Is Psychiatric Illness Associated With Risk for Postoperative Complications in the Outpatient Setting?

PURPOSE: Little is known about the association between psychiatric illness and the risk for postoperative complications following outpatient oral and maxillofacial surgery treatment. The purpose of this study was to examine the significance of the presence of psychiatric illness on postoperative complications. MATERIALS/METHODS: This was a retrospective cohort study conducted in 2018 that identified patients by searching through the University of Cincinnati's electronic health records. The predictor variable in this study is the presence of psychiatric illness and the outcome variable is the presence or absence of postoperative complications. Additional covariates such as age, race, location, procedure type, and anesthesia type were also included. Results of appropriate descriptive statistics and multivariate logistic regression were presented. Statistical significance was set at P value < .05. RESULTS: The total number of patients who underwent procedures involving local anesthetic and intravenous sedition in clinic in 2018 were 3,874, of which 1,588 were males (40.99%) and 2,286 were females (59.01%) with a mean age of 36.14 and 35.08 years, respectively. The sample consisted of White (45.87%), Black (35.34%), Hispanic/Latino (2.27%), Asians (1.60%), other races (3.33%), and 11.59% patients have missing data on race. A psychiatric diagnosis was found in 21.37% patients (n = 828). The percentage of patients with 2 or more psychiatric diagnoses was 5.78% (n = 224). The rate of postoperative was reported as 11.33%. A bivariate logistic regression analysis of postoperative complications as an outcome variable found that postoperative complications were not associated with psychiatric history (Odds ratio = 1.049, 95% confidence interval: 0.825 to 1.333, P value = .695). However, sex (P value = < .0001), surgical procedure (P value = < .0001), and anesthetic technique (P value = < .0001) had statistically significant associations with postoperative complications. Other covariates like race (P value = .5943), American Society of Anesthesiologists score (P value = .2539), location (P value = .5323), and multiple psychiatric diagnoses (P value = .7256) were not found to be significantly associated with postoperative complications. CONCLUSION: Although our study did show a higher prevalence of psychiatric illnesses in our patient population, it did not show any statistically significant correlation between psychiatric illness and postoperative complications. In addition, there were no statistically significant differences in postoperative complications between different Diagnostic and Statistical Manual of Mental Disorders classes.

Predicting in situ nanoparticle behavior using multiple particle tracking and artificial neural networks.

Predictive models of nanoparticle transport can drive design of nanotherapeutic platforms to overcome biological barriers and achieve localized delivery. In this paper, we demonstrate the ability of artificial neural networks to predict both nanoparticle properties, such as size and protein adsorption, and aspects of the brain microenvironment, such as cell internalization, viscosity, and brain region by using large (>100 000) trajectory datasets collected via multiple particle tracking in in vitro gel models of the brain and cultured organotypic brain slices. Our neural network achieved a 0.75 recall score when predicting gel viscosity based on trajectory datasets, compared to 0.49 using an obstruction scaling model. When predicting in situ nanoparticle size based on trajectory datasets, neural networks achieved a 0.90 recall score compared to 0.83 using an optimized Stokes-Einstein predictor. To distinguish between nanoparticles of different sizes in more complex nanoparticle mixtures, our neural network achieved up to a recall score of 0.85. Even in cases of more nuanced output variables where mathematical models are not available, such as protein adhesion, neural networks retained the ability to distinguish between particle populations (recall score of 0.89). These findings demonstrate how trajectory datasets in combination with machine learning techniques can be used to characterize the particle-microenvironment interaction space.

diff_classifier: Parallelization of multi-particle tracking video analyses.

The diff_classifier package seeks to address the issue of scale-up in multi-particle tracking (MPT) analyses via a parallelization approach. MPT is a powerful analytical tool that has been used in fields ranging from aeronautics to oceanography (Pulford, 2005) allowing researchers to collect spatial and velocity information of moving objects from video datasets. Examples include: Tracking tracers in ocean currents to study fluid flowTracking molecular motors (e.g., myosin, kinesin) to assess motile activityMeasuring intracellular trafficking by tracking membrane vesiclesAssessing microrheological properties by tracking nanoparticle movement.

3D printed coaxial nozzles for the extrusion of hydrogel tubes toward modeling vascular endothelium.

