Analysis of visual quality improvement after implantation of PanOptix trifocal intraocular lens in cataract patients with different axial lengths.

OBJECTIVE: To assess the visual quality, both subjective and objective, of cataract patients with varying axial lengths (AL) after PanOptix trifocal intraocular lens (IOL) implantation and investigated the lens tilt and its correlation with visual outcomes. METHODS: From July 2020 to June 2022, 70 patients (140 eyes) diagnosed with age-related cataracts and undergoing PanOptix implantation at Chongqing Eye and Vision Care Hospital, Aier Eye Hospital Group, were included. Patients were assigned to either the observation group (35 cases, 70 eyes with PanOptix trifocal IOL) or the control group (35 cases, 70 eyes with bifocal IOL). Patients were further subdivided based on AL into AL < 24 mm (observation group: 23 eyes; control group: 26 eyes) and AL ≥ 24 mm (observation group: 47 eyes; control group: 44 eyes). Postoperative follow-up lasted three months. Visual acuity (distant, intermediate, near), objective visual quality (Strehl ratio: SR, total eye modulation transfer function (MTF)), and visual aberrations were measured preoperatively and at 3 months post-operation. RESULTS: Postoperatively, all groups saw significant improvements in uncorrected distance visual acuity (UCDVA), uncorrected intermediate visual acuity (UCIVA), and uncorrected near visual acuity (UCNVA) compared to preoperative values (T0) (all P < 0.05). Notably, UCIVA was significantly better in the observation group than in the control group (P < 0.05). At three months (T1), reductions in total high-order aberration (tHOA), internal high-order aberration (iHOA), coma, and trefoil aberrations were observed in both groups compared to baseline, with more significant decreases in the observation group (all P < 0.05). Both SR and MTF cutoff showed marked improvement from T0 to T1, with the observation group experiencing greater enhancements (both P < 0.05). The defocus curve of the observation group showed a gentle slope between +0.5 D and -3.0 D, maintaining superior visual acuity compared to the control group (P < 0.05). Subjective visual quality scores at T1 were significantly higher than at T0 for both groups (P < 0.05), with patients in the observation group scoring higher than those in the control group across all AL categories (P < 0.05). Spearman correlation analysis indicated that the tilt after PanOptix trifocal IOL implantation was associated with tHOA (r = 0.273, P = 0.022), iHOA (r = 0.433, P < 0.001), Trefoil (r = 0.360, P = 0.002) and coma (r = 0.688, P < 0.001). CONCLUSION: PanOptix trifocal IOL implantation in cataract patients across different AL significantly enhances visual quality compared to bifocal IOLs, suggesting a strong case for its clinical adoption.

Hospital frailty risk score predicts high-value care outcomes following brain metastasis resection.

OBJECTIVE: Brain metastases (BM) are the most common adult intracranial tumors, representing a significant source of morbidity in patients with systemic malignancy. Frailty indices, including 11- and 5-factor modified frailty indices (mFI-11 and mFI-5), American Society of Anesthesiologists (ASA) physical status classification, and Charlson Comorbidity Index (CCI), have recently demonstrated an important role in predicting high-value care outcomes in neurosurgery. This study aims to investigate the efficacy of the newly developed Hospital Frailty Risk Score (HFRS) on postoperative outcomes in BM patients. METHODS: Adult patients with BM treated surgically at a single institution were identified (2017-2019). HFRS was calculated using ICD-10 codes, and patients were subsequently separated into low (<5), intermediate (5-15), and high (>15) HFRS cohorts. Multivariate logistic regressions were utilized to identify associations between HFRS and complications, length of stay (LOS), hospital charges, and discharge disposition. Model discrimination was assessed using receiver operating characteristic (ROC) curves. RESULTS: A total of 356 patients (mean age: 61.81±11.63 years; 50.6 % female) were included. The mean±SD for HFRS, mFI-11, mFI-5, ASA, and CCI were 6.46±5.73, 1.31±1.24, 0.95±0.86, 2.94±0.48, and 8.69±2.07, respectively. On multivariate analysis, higher HFRS was significantly associated with greater complication rate (OR=1.10, p<0.001), extended LOS (OR=1.13, p<0.001), high hospital charges (OR=1.14, p<0.001), and nonroutine discharge disposition (OR=1.12, p<0.001), and comparing the ROC curves of mFI-11, mFI-5, ASA,and CCI, the predictive accuracy of HFRS was the most superior for all four outcomes assessed. CONCLUSION: The predictive ability of HFRS on BM resection outcomes may be superior than other frailty indices, offering a new avenue for routine preoperative frailty assessment and for managing postoperative expectations.

