Image Download Research Articles

Feasibility of Remote Wound Care: A Pilot Study Implementing a Patient-centered Remote Wound Monitoring System Using a Smartphone Application

Regular clinical assessment is critical to optimize lower extremity wound healing. However, social, transportation, and time barriers often limit patient follow-up. We aimed to assess the feasibility of using a novel, patient-centered, remote wound monitoring application (Healthy.io Minuteful for Wound smartphone “app”) for the surveillance of lower extremity wounds. We enrolled 25 patients who presented to our outpatient multidisciplinary clinic with a lower extremity wound related to peripheral artery disease and/or diabetes. All patients underwent definitive revascularization and podiatric interventions prior to enrollment. Patients and their caregivers were instructed on wound app use and asked to perform one at-home wound scan per week for a total of 8 weeks (Fig 1). Patient engagement, wound app useability, and patient and provider satisfaction with the app were collected prospectively and reported using descriptive statistics. Twenty-five patients (mean age, 65.5 ± 13.7 years, 60.0% male, 52.0% Black, 68.0% with diabetes) were enrolled over the course of 3 months. Mean baseline wound area was 18.0 ± 15.2 cm2, 24.0% of patients were recovering from osteomyelitis, and post-surgical Wound, Ischemia, foot Infection stage was 1 in 24.0%, 2 in 40.0 %, 3 in 28.0%, and 4 in 8.00% of patients. Twenty-eight percent of patients required a borrowed smartphone, and wound scans were obtained by both patients (40.0%) and caregivers (60.0%). The mean number of wound scans acquired per patient was 0.72 ± 0.63 per week, for a total mean of 5.80 ± 5.30 scans over the course of 8 weeks. Wound app use triggered an early change in wound management for 36.0% of patients. Ninety-four percent of patients and physicians involved in the study reported the app was useful (Fig 2). The Healthy.io Minuteful for Wound app is a feasible means of remote wound monitoring for use by patients and/or their caregivers. This study is the impetus for a new randomized controlled trial investigating the efficacy of wound healing with remote wound app monitoring vs standard in-person clinic visits for the treatment of lower extremity wounds, in which we hope to show the barriers that often interfere with in-person follow-up visits will no longer interfere with proper wound care.Fig 2Post-study patient survey results documenting perceived ease of use, patient empowerment, and overall usefulness of the Healthy.io Minuteful for smartphone app.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Association of Race and Neighborhood Socioeconomic Disadvantage with Incident Peripheral Artery Disease and Chronic Limb-threatening Ischemia

There are disparities in peripheral artery disease (PAD) outcomes according to both race and socioeconomic disadvantage separately. However, few studies have investigated the association of race and socioeconomic deprivation together with risk of PAD. We aimed to investigate the association of race and socioeconomic disadvantage with risk of incident PAD and incident chronic limb-threatening ischemia (CLTI). We included all non-Hispanic white and non-Hispanic Black adults in the Maryland Health Services Cost Review Commission from January 2013 through December 2019 without prevalent PAD or CLTI at their index visit. PAD and CLTI were defined by inpatient and outpatient diagnosis codes. Socioeconomic disadvantage was determined by the area deprivation index (ADI), a comprehensive measure of socioeconomic deprivation, using nine-digit zip codes. Patients living in neighborhoods with greater socioeconomic deprivation (ADI 3 and 4) were categorized as high ADI, while patients living in neighborhoods with lower socioeconomic deprivation (ADI 1 and 2) were categorized as low ADI. We estimated the cumulative incidence of PAD and CLTI and quantified hazard ratios (HR) using multivariable Cox proportional hazards models across four race and ADI groups after correcting for traditional demographic and cardiovascular risk factors. A total of 5,592,650 adult patients without PAD or CLTI at baseline (51.6% ≥65 years of age, 37.9% Black, 31.2% with high ADI) were followed for a median of 10.71 years (interquartile range, 5-31 years). The overall cumulative incidence of PAD and CLTI was 22% and 6%, respectively, and varied significantly by race and ADI (Figs 1 and 2). After adjusting for baseline differences between groups, the risk of incident PAD was highest for the Black-high ADI group (hazard ratio [HR], 1.40; 95% confidence interval [CI], 1.38-1.43), followed by White-high ADI (HR, 1.22; 95% CI, 1.20-1.24) and Black-low ADI (HR, 1.00; 95% CI, 0.99- 1.01) compared to White-low ADI (Table). Similarly, the risk of incident CLTI was highest for the Black-high ADI group (HR, 1.52; 95% CI, 1.48-1.57), followed by White-high ADI (HR, 1.38; 95% CI, 1.33-1.42), then Black-low ADI (HR, 1.14; 95% CI, 1.11-1.17) compared to White-low ADI. Previously reported racial differences in risk of PAD and CLTI are largely explained by socioeconomic deprivation, as characterized by ADI. Adults living in areas with higher socioeconomic deprivation are at higher risk of incident PAD and CLTI than their less socioeconomically deprived counterparts.Fig 2Cumulative Incidence Function Curves of Incident CLTI in health Services Cost Review Commission Database from 2013 through 2019 Stratified by Race and ADI.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Infrapopliteal Peripheral Vascular Interventions for Claudication Are Associated With Poor Long-term Outcomes Regardless of Anatomical and Disease Severity

