ChemInform Research Articles

Biochar Amendment and its Impacts on Medicinal and Aromatic Plants in Sustainable Agriculture

Introduction: Biochar application and research have experienced a significant increase in recent decades. It can produce different kinds of organic materials, and it can be employed for different purposes, such as soil conditioning, carbon sequestration and filtration of pollutants from gas and aqueous media. Biochar is a C-rich material, which can be obtained from different types of organic feedstock, such as animal manure, sewage sludge, wood and crop residues and other organic waste. It is also considered an environmentally friendly and resource-saving approach in medicinal and aromatic plants production. Biochar can lead to plant growth improvement and influence on chemical components of medicinal plants, stimulate the growth of soil microflora, increase soil carbonsequestration, bioremediation of soil, regulate carbon fluxes between atmosphere and biosphere, reduce biotic stress in plants, improve soil nutrient availability, decrease abiotic stress in plants, wastewater treatment, immobilization and sorption of soil heavy metal contaminants. Methods: Relevant literature has been obtained using the keywords “biochar”, “organic amendment”, “soil quality”, “medicinal Plants”, “natural products”, “soil quality”, “macronutrient”, and “chemical components” in scientific databases, such as “PubMed”, “SciFinder”, “Elsevier”, and “Web of Science”. Results: The aim of this literature review is to study the impact of different kinds of biochars on medicinal and aromatic plants, soil quality and soil fertility by considering case studies of successful paradigms. Conclusion: Conclusively, we consider our review article will provide an appropriate guide for practitioners and researchers for future studies as well as large-scale field applications.

Inaccurate Clinical Stage is Common and Associated With Poor Survival in Patients With Lung Cancer

IntroductionClinical staging in lung cancer has implications for treatment planning and prognosis. We sought to determine the rate of inaccurate clinical stage (relative to pathologic), identify risk factors for inaccuracy, and evaluate the association of inaccuracy on survival. We hypothesized that inaccurate staging was associated with poor survival. MethodsIn this retrospective cohort study, adult patients who received surgical resection without neoadjuvant treatment for nonsmall cell lung cancer from 2004 to 2020 in the National Cancer Database were categorized by accuracy of clinical stage (relative to pathologic stage). Multivariate models were used to determine risk factors for inaccuracy. The association between inaccuracy and overall survival was also analyzed. ResultsWe identified 255,598 patients with lung cancer, including 84,543 patients (33.1%) who were inaccurately staged. Stage inaccuracy was associated with higher tumor, node, metastasis stage (T-category 3: odds ratio [OR] = 1.2, 95% confidence interval [CI] 1.15-1.28; N-category 2: OR = 2.6, 95% CI 2.47-2.79), greater quantity of lymph nodes evaluated, and more extensive resection (extended lobectomy/bilobectomy: OR = 1.3, 95% CI 1.20-1.37; pneumonectomy: OR = 1.6, 95% CI 1.54-1.74). Patients undergoing robotic surgery were less likely to be inaccurately staged (OR = 0.89, 95% CI 0.852-0.939). Inaccurate staging was associated with worse overall survival (5-y 67.5% accurate versus 55.4% inaccurate, P < 0.001). Inaccurate staging was also associated with worse survival in a multivariate Cox model (hazard ratio [HR] = 1.3, 95% CI 1.29-1.33). Both “understaging” (path > clinical) and “overstaging” (clinical > path) were associated with inferior survival. ConclusionsInaccurate clinical stage (relative to pathologic) occurs in one-third of patients receiving surgery for lung cancer. Inaccuracy is associated with poor survival. Quality improvement initiatives should focus on improving clinical staging accuracy.

