Category: Nevin Manimala

Orthop Surg. 2024 Mar 6. doi: 10.1111/os.14025. Online ahead of print.

ABSTRACT

OBJECTIVE: The Isobar TTL dynamic fixation system has demonstrated favorable outcomes in the short-term treatment of lumbar degenerative disc diseases (LDDs). However, there is a paucity of extensive research on the long-term effects of this system on LDDs. This study aimed to evaluate the long-term clinical and radiological outcomes of patients with LDDs who underwent treatment utilizing the Isobar TTL dynamic fixation system.

METHODS: The study analyzed the outcomes of 40 patients with LDDs who underwent posterior lumbar decompression and received single-segment Isobar TTL dynamic internal fixation at our hospital between June 2010 and December 2016. The evaluation of clinical therapeutic effect involved assessing postoperative pain levels using the visual analogue scale (VAS) and Oswestry disability index (ODI), both before surgery, 3 months after, and the final follow-up. To determine the preservation of functional motion in dynamically stable segments, we measured the range of motion (ROM) and disc height of stabilized and adjacent segments preoperatively and during the final follow-up. Additionally, we investigated the occurrence of adjacent segment degeneration (ASD).

RESULTS: Forty patients were evaluated, with an average age of 44.65 years and an average follow-up period of 79.37 months. Fourteen patients belonged to the spondylolisthesis group, while the remaining 26 were categorized under the stenosis or herniated disc group. The preoperative ROM of the stabilized segment exhibited a significant reduction from 8.15° ± 2.77° to 5.00° ± 1.82° at the final follow-up (p < 0.001). In contrast, there was a slight elevation in the ROM of the adjacent segment during the final follow-up, increasing from 7.68° ± 2.25° before surgery to 9.36° ± 1.98° (p < 0.001). The intervertebral space height (IH) in the stabilized segment exhibited a significant increase from 10.56 ± 1.99 mm before surgery to 11.39 ± 1.90 mm at the one-week postoperative follow-up (p < 0.001). Conversely, there was a notable decrease in the IH of the adjacent segment from 11.09 ± 1.82 mm preoperatively to 10.86 ± 1.79 mm at the one-week follow-up after surgery (p < 0.001). The incidence of ASD was 15% (6/40) after an average follow-up period of 79.37 months, with a rate of 15.38% (4/26) in the stenosis or herniated disc group and 14.29% (2/14) in the spondylolisthesis group; however, no statistically significant difference was observed in the occurrence of ASD among these groups (p > 0.05).

CONCLUSION: The Isobar TTL dynamic fixation system is an effective treatment for LDDs, improving pain relief, quality of life (QoL) and maintaining stabilized segmental motion. It has demonstrated excellent long-term clinical and radiographic results.

PMID:38445544 | DOI:10.1111/os.14025

Int J Surg. 2024 Mar 5. doi: 10.1097/JS9.0000000000001230. Online ahead of print.

ABSTRACT

BACKGROUND: Following an initiative published by Lancet in 2002 and an IDEAL-D framework, the value of preclinical animal studies has garnered increasing attention in recent research. Numerous preclinical animal experiments tried to generate evidence to guide the development of barbed sutures. However, discernible drawbacks and incongruities in outcomes have emerged between clinical and preclinical animal studies. Therefore, this meta-analysis aimed to review the preclinical animal experiments comparing barbed sutures with conventional sutures. We hope to facilitate clinical translation of barbed sutures by evaluating effectiveness, safety, and physical properties/reliability.

MATERIALS AND METHODS: A systematic search of PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov was conducted to identify controlled preclinical animal experiments comparing barbed sutures with conventional sutures. The risk of bias was assessed using SYRCLE. GRADE approach was used to evaluate evidence quality. Revman was applied to analyze all the data. Subgroup, sensitivity, and meta-regression analyses were also performed.

RESULTS: A total of 55 articles were eligible with low to moderate quality, including 1937 samples from 10 different animal species across 25 surgical procedures. Barbed suture exhibited a significant reduction in suture time, limited change in Cross-Sectional Area (CSA), and decreased instances of tissue disruption (all P ＜0.05). Subgroup analyses, considering both clinical and research significance, indicated that barbed sutures might cause more specific adverse events and demonstrate suboptimal performance of physical properties/reliability. Meta-regression suggested that heterogeneity resulted from variations in studies and animal models.

CONCLUSION: Although barbed suture demonstrated superiority in numerous surgeries for time efficiency, its safety and physical properties/reliability might be influenced by diverse preclinical models, sutures’ brand, surgeries, and anatomical sites. Further evaluation, based on standardized and well-designed animal experiments, is essential for medical device development and applications in human beings.

