Medical Specialties Commons^™

Clinical Impact Of Standardized Tavr Technique And Care Pathway: Insights From The Optimize Pro Study., Kendra J Grubb, Hemal Gada, Suneet Mittal, Tamim Nazif, Josep Rodés-Cabau, Douglas G W Fraser, Lang Lin, Joshua D Rovin, Ramzi Khalil, Ibrahim Sultan, Blake Gardner, David Lorenz, Stanley J Chetcuti, Nainesh C Patel, James E Harvey, Paul Mahoney, Brian Schwartz, Zubair Jafar, John Wang, Srinivasa Potluri, Amit N Vora, Carlos Sanchez, Amy Corrigan, Shuzhen Li, Steven J Yakubov

Heart and Vascular Articles

BACKGROUND: Procedural success and clinical outcomes after transcatheter aortic valve replacement (TAVR) have improved, but residual aortic regurgitation (AR) and new permanent pacemaker implantation (PPI) rates remain variable because of a lack of uniform periprocedural management and implantation.

OBJECTIVES: The Optimize PRO study evaluates valve performance and procedural outcomes using an "optimized" TAVR care pathway and the cusp overlap technique (COT) in patients receiving the Evolut PRO/PRO+ (Medtronic) self-expanding valves.

METHODS: Optimize PRO, a nonrandomized, prospective, postmarket study conducted in the United States, Canada, Europe, Middle East, and Australia, is enrolling patients with severe symptomatic aortic stenosis and no pre-existing …

Heterotopic Pregnancy: A Difficult And Rarely Considered Diagnosis., Joseph M Crum, Howard W Levitin

Women’s Health Articles

A 34-year-old pregnant female presented to the emergency department (ED) with complaints of abdominal pain and vaginal bleeding for two days. The day prior, she was evaluated by her obstetrician and gynecologist with a transvaginal ultrasound demonstrating an intrauterine pregnancy at approximately six weeks gestation. After treatment of symptoms and reassuring laboratory testing, she went home. However, she returned two days later with worsening complaints. It was discovered that the patient had a heterotopic pregnancy, or a concomitant intrauterine and extrauterine pregnancy, resulting from natural conception in the absence of identifiable risk factors. While exceedingly rare, this diagnosis is frequently …

Incidence And Predictors Of Acute Limb Ischemia In Acute Myocardial Infarction Complicated By Cardiogenic Shock., Carlos M Romero, Irfan Shafi, Aadhar Patil, Eric Secemsky, Ido Weinburg, Raghu Kolluri, Huaqing Zhao, Vladimir Lakther, Riyaz Bashir

Heart and Vascular Articles

OBJECTIVE: To describe the incidence and predictors of acute limb ischemia (ALI) in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS).

METHODS: Patients with index hospitalizations for AMI complicated by cardiogenic shock from 2016 to 2019 in the US National Readmission Database were identified. We evaluated the incidence of ALI and its associated mortality, length of stay, and cost of hospitalization. We used multivariable logistic regression to determine independent predictors of ALI in this population.

RESULTS: A total of 84,615 patients had AMI complicated by cardiogenic shock and 1302 (1.54%) developed ALI. The rates of ALI increased …

Peri-Implant Proximal Humerus Fracture Stabilized With Stacked Plating: A Case Report., Daniel T Degenova, Matthew T Glazier, John B Schrock, Brian W Skura, Taylor N Hockman, Benjamin C Taylor

Surgery Articles

INTRODUCTION: A peri-implant proximal humerus fracture is a rare complication after open reduction and internal fixation (ORIF) and poses a surgical dilemma.

CASE REPORT: A 56-year-old male sustained a peri-implant proximal humerus fracture after undergoing ORIF. We present a stacked plating method for fixation of this injury. This construct allows for decreased operative time, less soft-tissue dissection, and the ability to leave previous intact hardware in place.

CONCLUSION: We describe the rare case of a peri-implant proximal humerus treated with stacked plating.

Differences Between Patients With Diabetes Mellitus And Those Without In Cases Of Necrotizing Fasciitis., Daniel T Degenova, Scott S Hyland, Tucker Peabody, Nolan P Schmitz, Devon Myers, Robert Patterson, Jignesh Patel

Surgery Articles

Purposes This study aims to evaluate further differences between patients with diabetes and those without who have been diagnosed with necrotizing fasciitis (NF) to assist clinicians in improving morbidity and mortality. Methods All patients diagnosed with NF of an extremity were retrospectively reviewed and divided into two groups based on a diagnosis of diabetes. Patient charts were reviewed to obtain multiple variables, which were compared between groups. Results From 2015 to 2021, 115 patients underwent surgical intervention due to concern for NF of an extremity with 92 patients included for data computation. Patients with diabetes had an average Laboratory Risk …

The Increased Clinical And Economic Burden Of Hyperkalemia In Medicare Patients Admitted To Long-Term Care Settings., James F Neuenschwander, Alison R Silverstein, Christie L Teigland, Shambhavi Kumar, Edric Y Zeng, Abiy T Agiro, William J Pottorf, W Frank Peacock

Ambulatory and Primary Care Articles

INTRODUCTION: Older patients are at increased risk for hyperkalemia (HK). This study describes the prevalence, recurrence, and clinical and economic burden of HK in Medicare patients admitted to a long-term care (LTC) setting.

