Inter-reader variability and reproducibility of the PI-QUAL score in a multicentre setting.

PURPOSE: To assess the inter-reader reproducibility of the Prostate Imaging Quality (PI-QUAL) score between readers with varying clinical experience and its reproducibility at assessing imaging quality between different institutions. METHODS: Following IRB approval, we assessed 60 consecutive prostate MRI scans performed at different academic teaching and non-academic hospitals uploaded to our institutes' PACS for second opinion or discussion in case conferences. Anonymized scans were independently reviewed using the PI-QUAL scoring sheet by three readers - two radiologists (with 1 and 12 years Prostate MRI reporting experience), and an experienced MRI technician with interest in image acquisition and quality. All readers were blinded to the site where scans were acquired. RESULTS: Agreement coefficients between the 3 readers in paired comparison for each individual PI-QUAL score was moderate. When the scans were clustered into 2 groups according to their ability to rule in or rule out clinically significant prostate cancer [i.e., PI-QUAL score 1-3 vs PI-QUAL score 4-5], the Gwet AC1 coefficients between the three readers in paired comparison was good to very good [Gwet AC 1:0.77, 0.67, 0.836 respectively] with agreement percentage of 88.3%, 83.3% and 91.7% respectively. Agreement coefficient was higher between the experienced radiologist and the experienced MRI technician than between the less experienced trainee radiologist and the other two readers. The mean PI-QUAL score provided by each reader for the scans was significantly higher in the academic hospitals (n = 32) compared to the community hospital (n = 28) [experienced radiologist 4.6 vs 2.9; trainee radiologist 4.5 vs 2.4; experienced technologist 4.4 vs 2.4; p value < 0.001]. CONCLUSION: We observed good to very good reproducibility in the assessment of each MRI sequence and when scans were clustered into two groups [PI-QUAL 1-3 vs PI-QUAL 4-5] between readers with varying clinical experience. However, the reproducibility for each single PI-QUAL score between readers was moderate. Better definitions for each PI-QUAL score criteria may further improve reproducibility between readers. Additionally, the mean PI-QUAL score provided by all three readers was significantly higher for scans performed at academic teaching hospitals compared to community hospital.

Controlled environments for cannabis cultivation to support "omics" research studies and production.

The cannabis (Cannabis sativa L.) genome is highly heterozygous and, to retain genetic identity, clonal propagation of cultivars is very common. Establishing controlled environments, often involving multiple locations throughout a single grow, is critical for reliably generating materials to be used in research and production. In this article, we break down different periods of the grow cycle, such as cloning, hardening (optional), vegetative growth, flowering growth, and harvest, into individual steps. We are including images and videos for an in-depth coverage of methodological details. We are providing a list of equipment, supplies, reagents, and other resources to help with planning a grow experiment. Finally, we are discussing considerations for different aspects of controlled environments, including lighting, fertilizer regimes, and integrated pest management. With this article, it is our goal to empower researchers to reliably generate disease-free cannabis material suitable for genetic and biochemical studies that require full control of environmental factors.

Characterization of cardiac bradyarrhythmia associated with LGI1-IgG autoimmune encephalitis.

Objective: To evaluate and characterize cardiac arrythmias associated with LGI1-IgG (Leucine-rich glioma inactivated 1-IgG) autoimmune encephalitis (AE). Patients and methods: In this retrospective descriptive study, we identified Mayo Clinic patients (May 1, 2008 - December 31, 2020) with LGI1-IgG AE who had electrocardiogram proven bradyarrhythmias during the initial presentation. Inclusion criteria were 1) LGI1-IgG positivity with a consistent clinical syndrome; 2) electrocardiographic evidence of bradyarrhythmia; and 3) sufficient clinical details. We excluded patients who were taking negative ionotropic agents at the time of their bradyarrhythmias. We collected demographic/clinical data including details of bradyarrhythmia (severity, duration, treatments), and neurologic and cardiac outcomes. Results: We found that patients with LGI1-IgG AE had bradyarrhythmia at a frequency of 8% during the initial presentation. The bradyarrhythmia was often asymptomatic (6/11, 55%); however, the episode was severe with one patient requiring a pacemaker. Outcome was also generally favorable with the majority (8/11, 73%) having full resolution without further cardiac intervention. Lastly, we found that mouse and human cardiac tissues express LGI1 (mRNA and protein). Conclusion: LGI1-IgG AE can be rarely associated with bradyarrhythmias. Although the disease course is mostly favorable, some cases may require pacemaker placement to avoid devastating outcomes.