PMID:38445518 | DOI:10.1097/JS9.0000000000001230

Hypertension. 2024 Mar 6. doi: 10.1161/HYPERTENSIONAHA.123.22614. Online ahead of print.

ABSTRACT

BACKGROUND: Hypertension, a complex condition, is primarily defined based on blood pressure readings without involving its pathophysiological mechanisms. We aimed to identify biomarkers through a proteomic approach, thereby enhancing the future definition of hypertension with insights into its molecular mechanisms.

METHODS: The discovery analysis included 1560 participants, aged 55 to 74 years at baseline, from the KORA (Cooperative Health Research in the Region of Augsburg) S4/F4/FF4 cohort study, with 3332 observations over a median of 13.4 years of follow-up. Generalized estimating equations were used to estimate the associations of 233 plasma proteins with hypertension and systolic blood pressure (SBP). For validation, proteins significantly associated with hypertension or SBP in discovery analysis were validated in the KORA-Age1/Age2 cohort study (1024 participants, 1810 observations). A 2-sample Mendelian randomization analysis was conducted to infer causalities of validated proteins with SBP.

RESULTS: Discovery analysis identified 49 proteins associated with hypertension and 99 associated with SBP. Validation in the KORA-Age1/Age2 study replicated 7 proteins associated with hypertension and 23 associated with SBP. Three proteins, NT-proBNP (N-terminal pro-B-type natriuretic peptide), KIM1 (kidney injury molecule 1), and OPG (osteoprotegerin), consistently showed positive associations with both outcomes. Five proteins demonstrated potential causal associations with SBP in Mendelian randomization analysis, including NT-proBNP and OPG.

CONCLUSIONS: We identified and validated 7 hypertension-associated and 23 SBP-associated proteins across 2 cohort studies. KIM1, NT-proBNP, and OPG demonstrated robust associations, and OPG was identified for the first time as associated with blood pressure. For NT-proBNP (protective) and OPG, causal associations with SBP were suggested.

PMID:38445514 | DOI:10.1161/HYPERTENSIONAHA.123.22614

Eur Heart J Cardiovasc Imaging. 2024 Mar 6:jeae058. doi: 10.1093/ehjci/jeae058. Online ahead of print.

ABSTRACT

AIMS: To date, no studies have investigated the association between lipid species and coronary plaque changes over time, quantitatively assessed by serial imaging. We aimed to prospectively determine the association between lipid species quantified by plasma lipidomic analysis, with coronary plaque changes according to composition assessed by quantitative serial analysis of coronary computed tomography angiography (CTA).

METHODS AND RESULTS: Patients with suspected coronary artery disease (CAD) undergoing baseline coronary CTA were prospectively enrolled by 7 EU Centers in the SMARTool study and submitted to clinical, molecular and coronary CTA re-evaluation at follow-up (interscan period 6.39 ± 1.17 years). From the 202 patients that were analysed in the SMARTool main clinical study, lipidomic analysis was performed in 154 patients before the baseline coronary CTA, and this group was included in the present study. Quantitative CTA analysis was performed by a separate core laboratory blinded from clinical data. In univariable analysis, no lipid species were significantly associated with annual total and calcified plaque changes. After adjusting for clinical variables at baseline and statin use, 3 lipid species were significantly associated with non-calcified plaque progression. In detail, cholesteryl ester (CE)(20:3), sphingomyelin (SM)(40:3) and SM(41:1) were found positively related to non-calcified plaque progression (Bonferroni adjusted P-value = 0.005, 0.016 and 0.004, respectively).

CONCLUSION: The current study showed an independent relationship between specific lipid species determined by plasma lipidomic analysis, and non-calcified coronary plaque progression assessed by serial, quantitative coronary CTA analysis.

PMID:38445505 | DOI:10.1093/ehjci/jeae058

Iran Biomed J. 2023 Sep 3. doi: 10.61186/ibj.3845. Online ahead of print.

ABSTRACT

BACKGROUND: Non-small cell lung cancer accounts for 85% of tumors of the lung and is a leading cause of cancer mortality worldwide. MiR-34a and miR-126 mainly act as tumor suppressors and are often downregulated in various cancers, including NSCLC.

METHODS: The current study included 63 paraffin-embedded NSCLC and paired adjacent normal tissues. After DNA extraction and bisulfite treatment, the methylation status of miR-34a and miR-126 were evaluated using the MSP method.

RESULTS: There was no statistically significant difference between tumor and normal tissues regarding the methylation status of miR-34a and miR-126 (p > 0.05). Moreover, we found no significant correlation between the methylation status of miR-34a and miR-126 with patients’ demographic parameters, including gender, age, and pathology subtype (p > 0.05).

