Diagnosis Of Syndrome Research Articles

2263 Learning geriatric syndromes through case-based discussion (CBD)

Abstract Introduction Geriatric syndromes are traditionally taught through didactic teaching and bed side tutorials. However, these do not consider the science of learning and the strategies needed for a novice learner. It is prudent to manage cognitive load, create associations through testing and enforce deliberate practice for a novice as opposed to an advanced learner. Case- Based discussions (CBD) serve as an apt tool to deliver knowledge covering geriatric syndromes; aimed at testing learner’s understanding through its application to a simulated patient profile. This pilot aimed to test the applicability of CBD to teach geriatric syndromes to novice learners. Method A scoping review was completed by medical officers starting on their geriatric medicine rotation in a Singapore tertiary hospital to determine syndromes which they request dedicated teaching for within curriculum. Learners ranked Incontinence and Falls with Osteoporosis management as the top 2 geriatric syndromes of interest. Focus group discussion using Rogers’s theory of diffusion principle was undertaken to understand both the advantages and challenges of CBD. Clinical scenarios were curated specific to the 2 topics with learner’s completing a pre session quiz beforehand to determine their baseline knowledge. The topic specific CBD was done via zoom platform with questions applied in a graded fashion; components include that of diagnosis, evaluation, and management of select syndrome. Learners completed a post session quiz 1 week after the CBD to determine retention of knowledge. Results Quantitative Feedback received from the learners highlighted that more than 90% would want CBD to be implemented for other geriatric syndromes. There was an improvement in the average score obtained in post session quiz for Osteoporosis from 6.09 to 6.75. However, there was notably poor participation in the post session quiz. Conclusion This pilot highlights that CBD should be utilised to enhance teaching of clinical concepts in geriatric medicine.

BERTOLOTTI'S SYNDROME: DIAGNOSIS AND TREATMENT

IntroductionLumbosacral transitional vertebrae (LSTV) are increasingly recognized as a common anatomical variant and is the most common congenital anomaly of the lumbosacral spine. Patients can have symptomatic LSTV, known as Bertolotti's Syndrome, where transitional anatomy can cause back, L5 distribution leg, hip, and groin pain. We propose an outline for diagnosis and treatment of Bertolotti's Syndrome.MethodsWe retrospectively reviewed over 500 patients presenting to the primary author with low back, buttock, hip, groin and/or leg pain from April 2009 through April 2024. Patients with radiographic findings of an LSTV and clinical presentation underwent diagnostic injections to confirm diagnosis of Bertolotti's syndrome. Treatment was determined based on patient's LSTV classification. 157 patients with confirmed Bertolotti's syndrome underwent surgical treatment.ResultsOver 500 patients presented with an appropriate clinical presentation and radiographic findings of an LSTV. Diagnostic injections were targeted into the transitional anatomy confirming the LSTV as the primary pain generator to make the diagnosis of Bertolotti's syndrome. The decision in the type of surgical intervention, resection or fusion, was made based on patient's LSTV anatomy. 157 patients with confirmed Bertolotti's Syndrome underwent surgical treatment (121 fusions (77%), 36 resections (23%)). The classification system and surgical outcomes, in part, have been previously published in World Neurosurgery.ConclusionWe have outlined the best practice of diagnosis and treatment selection for Bertolotti's syndrome. We have shown significant improvement in outcomes based on this method. We hope to aid in both patient education and provide an outline on how clinicians can become knowledgeable on Bertolotti's syndrome.Conflicts of interestNo conflicts of interestSources of fundingNo funding obtained

Retraction of: Abstract 18128: How Long Should We Tilt?: Challenging the 10-Minute Cutoff in the Diagnosis of Postural Tachycardia Syndrome (POTS).

Retraction of: Abstract 18128: How Long Should We Tilt?: Challenging the 10-Minute Cutoff in the Diagnosis of Postural Tachycardia Syndrome (POTS).

Diagnostic accuracy of alternative biomarkers for acute aortic syndrome: a systematic review

BackgroundD-dimer is the only biomarker currently recommended in guidelines for the diagnosis of acute aortic syndrome (AAS). We undertook a systematic review to determine whether any alternative biomarkers could be...

