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Perioperative medicine is an evolving field with important publications each year across multiple disciplines. Staying up to date in the field is complicated due to the wide range of journals that publish relevant articles. This review summarizes the most noteworthy perioperative publications in 2023. We conducted a multi-database search of the literature from January to December 2023 and included all original research articles, meta-analyses, systematic reviews, and guidelines. Abstracts, case reports, letters, protocols, pediatric and obstetric articles, and cardiac surgery publications were excluded. Two authors reviewed each reference using the Distiller SR systematic review software (Evidence Partners Inc., Ottawa, Ontario, Canada). A modified Delphi technique was used to identify eight practice-changing articles as well as another eight articles for table-based summary., Competing Interests: Declaration of competing interest Matthew A. Bartlett, M.B., B.Ch., B.A.O. reports stock ownership in Johnson and Johnson and received honoraria from Elsevier Clinical Key as an expert contributor on “Dual Antiplatelet Therapy, Perioperative Management”. No other authors report conflicts of interest. All authors had access to the data and a role in writing the manuscript., (Copyright © 2024. Published by Elsevier Inc.)

Matthew A Bartlett, Karen F Mauck, Paul R Daniels Division of General Internal Medicine, Mayo Clinic Thrombophilia Center, Department of Medicine, Mayo Clinic, Rochester, MN, USA Abstract: Bariatric surgical procedures are now a common method of obesity treatment with established effectiveness. Venous thromboembolism (VTE) events, which include deep vein thrombosis and pulmonary embolism, are an important source of postoperative morbidity and mortality among bariatric surgery patients. Due to an understanding of the frequency and seriousness of these complications, bariatric surgery patients typically receive some method of VTE prophylaxis with lower extremity compression, pharmacologic prophylaxis, or both. However, the optimal approach in these patients is unclear, with multiple open questions. In particular, strategies of adjusted-dose heparins, postdischarge anticoagulant prophylaxis, and the role of vena cava filters have been evaluated, but only to a limited extent. In contrast to other types of operations, the literature regarding VTE prophylaxis in bariatric surgery is notable for a dearth of prospective, randomized clinical trials, and current professional guidelines reflect the uncertainties in this literature. Herein, we summarize the available evidence after systematic review of the literature regarding approaches to VTE prevention in bariatric surgery. Identification of risk factors for VTE in the bariatric surgery population, analysis of the effectiveness of methods used for prophylaxis, and an overview of published guidelines are presented. Keywords: bariatric surgery, venous thromboembolism, prophylaxis, vena cava filter, heparin

The i-propyl + O2 reaction mechanism has been investigated by definitive quantum chemical methods to establish this system as a benchmark for the combustion of secondary alkyl radicals. Focal point analyses extrapolating to the ab initio limit were performed based on explicit computations with electron correlation treatments through coupled cluster single, double, triple, and quadruple excitations and basis sets up to cc-pV5Z. The rigorous coupled cluster single, double, and triple excitations/cc-pVTZ level of theory was used to fully optimize all reaction species and transition states, thus, removing some substantial flaws in reference geometries existing in the literature. The vital i-propylperoxy radical (MIN1) and its concerted elimination transition state (TS1) were found 34.8 and 4.4 kcal mol-1 below the reactants, respectively. Two β-hydrogen transfer transition states (TS2, TS2') lie above the reactants by (1.4, 2.5) kcal mol-1 and display large Born-Oppenheimer diagonal corrections indicative of nearby surface crossings. An α-hydrogen transfer transition state (TS5) is discovered 5.7 kcal mol-1 above the reactants that bifurcates into equivalent α-peroxy radical hanging wells (MIN3) prior to a highly exothermic dissociation into acetone + OH. The reverse TS5 → MIN1 intrinsic reaction path also displays fascinating features, including another bifurcation and a conical intersection of potential energy surfaces. An exhaustive conformational search of two hydroperoxypropyl (QOOH) intermediates (MIN2 and MIN3) of the i-propyl + O2 system located nine rotamers within 0.9 kcal mol-1 of the corresponding lowest-energy minima., (© 2023 Author(s). Published under an exclusive license by AIP Publishing.)

Objective: To determine whether anticoagulation therapy is associated with an increased risk of complications after initiation of intrauterine contraception (IUC)., Patients and Methods: We retrospectively reviewed records of women receiving anticoagulation therapy at the time of IUC placement from 2000 to 2017 and records of controls (no anticoagulation), matched by race, age, and body mass index. The primary outcome was the cumulative incidence of bleeding (more than spotting [World Health Organization bleeding grades 2 to 4]), IUC expulsion, and IUC removal. Secondary outcomes included treatment for bleeding and bleeding patterns stratified by medication and IUC type. Outcomes were assessed at 24 hours, 30 days, and 6 months after IUC placement., Results: We matched 208 women taking anticoagulants with 421 controls. The most common anti-coagulant agents were aspirin (60.1%) and warfarin (36.1%). Most women received the levonorgestrel IUC. No complications occurred within 24 hours. Patients receiving anticoagulants had higher rates of the primary composite outcome at 30 days (odds ratio, 1.77 [95% CI, 1.04 to 3.04]; P =.04) and at 6 months (odds ratio, 2.05 [95% CI, 1.29 to 3.26]; P =.002). Primary complications did not differ by IUC type among control patients, but among women receiving anticoagulants, nonhormonal IUC was associated with an increased rate of complications ( P =.04)., Conclusion: Anticoagulation therapy was associated with higher rates of bleeding at 30 days and 6 months, and nonhormonal IUC plus anticoagulation therapy was associated with higher rates of primary complications. Our findings support current periprocedural anticoagulation guidelines, which state that anticoagulation and antiplatelet therapy can be continued at the time of IUC insertion., (© 2022 The Authors.)

Venous thromboembolism (VTE) is a preventable cause of postoperative morbidity and mortality; however, audits suggest that the use of thromboprophylaxis is underused. In this review, we describe our approach to prevention of postoperative VTE and provide guidance on how to formulate an optimal VTE prophylaxis plan. We recommend that all patients undergo thrombosis- and bleeding-risk assessment as part of their preoperative evaluation. The risk of thrombosis can be estimated based on patient- and procedure-specific factors, using validated risk-assessment models such as the Caprini score. There are no validated models to predict perioperative bleeding; however, several risk factors have been proposed. Patients should ambulate early and frequently after surgery. We recommend no additional prophylaxis in patients at very low risk of VTE (Caprini score 0). Patients at low risk of VTE (Caprini 1 to 2) are recommended to receive either mechanical or pharmacological prophylaxis. Patients at moderate (Caprini 3 to 4) to high risk of VTE (Caprini ≥5) are recommended pharmacological prophylaxis either alone or combined with mechanical prophylaxis. Patients at high risk of bleeding should receive mechanical prophylaxis until their risk of bleeding is reduced and pharmacological prophylaxis can be reconsidered. Populations for which the Caprini score has not been validated (such as orthopedic surgery) are recommended prophylaxis based on individual and procedure-specific risk factors. Prophylaxis is typically continued until the patient is ambulatory or until hospital dismissal; however, longer durations can be considered in certain circumstances (high-risk patients undergoing malignant abdominopelvic operations, bariatric operations, and certain orthopedic operations)., (Copyright © 2020 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)

We report the first preparation of the s - cis , s - cis conformer of dihydroxycarbene ( 1 cc ) by means of pyrolysis of oxalic acid, isolation of the lower-energy s - trans , s - trans ( 1 tt ) and s - cis , s - trans ( 1 ct ) product conformers at cryogenic temperatures in a N 2 matrix, and subsequent narrow-band near-infrared (NIR) laser excitation to give 1 cc . Carbene 1 cc converts quickly to 1 ct via quantum-mechanical tunneling with an effective half-life of 22 min at 3 K. The potential energy surface features around 1 were pinpointed by convergent focal point analysis targeting the AE-CCSDT(Q)/CBS level of electronic structure theory. Computations of the tunneling kinetics confirm the time scale of the 1 cc → 1 ct rotamerization and suggest that direct 1 cc → H 2 + CO 2 decomposition may also be a minor pathway. The intriguing latter possibility cannot be confirmed spectroscopically, but hints of it may be present in the measured kinetic profiles.

