SC Group Research Articles

The Effect of an Intraoperative Real-Time Counter on Radiation Exposure Events During Operative Treatment of Distal Radius Fractures

Occupational radiation exposure can have adverse health consequences for surgeons. The purpose of this study was to determine if utilization of an intraoperative, real-time radiograph counter results in decreased radiation exposure events (REEs) during open reduction and internal fixation (ORIF) of distal radius fractures (DRFs). We reviewed all cases of isolated ORIF DRFs performed at a single center from January 2021 to February 2023. All cases performed on or after January 1, 2022 used an intraoperative radiograph counter, referred to as a "shot-clock" (SC) group. Cases prior to this date were performed without a SC and served as a control group (NoSC group). Baseline demographics, fracture, and surgical characteristics were recorded. Final intraoperative radiographs were reviewed to record reduction parameters (radial inclination, volar tilt, and ulnar variance). REEs, fluoroscopy exposure times, and total radiation doses milligray (mGy) were compared between groups. A total of 160 ORIF DRF cases were included in the NoSC group, and 135 were included in the SC group. The NoSC group had significantly more extra-articular fractures compared with the SC group. Reduction parameters after ORIF were similar between groups. The mean number of REEs decreased by 48% in the SC group. Cases performed with the SC group had significantly lower total radiation doses (0.8 vs 0.5 mGy) and radiation exposure times (41.9 vs 24.2 seconds). Mean operative times also decreased for the SC group (70 minutes) compared with that for the NoSC group (81 minutes). A real-time intraoperative radiograph counter was associated with decreased REEs, exposure times, and total radiation doses during ORIF DRFs. Cases performed with a SC had significantly shorter operative times without compromising reduction quality. Using an intraoperative SC counter during cases requiring fluoroscopy may aid in decreasing radiation exposure, which serves as an occupational hazard for hand and upper-extremity surgeons. Therapeutic II.

Sleep Deprivation Impairs Human Cognitive Reappraisal Ability: A Randomized Controlled Trial.

This study aims to examine the impact of sleep deprivation on individual cognitive reappraisal ability using a standardized behavioral paradigm. A randomizedpretest-posttest control group design was conducted. Thirty-nine participants were eventually enrolled and randomly assigned to receive either the sleep control (SC: n = 17) or the sleep deprivation (SD: n = 22). Both of them were required to perform a standardized behavioral paradigm of measuring cognitive reappraisal ability one time under sleep-rested condition and another time under the condition of different sleep manipulation a week later. Mean valence ratings of SD group were more negative than SC group's (p < 0.05) and mean arousal ratings of SD group were higher than SC group's (p < 0.01). Sleep deprivation may impair individual cognitive reappraisal ability and could potentially undermine the efficacy of cognitive therapy in terms of emotion regulation.

Buchholzia coriacea Leaves Attenuated Dyslipidemia and Oxidative Stress in Hyperlipidemic Rats and Its Potential Targets In Silico

AbstractThe study aimed to investigate how the solvent extract of Buchholzia coriacea (BCE), a widely known hypolipidemic agent, could contribute to hyperlipidemia treatment and identify the potential bioactive compounds. We studied Wistar albino rats, dividing them into seven groups: the normal control, normal rats treated with 400 mg/kg.b.wt of BCE (NRG group), the hyperlipidemic control (HPC group), hyperlipidemic rats treated with atorvastatin, a standard control drug (SC group), as well as 200, 400, and 800 mg/kg.b.wt of BCE extract respectively (T1, T2, T3 groups). The potential compounds that functioned in BCE extract were analyzed by in silico binding to acetyl-CoA carboxylase (ACC) and fatty acid synthase (FASN). The binding affinities and drug-like properties of the compounds were determined using virtual screening and absorption distribution metabolism excretion and toxicity prediction analysis. The gas chromatography-mass spectrometry analysis identified alkaloids, saponins, flavonoids, phenols, terpenoids, and 44 chemical compounds in the leaf extract of BCE. BCE significantly reduced the levels of triacylglycerol, total cholesterol, low-density lipoprotein, very low-density lipoprotein, atherogenic coefficient, atherogenic index, and coronary risk index, while enhancing the levels of high-density lipoprotein and cardioprotective index in comparison to the HPC group. The BCE reduced malondialdehyde quantities, which exhibit high levels in HPC. Superoxide dismutase and glutathione peroxidase activities as well as glutathione levels, which are otherwise reduced in HPC, were increased upon the BCE treatment. Among the identified BCE compounds, lupenone and 2,7-dimethylnaphthalene exhibited the highest binding affinities to ACC and FASN, suggesting that these two compounds might be the bioactive BCE components displaying hypolipidemic properties. BCE is found to be beneficial in blocking hyperlipidemia through the modulation of lipid profile, the protection of cardiovascular function, as well as the suppression of oxidative stress. BCE may be a natural source for exploring novel drugs for the treatment of dyslipidemia.