The use of infrapopliteal peripheral vascular interventions (PVI) in the treatment of claudication has been controversial. We have previously shown that infrapopliteal PVI for claudication is associated with poor long-term outcomes among Medicare beneficiaries, but could not account for anatomical characteristics using an administrative dataset. Here, we aimed to show that infrapopliteal PVI is persistently associated with poor long-term outcomes in patients with claudication when compared with isolated femoropopliteal PVI, even after accounting for anatomical and disease severity characteristics. We identified all patients who underwent an index infrainguinal PVI for an indication of claudication between 2004 and 2020 in the Vascular Quality Initiative and Vascular Implant Surveillance and Interventional Outcomes Network. Our primary outcomes were conversion to chronic limb-threatening ischemia and any repeat PVI. Kaplan-Meier curves and multivariable Cox proportional hazards models were used to assess the association of infrapopliteal PVI with long-term outcomes after adjusting for baseline patient characteristics (demographics, socioeconomic status, comorbidities, medications, site of service, treatment type performed) and anatomical/disease severity characteristics (ankle brachial index, femoropopliteal TASC classification, ambulation) and clustering by treating physician. Of 13,824 patients (mean age, 72.1 ± 0.1 years; 40.9% female; 19.6% non-White/Hispanic) who underwent an index PVI for claudication, 2565 (18.6%) underwent an infrapopliteal PVI, including 10.5% (n = 1423) with one infrapopliteal PVI and 8.5% (n = 1141) with two or more vessel infrapopliteal PVI. Median follow-up was 3.1 years (interquartile range, 1.6-5.5 years). The estimated 3-year rates of conversion to CTLI (31.3% vs 20.0%) and repeat PVI (42.4% vs 34.3%) were higher for patients who underwent any infrapopliteal PVI vs those who underwent an isolated femoropopliteal PVI (both; P < .001) (Fig 1). After adjusting for baseline and anatomical characteristics, index infrapopliteal PVI was associated with a higher risk of conversion to chronic limb-threatening ischemia (adjusted hazard ratio, 1.45; 95% CI, 1.29-1.63) and repeat PVI (adjusted hazard ratio, 1.25; 95% CI, 1.14-1.36) than isolated femoropopliteal PVI. These associations remained significant with any number of infrapopliteal vessels treated, as well as among patients stratified by TASC classification (all P < .001) (Fig 2). The use of infrapopliteal PVI for claudication is common and associated with worse long-term outcomes compared to the use of isolated femoropopliteal PVI, even after accounting for anatomical characteristics of peripheral artery disease. Infrapopliteal PVI performed for claudication is harmful, and should not be part of the treatment paradigm for claudication.Fig 2Forest plot depicting the adjusted* hazard ratios of infrapopliteal peripheral vascular intervention (PVI) with conversion to chronic limb-threatening ischemia (CLTI) and repeat PVI, overall, by number of infrapopliteal vessels treated, and among subgroups stratified by TASC classification.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Medicare Patients with Symptomatic Carotid Disease Requiring Carotid Revascularization Are Likely to Have Delayed Access: An Analysis of a Multicenter Surgical Data