A single thiocatecholate group has been combined with a phthalocyanine and used to coordinate a [Ni(dppe)]2+ fragment to give the unprecedented title complex [(dppe)Ni(S2PcH2)]. UV-Vis spectroscopy shows new strong transitions in the Q-band, which TDDFT calcualtions predict result from internal charge transfer processes. Insights are gained with respect to designing future photocatalytic systems.

Background: Use of chemoprophylaxis for prevention of venous thromboembolism (VTE) after bariatric surgery is a generally accepted principle; however, the optimal strategy in terms of medication type and pre- and postoperative dosing is uncertain. In our healthcare system, four hospitals performed bariatric surgery and utilized differing protocols for VTE prophylaxis. The analysis sought to evaluate the association of differing prophylaxis strategies on bleeding and VTE occurrence., Methods: Adult patients who underwent laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) from 2018 to 2021 at four hospitals were studied. Patients were grouped by whether or not they received preoperative chemoprophylaxis. The primary outcome was postoperative bleeding, defined as requiring a blood transfusion or reoperation for bleeding within 30 days. Bivariate analyses were performed with Chi-square and Wilcoxon Rank tests where applicable. Multivariate logistic regression was performed for the outcome of postoperative bleeding., Results: A total of 2145 bariatric surgeries were evaluated (33.6% RYGB, 66.4% SG). Among 1712 patients who underwent surgery at Hospitals A, B, and C, 93.1% received preoperative VTE prophylaxis, compared with 1 patient (0.1%) among 433 patients operated on at Hospital D. Postoperative bleeding occurred more frequently in patients who received preoperative VTE prophylaxis versus those who did not (3.7% vs 1.1%; p < 0.01). After multivariable regression analysis, only RYGB (OR 3.59; p < 0.01) and preoperative VTE prophylaxis (OR 3.54; p = 0.02) were significantly associated with postoperative bleeding. Rates of VTE for patients receiving preoperative VTE prophylaxis or no prophylaxis were not significantly different (0.6% vs. 0.2%; p = 0.26)., Discussion: Preoperative VTE prophylaxis prior to bariatric surgery was associated with postoperative bleeding without differences in VTE occurrence. These results call into question the routine use of VTE chemoprophylaxis for all patients undergoing bariatric surgery and favor selective usage., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

A 56-year-old truck driver with a history of tobacco use presented with acute onset digital ischaemia in the ulnar distribution of his dominant hand, associated with severe pain. Occupational exposures included extensive manual labour and prolonged vibratory stimuli. Workup with Doppler and angiography confirmed the diagnosis of hypothenar hammer syndrome (HHS). After the failure of medical management, he underwent ulnar artery thrombectomy with reconstruction and arterial bypass grafting. His pain improved significantly postsurgically, and he was able to return to a normal routine. This case illustrates the classic presentation, examination, imaging findings and management options of HHS. HHS should be considered in patients with digital ischaemia and associated occupational exposures. Diagnosing the condition appropriately allows for optimal management, aiming at minimising symptoms and maximising quality of life., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

The hydridotrioxygen (HO 3 ) radical has been investigated in many previous theoretical and experimental studies over several decades, originally because of its possible relevance to the tropospheric HO x cycle but more recently because of its fascinating chemical bonding, geometric structure, and vibrational dynamics. We have executed new, comprehensive research on this vexing molecule via focal point analyses (FPA) to approach the ab initio limit of optimized geometric structures, relative energies, complete quartic force fields, and the entire reaction path for cis-trans isomerization. High-order coupled cluster theory was applied through the CCSDT(Q) and even CCSDTQ(P) levels, and CBS extrapolations were performed using cc-pVXZ (X = 2-6) basis sets. The cis isomer proves to be higher than trans by 0.52 kcal mol -1 , but this energetic ordering is achieved only after the CCSDT(Q) milestone is reached; the barrier for cis → trans isomerization is a minute 0.27 kcal mol -1 . The FPA central r e (O-O) bond length of trans-HO 3 is astonishingly long (1.670 Å), consistent with the semiexperimental r e distance we extracted from microwave rotational constants of 10 isotopologues using FPA vibration-rotation interaction constants (α i ). The D 0 (HO-O 2 ) dissociation energy converges to a mere 2.80 ± 0.25 kcal mol -1 . Contrary to expectation for such a weakly bound system, vibrational perturbation theory performs remarkably well with the FPA anharmonic force fields, even for the torsional fundamental near 130 cm -1 . Exact numerical procedures are applied to the potential energy function for the torsional reaction path to obtain energy levels, tunneling rates, and radiative lifetimes. The cis → trans isomerization occurs via tunneling with an inherent half-life of 1.4 × 10 -11 s and 8.6 × 10 -10 s for HO 3 and DO 3 , respectively, thus resolving the mystery of why the cis species has not been observed in previous experiments executed in dissipative environments that allow collisional cooling of the trans-HO 3 product. In contrast, the pure ground eigenstate of the cis species in a vacuum is predicted to have a spontaneous radiative lifetime of about 1 h and 5 days for HO 3 and DO 3 , respectively.

Objective: To compare the clinical efficacy and safety of apixaban with those of rivaroxaban for the treatment of acute venous thromboembolism (VTE)., Patients and Methods: Consecutive patients enrolled in the Mayo Thrombophilia Clinic Registry (between March 1, 2013, and January 30, 2018) and treated with apixaban or rivaroxaban for acute VTE were followed forward in time. The primary efficacy outcome was VTE recurrence. The primary safety outcome was major bleeding; the second safety outcome was clinically relevant nonmajor bleeding (CRNMB); and the third was a composite of major bleeding or CRNMB., Results: Within the group of 1696 patients with VTE enrolled, 600 (38%) were treated either with apixaban (n=302, 50%) or rivaroxaban (n=298, 50%) within the first 14 days of VTE diagnosis and who completed at least 3 months of therapy or had a study event. Recurrent VTE was diagnosed in 7 patients (2.3%) treated with apixaban and in 6 (2%) treated with rivaroxaban (adjusted hazard ratio [aHR], 1.4; 95% CI, 0.5-3.8). Major bleeding occurred in 11 patients (3.6%) receiving apixaban and in 9 patients (3.0%) receiving rivaroxaban (aHR, 1.2; 95% CI, 0.5-3.2). Clinically relevant nonmajor bleeding was diagnosed in 7 patients (2.3%) receiving apixaban and in 20 (6.7%) receiving rivaroxaban (aHR, 0.4; 95% CI, 0.2-0.9). The rates of composite major bleeding or CRNMB were similar (aHR, 0.6; 95% CI, 0.3-1.2). Most study events occurred in patients with cancer., Conclusion: In the setting of a standardized, guideline-directed, patient-oriented clinical practice, the efficacy and safety of apixaban and rivaroxaban for the treatment of acute VTE were comparable., (Copyright © 2018 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)

A new and facile method of generating thiolate groups at the phthalocyanine (Pc) β-position is presented as well the unique properties that these groups confer on the Pc ligand upon coordination of group 10 metals Ni, Pd and Pt(dppe) or SnMe3. In particular, the Q-band is shifted to almost 800 nm for all group 10 metals used, and the complexes show panchromatic absorption owing to new absorbance bands that appear between 400 and 650 nm. Enhanced intersystem-crossing for all transition metal coordinated Mg(Pc) complexes was demonstrated by the moderate to very high singlet oxygen quantum yields of 0.36, 0.76 and 0.91 for the Ni, Pd and Pt coordinating complexes, respectively, which show that the heavy metals have direct influence on the Pc π-system and inter-system-crossing (ISC). This was further confirmed by MO calculations, which show mixing of metal and ligand orbitals, as well as suggest that the Q-band transition has both π → π* and ligand-to-metal charge transfer characteristics. Furthermore, the origin of the Q-band red-shift was shown to be due to greater destabilization of the HOMO compared to LUMO/LUMO+1, thus decreasing the HOMO-LUMO band gap.

