Category: Nevin Manimala

Stroke. 2023 Jul 13. doi: 10.1161/STROKEAHA.123.043285. Online ahead of print.

ABSTRACT

BACKGROUND: Patient-specific factors associated with successful recanalization in mechanical thrombectomy (MT) have been evaluated for acute ischemic stroke with large vessel occlusion. However, MT for M2 occlusions is still a matter of debate, and predictors of successful and futile recanalization have not been assessed in detail. We sought to identify predictors of recanalization success in patients with M2 occlusions undergoing MT based on large-scale clinical data.

METHODS: All patients prospectively enrolled in the German Stroke Registry (May, 2015 to December, 2021) were screened (N=13 082). Inclusion criteria for the complete case analysis were isolated M2 occlusions. Standard descriptive statistics and multivariable logistic regression analysis were used to identify factors associated with successful recanalization (Thrombolysis in Cerebral Infarction [TICI]≥2b), complete recanalization (TICI=3) and futile recanalization (TICI≥2b with 90-day modified Rankin Scale [mRS] score >2).

RESULTS: One thousand two hundred ninety-four patients were included, thereof 439 (33.9%) with TICI=2b and 643 (49.7%) with TICI=3. Five hundred sixty-nine (44%) patients had good functional outcome (90-day mRS score ≤2). In multivariable logistic regression, general anesthesia (adjusted odds ratio [aOR], 1.47 [95% CI, 1.05-2.09]; P<0.05) was associated with higher probability of TICI≥2b while intraprocedural change from local to general anesthesia (aOR, 0.49 [0.26-0.95]; P<0.05) and higher pre-mRS (aOR, 0.75 [0.67-0.85]; P<0.001) lowered probability of successful recanalization. Futile recanalization was associated with higher age (aOR, 1.05 [1.04-1.07]; P<0.001), higher prestroke mRS (aOR, 3.12 [2.49-3.91]; P<0.001), higher NIHSS at admission (aOR, 1.11 [1.08-1.14]; P<0.001), diabetes (aOR, 1.96 [1.38-2.8]; P<0.001), higher number of passes (aOR, 1.29 [1.14-1.46]; P<0.001), and adverse events (aOR, 1.82 [1.2-2.74]; P<0.01). Higher Alberta Stroke Program Early CT Score (aOR, 0.85 [0.76-0.94]; P<0.01) and IV thrombolysis (aOR, 0.71 [0.52-0.97]; P<0.05) reduced risk of futile recanalization.

CONCLUSIONS: In patients with M2 occlusions, successful recanalization was significantly associated with general anesthesia and low prestroke mRS, while intraprocedural change from conscious sedation to general anesthesia increased risk of unsuccessful recanalization, presumably caused by difficult anatomy and movement of patients in these cases. Futile recanalization was associated with severe prestroke mRS, comorbidity diabetes, number of passes and adverse events during treatment. IV thrombolysis reduced the risk of futile recanalization.

PMID:37439204 | DOI:10.1161/STROKEAHA.123.043285

Am J Physiol Renal Physiol. 2023 Jul 13. doi: 10.1152/ajprenal.00083.2023. Online ahead of print.

ABSTRACT

The objective of this study was to determine if treatment with N-acetylcysteine (NAC) could reduce access-related limb dysfunction in mice. Male and female C57BL6J mice were fed an adenine supplemented diet to induce chronic kidney disease prior to surgical creation of an arteriovenous fistula (AVF) in the iliac vascular bundle. AVF creation significantly increased peak aortic and infrarenal vena cava blood flow velocities, but NAC treatment had no significant impact indicating that fistula maturation was not impacted by NAC treatment. Hindlimb muscle and paw perfusion recovery and muscle capillary density in the AVF limb were unaffected by NAC treatment. However, NAC treatment significantly increased the mass of the tibialis anterior (P=0.0120) and soleus (P=0.0452) muscles post-AVF. There was a significant main effect of NAC treatment on hindlimb grip strength at post-operative day (POD) 12 (P=0.0003), driven by significantly higher grip strength in both male (P=0.0273) and female (P=0.0031) mice treated with NAC. There was also a significant main effect of NAC treatment on walking speed at POD12 (P=0.0447), and post-hoc testing revealed improvement in NAC male mice (P=0.0091). The area of post-synaptic acetylcholine receptors (P=0.0263) and motor endplates (P=0.0240) were also increased by NAC treatment. Interestingly, hindlimb skeletal muscle mitochondrial oxidative phosphorylation was trending higher in NAC female mice but was not statistically significant (P=0.0973). Muscle glutathione levels and redox status were not significantly impacted by NAC treatment in either sex. In summary, NAC treatment attenuated some aspects of neuromotor pathology in mice with chronic kidney disease following AVF creation.

