Strong Evidence Research Articles

Using Progress Feedback to Enhance Treatment Outcomes: A Narrative Review.

We face increasing demand for greater access to effective routine mental health services, including telehealth. However, treatment outcomes in routine clinical practice are only about half the size of those reported in controlled trials. Progress feedback, defined as the ongoing monitoring of patients' treatment response with standardized measures, is an evidence-based practice that continues to be under-utilized in routine care. The aim of the current review is to provide a summary of the current evidence base for the use of progress feedback, its mechanisms of action and considerations for successful implementation. We reviewed ten available meta-analyses, which report small to medium overall effect sizes. The results suggest that adding feedback to a wide range of psychological and psychiatric interventions (ranging from primary care to hospitalization and crisis care) tends to enhance the effectiveness of these interventions. The strongest evidence is for patients with common mental health problems compared to those with very severe disorders. Effect sizes for not-on-track cases, a subgroup of cases that are not progressing well, are found to be somewhat stronger, especially when clinical support tools are added to the feedback. Systematic reviews and recent studies suggest potential mechanisms of action for progress feedback include focusing the clinician's attention, altering clinician expectations, providing new information, and enhancing patient-centered communication. Promising approaches to strengthen progress feedback interventions include advanced systems with signaling technology, clinical problem-solving tools, and a broader spectrum of outcome and progress measures. An overview of methodological and implementation challenges is provided, as well as suggestions for addressing these issues in future studies. We conclude that while feedback has modest effects, it is a small and affordable intervention that can potentially improve outcomes in psychological interventions. Further research into mechanisms of action and effective implementation strategies is needed.

Factors associated with posttraumatic stress and anxiety among the parents of babies admitted to neonatal care: a systematic review

BackgroundPosttraumatic stress (PTS) and anxiety are common mental health problems among parents of babies admitted to a neonatal unit (NNU). This review aimed to identify sociodemographic, pregnancy and birth, and psychological factors associated with PTS and anxiety in this population.MethodStudies published up to December 2022 were retrieved by searching Medline, Embase, PsychoINFO, Cumulative Index to Nursing and Allied Health electronic databases. The modified Newcastle–Ottawa Scale for cohort and cross-sectional studies was used to assess the methodological quality of included studies. This review was pre-registered in PROSPERO (CRD42021270526).ResultsForty-nine studies involving 8,447 parents were included; 18 studies examined factors for PTS, 24 for anxiety and 7 for both. Only one study of anxiety factors was deemed to be of good quality. Studies generally included a small sample size and were methodologically heterogeneous. Pooling of data was not feasible. Previous history of mental health problems (four studies) and parental perception of more severe infant illness (five studies) were associated with increased risk of PTS, and had the strongest evidence. Shorter gestational age (≤ 33 weeks) was associated with an increased risk of anxiety (three studies) and very low birth weight (< 1000g) was associated with an increased risk of both PTS and anxiety (one study). Stress related to the NNU environment was associated with both PTS (one study) and anxiety (two studies), and limited data suggested that early engagement in infant’s care (one study), efficient parent-staff communication (one study), adequate social support (two studies) and positive coping mechanisms (one study) may be protective factors for both PTS and anxiety. Perinatal anxiety, depression and PTS were all highly comorbid conditions (as with the general population) and the existence of one mental health condition was a risk factor for others.ConclusionHeterogeneity limits the interpretation of findings. Until clearer evidence is available on which parents are most at risk, good communication with parents and universal screening of PTS and anxiety for all parents whose babies are admitted to NNU is needed to identify those parents who may benefit most from mental health interventions.

Lifestyle intervention formetabolic dysfunction-associated fatty liver disease: a 24-h integrated behavior perspective.

