Tag: nevin manimala

BMJ Open Qual. 2024 Apr 8;13(2):e002453. doi: 10.1136/bmjoq-2023-002453.

ABSTRACT

INTRODUCTION: Effective communication in the operating room (OR) is crucial. Addressing a colleague by their name is respectful, humanising, entrusting and associated with improved clinical outcomes. We aimed to enhance team communication in the perioperative environment by offering personalised surgical caps labelled with name and provider role to all OR team members at a large academic medical centre.

MATERIALS AND METHODS: This was a quasi-experimental, uncontrolled, before-and-after quality improvement study. A survey regarding perceptions of team communication, knowledge of names and roles, communication barriers, and culture was administered before and after cap delivery. Survey results were measured on a 5-point Likert Scale; descriptive statistics and mean scores were compared. All cause National Surgical Quality Improvement Project (NSQIP) morbidity and mortality outcomes for surgical specialties were examined.

RESULTS: 1420 caps were delivered across the institution. Mean survey scores increased for knowing the names and roles of providers around the OR, feeling that people know my name and feeling comfortable communicating without barriers across disciplines. The mean score for team communication around the OR is excellent was unchanged. The highest score both before and after was knowing the name of an interdisciplinary team member is important for patient care. A total of 383 and 212 providers participated in the study before and after cap delivery, respectively. Participants agreed or strongly agreed that labelled surgical caps made it easier to talk to colleagues (64.9%) while improving communication (66.0%), team culture (60.5%) and patient care (56.8%). No significant differences were noted in NSQIP outcomes.

CONCLUSIONS: Personalised labelled surgical caps are a simple, inexpensive tool that demonstrates promise in improving perioperative team communication. Creating highly reliable surgical teams with optimal communication channels requires a multifaceted approach with engaged leadership, empowered front-line providers and an institutional commitment to continuous process improvement.

PMID:38589054 | DOI:10.1136/bmjoq-2023-002453

Plant Sci. 2024 Apr 6:112079. doi: 10.1016/j.plantsci.2024.112079. Online ahead of print.

ABSTRACT

The cotton boll weevil (CBW, Anthonomus grandis) stands as one of the most significant threats to cotton crops (Gossypium hirsutum). Despite substantial efforts, the development of a commercially viable transgenic cotton event for effective open-field control of CBW has remained elusive. This study describes a detailed characterization of the insecticidal toxins Cry23Aa and Cry37Aa against CBW. Our findings reveal that CBW larvae fed exclusively on artificial diets supplemented with Cry37Aa alone displayed no statistical difference compared to the control. Conversely, when exposed solely to Cry23Aa, larval survival decreased by roughly 69%. However, the combined provision of both Cry23Aa and Cry37Aa in the artificial diet led to mortality rates approaching 100% among CBW larvae (LC₅₀ equal to 0.26 PPM). Additionally, we engineered transgenic cotton plants by introducing cry23Aa and cry37Aa genes under the regulation of the flower bud-specific pGhFS4 and pGhFS1 promoters, respectively. After confirming forty-five transgenic cotton events, we selected the top seven events that exhibited elevated expression levels of Cry23Aa and Cry37Aa toxins in flower buds, 70%, for greenhouse bioassays. The mortality rate of CBW larvae feeding on both T₀ and T₁ generation transgenic cotton plants ranged from 75 to 100%. Our computational analyses unveiled that Cry23Aa possesses all the hallmark characteristics of a β-pore-forming toxin (β-PFT), specifically binding to sugar components in glycoproteins. Intriguingly, our studies also discovered a distinctive zinc-binding site within Cry23Aa, which appears to be involved in protein-protein interactions. Ultimately, our discussion centers on the crucial structural attributes of Cry23Aa that likely play a role in the toxin’s mechanism of action. With the observed low LC₅₀ for CBW and the significant accumulation of these toxins in the flower buds of both T₀ and T₁ plants, we anticipate that across successive generations of these transgenic lines, cotton plants engineered to overexpress cry23Aa and cry37Aa hold promise for effectively managing CBW infestations in cotton crops.

PMID:38588981 | DOI:10.1016/j.plantsci.2024.112079

J Endod. 2024 Apr 6:S0099-2399(24)00226-7. doi: 10.1016/j.joen.2024.03.014. Online ahead of print.

