Using Bibliometric Data to Define and Understand Publishing Network Equity in Anesthesiology.

BACKGROUND: Anesthesiology departments and professional organizations increasingly recognize the need to embrace diverse membership to effectively care for patients, to educate our trainees, and to contribute to innovative research. 1 Bibliometric analysis uses citation data to determine the patterns of interrelatedness within a scientific community. Social network analysis examines these patterns to elucidate the network's functional properties. Using these methodologies, an analysis of contemporary scholarly work was undertaken to outline network structure and function, with particular focus on the equity of node and graph-level connectivity patterns. METHODS: Using the Web of Science, this study examines bibliographic data from 6 anesthesiology-specific journals between January 1, 2017, and August 26, 2022. The final data represent 4453 articles, 19,916 independent authors, and 4436 institutions. Analysis of coauthorship was performed using R libraries software. Collaboration patterns were assessed at the node and graph level to analyze patterns of coauthorship. Influential authors and institutions were identified using centrality metrics; author influence was also cataloged by the number of publications and highly cited papers. Independent assessors reviewed influential author photographs to classify race and gender. The Gini coefficient was applied to examine dispersion of influence across nodes. Pearson correlations were used to investigate the relationship between centrality metrics, number of publications, and National Institutes of Health (NIH) funding. RESULTS: The modularity of the author network is significantly higher than would be predicted by chance (0.886 vs random network mean 0.340, P < .01), signifying strong community formation. The Gini coefficient indicates inequity across both author and institution centrality metrics, representing moderate to high disparity in node influence. Identifying the top 30 authors by centrality metrics, number of published and highly cited papers, 79.0% were categorized as male; 68.1% of authors were classified as White (non-Latino) and 24.6% Asian. CONCLUSIONS: The highly modular network structure indicates dense author communities. Extracommunity cooperation is limited, previously demonstrated to negatively impact novel scientific work. 2 , 3 Inequitable node influence is seen at both author and institution level, notably an imbalance of information transfer and disparity in connectivity patterns. There is an association between network influence, article publication (authors), and NIH funding (institutions). Female and minority authors are inequitably represented among the most influential authors. This baseline bibliometric analysis provides an opportunity to direct future network connections to more inclusively share information and integrate diverse perspectives, properties associated with increased academic productivity. 3 , 4.

Phytochemical compound PB125 attenuates skeletal muscle mitochondrial dysfunction and impaired proteostasis in a model of musculoskeletal decline.

Impaired mitochondrial function and disrupted proteostasis contribute to musculoskeletal dysfunction. However, few interventions simultaneously target these two drivers to prevent musculoskeletal decline. Nuclear factor erythroid 2-related factor 2 (Nrf2) activates a transcriptional programme promoting cytoprotection, metabolism, and proteostasis. We hypothesized daily treatment with a purported Nrf2 activator, PB125, in Hartley guinea pigs, a model of musculoskeletal decline, would attenuate the progression of skeletal muscle mitochondrial dysfunction and impaired proteostasis and preserve musculoskeletal function. We treated 2- and 5-month-old male and female Hartley guinea pigs for 3 and 10 months, respectively, with the phytochemical compound PB125. Longitudinal assessments of voluntary mobility were measured using Any-MazeTM open-field enclosure monitoring. Cumulative skeletal muscle protein synthesis rates were measured using deuterium oxide over the final 30 days of treatment. Mitochondrial oxygen consumption in soleus muscles was measured using high resolution respirometry. In both sexes, PB125 (1) increased electron transfer system capacity; (2) attenuated the disease/age-related decline in coupled and uncoupled mitochondrial respiration; and (3) attenuated declines in protein synthesis in the myofibrillar, mitochondrial and cytosolic subfractions of the soleus. These effects were not associated with statistically significant prolonged maintenance of voluntary mobility in guinea pigs. Collectively, treatment with PB125 contributed to maintenance of skeletal muscle mitochondrial respiration and proteostasis in a pre-clinical model of musculoskeletal decline. Further investigation is necessary to determine if these documented effects of PB125 are also accompanied by slowed progression of other aspects of musculoskeletal dysfunction. KEY POINTS: Aside from exercise, there are no effective interventions for musculoskeletal decline, which begins in the fifth decade of life and contributes to disability and cardiometabolic diseases. Targeting both mitochondrial dysfunction and impaired protein homeostasis (proteostasis), which contribute to the age and disease process, may mitigate the progressive decline in overall musculoskeletal function (e.g. gait, strength). A potential intervention to target disease drivers is to stimulate nuclear factor erythroid 2-related factor 2 (Nrf2) activation, which leads to the transcription of genes responsible for redox homeostasis, proteome maintenance and mitochondrial energetics. Here, we tested a purported phytochemical Nrf2 activator, PB125, to improve mitochondrial function and proteostasis in male and female Hartley guinea pigs, which are a model for musculoskeletal ageing. PB125 improved mitochondrial respiration and attenuated disease- and age-related declines in skeletal muscle protein synthesis, a component of proteostasis, in both male and female Hartley guinea pigs.

