Author: Nevin Manimala

World Neurosurg. 2024 Apr 15:S1878-8750(24)00615-6. doi: 10.1016/j.wneu.2024.04.052. Online ahead of print.

ABSTRACT

Retrospective cohort study. Level of Evidence Level III. Dural tears (DT) are a frequent complication after lumbar spine surgery. With this study we sought to determine the incidence of DT and the related impact on healthcare expenditures after lumbar discectomies. All patients with first-time single level lumbar discectomies at our institution that underwent minimally-invasive surgery from 2015 to 2019 were reviewed. Age, sex, weight, height, body mass index (BMI), costs, revenues, length of stay (LOS), American Society of Anesthesiology (ASA) score, Charlson Comorbidity Index (CCI) and operation time (OT) were assessed. Exclusion criteria were age < 18 years, previous spine surgery, multiple or traumatic disc herniations but also malignant and infectious diseases. The follow-up time was at least 12 months postoperatively. 358 patients with lumbar discectomies were identified and 230 met the inclusion criteria. The DT incidence was 3.5%. The mean costs (p < 0.001), the loss (p < 0.01) and the operation time (p < 0.0001) were found to be significantly higher in the DT group when compared to the control group of patients without a DT. The revenues were not statistically different between both groups (p > 0.05). Further analysis of the control group by profit and loss revealed significantly higher BMI (p < 0.05), LOS (p < 0.0001) and OT (p < 0.0001) in the loss group. DT represent a significant socioeconomic burden in lumbar spine surgery and cause severe secondary complications. The DT-related impact on healthcare expenses is primarily based on significantly higher OT and a higher mean LOS.

PMID:38631663 | DOI:10.1016/j.wneu.2024.04.052

Sci Total Environ. 2024 Apr 15:172527. doi: 10.1016/j.scitotenv.2024.172527. Online ahead of print.

ABSTRACT

In recent years, economies have been increasingly focused on achieving the United Nations’ Sustainable Development Goals, recognizing that their achievement is vital to ecological sustainability and green growth. In this context, this paper focuses on investigating the impact of green innovation, green investment, economic growth, and natural resources on ecological sustainability in the five best-performing European Union countries in terms of the Climate Change Performance Index. This study uses the load capacity factor as a comprehensive proxy of ecological sustainability and also assesses the load capacity curve hypothesis in sample nations. Continuously updated fully modified and continuously updated bias-corrected estimators are used to analyze the data from 1995 to 2020 in the context of climate action perspective. The econometric analysis revealed that the load capacity curve hypothesis is invalid in the sample countries. Natural resources decrease environmental sustainability. However, green investments and green innovations contribute to environmental quality and thereby, can be used for effective climate action. Based on these findings, the study recommends specific policies to achieve the Sustainable Development Goals, with a particular focus on target 13.

PMID:38631639 | DOI:10.1016/j.scitotenv.2024.172527

Sci Total Environ. 2024 Apr 15:172525. doi: 10.1016/j.scitotenv.2024.172525. Online ahead of print.

ABSTRACT

Bumblebees play a vital role in both natural and agricultural environments, however there has been a noticeable decline in their populations. Pesticides, particularly neonicotinoids, are widely regarded as a substantial contributing factor to the decline in bumblebee populations, as evidenced by the detrimental impacts documented across many stages of their life cycle. Mating is vital for the population maintenance of bumblebees. Nevertheless, there is a scarcity of research conducted on the effects of pesticides on the mating process. In this study, we individually examined the impact of imidacloprid on the mating behavior of bumblebee males and queens. A competitive mating experiment was conducted to evaluate the effect on the competitive prowess of male individuals and the mate selection behavior of female individuals. The study revealed that the mating rate of bumblebees exposed to a concentration of 10 ppb of imidacloprid was 3 %. This finding demonstrated a statistically significant impact when compared to the control group, which exhibited a mating rate of 58 % in the normal mating experiment. Furthermore, in the competitive mating experiment, we found that the competitive mating success rate of treated males (1 %) was significantly lower than that of untreated males (35 %). Hence, it provides evidence that neonicotinoid imidacloprid negatively affects bumblebee mating success and cautions us to protect bumblebees from pesticide exposure to prevent a severe impact on their populations.

PMID:38631635 | DOI:10.1016/j.scitotenv.2024.172525

Int J Biol Macromol. 2024 Apr 15:131629. doi: 10.1016/j.ijbiomac.2024.131629. Online ahead of print.