Bonding performance of glass ionomer cement to carious dentin treated with different surface treatment protocols using silver diamine fluoride

This study investigated the influence of silver diamine fluoride (SDF) on the shear bond strength (SBS) to artificial carious dentin and GIC restorations with various SDF application protocols. Artificial caries were prepared on human dentin discs using bacteria model. These samples were randomly allocated to five groups (n = 10/group) according to the following treatment: (1) control group (CD): no treatment (2) CSR: dentin conditioner, SDF, and rinsing (3) CS: dentin conditioner and SDF (4) SRC: SDF, rinsing and dentin conditioner, and (5) SC: SDF and dentin conditioner. The treated-dentin surface was bonded with GIC and subjected to SBS test. Mean SBS was analyzed using one-way ANOVA. Surface morphology and elemental contents after surface treatment were examined (n = 3/group) by scanning electron microscopy with energy-dispersive X-ray spectroscopy (SEM/EDX). There was no significant difference in the mean SBS among CD (2.45 ± 0.99 MPa), CSR (1.76 ± 0.65 MPa), and SRC (2.64 ± 0.95 MPa). Meanwhile, the mean SBS of CS (0.35 ± 0.21 MPa) was significantly lower than the control and SRC group. SEM/EDX demonstrated deeper silver penetration in CSR and CS groups when compared to SRC and SC groups. SDF-modified GIC restorations resulted in significantly lower bond strength in CS and SC groups. The findings suggested treating the carious dentin surface with CSR and SRC protocol. SDF-treated carious dentin should be rinsed off prior to restore with GIC.

Subcutaneous and intramuscular administration of a SARS-CoV-2 vaccine are similarly effective in generating a humoral response in domestic goats (Capra hircus).

To determine severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) serum antibody titers in domestic goats after SC and IM administration of an experimental, veterinary SARS-CoV-2 vaccine. 31 healthy adult domestic goats from 4 zoological institutions. On day 0, blood was collected for baseline serum titer before vaccination with 1 mL SARS-CoV-2 recombinant S protein vaccine SC (n = 22) or IM (n = 9). A booster vaccination was administered 21 (SC group) or 28 days (IM group) after the initial vaccine and blood samples were collected at days 21 (SC group) or 28 (IM group), 42, 90, and 180 postvaccinations. The study took place between September 27, 2021, and June 01, 2022. Seroconversion for SARS-CoV-2 was assessed by a SARS-CoV-2 virus neutralization (VN) assay. Before vaccination, no goats had detectable antibodies. On day 42, 100% of goats had detectable serum titers. Serum titers peaked at day 42 for 94% of goats vaccinated by either route of administration. There was a significant difference between SC and IM groups regarding the proportion of goats with detectable titers on day 21/28 (68% vs 0%, respectively) and day 180 (50% vs 89%, respectively), relative to day 0. The 2 vaccination protocols (SC 21 days apart and IM 28 days apart) were similarly effective in mounting serum antibody response in goats. The SC route of administration appeared to have a more rapid onset of immunity, while the IM route may have produced a longer duration of immunity. These data may be useful in determining appropriate SARS-CoV-2 vaccination schedules in ruminants.

Neoadjuvant docetaxel, oxaliplatin, and S-1 plus surgery and adjuvant S-1 for resectable advanced gastric cancer: Final survival outcomes of the randomized phase 3 PRODIGY trial.

30 Background: The phase 3 PRODIGY study compared neoadjuvant docetaxel, oxaliplatin and S-1 (DOS) chemotherapy followed by surgery followed by adjuvant S-1 with surgery followed by adjuvant S-1 for Korean patients with resectable locally advanced gastric cancer (LAGC) (Kang et al. J Clin Oncol. 2021). The planned analysis of the primary endpoint of PRODIGY showed that the addition of neoadjuvant DOS to surgery and adjuvant S-1 improved progression-free survival (PFS). We herein report the long-term follow-up outcomes, including overall survival (OS), from this trial. Methods: Patients with histologically confirmed primary gastric or gastroesophageal junction adenocarcinoma with clinical T2-3N+ or T4Nany disease were enrolled from 18 Korean study sites. Patients were randomly assigned to D2 surgery followed by adjuvant S-1 (40–60 mg orally twice a day, days 1–28 q6w for eight cycles; SC group) or neoadjuvant DOS (docetaxel 50 mg/m2, oxaliplatin 100 mg/m2 intravenously day 1, S-1 40 mg/m2 orally twice a day, days 1–14 q3w for three cycles) before D2 surgery, followed by adjuvant S-1 (CSC group). The primary endpoint was PFS. OS was the secondary endpoint. This analysis presents the final assessment of the outcomes after 5 years. Results: A total of 266 and 264 patients were randomly assigned to the CSC and SC arms, respectively, among which 238 and 246 patients were treated and included in the full analysis set. As of the data cut-off date (SEP-2022), the median follow-up duration of the surviving patients was 99.5 months (range, 68.6–127.7 months). As compared to SC, CSC significantly increased the OS (adjusted hazard ratio, 0.72; 95% CI, 0.54 to 0.97; stratified log-rank P=0.028) with a 5-year OS rate of 66.8% and 63.0% for the CSC and SC arms, respectively. CSC also significantly improved the PFS (adjusted hazard ratio, 0.71; 95% CI, 0.53 to 0.94; stratified log-rank P=0.019) with a 5-year PFS rate of 60.6% and 56.9% for the CSC and SC arms, respectively. Among the patient subgroups determined based on different clinical T/N categories, a patient subgroup with cT4Nany disease showed the greatest relative risk reduction in OS with neoadjuvant chemotherapy (HR 0.69, 95% CI 0.51–0.95). Conclusions: The addition of neoadjuvant docetaxel, oxaliplatin and S-1 (DOS) chemotherapy, as part of perioperative chemotherapy, to surgery and adjuvant S-1 prolonged the OS and PFS of Asian patients with LAGC relative to patients treated with surgery and adjuvant S-1 alone. Neoadjuvant DOS chemotherapy should be considered one of the standard treatment options for patients with LAGC in Asia. Unlike in the Western setting, neoadjuvant chemotherapy may be preferentially considered for patients with cT4 disease in Asia. Clinical trial information: NCT01515748 .

