ROBOtic Care Outcomes Project for acute gallbladder pathology

BACKGROUND

Robotic cholecystectomy is being increasingly used for patients with acute gallbladder disease who present to the emergency department, but clinical evidence is limited. We aimed to compare the outcomes of emergent laparoscopic and robotic cholecystectomies in a large real-world database.

METHODS

Patients who received emergent laparoscopic or robotic cholecystectomies from 2020 to 2022 were identified from the Intuitive Custom Hospital Analytics database, based on deidentified extraction of electronic health record data from US hospitals. Conversion to open or subtotal cholecystectomy and complications were defined using ICD10 and/or CPT codes. Multivariate logistic regression with inverse probability treatment weighting (IPTW) was performed to compare clinical outcomes of laparoscopic versus robotic approach after balancing covariates. Cost analysis was performed with activity-based costing and adjustment for inflation.

RESULTS

Of 26,786 laparoscopic and 3,151 robotic emergent cholecystectomy patients being included, 64% were female, 60% were ≥45 years, and 24% were obese. Approximately 5.5% patients presented with pancreatitis, and 4% each presenting with sepsis and biliary obstruction. After IPTW, distributions of all baseline covariates were balanced. Robotic cholecystectomy decreased odds of conversion to open (odds ratio, 0.68; 95% confidence interval, 0.49-0.93; p = 0.035), but increased odds of subtotal cholecystectomy (odds ratio, 1.64; 95% confidence interval, 1.03-2.60; p = 0.037). Surgical site infection, readmission, length of stay, hospital acquired conditions, bile duct injury or leak, and hospital mortality were similar in both groups. There was no significant difference in hospital cost.

CONCLUSION

Robotic cholecystectomy has reduced odds of conversion to open and comparable complications, but increased odds of subtotal cholecystectomy compared with laparoscopic cholecystectomy for acute gallbladder diseases. Further work is required to assess the long-term implications of these differences.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level IV.

Mid-infrared single-photon upconversion spectroscopy enabled by nonlocal wavelength-to-time mapping

Ultrasensitive spectroscopy is an essential component in mid-infrared (MIR) technology. However, the drawbacks of MIR detectors pose challenges to robust MIR spectroscopy at the single-photon level. We propose an MIR single-photon frequency upconversion spectroscopy nonlocally mapping the MIR information to the time domain. Broadband MIR photons from spontaneous parametric downconversion are frequency-upconverted to the near-infrared band with quantum correlation preservation. Via the group delay of fiber, the MIR spectral information within a 1.18-micrometer bandwidth of 2.76 to 3.94 micrometers is then successfully projected to arrival times of correlated photon pairs. Under the conditions of 6.4 × 106 photons per second illumination, the transmission spectra of polymers with single-photon sensitivity are demonstrated using single-pixel detectors. The developed approach circumvents scanning and frequency selection instability, which stands out for its inherent compatibility for evolving environments and scalability for various wavelengths. Because of its high sensitivity and robustness, characterization of biochemical samples and weak measurement of quantum systems are possible to foresee.

Association of Residency Applicants' Hobbies and Subsequent Technical Proficiency Ratings as General Surgery Chief Residents: A Multi-Institutional Study

OBJECTIVE

To determine whether participation in certain hobbies (e.g., participation in sports, playing musical instruments, or other hobbies requiring fine motor skills), preresidency, are associated with higher technical skills ratings at the time of residency graduation.

DESIGN

Faculty members from 14 general surgery residency programs scored individual graduates from 2017 to 2020 on their technical skills using a 5-point Likert scale. Hobbies for these residents were collected from their Electronic Residency Application Service (ERAS) data. A single reviewer classified each ERAS hobby into predefined categories including musical instruments, sports requiring hand-eye coordination, team sports, and activities necessitating hand-eye coordination. Spearman correlation coefficients were calculated for the relationship between each category of hobby-as well as the total number of hobbies in each category-and the outcome of surgical faculty ratings of residents' technical surgical skills during their last year of residency. A proportional odds model including the above predictive variables was also fit to the data.

SETTING

Fourteen general surgery residency programs.

PARTICIPANTS

General surgery residency graduates from 14 different programs from 2017 to 2020.

RESULTS

There were 296 residents across 14 institutions. The average ranking of residents' technical skills was 3.24 (SD 1.1). A total of 40% of residents played sports involving hand-eye coordination, 31% played team sports, 28% participated in nonsport hobbies that require eye-hand coordination, and 20% played musical instruments. Correlation coefficients were not statistically significant for any of the categories. In the proportional odds model, none of the variables were associated with statistically significant increased odds of a higher technical skills rating.

CONCLUSIONS

There was no correlation between general surgery chief residents' technical skills as rated by faculty, and self-reported pre-residency hobbies on the ERAS application. These findings suggest such hobbies prior to residency are unlikely to predict future technical skills prowess.

A Medium-Term Comparison of Quality of Life and Pain After Robotic or Laparoscopic Cholecystectomy

INTRODUCTION

We sought to compare medium-term outcomes between robotic-assisted cholecystectomy (RC) and laparoscopic cholecystectomy (LC) using validated quality of life (QoL) and pain assessments.

MATERIALS AND METHODS

Patients who underwent RC or LC between 2012 and 2017 at a single academic institution were examined. Cases converted to open were excluded. Patients were contacted by telephone in 2019 and completed two standardized surveys to rate their QoL and pain.

RESULTS

Of those screened, 122 (35.8%) completed both surveys. Ninety three (76.2%) underwent RC and 29 (23.8%) underwent LC. The groups (RC versus LC) were similar based on mean age (47.9 versus 45.5 y, P = 0.48), gender (66.7% versus 72.4% female, P = 0.56), race (86.0% White/5.4% Black versus 72.4% White/13.8% Black, P = 0.2), insurance status (98.9% versus 100.0% insured, P = 0.58), median body mass index (31.8 versus 31.3, P = 0.43), and median Charlson Comorbidity Index (1 versus 0, P = 0.14). Fewer RC patients had a history of steroid use compared to LC (16.1% versus 34.5%, P = 0.03). No overall significant difference in QoL was demonstrated. LC group had higher severity of "tiring-exhausting pain" (P = 0.04), "electric-shock pain" (P = 0.003), and "shooting pain" (P = 0.05). The "overall intensity" of pain in the "gallbladder region" between the groups was similar at the time of follow-up (P = 0.31).

CONCLUSIONS

QoL over 2-7 y following time of surgery is comparable for robotic-assisted versus conventional laparoscopic cholecystectomies. The laparoscopic approach may be associated with a higher severity of subset categories of pain, but overall pain between the two approaches is comparable.

Wide-field mid-infrared hyperspectral imaging beyond video rate

Mid-infrared hyperspectral imaging has become an indispensable tool to spatially resolve chemical information in a wide variety of samples. However, acquiring three-dimensional data cubes is typically time-consuming due to the limited speed of raster scanning or wavelength tuning, which impedes real-time visualization with high spatial definition across broad spectral bands. Here, we devise and implement a high-speed, wide-field mid-infrared hyperspectral imaging system relying on broadband parametric upconversion of high-brightness supercontinuum illumination at the Fourier plane. The upconverted replica is spectrally decomposed by a rapid acousto-optic tunable filter, which records high-definition monochromatic images at a frame rate of 10 kHz based on a megapixel silicon camera. Consequently, the hyperspectral imager allows us to acquire 100 spectral bands over 2600-4085 cm-1 in 10 ms, corresponding to a refreshing rate of 100 Hz. Moreover, the angular dependence of phase matching in the image upconversion is leveraged to realize snapshot operation with spatial multiplexing for multiple spectral channels, which may further boost the spectral imaging rate. The high acquisition rate, wide-field operation, and broadband spectral coverage could open new possibilities for high-throughput characterization of transient processes in material and life sciences.