Venous thromboembolism (VTE) management is rapidly evolving and staying up-to-date is challenging. We identified the most practice-informing articles published in 2017 relevant to the nonspecialist provider managing VTE. We performed a systematic search of the literature (Appendix A), limiting the search to a publication date of 2017. Two reviewers screened the 2735 resulting abstracts to identify high-quality, clinically relevant publications related to VTE management. One-hundred and six full-text articles were considered for inclusion. The five authors used a modified Delphi method to reach consensus on inclusion of seven articles for in-depth appraisal, following predetermined criteria of clinical relevance to nonspecialist providers, potential for practice change, and strength of the evidence.

A 67-year-old woman presented with 5 days of myalgias and fevers on completion of a 21-day course of amoxicillin for Lyme disease ( Borrelia burgdorferi infection). She was found to have profound thrombocytopenia, as well as new anaemia and leucopenia. Workup revealed Babesia microti as the causative agent of her symptoms. The patient quickly improved after appropriate antimicrobial therapy directed against babesiosis was started. This case illustrates the importance of basic microbiology, including epidemiology and common vectors, when creating a differential diagnosis. Because the Ixodes scapularis tick can harbour and transmit multiple parasites simultaneously, the possibility of coinfection should be considered in any patient not responding to appropriate initial medical therapy., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2018. No commercial re-use. See rights and permissions. Published by BMJ.)

Disentangling internal and external effects is a key requirement for understanding conformational tunneling processes. Here we report the s- trans/ s- cis tunneling rotamerization of carbonic acid monomethyl ester (1) under matrix isolation conditions and make comparisons to its parent carbonic acid (3). The observed tunneling rate of 1 is temperature-independent in the 3-20 K range and accelerates when using argon instead of neon as the matrix material. The methyl group increases the effective half life (τ eff ) of the energetically disfavored s- trans-conformer from 3-5 h for 3 to 11-13 h for 1. Methyl group deuteration slows the rotamerization further (τ eff ≈ 35 h). CCSD(T)/cc-pVQZ//MP2/aug-cc-pVTZ computations of the tunneling probability suggest that the rate should be almost unaffected by methyl substitution or its deuteration. Thus the observed relative rates are puzzling, and they disagree with previous explanations involving fast vibrational relaxation after the tunneling event facilitated by the alkyl rotor.

While ring-walking is a critical step in transition metal catalyzed cross-coupling reactions, the associated metastable intermediates are often difficult to isolate and characterize. In this work, theoretical structures and energetics for ring-walking and oxidative addition of zerovalent nickel with 1-bromo-2-methylbenzene, 2-bromopyridine, 2-bromo-3-methyl-thiophene, and 2-bromopyrrole were computed at the B3LYP-D3/TZ2P-LANL2TZ(f)-LANL08d level. The mechanisms vary qualitatively with substrate ring size and type-the catalyst weaves along the edges of the benzene and pyridine rings, cuts through the interior of the thiophene ring, and arcs along the bond opposite the nitrogen atom in the pyrrole ring. Analogous computations on the ring-walking and oxidative addition of zerovalent palladium with 1-bromo-2-methylbenzene reveal an energetic profile similar to that of Ni but with much weaker overall binding to the arene. In all cases, dispersion corrections are found to be very important for computing accurate metal-substrate binding energies.

Objective: The objective of this study was to examine the utility of a combination of the modified Caprini score and D-dimer levels for the evaluation and management of lower extremity venous thrombosis following lung cancer surgery. The purpose was to offer insights for developing clinical intervention programs. Methods: The study sample consisted of 224 patients who underwent surgery for lung cancer at the First Central Hospital of Baoding City. General patient data and D-dimer levels on the first day post-surgery were collected. The modified Caprini risk assessment score was calculated. All patients underwent ultrasonography of the lower limb veins before and after surgery to identify venous thrombosis in the lower limb veins. Differences in lower extremity venous thrombosis and D-dimer levels among patients in various modified Caprini score groups were compared and analyzed. Results: Based on the modified Caprini risk assessment score, all patients were categorized into three groups: the low-risk, medium-risk, and high-risk groups. The groups did not differ significantly in terms of age, but the differences in the rates of lower extremity venous thrombosis in the low, intermediate, and high-risk Caprini risk groups (16.5%, 19.2%, and 37.1%, respectively) were statistically significant. Out of the total 224 patients, 47 (21%) were diagnosed with venous thromboembolisms post-surgery, and all of them had thrombosis of the intermuscular veins of the lower extremity. The difference in the modified Caprini risk assessment score between patients with and without lower extremity venous thrombosis was statistically significant (P = 0.035), as were the postoperative D-dimer levels (1.28 ± 1.64 vs. 2.69 ± 2.77, respectively; P < 0.05) between these two groups of patients. The modified Caprini risk assessment score showed an association with lower extremity venous thrombosis (r = 0.15, P = 0.56) with an area under the receiver operating characteristic curve (AUC) of 0.59. Conclusion: In this study, we found that combining the modified Caprini risk assessment score with D-dimer measurements enhanced the accuracy of assessing the severity of deep vein thrombosis (DVT). This combination can be beneficial in evaluating thrombosis risk post-lung cancer surgery and holds significant clinical utility. [ABSTRACT FROM AUTHOR]

Venous thromboembolic disease (VTE) occupies an important place as a cause of morbidity and mortality in surgical patients in all specialties. Despite the existence of guidelines for thrombo prophylaxis in surgery, it is not clear due to the lack of current evidence, how to develop antithrombotic prophylaxis in varicose vein surgery and many questions arise when the surgeon is faced with a patient to be operated on. A comprehensive review of the literature was conducted to examine the evidence about the prevention of the venous thromboembolism in varicose veins surgery patients, and aims to guide the reader through questions that arise in daily practice, discussing the different scenarios presented in the literature for the choice of the most appropriate prophylaxis for each case. The lack of conclusive literature determines that risk should be individualized using available scales and other procedure-related factors, so that the type and duration of prophylaxis can be determined on a case-by-case basis. [ABSTRACT FROM AUTHOR]

Background: Identifying factors that correlate with the incidence of venous thromboembolism (VTE) has the potential to improve VTE prevention and positively influence decision-making regarding prophylaxis. In this study, we aimed to investigate the correlation between statin consumption and the incidence of VTE in patients who sustained an ankle fracture. Methods: In this retrospective, case-controlled study, cases were those who developed VTE and controls were those who had no VTE, and the ratio was 1:4. Patients' demographics, history of hyperlipidemia, and reported statins use were obtained. A random forest classifier (RFC) model was used to predict whether statin consumers were at risk of VTE after ankle fracture regardless of VTE prophylaxis administration based on statin consumption, body mass index (BMI), age, and biological sex Results: Of the 1175 patients with ankle fractures, 238 had confirmed VTE (case group), and 937 had no symptomatic VTE (control group; ratio 1:4). Fifty (21%) cases and 407 (43%) controls were on a statin. Statin users had a significantly lower incidence of VTE after ankle fracture, odds ratio (OR) = 0.35, 95% CI: 0.25, 0.49, P <.001. Our model showed an area under the receiving operator curve (AUROC) of 78%, a sensitivity of 73%, and a specificity of 83% in predicting the risk of VTE. The importance of the predictors of VTE, other than the use of statins (model importance = 0.1), were age (model importance of 0.72), BMI (model importance of 0.24), and biological sex (model importance of 0.02). Conclusion: Statins were significantly associated with a lower rate of VTE in our population of patients who sustained an ankle fracture. Levels of Evidence: 3 [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to establish and validate machine learning-based models for predicting the risk of venous thromboembolism (VTE) in intensive care unit (ICU) patients. Patients and Methods: The clinical data of 1494 ICU patients who underwent Doppler ultrasonography or venography between December 2020 and March 2023 were extracted from three tertiary hospitals. The Boruta algorithm was used to screen the essential variables associated with VTE. Five machine learning algorithms were employed: Random Forest (RF), eXtreme Gradient Boosting (XGBoost), Support Vector Machine (SVM), Gradient Boosting Decision Tree (GBDT), and Logistic Regression (LR). Hyperparameter optimization was conducted on the predictive model of the training dataset. The performance in the validation dataset was measured using indicators, including the area under curve (AUC) of the receiver operating characteristic (ROC) curve, specificity, and F1 score. Finally, the optimal model was interpreted using the SHapley Additive exPlanation (SHAP) package. Results: The incidence of VTE among the ICU patients in this study was 26.04%. We screened 19 crucial features for the risk prediction model development. Among the five models, the RF model performed best, with an AUC of 0.788 (95% CI: 0.738– 0.838), an accuracy of 0.759 (95% CI: 0.709– 0.809), a sensitivity of 0.633, and a Brier score of 0.166. Conclusion: A machine learning-based model for prediction of VTE in ICU patients were successfully developed, which could assist clinical medical staff in identifying high-risk populations for VTE in the early stages so that prevention measures can be implemented to reduce the burden on the ICU patients. [ABSTRACT FROM AUTHOR]

