bluuebunny/crossref_metadata_2025 huggingface dataset:
Unveiling Dominant Fungal Pathogens Associated with Root Rot of Hybrid Bermudagrass Based on Culture Dependent and Independent Methods
Authors: Cao Zhiling , Zhou Yuxin , Lamour Kurt , Yang Zhimin , Liu Jun , Hu Jian
Published: November 2023

Hybrid bermudagrass (Cynodon dactylon × C. transvaalensis) is widely used as turf in southern and transition zones of China. From June to September in 2022, an unknown disease was consistently observed on hybrid bermudagrass in different regions of Nanjing, China, that exhibited distinct symptoms of leaf necrosis, severe root rot, and circular or irregular necrotic patches with 20- to 300-cm diameters. In this study, culture-independent and -dependent methods were used to elucidate the dominant fungal pathogens associated with the disease. Basidiomycota and Marasmiellus were shown to be the dominant phyla (51.96 to 70.60%) and genera (50.09 to 69.84%) in the symptomatic samples. A total of 128 fungal strains were isolated from symptomatic root tissues, and 40 strains representing the largest proportion (31.25%) were identified as Marasmiellus mesosporus based on the morphological characteristics, phylogenetic analysis of the ITS and LSU rDNA region, and pathogenicity testing. Temperature sensitivity tests revealed that M. mesosporus grew well at high temperatures (growth rate of 13.74 mm/day at 36°C). To our knowledge, this is the first report of M. mesosporus causing root rot disease on hybrid bermudagrass during hot summer months. The study will have important implications for the management of the disease.
Survival of Sclerotinia sclerotiorum Sclerotia in Central New York
Authors: Pethybridge Sarah J. , Murphy Sean , Lund Margaret , Kikkert Julie R.
Published: November 2023

White mold caused by Sclerotinia sclerotiorum is a serious disease affecting many field and specialty crops in New York (NY). The primary inoculum for white mold is sclerotia, which are hardened masses of mycelia that survive adverse environmental conditions and periods of nonhosts. However, NY crop guidelines lack rotation and residue management recommendations based on local knowledge of sclerotial survival. A field trial was established in October 2020 by deploying S. sclerotiorum sclerotia in mesh bags on the soil surface or shallowly buried (placed at a 3-cm depth in the soil) at Geneva, NY. Bags were periodically collected from 67 to 769 days. At each collection, sclerotial retrieval (number of sclerotia) was assessed by counting, and their viability was evaluated through myceliogenic germination. Sclerotial retrieval was significantly affected by soil depth and was higher in those on the surface than those buried. Time also affected the retrieval of sclerotia, which was significantly reduced after 250 days. The interaction between burial and time had a significant effect on sclerotial viability. Approximately 15% of sclerotia placed on the surface were still viable after 769 days. After 433 days, the viability of buried sclerotia was also significantly reduced compared to those on the surface. After 670 days, none of the buried sclerotia were viable. These findings suggest a rotation of at least 2 years between susceptible crops is required to reduce primary inoculum. However, given that low inoculum densities are sufficient to initiate a white mold outbreak, a longer rotation may be beneficial. In a cultivated system, timely tillage of crop residue to bury sclerotia after harvest to promote degradation is encouraged.
Functional Roles of Two β-Tubulin Isotypes in Regulation of Sensitivity of Colletotrichum fructicola to Carbendazim
Authors: Zhu Yuanye , Ma Mengting , Li He
Published: November 2023

Colletotrichum fructicola is the major pathogen of anthracnose in tea-oil trees in China. Control of anthracnose in tea-oil trees mainly depends on the application of chemical fungicides such as carbendazim. However, the current sensitivity of C. fructicola isolates in tea-oil trees to carbendazim has not been reported. Here, we tested the sensitivity of 121 C. fructicola isolates collected from Guangdong, Guangxi, Guizhou, Hainan, Hunan, Jiangsu, and Jiangxi provinces in China to carbendazim. One hundred and ten isolates were sensitive to carbendazim, and 11 isolates were highly resistant to carbendazim. The growth rates, morphology, and pathogenicity of three resistant isolates were identical to those of three sensitive isolates, which indicates that these resistant isolates could form a resistant population under carbendazim application. These results suggest that carbendazim should not be the sole fungicide in control of anthracnose in tea-oil trees; other fungicides with different mechanisms of action or mixtures of fungicides could be considered. In addition, bioinformatics analysis identified two β-tubulin isotypes in C. fructicola: Cfβ1tub and Cfβ2tub. E198A mutation was discovered in the Cfβ2tub of three carbendazim-resistant isolates. We also investigated the functional roles of two β-tubulin isotypes. CfΔ β1tub exhibited slightly increased sensitivity to carbendazim and normal phenotypes. Surprisingly, CfΔ β2tub was highly resistant to carbendazim and showed a seriously decreased growth rate, conidial production, pathogenicity, and abnormal hyphae morphology. Promoter replacement mutant CfΔ β2-2 ×β1 showed partly restored phenotypes, but it was still highly resistant to carbendazim, which suggests that Cfβ1tub and Cfβ2tub are functionally interchangeable to a certain degree.
Perioperative Regional Anesthesia Pain Outcomes in Children
Authors: Xie James , De Souza Elizabeth , Perez Felipe , Suárez-Nieto María Valentina , Wang Ellen , Anderson T. Anthony
Published: November 2023

Objective:

Randomized controlled trials indicate regional anesthesia (RA) improves postoperative outcomes with reduced pain and opioid consumption. Therefore, we hypothesized children who received RA, regardless of technique, would have reduced pain/opioid use in routine practice.