METHODS: Retrospective cohort study using 100% Medicare Fee-for-Service (FFS) claims identified patients aged ≥ 65 years with index admission between 2017 and 2019 to a LTC setting (skilled nursing, home health, inpatient rehabilitation, or long-term acute care). Beneficiaries were required to have 12 months continuous medical and pharmacy coverage prior to index LTC admission and ≥ 30 days after LTC discharge (follow-up). Patient characteristics, healthcare resource utilization, …

Trigeminal Trophic Syndrome In A Pediatric Patient With Diffuse Intrinsic Pontine Glioma., Ezra Hoover, Ryan Jay, Patricia Witman

Ambulatory and Primary Care Articles

A 13-year-old girl with a history of diffuse intrinsic pontine glioma (DIPG) suffered from progressively worsening facial ulcerations secondary to paresthesia-induced self-excoriation. She was diagnosed with trigeminal trophic syndrome (TTS) induced by DIPG and struggled to heal her lesions in the background of this excoriation disorder. A multidisciplinary approach that included mood disorder management with sertraline and amitriptyline helped diminish paresthesia, improve her quality of life, and promote healing of the ulcers despite the progression of her DIPG. This case highlights the multifactorial complexity of TTS in pediatric patients and the need for successful management strategies.

Hypernatremia In Diabetic Ketoacidosis: A Rare Metabolic Derangement Requiring A Cautionary Approach In Fluid Resuscitation., Pooya Zardoost, Zeryab Khan, Henry L Wehrum, Ryan Martin

Ambulatory and Primary Care Articles

Diabetic ketoacidosis (DKA) with hypernatremia is an atypical metabolic derangement that warrants additional consideration in choosing IV fluids. Our patient, a middle-aged male with a history of insulin-dependent diabetes mellitus type 2 and hypertension, presented with DKA and hypernatremia in the setting of poor intake, community-acquired pneumonia (CAP), and COVID-19. DKA and hypernatremia led to a meticulous approach to fluid resuscitation, where a crystalloid solution was the choice in treating and preventing exacerbation of either condition. Successful treatment of these conditions requires understanding the unique pathophysiology, which demands further research on management.

A Phase 2 Trial Of Ibrutinib And Nivolumab In Patients With Relapsed Or Refractory Classical Hodgkin's Lymphoma., Walter Hanel, Polina Shindiapina, David A Bond, Yazeed Sawalha, Narendranath Epperla, Timothy Voorhees, Rina Li Welkie, Ying Huang, Gregory K Behbehani, Xiaoli Zhang, Eric Mclaughlin, Wing K Chan, Jonathan E Brammer, Samantha Jaglowski, John C Reneau, Beth A Christian, Basem M William, Jonathon B Cohen, Robert A Baiocchi, Kami Maddocks, Kristie A Blum, Lapo Alinari

Oncology Articles

BACKGROUND: Relapsed or refractory classical Hodgkin lymphoma (cHL) remains a difficult treatment challenge. Although checkpoint inhibitors (CPI) have provided clinical benefit for these patients, responses are generally not durable, and progression eventually occurs. Discovering combination therapies which maximize the immune response of CPI therapy may overcome this limitation. We hypothesized that adding ibrutinib to nivolumab will lead to deeper and more durable responses in cHL by promoting a more favorable immune microenvironment leading to enhanced T-cell-mediated anti-lymphoma responses.

METHODS: We conducted a single arm, phase II clinical trial testing the efficacy of nivolumab in combination with ibrutinib in patients ≥18 …

Editorial: Autologous And Allogeneic Stem Cell Transplant In Cancer Therapy., Nidhi Sharma, Yvonne A Efebera

Oncology Articles

Over the last 10 to 20 years, there have been significant improvements in the fields of both autologous and allogenic transplantation [...].

A Multicenter Study Of Clinical Impact Of Variant Of Uncertain Significance Reclassification In Breast, Ovarian And Colorectal Cancer Susceptibility Genes., Sukh Makhnoon, Brooke Levin, Megan Ensinger, Kristin Mattie, Robert J Volk, Zhongming Zhao, Tito Mendoza, Sanjay Shete, Laila Samiian, Generosa Grana, Andrew Grainger, Banu Arun, Brian H Shirts, Susan K Peterson

Oncology Articles

BACKGROUND: Clinical interpretation of genetic test results is complicated by variants of uncertain significance (VUS) that have an unknown impact on health but can be clarified through reclassification. There is little empirical evidence regarding VUS reclassification in oncology care settings, including the prevalence and outcomes of reclassification, and racial/ethnic differences.

