MyI-Net: Fully Automatic Detection and Quantification of Myocardial Infarction from Cardiovascular MRI Images.

Myocardial infarction (MI) occurs when an artery supplying blood to the heart is abruptly occluded. The "gold standard" method for imaging MI is cardiovascular magnetic resonance imaging (MRI) with intravenously administered gadolinium-based contrast (with damaged areas apparent as late gadolinium enhancement [LGE]). However, no "gold standard" fully automated method for the quantification of MI exists. In this work, we propose an end-to-end fully automatic system (MyI-Net) for the detection and quantification of MI in MRI images. It has the potential to reduce uncertainty due to technical variability across labs and the inherent problems of data and labels. Our system consists of four processing stages designed to maintain the flow of information across scales. First, features from raw MRI images are generated using feature extractors built on ResNet and MoblieNet architectures. This is followed by atrous spatial pyramid pooling (ASPP) to produce spatial information at different scales to preserve more image context. High-level features from ASPP and initial low-level features are concatenated at the third stage and then passed to the fourth stage where spatial information is recovered via up-sampling to produce final image segmentation output into: (i) background, (ii) heart muscle, (iii) blood and (iv) LGE areas. Our experiments show that the model named MI-ResNet50-AC provides the best global accuracy (97.38%), mean accuracy (86.01%), weighted intersection over union (IoU) of 96.47%, and bfscore of 64.46% for the global segmentation. However, in detecting only LGE tissue, a smaller model, MI-ResNet18-AC, exhibited higher accuracy (74.41%) than MI-ResNet50-AC (64.29%). New models were compared with state-of-the-art models and manual quantification. Our models demonstrated favorable performance in global segmentation and LGE detection relative to the state-of-the-art, including a four-fold better performance in matching LGE pixels to contours produced by clinicians.

Developing an analytical framework for estimating food security indicators in the United Arab Emirates: A review.

Rapid population growth, climate change, limited natural resources, and the COVID-19 pandemic contribute to increased global hunger, necessitating intensive efforts to ensure food security and nutrition (FSN). Previous FSN approaches covered some dimensions, but not all, resulting in significant gaps in food security indicators. The Gulf Cooperation Council (GCC) and the Middle East and North Africa (MENA) regions have received less attention in food security studies, thus far necessitating considerable effort to develop an appropriate analytical framework. This study reviewed articles and international reports of FSN indicators, drivers and policies, methods, and models and extracted the challenges and gaps from the global and UAE contexts. The UAE and the world have gaps in FSN drivers, indicators, and methods, necessitating potential solutions to meet future challenges such as rapid population growth, pandemics, and limited natural resources. As a result, we created a newly developed analytical framework that addresses the shortcomings of previous approaches such as sustainable food systems developed by FAO and the Global Food Security Index (GFSI) and covers all aspects of food security. Gaps in knowledge in FSN drivers and policies, indicators, big data, methods, and models were considered in the developed framework, which has specific advantages. The novel developed framework addresses all food security dimensions (access, availability, stability, and utilization), ensuring poverty reduction, food security, and nutrition security while outperforming previous approaches (i.e., FAO and GFSI). The developed framework could be used successfully not only in the UAE and MENA, but also, globally, helping to solve food insecurity and malnutrition for future generations. The scientific community and policymakers should disseminate such solutions to address global food insecurity and ensure nutrition for future generations in the face of rapid population growth, limited natural resources, climate change, and spreading pandemics. Supplementary Information: The online version contains supplementary material available at 10.1007/s10668-023-03032-3.

Endoscopic procedure as a diagnostic tool for intestinal parasitic pathological changes.

