bluuebunny/crossref_metadata_2025 huggingface dataset:
Damage control surgery: old concepts and new indications
Authors: Chung C. Yvonne , Scalea Thomas M.
Published: October 2023

Purpose of review

While the principles of damage control surgery - rapid hemorrhage and contamination control with correction of physiologic derangements followed by delayed definitive reconstruction - have remained consistent, forms of damage control intervention have evolved and proliferated dramatically. This review aims to provide a historic perspective of the early trends of damage control surgery as well as an updated understanding of its current state and future trends.

Recent findings

Physiologically depleted patients in shock due to both traumatic and nontraumatic causes are often treated with damage control laparotomy and surgical principles. Damage control surgery has also been shown to be safe and effective in thoracic and orthopedic injuries. Damage control resuscitation is used in conjunction with surgical source control to restore patient physiology and prevent further collapse. The overuse of damage control laparotomy, however, is associated with increased morbidity and complications. With advancing technology, catheter- and stent-based endovascular modalities are playing a larger role in the resuscitation and definitive care of patients.

Optimal outcome in the care of the most severely injured patients requires judicious use of damage control surgery supplemented by advancements in resuscitation and surgical adjuncts.
Management of the kidney transplant recipient in the intensive care unit
Authors: Voora Santhi , Shah Sapna , Nadim Mitra K.
Published: October 2023

Purpose of review

Kidney transplantation is the ideal treatment for patients with chronic kidney disease and end stage renal disease. While centers are performing more transplants every year, the need for organ transplantation outpaces the supply of organ donors. Due to a growing population of patients with advanced kidney disease and a scarcity of kidneys from deceased donors, patients face extended wait times. By the time patients approach transplantation they have multiple comorbidities, in particular cardiovascular complications. Their risk of complications is further compounded by exposure to immunosuppression post kidney transplantation. Kidney transplant recipients (KTRs) are medically complex and may require acute management in the intensive care unit (ICU), as a result of cardiovascular complications, infections, and/or respiratory compromise from lung infections and/or acute pulmonary edema. Acute complication of immunosuppression, such as thrombotic microangiopathy and posterior reversible encephalopathy syndrome may also warrant ICU admission. This review will cover assessment of high-risk complications and management strategies following kidney transplantation.

Recent findings

For intensivists caring for KTRs, it is imperative to understand anatomical considerations of the transplanted kidney, unique infectious risks faced by this population, and appropriate modulation of immunosuppression.

Recognizing potential complications and implementing appropriate management strategies for KTRs admitted to the ICU will improve kidney allograft and patient survival outcomes.
Telephone cardiopulmonary resuscitation, first responder systems, cardiac arrest centers, and global campaigns to save lives
Authors: Müller Michael P. , Jonsson Martin , Böttiger Bernd W. , Rott Nadine
Published: October 2023

Purpose of review

The latest resuscitation guidelines contain a new chapter, which focuses on systems improving care for patients with out-of-hospital cardiac arrest (OHCA). In this article, we describe recent developments regarding telephone cardiopulmonary resuscitation (CPR), first responder systems, cardiac arrest centers, and global campaigns.

Recent findings

Telephone CPR has been implemented in many countries, and recent developments include artificial intelligence and video calls to improve dispatch assisted CPR. However, the degree of implementation is not yet satisfying. Smartphone alerting systems are effective in reducing the resuscitation-free interval, but many regions do not yet use this technology. Further improvements are needed to reduce response times. Cardiac arrest centers increase the survival chance after OHCA. Specific criteria need to be defined and professional societies should establish a certification process. Global campaigns are effective in reaching people around the world. However, we need to evaluate the effects of the campaigns.

Telephone CPR, first responder systems, cardiac arrest centers, and global campaigns are highlighted in the recent resuscitation guidelines. However, the degree of implementation is not yet sufficient. We do not only need to implement these measures, but we should also aim to monitor the systems regarding their performance and further improve them.
The phospholipase PNPLA7 functions as a positive indicator in human colorectal and gastric cancers
Authors: Bai Yang , Luo Kunlun , Xie Weixuan
Published: October 2023

Early diagnosis of gastrointestinal tumors remains a clinical challenge due to their insidious onset. Patatin-like phospholipase domain containing protein 7 (PNPLA7) has been shown to be associated with the occurrence and development of hepatocellular carcinoma. However, the expressions of PNPLA7 in colorectal and gastric cancers remain unclear. The online gene expression profiling interactive analysis and Kaplan–Meier Plotter databases were used for the analysis of the expression of PNPLA7 and the survival curve, respectively. The tumor tissues and their corresponding normal noncancerous tissues from colorectal cancer or gastric cancer patients were collected and quantitative real-time polymerase chain reaction assay was performed to evaluate the expression of related genes. PNPLA7 was significantly down-regulated in gastric and colorectal cancer tumor tissues compared to adjacent normal tissues. Receiver operating characteristic analysis showed that PNPLA7 could be used as a diagnostic marker for gastric and colorectal tumors. The overall survival of patients with high expression of PNPLA7 was also significantly higher than that of patients with low expression in stomach and rectum adenocarcinoma. Phospholipase PNPLA7 can be used as a positive diagnostic indicator for colorectal and gastric cancers.
FTO, PIK3CB serve as potential markers to complement CEA and CA15-3 for the diagnosis of breast cancer
Authors: Mi Jintao , Zhang Hongsheng , Cao Weiwei , Yuan Chengliang
Published: October 2023

