Category: Nevin Manimala

J Neurol. 2021 Aug 29. doi: 10.1007/s00415-021-10764-7. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the difference in clinical course after the first optic neuritis (ON) between aquaporin-4 IgG-associated disorder (AQPAD) and myelin oligodendrocyte glycoprotein-IgG-associated disorder (MOGAD) METHODS: In this study, 31 eyes in 24 patients with AQPAD and 26 eyes in 18 patients with MOGAD were included. The clinical course for the first 6 months after the first ON was monitored by a retrospective cohort study. Best-corrected visual acuity (BCVA) was observed before the onset and at nadir, 2 weeks (2 W), 1 month (1 M), 2 months (2 M), 3 months (3 M) and 6 months (6 M). The decimal BCVA was converted to the logarithm of the minimal angle of resolution (logMAR) for statistical analyses.

RESULTS: MOGAD eyes showed longer median number of days from ON onset to nadir (6.0 vs. 11.5, P = 0.012) and to treatment (7.0 vs. 11.0, P = 0.020) than AQPAD eyes. The median logMAR was higher in AQPAD eyes than in MOGAD eyes at nadir (2.00 vs. 1.77, P = 0.050), 2 W (1.85 vs. 0.40, P = 0.001), 2 M (0.023 vs. – 0.079, P = 0.032) and 3 M (0.046 vs. – 0.079, P = 0.002). The median time to recovery of BCVA to 0.7 was longer in AQPAD eyes than in MOGAD eyes (44.0 vs. 21.0 days, P = 0.024), but that to BCVA 1.0 was not different between the two disorders (168.0 vs. 40.0 days, respectively, P = 0.056).

CONCLUSION: Compared with MOGAD eyes, AQPAD eyes tended to show worse visual outcome even during the first ON episode.

PMID:34455476 | DOI:10.1007/s00415-021-10764-7

World J Urol. 2021 Aug 29. doi: 10.1007/s00345-021-03806-2. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of the article is to compare the results of using new screwed Amplatz sheath with results of the conventional Amplatz sheath regarding success and complications during percutaneous nephrolithotomy.

METHODS: 100 patients aged more than 18 years with renal calculi more than 2 cm with guy’s score 1 from December 2018 till July 2020 were randomly stratified by closed envelope in group A (50 patients) with using conventional sheath and group B (50 patients) with new screwed sheath. We exclude morbid obese patients and patients with contraindication for PNL.

RESULTS: There were no significant differences between both groups regarding patients demographic and stone demographic. Operative time and fluoroscopy time were significantly lower in group B rather than group A. Tract stability was in favor of group B as no tract loss recorded while in group A, 5 cases were recorded. In overall complications there were no significant differences between both groups. Bleeding was higher in group A (14%) than in group B (4%), but it was not statistically significant. Success rates were 78% for group A and 88% for group B but it was not statistically significant.

CONCLUSION: The screwed Amplatz sheath had showed less operative and fluoroscopy time. Also it enables urologists to have stable PNL tract. So it may be a promising tool to make PNL easier with higher success rate and lower complications.

PMID:34455455 | DOI:10.1007/s00345-021-03806-2

J Reconstr Microsurg. 2021 Aug 28. doi: 10.1055/s-0041-1733993. Online ahead of print.

ABSTRACT

BACKGROUND: Enhanced recovery after surgery (ERAS) protocols are effective in decreasing hospital length of stay and inpatient opioid consumption. Implementation of these protocols in abdominally based breast reconstruction has been successful. When a patient is a poor candidate for abdominally based flaps a popular secondary option is the profunda artery perforator (PAP) flap. We present our experience with implementation of our ERAS protocol in patients treated with PAP flaps for breast reconstruction.

METHODS: Retrospective review of patients treated with autologous breast reconstruction using PAP flaps before and after ERAS implementation were performed. Patient characteristics, postoperative oral morphine equivalents (OMEs), and flap data were collected.

