Applications of natural language processing tools in the surgical journey.

Background: Natural language processing tools are becoming increasingly adopted in multiple industries worldwide. They have shown promising results however their use in the field of surgery is under-recognised. Many trials have assessed these benefits in small settings with promising results before large scale adoption can be considered in surgery. This study aims to review the current research and insights into the potential for implementation of natural language processing tools into surgery. Methods: A narrative review was conducted following a computer-assisted literature search on Medline, EMBASE and Google Scholar databases. Papers related to natural language processing tools and consideration into their use for surgery were considered. Results: Current applications of natural language processing tools within surgery are limited. From the literature, there is evidence of potential improvement in surgical capability and service delivery, such as through the use of these technologies to streamline processes including surgical triaging, data collection and auditing, surgical communication and documentation. Additionally, there is potential to extend these capabilities to surgical academia to improve processes in surgical research and allow innovation in the development of educational resources. Despite these outcomes, the evidence to support these findings are challenged by small sample sizes with limited applicability to broader settings. Conclusion: With the increasing adoption of natural language processing technology, such as in popular forms like ChatGPT, there has been increasing research in the use of these tools within surgery to improve surgical workflow and efficiency. This review highlights multifaceted applications of natural language processing within surgery, albeit with clear limitations due to the infancy of the infrastructure available to leverage these technologies. There remains room for more rigorous research into broader capability of natural language processing technology within the field of surgery and the need for cross-sectoral collaboration to understand the ways in which these algorithms can best be integrated.

Evaluation of Fungal Volatile Organic Compounds for Control the Plant Parasitic Nematode Meloidogyne incognita.

Plant parasitic nematodes are a serious threat to crop production worldwide and their control is extremely challenging. Fungal volatile organic compounds (VOCs) provide an ecofriendly alternative to synthetic nematicides, many of which have been withdrawn due to the risks they pose to humans and the environment. This study investigated the biocidal properties of two fungal VOCs, 1-Octen-3-ol and 3-Octanone, against the widespread root-knot nematode Meloidogyne incognita. Both VOCs proved to be highly toxic to the infective second-stage juveniles (J2) and inhibited hatching. Toxicity was dependent on the dose and period of exposure. The LD50 of 1-Octen-3-ol and 3-Octanone was 3.2 and 4.6 µL, respectively. The LT50 of 1-Octen-3-ol and 3-Octanone was 71.2 and 147.1 min, respectively. Both VOCs were highly toxic but 1-Octen-3-ol was more effective than 3-Octanone. Exposure of M. incognita egg-masses for 48 h at two doses (0.8 and 3.2 µL) of these VOCs showed that 1-Octen-3-ol had significantly greater nematicidal activity (100%) than 3-Octanone (14.7%) and the nematicide metham sodium (6.1%). High levels of reactive oxygen species detected in J2 exposed to 1-Octen-3-ol and 3-Octanone suggest oxidative stress was one factor contributing to mortality and needs to be investigated further.

Efficacy of Azadirachtin in the Integrated Management of the Root Knot Nematode Meloidogyne incognita on Short- and Long-Cycle Crops.

Activity of azadirachtin on phytoparasitic nematodes has been documented for some decades, but the relationship between its nematicidal efficacy and crop cycle length has not yet been clarified. This study aimed to assess the efficacy of an azadirachtin-based nematicide, for controlling the infestation of the root-knot nematode Meloidogyne incognita, on the short- and long-cycle crops, lettuce and tomato, respectively. Experiments on lettuce and tomato were carried out in a greenhouse infested by M. incognita, including non-treated soil, or treated with the nematicide fluopyram, as controls. In the experiment on the short-cycle lettuce crop, the azadirachtin product effectively suppressed M. incognita infestation and increased crop yield, without significant differences from fluopyram. In the tomato crop, both azadirachtin and fluopyram were not able to control nematode infestation, but resulted in significantly higher yields. Data from this study indicated that azadirachtin can be a valid alternative to fluopyram and other nematicides, for root-knot nematode control in short-cycle crops. Integration of azadirachtin with a synthetic nematicide or nematode-suppressive agronomical techniques, should be more suitable to long-cycle crops.

Selection of Bacterial Strains for Control of Root-Knot Disease Caused by Meloidogyne incognita.