Anesthetics affect peripheral venous pressure waveforms and the cross-talk with arterial pressure.

Analysis of peripheral venous pressure (PVP) waveforms is a novel method of monitoring intravascular volume. Two pediatric cohorts were studied to test the effect of anesthetic agents on the PVP waveform and cross-talk between peripheral veins and arteries: (1) dehydration setting in a pyloromyotomy using the infused anesthetic propofol and (2) hemorrhage setting during elective surgery for craniosynostosis with the inhaled anesthetic isoflurane. PVP waveforms were collected from 39 patients that received propofol and 9 that received isoflurane. A multiple analysis of variance test determined if anesthetics influence the PVP waveform. A prediction system was built using k-nearest neighbor (k-NN) to distinguish between: (1) PVP waveforms with and without propofol and (2) different minimum alveolar concentration (MAC) groups of isoflurane. 52 porcine, 5 propofol, and 7 isoflurane subjects were used to determine the cross-talk between veins and arteries at the heart and respiratory rate frequency during: (a) during and after bleeding with constant anesthesia, (b) before and after propofol, and (c) at each MAC value. PVP waveforms are influenced by anesthetics, determined by MANOVA: p value < 0.01, η2 = 0.478 for hypovolemic, and η2 = 0.388 for euvolemic conditions. The k-NN prediction models had 82% and 77% accuracy for detecting propofol and MAC, respectively. The cross-talk relationship at each stage was: (a) ρ = 0.95, (b) ρ = 0.96, and (c) could not be evaluated using this cohort. Future research should consider anesthetic agents when analyzing PVP waveforms developing future clinical monitoring technology that uses PVP.

Rebooting the Electronic Health Record.

Justifications for the widespread adoption and integration of an electronic health record (EHR) have long leaned on the purported benefits of the technology. However, the performance of the EHR has been underwhelming relative to the promises of immediate access to relevant patient information, clinical decision supports, computerized ordering, and transferable patient data. In this narrative review, we provide an overview of the historical problems and limitations of the EHR, detail the core principles that define agile processes that may overcome the barriers faced by the current EHR, and re-imagine what an integrated, seamless EHR that serves its users and patients might look like. Moving forward, the EHR should be redesigned using a middle-out framework and empowering dual-type champions to maintain the sustainable diffusion of future innovations.

Interview Data Highlight Importance of "Same-State" on Anesthesiology Residency Match.

BACKGROUND: The US residency application, interview, and match processes are costly and time-intensive. We sought to quantify the importance of an applicant being from the same-state as a residency program in terms of how this impacted the number of interviews needed to match. METHODS: We examined data from interview scheduling software used by 32 programs located in 31 US states and 1300 applicants for the US anesthesiology recruitment cycles from 2015 to 2018. Interviewee data (distance from program, region, numbers of interviews, and program at which interview occurred) were analyzed to quantify the effect of the interviewee being from the same state as the residency program on the odds of matching to that program. Other variables of interest (medical school, current address, US Medical Licensing Exam [USMLE] Step 1 and 2 clinical knowledge [CK] scores, Alpha Omega Alpha [AOA] status, medical school ranking) were also examined as controls. Confidence intervals (CI) were calculated for the ratios of odds ratios. RESULTS: An interviewee living in the same state as the interviewing program could have 5.42 fewer total interviews (97.5% CI, 3.02-7.81) while having the same odds of matching. The same state effect had an equivalent value as an approximately 4.14 USMLE points-difference from the program's mean (97.5% CI was 2.34-5.94 USMLE points). Addition of whether the interviewee belonged to an affiliated medical school did not significantly improve the model; same-state remained significant (P < .0001) while affiliated medical school was not (P = .40). CONCLUSIONS: Our analysis of anesthesiology residency recruitment using previously unstudied interview data shows that same-state locality is a viable predictor of residency matching and should be strongly considered when evaluating whether to interview an applicant.