Approaching Effective Differential Centrifugal Fractionation by Combining Image Analysis with Analytical Ultracentrifugation

Centrifugation is one of the most commonly used methods for separation in biology and chemistry. However, effective fractionation is not always easy to obtain, as preparative centrifuge experiments are mostly conducted in an empirical way, even when it is guided by the quantitative results from analytical ultracentrifuge (AUC). Very few works have been performed to enhance the fractionation resolution of the differential centrifugation method in a swing-out rotor. This is primarily due to the absence of a characterization tool for sedimentation in the preparative centrifuge. In this study, we utilized image analysis to map the particle concentration distribution throughout the preparative centrifuge tube, revealing an unexpected and abnormal sedimentation process. By characterizing the sedimentation coefficient distributions of the fractionated product via AUC, we demonstrated that the overall sedimentation efficiency in a swing-out preparative centrifuge was significantly reduced. Furthermore, effective fractionation was confined to the intermediate phase of the entire sedimentation process. We propose that the mechanism here is a combination of the inverse Boycott effect and droplet sedimentation. The actual sedimentation process within a preparative centrifuge can be described by modifying the Lamm equation phenomenologically, which simply results in an effective sedimentation coefficient. Our work builds a foundation for determining the optimal preparative centrifugation conditions for various systems.

EMNPD: a comprehensive endophytic microorganism natural products database for prompt the discovery of new bioactive substances

The discovery and utilization of natural products derived from endophytic microorganisms have garnered significant attention in pharmaceutical research. While remarkable progress has been made in this field each year, the absence of dedicated open-access databases for endophytic microorganism natural products research is evident. To address the increasing demand for mining and sharing of data resources related to endophytic microorganism natural products, this study introduces EMNPD, a comprehensive endophytic microorganism natural products database comprising manually curated data. Currently, EMNPD offers 6632 natural products from 1017 endophytic microorganisms, targeting 1286 entities (including 94 proteins, 282 cell lines, and 910 species) with 91 diverse bioactivities. It encompasses the physico-chemical properties of natural products, ADMET information, quantitative activity data with their potency, natural products contents with diverse fermentation conditions, systematic taxonomy, and links to various well-established databases. EMNPD aims to function as an open-access knowledge repository for the study of endophytic microorganisms and their natural products, thereby facilitating drug discovery research and exploration of bioactive substances. The database can be accessed at http://emnpd.idrblab.cn/ without the need for registration, enabling researchers to freely download the data. EMNPD is expected to become a valuable resource in the field of endophytic microorganism natural products and contribute to future drug development endeavors.

Association of tea and coffee consumption with the risk of all-cause and cause-specific mortality among individuals with metabolic syndrome: a prospective cohort study

BACKGROUND

The relationship between tea and coffee consumption and mortality among patients with metabolic syndrome (MetS) remains barely explored. Herein, this study aimed to examine the association between tea and coffee consumption and the likelihood of all-cause and cause-specific mortality in patients with MetS.

METHODS

A total of 118,872 participants with MetS at baseline from the UK Biobank cohort were included. Information on tea and coffee consumption was obtained during recruitment using a touchscreen questionnaire. Hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality were determined using Cox proportional hazards models.

RESULTS

During a median follow-up of 13.87 years, 13,666 deaths were recorded, with 5913, 3362, and 994 deaths from cancer, cardiovascular diseases (CVD), and respiratory disease (RD), respectively. This research showed a significant inverse association between tea intake and the risk of all-cause and cancer mortality, the respective HRs (95% CI) for consuming tea 2 vs. 0 cup/day were 0.89 (0.84-0.95), and 0.91 (0.83-0.99), and tea intake ≥ 4 cups/day could reduce CVD mortality by 11% (HR 0.89; 95% CI 0.81-0.98). The U-shaped nonlinear association between coffee intake and all-cause/CVD mortality was examined (all p-nonlinear < 0.001). The HRs (95% CI) for coffee consumption 1 vs. 0 cup/day were 0.93 (0.89-0.98) and 0.89 (0.80-0.99), and for ≥ 4 vs. 0 cup/day were 1.05 (1.01-1.11) and 1.13 (1.03-1.25), respectively. Notably, the combined intake of tea and coffee presented a protective effect against all-cause mortality (HR < 1).

CONCLUSIONS

The importance of daily tea and moderate coffee consumption in individuals with MetS to optimise health benefits are highlighted.

Prospective Assessment of Social Determinants of Health and Length of Stay Among Emergency General Surgery and Trauma Patients

BACKGROUND

Social determinants of health (SDOH) including insurance and substance use affect 50-90% of health outcomes, yet there remains no standard means to quantify or predict their impact. We prospectively evaluated the effects of SDOH on length of stay (LOS) and readmissions among emergency general surgery (EGS) and trauma patients. We compared these outcomes with Medicare Diagnosis Related Group (DRG) data to better quantify the impact of SDOH.

METHODS

Adult (≥18 years old) EGS/trauma patients admitted July 7-28, 2020 at a Level 1 trauma center were prospectively enrolled. Primary outcomes were overall LOS, one-year readmissions, and excess LOS (eLOS), defined as days beyond DRG mean LOS.

RESULTS

Assessment of SDOH among the 52 patients enrolled revealed that 5.8% of patients were homeless; 26.9% experienced substance abuse; 13.5% were uninsured on admission; and 7.7% on discharge. Mean LOS was 5 ± 4 days; 1-year readmission rate 25.0%; eLOS mean 1.75 ± 2.4 days. LOS was associated with substance use (OR 70.6 95% CI 11.7-160.4). eLOS was associated with substance use (OR 6.1, 95% CI 1.5-25.1) and public or no insurance (OR 26.0, 95% CI 4.9-138.1). No correlations were found between SDOH and readmission rates.

DISCUSSION

EGS and trauma patients experience high rates of negative SDOH which affect clinical outcomes including LOS and readmissions. Medicare DRG determined eLOS is a fiscally relevant measure of the impact of SDOH and differs from LOS and readmissions. Further investigation is required to determine if eLOS can delineate the effects of other SDOH on admission outcomes for this patient population.

Association of serum 25-hydroxyvitamin D with the incidence of 16 cancers, cancer mortality, and all-cause mortality among individuals with metabolic syndrome: a prospective cohort study

PURPOSE

The relationship between vitamin D levels and cancer incidence and mortality in individuals with metabolic syndrome (MetS) remains poorly explored. Herein, we aimed to determine the association between 25-hydroxyvitamin D [25(OH)D] concentrations and the risk of 16 cancer incidence types and cancer/all-cause mortality in patients with MetS.

METHODS

We enrolled 97,621 participants with MetS at recruitment from the UK Biobank cohort. The exposure factor was baseline serum 25(OH)D concentrations. The associations were examined using Cox proportional hazards models, which were displayed as hazard ratios (HRs) with 95% confidence intervals (CIs).

RESULTS

Over a median follow-up period of 10.92 years for cancer incidence outcomes, 12,137 new cancer cases were recorded. We observed that 25(OH)D concentrations were inversely related to the risk of colon, lung, and kidney cancer, and HRs (95% CI) for 25(OH)D ≥ 75.0 vs. < 25.0 nmol/L were 0.67 (0.45-0.98), 0.64 (0.45-0.91), and 0.54 (0.31-0.95), respectively. The fully adjusted model revealed a null correlation between 25(OH)D and the incidence of stomach, rectum, liver, pancreas, breast, ovary, bladder, brain, multiple myeloma, leukemia, non-Hodgkin lymphoma, esophagus, and corpus uteri cancer. Over a median follow-up period of 12.72 years for mortality outcomes, 8286 fatalities (including 3210 cancer mortalities) were documented. An "L-shaped" nonlinear dose-response correlation was detected between 25(OH)D and cancer/all-cause mortality; the respective HRs (95% CI) were 0.75 (0.64-0.89) and 0.65 (0.58-0.72).

