Jacksonville University

Early bioprosthetic valve thrombosis is a life-threatening complication, and hypercoagulable states such as heparin-induced thrombocytopenia (HIT) can contribute to the formation of thrombi. A 67-year-old woman with a prior history of HIT and surgical replacement of mitral and tricuspid valves presented with shortness of breath. Transthoracic echocardiography showed an atrial septal defect with right-to-left shunt and thickened tricuspid valve leaflets. Intraoperative transesophageal echocardiography revealed a severe thrombotic bioprosthetic tricuspid valve. She underwent successful transcatheter tricuspid valve-in-valve (TTViV) and atrial septic device closure. TTViV is a critical option for patients presenting with early tricuspid valve thrombosis due to HIT. Increased right atrial pressure from tricuspid thrombosis can result in dehiscence of the interatrial sutures, leading to a hemodynamically significant shunt and necessitating its closure. HIT is a prothrombotic state that can lead to early valve thrombosis. TTViV offers an effective treatment option for high-surgical risk patients.

Abstract Reactive arthritis is an immune-mediated arthropathy caused by a preceding remote infection. Typically, reactive arthritis affects the joints of the lower extremities but can occur in the upper extremity. There are a few case reports of reactive arthritis primarily involving the joints of the hand and wrist, necessitating surgical intervention. We describe the case of a 37-year-old, right-hand dominant female who presented with severe left wrist pain. After obtaining radiographs, she was diagnosed with severe erosive changes in the radiolunate joint and distal radioulnar joint (DRUJ) and secondary reactive gonococcal arthritis of the DRUJ. The patient failed conservative measures and ultimately underwent radioscapholunate (RSL) arthrodesis, distal ulna resection, and wrist denervation. Postoperatively, she had resolution of her pain and an excellent functional outcome. Refractory reactive arthritis of the DRUJ can cause concomitant adjacent joint erosive changes. Performing RSL arthrodesis and distal ulna resection can provide an excellent functional outcome and still allow motion to be preserved through the midcarpal joint. IV: Case report level IV or higher evidence.

The safe and efficient integration of small unmanned aircraft systems (sUAS) into the National Airspace System (NAS) requires a systems-based understanding of the interrelations among human, technological, and regulatory components. Existing Federal Aviation Administration (FAA) guidelines restrict most operations to visual line of sight (VLOS), which constrains operational scalability and underscores the need for system-level innovations supporting beyond-visual-line-of-sight (BVLOS) operations. This study adopted a socio-technical systems approach to evaluate how first-person view (FPV) technologies influence operator workload and situational awareness (SA), key human performance elements within the broader sUAS safety system. Participants meeting FAA Part 107 eligibility criteria were assigned to one of three visual configurations: (a) traditional VLOS, (b) FPV using a 21-inch monitor, or (c) FPV with immersive goggles. Workload was measured with the NASA Task Load Index (NASA-TLX), and Level 1 SA was assessed via post-task recall. ANOVA results revealed no statistically significant differences across visual conditions, indicating no evidence that FPV integration either increased cognitive load or impaired perceptual awareness compared to traditional methods. Complementary analysis of NASA’s Aviation Safety Reporting System (ASRS) identified SA as the most recurrent human-factor issue, suggesting system-level implications for human–machine interaction and training design. These findings contribute to the systemic understanding of human factors in UAS operations, supporting FPV’s potential as a viable subsystem for achieving safe and effective BVLOS integration within complex socio-technical aviation systems.

Introduction: Spontaneous intracerebral hemorrhage (sICH) is a neurological condition associated with poor functional outcomes and high mortality. The role of surgical intervention is an area of ongoing research, with several trials showing mixed results. We conducted a meta-analysis to investigate the effectiveness of surgery compared to best medical management (BMM) in patients with sICH. Methods: We analyzed randomized controlled trials found through PubMed, Embase, and Cochrane databases. Studies that were not randomized control trials or included the pediatric population were excluded. Studies that investigated other causes of ICH such as vascular malformations or sinus thrombosis were also excluded. We used modified Rankin Scale (mRS) score of 0-3 at 180 days as the efficacy outcome. Mortality at 90 days was evaluated as the safety outcome. We assessed heterogeneity using a restricted maximum-likelihood estimator, along with the Q-test and I 2 statistic. Results: Four clinical trials, namely STICH-I, STICH-II, MISTIE, III and ENRICH, were included. STICH-II only enrolled patients with lobar sICH, while the other studies included lobar, basal ganglia, and thalamic hemorrhages. STICH-I and STICH-II trials randomized patients to BMM or invasive surgery (e.g., craniotomy, stereotactic and burr hole surgery). MISTIE-III and ENRICH trials randomized patients between BMM and minimally invasive surgery (MIS). When analyzed separately, invasive surgical intervention (OR 1.20, 95% CI [0.97, 1.48]) and MIS (OR 1.32, 95%CI [0.98, 1.76]) did not show any benefit over BMM. However, there was a higher likelihood of a favorable outcome (OR 1.24, 95% CI [1.05, 1.47]) and improved mortality (OR 0.79, 95% CI [0.63, 0.99]) with any surgical intervention (invasive or MIS) when compared to BMM. Conclusion: Our results showed better functional outcomes and improved mortality with surgical intervention in patients with sICH. Further research is warranted to elucidate these findings.

Calcified atherosclerotic plaques are a well-recognized cause of chronic mesenteric ischemia (CMI). We present a case where intravascular lithotripsy (IVL) was successfully used to treat a severely calcified and stenotic superior mesenteric artery (SMA). A 72-year-old male with diffuse atherosclerotic disease presented with acute-on-chronic abdominal pain and weight loss. Computed tomography angiography (CTA) demonstrated extensive calcified aortic atherosclerotic disease extending to the major branches, particularly the SMA, causing severe stenosis. Plain old balloon angioplasty (POBA) followed by Shockwave™ IVL enabled the placement of a stent graft, resulting in successful recanalization. Following the procedure, the patient reported significant improvement in abdominal pain. IVL provides a safe and effective method for managing severely calcified mesenteric lesions, particularly when standard angioplasty alone is insufficient. This case contributes meaningfully to the limited body of evidence supporting SMA-IVL and underscores its value in complex paravisceral arterial disease.

Penile squamous cell carcinoma (SCC) is the most common type of penile malignancy affecting males in their sixth to eighth decade of life. We discuss a case of an 89-year-old male with dementia who initially presented to the emergency department with a penile lesion and symptoms consistent with a urinary tract infection. Further evaluation with MRI and a subsequent biopsy confirmed the diagnosis of penile SCC, which caused multiple strictures in the penile urethra. This report demonstrates a rare instance of penile SCC causing multifocal urethral obstructions and highlights the utility of MRI in characterizing penile lesions.