Category: Nevin Manimala

J Long Term Eff Med Implants. 2021;31(3):15-26. doi: 10.1615/JLongTermEffMedImplants.2021038016.

ABSTRACT

A combination treatment using a retrograde intramedullary (IM) nail and a lateral locking plate has scarcely been described in distal femur fracture treatment. In this retrospective inquiry, we review 97 patients who were treated for distal femur fracture by one of five fellowship-trained orthopedic trauma surgeons at an urban level-1 trauma center. Of the 97 patients enrolled in this investigation, eight were treated with a combined nail-plate hybrid construct. The remaining 89 patients were treated with either traditional IM nailing (22 patients) or locking plate fixation (67 patients) alone. Patient demographics, fracture and injury characteristics, operative variables, radiographic information, and postoperative outcome measurements were recorded for each patient in the study. All eight patients who were treated with the combined nail-plate construct proceeded to fracture union (100% vs. 69% in the control group; p = 0.33). Both procedure duration (p = 0.006) and total fluoroscopy time (p = 0.004) were significantly higher in the nail-plate construct group. No statistically significant difference was found between the two groups regarding complication rate. A combined nail-plate construct is a successful treatment alternative for acute management of distal femur fractures. This technique may be most beneficial for patients at higher risk for nonunion (i.e., those with open, comminuted metaphysis fractures) or those with a need for an additional load-sharing construct (i.e, osteopenic or noncompliant patients).

PMID:34369718 | DOI:10.1615/JLongTermEffMedImplants.2021038016

J Long Term Eff Med Implants. 2021;31(3):27-32. doi: 10.1615/JLongTermEffMedImplants.2021036412.

ABSTRACT

AIM: The aim of the current study is to assess and evaluate the effectiveness of concentrated growth factors on wound healing after implant placement procedures.

METHODOLOGY: Twenty-four patients who underwent implant placement were included in the study and were divided into two groups (group 1 = non-CGF group; group 2 = CGF group). Conventional implant placement was done in both the groups followed by placement of CGF membrane and closure using 3-0 silk in the CGF group and only closure using 3-0 silk sutures in the control group. The patients were asked to report on the 3rd and 7th day respectively and the wound healing was assessed using an early wound healing index given by Lorenzo Marini.

STATISTICAL ANALYSIS: Shapiro-Wilk test was used to test the normality of the test, which was found to deviate from normal distribution and hence Mann-Whitney U test was employed to evaluate the statistical significance of the two independent samples.

RESULTS: The mean ± SD was found to be 6.17 ± 2.04 for the control (group 1) and 5.67 ± 0.51 for CGF group (group 2) on the 3rd day. The mean and SD of control group and test group on the 7th day was 7 ± 1.55 and 9.33 ± 1.63, respectively. The difference between the groups on the 7th day was found to be statistically significant (P value < 0.05).

CONCLUSION: Concentrated growth factor application had positive effects on surgical wound healing after implant placement.

PMID:34369719 | DOI:10.1615/JLongTermEffMedImplants.2021036412

J Magn Reson Imaging. 2021 Aug 9. doi: 10.1002/jmri.27877. Online ahead of print.

ABSTRACT

BACKGROUND: Knee assessment with and without load using magnetic resonance imaging (MRI) can provide information on knee joint dynamics and improve the diagnosis of knee joint diseases. Performing such studies on a routine MRI-scanner require a load-exerting device during scanning. There is a need for more studies on developing loading devices and evaluating their clinical potential.

PURPOSE: Design and develop a portable and easy-to-use axial loading device to evaluate the knee joint dynamics during the MRI study.

STUDY TYPE: Prospective study.

SUBJECTS: Nine healthy subjects.

FIELD STRENGTH/SEQUENCE: A 0.25 T standing-open MRI and 3.0 T MRI. PD-T₂ -weighted FSE, 3D-fast-spoiled-gradient-echo, FS-PD, and CartiGram sequences.

