Category: Nevin Manimala

Pain Physician. 2021 Aug;24(5):E555-E563.

ABSTRACT

BACKGROUND: Quadratus lumborum (QL) block has shown promising analgesic efficacy in the adult population in previous meta-analyses. However, the response of the pediatric group to pain stimulation is stronger than that in the adult population, and the management of pediatric pain is constrained by limited available analgesia agents. All data analyzed during this study are collected from published articles.

OBJECTIVE: The purpose of our systematic review was to evaluate whether QL block is also an effective postoperative analgesic technique, compared to other analgesic skills in pediatric patients undergoing lower abdominal surgery.

STUDY DESIGN: A meta-analysis.

METHODS: We identified randomized controlled trials (RCTs) from PubMed, Embase, the Cochrane Library, Web of Science, and Science Direct to compare QL block with other analgesic methods for relief of postoperative pain in pediatric patients undergoing lower abdominal surgeries under general anesthesia. The primary outcome was the rate of postoperative rescue analgesia; secondary outcomes include: pain scores at 30 minutes and 1, 2, 4, 6, 12, and 24 hours postoperatively, patient satisfaction, and block related complications.

RESULTS: A total of 7 studies with 346 patients were included. QL block showed a significant reduction in the rate of postoperative rescue analgesia in the first 24 hours (RR = 0.41; 95% CI = 0.28 to 0.59; P < 0.001) compared to other analgesic techniques, without significant heterogeneity among the articles (I2 = 49%, P = 0.08). Compared with other analgesic methods, QL block significantly reduced the pain scores at 2 hours (Std.MD = -0.76; 95% CI = -1.16 to -0.35; P < 0.001) (I2 < 0.001%, P = 0.41), 4 hours (Std.MD = -0.34; 95% CI = -0.67 to -0.01; P = 0.04) (I2 < 0.001%, P = 0.53) and 12 hours postoperatively (Std.MD = -0.95; 95% CI = -1.44 to -0.47; P < 0.001) (I2 = 27%, P = 0.24). No significant differences were found between techniques at 30 minutes and 1, 6, or 24 hours postoperatively (P > 0.05). There was no statistically significant change in patient satisfaction (Std.MD = 0.49; 95% CI = -0.32 to 1.29; P = 0.24) or side effects (RD = -0.02; 95% CI = -0.06 to 0.02; P = 0.31) with QL block.

LIMITATIONS: The major limitation of this meta-analysis is the relatively few RCTs and limited results included. Similarly, the differences in block approaches among the control groups (TAP, ESP, caudal block, opioid-based analgesia), drug types and concentrations, and multimodal analgesia programs led to considerable heterogeneity. Furthermore, some relevant outcomes were not investigated.

CONCLUSION: Our systematic review and meta-analysis suggests QL block use for the pediatric population undergoing lower abdominal surgery, based on the current limited research evidence, as this method was an effective postoperative analgesic technique.

PMID:34323442

Pain Physician. 2021 Aug;24(5):E573-E581.

ABSTRACT

BACKGROUND: Mechanical compression on the trigeminal root entry zone (TREZ) by microvascular is the main etiology of primary trigeminal neuralgia (TN).

OBJECTIVES: To study the pathogenesis of TN, hub genes screening in the TREZ of TN in an animal model was performed.

STUDY DESIGN: A double blind, randomized study was designed in a controlled animal trial.

SETTING: The research took place in the Laboratory of Clinical Applied Anatomy at the School of Basic Medical Science of Fujian Medical University.

METHODS: Twelve male rats were randomly divided into a sham operation group and a TN animal model group. TN animal model was induced by chronic compression of trigeminal nerve root (CCT) operation. Gene expression in the TREZ were analyzed by RNA sequencing (RNA-Seq) technique. KEGG analysis, GO analysis, and PPI analysis were performed in the DEGs. Key signaling pathways analyzing by GSEA and the hub genes in the DEGs were also studied. Reverse transcription real-time polymerase chain reaction (RT-qPCR) was used to verify the RNA-Seq results.

RESULTS: Transcriptome data showed that 352 genes up-regulated and 59 genes down-regulated in DEGs on post-operation day 21, after CCT operation in the TN group. KEGG analysis revealed that, “neuroactive ligand receptor interaction” and “cytokine cytokine receptor interaction” may be related to the pathogenesis of TN. GO analysis showed “regulation of signing receptor activity”, “chemokine activity”, and “carbohydrate binging” may be related to TN. The RT-qPCR results were consistent with the test results, indicating that the transcriptome sequencing results were reliable.