ABSTRACT

INTRODUCTION: Pathological conditions such as internal root resorption (IRR) may complicate root canal filling. This study aimed to evaluate and compare the obturation quality by measuring the percentage of obturation volume (POV) in root canals with artificial IRR obturated with different materials and techniques using cone beam computed tomography (CBCT).

METHODS: Forty single canal extracted mandibular premolars were decoronated to standardize their length to 14mm. Following instrumentation, the roots were cut horizontally, and artificial IRR cavities were made at the level of 7mm from the apex. The root halves were joined using cyanoacrylate adhesive. The samples were randomly assigned to four groups (n = 10), and the canals were filled as follows: Single-cone technique (SC), bulk-fill Bio-C Sealer (BF), Bio-C Repair for the coronal and middle third (BCR) +cold lateral condensation technique (CLC) for the apical third and continuous wave compaction technique (CWC). The pre-and post-obturation volumes and the POV were measured in the total canal and for the apical, middle, and coronal thirds separately using CBCT and Mimics Medical software. The results were analyzed statistically using one-way ANOVA and Tukey HSD test, and statistical significance was set at p<0.05.

RESULTS: BF group resulted in significantly lower total, coronal, middle and apical POV values compared to SC, BCR+ CLC, and CWC groups (p < 0.05), respectively. Also, at the apical third, the BCR+ CLC group showed significantly lower POV than the SC and CWC groups (P<0.05), respectively. The intra-group comparison showed that BF and BCR+ CLC groups had a significantly lower POV in the apical third compared to the middle third (p<0.05). Conversely, the CWC group had a significantly higher apical POV than the middle third (p<0.05).

CONCLUSIONS: The maximum POV was obtained using the CWC technique, Bio-C Repair, and SC technique with Bio-C Sealer, making their application in IRR more preferable than the BF Bio-C Sealer.

PMID:38588977 | DOI:10.1016/j.joen.2024.03.014

Am J Pharm Educ. 2024 Apr 6:100698. doi: 10.1016/j.ajpe.2024.100698. Online ahead of print.

ABSTRACT

OBJECTIVE: One of the barriers that might prevent an underrepresented minority (URM) individual from pursuing a professional career in the United States is finances. The high disproportionate burden of student debt among URM students further perpetuates the racial wealth gap. Therefore, this study sought to evaluate the extent to which URM students’ personal finance perceptions, and current and projected student loan indebtedness, affect post-graduation career intentions.

METHODS: A cross-sectional analysis was conducted using data from 4 cohorts of pharmacy students using a survey from November 2, 2022 to February 1, 2023. The financial perception survey included subscales namely personal finance self-efficacy, debt influence and pressure, and risk mitigation and retirement. Descriptive statistics, simple logistic regression, and multivariate logistic regression analyses were conducted.

RESULTS: 93 students completed the survey and had a mean age of 28.1+5.3 years. Seventy-one percent of the respondents were female, and 67.7% had completed a 4-year bachelor’s degree. There was a significant association between age and the intention to pursue postgraduate training as well as a significant association between risk mitigation and retirement perceptions and intention to pursue postgraduate training after adjusting for other factors.

CONCLUSION: Among students from largely minority backgrounds, age and confidence in their ability to make wise investment decisions for retirement are associated with a greater likelihood of pursuing post-graduate training opportunities.

PMID:38588974 | DOI:10.1016/j.ajpe.2024.100698

Ann Vasc Surg. 2024 Apr 6:S0890-5096(24)00173-0. doi: 10.1016/j.avsg.2024.02.007. Online ahead of print.

ABSTRACT

BACKGROUND: We investigated the long-term safety and efficacy of anatomical and extra-anatomical bypass for the treatment of unilateral iliac artery disease.

METHODS: A systematic search on PubMed, Scopus and Web of science for articles published by June 2023 was performed. We implemented a two-stage individual participant data (IPD) meta-analysis and pooled survival probabilities using the multivariate methodology of DerSimonian and Laird. The primary endpoint was primary patency at five and ten years of follow-up.

