Patient Reported Outcome Measures used in Surgical Evaluation of Obstructive Sleep Apnea: A Systematic Review.

OBJECTIVE: To identify patient-reported outcome measures (PROMs) used to measure adult obstructive sleep apnea (OSA)-related quality of life in sleep surgery and analyze key psychometric properties in the original design and development of each PROM. DATA SOURCES: PubMed, Web of Science, Embase, PsychINFO, and CINAHL. REVIEW METHODS: A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Disease-specific instruments assessing sleep-related quality of life that were used in sleep surgery studies and validated in patients with sleep disorders were included. The Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) criteria were used to evaluate methodological quality. RESULTS: A total of 2494 abstracts were retrieved, and 216 underwent full-text review. Seven PROMs assessing sleep-related quality of life were identified. Only one (14%) PROM (SAQLI) was developed using both patient and physician input, and none were rated as "adequate" for content validity. Two PROMs utilized patients with sleep-disordered breathing during content development and none specifically queried patients considering surgery. Six (86%) PROMs demonstrated "very good" analysis of internal consistency per COSMIN criteria, and six (86%) included data on test-retest reliability. CONCLUSION: Several PROMs are utilized in sleep-related quality-of-life assessments for patients treated with OSA surgery. The measurement properties of these PROMs are of variable quality, and notably, no PROMs meet adequate quality measurements for content validity. New and updated PROMs for OSA-related quality of life should consider input from sleep surgery patients and providers. Laryngoscope, 2024.

Two-year outcomes of internal fixation with femoral neck system in patients with femoral neck fracture in an Asian population.

Background: Femoral neck fractures (FNF) are one of the most common fractures, with a projected increase in incidence with population growth and ageing. The Femoral Neck System (FNS) launched in 2019 was developed specifically for fixation of FNF with the purported advantages of providing both angular and rotational stability. We report our experience with the FNS and evaluate its effectiveness and associated complications. Methods: A retrospective case series of 50 patients who underwent surgical fixation for FNF from August 2020 to October 2021 using the FNS in two Singapore tertiary institutions with at least 2 years follow-up were included. Clinical data (patients' demographics, fracture classification, intra-operative and post-operative complications) were reviewed. Radiological analysis assessed the pre- and immediate post-operative garden alignment index (GAI) and presence of femoral neck shortening at 3 months. Results: The mean age was 63.5 years (SD 16.9, range 26-92). Five (10 %), 34 (68 %) and 11 (22 %) were ASA 1, 2 and 3 respectively. Twenty-four (48 %), 16 (32 %), 4 (8 %), and 6 (12 %) patients sustained Garden's 1, 2, 3 and 4 FNF respectively. The mean operative duration was 66.2 min (SD 20.5) and length of stay was 6.9 days (SD 4.6).The post-operative improvement in garden alignment index (GAI) was a mean of 9.1° (p < 0.001) on lateral view. The mean femoral neck shortening was 1.97 mm (SD 5.3) at 3 months. There were no intra-operative complications. Post-operatively, 1 (2 %) patient required blood transfusion, 1 (2 %) patient had implant cut-out and non-union managed non-operatively, 2 (4 %) patients developed avascular necrosis and required revision to total hip replacements. There were two (4 %) cases of 1-year mortality. Conclusion: The FNS achieved good outcomes with low rates of complications. The promising results justify its continued use and further evaluation in comparison to other devices.

Aspirin therapy is associated with a lower risk of pregnancy loss in both JAK2- and CALR-mutated essential thrombocythemia-A Mayo Clinic study of 200 pregnancies.