Methods:

Using a retrospective cohort, we assessed the association of RA with perioperative outcomes in everyday practice at our academic pediatric hospital. Patients ≤18 years undergoing orthopedic, urologic, or general surgeries with and without RA from 5/2014 to 9/2021 were categorized as single-shot, catheter-based, or no-block. Outcomes included: intraoperative opioid exposure and dose, pre-incision anesthesia time, post anesthesia care unit (PACU) opioid exposure and dose, PACU antiemetic/antipruritic administration, PACU/inpatient pain scores, PACU/inpatient lengths of stay, and cumulative opioid exposure. Regression models estimated the adjusted association of RA with outcomes, controlling for multiple variables.

Results:

11,292 procedures with 3,160 RAs were included. Compared to no-block group, single-shot and catheter-based blocks were associated with opioid-free intraoperative anesthesia and opioid-free PACU stays. Post-PACU (i.e. while inpatient), single-shot blocks were not associated with improved pain scores or reduced opioid use. Catheter-based blocks were associated with reduced PACU and inpatient opioid use until 24 hours post-op, no difference of opioid use from 24 to 36 hours, and higher probability of use from 36 to 72 hours. RA was not associated with reduced cumulative opioid consumption.

Discussion:

Despite adjustment for confounders, the association of RA with pediatric pain/opioid use outcomes was mixed. Further investigation is necessary to maximize the benefits of RA.
Mindfulness-based Interventions for Chronic Low Back Pain
Authors: Paschali Myrella , Lazaridou Asimina , Sadora Jason , Papianou Lauren , Garland Eric L. , Zgierska Aleksandra E. , Edwards Robert R.
Published: November 2023

Objective:

This systematic review aimed to compile existing evidence examining the effects of mindfulness-based interventions (MBIs) for chronic low back pain (CLBP). CLBP leads to millions of disabled individuals in the US each year. Current pharmacologic treatments are only modestly effective and may present long-term safety issues. MBIs, which have an excellent safety profile, have been shown in prior studies to be effective in treating CLBP yet remained underutilized.

Design:

Ovid/Medline, PubMed, Embase, and the Cochrane Library were searched for, randomized controlled trials (RCTs), pilot RCTs and single-arm studies that explored the effectiveness of MBIs in CLBP.

Methods:

Separate searches were conducted to identify trials that evaluated MBIs in reducing pain intensity in individuals with CLBP. A meta-analysis was then performed using R v3.2.2, Metafor package v 1.9-7.

Results:

Eighteen studies used validated patient-reported pain outcome measures and were therefore included in the meta-analysis. The MBIs included Mindfulness Meditation, Mindfulness-Based Stress Reduction, Mindfulness-Based Cognitive Therapy, Mindfulness Oriented Recovery Enhancement, Acceptance and Commitment Therapy, and Dialectical Behavioral Therapy, Meditation-CBT, Mindfulness-Based Care for Chronic Pain, Self-Compassion course and Loving-Kindness course. Pain intensity scores were reported using a numerical rating scale (0-10) or an equivalent scale. The meta-analysis revealed that MBIs have a beneficial effect on pain intensity with a large-sized effect in adults with CLBP.

Conclusion:

MBIs seem to be beneficial in reducing pain intensity. Although these results were informative, findings should be carefully interpreted due to the limited data and the high variability in study methodologies. More large-scale RCTs are needed to provide reliable effect size estimates for MBIs in persons with CLBP.
Prediction of Complications and Prognostication in Perioperative Medicine: A Systematic Review and PROBAST Assessment of Machine Learning Tools
Authors: Arina Pietro , Kaczorek Maciej R. , Hofmaenner Daniel A. , Pisciotta Walter , Refinetti Patricia , Singer Mervyn , Mazomenos Evangelos B. , Whittle John
Published: November 2023

Background

The utilization of artificial intelligence and machine learning as diagnostic and predictive tools in perioperative medicine holds great promise. Indeed, many studies have been performed in recent years to explore the potential. The purpose of this systematic review is to assess the current state of machine learning in perioperative medicine, its utility in prediction of complications and prognostication, and limitations related to bias and validation.

Methods

A multidisciplinary team of clinicians and engineers conducted a systematic review using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocol. Multiple databases were searched, including Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, PubMed, Medline, Embase, and Web of Science. The systematic review focused on study design, type of machine learning model used, validation techniques applied, and reported model performance on prediction of complications and prognostication. This review further classified outcomes and machine learning applications using an ad hoc classification system. The Prediction model Risk Of Bias Assessment Tool (PROBAST) was used to assess risk of bias and applicability of the studies.

Results

A total of 103 studies were identified. The models reported in the literature were primarily based on single-center validations (75%), with only 13% being externally validated across multiple centers. Most of the mortality models demonstrated a limited ability to discriminate and classify effectively. The PROBAST assessment indicated a high risk of systematic errors in predicted outcomes and artificial intelligence or machine learning applications.