Clinical characteristics and outcomes of children with COVID-19 in pediatric intensive care units during the Omicron wave in Taiwan.

BACKGROUND: Since April 2022, the SARS-CoV-2 Omicron variant has caused a notable increase in pediatric COVID-19 cases in Taiwan. During the acute phase of infection, some children required admissions to pediatric intensive care units (PICU). This study aimed to analyze their clinical presentations and outcomes while exploring associated factors. METHODS: Medical records were retrospectively collected from patients with COVID-19 (aged <18 years) admitted to our PICU from April 2022-March 2023. Early stage is defined as the period without adequate vaccination and treatment guidelines for children from April-June 2022, and the remaining months are referred to as late stage. Clinical characteristics and outcomes were compared between patients in early and late stages. RESULTS: We enrolled 78 children with COVID-19, with a median length of stay (LOS) in PICU of 3 days and a 5% mortality rate. Patients admitted during the early stage had lower vaccination rates (7% vs. 50%), higher pediatric logistic organ dysfunction scores (2 vs. 0.1), and longer LOS in the PICU (6 vs. 2 days) than those admitted during the late stage. Multivariate analysis identified admission during the early stage as a risk factor for prolonged LOS (>7 days) in the PICU (odds ratio: 3.65, p = 0.047). CONCLUSION: Without available vaccinations and suitable treatment guidelines, children with COVID-19 tended to have more severe illness and prolonged LOS in the PICU. These observations highlight the importance of vaccinations and familiarity of medical providers with adequate management of this newly-emerging infectious disease.

Ultrasound-guided techniques for managing length- unstable femoral shaft fractures in children.

OBJECTIVE: The management of length-unstable femoral shaft fractures(LUFSFs) in pediatric patients is still controversial. This study aims to explore the clinical efficacy of ultrasound-guided closed reduction combined with external fixation for treating LUFSFs in children. METHODS: We conducted a retrospective analysis of clinical data from 19 pediatric patients with LUFSFs who underwent ultrasound-guided closed reduction and external fixation between January 2018 and January 2023. Ultrasound was employed not only to facilitate closed reduction of the fracture but also to guide real-time insertion of Schanz pins and monitor pin length as it traversed the opposite cortex. Surgical time, intraoperative fluoroscopy count, hospital stay length, fracture fixation duration, complication incidence, fracture reduction quality at the final follow-up were recorded. RESULTS: The patients' average age was 7.5 years( range: 5 to 11 years). The mean surgical duration was 70.4 min (range: 48-105 min), and the average intraoperative fluoroscopy count was 6.5 (range: 2-16). Fracture fixation lasted an average of 10.9 weeks (range: 7-20 weeks). All patients were followed up for more than one year. 6 cases of superficial pin tract infection occurred, which resolved with oral antibiotics and enhanced needle tract care. No deep infections were observed. Temporary stiffness of the knee joint was observed in 2 patients. According to Flynn's efficacy evaluation system, fracture reduction quality at the final follow-up was rated as excellent in 11 cases and satisfactory in 8 cases, yielding a combined success rate of 100% (19/19). CONCLUSIONS: The technique of ultrasound-guided closed reduction combined with external fixation offers favorable outcomes for children aged 5 to 11 years with LUFSFs, reducing reliance on fluoroscopic guidance.

Understanding the Correlation between Blood Profile and the Duration of Hospitalization in Pediatric Bronchopneumonia Patients: A Cross-Sectional Original Article.

Introduction: Pediatric bronchopneumonia is a prevalent life-threatening disease, particularly in developing countries. Affordable and accessible blood biomarkers are needed to predict disease severity which can be based on the Duration of Hospitalization (DOH). Aim of the Study: To assess the significance and correlation between differential blood profiles, especially the Neutrophil-Lymphocyte Ratio (NLR), and the DOH in bronchopneumonia children. Material and Methods: A record-based study was conducted at a secondary care hospital in Indonesia. After due ethical permission, following inclusion and exclusion criteria, 284 children with confirmed diagnoses of bronchopneumonia were included in the study. Blood cell counts and ratios were assessed with the DOH as the main criterion of severity. Mann-Whitney test and correlation coefficient were used to draw an analysis. Results: Study samples were grouped into DOH of ≤ 4 days and > 4 days, focusing on NLR values, neutrophils, lymphocytes, and leukocytes. The NLR median was higher (3.98) in patients hospitalized over 4 days (P<0.0001). Lymphocyte medians were significantly higher in the opposite group (P<0.0001). Thrombocyte medians were similar in both groups (P=0.44481). The overall NLR and DOH were weakly positively correlated, with a moderate positive correlation in total neutrophils and DOH, and a moderate negative correlation in total lymphocytes and DOH. The correlation between the DOH ≤ 4 days group with each biomarker was stronger, except for leukocyte and thrombocyte. Analysis of the longer DOH group did not yield enough correlation across all blood counts. Conclusions: Admission levels of leukocyte count, neutrophil, lymphocyte, and NLR significantly correlate with the DOH, with NLR predicting severity and positively correlated with the DOH.

