Category: Nevin Manimala

Environ Monit Assess. 2022 Nov 29;195(1):165. doi: 10.1007/s10661-022-10731-3.

ABSTRACT

The Gushegu Municipality and the East Mamprusi District in Ghana are dominated by the Oti/Pendjari Group within the Voltaian Supergroup. The major rock types found in the area are quartzites, siltstones, conglomerates, and shales with minor occurrences of tillites, silexites, limestones, and barite-rich dolomites. The inhabitants of the area are mainly peasant farmers, and their activities might be influencing the groundwater chemistry, but little is known about the quality of the groundwater. Therefore, this study evaluated the suitability of groundwater resources in the Gushegu Municipality, and some parts of the East Mamprusi District in Ghana for domestic and irrigation uses, employing hydrogeochemical graphing, geochemical modelling, multivariate statistical analysis, and computation of water quality indices. Sodium (Na⁺), with concentrations ranging from 4.93 to 323 mg/L and a mean of 169 mg/L, is found to be the major cation in the groundwater, while bicarbonate (HCO₃^–), with concentrations ranging from 19.9 to 685 mg/L and a mean of 397 mg/L, is the major anion in the area. The dominant hydrochemical facies is the Na-HCO3 type, accounting for about 72.7% of the study area’s groundwater and is influenced by silicate weathering, carbonate mineral dissolution, and ion exchange reactions. Other factors accounting for this dominance may be anthropogenic activities, including the dissolution and leaching of fertilizers from farmlands. Overall, this study reveals that the groundwater in the area is suitable for drinking based on the WQI classification. There are localized contaminations with respect to B and F^–, making the water in those areas unsuitable for drinking. Also, the groundwater in the area is unsuitable for irrigation purposes due to the high Na% values (43 to 99% with a mean of 86%), magnesium hazard values (1 to 312 with a mean of 88), and sodium adsorption ratio (0.57 to 42.4 with a mean of 12.7). All these indices exceed their respective standards for irrigation purposes.

PMID:36445497 | DOI:10.1007/s10661-022-10731-3

Eur J Orthop Surg Traumatol. 2022 Nov 29. doi: 10.1007/s00590-022-03431-8. Online ahead of print.

ABSTRACT

PURPOSE: This study, set in in the Kurdistan region of Iraq, describes the epidemiology and outcomes of anterior cruciate ligament reconstruction (ACLR) followed by home-based rehabilitation alone.

METHODS: A cohort observational study of patients aged ≥ 16 years with an ACL rupture who underwent an ACLR under a single surgeon. Followed by a home-based rehabilitation programme of appropriate simplicity for completion in the home setting; consisting of stretching, range of motion and strengthening exercises. Demographics, mechanism of injury, operative findings, and outcome data (Lysholm, Tegner Activity Scale (TAS), and revision rates) were collected from 2016 to 2021. Data were analysed using descriptive statistics.

RESULTS: The cohort consisted of 545 patients (547 knees), 99.6% were male with a mean age of 27.8 years (SD 6.18 years). The mean time from diagnosis to surgery was 40.6 months (SD 40.3). Despite data attrition Lysholm scores improved over the 15-month follow-up period, matched data showed the most improvement occurred within the first 2 months post-operatively. Post-operative TAS results showed an improvement in level of function, but did not reach pre-injury levels by final follow-up. At final follow-up, six (1.1%) patients required an ACLR revision.

CONCLUSION: Patients who completed a home-based rehabilitation programme in Kurdistan had low revision rates and improved Lysholm scores 15 months post-operatively. To optimise resources, further research should investigate the efficacy of home-based rehabilitation for trauma and elective surgery in low- to middle-income countries and the developed world.

PMID:36445460 | DOI:10.1007/s00590-022-03431-8

Hum Genet. 2022 Nov 29. doi: 10.1007/s00439-022-02507-z. Online ahead of print.

ABSTRACT

Pain often occurs in parallel with neuropsychiatric disorders. However, the underlying mechanisms and potential causality have not been well studied. We collected the genome-wide association study (GWAS) summary statistics of 26 common pain and neuropsychiatric disorders with sample size ranging from 17,310 to 482,730 in European population. The genetic correlation between pair of pain and neuropsychiatric disorders, as well as the relevant cell types were investigated by linkage disequilibrium (LD) score regression analyses. Then, transcriptome-wide association study (TWAS) was applied to identify the potential shared genes by integrating the gene expression information and GWAS. In addition, Mendelian randomization (MR) analyses were conducted to infer the potential causality between pain and neuropsychiatric disorders. Among the 169 pairwise pain and neuropsychiatric disorders, 55 pairs showed positive correlations (median r_g = 0.43) and 9 pairs showed negative correlations (median r_g = -0.31). Using MR analyses, 26 likely causal associations were identified, including that neuroticism and insomnia were risk factors for most of short-term pain, and multisite chronic pain was risk factor for neuroticism, insomnia, major depressive disorder and attention deficit/hyperactivity disorder, and vice versa. The signals of pain and neuropsychiatric disorders tended to be enriched in the functional regions of cell types from central nervous system (CNS). A total of 19 genes shared in at least one pain and neuropsychiatric disorder pair were identified by TWAS, including AMT, NCOA6, and UNC45A, which involved in glycine degradation, insulin secretion, and cell proliferation, respectively. Our findings provided the evidence of shared genetic structure, causality and potential shared pathogenic mechanisms between pain and neuropsychiatric disorders, and enhanced our understanding of the comorbidities of pain and neuropsychiatric disorders.

