Risk factors for corneal conjunctival grafting failure in dogs at four referral centers in the southern United States (203 patients): 2015-2021.

OBJECTIVE: To report risk factors associated with conjunctival graft failure in dogs at four referral specialty centers. PROCEDURES: Records of 203 dogs (229 eyes) undergoing conjunctival graft repair of ulcerative keratitis at four hospitals from 2015 to 2021 were reviewed. Success was defined as full graft integration with globe retention at the last postoperative evaluation; vision status was reported separately. Factors assessed included patient signalment, ophthalmic examination findings, surgical factors, and follow-up information. RESULTS: Conjunctival graft failure occurred in 11% (25/229) of eyes and was significantly associated with ulcer depth, with corneal perforations having increased odds of graft failure compared with descemetoceles (odds ratio [OR] = 3.22, 95% confidence interval [CI] 1.11-9.32; p = .03) and stromal ulcers (OR = 10.89 [95% CI 1.38-86.18], p = .02). Brachycephalic dogs were significantly more likely than non-brachycephalic dogs to experience graft failure (OR = 5.02 [95% CI 1.42-17.74], p < .01). Surgery on the opposite eye relative to surgeon handedness was significantly associated with an increased risk of graft failure (OR 4.28 [95% CI 1.53-11.94], p < .01). The use of 7-0 and 8-0 suture versus 9-0 (p = .03) and the use of a combined simple continuous and interrupted pattern (p = .03) were significantly associated with an increased risk of graft failure. At the last follow-up, (median 61.5 days), 87% of dogs were visual. CONCLUSIONS: Corneal perforations, surgery on the opposite eye relative to surgeon handedness, suture size and pattern, and brachycephalic conformation were significantly associated with an increased risk of graft failure in this study. These characteristics can be considered when determining prognosis for ulcerative keratitis requiring surgical intervention.

Alterations to the bovine bacterial ocular surface microbiome in the context of infectious bovine keratoconjunctivitis.

BACKGROUND: Infectious bovine keratoconjunctivitis (IBK) is a common cause of morbidity in cattle, resulting in significant economic losses. This study aimed to characterize the bovine bacterial ocular surface microbiome (OSM) through conjunctival swab samples from Normal eyes and eyes with naturally acquired, active IBK across populations of cattle using a three-part approach, including bacterial culture, relative abundance (RA, 16 S rRNA gene sequencing), and semi-quantitative random forest modeling (real-time polymerase chain reaction (RT-PCR)). RESULTS: Conjunctival swab samples were obtained from eyes individually classified as Normal (n = 376) or IBK (n = 228) based on clinical signs. Cattle unaffected by IBK and the unaffected eye in cattle with contralateral IBK were used to obtain Normal eye samples. Moraxella bovis was cultured from similar proportions of IBK (7/228, 3.07%) and Normal eyes (1/159, 0.63%) (p = 0.1481). Moraxella bovoculi was cultured more frequently (p < 0.0001) in IBK (59/228, 25.88%) than Normal (7/159, 4.40%) eyes. RA (via 16 S rRNA gene sequencing) of Actinobacteriota was significantly higher in Normal eyes (p = 0.0045). Corynebacterium variabile and Corynebacterium stationis (Actinobacteriota) were detected at significantly higher RA (p = 0.0008, p = 0.0025 respectively) in Normal eyes. Rothia nasimurium (Actinobacteriota) was detected at significantly higher RA in IBK eyes (p < 0.0001). Alpha-diversity index was not significantly different between IBK and Normal eyes (p > 0.05). Alpha-diversity indices for geographic location (p < 0.001), age (p < 0.0001), sex (p < 0.05) and breed (p < 0.01) and beta-diversity indices for geographic location (p < 0.001), disease status (p < 0.01), age (p < 0.001), sex (p < 0.001) and breed (p < 0.001) were significantly different between groups. Modeling of RT-PCR values reliably categorized the microbiome of IBK and Normal eyes; primers for Moraxella bovoculi, Moraxella bovis, and Staphylococcus spp. were consistently the most significant canonical variables in these models. CONCLUSIONS: The results provide further evidence that multiple elements of the bovine bacterial OSM are altered in the context of IBK, indicating the involvement of a variety of bacteria in addition to Moraxella bovis, including Moraxella bovoculi and R. nasimurium, among others. Actinobacteriota RA is altered in IBK, providing possible opportunities for novel therapeutic interventions. While RT-PCR modeling provided limited further support for the involvement of Moraxella bovis in IBK, this was not overtly reflected in culture or RA results. Results also highlight the influence of geographic location and breed type (dairy or beef) on the bovine bacterial OSM. RT-PCR modeling reliably categorized samples as IBK or Normal.

