Interplay of fatty acids, insulin and exercise in vascular health.

Fatty acid metabolism, exercise, and insulin action play critical roles in maintaining vascular health, especially relevant in metabolic disorders such as obesity, type 2 diabetes, and cardiovascular disease. Insulin, a vasoactive hormone, induces arterial vasodilation throughout the arterial tree, increasing arterial compliance and enhancing tissue perfusion. These effects, however, are impaired in individuals with obesity and type 2 diabetes, and evidence suggests that vascular insulin resistance contributes to the pathogenesis of type 2 diabetes and its cardiovascular complications.

Use of Supplemental Rod Constructs in Adult Spinal Deformity Surgery: A Review.

Adult spinal deformity comprises a heterogeneous group of disorders that primarily affects older patients and can have a significant negative affect on health-related quality of life. Operative treatment for adult spinal deformity typically entails posterior instrumented fusions that have demonstrated the potential to significantly improve health-related quality of life outcomes. However, until fusion is achieved, the instrumentation providing structural support is subject to repetitive cyclical loading that disproportionately fatigues high-stress areas and can result in instrumentation failure.

Recurrent drug eluting stent, in-stent restenosis (DES-ISR): Epidemiology, pathophysiology & treatment.

Coronary artery in-stent restenosis (ISR) is driven by neointimal hyperplasia and neoatherosclerosis in previously placed stents. Drug eluting stents (DES) have been adopted as first line therapy for the initial episode of ISR. However, recurrent ISR has limited durable salvage options.

Developing a framework for tracking antimicrobial resistance gene movement in a persistent environmental reservoir.

Mobile genetic elements are key to the global emergence of antibiotic resistance. We successfully reconstructed the complete bacterial genome and plasmid assemblies of isolates sharing the same carbapenemase gene to understand evolution over time in six confined hospital drains over five years. From 82 isolates we identified 14 unique strains from 10 species with 113 carrying plasmids across 16 distinct replicon types.

Patient-derived response estimates from zero-passage organoids of luminal breast cancer.

Background: Primary luminal breast cancer cells lose their identity rapidly in standard tissue culture, which is problematic for testing hormone interventions and molecular pathways specific to the luminal subtype. Breast cancer organoids are thought to retain tumor characteristics better, but long-term viability of luminal-subtype cases is a persistent challenge. Our goal was to adapt short-term organoids of luminal breast cancer for parallel testing of genetic and pharmacologic perturbations.

Comparison of 1% chloroprocaine hydrochloride versus hyperbaric bupivacaine spinal in patients undergoing anorectal surgery in an ambulatory surgery center: a double-blind randomized clinical trial.

Background: Preservative-free chloroprocaine is a promising spinal anesthetic for ambulatory surgeries, offering a short duration of action and minimal side effects, which promote faster recovery and discharge. Thus, this study aimed to compare chloroprocaine hydrochloride to the widely used bupivacaine as a spinal anesthetic in ambulatory anorectal surgeries. We hypothesized that chloroprocaine will lead to quicker recovery and discharge, supporting its use in the ambulatory surgical setting.

Shared Decision-Making in Total Hip and Knee Arthroplasty: Understanding Surgeon and Patient Perspectives Regarding When It Is Time for Surgery.

Background: Although total hip and total knee arthroplasty are highly successful operations, the decision of whether and when to undergo surgery is highly subjective and discretionary, and specific guidelines regarding readiness for surgery remain elusive. The nature of these decisions underscores the importance of shared decision-making, which is founded on the concept that patients substantially contribute to determining their own readiness for surgery. The OPTION survey was developed as a conversation aid to facilitate shared decision-making in the context of total joint arthroplasty.

Volumetric Humeral Canal Fill Ratio Effects Primary Stability and Cortical Bone Loading in Short and Standard Stem Reverse Shoulder Arthroplasty: A Biomechanical and Computational Study.

Objective: This study evaluated the effect of three-dimensional (3D) volumetric humeral canal fill ratios (VFR) of reverse shoulder arthroplasty (RSA) short and standard stems on biomechanical stability and bone deformations in the proximal humerus.

Methods: Forty cadaveric shoulder specimens were analyzed in a clinical computed tomography (CT) scanner allowing for segmentation of the humeral canal to calculate volumetric measures which were verified postoperatively with plain radiographs. Virtual implant positioning allowed for group assignment (VFR < 0.

HIV, measles, and syphilis: histopathologic characteristics of lymphatic system involvement of three reemerging infectious diseases.

The resurgence of measles, syphilis, and HIV presents a significant threat to global health, especially in the wake of the COVID-19 pandemic. These three infections involve lymph nodes and have unique pathologic findings in lymph nodes. We explore the pathological and clinical characteristics of these infections, focusing on their involvement of lymph nodes and their pathologic diagnosis in lymph node specimens.

Lateral Opening Distal Femoral Osteotomy With Concomitant Medial Patellofemoral Ligament Reconstruction Is Efficacious in Addressing Patellar Instability.

Purpose: To describe the clinical and radiographic outcomes of patients undergoing a lateral opening distal femur osteotomy (DFO) to address valgus alignment and restore patellar stability.

Methods: A retrospective review of patients who underwent lateral opening DFO for recurrent patellar instability in the setting of valgus leg alignment at a single academic institution between January 2016 to December 2021 was performed. Patients without a minimum 24-month postoperative follow-up were excluded.

