Complex Lower Extremity Salvage Using Composite Flap Grafting in COVID-19-Induced Arterial Thrombosis: A Case Report.

Case: We present a 42-year-old man who developed extensive left lower extremity arterial thrombosis following COVID-19 pneumonia. Despite multiple revascularization attempts and a below-knee amputation, he faced wound necrosis and insufficient soft tissue coverage. An innovative approach using a pedicled flap and sequential flow-through free flaps was used for limb salvage.

Career Planning and Maintaining Well-being in Academic Plastic Surgery.

Success in academic plastic surgery is based on the traditional pillars of promotion: clinical excellence, teaching, research, leadership, and service to the university and community. The time commitment and workload for career advancement are highly demanding and, therefore, well-being is essential to avoid burnout. A congruent healthy work environment that meets institutional goals and surgeons' objectives can be established through inclusive, transparent, strategic, and operational planning.

Comparative main effects, mediators, and moderators of cognitive behavioral therapy, acceptance and commitment therapy, and emotional awareness and expression therapy for chronic spinal pain: Randomized controlled trial rationale and protocol.

Background: Chronic spinal (back/neck) pain is common and costly. Psychosocial treatments are available but have modest effects. Knowledge of treatment mechanisms (mediators and moderators) can be used to enhance efficacy.

The Society of Thoracic Surgeons General Thoracic Surgery Database: 2024 Update on Outcomes and Research.

The Society of Thoracic Surgeons General Thoracic Surgery Database (STS GTSD) remains the largest and most comprehensive audited thoracic surgical database in the world. As the STS GTSD grows to nearly 1 million cases, the pulmonary resection for cancer and esophagectomy short-term risk models have been refined to provide participants with benchmarked performance reports to facilitate quality improvement efforts. New for 2025 will be the development of long-term risk models and the online release of both short- and long-term risk calculators.

Association of Year-to-Year Lipid Variability With Risk of Cognitive Decline and Dementia in Community-Dwelling Older Adults.

Background And Objectives: Lipid metabolism in older adults is affected by various factors including biological aging, functional decline, reduced physiologic reserve, and nutrient intake. The dysregulation of lipid metabolism could adversely affect brain health. This study investigated the association between year-to-year intraindividual lipid variability and subsequent risk of cognitive decline and dementia in community-dwelling older adults.

Buruli Ulcer Transmission: Environmental Pathways and Implications for Dermatologic Care.

Buruli ulcer (BU) is a necrotizing skin and soft tissue disease caused by Mycobacterium ulcerans that is common in hot and humid climates. Mycobacterium ulcerans is a nontuberculous mycobacterium and ubiquitous acid-fast gram-positive bacillus known to thrive in aquatic environments and water insects. The mode of transmission to humans is poorly understood and varies by geography.

A Brief Intervention for Injury-Related Traumatic Stress: Results From a Feasibility Study.

Background: Post-traumatic stress disorder (PTSD) significantly impacts post-injury quality of life; however, many injured patients struggle to access necessary psychosocial care. A brief intervention, Talk, Listen, Communicate to Recover (TLC to Recover), may facilitate access to psychosocial care in low resource trauma centers.

Objective: This study assessed staff and patient perceptions regarding the feasibility and acceptability of implementing TLC to Recover at a Level I trauma center.

Refractory Psychosis as a Red Flag for End of Life in Individuals With Dementia With Lewy Bodies: A Case Series and Re-analysis of Prior Qualitative Data.

Objectives: Many individuals with dementia with Lewy bodies (DLB) die of disease-related complications, but predicting the end of life can be challenging. We identified a phenotype associated with approaching end of life.

Methods: We present 4 exemplar cases where individuals with DLB experienced refractory psychosis before death.

Larsucosterol for the Treatment of Alcohol-Associated Hepatitis.

Background: Larsucosterol is a DNA methyltransferase inhibitor in development for alcohol-associated hepatitis (AH), a disease for which there is no approved therapy.

Methods: In this phase 2b trial, patients with severe AH were randomly assigned 1:1:1 to receive 30 mg or 90 mg of larsucosterol or placebo; a second dose was administered after 72 hours if the patient remained hospitalized. All patients received supportive care as determined by investigators.

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.

Influence of lung function on macro- and micro-structural brain changes in mid- and late-life.

Introduction: Lung function has been associated with cognitive decline and dementia, but the extent to which lung function impacts brain structural changes remains unclear. We aimed to investigate the association of lung function with structural macro- and micro-brain changes across mid- and late-life.

Methods: The study included a total of 37 164 neurologic disorder-free participants aged 40-70 years from the UK Biobank, who underwent brain MRI scans 9 years after baseline.

Accuracy and variability in clinical predictions of speech recognition outcomes for cochlear implant users.

Objectives: An improvement in speech perception is a major well-documented benefit of cochlear implantation (CI), which is commonly discussed with CI candidates to set expectations. However, a large variability exists in speech perception outcomes. We evaluated the accuracy of clinical predictions of post-CI speech perception scores.

