Prolonged Time Research Articles

Impact of Head and Neck Multidisciplinary Clinic on Treatment Package Time During 2 Years of the COVID-19 Pandemic: A Single-Institution Experience.

Prolongation of treatment package time is strongly associated with inferior oncologic outcomes. We examine the effect of creation of a multidisciplinary head and neck clinic on treatment package times. This was a retrospective cohort study evaluating treatment package time in patients receiving adjuvant radiation through a multidisciplinary clinic compared with standard clinics at a single academic institution between 7/31/2020 and 7/31/2022. Adjuvant radiotherapy was administered to 23 patients in multidisciplinary clinic, 68 patients in standard clinic and 17 patients in satellite clinics. Patients seen in multidisciplinary clinic began adjuvant radiation sooner (median 35 vs 41 vs 48 days, p=0.01) with more compact treatment package times (median 78 vs 84 vs 86 days, p=0.003). Nine patient (13%) in standard clinics and 4 patients (24%) at the satellite clinics had adjuvant treatment package times exceeding 100 days. No patient seen in multidisciplinary clinic had treatment package times exceeding 100 days. Colocalization of radiation oncology and otolaryngology care in multidisciplinary clinic substantially improved time to postoperative radiotherapy and treatment package times. This is likely due to the identification of patients requiring adjuvant radiation earlier in their clinical presentation which in turn allowed for advanced planning and minimization of delays in initiation of adjuvant radiation.

Biochar-based fertilizers from co-pyrolysis of algae and hazelnut shell with triple superphosphate: Physicochemical properties and slow release performance.

Phosphorus (P) is a vital nutrient for plant growth and food production. Excessive amounts of P fertilizers to a greater extent of crop P offtake are inevitably applied due to low utilization efficiency, causing environmental pollution. This study aimed to evaluate biochar-based fertilizers (BBFs) produced by co-pyrolyzing algae (A) and hazelnut shell (H) biomasses with triple superphosphate (TSP) at a ratio of 4:1 (w/w). The potential of the slow-release performance of BBFs was studied during kinetics experiments. The co-pyrolysis of biomasses with TSP yielded BBFs with significantly different properties, including electrical conductivity, pH, elemental ratios, functional groups, specific surface area and pore size characteristics. Phosphorus release from all biochars and BBFs followed the Elovich model, except for TSP and H+TSP. Kinetic studies revealed prolonged P-release times and slower release rates for BBFs compared to conventional TSP. So that, TSP released 100% of the total P, whereas H+TSP and A+TSP biochars released only 3.14% and 5.14% of the total P, respectively, during a 240-hour experiment. The slow-release performance of BBFs suggests their potential as promising alternatives to conventional phosphate fertilizers. BBFs have the potential to enhance P utilization efficiency, increase crop yield and mitigate the environmental impact of P fertilizer runoff.

Day case laparoscopic cholecystectomy: a review of patient selection factors and identification of potential barriers to same-day discharge.

Day-case laparoscopic cholecystectomy (DCLC) is a useful tool for minimizing hospital admissions and prolonged presurgical wait times in suitable patient cohorts. There have been many international studies to support this finding and an increasing interest has grown in implementation in Australia. This review aims to provide clarity how to best implement this tool in gallbladder disease patient demographic. This literature review evaluates studies on day-case cholecystectomy procedures, focusing on patient factors, procedural aspects, surgical morbidity, and systemic implications. It explores inclusion and exclusion criteria for day-case suitability, factors influencing same-day discharge, reasons for hospital admission, pain management, patient quality of life, patient satisfaction, and cost implications. DCLC, when selected judiciously, is a safe alternative to overnight stay procedures for cholecystectomy with comparable surgical outcomes and patient satisfaction, affirming its viability. Strict patient selection criteria can aid in optimizing the successful implementation procedure, reducing unexpected admissions and readmissions and we have demonstrated useful criteria for guidance in establishing day-case laparoscopic cholecystectomy protocol at a hospital.