Root-knot disease caused by Meloidogyne incognita leads to significant crop yield losses that may be aggravated by the association with pathogenic fungi and bacteria. Biological agents can be effectively used against the complex disease of root-knot nematode and pathogenic fungi. In this study, 35 bacterial strains were analyzed for their in vitro nematicidal, antagonistic and growth stimulation activities. Based on results from the in vitro assays, grow-box experiments on tomato and cucumber were carried out with the strain BZR 86 of Bacillus velezensis applied at different concentrations. Effects of B. velezensis BZR 86 on the development of root-knot disease were evaluated by recording root gall index, number of galls and number of eggs in egg masses. Application of B. velezensis BZR 86 noticeably decreased the development of root-knot disease on tomato and cucumber plants, as well as significantly increased growth and biomass of cucumber plants in accordance with bacterial concentration. This study seems to demonstrate that strain B. velezensis BZR 86 could be an additional tool for an environmentally safe control of root-knot disease on horticultural crops.

Bacteria as Biocontrol Tool against Phytoparasitic Nematodes.

Phytoparasitic nematodes cause severe damage and yield losses to numerous agricultural crops. Considering the revision of the EU legislation on the use of pesticides on agricultural crops, control strategies with low environmental impact are required. The approach based on the use of bacteria seems particularly promising as it also helps to reduce the applied amounts of chemicals and stabilize ecological changes. This paper gives an overview of the main types of bacteria that can be used as biological control agents against plant parasitic nematodes and their interrelationships with plants and other organisms. Many experiments have given positive results of phytoparasitic nematode control by bacteria, showing possible prospects for their application. In vitro, greenhouse and field experiments have shown that bacteria can regulate the development of ecto- and endoparasitic nematodes by different modes of action. Triggering the induction of plant defense mechanisms by bacteria is seen as the optimum tool because the efficacy of bacterial treatment can be higher than that of chemical pesticides or at least close to it. Moreover, bacterial application produces additional positive effects on growth stimulation, raises yields and suppresses other pathogenic microorganisms. Commercial formulations, both as single bacterial strains and bacterial complexes, are examined.

Plant Health and Rhizosphere Microbiome: Effects of the Bionematicide Aphanocladium album in Tomato Plants Infested by Meloidogyne javanica.

The artificial introduction in the soil of antagonistic microorganisms can be a successful strategy, alternative to agrochemicals, for the control of the root-knot nematodes (Meloidogyne spp.) and for preserving plant health. On the other hand, plant roots and the associated rhizosphere constitute a complex system in which the contribution of microbial community is fundamental to plant health and development, since microbes may convert organic and inorganic substances into available plant nutrients. In the present study, the potential nematicidal activity of the biopesticide Aphanocladium album (A. album strain MX-95) against the root-knot nematode Meloidogyne javanica in infected tomato plants was investigated. Specifically, the effect of the A. album treatment on plant fitness was evaluated observing the plant morphological traits and also considering the nematode propagation parameters, the A. album MX-95 vitality and population density. In addition, the treatment effects on the rhizosphere microbiome were analysed by a metabarcoding procedure. Treatments with A. album isolate MX-95 significantly decreased root gall severity index and soil nematode population. The treatment also resulted in increased rhizosphere microbial populations. A. album MX-95 can be favourably considered as a new bionematicide to control M. javanica infestation.

Electron-Deficient Alkynes as Powerful Tools against Root-Knot Nematode Melodogyne incognita: Nematicidal Activity and Investigation on the Mode of Action.

The present study reports on the powerful nematicidal activity of a series of electron-deficient alkynes against the root-knot nematode Meloidogyne incognita (Kofoid and White) Chitwood. Interestingly, we found that the conjugation of electron-withdrawing carbonyl groups to an alkyne triple bond was extremely proficient in inducing nematode paralysis and death. In particular, dimethylacetylenedicarboxylate (10), 3-butyn-2-one (1), and methyl propiolate (4), with EC50/48 h of 1.54 ± 0.16, 2.38 ± 0.31, and 2.83 ± 0.28 mg/L, respectively, were shown to be the best tested compounds. Earlier studies reported on the ability of alkynoic esters and alkynones to induce a chemoselective cysteine modification of unprotected peptides. Thus, also following our previous findings on the impairment of vacuolar-type proton translocating ATPase functionality by activated carbonyl derivatives, we speculate that the formation of a vinyl sulfide linkage might be responsible for the nematicidal activity of the presented electron-deficient alkynes.

