Nevin Manimala

Abdom Radiol (NY). 2024 Dec 24. doi: 10.1007/s00261-024-04765-z. Online ahead of print.

ABSTRACT

OBJECTIVES: Implementation of diffusion-weighted imaging (DWI) for abdominal imaging in children has challenges due to motion artifacts exacerbated by long acquisition times. We aimed to compare acquisition time and image quality between conventional DWI and multi-band (MB) DWI of the liver in children and young adults.

METHODS: Clinical MRI exams from May 2023 to January 2024 were reviewed, including four DWI sequences: respiratory-triggered (RTr, clinical standard), free-breathing (FB), MB-DWI with shift factor 1 (MBsf1), and MB-DWI with shift factor 2 (MBsf2). Acquisition times were recorded, and signal intensity and apparent signal-to-noise ratio (aSNR) were calculated for the liver and spleen. Six blinded pediatric radiologists independently assessed image quality, artifacts, and lesion visualization on a 5-point Likert scale and identified their preferred sequence. Statistical comparisons were made using Kruskal-Wallis and ANOVA tests.

RESULTS: Median acquisition times were significantly reduced with MB-DWI (43 s for MBsf1/MBsf2) compared to FB (84 s) and RTr (240 s). Image quality and artifact scores were highest for RTr and FB sequences (p < 0.0001). Mean image quality scores were 3.7 (RTr, FB), 3.4 (MBsf1), and 3.5 (MBsf2), while artifact scores followed a similar trend (higher score = fewer artifacts). Lesion visualization scores were comparable across sequences (p = 0.11), and reviewers expressed no preference in 47% of cases. Apparent diffusion coefficient (ADC) values were consistent across all sequences (p > 0.05).

CONCLUSION: MB-DWI significantly reduces acquisition time while maintaining acceptable image quality and lesion visualization, making it a valuable option for pediatric abdominal MRI.

PMID:39718630 | DOI:10.1007/s00261-024-04765-z

Aesthetic Plast Surg. 2024 Dec 24. doi: 10.1007/s00266-024-04638-2. Online ahead of print.

ABSTRACT

BACKGROUND: Oncoplastic surgery for breast cancer patients poses the challenge of achieving optimal aesthetic outcomes without increasing the risk of complications. Omental flap has emerged as n reconstructive option in breast surgery, yet the efficacy and safety of large omental flaps remain uncertain. This study aims to conduct a systematic review and single-arm meta-analysis to comprehensively evaluate the effectiveness, safety, and cosmetic outcomes of large omental flap breast reconstruction, providing updated evidence for clinical practice.

METHODS: We systematically searched Embase, PubMed, Cochrane Library, and CNKI databases until August 2023. Studies were screened using inclusion and exclusion criteria. The quality of each study was evaluated with the Newcastle-Ottawa Scale. Meta-analysis was performed using R version 4.2.0.

RESULTS: A total of 22 studies with 1031 patients were reviewed and analyzed. Meta-analysis results showed that hematoma and seroma rate were 4.1% (95%CI 0.8-8.8, P < 0.01). The pooled cosmetic outcomes demonstrated excellent rate 56.7% (95%CI 46.4-69.3, P < 0.01), good rate 7.9% (95%CI 3.9-11.9, P < 0.01), fair rate 28.7% (95%CI 19.9-37.5, P < 0.01). The pooled blood loss was 110.74 ml (95%CI: 72.33-149.14, P = 0), hospital stays was 7.27 (95%CI 5.65-8.89, P < 0.01), the time of omental flap harvest was 65.63 min (95%CI 59.95-71.32, P < 0.01), the time for surgery was 240.87 min (95%CI 5.65- 8.89, P = 0).

CONCLUSIONS: This meta-analysis indicates that the omental flap in breast reconstruction is safe and effective with good cosmetic outcomes and a low incidence of complications. The study highlights the benefits of comprehensive assessment, warranting further investigation through high-quality studies and long-term follow-up.

LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

PMID:39718627 | DOI:10.1007/s00266-024-04638-2

Eur J Nutr. 2024 Dec 24;64(1):55. doi: 10.1007/s00394-024-03551-3.

ABSTRACT

PURPOSE: Although total dietary protein intake has been associated with bladder cancer (BC) risk, the effect of the origin (plant or animal) and the substitutions remain to be understood. This study aimed to investigate the effect of total dietary protein, animal-based protein, plant-based protein, and their substitutions with each other on the risk of BC using a pooled analysis of 10 cohort studies.