METHODS: This was a retrospective analysis of persons with and without a personal history of cancer carrying VUS (with or without an accompanying pathogenic or likely pathogenic [P/LP] variant) in breast, ovarian, and colorectal cancer predisposition genes seen at four cancer care settings (in Texas, Florida, Ohio, and New Jersey) …

Paxlovid-Induced Tacrolimus Toxicity In The Treatment Of Covid-19: A Case Report., Stephanie Michael, Rachel Heilbronner, Christopher M Lloyd, Howard W Levitin

Pharmacy Articles

Paxlovid^TM (nirmaltrelvir/ritonavir) received emergency use authorization from the Food and Drug Administration (FDA) in December 2021 to treat coronavirus disease 2019 (COVID-19). Given the actions of Paxlovid on cytochrome P450-3A4 (CYP3A4) enzymes, it is imperative to check for potential drug-drug interactions before prescribing. We describe a case in which the common emergency department presentation of generalized weakness was found to be caused by interactions between Paxlovid and a patient's home medications resulting in tacrolimus toxicity.

Hybrid Epicardial-Endocardial Ablation For Long-Standing Persistent Atrial Fibrillation: A Subanalysis Of The Converge Trial., David B Delurgio, Christopher Blauth, Michael E Halkos, Karl J Crossen, David Talton, Saumil R Oza, Anthony R Magnano, Mark A Mostovych, Sreedhar Billakanty, Steven Duff, Christopher Stees, Jason Sperling, Syed Ahsan, John Yap, Christian Shults, David Pederson, James Garrison, Paul Tabereaux, David M Gilligan, Graham Bundy, Otto Costantini, Eric Espinal, Angelo La Pietra, Felix Yang, Yisachar Greenberg, Israel Jacobowitz, Jaswinder Gill

Heart and Vascular Articles

BACKGROUND: Favorable clinical outcomes are difficult to achieve in long-standing persistent atrial fibrillation (LSPAF) with catheter ablation (CA). The CONVERGE (Convergence of Epicardial and Endocardial Ablation for the Treatment of Symptomatic Persistent Atrial FIbrillation) trial evaluated the effectiveness of hybrid convergent (HC) ablation vs endocardial CA.

OBJECTIVE: The study sought to evaluate the safety and effectiveness of HC vs CA in the LSPAF subgroup from the CONVERGE trial.

METHODS: The CONVERGE trial was a prospective, multicenter, randomized trial that enrolled 153 patients at 27 sites. A post hoc analysis was performed on LSPAF patients. The primary effectiveness was freedom from …

Structural Valve Deterioration After Self-Expanding Transcatheter Or Surgical Aortic Valve Implantation In Patients At Intermediate Or High Risk., Daniel O'Hair, Steven J Yakubov, Kendra J Grubb, Jae K Oh, Saki Ito, G Michael Deeb, Nicolas M Van Mieghem, David H Adams, Tanvir Bajwa, Neal S Kleiman, Stanley Chetcuti, Lars Søndergaard, Hemal Gada, Mubashir Mumtaz, John Heiser, William M Merhi, George Petrossian, Newell Robinson, Gilbert H L Tang, Joshua D Rovin, Stephen H Little, Renuka Jain, Sarah Verdoliva, Tim Hanson, Shuzhen Li, Jeffrey J Popma, Michael J Reardon

Heart and Vascular Articles

IMPORTANCE: The frequency and clinical importance of structural valve deterioration (SVD) in patients undergoing self-expanding transcatheter aortic valve implantation (TAVI) or surgery is poorly understood.

OBJECTIVE: To evaluate the 5-year incidence, clinical outcomes, and predictors of hemodynamic SVD in patients undergoing self-expanding TAVI or surgery.

DESIGN, SETTING, AND PARTICIPANTS: This post hoc analysis pooled data from the CoreValve US High Risk Pivotal (n = 615) and SURTAVI (n = 1484) randomized clinical trials (RCTs); it was supplemented by the CoreValve Extreme Risk Pivotal trial (n = 485) and CoreValve Continued Access Study (n = 2178). Patients with severe aortic valve …

A Symptomatic Cystic Axillary Mass In A Post-Partum Female., Nicole Werwie, Jodi Oostra, Kelly Hanley

Surgery Articles

Hemangiomas are rarely found in the axilla, with the most commonly identified axillary mass being lymphadenopathy. We report a unique case report of a post-partum female with an axillary mass that became larger and symptomatic while breastfeeding. On imaging, the mass was found to be complex and cystic, and aspiration was attempted several times. With a rapid return of swelling and worsening symptoms, there was concern for bleeding into the cystic cavity. Ultimately, the >10 cm mass had to be formally excised in the operating room, yielding definitive relief of symptoms. Final pathology reported the mass as a vascular malformation, …

