Successful Aspiration Research Articles

"Come to us first": Centering Community Organizations in Artificial Intelligence for Social Good Partnerships

Artificial Intelligence for Social Good (AI4SG) has emerged as a growing body of research and practice exploring the potential of AI technologies to tackle social issues. This area emphasizes interdisciplinary partnerships with community organizations, such as non-profits and government agencies. However, amidst excitement about new advances in AI and their potential impact, the needs, expectations, and aspirations of these community organizations--and whether they are being met--are not well understood. Understanding these factors is important to ensure that the considerable efforts by AI teams and community organizations can actually achieve the positive social impact they strive for. Drawing on the Data Feminism framework, we explored the perspectives of community organization members on their partnerships with AI teams through 16 semi-structured interviews. Our study highlights the pervasive influence of funding agendas and the optimism surrounding AI's potential. Despite the significant intellectual contributions and labor provided by community organization members, their goals were frequently sidelined in favor of other stakeholders, including AI teams. While many community organization members expected tangible project deployment, only two out of 14 projects we studied reached the deployment stage. However, community organization members sustained their belief in the potential of the projects, still seeing diminished goals as valuable. To enhance the efficacy of future collaborations, our participants shared their aspirations for success, calling for co-leadership starting from the early stages of projects. We propose data co-liberation as a grounding principle for approaching AI4SG moving forward, positing that community organizations' co-leadership is essential for fostering more effective, sustainable, and ethical development of AI.

A Girlfriend Gaze on Romantic Feelings: Coconstructing Postfeminist Selfhood on Douban

This article discusses how postfeminism plays into the exchange of romantic relationship advice between young women on the Chinese social media platform Douban. Employing Fairclough’s approach to critical discourse analysis, we elucidate how the process of giving and receiving romantic relationship advice facilitates the construction of a normative, postfeminist selfhood specific to China’s post-socialist transition. Under postfeminist aspirations for independence, self-empowerment, and personal success, this selfhood is constructed in social-mediated communication to offer an instrumentalist assessment of romantic relationships. In doing so, young Chinese women repudiate each other’s lovesickness, pathologizing romantic desires to achieve a false sense of emotional stability and mental strength. This gives rise to a girlfriend gaze on women’s emotional changes, establishing a self-/peer surveillance mechanism that regulates how members of the Douban community engage each other on the platform. While masked with a veneer of female empowerment and sisterly help, this mode of self-/peer surveillance not only perpetuates the stereotypical association of women with emotionality and irrationality but also marginalizes public discussions on structural gender inequalities, undermining collective efforts to challenge the patriarchal status quo. The research findings shed light on the functioning of neoliberal governance in contemporary China in the context of social-mediated communication.

Biochemical analysis of soft tissue infectious fluids and its diagnostic value in necrotizing soft tissue infections: a 5-year cohort study

BackgroundNecrotizing soft tissue infections (NSTI) are rapidly progressing and life-threatening conditions that require prompt diagnosis. However, differentiating NSTI from other non-necrotizing skin and soft tissue infections (SSTIs) remains challenging. We aimed to evaluate the diagnostic value of the biochemical analysis of soft tissue infectious fluid in distinguishing NSTIs from non-necrotizing SSTIs.MethodsThis cohort study prospectively enrolled adult patients between May 2023 and April 2024, and retrospectively included patients from April 2019 to April 2023. Patients with a clinical suspicion of NSTI in the limbs who underwent successful ultrasound-guided aspiration to obtain soft tissue infectious fluid for biochemical analysis were evaluated and classified into the NSTI and non-necrotizing SSTI groups based on their final discharge diagnosis. Common extravascular body fluid (EBF) criteria were applied.ResultsOf the 72 patients who met the inclusion criteria, 10 patients with abscesses identified via ultrasound-guided aspiration were excluded. Based on discharge diagnoses, 39 and 23 patients were classified into the NSTI and non-necrotizing SSTI groups, respectively. Biochemical analysis revealed significantly higher albumin, lactate, lactate dehydrogenase (LDH), and total protein levels in the NSTI group than in the non-necrotizing SSTI group, and the NSTI group had significantly lower glucose levels and pH in soft tissue fluids.In the biochemical analysis, LDH demonstrated outstanding discrimination (area under the curve (AUC) = 0.955; p < 0.001) among the biochemical markers. Albumin (AUC = 0.884; p < 0.001), lactate (AUC = 0.891; p < 0.001), and total protein (AUC = 0.883; p < 0.001) levels also showed excellent discrimination. Glucose level (AUC = 0.774; p < 0.001) and pH (AUC = 0.780; p < 0.001) showed acceptable discrimination. When the EBF criteria were evaluated, the total scores of Light’s criteria (AUC = 0.925; p < 0.001), fluid-to-serum LDH ratio (AUC = 0.929; p < 0.001), and fluid-to-serum total protein ratio (AUC = 0.927; p < 0.001) demonstrated outstanding discrimination.ConclusionBiochemical analysis and EBF criteria demonstrated diagnostic performances ranging from acceptable to outstanding for NSTI when analyzing soft tissue infectious fluid. These findings provide valuable diagnostic insights into the recognition of NSTI. Further research is required to validate these findings.