The diagnostic efficacy of carcinoembryonic antigen (CEA) and carbohydrate antigen 15-3 (CA15-3) is limited in breast cancer (BC), highlighting the necessity of exploring novel biomarkers to improve for BC diagnosis. Therefore, we assessed the diagnostic value of fat mass and obesity-associated protein (FTO), phosphatidylinositol-4,5-biphosphate 3-kinase catalytic subunit β (PIK3CB) as a potential complementary biomarker to CEA and CA153 in breast cancer by measuring serum FTO,PIK3CB levels. FTO, PIK3CB, CEA and CA15-3 levels were measured in 112 BC patients and 64 healthy controls using enzyme-linked immunosorbent assay or electrochemiluminescence immunoassay. Spearman’s rank correlation analysis was conducted to assess the correlation between the levels of the 2 markers. The relationships between FTO, PIK3CB, CEA, CA15-3 and clinical characteristics were evaluated. Receiver operating characteristic curve (ROC) analysis was performed to assess the diagnostic value of FTO, PIK3CB, CEA and CA15-3 of BC. Serum FTO, PIK3CB, CEA and CA15-3 levels were significantly increased in BC. There was no correlation between FTO, PIK3CB and CEA, CA15-3. FTO and PIK3CB demonstrated significant diagnostic performance for breast cancer, with FTO achieving a specificity of 90.63%. The diagnostic performance of 2-four biomarker combinations was significantly superior to individual CEA or CA153, with a combined panel of 4 biomarkers yielding an area under the curve (AUC) of 0.918, sensitivity of 81.25% and specificity of 85.94%. In early-stage breast cancer (I + II), the combination of FTO, PIK3CB, CEA and CA153 yielded an AUC of 0.895, sensitivity of 77.22% and specificity of 85.71%. FTO and PIK3CB can be served as potential biomarkers to complement CEA and CA15-3 for BC diagnosis. Combining FTO, PIK3CB, CEA and CA15-3 improves the diagnostic efficiency of breast cancer.
Remimazolam sedation with regional anesthesia in difficult airway due to huge thyroid goiter: A case report
Authors: Kim Gwanbeom , Kim Yu Yil , Heo Hyun Joo , Park Junyoung
Published: October 2023

Rationale:

Remimazolam, a novel benzodiazepine, is known to have less respiratory depression compared to other anesthetic agents, and it also has a reversal agent that can be used in emergency situations. Remimazolam with these characteristics can be usefully utilized in the anesthetic management of patients with difficult airway.

Patient concerns:

A 78-year-old female patient was scheduled proximal humerus fracture surgery. The patient occasionally complained dyspnea and had multiple comorbidities including thyroid goiter, dementia, and delirium.

Diagnoses:

The patient had a large thyroid goiter compressing and deviating the trachea. A short neck with increased circumference was confirmed. A difficult airway was anticipated in the preanesthetic evaluation.

Interventions:

Sedation with remimazolam followed by regional anesthesia was performed for the surgery.

Outcomes:

The surgery was completed without complications. The patient recovered and was discharged on 15th postoperative days.

Lessons:

The use of remimazolam for sedation may be an appropriate option in the anesthetic management of patients with difficult airway.
Application of ultrasonic cavitation combined with rapid pathological tissue processing method of novel environmental protection reagents in pathological diagnosis
Authors: Yang Fan , Dou Wei , Wang Haisu , Cui Dandan , Li Chunyan
Published: October 2023

To investigate the effect of pretreatment of tumor biopsy specimens using fixed, dehydrated and transparent three-in-one composite environmental protection reagent ultrasound tissue rapid processing technique on subsequent detection. From April 2020 to October 2020, a total of 100 cases including breast, stomach and lung tissues were submitted to our diagnosis, and 3 specimens were collected from each specimen and divided into the control group (traditional biopsy tissue processing method), experimental group 1 (3.7% neutral buffered formaldehyde fixation, compound environmental protection reagent rapid ultrasound tissue processing technique, processing temperature 48 °C, time 20 minutes/time, twice, wax immersion temperature 62 °C, time 25 minutes) and experimental group 2 (3.7% neutral buffered formaldehyde fixation, compound environmental protection reagent rapid ultrasound tissue processing technique, processing temperature 50 °C, time 15 min/time, twice, Wax dipping temperature 64 °C, time 20 minutes). The effects of different treatments on hematoxylin eosin section, immunohistochemistry (IHC) and molecular pathological examination were analyzed. The detection results of hematoxylin eosin, fluorescence in situ hybridization and IHC against human epidermal growth factor receptor 2 and epidermal growth factor receptor gene mutation in the experimental group were completely consistent with those in the control group. There was no significant difference in the results between experiment 1 and experiment 2 groups. The rapid processing technique of ultrasound tissue with compound environmental protection reagent can be applied to the rapid detection of tumor biopsy specimens, and different processing temperatures and durations have no significant effect on the accuracy of HE staining, IHC, fluorescence in situ hybridization and gene mutation detection.
The efficacy and safety of aspirin in preventing venous thrombosis in major orthopedic surgery: An updated meta-analysis of randomized controlled trials
Authors: Liu Heng-Zhi , Liang Jie , Hu Ai-Xin
Published: October 2023

Background:

Major orthopedic surgery, including hip and knee replacement and lower extremity trauma fractures surgery, is associated with a high risk of venous thromboembolism (VTE), especially proximal deep vein thrombosis (DVT), and pulmonary embolism (PE), and is linked with high morbidity and mortality rates. Chemical anticoagulation is routinely used to prevent VTE, with previous meta-analyses reporting on the efficacy and safety of aspirin and other anticoagulants, however, opinions are divided. In the past 2 years, several large randomized controlled trials have been published, therefore, we reanalyzed aspirin efficacy and safety when compared with other anticoagulants in preventing VTE in major orthopedic surgery.