Avoiding the needle: A quality improvement program introducing apixaban for extended thromboprophylaxis after major gynecologic cancer surgery

ObjectivePatients undergoing gynecologic cancer surgery at our centre are recommended up to 28 days of enoxaparin for extended post-operative thromboprophylaxis (EP). Baseline survey revealed 92% patient adherence, but highlighted negative effects on patient experience due to the injectable route of administration. We aimed to improve patient experience by reducing pain and bruising by 50%, increasing adherence by 5%, and reducing out-of-pocket cost after introducing apixaban as an oral alternative for EP. MethodsIn this interrupted time series quality improvement study, gynecologic cancer patients were offered a choice between apixaban (2.5 mg orally twice daily) or enoxaparin (40 mg subcutaneously once daily) at time of discharge. A multidisciplinary team informed project design, implementation, and evaluation. Process interventions included standardized orders, patient and care team education programs. Telephone survey at 1 and 6 weeks and chart audit informed outcome, process, and balancing measures. ResultsFrom August to October 2022, 127 consecutive patients were included. Apixaban was chosen by 84%. Survey response rate was 74%. Patients who chose apixaban reported significantly reduced pain, bruising, increased confidence with administration, and less negative impact of the medication (p < 0.0001 for all). Adherence was unchanged (92%). The proportion of patients paying less than $125 (apixaban cost threshold) increased from 45% to 91%. There was no difference in bleeding and no VTE events. ConclusionsIntroduction of apixaban for EP was associated with significant improvement in patient-reported quality measures and reduced financial toxicity with no effect on adherence or balancing measures. Apixaban is the preferred anticoagulant for EP at our centre.

Fetal Brain MRI Abnormalities in Pyruvate Dehydrogenase Complex Deficiency.

Pyruvate dehydrogenase complex deficiency (PDCD) is a disorder of mitochondrial metabolism that is caused by pathogenic variants in multiple genes, including PDHA1. Typical neonatal brain imaging findings have been described, with a focus on malformative and encephaloclastic features. Fetal brain MRI in PDCD has not been comprehensively described. The aims of this study were (1) to further characterize the fetal brain MRI findings in PDCD using comprehensive fetal imaging and genetic testing and (2) to determine whether markers of diagnosis of PDCD could be identified on prenatal imaging. Fetuses with a diagnosis of PDCD related to a genetic etiology that had undergone fetal MRI were included. Fetuses were identified retrospectively from local databases of 4 fetal diagnostic clinics within tertiary pediatric health care centers. Electronic medical records were reviewed retrospectively: demographics, maternal and pregnancy history, fetal outcomes, and neonatal outcomes (if available) were reviewed and recorded. Fetal and neonatal imaging reports were reviewed; source fetal and neonatal brain MRI scans were reviewed by a single pediatric neuroradiologist (J.W.S.) for consistency. Genetic testing strategies and results including variant type, zygosity, inheritance pattern, and pathogenicity were recorded. Deidentified data were combined and reported descriptively. A total of 10 fetuses with a diagnosis of PDCD were included. 8 fetuses had corpus callosum dysgenesis, 6 had an abnormal gyration pattern, 10 had reduced brain volumes, and 9 had cystic lesions. 1 fetus had intraventricular hemorrhages. 1 fetus had a midbrain malformation with aqueductal stenosis and severe hydrocephalus. 6 fetuses imaged in the second trimester had cystic lesions involving the ganglionic eminences (GEs) while GE cysts were not present in the 4 fetuses imaged in the third trimester. Fetuses with PDCD have similar brain MRI findings to neonates described in the literature, although some of these findings are subtle early in pregnancy. Additional features, such as cystic lesions of the GEs, are noted in the second trimester in fetuses with PDCD. These may represent an early diagnostic marker of PDCD, although more data are needed to validate this association. Early diagnosis of PDCD using fetal MRI may inform genetic counseling, pregnancy decision making, and neonatal care planning.

Impact of Preoperative Time Intervals for Neoadjuvant Chemoradiotherapy on Short-term Postoperative Outcomes of Esophageal Cancer Surgery: A Population-Based Study Using the Dutch Upper Gastrointestinal Cancer Audit (DUCA) Data.

