30-day Morbidity and Mortality after Cholecystectomy for Benign Gallbladder Disease (AMBROSE): A Prospective, International Collaborative Cohort Study.

OBJECTIVE: This study aimed to assess 30-day morbidity and mortality rates following cholecystectomy for benign gallbladder disease and identify the factors associated with complications. SUMMARY BACKGROUND DATA: Although cholecystectomy is common for benign gallbladder disease, there is a gap in the knowledge of the current practice and variations on a global level. METHODS: A prospective, international, observational collaborative cohort study of consecutive patients undergoing cholecystectomy for benign gallbladder disease from participating hospitals in 57 countries between January 1 and June 30, 2022, was performed. Univariate and multivariate logistic regression models were used to identify preoperative and operative variables associated with 30-day postoperative outcomes. RESULTS: Data of 21,706 surgical patients from 57 countries were included in the analysis. A total of 10,821 (49.9%), 4,263 (19.7%), and 6,622 (30.5%) cholecystectomies were performed in the elective, emergency, and delayed settings, respectively. Thirty-day postoperative complications were observed in 1,738 patients (8.0%), including mortality in 83 patients (0.4%). Bile leaks (Strasberg grade A) were reported in 278 (1.3%) patients and severe bile duct injuries (Strasberg grades B-E) were reported in 48 (0.2%) patients. Patient age, ASA physical status class, surgical setting, operative approach and Nassar operative difficulty grade were identified as the five predictors demonstrating the highest relative importance in predicting postoperative complications. CONCLUSION: This multinational observational collaborative cohort study presents a comprehensive report of the current practices and outcomes of cholecystectomy for benign gallbladder disease. Ongoing global collaborative evaluations and initiatives are needed to promote quality assurance and improvement in cholecystectomy.

Colloidal, Room-Temperature Growth of Metal Oxide Shells on InP Quantum Dots.

We demonstrate colloidal, layer-by-layer growth of metal oxide shells on InP quantum dots (QDs) at room temperature. We show with computational modeling that native InP QD surface oxides give rise to nonradiative pathways due to the presence of surface-localized dark states near the band edges. Replacing surface indium with zinc to form a ZnO shell results in reduced nonradiative decay and a density of states at the valence band edge that resembles defect-free, stoichiometric InP. We then developed a synthetic strategy using stoichiometric amounts of common atomic layer deposition precursors in alternating cycles to achieve layer-by-layer growth. Metal-oxide-shelled InP QDs show bulk and local structural perturbations as determined by X-ray diffraction and extended X-ray absorption fine structure spectroscopy. Upon growing ZnSe shells of varying thickness on the oxide-shelled QDs, we observe increased photoluminescence (PL) quantum yields and narrowing of the emission linewidths that we attribute to decreased ion diffusion to the shell, as supported by phosphorus X-ray emission spectroscopy. These results present a versatile strategy to control QD interfaces for novel heterostructure design by leveraging surface oxides. This work also contributes to our understanding of the connections between structural complexity and PL properties in technologically relevant colloidal optoelectronic materials.

Deposition of Ultrathin MgB2 Films from a Suspension Using Cosolvent Marangoni Flow.

Magnesium diboride (MgB2) has demonstrated, theoretically and experimentally, promise as a candidate material for hydrogen storage and has thus attracted much contemporary research interest. To study hydrogen gas adsorption on MgB2 thin films using a quartz crystal microbalance (QCM)─a workhorse apparatus for this specific experiment─MgB2 must be deposited uniformly on the active surface of the QCM without damaging the quartz's performance. In work presented here, a wet-chemistry colloid synthesis and deposition process of a MgB2 thin film on a gold (Au) surface was established to avoid the extreme conditions of conventional physical deposition methods. This process also counteracts the unwanted phenomena of drying droplets on a solid surface, particularly the coffee-ring effect. To verify the normal function of the QCM after MgB2 deposition and its ability to obtain meaningful data, simple gas adsorption tests were conducted on the QCM, and the MgB2 film on the QCM was characterized with X-ray photoelectron spectroscopy (XPS) and atomic force microscopy (AFM) for elemental analysis and surface roughness, respectively. To obtain information about the thickness and the involvement of the coffee-ring effect, the same synthesis route was applied on a similar gold substrate─an evaporated Au film on glass. XPS characterization of the film and its precursor suspension shows the potential existence of both MgB2 and its oxide forms. The film's thickness on evaporated Au was measured by scanning transmission electron microscopy (STEM) to be 3.9 nm. The resulting samples show mitigation of the coffee-ring effect through roughness measurements with AFM at two scan sizes of 50 × 50 and 1 × 1 µm2.