International Multicenter Study Comparing Covid-19 In Patients With Cancer To Patients Without Cancer: Impact Of Risk Factors And Treatment Modalities On Survivorship., Issam I Raad, Ray Hachem, Nigo Masayuki, Tarcila Datoguia, Hiba Dagher, Ying Jiang, Vivek Subbiah, Bilal Siddiqui, Arnaud Bayle, Robert Somer, Ana Fernández Cruz, Edward Gorak, Arvinder Bhinder, Nobuyoshi Mori, Nelson Hamerschlak, Samuel Shelanski, Tomislav Dragovich, Yee Elise Vong Kiat, Suha Fakhreddine, Abi Hanna Pierre, Roy F Chemaly, Victor Mulanovich, Javier Adachi, Jovan Borjan, Fareed Khawaja, Bruno Granwehr, Teny John, Eduardo Yepez Yepez, Harrys A Torres, Natraj Reddy Ammakkanavar, Marcel Yibirin, Cielito C Reyes-Gibby, Mala Pande, Noman Ali, Raniv Dawey Rojo, Shahnoor M Ali, Rita E Deeba, Patrick Chaftari, Takahiro Matsuo, Kazuhiro Ishikawa, Ryo Hasegawa, Ramón Aguado-Noya, Alvaro Garcia García, Cristina Traseira Puchol, Dong Gun Lee, Monica Slavin, Benjamin Teh, Cesar A Arias, Dimitrios P Kontoyiannis, Alexandre E Malek, Anne-Marie Chaftari

Oncology Articles

BACKGROUND: In this international multicenter study, we aimed to determine the independent risk factors associated with increased 30 day mortality and the impact of cancer and novel treatment modalities in a large group of patients with and without cancer with COVID-19 from multiple countries.

METHODS: We retrospectively collected de-identified data on a cohort of patients with and without cancer diagnosed with COVID-19 between January and November 2020 from 16 international centers.

RESULTS: We analyzed 3966 COVID-19 confirmed patients, 1115 with cancer and 2851 without cancer patients. Patients with cancer were more likely to be pancytopenic and have a smoking history, …

