Although uncommon, invasive meningococcal disease (IMD) results in death in 5%-10% of cases in healthy children and adolescents. This study aimed to examine demographics, clinical presentation, treatment and outcomes of Australian children hospitalized with IMD during the introduction of the meningococcal vaccine program, overall and by serogroup/disease severity. This prospective, multicenter study was conducted through the Paediatric Active Enhanced Disease Surveillance network across 8 tertiary pediatric hospitals in Australia. Children 0-18 years of age with laboratory-confirmed IMD admitted between July 2016 and June 2022 were included. Clinical data were collected using standardized protocols. Logistic, quantile, negative binomial regression and univariate comparisons were used to compare characteristics by serogroup and to investigate factors associated with disease severity. Among 137 IMD cases included, 56% were male with a median age of 2 years, 37% were Aboriginal/Torres Strait Islander children and over half resided in socioeconomically disadvantaged areas. Meningococcal serogroup B (MenB) accounted for 55% of cases, followed by MenW (28%) and MenY (4%). The case fatality rate was 3%. Antibiotics were administered within 1 hour of presentation in 17% of cases. At discharge, 29% had ongoing sequelae, including scarring, arthritis, limb deformities or amputation. Most MenB cases were unvaccinated against MenB (93%), and only 1 MenY case had prior quadrivalent polysaccharide vaccination. This study highlights the continued burden of MenB disease, particularly among socioeconomically disadvantaged and Aboriginal and Torres Strait Islander children, underscores the importance of earlier recognition and treatment to reduce morbidity and mortality, and emphasizes the need for improving vaccine uptake and vaccine availability.

Large language models (LLMs) have shown considerable promise in supporting clinical decision-making. However, their adoption and evaluation in dermatology remains limited. This study aimed to explore the preferences of Chinese dermatologists regarding LLM-generated responses in clinical psoriasis scenarios and to assess how they prioritize key quality dimensions, including accuracy, traceability, and logicality. A cross-sectional, web-based survey was conducted between December 25, 2024, and January 22, 2025, following the Checklist for Reporting Results of Internet E-Surveys guidelines. A total of 1247 valid responses were collected from practicing dermatologists across 33 of China's provincial-level administrative divisions. Participants evaluated responses to five categories of clinical questions (etiology, clinical presentation, differential diagnosis, treatment, and case study) generated by five LLMs: ChatGPT-4o, Kimi.ai, Doubao, ZuoYiGPT, and Lingyi-agent. Statistical associations between participant characteristics and model preferences were examined using chi-square tests. ChatGPT-4o (Model 1) emerged as the most preferred model across all clinical tasks, consistently receiving the highest number of votes in case study (n = 740), clinical presentation (n = 666), differential diagnosis (n = 707), etiology (n = 602), and treatment (n = 656). Significant variation in model preference by professional title was observed only for the differential diagnosis task (χ 2 = 21.13, df = 12, p = 0.0485), while no significant differences were found across hospital tiers (p > 0.05). In terms of evaluation dimensions, accuracy was most frequently rated as "very important" (n = 635). A significant association existed between hospital tier and the most valued dimension (χ 2 = 27.667, df = 9, p = 0.0011), with dermatologists in primary hospitals prioritizing traceability more than their peers in higher-tier hospitals. No significant associations were found across professional titles (p = 0.127). Chinese dermatologists suggest a strong preference for ChatGPT-4o over domestic LLMs in psoriasis-related clinical tasks. While accuracy remains the primary criterion, traceability and logicality are also critical, particularly for clinicians in lower-tier hospitals. These findings suggest that future clinical LLMs should prioritize not only content accuracy but also source transparency and structural clarity to meet the diverse needs of different clinical settings.