Parasitic infections of the gastrointestinal tract (GIT) may cause severe morbidity and even death in untreated patients. In certain cases, endoscopy may be the only possible option for diagnosis and management of GIT parasitic diseases. This study aimed to elucidate the role of endoscopy in the identification of GIT pathological changes during parasitic infections. Three hundred patients suffering from GIT manifestation were enrolled in this study. Stool samples were collected from all patients and examined for the presence of parasitic stages by direct and concentrated techniques. Parasite-infected patients were further examined by CBC and narrow-band endoscopic procedure. Stool examination has demonstrated parasitic stages in stool samples of 100 (33.3%) patients. Eighty-nine patients (89%) had a single parasitic infection while 11 patients (11%) had mixed infections. Complete blood examination of infected patients was within the normal ranges in almost all types of infections except for eosinophilia in some of them. Upper endoscopic examination revealed that parasitic infections led to various pathological changes in the esophagus (6%), stomach (42%), and duodenum (50%). Colonoscopy revealed abnormal findings at the rectum (25%) and the colon (32%). In conclusion, the endoscopic examination can be considered an important diagnostic option for the detection of pathological changes in GIT during chronic parasitic diseases and can be included in the differential diagnosis of other GIT pathological changes detected by endoscopy.

Optimizing sowing window, cultivar choice, and plant density to boost maize yield under RCP8.5 climate scenario of CMIP5.

The impacts of climate change and possible adaptations to food security are a global concern and need greater focus in arid and semi-arid regions. It includes scenario of Coupled Model Intercomparison Phase 5 (CMIP-RCP8.5). For this purpose, two DSSAT maize models (CSM-CERES and CSM-IXIM) were calibrated and tested with two different maize cultivars namely Single Cross 10 (SC10) and Three Way Cross 324 (TW24) using a dataset of three growing seasons in Nile Delta. SC10 is a long-growing cultivar that is resistant to abiotic stresses, whereas TW24 is short and sensitive to such harsh conditions. The calibrated models were then employed to predict maize yield in baseline (1981-2010) and under future time slices (2030s, 2050s, and 2080s) using three Global Climate Models (GCMs) under CMIP5-RCP8.5 scenario. In addition, the use of various adaptation options as shifting planting date, increasing sowing density, and genotypes was included in crop models. Simulation analysis showed that, averaged over three GCMs and two crop models, the yield of late maturity cultivar (SC10) decreased by 4.1, 17.2, and 55.9% for the three time slices of 2030s, 2050s, and 2080s, respectively, compared to baseline yield (1981-2010). Such reduction increased with early maturity cultivar (TW24), recording 12.4, 40.6, and 71.3% for near (2030s), mid (2050s), and late century (2080s) respectively relative to baseline yield. The most suitable adaptation options included choosing a stress-resistant genotype, changing the planting date to plus or minus 30 days from baseline planting date, and raising the sowing density to 9 m-2 plants. These insights could minimize the potential reduction of climate change-induced yields by 39% by late century.

Postoperative management of Zenker's diverticulum: Results of the American Bronchoesophagological Association survey.

INTRODUCTION: Although treatment of Zenker's diverticulum (ZD) is commonly performed by otolaryngologists using a variety of surgical techniques, there is little published data on the postoperative management of patients. We sought to determine practice patterns among members of the American Bronchoesophagological Association (ABEA) after surgery for ZD. METHODS: An online questionnaire was designed via JotForm™ and subsequently sent to active members of the ABEA. Responses were analyzed using descriptive statistics. RESULTS: Twenty-three members (6.6 %) completed the survey. Most (73.9 %) were fellowship trained in laryngology and reported performing >5 procedures per year. Most laryngologists reported employing multiple techniques including transcervical (TC) (73.9 %), endoscopic stapling (ES) (65.2 %), endoscopic CO2 laser (EL) (56.5 %), and endoscopic harmonic scalpel (EH) (4.3 %). Postoperatively, 52.3 % of respondents placed patients in 23-hour observation after TC, 66.7 % after ES, 69.2 % after EL, and 100 % after EH. 47.1 % of respondents used standard overnight admission after TC, as compared to 13.3 % after ES, 23.1 % after EL and 0 % after EH. Postoperative esophagography was utilized by 70.6 % of respondents after TC, 20 % after ES, 38.5 % after EL, and 100 % after EH. A peroral diet was started postoperatively on the day of surgery by 26.7 % respondents after ES but not after any of the other techniques. CONCLUSION: Most laryngology trained respondents employ multiple techniques for the treatment of ZD including at least 1 endoscopic technique. Respondents were more likely to hospitalize patients after a transcervical than endoscopic approach. Postoperative esophagography was utilized in most patients after TC, but not after ES or EL. Most respondents admit patients for 23-hour observation and start a peroral diet on postoperative day 1 regardless of technique.