Abamectin Efficacy on the Potato Cyst Nematode Globodera pallida.

The potato cyst nematode Globodera pallida is a major pest of the potato crop. Abamectin is a biological pesticide showing high nematicide activity, but its efficacy to control G. pallida has not been investigated to date. In this study, combination of different abamectin concentrations ranging from 1.125 to 36 µg/mL x exposure times from 24 to 384 h were tested on the nematode in a hatching test. Abamectin induced mortality with LD50 value in the range of 13.23 (after 24 h) to 2.90 µg/mL (after 384 h). A glasshouse experiment was also performed in pots filled with soil infected with G. pallida in the presence of sprouted potato tubers cultivar "Spunta". Abamectin at 4.5, 9.0, 18.0 and 36.0 µg/mL was used in comparison with nematicide fosthiazate. The doses of 18 and 36 µg/mL significantly reduced number of eggs, juveniles, cyst/g soil and reproduction rate in comparison to both untreated control and fosthiazate treatment. Soil applications of abamectin provided significant G. pallida control with LD50 and LD99.9 of 14.4 and 131.3 µg/mL, respectively. These results indicate the efficacy of abamectin to control G. pallida on potato crops and its potential use in organic agriculture or in an integrated pest management program.

Ozonated water reduces susceptibility in tomato plants to Meloidogyne incognita by the modulation of the antioxidant system.

Few studies have been carried out on the effect of ozonated water (O3 wat) on the oxidative stress of root systems and, in particular, in combination with biotic stress. The aim of this study was to determine whether aqueous ozone is effective in the control of root-knot nematode (RKN) infection and to investigate the concomitant changes in the basal defence system. A tomato cultivar susceptible to Meloidogyne incognita was treated with O3 wat as a soil drench. No negative effects were seen following ozone application in comparison with the control under the exposure conditions used. The treatment reduced significantly the nematode infection rate and induced changes in the morphology of nematode feeding sites, some of which were characterized by visible symptoms of senescence. The antioxidant response, as well as parameters of oxidative damage, were examined in untreated and O3 wat-treated galls at 2, 4 and 7 days after inoculation and compared with uninfected roots. High levels of reactive oxygen species (ROS), H2 O2 and malondialdehyde were generated in galls in response to combined abiotic and biotic stresses. Throughout the experimental period, the activities and relative transcript levels of the antioxidant enzymes catalase, superoxide dismutase and ascorbate peroxidase produced different responses when exposed to ozone treatment and/or infection. The results demonstrate how O3 wat protects tomato against the RKN M. incognita through the modulation of basal defence mechanisms.

Untargeted Metabolomics of Tomato Plants after Root-Knot Nematode Infestation.

After 2 months from the infestation of tomato plants with the root-knot nematode (RKN) Meloidogyne incognita, we performed a gas chromatography-mass spectrometry untargeted fingerprint analysis for the identification of characteristic metabolites and biomarkers. Principal component analysis, and orthogonal projections to latent structures discriminant analysis suggested dramatic local changes of the plant metabolome. In the case of tomato leaves, ß-alanine, phenylalanine, and melibiose were induced in response to RKN stimuli, while ribose, glycerol, myristic acid, and palmitic acid were reduced. For tomato stems, upregulated metabolites were ribose, sucrose, fructose, and glucose, while fumaric acid and glycine were downregulated. The variation in molecular strategies to the infestation of RKNs may play an important role in how Solanum lycopersicum and other plants adapt to nematode parasitic stress.

Potent Nematicidal Activity of Maleimide Derivatives on Meloidogyne incognita.

