Lower Infection Rates Research Articles

Migration behaviors leaving metropolitan areas: assessing the impacts of health risks and teleworking in the COVID-19 context

An increase in the number of people leaving metropolitan areas (MAs) was observed in various countries in the early years of the COVID-19 pandemic. While considerable attention has been paid to the impacts of health risks and teleworking, two prominent topics related to health-crisis-led migration, empirical evidence remains inadequate. This study aims to empirically investigate the impacts and temporal changes of these two factors on migration leaving MAs (LMA migration). It utilizes survey data from the Japanese government and employs fixed effects logit models. (1) By using infection rates in a more accurate measurement than previous studies, this study confirms the health-risk-aversion motives in LMA migration. (2) Teleworking’s influence on LMA migration is found to be insignificant over the long term. Nevertheless, it increases the likelihood of formal employees staying in MAs and strengthens the tendency of the self-employed to leave for local areas. (3) Temporally, the significant impact of lower COVID-19 infection rates attracting metropolitan residents persisted beyond the pandemic stringency and continued for several months afterward, though it eventually reversed. Teleworking shows a positive influence on LMA migration only in the later stage of COVID-19. These findings suggest a tendency of ‘deferred decisions’ in LMA migration due to people’s unfamiliarity with an unprecedented health crisis. However, the negative impact of infection risks emerges sooner than the significant effect of teleworking, indicating that safety is a pressing priority for LMA migration in the early stages of a major health crisis. (4) Self-employed individuals, homeworkers, and the unemployed are more likely to engage in LMA migration, while employees (whether formal or informal) are less likely, highlighting the role of opportunity costs. Policy implications suggest that local governments should focus on attracting the self-employed from MAs during health crises and on enhancing the teleworking environment for the long term.

Zero incidence of culture-positive septic arthritis and low infection rate following ACLR with all-soft tissue quadriceps tendon autograft: An analysis of 1053 cases.

To evaluate the infection rate following anterior cruciate ligament reconstruction (ACLR) using all-soft tissue quadriceps tendon (ASTQT) autograft. All primary ASTQT autograft ACLRs within a single surgeon's prospectively collected database from 2011 to 2021 were retrospectively reviewed. No topical antibiotics were administered and no graft-soaking with antibiotics was performed during the study period. Patients who underwent multiligament knee reconstruction or a cartilage restoration procedure were excluded. Patients who underwent a subsequent procedure, including irrigation and debridement (I&D) of the knee joint, were included. Case-specific data, including fluid culture analysis, antibiotics (type, route of administration and duration), time to debridement and method of debridement, were collected. Descriptive statistics were utilized to analyze demographics, incidence and possible association between the need for I&D and concomitant meniscus surgery. Out of 1053 cases (mean age: 20.2 ± 6.3, 44.6% female), four patients (0.38%) (mean age: 18.5 ± 4.0, 25% female) underwent subsequent I&D (arthroscopic I&D only [n = 1], graft harvest site I&D only [n = 1], combined graft harvest site and arthroscopic I&D [n = 1] and tibia wound and arthroscopic I&D [n = 1]). There was no significant difference with regard to demographics. No joint fluid cultures returned positive; one wound culture returned positive for Methicillin-susceptible Staphylococcus aureus from their graft harvest site. The time to I&D ranged from 18 to 23 days. Concomitant meniscectomy or meniscal repair was not associated with requiring surgical I&D. All patients who underwent I&D were prescribed antibiotics for a minimum of 10 days and a maximum of 31 days (mean: 16.25 days). Three patients (75%) who underwent I&D ultimately returned to sport. One patient was lost to follow-up. ACL grafts were retained in all patients. The incidence of culture-positive septic arthritis following ASTQT autograft ACLR is 0%, while the overall need for I&D of 0.38% is low and not related to concomitant meniscal procedures or patient-specific factors. Level IV.