Methods:

Using PubMed, The Cochrane Library, Embase, and Web of Science databases, we conducted a RCT search in August 2023. The main outcomes included VTE, proximal DVT or PE. Additional outcomes included bleeding events, wound complications, wound infections, blood transfusions, and death events.

Results:

In total, 17 eligible articles, involving 29,522 patients (15,253 aspirin vs 14,269 other anticoagulant cases), were included. Primary outcomes showed that VTE incidence was more high in the aspirin group when compared with other anticoagulants (risk ratio [RR] = 1.45, 95% confidence interval [CI] = 1.18–1.77, P = .0004) and proximal in the aspirin group the DVT and/or PE incidence was significantly higher in the aspirin group when compared with other anticoagulants (RR = 1.19, 95% CI = 1.02–1.39, P = .03). No significant secondary outcome differences were identified in the aspirin group when compared with other anticoagulants (bleeding events [RR] = 0.83, 95% CI = 0.63–1.10, P = .20); wound complications (RR = 0.45, 95% CI = 0.20–1.04, P = .06); wound infection (RR = 1.08, 95% CI = 0.85–1.38, P = .53); blood transfusion events (RR = 1.00, 95% CI = 0.84–1.19, P = 1.00) and death events (RR = 1.11, 95% CI = 0.78–1.57, P = .55).

Conclusions:

Our updated meta-analysis showed that aspirin was inferior to when compared with other anticoagulants in VTE-related orthopedic major surgery, including proximal DVT and/or PE, and was more likely to form VTE. No differences between groups were identified for bleeding, wound complications, wound infections, transfusion, or death events.
Spontaneous hemorrhage of spinal epidural capillary hemangioma resulting in hyperacute neurologic deficit: A case report
Authors: Kliea Marwa , Alsultan Mohammad , Chatty Eyad , Qatleesh Safaa , Hamzeh Ghassan
Published: October 2023

Introduction:

Spinal epidural capillary hemangioma is a very rare variety of tumors, usually with a predilection for the thoracic spine.

Case presentation:

A 16-year-old female complained of hyperacute neurologic deficit progressed within hour, which presented by acute paraplegia, and loss of all sensations from her lower limbs up to her breasts. Neurologic exam revealed paralysis of lower limbs (0/5 on both legs) with a flaccid tone, absence of reflexes, weakness of the trunk with sensory level T4, bilateral flexion of plantar reflexes, and loss of sphincters’ controls. Emergent magnetic resonance imaging showed a dumbbell-shaped epidural mass in the posterior aspect of the spinal canal at the T1–T2 level, measuring approximately 1.1 × 4.5 × 1.5 cm in size. The lesion was isointense on T1-weighted, hyperintense on T2-weighted, and a little enhancement after gadolinium administration. The surgery was obtained nearly 16 hours after paralysis, which eradicated the lesion with good hemostasis. Histological examination showed a well-organized vascular tissue that haphazardly arranged and confirmed the diagnosis of capillary hemangioma. Neurological improvement was quickly observed within days after surgery and further complete recovery was achieved 2 months after discharge.

Conclusion:

We report an extremely rare case of spinal epidural capillary hemangioma, where acute spontaneous hemorrhage in the lesion resulted in the hyperacute neurologic deficit within an hour. Since these are benign lesions, the immediate surgical intervention results in a very favorable prognosis and is considered the treatment of choice. Also, this case highlighted and rose the question of a better neurologic improvement in younger age patients with spinal cord injury.
Risk factors associated with hemorrhagic cerebrovascular accident: A cross-sectional study in patients from a hospital in Peru
Authors: Rosales-Rimache Jaime , Ramos-Martínez Paola , Soncco-Llulluy Fernando , Bendezu-Quispe Guido
Published: October 2023

In Peru, cardiovascular accidents (CVA) cause around 15% of premature death, with an increase in CVA due to the prevalence of risk factors for CVA in the Peruvian population. Hemorrhagic CVA presents higher mortality compared to ischemic. This research aimed to identify the risk factors associated with hemorrhagic CVA. We carried out a retrospective cross-sectional study using the medical records of patients with a diagnosis of CVA treated at the Regional Hospital of Ica during the years 2018 and 2019. Independent variables included age, sex, type 2 diabetes, dyslipidemia, hypertension, smoking, obesity, and intracranial carotid artery calcification. To identify factors associated with an increased probability for hemorrhagic CVA compared to ischemic CVA, a generalized linear model with logit link and binomial family, obtaining the odds ratio (OR) and its 95% confidence interval (CI). we evaluated the data from 132 patients. Of them, 46 (34.85%) had hemorrhagic CVA. Only systolic blood pressure (OR: 1.04; 95% CI: 1.02–1.06) and hypertension (OR: 0.29; 95% CI: 0.10–0.89) were significantly associated with hemorrhagic CVA compared to ischemic CVA. Hypertension is associated with hemorrhagic CVA compared to ischemic CVA. These results are consistent with the literature.
Meta-analysis and time trend prediction of the prevalence of hypertension in Chinese college students
Authors: Zhang Zhaoqi , Li Minghui , Li Jiatong , Yu Ouyang , Jiang Baoyuan , Chen Yan , Guo Lianying
Published: October 2023

Background:

To understand the prevalence of hypertension among Chinese college students over the past decade (2010–2020) and predict its future trend, we aim to provide a basis for preventing and controlling hypertension among college students.