Two-hundred pregnancies involving 100 women with essential thrombocythemia (ET) were accessed from Mayo Clinic databases (1990-2023). Median platelet count displayed a decline during pregnancy, nadiring at 48% of baseline, in the third trimester: 704-369 × 109/L. Live birth rate was 72%. Of 53 (27%) unintentional pregnancy losses, 48 (24%) occurred in the first trimester. Other fetal complications included preterm birth 3%, intrauterine growth retardation 3%, and stillbirth 1%. Maternal complications included major hemorrhage (7%), preeclampsia (6%), thrombosis (1%), and placental abruption (0.5%). Antepartum management included no specific therapy in 52 (26%), aspirin alone in 112 (56%), aspirin combined with cytoreductive drugs or systemic anticoagulants in 23 (12%), and other permutations in the remaining. Postpartum systemic anticoagulation was documented in 29 (15%) pregnancies. Unintentional first-trimester loss was predicted by prior fetal loss (43% vs. 18%; p < .01), diabetes mellitus (DM; 67% vs. 23%; p = .02), and absence of aspirin therapy (45% vs. 14%; p < .01); the salutary effect of aspirin therapy was independent of the other two risk factors and apparent in both high (presence of ≥1 risk factor; 33% vs. 61%; p = .07) and low (absence of both risk factors; 10% vs. 34%; p < .01) risk scenarios. The benefit of aspirin therapy, in preventing first-trimester loss, was significant in both JAK2-mutated (18% vs. 50%; p < .01) and CALR-mutated (8% vs. 43%; p < .01) cases. Aspirin use was also associated with a lower risk of venous thrombosis (0% vs. 3%; p = .03). By contrast, the use of systemic anticoagulation, antepartum or postpartum, did not influence fetal or maternal complication rates. CALR mutation and DM predicted maternal hemorrhage (13% vs. 4%; p = .05) and preeclampsia (33% vs. 5%; p = .03), respectively. The current study demonstrates the protective role of aspirin in preventing first-trimester loss in ET, independent of driver mutation status or other risk factors.

Opioid Prescription Trends Among Sleep Surgeons in the United States.

OBJECTIVE: This study aimed to describe trends in opioid prescriptions among US sleep surgeons between 2013 and 2021 via a retrospective analysis conducted using publicly available data. METHODS: Utilizing the CMS part D database, we analyzed data from 82 sleep surgeons, focusing on metrics including number of opioid beneficiaries and claims, opioid cost, and opioid day supply per beneficiary. We employed statistical methods including ANOVA, t-tests, Fisher's exact test with Monte Carlo Simulation, and regression models. RESULTS: There were no significant changes in the number of opioid claims (p = 0.782) or beneficiaries per provider (p = 0.590) nor was there a decrease in opioid day supply per beneficiary (p = 0.489) over time. Surgeons who graduated residency before 2000 prescribed significantly more opioids over the course of the study period compared to those graduating after 2000 with higher opioid day supply per beneficiary (13.34 vs. 7.42, p < 0.001), higher opioid beneficiaries per provider (21.62 vs. 19.36, p = 0.028), and higher opioid claims per provider (30.30 vs. 21.78, p < 0.001). A significant annual decrease in opioid cost per beneficiary (ANOVA, p = 0.006) was noted. CONCLUSIONS: This study illuminates a significant impact of provider years in practice on opioid prescribing trends, alongside a decreasing trend in opioid cost per beneficiary. Despite the evolving paradigm emphasizing opioid reduction and evidence of decreasing opioid prescriptions in other otolaryngology subspecialties, our findings depict that opioid prescriptions among sleep surgeons remained stable from 2013 to 2021. LEVEL OF EVIDENCE: III Laryngoscope, 2024.

Sociodemographic and Healthcare System Barriers to PAP Alternatives for Adult OSA: A Scoping Review.

OBJECTIVE: To investigate sociodemographic and healthcare system barriers to access and utilization of alternative treatments to positive airway pressure (PAP) in the management of adult obstructive sleep apnea (OSA). DATA SOURCES: PubMed, Embase, and Web of Science databases were searched from 2003 to 2023 for English-language studies containing original data on sociodemographic and healthcare system barriers to PAP-alternative treatments for adult OSA. REVIEW METHODS: Studies were assessed using the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Title and abstract screening, full-text review, and data collection were conducted by two investigators independently. RESULTS: Out of 1,615 studies screened, 13 studies met inclusion criteria and reported on a total of 1,206,115 patients who received PAP alternative treatments, including surgery (n = 9 studies), and oral appliances (OAs) (n = 3 studies). The chance of receiving a PAP-alternative treatment such as surgery was greater among patients aged 39 years or younger, had body mass index below 30 kg/m2, fewer comorbidities, private insurance, and a higher occupational and income status. The decision of individuals to receive PAP alternative treatments was influenced by increased patient education from providers, as well as improvements in daytime sleepiness and partner perception of snoring and apnea. CONCLUSION: Cumulative evidence suggests that several sociodemographic and healthcare system factors are associated with decreased use of PAP alternatives when PAP therapy fails. Investigation of interventions to eliminate these potential barriers may improve access and treatment outcomes. Laryngoscope, 2024.

