Category: Nevin Manimala

Int J Surg. 2023 May 11. doi: 10.1097/JS9.0000000000000446. Online ahead of print.

ABSTRACT

OBJECTIVES: Hepatocellular carcinoma (HCC) is a common indication for hepatectomy that is often complicated by postoperative complication. We sought to investigate the relationship between open with laparoscopic approach of hepatectomy and incidences of postoperative infectious complications.

METHODS: Using a multicenter database, HCC patients who underwent laparoscopic hepatectomy (LH) or open hepatectomy (OH) were reviewed and analyzed. Propensity score matching (PSM), inverse probability of treatment weight (IPTW), and multivariate logistic regression analyses were utilized to assess the association of operative approach with postoperative infectious complications including incisional surgical site infection (SSI), organ/space SSI, and remote infection (RI).

RESULTS: Among 3,876 patients, 845 (21.8%) and 3,031 (78.2%) patients underwent LH and OH, respectively. The overall incidence of infection was 6.9% versus 14.6% among patients who underwent LH versus OH, respectively (P<0.001). Of note, the incidences of incisional SSI (1.8% vs. 6.3%, P<0.001), organ/space SSI (1.8% vs. 4.6%, P<0.001), and RI (3.8% vs. 9.8%, P<0.001) were all significantly lower among patients who underwent LH versus OH. After PSM (6.9%, 1.8%, 1.8% and 3.8% vs. 18.5%, 8.4%, 5.2% and 12.8%, respectively) and IPTW (9.5%, 2.3%, 2.1% and 5.5% vs. 14.3%, 6.3%, 4.5% and 9.8%, respectively), LH remained associated with statistically lower incidences of all types of infectious complications. After adjustment for other confounding factors on multivariate analyses, LH remained independently associated with lower incidences of overall infection, incisional SSI, organ/space SSI, and RI in the overall, PSM, and IPTW cohorts, respectively.

CONCLUSION: Compared with open approach, laparoscopic approach was independently associated with lower incidences of postoperative infectious complications following hepatectomy for HCC.

PMID:37161522 | DOI:10.1097/JS9.0000000000000446

Turk J Pharm Sci. 2023 May 9;20(2):100-107. doi: 10.4274/tjps.galenos.2022.50887.

ABSTRACT

OBJECTIVES: Aim of the current study was to evaluate the stress-protective effect of oligopeptides-homologues of the adrenocorticotropic hormone (ACTH) fragment 15-18 on morphogenetic signs of stress reaction of the adrenal glands under acute cold exposure (CE) in rats.

MATERIALS AND METHODS: The acute cold stress was reproduced by placing random-bred male rats in a freezer at a temperature of -18°C for 2 hours. The peptides-homologous of ACTH_15-18 acetyl-(D-Lys)-Lys-Arg-Arg-amide (KK-1) and acetyl-(D-Lys)-Lys-(D-Arg)-Arg-amide (KK-5) and the reference medicine (Sema) were administered intranasally in a dose of 20 mg/kg 30 minutes before and after CE. Rectal temperature was measured before and 10 min after CE. Zona glomeruloza, zona fasciculata, zona reticularis, and the area of cells and nuclei of adrenocorticocytes of the zona fasciculata were measured.

RESULTS: KK-1 significantly prevented structural changes in the adrenal cortex and medulla and stabilized the secretory activity of glucocorticoid-producing cells. However, the congestion of the capillaries of the zona fasciculata and zona reticularis remained in some locations. Zona fasciculata cells had a marked tendency to decrease, and the area of nuclei significantly decreased (p<0.05) recovering the width to control animals’ markers. KK-5 had a more marked recovery of the adrenal glands (a greater saturation of cytoplasm of adrenocorticocytes of zona glomerulosa and zona fasciculata). The number of chromaffin cells at rest was increased in the adrenal medulla. KK-5 statistically significantly normalized both the area of cells (p<0.05) and the area of nuclei (p<0.05) of the zona fasciculata, unlike KK-1, which reliably restored only the marker of the nuclei area. Some morphometric parameters of acute stress hypertrophy remained in the adrenal glands of rats receiving Sema.

CONCLUSION: KK-1 and KK-5 prevented the manifestation of acute stress reactions in the adrenal cortex of rats. KK-5 had a more marked stress-protective effect compared with the peptide KK-1. Both study substances exceeded the reference medicine Sema. KK-5 is a promising stres-sprotector and frigoprotector.