Evaluating adherence and inhaler monitoring among adolescent asthmatic patients: a systematic review and meta-analysis of interventions

Abstract Introduction Inadequate care for asthma has been linked to higher hospital admissions and morbidity. Researchers have developed several strategies to improve treatment adherence in this specific group. We aimed to investigate the impact of several interventions on the adherence of asthmatic patients to controller inhalers. Data sources We searched four databases (the Cochrane Library, PubMed, Embase, and Web of Science) for studies published between 1998 and 2022. Study selections We considered studies that assessed adherence as the main finding of an intervention for asthma patients. Data were extracted and analyzed. Results The analysis included a total of 40 studies. A diverse range of interventions was identified, including educational sessions on asthma, reminders via text messages, and technology-based feedback systems. The overall efficacy of interventions compared to the control group resulted in a small effect size, but it was statistically significant, with an estimated SMD of 0.44 (95% CI 0.24 to 0.63, P < 0.001). Electronic monitoring achieved a significantly higher effect size [SMD 0.8, 95% CI 0.46 to 1.14, P < 0.001) compared to pharmacy refill and self-report methods [(SMD 0.09, 95% CI − 0.18–0.37, P = 0.51), and (SMD 0.25, 95% CI − 0.03, 0.54, P = 0.08), respectively]. Conclusions Adherence promotion interventions have been proven effective among patients with asthma. Electronic monitoring modalities have demonstrated superiority and effectiveness in improving patient adherence to asthma inhalers. Additional longitudinal research studies can be conducted to evaluate the cost-effectiveness and identify a more accurate measure of intervention efficiency for prolonged follow-up time.

Effective pretreatment of microwave combined with acetic acid soaking on oil absorption and quality of fried potato chips.

This study applied a combined pretreatment method involving microwave and acetic acid (AA) soaking to monitor oil absorption of fried potato chips based on texture and microstructure characteristics. Results demonstrated that medium-low microwave combined with 4 h of AA soaking significantly improved the texture profile of potato chips, and reduced oil content by approximately 53.25%. Higher microwave intensity led to greater surface roughness of samples, whereas AA soaking for 1-4 h effectively reduced surface roughness. The decrease in Fm and Nwr, along with the increase in Fwr and Wc with prolonged AA soaking time for 1-4 h indicated that medium-low microwave intensity combined with AA pretreatment enhanced hardness and brittleness of samples. Microscopic examination of cell structure revealed that this combined pretreatment facilitated pectin gelation between the cell walls of potato chips, resulting in a more intact cell structure with fewer gaps. Additionally, the color of pretreated potato chips became brighter. The combination of medium-low microwave intensity and AA soaking pretreatment resulted in a decrease in the oil content and improved the texture profile of fried potato chips. This study provides new strategies and insights for producing low-fat potato chips based on low-cost pretreatment. © 2024 Society of Chemical Industry.

Long-term maintenance-related complications of brachiocephalic vein cannulations in neonates: A retrospective evaluation.

Neonates are relatively prone to immediate, early, and late complications related to central venous cannulation (CVC). Ultrasound-guided brachiocephalic vein (BCV) cannulation has proven to be safe in neonates. Although studies addressed the immediate and early complications of CVC via BCV in neonates, few explored long-term maintenance-related complications. To evaluate the incidences of long-term maintenance-related complications including central line-associated blood stream infection (CLABSI), central line-associated thrombosis (CLAT), and mechanical complications (CLAMC) of nontunneled BCV cannulation in neonates and their relationship with patient and catheter-related factors. This study included BCV cannulations of neonates with postconceptional age of ≤44 weeks performed between January 2018 and January 2023. The incidences of complications were determined. Correlations between complications and postconceptional age, body weight, indication for catheter placement, the size and side of the catheter, as well as catheter dwell time were analyzed. In total, 89 BCV cannulations performed in 71 neonates. The incidences were 19.3 [95%CI: 12.88-28.76] total complications, 5.9 [95%CI: 2.84-12.06] CLABSI, 3.4 [95%CI: 1.30-8.58] CLAT and 10.1 [95%CI: 5.76-17.49] CLAMC in 1000 catheter days. There were 23 (25.8%) total complications; 7 (7.9%) were CLABSI, 4 (4.5%) were CLAT, and 12 (13.5%) were CLAMC. The multivariate analysis revealed that prolonged dwell time was associated with high incidence of total complications [OR: 1.07, 95% CI: 1.00-1.14, p = .047] and the catheter of smaller size (3F in this study) was associated with higher incidence of CLABSI [OR: 8.91, 95% CI: 1.03-77.45, p = .047]. In this study, the prolonged dwell time and smaller sized catheter was found to be independent predictors of total complications and CLABSI, respectively. The independent predictive effects of postconceptional age and body weight should be addressed in larger studies as potential risk factors.