Correlation of Imaging and Hemodynamic Findings with Clinical Outcomes for Diagnosis of Left Renal Vein Compression Syndrome.

Left renal vein compression syndrome (LRVCS) remains a challenging diagnosis. This study aimed to correlate imaging and hemodynamic findings with clinical outcomes for patients with LRVCS. A retrospective review of 66 renal venography procedures with or without intravascular ultrasound (IVUS) was performed from 2017 to 2023 at a single institution. Patients with prior LRVCS treatment or other indications were excluded (n = 11). Primary outcome measure was correlation of catheter-based endovascular (CBE) findings with clinical outcomes (n = 55). Secondary outcome measures included correlation of CBE findings and LRV (i.e., beak) angle > 32°, beak sign, aortomesenteric angle (AMA < 41°), and hilar-to-aortomesenteric ratio (HTAMR ≥ 4.9) on cross sectional imaging. Descriptive statistics, chi-square testing, and ROC analyses were used. Of the 55 patients, 52 (94.5%) were females (median age 31, range 14-72) and 56.4% (n = 31) had a diagnosis of LRVCS on CBE evaluation. A renocaval pressure gradient of ≥ 3mmHg, presence of collaterals, and > 50% area stenosis on IVUS were significantly associated with CBE diagnosis of LRVCS (p < 0.001). Surgical treatment (renal autotransplantation or LRV transposition) was recommended to all patients with CBE diagnosis of LRVCS (n = 31). 81.2% (18/22) of patients who underwent surgery reported symptom resolution or improvement. When the cross sectional imaging measurements were compared with CBE evaluation, AMA was the most sensitive (100%), HTAMR and beak sign were highly specific (93.3%), and beak angle was the most predictive (77.4% sensitivity; 86.7% specificity). CBE diagnosis of LRVCS was highly predictive of surgical candidacy and post-surgical symptom resolution. The presence of collaterals, > 50% area stenosis on IVUS, or a renocaval pressure gradient ≥ 3mmHg had a significant association with a CBE diagnosis of LRVCS.

An unusual case of HHV-8 negative, idiopathic, multicentric Castleman disease following chronic lymphocytic leukaemia

Background: Castleman disease is a rare condition characterised by polytypic lymphocytes proliferation and lymphadenopathy generally with a benign course. Whereas high grade lymphoma (Richter syndrome) is a classical complication seen in chronic lymphocytic leukaemia with a poor outcome, benign conditions mimicking this entity are infrequent. Case description: We describe the case of an 81-year-old Caucasian male who developed a human herpesvirus-8 (HHV-8)–negative, idiopathic multicentric Castleman disease (iMCD) following a treated Binet C chronic lymphocytic leukaemia (CLL). The clinical and radiological pattern raised initially the suspicion of a classical Richter transformation. Blood analysis showed auto-immune haemolytic anaemia and thrombocytopenia. He had normal immunoglobulin levels. The anatomopathological analysis of a cervical adenomegaly showed hypervascularisation and a polytypic plasmocytic proliferation compatible with a plasmocytic iMCD type. Interestingly, bone marrow examination showed reticuline fibrosis but, in the absence of anasarca or generalised oedema, we were not allowed to conclude to the diagnosis of a TAFRO syndrome. We exclude all other mimicking conditions, comprising haematological malignancies, infections, and auto-immune diseases He was first treated with corticosteroids with poor results but dramatically responded to tocilizumab (anti-Il6). Conclusion: To our knowledge, this the first case described of a Castleman disease following CLL and surprisingly mimicking Richter syndrome. Clinicians should be aware of this rare misleading condition.

Performance and Clinical Impact of Radiomics and 3D-CNN Models for the Diagnosis of Neurodegenerative Parkinsonian Syndromes on 18 F-FDOPA PET.