Highly accurate single-color fluorogenic DNA decoding sequencing for mutational genotyping.

We proposed a single-color fluorogenic DNA decoding sequencing method designed to improve sequencing accuracy, increase read length and throughput, as well as decrease scanning time. This method involves the incorporation of a mixture of four types of 3'-O-modified nucleotide reversible terminators into each reaction. Among them, two nucleotides are labeled with the same fluorophore, while the remaining two are unlabeled. Only one nucleotide can be extended in each reaction, and an encoding that partially defines base composition can be obtained. Through cyclic interrogation of a template twice with different nucleotide combinations, two sets of encodings are sequentially obtained, enabling the determination of the sequence. We demonstrate the feasibility of this method using established sequencing chemistry, achieving a cycle efficiency of approximately 99.5 %. Notably, this strategy exhibits remarkable efficacy in the detection and correction of sequencing errors, achieving a theoretical error rate of 0.00016 % at a sequencing depth of ×2, which is lower than Sanger sequencing. This method is theoretically compatible with the existing sequencing-by-synthesis (SBS) platforms, and the instrument is simpler, which may facilitate further reductions in sequencing costs, thereby broadening its applications in biology and medicine. Moreover, we demonstrate the capability to detect known mutation sites using information from only a single sequencing run. We validate this approach by accurately identifying a mutation site in the human mitochondrial DNA.

How can we optimize the diagnostic and therapeutic approach to pneumonia? Expert opinion-based recommendations.

Pneumonia continues to be one of the most frequent infectious syndromes and a relevant cause of death and health resources utilization. The OPENIN ("Optimización de procesos clínicos para el diagnóstico y tratamiento de infecciones") Group is composed of Infectious Diseases specialists and Microbiologists and aims at generating recommendations that can contribute to improve the approach to processes with high impact on the health system. Such task relies on a critical review of the available scientific evidence. The first Group meeting (held in October 2023) aimed at answering the following questions: Can we optimize the syndromic and microbiological diagnosis of pneumonia? Is it feasible to safely shorten the length of antibiotic therapy? And, is there any role for the immunomodulatory strategies based on the adjuvant use of steroids, macrolides or immunoglobulins? The present review summarizes the literature reviewed for that meeting and offers a series of expert recommendations.

Risk-adjusted discrete increases in length of stay by complication following anatomic lung resection: an analysis of 32 133 cases across the USA.

OBJECTIVES: Prior studies have associated morbidity following anatomic lung resection with prolonged postoperative length of stay; however, each complication's individual impact on length of stay as a continuous variable has not been studied. The purpose of this study was to determine the risk-adjusted increase in length of stay associated with each individual postoperative complications following anatomic lung resection. METHODS: Patients who underwent anatomic lung resection cataloged in the prospectively collected American College of Surgeons National Surgical Quality Improvement Program participant use file, 2005-2018, were targeted. The association between preoperative characteristics, postoperative complications and length of stay in days was tested. A negative binomial model adjusting for the effect of preoperative characteristics and 18 concurrent postoperative complications was used to generate incidence rate ratios. This model was fit to generate risk-adjusted increases in length of stay by complication. RESULTS: Of 32 133 patients, 5065 patients (15.8%) experienced at least one post-operative complication. The most frequent complications were pneumonia (n = 1829, 5.7%), the need for transfusion (n = 1794, 5.6%) and unplanned reintubation (n = 1064, 3.3%). The occurrence of each of the 18 individual complications was associated with significantly increased length of stay. This finding persisted after risk-adjustment, with the greatest risk-adjusted increases being associated with prolonged ventilation (+17.4 days), followed by septic shock (+17.2 days), acute renal failure (+16.5 days) and deep surgical site infection (+13.2 days). CONCLUSIONS: All 18 postoperative complications studied following anatomic lung resection were associated with significant risk-adjusted increases in length of stay, ranging from an increase of 17.4 days with prolonged ventilation to 2.6 days following the need for transfusion.