Background Ameloblastoma is a common benign, odontogenic tumour with high prevalence in Africans, particularly Nigerians. We describe the epidemiology, clinicopathology, pattern of management and incidence of recurrence of ameloblastoma and ameloblastic carcinoma, in Lagos, Nigeria. Methods This retrospective study included ameloblastoma cases surgically managed at the Lagos University Teaching Hospital from January 2012 to December 2021. Primary outcome was recurrence; secondary outcomes were length of hospital (LOH) stay and postoperative complications. Results We included 63 patients with a mean (SD) age of 34.2 (14.8) years, peak incidence (31.7%) in the 3rd decade of life, and male-to-female ratio of 1.03. The most common location, radiological feature and histological type were posterior mandible (77.8%), multilocular radiolucency (90.5%) and follicular ameloblastoma (50.8%), respectively. For surgical intervention, majority of patients had nasotracheal intubation (67.3%) and mandibulectomy (88.9%), and the most common surgical approach was extraoral (67.3%). The mean (SD) LOH stay was 9.4 (2.4) days, and the transoral approach was associated with shortened LOH. The mean follow-up was 2.7 years, and recurrence was recorded in 2 patients who had conventional ameloblastoma, and one who had ameloblastic carcinoma at 3 years and 3 months postoperatively, respectively. No significant association was noted for recurrence-free survival based on tumour size, tumour diagnosis, histological type and surgical approach (p>0.05). Conclusion Although the epidemiology, clinicopathology and treatment of ameloblastoma reported were similar to older reports, this study provides more recent information on the persistent public health burden of ameloblastoma, which can be used for comparisons with ameloblastoma in other populations.

Background and ObjectivesThis study aims to assess whether adult patients with encephalitis from different racial and ethnic backgrounds exhibit significant differences in clinical presentation, diagnostic findings, and outcomes.Design and MethodsA retrospective cohort study was conducted by utilizing the electronic health records of encephalitis patients in the greater Houston and Baltimore areas. Patients were categorized by race/ethnicity into White or ethnic minority (including Black, Hispanic, and Asian patients). Data was analyzed for the presence of significant differences in clinical characteristics between the two groups.ResultsAmong 599 patients, 312 (52.1%) were White and 287 (47.9%) were of an ethnic minority. White patients were more often over sixty years-old upon presentation (43.1% vs 23.9%, P < 0.001) and more likely to present with memory deficits (36% vs 26.3%, P = 0.012). Ethnic minority patients more frequently presented with co-existing HIV (20.3% vs 3.4%, P < 0.001), severe organ dysfunction (44% vs 34.4%, P = 0.028), cerebrospinal fluid (CSF) pleocytosis (white blood cell count ≥5 cells/µL) (83.1% vs 69.3%, P < 0.001), and abnormal electroencephalogram (EEG) findings (84.3% vs 71.9%, P = 0.035). Ethnic minority patients also had worse outcomes on the Glasgow Outcome Scale (GOS) as defined by GOS <4 (59.3% vs 47.2%, P = 0.005). Binary logistic regression identified abnormal magnetic resonance imaging (MRI) and Glasgow Coma Scale (GCS) <13 as independent predictors of an adverse clinical outcome (GOS <4) with an adjusted odds ratio [95% confidence interval] (P value) of 1.609 [1.042-2.486] (P = 0.032) and 2.689 [1.675-4.317] (P < .001), respectively.ConclusionEthnic minority patients with encephalitis present at a younger age and are more likely to have co-existing HIV, severe initial organ dysfunction, CSF pleocytosis, abnormal EEG findings, and worse clinical outcomes. Abnormal MRI and GCS <13 are independent predictors of an unfavorable clinical outcome and may aid in risk stratification.

The study aimed to analyse trends in emergency department (ED) presentations in New South Wales (NSW) from 2015 to 2022, focusing on demographic and clinical factors influencing these trends and evaluating their impact on ED performance metrics. This was a retrospective, longitudinal study using routinely collected data from all NSW public hospital EDs presentations between 2015 and 2022. Key measures included the rate of ED presentations per 1000 population, emergency treatment performance (ETP), length of stay (LOS), and Did Not Wait (DNW) cases. The study identified that the rate of unique ED presentations increased by 0.51% per annum, in contrast to the higher rates reported in previous studies. The most notable increase was observed among individuals aged 60-80 and over 80 years. High-acuity cases (Categories 1 and 2) increased from 12.0% in 2015 to 15.0% in 2022, while low-acuity cases (Categories 4 and 5) decreased from 55.9% to 49.0%. ETP declined from 72.1% in 2015 to 56.4% in 2022, and DNW cases rose from 5.4% to 8.5%, indicating issues with patient flow and resource allocation. This long-term study of ED presentations highlighted the stable demand for ED services associated with a dramatic decrease in ETP and an increase in DNW cases suggesting a health system operating at critical levels of capacity. Addressing these challenges requires a multifaceted approach, and our study may assist in providing a foundation for future research and policy development aimed at improving ED efficiency and patient outcomes.