CONCLUSION

These findings emphasize the importance of 25(OH)D in cancer prevention and longevity promotion among patients with MetS.

Childhood-Onset Lupus Nephritis in the Childhood Arthritis and Rheumatology Research Alliance Registry: Short-Term Kidney Status and Variation in Care

OBJECTIVE

The goal was to characterize short-term kidney status and describe variation in early care utilization in a multicenter cohort of patients with childhood-onset systemic lupus erythematosus (cSLE) and nephritis.

METHODS

We analyzed previously collected prospective data from North American patients with cSLE with kidney biopsy-proven nephritis enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry from March 2017 through December 2019. We determined the proportion of patients with abnormal kidney status at the most recent registry visit and applied generalized linear mixed models to identify associated factors. We also calculated frequency of medication use, both during induction and ever recorded.

RESULTS

We identified 222 patients with kidney biopsy-proven nephritis, with 64% class III/IV nephritis on initial biopsy. At the most recent registry visit at median (interquartile range) of 17 (8-29) months from initial kidney biopsy, 58 of 106 patients (55%) with available data had abnormal kidney status. This finding was associated with male sex (odds ratio [OR] 3.88, 95% confidence interval [95% CI] 1.21-12.46) and age at cSLE diagnosis (OR 1.23, 95% CI 1.01-1.49). Patients with class IV nephritis were more likely than class III to receive cyclophosphamide and rituximab during induction. There was substantial variation in mycophenolate, cyclophosphamide, and rituximab ever use patterns across rheumatology centers.

CONCLUSION

In this cohort with predominately class III/IV nephritis, male sex and older age at cSLE diagnosis were associated with abnormal short-term kidney status. We also observed substantial variation in contemporary medication use for pediatric lupus nephritis between pediatric rheumatology centers. Additional studies are needed to better understand the impact of this variation on long-term kidney outcomes.

Mid-infrared single-photon 3D imaging

Active mid-infrared (MIR) imagers capable of retrieving three-dimensional (3D) structure and reflectivity information are highly attractive in a wide range of biomedical and industrial applications. However, infrared 3D imaging at low-light levels is still challenging due to the deficiency of sensitive and fast MIR sensors. Here we propose and implement a MIR time-of-flight imaging system that operates at single-photon sensitivity and femtosecond timing resolution. Specifically, back-scattered infrared photons from a scene are optically gated by delay-controlled ultrashort pump pulses through nonlinear frequency upconversion. The upconverted images with time stamps are then recorded by a silicon camera to facilitate the 3D reconstruction with high lateral and depth resolutions. Moreover, an effective numerical denoiser based on spatiotemporal correlation allows us to reveal the object profile and reflectivity under photon-starving conditions with a detected flux below 0.05 photons/pixel/second. The presented MIR 3D imager features high detection sensitivity, precise timing resolution, and wide-field operation, which may open new possibilities in life and material sciences.

Temperature-dependent photoluminescence properties of single defects in AlGaN micropillars

Single-photon emitters (SPEs) are attractive as integrated platforms for quantum applications in technologically mature wide-bandgap semiconductors since their stable operation at room temperature or even at high temperatures. In this study, we systematically studied the temperature dependence of the SPE in AlGaN micropillar by experiment. The photoluminescence (PL) spectrum, PL intensity, radiative lifetime and second-order autocorrelation function measurements are investigated over the temperature range from 303 to 373 K. The point defects of AlGaN show strong zero phonon line in the wavelength range of 800-900 nm and highly antibunched photon emission even up to 373 K. Our study reveals a possible mechanism for linewidth broadening in AlGaN SPE at high temperatures. This indicates a possible key for on-chip integration applications based on this material operating at high temperatures.

Data-driven electrolyte design for lithium metal anodes

Improving Coulombic efficiency (CE) is key to the adoption of high energy density lithium metal batteries. Liquid electrolyte engineering has emerged as a promising strategy for improving the CE of lithium metal batteries, but its complexity renders the performance prediction and design of electrolytes challenging. Here, we develop machine learning (ML) models that assist and accelerate the design of high-performance electrolytes. Using the elemental composition of electrolytes as the features of our models, we apply linear regression, random forest, and bagging models to identify the critical features for predicting CE. Our models reveal that a reduction in the solvent oxygen content is critical for superior CE. We use the ML models to design electrolyte formulations with fluorine-free solvents that achieve a high CE of 99.70%. This work highlights the promise of data-driven approaches that can accelerate the design of high-performance electrolytes for lithium metal batteries.

Plasma poration: Transdermal electric fields, conduction currents, and reactive species transport

Radical species and electric fields produced by gas plasmas are increasingly used in dermatology. Plasma-poration is the key basis for the efficient plasma skin treatment, which involves the plasma electric field, the directional motion of charged particles, and the transport of reactive particles. However, the enabling mechanisms of the plasma-poration remain unclear and require urgent attention. Here, the plasma-induced electric fields in each skin layer are accurately measured for the first time. The maximum electric field in the stratum corneum is 43 kV/cm, while the electric field in the active epidermis and dermis is about 1.8 kV/cm. This electric field strength is in the range of strength required for electroporation. Different from traditional electroporation treatments, the plasma-poration mainly relies on the effects of strong electric fields and the conductive current. The active power of the plasma-poration up to 18.5 kW/cm3 in the stratum corneum can rapidly change the structure of the skin. At the same time, reactive oxygen and nitrogen species also pass through the stratum corneum and effectively interact with the skin tissue. The plasma-poration does not cause any pain, which is an inevitable side effect of common electroporation.

Deciphering the photophysical properties of near-infrared quantum emitters in AlGaN films by transition dynamics

Point defects in wide bandgap III-nitride semiconductors have been recently reported to be one kind of the most promising near-infrared (NIR) quantum emitters operating at room temperature (RT). But the identification of the point defect species and the energy level structures as well as the transition dynamics remain unclear. Here, the photophysical properties of single-photon emission from point defects in AlGaN films are investigated in detail. According to the first-principles calculations, a three-level model was established to explain the transition dynamics of the quantum emitters. An anti-site nitrogen vacancy complex (V_NN_Ga) was demonstrated to be the most likely origin of the measured emitter since the calculated zero-phonon line (ZPL) and the lifetime of V_NN_Ga in the AlGaN film coincide well with the experimental results. Our results provide new insights into the optical properties and energy level structures of quantum emission from point defects in AlGaN films at RT and establish the foundation for future AlGaN-based on-chip quantum technologies.

Intraarticular steroids as DMARD-sparing agents for juvenile idiopathic arthritis flares: Analysis of the Childhood Arthritis and Rheumatology Research Alliance Registry

BACKGROUND

Children with juvenile idiopathic arthritis (JIA) who achieve a drug free remission often experience a flare of their disease requiring either intraarticular steroids (IAS) or systemic treatment with disease modifying anti-rheumatic drugs (DMARDs). IAS offer an opportunity to recapture disease control and avoid exposure to side effects from systemic immunosuppression. We examined a cohort of patients treated with IAS after drug free remission and report the probability of restarting systemic treatment within 12 months.

METHODS

We analyzed a cohort of patients from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry who received IAS for a flare after a period of drug free remission. Historical factors and clinical characteristics and of the patients including data obtained at the time of treatment were analyzed.