LIMITATIONS: Although the incidence of TN in female rats was higher than in male rats, we only used male SD rats to establish the TN animal model, to avoid the effect of estrogen on experimental results. This study only presents some respects of RNA-Seq technique and, therefore, did not identify the DEGs at the protein level. The relationship between the DEGs at different levels shoud be done in the future.

CONCLUSIONS: Based on the results of RNA-seq, this study discovered 6 hub genes in the TREZ that are closely related to the TN animal model, which provide a potential breakthrough point to explore the pathogenesis of TN.

PMID:34323444

J Tissue Eng Regen Med. 2021 Jul 29. doi: 10.1002/term.3230. Online ahead of print.

ABSTRACT

The effort to develop an effective and safe temporomandibular joint (TMJ) disc substitute has been one of the mainstreams of tissue engineering. Biodegradable customized scaffolds could meet safety and effectiveness to regenerate a new autologous disc, rather than using non-biodegradable materials. However, it is still technically challenging to mimic the biomechanical properties of the native disc with biodegradable polymers. In this study, new 3D tailored TMJ disc implants were developed: (1) Poly(glycerol sebacate)-PGS scaffold reinforced with electrospun Poly(εcaprolactone)-PCL fibers on the outer surface (PGS+PCL); (2) PCL and polyethylene glycol diacrylate-PEGDA (PCL+PEGDA) and (3) PCL. The TMJ implants were tested in a randomized preclinical trial, conducted in 24 black Merino sheep TMJ, perfoming bilateral interventions. Histologic, imaging, and kinematics analysis was performed. No statistical changes were observed between the PGS+PCL disc and the control group. PCL+PEGDA and PCL groups were associated with statistical changes in histology (p=0.004 for articular cartilage mid-layer; p=0.019 for structure changes and p=0.017 for cell shape changes), imaging (p=0.027 for global appreciation) and dangerous material fragmentation was observed. No biomaterial particles were observed in the multi-organ analysis in the different groups. The sheep confirmed to be a relevant animal model for TMJ disc surgery and regenerative approaches. PCL and PCL+PEGDA discs presented a higher risk to increase degenerative changes, due to material fragmentation. None of the tested discs regenerate a new autologous disc, however, PGS+PCL was safe, demonstrated rapid resorption, and was capable to prevent condyle degenerative changes. This article is protected by copyright. All rights reserved.

PMID:34323386 | DOI:10.1002/term.3230

Plant Genome. 2021 Jul 29:e20118. doi: 10.1002/tpg2.20118. Online ahead of print.

ABSTRACT

Genomic selection (GS) is revolutionizing conventional ways of developing new plants and animals. However, because it is a predictive methodology, GS strongly depends on statistical and machine learning to perform these predictions. For continuous outcomes, more models are available for GS. Unfortunately, for count data outcomes, there are few efficient statistical machine learning models for large datasets or for datasets with fewer observations than independent variables. For this reason, in this paper, we applied the univariate version of the Poisson deep neural network (PDNN) proposed earlier for genomic predictions of count data. The model was implemented with (a) the negative log-likelihood of Poisson distribution as the loss function, (b) the rectified linear activation unit as the activation function in hidden layers, and (c) the exponential activation function in the output layer. The advantage of the PDNN model is that it captures complex patterns in the data by implementing many nonlinear transformations in the hidden layers. Moreover, since it was implemented in Tensorflow as the back-end, and in Keras as the front-end, the model can be applied to moderate and large datasets, which is a significant advantage over previous GS models for count data. The PDNN model was compared with deep learning models with continuous outcomes, conventional generalized Poisson regression models, and conventional Bayesian regression methods. We found that the PDNN model outperformed the Bayesian regression and generalized Poisson regression methods in terms of prediction accuracy, although it was not better than the conventional deep neural network with continuous outcomes.

PMID:34323393 | DOI:10.1002/tpg2.20118

Cytometry A. 2021 Jul 29. doi: 10.1002/cyto.a.24486. Online ahead of print.