The aim of this study was to compare the performance and added clinical value of a semiautomated radiomics model and an automated 3-dimensinal convolutional neural network (3D-CNN) model for diagnosing neurodegenerative parkinsonian syndromes on 18 F-FDOPA PET images. This 2-center retrospective study included 687 patients with motor symptoms consistent with parkinsonian syndrome. All patients underwent 18 F-FDOPA brain PET scans, acquired on 3 PET systems from 2 different hospitals, and classified as pathological or nonpathological (by an expert nuclear physician). Artificial intelligence models were trained to replicate this medical expert's classification using 2 pipelines. The radiomics pipeline was semiautomated and involved manually segmenting the bilateral caudate and putamen nuclei; 43 radiomic features were extracted and combined using the support vector machine method. The deep learning pipeline was fully automatic and used a 3D-CNN model. Both models were trained on 417 patients and tested on an internal (n = 100) and an external (n = 170) test set. The final models' performance was evaluated using balanced accuracy and compared with that of a junior medical expert and nonexpert nuclear physician. On the internal test set, the 3D-CNN model outperformed the radiomic model with a balanced accuracy of 99% (vs 96%). It led to diagnostic performance similar to that of a junior medical expert (only 1 in 100 patients misclassified by both). On the external test set from a less experienced hospital, the 3D-CNN model allowed physicians to correctly reclassify the diagnosis of 10 out 170 patients (6%). The developed 3D-CNN model can automatically diagnose neurodegenerative parkinsonian syndromes, also reducing diagnostic errors by 6% in less-experienced hospitals.

European survey of diagnosis and management of the polycystic ovary syndrome: full report on the ESE PCOS Special Interest Group's 2023 Questionnaire.

Although polycystic ovary syndrome (PCOS) is a very common endocrinopathy, there are several issues related to this disorder which perplex clinicians in their everyday practice. To determine the current state of knowledge among European endocrinologists concerning the full spectrum of PCOS. An online survey comprising 41 items covering various aspects of PCOS diagnosis and management was distributed to members of the European Society of Endocrinology. A total of 505 European endocrinologists (64% females), with a mean age of 47 ± 11.6 years, participated in the survey. The Rotterdam criteria were the primary diagnostic tool for 85% of respondents. Most referrals (87.1%) occurred between ages 20 and 40 years. Twenty-five percent of physicians have access to mass spectrometry for the evaluation of androgen levels. While an extended metabolic profile was commonly employed as part of the workup, there was uncertainty regarding chronic anovulation diagnosis. Diabetes, including gestational or type 2, was recognized as a significant risk factor with universal screening irrespective of BMI status. Lifestyle modification and metformin were considered as standard interventions by all participants alongside oral contraceptives, though there was significant discrepancy in treatment duration. The Rotterdam diagnostic criteria are widely adopted for PCOS diagnosis among European endocrinologists. The current updated survey shows an emphasis on steroid profiling as an important part of diagnostic workup and a strong position held for recognition of PCOS as a metabolic condition with potentially serious implications. Current therapy thus shifted to the demand for prioritizing lifestyle interventions and metabolic therapies, either as monotherapy or in combination with standard hormone compounds.

Secondary Multiple Evanescent White Dot Syndrome Following Blunt Trauma.

To report a case of secondary unilateral MEWDS following blunt trauma to the eye. Observational case report of one patient. A 25-year-old male initially presented after being hit in the left eye with a football, with visual acuity of 20/50, traumatic iritis, commotio retinae, vitreous hemorrhage, and a large pigment epithelial detachment in the superior macula. He was lost to follow-up for two years before presenting with a sudden decrease in vision. On exam, best corrected VA (BCVA) was counting fingers and clinical exam demonstrated fibrosis in the superior macula, small white lesions around the optic disc and throughout the posterior pole, and ellipsoid zone disruption on OCT. Given the clinical appearance, a diagnosis of Multiple Evanescent White Dot Syndrome was made and the decision was made to observe. Two months later, without treatment, BCVA improved to 20/20, and there was resolution of the white lesions in the posterior pole as well as improved continuity of the ellipsoid zone on OCT. We describe a case of Multiple Evanescent White Dot Syndrome two years after blunt trauma to the eye; a far longer latency than previously reported cases of MEWDS secondary to blunt trauma.

Kawasaki disease with shock as the primary manifestation: How to distinguish from toxic shock syndrome?: A case report and literature review.