The Society for Vascular Surgery clinical practice guidelines for management of extracranial cerebrovascular disease recommends carotid revascularization as soon as the patient is neurologically stable after 48 hours and before 14 days of symptom onset in patients with recent stroke. In the United States, insurance status has been demonstrated to play a role in wait times for surgical care. There are no large-scale studies that assess the effect of patient primary insurance status on time to surgery in patients with symptomatic carotid disease. We utilized the Vascular Quality Initiative (VQI) database to evaluate our hypothesis that insurance status is associated with waiting times before surgery in patients with symptomatic carotid disease. All patients who underwent carotid revascularization in the VQI dataset from 2010 to 2022 were included. Patients with incomplete or missing outcomes data, Modified Rankin score of >2 and asymptomatic were excluded. Primary outcome was time between onset of symptomatic carotid disease and intervention. Categorical variables were compared using χ2 test and one-way analysis of variance for continuous variables. Multivariable logistic regression was used to assess the association between insurance status and waiting time to surgery while adjusting for potential confounders. The study consisted of 11,973 patients who had carotid revascularization within 14 days of symptoms (early cohort) and 21,253 patients in the late cohort (after 14 days). Patients in the late cohort were older (70.1 ± 9.8 vs 69.8 ± 10.5; P = .02), less likely to undergo carotid endarterectomy (85.9% vs 88.4%; P < .01), and more likely to have an elective procedure (90.3% vs 44.3%; P < .01). Fig 1 shows the distribution of insurance coverage among the study cohort. After adjusting for potential confounders, compared to Medicare, recipients of other insurer types had lower odds of experiencing delayed surgery: Medicare Advantage (adjusted odds ratio [aOR], 0.89; 95% confidence interval [CI], 0.80-0.99; P = .03), commercial (aOR, 0.84; 95% CI, 0.78-0.90; P < .001), military/Department of Veterans Affairs (aOR, 0.67; 95% CI, 0.54-0.84; P < .001), and self-pay (aOR, 0.54; 95% CI, 0.45-0.65; P < .001). Medicaid patients had similar delay (aOR, 0.90; 95% CI, 0.78-1.03; P = .14) and non-US insurance had longer delay to surgery (aOR, 1.48; 95% CI, 1.13-1.95; P = .005), in comparison to Medicare patients (Fig 2). Symptomatic carotid patients on Medicare and Medicaid are more likely to receive delayed revascularization procedures compared to patient with commercial insurance. Future studies are needed to investigate and potentially mitigate the underlying causes for the delay and the overall health implications of such a delay on the long-term outcomes of these patients.Fig 2Adjusted odds of receiving late carotid revascularization in symptomatic patients requiring surgery: comparing other major insurance providers with Medicare. *Model adjusted for urgency of procedure, prior coronary artery disease, prior carotid endarterectomy/coronary artery stenting, preoperative beta-blocker use, prior congestive heart failure, type of procedure (carotid endarterectomy, transcarotid artery revascularization, transfemoral carotid artery stenting), age, race, body mass index, preoperative creatinine levels, preoperative hemoglobin concentration, preoperative dysrhythmia, previous major amputation, preoperative functional status, American Society of Anesthesiologists class, chronic obstructive pulmonary disease, and degree of stenosis.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Distal Bypass Improves Skin Perfusion Pressure at the Entire Foot Regardless of Angiosomes in Patients with Chronic Limb-Threatening Ischaemia

This study evaluated the tissue blood pressure of the direct revascularised (DR) and indirect revascularised (IR) areas after distal bypass surgery using repeated skin perfusion pressure (SPP) measurements. Twenty-two patients received regular hemodialysis, and all limbs were classified as Rutherford 5. SPP of the direct and indirect revascularization area was measured at 10 time points, including pre- and post-days 3 to 6, 7 to 9, 10 to 12, 13 to 14, 15 to 17, 18 to 20, 21 to 23, 24 to 26, and 27 to 29. Patients were divided into two groups according to the number of postoperative days to the SPP peak at the DR, as follows: group A (n = 14; SPP peak day within 9 days), group B (n = 15; peak day after 10 days). In total, 446 SPP measurements were collected from 58 measurement sites, and the transition of the SPP at the DR was 35.4, 62.5, 59.5, 70.2, 58.2, 62.2, 63.1, 63.6, 63.8, and 73.4 mmHg and IR was 29.4, 53.4, 53.7, 58.8, 51.3, 63.1, 47.9, 62.1, 57.6, and 61.0 mmHg. No significant differences were observed between SPP at the DR and IR except post-days 18 to 20 (Fig 1). Fifteen wounds on the DR (62.5%) and five on the IR (100.0%) healed. The wound healing rate and time were 92.9% and 81 days in group A, 53.3% and 222 days in group B (Fig 2). Distal artery bypass improved SPP in the IR and DR of patients with chronic limb-threatening ischemia. An early SPP peak could be an indicator of wound healing.Fig 2Cumulative incidence curve of wound healing in each group. There was a significant difference in the wound healing rate (P = .01).View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Vascular Surgery Innovation Over Three Decades: An Analysis of Food and Drug Administration Device Approvals

