Long-term disease-specific quality of life after laparoscopic Nissen fundoplication in patients with borderline GERD.

BACKGROUND: Historically, DeMeester score over 14.7 has been used to diagnose GERD. The 2022 American Gastroenterological Association clinical guidelines define GERD based on acid exposure time (AET) instead of DeMeester score. We aim to compare outcomes after laparoscopic Nissen fundoplication (LNF) in patients based on differing GERD diagnostic criteria. METHODS: Patients who underwent first-time LNF between 2009 and 2017 were identified. Demographics, objective GERD evaluation, and outcomes were maintained in an IRB-approved database. Disease-specific quality of life was assessed with a survey (GERD-HRQL) with higher values representing more symptomatic disease. Descriptive statistics, Fischer's exact test and logistic regression were used to analyze the data, p-value < 0.05. RESULTS: 225 patients were stratified into two groups: borderline GERD (AET 4-6%, n = 25.11%) and GERD (AET ≥ 6%, n = 200.89%). The mean age was 50.1 ± 13.4 years and 169 (75%) were female. Baseline GERD-HRQL was lower in the borderline group (24.3 vs 30.0, p = 0.031). Short-term (5 weeks [IQR 4, 8]), medium-term (14 months [IQR 7.25, 31]) and long-term (6.75 years [IQR 5.5, 8]) follow-up was performed. GERD-HRQL scores did not differ between borderline and GERD patients at short-(6.0 vs 7.1, p = 0.630), medium-(12.0 vs 12.1, p = 0.818), or long-term follow-up (10.0 vs 9.0, p = 0.757). The absolute long-term improvement in GERD-HRQL was -12.3 (p = 0.022) vs. -21.3 (p < 0.001). At long-term follow-up there was no difference in PPI use (50% vs 47%, p = 0.852), satisfaction (58% vs 76%, p = 0.187), willingness to repeat the procedure given the benefit of hindsight (75% vs 85%, p = 0.386), or need for reoperation (14% vs 13%, p = 0.910). CONCLUSION: Both patients with borderline GERD and GERD achieve GERD-HRQL improvements at 7 years following laparoscopic Nissen fundoplication and demonstrate similar long-term PPI usage and satisfaction with surgical results. Borderline GERD patients have lower GERD-HRQL at baseline, and thus have smaller improvements in their QOL scores. Anti-reflux surgery should be considered for patients with a diagnosis of borderline GERD refractory to medical therapy.

A Systematic Review of the State of Preclinical Mentorship Programs in Plastic and Reconstructive Surgery.

Background: Plastic and reconstructive surgery is consistently one of the most competitive medical specialties in the match. The recent United States Medical Licensing Examination score reporting switch to pass-fail led to a change in metrics by which applicants are evaluated by plastic surgery programs. Applicant research productivity and the demand for plastic surgery mentorship will continue to rise. Given the competitive nature of the residency match and shift in metrics emphasis after the change in STEP 1 scoring, early exposure to plastic surgery and mentoring relationships are paramount to applicant success. However, most medical students are not exposed to plastic surgery until they begin clinical rotations. Methods: A literature review of plastic surgery mentorship programs available during preclinical years was conducted to identify preclinical mentorship opportunities in plastic surgery. Sixty-eight references were identified, but only two studies met the inclusion criteria of addressing mentorship programs in preclinical years. Results: Examination of the included studies indicated that preclinical medical students achieve self-identified goals and generate longitudinal benefits in plastic surgery by participating in early and focused mentorship programs. Conclusions: The limited number of studies in this review highlights a lack of available, studied preclinical mentorship programs in plastic surgery and reveals a knowledge gap concerning the creation of successful preclinical mentorship programs. Early exposure to plastic surgery, combined with the development of structured preclinical mentorship programs, can potentially replicate successful outcomes seen in other surgical subspecialties' mentorship programs while addressing the lack of formalized mentorship opportunities for preclinical students in plastic surgery.

Reducing Opioid Overprescribing through Procedure-specific Prescribing Guidelines.

