Purpose: Acute intracranial internal carotid artery (ICA) occlusion has high clot burden and poor outcomes. No consensus exists on optimal first-line mechanical thrombectomy (MT) using direct aspiration first pass technique (ADAPT), stent retriever (SR) alone, or combined thrombectomy (non-ADAPT). We compared outcomes between ADAPT and non-ADAPT strategies for ICA occlusion. Materials and Methods: Data were collected from a comprehensive stroke center between January 2019 and August 2024. Patients with intracranial ICA occlusions were divided into ADAPT and non-ADAPT groups. Demographic, clinical, angiographic, and clinical outcomes (National Institute of Health Stroke Scale [NIHSS] score at 24 hours and modified Rankin Scale [mRS] score at 3 months) were compared. Good functional outcome was defined as a mRS score of 0–2. Results: Of 85 patients (mean age, 75 years; 47% females), 60 (70.6%) received ADAPT and 25 (29.4%) non-ADAPT (18 with aspiration and SR combined and 7 with SR alone). ADAPT achieved successful recanalization with shorter procedure time (median, 32 minutes vs. 60 minutes, P=0.001), higher modified Treatment In Cerebral Ischemia (mTICI) recanalization rates (final mTICI 2c-3, 75% vs. 52%; P=0.038; mTICI 2b-3, 98.3% vs. 88%; P=0.074), and better outcomes at 3 months (mRS ≤2, 47% vs. 22%; P=0.039). Multivariate analysis showed NIHSS at discharge as the only significant predictor of good functional outcome at 3 months (odds ratio [OR] 0.68, P<0.001), while ADAPT exhibited a trend toward significance (OR 5.10, P=0.075). Conclusion ADAPT exceeded other strategies for intracranial ICA occlusion as first-line technique, achieving faster recanalization and potentially impacting long-term functional outcome.

Methods: This retrospective cohort study evaluated adult civilian patients (≥18 years) treated for spinal gunshot wounds at Latin American institutions between 2014 and 2022. Demographic, clinical, and injury characteristics, treatment approaches, and infectious complications were analyzed. Results: After exclusions, 292 patients, primarily adult males (n=251, 86.0%) with a mean age of 32.6 years (standard deviation=11), were included. Most injuries affected the thoracic (n=135; 46.2%) and lumbosacral (n=95; 32.5%) spine. Infectious complications occurred in 20 patients (6.8%), including spinal infections (n=3; 1.0%), non-spinal infections (n=6; 2.1%), and wound infections (n=11; 3.8%). Most patients received prolonged antibiotic prophylaxis. The median duration of antibiotic administration was significantly increased in patients with dirty wounds (p<0.001) and high-velocity injuries (p=0.001). However, the duration of antibiotic administration did not influence spinal infection rates. Conclusions Our findings indicate a low incidence (1%) of spinal infections among patients with spinal gunshot wounds. Prolonged antibiotic use failed to reduce the risk of spinal infectious complications. Standardized guidelines for antibiotic prophylaxis in these injuries remain necessary to optimize care.

Chronic wounds have traditionally been classified based on their etiology (venous ulcers, diabetic ulcers, pressure ulcers, etc.), reinforcing a reductionist perspective of the problem. However, this fragmented model has undermined understanding of their common pathophysiology and standardizing management approaches. From a medical epistemology standpoint, the evolution of pathological concepts has demonstrated that many syndromes were initially considered heterogeneous disorders until their underlying commonality became evident (e.g., metabolic syndrome, systemic inflammatory response syndrome). This review discusses and supports the proposition that chronic wounds should be conceptualized within a syndromic framework, wherein a shared set of pathophysiological processes underlies their diverse clinical manifestations, prompting a move beyond etiological reductionism. This proposition is supported by three epistemological arguments: biological, clinical, and practical. Through an analysis of fundamental syndromic principles, relevant examples illustrate this novel perspective. Ultimately, this proposition aims to advance a comprehensive and multi-level approach to chronic wound care, emphasizing multidimensional therapies that facilitate optimal, timely, and cost-effective outcomes. Such a conceptual shift would enable the integration of therapeutic strategies, the development of cross-cutting biomarkers, improved prediction of treatment responses, and greater consensus in research.