ASSESSMENT: Design and development of loading device, calibration of loads, MR safety assessment (using projectile angular displacement, torque, and temperature tests). Scoring system for ease of doing. Qualitative (by radiologist) and quantitative (using structural similarity index measure [SSIM]) image-artifact assessment. Evaluation of repeatability, comparison with various standing stances load, and loading effect on knee MR parameters (tibiofemoral bone gap [TFBG], femoral cartilage thickness [FCT], tibial cartilage thickness [TCT], femoral cartilage T₂ -value [FCT2], and tibia cartilage T₂ -value [TCT2]). The relative percentage change (RPC) in parameters due to the device load was computed.

STATISTICAL TEST: Pearson’s correlation coefficient (r).

RESULTS: The developed device is conditional-MR safe (details in the manuscript and supplementary materials), 15 × 15 × 45 cm³ dimension, and <3 kg. The ease of using the device was 4.9/5. The device introduced no visible image artifacts, and SSIM of 0.9889 ± 0.0153 was observed. The TFBG intraobserver variability (absolute difference) was <0.1 mm. Interobserver variability of all regions of interest was <0.1 mm. The load exerted by the device was close to the load during standing on both legs in 0.25 T scanner with r > 0.9. Loading resulted in RPC of 1.5%-11.0%, 7.9%-8.5%, and -1.5% to 13.0% in the TFBG, FCT, and TCT, respectively. FCT2 and TCT2 were reduced in range of 1.5-2.7 msec and 0.5-2.3 msec due to load.

DATA CONCLUSION: The proposed device is conditionally MR safe, low cost (material cost < INR 6000), portable, and effective in loading the knee joint with up to 50% of body weight.

EVIDENCE LEVEL: 1 TECHNICAL EFFICACY: Stage 1.

PMID:34369633 | DOI:10.1002/jmri.27877

Zhen Ci Yan Jiu. 2021 Jul 25;46(7):586-91. doi: 10.13702/j.1000-0607.200616.

ABSTRACT

OBJECTIVE: To evaluate the therapeutic effect and safety of transcutaneous electrical acupoint stimulation (TEAS) on epidural-related maternal fever in parturients undergoing epidural labor analgesia.

METHODS: A total of 198 primiparas with single birth, full-term pregnancy and head position were recruited and randomized into a TEAS group (98 cases) and a control group (100 cases). In the TEAS group, after epidural labor analgesia, TEAS was applied to bilateral Hegu (LI4) and Quchi (LI11), once an hour, for 30 min each time, till the end of childbirth. In the control group, after epidural labor analgesia, TEAS electrodes were attached to the same acupoints, but without electric stimulation. Maternal tympanic temperature and the score of Visual Analogue Score (VAS) were measured before analgesia, at 1, 2, 3, 4 and 5 h after analgesia and during labor respectively and maternal fever rate was evaluated in the parturients of two groups. Separately, before analgesia, 2 h after analgesia and during labor, the levels of serum interleukin (IL-6) and IL-1β were determined in the parturients of two groups. The duration of labor, the mode of labor, oxytocin dosage, postpartum hemorrhage, neonatal Apgar scores, time of labor analgesia, labor analgesic consumption and adverse effects were recorded in the parturients of two groups.

RESULTS: Maternal tympanic temperature increased progressively in two groups as analgesic time prolonged. Tympanic temperature at 3, 4 and 5 h after analgesia and du-ring labor, and maternal fever rate during labor in the TEAS group were all lower than those in the control group respectively (P<0.05). The levels of serum IL-6 and IL-1β increased after analgesia in the parturients of two groups. The serum IL-6 level during labor and the level of IL-1β at 2 h after analgesia and during labor in the parturients of the TEAS group were lower than those in the control group (P<0.05). The analgesic consumption in the TEAS group was less than that in the control group (P<0.05). The incidence of chills in the TEAS group was lower than that in the control group (P<0.05). The differences were not statistical in VAS score, duration of labor, mode of labor, oxytocin dosage, postpartum hemorrhage, time of labor analgesia and neonatal Apgar score, as well as the incidence of urine retention, nausea and vomiting and urinary retention between two groups (P>0.05).

