Category: Nevin Manimala

Acta Oncol. 2022 May 25:1-9. doi: 10.1080/0284186X.2022.2073186. Online ahead of print.

ABSTRACT

BACKGROUND: The effectiveness of abdominal compression for motion management in hepatobiliary-pancreatic (HPB) radiotherapy has not been systematically evaluated.

METHODS & MATERIALS: A systematic review was carried out using PubMed/Medline, Cochrane Library, Web of Science, and CINAHL databases up to 1 July 2021. No date restrictions were applied. Additional searches were carried out using the University of Manchester digital library, Google Scholar and of retrieved papers’ reference lists. Studies conducted evaluating respiratory motion utilising imaging with and without abdominal compression in the same patients available in English were included. Studies conducted in healthy volunteers or majority non-HPB sites, not providing descriptive motion statistics or patient characteristics before and after compression in the same patients or published without peer-review were excluded. A narrative synthesis was employed by tabulating retrieved studies and organising chronologically by abdominal compression device type to help identify patterns in the evidence.

RESULTS: The inclusion criteria were met by 6 studies with a total of 152 patients. Designs were a mix of retrospective and prospective quantitative designs with chronological, non-randomised recruitment. Abdominal compression reduced craniocaudal respiratory motion in the majority of patients, although in four studies there were increases seen in at least one direction. The influence of patient comorbidities on effectiveness of compression, and/or comfort with compression was not evaluated in any study.

CONCLUSION: Abdominal compression may not be appropriate for all patients, and benefit should be weighed with potential increase in motion or discomfort in patients with small initial motion (<5 mm). Patient factors including male sex, and high body mass index (BMI) were found to impact the effectiveness of compression, however with limited evidence. High-quality studies are warranted to fully assess the clinical impact of abdominal compression on treatment outcomes and toxicity prospective in comparison to other motion management strategies.

PMID:35611555 | DOI:10.1080/0284186X.2022.2073186

Lett Appl Microbiol. 2022 May 25. doi: 10.1111/lam.13746. Online ahead of print.

ABSTRACT

β-cyclodextrin glucosyltransferase (β-CGTase) is an essential enzyme to catalyze the biotransformation of starch into β-cyclodextrins (β-CD). β-CD has widespread applications in the biomedical, pharmaceutical, and food industries. The present study focused on β-CGTase production using an efficient natural microbial strain and statistical production optimization for enhanced production. The isolated organism Bacillus sp. NCIM 5799 was found to be 5μm short bacilli under FE-SEM and alkalihalophilic in nature. The β-CGTase production was optimized using a combination of Plackett-Burman design (PBD) and Central Composite Design – Response Surface Methodology (CCD-RSM). On PBD screening Na₂ CO₃ , peptone, and MgSO₄ .7H₂ O were found to be significant for optimal β-CGTase production, whereas the soluble starch and K₂ HPO₄ concentrations were found to be non-significant for β-CGTase production. The significant factors obtained after PBD were further optimized using CCD-RSM design. Peptone was found to have a significant interaction effect with Na₂ CO₃ , and MgSO₄ .7H₂ O and Na₂ CO₃ exhibited significant effect on production of CGTase. The production of β-CGTase was enhanced in the presence of peptone (3%) and Na₂ CO₃ (0.8%). CGTase production obtained was 156.76 U/ml when optimized using CCD-RSM. The final optimized medium (RSM) shows 7.7 and 5.4 fold high production as compared to un-optimized and one factor at a time production media.

PMID:35611566 | DOI:10.1111/lam.13746

EuroIntervention. 2022 May 25:EIJ-D-21-00846. doi: 10.4244/EIJ-D-21-00846. Online ahead of print.

ABSTRACT

BACKGROUND: In the MITRA-FR trial, transcatheter mitral valve repair (TMVR) was not associated with a 2-year clinical benefit in patients with secondary mitral regurgitation (SMR).

AIMS: This landmark analysis aimed at investigating a potential reduction of the hospitalisation rate for heart failure (HF) between 12 and 24 months after inclusion in the MITRA-FR trial in patients randomised to the intervention group (TMVR with the MitraClip device), as compared with patients randomised to the control group (guideline-directed medical therapy [GDMT]).

METHODS: The MITRA-FR trial randomised 307 patients with SMR for TMVR on top of GDMT (TMVR group; n=152) or for GDMT alone (control group; n=155). We conducted a 12-month landmark analysis in surviving patients who were not hospitalised for HF within the first 12 months of follow-up. The primary endpoint was the 1-year cumulative number of HF hospitalisations.