Purpose: Periprosthetic joint infection (PJI) is a devastating complication following limb salvage surgery with tumor megaprosthetic reconstruction, leading to high morbidity and complex management. Despite advancements in prosthesis design and materials, infection rates are notably higher than in conventional arthroplasty. This narrative review synthesizes current evidence on the etiology, diagnosis, and management of PJIs in this unique setting. Methods: We conducted narrative review of literature from PubMed and Embase using keywords related to PJIs and tumor megaprostheses, aiming to summarize risk factors, diagnostic criteria, pathogen profiles, and treatment outcomes. Results: Key findings indicate that the risk of PJI is multifactorial, involving patient-related, disease-related, and treatment-related factors. Diagnosis relies on a combination of clinical presentation, serological markers, imaging, and microbiological studies, though established criteria for conventional PJI may require adaptation for tumor cases. Treatment strategies include irrigation and debridement (I&D), debridement, antibiotics, implant retention with modular component exchange (DAIR), one-stage or two-stage revision, and amputation. Success rates vary, and optimal management requires a multidisciplinary, individualized approach. However, two-stage revision is considered the gold standard for chronic PJIs. Conclusions: PJIs after tumor megaprosthetic reconstruction presents distinct challenges. Management requires a multidisciplinary, individualized approach. Future research should focus on validated diagnostic criteria for this population, novel anti-biofilm strategies, and standardized treatment protocols.

BackgroundRubella virus (RuV), a single stranded RNA virus, has detrimental effects in pregnancy due to miscarriage and congenital rubella syndrome. RuV was declared eliminated from the United States in 2004 due to successful implementation of the combined measles, mumps, and rubella (MMR) vaccine.1 Despite this eradication, rubella virus (RuV)-associated granulomas have been reported in the literature but are limited to case reports and series, with no reported prevalence rate.2 This study aims to assess the prevalence of cutaneous RuV granulomas and to further characterize the disease.Table 1:Characteristics of patients by rubella statusTable 2:Granulomatous disease presentation and referral diagnosisMethodsA multicenter retrospective cohort study of adult patients with atypical granulomas on histopathology, defined as suppurative granulomatous inflammation without an infectious cause or a granulomatous pattern without a specified diagnosis, were included. RuV immunostaining was performed on paraffin-embedded cutaneous tissue by the Centers for Disease Control and Prevention (CDC). Demographics and record review were collected.ResultsOf 117 patients, 71 were RuV-positive (61%) with a mean age of 53.44 ± 15.35; 61% were female (Table 1). RuV-positive lesions predominantly occurred on the extremities (80%, p=0.04) followed by head/neck (7%) and trunk (7%). Known immunocompromised status was not more prevalent in RuV-positive cases compared to RuV-negative (p=0.31). A third of cases came from outside referrals with a presumed diagnosis of both infectious and noninfectious etiologies (Table 2). Of the RuV-positive cases, 77% received one or more therapies. Biologics were used for 27% of patients, with TNF inhibitors most commonly used (72%).ConclusionIn this study, a high number of atypical cutaneous granulomas are positive for RuV (61%) with a predilection for the extremities. Atypical granulomas with extensive and unrevealing results should prompt testing for RuV. Future directions include thorough evaluation of patients, potential shedding into the environment and identification of best therapeutic interventions, including effective anti-virals against RuV. There is a need for prospective analysis to determine if RuV is vaccine-derived or wild type to further support public health interventions.DisclosuresMisha Rosenbach, MD, Johnson & Johnson: Advisor/Consultant|Merck: Advisor/Consultant|Novartis: Advisor/Consultant|Priovant: Advisor/Consultant|Priovant: Grant/Research Support Bridget Shields, MD, Priovant Therapeutics: Advisor/Consultant|UpToDate: Chapter Author Beth Drolet, Md, Arkayli: Board Member|Arkayli: Owner|Arkayli: Ownership Interest Megan Noe, MD, MPH, MSCE, Boehringer Ingelheim: Advisor/Consultant|Boehringer Ingelheim: Grant/Research Support|Bristol Meyer Squibb: Grant/Research Support|Sanofi: Employee|Takeda: Advisor/Consultant