Introduction: Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a serious public health problem. Each hospitalized patient should be assessed for the risk of thrombosis. However, it should be noted that in some cases patients may have rare risk factors which may not be known at the initial assessment stage. Material and methods: The purpose of this paper was to present a case report of a 76-year-old female patient with a second episode of PE, who had a rare risk factor in the form of extensive hiatal hernia (HH) causing pressure on the pulmonary arteries. Results: A 76-year-old patient was admitted to the Clinic as part of the emergency service due to dyspnoea that had been increasing for three days and fainting. For approximately a week, the patient stopped taking previously recommended medications, including anticoagulant treatment initiated due to PE diagnosed two months earlier. As a result of the diagnostic tests, a second episode of intermediate-risk PE associated with a massive HH was diagnosed. Conclusions: A large HH is a rare but important factor that may lead to an increased risk of PE occurrence due to compression of the pulmonary arteries, especially if it coexists with a significant deepening of thoracic kyphosis, which is associated with an additional increase in mediastinal tightness. [ABSTRACT FROM AUTHOR]

Newly synthesized ligand 2-(2- acetamidophenyl)-2-oxo-N-(pyridin-2-ylmethyl)acetamide and its copper(II) complex were characterized by elemental analyses, FT-IR, UV–Vis., ESR, 1H-NMR, and thermal analysis along with the theoretical quantum chemical studies. Combined experimental and theoretical DFT (density functional theory) studies showed the ligand to be a tridentate ligand with three coordinate bonds. The complex was suggested to be in a distorted octahedral structure with dx2-y2 ground state. The activation energy, ΔE*; entropy ΔS*; enthalpy ΔH* and order of reaction has been derived from differential thermogravimetric (DTA) curve, using Horowitz–Metzeger method. The nujol mull electronic spectrum of the ligand and Cu(II) complex have been recorded and the difference of the excited and ground state densities has also been theoretically calculated and plotted to investigate the movement of electrons on excitation. The Cu(II) complex was evaluated for its antibacterial activity against two bacterial species, namely Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus). Antifungal screening was performed against two species (Condida albicans and Aspergillus flavus). The complex under investigation was found to possess notable biological activity. Molecular docking investigation predicted different types of non-covalent interactions of the synthesized ligand towards Insulin-like growth factor 1 receptor (ID: 5FXR). [ABSTRACT FROM AUTHOR]

Continuous-wave measurement-based methods offer a rapid cost-effective way to determine optical properties in turbid media. This method requires a measure of the refractive index of the medium, which is often unknown a priori. Whereas previous studies have reported that the refractive index has little impact on the measurement of optical properties, here we show a significant effect of refractive indices on measurements, using both simulations and experiments. In addition we propose a noniterative method to determine the refractive index of the medium. This method can also provide an optimal initial guess of the optical properties for the standard iterative method for determining optical properties in turbid media. Our method is confirmed by simulations and experiments with latex spheres and Intralipid suspensions.

Background: Despite the possible overall health benefits of a vegetarian diet, there is concern that some vegetarians and infrequent meat eaters, particularly females, may have inadequate iron status because of low or no heme-iron intakes., Objective: The objective was to investigate the nutritional intake and iron status of vegetarian women., Design: The nutritional intakes of 50 free-living vegetarian women aged 18-45 y and 24 age-matched omnivorous control women were assessed by using 12-d weighed dietary records. Iron status was assessed by measuring hemoglobin and serum ferritin concentrations., Results: There was no significant difference between mean (+/-SD) daily iron intakes of vegetarians and omnivores (10.7 +/- 4.4 and 9.9 +/- 2.9 mg, respectively), although heme-iron intakes were low in the vegetarians. Vegetarians had significantly lower intakes of protein (P < 0.01), saturated fat (P < 0.01), and cholesterol (P < 0.001), and significantly higher intakes of dietary fiber (P < 0.001) and vitamin C (P < 0.05). Mean serum ferritin concentrations were significantly lower (P = 0.025) in vegetarians (25.0 +/- 16.2 microg/L) than in omnivores (45.5 +/- 42.5 microg/L). However, similar numbers of vegetarians (18%) and omnivores (13%) had serum ferritin concentrations <12 microg/L, which is a value often used as an indicator of low iron stores. Hemoglobin concentrations were not significantly different., Conclusion: It is important that both vegetarian and omnivorous women maintain an adequate iron status and follow dietary practices that enhance iron absorption.

One of the most serious complications after surgical interventions on the arteries of the lower extremities is thrombosis of the vascular prosthesis. Unfortunately, it is almost impossible to protect the patient from contact with the surgical thread with flowing blood, which makes the location of the surgical operation a focus of thrombosis. The purpose of this scientific study is to evaluate the possibility of modifying the surface of a polypropylene thread with heparin using chemical inoculation in order to increase the thromboresistant properties of the suture material. To do this, a polyhydroxybutyrate/oxivalerate copolymer and a heparin solution were applied to the surface of the polypropylene filament. An additional sublayer of polymethacrylyl chloride contributed to the strong inoculation of heparin to the polymer. The polymer substrate reacted with heparin to form strong covalent ester bonds. Applying a thin and uniform layer of polyhydroxybutyrate/oxivalerate to the thread with a thickness of no more than 4 microns makes its surface smooth. After chemical modification and application of heparin to the surface of the thread, it acquired a uniform spongy structure, due to the formation of a new polymer layer with firmly grafted heparin. Thus, it is possible to create a bio- and hemocompatible coating based on a biodegradable polymer and heparin on the surface of a polypropylene thread. [ABSTRACT FROM AUTHOR]