PMID:36445456 | DOI:10.1007/s00439-022-02507-z

Brain. 2022 Nov 29:awac439. doi: 10.1093/brain/awac439. Online ahead of print.

ABSTRACT

There is a lack of imaging markers revealing the functional characteristics of different brain regions in paediatric dystonia. In this observational study, we assessed the utility of [18F]2-fluoro-2-deoxy-D-glucose (FDG)-PET in understanding dystonia pathophysiology by revealing specific resting awake brain glucose metabolism patterns in different childhood dystonia subgroups. PET scans from 267 children with dystonia being evaluated for possible Deep Brain Stimulation (DBS) surgery between September 2007 and February 2018 at Evelina London Children’s Hospital (ELCH) United Kingdom were examined. Scans without gross anatomical abnormality (e.g. large cysts, significant ventriculomegaly; n = 240) were analysed with Statistical Parametric Mapping (SPM12). Glucose metabolism patterns were examined in the 144/240 (60%) cases with the ten commonest childhood-onset dystonias, focusing on nine anatomical regions. A group of thirty-nine adult controls was used for comparisons. The genetic dystonias were associated with the following genes: TOR1A, THAP1, SGCE, KMT2B, HPRT1 (Lesch Nyhan disease), PANK2 and GCDH (Glutaric Aciduria type 1). The acquired Cerebral Palsy (CP) cases were divided into those related to prematurity (CP-Preterm), neonatal jaundice/kernicterus (CP-Kernicterus) and hypoxic-ischaemic encephalopathy (CP-Term). Each dystonia subgroup had distinct patterns of altered FDG-PET uptake. Focal glucose hypometabolism of the pallidi, putamina, or both, was the commonest finding, except in PANK2, where basal ganglia metabolism appeared normal. HPRT1 uniquely showed glucose hypometabolism across all nine cerebral regions. Temporal lobe glucose hypometabolism was found in KMT2B, HPRT1 and CP-Kernicterus. Frontal lobe hypometabolism was found in SGCE, HPRT1, and PANK2. Thalamic and brainstem hypometabolism were seen only in HPRT1, CP-Preterm and CP-term dystonia cases. The combination of frontal and parietal lobe hypermetabolism was uniquely found in CP-term cases. PANK2 cases showed a distinct combination of parietal hypermetabolism with cerebellar hypometabolism but intact putaminal-pallidal glucose metabolism. HPRT1, PANK2, CP-kernicterus and CP-preterm cases had cerebellar and insula glucose hypometabolism as well as parietal glucose hypermetabolism. The study findings offer insights into the pathophysiology of dystonia and support the network theory for dystonia pathogenesis. “Signature” patterns for each dystonia subgroup could be a useful biomarker to guide differential diagnosis and inform personalised management strategies.

PMID:36445406 | DOI:10.1093/brain/awac439

Disabil Rehabil. 2022 Nov 29:1-4. doi: 10.1080/09638288.2022.2133174. Online ahead of print.

ABSTRACT

In the USA, low back pain related illness accounts for approximately 149 million workdays lost each year. Initial management of back pain typically involves allied healthcare professionals who implement various treatments, such as chiropractic manipulation, physiotherapy, and acupuncture which have varying outcomes and levels of supporting evidence. Another passive treatment for back pain is inversion table therapy (ITT). It is a form of spinal traction which is thought to have a role in relieving low back pain due to the gravity-facilitated traction of the spine which distracts the lumbar vertebrae. However, ITT is not without risk. According to the Food and Drug Administration (FDA) Medical Device Reporting Events Database, ITT has resulted in serious injuries including spinal cord injury, fractures, lacerations, and death. The FDA has regulated ITT for only manufacturers that indicated medical use; however, most manufacturers have not made such medical claims and were exempt from FDA regulation. This article discusses the risks of ITT, the current regulatory process for ITT, and the need for a better understanding of the role of ITT in the treatment of spinal pain while optimizing consumer safety.Implications for rehabilitationInversion table therapy (ITT) is a form of spinal traction which is thought to have a role in relieving low back pain due to the gravity-facilitated traction of the spine which distracts the lumbar vertebrae.According to the Food and Drug Administration (FDA) statistics, injuries due to non-powered traction from various medical devices have been rising since 2011.The FDA has regulated ITT for only manufacturers that indicated medical use; however, most manufacturers have not made such medical claims and were exempt from FDA regulation.This article discusses the risks of ITT, the current regulatory process for ITT, and the need for a better understanding of the role of ITT in the treatment of spinal pain while optimizing consumer safety.