Chaperone Use During Plastic Surgery Physical Examinations: Nationwide Provider Practices and Impact of Level of Training.

BACKGROUND: Medical chaperones often play an important role during physical examinations, providing patient comfort and serving as medicolegal witness. The purpose of this study was to evaluate and compare practices regarding chaperone use by plastic surgery attendings and trainees. METHODS: A voluntary survey was distributed to members of the American Council of Academic Plastic Surgeons. The survey included a standardized set of questions regarding physician demographics, nature of practice training, and current practices pertaining to chaperone use. Data were analyzed in a descriptive fashion. Ordinal logistic regression models were used to identify predictors of chaperone use. RESULTS: We received 167 responses, of which 107 (64.1%) were attendings and 60 (35.9%) were trainees. In total, 78.3% of the respondents were male and 21.7% were female. Routine use of chaperones was reported at 58.6%. Compared with plastic surgery trainees, attending surgeons were 12.8 times more likely to use a chaperone during sensitive examinations (P < 0.001). In addition, male respondents were 6.43 times more likely than their female counterparts to involve a chaperone during sensitive examinations (P < 0.001). Forty-eight percent of the trainees acknowledged receiving education regarding chaperone use, and this cohort was 7 times more likely to use a chaperone when compared with trainees who had not received chaperone instruction (P < 0.001). CONCLUSIONS: This study highlights the wide variability of chaperone use among plastic surgery attendings and trainees. Integration and standardization of chaperone education within plastic surgery training may be an effective technique to promote this practice and lead to improved patient-provider clinical experiences.

Standardized statement for the ethical use of human cadaveric tissues in anatomy research papers: Recommendations from Anatomical Journal Editors-in-Chief.

Human cadaveric donors are essential for research in the anatomical sciences. However, many research papers in the anatomical sciences often omit a statement regarding the ethical use of the donor cadavers or, as no current standardized versions exist, use language that is extremely varied. To rectify this issue, 22 editors-in-chief of anatomical journals, representing 17 different countries, developed standardized and simplified language that can be used by authors of studies that use human cadaveric tissues. The goal of these editor recommendations is to standardize the writing approach by which the ethical use of cadaveric donors is acknowledged in anatomical studies that use donor human cadavers. Such sections in anatomical papers will help elevate our discipline and promote standardized language use in others non anatomy journals and also other media outlets that use cadaveric tissues.

Curcumin and ustekinumab cotherapy alleviates induced psoriasis in rats through their antioxidant, anti-inflammatory, and antiproliferative effects.

INTRODUCTION: Psoriasis is a chronic multifactorial inflammatory disease that affects 3% of people worldwide. Ustekinumab is a selective anti-IL-12/23 biologic that alleviates psoriasis, and curcumin is a natural, effective dietary turmeric extract applied to treat numerous diseases through its antioxidant and anti-inflammatory effects. OBJECTIVE: The current study evaluated the therapeutic effects of curcumin and ustekinumab cotherapy (CUC) on imiquimod (IQ)-induced psoriasis in a rat model. MATERIALS AND METHODS: Twenty rats were divided into four groups, G1 (control group), G2 (IQ-treated group), G3 (IQ + ustekinumab), and G4 (IQ + CUC). Clinical, histopathological (HP), immunohistochemical (IHC), antioxidant, and biochemical investigations evaluated the efficacy of these drugs for treating IQ induced-psoriasis. RESULTS: Rats of G2 exhibited clinical signs of psoriatic skin lesions (erythema, scaling, and skin thickening) with epidermal changes (acanthosis and parakeratosis). Additionally, the biochemical analysis revealed significant (p < 0.05) reductions in the levels of antioxidant biomarkers (SOD, GPx, and CAT) with significant (p < 0.05) elevations in psoriasis-related cytokines (TNF-α, IL-17A, IL-12P40, and IL-23). In contrast, CUC alleviated the psoriatic changes in G4 better than ustekinumab monotherapy in G3. CONCLUSIONS: Ustekinumab inhibits the inflammatory cytokines IL-12P40 and IL-23, while curcumin has antioxidant effects (increasing SOD, GPx, and CAT levels) with anti-inflammatory effects (decreasing the proinflammatory cytokine TNF-α and IL-17). Therefore, CUC could be an excellent cost-effective regimen that can improve the treatment of psoriasis by the synergistic effects of CUC.HighlightsIQ-induces psoriasis by elevating TNF-α, IL-17A, IL-12, and IL-23 and decreasing GPx, SOD, and CATUstekinumab exhibits anti-inflammatory effects by inhibiting IL-12 and IL-23Curcumin inhibits TNF-α and IL-17A, and increases GPx, SOD, and CAT levelsCUC mitigates psoriasis by synergistic antioxidant and anti-inflammatory effectsCUC inhibits TNF-α, IL-17A, IL-12, and IL-23 and increases GPx, SOD, and CAT levels.

