Citations

After successfully implementing an acute care telemedicine program internally, health care institutions often consider expanding and scaling services externally beyond the initial organizational network. This report outlines important considerations when expanding acute care telemedicine services externally, including cultural alignment and agility, practice context, staffing models, telemedicine technology selection, interrelated services, legal and compliance considerations, quality assurance, risk management, financing, and integration with medical education. These factors may inform program leaders of major planning considerations, potential barriers, and could influence strategic planning. Prospectively identifying and resolving challenges prior to contracting with new external sites will facilitate smooth, successful implementation and high utilization of the acute care telemedicine service.

Abstract A modified myocardium-blood composite model enables the temporal changes in instantaneous extension and contraction of in vivo myocardial fiber to be computed by using the measured blood volume fractions and wall thicknesses in the investigated left ventricular region. A 16 time-increment study of 6 dogs shows that myocardial fiber may undergo an average length change of 62% and −38% during the diastolic and systolic phases of cardiac cycle, respectively. Two comparable results had been obtained previously, but the new method is much simpler, removes the incompressibility assumption and takes into consideration the intravascular blood in the ventricular wall.

Abstract For biomechanics analysis of body organs, finite element method [1∼3] is the practical tool for dealing with the complex geometric shapes and material composition involved. Either for direct computation of the stresses and strains in the body organ or inverse determination of its material properties, the change of geometrical shapes and dimensions and the change of the loadings, both in time, must be accurately recorded. Moreover, fast imaging techniques [4] and a vast volume of computer storage memory are necessary for acquisition of such temporal data, particularly if finite-element biomedical algorithms are to be developed for routine use. This paper reports a chronological development of finite-element inverse determination of global and regional material properties, passive diastolic stiffness and active systolic contractile strength of the in vivo heart wall. A collection of computer algorithms has been accumulated as a result of continuing collaborative research on cardiopulmonary dynamics by the authors and their co-workers since 1973.

ABSTRACT Background and hypothesis End-stage renal disease patients require peritoneal dialysis (PD) as a life-saving therapy; however, they continue to experience systemic inflammation and increased cardiovascular pathology. These complications can be exacerbated by exposure to PD solutions (PDS) containing glucose. This highlights the clinical unmet need for novel osmotic agents to replace glucose. Here, we tested troxerutin, a Food and Drug Administration–approved drug, as a potential osmotic agent. Methods To evaluate troxerutin osmotic and non-toxic effects, in vitro and in vivo experiments were carried out using artificial membranes, mice and cultured human mesothelial cells (MCs). The local and systemic consequences of chronic peritoneal exposure to PDS associated to renal insufficiency were investigated in a preclinical model. 5/6 nephrectomized C57BL/6J mice were daily exposed to glucose- or troxerutin-PDS for 60 days, then evaluating tissue damage, proinflammatory markers and cardiac damage. Results In vitro and in vivo studies revealed that troxerutin exhibits similar osmotic and ultrafiltration capacities to glucose, but with colloidal properties. Moreover, only glucose, but not troxerutin, reduced MC viability, induced mesothelial-to-mesenchymal transition, and increased damage markers (such as interleukin-6 and vascular endothelial growth factor A). In the preclinical model, long-term treatment with glucose-PDS, but not troxerutin-PDS, significantly increased peritoneal membrane thickening, tissue proinflammatory markers (evaluated in peritoneum, kidney, heart and aorta) and cardiovascular damage (cardiac hypertrophy and fibrosis) in mice. These preclinical data clearly demonstrate the wide deleterious effects of chronic peritoneal exposure to glucose-containing PDS in mice with kidney insufficiency and that the replacement of glucose with troxerutin notably reduces these effects. Conclusion Troxerutin emerges as a more biocompatible alternative to glucose as an osmotic agent for PD therapy, exhibiting no adverse local or systemic side effects in preclinical studies. This research presents a novel approach to reduce cardiovascular complications of PD in end-stage kidney disease.

Abstract Background Plantar vein thrombosis is a rare vascular condition typically presenting with unilateral plantar foot pain and edema. Of interest to the musculoskeletal clinician, mechanical trauma to the plantar foot has been cited as a risk factor for development of these thrombi. Objective To assess the demographics, presenting history, risk factors, treatment protocols, and long‐term sequelae of patients with plantar vein thrombosis secondary to increased mechanical trauma. Design Retrospective chart review. Setting Tertiary care center. Participants Adult patients with mention of plantar vein thrombosis in imaging impressions. Main Outcome Measures Primary outcome measure was determination of the demographic and clinical characteristics of plantar vein thrombosis in patients with mechanical trauma as a preceding risk factor. Secondary outcome was evaluation of treatment options in this patient population. Results Between 2005 and 2023, nine patients at a single institution were diagnosed with plantar vein thrombosis through imaging and were determined to have developed the thrombus due at least in part to mechanical trauma. Patients typically presented with localized plantar foot pain and foot edema. Diagnosis was made via magnetic resonance imaging or ultrasound. The most frequent treatment was therapeutic anticoagulation but initial conservative treatment with serial ultrasound resulted in conversion to anticoagulation in only one patient. Among those patients with mechanical trauma as an inciting factor, the only noted complication was propagation of the thrombosis in one patient. Conclusions Although rare, plantar vein thrombosis should be considered by the musculoskeletal clinician in the differential diagnosis of unilateral plantar foot pain. Treatment of these thrombi is most commonly therapeutic anticoagulation, but in the absence of additional high‐risk factors serial ultrasound evaluations may be an adequate first line treatment due to the overall minimal risk of thrombosis propagation.