To clarify the impact of the preoperative time intervals on short-term postoperative and pathological outcomes in esophageal cancer patients who underwent neoadjuvant chemoradiotherapy (nCRT) followed by esophagectomy. The impact of preoperative intervals on esophageal cancer patients who received multimodality treatment remains unknown. Patients(cT1-4aN0-3M0) treated with nCRT plus esophagectomy were included using the Dutch national DUCA-database. Multivariate logistic regression was used to determine the effect of different time intervals upon short-term postoperative and pathological outcomes: diagnosis-to-nCRT intervals (≤5, 5-8 and 8-12wk), nCRT-to-surgery intervals (5-11, 11-17 and >17wk) and total preoperative intervals (≤16, 16-25 and >25wk). Between 2010-2021, a total of 5052 patients were included. Compared to diagnosis-to-nCRT interval ≤5 weeks, the interval 8-12 weeks was associated with higher risk of overall complications (P=0.049). Compared to nCRT-to-surgery interval 5-11 weeks, the longer intervals (11-17wk and >17wk) were associated with higher risk of overall complications (P-value=0.016; P-value<0.001) and anastomotic leakage (P-value=0.004; P-value=0.030), but the interval >17 weeks was associated with lower risk of ypN+ (P-value=0.021). The longer total preoperative intervals were not associated with the risk of 30-day mortality and complications compared to the interval ≤16 weeks, but the longer total preoperative interval (>25wk) was associated with higher ypT stage (P-value=0.010) and lower pCR rate (P-value=0.013). In patients with esophageal cancer undergoing nCRT and esophagectomy, prolonged preoperative time intervals may lead to higher morbidity and disease progression, and the causal relationship requires further confirmation.

The role of geriatric assessment in the care of older adults undergoing urologic cancer surgery.

Older adults undergoing urologic cancer surgery have unique needs and require unique risk assessment and management. This review will discuss recent literature on brief screening tools to identify high risk older adults in the preoperative period and the role of comprehensive geriatric assessment (CGA) in identifying and addressing geriatric vulnerabilities for older adults undergoing urologic cancer surgery. Frailty screening tools such as the G8 can be used to identify patients who are at an increased risk of adverse postoperative outcomes such as postoperative complications and prolonged length of stay. CGA can provide more detailed information about geriatric syndromes prior to urologic cancer surgery. Screening tools for geriatric vulnerabilities and CGA are valuable tools for the urologist in identifying high-risk older adults, counseling patients on perioperative risk and addressing vulnerabilities prior to surgery. Making health system-wide changes can allow this optimal practice to reach more older surgical patients.

Different DLCO Parameters as Predictors of Postoperative Pulmonary Complications in Mild Chronic Obstructive Pulmonary Disease Patients with Lung Cancer.

Numerous studies have investigated methods of predicting postoperative pulmonary complications (PPCs) in lung cancer surgery, with chronic obstructive pulmonary disease (COPD) and low forced expiratory volume in 1 second (FEV1) being recognized as risk factors. However, predicting complications in COPD patients with preserved FEV1 poses challenges. This study considered various diffusing capacity of the lung for carbon monoxide (DLCO) parameters as predictors of pulmonary complication risks in mild COPD patients undergoing lung resection. From January 2011 to December 2019, 2,798 patients undergoing segmentectomy or lobectomy for non-small cell lung cancer (NSCLC) were evaluated. Focusing on 709 mild COPD patients, excluding no COPD and moderate/severe cases, 3 models incorporating DLCO, predicted postoperative DLCO (ppoDLCO), and DLCO divided by the alveolar volume (DLCO/VA) were created for logistic regression. The Akaike information criterion and Bayes information criterion were analyzed to assess model fit, with lower values considered more consistent with actual data. Significantly higher proportions of men, current smokers, and patients who underwent an open approach were observed in the PPC group. In multivariable regression, male sex, an open approach, DLCO <80%, ppoDLCO <60%, and DLCO/VA <80% significantly influenced PPC occurrence. The model using DLCO/VA had the best fit. Different DLCO parameters can predict PPCs in mild COPD patients after lung resection for NSCLC. The assessment of these factors using a multivariable logistic regression model suggested DLCO/VA as the most valuable predictor.