Immunity priming and biostimulation by airborne nonanal increase yield of field-grown common bean plants

IntroductionStress-induced volatile organic compounds (VOCs) that induce plant immunity bear potential for biocontrol. Here, we explore the potential of nonanal to enhance the seed yield of common bean (Phaseolus vulgaris) under open field conditions that are realistic for smallholder farmers.Methods and resultsUsing plastic cups with a nonanal-containing lanolin paste as low-cost dispensers, we observed that exposure of Flor de Junio Marcela (FJM) plants over 48h to airborne nonanal was followed by a 3-fold higher expression of pathogenesis-related (PR) genes PR1 and PR4. Both genes further increased their expression in response to subsequent challenge with the fungal pathogen Colletotrichum lindemuthianum. Therefore, we conclude that nonanal causes resistance gene priming. This effect was associated with ca. 2.5-fold lower infection rates and a 2-fold higher seed yield. Offspring of nonanal-exposed FJM plants exhibited a 10% higher emergence rate and a priming of PR1- and PR4-expression, which was associated with decreased infection by C. lindemuthianum and, ultimately, a ca. 3-fold increase in seed yield by anthracnose-infected offspring of nonanal-exposed plants. Seeds of nonanal-exposed and of challenged plants contained significantly more phenolic compounds (increase by ca 40%) and increased antioxidant and radical scavenging activity. Comparative studies including five widely used bean cultivars revealed 2-fold to 3-fold higher seed yield for nonanal-exposed plants. Finally, a cost-benefit analysis indicated a potential economic net profit of nonanal exposure for some, but not all cultivars.OutlookWe consider nonanal as a promising candidate for an affordable tool that allows low-income smallholder farmers to increase the yield of an important staple-crop without using pesticides

Infections and Patient Satisfaction in WALANT Hand Surgery in a Hospital Procedure Room.

Background: Wide-awake hand surgery has allowed many hand procedures to be moved out of the operating room and into minor procedure rooms while increasing efficiency, maintaining safety, and reducing both patient and hospital costs. The goal of this study was to evaluate patient satisfaction and postoperative complications of wide-awake local anesthesia with no tourniquet procedures performed in a community-based hospital procedure room. Methods: A total of 786 patients underwent 948 elective hand procedures in a hospital procedure room. At the conclusion of their surgeries, the patients were surveyed regarding their satisfaction. Following surgery, patients were evaluated for postoperative complications including infections. The trend in postoperative infection rates across 8 age groups was analyzed using a Cochran-Armitage test in R. Results: The overall infection rate was 6.2% (n = 59). All infections were superficial. Carpal tunnel had the highest number of infections (n = 25), followed by trigger finger (n = 8), and the combination trigger finger with carpal tunnel (n = 7). All infections were managed with antibiotics and/or soaks. Three patients did require a return to the operating room for irrigation and debridement. Ninety-nine percent of patients said the procedure room experience was better or the same as going to the dentist, would recommend wide-awake anesthesia to a friend or family member, and would undergo the procedure again. Conclusion: Wide-awake procedures performed in a hospital procedure room have low infection rates with high patient satisfaction.

A new portable negative pressure wound therapy device: a prospective study investigating clinical outcomes.

Closed surgical incision sites at high risk of complications, and with exudate or leakage, are increasingly being managed with closed incision negative pressure wound therapy (ciNPWT) to reduce tissue stress and increase the force necessary to disrupt the incision. This study was undertaken to investigate the performance and safety of a canister-based, single-use NPWT (suNPWT) system when used on closed surgical incision sites. The investigation was designed as a prospective, open, non-comparative, multicentre study aimed at confirming the safety and performance attributes of the suNPWT system when applied to low-to-moderately exuding closed surgical incisions. The primary performance measure was the wound remaining closed from baseline to the last follow-up visit on day 14. Secondary performance measures included: wound and periwound condition; wear time of the system; product consumption; adherence to therapy; and patients' pain progress. Details of adverse events were also collected. Some 35 patients were recruited. The closed surgical incisions responded well to treatment with the tested suNPWT system. All wounds remained closed throughout the investigation. Consistent with other studies of ciNPWT reporting low infection rates, the current study observed either no or low exudation in 90.4% of wounds at the final visit, together with absence of surgical site infection. Pain severity levels were low, both at dressing change and during delivery of negative pressure. No serious adverse device events were reported. In this study, the suNPWT system supported the healing of closed surgical incisions with no safety concerns relating to its use.

