The therapeutic potential of isosakuranetin against perfluorooctane sulfonate instigated cardiac toxicity via modulating Nrf-2/Keap-1 pathway, inflammatory, apoptotic, and histological profile.

Perfluorooctane sulfonate (PFOS) is a pervasive organic toxicant that damages body organs, including heart. Isosakuranetin (ISN) is a plant-based flavonoid that exhibits a broad range of pharmacological potentials. The current investigation was conducted to evaluate the potential role of ISN to counteract PFOS-induced cardiac damage in rats. Twenty-four albino rats (Rattus norvegicus) were distributed into four groups, including control, PFOS (10 mg/kg) intoxicated, PFOS + ISN (10 mg/kg + 20 mg/kg) treated, and ISN (20 mg/kg) alone supplemented group. It was revealed that PFOS intoxication reduced the expressions of Nrf-2 and its antioxidant genes while escalating the expression of Keap-1. Furthermore, PFOS exposure reduced the activities of glutathione reductase (GSR), superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), glutathione S-transferase (GST), Heme oxygenase-1 (HO-1) and glutathione (GSH) contents while upregulating the levels of reactive oxygen species (ROS) and malondialdehyde (MDA). Besides, PFOS administration upregulated the levels of creatine kinase-MB (CK-MB), troponin I, creatine phosphokinase (CPK), and lactate dehydrogenase (LDH). Moreover, the levels of tumor necrosis factor-alpha (TNF-α), nuclear factor kappa-B (NF-κB), interleukin-6 (IL-6), and interleukin-1ß (IL-1ß) were increased after PFOS intoxication. Additionally, PFOS exposure downregulated the expression of Bcl-2 while upregulating the expressions of Bax and Caspase-3. Furthermore, PFOS administration disrupted the normal architecture of cardiac tissues. Nonetheless, ISN treatment remarkably protected the cardiac tissues via regulating aforementioned dysregulations owing to its antioxidative, anti-inflammatory, and antiapoptotic properties.

Predictive modeling of skin permeability for molecules: Investigating FDA-approved drug permeability with various AI algorithms.

The transdermal route of drug administration has gained popularity for its convenience and bypassing the first-pass metabolism. Accurate skin permeability prediction is crucial for successful transdermal drug delivery (TDD). In this study, we address this critical need to enhance TDD. A dataset comprising 441 records for 140 molecules with diverse LogKp values was characterized. The descriptor calculation yielded 145 relevant descriptors. Machine learning models, including MLR, RF, XGBoost, CatBoost, LGBM, and ANN, were employed for regression analysis. Notably, LGBM, XGBoost, and gradient boosting models outperformed others, demonstrating superior predictive accuracy. Key descriptors influencing skin permeability, such as hydrophobicity, hydrogen bond donors, hydrogen bond acceptors, and topological polar surface area, were identified and visualized. Cluster analysis applied to the FDA-approved drug dataset (2326 compounds) revealed four distinct clusters with significant differences in molecular characteristics. Predicted LogKp values for these clusters offered insights into the permeability variations among FDA-approved drugs. Furthermore, an investigation into skin permeability patterns across 83 classes of FDA-approved drugs based on the ATC code showcased significant differences, providing valuable information for drug development strategies. The study underscores the importance of accurate skin permeability prediction for TDD, emphasizing the superior performance of nonlinear machine learning models. The identified key descriptors and clusters contribute to a nuanced understanding of permeability characteristics among FDA-approved drugs. These findings offer actionable insights for drug design, formulation, and prioritization of molecules with optimum properties, potentially reducing reliance on costly experimental testing. Future research directions include offering promising applications in pharmaceutical research and formulation within the burgeoning field of computer-aided drug design.

Landing and take-off capabilities of bioinspired aerial vehicles: a review.