Conclusions

The findings indicate that the development of this field is still in its early stages. This systematic review indicates that application of machine learning in perioperative medicine is still at an early stage. While many studies suggest potential utility, several key challenges must be first overcome before their introduction into clinical practice.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Obstetric and Neonatal Outcomes After Transferring More Than One Embryo in Patients With Preimplantation Genetic Testing
Authors: Gerber Rachel S. , Kappy Michelle , Gingold Julian , Wu Haotian , Lieman Harry J. , Singh Manvinder , Pollack Staci E. , Jindal Sangita
Published: November 2023

OBJECTIVE:

To compare obstetric and neonatal outcomes after single embryo transfer (SET) compared with multiple embryo transfer (MET) from frozen-thawed transfer cycles of embryos that underwent preimplantation genetic testing for aneuploidies (PGT-A).

METHODS:

We conducted a retrospective cohort study from the SART CORS (Society for Assisted Reproductive Technology Clinic Outcome Reporting System) national database. Clinical and demographic data were obtained from the SART CORS database for all autologous and donor egg frozen-thawed transfer cycles of embryos that underwent PGT-A between 2014 and 2016, after excluding cycles that used frozen oocytes, fresh embryo transfer, and transfers of embryos from more than one stimulation cycle. Multivariable linear and log-binomial regression models were used to estimate the relative and absolute difference in live-birth rate, multiple pregnancy rate, gestational age at delivery, and birth weight between SET compared with MET.

RESULTS:

In total, 15,638 autologous egg transfer cycles and 944 donor egg transfer cycles were analyzed. Although the live-birth rate was higher with MET compared with SET in the autologous oocyte cycles (64.7% vs 53.2%, relative risk [RR] 1.24, 95% CI, 1.20–1.28), the multiple pregnancy rate was markedly greater (46.2% vs 1.4%, RR 32.56, 95% CI, 26.55–39.92). Donor oocyte cycles showed similar trends with an increased live-birth rate (62.0% vs 49.7%, RR 1.26, 95% CI, 1.11–1.46) and multiple pregnancy rate (54.0% vs 0.8%) seen with MET compared with SET. Preterm delivery rates and rates of low birth weight were significantly higher in MET compared with SET in both autologous and donor oocyte cycles and were also higher in the subanalysis of singleton deliveries that resulted from MET compared with SET.

CONCLUSION:

Despite some improvement in live-birth rate, nearly half of the pregnancies that resulted from MET of embryos that underwent PGT-A were multiples. Compared with SET, MET is associated with significantly higher rates of neonatal morbidity, including preterm delivery and low birth weight. The transfer of more than one embryo that underwent PGT-A should continue to be strongly discouraged, and patients should be counseled on the significant potential for adverse outcomes.
Extracorporeal Membrane Oxygenation in Pregnant and Postpartum Women With Critical Coronavirus Disease 2019 (COVID-19) Acute Respiratory Distress Syndrome
Authors: Shamshirsaz Amir A. , Byrne John J. , Ramsey Patrick S. , Cahill Alison G. , Turrentine Mark A.
Published: November 2023

OBJECTIVE:

To estimate the maternal survival and live-birth rates in pregnant women with acute respiratory distress syndrome (ARDS) secondary to critical coronavirus disease 2019 (COVID-19) who are treated with extracorporeal membrane oxygenation (ECMO) by performing a systematic review and meta-analysis.

DATA SOURCES:

From database inception through August 2023, we explored MEDLINE, Web of Science, EMBASE, CINAHL, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials. Studies reporting maternal survival and live-birth rates in pregnant women with critical COVID-19 undergoing ECMO were included.

METHODS OF STUDY SELECTION:

Two reviewers separately ascertained studies, obtained data, and evaluated study quality. Summary estimates of maternal survival and live-birth rates were measured, and 95% CIs were calculated.

TABULATION, INTEGRATION, AND RESULTS:

Nine retrospective case series and 12 retrospective cohort studies were identified with 386 pregnant women with critical COVID-19 who underwent ECMO. Studies evaluated women that were treated from January 2020 to October 2022. Four studies were from the United States; three were from Turkey; two were from France; two were from Israel; and one each was from Columbia, Germany, Italy, Kuwait, Poland, Republic of Srpska, the United Arab Emirates, the United Kingdom, a consortium from Belgium, France, Switzerland, and an international registry. The pooled estimate of the maternal survival rate among pregnant patients who were initiated on ECMO was 75.6% (95% CI, 66.0–84.1%, I
2=72%). The pooled estimate of the live-birth rate among pregnant patients who were initiated on ECMO was 83.7% (95% CI, 76.8-89.6%, 153 neonates, I
2=11%). When the case series and cohort studies were examined separately, the results were similar.

CONCLUSION:

Among pregnant women with acute respiratory distress syndrome attributable to critical COVID-19 who were managed with ECMO, maternal survival and live-birth rates were high.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO, CRD42023442800.
Network Meta-analysis of C5 Palsy after Anterior Cervical Decompression of 3-6 Levels
Authors: Takase Hajime , Haze Tatsuya , Yamamoto Daisuke , Inagaki Naoko , Nitta Manabu , Hidetoshi Murata , Yamamoto Tetsuya
Published: November 2023

Study Design.

Systematic review and meta-analysis.

Objective.

Using a network meta-analysis, this study aimed to compare the risks of C5 palsy after three different procedures of anterior cervical decompression.

Summary of Background Data.

C5 palsy is a well-known complication affecting quality of life after anterior procedures. Due to the limited evidence on the various procedures available, we evaluate the basis for selection to prevent palsy and achieve maximal decompression in cases spanning 3-6 levels.

Methods.

We conducted a comprehensive search for C5 palsy and complications after three representative procedures, including anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), and their combination (Hybrid), involving 3-6 intervertebral levels. The incidence of C5 palsy was compared using a network meta-analysis.