Low-Volume Surgeons Operating at High-Volume Hospitals Have Low Rates of Periprosthetic Joint Infection after Hip and Knee Arthroplasty

IntroductionThe relationship between surgeon and hospital case volumes and postoperative risk following total hip and total knee arthroplasty (THA and TKA) has been described independently. This study aimed to assess the risk of periprosthetic joint infection (PJI) following primary TKA and THA to determine if lower volume surgeons operating at higher volume centers would have lower rates of complications compared to lower volume surgeons operating at lower volume hospitals. MethodsA healthcare database was used to retrospectively identify all primary, and elective total joint arthroplasties (TJAs) from October 2015 to December 2021. Using restricted cubic splines, high-volume hospitals were defined using Markov chain Monte Carlo simulation, which identified a volume beyond which PJI rates no longer decreased significantly with increasing hospital volume. A similar methodology was used to identify low-volume surgeons operating in high- and low-volume hospitals. There were 605,254 patients who underwent TJA (total hip arthroplasty [THA]: 37.71%; total knee arthroplasty [TKA]: 62.29%) by low-volume surgeons (< 57 THAs and < 68 TKAs) identified and divided into high-volume and low-volume hospital cohorts. High-volume hospitals were defined as > 508 THA and > 812 TKAs per year, and low-volume hospitals were defined as < 145 THAs and < 243 TKAs per year. Multivariable models accounting for potential confounding covariates were created to determine the odds of PJI between cohorts. ResultsAfter taking confounding variables into account, low-volume surgeons at high-volume hospitals had lower rates of PJI relative to their counterparts at low-volume hospitals (THA 0.67 versus 0.80%, aOR [adjusted odds ratio] = 0.69 [95% confidence interval (CI) = 0.54 to 0.88], P = 0.002; TKA 0.51 versus 0.69%, aOR = 0.73, [95%-CI = 0.61 to 0.87], P = 0.007). ConclusionIncreasing institutional case volume may mitigate the increased risk of PJI associated with low annual surgeon case volume.

Current Trends in the Treatment of Pediatric Hydrocephalus: A Narrative Review Centered on the Indications, Safety, Efficacy, and Long-Term Outcomes of Available Treatment Modalities

The pathophysiologic substrate of pediatric hydrocephalus has not been thoroughly elucidated. Valve-based shunt systems have constituted the main therapeutic option since the late 1950s. The initially used systems were concerning the ventricular system and the atrium. In the 1970s, VA shunts were not the main stay of treatment as the preferred option for the terminal end of the drainage system was the peritoneum. Our review analyzes these valve types and attempts a comparison, based on their functional characteristics. Nowadays, the only available surgical alternative for the treatment of hydrocephalus is ETV. This technique is associated with lower infection rates as well as, on average, a lower re-operation rate. Another term that deserves special mention is related to the outcome of ETV in children who had a medical history of previously incorporated shunts and who were subsequently suffering from shunt malfunction. Well-recognized predictive factors associated with secondary ETV failure include age, early onset of hydrocephalus, and prematurity. Although several attempts have been made in order to establish the optimum surgical treatment management in the different subgroups of patientswho are suffering from shunt dysfunction, there is no universal agreement. Therefore, this review attempts to identify the specific subpopulations of patients in whom the insertion of a drainage system as the preferred treatment modality is associated with an optimum long-term prognosis, compared to ETV, and vice versa. The objective of our study is to analyze the safety, efficacy, and outcomes of drainage devices and ETV in pediatric hydrocephalus patients.

Societal Adaptation to Pandemic Challenges: Analysing the Role of Local Governance and Healthcare Systems in Madhya Pradesh

The COVID-19 pandemic posed unprecedented challenges, compelling communities globally to adapt rapidly to protect lives and maintain societal functions. This study examines the role of local governance and healthcare systems in Madhya Pradesh in addressing these challenges and fostering societal resilience. Drawing on quantitative data from government health agencies and qualitative insights from community feedback, this research explores how local governance structures facilitated public health response, resource allocation, and pandemic preparedness. Findings indicate that decentralized decision-making and robust healthcare infrastructure were instrumental in managing health crises, providing essential services, and supporting economic resilience at the grassroots level. Key results show that regions with stronger local governance exhibited a 30% lower infection rate compared to less governed areas, while areas with well-resourced healthcare systems saw a 20% higher recovery rate. Resource distribution, however, varied significantly, with urban areas receiving 60% more medical supplies than rural regions, creating disparities in healthcare access. Data analysis revealed that healthcare facilities that integrated digital solutions, such as telemedicine, were able to serve 45% more patients remotely, mitigating the risk of virus spread and reducing hospital overload. The study identifies the need for capacity-building initiatives, infrastructure strengthening, and data-driven decision-making to enhance future pandemic preparedness. Future prospects include continuous training programs for healthcare workers, increasing community awareness of health protocols, and leveraging technology for real-time data monitoring. These insights contribute to a comprehensive framework for building resilient healthcare systems in Madhya Pradesh, better prepared for future public health crises.

