Category: Nevin Manimala

Am J Transplant. 2022 Feb 18. doi: 10.1111/ajt.17005. Online ahead of print.

ABSTRACT

The CD86 occupancy assay has been developed to measure the number of CD86 molecules unbound to belatacept, but its association with clinical outcomes has not been assessed yet. All kidney transplant patients switched to belatacept in our centre between 2016 and 2018 were included. Blood samples were collected before each infusion for one year to assess CD86 occupancy by CD86 antibody cytometry staining on the surface of CD14⁺ monocytes. Results were expressed as the median fluorescence intensity (MFI) value of CD86 staining. At each infusion, the MFI_{Day of infusion} /MFI_Day0 ratio was calculated. Forty-one patients were consecutively included. After the every-two-weeks infusions period, CD86 MFI ratio dropped from 1.00 to 0.73 [0.57-0.98], p=0.07. However, this ratio progressively increased to 0.78 [0.53-1.13] at one year, which was not statistically different from pre-switch ratio, p=0.4. Over the first year, the MFI ratio coefficient of variation was 31.58% [23.75-38.31]. MFI ratio was not different between patients with or without opportunistic infections: 0.73 [0.60-0.88] versus 0.80 [0.71-1.00], p=0.2, or between patients with or without EBV DNAemia, p=0.2. Despite previous in-vitro results, the CD86 occupancy assay suffers from a high intra-individual variability and does not appear to be relevant to clinical outcomes.

PMID:35181996 | DOI:10.1111/ajt.17005

J Cell Mol Med. 2022 Feb 19. doi: 10.1111/jcmm.17238. Online ahead of print.

ABSTRACT

Inflammation is a major risk factor for osteoporosis, and reducing inflammatory levels is important for the prevention of osteoporosis. Although nuclear receptor 77 (Nur77) protects against inflammation in a variety of diseases, its role in osteoporosis is unknown. Therefore, the main purpose of this study was to investigate the osteoprotective and anti-inflammatory effects of Nur77. The microCT and haematoxylin and eosin staining results indicated that knockout of Nur77 accelerated femoral bone loss in mice. The enzyme-linked immunosorbent assay (ELISA) results showed that knockout of Nur77 increased the serum levels of hsCRP and IL-6. The expression levels of NF-κB, IL-6, TNF-α and osteoclastogenesis factors (TRAP, NFATC1, Car2, Ctsk) in the femurs of Nur77 knockout mice were increased significantly. Furthermore, in vitro, shNur77 promoted the differentiation of RAW264.7 cells into osteoclasts by activating NF-κB, which was confirmed by PDTC treatment. Mechanistically, Nur77 inhibited osteoclast differentiation by inducing IκB-α and suppressing IKK-β. In RAW264.7 cells, overexpression of Nur77 alleviated inflammation induced by siIκB-α, while siIKK-β alleviated inflammation induced by shNur77. Consistent with the in vivo studies, we found that compared with control group, older adults with high serum hsCRP levels were more likely to suffer from osteoporosis (OR = 1.76, p < 0.001). Our data suggest that Nur77 suppresses osteoclast differentiation by inhibiting the NF-κB signalling pathway, strongly supporting the notion that Nur77 has the potential to prevent and treat osteoporosis.

PMID:35181992 | DOI:10.1111/jcmm.17238

J Cosmet Dermatol. 2022 Feb 18. doi: 10.1111/jocd.14868. Online ahead of print.

ABSTRACT

OBJECTIVE: This study was performed to analyze the efficacy, adverse reactions of fractional CO₂ laser for atrophic acne scars, and related clinical factors.

METHODS: The clinical data of 121 patients with atrophic acne scars treated with ultra-pulsed fractional CO₂ laser in the Cosmetic Dermatology from August 2014 to March 2020 were retrospectively analyzed. The efficacy and adverse reactions of atrophic acne scar after fractional CO₂ laser therapy were statistically analyzed. The clinical factors related to efficacy and adverse reactions after the first therapy session were analyzed by multivariate logistic regression.