RESULTS: A total of 87 patients were included in this study (58 patients in pre-ERAS and 29 patients in ERAS group). There was no statistical difference in patient age, comorbidities, smoking, and radiation between two groups. The ERAS group had statistically lower hospital length of stay (2.6 vs. 3.8 days), procedure time (315 vs. 433 minutes), postoperative day 0 (54.8 vs. 96.3), postoperative day 1 (29.9 vs. 57.7), and total opioid consumption (103.7 vs. 192.1). There was no statistical difference in average pain scores between two groups. Multivariate analysis revealed that procedure time significantly increased the amount of opioid consumption while ERAS implementation significantly reduced LOS and opioid consumption.

CONCLUSION: Use of an ERAS protocol in PAP flap breast reconstruction has not been previously studied. Our work shows that ERAS implementation in PAP flap breast reconstruction significantly reduces inpatient opioid use and length of hospital stay.

PMID:34454407 | DOI:10.1055/s-0041-1733993

J Reconstr Microsurg. 2021 Aug 28. doi: 10.1055/s-0041-1733978. Online ahead of print.

ABSTRACT

BACKGROUND: Studies reporting on the deep circumflex iliac artery (DCIA) free flap are restricted to a limited number of patients and areas of application. The aim of this review was to assess the reliability and versatility of the DCIA free flap during reconstruction.

METHODS: A comprehensive review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines using PubMed, Web of Science, Cochrane CENTRAL, and SCOPUS. A critical analysis of pooled data was performed to assess outcomes employing the DCIA free flap.

RESULTS: A total of 445 DCIA free flaps were included. The main recipient sites were head and neck (72.35%), lower extremity (20.67%), and upper extremity (6.74%). The main indications for reconstruction were tumor resection (73.8%) and trauma (17.43%). Fifty non-DCIA flaps were required to finalize the reconstruction of several defects. The pooled flap failure rate using the DCIA free flap was 4% (95% confidence interval: 1-8%). No significant heterogeneity was present across studies (Q statistic 22.12, p = 0.14; I ² = 27.68%, p = 0.139). Complication rates for head and neck and limb reconstruction were 57.37 and 40.16%, respectively. The average length and surface area of bone flaps were 7.79 cm and 22.8 cm², respectively. The area of the skin paddles was 117 cm².

CONCLUSION: The DCIA free flap has shown to be a versatile reconstructive alternative for head and neck and short-medium size limb defects. However, the complexity of functions, the recipient site location, and a potential large defect can detract from the use of the DCIA free flap as an initial reconstructive option for head and neck and extensive limb defects.

PMID:34454408 | DOI:10.1055/s-0041-1733978

Am J Emerg Med. 2021 Aug 18;50:352-355. doi: 10.1016/j.ajem.2021.08.036. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to evaluate the exertional heat stroke score (EHSS) system for the prognosis of exertional heat stroke (EHS) patients.

METHODS: Forty-two EHS patients who had been treated in our hospital between January 2017 and December 2019 were divided into two groups according to their prognosis, a survival group and a non-survival group. All the patients had received comprehensive EHS treatment after admission, and their EHSS parameters were collected within 24 h of admission, including body temperature, hepatorenal function, and coagulation function. A retrospective comparative evaluation was made of the effectiveness of the EHSS, the Acute Physiology and Chronic Health Evaluation II (APACHE II) and the Sequential Organ Failure Assessment (SOFA) in making an EHS prognosis.