Bioinspired flapping-wing micro aerial vehicles (FWMAVs) have emerged over the last two decades as a promising new type of robot. Their high thrust-to-weight ratio, versatility, safety, and maneuverability, especially at small scales, could make them more suitable than fixed-wing and multi-rotor vehicles for various applications, especially in cluttered, confined environments and in close proximity to humans, flora, and fauna. Unlike natural flyers, however, most FWMAVs currently have limited take-off and landing capabilities. Natural flyers are able to take off and land effortlessly from a wide variety of surfaces and in complex environments. Mimicking such capabilities on flapping-wing robots would considerably enhance their practical usage. This review presents an overview of take-off and landing techniques for FWMAVs, covering different approaches and mechanism designs, as well as dynamics and control aspects. The special case of perching is also included. As well as discussing solutions investigated for FWMAVs specifically, we also present solutions that have been developed for different types of robots but may be applicable to flapping-wing ones. Different approaches are compared and their suitability for different applications and types of robots is assessed. Moreover, research and technology gaps are identified, and promising future work directions are identified.

A Method Based on a Modified Fluorescence In Situ Hybridization (FISH) Approach for the Sensing of Staphylococcus aureus from Nasal Samples.

Staphylococcus aureus is a major source of bacteremia and develops several complications, causing high morbidity and mortality. Rapid identification and detection of these bacteria have become an important issue for biomedical applications. Herein, an optical method based on a modified fluorescence in situ hybridization (FISH) approach has been established using DNA hybridization technology for the swift detection of pathogenic S. aureus from clinical samples. The platform was constructed with single-stranded genomic DNA and microbial colony by directly immobilizing in agarose-polyvinyl alcohol (AG-PVA) hydrogel on the surface of a glass slide. The probe was based on an elongation factor encoding the tuf gene, which binds with equal affinity to single-stranded DNA targets as well as surface proteins on microbial cells. The probe was labeled with MFP488 fluorophore having excitation wavelength 501 nm. The hybridization of the labeled probe with the target DNA and surface proteins was carried out under optimal FISH conditions, and the detection of bacteria was based on temporary field excitation of the labeled probe under a fluorescence microscope. Positive hybridization signals were detected by high fluorescence intensity. In comparison to genomic DNA, robust signals were observed with microbial cells, perhaps due to the moonlighting effect of the elongation factor Tu (Ef-Tu) expressed on the surface of bacterial cells. The applicability of the developed platform was tested on pediatric nasal samples, and results were verified with real-time qPCR. The designed platform is stable and sensitive, and after detailed optimization, a portable structure for on-site detection of pathogenic bacteria from clinical samples can be produced.

A Prospective Multicenter ≥2 Years Clinical Study of the Active Apex Correction (APC) Technique in Early Onset Scoliosis (EOS) Patients.

STUDY DESIGN: prospective multicenter study. OBJECTIVES: Active apex correction (APC) is posterior tethering technique for correction of early onset scoliosis (EOS) via reverse modulation at the apex. Active apex correction has been increasingly used worldwide. This study aimed to assess short-term outcomes of multicenter study with ≥2 years of APC on spine length, curve correction, complications, unplanned surgeries, and proposed low crankshaft phenomena incidence. METHODS: Prospective multicenter study including 24 EOS patients treated by APC; involves inserting and compressing pedicle screws on convex side of apex proximal and distal to most wedged vertebra allowing apex modulation according to Hueter-Volkmann law. Excluded patients with <2 years follow-up whom APC was not primary surgery. RESULTS: Mean age 85.97 ± 32.43 months, 71% congenital scoliosis, mean follow-up 35.54 ± 12.36 months. At final follow-up, statistically significant improvement in Cobbs angle (∆ = 23.96%, P < .0001), spinal length T1-T12 (∆ = 12.83%, P < .0001), T1-L5 (∆ = 13.41%, P < .0001) but not in apical vertebral translation (AVT) albeit clinical improvement (∆ = 7.9%, P = .36) compared to preoperative measurements. Comparing immediate postoperative measurements to >2 years follow-up, statistically significant improvement in spinal length T1-T12 (∆ = 6.03%, P = .0002) and T1-L5 (∆ = 6.26%, P < .0001) but not in Cobbs angle (∆ = 4.93%, P = .3) or AVT (∆ = 14.77%, P = .25). 9 complications requiring 3 unplanned surgeries recorded in all patients including 2 broken rods, 2 adding-on and 4 screw dislodgement. CONCLUSION: Active apex correction is a novel technique that has been incorporated in several countries as treatment modality for EOS. Short-term outcomes are promising in terms of clinical improvement, complication rates and decreased need for multiple operations or unplanned surgeries.