Global Impact Of The Covid-19 Pandemic On Stroke Volumes And Cerebrovascular Events: A 1-Year Follow-Up., Thanh N Nguyen, Muhammad M Qureshi, Piers Klein, Hiroshi Yamagami, Robert Mikulik, Anna Czlonkowska, Mohamad Abdalkader, Petra Sedova, Anvitha Sathya, Hannah C Lo, Ossama Yassin Mansour, Husitha Reddy Vanguru, Emilie Lesaine, Georgios Tsivgoulis, Aaron I Loochtan, Jelle Demeestere, Ken Uchino, Violiza Inoa, Nitin Goyal, Andreas Charidimou, James E Siegler, Shadi Yaghi, Diana Aguiar De Sousa, Mahmoud H Mohammaden, Diogo C Haussen, Espen Saxhaug Kristoffersen, Virginia Pujol Lereis, Sergio Daniel Scollo, Bruce C V Campbell, Alice Ma, James Orton Thomas, Mark W Parsons, Shaloo Singhal, Lee-Anne Slater, Rodrigo Tomazini Martins, Chris Enzinger, Thomas Gattringer, Aminur Rahman, Thomas Bonnet, Noemie Ligot, Sylvie De Raedt, Robin Lemmens, Peter Vanacker, Fenne Vandervorst, Adriana Bastos Conforto, Raquel C T Hidalgo, Luciana De Oliveira Neves, Rodrigo Targa Martins, Daissy Liliana Mora Cuervo, Leticia C Rebello, Igor Bessa Santiago, Isabelle Lameirinhas Da Silva, Teodora Sakelarova, Rosen Kalpachki, Filip Alexiev, Luciana Catanese, Elena Adela Cora, Mayank Goyal, Michael D Hill, Michael E Kelly, Houman Khosravani, Pascale Lavoie, Lissa Peeling, Aleksandra Pikula, Rodrigo Rivera, Hui-Sheng Chen, Yimin Chen, Xiaochuan Huo, Zhongrong Miao, Shuiquan Yang, Marina Roje Bedekovic, Marina Bralic, Hrvoje Budincevic, Angel Basilio Corredor-Quintero, Osvaldo E Lara-Sarabia, Martin Cabal, Dusan Tenora, Petr Fibrich, Roman Herzig, Helena Hlaváčová, Emanuela Hrabanovska, David Hlinovsky, Lubomir Jurak, Jana Kadlcikova, Igor Karpowicz, Lukas Klecka, Martin Kovar, David Lauer, Jiri Neumann, Hana Palouskova, Martin Reiser, Petra Rekova, Vladimir Rohan, Ondrej Skoda, Miroslav Škorňa, Lenka Sobotková, Martin Sramek, Lenka Zakova, Hanne Christensen, Nicolas Drenck, Helle Klingenberg Iversen, Thomas Clement Truelsen, Troels Wienecke, Khalid Sobh, Pauli Ylikotila, Kemal Alpay, Daniel Strbian, Patricia Bernady, Philippe Casenave, Maria Dan, Jean-Marc Faucheux, Jean-Christophe Gentric, Elsa Magro, Candice Sabben, Peggy Reiner, Francois Rouanet, Ferdinand O Bohmann, Stefan Boskamp, Joshua Mbroh, Simon Nagel, Christian H Nolte, Peter A Ringleb, Michael Rosenkranz, Sven Poli, Götz Thomalla, Theodoros Karapanayiotides, Ioanna Koutroulou, Odysseas Kargiotis, Lina Palaiodimou, Jose Dominguo Barrientos Guerra, Vikram Huded, Bindu Menon, Shashank Nagendra, Chintan Prajapati, P N Sylaja, Nyoman Angga Krishna Pramana, Achmad Firdaus Sani, Abdoreza Ghoreishi, Mehdi Farhoudi, Elyar Sadeghi Hokmabadi, Tariq Abu Raya, Shani Avnery Kalmanovich, Levite Ronen, Sergiu Ionut Sabetay, Maurizio Acampa, Alessandro Adami, Lucio Castellan, Marco Longoni, Raffaele Ornello, Leonardo Renieri, Claudia Rolla Bigliani, Michele Romoli, Simona Sacco, Andrea Salmaggi, Davide Sangalli, Andrea Zini, Ryosuke Doijiri, Hiroki Fukuda, Toshiyuki Fujinaka, Kyohei Fujita, Hirotoshi Imamura, Nobuyuki Sakai, Takuya Kanamaru, Naoto Kimura, Ryuhei Kono, Kosuke Miyake, Manabu Sakaguchi, Kenichiro Sakai, Kazutaka Sonoda, Kenichi Todo, Fumio Miyashita, Naoki Tokuda, Yuji Matsumaru, Shoji Matsumoto, Nobuyuki Ohara, Seigo Shindo, Yohei Takenobu, Takeshi Yoshimoto, Kazunori Toyoda, Takeshi Uwatoko, Yoshiki Yagita, Takehiro Yamada, Nobuaki Yamamoto, Ryoo Yamamoto, Yukako Yazawa, Yuri Sugiura, Peter Kuria Waweru, Jang-Hyun Baek, Si Baek Lee, Kwon-Duk Seo, Sung-Il Sohn, Anita Ante Arsovska, Yong Chieh Chan, Wan Asyraf Wan Zaidi, Ainul Syahrilfazli Jaafar, Fernando Gongora-Rivera, Manuel Martinez-Marino, Adrian Infante-Valenzuela, Stanislav Groppa, Pavel Leahu, Jonathan M Coutinho, Leon A Rinkel, Diederik W J Dippel, Dianne H K Van Dam-Nolen, Annemarei Ranta, Teddy Y Wu, Tajudeen Temitayo Adebayo, Abiodun H Bello, Ernest Okwundu Nwazor, Taofiki Ajao Sunmonu, Kolawole Wasiu Wahab, Ole Morten Ronning, Else Charlotte Sandset, Amal M Al Hashmi, Saima Ahmad, Umair Rashid, Liliana Rodriguez-Kadota, Miguel Ángel Vences, Patrick Matic Yalung, Jon Stewart Hao Dy, Maria Carissa Pineda-Franks, Christian Oliver Co, Waldemar Brola, Aleksander Debiec, Malgorzata Dorobek, Michal Adam Karlinski, Beata M Labuz-Roszak, Anetta Lasek-Bal, Halina Sienkiewicz-Jarosz, Jacek Staszewski, Piotr Sobolewski, Marcin Wiacek, Justyna Zielinska-Turek, Andre Pinho Araujo, Mariana Rocha, Pedro Castro, Vitor Tedim Cruz, Paulo Venancio Ferreira, Patricia Ferreira, Ana Paiva Nunes, Luisa Fonseca, João Pedro Marto, Teresa Pinho E Melo, Miguel Rodrigues, M Luis Silva, Adela Dimitriade, Cristian Falup-Pecurariu, May Adel Hamid, Narayanaswamy Venketasubramanian, Georgi Krastev, Miroslav Mako, Oscar Ayo-Martin, Francisco Hernández-Fernández, Jordi Blasco, Alejandro Rodríguez-Vázquez, Antonio Cruz-Culebras, Francisco Moniche, Joan Montaner, Soledad Perez-Sanchez, María Jesús García Sánchez, Marta Guillán Rodríguez, Katarina Jood, Annika Nordanstig, Michael V Mazya, Tiago T P Moreira, Gianmarco Bernava, Morin Beyeler, Manuel Bolognese, Emmanuel Carrera, Tomas Dobrocky, Grzegorz Marek Karwacki, Emanuela Keller, Chang Yang Hsieh, Surawan Boonyakarnkul, Anchalee Churojana, Ozlem Aykac, Atilla Ã-Zcan Ozdemir, Arsida Bajrami, Songul Senadim, Syed Irteza Hussain, Seby John, Soma Banerjee, Joseph Kwan, Kailash Krishnan, Robert Lenthall, Ashok Matthews, Ken Wong, Liqun Zhang, Dorothea Altschul, Kaiz S Asif, Zeelalem Bahiru, Kristine Below, José Biller, Sean Ruland, Saqib A Chaudry, Michael Chen, Alex Chebl, Jackie Cibulka, Leon Cistrunk, Judith Clark, Marco Colasurdo, Alexandra Czap, Adam De Havenon, Salvatore D'Amato, Sushrut Dharmadhikari, Kasey B Grimmett, Adam A Dmytriw, Mark R Etherton, Chizoba Ezepue, Mudassir Farooqui, Steven K Feske, Lauren Fink, Ulviyya Gasimova, Amy K Guzik, Maryam Hakemi, Majesta Hovingh, Muhib Khan, Dinesh Jillela, Peter T Kan, Rakesh Khatri, Ayaz M Khawaja, Naim N Khoury, Nicole L Kiley, Benny S Kim, Murali K Kolikonda, Anna Luisa Kuhn, Stephanie Lara, Guillermo Linares, Italo Linfante, Timothy G Lukovits, Sarah Lycan, Shailesh S Male, Laith Maali, John Mancin, Hesham Masoud, Ghada A Mohamed, Andre Monteiro, Fadi Nahab, Krishna Nalleballe, Santiago Ortega-Gutierrez, Ajit S Puri, Yazan Radaideh, Rahul H Rahangdale, Ansaar Rai, Pankajavalli Ramakrishnan, Aravind B Reddy, Diana M Rojas-Soto, Jose Rafael Romero, Natalia S Rost, Aaron Rothstein, Setareh Salehi Omran, Sunil A Sheth, Adnan H Siddiqui, Amy K Starosciak, Nicholas E Tarlov, Robert A Taylor, Michael J Wang, Jared Wolfe, Ka-Ho Wong, Huynh Vu Le, Quy Viet Nguyen, Thong Nhu Pham, Trung Thanh Nguyen, Hoang Thi Phan, Mai Duy Ton, Urs Fischer, Patrik Michel, Davide Strambo, Sheila O Martins, Osama O Zaidat, Raul G Nogueira