PMID:37439200 | DOI:10.1152/ajprenal.00083.2023

Nan Fang Yi Ke Da Xue Xue Bao. 2023 Jun 20;43(6):964-969. doi: 10.12122/j.issn.1673-4254.2023.06.11.

ABSTRACT

OBJECTIVE: To investigate whether gut microbiota disturbance after cardiopulmonary bypass (CPB) contributes to the development of perioperative neurocognitive disorders (PND).

METHODS: Fecal samples were collected from healthy individuals and patients with PND after CPB to prepare suspensions of fecal bacteria, which were transplanted into the colorectum of two groups of pseudo-germ-free adult male SD rats (group NP and group P, respectively), with the rats without transplantation as the control group (n=10). The feces of the rats were collected for macrogenomic sequencing analysis, and serum levels of IL-1β, IL-6 and TNF-α were measured with ELISA. The expression levels of GFAP and p-Tau protein in the hippocampus of the rats were detected using Western blotting, and the cognitive function changes of the rats were assessed with Morris water maze test.

RESULTS: In all the 3 groups, macrogenomic sequencing analysis showed clustering and clear partitions of the gut microbiota after the transplantation. The relative abundances of Klebsiella in the control group (P < 0.005), Akkermansia in group P (P < 0.005) and Bacteroides in group NP (P < 0.005) were significantly increased after the transplantation. Compared with those in the control group, the rats in group NP and group P showed significantly decreased serum levels of IL-1β, IL-6 and TNF-α and lowered expression levels of GFAP and p-Tau proteins (all P < 0.05). Escape platform crossings and swimming duration in the interest quadrant increased significantly in group NP (P < 0.05), but the increase was not statistically significant in group N. Compared with those in group P, the rats in group NP had significantly lower serum levels of IL-1β, IL-6 and TNF-α and protein expressions of GFAP and p-Tau (all P < 0.05) with better performance in water maze test (P < 0.05).

CONCLUSION: In patients receiving CPB, disturbances in gut mirobiota contributes to the development of PND possibly in relation with inflammatory response.

PMID:37439168 | DOI:10.12122/j.issn.1673-4254.2023.06.11

Clin Adv Periodontics. 2023 Jul 13. doi: 10.1002/cap.10259. Online ahead of print.

ABSTRACT

BACKGROUND: A biological seal that protects the implant from any biological or external impingement is created by the supracrestal attached tissues. Sohn’s poncho technique is a technique that utilizes a healing abutment at the implant site to stabilize the Platelet Rich Fibrin membrane. Thus, the aim of this study is to evaluate the efficacy of Sohn’s poncho technique used for placement of leukocyte platelet rich fibrin (L-PRF) membrane in improving the peri-implant mucosal thickness and width of keratinized mucosa as well as in the acceleration of healing process compared to the peri-implant mucosa surrounding healing abutments placed without the L-PRF membrane.

MATERIALS AND METHODS: A split mouth randomized controlled clinical trial was designed in which implants were placed in the mandibular posterior region. Healing abutment is placed along with the L-PRF membrane at the test site using Sohn’s poncho technique and at control site conventional healing abutment placement was done at second stage. The thickness of peri-implant mucosa as primary outcome and the Width of keratinized tissue and healing as secondary outcomes were measured and assessed at various time intervals.