Predictive value of joint fluid volume on advanced pre-procedure imaging related to success of arthrocentesis and presence of septic arthritis.

Septic arthritis is a dangerous medical condition requiring prompt diagnosis, often via arthrocentesis. A "dry tap" occurs when no fluid is aspirated. We hypothesized that the absence of a joint effusion on pre-procedure advanced imaging would reliably predict a dry tap and exclude septic arthritis. A cohort of 217 arthrocentesis cases of large joints (hips, shoulders, knees) from our institution, with pre-procedure advanced imaging (CT, MR, US) of the same joint performed within the previous 48h, was analyzed. Exclusion criteria included non-native joints or inadequate imaging of the affected joint. These cases underwent blinded review by 4 radiologists who measured the deepest pocket of joint fluid on the pre-procedure imaging. Wilcoxon rank-sum test was performed comparing joint fluid pocket size to outcomes of successful aspiration and final diagnosis. A smaller average joint pocket fluid size was present on advanced imaging in both dry taps compared with successful arthrocenteses (p < .0001), and in uninfected joints compared with septic joints (p = .0001). However, the overlap of values was too great to allow for a perfectly predictive cutoff. 29% (5/17) of patients with no visible joint fluid on pre-aspiration imaging underwent successful arthrocentesis, one case representing septic arthritis. Volume of joint fluid on advanced pre-arthrocentesis imaging cannot reliably predict subsequent dry tap nor exclude septic arthritis.

Successful aspiration thrombectomy of an 80-mm-long thrombus using a guide extension catheter in a patient with ST-elevation acute myocardial infarction.

Successful aspiration thrombectomy of an 80-mm-long thrombus using a guide extension catheter in a patient with ST-elevation acute myocardial infarction.

Poster 229: Intra-articular VEGF and MMP-1 Are the Primary Drivers of Worse Baseline KOOS Symptoms and Quality of Life Subscores at Time of Knee Chondroplasty

Objectives: Biomarkers are a topic of interest in orthopaedics in the setting of osteoarthritis and patients undergoing knee arthroscopy for any reason. However, in patients undergoing knee arthroscopy for chondral defects, the influence of cytokines on patient pain and function is not fully understood. The purpose of this study is to investigate the concentrations of synovial inflammatory cytokines in patients undergoing arthroscopic chondroplasty for chondral defects in the knee and correlate those cytokine levels with baseline patient reported outcome measures (PROs) and defect characteristics. We hypothesized that the synovial cytokine environment will correlate with patient symptoms more so than baseline defect characteristics. Methods: Sixty patients 18-50 years old undergoing arthroscopic chondroplasty for knee cartilage defects were enrolled. Patients were assigned preoperative Knee injury and Osteoarthritis Outcome Score (KOOS) and International Knee International Knee Documentation Committee (IKDC) Subjective Knee Forms. Preoperative magnetic resonance images were used to calculate AMADEUS (Area Measurement And Depth Underlying Structure) scores. All patients received a successful synovial fluid aspiration just prior to initiation the arthroscopic procedure. The number of defects, total defect area, and ICRS grades were recorded based on intraoperative assessment. Patients with concomitant procedures beyond partial meniscectomy were excluded. Multiplex ELISA analyzed aspirations for: PDGF-BB, CCL-5/RANTES, MMP-3, MMP-1, EGF, VEGF, IL-1a, FGF-2, CCL-2, BMP-2, and aggrecan. Univariate correlation testing was used to assess significance between cartilage defect characteristics, PROs, and cytokine concentrations (Figure 1). The Akaike Information Criterion (AIC) was utilized to select the best-fit multivariate regression model using the 4 most significant independent variables for each cytokine (Figure 2). AIC best-fit modeling was repeated for each PRO that had at least two significant cytokine associations on univariate testing (Figure 3). Significance was set at P&lt;0.05. Results: MMP-1 had a positive correlation with number of defects treated ( P=0.016) and negative correlation with KOOS quality of life (QOL) subscores ( P=0.035; R2 =0.173). VEGF was positively correlated with defects treated ( P=0.005) and negatively correlated with KOOS Symptoms scores ( P=0.035; R2 =0.225). The treatment of multiple defects was an independent predictor of elevated IL-1a ( P=0.002, R2 =0.202). CCL-2 was positively correlated with multiple defects ( P=0.012) and negatively with KOOS QOL ( P=0.016, R2 =0.173). Female sex was correlated with higher concentrations of MMP-3 ( P=0.007, R2 =0.144), FGF ( P=0.012, R2 =0.178), and BMP-2 ( P=0.008; R2 = 0.169). BMP-2 was negatively correlated with KOOS Symptom ( P=0.019). The primary driver of preoperative KOOS Symptoms scores on multivariate analysis was VEGF ( P=0.023, R2 =0.120), influencing patient symptoms beyond defect characteristics. Similarly, KOOS QOL was independently correlated with MMP-1 concentration ( P= 0.045, R2 =0.079), more so than ICRS grade (Figure 3). Conclusions: Multivariate regression analysis revealed that elevated MMP-1 was the primary driver of worse preoperative KOOS QOL scores, more so than defect characteristics such as the number of lesions treated. Similarly, worse preoperative KOOS Symptoms scores were more strongly correlated with elevated VEGF concentrations rather than defect ICRS grades. Our study demonstrated that synovial fluid cytokines appear to be the primary drivers of patients’ subjective assessments of their pain and function preoperatively.