Comparison of Micro-US and Multiparametric MRI for Prostate Cancer Detection in Biopsy-Naive Men.

Background Multiparametric MRI has led to increased detection of clinically significant prostate cancer (csPCa). Micro-US is being investigated for csPCa detection. Purpose To compare multiparametric MRI and micro-US in detecting csPCa (grade group ≥2) and to determine the proportion of MRI nodules visible at micro-US for real-time targeted biopsy. Materials and methods This prospective, single-center trial enrolled biopsy-naive men with suspected prostate cancer (PCa) between May 2019 and September 2020. All patients underwent multiparametric MRI followed by micro-US; findings at both were interpreted in a blinded fashion, followed by targeted biopsy and nontargeted systematic biopsy using micro-US. Proportions were compared using the exact McNemar test. The differences in proportions were calculated. Results Ninety-four men (median age, 61 years; IQR, 57-68 years) were included. MRI- and micro-US-targeted biopsy depicted csPCa in 37 (39%) and 33 (35%) of the 94 men, respectively (P = .22); clinically insignificant PCa in 14 (15%) and 15 (16%) (P > .99); and cribriform and/or intraductal PCa in 14 (15%) and 13 (14%) (P > .99). The MRI- plus micro-US-targeted biopsy pathway depicted csPCa in 38 of the 94 (40%) men. The addition of nontargeted systematic biopsy to MRI- plus micro-US-targeted biopsy did not enable identification of any additional men with csPCa but did help identify nine additional men with clinically insignificant PCa (P = .04). Biopsy was avoided in 32 of the 94 men (34%) with MRI and nine of the 94 men (10%) with micro-US (P < .001). Among 93 MRI targets, 62 (67%) were prospectively visible at micro-US. Conclusion MRI and micro-US showed similar rates of prostate cancer detection, but more biopsies were avoided with the MRI pathway than with micro-US, with no benefit of adding nontargeted systematic biopsy to the MRI- plus micro-US-targeted biopsy pathway. Most MRI lesions were prospectively visible at micro-US, allowing real-time targeted biopsy. ClinicalTrials.gov registration no.: NCT03938376 © RSNA, 2022 Online supplemental material is available for this article.

Meta-analysis of effectiveness of steroid-sparing attack prevention in MOG-IgG-associated disorder.

OBJECTIVE: To estimate the efficacy of the commonly used long-term immunotherapies in myelin oligodendrocyte glycoprotein IgG associated disorder (MOGAD) METHOD: A comprehensive search of the databases including PubMed/MEDLINE, EMBASE, and Cochrane database was performed for all studies that assessed the efficacy of azathioprine (AZA), mycophenolate mofetil (MMF), rituximab (RTX), and maintenance intravenous immunoglobulin (mIVIG) in MOGAD. The random-effect model is used to estimate the standard mean difference (SMD) of annualized relapse rate (ARR) and expanded disability status scale (EDSS), mean ARR, probabilities of relapse and worsening EDSS during treatment. RESULTS: The initial search identified 714 articles, and 21 satisfied eligibility criteria. All immunotherapies significantly reduced ARR in both pediatric and adult populations. Relapse probabilities and pooled mean ARR (SE: standard error) during therapies were as follow: AZA 53.1% [95%CI 37.4% to 68.2%; ARR 0.291 (0.134)], MMF 38.5% [95%CI 19.4% to 62.0%; ARR 0.836 (0.176)], RTX 48.9% [95%CI 37.8% to 60.2%; ARR 0.629(0.162)], and mIVIG 25.3% [95%CI 14.0% to 41.3%; ARR 0.081 (0.058)]. Only RTX significantly improved EDSS, SMD -0.499 (95%CI -0.996 to -0.003). The proportion of worsening EDSS with immunotherapies were 20.7% (95%CI 8.8% to 41.6%), 8.1% (95%CI 1.1% to 41.2%), and 10.8% (95%CI 3.8% to 26.8%) for AZA, MMF, and RTX, respectively. CONCLUSION: These commonly used immunotherapies significantly reduced ARR in MOGAD. Only RTX had a significant benefit in EDSS improvement. However, a substantial portion of patients continued to relapse with treatment. Randomized controlled studies are needed to verify these findings and perform head-to-head comparisons among these treatment options.