Short-term adverse remodeling progression in asymptomatic aortic stenosis.

OBJECTIVES: Aortic stenosis (AS) is characterised by a long and variable asymptomatic course. Our objective was to use cardiovascular magnetic resonance imaging (MRI) to assess progression of adverse remodeling in asymptomatic AS. METHODS: Participants from the PRIMID-AS study, a prospective, multi-centre observational study of asymptomatic patients with moderate to severe AS, who remained asymptomatic at 12 months, were invited to undergo a repeat cardiac MRI. RESULTS: Forty-three participants with moderate-severe AS (mean age 64.4 ± 14.8 years, 83.4% male, aortic valve area index 0.54 ± 0.15 cm2/m2) were included. There was small but significant increase in indexed left ventricular (LV) (90.7 ± 22.0 to 94.5 ± 23.1 ml/m2, p = 0.007) and left atrial volumes (52.9 ± 11.3 to 58.6 ± 13.6 ml/m2, p < 0.001), with a decrease in systolic (LV ejection fraction 57.9 ± 4.6 to 55.6 ± 4.1%, p = 0.001) and diastolic (longitudinal diastolic strain rate 1.06 ± 0.2 to 0.99 ± 0.2 1/s, p = 0.026) function, but no overall change in LV mass or mass/volume. Late gadolinium enhancement increased (2.02 to 4.26 g, p < 0.001) but markers of diffuse interstitial fibrosis did not change significantly (extracellular volume index 12.9 [11.4, 17.0] ml/m2 to 13.3 [11.1, 15.1] ml/m2, p = 0.689). There was also a significant increase in the levels of NT-proBNP (43.6 [13.45, 137.08] pg/ml to 53.4 [19.14, 202.20] pg/ml, p = 0.001). CONCLUSIONS: There is progression in cardiac remodeling with increasing scar burden even in asymptomatic AS. Given the lack of reversibility of LGE post-AVR and its association with long-term mortality post-AVR, this suggests the potential need for earlier intervention, before the accumulation of LGE, to improve the long-term outcomes in AS. KEY POINTS: • Current guidelines recommend waiting until symptom onset before valve replacement in severe AS. • MRI showed clear progression in cardiac remodeling over 12 months in asymptomatic patients with AS, with near doubling in LGE. • This highlights the need for potentially earlier intervention or better risk stratification in AS.

Chronic infarct size after spontaneous coronary artery dissection: implications for pathophysiology and clinical management.

