Category: Nevin Manimala

Knee Surg Sports Traumatol Arthrosc. 2023 Jul 2. doi: 10.1007/s00167-023-07499-5. Online ahead of print.

ABSTRACT

PURPOSE: Despite Total Knee Arthroplasty (TKA) being one of the most successful procedures for end stage arthritis, nearly 20% of patients undergoing this procedure remain dissatisfied. Various design options have been introduced to reduce this cohort of patients. One such option has been the introduction of the medial congruent (MC) polyethylene design. This study was undertaken to evaluate outcome measures and gait analysis in patients undergoing bilateral single stage TKA where the posterior cruciate ligament (PCL) was retained or excised in contralateral knees.

METHODS: 60 bilateral TKA’s were performed by a single surgeon using a MC design option from July to Sep 2021. The study lots included patients between the ages of 55 and 70 years with fixed varus deformity of degenerative aetiology, and Kellgren Lawrence Grade 3 and 4 radiological changes. Exclusion criteria were previous surgery to the lower extremities, sero positive arthropathies, post traumatic arthritis, valgus deformity, flexion contractures > 20°, and any pre-existing pathology impacting gait, e.g., poliomyelitis, or neuromuscular disorders. The PCL was retained or sacrificed on contralateral sides for the purpose of this study. Functional scores, outcomes and gait analysis on level and gradient walking were evaluated at a follow-up of 18 months.

RESULTS: At 18, months the Range of Motion (ROM) improved from a preoperative value of 97.3 ± 11.5 to 110.3 ± 6.1 on the PCL retained side (MC-PCL) and from 96.5 ± 10.8 to 113 ± 5.8 on the PCL excised side (MC-PCLX). Knee Society Score (KSS-2011) improved from a preoperative value of 21.2 ± 4.5 to 89.8 ± 3.4 at 18 months postoperatively on the MC-PCL side and from 21.5 ± 4 to 88.2 ± 3.7 on the MC-PCLX side. Forgotten Joint Score (FJS-12) was 8.8 ± 0.7 on the MC-PCL side and 8.1 ± 0.9 on the MC-PCLX side 18 months after surgery. Our gait analysis evaluation demonstrated a lower forefoot pressure in the MC-PCL group in comparison to the MC-PCLX group when subjects were made to walk on a 30° upward incline. This difference was found to be statistically significant.

CONCLUSION: In this study, while ROM was greater in the MC-PCLX study lot, patient satisfaction was higher in the MC-PCL study lot. Gait assessment demonstrated lower forefoot pressure while ascending an incline of 30° in the MC-PCL study lot as compared to the MC-PCLX study lot approximating normal gait patterns.

LEVEL OF EVIDENCE: II.

PMID:37393561 | DOI:10.1007/s00167-023-07499-5

Lasers Med Sci. 2023 Jul 2;38(1):153. doi: 10.1007/s10103-023-03776-4.

ABSTRACT

To evaluate the clinical efficacy of carbon dioxide laser in the treatment of female stress urinary incontinence and analyze the influencing factors. A total of 46 patients with stress urinary incontinence treated in the Affiliated Hospital of Nantong University from March 2021 to August 2022 were included through strict inclusion criteria and exclusion criteria. All patients were treated with transvaginal carbon dioxide laser therapy, and Patient Global Impression of Change (PGI-C) was used to evaluate patients’ subjective satisfaction after treatment. The efficacy was evaluated by patient’s subjective assessment of leakage, IngelmanSundberg scale, 1-h urine pad test, and international consultation on incontinence questionnaire short form (ICI-Q-SF) before and after treatment, and the adverse reactions after treatment were recorded. The treatment effect was divided into “significant effect group” and “no significant effect group” by subjective satisfaction and post-treatment-related scale evaluation. After laser treatment, patients’ subjective symptom improved, the volume of 1-h urine pad test was reduced, and the ICI-Q-SF score was decreased, and the differences were statistically significant (P < 0.05). There was no significant difference in IngelmanSundberg scale before and after treatment (P = 1.00). Multivariate logistic regression analysis showed that pad test volume was significantly correlated with treatment effect (P = 0.007). Transvaginal carbon dioxide laser is a safe and effective method for the treatment of mild to moderate stress urinary incontinence in females. The less severe the urinary leakage, the better the treatment effect.

PMID:37393550 | DOI:10.1007/s10103-023-03776-4

Br J Radiol. 2023 Jun 20:20200448. doi: 10.1259/bjr.20200448. Online ahead of print.