RESULTS: A total of 140 patients (TMVR group: 67; GDMT group: 73) were selected for this landmark analysis with similar characteristics at inclusion in the trial. The primary endpoint was 28 events per 100 patient-years in the TMVR group, as compared with 60 events per 100 patient-years in the GDMT group (hazard ratio [HR] 0.46, 95% confidence interval [CI]: 0.20-1.02; p=0.057).

CONCLUSIONS: In this landmark analysis of the MITRA-FR trial, the cumulative rate of HF hospitalisation between 12 and 24 months among patients treated with TMVR on top of GDMT was approximately half as many as those of patients treated with GDMT alone, a difference which did not reach statistical significance in the setting of a low number of events.

PMID:35611516 | DOI:10.4244/EIJ-D-21-00846

J Pediatr Hematol Oncol Nurs. 2022 May 25:27527530221092324. doi: 10.1177/27527530221092324. Online ahead of print.

ABSTRACT

Background: Acupressure is known to be a nursing intervention used to prevent chemotherapy-induced nausea and vomiting in children. Methods: This study was conducted to evaluate and compare the effectiveness of manual and wristband acupressure in the prevention of chemotherapy-induced nausea and vomiting in children. This double-blinded and placebo-controlled study was conducted with 44 children aged between 5 and 18 years receiving chemotherapy in a university hospital’s pediatric oncology clinic. Children were randomized into groups using a 2 × 2 factorial design: (a) The child who was given manual acupressure before the first chemotherapy was given placebo manual acupressure before the next chemotherapy; (b) the same child who was administered wristband acupressure before the first chemotherapy was administered placebo wristband acupressure before the next chemotherapy. After all interventions, the severity and number of episodes of nausea and vomiting and additional antiemetic needs in the children were monitored for 24 h. Results: In both groups, the severity and number of nausea and vomiting were lower according to their own placebo groups. Manual and wristband acupressure were effective in reducing the severity and number of nausea and vomiting, but manual acupressure was more effective in reducing the severity and number of nausea and vomiting in comparison to wristband acupressure (p < .05). No statistically significant difference was found between the groups regarding additional antiemetic drug use. Discussion: In this study, manual and wristband acupressure were determined to be effective in reducing the severity and number of nausea and vomiting related to chemotherapy.

PMID:35611515 | DOI:10.1177/27527530221092324

J Intensive Care Med. 2022 May 25:8850666221101856. doi: 10.1177/08850666221101856. Online ahead of print.

ABSTRACT

OBJECTIVES: Dysglycemia is associated with poor outcomes in critically ill patients,which is uncertain in patients with diabetes regarding to the situation of glucose control before hospitalization. This study was aimed to investigate the effect of the difference between the level of blood glucose during ICU stay and before admission to ICU upon the outcomes of critically ill patients with diabetes.

METHOD: Patients with diabetes expected to stay for more than 24hs were enrolled, HbA1c was converted to A1C-derived average glucose (ADAG) by the equation: ADAG = [ (HbA1c * 28.7) – 46.7 ] * 18^-1, blood glucose were measured four times a day during the first 7 days after admission, the mean glucose level(MGL) and SOFA (within 3, 5, and 7days) were calculated for each person, GAP_adm and GAP_mean was calculated as admission blood glucose and MGL minus ADAG, the incidence of moderate hypoglycemia(MH), severe hypoglycemia (SH), total dosage of glucocorticoids and average daily dosage of insulin, duration of renal replacement therapy(RRT), ventilator-free hours, and non-ICU days were also collected. Patients were divided into survival group and nonsurvival group according to survival or not at 28-day, the relationship between GAP and mortality were analyzed.

RESULTS: 431 patients were divided into survival group and nonsurvival group. The two groups had a comparable level of HbA1c, the nonsurvivors had greater APACHE II, SOFA, GAP_adm, GAP_mean-3, GAP_mean-5, GAP_mean-7 and higher MH and SH incidences. Less duration of ventilator-free, non-ICU stay and longer duration of RRT were recorded in the nonsurvival group. GAP_mean-5 had the greatest predictive power with an AUC of 0.807(95%CI: 0.762-0.851), the cut-off value was 3.6 mmol/L (sensitivity 77.7% and specificity 76.6%). The AUC was increased to 0.852(95%CI: 0.814-0.889) incorporated with SOFA₅ (NRI = 11.34%).

CONCLUSION: Glycemic GAP between the MGL within 5 days and ADAG was independently associated with 28-day mortality of critically ill patients with diabetes. The predictive power was optimized with addition of SOFA₅.