Extremity fractures, attempted suicide, blood transfusion and thromboembolic events are independent risk factors for a prolonged hospital stay in severely injured elderly.

METHODS: Due to demographic change, the number of polytraumatized geriatric patients (> 64 years) is expected to further increase in the coming years. In addition to the particularities of the accident and the associated injury patterns, prolonged inpatient stays are regularly observed in this group. The aim of the evaluation is to identify further factors that cause prolonged inpatient stays. A study of the data from the TraumaRegister DGU® from 2016-2020 was performed. Inclusion criteria were an age of over 64 years, intensive care treatment in the GAS-region, and an Injury Severity Score (ISS) of at least 16 points. All patients who were above the 80th percentile for the average length of stay or average intensive care stay of the study population were defined as so-called long-stay patients. This resulted in a prolonged inpatient stay of > 25 days and an intensive care stay of > 13 days. Among other, the influence of the cause of the accident, injury patterns according to body regions, the occurrence of complications, and the influence of numerous clinical parameters were examined. RESULTS: A total of 23,026 patients with a mean age of 76.6 years and a mean ISS of 24 points were included. Mean ICU length of stay was 11 ± 12.9 days (regular length of stay: 3.9 ± 3.1d vs. prolonged length of stay: 12.8 ± 5.7d) and mean inpatient stay was 22.5 ± 18.9 days (regular length of stay: 20.7 ± 15d vs. 35.7 ± 22.3d). A total of n = 6,447 patients met the criteria for a prolonged length of stay. Among these, patients had one more diagnosis on average (4.6 vs. 5.8 diagnoses) and had a higher ISS (21.8 ± 6 pts. vs. 26.9 ± 9.5 pts.) Independent risk factors for prolonged length of stay were intubation duration greater than 6 days (30-fold increased risk), occurrence of sepsis (4x), attempted suicide (3x), presence of extremity injury (2.3x), occurrence of a thromboembolic event (2.7x), and administration of red blood cell concentrates in the resuscitation room (1.9x). CONCLUSIONS: The present analysis identified numerous independent risk factors for significantly prolonged hospitalization of the geriatric polytraumatized patient, which should be given increased attention during treatment. In particular, the need for a smooth transition to psychiatric follow-up treatment or patient-adapted rehabilitative care for geriatric patients with prolonged immobility after extremity injuries is emphasized by these results.

Association of choroidal thickness and blood flow features with asymmetric axial lengths in children with unilateral myopic anisometropia.

BACKGROUND: Considering that changes in the choroidal thickness are closely related to ocular growth, we studied the choroidal thickness (CT) and the blood flow features in children with unilateral myopic anisometropia (UMA) as well as investigating the relationship between choroidal changes and myopia. METHODS: Subjective refractive, axial length (AL), and biometric parameters were measured in 98 UMA children (age: 8-15 years). CT and choroidal blood-flow features, including the choroidal vessel volume (CVV), choroidal vascularity index (CVI), and choriocapillaris perfusion area (CCPA), were measured through swept-source optical coherence tomography angiography. The macular region was categorized into four concentric circles of diameters 0-1 mm (central fovea), 1-3 mm (parafovea), 3-6 mm (perifovea), and 6-9 mm (extended), and further categorized into superior (S), inferior (I), temporal (T), and nasal (N) quadrants. RESULTS: The aforementioned four regions of myopic eyes displayed significantly lower CT, CVV, and CVI than those of non-myopic eyes. CCPA changes differed across different regions of both the eyes (parts of N and T quadrants). There was an inverse association between CT and the interocular AL difference (central and other regions S, T quadrant). No correlation was noted between CVV and CVI with interocular AL difference. CT and CVV were positively correlated in the 0-6-mm macular region of myopic eyes (Spearman correlation coefficient = 0.763, P < 0.001). CONCLUSIONS: In UMA children, CCT and blood flow may be related to myopia progression. A robust correlation between CT and CVV in the 0-6-mm macular region and reduced CT and diminished blood flow indicated an association with myopia.