Vascular surgery has undergone rapid changes, delivering improvements in patient outcomes. Much of this improvement has been catalyzed by the availability of new technology. We aim to evaluate the areas of past and ongoing innovation by analyzing all vascular device Food and Drug Administration (FDA) applications. We retrospectively compiled device approval applications submitted to the FDA Circulatory System Devices Advisory Panel since inception in 1963 (N = 134,037), including both Pre-Market Approval (PMA) and 510(k) applications. PMA applications, which typically require human trials before the approval of novel devices, were considered to represent a greater degree of innovation compared with 510(k)s, which are largely based on similarity to previously approved devices. Between 1995 and 2012, vascular applications grew rapidly, increasing over 140% during this time period (Fig 1); however, applications for vascular devices have fallen since 2012 by over 10%. The portion of these applications representing PMAs has increased steadily and remains statistically significantly higher than other procedural specialties (Fig 2). The categories with the greatest change in applications between 2010 and 2020 include embolectomy catheters (−71%, P < .001), guide catheters (−30%, P = .02), access devices (49%, P = .01), angioplasty catheters (156%, P < .001), visceral stents (248%, P < .001), and peripheral stents (61.8%, P < .001). Although we are limited in the degree to which we can evaluate their impact or novelty, applications for vascular device approval suggest that the burst of innovation following the beginning of the endovascular era has plateaued. More recent applications have focused on well-established categories and are increasingly sponsored by a small number of large corporations. Society and federal policies should aim to sustain the pace, quality, and diversity of innovation in vascular surgery.Fig 2PMAs as percentages of applications.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Thoracic Endovascular Aortic Repair vs Medical Therapy Alone for Uncomplicated Acute Type B Aortic Dissection

It remains controversial if thoracic endovascular aortic repair (TEVAR) or optimal medical therapy (OMT) should be the standard of care for uncomplicated type B aortic dissection (uTBAD). We evaluate our institutional experience to compare the outcomes of TEVAR vs OMT as primary treatment for uTBAD. Data were analyzed to compare early and late outcomes of 219 patients (135 men; 61.6%) with uTBAD who were triaged to OMT in 162 and TEVAR in 57 over 3 decades. Mean age was 64.5 ± 12.7 and 63.5 ± 15.9 years (P = .630) in the TEVAR and OMT groups, respectively. TEVAR group had significantly higher incidences of hypertension (87.8% vs 40.1; P < .001), smoking (63.2% vs 38.3%; P = .002), dyslipidemia (47.4% vs 16.7%; P < .001), chronic kidney disease (17.5% vs 6.2%; P = .016), and prior stroke/transient ischemic attack (14% vs 4.9%; P = .035). After TEVAR, neither death nor paraplegia occurred, while seven patients developed acute kidney injury not requiring hemodialysis (12.3%), and one sustained stroke (1.8%). In-hospital/30-day mortality was 0% with TEVAR vs 16% (26/162) with OMT (P < .001). Follow-up was 100% (193/193) at a median of 5.8 years (mean, 7.8; interquartile range [IQR], 2.0-12.3). In OMT group, 70 patients died at median 5.2 years (IQR, 2.0-8.8 years), and 72 underwent intervention at median 85 days (IQR, 0.01-1.2 years), including open descending repair in 60, TEVAR in 9, abdominal aortic repair in 2, and arch repair in 1. Following intervention, 40 died at median 1.8 years (IQR, 0.02-6.3 years). In TEVAR group, 18 underwent reintervention at median 48.5 days (IQR, 29-101 days), including 11 redo-TEVAR, 3 EVARs, 1 hemiarch, and 3 others; all were alive at latest follow-up except 1 expiring at 6.9 months postreintervention. At 3 months, 1 year, and 3 years following treatment, survival rates were significantly higher in TEVAR vs OMT patients (100% vs 83.2 ± 2.9%; 94.4 ± 3.1 vs 77.0 ± 3.3%; and 91.8 ± 4.0% vs 67.9 ± 3.7%) (P = .002, Fig 1); the respective freedom from (re)intervention were 75.4 ± 5.7% vs 72.7 ± 3.6%, 68.0 ± 6.2% vs 64.2 ± 3.9%, and 68.0 ± 6.2% vs 53.0 ± 4.2% (P = .198) in TEVAR vs OMT groups. After (re)intervention, the group with initial TEVAR had improved survival (94.4 ± 5.4% up to 3 years) compared to OMT patients (76.4 ± 5.0 at 1 year, 65.3 ± 5.6% at 3 years) (P = .039) (Fig 2). In the management of uTBAD, patients receiving initial OMT showed lower survival and required more intervention, while initial TEVAR achieved significantly higher survival up to 3 years, even after reintervention. These results argue favorably for the use of TEVAR as the primary treatment of choice for uTBAD.Fig 2Survival after (re)intervention, Kaplan-Meier survival curve comparing survival postsurgical (re)intervention after initial treatment by either thoracic endovascular aortic repair (TEVAR) or medical therapy up to 3 years after treatment. Log-rank P = .039.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Bariatric endoscopic antral myotomy: first-in-human proof of concept of a novel therapeutic method to delay gastric emptying and induce weight loss

