Scoping review of micronutrient imbalances, clinical manifestations, and interventions.

Micronutrients are fundamental to support and maintain normal physiological function. Deficiencies of these nutrients are a growing public health concern with potentially devastating consequences. An adequate diet of whole foods is the primary source of micronutrients; supplementation is sometimes necessary.

The revised risk analysis index outperforms the 5-factor modified frailty index in predicting postoperative morbidity after pilon fracture fixation.

Background: Pilon fractures often result from high energy mechanisms resulting in long-term morbidity and postoperative complications. While there is extensive literature investigating frailty scales as tools for preoperative risk stratification in orthopedic surgery, there is no literature regarding their use in fixation of pilon fractures. The objective of this study was to compare the predictive ability and discriminative accuracy of the Revised Risk Analysis Index (RAI-rev) and the 5-Item Modified Frailty (mFI-5) in 30-day postoperative outcomes following surgical fixation of pilon fractures.

Intradural Repair of Temporal Bone Encephalocele and Cerebrospinal Fluid Leak: Results from a Single Institution.

Background: Lateral temporal bone encephaloceles incidence is increasing with obesity rates. Middle fossa (MF) craniotomy, transmastoid (TM), or combined MF + TM access can be used for repair.

Methods: Retrospective review of MF or MF + TM repair with an intradural graft.

Predictive Value of Geriatric Nutritional Risk Index and Risk Analysis Index for Post-operative Outcomes in Spine Surgery Patients: A Comprehensive Analysis.

Study DesignRetrospective cohort study.ObjectivesFrailty and nutritional status are predictors of adverse spine surgery outcomes. This study evaluated the predictive utility of a combined Risk Analysis Index (RAI) and Geriatric Nutritional Risk Index (GNRI) model, and introduced a compound score integrating RAI, GNRI, American Society of Anesthesiologists (ASA) classification, and Preoperative Acute Severe Condition (PACS).

A Retrospective Time and Value Analysis of Surgical Oncology Cases Using 3D Printing: A Comprehensive Cancer Center Experience.

The use of 3D-printed models in surgical planning has gained traction in light of its potential to improve precision and patient outcomes. The objective of this study was to review data and provide a time and value analysis of the use of 3D printing at a National Cancer Institute (NCI)-designated comprehensive cancer center. The estimated time of surgical procedures for surgical planning was compared with the time required for procedures that did not use 3D printing.

Comparison of ENLYT, a Portable Flexible Nasopharyngoscope, with the Standard of Care Nasopharyngoscope.

ObjectivesThis study seeks to compare a newly developed portable flexible nasopharyngoscope (ENLYT) to the standard of care (SOC) flexible nasopharyngoscope.MethodsSubjects were consented to undergo a nasopharyngeal scope exam using ENLYT after SOC nasopharyngoscope examination. Data collection included a physician feedback survey consisting of questions regarding ease of use, video quality and perceived patient pain.

Predictive value of the risk analysis index for 30-day mortality following surgical management of thoracolumbar vertebral body fractures.

Purpose: Frailty has emerged as a key predictor of postoperative outcomes, with indices like the revised Risk Analysis Index (RAI) and the modified Frailty Index (mFI-5) used for assessment. The purpose of this study was to compare the predictive value and discriminatory accuracy of the mFI-5 and RAI for adverse outcomes following surgical management of thoracolumbar (TL) spine fractures.

Methods: This was a retrospective cohort study utilizing data from the 2015-2019 years of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database.

Rapid Neurological Decline in a Patient With Creutzfeldt-Jakob Disease: A Case Report.

Creutzfeldt-Jakob disease (CJD) is a rare, rapidly progressive spongiform encephalopathy caused by the accumulation of misfolded prion proteins, which undergo a transformation from the normal alpha-helix configuration (PrPC) to abnormal beta-pleated sheets (PrPSc). The disease typically leads to a rapidly progressive decline in motor, neurologic, and functional abilities, often culminating in severe disability or death within months. However, the rate of progression can vary significantly among patients, as well as the classification of CJD; being either sporadic, genetic, or acquired (infectious) with some cases demonstrating an exceptionally accelerated course.

Virtual and In-Person Interview Offerings in the General Surgery Residency Application Cycle: A How-to Hybrid.

PurposeVirtual General Surgery residency interviews remain common despite the easing of travel restrictions and health risks associated with the spread of COVID-19. The primary benefits of virtual interviews include time and cost savings for applicants and programs alike. Despite these benefits, many have advocated for a return to the in-person setting, citing improved ability for applicants to assess the intangibles of a program.

Patients with History of Metastasis Have Differing Surgical Indications and Increased Perioperative Risk Following Revision Total Joint Arthroplasty.

Introduction: Revision arthroplasty is an invasive procedure with increased morbidity relative to primary joint arthroplasty. Therefore, patients with metastatic cancer (Met) undergoing revision total joint arthroplasty (rTJA) may be at greater risk. This study assesses early postoperative outcomes among Met patients undergoing rTJA.

The Association of Preoperative Hydrocodone and Acetaminophen With Total Opioid Requirement, and Pain Experience in Children Undergoing Adenotonsillectomy.

