West Virginia School of Osteopathic Medicine

BACKGROUND:Isovolemic hemodilution red cell exchange (IHD-RCE) (as compared to standard, or STD-RCE) may: reduce per-procedure RBC use, result in a lower fraction of cells remaining (FCR), and provide an "iron unloading" benefit. We review the published literature to explore whether these benefits have been realized in real-world settings. METHODS:A literature search was conducted in PubMed, Embase, EBSCOhost, and Cochrane Library. Additional studies were identified through bibliography review. To be included, studies required STD-RCE versus IHD-RCE comparison groups. Data, including RBC utilization, actual FCR, ferritin levels, pre-hemoglobin S% (HbS%), and procedure intervals were extracted and analyzed using descriptive statistics. RESULTS:The initial search and bibliography review yielded 70 studies; 48 were excluded for not meeting inclusion criteria; of the remainder, 3 reports met full inclusion criteria and were retained for data extraction. Compared to STD-RCE, IHD-RCE reliably reduced red cell requirements, with reduction (in mL/mL Total Blood Volume) from 0.55 (0.42-0.66) to 0.49 (0.34-0.54), among 15 patients (p = 0.02); and (in mL/kg) from 39.5 ± 4.6 to 35.5 ± 4.1 (p < 0.001) in another 20 patients. While actual FCR was lower than programmed FCR with both STD-RBCx and IHD-RBCx, the magnitude of this difference was not significantly different (n = 15). Among 26 patients for whom ferritin levels were reported, a clear reduction was not observed. Furthermore, no clear safety signals were observed. CONCLUSIONS:Conversion to IHD-RCE appears safe and reduces per-procedure RBC utilization by approximately 1 unit. IHD-RCE did not demonstrate a clear iron-unloading benefit over STD-RCE.

This study developed and characterized a novel antimicrobial food packaging film fabricated from electrospun polycaprolactone (PCL) nanofibers incorporated with thyme oil nanoemulsions (TONEs). The concentration of TONEs in the film ranged from 2.5 to 15 % (v/v). The physicochemical properties, including pH, viscosity, and water absorption of the film were evaluated, with results showing favorable values (TONEs pH approximate to 5.46, viscosity approximate to 0.26 cP, contact angle approximate to 109-127(0) and water absorption approximate to 21.47 %). The microstructure of the film was observed using scanning electron microscopy (SEM), which revealed the uniform dispersion of TONEs within the PCL nanofibrous matrix, with average fiber diameters ranging from 555.68 to 571.09 nm. The TONEs interaction within the PCL matrix in the film was evaluated by Fourier-transform infrared (FTIR) spectroscopy, which revealed hydrogen-bonding interactions between thyme oil components and PCL ester groups. The antimicrobial activity of the films was assessed against common foodborne pathogens, including Escherichia coli, Salmonella enterica, Staphylococcus aureus, and Bacillus cereus. The films containing 10 % and 15 % TONEs demonstrated significant inhibition zones on agar plates (up to 25 mm for Salmonella enterica), confirming their excellent antimicrobial efficacy, with minimum inhibitory concentrations (MICs) as low as 0.078 % (v/v) for most pathogens. The nanoemulsion formulation exhibited optimal droplet sizes (75-99 nm) and polydispersity indices (<0.7), ensuring stable encapsulation and controlled release properties. These findings indicate that TONE-loaded PCL nanofibers are promising antimicrobial packaging materials capable of preventing the growth of foodborne pathogens.

Scar outcomes are traditionally evaluated at 12 months post-surgery, yet early prediction of long-term scar characteristics may facilitate timely interventions, enhance treatment strategies, shorten clinical trial durations, and improve patient outcomes. This study evaluates whether 3-month scar assessments reliably predict 12-month outcomes using validated scar assessment scales and interrater reliability measures. Two surgeons evaluated a prospective cohort of 40 surgical patients using standardised scar assessment tools. Logistic regression assessed the predictive value of 3-month classifications for 12-month binary outcomes ('good' vs. 'poor' scar quality), while linear regression evaluated continuous scar scores. Receiver operating characteristic (ROC) curves and area under the curve (AUC) values quantified predictive accuracy. Scars classified as 'good' at 3 months were significantly more likely to remain 'good' at 12 months (p < 0.001), with strong predictive performance (AUC = 0.763). Linear regression demonstrated significant predictive accuracy for width, height, and overall opinion. However, vascularity predictions were weak, and depth was not significantly associated with long-term outcomes. Interrater reliability was moderate to good across measures, with intraclass correlation coefficients values ranging from 0.215 (depth) to 0.714 (width), and Cohen's Kappa for binary scar classifications of 0.505 (p < 0.001). Early 3-month scar assessments reliably predict 12-month outcomes for width, height, and overall opinion, while vascularity and depth remain less predictable. Scars rated as 'good' at 3 months are unlikely to worsen, while 'poor' scars rarely improve without intervention. These findings highlight the utility of early scar evaluations in guiding postoperative management and patient counselling.