Bariatric endoscopic antral myotomy: first-in-human proof of concept of a novel therapeutic method to delay gastric emptying and induce weight loss

Mediastinal cysts associated with Paragonimus westermani

•Paragonimiasis can rarely manifest as a mediastinal cystic mass.•Paragonimiasis can be transmitted to the mediastinum in the absence of pulmonary lesions.•Surgical resection can aid in the diagnosis and treatment of mediastinal paragonimiasis. A 48-year-old man presented to the thoracic surgery clinic with an incidentally detected mediastinal mass on chest radiography (Figure 1a). He was asymptomatic with no relevant medical history. Laboratory studies showed normal leukocyte and eosinophil counts. Magnetic resonance imaging revealed multilocular cystic lesions (6 × 4.5 cm) with abscess formation in the pericardial space (Figure 1b-d). The first impression was multilocular thymic cysts. The cysts were removed by uniportal video-assisted thoracic surgery (Figure 2). Histologic analysis revealed a multicystic lesion with central necrosis and peripheral granulomas with parasitic eggs in the thymus (Figure 3). He was diagnosed with Paragonimus westermani infection. P. westermani can be transmitted by eating infected raw freshwater crabs [[1]Harinasuta T Pungpak S Keystone JS. Trematode infections. Opisthorchiasis, clonorchiasis, fascioliasis, and paragonimiasis.Infect Dis Clin North Am. 1993; 7: 699-716https://doi.org/10.1016/S0891-5520(20)30550-XAbstract Full Text PDF PubMed Google Scholar], and it mainly presents as subpleural consolidations, pneumothorax, and pleural effusion [[2]Singh TS Mutum SS Razaque MA. Pulmonary paragonimiasis: clinical features, diagnosis and treatment of 39 cases in Manipur.Trans R Soc Trop Med Hyg. 1986; 80: 967-971https://doi.org/10.1016/0035-9203(86)90275-0Abstract Full Text PDF PubMed Scopus (74) Google Scholar]. It is extremely rare that paragonimiasis presents as multilocular cysts in the mediastinum without pulmonary manifestation. He enjoyed eating raw crab marinated in soy sauce, and it is speculated that the larvae migrated through the diaphragm and made an abscess pocket in the anterior mediastinum. At the 15-month follow-up visit after surgical removal and medication of praziquantel, he showed no evidence of recurrence. When presented with unexplained mediastinal multilocular cysts, paragonimiasis can be included in the differential diagnosis.Figure 2Intraoperative observation of a cystic lesion of the anterior mediastinum.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3Histologic findings of (a) central necrosis and peripheral granulomas (b) with parasitic eggs in the thymus.View Large Image Figure ViewerDownload Hi-res image Download (PPT) The authors have no competing interests to declare.

The Cornified Envelope: A Versatile Contributor to the Epidermal Barrier

The Cornified Envelope: A Versatile Contributor to the Epidermal Barrier

NKX3.1 immunohistochemistry and methylome profiling in mesenchymal chondrosarcoma: additional diagnostic value for a well-defined disease?

