Category: Nevin Manimala

Zhonghua Yu Fang Yi Xue Za Zhi. 2024 Dec 6;58(12):1885-1893. doi: 10.3760/cma.j.cn112150-20240708-00545.

ABSTRACT

Objective: To investigate the distribution characteristics and analyze the clinical significance of dermatophagoides pteronyssinus allergen components in children with allergic rhinitis and asthma in Shenzhen. Methods: This study was a cross-sectional study. The clinical data of children with allergic rhinitis and asthma induced by dust mites admitted to the allergy clinic of Shenzhen Children’s Hospital from 2021 to 2024 were collected and the serum sIgE levels of dermatophagoides pteronyssinus, dermatophagoides farinae (Der p, Der f) and dermatophagoides pteronyssinus components (Der p 1, Der p 2, Der p 10, Der p 23) were detected by magnetic bead chemiluminescence method. The correlation between dermatophagoides pteronyssinus allergen components and clinical data of children was analyzed. According to the diagnosis, the children were divided into allergic rhinitis (AR) group and AR with asthma (ARAS) group. According to the age, the children were divided into preschool age (5 years ≤age<7 years), school age (7 years ≤age<10 years) and adolescence (10 years ≤age≤15 years). The expression differences of dermatophagoides pteronyssinus components among AR group and ARAS group and different age groups were compared. Results: A total of 314 children with allergic rhinitis and asthma caused by dust mites were included in the study, of whom 112 were male and 202 were female. There were 188 cases of AR and 126 cases of ARAS, aged 5-15 years, with a median age of 7.54 years and an average age of (8.02±2.24) years. BMI was 13.89-31.76 kg/m²,the median BMI was 15.87 kg/m² and average BMI was (16.55±3.05) kg/m². There was not statistically significant difference in gender, age, BMI, blood eosinophils, blood basophils, FeNO, FVC and FEV1 between the AR group and the ARAS group (P>0.05). There was significant difference in FEV1/FVC and small airway function indexes MMEF, MEF75%, MEF50% and MEF25% between the AR group and the ARAS group (P<0.05). In the 314 children, the dermatophagoides pteronyssinus allergen components sensitization rates were in the order of Der p 1 (97.1%), Der p 2 (89.8%), Der p 23 (55.1%), Der p 10 (8.6%), and the difference in the positive rate was statistically significant (χ²=658.31, P<0.001). There was not significant difference in Der p 1, Der p 2 and Der p 10 among children of different ages (P>0.05). There was significant difference in Der p 23 among children of different ages (χ²=7.29, P=0.03). A correlation analysis showed that Der p, Der f, Der p 1 and Der p 2 had a high positive correlation (P<0.001). Eosinophils are positively correlated with Der p, Der f, Der p 1, Der p 2, Der p 10 and Der p 23 (P<0.001). FeNO is positively correlated with Der p, Der f, and Der p 23 (P<0.05). Small airway function indicators MMEF, MEF50% and MEF25% are negatively correlated with Der p, Der f and Der p 1 (P<0.05). The sIgE levels of Der p, Der f, Der p 1, Der p 2 and Der p 10 in the AR group were significantly lower than those in the ARAS group (P<0.05). In the ARAS group, 120 cases (95.24%) showed positive results for at least 2 dermatophagoides pteronyssinus components, while 71 cases (56.35%) showed positive results for at least 3 dermatophagoides pteronyssinus components. In the AR group, 171 cases (90.96%) showed positive results for at least 2 dermatophagoides pteronyssinus components, while 94 cases (50.00%) showed positive results for at least 3 dermatophagoides pteronyssinus components. Conclusion: Der p 1, Der p 2 and Der p 23 may be the main dermatophagoides pteronyssinus allergen components that induce allergic rhinitis and asthma in Shenzhen City. The elevation of sIgE levels in the dermatophagoides pteronyssinus components can aggravate the severity of lower airway eosinophilic inflammation and airway obstruction. Attention should be paid to the detection of dermatophagoides pteronyssinus components in children with poor response to dust mite-allergen specific immunotherapy.

