Category: Nevin Manimala

J Neurosurg Pediatr. 2023 Mar 17:1-9. doi: 10.3171/2023.1.PEDS22341. Online ahead of print.

ABSTRACT

OBJECTIVE: Programmable valves have gained increasing popularity in the complex treatment of pediatric hydrocephalus. Over the last decade, adjustable serial valves have gradually replaced fixed-pressure valves in the authors’ department. The present study investigates this development by analyzing shunt- and valve-related outcomes for this vulnerable population.

METHODS: A retrospective analysis of all shunting procedures between January 2009 and January 2021 in children younger than 1 year of age was performed at the authors’ single-center institution. Postoperative complications and surgical revisions were set as outcome parameters. Shunt and valve survival rates were evaluated. Statistical analysis compared children who underwent implantation of the Miethke proGAV/proSA programmable serial valves with those who underwent implantation of the fixed-pressure Miethke paediGAV system.

RESULTS: Eighty-five procedures were evaluated. The paediGAV system was implanted in 39 cases and the proGAV/proSA in 46 cases. The mean ± SD follow-up was 247.7 ± 140 weeks. In 2009 and 2010, paediGAV valves were used exclusively, but by 2019, the use of proGAV/proSA had evolved into the first-line therapy. The paediGAV system was significantly more often revised (p < 0.05). The main indication for revision was proximal occlusion, with or without impairment to the valve. The valve and shunt survival rates of proGAV/proSA were significantly prolonged (p < 0.05). The surgery-free valve survival of proGAV/proSA was 90% after 1 year and 63% after 6 years. There were no overdrainage-related revisions of proGAV/proSA valves.

CONCLUSIONS: Favorable shunt and valve survival validates the increasing use of programmable proGAV/proSA serial valves in this delicate population. Potential benefits in postoperative treatment should be addressed in prospective multicenter studies.

PMID:36933264 | DOI:10.3171/2023.1.PEDS22341

J Neurosurg Pediatr. 2023 Mar 17:1-6. doi: 10.3171/2023.2.PEDS22569. Online ahead of print.

ABSTRACT

OBJECTIVE: Hemispherectomy is a complex surgical intervention for medically refractory epilepsy, and its surgical sequelae continue to be defined. The incidence, timing, and predictors of postoperative hydrocephalus are not well understood. Correspondingly, the aim of this study was to define the natural history of the development of hydrocephalus after hemispherectomy based on the authors’ institutional experience.

METHODS: The authors performed a retrospective review of their departmental database for all relevant cases between 1988 and 2018. Demographic and clinical results were abstracted and analyzed using regression analyses to identify predictors of postoperative hydrocephalus.

RESULTS: Of the 114 patients who satisfied selection criteria, there were 53 females (46%) and 61 males (53%) with mean ages of 2.2 and 6.5 years at first seizure and at hemispherectomy, respectively. There were 16 patients (14%) with a history of previous seizure surgery. In terms of surgery, the mean estimated blood loss was 441 ml, with a mean operative time of 7 hours, and 81 patients (71%) required intraoperative transfusions. A planned postoperative external ventricular drain (EVD) was placed in 38 patients (33%). The most common procedural complications were infection and hematoma, occurring in 7 patients (6%) each. Overall, there were 13 patients (11%) with postoperative hydrocephalus requiring permanent CSF diversion, occurring at a median of 1 year (range 0.1-5 years) after surgery. On multivariable analysis, a postoperative EVD (OR 0.12, p < 0.01) was significantly associated with a decreased likelihood of postoperative hydrocephalus, whereas previous surgery history (OR 4.32, p = 0.03) and postoperative infection complication (OR 5.14, p = 0.04) were significantly associated with increased likelihood of postoperative hydrocephalus.