Methods:

Databases such as Chinese National Knowledge Infrastructure, Wanfang database, PubMed, and Web of Science were searched, and publications on the prevalence of hypertension among Chinese college students from 2010 to 2020 were collected. Search for publications in both Chinese and English databases using keywords “hypertension,” “prevalence,” “disease status,” “cross-sectional survey,” “epidemiology,” “China,” “adolescents,” and “college students.” Publication screening, data extraction, and quality assessment were independently conducted by 2 researchers. Meta-analysis was performed using Stata 16, and trends in the prevalence of hypertension among college students were analyzed using R 4.2.0.

Results:

A total of 37 publications were included in this analysis, which involved 233,603 Chinese college students. The Meta-analysis results showed significant heterogeneity among the studies (I2 = 98.9%, P < .05). Using a random-effects model, the overall prevalence of hypertension among college students was estimated to be 3.3% (95% CI = 2.9%–3.6%), with a higher prevalence among male students (6.2%, 95% CI = 5.4%–7.1%) than female students (1.1%, 95% CI = 0.9%–1.3%). The prevalence of hypertension is notably higher in northern regions than in southern regions. The prevalence of hypertension among college students showed an increasing trend from 2010 to 2020. Trend analysis predicted that the prevalence of hypertension among college students will reach 10% and 14.6% by 2030 and 2040, respectively. The risk of hypertension in male students was 4.63 times higher than that of female students (95% CI = 2.97–7.23). Compared normal weight students, overweight and obese students had 3.08 times (95% CI = 2.48–3.82) and 6.69 times (95% CI = 2.25–19.90) higher risk of hypertension, respectively.

Conclusion:

The prevalence of hypertension in Chinese college students was about 3.3%. The prevalence of hypertension in male college students was higher than that in females, and the prevalence in northern regions was generally higher than that in southern regions. The prevalence of hypertension among Chinese college students will reach 10.0% in the next 10 years and 14.6% in the next 20 years. Male and BMI ≥ 24 were risk factors for hypertension among college students.
MRI-based radiomics approach for the prediction of recurrence-free survival in triple-negative breast cancer after breast-conserving surgery or mastectomy
Authors: Zhao Jingwei , Zhang Qi , Liu Muqing , Zhao Xinming
Published: October 2023

To explore the value of a radiomics signature and develop a nomogram combined with a radiomics signature and clinical factors for predicting recurrence-free survival in triple-negative breast cancer patients. We enrolled 151 patients from the cancer imaging archive who underwent preoperative contrast-enhanced magnetic resonance imaging. They were assigned to training, validation and external validation cohorts. Image features with coefficients not equal to zero in the 10-fold cross-validation were selected to generate a radiomics signature. Based on the optimal cutoff value of the radiomics signature determined by maximally selected log-rank statistics, patients were stratified into high- and low-risk groups in the training and validation cohorts. Kaplan–Meier survival analysis was performed for both groups. Kaplan–Meier survival distributions in these groups were compared using log-rank tests. Univariate and multivariate Cox regression analyses were used to construct clinical and combined models. Concordance index was used to assess the predictive performance of the 3 models. Calibration of the combined model was assessed using calibration curves. Four image features were selected to generate the radiomics signature. The Kaplan–Meier survival distributions of patients in the 2 groups were significantly different in the training (P < .001) and validation cohorts (P = .001). The C-indices of the radiomics model, clinical model, and combined model in the training and validation cohorts were 0.772, 0.700, 0.878, and 0.744, 0.574, 0.777, respectively. The C-indices of the radiomics model, clinical model, and combined model in the external validation cohort were 0.778, 0.733, 0.822, respectively. The calibration curves of the combined model showed good calibration. The radiomics signature can predict recurrence-free survival of patients with triple-negative breast cancer and improve the predictive performance of the clinical model.
Hashimoto’s thyroiditis-related myopathy in a patient with SARS-CoV-2 infection: A case report and systematic literature review
Authors: Lee Zheng Cong , Wong Yu Jun Eugene , Ti Lian Lian , Shrikant Digambarrao Pande , Tay Tunn Lin , Santosa Anindita
Published: October 2023

Rationale:

Hashimoto’s thyroiditis (HT) is a common autoimmune disease. However, its presentation and management in the context of COVID-19 are unclear, and COVID-19-triggered HT, along with myopathy and persistent creatine kinase (CK) levels, have not been previously reported. Moreover, no literature review is currently available on HT in the context of COVID-19. This study is a case report and systematic review of the literature.

Patient concerns:

A 33-year-old man was admitted with acute-onset myalgia, anosmia, loss of taste, fever, and upper respiratory tract symptoms.

Diagnoses:

He was diagnosed with coronavirus disease (COVID-19) during hospitalization and had abnormal CK levels. The elevated CK level persisted even after the resolution of COVID-19. After excluding myopathies and cardiac factors, HT was diagnosed.

