Femoropopliteal disease comprises more than one half of lesions in peripheral vascular disease. The treatment modalities for stenosis or occlusion of this anatomic region include femoropopliteal bypass and percutaneous transluminal angioplasty with or without stenting. Our patient developed acute leg ischemia 3 years after stenting, secondary to stent fracture, with distal embolization of stent fragments. Using mechanical thromboembolectomy and superficial femoral artery to below-the-knee popliteal in situ saphenous vein bypass, we were able to restore perfusion to the limb and retrieve fragments of the fractured stent.

Abstract Large neural models have brought a new challenge to natural language generation (NLG): it has become imperative to ensure the safety and reliability of the output of models that generate freely. To this end, we present an evaluation framework, Attributable to Identified Sources (AIS), stipulating that NLG output pertaining to the external world is to be verified against an independent, provided source. We define AIS and a two-stage annotation pipeline for allowing annotators to evaluate model output according to annotation guidelines. We successfully validate this approach on generation datasets spanning three tasks (two conversational QA datasets, a summarization dataset, and a table-to-text dataset). We provide full annotation guidelines in the appendices and publicly release the annotated data at https://github.com/google-research-datasets/AIS.

To integrate patient-reported outcome measures (PROMs) and health care costs to compare the value achieved by watchful waiting (WW) versus physical therapy (PT) for the conservative management of adhesive capsulitis (frozen shoulder).

Leveraging time-driven activity-based costing (TDABC), this study aims to (1) quantify the cost of arthroscopic acetabular labral repair or debridement and (2) explore variation in costs based on patient-specific characteristics, operative techniques employed, and surgical settings.

By integrating postoperative patient-reported outcome measures (PROMs) with time-driven activity-based costing, this study aims to (1) quantify variations in the value of hip arthroscopy (HA) for acetabular labral repair and (2) explore patient-level characteristics (e.g., demographics, comorbidities, preoperative PROMs, and intraoperative variables) that may contribute to this variation.

Bexarotene, a drug approved for the treatment of cutaneous T-cell lymphoma (CTCL), is classified as a rexinoid due to its ability to act as a retinoid X receptor (RXR) agonist with high specificity. Rexinoids are capable of inducing RXR homodimerization leading to the induction of apoptosis and inhibition of proliferation in human cancers. Numerous studies have shown that bexarotene is effective in reducing viability and proliferation in CTCL cell lines. However, many treated patients present with cutaneous toxicity, hypothyroidism, and hyperlipidemia due to crossover activity with retinoic acid receptor (RAR), thyroid hormone receptor (TR), and liver X receptor (LXR) signaling, respectively. In this study, fourteen novel analogs were evaluated for their potential to bind RXR through modeling and then assayed in an RXR-RXR mammalian-2-hybrid (M2H) system and in RXRE-mediated luciferase reporter assays. In addition, these analogs were tested for their effectiveness to inhibit proliferation in CTCL cells relative to bexarotene. Furthermore, the most effective analogs were analyzed via qPCR to determine efficacy in modulating expression of two critical tumor suppressor genes, ATF3 and EGR3. Our results suggest that these new compounds possess similar or enhanced therapeutic potential as several of our novel rexinoids display more selective RXR activation with equivalent or greater reduction in CTCL cell proliferation, as well as the ability to induce ATF3 and EGR3. This work broadens our understanding of RXR-ligand relationships and permits development of more highly efficacious pharmaceutical drugs. Modifications of RXR agonists can yield agents with enhanced biological selectivity and potency when compared to the parent compound, potentially leading to improved patient outcomes. NCUIRE Undergraduate Research Program (ASU) & National Institutes of Health (NIH) CA140285 (to PWJ, CEW and PAM) This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Introduction: Metformin-associated lactic acidosis (MALA) is a well-known but rarely seen toxicity in patients. The build-up of serum lactate is attributed to an overdose of metformin or decreased renal clearance which increases the risk of lactic acidosis. Our case follows an initially stroke-like patient with rapidly declining mentation and severe acidosis. Description: A 64-year-old African American female with DM2 and atrial fibrillation on metformin 850 milligram twice daily, presented to the emergency room after her son noticed slurred speech and confusion with concomitant right sided facial droop and weakness. Workup for stroke was negative and the patient’s mental status rapidly deteriorated. She was intubated with a Glasgow coma scale of 5. Labs showed severe acute renal failure with uremia; blood urea nitrogen 104, creatinine 8.4 and anion gap 50. Her lactic acid levels were 17.6 initially and 20 on repeat. Postintubation arterial blood gas (ABG) showed pH of 6.68 and a bicarbonate of 1.3. She was given bicarbonate and started on a bicarbonate drip, receiving ~ 500 milliequivalent during her initial hours of resuscitation. ABG 3 hours later showed pH 7.003 and bicarbonate 5.7. She developed distributive shock and required 4 pressors. After 24 hours of continuous renal replacement therapy and aggressive resuscitation, her mean arterial pressure improved and ABG demonstrated pH 7.357 and bicarbonate 27.6. Additional history revealed the patient had been taking extra metformin. She continued to improve and was extubated within 48 hours, resolution of shock at 72 hours, and return of normal renal function. No other source of lactic acidosis was identified. Discussion: MALA is a rare life-threatening toxicity experienced in fewer than ten cases in 100,000 patient-years. While lab values of severe acidosis with pH < 6.9 and lactic acid levels >25 are alarming, they do not predict the prognosis of MALA. Current guidelines for MALA include intermittent hemodialysis or CRRT and bicarbonate infusion. This case illustrates the potentially fatal but rare side effect of MALA and the importance of rapidly correcting it. Recognition of this condition is critical for appropriate therapy and prevention of mortality.

