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Type II endoleaks are the most common complication after endovascular aneurysm repair typically arising from mesenteric and lumbar inflow vessels, whereas alternative collateral sources are less frequently recognized. We report a case of a deep circumflex iliac artery-mediated collateral causing persistent sac perfusion, identified on preprocedural imaging and confirmed angiographically. Targeted coil embolization resulted in occlusion of the culprit pathway with resolution of sac opacification. Follow-up imaging demonstrated a separate endoleak from a distinct collateral source without sac enlargement, consistent with flow redistribution. These findings highlight the importance of evaluating atypical collateral pathways.

Off-pump coronary artery bypass (OPCAB) surgery is frequently chosen for high-risk patients to mitigate cardiopulmonary bypass-related complications. However, OPCAB is associated with significant intraoperative hemodynamic challenges, particularly in patients with impaired ventricular function and pre-existing conduction abnormalities. High-grade atrioventricular (AV) conduction disturbances during off-pump coronary artery bypass surgery are rare but can result in life-threatening hemodynamic collapse. We report the case of a 75-year-old man with severe ischemic cardiomyopathy (LVEF 36%) and baseline left bundle branch block who underwent off-pump coronary artery bypass surgery for multivessel coronary artery disease with collateral-dependent coronary circulation. During right internal mammary artery harvesting, the patient developed progressive PR prolongation followed by transient complete atrioventricular block. Although the initial conduction disturbance was hemodynamically tolerated with vasoactive support, subsequent minimal cardiac displacement for left anterior descending artery exposure precipitated profound hemodynamic instability. The instability was refractory to ventricular pacing and maximal pharmacologic support but resolved immediately after spontaneous restoration of sinus rhythm, allowing completion of the procedure without conversion to cardiopulmonary bypass. This case highlights the critical importance of atrioventricular synchrony in maintaining hemodynamic stability during off-pump coronary artery bypass surgery, particularly in patients with low ejection fraction, baseline conduction abnormalities, and collateral-dependent coronary circulation. Even surgical maneuvers considered relatively safe, such as right internal mammary artery harvesting or minimal cardiac displacement, may precipitate life-threatening hemodynamic collapse when AV synchrony is lost. Awareness of this interaction is essential for timely recognition and appropriate intraoperative decision-making in high-risk patients undergoing OPCAB.

The rapid rise of multidrug-resistant bacterial pathogens has renewed interest in bacteriophage therapy, yet bacterial resistance to phages can evolve rapidly. Two evolutionary strategies have been proposed to address this challenge: coevolutionary phage training, which adapts phages to anticipated resistance mechanisms, and phage-antibiotic synergy, which exploits tradeoffs between phage resistance and antibiotic susceptibility. Here, we show that these strategies intersect in complex but predictably exploitable ways. Using Escherichia coli and bacteriophage λ, we demonstrate that resistance to a trained-but not an untrained-phage generates collateral sensitivity to erythromycin and rifampicin, but not to five other antibiotics. This training-induced synergy is mechanistically linked to repeated disruption of lpcA, a gene involved in lipopolysaccharide core biosynthesis. Leveraging this mechanistic insight, we successfully predicted that novobiocin and rifapentine would also exhibit collateral sensitivity with a trained λ phage. We further show that incorporating sub-lethal erythromycin during phage training reshapes coevolutionary trajectories, increasing the frequency with which phages evolve the ability to use a second host receptor and thereby enhancing bacterial suppression. Together, these results reveal that despite the inherent complexity of phage-bacteria coevolution, key outcomes can be anticipated and directed. Our findings highlight the promise of evolution-informed, predictive strategies for designing therapies.

This review discusses the utility of early open repair of multiligamentous knee injuries in patients with high-energy mechanisms. The surgical technique for anterior cruciate ligament, posterior cruciate ligament, and medial collateral ligament repair was demonstrated on a polytraumatized patient using the medial parapatellar approach. The posterior cruciate ligament was repaired first with suture through a drill tunnel in the femoral insertion followed by the anterior cruciate ligament in a similar fashion. The medial collateral ligament was repaired last with a staple. With some exceptions, weight bearing and knee range of motion are permitted immediately postoperatively. In the right patient population, this procedure may expedite patients' recovery and return to daily life.

