Efficient photoanode with a MoS2/TiO2/Au nanoparticle heterostructure for ultraviolet-visible photoelectrocatalysis.

Green energy technology is generally becoming one of hot issues that need to be solved due to the adverse effects on the environment of fossil fuels. One of the strategies being studied and developed by theorists and experimentalists is the use of photoelectrochemical (PEC) cells, which are emerging as a candidate to produce hydrogen from water splitting. However, creating photoelectrodes that meet the requirements for PEC water splitting has emerged as the primary obstacle in bringing this technology to commercial fruition. Here, we construct a heterostructure, which consists of MoS2/TiO2/Au nanoparticles (NPs) to overcome the drawbacks of the photoanode. Owing to the dependence on charge transfer, the bandgap of MoS2/TiO2and the utilization the Au NPs as a stimulant for charges separation of TiO2by localized surface plasmon resonances effect as well as the increase of hot electron injection to cathode, leading to photocatalytic activities are improved. The results have recorded a significant increase in the photocurrent density from 2.3µAcm-2of TiO2to approximately 16.3µAcm-2of MoS2/TiO2/Au NPs. This work unveils a promising route to enhance the visible light adsorption and charge transfer in photo-electrode of the PEC cells by combining two-dimensional materials with metal NPs.

Layer-by-layer thinning of two-dimensional materials.

Etching technology - one of the representative modern semiconductor device makers - serves as a broad descriptor for the process of removing material from the surfaces of various materials, whether partially or entirely. Meanwhile, thinning technology represents a novel and highly specialized approach within the realm of etching technology. It indicates the importance of achieving an exceptionally sophisticated and precise removal of material, layer-by-layer, at the nanoscale. Notably, thinning technology has gained substantial momentum, particularly in top-down strategies aimed at pushing the frontiers of nano-worlds. This rapid development in thinning technology has generated substantial interest among researchers from diverse backgrounds, including those in the fields of chemistry, physics, and engineering. Precisely and expertly controlling the layer numbers of 2D materials through the thinning procedure has been considered as a crucial step. This is because the thinning processes lead to variations in the electrical and optical characteristics. In this comprehensive review, the strategies for top-down thinning of representative 2D materials (e.g., graphene, black phosphorus, MoS2, h-BN, WS2, MoSe2, and WSe2) based on conventional plasma-assisted thinning, integrated cyclic plasma-assisted thinning, laser-assisted thinning, metal-assisted splitting, and layer-resolved splitting are covered in detail, along with their mechanisms and benefits. Additionally, this review further explores the latest advancements in terms of the potential advantages of semiconductor devices achieved by top-down 2D material thinning procedures.

Percutaneous Disc Biopsy versus Bone Biopsy for the Identification of Infectious Agents in Osteomyelitis/Discitis.

PURPOSE: To determine whether sampling of the disc or bone is more likely to yield positive tissue culture results in patients with vertebral discitis and osteomyelitis (VDO). MATERIALS AND METHODS: Retrospective review was performed of consecutive patients who underwent vertebral disc or vertebral body biopsy at a single institution between February 2019 and May 2023. Inclusion criteria were age ≥18 years, presumed VDO on spinal magnetic resonance (MR) imaging, absence of paraspinal abscess, and technically successful percutaneous biopsy with fluoroscopic guidance. The primary outcome was a positive biopsy culture result, and secondary outcomes included complications such as nerve injury and segmental artery injury. RESULTS: Sixty-six patients met the inclusion criteria; 36 patients (55%) underwent disc biopsy, and 30 patients (45%) underwent bone biopsy. Six patients required a repeat biopsy for an initially negative culture result. No significant demographic, laboratory, antibiotic administration, or pain medication use differences were observed between the 2 groups. Patients who underwent bone biopsy were more likely to have a history of intravenous drug use (26.7%) compared with patients who underwent disc biopsy (5.5%; P = .017). Positive tissue culture results were observed in 41% of patients who underwent disc biopsy and 15% of patients who underwent bone biopsy (P = .016). No vessel or nerve injuries were detected after procedure in either group. CONCLUSIONS: Percutaneous disc biopsy is more likely to yield a positive tissue culture result than vertebral body biopsy in patients with VDO.