High density genomic surveillance and risk profiling of clinical Listeria monocytogenes subtypes in Germany.

Foodborne infections such as listeriosis caused by the bacterium Listeria monocytogenes represent a significant public health concern, particularly when outbreaks affect many individuals over prolonged time. Systematic collection of pathogen isolates from infected patients, whole genome sequencing (WGS) and phylogenetic analyses allow recognition and termination of outbreaks after source identification and risk profiling of abundant lineages. We here present a multi-dimensional analysis of > 1800 genome sequences from clinical L. monocytogenes isolates collected in Germany between 2018 and 2021. Different WGS-based subtyping methods were used to determine the population structure with its main phylogenetic sublineages as well as for identification of disease clusters. Clinical frequencies of materno-foetal and brain infections and in vitro infection experiments were used for risk profiling of the most abundant sublineages. These sublineages and large disease clusters were further characterised in terms of their genetic and epidemiological properties. The collected isolates covered 62% of all notified cases and belonged to 188 infection clusters. Forty-two percent of these clusters were active for > 12months, 60% generated cases cross-regionally, including 11 multinational clusters. Thirty-seven percent of the clusters were caused by sequence type (ST) ST6, ST8 and ST1 clones. ST1 was identified as hyper- and ST8, ST14, ST29 as well as ST155 as hypovirulent, while ST6 had average virulence potential. Inactivating mutations were found in several virulence and house-keeping genes, particularly in hypovirulent STs. Our work presents an in-depth analysis of the genomic characteristics of L. monocytogenes isolates that cause disease in Germany. It supports prioritisation of disease clusters for epidemiological investigations and reinforces the need to analyse the mechanisms underlying hyper- and hypovirulence.

Severe bleeding events among critically ill patients with haematological malignancies.

Bleeding events are common complications in critically ill patients with haematological malignancies. The objective of this study was to assess the incidence and identify determinants of ICU-acquired severe bleeding events in critically ill patients with haematological malignancies. We conducted a single-center retrospective study including all adult patients with a history of haematological malignancy requiring unplanned ICU admission over a 12-year period (2007-2018). The primary endpoint was the occurrence of ICU-acquired (i.e. after the first 24h in the ICU) severe bleeding events, as defined as grades 3 or 4 of the World Health Organization classification. A total of 1012 patients were analysed, mainly with a diagnosis of lymphoma (n = 434, 42.9%) and leukaemia or myelodysplastic syndrome (n = 266, 26.3%). Most patients were recently diagnosed (n = 340, 33.6%) and under active cancer treatment within the last 3 months (n = 604, 59.7%). The main cause for admission was infection (n = 479, 47.3%), but a significant proportion of patients were admitted for a primary haemorrhage (n = 99, 10%). ICU-acquired severe bleeding events occurred in 109 (10.8%) patients after 3.0 days [1.0-7.0] in the ICU. The main source of bleeding was the gastrointestinal tract (n = 44, 40.3%). Patients experiencing an ICU-acquired severe bleeding event displayed prolonged in-ICU length of stay (9.0 days [1.0-6.0] vs. 3.0 [3.5-15.0] in non-bleeding patients, p < 0.001) and worsened outcomes with increased in-ICU and in-hospital mortality rates (55% vs. 18.3% and 65.7% vs. 33.1%, respectively, p < 0.001). In multivariate analysis, independent predictors of ICU-acquired severe bleeding events were chronic kidney disease (cause-specific hazard 2.00 [1.19-3.31], p = 0.008), a primary bleeding event present at the time of ICU admission (CSH 4.17 [2.71-6.43], p < 0.001), non-platelet SOFA score (CSH per point increase 1.06 [1.01-1.11], p = 0.02) and prolonged prothrombin time (CSH per 5-percent increase 0.90 [0.85-0.96], p = 0.001) on the day prior to the event of interest. Major bleeding events are common complications in critically ill patients with haematological malignancies and are associated with a worsened prognosis. We identified relevant risk factors of bleeding which may prompt closer monitoring or preventive measures.

