Nevin Manimala

Arch Orthop Trauma Surg. 2024 Dec 23;145(1):89. doi: 10.1007/s00402-024-05723-6.

ABSTRACT

OBJECTIVES: Distal femur fractures (DFF) are frequently treated surgically with single traditional constructs (STC), such as with a lateral plate or intramedullary nail, although nail-plate combination constructs (NPCC) are gaining attention. The purpose of this study is to compare outcomes between NPCC and STC for surgical fixation of DFF to guide surgeon decision-making.

METHODS: Data Sources: This study is a systematic review and meta-analysis using PubMed, CINAHL, MEDLINE, Web of Science, Science Direct, and SPORTDiscus from database inception until January 10th, 2024.

STUDY SELECTION: Inclusion criteria were comparative studies that examined clinical outcomes and complications for NPCC versus STC for DFF in adult patients.

DATA EXTRACTION: Data included operative time, estimated blood loss (EBL), length of stay (LOS), as well as likelihood of total complications, total unplanned reoperations, and malunion.

DATA SYNTHESIS: Statistical analysis included a random-effects model using unstandardized mean difference or odds ratio (OR).

RESULTS: Five retrospective comparative studies (n = 1,368 patients; mean age: 52.3 ± 8.1 years; 134 patients in the NPCC group) were included. There was no statistically significant difference in operative time (p = 0.696), EBL (p = 0.408), or LOS (p = 0.963) between patients in the NPCC group as compared to patients in the STC group after DFF. Patients in the NPCC group had a statistically significant lower number of total complications (p = 0.009; OR: 0.31; 10.6% versus 16.0%) and total unplanned reoperations (p = 0.027; OR: 0.42; 8.2% versus 14.8%) as compared to patients in the STC group after DFF. However, there was no statistically significant difference in the number of malunion cases between groups (p = 0.130), although the NPCC group had far fewer cases than the STC group (2.9% versus 10.5%).

CONCLUSION: Patients treated with NPCC had significantly fewer cases of total complications and total unplanned reoperations without significant differences in operative time, EBL, or LOS as compared to patients treated with STC for DFF, although these associations are limited by sample size.

LEVEL OF EVIDENCE: Level IV.

PMID:39714731 | DOI:10.1007/s00402-024-05723-6

Pulm Ther. 2024 Dec 23. doi: 10.1007/s41030-024-00281-z. Online ahead of print.

ABSTRACT

INTRODUCTION: Asthma is a complex condition characterized by airway inflammation. Interleukin-6 (IL-6) plays a significant role in asthma pathogenesis through its effects on T cells and its association with pro-inflammatory responses. Both lung and circulating IL-6 levels are elevated in asthma. IL-6 is positively associated with disease severity, frequent exacerbations, and impaired lung function, all of which can be observed clinically. We developed an IL-6 cut-off model to examine the association between high IL-6, race, high body mass index (BMI), metabolic disease, and asthma severity as assessed by reduced lung function.

METHODS: This study utilized the Coronary Artery Risk Development in Young Adults (CARDIA) database, comprised of 5115 adults, to investigate the relationship between IL-6 levels, asthma, race, and metabolic dysfunction. A “healthy” subset of 427 patients was used to compute the IL-6 cut-off. IL-6 levels within detection limits (0.15-12 pg/mL) were analyzed. The IL-6 cut-off was determined using the 95th percentile of log-transformed IL-6 values for lean (BMI < 25) and healthy individuals. Specific cut-offs were established for racial groups. Statistical analyses involved comparing patient characteristics between high and low IL-6 groups, regression analyses, and assessment of factors influencing lung function changes.

RESULTS: Using an IL-6 cut-off of 4.979 pg/mL, the cohort was divided into high and low IL-6 groups. High IL-6 correlated with Black race, higher BMI, hypertension, and markers of metabolic dysfunction, e.g., elevated HbA1c, C-reactive protein (CRP), and reduced lung function. Multivariable analysis linked high IL-6 with male gender, high BMI, Black race, HbA1c, CRP, and inversely with lung function and total cholesterol. Obesity showed a consistent positive association with elevated IL-6, regardless of the presence or absence of asthma. Patients with asthma and high IL-6 were more likely to be Black and showed increased CRP. Lung function was lowest in non-lean, high IL-6 patients with asthma, with similar trends in non-lean (BMI ≥ 25) patients without asthma.

CONCLUSION: This study underscores the significant association between IL-6, asthma, obesity, and metabolic dysfunction. Elevated IL-6 correlates with asthma severity, particularly in individuals with obesity. Future research should explore anti-IL-6 therapies for specific phenotypes, such as obesity-related asthma. These findings advance our understanding of asthma and the role of IL-6 in its pathogenesis.

PMID:39714726 | DOI:10.1007/s41030-024-00281-z

Phys Rev Lett. 2024 Dec 6;133(23):237101. doi: 10.1103/PhysRevLett.133.237101.