Green finance and environmental sustainability: a systematic review and future research avenues.

This study critically examines the dynamic interplay between green finance and environmental sustainability using a systematic review and bibliometric analysis. The analysis is centered on 507 scholarly articles published between 2013 and 2023 in the Scopus database and leverages Microsoft Excel, Harzing Publish or Perish, and VOSviewer to identify publication trends, key contributors, research impact, and emergent themes in this rapidly evolving field. The findings reveal that research on green finance and environmental sustainability has increased exponentially over the past decade, with China and institutions in Asia emerging as prominent contributors compared to other regions. This study also identified the Environmental Science and Pollution Research journal as the most active source title, demonstrating its commitment to publishing current findings on the topic. Through keyword analysis, several research avenues have been proposed to guide future research on enhancing the strategic role of green finance in promoting environmental sustainability. These avenues include broadening the geographical scope of research, exploring the synergies between green finance and emerging fintech innovations, developing robust metrics to quantify the socioeconomic impacts of green finance, establishing a risk and resilience framework to protect green finance against uncertainties, and creating a Green Finance Performance Index to evaluate the dual returns of environmental and financial performance.

Evaluation of the photocatalytic degradation mechanism of methylene blue using nascent and Ag+ ions-modified TiO2.

In photocatalytic removal of organic pollutants, adsorption and degradation are two important processes that take place. Various instrumental techniques and trapping experiments have been used to identify the reactive species and the mechanism of photodegradation. The present work focuses on investigating the mechanism of photo-induced degradation from the comparative characterization of fresh and used samples, isotherm models, competitive adsorption, and desorption studies of pure and Ag+-modified TiO2 NPs. The comparative characterizations of fresh and used NPs were carried out with FT-IR, EDX, and XRF analyses after methylene blue (MB) degradation. The Ag+ doped TiO2 used in this study was fabricated using simple impregnation technique. The prepared NPs were characterized using techniques including XPS, XRD, SEM/EDX, XRF, UV-DRS, and pH point-zero charge analyses (pHPZC). The Ag+-modified TiO2 NPs showed improved efficiency compared to pure TiO2 NPs using normal compact fluorescent light (CFL). The Langmuir and Freundlich isotherm models were applied to test the adsorption behavior on the surface photocatalysts. The investigational data finest fitted to the Langmuir isotherms model compared to Freundlich model, suggesting the homogeneous monolayer adsorption followed by degradations. The competitive removal of MB in the presence of a photo-generated electrons trapper (Cd2+) was enhanced almost 3-folds (115 mg/L) compared to the removal from a single MB solution (40 mg/L). The characterization of the used samples as well as adsorption in the dark and negligible desorption of used samples support the involvement of the proposed photo-induced degradation mechanism.

Evaluation of possible attenuative role of chrysoeriol against polyethylene microplastics instigated testicular damage: A biochemical, spermatogenic and histological study.

The current study was designed to evaluate the protective role of chrysoeriol against polyethylene microplastics (PE-MP) induced testicular damage. Forty eight male rats were distributed into 4 equal groups: vehicle control, PE-MP administrated, PE-MP + chrysoeriol co-administrated and only chrysoeriol supplemented group. The administration of PE-MP significantly reduced the activities of anti-oxidant enzymes, i.e., glutathione peroxidase, catalase, glutathione reductase and superoxide dismutase, whereas the levels of reactive oxygen species and malondialdehyde were increased. PE-MP exposure increased the levels of inflammatory markers (TNF-α, 1L-1ß, NF-κß, IL-6 & COX-2). Additionally, a considerable increase was observed in dead sperms number, abnormality of sperms (tail, midpiece and head), while a potential decrease was noticed in sperm motility in PE-MP treated rats. The expressions of steroidogenic enzymes were also decreased in PE-MP administrated group. The levels of plasma testosterone, luteinizing & follicle stimulating hormone were decreased in PE-MP treated group. Moreover, Bax and Caspase-3 expressions were increased, whereas Bcl-2 expressions were reduced. Furthermore, histopathological analysis showed that PE-MP exposure considerably damaged the testicular tissues. However, chrysoeriol supplementation potentially decreased all the adverse effects induced by PE-MP. Taken together, our findings indicate that chrysoeriol holds significant potential to avert PE-MP-induced testicular damage due to its androgenic, anti-apoptotic, anti-oxidant and anti-inflammatory nature.

