Category: Nevin Manimala

Birth Defects Res. 2023 Jul 4. doi: 10.1002/bdr2.2217. Online ahead of print.

ABSTRACT

BACKGROUND: Silymarin is an antioxidant without side effects even at relatively high physiological dosage. Therefore, it is safely used as a herbal medicine for treating different diseases.

AIM OF WORK: The purpose of this study was to examine the toxicity of cadmium (Cd) in pregnant rats and their fetuses and the ameliorative effects of silymarin (SL) against this toxicity.

MATERIALS & METHODS: A total of 24 pregnant rats allocated into four equal groups. Control, silymarin (200 mg/kg), Cd (5 mg/kg), and a combination of Cd and silymarin concurrent from 6 to 20th gestational day. Number of corpora lutea, dams’, gravid uteri, placental weights, and likewise fetal body weights and lengths were analyzed as physical parameters. Serum levels of aspartate transaminase, alanine transaminase, creatinine, urea, uric acid, and maternal and fetal liver tissues for malondialdehyde, superoxide dismutase, catalase and glutathione activity were studied. The histology of hepatic and renal tissues for both mothers and fetuses was examined. Data were statistically analyzed by analysis of variance test and Duncan’s multiple range test was used to compare group means.

RESULTS: The findings evidenced that Cd causes teratogenic abnormalities and histopathological variation in hepatic and renal tissues of both mothers and fetuses. Cd triggers oxidative stress and disrupts liver and kidney function. In Cd + silymarin treated rats exhibited improvement in the pregnancy outcomes, reduced histopathological changes, oxidative stress as well as liver and kidney enzymes.

CONCLUSION: We deduced that using of silymarin during gestation is effective and ameliorate the toxic maternal complications caused by cadmium.

PMID:37401502 | DOI:10.1002/bdr2.2217

J Korean Med Sci. 2023 Jul 3;38(26):e203. doi: 10.3346/jkms.2023.38.e203.

ABSTRACT

BACKGROUND: Lead exposure is a known risk factor for cardiovascular disease (CVD), and coronary artery calcification (CAC) is a biomarker for diagnosing atherosclerotic CVD. This study investigated the association between blood lead level (BLL) and CAC using coronary computed tomography (CT) angiography.

METHODS: This study enrolled 2,189 participants from the general population with no history or symptoms of CVD. All participants underwent coronary CT angiography, health examination, and BLL testing. The association between coronary artery calcium score (CACS) and BLL was analyzed.

RESULTS: The arithmetic mean of BLL was 2.71 ± 1.26 μg/dL, and the geometric mean was 2.42 (1.64) μg/dL, ranging from 0.12 to 10.14 μg/dL. There was a statistically significant positive correlation between CACS and BLL (r = 0.073, P < 0.001). Mean BLLs among predefined CACS categories were as follows: absent grade (CACS = 0), 2.67 ± 1.23 μg/dL; minimal grade (> 0, < 10), 2.81 ± 1.25 μg/dL; mild grade (≥ 10, < 100), 2.74 ± 1.29 μg/dL; moderate grade (≥ 100, < 400), 2.88 ± 1.38 μg/dL; severe grade (≥ 400): 3.22 ± 1.68 μg/dL. The odds ratio for severe CAC was 1.242 in association with an 1 μg/dL increase in BLL (P = 0.042).

CONCLUSION: Using coronary CT angiography, we determined a positive correlation between BLL and CAC among participants without CVD from the general population. To reduce the burden of CVD, efforts and policies should be geared toward minimizing environmental lead exposure.

PMID:37401496 | DOI:10.3346/jkms.2023.38.e203

Res Psychother. 2023 Jul 4;26(2). doi: 10.4081/ripppo.2023.681.

