Three spectrophotometric quantitative analysis of bisoprolol fumarate and telmisartan in fixed-dose combination utilizing ratio spectra manipulation methods.

Hypertension is a chronic condition with multiple drug regimens. Limiting these medicines is critical to patient compliance. Therefore, bisoprolol and telmisartan were recently developed in a fixed-dose combination to control blood pressure. The UV absorption spectra of bisoprolol and telmisartan overlapped significantly. Thus, three spectrophotometric methods have been developed for simultaneous determination of bisoprolol and telmisartan without prior separation. Method A is ratio difference of ratio spectra (RD), which measures the amplitude difference between (210-224) nm for bisoprolol and between (255-365) nm for telmisartan. Method B, the first derivative of ratio spectra (1DD), measures amplitude signals at 232 and 243 nm for bisoprolol and telmisartan, respectively. Method C is the mean centering of ratio spectra (MC), which measures the mean-centered ratio spectra's values at 223 nm for bisoprolol and 245 nm for telmisartan. The applied methods showed good linearity 2-20 µg/mL for bisoprolol, 4-32 µg/mL for telmisartan, with sufficient accuracy and precision. The methods were sensitive, with LOD values of 0.243 µg/mL and 0.596 µg/mL in RD method, 0.313 µg/mL and 0.914 µg/mL in 1DD method, and 0.406 and 0.707 µg/mL in MC method for bisoprolol and telmisartan, respectively, the methods were validated per ICH criteria. The novel methods are precise and accurate and can be used for routine analysis and quality control of bisoprolol and telmisartan in pure and dosage form. Furthermore, the greenness of the approaches was evaluated using Analytical Greenness assessment (AGREE), and the suggested method received a high greenness score.

Individual or successiveseed priming with nitric oxide and calcium toward enhancing salt tolerance of wheat crop through early ROS detoxification and activation of antioxidant defense.

Despite the considerable efforts reported so far to enhance seed priming, novel ideas are still needed to be suggested to this sustainable sector of agri-seed industry. This could be the first study addressing the effect of nitric oxide (NO) under open field conditions. The impacts of seed redox-priming using sodium nitroprusside (SNP) and osmo-priming with calcium chloride (CaCl2), both applied individually or successively, were investigated under salinity stress conditions on wheat plants (Triticum aestivum L.). Various parameters, including water relations, growth, yield, photosynthetic pigments, and antioxidant activities (enzymatic and non-enzymatic), were recorded to assess the outcomes of these priming agents on mitigating the negative impacts of salinity stress on wheat plants. Water consumptive use (ETa) and irrigation water applied (IWA) decreased with seeds priming. Successive priming with SNP + CaCl2 induced the greatest values of crop water productivity (CWP), irrigation water productivity (IWP), seed index, grain yield and grain nitrogen content.Under salinity stress, the dry weight of plants was decreased. However, hydro-priming and successive chemical priming agents using combinations of calcium chloride and sodium nitroprusside (CaCl2 + SNP & SNP + CaCl2) preserved growth under salinity stress.Individual priming with sodium nitroprusside (SNP) and calcium chloride (CaCl2) resulted in the lowest recorded content of sodium in the shoot, with a value of 2 ppm. On the other hand, successive priming using CaCl2 + SNP or SNP + CaCl2 induced the contents of potassium in the shoot, with values of 40 ppm and 39 ppm, respectively. Malondialdehyde decreased in shoot significantly withapplicationof priming agents. Successive priming with CaCl2 + SNP induced the highest proline contents in shoot (6 µg/ g FW). The highest value of phenolics and total antioxidants contents in shoot were recorded under successive priming using CaCl2 + SNP and SNP + CaCl2.Priming agents improved the activities of ascorbate peroxidase and catalase enzymes. The successive priming improved water relations (ETa, IWA, CWP and IWP) and wheat growth and productivity under salinity stress more than individual priming treatments.

A proposed hybrid model of ANN and KNN for solar cell defects detection and temperature prediction using fuzzy image segmentation.