Interventions:

CK levels did not decrease appreciably until 14 d after levothyroxine administration.

Outcomes:

The patient was discharged from the hospital in good health. In the systematic literature review, 7 case reports on COVID-19-associated HT were observed, although no incidence of associated myopathy or persistent elevation of CK was noted.

Lessons:

This case report highlights the potential link between COVID-19 and autoimmune thyroid diseases. In particular, this study underscores the significance of recognizing new-onset autoimmune thyroid disease in COVID-19-positive patients with elevated CK levels that cannot be attributed to other factors. This systematic review offers additional perspectives for diagnosing and managing HT in COVID-19 settings. Overall, the findings of this study could have important clinical implications for the care of COVID-19 patients, as early identification and treatment of autoimmune thyroid disease could help prevent long-term complications. Additional research is essential to elucidate the fundamental correlations between COVID-19 and HT and assess the effectiveness of therapeutic approaches for autoimmune thyroid conditions related to COVID-19.
Distribution characteristics of pathogens in different stages of pressure ulcers and the therapeutic effect of linear polarized polychromatic light combined with silver sulfadiazine cream
Authors: Chen Binxiong , Liu Yang , Liu Yueming , Xu Shi
Published: October 2023

To investigate the distribution characteristics of pathogens in different stages of pressure ulcers and observe the application of linear polarized polychromatic light (LPPL) combined with silver sulfadiazine cream in treating varying stages of pressure ulcers. This study comprised 88 patients with pressure ulcers who were enrolled in the department of burn and plastic surgery of our hospital from April 2019 to April 2022. The wound exudates from patients were collected, followed by analyzing the distribution of pathogens in different stages of pressure ulcers. Patients were randomly divided into 2 groups. The first group (n = 44) received LPPL combined with silver sulfadiazine. The other group was intervened with LPPL group only for 2 weeks. The clinical efficacy, condition, and pain in the 2 groups, as well as the healing timeframes for patients were measured at different stages. The findings showed that among 88 patients with pressure ulcers, 62 were infected, and the infection rate was 70.45%. The pathogens that were observed in stage II and III to IV pressure ulcers were mainly Gram-negative bacteria. The total effective rate in the combined group was 90.91%, which was much higher than that of LPPL group (70.45%). Compared with LPPL group, the pressure ulcer scale for healing and visual analogue scale scores in the combined group were markedly lower (P < .05). It is important to note that in LPPL group, the healing time of patients in stage II and stage III to IV in the combined arm were 9.76 ± 2.38 days and 13.19 ± 2.54 days, respectively. The corresponding time in the LPPL group was prolonged to 13.20 ± 3.76 and 18.82 ± 4.17 days, respectively. The main pathogens associated with wound infection in patients with pressure ulcers are Gram-negative bacteria. The curative effects of LPPL combined with sulfadiazine silver cream on patients with pressure ulcer is obviously improved, and the recovery and pain relief are faster while the healing time of pressure ulcer is shorter.
Effect of ultrasound-guided femoral nerve block with dexmedetomidine and ropivacaine on postoperative analgesia in patients undergoing total knee arthroplasty: a randomized controlled trial
Authors: Hao Conghui , Qian Haitao , Li Han , Zhu Pin , Zhang Xiaobao , Zhao Zhibin , Luan Hengfei
Published: October 2023

Background:

Dexmedetomidine, a potent and highly selective α2-adrenoreceptor agonist, has become a popular adjuvant to local anesthetics. This study was designed to investigate the effect of dexmedetomidine with ropivacaine for femoral nerve block on postoperative analgesia after total knee arthroplasty.

Methods:

Forty-six patients after total knee arthroplasty received ultrasound-guided femoral nerve block with either 0.3% ropivacaine alone (group R) or 0.3% ropivacaine with 0.5 μg/kg dexmedetomidine (group RD). Total 24-h sufentanil consumption, visual analogue scale (VAS) pain scores, frequency of patient-controlled analgesia (PCA) pressed, Ramsay sedation score, the incidence of bradycardia and hypotension, and incidence of postoperative nausea and vomiting (PONV) were recorded.

Results:

Compared to group R, the total 24-h sufentanil consumption was significantly reduced (110.76 ± 11.56 vs. 99.09 ± 13.31; P<0.05), the VAS scores were lower at 10 and 12 h postoperatively [3(2–3) vs. 2(1–2) and 3(2–3) vs. 2(1–3), respectively; P<0.05], the frequency of PCA pressed was lower at 8–12 and 12–16-h time intervals [(5(3–6) vs. 2(1–3) and 4(3–4) vs. 2(1–3), respectively; P<0.05]. However, there were no differences in Ramsay’s sedation score and the incidence of PONV. Also, no patient experienced bradycardia and hypotension.

Conclusions:

0.5 μg/kg dexmedetomidine with 0.3% ropivacaine for femoral nerve block significantly decreased the total 24-h sufentanil consumption, prolonged and enhanced the analgesic efficacy of ropivacaine, without clinically relevant cardiovascular depression or over-sedation in patients undergoing total knee arthroplasty.
Increasing COVID-19 Immunization Awareness in Rural Communities Through a Multimedia Campaign
Authors: Skuras Alexis , Iseler Jackeline
Published: October 2023

Purpose/Objectives

The purpose of this project was to implement a multimedia campaign to increase COVID-19 vaccine awareness and acceptance in rural communities.