PMID:37161509 | DOI:10.4274/tjps.galenos.2022.50887

AIDS Res Ther. 2023 May 9;20(1):26. doi: 10.1186/s12981-023-00519-x.

ABSTRACT

BACKGROUND: Prolonged exposure to HIV and anti-retroviral therapy (ART) has been linked with endothelial cell activation which subsequently predisposes people living with HIV (PLWH) to cardiovascular diseases. Serum biomarkers of endothelial cell activation such as E-Selectin and endothelial cell-specific molecule-1 (ESM-1) could aid in early detection of PLWH at a risk of cardiovascular diseases. However, there is a paucity of data on these biomarkers like E-selectin and endothelial cell-specific molecule-1 (ESM-1) among PLWH on long term ART (≥ 10 years) in Uganda. The aim of this study is to determine the serum levels of these biomarkers in this population.

METHODS: This was a cross-sectional study where we randomly sampled 73 stored serum samples of PLWH who were enrolled in the Infectious Diseases Institute (IDI) ART long term (ALT cohort). We measured serum levels of E-selectin and ESM-1 by ELISA. Data was summarized using median and interquartile range. Inferential statistics were performed to determine predictors of elevated levels of E-selectin.

RESULTS: Of the 73 samples analyzed, 38 (52.1%) were from female participants. The mean age was 54 ± 9.0 years. Twenty participants (27.4%) had a history of smoking while 52 (71.2%) had a history of alcohol intake. Twenty-five (34.3%) of the participants were overweight whereas 4 (5.6%) were obese. Fifty-four (74%) had an undetectable viral load (≤ 0 copies/ml) and the mean duration of ART at the time of sampling (2014/2015) was 10.4 ± 0.4 years. While serum levels of ESM-1 were not detectable in any of our samples, the median E-selectin levels was 147.6 μm/L ranging from 8.44 μm/L and 1,979.36 μm/L. Sixty-seven participants (91.8%) had elevated levels of E-selectin (> 39 μm/L). CD4 count > 500 cells/µl compared to lower counts was a predictor of elevated levels of E-Selectin (adjusted Odd Ratio 12.5, 95% CI (1.03 – 149.95, p < 0.05).

CONCLUSIONS: The majority (91.8%) of PLWH on long term ART had elevated levels of E-selectin. Having high CD4 count (> 500 cells/µl) was predictive of elevated levels of E-Selectin. Future work should longitudinally assess the trend of levels of E-selectin and ESM-1 while assessing for cardiovascular diseases endpoint.

PMID:37161496 | DOI:10.1186/s12981-023-00519-x

AIDS Res Ther. 2023 May 9;20(1):27. doi: 10.1186/s12981-023-00517-z.

ABSTRACT

BACKGROUND: COVID-19 has not only taken a staggering toll in terms of cases and lives lost, but also in its psychosocial effects. We assessed the psychosocial impacts of the COVID-19 pandemic in a large cohort of people with HIV (PWH) in Washington DC and evaluated the association of various demographic and clinical characteristics with psychosocial impacts.

METHODS: From October 2020 to December 2021, DC Cohort participants were invited to complete a survey capturing psychosocial outcomes influenced by the COVID-19 pandemic. Some demographic variables were also collected in the survey, and survey results were matched to additional demographic data and laboratory data from the DC Cohort database. Data analyses included descriptive statistics and multivariable logistic regression models to evaluate the association between demographic and clinical characteristics and psychosocial impacts, assessed individually and in overarching categories (financial/employment, mental health, decreased social connection, and substance use).

RESULTS: Of 891 participants, the median age was 46 years old, 65% were male, and 76% were of non-Hispanic Black race/ethnicity. The most commonly reported psychosocial impact categories were mental health (78% of sample) and financial/employment (56% of sample). In our sample, older age was protective against all adverse psychosocial impacts. Additionally, those who were more educated reported fewer financial impacts but more mental health impacts, decreased social connection, and increased substance use. Males reported increased substance use compared with females.

CONCLUSIONS: The COVID-19 pandemic has had substantial psychosocial impacts on PWH, and resiliency may have helped shield older adults from some of these effects. As the pandemic continues, measures to aid groups vulnerable to these psychosocial impacts are critical to help ensure continued success towards healthy living with HIV.

