Category: Nevin Manimala

Sci Rep. 2023 Dec 8;13(1):21731. doi: 10.1038/s41598-023-49234-7.

ABSTRACT

To describe trends and identify maternal and pregnancy predictive risk factors for having a compensated claim for a maternal injury during delivery, as a proxy for having received suboptimal care. This nationwide retrospective cohort study included 1 754 869 births in Sweden between 2000 and 2016, including 4488 maternal injury claims filed with The National Swedish Patient Insurance Company (Löf), of which 1637 were compensated. Descriptive statistics on maternal and pregnancy characteristics, trends in filed/compensated claims over time, and distribution of compensated claims by clinical classification are presented. Characteristics associated with suboptimal care were identified using multivariable logistic regression, with mutual adjustment in the final model. Compensated claims were sorted into 14 clinical classifications (ICD-10 codes for main condition, injury, and causality). Overall, there was a two-fold increase in filed claims from 2000 to 2016, peaking in 2014. The rate of compensated claims only increased marginally, and 36.5% of filed claims were deemed avoidable. Perineal and pelvic floor injuries, as well as medical and diagnostic errors, were responsible for the majority of compensated claims. Women with a previous caesarean section, post term delivery, chronic or gestational disease, > 13 antenatal visits, or a multiple pregnancy had increased risk of having a compensated claim for a maternal injury during delivery. Understanding the risk factors for having a compensated maternal injury claim may guide health workers and maternity wards in improving the quality and organisation of care to reduce the risk of childbirth related injuries.

PMID:38066197 | DOI:10.1038/s41598-023-49234-7

Surg Endosc. 2023 Dec 8. doi: 10.1007/s00464-023-10616-7. Online ahead of print.

ABSTRACT

BACKGROUND: A scope actuation system assists a surgeon in steering a scope for navigating an operative field during an interventional or diagnostic procedure. Each system is tailored for a specific surgical procedure. The development of a generic scope actuation system could assist various laparoscopic and endoscopic procedures. This has the potential to reduce the deployment and maintenance costs for a hospital, making it more accessible for clinical usage.

METHODS: A modular actuation system (for maneuvering rigid laparoscopes) was adapted to enable incorporation of flexible endoscopes. The design simplifies the installation and disassembly processes. User studies were conducted to assess the ability of the system to focus onto a diagnostic area, and to navigate during a simulated esophagogastroduodenoscopy procedure. During the studies, the endoscope was maneuvered with (robotic mode) and without (manual mode) the actuation system to navigate the endoscope’s focus on a predefined track.

RESULTS: Results show that the robotic mode performed better than the manual mode on all the measured performance parameters including (a) the total duration to traverse a track, (b) the percentage of time spent outside a track while traversing, and (c) the number of times the scope focus shifts outside the track. Additionally, robotic mode also reduced the perceived workload based on the NASA-TLX scale.

CONCLUSIONS: The proposed scope actuation system enhances the maneuverability of flexible endoscopes. It also lays the groundwork for future development of modular and generic scope assistant systems that can be used in both laparoscopic and endoscopic procedures.

PMID:38066193 | DOI:10.1007/s00464-023-10616-7

J Pharm Biomed Anal. 2023 Dec 3;239:115900. doi: 10.1016/j.jpba.2023.115900. Online ahead of print.