Description of Project

This project was created and implemented in partnership with a public university in Michigan and targeted to rural Michigan communities. The campaign consisted of digital advertisements and video interviews with nurses from rural areas. Interview questions were developed using knowledge of the health belief model and allowed the nurses to share their COVID-19 stories. Video interviews were published to social media, and digital advertisements were targeted to rural areas via geofencing. A viewer response survey was provided to measure likelihood of behavior change after viewing.

Outcome

The campaign advertisements and videos reached 602 980 people during the implementation period, and 239 surveys were completed. Of the 53 unvaccinated respondents, 87% stated an increased likelihood to vaccinate.

Conclusion

This project supports the ability of the clinical nurse specialist to lead a multimedia campaign partnership that can reach thousands of people and increase the likelihood of vaccination. As the popularity of digital media continues to rise, clinical nurse specialists can embrace these channels to disseminate critical health information.
Optimizing Surgical Wound Care in Obstetrics and Gynecology
Authors: Salinaro Julia R. , Jones Penny S. , Beatty Amelia B. , Dotters-Katz Sarah K. , Kuller Jeffrey A. , Kerner Nicole P.
Published: October 2023

Importance

Obstetrics and gynecology (OB/GYN) accounts for at least half of all open abdominal surgeries performed. Rates of surgical wound complications after open procedures in OB/GYN range from 5% to 35%. Therefore, optimizing management of surgical wound complications has the potential to significantly reduce cost and morbidity. However, guidelines addressing best practices for wound care in OB/GYN are limited.

Objective

The objectives of this review are to describe the fundamentals of wound healing and to evaluate available evidence addressing surgical wound care. Based on these data, we provide recommendations for management of extrafascial surgical wound dehiscence after OB/GYN procedures.

Evidence Acquisition

Literature search was performed in PubMed, Medline, OVID, and the Cochrane database. Relevant guidelines, systematic reviews, and original research articles investigating mechanisms of wound healing, types of wound closure, and management of surgical wound complications were reviewed.

Results

Surgical wound complications in OB/GYN are associated with significant cost and morbidity. One of the most common complications is extrafascial dehiscence, which may occur in the setting of hematomas, seromas, or infection. Management includes early debridement and treatment of any underlying infection until healthy granulation tissue is present. For wounds healing by secondary intention, advanced moisture retentive dressings reduce time to healing and are cost-effective when compared with conventional wet-to-dry gauze dressings. Negative pressure wound therapy can be applied to deeper wounds healing by secondary intention. Review of published evidence also supports the use of delayed reclosure to expedite wound healing for select patients.

Conclusions

Optimizing surgical wound care has the potential to reduce the cost and morbidity associated with surgical wound complications in OB/GYN. Advanced moisture retentive dressings should be considered for wounds healing by secondary intention. Data support delayed reclosure for select patients, although further studies are needed.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After reading this article, the provider will be better able to explain the clinical significance of surgical wound complications, particularly in OB/GYN; identify the stages of wound healing and types of wound closure; discuss the TIME framework for wound care; and describe a recommended approach for the management of extrafascial wound dehiscence.
A New Era in Magnetic Resonance Contrast Media
Authors: Runge Val M. , Heverhagen Johannes T.
Published: October 2023

Next-generation gadolinium-based contrast agents (GBCAs), including both high relaxivity agents and targeted agents, and manganese-based agents with a high probably of commercial success are discussed in some depth. It is highly likely that gadopiclenol and gadoquatrane, both next-generation high relaxivity gadolinium-based compounds, will come in time to replace the current macrocyclic gadolinium chelates, despite the wide acceptance, very high safety profile, and high stability of the latter group. Current research has also made possible the development of 2 new targeted gadolinium chelates, which look very promising, with the potential to improve cancer detection (for both MT218 and ProCA32.collagen) as well as diseases of collagen (for the latter agent). Further work with manganese-based compounds, a topic left fallow for more than 20 years, has also now produced 2 agents with high potential for clinical use, one (manganese chloride tetrahydrate, administered orally) developed primarily for imaging of the liver and the other (Mn-PyC3A, administered intravenously) as a gadolinium-free replacement for the GBCAs. New detail has recently emerged regarding specific circumscribed subregions of the brain with specialized cytoarchitecture and functions in which high gadolinium concentrations are seen following injection of the linear agent gadodiamide. These findings pave the way for tailored functional neurological testing, specifically in patients at potential risk due to the continued wide use in many countries across the world of the linear GBCAs. The impact of artificial intelligence is also critically discussed, with its most likely applications being dose reduction and new clinical indications.
The impact of acquired immune deficiency syndrome on colorectal surgery
Authors: Weledji Elroy Patrick
Published: October 2023

The patients infected with the human immunodeficiency virus are not a homogeneous group and are generally living longer on human active antiretroviral therapy. They are amenable to the colorectal diseases in the general population for which colorectal surgery is safe and effective. Surgical intervention is obligatory in life-threatening surgical correctable disease, but aggressive surgical intervention must be undertaken with caution and adequate perioperative care is required. A close liaison between the human immunodeficiency virus/acquired immune deficiency syndrome physician and the surgeon will decrease negative laparotomies and exclude preterminal cases. The knowledge of anorectal sexually transmitted diseases is important, and the symptomatic improvement of anorectal pathology in acquired immune deficiency syndrome may render delayed wound healing an acceptable complication.
Hoeflea poritis sp. nov., isolated from a bleached scleractinian coral Porites lutea
Authors: Zhang Guoqiang , Zhang Zongyao , Sajid Sumbal , Wei Qiaoyan , Cai Lin
Published: October 2023

