Category: Nevin Manimala

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

Altern Ther Health Med. 2023 Dec 8:AT9481. Online ahead of print.

ABSTRACT

OBJECTIVE: China has an aging society; the issue of aging is becoming increasingly serious. This study aimed to explore the factors influencing the demand for medical treatment and health care services among the elderly and offer countermeasures and suggestions.

METHODS: In this cross-sectional study, a questionnaire method was used to inquire about 386 elderly people in three communities from Bincheng District, Binzhou City, and Shandong Province.

RESULTS: The demand of community-dwelling elderly for chronic disease medication consultation services was 91.71%, with 53.88% in urgent need of the service. Their demand for dietary guidance was 91.19%, with 52.07% having a great demand for the guidance. The demand for medical expenses guarantee was 87.82%, and those in great need accounted for 47.93%. 84.98% required hospice care service, with 31.87% in great need of the service. The demand for psychological and spiritual services was 84.20% and 44.56% of them reported high demand for it. From multiple regression analysis, the factors influencing the demand of the elderly for medical treatment and health care services were identified as the sources of income, harmonious relationship with their children, medical expenses guarantee, and psychological and spiritual services, with statistical significance (P < .05).

CONCLUSIONS: Chronic disease medication consultation service, dietary guidance, and medical expenses guarantee are listed as the top three demands among the elderly living in the community from medical treatment and health care services. This warrants an urgent need to establish a multi-level, personalized, and diversified medical treatment and health care model, with improved long-term care insurance system, and trained medical professionals to provide professional services in order to improve the quality of life and health level of the elderly.

PMID:38064627

Altern Ther Health Med. 2023 Dec 8:AT8976. Online ahead of print.

ABSTRACT

AIMS: An imaging study to investigate electroconvulsive modulation of brain markers of emotional processing and activity of various brain regions in patients with schizophrenia.

MATERIALS AND METHODS: One hundred and twenty patients with schizophrenia admitted to The Brain Hospital of Hunan Province from January 2020 to July 2022 were divided into a comparison group and a study group of 60 patients each according to the order of admission. The comparison group received conventional pharmacological interventions and the study group implemented conventional pharmacological and electroconvulsive modulation therapy to compare the neurotransmitter power, neuropsychological assessment, and efficacy evaluation between the two groups.

RESULTS: Before treatment, there was no statistically significant difference in neurotransmitter power between the two groups (P > .05); 30 min after treatment, GABA, Glu, 5-HT, Ach, NE, and DA were elevated in both groups and were higher in the study group than in the comparison group, and the difference was statistically significant (P < .05). Before treatment, there was no statistically significant difference in the neuropsychological measurements between the two groups (P > .05). Clinical efficacy evaluation after treatment revealed that the clinical efficacy rate of patients in the study group was 95.00% significantly higher than that of the comparison group, which was 83.33%, and the comparative difference was statistically significant (P < .05).

CONCLUSION: Electroconvulsive therapy was found to significantly improve neuropsychological assessment and clinical outcomes in patients with psychiatric disorders.

PMID:38064618

Altern Ther Health Med. 2023 Dec 8:AT8962. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to investigate and analyze the correlation between EGFR-TKI first-line therapy and EGFR mutation status in patients with advanced lung cancer.

METHODS: We selected 60 patients with advanced lung cancer and EGFR mutations (diagnosed as stage IIIb or IV) from our hospital between January 2019 and November 2022. Each patient underwent an EGFR mutation test and was categorized into two groups based on their mutation status: 28 patients with exon 21 mutations and 32 with exon 19 deletions. After three months of therapy, we assessed treatment efficacy and adverse reactions.

RESULTS: Our data revealed that in the EGFR exon 21 mutation group, the objective response rate (ORR) and disease control rate (DCR) were 57.14% and 60.71%, respectively. In the EGFR exon 19 deletion group, the ORR and DCR were 68.75% and 84.38%, respectively. There were significant differences in DCR and ORR between the two EGFR mutation states, with statistical significance (P < .05). The progression-free survival (PFS) in the EGFR exon 21 mutant group was 8.4 months after third-generation EGFR-TKI treatment, while the EGFR exon 19 deletion group had a PFS of 12.7 months after the same treatment, with a statistically significant difference (P < .05). Cox regression analysis showed that female patients with no smoking history and an adenocarcinoma pathological type had significantly better PFS after treatment compared to male patients with a smoking history and squamous cell carcinoma type, with statistical significance (P < .05). Age and clinical stage did not significantly impact PFS after third-generation EGFR-TKI treatment (P > .05). Adverse reaction incidences, such as nausea, fatigue, diarrhea, vomiting, and rash, did not significantly differ in either the EGFR exon 21 mutation group or the EGFR exon 19 deletion group (P > .05).

CONCLUSION: The status of EGFR mutations serves as a predictive factor for PFS, DCR, and ORR in lung cancer patients undergoing EGFR-TKI first-line therapy. This status can be a valuable predictive indicator of lung cancer treatment efficacy, with potential applications in clinical practice.

PMID:38064607

Altern Ther Health Med. 2023 Dec 8:AT9764. Online ahead of print.

ABSTRACT

OBJECTIVE: Exploring the perinatal outcomes of forceps delivery and the risk factors of postpartum hemorrhage, laying a certain foundation for early identification of indications for forceps assisted delivery and suppressing the risk of bleeding during forceps assisted delivery, and improving delivery quality.

METHOD: Retrospective analysis was made on the clinical information of 1520 parturients delivered by vagina in hospitals from December 2019 to December 2021. They were divided into normal vaginal delivery group (sample size=1454) and forceps assisted delivery group (sample size 66) according to whether forceps-assisted delivery occurred during the second stage of labor. They were divided into a postpartum hemorrhage group (sample size 9) and non-postpartum hemorrhage group (sample size 47) according to whether forceps-assisted delivery occurred, the risk factors of postpartum hemorrhage were analyzed by logistic regression.

RESULT: The incidence of perinatal infants in the forceps assisted delivery group compared to those in the normal vaginal delivery group who were transferred to the neonatal intensive care unit (25.76% vs 9.97%), neonatal asphyxia (4.55% vs 1.03%), shoulder dystocia (1.52% vs 0.69%), and facial scratches (40.91% vs 0.14%) was statistically significant (P < .05), except for shoulder dystocia. Univariate analysis showed that abnormal coagulation function, fetal orientation during midwifery, soft birth canal laceration, perineum lateral incision, and neonatal birth weight were the single factors related to postpartum hemorrhage during forceps delivery (P < .05). Multivariate analysis showed that abnormal coagulation function, laceration of the soft birth canal, and lateral episiotomy were independent risk factors for postpartum hemorrhage during forceps-assisted delivery. The rate of postpartum hemorrhage under forceps-assisted delivery was relatively low when the fetal orientation was occipital transverse (P < .05).

CONCLUSION: The incidence of postpartum hemorrhage in the forceps assisted delivery group is higher, with occipital posterior position, abnormal coagulation function, soft birth canal tear, and lateral perineal incision being high-risk factors for postpartum hemorrhage in forceps assisted delivery. We need to strengthen prevention and control measures to improve the quality of the perinatal period. This study has guiding significance for early identification of high-risk factors for postpartum hemorrhage, strengthening pre pregnancy knowledge education, strengthening labor process monitoring, actively correcting fetal orientation, and improving midwifery techniques.

PMID:38064601