CONCLUSIONS: Postoperative hydrocephalus mandating permanent CSF diversion following hemispherectomy can be expected in approximately 1 in 10 cases, presenting months after surgery on average. A postoperative EVD appears to reduce this likelihood, whereas postoperative infection and previous history of seizure surgery were shown to statistically increase this likelihood. These parameters should be carefully considered in the management of pediatric hemispherectomy for medically refractory epilepsy.

PMID:36933263 | DOI:10.3171/2023.2.PEDS22569

J Neurosurg Spine. 2023 Mar 17:1-8. doi: 10.3171/2023.2.SPINE221071. Online ahead of print.

ABSTRACT

OBJECTIVE: Bertolotti syndrome is a clinical diagnosis given to patients with low-back pain arising from a lumbosacral transitional vertebra (LSTV). While biomechanical studies have demonstrated abnormal torques and range of motion occurring at and above this type of LSTV, the long-term effects of these biomechanical changes on the LSTV adjacent segments are not well understood. This study examined degenerative changes at segments superjacent to the LSTV in patients with Bertolotti syndrome.

METHODS: This study involved a retrospective comparison of patients between 2010 and 2020 with an LSTV and chronic back pain (Bertolotti syndrome) and control patients with chronic back pain with no LSTV. The presence of an LSTV was confirmed on imaging, and the caudal-most mobile segment above the LSTV was assessed for degenerative changes. Degenerative changes were assessed by grading the intervertebral disc, facets, degree of spinal stenosis, and spondylolisthesis using well documented grading systems. All computations were performed in R, version 4.1.0. All tests were two-sided, and p values < 0.05 was considered statistically significant. Separate logistic regression analyses were run with the associated dependent variables for each aim, with age at MRI and sex included as covariates. Odds ratios and 95% confidence intervals were computed.

RESULTS: A total of 172 patients were included, 101 with Bertolotti syndrome and 71 controls. Control patients consisted of patients with low-back pain but no diagnosis of Bertolotti syndrome or an LSTV. Fifty-six Bertolotti (55.4%) and 27 control (38.0%) patients were female, (p = 0.03). After adjusting for age at MRI and sex, Bertolotti patients had pelvic incidence (PI) that was 9.83° greater than control patients (95% CI 5.15°-14.50°, p < 0.001). Sacral slope was not significantly different between the Bertolotti and control groups (beta estimate 3.10°, 95% CI -1.07° to 7.27°; p = 0.14). Bertolotti patients had 2.69 times higher odds of having a high disc grade at L4-5 (3-4 vs 0-2), compared with control patients (OR 2.69, 95% CI 1.28-5.90; p = 0.01). There were no significant differences between Bertolotti patients and controls for spondylolisthesis, facet grade, or spinal stenosis grade.

CONCLUSIONS: Patients with Bertolotti syndrome had a significantly higher PI and were more likely to have adjacent-segment disease (ASD; L4-5) compared with control patients. However, after controlling for age and sex, PI and ASD did not appear to have a significant association within the cohort of Bertolotti patients. The altered biomechanics and kinematics in this condition may be a causative factor in this degeneration, although proof of causation is not possible in this study. This association may warrant closer follow-up protocols for patients being treated for Bertolotti syndrome, but further prospective studies are needed to establish if radiographic parameters can serve as an indicator for biomechanical alterations in vivo.

PMID:36933261 | DOI:10.3171/2023.2.SPINE221071

J Neurosurg. 2023 Mar 17:1-11. doi: 10.3171/2023.1.JNS222269. Online ahead of print.

ABSTRACT

OBJECTIVE: Characterizing changes in the geographic distribution of neurosurgeons in the United States (US) may inform efforts to provide a more equitable distribution of neurosurgical care. Herein, the authors performed a comprehensive analysis of the geographic movement and distribution of the neurosurgical workforce.