Relationship between the bacterial ocular surface microbiota and outcomes for cats with feline herpesvirus type 1 ocular surface disease.

OBJECTIVE: Feline herpesvirus 1 (FHV-1) causes ocular surface disease in domestic cats. The purpose of this study was to assess the relationship between bacterial ocular surface microbiota and outcomes for cats with FHV-1 ocular surface disease. ANIMALS STUDIED: Twenty-two shelter-housed cats with confirmed FHV-1 ocular surface disease. PROCEDURES: Animals were grouped according to FHV-1 shedding and ocular clinical scores following intervention: worsened outcome (WorOut, n = 11) or improved outcome (ImpOut, n = 11). Scoring and conjunctival sampling were completed on Days 1 and 8 of twice daily antiviral treatment. Bacterial DNA was extracted and submitted for 16S rRNA gene sequencing. Real-time polymerase chain reaction was performed for selected bacterial species. Overall DNA concentration between groups was assessed. RESULTS: Bacterial microbiota relative abundance composition was significantly different between ImpOut and WorOut groups (weighted UniFrac p = .006). Alpha diversity was significantly higher in the ImpOut group compared with the WorOut group (Shannon p = .042, Simpson's p = .022, Pielou's p = .037). Differences in the relative abundance of various phyla and species were detected between groups. Total DNA concentration was higher in the WorOut group compared with the ImpOut group (p = .04). Feline GAPDH (p = .001) and Bilophila wadsworthia (p = .024) copy number was significantly higher in the ImpOut group compared with the WorOut group. CONCLUSIONS: The results highlight the important relationship between the bacterial ocular surface microbiota and FHV-1 infection outcomes in cats treated with antiviral medications. Low bacterial species diversity, higher overall DNA (presumed predominantly bacterial) load, and certain bacterial phyla/species were associated with poor outcomes for cats with FHV-1 ocular disease.

Needs Assessment for a Resuscitative Thoracotomy Curriculum for General Surgery Residents in the Northeast Region.

INTRODUCTION: Resuscitative thoracotomy (RT) is a high-acuity low occurrence (HALO) procedure with which general surgical resident (GSR) experience and confidence are unknown. We sought to identify and describe this educational gap by conducting a targeted needs assessment for an RT curriculum for GSRs. METHODS: An online regional needs assessment survey was conducted for an RT curriculum for GSRs. The survey was developed by a group of trauma stakeholders and revised after being piloted on a small, representative group of GSRs. We surveyed GSRs in the Northeast region regarding their experience and confidence with RT; interest in an RT curriculum; and content, format, and scope for an RT curriculum. RESULTS: The survey response rate was 43%, reflecting the viewpoints of GSRs at 8 major training centers across the Northeast. Only 13% of respondents were interested in pursuing a career in Trauma and Critical Care despite 97% of them training at a Level I Trauma Center. Twenty-nine percent and 33% of GSRs had ever assisted with or performed RT, respectively. Twenty-one percent of GSRs reported feeling confident performing RT. Most respondents (98%) agreed or strongly agreed that an RT curriculum would add value to their general surgery education. The most positively rated content topics were resuscitative maneuvers (100% positive responses [PR]), when to cease resuscitative efforts (100% PR), and morbidity and mortality associated with RT (98% PR). The most highly rated learning methods were individual RT simulation time (97% PR) and a tour of the trauma bay equipment (97% PR). CONCLUSIONS: This needs assessment demonstrates a lack of experience and confidence with RT, a strong learner interest in an RT curriculum, and a desire for experiential learning methods. Learning objectives are defined herein, and the next steps involve developing educational materials for an RT curriculum for GSRs.