NO ABSTRACT

PMID:34323357 | DOI:10.1002/cyto.a.24486

Int J Rheum Dis. 2021 Jul 29. doi: 10.1111/1756-185X.14195. Online ahead of print.

ABSTRACT

BACKGROUND: Fibromyalgia is a chronic pain syndrome of unknown etiology characterized by chronic widespread musculoskeletal pain and tenderness. It affects the quality of life of patients and has been associated with the human immunodeficiency virus (HIV). The study aimed to determine the prevalence of fibromyalgia in HIV-positive patients and assess the effect of fibromyalgia on their functional status.

METHODOLOGY: This was a cross-sectional study comprising 160 treatment-naive HIV-positive patients and 160 age- and sex-matched HIV-negative controls. The diagnosis of fibromyalgia was based on the 2011 modification of the 2010 American College of Rheumatology diagnostic criteria by assessing the widespread pain index and symptom severity score. The severity of fibromyalgia was assessed with the revised fibromyalgia impact questionnaire.

RESULTS: The prevalence of fibromyalgia in HIV-positive individuals was found to be 10.6%, which was significantly higher compared with controls (3.1%; P = .008). There was no significant association between fibromyalgia and age, gender, or occupation. There was a significant relationship between CD4 count levels (P < .001), WHO clinical stage (P < .001), and fibromyalgia. A statistically significant higher score on the Revised FM Impact Questionnaire was found in HIV-positive individuals with fibromyalgia (P < .001).

CONCLUSION: The study found that HIV-positive patients had a significantly higher incidence of fibromyalgia than controls and this was related to active indices of HIV disease. Fibromyalgia had a greater clinical impact on HIV patients than in controls. As a result, fibromyalgia should be identified and treated in people living with HIV.

PMID:34323376 | DOI:10.1111/1756-185X.14195

J Hum Nutr Diet. 2021 Jul 29. doi: 10.1111/jhn.12936. Online ahead of print.

ABSTRACT

OVERVIEW: This study examined the effect of a herbal supplement containing a Gynostemma pentaphyllum (Gpp) extract (ActivAMP®) on improving body composition in overweight males and females.

METHODS: One-hundred and seventeen men and women aged over 18 completed 16 weeks of daily supplementation with either Gpp or a placebo. Participants underwent dual-energy X-rays to assess body composition (fat mass, lean mass and mass distribution) as well as anthropometric measures (weight, height, hip and waist circumference) and blood tests to assess inflammatory and safety markers.

RESULTS: Following 16 weeks of treatment the Gpp group had a significant reduction in total body weight, BMI, total fat mass and gynoid fat mass compared to the placebo group. Blood measures showed plasma triglyceride, ALT and TNF-α statistically different between groups at week 16. Sub-group analysis of gender for fat distribution showed males in the Gpp group had a significant reduction in visceral fat compared to males in the placebo group and females in the Gpp group had a significant reduction in gynoid fat compared to the placebo group.

CONCLUSIONS: Gpp was capable of altering fat mass and fat distribution in overweight and obese males and females compared to a placebo. This article is protected by copyright. All rights reserved.

PMID:34323337 | DOI:10.1111/jhn.12936

Pediatr Infect Dis J. 2021 Jul 27. doi: 10.1097/INF.0000000000003179. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of the study was to identify early predictors of mortality in children with severe dengue fever admitted to pediatric intensive care unit (PICU).

MATERIALS AND METHODS: All consecutive children with laboratory-confirmed severe dengue fever were enrolled in this prospective observational study. Besides demographic data, disease severity and organ dysfunction scores, laboratory investigations and interventions are done in PICU were recorded and analyzed.

RESULTS: During the study period of 42 months, 172 patients with dengue fever were admitted to PICU. A total of 78 (45.3%) patients with severe dengue fever were included and analyzed. There were 20 (25.6%) deaths. There were significant differences in disease severity and organ dysfunction scores, transaminases, blood lactate level and serum creatinine between survivors and nonsurvivors. A significantly higher number of nonsurvivors required interventions in first 24 hours of admission. Platelet counts (P value 0.22) and hematocrit (P value 0.47) were not statistically different in 2 groups. There was a significantly high vasopressor-inotrope score (VIS) (<0.001) and positive fluid balance >10% (0.002) in nonsurvivors. Multivariate stepwise logistic regression analysis identified serum glutamic pyruvic transaminases (≥ 284 IU/L; odds ratio [OR] 1.002, 95% confidence interval [CI]: 1.001-1.003), blood lactate level (≥2.73 mmol/L; OR 2.08, 95% CI: 1.354-3.202), Pediatric Risk of Mortality score at 12 hours (≥14.5; OR 1.35, 95% CI: 1.077-1.693), VIS (≥22.5, OR 1.129, 95% CI: 1.059-1.204) and positive fluid balance >10% (OR 22.937, 95% CI: 2.393-219.84) at 24 hours of admission as independent predictors of mortality.