When Chinese patients with plasma cell disorders encountered the nationwide Omicron outbreak (December 2022): a real-world multicenter and multiregional study.

This study aims to assess the impact of the nationwide Omicron outbreak in December 2022 on Chinese patients with plasma cell disorders (PCD), focusing on the clinical characteristics of PCD patients with COVID-19 and the risk factors contributing to adverse clinical courses (severity and hospitalization) and outcomes. A multicenter retrospective study was performed from December 1, 2022, to January 19, 2023. The study population includes 404 PCD patients, divided into a COVID-19 group (n = 342) and an uninfected group (n = 62). The frequency of COVID-19 infection was 84.7% (342/404), and 16.4% (56/342) were severe COVID-19. Among the 277 patients with complete follow-up, 2 deaths (0.7%) were reported, while 231 (83.4%) recovered from COVID-19. Age > 65 (P = 0.02) and prior anti-CD38 monoclonal antibody (mAb) treatment within six months (P = 0.03) were independent risk factors for severe infection. Additionally, previous chimeric antigen receptor T-cell (CAR-T) therapy within six months was correlated with a higher risk of hospitalization (P = 0.04) and prolonged recovery time (P = 0.03). No significant protective effect of vaccination on infection or severe infection was observed (P > 0.05). The latest Omicron outbreak results in higher rates of severe infection and mortality in PCD patients compared with the general population in China, highlighting the need to protect this vulnerable population during the pandemic. Recent use of anti-CD38 mAb and CAR-T therapy are associated with poorer clinical courses and outcomes of PCD patients with COVID-19.

MRI at low field: A review of software solutions for improving SNR.

Low magnetic field magnetic resonance imaging (MRI) ( <1T) is regaining interest in the magnetic resonance (MR) community as a complementary, more flexible, and cost-effective approach to MRI diagnosis. Yet, the impaired signal-to-noise ratio (SNR) per square root of time, or SNR efficiency, leading in turn to prolonged acquisition times, still challenges its relevance at the clinical level. To address this, researchers investigate various hardware and software solutions to improve SNR efficiency at low field, including the leveraging of latest advances in computing hardware. However, there may not be a single recipe for improving SNR at low field, and it is key to embrace the challenges and limitations of each proposed solution. In other words, suitable solutions depend on the final objective or application envisioned for a low-field scanner and, more importantly, on the characteristics of a specific low field. In this review, we aim to provide an overview on software solutions to improve SNR efficiency at low field. First, we cover techniques for efficient k-space sampling and reconstruction. Then, we present post-acquisition techniques that enhance MR images such as denoising and super-resolution. In addition, we summarize recently introduced electromagnetic interference cancellation approaches showing great promises when operating in shielding-free environments. Finally, we discuss the advantages and limitations of these approaches that could provide directions for future applications.

Investigations on the Impacts of Drugs or Excipients with Different Physicochemical and Compaction Properties on the Disintegration Behavior of Kollidon®SR-Based Binary Controlled Release Matrix Tablets.

The objective of this study was to examine the impact of the physicochemical properties of the loaded drug or excipient, the concentration of Kollidon®SR (KSR), and the mechanical characteristics of KSR compacts on their disintegration times. Using disintegration apparatus, a two-hour constraint was chosen as the process's end point. Lactose-KSR compacts subjected to the highest compression pressure and Microcrystalline cellulose-KSR compacts with KSR concentrations exceeding 30% exhibited disintegration times of less than ten minutes. Likewise, compacts containing Diltiazem HCl-KSR demonstrated brief disintegration times across all tested KSR concentrations and compression pressures. Compacts of Modafinil, Metformin HCl, and Ascorbic acid-KSR displayed disintegration times ranging from fast to moderate, contingent upon the levels of KSR and compression pressure applied. Compacts containing KSR with Aspirin, Salicylic acid, or Ibuprofen did not exhibit significant disintegration even at minimal amounts of KSR (0.5%). Theophylline-KSR tablets also showed prolonged dissolution times, even at very low concentrations of KSR. The disintegration times of Dic-KSR tablets were roughly close to an hour and were predominantly unaffected by varying KSR levels and only marginally influenced by compression pressures. It is possible to draw the conclusion that different drugs or excipients have different minimum KSR requirements to resist compacts' disintegration process. Compounds that demonstrate low solubility in water can result in extended disintegration times for KSR compacts. The melting points of these compounds, in conjunction with the Py values of the compacts and their compaction properties, could affect the disintegration process, although a precise evaluation is necessary.