Results.

We identified 1655 patients in 11 studies that met inclusion criteria. Sixty-nine patients (4.2%) developed delayed C5 palsies. The incidences among ACDF, ACCF, and Hybrid cases were 2.3% (16/684, 95% confidence interval [CI] 1.4−3.8%), 6.4% (39/613, 95%CI 4.7−8.6%), and 3.9% (14/358, 95%CI 2.3−6.5%), respectively (P<0.01). A network meta-analysis was performed for 15 pairwise comparisons across the three procedure arms: ACDF versus Hybrid, 7/232 (3.0%) versus 11/234 (4.7%); Hybrid versus ACCF, 14/301 (4.3%) versus 18/224 (8.0%); ACCF versus ACDF, 38/523 (7.8%) versus 16/619 (2.6%). Compared with ACDF, the risk of C5 palsy was significantly higher in ACCF (odds ratio [OR] 2.72, 95%CI 1.47−5.01), while ACDF versus Hybrid did not significantly differ in risk (OR 1.56, 95%CI 0.68−3.60).

Conclusion.

We determined that ACCF was associated with a higher risk of postoperative C5 palsy than ACDF in cases spanning 3-6 intervertebral levels. If practicable, ACDF surgery may be an appropriate choice for cases requiring anterior decompression of 3-6 levels.

Level of Evidence.

3
Techniques for Improving Electronic Survey Response Rate
Authors: Radack Tyler , Meade Matthew , Woods Barrett
Published: November 2023

Electronic surveys are readily utilized for the conduction of orthopedic research and are commonly plagued by decreased response rates as compared with more conventional telephone and paper surveys. Given the rise of electronic survey usage and technological implementation into medical research, this paper aims to summarize factors both intrinsic and extrinsic which can increase survey completion in the clinical setting.
Changes in the Utilization of Cervicothoracic Injections Between 2010 and 2020
Authors: Ratnasamy Philip P. , Oghenesume Oghenewoma P. , Maloy Gwyneth C. , Grauer Jonathan N.
Published: November 2023

Study Design:

Descriptive epidemiologic study.

Objective:

To analyze trends and patient characteristics of those undergoing cervicothoracic transforaminal, interlaminar, and facet injections over time.

Background:

Cervicothoracic transforaminal, interlaminar, and facet injections are considered for varied spinal pathologies. Evolving literature, changing physician preferences, insurance reimbursement policies, and patient factors may influence the utilization of such injections over time.

Methods:

Patients undergoing cervicothoracic transforaminal, interlaminar, and facet injections 2010–2020 were identified in the M151Ortho PearlDiver database using Current Procedural Terminology coding. Patient age, sex, Elixhauser Comorbidity Index, insurance plan (commercial, Medicaid, Medicare), and region of the country where the procedure was performed (Midwest, Northeast, South, and West) were extracted and assessed over study intervals based on prevalence per 100,000 covered lives.

Results:

Cervicothoracic transforaminal, interlaminar, and facet injections were identified for 195,221 (11.3%), 951,191 (55.2%), and 575,228 (33.4%) patients, respectively. Patient characteristics for each injection type were defined. The annual number of injections performed per 100,000 covered lives decreased during the study period for transforaminal (17.1% decrease) and interlaminar (9.3% decrease) but increased for facet (3.7% increase) injections (P<0.0001 for each). Stratifying by patient insurance type, administration of transforaminal, interlaminar, and facet injections per 100,000 covered lives was proportionally greatest for commercially insured patients (55%, 50%, and 45%, respectively), and proportionally smallest for Medicaid patients (10%, 13%, and 13%, respectively). Anesthesiology physicians performed the most injections, followed by physical medicine and rehabilitation physicians, with both provider types most frequently performing interlaminar injections, followed by facet and transforaminal injections.

Conclusion:

Annual cervicothoracic transforaminal and interlaminar injection utilization declined by 17.1% and 9.3% from 2010 to 2020, whereas facet injection administration increased by 3.7% over the same interval. Evolving practice patterns are important to consider in characterizing the overall landscape of spine care.
Evidence-Based Medicine and Observational Studies
Authors: Meade Matthew , Buchan Levi , Stark Michael , Woods Barrett
Published: November 2023

Evidence-based medicine drives medical decision-making in the modern era, which has historically favored randomized control trials. Despite their notoriety, randomized control trials have multiple disadvantages when applied to spinal surgery. Observational studies are popular in spinal surgery literature and are seen in various forms, such as retrospective studies and prospective cohort studies. For researchers, learners, and practicing spine surgeons, this paper describes options for study design when applied to spinal surgery.
Staged Intracranial Free Tissue Transfer and Cranioplasty for a Refractory Nasal-cranial Base Fistula
Authors: Emanuels Andrew F. , Cherukuri Sai , Van Gompel Jamie J. , Stokken Janalee , Mardini Samir , Gibreel Waleed
Published: November 2023