A qualitative focus on community pharmacists’ attitudes and barriers toward continuing professional development: implications for professional practice

Background: Continuing professional development and continuing education are important components of professional practice for pharmacists. Mandatory continuing professional development requirements have been introduced in several countries, including Jordan. However, information on the uptake of continuing professional development is lacking, particularly in the Jordanian context. Objective: This study’s principal aim was to investigate community pharmacists’ views of continuing professional development and to explore pharmacists’ perceptions of the most common facilitators and barriers to participation in continuing education. Methods: A series of seven focus group sessions were undertaken with groups of four to seven community pharmacists. Focus group transcripts were thematically analyzed using a qualitative data analysis method. Results: The study included 34 pharmacists out of 95 who received invitation letters. Four key themes were identified: (1) community pharmacists’ attitudes toward continuing professional development; (2) perceived motivating factors for continuing professional development; (3) experienced barriers to continuing professional development; (4) and potential strategies for improving pharmacists’ continuing professional development. In terms of attitudes, participants generally understood the concept of continuing professional development. Motivating factors were mainly attributed to personal, work-related, and service provision-related factors. However, experienced barriers that could prevent community pharmacists from participating in continuing professional development despite their motivation were: barriers pertaining to workload, barriers pertaining to pharmacists, and barriers related to lack of resources. (AU)

Biodiesel production from Sisymbrium irio as a potential novel biomass waste feedstock using homemade titania catalyst.

Biomass waste streams are a possible feedstock for a range of eco-friendly products and a crucial alternative energy source for achieving carbon neutrality; therefore, the efficient management of biomass waste has taken on a greater significance in recent years. Due to its well-comparable physic-chemical properties with fossil diesel, biodiesel is a potential substitute for fossil fuel. This study aimed to synthesize biodiesel from the widely available non-edible seed oil of Sisymbrium irio L. (a member of the Brassicaceae family) via a transesterification procedure over a homemade TiO2 catalyst. At 1:16 oil to methanol ratio, 93% biodiesel yield was obtained over 20 mg catalyst at 60 °C and 60 min. The ASTM methods were used to analyze the fuel properties. The quantitative and qualitative analysis was performed by FT-IR, GC-MS, and NMR spectroscopy. GC-MS study confirms 16 different types of fatty acids of methyl esters. FT-IR analysis showed important peaks that confirm the successful occurrence of biodiesel. 1H-NMR and 13C-NMR showed important peaks for converting triglycerides into corresponding FAMEs. The acid value (0.42 mg KOH/mg/kg), flash point (106 °C), and water content (0.034) of biodiesel are below the specified limit of ASTM D6751 whereas kinetic viscosity (3.72 mm2/s), density (0.874 kg/L), cloud point (- 4.3 °C) and pour point (- 9.6 °C) and high heating value (41.62 MJ/kg) fall within the specified range of ASTM D6751 test limit. The Unsaturation degree and oxidative stability of biodiesel are above ASTM D6751 test limit. The physic-chemical properties of the SIB confirm that it is eco-friendly fuel and a competitive source for manufacturing biodiesel on a commercial scale. Furthermore, the SIB is engine friendly and has good fuel efficacy.

Vertebral body tethering: An alternative to posterior spinal fusion in idiopathic scoliosis?