RESULTS: Among 42 patients, 28 patients were treated successfully and discharged from the hospital, 5 were given a poor prognosis, and 9 died, amounting to a fatality rate of 21.42%. Univariate analysis showed that within 24 h of admission, the differences were statistically significant (p < 0.05) in the comparison of the following factors: lactate concentration, platelets, prothrombin time, fibrinogen, troponin, aspartate aminotransferase, total bilirubin, urinary creatinine, acute gastrointestinal injury, temperature, and Glasgow coma score. However, no statistically significant difference in blood pH was observed between the two groups of patients (p = 0.117). The EHSS, APACHE II, and SOFA scores of the survival group were significantly lower than those of the non-survival group (p < 0.001). The area under the receiver operating characteristic curve of the EHSS, APACHE II and SOFA scores were the area under the curve (AUC) _EHSS = 0.96 (0.901, 0.990), AUC _{Apache II} = 0.895 (0.802, 0.950), and AUC _SOFA = 0.884 (0.837, 0.964), respectively. Thus, the EHSS diagnostic efficacy of the survival group was significantly higher than that of the other two scores. In addition, the sensitivity and specificity of EHSS were higher than those of the APACHE II and SOFA scores.

CONCLUSION: The EHSS has a good diagnostic efficacy for the prognosis of EHS patients and is significantly higher than that of the APACHE II and SOFA scores. This finding provides a theoretical basis for further increasing the rescue success rate of EHS patients and improving their prognostic quality of life.

PMID:34454398 | DOI:10.1016/j.ajem.2021.08.036

EBioMedicine. 2021 Aug 25;71:103542. doi: 10.1016/j.ebiom.2021.103542. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with breast cancer presenting with single lymph node metastasis (from a sentinel node) experience prolonged survival compared to patients with multiple lymph node metastases (≥3). However, little information is available on the genetic and immunological characteristics of breast cancer metastases within the regional lymph nodes as they progress from the sentinel lymph node (SLN) downstream to multiple regional lymph nodes (MLNs).

METHODS: Genomic profiling was performed using a next-generation sequencing panel covering 520 cancer-related genes in the primary tumour and metastatic lymph nodes of 157 female patients with breast cancer. We included primary tumours, metastatic lymph nodes and adjacent clinically normal lymph nodes (20 patients from the SLN group and 28 patients from the MLNs group) in the whole transcriptome analysis.

FINDINGS: The downstream metastatic lymph nodes (P = 0.029) and the primary breast tumours (P = 0.011) had a higher frequency of PIK3CA mutations compared to the SLN metastasis. We identified a distinct group of 14 mutations from single sentinel node metastasis and a different group of 15 mutations from multiple nodal metastases. Only 4 distinct mutations (PIK3CA, CDK4, NFKBIA and CDKN1B) were conserved in metastases from both lymph node settings. The tumour mutational burden (TMB) was significantly lower in single nodal metastasis compared to the paired primary breast cancer (P = 0.0021), while the decline in TMB did not reach statistical significance in the MLNs group (P = 0.083). In the gene set enrichment analysis, we identified 4 upregulated signatures in both primary tumour and nodal metastases from the MLNs group, including 3 Epithelial-mesenchymal transition(EMT) signatures and 1 angiogenesis signature. Both the CD8/Treg ratio and the CD8/EMT ratio were significantly higher in adjacent normal lymph nodes from patients with a single metastasis in the SLN compared with samples from the MLNs group (P = 0.045 and P = 0.023, respectively). This suggests that the immune defence from the MLNs patients might have a less favourable microenvironment, thus permitting multiple lymph nodes metastasis.

INTERPRETATION: Single lymph node metastases and multiple lymph node metastases have significant differences in their molecular profiles and immune profiles. The findings are associated with more aggressive tumour characteristics and less favourable immune charactoristics in patients with multiple nodal metastases compared to those with a single metastasis in the sentinel node.

FUNDING: This work was supported by funds from High-level Hospital Construction Project (DFJH201921), the National Natural Science Foundation of China (81902828 and 82002928), the Fundamental Research Funds for the Central Universities (y2syD2192230), and the Medical Scientific Research Foundation of Guangdong Province (B2019039).

PMID:34454403 | DOI:10.1016/j.ebiom.2021.103542

Animal. 2021 Aug 25;15(9):100345. doi: 10.1016/j.animal.2021.100345. Online ahead of print.