Alterations of the bacterial ocular surface microbiome are found in both eyes of horses with unilateral ulcerative keratitis.

Next generation sequencing (NGS) studies in healthy equine eyes have shown a more diverse ocular surface microbiota compared to culture-based techniques. This study aimed to compare the bacterial ocular surface microbiota in both eyes of horses with unilateral ulcerative keratitis (UK) with controls free of ocular disease. Conjunctival swabs were obtained from both ulcerated eyes and unaffected eyes of 15 client-owned horses with unilateral UK following informed consent, as well as from one eye of 15 healthy horses. Genomic DNA was extracted from the swabs and sequenced on an Illumina platform using primers that target the V4 region of bacterial 16S rRNA. Data were analyzed using Quantitative Insights Into Molecular Ecology (QIIME2). The ocular surface of ulcerated eyes had significantly decreased species richness compared with unaffected fellow eyes (Chao1 q = 0.045, Observed ASVs p = 0.045) with no differences in evenness of species (Shannon q = 0.135). Bacterial community structure was significantly different between either eye of horses with UK and controls (unweighted UniFrac: control vs. unaffected, p = 0.03; control vs. ulcerated, p = 0.003; unaffected vs. ulcerated, p = 0.016). Relative abundance of the gram-positive taxonomic class, Bacilli, was significantly increased in ulcerated eyes compared with controls (q = 0.004). Relative abundance of the taxonomic family Staphylococcaceae was significantly increased in ulcerated and unaffected eyes compared with controls (q = 0.030). The results suggest the occurrence of dysbiosis in infected eyes and reveal alterations in beta diversity and taxa of unaffected fellow eyes. Further investigations are necessary to better understand the role of the microbiome in the pathophysiology of ocular surface disease.

Practical and Ethical Guidelines for the Involvement of Trainees in Global Surgery: Consensus Statement and Recommendations from the Resident and Associate Society of the American College of Surgeons Global Surgery Work Group.

BACKGROUND: The guidelines provided by US professional surgical organizations for involvement of trainees in global surgery are limited. The aim of this consensus statement is to provide surgical trainees with official recommendations from the Resident and Associate Society of the American College of Surgeons Global Surgery Work Group (GSWG) regarding professional, practical, and ethical guidelines for participation in global surgery endeavors. STUDY DESIGN: A task force was created within the GSWG to review and define the scope of involvement of trainees in global surgery, and a consensus process was undertaken for the group at large to approve a set of proposed guidelines. RESULTS: The list of practical and ethical guidelines for the engagement of trainees in global surgery covering the themes of preparedness, reciprocity and collaboration, ethical considerations, and sustainability was approved with consensus from the GSWG. CONCLUSIONS: This consensus statement from the Resident and Associate Society of the American College of Surgeons GSWG outlines the official recommendations for guidelines for involvement of trainees in global surgery, with an aim to support equitable, sustainable collaborations that center on improving access to safe, timely, and affordable surgical care for the global community at large. Future processes seek to involve representation and perspectives from a larger body of low- to middle-income country surgical trainees.

Relative and Quantitative Characterization of the Bovine Bacterial Ocular Surface Microbiome in the Context of Suspected Ocular Squamous Cell Carcinoma.

The ocular surface microbiome is altered in certain disease states. The aim of this study was to characterize the bovine bacterial ocular surface microbiome (BBOSM) in the context of ocular squamous cell carcinoma (OSCC). The conjunctiva of normal (n = 28) and OSCC (n = 10) eyes of cows aged 2 to 13 years from two farms in Louisiana and Wyoming were sampled using individual sterile swabs. DNA extraction followed by 16S ribosomal ribonucleic acid (rRNA) gene sequencing and real-time polymerase chain reaction (RT-PCR) were performed to, respectively, assess the relative and absolute BBOSM. Discriminant analysis (DA) was performed using RT-PCR data, and relative abundance analysis was performed using 16S rRNA gene sequencing data. The 11 most abundant phyla in both normal and OSCC-affected cows were identified using 16S rRNA gene sequencing analysis. The relative abundance of Euryarchaeota was found to be significantly lower (p = 0.0372) in OSCC eyes compared to normal eyes. Relative abundance differences within and between geographic locations were also identified. Quadratic DA categorized samples as OSCC or normal with 100% sensitivity and 83.3-100% specificity. Relative abundance analysis identified relative BBOSM phylum alterations in OSCC. Quadratic DA can be used to accurately categorize BBOSM from normal and OSCC ocular surface samples.