A purified membrane protein from Akkermansia muciniphila blunted the sepsis-induced acute lung injury by modulation of gut microbiota in rats.

The gut microbiota has been implicated in the pathogenesis and progression of sepsis. Akkermansia muciniphila is considered to be a promising probiotic with reduced abundance in cecal ligation and puncture (CLP)-induced sepsis model, and its specific outer membrane protein (Amuc_1100) can partially recapitulate the probiotic function of Akkermansia muciniphila. However, its role in sepsis is unclear. This study aimed to investigate the effect of Amuc_1100 on the gut microbiota of septic rats, thereby improving the prognosis of septic acute lung injury (ALI). A total of 42 adult Sprague-Dawley (SD) rats were randomly divided into three groups: the sham control (SC group), the septic ALI induced by CLP method (CLP group), and administered Amuc_1100 by oral gavage (3µg/d) for 7 d before the CLP procedure (AMUC group). The survival of the three groups was recorded and the feces and lung tissues of rats were collected 24h after treatment for 16S rRNA sequencing and histopathological evaluation. Oral administration of Amuc_1100 improved the survival rate and alleviated lung histopathological damage induced by sepsis. Serum levels of pro-inflammatory cytokines and chemokines were substantially attenuated. Amuc_1100 significantly increased the abundance of some beneficial bacteria in septic rats. Additionally, the Firmicutes/Bacteroidetes ratio was low in septic rats, which was partially corrected by increasing Firmicutes and decreasing Bacteroidetes after oral administration of Amuc_1100 (p<0.05). In addition, Escherichia-Shigella, Bacteroides, and Parabacteroides were relatively enriched in septic rats, while in the AMUC group, their abundance was restored to levels similar to that of the healthy group. Amuc_1100 protects against sepsis by enhancing beneficial bacteria and reducing potential pathogenic bacteria. These findings indicate that Amuc_1100 can blunt CLP-induced ALI through the modulation of gut microbiota, thereby providing a new promising therapeutic target in sepsis.

Phenomenology of spontaneous closure in degenerative and mixed type lamellar macular hole.

To the describe OCT imaging characteristics of a cohort of patients showing spontaneously closing degenerative or mixed type lamellar macular holes (LMH) and to compare them to the ones of a sex and age matched group showing stable lesions. Patients diagnosed with degenerative and mixed type LMHs showing OCT-documented spontaneous anatomical closure were retrospectively selected from 3 specialized retina centres. An equal number of age and sex matching subjects were randomly selected among patients with anatomically stable lesions. Eleven (11) spontaneously closing (SC group) and 11 stable (ST group) degenerative LMH with a mean follow up of 4 years were recruited. Hyperreflective inner border (HIB) and linear hyperreflectivity in the outer plexiform layer (LHOP) at baseline were significantly more prevalent in SC group in processed images (respectively p = 0.007 and p = 0.003). A borderline significance in lamellar hole associated epiretinal proliferation (LHEP) at last follow up was detected (p = 0.085). As for mixed type LMH, 10 patients for SC group and 10 for ST group were recruited. LHOP at baseline in processed images was significantly more prevalent in SC group (p = 0.005). Spontaneously closing LMHs show higher prevalence of HIB and LHOP at the beginning of the closing process, a difference which is enhanced by image processing. These signs might be a signal of microglial and Muller cells coordinated activation.

The effect of maternal vitamin D deficiency during pregnancy on glycolipid metabolism of offspring rats and the improvement of vitamin D intervention after weaning.