Kawasaki disease (KD) is a vasculitis syndrome of small to medium-sized arteries that has typical clinical characteristics such as fever, rash, cervical lymphadenopathy, conjunctivitis, and mucosal changes. Cardiac manifestations, including coronary artery aneurysms, myocarditis, myocardial infarction, and sudden cardiac death, are the most serious complications observed in KD. On rare occasions, it may accompanied with reduced organ perfusion due to systolic hypotension, a condition known as Kawasaki disease shock syndrome (KDSS). KDSS is a serious complication that can be presented to the emergency department as an initial feature when typical clinical symptoms of KD have not be detected. We report the case of a 12-year-old boy admitted with prolonged fever, bilateral non-purulent conjunctivitis, and signs of shock such as hypotension and tachycardia. Laboratory findings showed elevated inflammatory markers, hypoalbuminemia, and sterile pyuria. He was initially treated with intravenous cefotaxime and vancomycin considering the possible diagnosis of toxic shock syndrome, while the treatment was not effective. Subsequent chest computerized tomography and ultrasound identified pulmonary consolidation and polyserous effusion. Echocardiography revealed mild biatrial dilatation and mild valvular regurgitation with preserved left ventricular function. After a multidisciplinary consultation, a diagnosis of KDSS was made. To prevent coronary artery lesions and other severe complications, the patient immediately received immunoglobulin, corticoid, and acetylsalicylic acid. Soon afterwards, he showed significant improvement, with the temperature dropped to normal and hypotension corrected about 24 hours post-intravenous immunoglobulin therapy. Polyserous effusions also disappeared before discharge. Follow-up echocardiography revealed normal results. Clinicians should maintain a high index of suspicion for KD and consider pulmonary involvement and polyserous effusions as potential complications. For children with KD, any symptoms pointing to infection should be carefully considered. When there is no etiologic evidence, antibiotics should be used with caution. Our case also highlights the importance of considering KDSS as a differential diagnosis in children presenting with prolonged fever and shock. Early recognition, timely treatment, and close monitoring are key to preventing severe complications and ensuring favorable outcomes in patients with KDSS.

Expert consensus on diagnosis and treatment of Alagille syndrome associated liver disease (2024)

Expert consensus on diagnosis and treatment of Alagille syndrome associated liver disease (2024)

Delayed diagnosis of TAFRO syndrome: A case report.

TAFRO syndrome is a systemic inflammatory disorder, manifesting as thrombocytopenia (t), anasarca (a), fever (f), reticulin myelofibrosis/renal insufficiency (r), and organomegaly (o), and considered as a unique clinical subtype of idiopathic multicentric Castleman disease (iMCD). Such syndrome gave rise to a clinical picture similar to that of either a connective tissue disease or an autoimmune disease. A Chinese young female initially presenting with arthralgia, Raynaud phenomenon, generalized edema, and a positive anti-small nuclear ribonucleoprotein particle antibody was diagnosed as mixed connective tissue disease. The kidney biopsy showed thrombotic microangiopathy. Bone marrow smear showed bone marrow hyperplasia and biopsy revealed suspected light chain restricted expression, megakaryocyte proliferation, and moderate to severe bone marrow fibrosis. A lymph node biopsy was conducted and the histopathological findings were consistent with the subtype of mixed Castleman disease. The clinical symptoms were relieved after regular chemotherapy. After above examination results and clinical manifestations, the final diagnoses was TAFRO syndrome. The she was started on chemotherapy with bortezomib, cyclophosphamide, and dexamethasone. After chemotherapy, symptoms such as thrombocytopenia, hematuria and proteinuria disappeared, lymphadenopathy and VEGF level decreased, and bone marrow fibrosis relieved. Our case illustrated the first cases of shared characteristics of mixed connective tissue disease and iMCD-TAFRO syndrome. Cytokines may play a role in the shared pathogenicity of the iMCD-TAFRO syndrome and systemic autoimmune diseases. Therapy directly against inflammatory factors such as corticosteroids or chemotherapy have an important therapeutic implication.