Neuroscience Articles

BACKGROUND AND OBJECTIVES: Declines in stroke admission, IV thrombolysis (IVT), and mechanical thrombectomy volumes were reported during the first wave of the COVID-19 pandemic. There is a paucity of data on the longer-term effect of the pandemic on stroke volumes over the course of a year and through the second wave of the pandemic. We sought to measure the effect of the COVID-19 pandemic on the volumes of stroke admissions, intracranial hemorrhage (ICH), IVT, and mechanical thrombectomy over a 1-year period at the onset of the pandemic (March 1, 2020, to February 28, 2021) compared with the immediately preceding year …

Thrombectomy Outcomes With General Vs Nongeneral Anesthesia: A Pooled Patient-Level Analysis From The Extend-Ia Trials And Select Study., Amrou Sarraj, Gregory W Albers, Peter J Mitchell, Ameer E Hassan, Michael G Abraham, Spiros Blackburn, Gagan Sharma, Nawaf Yassi, Timothy J Kleinig, Darshan G Shah, Teddy Y Wu, Muhammad Shazam Hussain, Wondwoseen G Tekle, Santiago Ortega Gutierrez, Amin Nima Aghaebrahim, Diogo C Haussen, Gabor Toth, Deep Pujara, Ronald F Budzik, William Hicks, Nirav Vora, Randall C Edgell, Sabreena Slavin, Colleen G Lechtenberg, Laith Maali, Abid Qureshi, Lee Rosterman, Mohammad Ammar Abdulrazzak, Tareq Almaghrabi, Faris Shaker, Osman Mir, Ashish Arora, Sheryl Martin-Schild, Clark W Sitton, Leonid Churilov, Rishi Gupta, Maarten G Lansberg, Raul G Nogueira, James C Grotta, Geoffrey Alan Donnan, Stephen M Davis, Bruce C V Campbell

Neuroscience Articles

BACKGROUND AND OBJECTIVES: The effect of anesthesia choice on endovascular thrombectomy (EVT) outcomes is unclear. Collateral status on perfusion imaging may help identify the optimal anesthesia choice.

METHODS: In a pooled patient-level analysis of EXTEND-IA, EXTEND-IA TNK, EXTEND-IA TNK part II, and SELECT, EVT functional outcomes (modified Rankin Scale score distribution) were compared between general anesthesia (GA) vs non-GA in a propensity-matched sample. Furthermore, we evaluated the association of collateral flow on perfusion imaging, assessed by hypoperfusion intensity ratio (HIR) - Tmax > 10 seconds/Tmax > 6 seconds (good collaterals - HIR < 0.4, poor collaterals - HIR ≥ 0.4) on the association between anesthesia type and EVT outcomes.

RESULTS: Of 725 treated with EVT, 299 (41%) received GA …

Dosimetric And Radiobiological Comparison Between Conventional And Hypofractionated Breast Treatment Plans Using The Halcyon System., Duong Thanh Tai, Luong Tien Phat, Nguyen Ngoc Anh, Huynh Van Tran Sang, Tran Minh Loc, Nguyen Xuan Hai, Peter A Sandwall, David Bradley, James C L Chow

Oncology Articles

PURPOSE: The objective of this research is to compare the efficacy of conventional and hypofractionated radiotherapy treatment plans for breast cancer patients, with a specific focus on the unique features of the Halcyon system.