METHODS: A list containing all board-certified neurosurgeons practicing in the US in 2019 was obtained from the American Association of Neurological Surgeons membership database. Chi-square analysis and a post hoc comparison with Bonferroni correction were performed to assess differences in demographics and geographic movement throughout neurosurgeon careers. Three multinomial logistic regression models were performed to further evaluate relationships among training location, current practice location, neurosurgeon characteristics, and academic productivity.

RESULTS: The study cohort included 4075 (3830 male, 245 female) neurosurgeons practicing in the US. Seven hundred eighty-one neurosurgeons practice in the Northeast, 810 in the Midwest, 1562 in the South, 906 in the West, and 16 in a US territory. States with the lowest density of neurosurgeons included Vermont and Rhode Island in the Northeast; Arkansas, Hawaii, and Wyoming in the West; North Dakota in the Midwest; and Delaware in the South. Overall, the effect size, as measured by Cramér’s V statistic, between training stage and training region is relatively modest at 0.27 (1.0 is complete dependence); this finding was reflected in the similarly modest pseudo R2 values of the multinomial logit models, which ranged from 0.197 to 0.246. Multinomial logistic regression with L1 regularization revealed significant associations between current practice region and residency region, medical school region, age, academic status, sex, or race (p < 0.05). On subanalysis of the academic neurosurgeons, the region of residency training correlated with an advanced degree type in the overall neurosurgeon cohort, with more neurosurgeons than expected holding Doctor of Medicine and Doctor of Philosophy degrees in the West (p = 0.021).

CONCLUSIONS: Female neurosurgeons were less likely to practice in the South, and neurosurgeons in the South and West had reduced odds of holding academic rather than private positions. The Northeast was the most likely region to contain neurosurgeons who had completed their training in the same locality, particularly among academic neurosurgeons who did their residency in the Northeast.

PMID:36933250 | DOI:10.3171/2023.1.JNS222269

Altern Ther Health Med. 2023 Mar 20:AT7999. Online ahead of print.

ABSTRACT

CONTEXT: Chronic renal failure (CRF) is the outcome of the continuous progression of various chronic kidney diseases. Effective treatment of a wide range of diseases may require decreasing patients’ negative emotions and enhancing their disease resilience. Narrative care focuses on patients’ inner awareness, feelings, and experience of a disease, stimulating positive energy in the face of it.

OBJECTIVE: The study intended to investigate the effects of using narrative care during high flux hemodialysis (HFHD) on clinical outcomes and prognosis of quality of life (QoL) for patients with chronic renal failure (CRF), to provide a reliable theoretical reference for future clinical treatment.

DESIGN: The research team performed a randomized controlled trial.

SETTING: The study took place at the Blood Purification Center at the Affiliated Hospital of Medical School at Ningbo University in Ningbo, Zhejiang, China.

PARTICIPANTS: Participants were 78 patients with CRF who received treat with HFHD at the hospital between January 2021 and August 2022.

INTERVENTION: The research team divided participants into two groups using the random number table method, with 39 participants in each group: (1) and intervention group who received narrative nursing care and (2) a control group who receive the usual care.

OUTCOME MEASURES: The research team: (1) evaluated the clinical efficacy for both groups; (2) at baseline and postintervention, measured participants’ blood creatinine (SCr) and blood urea nitrogen (BUN) using blood sampling; (3) counted adverse effects; (4) investigated participants’ nursing satisfaction postintervention; (5) at baseline and postintervention, assessed psychology and QoL using the Self-Assessment Scale for Anxiety (SAS), the Self-Assessment Scale for Depression (SDS), and the General Quality of Life Inventory (GQOLI-74) scale.

RESULTS: No statistically significant differences existed between the groups in terms of efficacy or renal function postintervention (P > .05). The incidence of adverse reactions was significantly lower in the intervention group than in the control group postintervention (P = .033), and the group’s nursing satisfaction was significantly higher (P = .042). In addition, participants’ SAS and SDS scores decreased significantly in the intervention group postintervention (P < .05), while no change occurred for the control group (P > .05). Finally, the GQOLI-74 scores were all significantly higher in the intervention group than in the control group.

