Intraoperative Vasopressor Use Does Not Adversely Impact Free Flap Outcomes in Lower Extremity Limb Salvage Procedures in a Highly Comorbid Atraumatic Wound Population.

The use of vasopressors during microsurgical reconstruction is debated. Their effect on the comorbid lower extremity (LE) wound population is unstudied. This study characterizes the impact of intraoperative vasopressor use in LE free tissue transfer (FTT) for limb salvage.

Assessing the adequacy of immunosuppression in pediatric liver transplantation with immune Monitoring: Are we there yet?

Current approaches used for pediatric liver transplant (LT) surveillance have diagnostic limitations. We used pleximmune™ immune reactivity index (IRI) and anti-HLA donor specific antibody (DSA) to predict the adequacy of immunosuppression (IS) relative to risk of acute cellular rejection (ACR) at 1-year post LT. This is a retrospective chart review of children who underwent LT between January 1, 2016, through December 31, 2020, and had at least one pleximmune measurement performed within 60-days of a liver biopsy.

Sudden Death in Children and Young Adults: Etiologies, Risk Stratification, and Prevention Strategies.

Sudden death in children and young adults, while uncommon, carries profound clinical and societal implications. Cardiac causes, particularly inherited arrhythmias and cardiomyopathies, account for most cases, though neurologic, toxicologic, traumatic, and infectious etiologies also contribute significantly. This review explores the epidemiology, classification, and pathophysiologic mechanisms of sudden death in this population, emphasizing early clinical warning signs and identifiable risk factors.

Identification of Decompressive Craniectomy Patients with Refractory ICP using Burst Suppression Ratio and novel subgaleal qEEG: A Technical note.

Background: Decompressive hemicraniectomy (DHC) can improve outcome in patients with elevated intracranial pressure (ICP) refractory to medical therapy. However, this transition point for treating refractory ICPs with DHC is unclear as ICPs can often be controlled with escalating doses of medical management. A more individualized and precise way to monitor and define medically "refractory ICP" may be achieved with the utilization of a quantitative electroencephalography (EEG) parameter called burst suppression ratio (BSR).

Methotrexate-Associated Primary Cutaneous Epstein-Barr Virus-Positive Polymorphic B-Cell Lymphoproliferative Disorder With Metachronous T-Cell Clonally Related Angioimmunoblastic T-Cell Lymphoma: A Case Report and Review of the Literature.

Primary cutaneous Epstein-Barr virus (EBV)-positive polymorphic B-cell lymphoproliferative disorder (LPD) is a rare LPD associated with iatrogenic and endogenous immune dysregulation with the commonest risk factor being immunosuppressive therapy. We present a 55-year-old woman with rheumatoid arthritis, previously on methotrexate, who developed a waxing and waning papulonodular eruption on the chest and neck. Histopathology revealed a lymphohistiocytic infiltrate with atypical EBV+/CD30+ B cells, consistent with EBV+ polymorphic B-cell LPD.

Quality assurance in machine Learning: Do we hit the mark for total joint arthroplasty models? A systematic review.

Background: Machine learning (ML) models are increasingly used in total hip arthroplasty (THA) and total knee arthroplasty (TKA) to enhance outcomes and optimize clinical decision-making. However, quality assurance (QA) measures vary within models and are often inadequately reported. This study aims to provide a high-level overview of QA practices in ML models within THA and TKA.

Safety of One of the Most Commonly Used Probiotic Strains: Systematic Review and Meta-analysis of Reported Adverse Events.

Probiotics are defined as live microorganisms that, when administered in adequate amounts, confer a health benefit on the host. Probiotics are widely used in everyday foods and supplements but very few studies have thoroughly evaluated safety. We evaluated adverse events (AEs) for one of the most widely used strains, Bifidobacterium animalis subsp.

Impact of proning with and without inhaled pulmonary vasodilators and neuromuscular blocking agents in COVID acute respiratory distress syndrome.

Background: A major cause of mortality in the coronavirus disease 2019 (COVID-19) pandemic was acute respiratory distress syndrome (ARDS). Currently, moderate to severe ARDS induced by COVID-19 (COVID ARDS) and other viral and non-viral etiologies are treated by traditional ARDS protocols that recommend 12-16 hours of prone position ventilation (PPV) with neuromuscular blocking agents (NMBA) and a trial of inhaled vasodilators (IVd) if oxygenation does not improve. However, debate on the efficacy of adjuncts to PPV and low tidal volume ventilation persists and evidence about the benefits of IVd/NMBA in COVID ARDS is sparse.

Increasing Physical Activity in Children During Cancer Treatment: A Qualitative Study of Parents' Perspectives.

This qualitative study explored barriers, facilitators, and preferences for promoting physical activity (PA) in children undergoing cancer therapy by interviewing 36 parents of children aged 4-15 years, on-therapy or less than 1 year post-therapy at three hospitals. Key barriers included safety concerns, risk of infection, and treatment side effects. Facilitators included social support and oncologist recommendations for PA.

An Anesthesiologist's Moral Distress With Organ Procurement: A Narrative Review.