ABSTRACT

Early access to evidence-based help is crucial for adolescents with anxiety disorders. Internet-delivered acceptance and commitment therapy (iACT) may offer adolescents increased access to care and more flexibility in engaging with treatment when and how they prefer. Process-based therapies, such as ACT, focus on theoretically derived and empirically tested key mechanisms in treatment that enable change. This study aimed to investigate the effectiveness of iACT for adolescents with anxiety disorders. The study also assessed the relationship between psychological flexibility and treatment outcomes and the relationship between participating adolescents’ and therapists’ perceived alliance and treatment outcomes. This was a randomized controlled trial comparing a 10-week intervention group with a wait-list control group. The 52 participants, aged 15 to 19, were recruited from all over Sweden. The treatment was effective in increasing quality of life and psychological flexibility, with moderate between-group effect sizes based on observed values. Changes in psychological flexibility was associated with changes in anxiety symptoms. The results further showed a statistically significant between-group difference in post-treatment diagnoses. No significant time per group interaction was found for anxiety symptoms, as both groups improved. Working alliance was rated as high by both participating adolescents and therapists but showed no significant relationship with treatment outcomes. Participants found the treatment an acceptable intervention. This study shows promising results for iACT in treating adolescents with anxiety disorders. The results suggest the model of psychological flexibility as an important process of change in treatment outcomes. Future research should validate these findings in larger samples and clinical contexts.

PMID:37401474 | DOI:10.4081/ripppo.2023.681

J Child Lang. 2023 Jul 4:1-11. doi: 10.1017/S0305000923000387. Online ahead of print.

ABSTRACT

We examined how noun frequency and the typicality of surrounding linguistic context contribute to children’s real-time comprehension. Monolingual English-learning toddlers viewed pairs of pictures while hearing sentences with typical or atypical sentence frames (Look at the… vs. Examine the…), followed by nouns that were higher- or lower-frequency labels for a referent (horse vs. pony). Toddlers showed no significant differences in comprehension of nouns in typical and atypical sentence frames. However, they were less accurate in recognizing lower-frequency nouns, particularly among toddlers with smaller vocabularies. We conclude that toddlers can recognize nouns in diverse sentence contexts, but their representations develop gradually.

PMID:37401467 | DOI:10.1017/S0305000923000387

Heart Surg Forum. 2023 Jun 25;26(3):E284-E291. doi: 10.1532/hsf.5445.

ABSTRACT

BACKGROUND: Sutureless aortic valve replacement (SU-AVR) and transcatheter aortic valve implantation (TAVI) are becoming increasingly common. The aim of this study is to compare the clinical outcome and cost-effectiveness of the two methods.

METHODS: In this study, cross-sectional retrospective data were collected on 327 patients who underwent SU-AVR (n = 168) and TAVI (n = 159). Homogeneous groups were provided by the “propensity score matching” method, and 61 patients from the SU-AVR group and 53 patients from the TAVI group were included in the study sample.

RESULTS: The two groups did not have statistically different death rates, complications after surgery, lengths of hospital stays, or visits to the intensive care unit. It is stated that the SU-AVR method provides an additional 1.14 Quality-Adjusted Life Year (QALY) compared to the TAVI method. The TAVI was more expensive than the SU-AVR in our study, but the difference was not statistically significant ($40,520.62 vs. $38,405.62, p > 0.05). For SU-AVR, the most expensive factor was the length of stay in the intensive care unit; for TAVI, it was arrhythmia, bleeding, and renal failure.

CONCLUSIONS: These bioprostheses are safe and effective treatments for valve stenosis. Clinical outcomes were similar between the two groups. Therefore, clinicians may find it difficult to determine an effective treatment strategy. According to the evaluation made in terms of cost-effectiveness, it was found that the SU-AVR method gave a higher QALY at a lower cost compared to the TAVI method. However, this result is not statistically significant.

PMID:37401432 | DOI:10.1532/hsf.5445

Heart Surg Forum. 2023 May 31;26(3):E234-E239. doi: 10.1532/hsf.5465.

