Wearing a Surgical Vest With a Sterile Surgical Helmet System Decreases Contamination of the Surgical Field.

BACKGROUND: Sterile surgical helmet systems are frequently utilized in total knee arthroplasty procedures to protect the surgeon while maintaining a comfortable working environment. However, common helmet systems pressurize the space between the surgical gown and the surgeon's skin. In gowns with a back seam, this may allow contaminated skin particles to escape into the surgical field. By measuring bacterial colony-forming units (CFUs), this study sought to determine if occlusion of the open back seam reduced the risk of potential contamination. METHODS: First, qualitative analysis depicting airflow variations between gown configurations was performed using the Schlieren Spherical Mirror imaging system. Each gown configuration consisted of a sterile surgical helmet and one of 3 gown configurations: a standard gown with rear-tied closure, a standard gown with a surgical vest, and a zippered Toga-style gown. Next, a surgeon then performed simulated surgical activities for 60 minutes within a 1.4 m3 isolation chamber with work surfaces and controllable filtered air exchanges. During each procedure, contaminated particles were collected on sets of agar settle plates positioned directly behind the surgeon. Upon completion, the agar plates were incubated in a biolab, and the number of bacterial and fungal CFUs was counted. The experimental procedure was repeated 12 times for each gown configuration, with sterilization of the chamber between runs. Contamination rates were expressed as CFUs/m2/h. RESULTS: The mean contamination rate measured with the standard gown was 331.7 ± 52.0 CFU/m2/h. After the addition of a surgical vest, this rate decreased by 45% to 182.2 ± 30.8 CFU/m2/h (P = .02). Similarly, with the Toga-style gown, contamination rates dropped by 49% to 170.5 ± 41.9 CFU/m2/h (P = .01). CONCLUSIONS: When used in conjunction with surgical helmet systems, conventional surgical gowns do not prevent potential contamination of the surgical field. We recommend that staff within the surgical field cover the back seam of standard gowns with a vest or don a zippered Toga-style gown.

Operating Room Airborne Microbial Load: Non-Scrubbed Staff Apparel Matters.

BACKGROUND: Infection is a leading cause of total joint arthroplasty failure. In previous studies, we found correlations between the level of contamination, concentrations of airborne particles, and the number of staff present. In this study, we focused on the apparel of non-scrubbed operating room (OR) staff to elucidate their contribution to the airborne microbial load. METHODS: We compared hospital-laundered scrubs to disposable coveralls using two methods. 1) Participants entered an isolation chamber with a controlled environment and completed tasks for one hour wearing both the approved and alternative OR attire. Settle plates collected viable contaminants that were shed by the participants during testing. 2) Lab members conducted standardized maneuvers in a functional OR that simulated typical movements of the nurse, anesthesiologist, implant representative, and entering/exiting staff. An airborne particle counter and settle plates were positioned throughout the OR. After one hour, the staff changed apparel and repeated the test. Each session of both phases consisted of two tests by the same individuals on the same day. RESULTS: There was approximately a 10-fold difference in the settlement rate of viable particles between groups when employing the isolation chamber. The settle rate for scrubs was 5,519 ± 1,381 colony-forming units (CFUs)/m2/hour, while the settle rate for coveralls was 505 ± 55 CFUs/m2/hour (P = 0.008). During testing in the OR, 218.7 ± 35 CFUs/m2/hour were captured for scrubs, compared to 50.5 ± 13 CFUs/m2/hour for the coverall (P < 0.01). The concentration of airborne particles collected for scrubs was 4,952.1 ± 495 particles/m3 and 1,065 ± 53 particles/m3 for the coveralls (P < 0.01). This was a 77 and 79% reduction for both measures, respectively. CONCLUSION: The open nature of standard scrubs allows contaminated particles to escape into the OR environment, whereas the one-piece design of the coveralls restricts pathways of escape. The results of this study may be helpful when developing hospital infection prevention policies.