An animal as a cultural landscape: the horse in Seoul, South Korea

ABSTRACT The horse holds a special place in Korean culture and history. This paper explores how this animal is manifested in Seoul, aiming to reveal the interests and agendas that these manifestations serve, and what this nonhuman presence can tell about contemporary Seoul and South Korea. The paper adds a new perspective to the literature on Seoul’s development and identity formation. It also provides a case study on the interaction between humans and nonhuman-animals. Lastly, it intervenes into cultural landscape theory by offering the concept of ‘collaged cultural landscape’. It is argued that, the multilayered presence of the horse in Seoul represents South Korean aspirations for economic success, positive branding, and post-colonial strength, confidence, and legitimacy, by conveying a wide range of images, including beauty, cuteness, vigor, and valor. Furthermore, there is no other animal in Seoul, and perhaps in all of South Korea, that matches the horse’s complex presence.

Saddle Pulmonary Embolus Treated With Bilateral Emergent Aspiration Pulmonary Thrombectomy

A 77 year old man with recurrent lower extremity thrombosis presented with acute onset shortness of breath and new onset hypoxemia three days after prostatectomy for adenocarcinoma of the prostate. He had been off anticoagulation during the perioperative period. In addition to his new diagnosis of prostate cancer he also had a remote history of treated non-invasive melanoma. Based on this presentation he was at high risk of developing thromboembolic disease. Computed tomography angiogram (CTA) of his chest confirmed a large saddle pulmonary embolus, echocardiogram was positive for new right ventricular wall motion dyskinesis and lower extremity ultrasound revealed bilateral acute and chronic deep vein thrombosis. Given his high bleeding risk, hypoxia and elevated troponin I, he underwent emergent successful aspiration pulmonary thrombectomy. This case is of interest to hospitalists and intesivists as it provides an overview of the current invasive management of pulmonary embolus in the acute setting when systemic anticoagulation is contraindicated. Emergent Aspiration Pulmonary Thrombectomy can restore pulmonary artery flow and cardiopulmonary hemodynamics. A collaborative team based approach that involves the emergency department, intensive care unit, interventional teams and hospitalists is favored.

A “Dry Tap” in Prosthetic Joint Infection Workup of Total Hip Arthroplasty Is Not Reassuring

BackgroundSynovial fluid analysis is important in diagnosing prosthetic joint infection (PJI). The rate of culture-positive PJI in patients who have a dry tap of a total hip arthroplasty (THA) is not well described. MethodsWe reviewed all image-guided THA aspirations, performed from 2014 to 2021 at a single academic institution. Aspirations were categorized as successful (≥ 0.5 mL) or unsuccessful (< 0.5 mL, “dry tap”). We analyzed culture data on all repeat aspirations and revision surgeries performed within 90 days of the initial dry tap. ResultsWe reviewed 275 consecutive attempted THA aspirations of which 100 (36.4%) resulted in a dry tap. The dry tap cohort had a significantly higher percentage of fluoroscopic-guided aspirations (64%) and fewer ultrasound-guided aspirations (36%) compared to the successful aspiration cohort (48.9% fluoroscopic, 53.1% ultrasound, P = .0061). Of the 100 patients who have dry taps, 48 underwent revision surgery within 90 days of the initial dry tap, and 15 resulted in 2 or more positive cultures. The rate of PJI defined by MusculoSkeletal Infection Society major criteria in the dry tap cohort was 16.0%. ConclusionsAttempted aspiration of a THA resulted in a dry tap 36.4% of the time. Of those patients who had a dry tap, 16.0% were subsequently found to have PJI based on MusculoSkeletal Infection Society major criteria. Therefore, a “dry tap” does not exclude the diagnosis of infection and should not be considered reassuring for the absence of PJI.