CONCLUSION: Disease severity, hyperlactatemia at admission, need for multiple vasoactive drugs and positive fluid balance are predictors of mortality in severe dengue infection in children admitted to PICU.

PMID:34321449 | DOI:10.1097/INF.0000000000003179

Med Sci Monit. 2021 Jul 29;27:e930000. doi: 10.12659/MSM.930000.

ABSTRACT

BACKGROUND Although percutaneous disc nucleoplasty (PDN) has been widely applied in treating lumbar disc herniation (LDH) in recent years, the efficacy of surgical levels for PDN on LDH has been reported in limited studies. This study aimed to explore and compare the efficacy of surgical levels (single level vs double level) of PDN in treating LDH. MATERIAL AND METHODS All patients diagnosed with LDH from January 2012 to December 2014 in our hospital who underwent PDN were included in this study. Patients were divided into a single-level group and double-level group based on the number of discs/surgical treatment levels. The improvement of visual analog scale (VAS) score, patient satisfaction, and reoperation occurrence were compared between the 2 groups. RESULTS Of 105 total patients, 75 patients were treated with single-level treatment and 30 patients with double-level treatment. VAS for leg pain and patient satisfaction scores in the double-level group were worse than those in the single-level group at 6 months after surgery (P<0.05). Among all 105 patients, the incidence of reoperation was 11.4%. Also, there was a marked difference in reoperation occurrence at 6 months after surgery between the single-level (6.7%) and double-level (23.3%) groups; however, the difference was not statistically significant (P=0.05). CONCLUSIONS PDN is a safe and minimal-invasive approach, which could effectively treat LDH. The number of surgical levels might be an important factor influencing the efficacy of PND. Caution should be exercised to strictly follow the clinical indications for nucleoplasty.

PMID:34321453 | DOI:10.12659/MSM.930000

J Cardiovasc Nurs. 2021 Jul 23. doi: 10.1097/JCN.0000000000000837. Online ahead of print.

ABSTRACT

BACKGROUND: For the 720 000 Americans expected to experience a new acute cardiac event this year, cardiac rehabilitation is an important part of recovery. Symptoms of depression and anxiety undermine recovery efforts, leaving recovering patients at risk for diminished functional capacity and heightened risk of mortality. Poor emotion regulation can worsen symptoms of depression and anxiety and hinder recovery efforts.

OBJECTIVE: The purpose of this randomized controlled trial was to evaluate the early efficacy testing of a theoretically based emotion regulation treatment (Regulating Emotions to Improve Self-management of Nutrition, Exercise, and Stress [RENEwS]) designed to assist survivors of an acute cardiac event in cardiac rehabilitation to optimize recovery.

METHODS: Survivors of an acute cardiac event in cardiac rehabilitation (n = 30, 83% men) were randomized to five 1-hour in-person group sessions of RENEwS or a phone-based attention-control group. Participants completed measures of depression and anxiety symptoms at 3 time points. Moderate to vigorous physical activity (MVPA) was objectively measured for 7 days at each time point using waist-worn actigraphy monitors. Between-group differences were calculated using analysis of variance with Cohen f effect sizes calculated to evaluate initial efficacy.

RESULTS: There was no statistically significant difference in depression, anxiety, or MVPA over time based on group assignment (all P > .05). Compared with attention control participants, in RENEwS participants, preliminary effects showed greater reductions in depression (Cohen f = 0.34) and anxiety (Cohen f = 0.40) symptoms but only modest improvements in MVPA from baseline to 5 months (Cohen f = 0.08).

CONCLUSIONS: Findings show that RENEwS is a promising emotion regulation intervention to enhance cardiac rehabilitation and potentially decrease symptoms of depression and anxiety.

PMID:34321436 | DOI:10.1097/JCN.0000000000000837