Vitamin D deficiency during pregnancy is common, but whether maternal vitamin D status affects glycolipid metabolism of offspring remains unclear. To evaluate the effect of maternal vitamin D deficiency during pregnancy on the glycolipid metabolism of offspring at different life-cycles (from birth to adulthood) and to explore the improvement of different dosages of vitamin D supplementation. Sprague-Dawley rats were fed vitamin D-deprived (VDD group) or standard vitamin D diets (SC group) during pregnancy, and their diets were changed to standard vitamin D diets during lactation (the offspring were sorted into VDDoffspring and SCoffspring groups). After weaning, rats in the VDDoffspring group were randomly assigned to the VDDoffspring, VDDoffspring-S3300 and VDDoffspring-S10000 groups with diets containing standard, medium and high dosages of vitamin D for 12 wk. Serum was collected for biochemical analyses at postnatal Day 21, postnatal Day 56 and postnatal Day 84. Oral glucose tolerance test (OGTT) was performed at postnatal Day 70. Compared to SCoffspring, rats in the VDDoffspring group had significantly lower birth weight with faster weight gain and higher levels of lipid metabolism in early life. After near adulthood, the differences in weight and lipid metabolism between the two groups disappeared. OGTT showed significantly higher blood glucose levels in the VDDoffspring group at 30 min, 60 min, and 90 min. The continuation of vitamin D supplementation at medium and high dosages after weaning did not cause any obvious changes in weight or glycolipid metabolism (except for postprandial hyperglycemia). OGTT demonstrated that the glucose levels in the VDDoffspring-S3300 group were lowest at all the time points and that those in the VDDoffspring-S10000 group were the highest at 30 min, 60 min, and 90 min among the three groups. The adverse effects of vitamin D deficiency during pregnancy on glycolipid metabolism in offspring vary in different stages. Over a long time period, adequate vitamin D supplementation is beneficial to glycolipid metabolism for the offspring of subjects with vitamin D deficiency during pregnancy; however, further improvement is required.

Impact of genotype on clinical course in sickle cell disease and the utility of neutrophil-lymphocyte ratio: a ten-year single-institution experience

ABSTRACT Background Sickle cell disease (SCD) is a diverse group of blood disorders with significant global disease burden. Contemporary interest in the underlying inflammatory paradigm of SCD has emphasized the role of the neutrophil–lymphocyte ratio (NLR) as a prognostic inflammatory marker. Methods We retrospectively reviewed 268 hospitalized patients with SCDs of different genotypes (HbSS, HbSβ0 thalassemia, HbSβ+ thalassemia, and HbSC), totaling 3329 hospital admissions over a 10-year period. Patients were stratified into SS/Sβ0 and Sβ+/SC groups for statistical analysis of parameters collected at steady state and at hospital admission. Results At steady state, per unit increase of hemoglobin values was associated with reduced odds of ≥ 2 hospital admissions per year in SS/Sβ0 and Sβ+/SC groups; per unit increase in platelet count and white blood cell count was associated with increased odds only in the SS/Sβ0 group. The NLR had no association in either group. During admission, a cutoff of NLR = 3.5 discerned infection with a sensitivity of 60% and specificity of 57%. Performance improved when excluding patients on outpatient hydroxyurea therapy (cutoff of NLR = 3.5; sensitivity of 68% and specificity of 64%). Conclusion This study supports the utility of NLR as an accessible adjunctive clinical tool in SCD prognostication.

Blink-related EEG oscillations are neurophysiological indicators of subconcussive head impacts in female soccer players: a preliminary study.

Repetitive subconcussive head impacts can lead to subtle neural changes and functional consequences on brain health. However, the objective assessment of these changes remains limited. Resting state blink-related oscillations (BROs), recently discovered neurological responses following spontaneous blinking, are explored in this study to evaluate changes in BRO responses in subconcussive head impacts. We collected 5-min resting-state electroencephalography (EEG) data from two cohorts of collegiate athletes who were engaged in contact sports (SC) or non-contact sports (HC). Video recordings of all on-field activities were conducted to determine the number of head impacts during games and practices in the SC group. In both groups, we were able to detect a BRO response. Following one season of games and practice, we found a strong association between the number of head impacts sustained by the SC group and increases in delta and beta spectral power post-blink. There was also a significant difference between the two groups in the morphology of BRO responses, including decreased peak-to-peak amplitude of response over left parietal channels and differences in spectral power in delta and alpha frequency range post-blink. Our preliminary results suggest that the BRO response may be a useful biomarker for detecting subtle neural changes resulting from repetitive head impacts. The clinical utility of this biomarker will need to be validated through further research with larger sample sizes, involving both male and female participants, using a longitudinal design.