(324) History of Priapism Treatment in the 20th Century

Abstract Introduction Priapism, defined as a prolonged erection in the absence of sexual arousal, leads to decreased quality of life, physical health, and increased erectile dysfunction. The modern priapism treatments of vasoconstriction and cavernous aspiration stem from strides made throughout the last century. Objective As a result, we seek to chronicle the history of priapism treatment throughout the 20th century. Methods We reviewed over two dozen academic articles and medical textbooks from 1872 to 1990 with relevant information on priapism treatment. Results In the 19th century, treatment of priapism solely involved symptomatic management with morphine and medicinal leeches. In 1928, Dr. Robert McKay and Dr. John Colston discovered that a thrombotic condition is sufficient to sustain an erection and that removing clots from the penis is sufficient to alleviate the erection. They recommended the newly-discovered anticoagulant heparin as a potential remedy. Dr. Rita Franklin then established in 1940 a positive association between testosterone propionate levels and priapism in eunuchoid men. Priapism therapies improved exponentially beginning in the late 1950s. Dr. H. Stephen Brody conducted the first successful penile aspiration in 1957 by aspirating blood from the base of each corpus cavernosum in a hypotensive patient. This groundbreaking procedure is conducted to this day for patients who do not respond effectively to medication management. Nine years after Dr. Brody’s study in 1966, Dr. Robert Garrett and Dr. Donald Rhamy reported penile flaccidity and sexual satisfaction in five patients who underwent a corpus-saphenous shunt to improve venous drainage. In 1997, Dr. Pierre Bondil and colleagues conducted a novel experiment demonstrating the efficacy of vasoconstrictive alpha agonist agents in decreasing penile blood flow to decrease erections and preserve erectile function. Conclusions The last one hundred years has shown significant innovation in the treatment of priapism. Some of the major developments in the first half of the 20th century included the use of heparin and the establishment of a relationship between testosterone and priapism. The second half of the 20th included treatment still in use today, such as carvenoglandular shunts and vasoconstrictive agents. Therapies from the 20th century will continue to play a vital role in the treatment and research of priapism management. Disclosure No.

A case report on ultrasound-guided pericardiocentesis with a right parasternal approach: a novel in-plane lateral-to-medial technique

IntroductionEmergency pericardiocentesis is a life-saving procedure that is performed to aspirate fluid from the pericardial space in patients who have severe pericardial effusion that is causing hemodynamic compromise. The current gold standard for pericardial fluid aspiration is ultrasound-guided pericardiocentesis. Echocardiography with a low-frequency transducer has generally been used in pericardiocentesis, but this method lacks real-time visualization of the needle trajectory, leading to complications. Therefore, we describe a case involving an ultrasound-guided pericardiocentesis method using a novel in-plane technique with a lateral-to-medial approach via the right parasternal and a high-frequency probe. The method was performed for an infant with cardiac tamponade.Case presentationWe present a case of a 14-month-old male infant who was brought to the emergency room with a history of cough, shortness of breath, and fever following recurrent chest infections. Despite prior treatments, his condition deteriorated, and signs of cardiac tamponade were evident upon examination. Cardiopulmonary point-of-care ultrasound confirmed the presence of a large pericardial effusion with tamponade. Emergency pericardiocentesis was performed using the novel in-plane technique, resulting in successful fluid aspiration and stabilization of the patient’s condition.Technique descriptionThe proposed technique involves positioning a high-frequency ultrasound probe over the right parasternal area to obtain real-time visualization of the needle trajectory and surrounding structures, including the sternum, right internal thoracic vessels, pleural sliding end point, pericardial effusion, and myocardium. The needle is inserted laterally to medially at a 45-degree angle, ensuring safe passage between the pleural sliding endpoint and the right internal thoracic vessels while reaching the pericardial effusion.ConclusionThe presented technique provides real-time visualization of the needle and surrounding structures, which may potentially help to avoid complications and improve accuracy. The proposed technique may potentially enable access for emergency pericardiocentesis and for loculated pericardial effusion that has formed around the right atrium. Nevertheless, further studies with large patient populations are needed.

Intra-articular VEGF and MMP-1 are the Primary Drivers of Worse Baseline KOOS Symptoms and Quality of Life Subscores at Time of Knee Chondroplasty