Incarceration has vast and unequal impacts on public health beyond prison walls. Research from the United States documents these collateral consequences, including elevated mental illness and morbidity for the children and partners of incarcerated individuals, alongside community-level effects such as increased rates of teenage pregnancy and multidrug-resistant tuberculosis. In Latin America, however, these broader health impacts remain critically understudied. A significant barrier is the absence of data collection efforts or theoretical frameworks for mapping how Latin America's prisons affect the health of families and surrounding communities. This scoping review synthesises existing evidence on the collateral health consequences of incarceration in Latin America by conducting a comprehensive search in 2025 that included English, Spanish and Portuguese language peer-reviewed studies. From 17 included documents, prisons emerge as epicentres for tuberculosis transmission to visiting families and surrounding communities. The evidence reveals significant mental and physical health burdens on families. Women with incarcerated partners experience depression and anxiety whilst managing economic strain and expanded caregiving responsibilities, often neglecting their own health. Children of incarcerated parents show marked emotional distress, and incarcerated mothers alongside their young children face severely inadequate healthcare access within detention spaces. Despite collecting demographic data, most studies overlook how these burdens fall unequally across racialised populations. Future research must centre ethnoracial disparities and situated knowledge. Incarceration in Latin America has far-reaching effects on partners, children, families, and communities beyond prisons walls. While we know prisons’ health impacts on incarcerated people, we know far less about these broader impacts on families and communities. Most research comes from the United States, but Latin American prisons face different challenges, from severe overcrowding to limited healthcare access. In this study, researchers searched for all available evidence on incarceration’s health consequences for people outside prison walls in Latin America, finding 17 studies published in English, Spanish, and Portuguese examining impacts on partners, children, families, and communities. The evidence reveals that Latin American prisons act as amplifiers of infectious diseases, particularly tuberculosis, which spreads to families during visits and to communities after release. Beyond infectious diseases, the research shows troubling patterns for families, especially women. Female partners of incarcerated men experience high rates of depression and anxiety, and some studies found elevated stress hormones and increased cardiovascular disease risk among these women. Many neglect their own healthcare while managing financial strain, emotional burden, and increased caregiving responsibilities for children and family. Children and families experience significant emotional distress, intensified during events like COVID-19 visitation bans. The review also identified inadequate prenatal and child healthcare for pregnant women and young children living with their mothers in prison due to poor detention conditions. Understanding incarceration’s impacts on family and community health is essential for developing effective public health policies. A significant limitation appeared in how studies handled ethnoracial diversity: although some collected this information, it rarely informed health impact analysis. This oversight is particularly troubling in a region with diverse Indigenous and Afro-descendant populations, where robust evidence demonstrates pervasive racial inequalities across health, criminal justice, and other socioeconomic metrics. Future research must compile ethnoracial data informed by Latin American and locally-situated knowledge.

The therapeutic landscape of acute ischemic stroke (AIS) has been transformed by expanding endovascular therapy (EVT) criteria. With the incorporation of MR perfusion imaging in the 2026 AHA/ASA Guidelines for the early management of patients with AIS to support EVT patient selection, there is renewed energy and focus on the clinical applications of different MR perfusion techniques in AIS. A reliable, contrast-free perfusion technique with acceptable acquisition time and capability to identify salvageable tissue and assess collateral status may be utilized in certain clinical contexts. Arterial spin labeling (ASL) is a clinically feasible technique that can be considered as a valuable modality within stroke workflows and MRI-based EVT selection protocols, particularly in patients with renal insufficiency, contrast allergy, and contrast-limited settings. Although ASL has been investigated in multiple previous studies, its systematic integration into contemporary acute stroke clinical workflows has yet to be routinely adopted and standardized practical guidance in this regard is lacking. Furthermore, ASL is not yet validated in prospective EVT-selection trials to support timely reperfusion decisions. This state-of-practice paper was developed on behalf of the American Society of Functional Neuroradiology (ASFNR) by an expert panel of neuroradiologists with expertise in cerebrovascular imaging and MR perfusion. We appraise the current evidence, clinical applications, implications for therapeutic decision-making, and translational barriers of ASL in AIS triage and EVT patient selection. We also discuss ASL challenges related to workforce capacity and reimbursement, and propose recommendations for future clinical validation and implementation. ASL may serve as a valuable adjunct within MRI-based stroke workflows by providing complementary information on ischemic penumbra and collateral status. However, validation through multicenter prospective studies for EVT patient selection, standardized acquisition protocols, and automated postprocessing quantification pipelines are needed before ASL can be routinely integrated into time-sensitive stroke workflows.

The progression of heart failure (HF) following myocardial ischemia/reperfusion (I/R) injury is driven by regulated cell death. Unlike the restrained nature of apoptosis, pyroptosis and necroptosis are lytic processes that trigger inflammatory cascades, causing extensive collateral damage to the non-regenerative myocardium. Understanding the integrated regulation of these pathways (PANoptosis) is essential for limiting infarct expansion. We examined PANoptosis in rat I/R and H9c2 OGD/R models using transmission electron microscopy, immunofluorescence, and molecular markers (C-CASP3, N-GSDMD, p-MLKL). The functional hierarchy of the BIRC3-CASP8 axis was dissected using AAV-mediated gene transfer and pharmacological inhibitors. We confirmed that I/R injury induces PANoptosis with interdependent crosstalk. Mechanistically, BIRC3 acted as a pivotal checkpoint: its upregulation inhibited CASP8, promoting membrane-rupturing pyroptosis and necroptosis. Crucially, BIRC3 silencing disinhibited CASP8, redirecting the cell death machinery toward apoptosis. This phenotypic shift preserved cell membrane integrity and minimized the release of inflammatory mediators, effectively halting the propagation of cell death to surrounding healthy cardiomyocytes. For cardiomyocytes destined to die, the BIRC3-CASP8 axis serves as a decisive switch between destructive and silent death modes. By leveraging this axis to shift PANoptosis toward an apoptosis-dominant phenotype, we can reduce the inflammatory storm and collateral injury. This offers a promising therapeutic paradigm to maximize the preservation of functional myocardium and arrest HF progression.