Standardising the biochemical confirmation of adult male hypogonadism: A joint position statement by the Society for Endocrinology and Association of Clinical Biochemistry and Laboratory Medicine.

BACKGROUND: Inter-assay variation between different immunoassays and different mass spectrometry methods hampers the biochemical confirmation of male hypogonadism. Furthermore, some laboratories utilise assay manufacturer reference ranges that do not necessarily mirror assay performance characteristics, with the lower limit of normality ranging from 4.9 nmol/L to 11 nmol/L. The quality of the normative data underlying commercial immunoassay reference ranges is uncertain. DESIGN: A working group reviewed published evidence and agreed upon standardised reporting guidance to augment total testosterone reports. RESULTS: Evidence-based guidance on appropriate blood sampling, clinical action limits, and other major factors likely to affect the interpretation of results are provided. CONCLUSIONS: This article aims to improve the quality of the interpretation of testosterone results by non-specialist clinicians. It also discusses approaches for assay harmonisation which have been successful in some but not all healthcare systems.

Revealing the Reactivity of Individual Chemical Entities in Complex Mixtures: the Chemistry Behind Bio-Oil Upgrading.

Bio-oils are precursors for biofuels but are highly corrosive necessitating further upgrading. Furthermore, bio-oil samples are highly complex and represent a broad range of chemistries. They are complex mixtures not simply because of the large number of poly-oxygenated compounds but because each composition can comprise many isomers with multiple functional groups. The use of hyphenated ultrahigh-resolution mass spectrometry affords the ability to separate isomeric species of complex mixtures. Here, we present for the first time, the use of this powerful analytical technique combined with chemical reactivity to gain greater insights into the reactivity of the individual isomeric species of bio-oils. A pyrolysis bio-oils and its esterified bio-oil were analyzed using gas chromatography coupled to Fourier transform ion cyclotron resonance mass spectrometry, and in-house software (KairosMS) was used for fast comparison of the hyphenated data sets. The data revealed a total of 10,368 isomers in the pyrolysis bio-oil and an increase to 18,827 isomers after esterification conditions. Furthermore, the comparison of the isomeric distribution before and after esterification provide new light on the reactivities within these complex mixtures; these reactivities would be expected to correspond with carboxylic acid, aldehyde, and ketone functional groups. Using this approach, it was possible to reveal the increased chemical complexity of bio-oils after upgrading and target detection of valuable compounds within the bio-oils. The combination of chemical reactions alongside with in-depth molecular characterization opens a new window for the understanding of the chemistry and reactivity of complex mixtures.

A terrestrial planet candidate in a temperate orbit around Proxima Centauri.

At a distance of 1.295 parsecs, the red dwarf Proxima Centauri (α Centauri C, GL 551, HIP 70890 or simply Proxima) is the Sun's closest stellar neighbour and one of the best-studied low-mass stars. It has an effective temperature of only around 3,050 kelvin, a luminosity of 0.15 per cent of that of the Sun, a measured radius of 14 per cent of the radius of the Sun and a mass of about 12 per cent of the mass of the Sun. Although Proxima is considered a moderately active star, its rotation period is about 83 days (ref. 3) and its quiescent activity levels and X-ray luminosity are comparable to those of the Sun. Here we report observations that reveal the presence of a small planet with a minimum mass of about 1.3 Earth masses orbiting Proxima with a period of approximately 11.2 days at a semi-major-axis distance of around 0.05 astronomical units. Its equilibrium temperature is within the range where water could be liquid on its surface.

Do Ultraviolet Air Disinfection Units Reduce Contamination by Particulates in Total Knee Replacement Procedures?