Immune antibodies recognizing the stem region of SARS-CoV-2 spike protein: Molecular modeling and in vitro study of synthetic peptides presentation to the antibodies.

Emergency department (ED) utilisation and delays are a major public health concern internationally, with increased mortality with ED delays and overcrowding. The study aimed to assess how the population characteristics of ED catchment areas are associated with ED use and delays to admission or discharge, and how catchment presentation rates are associated with ED delays. A cross-sectional study of presentations and delays to all 27 Scottish EDs for December 2023-February 2024. Catchment areas were defined for every ED in Scotland and population demographics for each, as Scottish Index of Multiple Deprivation (SIMD) and 8-fold Urban-Rural Classification (UR8). ED performance metrics for the study period were extracted from routinely reported data. Robust regression assessed the associations between catchment area demographics and ED delays, with negative binomial regression analysis of the association between catchment area demographics and presentation rates for the local population, reported as incidence rate ratio (IRR). For each decile lower (more deprived) in median SIMD, monthly attendances increased by 10% (IRR 1.10, 95% CI 1.10 to 1.11). For each step more rural in the median UR8 of a catchment, the percentage of patients experiencing a delay to admission or discharge of over 4 hours reduced by 5.3% (95% CI 4.9% to 5.7%), and each step more deprived in median SIMD decile of a catchment area was associated with 4.8% more delays beyond 4 hours (95% CI 3.0 to 6.8%). There was no association between presentation rates and delay to admission or discharge. EDs with more deprived catchment areas have higher presentation rates and greater delays in care. More rural EDs have fewer delays, which may mitigate some of the effects of geographical isolation in the provision of more timely care. In isolation, ED presentation rates are not associated with delays to care, adding to evidence that overall attendances are less important than other factors contributing to ED delays. Policymakers should consider the allocation of resources to best promote health equity.

Abstract Introduction Hundreds of abstracts are presented at the annual Sexual Medicine Society of North America (SMSNA) meeting. Findings presented at this meeting have the potential to influence clinical practice. It is unclear how many of these abstracts subsequently become peer-reviewed publications. Objective The objective of this study was to determine the overall publication rate among these abstracts as well as predictors of publication. Methods All poster and podium presentations from the October 2019 SMSNA annual meeting were reviewed and assessed for publication through May 1, 2025. Abstracts were classified by country, presentation type, topic area, and study design. In order to determine publication, abstract authors were individually searched with key abstract terms added sequentially until &amp;lt;30 results were generated in PubMed. Abstracts were classified as published if at least 1 author and 1 conclusion matched a manuscript. Publication rate, time to publication, journal impact factor (IF), and citations were collected. Abstracts with associated publications prior to the SMSNA meeting were excluded. Results Of the 232 abstracts reviewed, 100 (43.1%) achieved publication as of May 1, 2025, with a median time to publication of 9.5 months (IQR 4.8-19.1). Manuscripts were published in 28 different journals, most commonly in Journal of Sexual Medicine (26%), International Journal of Impotence Research (17%), and Urology (12%), with a median IF 2.8 (IQR 2.1-3.3) and a median of 3 citations (IQR 1-8). Table 1 shows publication rate by presentation type, country, study design, and topic area. There was no significant difference in publication rate for United States versus international abstracts or basic science versus clinical research designs. Moderated posters and podium presentations were more likely to be published compared to E-posters (p=0.025). Abstracts classified under Peyronie’s disease had the highest rate of publication (63%), and were significantly more likely to be published compared to abstracts of all other topics (p=0.038). Conclusions While SMSNA abstract presentations allow for the dissemination of valuable data, less than half are published in peer-reviewed journals over five years later. Meeting attendees should be cautious in making practice changes based on abstract presentations alone. Future research will seek to better understand the potential reasons behind why meeting abstracts are not published, and continued efforts should be made to increase publication of sexual health abstracts presented at the SMSNA annual meetings. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Stanton Honig - Coloplast, Endo pharmaceuticals, Fellow, Posterity Health, HIMS, Haleon, WIN fertility