Despite advances in opioid-sparing pain management, postdischarge opioid overprescribing in plastic surgery remains an issue. Procedure-specific prescribing protocols have been implemented successfully in other surgical specialties but not broadly in plastic surgery. This study examined the efficacy of procedure-specific prescribing guidelines for reducing postdischarge opioid overprescribing. Methods: A total of 561 plastic surgery patients were evaluated retrospectively after a prescribing guideline, which recommended postdischarge prescription amounts based on the type of operation, was introduced in July 2020. Prescription and postdischarge opioid consumption amounts before (n = 428) and after (n = 133) guideline implementation were compared. Patient satisfaction and prescription frequency of nonopioid analgesia were also compared. Results: The average number of opioid pills per prescription decreased by 25% from 19.3 (27.4 OME) to 15.0 (22.7 OME; P = 0.001) after guideline implementation, with no corresponding decrease in the average number of postdischarge opioid pills consumed [10.6 (15.1 OME) to 8.2 (12.4 OME); P = 0.147]. Neither patient satisfaction with pain management (9.6-9.6; P > 0.99) nor communication (9.6-9.5; P > 0.99) changed. The rate of opioid-only prescription regimens decreased from 17.9% to 7.6% (P = 0.01), and more patients were prescribed at least two nonopioid analgesics (27.5% to 42.9%; P = 0.003). The rate of scheduled acetaminophen prescription, in particular, increased (54.7% to 71.4%; P = 0.002). Conclusions: A procedure-specific prescribing model is a straight-forward intervention to promote safer opioid-prescribing practices in plastic surgery. Its usage in clinical practice may lead to more appropriate opioid prescribing.

MoO3 thin layers on NiCo2S4 substrate for efficient electrochemical charge storage.

Ternary oxides/sulfides have long been investigated as promising electrode materials for charge storage applications. However, it is important to rationally design nanostructured hybrid composites for superior charge storage performance as electrodes in devices. In this work, MoO3@NiCo2S4 hybrid composites materials are synthesized by the hydrothermal method followed by annealing at different temperatures. The charge storage properties of these materials are tested by cyclic voltammetry, galvanostatic charge-discharge curves and electrochemical impedance spectroscopy. It is found that the structure of the hybrid composite material not only assists electron and charge transportation but also precisely control the volume expansion during redox reactions, contributing to superior electrochemical behavior. Among all the electrodes, the electrode fabricated with MoO3@NiCo2S4 composite material annealed at 400 °C (MoO3@NiCo2S4-400) is the best for charge storage applications. At 400 °C, MoO3 spreads as a thin layer of surface polymeric molybdates on NiCo2S4 as seen in the XRD pattern. Significantly, it delivers the highest capacitance of 1622 F g-1 at 1 A g-1 in 2 M aqueous KOH electrolyte compared to other hybrid composite electrodes, NiCo2S4 (962 F g-1), MoO3@NiCo2S4-500 (1412 F g-1) and MoO3@NiCo2S4-600 (970 F g-1), under the same measurement conditions. Furthermore, the MoO3@NiCo2S4-400 hybrid electrode shows better cyclic stability with 93% capacitance retention after 3000 charge-discharge cycles at 8 A g-1. The synergistic effect of two components and annealing temperature plays important role in enhancing the charge storage performance. This work shows the importance of the synthesis temperature on the functional character of ternary sulfide/oxide composite materials for charge storage applications.

Design, optimization and analysis of large DNA and RNA nanostructures through interactive visualization, editing and molecular simulation.

This work seeks to remedy two deficiencies in the current nucleic acid nanotechnology software environment: the lack of both a fast and user-friendly visualization tool and a standard for structural analyses of simulated systems. We introduce here oxView, a web browser-based visualizer that can load structures with over 1 million nucleotides, create videos from simulation trajectories, and allow users to perform basic edits to DNA and RNA designs. We additionally introduce open-source software tools for extracting common structural parameters to characterize large DNA/RNA nanostructures simulated using the coarse-grained modeling tool, oxDNA, which has grown in popularity in recent years and is frequently used to prototype new nucleic acid nanostructural designs, model biophysics of DNA/RNA processes, and rationalize experimental results. The newly introduced software tools facilitate the computational characterization of DNA/RNA designs by providing multiple analysis scripts, including mean structures and structure flexibility characterization, hydrogen bond fraying, and interduplex angles. The output of these tools can be loaded into oxView, allowing users to interact with the simulated structure in a 3D graphical environment and modify the structures to achieve the required properties. We demonstrate these newly developed tools by applying them to design and analysis of a range of DNA/RNA nanostructures.

Histopathological changes in testis of the freshwater fish, Heteropneustes fossilis (Bloch) exposed to linear alkyl benzene sulphonate (LAS).

The objective of this study was to use the freshwater food fish, Heteropneustes fossilis, as a model to evaluate the concentration-dependent effects of LAS on the testicular structure through short-term static bioassays. Concentration mediated histopathological leisions were observed in testis of H. fossilis, treated with four different concentrations of LAS for 24, 48, 72 and 96 hr Inference drawn from the study is that the cytotoxic damage is more pronounced in fish exposed to higher concentrations of LAS for shorter durations than lower concentrations of LAS for longer durations. Gross damage of germinal epithelium, inflammatory response, intertubular vacuolations and contraction and condensation in the cells of tubules under all sets of intoxication and exposures are quite suggestive of reproductive impairment leading to delayed gonadal maturity.