After a transnasal endoscopic resection of a high-grade adenoid cystic carcinoma that underwent adjuvant chemoradiation, there was delayed recurrence managed by en bloc resection through an open craniofacial approach. Subsequently, the patient developed a chronic nasocranial fistula with secondary infection and bone flap resorption. This resulted in infectious episodes with secondary scalp incisional dehiscence and hardware exposure which required multiple bone debridement procedures, hardware removal, prolonged IV antibiotics, and hyperbaric oxygen treatment. The nasocranial fistula and chronic frontal bone osteomyelitis persisted despite the previous interventions. The patient underwent a frontal bone removal and obliteration of the anterior cranial base fistula with a free vastus lateralis muscle flap. At 4 weeks postoperatively, the intranasal portion of the muscle flap had completely mucosalized. After a 6-week course of IV antibiotics, a secondary cranioplasty using a custom-made poly-ether-ether-ketone implant was performed. The patient remained disease- and infection-free for the duration of follow-up (17 months).
Impact of Previous Cataract Surgery in Corneal Donors on the Outcome of Descemet Membrane Endothelial Keratoplasty
Authors: Trouvain André M. , Szurman Peter , Wahl Silke , Siegel Rudolf , Boden Karl Thomas , Seitz Berthold , Fries Fabian N. , Rickmann Annekatrin
Published: November 2023

Purpose:

The aim of this study was to investigate differences between phakic, pseudophakic, and scarred stromal donor tissue for their influence on complication rates during preparation or implantation and on the postoperative outcome of Descemet membrane endothelial keratoplasty (DMEK).

Methods:

We retrospectively compared 484 eyes undergoing DMEK, divided into 3 subgroups of donor tissue (1: phakic, 2: pseudophakic, and 3: scarred stromal). Visual acuity, central corneal thickness (CCT), and endothelial cell count were monitored preoperatively and postoperatively at 6 weeks and 3, 6, 12, and 24 months. The incidence of intraoperative and postoperative complications was analyzed.

Results:

The risk of adherence and tearing during preparation was significantly higher in group 2 than in the other groups (p’s < 0.001). No significant difference was found for visual acuity (p’s ≥ 0.368) and long-term CCT, but CCT recovery took longer in group 2 (P = 0.003), normalizing after 3 months (p’s ≥ 0.096). The overall mean endothelial cell count was lower in group 2 compared with the other groups (P = 0.011). No difference in the rebubbling rate was detected (P = 0.890). However, the risk of repeat keratoplasty for phakic grafts was lower compared with group 2 (P = 0.008).

Conclusions:

Pseudophakic donor grafts are more difficult to prepare and implant, resulting in longer recovery times and a higher risk of graft failure. However, when the preparation is uneventful and no graft failure occurs, pseudophakic grafts show a comparable outcome. Given the shortage of corneal donors and the high prevalence of pseudophakic corneal donors, they should not generally be excluded from corneal donation for DMEK.
Providers' Perceptions of the Effectiveness of Electronic Health Records in Identifying Opioid Misuse
Authors: Glenn Jeffrey , Gibson Danica , Thiesset Heather F.
Published: November 2023

Goal:

This study aimed to understand prescribing providers' perceptions of electronic health record (EHR) effectiveness in enabling them to identify and prevent opioid misuse and addiction.

Methods:

We used a cross-sectional survey designed and administered by KLAS Research to examine healthcare providers' perceptions of their experiences with EHR systems. Univariate analysis and mixed-effects logistic regression analysis with organization-level random effects were performed.

Principal Findings:

A total of 17,790 prescribing providers responded to the survey question related to this article's primary outcome about opioid misuse prevention. Overall, 34% of respondents believed EHRs helped prevent opioid misuse and addiction. Advanced practice providers were more likely than attending physicians and trainees to believe EHRs were effective in reducing opioid misuse, as were providers with fewer than 5 years of experience.

Practical Applications:

Understanding providers' perceptions of EHR effectiveness is critical as the health outcome of reducing opioid misuse depends upon their willingness to adopt and apply new technology to their standardized routines. Healthcare managers can enhance providers' use of EHRs to facilitate the prevention of opioid misuse with ongoing training related to advanced EHR system features.
Combination of aspirin and rosuvastatin for reduction of venous thromboembolism in severely injured patients: a double-blind, placebo-controlled, pragmatic randomized phase II clinical trial (The STAT Trial)
Authors: Barrett Christopher D. , Moore Hunter B. , Moore Ernest E. , Chandler James , Sauaia Angela
Published: November 2023

Introduction

Venous thromboembolism (VTE) remains a significant source of postinjury morbidity and mortality. Beta-hydroxy beta-methylglutaryl-CoA (HMG-CoA) reductase inhibitors (rosuvastatin) significantly reduced pathologic clotting events in healthy populations in a prior trial. Furthermore, acetylsalicylic acid (ASA) has been shown to be noninferior to prophylactic heparinoids for VTE prevention following orthopedic surgery. We hypothesized that a combination of rosuvastatin/ASA, in addition to standard VTE chemoprophylaxis, would reduce VTE in critically ill trauma patients.

Methods

This was a double-blind, placebo-controlled, randomized trial, evaluating VTE rates in two groups: ASA + statin (Experimental) and identical placebos (Control). Injured adults, 18–65 years old, admitted to the surgical intensive care unit without contraindications for VTE prophylaxis were eligible. Upon initiation of routine VTE chemoprophylaxis (i.e. heparin/heparin-derivatives), they were randomized to the Experimental or Control group. VTE was the primary outcome.

Results

Of 112 potentially eligible patients, 33% (n = 37, median new injury severity scale = 27) were successfully randomized, of whom 11% had VTEs. The Experimental group had no VTEs, while the Control group had 6 VTEs (4 PEs and 2 DVTs) in 4 (22%) patients (P = 0.046). The Experimental treatment was not associated with any serious adverse events. Due to the COVID-19 pandemic, the study was interrupted at the second interim analysis at <10% of the planned enrollment, with significance declared at P < 0.012 at that stage.