Crohn's disease (CD) is a chronic inflammatory bowel disease characterized by transmural inflammation that can affect any part of the gastrointestinal tract. Early and accurate diagnosis remains challenging due to the heterogeneous nature of the disease and overlapping symptoms with other gastrointestinal disorders. Current diagnostic approaches rely on a combination of clinical presentation, endoscopic findings, histological examination, and imaging studies, which can be invasive and time-consuming. The identification of reliable biomarkers could significantly improve diagnostic accuracy and reduce the need for invasive procedures. This review examines currently used biomarkers, including C-reactive protein, fecal calprotectin, and anti-Saccharomyces cerevisiae antibodies, while exploring emerging potential biomarkers such as microRNA panels, metabolomic signatures, and novel inflammatory mediators. Recent advances in genomics, proteomics, and metabolomics have revealed promising biomarker candidates that could enhance diagnostic precision and enable personalized treatment approaches. Understanding the performance characteristics and clinical utility of these biomarkers is crucial for their implementation in routine clinical practice and improved patient outcomes.

Background: Bladder cancer is the ninth most common cancer worldwide and is responsible for significant morbidity and mortality. Treatment of bladder cancer depends on the age, extent, stage and microscopic grade of the tumour. Hence, histopathological examination plays a vital role in patient management. The aim and objective is to determine the histomorphological spectrum of urinary bladder lesions. To categorise the neoplastic lesions according to the WHO urinary bladder tumours classification, 5th edition. To estimate the frequency of bladder lesions according to age, sex and site. Study of various clinical presentations of bladder lesions. Material and Methods: Study type: Retrospective study. Study period: January 2022 to December 2023. Inclusion criteria: All Transurethral Resection of Bladder Tumours (TURBT) biopsies and Cystectomy specimens received in the Department of Pathology will be included in the study. Exclusion criteria: Inadequate and autolysed biopsies were excluded from the study. Sample Collection Method: The H&amp;E slides of the patients who underwent TURBT and cystectomy from January 2022 to December 2023 will be reviewed. The patient's details, cystoscopic findings, and clinical presentation will be collected from the medical records available at the institution. All the details will be correlated with histopathological findings and analysed. Out of 52 cases, 40 were male, and 12 were female. The most common age at presentation was 70-80 years, followed by 60-70 years. Forty-seven were TURBT specimens, and 5 were radical cystectomy specimens. The majority of lesions involve the left lateral wall, followed by the vesico-ureteric junction and the posterior wall. Among the neoplastic lesions, 16 were proliferative growths, 6 were polypoidal lesions, five presented as strictures/stenoses and 1 was a multifocal growth. Out of 52 cases, Neoplastic cases were 41, Non-neoplastic cases were 11. Among the Neoplastic cases, Invasive urothelial carcinomas constitute the predominant category, with Infiltrating urothelial carcinomas accounting for 26 cases, 4 with divergent differentiation. Nineteen were high-grade tumours, and 11 were low-grade tumours. Among the 19 cases, 10 showed muscle invasion, and among the 11 low-grade cases, 3 showed muscle invasion. Hematuria was the commonest, followed by burning micturation, dysuria and loin pain. Conclusion: As the common age of presentation was between 60 and 80 years, elderly males presenting with hematuria need to be evaluated to rule out bladder cancer. Cystoscopic examination with histopathology helps in initiating early treatment and a better prognosis in case of urothelial carcinoma. Keywords: Bladder cancer, histopathology, TURBT, cystoscopy, bladder lesions.