RESULTS

We identified 46 patients who met the inclusion criteria. Of those with follow up data available 49% had restarted systemic treatment 6 months after IAS injection and 70% had restarted systemic treatment at 12 months. The proportion of patients with prior use of a biologic DMARD was the only factor that differed between patients who restarted systemic treatment those who did not, both at 6 months (79% vs 35%, p < 0.01) and 12 months (81% vs 33%, p < 0.05).

CONCLUSION

While IAS are an option for all patients who flare after drug free remission, it may not prevent the need to restart systemic treatment. Prior use of a biologic DMARD may predict lack of success for IAS. Those who previously received methotrexate only, on the other hand, are excellent candidates for IAS.

Operating Room Lockers and Gender Equity in the Surgical Workforce

This study assesses gender parity in operating room locker room conditions.

Genetic risk, incident colorectal cancer, and the benefits of adhering to a healthy lifestyle: A prospective study using data from UK Biobank and FinnGen

Background

Genetic factors increase the individual risk of colorectal cancer (CRC); however, the extent to which a healthy lifestyle can offset increased genetic risk is unknown. This study investigated whether a healthy lifestyle is associated with lower CRC risk, regardless of genetic risk.

Methods

We recruited 390,365 participants without cancer at baseline (2006-2010) from the UK Biobank. The primary outcome was CRC incidence. A healthy lifestyle score constructed using 16 factors of six dimensions (smoking, drinking, body mass index, diet, exercise, and sleep) was categorized into three risk categories: favorable, intermediate, and unfavorable. To calculate the polygenic risk scores (PRSs) of UK Biobank participants, we extracted 454,678 single nucleotide polymorphisms (SNPs) from the UK Biobank and FinnGen Biobank after quality control. Cox proportional hazards regression was performed to evaluate the associations and was expressed as hazard ratios (HRs) with 95% confidence intervals (CIs).

Results

During a median follow-up of 10.90 years, 4,090 new CRC cases were reported in the UK Biobank. The "best-fit" PRSs were constructed using 59 SNPs based on the UK Biobank cohort and FinnGen genome-wide association study summary data (R² = 0.23%) and were divided into low (lowest quintile), intermediate (including second-fourth quintile), and high (highest quintile) genetic risk categories. The multivariate-adjusted Cox model revealed that participants with favorable lifestyles had HRs of 0.66 (95% CI = 0.60-0.72) for developing CRC vs. those with unfavorable lifestyles; low genetic risk was associated with a decreased risk of CRC (HR = 0.67, 95% CI =0.61-0.74) compared with those with high genetic risk. The HRs for low genetic risk participants with favorable lifestyles were 0.44 (95% CI =0.36-0.55) vs. participants with high genetic risk and unfavorable lifestyles. Among the participants with low, intermediate, or high genetic risk, the HRs of favorable vs. unfavorable lifestyles were 0.74, 0.64, and 0.72 (all p< 0.05).

Conclusions

Low genetic risk and a favorable lifestyle were significantly associated with a decreased risk of CRC. A favorable lifestyle was associated with a lower CRC risk, regardless of genetic risk.

Predictors of surgical site infection in glioblastoma patients undergoing craniotomy for tumor resection

OBJECTIVE

Surgical site infections (SSIs) burden patients and healthcare systems, often requiring additional intervention. The objective of this study was to identify the relationship between preoperative predictors inclusive of scalp incision type and postoperative SSI following glioblastoma resection.

METHODS

The authors retrospectively reviewed cases of glioblastoma resection performed at their institution from December 2006 to December 2019 and noted preoperative demographic and clinical presentations, excluding patients missing these data. Preoperative nutritional indices were available for a subset of cases. Scalp incisions were categorized as linear/curvilinear, reverse question mark, trapdoor, or frontotemporal. Patients were dichotomized by SSI incidence. Multivariable logistic regression was used to determine predictors of SSI.

RESULTS

A total of 911 cases of glioblastoma resection were identified, 30 (3.3%) of which demonstrated postoperative SSI. There were no significant differences in preoperative malnutrition or number of surgeries between SSI and non-SSI cases. The SSI cases had a significantly lower preoperative Karnofsky Performance Status (KPS) than the non-SSI cases (63.0 vs 75.1, p < 0.0001), were more likely to have prior radiation history (43.3% vs 26.4%, p = 0.042), and were more likely to have received steroids both preoperatively and postoperatively (83.3% vs 54.5%, p = 0.002). Linear/curvilinear incisions were more common in non-SSI than in SSI cases (56.9% vs 30.0%, p = 0.004). Trapdoor scalp incisions were more frequent in SSI than non-SSI cases (43.3% vs 24.2%, p = 0.012). On multivariable analysis, a lower preoperative KPS (OR 1.04, 95% CI 1.02–1.06), a trapdoor scalp incision (OR 3.34, 95% CI 1.37–8.49), and combined preoperative and postoperative steroid administration (OR 3.52, 95% CI 1.41–10.7) were independently associated with an elevated risk of postoperative SSI.

CONCLUSIONS

The study findings indicated that SSI risk following craniotomy for glioblastoma resection may be elevated in patients with a low preoperative KPS, a trapdoor scalp incision during surgery, and steroid treatment both preoperatively and postoperatively. These data may help guide future operative decision-making for these patients.

Characteristics Associated With Outstanding General Surgery Residency Graduate Performance, as Rated by Surgical Educators

Importance

Characteristics of outstanding graduating surgical residents are currently undefined. Identifying these qualities may be important in guiding resident selection and resident education.

Objective

To determine characteristics that are most strongly associated with being rated as an outstanding graduating surgical resident.

Design, Setting, and Participants

The multi-institutional study had 3 phases. First, an expert panel developed a list of characteristics embodied by top graduating surgical residents. Second, groups of faculty from 14 US general-surgery residency programs ranked 2017 through 2020 graduates into quartiles of overall performance. Third, faculty evaluated their graduates on each characteristic using a 5-point Likert scale. Data were analyzed using Spearman rank-order correlation to identify which individual characteristics were associated with overall graduate performance. A least absolute shrinkage and selection operator (LASSO) ordinal regression was performed to select a parsimonious model to predict the outcome of overall performance rating from individual characteristic scores.

Main Outcome and Measures

Surgical educators' rankings of general surgery residency graduates' overall performance.

Results

Fifty faculty from 14 US residency programs with a median of 13 (range, 5-30) years of surgical education experience evaluated 297 general surgery residency graduates. Surgical educators identified 21 characteristics that they believed outstanding graduating surgical residents possessed. Two hundred ninety-seven surgical residency graduates were evaluated. Higher scores in every characteristic correlated with better overall performance. Characteristics most strongly associated with higher overall performance scores were surgical judgment (r = 0.728; P < .001), leadership (r = 0.726; P < .001), postoperative clinical skills (r = 0.715; P < .001), and preoperative clinical skills (r = 0.707; P < .001). The remainder of the characteristics were moderately associated with overall performance. The LASSO regression model identified 3 characteristics from which overall resident performance could be accurately predicted without measuring other qualities: surgical judgment (odds ratio [OR] per 1 level of 5-level Likert scale OR, 1.27; 95% CI, 1.03-1.51), leadership (OR, 1.27; 95% CI, 1.06-1.48), and medical knowledge (OR, 1.16; 95% CI, 1.01-1.33).

Conclusions and Relevance

All individual characteristics identified by surgical educators as being qualities of outstanding graduating surgical residents were positively associated with overall graduate performance. Surgical judgment and leadership skills had the strongest individual associations. Assessment of only 3 qualities (surgical judgment, leadership, and medical knowledge) were required to predict overall resident performance ratings. These findings highlight the importance of developing specific surgical judgment and leadership skills curricula and assessments during surgical residency.