Longer ICU stay and invasive mechanical ventilation accelerate telomere shortening in COVID-19 patients 1 year after recovery.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes virus-induced-senescence. There is an association between shorter telomere length (TL) in coronavirus disease 2019 (COVID-19) patients and hospitalization, severity, or even death. However, it remains unknown whether virus-induced-senescence is reversible. We aim to evaluate the dynamics of TL in COVID-19 patients 1 year after recovery from intensive care units (ICU). Longitudinal study enrolling 49 patients admitted to ICU due to COVID-19 (August 2020 to April 2021). Relative telomere length (RTL) quantification was carried out in whole blood by monochromatic multiplex real-time quantitative PCR (MMqPCR) assay at hospitalization (baseline) and 1 year after discharge (1-year visit). The association between RTL and ICU length of stay (LOS), invasive mechanical ventilation (IMV), prone position, and pulmonary fibrosis development at 1-year visit was evaluated. The median age was 60 years, 71.4% were males, median ICU-LOS was 12 days, 73.5% required IMV, and 38.8% required a prone position. Patients with longer ICU-LOS or who required IMV showed greater RTL shortening during follow-up. Patients who required pronation had a greater RTL shortening during follow-up. IMV patients who developed pulmonary fibrosis showed greater RTL reduction and shorter RTL at the 1-year visit. Patients with longer ICU-LOS and those who required IMV had a shorter RTL in peripheral blood, as observed 1 year after hospital discharge. Additionally, patients who required IMV and developed pulmonary fibrosis had greater telomere shortening, showing shorter telomeres at the 1-year visit. These patients may be more prone to develop cellular senescence and lung-related complications; therefore, closer monitoring may be needed.

Stem traits promote wheat climate-resilience.

Introduction: Wheat grain filling processes under post-anthesis stress scenarios depend mainly on stem traits and remobilization of stem water-soluble carbohydrates (WSC). Methods: A diverse panel of advanced semi-dwarf spring wheat lines, representing a natural variation in stem traits (WSC content, stem diameter, peduncle length, and stem wall width), was used to identify specific traits that reliably reflect the relationship between WSC and grain yield. The panel was phenotyped under various environmental conditions: well-watered, water-limited, and heat stress in Mexico, and terminal-drought in Israel. Results: Environmental stresses reduced grain yield (from 626 g m-2 under well-watered to 213 g m-2 under heat), lower internode diameter, and peduncle length. However, stem-WSC generally peaked 3-4 weeks after heading under all environmental conditions except heat (where it peaked earlier) and expressed the highest values under water-limited and terminal-drought environments. Increased investment in internode diameter and peduncle length was associated with a higher accumulation of stem WSC, which showed a positive association with yield and kernel weight. Across all environments, there were no apparent trade-offs between increased crop investment in internode diameter, peduncle length, and grain yield. Discussion: Our results showed that selecting for genotypes with higher resource investment in stem structural biomass, WSC accumulation, and remobilization could be a valuable strategy to ameliorate grain size reduction under stress without compromising grain yield potential. Furthermore, easy-to-measure proxies for WSC (stem diameter at specific internodes and length of the last internode, i.e., the peduncle) could significantly increase throughput, potentially at the breeding scale.

Comparison of perioperative outcomes between colorectal operations performed on weekends vs those performed on weekdays.

BACKGROUND: Weekend surgical time is an underused asset. Concerns over a possible weekend effect (substandard care) may be a barrier. METHODS: This study examined whether a weekend effect applies to elective colorectal surgery via a single-center retrospective analysis comparing outcomes between patients who underwent elective colorectal surgery on a weekend vs a weekday. Demographics, length of stay (LOS), operative and anesthesia time, the rate of reoperation within 30 days, and the rate of major complications were compared between patient groups. RESULTS: Of the 2008 patients identified, 1721 (85.7%) underwent surgery on a weekday, and 287 (14.3%) underwent surgery on a weekend. The proportion of operations with an open approach was higher on weekends than weekdays (49.5% vs 41.8%, P = .017). Patients who underwent surgery on the weekend tended to have a shorter mean (SE) for LOS (4.2 [0.2] vs 6.1 [0.2], P < .001), anesthesia time (233.8 [6.5] vs 307.6 [3.3] minutes, P < .001), and operative time (225.4 [6.4] vs. 297.6 [3.3] minutes, P < .001). On multivariable analysis, patients who had an operation on a weekend had a 38% lower chance of having a prolonged LOS (>75th percentile of LOS) compared with those who had an operation on a weekday (adjusted odds ratio = 0.62; 95% CI 0.42-0.92). There were no differences in rates of complications or reoperation for patients undergoing surgery on a weekend compared with a weekday. CONCLUSION: At centers with experienced anesthesiologists, appropriately trained nursing staff, and expert surgeons, colorectal surgery performed on a weekend has similar safety outcomes as surgeries performed on a weekday.