This paper presents a novel hybrid model employing Artificial Neural Networks (ANN) and Mathematical Morphology (MM) for the effective detection of defects in solar cells. Focusing on issues such as broken corners and black edges caused by environmental factors like broken glass cover, dust, and temperature variations. This study utilizes a hybrid model of ANN and K-Nearest Neighbor (KNN) for temperature prediction. This hybrid approach leverages the strengths of both models, potentially opening up new avenues for improved accuracy in temperature forecasting, which is critical for solar energy applications. The significance lies in the interconnectedness of temperature fluctuations and solar cell efficiency, leading to defects. The proposed model aims to predict temperatures accurately, providing insights into potential solar cell efficiency problems. Subsequently, this work studies the transitions to defect detection using Fuzzy C-Means (FCM) clustering and MM techniques. The hybrid model demonstrates accurate temperature prediction with Mean Absolute Percentage Error (MAPE) values of 0.92 %, 0.72 %, and 1.3 % for average, maximum, and minimum temperatures, respectively. The defect detection process yields a detection accuracy (CR) of 96 % and sensitivity of detection (SD) of 89 %. This work is validated compared to the literature work done and by using K-fold cross validation technique. The proposed work emphasizes the improvement in defect detection accuracy and the overall quality enhancement of solar cells.

Influence of surgical scrubs outside the operation theatre on post-operative infections - A systematic review.

Background and Aims: Healthcare workers (HCWs), which include surgeons, anaesthesiologists, nurses, technicians, and other non-medical staff working in the operation theatre (OT), change to surgical scrubs for providing designated services. This study was intended to investigate the association of moving in and out of OT to other hospital areas without changing scrubs and its impact on bacterial infection. Methods: After PROSPERO registration, we performed a systematic review to compare the occurrence of surgical site infections (SSIs) with or without the movement of HCWs outside OT. We searched PubMed, Scopus, and Cochrane Library using relevant keywords. RoB-2 and ROBINS-E tools were used to assess the risk of bias in randomised controlled trials (RCTs) and observational studies, respectively. Results: We identified six articles that fulfilled the inclusion criteria: three RCTs and three observational studies. A risk of bias assessment revealed an overall low bias in the RCTs and an overall high bias in the observational studies. The analysis revealed a comparable incidence of bacterial infection in terms of colony-forming units when scrubs when HCWs moved in and out of OT with the same scrubs. A meta-analysis was not performed due to heterogeneity in participants and the OT set-up, as well as fewer studies and sample size. Conclusion: The evidence is insufficient to suggest that wearing scrubs outside the OT could increase the incidence of SSI in surgical patients or transmit the organisms to patients, causing infection. The present review neither supports nor is against wearing surgical scrubs outside OT premises.

Co-pyrolysis of chicken feathers and macadamia nut shells, a promising strategy to create nitrogen-enriched electrode materials for supercapacitor applications.

Global food waste emits substantial quantities of nitrogen to the environment (6.3 Mtons annually), chicken feather (CF) waste is a major contributor to this. Pyrolysis, in particular co-pyrolysis of nitrogen-rich and lignocellulosic waste streams is a promising strategy to improve the extent of pyrolytic nitrogen retention by incorporating nitrogen in its solid biochar structure. As such, this biochar can serve as a precursor for nitrogen-enriched activated carbons for application in supercapacitors. Therefore, this study investigates the co-pyrolysis of CF with macadamia nut shells (MNS) to create nitrogen-rich activated carbons. Co-pyrolysis increased nitrogen retention during pyrolysis from 9 % to 18 % compared to CF mono-pyrolysis, while the porosity was maintained. After removing undesirable inorganic impurities by dilute acid washing, this led to a specific capacitance of 21F/g using a scan rate of 20 mV/s. Finally, cycling stability tests demonstrated good stability with 73 % capacitance retention after 10 000 cycles.