BACKGROUND: Prosthetic joint infections have become the leading cause of joint replacement failure. The primary sources of contamination are skin flora and bacteria from airborne particles. Portable ultraviolet air disinfection units are used in the Operating Room (OR) to prevent contamination from airborne particles; however, their effectiveness is not proven. The purpose of this study was to compare the rate of contamination of sites with and without Ultraviolet (UV) air disinfection units during active surgeries. METHODS: Sedimentation rates of viable particles were measured during 40 primary TKA procedures. Half of the procedures were performed with ultraviolet air disinfection units. Air-borne particles were collected on nitrocellulose membranes at 5 locations within the OR. After incubation, all microbial colonies were counted and the sedimentation rates were reported in CFUs/m2/hr. 10 additional trials were performed in an empty OR with no staff present. RESULTS: The average contamination rate of all sites was 22 ± 1.1 CFUs/m2/hr in the empty OR vs. 21.3 ± 4.6 CFUs/m2/hr with UV units and 20.3 ± 4.9 CFUs/m2/hr without (P = .03, P = .03, P = .964). Viable contaminates were found in the sterile field in 25% of UV cases vs 45% non-UV. These differences were not statistically significant. There were differences found however, according to the number of staff in the room (6 vs 7 staff: P = .036, 6 vs 8 staff: P = .004). CONCLUSION: There was no statistical difference in contamination rate with the usage or non-usage of UV units. These 40 cases shows that the largest variables affecting the contamination rate were the number of staff present and size of the OR.

The role of anthropogenic habitats in freshwater mussel conservation.

Anthropogenic freshwater habitats may provide undervalued prospects for long-term conservation as part of species conservation planning. This fundamental, but overlooked, issue requires attention considering the pace that humans have been altering natural freshwater ecosystems and the accelerated levels of biodiversity decline in recent decades. We compiled 709 records of freshwater mussels (Bivalvia, Unionida) inhabiting a broad variety of anthropogenic habitat types (from small ponds to large reservoirs and canals) and reviewed their importance as refuges for this faunal group. Most records came from Europe and North America, with a clear dominance of canals and reservoirs. The dataset covered 228 species, including 34 threatened species on the IUCN Red List. We discuss the conservation importance and provide guidance on how these anthropogenic habitats could be managed to provide optimal conservation value to freshwater mussels. This review also shows that some of these habitats may function as ecological traps owing to conflicting management practices or because they act as a sink for some populations. Therefore, anthropogenic habitats should not be seen as a panacea to resolve conservation problems. More information is necessary to better understand the trade-offs between human use and the conservation of freshwater mussels (and other biota) within anthropogenic habitats, given the low number of quantitative studies and the strong biogeographic knowledge bias that persists.

Micromotion and Migration of Cementless Tibial Trays Under Functional Loading Conditions.

BACKGROUND: The outcome of cementless total knee arthroplasty (TKA) relies on successful bony ingrowth into the implant surfaces. Failures due to aseptic loosening are still reported, especially in younger and more active patients. The objective of this study is to quantify the micromotion of a commercially available design of cementless tibial tray under loading conditions simulating walking and stair descent. METHOD: A commercially available design of cementless total knee arthroplasty was implanted in 7 cadaveric knees which were preconditioned with 500 cycles of 0°-100° flexion under a vertical load of 1050 N in a custom-built, multiaxial functional activity simulator. This was followed by application of the peak forces and moments occurring during walking and stair descent. During each loading procedure, 3-dimensional motion at the bone-prosthesis interface was measured using digital image correlation. RESULTS: The tray migrated 101 ± 25 µm on average during preconditioning, which was dominated by rotation in the sagittal plane (92% of total migration), combined with posterior translation (28%) and minimal rotation in the transverse plane (14%). The migration varied 2.7-fold (61-167 µm) between the 6 measurement zones. Stair descent produced significantly higher total micromotion than walking in zone #5 (62 ± 9 vs 51 ± 10 µm, P < .05) and zone #6 (68 ± 17 vs 37 ± 10 µm, P < .05). In addition, during stair descent, the tray exhibited significantly more tilting (anterior zones: 31 ± 17 vs -16 ± 20 µm, P < .05; posterior zones: -60 ± 8 vs -40 ± 7 µm, P < .05) and more anteroposterior displacement in the anterior zones (-25 ± 3 vs -13 ± 2 µm, P < .05) when compared to walking. CONCLUSION: The relative motion at the bone-prosthesis interface varied substantially around the periphery of the cementless tray. Under the loading conditions evaluated, the tray primarily underwent a rocking motion in the sagittal plane. Compared with walking, stair descent produced significantly more micromotion, especially in the posterior zones.

