Cynthia M. Schmidt

Purpose To identify and technically characterize published attempts at direct superior ophthalmic vein (SOV) access for cavernous sinus dural arteriovenous fistula (CCF; indirect carotid-cavernous fistula) when SOV caliber, patency, or angiographic visibility was unfavorable, and to describe a separate institutional illustrative case. Methods We performed a PRISMA 2020-compliant systematic review with descriptive technical synthesis. MEDLINE, CINAHL, PsycINFO, EMBASE, the Cochrane Library, and Scopus were searched in April 2026. Eligible reports described direct exposure, puncture, cannulation, or attempted cannulation of the SOV itself and provided sufficient case-level technical detail. Caliber, patency, and angiographic visibility were classified separately. Outcomes were summarized as raw counts. The institutional case was not included in review denominators. Results Five reports provided eight published access attempts. Numerical SOV diameter was not reported in any literature case. Patency was described as thrombosed in four attempts, occluded in one, stenosed or narrowed in one, without reported obstruction in one, and not reported in one. Angiographic visibility was incompletely characterized. The complete sequence of direct SOV cannulation, target-compartment navigation, and embolization was reported in six attempts. Two attempts failed because a small, stenotic, or fibrotic vein could not be traversed. All six successfully treated cases had immediate angiographic occlusion and clinical improvement. Paired visual acuity improved in the five successfully treated cases with extractable data. No SOV-access complication was reported in those six cases, but adverse-event reporting and follow-up were heterogeneous, and only one had explicitly reported follow-up angiography. The institutional case had complete occlusion at 3 months. Conclusions Published case-based experience documents that direct SOV access can be technically feasible despite non-dilation, impaired patency, or poor angiographic visibility. It may be considered a salvage option in experienced centers when conventional venous routes are not feasible. However, the evidence is too small and selected to estimate expected success, safety, or superiority of any access or embolization technique. Key points • Non-dilated, stenosed, or angiographically occult superior ophthalmic vein with or without thrombosis may remain surgically identifiable and catheterizable for treatment in selected carotid-cavernous fistulas. • Direct superior ophthalmic vein access may be considered a salvage strategy option in experienced centers after failed or infeasible conventional transvenous access. • The complete sequence of direct SOV cannulation, target-compartment navigation, and embolization was reported in six of eight published access attempts. These counts are not estimates of expected procedural success. • The evidence is limited to five reports with heterogeneous anatomy, incomplete imaging definitions, variable follow-up, and substantial publication and reporting bias.

Background: Ectopic pregnancy has been observed to follow temporal patterns. Despite nearly a century of documented trends, no standardized approach has been established to define, understand, or investigate these patterns. Doing so could provide insights into possible environmental, biological, or sociocultural factors driving these patterns. Objective: This scoping review aimed to synthesize the evidence of temporal patterns in tubal ectopic pregnancy rates worldwide, assess the methodologies, and identify research gaps possibly hindering causal factors inquiry. Methods: Following Joanna Briggs Institute guidelines, we searched EMBASE, MEDLINE, CINAHL, The Cochrane Library, Scopus, and Google Scholar in June 2024. Peer-reviewed studies, gray literature, and editorial sources reporting seasonal, monthly, or quarterly fluctuations in tubal ectopic pregnancy incidence in humans were considered without limitation to publication year. Study characteristics, analytic approaches, noted limitations, temporal trends, and hypotheses to explain those trends were extracted and summarized descriptively. Results: Thirty-two studies spanning 18 countries, published between 1932 and 2022, met eligibility criteria. Many studies reported seasonal or monthly peaks, though findings were inconsistent worldwide. Data sources, incidence denominators, and methods for analyzing ectopic pregnancy temporal patterns were heterogenous. Studies used either the estimated conception date or diagnosis date as the timepoint of interest for analysis, a methodological difference that limited cross-study comparisons. Conclusions: There are significant methodological gaps in the study of ectopic pregnancy temporal patterns. To improve temporal analysis and generalizability, future research should use data sets that include outpatient records and conduct conception date-based analysis with universal units of time like weeks or months.

Background. We evaluated perioperative intrathecal morphine (ITM) compared with placebo or standard postoperative pain strategies in adults undergoing elective posterior lumbar fusion. Methods. A systematic search of EMBASE, MEDLINE, the Cochrane Library, and Google Scholar (December 12, 2023) identified studies involving ITM in posterior lumbar fusion. Eligible patients were ≥18 years. Two reviewers extracted outcomes and assessed non-randomized studies with the Newcastle- Ottawa scale. Odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using fixed- and random-effects models. Results. Eleven studies met the inclusion criteria. ITM significantly lowered opioid requirements within 24 hours (MD -0.72, 95% CI [-1.30, -0.14], I² = 91.08%, p = 0.015) and pain scores at 24 hours (MD -0.57, 95% CI [-1.01, -0.13], I² = 73.17%, p = 0.010). Reductions were also seen in pain scores at 48 hours (MD -0.63, 95% CI [-1.55, 0.29], p = 0.178), hospital stay (MD -0.71, 95% CI [-1.77, 0.36], p = 0.191), sedation (OR -0.18, p = 0.594), and respiratory depression (OR -0.08, p = 0.782), though these were not statistically significant. ITM increased the incidence of pruritus (OR 1.04, 95% CI [0.45, 1.64], I² = 43.55%, p < 0.001), with non-significant rises in urinary retention (OR 0.45, p = 0.070) and nausea/vomiting (OR 0.03, p = 0.847). Conclusion. Although based on relatively small and methodologically heterogeneous studies, these analyses suggest that perioperative ITM enhances analgesia and maintains an acceptable safety profile following posterior lumbar fusion.