Association of sleep duration and noise exposure with hearing loss among Chinese and American adults: two cross-sectional studies

OBJECTIVES

To examine the associations of sleep duration (SPD) and noise exposure with hearing loss (HL) among Chinese and American adults.

DESIGN

Two cross-sectional studies.

SETTING

The National Health and Nutrition Examination Survey (2011-2012), and Zhejiang Chinese participants between 1 January 2018 and 1 November 2021.

PARTICIPANTS

3322 adults from the USA and 4452 adults from Zhejiang, China.

MAIN OUTCOME MEASURES

HL was defined as a pure-tone average >20 dB in the better ear at low frequency (500, 1000 and 2000 Hz), speech frequency (500, 1000, 2000 and 4000 Hz) or high frequency (3000, 4000, 6000 and 8000 Hz). Binary logistic regression analysis quantified the associations between SPD, noise exposure (at work or off-work) and HL.

RESULTS

SPD ≥8 hours/night had an OR of 0.71 (95% CI 0.59 to 0.84) for high-frequency HL vs. an SPD of 6-8 hours/night among the Chinese participants but had an OR of 1.28 (95% CI 1.03 to 1.58) among American participants. Noise exposure (both at work and off-work) was associated with poorer low-frequency (OR 1.58, 1.43; p<0.05), speech-frequency (OR 1.63, 1.29; p<0.05) and high-frequency (OR 1.37, 1.23; p<0.05) hearing among the Chinese participants; and it was associated with worse high-frequency hearing (OR 1.43, 1.66; p<0.05) among the American participants. The negative relationship between SPD ≥8 hours/night and HL was mainly observed in the Chinese participants with noise exposure (OR <1, p<0.05), and SPD ≥8 hours/night associated with poorer HF hearing was only identified in the American participants without noise exposure (OR >1, p<0.05).

CONCLUSIONS

Noise exposure was associated with poorer hearing. SPD ≥8 hours/night was negatively associated with HL in the Chinese participants especially when exposed to noise. SPD ≥8 hours/night was related to poorer high-frequency hearing in the American participants when they had no noise exposure.

Noncausal effects of genetic predicted depression and colorectal cancer risk: A Mendelian randomization study

Depression has been associated with colorectal cancer (CRC) in observational studies. However, the causality of depression on CRC risk remained unknown. This study aimed to evaluate the potential causal association between genetic variants related to depression and the risk of CRC using Mendelian randomization (MR). Two-sample MR analysis using summary data was performed to examine whether depression was causally associated with CRC risk. We used 2 sets of instrumental variables (IV) from the genome-wide association study results for analysis. A set of IV related to major depressive disorder contain 44 single-nucleotide polymorphisms. Another set of IV was related to major depression, including 53 single-nucleotide polymorphisms. Summary data of CRC was from the FinnGen consortium. Based on the results of MR using inverse-variance weighted method, we found that genetically determined major depressive disorder (odds ratio = 1.06, 95% confidence interval = 0.77-1.45) or major depression (odds ratio = 0.77, 95% confidence interval = 0.57-1.04) did not causally increase CRC risk. The results of MR-Egger and the weighted median method are consistent with the inverse-variance weighted method. The two-sample MR analysis showed that depression is not causally associated with CRC risk. Further research is needed to investigate the association between depression and CRC.

A bidirectional Mendelian randomization study supports the causal effects of a high basal metabolic rate on colorectal cancer risk

Purpose

We conducted a bidirectional two-sample Mendelian randomization (MR) study to determine whether genetically predicted basal metabolic rate (BMR) was a causal risk factor for colorectal cancer (CRC) or whether a genetically predicted CRC risk can influence the BMR level (i.e., reverse causation).

Methods

We employed 1,040 genetic variants as proxies for BMR to obtain effect estimates on CRC risk. Another 58 CRC-associated variants were used to estimate effects on BMR levels. Stratified analysis by tumor site was used to examine the causal associations between BMR and colon/rectal cancer risk.

Results

The inverse variance weighted (IVW) method indicated a significant causal effect of genetically determined BMR on CRC risk (OR_SD = 1.27, 95% CI = 1.07–1.51). No significant reverse causal association was identified between genetically increased CRC risk and BMR levels [IVW (β = 0, 95% CI = -0.01 to 0)]. The results of MR-Egger and the weighted median method were consistent with the IVW method. Stratified analysis by CRC sites identified significant causal associations between BMR and colon cancer [IVW (OR_SD = 1.45, 95% CI = 1.16-1-80)], and null evidence of a causal association between BMR and rectal cancer risk was found (p > 0.05).

Conclusion

Our findings add to the current literature by validating a positive relationship between high BMR levels and CRC risk instead of reverse causality. The genetically predicted BMR level was causally associated with colon cancer risk but not rectal cancer risk.

Association of a Healthy Lifestyle with All-Cause, Cause-Specific Mortality and Incident Cancer among Individuals with Metabolic Syndrome: A Prospective Cohort Study in UK Biobank

This study investigated the association between a healthy lifestyle with all-cause, cause-specific mortality, and cancer incidence among individuals with metabolic syndrome (MetS). Healthy lifestyle scores were created based on MetS management guidelines, including never/quitting smoking, moderate drinking, good sleep, healthy diet, sufficient exercise, social support, and less sedentary behaviour. Weighted healthy lifestyle scores were further constructed and classified into three groups: unfavourable (lowest quintile), intermediate (quintiles 2−4), and favourable (highest quintile) lifestyles. We included 87,342 MetS participants from the UK Biobank. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using multivariate-adjusted Cox proportional hazards regression. During a median follow-up of 12.54 years, 6739 deaths were reported; during a median follow-up of 10.69 years, 10,802 new cancer cases were documented. We found a favourable lifestyle was inversely associated with all-cause mortality (HR: 0.57; 95%CI: 0.53−0.62), cause-specific mortality from respiratory disease, cancer, digestive disease, cardiovascular disease (HR < 1; p-trend < 0.001), and overall cancer incidence (HR: 0.84; 95% CI: 0.79−0.90). Our results indicate that adherence to healthy lifestyles is associated with lower overall cancer incidence and all-cause mortality risk among MetS individuals. However, causality cannot be made due to the nature of observational studies.

Consumption of fruits, vegetables, and legumes are associated with overweight/obesity in the middle- and old-aged Chongqing residents: A case-control study

This study aimed to investigate the association of dietary habits with the risk of overweight/obesity among middle-and-old-aged Chongqing residents and also to examine the joint effects of behavioral lifestyles, dietary habits, and overweight/obesity. In this case-control study, age (±3 years), sex, and time of physical exercise matched 979 overweight/obesity residents, and 979 normal weight residents were recruited. A validated questionnaire was used to collect participants' information. Conditional logistic regression analysis was performed to determine the adjusted odds ratios (ORs) and 95% CIs of dietary habits and lifestyles associated with overweight/obesity risk. Overweight/obesity was defined as body mass index (BMI) ≥ 24 kg·m-2, and normal weight was defined as 18.5 ≤ BMI < 24 kg·m-2. The multivariate-adjusted models showed the weekly intake frequency of fruits 0-1 (day/week) (OR = 1.79, 95% CI = 1.04-3.10), and legumes 0-1 (day/week) (OR = 2.45, 95% CI = 1.28-4.67), as well as the weekly intake percentage of vegetables ≥ 15% (OR = 2.44, 95% CI = 1.04-5.71) were associated with a higher risk of overweight/obesity. Besides, there were joint effects of lifestyles (smoking or drinking) and dietary habits on overweight/obesity risk (P for interaction < 0.05). The consumption of vegetables, fruits, legumes, and the joint effects of behavioral habits (smoking or drinking) may modify the risk of being overweight/obese. It is essential to consume fruits and legumes at least 2 days/week, quit smoking, and stop consuming alcohol to avoid overweight/obesity among middle-aged and elderly people in Chongqing, China.