RESULTS: Ten studies encompassing 1907 patients were included. The five- and ten-year pooled primary patency for anatomical bypass was 83.27% (95% CI:69.99- 99.07) and 77.30% (95% CI:60.32- 99.04), with a mean primary patency time representing the duration individuals remained event-free of 10.08 years (95% CI:8.05-10.97). The five- and ten-year pooled primary patency for extra-anatomical bypass was 77.02% (95% CI:66.79-88.80) and 68.54% (95% CI:53.32-88.09) with a mean primary patency time of 9.25 years, (95% CI:7.21-9.68). Upon two-stage IPD meta-analysis anatomical bypass displayed a decreased risk for loss of primary patency compared to extra-anatomical bypass, hazard ratio (HR) 0.51 (95% CI:0.30-0.85). The five- and ten-year secondary patency for anatomical bypass was 96.83% (95% CI:90.28-100) and 96.13% (95% CI:88.72.3-100). The five- and ten-year secondary patency for extra-anatomical bypass was 91.39% (95% CI:84.32-99.04) and 85.05% (95% CI:74.43-97.18), with non-statistically significant difference between the two groups. The five- and ten-year survival for patients undergoing anatomical bypass was 67.99% (95% CI:53.84-85.85) and 41.09% (95% CI:25.36-66.57). The five- and ten-year survival for extra-anatomical bypass was 70.67% (95% CI:56.76-87.98) and 34.85% (95% CI:19.76-61.44). The mean survival time was 6.92 years (95% CI:5.56-7.89) for the anatomical and 6.78 years (95% CI:5.31-7.63) for the extra-anatomical groups. The pooled overall thirty-day mortality was 2.32% (95% CI:1.12-3.87) with meta-regression analysis displaying a negative association between year of publication and mortality (β =-0.0065, p<0.01). Further analysis displayed a thirty-day mortality of 1.29% (95% CI:0.56-2.26) versus 4.02% (95% CI:1.78-7.03), (p=0.02) for studies published after and before the year 2000. Non-statistically significant differences were identified between the two groups concerning long-term and thirty-day mortality outcomes.

CONCLUSION: While we have demonstrated favorable long-term primary and secondary patency outcomes for both surgical techniques, anatomical bypass exhibited a reduced risk of primary patency loss potentially reflecting its inherent capacity to circumvent the anticipated disease progression in the distal aorta and the contralateral donor artery. The reduction in perioperative mortality observed in our review, coupled with the anachronistic demographic characteristics and inclusion criteria presented in the existing literature, underscores the imperative necessity for contemporary research.

PMID:38588957 | DOI:10.1016/j.avsg.2024.02.007

Am J Med. 2024 Apr 6:S0002-9343(24)00216-X. doi: 10.1016/j.amjmed.2024.04.007. Online ahead of print.

ABSTRACT

PURPOSE: Long COVID and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) patients experience multiple complex symptoms, potentially linked to imbalances in brain neurochemicals. This study aims to measure brain neurochemical levels in long COVID and ME/CFS patients as well as healthy controls to investigate associations with severity measures.

METHODS: Magnetic resonance spectroscopy (MRS) data was acquired with a 3T Prisma MRI scanner. We measured absolute levels of brain neurochemicals in the posterior cingulate cortex in long COVID (n=17), ME/CFS (n=17), and healthy controls (n=10) using Osprey software. The statistical analyses were performed using SPSS version 29. Age and sex were included as nuisance covariates.

RESULTS: Glutamate levels were significantly higher in long COVID (p=0.02) and ME/CFS (p=0.017) than in healthy controls. No significant difference was found between the two patient cohorts. Additionally, N-acetyl-aspartate levels were significantly higher in long COVID patients (p=0.012). Importantly, brain neurochemical levels were associated with self-reported severity measures in long COVID and ME/CFS.

CONCLUSION: Our study identified significantly elevated Glutamate and N-acetyl-aspartate levels in long COVID and ME/CFS patients compared with healthy controls. No significant differences in brain neurochemicals were observed between the two patient cohorts, suggesting a potential overlap in their underlying pathology. These findings suggest that imbalanced neurochemicals contribute to the complex symptoms experienced by long COVID and ME/CFS patients.

PMID:38588934 | DOI:10.1016/j.amjmed.2024.04.007

Radiother Oncol. 2024 Apr 6:110271. doi: 10.1016/j.radonc.2024.110271. Online ahead of print.

