Influence of maximum diameter on fine-needle aspiration biopsy outcomes in ACR TI-RADS 5 thyroid nodules.

Introduction: Fine needle aspiration (FNA) biopsy is a widely accepted method for diagnosing thyroid nodules. However, the influence of maximum diameter (MD) of ACR TIRADS 5 (TR5) thyroid nodules on the FNA outcomes remains debated. This study examined the influence of MD on the FNA outcomes and investigated the optimal MD threshold for FNA in TR5 nodules. Methods: We conducted a retrospective analysis of 280 TR5 thyroid nodules from 226 patients who underwent FNA from January to June 2022 in our department. Probably malignant (PM) group was defined as Bethesda V in cytopathology with confirmed BRAF V600E mutation or Bethesda VI, the other cytopathology outcomes were defined as probably benign (PB) group. We examined factors influencing malignant cytopathology outcomes and determined the optimal MD threshold for FNA in TR5 nodules using logistic regression and restricted cubic spline (RCS) analysis. Results: Among these nodules, 58.2% (163/280) had PM outcomes. The PM group had a significantly larger MD than the PB group [6.5mm (range 5.0-8.4) vs. 5.3mm (range 4.0-7.0), p < 0.001]. In multivariate logistic regression fully adjusted for confounders, MD was significantly associated with PM outcomes [odds ratio 1.16, 95%CI 1.05-1.31; p = 0.042]. The highest quartile of MD had a greater likelihood of PM outcomes compared to the lowest quartile [odds ratio 4.71, 95% CI 1.97-11.69, p = 0.001]. The RCS analysis identified 6.2 mm as the optimal MD threshold for FNA in TR5 nodules. Conclusion: MD significantly affects the probability of malignant outcomes in FNA of TR5 thyroid nodules. A MD threshold of ≥6.2mm is suggested for FNA in these nodules.

Exploiting genomic tools for genetic dissection and improving the resistance to Fusarium stalk rot in tropical maize.

KEY MESSAGE: A stable genomic region conferring FSR resistance at ~250 Mb on chromosome 1 was identified by GWAS. Genomic prediction has the potential to improve FSR resistance. Fusarium stalk rot (FSR) is a global destructive disease in maize; the efficiency of phenotypic selection for improving FSR resistance was low. Novel genomic tools of genome-wide association study (GWAS) and genomic prediction (GP) provide an opportunity for genetic dissection and improving FSR resistance. In this study, GWAS and GP analyses were performed on 562 tropical maize inbred lines consisting of two populations. In total, 15 SNPs significantly associated with FSR resistance were identified across two populations and the combinedPOP consisting of all 562 inbred lines, with the P-values ranging from 1.99 × 10-7 to 8.27 × 10-13, and the phenotypic variance explained (PVE) values ranging from 0.94 to 8.30%. The genetic effects of the 15 favorable alleles ranged from -4.29 to -14.21% of the FSR severity. One stable genomic region at ~ 250 Mb on chromosome 1 was detected across all populations, and the PVE values of the SNPs detected in this region ranged from 2.16 to 5.18%. Prediction accuracies of FSR severity estimated with the genome-wide SNPs were moderate and ranged from 0.29 to 0.51. By incorporating genotype-by-environment interaction, prediction accuracies were improved between 0.36 and 0.55 in different breeding scenarios. Considering both the genome coverage and the threshold of the P-value of SNPs to select a subset of molecular markers further improved the prediction accuracies. These findings extend the knowledge of exploiting genomic tools for genetic dissection and improving FSR resistance in tropical maize.

Complications of microwave ablation in patients with persistent/recurrent hyperparathyroidism after surgical or ablative treatment.