This pilot study investigates the relationship between stress situations and speech fluency in virtual reality environments. It aims to analyze how different stress scenarios, classified into low-, medium-, and high-stress environments, can affect speech rate, increase syllable/word repetitions, and lead to hesitations in university students. Previous research has established connections between stress situations and speech fluency, highlighting that stress can negatively influence behavior, cognitive processes, and communicative performance across various contexts, including oral presentations. An experiment was conducted with 30 participants randomly divided into three groups. Each group was exposed to different virtual stress environments (low/medium/high) during simulated oral presentations. A virtual reality platform was created to establish controlled environments and monitor the participants’ fluency in real time. An Analysis of Variance (ANOVA) test revealed that participants in the low-stress virtual environment performed better, achieving higher word and syllable production. In contrast, the high-stress virtual environment demonstrated an increase in disfluencies and hesitations. Results emphasize the impact of stress situations on oral communication, advocating for the use of virtual reality technology as a means of preparing individuals for challenging speaking scenarios. This approach has the potential to enhance speech fluency as a result of targeted practice in stress-inducing environments; that is to say, alleviating anxiety and improving overall communicative efficacy.

Intra-Cytoplasmic Sperm Injection (ICSI) is one of the most common infertility treatments in which ovarian stimulation is carried out to extract the eggs from the ovaries. There are three, short, long, and pure treatment protocols of ovarian stimulation that vary by the type of medicine, the dosage of medicine, and the treatment term.Today, physicians choose an appropriate treatment protocol based on the patient's condition, such as age, and hormonal condition. This could be a relatively subjective and inaccurate method, particularly if the physician is not highly experienced. The present study investigates whether a decision support system can propose a more objective treatment protocol based on the patients’ data and data mining methods like logistic regression, decision tree, and SVM. Such a system draws upon classification methods to propose proper treatment protocols for ICSI. Moreover, a separate module was developed to calculate the success rate of the proposed protocols. The system was tested with real data of treated patients at a Hospital in Tehran, Iran. The results showed the proposed system can predict the most proper treatment protocol with an accuracy of 81.90%. The proposed system can help inexperienced physicians to feel more confident about their advice.

Peptide-based therapeutic vaccines exploit cross-presentation by dendritic cells for the induction of effective T cell responses. Their clinical success, however, has been limited due to incomplete understanding of antigen processing and presentation (APP). Bioorthogonal chemistry (BOC) uses chemical "click" reactions that can be performed selectively without interference of the cellular environment. A "click handle" can be incorporated into a biomolecule with only minor effects on its characteristics, allowing selective visualization and tracking of the biomolecule. We generated 10 analogues of the HLA-A2-restricted, immunogenic hepatitis B virus-derived epitope HBcAg18-27 by replacing each amino acid with the click handle homopropargylglycine. Each analogue was tested for (1) peptide binding affinity to HLA-A2, (2) preservation of immunogenicity, and (3) accessibility for on-cell click reactions. Lastly, we performed a proof-of-concept experiment in which we demonstrate the feasibility of BOC for APP studies. All amino acids could be modified with the click handle without loss of HLA binding. Furthermore, 7 out of 10 analogues retained cognate T cell recognition. Two of the most promising analogues were tested and demonstrated to be accessible for on-cell click as well as suitable for long peptide processing and presentation studies. To our knowledge, we are the first to show the feasibility of BOC to study APP in the human setting. With BOC techniques, we may now be able to sensitively follow antigen routing by visualizing the intracellular location of (long) peptides. Furthermore, this tool enables direct and quantitative epitope studies in a T cell-independent manner.