PMID:37161481 | DOI:10.1186/s12981-023-00517-z

Biom J. 2023 May 9:e2200183. doi: 10.1002/bimj.202200183. Online ahead of print.

ABSTRACT

Classical power analysis for sample size determination is typically performed in clinical trials. A “hybrid” classical Bayesian or a “fully Bayesian” approach can be alternatively used in order to add flexibility to the design assumptions needed at the planning stage of the study and to explicitly incorporate prior information in the procedure. In this paper, we exploit and compare these approaches to obtain the optimal sample size of a single-arm trial based on Poisson data. We adopt exact methods to establish the rejection of the null hypothesis within a frequentist or a Bayesian perspective and suggest the use of a conservative criterion for sample size determination that accounts for the not strictly monotonic behavior of the power function in the presence of discrete data. A Shiny web app in R has been developed to provide a user-friendly interface to easily compute the optimal sample size according to the proposed criteria and to assure the reproducibility of the results.

PMID:37160700 | DOI:10.1002/bimj.202200183

Biom J. 2023 May 9:e2100373. doi: 10.1002/bimj.202100373. Online ahead of print.

ABSTRACT

Feature screening is a useful and popular tool to detect informative predictors for ultrahigh-dimensional data before developing statistical analysis or constructing statistical models. While a large body of feature screening procedures has been developed, most methods are restricted to examine either continuous or discrete responses. Moreover, even though many model-free feature screening methods have been proposed, additional assumptions are imposed in those methods to ensure their theoretical results. To address those difficulties and provide simple implementation, in this paper we extend the rank-based coefficient of correlation to develop a feature screening procedure. We show that this new screening criterion is able to deal with continuous and binary responses. Theoretically, the sure screening property is established to justify the proposed method. Simulation studies demonstrate that the predictors with nonlinear and oscillatory trajectories are successfully retained regardless of the distribution of the response. Finally, the proposed method is implemented to analyze two microarray datasets.

PMID:37160692 | DOI:10.1002/bimj.202100373

Can J Neurol Sci. 2023 Jun;50(s1):s17-s25. doi: 10.1017/cjn.2023.18. Epub 2023 May 10.

ABSTRACT

Geographic, social, political, and economic factors shape access to advanced neurotechnologies, yet little previous research has explored the barriers, enablers, and areas of opportunity for equitable and meaningful access for diverse patient communities across Canada. We applied a mixed-mode approach involving semi-structured interviews and rating scale questions to consult with 24 medical experts who are involved in the care of patients who undergo functional neurosurgery targeting the brain. Seven major themes emerged from the qualitative analysis: Health care system, Neurotechnology features, Patient demographics, Target condition features, Ethics, Upstream barriers and enablers, and Areas of opportunity. Descriptive statistics of the Likert-scale responses suggest that interviewees perceive a disparity between the imperative of access to advanced neurotechnologies for people living in rural and remote areas and the likelihood of achieving such access. The results depict a complex picture of access to functional neurosurgery in Canada with pockets of excellence and a motivation to improve the availability of care for vulnerable populations through the expansion of distributed care models, improved health care system efficiencies, increasing funding and support for patient travel, and increasing awareness about and advocacy for advanced neurotechnologies.

PMID:37160675 | DOI:10.1017/cjn.2023.18

J Dent Educ. 2023 May 9. doi: 10.1002/jdd.13233. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this study was to develop and evaluate the effect of a manual dexterity training program on manual dexterity, perception of self-confidence, quality of cavity preparations, and ergonomic work posture of dental students prior to preclinical training.

METHODS: Students in the first year of the undergraduate dentistry program (N = 63) participated in this study. The program consisted of eight phases in which students performed different types of activities. The dependent variables were: manual dexterity assessed by the modified Dental Manual Dexterity Assessment; self-confidence to perform a preclinical procedure using the VAS scale; quality of Class I cavity preparation; angular deviation from the neutral position of the neck, trunk, wrist and distance between the student’s eyes and the mannequin’s tooth. These variables were evaluated at two different times: before and after the application of the program. The independent variable was the preclinical manual dexterity training program. After meeting the assumption of normality, the paired t-Student test was performed, the significance level was 5%.

