Prebiotics for Induction and Maintenance of Remission in Inflammatory Bowel Disease: Systematic Review and Meta-Analysis.

BACKGROUND: Prebiotics are nondigestible carbohydrates fermented by gut bacteria into metabolites that confer health benefits. However, evidence on their role for inflammatory bowel disease (IBD) is unclear. This study systematically evaluated the research on prebiotics for treatment of IBD. METHODS: A search was performed in PubMed, Embase, Cochrane, and Web of Science. Eligible articles included randomized controlled trials or prospective observational studies that compared a prebiotic with a placebo or lower-dose control in patients with IBD. Meta-analyses were performed using random-effects models for the outcomes of clinical remission, clinical relapse, and adverse events. RESULTS: Seventeen studies were included. For induction of clinical remission in ulcerative colitis (UC), the fructooligosaccharide (FOS) kestose was effective (relative risk, 2.75, 95% confidence interval, 1.05-7.20; n = 40), but oligofructose-enriched inulin (OF-IN) and lactulose were not. For maintenance of remission in UC, germinated barley foodstuff trended toward preventing clinical relapse (relative risk, 0.40; 95% confidence interval, 0.15-1.03; n = 59), but OF-IN, oat bran, and Plantago ovata did not. For Crohn's disease, OF-IN and lactulose were no different than controls for induction of remission, and FOS was no different than controls for maintenance of remission. Flatulence and bloating were more common with OF-IN; reported adverse events were otherwise similar to controls for other prebiotics. CONCLUSION: Prebiotics, particularly FOS and germinated barley foodstuff, show potential as effective and safe dietary supplements for induction and maintenance of remission in UC, respectively. The overall certainty of evidence was very low. There would be benefit in further investigation on the role of prebiotics as treatment adjuncts for IBD.

Prebiotics are nutrients fermented by gut microbes into healthful metabolites. This systematic review and meta-analysis examined the available research on the efficacy and safety of prebiotics for the treatment of inflammatory bowel diseases.

Astronomy's climate emissions: Global travel to scientific meetings in 2019.

Travel to academic conferences-where international flights are the norm-is responsible for a sizeable fraction of the greenhouse gas (GHG) emissions associated with academic work. In order to provide a benchmark for comparison with other fields, as well as for future reduction strategies and assessments, we estimate the CO2-equivalent emissions for conference travel in the field of astronomy for the prepandemic year 2019. The GHG emission of the international astronomical community's 362 conferences and schools in 2019 amounted to 42,500 tCO2e, assuming a radiative-forcing index factor of 1.95 for air travel. This equates to an average of 1.0 ± 0.6 tCO2e per participant per meeting. The total travel distance adds up to roughly 1.5 Astronomical Units, that is, 1.5 times the distance between the Earth and the Sun. We present scenarios for the reduction of this value, for instance with virtual conferencing or hub models, while still prioritizing the benefits conferences bring to the scientific community.

Herbal Medicines for the Treatment of Active Ulcerative Colitis: A Systematic Review and Meta-Analysis.

Herbal medicines are used by patients with IBD despite limited evidence. We present a systematic review and meta-analysis of randomized controlled trials (RCTs) investigating treatment with herbal medicines in active ulcerative colitis (UC). A search query designed by a library informationist was used to identify potential articles for inclusion. Articles were screened and data were extracted by at least two investigators. Outcomes of interest included clinical response, clinical remission, endoscopic response, endoscopic remission, and safety. We identified 28 RCTs for 18 herbs. In pooled analyses, when compared with placebo, clinical response rates were significantly higher for Indigo naturalis (IN) (RR 3.70, 95% CI 1.97-6.95), but not for Curcuma longa (CL) (RR 1.60, 95% CI 0.99-2.58) or Andrographis paniculata (AP) (RR 0.95, 95% CI 0.71-1.26). There was a significantly higher rate of clinical remission for CL (RR 2.58, 95% CI 1.18-5.63), but not for AP (RR 1.31, 95% CI 0.86-2.01). Higher rates of endoscopic response (RR 1.56, 95% CI 1.08-2.26) and remission (RR 19.37, 95% CI 2.71-138.42) were significant for CL. CL has evidence supporting its use as an adjuvant therapy in active UC. Research with larger scale and well-designed RCTs, manufacturing regulations, and education are needed.

searchRxiv: A Resource for Sharing Database Search Strategies.