Objective: To investigate the genetic underpinnings of the association between type 2 diabetes (T2D), glycemic indicators such as fasting glucose (FG), fasting insulin (FI), and glycated hemoglobin (GH), and venous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), thereby contributing novel insights to the scholarly discourse within this domain. Methods: Genome-wide association study (GWAS) summary data pertaining to exposures (T2D, FG, FI, GH) and outcomes (VTE, DVT, PE) were acquired from the IEU Open GWAS database, encompassing participants of European descent, including both male and female individuals. Two-sample Mendelian randomization (MR) analyses were conducted utilizing the TwoSampleMR and MRPRESSO packages within the R programming environment. The primary analytical approach employed was the random-effects inverse variance weighted (IVW) method. Heterogeneity was assessed via Cochran's Q statistic for MR-IVW and Rucker's Q statistic for MR-Egger. Horizontal pleiotropy was evaluated using the intercept test of MR Egger and MR pleiotropy residual sum and outlier (MR-PRESSO) analysis, with the latter also employed for outlier detection. Additionally, a "Leave one out" analysis was conducted to ascertain the influence of individual single nucleotide polymorphisms (SNPs) on MR results. Results: The random-effects IVW analysis revealed a negative genetic causal association between T2D) and VTE (P = 0.008, Odds Ratio [OR] 95% confidence interval [CI] = 0.896 [0.827–0.972]), as well as between FG and VTE (P = 0.002, OR 95% CI = 0.655 [0.503–0.853]), GH and VTE (P = 0.010, OR 95% CI = 0.604 [0.412–0.884]), and GH and DVT (P = 0.002, OR 95% CI = 0.413 [0.235–0.725]). Conversely, the random-effects IVW analysis did not detect a genetic causal relationship between FI and VTE (P > 0.05), nor between T2D, FG, or FI and DVT (P > 0.05), or between T2D, FG, FI, or GH and PE (P > 0.05). Both the Cochran's Q statistic for MR-IVW and Rucker's Q statistic for MR-Egger indicated no significant heterogeneity (P > 0.05). Moreover, the intercept tests of MR Egger and MR-PRESSO suggested the absence of horizontal pleiotropy (P > 0.05). MR-PRESSO analysis identified no outliers, while the "Leave one out" analysis underscored that the MR analysis was not influenced by any single SNP. Conclusion: Our investigation revealed that T2D, FG, and GH exhibit negative genetic causal relationships with VTE at the genetic level, while GH demonstrates a negative genetic causal relationship with DVT at the genetic level. These findings furnish genetic-level evidence warranting further examination of VTE, DVT, and PE, thereby making a contribution to the advancement of related research domains. [ABSTRACT FROM AUTHOR]

Deep vein thrombosis (DVT) is a common complication in patients with lower extremity fractures. Once it occurs, it will seriously affect the quality of life and postoperative recovery of patients. Therefore, early prediction and prevention of DVT can effectively improve the prognosis of patients. This study constructed different machine learning models to explore their effectiveness in predicting DVT. Five prediction models were applied to the study, including Extreme Gradient Boosting (XGBoost) model, Logistic Regression (LR) model, RandomForest (RF) model, Multilayer Perceptron (MLP) model, and Support Vector Machine (SVM) model. Afterwards, the performance of the obtained prediction models was evaluated by area under the curve (AUC), accuracy, sensitivity, specificity, F1 score, and Kappa. The prediction performances of the models based on machine learning are as follows: XGBoost model (AUC = 0.979, accuracy = 0.931), LR model (AUC = 0.821, accuracy = 0.758), RF model (AUC = 0.970, accuracy = 0.921), MLP model (AUC = 0.830, accuracy = 0.756), SVM model (AUC = 0.713, accuracy = 0.661). On our data set, the XGBoost model has the best performance. However, the model still needs external verification research before clinical application. [ABSTRACT FROM AUTHOR]

Background: Casuarina equisetifolia belongs to the Casuarina species with the most extensive natural distribution, which contain various phytochemicals with potential health benefits. This study aimed to investigate the chemical composition and biological activities of different extracts of Casuarina equisetifolia. Methods: The n-hexane extract was analyzed for its unsaponifiable and fatty acid methyl esters fractions, while chloroform, ethyl acetate, and butanol extracts were studied for their phenolic components. Six different extracts of C. equisetifolia needles were evaluated for their total phenolic content, total flavonoid content, and their antioxidant, antimicrobial, and cytotoxic activities. Results: The n-hexane extract contained mainly hydrocarbons and fatty acid methyl esters, while ten phenolic compounds were isolated and identified in the chloroform, ethyl acetate, and butanol extracts. The methanolic extract exhibited the highest total phenolic and flavonoid content, highest antioxidant activity, and most potent cytotoxic activity against HepG-2 and HCT-116 cancer cell lines. The ethyl acetate extract showed the most significant inhibition zone against Staphylococcus aureus and Bacillus subtilis. Conclusion: Casuarina equisetifolia extracts showed promising antioxidant, antimicrobial, and cytotoxic activities. Overall, Casuarina equisetifolia is a versatile tree with a variety of uses, and its plant material can be used for many different purposes. [ABSTRACT FROM AUTHOR]

Objective: Benign nerve sheath tumors (BNSTs) present diagnostic challenges due to their heterogeneous nature. This study aimed to determine the significance of NRG1 as a novel diagnostic biomarker in BNST, emphasizing its involvement in the PI3K-Akt pathway and tumor immune regulation. Methods: Differential genes related to BNST were identified from the GEO database. Gene co-expression networks, protein-protein interaction networks, and LASSO regression were utilized to pinpoint key genes. The CIBERSORT algorithm assessed immune cell infiltration differences, and functional enrichment analyses explored BNST signaling pathways. Clinical samples helped establish PDX models, and in vitro cell lines to validate NRG1's role via the PI3K-Akt pathway. Results: Nine hundred eighty-two genes were upregulated, and 375 downregulated in BNST samples. WGCNA revealed the brown module with the most significant difference. Top hub genes included NRG1, which was also determined as a pivotal gene in disease characterization. Immune infiltration showed significant variances in neutrophils and M2 macrophages, with NRG1 playing a central role. Functional analyses confirmed NRG1's involvement in key pathways. Validation experiments using PDX models and cell lines further solidified NRG1's role in BNST. Conclusion: NRG1 emerges as a potential diagnostic biomarker for BNST, influencing the PI3K-Akt pathway, and shaping the tumor immune microenvironment. [ABSTRACT FROM AUTHOR]

Although infections resulting from cosmetic surgery performed outside the United States have been regularly reported, deaths have rarely been identified. During 2009-2022, 93 U.S. citizens died after receiving cosmetic surgery in the Dominican Republic. The number of deaths increased from a mean of 4.1 per year during 2009-2018 to a mean of 13.0 during 2019-2022 with a peak in of 17 in 2020. A subset of postcosmetic surgery deaths occurring during peak years was investigated, and most deaths were found to be the result of embolic events (fat emboli or venous thromboembolism) for which a high proportion of the patients who died had risk factors, including obesity and having multiple procedures performed during the same operation. These risk factors might have been mitigated or prevented with improved surgical protocols and postoperative medical care, including prophylactic measures against venous thromboembolism. U.S. citizens interested in receiving elective cosmetic surgery outside the United States should consult with their health care professionals regarding their risk for adverse outcomes. Public health authorities can support provider education on the importance of preoperative patient evaluation and the potential danger of performing multiple cosmetic procedures in one operation. [ABSTRACT FROM AUTHOR]

Background: To compare the early clinical efficacy of percutaneous endoscopic posterior lumbar interbody fusion (PE-PLIF) and modified posterior lumbar interbody fusion (MPLIF) in the treatment of lumbar degenerative disease (LDD). Methods: A total of 37 patients who underwent PE-PLIF and 58 patients who underwent MPLIF from March 2019 to January 2022 were retrospectively reviewed. The operation time, intraoperative blood loss, post-operative hospitalization time, and post-operative bedrest time were recorded. The visual analogue scale (VAS) scores of leg pain and low back pain, Japanese Orthopaedic Association (JOA) scores, and the Oswestry Disability Index (ODI) scores were evaluated and compared before the operation, 3 days after the operation, 1 week after the operation, 1 month after the operation, 6 months after the operation and at the last follow-up. The modified MacNab's criteria were applied at the last follow-up. The fusion rate and surgical-related complications during follow-up were recorded. Results: The average operation time in the PE-PLIF group was highly significant longer than that in the MPLIF group (P < 0.01). The intraoperative blood loss, post-operative hospitalization time, and post-operative bedrest time were significantly less in the PE-PLIF group than those in the MPLIF group (P < 0.01). There were highly significant differences in VAS scores of leg pain, VAS scores of low back pain, JOA scores, ODI scores at the last follow-up compared with those before the operation in the two groups (P < 0.01). Three days after the operation and 1 week after the operation, the VAS scores for low back pain and ODI were highly significant less in the PE-PLIF group than that in the MPLIF group (P < 0.01). Three days after the operation, the JOA scores were highly significant higher in the PE-PLIF group than that in the MPLIF group (P < 0.01). All patients showed intervertebral fusion at 6 months after the operation. Two patients (5.4%) in the PE-PLIF group experienced complications. Conclusion: Both PE-PLIF and MPLIF surgery were clinically effective and safe for patients with single-segment LDD. PE-PLIF surgery is a promising technique that can be used as an alternative treatment for single-segment LDD. [ABSTRACT FROM AUTHOR]