How effective is rescue therapeutic plasma exchange in treatment of SARS-Coronavirus-2?

INTRODUCTION: After the FDA gave emergency approval for the use of therapeutic plasma exchange in treatment for SARS-Coronoavirus-2, we analyzed its efficacy in patients who had failed all other known therapies. METHODS: This was a prospective observational study of 42 patients with SARS-Coronoavirus-2 who had failed conventional therapy and were treated with therapeutic plasma exchange. Pre- and postexchange clinical and laboratory parameters were monitored. The patients were then also compared with a group of 147 patients with SARS-Coronoavirus-2 who were referred for stage 3 acute renal failure and dialysis from SARS-Coronoavirus-2. RESULTS: After therapeutic plasma exchange, there were significant improvements in some clinical parameters but mortality remained high; although better than the renal failure group (43.9% vs. 50.7%, p = 0.004). CONCLUSION: SARS-CoV-2 patients who failed all other therapies had significant mortality with therapeutic plasma exchange; however, their survival was better than SARS-CoV-2 patients with stage 3 acute renal failure.

Which "weigh" to Go? Alternative Vancomycin Dosing Strategies in Obese Patients.

PurposeThis study aims to compare the performance of alternative weight-based vancomycin dosing strategies to traditional dosing in obese patients using area under the curve (AUC) monitoring. Methods: This retrospective study compared target attainment of an AUC between 400-600mcg*H/mL using alternative vancomycin dosing strategies. All patients received allometrically dosed vancomycin, with patient-specific AUCs calculated using 2 post-infusion steady-state vancomycin serum concentrations using the trapezoidal rule. Predicted AUCs were calculated using the following: 15 mg/kg total body weight (TBW), 15 mg/kg corrected body weight (CBW), and 12.5 mg/kg TBW. Predicted AUCs from the traditional 15 mg/kg TBW dosing were then compared to alternative dosing strategies using the predicted AUCs from 12.5 mg/kg TBW, 15 mg/kg CBW, and the actual AUCs calculated using allometrically scaled vancomycin dosing. The primary outcome was attainment of initial AUC within the target range of 400-600mcg*H/mL for each dosing method. Results: Eighty-four patients were included. When AUCs were compared to traditional 15 mg/kg dosing strategy, the CBW, 12.5 mg/kg, and allometric dosing strategies were significantly more likely to result in initial attainment of an AUC within a target range of 400-600 mcg*H/mL (P = 0.0003, 0.0135, and 0.0088, respectively). No significant differences were seen between each of the alternative dosing methods (P = 0.73). Conclusion: The 3 alternative vancomycin dosing strategies examined were all significantly more likely to achieve an initial AUC within the target range compared to traditional vancomycin dosing in obese patients. Clinicians should strongly consider one of these alternative dosing strategies for obese patients as opposed to traditional vancomycin dosing.

Cli-fi videos can increase charitable donations: experimental evidence from the United Kingdom.

Recent research has begun to investigate if climate fiction, or cli-fi, can increase people's support for pro-climate initiatives. Emerging evidence focuses on whether cli-fi stories affect people's self-reported emotions, attitudes, and intentions. Few studies, however, examine the effect of such stories on revealed behavior, and whether the cli-fi story medium, i.e., whether stories are presented in text, audio, or audio-visual format, matters. We investigate the causal effect of cli-fi stories, and the medium through which they are communicated (textual, audio, or audio-visual) on self-reported support for climate policy, individual and collective action intentions, and a revealed measure of charitable donations. In a pre-registered online experiment (n = 1,085 UK adults), participants were randomly assigned to one of 5 conditions - to read scientific information about climate change (scientific information condition), read a story unrelated to the environment (control), read a cli-fi story in which a protagonist took intentional pro-environmental actions (fiction text), listen to the same cli-fi story in audio format (fiction audio), or watch an animation of the cli-fi story (fiction video). When comparing the fiction-text, fact-text, and control conditions, we found that cli-fi stories are not always more effective than alternative climate communications: participants in the fact-text condition reported higher support for climate policies, and intentions of taking individual environmental actions, and negative feelings of sadness, disappointment, and guilt, compared to the text-based control and cli-fi text condition. When comparing the cli-fi media format, we found that cli-fi videos were most effective in increasing pro-environmental charitable donations in an incentivized choice task, and self-reported feelings of happiness, hope, and inspiration. The findings show that scientific information about the climate and climate-fiction have an important place in the climate communications toolkit and can offer distinct pathways to enhance support for policy and behavioral change. Communicators seeking to inspire individual pro-environmental actions can consider telling cli-fi stories in video, which may be more compelling. And communicators seeking to enhance public support for societal changes, via climate policies, may benefit from disseminating scientific information about climate change.