Engineered tubular constructs made from soft biomaterials are employed in a myriad of applications in biomedical science. Potential uses of these constructs range from vascular grafts to conduits for enabling perfusion of engineered tissues and organs. The fabrication of standalone tubes or complex perfusable constructs from biofunctional materials, including hydrogels, via rapid and readily accessible routes is desirable. Here we report a methodology in which customized coaxial nozzles are 3D printed using commercially available stereolithography (SLA) 3D printers. These nozzles can be used for the fabrication of hydrogel tubes via coextrusion of two shear-thinning hydrogels: an unmodified Pluronic® F-127 (F127) hydrogel and an F127-bisurethane methacrylate (F127-BUM) hydrogel. We demonstrate that different nozzle geometries can be modeled via computer-aided design and 3D printed in order to generate tubes or coaxial filaments with different cross-sectional geometries. We were able to fabricate tubes with luminal diameters or wall thicknesses as small as ∼150 µm. Finally, we show that these tubes can be functionalized with collagen I to enable cell adhesion, and human umbilical vein endothelial cells can be cultured on the luminal surfaces of these tubes to yield tubular endothelial monolayers. Our approach could enable the rapid fabrication of biofunctional hydrogel conduits which can ultimately be utilized for engineering in vitro models of tubular biological structures.

Colloidal stability as a determinant of nanoparticle behavior in the brain.

Drug delivery to the brain is challenging due to a highly regulated blood-brain barrier (BBB) and a complex brain microenvironment. Nanoparticles, due to their tailorability, provide promising platforms to enhance therapeutic delivery and achieve controlled release and disease-specific localization in the brain. However, we have yet to fully understand the complex interactions between nanoparticles and the biological environments in which they operate. It is important to perform a systematic study to characterize nanoparticle behavior as a function of ion composition, concentration, and pH in cerebrospinal fluid (CSF). These could alter nanoparticle biological identity and influence diffusive capability and cellular uptake. In this study, poly(ethylene glycol) (PEG)-coated and carboxyl-coated polystyrene (PS-PEG and PS-COOH respectively) nanoparticles (NPs) were used to evaluate the aggregation kinetics, colloidal stability, and diffusive capability of nanoparticles in conditions relevant to the brain microenvironment. Size, surface charge, and surface coating were varied in a range of CSF ion concentrations and compositions, pH conditions, and temperatures. Small changes in calcium concentration and pH destabilize nanoparticles in CSF. However, PS-PEG NPs remain stable over a wider variety of conditions than PS-COOH NPs, and have higher diffusion capabilities in both agarose gels, an in vitro model of the brain microenvironment, and an organotypic brain tissue slice model. These results demonstrate the need for steric stabilization to maintain nanoparticle colloidal stability in a wide range of conditions. Importantly, colloidal stabilization allows for increased diffusive capability and can be used to predict diffusive behavior in the brain microenvironment.

Group B streptococcus exploits vaginal epithelial exfoliation for ascending infection.

Thirteen percent of pregnancies result in preterm birth or stillbirth, accounting for fifteen million preterm births and three and a half million deaths annually. A significant cause of these adverse pregnancy outcomes is in utero infection by vaginal microorganisms. To establish an in utero infection, vaginal microbes enter the uterus by ascending infection; however, the mechanisms by which this occurs are unknown. Using both in vitro and murine models of vaginal colonization and ascending infection, we demonstrate how a vaginal microbe, group B streptococcus (GBS), which is frequently associated with adverse pregnancy outcomes, uses vaginal exfoliation for ascending infection. GBS induces vaginal epithelial exfoliation by activation of integrin and ß-catenin signaling. However, exfoliation did not diminish GBS vaginal colonization as reported for other vaginal microbes. Rather, vaginal exfoliation increased bacterial dissemination and ascending GBS infection, and abrogation of exfoliation reduced ascending infection and improved pregnancy outcomes. Thus, for some vaginal bacteria, exfoliation promotes ascending infection rather than preventing colonization. Our study provides insight into mechanisms of ascending infection by vaginal microbes.

A Ferret Model of Encephalopathy of Prematurity.