Postoperative pulmonary complications (PPCs) arise from a complex interplay of patient, surgical, and anesthesia-related factors. Despite their significant impact, there are currently no standardized guidelines recommending a comprehensive preoperative approach to assessing patients with PPC risk factors. Preoperative pulmonary evaluation (PPE) plays a pivotal role in identifying underlying patient conditions, undiagnosed diseases and optimal treatments. PPE involves systematic identification of patient, surgical, and anesthesia-related risk factors. Severe PPCs include atelectasis, pneumonia, respiratory failure, pulmonary embolism, and worsening chronic lung disease. Surgical urgency, type, duration, approach of the surgical procedure, and comorbidities influence PPC rates, with cardiac, thoracic, abdominal, and vascular surgeries being particularly vulnerable. Patient-related risk factors encompass non-pulmonary and pulmonary factors. Aging populations increase surgical demand, with advanced age and frailty predicting higher morbidity and mortality risks. Conditions like congestive heart failure, obesity, obstructive sleep apnea, and smoking heighten PPC risks. Asthma, chronic obstructive pulmonary disease, interstitial lung diseases, pulmonary hypertension, previous pulmonary thromboembolism, acute respiratory infections, and COVID-19 impact pulmonary risk profiles. Surgery and anesthesia-related risk factors include the site of surgery, operation time, and emergency surgery. Surgery near the diaphragm elevates PPC risk, while longer operation times correlate with increased PPC incidence. Emergency surgeries pose challenges in risk assessment. Anesthetic techniques influence outcomes, with regional anesthesia often preferable. Neuromuscular blocking agents impact PPCs, and protective ventilation strategies can mitigate complications. As current literature lacks a comprehensive approach to PPE, in this review, we present a comprehensive approach to preoperative pulmonary approach to surgical patients to help in risk stratification, further optimization, as well as shared decision making between the surgeon and the patients and their family prior to consenting for a major surgical procedure. [ABSTRACT FROM AUTHOR]

We selected 145 reference organic molecules that include model fragments used in computer-aided drug design. We calculated 158 conformational energies and barriers using force fields, with wide applicability in commercial and free softwares and extensive application on the calculation of conformational energies of organic molecules, e.g. the UFF and DREIDING force fields, the Allinger's force fields MM3-96, MM3-00, MM4-8, the MM2-91 clones MMX and MM+, the MMFF94 force field, MM4, ab initio Hartree–Fock (HF) theory with different basis sets, the standard density functional theory B3LYP, the second-order post-HF MP2 theory and the Domain-based Local Pair Natural Orbital Coupled Cluster DLPNO-CCSD(T) theory, with the latter used for accurate reference values. The data set of the organic molecules includes hydrocarbons, haloalkanes, conjugated compounds, and oxygen-, nitrogen-, phosphorus- and sulphur-containing compounds. We reviewed in detail the conformational aspects of these model organic molecules providing the current understanding of the steric and electronic factors that determine the stability of low energy conformers and the literature including previous experimental observations and calculated findings. While progress on the computer hardware allows the calculations of thousands of conformations for later use in drug design projects, this study is an update from previous classical studies that used, as reference values, experimental ones using a variety of methods and different environments. The lowest mean error against the DLPNO-CCSD(T) reference was calculated for MP2 (0.35 kcal mol−1), followed by B3LYP (0.69 kcal mol−1) and the HF theories (0.81–1.0 kcal mol−1). As regards the force fields, the lowest errors were observed for the Allinger's force fields MM3-00 (1.28 kcal mol−1), ΜΜ3-96 (1.40 kcal mol−1) and the Halgren's MMFF94 force field (1.30 kcal mol−1) and then for the MM2-91 clones MMX (1.77 kcal mol−1) and MM+ (2.01 kcal mol−1) and MM4 (2.05 kcal mol−1). The DREIDING (3.63 kcal mol−1) and UFF (3.77 kcal mol−1) force fields have the lowest performance. These model organic molecules we used are often present as fragments in drug-like molecules. The values calculated using DLPNO-CCSD(T) make up a valuable data set for further comparisons and for improved force field parameterization. [ABSTRACT FROM AUTHOR]

In the present work, using on‐the‐fly classical trajectory calculations along with quantum chemical computation, we have shown that HO2•$_{2}^{\bullet }$+O3→ OH•+2O2 reaction can be a potential source of the vibrationally excited OH radical. The investigation suggests that OH radical will be majorly produced in ν=1 and ν=2 states. We have also shown that the vibrationally hot OH radical is key in interpreting the observed branching fraction of 16OH• in the gas phase experiment of Nelson and Zahniser (J. Phys. Chem. 1994, 98, 2101–2104). Lastly, we have discussed the atmospheric implications of title reaction by comparing it with other chemical reactions known to produce hot OH radical in the atmosphere. [ABSTRACT FROM AUTHOR]

Introduction : Portomesenteric vein thrombosis (PMVT) is a rare but potentially fatal complication of sleeve gastrectomy (SG). The rising prevalence of SG has led to a surge in the occurrence of PMVT, while the associated risk factors have not been fully elucidated. This study aims to determine the incidence and risk factors of PMVT in patients undergoing SG. Methods : A comprehensive literature search was performed in PubMed and EMBASE databases. Proportion and regression meta-analyses were conducted. Results : In a total of 76 studies including 101,914 patients undergoing SG, we identified 357 patients with PMVT. Mean follow-up was 14.4 (SD: 16.3) months. The incidence of PMVT was found to be 0.50% (95%CI: 0.40–0.61%). The majority of the population presented with abdominal pain (91.8%) at an average of 22.4 days postoperatively and PMVT was mainly diagnosed with computed tomography (CT) (96.0%). Hematologic abnormalities predisposing to thrombophilia were identified in 34.9% of the population. Advanced age (p=0.02) and low center volume (p <0.0001) were significantly associated with PMVT, while gender, BMI, hematologic abnormality, prior history of deep vein thrombosis or pulmonary embolism, type of prophylactic anticoagulation, and duration of prophylactic anticoagulation were not associated with the incidence of PMVT in meta-regression analyses. Treatment included therapeutic anticoagulation in 93.4% and the mortality rate was 4/357 (1.1%). Conclusion : PMVT is a rare complication of sleeve gastrectomy with an incidence rate <1% that is associated with low center volume and advanced age but is not affected by the duration or type of thromboprophylaxis administered postoperatively. [ABSTRACT FROM AUTHOR]

Purpose: Postoperative venous thromboembolism (VTE) can potentially be associated with significant morbidity, mortality, and healthcare costs. The aim of this study was to determine the utilization of Caprini guideline indicated VTE in elective gynecologic surgery patients and its impact on postoperative VTE and bleeding complications. Methods: This was a retrospective cohort study of elective gynecologic surgical procedures performed between January 1, 2016, and May 31, 2021. Two study cohorts were generated: (1) those who received and (2) those who did not receive VTE prophylaxis based on Caprini score risk stratification. Outcome measures were then compared between the study cohorts and included the development of a VTE up to 90-days postoperatively. Secondary outcome measures included postoperative bleeding events. Results: A total of 5471 patients met inclusion criteria and the incidence of VTE up to 90 days postoperatively was 1.04%. Overall, 29.6% of gynecologic surgery patients received Caprini score-based guideline VTE prophylaxis. 39.2% of patients that met high-risk VTE criteria (Caprini > 5) received appropriate Caprini score-based prophylaxis. In multivariate regression analysis, the American Society of Anesthesiologists (ASA) score (OR 2.37, CI 1.27–4.45, p < 0.0001) and Caprini score (OR 1.13, CI 1.03–1.24, p = 0.008) predicted postoperatively VTE occurrence. Increasing Charlson comorbidity score (OR 1.39, CI 1.31–1.47, P < 0.001) ASA score (OR 1.36, CI 1.19–1.55, P < 0.001) and Caprini score (OR 1.10, CI 1.08–1.13, P < 0.001) were associated with increased odds of receiving appropriate inpatient VTE prophylaxis. Conclusion: While the overall incidence of VTE was low in this cohort, enhanced adherence to risk-based practice guidelines may provide more patient benefit than harm to postoperative gynecologic patients. [ABSTRACT FROM AUTHOR]