Quantifying the value of on-farm measurements to inform the selection of key performance indicators for livestock production systems.

The use of key performance indicators (KPIs) to assist on-farm decision making has long been seen as a promising strategy to improve operational efficiency of agriculture. The potential benefit of KPIs, however, is heavily dependent on the economic relevance of the metrics used, and an overabundance of ambiguously defined KPIs in the livestock industry has disincentivised many farmers to collect information beyond a minimum requirement. Using high-resolution sheep production data from the North Wyke Farm Platform, a system-scale grazing trial in southwest United Kingdom, this paper proposes a novel framework to quantify the information values of industry recommended KPIs, with the ultimate aim of compiling a list of variables to measure and not to measure. The results demonstrated a substantial financial benefit associated with a careful selection of metrics, with top-ranked variables exhibiting up to 3.5 times the information value of those randomly chosen. When individual metrics were used in isolation, ewe weight at lambing had the greatest ability to predict the subsequent lamb value at slaughter, surpassing all mid-season measures representing the lamb's own performance. When information from multiple metrics was combined to inform on-farm decisions, the peak benefit was observed under four metrics, with inclusion of variables beyond this point shown to be detrimental to farm profitability regardless of the combination selected. The framework developed herein is readily extendable to other livestock species, and with minimal modifications to arable and mixed agriculture as well.

CNS Demyelinating Attacks Requiring Ventilatory Support With Myelin Oligodendrocyte Glycoprotein or Aquaporin-4 Antibodies.

BACKGROUND AND OBJECTIVE: Severe attacks of myelin oligodendrocyte glycoprotein (MOG) antibody-associated disorder (MOGAD) and aquaporin-4 (AQP4) antibody-positive neuromyelitis optica spectrum disorder (AQP4-NMOSD) may require ventilatory support, but data on episodes are limited, particularly for MOGAD. We sought to compare the frequency, characteristics, and outcomes of MOGAD and AQP4-NMOSD attacks requiring ventilatory support. METHODS: This retrospective descriptive study identified Mayo Clinic patients (January 1, 1996-December 1, 2020) with MOGAD or AQP4-NMOSD and an attack requiring noninvasive or invasive ventilation at Mayo Clinic or an outside facility by searching for relevant terms in their electronic medical record. Inclusion criteria were (1) attack-related requirement for noninvasive (bilevel positive airway pressure or continuous positive airway pressure) or invasive respiratory support (mechanical ventilation); (2) MOG or AQP4 antibody positivity with fulfillment of MOGAD and AQP4-NMOSD clinical diagnostic criteria, respectively; and (3) sufficient clinical details. We collected data on demographics, comorbid conditions, indication for and duration of respiratory support, MRI findings, treatments, and outcomes. The races of those with attacks requiring respiratory support were compared to those without such attacks in MOGAD and AQP4-NMOSD. RESULTS: Attacks requiring ventilatory support were similarly rare in patients with MOGAD (8 of 279, 2.9%) and AQP4-NMOSD (11 of 503 [2.2%]) (p = 0.63). The age at attack (median years [range]) (MOGAD 31.5 [5-47] vs AQP4-NMOSD 43 [14-65]; p = 0.01) and percentage of female sex (MOGAD 3 of 8 [38%] vs AQP4-NMOSD 10 of 11 [91%]; p = 0.04) differed. The reasons for ventilation differed between MOGAD (inability to protect airway from seizure, encephalitis or encephalomyelitis with attacks of acute disseminated encephalomyelitis 5 [62.5%] or unilateral cortical encephalitis 3 [37.5%]) and AQP4-NMOSD (inability to protect airway from cervical myelitis 9 [82%], rhombencephalitis 1 [9%], or combinations of both 1 [9%]). Median ventilation duration for MOGAD was 2 days (range 1-7 days) vs 19 days (range 6-330 days) for AQP4-NMOSD (p = 0.01). All patients with MOGAD recovered, but 2 of 11 (18%) patients with AQP4-NMOSD died of the attack. For AQP4-NMOSD, Black race was overrepresented for attacks requiring ventilatory support vs those without these episodes (5 of 11 [45%] vs 88 of 457 [19%]; p = 0.045). DISCUSSION: Ventilatory support is rarely required for MOGAD and AQP4-NMOSD attacks, and the indications differ. Compared to MOGAD, these attacks in AQP4-NMOSD may have higher morbidity and mortality, and those of Black race were more predisposed, which we suspect may relate to socially mediated health inequality.

