Citations

Medial ulnar collateral ligament (MUCL) injuries of the elbow have increased over the past 2 decades, particularly among adolescent and young adult overhead throwing athletes. Over time, operative techniques for MUCL injuries have evolved, with the goals of improving time to return and rates of return to sport and meeting athlete-specific demands. The purpose of this review is to evaluate the state of surgical management of MUCL injuries, assessing indications, techniques, and outcomes. Surgical techniques reviewed included MUCL-augmented repair with internal bracing, traditional reconstruction, reconstruction augmented with internal bracing, and revision MUCL reconstruction. While MUCL reconstruction has been the gold standard of treatment, augmented reconstruction and repair techniques have shown promising outcomes; these strategies emphasize anatomic restoration, preservation of native tissue, and individualized patient selection.

Background:Aortic valve replacement is the primary treatment for aortic valve disease and can be performed using either transcatheter (TAVR) or surgical (SAVR) approaches. The risk of aortic dissection (AD) with TAVR compared with SAVR remains unclear. We aimed to compare AD risk between TAVR and SAVR using a large, real-world cohort. Methods:We conducted a retrospective cohort analysis using the TriNetX research network. Patients with a diagnosis of aortic stenosis, aortic insufficiency, mixed aortic valve disease (AVD), or unspecified AVDwho underwent either TAVR or SAVR were included. A 1:1 propensity score-matching (PSM) based on baseline characteristics was performed to adjust for potential confounding. Logistic regression and Cox proportional hazards models were used to estimate odds ratios (ORs) and hazard ratios (HRs), with 95% confidence intervals (CIs).Results:Among 95,043 patients undergoing isolated aortic valve replacement, 20,237 matched pairs were analyzed after 1:1 PSM. Baseline characteristics were well balanced, with a mean age of 73.3 ± 9.3 years in the TAVR group and 73.2 ± 8.5 years in the SAVR group; 60.8% and 60.7% were male, respectively. TAVR was associated with significantly lower odds of composite AD than SAVR at all time points (1-year OR 0.60; 95% CI 0.44–0.82; 3-year OR 0.64; 95% CI 0.48–0.83; 5-year OR 0.66; 95% CI 0.51–0.85; p < 0.01 for all). Stratified analyses demonstrated lower odds of both Stanford type A and type B AD at all time points. Kaplan–Meier analysis demonstrated a separation in composite AD-free survival between the two groups (HR 0.66; 95% CI 0.51–0.86; p = 0.002).Conclusion:In this large, real-world cohort, despite a low event rate, TAVR was associated with a significantly lower likelihood of composite AD than SAVR.

Background:The development of symptoms or left ventricular dysfunction in severe aortic stenosis (AS) is associated with high morbidity and mortality. While elective transcatheter aortic valve replacement (TAVR) is supported by robust randomized evidence, data on TAVR performed in non-elective settings (urgent, emergent, or salvage) remain limited and heterogeneous. In these settings, outcomes may be influenced more by baseline clinical severity than by procedural factors. This study aimed to systematically evaluate the safety and effectiveness of non-elective TAVR and to compare the associated outcomes with those of elective TAVR.Methods:This systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and registered with PROSPERO. The PubMed, Embase, and Scopus databases were searched for studies published after 2002 evaluating urgent, emergent, or salvage TAVR in adult patients with severe AS. Eligible studies were required to include elective TAVR as a comparator. Outcomes included mortality and major procedural complications. Prespecified era-based analyses and sensitivity analyses excluding studies at critical risk of bias were performed. Risk of bias was assessed using the ROBINS-I tool.Results:A total of 17 observational studies published between 2015 and 2025 were included, comprising 215,141 patients. Compared with elective patients, those undergoing non-elective TAVR had more advanced heart failure, higher NYHA class, greater comorbidity burden, and higher surgical risk scores, whereas baseline echocardiographic severity of AS was similar. Pooled outcomes for non-elective TAVR showed in-hospital, 30-day, and 1-year mortality rates of 5.1%, 12.4%, and 26.7%, respectively. Non-elective TAVR was associated with higher mortality at all time points compared with elective procedures; meanwhile, rates of stroke, vascular complications, and permanent pacemaker implantation were similar, while major bleeding and acute kidney injury were more frequent. Era-based analyses showed a stable relative mortality risk over time.Conclusions:Although non-elective TAVR is associated with worse outcomes than elective procedures, these differences appear to be largely driven by baseline clinical severity rather than by the transcatheter intervention. In unstable patients with severe AS, non-elective TAVR remains the most effective definitive treatment option compared with balloon aortic valvuloplasty or conservative management.The PROSPERO Registration:CRD420251239620, https://www.crd.york.ac.uk/PROSPERO/view/CRD420251239620.