Comparison of predictive models in postoperative nausea and vomiting in patients undergoing breast cancer surgery

BackgroundPost-operative nausea and vomiting remain an unresolved concern in Türkiye and some parts of the world, impacting the quality of the patient's recovery process and diminishing overall satisfaction.ObjectiveThis study was conducted as a descriptive investigation to compare the incidence of nausea and vomiting following breast cancer surgery with the nausea and vomiting risk scores proposed by Apfel and Koivuranta.MethodsThis study was conducted with 100 patients admitted to the General Surgery service of a university hospital between 31 August 2019 and 31 May 2021 for breast cancer surgery. The patient information form developed by the researchers, Apfel Nausea and Vomiting Risk Score, and Koivuranta Nausea and Vomiting Risk Score were used as data collection tools.ResultsIt was identified that 61% of the patients experienced nausea and vomiting within the initial 24 h following surgery. A significant correlation was found between age, post-operative opioid use, motion sickness or history of PONV, and nausea and vomiting (p < 0,05). The sensitivity of the Apfel score obtained was 80%, the specificity was 46%, and the AUC value was 0.686. The sensitivity of the Koivuranta score was 80%, the specificity was 35%, and the AUC value was 0.675 (p < 0.05).ConclusionIt has been observed that patients experience high rates of nausea and vomiting after breast cancer surgery and that the Apfel and Koivuranta Risk Scores are equally applicable in predicting post-operative nausea and vomiting.

Enzyme Engineering by Force: DNA Springs for the Modulation of Biocatalytic Trajectories.

The engineering of enzymatic activity generally involves alteration of the protein primary sequences, which introduce structural changes that give rise to functional improvements. Mechanical forces have been used to interrogate protein biophysics, leading to deep mechanistic insights in single-molecule studies. Here, we use simple DNA springs to apply small pulling forces to perturb the active site of a thermostable alcohol dehydrogenase. Methods were developed to enable the study of different spring lengths and spring orientations under bulk catalysis conditions. Tension applied across the active site expanded the binding pocket volume and shifted the preference of the enzyme for longer chain-length substrates, which could be tuned by altering the spring length and the resultant applied force. The substrate specificity changes did not occur when the DNA spring was either severed or rotated by ∼90°. These findings demonstrate an alternative approach in protein engineering, where active site architectures can be dynamically and reversibly remodeled using applied mechanical forces.

Accuracy of thoracic nerves recognition for surgical support system using artificial intelligence

We developed a surgical support system that visualises important microanatomies using artificial intelligence (AI). This study evaluated its accuracy in recognising the thoracic nerves during lung cancer surgery. Recognition models were created with deep learning using images precisely annotated for nerves. Computational evaluation was performed using the Dice index and the Jaccard index. Four general thoracic surgeons evaluated the accuracy of nerve recognition. Further, the differences in time lag, image quality and smoothness of movement between the AI system and surgical monitor were assessed. Ratings were made using a five-point scale. The computational evaluation was relatively favourable, with a Dice index of 0.56 and a Jaccard index of 0.39. The AI system was used for 10 thoracoscopic surgeries for lung cancer. The accuracy of thoracic nerve recognition was satisfactory, with a recall score of 4.5 ± 0.4 and a precision score of 4.0 ± 0.9. Though smoothness of motion (3.2 ± 0.4) differed slightly, nearly no difference in time lag (4.9 ± 0.3) and image quality (4.6 ± 0.5) between the AI system and the surgical monitor were observed. In conclusion, the AI surgical support system has a satisfactory accuracy in recognising the thoracic nerves.

