Suzanne I. Riskin

Digital variance angiography (DVA), also referred to as kinetic imaging angiography, is an imaging technique that enhances vascular visualization by analyzing contrast flow motion. Although digital subtraction angiography (DSA) remains the current standard of care, DVA has demonstrated potential improvements in image quality and reductions in both radiation exposure and contrast use. This literature review aimed to evaluate currently available literature focusing on the use of DVA during angiographic procedures. The review was conducted using PubMed, EMBASE, and Web of Science, with the process being reflected in a Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) flowchart. Across multiple clinical applications, DVA consistently demonstrated higher objective image quality metrics including contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) as compared with DSA. Several studies reported that expert reviewers observed improved subjective image quality and substantial reductions in radiation exposure. In addition, DVA has also been shown to facilitate reduced use of contrast, potentially decreasing contrast-related complications and healthcare costs. Collectively, current evidence suggests that DVA represents a promising advancement in angiographic imaging, with the potential to deliver superior image quality with reduced radiation exposure and contrast use.

Rupioid syphilis (malignant syphilis or lues maligna) is a severe ulcero-nodular manifestation of infection originating from Treponema pallidum. It is typically associated with immunosuppressed states, notably those derived from HIV co-infection. This systematic review aims to highlight the rare instances in which this multi-faceted disease affects those with HIV seronegative immune status. A review of cases was conducted using PubMed, Embase, and Web of Science databases with Boolean operators utilizing all variants of “malignant syphilis” or “lues maligna” or “rupioid syphilis” combined with “immunocompetent.” Relevant studies included those from inception through August 2026. After removal of duplicates and screening, a total of 20 cases were selected based on inclusion criteria. The results revealed consistent clinical features, including systemic symptoms and ulcerative-necrotic lesions in 20 patients lacking underlying HIV immunosuppression. These findings underscore the importance of maintaining high clinical suspicion for syphilis in patients presenting with necrotic papuloulcerative lesions and systemic manifestations, regardless of HIV status, to ensure timely diagnosis and management.

Plaque psoriasis is a chronic autoimmune skin condition characterized by erythematous, scaly plaques that commonly affect the scalp, trunk, and extensor surfaces. As the most prevalent form of psoriasis, it results from immune system dysregulation, particularly involving cytokines. Cytokines such as interleukin-17 (IL-17) and interleukin-23 (IL-23), as well as downstream Janus kinase (JAK)/tyrosine kinase 2 (TYK2) signal pathways, lead to accelerated skin cell turnover. While an expanding array of treatment options exists, including topical agents, conventional oral medications, and targeted biologics, gaps persist in optimizing long-term management, such as improving access to medications and balancing efficacy with patient preference. Effective, practical, and acceptable long-term treatment options are needed. Injectable interleukin inhibitors, such as risankizumab (Skyrizi©) and bimekizumab (Bimzelx©), have demonstrated significant efficacy in treating moderate to severe plaque psoriasis. However, the recent FDA approval of deucravacitinib (Sotyktu©), an oral TYK2-selective JAK inhibitor, presents a promising alternative that may represent an important oral alternative for selected patients, particularly for patients who are needle-averse, have limited access to biologic infusions, or prefer oral therapies. This structured narrative review evaluates the current evidence surrounding leading IL-17 and IL-23 inhibitors and evaluates the potential role of JAK/TYK2 inhibition in addressing gaps in care. By comparing efficacy, safety profiles, and practical considerations across these agents, this review highlights the need for further longitudinal studies and real-world evidence to guide individualized treatment planning and broaden access to patient-centered care.

Peripheral artery disease (PAD) is a chronic vascular condition that affects millions of individuals worldwide and is a significant burden on public health. Although female subjects may be at greater risk of developing PAD owing to sex-specific risk factors and frequently present with atypical symptoms, diagnosis rates are comparable between women and men. Treatment of PAD commonly relies on endovascular interventions, including angioplasty, stenting, and atherectomy. While these interventions have proven effective, understanding sex-specific differences in outcomes has been insufficiently studied. This scoping review was conducted to assess the health outcomes of endovascular interventions for PAD in female subjects residing in the United States (US). A systematic search was performed across multiple databases, including EMBASE, Ovid MEDLINE, and Web of Science. The inclusion criteria focused on studies published between 2016 and 2024, involving lower extremity PAD interventions across the US female populations. Studies evaluating non-US populations, pharmacological treatments, and asymptomatic individuals were excluded. Data extraction focused on key factors, including (1) complication rates, (2) need for reintervention, and (3) long-term health outcomes. Nine retrospective cohort studies met the inclusion criteria. We analyzed complications, reintervention rates, amputation risks, and mortality outcomes, revealing variation in findings. Five studies reported increased complications in female patients, such as arterial dissection and hematoma formation. Additionally, four studies showed higher rates of reintervention among female patients, while one found no significant sex-based differences in reintervention or complications. Similarly, while three studies identified a greater risk of amputation and mortality in female patients, two others revealed no disparities or better outcomes among female patients. The variability in outcome measures, study designs, and patient populations may have contributed to the inconsistencies across these findings. These varied findings highlight the need for more standardized research measures to accurately assess how sex-based differences impact PAD treatment outcomes. Further research is necessary to explore anatomical, physiological, and sociocultural factors contributing to these disparities and to improve treatment strategies for female patients with PAD.

