Category: Nevin Manimala

ACS Biomater Sci Eng. 2024 Oct 28. doi: 10.1021/acsbiomaterials.4c00608. Online ahead of print.

ABSTRACT

This study aimed to investigate the healing effect of a polylactic-co-glycolic acid (PLGA) scaffold containing nanohydroxyapatite (NHA) along with curcumin (CCM), loaded with adipose-derived mesenchymal stem cells (AD-MSCs), on mandibular bone defects. The designed PLGA scaffolds containing NHA were evaluated for their mechanical and structural properties. Forty rats were divided into five groups (n = 8) based on the treatment: Sham, PLGA scaffolds containing NHA, PLGA scaffolds containing NHA + CCM, PLGA scaffolds containing NHA + AD-MSCs, and PLGA scaffolds containing NHA + CCM + AD-MSCs. After 8 weeks’ follow-up, mandible bones were isolated for histomorphometry evaluation. Data were analyzed using SPSS version 21, with p-values <0.05 considered statistically significant. SEM evaluation showed that the designed nanocomposite scaffold had 80% porosity. Histomorphometry results indicated a significant difference in osteocyte, osteoblast, bone area, and vascular area parameters in the group treated with scaffolds loaded with AD-MSCs + CCM compared to the other groups (p < 0.05). The PLGA-containing NHA-CCM nanocomposite scaffold demonstrated good porosity and dispersion, suitable for treating bone defects. Rats treated with scaffolds containing AD-MSCs and CCM showed better therapeutic results than the other groups. Further research is needed to evaluate its anti-inflammatory, antioxidant properties, osteogenesis, and therapeutic effects in larger animal models.

PMID:39467692 | DOI:10.1021/acsbiomaterials.4c00608

Orthop Surg. 2024 Oct 28. doi: 10.1111/os.14275. Online ahead of print.

ABSTRACT

PURPOSE: Long-segment spinal fusions are associated with lumbosacral complications (LSC), but the associated risk factors are not known. This study aimed to identify the risk factors for LSC after long-segment instrumented fusion with distal fixation to the L5 vertebral body in adult degenerative scoliosis (ADS).

METHODS: We retrospectively evaluated 294 patients with ADS who underwent long-segment floating fusion between January 2014 and March 2022, with follow-up for at least 2 years. Patients were matched to the baseline data using fusion level > 5 as a grouping variable. Patients who completed matching were divided into two groups according to the presence or absence of LSC. Univariate logistic regression was applied to identify potential risk factors for LSC, and multivariate logistic regression was used to identify independent risk factors for postoperative LSC.

RESULTS: The overall incidence of LSC was 21.77% in the 294 patients, with disc degeneration in 28 (9.52%) and radiographic ASD in 44 (14.97%) patients. The mean time to LSC development after surgery was 26.91 ± 8.43 months. A total of 54 pairs of patients were matched and grouped, and the complication group had higher Oswestry Disability Index (ODI) and visual analog scale (VAS) scores at the last follow-up. Multivariate analysis showed that gender (OR = 0.274, p = 0.026 [0.087, 0.859]); levels of fusion > 5 (OR = 3.127, p = 0.029 [1.120, 8.730]), main curve correction rate (OR = 0.009, p = 0.005 [0.000, 0.330]), and postoperative pelvic incidence minus lumbar lordosis (PI-LL) > 15° (OR = 3.346, p = 0.022 [1.195, 9.373]) were independent risk factors for postoperative LSC. The area under the curve value of the prediction model was 0.804, with a 95% confidence interval of 0.715-0.892, indicating that the model had a high prediction accuracy. Collinearity statistics showed no collinearity between variables.

CONCLUSION: Sex, level of fusion > 5, main curve correction rate, and postoperative PI-LL > 15° were independent risk factors for the development of LSC after long-segment floating fusion. These results will improve our ability to predict personal risk conditions and provide better medical optimisation for surgery.

PMID:39467685 | DOI:10.1111/os.14275

Zhongguo Dang Dai Er Ke Za Zhi. 2024 Oct 15;26(10):1078-1085. doi: 10.7499/j.issn.1008-8830.2402079.

ABSTRACT

OBJECTIVES: To explore the clinical characteristics of children with acute T-lymphoblastic leukemia (T-ALL) and analyze their relationship with prognosis.

