Pulmonary hypertension associated with left-sided heart failure.

Purpose Of Review: Pulmonary hypertension is a common phenomenon in heart failure patients that is highly relevant for morbidity and outcome. Although postcapillary in nature, the pathophysiology of pulmonary hypertension in patients with heart failure with reduced or preserved ejection fraction is complex, and decisions about management strategies remain challenging.

Recent Findings: Recently, the hemodynamic definitions and subclassification of postcapillary pulmonary hypertension have been revisited.

Pre-hospital care & interfacility transport of 385 COVID-19 emergency patients: an air ambulance perspective.

Background: COVID-19, the pandemic caused by the severe acute respiratory syndrome coronavirus-2, is challenging healthcare systems worldwide. Little is known about problems faced by emergency medical services-particularly helicopter services-caring for suspected or confirmed COVID-19 patients. We aimed to describe the issues faced by air ambulance services in Europe as they transport potential COVID-19 patients.

Proximal Median Nerve Compression: Pronator Syndrome.

Pronator syndrome (PS) is a compressive neuropathy of the median nerve in the proximal forearm, with symptoms that often overlap with carpal tunnel syndrome (CTS). Because electrodiagnostic studies are often negative in PS, making the correct diagnosis can be challenging. All patients should be initially managed with nonsurgical treatment, but surgical intervention has been shown to result in satisfactory outcomes.

Left Ventricular Papillary Fibroelastoma Presenting with Dyspnea on Exertion.

• A patient presented with reduced effort tolerance and abnormal stress test. • He was subsequently found to have a left ventricular mass. • Multimodal imaging was utilized; however, diagnostic certainty remained limited.

Real-Time 3-D Imaging Using an Air-Coupled Ultrasonic Phased-Array.

We present an air-coupled ultrasonic imaging system based on a 40-kHz 8×8 phased-array for 3-D real-time localization of multiple objects in the far-field. By attaching a waveguide to the array, the effective interelement spacing is reduced to half wavelength. This enables grating lobe-free transmit and receive beamforming with a uniform rectangular array of efficient low-cost transducers.

Vestibular Migraine Following Radiosurgery for Vestibular Schwannoma.

Vestibular schwannoma (VS) is associated with dizziness and vertigo during all stages of treatment. This report describes a patient who presented with a one-year history of intermittent motion sickness, dizziness, headache, imbalance, and nausea. MRI showed a right-side VS in the cerebellopontine angle and internal auditory canal.

ZAP-X: A Novel Radiosurgical Device for the Treatment of Trigeminal Neuralgia.

Introduction The treatment of trigeminal neuralgia (TN) is one of the most demanding of all radiosurgery procedures, requiring accurate delivery and sharp dose fall off. ZAP-X®, a new, innovative frameless radiosurgical device, maybe an attractive platform for the treatment of TN and other functional brain disorders. Here, we compared the dosimetry of ZAP-X plans for a single patient to that generated by a well-established dedicated radiosurgery device, the CyberKnife.

Association Between Steroid-Sparing Therapy and the Risk of Perianal Fistulizing Complications Among Young Patients With Crohn Disease.

Importance: Perianal fistulizing complications (PFCs) develop in 15% to 30% of patients with Crohn disease (CD), are difficult to treat, worsen quality of life, increase cost of care, and commonly recur. Evidence-based strategies to prevent PFCs are lacking.

Objectives: To investigate the effectiveness of medical therapy for reducing risk of PFCs among young people with CD and to test the hypothesis that steroid-sparing therapy (SST) use would be associated with reduced risk of PFC development.

Silent hypoxia: A harbinger of clinical deterioration in patients with COVID-19.

Patients infected with the SARS-CoV-2 virus can present with a wide variety of symptoms including being entirely asymptomatic. Despite having no or minimal symptoms, some patients may have markedly reduced pulse oximetry readings. This has been referred to as "silent" or "apathetic" hypoxia (Ottestad et al.

Clinical Considerations in Neurosurgical Radiosurgery in the Time of COVID-19.

The COVID-19 pandemic is affecting all aspects of the healthcare ecosystem, including administration of stereotactic radiosurgery (SRS). The clinical and logistical challenges created by the COVID-19 public health crisis are clear, but the solutions to these issues are less readily apparent. The goal of this work is to use our experience at a large, academic medical center as a lens for interpreting the many looming issues specific to radiosurgery and its role in the treatment of brain and spine disorders.

Managing haematology and oncology patients during the COVID-19 pandemic: interim consensus guidance.

Introduction: A pandemic coronavirus, SARS-CoV-2, causes COVID-19, a potentially life-threatening respiratory disease. Patients with cancer may have compromised immunity due to their malignancy and/or treatment, and may be at elevated risk of severe COVID-19. Community transmission of COVID-19 could overwhelm health care services, compromising delivery of cancer care.

Factors Associated With Development of Perianal Fistulas in Pediatric Patients With Crohn's Disease.

Perianal fistulizing complications (PFCs) develop among 15%-40% of patients with Crohn's disease (CD), are difficult to treat, commonly recur, and increase healthcare costs. Few reliable predictors of PFCs are known, and no evidence-based preventive strategies exist. Studies often rely on inconsistent methods for identifying PFCs.

Effects of Focal Radiation on [ F]-Fluoro-D-Glucose Positron Emission Tomography in the Brains of Miniature Pigs: Preliminary Findings on Local Metabolism.