The additional value of ultrasound markers in the diagnosis of polycystic ovary syndrome

ObjectiveTo study the value of current definitions for follicle number per ovary and ovarian volume in the diagnosis of polycystic ovary syndrome (PCOS). DesignCross-sectional study. SubjectsWomen diagnosed with PCOS after standardized screening were eligible for inclusion in the PCOS group. Women without PCOS who underwent the same screening, had regular menstrual cycles, normal hormonal values, and no other endocrine pathology were eligible for inclusion. Exposure: -Main Outcome measuresFollicle number per ovary and ovarian volume in women with PCOS, stratified by age. Linear regression models to investigate the influence of BMI on follicle number per ovary and ovarian volume. Differences of follicle number per ovary and ovarian volume between the PCOS phenotypes and the additional value of ovarian volume compared to follicle number per ovary. ResultsA total of 2492 women (16 – 50 years) with PCOS and 152 women without PCOS were included. Most women with PCOS up to age 35 exhibit a follicle number per ovary ≥ 20 (87.8 – 100%) (using an ultrasound transducer ≥ 8 MHz) or ≥ 12 (95.1 – 98.6%) (using a transducer < 8 MHz), followed by a decline in follicle number per ovary above the age of 35. Median ovarian volume was below the 10 mL cut-off in every age group, for both ultrasound transducers. Follicle number per ovary and ovarian volume was higher in women with PCOS compared to women without PCOS in every age category. In our cohort, 13/2297 women with PCOS (0.6%) would not have received the diagnosis if ovarian volume was not considered as a marker for polycystic ovarian morphology. For both ultrasound transducers, women with phenotype A (ovulatory dysfunction + hyperandrogenism + polycystic ovarian morphology) exhibited the highest follicle number per ovary and ovarian volume, followed by phenotype D (ovulatory dysfunction + polycystic ovarian morphology), then phenotype C (hyperandrogenism + polycystic ovarian morphology), and then phenotype B (ovulatory dysfunction + hyperandrogenism) (all p-values < 0.001 after adjusting for age). No clinically significant correlation between BMI and follicle number per ovary or ovarian volume was observed. ConclusionCriteria to define follicle number per ovary should be established per age category, as follicle number per ovary decreases with age. Ovarian volume shows a less clear decline with age and has a lower discriminative power, and therefore could be excluded from the diagnostic criteria. follicle number per ovary does not need to be stratified by BMI.

Oral Levodopa Stimulates Copeptin Secretion in Children and Adolescents with Intact Posterior Pituitary Function

BackgroundCopeptin stimulation tests can be used in the differential diagnosis of polyuria-polydipsia syndrome. Current stimulation methods rely on intravenous or subcutaneous administration. Oral stimulus can further simplify the diagnostic approach. The levodopa stimulation test is widely used in the evaluation of growth hormone deficiency, and the dopamine pathway was reported to be associated with arginine vasopressin secretion. This study aims to investigate the effect of oral levodopa on copeptin secretion. MethodsThis study was a prospective observational single-center cohort study. Patients <18 years old with short stature and no symptoms of polyuria or polydipsia undergoing the levodopa stimulation test for suspected growth hormone deficiency were recruited from May 2023 to Nov 2023. Copeptin and growth hormone were measured at 0, 30, 60, 90, and 120 min during the levodopa test. The insulin tolerance test with copeptin and growth hormone measured at the same time points was conducted in part of patients. ResultsForty-four participants were included in the final analysis. In the levodopa stimulation test, the median (interquartile range) copeptin concentration increased from 5.20 (3.51, 8.25) pmol/L to a maximum of 19.36 (8.97, 108.08) pmol/L (P < .001), 3.94 (1.41, 13.88) times that of the baseline (P < .001). Compared with the insulin tolerance test, peak copeptin in the levodopa test was significantly higher (34.61 [13.67, 98.96] vs 8.88 [7.14, 15.42] pmol/L, P = .009). Higher copeptin was associated with a larger dose of levodopa. ConclusionsOral levodopa could be used to stimulate copeptin.

Paraneoplastic Neurologic Disorders.