AIMS: To report the extent and distribution of myocardial injury and its impact on left ventricular systolic function with cardiac magnetic resonance imaging (CMR) following spontaneous coronary artery dissection (SCAD) and to investigate predictors of myocardial injury. METHODS AND RESULTS: One hundred and fifty-eight angiographically confirmed SCAD-survivors (98% female) were phenotyped by CMR and compared in a case-control study with 59 (97% female) healthy controls (44.5 ± 8.4 vs. 45.0 ± 9.1 years). Spontaneous coronary artery dissection presentation was with non-ST-elevation myocardial infarction in 95 (60.3%), ST-elevation myocardial infarction (STEMI) in 52 (32.7%), and cardiac arrest in 11 (6.9%). Left ventricular function in SCAD-survivors was generally well preserved with small reductions in ejection fraction (57 ± 7.2% vs. 60 ± 4.9%, P < 0.01) and increases in left ventricular dimensions (end-diastolic volume: 85 ± 14 mL/m2 vs. 80 ± 11 mL/m2, P < 0.05; end-systolic volume: 37 ± 11 mL/m2 vs. 32 ± 7 mL/m2, P <0.01) compared to healthy controls. Infarcts were small with few large infarcts (median 4.06%; range 0-30.9%) and 39% having no detectable late gadolinium enhancement (LGE). Female SCAD patients presenting with STEMI had similar sized infarcts to female Type-1 STEMI patients age <75 years. Multivariate modelling demonstrated STEMI at presentation, initial TIMI 0/1 flow, multivessel SCAD, and a Beighton score >4 were associated with larger infarcts [>10% left ventricular (LV) mass]. CONCLUSION: The majority of patients presenting with SCAD have no or small infarctions and preserved ejection fraction. Patients presenting with STEMI, TIMI 0/1 flow, multivessel SCAD and those with features of connective tissue disorders are more likely to have larger infarcts.

Assessment of Opioid-Prescribing Practices in Breast Augmentation: Future Directions for Prescribing Guidelines.

BACKGROUND: The United States (US) is in the mid of an opioid epidemic propagated, in part, by prescription opioids. With excess overprescribing documented in a variety of surgical procedures, several societies have recommended opioid-prescribing guidelines. Considering the scope and postoperative pain associated with aesthetic plastic surgery procedures, earnest evaluation into opioid-prescribing practices for breast augmentation was conducted. METHODS: Members of the American Society for Aesthetic Plastic Surgery were electronically surveyed on their opioid-prescribing patterns. The survey was distributed to 1709 plastic surgeons. Descriptive statistics were collated into percentages, deviations, and morphine milligram equivalents (MMEs), when appropriate. RESULTS: Two hundred twenty-nine American Society for Aesthetic Plastic Surgery members (13.4%) provided responses. A total of 91.2% of respondents prescribe opioids to patients undergoing breast augmentation. The most commonly prescribed agents included oxycodone/acetaminophen (Percocet, 47.0%) and hydrocodone/acetaminophen (Vicodin, 38.3%). On average, 165.3 ± 81.7 MMEs were dispensed (range, 25.0-600.0 MMEs; number tablets, 5-60). Prescribers felt that a lack of phone-in prescribing (52.4%) and the ease of preemptively prescribing opioids (52.4%) propagate opioid overprescribing. A total of 61.3% of respondents reported that they are or may be in favor of developing plastic surgery societal guidelines related to opioid prescribing. These respondents indicated support for guidelines on opioid-sparing pain management strategies (74.2%) and guidelines identifying the type (54.7%), duration of use (69.5%), and number of opioid tablets (61.7%) necessary for procedures. CONCLUSIONS: Considerable variability exists among prescribing patterns after breast augmentation. Societal guidelines aimed at providers and patients may serve a future role in opioid prescribing.

A vermicompost and deep tillage system to improve saline-sodic soil quality and wheat productivity.

Land degradation due to soil salinity and sodicity is a serious concern in arid ecosystems. Despite the importance of conservation tillage in carbon sequestration and improving soil properties, its effect on saline-sodic soils under amendment application remains unknown. Therefore, the present study aimed to explore the combined effects of inorganic (sulfuric acid and gypsum) and organic (vermicompost) soil amendments and tillage systems (zero, reduced and deep tillage) on saline-sodic soil properties and wheat productivity. Deep tillage with vermicompost application significantly improved soil physical and chemical properties compared with control. Interestingly, integration between deep tillage and vermicompost decreased soil salinity and sodicity by 37% and 34%, respectively, compared with zero tillage and unamended soils. The application of vermicompost surpassed chemical amendments in the improvement of saline-sodic soils and consequently increased the growth and yield of wheat, provided that deep tillage was used as a suitable tillage system. Although deep tillage reduced soil organic carbon, application of vermicompost not only compensated this reduction, but also significantly increased soil organic carbon. This confirms the potential of combined deep tillage and vermicompost as a method for environmentally reclaiming saline-sodic soils.