Introduction: Skeletally immature patient with adolescent idiopathic scoliosis (AIS) whose curves continue to progress despite bracing should be treated surgically. Vertebral body tethering (VBT) is a non-fusion, compression-based, growth preserving alternative to posterior spinal fusion (PSF) based on the concept of 'growth modulation' to prevent possible functional complications secondary to fusion while correcting scoliotic deformity. This review aims to shed light on the indications of VBT, short- and medium-term outcomes, describe the surgical technique and associated complications, and to compare its efficacy to that of PSF. Methods: A review of peer-reviewed literature on VBT as a surgical technique, its indications, outcomes, complications, and comparison with other surgical interventions to correct AIS was conducted in December 2022. Results: Indications remain controversial and mainly include stage of skeletal maturity based on radiographic markers, curve location, magnitude and flexibility, and presence of secondary curve. Assessment of VBT clinical success should not be restricted to improvement in radiographic parameters but should include functional results and patient-centered outcomes, improved body image and pain, and durability of outcomes. In contrast to fusion, VBT seems to be associated with preserved spinal growth, shorter recovery, potentially better functional outcomes, less motion loss but possibly less curve correction. Discussion: Yet still, with VBT there exists a risk of overcorrection, construct breakage or failure of procedure which require revision and at times conversion to PSF. Patient and family preferences must be accounted for acknowledging gaps in knowledge, attributes and drawbacks of each intervention.

A Cross-Cultural Analysis of Medicinal Plant Utilization among the Four Ethnic Communities in Northern Regions of Jammu and Kashmir, India.

Medicinal plants are utilized around the globe for the treatment of a wide range of ailments. This study is an attempt to document the utilization of medicinal plants across the four different cultural groups residing in the rural and remote villages of the northern districts of the Union territory of Jammu and Kashmir, India. To gather information related to medicinal plants and health care practices among the local folk, field surveys were conducted from February 2018 to May 2021. The ethnomedicinal information was gathered through semi-structured interviews and group discussions. During the study, a total of 109 plant species belonging to 35 families were recorded as commonly utilized by the local population, with Asteraceae reported as the dominant family. The most common growth form was herbs, with a percentage contribution of 86%. Leaves (38%) were the most commonly used plant part for the preparation of traditional remedies, and most of the remedies were prepared as paste and applied topically. The highest use value of 0.30 was reported for Capsella bursa-pastoris. Greater similarity (14% species) in the usage of plants was shown by Bakerwal, Gujjar, and Pahadi ethnic groups, whereas the least similarity (1%) was observed between Bakerwal and Kashmiri ethnic groups. Based on the results obtained in the present study, further phytochemical and pharmacological analysis of plants is recommended to confirm the efficacy and safety of the remedies used and to possibly elucidate candidates for the development of new drugs.

Biological control potential of entomopathogenic fungal strains against peach Fruit fly, Bactrocera zonata (Saunders) (Diptera: Tephritidae).

The peachfruit fly, Bactrocera zonata (Saunders) is a polyphagous pest in nature, belonging to order, Diptera and their respective family is Tephritidae. It mostly feeds on different crops, vegetables and fruits. Different traditional chemical insecticides have been used to control this notorious pest. Excessive consumption of pesticides has become a major threat to the fresh fruits trade since many importing countries refused to accept the shipments due to public health and environmental concerns. There is a growing trend to control these pests using the most effective biological control methods and other preventive measures have been adopted for reducing their attacks. Fungal agents have been used as biological agents to manage the attack of different insects pest through biological means. The present study was conducted to assess the virulence of three entomopathogenic fungi, Metarhizium anisopliae, Beauveria bassiana and Verticillium lecanii, against Bactrocera zonata stages under different laboratory conditions. The results showed that B. bassiana and M. anisopliae were more effective in pathogenicity and potentially kill at all stages of B. zonata as compared to V. lecanii. The highest mortality rate for the third larval instar and the pupal stage were recorded after exposure to the 1 × 1010 conidia/ml concentrations, B. bassiana, with 68.67% and 89.67%, respectively. Adult B. zonata flies were the most susceptible to all entomopathogenic fungi. However, M. anisopliae was more virulent against B. zonata adult flies than B. bassiana and V. lecanii at 1 × 1010 conidial concentration. Therefore, the entomopathogenic fungi B. bassiana and M. anisopliae can be used as an cost effective bio-insecticide in the integrated pest management programs to control B. zonata. This study will be helpful to overcome this pest through biological control means.

Traditions for Future Cross-National Food Security-Food and Foraging Practices among Different Native Communities in the Western Himalayas.