METHODS: The study was conducted within the “BLadder cancer Epidemiology and Nutritional Determinants” (BLEND) study, including 10 prospective cohort studies from several European countries, the United Kingdom, and the United States. Individual data from 10 prospective cohorts containing 434,412 participants (overall male/female ratio was almost 3:1) with a total of 4,224,643.8 person-years of follow-up was analyzed. Hazard ratios (HRs) and 95% confidence intervals (CIs) for BC risk for animal and plant-based protein substitutions of 30gram (g) per day (g/day) were estimated by multivariable adjusted HRs using Cox proportional hazards models.

RESULTS: During 11.4 years of follow-up, among 434,412 participants (73.28% female), 1,440 new cases of BC were identified. After multivariable adjustment, no association was observed between the intake of total, animal-based protein, and plant-based protein and BC risk. Replacement of every 30 g/day of animal-based protein intake by the same amount of plant-based protein intake or vice versa was not associated with the risk of BC.

CONCLUSION: In conclusion, our study found no association between protein intake-whether from animal or plant sources-and the risk of BC. Substituting animal-based protein with plant-based protein, or the reverse, did not influence BC risk. Future studies are required to provide information on the link between animal- and plant-based proteins and BC risk.

PMID:39718625 | DOI:10.1007/s00394-024-03551-3

Naunyn Schmiedebergs Arch Pharmacol. 2024 Dec 24. doi: 10.1007/s00210-024-03745-w. Online ahead of print.

ABSTRACT

The research investigated the capacity of myo-inositol (MI) in order that it improves biochemical markers in serum and follicular fluid and, ultimately, intracytoplasmic sperm injection (ICSI) outcomes of women with PCOS. Sixty infertile patients with PCOS, who were undergoing ovulation induction for ICSI, were randomly divided to two groups. The MI group received 2000 mg myo-inositol + 1 mg folic acid twice a day for 6 weeks with starting the ICSI cycle. For the same period, the control group received a placebo containing only folic acid (1 mg). Levels of hormonal profiles in serum and follicular fluid, as well as oxidative stress markers (MDA, TAC, GPx, and SOD), were estimated using an ELISA assay. Primary end points were ICSI cycle outcomes. Compared to the placebo group, the MI group demonstrated significant reduction in serum and follicular fluid levels of LH, LH/FSH ratio, total testosterone, AMH, and androstenedione. Furthermore, the MI group exhibited meaningful increases in TAC, GPx, and SOD, but MDA significantly decreased. While the number of retrieved and mature oocytes is not statistically similar among the groups, the MI group showed significant improvements in the percentage of immature oocytes, cleavage rate, and good embryo quality. A meaningful correlation was checked between follicular fluid AMH level and LH, FSH, total testosterone, androstenedione, insulin, MDA, the number of retrieved oocytes, and immature oocytes. Our outcomes indicate that myo-inositol administration in women with PCOS undergoing ART helps to improve their hormonal profiles, and the quality of oocytes and embryos. Registration details: Date: 2022.10.19, Registry: https://irct.behdasht.gov.ir/trial/66005 , and Trial registration: IRCT202220921056008N1.

PMID:39718613 | DOI:10.1007/s00210-024-03745-w

Naunyn Schmiedebergs Arch Pharmacol. 2024 Dec 24. doi: 10.1007/s00210-024-03733-0. Online ahead of print.

