Hartford Hospital, Inc.

The incidence of major lower extremity amputation (MLA) is related to increasing rates of diabetes mellitus and peripheral arterial disease. Factors which influence functional mobility following MLA are less known. We aimed to investigate determinants of improved prosthetic fitting rate and greater functional mobility following MLA in patients with vascular disease.

We performed a retrospective analysis of adults who underwent MLA for vascular disease at a tertiary center from June 2016 to November 2022. Patients were stratified by prosthesis fitting completion. Functional mobility was recorded using Prosthetic Limb Users Survey of Mobility (PLUS-M) scoring. Multivariate logistic regression was performed to identify factors associated with improved functional mobility.

Three hundred sixty-one amputations in 350 patients were included in the study. Prosthesis fitting was completed following 134 (37.1%) amputations. Ninety-two patients had documented ambulation after fitting, and 82 (61.2%) patients recorded a PLUS-M score. Thirty-four PLUS-M scores (41.5%) achieved mobility above mean normative PLUS-M score, and 48 (58.5%) did not. Patients with above-average mobility had fewer comorbidities, had a higher incidence of prior coronary artery bypass graft (CABG), were more likely to have private insurance or Medicare, and were more likely to be discharged home or to acute rehab instead of a skilled nursing facility. On multivariate logistic regression, hypertension, cerebrovascular disease, and Medicaid insurance were associated with below-average mobility.

In patients with vascular disease who undergo MLA, prior CABG and private or Medicare insurance were associated with above-average mobility. Efforts to achieve home discharge or acute rehab following MLA may improve functional outcomes.

Transcranial focused ultrasound (FUS) non-invasively transmits acoustic energy across the skull, resulting in biological effects. Although early studies focused on adult movement disorders, transcranial FUS is now being explored for pediatric patients as well. Here, we review the emerging applications of transcranial FUS in pediatric neurosurgery and explore the unique considerations for this patient population.

A scoping review was conducted using PRISMA-ScR guidelines.

A total of 20 studies were included. Six clinical investigations reported the outcomes of 22 individual patients, ten of whom underwent thermal ablation of brain tumors or lesions. Eleven patients underwent sonodynamic therapy of brainstem tumors without adverse effects, and one patient underwent blood-brain barrier (BBB) opening prior to the infusion of doxorubicin. Preclinical studies further explored the use of low-intensity FUS to transiently disrupt the BBB and improve the delivery of therapeutic agents to diffuse midline gliomas or medulloblastomas.

This review highlights the growing interest in expanding transcranial FUS to pediatric neurosurgical patients. In parallel to ongoing work in the adult neurosurgical community, pediatric neurosurgical applications of this novel technology will continue to expand, but will require conscious and intentional efforts to optimize its use given the unique features of the pediatric population.

Cannabis use remains common in the United States as legal and social norms evolve. Few studies have assessed cannabis use patterns, which is important for public health planning.

Data from 119,068 individuals who responded to cannabis-related questions in the 2023 Behavioral Risk Factor Surveillance System, a national, cross-sectional survey, were analyzed. Cross-tabulations and logistic regression models were constructed to investigate patterns of cannabis use by demographic, health, and substance use correlates. A negative binomial regression was used to examine correlates of cannabis use frequency.

Past-30-day cannabis use was common (14.7 %, 95 % CI: 14.3-15.1 %), of whom 77.1 % (95 % CI: 75.8-78.4 %) smoked, 44.3 % (95 % CI: 42.7-45.9 %) ingested, 32.7 % (95 % CI: 31.2-34.3 %) vaped, and 14.0 % (95 % CI: 12.8-15.2) dabbed. Most commonly, individuals either exclusively smoked (35.4 %, 95 % CI: 33.8-36.9 %) or ingested (15.2 %, 95 % CI: 14.1-16.2 %). Exclusive vaping was uncommon (3.1 %; 95 % CI 2.6-3.6 %), though a large minority (32.7 %; 95 % CI: 31.2-34.3 %) reported vaping, typically as part of a multimodal use pattern. Multimodal cannabis use was associated with increased use frequency. Tobacco smoking and cannabis smoking (OR 3.65, 95 % CI: 2.97-4.49), and e-cigarette use and cannabis vaping (OR 3.58, 95 % CI: 2.99, 4.28) were highly corelated.

Exclusive smoking or ingesting were the most common cannabis use patterns; 3 of 5 cannabis users used one or both of those modalities. A significant minority use multiple cannabis modalities, but rarely exclusively vape or dab. Robust associations were identified between cannabis smoking and tobacco use, and between cannabis vaping and e-cigarette use.