PMID:39710466 | DOI:10.3760/cma.j.cn112150-20240708-00545

J Oral Maxillofac Surg. 2024 Dec 4:S0278-2391(24)00977-7. doi: 10.1016/j.joms.2024.12.001. Online ahead of print.

ABSTRACT

BACKGROUND: Fibrous dysplasia/McCune-Albright syndrome (FD/MAS) is a genetic disorder, marked by bone lesions, often affecting the craniofacial skeleton. Pain is a prevalent yet heterogeneous symptom reported by patients with craniofacial FD. Effective treatments are currently lacking, posing a significant clinical challenge to patient care.

PURPOSE: This preliminary study examined pain profiles in craniofacial FD and aimed to identify subtypes of patients based on pain phenotypes and emotional health.

STUDY DESIGN, SETTING, SAMPLE: A prospective, cross-sectional study involving 15 patients with FD/MAS, conducted at Boston Children’s Hospital and Massachusetts General Brigham’s Hospitals.

PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE: Headache frequency, craniofacial pain severity, neuropathic pain quality, pain interference, allodynia, photophobia, depression, and anxiety were assessed using clinical questionnaires.

MAIN OUTCOME VARIABLE(S): The primary outcome variable was the symptom profile derived from standardized clinical questionnaires and analyzed using principal component analysis and K-means clustering.

COVARIATES: Covariates included demographic data, diagnosis, and lesion location(s).

ANALYSES: Principal component analysis and K-means clustering of patient-reported measures of pain and emotional health were performed. Analysis of variance was conducted to determine significant differences among patient subtypes. Statistical significance was set at (P < .05).

RESULTS: The study included 15 subjects with FD/MAS, with a mean age of 36.2 (13.9) years, including 1 male. Clustering analysis identified 3 subtypes of patients with distinct symptom profiles. Cluster 1 (n = 2) averaged 70 (28.3) headache days in a 90-day period, pain level of 7.5 (0.7) on a 0-10 scale, and severe anxiety, depression, allodynia, photophobia, and pain interference. Cluster 2 (n = 7) patients reported an average of 5.4 (7.5) headache days, an average pain level of 2.7 (2.6), mild or no anxiety, depression, allodynia, photophobia, and pain interference. Cluster 3 (n = 6) patients displayed a mixed symptom profile with an average of 47.3 (36.4) headache days and a pain level of 5.25 (1.4). Notably, patients with temporal and skull base lesions were predominantly found in Clusters 1 and 3, which exhibited the most severe symptomatology.

CONCLUSIONS AND RELEVANCE: This study establishes a basis for future longitudinal research aimed at understanding underlying pain mechanisms and evaluating the response to personalized pain management strategies in subtypes of patients with craniofacial FD.

PMID:39710366 | DOI:10.1016/j.joms.2024.12.001

J Oral Maxillofac Surg. 2024 Dec 9:S0278-2391(24)00979-0. doi: 10.1016/j.joms.2024.11.016. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with cleft lip and palate (CLP) often exhibit unique anatomical variations in the pterygoid plates, which can influence fracture patterns at the pterygomaxillary junction (PMJ) during Le Fort I osteotomy. These differences may increase the risk of unfavorable fractures, complicating surgery and recovery.

PURPOSE: The study purpose was to measure the association between the osteotomy level with the PMJ fracture patterns in CLP patients undergoing Le Fort I osteotomy.

STUDY DESIGN, SETTING, AND SAMPLE: This retrospective cohort study included 100 patients with CLP, representing 200 tomographic views of the right and left pterygomaxillary regions. Preoperative tomographic scans were analyzed to measure morphometric features of the pterygomaxillary suture in the axial and sagittal planes.

PREDICTOR VARIABLE: The primary predictor was osteotomy level: at the level or above of the PMJ.

MAIN OUTCOME VARIABLE: The main outcome was the pterygomaxillary fracture pattern, categorized as favorable or unfavorable.

COVARIATES: The covariates included age, sex, side of the mandible, pterygomaxillary suture thickness, pterygomaxillary suture width, distance between the greater palatine canal and the pterygoid suture, length of the medial plate, length of the lateral plate, insertion of the pterygomaxillary suture in the posterior part of the maxilla, and the length and height of the tuber.