ABSTRACT

Current management of HCV infection is based on Direct-Acting Antiviral Drugs (DAAs). However, resistance-associated mutations, especially in the NS3 and NS5B regions are gradually decreasing the efficacy of DAAs. Among the most effective HCV NS3/4A protease drugs, Sofosbuvir also develops resistance due to mutations in the NS3 and NS5B regions. Four mutations at positions A156Y, L36P, Q41H, and Q80K are classified as high-level resistance mutations. The resistance mechanism of HCV NS3/4A protease toward Sofosbuvir caused by these mutations is still unclear, as there is less information available regarding the structural and functional effects of the mutations against Sofosbuvir. In this work, we combined molecular dynamics simulation, molecular mechanics/Generalized-Born surface area calculation, principal component analysis, and free energy landscape analysis to explore the resistance mechanism of HCV NS3/4A protease due to these mutations, as well as compare interaction changes in wild-type. Subsequently, we identified that the mutant form of HCV NS3/4A protease affects the activity of Sofosbuvir. In this study, the resistance mechanism of Sofosbuvir at the atomic level is proposed. The proposed drug-resistance mechanism will provide valuable guidance for the design of HCV drugs.

PMID:38631585 | DOI:10.1016/j.ijbiomac.2024.131629

J Invertebr Pathol. 2024 Apr 15:108109. doi: 10.1016/j.jip.2024.108109. Online ahead of print.

ABSTRACT

Varroa destructor is one of the most destructive enemies of the honey bee, Apis mellifera all around the world. Several control methods are known to control V. destructor, but the efficacy of several alternative control methods remains unexplored. Irradiation can be one of these unknown solutions but before practical application, the effectiveness, and the physiological effects of ionizing radiation on the host and the parasite are waiting to be tested. Therefore, the objective of our study was to investigate the effects of different doses (15, 50, 100, and 150 Gy) of high-energy X-ray irradiation through mortality rates and hemocyte composition changes in A. mellifera workers and record the mortality rates of the parasite. The mortality rate was recorded during short-term (12, 24, and 48 h) and long-term periods (3, 6, 12, 18, and 24d). The sensitivity of the host and the parasite in case of the higher doses of radiation tested (50, 100, and 150 Gy) been demonstrated by total mortality of the host and 90 % of its parasite has been observed on the 18th day after the irradiation. V. destructor showed higher sensitivity (1.52-times higher than the adult honey bee workers) at the lowest dose (15 Gy). A. mellifera hemocytes were influenced significantly by radiation dosage and the elapsed time after treatment. The higher radiation doses increased plasmatocyte numbers in parallel with the decrease in prohemocyte numbers. On the contrary, the numbers of granulocytes and oencoytes increased in the treated samples, but the putative effects of the different dosages on the recorded number of these hemocyte types could not be statistically proven. In summary, based on the outcome of our study X-ray irradiation can be deemed an effective tool for controlling phoretic V. destructor. However, further research is needed to understand the physiological response of the affected organisms.

PMID:38631557 | DOI:10.1016/j.jip.2024.108109

Osteoarthritis Cartilage. 2024 Apr 15:S1063-4584(24)01153-1. doi: 10.1016/j.joca.2024.04.004. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine if global, central, or peripheral adiposity is associated with prevalent and worsening cartilage lesions following anterior cruciate ligament reconstruction (ACLR).

METHODS: In 107 individuals one-year post-ACLR, adiposity was assessed globally (body mass index, BMI), centrally (waist circumference), and peripherally (knee subcutaneous adipose tissue thickness) from magnetic resonance imaging (MRI). Tibiofemoral and patellofemoral cartilage lesions were assessed from knee MRIs at 1- and 5-years post-ACLR. Poisson regression evaluated the relation of adiposity with prevalent and worsening tibiofemoral and patellofemoral cartilage lesions adjusting for age, sex, and activity level.

RESULTS: The prevalence ratios of adiposity with tibiofemoral (presence in 49%) and patellofemoral (44%) cartilage lesions ranged from 0.99 to 1.03. Adiposity was more strongly associated with longitudinal changes in tibiofemoral (worsening in 21%) and patellofemoral (44%) cartilage lesions. One-unit increase in global (kg/m²), central (cm), and peripheral (mm) adiposity was associated with a higher risk of worsening tibiofemoral cartilage lesions by 17% (risk ratios [95% CI]: 1.17 [1.09 to 1.23]), 5% (1.05 [1.02 to 1.08]), and 9% (1.09 [1.03 to 1.16]), and patellofemoral cartilage lesions by 5% (1.05 [1.00 to 1.12]) 2% (1.02 [1.00 to 1.04]) and 2% (1.02 [1.00 to 1.04]), respectively.