Supportive care needs after surgery in patients with breast cancer

PurposeThis study aimed to determine supportive care needs and related factors after surgery in patients with breast cancer.MethodsThis cross-sectional study was conducted with 98 breast cancer patients in a Training and Research Hospital in Istanbul between September 2022 and November 2023. The Personal Information Form and the Supportive Care Needs Survey Short Form Turkish version were used to collect data. One-way variance analysis, post hoc (Tukey, LSD), and t-test were used to analyze the data.ResultsThe total scale mean score for women who underwent surgery for breast cancer in the study was 83.95 22.97. Statistically significantly higher total scale scores were observed in younger women and those who received chemotherapy and radiotherapy than in others. The mean physical and daily living subscale scores of those who received chemotherapy and radiotherapy were higher than those who did not (p < .05). The psychology subscale mean scores of those who were young and unemployed were higher than the others (p < .05). The mean sexuality scores of those who were young, those with high education levels, and those who received chemotherapy were higher than the other groups (p < .05). Age factor affects SCN scores in women with breast cancer.ConclusionSupportive care needs are higher among women with breast cancer who are younger and receive chemotherapy and radiotherapy. The physical needs of those who receive chemotherapy and radiotherapy, the psychological needs of those who are younger and unemployed, and the need for support regarding sexuality were greater among those who are younger and with higher education. Nurses should be aware of the specific needs of these disadvantaged groups and provide individualized holistic care.

Drug and biomarker tissue levels in a randomized presurgical trial on exemestane alternative schedules.

The drug's activity at the target tissue could help to define the minimal effective dose to promote cancer preventive therapy. Here we present exemestane and sex hormone concentrations within breast tissue from a pre-surgical study of alternative exemestane schedules. Postmenopausal women candidate for breast surgery for estrogen receptor-positive breast cancer were randomized to exemestane 25 mg once daily (QD), 25 mg three times/week (TIW), or 25 mg per/week (QW) for 4-6 weeks before surgery. Drug and sex hormones were analyzed from homogenized frozen tissue using a QTRAP 6500+ LC-MS/MS System. Tissue drug concentrations were detectable only in the QD arm with higher concentrations in non-malignant tissue. Estradiol was nearly suppressed in all groups in the non-malignant tissue (QD vs TIW p = .364 and QD vs QW p = .693). In contrast, a dose-response trend was observed in cancer tissue. Based on estradiol suppression in non-malignant tissue, lower exemestane schedules should be explored for breast cancer preventive therapy.

Pediatric Sedation Assessment and Management System (PSAMS) for Pediatric Sedation in China: Development and Implementation Report.

Recently, the growing demand for pediatric sedation services outside the operating room has imposed a heavy burden on pediatric centers in China. There is an urgent need to develop a novel system for improved sedation services. This study aimed to develop and implement a computerized system, the Pediatric Sedation Assessment and Management System (PSAMS), to streamline pediatric sedation services at a major children's hospital in Southwest China. PSAMS was designed to reflect the actual workflow of pediatric sedation. It consists of 3 main components: server-hosted software; client applications on tablets and computers; and specialized devices like gun-type scanners, desktop label printers, and pulse oximeters. With the participation of a multidisciplinary team, PSAMS was developed and refined during its application in the sedation process. This study analyzed data from the first 2 years after the system's deployment. From January 2020 to December 2021, a total of 127,325 sedations were performed on 85,281 patients using the PSAMS database. Besides basic variables imported from Hospital Information Systems (HIS), the PSAMS database currently contains 33 additional variables that capture comprehensive information from presedation assessment to postprocedural recovery. The recorded data from PSAMS indicates a one-time sedation success rate of 97.1% (50,752/52,282) in 2020 and 97.5% (73,184/75,043) in 2021. The observed adverse events rate was 3.5% (95% CI 3.4%-3.7%) in 2020 and 2.8% (95% CI 2.7%-2.9%) in 2021. PSAMS streamlined the entire sedation workflow, reduced the burden of data collection, and laid a foundation for future cooperation of multiple pediatric health care centers.