KairosMS: A New Solution for the Processing of Hyphenated Ultrahigh Resolution Mass Spectrometry Data.

The use of hyphenated Fourier transform mass spectrometry (FTMS) methods affords additional information about complex chemical mixtures. Coeluted components can be resolved thanks to the ultrahigh resolving power, which also allows extracted ion chromatograms (EICs) to be used for the observation of isomers. As such data sets can be large and data analyses laborious, improved tools are needed for data analyses and extraction of key information. The typical workflow for this type of data is based upon manually dividing the total ion chromatogram (TIC) into several windows of usually equal retention time, averaging the signal of each window to create a single mass spectrum, extracting a peak list, performing the compositional assignments, visualizing the results, and repeating the process for each window. Through removal of the need to manually divide a data set into many time windows and analyze each one, a time-consuming workflow has been significantly simplified. An environmental sample from the oil sands region of Alberta, Canada, and dissolved organic matter samples from the Suwannee River Fulvic Acid (SRFA) and marine waters (Marine DOM) were used as a test bed for the new method. A complete solution named KairosMS was developed in the R language utilizing the Tidyverse packages and Shiny for the user interface. KairosMS imports raw data from common file types, processes it, and exports a mass list for compositional assignments. KairosMS then incorporates those assignments for analysis and visualization. The present method increases the computational speed while reducing the manual work of the analysis when compared to other current methods. The algorithm subsequently incorporates the assignments into the processed data set, generating a series of interactive plots, EICs for individual components or entire compound classes, and can export raw data or graphics for off-line use. Using the example of petroleum related data, it is then visualized according to heteroatom class, carbon number, double bond equivalents, and retention time. The algorithm also gives the ability to screen for isomeric contributions and to follow homologous series or compound classes, instead of individual components, as a function of time.

The fingerprint of essential bio-oils by Fourier transform ion cyclotron resonance mass spectrometry.

Six essential oils were analyzed by Fourier transform ion cyclotron resonance mass spectrometry coupled to negative-ion electrospray ionization (ESI(-)/FT-ICR MS). ESI offers selective ionization of a compound's polar functional groups containing nitrogen and oxygen heteroatoms. ESI in negative-ion mode allows the identification of the acidic compounds. The results showed that the samples contain between 1100-3600 individual molecular compositions, which corresponds to the greatest number of species detected to date in essential oils obtained from aromatic plant material. The compositions cover a mass range between m/z 150-500 with up to 41 carbon atoms. The dominant organic constituents of the essential oils correspond to species incorporating 2-5 oxygen atoms, detected as deprotonated/sodiated/chlorinated species. A set of 580 molecular assignments were found in common across all the samples and for the first time, a set of unique molecular systems were identified, and up to 1373 species as a unique composition for each essential oil. The molecular distributions plotted in van Krevelen diagrams (classified by their H/C vs. O/C values) suggest the presence of species with long alkyl chains and low numbers of rings plus double bonds.

How Flat Is the Tibial Osteotomy in Total Knee Arthroplasty?