Development and Evaluation of a Risk-Adjusted Measure of Intraoperative Hypotension in Patients Having Nonemergent, Noncardiac Surgery.

BACKGROUND: Intraoperative hypotension is common and associated with organ injury and death, although randomized data showing a causal relationship remain sparse. A risk-adjusted measure of intraoperative hypotension may therefore contribute to quality improvement efforts. METHODS: The measure we developed defines hypotension as a mean arterial pressure <65 mm Hg sustained for at least 15 cumulative minutes. Comparisons are based on whether clinicians have more or fewer cases of hypotension than expected over 12 months, given their patient mix. The measure was developed and evaluated with data from 225,389 surgeries in 5 hospitals. We assessed discrimination and calibration of the risk adjustment model, then calculated the distribution of clinician-level measure scores, and finally estimated the signal-to-noise reliability and predictive validity of the measure. RESULTS: The risk adjustment model showed acceptable calibration and discrimination (area under the curve was 0.72 and 0.73 in different validation samples). Clinician-level, risk-adjusted scores varied widely, and 36% of clinicians had significantly more cases of intraoperative hypotension than predicted. Clinician-level score distributions differed across hospitals, indicating substantial hospital-level variation. The mean signal-to-noise reliability estimate was 0.87 among all clinicians and 0.94 among clinicians with >30 cases during the 12-month measurement period. Kidney injury and in-hospital mortality were most common in patients whose anesthesia providers had worse scores. However, a sensitivity analysis in 1 hospital showed that score distributions differed markedly between anesthesiology fellows and attending anesthesiologists or certified registered nurse anesthetists; score distributions also varied as a function of the fraction of cases that were inpatients. CONCLUSIONS: Intraoperative hypotension was common and was associated with acute kidney injury and in-hospital mortality. There were substantial variations in clinician-level scores, and the measure score distribution suggests that there may be opportunity to reduce hypotension which may improve patient safety and outcomes. However, sensitivity analyses suggest that some portion of the variation results from limitations of risk adjustment. Future versions of the measure should risk adjust for important patient and procedural factors including comorbidities and surgical complexity, although this will require more consistent structured data capture in anesthesia information management systems. Including structured data on additional risk factors may improve hypotension risk prediction which is integral to the measure's validity.

Identification of Generalized Convulsive Status Epilepticus from Emergency Medical Service Records: A Validation Study of Diagnostic Coding.

BACKGROUND: Generalized convulsive status epilepticus (GCSE) is a neurologic emergency demanding prehospital identification and treatment. Evaluating real-world practice requires accurately identifying the target population; however, it is unclear whether emergency medical services (EMS) documentation accurately identifies patients with GCSE. OBJECTIVE: To evaluate the validity of EMS diagnostic impressions for GCSE. METHODS: This was an analysis of electronic medical records of a California county EMS system from 2013 to 2018. We identified all cases with a primary diagnostic impression of "seizure-active," "seizure-post," or "seizure-not otherwise specified (NOS)" and within each diagnostic category, we randomly selected 75 adult and 25 pediatric records. Two authors reviewed the provider narrative of these 300 charts to determine a clinical seizure diagnosis according to prespecified definitions. We calculated a kappa for interrater reliability of the clinical diagnosis. We then calculated the positive predictive value (PPV), sensitivity, and specificity of an EMS diagnosis of "seizure-active" diagnosis for identifying GCSE. Sensitivity and specificity calculations were weighted according to the distribution of seizure cases in the overall population. We performed a descriptive analysis of records with an incorrect EMS diagnosis of GCSE or seizure. RESULTS: Of 38,995 total records for seizure, there were 3401 (8.7%) seizure-active cases, 12,478 (32.0%) seizure-NOS cases, and 23,116 (59.4%) seizure-post cases. An EMS diagnosis of "seizure-active" had a PPV of 65.0% (95% CI 54.8-74.3), sensitivity of 54.6% (95% confidence interval [CI] 39.3-69.0), and specificity of 96.6% (95% CI 95.1-97.6) for capturing GCSE. Limiting the case definition to patients who received an EMS diagnosis of "seizure-active" and were treated with a benzodiazepine increased the PPV (80.2%; 95% CI 69.9-88.2) and specificity (99.3%; 95% CI 98.7-99.6) while the sensitivity decreased (25.1%; 95% CI 17.0-35.3). Across the 300 records reviewed, there were 19 (6.3%) patients who had a non-seizure related diagnosis including non-epileptic spells (7 records), altered mental status (8 records), tremors (2 records), anxiety (1 record), and stroke (1 record). CONCLUSIONS: EMS diagnostic impressions have reasonable PPV and specificity but low sensitivity for GCSE. Improved coding algorithms and training will allow for improved benchmarking, quality improvement, and research about this neurologic emergency.