OBJECTIVE: To evaluate the complications associated with microwave ablation (MWA) in treating persistent/recurrent hyperparathyroidism (HPT) post-surgical or ablative treatments. MATERIALS AND METHODS: From January 2015 to December 2022, 87 persistent/recurrent HPT patients (primary HPT [PHPT]: secondary HPT [SHPT] = 13:74) who underwent MWA after surgical or ablative treatment were studied. Grouping was based on ablation order (initial vs. re-MWA), prior treatment (parathyroidectomy [PTX] vs. MWA), and etiology (PHPT vs. SHPT). The study focused on documenting and comparing treatment complications and analyzing major complication risk factors. RESULT: Among the 87 patients, the overall complication rate was 17.6% (15/87), with major complications at 13.8% (12/87) and minor complications at 3.4% (3/87). Major complications included recurrent laryngeal nerve (RLN) palsy (12.6%) and Horner syndrome (1.1%), while minor complications were limited to hematoma (3.4%). Severe hypocalcemia noted in 21.6% of SHPT patients. No significant differences in major complication rates were observed between initial and re-MWA groups (10.7% vs. 13.8%, p = 0.455), PTX and MWA groups (12.5% vs. 15.4%, p = 0.770), or PHPT and SHPT groups (15.4% vs. 13.5%, p > 0.999). Risk factors for RLN palsy included ablation of superior and large parathyroid glands (>1.7 cm). All patients recovered spontaneously except for one with permanent RLN palsy in the PTX group (2.1%). CONCLUSION: Complication rates for MWA post-surgical or ablative treatments were comparable to initial MWA rates. Most complications were transient, indicating MWA as a viable and safe treatment option for persistent/recurrent HPT patients.

Safety enhancement of improved hydrodissection for microwave ablation in secondary hyperparathyroidism.

OBJECTIVE: To study the safety of improved hydrodissection based on the periparathyroidal fascial space during microwave ablation (MWA) for secondary hyperparathyroidism (SHPT). MATERIALS AND METHODS: Data from 337 patients (162 males and 175 females; mean age, 50.8 ± 12.8 [range, 16-84] years) who underwent MWA for SHPT were retrospectively reviewed. Among them, 177 patients underwent traditional hydrodissection (traditional group) and 160 patients underwent improved hydrodissection based on periparathyroidal fascial spaces (improved group). Safety enhancement was analyzed by comparing the complications between the two groups. The characteristics of the hydrodissected fascial spaces, complications, and the follow-up results were recorded. The baseline data, clinical parameters, laboratory indices and characteristics of SHPT lesions were analyzed to assess the risk factors associated with hoarseness. RESULTS: Hydrodissection was successfully performed in all the enrolled patients according to the protocol. Six periparathyroid fascial spaces were hydrodissected, depending on the location of the SHPT lesions. The incidence of hoarseness due to recurrent laryngeal nerve injury, the most common complication of thermal ablation for SHPT lesions, was lower in the improved group than in the traditional group (6.9% vs. 13.0%, p = 0.044). The median hoarseness recovery time in the improved group was shorter than that in the traditional group (2 vs. 6 months, p < 0.001). There was no difference in technical efficiency between the two groups (improved group vs. traditional group: 75.0% vs. 70.6%; p > 0.05). CONCLUSIONS: Compared with traditional hydrodissection, improved hydrodissection based on periparathyroidal fascial spaces could enhance safety during MWA for SHPT.

Influence factors and nomogram for volume reduction rate in benign thyroid nodule after thermal ablation.

BACKGROUND: Thermal ablation is a minimally invasive and safe treatment for benign thyroid nodules, and the volume reduction rate (VRR) of nodule is a primary clinical efficacy indicator. PURPOSE: To screen factors influencing VRR in benign thyroid nodules after thermal ablation and establish a predictable nomogram. MATERIALS AND METHODS: This retrospective study enrolled 238 patients with benign thyroid nodules who underwent thermal ablation between January 2016 and September 2021. Clinical information and imaging characteristics in routine ultrasound (US) and contrast-enhanced ultrasound (CEUS) were evaluated. Factors influencing the VRR ≥75% were screened using multivariate logistic regression, and a predictable nomogram was established. RESULTS: At the 12-month follow-up, the VRR of nodule was 77.0 ± 20.6% (18.4-100%). Seven factors influencing the VRR ≥75.0% were identified: echogenicity, component, calcification, enhancement degree, enhancement defect, ring enhancement, and energy of ablation. A nomogram was established based on the above factors, and the predictive ability of the model was confirmed by internal validation with 1000 bootstrap repetitions. The area under the receiver-operating characteristic curve (AUC) of the model was 0.926, and the calibration curve and decision curve analysis (DCA) revealed that this model demonstrated predictive ability. CONCLUSION: Seven factors influencing VRR in benign thyroid nodules after thermal ablation were screened out in the present study and used to establish a nomogram to predict the probability of VRR ≥75% at the 12-month follow-up. It would be beneficial to make personalized medical decisions to trigger thermal ablation in patients with benign thyroid nodules.