Exploitation of green synthesized chromium doped zinc oxide nanorods (NRs) mediated by flower extract of Rhododendron arboreum for highly efficient photocatalytic degradation of cationic dyes Malachite green (MG) and Fuchsin basic (FB).

In this work, green method to synthesize chromium-doped zinc oxide (ZnO) nanorods (NRs) using an aqueous flower extract from Rhododendron arboretum is explored. Herein, chromium-doped ZnO NRs were prepared with different amount of chromium doping, varied as 2-10%. The green synthesized products underwent substantial analysis through X-ray diffraction (XRD), spectroscopic such as ultraviolet spectroscopy(UV-Vis) and scanning electron microscopy (SEM) methods. All samples were found to have hexagonal wurtzite ZnO, with average particle sizes of 52.41, 56.6, 54.44, 53.05, and 56.99 nm, respectively, for 2, 4, 6, 8, and 10% chromium doping in ZnO NRs. The Cr-doped ZnO NRs exhibited remarkable photocatalytic degradation activity of cationic dyes under UV-light, i.e., Malachite Green and Fuchsin Basic with degradation of 99.604 and 99.881%, respectively in 90 min. The reusability tests for these green synthesized Cr-doped ZnO NRs have also been carried out, showed 9-11 cycles with 85% of degradation efficiency. In addition, the Cr-doped ZnO NRs exhibited high selectivity for cationic dyes when experiments against mixture of dyes were performed. Photodegradation kinetics followed the pseudo-first-order model. The flower-extract-stabilized chromium-doped ZnO NRs demonstrated high photocatalytic activity toward malachite green and fuchsin basic dyes, potential material for pollution remediation.

Cr-doped ZnO NRs by green method using flower extract of Rhododendon arboretum were prepared for the first time under ambient reaction conditions.Effect of Dopant i.e. Cr on Photocatalytic activity have been exploited.Selective photocatalytic degradation of cationic dyes i.e. MG, and FB has been achieved in 60­90 minutes.Optimization of reaction condition and various parameters has also been carried out.Recyclability of Cr-doped ZnO NRs was also evaluated and were found to be reusable for 11 cycles for degradation.

Discovery and Visualization of the Hidden Relationships among N-Glycosylation, Disulfide Bonds, and Membrane Topology.

Membrane proteins (MPs) are functionally important but structurally complex. In particular, MPs often carry three structural features, i.e., transmembrane domains (TMs), disulfide bonds (SSs), and N-glycosylation (N-GLYCO). All three features have been intensively studied; however, how the three features potentially correlate has been less addressed in the literature. With the growing accuracy from computational prediction, we used publicly available information on SSs and N-GLYCO and analyzed the potential relationships among post-translational modifications (PTMs) and the predicted membrane topology in the human proteome. Our results suggested a very close relationship between SSs and N-GLYCO that behaved similarly, whereas a complementary relation between the TMs and the two PTMs was also revealed, in which the high SS and/or N-GLYCO presence is often accompanied by a low TM occurrence in a protein. Furthermore, the occurrence of SSs and N-GLYCO in a protein heavily relies on the protein length; however, TMs seem not to possess such length dependence. Finally, SSs exhibits larger potential dynamics than N-GLYCO, which is confined by the presence of sequons. The special classes of proteins possessing extreme or unique patterns of the three structural features are comprehensively identified, and their structural features and potential dynamics help to identify their susceptibility to different physiological and pathophysiological insults, which could help drug development and protein engineering.

Human Papillomavirus-Associated Oropharyngeal Cancer: Global Epidemiology and Public Policy Implications.

