Citations

Introduction: Spinal cord infarction (SCI) is a rare but serious neurological condition that accounts for 1-2% of all ischemic strokes and can lead to significant disability. Despite its clinical importance, existing studies are limited by small sample sizes that lack national generalizability, and little is known about post-discharge events such as hospital readmissions. We aimed to evaluate factors associated with all-cause hospital readmissions among hospitalizations with primary diagnosis of SCI, utilizing the Nationwide Readmissions Database (NRD). Methods: NRD data were abstracted from 2016 to 2022 including all hospitalizations of adult patients (≥18 years) with a primary diagnosis of SCI. Multiple-predictor logistic regression models were estimated to assess the association of demographic and clinical variables with all-cause 90-day readmissions. We included specific comorbidities often used in comorbidity scoring systems and added conditions or complications that are known to be associated with SCI. Statistically significant covariates from the unadjusted model were retained in the multiple-predictor model. Odds ratios (OR) with associated 95% Confidence intervals (CI) and p-values were reported. Results: From 2016 to 2022, there were an estimated 3321 hospitalizations with a primary diagnosis of SCI, out of which 27% (95% CI: 24-30%) were readmitted within 90 days. Demographic factors that were associated with lower odds of readmission included private insurance (vs. Medicare) and high-income quartile (Fig. 1). [AH1] [AAs2] Clinical factors that were associated with increased odds of readmission included autonomic dysfunction (OR = 5.44, 95% CI: 1.86 to 15.94), renal disease (OR = 3.57, 95% CI: 1.83 to 6.96), liver disease (OR = 2.40, 95% CI: 1.34 to 4.32), full clinical associations shown in Figure 2. Conclusion: We identified several clinical and demographic factors that were significantly associated with increased all-cause readmissions after SCI hospitalizations. Autonomic dysfunction and renal disease were among the top predictors of readmissions. We uncovered socioeconomic disparities in readmissions rates following SCI. This data may assist vascular neurologists, physicians and healthcare administrators in reducing readmissions after SCI and addressing these disparities. Additionally, our results can guide future studies focusing on the management of this rare entity.

What was done? A review of artificial intelligence (AI) applications for the imaging of uterine fibroids, endometriosis, and adenomyosis. What was found? AI models can assist with the recognition, segmentation, and localization of uterine fibroids, and the differentiation of benign fibroids and sarcomas. Models can aid in the diagnosis of adenomyosis and endometriosis, and the prediction of the impact of endometriosis on fertility. What the findings mean? Deployed thoughtfully, AI tools could reduce variability, shorten read times, and add objective measurements to routine care. Studies evaluating these models are limited by single-institution designs and continued reliance on expert sonologists and radiologists.

Abstract Aims Obesity, particularly visceral adiposity, is a key driver of cardiovascular mortality (CVM), yet conventional measures such as body mass index (BMI) inadequately capture fat distribution. The Body Roundness Index (BRI) is a novel anthropometric measure integrating waist circumference and height to better reflect body shape and visceral fat. This study examined the association between BRI and CVM in U.S. adults and across sociodemographic subgroups. Methods and results We analysed data from 31 351 adults (median age 43 yrs, 50% females) aged ≥20 years in NHANES 1999–2018, excluding those with prior cardiovascular disease or cancer. BRI was computed using a validated equation and categorized into quintiles (Q3 as reference). The primary outcome was CVM; secondary outcomes included all-cause, heart disease, and cerebrovascular mortality. Weighted Cox proportional hazards and restricted cubic spline (RCS) models evaluated associations after adjustment for demographic, behavioural, and clinical factors. Subgroup and sensitivity analyses tested consistency and effect modification. During a median follow-up of 10.1 years (IQR: 5.3–14.9 years), 883 cardiovascular deaths occurred. In fully adjusted models, participants in the highest BRI quintile had a 54% higher risk of CVM (HR, 1.54; 95% CI, 1.13–2.08; P = 0.006) vs. Q3. This risk remained high even among those with normal BMI. RCS analysis indicated a modest U-shaped association. Stronger effects were observed among middle-aged adults (45–64 years) and those with higher educational attainment. Conclusion Higher BRI is independently associated with increased cardiovascular mortality, particularly among middle aged adults and those with normal BMI, underscoring its potential as a practical, noninvasive tool for cardiovascular risk stratification. Incorporating BRI into clinical and public health assessment may improve identification of individuals at elevated risk.