Arabic gum/chitosan/Zn-NPs composite film maintains the quality of Hass avocado fruit by delaying ripening and activating enzymatic defense mechanisms.

Avocado fruit is a climacteric fruit that has a short life after harvest. Chitosan (Ch) and Arabic gum (AG) have a pronounced effect on the storability of fruits. This investigation aimed to determine the effect of individual or combined use of Ch and AG as well as Ch/AG enriched with 2, 4, 8% Zn-NPs on physio-biochemical attributes and antioxidant capacity of Hass avocado fruit during cold storage (7 °C). The result showed that Ch or AG alone succeeded in maintaining fruit quality of Hass fruit during cold storage. Also, combined application of Ch/AG was more effective than individual application of Ch or AG in reducing fruit weight and polyphenol oxidase activity (PPO) as well as increasing total antioxidant capacity (TAC) and malondialdehyde (MDA). Moreover, Ch/AG coating enriched with 8% Zn-NPs recorded the lowest fruit weight loss, fruit decay %, TSS fruit content, fruit firmness and improved fruit skin and pulp color significantly compared to Ch/AG and control. Coating with Ch/AG/2%Zn NPs recorded the highest peroxidase (POD) activity, while Ch/AG/8% Zn-NPs recorded the highest TAC and the lowest PPO activity. Moreover, enriched Ch/GA with Zn-NPs recorded the highest CAT and POD activity compared to the control. This study shows the efficiency of Ch/AG enriched with Zn-NPs on preserving Hass avocado fruit quality during cold storage by delaying ripening process and activating enzymatic defense mechanisms.

Application of Enhanced Recovery After Surgery Pathways in Patients Undergoing Laparoscopic Cholecystectomy With and Without Common Bile Duct Exploration: A systematic review and meta-analysis.

Many researchers have implemented enhanced recovery after surgery (ERAS) pathways for laparoscopic cholecystectomy (LC) and found it effective over conventional care. This review investigates the efficacy and safety of such pathways compared to conventional practices. PubMed Central/Medline, Scopus, Ovid and clinicaltrials. gov were searched using relevant keywords to identify studies in which ERAS pathways for LC were compared to conventional pathways. The primary outcome was length of stay (LOS) from the day of surgery and the secondary outcomes were pain scores, postoperative nausea/vomiting (PONV), readmissions (within 30 days after surgery), complications (medical and surgical), time to first flatus and cost. Out of 590 articles identified, six studies (n = 1,489 patients) fulfilled the inclusion criteria and were used for qualitative and quantitative analysis. On pooled analysis, LOS, time to first flatus, PONV and pain scores were significantly less in the ERAS group than in the conventional one, while readmission and complications were comparable in both groups.

A proposed novel adaptive DC technique for non-stationary data removal.

The stationarity of a time series is an important assumption in the Box-Jenkins methodology. Removing the non-stationary feature from the time series can be done using a differencing technique or a logarithmic transformation approach, but it is not guaranteed from the first step. This paper proposes a new adaptive DC technique, a novel technique for removing a non-stationary time series from the first step. The technique involves transferring non-stationary data into another domain that deals with it as a stationary time series, as it is much easier to be forecasted in that domain. The adaptive DC technique has been applied to different time series, including gasoline and diesel fuel prices, temperature, demand side, inflation rate and number of internet users time series. The performance of the proposed technique is evaluated using different statistical tests, including Augmented Dickey-Fuller (ADF), Kwiatkowski-Phillips-Schmidt-Shin (KPSS), and Phillips Perron (PP). Additionally, the technique is validated by comparing it with a differencing technique, and the results show that the proposed technique slightly outperforms the differencing method. The importance of the proposed technique is its capability to get the stationarity data from the first step, whereas the differencing technique sometimes needs more than one step.

Endoscopic ultrasound-guided biliary drainage for distal malignant biliary obstruction: a prospective 3-year multicenter Egyptian study.