Intralesional Marginal Resection for Osteoblastoma in the Mobile Spine: Experience From a Single Center.

Osteoblastoma (OB) is a benign bone tumor with aggressive behavior and a tendency for local recurrence. The appropriate surgical strategy for spinal OB remains unclear. This retrospective study aimed to verify the clinical efficacy and safety of intralesional marginal resection of OB in the mobile spine. We enrolled 50 consecutive patients with spinal OB between January 2009 and December 2019. The tumors were staged based on the Enneking system, with 21 and 29 lesions being determined as stage 2 (St.2) and stage 3 (St.3), respectively. Among them, 42 patients underwent intralesional marginal resection, five underwent extensive curettage, and three underwent en bloc resection successfully since their lesions were limited to the posterior element in a single vertebra. We analyzed clinical characteristics, perioperative and follow-up images, surgical details, and follow-up data. Within a median follow-up duration of 50 (range: 24-160) months, six (12.0%) patients had local recurrence. The recurrence rates among patients who underwent intralesional marginal resection, curettage, en bloc resection were 7.1%(3/42), 60.0%(3/5), and 0%(0/3), respectively. The recurrence rate of intralesional marginal resection of St.3 lesions was slightly higher than that of St.2 lesions (7.7%[2/26] vs. 6.3%[1/16]). There were 16(38.1%), 3(60.0%), and 0 patients with surgical complications among those who underwent intralesional marginal resection, curettage, and en bloc resection, respectively. Local recurrence was observed in five (5/14, 35.7%) patients who had vertebral artery extension and in none who did not have vertebral artery extension (p = 0.02). Our findings suggest that intralesional marginal resection could be an appropriate treatment choice for patients with spinal OB, both St.2 and St.3 lesions, with an acceptable local recurrence rate and a low risk of complications. Vertebral artery extension could be a strong risk factor for local recurrence in patients with spinal OB.

Schwannoma Gene Therapy via Adeno-Associated Viral Vector Delivery of Apoptosis-Associated Speck-like Protein Containing CARD (ASC): Preclinical Efficacy and Safety.

Schwannomas are tumors derived from Schwann-lineage cells, cells that protect and support myelinated nerves in the peripheral nervous system. They are typically slow-growing, encapsulated and benign. These tumors develop along peripheral, spinal and cranial nerves causing pain, sensory-motor dysfunction and death. Primary treatment for schwannoma is operative resection which can be associated with significant morbidity. Pharmacotherapy is largely restricted to bevacizumab, which has minimal or no efficacy for many patients and can be associated with treatment-limiting adverse effects. Given the suffering and morbidity associated with schwannoma and the paucity of therapeutic options, there is an urgent need for safe and effective therapies for schwannomas. We previously demonstrated that adeno-associated virus serotype 1 (AAV1) vector mediated delivery of the inflammasome adaptor protein, apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC) under the control of the P0 promoter, produced a prolonged reduction in tumor volume and tumor-associated pain in human xenograft and mouse syngeneic schwannoma models. Here, we present data essential for the translation of our AAV1-P0-ASC schwannoma gene therapy to clinical trials. We determine the minimum effective dose of AAV1-P0-hASC required to induce an anti-tumor effect in the xenograft human-schwannoma model. We also show that the presence of preexisting AAV1 immunity does not alter the antitumor efficacy of AAV-P0-mASC in a syngeneic mouse schwannoma model. Furthermore, the maximum deliverable intratumoral dose of AAV1-P0-ASC was not associated with neuronal toxicity in immunocompetent mice. Taken together, these safety and efficacy data support the translation of the AAV1-P0-ASC schwannoma gene therapy strategy to clinical trials.

Surgical treatment of spinal tenosynovial giant cell tumor: Experience from a single center and literature review.