Social determinants of health influence disease activity and functional disability in Polyarticular Juvenile Idiopathic Arthritis

BACKGROUND

Social determinants of health (SDH) greatly influence outcomes during the first year of treatment in rheumatoid arthritis, a disease similar to polyarticular juvenile idiopathic arthritis (pJIA). We investigated the correlation of community poverty level and other SDH with the persistence of moderate to severe disease activity and functional disability over the first year of treatment in pJIA patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry.

METHODS

In this cohort study, unadjusted and adjusted generalized linear mixed effects models analyzed the effect of community poverty and other SDH on disease activity, using the clinical Juvenile Arthritis Disease Activity Score-10, and disability, using the Child Health Assessment Questionnaire, measured at baseline, 6, and 12 months.

RESULTS

One thousand six hundred eighty-four patients were identified. High community poverty (≥20% living below the federal poverty level) was associated with increased odds of functional disability (OR 1.82, 95% CI 1.28-2.60) but was not statistically significant after adjustment (aOR 1.23, 95% CI 0.81-1.86) and was not associated with increased disease activity. Non-white race/ethnicity was associated with higher disease activity (aOR 2.48, 95% CI: 1.41-4.36). Lower self-reported household income was associated with higher disease activity and persistent functional disability. Public insurance (aOR 1.56, 95% CI 1.06-2.29) and low family education (aOR 1.89, 95% CI 1.14-3.12) was associated with persistent functional disability.

CONCLUSION

High community poverty level was associated with persistent functional disability in unadjusted analysis but not with persistent moderate to high disease activity. Race/ethnicity and other SDH were associated with persistent disease activity and functional disability.

Wide-field mid-infrared single-photon upconversion imaging

Frequency upconversion technique, where the infrared signal is nonlinearly translated into the visible band to leverage the silicon sensors, offers a promising alternation for the mid-infrared (MIR) imaging. However, the intrinsic field of view (FOV) is typically limited by the phase-matching condition, thus imposing a remaining challenge to promote subsequent applications. Here, we demonstrate a wide-field upconversion imaging based on the aperiodic quasi-phase-matching configuration. The acceptance angle is significantly expanded to about 30°, over tenfold larger than that with the periodical poling crystal. The extended FOV is realized in one shot without the need of parameter scanning or post-processing. Consequently, a fast snapshot allows to facilitate high-speed imaging at a frame rate up to 216 kHz. Alternatively, single-photon imaging at room temperature is permitted due to the substantially suppressed background noise by the spectro-temporal filtering. Furthermore, we have implemented high-resolution time-of-flight 3D imaging based on the picosecond optical gating. These presented MIR imaging features with wide field, fast speed, and high sensitivity might stimulate immediate applications, such as non-destructive defect inspection, in-vivo biomedical examination, and high-speed volumetric tomography.

The authors present a simple yet effective solution to dramatically boost the performances of an upconversion imaging system, which leads to unprecedented mid-infrared imaging features with large field of view, single-photon sensitivity and a MHz-level frame rate.

A phase 3, randomized, open-label, multicenter, global study of the efficacy and safety of durvalumab (D) + tremelimumab (T) + enfortumab vedotin (EV) or D + EV for neoadjuvant treatment in cisplatin-ineligible muscle-invasive bladder cancer (MIBC) (VOLGA)

TPS579

Background: The standard management of MIBC involves neoadjuvant cisplatin-based chemotherapy followed by radical cystectomy and pelvic lymph node dissection. Approximately 40% of patients with MIBC are cisplatin ineligible, the standard of care (SoC) for these patients is to proceed directly to cystectomy as there are no effective or approved neoadjuvant therapies in this setting. Only nivolumab has been approved as adjuvant treatment for patients who are at high risk of recurrence after radical resection. Given this, there remains an unmet need. D (anti–PD-L1 antibody) +T (anti–CTLA-4 antibody) have demonstrated a manageable safety profile with clinical activity in metastatic urothelial carcinoma and in a phase 2 neoadjuvant trial, D+T showed anti-tumor activity, including meaningful pathologic complete responses (pCR), in cisplatin-ineligible MIBC with high-risk features. Targeted cytotoxic antibody drug conjugates (ADCs) are known to have the potential to induce immunogenic tumor cell death, which promotes activation and recruitment of immune cells. EV is a vedotin ADC comprising an antibody against Nectin-4 linked to a microtubule-disrupting agent MMAE that has demonstrated efficacy in, and is approved for, advanced urothelial cancer. Thus, we hypothesize that EV in combination with PD-L1 inhibition, with or without CTLA-4 inhibition, may improve outcomes in patients with MIBC by downstaging of disease before cystectomy and that adjuvant therapy with D or D+T may further improve time to disease relapse. Methods: VOLGA (NCT04960709) is a phase 3, randomized, open-label, multicenter, international trial that will enroll ̃830 patients with MIBC. Eligible patients include those aged ³18 years with histologically or cytologically documented MIBC (transitional and mixed transitional cell histology), who are cisplatin ineligible and with a clinical stage of T2-4aN0-N1M0. Patients will be randomized to 3 arms to receive 3 cycles of neoadjuvant therapy Q3W as follows: (Arm 1) D (1500 mg day 1) +T (75 mg day 1) +EV (1.25 mg/kg Days 1 & 8); (Arm 2) D (1500 mg day 1) +EV (1.25 mg/kg Days 1 & 8); or (Arm 3) no neoadjuvant treatment (SoC). A safety run-in study is included. Following radical cystectomy, patients will then receive: (Arm 1) 1 cycle of T on Day 1 plus 9 cycles of D Q4W; (Arm 2) 9 cycles of D Q4W; or (Arm 3) either no adjuvant treatment (observation only) or adjuvant nivolumab in high-risk patients where available and approved (planned amendment). The dual primary endpoints are pCR and event-free survival. Secondary endpoints include overall survival, disease-free survival, pathologic downstaging rate to < pT2, disease-specific survival, quality of life, immunogenicity, and pharmacokinetics. The study is actively enrolling. Clinical trial information: NCT04960709.

Predicting High-Value Care Outcomes After Surgery for Non-Skull Base Meningiomas

OBJECTIVE

A need exists to better understand the prognostic factors that influence high-value care outcomes after meningioma surgery. The goal of the present study was to develop predictive models to determine the patients at risk of experiencing an extended hospital length of stay (LOS), nonroutine discharge disposition, and/or a 90-day hospital readmission after non-skull base meningioma resection.

METHODS

In the present study, we analyzed the data from 396 patients who had undergone surgical resection of non-skull base meningiomas at a single institution between January 1, 2005 and December 31, 2020. The Mann-Whitney U test was used for bivariate analysis of the continuous variables and the Fisher exact test for bivariate analysis of the categorical variables. A multivariate analysis was conducted using logistic regression models.

RESULTS

Most patients had had a falcine or parasagittal meningioma (66.2%), with the remainder having convexity (31.8%) or intraventricular (2.0%) tumors. Nonelective surgery (P < 0.0001) and an increased tumor volume (P = 0.0022) were significantly associated with a LOS >4 days on multivariate analysis. The independent predictors of a nonroutine discharge disposition included male sex (P = 0.0090), nonmarried status (P = 0.024), nonelective surgery (P = 0.0067), tumor location within the parasagittal or intraventricular region (P = 0.0084), and an increased modified frailty index score (P = 0.039). Hospital readmission within 90 days was independently associated with nonprivate insurance (P = 0.010) and nonmarried status (P = 0.0081). Three models predicting for a prolonged LOS, nonroutine discharge disposition, and 90-day readmission were implemented in the form of an open-access, online calculator (available at: https://neurooncsurgery3.shinyapps.io/non_skull_base_meningiomas/).