ANALYSIS: Statistical analyses included t-tests for mean differences (P < .05) and χ² tests for associations. Relative risk was calculated for osteotomy levels to assess the significance of associations with fracture patterns.

RESULTS: The study comprised 100 participants (47 men, 53 women), with a mean age of 23 years (SD = 2.31). In total, 110 (55%) fractures were classified as favorable. The frequency of unfavorable fractures was significantly higher when the osteotomy was performed above the PMJ (P < .005). The relative risk for unfavorable fractures was 23.06 on the right side (95% confidence interval = [5.94, 89.53], P < .001) and 65.00 on the left side (95% confidence interval = [9.30, 454.52], P < .001).

CONCLUSION: The study findings suggest that in cleft surgery the osteotomy should be performed at the level of the PMJ to reduce the risk of inadvertent pterygomaxillary fractures.

PMID:39710365 | DOI:10.1016/j.joms.2024.11.016

Chest. 2024 Dec 20:S0012-3692(24)05717-9. doi: 10.1016/j.chest.2024.12.015. Online ahead of print.

ABSTRACT

BACKGROUND: A large number of symptomatic individuals with central sleep apnea (CSA) in clinical practice have an indication for adaptive servo-ventilation (ASV) therapy.

RESEARCH QUESTION: What are the effects of ASV therapy on sleep quality and PROMs in patients with CSA across a range of devices and indications.

METHODS: This prospective, multicenter, observational cohort study was conducted in France and enrolled participants from June 2017 to February 2020. Adults with predominant CSA at diagnosis or obstructive sleep apnea with central events not controlled with continuous positive airway pressure who had an indication for ASV were eligible. Participants attended clinic visits at baseline, and after 1, 3, 6 and 12 months of follow-up. The primary endpoint was the change in Pittsburgh Sleep Quality Index (PSQI) score from baseline to 6-month follow-up (evaluated using a Wilcoxon signed rank test on paired data).

RESULTS: We included 526 individuals (median age 69 years, 88.2% male). The indication for ASV included CSA with cardiovascular/neurologic etiology (38.4%), treatment-emergent CSA (36.1%), idiopathic CSA (14.1%) or drug-induced CSA (11.4%). At 6-month follow-up, study participants were using ASV for a median of 6.1 h/night. The median [interquartile range] change in the PSQI score from baseline to 6 months in the overall study population was -1 [-3; 0] (p<0.001), with significant results across all indications for ASV except for drug-induced CSA, where the median change was similar to the overall result but did not achieve statistical significance (-1 [-2; 1]; p=0.0866). Overall, 65% of participants had a ≥1-point improvement in the PSQI.

INTERPRETATION: Individuals with a clinical indication for ASV therapy experienced improved sleep quality during real-world treatment, irrespective of which ASV device was used.

PMID:39710250 | DOI:10.1016/j.chest.2024.12.015

World Neurosurg. 2024 Dec 20:123593. doi: 10.1016/j.wneu.2024.123593. Online ahead of print.

ABSTRACT

This paper reviews the historical progression of ventriculoperitoneal shunt valve designs with the goal of providing an understanding of their functionality and failure mechanisms. While shunting is the predominant treatment for hydrocephalus, the statistics of overall shunt failure remain high, and valve failure is responsible for a significant percentage of revision surgeries. Therefore, this review spans valve evolution from an engineering perspective with an emphasis on discussing potential failure mechanisms and patient specific valve selection. Information is provided on the importance of valves in hydrocephalus treatment with discussion on each class of valves and their advantages and shortcomings. Substantial development over decades has significantly improved valve functionality, and ongoing research continues to provide more robust valves and shunt systems for hydrocephalus management.

PMID:39710199 | DOI:10.1016/j.wneu.2024.123593

World Neurosurg. 2024 Dec 20:123586. doi: 10.1016/j.wneu.2024.123586. Online ahead of print.

