Skin Antisepsis before Surgical Fixation of Extremity Fractures.

BACKGROUND: Studies evaluating surgical-site infection have had conflicting results with respect to the use of alcohol solutions containing iodine povacrylex or chlorhexidine gluconate as skin antisepsis before surgery to repair a fractured limb (i.e., an extremity fracture). METHODS: In a cluster-randomized, crossover trial at 25 hospitals in the United States and Canada, we randomly assigned hospitals to use a solution of 0.7% iodine povacrylex in 74% isopropyl alcohol (iodine group) or 2% chlorhexidine gluconate in 70% isopropyl alcohol (chlorhexidine group) as preoperative antisepsis for surgical procedures to repair extremity fractures. Every 2 months, the hospitals alternated interventions. Separate populations of patients with either open or closed fractures were enrolled and included in the analysis. The primary outcome was surgical-site infection, which included superficial incisional infection within 30 days or deep incisional or organ-space infection within 90 days. The secondary outcome was unplanned reoperation for fracture-healing complications. RESULTS: A total of 6785 patients with a closed fracture and 1700 patients with an open fracture were included in the trial. In the closed-fracture population, surgical-site infection occurred in 77 patients (2.4%) in the iodine group and in 108 patients (3.3%) in the chlorhexidine group (odds ratio, 0.74; 95% confidence interval [CI], 0.55 to 1.00; P = 0.049). In the open-fracture population, surgical-site infection occurred in 54 patients (6.5%) in the iodine group and in 60 patients (7.3%) in the chlorhexidine group (odd ratio, 0.86; 95% CI, 0.58 to 1.27; P = 0.45). The frequencies of unplanned reoperation, 1-year outcomes, and serious adverse events were similar in the two groups. CONCLUSIONS: Among patients with closed extremity fractures, skin antisepsis with iodine povacrylex in alcohol resulted in fewer surgical-site infections than antisepsis with chlorhexidine gluconate in alcohol. In patients with open fractures, the results were similar in the two groups. (Funded by the Patient-Centered Outcomes Research Institute and the Canadian Institutes of Health Research; PREPARE ClinicalTrials.gov number, NCT03523962.).

A Case of Testicular Tumor Presenting as Acute Scrotum.

Germ cell tumors (GCTs) are the most common testicular malignancies in men. GCT typically presents as a painless nodule or swelling of the testicles with an atypical presentation such as heaviness or dull ache of the scrotum and/or the lower abdomen. Herein, we report a rare case of a testicular tumor presenting as an acute scrotum. This is a case of a 25-year-old male with no significant medical history; he presented to the emergency department with an acute scrotum for less than one day that was highly suspicious for testicular torsion. Surgical exploration and histopathology investigation revealed that this was a case of mixed GCTs.

Artificial Intelligence in Orthopaedic Surgery: Can a Large Language Model "Write" a Believable Orthopaedic Journal Article?

ABSTRACT: ➢ Natural language processing with large language models is a subdivision of artificial intelligence (AI) that extracts meaning from text with use of linguistic rules, statistics, and machine learning to generate appropriate text responses. Its utilization in medicine and in the field of orthopaedic surgery is rapidly growing.➢ Large language models can be utilized in generating scientific manuscript texts of a publishable quality; however, they suffer from AI hallucinations, in which untruths or half-truths are stated with misleading confidence. Their use raises considerable concerns regarding the potential for research misconduct and for hallucinations to insert misinformation into the clinical literature.➢ Current editorial processes are insufficient for identifying the involvement of large language models in manuscripts. Academic publishing must adapt to encourage safe use of these tools by establishing clear guidelines for their use, which should be adopted across the orthopaedic literature, and by implementing additional steps in the editorial screening process to identify the use of these tools in submitted manuscripts.

Targeting de novo lipid synthesis induces lipotoxicity and impairs DNA damage repair in glioblastoma mouse models.