Global trends in human papillomavirus (HPV)-associated head and neck cancers (HNC), specifically in the oropharynx subsite, have been dynamically changing, leading to new staging and treatment paradigms. Epidemiologic studies have noted regional variations in HPV-associated oropharyngeal squamous cell carcinoma (OPSCC). While HPV vaccination remains the main preventative approach, vaccination policy in relation to gender neutrality is heterogeneous and particularly sparse in low- and middle-income countries, where the burden of global cancer cases and HPV-associated HNC are not well-characterized in certain regions. This review summarizes the existing literature on regional variations of HPV-associated OPSCC and gender-neutral vaccine policies. Based on available data, the incidence of HPV-associated OPSCC is highest in North America, Europe, and Oceania. As of 2022, 122 of 195 (63%) World Health Organization (WHO) member states had incorporated HPV vaccinations nationally; of these, 41 of 122 (34%) member states have introduced gender-neutral vaccine coverage. Future research is needed to describe continued evolving trends in HPV-associated OPSCC, understand underlying risk factors leading to regional variation in disease, and implement gender-neutral policy more broadly.

Synthetic biology tools for environmental protection.

Synthetic biology transforms the way we perceive biological systems. Emerging technologies in this field affect many disciplines of science and engineering. Traditionally, synthetic biology approaches were commonly aimed at developing cost-effective microbial cell factories to produce chemicals from renewable sources. Based on this, the immediate beneficial impact of synthetic biology on the environment came from reducing our oil dependency. However, synthetic biology is starting to play a more direct role in environmental protection. Toxic chemicals released by industries and agriculture endanger the environment, disrupting ecosystem balance and biodiversity loss. This review highlights synthetic biology approaches that can help environmental protection by providing remediation systems capable of sensing and responding to specific pollutants. Remediation strategies based on genetically engineered microbes and plants are discussed. Further, an overview of computational approaches that facilitate the design and application of synthetic biology tools in environmental protection is presented.

[3+2]-Cycloaddition Reactions of gem-Difluorocyclopropenes with Azomethine Ylides - Access to Novel Fluorinated Scaffolds.

The introduction of fluorinated moieties into drugs as well as the increase of their overall three-dimensionality have become key strategies amongst medicinal chemists to generate sets of compounds with favorable drug-like properties. However, the introduction of fluorinated cyclopropane ring systems which combines both strategies is not widely exploited to date. This paper reports synthetic strategies exploiting the reactivity of gem-difluorocyclopropenes in dipolar cycloaddition reactions with azomethine ylides to afford sets of new fluorine-containing 3-azabicyclo[3.1.0]hexanes. In addition, the unexpected formation of complex trifluorinated scaffolds arising from proline esters and gem-difluorocyclopropenes is highlighted along with computational studies to elucidate the underlying mechanism. This study presents new avenues towards pharmaceutically relevant fluorinated 3-azabicyclo[3.1.0]hexanes that are accessible via robust and short synthetic sequences.

Pembrolizumab-associated chronic rhinosinusitis: A new endotype and management considerations.

KEY POINTS: Patients treated with pembrolizumab experience an increase in paranasal sinus inflammation Use of topical triamcinolone in carboxymethylcellulose is a treatment option for such patients.

Prediction Framework on Early Urine Infection in IoT-Fog Environment Using XGBoost Ensemble Model.

Urine infections are one of the most prevalent concerns for the healthcare industry that may impair the functioning of the kidney and other renal organs. As a result, early diagnosis and treatment of such infections are essential to avert any future complications. Conspicuously, in the current work, an intelligent system for the early prediction of urine infections has been presented. The proposed framework uses IoT-based sensors for data collection, followed by data encoding and infectious risk factor computation using the XGBoost algorithm over the fog computing platform. Finally, the analysis results along with the health-related information of users are stored in the cloud repository for future analysis. For performance validation, extensive experiments have been carried out, and results are calculated based on real-time patient data. The statistical findings of accuracy (91.45%), specificity (95.96%), sensitivity (84.79%), precision (95.49%), and f-score(90.12%) reveal the significantly improved performance of the proposed strategy over other baseline techniques.

Relationships of hospitalization outcomes and timing to endoscopy in non-variceal upper gastrointestinal bleeding: A nationwide analysis.