Medical librarians can increase their work visibility and highlight their unique role on evidence synthesis teams with searchRxiv, an open access repository that makes librarian's efforts easily citable and resolves longstanding challenges pertaining to reproducing full search strategies within literature review articles. This column will discuss how to navigate searchRxiv to find, reuse, and cite published search strategies, as well as the process of depositing search strategies.

Differential Interferon Signaling Regulation and Oxidative Stress Responses in the Cerebral Cortex and Cerebellum Could Account for the Spatiotemporal Pattern of Neurodegeneration in Niemann-Pick Disease Type C.

Niemann-Pick disease type C (NPC) is a fatal neurodegenerative condition caused by genetic mutations of the NPC1 or NPC2 genes that encode the NPC1 and NPC2 proteins, respectively, which are believed to be responsible for cholesterol efflux from late-endosomes/lysosomes. The pathogenic mechanisms that lead to neurodegeneration in NPC are not well understood. There are, however, well-defined spatiotemporal patterns of neurodegeneration that may provide insight into the pathogenic process. For example, the cerebellum is severely affected from early disease stages, compared with cerebral regions, which remain relatively spared until later stages. Using a genome-wide transcriptome analysis, we have recently identified an aberrant pattern of interferon activation in the cerebella of pre-symptomatic Npc1-/- mice. Here, we carried out a comparative transcriptomic analysis of cerebral cortices and cerebella of pre-symptomatic Npc1-/- mice and age-matched controls to identify differences that may help explain the pathological progression within the NPC brain. We report lower cerebral expression of genes within interferon signaling pathways, and significant differences in the regulation of oxidative stress, compared with the cerebellum. Our findings suggest that a delayed onset of interferon signaling, possibly linked to lower oxidative stress, may account for the slower onset of cerebral cortical pathology in the disease.

A systematic review of evidence on integrated management of psychiatric disorders in youth who use cannabis.

Given the risks to mental health associated with cannabis use in youth and the increase in cannabis legalization worldwide and in the U.S., there is a need to understand existing evidence-based approaches to integrated management of psychiatric disorders in youth who use cannabis. This systematic review aimed to appraise the current evidence on integrated treatment for adolescents and young adults with common psychiatric disorders who engage in regular cannabis use. A total of 989 studies were screened for inclusion. Study's titles and abstracts were screened and advanced to full text review for further screening by two independent reviewers. Thirty-five full-text articles were reviewed, with five articles ultimately meeting all criteria for inclusion. Five randomized controlled trials examined the effects of therapeutic interventions in youth with common psychiatric disorders who used cannabis, including two studies on depression, one on bipolar disorder, one on anxiety and one on PTSD were reviewed. No studies were considered high in risk of bias. Overall, there is a paucity of research on the treatment of comorbid adolescent mental health disorders and cannabis use, which limits the ability to draw evidence-based treatment recommendations.

A systematic review of cognition in idiopathic intracranial hypertension.

Background: Cognitive disturbance is not pathognomonic of idiopathic intracranial hypertension (IIH), and therefore is not routinely assessed unless it presents as a major complaint. Consequently, cognition has been slow to gain substantial traction in IIH-related research, despite its notable impact on a subset of patients. We completed a systematic review of the literature examining the neurocognitive profile of patients with IIH. Methods: A PRISMA compliant literature search was conducted in Ovid Medline, PubMed, PsycInfo, Embase, Web of Science, Cochrane, Cinahl, and Scopus databases. The initial query yielded 1376 unique articles. These articles were narrowed to those including empirical analyses of cognitive assessment in adult patients with IIH. Results: A final cohort of nine articles resulted, comprising the findings from 309 patients with IIH and 153 healthy control subjects. Although there was considerable variability in methodology particularly with respect to cognitive assessment, fairly consistent deficits were observed across studies in the domains of processing speed, working memory, sustained and complex attention, set-shifting, and confrontation naming. Body mass index and body weight were not associated with cognitive performance. Pertinent limitations of the literature were identified, most notably failure to report trial-level cognitive testing data, the need for more comprehensive testing batteries with less reliance on screening tools, and not controlling for variables that may impact cognition. Conclusions: A more complete understanding of the cognitive profile in patients with idiopathic intracranial hypertension could lead to the increased -relevance of cognitive screening in disease management, and therefore more appropriate neuropsychological referral, earlier identification of functional limitations, and targeted neurorehabilitation.