Recycling of sugar crop disposal to boost the adaptation of canola (Brassica napus L.) to abiotic stress through different climate zones.

We need to produce higher foods even under declining natural resources to feed the projected population of 9 billion by 2050 and to sustain food security and nutrition. Abiotic stress has adversely affected canola crop and oil quality especially in sandy soils. To combat this stress, adaptation at the farm level using new and cost-effective amendments are required. Field trials were conducted in two different climatic zones to determine the efficacy of cane molasses, bagasse ash, sugar beet factory lime, and their compost mixtures to improve soil quality and heat stress-adapting canola. The results showed a significant improvement in bulk density, hydraulic conductivity, organic matter content, and available macronutrients of sandy soil and subsequent canola growth, yield, quality and water productivity due to the application of the tested soil amendments, particularly those mixed with compost. Despite the estimated reduction of yield by 18.5% due to heat stress, application of sugar beet lime and compost mixture not only compensated for this reduction but also increased the seed yield by 27.0%. These findings highlight the value of recycling compost-based sugar crop disposal as a cost-effective technology to boost crop tolerance to abiotic stress, ensuring sustainable agriculture and food security in arid environments.

Tongue symptoms, suspension force and duration during operative laryngoscopy.

PURPOSE: Suspension laryngoscopy is a commonly performed procedure in otolaryngology. During the procedure, the laryngoscope applies direct force to the tongue. Postoperative tongue symptoms include pain, swelling, numbness, taste disturbance, and rarely motor deficits. Duration and magnitude of force applied have previously been associated with post-operative throat and tongue pain, respectively. We sought to correlate postoperative tongue symptoms with magnitude of force applied and/or duration of suspension and investigate any risk factors for tongue morbidity. MATERIALS AND METHODS: A sample of patients undergoing suspension laryngoscopy between 2015 and 2018 were prospectively recruited. Those with preexisting tongue symptoms, disease or surgery were excluded. Patients completed preoperative and postoperative questionnaires evaluating tongue swelling, numbness, motion and taste disturbance. Symptoms were subjectively scored on a visual scale from 0 to 10. Patient demographics, past medical and social history were also recorded. Intraoperative pressures were measured using a spring force scale, positioned between the suspension arm and Mayo stand. Initial and end suspension forces and duration of suspension were recorded. RESULTS: 120 patients met inclusion criteria, of which 63 completed both preoperative and postoperative questionnaires. 6 patients (9.5%) experienced postoperative tongue symptoms. Suspension force and duration of suspension were not significantly predictive of postoperative tongue symptoms. While all symptomatic patients were current or former cigarette smokers, smoking status was not found to be a statistically significant factor. CONCLUSIONS: Neither suspension forces nor duration of suspension were predictive of postoperative tongue morbidity. Further research is needed to evaluate the role of smoking status on postoperative tongue symptoms.

Immediate Reconstruction After Colorectal Cancer Resection: A Cohort Analysis Through the National Surgical Quality Improvement Program and Outcomes Review.

BACKGROUND: Colorectal cancer is one of the most common and fatal malignancies in the United States. When localized to the distal gastrointestinal tract, surgical therapy includes abdominoperineal resection (APR) or pelvic exenteration (PEX). Subsequent ablative defects are considerable, impart concerning morbidity, and often necessitate autologous reconstruction. The aim of this study was to assess postoperative outcomes after reconstruction of APR and PEX defects. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (2005-2017) was queried for patients undergoing APR for lower gastrointestinal malignancies with concurrent autologous reconstructions. Cases of disseminated cancer were excluded. Postoperative adverse event profiles, including rates of wound and systemic complications, were evaluated. Multivariate regression analysis controlling for age, sex, body mass index, and operative time was performed to calculate adjusted odds ratios (ORs). RESULTS: A total of 1309 patients were identified as undergoing APR/PEX with concomitant reconstruction. The majority (96.9%) of reconstructions consisted of muscle, myocutaneous, fasciocutaneous, or omental pedicled flaps. Of the cohort, 45.7% experienced at least 1 all-cause complication within 30-days of the procedure. Having a limited or moderate frailty (frailty index of "1" or "2") was identified as a predictor of all-cause complications [OR, 1.556; 95% confidence interval (CI), 1.187-2.040, P = 0.001; and OR, 1.741; 95% CI, 1.193-2.541, P = 0.004, respectively], whereas smoking was a predictor of wound complications (OR, 1.462; 95% CI, 1.070-1.996, P = 0.017) and steroid use was a predictor of mild systemic complications (OR, 2.006; 95% CI, 1.058-3.805, P = 0.033). CONCLUSION: Anorectal cancer resection often necessitates reconstruction secondary to postexenteration perineal defects. The incidence of postoperative complications is relatively high, and several risk factors are identified to help refine patient optimization.