Background: Pseudoaneurysm arising from the distal segment of an intracranial artery is a rare cause of subdural hematoma (SDH). We report a patient diagnosed with a pseudoaneurysm of a cortical branch of the distal anterior cerebral artery (ACA) during planned middle meningeal artery embolization for SDH and present a systematic review to summarize the present literature. Methods: A systematic literature search was conducted across EMBASE, MEDLINE, CINAHL, the Cochrane Library, and Scopus to identify studies reporting SDH due to pseudoaneurysms in the terminal intracranial artery segments. Details regarding clinical presentation, management, and outcomes were extracted. Results: Twenty patients from the 18 retrospective studies and the patient from the present report were included in the review. The mean age of the patients was 49.4 years; 80.9% of the patients were males. A history of nonpenetrating head trauma was present in 11 (52.4%) patients. The most common presenting symptoms were hemiparesis and altered mental status. Catheter angiography established the diagnosis in the majority of the patients (85.7%). Angiography was performed due to a clinical/radiological suspicion for a pseudoaneurysm in 6 (28.5%) patients. In the majority of the patients (66.7%), angiography was performed for a different indication. Middle cerebral artery (15 patients, 71.4%) was the most common location of the pseudoaneurysm, followed by ACA, posterior cerebral artery, and posterior inferior cerebellar artery. Pseudoaneurysm was treated surgically in 14 patients (66.7%) and by endovascular modalities in 5 patients (23.8%). One patient undergoing endovascular treatment required surgical evacuation of SDH. The majority of the patients in both treatment groups (surgical – 72.7%, endovascular – 80%) recovered without severe disability (modified Rankin Scale ≤ 4). Conclusion: Pseudoaneurysms of distal segments of intracranial arteries are a very rare cause of SDH. A high index of suspicion is required for their identification. While a definitive diagnosis requires catheter angiography, indications to perform angiography in SDH are unclear. Pseudoaneurysms with SDH can be treated safely with both microsurgical and endovascular modalities. Microsurgery has the advantage of draining SDH at the same time. The relative efficacy of different treatment approaches and the indications for each are not yet defined.

Allogeneic stem cell transplantation is a lifesaving treatment for many malignancies. Post-transplant patients may suffer from graft versus host disease in the acute and/or the chronic form(s). Post-transplantation immune deficiency due to a variety of factors is a major cause of morbidity and mortality. Furthermore, immunosuppression can lead to alterations in host factors that predisposes these patients to infections. Although patients who receive stem cell transplant are at an increased risk of opportunistic pathogens, which include fungi and viruses, bacterial infections remain the most common cause of morbidity. Here, we review bacterial pathogens that lead to pneumonias specifically in the chronic GVHD population.

Background: Health librarians have traditionally provided mediated searches to support patient care, education and research.Objectives: This study aims to discover the types of search result formats used by health science libraries, determine current practice among health science libraries (types of requesters served, fees, deduplication, turnaround time and citation manager use) and uncover innovative methods for providing search results.Methods: An online survey was distributed to the MEDLIB‐L, ExpertSearching, MidContinental Chapter of the Medical Library Association and ICON listservs and through direct email to selected Association of Academic Health Sciences Libraries reference and education librarians.Results: Librarians affiliated with 127 institutions from 11 countries (including the USS) and 36 USS states and territories responded. One hundred and forty‐two of the total 150 analysed responses provided information on full‐text access, and 81 of those 142 responses (57%) indicated that the institutions' link‐resolver links were included in search results provided to the requester. The survey responses provide information on literature search services regarding turnaround time, use of a citation managers, fees and deduplication.Conclusion: With the developing landscape of citation managers and the tools offered, these data can be used as a benchmark for librarians who are considering evaluating or modifying their search service delivery.

Objective: To identify whether rheumatoid arthritis (RA) is associated with driving ability and/or the use of assistive devices or modifications to improve driving ability.Methods: We conducted a systematic literature review following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines of RA and driving ability/adaptations by searching multiple databases from inception to April 2018. Eligible studies were original articles in the English language that had quantitative data regarding the study objective and at least 5 RA patients. Similar outcomes were extracted across studies and grouped into categories for review.Results: Our search yielded 1,935 potential reports, of which 22 fulfilled eligibility criteria, totaling 6,285 RA patients. The prevalence of driving issues in RA was highly variable among the studies. Some of the shared themes addressed in these publications included RA in association with rates of motor vehicle crashes, self‐reported driving difficulty, inability to drive, use of driving adaptations, use of assistance by other people for transport, and difficulty with general transportation.Conclusion: Despite variability among individual reports, driving difficulties and the use of driving adaptations are relatively common in individuals with RA. Given the central importance of automobile driving for the quality of life of RA patients, further investigations of driving ability and potential driving adaptations that can help overcome barriers to safe driving are needed.