Different maleimide derivatives were synthesized and assayed for their in vitro activity on the soil inhabiting, plant-parasitic nematode Meloidogyne incognita, also known as root-knot nematode. The compounds maleimide, N-ethylmaleimide, N-isopropylmaleimide, and N-isobutylmaleimide showed the strongest nematicidal activity on the second stage juveniles of the root-knot nematode with EC50/72h values of 2.6 ± 1.3, 5.1 ± 3.4, 16.2 ± 5.4, and 19.0 ± 9.0 mg/L, respectively. We also determined the nematicidal activity of copper sulfate, finding an EC50 value of 48.6 ± 29.8 mg/L. When maleimide at 1 mg/L was tested in combination with copper sulfate at 50 mg/L, we observed 100% mortality of the nematodes. We performed a GC-MS metabolomics analysis after treating nematodes with maleimide at 8 mg/L for 24 h. This analysis revealed altered fatty acids and diglyceride metabolites such as oleic acid, palmitic acid, and 1-monopalmitin. Our results suggest that maleimide may be used as a new interesting building block for developing new nematicides in combination with copper salts.

Effects of extracorporeal shock wave therapy on functional and strength recovery of handgrip in patients affected by epicondylitis.

Extracorporeal shock wave therapy (ESWT) is effective in the treatment of tendinopathy. We designed a prospective observational clinical study to assess the correlation between clinical and functional measures and recovery of strength after ESWT for epicondylitis. We analyzed 26 patients. We measured progressive improvement in visual analogue scale values (p < 0.0005) and Mayo Elbow Performance Index scores (p = 0.004) for the pathologic limb. Monitoring of handgrip failed to reveal changes in values at any follow-up (p > 0.05). We found no correlation between degree of clinical function and muscle deficit during follow-up. After ESWT, there was a tendency toward a decrease in grip strength, especially in the dominant limb. This could be related to the effects of ESWT, which reduces spasticity in painful hypertonic muscles. These data may be useful in defining the expectations for function during ESWT for epicondylitis, particularly for elite athletes.

Tulipaline A: structure-activity aspects as a nematicide and V-ATPase inhibitor.

Carbonyl groups are known to form covalent adducts with endogenous proteins, but so far, their nematicidal mechanism of action of has been overlooked. The nematicidal activity of ten lactones was tested in vitro against the root knot nematodes Meloidogyne incognita and Meloidogynearenaria. In particular, the saturated lactones α-methylene-γ-butyrolactone or tulipaline A (1) and γ-butyrolactone (3) were active against M. incognita with an EC50/48h of 19.3±10.0 and 40.0±16.2mg/L respectively. Moreover the α, ß-unsaturated lactone 5,6-dihydro-2H-pyran-2-one (2) exhibited the strongest nematicidal activity against the two species with EC50/48h 14.5±5.3 and 21.2±9.7mg/L respectively. Here we propose that the toxic effects of lactones and aldehydes on M.incognita and M. arenaria might be a consequence of their vacuolar-type H(+)-ATPase (V-ATPase) inhibition activity; in fact α-methylene-γ-butyrolactone (1) and salicylaldehyde (12) produced an increased pH in lysosomal-like organelles on HeLa human cell line and this alteration was most likely related to a V-ATPase impairment.

Potent nematicidal activity of phthalaldehyde, salicylaldehyde, and cinnamic aldehyde against Meloidogyne incognita.

The nematicidal activity of selected aromatic aldehydes was tested against the root knot nematode Meloidogyne incognita. The most active aldehyde was phthalaldehyde (1) with an EC(50) value of 11 ± 6 mg/L followed by salicylaldehyde (2) and cinnamic aldehyde (3) with EC(50) values of 11 ± 1 and 12 ± 5 mg/L, respectively. On the other hand, structurally related aldehydes such as 2-methoxybenzaldehyde (21), 3,4-dimethoxybenzaldehyde, and vanillin (23) were not active at the concentration of 1000 mg/L. By liquid chromatography-mass spectrometry the reactivity of tested aldehydes against a synthetic peptide resembling the nematode cuticle was characterized. At the test concentration of 1 mM, the main adduct formation was observed for 3,4-dihydroxybenzaldehyde (22), 2-methoxybenzaldehyde (21), and 3,4-dimethoxybenzaldehyde. Considering that 2-methoxybenzaldehyde (21) and 3,4-dimethoxybenzaldehyde were not active against M. incognita in in vitro experiments led us to hypothesize a different mechanism of action rather than an effect on the external cuticle modification of nematodes. When the toxicity of the V-ATPase inhibitor pyocyanin (10) was tested against M. incognita J2 nematodes, an EC(50) at 24 h of 72 ± 25 mg/L was found. The redox-active compounds such as phthalaldehyde (1) and salicylaldehyde (2) may share a common mode of action inhibiting nematode V-ATPase enzyme. The results of this investigation reveal that aromatic redox-active aldehydes can be considered as potent nematicides, and further investigation is needed to completely clarify their mode of action.