ABSTRACT

OBJECTIVE: The study explores the application value of three-dimensional arterial spin labeling magnetic resonance imaging (3D pCASL) in early assessment of radiation encephalopathy (REP) in patients with nasopharyngeal carcinoma (NPC).

METHODS: A retrospective analysis of 39 cases of NPC was performed. Routine enhanced MRI scan and 3D pCASL imaging were used to examine the apparent diffusion coefficient (ADC) and brain blood flow (CBF) before and after treatment with intensity-modulated radiotherapy (IMRT). Dosimetric analysis of irradiation was performed. Receiver operating characteristic curve (ROC) was used to analyze diagnostic performance of two imaging methods.

RESULTS: There was no statistically significant difference between the two methods for the measurement of temporal white matter ADC, but statistically significant difference was found in CBF. 3D pCASL imaging showed more sensitivity, specificity and higher accuracy than conventional MRI enhanced scan in showing REP. The maximum dose of the temporal lobe was at the enhanced area.

CONCLUSION: The present study demonstrates that 3D pCASL scan at month 3 can reflect blood flow perfusion differences in NPC patients after IMRT and can accurately assess the possibility of REP at early stage. Enhanced areas have a higher probability of REP than the surrounding areas.

ADVANCES IN KNOWLEDGE: There is few magnetic resonance angiography studies used to evaluate arterial circulation on its application on potential REP after radiotherapy for NPC. In our study, we evaluate the application value of 3D pCASL in the early assessment of potential REP in patients with NPC after radiotherapy. The study was to provide an improved understanding of the early specific characteristics on MRI imaging and evolution of potential radiation encephalopathy using 3D pCASL technique, which can quantitatively evaluate the changes of blood flow in tissues at early stage and help to diagnose and treat potential radiation encephalopathy as early as possible.

PMID:37393533 | DOI:10.1259/bjr.20200448

J Alzheimers Dis. 2023 Jun 24. doi: 10.3233/JAD-230322. Online ahead of print.

ABSTRACT

BACKGROUND: The longevity gene Klotho (KL) was recently associated with neurodegenerative diseases including Alzheimer’s disease (AD). Its role in the brain has not been completely elucidated, although evidence suggests that KL-VS heterozygosity is associated with a reduced risk of AD in Apolipoprotein E ɛ4 carriers. Conversely, no data about genetic association with frontotemporal dementia (FTD) are available so far.

OBJECTIVE: To investigate the involvement of KL in AD and FTD by the determination of the genetic frequency of KL-VS variant and the expression analysis of KL gene.

METHODS: A population consisting of 438 patients and 240 age-matched controls was enrolled for the study. KL-VS and APOE genotypes were assessed by allelic discrimination through a QuantStudio 12K system. KL gene expression analysis was performed in a restricted cohort of patients consisting of 43 AD patients, 41 FTD patients and 19 controls. KL gene expression was assessed in peripheral blood mononuclear cells with specific TaqMan assay. Statistical analysis was performed using GraphPad 9 Prims software.

RESULTS: KL-VS frequency was comparable to the ones found in literature and no differences were found in both allelic and genotypic frequencies between patients and controls were found. Conversely, KL expression levels were significantly lower in AD and FTD patients compared with controls (mean fold regulation – 4.286 and – 6.561 versus controls in AD and FTD, respectively, p = 0.0037).

CONCLUSION: This is the first study investigating KL in FTD. We showed a decreased expression of the gene in AD and FTD, independent of the genotype, suggesting a role of Klotho in common steps during neurodegeneration.

PMID:37393504 | DOI:10.3233/JAD-230322

J Alzheimers Dis. 2023 Jun 26. doi: 10.3233/JAD-230266. Online ahead of print.

ABSTRACT

BACKGROUND: Fear of falling (FoF) is a condition associated with falls, multi-morbidity, and functional impairment. To date it remains unknow which clinical, somatic, socio-demographic, behavioral, and emotional factors are associated with FoF and how these factors interact in people with Alzheimer’s disease (AD) and behavioral variant frontotemporal dementia (bvFTD).

OBJECTIVE: Identify the association of FoF with clinical, socio-demographic, and neuropsychiatric factors in patients with AD and bvFTD.

METHODS: We evaluated 98 participants, 58 with AD and 40 with bvFTD at mild or moderate stages and assess FoF using the Falls Efficacy Scale-International. Additionally, we analyzed cognitive, physical performance variables, functional impairment, and affective and behavioral symptoms associated with FoF using standardized scales and a regression model analysis.