Objectives: Biomarkers are a topic of interest in orthopaedics in the setting of osteoarthritis and patients undergoing knee arthroscopy for any reason. However, in patients undergoing knee arthroscopy for chondral defects, the influence of cytokines on patient pain and function is not fully understood. The purpose of this study is to investigate the concentrations of synovial inflammatory cytokines in patients undergoing arthroscopic chondroplasty for chondral defects in the knee and correlate those cytokine levels with baseline patient reported outcome measures (PRO’s) and defect characteristics. We hypothesized that the synovial cytokine environment will correlate with patient symptoms more so than baseline defect characteristics. Methods: Sixty patients 18-50 years old undergoing arthroscopic chondroplasty for knee cartilage defects were enrolled. Patients were assigned preoperative Knee injury and Osteoarthritis Outcome Score (KOOS) and International Knee International Knee Documentation Committee (IKDC) Subjective Knee Forms. Preoperative magnetic resonance images were used to calculate AMADEUS (Area Measurement And Depth Underlying Structure) scores.1 All patients received a successful synovial fluid aspiration just prior to initiation the arthroscopic procedure. The number of defects, total defect area, and ICRS grades were recorded based on intraoperative assessment. Patients with concomitant procedures beyond partial meniscectomy were excluded. Multiplex ELISA analyzed aspirations for: PDGF-BB, CCL-5/RANTES, MMP-3, MMP-1, EGF, VEGF, IL-1a, FGF-2, CCL-2, BMP-2, and aggrecan. Univariate correlation testing was used to assess significance between cartilage defect characteristics, PROs, and cytokine concentrations (Figure 1). The Akaike Information Criterion (AIC) was utilized to select the best-fit multivariate regression model using the 4 most significant independent variables for each cytokine (Figure 2). AIC best-fit modeling was repeated for each PRO that had at least two significant cytokine associations on univariate testing (Figure 3). Significance was set at P&lt;0.05. Results: MMP-1 had a positive correlation with number of defects treated (P=0.016) and negative correlation with KOOS quality of life (QOL) subscores (P=0.035; R2 =0.173). VEGF was positively correlated with defects treated (P=0.005) and negatively correlated with KOOS Symptoms scores (P=0.035; R2 =0.225). The treatment of multiple defects was an independent predictor of elevated IL-1a (P=0.002, R2 =0.202). CCL-2 was positively correlated with multiple defects (P=0.012) and negatively with KOOS QOL (P=0.016, R2 =0.173). Female sex was correlated with higher concentrations of MMP-3 (P=0.007, R2 =0.144), FGF (P=0.012, R2 =0.178), and BMP-2 (P=0.008; R2 = 0.169). BMP-2 was negatively correlated with KOOS Symptom (P=0.019). The primary driver of preoperative KOOS Symptoms scores on multivariate analysis was VEGF (P=0.023, R2 =0.120), influencing patient symptoms beyond defect characteristics. Similarly, KOOS QOL was independently correlated with MMP-1 concentration (P= 0.045, R2 =0.079), more so than ICRS grade (Figure 3). Conclusions: Multivariate regression analysis revealed that elevated MMP-1 was the primary driver of worse preoperative KOOS QOL scores, more so than defect characteristics such as the number of lesions treated. Similarly, worse preoperative KOOS Symptoms scores were more strongly correlated with elevated VEGF concentrations rather than defect ICRS grades. Our study demonstrated that synovial fluid cytokines appear to be the primary drivers of patients’ subjective assessments of their pain and function preoperatively.

“Upgrade yourself for 10 days” programme as a modernisation stage of the consciousness of Kazakh adolescents

Relevance. The relevance of the research in this article is due to the problem of improving the competitiveness of the younger Kazakh generation, through the revival of their spiritual values based on consciousness modernisation. Purpose. The aim of the article is to develop a model program of consciousness modernisation for personal growth forming moral and value orientations of teenagers, which will contribute to their competitiveness. Methodology. Leading methods for the study of this problem include testing on the development of O. I. Motkov “Psychological culture of personality” and the survey by T. Ehlers “Study of motivation to succeed”, which together allow one to determine the internal drive within the value orientations and criteria of personal aspirations for success in their lives in the performance of any action, or, in general, as the goal determining factor. Results. The article presents the developed model of formation of value internal aspirations in indicative personal characteristics which promote aspiration of the person to reveal the skills and talents based on a set of moral values which allow teenagers to become competitive experts in various areas that represents the programme “Upgrade yourself for 10 days” based on psychological training, as part of giving answers to motivational questions, which allow forming necessary internal completion through the development of their own talents that increase self-confidence and self-esteem. Conclusions. The completion of the training program ensures the successful modernisation of the creation based on the awareness of important and target settings for success with the preservation of the internal moral position in achieving success for personal purposes, which in general has an educational function of cultural and successful personality, thus bearing practical significance for the field of the educational and pedagogical sphere.

Feasibility demonstration of a device for vitreous liquid biopsy incidental to intravitreal injection.