Traditional diets exist in all cultures and geographic regions, and they often represent healthy eating options. Traditional culinary preparations have, however, often undergone profound change, even in the isolated Himalayan region. Therefore, we adapted methods to identify traditional plant foraging activities to better understand their significance in food system sustainability, as well as to promote innovative local gastronomies. Information on wild food and foraging practices was gathered from varied ethnic groups such as Kashmiri, Gujjars, Pahari, Dogra, Bakarwal, Balti, Beda and Brokpa through interviews (n = 716) and group discussions (n = 67) in four bio-geographic regions of the Jammu and Kashmir Himalayas (J&KH). The data were subjected to ordination techniques (Principal Component Analysis) via R software Ver. 4.0.0. We documented 209 food species, of which 73% were plants and 27% animals, used by the inhabitants of four bio-geographic regions of J&KH. The highest number of food plant species was recorded in Indian Kashmir, followed by Jammu, Azad Kashmir and Ladakh (81, 65, 60 and 27 species, respectively), and the maximum number of animal species was reported in Indian Kashmir, followed by Azad Kashmir, Ladakh and Jammu (33, 21, 19 and 17 species, respectively). The Azad Kashmir and Indian Kashmir regions showed greater similarity, whereas the least overlap was observed between Kashmir and Ladakh. The PCA showed considerable variation between different regions, and specific groups of species were more related to one specific region than others. The reported uses of Abies pindrow, Acacia modesta, Bergenia ciliata, Bergenia stracheyi and Juglans regia among plants, and Jynx torquilla, Streptopelia orientalis and Tadorna ferruginea among animals, are novel for the gastronomy of this part of the Himalayan region. We also recorded for the first time from this region seven unique food preparations of wild animals. This study documented extensive traditional knowledge on the usage of wild species, and is the first scientific description of wild food species and their vernacular names in the Western Himalayas, Jammu and Kashmir. Our findings can contribute significantly to combating food insecurity by revitalizing and reconsidering the rich bio-cultural food heritage around which local traditional communities have developed their food systems.

Evaluation and identification of essential therapeutic proteins and vaccinomics approach towards multi-epitopes vaccine designing against Legionella pneumophila for immune response instigation.

The Legionellaceae group comprises the Legionella, containing 58 species with 70 serotypes. For instance, Legionella pneumophila is the deadliest serotype to cause Legionnaires infectious and is responsible for 90% of the infections in humans. The bacterial pathogen is associated with a severe lung infection, known as legionaries' disease. It is resistant to multiple drugs, thus warranting novel vaccine candidates identification to immune the host against infections caused by the said pathogen. For this, we applied the subtractive proteomics and reverse vaccinology approaches to annotate the most essential genes suitable for vaccine designing. From the whole proteome, only five proteins (Q5ZVG4, Q5ZRZ1, Q5ZWE6, Q5ZT09, and Q5ZUZ8) as the best targets for further processing as they fulfill all the standard parameters set for in silico vaccine design. Immuno-informatics approaches were further applied to the selected protein sequences to prioritized antigenic epitopes for design a multi-epitope subunit vaccine. A multi-epitopes vaccine was designed by using suitable linkers to link the CTL (cytotoxic T lymphocytes), HTL (Helper T lymphocytes), B cell epitopes, and adjuvant to strengthen the vaccine's immunogenicity. The MEVC(multi-epitopes vaccine construct) was reported to interact with human immune receptor TLR-2 (toll-like receptor) robustly (docking score = -357.18 kcal/mol), and a higher expression was achieved in the Escherichia coli system (CAI = 0.88, and GC contents = 54.34%). Moreover, immune simulation revealed that on the 3rd day, the neutralization of the antigen started, while on the 5th day, the antigen was completely neutralized by the secreted immune factors. In conclusion, the designed vaccine candidate effectively triggered the immune response against eh pathogen; however, wet lab-based experimentations are highly recommended to prove the protective immunological proficiency of the vaccine against L. pneumophila.

Marijuana and thromboembolic events in geriatric trauma patients: The cannabinoids clots correlation!