Delirium Among Patients With Cancer in the Intensive Care Unit: Prognostic Sign or Opportunity for Intervention.

Delirium continues to be challenging for medical providers, patients, and caregivers. In a recent editorial, the authors review a retrospective analysis of critically ill, nonterminal patients with cancer admitted to a mixed medical-surgical ICU and discuss how these findings offer opportunities for intervention and goals-of-care conversations.

Clinical ophthalmic parameters of the Quaker parrot (Myiopsitta monachus).

PURPOSE: Ophthalmic diagnosis in many avian species remains hindered by a lack of normative values. This study aimed to establish normal ophthalmic parameters for select diagnostic tests in clinically normal Quaker parrots. METHODS: Ninety-six captive Quaker parrots aged 8-18 years underwent ophthalmic examination to include assessment of neuro-ophthalmic reflexes, phenol red thread test, rebound tonometry, fluorescein staining, palpebral fissure length measurements, slit lamp biomicroscopy, indirect ophthalmoscopy, and ocular ultrasound biometry. RESULTS: Menace response, dazzle reflex, and direct pupillary light reflex were present for all Quaker parrots. Tear production (mean ± SD) was 13.3 ± 4.0 mm/15 s and intraocular pressure (IOP, mean ± SD) was 10.6 ± 1.4 and 6.0 ± 1.3 mmHg in the D and P rebound tonometer calibration settings, respectively. For IOP measurement, D and P calibration settings were not interchangeable, with the lesser variation of the D setting preferred in the absence of a gold standard. Ultrasound measurement of the anterior chamber depth increased with age and males had longer axial globe and vitreous lengths. Incidental adnexal and ocular lesions, identified in 36/96 (37.5%) of Quaker parrots, did not statistically affect the created reference data. CONCLUSIONS: This work provides reference values and clinical findings to assist with monitoring the health of wild populations and maintaining the health of captive Quaker parrots.

Paclitaxel and Urolithin A Prevent Histamine-Induced Neurovascular Breakdown Alike, in an Ex Vivo Rat Eye Model.

Neurovascular eye problems are better prevented than managed or treated. Despite growing concern of occurrence in aging populations and development secondary to diseases such as diabetes and hypertension, we currently have very few options to tackle this global problem. Creating effective and high-throughput screening strategies is as important as the intervention itself. Here, we present for the first time a robust ex vivo rat eye model of histamine-induced vascular damage for investigating the therapeutic potential of paclitaxel (PTX) and urolithin A (UA) as alternatives to dexamethasone for preventing vascular damage in the retina. Extensive loss of vascularization and apoptosis were observed in the histamine-challenged group and successfully prevented in the intervention groups, more significantly in the PTX and UA. These important early results indicate that PTX and UA could be developed as potential preventive strategies for a wide variety of retinal diseases.

Description of non-brachycephalic canine conjunctival microbiome before and after application of an antiseptic preparation.

OBJECTIVE: To evaluate canine conjunctival microbiome before and after an antiseptic preparation using aerobic culture and DNA sequencing. ANIMALS STUDIED: Six healthy non-brachycephalic dogs. PROCEDURES: Dogs randomly received povidone-iodine 1:50 dilution solution in one eye with the second eye serving as a control. Standardized volumes of solution, number of sterile cotton tipped applicators, and preparation times of 5 min were used. Aerobic culture and DNA sequencing samples were collected from inferior conjunctival fornices at baseline, immediately following, 24 h, and 4 weeks following antiseptic preparation. Aerobic culture data were evaluated using paired t-test and linear regression. Illumina platform was used to sequence bacterial DNA using primers to target the V4 region of bacterial 16S rRNA. Quantitative Insights Into Molecular Ecology (QIIME 2.0) was used to analyze data. RESULTS: Baseline aerobic cultures consisted of Bacillus (35%), Staphylococcus (30%), Streptococcus (20%), Moraxella (5%), Micrococcus (5%), and Simonsiella spp. (5%). No significant difference was detected in mean number of species cultured at baseline and following treatment (p = .465). Treatment, sample time, or interaction was not significant (p > .393). The most abundant phyla at baseline via DNA sequencing were Proteobacteria (57.04%), Actinobacteria (19.89%), Firmicutes (3.25%), and Bacteroidetes (5.5%). Alpha and beta diversity matrices at baseline and over time revealed no significant change in species richness or bacterial composition. Relative abundance of bacterial taxa did not significantly differ in treated or control eyes over time. CONCLUSIONS: Conjunctival bacterial flora identified differed between culture dependent and independent methods. The bacterial community remained stable over time after application of the antiseptic preparation.

