Category: Nevin Manimala

Cir Cir. 2023;91(5):658-663. doi: 10.24875/CIRU.22000419.

ABSTRACT

BACKGROUND: Open abdomen is an alternative for the management of trauma patient, and negative pressure therapy of the wound using VAC^® device is a genuine sort of treatment. Although the device poses technical advantages, risks are present and a critical complication is the enteroatmospheric fistula formation (EAF).

OBJECTIVE: To analize the role of negative pressure therapy length and VAC^® device number of changes on the EAF formation in trauma patients udergoing open abdomen.

METHOD: Cut-off points were calculated using receiver operational characteristics curve. Values were compared with Student’s t or Mann-Withney U tests, considering statistically significant p < 0.05.

RESULTS: EAF were present in 39 cases (5.9%). A significant difference in the presence of EAF was present in patients with negative pressure therapy of the wound length ≥ 11.2 days (46.9 vs. 1.3%; relative risk [RR]: 3.67; 95% confidence interval [95% IC]: 2.4-6.68; p = 0.017) and when ≥ 2.6 VAC^® device changes were performed (34.6 vs. 0.5%; RR: 6.92; 95% IC: 1.1-4.3; p < 0.001).

CONCLUSIONS: At our institution, the practice of >3 VAC^® device changes and length of therapy > 11 days should be carefully considered leading to reduce the risk of EAF formation.

PMID:37844886 | DOI:10.24875/CIRU.22000419

Cir Cir. 2023;91(5):596-600. doi: 10.24875/CIRU.22000203.

ABSTRACT

OBJECTIVE: To compare the protective effect of nitroglycerin ointment 2% and Dimethylsulfoxide (DMSO) in dorsal flaps of the rat.

METHODS: A blind, experimental study was conducted in 24 male Wistar rats, with a mean weight of 320 (286-376) grams. Group 1: Control. Petrolatum jelly (Vaseline), n = 8, Group 2: Nitroglycerin (NTG) ointment 2% (Nitro-Bid, Altana Co.) n = 8, and Group 3: DMSO gel 90% (Neogen corp. Lexington KY, 40611), n = 8.

RESULTS: A total of 24 rats were operated on in the 6-month period of this study. Using a non-parametric Mann-Whitney U-test analysis, a statistically significant p was obtained between the control group and 2% NTG ointment, both in the area of necrosis and in the healthy area (p = 0.026). In contrast, the comparison between DMSO [CH3) 2SO] and the control group (p = 0.180) and between both study groups, with a p = 0.18, was not significant.

CONCLUSIONS: Our study concluded that there is a protective effect of 2% NTG ointment for flap survival in relation to the control group (petrolatum). DMSO administered topically did not show a protective effect, compared to the control group.

PMID:37844881 | DOI:10.24875/CIRU.22000203

Am J Clin Nutr. 2023 Oct 13:S0002-9165(23)66178-7. doi: 10.1016/j.ajcnut.2023.10.004. Online ahead of print.

NO ABSTRACT

PMID:37844874 | DOI:10.1016/j.ajcnut.2023.10.004

SLAS Technol. 2023 Oct 14:S2472-6303(23)00060-2. doi: 10.1016/j.slast.2023.10.002. Online ahead of print.

ABSTRACT

Rapid and accurate measurements of immune protein markers are essential for diagnosis and treatment in all clinical settings. The recent pandemic has revealed a stark need for developing new tools and assays that could be rapidly used in diverse settings and provide useful information to clinicians. Here, we describe the development and test application of a novel one-step CRP/IP-10 duplex assay for the LightDeck platform capable of delivering reproducible and accurate measurements in under eight minutes. We used the optimized assay to measure CRP and IP-10 levels in human blood and serum samples from healthy, SARS-CoV-2 (COVID-19) positive, and influenza-like illness (ILI) presenting patients. Our results agreed with previously published analyte levels and enabled us to make statistically significant comparisons relevant to multiple clinical parameters. Our duplex assay is a simple and powerful tool for aiding prognostic decision-making in diverse settings.

PMID:37844868 | DOI:10.1016/j.slast.2023.10.002

J Shoulder Elbow Surg. 2023 Oct 14:S1058-2746(23)00734-6. doi: 10.1016/j.jse.2023.09.009. Online ahead of print.

ABSTRACT

BACKGROUND: Giant cell tumors of bone (GCTB) are rare aggressive tumors and proximal humerus is a relatively rare location for GCTB as well, limited evidence exists on which surgical approaches and reconstruction techniques are optimal. Here, using the largest case series to date, we evaluated the recurrence rate of proximal humerus GCTBs and the functional outcomes of different resection and reconstruction options in this multicenter study.