CONCLUSION: Transcutaneous electrical acupoint stimulation at LI11 and LI4 is conductive to relieving epidural-rela-ted maternal fever and reducing serum levels of IL-6 and IL-1β in the parturients undergoing epidural labor analgesia. It is safe and effective in clinical application.

PMID:34369679 | DOI:10.13702/j.1000-0607.200616

J Cell Physiol. 2021 Aug 9. doi: 10.1002/jcp.30551. Online ahead of print.

ABSTRACT

Elevated plasma levels of plasminogen activator inhibitor-1 (PAI-1) are documented in patients with sepsis and levels positively correlate with disease severity and mortality. Our previous work demonstrated that visceral adipose tissues (VAT) are a major source of PAI-1, especially in the aged (murine endotoxemia), that circulating PAI-1 protein levels match the trajectory of PAI-1 transcript levels in VAT (clinical sepsis), and that PAI-1 in both VAT and plasma are positively associated with acute kidney injury (AKI) in septic patients. In the current study utilizing preclinical sepsis models, PAI-1 tissue distribution was examined and cellular sources, as well as mechanisms mediating PAI-1 induction in VAT, were identified. In aged mice with sepsis, PAI-1 gene expression was significantly higher in VAT than in other major organs. VAT PAI-1 gene expression correlated with PAI-1 protein levels in both VAT and plasma. Moreover, VAT and plasma levels of PAI-1 were positively associated with AKI markers, modeling our previous clinical data. Using explant cultures of VAT, we determined that PAI-1 is secreted robustly in response to recombinant transforming growth factor β (TGFβ) and tumor necrosis factor α (TNFα) treatment; however, neutralization was effective only for TNFα indicating that TGFβ is not an endogenous modulator of PAI-1. Within VAT, TNFα was localized to neutrophils and macrophages. PAI-1 protein levels were fourfold higher in stromal vascular fraction (SVF) cells compared with mature adipocytes, and among SVF cells, both immune and nonimmune compartments expressed PAI-1 in a similar fashion. PAI-1 was localized predominantly to macrophages within the immune compartment and preadipocytes and endothelial cells within the nonimmune compartment. Collectively, these results indicate that induction and secretion of PAI-1 from VAT is facilitated by a complex interaction among immune and nonimmune cells. As circulating PAI-1 contributes to AKI in sepsis, understanding PAI-1 regulation in VAT could yield novel strategies for reducing systemic consequences of PAI-1 overproduction.

PMID:34369600 | DOI:10.1002/jcp.30551

J Card Surg. 2021 Aug 9. doi: 10.1111/jocs.15888. Online ahead of print.

ABSTRACT

PURPOSE: Extracorporeal membrane oxygenation (ECMO) is a refractory treatment for acute respiratory distress syndrome (ARDS) due to influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, also referred to as coronavirus disease 2019 [COVID-19]). We conducted this study to compare the outcomes of influenza patients treated with veno-venous-ECMO (VV-ECMO) to COVID-19 patients treated with VV-ECMO, during the first wave of COVID-19.

METHODS: Patients in our institution with ARDS due to COVID-19 or influenza who were placed on ECMO between August 1, 2010 and September 15, 2020 were included in this comparative, retrospective study. To improve homogeneity, only VV-ECMO patients were analyzed. The clinical characteristics and outcomes were extracted and analyzed.

RESULTS: A total of 28 COVID-19 patients and 17 influenza patients were identified and included. ECMO survival rates were 68% (19/28) in COVID-19 patients and 94% (16/17) in influenza patients (p = .04). Thirty days survival rates after ECMO decannulation were 54% (15/28) in COVID-19 patients and 76% (13/17) in influenza patients (p = .13). COVID-19 patients spent a longer time on ECMO compared to flu patients (21 vs. 12 days; p = .025), and more COVID-19 patients (26/28 vs. 2/17) were on immunomodulatory therapy before ECMO initiation (p < .001). COVID-19 patients had higher rates of new infections during ECMO (50% vs. 18%; p = .03) and bacterial pneumonia (36% vs. 6%; p = .024).