ABSTRACT

There is an accelerated progression of liver necroinflammation and fibrosis in the liver during the immune clearance (IC) phase of Chronic hepatitis B virus (HBV) infection, which are critical indicators of antiviral treatment for chronic hepatitis B (CHB) infection. This study applied serum metabolomics to identify the potential metabolite biomarkers for differential diagnosis between the CHB immune tolerance (IT) and Immune clearance (IC) phases. A liquid chromatography-mass spectrometry (LC-MS)-based approach was applied to evaluate and compared the serum metabolic profiles of 28 patients in IT phase and 33 patients in IC phase and appropriate statistical methods with MetaboAnalystR 2.0 R package to analyze those metabolites. The differential metabolites between IT and TC groups were classified and the top altered classification were lipids and lipid-like molecules and fatty acyls, clearly indicating that there were differences in the lipid metabolomic profile of HBV-infected patients with IT vs. IR phase. We identified the top 10 potential metabolite biomarkers for differential diagnosis between IT and IR. There were four lipid metabolites among them and the AUC of two of them, octadecadienoyl-sn-glycero-3-phosphocholine and 3-Cycloheptene-l-acetic acid, were 0.983 and 0.933. octadecadienoyl-sn-glycero-3-phosphocholine is Diacylglycerol (18:2n6/18:0) and 3-Cycloheptene-l-acetic acid is hydroxy fatty acids, both of which were associated with lipid metabolism. This study not only provides the potential metabolic biomarkers but also insight into the mechanism of CHB progression during IT clearance phase.

PMID:38064772 | DOI:10.1016/j.jpba.2023.115900

J Pharm Biomed Anal. 2023 Dec 3;239:115869. doi: 10.1016/j.jpba.2023.115869. Online ahead of print.

ABSTRACT

Hepatocellular carcinoma (HCC) is one of the most prevalent malignant cancers worldwide. Due to the asymptomatic features of HCC at early stages, patients are often diagnosed at advanced stages and missed effective treatment. Thus, there is an urgent need to identify sensitive and specific biomarkers for HCC early diagnosis. In the present study, an ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) approach was used to profile serum metabolites from HCC patients, liver cirrhosis (LC) patients, and normal controls (NC). Univariate and multivariate statistical analyses were performed to obtain the metabolomic differences of the three groups and select significantly changed metabolites that can be used as diagnostic biomarkers. In total, 757 differential metabolites were quantified among the three groups, and pathway enrichment analysis of these metabolites indicated that glycerophospholipid metabolism, pentose and glucuronate interconversions, phenylalanine, tyrosine and tryptophan biosynthesis, and linoleic acid metabolism were the most altered pathways involved in HCC development. Receiver operating characteristic (ROC) curve analysis was performed to select and evaluate the diagnostic biomarker performance. Seven metabolites were identified as potential biomarkers that can differentiate HCC from LC and NC, and LC from NC with the good diagnostic performance of area under the curve (AUC) from 0.890 to 0.990. In summary, our findings provide highly effective biomarker candidates to differentiate HCC from LC and NC, LC, and NC, which shed insight into HCC pathological mechanisms and will be helpful in better understanding and managing HCC.

PMID:38064771 | DOI:10.1016/j.jpba.2023.115869

J Neurosurg Pediatr. 2023 Dec 8:1-10. doi: 10.3171/2023.11.PEDS23350. Online ahead of print.

ABSTRACT

OBJECTIVE: The occurrence and predictors of symptomatic subdural hygroma (SSH) subsequent to the fenestration of pediatric intracranial arachnoid cysts (IACs) are unclear. In this study, the authors aimed to investigate the likelihood of an SSH following IAC fenestration and the impact on operative efficacy with the ultimate goal of constructing a nomogram.

METHODS: The medical records of 1782 consecutive patients who underwent surgical treatment at the Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were reviewed. Among these patients, a training cohort (n = 1214) underwent surgery during an earlier period and was used for the development of a nomogram. The remaining patients formed the validation cohort (n = 568) and were used to confirm the performance of the developed model. The development of the nomogram involved the use of potential predictors, while internal validation was conducted using a bootstrap-resampling approach.

RESULTS: SSH was detected in 13.2% (160 of 1214) of patients in the training cohort and in 11.1% (63 of 568) of patients in the validation cohort. Through multivariate analysis, several factors including Galassi type, IAC distance to the basal cisterns, temporal bulge, midline shift, IAC shape in the coronal view, area of the stoma, and artery location near the stoma were identified as independent predictors of SSH. These 7 predictors were used to construct a nomogram, which exhibited a concordance statistic (C-statistic) of 0.826 and demonstrated good calibration. Following internal validation, the nomogram maintained good calibration and discrimination with a C-statistic of 0.799 (95% CI 0.665-0.841). Patients who had nomogram scores < 30 or ≥ 30 were considered to be at low and high risk of SSH occurrence, respectively.