METHODS: All 51 patients received initial surgical treatment for proximal humerus GCTBs from January 2007 to December 2020, with a minimum two-year follow-up. Local recurrence and functional outcomes were statistically analyzed in relation to demographic, clinical, and primary surgical variables. Functional outcomes were patient-reported and assessed by the Musculoskeletal Tumor Society (MSTS) score and the Disabilities of the Arm, Shoulder and Hand (QuickDASH) instrument.

RESULTS: Mean follow-up was 81.5 months (range, 30-191 months), and overall recurrence rate was 17.6% (9/51). The majority of the recurrence (N=7) occurred in the first two years of follow-up. The intralesional curettage group (N=23) had a statistically significant difference in recurrence rate compared to en-bloc resection (N=28) (34.8% vs. 3.6%, p=0.007). Among patients receiving en-bloc resection, 16 shoulders were reconstructed with hemiarthroplasty, 8 with reverse total shoulder arthroplasty (rTSA) with allograft-prosthetic composite (APC) reconstruction, and 4 with arthrodesis. Based on intention-to-treat analysis, the mean functional MSTS scores of the curettage groups, rTSA with APC, hemiarthroplasty, or arthrodesis was 26.0±3.1 vs. 26.0±1.7 vs. 20.3±2.8 vs. 22.5±1.3 (p<0.001 [curettage vs. hemiarthroplasty, p<0.001; rTSA with APC vs. hemiarthroplasty, p=0.004]), respectively, while for QuickDASH, it was 14.0±11.0 vs. 11.6±4.5 vs. 33.1±11.8 vs. 21.6±4.7 (p<0.001 [curettage vs. hemiarthroplasty, p<0.001; rTSA with APC vs. hemiarthroplasty, p=0.003]), respectively.

CONCLUSIONS: Based on our data, en-bloc resection followed by reverse shoulder arthroplasty showed a lower recurrence rate, and no significant difference in functional outcome scores for proximal humerus GCTBs compared with intralesional curettage. Therefore, we believe that rTSA with APC may be reasonable for initial treatment of proximal humerus GCTBs.

PMID:37844829 | DOI:10.1016/j.jse.2023.09.009

J Affect Disord. 2023 Oct 14:S0165-0327(23)01259-4. doi: 10.1016/j.jad.2023.10.077. Online ahead of print.

ABSTRACT

BACKGROUND: The purpose of this study was to validate the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) Cross-Cutting Symptom Measure (CCSM) as a screening tool for a wide variety of disorders within busy community outpatient mental health settings.

METHOD: Participants (N = 851) were referred for coordinated specialty care services (mean age = 20.26 years (SD = 2.97); 82.5 % Caucasian, 7.5 % African American, 0.7 % Native American, 0.7 % Pacific Islander, 0.8 % Asian, 7.8 % Multiracial; 15.1 % Latinx; 53.1 % female, 45.5 % male, 1.4 % other gender).

RESULTS: At optimal cut-score, specificity ranged from 57 to 77 % for depression, anxiety, substance use and psychosis domains; sensitivity ranged from 63 to 72 %. Scores for depression, anxiety, substance use and psychosis domains differed significantly by groups with and without diagnoses. Correlations among domains were larger where expected (r = 0.52, depression-suicidal ideation), and relatively smaller where expected (r = 0.28, suicidal ideation-inattention). Depression, anxiety, substance use and psychosis domains evidenced incremental validity for their respective diagnoses (change in explained variance, 3-15 %). Psychometric features of CCSM were broadly supported.

LIMITATIONS: Criterion measures did not have inter-rater reliabilities as this is generally prohibitive in clinic settings.

CONCLUSION: The CCSM could provide a first step in screening for multiple disorders; however, it cannot replace structured interviews for making diagnoses related to these conditions.

PMID:37844781 | DOI:10.1016/j.jad.2023.10.077

J Affect Disord. 2023 Oct 14:S0165-0327(23)01247-8. doi: 10.1016/j.jad.2023.10.066. Online ahead of print.

ABSTRACT

BACKGROUND: Few studies have focused on the associations of adolescent substance use and depressive symptoms with adult major depressive disorder (MDD).

METHODS: Data from 168,859 adults, among which, 15,959 had experienced MDD in the past year, as indicated by a major depressive episode (MDE) marked by MDD symptoms, were from the 2016-2019 National Surveys on Drug Use and Health. Weighted multivariable logistic regression (MLR) analyses were used to determine the associations.