CONCLUSIONS: COVID-19 patients who were treated in our institution with VV-ECMO had statistically lower ECMO survival rates than influenza patients. It is possible that COVID-19 immunomodulation therapies may increase the risk of other superimposed infections.

PMID:34369601 | DOI:10.1111/jocs.15888

Med Phys. 2021 Aug 9. doi: 10.1002/mp.15149. Online ahead of print.

ABSTRACT

PURPOSE: PET attenuation correction (AC) in PET/MR scanners constitutes a critical and barely explored issue in spinal cord investigation, mainly due to the limitations in accounting for highly attenuating bone structures which surround the spinal canal. Our study aims at evaluating the clinical suitability of MR-driven AC (MRAC) for ¹⁸ F-FDG-PET in spinal cord.

METHODS: Thirty-six patients, undergoing PET/CT and PET/MR in the same session for oncological examination, were retrospectively analyzed. For each patient, raw PET data from PET/MR scanner were reconstructed with 4- and 5-class MRAC maps, generated by hybrid PET/MR system (PET_MRAC4 and PET_MRAC5, respectively), and an AC map derived from CT data after a custom co-registration pipeline (PET_rCTAC), which served as reference. Mean PET standardized uptake values (SUV_m ) were extracted from the three reconstructed PET images by regions of interest (ROIs) identified on T2-weighted MRI, in the spinal cord, lumbar cerebrospinal fluid (CSF), and vertebral marrow at 5 levels (C2, C5, T6, T12, and L3). SUV_m values from PET_MRAC4 and PET_MRAC5 were compared with each other and with the reference by means of paired t-test, and correlated using Pearson’s correlation (r) to assess their consistency. Cohen’s d was calculated to assess the magnitude of differences between PET images.

RESULTS: SUV_m values from PET_MRAC4 were lower than those from PET_MRAC5 in almost all analyzed ROIs, with a mean difference ranging from 0.03 to 0.26 (statistically significant in the vertebral marrow at C2 and C5, spinal cord at T6 and T2, and CSF at L3). This was also confirmed by the effect size, with highest values at low spinal levels (d = 0.45 at T12 in spinal cord, d = 0.95 at L3 in CSF). SUV_m values from PET_MRAC4 and PET_MRAC5 showed a very good correlation (0.81 < r < 0.97, p < 0.05) in all spinal ROIs. Underestimation of SUV_m between PET_MRAC4 and PET_rCTAC was observed at each level, with a mean difference ranging from 0.02 to 0.32 (statistically significant in the vertebral marrow at C2 and T6, and CSF at L3). Although also PET_MRAC5 underestimates PET_rCTAC (mean difference ranging from 0.02 to 0.3), an overall decrease in effect size could be observed for PET_MRAC5, mainly at lower spinal levels (T12, L3). SUV_m from both PET_MRAC4 and PET_MRAC5 methods showed r value from good to very good with respect to PET_rCTAC (0.67 < r < 0.9 and 0.73 < r < 0.94, p < 0.05, respectively).

CONCLUSIONS: Our results showed that neglecting bones in AC can underestimate the FDG uptake measurement of the spinal cord. The inclusion of bones in MRAC is far from negligible and improves the AC in spinal cord, mainly at low spinal levels. Therefore, care must be taken in the spinal canal region and the use of AC map reconstruction methods accounting for bone structures could be beneficial. This article is protected by copyright. All rights reserved.

PMID:34369590 | DOI:10.1002/mp.15149

Brief Funct Genomics. 2021 Aug 9:elab034. doi: 10.1093/bfgp/elab034. Online ahead of print.

ABSTRACT

We propose the hierarchical Projective Adaptive Resonance Theory (PART) algorithm for classification of gene expression data. This algorithm is realized by combing transposed quasi-supervised PART and unsupervised PART. We develop the corresponding validation statistics for each process and compare it with other clustering algorithms in a case study of tuberculosis (TB). First, we use sample-based transposed quasi-supervised PART to obtain optimal clustering results of samples distinguished by time post-infection and the representative genes for each cluster including up-regulated, down-regulated and stable genes. The up- and down-regulated genes show more than 90% similarity to the result derived from Linear Models for Microarray Data and are verified by weighted k-nearest neighbor model on TB projection. Second, we use gene-based unsupervised PART algorithm to cluster these representative genes where functional enrichment analysis is conducted in each cluster. We further confirm the main immune response of human macrophage-like THP-1 cells against TB within 2 days is type I interferon-mediated innate immunity. This study demonstrates how hierarchical PART algorithm analyzes microarray data. The sample-based quasi-supervised PART extracts representative genes and narrows down the shortlist of disease-relevant genes and gene-based unsupervised PART classifies representative genes that help to interpret immune response against TB.