Background/Aim: Malignant biliary obstruction (MBO) is often diagnosed at late stages with mostly unresectable lesions. Recently, EUS-guided biliary drainage (EUS-BD) has gained wide acceptance and appears to be a feasible and safe backup option after ERCP failure in such patients. Herein, we aimed to represent a 3-year multi-center Egyptian experience in the application of this challenging procedure for distal MBO as a salvage technique after failed ERCP. Patients and methods: This was a prospective multi-center study of patients underwent EUS-BD for distal MBO in the duration between December 2018 and December 2021, after ERCP failure. Results: Ninety-one patients (59 males, median age: 61 years) were included in the study. EUS-guided extrahepatic approach including choledocho-duodenostomy (CDS) was done for 48 patients (52.8%), followed by choledecho-antrostomy (CAS) in 4 patients (4.4%). The intrahepatic approach included hepaticogastrostomy (HGS) for 35 patients (38.5%) and antegrade stenting (AG) stenting in 2 patients (2.2%), while Rendezvous (RV) approach was performed in 2 patients (2.2%). Technical and Clinical success were achieved in the majority of cases; 93.4% and 94.1% respectively. Adverse events occurred in 13.2% of patients which were mostly mild (8.2%) to moderate (2.4%). Only one patient died within 48h after the procedure with progression of preceding sepsis and organ failure. Conclusion: EUS-BD is a feasible option, even in developing countries, after a failed ERCP, and it is a relatively safe option in patients with MBO once experienced team and resources were present. Majority of cases in our study have achieved technical and clinical success with relatively low incidence of adverse events.

Postoperative Urinary Retention after Pediatric Orthopedic Surgery.

Purpose: This study aims to describe the incidence of postoperative urinary retention among pediatric patients undergoing orthopedic surgery and identify risk factors. Methods: The Pediatric Health Information System was used to identify children aged 1−18 years who underwent orthopedic surgery. Collected from each patient's record were demographic information, principal procedure during hospitalization, the presence of neurologic/neuromuscular conditions and other complex chronic medical conditions, the total postoperative length of stay, and the presence of postoperative urinary retention. Results: The overall incidence of postoperative urinary retention was 0.38%. Children with complex chronic neuromuscular conditions (OR 11.54 (95% CI 9.60−13.88), p = < 0.001) and complex chronic non-neuromuscular medical conditions (OR 5.07 (95% CI 4.11−6.25), p ≤ 0.001) had a substantially increased incidence of urinary retention. Surgeries on the spine (OR 3.98 (95% CI 3.28−4.82, p ≤ 0.001) and femur/hip (OR 3.63 (95% CI 3.03−4.36), p ≤ 0.001) were also associated with an increased incidence. Conclusions: Children with complex chronic neuromuscular conditions have a substantially increased risk of experiencing postoperative urinary retention. Complex chronic non-neuromuscular medical conditions and surgeries to the spine, hip, and femur also carry a notably increased risk.

Evaluation Method for Quality Risks of Safety in Prefabricated Building Construction Using SEM-SDM Approach.

The construction of prefabricated buildings is an effective and efficient approach to improving construction processes and productivity. However, there are practical problems in this approach, such as listing, safety risk levels, and quality control. This study aims to develop a systematic approach for determining the key factors affecting prefabricated building projects' quality and safety risk and assessing this risk. Based on the literature review, a structured questionnaire was distributed to 408 China-based construction organizations. Considering the factors of safety risk evaluation systems for construction, the safety risk model of prefabricated buildings is established and combined with structural equation modeling (SEM) and a system dynamic model (SDM). A detailed case study was conducted to verify the empirical findings. The results show that pre-construction, during-construction, and after-construction significantly influence the quality risk (from high to low). The final comprehensive score is 92.71, indicating that the construction safety of the residential building is generally controllable and the quality is guaranteed. Furthermore, the investment risk of such projects can be assessed using SEM and SDM. This study contributes to the literature by considering quality-risk-influencing factors in this field. Furthermore, the findings provide an understanding of implementation and quality risk control for prefabricated building projects and provide valuable information to departments in charge of improving the safety risk performance of such projects.