Spinal epidural steroid injections (SESI) are commonly used for radiating low back and cervical pain but remain limited by target imprecision, operator variability, and inconsistent outcomes. Artificial intelligence (AI) has been increasingly investigated as a tool to augment image interpretation, trajectory planning, and decision support in interventional procedures, prompting interest in its potential role in procedural guidance for SESI. This scoping review aimed to summarize the current evidence on the use of AI to support procedural guidance for SESI. A search was conducted across three databases, PubMed (National Library of Medicine (NLM)), Web of Science, and Embase, for English-language primary studies published between 2015 and 2025. Nine studies met the inclusion criteria. The AI architectures included machine learning, deep learning, and neural network-based models. Evidence was clustered into three domains: pre-procedural planning (e.g., anatomic segmentation and trajectory optimization using CT or MRI), intraprocedural guidance (e.g., real-time needle localization or plane identification using ultrasound or robotic systems), and post-procedural outcome prediction (e.g., forecasting pain reduction following SESI based on imaging data). Most studies demonstrated improvements in trajectory planning, needle localization, segmentation efficiency, or predictive performance. Potential benefits included reduced puncture time, decreased radiation exposure, and improved patient selection. However, AI performance was model-dependent, with some systems showing higher error rates than others. Additional limitations included small datasets, heterogeneity in AI model design, and underrepresentation of patients with spinal pathology or elevated body mass index. Overall, AI shows promise for enhancing SESI procedural guidance, but larger, more standardized studies are needed before its routine clinical use.

Chronic pruritus is a common and difficult-to-manage feature of inflammatory skin conditions. It develops through complex interactions between the skin barrier, immune system, and peripheral nervous system. Interleukin-31 (IL-31) and oncostatin M (OSM), both members of the interleukin-6 (IL-6) cytokine family, share the same receptor subunit, OSM receptor β (OSMRβ), and activate common downstream intracellular pathways, particularly the Janus kinase-signal transducer and activator of transcription (JAK-STAT) cascade. This systematic review aims to synthesize evidence in the current literature that supports IL-31 and OSM signaling across chronic pruritic dermatoses, with an emphasis on downstream JAK1-STAT3 pathways. A comprehensive search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using PubMed, Embase, Ovid MEDLINE, and the Web of Science databases. Studies evaluating OSM, IL-31, their shared receptor components (IL-31 receptor A (IL-31RA) and OSMRβ), and downstream intracellular signaling in chronic pruritic dermatoses were included. Twenty-six studies met the eligibility criteria, comprising randomized controlled trials, case-control studies, cross-sectional studies, case series, and experimental laboratory studies. Across atopic dermatitis (AD), prurigo nodularis (PN), psoriasis, cutaneous T-cell lymphoma (CTCL), dermatomyositis, and primary localized cutaneous amyloidosis (PLCA), both IL-31 and OSM contribute to chronic itch through overlapping pathways, including shared receptor architecture and activation of JAK1-STAT3 signaling. They were found to differ, however, in the way they influence neuronal activation and sensitization. IL-31 acts as a direct pruritogenic cytokine through activation of the IL-31RA/OSMRβ receptor complex on sensory neurons. In contrast, OSM may act to increase neuronal sensitivity, enhance excitability, and strengthen the response to other pruritic-inducing stimuli through the gp130/OSMRβ receptor complex. Despite these differences, both cytokines converge on the JAK1-driven STAT3 signaling pathway, ultimately contributing to skin barrier dysfunction, ongoing inflammation, and persistent neural sensitization. Blocking IL-31RA with nemolizumab or targeting OSMRβ with vixarelimab has led to clinically significant improvements in itch severity, patient-reported quality of life, and sleep disturbance. Together, these findings suggest that the shared components of the IL-31 and OSM pathways, including OSMRβ and JAK1-STAT3, provide us with a big picture framework for understanding itch pathogenesis in chronic pruritic dermatoses and may help guide therapeutic strategies in the future.