VitreoDx is an experimental device enabling push-button collection of a neat vitreous liquid biopsy incidental to an intravitreal injection. We explored the ability of the device to collect a sample usable for proteomic biomarker discovery and testing. Pilot study using ex vivo human eyes. Non-vitrectomized, human eyes from nine donors 75-91 years of age were refrigerated in BSS and used within 5 days of death. Four VitreoDx devices fitted with 25G needles, and four staked needle insulin syringes with 30G needles, were inserted at equal intervals through the pars plana of each eye and held in place by a fixture. The sampling mode of each VitreoDx device was triggered to attempt to acquire a liquid biopsy up to 70 μL. The plunger of each insulin syringe was retracted to attempt to obtain a liquid biopsy with a maximum volume of 50 μL. Samples acquired with the VitreoDx were extracted to polypropylene cryovials, refrigerated to -80 ºC, and sent for offsite proteomic analysis by proximity extension assay with a focus on panels containing approved and pipelined drug targets for neovascular disease and inflammatory factors. Of the attempted liquid biopsies with the novel 25G VitreoDx, 92% (66 of 72) resulted in successful acquisition (>25 μL) while 89% (64 of 72) attempted by a traditional 30G needle resulted in a successful acquisition. Sample volume sufficient for proteomics array analysis was acquired by the VitreoDx for every eye. Detectable protein was found for 151 of 166 unique proteins assayed in at least 25% of eyes sampled by VitreoDx. The high acquisition rate achieved by the prototype was similar to that achieved in previous clinical studies where a standard syringe was used with a 25G needle to biopsy vitreous fluid directly prior to standard intravitreal injection. Successful aspiration rates were likewise high for 30G needles. Together, these suggest that it is possible to routinely acquire liquid vitreous biopsies from patients who typically receive intravitreal injections with an injection device using a standard size needle without a vitreous cutter. Protein analysis shows that proteins of interest survive the sampling mechanism and may have potential to direct care in the future.

Aristotle‐Only Direct Aspiration First‐Pass Technique (AO‐ADAPT) for Endovascular Mechanical Thrombectomy: A Technical Series of a Novel Technique Demonstrating Safety and Efficacy

Background The introduction of soft, large‐profile microwires has improved aspiration catheter delivery for intracranial large‐vessel occlusions. The Aristotle‐only direct aspiration first‐pass technique (AO‐ADAPT) uses the Aristotle 24 microwire to deliver a large‐bore aspiration catheter to the target occlusion without a microcatheter. We characterized rates of technical success achieved using this technique for mechanical aspiration thrombectomy. Methods A retrospective review of prospectively collected thrombectomy databases at 4 academic institutions identified patients undergoing procedures in which AO‐ADAPT was used. Patient demographics, clinical considerations, technical details, and radiographic outcomes were collected. Rates of successful aspiration catheter delivery without adjunctive devices and of successful reperfusion (Thrombolysis in Cerebral Infarction≥2B) were collected. Results Forty‐five patients met inclusion criteria (mean age 72.2±13.2 years, 62.2% female; 71.1% M1 occlusions). With a first‐line AO‐ADAPT approach, 42/45 (93.3%) patients achieved Thrombolysis in Cerebral Infarction≥2B reperfusion, with first‐pass recanalization in 26/45 (57.8%). We delivered the aspiration catheter to the target occlusion without adjunctive device in 35/45 (77.8%) patients. Of these, 29 (82.9%) underwent successful contact aspiration. This entire cohort (64.4% of the population) achieved Thrombolysis in Cerebral Infarction≥2B, with a mean time to reperfusion of 16 minutes and a first‐pass recanalization rate of 66%. Of the 16 patients who did not achieve successful AO‐ADAPT reperfusion, 6 needed a microcatheter for aspiration catheter delivery but underwent successful contact aspiration, 6 achieved microcatheter‐free delivery but needed a stentriever for final recanalization, and 4 required both microcatheter for delivery and stentriever for final recanalization. No intracranial vascular complications occurred during the procedures; 1 patient (2.2%) experienced symptomatic intracranial hemorrhage secondary to reperfusion injury. Conclusion The AO‐ADAPT approach to mechanical thrombectomy safely and effectively achieved reperfusion for patients with large‐vessel occlusions, with first‐pass success and successful recanalization rates comparable with other techniques. For most cases in this series, this technique obviated the need for a microcatheter and/or stentriever.

Looking Cool, Doing Tricks, Managing Stress, and Nicotine Addiction: Youth Perspectives on Nicotine Vaping and Implications for Prevention.

To understand the contextual and psychosocial factors associated with youth vaping in Colorado, the state with the highest youth vaping rates in 2019, and to propose strategies for prevention interventions. Focus groups. In-person. 24 youth aged 11-17, including youth who had vaped (n = 11) and who had never vaped (n = 13). Qualitative responses using a semi-structured focus group guide were analyzed using a matrix approach with a mixed deductive/inductive content analysis. Analysis revealed the highly social nature of vaping initiation and use; the use of vaping to control negative emotions; and the acquisition of vaping products through retail outlets, friends, family, and other youth who sell a variety of substances and devices to youth. Youth provided insight into how vaping is concealed from parents and teachers, and their attitudes about the health risks and benefits of vaping. When considered with other studies, our findings suggest a universality in the youth vaping experience that is highly social. Interventions should include peer-to-peer messaging with an emphasis on changing social norms and highlighting undesirable outcomes of vaping such as negative reactions by friends and close adults, adverse effects on athletic success and future aspirations, expense, addiction, and punishment. Parent education is also recommended. Rigorous research is needed to test interventions to reverse the growing trend of youth vaping.