Organ procurement procedures have evolved significantly over the past decade, resulting in new moral uncertainties. The dead donor rule (DDR), a foundational principle, mandates that organ procurement occurs only after death is confirmed. However, developments such as donation after circulatory death (DCD) and normothermic regional perfusion (NRP) have raised ethical issues, creating moral distress and moral injury among anesthesiologists.

Lower Extremity Free Tissue Transfer in Peronea Arteria Magna: An Observational Retrospective Cohort Study of Anatomic and Microsurgical Considerations.

Background: Patients with only peroneal artery blood supply to the foot, known as peronea arteria magna (PAM), represent a rare cohort and a unique challenge in the setting of complex lower free (LE) tissue transfer (FTT). The present study aims to leverage a high volume lower extremity reconstruction center to determine the incidence and microsurgical considerations in PAM.

Methods: A retrospective cohort study was conducted at a single tertiary limb salvage center, reviewing all patients who underwent lower LE FTT from July 2011 to January 2024.

Bridging diagnostic safety and mental health: a systematic review highlighting inequities in autism spectrum disorder diagnosis.

Introduction: There is increased recognition that diagnostic errors disproportionately affect marginalised and underserved patient populations in the USA. However, evidence on diagnostic inequities in mental disorders is sparse and not well integrated into the overall diagnostic safety literature.

Objective: We systematically reviewed and narratively synthesised evidence on inequities in diagnosis of mental disorders, guided by the Diagnostic Process Framework developed by The National Academies of Sciences, Engineering, and Medicine.

Pilot Study on Resuscitation Volume's Effect on Perfusion and Inflammatory Cytokine Expression in Peri-Burn Skin: Implications for Burn Conversion.

Fluid resuscitation after thermal injury is paramount to avoid burn shock and restore organ perfusion. Both over- and under-resuscitation can lead to unintended consequences affecting patient outcomes. While many studies have examined systemic effects, limited data exist on how fluid resuscitation impacts burn wound progression in the acute period.

Predictive value of the risk analysis index for 30-day mortality following surgical management of thoracolumbar vertebral body fractures.

Purpose: Frailty has emerged as a key predictor of postoperative outcomes, with indices like the revised Risk Analysis Index (RAI) and the modified Frailty Index (mFI-5) used for assessment. The purpose of this study was to compare the predictive value and discriminatory accuracy of the mFI-5 and RAI for adverse outcomes following surgical management of thoracolumbar (TL) spine fractures.

Methods: This was a retrospective cohort study utilizing data from the 2015-2019 years of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database.

Sinonasal mucosal melanoma presenting with ocular symptoms: Two case reports and a literature review.

PurposeSinonasal mucosal melanoma (SNMM) accounts for approximately 4-8% of sinonasal malignancies. SNMM frequently originates in the nasal cavity, causing nonspecific nasal symptoms that inevitably delay diagnosis. Left untreated, the tumor may extend into the orbit.

Large Basal Cell Carcinoma Treated with Combination Topical Therapy.

Basal cell carcinoma (BCC) is the most common skin cancer in the United States. Common treatment approaches for superficial, small, and/or low grade BCCs include topical therapy or curettage plus electrodesiccation and cryotherapy. For larger, high-grade, and/or certain subtypes of BCC, surgical therapy is typically pursued, occasionally under anesthesia for large lesions.

Correlation of Upper Instrumented Vertebrae and Future Cervical Spine Surgery to Patient-reported Outcomes in Adolescent Idiopathic Scoliosis Treated With Harrington Rod Instrumentation: A Minimum 40-year Follow-up.

Study Design: Long-term retrospective observational study.

Objective: Assess the influence of upper instrumented vertebrae (UIV) and future cervical spine surgery on patient-reported outcomes in Adolescent Idiopathic Scoliosis (AIS) treated with Harrington rod fusion.

Summary Of Background Data: Harrington rod has been largely replaced by pedicle screw fixation due to many considerations, including complications like pseudoarthrosis and implant failure.

Endothelial dysfunction in areas of unburned skin in a burn injury model.

Introduction: Burn shock is mediated by a complex inflammatory response leading to endothelial cell dysfunction (EnD) and increased vascular permeability in large total body surface area (TBSA) injuries. Smaller TBSA burns do not induce systemic EnD. Previous studies in animal models have examined systemic markers of endothelial cell dysfunction following thermal injury and have aimed to characterize this dysfunction in various end organs.

Regional variation in distal femur subchondral bone mineral density: An in vitro human cadaveric model.

Background: Osteochondral defects of the knee are a frequent cause of pain that often require surgical intervention. Restorative procedures such as osteochondral autograft transplantation (OAT) and osteochondral allograft transplantation (OCA) aim to replace cartilage lesions with healthy autologous tissue or cadaveric tissue from the distal femur, respectively. Osteochondral graft donor sites are selected to optimize donor-recipient site congruity by assessing factors such as surface topography, cartilage thickness, and contact pressures.

Exploring Residents' Beliefs Regarding the Role of Race in Clinical Decision-Making: A Qualitative Study.

Race has long been treated as a biological determinant in medicine, and many US faculty still reference it in clinical contexts. As the field shifts away from this model, the medical community faces the challenge of addressing how race shapes patients' experiences and outcomes without reinforcing harmful practices. Internal medicine residents must navigate this transition amid conflicting guidance on incorporating race into clinical reasoning.