Primary contributors to gastrostomy tube placement in infants with Congenital Diaphragmatic Hernia.

OBJECTIVE: To identify factors associated with gastrostomy tube (GT) placement in infants with congenital diaphragmatic hernia (CDH). METHODS: Retrospective cohort study of 114 surviving infants with CDH at a single tertiary care neonatal intensive care unit from 2010-2019. Prenatal, perinatal and postnatal characteristics were compared between patients who were discharged home with and without a GT. Prenatal imaging was available for 50.9% of the cohort. Logistic regression was used to assess the association between GT placement and pertinent clinical factors. ROC curves were generated, and Youden's J statistic was used to determine optimal predictive cutoffs for continuous variables. Elastic net regularized regression was used to identify variables associated with GT placement in multivariable analysis. RESULTS: GT was placed in 43.9% of surviving infants with CDH. Prenatal variables predictive of GT placement were percent predicted lung volume (PPLV) <21%, total lung volume (TLV) <30 ml, lung-head ratio (LHR) <1.2 or observed to expected LHR (O/E LHR) <55%. Infants who required a GT were diagnosed earlier prenatally (23.6 ± 3.4 vs. 26.4 ± 5.6 weeks). Patients whose stomach was above the diaphragm on prenatal ultrasound (up) had a higher odds of GT placement compared to those with stomachs below the diaphragm (down) position by a factor of 2.9 (95% CI: 1.25, 7.1); p = 0.0154. Postnatally, infants with GT had lower Apgar scores at 1 and 5 min, longer lengths of stay and higher proportion of flap closures. Infants with a type C or D defect and extracorporeal membrane oxygenation (ECMO) were associated with increased odds of needing a GT. Postnatal association included being NPO for >12 days, need for transpyloric (TP) feeds for >10 days, >14 days to transition to a 30 min bolus feed, presence of gastro-esophageal reflux (GER), chronic lung disease and pulmonary hypertension. In multivariable analysis, duration of NPO, time to TP feeds, transition to 30 min bolus feeds remained significantly associated with GT placement after adjusting for severity of pulmonary hypertension (PH), GER diagnosis and sildenafil treatment. CONCLUSION: Identification of risk factors associated with need for long-term feeding access may improve timing of GT placement and prevent prolonged hospitalization related to feeding issues. LEVEL OF EVIDENCE RATING: Level II (Retrospective Study).

Saving Lives Now From Ebola in Africa.

In his letter, Peace is a better focus than Ebola in the Democratic Republic of the Congo (DRC), David M. Brett-Major provides a vital reminder of the tragic undercurrent of violence and political instability dominating African regions currently impacted by the second worst Ebola outbreak in modern history. He characterizes health-centric activities as a "common mistake" to remedy the "vicious cycle" of endemic violence and disease outbreaks in DRC and surrounding areas. What is truly needed is a "concerted peace and development process, with health as a voice in a chorus - not alone."

Obesity Is Not an Independent Predictor of Necrotizing Soft Tissue Infection Outcomes.