Simplified phenotyping of CYP2D6 for tamoxifen treatment using the N-desmethyl-tamoxifen/ endoxifen ratio.

INTRODUCTION: CYP2D6 protein activity can be inferred from the ratio of N-desmethyl-tamoxifen (NDMT) to endoxifen (E). CYP2D6 polymorphisms are common and can affect CYP2D6 protein activity and E level. Some retrospective studies indicate that E < 16 nM may relate to worse outcome. MATERIALS AND METHODS: A target NDMT/E ratio was defined as associated with an E level of 15 nM in the 161 patient Test cohort of tamoxifen-treated patients, dichotomizing them into 'Normal' (NM) and 'Slow' (SM) CYP2D6 metabolizer groups. This ratio was then tested on a validation cohort of 52 patients. Patients were phenotyped based on the standard method (ultrarapid/extensive, intermediate or poor metabolizers; UM/EM, IM, PM) or a simplified system based on whether any variant allele (V) vs wildtype (wt) was present (wt/wt, wt/V, V/V). Comprehensive CYP2D6 genotyping was undertaken on germline DNA. RESULTS: A target NDMT/E ratio of 35 correlated with the 15 nM E level, dichotomizing patients into NM (<35; N = 117) and SM (>35; N = 44) groups. The ratio was independently validated by a validation cohort. The simplified system was better in predicting patients without slow metabolism, with specificity and sensitivity of 96% and 44% respectively, compared with the standard method - sensitivity 81% and specificity 83%. CONCLUSIONS: The simplified classification system based on whether any variant was present better identified patients who were truly not CYP2D6 slow metabolizers more accurately than the current system. However, as CYP2D6 genotype is not the only determinant of endoxifen level, we recommend that direct measurement of endoxifen should also be considered.

Comparison of Vancomycin Treatment Failures for Methicillin-Resistant Staphylococcus aureus Bacteremia Stratified by Minimum Inhibitory Concentration.

Background: Optimal treatment of methicillin-resistant Staphylococcus aureus bacteremias (MRSABs) with vancomycin minimum inhibitory concentrations (MICs) high within the susceptible range is of concern due to the high rate of mortality and increased prevalence. Objective: The purpose of this study is to evaluate vancomycin treatment failures in patients with MRSAB stratified by vancomycin MIC. Methods: In this retrospective chart review, patients ≥19 years of age with MRSAB between July 2010 and December 2016 were included if they received intravenous vancomycin for ≥72 hours. Vancomycin treatment failures were compared between patients with vancomycin MICs of ≤1 mg/L and 2 mg/L. Vancomycin treatment failure was defined as microbiological failure at 7 days. Inpatient mortality, 30-day readmission, vancomycin-associated nephrotoxicity, and early bacteremia clearance at 48 to 96 hours were assessed as secondary endpoints. Results: Fifty-eight patients were included in the vancomycin MIC ≤1 mg/L group and 22 patients in the vancomycin MIC 2 mg/L group. No significant difference was found in vancomycin treatment failures at 7 days between groups (88% vs 91%, respectively; P = .850). At 96 hours, there was no significant difference in vancomycin treatment failures between groups (72% vs 90%, respectively; P = .127). No significant difference was found in mortality (P > .99) or 30-day readmission (P > .99). Conclusions: In this study, vancomycin treatment failures were not more prevalent in patients with vancomycin MIC of 2 mg/L at 7 days. Regardless of MIC, antibiotics should be switched to an alternative agent at 7 days for persistent bacteremia.

Grammaticality differences between Spanish-speaking children with specific language impairment and their typically developing peers.