Poster 144: No Difference in Chondrocyte Viability Using Scissor as Compared to Custom Cutter for Matrix-Induced Autologous Chondrocyte Implantation Membrane (MACI)

Objectives: Matrix-induced autologous chondrocyte implantation (MACI) is a well-established method for knee cartilage restoration that uses autologous chondrocytes seeded onto a porcine membrane. Preserving chondrocyte viability while ensuring the correct size and contour of the MACI membrane is critical to the outcome. Traditional manual preparation has been performed using scissors (Sc). More recently, custom cutters (CC) have made preparation easier and more efficient. However, the effect of the MACI preparation method on cell viability is currently unknown. The purpose of this study was to determine the difference in chondrocyte viability between MACI membranes prepared with either the Sc or CC technique. Our hypothesis was that there would be no difference in overall cell viability between groups. Methods: The study was approved by the Institutional Review Board (IRB), and all the patients were consented prior to surgery. The remnant MACI membrane following surgical implantation (N=5 patients) was utilized for study purposes. A board-certified and fellowship-trained surgeon prepared each membrane on the back table using sterile technique. Preparation included an untouched region (control), a hand-cut 15 mm circular region (Sc), and a custom-cut 15mm circular region (CC). The samples were carefully transported in media to the laboratory setting. In the laboratory, The Sc and the CC regions were further divided into three distinct zones depending on their proximity to the cutting area (i.e., impact, adjacent, and central zones), and tested using confocal laser scanning microscopy with 3D Spot Segmentation to quantify the percentage of Live/Dead cells within the various zones (percentage of live cells and cell density were presented in x105/cm2). The Impact Zone, which was the closest to the cutting edge, was defined by the boundary of high cell density. This was followed by the Adjacent Zone between the Impact Zone and the most inner Central Zone. The size of the Impact Zone was calculated relative to the size of the entire sample. The increase of dead cells in the affected zones were calculated relative to the total cell count and represented as a percentage. Results were analyzed statistically. Results: The cell viability was lower in the Impact Zone of both the Sc (40.94% ± 2.85, p &lt; 0.005) and CC (36.42% ± 3.85, p &lt; 0.005) groups when compared to the Adjacent Zone (74.17% ± 2.8 and 77.69% ± 2.97, respectively). The cell viability remained high in the Central Zone in all samples, with no significant differences between the Sc and CC groups. (77.18% ± 1.38 to 79.95% ± 1.99, p&gt;.05). The average cell density in both Impact and Adjacent Zones was 5.84 ± 0.26 to 6.49 ± 0.34 x 105/cm2 (p&gt;.05) respectively. The total size of the Impact Zone in both Sc and CC groups was 9.22% ± 0.79 for the CC group and 10.17% ± 1.59 for the Sc group, p&gt;.05. Similarly, the percentage of non-viable cells resulting from the cutting preparation was 3.75% ± 0.38 and 3.97% ± 0.22 for the custom cut and hand-cut groups, respectively, without significant differences between the groups. Conclusions: MACI membrane prepared with either the Sc or CC technique demonstrated a significant reduction in cell viability in the Impact Zone (i.e. periphery) as compared to the Central Zone of the MACI transplant. The Impact Zone was estimated to be approximately 10% of the overall membrane with roughly 4% increased cell death attributed to membrane cutting in each group. There was no difference in the overall chondrocyte viability or size of the Impact Zone when comparing Sc to CC groups. Based on these study results, surgeons may consider using either technique when performing the MACI procedure.

Effects of Dairy Cows Management Systems on the Physicochemical and Nutritional Quality of Milk and Yogurt, in a North-Eastern Romanian Farm

The study’s objective was to investigate changes in the fatty acid composition of cow milk in general and in 80 Romanian Spotted cows’ husbandry and feeding systems in particular (grazing–GC group vs. stabulation–SC group). The ultimate objective was to determine if the changes that happened in the milk also transferred to the finished product. Also, the influence of the quality of raw milk produced by both systems was evaluated when yogurt was made from it. The milk was gathered in May, July and September and used for both the yogurt-making process and the study, which lasted from May to October. In comparison to milk from SC, milk from grazed caws had larger percentages of fat and dry matter throughout the summer (GC) season. Moreover, pasture-based rations (MGC) contained more PUFA than MCS did. Data research revealed that not only do factors such as milk origin and initial quality have a substantial impact on yogurt quality parameters, but also technologies such as milk fermentation have a considerable impact on the fatty acid profile of yogurt. In comparison to cows kept permanently in stables, grazed cows (MGC) had fat with a lower concentration of saturated fatty acids and a higher proportion of rumenic, vaccenic and oleic acids (MSC). When fresh milk is processed into yogurt and other dairy products, the fatty acid profiles alter, with saturated fatty acids predominating over unsaturated ones. The findings show that pasture-fed cows have a positive impact on milk quality, particularly in terms of fatty acid profile, as well as on yogurt’s ultimate nutritional and dietary quality.