Perceived Physician Empathy in Pediatric Orthopedics: A Cross-Sectional Study.

Empathy is the cornerstone of the patient-physician relationship and is consistently ranked by patients as one of the most important factors in the quality of their care. In this paper we examine the degree to which perceived physician empathy is associated with the characteristics of the caregiver (parent or legal guardian) and physician in pediatric orthopedic surgery. This was a cross-sectional survey study of 200 English-speaking caregivers of pediatric patients at a large children's hospital. The Consultation and Relational Empathy (CARE) Measure was used to measure perceived physician empathy. Only if the caregiver felt carefully listened to by the physician (p-value < 0.001), and if the physician showed respect for what the caregiver had to say (p-value = 0.007) were statistically significant and positively associated with perceived physician empathy. The most significant determinant of perceived physician empathy is whether the caregiver felt listened to during the encounter. Other factors such as caregiver demographics, health literacy, self-rated mental health, wait time, and time spent with the physician do not significantly affect perceived physician empathy.

Green electrochemical and chromatographic quantifications of the extremolyte ectoine in halophilic bacterial cultures and related pharmaceutical preparations.

The realistic implementation of electrochemistry into bacterial biosynthesis monitoring programs has always been a challenging task. In this study, two simple, rapid, selective, and sensitive potentiometric sensors were developed and optimized for quantitative analysis of the extremolyte / osmoprotector ectoine (ECT) in halophilic bacterial cultures and also in its related pharmaceutical products. The developed sensors were a Polyvinyl chloride membrane sensor (ECT-PVC) and a coated graphite sensor (ECT-CG). They were established based on the ion association complex of ectoine cation with phosphotungstic acid (ECT-PTA) counter anion as ion exchange site using dioctyl-phthalate (DOP) as a solvent mediator or plasticizer. The sensors exhibited fast, stable, selective, and linear Nernstian responses over a broad range of concentrations ranging from 1 × 10-5 to 1 × 10-2 M of the studied drug. The developed sensors were optimized and cross-validated with a proposed HPLC method according to ICH guidelines. The proposed methods were successfully employed to quantify the studied drug in three different types of halophilic bacterial cultures and in an ectoine nasal spray pharmaceutical product. The selected bacteria species were Chromohalobacter salexigens, Halobacillus halophilus, and Halomonas elongata. The proposed methods were statistically compared with the reported methods, demonstrating no significant difference with respect to accuracy and precision. Greenness and environmental impact were also evaluated for the proposed procedures, verifying that they were excellent green and eco-friendly analytical methods.

Quantitative Electroencephalography After Pediatric Anterior Circulation Stroke.

OBJECTIVE: Regional differences were investigated in quantitative EEG (QEEG) characteristics and associations of QEEG to hemodynamics after pediatric acute stroke. METHODS: Quantitative EEG was analyzed, including power in delta, theta, alpha, and beta bands, alpha-delta power ratio, total power, and spectral edge frequency from 11 children with unilateral, anterior circulation strokes during the first 24 hours of continuous EEG recording. Differences between injured and uninjured hemispheres were assessed using multivariate dynamic structural equations modeling. Dynamic structural equations modeling was applied to six children with hemorrhagic stroke undergoing arterial blood pressure, heart rate, and cerebral oximetry monitoring to investigate associations between hemodynamics with QEEG adjacent to anterior circulation regions. RESULTS: All patients with acute ischemic stroke ( n = 5) had lower alpha and beta power and spectral edge frequency on injured compared with uninjured regions. This was not consistent after hemorrhagic stroke ( n = 6). All hemorrhagic stroke patients demonstrated negative association of total power with arterial blood pressure within injured regions. No consistency was observed for direction or strength of association in other QEEG measures to arterial blood pressure nor were such consistent relationships observed for any QEEG measure studied in relation to heart rate or cerebral oximetry. CONCLUSIONS: After pediatric anterior circulation acute ischemic stroke, reduced spectral edge frequency and alpha and beta power can be observed on injured as compared with noninjured regions. After pediatric anterior circulation hemorrhagic stroke, total power can be negatively associated with arterial blood pressure within injured regions. Larger studies are needed to understand conditions in which QEEG patterns manifest and relate to hemodynamics and brain penumbra.

