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Accurate assessment of distal tibiofibular syndesmotic injuries is essential to prevent chronic instability and poor functional outcomes, and conventional radiography, CT, and MRI play complementary and critical roles in the imaging of these injuries.

Introduction: Plasma biomarkers of Alzheimer’s disease (AD), including amyloid-β (Aβ42/Aβ40), phosphorylated tau (p-tau181), neurofilament light (NfL), and glial fibrillary acidic protein (GFAP) have shown strong reliability in predicting dementia risk. White matter hyperintensities (WMH) represent a major vascular contributor to dementia. We investigated how plasma biomarkers of AD interact with WMH on MRI to influence incident dementia risk. Methods: We included dementia-free participants from the Atherosclerosis Risk in Communities (ARIC) Study who underwent MRI and plasma biomarker assessment at Visit 5 (2011–2013). WMH was quantified and considered continuously (log-transformed and standardized), and in tertiles. Plasma biomarkers were log-base-2-transformed. Cox proportional hazards models were used to estimate dementia risk over 10 years associated with plasma biomarkers and WMH, independently and multiplicatively. Models were adjusted for demographic variables (age, sex, race, and education), vascular risk factors (hypertension, diabetes, smoking status, body mass index, and estimated glomerular filtration rate), and APOE ε4 status. Results: Among 1,538 participants (aged 67- 90 years, 29% Black), 30% ( N = 462) developed dementia over the 10-year follow-up period. For every doubling of plasma Aβ42/Aβ40 , indicating lower amyloid burden, dementia risk decreased, while doubling of p-tau 181 , NfL, and GFAP were each associated with increased dementia risk, in separate models; each of these associations was independent of WMH (Table 1). Additionally, dementia risk increased per SD increase in WMH, independent of each plasma biomarker. Although no multiplicative interaction terms reached statistical significance (p<0.05), there was suggestive evidence that Aβ42/Aβ40 and GFAP have smaller effect sizes on dementia risk in subgroups at the highest WMH tertile (p-interactions<0.10; see Table 2). Discussion: Plasma biomarkers and WMH independently predict dementia risk over 10 years, though there remained limited evidence of multiplicative effects. Plasma biomarkers may be less important for dementia risk in individuals who also have extensive WMH. These findings emphasize the importance of incorporating both AD-specific plasma markers as well as indicators of cerebral small vessel disease, such as WMH, into dementia risk profiling.

Background: Cervical artery dissection (CeAD) accounts for nearly 25% of all ischemic strokes in young adults. CeAD can lead to the development of dissecting aneurysms (DA). However, the incidence, risk factors and outcomes of CeAD patients with DA is not well established. This study aims to identify risk factors for developing DA, subsequent growth, and impact on patient outcomes. Methods: This is a secondary analysis of the Antithrombotics for Stroke Prevention in Cervical Artery Dissection (STOP-CAD), a multicenter cross-sectional international retrospective study. CeAD patients were stratified for the presence of DA. We used multivariable regression to identify factors associated with DA. Patients with DA were further analyzed for DA growth. The primary outcome was ischemic stroke after CeAD+DA diagnosis. Secondary outcomes included ischemic stroke after CeAD+DA with DA growth. Multivariable logistic regression analysis was used to assess the association between DA and risk factors. We also performed univariate Cox regression and generated Kaplan-Meier survival curves comparing study outcomes based on presence of DA and subsequent growth. Results: Of the 4023 patients included in the STOP-CAD study, 4008 were included in this analysis and 767 (19%) patients had DA (546 with DA on initial presentation). Patients with DA had a mean age of 46 [IQR 37-55] years and 50% (383) were women. In combined adjusted analyses, DA patients were more often non-Hispanic (aOR 0.63, 95% CI 0.41-0.94, p<0.02), more commonly had a history of migraine (aOR 1.27, 95% CI 1.01-1.59, p=0.037), connective tissue disorder (aOR 2.02, 95% CI 1.22-3.36, p=0.007), minor neck trauma (aOR 1.70, 95% CI 1.29-2.26, p<0.001) and were more likely to present with ischemic stroke (aOR 1.73, 95% CI 1.05-2.87, p=0.031). DA growth was noted in 55 out of 546 (10%) patients with DA on presentation. There was no significant difference in the risk of ischemic stroke by day 180 in patients with DA (hazard ratio [HR] 0.92 [95% CI, 0.65-1.30]; P =0.63) or DA growth (HR 2.40, [95% CI, 0.79-7.24]; P =0.12). Conclusion: In this subanalysis of STOP-CAD, nearly one in five patients with CeAD developed a DA. Factors associated with a higher likelihood of DA included non-Hispanic ethnicity, history of migraine, connective tissue disorder, minor neck trauma, and ischemic stroke at presentation. DA diagnosis and DA growth did not impact the risk of subsequent ischemic stroke at 6 months.