ABSTRACT

Optical simulators for the Ising model have demonstrated great promise for solving challenging problems in physics and beyond. Here, we develop a spatial optical simulator for a variety of classical statistical systems, including the clock, XY, Potts, and Heisenberg models, utilizing a digital micromirror device composed of a large number of tiny mirrors. Spins, with desired amplitudes or phases of the statistical models, are precisely encoded by a patch of mirrors with a superpixel approach. Then, by modulating the light field in a sequence of designed patterns, the spin-spin interaction is realized in such a way that the Hamiltonian symmetries are preserved. We successfully simulate statistical systems on a fully connected network, with ferromagnetic or Mattis-type random interactions, and observe the corresponding phase transitions between the paramagnetic and the ferromagnetic or spin-glass phases. Our results largely extend the research scope of spatial optical simulators and their versatile applications.

PMID:39714667 | DOI:10.1103/PhysRevLett.133.237101

Support Care Cancer. 2024 Dec 21;33(1):49. doi: 10.1007/s00520-024-09100-2.

ABSTRACT

PURPOSE: Compare the effects of low-intensity and moderate-intensity exercise on physical functioning in breast cancer survivors.

METHODS: Women aged 50 + years and post-primary treatment for stage 0 to III breast cancer were randomly assigned to a 6-month low-intensity (LIG) or moderate-intensity (MIG) exercise group. Participants were instructed to walk (low- or moderate-intensity) for 30 min five days a week, followed by flexibility exercises, and do strengthening and balance exercises twice weekly. Exercise adherence was facilitated with seven individual counseling sessions tapered over six months and a Theory of Planned Behavior-based booklet. Assessments occurred at baseline, 6 months (post-intervention), and 12 months. Primary measures were PROMIS Physical Functioning, PROMIS Global Health, and six-minute walk test (6MWT).

RESULTS: Of 101 women randomized, 65 (64.4%) completed the study. No statistically significant between-group differences occurred at post-intervention or 12 months. Compared to baseline, within-group improvements in PROMIS physical functioning occurred (LIG increased from 45.87 ± 7.58 to 48.37 ± 7.13 post-intervention (p = 0.01); MIG increased from 45.26 ± 7.27 to 49.53 ± 8.80 post-intervention (p = 0.002) and 48.91 ± 9.29 at 12 months (p = 0.02)). Similarly, Global Health physical health improved (LIG increased from 46.04 ± 5.00 to 49.19 ± 5.76 post-intervention (p = 0.001); MIG increased from 45.06 ± 6.59 to 48.20 ± 7.33 post-intervention (p = 0.005) and 48.49 ± 7.89 at 12 months (p = 0.007)). 6MWT improved between post-intervention and 12 months for the LIG (469.99 ± 64.69 m to 492.19 ± 68.64 m, p = 0.008) and between baseline and post-intervention for the MIG (471.01 ± 62.69 m to 495.88 ± 66.64 m, p = 0.006).

CONCLUSION: Both low and moderate-intensity exercise led to significant improvement in physical functioning. When feasible and acceptable, prescribing low-intensity exercise can yield important benefits.

TRIAL REGISTRATION NUMBER: ClinicalTrials.gov identifier: NCT02982564.

PMID:39714637 | DOI:10.1007/s00520-024-09100-2

Environ Monit Assess. 2024 Dec 23;197(1):94. doi: 10.1007/s10661-024-13562-6.

ABSTRACT

PM_2.5 pollution is a major global concern, especially in Vietnam, due to its harmful effects on health and the environment. Monitoring local PM_2.5 levels is crucial for assessing air quality. However, Vietnam’s state-of-the-art (SOTA) dataset with a 3 km resolution needs to be revised to depict spatial variation in smaller regions accurately. In this research, we investigated machine learning-based downscaling methods to improve the spatial resolution and quality of Vietnam’s existing 3 km PM_2.5 products using different approaches: traditional machine learning models (random forest, XGBoost, Catboost, support vector regression (SVR), mixed effect model (MEM)) and deep learning models (long short-term memory (LSTM), convolutional neural network (CNN), convolutional LSTM (ConvLSTM)). Overall, the CatBoost 2-day lag model exhibited superior performance. In terms of modeling, integrating temporal factors into tree-based models can enhance predictive accuracy. Furthermore, when faced with small datasets, traditional machine learning models demonstrate superior performance over complex deep learning approaches. The validation of machine and deep learning models based on their PM_2.5 generated maps is requested because these models can obtain very high results for model evaluation but are unrealistic for application. In this study, compared to the state-of-the-art (SOTA) PM_2.5 maps in Vietnam and the SOTA global maps, the proposed CatBoost 2-day lag model’s maps showed a 57% increase in the correlation coefficient (Pearson R), as well as 42-73%, 28-75%, and 39-75% reductions in root mean squared error (RMSE), mean relative error (MRE), and mean absolute error (MAE), respectively. Additionally, the daily, monthly, and year-average maps generated by the Catboost 2-day lag model effectively capture the spatial distribution and seasonal variations of PM_2.5 in Ho Chi Minh City. These findings indicate a substantial enhancement in the accuracy and reliability of downscaled PM_2.5 maps.