ABSTRACT

PURPOSE: Re-irradiation (re-RT) for recurrent intracranial meningiomas is hindered by the limited radiation tolerance of surrounding tissue and the risk of side effects. This study aimed at assessing outcomes, toxicities and prognostic factors in a cohort of patients with recurrent meningiomas re-treated with different RT modalities.

MATERIALS AND METHODS: A multi-institutional database from 8 Italian centers including intracranial recurrent meningioma (RM) patients who underwent re-RT with different modalities (SRS, SRT, PT, EBRT) was collected. Biologically Equivalent Dose in 2 Gy-fractions (EQD2) and Biological Effective Dose (BED) for normal tissue and tumor were estimated for each RT course (α/β = 2 for brain tissue and α/β = 4 for meningioma). Primary outcome was second progression-free survival (s-PFS). Secondary outcomes were overall survival (OS) and treatment-related toxicity. Kaplan-Meier curves and Cox regression models were used for analysis.

RESULTS: Between 2003 and 2021 181 patients (pts) were included. Median age at re-irradiation was 62 (range 20-89) and median Karnofsky Performance Status (KPS) was 90 (range 60-100). 78 pts were identified with WHO grade 1 disease, 65 pts had grade 2 disease and 10 pts had grade 3 disease. 28 pts who had no histologic sampling were grouped with grade 1 patients for further analysis. Seventy-five (41.4 %) patients received SRS, 63 (34.8 %) patients SRT, 31 (17.1 %) PT and 12 (6.7 %) EBRT. With a median follow-up of 4.6 years (interquartile range 1.7-6.8), 3-year s-PFS was 51.6 % and 3-year OS 72.5 %. At univariate analysis, SRT (HR 0.32, 95 % CI 0.19-0.55, p < 0.001), longer interval between the two courses of irradiation (HR 0.37, 95 % CI 0.21-0.67, p = 0.001), and higher tumor BED (HR 0.45 95 % CI 0.27-0.76, p = 0.003) were associated with longer s-PFS; in contrast, Ki67 > 5 % (HR 2.81, 95 % CI 1.48-5.34, p = 0.002) and WHO grade > 2 (HR 3.08, 95 % CI 1.80-5.28, p < 0.001) were negatively correlated with s-PFS. At multivariate analysis, SRT, time to re-RT and tumor BED maintained their statistically significant prognostic impact on s-PFS (HR 0.36, 95 % CI 0.21-0.64, p < 0.001; HR 0.38, 95 % CI 0.20-0.72, p = 0.003 and HR 0.31 95 % CI 0.13-0.76, p = 0.01, respectively). Acute and late adverse events (AEs) were reported in 38 (20.9 %) and 29 (16 %) patients. Larger tumor GTV (≥10 cc) was significantly associated with acute and late toxicity (p < 0.001 and p = 0.009, respectively).

CONCLUSIONS: In patients with recurrent meningiomas, reirradiation is a feasible treatment option associated with acceptable toxicity profile. Prognostic factors in the decision-making process have been identified and should be incorporated in daily practice.

PMID:38588920 | DOI:10.1016/j.radonc.2024.110271

Free Radic Biol Med. 2024 Apr 6:S0891-5849(24)00382-4. doi: 10.1016/j.freeradbiomed.2024.04.211. Online ahead of print.

ABSTRACT

DNA repair is essential to maintain genomic integrity and may affect colorectal cancer (CRC) patients’ risk of secondary cancers, treatment efficiency, and susceptibility to various comorbidities. Bioactive compounds identified in plant food have the potential to modulate DNA repair mechanisms, but there is limited evidence of how dietary factors may affect DNA repair activity in CRC patients in remission after surgery. The aim of this study was to investigate the effect of a 6 months personalized intensive dietary intervention on DNA repair activity in post-surgery CRC patients (stage I-III). The present study included patients from the randomized controlled trial CRC-NORDIET, enrolled 2-9 months after surgery. The intervention group received an intensive dietary intervention emphasizing a prudent diet with specific plant-based foods suggested to dampen inflammation and oxidative stress, while the control group received only standard care advice. The comet-based in vitro repair assay was applied to assess DNA repair activity, specifically base excision repair (BER), in peripheral blood mononuclear cells (PBMCs). Statistical analyses were conducted using gamma generalized linear mixed models (Gamma GLMM). A total of 138 CRC patients were included, 72 from the intervention group and 66 from the control group. The BER activity in the intervention group did not change significantly compared to the control group. Our findings revealed a substantial range in both inter- and intra-individual levels of BER. In conclusion, the results do not support an effect of dietary intervention on BER activity in post-surgery CRC patients during a 6-month intervention period.