CONCLUSION: Considering the low expression of mir-126 and mir-34 in NSCLC, more sensitive methods are recommended to be exploited for detecting the level of methylation or underlying mechanisms other than promoter hypermethylation in silencing these genes in NSCLC.

PMID:38445462 | DOI:10.61186/ibj.3845

Int J Surg. 2024 Mar 4. doi: 10.1097/JS9.0000000000001149. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Besides the increased risk of perioperative morbidity, graft failure, and mortality, the majority of PVT are diagnosed at liver transplantation (LT). Improving preoperative management and patient selection may lead to better short-term and long-term outcomes and reduce the risk of a futile LT. The authors aimed to identify predictors of adverse outcomes after LT in patients with nonmalignant portal vein thrombosis (PVT) and improve donor to recipient matching by analyzing the results of the Italian cohort of LT recipients.

METHODS: Adult patients who underwent LT in Italy between January 2000 and February 2020 diagnosed with PVT pre-LT or at time of LT were considered eligible for inclusion. Based on a survey encompassing all 26 surgeons participating in the study, a binary composite outcome was defined. Patients were classified as having the composite event if at least one of these conditions occurred: operative time more than 600 min, estimated blood loss greater than 5000 ml, more than 20 ICU days, 90 days mortality, 90 days retransplant.

RESULTS: Seven hundred fourteen patients were screened and 698 met the inclusion criteria. The analysis reports the results of 568 patients that fulfilled the criteria to enter the composite outcome analysis.Overall, 156 patients (27.5%) developed the composite outcome. PVT stage 3/4 at transplant and need for any surgical correction of PVT are independent predictors of the composite outcome occurrence. When stratified by PVT grade, overall survival at 1-year ranges from 89.0% with PVT grade 0/1 to 67.4% in patients with PVT grade 3/4 at LT (P<0.001). Nevertheless, patients with severe PVT can improve their survival when identified risk factors are not present.

CONCLUSIONS: Potential LT candidates affected by PVT have a benefit from LT that should be adequately balanced on liver function and type of inflow reconstruction needed to mitigate the incidence of adverse events. Nonetheless, the absence of specific risk factors may improve the outcomes even in patients with PVT grades 3-4.

PMID:38445440 | DOI:10.1097/JS9.0000000000001149

Br J Surg. 2024 Mar 2;111(3):znae049. doi: 10.1093/bjs/znae049.

ABSTRACT

BACKGROUND: Evidence for the routine use of robotic technology and its impact on short-term outcomes in colon cancer surgery is lacking. The aim of this study was to compare the surgically induced systemic stress response and clinical and patient-reported outcomes for patients undergoing robot-assisted or laparoscopic colon cancer surgery.

METHODS: In this double-blinded superiority RCT completed between August 2021 and March 2023, patients with stage 1-3 colon cancer were randomized in a 1 : 1 ratio to undergo either robot-assisted or laparoscopic colon cancer surgery. The primary outcome was changes in the systemic stress response, characterized by C-reactive protein expression in the first three postoperative days. Secondary outcomes were intraoperative and postoperative complications and patient-reported outcomes. The latter included quality of recovery-15 and pain intensity using a visual analogue scale.

RESULTS: In total, 128 patients were screened for potential inclusion in this study; 50 patients (25 in the robot-assisted group and 25 in the laparoscopic group) were included in the final follow-up and analysis. The postoperative C-reactive protein response was higher on the first postoperative day in the laparoscopic group (mean difference = 19.88 mg/l, 95% c.i. 3.89-35.86; P = 0.045). No statistically significant differences were noted for C-reactive protein expression on the second and third postoperative days.

CONCLUSION: Adopting robot-assisted surgery for stage 1-3 colon cancer is associated with a reduction in the surgical stress response.

REGISTRATION NUMBER: NCT04687384 (http://www.clinicaltrials.gov).

PMID:38445434 | DOI:10.1093/bjs/znae049

Nanoscale. 2024 Mar 6. doi: 10.1039/d3nr04907h. Online ahead of print.