Traumatic Injury Under COVID-19 Stay-at-Home Advisory: Experience of a New England Trauma Center.

BACKGROUND: With the onset of the COVID-19 pandemic and subsequent widespread stay-at-home advisories throughout early 2020, hospitals have noticed a decrease in illnesses unrelated to COVID-19. However, the impact on traumatic injury is relatively unknown. This study aims to characterize patterns of trauma during the COVID-19 pandemic at a Level I Trauma Center. MATERIALS & METHODS: A retrospective review was performed of adult trauma patients from March to June, in the years 2018 through 2020. Primary outcome was the number of trauma activations (volume). Secondary outcomes included activation level, mechanism of injury, mortality rate, and length of stay, and other demographic background. Trauma patterns of the 2018 and 2019 periods were combined as historical control, and compared to patterns of the biweekly-matched period of 2020. RESULTS: A total of 2,187 patients were included in analysis (Pre-COVID n = 1,572; COVID n = 615). Results were significant for decreased trauma volume but longer length of stay during COVID cohort, and for an increased proportion of males. No significant difference was found for other demographic variables, trauma mechanisms, or severity. Trauma volume patterns mirrored COVID rates in the state. CONCLUSIONS: Despite a decline in trauma volume, other trauma patterns including severity and mechanism remained unchanged during the COVID-19 period. The decreased volume was not associated with a markedly lower clinical workload, change in team structure, or provider coverage re-distribution. Our data suggests that trauma volume and severity remained high enough during COVID-19 peak to necessitate full staffing, which may provide guidance in the event of a pandemic resurgence.

An abbreviated Caprini model for VTE risk assessment in trauma.

The Caprini risk assessment model (RAM) is widely used to assess risk of venous thromboembolism (VTE). However, it is cumbersome with 31 variables and poses challenges with inter-rater reliability. This study aimed to determine if an abbreviated model could perform similarly in VTE risk assessment. We performed a retrospective review of trauma patients ≥ 18 years old and admitted for over 24 h at a Level I trauma center from January 1, 2018, to December 31, 2018. Demographic and clinical data were analyzed to generate Caprini scores. Using a p-value cutoff of < 0.05, the individual components of the original Caprini RAM most highly associated with VTE were identified and used to calculate an abbreviated Caprini score. Logistic regression assessed odds of inpatient VTE with the original or abbreviated Caprini RAMs. Receiver operating characteristic curves and c-statistics were generated to assess discriminatory ability. The study sample included 1279 patients. Ten risk factors were included in the abbreviated model (recent major surgery, length of surgery > 2 h, transfusion, restricted mobility > 72 h, central venous catheter, current major surgery, age, history of VTE, hip or leg fracture, and serious trauma). Compared to the original, the abbreviated model had a similar odds ratio (1.17 vs 1.07, both p-values < 0.001), c-statistic (0.747 vs 0.753), sensitivity (0.73 vs 0.76) and specificity (0.62 vs 0.61). An abbreviated Caprini RAM performs similarly to the original, may streamline workflow and allow for automation in electronic health records, potentially enhancing its use in resource limited settings.

Uveal Malignant Melanoma in a Hybrid Macaw Parrot (Ara chloropterus × Ara militaris).