PMID:34369558 | DOI:10.1093/bfgp/elab034

East Mediterr Health J. 2021 Jul 29;27(7):656-664. doi: 10.26719/2021.27.7.656.

ABSTRACT

BACKGROUND: Efforts to reduce inappropriate hospital stay, including alternatives such as homecare, are important to improve patient care and reduce health care costs.

AIMS: This study evaluated inappropriate hospital stay in Shiraz, Islamic Republic of Iran and the extent to which these stays were due to lack of homecare services and others factors needed for homecare.

METHODS: This cross-sectional study was conducted between January 2018 and September 2019 at two public hospitals in Shiraz. All adult patients hospitalized in these two hospitals in the study period were included, except patients in mental care wards. Appropriateness of patients’ hospital stay was assessed on a daily basis using the Iranian version of the Appropriateness Evaluation Protocol. The chi-squared test was used to assess association between need for homecare and patient characteristics.

RESULTS: Of 6458 hospitalization days assessed (for 1954 patients), 710 (11.0%) days were inappropriate. The greatest proportion of causes of inappropriate stay were physician-related (32.9%). Of the 710 inappropriate hospitalization days, 231 were due to lack of homecare services. Most patients who were inappropriately hospitalized because of lack of homecare services were insured through Salamat insurance (64.0%). A statistically significant relationship was found between the need for homecare services and the type of health insurance (P = 0.01). Of the patients admitted to hospital because of lack of homecare services, 36.8% had endocrine diseases, especially diabetes, and 21.8% needed oxygen services.

CONCLUSION: Institutionalizing home health care in the Iranian health system could encourage more home health care referral and reduce inappropriate hospitalization, especially for diabetes.

PMID:34369579 | DOI:10.26719/2021.27.7.656

J Neurol Phys Ther. 2021 Aug 6. doi: 10.1097/NPT.0000000000000368. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: Falls are a major health concern after stroke. Spatial and temporal gait asymmetry and variability can contribute to instability and increased fall risk in persons with stroke (PwS). We aimed to quantify gait spatiotemporal symmetry and variability parameters in PwS undergoing rehabilitation in the subacute stage of the disease, by comparison to healthy participants, and to examine the associations between these parameters and patients’ reactive and proactive balance capacity.

METHODS: Twenty-two PwS and 12 healthy adults walked over a computerized treadmill system at their self-selected walking speed. Symmetry and variability of gait parameters (step length, swing time, and stance time) as well as upper extremity and lower extremity angular range of motion in the sagittal plane were extracted. In addition, the Berg Balance Scale (BBS) and the fall threshold in response to sudden surface translations at increasing intensities were assessed.

RESULTS: PwS demonstrated significantly higher asymmetry in all gait parameters in comparison to controls. Also, PwS demonstrated increased stance time variability in comparison to healthy controls and increased swing time variability in the paretic lower extremity. Significant negative associations were found between fall threshold and stance time asymmetry in PwS (r = -0.48, P = 0.022), between the BBS and swing time asymmetry (r = -0.50, P = 0.018), and between the BBS and stance time variability of the paretic lower extremity (r = -0.56, P = 0.006).

DISCUSSION AND CONCLUSIONS: Findings highlight the importance of gait temporal symmetry and variability measures for dynamic balance control after stroke. These parameters should be considered when assessing gait recovery and safety in PwS.Video Abstract available for more insight from the authors (see the Supplementary Video, available at: http://links.lww.com/JNPT/A355).

PMID:34369447 | DOI:10.1097/NPT.0000000000000368