The prevalence, health and socioeconomic burden of metabolic dysfunction-associated fatty liver disease (MAFLD) is growing, increasing the need for novel evidence-based lifestyle approaches. Lifestyle is the cornerstone for MAFLD management and co-existing cardiometabolic dysfunction. The aim of this review was to evaluate the evidence for lifestyle management of MAFLD, with a specific lens on 24-hour integrated behaviour and provide practical recommendations for implementation of the evidence. Weight loss ≥ 7-10% is central to lifestyle management; however, liver and cardiometabolic benefits are attainable with improved diet quality and exercise even without weight loss. Lifestyle intervention for MAFLD should consider an integrated '24-h' approach that is cognisant of diet, physical activity/exercise, sedentary behavior, smoking, alcohol intake and sleep. Dietary management emphasises energy deficit and improved diet quality, especially the Mediterranean diet, although sociocultural adaptations to meet preferences should be considered. Increasing physical activity and reducing sedentary behavior can prevent MAFLD, with strongest evidence in MAFLD supporting regular structured moderate-vigorous aerobic exercise for 150-240 min/week. Resistance training in addition to aerobic exercise should be considered and prioritised for those who are losing body mass via diet and/or pharmacological approaches and those with sarcopenia, to minimise bone and lean mass loss. Limited evidence suggests that sleep is important for MAFLD prevention. Emerging novel approaches to diet and exercise may address some of the key barriers to behaviour change (e.g. lack of time, access to resources and social support). Large-scale multidisciplinary trials in people with MAFLD with long-term follow-up, that can be scaled up into mainstream healthcare, are required. Future management guidelines should consider the heterogeneity of MAFLD and specialised models of care that coordinate the health workforce to manage the increased and growing MAFLD population.

Recommendations for the management of acute immune thrombocytopenia in children. A Consensus Conference from the Italian Association of Pediatric Hematology and Oncology.

Immune thrombocytopenia (ITP) is an acquired immune-mediated bleeding disorder characterized by isolated thrombocytopenia. Its estimated yearly incidence in the pediatric population is 1.9-6.4/100,000. ITP in children is usually a self-limiting and benign disorder. The clinical management of children with ITP often remains controversial, as robust randomized trials on the management of this disorder are lacking. Treatments vary widely in clinical practice and existing guidelines from hematology societies on clinical management offer indications based largely on expert opinion rather than strong evidence. The Coagulative Disorder Working Group of the Italian Association of Pediatric Hematology and Oncology (AIEOP) developed this document to collect shared expert opinions on the management of newly diagnosed ITP, updating previous guidelines and providing recommendations to pediatricians. Each statement has been given a score expressing the strength of evidence, appropriateness and agreement among participants. Clear-cut definitions of the clinical phases of the disease and clinical response are stated. Recommendations are given regarding the classification of bleeding symptoms, evaluation of bleeding risk, diagnosis, and prognostic factors. Specific recommendations for treatment include indications for first-line (intravenous immunoglobulins, steroids) and second-line (combined therapy, thrombopoietin receptor agonists, immunosuppressive drugs, rituximab) therapeutic agents, as well as hemorrhagic emergency and supportive treatment, including emergency splenectomy. The optimal follow-up schedule, the relation between ITP and vaccines and health-related quality-of-life issues are also discussed. The panel achieved broad consensus on issues related to how to treat children with newly diagnosed ITP, providing a comprehensive review of all relevant clinical aspects.

Helicobacter pylori infection does not influence the progression from gastroesophageal reflux disease to Barrett's esophagus to esophageal adenocarcinoma.

We conducted a meta-analysis evaluating the overall risk of esophageal adenocarcinoma (EAC) in individuals with Helicobacter pylori infection, and a network meta-analysis to assess the role of H. pylori infection in the progression from Barrett's esophagus (BE) to EAC. The MEDLINE, EMBASE and Cochrane databases were searched between 1988 and June 2023 for observational studies of H. pylori infection and the risk of EAC. Summary odds ratios (OR) and 95% confidence intervals (95% CI) were calculated using the DerSimonian-Laird method. I2 statistics were calculated to examine heterogeneity. Thirteen studies were included in the meta-analysis and 3 additional studies were included in the network meta-analysis. For comparisons with controls, individuals with H. pylori infection were 46% less likely to develop EAC than individuals without H. pylori infection (OR, 0.54; 95% CI: 0.46, 0.64), with low heterogeneity between studies (I2=4.4%). The magnitude of the inverse association was stronger in the two large cohort studies (OR=0.31) than in the 11 case-control studies (OR=0.55). When comparing to controls, the network meta-analysis of 6 studies showed that H. pylori infection was associated with a lower risk of GERD (OR=0.68) or BE (OR=0.59) or EAC (OR=0.54); however, H. pylori infection was not associated with risk of EAC in patients with BE (OR=0.91; 95% CI: 0.68, 1.21). This meta-analysis provides the strongest evidence yet that H. pylori infection is inversely associated with EAC. H. pylori does not appear to be associated with BE progression to EAC.