Stochastic-offset-enhanced restricted slice excitation and 180° refocusing designs with spatially non-linear ΔB0 shim array fields.

PURPOSE: Developing a general framework with a novel stochastic offset strategy for the design of optimized RF pulses and time-varying spatially non-linear ΔB0 shim array fields for restricted slice excitation and refocusing with refined magnetization profiles within the intervals of the fixed voxels. METHODS: Our framework uses the decomposition property of the Bloch equations to enable joint design of RF-pulses and shim array fields for restricted slice excitation and refocusing with auto-differentiation optimization. Bloch simulations are performed independently on orthogonal basis vectors, Mx, My, and Mz, which enables designs for arbitrary initial magnetizations. Requirements for refocusing pulse designs are derived from the extended phase graph formalism obviating time-consuming sub-voxel isochromatic simulations to model the effects of crusher gradients. To refine resultant slice-profiles because of voxelwise optimization functions, we propose an algorithm that stochastically offsets spatial points at which loss is computed during optimization. RESULTS: We first applied our proposed design framework to standard slice-selective excitation and refocusing pulses in the absence of non-linear ΔB0 shim array fields and compared them against pulses designed with Shinnar-Le Roux algorithm. Next, we demonstrated our technique in a simulated setup of fetal brain imaging in pregnancy for restricted-slice excitation and refocusing of the fetal brain. CONCLUSIONS: Our proposed framework for optimizing RF pulse and time-varying spatially non-linear ΔB0 shim array fields achieve high fidelity restricted-slice excitation and refocusing for fetal MRI, which could enable zoomed fast-spin-echo-MRI and other applications.

k-Fold Cross-Validation Can Significantly Over-Estimate True Classification Accuracy in Common EEG-Based Passive BCI Experimental Designs: An Empirical Investigation.

In passive BCI studies, a common approach is to collect data from mental states of interest during relatively long trials and divide these trials into shorter "epochs" to serve as individual samples in classification. While it is known that using k-fold cross-validation (CV) in this scenario can result in unreliable estimates of mental state separability (due to autocorrelation in the samples derived from the same trial), k-fold CV is still commonly used and reported in passive BCI studies. What is not known is the extent to which k-fold CV misrepresents true mental state separability. This makes it difficult to interpret the results of studies that use it. Furthermore, if the seriousness of the problem were clearly known, perhaps more researchers would be aware that they should avoid it. In this work, a novel experiment explored how the degree of correlation among samples within a class affects EEG-based mental state classification accuracy estimated by k-fold CV. Results were compared to a ground-truth (GT) accuracy and to "block-wise" CV, an alternative to k-fold which is purported to alleviate the autocorrelation issues. Factors such as the degree of true class separability and the feature set and classifier used were also explored. The results show that, under some conditions, k-fold CV inflated the GT classification accuracy by up to 25%, but block-wise CV underestimated the GT accuracy by as much as 11%. It is our recommendation that the number of samples derived from the same trial should be reduced whenever possible in single-subject analysis, and that both the k-fold and block-wise CV results are reported.

Longitudinal Olfactory Patterns in Multiple Sclerosis: A Scoping Review and Implication for Use in Management of Disease.

