Category: Nevin Manimala

J Hand Surg Glob Online. 2021 Nov 8;4(1):25-31. doi: 10.1016/j.jhsg.2021.08.007. eCollection 2022 Jan.

ABSTRACT

PURPOSE: We evaluated the literature on complications associated with different positions used for immobilizing the upper extremity during conservative treatment of distal radius fractures (DRF).

METHODS: A search of PubMed, Embase, and Medline was conducted to identify original research on the effects that upper extremity positioning during the treatment of DRFs has on complication rates. Treatment groups were categorized by wrist positioning in flexion, extension, or neutral, as well as forearm positioning in pronation, supination, or neutral. The primary endpoints examined included the loss of reduction, recasting/refabricating an orthosis, and functional limitations.

RESULTS: A total of 1,655 articles were identified through an initial database search. Ultimately, 8 studies, with 786 total patients, met the inclusion criteria for this systematic review. A qualitative analysis determined that immobilizing DRFs with the wrist in extension results in better functional and radiographic outcomes with lower rates of complications, such as pain, recasting, and the need for operation. The 2 studies that compared forearm pronation versus supination revealed contradictory results regarding which position was associated with superior outcomes. A meta-analysis comparing the various wrist and forearm positions failed to demonstrate statistically significant differences in the rates of loss of reduction or recasting/refabricating an orthosis between the groups. This analysis was limited by considerable heterogeneity in the data from the different studies.

CONCLUSIONS: Despite the high incidence of DRFs, there is limited research on the optimal position of immobilization for conservative treatment of them. Available evidence suggests that the wrist should be immobilized in extension, as these patients had improved functional and radiographic outcomes. No conclusion can be drawn from the existing literature on ideal forearm position during immobilization. This review also suggests better data reporting practices for studies researching DRFs, so that future meta-analyses can be more comprehensive.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.

PMID:35415593 | PMC:PMC8991451 | DOI:10.1016/j.jhsg.2021.08.007

J Hand Surg Glob Online. 2021 Aug 11;3(6):348-351. doi: 10.1016/j.jhsg.2021.06.010. eCollection 2021 Nov.

ABSTRACT

PURPOSE: The use of self-tapping cortical screws is indicated in patients with metacarpal and phalangeal fractures requiring formal stabilization. The aim of this study was to systematically compare and evaluate the design parameters of 4 commercially available self-tapping screw systems.

METHODS: We measured various design parameters of self-tapping cortical screws of different lengths from several manufactures using scanning electron microscopy. Screws were obtained in 8, 12, 16, and 20 mm lengths. The measured parameters included screw length, head height, pitch, outer diameter, inner diameter, terminal thread diameter, terminal thread-to-tip distance, thread-to-tip distance of 1 full revolution, and crest width. Data were assessed statistically using 1- and 2-way analysis of variance (ANOVA) tests, and the significance level was set at a P value < .05.

RESULTS: There was variability in advertised screw lengths compared with measured screw lengths with 2 manufacturers. There was a statistically significant difference between the thread-to-tip distance and head height between screws while controlling for diameter.

CONCLUSIONS: Screw sizes and dimensions are critical in order to avoid complications such as prominent hardware and postoperative stiffness. Knowledge of the design parameters presented for each of the different manufacturers may prove useful to hand surgeons when selecting screws for fixation of metacarpal and phalangeal fractures.

CLINICAL RELEVANCE: Specific design characteristics of commonly used screws in hand surgery vary slightly by manufacturer and may have clinically relevant implications in fixation of metacarpal and phalangeal fractures.

PMID:35415582 | PMC:PMC8991776 | DOI:10.1016/j.jhsg.2021.06.010

Horm Res Paediatr. 2022 Apr 12. doi: 10.1159/000524573. Online ahead of print.

ABSTRACT

INTRODUCTION: Turner syndrome (TS) is associated with a high risk of primary ovarian insufficiency. Current guidelines recommend early fertility counseling for affected youth and their families. This study assessed pediatric endocrinologists’ fertility counseling practices for girls with TS.

METHODS: TS providers were invited to complete a survey via the Pediatric Endocrine Society listserv. Descriptive statistics summarized variables of interest. Correlations were used to identify associations between barriers/practice characteristics and fertility preservation (FP) referral. Thematic analysis was used to examine qualitative responses.