CONCLUSION: Greater adiposity was a risk factor for worsening cartilage lesions up to 5 years post-ACLR. Clinical interventions aimed at mitigating excess adiposity may be beneficial in preventive approaches for early post-traumatic OA.

PMID:38631554 | DOI:10.1016/j.joca.2024.04.004

Appetite. 2024 Apr 15:107359. doi: 10.1016/j.appet.2024.107359. Online ahead of print.

ABSTRACT

A reduction in meat consumption is necessary to mitigate negative impacts of climate change and adverse health outcomes. The UK has an increasingly multi-ethnic population, yet there is little research on meat consumption habits and attitudes among ethnic groups in the UK. We ran a survey (N=1014) with quota samples for ethnic groups and analyzed attitudes, behaviors and norm perceptions of White, South Asian and Black British respondents. Most respondents believe overconsumption of red and processed meat has negative impacts on health (73.3%) and the environment (64.3%).South Asian respondents were statistically significantly less likely to be meat eaters than White respondents (OR = .44, 95% CIs: .30-.65, t= -4.15, p= .000), while there was no significant difference between White and Black respondents (OR = 1.06, 95% CIs: .63-1.76, t= 0.21, p= .834). Both South Asian (OR = 2.76, 95% CIs: 1.89-4.03 t= 5.25, p= .000) and Black respondents (OR =2.09, 95% CIs: .1.30-3.35, t =3.06, p = .002) were significantly more likely to express being influenced by friends and family in their food choices than White respondents. South Asian (OR = 3.24 ,95% CIs: 2.17-4.84, t= 5.74, p= .000) and Black (OR = 2.02 ,95% CIs: 1.21-3.39, t= 2.69, p= .007) respondents were also both significantly more likely to report they would want to eat similarly to their friends and family than White respondents. Statistical analyses suggested some gender and socioeconomic differences across and among ethnic groups, which are reported and discussed. The differences in meat consumption behaviors and norm conformity between ethnic groups raises the prospect that interventions that leverage social norms may be more effective in South Asian groups than Black and White groups in the UK.

PMID:38631543 | DOI:10.1016/j.appet.2024.107359

Int J Radiat Oncol Biol Phys. 2024 Apr 15:S0360-3016(24)00513-3. doi: 10.1016/j.ijrobp.2024.04.014. Online ahead of print.

ABSTRACT

PURPOSE: Regional nodal irradiation (RNI) to the axilla and supraclavicular area presents distinct toxicities, such as lymphedema and shoulder stiffness, compared to whole-breast irradiation. There is insufficient evidence on the safety of dose-escalation in hypofractionated RNI. We aimed to evaluate and compare toxicity rates in patients with breast cancer who received hypofractionated RNI with and without dose-escalation.

METHODS: We retrospectively analyzed 381 patients with breast cancer treated with hypofractionated RNI between March 2015 and February 2017. Patients received either the standard-dose to the regional nodal area (43.2 Gy/16 fx; 48.7 Gy_3.5 EQD2, 2 Gy equivalent dose with α/β=3.5 Gy) or dose-escalation with a median dose of 54.8 Gy_3.5 EQD2 (range, 51.7 – 60.9 Gy_3.5 EQD2) depending on clinical and pathologic nodal stage. Toxicity rates of lymphedema and shoulder stiffness were assessed, and statistical analyses were conducted to identify associated factors.

RESULTS: The median follow-up time was 32.3 months (5.7 – 47.0 months). After radiotherapy, 71 (18.6%) patients developed lymphedema, and 48 (12.6%) developed shoulder stiffness. Patients who received dose-escalation exhibited significantly higher rates of lymphedema (32.1% vs. 14.8%; Odds Ratio (OR): 2.72, p=0.0004) and shoulder stiffness (23.8% vs. 9.4%; OR: 2.01, p=0.0205) compared to the standard-dose group. Moreover, dose-escalation showed a tendency to increase the severity of lymphedema and shoulder stiffness.

CONCLUSIONS: Patients who received dose-escalation in hypofractionated RNI face a higher risk of developing lymphedema and shoulder stiffness compared to those who received standard-dose hypofractionated RNI. Therefore, it is crucial to implement close and frequent monitoring for early detection, along with timely rehabilitation interventions for these patients.

PMID:38631540 | DOI:10.1016/j.ijrobp.2024.04.014

Int J Radiat Oncol Biol Phys. 2024 Apr 15:S0360-3016(24)00481-4. doi: 10.1016/j.ijrobp.2024.04.001. Online ahead of print.