BACKGROUND: Although studies regarding multiple sclerosis (MS) and olfactory dysfunction (OD) have been previously described and summarized, there is not a sole review of longitudinal studies regarding the matter. This review examines the existing literature investigating MS and its effect on olfaction. In addition, the role of OD in the diagnosis and prognosis of MS is explored. METHODS: A scoping review of the literature was performed covering longitudinal studies investigating MS and OD. Systematic searches of PubMed, Google Scholar, Web of Science, Embase, PsycInfo, Cumulative Index to Nursing and Allied Health Literature, AgeLine, and MEDLINE were performed using terms that encompassed MS and olfaction. The aim of this review was to build on the existing literature by summarizing only findings that were demonstrated longitudinally. RESULTS: Of 6938 articles identified from the search, 9 met the inclusion criteria: longitudinal observation of relapsing-remitting or progressive MS. Olfaction was measured and scored using various testing arrays, and these scores were then correlated with a multitude of clinical markers. Across all studies, patients with MS demonstrated increased OD. Longitudinally, 2 contrasting patterns were identified: (1) clinical markers of acute inflammation correlated with an increased odor threshold and (2) clinical markers of neurodegeneration, or progression of disease, correlated with a decreased ability to discriminate and identify odors. CONCLUSIONS: These studies suggest that olfaction is a dynamic, dependent variable of neurodegeneration, correlating with inflammation and clinical markers. This opens the door for future exploration of olfaction's relationship with MS diagnosis, characterization, and therapeutic response.

Latent signal models: Learning compact representations of signal evolution for improved time-resolved, multi-contrast MRI.

PURPOSE: To improve time-resolved reconstructions by training auto-encoders to learn compact representations of Bloch-simulated signal evolution and inserting the decoder into the forward model. METHODS: Building on model-based nonlinear and linear subspace techniques, we train auto-encoders on dictionaries of simulated signal evolution to learn compact, nonlinear, latent representations. The proposed latent signal model framework inserts the decoder portion of the auto-encoder into the forward model and directly reconstructs the latent representation. Latent signal models essentially serve as a proxy for fast and feasible differentiation through the Bloch equations used to simulate signal. This work performs experiments in the context of T2 -shuffling, gradient echo EPTI, and MPRAGE-shuffling. We compare how efficiently auto-encoders represent signal evolution in comparison to linear subspaces. Simulation and in vivo experiments then evaluate if reducing degrees of freedom by incorporating our proxy for the Bloch equations, the decoder portion of the auto-encoder, into the forward model improves reconstructions in comparison to subspace constraints. RESULTS: An auto-encoder with 1 real latent variable represents single-tissue fast spin echo, EPTI, and MPRAGE signal evolution to within 0.15% normalized RMS error, enabling reconstruction problems with 3 degrees of freedom per voxel (real latent variable + complex scaling) in comparison to linear models with 4-8 degrees of freedom per voxel. In simulated/in vivo T2 -shuffling and in vivo EPTI experiments, the proposed framework achieves consistent quantitative normalized RMS error improvement over linear approaches. From qualitative evaluation, the proposed approach yields images with reduced blurring and noise amplification in MPRAGE-shuffling experiments. CONCLUSION: Directly solving for nonlinear latent representations of signal evolution improves time-resolved MRI reconstructions.

Current Definitions of Failure in Lateral Ankle Instability Surgery: A Systematic Review.

BACKGROUND: "Failure" is a term that is frequently used to describe an unfavorable outcome for patients who undergo surgical treatment for lateral ankle instability (LAI). A standard definition of failure for the surgical treatment of ankle instability has not been established by clinicians and researchers. PURPOSE: To identify the definitions of ankle instability treatment failure that are currently in the literature and to work toward the standardization of the definition. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A systematic search of MEDLINE, SPORTDiscus, CINAHL, Embase, and Web of Science was conducted to identify clinical studies that included patients who underwent surgical treatment for LAI and included information about surgical failure. Studies with level of evidence 1 to 4 were included in this review. Animal studies, biomechanical studies, cadaveric studies, review articles, and expert opinions were excluded. The included studies were then reviewed for definitions of failure of any surgical procedure that was performed to correct LAI. RESULTS: Of the 1200 studies found, 3.5% (42/1200) published between 1984 and 2021 met the inclusion criteria and were analyzed. After reviewing the data, we found numerous definitions were reported in the literature for LAI surgical failure. The most common was recurrent instability (40% [17/42]), followed by rerupture (19% [8/42]). For the original surgical procedure, the anatomic Broström-Gould technique was used most frequently (57% [24/42]). The failure rate of the Broström-Gould technique ranged from 1.1% to 45.2% depending on the definition of failure. CONCLUSION: There were multiple definitions of failure for the surgical treatment of LAI, which is one of the reasons why the rate of failure can vary greatly. The literature would benefit greatly from the standardization of the definition of ankle instability treatment failure. This definition should include specific, objective physical examination findings that eliminate the ambiguity surrounding failure.