ABSTRACT

BACKGROUND: In general, cerebral blood flow accounts for 10-15% of cardiac output (CO), of which about 75% is delivered through the carotid arteries. Hence, if carotid blood flow (CBF) is constantly proportional to CO with high reproducibility and reliability, it would be of great value to measure CBF as an alternative to CO. The aim of this study was to investigate the direct correlation between CBF and CO. We hypothesized that measurement of CBF could be a good substitute for CO, even under more extreme hemodynamic conditions, for a wider range of critically ill patients.

METHODS: Patients aged 65-80 years, undergoing elective cardiac surgery were included in this study. CBF in different cardiac cycles were measured by ultrasound: systolic carotid blood flow (SCF), diastolic carotid blood flow (DCF), and total (systolic and diastolic) carotid blood flow (TCF). CO simultaneously was measured by transesophageal echocardiography.

RESULTS: For all patients, the correlation coefficients between SCF and CO, TCF and CO were 0.45 and 0.30, respectively, which were statistically significant, but not between DCF and CO. There was no significant correlation between either SCF, TCF or DCF and CO, when CO was <3.5 L/min.

CONCLUSIONS: Systolic carotid blood flow may be used as a better index to replace CO. However, the method of direct measurement of CO is essential when the patient’s heart function is poor.

PMID:37401430 | DOI:10.1532/hsf.5465

Heart Surg Forum. 2023 Jun 29;26(3):E292-E302. doi: 10.59958/hsf.5607.

ABSTRACT

Emboli caused by cardiac myxomas mostly occur in the cardiovascular or cerebrovascular systems and rarely in the lower extremity vasculature. We introduce the rare case of a patient with left atrial myxoma (LAM) whose right lower extremity (RLE) suffered from acute ischemia due to tumor fragments, along with a review of the relevant literature, and highlight the clinical characteristics of LAM. An 81-year-old female presented with acute ischemia of RLE. Color Doppler ultrasound showed no blood flow signal far from the RLE femoral artery. Computed tomography angiography showed an occlusion of the right common femoral artery. A transthoracic echocardiogram revealed a left atrial mass. Femoral artery embolectomy was performed under local anesthesia, followed by thoracotomy with tumor resection under general anesthesia on postoperative day seven. The tumor was pathologically confirmed as an atrial myxoma. A literature search of the PubMed database returned 58 cases of limb ischemia due to LAM, and the conclusions drawn from the statistical analysis were that emboli from LAM occurred most commonly in the aortoiliac and bilateral lower limb vasculature and were rarely associated with upper extremity and atrial fibrillation. Multisystem embolism is characteristic of cardiac myxoma. The removed embolus should be examined pathologically for signs of a cardiac myxoma. Lower-limb embolisms should be promptly diagnosed and treated to avoid osteofascial compartment syndrome.

PMID:37401427 | DOI:10.59958/hsf.5607

Heart Surg Forum. 2023 Jun 14;26(3):E249-E254. doi: 10.1532/hsf.5621.

ABSTRACT

BACKGROUND: Improving health related quality of life is an important goal of aortic valve replacement. Inadequate effective orifice area of prosthesis according to the patient’s body surface area may be associated with poor outcomes. In this study, we aimed to analyze impact of indexed effective orifice area (iEOA) on patients’ quality of life after aortic valve replacement.

METHODS: A total of 138 patients who underwent isolated aortic valve replacement were included to the study. Quality of life assessment was performed with EuroQol Group EQ-5D-5L questionnaire. Patients were divided into three groups based on iEOA (Group 1 had an iEOA of <0.65 cm2/m2 (19 patients), Group 2 had an iEOA between 0.65-0.85 cm2/m2 (71 patients), and Group 3 had an iEOA of >0.85 cm2/m2). Mean EQ-5D-5L scores were compared among the groups statistically.

RESULTS: Mean EQ-5D-5L scores were lower in Group 1 than in Groups 2 and 3 (Group 1: 0.72 ± 0.18, Group 2: 0.83 ± 0.20, and Group 3: 0.86 ± 0.9, p = 0.044 and p = 0.014). The EQ-5D-5L score was significantly lower in patients with a ≥20 mmHg transvalvular gradient than those with a <20 mmHg (0.74 ± 0.25 vs. 0.84 ± 0.18, p = 0.014).