RESULTS: The prevalence of FoF in AD and bvFTD was 51% and 40%, respectively. In the AD group, physical performance [F (3, 53) = 4.318, p = 0.009], the behavioral symptoms model [F (19, 38) = 3.314, p = 0.001], and the anxiety model [F (1, 56) = 13.4, p≤0.01] showed statistically significant values. In addition, the presence of hallucinations assessed with the Neuropsychiatric Inventory and social behavior assessed with the Mild Behavioral Impairment Checklist were significant. In contrast, in the bvFTD group, a homologous group of models was evaluated but we did not find any significant results.

CONCLUSION: FoF in people with AD was related to physical performance, neuropsychiatric symptoms such as apathy and hallucinations, and affective symptoms such as anxiety. However, this pattern was not seen in the bvFTD group, and therefore further studies are required.

PMID:37393502 | DOI:10.3233/JAD-230266

J Alzheimers Dis. 2023 Jun 30. doi: 10.3233/JAD-230128. Online ahead of print.

ABSTRACT

BACKGROUND: Most previous studies supported that the mammalian target of rapamycin (mTOR) is over-activated in Alzheimer’s disease (AD) and exacerbates the development of AD. It is unclear whether the causal associations between the mTOR signaling-related protein and the risk for AD exist.

OBJECTIVE: This study aims to investigate the causal effects of the mTOR signaling targets on AD.

METHODS: We explored whether the risk of AD varied with genetically predicted AKT, RP-S6K, EIF4E-BP, eIF4E, eIF4A, and eIF4 G circulating levels using a two-sample Mendelian randomization analysis. The summary data for targets of the mTOR signaling were acquired from published genome-wide association studies for the INTERVAL study. Genetic associations with AD were retrieved from the International Genomics of Alzheimer’s Project. We utilized the inverse variance weighted as the primary approach to calculate the effect estimates.

RESULTS: The elevated levels of AKT (OR = 0.910, 95% CI=0.840-0.986, p = 0.02) and RP-S6K (OR = 0.910, 95% CI=0.840-0.986, p = 0.02) may decrease the AD risk. In contrast, the elevated eIF4E levels (OR = 1.805, 95% CI=1.002-1.174, p = 0.045) may genetically increase the AD risk. No statistical significance was identified for levels of EIF4-BP, eIF4A, and eIF4 G with AD risk (p > 0.05).

CONCLUSION: There was a causal relationship between the mTOR signaling and the risk for AD. Activating AKT and RP-S6K, or inhibiting eIF4E may be potentially beneficial to the prevention and treatment of AD.

PMID:37393500 | DOI:10.3233/JAD-230128

J Alzheimers Dis. 2023 Jun 27. doi: 10.3233/JAD-230039. Online ahead of print.

ABSTRACT

BACKGROUND: DNA methylation (DNAm), an epigenetic mark reflecting both inherited and environmental influences, has shown promise for Alzheimer’s disease (AD) prediction.

OBJECTIVE: Testing long-term predictive ability (>15 years) of existing DNAm-based epigenetic age acceleration (EAA) measures and identifying novel early blood-based DNAm AD-prediction biomarkers.

METHODS: EAA measures calculated from Illumina EPIC data from blood were tested with linear mixed-effects models (LMMs) in a longitudinal case-control sample (50 late-onset AD cases; 51 matched controls) with prospective data up to 16 years before clinical onset, and post-onset follow-up. Novel DNAm biomarkers were generated with epigenome-wide LMMs, and Sparse Partial Least Squares Discriminant Analysis applied at pre- (10-16 years), and post-AD-onset time-points.

RESULTS: EAA did not differentiate cases from controls during the follow-up time (p > 0.05). Three new DNA biomarkers showed in-sample predictive ability on average 8 years pre-onset, after adjustment for age, sex, and white blood cell proportions (ps: 0.022-<0.00001). Our longitudinally-derived panel replicated nominally (p = 0.012) in an external cohort (n = 146 cases, 324 controls). However, its effect size and discriminatory accuracy were limited compared to APOEɛ4-carriership (OR = 1.38 per 1 SD DNAm score increase versus OR = 13.58 for ɛ4-allele carriage; AUCs = 77.2% versus 87.0%). Literature review showed low overlap (n = 4) across 3275 AD-associated CpGs from 8 published studies, and no overlap with our identified CpGs.

PMID:37393498 | DOI:10.3233/JAD-230039

J Alzheimers Dis. 2023 Jun 27. doi: 10.3233/JAD-221210. Online ahead of print.

ABSTRACT

BACKGROUND: Race/ethnicity is associated with differences in reproductive history and cognition individually, yet it remains an understudied factor in the relationship between parity and later-life cognition.