Mesenchymal chondrosarcoma (MCS) is a rare and highly aggressive tumour of soft tissue and bone that is defined by an underlying and highly specific fusion transcript involving HEY1 and NCOA2. Histologically, the tumours show a biphasic appearance consisting of an undifferentiated blue and round cell component as well as islands of highly differentiated cartilage. Particularly in core needle biopsies, the chondromatous component can be missed and the non-specific morphology and immunophenotype of the round cell component can cause diagnostic challenges. We applied NKX3.1 immunohistochemistry which was recently reported as a highly specific marker as well as methylome and copy number profiling to a set of 45 well characterised MCS cases to evaluate their potential diagnostic value. Methylome profiling revealed a highly distinct cluster for MCS. Notably, the findings were reproducible also when analysing the round cell and cartilaginous component separately. Furthermore, four outliers were identified by methylome profiling for which the diagnosis had to be revised. NKX3.1 immunohistochemistry showed positivity in 36% of tumours, the majority of which was rather focal and weak. Taken together, NKX3.1 expression showed a low sensitivity but a high specificity in our analysis. Methylome profiling on the other hand represents a sensitive, specific and reliable tool to support the diagnosis of MCS, particularly if only the round cell component is obtained in a biopsy and the diagnosis is not suspected. Furthermore, it can aid in confirming the diagnosis in case RNA sequencing for the HEY1::NCOA2 fusion transcript is not available.

Variation in Incidence of Pneumothorax Complications After Percutaneous Lung Biopsies Among Veterans Health Administration Hospitals

Variation in Incidence of Pneumothorax Complications After Percutaneous Lung Biopsies Among Veterans Health Administration Hospitals

A-20 | ST-Segment Elevation Myocardial Infarction in the Younger Population in the United States and Their Predictors: A Race- and Gender-Based Analysis

Incidence of STEMI in the young population has been rising in the US. Little is known about the effect of race and gender on the prevalence, localization, and predictors of STEMI among the young population. We queried young patients (age < 50 yrs) with primary diagnosis of STEMI from the National Inpatient Sample database (2017-2019) and studied the effect of race on STEMI prevalence and localization among young men and women. We also evaluated the predictors of STEMI among young patients using the logistic regression. A total of 69,950 STEMI patients (mean age 43 yrs, 78% men, 66% White) were studied. Black women had a higher and black men had a lower prevalence of STEMI. White young men had a higher prevalence of inferior STEMI. Known CAD, familial hypercholesterolemia, smoking and family history of CAD are strong and independent predictors of STEMI in young. Our study highlights key racial and gender-based disparities and major predisposing factors of STEMI in the young which can help optimize the preventive strategies and improve patient outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Pitfalls of EUS-guided gastrojejunostomy in a patient with history of Roux-en-Y gastric bypass and a frozen abdomen.

Video 1Case of EUS-guided gastrojejunostomy in a patient with a history of Roux-en-Y gastric bypass and a frozen abdomen.

Management of donor partial anomalous pulmonary veins during lung transplantation

Management of donor partial anomalous pulmonary veins during lung transplantation

Successful endoscopic management of a large esophageal defect due to Boerhaave syndrome with endoscopic vacuum therapy using vacuum sponge and vacuum stent

Video 1Successful endoscopic management of a large esophageal defect due to Boerhaave syndrome with endoscopic vacuum therapy using EsoSponge and VACStent.

Genetic Validation of Psoriasis Phenotyping in UK Biobank Supports the Utility of Self-Reported Data and Composite Definitions for Large Genetic and Epidemiological Studies

Genetic Validation of Psoriasis Phenotyping in UK Biobank Supports the Utility of Self-Reported Data and Composite Definitions for Large Genetic and Epidemiological Studies

Reimagining Gastroenterology Fellowship Training: The Third Year of the Future

Reimagining Gastroenterology Fellowship Training: The Third Year of the Future

Crosslinked polymer electrolyte constructed by metal-oxo clusters for solid lithium metal batteries

By using structurally well-defined metal-oxo clusters as crosslinkable nanofillers, the authors develop a hybrid inorganic/organic crosslinked polymer electrolyte. With the favorable electrochemical and mechanical properties, as well as the enhanced lithium dendrite-suppressing capability, the metal-oxo cluster crosslinked polymer electrolyte can significantly improve the capacities, rate capabilities, and cycling stabilities of solid lithium metal batteries. Download : Download high-res image (175KB)Download : Download full-size image

Emergent open repair of a symptomatic type III thoracoabdominal aneurysm.

Emergent open repair of a symptomatic type III thoracoabdominal aneurysm.