Sickle cell disease (SCD) is a genetic blood disorder that largely affects African Americans in the United States. This disease leads to an increased risk of neurocognitive decline and delay in pediatric patients with or without cerebral events. Despite its proven benefits, early intervention (EI) is underutilized in this population. This review aims to investigate the use of specific EI services within the pediatric SCD population and whether any combination of these services can lead to a better outcome than others. A scoping review was conducted using PubMed, Excerpta Medica Database (Embase), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The methods involved a systematic search using Boolean-modifier terms related to sickle cell and neurocognitive delay, with inclusion and exclusion criteria applied to select 19 relevant pediatric-focused articles, guided by PRISMA methodology. Results found that the use of EI services has proven to be beneficial in this population. Further research is needed to investigate EI services, such as the use of these therapies for preventative measures prior to symptoms or diagnosis of neurocognitive delay, and whether the starting age could affect the neurocognitive outcomes of the patients.

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder of reproductive-aged females. However, much of its pathophysiology is not well investigated or understood. Research has demonstrated an association between PCOS and metabolic dysfunction, including insulin resistance. The aim of this review was to investigate how immunological dysregulation might be mediating these metabolic disturbances, as well as how exercise might modulate the over-inflammatory state that has been observed in the PCOS population. A review of literature was conducted using PubMed, following the Preferred Reporting Items for Systemic Reviews and Meta-Analysis (PRISMA) guidelines. Results indicated that women with PCOS had higher levels of immunological mediators at baseline when compared to their counterparts without PCOS, suggestive of dysregulated immunological mechanisms. Despite exercise demonstrating benefits in lowering these inflammatory markers in women with PCOS, participants enrolled in exercise programs were unsuccessful in reaching the levels of inflammation comparable to women without PCOS. Further research is warranted to continue investigation into the mechanisms behind the over-inflammatory state observed in women with PCOS and how to best advise patients in managing such inflammation for an improved quality of life.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the coronavirus disease 2019 (COVID-19) pandemic, uses the surface angiotensin-converting enzyme 2 (ACE2) receptor as the site of entry into host cardiac, respiratory, intestinal, renal, and nervous system cells. Predisposing risk factors such as cardiovascular disease increase the risk of developing severe disease. Hypertension is characterized by the stimulation of the renin-angiotensin-aldosterone system (RAAS). Angiotensin-converting enzyme inhibitors (ACEis) and angiotensin 2 receptor blockers (ARBs), medications used to treat hypertension, inhibit RAAS and its downstream effects; however, they have also been shown to upregulate ACE2 receptors. In this review, we aim to evaluate the effectiveness of ACEi/ARBs as an adjunct therapy in patients with SARS-CoV-2 as well as examine the possible protective effects and impact on infection rate and disease severity. A PubMed literature search excluding sources outside the United States and duplicates was performed using the following search criteria: “COVID-19 AND cardiovascular disease AND ACEi AND ARB”, “SARS-COVID-19 OR COVID-19, AND ACEi AND ARB AND Infection rate”, “COVID-19 AND ACEi and ARB”, “Omicron BA.1 and BA.2 AND ACE2 OR ARBs”, “Omicron AND ACEi AND ARBs”. This resulted in 33 final sources. The review concluded that ACEi/ARB therapy may continue to improve COVID-19 survival as previous treatment is associated with positive clinical outcomes. Patients taking ACEis or ARBs were found to have a decreased risk of hospitalization, reduced severity of COVID-19 pneumonia, a lesser need for mechanical ventilation, and an overall reduction in mortality rate. No statistically significant association between ACEi/ARB use and enhanced COVID-19 infectivity was found. The Omicron variant is theoretically more infectious and was associated with increased negative clinical outcomes in those undertreated with ACEis/ARBs. The majority of the literature supports the current guidelines from the American College of Cardiology (ACC), American Heart Association (AHA), European Society of Cardiology (ESC), and Heart Failure Society of America (HFSA), which state that ACEi and ARB medications should not be withdrawn from or initiated on patients with cardiovascular disease who are infected with SARS-CoV-2. More research needs to be conducted on the association between the emerging COVID-19 variants and ACEis/ARBs to give clinicians confidence when treating patients within this subgroup of the population.