Circle of Willis Variations and Features in an American Midwestern Cadaver Population

Background: The Circle of Willis (CoW) is a critical cerebral arterial network. This study investigates CoW variants in a Midwestern U.S. cadaveric population. Methods: The CoWs of 25 formalin-fixed human cadavers were evaluated with vessel measurements obtained through ImageJ software. Variations were classified per a previously published system with R Studio statistical analysis, including comparisons by sex and body mass index (BMI). Results: A typical CoW configuration was identified in 2 of 25 specimens (8 %), with the remaining 92 % demonstrating anatomical variants. The most common variations were unilateral hypoplasia (38.3 %), bilateral hypoplasia (21.3 %), and duplications (12.8 %). Variations most commonly involved the posterior communicating artery (73.9 %; PComA; especially PComA hypoplasia), the anterior communicating artery (60.9 %; AComA), and the anterior cerebral artery (52.2 %). Rare anatomical variants included quadruplication of the A2 segment, fetal-type PComA, and AComA aplasia. Males exhibited significantly greater vessel diameters and lengths across most segments, except for PComA diameter, which was larger in females (p \u3c 0.05). Non- overweight body mass index (BMI \u3c 25) correlated positively with the diameter of the extra triplicated A2, and increased BMI ( ≥ 25) showed a significant increase in the right A1 ACA diameter (p \u3c 0.05). No statistically significant differences were observed in arterial lengths. Conclusions: This study highlights the high prevalence of CoW anatomical variations in the Midwestern population, including several distinctive variants, adding to the literature. Significant differences based on sex and BMI were identified, suggesting potential implications for neurosurgical and vascular surgery considerations. Further research with additional cohorts is necessary to validate and expand upon these observations

Sensitivity and Specificity of Natural Language Processing Systems for Identification of Hospitalized People Who Use Drugs

Background: People who use drugs (PWUD) often lack access to optimal harm reduction and substance use disorder treatment tools. Tracking the epidemiology of acute care utilization by PWUD is crucial to improving systems of care. Chart reviews and International Classification of Diseases (ICD) codes are the most common systems of identifying hospitalizations of PWUD but are limited by high labor costs and inaccuracy. This study evaluates whether natural language processing (NLP) enhances the sensitivity and specificity of ICD-10 codes in identifying hospitalizations of PWUD. Methods: We analyzed admissions at Tufts Medical Center between 2018 and 2023. Two NLP tools (Regular Expression and Open Health NLP Toolkit) were developed to identify PWUD and were compared with ICD-10 algorithms. The NLP and ICD-10 algorithms were applied to all admissions, and demographic and hospitalization-related data were extracted. The research team manually reviewed notes written during 790 hospitalizations of PWUD as the gold standard. We calculated sensitivity, specificity, and net reclassification indices. Results: ICD-10 codes alone demonstrated low sensitivity (43%) but high specificity (99%). Adding NLP systems improved sensitivity up to 94%, though specificity decreased to 46%. Threshold adjustments (eg, notes flagged ≥50%) revealed a trade-off between sensitivity (47%) and specificity (96%). The most practical model-Regular Expression or ICD-10 codes-resulted in a sensitivity of 74% and specificity of 87%. Conclusions: NLP is an innovative tool that can create functional, cost-effective, and accurate systems of identifying hospitalized PWUD. These findings support further development of NLP technologies to improve health care equity for PWUD

Seashore

Samsung Galaxy S2

Serial Irrigation and Debridement with the Use of Kerecis in the Treatment of Necrotizing Fasciitis: A Case Report

Introduction: Necrotizing fasciitis is a life-threatening infection that requires emergent irrigation and radical debridement. One of the challenges surgeons often encounter is gaining adequate soft tissue coverage of the defects that remain after debridement. Kerecis SurgiClose (Coloplast, Denmark), a fish skin xenograft, is one option for wound coverage. This has demonstrated potential for fostering an environment beneficial for wound healing in various types of wounds. Case presentation: A 39-year-old female presented to the emergency department with a one-week history of left knee pain after a fall. She had a wound on the anterior knee, which began to develop erythema. Necrotizing fasciitis was diagnosed with the patient’s Laboratory Risk Indication of Necrotizing Fasciitis (LRINEC) score of 10. She was started on antibiotics and was taken to surgery. She underwent debridements until a bed of healthy tissue was appreciated. Kerecis SurgiClose was applied over the defect which helped create a healthy tissue bed prior to placing a skin autograft. After grafting, daily dressing changes started and evident healing in the recipient site was seen. Conclusion: This case demonstrates the importance of early diagnosis of necrotizing fasciitis, as well as the utility of fish xenografts in wound coverage once a healthy tissue environment is established. These xenografts are used for many types of wounds, however there is a paucity in the literature supporting their use in necrotizing soft tissue infections. The properties of these grafts potentiate various aspects of healing and show promising results in the healing of deep soft tissue voids

Between Earth and Sky 4

Nikon D560

Kenya Series 2

Canon EOS Rebel T7 with an 18-55mm len

Aurora in Joplin MO

Canon 2000