RESULTS: 119 providers completed the survey. Seventy percent of providers reported discussing fertility implications of TS routinely in pediatric care. Fifty-six percent of providers reported often or always referring patients with spontaneous menarche to FP specialists, whereas only 19% reported often or always referring their patients without spontaneous menarche (p<0.001). Barriers associated with FP referral frequency included unfamiliarity with FP options, belief that FP is not a possible goal for their patients and absence of a local reproductive endocrinologist. Qualitatively, four referral barrier themes were identified: (1) Questionable utility of referral, (2) Lack of perceived interest among patients/families, (3) Provider barriers (e.g. lack of knowledge), (4) Logistical/structural barriers to accessing fertility-related care.

DISCUSSION/CONCLUSION: Providers report inconsistently discussing fertility implications of TS. The frequency of referral to a FP specialist and factors/barriers affecting the decision to refer remain variable. Future research should focus on expanding provider education, addressing barriers to high quality fertility counseling and referral for patients with TS, and investigating FP outcomes in TS.

PMID:35413716 | DOI:10.1159/000524573

Am J Emerg Med. 2022 Apr 6;56:188-195. doi: 10.1016/j.ajem.2022.03.060. Online ahead of print.

ABSTRACT

OBJECTIVES: The purpose of this study was to compare and determine whether there were any differences in clinical outcomes between pregnant and non-pregnant women who had been infected with COVID-19.

METHODS: A literature search was performed in 9 databases on November 20, 2021. The relative risk (RR) with 95% confidence interval (95% CI) was used to estimate the effect of pregnancy on COVID-19 outcomes. The I square value was used to assess heterogeneity, and the random or the fixed-effects model were adopted. Sensitivity and publication bias analyses were performed.

RESULTS: This study included 8 published studies with 859,278 COVID-19 female patients. The incidences of fever and cough among pregnant women with COVID-19 were 19.07% and 28.79%, respectively. Pregnancy was associated with significantly increased risks of intensive care unit (ICU) admission (RR = 2.23, 95% CI = 1.58-3.16) and ventilation (RR = 2.13, 95% CI = 1.06-4.28), but was not associated with a statistically significant increase in mortality.

CONCLUSIONS: Our results suggest that pregnant women with COVID-19 have a significantly higher probability of being hospitalized to the ICU and ventilation than non-pregnant women with COVID-19. To avoid these adverse outcomes, pregnant women should take precautions (for example, reduce going out, maintain social distance, and wear a mask) to avoid COVID-19 infection. Finally, additional research into the fetal outcomes is required to better investigate the impact of COVID-19 on pregnancy.

PMID:35413655 | DOI:10.1016/j.ajem.2022.03.060

J Neural Eng. 2022 Apr 12. doi: 10.1088/1741-2552/ac669a. Online ahead of print.

ABSTRACT

OBJECTIVE: Fast neural Electrical Impedance Tomography (FnEIT) is an imaging technique that has been successful in visualising electrically evoked activity of myelinated fibres in peripheral nerves by measurement of the impedance changes (dZ) accompanying excitation. However, imaging of unmyelinated fibres is challenging due to temporal dispersion (TP) which occurs due to variability in conduction velocities of the fibres and leads to a decrease of the signal below the noise with distance from the stimulus. To overcome TP and allow EIT imaging in unmyelinated nerves, a new experimental and signal processing paradigm is required allowing dZ measurement further from the site of stimulation than compound neural activity is visible. The development of such a paradigm was the main objective of this study.

APPROACH: A FEM-based statistical model of temporal dispersion in porcine subdiaphragmatic nerve was developed and experimentally validated ex-vivo. Two paradigms for nerve stimulation and processing of the resulting data – continuous stimulation and trains of stimuli, were implemented; the optimal paradigm for recording dispersed dZ in unmyelinated nerves was determined.

MAIN RESULTS: While continuous stimulation and coherent spikes averaging led to higher signal-to-noise ratios (SNR) at close distances from the stimulus, stimulation by trains was more consistent across distances and allowed dZ measurement at up to 15 cm from the stimulus (SNR = 1.8±0.8) if averaged for 30 minutes.

SIGNIFICANCE: The study develops a method that for the first time allows measurement of dZ in unmyelinated nerves in simulation and experiment, at the distances where compound action potentials are fully dispersed.

PMID:35413701 | DOI:10.1088/1741-2552/ac669a

Neuroimage Clin. 2022 Apr 6;34:103003. doi: 10.1016/j.nicl.2022.103003. Online ahead of print.

