Limitation of site-stratified cox regression analysis in survival data: a cautionary tale of the PANAMO phase III randomized, controlled study in critically ill COVID-19 patients.

Current guidelines tend to focus on a p-value threshold of a pre-specified primary endpoint tested in randomized controlled clinical trials to determine a treatment effect for a specific drug. However, a p-value does not always provide evidence on the treatment effect of a drug, especially when stratification of the data does not account for unforeseen variables introduced into the analysis. We report and discuss a rare case in which investigational site stratification in the pre-specified analysis method of a primary endpoint results in a loss of statistical power in the evaluation of the treatment effect due to data attrition of almost 17% of outcome data in the phase III randomized, controlled PANAMO study in critically ill COVID-19 patients.

Dual Chamber Aveir Retrievable Leadless Pacemaker Implant via the Right Internal Jugular Vein in a 13-year-old With Congenital Complete Heart Block.

Introduction: Congenital complete heart block is a condition where there is a risk of Stokes Adam's attacks and sudden death may occur. Once the escape rate is too low, or other high-risk factors occur, these patients ultimately need pacemakers placed. Epicardial or transvenous pacemakers have typically been in employed dependent on size of the patient and other circumstances.

Treatment-Resistant Chromoblastomycosis Successfully Managed With Surgical Excision.

Chromoblastomycosis is an uncommon, chronic granulomatous fungal infection of the skin and subcutaneous tissue. Chromoblastomycosis is most commonly caused by the traumatic inoculation of dematiaceous (pigmented) fungi, most commonly species,  species, and species. Chromoblastomycosis usually affects agricultural workers in tropical and subtropical climates.

How I Do It: Managing Cavitary Coccidioidomycosis Expert Opinions for Improving Patient Outcomes.

Coccidioidomycosis (CM), caused by the dimorphic fungi Coccidioides immitis (C. immitis) and C. posadasii, is recognized as an increasing threat both nationally and worldwide.

Symptomatic giant lipoma of the neck in an adolescent.

Lipomas are the most common soft tissue tumours in adults, but they represent less than 10% of paediatric mesenchymal tumours. In adults, they are typically slow growing and painless. We describe an adolescent with a rapidly enlarging neck mass causing dyspnoea and chest pain.

Left internal jugular vein approach to right atrial appendage base implantation of the Aveir AR leadless pacemaker.

Introduction: There is no prior report of an Aveir leadless pacemaker implantation into the atrial appendage via the internal jugular vein.

Case: A 44-year-old female patient with history of multiple ablations for sinus node dysfunction presented with symptomatic bradycardia. The patient had femoral veins <9mm, chronic pain at the femoral vein insertion sites, as well as a recent car accident with persistent leg pain due to femoral fractures.

Endovascular repair with the Gore thoracoabdominal multibranch endoprosthesis for proximal degeneration after prior fenestrated endovascular aortic repair.

Degeneration of the thoracoabdominal aorta proximal to a prior fenestrated endovascular aortic repair represents a complex issue with limited options for repair. Previously, modified endografts or open conversion with endograft explant offered the only options for management. Here we describe use of the Gore Thoracoabdominal Multibranch Endoprosthesis for exclusion of an extent III thoracoabdominal aneurysm in the setting of degeneration proximal to a previously placed fenestrated device.

Temporal Incision Super-high Superficial Musculoaponeurotic System Face Lift for Chinese Patients.

Background: This investigation assessed patient satisfaction with a temporal incision technique using a super-high superficial musculoaponeurotic system (SMAS) flap for midface lifting in a Chinese patient cohort.

Methods: From July 2019 to July 2023, 95 patients underwent midface lifts via a temporal incision approach at our institution. The extent of SMAS flap dissection spanned 2 cm above the outer canthus, to the lower margin of the zygomatic arch inferiorly, and medially to the zygomaticus major muscle.

The impact of mild episodic ketosis on microglia and hippocampal long-term depression in 5xFAD mice.