RESULTS: A total of 121 patients received 206 sessions of fractional CO₂ laser therapy, with an average of 1.7 sessions. Moderate to excellent improvement rate reached 50.4% after the first session. Multivariate logistic regression analysis indicated that rolling scars responded better to fractional CO₂ laser treatment than icepick scars (OR = 7.3, 95% CI [1.2, 43.4], P = 0.029), and scar improvement was more significant in the high-energy laser group than in the low-energy laser group (OR = 10.9, 95% CI [1.1, 106.8], P = 0.041). The main adverse reactions after fractional laser surgery were pigmentation, skin sensitivity, persistent erythema and acneiform eruption. Multivariate logistic analysis revealed that the longer the scar duration, the higher incidence of postoperative adverse reactions (OR = 1.3, 95% CI [1.1, 1.5], P = 0.008). Compared with icepick scars, rolling scars (OR = 10.4, 95% CI [2.3, 47.7], P = 0.003) and boxcar scars (OR = 12.0, 95% CI [3.3, 44.0], P < 0.001) had higher risk of developing adverse reactions. The incidence of postoperative adverse reactions was also higher in the combined mode group (DeepFX mode + ActiveFX mode) than in the single mode group (OR = 7.8, 95% CI [2.4, 25.5], P < 0.001).

CONCLUSION: Fractional CO₂ laser was effective in the treatment of atrophic acne scars, without serious adverse reactions. Scar type and laser energy were independent clinical factors affecting its efficacy. Scar course, scar type and fractional laser mode were independent clinical factors affecting its adverse reactions.

PMID:35181995 | DOI:10.1111/jocd.14868

Eur J Dent Educ. 2022 Feb 18. doi: 10.1111/eje.12791. Online ahead of print.

ABSTRACT

INTRODUCTION: Research is limited in measuring the effectiveness of pre-clinical programs in preparing students for fixed prosthodontics clinical practice. The aim of this retrospectively study was to assess the influence of a major pre-clinical program restructure on undergraduate student fixed prosthodontics clinical unit completions.

MATERIALS AND METHODS: The fixed prosthodontics treatment registers from 2011 to 2020 were reviewed and units completed per student (UCS) and units completed per student per session (UCSS) were calculated in the years before (2011-2013) and after (2014-2020) a major pre-clinical program restructure (PR). Data was summarised in Microsoft Excel software (version 2016) and Student’s t-test and paired t-tests were performed to determine the significance of difference in UCS and UCSS in the years before and after the PR.

RESULTS: There was a significant difference in the UCS (p < .05) and UCSS (p < .01) in the years before and after the PR. The average UCS in the years before the PR was 2.20 units compared with 3.86 units after the PR, an increase of 75% per student. The average UCSS in the years before the PR was 0.15 units compared with 0.28 units after the PR, an increase of 87% per session.

CONCLUSION: The fixed prosthodontics pre-clinical program restructure resulted in statistically significantly increased student clinical unit completions.

PMID:35181974 | DOI:10.1111/eje.12791

J Clin Nurs. 2022 Feb 18. doi: 10.1111/jocn.16250. Online ahead of print.

ABSTRACT

AIMS: A meta-analysis was carried out to review and identify correlates of stigma in poststroke patients.

BACKGROUND: Patients suffer from impaired physical functions and sequelae of stroke. Stroke-related stigma hinders the recovery process and produces poorer clinical outcomes of stroke, leading to compromised quality of life.

DESIGN: A systematic review and meta-analysis was reported by following PRISMA 2020 guidelines.

REVIEW METHODS: Nine databases were searched from their inception to May 2021 to identify studies focused on the relationships among demographics, disease-related factors, psychosocial factors and poststroke stigma. Included studies were assessed by using the Agency for Healthcare Research and Quality (AHRQ) scale. The statistical software R studios were used to perform statistical analysis.

RESULTS: Nineteen studies were included in the meta-analysis. Four demographic factors (age, caregiver, residence, monthly income), seven stroke-related characteristics (type of stroke, mRS, ADLs, stroke duration, recurrence, sequelae, chronic disease comorbidity) and three psychosocial factors (depression, social support, quality of life) showed significant associations with stroke-related stigma.

CONCLUSIONS: The results of our study can serve as a foundation for designing interventions to reduce stigma and improve the overall quality of life of poststroke patients and may produce positive clinical outcomes. Healthcare professionals should be aware of stroke patients who are characterised by correlates of stigma. Relevance to clinical practice Poststroke patients showed a moderate-to-high level of stigma, and this issue warrants more attention. This review provides a preliminary foundation for healthcare professionals to develop interventions to address stroke-related stigma by focusing on demographic, disease-related and psychosocial factors. Additionally, stigma identification should be a part of clinical nursing evaluation. The involvement of clinical and community nursing is very important to screen stroke-related stigma and pay attention to this population.

PMID:35181955 | DOI:10.1111/jocn.16250

Phytother Res. 2022 Feb 18. doi: 10.1002/ptr.7412. Online ahead of print.