Physical and psychosocial work-related exposures and the occurrence of disorders of the shoulder: A systematic review update

This review is an update of a previous systematic review and assesses the evidence for the association of work-related physical and psychosocial risk factors and specific disorders of the shoulders. Medline, Embase, Web of Science Core Collection, Cochrane Central and PsycINFO were searched and study eligibility and risk of bias assessment was performed by two independent reviewers. A total of 14 new articles were added with the majority focusing on rotator cuff syndrome (RCS) with seven studies. Nine articles reported psychosocial exposures in addition to physical exposures. The strongest evidence was found for the association between elevation, repetition, force and vibration and the occurrence of SIS and tendinosis/tendonitis. Evidence also suggests that psychosocial exposures are associated with the occurrence of RCS and tendinosis/tendonitis. Other findings were inconsistent which prevents drawing strong conclusions.

Associations between attention-deficit hyperactivity disorder genetic liability and ICD-10 medical conditions in adults: utilizing electronic health records in a Phenome-Wide Association Study.

Attention-deficit hyperactivity disorder (ADHD) is often comorbid with other medical conditions in adult patients. However, ADHD is extremely underdiagnosed in adults and little is known about the medical comorbidities in undiagnosed adult individuals with high ADHD liability. In this study we investigated associations between ADHD genetic liability and electronic health record (EHR)-based ICD-10 diagnoses across all diagnostic categories, in individuals without ADHD diagnosis history. We used data from the Estonian Biobank cohort (N = 111 261) and generated polygenic risk scores (PRS) for ADHD (PRSADHD) based on the ADHD genome-wide association study. We performed a phenome-wide association study (PheWAS) to test for associations between standardized PRSADHD and 1515 EHR-based ICD-10 diagnoses in the full and sex-stratified sample. We compared the observed significant ICD-10 associations to associations with (1) ADHD diagnosis and (2) questionnaire-based high ADHD risk analyses. After Bonferroni correction (p = 3.3 × 10-5) we identified 80 medical conditions associated with PRSADHD. The strongest evidence was seen with chronic obstructive pulmonary disease (OR 1.15, CI 1.11-1.18), obesity (OR 1.13, CI 1.11-1.15), and type 2 diabetes (OR 1.11, CI 1.09-1.14). Sex-stratified analysis generally showed similar associations in males and females. Out of all identified associations, 40% and 78% were also observed using ADHD diagnosis or questionnaire-based ADHD, respectively, as the predictor. Overall our findings indicate that ADHD genetic liability is associated with an increased risk of a substantial number of medical conditions in undiagnosed individuals. These results highlight the need for timely detection and improved management of ADHD symptoms in adults.

Treat Yourself: Pilot Testing a New Method to Treat Mange in Wild Carnivores.

Mange is a skin disease caused by mites that parasitize an animal's skin, often yielding inflamed immune responses and hair loss. At a population level, mange may reduce survival and cause population declines. Many forms of mange can be treated quite effectively when an animal is in hand; however, this is not often feasible for many free-ranging wildlife populations. Some animals, particularly territorial carnivores, will rub or roll to scent mark and transmit information about their presence to other individuals. We posited that rub stations comprised, in part, of anthelmintic medication and foreign scents that induce rubbing could be used to remotely treat mange in the wild. We deployed 39 rub stations containing lure and dye in Santa Monica Mountains National Recreation Area, Southern California, USA, October-November 2022. Carnivores rubbed or rolled at >97% of rub stations, with coyotes (Canis latrans), gray foxes (Urocyon cinereoargenteus), and bobcats (Lynx rufus) being the most abundant species. Time to first rub or roll was generally <1 wk. Several sympatric species (e.g., mule deer, Odocoileus hemionus) were detected at rub stations but did not rub. Our pilot test provides strong evidence that treating mange in wild carnivores may be possible using the remote medicinal rub stations we describe. Future efforts to add medicine to rub stations and monitor for a change in mange prevalence are a logical next step.

Sleep loss and emotion: A systematic review and meta-analysis of over 50 years of experimental research.