Discussion

The combination of ASA and rosuvastatin with standard VTE prophylaxis showed a favorable trend toward reducing VTEs with no serious adverse events. An appropriately powered phase III multicenter trial is needed to further investigate this therapeutic approach.

Level of Evidence

Level II, Therapeutic
Bronchoscopic interventions for chronic bronchitis
Authors: Tana Anand , Zhang Chenchen , DiBardino David , Orton Christopher M. , Shah Pallav L.
Published: November 2023

Purpose of review

Chronic bronchitis is a phenotype of chronic obstructive pulmonary disease (COPD), characterized by chronic cough and sputum production, associated with an increased rate of COPD exacerbations and hospital admissions, a more rapid decline in lung function and reduced life expectancy. Despite optimal medical therapy, chronic bronchitis remains difficult to treat. Interventional bronchoscopic procedures offer novel therapeutic approaches to this highly symptomatic condition.

Recent findings

A characteristic feature of chronic bronchitis is the presence of an abnormal epithelium with excessive mucus producing cells, parasympathetic overactivity, and airway inflammation. Metered cryospray and bronchial rheoplasty are designed to target this abnormal epithelium to reduce mucus production and inflammation. Targeted lung denervation aims to reduce parasympathetic overactivity, which may drive mucus hypersecretion. Here, we review the available evidence to determine the safety and efficacy across the bronchoscopic interventions.

Interventional bronchoscopy is a rapidly expanding field and its application in the treatment of chronic bronchitis has been recognized by the Global initiative for chronic Obstructive Lung Disease (GOLD). The outcomes from the latest clinical trials will guide future treatment approaches in patients with difficult to treat chronic bronchitis.
Effect of exercise intervention on clinical parameters in patients with non-alcoholic fatty liver disease and type 2 diabetes mellitus: a meta-analysis of randomized controlled trials
Authors: Zeng Yu , Zhang Xuemei , Luo Wenling , Sheng Yunjian
Published: November 2023

The effect of exercise on clinical parameters in patients with non-alcoholic fatty liver disease (NAFLD) combined with type 2 diabetes mellitus (T2DM) is unknown. In this meta-analysis, we identified and evaluated the effect of exercise on clinical parameters (BMI, ALT, lipid metabolism, glucose metabolism) in patients with NAFLD combined with T2DM. We conducted a comprehensive search of Medline, Embase, Web of Science, Cochrane Database of Systematic Reviews, and CNKI in December 2022. Data from relevant randomized controlled trials were collected according to inclusion and exclusion criteria. 6 eligible studies with 238 subjects were finally included. We used Review Manager 5.3 for meta-analysis. The study found that exercise improved BMI, ALT, TC, LDL-C, HbA1c, and HOMA-IR, TG, but did not significantly improve HDL-C. Subgroup analysis showed that high-intensity interval training significantly improved BMI (SMD: −0.43, 95% CI: −0.80, −0.06), ALT (SMD: −4.63, 95% CI: −8.42, −0.83), TC (SMD: −0.94, 95% CI: −1.82, −0.07), LDL-C (SMD: −0. 87, 95% CI: −1.26, −0.49), HbA1c (SMD: −1.12, 95% CI: −1.75, −0.48), HOMA-IR (SMD: −0.59, 95% CI: −0.94, −0.25); moderate-intensity continuous training improved ALT (SMD: −3.96, 95% CI: −7.71, −0.21), TG (SMD: −1.59, 95% CI: −2.58, −0.61), HbA1c (SMD: −0.71, 95% CI: −1.37, −0.05), HOMA-IR (SMD: −1.73, 95% CI: −3.40, −0. 06), and to some extent HDL-C levels (SMD: 0.53, 95% CI: 0.04, 1.02); resistance training improved LDL-C (SMD: −2.06, 95% CI: −3.14, −0.98). In conclusion, exercise improved indicators in patients with NAFLD combined with T2DM, but the improvement indicators varied by type of exercise.
Estimating the environmental impact of endoscopic activity at a tertiary center: a pilot study
Authors: Ribeiro Tiago , Morais Rui , Monteiro Cristiana , Carvalho Ana , Barros Sónia , Fernando André , Pioche Mathieu , de Santiago Enrique Rodríguez , Macedo Guilherme
Published: November 2023

Introduction

The growing number of endoscopic procedures, frequently requiring single-use disposable instruments, is responsible for the production of a large amount of waste. To this date, the reality of waste production at large European Gastroenterology centers is unknown. This study aimed to estimate the amount of waste due to endoscopic practice at a tertiary center in Portugal.

Methods

We performed a prospective study to calculate the mass (in kg) of residues generated during a period of 5 working days of endoscopic practice. We included residues produced at endoscopy suites, pre and postprocedure areas and during endoscope reprocessing. Residues were categorized as non-dangerous (groups I/II), of biologic risk (group III) and specific hazardous hospital residues (group IV). The production of residues separated for recycling/valorization (paper/card and plastic) was also quantified. The volume of water used for reprocessing an endoscope was also assessed.

Results

During the analyzed period, 241 endoscopic procedures were performed. A total of 443.2 kg of waste (22.6 kg from groups I/II, 266.9 kg from group III and 3.9 kg from group IV) were produced, most from group III (75%). For each endoscopic procedure, 1.8 kg of waste was generated. Of the total waste mass, 17.8% was separated for recycling/valorization. A volume of 55L of water was required for reprocessing one endoscope.