ABSTRACT

Turmeric is one of the most used herbal supplements among cancer patients. It reportedly modulates the function of CYP450 enzymes and drug transporters. This study investigates the effect of turmeric on the pharmacokinetics of paclitaxel in breast cancer patients. This is a prospective longitudinal study with 60 breast cancer patients on treatment with single-agent paclitaxel and turmeric. The patients were followed up for two consecutive chemotherapy cycles, and their blood samples were collected, first without turmeric (first cycle) and the next after a 21-day concomitant administration of 2 g/day turmeric (second cycle). Plasma samples were quantified for paclitaxel concentration using High Performance Liquid Chromatograph with UV detector (HPLC-UV) method. The sparse concentration-time data of paclitaxel were subjected to population pharmacokinetic modeling, and then noncompartmental analysis (NCA) was performed on the simulated data to estimate the pharmacokinetic parameters of paclitaxel, before and after turmeric supplementation, for comparisons. The population pharmacokinetic parameters of paclitaxel differed from before to after turmeric supplementation. NCA of simulated concentration-time profiles showed a statistically significant reduction of 7.7% and 12.1% in AUC_inf and Cmax, respectively. Given the small magnitude of the changes in pharmacokinetic parameters, the observed changes are not clinically relevant. Thereby, turmeric at the recommended dose can be combined safely with paclitaxel.

PMID:35181963 | DOI:10.1002/ptr.7412

Neurourol Urodyn. 2022 Feb 19. doi: 10.1002/nau.24891. Online ahead of print.

ABSTRACT

AIMS: While behavior-based pelvic floor muscle exercise therapy is an effective treatment for overactive bladder in Parkinson’s disease (PD) patients, cognitive function may be a predictor of rehabilitation outcomes.

METHODS: In a planned exploratory analysis, participants who had a Montreal Cognitive Assessment (MoCA) with a score ≥18 who were randomized in a clinical trial to behavioral treatment were classified by perceived improvement (Benefit vs. No Benefit) as reported on a validated Satisfaction and Benefit Questionnaire. General cognition (MoCA), motor procedural learning (Serial reaction time task), verbal memory (Buschke delayed recall), spatial memory (Nonverbal/Spatial selective reminding test), and working memory (Wisconsin card sorting task) were compared between the two groups using Wilcoxon rank-sum test.

RESULTS: Of the 26 participants randomized to behavioral treatment (70% male, mean age 71 ± 6.1 years), 22 participants (85%) reported Benefit and four reported No Benefit. General cognition, motor procedural learning, verbal memory, spatial memory, and working memory did not differ between these groups. While the difference between the time to complete the final practiced series and the random series of the Serial Reaction Time Task (SRTT) was statistically similar between the groups, the Benefit group performed the random sequence more quickly (567.0 ± 136.5 ms) compared to the No Benefit group (959.4 ± 443.0 ms; p = 0.03) and trended toward faster performance in the final practiced series.

CONCLUSIONS: Perceived benefit from behavioral treatment for overactive bladder was not associated with measures of baseline cognition other than faster completion of the SRTT. This is noteworthy because many behavior-based therapy studies exclude participants with mild cognitive impairment. Additional studies may evaluate if domain-specific cognitive function, particularly the assessment of implicit memory, could lead to individualized behavioral therapy recommendations.

PMID:35181928 | DOI:10.1002/nau.24891

J Dent Educ. 2022 Feb 18. doi: 10.1002/jdd.12903. Online ahead of print.

ABSTRACT

BACKGROUND: One challenge in dental education is new faculty members can be hired with limited teaching experience or understanding of pedagogy. Recent publications document increasing initiatives of faculty development in US and Canadian dental schools. This study evaluates full-time faculty perspectives of their develop and academic environment.

METHODS: A 33-item questionnaire distributed to senior administrators and forwarded to faculty, collected data on demographics and satisfaction, utilizing a 5-item Likert scale, multiple choice, and binary yes/no questions. Responses were descriptively and statistically analyzed utilizing an analysis of variance, chi-square, and two-sample t-test.

RESULTS: There were 183 faculty respondents (37.7% male/62.3% female), age ranges were 20-29 (2.2%), 30-39 (53.5%), and 41-49(44.3). Respondents reported race/ethnicity: Caucasian (60.7%), Asian (19.1%), Hispanic (12.6%), Black/African American (5.5%), two or more races (2.2%), and Native American 0%. Length of employment was significantly associated with primary responsibility (p = 0.0023), recent publications (p < 0.0011), and short-term intent to remain in academia (p = 0.046). There was a statistically significant difference between age and satisfaction with professional development (p = 0.0411), achieving career objectives (p = 0.0151), well-being (p = 0.0492), access to resources for scholarly interests (p = 0.0114), communication (p = 0.0058), and assessment training (p = 0.0249). Non-Caucasian faculty reported greater dissatisfaction with being treated respectfully (p = 0.0302), departmental commitment to diversity and inclusion (p = 0.0075), and departmental cooperation/teamwork (p = 0.0323).