A facile paper-based chromatography coupled Au nanodendrite on nickel foam for application in separation and SERS measurement.

A simple paper-based chromatography coupling with nickel foam decorated Au nanodendrite (PP-AuND/NiF) was fabricated for simultaneous separation and surface-enhanced Raman scattering (SERS) detection of Rhodamine-6G (R6G) from a mixture of analytes. The three-dimensional porous nickel foam (NiF) was employed as a sampling diffusion platform, and AuND with a high surface active area beneficial for SERS efficiency was electro-deposited directly onto the NiF frame. The structure of AuND/NiF was characterized by X-ray diffraction and scanning electron microscopy. The AuND/NiF could detect R6G at 0.1 nM, and the enhancement factor was 1.84 x 106. The AuND/NiF was durable, with a slight signal decrease after 6 m of drop-testing. Also, upon three days of exposure to ambient air, the signal droped only 3.35 %. Subsequently, the PP-AuND/NiF was constructed by directly situating AuND/NiF on a paper strip, serving as a sample in and out to AuND/NiF. A mixture of two SERS active compounds, namely 2-Naphthalenethiol (2-NpSH) and Rhodamine 6G (R6G), was prepared in ethanol: water (1:1) solution to evaluate PP-AuND/NiF separation capability. Raman measurements along different distances of AuND/NiF were performed, and the signal of 2-NpSH was dismissed after 3.0 mm, while R6G's signals were observed throughout AuND/NiF. In general, the PP-AuND/NiF demonstrated effective separation and SERS measurement of analytes in a mixture, which could be applicable for more complex samples in the future, especially in clinical analysis.

Mechanism of chronic iatrogenic CSF leak following dural puncture-ventral dural leak: case report.

BACKGROUND: Postdural puncture headache has been traditionally viewed as benign, self-limited, and highly responsive to epidural blood patching (EBP) when needed. A growing body of data from patients experiencing unintended dural puncture (UDP) in the setting of attempted labor epidural placement suggests a minority of patients will have more severe and persistent symptoms. However, the mechanisms accounting for the failure of EBP following dural puncture remain obscure. An understanding of these potential mechanisms is critical to guide management decisions in the face of severe and persistent cerebrospinal fluid (CSF) leak. CASE PRESENTATION: We report the case of a peripartum patient who developed a severe and persistent CSF leak unresponsive to multiple EBPs following a UDP during epidural catheter placement for labor analgesia. Lumbar MRI revealed a ventral rather than dorsal epidural fluid collection suggesting that the needle had crossed the thecal sac and punctured the ventral dura, creating a puncture site not readily accessible to blood injected in the dorsal epidural space. The location of this persistent ventral dural defect was confirmed with digital subtraction myelography, permitting a transdural surgical exploration and repair of the ventral dura with resolution of the severe intracranial hypotension. CONCLUSIONS: A ventral rather than dorsal dural puncture is one mechanism that may contribute to both severe and persistent spinal CSF leak with resulting intracranial hypotension following a UDP.

A study of genetic variants associated with skin traits in the Vietnamese population.