OBJECTIVE: To evaluate if the association between parity and cognition differs between racial/ethnic groups.

METHODS: Participants included 778 older, postmenopausal women from the Health and Nutrition Examination Survey (Latina: n = 178, Non-Latino Black [NLB]: n = 169, Non-Latino White [NLW]: n = 431) who self-reported at least one birth. Cognitive outcomes included working memory, learning memory, and verbal fluency. Covariates included age, education, cardiovascular and other reproductive health factors, adult socioeconomic status (SES) and depressive symptoms. We fit a series of linear models to examine a) whether parity was associated with cognitive functioning, b) if this association varied by race/ethnicity through parity by race/ethnicity interactions, and c) individual parity with cognition associations stratified by race/ethnicity.

RESULTS: In the full sample, parity was significantly negatively associated with Digit Symbol Substitution Test (DSST) performance (b = -0.70, p = 0.024) but not Animal Fluency or word-list learning and memory. Tests of race/ethnicity-by-parity interactions were not statistically significant (ps > 0.05). However, stratified analyses by race/ethnicity showed a differential effect of parity on DSST performance, such that parity was significantly negatively associated with DSST performance (b = -1.66, p = 0.007) among Latinas but not in NLWs (b = -0.16, p = 0.74) or NLBs (b = -0.81, p = 0.191).

CONCLUSION: Among Latina, but not NLB or NLW women, greater parity was associated with worse processing speed/executive functioning later in life. Further research is needed to understand the mechanisms driving racial/ethnic differences.

PMID:37393496 | DOI:10.3233/JAD-221210

Work. 2023 Jun 24. doi: 10.3233/WOR-230022. Online ahead of print.

ABSTRACT

BACKGROUND: Adaption to clinical work during the internship can induce several stressors among medical students, especially in the context of the coronavirus disease 2019 (COVID-19) pandemic. Particularly, job stress could be linked to the development of psychological traits and the formation of the professional identity of medical interns.

OBJECTIVE: This study aimed to explore the relationship between job stress, psychological capital, and professional identity through a mediation analysis of Chinese medical interns.

METHODS: A descriptive cross-sectional study was conducted in 30 hospitals and clinics in China from June 2021 to March 2022. A total of 665 medical interns filled out questionnaires related to demographic questions, psychological capital, job stress, and professional identity. Data analysis was executed using the IBM SPSS version 22.0 software and its add-in PROCESS Windows version 4.0.

RESULTS: The findings indicated a statistically significant mediating effect of psychological capital between job stress and professional identity. Job stress and job stress combined with psychological capital accounted for 5.3% and 37.9%, respectively, of the variance in professional identity. The bootstrapping method corroborated the significance of the indirect effect of job stress through psychological capital (95% bootstrap CI = -4.7921, -2.4345).

CONCLUSION: The current findings underscore the need for increased attention on improving the psychological capital of medical interns.

PMID:37393480 | DOI:10.3233/WOR-230022

Work. 2023 Jun 24. doi: 10.3233/WOR-230015. Online ahead of print.

ABSTRACT

BACKGROUND: Internet addiction and physical inactivity are often a major public health problem.

OBJECTIVE: This study aimed to determine the relationship between internet addiction (IA) and physical activity (PA) levels of university students in a province in eastern Turkey.

METHODS: This cross-sectional study was conducted among 638 students. Internet Addiction Test (IAT), and International Physical Activity Questionnaire (IPAQ) were administered. Chi-square, independent sample t-test, correlation analysis, one-way analysis of variance tests (ANOVA), Tukey HSD test, multivariate logistic regression analysis were performed.

RESULTS: 64.6% of the participants were female, with a mean age of 20.4±2.4 and a mean body mass index (BMI) of 22.3±3.5. 83.4% of the participants were identified as those asymptomatic, 15.2% showed limited symptoms, and 1.4% were pathological internet users according to IAT. A statistically significant difference was found between IAT scores and gender, mother’s education level, father’s education level, academic success, smoking status, and alcohol use (p < 0.05). According to IPAQ scores, 28.1% of the students were inactive, 56.3% were moderate PA and 15.7% had vigorous PA levels. IPAQ total scores of male participants, smokers, and participants with exercise habits were found to be significantly higher (p < 0.05). The mean score IAT and IPAQ was found to be 30.9±18.9 and 1697.7±1847.0. A negative, significant correlation was found between students’ PA and IA levels (p < 0.01).

CONCLUSION: It has been observed that IA negatively affects PA. Seminars, conferences, and panels on the internet and physical activity should be organized for university students.

PMID:37393479 | DOI:10.3233/WOR-230015