CONCLUSIONS: A significant number of junior faculty have interest in academic dental careers. Institutions should invest in improving onboarding and professional development. Improve the early experiences of faculty, and foster diversity and inclusion and faculty well-being.

PMID:35181890 | DOI:10.1002/jdd.12903

Neurourol Urodyn. 2022 Feb 19. doi: 10.1002/nau.24893. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to report sacral neuromodulation (SNM) outcomes in detrusor underactivity (DU).

METHODS: A multicentric, multinational, retrospective case series was conducted between March 2017 and June 2021 in three different referral centers. Initial test phase stimulation included either a percutaneous nerve evaluation (PNE) or an advanced lead evaluation test phase (ALTP) before permanent SNM implantation. The test phases were performed under local anesthesia, either in the outpatient (PNE) or operating room (ALTP), in the prone position, which was implanted in the third or fourth sacral foramina under fluoroscopic guidance. Patients with favorable response to the initial test phase during the first 2 weeks underwent the implantable pulse generator (IPG) implantation (Medtronic neurostimulation generator device InterStim™). Favorable response was defined as ≥ 50% improvement in symptoms, frequency of clean intermittent catheterization (CIC) and/or decrease in postvoid residual (PVR), increase in voided volume, or improvement in bladder voiding efficiency (BVE) based on the bladder diary.

RESULTS: Fifty-eight patients were recruited with a mean age of 39.95 ± 15.28 years. Among the 58 cases, 36 (62.1%) patients responded to the initial stage. Of these, 12 patients (30.8%) with non-neurogenic etiology and nine patients (52.9%) with neurologic etiology did not respond to the initial test phase; thus, they did not undergo full implantation (p = 0.141). Voided volume, PVR, and the median maximum flow rate (Qmax) improved significantly (p < 0.001) in both sexes; however, there was no statistical difference between both genders. Most female cases (78.3%), and nearly half of the men (51.4%), responded to the test phase and were candidates for the IPG phase. Among the 35 cases who underwent IPG, 27 patients (72.2% of males, and 77.8% of females; p = 0.700) had a favorable response to IPG. 46.6% of patients had a successful outcome at the end of the study.

CONCLUSION: This multicentric study showed that SNM effectively and safely provided symptom improvement in refractory DU in males similar to females which is an important finding as previously it has been suggested that SNM works better in nonobstructive urinary retention in women and not in women.

PMID:35181913 | DOI:10.1002/nau.24893

J Dent Educ. 2022 Feb 18. doi: 10.1002/jdd.12892. Online ahead of print.

ABSTRACT

PURPOSE/OBJECTIVES: The objective of this retrospective study was twofold: it aimed to investigate dental students’ communication and physical exam self-assessment skills by comparing students’ self-evaluations with those completed by faculty and standardized patients (SPs). Second, it aimed to compare faculty and SPs assessment of students’ communication skills.

METHODS: At the end of their first year of training, students (n = 127), participated in one SP encounter about an initial dental consultation. Students completed self-assessment before receiving feedback from faculty (n = 19) and SPs (n = 19). The data source included evaluation forms submitted by students, faculty and SPs. The Wilcoxon signed rank test was used to compare the overall scores between groups. Agreement between evaluations items were analyzed with McNemar’s test (p < 0.05).

RESULTS: Overall, there were no statistically significant differences in how students and faculty graded for either communication (p = 0.6724) or physical exam (p = 0.1921) skills. However, both students and faculty provided less favorable marks than SPs for communication skills with a statistically significant difference in the overall grading between both students and SPs (p = 0.0146) and between faculty and SPs (p = 0.0045).

CONCLUSIONS: While there was disagreement between students and faculty versus SPs, they weren’t meaningful differences in scores and the dissimilarities mainly consisted of ratings of explanation skills. We suggest that, when applicable, dental student’s self-evaluations may represent an alternative to faculty assessments of communication and physical exam skills. Nonetheless, we recommend that SPs be included in the assessment of communication skills to provide students with comprehensive feedback that more realistically represents the natural patient-provider relationship.

PMID:35181888 | DOI:10.1002/jdd.12892