BACKGROUND: Most skin-related traits have been studied in Caucasian genetic backgrounds. A comprehensive study on skin-associated genetic effects on underrepresented populations such as Vietnam is needed to fill the gaps in the field. OBJECTIVES: We aimed to develop a computational pipeline to predict the effect of genetic factors on skin traits using public data (GWAS catalogs and whole-genome sequencing (WGS) data from the 1000 Genomes Project-1KGP) and in-house Vietnamese data (WGS and genotyping by SNP array). Also, we compared the genetic predispositions of 25 skin-related traits of Vietnamese population to others to acquire population-specific insights regarding skin health. METHODS: Vietnamese cohorts of whole-genome sequencing (WGS) of 1008 healthy individuals for the reference and 96 genotyping samples (which do not have any skin cutaneous issues) by Infinium Asian Screening Array-24 v1.0 BeadChip were employed to predict skin-associated genetic variants of 25 skin-related and micronutrient requirement traits in population analysis and correlation analysis. Simultaneously, we compared the landscape of cutaneous issues of Vietnamese people with other populations by assessing their genetic profiles. RESULTS: The skin-related genetic profile of Vietnamese cohorts was similar at most to East Asian cohorts (JPT: Fst = 0.036, CHB: Fst = 0.031, CHS: Fst = 0.027, CDX: Fst = 0.025) in the population study. In addition, we identified pairs of skin traits at high risk of frequent co-occurrence (such as skin aging and wrinkles (r = 0.45, p = 1.50e-5) or collagen degradation and moisturizing (r = 0.35, p = 1.1e-3)). CONCLUSION: This is the first investigation in Vietnam to explore genetic variants of facial skin. These findings could improve inadequate skin-related genetic diversity in the currently published database.

Matched-pair analysis of patients with ischemic stroke undergoing thrombectomy using next-generation balloon guide catheters.

BACKGROUND: Balloon guide catheters (BGCs) have not been widely adopted, possibly due to the incompatibility of past-generation BGCs with large-bore intermediate catheters. The next-generation BGC is compatible with large-bore catheters. We compared outcomes of thrombectomy cases using BGCs versus conventional guide catheters. METHODS: We conducted a retrospective study of 110 thrombectomy cases using BGCs (n=55) and non-BGCs (n=55). Sixty consecutive thrombectomy cases in whom the BOBBY BGC was used at a single institution between February 2021 and March 2022 were identified. Of these, 55 BGC cases were 1:1 matched with non-BGC cases by proceduralists, age, gender, stent retriever + aspiration device versus aspiration-only, and site of occlusion. First-pass effect was defined as Thrombolysis In Cerebral Infarction 2b or higher with a single pass. RESULTS: The BGC and non-BGC cohorts had similar mean age (67.2 vs 68.9 years), gender distribution (43.6% vs 47.3% women), median initial National Institutes of Health Stroke Scale score (14 vs 15), and median pretreatment ischemic core volumes (12 mL vs 11.5 mL). BGC and non-BGC cases had similar rates of single pass (60.0% vs 54.6%), first-pass effect (58.2% vs 49.1%), and complications (1.8% vs 9.1%). In aspiration-only cases, the BGC cohort had a significantly higher rate of first-pass effect (100% vs 50.0%, p=0.01). BGC was associated with a higher likelihood of achieving a modified Rankin Scale score of 2 at discharge (OR 7.76, p=0.02). No additional procedural time was required for BGC cases (46.7 vs 48.2 min). CONCLUSION: BGCs may be safely adopted with comparable procedural efficacy, benefits to aspiration-only techniques, and earlier functional improvement compared with conventional guide catheters.

Metal-Induced Trap States: The Roles of Interface and Border Traps in HfO2/InGaAs.

By combining capacitance-voltage measurements, TCAD simulations, and X-ray photoelectron spectroscopy, the impact of the work function of the gate metals Ti, Mo, Pd, and Ni on the defects in bulk HfO2 and at the HfO2/InGaAs interfaces are studied. The oxidation at Ti/HfO2 is found to create the highest density of interface and border traps, while a stable interface at the Mo/HfO2 interface leads to the smallest density of traps in our sample. The extracted values of Dit of 1.27 × 1011 eV-1cm-2 for acceptor-like traps and 3.81 × 1011 eV-1cm-2 for donor-like traps are the lowest reported to date. The density and lifetimes of border traps in HfO2 are examined using the Heiman function and strongly affect the hysteresis of capacitance-voltage curves. The results help systematically guide the choice of gate metal for InGaAs.

Impact of an Underlying 2DEG on the Performance of a p-Channel MOSFET in GaN.