In a largely sleep-deprived society, quantifying the effects of sleep loss on emotion is critical for promoting psychological health. This preregistered systematic review and meta-analysis quantified the effects of various forms of sleep loss on multiple aspects of emotional experiences. Eligible studies used experimental reductions of sleep via total sleep deprivation, partial sleep restriction, or sleep fragmentation in healthy populations to examine effects on positive affect, negative affect, general mood disturbances, emotional reactivity, anxiety symptoms, and/or depressive symptoms. In total, 1,338 effect sizes across 154 studies were included (N = 5,717; participant age range = 7-79 years). Random effects models were conducted, and all forms of sleep loss resulted in reduced positive affect (standardized mean difference [SMD] = -0.27 to -1.14), increased anxiety symptoms (SMD = 0.57-0.63), and blunted arousal in response to emotional stimuli (SMD = -0.20 to -0.53). Findings for negative affect, reports of emotional valence in response to emotional stimuli, and depressive symptoms were mixed and depended on the type of sleep loss. Nonlinear effects for the amount of sleep loss as well as differences based on the stage of sleep restricted (i.e., rapid eye movement sleep or slow-wave sleep) were also detected. This study represents the most comprehensive quantitative synthesis of experimental sleep and emotion research to date and provides strong evidence that periods of extended wakefulness, shortened sleep duration, and/or nighttime awakenings adversely influence human emotional functioning. Findings provide an integrative foundation for future research on sleep and emotion and elucidate the precise ways that inadequate sleep may impact our daytime emotional lives. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Perceptual similarity judgments do not predict the distribution of errors in working memory.

Population coding models provide a quantitative account of visual working memory (VWM) retrieval errors with a plausible link to the response characteristics of sensory neurons. Recent work has provided an important new perspective linking population coding to variables of signal detection, including d-prime, and put forward a new hypothesis: that the distribution of recall errors on, for example, a color wheel, is a consequence of the psychological similarity between points in that stimulus space, such that the exponential-like psychophysical distance scaling function can fulfil the role of population tuning and obviate the need to fit a tuning width parameter to recall data. Using four different visual feature spaces, we measured psychophysical similarity and memory errors in the same participants. Our results revealed strong evidence for a common source of variability affecting similarity judgments and recall estimates but did not support any consistent relationship between psychophysical similarity functions and VWM errors. At the group level, the responsiveness functions obtained from the psychophysical similarity task diverged strongly from those that provided the best fit to working memory errors. At the individual level, we found convincing evidence against an association between observed and best-fitting similarity functions. Finally, our results show that the newly proposed exponential-like responsiveness function has in general no advantage over the canonical von Mises (circular normal) function assumed by previous population coding models. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Dynamic saccade context triggers more stable object-location binding.

Our visual systems rapidly perceive and integrate information about object identities and locations. There is long-standing debate about if and how we achieve world-centered (spatiotopic) object representations across eye movements, with many studies reporting persistent retinotopic (eye-centered) effects even for higher level object-location binding. But these studies are generally conducted in fairly static experimental contexts. Might spatiotopic object-location binding only emerge in more dynamic saccade contexts? In the present study, we investigated this using the spatial congruency bias paradigm in healthy adults. In the static (single-saccade) context, we found purely retinotopic binding, as before. However, robust spatiotopic binding emerged in the dynamic saccade context (multiple frequent saccades and saccades during stimulus presentation). We further isolated specific factors that modulate retinotopic and spatiotopic binding. Our results provide strong evidence that dynamic saccade context can trigger more stable object-location binding in ecologically relevant spatiotopic coordinates, perhaps via a more flexible brain state that accommodates improved visual stability in the dynamic world. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Efficient alternatives for Bayesian hypothesis tests in psychology.