CONCLUSIONS: Our results show that an iEOA <0.65 cm2/m2 is significantly associated with impaired postoperative health-related quality of life. Newer generation prostheses, transcatheter valve implantation, and root enlargement techniques should be kept in mind in preoperative planning.

PMID:37401426 | DOI:10.1532/hsf.5621

Cardiol J. 2023 Jul 4. doi: 10.5603/CJ.a2023.0045. Online ahead of print.

ABSTRACT

BACKGROUND: To investigate the influence of coronary calcification on the diagnostic performance of Murray law-based quantitative flow ratio (μQFR) in identifying hemodynamically significant coronary lesions referenced to fractional flow reserve (FFR).

METHODS: A total of 571 intermediate lesions from 534 consecutive patients (66.1 ± 10.0 years, 67.2% males) who underwent coronary angiography and simultaneous FFR measurement were included. Calcific deposits were graded by angiography as none or mild (spots), moderate (involving ≤ 50% of the reference vessel diameter), and severe (> 50%). Performance of μQFR to detect functional ischemia (FFR ≤ 0.80) was evaluated, including diagnostic parameters and areas under the receiver-operating curves (AUCs).

RESULTS: The discrimination of ischemia by μQFR was comparable between none/mild and moderate/severe calcification (AUC: 0.91 [95% confidence interval: 0.88-0.93] vs. 0.87 [95% confidence interval: 0.78-0.94]; p = 0.442). No statistically significant difference was observed for μQFR between the two categories in sensitivity (0.70 vs. 0.69, p = 0.861) and specificity (0.94 vs. 0.90, p = 0.192). Moreover, μQFR showed significantly higher AUCs than quantitative coronary angiographic diameter stenosis in both vessels with none/mild (0.91 vs. 0.78, p < 0.001) and moderate/severe calcification (0.87 vs. 0.69, p < 0.001). By multivariable analysis, there was no association between calcification and μQFR-FFR discordance (adjusted odds ratio: 1.529, 95% confidence interval: 0.788-2.968, p = 0.210) after adjustment for other confounding factors.

CONCLUSIONS: μQFR demonstrated robust and superior diagnostic performance for lesion-specific ischemia compared with angiography alone regardless of coronary calcification.

PMID:37401417 | DOI:10.5603/CJ.a2023.0045

Geospat Health. 2023 Jul 3;18(2). doi: 10.4081/gh.2023.1151.

ABSTRACT

Few studies have considered the impacts of sample size and sample ratio of presence and absence points on the results of random forest (RF) testing. We applied this technique for the prediction of the spatial distribution of snail habitats based on a total of 15,000 sample points (5,000 presence samples and 10,000 control points). RF models were built using seven different sample ratios (1:1, 1:2, 1:3, 1:4, 2:1, 3:1, and 4:1) and the optimal ratio was identified via the Area Under the Curve (AUC) statistic. The impact of sample size was compared by RF models under the optimal ratio and the optimal sample size. When the sample size was small, the sampling ratios of 1:1, 1:2 and 1:3 were significantly better than the sample ratios of 4:1 and 3:1 at all four levels of sample sizes (p<0.01) and there was no significant difference among the ratios of 1:1, 1:2 and 1:3 (p>0.05). The sample ratio of 1:2 appeared to be optimal for a relatively large sample size with the lowest quartile deviation. In addition, increasing the sample size produced a higher AUC and a smaller slope and the most suitable sample size found in this study was 2400 (AUC=0.96). This study provides a feasible idea to select an appropriate sample size and sample ratio for ecological niche modelling (ENM) and also provides a scientific basis for the selection of samples to accurately identify and predict snail habitat distributions.

PMID:37401413 | DOI:10.4081/gh.2023.1151