ABSTRACT

One-third of beef calves fail to achieve adequate transfer of passive immunity (TPI) through timely ingestion of colostrum, which substantially increases their risk of preweaning morbidity and mortality. Two randomized clinical trials were designed to assess the impact of volume, immunoglobulin G (IgG) concentration, and feeding method of colostrum product on neonatal nursing behavior and TPI. In Trial 1, 47 calves were randomly assigned to receive one of three colostrum interventions by oro-esophageal tube feeder (OET): 1 L with 100 g/L IgG, 1.4 L with 70 g/L IgG, or 2 L with 100 g/L IgG. In Trial 2, 29 calves were randomly assigned to be fed 1 L of colostrum product with 100 g/L IgG by either nipple bottle (NB) or OET. Colostrum intervention (i.e. feeding of colostrum product) occurred within 60 minutes of birth. Cow-calf pairs were monitored by video surveillance in individual stalls for 24 h. Dam colostrum was collected at 10 minutes and calf serum was collected at 24-36 h after birth to assess IgG concentration. Differences among colostrum intervention groups on latency to stand and nurse were analyzed using Kaplan-Meier survival curves and Cox proportional hazard models. The impact of colostrum intervention group on TPI was assessed using multivariable linear regression modeling. In Trial 1, calves fed 1.4 L with 70 g/L IgG by OET nursed from their dams statistically significantly earlier compared to calves fed 1 L with 100 g/L IgG (P = 0.003) and calves fed 2 L with 100 g/L IgG (P = 0.008). Six of the 15 calves in the NB group in Trial 2 refused to consume part of the colostrum feeding offered by bottle and required follow-up tube feeding of the remaining volume. These calves were analyzed as a separate group (NB + OET). Calves fed 1 L by NB stood and nursed statistically significantly earlier than calves fed by OET (P = 0.005) or a combination of NB + OET (P = 0.003). Calf serum IgG concentrations were not statistically significantly different among colostrum intervention groups (P > 0.1). Overall, the colostrum interventions assessed in this study led to only one calf with failed TPI. While statistically significant differences in serum IgG concentrations were not detected in this study, subsequent nursing behavior did vary and was improved by feeding a moderate volume (1.4 L with 70 g/L IgG) of colostrum when using an OET, and by using the NB when feeding a smaller volume (1 L with 100 g/L IgG).

PMID:34454347 | DOI:10.1016/j.animal.2021.100345

Forensic Sci Int. 2021 Aug 19;327:110961. doi: 10.1016/j.forsciint.2021.110961. Online ahead of print.

ABSTRACT

Traumatic brain injury (TBI) is one of the leading causes of mortality and morbidity. The key component of TBI pathophysiology is traumatic axonal injury (TAI), commonly referred to as diffuse axonal injury (DAI). Coma is a serious complication which can occur following traumatic brain injury (TBI). Recently, studies have shown that the central orexinergic/ hypocretinergic system exhibit prominent arousal promoting actions. Therefore, the purpose of this study is to investigate by immunohistochemistry the expression of beta-amyloid precursor protein (β-APP) in white matter of parasagittal region, corpus callosum and brainstem and the expression of orexin-A (ORXA) in the hypothalamus after traumatic brain injury. RESULTS: DAI was found in 26 (53.06%) cases, assessed with β-APP immunohistochemical staining in parasagittal white matter, corpus callosum and brainstem. Orexin-A immunoreactivity in hypothalamus was completely absent in 5 (10.2%) of the cases; moderate reduction of ORXA was observed in 9 (18.4%) of the cases; and severe reduction was observed in 7 (14.3%) of the cases. A statistically significant correlation was found between β-APP immunostaining in white matter, corpus callosum and brainstem in relation to survival time (p < 0.002, p < 0.003 and p < 0.005 respectively). A statistically positive correlation was noted between ORX-A immunoreactivity in hypothalamus to survival time (p < 0.003). An inverse correlation was noted between the expression of β-APP in the regions of brain studied to the expression of ORX-A in the hypothalamus of the cases studied (p < 0.005). CONCLUSIONS: The present study demonstrated by immunohistochemistry that reduction of orexin-A neurons in the hypothalamus, involved in coma status and arousal, enhanced the immunoexpression of β-APP in parasagital white matter, corpus callosum and brainstem.