Bayesian hypothesis testing procedures have gained increased acceptance in recent years. A key advantage that Bayesian tests have over classical testing procedures is their potential to quantify information in support of true null hypotheses. Ironically, default implementations of Bayesian tests prevent the accumulation of strong evidence in favor of true null hypotheses because associated default alternative hypotheses assign a high probability to data that are most consistent with a null effect. We propose the use of "nonlocal" alternative hypotheses to resolve this paradox. The resulting class of Bayesian hypothesis tests permits more rapid accumulation of evidence in favor of both true null hypotheses and alternative hypotheses that are compatible with standardized effect sizes of most interest in psychology. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Developing a Diverse, Equitable, and Inclusive Curriculum for Trainees

The importance of diversity in medical education has become increasingly clear with strong evidence showing its benefits in helping to reduce healthcare disparities and mortality, increase access to medical care, increase the number of clinicians practicing in medically underserved and rural communities, increased patient trust, improvement in patient-physician relationships, and better financial outcomes for health systems. As leaders in graduate medical education, the Teaching and Training Committee of the American Association for Geriatric Psychiatry (AAGP) proposed the creation and development of a curriculum that fosters an inclusive learning environment for our fellows, promotes open dialogue among everyone involved in the clinical process, and establishes anti-bias principles as integral parts of geriatric psychiatry education. The AAGP Diversity, Equity, and Inclusion (DEI) Curriculum Development subcommittee was established to carry out this task. Themes to be explored include ageism, racism and bias, social determinants of health, cultural humility, ethics of decision making in older adults, substance use, neurobiology of stress, the mental health of minoritized older adults, psychosocial and cultural aspects of aging, and laws that impact this population.This session details the process of establishing this important curricular thread as a template or framework that can be used in Geriatric Psychiatry training programs throughout the country and, in acknowledgement of the importance of the workforce that cares for older adults, ensures that it is practical and applicable to clinicians in non-academic settings. The panelists will highlight DEI curricular development in one fellowship program from the view of a trainee, the impact on recruiting a more representative workforce, and how to improve trainee and faculty engagement within and across programs.This presentation is sponsored by the Teaching and Training Committee.

(O-25) SURGICAL TREATMENT FOR CHRONIC TESTICULAR PAIN: A SYSTEMATIC REVIEW

Abstract Introduction and Objetives Chronic testicular pain (CTP) is defined as 3 months of intermittent or constant testicular pain that is significantly bothersome to the patient. There exist a variety of different surgical treatment options for CTP. They are generally kept as second or even third-line option for persistent cases. This study aims to review and elucidate the literature about surgical treatment for chronic testicular pain. Methods We searched Pubmed, Embase and Cochrane for articles evaluating surgical treatments for CTP. Search terms included “orchialgia”, “spermatic cord”, “chronic scrotal pain”, “chronic testicular pain” and “surgery”. Results Microsurgical Denervation of the Spermatic Cord (MDSC) is the surgical standard when a procedure is indicated for idiopathic chronic orchialgia unresponsive to conservative therapies. The positive response to spermatic cord block is a predictor of MDSC response. Pain relief after MDSC ranges from 76% to 100%. Ultrasound-guided targeted cryoablation could be used in persistent CTP after MDSC with 75% success rate. Epididymectomy is better indicated for CTP in structural abnormality such as cyst, granuloma or mass, with pain relief reaching 50% to 92%. In case of post-vasectomy pain syndrome, vasectomy reversal and MDSC has an overall success from 50% to 100% and 71% to 81% respectively. Ilioinguinal and genitofemoral peripheral nerve stimulation could be used in persistant CTP, and spinal cord stimulation as well. Orchiectomy can be considered as a last resort in case patients do not respond to other forms of treatment, but do not delivers a 100% relief a pain. Conclusion Although it’s variables choices, there is not a gold standard surgical treatment for CTP, representing a challenge for clinicians. Large, controlled trials must be performed to establish strong and reliable evidence for the surgical treatment of CTP. Financing No conflict.

Palladium-Catalyzed Cascade Heck Coupling and Allylboration of Iododiboron Compounds via Diboryl Radicals.

Geminal bis(boronates) are versatile synthetic building blocks in organic chemistry. The fact that they predominantly serve as nucleophiles in the previous reports, however, has restrained their synthetic potential. Herein we disclose the ambiphilic reactivity of α-halogenated geminal bis(boronates), of which the first catalytic utilization was accomplished by merging a formal Heck cross-coupling with a highly diastereoselective allylboration of aldehydes or imines, providing a new avenue for rapid assembly of polyfunctionalized boron-containing compounds. We demonstrated that this cascade reaction is highly efficient and compatible with various functional groups, and a wide range of heterocycles. In contrast to a classical Pd(0/II) scenario, mechanistic experiments and DFT calculations have provided strong evidence for a catalytic cycle involving Pd(I)/diboryl carbon radical intermediates.