METHODS: A retrospective analysis was conducted on the clinical data and follow-up results of 50 children with T-ALL who were treated using the CCCG-ALL-2015 protocol at the Department of Hematology and Oncology, Children’s Hospital of Nanjing Medical University from November 2015 to December 2019. Kaplan-Meier survival analysis and Cox regression analysis were employed to identify factors affecting prognosis.

RESULTS: Among the 50 T-ALL patients, there were 7 cases of relapse. There was no statistically significant difference in the baseline clinical data between the relapse group and the non-relapse group (P>0.05). However, the positive rate of minimal residual disease (MRD) (≥0.01%) on day 46 after induction remission therapy in the relapse group was significantly higher than that in the non-relapse group (P=0.037). The 5-year overall survival rate for the 50 patients was (87±5)%, and the 5-year event-free survival rate was (86±5)%. Multivariate Cox regression analysis indicated that the MRD level on day 46 after induction remission therapy was an independent prognostic factor (HR=0.104, 95%CI: 0.015-0.740, P=0.024).

CONCLUSIONS: MRD is of significant importance for the prognosis of T-ALL children. Personalized treatment should be provided based on MRD levels to prevent relapse and improve prognosis in these patients.

PMID:39467678 | DOI:10.7499/j.issn.1008-8830.2402079

Zhongguo Dang Dai Er Ke Za Zhi. 2024 Oct 15;26(10):1053-1057. doi: 10.7499/j.issn.1008-8830.2404029.

ABSTRACT

OBJECTIVES: To investigate the early cognitive development characteristics of children with Williams syndrome (WS) at different age stages.

METHODS: From September 2018 to June 2023, 106 children diagnosed with WS at the Department of Pediatric Health Care, Children’s Hospital, Zhejiang University School of Medicine, aged 1 to <5 years, were prospectively enrolled. All children underwent Gesell developmental diagnostic assessments to analyze the cognitive development characteristics of WS children across different age groups.

RESULTS: The average age of the 106 WS children was (3.1±1.2) years; 58 were male, and 48 were female. There were no significant differences in developmental levels between males and females in the five domains of gross motor skills, fine motor skills, language, personal-social skills, and adaptive behavior (P>0.05). The incidence rates of mild, moderate, severe, and profound developmental disabilities among children of different age groups showed no significant differences (P>0.05). Comparisons of developmental levels in gross motor skills, language, personal-social skills, and adaptive behavior among different age groups were also not statistically significant (P>0.05). With the increase of age, the developmental level of fine motor skills showed a decreasing trend (P<0.05). There were no significant differences in verbal IQ and non-verbal IQ within each age group of WS children (P>0.05).

CONCLUSIONS: The overall developmental level of WS children stabilizes with age, and their early language abilities do not significantly exceed their non-verbal abilities.

PMID:39467674 | DOI:10.7499/j.issn.1008-8830.2404029

Zhongguo Dang Dai Er Ke Za Zhi. 2024 Oct 15;26(10):1019-1026. doi: 10.7499/j.issn.1008-8830.2404116.

ABSTRACT

OBJECTIVES: To explore the associations of parental smoking and alcohol consumption during the periconceptional period and their interactions with risk of congenital heart disease (CHD) in offspring.

METHODS: The parents of children with simple CHD aged 0 to 1 year (n=683) were recruited as the case group, while the parents of healthy children aged 0 to 1 year (n=740) served as the control group. A case-control study was conducted, and a questionnaire was used to collect information on perinatal exposures. After controlling for relevant confounding factors using multivariate logistic regression analysis and propensity score matching, the associations of parental smoking and alcohol consumption during the periconceptional period and their interactions with CHD were examined, as well as the cumulative effects of smoking and drinking on CHD risk.

RESULTS: Maternal active smoking (OR=2.91, 95%CI: 1.60-5.30), passive smoking (OR=1.94, 95%CI: 1.56-2.42), and alcohol consumption (OR=2.59, 95%CI: 1.89-3.54), as well as paternal smoking (OR=1.52; 95%CI: 1.22-1.90) and drinking (OR=1.48, 95%CI: 1.19-1.84), were associated with an increased risk of CHD in offspring. There was no interaction between parental smoking and drinking behaviors during the periconceptional period concerning the risk of CHD in offspring (P>0.05). The more parents’ smoking and drinking behaviors during the perinatal pregnancy, the higher the risk of CHD in their offspring (OR=1.50, 95%CI: 1.36-1.65).