Nematicidal activity of 2-thiophenecarboxaldehyde and methylisothiocyanate from caper (Capparis spinosa) against Meloidogyne incognita.

New pesticides based on plant extracts have recently gained interest in the development of nontoxic crop protection chemicals. Numerous research studies are focused on the isolation and identification of new active compounds derived from plants. In this manuscript we report about the use of the Mediterranean species Capparis spinosa as a potent natural nematicidal agent against the root knot nematodes Meloidogyne incognita. Leaves, stems, and caper buds of Capparis spinosa were used to obtain their methanol extracts (LME, SME, BME) that were successively in vitro tested against second stage nematode juveniles (J2). In terms of paralysis induction, the methanol extract of the stem part (SME) was found more effective against M. incognita and then the caper methanol buds and leaves extracts. The chemical composition analysis of the extracts carried out by GC/MS and LC/MS techniques showed that methylisothiocyanate was the main compound of SME. The EC50 for SME after 3 days of immersion was 215 ± 36 mg/L. The constituent components of SME such as 2-thiophenecarboxaldehyde and methylisothiocyanate were successively in vitro tested for their nematicidal activity against J2. Both compounds induced paralysis on root knot nematodes ranking first (EC50 = 7.9 ± 1.6, and 14.1 ± 1.9 mg/L respectively) for M. incognita. Moreover, 2-thiophenecarboxaldehyde showed a strong fumigant activity.

Evaluation of counter movement jump parameters in young male soccer players.

PURPOSE: The Counter Movement Jump (CMJ) is widely used as a field test to evaluate the muscular explosive power of lower limbs in various sports, including soccer. The aim of the present study was to verify the possibility to discriminate the effect of training level and age on young adult male soccer players, adopting the flight time, the peak force, or the peak power obtained from a countermovement jump. METHODS: One hundred and twenty three young male soccer players were enrolled in the study; the participants were split into groups according to Tanner's stages (pre- and post-pubertal) and training level (high and low activity). A piezoelectric force plate was used to acquire the ground reaction force used to calculate the flight time, the peak value of the vertical component of the ground reaction force, and the peak value of the developed power. RESULTS: As expected, the best performances were obtained by the post pubertal highly-trained soccer players. All performance parameters presented statistically significant differences between ages, while only the flight time exhibited statistically significant differences between training levels. After normalization of the experimental data to body height and weight, there were no statistical differences between ages; statistically significant differences were found only for the flight time and for peak power between training levels. CONCLUSIONS: The flight time was the parameter more sensitive to detect differences in the jump performance related to training and age. Adopting a normalization procedure it was possible to highlight that only the flight time and the peak power are sensitive to training effects on young adult male soccer players.

Relevance of orthostatic posturography for clinical evaluation of hip and knee joint arthroplasty patients.

In order to verify whether orthostatic posturography (OP) can support clinical assessment of total hip (THA) and knee arthroplasty (TKA), 81 subjects with THA and 100 with TKA were recruited and compared with 59 healthy volunteers. All patients were tested one or two days prior to surgery; 42 subjects (20 THA and 22 TKA) were tested again after six months, and 34 (14 THA and 20 TKA) yet again after 12 months. OP was performed using a Kistler 9286A piezoelectric force plate and the following postural parameters (PPs) were adopted on account of their functional meaning: mean velocity and the root mean square of the distance of the centre of pressure (CoP), sway area, and 95% of the CoP power frequency. Eye condition and fatigue related to the test duration were also examined. The three most meaningful PPs were identified and a logarithmic transformation was then applied to these, as well as standardization. Almost all the PP values were higher preoperatively in the patients as compared with the healthy subjects and it was possible to detect many statistically significant differences between patients and healthy subjects. However, when examining the 181 subjects at the preoperative stage, the PPs did not show congruence with the clinical scores as well as they did during follow-up. Therefore, the use of the OP is not recommended to monitor patients undergoing THA or TKA.

