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Background: Clavicle fractures represent approximately 2.6∼4 % of all fractures. The management of midshaft clavicle fractures is a topic of debate. The evaluation of clavicular shortening relies on the assumption of clavicular symmetry., Objective: Our hypothesis posited that clavicles were not of identical length, challenging the assumption of clavicular symmetry., Methods: This retrospective study was conducted at a level 1 hospital between February 1, 2022, and February 28, 2022, with a total of 200 consistent thoracic CT scans from patients with suspected pneumonia reviewed. Bilateral clavicle lengths were measured using thoracic CT plain scans. Intraclass correlation coefficients (ICC) were examined. Linear and logistic regression were performed., Results: In a total number of 170 patients, the left clavicles were 1.96 mm longer than the right clavicles on average (95 % CI 1.25-2.68, p < 0.001). In 118 patients (69.4 %), the bilateral clavicle length difference was between 0-5 mm; In 45 patients (26.5 %), the difference was 5-10 mm, and in 7 patients (4.1 %), the difference was greater than 10 mm. Positive correlations were found between height (p = 0.002), male gender (p < 0.001), and the absolute difference, respectively., Conclusion: Clavicle asymmetry is present with a positive correlation with male gender and height. Surgeons shall be aware of this asymmetry in managing midshaft clavicle fractures., Competing Interests: Declaration of competing interest None., (Copyright © 2024. Published by Elsevier Ltd.)

The multifunction antibacterial hemostatic materials can reduce blood loss, infection and wound complications, which probably decrease morbidity and health care costs. However, the contradictory relationship between antibacterial ability and biocompatibility, and the unnecessary blood loss restricts the practical application of hydrophilic cationic antibacterial hemostatic materials. Herein, a multifunctional temperature-triggered antibacterial hemostatic fluorocopolymer aggregate coating was developed. After self-assembly and quaternization process, the quaternized poly(N,N-dimethylaminoethylmethacrylate)-b-poly(1H,1H,2H,2H-heptadecafluorodecyl acrylate) block copolymers (PDMA-b-PFOEMA) aggregate coating consisting of fluoropolymer and quaternary ammonium salt were built. The synergistic effect on fluorinated block with low surface energy and quaternary ammonium salt block with bactericide activity severs the way of initial bacterial attachment and proliferation, while the migration of fluorinated block greatly promotes the biocompatibility and anti-adhesion performance in response to the switch from room temperature to physiological temperature. Furthermore, the fluorocopolymer aggregate coating with hydrophobic properties possessed the property of rapid coagulation, low blood loss, minor secondary bleeding and least bacteria infiltration. The multifunctional temperature-triggered fluorocopolymer aggregate coating with antifouling, antibacterial and hemostatic properties may have a great potential in the biomedical application., (Copyright © 2022 Elsevier B.V. All rights reserved.)

The environmental threshold for upland soil phosphorus (P) content (ETSP, i.e., inflection point of soil P content leading to enhanced P loss) provides an important metric for guiding agricultural nonpoint source P pollution control. This study achieved the first meta-analysis to determine ETSP values for upland soils in China. The estimated national-level ETSP based on 472 field experimental observations of Olsen-P content and P loss rate was 30.1 ± 4.0 mg P kg -1 , which was lower than the average ETSP value (52.1 ± 5.0 mg P kg -1 ) but higher than the average agronomic threshold values (16.0 ± 6.4 mg P kg -1 ) previously reported. Lower upland ETSP values occurred in acidic soils and soils having higher organic matter content (SOM), precipitation and slope (ETSP: 30.5 for pH < 7.0 versus 46.1 for pH ≥ 7.0; >56.4 for SOM < 2%, 49.9 for SOM = 2%-3%, and <3 for SOM > 3%; 33 for precipitation < 1000 mm yr -1 , 27.5 for precipitation = 1000-1200 mm yr -1 and <5 for precipitation > 1200 mm yr -1 ; and 39.8 for slopes < 5° versus <9 for slopes ≥ 5°). A multiple regression model that incorporates SOM, pH, precipitation and slope was developed to predict upland ETSP values (R 2 = 0.73, p < 0.01). The model estimated national upland ETSP values ranging from ~0 to 100 mg P kg -1 with an areal-weighted average of 60.6 mg P kg -1 and 15% of national upland soils having ETSP values <30 mg P kg -1 . Upland soil P contents in Guangdong, Fujian and Zhejiang provinces largely exceeded their corresponding ETSP values by 1-22 mg P kg -1 , indicating high P loss risks. Controlling upland P loss requires integrated management of soil P content, SOM, pH and erosion control. This study provides the first national estimate of upland soil ETSP, providing critical quantitative information for designing management practices to attenuate agricultural nonpoint source P pollution., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