ABSTRACT

BACKGROUND: While studies have examined the relationship between sex and outcomes after lumbar fusion surgery, few have strictly controlled for other patient-level variables. In this study, we use coarsened exact matching to determine the effect of patient-reported sex on spinal fusion outcomes.

METHODS: Outcomes across 4680 consecutive adult single-level, posterior-only lumbar fusions at a multihospital academic medical center were retrospectively assessed. First, univariate analyses were performed to broadly examine the effect of sex on surgical outcomes, uncontrolled for other patient factors. Next, the population was split by sex (male vs. female) and matched 1:1 on demographic and medical factors known to influence outcomes (including age, race, smoking status, and past surgical history) using coarsened exact matching (CEM). CEM effectively controls for confounding variable bias by creating pairs of matched samples and preserving the fidelity of each covariate through binning. Primary outcomes included 30- and 90-day readmissions, Emergency Department visits, reoperations, and mortality. Secondary outcomes included discharge disposition and length of hospital stay.

RESULTS: Between otherwise exactly matched male-female pairs, females were less likely to be discharged home (OR 1.70, p<0.001) and had a longer length of stay (mean: 95.7 vs 87 hr, p<0.001). No differences in readmissions or reoperations were observed between matched cohorts.

CONCLUSION: Female patients encountered longer hospital stays and higher odds of non-home discharge after single-level lumbar fusion compared to otherwise exactly matched male patients.

PMID:39710198 | DOI:10.1016/j.wneu.2024.123586

World Neurosurg. 2024 Dec 20:123585. doi: 10.1016/j.wneu.2024.123585. Online ahead of print.

ABSTRACT

OBJECTIVE: Cervical medial branch blocks (CMBB) are frequently used for the treatment of facet arthropathy. The present study compares the effectiveness of lidocaine and prilocaine in CMBB procedures.

METHODS: Patients with facet arthropathy scheduled for CMBB were randomly divided into two groups who were administered a combination of 2 mg dexamethasone and either 1% lidocaine or 1% prilocaine with a total volume of 1 mL per level. All patients were assessed prior to the procedure (baseline), and at 1 hour, 1 week and 1 month after the procedure using the Numeric Rating Scale-11 (NRS-11), Neck Disability Index (NDI), and patient satisfaction was evaluated at 1 hour, 1 week and 1 month after the procedure.

RESULTS: A total of 97 patients were included in the study (n = 49 in the lidocaine group and n = 48 in the prilocaine group). A significant decrease was noted in the NRS-11 and NDI scores recorded during all follow-up assessments in both groups (p<0.001), while the NRS-11, NDI scores and patient satisfaction did not statistically differ between groups at 1 hour, 1 week and 1 month following the procedure (p˃0.05).

CONCLUSION: CMMB achieved with either lidocaine or prilocaine decreased the recorded pain severity and disability scores to a similar degree. The selection of either lidocaine or prilocaine for CMBB is thus at the clinician’s discretion.

PMID:39710195 | DOI:10.1016/j.wneu.2024.123585

Rev Esp Med Nucl Imagen Mol (Engl Ed). 2024 Dec 20:500080. doi: 10.1016/j.remnie.2024.500080. Online ahead of print.

ABSTRACT

OBJECTIVE: Overexpression of Human Epidermal Growth Factor Receptor 2 (HER2) is thought to be more aggressive in gastric cancer. This study aimed to evaluate the predictability of HER2 status and other prognostic pathologic parameters using [¹⁸F]FDG PET/CT and to investigate its impact on survival.

METHODS: Pretreatment metabolic parameters measured by [¹⁸F]FDG PET/CT as a prognostic factor were retrospectively evaluated in 117 HER2-analysed patients. The relationship between pathological data, tumor metabolic characteristics, and distant metastases was examined, and the effect on survival was investigated.

RESULTS: Among the 117 patients, 17.1% were HER2-positive (HER2+), and 82.9% were HER2-negative (HER2-). There was no significant association between PET/CT parameters in the HER2+ and HER2- patient groups. HER2+ patients had higher 1- and 3-year survival expectations than HER2- patients (80%-%37.9; %47.5-%20; respectively). There was no statistically significant difference in overall survival. In Cox-regression analysis, while the presence of vascular invasion, local invasion, and distant metastasis were poor prognostic factors, HER2 was not a prognostic factor. Vascular invasion and local invasion (T3/T4) were also associated with higher SUVmax values. Patients with distant metastases had significantly higher SUVmax, SUVmean, and TLG.

