Medical tourism is increasingly popular for elective cosmetic surgical procedures. However, medical tourism has been accompanied by reports of post-surgical infections due to rapidly growing mycobacteria (RGM). The authors' experience working with patients with RGM infections who have returned to the USA after traveling abroad for cosmetic surgical procedures is described here. Patients who developed RGM infections after undergoing cosmetic surgeries abroad and who presented at the Montefiore Medical Center (Bronx, New York, USA) between August 2015 and June 2016 were identified. A review of patient medical records was performed. Four patients who presented with culture-proven RGM infections at the sites of recent cosmetic procedures were identified. All patients were treated with a combination of antibiotics and aggressive surgical treatment. This case series of RGM infections following recent cosmetic surgeries abroad highlights the risks of medical tourism. Close monitoring of affected patients by surgical and infectious disease specialties is necessary, as aggressive surgical debridement combined with appropriate antibiotic regimens is needed to achieve cure. Given the increasing reports of post-surgical RGM infections, consultants should have a low threshold for suspecting RGM, as rapid diagnosis may accelerate the initiation of targeted treatment and minimize morbidity.

To report the 24-month outcomes and subgroup analysis evaluating the safety and effectiveness of the genicular artery embolization (GAE) for the treatment of symptomatic knee osteoarthritis (OA). Forty participants with symptomatic moderate to severe knee OA from a single-center, single-arm prospective trial of GAE were included in this study. Abnormal genicular artery neovascularity was identified at the subject's focal knee pain with digital subtraction angiography and cone-beam computed tomography. Embolization was performed with 100-μm microspheres. The primary end point was treatment effectiveness as measured by sustained improvement in OA symptoms at 24 months, quantified using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Treatment success was defined as ≥50% decrease in WOMAC relative to baseline. Clinical outcomes were assessed with mean age of 66.0 ± 8.1 years and BMI of 30.1 ± 6.2 kg/m². Two of the forty (5.0%) patients were lost to follow up. Overall, 18 of 38 (47.4%) patients demonstrated ≥50% reduction in WOMAC at 24 months. In the subset of patients with initial clinical success at 12 months, 18 of 25 (72.0%) reported sustained clinical success at 24 months. Seven of 25 (28.0%) had symptom recurrence between 12 and 24 months and were determined to be clinical failures. All treatment-related adverse events occurred within 12 months following GAE, without additional events after 12 months. GAE is effective in achieving sustained symptom relief related to moderate to severe knee OA for up to 24 months with an acceptable safety profile.

Hereditary hemorrhagic telangiectasia (HHT), an autosomal dominant vasculopathy afflicting 1 in 5000 individuals, is the second-most-common inherited bleeding disorder worldwide. Despite this prevalence, comprehensive data on disease manifestations and complications remain limited. To address this gap, the U.S. Congress allocated funding leading to the Comprehensive HHT Outcomes Registry of the United States (CHORUS; NCT06259292), a prospective, 15-center longitudinal registry enrolling unselected patients with confirmed HHT. In this initial report, we describe findings from the first 600 participants, with a median (range) age of 53 (0-88) years and 60% female. Despite most participants developing typical HHT manifestations by age 13, the majority (63%) were not diagnosed until mid-to-late adulthood. Recurrent spontaneous epistaxis occurred in 95% of participants, chronic gastrointestinal bleeding in 30%, and heavy menstrual bleeding in 35% of post-menarche females, together resulting in moderate-to-severe mucosal bleeding in 76%. Iron deficiency and/or anemia were diagnosed in 68%, with 41% requiring intravenous iron and 25% requiring red cell transfusions. Serious complications of solid-organ arteriovenous malformations were frequent, including intracranial hemorrhage (3%), pulmonary hemorrhage (2%), venous thromboembolism (7%), arterial thromboembolism (11%), heart failure (7%), and pulmonary hypertension (7%). This data from CHORUS, the first national registry of its kind, provides reliable, real-world estimates of the incidence, prevalence and severity of numerous HHT manifestations and complications. HHT has a high burden of moderate-to-severe bleeding, anemia, thrombosis, and major neurologic and cardiopulmonary complications. There is a mean interval between first symptoms and diagnosis of over two decades, during which substantial serious, preventable HHT morbidity, including early intracranial hemorrhage, may occur.

Pollution by metals may adversely affect organisms through the generation of reactive oxygen species (ROS). In this study, we examined the sublethal effects of two metals, copper and cadmium, on horseshoe crab (Limulus polyphemus) embryos. Exposure to copper or cadmium at concentrations of 0.01–10 mg/L for periods of 4, 8, 16 and 24 h had minimal effect on embryo survival except at 100 mg/L Cu. However, metal-exposed embryos took significantly longer to hatch into first instar (“trilobite”) larvae than seawater controls. Levels of superoxide dismutase (SOD), believed to be important in the response to oxidative stress, were determined by Western blotting. Both the Cu/Zn and Mn cofactor forms of SOD tended to be somewhat elevated in metal-exposed embryos, but the increases were neither dose nor time-dependent. Likewise, SOD enzymatic activity showed no significant differences comparing embryos exposed to metals with seawater controls. We conclude that the protective role of SOD’s against ROS produced in response to metal exposure appears to be limited in horseshoe crab embryos, at least under our experimental conditions.

Background/Objectives: Microvascular plug embolization in the distal feeding artery (FA-MVP) and coil embolization targeting the nidus and feeding artery (NiFA-coil) are effective treatments for pulmonary arteriovenous malformations (PAVMs). This study compares their outcomes. Methods: A retrospective chart review was conducted on patients who underwent NiFA-coil or FA-MVP embolization for PAVMs between October 2014 and May 2024, with initial (short-term) follow-up chest CT imaging performed within 18 months, and the latest (long-term) follow-up performed at least 3 years post-treatment. Durable occlusion was defined as ≥70% shrinkage of the nidus or draining vein on follow-up CT. A Cox proportional hazards regression model assessed the association between technique and durable occlusion, with inverse propensity score weighting used to adjust for patient and PAVM characteristics. Results: A total of 142 PAVMs (48 FA-MVP, 94 NiFA-coil) in 85 patients were analyzed. Durable occlusion was 97.2% (138/142) at a median short-term follow-up of 4.2 months and 90.2% (37/41) at a median long-term follow-up of 56.0 months. Simple PAVMs were more frequent in the FA-MVP group (93.8%, 45/48) than in the NiFA-coil group (61.2%, 58/94) (p < 0.001). The NiFA-coil group had larger feeding arteries (3.8 mm vs. 2.3 mm, p < 0.001) and sac sizes (13.1 mm vs. 7.7 mm, p = 0.040). Short and long-term durable occlusion rates were comparable (NiFA-coil: 96.8% and 88.9%; FA-MVP: 97.8% and 92.9%, respectively; p > 0.99, p > 0.99). After propensity score matching, compared to FA-MVP, NiFA-coil had a hazard ratio for short-term persistence of 1.06 (95% CI, 0.16–6.99; p = 0.956). Conclusions: Both NiFA-coil and FA-MVP embolization are highly effective for PAVM treatment, with similar success rates.