The influence of an underlying 2-dimensional electron gas (2DEG) on the performance of a normally off p-type metal oxide semiconductor field effect transistor (MOSFET) based on GaN/AlGaN/GaN double heterojunction is analyzed via simulations. By reducing the concentration of the 2DEG, a greater potential can be dropped across the GaN channel, resulting in enhanced electrostatic control. Therefore, to minimize the deleterious impact on the on-state performance, a composite graded back-to-back AlGaN barrier that enables a trade-off between n-channel devices and Enhancement-mode (E-mode) p-channel is investigated. In simulations, a scaled p-channel GaN device with LG = 200 nm, LSD = 600 nm achieves an ION of 65 mA/mm, an increase of 44.4% compared to a device with an AlGaN barrier with fixed Al mole fraction, ION/IOFF of ∼1012, and |Vth| of | - 1.3 V|. For the n-channel device, the back-to-back barrier overcomes the reduction of ION induced by the p-GaN gate resulting in an ION of 860 mA/mm, an increase of 19.7% compared with the counterpart with the conventional barrier with 0.5 V positive Vth shift.

Integrated Graphene Heterostructures in Optical Sensing.

Graphene-an outstanding low-dimensional material-exhibited many physics behaviors that are unknown over the past two decades, e.g., exceptional matter-light interaction, large light absorption band, and high charge carrier mobility, which can be adjusted on arbitrary surfaces. The deposition approaches of graphene on silicon to form the heterostructure Schottky junctions was studied, unveiling new roadmaps to detect the light at wider-ranged absorption spectrums, e.g., far-infrared via excited photoemission. In addition, heterojunction-assisted optical sensing systems enable the active carriers' lifetime and, thereby, accelerate the separation speed and transport, and then they pave new strategies to tune high-performance optoelectronics. In this mini-review, an overview is considered concerning recent advancements in graphene heterostructure devices and their optical sensing ability in multiple applications (ultrafast optical sensing system, plasmonic system, optical waveguide system, optical spectrometer, or optical synaptic system) is discussed, in which the prominent studies for the improvement of performance and stability, based on the integrated graphene heterostructures, have been reported and are also addressed again. Moreover, the pros and cons of graphene heterostructures are revealed along with the syntheses and nanofabrication sequences in optoelectronics. Thereby, this gives a variety of promising solutions beyond the ones presently used. Eventually, the development roadmap of futuristic modern optoelectronic systems is predicted.

DEEP MOVEMENT: Deep learning of movie files for management of endovascular thrombectomy.

OBJECTIVES: Treatment and outcomes of acute stroke have been revolutionised by mechanical thrombectomy. Deep learning has shown great promise in diagnostics but applications in video and interventional radiology lag behind. We aimed to develop a model that takes as input digital subtraction angiography (DSA) videos and classifies the video according to (1) the presence of large vessel occlusion (LVO), (2) the location of the occlusion, and (3) the efficacy of reperfusion. METHODS: All patients who underwent DSA for anterior circulation acute ischaemic stroke between 2012 and 2019 were included. Consecutive normal studies were included to balance classes. An external validation (EV) dataset was collected from another institution. The trained model was also used on DSA videos post mechanical thrombectomy to assess thrombectomy efficacy. RESULTS: In total, 1024 videos comprising 287 patients were included (44 for EV). Occlusion identification was achieved with 100% sensitivity and 91.67% specificity (EV 91.30% and 81.82%). Accuracy of location classification was 71% for ICA, 84% for M1, and 78% for M2 occlusions (EV 73, 25, and 50%). For post-thrombectomy DSA (n = 194), the model identified successful reperfusion with 100%, 88%, and 35% for ICA, M1, and M2 occlusion (EV 89, 88, and 60%). The model could also perform classification of post-intervention videos as mTICI < 3 with an AUC of 0.71. CONCLUSIONS: Our model can successfully identify normal DSA studies from those with LVO and classify thrombectomy outcome and solve a clinical radiology problem with two temporal elements (dynamic video and pre and post intervention). KEY POINTS: • DEEP MOVEMENT represents a novel application of a model applied to acute stroke imaging to handle two types of temporal complexity, dynamic video and pre and post intervention. • The model takes as an input digital subtraction angiograms of the anterior cerebral circulation and classifies according to (1) the presence or absence of large vessel occlusion, (2) the location of the occlusion, and (3) the efficacy of thrombectomy. • Potential clinical utility lies in providing decision support via rapid interpretation (pre thrombectomy) and automated objective gradation of thrombectomy outcomes (post thrombectomy).