Background: The clinical characteristics and complications associated with de novo pseudoaneurysm formation beyond the acute phase of cervical artery dissection remain poorly defined. In this study, we examined the incidence, risk factors, and related ischemic and hemorrhagic events of post-acute de novo pseudoaneurysm formation. Methods: We analyzed data from the STOP-CAD study (Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection). A de novo pseudoaneurysm was defined as a new (not present on initial imaging) focal enlargement in the diameter of the artery, greater than the native lumen. The incidence of de novo pseudoaneurysm was assessed at 90 days, 180 days, and beyond 180 days of follow-up. Univariate and multivariate regression analyses were conducted to identify risk factors for post-acute de novo pseudoaneurysm formation. Kaplan-Meier survival estimates were used to compare ischemic and hemorrhagic events between patients with and without de novo pseudoaneurysms. Results: Among 4008 patients, 546 were excluded as they had dissecting pseudoaneursyms on initial presentation. Therefore, 3,462 patients were included in this analysis of whom 220 patients (6.35%) developed a de novo pseudoaneurysm over a maximum follow-up of 4.4 years. Of these, 127 (57.72%) were detected within the first 90 days, and 172 (78.18%) within the first 180 days. In multivariate regression analyses, in addition to hypertension, active smoking and Hispanic ethnicity, fibromuscular dysplasia (FMD) was an independent risk factor for post-acute de novo pseudoaneurysm formation (adjusted OR: 2.160; 95% CI: 1.408–3.315; p < 0.001). Notably, the presence of a de novo pseudoaneurysm was not associated with a significant increase in ischemic (hazard ratio [HR] 1.43 [95% CI, 0.89–2.30]; P=0.14) or hemorrhagic events (hazard ratio [HR] 1.42 [95% CI, 0.43–4.69]; P=0.57). Conclusion: De novo pseudoaneurysm formation following a diagnosis of a cervical artery dissection is not uncommon and most frequently occurs within the first 180 days. FMD was independently associated with this complication. The development of a de novo pseudoaneurysm did not significantly increase the risk of subsequent ischemic or hemorrhagic events.

Background: Stroke is a frequent manifestation of non-bacterial thrombotic endocarditis (NBTE), yet current knowledge largely stems from case reports and small series. This systematic review aimed to comprehensively describe stroke presentation, imaging features, management, and outcomes in NBTE patients. Methods: A comprehensive search of EMBASE, PubMed, MEDLINE, Web of Science and PsycINFO databases was conducted through September 2023. Studies reporting individual cases or case series of NBTE-related stroke were included. Extracted data included demographics, vascular risk factors, stroke presentation, imaging features, NBTE etiology, treatment modalities (unfractionated heparin/low molecular weight heparin (UFH/LMWH), warfarin, direct oral anticoagulants (DOACs), and valvular intervention), stroke recurrence, and mortality. Multivariate regression was performed to identify predictors of recurrent stroke and mortality. Results: A total of 129 patients from 118 studies were included (median age 56 [IQR:44-64], 62% females). Right (28%) and left (26%) hemispheric stroke syndromes accounted for the majority of clinical presentation, and multivessel ischemic infarcts (>2 territories) were observed in 66%. Conventional vascular risk factors were infrequent (1%-21%), while deep vein thrombosis and systemic embolism occurred in 59% and 38% of patients, respectively, either preceding or coinciding with stroke onset. Malignancy and autoimmune diseases were identified in 72% and 22%, respectively. Anticoagulation was initiated in 66% and 21% underwent valvular treatment. Over a median follow-up of 1.3 months, stroke recurrence and death occurred in 48% and 50%, respectively. Malignancy significantly increased mortality risk (OR 16.8, P<0.001), while autoimmune-related NBTE (OR 0.2, P=0.029), and anticoagulation with UFH/LMWH (OR 0.3, P=0.011) and VKA (OR 0.09, P=0.002) reduced mortality. Recurrent stroke was more likely in patients with malignancy (OR 16.8, P=0.001) and those receiving DOACs (OR 6.2, P=0.057) Conclusion: NBTE should be considered in stroke patients lacking conventional risk factors, particularly with underlying malignancy or autoimmune disease. Malignancy and DOAC use may increase the risk of recurrent strokes in this patient population.