PMID:38588903 | DOI:10.1016/j.freeradbiomed.2024.04.211

Mol Biochem Parasitol. 2024 Apr 6:111618. doi: 10.1016/j.molbiopara.2024.111618. Online ahead of print.

ABSTRACT

Trypanosoma cruzi is a parasite with a high capacity to adapt to the host. Animal models have already demonstrated that the tropism of this parasite occurs not only in cardiac/digestive tissues but also in adipose tissue (AT). That said, the consequences ofT. cruziinfection for AT and the implications of treatment with Benzonidazole in this tissue are under discussion. Here, we tested the hypothesis that T. cruzi infection in adipose tissue upon treatment with Benzonidazole (Bz) and the interaction of mononuclear immune cells (PBMC) influences the relative expression of ACAT1, FASN, and PNPLA2 genes. Thus, stem cells derived from adipose tissue (ADSC) after adipogenic differentiation were indirectly cultivated with PBMC after infection with the T. cruzi Y strain and treatment with Bz. We use the TcSAT-IAM system and RT-qPCR to evaluate the parasite load and the relative quantification (ΔCt) of the ACAT1, FASN, and PNPLA2 genes. Our results demonstrate that treatment with Bz did not reduce adipocyte infection in the presence (p-value: 0.5796) or absence (p-value: 0.1854) of cultivation with PBMC. In addition, even though there is no statistical difference when compared to the control group (AT), T. cruzi induces the FASN expression (Rq: 14.00). However, treatment with Bz in AT suggests the increases of PNPLA2 expression levels (Rq: 12.58), even in the absence of T. cruzi infection. During indirect cultivation with PBMC, T. cruzi smooths the expression of PNPLA2 (Rq: 0.824) and instigates the expression of ACAT1 (Rq: 1.632) and FASN (Rq: 1.394). Furthermore, the treatment with Bz during infection induces PNPLA2 expression (Rq: 1.871), maintaining FASN expression levels (Rq: 1.334). Given this, our results indicate that treatment with Benzonidazole did not decrease T. cruzi infection in adipose tissue. However, treating the adipocyte cells with Bz during the interaction with PBMC cells influences the lipid pathways scenario, inducing lipolytic metabolism through the expression of PNPLA2.

PMID:38588892 | DOI:10.1016/j.molbiopara.2024.111618

J Foot Ankle Surg. 2024 Apr 6:S1067-2516(24)00068-1. doi: 10.1053/j.jfas.2024.03.003. Online ahead of print.

ABSTRACT

Residual osteomyelitis is a frequent problem following surgical intervention for diabetic foot infection. The current Infectious Disease Society of America guidelines recommend 4-6 weeks of initial intravenous antibiotics for treatment of residual osteomyelitis. However, recent literature suggests oral antibiotic therapy is not inferior to intravenous therapy. The primary aim of this study was to evaluate treatment success in 128 patients receiving oral versus intravenous antibiotics for residual osteomyelitis in the diabetic foot after amputation at a Level 1 academic medical trauma center. Treatment success was defined as completion of at least 4 weeks antibiotic therapy, complete surgical wound healing, and no residual infection requiring further debridement or amputation within one year of the initial surgery. Patients with peripheral arterial disease were excluded. A retrospective chart review was performed, and we found no statistically significant difference in treatment success between these two groups (p=0.2766). Median time to healing for oral antibiotic treatment was 3.17 months compared to 4.06 months for intravenous treatment (p=0.1045). Furthermore, there was no significant difference in group demographics or comorbidities, aside from more patients in the intravenous group having coronary artery disease (p=0.0416). Type of closure and type of microbial infection was also not associated with a difference in outcomes between the two treatment arms. The results of the present study suggest oral antibiotics for treatment of residual osteomyelitis are not inferior to intravenous therapy and may be more efficacious for certain patients regarding cost and ease of administration. LEVEL OF CLINICAL EVIDENCE: : 3.

PMID:38588891 | DOI:10.1053/j.jfas.2024.03.003