"The Secret" to Success? The Psychology of Belief in Manifestation.

We explored the psychology of those who believe in manifestation: the ability to cosmically attract success in life through positive self-talk, visualization, and symbolic actions (e.g., acting as if something is true). In three studies (collective N = 1,023), we developed a reliable and valid measure-the Manifestation Scale-and found over one third of participants endorsed manifestation beliefs. Those who scored higher on the scale perceived themselves as more successful, had stronger aspirations for success, and believed they were more likely to achieve future success. They were also more likely to be drawn to risky investments, have experienced bankruptcy, and to believe they could achieve an unlikely level of success more quickly. We discuss the potential positives and negatives of this belief system in the context of growing public desire for success and an industry that capitalizes on these desires.

Poster 238: Early Postoperative Increase of IL-1a in Synovial Fluid Correlates with Worse Short-Term Patient-Reported Outcomes after Cartilage Transplantation in the Knee

Objectives: The purpose of this study was to determine the longitudinal concentrations of several synovial fluid biomarkers after cartilage transplantation and potential correlations with patient reported outcomes. Methods: After institutional IRB approval, patients undergoing osteochondral allograft (OCA) transplantation or autochondrocyte implantation (ACI) were consented and enrolled into a prospective study involving intraoperative synovial fluid aspiration of the operative knee, as well as postoperative aspirations of the operative knee at standardized clinic follow-up timepoints: 2 weeks, 6 weeks, 6 months, and 1 year postoperatively. For this analysis, patients undergoing cartilage transplantation (OCA or ACI) with preoperative aspiration and at least one successful postoperative aspiration were included. Exclusion criteria for aspirations from the analysis included subsequent surgical procedure or articular injections on the index knee within 1 year of the transplant. The synovial fluid samples were analyzed for the following inflammatory biomarkers with Multiplex ELISA: CCL5, MMP-1, EGF, VEGF, IL1a, FGF2, CCL2, BMP2, and Aggrecan (ACAN). The samples were digested 1:1 with 3mg/mL hyaluronidase prior to execution of the assay in accordance with the manufacturer’s protocol. A minimum of 3uL was required for analysis. Patients prospectively completed Knee Injury and Osteoarthritis Outcome Score (KOOS), including Activities of Daily Living (ADL), Pain, Quality of Life (QoL), Sports, Symptoms, and Joint Replacement (JR) subscores, preoperatively and at 6 months and 1 year postoperatively. All statistical analyses were performed on RStudio and STATA. Non-parametric tests were utilized to avoid assumptions of normality. Skillings-Mack tests were utilized as a non-parametric alternative for a repeated-measures ANOVA in the setting of sporadic missing values (i.e., dry aspirations). Post-hoc pairwise Wilcoxon ranksum tests with Bonferroni corrections for multiple comparisons were performed for significant tests. Univariate linear regressions were performed to determine correlations between cytokine changes and patient-reported outcomes. A minimum of 10 observations per predictor was considered sufficient for the analysis. All testing was two-sided, and significance was set at p&lt;0.05. Results: A total of 63 aspirations from 19 patients were evaluated. Postoperatively, successful aspirations were able to be performed on 13 patients at 2 weeks (68%), 17 patients at 6 weeks (89%), 9 patients at 6 months (47%), and 5 patients at 1 year (26%) (Table 1). One patient underwent a subsequent procedure on the index knee (lysis of adhesions) 10 weeks after cartilage transplantation, thereby excluding their 6 month and 1-year aspirations from analysis. Across all timepoints, there were significant differences in MMP-1 (p=0.003), ACAN (p&lt;0.001), and FGF2 (p=0.026). Specifically, ACAN was significantly elevated at 2 (p&lt;0.001) and 6 weeks (p&lt;0.001), and MMP- 1 was the greatest at 6 weeks relative to transplant (p&lt;0.001), 6 months (p=0.01), and 1 year (p=0.04). In contrast, FGF2 was significantly lower at 2 weeks compared to transplant levels (p=0.02). There were no significant differences across timepoints for CCL5 (p=0.88), VEGF (p=0.068), CCL2 (p=0.071), BMP2 (p=0.067), IL-1a (p=0.13), or EGF (p=0.01, p&gt;0.05 for all pairwise comparisons after Bonferroni correction) (Figure 1). A subanalysis was performed for cytokines which demonstrated at least 5 “pro-inflammatory” responses (positive fold-change) and at least 5 “anti-inflammatory” responses (negative fold-change), with a minimum of 10 observations with associated patient-reported outcomes at 6 and/or 12 months postoperatively. From the 2-week aspiration samples, CCL5 (5 increase/7 decrease), IL-1a (5/7), and CCL2 (6/7) met the inclusion criteria. Increase in IL-1a demonstrated significant linear associations with worse postoperative KOOS ADL (p=0.048), Pain (p=0.01), Quality of Life (p=0.01), and Symptoms (p=0.01) scores at 6 months (Table 2, Figure 2). Similarly, an increase in CCL-2 postoperatively was associated with worse KOOS ADL (p=0.04) and Pain (p=0.04) scores at 6 months. No significant linear associations between cytokine changes at 6 weeks and later PROMs were identified. Conclusions: Following cartilage transplantation of the knee, the synovial fluid profile may demonstrate early postoperative increases in MMP-1 and ACAN and a decrease in FGF-2. An early pro-inflammatory response with IL-1a within the first two postoperative weeks may be linearly associated with worse short-term patient-reported outcomes compared to an early decrease. [Table: see text] [Table: see text]