RESULTS: Statistically significant difference was seen in inter-group analysis when peri-implant mucosal thickness (3.8mm ± 0.4 vs 2.3mm ± 0.4) and width of keratinized mucosa (3.6mm ± 0.6 vs 2.7mm ± 0.3) in test and control groups respectively and intra-group analysis of test and control groups at 4 weeks and 6 weeks’ time points. The control group showed faster healing when compared to the test group.

CONCLUSION: Sohn’s poncho technique in combination with L-PRF has the potential to improve the thickness of peri-implant mucosa and the width of keratinized mucosa around implants. This article is protected by copyright. All rights reserved.

PMID:37439152 | DOI:10.1002/cap.10259

Vox Sang. 2023 Jul 13. doi: 10.1111/vox.13495. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Room temperature-stored platelets (RTPs) maximize platelet viability but limit shelf life. The aims of this study were to investigate the impact of donor variability on cold-stored platelets (CSPs) and RTP, to determine whether RTP quality markers are appropriate for CSP.

MATERIALS AND METHODS: Double platelet donations (n = 10) were collected from consented regular male donors stored in 100% plasma. A full blood count, donor age, weight, height and body mass index (BMI) were collected at the time of donation. Platelet donations were split equally into two bags, and assigned to non-agitated CSP or agitated RTP. The quality and function of platelets were assessed throughout the standard 7 days of storage and at expiry (day 8). Non-parametric statistical analyses were used to analyse results given the small sample size.

RESULTS: As expected, there were significant differences between CSP and RTP throughout storage including a reduction in CSP concentration as well as a loss of swirling. Furthermore, a significant increase in CSP exhibiting activation and apoptotic markers was observed. Platelet concentrations were further impacted by donor BMI, and donors with the highest BMI (>29) had the lowest platelet concentration and activation response at the end of CSP storage.

CONCLUSION: Platelet quality and functionality play a vital role in transfusion outcomes; however, blood components are inherently variable. This study demonstrated, for the first time, the specific impact of donor BMI on CSP quality and function and highlights the requirement for novel quality markers for assessing CSPs.

PMID:37439150 | DOI:10.1111/vox.13495

J Psychosom Obstet Gynaecol. 2023 Dec;44(1):2229010. doi: 10.1080/0167482X.2023.2229010.

ABSTRACT

This pilot study investigated the feasibility of postpartum Eye Movement Desensitization and Reprocessing (EMDR) for improving posttraumatic stress disorder (PTSD) symptoms, and its association with work absence, relationship difficulties, and development of psychiatric disorders in women with a traumatic childbirth experience who do not meet all criteria for PTSD. A randomized controlled study was conducted among 20 women (EMDR (N=11) vs. care as usual (CAU) (N=9)) who reported a traumatic birth. Outcomes were measured by questionnaires and a semi-structured interview. The results showed improvement of trauma-related psychological complaints for all women. EMDR appears to be more effective in reducing PTSD symptoms than CAU. Moreover, EMDR showed a small positive effect on work absence due to factors related to the traumatic childbirth experience. Results from the questionnaires were substantiated by interviews. However, due to the small size of the study, no statistically significant differences were found. In addition, no differences were found for relationship difficulties and development of psychiatric disorders. In conclusion, women with a traumatic birth experience may benefit from EMDR, even if they do not qualify for a diagnosis of PTSD. This study could be a starting point for future research aimed at early treatment that reduces trauma-related psychological complaints in postpartum women.

PMID:37439144 | DOI:10.1080/0167482X.2023.2229010

Environ Sci Technol. 2023 Jul 13. doi: 10.1021/acs.est.3c02965. Online ahead of print.