CONCLUSIONS: Narrative care can effectively enhance the safety of HFHD treatment in CRF patients and reduce patients’ negative emotions postintervention, which is important for improving their QoL.

PMID:36933248

Altern Ther Health Med. 2023 Mar 20:AT7962. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the influence of long non-coding ribonucleic acid (lncRNA) small nucleolar RNA host gene 6 (SNHG6) on proliferation and apoptosis of non-small cell lung cancer (NSCLC) cells and to provide a theoretical basis for the clinical treatment of NSCLC.

METHODS: This study included 25 samples of NSCLC and 20 normal tissues as the experimental group. Fluorescence quantitative reverse transcription-polymerase chain reaction (qRT-PCR) was used to detect lncRNA SNHG6 and p21. The relationship between lncRNA SNHG6 and p21 in NSCLC tissues was analyzed statistically. Colony formation assay and flow cytometry were used to determine the cell cycle distribution and cell apoptosis. Methyl thiazolyl tetrazolium (MTT) assay was used to determine cell proliferation, and Western blotting (WB) was used to measure the protein expression of p21.

RESULTS: The expression level of SNHG6 [(1.98 ± 0.23) vs. (4.46 ± 0.52)] (P < .01) was significantly higher, but p21 expression [(1.02 ± 0.23) vs. (0.33 ± 0.15)] (P < .01) was lower in the 25 cases of NSCLC tissues than in the control group. The expression of SNHG6 was negatively correlated with p21 (r2 = 0.2173, P = .0188). Transfection of SNHG6 small interfering RNA (siRNA) (si-SNHG6) in HCC827 and H1975 cells significantly reduced the level of SNHG6. The viability of BEAS-2B cells transfected with pcDNA-SNHG6 had a more robust proliferative and colony-forming capacity than normal cells (P < .01). Up-regulation of SNHG6 promoted the formation of the malignant phenotype and proliferative capacity of BEAS-2B cells. Proliferation, colony-forming capacity, and G1 phase of the cell cycle in HCC827 and H1975 cells were significantly repressed via influencing the apoptosis and p21 expression after the knockdown of SNHG6 (P < .01).

CONCLUSION: Silencing lncRNA SNHG6 represses the proliferation and facilitates the apoptosis of NSCLC cells through regulating p21.

PMID:36933244

Altern Ther Health Med. 2023 Mar 20:AT7813. Online ahead of print.

ABSTRACT

This study aims to analyze the correlation between the persistence and recurrence of stroke in young patients via big data in healthcare. It provides an in-depth introduction to the background of big data in healthcare and a detailed description of stroke symptoms, so as to better apply the Apriori parallelization algorithm based on compression matrix (PBCM) algorithm against the background of big data in healthcare to analyze it. In our study, patients were randomly divided into 2 groups. By observing the different persistent relationships in the groups, the factors affecting the patients’ fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), blood pressure (BP), blood lipids, alcohol consumption, smoking and so on were analyzed. The National Institute of Health Stroke Scale (NIHSS) score, FBG, HbA1c, triglycerides (TG), high-density lipoprotein (HDL), body mass index (BMI), length of hospital stay, gender and high BP, diabetes, heart disease, smoking and other factors affect the recurrence rate of stroke as they all affect the brain, although they are all statistically different (P < .05). The recurrence of stroke requires more attention in the treatment of stroke.

PMID:36933243

Attach Hum Dev. 2023 Mar 18:1-11. doi: 10.1080/14616734.2023.2187851. Online ahead of print.