Corrigendum: Upregulation of Mir342 in Diet-Induced Obesity Mouse and the Hypothalamic Appetite Control.

[This corrects the article DOI: 10.3389/fendo.2021.727915.].

Upregulation of Mir342 in Diet-Induced Obesity Mouse and the Hypothalamic Appetite Control.

In obesity and type 2 diabetes, numerous genes are differentially expressed, and microRNAs are involved in transcriptional regulation of target mRNAs, but miRNAs critically involved in the appetite control are not known. Here, we identified upregulation of miR-342-3p and its host gene Evl in brain and adipose tissues in C57BL/6 mice fed with high fat-high sucrose (HFHS) chow by RNA sequencing. Mir342 (-/-) mice fed with HFHS chow were protected from obesity and diabetes. The hypothalamic arcuate nucleus neurons co-express Mir342 and EVL. The percentage of activated NPY+pSTAT3+ neurons were reduced, while POMC+pSTAT3+ neurons increased in Mir342 (-/-) mice, and they demonstrated the reduction of food intake and amelioration of metabolic phenotypes. Snap25 was identified as a major target gene of miR-342-3p and the reduced expression of Snap25 may link to functional impairment hypothalamic neurons and excess of food intake. The inhibition of miR-342-3p may be a potential candidate for miRNA-based therapy.

Sphenopalatine Ganglion Nerve Block for the Treatment of Migraine Headaches in the Pediatric Population.

BACKGROUND: Persistent headaches and migraines are common in pediatrics with various treatment options. The sphenopalatine ganglion (SPG) has been identified as communicating with the parasympathetic autonomic nervous system and pain receptors. In adults, SPG block is an established treatment but there is no published literature in pediatrics. OBJECTIVES: The purpose of this study is to analyze the SPG block in pediatrics. STUDY DESIGN: Retrospective, single-center study. SETTING: This study was conducted at Phoenix Children's Hospital in Phoenix, Arizona. METHODS: A comprehensive review of patient charts from 2015-2018 of all pediatric SPG blockades performed by interventional radiology were included in the analysis. Utilizing fluoroscopic guidance, a SphenoCath was inserted into each nostril and after confirming position, and 4% lidocaine injected. Pre- and postprocedural pain was assessed using the Visual Analog Scale (VAS). Immediate and acute complications were documented. RESULTS: A total of 489 SPG blocks were performed in patients between ages 6 and 26 years who were diagnosed with migraine or status migrainosus. One hundred percent technical success was achieved with mean reduction of pain scores of 2.4, which was statistically significant (P < 0.0001). There were no immediate or acute complications. LIMITATIONS: Results of this study were based on retrospective study. The use of VAS may be subjective, and the need of a prospective study may be necessary. CONCLUSIONS: With 100% technical success, statistically significant pain reduction, and no complications, we support SPG block in the pediatric population as a simple, efficacious, and safe treatment option for refractory headaches. It is routinely performed in less than 10 minutes and commonly negates the need for inpatient headache pain management. Given its minimal invasivity, we support the use of SPG blockade as a therapeutic treatment in refractory pediatric migraines as it reduces the need for intravenous medications, prolonged pain control, or hospital admission.

Eco-friendly multivariate curve resolution-alternating least squares and chromatographic quantifications of some veterinary drug residues in pharmaceutical industrial wastewater.