Antibiotic Duration Following Abdominal Gunshot Injuries With Associated Pelvis or Spine Involvement: A 20-Year Single-Center Experience

IntroductionOptimal antimicrobial prophylaxis duration following gunshot wounds (GSW) to the abdomen with an associated orthopedic fracture is unknown. This study evaluated the safety and efficacy of short versus long courses of prophylactic antibiotics following penetrating hollow viscus injury with communicating orthopedic fracture. MethodsThis retrospective study included adult patients admitted to the trauma service over a 20-y period who sustained an abdominal GSW with hollow viscus injury and communicating spine or pelvic fractures. Patients were stratified into cohorts based on prophylactic antibiotic duration: short course (SC, ≤48 h) and long course (>48 h). The primary outcome was the incidence of osteomyelitis and meningitis up to 1-y postinjury. Secondary outcomes included hospital length of stay and the incidence of multidrug-resistant organisms and Clostridioides difficile infections. Risk factors for osteomyelitis and meningitis were determined. ResultsA total of 125 patients were included with 45 (36%) in the SC group. Median prophylactic antibiotic durations were SC, 1 (interquartile range [IQR], 1-2) versus long course, 7 (IQR, 5-7) d (P < 0.001). There was no difference in osteomyelitis and meningitis incidence (2 [4.4%] versus 4 [5%], P = 0.77). Median hospital length of stay (7 [IQR, 6-11] versus 9 [IQR, 6-15] d, P = 0.072) and incidence of multidrug-resistant organisms (6 [13.3%] versus 13 [16.3%], P = 0.86) and Clostridioides difficile infections (0 [0%] versus 1 [1.3%], P = 0.77) were similar between groups. There were no independent risk factors identified for osteomyelitis or meningitis. ConclusionsA shorter course of antibiotic prophylaxis ≤48 h may be adequate following abdominal GSW that traverses a hollow viscus and results in pelvic fracture or spinal column injury.

Therapeutic communication improves patient comfort during venipuncture in children: a single-blinded intervention study

The aim of this study was to examine whether therapeutic communication improves children’s comfort during venipuncture compared to standard communication. This study was registered in the Dutch trial register (NL8221), December 10, 2019. This single-blinded interventional study was carried out in an outpatient clinic of a tertiary hospital. Inclusion criteria were age between 5 and 18 years, use of topical anesthesia (EMLA) and sufficient understanding of the Dutch language. 105 children were included, 51 assigned to the standard communication group (SC group) and 54 patients to the therapeutic communication group (TC group). The primary outcome measure was self-reported pain based on the Faces Pain Scale Revised (FPS-R). Secondary outcome measures were observed pain (numeric rating scale (NRS)), self-reported/observed anxiety in child and parent (NRS), self-reported satisfaction in child, parent and medical personnel (NRS), and procedural time. No difference was found for self-reported pain. Self-reported and observed anxiety (by parents and medical personnel) was lower in the TC group (p-values ranged from p = 0.005 to p = 0.048). Procedural time was lower in the TC group (p = 0.011). Satisfaction level of medical personnel was higher in the TC group (p = 0.014). Conclusion: TC during venipuncture did not result in lower self-reported pain. However, secondary outcomes (observed pain, anxiety and procedural time) were significantly improved in the TC group.What is Known:• Medical procedures, especially needle related procedures, cause anxiety and fear in children and adults.• In adults communication techniques based on hypnosis are effective in reducing pain and anxiety during medical procedures.What is New:• Our study found that with a small change in communication technique (called therapeutic communication or TC), the comfort of children during venipuncture improves.• This improved comfort was mainly reflected by reduced anxiety scores and shorter procedural time. This makes TC suitable for the outpatient setting.

Parent-implemented augmented communication intervention and young children with Down syndrome: an exploratory report.

Young children with Down syndrome (DS) present with speech and language impairments very early in childhood. Historically, early language intervention for children with DS included manual signs, though recently there has been an interest in the use of speech-generating devices (SGDs). This paper examines the language and communication performance of young children with DS who participated in parent-implemented communication interventions that included SGDs. Specifically, we compared the functional vocabulary usage and communication interaction skills of children with DS who received augmented communication interventions (AC) that included an SGD with those children with DS who received spoken communication intervention (SC). Twenty-nine children with DS participated in this secondary data analysis. These children were part of one of two longitudinal RCT studies investigating the effectiveness of parent-implemented augmented communication interventions in a larger sample of 109 children with severe communication and language impairments. There were significant differences between children with DS in the AC and SC groups in terms of the number and proportion of functional vocabulary targets used and the total vocabulary targets provided during the intervention at sessions 18 (lab)and 24 (home). Overall, the AC interventions provided the children with a way to communicate via an SGD with visual-graphic symbols and speech output, while the children in the SC intervention were focused on producing spoken words. The AC interventions did not hinder the children's spoken vocabulary development. Augmented communication intervention can facilitate the communication abilities of young children with DS as they are emerging spoken communicators.

SCORE: A multisite randomised controlled trial evaluating shared care for colorectal cancer survivors.