BACKGROUND: Tetrahydrocannabinol (THC) can alter the coagulation cascade resulting in hypercoagulability. The aim of our study is to evaluate the impact of THC use on thromboembolic complications (TEC) in geriatric trauma patients (GTP). METHODS: This is a 2017 analysis of the TQIP database including all GTP (age ≥65 years). Patients were stratified based on THC use. Propensity score matching (1:2 ratio) was performed. RESULTS: A total of 2,835 patients were matched (THC+: 945 and THC-: 1,890). Mean age was 70 ± 6 years, 94% sustained blunt injuries, and median ISS was 22[12-27]. Sixty-two percent of patients received thromboprophylaxis, with median time to initiation of 27 h from admission. Overall, the rate of TEC was 2.1% and mortality was 6.0%. THC + patients had significantly higher rates of TEC compared to THC- patients (3.0% vs. 1.7%; p = 0.01). Rates of DVT (2.2% vs 0.6%, p < 0.01) and PE (1.4% vs 0.4%, p < 0.01) were higher in the THC + group. CONCLUSION: THC exposure increases the risk of TEC in GTP. Incorporation of THC use into risk assessment protocols merits serious consideration in GTP.

Evaluation of Frailty Assessment Compliance in Acute Care Surgery: Changing Trends, Lessons Learned.

BACKGROUND: Routine frailty assessment has emerged recently in the surgical literature and is an important prognostication and risk stratification tool. The aim of our study was to review our 7-y experience with two frailty assessment tools and changing trends in their use. METHODS: We performed a 7-y (2011-2017) analysis of our prospectively maintained frailty database. Frail patients were identified using the emergency general surgery and trauma specific frailty indices. Outcome measures were rates of compliance with frailty assessment, overall complications, discharge to skilled nursing facility (SNF)/rehab, and mortality over the study period. Multivariate logistic regression and Cochran-Armitage trend analyses were performed. RESULTS: We evaluated a total of 1045 geriatric patients (Trauma: 587, EGS: 458). Mean age was 74.5 ± 7.9 y, 74% were males, and 81% were white. Overall, 34% of the patients were frail. Compared to non-frail patients, frail patients had higher adjusted rates of complications (OR 2.4 [1.9-2.9]), mortality (OR 1.8 [1.4-2.3]), and rehab/SNF disposition (OR 3.7 [3.1-4.3]). The compliance rate of measuring frailty increased from 12% in 2011 to 78% in 2017, P < 0.001 (Figure). The complication rate decreased (33% versus 21%, P < 0.001), while the rate of discharge disposition to SNF/Rehab increased (41% versus 58%, P < 0.001). There was no difference in mortality (11% versus 9.8%, P = 0.48) over the study period. CONCLUSIONS: Adherence to frailty measurement increased over the study period. This was accompanied by a significant decline in overall in-hospital complications. Frailty indices can be utilized to identify high-risk patients and develop post-operative strategies to improve outcomes in acute care surgery.

Two-Year Retrospective Patient-Reported Outcomes Following Superior Capsular Reconstruction.

PURPOSE: The purpose of this study was to evaluate the short-term patient-reported outcomes of superior capsular reconstruction (SCR) and identify factors contributing to the success or failure of the procedure at 2 years. METHODS: A retrospective review was performed on data prospectively collected from the Surgical Outcomes System database. Patient-reported outcomes (PROMs) including American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, visual analog scale for pain, and Veterans RAND 12-Item Health Survey (VR-12) were evaluated at a minimum of 2 years postoperatively and reported using a minimal clinically important difference (MCID) and the percent of maximal possible improvement (MPI). In addition, preoperative and intraoperative variables were evaluated in patients with and without a postoperative improvement in ASES and SANE scores meeting the threshold of MCID. RESULTS: Two-year follow-up data were available for 350 patients. Statistically significant improvements were noted in all PROMs at 2-year follow-up. In total, 240 patients (68.8%) achieved an MCID improvement of >17.5 in ASES score, and 185 patients (52.9%) achieved an MCID of >29.8 improvement in the SANE score. Primary SCRs were associated with a higher MPI in the ASES score (60.1% ± 39.8% vs 40.4% ± 47.9%; P = .025) and VR-12 physical score (14.0% ± 13.8% vs 8.0% ± 14.7%; P = .028) compared to revision repairs. Only diabetes was identified as a predictor of SANE score improvement (64.5% vs 62.2%; P = .041). CONCLUSIONS: SCR is associated with improvement in patient-reported outcomes at short-term follow-up, with 53% to 69% of patients achieving an improvement considered to meet the MCID. Greater improvement is expected when SCR is performed as a primary procedure rather than as a revision procedure for failed rotator cuff repair. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Pre-Hospital Administration of Opioids in Trauma Patients: Is Dose Associated With Outcomes?