PMID:35611506 | DOI:10.1177/08850666221101856

Hand (N Y). 2022 May 25:15589447221093674. doi: 10.1177/15589447221093674. Online ahead of print.

ABSTRACT

BACKGROUND: Much has been written about the diagnosis and treatment of soft tissue mallet injuries. However, there has been little regarding the characteristics of this injury affecting patients’ prognosis. The purpose of this prospective study was to identify factors influencing the outcome of treatment of soft tissue mallet injuries.

METHODS: Patients diagnosed with soft tissue mallet injuries were enrolled prospectively in a protocol of dorsal splinting for 6 to 12 weeks, followed by weaning over 2 weeks and then evaluated at 6, 9, and ≥12 months.

RESULTS: Thirty-seven patients (38 digits) completed the study. Treatment success was defined as a final extensor lag of <15° and failure as a final extensor lag of ≥15°. Those failing splint treatment were older compared with those successfully treated. Patient compliance was significantly associated with a successful outcome. Factors that did not significantly affect success included time to treatment, initial injury severity, splinting duration, sex, and ligamentous laxity. Disabilities of Arm, Shoulder, and Hand scores >0 were not associated with treatment failure. Radiographic and clinical extension lag were statistically comparable.

CONCLUSIONS: This study shows strong association between the success of splint treatment, younger patient age, and compliance with the treatment protocol. Despite this finding, most patients did not report any functional limitations, irrespective of the treatment success. In contrast to prior results, time to treatment and initial extensor lag did not significantly affect treatment success.

PMID:35611505 | DOI:10.1177/15589447221093674

Phys Occup Ther Pediatr. 2022 May 24:1-24. doi: 10.1080/01942638.2022.2073801. Online ahead of print.

ABSTRACT

AIMS: Developmental Coordination Disorder (DCD) is a chronic condition affecting motor coordination in daily activities. While motor difficulties are well documented in this population, it is unclear how frequent and to what extent academic activities are affected. This systematic review aims to comprehensively summarize the knowledge regarding the prevalence and extent of academic difficulties in reading, writing and mathematics in school-aged children with DCD.

METHODS: Two independent reviewers analyzed original studies on academic difficulties in school-aged children with DCD. A binary random-effects model was used to calculate the pooled prevalence by academic difficulty. A random-effects model using standardized mean differences (g statistic) was calculated to estimate the extent of the academic difficulties.

RESULTS: Twenty-four studies were included. A pooled prevalence of 84% of handwriting difficulties and 89.5% of mathematical difficulties was reported. No pooled prevalence of difficulties could be calculated for the other academic outcomes. Children with DCD present with poorer performance in handwriting legibility (g = -1.312) and speed (g = -0.931), writing (g = -0.859), mathematics (g = -1.199) and reading (g = -1.193).

CONCLUSIONS: This review highlights the high frequency and severity of academic difficulties in children with DCD, specifically in mathematics, which stresses the importance of evaluating academic performance to target interventions to support optimal functioning in daily life.

PMID:35611495 | DOI:10.1080/01942638.2022.2073801

Acta Orthop. 2022 May 24;93:478-487. doi: 10.2340/17453674.2022.2743.

ABSTRACT

BACKGROUND AND PURPOSE: The main treatments for severe medial compartment knee arthritis are unicompartmental (UKR) and total knee replacement (TKR). UKRs have higher revision rates, particularly for aseptic loosening, therefore the cementless version was introduced. We compared the outcomes of matched cementless UKRs and TKRs.

PATIENTS AND METHODS: The National Joint Registry was linked to the English Hospital Episode Statistics and Patient Reported Outcome Measures (PROMs) databases. 10,552 cementless UKRs and 10,552 TKRs were propensity matched and regression analysis used to compare revision/reoperation risks. 6-month PROMs were compared. UKR results were stratified by surgeon caseload into low- (< 10 UKRs/year), medium- (10 to < 30 UKRs/year), and high-volume (≥ 30 UKRs/year).

RESULTS: 8-year cementless UKR revision survival for the 3 respective caseloads were 90% (95% CI 87-93), 93% (CI 91-95), and 96% (CI 94-97). 8-year reoperation survivals were 76% (CI 71-80), 81% (CI 78-85), and 84% (CI 82-86) respectively. For TKR the 8-year implant survivals for revision and reoperation were 96% (CI 95-97) and 81% (CI 80-83). The HRs for the 3 caseload groups compared with TKR for revision were 2.0 (CI 1.3-2.9), 2.0 (CI 1.6-2.7), and 1.0 (CI 0.8-1.3) and for reoperation were 1.2 (CI 1.0-1.4), 0.9 (CI 0.8-1.0), and 0.6 (CI 0.5-0.7). 6-month Oxford Knee Score (OKS) (39 vs. 37) and EQ-5D (0.80 vs. 0.77) were higher (p < 0.001) for the cementless UKR.