BACKGROUND: Cementless total knee arthroplasty has been developed to decrease the incidence of failure in younger and more active patients. However, failures are still more common in cementless versus cemented components. It is hypothesized that this is triggered by incomplete bone-tray contact. The present study compares the final contact area of a cementless tray as a function of the initial osteotomy flatness. METHODS: Eight surgeons prepared 14 cadaveric knees for cementless total knee replacement using standard instrumentation. The topography of each osteotomy was captured with a laser scanner; 3-dimensional computer models of the surfaces were generated. After scanning each tibia, the surgeons implanted cementless tibial trays using a manual impactor. Each tibia was then dissected, embedded in mounting resin, and sectioned. The sectioned blocks were observed under stereomicroscopy to identify points of bone-tray contact which were incorporated into the 3-dimensional models. Maps were then generated illustrating depicting contacting and noncontacting areas. RESULTS: The mean initial flatness of all specimens was 1.1 ± 0.35 mm. After impaction, 79.4% ± 0.3% of the surface had established bony contact. Of the noncontacting areas, 17.6% were within 0.3 mm of the tray. Only 2.6% of the surface was at distances reported to impede ingrowth. Noncontacting areas were typically located centrally. A trend in decreasing percent contact area with increased flatness tolerance was observed (R2 = 0.605). CONCLUSION: (1) There is an inverse correlation between the flatness of the tibial osteotomy and the percentage of the bony surface in contact with underside of the tibial tray. (2) Almost all tray-tibia contact is generated during implantation through flattening of elevated features on the tibial surface. (3) Gaps between the tray and the tibia are consistently located in the central regions of the osteotomy proximal to the medullary canal.

Experimental habitat fragmentation disrupts nematode infections in Australian skinks.

Habitat conversion and fragmentation threaten biodiversity and disrupt species interactions. While parasites are recognized as ecologically important, the impacts of fragmentation on parasitism are poorly understood relative to other species interactions. This lack of understanding is in part due to confounding landscape factors that accompany fragmentation. Fragmentation experiments provide the opportunity to fill this knowledge gap by mechanistically testing how fragmentation affects parasitism while controlling landscape factors. In a large-scale, long-term experiment, we asked how fragmentation affects a host-parasite interaction between a skink and a parasitic nematode, which is trophically transmitted via a terrestrial amphipod intermediate host. We expected that previously observed amphipod declines resulting from fragmentation would result in decreased transmission of nematodes to skinks. In agreement, we found that nematodes were absent among skinks in the cleared matrix and that infections in fragments were about one quarter of those in continuous forest. Amphipods found in gut contents of skinks and collected from pitfall traps mirrored this pattern. A structural equation model supported the expectation that fragmentation disrupted this interaction by altering the abundance of amphipods and suggested that other variables are likely also important in mediating this effect. These findings advance understanding of how landscape change affects parasitism.

Parity time-symmetric vertical cavities: intrinsically single-mode regime in longitudinal direction.

We explore a new class of distributed feedback (DFB) structures that employ the recently-developed concept of parity-time (PT) symmetry in optics. We show that, based on PT-symmetric pure reflective volume gratings, a vertical surface-emitting cavity can be constructed. We provide a detailed analysis of the threshold conditions as well as the wavelength and angular spectral characteristics using the Kogelnik coupled-wave approximation, backed up by an exact solution of the Helmholtz equation. We show that such a PT-symmetric cavity can be configured to support one and only one longitudinal mode, leading to inherently single-mode lasing.

What Is the Optimal Minimum Penetration Depth for "All-Inside" Meniscal Repairs?

