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Progressive supranuclear palsy (PSP) is an adult-onset neurodegenerative disorder characterized by postural instability, ocular motor dysfunction, akinesia, and cognitive impairment. The accumulation of tau protein disrupts microtubule dynamics and axonal transport, leading to neurodegeneration in subcortical structures such as the basal ganglia and brainstem. These effects result in the clinical features of motor dysfunction and cognitive impairment associated with PSP. Dementia in patients with PSP is common but may be difficult to diagnose. This narrative review describes the cognitive decline and dementia associated with PSP. The pathological hallmarks of PSP, clinical features, and diagnostic criteria are also discussed to provide additional context for the diagnosis of PSP dementia.
The esophagogastric junction contractile integral (EGJ-CI) is a manometric parameter used to assess EGJ function. EGJ-CI must be manually calculated using a multi-step process. An earlier metric, the lower esophageal sphincter pressure integral (LESPI), is conceptually similar to EGJ-CI, but has a more straightforward calculation algorithm. This study aimed at proposing a new, easier to calculate metric, the modified EGJ-CI (m-EGJ-CI) and to compare its fidelity to EGJ-CI. After Institutional Review Board (IRB) approval, we conducted a cross-sectional study. High-resolution manometry studies performed between February 2018 and October 2024 at our center were retrieved. Patients with prior foregut procedures, distal esophageal spasm, hypercontractile esophagus, EGJ outflow disorders, hiatal hernias > 5 cm and lung transplant candidates/recipients were excluded. An experienced interpreter calculated the EGJ-CI and m-EGJ-CI for each study. Correlations were assessed using Spearman’s rank coefficient. The complexity of each parameter was estimated based on the calculation time required. Studies from 84 patients (58 women [69
PURPOSE:The purpose of this study was to compare the clinical outcomes, radiographs, and complications of radial head arthroplasty in patients with concomitant Monteggia or transolecranon fracture dislocations to patients with isolated radial head fractures. METHODS:A retrospective cohort comparison was performed, identifying unreconstructible radial head fractures that were treated with radial head arthroplasty. Patients >18 years of age with at least 1 year of follow-up were included. Patients with Monteggia or transolecranon fracture dislocations were matched by age (within 5 years), sex, and smoking status to patients with isolated radial head fractures for comparison. Outcome measures included range of motion, patient-reported outcome scores, complications, and reoperation rates. RESULTS:A total of 58 patients with a Monteggia (n = 38) or transolecranon fracture dislocation (n = 20) met the inclusion criteria and were matched to 58 patients with isolated radial head fractures. Clinical outcomes were similar across all three groups in range of motion and patient-reported outcome scores. There were significantly more complications and reoperations in the Monteggia and transolecranon fracture dislocation groups compared with the isolated radial head fracture group. Functional stiffness (flexion less than 30°-130°) and hardware irritation were more common in the Monteggia and transolecranon groups. Additionally, a higher incidence of ulnohumeral arthritis was identified in patients with transolecranon fractures (grades 3-4, 25%). CONCLUSIONS:There were similar functional outcomes achieved in patients who underwent radial head arthroplasty in Monteggia and transolecranon fracture dislocations compared with isolated radial head fractures. The Monteggia and transolecranon groups had a higher incidence of complications and higher rates of reoperation, specifically hardware irritation and elbow stiffness requiring removal of hardware (proximal ulna plate) and contracture release, respectively. TYPE OF STUDY/LEVEL OF EVIDENCE:Prognostic IV.
BACKGROUND:Donor lung procurement and preservation is critical for lung transplantation success. Unfortunately, the large variability in techniques impacts organ utilization rates and transplantation outcomes. Compounding this variation, recent developments in cold static preservation and new technological advances with machine perfusion have increased the complexity of the procedure. The objective of the American Association for Thoracic Surgery (AATS) Clinical Practice Standards Committee (CPSC) expert panel was to make evidence-based recommendations for best practices in donor lung procurement and preservation based on review of the existing literature. METHODS:The AATS CPSC assembled an expert panel of 16 lung transplantation surgeons from 14 centers who developed a consensus document of recommendations. The panel was divided into 7 subgroups covering (1) intraoperative donor assessment, (2) surgical techniques, (3) ex situ static lung preservation methods, (4) hypothermic preservation, (5) normothermic ex vivo lung perfusion (EVLP), (6) donation after circulatory death (DCD) and normothermic regional perfusion, and (7) donor management centers, organ assessment centers, and third-party procurement teams. Following a focused literature review, each subgroup formulated recommendation statements for each subtopic, which were reviewed and further refined using a Delphi process until a 75% consensus was achieved on each final statement by the voting group. RESULTS:The expert panel achieved consensus on 34 recommendations for current best practices in donor lung procurement and preservation both in brain-dead as well as DCD donation. The use of new methods of cold preservation, the role of EVLP, and DCD with and without concomitant heart donation are described in detail. CONCLUSIONS:Consistent and best practices in donor lung procurement and preservation are critical to improve both lung transplantation numbers as well as recipient outcomes. The recommendations described here provide guidance for professionals involved in the care of patients with end-stage lung disease considered for transplantation.
Postoperative pain remains a common concern following ventral hernia repair (VHR), especially for open procedures. We aim to assess the effectiveness of the Transversus Abdominis Plane (TAP) block for the management of postoperative pain following VHR. Cochrane, EMBASE, and PubMED, MEDLINE, and Web of Science were systematically searched for studies comprising adults undergoing VHR with preoperative TAP block, compared to placebo and epidural analgesia. The outcomes selected for analysis were postoperative pain with the numeric rating scale (NRS), postoperative morphine milligram equivalents (MME) per day, and hospital length of stay (LOS). Subgroup analysis was performed for studies using the Liposomal Bupivacaine (Exparel®) for TAP block. 1,460 results were screened, and 14 included, comprising 9 retrospective cohort studies and 5 RCTs, totaling 1,617 patients. TAP block was associated with a shorter LOS compared to conventional pain measures (MD -1,14 days; 95