CONCLUSIONS: The predictive model and derived nomogram achieved satisfactory preoperative prediction of SSH. Using this nomogram, the risk for an individual patient can be estimated, and the appropriate surgery can be performed in high-risk patients.

PMID:38064705 | DOI:10.3171/2023.11.PEDS23350

J Neurosurg Spine. 2023 Dec 8:1-8. doi: 10.3171/2023.10.SPINE23718. Online ahead of print.

ABSTRACT

OBJECTIVE: Lumbar microdiscectomy (LMD) is still the gold-standard treatment for lumbar disc herniations with progressive neurological deficits that are refractory to conservative treatment. With improvement of endoscopic systems in recent years, endoscopic discectomy techniques have been developed as an alternative to LMD. The unilateral biportal endoscopic discectomy (UBE) technique is one of these endoscopic techniques, and its popularity has increased in recent years because it does not require high-cost specialized endoscopes, many microsurgical instruments are compatible with this system, and it is similar to LMD in terms of anatomical orientation. This study compared results between LMD and UBE techniques in patients with lumbar disc herniations performed by the same spine surgeons at a single center.

METHODS: The data of patients with lumbar disc herniation who were operated on with LMD and UBE techniques were retrospectively reviewed. The data obtained were statistically evaluated. The operative video of one of the patients who underwent UBE was edited for demonstration.

RESULTS: Between January 2021 and June 2022, 93 patients were operated on for lumbar disc herniation. LMD was performed in 39 patients, and UBE was performed in 54 patients. There were no significant differences in the complications, recurrence, postoperative back and leg pain, patient satisfaction rates, and quality of life index results of the patients in the two groups. The operation time was shorter in the LMD group. In the UBE group, estimated blood loss was lower and postoperative hospitalization was shorter.

CONCLUSIONS: Although LMD is still the gold-standard treatment for lumbar disc herniation, the results of UBE are comparable to those of LMD, and it may be a good alternative for spine surgeons who prefer minimally invasive surgery.

PMID:38064698 | DOI:10.3171/2023.10.SPINE23718

J Neurosurg Spine. 2023 Dec 8:1-11. doi: 10.3171/2023.10.SPINE23512. Online ahead of print.

ABSTRACT

OBJECTIVE: Most studies on the enhanced recovery after surgery (ERAS) protocol in spine surgery have focused on patients with degenerative spinal diseases (DSDs), resulting in a lack of evidence for a comprehensive ERAS protocol applicable to patients with primary spine tumors (PSTs) and other spinal diseases. The authors had developed and gradually adopted components of the comprehensive ERAS protocol for all spine surgical procedures from 2003 to 2011, and then the current ERAS protocol was fully implemented in 2012. This study aimed to evaluate the impact and the applicability of the comprehensive ERAS protocol across all spine surgical procedures and to compare outcomes between the PST and DSD groups.

METHODS: Adult spine surgical procedures were conducted from 2003 to 2021 at the Seoul National University Hospital Spine Center and data were retrospectively reviewed. The author divided the study periods into the developing ERAS (2003-2011) and post-current ERAS (2012-2021) periods, and outcomes were compared between the two periods. Surgical procedures for metastatic cancer, infection, and trauma were excluded. Interrupted time series analysis (ITSA) was used to assess the impact of the ERAS protocol on medical costs and clinical outcomes, including length of stay (LOS) and rates of 30-day readmission, reoperation, and surgical site infection (SSI). Subgroup analyses were conducted on the PST and DSD groups in terms of LOS and medical costs.