The critical role of instructional response in defining and identifying students with dyslexia: a case for updating existing definitions.

We address defining and identifying students with dyslexia within the context of multi-tier systems of support (MTSS). We review proposed definitions of dyslexia, evidence for proposed definitional attributes, and emphasize the role of instructional response in identifying students with dyslexia. We identify dyslexia as individuals with specific deficits in reading and spelling single words combined with inadequate response to evidence-based instruction. We propose a hybrid identification process in which assessment is utilized within school-wide MTSS allowing for integration of routinely collected progress monitoring data as well integrating with more formal diagnostic measures. This proposed "hybrid" method demonstrates strong evidence for valid decision-making and directly informs instruction. We close proposing a revised definition of dyslexia that incorporates these elements.

Abstract 2137: Racial disparities in triple-negative breast cancer (TNBC) mortality rates in Hampton Roads Virginia and the effects of SIAH expression on prognosis

Abstract Background: While high-resolution imaging and advancements in therapies have significantly improved breast cancer survival rates, 43,170 breast cancer patients will die in the United States in 2023 alone. Triple-negative breast cancer (TNBC) is the most aggressive breast cancer subtype and disproportionately affects BRCA1 mutation carriers and young black women. Black/African American (AA) patients have the highest mortality and the shortest survival of any racial/ethnic group in the US. Persistent cancer racial disparities remain due to a variety of risk factors. The SEER/CDC data show an 8% lower breast cancer incidence rate and a 41% higher mortality rate in Black/AA patients compared to their white counterparts. Methods: Chart review was conducted using Sentara MD Office/EPIC and VOA iKnowMedicine portals to update tumor relapse, metastasis, and survival in 577 TNBC patients. Supported by strong evidence in developmental, evolutionary, and cancer biology, we hypothesize that persistent EGFR/K-RAS/SIAH pathway activation is a major driving force of TNBC malignancy, racial disparity, early relapse, and high mortality. We propose to integrate SIAH expression to augment the existing clinicopathological parameters to improve patient risk stratification, therapy quantification, and relapse/survival prediction at the 1st-line neoadjuvant settings. Results: We report that cancer disparity and high mortality rates are even more pronounced in our racially-diverse communities in Hampton Roads Virginia. We discovered that SIAH is a tumor-specific, therapy-responsive, and prognostic biomarker in TNBC. High SIAH expression in residual tumors reflects tumor-driving EGFR/K-RAS/SIAH pathway activation (ON) that will predict cancer disparity, treatment resistance, early relapse, and poor survival. Low SIAH expression in residual tumors reflect EGFR/K-RAS/SIAH pathway inactivation (OFF) that will predict tumor remission and prolonged survival. Conclusion: We detect a major racial disparity of TNBC patients at Sentara-EVMS-VOA. Our local Black/AA TNBC patients have a 1.6-fold higher mortality rate than their White counterparts. Encouraged by our preliminary data, we aim to develop a SIAH-centered biomarker panel by measuring the EGFR/K-RAS/SIAH pathway activation (ON)/inactivation (OFF), and use SIAH as a new prognostic biomarker to risk stratify patients, detect cancer racial disparities, forecast tumor relapse, and predict patient survival at 1st-line neoadjuvant settings. By targeting SIAH, individualized treatments can be created to allow for increased survival rates in at risk individuals with more aggressive TNBCs. Citation Format: Claire B. Piatak, Taylor N. Drake, Ashleigh Hannah, Jonathan Baker, Caroline L. Dasom, Emily L. Breeding, Janet S. Winston, Billur Samli, Rick Jansen, Michael Danso, Richard A. Hoefer, Amy H. Tang. Racial disparities in triple-negative breast cancer (TNBC) mortality rates in Hampton Roads Virginia and the effects of SIAH expression on prognosis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2137.