CONCLUSIONS

After external validation, our open-access, online calculator could be useful for assessing the likelihood of adverse postoperative outcomes for patients undergoing surgery of non-skull base meningioma.

The role of anticoagulation for superior sagittal sinus thrombosis following craniotomy for resection of parasagittal/parafalcine meningiomas

OBJECTIVE

The safety and efficacy of anticoagulation in managing superior sagittal sinus (SSS) thrombosis remains unclear. The present study investigated the relationship between anticoagulation and cerebrovascular complications in parasagittal/parafalcine meningioma patients presenting with post-surgical SSS thrombosis.

METHODS

We analyzed 266 patients treated at a single institution between 2005 and 2020. Bivariate analysis was conducted using the Mann-Whitney U test and Fisher's exact test. Multivariate analysis was conducted using a logistic regression model. Blood thinning medications investigated included aspirin, warfarin, heparin, apixaban, rivaroxaban, and other novel oral anticoagulants (NOACs). A symptomatic SSS thrombosis was defined as a radiographically apparent thrombosis with new headaches, seizures, altered sensorium, or neurological deficits.

RESULTS

Our patient cohort was majority female (67.3%) with a mean age ([Formula: see text] SD) of 58.82 [Formula: see text] 13.04 years. A total of 15 (5.6%) patients developed postoperative SSS thrombosis and 5 (1.9%) were symptomatic; 2 (0.8%) symptomatic patients received anticoagulation. None of these 15 patients developed cerebrovascular complications following observation or anticoagulative treatment of asymptomatic SSS thrombosis. While incidence of any other postoperative complications was significantly associated with SSS thrombosis in bivariate analysis (p = 0.015), this association was no longer observed in multivariate analysis (OR = 2.15, p = 0.16) when controlling for patient age, sex, and anatomical location of the tumor along the SSS.

CONCLUSIONS

Our single-institution study examining the incidence of SSS thrombosis and associated risk factors highlights the need for further research efforts better prognosticate this adverse outcome. Conservative management may represent a viable treatment strategy for patients with SSS thrombosis.

Polarization control of plasmon-induced transparency in metamaterials with reversibly convertible bright and dark modes

We numerically demonstrate a Z-shaped metal-based metamaterial to realize an active polarization-controlled plasmon-induced transparency (PIT). The metamaterial unit cell contains two horizontal Au bars and a vertical Au bar. Simply by varying the incident light polarization, a tunable PIT can be achieved due to the reversible conversion of bright and dark modes between the horizontal and vertical Au bars. Moreover, a switchable PIT window modulation can be accomplished via changing the geometrical parameters, and the theoretical fittings according to the coupled Lorentz oscillator model display consistency with the simulated results. Our proposed metamaterials provide a promising strategy for fabricating compact PIT devices such as optical switching, sensing, and selective filters.

A survey study examining the motivations, concerns, and perspectives of medical students engaging in neurosurgical research

Background

In a competitive landscape for neurosurgical residency admission, research productivity is increasingly important. Medical school applicants to neurosurgery report high numbers of "scholarly products" as published by the National Residency Match Program. Despite increased student involvement in research and productivity, to the best of our knowledge, no previous reported studies have examined student perspectives on their involvement in neurosurgical research.

Methods

For 2 consecutive years (February 2019 and February 2020), medical students (n = 55) from around the United States presented original research at the Student Neurosurgical Research Conference. Participants were administered a mixed-method survey designed to assess experiences and perspectives on engaging in neurosurgical research. Survey responses were analyzed independently by two researchers to assess for common themes and perspectives.

Results

Medical students engaged in all types of research work across nearly every neurosurgical subfield with "Basic/Bench Lab work" (38.5%) and "Chart Review" (23.1%) representing the majority of projects. Students commonly cited "curiosity/interest," and "residency application competitiveness" as main reasons for participation in research. About 66% of respondents reported experiencing anxiety/concern about research productivity "often" or "very often." Thematic analysis revealed that sources of research-related stress were (1) having enough publications to match into residency, and (2) having enough time in medical school to engage in research.

Conclusion

Medical students engaging in neurosurgical research are highly motivated students driven by scientific curiosity and pressure to prepare for competitive residency applications. Students experience anxiety due to time constraints in medical curricula and increasing demands for scholarly productivity.

1370 Classifying Morbidity and Error in Oral and Maxillofacial Trauma Using the Clavien-Dindo Classification: A Prospective Pilot Study

Introduction

The collection of morbidity outcomes following surgery was recommended by the Royal College of Surgeons of England in 2014. They suggest a structure to stratify complications into groupings but do not include a classification this limits comparison. Our unit, a regionalised maxillofacial trauma service, introduced a standardised morbidity and error classification to be applied at M&M meetings.

Method

Prospective collection of data from March 2019 to February 2020. All patients discussed at our M&M meeting were then classified according to the Clavien-Dindo Classification (2004), assigned an error type and recommended action determined through a panel of between 5-10 consultants.

Results

301 surgical procedures were carried out with a 7% complication rate. 26 cases were discussed at M&M. The commonest error type was ‘nature of the disease’ (48%) followed by ‘error in judgement’ (37%). Clavien-Dindo Classification IIIb (intervention under GA) was the most frequent morbidity (74%)

Conclusions

Standardised national data collection of morbidity and error can be used to analyse a single institution or between institutions to improve patient care. To our knowledge, this is the first standardised classification of morbidity in maxillofacial trauma and was of educational and service benefit. However, there was discussion of the appropriateness of the classification systems to facial fractures. We would therefore recommend further development of both a morbidity classification and an error type classification specific to treatment of facial fractures so that it can be used to improve outcomes for our patients in the future.

Plasmon Enhanced Second Harmonic Generation from ZnO Nanofilms on Vertical Au Nanorod Arrays

Vertically aligned gold nanorod arrays have attracted much attention for their fascinating optical properties. Different from longitudinal surface plasmon wavelength (LSPW) and edge-to-edge spacing of gold nanorods, the role of gold nanorod diameter in plasmonic enhancement ability of vertical gold nanorod arrays has rarely been explored. In this work, we selected gold nanorods with similar LSPW but two different diameters (22 and 41 nm), the optical properties of which are dominated by absorption and scattering cross sections, respectively. The vertically aligned arrays of these gold nanorods formed by evaporation self-assembly are coupled with nonlinear ZnO nanocrystal films spin-coated on their surfaces. It was found that the gold nanorod array with a larger diameter can enhance the second harmonic generation (SHG) of ZnO nanofilm by a factor of 27.0, while it is about 7.3 for the smaller gold nanorod array. Theoretical simulations indicate that such stronger enhancement of the larger vertical gold nanorod array compared with the smaller one is due to its stronger scattering ability and greater extent of near-field enhancement at SHG fundamental wavelength. Our work shows that the diameter of gold nanorods is also an important factor to be considered in realizing strong plasmon enhancement of vertically aligned gold nanorod arrays.

Cumulative summation analysis of learning curve for robotic-assisted hiatal hernia repairs

BACKGROUND

Robotic-assisted laparoscopic surgery (RALS) is evolving as an important surgical approach in the field of general surgery. We aimed to evaluate the learning curve for RALS procedures involving repair of hiatal hernias.