ABSTRACT

Intergenerational transmission of attachment is one of the core hypotheses of attachment theory. How parents or other caregivers look back on their childhood attachment experiences is suggested to shape their infants’ attachments. In the current paper, we show that a new twist to correspondence analysis (Canonical Correlation Analysis [CCA]) of cross-tabulated attachment classifications with oblique rotation Correspondence Analysis (CA) may uncover the latent structure of intergenerational transmission showing the unique role of parental Unresolved representations in predicting infant Disorganized attachments. Our model of intergenerational transmission of attachment supports predicted associations between parental and infant attachments. Despite growing skepticism about the validity of parental Unresolved trauma and infant Disorganized attachment, we come to an evidence-based statistical defense of these generative clinical components of attachment theory awaiting a substantive experimentum crucis.

PMID:36933237 | DOI:10.1080/14616734.2023.2187851

J Am Vet Med Assoc. 2023 Mar 17:1-8. doi: 10.2460/javma.22.09.0419. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of this prospective study was to investigate the prevalence and severity of radiographic abnormalities of the interspinous spaces (ISSs) in the thoracolumbar vertebral column of unbroken yearlings and to compare these findings with a group of older trained Thoroughbred horses without perceived back pain.

ANIMALS: Yearlings (n = 47) and trained horses (55); 102 total.

PROCEDURES: Each horse underwent a digital radiographic study of the thoracolumbar vertebral column (T7-L3) and each space graded for narrowing of the ISSs, increased opacity, radiolucency, and modeling of the cranial and caudal margins of 2 contiguous dorsal spinous processes (DSPs). This generated both an individual anatomical space score for each space and a total score for each horse for subsequent comparison. Statistical analysis of the results was then undertaken.

RESULTS: Narrowing and impingement were detected in a third of the examined ISSs, while DSP increased opacity, radiolucencies, and modeling were found in over half of the yearlings. The median total score per horse was 33 (0 to 96) in the yearlings and 30 (0 to 101) in trained horses, indicating no significant difference in radiographic abnormalities (P = .91). Likewise, the median total score per anatomical space was 112 (25 to 259) and 127.5 (24 to 284) in the yearlings and trained horses (P = .83). No differences were found between the groups for number of radiographic abnormalities, scores, and total score.

CLINICAL RELEVANCE: This study reported the incidence of DSP radiographic abnormalities in Thoroughbred horses. The absence of difference in occurrence between yearlings and older horses supported a developmental rather than acquired etiology.

PMID:36933209 | DOI:10.2460/javma.22.09.0419

Eur Arch Paediatr Dent. 2023 Mar 18. doi: 10.1007/s40368-023-00793-3. Online ahead of print.

ABSTRACT

PURPOSE: To compare pain perception associated with two computer-controlled local anesthesia devices, the WAND™ STA (Milestone Scientific Inc., Livingston, NJ, USA) and the Calaject (Rønvig dental MFG, Daugaard, Denmark) in young children.

METHODS: A split-mouth randomized clinical trial comprising 30 patients, aged 6-12 years, received randomly, in two separate sessions, a local anesthesia injection in the maxillary using either the wand STA or the Calaject. Pain perception was evaluated using the patient’s heart rate, an 11-point numerical scale (NRS), and the Sound, Eye, and Motor (SEM) body movements. Statistical difference was set at p = 0.05. Repeated measures analysis of variance were conducted to compare the mean pulse for Calaject and STA at different times. It was followed by univariate analysis and Bonferroni multiple comparisons tests. Wilcoxon tests were performed to compare NRS, SEM, and injection duration between Calaject and STA.

RESULTS: There was no significant statistical difference between Calaject and STA in pulse rate before injection (p = 0.720), during injection (p = 0.767), and after injection (p = 0.757). The mean NRS score was significantly greater with STA in comparison with Calaject (p = 0.017). The mean SEM score was also significantly greater with STA in comparison with Calaject (p = 0.002). However, the mean duration was significantly longer with Calaject (p = 0.001).

CONCLUSIONS: Calaject was more effective than STA in reducing pain perception associated with periapical injection in young children.

PMID:36933183 | DOI:10.1007/s40368-023-00793-3