Background: Social determinants of health —including socioeconomic status, race and ethnicity, and access to care—affect health outcomes and contribute to disparities in disease burden and treatment. We sought to describe racial and ethnic differences in pediatric WPW patients (pts), focusing on healthcare utilization, management, and life-threatening events (LTEs) using a multicenter registry. Methods: Data were extracted from the international ambispective WPW registry, which enrolled pts age &lt; 21 years (2017- 2024). Demographics, clinical presentation, ED visits, hospital/ICU admissions, antiarrhythmic use, and EP study (EPS) (transesophageal and/or invasive) were compared by race (White vs. non-White) and ethnicity (Hispanic vs. non-Hispanic). LTEs were defined as sudden death (SD), aborted SD, or pre-excited AF with rapid conduction or hemodynamic instability. Logistic regression model adjusting for age at enrollment was performed to evaluate associations between race and total and invasive EPS rates. Results: 1118 pts from 23 centers were included. Racial distribution was White (87%), Black (6%), Asian (3%), others (1%), and &gt; 1 race (3%). Most pts with reported ethnicity were non-Hispanic (NH) (93%). Compared to White pts, non-White pts were more likely to have congenital heart disease and persistent pre-excitation but less likely to require ICU admission or undergo EPS, including invasive EPS (Table 1). There were no significant racial differences in age at presentation at EPS, symptoms at presentation, hospitalization, antiarrhythmic drug use, or LTEs at presentation or f/u. In logistic regression models adjusting for age at enrollment, race was not significantly associated with invasive EPS (p=0.067). However, White pts were significantly more likely to undergo any EPS than non-White pts (OR 1.82, 95% CI 1.05–3.14). With respect to ethnicity, Hispanic pts underwent EPS at a younger age than NH pts (12.13 vs. 13.28 yrs, p=0.033). There were no other significant management or outcome differences between ethnic groups. Conclusion: Racial disparities in healthcare utilization and management strategies exist among pediatric WPW pts, with non-White pts less likely to undergo any EPS despite higher rates of persistent pre-excitation. Rates of LTE, however, were similar between racial and ethnic groups. Future studies should focus on exploring causes of racial disparities that would inform targeted interventions to promote equitable care.

Background: An aortic pseudoaneurysm (APA) is a contained rupture of the aortic wall that is often asymptomatic and detected as an incidental imaging finding. APAs can result from blunt thoracic trauma or can be iatrogenic. APAs secondary to aortic dissections are rare, and can lead to severe complications including rupture, hemorrhage, and death. Due to its high-risk nature, once discovered, prompt surgical or endovascular repair is important to prevent further complications. Case/Methods: A 42-year-old male with history of a Type A aortic dissection with surgical repair 3 years earlier, resistant hypertension, hyperlipidemia, and prior tobacco use, presented for chest pain radiating to his back. Physical exam was notable for a 2/6 systolic murmur, most prominent at the aortic position. Initial vitals were significant for hypertension, with a blood pressure of 164/105 mmHg. Laboratory testing showed troponin elevated to 30 ng/L (reference &lt; 15 ng/L), with a stable 3-hour trend. EKG showed normal sinus rhythm with left axis deviation and left ventricular hypertrophy. A CT angiography (CTA) dissection protocol showed a dissection flap distal to the left subclavian artery, extending into the abdominal aorta, consistent with a Stanford Type B aortic dissection (TBAD). The patient was managed with beta blockers and vasodilators to maintain systolic blood pressure under 120 mmHg and heart rate under 60 beats per minute. Following symptom resolution, a repeat thoracic CTA revealed a 2.5 cm sac near the origin of the right main coronary artery, representing a pseudoaneurysm not seen prior. Subsequent cardiac CTA confirmed this pseudoaneurysm outpouching secondary to degeneration of the TBAD. The patient underwent successful pseudoaneurysm repair with anastomosis construction and Dacron patch placement. Discussion: While the patient’s initial presentation and imaging studies, consistent with a TBAD, suggested conservative management, repeat imaging was imperative and changed the therapeutic plan despite the resolution of his symptoms. Current ACC/AHA guidelines recommend medical management for uncomplicated Type B dissections with close monitoring; however, aneurysmal progression mandates timely surgical intervention to mitigate rupture risk. This case highlights the importance of serial imaging in patients with TBADs to detect evolving complications such as APA formation, which may initially be occult but carry high mortality risk if left untreated.