Racial/ethnic differences in treatment efficacy and safety for moderate-to-severe plaque psoriasis: a systematic review.

Biologic medications have revolutionized treatment of psoriasis; however, there remains uncertainty in which medications should be used to maximize efficacy based on race/ethnicity. The purpose was to determine if efficacy of biological medications differs based on race/ethnicity. A systematic review identified all clinical trials focused on biologic treatment outcomes from inception of database until March 5th, 2021. Included studies provided data on racial/ethnic differences in biologic skin clearance efficacy using the Psoriasis Area and Severity Index (PASI) and "clear/almost clear" scores. There were 1220 studies identified, and 24 included in the review. The races/ethnicities included were Asian (n = 2740), White (n = 9745), Black (n = 138), and Latino (n = 728). Ixekizumab provided the highest "clear/almost clear" score (90.7%, 89.4%) and PASI 75 (98.8%, 96.6%) for Asian and Latino patients, respectively. Guselkumab had the highest "clear/almost clear" score for White (86.8%) patients, while Black patients had highest "clear/almost clear" (75.0%) and PASI 75 (91.7%) scores to brodalumab. Limitations included lack of studies reporting outcome data based on race/ethnicity and lack of patients of color within psoriasis clinical trials. For treatment of plaque psoriasis, there is evidence of differences in efficacy of biologics improving clinical disease severity between different races or ethnicities.

A Hybrid Volume-Surface Integral Equation Method for Rapid Electromagnetic Simulations in MRI.

OBJECTIVE: We developed a hybrid volume surface integral equation (VSIE) method based on domain decomposition to perform fast and accurate magnetic resonance imaging (MRI) simulations that include both remote and local conductive elements. METHODS: We separated the conductive surfaces present in MRI setups into two domains and optimized electromagnetic (EM) modeling for each case. Specifically, interactions between the body and EM waves originating from local radiofrequency (RF) coils were modeled with the precorrected fast Fourier transform, whereas the interactions with remote conductive surfaces (RF shield, scanner bore) were modeled with a novel cross tensor train-based algorithm. We compared the hybrid-VSIE with other VSIE methods for realistic MRI simulation setups. RESULTS: The hybrid-VSIE was the only practical method for simulation using 1 mm voxel isotropic resolution (VIR). For 2 mm VIR, our method could be solved at least 23 times faster and required 760 times lower memory than traditional VSIE methods. CONCLUSION: The hybrid-VSIE demonstrated a marked improvement in terms of convergence times of the numerical EM simulation compared to traditional approaches in multiple realistic MRI scenarios. SIGNIFICANCE: The efficiency of the novel hybrid-VSIE method could enable rapid simulations of complex and comprehensive MRI setups.

MARIE 2.0: A Perturbation Matrix Based Patient-Specific MRI Field Simulator.

High static field MR scanners can produce human tissue images of astounding clarity, but rely on high frequency electromagnetic radiation that generates complicated in-tissue field patterns that are patient-specific and potentially harmful. Many such scanners use parallel transmitters to better control field patterns, but then adjust the transmitters based on general guidelines rather than optimizing for the specific patient, mostly because computing patient-specific fields was presumed far too slow. It was recently demonstrated that the combination of fast low-resolution tissue mapping and fast voxel-based field simulation can be used to perform a patient-specific MR safety check in minutes. However, the field simulation required several of those minutes, making it too slow to perform the dozens of simulations that would be needed for patient-specific optimization. In this paper we describe a compressed-perturbation-matrix technique that nearly eliminates the computational cost of including complex coils (or coils and shields) in voxel-based field simulation of tissue, thereby reducing simulation time from minutes to seconds. The approach is demonstrated on a wide variety of head+coil and head+coil+shield configurations, using the implementation in MARIE 2.0, the latest version of the open-source MR field simulator MARIE.

Dietary Interventions for the Treatment of Inflammatory Bowel Diseases: An Updated Systematic Review and Meta-analysis.