Families' perceptions of consumer-grade, inexpensive oxygen saturation monitors.

We evaluated what proportion of families have a consumer-grade pulse oximeter, why they bought one, and how they choose to use it. We hypothesized that children followed in cardiorespiratory clinics would be more likely to have an oximeter than children attending a more general clinic. We carried out a cross-sectional study using a convenience sample of children attending a respirology, cardiology, or gastroenterology clinic at a children's hospital. Consenting guardians completed a survey. Two-hundred families completed the survey. Fifty-three (26.5%; 53/200) had an oximeter at home. The proportion of children attending a cardiorespiratory clinic who had an oximeter was higher than another clinic (p = 0.08), but 15.5% of children attending the latter also had access to one. Of devices not funded by government insurance, over 80% of devices were "fingertip" clamp-style oximeters, and 50% were purchased online. Most devices were used only when the child was ill (83.7%; 36/43). Only about 1/3 of families had received education about using an oximeter, and a similar proportion had compared their oximeter to a medical-grade device. Only 2.4% (1/42) respondents did not feel that their device was "somewhat" or "very" accurate. The oxygen saturation that would prompt seeking emergency care was similar to most pediatric acute care guidelines. Many children, particularly those with cardiorespiratory conditions, have access to consumer-grade pulse oximeters. Asking about the presence of an oximeter should be part of the pediatric history, and families responding affirmatively should be offered education.

Quantum Mechanical Cluster Models for Calculations on Enzymatic Reaction Mechanisms: Set-Up and Accuracy.

Enzymes turnover substrates into products with amazing efficiency and selectivity and as such have great potential for use in biotechnology and pharmaceutical applications. However, details of their catalytic cycles and the origins surrounding the regio- and chemoselectivity of enzymatic reaction processes remain unknown, which makes the engineering of enzymes and their use in biotechnology challenging. Computational modelling can assist experimental work in the field and establish the factors that influence the reaction rates and the product distributions. A popular approach in modelling is the use of quantum mechanical cluster models of enzymes that take the first- and second coordination sphere of the enzyme active site into consideration. These QM cluster models are widely applied but often the results are dependent on model choice and selection. Herein, we show that QM cluster models can produce highly accurate results that reproduce experimental product distributions and free energies of activation, regarded that large cluster models with >300 atoms are used. In this tutorial review, we give general guidelines on the set-up and applications of the QM cluster method and discuss its accuracy and reproducibility. Finally, several representative QM cluster model examples on metal-containing enzymes are presented, which highlight the strength of the approach.

Quality of Reporting on Anastomotic Leaks in Colorectal Cancer Trials: A Systematic Review.

Although attempts have been made in the past to establish consensus regarding the definitions and grading of the severity of colorectal anastomotic leakage, widespread adoption has remained limited. A systematic review of the literature was conducted with the objective of examining the various elements used to report and define anastomotic leakage in colorectal cancer resections. A systematic review, using the PubMed, Embase, and Cochrane Library Database, of all published randomized controlled trials, systematic reviews, and meta-analyses containing data related to adult patients undergoing colorectal cancer surgery and reporting anastomotic leakage as a primary or secondary outcome, with a definition of anastomotic leakage included. Definitions of anatomotic leakage, clinical symptoms, radiological modalities and findings, findings at reoperation, as well as grading terminology or classifications for anastomotic leakage. Of the 471 articles reporting anastomotic leakage as a primary or secondary outcome, a definition was reported in 95 studies (45 randomized controlled trials, 13 systematic reviews, and 37 meta-analyses), involving a total of 346,140 patients. Of these 95 articles, 68% reported clinical signs and symptoms of anastomotic leakage, 26% biochemical criteria, 63% radiological modalities, 62% radiological findings, and 13% findings at reintervention. Only 45% (n = 43) of included studies reported grading of anastomotic leakage severity or leak classification, and 41% (n = 39) included a timeframe for reporting. There was a high heterogeneity between the included studies. This evidence synthesis confirmed incomplete and inconsistent reporting of anastomotic leakage across the published colorectal cancer literature. There is a great need for the development and implementation of a consensus framework for defining, grading, and reporting anastomotic leakage. Prospectively registered at PROSPERO ID 454660.