A Gram-stain-negative, aerobic, rod-shaped, nonmotile and yellow-pigmented bacterium designated E7-10T was isolated from a bleached scleractinian coral Porites lutea. Strain E7-10T grew with 1.0–8.0 % (w/v) NaCl (optimum, 4.0 %), at 18–41 °C (optimum, 28 °C) and at pH 6.0–10.0 (optimum, pH 8.0). Phylogenetic analysis using 16S rRNA gene sequences revealed that E7-10T formed a lineage within the genus

Hoeflea

, but it was distinct from the closest species ‘Hoeflea prorocentri’ PM5-8T, showing 98.01 % sequence similarity. The predominant cellular fatty acids of E7-10T were summed feature 8 (26.7 %), C18 : 1
 ω7c 11-methyl (26.2 %), C16 : 0 (20.8 %) and C19 : 0 cyclo ω8c (17.9 %). The major respiratory quinone was Q-10. The polar lipids mainly comprised phosphatidylethanolamine, two glycolipids and five phospholipids. The genome size of E7-10T was 5.58 Mb with G+C content 60.27 mol%. The digital DNA–DNA hybridization and average nucleotide identity values between the genomes of strains E7-10T and PM5-8T were 19.50 and 75.95 %, respectively, which were both below the defined cutoff values (70 % and 95–96 %, respectively) for species delimitation. Thus, strain E7-10T represents a novel species within the genus

Hoeflea

, for which the name Hoeflea poritis sp. nov. is proposed. The type strain is E7-10T (=JCM 35852T=MCCC 1K08229T).
Population heterogeneity in Mycobacterium smegmatis and Mycobacterium abscessus
Authors: Born Sarah E. M. , Reichlen Matthew J. , Bartek Iona L. , Benoit Jeanne B. , Frank Daniel N. , Voskuil Martin I.
Published: October 2023

Bacteria use population heterogeneity, the presence of more than one phenotypic variant in a clonal population, to endure diverse environmental challenges – a ‘bet-hedging’ strategy. Phenotypic variants have been described in many bacteria, but the phenomenon is not well-understood in mycobacteria, including the environmental factors that influence heterogeneity. Here, we describe three reproducible morphological variants in

M. smegmatis

– smooth, rough, and an intermediate morphotype that predominated under typical laboratory conditions.

M. abscessus

has two recognized morphotypes, smooth and rough. Interestingly,

M. tuberculosis

exists in only a rough form. The shift from smooth to rough in both

M. smegmatis

and

M. abscessus

was observed over time in extended static culture, however the frequency of the rough morphotype was high in pellicle preparations compared to planktonic culture, suggesting a role for an aggregated microenvironment in the shift to the rough form. Differences in growth rate, biofilm formation, cell wall composition, and drug tolerance were noted among

M. smegmatis

and

M. abscessus

variants. Deletion of the global regulator lsr2 shifted the

M. smegmatis

intermediate morphotype to a smooth form but did not fully phenocopy the naturally generated smooth morphotype, indicating Lsr2 is likely downstream of the initiating regulatory cascade that controls these morphotypes. Rough forms typically correlate with higher invasiveness and worse outcomes during infection and our findings indicate the shift to this rough form is promoted by aggregation. Our findings suggest that mycobacterial population heterogeneity, reflected in colony morphotypes, is a reproducible, programmed phenomenon that plays a role in adaptation to unique environments and this heterogeneity may influence infection progression and response to treatment.
Preventing injuries: How augmented reality reduces fall risks in pseudo-natural environments
Authors: Ball Felix , Bomba Judith , Nentwich Annika , Meier Fabian , Vavra Peter , Noesselt Toemme
Published: October 2023

Falling is a major contributor to injury-related incidents and the 2nd most likely cause for unintentional injury deaths world-wide. Here, we therefore tested a vision aid for obstacle detection during a navigation task in pseudo-natural environments (virtually created cities). The vision aid had nine different setups (i.e. no highlighting of hazardous objects vs. eight different hit / false alarm ratios [cue validity]). Elderly and healthy, young adults completed the navigation task. As in real life, elderly walked slower and fell more often in pseudo-natural environments, suggesting the ecological validity of such safe experimental setups to test hazardous situations. Importantly, the vision aid reduced the risk of falling (by up to 33 %) for both age groups. Thus, our study highlights that a vision aid which augments reality could be a substantial contributor in preventing falls and related injuries, decreasing the financial burden on the health system and increasing life quality.
Break-up and Recovery of Harmony between Direct and Indirect Pathways in The Basal Ganglia; Huntington's Disease and Treatment
Authors: Kim Sang-Yoon , Lim Woochang
Published: October 2023

