Determining Outcomes in Patients With Large Vessel Occlusion and Mild Stroke Who Did or Did Not Receive Thrombolytics and/or Thrombectomy.

Objectives: The utility of thrombolysis and/or thrombectomy in patients with mild stroke and large vessel occlusion (LVO) remains inconclusive. This retrospective study compared short-term and long-term outcomes in patients treated with best medical therapy (BMT group) versus with intravenous thrombolytics and/or endovascular thrombectomy (intervention group).

Methods: Patients with acute ischemic stroke (AIS), LVO, and National Institutes of Health Stroke Score (NIHSS) ≤5 were included.

Systolic Anterior Motion of the Mitral Valve Post-Heart Transplant Secondary to an Unusual Mechanism.

In this case report, we discuss the critical interdependence of structure and function in demonstrating systolic anterior motion (SAM) of the mitral valve after repeat heart transplantation, where residual apical tissue of the explanted heart remained in place. The resulting conformational changes led to anterior displacement of the mitral valve and persistent SAM.

Tramadol as a fentanyl adulterant: Prevalence and management in a ToxIC Fentalog study prospective cohort.

Background: Tramadol is an adulterant of illicit opioids. As it is a serotonin-norepinephrine reuptake inhibitor as well as a μ-opioid agonist, tramadol adulteration may worsen overdose signs and symptoms or affect the amount of naloxone patients receive.

Methods: This is a multicenter, prospective cohort of adult patients with suspected opioid overdoses who presented to one of eight United States emergency departments and were included in the Toxicology Investigators Consortium's Fentalog Study.

Medical Marijuana Documentation Practices in Patient Electronic Health Records: Retrospective Observational Study Using Smart Data Elements and a Review of Medical Records.

Background: Medical marijuana (MMJ) is available in Pennsylvania, and participation in the state-regulated program requires patient registration and receiving certification by an approved physician. Currently, no integration of MMJ certification data with health records exists in Pennsylvania that would allow clinicians to rapidly identify patients using MMJ, as exists with other scheduled drugs. This absence of a formal data sharing structure necessitates tools aiding in consistent documentation practices to enable comprehensive patient care.

Return on Investment of Preoperative Anemia Management Programs in Cardiac Surgery: An Advisory From the Society of Cardiovascular Anesthesiologists Clinical Practice Improvement Committee With Endorsement by the Society for the Advancement of Patient Blood Management.

Despite multiple recent guidelines recommending the diagnosis and treatment of anemia before elective cardiac surgery, few institutions have formal programs or methods in place to accomplish this. A major limitation is the perceived financial shortfall and the leadership buy-in required to undertake such an initiative. The purpose of this advisory from the Society of Cardiovascular Anesthesiologists (SCA) Clinical Practice Improvement Committee with endorsement by the Society for the Advancement of Patient Blood Management (SABM) is to provide an overview of preoperative anemia management programs with an emphasis on the associated financial implications.

Complications: skull base and cerebrovascular.

Neurosurgical complications are a rich source for learning, but they are grossly underutilized for the purpose of surgeon education. Details of the complications, which make them all the more powerful as teaching tools, are restricted to morbidity and mortality conferences behind closed doors, and open discussions of the topic are blurred by hypotheticals in order to shield the presenters from medicolegal risks. In this issue of Neurosurgical Focus, 9 neurosurgeons were invited to present complications they encountered along with the details and specific lessons they learned.

Symptomatic Anemia Due to Cameron Lesions: A Case Report.

Cameron lesions are a unique and relatively rare cause of upper gastrointestinal bleeding that appears in the mucosa of the gastric body in the presence of a large hiatal hernia. These lesions can be a source of occult bleeding and subsequent chronic iron deficiency anemia (IDA) but may often be missed on initial endoscopy, requiring repeat studies to diagnose. Prompt treatment for Cameron lesions is necessary to avoid the high mortality rate associated with them.

Nivolumab plus relatlimab and nivolumab plus ipilimumab for patients with advanced renal cell carcinoma: results from the open-label, randomised, phase II FRACTION-RCC trial.

Background: The Fast Real-time Assessment of Combination Therapies in Immuno-ONcology study in patients with aRCC (FRACTION-RCC) was designed to assess new immuno-oncology (IO) combinations in patients with advanced renal cell carcinoma (aRCC). We present results in IO-naive patients treated with nivolumab (NIVO) + relatlimab (RELA) or NIVO + ipilimumab (IPI) in track 1.

Methods: The open-label, randomised, phase II FRACTION-RCC trial enrolled patients with aRCC from 32 hospitals and cancer centres across six countries.

"Dangling choroid" with contralateral glomus displacement and ischemic torsion in congenital hydrocephalus: illustrative case.