BACKGROUND & AIMS: This study aimed (1) to systematically review controlled trials of solid food diets for the treatment of inflammatory bowel disease (IBD); and (2) to grade the overall quality of evidence. METHODS: Systematic review of prospective controlled trials of solid food diets for the induction or maintenance of remission in IBD. Two authors independently performed study selection, data extraction, and assessment of certainty of evidence. Meta-analyses were performed on studies with quantitative data on response, remission, and relapse. RESULTS: There were 27 studies for meta-analysis. For induction of remission in Crohn's disease (CD), low refined carbohydrate diet and symptoms-guided diet outperformed controls, but studies had serious imprecision and very low certainty of evidence. The Mediterranean diet was similar to the Specific Carbohydrate Diet (low certainty of evidence), and partial enteral nutrition (PEN) was similar to exclusive enteral nutrition (very low certainty of evidence). PEN reduced risk of relapse (very low certainty of evidence), whereas reduction of red meat or refined carbohydrates did not (low certainty of evidence). For ulcerative colitis, diets were similar to controls (very low and low certainty of evidence). CONCLUSIONS: Among the most robust dietary trials in IBD currently available, certainty of evidence remains very low or low. Nonetheless, emerging data suggest potential benefit with PEN for induction and maintenance of remission in CD. Reduction of red meat and refined carbohydrates might not reduce risk of CD relapse. As more dietary studies become available, the certainty of evidence could improve, thus allowing for more meaningful recommendations for patients.

Evaluation of arts and humanities programs in surgery education: a systematic review.

PURPOSE: This systematic review seeks to understand what outcomes have been reported for arts and humanities programs in surgery education. METHODS: Authors searched Medline ALL (Ovid), Embase.com, Web of Science, and Academic Search Ultimate to identify articles on evaluated arts and humanities programs in surgery education. The search identified 1,282 titles and abstracts, of which 55 underwent independent full-text review. The authors identified 10 articles that met inclusion criteria, from which they collected and analysed data. RESULTS: Medical students were the identified learners in most studies (6/10; 60%). Reflective writing was the arts and humanities activity in half of the studies (5/10; 50%); activities based on film, visual art other than film, literature, or social media in the remaining studies (5/10; 50%). Most studies (8/10; 80%) featured a non-controlled, non-randomized design. Authors categorised 5 studies (50%) as Kirkpatrick Level 1, 4 (40%) as Level 2, and 1 (10%) as Level 3. CONCLUSION: Integration of the arts and humanities into surgery education may promote increased levels of learner reflection and empathy, in addition to improved acquisition of surgical skills. More rigorous evaluation of these programs would clarify the impact of arts and humanities programs on surgery learners.

A systematic review of the arts and humanities in psychiatry education.

This systematic review characterizes the published literature on arts and humanities curricula for psychiatry learners that include any form of program evaluation. Authors searched three databases (Medline ALL, Embase.com, and PsycINFO) to identify articles on arts and humanities in psychiatry education. Criteria for the review included articles reporting outcome measures for arts and humanities learning activities in psychiatry learners. For those articles meeting inclusion criteria, a descriptive analysis was performed as well as an assessment of the level of program evaluation using the Kirkpatrick framework. Of 1,287 articles identified, 35 met inclusion criteria. About half of the programs included medical students (n = 17, 49%). Film and television was the most frequent arts and humanities subject (n = 16, 46%). Most studies incorporated a non-randomized, non-controlled design (n = 30, 86%). Twenty-two (63%) achieved a Kirkpatrick Level 1 designation, 12 achieved Level 2 (34%), and one study achieved Level 3 (3%). Arts and humanities programs have a promising role in psychiatry education. At present, significant heterogeneity in the extant literature makes it difficult to draw general conclusions that could guide future program development. This review underscores the need for rigorous evaluative methods of arts and humanities programs for psychiatry learners.

Irrigation techniques used in spine surgery for surgical site infection prophylaxis: a systematic review and meta-analysis.