PMID:36444821 | DOI:10.1080/09638288.2022.2133174

Epidemics. 2022 Nov 17;41:100654. doi: 10.1016/j.epidem.2022.100654. Online ahead of print.

ABSTRACT

During the summers of 2020 and 2021, the number of confirmed cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in Switzerland remained at relatively low levels, but grew steadily over time. It remains unclear to what extent epidemic growth during these periods was a result of the relaxation of local control measures or increased traveling and subsequent importation of cases. A better understanding of the role of cross-border-associated cases (imports) on the local epidemic dynamics will help to inform future surveillance strategies. We analyzed routine surveillance data of confirmed cases of SARS-CoV-2 in Switzerland from 1 June to 30 September 2020 and 2021. We used a stochastic branching process model that accounts for superspreading of SARS-CoV-2 to simulate epidemic trajectories in absence and in presence of imports during summer 2020 and 2021. The Swiss Federal Office of Public Health reported 22,919 and 145,840 confirmed cases of SARS-CoV-2 from 1 June to 30 September 2020 and 2021, respectively. Among cases with known place of exposure, 27% (3,276 of 12,088) and 25% (1,110 of 4,368) reported an exposure abroad in 2020 and 2021, respectively. Without considering the impact of imported cases, the steady growth of confirmed cases during summer periods would be consistent with a value of R_e that is significantly above the critical threshold of 1. In contrast, we estimated R_e at 0.84 (95% credible interval, CrI: 0.78-0.90) in 2020 and 0.82 (95% CrI: 0.74-0.90) in 2021 when imported cases were taken into account, indicating that the local R_e was below the critical threshold of 1 during summer. In Switzerland, cross-border-associated SARS-CoV-2 cases had a considerable impact on the local transmission dynamics and can explain the steady growth of the epidemic during the summers of 2020 and 2021.

PMID:36444785 | DOI:10.1016/j.epidem.2022.100654

Stat Med. 2022 Nov 29. doi: 10.1002/sim.9618. Online ahead of print.

ABSTRACT

Study of prognostic and predictive biomarkers plays an important role in the design and analysis of clinical trials. The Cox proportional hazards model is often used to study the biomarker main effect and the treatment-biomarker interaction effect for survival data. The estimated effects can be biased if the proportional hazards assumption is violated. The restricted mean survival time is becoming popular in clinical studies for having a clear intuitive interpretation. In this article, we first propose nonparametric methods to make statistical inference for the one-sample problem of the biomarker effect on the restricted mean survival time; we then extend the methods to the two-sample problem for studying the difference in the biomarker effects between treatment groups in clinical trials. For a given biomarker, the restricted mean survival time is estimated by kernel smoothing methods with the inverse probability of censoring weights. We prove the consistency for the estimates and develop simultaneous confidence bands for the biomarker effects on the restricted mean survival time. The simultaneous confidence bands are evaluated in extensive simulation studies and are found to have good finite sample performance. We then apply the proposed methods to a breast cancer study conducted by the Breast International Group (BIG) to illustrate how the Ki67 biomarker, a protein marker of cell proliferation, affects the survival time of patients, compared between the treatment groups.

PMID:36444774 | DOI:10.1002/sim.9618

Global Spine J. 2022 Nov 29:21925682221143991. doi: 10.1177/21925682221143991. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective.

OBJECTIVE: To compare the rate of positive pathology on thoracic MRI ordered by surgical spine specialists to those ordered by nonsurgical spine specialists.

METHODS: Outpatient thoracic MRIs from January-March 2019 were evaluated from a single academic health care system. Studies without a known ordering provider, imaging report, or patients with known presence of malignancy, multiple sclerosis, recent trauma, or surgery were excluded (n = 320). Imaging studies were categorized by type of provider placing the order (resident, attending, or advanced practice practitioner) and department. MRIs were deemed positive if they showed relevant pathology that correlated with indication for exam as determined by a radiologist. One-sided chi-squared analysis was performed to determine statistical significance.