Factors Associated with Hospital Length of Stay among VTE Cases: Insights from the i-RegVed Registry.

INTRODUCTION: Venous thromboembolism (VTE) is a multifactorial condition and one of the leading causes of mortality and disability. The present study explores the factors associated with hospitalization duration among different types of venous thromboembolism diagnoses, such as deep vein thrombosis (DVT), pulmonary embolism (PE), and other forms of thrombosis. METHODS: The data included participants with VTE admitted to 13 hospitals within pan-India from June 2022 to December 2023 to the i-RegVed registry, where socio-demographic data, clinical history, and various factors associated with hospital length of stay (LOS) were included for analyses. Multilinear regression was performed to explore the factors associated with hospital LOS among VTE conditions such as DVT, PE, forms of thrombosis other than PE and DVT, and all VTE diagnoses. RESULTS: A total of 633 participants were included in the study, with 55% being males, and 28.9% being homemakers. Longer hospital LOS was significantly associated with age (ß = -.09, P < .05), sex (ß = 3.21, P < .05), and non-communicable diseases (ß = 3.51, P < .05) among participants with DVT and among participants with at least one of the VTE diagnoses, age (ß = -.12, P < .001) and anticoagulant use (ß = -2.49, P < .05) was significantly associated. CONCLUSION: The findings provide insights into the factors influencing hospital outcomes among participants with different types of VTE, highlighting the importance of age and comorbidities in predicting the hospital LOS.

Reverse Electrodialysis with Continuous Random Variation in Nanochannel Shape: Salinity Gradient-Driven Power Generation.

The shape of nanochannels plays a crucial role in the ion selectivity and overall performance of reverse electrodialysis (RED) systems. However, current research on two-dimensional nanochannel shapes is largely limited to a few fixed asymmetric forms. This study explores the impact of randomly shaped nanochannels using dimensionless methods, controlling their randomness by varying their length and shape amplitude. The research systematically compares how alterations in the nanochannel length and shape amplitude influence various system performance parameters. Our findings indicate that increasing the nanochannel length can significantly enhance the system performance. While drastic changes in the nanochannel shape amplitude positively affect the system performance, the most significant improvements arise from the interplay between the nanochannel length and shape amplitude. This compounding effect creates a local optimum, resulting in peak system performance. Within the range of dimensionless lengths from 0 to 30, the system reaches its optimal performance at a dimensionless length of approximately 25. Additionally, we explored two other influencing factors: the nanochannel surface charge density and the concentration gradient of the solution across the nanochannel. Optimal performance is observed when the nanochannel has a high surface charge density and a low concentration gradient, particularly with random shapes. This study advances the theoretical understanding of RED systems in two-dimensional nanochannels, guiding research towards practical operational conditions.

Decreasing Postsurgical Length of Stay in the Postanesthesia Care Unit for Obstructive Sleep Apnea and Obese Patients Using Exspiron Minute Ventilation Monitoring.

PURPOSE: In the postanesthesia care unit (PACU), it is imperative to monitor respiration and ventilation, especially in patients diagnosed with or at risk for obstructive sleep apnea (OSA). Research studies have been published to highlight the importance of minute ventilation monitoring (MVM) as an early warning system of impending respiratory compromise, warranting studies to assess timely safe discharge in this high-risk population at UC San Diego Health. DESIGN: This quantitative study was conducted using a two-group comparative design method. METHODS: Length of stay was measured in 100 patients identified as high risk in the surgical setting with diagnosed or suspected OSA or a documented body mass index ≥40 with and without the use of MVM to evaluate its impact on PACU length of stay. Fifty patients were monitored using the University of California San Diego (USCD) Health standard of care monitoring of respiratory rate, pulse oximetry, and capnography when indicated, then compared to 50 patients monitored with the UCSD Health standard of care with the addition of MVM using the Exspiron monitoring device. FINDINGS: PACU length of stay decreased for those who received MVM (M = 106.22, SD = 56.85) than those who did not (M = 140.96, SD = 81.55), a statistically significant difference of 34.74 (95% CI, 6.64 to 62.83), t(97) = 2.46, P = .016. Total time savings between the 2 groups was 1,843 minutes of PACU bed occupancy. CONCLUSIONS: The use of minute ventilation monitoring in addition to the standard of care in postsurgical patients can significantly reduce the length of high-risk patients with known or suspected OSA safely from the postoperative care unit.