Introduction: Spinal tenosynovial giant cell tumor (TGCT) is a rare benign primary spinal tumor with aggressive behavior. The treatment strategy and prognosis of spinal TGCT remain unclear. This retrospective study aimed to evaluate the effectiveness of surgical treatment of spinal TGCT. Methods: We enrolled 18 patients with spinal TGCT who underwent surgical treatment in our hospital between January 2002 and January 2021. Additionally, we reviewed 72 cases of spinal TGCT with surgical treatment reported in the previous literature. Therefore, a total of 90 cases of spinal TGCT were evaluated for their clinical characteristics, surgical details, radiotherapy, and prognosis. Results: In terms of the extent of resection, 73 cases (81.1%) underwent gross total resection (GTR), and 17 cases (18.9%) underwent subtotal resection (STR). Regarding the technique of GTR, 12 cases (16.7%) underwent en bloc resection, while 60 cases (83.3%) underwent piecemeal resection. During a median follow-up duration of 36 months (range: 3-528 months), 17.8% (16/90) cases experienced local recurrence/progression. The local recurrence/progression rate in cases that underwent GTR was 8.2% (6/73), which was significantly lower than that in cases with STR (58.8%, 10/17) (p<0.001). The local recurrence/progression rate of en bloc resection was 8.3% (1/12), and that of piecemeal resection was 8.3% (5/60). Twelve cases underwent perioperative adjuvant radiotherapy, and one (8.3%, 1/12) of them showed disease progression during follow-up. Six recurrent/progressive lesions were given radiotherapy and all of them remained stable in the subsequent follow-up. Eight recurrent/progressive lesions were only treated with re-operation without radiotherapy, and half of them (50.0%, 4/8) demonstrated repeated recurrence/progression in the subsequent follow-up. Conclusion: Surgical treatment could be effective for spinal TGCT cases, and GTR is the preferred surgical strategy. Piecemeal resection may be appropriate for spinal TGCT cases with an acceptable local recurrence/progression rate. Perioperative adjuvant radiotherapy may reduce the risk of postoperative local recurrence/progression, and radiotherapy plays an important role in the treatment of recurrent/unresectable spinal TGCT lesions.

Genomic Prediction of Resistance to Tar Spot Complex of Maize in Multiple Populations Using Genotyping-by-Sequencing SNPs.

Tar spot complex (TSC) is one of the most important foliar diseases in tropical maize. TSC resistance could be furtherly improved by implementing marker-assisted selection (MAS) and genomic selection (GS) individually, or by implementing them stepwise. Implementation of GS requires a profound understanding of factors affecting genomic prediction accuracy. In the present study, an association-mapping panel and three doubled haploid populations, genotyped with genotyping-by-sequencing, were used to estimate the effectiveness of GS for improving TSC resistance. When the training and prediction sets were independent, moderate-to-high prediction accuracies were achieved across populations by using the training sets with broader genetic diversity, or in pairwise populations having closer genetic relationships. A collection of inbred lines with broader genetic diversity could be used as a permanent training set for TSC improvement, which can be updated by adding more phenotyped lines having closer genetic relationships with the prediction set. The prediction accuracies estimated with a few significantly associated SNPs were moderate-to-high, and continuously increased as more significantly associated SNPs were included. It confirmed that TSC resistance could be furtherly improved by implementing GS for selecting multiple stable genomic regions simultaneously, or by implementing MAS and GS stepwise. The factors of marker density, marker quality, and heterozygosity rate of samples had minor effects on the estimation of the genomic prediction accuracy. The training set size, the genetic relationship between training and prediction sets, phenotypic and genotypic diversity of the training sets, and incorporating known trait-marker associations played more important roles in improving prediction accuracy. The result of the present study provides insight into less complex trait improvement via GS in maize.

Genetic Dissection of Quantitative Resistance to Common Rust (Puccinia sorghi) in Tropical Maize (Zea mays L.) by Combined Genome-Wide Association Study, Linkage Mapping, and Genomic Prediction.

Common rust is one of the major foliar diseases in maize, leading to significant grain yield losses and poor grain quality. To dissect the genetic architecture of common rust resistance, a genome-wide association study (GWAS) panel and a bi-parental doubled haploid (DH) population, DH1, were used to perform GWAS and linkage mapping analyses. The GWAS results revealed six single-nucleotide polymorphisms (SNPs) significantly associated with quantitative resistance of common rust at a very stringent threshold of P-value 3.70 × 10-6 at bins 1.05, 1.10, 3.04, 3.05, 4.08, and 10.04. Linkage mapping identified five quantitative trait loci (QTL) at bins 1.03, 2.06, 4.08, 7.03, and 9.00. The phenotypic variation explained (PVE) value of each QTL ranged from 5.40 to 12.45%, accounting for the total PVE value of 40.67%. Joint GWAS and linkage mapping analyses identified a stable genomic region located at bin 4.08. Five significant SNPs were only identified by GWAS, and four QTL were only detected by linkage mapping. The significantly associated SNP of S10_95231291 detected in the GWAS analysis was first reported. The linkage mapping analysis detected two new QTL on chromosomes 7 and 10. The major QTL on chromosome 7 in the region between 144,567,253 and 149,717,562 bp had the largest PVE value of 12.45%. Four candidate genes of GRMZM2G328500, GRMZM2G162250, GRMZM2G114893, and GRMZM2G138949 were identified, which played important roles in the response of stress resilience and the regulation of plant growth and development. Genomic prediction (GP) accuracies observed in the GWAS panel and DH1 population were 0.61 and 0.51, respectively. This study provided new insight into the genetic architecture of quantitative resistance of common rust. In tropical maize, common rust could be improved by pyramiding the new sources of quantitative resistance through marker-assisted selection (MAS) or genomic selection (GS), rather than the implementation of MAS for the single dominant race-specific resistance gene.