Cranioplasty Approaches for Cranial Defects: A Case Series

Abstract Cranial defects are commonly caused due to road traffic accidents, tumor, postneurosurgery, or congenital deformities. Protection of the cranial structures, maintaining cerebrospinal fluid dynamics, and esthetics are some of the prime considerations while restoration of such defects. The use of autograft or allograft materials such as bone from a self or another donor site from ribs, ilium, tibia, scapula, and fascia and procedures such as split-thickness cranioplasty were carried out in the past. However, in larger defects, alloplastic materials such as celluloids, methyl methacrylate, hydroxyapatite, polyethylene, silicone, and metals such as titanium, aluminum, and stainless steel, were used for restoration. Irrespective of the material of choice, it is desirable of the prosthetic material to demonstrate low thermal conductivity, optimal strength, low infection rate, longevity, close adaptation to the defect, and fixability with plates to adjacent bone. Before digital imaging, conventional impressions were made, and approximations were done to fabricate cranial plates. With the advent of digital technology and bone imaging techniques with alongside the development of printed and milled materials, accurate cranial prosthesis can be fabricated. We cannot disregard conventional techniques as these are still used in places where access to digital technology is limited and also for patients who cannot afford the cost incurred with digital technology. The case series presents one case, which was fabricated with a conventional method, and two cases with two different approaches using digital technology. The paper aims to present various advantages, limitations, and nuances needed while the fabrication of such a prosthesis with these three methods.

Chlamydia infection with vaccination asymptotic for qualitative and chaotic analysis using the generalized fractal fractional operator

In this work, we solve a system of fractional differential equations utilizing a Mittag-Leffler type kernel through a fractal fractional operator with two fractal and fractional orders. A six-chamber model with a single source of chlamydia is studied using the concept of fractal fractional derivatives with nonsingular and nonlocal fading memory. The fractal fractional model of the Chlamydia system can be solved by using the characteristics of a non-decreasing and compact mapping. A suggested model with the Lipschitz criteria and linear growth is studied both qualitatively and quantitatively, taking into account boundedness, uniqueness, and positive solutions at equilibrium points with Leray-Schauder results under time scale concepts. We examined the framework of local and global stability and insight into Lyapunov function properties for the infectious disease model. Chaos Control will employ the regulate for linear responses approach to stabilize the system following its equilibrium points. This will take into consideration a fractional order framework with a managed design, where solutions are bounded in the feasible domain and have a greater impact at the lower minimum infectious rate. To illustrate the implications of fractional and fractal dimensions with varying interest rate values through simulations with Newton’s polynomial method under the Mittag-Lefller kernel. Additionally, a comparative analysis of results is also derived by employing power and exponential decay kernels at various fractional orders.

The efficacy of neuroendoscopic surgery treating patients with thalamic hemorrhage accompanied by intraventricular hematoma

ObjectiveNeuroendoscopic surgery (NES) has been proven to be safe and effective in hematoma evacuation for cerebral hemorrhage. However, its efficacy for thalamic hemorrhage accompanied by intraventricular hematoma (THAVH) remains unclear. The aim of this study is to determine the efficacy of NES in treating THAVH.MethodA retrospective study was carried out. The data of patients diagnosed with THAVH were collected from January 1st, 2019, to January 1st, 2022. Patients received the NES or external ventricle drainage (EVD) treatment were assigned to the NES or EVD group, respectively. As primary outcomes, the hematoma evacuation volume, residual hematoma volume, and hematoma clearance rate were separately calculated based on the hematoma site; and the 180-day-mRS score was assessed. As secondary outcomes, the length of stay in the ICU and hospital, and the adverse events were also compared.ResultsThirty-five patients, aged 66.37 ± 6.62 years, were in the NES group; and 40 patients, aged 68.75 ± 7.22 years, were in the EVD group. The baseline characteristics in the two groups were similar (P &amp;gt; 0.05). The gross hematoma evacuation volume, volume of hematoma evacuated in the thalamus or the ventricle, and the hematoma clearance rate were greater in the NES group than in the EVD group on the 1st day after surgery (P &amp;lt; 0.05). The patients had a better rank of mRS in the NES group (P &amp;lt; 0.05). Compared with patients with mRS &amp;gt; 3, the mean residual hematoma volume in the thalamus of patients with mRS ≤3 on the 1st and 7th day were less in each group (P &amp;lt; 0.05), respectively. A residual hematoma volume in the ventricle of patients with mRS ≤3 was less than that of patients with mRS &amp;gt;3 in the EVD group on the 1st day after surgery (P &amp;lt; 0.05). GCS score on the 3rd day was greater in the NES group (P &amp;lt; 0.05). The incidence of lung infection was lower in the NES group (P &amp;lt; 0.05). The length of stay in the ICU and hospitalization duration were shorter in the NES group (P &amp;lt; 0.05).ConclusionsNeuroendoscopic surgery has a greater hematoma clearance rate, a lower lung infection rate and a shorter duration in the hospital. Neuroendoscopic surgery might improve patients’ prognosis. Neuroendoscopic surgery is a safe and effective procedure for treating thalamic hemorrhage accompanied by intraventricular hematoma.