Background: Necrotizing soft tissue infections (NSTIs) are a group of rapidly progressive infections of the skin and its underlying tissue. These infections result in substantial morbidity and mortality. The focus of this study was to determine if obesity is associated with a worsened clinical outcome or prolonged hospital course for patients with NSTIs. Patients and Methods: We conducted a retrospective chart review of patients with NSTI presenting to a single tertiary hospital. Fat content, measured with body mass index (BMI) and abdominal fat thicknesses, including subcutaneous and visceral fat, were compared against primary and secondary outcomes of NSTIs. Results: We found that women had a higher mortality rate compared with men (27% vs. 15% mortality). Women also had an increased subcutaneous abdominal fat thickness (55.7 vs. 36.9 mm, p = 0.028). However, no measurements of fat, BMI, subcutaneous fat, or visceral fat differed between survivors and mortalities of NSTIs. In fact, with the exception of a higher BMI in those who developed acute kidney injury (AKI, p = 0.034), we found no correlation between increases in fat measurement and secondary outcome, including propensity to develop sepsis during hospitalization, length of hospital stay, length of intensive care stay, or antibiotic usage. Multivariable logistic regression analysis was conducted, and we found no statistically significant differences in primary or secondary outcomes. Conclusion: Women appear to have a higher mortality in NSTI, although the reasons for this are unclear. Obesity, as measured by BMI, subcutaneous, and visceral fat thicknesses, does not appear to be an independent risk factor.

Differentiating combined pulmonary fibrosis and emphysema from pure emphysema: utility of late gadolinium-enhanced MRI.

BACKGROUND: Differentiating combined pulmonary fibrosis with emphysema (CPFE) from pure emphysema can be challenging on high-resolution computed tomography (HRCT). This has antifibrotic therapy implications. METHODS: Twenty patients with suspected CPFE underwent late gadolinium-enhanced (LGE) thoracic magnetic resonance imaging (LGE-MRI) and HRCT. Data from twelve healthy control subjects from a previous study who underwent thoracic LGE-MRI were included for comparison. Quantitative LGE signal intensity (SI) was retrospectively compared in regions of fibrosis and emphysema in CPFE patients to similar lung regions in controls. Qualitative comparisons for the presence/extent of reticulation, honeycombing, and traction bronchiectasis between LGE-MRI and HRCT were assessed by two readers in consensus. RESULTS: There were significant quantitative differences in fibrosis SI compared to emphysema SI in CPFE patients (25.8, IQR 18.4-31.0 versus 5.3, IQR 5.0-8.1, p < 0.001). Significant differences were found between LGE-MRI and HRCT in the extent of reticulation (12.5, IQR 5.0-20.0 versus 25.0, IQR 15.0-26.3, p = 0.038) and honeycombing (5.0, IQR 0.0-10.0 versus 20.0, IQR 10.6-20.0, p = 0.001) but not traction bronchiectasis (10.0, IQR 5-15 versus 15.0, IQR 5-15, p = 0.878). Receiver operator curve analysis of fibrosis SI compared to similarly located regions in control subjects showed an area under the curve of 0.82 (p = 0.002). A SI cutoff of 19 yielded a sensitivity of 75% and specificity of 86% in differentiating fibrosis from similarly located regions in control subjects. CONCLUSION: LGE-MRI can differentiate CPFE from pure emphysema and may be a useful adjunct test to HRCT in patients with suspected CPFE.

Disease-Modifying Therapies During the COVID-19 Outbreak: A Narrative Review of International and National Recommendations.

BACKGROUND: Managing multiple sclerosis (MS) during the novel coronavirus disease 2019 (COVID-19) pandemic is a challenge due to the lack of evidence from clinical studies. Disease-modifying therapies (DMTs) may affect the immune response and subsequently alter the risk of COVID-19 infections. METHODS: A literature search was conducted on the MEDLINE, Embase, and Cochrane databases. A focused Google search was also performed. Recommendations regarding the use of DMTs during the COVID-19 outbreak from national and international MS/neurology societies were identified and reviewed. RESULTS: The review included 16 recommendations from international and national MS organizations. All recommendations are based on expert opinions. The recommendations regarding DMT initiation and management during this outbreak are summarized. Moreover, the experts' views about the risk of COVID-19 infection with each DMT are discussed. CONCLUSIONS: There is significant agreement among most experts' recommendations from a variety of sources based on collective clinical experience. However, the recommendations will likely evolve because sufficient clinical data are limited. Several ongoing registries will help provide information for future recommendations.

Regional differences in the association of cytomegalovirus seropositivity and multiple sclerosis: A systematic review and meta-analysis.