BACKGROUND: Opioids are commonly used as an analgesic agent in the prehospital setting. Current efforts to prevent and control prescription opioid overuse are focused on the in-hospital and post-discharge phases. The aim of our study was to assess the associations between pre-hospital opioids use and in-hospital outcomes among trauma patients. METHODS: We performed a 2 year (2016-2017) retrospective analysis of our Level-I trauma center database. We included all adult trauma patients (age > 18y) who received pre-hospital opioids (Fentanyl (F) or Morphine-Sulfate (MS)). Outcome measures were emergency-department (ED) hypotension (SPB < 90 mmHg), ED intubation, prescription opioid medication upon discharge, and mortality. Multivariate logistic regression was performed. RESULTS: In total, 709 patients were included in the analysis. Cutoff values of 200 mcg F and 15 mg MS were significantly associated with adverse outcomes. Overall, the ED hypotension rate was 14.4%, ED intubation rate was 6%, and ED mortality rate was 3.1%. On regression analysis, higher dosages of both pre-hospital F and pre-hospital MS were independently associated with increased odds of ED hypotension, ED intubation, and discharge on opioid medications, but not with ED mortality. CONCLUSION: Pre-hospital administration of high dose opioids is associated with increased odds of adverse outcomes. Collaborative efforts to standardize and control the overuse of opioids should target the pre-hospital setting to limit opioid associated adverse effects.

Open Versus Laparoscopic Repair of Traumatic Diaphragmatic Injury: A Nationwide Propensity-Matched Analysis.

INTRODUCTION: Minimally invasive surgical techniques have become routinely applied in the evaluation and treatment of patients with isolated traumatic diaphragmatic injuries (TDI). However, there remains a paucity of data that compares the laparoscopic repair to the open repair approach. The aim of our study is to examine patient outcomes between TDI patients managed laparoscopically versus those managed using open repair. METHODS: Adult (age ≥18 years) trauma patients presenting with TDI that required surgical repair were identified in the Trauma Quality Improvement Program database 2017. Patients were excluded if they underwent any other surgical procedure of the abdomen or chest. Patients were then stratified into 2 groups based on the surgical approach: laparoscopic repair of the diaphragm versus open repair. Propensity-score matching in a 1:2 ratio was performed. Primary outcome measures were in-hospital major complications and length of stay (LOS). Secondary outcome measure was in-hospital mortality. RESULTS: A total of 177 adult trauma patients who had a laparoscopic repair of their isolated diaphragmatic injury were matched to 354 patients who had an open repair. Mean age was 35 ± 16 years, 78% were male, and mean BMI was 27 ± 7 kg/m2. 67 percent of the patients had penetrating injuries, and the median ISS was 17 [9-21]. CT imaging was done in 67% of the patients, with 71% presenting with left-sided injury and 21% having visceral herniation. Conversion from laparoscopic to open was reported in 7.3% of the cases. Patients with a laparoscopic repair had significantly lower rates of major complications (5.6 versus 14.4%; P<0.001), shorter hospital LOS (6 [3-9] versus 9 [5-13] days; P<0.001) and ICU LOS (3 [2-7] versus 5 [2-10] days; P<0.001). No difference was found in rates of in-hospital mortality (0.6 versuss 2.0%; P = 0.129) between the 2 groups. CONCLUSION: Laparoscopic repair of traumatic diaphragmatic injury was associated with decreased morbidity and a shorter hospital course, with a low conversion rate to open repair. Future studies remain necessary to further explore the long-term outcomes of patients with such injury. LEVEL OF EVIDENCE: Level III STUDY TYPE: Therapeutic.