RESULTS: The overall MDD prevalence was 7.2 %, whereas the prevalence for adults without early onset depressive symptoms prior to age 18 was 4.6 %. Variable cluster analysis revealed that adolescent use of alcohol, cigarettes, marijuana, cocaine, hallucinogen use, and inhalants prior to age 18 were in one cluster. MLR analyses showed that the presence of depressive symptoms prior to age 18 was the major risk factor for MDD, while adolescent use of alcohol, marijuana, and inhalants prior to age 18 were associated with increased odds of MDD (p < 0.05) both in the whole data and the subset of adults without depressive symptoms prior to age 18. Adolescent use of cocaine prior to age 18 were associated with MDD only in the whole data, whereas adolescent smokeless tobacco use was associated with MDD only in those without depressive symptoms prior to age 18.

CONCLUSIONS: These findings highlight the comorbid early substance use and depressive symptoms during adolescence with adult MDD. Intervention strategies should simultaneously address early-onset substance use and depressive symptoms prior to age 18.

PMID:37844780 | DOI:10.1016/j.jad.2023.10.066

Ageing Res Rev. 2023 Oct 14:102089. doi: 10.1016/j.arr.2023.102089. Online ahead of print.

ABSTRACT

Parkinson’s disease (PD) is a neurodegenerative disorder, characterized by motor and non-motor symptoms, that still lacks of a disease-modifying treatment. Consistent evidence proved the benefits of physical therapy on motor and non-motor symptoms in PD patients, leading the scientific community to propose physical activity as disease-modifying therapy for PD and suggesting the involvement of neurotrophic factors (NFs) as key mediators of neuroplasticity. However, the lack of standardized exercise training and methodological flaws of clinical trials have limited the evidence demonstrating the exercise-induced changes in serum and plasma neurotrophic factors concentration. A systematic search, covering 20 years of research in this field and including randomized and non-randomized controlled trials (RCTs and non-RCTs), which reported changes in serum and plasma NFs after a specific intervention, were reviewed. Pooled effect sizes (p-ESs) and 95% confidence intervals (95%CIs) were calculated using a random effects model with R software. A total of 18 articles, of which exercise programs of interventions were codified in terms of type, intensity and duration adopting a standardisation methodology, were included in the systematic review. Six papers, describing the effect of different training programs on BDNF and IGF-1 levels, were included and independently analysed in two meta-analyses. Quantitative analysis for BDNF indicated a statistically significant improvement in serum concentration of PD patients (MD: 5.99ng/mL; 95%IC: 0.15 -11.83; I²= 77%) performing physical activity compared with control conditions in RCTs. Preliminary evidence supported the hypothesis that a moderate intensity aerobic exercise (MIAE) would be necessary to induce the changes in NFs. However, sensitivity analysis of meta-analysis and the few studies included in subgroup analysis did not support these results. Alongside, meta-analysis followed by sensitivity analysis revealed a potential change in serum IGF-1 (MD: 33.47ng/mL; 95%IC: 8.09-58.85) in PD patients performing physical activity with respect controls in RCT studies. Considering the limited evidence to support or refute the increase in NFs levels in PD patients performing physical activity, there is a need to develop a rigorous controlled randomized trial, with standardization for loading intensity of physical activity, greater sample size, and a correct stratification of PD patients to establish a well-defined correlation between physical activity and NFs levels.

PMID:37844764 | DOI:10.1016/j.arr.2023.102089

J Ethnopharmacol. 2023 Oct 14:117199. doi: 10.1016/j.jep.2023.117199. Online ahead of print.

ABSTRACT

ETHNOPHARMACOLOGICAL RELEVANCE: An herbal pair is a classic form of clinical dispensing in Traditional Chinese Medicine (TCM), often used in prescriptions to enhance the effect or reduce potential side effects. It is the smallest component unit of Chinese medicine prescription and an essential bridge between Chinese medicine and prescription. Curcumae Rhizoma (called Ezhu in Chinese) is a representative TCM herb that promotes blood circulation and removes blood stasis. It has been used in Chinese medicine for thousands of years. Ezhu is generally used in clinical applications as a part of a “drug pair” to treat heartburn, stomach pain, tumour, amenorrhea and abdominal pain caused by blood stasis, qi stagnation and injury.

AIMS OF THE REVIEW: This review aims to summarize the latest and comprehensive situation of the biological activity and clinical application of drug pairs containing Ezhu, find the law of Ezhu compatibility application, and discuss the rationalization of Ezhu drug compatibility. For Ezhu, herb pairs to provide a theoretical basis for clinical research in TCM and serve as a research foundation for developing new drugs.