Background: Despite the risks of venous thromboembolism (VTE) in surgical patients are well defined, primary thromboprophylaxis (TP) can be neglected. The aim of this study was to evaluate the risk of VTE and appropriateness of TP and to assess the effects of education and clinical pharmacy (CP) services. Methods: This study was conducted in a total of 3 periods (n = 800): pre-education (n = 340), post-education (n = 269) and CP intervention period (n = 191) and the risk of VTE and the appropriateness of TP were evaluated. At the end of pre-education period, patients were re-evaluated after education was given about the guidelines on TP and an educative poster was posted in the services (post-education period). During the CP intervention period, the CP made recommendations in terms of optimal TP use to the physicians in charge. Results: While there was no significant difference in the optimal TP rate administered to the patients before and after education (138/340, 40.6% vs. 122/269, 45.4%; p = 0.238); this rate was increased to 113/191 (59.2%) in the CP intervention period (p = 0.004). High-risk patients who received one type of TP constituted the majority of patients who did not receive optimal TP. While the ratio of high-risk patients undergoing a single type of TP in the pre- and post-education periods (104/340, 30.6% vs. 83/269, 30.9%), was similar (p = 0.819); with the CP interventions, this rate was reduced to 35/191 (18.3%) (p = 0.001). Conclusion: Even though education has positive influence on surgeons, the implementation of CP practices is more effective especially in terms of maintaining optimal TP. [ABSTRACT FROM AUTHOR]

With almost 700 000 estimated cases each year in the United States and Europe, Lyme borreliosis (LB), also called Lyme disease, is the most common tick-borne illness in the world. Transmitted by ticks of the genus Ixodes and caused by bacteria Borrelia burgdorferi sensu lato, LB occurs with various symptoms, such as erythema migrans, which is characteristic, whereas others involve blurred clinical features such as fatigue, headaches, arthralgia, and myalgia. The diagnosis of Lyme borreliosis, based on a standard two-tiered serology, is the subject of many debates and controversies, since it relies on an indirect approach which suffers from a low sensitivity depending on the stage of the disease. Above all, early detection of the disease raises some issues. Inappropriate diagnosis of Lyme borreliosis leads to therapeutic wandering, inducing potential chronic infection with a strong antibody response that fails to clear the infection. Early and proper detection of Lyme disease is essential to propose an adequate treatment to patients and avoid the persistence of the pathogen. This review presents the available tests, with an emphasis on the improvements of the current diagnosis, the innovative methods and ideas which, ultimately, will allow more precise detection of LB. [ABSTRACT FROM AUTHOR]

Background: Enhanced recovery after surgery (ERAS) is a pathway designed to improve the care of surgical patients and achieve early recovery. The clinical outcomes and usage of key elements of ERAS pathways in total joint arthroplasty (TJA) need further reanalysis. This article aims to provide an overview of the latest clinical outcomes and current usage of key elements of ERAS pathways in TJA. Methods: We undertook a systematic review of the PubMed, OVID, and EMBASE databases in February 2022. Studies investigating the clinical outcomes and usage of key elements of ERAS in TJA were included. The components of successful ERAS programs and their usage were further determined and discussed. Results: Twenty‐four studies involving 216,708 patients assessed ERAS pathways for TJA. A total of 95.8% (23/24) of studies reported a reduced length of stay (LOS), followed by reduce overall opioid consumption or pain (87.5% [7/8]), save costs (85.7% [6/7]), improvements in patient‐reported outcomes or functional recovery (60% [6/10]), and reduced incidence of complications (50% [5/10]). In addition, preoperative patient education (79.2% [19/24]), anesthetic protocol (54.2% [13/24]), use of local anesthetics for infiltration analgesia or nerve blocks (79.2% [19/24]), perioperative oral analgesia (66.7% [16/24]), perioperative surgical factors including reduced use of tourniquets and drains (41.7% [10/24]), use of tranexamic acid (41.7% [10/24]) and early mobilization (100% [24/24]) were contemporary comparatively "active" components of ERAS. Conclusions: ERAS for TJA has favorable clinical outcomes in terms of reducing LOS and overall pain, saving costs, accelerating functional recovery, and reducing complications, although the evidence is still low in quality. In the current clinical scenario, only some "active" components of the ERAS program are widely used. [ABSTRACT FROM AUTHOR]

Objective: The aim was to determine the utilization of Caprini guideline-indicated venous thromboembolism (VTE) prophylaxis and impact on VTE and bleeding outcomes in otolaryngology (ORL) surgery patients., Methods: Elective ORL surgeries performed between 2016 and 2021 were retrospectively identified. Logistic regression models were used to examine the association between patient characteristics and receiving appropriate prophylaxis, inpatient, 30- and 90-day VTE and bleeding events., Results: A total of 4955 elective ORL surgeries were analyzed. Thirty percent of the inpatient cohort and 2% of the discharged cohort received appropriate risk-stratified VTE prophylaxis. In those who did not receive appropriate prophylaxis, overall inpatient VTE was 3.5-fold higher (0.73% vs. 0.20%, p = 0.015), and all PE occurred in this cohort (0.47% vs. 0.00%, p = 0.005). All 30- and 90-day discharged VTE events occurred in those not receiving appropriate prophylaxis. Inpatient, 30- and 90-day discharged bleeding rates were 2.10%, 0.13%, and 0.33%, respectively. Although inpatient bleeding was significantly higher in those receiving appropriate prophylaxis, all 30- and 90-day post-discharge bleeding events occurred in patients not receiving appropriate prophylaxis. On regression analysis, Caprini score was significantly positively associated with likelihood of receiving appropriate inpatient prophylaxis (odds ratio [OR] 1.05, confidence interval [CI] 1.03-1.07) but was negatively associated in the discharge cohort (OR 0.43, CI 0.36-0.51). Receipt of appropriate prophylaxis was associated with reduced odds of inpatient VTE (OR 0.24, CI 0.06-0.69), but not with risk of bleeding., Conclusion: Although Caprini VTE risk-stratified prophylaxis has a positive impact in reducing inpatient and post-discharge VTE, it must be balanced against the risk of inpatient postoperative bleeding., Level of Evidence: 3 Laryngoscope, 134:1169-1182, 2024., (© 2023 The American Laryngological, Rhinological and Otological Society, Inc.)