Comparable efficacy of 100 mg aspirin twice daily and rivaroxaban for venous thromboembolism prophylaxis following primary total hip arthroplasty: a randomized controlled trial.

BACKGROUND: Aspirin has demonstrated safety and efficacy for venous thromboembolism (VTE) prophylaxis following total hip arthroplasty (THA); however, inconsistent dose regimens have been reported in the literature. This study aimed to evaluate and compare the safety and efficacy of 100 mg aspirin twice daily with rivaroxaban in VTE prophylaxis following THA. METHODS: Patients undergoing elective unilateral primary THA between January 2019 and January 2020 were prospectively enrolled in the study and randomly allocated to receive 5 weeks of VTE prophylaxis with either oral enteric-coated aspirin (100 mg twice daily) or rivaroxaban (10 mg once daily). Medication safety and efficacy were comprehensively evaluated through symptomatic VTE incidence, deep vein thrombosis (DVT) on Doppler ultrasonography, total blood loss (TBL), laboratory bloodwork, Harris hip score (HHS), post-operative recovery, and the incidence of other complications. RESULTS: We included 70 patients in this study; 34 and 36 were allocated to receive aspirin and rivaroxaban prophylaxis, respectively. No cases of symptomatic VTE occurred in this study. The DVT rate on Doppler ultrasonography in the aspirin group was not significantly different from that in the rivaroxaban group (8.8% vs. 8.3%, χ2 = 0.01, P = 0.91), confirming the non-inferiority of aspirin for DVT prophylaxis (χ2 = 2.29, P = 0.01). The calculated TBL in the aspirin group (944.9 mL [658.5-1137.8 mL]) was similar to that in the rivaroxaban group (978.3 mL [747.4-1740.6mL]) (χ2 = 1.55, P = 0.12). However, there were no significant inter-group differences in HHS at post-operative day (POD) 30 (Aspirin: 81.0 [78.8-83.0], Rivaroxaban: 81.0 [79.3-83.0], χ2 = 0.43, P = 0.67) and POD 90 (Aspirin: 90.0 [89.0-92.0], Rivaroxaban: 91.5 [88.3-92.8], χ2 = 0.77, P = 0.44), the incidence of bleeding events (2.9% vs. 8.3%, χ2 = 0.96, P = 0.33), or gastrointestinal complications (2.9% vs. 5.6%, χ2 = 1.13, P = 0.29). CONCLUSION: In terms of safety and efficacy, the prophylactic use of 100 mg aspirin twice daily was not statistically different from that of rivaroxaban in preventing VTE and reducing the risk of blood loss following elective primary THA. This supports the use of aspirin chemoprophylaxis following THA as a less expensive and more widely available option for future THAs. TRIAL REGISTRATION: Chictr.org, ChiCTR18000202894; http://www.chictr.org.cn/showproj.aspx?proj=33284.

Leaf transcriptomic response mediated by cold stress in two maize inbred lines with contrasting tolerance levels.