ABSTRACT

Titania nanoparticles with a diameter of 8 nm underwent an anisotropic modification using apolar 6-bromohexylphosphonic acid and cationic polar N,N,N-trimethyl-6-phosphonohexan-1-aminium bromide. The Janus modification was achieved through a straightforward one-step Pickering emulsion approach using toluene-water mixtures. The resulting Janus particles were compared with isotropically and statistically modified titania particles, where either a single coupling agent is attached to the surface or both coupling agents are assembled over the surface randomly, respectively. The covalent binding of the phosphonic acids to the titania surface was confirmed by FTIR and ³¹P solid-state CP-MAS NMR analyses. The grafting density was assessed using TGA, elemental analysis, and ICP-MS, revealing grafting densities of 0.1 mmol g^-1 to 0.5 mmol g^-1 for the cationic coupling agent and 1.2 mmol g^-1 to 1.5 mmol g^-1 for the apolar coupling agent, respectively. ζ-Potential titration measurements of both pristine and modified particles revealed isoelectric points at pH 4.5 to 9.3, depending on the type of modification. The ability of the particles to stabilize Pickering emulsions was tested under various conditions, with statistically and Janus-modified particles demonstrating a significant increase in stabilization compared to their isotropically modified counterparts. Furthermore, Janus particles were deposited onto glass substrates by a simple layer-by-layer approach. Through the self-assembly of these Janus particles, the glass substrate’s properties could be tailored from hydrophilic to hydrophobic to hydrophilic, depending on the dipping cycle.

PMID:38445431 | DOI:10.1039/d3nr04907h

Ren Fail. 2024 Dec;46(1):2325640. doi: 10.1080/0886022X.2024.2325640. Epub 2024 Mar 6.

ABSTRACT

BACKGROUND: The severity and course of sepsis-associated acute kidney injury (SA-AKI) are correlated with the mortality rate. Early detection of SA-AKI subphenotypes might facilitate the rapid provision of individualized care.

PATIENTS AND METHODS: In this post-hoc analysis of a multicenter prospective study, we combined conventional kidney function variables with serial measurements of urine (tissue inhibitor of metalloproteinase-2 [TIMP-2])* (insulin-like growth factor-binding protein [IGFBP7]) at 0, 6, 12, and 24 h) and then using an unsupervised hierarchical clustering of principal components (HCPC) approach to identify different phenotypes of SA-AKI. We then compared the subphenotypes with regard to a composite outcome of in-hospital death or the initiation of renal replacement therapy (RRT).

RESULTS: We included 184 patients presenting SA-AKI within 6 h of the initiation of catecholamines. Three distinct subphenotypes were identified: subphenotype A (99 patients) was characterized by a normal urine output (UO), a low SCr and a low [TIMP-2]*[IGFBP7] level; subphenotype B (74 patients) was characterized by existing chronic kidney disease (CKD), a higher SCr, a low UO, and an intermediate [TIMP-2]*[IGFBP7] level; and subphenotype C was characterized by very low UO, a very high [TIMP-2]*[IGFBP7] level, and an intermediate SCr level. With subphenotype A as the reference, the adjusted hazard ratio (aHR) [95%CI] for the composite outcome was 3.77 [1.92-7.42] (p < 0.001) for subphenotype B and 4.80 [1.67-13.82] (p = 0.004) for subphenotype C.

CONCLUSIONS: Combining conventional kidney function variables with urine measurements of [TIMP-2]*[IGFBP7] might help to identify distinct SA-AKI subphenotypes with different short-term courses and survival rates.

PMID:38445412 | DOI:10.1080/0886022X.2024.2325640

Tunis Med. 2023 Aug-Sep;101(8-9):709-714.

ABSTRACT

INTRODUCTION: The worldwide obesity epidemic continues unabated. Obesity and its associated health risks are considered as the major causes of morbidity and mortality. Currently, bariatric surgery is the most effective treatment for people with severe obesity resulting in sustainable weight loss and a reduced risk for co-morbidities. Sleeve gastrectomy is the most common bariatric procedure undertaken in Tunisia.

AIM: we aim to evaluate the vitamin status of the obese patients before and after sleeve gastrectomy.

METHODS: Thirty obese patients undergoing sleeve gastrectomy, were recruited from Obesity unit. In this study. A biological assessment was performed pre-operatively and controlled 6 months following the sleeve gastrectomy including: calcemia, parathyroid hormone (PTH), albuminemia and dosage of vitamin D, vitamin B9 and vitamin B12.

RESULTS: Six months post sleeve gastrectomy, vitamin deficiencies were more prevalent: the mean level of vitamin B9, vitamin B12 and vitamin D respectively, has decreased from 5.03±3.28 ng / ml to 2.71±1.52 ng / ml, from 348.06±158.92 pg/ml to 264.62±119.77 pg/ml and from 17.18±11.45 ng/ml to 11.69±8.22 ng/ml, with a statistically significant difference (p=0.008, p=0.01 and p=0.012). Sleeve gastrectomy has proven to be an effective weight loss treatment. However, nutritional deficiencies have worsened during postoperative period.

CONCLUSION: This study highlights the importance of early identification, appropriate treatment and prophylactic micronutrient supplementation.

PMID:38445407