METHODS

A series of robotic-assisted hiatal hernia (HH) repairs were performed between 2013 and 2017 by a surgeon at a single institution. Data were entered into a retrospective database. Patient demographics and intraoperative parameters including console time (CT), surgery time (ST), and total operative time (OT) were examined and abstracted for learning curve analysis using the cumulative sum (CUSUM) method. Assessment of perioperative and post-operative outcomes were calculated using descriptive statistics.

RESULTS

The average age of the patients was 57.4 years, average BMI was 29.9 kg/m², median American Society of Anesthesiologists (ASA) classification was 2, and average Charlson Comorbidity Index (CCI) score was 2.8. The series had a mean CT of 132.6 min, mean ST of 145.1 min, and mean OT of 197.4 min. The CUSUM learning curve for CT was best approximated as a third-order polynomial consisting of three unique phases: the initial training phase (case 1-40), the improvement phase (case 41-85), and the mastery phase (case 86 onwards). There was no significant difference in perioperative complications between the phases. Short-term clinical outcomes were comparable with national standards and did not correlate significantly with operative experience.

CONCLUSIONS

The three phases identified with CUSUM analysis represented characteristic stages of the learning curve for robotic hiatal hernia procedures. Our data suggest the training phase is achieved after 40 cases and a high level of mastery is achieved after approximately 85 cases. Thus, the CUSUM method serves as a useful tool for objectively evaluating practical skills for surgeons and can ultimately help establish milestones that assess surgical competency during robotic surgery training.

Distance-Dependent Plasmon-Enhanced Fluorescence of Submonolayer Rhodamine 6G by Gold Nanoparticles

We investigate the fluorescence from submonolayer rhodamine 6G molecules near gold nanoparticles (NPs) at a well-controlled poly (methyl methacrylate) (PMMA) interval thickness from 1.5 to 21 nm. The plasmonic resonance peaks of gold NPs are tuned from 530 to 580 nm by the PMMA spacer of different thicknesses. Then, due to the plasmonic resonant excitation enhancement, the emission intensity of rhodamine 6G molecules at 562 nm is found to be enhanced and shows a decline as the PMMA spacer thickness increases. The variation of spectral intensity simulated by finite-difference time-domain method is consistent with the experimental results. Moreover, the lifetime results show the combined effects to rhodamine 6G fluorescence, which include the quenching effect, the barrier effect of PMMA as spacer layer and the attenuation effect of PMMA films.

[Correlation analysis between type 2 diabetes and core gut microbiota]

OBJECTIVE

To analyze the species, abundance and structure differences of intestinal flora between patients with type 2 diabetes mellitus (T2D) and healthy individuals and explore the correlation between intestinal flora changes and T2D.

OBJECTIVE

We collected a total of 133 clinical fecal samples from 78 healthy individuals and 55 patients with T2D. Hiseq2500 was used for high-throughput sequencing of the V3+V4 regions of the 16S rRNA gene. Usearch and QIIME were used for data splicing and filtering, classification and species annotation. The Alpha diversity index and Beta diversity index of the samples were analyzed using R language data packets to compare the richness and diversity of the sample flora. The flora differences were compared between the two groups and the disease marker flora was screened after correction of the relevant factors. PICRUST software was used to predict the function of different flora.

OBJECTIVE

There was significant difference in the intestinal flora diversity between the two groups. Cluster analysis showed that Fimicutes and Bacteroidetes were the dominant species at the phylum level. LefSe analysis showed that significant differences in the relative abundance between the two groups in 2 phyla, 3 classes, 3 orders, 4 families and 10 genera. After correction for the influence of related factors, the markers of T2Drelated bacteria groups were identified, including Bifidobacterium, Bifidobacteriales, Bifidobacteriaceae, Actinobacteria, Bacilli, Lactobacillales, Lactobacillaceae and Lactobacillus. On this basis, analysis of KEGG metabolic pathways of the differential flora revealed significant differences in 36 KEGG metabolic pathways between the two groups, and the citric acid cycle, lipopolysaccharide biosynthesis and other metabolic pathways were all up-regulated in T2D group.

OBJECTIVE

The composition and abundance of intestinal flora were different between T2D group and the normal group, and T2D group showed the characteristics of ecological imbalance.

Observational study on wearable biosensors and machine learning-based remote monitoring of COVID-19 patients

Patients infected with SARS-CoV-2 may deteriorate rapidly and therefore continuous monitoring is necessary. We conducted an observational study involving patients with mild COVID-19 to explore the potentials of wearable biosensors and machine learning-based analysis of physiology parameters to detect clinical deterioration. Thirty-four patients (median age: 32 years; male: 52.9%) with mild COVID-19 from Queen Mary Hospital were recruited. The mean National Early Warning Score 2 (NEWS2) were 0.59 ± 0.7. 1231 manual measurement of physiology parameters were performed during hospital stay (median 15 days). Physiology parameters obtained from wearable biosensors correlated well with manual measurement including pulse rate (r = 0.96, p < 0.0001) and oxygen saturation (r = 0.87, p < 0.0001). A machine learning-derived index reflecting overall health status, Biovitals Index (BI), was generated by autonomous analysis of physiology parameters, symptoms, and other medical data. Daily BI was linearly associated with respiratory tract viral load (p < 0.0001) and NEWS2 (r = 0.75, p < 0.001). BI was superior to NEWS2 in predicting clinical worsening events (sensitivity 94.1% and specificity 88.9%) and prolonged hospitalization (sensitivity 66.7% and specificity 72.7%). Wearable biosensors coupled with machine learning-derived health index allowed automated detection of clinical deterioration.

Predictors of Mortality in Traumatic Intracranial Hemorrhage: A National Trauma Data Bank Study

Background/Objective: Traumatic intracranial hemorrhage (tICH) accounts for significant trauma morbidity and mortality. Several studies have developed prognostic models for tICH outcomes, but previous models face limitations, including poor generalizability and limited accuracy. The objective was to develop a prognostic model and determine predictors of mortality using the largest trauma database in the U.S., applying rigorous analytical methodology with true hold-out-set model validation.

Methods: We identified 248,536 patients in the National Trauma Data Bank (NTDB) from 2012 to 2016 with a diagnosis code associated with tICH. For each admission, we collected demographic information, systolic blood pressure, blood alcohol level (BAL), Glasgow Coma Score (GCS), Injury Severity Score (ISS), presence of epidural/subdural/subarachnoid/intraparenchymal hemorrhage, comorbidities, complications, trauma center level, and trauma center region. Our final study population was 212,666 patients following exclusion of records with missing data. The dependent variable was patient death. Linear support vector machine (SVM) classification was carried out with recursive feature selection. Model performance was assessed using holdout 10-fold cross-validation.

Results: Cross-validation demonstrated a mean accuracy of 0.792 (95% CI 0.783–0.799). Accuracy, precision, recall, and AUC were 0.827, 0.309, 0.750, and 0.791, respectively. In the final model, high ISS, advanced age, subdural hemorrhage, and subarachnoid hemorrhage were associated with increased mortality, while high GCS verbal and motor subscores, current smoker, BAL beyond the legal limit, and level 1 trauma center were associated with decreased mortality.

Conclusions: A linear SVM model was developed for tICH, with nine features selected as predictors of mortality. These findings are applicable to multiple hemorrhage subtypes and may benefit the triage of high risk patients upon admission. While many studies have attempted to create models to predict mortality in TBI, we sought to confirm those predictors using modern modeling approaches, machine learning, and true hold-out test sets, using the largest available TBI database in the U.S. We find that while the predictors we identify are consistent with prior reports, overall prediction accuracy is somewhat lower than prior reports when assessed more rigorously.