An adult male green-winged (Ara chloropterus) × military (Ara militaris) hybrid macaw of unknown age was presented to the Texas A&M Veterinary Medical Teaching Hospital for evaluation of left periocular swelling, blepharospasm, and ocular discharge. Complete ophthalmic examination and B mode ocular ultrasonography were performed to evaluate the affected eye. Ocular examination revealed a blind left globe with exophthalmos, periocular swelling, diffuse corneal edema, and severe anterior fibrinous uveitis obscuring visualization of the intraocular structures. An ultrasound examination revealed a hyperechoic mass that filled the posterior segment of the globe. Focal discontinuity of the posterior sclera suggested scleral rupture. Enucleation with histopathology was recommended and performed 1.5 months later. Intraoperatively, a heavily pigmented and friable soft tissue mass extruded through the posterior sclera and extended into the orbit. Histologically, the mass was consistent with a malignant melanoma. The patient died 18 hours after the surgical procedure because of unknown complications. Postmortem examination did not identify evidence of metastasis. This study described the clinical appearance and histopathologic findings of a rare ocular neoplasm with extrascleral extension in a hybrid macaw. Although uncommon in psittacine birds, primary ocular melanocytic neoplasms may display features of malignancy with scleral or orbital invasion, or both.

A longitudinal surgical systems strengthening research program for medical students: the exploration of a model for global health education.

BACKGROUND: In response to the staggering global burden of conditions requiring emergency and essential surgery, the development of international surgical system strengthening (SSS) is fundamental to achieving universal, timely, quality, and affordable surgical care. Opportunity exists in identifying optimal collaborative processes that both promote global surgery research and SSS, and include medical students. This study explores an education model to engage students in academic global surgery and SSS via institutional support for longitudinal research. OBJECTIVES: We set out to design a program to align global health education and longitudinal health systems research by creating an education model to engage medical students in academic global surgery and SSS. PROGRAM DESIGN AND IMPLEMENTATION: In 2015, medical schools in the United States and Colombia initiated a collaborative partnership for academic global surgery research and SSS. This included development of two longitudinal academic tracks in global health medical education and academic global surgery, which we differentiated by level of institutional resourcing. Herein is a retrospective evaluation of the first two years of this program by using commonly recognized academic output metrics. MAIN ACHIEVEMENTS: In the first two years of the program, there were 76 total applicants to the two longitudinal tracks. Six of the 16 (37.5%) accepted students selected global surgery faculty as mentors (Acute Care Surgery faculty participating in SSS with Colombia). These global surgery students subsequently spent 24 total working weeks abroad over the two-year period participating in culminating research experiences in SSS. As a quantitative measure of the program's success, the students collectively produced a total of twenty scholarly pieces in the form of accepted posters, abstracts, podium presentations, and manuscripts in partnership with Colombian research mentors. POLICY IMPLICATIONS: The establishment of scholarly global health education and research tracks has afforded our medical students an active role in international SSS through participation in academic global surgery research. We propose that these complementary programs can serve as a model for disseminated education and training of the future global systems-aware surgeon workforce with bidirectional growth in south and north regions with traditionally under-resourced SSS training programs.

Analgesic effects of a retrobulbar block with 0.75% ropivacaine in dogs undergoing enucleation.

OBJECTIVE: To assess the analgesic effects of a retrobulbar block with ropivacaine in dogs undergoing enucleation. STUDY DESIGN: Prospective, randomized, masked placebo-controlled trial. ANIMALS: A total of 23 client-owned dogs. METHODS: Dogs were randomized to be administered a preoperative inferior-temporal palpebral retrobulbar injection of either ropivacaine 0.75% (1 mL 10 kg-1; group RG) or equivalent volume of 0.9% saline (control; group CG). Intraoperative variables recorded to detect a response to noxious stimuli included heart rate (HR) and mean arterial pressure (MAP). Three observers assessed and recorded pain using a numerical rating pain scale and visual analog scale (VAS) before anesthesia (baseline) and postoperatively at 0, 0.5, 1, 2, 3, 4, 5, 6 and 24 hours after extubation. Rescue analgesia was administered if intraoperative HR or MAP increased by ≥ 20% from the previously recorded surgical time point, average postoperative pain scores totaled ≥ 9/20, scored ≥ 3/4 in any one category with VAS ≥ 35/100, or if VAS was ≥ 35/100 with a palpation score > 0/4. RESULTS: Intraoperatively, there was no significant difference in HR or MAP between groups. Rescue analgesia was administered intraoperatively to four and one dogs and postoperatively to five and seven dogs in groups CG and RG, respectively, with no significant difference between groups. VAS scores were significantly lower in ropivacaine dogs at extubation (p = 0.02), but not at other postoperative time points. Adverse events were not observed in either group. CONCLUSIONS AND CLINICAL RELEVANCE: Preoperative retrobulbar 0.75% ropivacaine injection (1 mL 10 kg-1) provided analgesia in dogs following enucleation at extubation; however, intraoperative and postoperative pain control did not differ from a placebo injection with saline. Lack of differences between groups may have been influenced by sample size limitations.