Introduction: Emerging evidence highlights the increased white matter hyperintensity (WMH) burden in APOE4 homozygotes, the greatest genetic risk factor for late-onset Alzheimer's disease (AD). The link between WMH and cerebral amyloid-beta (Aβ) accumulation remains unclear, especially in presymptomatic AD phases. We aimed to determine whether WMH burden (global or regional) mediates the association between APOE4 homozygosity and amyloid-PET Aβ deposition in a population of subjects with intact cognition. Methods: WMH were segmented using a deep learning model applied to T1 and T2-FLAIR MRI scans from 49 cognitively intact individuals older than 50. The global and regional (periventricular, lobar, basal ganglia, infratentorial) WMH volumes were adjusted for total intracranial volume and log-transformed to normalize distribution. Amyloid-PET cerebral Aβ burden was quantified in centiloid units; individuals with centiloid > 20 were classified as Aβ-positive. To examine our mediation hypothesis, we tested three pathways using logistic and linear regression models: 1) Path a, the association between APOE4 and global or regional WMH volumes (outcome); 2) Path b, the association between WMH volumes and Aβ positivity (outcome); 3) Path c (total) and c' (direct) effects of APOE4on Aβ positivity (outcome), before and after adjusting for WMH volumes. All models incorporated age and vascular risk factors (hypertension, diabetes, hypercholesterolemia, cigarette smoking). Results: We included 11 APOE4 homozygotes, of whom 7 were Aβ-positive and 38 non-carriers (35 3/3 and 3 3/2) (6 Aβ-positive). Compared to APOE4 non-carriers, APOE4 homozygotes had significantly greater WMH volumes in the posterior periventricular region only (p= 0.0453) (path a). Homozygotes were significantly more likely to be Aβ-positive compared to non-carriers (total effect, path c p=0.0019). This association remained significant after adjusting for WMH (direct effect, path c'= 0.0027). However, neither global (p=0.72) nor posterior periventricular (p=0.84) WMH volumes predicted Aβ positivity (path b) (Figure). Conclusions: In our cohort of cognitively normal individuals including preclinical AD, neither global nor regional WMH burden mediated the relationship between APOE4 homozygosity and Aβ positivity. Larger studies are needed to further evaluate the mechanistic relationship between WMH and neurodegeneration in APOE4 carriers.

ABSTRACT Based on anecdotal observation of fatty infiltration (FI) of the opponens pollicis (OPP) muscle in patients with thumb carpometacarpal (CMC) Osteoarthritis (OA), we sought to examine the association of FI with CMC OA. We reviewed 747 consecutive 3 T wrist magnetic resonance imaging (MRI) studies for evidence of FI in the thenar muscles. This population was divided into two cohorts based on radiographic analysis: a cohort without thumb CMC OA ( n = 440) and a second cohort with thumb CMC OA ( n = 307), staged according to the Eaton–Littler classification. Statistical analysis using logistic regression was performed to investigate clinical factors associated with the presence of FI in the thenar muscles. FI was present in 133 patients with CMC OA (43.3%). FI, when present, was located only in the OPP. We found no OPP FI in the cohort without CMC OA (440 patients). Among patients with CMC OA, increasing age, male sex and advanced OA stage were significantly associated with the presence of OPP FI. OPP FI is a frequent finding in CMC OA. This FI could affect the biomechanical function of the OPP. In the future, we plan to analyze clinical outcomes in CMC OA patients with and without FI, and more focused in vivo studies of OPP function. OPP FI could potentially affect the function and the stability of the thumb CMC joint in patients with CMC OA. Orthopaedic Research Society. Journal of Orthopaedic Research® 00:00–00, 2026.

In 1995, Medicare reduced payments by 50% for anesthesiologists teaching two residents concurrently. By 2004, anesthesiology residency programs were losing, on average, $400,000 per year, causing many institutions to close their anesthesiology training programs. American Society of Anesthesiologists leaders tried unsuccessfully for several years to address this situation through appeals to Medicare. They then organized an advocacy effort to pass the Medicare Anesthesiology Teaching Funding Restoration Act of 2007, which in 2010 restored full payments for teaching anesthetics. From 2010 through 2024, anesthesiologists received $1.262 billion from Medicare for 2.8 million cases involving residents, which is between $442 million and $568 million more than if the legislation had not been enacted. Anesthesiology residency programs increased from 131 to 167 after the enactment. This historic legislation taught anesthesiologists that changing Medicare policies may require congressional action and that persistent and broad-based advocacy can make a legislative campaign successful.

The purpose of this study was to examine the validity of a Garmin device for estimating heart rate, energy expenditure, and step count during incremental treadmill exercise. Eighteen physically active males (n = 12; mean ± SD age = 22.8 ± 4.7 years; body mass = 83.8 ± 13.4 kg) and females (n = 6; 24.2 ± 5.6 years; 65.2 ± 9.6 kg) completed an incremental treadmill test with the Garmin Vivoactive 4 and criterion methods measuring heart rate, energy expenditure, and step count. Mean absolute percent error (MAPE) and Bland–Altman plots were used to assess accuracy. Acceptable accuracy was defined as MAPE < 5% for heart rate and <10% for energy expenditure and step count. MAPE (±SD) values were 13.0 (±10.1), 19.1 (±15.0), and 4.6 (±5.3)% for heart rate, energy expenditure, and step count, respectively. The Bland–Altman regression analyses illustrated proportional bias was present for heart rate (r = 0.591, p < 0.001) and step count (r = 0.516, p = 0.028), but not energy expenditure (r = 0.351, p = 0.153). These findings indicated that the Garmin Vivoactive 4 provided acceptable accuracy for step count but unacceptable accuracy for heart rate and energy expenditure during incremental treadmill exercise.