ABSTRACT

This study evaluates the protective effects of sinapic acid (SA), a polyphenolic compound with diverse biological activities, against ethanol-induced gastric ulcers in rats. A gastric ulcer model was established using ethanol (ETH), and the experimental groups received either omeprazole (OMEP, 20 mg/kg) or SA at doses of 20 mg/kg and 40 mg/kg via oral gavage for 14 days. Biochemical markers, including total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), malondialdehyde (MDA), and myeloperoxidase (MPO) activity, were assessed alongside proinflammatory cytokines (tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), and IL-6) using ELISA. Histopathological and immunohistochemical analyses were conducted to evaluate tissue integrity and apoptosis. Statistical analysis was performed using one-way ANOVA, followed by Tukey’s HSD test for post hoc comparisons. For non-parametric data, the Kruskal-Wallis test and Mann-Whitney U test were used. A p-value < 0.05 was considered statistically significant. Results revealed that SA significantly enhanced antioxidant defenses, as evidenced by elevated TAS levels and reductions in TOS, OSI, MPO activity, and MDA levels (p < 0.05). Additionally, SA treatment mitigated inflammation and apoptosis by decreasing TNF-α, IL-1β, IL-6, and Bax expression (p < 0.05). These effects were comparable to those observed with OMEP, a widely used clinical agent. Notably, the findings underscore SA’s potential as a novel therapeutic agent for managing ethanol-induced gastric ulcers. By targeting oxidative stress and inflammatory pathways, SA could complement or serve as an alternative to current treatment strategies. Future research should focus on exploring SA’s molecular mechanisms, dose optimization, and long-term efficacy in clinical settings, paving the way for its integration into therapeutic regimens for gastric mucosal injuries.

PMID:39718611 | DOI:10.1007/s00210-024-03733-0

Eur J Orthop Surg Traumatol. 2024 Dec 24;35(1):46. doi: 10.1007/s00590-024-04149-5.

ABSTRACT

BACKGROUND: Due to the specific anatomical features of the tibia (limited soft tissue coverage), more than a quarter of its fractures are classified as open, representing the most common open long-bone injuries. Open tibial fractures frequently cause significant bone comminution, periosteal stripping, soft tissue loss, contamination and are prone to bacterial entry with biofilm formation, which increases the risk of deep bone infection. The main objective of this study was to determine prevalence of infection and its associated factors in surgically treated open tibial fracture, at Addis Ababa Burn Emergency and Trauma (AaBET) hospital.

METHOD: A facility-based retrospective cross-sectional study was conducted among patient treated for open tibial fracture at AaBET hospital from September 2018 to September 2021. The data were collected from patient’s chart using a structured data collection form and entered and analyzed using SPSS version 26. Binary logistic regression was fitted to determine risk factors associated with surgically treated open tibial fracture. Multicollinearity was checked using variance inflation factor and tolerance. Model adequacy was tested using the Hosmer-Lemeshow goodness-of-fitness test, and adjusted odds ratio (AOR) with a 95% CI at p value < 0.05 was reported statistically significant.

RESULT: From a total of 235 patients enrolled in the study, 33.9% of the patients developed infection. Initial IV antibiotic time (AOR = 2.924, 95% CI 1.160-7.370) and time of wound closure from injury (AOR = 3.524, 95% CI 1.798-6.908), injury to admission time (AOR = 2.895, 95% CI 1.402-5.977) and definitive fixation method (AOR = 0.244, 95% CI 0.113-0.4508) were the factors found to had significantly increased the risk of the occurrence of infection.

CONCLUSION: The high rate of infection in open tibial fractures indicates that there is a need to improve the management of open tibial fractures treated at AaBET hospital. Significant delay of patient with open tibial fracture was found from in injury time to presentation to trauma center since majority of the cases were from peripheral health facility without getting prophylactic antibiotics.

PMID:39718604 | DOI:10.1007/s00590-024-04149-5

Elife. 2024 Dec 24;13:RP96312. doi: 10.7554/eLife.96312.

ABSTRACT

Chronic back pain (CBP) is a global health concern with significant societal and economic burden. While various predictors of back pain chronicity have been proposed, including demographic and psychosocial factors, neuroimaging studies have pointed to brain characteristics as predictors of CBP. However, large-scale, multisite validation of these predictors is currently lacking. In two independent longitudinal studies, we examined white matter diffusion imaging data and pain characteristics in patients with subacute back pain (SBP) over 6- and 12-month periods. Diffusion data from individuals with CBP and healthy controls (HC) were analyzed for comparison. Whole-brain tract-based spatial statistics analyses revealed that a cluster in the right superior longitudinal fasciculus (SLF) tract had larger fractional anisotropy (FA) values in patients who recovered (SBPr) compared to those with persistent pain (SBPp), and predicted changes in pain severity. The SLF FA values accurately classified patients at baseline and follow-up in a third publicly available dataset (Area under the Receiver Operating Curve ~0.70). Notably, patients who recovered had FA values larger than those of HC suggesting a potential role of SLF integrity in resilience to CBP. Structural connectivity-based models also classified SBPp and SBPr patients from the three data sets (validation accuracy 67%). Our results validate the right SLF as a robust predictor of CBP development, with potential for clinical translation. Cognitive and behavioral processes dependent on the right SLF, such as proprioception and visuospatial attention, should be analyzed in subacute stages as they could prove important for back pain chronicity.