Conclusion

Each endoscopic procedure generated a significant amount of waste and water consumption during reprocessing. These real-life analyses are a pivotal step before implementing effective measures to improve resource utilization and more sustainable practices.
Factors Influencing Intention on Condom Use During Sexual Intercourse With Regular Female Partners Among Men Who Have Sex With Men in Western China: A Structural Equation Modeling Analysis
Authors: Cao Zhen , Chen Jin , Lin Bing , Zhang Cong , Zhong Xiaoni
Published: November 2023

Background

Given the rapid rise in HIV infection among men who have sex with men (MSM) in China, they may be a potential bridge for HIV transmission to the general female population, and increasing condom use is an important protective measure. This study aimed to explore factors that influence the intention of condom use during sexual intercourse with regular female partners among MSM in Western China, based on the Health Action Process Approach model.

Methods

This study used a baseline sample from a cohort study of the National Science and Technology Major Project. A nonprobability sampling method was adopted to recruit MSM from western China. Information on sociodemographic characteristics, HIV-related characteristics, sexual behavior, and constructs of the Health Action Process Approach model was collected through structured questionnaires, and the data were analyzed using a structural equation model.

Results

Among 232 participants, 62.9% (146 of 232) intended to use condoms every time they had sex with their regular female partners during the following 3 months. The results of the structural equation model showed that self-efficacy had the greatest influence on behavioral intention (β = 0.398, P < 0.001), followed by negative outcome expectancy (β = −0.303, P < 0.05). In addition, risk perception (β = 0.206, P < 0.05) and positive outcome expectancy (β = 0.270, P < 0.01) had indirect effects on intention, whereas self-efficacy played a mediating role in these indirect influencing factors.

Conclusions

Risk perception, outcome expectancy, and self-efficacy are predictors of condom use intention, with self-efficacy in particular serving as a significant medium for future interventions. These findings could provide a reference for future targeted interventions to reduce the likelihood of HIV transmission from MSM to the female population.
Modified Furlow Palatoplasty Using Small Double-Opposing Z-Plasty: Long-Term Outcome and Comparison with 2-Flap Palatoplasty
Authors: Hattori Yoshitsugu , Pai Betty Chien-Jung , Saito Takafumi , Tu Junior Chun-Yu , Chou Pang-Yun , Lo Lun-Jou
Published: November 2023

Background:

Postpalatoplasty velopharyngeal function needs to be evaluated through long-term follow-up, but such reports are limited in the literature, and there has been no consensus as to which surgical technique yields optimal velopharyngeal function with minimum complication rate. This study aimed to evaluate the long-term outcome of the modified Furlow palatoplasty using small double-opposing Z-plasty (small-DOZ).

Methods:

A retrospective review was conducted of consecutive patients who underwent palatoplasty performed by the senior author (L.J.L.) between January of 2000 and March of 2014. Nonsyndromic patients who underwent palatoplasty before the age of 18 months and followed up until at least 9 years of age were included. Comparisons between the small-DOZ and 2-flap methods for soft palate repair were made.

Results:

A total of 196 small-DOZ and 167 2-flap palatoplasty patients were eligible in the study. Among the small-DOZ palatoplasty patients, 1 patient (0.5%) developed oronasal fistula and 18 patients (9.2%) developed velopharyngeal insufficiency (VPI) surgery (10 patients at preschool age, and 8 at 9 years of age). Compared with the small-DOZ palatoplasty, the oronasal fistula rate, VPI surgery rate, and the need for myringotomy tube insertion were significantly higher in the 2-flap group (P = 0.01, P < 0.01, and P < 0.01, respectively). Patients who developed oronasal fistula had significantly higher likelihood of having VPI (P < 0.01).

Conclusions:

The small-DOZ provided successful palatal repair with low rates of oronasal fistula and VPI in the long term. Wound closure under minimal tension facilitated avoiding oronasal fistula. Reconstruction of the functional muscle sling enabled the authors to achieve normal velopharyngeal function with favorable speech outcome and middle ear function.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Chronic Active Antibody-mediated Rejection: Opportunity to Determine the Role of Interleukin-6 Blockade
Authors: Berger Mel , Baliker, Mary , Van Gelder Teun , Böhmig Georg A. , Mannon Roslyn B. , Kumar Deepali , Chadban Steve , Nickerson Peter , Lee Laurie A. , Djamali Arjang
Published: November 2023

Chronic active antibody-mediated rejection (caAMR) is arguably the most important cause of late kidney allograft failure. However, there are no US Food and Drug Administration (FDA)-approved treatments for acute or chronic AMR and there is no consensus on effective treatment. Many trials in transplantation have failed because of slow and/or inadequate enrollment, and no new agent has been approved by the FDA for transplantation in over a decade. Several lines of evidence suggest that interleukin-6 is an important driver of AMR, and clazakizumab, a humanized monoclonal antibody that neutralizes interleukin-6, has shown promising results in phase 2 studies. The IMAGINE trial (Interleukin-6 Blockade Modifying Antibody-mediated Graft Injury and Estimated Glomerular Filtration Rate Decline) (NCT03744910) is the first to be considered by the FDA using a reasonably likely surrogate endpoint (slope of estimated glomerular filtration rate decline >1 y) for accelerated approval and is the only ongoing clinical trial for the treatment of chronic rejection. This trial offers us the opportunity to advance the care for our patients in need, and this article is a call to action for all transplant providers caring for patients with caAMR.
Evaluation of kit-based loop-mediated isothermal amplification (TB-LAMP) assay in the diagnosis of tubercular lymphadenitis
Authors: Das Saurav , Nischal Neeraj , Singh Binit Kumar , Ray Animesh , Jorwal Pankaj , Soneja Manish , Khan Maroof Ahmad , Sikka Kapil , Sinha Sanjeev , Wig Naveet
Published: November 2023