Acupuncture for clinical improvement of endometriosis-related pain: a systematic review and meta-analysis.

Endometriosis is a common chronic gynecological condition characterized by the presence of endometrial tissue outside the uterine cavity, leading to chronic inflammation, pelvic nodules and masses, pelvic pain, and infertility. Acupuncture has been shown to improve pain associated with endometriosis by modulating abnormal levels of prostaglandins, β-endorphins, dynorphins, electrolytes, and substance P. This review aims to evaluate the clinical efficacy of acupuncture in treating endometriosis, specifically focusing on its efficacy in relieving pain associated with endometriosis. A comprehensive search was conducted in eight databases (PubMed, EMBASE, Cochrane, Web of Science, China National Knowledge Infrastructure (CNKI), the China Biology Medicine (CBM), Wanfang, and Weipu database) to identify randomized controlled trials (RCTs) published from database inception to December 16, 2022, which investigated the use of acupuncture for endometriosis-related pain. Two researchers independently screened articles, extracted data, and assessed methodological quality using the Cochrane Collaboration's risk of bias tool. Meta-analysis was performed using Stata statistical software. A total of 1991 articles were identified, and ultimately, 14 studies involving 793 patients (387 in the acupuncture group and 359 in the control group) were included. The control interventions in the included studies included placebo, traditional Chinese medicine (TCM), and Western medicine treatments. Meta-analysis results showed that compared to the control group, acupuncture treatment for pain associated with endometriosis demonstrated significant reductions in pain severity [SMD = -1.10, 95% CI (-1.45, -0.75), P < 0.001], improved response rate [RR = 1.25, 95% CI (1.09, 1.44), P = 0.02], and decreased serum CA-125 levels [SMD = -0.62, 95% CI (-1.15, -0.08), P = 0.024]. Furthermore, subgroup analysis revealed that electroacupuncture and auricular acupuncture were superior to the control group in reducing pain severity, while auricular acupuncture and warm needling showed greater clinical efficacy compared to the control group. However, there were no significant differences between electroacupuncture or fire needling and the control group in terms of pain relief. The findings suggest that acupuncture is effective in improving pain associated with endometriosis. In conclusion, acupuncture is effective in alleviating dysmenorrhea and pelvic pain associated with endometriosis, reducing serum CA-125 levels, decreasing the size of nodules, improving patients' quality of life, and lowering the recurrence rate. However, it should be noted that the current evidence is limited by the design and quality flaws of the original studies, as well as a lack of research specifically focusing on subtypes of acupuncture. Therefore, caution should be exercised when interpreting the results.

Evaluation of the use of telemedicine in pediatric intensive care units: a cluster-randomized trial