CONCLUSIONS: Parental smoking and alcohol consumption during the periconceptional period are associated with the occurrence of CHD in offspring, and there is a cumulative effect on CHD risk, suggesting that reducing tobacco and alcohol exposure during the periconceptional period may lower the incidence of CHD.

PMID:39467669 | DOI:10.7499/j.issn.1008-8830.2404116

JMIR Med Educ. 2024 Oct 28;10:e54280. doi: 10.2196/54280.

ABSTRACT

BACKGROUND: Critical evaluation of naloxone coprescription academic detailing programs has been positive, but little research has focused on how participant thinking changes during academic detailing.

OBJECTIVE: The dual purposes of this study were to (1) present a metacognitive evaluation of a naloxone coprescription academic detailing intervention and (2) describe the application of a metacognitive evaluation for future medical education interventions.

METHODS: Data were obtained from a pre-post knowledge assessment of a web-based, self-paced intervention designed to increase knowledge of clinical and organizational best practices for the coprescription of naloxone. To assess metacognition, items were designed with confidence-weighted true-false scoring. Multiple metacognitive scores were calculated: 3 content knowledge scores and 5 confidence-weighted true-false scores. Statistical analysis examined whether there were significant differences in scores before and after intervention. Analysis of overall content knowledge showed significant improvement at posttest.

RESULTS: There was a significant positive increase in absolute accuracy of participant confidence judgments, confidence in correct probability, and confidence in incorrect probability (all P values were <.05). Overall, results suggest an improvement in content knowledge scores after intervention and, metacognitively, suggest that individuals were more confident in their answer choices, regardless of correctness.

CONCLUSIONS: Implications include the potential application of metacognitive evaluations to assess nuances in learner performance during academic detailing interventions and as a feedback mechanism to reinforce learning and guide curricular design.

PMID:39467302 | DOI:10.2196/54280

JMIR Mhealth Uhealth. 2024 Oct 28;12:e47104. doi: 10.2196/47104.

ABSTRACT

BACKGROUND: Obesity is a rapidly increasing health problem in China, causing massive economic and health losses annually. Many techniques have emerged to help people with obesity better adhere to intervention programs and achieve their weight loss goals, including food replacement and internet-delivered weight loss consultations. Most studies on weight loss interventions mainly focused on the change in body weight or BMI; however, body fat, especially visceral fat mass, is considered the main pathogenic factor in obesity. In China, more reliable evidence is required on this topic. Moreover, it is unclear whether an integrated weight loss program combining food replacement products, mobile app-based platforms, and daily body composition monitoring using a wireless scale is useful and practical in China.

OBJECTIVE: In this 2-arm, parallel-designed, randomized study, we explored the effectiveness and safety of the Metawell (Weijian Technologies Inc) weight loss program in China, which combines prepackaged biscuits, a wireless scale, and a mobile app.

METHODS: Participants in the intervention group were guided to use food replacement products and a scale for weight loss and monitoring, whereas participants in the control group received printed material with a sample diet and face-to-face education on weight loss at enrollment. The intervention lasted for 3 months, and follow-up visits were conducted at months 3 and 6 after enrollment. Dual-energy x-ray absorptiometry and quantitative computed tomography were used to assess body fat. A multilevel model for repeated measurements was used to compare differences between the 2 groups.

RESULTS: In total, 220 patients were randomly assigned to intervention (n=110) and control (n=110) groups. Participants in the intervention group had significantly greater decreases in BMI, total body fat, visceral adipose area, and subcutaneous adipose area (all P<.001) than those in the control group. However, the rate of change in lean mass was not significantly different between the 2 groups (P=.62). Further, 35 participants in the intervention group reported adverse events. Constipation was the most frequently reported adverse event (11/110), followed by dizziness (6/110), hypoglycemia (4/110), fatigue (3/110), and gastritis (3/35).

CONCLUSIONS: The Metawell program was effective for weight loss. After the intervention, participants in the intervention group lost more body weight and body fat while retaining muscle mass than those in the control group.