ABSTRACT

Conceptualizing mental disorders as deviations from normative functioning provides a statistical perspective for understanding the individual heterogeneity underlying psychiatric disorders. To broaden the understanding of the idiosyncrasy of brain aging in schizophrenia, we introduced an imaging-derived brain age paradigm combined with normative modeling as novel brain age metrics. We constructed brain age models based on GM, WM, and their combination (multimodality) features of 482 normal participants. The normalized predicted age difference (nPAD) was estimated in 147 individuals with schizophrenia and their 130 demographically matched controls through normative models of brain age metrics and compared between the groups. Regression analyses were also performed to investigate the associations of nPAD with illness duration, onset age, symptom severity, and intelligence quotient. Finally, regional contributions to advanced brain aging in schizophrenia were investigated. The results showed that the individuals exhibited significantly higher nPAD (P < 0.001), indicating advanced normative brain age than the normal controls in GM, WM, and multimodality models. The nPAD measure based on WM was positively associated with the negative symptom score (P = 0.009), and negatively associated with the intelligence quotient (P = 0.039) and onset age (P = 0.006). The imaging features that contributed to nPAD mostly involved the prefrontal, temporal, and parietal lobes, especially the precuneus and uncinate fasciculus. This study demonstrates that normative brain age metrics could detect advanced brain aging and associated clinical and neuroanatomical features in schizophrenia. The proposed nPAD measures may be useful to investigate aberrant brain aging in mental disorders and their brain-phenotype relationships.

PMID:35413648 | DOI:10.1016/j.nicl.2022.103003

Oral Oncol. 2022 Apr 9;128:105832. doi: 10.1016/j.oraloncology.2022.105832. Online ahead of print.

ABSTRACT

OBJECTIVES: Base-of-tongue (BOT)/tonsillar cancer incidence is rising, primarily due to human papillomavirus; meanwhile, rates of the mainly smoking-associated laryngeal cancer is declining. Little is known about whether these trends are seen in all socioeconomic levels and age-groups. We describe incidence trends of BOT/tonsillar and laryngeal cancer in Denmark 1994-2018 by educational level and age.

METHODS: BOT/tonsillar and laryngeal cancer cases diagnosed 1994-2018 were identified from the Danish Cancer Registry. We obtained individual-level educational information from nationwide registries. We estimated age-standardized incidence rates of BOT/tonsillar and laryngeal cancer according to sex, education and age. Temporal incidence trends were evaluated by the average annual percentage change (AAPC) with corresponding 95% confidence intervals (CIs) using linear and Poisson regression models for age-standardized incidence rates.

RESULTS: We identified 4245 individuals with BOT/tonsillar cancer and 6123 with laryngeal cancer. BOT/tonsillar cancer incidence increased among men with short (AAPC:3.4, 95% CI 2.1;4.6) and long (AAPC:5.1, 95% CI 3.2;7.1) education, and all age-groups, while decreased from 2012 among men with medium education (AAPC:-4.3, 95 %CI -7.6;-1.0). Laryngeal cancer incidence decreased from 2007 in men with medium (AAPC:-4.7, 95% CI -6.7;-2.7) and long (AAPC:-2.4, 95% CI -3.4;-1.4) education, and all age-groups, whereas increased in men with short education (AAPC:1.0, 95% CI 0.2;1.8). Similar trends were seen among women.

CONCLUSIONS: Over the last 25 years, BOT/tonsillar cancer incidence in Denmark has generally increased in all age-groups and educational levels. In contrast, social inequality was seen in laryngeal cancer trends as incidence decreased in individuals with medium and long education, while incidence increased in individuals with short education.

PMID:35413640 | DOI:10.1016/j.oraloncology.2022.105832

Poult Sci. 2022 Mar 10;101(6):101840. doi: 10.1016/j.psj.2022.101840. Online ahead of print.

ABSTRACT

The long-term semen cryopreservation is increasingly crucial for conservation of endangered livestock and poultry species. Glycerol is the most widely used cryoprotectant for freezing chicken semen. Continuous improvement in details with glycerol may help increase the fertility of post-thawed semen. Two experiments were performed in the present study to investigate the effects of glycerol concentration, removal method, and straw type on the quality of post-thawed sperm. In experiment 1, glycerol concentration (3%, 5%, 7%, 9%, 11%, and 13%) and glycerol removal method (final dilution ratio 1:1, 1:2, 1:4, 1:8, 1:16, and 1:20) combination groups were investigated for post-thawed sperm quality, residual glycerol concentration, and fertility to find the best combinations. Experiment 2 was performed to evaluate the effects of straw type (0.25 and 0.5 mL) and glycerol concentration (3%, 5%, 7%, 9%, 11%, and 13%) on the post-thawed sperm quality. Results showed that post-thawed sperm motility of 6 glycerol concentration groups were different (P < 0.01). Sperm motility of 5%, 7%, 9%, 11% and 13% was higher than that of 3% (P < 0.01). There was no difference among different concentrations of glycerol in VSL, VCL, VAP, ALH, WOB, BCF, LIN, or STR (P > 0.05). As for the glycerol removal method, sperm motility of 1:8 dilution was the highest, followed by 1:1 and 1:2, while the difference among groups was not statistically significant (P = 0.11). Glycerol concentration and removal method had no interaction effect on sperm motion parameters (P > 0.05). The highest fertility (48.70%) was found for the 5% and 1:2 combination. There was no difference for sperm motility between 0.25 and 0.5 mL straws (P > 0.05). Glycerol concentration and straw type had no interaction effect on the sperm motion parameters (P > 0.05). It can be concluded from these observations that the combination of 5% glycerol and 1:2 dilution rendered higher fertility should be suggested in practice, and that both 0.25 and 0.50 mL straws fit the present procedure.