Effect of chain extension on processability and mechanical properties of poly(3‐hydroxybutyrate‐co‐4‐hydroxybutyrate)

AbstractPoly(3‐hydroxybutyrate‐4‐hydroxybutyrate) (P34HB) copolyester is a new type of biodegradable polymer material, but it cannot meet the market requirements because of its poor thermal stability. In this work, P34HB with a low degree of cross‐linking was successfully prepared by incorporating a small amount of a multiple epoxy chain extender, known as Joncryl ADR‐4380 (styrene‐methacrylic acid glycidyl ester copolymer), through reactive extrusion. The rheological properties, thermal stability, thermal behavior, and mechanical properties of the materials were investigated. Fourier transform infrared spectroscopy and gel content test showed that there was a significant chemical interaction between P34HB and ADR4380, and a cross‐linked structure was produced. Compared with pure P34HB, the samples after chain extension showed improved rheological properties, with increased viscosity and melt elasticity due to the formation of a gel network. Thermogravimetric analysis, dynamic time scanning experiment, and melt flow index (MFI) provided strong evidence for the enhanced of thermal stability of P34HB. The onset decomposition temperature of P34HB increased by 13.5°C, and its MFI decreased from 23.30 to around 5 at 170°C, and the complex viscosity remained relatively stable with time after modification. In terms of mechanical properties, the maximum elongation at break increased by 88.08% due to the improvement of toughness.

Braided silk sutures coated with photoreduced silver nanoparticles for eradicating Staphylococcus aureus and Streptococcus mutans infections

BackgroundInfections resulting from surgical procedures and wound closures continue to pose significant challenges in healthcare settings. To address this issue, the investigators have developed antibacterial non-resorbable braided silk sutures using in situ deposited silver nanoparticles (AgNPs) and investigated their efficacy in eradicating Staphylococcus aureus and Streptococcus mutans infections. MethodsThe braided silk sutures were modified through a simple and efficient in situ photoreduction method, resulting in the uniform distribution of AgNPs along the suture surface. The synthesized AgNPs were characterized using scanning electron microscopy (SEM), dynamic light scattering analysis (DLS) and Fourier Transform Infrared Spectroscopy analysis (FTIR) confirming their successful integration onto the silk sutures. The antibacterial activity of the nanoparticle coated sutures were compared and evaluated with non-coated braided silk sutures through in vitro assays against both S. aureus and S. mutans. ResultsThe surface and cross-sectional analysis of the treated sutures revealed a uniform and homogeneous distribution of silver particles achieved through the photoreduction of silver solution. This observation confirms the successful coating of silver nanoparticles (AgNPs) on the sutures. The antimicrobial studies conducted, demonstrated significant reductions in bacterial colonies when exposed to the silver nanoparticle-coated sutures. Notably, the width of the inhibition zone surrounding the coated sutures remained consistently wide and stable for duration up to 7 days. This sustained and robust inhibitory effect against gram-positive bacteria, specifically S. aureus and S. mutans, serves as strong evidence of the antibacterial efficacy of the coated sutures. ConclusionThe coating of silk sutures with AgNPs provided a significant and effective antibacterial capacity to the surgical sutures, with this activity being sustained for a period of 7 days. This suggests that AgNPs-in situ photoreduction deposited sutures have the potential to effectively manage S. aureus and S. mutans infections.

PROBIOTICS FOR THE PREVENTION OF VENTILATOR-ASSOCIATED PNEUMONIA

Ventilator-associated pneumonia is associated with a high rate of all-cause mortality and a prolonged duration of mechanical ventilation and intensive care unit stay. Ventilator associated pneumonia accounts for about half of all antibiotics given in the intensive care unit. Plenty of studies have assessed various kinds of prevention strategies, including pharmacological and non-pharmacological interventions, to prevent ventilator-associated pneumonia over the years. An emerging number of studies has assessed the non-antibiotic approaches for the prevention of ventilator-associated pneumonia in the last few years. One of the frequently used strategy is addition of probiotics in the preventive measures list. Regular consumption of probiotics can modulate immune responses and metabolic processes as well as antioxidant and anti-inflammatory effects. The strongest evidence in favor of probiotics lies in the prevention or treatment of necrotizing enterocolitis, acute infectious diarrhea, acute respiratory tract infections, antibiotic-associated diarrhea, and infant colic. The beneficial effects of probiotics in the prevention of ventilator-associated pneumonia were not yet entirely clarified. Multiple pieces of evidence indicate that the bacteria that populate the gut efficiently modulate the immune response. Treatment with probiotics have shown promising preliminary results to attenuate systemic inflammation, especially in postoperative infections and ventilation performance. This review aims to summarize latest data on the use probiotics to prevent ventilator-associated pneumonia in critical care unit.