Molecular dynamics simulation of DNAN/DNB cocrystal PBXs.

CONTEXT: The DNAN/DNB eutectic is a high-energy explosive eutectic with superior safety and thermal stability compared to traditional melt-cast explosives. However, the addition of polymer binders can effectively enhance its mechanical properties, allowing for continued production demands without the need for changes to existing factory equipment. In this paper, a model of the DNAN/DNB eutectic explosive was established, and five different types of polymers-cis-1,4-polybutadiene (BR), ethylene-vinyl acetate copolymer (EVA), polyethylene glycol (PEG), fluorinated polymer (F2603), and polyvinylidene fluoride (PVDF)-were added to the (1 0 - 1), (1 0 1), and (0 1 1) cleavage planes, respectively, to form polymer-bonded explosives (PBXs). The stability, trigger bond length, mechanical properties, and detonation performance of the various polymer-bound PBXs were predicted retrogressively. Among the five PBX models, the DNAN/DNB/PEG model exhibited the highest binding energy and the shortest trigger bond length, indicating a significant improvement in stability, compatibility, and sensitivity compared to the original eutectic. Additionally, although the detonation performance of DNAN/DNB decreased after the addition of binders, the final results were still satisfactory. Overall, the DNAN/DNB/PEG model demonstrated excellent comprehensive performance, proving that among the many polymer binders, PEG is the optimal choice for DNAN/DNB. METHODS: Within the Materials Studio software, molecular dynamics (MD) simulations were employed to predict the properties of the DNAN/DNB eutectic PBX. The MD simulation timestep was set to 1 fs, with a cumulative simulation duration of 2 ns. A 2 ns MD simulation was conducted using the isothermal-isobaric ensemble (NPT). The COMPASS force field was applied, and the temperature was fixed at 295 K.

Career Length After Surgically Treated ACL Plus Collateral Ligament Injury in Elite Athletes.

BACKGROUND: Limited data are available regarding career length and competition level after combined anterior cruciate ligament (ACL) and medial- or lateral-sided surgeries in elite athletes. PURPOSE: To evaluate career length after surgical treatment of combined ACL plus medial collateral ligament (MCL) and ACL plus posterolateral corner (PLC) injuries in elite athletes and, in a subgroup analysis of male professional soccer players, to compare career length and competition level after combined ACL+MCL or ACL+PLC surgeries with a cohort who underwent isolated ACL reconstruction (ACLR). STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A consecutive cohort of elite athletes undergoing combined ACL+MCL and ACL+PLC surgery was analyzed between February 2001 and October 2019. A subgroup of male elite soccer players from this population was compared with a previously identified cohort having had isolated primary ACLR without other ligament surgery. A minimum 2-year follow-up was required. Outcome measures were career length and competition level. RESULTS: A total of 98 elite athletes met the inclusion criteria, comprising 50 ACL+PLC and 48 ACL+MCL surgeries. The mean career length after surgical treatment of combined ACL+MCL and ACL+PLC injuries was 4.5 years. Return-to-play (RTP) time was significantly longer for ACL+PLC injuries (12.8 months; P = .019) than for ACL+MCL injuries (10.9 months). In the subgroup analysis of soccer players, a significantly lower number of players with combined ACL+PLC surgery were able to RTP (88%; P = .003) compared with 100% for ACL+MCL surgery and 97% for isolated ACLR, as well as requiring an almost 3 months longer RTP timeline (12.9 months; P = .002) when compared with the isolated ACL (10.2 months) and combined ACL+MCL (10.0 months) groups. However, career length and competition level were not significantly different between groups. CONCLUSION: Among elite athletes, the mean career length after surgical treatment of combined ACL+MCL and ACL+PLC injuries was 4.5 years. Professional soccer players with combined ACL+PLC surgery returned at a lower rate and required a longer RTP time when compared with the players with isolated ACL or combined ACL+MCL injuries. However, those who did RTP had the same career longevity and competition level.

Interventions and impact of pharmacist-delivered services in perioperative setting on clinically important outcomes: a systematic review and meta-analysis.