RESULTS: The study included 7143 surgical procedures, comprising 1494 for PSTs, 5340 for DSDs, and 309 for other spinal diseases. After ERAS protocol implementation, spine surgical procedures showed significant reductions in LOS and medical costs by 22% (p = 0.008) and 22% (p < 0.001), respectively. The DSD group demonstrated a 16% (p < 0.001) reduction in LOS, whereas the PST group achieved a 28% (p < 0.001) reduction, noting a more pronounced LOS reduction in PST surgical procedures (p = 0.003). Medical costs decreased by 23% (p < 0.001) in the DSD group and 12% (p = 0.054) in the PST group, with a larger cost reduction for DSD surgical procedures (p = 0.021). No statistically significant differences were found in the rates of 30-day readmission, reoperation, and SSI between the developing and post-current ERAS implementation periods (p = 0.65, p = 0.59, and p = 0.52, respectively).

CONCLUSIONS: Comprehensive ERAS protocol implementation significantly reduced LOS and medical costs in all spine surgical procedures, while maintaining comparable 30-day readmission, reoperation, and SSI rates. These findings suggest that the ERAS protocol is equally applicable to all spine surgical procedures, with a more pronounced effect on reducing LOS in the PST group and on reducing medical costs in the DSD group.

PMID:38064696 | DOI:10.3171/2023.10.SPINE23512

J Neurosurg. 2023 Dec 8:1-8. doi: 10.3171/2023.10.JNS231432. Online ahead of print.

ABSTRACT

OBJECTIVE: Olfactory groove meningiomas (OGMs) often require surgical removal. The introduction of recent keyhole approaches raises the question of whether these tumors may be better treated through a smaller cranial opening. One such approach, the supraorbital keyhole craniotomy, has never been compared with more traditional open transcranial approaches with regard to outcome. In this study, the authors compared clinical, radiographic, and functional quality of life (QOL) outcomes between the keyhole supraorbital approach (SOA) and traditional transcranial approach (TTA) for OGMs. They sought to examine the potential advantages and disadvantages of open/TTA versus keyhole SOA for the resection of OGMs in a relatively case-matched series of patients.

METHODS: A retrospective, single-institution review of 57 patients undergoing a keyhole SOA or larger traditional transcranial (frontotemporal, pterional, or bifrontal) craniotomy for newly diagnosed OGMs between 2005 and 2023 was performed. Extent of resection, olfaction, length of stay (LOS), radiographic volumetric assessment of postoperative vasogenic and cytotoxic edema, and QOL (using the Anterior Skull Base Questionnaire) were assessed.

RESULTS: Thirty-two SOA and 25 TTA patients were included. The mean EOR was not significantly different by approach (TTA: 99.1% vs SOA: 98.4%, p = 0.91). Olfaction was preserved or improved at similar rates (TTA: 47% vs SOA: 43%, p = 0.99). The mean LOS was significantly shorter for SOA patients (4.1 ± 2.8 days) than for TTA patients (9.4 ± 11.2 days) (p = 0.002). The authors found an association between an increase in postoperative FLAIR cerebral edema and TTA (p = 0.031). QOL as assessed by the ASQB at last follow-up did not differ significantly between groups (p = 0.74).

CONCLUSIONS: The keyhole SOA was associated with a statistically significant decrease in LOS and less postoperative edema relative to traditional open approaches.

PMID:38064694 | DOI:10.3171/2023.10.JNS231432

J Cardiopulm Rehabil Prev. 2023 Dec 8. doi: 10.1097/HCR.0000000000000837. Online ahead of print.

ABSTRACT

PURPOSE: Improving aerobic fitness through exercise training is recommended for the treatment of cardiovascular disease (CVD). However, strong justifications for the criteria of assessing improvement in key parameters of aerobic function including estimated lactate threshold (θLT), respiratory compensation point (RCP), and peak oxygen uptake (V˙o2peak) at the individual level are not established. We applied reliable change index (RCI) statistics to determine minimal meaningful change (MMCRCI) cutoffs of θLT, RCP, and V˙o2peak for individual patients with CVD.

METHODS: Sixty-six stable patients post-cardiac event performed three exhaustive treadmill-based incremental exercise tests (modified Bruce) ∼1 wk apart (T1-T3). Breath-by-breath gas exchange and ventilatory variables were measured by metabolic cart and used to identify θLT, RCP, and V˙o2peak. Using test-retest reliability and mean difference scores to estimate error and test practice/exposure, respectively, MMCRCI values were calculated for V˙o2 (mL·min-1.kg-1) at θLT, RCP, and V˙o2peak.