Ketotherapeutics is a potential metabolic intervention for mitigating dementias; however, its mechanisms and optimal methods of application are not well understood. Our previous in vitro study showed that β-hydroxybutyrate (BHB), a major ketone body, reverses pathological features of amyloid-β oligomer (AβO)-activated microglia. Here we tested the in vivo effects of BHB on microglia and synaptic plasticity in the 5xFAD Alzheimer's disease (AD) mouse model.

The California End of Life Option Act at UCSF: Examining the Utility of the Mandatory Mental Health Assessment.

Background: The End of Life Option Act (EOLOA) legalized medical aid in dying (MAID) in California in 2015. University of California, San Francisco (UCSF) Health initially implemented a policy requiring a mandatory mental health assessment of all patients seeking MAID, though this was not required by the EOLOA. State-level statistics on EOLOA are available, but less is known about outcomes at individual institutions and how institutional policy affects outcomes for patients seeking MAID.

Toddler Screen Time: Longitudinal Associations with Autism and ADHD Symptoms and Developmental Outcomes.

Greater screen time is associated with increased symptoms of autism spectrum disorder (autism), attention-deficit/hyperactivity disorder (ADHD), and lower scores on measures of development in preschool-aged community samples. In the current longitudinal study, we examined screen time differences at 18 months of age based on clinically-defined outcomes (i.e.

Unique N-glycosylation signatures in Aβ oligomer-and lipopolysaccharide-activated human iPSC-derived microglia.

Microglia are the immune cells in the central nervous system (CNS) and become pro-inflammatory/activated in Alzheimer's disease (AD). Cell surface glycosylation plays an important role in immune cells; however, the N-glycosylation and glycosphingolipid (GSL) signatures of activated microglia are poorly understood. Here, we study comprehensive combined transcriptomic and glycomic profiles using human induced pluripotent stem cells-derived microglia (hiMG).

Altered post-fracture systemic bone loss in a mouse model of osteocyte dysfunction.

Femur fracture leads to loss of bone at uninjured skeletal sites, which may increase risk of subsequent fracture. Osteocytes, the most abundant bone cells, can directly resorb bone matrix and regulate osteoclast and osteoblast activity, but their role in systemic bone loss after fracture remains poorly understood. In this study we used a transgenic (TG+) mouse model that overexpresses human B-cell lymphoma 2 (BCL-2) in osteoblasts and osteocytes.

Unbiased Method to Determine Articular Cartilage Thickness Using a Three-Dimensional Model Derived from Laser Scanning: Demonstration on the Distal Femur.

Measuring articular cartilage thickness from 3D models developed from laser scans has the potential to offer high accuracy. However, this potential has not been fulfilled, since generating these models requires that the cartilage be removed, and previous methods of removal have led to systematic errors (i.e.

Parkinson's Disease Polygenic Risk Score and Neurological Involvement in Carriers of the FMR1 Premutation Allele: A Case for Genetic Modifier.

Background: Premutation alleles of the FMR1 X-linked gene containing CGG repeat expansions ranging from 55 to 200 are associated with diverse late-onset neurological involvements, including most severe disorder termed Fragile X-associated Tremor/Ataxia Syndrome (FXTAS). It is intriguing that at least one-third of male, and a much lower than predicted from the X-linkage proportion of female carriers are free of this syndrome. This suggests the existence of secondary genetic factors modifying the risk of neurological involvements in these carriers.

GI Surgery Summit white paper: recruiting and training the next generation of surgeons.

Background: There is an ongoing debate on surgical training and its evolution to meet the demands of a complex and changing healthcare environment.

Methods: A GI Surgery Summit was held in January 2024 that included prominent leaders and rising talents from the Society for Surgery of the Alimentary Tract, Society of Surgical Oncology, Association for Academic Surgery, and Society of University Surgeons. This meeting was held to address the multifaceted current and future challenges of surgery.