Background: The perioperative arena is a unique and challenging environment that requires coordination of the complex processes and involvement of the entire care team. Pharmacists' scope of practice has been evolving to be patient-centered and to expand to variety of settings including perioperative settings. Objectives: To critically appraise, synthesize, and present the available evidence of the characteristics and impact of pharmacist-led interventions on clinically important outcomes in the perioperative settings. Design: A systematic review and meta-analysis. Methods: We searched PubMed, Embase, and CINAHL from index inception to September 2023. Included studies compared the effectiveness of pharmacist-led interventions on clinically important outcomes (e.g. length of stay, readmission) compared to usual care in perioperative settings. Two independent reviewers extracted the data using the DEPICT-2 (Descriptive Elements of Pharmacist Intervention Characterization Tool) and undertook quality assessment using the Crowe Critical Appraisal (CCAT). A random-effect model was used to estimate the overall effect [odds ratio (OR) for dichotomous and standard mean difference (SMD) for continuous data] with 95% confidence intervals (CIs). Results: Twenty-five studies were eligible, 20 (80%) had uncontrolled study design. Most interventions were multicomponent and continuous over the perioperative period. The intervention components included clinical pharmacy services (e.g. medication management/optimization, medication reconciliation, discharge counseling) and education of healthcare professionals. While some studies provided a minor description in regards to the intervention development and processes, only one study reported a theoretical underpinning to intervention development. Pooled analyses showed a significant impact of pharmacist care compared to usual care on length of stay (11 studies; SMD -0.09; 95% CI -0.49 to -0.15) and all-cause readmissions (8 studies; OR 0.60; 95% CI 0.39-0.91). The majority of included studies (n = 21; 84%) were of moderate quality. Conclusion: Pharmacist-led interventions are effective at improving clinically important outcomes in the perioperative setting; however, most studies were of moderate quality. Studies lacked the utilization of theory to develop interventions; therefore, it is not clear whether theory-derived interventions are more effective than those without a theoretical element. Future research should prioritize the development and evaluation of multifaceted theory-informed pharmacist interventions that target the whole surgical care pathway.

The impact of pharmacist activities on clinical outcomes in perioperative settings Why was the study done? The time around the surgery imposes significant risks to patient's health. While technical aspects of a procedure are important, it should be combined with the provision of optimal healthcare quality to increase the likelihood of desired clinical outcomes. Pharmacists are effective healthcare team members who have the potential to improve patient's outcomes in the perioperative settings. It is hence imperative to explore the roles and impact of clinical pharmacists in these settings. Thus far, there is no synthesis of literature regarding the pharmacist roles and effectiveness in the perioperative setting. What did the researchers do? We aimed to summarize and appraise the quality of evidence on the characteristics and impact of pharmacist activities on clinical outcomes in the perioperative settings. Three library databases were examined to identify studies eligible for inclusion. Two authors extracted data and assessed the quality of included studies. Statistical analysis was used to look at the success of the pharmacist interventions on different endpoints. What did the researchers find? A total of 25 studies were included. Most pharmacist activities consisted of multiple components (such as medication management and educating other healthcare providers) and spanned the whole perioperative journey. The analysis of included studies showed that pharmacist activities reduced the elapsed time in hospital and the number of times a patient winds up going back to a hospital after discharge. Most studies did not discuss the methods adopted to develop pharmacist activities. What do the findings mean? A number of pharmacist activity types were shown to be successful in reducing the duration of hospitalization and readmission episodes. New directions for future research should investigate the development of pharmacist-led interventions in terms of structure and processes to ensure the reproducibility of these interventions.

A novel non-invasive electromagnetic extendable intercalary endoprosthesis: a proof-of-concept study.

Introduction: Femur and tibia are the most commonly affected sites for primary malignant bone tumors in children. The wide resection of the tumor frequently requires the physis to be resected. The normal growth of the unaffected limb will result in a significant limb length discrepancy at skeletal maturity. To compensate for this resulting LLD, different generations of extendible endoprostheses have been developed. Non-invasive extendable prostheses eliminate the need for surgical procedures and general anesthesia, enabling gradual and painless lengthening. Currently available non-invasive extendable prostheses focus on joint reconstruction, and no case series analysis of intercalary non-invasive extendable prosthesis has been reported. Therefore, we have designed a novel non-invasive electromagnetic extendable intercalary endoprosthesis. Methods: In vitro mechanical experiments and in vivo animal experiments were conducted. Results: In vitro experiments have confirmed that the prosthetics can extend at a constant rate, increasing by 4.4 mm every 10 min. The average maximum extension force during prosthetic elongation can reach 1306N. In animal in vivo experiments, the extension process is smooth and non-invasive, and the sheep is in a comfortable state. Discussion: The in vitro and in vivo animal studies provide evidence to support the extension reliability, laying the foundation for future large-scale validation experiments.