Analysis to Establish Differences in Efficiency Metrics Between Operating Room and Non-Operating Room Anesthesia Cases.

While a number of studies have examined efficiency metrics in the operating rooms (ORs), there are few studies addressing non-operating room anesthesia (NORA) metrics. The standards established in the realm of OR studies may not apply to ongoing investigations of NORA efficiency. We hypothesize that there are significant differences in these commonly used metrics. Using retrospective data from a single tertiary care hospital in the 2015 calendar year, we measured turnover times, cancellation rates, first case start delays, and scheduling error (actual time minus scheduled time) for the OR and NORA settings. On average, TOTs for NORA cases were approximately 50% shorter than OR cases (16.21 min vs. 37.18 min), but had a larger variation (11.02 min vs. 8.12 min). NORA cases were 64% as likely to be cancelled compared to OR cases. In contrast, NORA cases had an average first case start delay that was two times greater than that of OR cases (24.45 min vs. 10.58 min), along with over double the standard deviation (11.97 min vs. 5.90 min). Case times for NORA settings tended to be overestimated (-4.07 min versus -2.12 min), but showed less variation (8.61 min vs. 17.92 min). In short, there are significant differences in common efficiency metrics between OR and NORA cases. Future studies should elucidate and validate appropriate efficiency benchmarks for the NORA setting.

Operating Room Management at the Edge of Order and Chaos.

The operating room (OR) management literature tends to view management problems as having finite solutions and assumes that equilibrium exists in the intricate encounters that occur every day. In this article, we review complexity theory and assess its applicability to the strategic, tactical, and operational issues facing OR managers. By building on complexity theory and its assumptions, we also show that as complex systems, ORs resemble high-reliability organizations more than they resemble ultra-safe organizations. This distinction and the limitations of the current, linear modeling may have potential implications for the future of OR management research and practice. Opening the door to complexity, understanding the underpinnings of high-reliability organizations, and admitting that OR systems are complex adaptive systems, will lead to self-governing, transparent processes that envision the OR as a living, growing, sustainable human endeavor.

Evaluation of Phosphorus Filter Media for an Inline Subsurface Drainage Treatment System.

Subsurface drainage from agricultural land has been identified as a contributor of both N and P into surface waters, leading to water quality degradation and eutrophication. This study evaluates the ability of P sorption media (PSM; expanded shale, expanded clay, furnace slag, and natural soil) to sorb P in both batch and column tests. Batch sorption tests estimated sorption of 3.4, 1.2, and 0.5 g P kg for expanded shale, expanded clay, and natural soil, respectively. Furnace slag sorption was evaluated for fine (FS), small (FS), and large (FS) particle sizes, with estimated sorption of 6.8, 5.1, and 3.8 g P kg, respectively. Phosphorus removal for the three furnace slag particle sizes and natural soil were tested in flow-through columns operated at residence times of 50, 17, and 7 s. A decrease in residence time reduced P removal in all columns evaluated. Following all trials, the average P removal from influent was 50% for FS, followed by 27% for FS (furnace slag-coated pea gravel), 22% for FS, and 6% for sandy loam-coated pea gravel. The data from this study provides crucial information for developing and sizing an inline tile drainage treatment system to remove P from tile drainage outlets before reaching surface waters.

Full and Partial Mid-substance ACL Rupture Using Mechanical Tibial Displacement in Male and Female Mice.