An Update on Deaths in the United Kingdom from 'Poppers' (Alkyl Nitrites), with a Particular Focus on 'Swallowing' Fatalities.

Alkyl nitrites are a class of inhalant, commonly known as 'poppers'. Although having medical uses, some other effects include a 'rush', 'high', 'euphoria', or feeling of excitement. This has led to their recreational use, in different scenarios, since the mid-1960s.

Food Security and Cardio-Metabolic Risk in Individuals with Metabolic Syndrome.

This study assessed the association of food security with potential cardio-metabolic risk factors among persons with metabolic syndrome (MetS). Data were derived from the baseline data of a randomized controlled lifestyle intervention trial for individuals with MetS. Household food security, fruit and vegetable intake, perceived food environment, and perceived stress were collected using validated questionnaires.

A randomized, placebo-controlled, cross-over trial of ketamine in Rett syndrome.

Background: Preclinical studies and anecdotal case reports support the potential therapeutic benefit of low-dose oral ketamine as a treatment of clinical symptoms in Rett syndrome (RTT); however, no controlled studies have been conducted in RTT to evaluate safety, tolerability and efficacy.

Design: This was a sequentially initiated, dose-escalating cohort, placebo-controlled, double blind, randomized sequence, cross-over study of oral ketamine in 6-12-year-old girls with RTT to evaluate short-term safety and tolerability and explore efficacy.

Methods: Participants were randomized to either five days treatment with oral ketamine or matched placebo, followed by a nine-day wash-out period and then crossed-over to the opposite treatment.

Focal Therapy for Prostate Cancer: Recent Advances and Insights.

Focal therapy has emerged as a balanced middle ground aiming to reduce overtreatment and the risk of progression, as well as patients' distress and anxiety. Focal therapy and partial gland ablation prioritize the precise elimination of the index lesion and a surrounding safety margin to optimize treatment outcomes and lower the risk of residual disease. The paradigm of whole-gland ablation has shifted towards more targeted approaches.

Influence of birthplace and age at migration on cognitive aging among Hispanic/Latino populations in the U.S.: Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA).

Background And Objectives: While Hispanic/Latino populations in the U.S. are remarkably diverse in terms of birthplace and age at migration, we poorly understand how these factors are associated with cognitive aging.

Is the freezing index a valid outcome to assess freezing of gait during turning in Parkinson's disease?

Introduction: Freezing of gait (FOG) is a disabling symptom for people with Parkinson's disease (PwPD). Turning on the spot for one minute in alternating directions (360 turn) while performing a cognitive dual-task (DT) is a fast and sensitive way to provoke FOG. The FOG-index is a widely used wearable sensor-based algorithm to quantify FOG severity during turning.

Exploring the Intersection of Gender Diversity and Intellectual Disability: A Scoping Review With a Focus on Clinical Care.

Background: Little research has been conducted solely exploring gender diversity in people with intellectual disabilities. This review explores the literature, discusses the prevalence, and identifies clinical best practices for people at the intersection of gender diversity and intellectual disability.

Method: A scoping review was conducted utilising PRISMA methodology of the following databases: PubMed, CINAHL Complete (EBSCO), Cochrane Library (Wiley), Dissertations & Theses Global (ProQuest), PsycInfo (EBSCO), Scopus and Web of Science.

Structure and mechanism of biosynthesis of Streptococcus mutans cell wall polysaccharide.

Streptococcus mutans, the causative agent of human dental caries, expresses a cell wall attached Serotype c-specific Carbohydrate (SCC) that is critical for cell viability. SCC consists of a polyrhamnose backbone of →3)α-Rha(1 → 2)α-Rha(1→ repeats with glucose (Glc) side-chains and glycerol phosphate (GroP) decorations. This study reveals that SCC has one predominant and two more minor Glc modifications.

Pitch Types and Their Influence on Elbow Varus Torque and Spin Rate in Professional Baseball Pitchers.

Background: Elbow injuries are prevalent among professional baseball pitchers as nearly 25% undergo ulnar collateral ligament reconstruction. Pitch type, ball velocity, and spin rate have been previously hypothesized to influence elbow varus torque and subsequent risk of injury, but existing research is inconclusive.

Purpose: To examine elbow varus torque, cumulative torque, and loading rate within professional pitchers throwing fastball, curveball, change-up, and slider pitches, as well as to identify potential influences of ball spin on the elbow.

Rome Foundation Working Team Report: Consensus Statement on the Design and Conduct of Behavioural Clinical Trials for Disorders of Gut-Brain Interaction.

Background: Brain-gut behaviour therapies (BGBT) have gained widespread acceptance as therapeutic modalities for the management of disorders of gut-brain interaction (DGBI). However, existing treatment evaluation methods in the medical field fail to capture the specific elements of scientific rigour unique to behavioural trial evaluation.

Aims: To offer the first consensus on the development and testing of BGBT in DGBI.