Background:Mycobacterium haemophilum is an uncommon nontuberculous mycobacterium that primarily affects immunocompromised hosts and may present with cutaneous and musculoskeletal manifestations that mimic inflammatory or infectious disorders. Its specialized growth requirements often delay diagnosis, particularly in solid organ transplant recipients. Case Presentation:A 59-year-old man with a history of deceased donor kidney transplantation presented with progressive bilateral ankle pain, lower extremity swelling, and painful nodular skin lesions. Initial evaluation suggested erythema nodosum and inflammatory arthritis, with nondiagnostic musculoskeletal imaging and arthrocentesis. Corticosteroid therapy resulted in only transient improvement. Persistent low-titer serum cryptococcal antigenemia with negative cerebrospinal fluid studies further complicated the diagnostic evaluation and prompted empiric fluconazole therapy. Progressive disease led to recurrent hospitalization and inability to bear weight. Initial synovial fluid aspiration demonstrated acid-fast bacilli, whereas repeat bilateral aspirations demonstrated concomitant monosodium urate crystals and acid-fast bacilli. Skin biopsy demonstrated rod-shaped acid-fast organisms with negative fungal staining. Routine cultures were unrevealing, but independent polymerase chain reaction testing performed at two reference laboratories identified M. haemophilum. Mycophenolate mofetil was withheld because of active infection, whereas tacrolimus therapy was continued with therapeutic drug monitoring. Prolonged multidrug antimicrobial therapy was individualized according to susceptibility testing and medication tolerance. Despite treatment-related complications, the patient experienced substantial clinical improvement with healing of cutaneous lesions, restoration of mobility, and preservation of kidney allograft function. Conclusion:This case highlights the diagnostic complexity of M. haemophilum infection in kidney transplant recipients. Simultaneous erythema nodosum-like lesions, crystal arthropathy, and persistent serum cryptococcal antigenemia obscured the diagnosis, whereas conventional microbiologic studies remained largely unrevealing. Early consideration of opportunistic nontuberculous mycobacterial infection and the use of molecular diagnostics may facilitate timely diagnosis and appropriate management in immunocompromised patients.

BACKGROUND:The locking attachment washer (LAW) plate offers an advancement in fixation techniques for supracondylar distal femur fractures. This study compared fixation outcomes for supracondylar distal femur fractures managed with traditional fixation techniques (ie, retrograde intramedullary nail, locking plate) versus DePuy Synthes RFN-ADVANCED Retrograde Femoral Nailing System incorporating the LAW plate. MATERIALS AND METHODS:A retrospective single-center comparative analysis was conducted of adult patients with supracondylar distal femur fractures treated between December 2022 and December 2024. Patients were divided into two groups: (1) traditional fixation and (2) nail plate construct using retrograde femoral nail with LAW plate. Outcomes focused on surgical parameters, functional recovery, and clinical implications. RESULTS:Forty-five patients met inclusion criteria: 17 treated with traditional fixation, 28 with the LAW construct. Patients in the LAW group were significantly more likely to have an estimated 76.43-minute reduction in operative time compared to patients in the traditional group (P = .009). Hospital length of stay trended shorter with LAW (7.5 vs 15.2 days) but failed to achieve statistical significance in both univariate and multivariate analyses. Postoperative weight bearing was significantly more common with LAW (67.8% vs 23.6%, P = .032), and the rate of radiographic union trended lower with LAW but did not achieve statistical significance. CONCLUSION:The LAW construct demonstrated shorter operative times and earlier advancement in weight-bearing protocols, despite use in an older cohort. Radiographic union and complication rates were comparable. Potential advantages of the LAW construct lend to clinical and research opportunities for these complex injuries.