ABSTRACT Introduction Telemedicine has shown promising results, allowing specialists to provide rapid and effective care in remote locations. However, to our knowledge, current evidence is not robust enough to prove the effectiveness of this tool. This cluster-randomized trial (CRT) aimed to evaluate the impact of telemedicine on clinical care indicators in pediatric intensive care units (PICUs). Methods An open-label CRT was conducted in 16 PICUs within the Brazilian public health system. The trial took place from August 2022 to December 2023 and compared an intervention group, which received telemedicine support, with a control group, which received usual PICU care. The primary outcome was the PICU length of stay. The main secondary outcomes were mortality rate and ventilator-free days. Results A total of 1393 participants were included, 657 in the control group and 736 in the intervention group. The mean PICU length of stay was 10.42 (SD, 10.71) days for the control group and 11.52 (SD, 10.80) days for the intervention group. The overall mean of ventilator-free days was 6.82 (SD, 7.71) days. Regarding mortality, 7.54% of participants died in total. No significant difference was found in the outcomes between the groups. Conclusion Despite the potential benefits of telemedicine, its effective implementation in the Brazilian public health system faces considerable challenges, highlighting the continued importance of investigating and improving the role of telemedicine in pediatric critical care. Clinical trial registration ClinicalTrials.gov NCT05260710 and ReBEC – RBR-7×j4wyp.

Development of the Competency Evaluation Scale for Clinical Nutritionists in China: A Delphi Study

Background: Clinical nutritionists are responsible for nutritional therapy in clinical practice, which significantly enhances patients’ nutritional status. This study aims to develop and validate a competency evaluation scale to effectively assess the abilities of clinical nutritionists. Methods: The competency evaluation scale for clinical nutritionists was developed based on the iceberg model, utilizing literature review, semi-structured interviews, and the Delphi method. The weights of each indicator were calculated using the Analytic Hierarchy Process (AHP), and the validity and reliability of the scale were confirmed through questionnaire surveys. Results: The competency evaluation scale of clinical nutritionists comprised five primary indicators, twelve secondary indicators, and sixty-six tertiary indicators. The primary indicators, including professional theoretical knowledge, professional practical skills, humanistic practice ability, interpersonal communication ability, and professional development capability, have respective weights of 0.2168, 0.2120, 0.2042, 0.2022, and 0.1649. The Cronbach’s α coefficients of the five dimensions of the scale were 0.970, 0.978, 0.969, 0.962, and 0.947, respectively. The results of the Exploratory Factor Analysis showed that the prerequisites for factor analysis were satisfied. Additionally, Bartlett’s test of sphericity yielded a significance level of p &lt; 0.001, confirming the scale’s reliability and validity. Conclusions: The competency evaluation scale for clinical nutritionists developed in this study is of high scientific reliability and validity, which provides assessment criteria for the training and assessment of clinical nutritionists.

Modified Frailty Index for Patients Undergoing Surgery for Colorectal Cancer: Analysis of the National Inpatient Sample From 2015 to 2019

Background Frailty is increasingly recognized as a perioperative risk for numerous surgical diseases. We applied the modified frailty index (mFI-11) to the National Inpatient Sample (NIS) for patients undergoing surgery for colorectal cancer (CRC). Methods We performed a retrospective analysis of the NIS (2015-2019) including CRC patients undergoing surgery. We classified patients into frail (ie, mFI ≥0.27) and robust (ie, mFI &lt;0.27) categories. Primary outcomes were in-hospital postoperative morbidity and mortality. The secondary outcomes included system-specific postoperative morbidity and length of stay (LOS). Multivariable regression models were fit. Results Within the 53,652 identified patients undergoing surgery for CRC, 19.1% were frail. Frail patients were at higher risk of postoperative mortality (3.1% vs 1.0%, odds ratio [OR] 1.96, 95% confidence intervals [CIs] 1.68-2.30, P &lt; 0.001), morbidity (41.3 % vs 23.1%, OR 1.75, 95% CI 1.66-1.83, P &lt; 0.001), and LOS (mean difference [MD] 1.46, 95% CI 0.29-1.62, P &lt; 0.001). Significant differences existed between groups in system-specific postoperative morbidity, with the largest effect estimates seen in cardiovascular morbidities (OR 4.07, 95% CI 3.36-4.93, P = 0.001), followed by respiratory (OR 1.75, 95% CI 1.66-1.83, P = 0.001). Conclusion Frail patients undergoing CRC surgery are at risk of increased postoperative complications. Preoperative frailty screening may allow for individualized preoperative counseling.