RESULTS: The results showed a statistically significant difference in relation to manual dexterity (p < 0.001), self-confidence (p < 0.001), quality of cavity preparations (p < 0.001), distance from the eyes of the student/mannequin (p < 0.001), deviation angle of the neutral position of the trunk (p = 0.007) and wrists (p < 0.001), with better results in posttraining.

CONCLUSION: It was possible to conclude that, in general, the proposed training positively influenced the self-confidence, dexterity, quality of work, and ergonomics of the evaluated students.

PMID:37160672 | DOI:10.1002/jdd.13233

Int Orthop. 2023 May 9. doi: 10.1007/s00264-023-05835-5. Online ahead of print.

ABSTRACT

PURPOSE: The modified anterolateral approach (Röttinger) for total hip arthroplasty (THA) offers great advantages over conventional approaches, especially concerning early postoperative symptoms, which are mild and well tolerated by patients. Robotic-assisted implantation might facilitate rapid adoption of the modified anterolateral approach without exposing surgeons to risks encountered during the learning curve. This study posits that the use of robotic assistance in conjunction with the modified anterolateral approach for total hip arthroplasty (THA) can provide a substantial enhancement in the accuracy of cup placement in comparison to manual surgery.

METHODS: Thirty-two robotic-assisted THAs met the inclusion criteria and were matched to 32 conventional cases. Acetabular cup inclination, anteversion, limb-length discrepancy, and acetabular offset were assessed using certified planning software by two independent observers using pre- and postoperative anterior-posterior radiographs. Data was analyzed for normal distribution. Chi² test was used to determine whether implanted acetabular cups that were within Lewinnek’s safe zones were influenced by type of implantation. Effect size estimates and statistical power analysis were also performed to appreciate the appropriateness of the chosen sample size.

RESULTS: Robotic-assisted implantation was found to significantly improve acetabular cup placement in terms of inclination (p < 0.001) but not anteversion (p = 0.783). Although mean postoperative limb-length discrepancy and mean acetabular offset did not differ between groups, a significantly smaller variance was found in the robotic-assisted group (p < 0.001) and (p = 0.04), respectively. There were no significant differences between the two groups in terms of consistently implanting the acetabular cup within the Lewinnek safe zones p = 0.641 for anteversion and p = 0.230 for inclination, respectively.

CONCLUSIONS: Our results show that although robotic-assisted acetabular cup implantation performed through the modified anterolateral approach did not significantly differ from conventional implantation, it did offer increased accuracy in cup positioning, acetabular bone preservation, and limb-length restoration.

PMID:37160646 | DOI:10.1007/s00264-023-05835-5

Trop Anim Health Prod. 2023 May 9;55(3):197. doi: 10.1007/s11250-023-03609-0.

ABSTRACT

This pilot study used an alternative and economically efficient technique, the Kompetitive Allele-Specific Polymerase Chain Reaction (KASP-PCR) to examine 48 SNPs from 11 parasite-resistance genes found on 8 chromosomes in 110 animals from five sheep breeds reared in Hungary; Hungarian Tsigai, White Dorper, Dorper, Ile de France, and Hungarian Merino. Allele and genotype frequencies, fixation index, observed heterozygosity, expected heterozygosity, F statistic, and their relationship with the Hardy-Weinberg equilibrium (WHE) and the polymorphic information content (PIC) were determined, followed by principal component analysis (PCA). As much as 32 SNPs out of the 48 initially studied were successfully genotyped. A total of 9 SNPs, 4 SNPs in TLR5, 1 SNP in TLR8, and 4 SNPs in TLR2 genes, were polymorphic. The variable genotype and allele frequency of the TLRs gene indicated genetic variability among the studied sheep breeds, with the Hungarian Merino exhibiting the most polymorphisms, while Dorper was the population with the most SNPs departing from the HWE. According to the PIC value, the rs430457884-TLR2, rs55631273-TLR2, and rs416833129-TLR5 were found to be informative in detecting polymorphisms among individuals within the populations, whereas the rs429546187-TLR5 and rs424975389-TLR5 were found to have a significant influence in clustering the population studied. This study reported a moderate level of genetic variability and that a low to moderate within-breed diversity was maintained in the studied populations.

PMID:37160635 | DOI:10.1007/s11250-023-03609-0