BACKGROUND: The optimal timing of esophagogastroduodenoscopy (EGD) and the impact of clinico-demographic factors on hospitalization outcomes in non-variceal upper gastrointestinal bleeding (NVUGIB) remains an area of active research. AIM: To identify independent predictors of outcomes in patients with NVUGIB, with a particular focus on EGD timing, anticoagulation (AC) status, and demographic features. METHODS: A retrospective analysis of adult patients with NVUGIB from 2009 to 2014 was performed using validated ICD-9 codes from the National Inpatient Sample database. Patients were stratified by EGD timing relative to hospital admission (≤ 24 h, 24-48 h, 48-72 h, and > 72 h) and then by AC status (yes/no). The primary outcome was all-cause inpatient mortality. Secondary outcomes included healthcare usage. RESULTS: Of the 1082516 patients admitted for NVUGIB, 553186 (51.1%) underwent EGD. The mean time to EGD was 52.8 h. Early (< 24 h from admission) EGD was associated with significantly decreased mortality, less frequent intensive care unit admission, shorter length of hospital stays, lower hospital costs, and an increased likelihood of discharge to home (all with P < 0.001). AC status was not associated with mortality among patients who underwent early EGD (aOR 0.88, P = 0.193). Male sex (OR 1.30) and Hispanic (OR 1.10) or Asian (aOR 1.38) race were also independent predictors of adverse hospitalization outcomes in NVUGIB. CONCLUSION: Based on this large, nationwide study, early EGD in NVUGIB is associated with lower mortality and decreased healthcare usage, irrespective of AC status. These findings may help guide clinical management and would benefit from prospective validation.

Interaction between Age and Primary Site on Survival Outcomes in Primary GI Melanoma over the Past Decade.

BACKGROUND: Primary malignant melanomas of the Gastrointestinal mucosa are uncommon. Most cases of gastrointestinal (GI) melanomas are secondary, arising from metastasis at distant sites. The purpose of this study is to assess to what extent the interaction between independent prognostic factors (age and tumor site) of primary GI melanoma influence survival. Furthermore, we also aimed to investigate the clinical characteristics, survival outcomes, and independent prognostic factors of patients with primary GI melanoma in the past decade. METHODS: A total of 399 patients diagnosed with primary GI melanoma, between 2008 and 2017, were enrolled in our study by retrieving data from the Surveillance, Epidemiology, and End Results (SEER) database. We analyzed demographics, clinical characteristics, and overall mortality (OM) as well as cancer-specific mortality (CSM) of primary GI melanoma. Variables with a p value < 0.1 in the univariate Cox regression were incorporated into the multivariate Cox model (model 1) to determine the independent prognostic factors, with a hazard ratio (HR) of greater than 1 representing adverse prognostic factors. Furthermore, we analyzed the effect of the interaction between age and primary location on mortality (model 2). RESULTS: Multivariate cox proportional hazard regression analyses revealed higher OM in age group 80+ (HR = 5.653, 95% CI 2.212-14.445, p = 0), stomach location of the tumor (HR = 2.821, 95% CI 1.265-6.292, p = 0.011), regional lymph node involvement only (HR = 1.664, 95% CI 1.051-2.635, p < 0.05), regional involvement by both direct extension and lymph node involvement (HR = 1.755, 95% CI 1.047-2.943, p < 0.05) and distant metastases (HR = 4.491, 95% CI 3.115-6.476, p = 0), whereas the lowest OM was observed in patients with small intestine melanoma (HR = 0.383, 95% CI 0.173-0.846, p < 0.05). Multivariate cox proportional hazard regression analyses of CSM also revealed higher mortality of the same groups and lower CSM in small intestine and colon melanoma excluding the rectum. For model 2, considering the interaction between age and primary site on mortality, higher OM was found in age group 80+, followed by age group 40-59 then age group 60-79, regional lymph node involvement only, regional involvement by both direct extension and lymph node involvement and distant metastases. The small intestine had a lower OM. The rectum as primary location and the age range 40-59 interacted to lower the OM (HR = 0.14, 95% CI 0.02-0.89, p = 0.038). Age and primary gastric location did not interact to affect the OM. For the CSM, taking into account the interaction between age and the primary location, higher mortality was found in the same groups and the colon location. The primary colon location also interacted with the age group 40-59 to increase the CSM (HR = 1.38 × 109, 95% CI 7.80 × 107-2.45 × 1010, p = 0). CONCLUSIONS: In this United States population-based retrospective cohort study using the SEER database, we found that only the age range 40-59 interacted with the rectum and colon to lower and increase mortality respectively. Primary gastric location, which was the single most important location to affect mortality, did not interact with any age range to influence mortality. With those results, we hope to shed some light on this rare pathology with a very dismal prognosis.