Objective. To assess in pharmacy academicians the six domains of worklife (community, control, fairness, reward, workload, values) that have been associated with burnout and poor job satisfaction.Methods. We aimed to assess the Areas of Worklife Survey (AWS) among a sample of pharmacy academicians attending a national meeting to evaluate personal, environmental, or workplace factors that may influence the worklife environment. Data were analyzed using SPSS, descriptive statistics were identified, and Kruskal-Wallis and Pearson correlations were performed.Results. The participant response rate was 40% (n=49/121 attendees). Eighty-eight percent of participants reported working more than 40 hours per week. Mean AWS scores ranged from 2.7 to 3.9 (whereby 1 indicated a strong mismatch between person and work environment and 5 indicated a strong match). The workload and fairness domains had the lowest reported scores, whereas control had the highest. Higher mean scores were reported for control and reward in those with a mentor and for fairness in those having a hobby.Conclusion. Participants gave the lowest ratings to two worklife areas, workload and fairness. Developing targeted interventions, such as in mentorship, hobbies, and transparency in the work setting, may be important for preventing burnout in pharmacy academicians. Further studies in a larger population may help to determine factors associated with the areas of worklife that received low ratings.

We monitored the persistence of a remnant population of pronghorn (Antilocapra americana) near Hillside, AZ, over an 11-year period from May 2008 through December 21, 2019. Originally consisting of three bucks, two does, and one female yearling, the last pregnant doe was seen March 13, 2014, and the last fawn was seen on November 10, 2014. Only one buck was seen after June 17, 2014, and no males after July 7, 2018. The last pronghorn seen were three does on a follow-up survey April 3, 2021. Although the possibility exists of animals immigrating or emigrating from the 78 km2 study area, we did not document such behavior during our study. With no overt attempts at management the population doubled, before losing four animals following a May 2014 Palmer Drought Severity Index (PDSI) of -4.09. The persistence of this population through 2021 is attributed to low adult mortality and a greater recruitment of females than males. The low percentage of available habitat utilized suggests an adequate carrying capacity. The disappearance of this population is attributed to inbreeding depression and low recruitment due to genetic bottle-necking. The Hillside population was too small and too isolated to survive without periodic translocations. Although we frequently observed coyotes during our surveys, predation was not considered the principal factor in the population's demise.