Three eco-friendly and cost-effective analytical methods were developed and optimized for quantitative analysis of some veterinary drug residues in production wastewater samples. The studied drugs were ivermectin, rafoxanide and sulfadimidine. A solid-phase extraction procedure was employed using Bond Elut C18 cartridges, prior to analysis. The first method was a chemometric approach called multivariate curve resolution - alternating least squares (MCR-ALS). A calibration model was developed and several figures of merit (RMSEP, SEP, bias, RE%) were calculated. The second method was a thin layer chromatography followed by densitometric measurements at 245 nm. The separation was performed using silica gel 60 F254 plates and ethyl acetate : acetonitrile : toluene : ammonia (20 : 3 : 2 : 1, by volume) as a developing system. The third method was a high performance liquid chromatographic separation on HiQsil C18 HS column with UV detection at 245 nm. The mobile phase consisted of acetonitrile : methanol : water (60 : 25 : 15, by volume), with a flow rate of 1.5 mL min-1. The proposed methods were validated according to ICH guidelines. The described procedures were applied to quantify the studied drug residues in synthetic and real industrial wastewater samples. The proposed methods were statistically compared with the official and the reported methods, showing no significant difference with respect to accuracy and precision at P = 0.05.

Determinants of caregiver satisfaction in pediatric orthopedics.

This study investigates determinants of pediatric orthopedic surgery patients' parent or guardian (caregiver) satisfaction with the physician in an outpatient office setting. This was a cross-sectional survey study of 200 English-speaking caregivers of pediatric patients that checked into the pediatric orthopedic clinic at the authors' institution from 1 March 2017 to 1 November 2018. Questionnaires given in clinic include the Newest Vital Sign and The Literacy in Musculoskeletal Problems survey to measure general and musculoskeletal health literacy, respectively, demographic information, expected/estimated wait time, Consultation and Relational Empathy Measure, and Consumer Assessment of Healthcare Providers and Systems Clinician and Group. After multivariate regression, only perceived physician empathy as measured by the Consultation and Relational Empathy Measure score was significantly correlated with caregiver satisfaction (P < 0.0001), accounting for 56% of the variability of caregiver satisfaction scores. The odds of a satisfaction score of at least 9 out of 10 were 21% higher for every unit increase of the Consultation and Relational Empathy Measure score [odds ratio = 1.21 (P < 0.0001)]. After logistic regression, the caregiver's gender was also correlated with patient satisfaction and the odds of a patient satisfaction score ≥9 for males was less than 1/4th that of females [odds ratio = 0.16 (P = 0.040)]. The most important determinant of caregiver satisfaction with the physician in an outpatient pediatric orthopedic setting is perceived physician empathy. This accounts for the majority of the caregiver's satisfaction. This is the first study to determine this relationship in pediatric orthopedic surgery.

Neoadjuvant chemotherapy in patients with breast cancer: Does response in the breast predict axillary node response?

INTRODUCTION: Determining the extent of residual disease in the breast and axilla following neoadjuvant chemotherapy (NACT) is vital for surgical planning. Traditionally patients with incomplete radiological response in the breast after NACT undergo axillary node clearance, regardless of axillary clinical and radiological response. The aim of this study was to determine whether radiological and/or pathological response in the breast to NACT were predictive of axillary response. MATERIALS AND METHODS: A retrospective cohort study of patients with operable breast cancer with histologically proven axillary lymph node involvement who received NACT and underwent definitive surgical treatment between 1/1/2016 and 31/12/2018 were included. All had MRI and/or US of the breast and axilla before, mid-treatment and at the end of NACT. RESULTS: The 83 patients had a median age of 50 years (range 25-77). MRI had a positive predictive value (PPV) of 52.6% and negative predictive value (NPV) of 81.8% for breast pathological complete response (pCR). For axillary pCR, US had a PPV of 60.0% and NPV of 89.6%. Only 71% of patients had radiological concordance; 15.9% had radiological complete response (rCR) in breast and axilla whilst 55.1% had neither breast nor axillary rCR. 85.6% of patients had pathological concordance (20.5% with breast and axillary pCR: 65.1% with residual disease in both). CONCLUSION: Radiological and pathological response in the breast to NACT does not accurately predict axillary response. The axilla and the breast should be viewed and assessed as two separate entities for treatment plans.