1505 Background: Few studies have considered shared follow up (FU) care (SC) between oncologists and primary care providers (PCPs). SCORE is the first large RCT of SC for survivors of colorectal cancer (CRC). Primary objective: compare SC vs UC on the EORTC QLQ-C30 Global Health Status/Quality of Life (GHQ-QoL) scale to 12 months (mo). Secondary objectives: compare SC vs UC on QoL; patient (pt) perceptions of care; costs and clinical care processes (CEA tests, recurrences). Methods: Pts had completed treatment for stage I-III CRC within 3 mo, had a PCP, and no prior cancer. After pt consent, PCPs could opt out. SC replaced 2 routine oncologist visits with PCP visits and included a survivorship care plan, concerns checklist and PCP management guidelines. PCPs were asked to request CEA tests at 3 and 9 mo visits. Assessments were at baseline (BL), 6 and 12 mo FU. Difference (diff) between groups on GHQ-QoL to 12 mo estimated from a mixed model for repeated measures (MMRM). Non-inferiority evaluated by comparing the lower limit of the two-sided 95% confidence interval (CI) for the estimated diff (SC–UC) against a non-inferiority margin (NIM) of -10 points. Per-protocol population (PPP) comprised all randomised pts with ≥ 1 post-BL questionnaire (6 +/or 12mo) and, for SC, ≥ 1 of the PCP visits. Results: 150 pts were randomised to SC (N=74) or UC (N=76); 11 PCPs had declined. Median age 63 years, 39% women, 24% had radiation. Primary site: colon (59%), rectum (32%), overlapping (9%). 138/150 (92%) had BL and ≥ 1 post-BL GHQ-QoL score. 65/74 (88%) of SC pts attended 3- and/or 9-mo PCP visits. The mean (SD) GHQ-QoL scores at baseline / 6 mo / 12 mo were: 69 (18.7) / 69 (21.2) / 72 (20.2) for SC versus 68 (20.0) / 73 (15.1) / 73 (17.2) for UC. The MMRM mean estimate of GHQ-QoL across the 6 mo and 12 mo FU was 69 for SC and 73 for UC, mean diff -4.0 (95% CI: -9.0 to 0.9). The lower limit of the 95% CI did not cross the NIM. For the PPP (N=130/150), mean diff was -5.0 (95% CI: -10.1 to 0.2). No clear evidence of between group differences on other QoL, unmet needs or satisfaction scales (C30, CR29, SUNS, PSQ), accounting for multiplicity. At 12 mo, more patients in SC (40/62, 65%) vs UC (24/58, 41%) felt their PCP was sufficiently knowledgeable (AOPSS). At 12 mo, most popular preferences for FU were: SC for 40/63 (63%) in the SC group; similar preferences for SC 22/62 (35%) and ‘Hospital-based care with the doctors that treated the cancer’ 22/62 (35%) in UC. CEA completion was 89% at 3 mo and 83% at 9 mo in SC; 63% and 68% in UC. 5 recurrences in SC and 6 in UC arms. Pts in SC on average incurred A$456 less in health costs vs UC pts. Conclusions: SCORE had high PCP participation and pt retention. Compared to UC, pts having SC had non-inferior QoL, and lower costs. Adherence to CEA testing was higher in SC. Pts exposed to SC prefer this model of FU. Clinical trial information: ACTRN12617000004369 .

Neoadjuvant docetaxel, oxaliplatin, and s-1 plus surgery and adjuvant s-1 for resectable advanced gastric cancer: Final survival outcomes of the randomized phase 3 PRODIGY trial.

4067 Background: The phase 3 PRODIGY study compared neoadjuvant docetaxel, oxaliplatin and S-1 (DOS) chemotherapy followed by surgery followed by adjuvant S-1 with surgery followed by adjuvant S-1 for Korean patients with resectable locally advanced gastric cancer (LAGC) (Kang et al. J Clin Oncol. 2021). The planned analysis of the primary endpoint of PRODIGY showed that the addition of neoadjuvant DOS to surgery and adjuvant S-1 improved progression-free survival (PFS). We herein report the long-term follow-up outcomes, including overall survival (OS), from this trial. Methods: Patients with histologically confirmed primary gastric or gastroesophageal junction adenocarcinoma with clinical T2-3N+ or T4Nany disease were enrolled from 18 Korean study sites. Patients were randomly assigned to D2 surgery followed by adjuvant S-1 (40–60 mg orally twice a day, days 1–28 q6w for eight cycles; SC group) or neoadjuvant DOS (docetaxel 50 mg/m2, oxaliplatin 100 mg/m2 intravenously day 1, S-1 40 mg/m2 orally twice a day, days 1–14 q3w for three cycles) before D2 surgery, followed by adjuvant S-1 (CSC group). The primary endpoint was PFS. OS was the secondary endpoint. This analysis presents the final assessment of the outcomes after 5 years. Results: A total of 266 and 264 patients were randomly assigned to the CSC and SC arms, respectively, among which 238 and 246 patients were treated and included in the full analysis set. As of the data cut-off date (SEP-2022), the median follow-up duration of the surviving patients was 99.5 months (range, 68.6–127.7 months). As compared to SC, CSC significantly increased the OS (adjusted hazard ratio, 0.72; 95% CI, 0.54 to 0.97; stratified log-rank P=0.028) with a 5-year OS rate of 66.8% and 63.0% for the CSC and SC arms, respectively. CSC also significantly improved the PFS (adjusted hazard ratio, 0.71; 95% CI, 0.53 to 0.94; stratified log-rank P=0.019) with a 5-year PFS rate of 60.6% and 56.9% for the CSC and SC arms, respectively. Conclusions: The addition of neoadjuvant docetaxel, oxaliplatin and S-1 (DOS) chemotherapy, as part of perioperative chemotherapy, to surgery and adjuvant S-1 prolonged the OS and PFS of Asian patients with LAGC relative to patients treated with surgery and adjuvant S-1 alone. Neoadjuvant DOS chemotherapy should be considered one of the standard treatment options for patients with LAGC in Asia. Clinical trial information: NCT01515748 .