The basal ganglia (BG) in the brain exhibit diverse functions for motor, cognition, and emotion. Such BG functions could be made via competitive harmony between the two competing pathways, direct pathway (DP) (facilitating movement) and indirect pathway (IP) (suppressing movement). As a result of break-up of harmony between DP and IP, there appear pathological states with disorder for movement, cognition, and psychiatry. In this paper, we are concerned about the Huntington's disease (HD), which is a genetic neurodegenerative disorder causing involuntary movement and severe cognitive and psychiatric symptoms. For the HD, the number of D2 SPNs (ND2) is decreased due to degenerative loss, and hence, by decreasingxD2(fraction ofND2), we investigate break-up of harmony between DP and IP in terms of their competition degreeCd, given by the ratio of strength of DP (SDP) to strength of IP (SIP) (i.e.,Cd= SDP/ SIP). In the case of HD, the IP is under-active, in contrast to the case of Parkinson's disease with over-active IP, which results in increase inCd(from the normal value). Thus, hyperkinetic dyskinesia such as chorea (involuntary jerky movement) occurs. We also investigate treatment of HD, based on optogenetics and GP ablation, by increasing strength of IP, resulting in recovery of harmony between DP and IP. Finally, we study effect of loss of healthy synapses of all the BG cells on HD. Due to loss of healthy synapses, disharmony between DP and IP increases, leading to worsen symptoms of the HD.
Long-TermIn VivoMolecular Monitoring Using Aptamer-Graphene Microtransistors
Authors: Wu Guangfu , Zhang Eric T. , Qiang Yingqi , Esmonde Colin , Chen Xingchi , Wei Zichao , Song Yang , Zhang Xincheng , Schneider Michael J. , Li Huijie , Sun He , Weng Zhengyan , Santaniello Sabato , He Jie , Lai Rebecca Y. , Li Yan , Bruchas Michael R. , Zhang Yi
Published: October 2023

Long-term, real-time molecular monitoring in complex biological environments is critical for our ability to understand, prevent, diagnose, and manage human diseases. Aptamer-based electrochemical biosensors possess the promise due to their generalizability and a high degree of selectivity. Nevertheless, the operation of existing aptamer-based biosensorsin vivois limited to a few hours. Here, we report a first-generation long-termin vivomolecular monitoring platform, named aptamer-graphene microtransistors (AGMs). The AGM incorporates a layer of pyrene- (polyethylene glycol)5-alcohol and DNase inhibitor-doped polyacrylamide hydrogel coating to reduce biofouling and aptamer degradation. As a demonstration of function and generalizability, the AGM achieves the detection of biomolecules such as dopamine and serotonin in undiluted whole blood at 37 °C for 11 days. Furthermore, the AGM successfully captures optically evoked dopamine releasein vivoin mice for over one week and demonstrates the capability to monitor behaviorally-induced endogenous dopamine release even after eight days of implantation in freely moving mice. The results reported in this work establish the potential for chronic aptamer-based molecular monitoring platforms, and thus serve as a new benchmark for molecular monitoring using aptamer-based technology.
Transporter-mediated depletion of extracellular proline directly contributes to plant pattern-triggered immunity against a bacterial pathogen
Authors: Rogan Conner J. , Pang Yin-Yuin , Mathews Sophie D. , Turner Sydney E. , Weisberg Alexandra J. , Lehmann Silke , Rentsch Doris , Anderson Jeffrey C.
Published: October 2023

Plants possess cell surface-localized immune receptors that detect pathogen-associated molecular patterns (PAMPs) and initiate defenses that provide effective resistance against microbial pathogens. Many PAMP-induced signaling pathways and cellular responses are known, yet how pattern-triggered immunity (PTI) limits pathogen growth in plants is poorly understood. Through a combined metabolomics and genetics approach, we discovered that plant-exuded proline is a virulence-inducing signal and nutrient for the bacterial pathogenPseudomonas syringae, and that PAMP-induced depletion of proline from the extracellular spaces of Arabidopsis leaves directly contributes to PTI againstP. syringae. We further show that PAMP-induced depletion of extracellular proline requires the amino acid transporterLysineHistidineTransporter1(LHT1). This study demonstrates that depletion of a single extracellular metabolite is an effective component of plant innate immunity. Given the important role for amino acids as nutrients for microbial growth, their depletion at sites of infection may be a broadly effective means for defense against many pathogens.
A role for conformational changes in enzyme catalysis
Authors: Rivoire Olivier
Published: October 2023

The role played by conformational changes in enzyme catalysis is controversial. In addition to examining specific enzymes, studying formal models can help identify the conditions under which conformational changes promote catalysis. Here, we present a model demonstrating how conformational changes can break a generic trade-off due to the conflicting requirements of successive steps in catalytic cycles, namely high specificity for the transition state to accelerate the chemical transformation and low affinity for the products to favor their release. The mechanism by which the trade-off is broken is a transition between conformations with different affinities for the substrate. The role of the effector that induces the transition is played by a substrate “handle”, a part of the substrate that is not chemically transformed but whose interaction with the enzyme is nevertheless essential to rapidly complete the catalytic cycle. A key element of the model is the formalization of the constraints causing the trade-off that the presence of multiple states breaks, which we attribute to the strong chemical similarity between successive reaction states – substrates, transition states and products. For the sake of clarity, we present our model for irreversible one-step unimolecular reactions. In this context, we demonstrate how the different forms that chemical similarities between reaction states can take impose limits on the overall catalytic turnover. We first analyze catalysts without internal degrees of freedom, and then show how two-state catalysts can overcome their limitations. Our results recapitulate previous proposals concerning the role of conformational changes and substrate handles in a formalism that makes explicit the constraints that elicit these features. In addition, our approach establishes links with studies in the field of heterogeneous catalysis, where the same trade-offs are observed and where overcoming them is a well-recognized challenge.