Effects of injection rates and tissue diffusivity in magnetic nano-particle hyperthermia.

Effects of injection rate and tumor physiology on the diffusion of magnetic nano-particles (MNPs) and temperature profile during magnetic hyperthermia are investigated in this work. The study considers three injection rates (2.5 µL/min, 10 µL/min, and 40 µL/min), and two MNP diffusion coefficients (10-9 m2/s and 10-11 m2/s). The simulation of this physics has been done on 3D tumor surrounded by healthy tissue. Transient MNP distribution in tissue is evaluated using Darcy's flow model and the MNP transport (convection-diffusion) equation. The temperature profile in the tumor model is computed by solving Penne's bioheat transfer equation (PBHTE). Results show tumors with high collagen content (with low MNP diffusivity) are more restrictive towards MNP transport than tumors having low collagen content. Thus, tumors with low MNP diffusivity need a higher injection rate to increase the homogeneity of MNP concentration as well as temperature profile during thermo-therapy. Results also show that, MNP fluid injected with a higher injection rate produces a more uniform MNP concentration up to greater depth than the lower injection rate.

Healthcare 4.0: recent advancements and futuristic research directions.

In recent years, Healthcare 4.0, the fourth healthcare revolution, has piqued the interest of numerous researchers around the world. Healthcare 4.0 is a relatively new term that has evolved from Industry 4.0 to meet diverse requirements in the healthcare domain. Healthcare 4.0 serves as a technological catalyst for accelerated growth by integrating cutting-edge industrial technologies. Despite the evolving nature of Healthcare 4.0 research, a complete and systematic survey of recent research on it has been scarce. Conspicuously, this study intends to present a systematic survey by investigating the recent trends, key constraints, and application areas of Healthcare 4.0. Further, a comprehensive survey of the research is used to identify the essential technologies required for the effective adoption of Healthcare 4.0. The research was conducted using the PRISMA methodology and an exhaustive search of all easily accessible libraries and academic repositories was made to obtain the relevant literature. At last, a diversity of outstanding issues are also presented to assist scholars and professionals who are interested in undertaking futuristic research in the current field.

Water-pluronic-ionic liquid based microemulsions: Preparation, characterization and application as micro-reactor for enhanced catalytic activity of Cytochrome-c.

Microemulsions (µEs), comprising water as polar component, pluronic (normal, L35 and reverse, 10R5) as surfactant and a hydrophobic ionic liquid (HIL) as non-polar component have been prepared and characterized. Owing to higher surface activity, pluronics have promoted the formation of µEs without the use of co-surfactant. Thus prepared µEs have been utilized as nano-reactors for the oxidation of guaiacol in the presence of Cytochrome-c (Cyt-c) at 15, 20, and 25 °C. A 3.2- and 1.3-fold increase in the rate of formation of product of enzymatic catalysis in direct µE (HIL-in-water) with reverse pluronic (10R5) is observed at 15 and 20 °C as compared to that in buffer. However, negligible enzymatic activity is observed in the direct µE formed by normal pluronic (L35). The catalytic activity of Cyt-c decreases in reverse µEs (water-in-HIL) as compared to direct µEs irrespective of the nature of pluronic used. The contrasting nature of nano-interfaces formed by pluronics in µEs and the extent of hydration of these nano-interfaces controlled by temperature exerts varying influence on the catalytic activity of Cyt-c. It is expected that the present work would result in providing a versatile platform for the creation of new IL and pluronic-based µEs for bio-catalytic applications, which have never been reported.