ABSTRACT

Whether perfluoroalkyl sulfonates (PFSAs) and perfluoroalkyl carboxylates (PFCAs) are responding to legislative restrictions and showing decreasing trends in top marine predators that range across the eastern North Pacific Ocean is unclear. Here, we examined longer-term temporal trends (1973-2019) of 4 PFSAs and 13 PFCAs, as well stable isotopes of δ¹³C and δ¹⁵N, in the eggs of 4 seabird species sampled along a nearshore-offshore gradient; double-crested cormorants (Nannopterum auritum), pelagic cormorants (Urile pelagicus), rhinoceros auklets (Cerorhinca monocerata), and Leach’s storm-petrels (Hydrobates leucorhous) from the Pacific coast of British Columbia, Canada. PFOS was the most abundant PFSA (79-94%) detected in all eggs regardless of colony and year, with the highest concentrations, on average, measured in auklet eggs (mean = 58 ng g^-1, range = 11-286 ng g^-1 ww). Perfluoroundecanoic acid (PFUdA) and perfluorotridecanoic acid (PFTriDA) were the dominant long-chain PFCAs (≥30% combined). The majority of PFSAs (including PFOS) are statistically declining (p < 0.001) in the eggs of all 4 species with PFOS half-lives ranging from 2.6 to 7.8 years. Concentrations of long-chain PFCAs exhibited a trajectory comprised of linear increases and second-order declines, suggesting that the rate of uptake of PFCAs is slowing or leveling off. These trends are consistent with the voluntarily ceased production of PFSAs by 3M circa 2000-2003 and are among the first from the northeast Pacific to indicate a positive response to several regulations and restrictions on PFCAs from facility emissions and product content.

PMID:37439143 | DOI:10.1021/acs.est.3c02965

Clin Exp Emerg Med. 2023 Jul 13. doi: 10.15441/ceem.23.022. Online ahead of print.

ABSTRACT

OBJECTIVE: Agriculture is one of the most hazardous industries. However, previous studies have mainly focused on injuries in agricultural workers and have not compared with injuries in non-agricultural workers. Thus, we aimed to compare the clinical characteristics and outcomes of injuries in agricultural workers compared to non-agricultural workers reported at the emergency department(ED).

METHODS: We established a prospective ED-based agricultural injury surveillance system at a tertiary university hospital. The adult injured patients visiting ED were divided into farmer and non-farmer groups depending on the agricultural engagement. Using adjusted multivariate analysis and propensity score matching(age, gender, inhabitant, and insurance type), we compared the clinical characteristics and outcomes of injuries among farmer vs. non-farmer group.

RESULTS: 38,556 adult injured patients(37,746 in non-farmer group and 810 in farmer group) were available for unmatched sample analysis. The 1,620 matched subjects were equally classified after 1-to-1 nearest neighbor propensity score matching. Multivariate logistic regression analysis of the unmatched sample revealed higher adjusted ORs for intensive care unit admission(adjusted OR: 1.752, p=0.003) and overall surgery(adjusted OR: 1.870, p<0.001) for farmers. In contrast, a univariate logistic regression analysis of the propensity score-matched sample found only a higher OR of overall surgery(OR: 1.786, p<0.001) in the farmer group.

CONCLUSIONS: Injuries in agricultural workers only had higher odds of overall surgery, while the differences in mortality were not statistically significant in both the matched and unmatched sample analyses.

PMID:37439139 | DOI:10.15441/ceem.23.022

J Cachexia Sarcopenia Muscle. 2023 Jul 13. doi: 10.1002/jcsm.13280. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic kidney disease (CKD) induces muscle wasting and a reduction in the maximum voluntary force (MVF). Little is known about the neuromuscular fatigability in CKD patients, defined as the reduction of muscle force capacities during exercise. Neuromuscular fatigability is a crucial physical parameter of the daily living. The quantification of explosive force has been shown to be a sensitive means to assess neuromuscular fatigability. Thus, our study used explosive force estimates to assess neuromuscular fatigability in elderly CKD patients.