RESULTS: There were no significant between-trial differences in V˙o2 at θLT (P = .78), RCP (P = .08), or V˙o2peak (P = .74) and each variable exhibited excellent test-retest variability (intraclass correlation: 0.97, 0.98, and 0.99; coefficient of variation: 6.5, 5.4, and 4.9% for θLT, RCP, and V˙o2peak, respectively). Derived from comparing T1-T2, T1-T3, and T2-T3, the MMCRCI for θLT were 3.91, 3.56, and 2.64 mL·min-1.kg-1; 4.01, 2.80, and 2.79 mL·min-1.kg-1 for RCP; and 3.61, 3.83, and 2.81 mL·min-1.kg-1 for V˙o2peak. For each variable, MMCRCI scores were lowest for T2-T3 comparisons.

CONCLUSION: These MMCRCI scores may be used to establish cutoff criteria for determining meaningful changes for interventions designed to improve aerobic function in individuals with CVD.

PMID:38064643 | DOI:10.1097/HCR.0000000000000837

Altern Ther Health Med. 2023 Dec 8:AT9276. Online ahead of print.

ABSTRACT

OBJECTIVE: To explore the combined efficacy of modified Yangxin Anshen decoction and Western medicine treatment in elderly patients with schizophrenia and sleep disorders.

METHODS: A total of 144 elderly patients with schizophrenia and sleep disorders in Wuhan Wudong Hospital were enrolled as participants in this study from April 2021 to April 2022. The participants were randomly and equally divided into a control group (receiving conventional Western medicine treatment) and two study groups: study group 1 received modified Yangxin Anshen decoction, and study group 2 receive modified Yangxin Anshen decoction in addition to Western medicine treatment. TCM syndrome scores, sleep quality, polysomnography, serum levels of 5-HT, DA, and MT were compared between the two groups. Moreover, the efficacy and adverse reactions were recorded.

RESULTS: After four weeks of treatment, the efficacy of study group 2 was significantly better than that of the control group and Study Group 1 (P < .05). There was no statistically significant difference between the three groups in secondary and main symptoms before treatment (P >.05), while the secondary and main symptoms of study group 2 were significantly lower than those of the control group and study group 1 after four weeks of treatment (P < .05). Before treatment, no statistically significant difference was found in sleep quality score between the three groups (P > .05), whereas the index of the study group 2 was evidently lower than that of the control group and study group 1 after four weeks of treatment (P < .05). Before treatment, there was no significant difference in terms of total recording time, total sleep time, sleep onset latency, sleep efficiency, and four stages (N1, N2, N3, and REM) between the three groups (P > .05). After four weeks of treatment, although no statistically significant difference was shown in total recording time between the three groups (P > .05), the total sleep time, sleep onset latency, sleep efficiency, and four stages (N1, N2, N3, and REM) of the study group 2 were significantly improved than those of the control group and the study group 1 (P < .05). Before treatment, there was no significant difference in serum levels of 5-HT, DA, and MT between the three groups (P > .05), while the three indexes were evidently lower than the control group and the study group 1 after four weeks of treatment (P < .05). During the treatment process, 1 case of mild dry mouth occurred in the study group who did not receive special treatment, and the incidence of adverse reactions was 1/48. In the control group, there were 3 cases of dry mouth, 1 case of constipation, 1 case of diarrhea, 1 case of decreased appetite, and 1 case of nausea, whose symptoms were not specially treated, with the incidence of adverse reactions of 7/48. Hence the incidence of adverse reactions in the study group was significantly lower than that in the control group (P < .05).

CONCLUSION: Combined treatment with modified Yangxin Anshen decoction and Western medicine improved sleep quality in elderly patients with schizophrenia and sleep disorders, which is available for wide clinical application.

PMID:38064632