Optical Microscopy as a Tool for Assessing Parenteral Nutrition Solution Stability: A Proof of Concept

Background/Objectives: Parenteral nutrition (PN) is used when enteral feeding is not possible. It is a complex mixture of nutrients that must meet a patient’s needs but can face stability issues, such as lipid emulsion destabilisation and precipitate formation. Stability studies are complex, and the methodologies used are very varied in the literature. In addition, many studies are outdated and use outdated components. This study conducts a stability analysis of PN solutions using optical microscopy. Methods: Samples were prepared according to clinical practice standards and previous studies. We used a counting chamber for optical microscopic observations and different storage conditions (RT, 4 °C 1–14 days). Results: Precipitates larger than 5 µm were found in 8 out of 14 samples after 14 days of storage at room temperature, and none were observed in refrigerated samples. More lipid globules larger than 5 µm were detected in samples stored at room temperature than in those stored in a refrigerator after 14 days. Additionally, the number of large globules generally increased from day 1 to day 14 in most samples. Conclusions: The observed precipitates were probably calcium oxalate crystals, the formation of which is possible in PN but is not expected under the usual storage conditions in a hospital environment. Prolonged storage time and storage at room temperature increases the formation of these precipitates. These findings highlight the importance of using filters during both the preparation and administration of PN to prevent large particles from reaching patients.

12431 14-year-old Presenting With Thrombocytopenia-Associated Multi-Organ Failure In The Setting Of Diabetic Ketoacidosis/Hyperosmolar Hyperglycemic Syndrome

Abstract Disclosure: N.C. Gunaratne-Breaux: None. D. Deplewski: None. Title: 14-Year-Old Presenting with Thrombocytopenia Associated Multi-Organ Failure in the setting of Diabetic Ketoacidosis/Hyperosmolar Hyperglycemic Syndrome Background: Coagulation complications are rare in hyperglycemia emergencies in children and adolescents. In patients presenting with severe and atypical hyperglycemia emergencies, special considerations need to be made to rule out life-threatening coagulopathy. Clinical Case: A 14-year-old male with history of Type 1 Diabetes presented in severe Diabetic Ketoacidosis/Hyperosmolar Hyperglycemic Syndrome overlap. Initially had severe hypotension and altered mental status concerning for cerebral edema. Initial venous blood gas showed pH of 6.82, pCO2 17.1, and HCO3 2.8, serum glucose was 1375 mg/dL, serum ketones &amp;gt;7.00 mmol/L, and serum osmolality was 384 mOsm/kg. Once insulin drip was started, glucose, ketones, and serum osmolality improved, but patient continued to be encephalopathic and had worsening tachypnea and desaturations. Patient was eventually intubated. After intubation, patient’s acidosis improved, but patient developed kidney failure (prompting initiation of dialysis), liver injury, decreased cardiac function, and high inflammatory state. A comprehensive multi-specialty team including pediatric intensive care, infectious diseases, rheumatology, neurology, and cardiology were involved in the care. On day three of admission, patient had multiple areas of ischemia on fingertips and ear and clotting of multiple IV and dialysis catheters, prompting a coagulopathy evaluation. Labs showed microcytic anemia (hemoglobin 10.0 g/dL; mean corpuscular volume 75fL), thrombocytopenia (platelet count 17 10e3/uL), coagulopathy (prothrombin time 16.8 sec, INR 1.3, prolonged thrombin time 48.8 sec), and elevated ferritin (507 ng/mL). Given labs and multi-organ involvement, determined by hematology to be Thrombocytopenia Associated Multi-Organ Failure (TAMOF). Patient was started on plasmapheresis and had dramatic improvement – was eventually extubated and returned to neurologic baseline without any notable deficits. Multi-specialty team ruled out all other possible causes of TAMOF; determination that the TAMOF developed secondary to DKA/HHS. Conclusion: Hyperglycemia emergencies can lead to a hyperinflammatory state that can lead to disruption of the coagulation cascade, including disseminated intravascular coagulopathy or thrombotic thrombocytopenia purpura. There have been rare reports of thrombocytopenia associated multi-organ failure provoked by DKA, thought secondary to critical illness mediated low ADAMST13 levels. This is a novel case of TAMOF caused by DKA/HHS overlap syndrome. It is important to screen for coagulopathy in cases of patients with DKA or DKA/HHS who do not show clinical improvement with resolution of ketosis and hyperosmolarity. Presentation: 6/2/2024