PMID:39718010 | DOI:10.7554/eLife.96312

Endocrinol Diabetes Metab. 2025 Jan;8(1):e70020. doi: 10.1002/edm2.70020.

ABSTRACT

PURPOSE: To investigate the impact of clinical and socio-economic factors on glycaemic control and construct statistical models to predict optimal glycaemic control (OGC) after implementing intermittently scanned continuous glucose monitoring (isCGM) systems.

METHODS: This retrospective study included 1072 type 1 diabetes patients (49.0% female) from three centres using isCGM systems. Clinical data and net income from the census tract were collected for each individual. OGC was defined as time in range > 70%, with time below 70 mg/dL < 4%. The sample was randomly split in two equal parts. Logistic regression models to predict OGC were developed in one of the samples, and the best model was selected using the Akaike information criterion and adjusted for Pearson’s and Hosmer-Lemeshow’s statistics. Model reliability was assessed via external validation in the second sample and internal validation using bootstrap resampling.

RESULTS: Out of 2314 models explored, the most effective predictor model included annual net income per person, sex, age, diabetes duration, pre-isCGM HbA1c, insulin dose/kg, and the interaction between sex and HbA1c. When applied to the validation cohort, this model demonstrated 72.6% specificity, 67.3% sensitivity, and an area under the curve (AUC) of 0.736. The AUC through bootstrap resampling was 0.756. Overall, the model’s validity in the external cohort was 80.4%.

CONCLUSIONS: Clinical and socio-economic factors significantly influence OGC in type 1 diabetes. The application of statistical models offers a reliable means of predicting the likelihood of achieving OGC following isCGM system implementation.

PMID:39718005 | DOI:10.1002/edm2.70020

Philos Trans A Math Phys Eng Sci. 2024 Dec 30;382(2287):20230331. doi: 10.1098/rsta.2023.0331. Epub 2024 Dec 24.

ABSTRACT

The quantum interference effects of mixing the most non-classical states of light, number states, with the most classical-like of pure field states, the coherent state, are investigated. We demonstrate how the non-classicality of a single photon when mixed with a coherent field can transform the statistical properties of the output and further demonstrate that the entanglement of the output is independent of the coherent state amplitude.This article is part of the theme issue ‘The quantum theory of light’.

PMID:39717975 | DOI:10.1098/rsta.2023.0331

Eur J Ophthalmol. 2024 Dec 24:11206721241306142. doi: 10.1177/11206721241306142. Online ahead of print.

ABSTRACT

INTRODUCTION: Keratoconus patients turn to the internet for answers to their disease expectations. Webpages are not filtered or submitted to evaluation before getting published. We aim to evaluate the quality and readability of the online information regarding keratoconus in Portugal and Brazil.

METHODS: Two independent ophthalmologists and one ophthalmologist supervisor evaluated 30 Portuguese and 30 Brazilian websites by order of appearance in Google with the word “Queratocone” and “Ceratocone”, respectively. Two quality scores were used: a quality index of consumer health information (DISCERN) and the Journal of the American Medical Association (JAMA) benchmark. Readability was evaluated with 3 scores: FleschKincaid Reading Ease (FRE), FleschKincaid Grade (FKG) and Automated Readability Index (ARI).

RESULTS: Sites from private hospitals or clinics were the most prevalent in both countries, followed by health platform sites. Final JAMA benchmark was 1.13 ± 1.18 in Portugal and 1.07 ± 1.00 in Brazil. Final DISCERN was 34.07 ± 11.71 in Portugal and 38.17 ± 10.51 in Brazil. FRE and FKG scores denoted “difficult to read” and “college school level” in both countries; ARI denoted “professor” level in Portugal and “college student” level in Brazil needed to understand the text, a statistically significant difference. There was no correlation between Google ranking and quality and readability scores.

DISCUSSION AND CONCLUSIONS: The information on keratoconus available online to Portuguese-speaking patients is of poor quality and difficult to interpret. Ophthalmologists have a shared responsibility to tackle this challenge through multifold efforts. Educating our patients on how to find reputable websites can help them navigate their life with keratoconus.

PMID:39717969 | DOI:10.1177/11206721241306142