Local muscle or myocutaneous flap transfer for emergent repair of Gustilo IIIB open tibiofibular fractures

This study aimed to investigate the clinical outcomes of local muscle or myocutaneous flap transfer for emergent repair of Gustilo IIIB open tibiofibular fractures. This retrospective case series study included patients with Gustilo IIIB open tibiofibular fractures treated by local muscle or myocutaneous flap transfer in Weifang People’s Hospital between May 2016 and April 2021. Fifteenpatients (11 males aged 19–72 years) were included. The follow-up ranged from 8 to 24 months. The ranges of bone healing time and wound healing time were 6–17 months and 1–3 weeks, respectively. The length of hospital stay was 26 days (11–50 days). All patients reported acceptable functional recovery and satisfactory leg appearance, with Johner-Wruhs scores of excellent, good, and fair in 10, four, and one patients, respectively. The excellent-good rate was 93.3%. The complications included one case of infection and one case of nonunion. In conclusion, local muscle or myocutaneous flap transfer for emergent repair of Gustilo IIIB open tibiofibular fractures may be useful in providing adequate soft tissue coverage and fracture healing with low complication and infection rates.

Lumpy Skin Disease: A review of epidemiological study and preventive measures

Background: Lumpy skin disease (LSD) is a highly infectious and economically important transboundary disease that is rapidly spreading to the globe. The disease causes high morbidity and a low mortality rate of infection. The animals show acute or chronic illnesses depending on the immune responses of the hosts. The economic burden of LSD manifested the poor-quality hides, a drop in milk and meat production, abortion, and death. Methods: This systematic literature review was accomplished according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The literature on lumpy skin disease has been explored over the last two decades and searched keywords on online databases such as Google Scholar, PubMed, and Scopus. Both automated and manual searching tools were used to screen the articles. The literature published other than English was rejected during the screening process. Conference papers were excluded during the screening. Results: LSD is transmitted by blood-sucking arthropods and is most prevalent in summer and rainy seasons. Exotic-bred cattle and calves are highly susceptible. Although the disease has low mortality, the high mortality of the disease prevails in endemic regions in complicated cases. Calves from unvaccinated cows should be vaccinated at any age, on the other hand, the calves from vaccinated cows should be immunized at 3 months of age. Animals should be vaccinated before the risk period. Strict biosecurity, quarantine, and immunoprophylaxis can reduce the prevalence of the disease. Conclusions: Lumpy skin disease (LSD) is an acute infectious and contagious disease affecting cattle and water buffaloes. The disease causes serious economic loss due to decreased production, skin problems, and mortality in complicated cases. Further details on genetic characterization, transmission dynamics, and host-pathogen interaction should be performed to prevent the prevalence of the disease in emerging or re-emerging countries.

Comparison of transforaminal endoscopic lumbar foraminotomy (TELF) in patients with degenerative scoliosis and patients with normal alignment