BACKGROUND: Despite of a few decades of investigations, the association and role of cytomegalovirus (CMV) and multiple sclerosis (MS) remain inconclusive. Herein, we performed a meta-analysis to investigate the association between CMV IgG serostatus and MS. METHODS: A literature search was conducted on MEDLINE, EMBASE, and Cochrane databases. Eligibility criteria included observational studies assessing the seroprevalence of CMV immunoglobulin G (IgG) in adults with MS and non-MS control. Two authors screened all resulting studies and evaluated the quality of the included studies. Pooled odd ratios (ORs) and 95% confidence intervals (CIs) were estimated using a random-effect model. RESULTS: The search identified 771 unique citations, and 15 (3,591 MS patients and 4,241 controls) satisfied eligibility criteria. The meta-analysis of all included studies showed no significant association between CMV IgG seropositivity and MS with a substantial heterogeneity (OR 1.190; 95%CI 0.780-1.813; I2 32.7%). Subgroup analysis, stratified by geographic area, showed different associations and less heterogeneity in each geographical area. In Europe, CMV IgG seroprevalence was lower among people with MS than controls (OR 0.750; 95%CI 0.599-0.940; I213.9%). In contrast, CMV IgG seropositivity was more common among MS patients compared to controls in the Middle East region (OR 5.089; 95%CI 01.067-24.263; I2 5.6%). There was no significant association in North America. CONCLUSIONS: There is evidence of the regional differences in the association between CMV IgG seropositivity and MS. Further biological and epidemiological studies are needed to identify the genetic or environmental factors which are potentially the effect modifiers of this association.

The Integration of Active Learning Teaching Strategies Into a Radiology Rotation for Medical Students Improves Radiological Interpretation Skills and Attitudes Toward Radiology.

PURPOSE: In recent years, there has been increased recognition of the benefits of teaching by active learning. However, there is a paucity of experimental studies utilizing active learning in undergraduate radiology rotations, which is traditionally a passive learning experience. We designed a new radiology rotation that integrated teaching by active learning. We prospectively examined the efficacy of this new rotation compared to our standard rotation in terms of students' radiological competency and attitudes toward radiology, as well as impact on departmental efficiency. METHODS: This was a prospective cohort study involving fourth year medical students completing a 1-week radiology rotation at our department between January and April 2018. One cohort completed a rotational model which incorporated active learning sessions (integrated cohort) while the remainder were taught using traditional passive learning methods (standard cohort). All participants completed a radiology examination before and after the rotation and were surveyed on their attitudes toward radiology. RESULTS: A total of 105 students enrolled in the study. The mean postrotation competency score obtained by the integrated cohort was significantly higher than that obtained by the standard cohort (82% vs 62%; P < 0.001). The integrated rotation freed up 7 hours of radiologists' time per week. While the students completing the integrated rotation had a more positive perception of radiology, they were no more likely to express a desire to pursue a career in radiology. CONCLUSIONS: The integration of active learning sessions into an undergraduate radiology rotation results in an improvement in students' postrotation radiological competency and attitudes toward radiology.

Assessing the ability of silage lactic acid bacteria to incorporate and transform inorganic selenium within laboratory scale silos.

Selenium (Se) is a non-metallic trace element essential for normal cellular function, which has been linked with reduced risk of cancer, cardiovascular disease, cognitive decline and thyroid disease in humans. Se deficiency in livestock is associated with white muscle disease, retained placenta, ill-thrift and mastitis. Where Se status or bioavailability from the soil for plants is poor, livestock rely on supplemental Se in their diets predominantly as either sodium selenite (inorganic form) or selenised-yeast (organic form). As lactic acid bacteria (LAB) have been shown to incorporate Se as either organic or elemental (Nano-Se) there may be potential to use silage inoculant bacteria to improve the Se status of feed to provide the Se requirements of livestock. We screened twenty-seven LAB in MRS broth in the presence of sodium selenite for growth and uptake of Se as organic (selenocysteine and selenomethionine), inorganic (selenite and selenate) or/and Nano-Se, with the aim to identify potential candidates for a mini-silo study. Sodium selenite addition into the growth medium of LAB reduced growth rates but also resulted in the conversion of the inorganic sodium selenite into predominately Nano-Se and small quantities of organic-Se. Based on a rank analysis of growth and ability to take up (total Se content) and convert inorganic Se (Nano and organic Se content), three LAB were selected for further investigation as silage inoculants: L. brevis DSMZ (A), L. plantarum LF1 (B), and L. plantarum SSL MC15 (C). Each LAB was used as an inoculant within a grass mini-silo trial, either cultured in the presence of sodium selenite before inoculation or sodium selenite added to the inoculum at inoculation versus controls with no Se. The addition of sodium selenite either into the growth media of LAB or applied at inoculation of grass silage did not interfere with the ability of the LAB to act as a silage inoculant with no difference in silage fermentation characteristic between LAB with no Se added. The addition of sodium selenite either to the LAB growth medium or at inoculation resulted in the conversion of sodium selenite into Nano-Se and organic-Se (Nano-Se, ca. 103 higher than organic), as previously shown in the screening trial. There was no difference between the three LAB for incorporation of Se or in silage quality, indicating the potential to develop silage inoculants to increase the bioavailable form of Se (elemental and organic) to livestock through conversion of inorganic forms during ensiling.