PURPOSE: To identify desired minimum depth setting for safe, effective placement of the all-inside meniscal suture anchors. METHODS: Using 16 cadaveric knees and standard arthroscopic techniques, 3-dimensional surfaces of the meniscocapsular junction and posterior capsule were digitized. Using standard anteromedial and anterolateral portals, the distance from the meniscocapsular junction to the posterior capsule outer wall was measured for 3 locations along the posterior half of medial and lateral menisci. Multiple all-inside meniscal repairs were performed on 7 knees to determine an alternate measure of capsular thickness (X2) and compared with the digitized results. RESULTS: In the digitized group, the distance (X1) from the capsular junction to the posterior capsular wall was averaged in both menisci for 3 regions using anteromedial and anterolateral portals. Mean distances of 6.4 to 8.8 mm were found for the lateral meniscus and 6.5 to 9.1 mm for the medial meniscus. The actual penetration depth was determined in the repair group and labeled X2. It showed a similar pattern to the variation seen in X1 by region, although it exceeded predicted distances an average 1.7 mm in the medial and 1.5 mm in the lateral meniscus owing to visible deformation of the capsule as it pierced. CONCLUSIONS: Capsular thickness during arthroscopic repair measures approximately 6 to 9 mm (X1), with 1.5 to 2 mm additional depth needed to ensure penetration rather than bulging of the posterior capsule (X2), resulting in 8 to 10 mm minimum penetration depth range. Surgeons can add desired distance away from the meniscocapsular junction (L) at device implantation, finding optimal minimal setting for penetration depth (X2 + L), which for most repairable tears may be as short as 8 mm and not likely to be greater than 16 mm. CLINICAL RELEVANCE: Minimum depth setting for optimal placement of all-inside meniscal suture anchors when performing all-inside repair of the medial or lateral meniscus reduces risk of harming adjacent structures secondary to overpenetration and underpenetration of the posterior capsule.

Molecular phylogenetic analysis supports a Gondwanan origin of the Hyriidae (Mollusca: Bivalvia: Unionida) and the paraphyly of Australasian taxa.

The freshwater mussel family Hyriidae (Mollusca: Bivalvia: Unionida) has a disjunct trans-Pacific distribution in Australasia and South America. Previous phylogenetic analyses have estimated the evolutionary relationships of the family and the major infra-familial taxa (Velesunioninae and Hyriinae: Hyridellini in Australia; Hyriinae: Hyriini, Castaliini, and Rhipidodontini in South America), but taxon and character sampling have been too incomplete to support a predictive classification or allow testing of biogeographical hypotheses. We sampled 30 freshwater mussel individuals representing the aforementioned hyriid taxa, as well as outgroup species representing the five other freshwater mussel families and their marine sister group (order Trigoniida). Our ingroup included representatives of all Australian genera. Phylogenetic relationships were estimated from three gene fragments (nuclear 28S, COI and 16S mtDNA) using maximum parsimony, maximum likelihood, and Bayesian inference, and we applied a Bayesian relaxed clock model calibrated with fossil dates to estimate node ages. Our analyses found good support for monophyly of the Hyriidae and the subfamilies and tribes, as well as the paraphyly of the Australasian taxa (Velesunioninae, (Hyridellini, (Rhipidodontini, (Castaliini, Hyriini)))). The Hyriidae was recovered as sister to a clade comprised of all other Recent freshwater mussel families. Our molecular date estimation supported Cretaceous origins of the major hyriid clades, pre-dating the Tertiary isolation of South America from Antarctica/Australia. We hypothesize that early diversification of the Hyriidae was driven by terrestrial barriers on Gondwana rather than marine barriers following disintegration of the super-continent.

Femoroacetabular impingement negates the acetabular labral seal during pivoting maneuvers but not gait.