Copper mitigates salinity stress by regulating water status, photosynthetic pigments and ion homeostasis and increases the yield of Eggplant (Solanum melongena)

Eggplant (Solanum melongena) is moderately sensitive to salinity. Seed priming and exogenous supplementation are technique that enhances germination, growth, and crop yield by overcoming salt stress. Therefore, this study was designed to understand the role of seed priming and copper (Cu) supplementation in modulating salt tolerance in eggplant. When exposed to salt stress, eggplant seedlings showed significantly higher Na+ content, an increased Na/K ratio, prolonged mean germination time, higher relative water loss, more days to flower bud initiation and first flowering, along with decreased germination rate, growth factors, water content, photosynthetic pigments, ionic contents (K+, Ca2+, Mg2+), and yield. The results demonstrated that the germination rate, final germination percentage, germination index, germination energy, and seed vigor index significantly improved, while the mean germination time decreased in Cu-primed seeds. The results also revealed that Cu supplementations increased seedling traits, leaf water content, photosynthetic pigment contents, ionic contents (K+, Ca2+, and Mg2+), and yield while decreasing the contents of Na+, and Na/K ratio, mean germination time, relative water loss, days to flower bud initiation, and days to 1st flowering under salt stress. Germination of seeds, seedlings growth traits, plant water status, plant pigments, yield, and ionic contents with the NaCl and Cu treatments were found to substantially interact with each other according to both hierarchical clustering and PCA. Overall, Cu seed priming and exogenous supplementation emerged as a promising strategy to enhance salt tolerance and promote germination, growth, and yield by regulating water status, photosynthetic pigments, and ion homeostasis in eggplant seedlings under NaCl stress. These findings provide valuable insights into the mechanisms of Cu-mediated stress alleviation in eggplant, with implications for sustainable crop production in saline environments.

7805 Adrenocortical Carcinoma - A Tertiary Center's Recent ∼10-Year Experience

Abstract Disclosure: E. Osher: None. K.M. Tordjman: None. Y. Sofer: None. N. Stern: None. J. Klausner: None. G. Lahat: None. N. Lubezky: None. Y. Goykhman: None. B. Sagie: None. G. Ravit: None. A. Asaf: None. K. Rivka: None. W. Ido: None. Y. Greenman: None. Background: Adrenocortical carcinoma (ACC) is a rare endocrine malignancy with a poor prognosis. Prospective randomized controlled studies to evaluate the optimal treatment modalities are limited. Therefore, retrospective studies are needed. The aim of the study is to describe and summarize additional data and knowledge on treatment modalities in a tertiary medical center treating patients with ACC by a multidisciplinary expert team. Methods: A retrospective study. Results: The study cohort included 42 subjects (57% females), followed for a median of 26 (range 0.3-237) months. The mean age at diagnosis was 54±17 years; 60% of tumors were functioning, 57 % were cortisol-secreting, 41% were androgen-secreting, 12% aldosterone-secreting, and 45% were co-secreting. ENSAT stage at diagnosis was stage 1 in 19%, stage 2 in 26%, stage 3 in 24% and stage 4 in 29%. Eighty-eight % of patients underwent surgery; residual disease was in 21% post surgery. Treatment with mitotane was initiated in 62% of patients, reaching a mean maximal dose of 3.1 ±2 grams/day. Oncologic pharmacological treatment (Chemotherapy, TKI, Immunotherapy) and/or radiation were given in 50 % and 21%, respectively. In 14 /42 patients, genetic evaluation was done, in most cases, no target for treatment was found. 52% of patients died during follow-up; all cohort median time to death was 31(range 0.3-237) months. Time to death longer than 31 months was also seen in advanced disease stage 3- 3/9(33%) and stage 4-4/11(36%). Except association between mitotane and prolonged time to death (p=0.013), no other factors (age, gender, surgery, radiation, residual disease functional status), were associated with prolonged survival. Conclusions: ACC remains a rare disease with a poor prognosis. However, it is a heterogeneous disease, with some patients with advanced disease achieving more prolonged survival. Further characterization of these patients may improve our understanding of the biology and treatment of this rare disease. Presentation: 6/2/2024

Surgical anatomy of the cystic artery: A systematic review with meta-analysis.