INTERPRETATION: Cementless UKRs have higher revision and reoperation rates than TKR for low-volume UKR surgeons, similar reoperation but higher revision rates for mid-volume surgeons, and lower reoperation and similar revision rates for high-volume surgeons. Cementless UKR also had better PROMs.

PMID:35611477 | DOI:10.2340/17453674.2022.2743

BJOG. 2022 May 24. doi: 10.1111/1471-0528.17230. Online ahead of print.

ABSTRACT

OBJECTIVE: Test the hypothesis potential missed opportunities for antenatal corticosteroids increase as gestational age decreases and are associated with adverse outcomes.

DESIGN: Observational cohort study.

SETTING: 24 US centers in the Neonatal Research Network.

POPULATION: Actively treated infants 22-25 weeks’ gestation and birth weight 401-1000 grams, without major birth defects, born 2006-2018.

METHODS: Potential missed opportunity was defined as no antenatal corticosteroids but did have prenatal antibiotics, and/or magnesium sulfate, and/or prolonged rupture of membranes. Poisson regression models adjusted for baseline characteristics.

MAIN OUTCOME MEASURES: Antenatal corticosteroid exposure, mortality, and severe intracranial hemorrhage or periventricular leukomalacia.

RESULTS: 6966 (87.5%) were exposed to antenatal corticosteroids, 454 (5.7%) had no exposure but potential missed opportunities for antenatal corticosteroid exposure, and 537 (6.7%) had no exposure and no evidence of potential missed opportunities. Compared with infants born at 25 weeks, potential missed opportunities for antenatal corticosteroid exposure were more likely at 22 weeks (adjusted relative risk (aRR) [95% CI] 11.06 [7.52-16.27]) and 23 weeks (3.24 [2.44-4.29]) but did not differ at 24 weeks (1.08 [0.82-1.42]). Potential missed opportunities for antenatal corticosteroids decreased over time at 22-23 weeks’ gestation. Antenatal corticosteroid exposed infants had lower risk of death (31.0% vs 54.8%; 0.77 [0.70-0.84]) and survivors had lower risk of severe brain injury (25.0% v 44.5%; 0.64 [0.55-0.73]) compared with infants with potential missed opportunities.

CONCLUSION: Potential missed opportunities for antenatal corticosteroid exposure increased with decreasing gestational age and were associated with higher rates of death and severe brain injury among actively treated periviable births.

PMID:35611472 | DOI:10.1111/1471-0528.17230

J Oral Rehabil. 2022 May 24. doi: 10.1111/joor.13343. Online ahead of print.

ABSTRACT

BACKGROUND: The symptomatology in Burning Mouth Syndrome (BMS) is complex and it should be considered in accordance with a biopsychosocial model.

OBJECTIVES: To evaluate the multidimensional aspects of pain with a complete battery of tests and to analyse its relationship with potential predictors such as mood disorders, sleep and quality of life.

METHODS: 40 patients with BMS vs an equal number of age and sex-matched healthy controls were enrolled. The VAS, SF-MPQ, BPI, PD-Q, BDI-II, STAI, PSQI, ESS, SF-36 and OHIP-14 were administered.

RESULTS: The scores of the VAS, SF-MPQ, BPI, PD-Q, BDI-II, STAI, PSQI, SF-36 and OHIP-14 were statistically significantly higher in the BMS patients than the controls (p < 0.001**). A strongly linear correlation between pain (VAS, SF-MPQ, BPI and PD-Q) and disease onset (STAI, BDI-II, PSQI and sub-items of SF-36 and OHIP-14) was found. In the multiple regression analysis, the contributions of the BDI-II and OHIP-14 were found to be statistically significant with the SF-MPQ, PD-Q and BPI in terms of severity and interference, while the contributions of the STAI and sleep were found to be statistically significant with the SF-MPQ and BPI in terms of severity and interference, respectively.

CONCLUSIONS: Pain tests are differently correlated with mood and quality of life. Therefore, a complete analysis of the patient requires several tools to better understand the multidimensional aspects of pain in BMS.

PMID:35611463 | DOI:10.1111/joor.13343