There is an ongoing need for relevant animal models in which to test therapeutic interventions for infants with neurological sequelae of prematurity. The ferret is an attractive model species as it has a gyrified brain with a white-to-gray matter ratio similar to that in the human brain. A model of encephalopathy of prematurity was developed in postnatal day 10 (P10) ferret kits, considered to be developmentally equivalent to infants of 24-26 weeks' gestation. Cross-fostered P10 ferret kits received 5 mg/kg of lipopolysaccharide (LPS) before undergoing consecutive hypoxia-hyperoxia-hypoxia (60 min at 9%, 120 min at 60%, and 30 min at 9%). Control animals received saline vehicle followed by normoxia. The development of basic reflexes (negative geotaxis, cliff aversion, and righting) as well as gait coordination on an automated catwalk were assessed between P28 and P70, followed by ex vivo magnetic resonance imaging (MRI) and immunohistochemical analysis. Compared to controls, injured animals had slower overall reflex development between P28 and P40, as well as smaller hind-paw areas consistent with "toe walking" at P42. Injured animals also displayed significantly greater lateral movement during CatWalk assessment as a result of reduced gait coordination. Ex vivo MRI showed widespread white-matter hyperintensity on T2-weighted imaging as well as altered connectivity patterns. This coincided with white-matter dysmaturation characterized by increased intensity of myelin basic protein staining, white-matter thinning, and loss of oligodendrocyte transcription factor 2 (OLIG2)-positive cells. These results suggest both pathological and motor deficits consistent with premature white-matter injury. This newborn ferret model can therefore provide an additional platform to assess potential therapies before translation to human clinical trials.

Systems-level thinking for nanoparticle-mediated therapeutic delivery to neurological diseases.

Neurological diseases account for 13% of the global burden of disease. As a result, treating these diseases costs $750 billion a year. Nanotechnology, which consists of small (~1-100 nm) but highly tailorable platforms, can provide significant opportunities for improving therapeutic delivery to the brain. Nanoparticles can increase drug solubility, overcome the blood-brain and brain penetration barriers, and provide timed release of a drug at a site of interest. Many researchers have successfully used nanotechnology to overcome individual barriers to therapeutic delivery to the brain, yet no platform has translated into a standard of care for any neurological disease. The challenge in translating nanotechnology platforms into clinical use for patients with neurological disease necessitates a new approach to: (1) collect information from the fields associated with understanding and treating brain diseases and (2) apply that information using scalable technologies in a clinically-relevant way. This approach requires systems-level thinking to integrate an understanding of biological barriers to therapeutic intervention in the brain with the engineering of nanoparticle material properties to overcome those barriers. To demonstrate how a systems perspective can tackle the challenge of treating neurological diseases using nanotechnology, this review will first present physiological barriers to drug delivery in the brain and common neurological disease hallmarks that influence these barriers. We will then analyze the design of nanotechnology platforms in preclinical in vivo efficacy studies for treatment of neurological disease, and map concepts for the interaction of nanoparticle physicochemical properties and pathophysiological hallmarks in the brain. WIREs Nanomed Nanobiotechnol 2017, 9:e1422. doi: 10.1002/wnan.1422 For further resources related to this article, please visit the WIREs website.

Go in for the kill: How plants deploy effector-triggered immunity to combat pathogens. [Corrected].

Plant resistance (R) proteins perceive specific pathogen effectors from diverse plant pathogens to initiate defense responses, designated effector-triggered immunity (ETI). Plant R proteins are mostly nucleotide binding-leucine rich repeat (NB-LRR) proteins, which recognize pathogen effectors directly or indirectly through sophisticated mechanisms. Upon activation by effector proteins, R proteins elicit robust defense responses, including a rapid burst of reactive oxygen species (ROS), induced biosynthesis and accumulation of salicylic acid (SA), a rapid programmed cell death (PCD) called hypersensitive response (HR) at the infection sites, and increased expression of pathogenesis-related (PR) genes. Initiation of ETI is correlated with a complex network of defense signaling pathways, resulting in defensive cellular responses and large-scale transcriptional reprogramming events. In this review, we highlight important recent advances on the recognition of effectors, regulation and activation of plant R proteins, dynamic intracellular trafficking of R proteins, induction of cell death, and transcriptional reprogramming associated with ETI. Current knowledge gaps and future research directions are also discussed in this review.