The anterior cruciate ligament (ACL) is the most commonly injured knee ligament. Surgical reconstruction is the gold standard treatment for ACL ruptures, but 20-50% of patients develop post-traumatic osteoarthritis (PTOA). ACL rupture is thus a well-recognized etiology of PTOA; however, little is known about the initial relationship between ligamentous injury and subsequent PTOA. The goals of this project were to: (1) develop both partial and full models of mid-substance ACL rupture in male and female mice using non-invasive mechanical methods by means of tibial displacement; and (2) to characterize early PTOA changes in the full ACL rupture model. A custom material testing system was utilized to induce either partial or full ACL rupture by means of tibial displacement at 1.6 or 2.0 mm, respectively. Mice were euthanized either (i) immediately post-injury to determine rupture success rates or (ii) 14 days post-injury to evaluate early PTOA progression following full ACL rupture. Our models demonstrated high efficacy in inciting either full or partial ACL rupture in male and female mice within the mid-substance of the ACL. These tools can be utilized for preclinical testing of potential therapeutics and to further our understanding of PTOA following ACL rupture.

Intravenous injection of adipose-derived mesenchymal stromal cells benefits gait and inflammation in a spontaneous osteoarthritis model.

Osteoarthritis (OA) is a leading cause of morbidity among aging populations, yet symptom and/or disease-modification remains elusive. Adipose-derived mesenchymal stromal cells (adMSCs) have demonstrated immunomodulatory and anti-inflammatory properties that may alleviate clinical signs and interrupt disease onset and progression. Indeed, multiple manuscripts have evaluated intra-articular administration of adMSCs as a therapeutic; however, comparatively few evaluations of systemic delivery methods have been published. Therefore, the aim of this study was to evaluate the short-term impact of intravenous (IV) delivery of allogeneic adMSCs in an established model of spontaneous OA, the Hartley guinea pig. Animals with moderate OA received once weekly injections of 2 × 106 adMSCs or vehicle control for 4 weeks in peripheral veins; harvest occurred 2 weeks after the final injection. Systemic administration of adMSCs resulted in no adverse effects and was efficacious in reducing clinical signs of OA (as assessed by computer-aided gait analysis) compared to control injected animals. Further, there were significant decreases in key inflammatory mediators (including monocyte chemoattractant protein-1, tumor necrosis factor, and prostaglandin E2 ) both systemically (liver, kidney, and serum) and locally in the knee (joint tissues and synovial fluid) in animals treated with IV adMSCs relative to controls (as per enzyme-linked immunosorbent assay and/or immunohistochemistry, dictated by tissue sample). Thus, systemic administration of adMSCs by IV injection significantly improved gait parameters and reduced both systemic and intra-articular inflammatory mediators in animals with OA. These findings demonstrate the potential utility of alternative delivery approaches for cellular therapy of OA, particularly for patients with multiple affected joints.

Elective operations delay and emergency department visits and inpatient admissions during COVID-19.

Introduction: At the beginning of the COVID-19 pandemic, many hospitals postponed elective operations for a 12-week period in early 2020. During this time, there was concern that the delay would lead to worse health outcomes. The objective of this study is to analyze the effect of delaying operations during this period on ED (Emergency Department) visits and/or urgent IP (Inpatient) admissions. Methods: Electronic Health Record (EHR) data on canceled elective operations between 3/17/20 to 6/8/20 was extracted and a descriptive analysis was performed looking at patient demographics, delay time (days), procedure type, and procedure on rescheduled, completed elective operations with and without a related ED visit and/or IP admission during the delay period. Results: Only 4 out of 197 (2.0%) operations among 4 patients out of 186 patients (2.0%) had an ED visit or IP admission diagnosis related to the postponed operation. When comparing the two groups, the 4 patients were older and had a longer median delay time compared to the 186 patients without an ED visit or IP admission. Conclusion: Postponement of certain elective operations may be done with minimal risk to the patient during times of crisis. However, this minimal risk may be due to the study site's selection of elective operations to postpone. For example, none of the elective operations canceled or postponed were cardiovascular operations, which have worse health outcomes when delayed.

Critical Information from High Fidelity Arterial and Venous Pressure Waveforms During Anesthesia and Hemorrhage.

PURPOSE: Peripheral venous pressure (PVP) waveform analysis is a novel, minimally invasive, and inexpensive method of measuring intravascular volume changes. A porcine cohort was studied to determine how venous and arterial pressure waveforms change due to inhaled and infused anesthetics and acute hemorrhage. METHODS: Venous and arterial pressure waveforms were continuously collected, while each pig was under general anesthesia, by inserting Millar catheters into a neighboring peripheral artery and vein. The anesthetic was varied from inhaled to infused, then the pig underwent a controlled hemorrhage. Pearson correlation coefficients between the power of the venous and arterial pressure waveforms at each pig's heart rate frequency were calculated for each variation in the anesthetic, as well as before and after hemorrhage. An analysis of variance (ANOVA) test was computed to determine the significance in changes of the venous pressure waveform means caused by each variation. RESULTS: The Pearson correlation coefficients between venous and arterial waveforms decreased as anesthetic dosage increased. In an opposing fashion, the correlation coefficients increased as hemorrhage occurred. CONCLUSION: Anesthetics and hemorrhage alter venous pressure waveforms in distinctly different ways, making it critical for researchers and clinicians to consider these confounding variables when utilizing pressure waveforms. Further work needs to be done to determine how best to integrate PVP waveforms into clinical decision-making.