In this paper, a novel approach was established on the basis of a molecularly imprinted technique with the aid of double-stranded deoxyribonucleic acid (dsDNA) embedded in a molecularly imprinted polymer (MIP) membrane as a new functional unit with chiral recognition for highly specific chiral recognition. The chiral molecules were immobilized and anchored in the cavities of the MIP membrane on the basis of the three-dimensional structure of a molecule determined by the functional groups, spatial characterization of the cavities of MIPs, and the spatial orientation with dsDNA embedded in MIPs. D-carnitine was selected as an example of a chiral molecular template, which intercalated into dsDNA immobilized on the gold electrode surface to form dsDNA-D-carnitine complex, and then the complex was embedded in the MIP during electropolymerization. After elution, the stereo-selective cavities were obtained. Our findings have shown that AAAA-TTTT base sequence had high affinity for D-carnitine intercalation. Combined with the electrochemical detection method, MIP sensor was prepared. The selectivity of the MIP sensor to ultratrace D-carnitine was significantly improved; the sensor had remarkable stereo-selectivity and highly chiral specific recognition to D-carnitine, and L-carnitine with a concentration of 10,000 times D-carnitine did not interfere with the detection of D-carnitine in the assay of raceme. The sensor also exhibited high sensitivity to ultratrace D-carnitine determination with a linear response to the concentration of D-carnitine in the range of 3.0 × 10 -16  mol/L to 4.0 × 10 -13  mol/L, with a detection limit of 2.24 × 10 -16  mol/L. The mechanism of chiral recognition was studied, and result showed that apart from the recognition effect of imprinted cavities, dsDNA provided chiral selectivity to the spatial orientation of chiral molecules via the intercalation of chiral molecules with dsDNA and electrostatic interaction with groups of DNA base., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objective: To evaluate the safety and efficacy of an enhanced recovery after surgery (ERAS) program for intraspinal tumors in a single-institutional prospective randomized controlled trial., Methods: A multimodal and multidisciplinary ERAS protocol for intraspinal tumor surgery was developed. A total of 94 enrolled patients were randomized into 2 groups: 48 were managed following the ERAS protocol (ERAS group), and 46 received conventional perioperative care (control group). The primary end point was postoperative length of stay (LOS). The secondary outcomes included postoperative pain score and pain medication use, urinary catheterization, ambulation, mortality, reoperation/readmission rates, complication rates, patient satisfaction, and overall cost., Results: A significant reduction in LOS was achieved in patients undergoing ERAS protocol compared with the controls (5 vs. 8 days; P < 0.0001). Moreover, patients in the ERAS group had better postoperative pain scores (1.0 ± 1.3 vs. 1.9 ± 1.3; P = 0.007), decreased use of patient-controlled analgesia (4.2% vs. 19.6%; P = 0.020) and oral opioid (37.5% vs. 58.7%; P = 0.040), early urinary catheter removal (58.3% vs. 6.5%; P < 0.0001), greater ambulation (68.8% vs. 17.4%; P < 0.0001), and higher satisfaction scores (91.8 ± 4.4 vs. 88.2 ± 6.8; P = 0.022) than did the control group. There were no deaths or 30-day readmission/reoperation in both groups, nor did the postoperative complication rates differ between groups., Conclusions: The ERAS protocol for intraspinal tumor surgery seems to be feasible, effective, and safe in shortening postoperative LOS, improving postoperative pain control with reduced opioid use, and accelerating functional recovery without increasing rates of complications or reoperation/readmission. Adoption of spine ERAS programs could be encouraged in practice, although validation with larger-scale multicenter trials is warranted., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Object: The aim of this study was to evaluate the effect of preoperative oral carbohydrate loading versus fasting on the outcomes of patients undergoing elective craniotomy., Methods: In a single-center randomized controlled study, 120 neurosurgical patients who were admitted for elective craniotomy were included and randomized into 2 groups: 58 patients received 400 mL of oral carbohydrate loading 2 h before surgery (intervention group), and 62 patients were fasting for 8 h prior to surgery as routine management (control group). The primary end point was glucose homeostasis. Secondary outcomes included handgrip strength, pulmonary function and postoperative complications., Results: Better glucose homeostasis (5.6 ± 1.0 mmol/L vs. 6.3 ± 1.2 mmol/L, P = 0.001) was achieved in patients who received preoperative oral carbohydrate loading compared to fasting. Furthermore, patients in the intervention group had better handgrip strength (25.3 ± 7.1 kg vs. 19.9 ± 7.5 kg, P < 0.0001) and pulmonary function (in terms of peak expiratory flow rate) (315.8 ± 91.5 L/min vs. 270.0 ± 102.7 L/min, P = 0.036) compared to the controls postoperatively. The rates of postoperative surgical and non-surgical complications did not differ between the groups. Both postoperative and total hospital length of stay (LOS) reduced significantly in the intervention group (-3d, P < 0.0001 and P = 0.004)., Conclusions: Oral carbohydrate loading given 2 h before surgery in patients undergoing elective craniotomy seems to improve glucose homeostasis, handgrip strength and pulmonary function as well as decrease LOS without increasing the risk of postoperative complications. Routine use of preoperative oral carbohydrate loading could be suggested in clinical settings, though further evaluation of its safety and efficacy is warranted., (Copyright © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)