BACKGROUND: Experimental disruption of the labrum has been shown to compromise its sealing function and alter cartilage lubrication. However, it is not known whether pathological changes to the labrum secondary to femoroacetabular impingement (FAI) have a similar impact on labral function. QUESTIONS/PURPOSES: Does damage to the labrum occurring in association with abnormal femoral morphology affect the labral seal? METHODS: Using 10 fresh cadaveric specimens (mean age 50 years, ±8), we measured the capacity of the central compartment of the hip (the iliofemoral joint) to maintain a seal during fluid infusion, which may help elucidate the function of the labrum during weightbearing. Specimens with and without abnormal femoral morphology (six normal-appearing specimens and four whose geometry suggested cam-type FAI) were tested in postures observed during functional activities, including simulations of normal gait, stooping, and pivoting. Each specimen with FAI morphology exhibited secondary damage of the labrum and the adjacent chondral surface, whereas specimens of normal morphology were undamaged. RESULTS: Average peak central compartment pressure was reduced during pivoting for specimens with the presence of labral damage secondary to FAI. When placed in pivoting positions, hips with FAI maintained lower fluid pressures within the central compartment compared with intact specimens (15±3 versus 42±8 kPa, respectively; effect size: 1.08 [-0.36 to 2.31]; p=0.007). No differences in peak pressure were observed between groups (FAI versus normal) for postures simulating either gait (21±6 versus 22±4 kPa; p=0.902) or stooping (9±2 versus 8±3 kPa; p=0.775) with the numbers available. CONCLUSIONS: The acetabular seal, quantified by the maximum intraarticular pressure, was reduced during pivoting; however, the seal was maintained during simulated gait and stooping. CLINICAL RELEVANCE: Because degeneration is progressive with repetitive impingement, loss of the labral seal starts to be seen during pivoting and may progress from there, but in this small-sample cadaver study that evaluated specimens in middle adulthood, the seal remains intact during simulated gait and stooping. Our study suggests that labral damage secondary to cam-type FAI may reduce the ability of the labral to provide an adequate seal of the central compartment of the hip during loading; however, the extent to which this is affected requires further investigation.

Sirolimus for Pediatric Cervicofacial Lymphatic Malformation: A Systematic Review and Meta-Analysis.

OBJECTIVE: This study is a systematic review and meta-analysis of the efficacy and safety of sirolimus in the management of pediatric cervicofacial lymphatic malformations (LMs). DATA SOURCES: EMBASE, Medline, Scopus, and Cochrane databases were searched, along with the reference list of all included articles. REVIEW METHODS: The study protocol was registered with PROSPERO and a systematic literature search strategy was designed and conducted with the aid of a medical librarian. All studies including case reports were included, with pooled analysis of raw data. A meta-analysis was conducted of magnetic resonance imaging (MRI), clinical, and airway outcomes. RESULTS: Thirteen case series and five individual case reports were included. Meta-analysis showed 78% (95% CI 57%-94%) of 62 patients had a reduction in LM volume, on MRI criteria, by 20% or more, and 32% (95% CI 11%-57%) had a reduction of 50% or more. Further meta-analysis showed 97% (95% CI 88%-100%) of 78 patients reported some clinical improvement on sirolimus. Sirolimus may be of particular value in management of airway LMs; out of 27 tracheostomy-dependent patients, meta-analysis showed 33% (95% CI 1%-78%) were decannulated after starting sirolimus. Individual patient meta-analysis on 24 individuals showed a statistically significant better response to sirolimus when initiated under the age of 2 years. CONCLUSION: This review and meta-analysis support the efficacy of sirolimus in pediatric LMs of the head, neck, and airway. A large multi-center trial is needed to further explore its role and limitations. Laryngoscope, 134:2038-2047, 2024.

The potential of suspended chitosan nanoparticles as a surgical irrigation fluid.

In this study, we sought to synthesize chitosan nanoparticles (CS-NPs) and characterize their morphology, efficacy in inhibiting bacterial attachment, and efficacy in eradicating bacteria established on implantable hardware. CS-NPs possess desirable properties, including antibacterial properties in biofilm-mediated infections. CS-NPs were produced using ionic gelation and characterized via scanning electron microscope imaging. Staphylococcus aureus was incubated with CS-NPs at various concentrations and compared to a 1% povidone-iodine with 1% H2 O2 control in 24-well plates. Stainless steel bone screws were placed in six-well plates and inoculated with S. aureus. After 24 h, the screws were transferred to one of three solutions (saline, 40 mg/mL CS-NP, or 1% povidone-iodine with 1% H2 O2 ). Four screws from each group were vortexed in saline and plated. The remaining screw from each group was prepped and imaged to map the location of persistent bacteria. Synthesized CS-NPs had a mean diameter of 0.39 ± 0.13 µm and circularity of 0.87 ± 0.05. The percent inhibition of bacterial attachment was 73% at 20 mg/mL, 73% at 30 mg/mL, 75% at 40 mg/mL, 79% at 50 mg/mL, and 78% at 60 mg/mL. When compared to saline, the 40 mg/mL CS-NP solution reduced bacteria on the screws by 76%. No bacteria were retrieved from the 1% povidone-iodine with 1% H2 O2 group. This study demonstrated that CS-NP solution effectively inhibited S. aureus bacterial attachment and was more effective than saline in eradicating bacteria from orthopedic hardware, suggesting that CS-NPs have the potential for prevention and treatment of musculoskeletal infections as a component of an intraoperative surgical irrigation solution.