Patterns of General Surgery Residency Social Media Use in the Age of COVID-19.

OBJECTIVE: The role for social media use by General Surgery departments continues to expand and social media accounts have been increasingly implemented as a tool for residency program for promotion and engagement. The importance of these accounts appears to have increased given the unprecedented changes with COVID-19 and the dramatic and unpredictable change to the application cycle including the use of virtual interviews, suggesting a perceived need for increased online engagement with applicants. The purpose of this study was to determine the patterns of creation and usage of Twitter and Instagram accounts of Accreditation Council for Graduate Medical Education (ACGME)-accredited General Surgery residency programs and their associated surgical departments. METHORDS: A cross-sectional study of the use of Twitter and Instagram by the 332 ACGME-accredited General Surgery residency programs and their associated departments was conducted in February 2021. Twitter and Instagram accounts were identified by accessing program/department websites as well as social media platform and internet searches. Year of creation, number of followers, and number of posts (July 1, 2018-December 31, 2020) were collected. Trends in usage were compared across years stratified by platform and by account owner (department vs. residency). RESULTS: Instagram accounts are more than five-times greater for residencies compared to departments (42% vs 8%, p < 0.001). There was not a significant difference between the number of department and residency Twitter accounts (26% vs 23%, p = 0.37). Significantly more residency Instagram and Twitter accounts were created or first posted in 2020 compared to department accounts (Instagram: 100 vs 7, p < 0.001; Twitter: 31 vs 6, p = 0.001). Over 18% of residency programs had both Twitter and Instagram accounts compared to only 6% of departments (p < 0.001). However, department Twitter and Instagram accounts had significantly higher median total posts from 7/1/2018-12/31/2020 (Twitter: p = 0.0001, Instagram p = 0.004). While the number of Instagram followers and accounts being followed were similar between residencies and departments, department Twitter accounts had a larger median number of followers (1141 vs. 430, p=0.003) and account followings (308 vs. 192, p = 0.001) compared to residency accounts. CONCLUSIONS: The number of residency social media accounts has significantly increased in 2020 compared to account creation of departments, with Instagram account creation exceeding that of Twitter and of departments. The opposite pattern in usage was seen related to number of posts, and with Twitter, followers, and number of followings, with departments outpacing residencies. This significant increase in account creation may have been influenced by the COVID-19 pandemic and the change to a virtual interview season, suggesting an unprecedented need for online engagement with applicants. As the increased social media presence will likely persist in future application cycles, further study about the impact of residency social media use on recruitment and applicant decision-making as well as effective strategies, is needed.

Nanoparticles that do not compete with endogenous ligands - Molecular characterization in vitro, acute safety in canine, and interspecies pharmacokinetics modeling to humans.

A vast majority, if not all of the receptor-mediated drug delivery systems utilize nanoparticles that are conjugated to physiological mimic ligands, with testing restricted to in vitro and rodent models. In this report, we present for the first time, a full spectrum characterization of transferrin receptor 1 (TfR1)-targeted polymeric nanoparticles (abbreviated, P2Ns-GA) that do not compete with endogenous transferrin, and serve as a versatile platform for oral drug delivery. Based on endocytosis inhibitors and receptor knockdown, the cellular uptake of P2Ns-GA is clathrin-mediated and dependent on TfR1 expression, but other trafficking mechanisms, particularly those involving caveolae/lipid rafts, can also play a role. The utility of P2Ns-GA in promoting the oral bioavailability of encapsulated compounds is demonstrated with a hydrophobic polyphenol, urolithin A (UA). When compared against plain UA or UA in ligand-free nanoparticles, UA-loaded P2Ns-GA led to markedly higher plasma concentrations among healthy canines, with no adverse health effects observed after oral dosing. Finally, a semi-mechanistic pharmacokinetic model was developed using both rat and dog datasets to quantitatively evaluate the effect of P2Ns-GA on oral bioavailability of UA. The model was allometrically scaled to humans to simulate clinical pharmacokinetics of plain UA and UA-loaded P2Ns-GA following oral administration.