Patients with liver disease and portal hypertension frequently require surgery carrying high morbidity and mortality. Accurately estimating surgical risk remains challenging despite improved medical and surgical management. This review aims to outline a comprehensive approach to preoperative assessment, appraise methods used to predict surgical risk, and provide an up-to-date overview of outcomes for patients with cirrhosis undergoing non-hepatic surgery. Robust preoperative, individually tailored, and precise risk assessment can reduce peri- and postoperative complications in patients with cirrhosis. Established prognostic scores aid stratification, providing an estimation of postoperative mortality, albeit with limitations. VOCAL-Penn Risk Score may provide greater precision than established liver severity scores. Amelioration of portal hypertension in advance of surgery may be considered, with prospective data demonstrating hepatic venous pressure gradient as a promising surrogate marker of postoperative outcomes. Morbidity and mortality vary between types of surgery with further studies required in patients with more advanced liver disease. Patient-specific considerations and practicing precision medicine may allow for improved postoperative outcomes. [ABSTRACT FROM AUTHOR]

Fondaparinux sodium is a chemically synthesized selective factor Xa inhibitor approved for the prevention and treatment of venous thromboembolic events, that is, deep vein thrombosis, pulmonary embolism, and superficial vein thrombosis, in acutely ill (including those affected by COVID-19 or cancer patients) and those undergoing surgeries. Since its approval in 2002, the efficacy and safety of fondaparinux is well demonstrated by many clinical studies, establishing the value of fondaparinux in clinical practice. Some of the advantages with fondaparinux are its chemical nature of synthesis, minimal risk of contamination, 100% absolute bioavailability subcutaneously, instant onset of action, a long half-life, direct renal excretion, fewer adverse reactions when compared with direct oral anticoagulants, and being an ideal alternative in conditions where oral anticoagulants are not approved for use or in patients intolerant to low molecular weight heparins (LMWH). In the last decade, the real-world use of fondaparinux has been explored in other conditions such as acute coronary syndromes, bariatric surgery, in patients developing vaccineinduced immune thrombotic thrombocytopenia (VITT) and in pregnant women with heparin-induced thrombocytopenia (HIT), or those intolerant to LMWH. The emerging data from these studies have culminated in recent updates in the guidelines that recommend the use of fondaparinux under various conditions. This paper aims to review the recent data and the subsequent updates in the recommendations of various guidelines on the use of fondaparinux sodium. [ABSTRACT FROM AUTHOR]

Background: In this study, we aimed to determine the mortality risk factors and whether placement of a vena cava filter improves the prognosis of acute upper extremity deep vein thrombosis (UEDVT). Methods: Clinical data and follow-up results were retrospectively analyzed. Cox regression analysis was conducted to identify the risk factors associated with all-cause mortality in all patients and subgroups of patients. Results are expressed as hazard ratio (HR) with 95% confidence intervals (95% CI). Receiver operating characteristic curves (ROC) were used to determine the optimal cut-off value. Kaplan–Meier survival curves were constructed and compared by the Log rank test. Results: The study cohort comprised 109 patients of median age 56 years (47.5, 64.5). The median follow-up time was 25 months (8, 47): 39 patients (35.8%) had died by 12 months, 55 (50.5%) by 36 months, and 60 (55%) by the end of follow-up. Presence of malignancy (HR: 5.882, 95% CI: 2.128– 16.667), D-dimer (HR: 1.56, 95% CI: 1.09– 1.94), platelet/lymphocyte ratio (PLR; HR: 2.02, 95% CI: 1.15– 3.54), and the systemic immune/inflammatory index (SII; HR: 1.471, 95% CI: 1.062– 1.991) were identified as independent risk factors for mortality. Subgroup analysis of patients with malignancy determined gender (HR: 2.936, 95% CI: 1.599– 5.393) and PLR (HR: 1.427,95% CI: 1.023– 1.989) as independent risk factors. Kaplan–Meier analysis showed that the mortality rate was much higher in patients with malignancy, high D-dimer (≥ 0.92ug/mL), high PLR (≥ 291) and high SII (≥ 1487). However, there was no significant difference between patients with and without vena cava filters. Conclusion: In this study, we identified PLR as an new independent predictor of mortality in patients with acute UEDVT. Emergency placement of a vena cava filter did not improve long-term prognosis. [ABSTRACT FROM AUTHOR]

K-12 schools are facing a syndemic of critical junctures right now: On the one hand, school communities and families are still reeling from the effects of racial reckonings and the COVID-19 pandemic, while on the other hand, school leaders and decision-makers are grappling with how to effectively engage families and students amid demands and realizations for equity and justice. The book Just Schools: Building Equitable Collaborations with Families and Communities (2020) by Ann Ishimaru provides tools and pathways forward. Ishimaru first describes how our education systems have long been incubators of oppression and disengagement, steeped in colonizing methods and deficit views of "nondominant" families and traditions. Through narratives--grounded in her experiences and those of other families--she highlights examples of how schools and systems have narrowed or blocked opportunities for "equitable collaborations." In response, Ishimaru offers frameworks grounded in critical race theory, decolonizing methods, cultural-historical activity theory, and cross-sector collaborations to foster more just and equitable partnerships between schools and families. To operationalize these frameworks and shape reader understanding, she then offers several case studies that exhibit participatory, co-designed spaces and processes that center the family and school community. Just Schools: Building Equitable Collaborations With Families and Communities is a critical read for educational leaders and school community stakeholders seeking to redesign school, family, and community partnerships; improve school governance structures and methods; and rewrite the dominant narrative of educational systems that often exclude parents and families via traditional methods of engagement. [ABSTRACT FROM AUTHOR]

Highlights: Ultrafast laser-induced nano-topography modifications: generation of highly concentrated 20 nm diameter nanowells on the surface with expected applications for storage of chemical and biological active species and for blocking crack propagation. Ultrafast laser-induced structural modifications: turning of a metallic glass to a composite material of monoclinic zirconia crystallites embedded inside amorphous metallic glass. A flexible one-step laser irradiation process without direct mechanical contact for thin film metallic glasses surface functionalization.We present an effective approach for fabricating nanowell arrays in a one-step laser process with promising applications for the storage and detection of chemical or biological elements. Biocompatible thin films of metallic glasses are manufactured with a selected composition of Zr65Cu35, known to exhibit remarkable mechanical properties and glass forming ability. Dense nanowell arrays spontaneously form in the ultrafast laser irradiation spot with dimensions down to 20 nm. The flared shape observed by transmission electron microscopy is ideal to ensure chemical or biological material immobilization into the nanowells. This also indicates that the localization of the cavitation-induced nanopores can be tuned by the density and size of the initial nanometric interstice from the columnar structure of films deposited by magnetron sputtering. In addition to the topographic functionalization, the laser-irradiated amorphous material exhibits structural changes analyzed by spectroscopic techniques at the nanoscale such as energy-dispersive X-ray spectroscopy and electron energy loss spectroscopy. Results reveal structural changes consisting of nanocrystals of monoclinic zirconia that grow within the amorphous matrix. The mechanism is driven by local oxidation process catalyzed by extreme temperature and pressure conditions estimated by an atomistic simulation of the laser-induced nanowell formation. [ABSTRACT FROM AUTHOR]

The science of nanotechnology is expanding daily and has the potential to benefit people. Moringa oleifera is an abundant source of phenolic compounds, which are bioactive substances. It is recognised as a necessary plant because of its medicinal potential and a wide variety of health benefits. The aim of the current study is to examine the antioxidant, antibacterial, and cytotoxicity effects of five nanoparticles (La2O3, CuO, Fe2O3, Ag, and ZnO) made using bioactive chemicals in the aqueous extract of Moringa oleifera leaves on four human cell lines (T47D, HepG2, A549, and Wi38). The UV–visible spectroscopy analysis with a surface plasmon peak in the 300–490 nm range and the value of the zeta potential of the various biosynthesized nanoparticles ranged from + 31 to + 37 mV, indicated the repulsion between the particles and the stability of the formulation nanoparticles confirmed the formation of all nanoparticles. Additionally, the DPPH method was used to assess the antioxidant activity of five distinct metal nanoparticles. The results show that this method works in parallel and is dependent on both the concentration of NPs and the incubation time. The anticancer effect of synthesized nanoparticles against four different cell lines has been tested. The cytotoxicity assay showed a dose-dependent and time-dependent effect of nanoparticles. The obtained results conclude that acceptable potency against T47D and A549 cell lines with IC50 ranged from 38 to 210 μg/mL and 26 to 115 μg/mL, respectively. However, HepG2 and Wi38 cell lines showed relatively higher resistance against all tested nanoparticles when compared with Doxorubicin. Moreover, the antibacterial results revealed that silver nanoparticles exhibited the highest antibacterial activity against both Enterococcus faecalis and Staphylococcus aureus. Nanoparticles' high therapeutic activity at low concentrations opens up new avenues for the development of novel therapeutic approaches against human pathogens. [ABSTRACT FROM AUTHOR]