Background. The rapid and accurate diagnosis of tubercular lymphadenitis remains a challenging task today. The World Health Organization (WHO) endorsed the LoopAMP MTBC kit (TB-LAMP) as a replacement for sputum smear microscopy in the diagnosis of pulmonary tuberculosis (PTB). However, no prospective diagnostic accuracy study of TB-LAMP for tubercular lymphadenitis in adults has been performed yet. The current study evaluated the diagnostic performance of TB-LAMP in tubercular lymphadenitis (LNTB).

Methods. In a prospective observational study conducted at a tertiary care hospital in India, 90 subjects (age >18 years) suspected of LNTB were recruited consecutively and followed up for 6 months between January 2019 and December 2020. Samples were processed for microscopy, culture, GeneXpert, histopathology and TB-LAMP. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of TB-LAMP against the composite reference standard (CRS) and culture were determined.

Results. TB-LAMP showed a sensitivity of 83.78 % (95 % CI, 73.76–90.47) and a specificity of 81.25 % (95 % CI, 56.99–93.41), respectively, against the CRS. The PPV and NPV were 95.38 % (95 % CI, 87.29–98.42) and 52.00 % (95 % CI, 33.50–69.97), respectively. TB-LAMP showed a sensitivity of 88.89 % (95 % CI, 71.94–96.15) and a specificity of 36.17 % (95 % CI, 23.97–50.46), respectively, against culture. The PPV and NPV were 44.44 % (95 % CI, 32–57.62) and 85 % (95 % CI, 63.96–94.76), respectively.

Conclusion. TB-LAMP can be used instead of conventional microscopy for the diagnosis of TB in lymph node specimens at primary healthcare centres. It provides rapid and cost-effective diagnosis of LNTB in resource-limited settings due to good sensitivity and NPV.
The hepatitis E virus ORF1 hypervariable region confers partial cyclophilin dependency
Authors: Buchanan Frazer J. T. , Chen Shucheng , Harris Mark , Herod Morgan R.
Published: November 2023

Hepatitis E virus (HEV) is an emerging pathogen responsible for more than 20 million cases of acute hepatitis globally per annum. Healthy individuals typically have a self-limiting infection, but mortality rates in some populations such as pregnant women can reach 30 %. A detailed understanding of the virus lifecycle is lacking, mainly due to limitations in experimental systems. In this regard, the cyclophilins are an important family of proteins that have peptidyl-prolyl isomerase activity and play roles in the replication of a number of positive-sense RNA viruses, including hepatotropic viruses such as hepatitis C virus (HCV). Cyclophilins A and B (CypA/B) are the two most abundant Cyps in hepatocytes and are therefore potential targets for pan-viral therapeutics. Here, we investigated the importance of CypA and CypB for HEV genome replication using sub-genomic replicons. Using a combination of pharmacological inhibition by cyclosporine A (CsA), and silencing by small hairpin RNA we find that CypA and CypB are not essential for HEV replication. However, we find that silencing of CypB reduces replication of some HEV isolates in some cells. Furthermore, sensitivity to Cyp silencing appears to be partly conferred by the sequence within the hypervariable region of the viral polyprotein. These data suggest HEV is atypical in its requirements for cyclophilin for viral genome replication and that this phenomenon could be genotype- and sequence-specific.
Topical siRNA therapy of diabetic-like wound healing
Authors: Neuhoferova Eva , Kindermann Marek , Buzgo Matej , Vocetkova Karolina , Panek Dalibor , Cigler Petr , Benson Veronika
Published: November 2023

Non-healing wounds are a serious complication in diabetic patients. One of the detrimental factors contributing to limited wound healing is the accumulation of metalloproteinase-9 (MMP-9) in the wound. Selective inhibition of MMP-9 is one of the established therapeutic targets for diabetic wound healing and is therefore of great interest. Here we focused on development of gene silencing system for localized delivery of antisense siRNA against MMP-9 into the wound. We have developed a functional and biocompatible wound dressing allowing controlled release of a traceable vector loaded with the target siRNA. Specifically, the dressing consists of a degradable scaffold of polymer nanofibers embedded with the vector nanosystem, polymer-coated fluorescent nanodiamonds (FNDs). The biocompatible cationic polymer shell on FNDs was designed and optimized for binding of siRNA and formation of colloidally stable FND-siRNA complexes in physiological environment. A hybrid nanofiber scaffold consisting of poly(vinyl alcohol) and poly(caprolactone) ensured continuous release of FND-siRNA complexes from the dressing. The photostable luminescence of FNDs allowed us to monitor the vector system in the wound. Our dressing was tested on murine fibroblasts and also applied to wounds in a diabetic murine model to evaluate its suitability in terms ofin vivotoxicity, biological efficacy and manipulation. The treatment resulted in significant local inhibition of MMP-9 and reduction of the wound healing time. The scar formation for treated diabetic-like animals became comparable with non-treated diabetes-free mice. Our results suggest that the application of our biocompatible dressing loaded with a non-toxic vector nanosystem is an effective and promising approach in gene therapy of non-healing wounds.