This article reviews the clinical presentations, neural antibody associations, and oncologic accompaniments of paraneoplastic neurologic syndromes and neurologic autoimmunity in the context of immune checkpoint inhibitor (ICI) cancer immunotherapy. Neural antibody discovery has improved the diagnosis of paraneoplastic neurologic syndromes. Neural antibodies also delineate the underlying disease pathophysiology and thus inform outcomes and treatments. Neural antibodies specific for extracellular proteins have pathogenic potential, whereas antibodies specific for intracellular targets are biomarkers of a cytotoxic T-cell immune response. A recent update in paraneoplastic neurologic syndrome criteria suggests high- and intermediate-risk phenotypes as well as neural antibodies to improve diagnostic accuracy in patients with paraneoplastic neurologic syndromes; a score was created based on this categorization. The introduction of ICI cancer immunotherapy has led to an increase in cancer-related neurologic autoimmunity with distinct clinical phenotypes. Paraneoplastic neurologic syndromes reflect an ongoing immunologic response to cancer mediated by effector T cells or antibodies. Paraneoplastic neurologic syndromes can present with manifestations at any level of the neuraxis, and neural antibodies aid diagnosis, focus cancer screening, and inform prognosis and therapy. In patients with high clinical suspicion of a paraneoplastic neurologic syndrome, cancer screening and treatment should be undertaken, regardless of the presence of a neural antibody. ICI therapy has led to immune-mediated neurologic complications. Recognition and treatment lead to improved outcomes.

The impact of metabolic syndrome on the cerebral cortex: a Mendelian randomization study.

Metabolic syndrome exhibits associations with diverse neurological disorders, and its potential influence on the cerebral cortex may be one of the many potential factors contributing to these adverse outcomes. In this study, we aimed to investigate the causal relationship between metabolic syndrome and changes in cerebral cortex structure using Mendelian randomization analysis. Genome-wide association study data for the 5 components of metabolic syndrome were obtained from individuals of European descent in the UK Biobank. Genome-wide association study data for 34 known cortical functional regions were sourced from the ENIGMA Consortium. Data on Alzheimer's disease, major depression, and anxiety disorder were obtained from the IEU Open genome-wide association study database. The causal links between metabolic syndrome elements and cerebral cortex architecture were evaluated using inverse variance weighting, Mendelian randomization-Egger, and weighted median techniques, with inverse variance weighting as the primary method. Inverse variance weighting, Mendelian randomization Egger, weighted median, simple mode, and weighted mode methods were employed to assess the relationships between metabolic syndrome and neurological diseases (Alzheimer's disease, major depression, and anxiety disorder). Outliers, heterogeneity, and pleiotropy were assessed using Cochran's Q test, MR-PRESSO, leave-one-out analysis, and funnel plots. Globally, no causal link was found between metabolic syndrome and overall cortical thickness or surface area. However, regionally, metabolic syndrome may influence the surface area of specific regions, including the caudal anterior cingulate, postcentral, posterior cingulate, rostral anterior cingulate, isthmus cingulate, superior parietal, rostral middle frontal, middle temporal, insula, pars opercularis, cuneus, and inferior temporal. It may also affect the thickness of the medial orbitofrontal, caudal middle frontal, paracentral, superior frontal, superior parietal, and supramarginal regions. These findings were nominally significant and withstood sensitivity analyses, showing no substantial heterogeneity or pleiotropy. Furthermore, we found an association between metabolic syndrome and the risk of Alzheimer's disease, major depression, and anxiety disorder. This study suggests a potential association between metabolic syndrome and changes in cerebral cortex structure, which may underlie certain neurological disorders. Furthermore, we found an association between metabolic syndrome and the risk of Alzheimer's disease, major depression, and anxiety disorder. Early diagnosis of metabolic syndrome holds significance in preventing these neurological disorders.

An Analysis of Surgeon Experience, Diagnostic Testing, and Treatment Recommendation For Carpal Tunnel Syndrome