Objectives Transforaminal endoscopic lumbar foraminotomy (TELF) is a well-described method of treating foraminal stenosis. However, there is little literature examining the usage of TELF to treat foraminal stenosis in patients with degenerative scoliosis. TELF is an attractive option for such patients as it results in lesser blood loss, shorter recovery time, and lower infection rates as compared to fusion surgery. However, TELF neither corrects the deformity nor alters the natural history of the disease. Therefore, the outcomes of TELF in patients with degenerative scoliosis may be worse than those without deformities. This study aims to compare the outcomes of TELF in these two groups of patients. Material and Methods This is a retrospective study of 19 patients who underwent TELF from July 2012 to April 2015. Eight patients had degenerative scoliosis, and 11 were without scoliosis. Visual analog scale and Oswestry disability index (ODI) scores were collected at 3 months postsurgery. Patient outcomes were graded as excellent, good, fair, and poor using a modified MacNab’s criteria. Results Both groups had significant improvements in back pain, leg pain, and ODI scores postoperatively. There were no differences between the two groups when comparing the preoperative and postoperative back pain, leg pain, and ODI scores. The majority of patients rated their outcomes as excellent or good. Conclusion The short-term outcomes of TELF in patients with degenerative scoliosis are comparable to those without scoliosis. Improvements in back and leg pain after surgery are expected. We recommend it as a palliative treatment for patients who are unable to undergo major surgery.

The Use of a Novel Surgical Irrigant May Be Associated with Decreased Incidence of Surgical Site Infections

Background Periprosthetic joint infection (PJI) represents a formidable challenge to patients undergoing elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). This investigation evaluated a novel antimicrobial surgical irrigation solution, XPerience (XP) (Next Science LLC, Jacksonville, FL), with proven high &amp; persistent in-vivo efficacy against planktonic bacteria and biofilm. The primary objective of this investigation was to compare the incidence of PJI following TKA performed with use of XP versus a standard control rinse (povidone-iodine). The secondary outcome was an all-cause return to operating room (OR) rate. Methods A retrospective cohort study was conducted from 824 consecutive patients undergoing primary THA/TKA from 12/1/2019 - 11/30/2021 treated using povidone-iodine solution and 471 consecutive patients undergoing primary THA/TKA from 12/1/2021 - 12/30/2022 treated with XP at a single institution by the senior author. All surgeries in both groups followed largely identical preoperative, perioperative, and postoperative protocols. A total of 1,295 cases were analyzed. The groups shared largely analogous background characteristics pertaining to age, sex, BMI, and American Society of Anesthesiologists (ASA) class. Results The overall SSI rate was 0% (0/471) in the XP group and 0.49% (4/824) in the control group (P = 0.3). The overall return to OR rate was 0.21% (1/471) in the XP group and 0.85% (7/824) in the control group (P = 0.3). Control group cases returned to the OR for hematoma debridements, periprosthetic fracture fixation, and PJI revisions. Conclusion This investigation is the first to remark on the clinical efficacy of a novel surgical irrigant. There was no statistically significant difference in rates of PJI or return to OR with the irrigant versus without, though a trend towards lower rates was observed in the context of a low baseline infection rate. Limitations pertaining to a single-center experience and sample size may be addressed by further studies incorporating broader enrollments.

Maximizing Influence in Social Networks Using Combined Local Features and Deep Learning-Based Node Embedding.

The influence maximization problem has several issues, including low infection rates and high time complexity. Many proposed methods are not suitable for large-scale networks due to their time complexity or free parameter usage. To address these challenges, this article proposes a local heuristic called Embedding Technique for Influence Maximization (ETIM) that uses shell decomposition, graph embedding, and reduction, as well as combined local structural features. The algorithm selects candidate nodes based on their connections among network shells and topological features, reducing the search space and computational overhead. It uses a deep learning-based node embedding technique to create a multidimensional vector of candidate nodes and calculates the dependency on spreading for each node based on local topological features. Finally, influential nodes are identified using the results of the previous phases and newly defined local features. The proposed algorithm is evaluated using the independent cascade model, showing its competitiveness and ability to achieve the best performance in terms of solution quality. Compared with the collective influence global algorithm, ETIM is significantly faster and improves the infection rate by an average of 12%.

Comparative Outcomes of Superomedial and Inferior Pedicles in Breast Reduction and Mastopexy: A Meta-Analysis of 5123 Breasts.