The current evidence-based systematic review with meta-analysis presents a detailed overview of the cystic artery (CA) surgical anatomy, including its origin, number, topography, and morphometry. Moreover, the surgical implications of these variants are further discussed. According to the Evidence-Based Anatomy Workgroup and PRISMA 2020 guidelines, the systematic review was performed using four online databases. The Anatomical Quality Assurance Tool was used to evaluate the risk of bias. Meta-analysis was performed with the R programming software. The pooled prevalence and pooled mean of different CA parameters were calculated. The CA most commonly originated from the right hepatic artery (a pooled prevalence of 85.75%). Other described origins (in order of frequency) were the aberrant right hepatic artery, the common hepatic, the left hepatic, the gastroduodenal, the superior mesenteric, and the middle hepatic arteries. The CA was single in 88.59%, while it can be identified as double, triple, or absent. Most commonly, it was located inside the cystohepatic triangle in 83.83%. Most commonly, it was superomedially to the cystic duct (77.80%) and posteriorly to the common hepatic duct (35.08%). The CA pooled mean length was 21.34mm, and its diameter was more commonly over 1mm. The CA surgical anatomy is paramount when operating on the gallbladder. The CA's altered anatomy and adjacent area could lead to confusion, iatrogenic injury, and prolonged surgical time. The CA depicts high morphological variability; therefore, surgeons should consider the typical anatomy and possible (usual and unusual) variants.

Postoperative challenges addressed through nursing care of patients receiving lower extremity tumor prosthesis

BackgroundPatients with primary Bone Sarcoma and Giant Cell Tumors in the lower extremities often require major surgery involving tumor prostheses. The postoperative course for this patient group can be complex and influenced by various factors and challenges that demand careful nursing care. This study aims to identify challenges related to the nursing care of individuals with primary bone tumors following surgery for tumor prostheses in the lower extremities.MethodsA retrospective cohort study of 15 patients treated at Rigshospitalet, Copenhagen, Denmark, between November 5. 2016, and April 1. 2020 was conducted by medical record review, focusing on challenges related to postoperative nursing care. All patients with the surgery code “Bone Excision” were identified within the surgery booking system and screened for eligibility.ResultsPatients experienced postoperative challenges such as severe pain, prolonged time to mobilization (mean: 4 days), and defecation (mean: 5 days). The mean length of stay at the Rigshospitalet was 13 days. Furthermore, eleven patients (73%) reported disrupted sleep and nausea.ConclusionPatients undergoing tumor prosthesis surgery in the lower extremities face considerable postoperative challenges that contribute to a prolonged hospital stay. These challenges, including severe pain, delayed mobilization, and gastrointestinal issues, significantly impact recovery. The findings highlight the urgent need for targeted nursing interventions to address these issues effectively. Enhanced pain management protocols, early mobilization strategies, and comprehensive postoperative care plans are essential to improve patient outcomes and reduce the length of hospital stays. Addressing these challenges through dedicated nursing care is crucial for optimizing the recovery process for patients receiving lower extremity tumor prostheses.

Novel sodium tauroursodeoxycholate-based multifunctional liposomal delivery system for encapsulation of oleanolic acid and combination therapy of type 2 diabetes mellitus

Liposomes have demonstrated great potential for drug delivery and diabetes treatment. However, hydrolysis by enzymes and emulsification by endogenous bile salts make liposomes unstable in the gastrointestinal tract. In this study, sodium tauroursodeoxycholate (TUDCNa)-based multifunctional bilosomes were designed to address the deficiencies of conventional liposomes. In the designed bilosomes, cholesterol was replaced by TUDCNa, which served as both a membrane stabilizer and an antidiabetic drug. Oleanolic acid (OA) was encapsulated in both conventional liposomes (OA-Ch-Lip) and bilosomes (OA-Tu-Bil) to compare their properties. Firstly, OA-Tu-Bil exhibited similar encapsulation efficiency and drug loading compared to OA-Ch-Lip, but with a smaller particle size. Secondly, OA-Tu-Bil showed better stability than OA-Ch-Lip. Thirdly, bilosomes exhibited prolonged intestinal retention time and improved permeability and oral bioavailability. Fourthly, in type 2 diabetes mellitus (T2DM) mice model, TUDCNa synergized with OA to exhibit the strongest therapeutic effect. In conclusion, TUDCNa have demonstrated the ability to substitute cholesterol in conventional liposomes, it provided a new approach for oral delivery of hypoglycemic drugs, and offered an innovative strategy for combination therapy.