METHODS AND MATERIALS: The study collected and analyzed dose volume histogram (DVH) data for two groups of treatment plans implemented using the Halcyon system. The first group consisted of 19 patients who received conventional fractionated (CF) treatment with a total dose of 50 Gy in 25 fractions, while the second group comprised 9 patients who received hypofractionated (HF) treatment with a total dose of 42.56 Gy …

International Collaboration On Palliative Care Development Between Asco And The Land Of Hornbills., Yin Yee Wong, Aaron Zi Jian Chiew, Vanessa Eaton, Frank D Ferris, Megan Kremzier, Boon Leong Lim, Winnie Hui Yee Ling, Asri Said, Vanessa Sarchet, Tung Hui Tiong, Pei Jye Voon, Yoke Ling Choo

Oncology Articles

PURPOSE: Palliative care in Sarawak is mainly provided by health care professionals with limited formal training in palliative care. Therefore, in 2020, collaborative work between Sarawak General Hospital, University Malaysia Sarawak, and ASCO began. This study reports on the outcome of this collaboration.

METHODS: The collaboration was initiated with the first ASCO Palliative Care e-course, Train the Trainer program, International Development and Education Award-Palliative Care and translation of ASCO Palliative Care Interdisciplinary Curriculum resources.

RESULTS: This collaboration has resulted in the change of practice of palliative care among the oncology team of Sarawak General Hospital.

CONCLUSION: It encourages more timely …

Organization Of Sensorimotor Activity In Anterior Cruciate Ligament Reconstructed Individuals: An Fmri Conjunction Analysis., Amber J Schnittjer, Howon Kim, Adam S Lepley, James A Onate, Cody R Criss, Janet E Simon, Dustin R Grooms

Neuroscience Articles

INTRODUCTION: Anterior cruciate ligament reconstruction (ACLR) is characterized by persistent involved limb functional deficits that persist for years despite rehabilitation. Previous research provides evidence of both peripheral and central nervous system adaptations following ACLR. However, no study has compared functional organization of the brain for involved limb motor control relative to the uninvolved limb and healthy controls. The purpose of this study was to examine sensorimotor cortex and cerebellar functional activity overlap and non-overlap during a knee motor control task between groups (ACLR and control), and to determine cortical organization of involved and uninvolved limb movement between groups.

METHODS: Eighteen …

A Novel Pulsed Stimulation Pattern In Spinal Cord Stimulation: Clinical Results And Postulated Mechanisms Of Action In The Treatment Of Chronic Low Back And Leg Pain., Mehul J Desai, John Salmon, Paul Verrills, Bruce Mitchell, Neels Du Toit, Dan Bates, Girish Vajramani, Adam Williams, Sarah Love-Jones, Nikunj Patel, Serge Nikolic, Vivek Mehta, Alia Ahmad, James Yu, Nick Christellis, Sam Harkin, Ganesan Baranidharan, Robert Levy, Peter Staats, Mark N Malinowski, James Makous, Nicholas Sullivan, Shilpa Kottalgi, Melissa Hartley, Lakshmi Narayan Mishra

Neuroscience Articles

OBJECTIVES: The aim of this article is to discuss the possible mechanisms of action (MOAs) and results of a pilot study of a novel, anatomically placed, and paresthesia-independent, neurostimulation waveform for the management of chronic intractable pain.

MATERIALS AND METHODS: A novel, multilayered pulsed stimulation pattern (PSP) that comprises three temporal layers, a Pulse Pattern layer, Train layer, and Dosage layer, was developed for the treatment of chronic intractable pain. During preliminary development, the utility was evaluated of anatomical PSP (aPSP) in human subjects with chronic intractable pain of the leg(s) and/or low back, compared with that of traditional spinal …

Associations Of Snfl With Clinico-Radiological Measures In A Large Ms Population., Elias S Sotirchos, Kathryn C Fitzgerald, Carol M Singh, Matthew D Smith, Maria Reyes-Mantilla, Carrie M Hersh, Megan H Hyland, Ryan Canissario, Sarah B Simmons, Georgina Arrambide, Xavier Montalban, Manuel Comabella, Robert T Naismith, Min Qiao, Lauren B Krupp, Jacqueline A Nicholas, Katja Akgün, Tjalf Ziemssen, Richard Rudick, Elizabeth Fisher, Robert A Bermel, Ellen M Mowry, Peter A Calabresi

Neuroscience Articles

OBJECTIVE: Evaluation of serum neurofilament light chain (sNfL), measured using high-throughput assays on widely accessible platforms in large, real-world MS populations, is a critical step for sNfL to be utilized in clinical practice.

METHODS: Multiple Sclerosis Partners Advancing Technology and Health Solutions (MS PATHS) is a network of healthcare institutions in the United States and Europe collecting standardized clinical/imaging data and biospecimens during routine clinic visits. sNfL was measured in 6974 MS and 201 healthy control (HC) participants, using a high-throughput, scalable immunoassay.

RESULTS: Elevated sNfL levels for age (sNfL-E) were found in 1238 MS participants (17.8%). Factors associated with …

Diabetes-Related Major And Minor Amputation Risk Increased During The Covid-19 Pandemic., Dominick J Casciato, Sara Yancovitz, John Thompson, Steven Anderson, Alex Bischoff, Shauna Ayres, Ian Barron

Heart and Vascular Articles

BACKGROUND: Along with significant case transmission, hospitalizations, and mortality experienced during the global severe acute respiratory syndrome coronavirus 2 pandemic, there existed a disruption in the delivery of health care across multiple specialties. We studied the effect of the pandemic on inpatients with diabetic foot problems in a Level I trauma center in central Ohio.