Background: Anterior vertebral body tethering (AVBT) is a promising fusionless alternative for treating idiopathic scoliosis; however, limited data exist on the learning curve for this procedure. Previous studies are limited by single-center and short-term complication data. This multicenter study assesses the learning curve by evaluating improvements in operative characteristics over time and radiographic measurements up to 2 years postoperatively. Methods: As recorded from a multicenter registry, surgeons with ≥10 index AVBT procedures for patients with idiopathic scoliosis aged 16 years and below were included. Relationships between case number and multiple surgical variables were determined using Pearson correlation and linear regression testing. For identification of an inflection point, consecutive cases were plotted against operative time per level and fitted with a locally weighted scatterplot smoothing curve. Independent samples t test and χ 2 test were used to compare outcomes between cases before and after the inflection point. Outcomes of interest included demographic, surgical, and radiographic information at the baseline, immediate postoperative, and 2-year timepointswhere available. Results: Eight surgeons and 325 index AVBT patients met the inclusion criteria. Inverse relationships were identified between case number and estimated blood loss, operative time, anesthesia time, and fluoroscopic time per level ( P < 0.005). The inflection point was identified at 15 cases. Operative time, anesthesia time, and fluoroscopy time per level were greater in the first 15 cases compared with those after ( P < 0.05). There were no significant differences in demographic variables, intraoperative complications, or length of stay between the early and late cases. Greater correction in the major coronal curve, minor coronal curve, and coronal balance occurred in the cases performed after the inflection point ( P < 0.05). Conclusions: AVBT is a safe alternative to posterior spinal fusion and demonstrates a predictable improvement in surgical performance over time. Large improvements can be expected during the first 15 AVBT cases performed with minimal differences in complications. Level of Evidence: Level III.

Objectives: The primary objective of this article was to examine literature from the last 10 years surrounding cardiovascular risks associated with NSAID use. Methods: A systematic search was developed to include randomized control trials and systematic review meta-analyses that focused on the cardiovascular effects associated with NSAID use. Results: The search and screen identified 10 articles published in the last 10 years to be included in the review. Discussion: The most common cardiovascular risks studied in the included literature were hemodynamic effects and myocardial infarction. The evidence in the included studies suggests that concerns of adverse hemodynamic effects may be overstated with short-term NSAID use. Myocardial infarction was shown to be a very serious, but rare, side effect associated with NSAID use. Practitioners should weigh this risk when using NSAIDs in patients with an increased risk of MI at baseline. Other included studies described risks of Kounis syndrome, QTc prolongation, and potential reversal of right ventricular dysfunction in patients using NSAIDs.

Background: Myxofibrosarcomas are notoriously highly infiltrative soft-tissue sarcomas, making negative surgical margins difficult to obtain. Recently, vacuum-assisted closure (VAC) is used to delay wound closure until a negative margin has been achieved; however, this can delay care and increase costs. Our institution has historically performed single-stage resections with intraoperative frozen margin analysis and reconstruction in these patients. The purpose of this study is to report the outcomes of this technique. Methods: We reviewed 112 patients (62 males, mean age 70 ± 14 years) with superficial myxofibrosarcoma. Eighty-eight patients received preoperative radiation. All patients underwent surgical resection with intraoperative frozen margin analysis, and the planned reconstruction was performed in a single anesthetic. Results: The 10-year local recurrence-free survival was 90%; positive intraoperative frozen section (HR 7.44, p = 0.004) and final permanent margins (HR 8.53, p = 0.007) were associated with local recurrence. Intraoperative margins were negative in 103 (92%) of patients, 1 of which was positive on final permanent section. There were nine cases of microscopically positive margins, of which seven underwent immediate re-excision to a negative margin. The accuracy of frozen margin assessment for myxofibrosarcoma was between 92.92 and 98.23%. All patients underwent reconstruction at the time of resection, with 19% needing an additional procedure, most commonly due to a wound complication (12%). Conclusions: Multidisciplinary single-stage excision with intraoperative frozen margin assessment and soft-tissue reconstruction yields low rates of local recurrence in patients with superficial myxofibrosarcoma.