BACKGROUND: The greater likelihood of morbidity, mortality, length of hospital stays and poorer long-term outcomes as a result of surgical site infections secondary to spinal surgery makes prophylactic measures an imperative focus. Therefore, the aim of this review was to evaluate the available research related to the efficacy of different intraoperative irrigation techniques used in spinal surgery for surgical site infection (SSI) prophylaxis. METHODS: We performed a comprehensive search using Ovid Medline, EMBASE, Web of Science and the Cochrane library pertaining to this topic. Our meta-analysis was conducted according to PRISMA guidelines. The inclusion criteria consist of spine surgeries with intraoperative use of any wound irrigation technique, comparison groups with a different intraoperative irrigation technique or no irrigation, SSI identified with bacterial cultures or clinically in the postoperative period, reported SSI rates. Data extracted from eligible studies included, but was not limited to, SSI rates, irrigation technique and control technique. Exclusion criteria consist of articles with no human subjects, reviews, meta-analyses and case control studies and no details about SSI identification or rates. Pooled risk ratios were calculated. A meta-analysis was performed with a forest plot to determine risk estimates' heterogeneity with I2 index, Q-statistic, and p value under a random-effects model. Funnel plot was used to assess publication bias. All databases were last checked on January, 2022. PROBAST tool was used to assess both risk of bias and applicability concerns. RESULTS: After reviewing 1494 titles and abstracts, 18 articles met inclusion criteria. They included three prospective randomized-controlled trials, 13 retrospective cohort studies, two prospective cohort studies. There were 54 (1.8%) cases of SSIs in the povidone-iodine irrigation group (N = 2944) compared to 159 (4.6%) in the control group (N = 3408). Using intraoperative povidone-iodine wound irrigation produced an absolute risk reduction of 2.8%. Overall risk ratio was 0.32 (95% CI 0.20-0.53, p < 0.00001). In a global analysis, study heterogeneity and synthesizing mostly retrospective data were primary limitations. CONCLUSION: The most evidence exists for povidone-iodine and has Level 2 evidence supporting SSI reduction during spinal surgery. Other antiseptic solutions such as dilute chlorhexidine lack published evidence in this patient population which limits the ability to draw conclusions related to its use in spinal surgery. LEVEL OF EVIDENCE: II - Systematic Review with Meta-Analysis.

Olfactory dysfunction in type II diabetes: Therapeutic options and lessons learned from other etiologies - A scoping review.

INTRODUCTION: Olfactory dysfunction (OD) is highly prevalent amongst type 2 diabetes mellitus (DM2) patients and has many associated health risks. For example, OD can lead to poor nutrition, safety issues related to diminished hazard detection, and increased mortality rates. While limited research exists about therapeutics for DM2-associated OD, recovery of olfactory function is better studied in other pathologic states. The objectives of this scoping review are to synthesize the existing data on interventions for DM2-associated OD and present the evidence for therapies that have been utilized for non-DM2-associated causes of OD. Additionally, the potential therapeutic opportunities for patients with DM2 are explored. METHODS: A scoping review was conducted with a medical librarian to identify studies investigating treatments of DM2-related OD. 6 databases were searched (Embase, CINAHL, the Cochrane Library, Google Scholar, OVID Medline, and Web of Science). Studies were eligible if the primary discussion involved treatment of olfactory deficits in the context of DM2. All publication dates were included, and studies published in languages other than English were excluded. RESULTS: 3631 articles were identified; 3 articles met inclusion criteria and underwent full text review. Hyperbaric oxygen (HBO), the DPP-4 inhibitor Linagliptin and the GLP-1 agonists Exenatide and Liraglutide are the only therapeutics that have been used in the context of DM2. Only HBO and GLP-1 agonists produced statistically significant improvements in olfactory identification. The literature regarding non-DM2-associated OD supports interventions such as olfactory training, dietary supplements, and intranasal insulin. Specifically, olfactory training was very effective in many contexts such as post-viral and traumatic OD while being affordable and non-invasive. CONCLUSION: This scoping review of olfactory rehabilitation options for DM2-induced OD demonstrates a paucity of prospective investigations of plausible therapeutics. Additionally, treatments for OD related to non-DM2-associated etiologies, such as olfactory training, are well-studied, efficacious, and should be investigated in the context of DM2. Future investigation has the potential to enhance the quality of clinical intervention for OD and improve short- and long-term outcomes for DM2 patients.