Concurrent Presence of Thoracolumbar Scoliosis and Chiari Malformation: Is Operative Risk Magnified?

Retrospective review of Kids' Inpatient Database (KID). Identify the risks and complications associated with surgery in adolescents diagnosed with Chiari and scoliosis. Scoliosis is frequently associated with Chiari malformation (CM). More specifically, reports have been made about this association with CM type I in the absence of syrinx status. The KID was used to identify all pediatric inpatients with CM and scoliosis. The patients were stratified into three groups: those with concomitant CM and scoliosis (CMS group), those with only CM (CM group), and those with only scoliosis (Sc group). Multivariate logistic regressions were used to assess association between surgical characteristics and diagnosis with complication rate. A total of 90,707 spine patients were identified (61.8% Sc, 37% CM, 1.2% CMS). Sc patients were older, had a higher invasiveness score, and higher Charlson comorbidity index (all p<0.001). CMS patients had significantly higher rates of surgical decompression (36.7%). Sc patients had significantly higher rates of fusions (35.3%) and osteotomies (1.2%, all p<0.001). Controlling for age and invasiveness, postoperative complications were significantly associated with spine fusion surgery for Sc patients (odds ratio [OR], 1.8; p<0.05). Specifically, posterior spinal fusion in the thoracolumbar region had a greater risk of complications (OR, 4.9) than an anterior approach (OR, 3.6; all p<0.001). CM patients had a significant risk of complications when an osteotomy was performed as part of their surgery (OR, 2.9) and if a spinal fusion was concurrently performed (OR, 1.8; all p<0.05). Patients in the CMS cohort were significantly likely to develop postoperative complications if they underwent a spinal fusion from both anterior (OR, 2.5) and posterior approach (OR, 2.7; all p<0.001). Having concurrent scoliosis and CM increases operative risk for fusion surgeries despite approach. Being independently inflicted with scoliosis or Chiari leads to increased complication rate when paired with thoracolumbar fusion and osteotomies; respectively.

Efficacy of Biejiajian Pill on Intestinal Microbiota in Patients with Hepatitis B Cirrhosis/Liver Fibrosis: A Randomized Double-Blind Controlled Trial.

To analyze the efficacy of Biejiajian Pill (BJJP) on intestinal microbiota in patients with hepatitis B cirrhosis/liver fibrosis, and explore its relationship with liver fibrosis. This was a prospective, randomized double-blind controlled trial. Using the stratified block randomization method, 35 patients with hepatitis B liver cirrhosis/liver fibrosis were randomly assigned (1:1) to receive entecavir (0.5 mg/d) combined with BJJP (3 g/time, 3 times a day) or placebo (simulator as control, SC group, simulator 3 g/time, 3 times a day) for 48 weeks. Blood and stool samples were collected from patients at baseline and week 48 of treatment, respectively. Liver and renal functions as well as hematological indices were detected. Fecal samples were analyzed by 16S rDNA V3-V4 high-throughput sequencing, and intestinal microbiota changes in both groups before and after treatment were compared, and their correlations with liver fibrosis were analyzed. Compared with the SC group, there was no significant difference in liver function, renal function and hematology indices in the BJJP group, however, the improvement rate of liver fibrosis was higher in the BJJP group (94.4% vs. 64.7%, P=0.041). Principal coordinate analysis (PCoA) based on weighted Unifrac distance showed significant differences in intestinal microbiota community diversity before and after BJJP treatment (P<0.01 and P=0.003), respectively. After 48 weeks' treatment, the abundance levels of beneficial bacteria (Bifidobacteria, Lactobacillus, Faecalibacterium and Blautia) increased, whereas the abundance levels of potential pathogenic bacteria, including Escherichia coli, Bacteroides, Ruminococcus, Parabacteroides and Prevotella decreased, among which Ruminococcus and Parabacteroides were significantly positively correlated with degree of liver fibrosis (r=0.34, P=0.04; r=0.38, P=0.02), respectively. The microbiota in the SC group did not change significantly throughout the whole process of treatment. BJJP had a certain regulatory effect on intestinal microbiota of patients with hepatitis B cirrhosis/liver fibrosis (ChiCTR1800016801).