Maize (Zea mays L.) is a thermophilic plant and a minor drop in temperature can prolong the maturity period. Plants respond to cold stress through structural and functional modification in cell membranes as well as changes in the photosynthesis and energy metabolism. In order to understand the molecular mechanisms underlying cold tolerance and adaptation, we employed leaf transcriptome sequencing together with leaf microstructure and relative electrical conductivity measurements in two maize inbred lines, having different cold stress tolerance potentials. The leaf physiological and transcriptomic responses of maize seedlings were studied after growing both inbred lines at 5 °C for 0, 12 and 24 h. Differentially expressed genes were enriched in photosynthesis antenna proteins, MAPK signaling pathway, plant hormone signal transduction, circadian rhythm, secondary metabolites related pathways, ribosome, and proteasome. The seedlings of both genotypes employed common stress responsive pathways to respond to cold stress. However, the cold tolerant line B144 protected its photosystem II from photooxidation by upregulating D1 proteins. The sensitive line Q319 was unable to close its stomata. Collectively, B144 exhibited a cold tolerance owing to its ability to mediate changes in stomata opening as well as protecting photosystem. These results increase our understanding on the cold stress tolerance in maize seedlings and propose multiple key regulators of stress responses such as modifications in photosystem II, stomata guard cell opening and closing, changes in secondary metabolite biosynthesis, and circadian rhythm. This study also presents the signal transduction related changes in MAPK and phytohormone signaling pathways in response to cold stress during seedling stage of maize.

Combination of volume-rendering 3D surface modeling and medical illustration to capture the living fetus.

OBJECTIVE: A good medical illustration renders essential aspects of a procedure or condition faithfully, yet idealizes it enough to make it widely applicable. Unfortunately, the live fetus is generally hidden from sight, and illustrating it relies either on autopsy material or manipulated newborn images. High-definition volume rendering of diagnostic imaging data can represent hidden conditions with an almost lifelike realism but is limited by the resolution and artifacts of the data capture. We have combined both approaches to enhance the accuracy and didactic value of illustrations of fetal conditions. METHODS: Three examples, of increasing complexity, are presented to demonstrate the creation of medical illustrations of the fetus based on semiautomatic computerized posthoc manipulation of diagnostic images. RESULTS: The end product utilizes the diagnostic accuracy of ultrasound and magnetic resonance imaging of the fetuses and the spatial manipulation of 3D models to create a lifelike, accurate and informative image of the fetal anomalies. CONCLUSION: Volume-rendering and 3D surface modeling can be combined with medical illustration to create realistic and informative images of the developing fetus, using a level of detail that is tailored to the intended audience.

Air Duster Inhalant Abuse Causing Non-ST Elevation Myocardial Infarction.

Inhalant abuse, also known as huffing, is common among teenagers and adolescents in the United States and worldwide. Inhaled aerosols are dangerous due to both the presence of volatile hydrocarbons causing direct organ damage and the risk of the compressed air causing physical trauma (e.g. expansion, barotrauma) or skin trauma from chemical or temperature burn. Here, we present the case of a 35-year-old man who was inhaling multiple canisters of Dust-Off (Falcon Safety Products Inc., Branchburg, NJ) keyboard air duster daily for approximately one month. He presented with intermittent burning chest pains, and was found to have elevated troponin (peak 17 ng/mL, normal range 0-0.5 ng/mL) without ST-segment elevations, concerning for non-ST elevation myocardial infarction (NSTEMI) as well as elevated aminotransferases and elevated serum creatinine. He was treated conservatively with supportive measures, with successful resolution of his laboratory abnormalities as well as his chest pain. Clinicians should be aware of the possible medical complications of inhalant abuse, and the expected clinical course. In this case, we aim to demonstrate the acute onset and self-resolution of significant cardiomyocyte damage in a young male patient abusing duster.

Discharge narcotic prescribing and management practices at pediatric trauma centers in the United States.

INTRODUCTION: Trauma is the leading cause of mortality among children in the US. Injured children often receive narcotic pain medication throughout their hospital stays and upon discharge from pediatric trauma centers. While effective, narcotics carry significant risks. There is a dearth of knowledge regarding narcotic education, prescribing practices, and pain management training at pediatric trauma centers. We hypothesize that there is a lack of standardization in these practices among pediatric trauma centers nationally. METHODS: A national survey was sent to medical directors at ACS-verified and state designated level 1 and 2 pediatric trauma centers. Data were collected over 6 months on discharge narcotic education and prescribing practices. RESULTS: Of 97 surveys sent, 92 were returned (94.8% response). Responses show that narcotics are most commonly prescribed by residents (79.1%). Electronic Medical Record (EMR) prescribing is common (89.2%); however, only 1.75% of EMRs give recommendation to prescribe naloxone. Only 9.7% report a standardized format of narcotic education. Most healthcare staff providing narcotic education receive no training in nonpharmacological pain management (68.8%). Most centers report no formal process to reduce the quantity of discharge narcotics prescribed (71.0%). Respondents report many barriers to providing discharge narcotic education to patients and families, including staff training on how to provide discharge narcotic education, staff availability, patient/ parent literacy, and format of available educational resources. CONCLUSION: The study results show that there is lack of standardization in discharge narcotic education and prescription practices among pediatric trauma facilities nationally and highlight the need for a standardized narcotic prescribing and management protocol. Despite the growing national concern of opiate misuse, particularly among children, respondents report inability to deliver adequate narcotic education owing to various communication and systems barriers. TYPE OF STUDY: Cross-sectional survey. LEVEL OF EVIDENCE: Level IV.