Evaluation of the ocular surface mycobiota in clinically normal horses.

The eye is host to myriad bacterial, fungal, and viral organisms that likely influence ocular surface physiology in normal and diseased states. The ocular surface mycobiota of horses has not yet been described using NGS techniques. This study aimed to characterize the ocular surface fungal microbiota (mycobiota) in healthy horses in 2 environmental conditions (stalled versus pasture). Conjunctival swabs of both eyes were obtained from 7 adult stallions stabled in an open-air pavilion and 5 adult mares living on pasture. Genomic DNA was extracted from ocular surface swabs and sequenced using primers that target the Internal Transcribed Spacer 1 (ITS1) region of the fungal genome on an Illumina platform. Sequences were processed using Quantitative Insights Into Molecular Ecology (QIIME 2.0) and taxonomy assigned with the Findley et al. 2013 ITS1 database. The most abundant genera identified were Leptosphaerulina (22.7%), unclassified Pleosporaceae (17.3%), Cladosporium (16.2%), Alternaria (9.8%), unclassified Pleosporales (4.4%), unclassified Montagnulaceae (2.9%), Fusarium (2.5%), and Pestalotiopsis (1.4%). Fungal community composition (Jaccard, R = 0.460, p = 0.001) and structure (Bray-Curtis, R = 0.811, p = 0.001) were significantly different between pastured mares and stabled stallions. The ocular surface of pastured mares had significantly increased fungal species richness and diversity compared to stabled stallions (Shannon p = 0.0224, Chao1 p = 0.0118, Observed OTUs p = 0.0241). Relative abundances of Aspergillus (p = 0.005) and Alternaria spp. (p = 0.002) were significantly increased in the mycobiota of pastured mares. This is the first report to describe the mycobiota of the equine ocular surface. Environmental factors such as housing influence the composition, structure, and richness of the equine ocular surface mycobiota.

CLINICAL OPHTHALMIC PARAMETERS OF THE TEXAS TORTOISE (GOPHERUS BERLANDIERI).

Ophthalmic studies of the Texas tortoise (Gopherus berlandieri) established normal ophthalmic parameters for select diagnostic tests in captive tortoises and assessment of differences among individuals of differing size and health status. Sixty-one tortoises of varying weight, shell size, Mycoplasma seroprevalence, and herpesvirus exposure were included. Complete ophthalmic examinations, including neuro-ophthalmic reflexes, phenol red thread test, rebound tonometry, fluorescein staining, palpebral fissure length measurement, slit lamp biomicroscopy, indirect fundoscopy, and ocular ultrasound measurements of axial globe length, anterior chamber depth, lens thickness, and vitreous length, were recorded. All tortoises had negative dazzle and pupillary light reflexes, inconsistent menace responses, and positive palpebral reflexes. Mean ± SD tear production and intraocular pressure (IOP) were 14.2 ± 5.6 mm/15 sec and 13.8 ± 2.4 mm Hg in healthy tortoises, respectively. Mycoplasma-seropositive tortoises (with or without herpesvirus exposure) had significantly increased tear production (20.2 ± 8.1 and 19.9 ± 8.9 mm/15 sec, respectively) compared with healthy seronegative tortoises (14.2 ± 5.6 mm/15 sec; P = 0.02). As body size decreased, so too did palpebral fissure length and ocular ultrasound measurements, while IOP increased. Overall, palpebral fissure length appeared relatively small, and tear production relatively increased compared with other chelonian species, likely on the basis of the relatively arid native habitat. Further work is recommended to establish baseline values in related species, as well as comparison in aquatic versus terrestrial chelonians. The authors further suggest that the finding of relatively increased tear production in tortoises may indicate the need to rule out mycoplasmosis as a cause of upper respiratory tract disease.