Tracking the history of polycyclic aromatic compounds in London through a River Thames sediment core and ultrahigh resolution mass spectrometry.

Polycyclic aromatic compounds (PACs), including polycyclic aromatic hydrocarbons (PAHs) and heteroatom-containing analogues, constitute an important environmental contaminant class. For decades, limited numbers of priority PAHs have been routinely targeted in pollution investigations, however, there is growing awareness for the potential occurrence of thousands of PACs in the environment. In this study, untargeted Fourier transform ion cyclotron resonance mass spectrometry was used for the molecular characterisation of PACs in a sediment core from Chiswick Ait, in the River Thames, London, UK. Using complex mixture analysis approaches, including aromaticity index calculations, the number of molecular PAC components was determined for eight core depths, extending back to the 1930s. A maximum of 1676 molecular compositions representing PACs was detected at the depth corresponding to the 1950s, and a decline in PAC numbers was observed up the core. A case linking the PACs to London's coal consumption history is presented, alongside other possible sources, with some data features indicating pyrogenic origins. The overall core profile trend in PAC components, including compounds with oxygen, sulfur, nitrogen, and chlorine atoms, is shown to broadly correspond to the 16 priority PAH concentration profile trend previously determined for this core. These findings have implications for other industry-impacted environments.

IPASS: a study on the tolerability and effectiveness of injectable testosterone undecanoate for the treatment of male hypogonadism in a worldwide sample of 1,438 men.

INTRODUCTION: Morbidity/mortality is higher in men with below-normal serum testosterone. Restoring testosterone to normal is beneficial. AIM: Assessment of safety and effectiveness of injectable long-acting testosterone undecanoate (TU) in hypogonadal men in daily clinical practice. METHODS: An international, multicenter, one-arm, prospective observational study in 23 countries. MAIN OUTCOME MEASURES: Parameters of erectile function, libido, vigor/vitality, mood, and ability to concentrate assessed by physician interview using items and five-point Likert scales. Physical and circulatory parameters as well as hematocrit, prostate-specific antigen (PSA) levels, glucose control, and lipid profiles. IPASS: An International, multicenter, Post-Authorisation (after authorized use in respective country) Surveillance Study on long-acting-intramuscular TU conducted at 155 centers in 23 countries in Europe, Asia, Latin America, and Australia. Patients received up to five TU injections during 9-12 months. RESULTS: Of the 1,493 hypogonadal men enrolled, 1,438 (aged 49.2 ± 13.9 years) having received 6,333 injections were analyzed. Scores of mental and psychosexual functions (libido, vigor, overall mood, and ability to concentrate) improved markedly, while mean waist circumference decreased from 100 to 96 cm. Blood pressure and lipid parameters were altered in a favorable and significant manner. After four TU injection intervals, the percentage of patients with "low" or "very low" levels of sexual desire/libido decreased from 64% at baseline to 10%; moderate, severe, or extremely severe erectile dysfunction decreased from 67% to 19%. At the last observation, 89% of patients were "satisfied" or "very satisfied" with TU therapy. Adverse events and adverse drug reactions (ADRs) occurred in 12% and 6% of patients, respectively, mostly mild to moderate. The most common ADRs were increase in hematocrit, increase in PSA, and injection site pain (all <1%). No case of prostate cancer was observed. CONCLUSION: In this largest worldwide sample of hypogonadal men, injectable long-acting TU was effective and well tolerated.