Osseointegration for transfemoral amputees: Influence of femur length and implant sizing on bone-implant contact and alignment.

Introduction: Clinical data on osseointegration (OI) for limb replacement indicates a concerning increase in mechanical complications after five years post-implantation. Since adequate bone-implant contact and proper implant alignment are critical factors for successful osseointegration, it is essential to identify the factors influencing these outcomes. This study aimed to assess the effects of residual femur length and implant sizing on bone-implant contact and implant alignment.

Endovascular Thrombectomy for Extracranial Internal Carotid Artery Occlusions With Large Ischemic Strokes: Insights From the SELECT2 Trial.

Background And Objectives: Although previous trials have established the efficacy and safety of endovascular thrombectomy (EVT) in large ischemic core strokes, most of them excluded patients with extracranial internal carotid artery (e-ICA) occlusion. We aimed to compare outcomes in patients with e-ICA occlusion and large ischemic core infarcts treated with EVT vs medical management (MM).

Methods: This was a secondary analysis of the SELECT2 trial, a randomized controlled trial conducted at 31 international sites.

Subendocardial ischemia: does CMD really exist?

Patients with angina but without obstructive epicardial coronary disease still require a specific mechanistic diagnosis to enable targeted treatment. The overarching term "coronary microvascular dysfunction" (CMD) has been applied broadly - but is it correct? We present a series of case examples culminating a systematic exploration of our large clinical database to distinguish among four categories of coronary pathophysiology. First, by far the largest group of "no stenosis angina" patients exhibits subendocardial ischemia during intact flow through diffuse epicardial disease during dipyridamole vasodilator stress.

Parenting Stress in Tuberous Sclerosis Complex.

Background: Tuberous sclerosis complex (TSC) is a multisystemic genetic disorder with clinical variability. As the needs of children with TSC may differ, parenting demands may similarly differ. Characterizing parenting stress, or emotional maladaptation from parenting duties, can enable health care providers to assist parents of children with TSC.

Impact of Massive Transfusion Activation on Time to Delivery of the First Cooler and Patient Survival: A Study of 4,313 Consecutive Activations.

Background: In 2012, TQIP guidelines for massive transfusion protocols (MTP) recommended delivery of blood product coolers within 15 minutes. Subsequent work found that every minute delay in cooler arrival was associated with a 5% increased risk of mortality. We sought to assess the impact and sustainability of quality improvement (QI) interventions on time to MTP cooler delivery and their association with trauma patient survival.

Supplementary motor area in speech initiation: A large-scale intracranial EEG evaluation of stereotyped word articulation.

Speech production engages a distributed network of cortical and subcortical brain regions. The supplementary motor area (SMA) has long been thought to be a key hub in coordinating across these regions to initiate voluntary movements, including speech. We analyzed direct intracranial recordings from 115 patients with epilepsy as they articulated a single word in a subset of trials from a picture-naming task.

Occluder Device Removal and Total Septation of "Swiss-Cheese" Ventricular Septal Defects.

"Swiss-cheese" ventricular septal defects present complex treatment challenges. Despite difficult defect visualization and closure, complete septation is the treatment of choice. We present the case of a 2-year-old with residual apical "Swiss-cheese" ventricular septal defects after failed percutaneous device closure with 2 occluder devices.

Pulmonary Atresia Intact Ventricular Septum With Anomalous Left Coronary Artery From Pulmonary Artery.

A patient with known pulmonary atresia and intact ventricular septum and ductal stent presented with low cardiac output and arrythmia. Intraoperatively, the patient was found to have an anomalous left coronary artery arising from the pulmonary artery. After reimplantation of the left coronary artery to the aortic root and placement of a central shunt, the patient progressed well and was discharged home.

Complete Resection of Aorticopulmonary Paraganglioma With Reconstruction in a Pediatric Patient.

Aorticopulmonary paragangliomas are exceedingly rare tumors in pediatric populations. Complete surgical resection is the only curative treatment. However, resection is challenging due to the vascularity of paragangliomas and their close relationship with the great vessels.

Tapinarof Improved Outcomes and Sleep for Patients and Families in Two Phase 3 Atopic Dermatitis Trials in Adults and Children.

Introduction: Tapinarof is a topical aryl hydrocarbon receptor (AhR) agonist in development for the treatment of atopic dermatitis (AD). In two phase 3 trials (ADORING 1 and 2), tapinarof cream 1% once daily (QD) demonstrated significant efficacy and was well tolerated in patients down to age 2 years with AD. Here, we evaluate patient-reported outcomes (PROs), including family impact, with tapinarof in ADORING 1 and 2.

Atrial Functional Tricuspid Regurgitation: A Comprehensive Review of Pathophysiology, Diagnosis, and Management Strategies.

Atrial fibrillation (AF), the most prevalent sustained cardiac arrhythmia, is intricately linked with atrial functional tricuspid regurgitation (AFTR), a condition distinguished from ventricular functional tricuspid regurgitation by its unique pathophysiological mechanisms and clinical implications. This review article delves into the multifaceted aspects of AFTR, exploring its epidemiology, pathophysiology, diagnostic evaluation, and management strategies. Further, we elucidate the mechanisms underlying AFTR, including tricuspid annular dilatation, right atrial enlargement, and dysfunction, which collectively contribute to the development of tricuspid regurgitation in the absence of significant pulmonary hypertension or left-sided heart disease.

Preventative treatment of tuberous sclerosis complex with sirolimus: Phase I safety and efficacy results.

Objective: Tuberous sclerosis complex (TSC) results from overactivity of the mechanistic target of rapamycin (mTOR). Sirolimus and everolimus are mTOR inhibitors that treat most facets of TSC but are understudied in infants. We sought to understand the safety and potential efficacy of preventative sirolimus in infants with TSC.

Metabolomic and lipidomic pathways in aneurysmal subarachnoid hemorrhage.

Aneurysmal subarachnoid hemorrhage (aSAH) results in a complex systemic response that is critical to the pathophysiology of late complications and has important effects on outcomes. Omics techniques have expanded our investigational scope and depth into this phenomenon. In particular, metabolomics-the study of small molecules, such as blood products, carbohydrates, amino acids, and lipids-can provide a snapshot of dynamic subcellular processes and thus broaden our understanding of molecular-level pathologic changes that lead to the systemic response after aSAH.

Reproducibility of quantitative myocardial perfusion and coronary flow capacity by positron emission tomography: 3D digital silicon photomultiplier solid state vs. legacy 2D analogue systems for clinical practice and trials.

Aims: Quantitative rest-stress myocardial perfusion in millilitres per minute per gram among multiple 2D and 3D positron emission tomography-computed tomography (PET-CT) scanners is essential for personalized cardiac management and clinical trials. Accordingly, this study reports the accuracy and precision of quantitative rest-stress millilitres per minute per gram and coronary flow capacity among 2D and two different digital 3D silicon photomultiplier (SiPM) PET-CT scanners for quantifying the severity of coronary pathophysiology for clinical trials or guiding interventions vs. medical treatment.

A Novel Urological Application of Hyaluronic Acid/Alginate Sheet to Prevent Adhesion Formation: A Technique Guide and Case Series.

Tissue gliding and mobility are paramount to the success of penile procedures. While postoperative healing is intended to protect, repair, and nourish injured tissues, an overzealous response often leaves painful and debilitating tethering between the corpora, including nerves, and surrounding tissues. This tethering interferes with the intended outcomes of surgery by preventing necessary gliding.