Early removal of the infrapatellar fat pad/synovium complex beneficially alters the pathogenesis of moderate stage idiopathic knee osteoarthritis in male Dunkin Hartley guinea pigs.

BACKGROUND: The infrapatellar fat pad (IFP) is the largest adipose deposit in the knee; however, its contributions to the homeostasis of this organ remain undefined. To determine the influence of the IFP and its associated synovium (IFP/synovium complex or IFP/SC) on joint health, this study evaluated the progression of osteoarthritis (OA) following excision of this unit in a rodent model of naturally-occurring disease. METHODS: Male Dunkin-Hartley guinea pigs (n=18) received surgical removal of the IFP in one knee at 3 months of age; contralateral knees received sham surgery as matched internal controls. Mobility and gait assessments were performed prior to IFP/SC removal and monthly thereafter. Animals were harvested at 7 months of age. Ten set of these knees were processed for microcomputed tomography (microCT), histopathology, transcript expression analyses, and immunohistochemistry (IHC); 8 sets of knees were dedicated to microCT and biomechanical testing (material properties of knee joints tissues and anterior drawer laxity). RESULTS: Fibrous connective tissue (FCT) developed in place of the native adipose depot. Gait demonstrated no significant differences between IFP/SC removal and contralateral hindlimbs. MicroCT OA scores were improved in knees containing the FCT. Quantitatively, IFP/SC-containing knees had more osteophyte development and increased trabecular volume bone mineral density (vBMD) in femora and tibiae. Histopathology confirmed maintenance of articular cartilage structure, proteoglycan content, and chondrocyte cellularity in FCT-containing knees. Transcript analyses revealed decreased expression of adipose-related molecules and select inflammatory mediators in FCTs compared to IFP/SCs. This was verified via IHC for two key inflammatory agents. The medial articular cartilage in knees with native IFP/SCs showed an increase in equilibrium modulus, which correlated with increased amounts of magnesium and phosphorus. DISCUSSION/CONCLUSION: Formation of the FCT resulted in reduced OA-associated changes in both bone and cartilage. This benefit may be associated with: a decrease in inflammatory mediators at transcript and protein levels; and/or improved biomechanical properties. Thus, the IFP/SC may play a role in the pathogenesis of knee OA in this strain, with removal prior to disease onset appearing to have short-term benefits.

Evaluation of electroacupuncture for symptom modification in a rodent model of spontaneous osteoarthritis.

OBJECTIVE: Faced with the frustration of chronic discomfort and restricted mobility due to osteoarthritis (OA), many individuals have turned to acupuncture for relief. However, the efficacy of acupuncture for OA is uncertain, as much of the evidence is inconclusive. The purpose of this study was to evaluate electroacupuncture (EA) in a rodent model of OA such that conclusions regarding its effectiveness for symptom or disease modification could be drawn. METHODS: Ten 12-month-old male Hartley guinea pigs-which characteristically have moderate to advanced OA at this age-were randomly assigned to receive EA for knee OA (n = 5) or anesthesia only (control group, n = 5). Treatments were performed three times weekly for 3 weeks, followed by euthanasia 2 weeks later. Gait analysis and enclosure monitoring were performed weekly to evaluate changes in movement. Serum was collected for inflammatory biomarker testing. Knee joints were collected for histology and gene expression. RESULTS: Animals receiving EA had significantly greater changes in movement parameters compared to those receiving anesthesia only. There was a tendency toward decreased serum protein concentrations of complement component 3 (C3) in the EA group compared to the control group. Structural and antioxidant gene transcripts in articular cartilage were increased by EA. There was no significant difference in total joint histology scores between groups. CONCLUSION: This study provides evidence that EA has a positive effect on symptom, but not disease, modification in a rodent model of OA. Further investigations into mechanistic pathways that may explain the efficacy of EA in this animal model are needed.