Identification and Management of Fusobacterium Nucleatum Liver Abscess and Bacteremia in a Young Healthy Man.

A 21-year-old previously healthy young man was admitted with five days of fever, persistent cough, worsening shortness of breath, and vomiting. On presentation, laboratory evaluation revealed extremely elevated procalcitonin and leukopenia followed by leukocytosis. The patient was started on empiric antibiotics. Further diagnostic evaluation after initiation of antibiotics included a computed tomography scan, which revealed a large hepatic abscess. Blood cultures obtained on admission grew Fusobacterium nucleatum; fluid obtained from the hepatic abscess also grew F. nucleatum. The patient's antibiotic regimen was narrowed for specific coverage of F. nucleatum. The liver abscess was drained several times via image-guided percutaneous abscess drainage, with eventual resolution of the abscess. Patient received a prolonged course of intravenous antibiotics and, once stabilized, was discharged on two weeks of Augmentin. Here, we present a rare case of hepatic abscess and bacteremia due to F. nucleatum in a previously healthy young man with good oral hygiene. With this case, we aim to demonstrate the following: (1) the acute onset and rapid disease progression of F. nucleatum bacteremia and liver abscess; (2) how extreme procalcitonin elevation may serve to be a clinically useful early marker of F. nucleatum infection; and (3) the importance of early diagnosis, treatment, and definitive abscess drainage of F. nucleatum bacteremia and liver abscess.

Comparison of ceramic-on-ceramic bearing vs ceramic-on-highly cross-linked polyethylene-bearing surfaces in total hip arthroplasty for avascular necrosis of femoral head: a prospective cohort study with a mid-term follow-up.

BACKGROUND: The ideal bearing surface for patients of avascular necrosis (AVN) undergoing total hip arthroplasty (THA) remains controversial. The purpose of this study is to evaluate the clinical outcomes, health-related quality of life (HRQL), and wear of the bearing surface between ceramic-on-ceramic (CoC) and ceramic-on-highly cross-linked polyethylene (CoXPE) THA for patients of AVN after midterm follow-up. METHODS: We performed a retrospective case-control analysis of 93 CoC and 77 CoXPE consecutive THAs for patients of AVN. The cases were followed at a minimum 5 years follow-up (average 7 years). Harris hip score (HHS) score and bearing-related complications were assessed. The health-related quality of life (HRQL) was assessed with the Short Form 36 (SF-36). Plain radiographs and computed tomography (CT) were used for radiographic evaluation. RESULTS: Both the CoC group and CoXPE group showed statistically significant improvements in HHS scores with no difference between the two bearing surfaces. There was no significant difference as for SF-36 at the latest follow-up between two groups, except for significant higher scores in the dimensions of general health in the CoC group (75.7 vs 64.7, P = 0.032). No radiographic evidence of osteolysis and loosening was present at the final follow-up. The mean wear rate of the CoC was 0.0096 mm/year and the CoXPE was 0.047 mm/year after evaluation with reconstructed CT. CONCLUSIONS: CoC THAs acts as well as CoXPE THAs for patients with femoral head avascular necrosis after midterm follow-up. CoC bearing can significantly decrease the wearing rate than CoXPE bearing.

Efficacy and reliability of active robotic-assisted total knee arthroplasty compared with conventional total knee arthroplasty: a systematic review and meta-analysis.