Outcomes of microvascular bone flaps versus osteocutaneous flaps in head and neck reconstruction.

BACKGROUND: Surgical resection of head and neck (H&N) neoplasms requiring osseous reconstruction have underdefined complication profiles. This study aimed to characterize postoperative outcomes of patients with H&N neoplasia undergoing osteocutaneous flap (OCF) or bare bone flap (BBF) reconstructions. MATERIALS AND METHODS: Retrospective analysis of the National Surgical Quality Improvement Program (NSQIP) 2005-2017 databases. Queried for diagnosis and procedural codes extracted patients with H&N neoplasms undergoing BBF or OCF reconstruction. Postoperative complications were evaluated. Multivariable regression generated adjusted odds ratios. RESULTS: A cohort of 746 patients were identified. Of reconstructions, 24.9% (n = 186/746) were BBFs while 75.1% (n = 560/746) were OCFs. 58.1% of the BBF cohort and 59.9% of the OCF cohort experienced an all-cause complication (p = .654). Sub-stratified, 24.2% of BBF and 17.5% of OCF patients experienced a wound complication (p = .045). Regression analysis demonstrated no difference in risk for medical complications between cohorts. However, patients receiving OCFs had a decreased likelihood of developing a wound complication (OR 0.652; 95%CI 0.430-0.989; p = .044) compared to patients receiving BBFs. CONCLUSION: The incidence of complications following osseous reconstruction of the H&N is considerable. Although several complication outcomes do not seem to differ between BBF or OCF reconstructions, OCFs is associated with a decreased likelihood of wound complications.

Racial Disparities in Outcomes of Reconstructive Breast Surgery: An Analysis of 51,362 Patients from the ACS-NSQIP.

BACKGROUND: In various surgical specialties, racial disparities in postoperative complications are widely reported. It is assumed that the effect of race can also be found in plastic surgical outcomes, although this remains largely undefined in literature. This study aims to provide data on the impact of race on outcomes of reconstructive breast surgery. METHODS: Data were collected using the NSQIP (National Surgical Quality Improvement Program) database (2008-2016). Outcomes of the reconstructive breast surgery of White patients were compared with those of African American, Asian, or other races. Logistic regression was performed to control for variations between all groups. Analysis of racial disparities was further sub-stratified according to four different types of breast reconstruction: delayed or immediate autologous, and delayed or immediate prosthesis-based reconstruction. RESULTS: In total, this study included 51,362 patients of which 43,864 were Caucasian, 5,135 African American, 2,057 Asian, and 332 of other races. When compared with White patients, patients of African American race had larger body mass indices (31.3 ± 7.0 vs. 27.6 ± 6.3, p-value < 0.001) in addition to higher rates of diabetes (12.3 vs 4.6%, p-value < 0.001) and hypertension (44.7 vs. 23.4%, p-value < 0.001). Both multivariate analysis and the sub-stratified analysis of different types of reconstruction showed no differences in overall complication rate. CONCLUSION: Among the four types of reconstructive procedures, differences in surgical outcomes do not appear to be based on race and therefore seem to be less evident in reconstructive breast surgery compared with the current literature within other surgical specialties.

Treatment of Brucellosis in Guinea Pigs via a Combination of Engineered Novel pH-Responsive Curcumin Niosome Hydrogel and Doxycycline-Loaded Chitosan-Sodium Alginate Nanoparticles: an In Vitro and In Vivo Study.