Scientific publishing faces growing challenges from rapid technological change, artificial intelligence (AI), research integrity concerns, and resource limitations, particularly in low- and middle-income countries. Editors, authors, and peer reviewers must navigate increasingly complex editorial requirements while operating within constrained institutional and financial environments. The emergence of AI-generated content and fabricated citations further threatens scholarly integrity and adds to editorial burdens. The unique challenges confronting regional journals necessitate strengthening editorial capacity, ethical governance, reviewer competency, and requires collaborative effort to sustain scientific publication that is relevant to the region.

Scientific publishing faces growing challenges from rapid technological change, artificial intelligence (AI), research integrity concerns, and resource limitations, particularly in low- and middle-income countries. Editors, authors, and peer reviewers must navigate increasingly complex editorial requirements while operating within constrained institutional and financial environments. The emergence of AI-generated content and fabricated citations further threatens scholarly integrity and adds to editorial burdens. The unique challenges confronting regional journals necessitate strengthening editorial capacity, ethical governance, reviewer competency, and requires collaborative effort to sustain scientific publication that is relevant to the region.

Purpose: Cardiovascular disease (CVD) is more prevalent in men than women, but the mechanisms responsible for this are not fully understood. We aimed to evaluate differences in trimethylamine (TMA), a microbial metabolite and its oxidized form, trimethylamine N-oxide (TMAO), which is thought to promote atherosclerosis, between men and women with coronary heart disease (CHD), using as a reference a non-CVD population. Materials and Methods: This study was carried out within the framework of the CORDIOPREV study (NCT00924937; June 19, 2009), a clinical trial which included 827 men and 175 women with CHD, with a non-CVD population of 375 individuals (270 men and 105 women) as a reference group. Plasma TMA and TMAO were measured by HPLC-MS/MS. The carotid study was ultrasonically assessed bilaterally by the quantification of intima-media thickness of both common carotid arteries (IMT-CC). Results: We found higher TMAO levels and TMAO/TMA ratio in CHD men than CHD women (p=0.034 and p=0.026, respectively). No TMA sex differences were found in CHD patients. The TMA and TMAO levels and TMAO/TMA ratio were lower, and no differences between sexes were found in the non-CVD population. TMAO levels in CHD patients were consistent with higher IMT-CC and more carotid plaques (p=0.032 and p=0.037, respectively) and lower cholesterol efflux in CHD men than CHD women (p<0.001). Conclusions Our results suggest that CHD men have augmented TMAO levels compared with CHD women, presumably as a consequence of higher rate of TMA to TMAO oxidation, which could be associated with CVD, as these sex differences are not observed in a non-CVD population.

An infected aortic aneurysm (IAA) is a rare but potentially life-threatening pathology characterized by rapid growth and a substantial risk of rupture compared to non-infected aneurysms. Reports on the endovscular treatment of infected paravisceral aneurysms are limited in the literature. This article describes our experience with endovascular repair of IAAs involving the visceral arteries and includes a literature review. We present two cases of symptomatic IAAs located at the celiac trunk ostium in high-risk surgical patients. Both cases were successfully treated with the parallel stent grafting (PG) technique in combination with prolonged antibiotic therapy. A bibliographic review of the endovascular treatment of IAAs was also conducted. Complex endovascular repair of paravisceral IAAs using a combination of a thoracic aortic stent graft and PG, together with prolonged antibiotic therapy, appears to be a reasonable treatment option with promising short- and medium-term results.

Background and Objectives: The risk profiles, procedural characteristics, and clinical outcomes for women undergoing bifurcation percutaneous coronary intervention (PCI) are not well defined compared to those in men. Methods: COronary BIfurcation Stenting III (COBIS III) is a multicenter, real-world registry of 2,648 patients with bifurcation lesions treated with second-generation drug-eluting stents.We compared the angiographic and procedural characteristics and clinical outcomes based on sex. The primary outcome was 5-year target lesion failure (TLF), a composite of cardiac death, myocardial infarction, and target lesion revascularization. Results: Women (n=635, 24%) were older, had hypertension and diabetes more often, and had smaller main vessel and side branch reference diameters than men. The pre- and post-PCI angiographic percentage diameter stenoses of the main vessel and side branch were comparable between women and men. There were no differences in procedural characteristics between the sexes. Women and men had a similar risk of TLF (6.3% vs. 7.1%, p=0.63) as well as its individual components and sex was not an independent predictor of TLF. This finding was consistent in the left main and 2 stenting subgroups. Conclusions In patients undergoing bifurcation PCI, sex was not an independent predictor of adverse outcome.