Clinical use of polygenic risk scores for detection of peripheral artery disease and cardiovascular events.

We have previously shown that polygenic risk scores (PRS) can improve risk stratification of peripheral artery disease (PAD) in a large, retrospective cohort. Here, we evaluate the potential of PRS in improving the detection of PAD and prediction of major adverse cardiovascular and cerebrovascular events (MACCE) and adverse events (AE) in an institutional patient cohort. We created a cohort of 278 patients (52 cases and 226 controls) and fit a PAD-specific PRS based on the weighted sum of risk alleles.

Evaluating prediction model performance.

This article highlights important performance metrics to consider when evaluating models developed for supervised classification or regression tasks using clinical data. When evaluating model performance, we detail the basics of confusion matrices, receiver operating characteristic curves, F1 scores, precision-recall curves, mean squared error, and other considerations. In this era, defined by the rapid proliferation of advanced prediction models, familiarity with various performance metrics beyond the area under the receiver operating characteristic curves and the nuances of evaluating model value upon implementation is essential to ensure effective resource allocation and optimal patient care delivery.

Use of Multi-Modal Data and Machine Learning to Improve Cardiovascular Disease Care.

Today's digital health revolution aims to improve the efficiency of healthcare delivery and make care more personalized and timely. Sources of data for digital health tools include multiple modalities such as electronic medical records (EMR), radiology images, and genetic repositories, to name a few. While historically, these data were utilized in silos, new machine learning (ML) and deep learning (DL) technologies enable the integration of these data sources to produce multi-modal insights.

Increased Frailty Associated with Higher Long-Term Mortality after Major Lower Extremity Amputation.

Background: Frailty assessments have been incorporated into preoperative planning for surgery in the elderly population. Frailty in patients undergoing lower extremity amputation has been associated with increased short-term mortality. We compared 2 frailty scores, modified Frailty Index (mFI) and Risk Analysis Index (RAI), to evaluate the short- and long-term mortality stratified by frailty status after lower extremity amputation.

Surgical risk calculators in veterans following lower extremity amputation.

Objective: To evaluate the accuracy of multiple risk calculators for 30-day mortality on patients undergoing major lower extremity amputation.

Methods: The actual 30-day mortality at a single Veterans Affairs institution was compared to the predicted outcome from the following risk calculators: ACS-NSQIP, VASQIP, amputation scoring tool (AST), and POTTER elective.

Results: The overall calculated 30-day mortality was similar to the actual mortality with the VASQIP and POTTER elective risk calculators, while the NSQIP and AST over-estimated the 30-day mortality.

Predictive Accuracy of the American College of Surgeons Risk Calculator in Patients Undergoing Major Lower Extremity Amputation.

Background: The American College of Surgeons Risk Calculator (ACS-RC) provides an assessment of a patient's risk of 30-day postoperative complications. The Surgeon Adjusted Risk (SAR) parameter of the calculator allows for ad hoc adjustment of risk based on risk factors not considered by the model. This study aims to evaluate the predictive accuracy of the ACS-RC in vascular surgery patients undergoing major lower-extremity amputation (LEA) and identify additional risk factors that warrant use of the SAR parameter.

An Analysis of Traumatic Ankle Fracture Patients: Does Income Status Influence Access to Acute Orthopaedic Surgical Care?

Purpose: To evaluate if income status affects the timing of presentation to orthopaedic care, surgical treatment, or continuity of care following a closed ankle fracture.

Methods: Th is retrospective study identified 434 patients with closed ankle fractures treated with operative fixation from 2014 to 2016. Median income data were extracted using the patients' ZIP codes and data from the U.

Surgical Site Complications in Open Pronation-Abduction Ankle Fracture-Dislocations With Medial Tension Failure Wounds.

Objectives: To examine the incidence of surgical site complications associated with pronation-abduction ankle fracture-dislocations with an open medial tension wound.

Design: Retrospective case series.

Setting: Accredited Level-1 trauma center.

Skin closure with surgical staples in ankle fractures: a safe and reliable method.

Purpose: The purpose of this study is to examine the rates of surgical site complications of staple closure versus suture closure following open reduction and internal fixation of closed unstable ankle fractures.

Methods: Between 2014 and 2016, a total of 545 patients with closed ankle fractures were treated at our level-1 trauma centre by means of open reduction and internal fixation. A total of 360 patients matched the inclusion criteria and were included in the final analysis of this study.

Fate of the Uninsured Ankle Fracture: Significant Delays in Treatment Result in an Increased Risk of Surgical Site Infection.

Objective: To examine the impact of insurance status on access to orthopaedic care and incidence of surgical site complications in patients with closed unstable ankle fractures.

Design: Retrospective chart review.

Setting: Certified Level-1 urban trauma center and county facility.

Creutzfeldt-Jakob Disease: In-hospital demographics report of national data in the United States from 2016 and review of a rapidly-progressive case.

Background: This report highlights a rapidly progressive case of Creutzfeldt-Jakob Disease (CJD) whose time from symptom onset to death spanned less than two months. We also explore the most recently available in-patient demographics data for discharges with CJD in the United States.

Methods: We reviewed a CJD case and systematically analyzed a retrospective cohort of CJD discharges using the Healthcare Cost and Utilization Project (HCUP) to evaluate the existing national data on the status of CJD demographics and dispositions in the United States in 2016.

Free-Floating Scapular Spine: A Rare Shoulder Injury.

A specific treatment protocol for managing scapular spine fractures does not currently exist. The purpose of our report is to describe this type of injury and detail our treatment management in order to better elucidate this rare pathology. We present a case of a 26-year-old female with an acute scapular spine and base fracture after a motor vehicle collision.

Endovascular repair of abdominal aortic aneurysm reduces intraoperative cortisol and perioperative morbidity.

Background: The release of catabolic stress hormones because of surgical trauma leads to a breakdown of fats, proteins, and carbohydrate stores and interference with immune function. This can delay wound healing and may increase the risk of systemic inflammatory response syndrome (SIRS)/sepsis and postoperative complications. Minimally invasive surgery can attenuate this response.

Pincher, a pinocytic chaperone for nerve growth factor/TrkA signaling endosomes.

A central tenet of nerve growth factor (NGF) action that is poorly understood is its ability to mediate cytoplasmic signaling, through its receptor TrkA, that is initiated at the nerve terminal and conveyed to the soma. We identified an NGF-induced protein that we termed Pincher (pinocytic chaperone) that mediates endocytosis and trafficking of NGF and its receptor TrkA. In PC12 cells, overexpression of Pincher dramatically stimulated NGF-induced endocytosis of TrkA, unexpectedly at sites of clathrin-independent macropinocytosis within cell surface ruffles.