during cesarean section, treatment of malignant hyperthermia, and perioperative blood conservation; cutting edge information on new regional anesthetic techniques, use of tranexamic acid, and an overview of implanted nerve stimulation technology. In addition, we have included articles that could be drawn directly from our current headlines: diversity in the anesthesia workforce, perioperative management of patients with substance abuse disorder, and a focused look at artificial intelligence and clinical informatics for anesthesiologists. One unusual article in this year’s volume is a Pro:Pro:Pro review of career options for anesthesiologists, team written by 2 academic anesthesiologists, a small-group practitioner, and a representative from the largest private practice in the United States. There is no “con” to this article because overall it’s a great time to be an anesthesiologist! Driven by our profession’s ability to care for any kind of patient, from neonate (or even in utero) to centenarian, and to facilitate any procedural aspect of modern medicine from electroconvulsive therapy to cardiac transplantation, anesthesiology is at a peak of influence never before achieved. Compensation is good; case numbers are growing, and residency positions are hotly sought after. Any kind of anesthesiology practice today has much to recommend it and represents a smart career choice for the talented medical student. Beyond the overall picture though, we solicited this article to share some hard-won information not commonly found in academic papers or conference presentations. The goal was to compare the benefits and challenges of different anesthesia practice models in a way that will help graduating residents and fellows pick the best spot to launch their own careers, thus helping to keep our profession on the rise. (Excerpt from text of this introduction to a special issue of Advances in Anesthesia, p. xix.)

Follow-up trends after emergency department discharge for acutely symptomatic hernias: A southwestern surgical congress multi-center trial.

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BACKGROUND: The objective of this multi-center study was to examine the follow-up trends after emergency department (ED) discharge in a large and socioeconomically diverse patient population. METHODS: We performed a 3-year retrospective analysis of adult patients with acutely symptomatic hernias who were discharged from the EDs of five geographically diverse hospitals. RESULTS: Of 674 patients, 288 (43%) were evaluated in the clinic after discharge from the ED and 253 (37%) underwent repair. Follow-up was highest among those with insurance. A total of 119 patients (18%) returned to the ED for hernia-related complaints, of which 25 (21%) underwent urgent intervention. CONCLUSION: The plan of care for patients with acutely symptomatic hernias discharged from the ED depends on outpatient follow-up, but more than 50% of patients are lost to follow-up, and nearly 1 in 5 return to the ED. The uninsured are at particularly high risk.

Aman, H., T. Shokri, L. V. Reddy and Y. Ducic (2019). “Secondary Management of Midface Fractures.” Facial Plast Surg 35(6): 640-644.

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Secondary reconstruction of posttraumatic facial deformities has been consistently described as one of the most challenging procedures performed. Ideal primary reconstruction cannot always be achieved, and often it is complicated by severe comminution or inadequate surgical management. It also can arise because of a lack of definitive surgical repair or excessive delay of initial treatment. Complications leading to secondary deformities can occur even when craniofacial injuries are treated by experienced surgeons. Following proper surgical principles, meticulous perioperative planning, and anticipation of potential functional and aesthetic sequelae limit many of those complications. Herein, we discuss secondary procedures in traumatic midface injuries.

Zhang, Q., Q. Zhang, S. Yang, P. C. Dechow, H. Zhu, H. Y. Yeh and Q. Wang (2019). “Divided zygoma in Holocene human populations from Northern China.” Am J Hum Biol 31(6): e23314.

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OBJECTIVES: Divided zygoma (DZ) occurs in contemporaneous human populations, with the highest incidences in people from East Asia and Southern Africa. The present study examines the prevalence and variation of this condition in the Holocene populations of Northern China for the first time. METHODS: In this study, 1145 skulls from various human populations living in Northern China from the Neolithic Age to recent dynasties (5000-300 years BP) were examined. Specifically, cranial measurements and a CT scan were conducted to quantify craniofacial morphology. RESULTS: Fifteen skulls were identified with DZ, revealing an overall prevalence of 1.3% in the collection, while it was determined to be higher in North Asian and Northeast Asian regional groups. In skulls with unilateral DZ, the superior division of the zygoma was generally slender, while the inferior division of the zygoma was more robust. In skulls with bilateral DZ, the maxillae were generally more laterally extended. Moreover, unilateral DZ skulls displayed differences in cortical bone thickness between two sides of the facial skeleton. DISCUSSION: In context, the distribution pattern within these data points toward a greater prevalence of the DZ phenotype in North and Northeast Asian regional groups, suggesting a hypothesis that the DZ trait is more frequent in populations characterized by flat and broad faces. Accordingly, further studies into the DZ condition will deepen our understanding of developments in plasticity, variation, and recent evolution of the human cranium.

Wang, Y., Q. Yan, Y. Zhao, X. Liu, S. Lin, P. Zhang, L. Ma, Y. Lai, X. Bai, C. Liu, C. Wu, J. Q. Feng, D. Chen, H. Cao and G. Xiao (2019). “Focal adhesion proteins Pinch1 and Pinch2 regulate bone homeostasis in mice.” JCI Insight 4(22).

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Mammalian focal adhesion proteins Pinch1 and Pinch2 regulate integrin activation and cell-extracellular matrix adhesion and migration. Here, we show that deleting Pinch1 in osteocytes and mature osteoblasts using the 10-kb mouse Dmp1-Cre and Pinch2 globally (double KO; dKO) results in severe osteopenia throughout life, while ablating either gene does not cause bone loss, suggesting a functional redundancy of both factors in bone. Pinch deletion in osteocytes and mature osteoblasts generates signals that inhibit osteoblast and bone formation. Pinch-deficient osteocytes and conditioned media from dKO bone slice cultures contain abundant sclerostin protein and potently suppress osteoblast differentiation in primary BM stromal cells (BMSC) and calvarial cultures. Pinch deletion increases adiposity in the BM cavity. Primary dKO BMSC cultures display decreased osteoblastic but enhanced adipogenic, differentiation capacity. Pinch loss decreases expression of integrin beta3, integrin-linked kinase (ILK), and alpha-parvin and increases that of active caspase-3 and -8 in osteocytes. Pinch loss increases osteocyte apoptosis in vitro and in bone. Pinch loss upregulates expression of both Rankl and Opg in the cortical bone and does not increase osteoclast formation and bone resorption. Finally, Pinch ablation exacerbates hindlimb unloading-induced bone loss and impairs active ulna loading-stimulated bone formation. Thus, we establish a critical role of Pinch in control of bone homeostasis.