Obligate anaerobes are abundant in human necrotizing soft tissue infection samples - a metagenomics analysis.

Necrotizing soft tissue infections (NSTIs) are associated with high morbidity and mortality and are increasing in incidence. Proper identification of the microbial causes of NSTIs is a crucial step in diagnosis and treatment, but the majority of data collected are culture based, which is biased against fastidious organisms, including obligate anaerobes. The goal of this study was to address this gap in knowledge by characterizing NSTI microbial communities through molecular diagnostics. We performed 16S rRNA sequencing on human NSTI samples and identified five genera most commonly found in NSTIs (Prevotella, Bacteroides, Peptoniphilus, Porphyromonas, and Enterococcus). We found that a >70% contribution of obligate anaerobes to the bacterial population distribution was associated with NSTI mortality, and that NSTI samples, from both survivors and non-survivors, had an increased relative abundance of gram negative bacteria compared to those of abscess patients. Based on our data, we conclude that obligate anaerobes are abundant in NSTIs and a high relative abundance of anaerobes is associated with a worse outcome. We recommend increasing anaerobe antibiotic coverage during the treatment of NSTIs even when anaerobes are not found by traditional clinical microbiology methods, and especially when there is a clinical suspicion for anaerobe involvement.

Effect of non-steroidal anti-inflammatory drugs on post-surgical complications against the backdrop of the opioid crisis.

The USA is currently going through an opioid crisis, associated with tremendous economic and societal impacts. In response to this crisis, healthcare professionals are looking for alternative pain management methods, and non-steroidal anti-inflammatory drugs (NSAIDs) are a sensible choice because of their effectiveness after surgical procedures. However, before surgeons start prescribing NSAIDs in place of opioids, it is crucial to first understand their potential post-surgical complications. The goal of this review is to summarize the data obtained through both animal and human studies, which suggest how a dramatic increase in NSAID use may affect these post-surgical complications. We first provide a short review outlining the mechanisms of action of NSAIDs, followed by a summary of animal studies, which show a trend towards the negative effects of NSAIDs on wound healing and an association between NSAID use and wound infections. Lastly, we present evidence from human studies on the association of NSAIDs with the following complications: anastomotic leaks, necrotizing soft tissue infections, bleeding complications, orthopedic injuries, wound healing, and cancer care. The human studies are much more variable in their conclusions as to whether NSAIDs are beneficial or not, with the only strong evidence showing that NSAIDs inhibit bone healing. This may partially be explained by male and female differences in response to NSAIDs as many animal studies showing the inhibitory effects of NSAIDs were performed on females, while all the human studies were performed with both sexes. We conclude that strong caution should be used in the prescription of NSAIDs, especially in female patients, but larger scale studies are warranted before solid recommendations can be made.

Improving Quality and Lowering Cost Through Community Care Teams.

EXECUTIVE SUMMARY: The U.S. healthcare industry has seen a sharpened focus on delivering value-based care. To accomplish this, providers have turned their attention toward high-risk patients who are in frequent contact with the healthcare system. Specific attention has been given to Medicaid patients, who make up a majority of the high-risk population. Providers are implementing new approaches and strategies to improve the quality of healthcare and lower the cost for high-risk Medicaid patients. This essay highlights how the implementation of community care teams (CCTs) can improve quality and lower costs for these patients. Through discussion of the success at Community Care North Carolina, other states can understand the impact CCTs have on high-risk Medicaid patients by delivering value-based care, improving quality, and lowering costs.