Objectives: It would be a medically important advance if durable and focal neuromodulation of the brain could be delivered noninvasively and without ablation. This ongoing study seeks to elucidate the effects of precisely delivered ionizing radiation upon focal brain metabolism and the corresponding cellular integrity at that target. We hypothesize that focally delivered ionizing radiation to the brain can yield focal metabolic changes without lesioning the brain in the process.

How long is long enough? Good neurologic outcome in out-of-hospital cardiac arrest survivors despite prolonged resuscitation: a retrospective cohort study.

Background: Despite all efforts, mortality of out of hospital cardiac arrest (OHCA) remains high. Patients with OHCA due to a primary shockable rhythm typically have a better prognosis. However, outcome worsens if return of spontaneous circulation (ROSC) cannot be achieved quickly.

Patents and Innovation Among Neurosurgeons from the American Association of Neurological Surgeons.

Objective Neurosurgeons have taken on the role of innovators, continuing to move the field forward over the centuries. More recently, innovation has taken the form of new technological devices and therapeutics, which require patenting. The aim of this study is to identify major areas of innovation in the field of neurosurgery by evaluating patent records.

Targets of cGMP/cGKI in Cardiac Myocytes.

The 3',5'-cyclic guanosine monophosphate (cGMP)-dependent protein kinase type I (cGKI aka PKGI) is a major cardiac effector acting downstream of nitric oxide (NO)-sensitive soluble guanylyl cyclase and natriuretic peptides (NPs), which signal through transmembrane guanylyl cyclases. Consistent with the wide distribution of the cGMP-generating guanylyl cyclases, cGKI, which usually elicits its cellular effects by direct phosphorylation of its targets, is present in multiple cardiac cell types including cardiomyocytes (CMs). Although numerous targets of cGMP/cGKI in heart were identified in the past, neither their exact patho-/physiological functions nor cell-type specific roles are clear.

Attenuation of autonomic dysreflexia during functional electrical stimulation cycling by neuromuscular electrical stimulation training: case reports.

Introduction: Spinal cord injury (SCI) may cause impairments of the motor, sensory, and autonomic nervous systems, which result in adverse changes in body composition and cardiovascular health. Functional electrical stimulation (FES) cycling may provide an effective alternative approach to perform exercise and improve cardiovascular health after SCI. Persons with an injury at or above T6 level are at high risk of developing a life-threatening complication of autonomic dysreflexia (AD).

A phase I/II trial of 5-fraction stereotactic radiosurgery with 5-mm margins with concurrent temozolomide in newly diagnosed glioblastoma: primary outcomes.

Background: We sought to determine the maximum tolerated dose (MTD) of 5-fraction stereotactic radiosurgery (SRS) with 5-mm margins delivered with concurrent temozolomide in newly diagnosed glioblastoma (GBM).

Methods: We enrolled adult patients with newly diagnosed glioblastoma to 5 days of SRS in a 3 + 3 design on 4 escalating dose levels: 25, 30, 35, and 40 Gy. Dose limiting toxicity (DLT) was defined as Common Terminology Criteria for Adverse Events grades 3-5 acute or late CNS toxicity, including adverse radiation effect (ARE), the imaging correlate of radiation necrosis.

A New Video Aid for Communicating Risk in the Treatment of Pediatric Inflammatory Bowel Disease.

Balancing risks of immune suppressive medications against risk of chronic disease is challenging for clinicians and families. Available aids commonly lack comparative information needed to inform treatment decisions. We developed a simple video aid to illustrate competing risks associated with medications and underlying disease in context of pediatric inflammatory bowel disease.

Understanding Buprenorphine for Use in Chronic Pain: Expert Opinion.

Objective: An expert panel convened to reach a consensus on common misconceptions surrounding buprenorphine, a Schedule III partial µ-opioid receptor agonist indicated for chronic pain. The panel also provided clinical recommendations on the appropriate use of buprenorphine and conversion strategies for switching to buprenorphine from a full µ-opioid receptor agonist for chronic pain management.

Methods: The consensus panel met on March 25, 2019, to discuss relevant literature and provide recommendations on interpreting buprenorphine as a partial µ-opioid receptor agonist, prescribing buprenorphine before some Schedule II, III, or IV options, perioperative/trauma management of patients taking buprenorphine, and converting patients from a full µ-opioid receptor agonist to buprenorphine.

Multi-Scale Learned Iterative Reconstruction.

Model-based learned iterative reconstruction methods have recently been shown to outperform classical reconstruction algorithms. Applicability of these methods to large scale inverse problems is however limited by the available memory for training and extensive training times, the latter due to computationally expensive forward models. As a possible solution to these restrictions we propose a multi-scale learned iterative reconstruction scheme that computes iterates on discretisations of increasing resolution.

Identity integration in people with acquired disabilities: A qualitative study.

Objective: This qualitative investigation focused on identity integration in a sample of individuals who acquired physical disabilities in adulthood. It also argues for the importance and ethics of these methods in the broader field of scholarship on personality change following adversity.

Method: Thirteen adults participated in the study.

Stereotactic Radiosurgery for Resected Brain Metastases: Single-Institutional Experience of Over 500 Cavities.

Purpose: Postoperative stereotactic radiosurgery (SRS) has less detrimental effect on cognition and quality of life compared with whole brain radiation therapy (WBRT) and is increasingly used for resected brain metastases (BMs). Postoperative SRS techniques are not standardized, and there is a concern for a different pattern of failure after postoperative SRS compared with WBRT. We aim to study the efficacy, toxicity, and failure pattern of postoperative SRS.