Determinants of recovery time from severe acute malnutrition among cholera-exposed and unexposed children in Ethiopia: a prospective cohort study

BackgroundThere is a vicious interplay between severe acute malnutrition (SAM) and diarrheal diseases including cholera. The lack of sufficient evidence on the time to recovery and its determinants among children with cholera prompted this investigation. The study aimed to evaluate the time to recovery and determinants among children with severe acute malnutrition, comparing cholera-exposed and unexposed children.MethodsA prospective cohort study was carried out from September 10, 2022, to February 21, 2023, among 224 children below 15 years. The study was conducted at cholera treatment centers and nearby communities in the Bale and Guji Zones of Oromia Regional state in Ethiopia. A structured questionnaire was used to obtain information and anthropometric measurements were conducted weekly. After checking all assumptions, a multivariable Cox Proportional Hazards model was used to identify independent determinants of time to recovery using an adjusted hazard ratio (AHR) with a 95% confidence interval (CI). Statistical significance was declared at p &amp;lt; 0.05.ResultsNearly 80% of participants recovered from SAM with a recovery rate of 40/1000 person-week observation and a median time to recovery of 21 days [Inter Quartile Range14-28]. The recovery time from SAM for cholera-exposed children was delayed by 54% [ARR: 0.46, 95% CI: 0.30–0.69] compared to unexposed children. Similarly, the recovery time from SAM for food-insecured families was delayed by 39% [ARR: 0.61, 95% CI: 0.38–0.96] compared to food-secured families. Moreover, children with more than three meal frequencies per day had 1.61 times [ARR: 1.61, 95% CI: 1.04–2.50] higher probability of fast recovery from SAM, compared to children with less than three meals. Children from families with good attitudes toward nutrition had more than two times [ARR: 2.23, 95% CI: 1.45–3.41] higher probability of faster recovery from SAM than families with poor attitudes.ConclusionThe study revealed that cholera exposure is one of the main determinants of prolonged recovery time for children with SAM. Food insecurity, meal frequency, and the attitude of parents toward children’s dietary habits were determinants for the recovery of children from SAM. The findings imply the need for designing interventions to enhance child feeding during cholera illness, focusing on key determinants.

A novel snake venom C-type lectin-like protein modulates blood coagulation by targeting von Willebrand factor and coagulation factor IX

Snake venom C-type lectin-like proteins (CLPs) belong to the nonenzymatic proteins. To date, no CLP with both platelet and coagulation factors activating activities has been reported. In this study, a novel CLP, termed protocetin, with molecular weight of 29.986 kDa, was purified from the Protobothrops mucrosquamatus venom (PMV). It consists of α- and β-chains, with 67% similarity in their N-terminal sequence. Protocetin activates glycoprotein Ib (GPIb) by binding to von Willebrand factor (vWF), inducing platelet aggregation. It also activates the intrinsic coagulation pathway by binding to coagulation factor IX. After injection of protocetin into mice at dose of 0.5 µg/g or 1.5 µg/g, it resulted in activation of platelets, a notable reduction in platelet count and prolonged tail bleeding time. Additionally, the plasma activated partial thromboplastin time (APTT) was significantly extended, and the fibrinogen concentration was markedly reduced. Thrombelastogram comfirmed the anticoagulation effect of protocetin. Notably, no microthrombosis was observed in tissues of lung, liver and kidney within 1 h after injection of protocetin into the mice at dose of 0.5 µg/g. This study revealed protocetin as a novel CLP from PMV that has dual functions in activating platelet and coagulation factor IX, thereby modulates coagulation in vivo. This work contributes to a better understanding of the structure and function of snake venom CLP.