BACKGROUND: In the field of prosthetics, the ultimate goal is to improve the clinical outcome by using a technique that prolongs the longevity of prosthesis. Active robotic-assisted total knee arthroplasty (TKA) is one such technique that is capable of providing accurate implant position and restoring mechanical alignment. Although relevant studies have been carried out, the differences in the efficacy and reliability between active robotic-assisted TKA and conventional arthroplasty have not yet been adequately discussed. METHODS: We referenced articles, including randomised controlled trials and comparative retrospective research, from PubMed, Embase, Cochrane Library and Web of Science, in order to compare active robotic-assisted TKA with the conventional technique. Data extraction and quality assessment were conducted for each study. Statistical analysis was performed using Revman V. 5.3. RESULTS: Seven studies with a total of 517 knees undergoing TKA were included. Compared with conventional surgery, active robotic TKA showed better outcomes in precise mechanical alignment (mean difference, MD: - 0.82, 95% CI: -1.15 to - 0.49, p < 0.05) and implant position, with lower outliers (p < 0.05), better functional score (Western Ontario and McMaster University, Knee Society Score functional score) and less drainage (MD: - 293.28, 95% CI: - 417.77 to - 168.79, p < 0.05). No significant differences were observed when comparing the operation time, range of motion and complication rates. CONCLUSION: The current research demonstrates that active robotic-assisted TKA surgeries are more capable of improving mechanical alignment and prosthesis implantation when compared with conventional surgery. Further studies are required to investigate the potential benefits and long-term clinical outcomes of active robotic-assisted TKA.

Roles and mechanisms of leptin in osteogenic stimulation in cervical ossification of the posterior longitudinal ligament.

BACKGROUND: Hyperleptinemia is a common feature of obese people, and leptin, an adipocyte-derived cytokine, is believed to be an important factor in the pathogenesis of cervical ossification of the posterior longitudinal ligament(C-OPLL). So this research was to identify the relation between the serum leptin and bone metabolic markers and how the leptin induced osteogenic effect in C-OPLL. METHODS: Sixty-four samples were selected to determine the concentration of leptin, insulin, and alkaline phosphatase. And the association of leptin with these factors was also examined. We also evaluate the effect of leptin on the development of C-OPLL and further explored the possible underlying mechanism in vitro. RESULTS: We found that serum leptin concentrations were higher in females than in males. Serum leptin and ALP concentrations were increased significantly in C-OPLL females compared to non-OPLL females. In OPLL subjects, the serum leptin concentration corrected for body mass index correlated negatively with the ALP concentrations. In C-OPLL cells, leptin treatment led to a significant increase in mRNA expressions of ALP and OCN and formation of mineralized nodule. Our experiments reported here that osteogenic effect of leptin in C-OPLL cells could be mediated via ERK1/2, p38 MAPK, and/or JNK signaling pathways. CONCLUSIONS: From this research, we got that leptin treatment led to a significant increase in mRNA expressions of ALP and OCN and formation of mineralized nodule. And the osteogenic effect of leptin in C-OPLL cells could be mediated via ERK1/2, p38 MAPK, and/or JNK signaling pathways.

Genomic Selection Outperforms Marker Assisted Selection for Grain Yield and Physiological Traits in a Maize Doubled Haploid Population Across Water Treatments.

To increase genetic gain for tolerance to drought, we aimed to identify environmentally stable QTL in per se and testcross combination under well-watered (WW) and drought stressed (DS) conditions and evaluate the possible deployment of QTL using marker assisted and/or genomic selection (QTL/GS-MAS). A total of 169 doubled haploid lines derived from the cross between CML495 and LPSC7F64 and 190 testcrosses (tester CML494) were evaluated in a total of 11 treatment-by-population combinations under WW and DS conditions. In response to DS, grain yield (GY) and plant height (PHT) were reduced while time to anthesis and the anthesis silking interval (ASI) increased for both lines and hybrids. Forty-eight QTL were detected for a total of nine traits. The allele derived from CML495 generally increased trait values for anthesis, ASI, PHT, the normalized difference vegetative index (NDVI) and the green leaf area duration (GLAD; a composite trait of NDVI, PHT and senescence) while it reduced trait values for leaf rolling and senescence. The LOD scores for all detected QTL ranged from 2.0 to 7.2 explaining 4.4 to 19.4% of the observed phenotypic variance with R2 ranging from 0 (GY, DS, lines) to 37.3% (PHT, WW, lines). Prediction accuracy of the model used for genomic selection was generally higher than phenotypic variance explained by the sum of QTL for individual traits indicative of the polygenic control of traits evaluated here. We therefore propose to use QTL-MAS in forward breeding to enrich the allelic frequency for a few desired traits with strong additive QTL in early selection cycles while GS-MAS could be used in more mature breeding programs to additionally capture alleles with smaller additive effects.