Effect of Enhanced Recovery After Surgery in Morbidly Obese Patients Undergoing Free Flap Breast Reconstruction.

Background: Enhanced Recovery After Surgery (ERAS) pathways have been widely implemented across many surgical practices, including autologous breast reconstruction. However, the benefits of ERAS in the morbidly obese population have yet to be defined.

Methods: A retrospective chart review of patients undergoing deep inferior epigastric artery perforator (DIEP) flap breast reconstruction at our institution from 2017 to 2022 was performed.

Prevalence of Parent-Reported Problematic Eating Behaviors and Skills at 8-24 Months of Age in Infants Born at Less Than 34 Weeks Gestation.

Purpose: The purpose of this study was to describe the evolution and prevalence of parent-reported problematic feeding behaviors and eating skills in infants born prior to 34 weeks at the time of eating solid foods between 8 and 24 months of age, and to explore the associations between problematic feeding and the impact on the parent and family.

Method: Parents of eligible children ( = 35) completed an online survey when their child was 8, 10, 12, 18, and 24 months corrected age. The survey included the Pediatric Eating Assessment Tool (PediEAT), Child Oral and Motor Proficiency Scale (ChOMPS), and the Feeding Impact Scales-Family and Parent.

Differential Diagnosis of a Pharyngeal Fricative and Therapeutic Monitoring of Velopharyngeal Function Using Magnetic Resonance Imaging.

Purpose: Speech disorders associated with velopharyngeal dysfunction (VPD) are common. Some require surgical management, while others are responsive to speech therapy. This is related to whether the speech error is obligatory (passive) or compensatory (active).

Sonographic Detection of Iatrogenic Carotid Artery Guidewires During Internal Jugular Vein Catheterization.

Visualization of the guidewire during internal jugular (IJ) vein catheterization by point of care ultrasound (POCUS) has been recommended for avoiding inadvertent carotid artery dilation. The purpose of this study was to determine the accuracy of POCUS for identifying guidewires inappropriately placed in the carotid artery. This prospective, observational study involved emergency medicine (EM) residents with varying experience in guidewire visualization.

Levator Veli Palatini Muscle Ratio Is a Clinically Significant Anatomic Predictor for Velopharyngeal Surgical Need.

Objective: Velopharyngeal insufficiency (VPI) poses challenges for normal speech production, often necessitating surgical intervention. Determining optimal candidates for surgery remains complex and requires a nuanced understanding of underlying anatomic factors contributing to VPI. This study aimed to identify anatomic predictors that drive surgical recommendations for VPI.

Major Bleeding and Mortality After Revascularization of Left Main Disease.

Background: The incidence and prognostic impact of major bleeding (MB) after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for left main coronary artery disease (LMCAD) are unknown.

Objectives: The goal of this study was to investigate the rates and outcomes of MB after LMCAD revascularization.

Methods: In the EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial, 1,905 patients with unprotected LMCAD were randomized to undergo PCI (n = 948) or CABG (n = 957) and followed up for 5 years.

Chronic Leg Ulcerations and Subcutaneous Panniculitis due to Dermal Herpes Zoster in an Immunosuppressed Woman.

Herpes zoster (HZ) is a cutaneous viral disease that typically presents with a dermatomal vesicular eruption. Immunosuppressed patients are more likely to have atypical HZ involving chronic ulceration and disseminated distribution, making diagnosis a challenge. The current report describes a unique case of HZ in a woman with systemic lupus on immunosuppressive therapy manifesting as persistent lower extremity ulceration with diffuse dermal and endothelial infection and secondary panniculitis without epidermal involvement.

Evaluating AI proficiency in nuclear cardiology: Large language models take on the board preparation exam.

Background: Previous studies evaluated the ability of large language models (LLMs) in medical disciplines; however, few have focused on image analysis, and none specifically on cardiovascular imaging or nuclear cardiology. This study assesses four LLMs-GPT-4, GPT-4 Turbo, GPT-4omni (GPT-4o) (Open AI), and Gemini (Google Inc.)-in responding to questions from the 2023 American Society of Nuclear Cardiology Board Preparation Exam, reflecting the scope of the Certification Board of Nuclear Cardiology (CBNC) examination.

Angiosarcoma of the Scalp Mimicking an Inflammatory Scarring Alopecia and Diagnosed on Horizontal Histologic Sections.

While most forms of alopecia neoplastica are attributable to cutaneous metastases from visceral primary malignancies, rarely a diffuse primary skin cancer may present as alopecia. Herein, we present a case of angiosarcoma which clinically mimicked an inflammatory alopecia and was diagnosed by examination of alopecia-protocol horizontal histologic sections. A 72-year-old female presented to her dermatologist with a chief complaint of hair loss and pruritus.

Hereditary Transthyretin Amyloidosis in Patients Referred to a Genetic Testing Program.

Background: Diagnosis of hereditary amyloid transthyretin (hATTR) amyloidosis with cardiomyopathy is frequently delayed, in large part because of symptom overlap with other cardiovascular diseases and limited provider knowledge of this disease. The sponsored and provider referred hATTR Compass Genetic Testing Program (Ionis, Carlsbad, CA; Ambry Genetics, Aliso Viejo, CA) provided no-cost genetic testing to adults with a family history or clinical suspicion of hATTR amyloidosis. This study aims to characterize patients with hATTR amyloidosis and increase awareness of genetic testing for hATTR.