Background: Emergency department (ED) presentations are common for people in their last year of life, but the characteristics of these presentations by regional patients known to palliative care services are limited. Objectives: To identify the characteristics and communication that occur when community-based palliative care (CBPC) patients present to the ED. Design: A retrospective, cross-sectional study of CBPC presentations to the ED over 12 months. Setting: Eligible participants were all regional CBPC patients who attended the index Australian ED between June 1, 2022, and May 31, 2023. Measurements: Data acquired included demographics, presentation details, documented communication, and ED discharge information. Results: An overall 235 CBPC patients presented to the index ED at least once (427 presentations), constituting 1.23% of all adult ED presentations. The median age was 75 years (interquartile range 65-82), and 82.6% had a primary diagnosis of cancer. The most common ED discharge diagnoses were symptom-related (78/427, 18.3%) and respiratory disease (77/427, 18%). Most (300/427, 70.3%) were admitted. Communication between ED and palliative care services was documented in 18.9% of presentations (81/427). Communication was more likely in patients who were admitted (88.9% vs. 11.1%), in work hours (55.6% vs. 44.4%), or in those with a cancer diagnosis (93.8% vs. 6.2%). Conclusion: CBPC patients presented to the ED with a high admission rate, which may indicate appropriate ED presentations. Coordinated care through communication was evident in only a minority of cases. Further studies to explore the complex palliative care needs of patients presenting to the ED and barriers to integrated care between services are vital to providing optimal care.

Introduction Venous anomalies are vascular malformations often characterized by a starburst pattern of smaller veins converging into larger veins. They are typically benign and discovered incidentally. Here, we describe a unique case of a venous anomaly arising in the frontal lobe with trans‐osseous egress into the forehead scalp. Methods We performed a thorough clinical evaluation and work‐up in preparation for a case report. Medical history, clinical presentation, and advanced imaging studies were reviewed. Results A 60‐year‐old male with a history of hypertension, hyperlipidemia, and Hepatitis C presented to the neuroendovascular clinic for a longstanding vascular malformation of the forehead. The lesion was first identified at the age of 12 in Mexico, where he underwent two forehead surgeries in the 1970s. He was informed that a residual remained, but did not undergo any further procedures. The lesion remained relatively stable; however, he noted progressive enlargement over several months before presentation. The patient reported that the lesion expands when leaning forward and during sleep, suggestive of gravity dependence. He also reported a sense of increased pressure when bending forward and expressed anxiety about potential bleeding, though he denied prior hemorrhage. The lesion was non‐tender at rest but became tender with flexion and palpation. Physical examination revealed an irregular, asymmetric, hyperpigmented plaque over the forehead adjacent to the midline measuring 8.1×1.2×4.8 cm, with a verrucous surface and hyperkeratosis (Figure 1A). With the patient leaning forward (1B), there was expansion of the lesion with non‐pulsatile fluid. The patient's neurological examination was intact. Non‐contrast CT head demonstrated thinning of the underlying frontal bone without signs of prior craniotomy, infarct, or hemorrhage (1C). CTA head showed the lesion to enhance, though hypodense relative to intracranial arteries, suggestive of underlying venous involvement (1D). T1 MRI pre‐ and post‐contrast showed enhancement of the lesion (1E‐F). T2 demonstrated flow voids in the region (1G), with MRA suggesting a predominantly venous pathology (1H). Digital subtraction angiography confirmed a venous anomaly in the frontal lobe without early arteriovenous shunting. The study (right internal carotid injection, lateral projection) revealed delayed trans osseous venous egress into the forehead scalp (1I arterial, 1J capillary, 1K early venous, 1L late venous phases). Conclusion After a multidisciplinary discussion including the neuroendovascular, neurosurgery, and plastic surgery teams, a decision was made to treat the lesion with a staged approach. After placement of tissue expanders, combined embolization and resection of the lesion, followed by scalp reconstruction, was performed. image

Abstract: For many applications, such as vests or parts of vests, the fibers are used in fabric, mat, or mesh. Ballistic resistance properties are also improved by the development of special fabrics architectures. It is known that heat and oxygen are the main factors in the aging process of polymers. The mechanisms of aging by oxidation can be investigated by monitoring the mechanical properties of a material exposed to prolonged aging in an oven, which is called the accelerated aging process by thermal oxidation. In previous studies, the epoxy matrix composite reinforced with 40% by volume of fique fabric, already tested and with good ballistic performance, was developed and proposed for individual ballistic protection applications. However, the impact of different environmental conditions on the dynamic properties of the composite has not been studied. Therefore, the present study, for the first time, aimed to apply accelerated weathering through high temperature to the composite, as well as to the epoxy matrix, aiming to evaluate the influence of aging.