ABSTRACT

PURPOSE: To provide an understanding of current FLI techniques, and their potential to improve dosimetry and outcomes for lung cancer patients receiving radiation therapy (RT).

METHODS: EMBASE, PubMed, and Cochrane Library were searched from 1990 until April 2023. Articles were included if they reported on FLI in one of: techniques, incorporation into RT planning for lung cancer, quantification of RT-related outcomes for lung cancer patients. Studies involving all RT modalities, including stereotactic body radiotherapy and particle therapy, were included. Meta-analyses were conducted to investigate differences in dose-function parameters between anatomical and functional RT planning techniques, as well as to investigate correlations of dose-function parameters with grade 2+ radiation pneumonitis (RP).

RESULTS: 178 studies were included in the narrative synthesis. We report on FLI modalities, dose-response quantification, functional lung (FL) definitions, FL avoidance techniques, and correlations between FL irradiation and toxicity. Meta-analysis results show that FL avoidance planning gives statistically significant absolute reductions of 3.22% to the fraction of well-ventilated lung receiving 20 Gy or more (vent-fV20), 3.52% to the fraction of well-perfused lung receiving 20 Gy or more (perf-fV20), 1.3 Gy to the mean dose to the well-ventilated lung (vent-fMLD), and 2.41 Gy to the mean dose to the well-perfused lung (perf-fMLD). Increases in the threshold value for defining FL are associated with decreases in functional parameters. For intensity-modulated radiation therapy and volumetric modulated arc therapy, avoidance planning results in a 13% rate of grade 2+ RP, which seems reduced compared to results from conventional planning cohorts. A trend of increased predictive ability for grade 2+ RP was seen in models using FL information, but was not statistically significant.

CONCLUSIONS: FLI shows promise as a method to spare FL during thoracic RT, but interventional trials related to FL avoidance planning are sparse. Such trials are critical to understanding the impact of FL avoidance planning on toxicity reduction and patient outcomes.

PMID:38631538 | DOI:10.1016/j.ijrobp.2024.04.001

Magn Reson Imaging. 2024 Apr 15:S0730-725X(24)00131-0. doi: 10.1016/j.mri.2024.04.018. Online ahead of print.

ABSTRACT

PURPOSE: Further acceleration of DWI in diagnostic radiology is desired but challenging mainly due to low SNR in high b-value images and associated bias in quantitative ADC values. Deep learning-based reconstruction and denoising may provide a solution to address this challenge.

METHODS: The effects of SNR reduction on ADC bias and variability were investigated using a commercial diffusion phantom and numerical simulations. In the phantom, performance of different reconstruction methods, including conventional parallel (SENSE) imaging, compressed sensing (C-SENSE), and compressed SENSE acceleration with an artificial intelligence deep learning-based technique (C-SENSE AI), was compared at different acceleration factors and flip angles using ROI-based analysis. ADC bias was assessed by Lin’s Concordance correlation coefficient (CCC) followed by bootstrapping to calculate confidence intervals (CI). ADC random measurement error (RME) was assessed by the mean coefficient of variation (CV¯) and non-parametric statistical tests.

RESULTS: The simulations predicted increasingly negative bias and loss of precision towards lower SNR. These effects were confirmed in phantom measurements of increasing acceleration, for which CCC decreased from 0.947 to 0.279 and CV¯ increased from 0.043 to 0.439, and of decreasing flip angle, for which CCC decreased from 0.990 to 0.063 and CV¯ increased from 0.037 to 0.508. At high acceleration and low flip angle, C-SENSE AI reconstruction yielded best denoised ADC maps. For the lowest investigated flip angle, CCC = {0.630, 0.771 and 0.987} and CV¯={0.508, 0.426 and 0.254} were obtained for {SENSE, C-SENSE, C-SENSE AI}, the improvement by C-SENSE AI being significant as compared to the other methods (CV: p = 0.033 for C-SENSE AI vs. C-SENSE and p < 0.001 for C-SENSE AI vs. SENSE; CCC: non-overlapping CI between reconstruction methods). For the highest investigated acceleration factor, CCC = {0.479,0.926,0.960} and CV¯={0.519,0.119,0.118} were found, confirming the reduction of bias and RME by C-SENSE AI as compared to C-SENSE (by trend) and to SENSE (CV: p < 0.001; CCC: non-overlapping CI).

CONCLUSION: ADC bias and random measurement error in DWI at low SNR, typically associated with scan acceleration, can be effectively reduced by deep-learning based C-SENSE AI reconstruction.

PMID:38631532 | DOI:10.1016/j.mri.2024.04.018