PMID:39467299 | DOI:10.2196/47104

Ann Intern Med. 2024 Oct 29. doi: 10.7326/M24-0178. Online ahead of print.

ABSTRACT

BACKGROUND: Rosuvastatin and atorvastatin are the most widely prescribed moderate- to high-intensity statins. However, evidence on their efficacy and safety during actual use is limited.

OBJECTIVE: To compare the real-world effectiveness and safety of rosuvastatin and atorvastatin.

DESIGN: Active comparator cohort study using target trial emulation.

SETTING: The China Renal Data System (CRDS) and UK Biobank (UKB) databases.

PARTICIPANTS: Adults newly prescribed rosuvastatin or atorvastatin.

MEASUREMENTS: The primary outcome was all-cause mortality. Cox proportional hazards regressions were used after 1:1 multilevel propensity score matching.

RESULTS: Among the 285 680 eligible participants in both databases, 6-year all-cause mortality was lower for rosuvastatin than for atorvastatin (2.57 vs. 2.83 per 100 person-years in the CRDS database and 0.66 vs. 0.90 per 100 person-years in the UKB database), with differences in cumulative incidence of -1.03% (95% CI, -1.44% to -0.46%) in the CRDS database and -1.38% (CI, -2.50% to -0.21%) in the UKB database. For secondary outcomes in both databases, rosuvastatin conferred lower risks for major adverse cardiovascular events and major adverse liver outcomes. In the UKB database, the risk for development of type 2 diabetes mellitus was higher with rosuvastatin, and the 2 medications carried similar risks for development of chronic kidney disease and other statin-related adverse effects.

LIMITATION: Possible residual confounding.

CONCLUSION: This study found differences in risks for some important outcomes associated with rosuvastatin and atorvastatin. The differences were relatively small, and many did not meet traditional standards for statistical significance. Further research is needed to understand whether these findings can be used with confidence in clinical practice.

PRIMARY FUNDING SOURCE: National Key R&D Program of China and National Natural Science Foundation of China.

PMID:39467290 | DOI:10.7326/M24-0178

JMIR Serious Games. 2024 Oct 28;12:e58963. doi: 10.2196/58963.

ABSTRACT

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) usually begins in childhood and is often accompanied by impairments in social functioning. Virtual reality (VR) has emerged as an adjunctive tool to embed in social skills training to enhance the social skills of children with ADHD, but its effectiveness requires further investigation.

OBJECTIVE: This study aims to enhance the social skills of children with ADHD by examining the feasibility and effectiveness of VR-based training in comparison to traditional social skills training.

METHODS: A 3-arm randomized controlled trial was conducted with 90 children with ADHD aged 6-12 years. Participants were randomly assigned to 3 weeks of 12-session VR-based social skills training, traditional social skills training, or a waitlist control group of equivalent duration. Outcome measures included assessments by a clinical psychologist who was blinded to group assignments, the Social Skills Improvement System Rating Scale, the Behavior Rating Inventory of Executive Function, and the Simulator Sickness Questionnaire, conducted at baseline and after the intervention.

RESULTS: The preliminary results support the feasibility and acceptability of VR training for children with ADHD aged 6-12 years. Analysis showed that the VR and traditional social skills training groups experienced a statistically significant improvement in the clinical psychologist assessment of social skills and parent-rated self-control, initiative, and emotional control after the intervention compared with baseline. The VR group performed significantly better than the traditional social skills group on social skills assessed by clinical psychologists (F_2,85=76.77; P<.001) and on parent-rated self-control (F_2,85=18.77; P<.001), initiative (F_2,85=11.93; P<.001), and emotional control (F_2,85=17.27; P<.001). No significant between-group differences were found for parent-rated cooperation and inhibition (all P>.05).

CONCLUSIONS: The findings provide preliminary evidence supporting the feasibility and superior effectiveness of VR-based social skills training compared to traditional approaches for enhancing social skills and related executive functions in children with ADHD. These results suggest that VR may be a valuable tool to embed within social skills interventions for this population. Further research is warranted to explore the long-term impacts and generalizability of these benefits.

TRIAL REGISTRATION: ClinicalTrials.gov NCT05778526; https://clinicaltrials.gov/study/NCT05778526.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/48208.

PMID:39467288 | DOI:10.2196/58963