METHODS: A retrospective chart review of patients necessitating a consultation by the foot and ankle surgery service were reviewed from the first 8 months of 2020. A total of 270 patients met the inclusion criteria and were divided into prepandemic (n = 120) and pandemic …

Case Report: It's Not Always About The Veins; Intervention Of Bilateral May-Thurner Syndrome Secondary To Iliac Aneurysm., Syed H Haq, Sidra R Shah, Jaya Chandra, Pavithra Kannan, Sandeep M Patel

Heart and Vascular Articles

May-Thurner Syndrome (MTS) remains evasive because of the insidiousness and variable etiologies by which it can manifest. In this study, we examine a unique presentation of MTS resulting from compression of both common iliac veins by a right common iliac artery aneurysm that required complex endovascular venous and arterial intervention.

Leukocytoclastic Vasculitis In A Patient With Crohn Disease: A Case Report., Mark Daniele Bugada, Vamsi K Emani

Ambulatory and Primary Care Articles

Leukocytoclastic vasculitis (LCV) is an idiopathic small vessel vasculitis. Leukocytoclastic vasculitis can be found in a spectrum of diseases and is noted as a rare extraintestinal manifestation of Crohn disease. This case report examines a 55-year-old man with a previous diagnosis of Crohn disease who was admitted after 5 days with a persistent rash. A biopsy confirmed LCV, and the patient followed up with dermatology for outpatient treatment. This study adds to the sparse medical literature on LCV cases relating to Crohn disease.

Addition Of Pericapsular Nerve Group And Transversus Abdominis Plane Blocks Significantly Reduces Opioid Use In Patients Undergoing Concomitant Hip Arthroscopy And Periacetabular Osteotomy., Sean Ellis, Joshua D Harris, Derek P Flemming, Thomas J Ellis, Robert C Kollmorgen

Surgery Articles

INTRODUCTION: Previous studies have evaluated the effect of the pericapsular nerve group block for hip arthroscopy and the transverse abdominis plane block for periacetabular osteotomy and have shown decreased narcotic consumption in both groups. No published study has evaluated the effectiveness of combining the blocks when performing hip arthroscopy and periacetabular osteotomy under the same general anesthesia. It was hypothesized that patients treated for hip dysplasia with hip arthroscopy and concomitant periacetabular osteotomy using a pericapsular nerve group block, transverse abdominis plane block, and general anesthesia would have decreased postoperative pain and require less narcotic consumption than those undergoing the …

Expandable Intravertebral Implants In Post-Traumatic Vertebral Necrosis - New Classification Suggestion., Diogo Lino Moura, Josué Pereira Gabriel

Trauma and Acute Care Articles

The progressive evolution of post-traumatic vertebral necrosis and consequent loss of structural integrity of the vertebral body along with neurological risk, makes it one of the most feared and unpredictable pathologies in spine traumatology. Several studies have addressed the role of vertebroplasty, kyphoplasty, and corpectomy in its treatment; however, it remains a controversial concept without a defined therapeutic algorithm. The recent emergence of expandable intravertebral implants, which allow, by a percutaneous transpedicular application, the capacity for intrasomatic filling and maintenance of the height of the vertebral body, makes them a viable option, not only in the treatment of acute vertebral …

Acute Pain Management Pearls: A Focused Review For The Hospital Clinician., Sara J Hyland, Andrea M Wetshtein, Samantha J Grable, Michelle P Jackson

Pharmacy Articles

Acute pain management is a challenging area encountered by inpatient clinicians every day. While patient care is increasingly complex and costly in this realm, the availability of applicable specialists is waning. This narrative review seeks to support diverse hospital-based healthcare providers in refining and updating their acute pain management knowledge base through clinical pearls and point-of-care resources. Practical guidance is provided for the design and adjustment of inpatient multimodal analgesic regimens, including conventional and burgeoning non-opioid and opioid therapies. The importance of customized care plans for patients with preexisting opioid tolerance, chronic pain, or opioid use disorder is emphasized, and …

Impact Of A Dedicated Atrial Fibrillation Clinic On Diagnosis-To-Ablation Time., Andrea Robinson, Nagesh Chopra, Auroa G Badin, Sreedhar R Billakanty, Keaira Cooper, Eugene Y Fu, Jennifer James, Victoria Murnane, Jill Swinning, Mitchell Stelzer, Jaret D Tyler, Anish K Amin

Heart and Vascular Articles

BACKGROUND: Outcomes following catheter ablation (CA) for atrial fibrillation (AF) improve as the diagnosis-to-ablation time (DAT) shortens. Use of a protocol-based integrated care model through a dedicated atrial fibrillation clinic (AFC) may serve to standardize treatment pathways and decrease DAT.

OBJECTIVE: To evaluate the DAT and clinical characteristics of patients with AF referred from an AFC vs a conventional electrophysiology clinic (EC).

METHODS: Retrospective analysis was completed in consecutive patients undergoing index AF ablation at Riverside Methodist Hospital in 2019 with minimum 1 year follow-up. Patients were categorized based off their CA referral source (AFC vs EC) and where the …