RESULTS: Overall, our data demonstrated 17.2% of studies with positive pathology. Compared to nonspecialty clinicians, subspecialists showed 35/184 (19.0%) positivity rate versus the non-specialist with 20/136 (14.7%) positivity rate (P = .156). Posthoc analysis demonstrated that surgical specialists who order thoracic MRIs yield significantly higher positivity rates at 19/79 (24.0%) compared to nonsurgical specialists at 36/241 (14.9%) (P < .05). Overall, neurosurgery demonstrated the highest rate of positive thoracic MRIs at 14/40 (35.0%). Comparison between the rate of positivity between physicians and advanced practitioners was insignificant (P > .05).

CONCLUSIONS: Clinical diagnosis of symptomatic thoracic spine degenerative disease requires an expert physical exam combined with careful attention to radiology findings. Although the percent of relevant pathology on thoracic MRI is low, our data suggests evaluation by a surgical specialist should precede ordering a thoracic spine MRI.

PMID:36444762 | DOI:10.1177/21925682221143991

J Magn Reson Imaging. 2022 Nov 29. doi: 10.1002/jmri.28546. Online ahead of print.

ABSTRACT

BACKGROUND: Reactive stroma is recognized as one of the independent prognostic factors in prostate cancer (PCa). Intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI) may be useful for assessing the reactive stromal grade (RSG).

PURPOSE: To investigate whether IVIM and DKI models can evaluate RSG in PCa patients.

STUDY TYPE: Retrospective.

SUBJECTS: A total of 56 PCa patients aged 73 years on average confirmed by MRI and transrectal ultrasound (MRI/TRUS) fusion biopsy divided into two subgroups (18 high RSG and 38 low RSG).

FIELD STRENGTH/SEQUENCE: A 3 T/T₁ WI-fs, T₁ WI, T₂ WI-fs, T₂ WI, DWI, IVIM, and DKI.

ASSESSMENT: Apparent diffusion coefficient (ADC), pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (f), mean diffusion (MD), mean kurtosis (MK) were obtained. Patients were divided into high RSG PCa (>50% reactive stroma) and low RSG PCa (≤50% reactive stroma) groups on hematoxylin and eosin (H&E) stained sections.

STATISTICAL TESTS: Spearman correlation and independent sample t-test or Wilcoxon’s rank sum test was used to investigate the relationship between each imaging parameter and RSG. The combined parameters were calculated using a binary logistic regression model. Receiver operating characteristic (ROC) analysis was used to explore the value of individual and combined parameters to differentiate between high and low RSG group. Area under the ROC curves (AUC) > 0.7 were used as reference standards.

RESULTS: ADC, D, f, and MD values showed positive correlation with RSG (r = 0.489, 0.619, 0.318, and 0.544, respectively); MK showed negative correlation with RSG (r = -0.444). ADC, D, f, and MD values were significantly lower in the low RSG group than in the high RSG group. The combined model showed the best diagnostic ability to differentiate low and high RSG groups (AUC = 0.887).

DATA CONCLUSION: Parameters of IVIM and DKI may be promising methods for assessment of RSG in PCa patients.

EVIDENCE LEVEL: 3.

TECHNICAL EFFICACY: Stage 3.

PMID:36444747 | DOI:10.1002/jmri.28546

Clin Oral Implants Res. 2022 Nov 29. doi: 10.1111/clr.14022. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the fracture strength and potential phase transformation of an injection-molded two-piece zirconia implant restored with a zirconia abutment after loading and/or aging.

METHODS: Thirty-two two-piece zirconia implants (4.0 mm diameter) restored with zirconia abutments were embedded according to ISO 14801 and divided into four groups (n=8/group): Three groups were either exclusively hydrothermally treated (group HT; 85°C), dynamically loaded (group DL; 10⁷ cycles; 98 N) or subjected to both treatments simultaneously (group DL/HT). One group remained untreated (group 0). A sample from each group was cross-sectioned and examined by scanning electron microscopy for possible crystal phase transformation. The remaining samples were then loaded to fracture in a static loading test. A one-way ANOVA was used for statistical analyses.

RESULTS: During dynamic loading, three implants of group DL and six implants of group DL/HT fractured at a load of 98 N. The fracture strength of group DL/HT (108±141 Ncm) was significantly reduced compared to the other groups (group 0: 342±36 Ncm; HT: 363±49 Ncm; DL: 264±198 Ncm) (p<0.05). Fractures from group 0 and HT occurred at both implant and abutment level, whereas implants from group DL and DL/HT fractured only at implant level. A shallow monoclinic transformation zone of approximately 2 μm was observed following hydrothermal treatment.

CONCLUSIONS: Within the limitations of this study, it can be concluded that dynamic loading and the combination of loading and aging reduced the fracture strength of the implant abutment combination. Hydrothermal treatment caused a shallow transformation zone which had no influence on the fracture strength.

PMID:36444693 | DOI:10.1111/clr.14022