Power output estimation in vertical jump performed by young male soccer players.

The purpose of the study was (a) to assess the accuracy of the regression equations available in the literature to estimate the actual peak power (PPac) of the countermovement jump (CMJ) executed by young male soccer players, (b) to develop new regression equations from this population, and (c) to verify whether regression equations obtained from age-based subgroups could increase the accuracy of the estimation (PPes) of PPac. In all, 117 young players (age: 13.6 ± 2.4 years) were enrolled in the study. Each subject performed 5 CMJs on a force platform. The new regression equations were obtained from the entire experimental sample (G1) and 3 age-based subsamples (G2 = prepubertal, G3 = peripubertal, G4 = postpubertal) using 2 different approaches: the best jump and the mean values achieved by each subject. All the equations in the literature underestimated the peak power (p < 0.00005) in all the groups. The approach based on the mean values was more accurate (adjusted R = 0.925, SEE = 302.9 W) than the one based on the best jump (adjusted R = 0.892; SEE = 360.8 W). Moreover, calculating the regression equations from the 3 age-based subsamples, SEE resulted improved (15.5% in G2, 5.6% in G3 and 0.9% in G4). Regression equations must be derived from homogeneous populations, in terms of gender, sports practice, and age. The approach based on the mean values for each subject was more accurate than the approach used in the literature up to now. In practical applications, regression equation estimates cannot be used to assess the performance of a single subject, because errors may exceed 50%, whereas they may be useful for group comparisons.

Evaluation of standing vertical jump by ankles acceleration measurement.

The use of accelerometers is discussed to evaluate standing vertical jump. Two accelerometers, mounted on each ankle and connected to a wearable system, were used for signal acquisition, and a piezoelectric platform was used to verify the results. Fifty-one subjects were enrolled, subdivided into a group of healthy subjects and 2 groups who had different surgery for Achilles tendon rupture. Each subject performed 5 countermovement and 5 squat jumps; 11 subjects also performed 5 countermovement jumps with voluntary leg rotations during the flight phase. A training set was used to assess signal processing, and a validation set was used to verify its accuracy. A peak detection algorithm was developed to quantify flight time from the acceleration modulus, and its results were compared with platform data. The Pearson correlation coefficient of ankle accelerations and the integral of each signal were adopted to describe, respectively, the movement coordination and the limbs rotation during the flight time. The flight times obtained from the accelerometers and force plate were highly correlated (Spearman's coefficient >0.95); they were compared, for each jump, and the maximum mean error, for subject, was 4.8%. The movement coordination was in good agreement with subjects' clinical features and with the different jump phases. The signal integral presented significant differences, among jumps, related to leg rotations (p < 0.0005). The method proposed allows the monitoring of standing vertical jump using the fight time and gives information on the legs coordination and on the motor strategies of the lower limbs. Therefore, it can be used to obtain performance reference also outside labs, both in clinical and sport settings.

Comparative functional analysis of two different achilles tendon surgical repairs.

BACKGROUND: A number of different surgical procedures have been developed to treat Achilles tendon injuries including open and mini-invasive type. The aim of the present work was to compare the functional outcome of two different techniques, applying a clinical and instrumented protocol. MATERIALS AND METHODS: Fifty-one subjects were enrolled in the study. The experimental group consisted of 34 patients with a ruptured Achilles tendon, 19 operated by open surgical reconstruction without reinforcement (Open Group), while 15 underwent a mini-invasive procedure (Mini-invasive Group); the Control Group consisted of 17 healthy subjects. The assessment was based on the standing vertical jump, in both 'countermovement jump' and 'squat jump' mode, studying the relative flight times and the coordination of movement of each limb. An accelerometer was fastened to each ankle to obtain an independent assessment of the movement of each limb. RESULTS: The surgically treated patients showed a comparable functional performance to that of the Control Group but despite this full recovery they showed a tendency to ''favor'' the affected limb. This finding was more marked in the Mini-invasive Group. The Control Group invariably showed better coordination of the movement of the two limbs than the two experimental groups. This was particularly apparent in the take-off phase, indicated by asymmetrical push-off of the two limbs. CONCLUSION: The jumping evaluation used in this study resulted in similar results between the open and the mini-invasive techniques.