Video-assisted thoracic surgery (VATS) is the preferred approach for lung resection. Magnetic anchoring technology (MAT) utilizes magnetic forces for organ retraction and improves surgical field exposure. This trial aimed to evaluate the safety and efficacy of MAT-assisted VATS for lung resection. This single-center randomized controlled trial (registered at the Chinese Clinical Trial Registry, ChiCTR2000029676) enrolled 40 patients scheduled for lung resection and randomly assigned them to MAT-assisted VATS (Group A, n = 20) or conventional VATS (Group B, n = 20). The primary outcomes included surgical field exposure efficacy, intraoperative collateral injuries, and operator-related adverse events. Secondary outcomes included surgeon satisfaction score, number of assistants, and perioperative recovery metrics with a 1-month postoperative follow-up. Surgical field exposure efficacy (graded as Excellent, Satisfactory, Normal, and Poor) was as follows: Group A, 15, 4, 1, and 0 cases; and Group B, 17, 2, 1, and 0 cases (p = 0.115). Intraoperative collateral injuries (graded as None, Mild, Moderate, and Severe) were as follows: Group A, 13, 6, 1, and 0 cases; Group B, 9, 6, 3, and 2 cases (p = 0.304). No significant differences were observed in the operative time (p = 0.136), intraoperative blood loss (p = 0.380), postoperative drainage tube removal time (p = 0.180), time to extubation (p = 0.529), time to ambulation (p = 0.260), total hospitalization duration (p = 0.685), or postoperative hospitalization duration (p = 0.305). Surgeon satisfaction score was significantly higher in Group A (p = 0.003). Moreover, MAT use markedly reduced dependence on surgical assistants, with fewer cases requiring two assistants in Group A (p = 0.006). The magnetic anchoring devices demonstrated seamless operability, with no adverse events reported during postoperative follow-up. MAT-assisted VATS lung resection is as effective and safe as conventional VATS.

Knee osteoarthritis is increasingly understood as a whole-joint disorder involving not only articular cartilage but also subchondral bone, synovium, menisci, capsule, ligaments, periarticular entheses, and neuromuscular control. In patients with pre-existing degenerative osteoarthritis whose symptoms worsen after an injury-related episode, treatment strategies focused only on the intra-articular cartilage environment may not adequately address coexisting ligamentous or capsular pain generators. Microfragmented adipose tissue has been explored as an autologous orthobiologic option for symptomatic knee osteoarthritis, while dextrose prolotherapy has been used for chronic musculoskeletal pain and ligamentous or capsular pain generators. We report the case of a 63-year-old woman with symptomatic right knee osteoarthritis who presented with a 12-month history of right knee pain beginning in May 2023, which worsened after a walking-related injury episode. She had osteoporosis, dyslipidemia, gastroesophageal reflux disease, a history of breast cancer surgery, and previous contralateral unicompartmental knee arthroplasty. Baseline radiographs demonstrated Kellgren-Lawrence grade III right knee osteoarthritis. Because she wished to delay arthroplasty due to previous postoperative pain and prolonged rehabilitation after contralateral knee surgery, she underwent intra-articular injection of 10 mL of autologous microfragmented adipose tissue processed by Adinizer (BSL Co. Ltd., Busan, KOR). Activities of daily living were resumed immediately as tolerated. Rehabilitation progressed from hip abductor and adductor isometric exercises to proprioceptive neuromuscular facilitation and band-resistance exercises. Nonsteroidal anti-inflammatory drugs were discontinued during follow-up. At three and six months, adjunctive prolotherapy was performed to clinically selected ligamentous and capsular targets, including the anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, lateral collateral ligament, and coronary ligament regions. Dextrose prolotherapy was not performed as a general non-targeted intra-articular osteoarthritis injection protocol. At the latest clinical follow-up, the visual analog scale (VAS) pain score improved from 8 to 2. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscores improved from 12 to 4 for pain, 6 to 1 for stiffness, and 38 to 11 for physical function. The total WOMAC score improved from 56 to 16. No donor-site pain, swelling, infection, or clinically significant adverse event was observed. Radiographs obtained in March 2026, approximately 22 months after treatment, showed persistent osteoarthritic changes without obvious radiographic progression. This report should not be interpreted as evidence that this combined intervention is effective for Kellgren-Lawrence grade III knee osteoarthritis in general or as support for a standardized treatment protocol. Rather, it describes a highly selected, arthroplasty-averse patient in whom a staged, individualized orthobiologic approach supplemented by clinically guided periarticular and capsuloligamentous prolotherapy was associated with sustained symptomatic improvement.