Automated detection of arterial landmarks and vascular occlusions in patients with acute stroke receiving digital subtraction angiography using deep learning.

BACKGROUND: Digital subtraction angiography (DSA) is the gold-standard method of assessing arterial blood flow and blockages prior to endovascular thrombectomy. OBJECTIVE: To detect anatomical features and arterial occlusions with DSA using artificial intelligence techniques. METHODS: We included 82 patients with acute ischemic stroke who underwent DSA imaging and whose carotid terminus was visible in at least one run. Two neurointerventionalists labeled the carotid location (when visible) and vascular occlusions on 382 total individual DSA runs. For detecting the carotid terminus, positive and negative image patches (either containing or not containing the internal carotid artery terminus) were extracted in a 1:1 ratio. Two convolutional neural network architectures (ResNet-50 pretrained on ImageNet and ResNet-50 trained from scratch) were evaluated. Area under the curve (AUC) of the receiver operating characteristic and pixel distance from the ground truth were calculated. The same training and analysis methods were used for detecting arterial occlusions. RESULTS: The ResNet-50 trained from scratch most accurately detected the carotid terminus (AUC 0.998 (95% CI 0.997 to 0.999), p<0.00001) and arterial occlusions (AUC 0.973 (95% CI 0.971 to 0.975), p<0.0001). Average pixel distances from ground truth for carotid terminus and occlusion localization were 63±45 and 98±84, corresponding to approximately 1.26±0.90 cm and 1.96±1.68 cm for a standard angiographic field-of-view. CONCLUSION: These results may serve as an unbiased standard for clinical stroke trials, as optimal standardization would be useful for core laboratories in endovascular thrombectomy studies, and also expedite decision-making during DSA-based procedures.

A case of Citrobacter koseri renal abscess and review of the literature.

Citrobacter species are anaerobic gram-negative bacteria that are known to cause infections in immunocompromised hosts, particularly in hospital settings. Their opportunistic nature and tendency to develop antibiotic resistance make Citrobacter species challenging to treat. Renal or perinephric abscess formation as a result of Citrobacter infection is uncommon, having only previously been reported in four cases. We present a case of a 70-year-old man with diabetes and prostate cancer who was diagnosed with an 18 cm perinephric and a 10 cm perihepatic abscess caused by Citrobacter koseri. The patient required drains and re-positioning of the drains multiple times in addition to a prolonged course of antibiotics to achieve complete radiographic resolution. This case highlights the challenges in treating renal and perinephric abscess, as it required drain re-placements two additional times after the initial placement and an additional 4 weeks of antibiotics. Successful treatment for larger abscesses usually requires a two-arm approach, with antibiotics in combination with either percutaneous or surgical abscess drainage.

Origins of the Schottky Barrier to a 2DHG in a Au/Ni/GaN/AlGaN/GaN Heterostructure.

We report the influence of thickness of an undoped GaN (u-GaN) layer on current transport to a 2DHG through the metal/p++GaN contact in a GaN/AlGaN/GaN heterostructure. The current is dominated by an internal potential barrier of 0.2-0.27 eV at the p+ GaN/u-GaN, which increases with thickness from 5 to 15 nm and remains constant thereafter due to Fermi pinning by a defect at ∼0.6 eV from the top valence band. We also report a nonideality factor, n, between 6 and 12, for the combined tunneling current through the p+GaN/u-GaN to the 2DHG. Our contact resistivity of 5.3 × 10-4 Ω cm2 and hole mobility, µ, of ∼15.65 cm2/V s are the best-in-class for this metal stack on a GaN/AlGaN/GaN heterostructure, reported to date.

Rethinking Clinical Trial Radiology Workflows and Student Training: Integrated Virtual Student Shadowing Experience, Education, and Evaluation.