PMID:34454377 | DOI:10.1016/j.forsciint.2021.110961

Gen Hosp Psychiatry. 2021 Aug 14;72:131-140. doi: 10.1016/j.genhosppsych.2021.08.004. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine the prevalence of anxiety in general hospital inpatients by conducting a systematic review and meta-analysis of all relevant published studies.

METHOD: We searched Ovid Medline, Ovid Embase and Ovid PsycINFO from inception to December 2020. We included studies of the prevalence of anxiety symptoms of clinically significant severity (using cut-off scores on rating scales) and of the prevalence of anxiety disorders (using diagnostic interviews) in general hospital inpatients. Two independent reviewers assessed articles and extracted data. The review is registered with PROSPERO, number CRD42020189722.

RESULTS: We included 32 studies. Pooled prevalence estimates in random-effects meta-analyses were: anxiety symptoms 28% (95% CI 19% to 38%, 95% prediction interval 5% to 72%), any anxiety disorder 8% (95% CI 5% to 12%, 95% prediction interval 2% to 33%), panic disorder 3% (95% CI 2% to 4%, 95% prediction interval 1% to 8%), generalized anxiety disorder 5% (95% CI 3% to 8%, 95% prediction interval 1% to 23%). There was high heterogeneity in prevalence, little of which was explained in exploratory analyses of a limited number of potential determinants.

CONCLUSION: Anxiety symptoms of clinically significant severity affect more than one in four inpatients and anxiety disorders affect nearly one in ten.

PMID:34454342 | DOI:10.1016/j.genhosppsych.2021.08.004

Adv Med Sci. 2021 Aug 21;66(2):403-410. doi: 10.1016/j.advms.2021.08.001. Online ahead of print.

ABSTRACT

PURPOSE: Although coronavirus disease 2019 (COVID-19) primarily affects the pulmonary system, the involvement of the heart has become a well-known issue. Pulmonary CT plays an additive role in the diagnosis and prognosis of the disease. We aimed to investigate the association of echocardiographic indices with pulmonary CT scores and mortality in COVID-19 patients.

MATERIALS AND METHODS: A total of 123 patients diagnosed with COVID-19 were included in this study. The British Society of Thoracic Imaging (BSTI) score and echocardiographic parameters were calculated, and echocardiographic indices were compared between BSTI score grades.

RESULTS: During in-hospital follow-up, 36 of 123 patients (29.3%) had died. BSTI score, IVS, LVPWd, RV mid-diameter, RV basal diameter, RV longitudinal diameter, sPAP, and RVMPI were higher, and RVFAC, TAPSE, and RVS were lower in the non-survivor group than in the survivor group. There were statistically significant changes between BSTI scores in terms of LVPWd, RV mid diameter, RV basal diameter, RV longitudinal diameter, sPAP, RVFAC, RVMPI, and TAPSE. BSTI score was positively correlated with sPAP and RV basal diameter and negatively correlated with TAPSE and RVFAC. Multivariate logistic regression analysis demonstrated that sPAP (OR ​= ​1.071, p ​= ​0.002) and RV basal diameter (OR ​= ​1.184, p ​= ​0.005) were independent predictors of high BSTI scores (grade 4 and 5). Furthermore, age, sPAP, and a high BSTI score (grade 5) were independent predictors of in-hospital mortality in COVID-19 patients.

CONCLUSION: Echocardiographic indices were correlated with BSTI scores, and patients with higher BSTI scores had more cardiac involvement in COVID-19.

PMID:34454343 | DOI:10.1016/j.advms.2021.08.001