Deregulated de novo lipid synthesis (DNLS) is a potential druggable vulnerability in glioblastoma (GBM), a highly lethal and incurable cancer. Yet the molecular mechanisms that determine susceptibility to DNLS-targeted therapies remain unknown, and the lack of brain-penetrant inhibitors of DNLS has prevented their clinical evaluation as GBM therapeutics. Here, we report that YTX-7739, a clinical-stage inhibitor of stearoyl CoA desaturase (SCD), triggers lipotoxicity in patient-derived GBM stem-like cells (GSCs) and inhibits fatty acid desaturation in GSCs orthotopically implanted in mice. When administered as a single agent, or in combination with temozolomide (TMZ), YTX-7739 showed therapeutic efficacy in orthotopic GSC mouse models owing to its lipotoxicity and ability to impair DNA damage repair. Leveraging genetic, pharmacological, and physiological manipulation of key signaling nodes in gliomagenesis complemented with shotgun lipidomics, we show that aberrant MEK/ERK signaling and its repression of the energy sensor AMP-activated protein kinase (AMPK) primarily drive therapeutic vulnerability to SCD and other DNLS inhibitors. Conversely, AMPK activation mitigates lipotoxicity and renders GSCs resistant to the loss of DNLS, both in culture and in vivo, by decreasing the saturation state of phospholipids and diverting toxic lipids into lipid droplets. Together, our findings reveal mechanisms of metabolic plasticity in GSCs and provide a framework for the rational integration of DNLS-targeted GBM therapies.

The Side Effects of COVID-19 Vaccines and Its Association With ABO Blood Type Among the General Surgeons in Saudi Arabia.

Introduction The benefits of vaccination outweigh its risks as it protects approximately two to three million individuals from infectious diseases annually. With the emergence of the coronavirus disease 2019 (COVID-19) pandemic, new vaccines have been developed. However, it is crucial to follow and recognize the side effects of COVID-19 vaccines. Previous studies have shown a relationship between ABO blood groups and coronavirus. Some vaccination side effects, such as muscle pain at the injection site and fatigue, may impair an individual's ability to perform tasks that require fine motor skills, such as those performed by a general surgeon. Therefore, this study aimed to identify the association between ABO blood groups and the side effects of COVID-19 vaccines among general surgeons in Saudi Arabia. Method A cross-sectional online survey-based study regarding the side effects following COVID-19 vaccination was conducted among Saudi and non-Saudi general surgeons working in public and private hospitals in Saudi Arabia who had received one or two doses of mRNA-based COVID-19 vaccines. Results A total of 612 surgeons responded. Approximately, 74.7% of the respondents reported side effects after receiving vaccines. Tiredness was the most commonly reported side effect of the vaccine, followed by severe local pain at the site of injection. Approximately, 16.2% of the participants started showing side effects 12 hours after receiving the vaccine. There was a significant relationship between the type of vaccine administered and the appearance of side effects (p = 0.004). The rate of appearance of side effects was higher in participants who received the Pfizer vaccine. However, there was no significant relationship between the appearance of side effects and age, gender, blood group, number of doses, and past history of COVID-19 infection (p > 0.05). Of the total participants, 256 (41.8%) stated that the side effects of the vaccine affected their work performance. Moreover, there was no significant difference in side effects, symptoms appearing after vaccination, the onset of symptoms, and duration of symptoms between the participants who received one dose and those who received two doses of the vaccine. In addition, there was no significant relationship between the severity of side effects and age, past history of COVID-19 infection, number of doses, and blood type (p > 0.05). However, there was a significant relationship between the severity of side effects and gender and type of vaccine (p = 0.000 and 0.004, respectively). A high percentage of females and those who received the AstraZeneca vaccine stated that their side effects affected their work performance. Conclusion Three-quarters of the participants reported side effects after the COVID-19 vaccination, which affected the work performance of 41% of participating general surgeons. There was no significant relationship between the appearance of symptoms and age, gender, blood group, number of doses, and past history of COVID-19 infection. However, there was a significant relationship between the severity of side effects and gender and type of vaccination. Future large-scale studies are recommended to further evaluate the implication of ABO blood type on COVID-19.

Exploring Determinants of Early Retirement Among Saudi Medical Staff.

The aim of this research was to explore the relationship between the push, pull, anti-push, and anti-pull factors vs. early retirement intention among Saudi medical staff, and to investigate whether there are gender differences in the early retirement intention. To this end, we designed a correlational and cross-sectional study, for which data were collected through an online survey. A total of 680 responses were gathered, of which 221 valid responses constituted the final sample for the analysis. Logistics regression was used to test the hypotheses of the study. The results showed that approximately 58% of the respondents indicated early retirement intention. The significant factors in predicting this intention were the pull, anti-push, and anti-pull factors, whereas the push factors were found to be insignificant. Moreover, female medical staff tend to retire earlier than males. Strategies recommended to delay retirement are providing flexible work hours, working shorter shifts or on a part-time basis, offering programs for professional development, and according more recognition.