METHODS: Inclusion criteria for CKD patients were age ≥ 60 years old and glomerular filtration rate (GFR) < 45 mL/min/1.73 m² not on dialysis, and those for controls were GFR > 60 mL/min/1.73 m² , age and diabetes matched. The fatigability protocol focused on a handgrip task coupled with surface electromyography (sEMG). Scalars were extracted from the rate of force development (RFD): absolute and normalized time periods (50, 75, 100, 150 and 200 ms, RFD₅₀ , RFD₇₅ , RFD₁₀₀ , RFD₁₅₀ and RFD₂₀₀ , respectively), peak RFD (RFD_peak in absolute; NRFD_peak normalized), time-to-peak RFD (t-RFD_peak ) and the relative force at RFD_peak (MVF-RFD_peak ). A statistical parametric mapping approach was performed on the force, impulse and RFD-time curves. The integrated sEMG with time at 0-30, 0-50, 0-100 and 0-200 ms time intervals relative to onset of sEMG activity was extracted and groups were compared separately for each sex.

RESULTS: The cohort of 159 individuals had a median age of 69 (9_IQR ) years and body mass index was 27.6 (6.2_IQR ) kg/m² . Propensity-score-matched groups balanced CKD patients and controls by gender with 66 males and 34 females. In scalar analysis, CKD patients manifested a higher decrement than controls in the early phase of contraction, regarding the NRFD_peak (P = 0.009; η² _p = 0.034) and RFD₇₅ and RFD₁₀₀ (for both P < 0.001; η² _p = 0.068 and 0.064). The one-dimensional analysis confirmed that CKD males manifest higher and delayed neuromuscular fatigability, especially before 100 ms from onset of contraction. sEMG was lower in CKD patients than controls in the 0-100 ms (at rest: P = 0.049, Cohen’s d = 0.458) and 0-200 ms (at rest: P = 0.016, Cohen’s d = 0.496; during exercise: P = 0.006, Cohen’s d = 0.421) time windows. Controls showed greater decrease of sEMG than CKD patients in the 0-30 ms (P = 0.020, Cohen’s d = 0.533) and 0-50 ms (P = 0.010, Cohen’s d = 0.640) time windows. As opposite to females, males showed almost the same differences between groups.

CONCLUSIONS: Our study is the first to show that CKD patients have higher fatigability than controls, which may be associated with an impaired motor-unit recruitment, highlighting a neural drive disturbance with CKD. Further studies are needed to confirm these findings.

PMID:37439126 | DOI:10.1002/jcsm.13280

Clin Linguist Phon. 2023 Jul 13:1-21. doi: 10.1080/02699206.2023.2232517. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this preliminary study was to compare the effects of variations in task demands on: (a) language productivity in sentences categorised into stuttered vs. non-stuttered sentences; (b) syntactic complexity in stuttered vs. non-stuttered sentence categories, and (c) stuttering and typical disfluencies in school-age children who stutter (CWS). Language Sample Analysis (LSA) was conducted on samples from three tasks – Conversation, fable retell, and critical thinking based on the fables.

METHODS: Participants were 14 CWS categorised into younger (9 to 12-year-olds, n = 8) and older age groups (13 to 15-year-olds, n = 6). The Computerized Language ANalysis program was used to conduct language and disfluency analyses. Repeated measures analysis of variance and nonparametric statistical analyses were used to investigate: (a) Language productivity in total number of words and sentences by task and sentence category; (b) Syntactic complexity at the word- (use of metacognitive verbs), phrase- (use of verb phrases), and utterance (Mean Length of Utterances in words, MLUw) levels by task and sentence category; and (c) Disfluencies measured using % stuttered syllables (%SS) and % typical disfluencies (%TD).

RESULTS AND CONCLUSIONS: Task effects in language productivity did not differ by sentence category and suggested limited influences of propositionality and volubility in stuttering. In contrast, higher syntactic complexity was obtained in the stuttered compared to non-stuttered sentences at the word, phrase, and utterance levels and it was the same task – conversation, that elicited the effect. Additionally, variations in task demands did not result in significant differences in %SS. The findings inform assessment planning with the selection of tasks guided by task demands and assessment requirements.

PMID:37439119 | DOI:10.1080/02699206.2023.2232517