MATERIALS AND METHODS: Using a self-built prescription database and Apriori algorithm for association rule mining. A systematic search for studies on herb pairs containing Ezhu was carried out by using the internet databases of PubMed, CNKI, Baidu Scholar, Google Scholar and Web of Science, as well as other relevant textbooks, reviews and documents (e.g. Chinese Pharmacopoeia, 2020 edition, Chinese herbal classic books and PhD and MSc theses, etc.). Among them with keywords including “Curcumae Rhizoma”, “Ezhu”, “herb pairs”, “clinical application”, etc. and their combinations. Moreover, the t-copula function was used to analyse the dose-coupling effect of five drug pairs, including Ezhu.

RESULTS: The preliminary statistical analysis retrieved Ezhu prescriptions from self-built prescription database and internet databases. The results showed that the compatibility frequency of Ezhu with the other five Chinese medicines was high. Most of these selected herbal combinations are used to treat internal diseases. In this paper, the progress of the ethnopharmacology of Ezhu was reviewed, emphasizing the changes in bioactive components and compatibility of Chinese traditional medicine combinations such as Ezhu and Astragalus Curcuma (Sparganium stoloniferum Buch. -Ham; called Sanleng in Chinese), Ezhu and Astragali Radix (Astragalus membranaceus (Fisch.) Bge. var. mongholicus (Bge.) Hsiao, Astragalus membranaceus (Fisch.) Bge.; called Huangqi in Chinese). Some other varieties, such as Ezhu and Rhizoma Chuanxiong (Ligusticum chuanxiong Hort.; called Chuanxiong in Chinese), Trionycis Carapax (Trionyx sinensis Wiegmann; called Biejia in Chinese), and Coptidis Rhizoma (Coptis chinensis Franch., Coptis deltoidea C. Y. Cheng et Hsiao, Coptis teeta Wall.; called Huanglian in Chinese), are also recorded in ancient books but rarely researched. The dose of Ezhu is strongly correlated with the amount of Sanleng, Huangqi, Biejia, Chuanxiong and Huanglian, respectively. Furthermore, there was a positive correlation between them.

CONCLUSIONS: The bioactive components and compatibility effects of Ezhu herb pairs were studied in detail using data mining and t-copula function analysis. Ezhu and Astragalus Curcuma (Sanleng) mainly treat gynecological disorders by activating blood circulation and relieving congestion. Ezhu and Astragali Radix (Huangqi) drug pair and Ezhu and Trionycis Carapax (Biejia) drug pair are all commonly used in the clinical treatment of tumors, the former is mainly used clinically for the treatment of digestive tract-related inflammation and tumors, liver cancer and gynecological tumors, and the latter is commonly used for the treatment of malignant tumors, such as liver cancer and mammary cancer.

PMID:37844744 | DOI:10.1016/j.jep.2023.117199

Ann Anat. 2023 Oct 14:152170. doi: 10.1016/j.aanat.2023.152170. Online ahead of print.

ABSTRACT

BACKGROUND: Anatomical variants of the left renal vein (LRV), such as the retroaortic (RLRV) and circumaortic (CLRV) course, are of surgical importance. Different morphological and topographical possibilities of the RLRV could occur. It was aimed at documenting the anatomical variables of the RLRV.

METHOD: A retrospective study on 375 computed tomography angiograms was performed. Five different anatomical types of LRV were documented: preaortic types 1 and 2 and retroaortic types 3 to 5.

RESULTS: In 344/375 cases, preaortic LRVs were found. In 31/375 cases, different types of RLRV were found: type 3a – single RLRV, 41.94%; type 3b – single RLRV with bifid caval end, 9.68%; type 3c – single RLRV with trifid caval end, 3.23%; type 4a – CLRV with extrahilar origin, 29.03%; type 4b – CLRV with renal sinus origin, 12.9%; type 5 – triple LRV (one preaortic LRV and two RLRVs), 3.23%. Reference vertebral levels were recorded for the prevertebral segment of the RLVR. The vertebral level of type 3a varied from the L1/L2 disc to the upper third of the L4 vertebra. Type 3b was found in 3/31 RLRV cases; in one of these, the hemiazygos vein was inserted by two roots into the LRV and its upper caval end trunk. There was a significant statistical association between type 3b and the vertebral level, all cases being centered on the middle third of the L4 vertebra.

CONCLUSIONS: New morphological possibilities of the LRV were distinguished, and a new anatomical classification system of the RLRV results. The RLRV variant should be documented case-by-case as it has its anatomical variables.

PMID:37844738 | DOI:10.1016/j.aanat.2023.152170