Background: Pre-emptive analgesia may be of benefit in reducing total opioid use and improving the pain experience perioperatively. However, there is conflicting evidence as to the benefits of pre-emptive analgesia, with limited evidence in children. The aim of this study was to examine the association between preoperative use of hydrocodone with acetaminophen and total opioid consumption in children undergoing adenotonsillectomy.

ChatGPT-4 in Neurosurgery: Improving Patient Education Materials.

Background And Objectives: Adequate understanding of health information has been shown to be a stronger determinant of health than several demographic factors, including age, income, or employment status. However, existing neurosurgical patient education materials (PEMs) may be too complex for the average American and may contribute to poor health literacy. Large language model chatbots may provide a rapid and low-cost means of rewriting existing PEMs at a lower reading level to improve patient understanding and overall health literacy.

Evidence Based Analysis Enhances Surgical Outcomes of Novice Resident Surgeons.

Evidence based practice enhances healthcare delivery and prevents unsafe procedures. While competency based assessments of resident cataract surgery are standard, evidence based analysis of refractive outcomes remains underutilized in educational curricula. This retrospective single center study evaluated refractive outcomes from 21 novice ophthalmology resident surgeons.

Concentrated bone marrow aspirate applications in bony fusion for foot and ankle orthopaedic surgery: A review.

There is an emerging role for orthobiologic adjuncts including concentrated bone marrow aspirate (CBMA) for the treatment of bony pathology of the foot and ankle. Animal studies and basic science investigations have provided the framework for the theoretical benefit of CBMA in augmenting bone healing. There is moderate to high level evidence to support the use of CBMA injectate for the non-operative treatment of delayed or non-union of bony fracture, possibly decreasing the need for surgical fixation and open fracture site augmentation, especially in high-risk patients.

Responding after Hurricane Helene: Rapidly Estimating Impacts to Environmental Health Services in North Carolina.

Hurricane Helene caused catastrophic flooding and infrastructure damage across the mountainous regions of western North Carolina. Responding agencies had to make real-time decisions about emergency response, infrastructure repair, and aid allocation. Here, we describe how our decade-long transdisciplinary research program supported data-driven recovery decisions in the days following a storm through the development of a novel emergency response decision support system (DSS).

Clin-STAR Corner: Practice Changing Advances in Diabetes Care.

Background: Diabetes is common among older adults. While most cases are type 2, treatment advances and more adult-onset cases have led to more individuals living with type 1 diabetes. All older adults with diabetes are at an increased risk for hypoglycemia, yet this risk is especially high among those with type 1 diabetes due to the lifelong requirement for insulin.

Impact of Professional Development Workshops on PA Faculty Retention and Career Advancement.

Introduction: Physician assistant (PA) programs have seen unprecedented growth in the past 10 years with over 300 accredited PA programs currently. With this growth comes the need for qualified faculty.

Methods: This retrospective quantitative data analysis examined the relationship between participation in the PA Education Association (PAEA) workshops and retention in PA education and/or career advancement post workshop attendance.

Femoral Vessel Occlusion Enhances Cardiac and Cerebral Perfusion in a Porcine Model of Cardiac Arrest.

Background: Closed chest compressions during cardiopulmonary resuscitation (CPR) mechanically circulate blood to the organs during cardiac arrest, yet cardiac arrest remains among the most fatal diseases, with a mortality rate that exceeds 85% to 90% globally. Novel methodologies to improve organ perfusion, particularly in resource-restricted settings, are overdue. This study evaluated the efficacy of external femoral vessel occlusion (FVO) during CPR in a large mammal model.

Primed for Precision: A Review of the Evidence for Heterogeneous Treatment Effects in Diabetes Distress Treatments Among Adults with Type 1 Diabetes and Recommendations for Future Research.

Purpose Of Review: Care guidelines recommend screening and intervention for diabetes distress (DD) as part of standard type 1 diabetes (T1D) care. The variability in how individuals with diabetes experience distress, alongside the range of treatment options, underscores the value of tailoring approaches for addressing diabetes distress. Our objective was to summarize contemporary clinical trials addressing DD directly in adults with T1D, focusing on evidence of heterogenous treatment effects.

Osteopathic manipulation to increase lactation quantity: a prospective case series.

Context: There is currently no clinical research investigating the effect of osteopathic manipulation on the milk supply of lactating patients. Herbal and prescription galactagogues are limited and have the potential for serious side effects.

Objectives: The objective of this study was to determine whether osteopathic manipulative treatment (OMT) can increase milk supply in lactating people with low milk supply (hypogalactia).

Immunofluorescence Assays to Visualize Tick-Borne Flaviviruses in Mouse Skin or Brain.

Multiplex immunofluorescence (IF) utilizes a combination of different fluorophore-linked antibodies to facilitate the simultaneous observation of multiple antigenic epitopes within a tissue section. In this chapter, we describe how tick-borne flaviviruses can be visualized in mouse skin biopsies harvested from the tick feeding site or in mouse brain tissue. Using antibodies specific to the North American tick-borne flavivirus, Powassan virus (POWV), and to Mus musculus cell markers, IF multiplex labeling experiments allow us to visualize how POWV antigen co-localizes with host cell markers.