Background: "Dangling choroid" is a prenatal sonographic marker of ventriculomegaly that measures the angle of choroid plexus (ChP) displacement in the lateral ventricle. To the authors' knowledge, postnatal sequelae related to this pathology, besides hydrocephalus, have never been reported.

Observations: A female fetus was diagnosed with bilateral ventriculomegaly.

Paroxysmal Hypertension in Congenital Hypothyroidism: An Unusual Case of Pheochromocytoma.

Pheochromocytomas are rare tumors arising from the chromaffin cells of the adrenal medulla that result in the secretion of excessive catecholamines. They are an uncommon cause of hypertension in the pediatric population. We present a case of a six-year-old male with hypertension, rapid weight loss, palpitations, excessive sweating, and vomiting.

The Role of Sex and Gender in Precision Emergency Medicine: A Scoping Review and Proposed Hierarchy.

Background: Precision medicine utilizes individual patient data to guide decision making. Sex and gender medicine is likewise focused on individual patients' biological sex or sociocultural gender as determinants of disease. How these two fields intersect with one another and with acute care medicine is unclear.

Protective effects of long term antiplatelet and anticoagulant therapy in hospitalized patients with inflammatory bowel disease.

Background: Inflammatory bowel disease (IBD), with its rising prevalence rates is associated with an increased risk of cardiovascular and thromboembolic events. Antiplatelets and/or anticoagulants agents are often prescribed but the literature on the impact of long-term anticoagulation and/or antiplatelet use among patients hospitalized with IBD is scarce. The aim of this study is to assess the outcomes of patients hospitalized with IBD on antiplatelet and/or anticoagulant agents.

Main versus segmental hepatic artery angioembolization in patients with traumatic liver injuries: A Western Trauma Association multicenter study.

Introduction: Hepatic angioembolization is highly effective for hemorrhage control in hemodynamically stable patients with traumatic liver injuries and contrast extravasation. However, there is a paucity of data regarding the specific location of angioembolization within the hepatic arterial vasculature and its implications on patient outcomes.

Methods: A post-hoc analysis of a multicenter prospective observational study across 23 centers was performed.

Intersection of Race and Gender in the Cardiothoracic Workforce: Study of Representation and Salary.

Background: Cardiothoracic surgery lacks gender and racial/ethnic diversity. Recent studies have highlighted disparities based on gender and race/ethnicity among academic cardiothoracic surgeons. The impact of the intersection of these factors on representation and salary is unknown.

Minimal Access Lateral Approach in Lower Eyelid Blepharoplasty for Three-Dimensional Recontouring.

Lower eyelid blepharoplasty has historically been approached from one of only two techniques, either the anterior subciliary incision or from the posterior transconjunctival approach. Both have been used with subtractive techniques of skin and fat resection in most cases and both have had issues with post operative lower lid retraction with scleral show, albeit less with the posterior approach. Lateral acces recontouring does not transgress either the anterior or posterior functional muscles of the lower lid and avoids damaging the innervation of the lower lid orbicularis.

Demographics in the context of health-care delivery for C1 and C2 fractures.

Introduction: Atlas and axis fractures are the most severe cervical fractures which may result in complete paralysis or death. The purpose of the current study is to identify disparities regarding length of stay (LOS), mortality, and demographic factors in patients with the most serious cervical spine fractures utilizing a nationally representative database.

Materials And Methods: The Nationwide Emergency Department Sample was utilized to provide a representative sample for patients with a primary diagnosis of C1 or C2 fracture presenting to emergency departments in years from October 2015 to December 2019.

Adeno-Associated Virus Gene Transfer Ameliorates Progression of Skeletal Lesions in Mucopolysaccharidosis IVA Mice.

Mucopolysaccharidosis type IVA (MPS IVA) is an autosomal congenital metabolic lysosomal disease caused by a deficiency of the -acetyl-galactosamine-6-sulfate sulfatase (GALNS) gene, leading to severe skeletal dysplasia. The available therapeutics for patients with MPS IVA, enzyme replacement therapy and hematopoietic stem cell transplantation, revealed limitations in the impact of skeletal lesions. Our previous study, a significant leap forward in MPS IVA research, showed that liver-targeted adeno-associated virus (AAV) gene transfer of human GALNS (hGALNS) restored GALNS enzymatic activity in blood and multiple tissues and partially improved the aberrant accumulation of storage materials.

Observation-first versus angioembolization-first approach in stable patients with blunt liver trauma: A WTA multicenter study.

Background: Prior studies evaluating observation versus angioembolization (AE) for blunt liver injuries (BLT) with contrast extravasation (CE) on computed tomography imaging have yielded inconsistent conclusions, primarily due to limitations in single-center and/or retrospective study design. Therefore, this multicenter study aims to compare an observation versus AE-first approach for BLT, hypothesizing decreased liver-related complications (LRCs) with observation.

Methods: We conducted a post hoc analysis of a multicenter, prospective observational study (2019-2021) across 23 centers.