BACKGROUND: A limited number of studies have analyzed grammaticality in monolingual Spanish-speaking children with specific language impairment (SLI). Most of the available data are based on bilingual speakers. AIMS: To extend previous studies by doing a more detailed analysis of grammatical types in monolingual Spanish-speakers with and without SLI. METHODS & PROCEDURES: Forty-nine Spanish-speaking children (18 with SLI, 17 age-matched typically developing controls, 14 language-matched controls) were recruited from schools in Mexico and observed in a spontaneous narrative task. OUTCOMES & RESULTS: The findings were inconsistent with those of previous studies. Significant differences were found for article, connector and preposition omissions, and the per cent of ungrammatical utterances. There were no significant differences found for clitics and verb phrases, though clitic substitutions were frequent. Language-matched controls did not produce different frequencies of ungrammatical utterances. CONCLUSIONS & IMPLICATIONS: Significant differences were found for three main items: the per cent of ungrammatical utterances, the omission of articles and the omission of prepositions. Therefore, we propose these components be taken into consideration when distinguishing typically developing children from children with SLI.

Safety and completion rate of short-course therapy for treatment of latent tuberculosis infection.

BACKGROUND: Nine months of isoniazid therapy is the recommended regimen for treatment of latent tuberculosis infection, but low completion rates are a serious problem. The search for shorter regimens, compared with the standard isoniazid regimen, is of vital importance. We describe our experience using short-course regimens for the treatment of latent tuberculosis infection. METHODS: We conducted a nonrandomized, observational study of 459 patients in a county health department from June 2000 to January 2006. Short-course therapy was defined as pyrazinamide and rifampin taken daily or twice weekly for 2 months or rifampin taken daily for 4-6 months. Conventional therapy consisted of a 9-month regimen of isoniazid. Liver function testing was performed for both groups in accordance with clinical guidelines. Treatment completion and hepatotoxicity (according to the World Health Organization classification) were determined for the short-course and conventional therapy groups. RESULTS: Treatment was completed by 241 (77.7%) of 310 patients in the short-course group and by 98 (65.8%) of 149 patients in the isoniazid group (P = .009). Moderate to severe hepatotoxicity (grades 3 and 4) occurred in 6.1% of patients receiving short-course therapy and in 2.0% of patients receiving isoniazid (P=.09). The hepatotoxicity observed in the short-course group was confined to patients receiving pyrazinamide and rifampin daily and was self limited in all cases after the medications were discontinued. CONCLUSIONS: The rate of treatment completion was significantly higher with short-course regimens, compared with the isoniazid regimen. Although the overall risk of hepatotoxicity in patients receiving pyrazinamide and rifampin daily for the treatment of latent tuberculosis infection was higher, liver functions returned to normal after the medications were discontinued.

Infección en el paciente inmunocomprometido / Infection in the immunocompromised patient

Los pacientes con cáncer tienen mayor riesgo de presentar infección que la población general, sobre todo cuando la cuenta absoluta de neutrófilos es inferior a 500 células /µL. Comunmente la etiología de la infección es por microorganismos de la flora normal, aislándose con mayor frecuencia E. coli, Klebsiella pneumoniae, S. aureus, S. epidermidis y S. viridans; así como gérmenes oportunistas encontrándose implicados principalmente: Pneumocystis carinii, Candida sp, Aspergillus sp. y Cryptococcus neoformans. Puesto que en ocasiones la fiebre es la única manifestación presente en estos sujetos, es importante detectarlos oportunamente, por lo que debemos realizar un examen físico cuidadoso, poniendo especial atención a nivel hematológico, pulmonar, tejidos blandos y superficies mucosas, ya que en el huésped neutropénico son los principales sitios de infección. Es fundamental el inicio temprano del tratamiento, existiendo actualmente múltiples esquemas para niños inmunocomprometidos, siendo los más utilizados la combinación ceftazidima-amikacina y la monoterapia con imipenem, a las que se agrega anfotericina B cuando la fiebre persiste por más de una semana

Cirugia de guerra / War surgery

Ingresaron 30 pacientes con heridas de guerra de diferentes gravedades, de los cuales 7 pacientes presentaban heridas múltiples, 5 pacientes heridas abdominales, 4 pacientes heridas de torax, 13 pacientes con heridas a nivel de miembros y 1 paciente con traumatismo de cadera y transtorno psiquiatrico grave. Presentaron complicaciones 70%, de las cuales 43% fueron locales y 26% complicaciones generales, con una mortalidad del 6% que es considerada escasa