Abstract Objective This study aimed to evaluate how differences in case complexity affect information-processing burden, as measured by eye-tracking, as well as the efficiency of electronic health record (EHR) use among healthcare providers in the intensive care unit. Materials and Methods This cross-sectional study recruited providers from 4 U.S. medical centers that use 2 prominent EHR systems (Epic and Oracle). After reporting demographic information, participants reviewed 2 complex cases and 2 standard cases in their institution’s EHR system and then responded to 5 questions about each case, yielding a performance score. Information-processing burden was assessed by measuring the number of eye fixations via eye-tracking software. The efficiency of EHR use was assessed by measuring the task completion time, number of mouse clicks per minute, number of EHR screens viewed, and performance score. Results Eighty-one providers were included for analysis. Providers exhibited significantly more eye fixations (P < .001) and longer task completion times (P < .001) for complex cases than for standard cases. There were also significantly fewer mouse clicks per minute during complex cases (P < .001). Reviewing a complex case first led to significantly more eye fixations (P = .015) and longer task completion times (P < .01) than when a standard case was presented first. Case complexity did not significantly affect performance scores or the number of EHR screens viewed. Discussion Higher case complexity was shown to be associated with greater information-processing burden and less efficient EHR use. These findings have implications for enhancing the efficiency of EHR use, thereby leading to improved clinical decision-making and patient safety. Furthermore, reviewing complex cases first led to a greater information-processing burden, suggesting that providers could benefit from “warming up” with standard cases before reviewing complex cases.

ABSTARCT BACKGROUND: IRRAflow is a novel active cerebrospinal fluid (CSF) exchange system for the treatment of hemorrhagic strokes and intracranial infections. It is a closed system that irrigates various medications dissolved in irrigation solutions at a speed of up to 180 mL/h, expediting resolution. Disrupting this closed system to withdraw CSF samples or infuse medications is necessary in certain circumstances. We report our novel approach for maintaining the sterility of the closed IRRAflow system using a needleless extension and assess the compatibility and safety of this technology throughout treatment. METHODS: We used a needleless extension to withdraw CSF samples and deliver medications to 5 patients treated with the IRRAflow system. We used 1 stopcock with a 3-way valve, 2 neutral needleless connectors, and 2 antiseptic caps. The stopcock was connected between the irrigation and drainage ports of the catheter. The needleless connectors were mounted at the 12 o’clock position of the attached stopcock and the irrigation port with antiseptic caps covering the distal ends. To initiate fluid exchange, the 2 needleless connectors were separated. The extra stopcock valve was connected between the drainage arm, the cassette, and the irrigation arm. The needleless connectors remained mounted at the 12 o’clock position of the stopcock and irrigation port throughout treatment. RESULTS: The needleless connectors mounted on the 12 o’clock position of the stopcock and irrigation port on the drainage and irrigation arms, respectively, provided efficient management of fluid exchange, CSF fluid sampling, and medication delivery. Our needleless extension was compatible with the IRRAflow device and prevented secondary infections despite repeated CSF sampling and medication delivery. CONCLUSION: The needleless extension facilitated a simple and safe interaction with the closed IRRAflow system without compromising the sterile environment during CSF sampling and medication delivery.

We describe an unusual case of a woman in her 30s who had recently undergone Roux-en-Y gastric bypass and presented to the emergency department with a 6-week history of intractable nausea and vomiting, accompanied by progressively worsening bilateral leg weakness. Examination revealed persistent upbeat nystagmus, paraparesis, areflexia in the lower extremities, brisk reflexes in the upper extremities and diminished sensation across all modalities in lower limbs. Brain and spine MRIs were unremarkable, there was no nerve root enhancement. Laboratory tests revealed thiamine deficiency, with a level of 28 nmol/L (reference range: 70–108 nmol/L). No gangliocyte antibodies were detected. Cerebrospinal fluid study showed no albuminocytological dissociation. Electrodiagnostic studies showed evidence of lumbosacral polyradiculopathy. The patient was eventually diagnosed with thiamine deficiency-related acute nutritional axonal neuropathy and Wernicke’s encephalopathy. After aggressive thiamine supplementation and 8 weeks of physical rehabilitation, her leg strength improved, but she still requires assistance to ambulate.