Manual aspiration of a pneumothorax after CT-guided lung biopsy: outcomes and risk factors.

Quantify the outcomes following pneumothorax aspiration and influence upon chest drain insertion. This was a retrospective cohort study of patients who underwent aspiration for the treatment of a pneumothorax following a CT percutaneous transthoracic lung biopsy (CT-PTLB) from January 1, 2010 to October 1, 2020 at a tertiary center. Patient, lesion and procedural factors associated with chest drain insertion were assessed with univariate and multivariate analyses. A total of 102 patients underwent aspiration for a pneumothorax following CT-PTLB. Overall, 81 patients (79.4%) had a successful pneumothorax aspiration and were discharged home on the same day. In 21 patients (20.6%), the pneumothorax continued to increase post-aspiration and required chest drain insertion with hospital admission. Significant risk factors requiring chest drain insertion included upper/middle lobe biopsy location [odds ratio (OR) 6.46; 95% CI 1.77-23.65, p = 0.003], supine biopsy position (OR 7.06; 95% CI 2.24-22.21, p < 0.001), emphysema (OR 3.13; 95% CI 1.10-8.87, p = 0.028), greater needle depth ≥2 cm (OR 4.00; 95% CI 1.44-11.07, p = 0.005) and a larger pneumothorax (axial depth ≥3 cm) (OR 16.00; 95% CI 4.76-53.83, p < 0.001). On multivariate analysis, larger pneumothorax size and supine position during biopsy remained significant for chest drain insertion. Aspiration of a larger pneumothorax (radial depths ≥3 cm and ≥4 cm) had a 50% rate of success. Aspiration of a smaller pneumothorax (radial depth 2-3 cm and <2 cm) had an 82.6% and 100% rate of success, respectively. Aspiration of pneumothorax after CT-PTLB can help reduce chest drain insertion in approximately 50% of patients with larger pneumothoraces and even more so with smaller pneumothoraces (>80%). Aspiration of pneumothoraces up to 3 cm was often associated with avoiding chest drain insertion and allowing for earlier discharge.

Clinical examination, ultrasound assessment and aspiration of knee effusion in primary knee osteoarthritis patients

BackgroundTo assess the diagnostic performance of clinical examination and ultrasound (US) assessment of knee effusion in primary knee osteoarthritis (KOA) patients. Furthermore, the success rate for effusion aspiration and the factors related to it were investigated.MethodsThis cross-sectional study included patients diagnosed with primary KOA-induced knee effusion clinically or sonographically. The affected knee of each patient was subjected to clinical examination and US assessment using the ZAGAZIG effusion and synovitis ultrasonographic score. Patients with confirmed effusion and consented to aspiration were prepared for direct US-guided aspiration under complete aseptic techniques.ResultsOne hundred and nine knees were examined. During visual inspection, swelling was detected in 80.7% of knees and effusion was confirmed by US in 67.8% of knees. Visual inspection was the most sensitive at 90.54% while bulge sign was the most specific at 65.71%. Only 48 patients (61 knees) consented to aspiration procedure; 47.5% had grade III effusion, and 45.9% had grade III synovitis. Successful aspiration was achieved in 77% of knees. Two needle types were used; a 22 gauge / 3.5-inch spinal needle in 44 knees and an 18 gauge/ 1.5-inch needle in 17 knees, with a success rate of 90.9% and 41.2%, respectively. Aspirated amount of synovial fluid correlated positively with effusion grade (rs=0.455, p < 0.001) and negatively with synovitis grade on US (rs = − 0.329, p = 0.01).ConclusionsThe superiority of the US over clinical examination in detecting knee effusion suggests that US should be used routinely to confirm the presence of effusion. Long needles (spinal needle) may have a higher success rate of aspiration than shorter needles.