PMID:35413595 | DOI:10.1016/j.psj.2022.101840

Clin Nutr. 2022 Mar 29;41(5):1122-1130. doi: 10.1016/j.clnu.2022.03.020. Online ahead of print.

ABSTRACT

BACKGROUND & AIMS: Tea has been shown to be associated with reduced risk of several diseases including cardiovascular diseases, stroke, metabolic syndrome, and obesity. However, the results on the relationship between tea consumption and bladder cancer are conflicting. This research aimed to assess the association between tea consumption and risk of bladder cancer using a pooled analysis of prospective cohort data.

METHODS: Individual data from 532,949 participants in 12 cohort studies, were pooled for analyses. Cox regression models stratified by study centre was used to estimate hazard ratios (HR) and corresponding 95% CIs. Fractional polynomial regression models were used to examine the dose-response relationship.

RESULTS: A higher level of tea consumption was associated with lower risk of bladder cancer incidence (compared with no tea consumption: HR = 0.87, 95% C.I. = 0.77-0.98 for low consumption; HR = 0.86, 95% C.I. = 0.77-0.96 for moderate consumption; HR = 0.84, 95% C.I. = 0.75-0.95 for high consumption). When stratified by sex and smoking status, this reduced risk was statistically significant among men and current and former smokers. In addition, dose-response analyses showed a lower bladder cancer risk with increment of 100 ml of tea consumption per day (HR-increment = 0.97; 95% CI = 0.96-0.98). A similar inverse association was found among males, current and former smokers while never smokers and females showed non-significant results, suggesting potential sex-dependent effect.

CONCLUSIONS: Higher consumption of tea is associated with reduced risk of bladder cancer with potential interaction with sex and smoking status. Further studies are needed to clarify the mechanisms for a protective effect of tea (e.g. inhibition of the survival and proliferation of cancer cells and anti-inflammatory mechanisms) and its interaction with smoking and sex.

PMID:35413574 | DOI:10.1016/j.clnu.2022.03.020

J Surg Res. 2022 Apr 9;276:291-297. doi: 10.1016/j.jss.2022.02.051. Online ahead of print.

ABSTRACT

INTRODUCTION: Given the negative clinical effects opiates can have, the search for alternative forms of analgesia to treat post-operative pain continues. We implemented an opiate reduction strategy using standing intravenous (IV) acetaminophen for infants aged less than 1 y who underwent abdominal or anorectal surgery and recovered on the acute care floor.

MATERIALS AND METHODS: Infants were administered standing IV acetaminophen every 6 h for a minimum of 48 h as the main form of post-operative analgesia. Pain severity was objectively scored using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale. A before-and-after retrospective cohort analysis was performed and process control charts were used to examine trends in post-operative opiate use in our pre-intervention (January 2012 to January 2016), roll-out (January 2016 to December 2016), and post-intervention (December 2016 to December 2020) cohorts.

RESULTS: A total of 131 infants were included: 56 in the pre-intervention, 17 in the roll-out, and 58 in the post-intervention group. Patient demographics were equivalent. The intervention was associated with a 36-fold reduction in post-operative morphine equivalents (median 0.36 mg/kg in the pre-intervention group versus 0.0 mg/kg in the post-intervention group, P < 0.0001). The median and maximum FLACC pain scores along with clinical safety profiles were statistically equivalent between the groups. The intervention was associated with a 2-d reduction in post-operative length of stay (P < 0.0001).

CONCLUSIONS: Standing IV acetaminophen is associated with a reduction of post-operative opioid use in infants being treated on the acute care floor while maintaining equivalent FLACC pain scores. Similar opiate reduction strategies may be of value at other institutions.

PMID:35413578 | DOI:10.1016/j.jss.2022.02.051