CONCLUSION: This study showed no association between HER2 expression and [¹⁸F]FDG PET/CT metabolic parameters. However, regardless of HER2 status, the results indicated distant metastasis, local invasion, and vascular invasion could be associated with primary tumor metabolism. PET/CT parameters predict tumor aggressiveness and disease prognosis better than HER2 status.

PMID:39710040 | DOI:10.1016/j.remnie.2024.500080

Forensic Sci Int. 2024 Dec 18;367:112352. doi: 10.1016/j.forsciint.2024.112352. Online ahead of print.

ABSTRACT

BACKGROUND: An increasing number of countries have legalised cannabis for medicinal purposes in recent years leading to tensions with other regulatory frameworks. Some countries grant a medical defence according to their drug driving legislations. This may lead to specific medico-legal assessments relating to the participation of cannabis patients in road traffic. In Germany, these enquiries for expert opinions are opposed by incomplete statistics on medicinal cannabis patients, which limits the assessment of individual cases.

METHODS: A cross-sectional, anonymous patient survey was carried out nationwide in the first quarter of 2022 using an online questionnaire. The overall collective (n = 1030) was analysed with regard to application patterns of cannabis-based medicines. In particular, a detailed evaluation of the cannabis flower sub-collective was carried out.

RESULTS: Taking into account patients with health insurance prescription and, for the first time, self-payers, a high proportion of cannabis flower patients was observed (89.9 %). On average, the intake of cannabis flowers is associated with substantially higher daily THC doses (336 mg) compared to the usage of other cannabis-based medicines (≤ 17 mg). In addition, 16.2 % of patients reported complex usage patterns consisting of combinations of different types of cannabis-based medicines. Over a quarter (28.4 %) of respondents stated a smoking intake of cannabis flowers which is not recommended from a medicinal point of view.

CONCLUSIONS: Descriptive information on individual application patterns of cannabis-based medicines provide a valuable source of information for medico-legal expert statements as well as a basis for further research projects.

PMID:39709741 | DOI:10.1016/j.forsciint.2024.112352

Pest Manag Sci. 2024 Dec 22. doi: 10.1002/ps.8600. Online ahead of print.

ABSTRACT

BACKGROUND: While the mother knows best/preference performance hypothesis has been well tested in natural ecosystems, how these ecological principles differ in agroecosystems is less explored. In this study, we investigated the ovipositional preference and offspring performance of fall armyworm (FAW) across vegetative and reproductive stages of soybean.

RESULTS: We examined trichomes, volatile organic compounds (VOCs) and assessed electroantennogram (EAG) measurements to understand how olfactory responses are affected by volatiles at different phenological stages during photoperiodism (photophase and scotophase). We found that gravid FAW preferred the vegetative compared to reproductive stage of soybean. Although VOC and EAG responses was not statistically different (P > 0.05) between photophase and scotophase, but vegetative stage exhibited significantly (P ≤ 0.05) higher emissions and responses than the reproductive stage during both photophase and scotophase. Additionally, reproductive stage had lower trichomes compared to the vegetative stage. Interestingly, no significant difference was observed in offspring performance between the vegetative and reproductive stages of soybean. This suggests that oviposition preference does not necessarily correlate with offspring performance, which was confirmed through offspring mass and mass gain studies. Olfactory and sensory cues from soybean at reproductive stage reduced oviposition by mother FAW.

CONCLUSION: Collectively, we show that while mother knows best may not fit FAW-Soybean interaction, muffled volatile emission in reproductive stages can have positive consequences for host success. The results from this study will enhance our understanding of FAW behavior across different phenological stages of host plants, that can be used to develop alternative and sustainable management strategies. © 2024 The Author(s). Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.

PMID:39710863 | DOI:10.1002/ps.8600