Superomedial and inferior pedicles are two commonly used techniques in breast reduction and mastopexy. This systematic review and meta-analysis aims to compare the clinical outcomes associated with these two techniques. PubMed, Scopus, and Web of Science were searched for relevant studies. We included all studies with data comparing superomedial and inferior pedicles. Statistical analyses were performed using RevMan version 5.4. The search yielded 1075 studies, of which 15 were included in the meta-analysis, encompassing 2633 patients (5123 breasts), with 3491 breasts receiving superomedial pedicles and 1632 breasts receiving inferior pedicles. Superomedial pedicles were associated with significantly shorter operative length (MD = - 24.71, 95% CI = - 37.63 to - 11.79, p = 0.0002), higher BREAST-Q breast satisfaction scores (MD = 10.34, 95% CI = 7.72 to 12.96, p < 0.00001), lower infection rates (RR = 0.46, 95% CI = 0.24 to 0.86, p = 0.02), higher incidence of seroma (RR = 3.00, 95% CI = 1.15 to 7.79, p = 0.02), and higher incidence of decreased nipple-areola complex (NAC) sensation (RR = 1.50, 95% CI = 1.12 to 2.01, p = 0.006). No significant differences were observed in asymmetry, fat necrosis, NAC loss, and hematoma. Superomedial pedicles demonstrated higher incidences of decreased NAC sensation and seroma formation, lower incidence of infection, shorter operative length, and higher BREAST-Q breast satisfaction scores compared to inferior pedicles. Further research is needed to confirm these findings and explore the long-term aesthetic outcomes associated with both techniques. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Polyetheretherketone (PEEK) Into the Future: Lowering Infection Rates in Cranioplasty

Polyetheretherketone (PEEK) Into the Future: Lowering Infection Rates in Cranioplasty

Haploidentical hematopoietic stem cell transplantation for hematologic malignancies: a novel conditioning regimen with anti-T lymphocyte immunoglobulin instead of anti-thymocyte globulin for in vivo T cell depletion.

We evaluated the safety and efficacy of a novel protocol for haploidentical stem cell transplantation (haplo-SCT) in 312 patients with hematologic malignancies. The protocol evolved from the Beijing platform replacing ATG with ATLG; adding Fludarabine and removing cytarabine and Simustine. GVHD prophylaxis combined Basiliximab and low-dose cyclophosphamide post-transplant; overall, the conditioning duration was shortened. Median times to neutrophil and platelet recovery were both 11 days. Graft rejection occurred in 0.96% of patients. Cumulative incidences of grades II-IV and III-IV acute GVHD by day 200 were 35.3% and 8.9%, respectively. Probabilities of total and extensive chronic GVHD at 2 years were 40.7% and 14.7%. CMV viremia was observed in 35.6% of patients, with a 1.9% 100-day CMV pneumonia incidence and no CMV-related mortality. Cumulative incidences of non-relapse mortality at 100 days, 1 year, and 2 years were 2.9, 4.4, and 6.6%. The 4-year OS, RFS, and GRFS rates were 78.9, 70.7, and 47.3%. Older recipient age was associated with higher NRM, while positive pre-transplant MRD predicted worse OS, RFS, and higher relapse incidence. Our novel protocol for haplo-SCT is associated with low infection rates and acceptable risks of graft failure, severe GVHD, and mortality, representing a safe and effective haploidentical transplantation strategy.

Effect of Phyto Constitutes of &lt;i&gt;Ayurveda&lt;/i&gt; and &lt;i&gt;Siddha&lt;/i&gt; Herbs on SARS-CoV-2/CoVID-19 Management by Modulating the Human Gut Microbiome

The therapeutic plants used in Ayurveda and Siddha medicine primarily function as immunomodulators to combat viral infection. The majority of the Indian states adopted an integrative approach to the treatment strategy for COVID-19 infection during the COVID-19 outbreak. A large percentage of Indians consume Ayurvedic and Siddha herbs as preventative medication or immune boosters during the COVID outbreak. ACE-2 receptor, Mpro, Nsp15, endoribonuclease, ACE-2-RBD interface, RBD complex, helicase inhibitors, and ACE-2-RBD interface are the main targets of the phytochemicals of medicinal plants, which also have the potential to limit their action and lower infection rates. The phytonutrients also preserve the permeability of the gut epithelial membrane and improve gut barrier proteins including occludin, Zo-1, and claudin. The phytonutrients also help probiotic bacteria flourish, such as Faecalibacterium, Rikenellaceae, Lactobacillus and Lachnospiraceae, which may lower proinflammatory cytokines and improve immunological function. A small number of opportunistic bacteria, such as Pseudomonas aeruginosa and Klebsiella pneumonia, co-infect with the SARS-CoV-2 virus and increase the frequency of hospital stays and severity of the illness. The co-infections or secondary infections may be reduced by the antibacterial and anti-inflammatory activities of phytochemicals.