There is consistent demand for clinical exposure from students interested in radiology; however, the COVID-19 pandemic resulted in fewer available options and limited student access to radiology departments. Additionally, there is increased demand for radiologists to manage more complex quantification in reports on patients enrolled in clinical trials. We present an online educational curriculum that addresses both of these gaps by virtually immersing students (radiology preprocessors, or RPs) into radiologists' workflows where they identify and measure target lesions in advance of radiologists, streamlining report quantification. RPs switched to remote work at the beginning of the COVID-19 pandemic in our National Institutes of Health (NIH). We accommodated them by transitioning our curriculum on cross-sectional anatomy and advanced PACS tools to a publicly available online curriculum. We describe collaborations between multiple academic research centers and industry through contributions of academic content to this curriculum. Further, we describe how we objectively assess educational effectiveness with cross-sectional anatomical quizzes and decreasing RP miss rates as they gain experience. Our RP curriculum generated significant interest evidenced by a dozen academic and research institutes providing online presentations including radiology modality basics and quantification in clinical trials. We report a decrease in RP miss rate percentage, including one virtual RP over a period of 1 year. Results reflect training effectiveness through decreased discrepancies with radiologist reports and improved tumor identification over time. We present our RP curriculum and multicenter experience as a pilot experience in a clinical trial research setting. Students are able to obtain useful clinical radiology experience in a virtual learning environment by immersing themselves into a clinical radiologist's workflow. At the same time, they help radiologists improve patient care with more valuable quantitative reports, previously shown to improve radiologist efficiency. Students identify and measure lesions in clinical trials before radiologists, and then review their reports for self-evaluation based on included measurements from the radiologists. We consider our virtual approach as a supplement to student education while providing a model for how artificial intelligence will improve patient care with more consistent quantification while improving radiologist efficiency.

Radiosurgery as a microsurgical adjunct: outcomes after microsurgical resection of intracranial arteriovenous malformations previously treated with stereotactic radiosurgery.

OBJECTIVE: Microsurgical resection of arteriovenous malformations (AVMs) can be aided by staged treatment consisting of stereotactic radiosurgery followed by resection in a delayed fashion. This approach is particularly useful for high Spetzler-Martin (SM) grade lesions because radiosurgery can reduce flow through the AVM, downgrade the SM rating, and induce histopathological changes that additively render the AVM more manageable for resection. The authors present their 28-year experience in managing AVMs with adjunctive radiosurgery followed by resection. METHODS: The authors retrospectively reviewed records of patients treated for cerebral AVMs at their institution between January 1990 and August 2019. All patients who underwent stereotactic radiosurgery (with or without embolization), followed by resection, were included in the study. Of 1245 patients, 95 met the eligibility criteria. Univariate and multivariate regression analyses were performed to assess relationships between key variables and clinical outcomes. RESULTS: The majority of lesions treated (53.9%) were high grade (SM grade IV-V), 31.5% were intermediate (SM grade III), and 16.6% were low grade (SM grade I-II). Hemorrhage was the initial presenting sign in half of all patients (49.5%). Complete resection was achieved among 84% of patients, whereas 16% had partial resection, the majority of whom received additional radiosurgery. Modified Rankin Scale (mRS) scores of 0-2 were achieved in 79.8% of patients, and 20.2% had poor (mRS scores 3-6) outcomes. Improved (44.8%) or stable (19%) mRS scores were observed among 63.8% of patients, whereas 36.2% had a decline in mRS scores. This includes 22 patients (23.4%) with AVM hemorrhage and 6 deaths (6.7%) outside the perioperative period but prior to AVM obliteration. CONCLUSIONS: Stereotactic radiosurgery is a useful adjunct in the presurgical management of cerebral AVMs. Multimodal therapy allowed for high rates of AVM obliteration and acceptable morbidity rates, despite the predominance of high-grade lesions in this series of patients.

Genome Sequencing and Apoptotic Markers to Assess Treatment Response of Lacrimal Gland Adenoid Cystic Carcinoma to Intra-Arterial Cytoreductive Chemotherapy.