Brucellosis is a common zoonotic infection, particularly in the developing world. The recommended treatment regimens for brucellosis involve the use of two medications such as doxycycline and curcumin in order to avoid relapses and prolonged use of these drugs. Doxycycline has excellent activity in the acidic phagolysosomal environment, while curcumin modulates the immune system function and macrophage activity. Due to the intracellular existence of Brucellae and the different anti-immune mechanisms of Brucella, the treatment of Brucella infection faces many limitations. The design of nanosystems is a promising treatment approach for brucellosis. The objective of this study was to design and evaluate the efficacy of in situ pH-responsive curcumin-loaded niosome hydrogel and doxycycline-loaded chitosan-sodium alginate nanoparticles as chemotherapeutic agents against brucellosis. The prepared formulae showed a spherical nano shape with a slow drug release pattern and small particle size. The prepared formulae were evaluated in vivo using Guinea pigs experimentally infected with Brucella melitensis biovar3. The prepared formula combination gave a significant high reduction rate of Brucella spleen viable count compared with that of untreated controls at p < 0.05. The results showed that the treatment schemes were not fully successful in eliminating Brucella infection in Guinea pigs; however, they significantly (p < 0.05) reduced the viable Brucella count in a shorter time and sub-therapeutic doses. Collectively the novel prepared formulae could be a successful therapy for the effective treatment of brucellosis infection at the recommended therapeutic doses. Graphical abstract.

Prevalence of Pre-Diabetes, Diabetes and Associated Cardiovascular Risk Amongst Healthcare Workers in Ahmadu Bello University Teaching Hospital (ABUTH), Zaria using Glycated Haemoglobin.

BACKGROUND: There is a global rise in the prevalence of diabetes mellitus and pre-diabetes is a fore-runner to type-2 diabetes. Pre-diabetes is reversible, therefore, measures should be taken to halt or slow down its progression to frank diabetes. AIM: The study aimed to evaluate the prevalence of pre-diabetes and diabetes amongst staff of ABUTH, Zaria and identify some cardiovascular risks associated with them. METHODS: A cross-sectional analytical study carried out on 377 healthcare workers who presented at the Medical out-patient department of ABUTH, Zaria in response to an invitation for the 2017 World Diabetes Day free medical screening. HbA1c was assessed via Immunofluorescence method. The difference in HbA1c amongst healthcare workers was determined by One-way Analysis of Variance with Post-hoc Bonferroni test. Cardiovascular risk associations were assessed via Multiple Binary Logistic Regression. RESULTS: Pre-diabetes and diabetes prevalence were 19.4% and 6.5% respectively. There were 28.6% undiagnosed diabetic healthcare workers. There was no significant (p=0.35) difference in HbA1c between different categories of healthcare workers, however, random blood glucose was significantly (p=0.042) higher in other healthcare workers than doctors. There was a significant (p<0.01) association between systolic hypertension and risk of developing pre-diabetes and diabetes (OR, 4.11, CI 0.98-17.30). CONCLUSION: There is a high prevalence of pre-diabetes and diabetes amongst healthcare workers in Zaria. The odds of hypertensive healthcare workers developing pre-diabetes and diabetes is high. Efforts should be geared at intensifying health education, increased work physical activity and proper diet.

Climate change impact and adaptation for wheat protein.

Wheat grain protein concentration is an important determinant of wheat quality for human nutrition that is often overlooked in efforts to improve crop production. We tested and applied a 32-multi-model ensemble to simulate global wheat yield and quality in a changing climate. Potential benefits of elevated atmospheric CO2 concentration by 2050 on global wheat grain and protein yield are likely to be negated by impacts from rising temperature and changes in rainfall, but with considerable disparities between regions. Grain and protein yields are expected to be lower and more variable in most low-rainfall regions, with nitrogen availability limiting growth stimulus from elevated CO2 . Introducing genotypes adapted to warmer temperatures (and also considering changes in CO2 and rainfall) could boost global wheat yield by 7% and protein yield by 2%, but grain protein concentration would be reduced by -1.1 percentage points, representing a relative change of -8.6%. Climate change adaptations that benefit grain yield are not always positive for grain quality, putting additional pressure on global wheat production.