We report an innovative interleaved voltammetric strategy to simultaneously quantify tonic levels of dopamine and serotonin in vivo using a single unmodified microelectrode, advancing our capability to monitor complex neurochemical interactions.

ABSTRACT This study assessed the level of agreement of perceived improvements among pediatric patients with chronic pain and their parents following an interdisciplinary pain management program. This is a retrospective chart review of a heterogeneous group of pediatric patients with chronic pain who completed an interdisciplinary pain management program (IPMP) and their parents ( N = 172 pairs). The IPMP took place in an outpatient pain management center affiliated with an academic rehabilitation hospital. The outcome measures included the Multidimensional Patient Impression of Change (MPIC) and the MPIC parent version were administered post‐treatment. The levels of agreement on the MPIC were analyzed between child and parent using the free‐marginal kappa statistic. The majority of both the parents and the children evaluated the patients to be much or very much improved in six of the eight domains assessed. The levels of agreement in the ratings were fair to moderate among the patient–parent dyads. Parents endorsed significantly higher levels of improved overall pain and mood than their child did, whereas the patients reported greater levels of improved ability to cope with pain than their parents did. Both the patients and their parents reported high levels of perceived improvement following the IPMP. However, there were some differences in their ratings of improvements in overall pain, mood, and ability to cope with pain. Given that some of the perceptions were discrepant, it is recommended that feedback be obtained from the patient and their parent.

ABSTRACT Genetic counselors describe their professional identity as who they are (personal characteristics and attributes), what they do (actions and skills), and what they possess (training and knowledge). A shared multidimensional perspective highlights the transferability of their skills across diverse roles and settings. This qualitative study aimed to identify factors that influence genetic counselors' perceptions and formation of their professional identities. Using Social Identity Theory as a theoretical framework, semi‐structured recorded interviews were conducted with 50 genetic counselors who were purposefully sampled to ensure diversity of personal demographics (gender, race/ethnicity, sexual orientation, disability, and caregiver status), as well as years, settings, and roles in genetic counseling practice. Transcripts were coded and subjected to codebook thematic analysis using NVivo. Professional identity was influenced by internal validation (sense of purpose in work, pride, and confidence), external validation (from other colleagues, work system, degree of autonomy, and patients), one's personal identities (demographics, life experiences, and persona), and connections with others (professional network, peer support, role models, and giving back). Alignment and misalignment of these factors and the perceived collective identity of the profession impacted genetic counselors' sense of belonging to the profession both positively and negatively, respectively. Continued efforts to diversify the profession, as well as expanded opportunities for genetic counselors to work in new settings and roles, require critical reflection and discussion about the collective identity of the genetic counseling profession. The findings of this study can inform the recruitment, training, credentialing, continuing education, and retention of genetic counselors to ensure that genetic counselors, regardless of their personal identities or their work roles or settings, develop and maintain a sense of belonging and commitment to the profession and its values. In turn, the support of professional identity formation can positively impact genetic counselors' job satisfaction, competency, and delivery of healthcare to their patients and the populations they serve.

ABSTRACT This study aims to identify and characterize fenestrations in the aortic and pulmonary valves using an endoscopic approach and compare their prevalence and morphology in adult and fetal hearts. The research explores whether these fenestrations are congenital or acquired and their potential clinical implications. We analyzed 41 adult human hearts (mean age: 74.25 years; range: 62–92) and 97 fetal human hearts (mean gestational age: 26 weeks; range: 12–40). Specimens were preserved in alcohol‐phenol‐formaldehyde and examined using a Stryker 5 mm 0 degree endoscope to visualize valve structures in situ, followed by post‐endoscopic dissection. Two independent investigators assessed the specimens for fenestration prevalence, distribution, and morphology, categorized into ovoid, filamentous, and fenestrated types. Fenestrations were absent in all fetal hearts. Fenestrations were identified in 75.61% of adult hearts (31/41), with 74 fenestrations observed in total. Of these, 41 were in the pulmonary valve and 33 in the aortic valve. Ovoid fenestrations predominated in both valves (aortic: 76.3%, pulmonary: 85%), with significant distribution along leaflet edges, particularly in the left coronary and semilunar leaflets. No correlation with age or sex was found. The findings from this study suggest that valve fenestrations are more likely to be acquired postnatally, rather than representing congenital anomalies. The complete absence of fenestrations in all fetal heart specimens, contrasted with their high prevalence in adult hearts, supports this hypothesis. While our results do not directly prove a causal relationship, they align with prior literature proposing that biomechanical factors, such as cumulative leaflet stress, turbulent flow, and repeated coaptation, may contribute to the formation of fenestrations over time. These insights into the prevalence, morphology and leaflet distribution of fenestrations provide a valuable foundation for future research investigating their etiology, clinical significance, and potential role in valve dysfunction.

ABSTRACT HLA‐DQA1*01:67:01 is characterised by a single nucleotide substitution in codon 100 in Exon 3.