Adenoid cystic carcinoma of the lacrimal gland is an aggressive, malignant epithelial neoplasm. We report the case of a 30-year-old male with lacrimal gland adenoid cystic carcinoma treated with neoadjuvant intra-arterial chemotherapy through the internal carotid artery, followed by orbital exenteration and chemoradiation. Treatment response was evaluated using a novel combination of pre- and posttreatment genome sequencing coupled with immunohistochemical evaluation, which showed diffuse tumor apoptosis. A posttreatment decrease in variant allele frequency of the NOTCH1 mutation, and robust tumor cytoreduction on imaging, supports exploration of NOTCH1 analysis as a potential marker of cisplatin sensitivity. The use of genome sequencing and immunohistochemical evaluation could provide a more targeted therapeutic assessment of neoadjuvant intra-arterial chemotherapy in the management of lacrimal gland adenoid cystic carcinoma.

Comparison of embolization strategies for mixed plexiform and fistulous brain arteriovenous malformations: a computational model analysis of theoretical risks of nidus rupture.

BACKGROUND: High-flow fistulas related to plexiform nidi are found in 40% of large brain arteriovenous malformations (AVMs). Endovascular occlusion of intranidal fistulas before plexiform components is empirically considered safe, but potential ensuing dangerous re-routing of flow through plexiform vessels may in theory raise their rupture risk. It remains unclear whether it is safer to embolize plexiform or fistulous vessels initially. We used a novel biomathematical AVM model to compare theoretical hemodynamic changes and rupture risks on sequential embolizations of both types of nidus vessels. METHODS: We computationally modeled a theoretical AVM as an electrical circuit containing a nidus consisting of a massive stochastic network ensemble comprising 1000 vessels. We sampled and individually simulated 10 000 different nidus morphologies with a fistula angioarchitecturally isolated from its adjacent plexiform nidus. We used network analysis to calculate mean intravascular pressure (Pmean) and flow rate within each nidus vessel; and Monte Carlo analysis to assess overall risks of nidus rupture when simulating sequential occlusions of vessel types in all 10 000 nidi. RESULTS: We consistently observed lower nidus rupture risks with initial fistula occlusion in different network morphologies. Intranidal fistula occlusion simultaneously reduced Pmean and flow rate within draining veins. CONCLUSIONS: Initial occlusion of AVM fistulas theoretically reduces downstream draining vessel hypertension and lowers the risk of rupture of an adjoining plexiform nidus component. This mitigates the theoretical concern that fistula occlusion may cause dangerous redistribution of hemodynamic forces into plexiform nidus vessels, and supports a clinical strategy favoring AVM fistula occlusion before plexiform nidus embolization.

Fatal autoimmune pneumonitis requiring bilobectomy and omental flap repair in a patient with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED).

We present a severe case of progressive autoimmune pneumonitis requiring surgical intervention in a patient with the monogenic syndrome, autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED). APECED is caused by loss-of-function mutations in the autoimmune regulator (AIRE) gene, which lead to impaired central immune tolerance and autoimmune organ destruction including pneumonitis, an underrecognized, life-threatening complication. When clinicians evaluate patients with pneumonitis, recurrent mucosal candidiasis, and autoimmunity, APECED should be considered in the differential. Additionally, in patients with established APECED, a chest computed tomography is preferred to identify pneumonitis early on and to promptly initiate lymphocyte-directed immunomodulatory treatment, which can prevent irreversible lung destruction.

Arteriovenous Malformations-Current Understanding of the Pathogenesis with Implications for Treatment.

Arteriovenous malformations are a vascular anomaly typically present at birth, characterized by an abnormal connection between an artery and a vein (bypassing the capillaries). These high flow lesions can vary in size and location. Therapeutic approaches are limited, and AVMs can cause significant morbidity and mortality. Here, we describe our current understanding of the pathogenesis of arteriovenous malformations based on preclinical and clinical findings. We discuss past and present accomplishments and challenges in the field and identify research gaps that need to be filled for the successful development of therapeutic strategies in the future.