The diagnosis of carpal tunnel syndrome (CTS) can be made clinically using the Carpal Tunnel Syndrome-6 (CTS-6) criteria. The role of electrodiagnostic studies (EDS) is controversial. We examined differences in the utilization of CTS-6 and EDS based on surgeon experience and practice setting. Members of the American Society for Surgery of the Hand were emailed an anonymous web-based link to participate. The survey included an assessment of hypothetical CTS scenarios with varying clinical severity. We collected surgeon demographic attributes, years in practice, practice setting, and frequency of CTS-6 and EDS utilization. A comparison was made of years of experience with surgeon-reported utilization of CTS-6 and EDS as well as treatment recommendation. We received 771 responses (25% response rate). Surgeons recommended carpal tunnel release (CTR) for patients without EDS (16%), normal EDS (33%), and abnormal EDS (90%). Fifty-three percent of surgeons with <15 years in practice reported often/always using CTS-6 criteria in their practice compared to 30% and 29% of surgeons with 16-30 years and > 30 years in practice, respectively. Surgeons with 16-30 and >30 years in practice had significantly lower odds of reporting often/almost always using CTS-6 relative to surgeons with 1-15 years in practice (OR 0.35 and 0.31, respectively). A greater proportion of surgeons with 16-30 years (68%) and >30 years (65.5%) in practice responded often/almost always applying EDS compared to surgeons with <15 years (56%) in practice. In addition, surgeons with 16-30 years and >30 years in practice had a higher odds of often/always using EDS (ORs 1.74 and 1.98, respectively) compared to surgeons with 1-15 years in practice (P < .05). Utilization of CTS-6 and EDS varied based on years in practice. This difference may reflect changing guidelines, the growing evidence regarding clinical assessment tools, and the emergence of other diagnostic modalities. Given the expense and invasiveness of EDS, opportunities to integrate clinical assessment tools readily into the diagnostic algorithm may shift the role of EDS toward selective utilization for complex clinical scenarios rather than for routine use.

Recurrent myocardial infarction in a patient with median arcuate ligament syndrome: a case report and literature review.

Median arcuate ligament (MAL) syndrome, otherwise known as celiac artery compression syndrome, is rare and is characterized by celiac artery compression by the median arcuate ligament. We report a unique case of MAL syndrome with recurrent myocardial infarction as the primary manifestation, and offer new pathophysiological insights. A man in his early 50s experienced recurrent upper abdominal pain, electrocardiographic changes, and elevated troponin concentrations, which suggested myocardial infarction. Contrast-enhanced computed tomography showed considerable celiac artery stenosis due to MAL syndrome. The patient was diagnosed with MAL syndrome and acute myocardial infarction. He declined revascularization owing to economic constraints, and opted to have conservative treatment with Chinese herbal extracts and medications. He succumbed to sudden cardiac death during a subsequent abdominal pain episode. The findings from this case show that MAL syndrome can present with recurrent myocardial infarction rather than typical intestinal angina symptoms. The pathophysiological link may involve intestinal and cardiac ischemia. An accurate diagnosis and appropriate management of MAL syndrome require careful evaluation and investigation.

Consensus Recommendations for Neurogenic Thoracic Outlet Syndrome from the INTOS Workgroup.

There is significant variation in methods used for diagnosis and treatment of neurogenic thoracic outlet syndrome (NTOS). The lack of definitions and criteria for diagnosis as well as controversy in treatment options hampers standardized reporting of outcomes. In the orthopedic and plastic hand surgery literature, there are not standardized guidelines to direct evidence-based practice for hand surgeons relating to NTOS. Hence, expert consensus may provide guidance for clinical practice. An international workgroup of 21 expert hand surgeons with cumulative experience of 5519 NTOS procedures was assembled. The Delphi method was used to arrive at consensus recommendations to guide diagnosis, treatment, surgery, and postoperative management of patients with NTOS. The workgroup achieved majority (greater than 75%) consensus with 17 statements. A modified version of the Society for Vascular Surgery clinical diagnostic criteria is recommended for diagnosis of NTOS. The elevated arm stress test and Tinel sign are recommended as provocative maneuvers. A cervical spine or chest radiograph should be routinely obtained preoperatively. Conservative management should be first line for NTOS, except in patients with significant muscle atrophy or weakness. An anterior supraclavicular approach is recommended for exposure of the supraclavicular brachial plexus, with the necessity for an additional infraclavicular approach or adjunctive surgeries indicated for specific patients. Standardized consensus guidelines help guide management of NTOS by specialized hand surgeons, with an aim toward standardizing criteria for diagnosis and treatment of patients as well as measures and tools used for research and reporting of outcomes.

Artificial Intelligence-Based Diagnosis of Obstructive Sleep Apnea Syndrome: A Scoping Review

Artificial Intelligence-Based Diagnosis of Obstructive Sleep Apnea Syndrome: A Scoping Review