Subterminal intracranial Internal Carotid Artery (ICA-I) occlusion is a lesser-known stroke subtype which may delay access to endovascular thrombectomy (EVT). We compared clinical presentation, imaging characteristics, treatment delays, outcomes, and diagnostic accuracy between EVT-treated patients with ICA-I and carotid terminus (ICA-T) occlusions. All EVT-treated patients with intracranial ICA occlusions registered in two Swedish national quality registers (2016-2022) were included. Outcomes included pre- and postoperative National Institutes of Health Stroke Scale (NIHSS), successful recanalization, and 90-day modified Rankin Scale. Perfusion images and original radiology reports from one comprehensive stroke center were analyzed to assess the relationship between collateral anatomical variants, stroke severity, perfusion deficits, and diagnostic accuracy. Among 6163 EVT-treated patients, 356 had ICA-I occlusions and 657 had ICA-T occlusions. Median baseline NIHSS was lower in ICA-I occlusions (17 vs. 19), but variability in NIHSS and modified Alberta Stroke Program Early CT Score were higher (both p&#x2009;<&#x2009;0.001). ICA-I occlusions were associated with EVT treatment delays, but recanalization rates, 24-hour NIHSS, and 90-day functional outcomes were similar between groups. In exploratory hypothesis-generating sub-group analyses of ICA-I occlusions, anterior collateral variants were associated with stroke severity, and fetal-type posterior cerebral artery variants were associated with larger perfusion deficits. In a sub-group analysis, ICA-I occlusions were correctly identified in 31% of baseline radiology reports compared with 57% of ICA-T occlusions. ICA-I occlusions show greater clinical and radiological heterogeneity, are frequently underrecognized on baseline imaging, and are associated with longer treatment delays than ICA-T occlusions. Increased awareness may improve acute stroke triage and reduce delays to treatment.

This study aimed to evaluate the association between multimodal CT imaging parameters and Early Neurologic Deterioration (END) and 90-day functional outcomes in patients with acute anterior-circulation ischemic stroke treated with intravenous thrombolysis. In this retrospective single-center study, patients with anterior-circulation ischemic stroke who underwent multimodal CT imaging, including noncontrast CT, CT angiography, and CT perfusion prior to thrombolysis, were analyzed. Imaging parameters, including ASPECTS, regional leptomeningeal collateral (rLMC) score, infarct core, perfusion lesion, and ischemic penumbra volumes, were quantified using RAPID software. Multivariable logistic regression models and receiver operating characteristic (ROC) curve analyses were applied to identify independent predictors of END and of long-term functional outcome, as measured by the 90-day modified Rankin Scale. A total of 131 patients were included, of whom 16% developed END. Lower rLMC scores and larger infarct core, perfusion lesion, and ischemic penumbra volumes were significantly associated with a higher risk of END and unfavorable 90-day outcomes. Perfusion lesion volume showed the strongest discrimination for predicting END, while the rLMC score demonstrated the highest predictive value for a favorable long-term functional outcome. ROC-derived thresholds exhibited only moderate accuracy and are considered exploratory. These findings highlight the prognostic relevance of collateral status and CT-derived perfusion parameters in identifying patients at higher risk of neurologic worsening and long-term disability after thrombolysis. Multimodal CT imaging parameters, particularly rLMC score and perfusion-based tissue volumes, are associated with END and 90-day outcomes following thrombolysis. Further multicenter validation is necessary before clinical implementation.

Kawasaki disease (KD) is the most common acquired heart disease in children. Coronary artery aneurysms (CAAs) occur in 25% of untreated and 5% of treated cases. Large CAAs increase the risk for thrombosis, myocardial ischemia, and chronic total occlusion (CTO). Patients with collateral formation may remain asymptomatic. After retrospective chart review, we describe 8 patients diagnosed with CTO between ages 2 to 50 years following childhood KD. All patients developed giant CAAs after KD. Four pediatric patients presented with CTO between ages 2 to 16 years. Four adults had childhood KD that was untreated or managed before standardized treatment and were lost to follow-up until CTO diagnosis between ages 31 to 50 years. Three patients had surgical bypass. Patients with KD and large CAAs remain at lifelong risk for thrombosis and CTO. Collateralization from slow, chronic ischemia may allow for conservative management in asymptomatic patients.