PMID:39714636 | DOI:10.1007/s10661-024-13562-6

Eur Radiol. 2024 Dec 23. doi: 10.1007/s00330-024-11315-0. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate the associations between gadolinium-based contrast agent (GBCA) administration and the occurrence of acute kidney injury (AKI) in pediatric patients, and to determine the risks associated with AKI.

MATERIALS AND METHODS: This retrospective study was conducted on pediatric patients who underwent contrast-enhanced or unenhanced MRI between January 1st, 2015, and June 30th, 2021. Examinations were included if they had data on height and serum creatinine levels within 3 months before and 2 days after the examinations. AKI was defined according to the AKI Network criteria. Multivariable generalized estimating equations, propensity score analyses, and inverse probability of treatment weighting analysis were used to evaluate associations between GBCA and AKI. Subgroup analyses were conducted to evaluate the interaction effects of GBCA and each subgroup variable (age, sex, examination type, admission type, chronic kidney disease stage, diabetes mellitus, cardiovascular disease, or surgery or contrast-enhanced CT performed 7 days before and 2 days after MRI).

RESULTS: A total of 2508 examinations were included (1996 with contrast-enhanced, 512 with unenhanced MRI). AKI occurred in 1.5% of the contrast group and 1.2% of the noncontrast group. Multivariable analysis showed no significant difference in AKI incidence between the groups (adjusted OR, 1.29 [95% CI: 0.53, 3.11]; p = 0.58). Propensity score matching and inverse probability of treatment weighting analysis also showed no significant association (p = 0.22 and p = 0.21, respectively). Subgroup analysis showed no significant interaction between GBCA and any of the subgroup variables.

CONCLUSION: The study found no significant association between gadolinium-based contrast agent administration and the occurrence of acute kidney injury in pediatric patients.

KEY POINTS: Question There is limited data on the development of acute kidney injury following exposure to gadolinium-based contrast agent in pediatric patients. Findings There was no significant association between the administration of gadolinium-based contrast agent and occurrence of acute kidney injury in pediatric patients. Clinical relevance The administration of gadolinium-based contrast agents does not increase the risk of acute kidney injury in pediatric patients following MRI.

PMID:39714605 | DOI:10.1007/s00330-024-11315-0

CHEST Crit Care. 2024 Dec;2(4):100103. doi: 10.1016/j.chstcc.2024.100103. Epub 2024 Oct 28.

ABSTRACT

BACKGROUND: A proposed new global definition of ARDS seeks to update the Berlin definition and account for nonintubated ARDS and ARDS diagnoses in resource-variable settings.

RESEARCH QUESTION: How do ARDS epidemiologic characteristics change with operationalizing the new global definition of ARDS in a resource-limited setting?

STUDY DESIGN AND METHODS: We performed a real-use retrospective cohort study among adult patients meeting criteria for the Berlin definition of ARDS or the global definition of ARDS at ICU admission in two public hospitals in the KwaZulu-Natal Department of Health, South Africa, from January 2017 through June 2022.

RESULTS: Among 5,760 adults (aged ≥ 18 years) admitted to the ICU, 2,027 patients (35.2%) met at least one ARDS definition, including 1,218 patients meeting the Berlin definition of ARDS (60.1% of all ARDS diagnoses) and 809 new diagnoses of the global definition of ARDS that were not captured by the Berlin definition alone (39.9% of all ARDS diagnoses and 14.0% of all ICU admissions). After adjustment for hospital-level factors, patients who met only the global definition of ARDS criteria (ie, who would not have been captured by the Berlin definition) showed no statistically significant ICU mortality difference vs patients with ARDS according to the Berlin definition (21.7% [95% CI, 18.9%-24.4%] vs 23.8% [95% CI, 21.5%-26.2%]; OR, 0.88 [95% CI, 0.70-1.10]; P = .25). In prespecified exploratory subgroup analyses, patients without COVID-19 who met only the criteria for the global definition of ARDS showed reduced ICU mortality (14.2% [95% CI, 11.6%-16.9%] vs 22.2% [95% CI, 19.8%-24.6%]; OR, 0.58 [95% CI, 0.45-0.75]; P < .0005) compared with patients without COVID-19 who met the Berlin definition for ARDS.

INTERPRETATION: The new global definition of ARDS captures a significant proportion of patients who would not have been included by the Berlin definition alone. These additional patients with ARDS may have heterogenous patterns of outcomes among diagnostic subgroups, including by COVID-19 status, compared with patients with ARDS according to the Berlin definition.

PMID:39711978 | PMC:PMC11661813 | DOI:10.1016/j.chstcc.2024.100103

Cytotechnology. 2025 Feb;77(1):22. doi: 10.1007/s10616-024-00683-6. Epub 2024 Dec 18.

ABSTRACT

The clinical evidence, complications and the pathogenesis of COVID-19 are not clearly understood. In COVID-19 patients, cellular immune response biomarkers and oxidative stress parameters have been used as gravity markers. Indeed, oxidative stress has been proposed to play an essential role in the genesis of COVID-19. In the present research, we investigated lipid peroxidation, protein oxidation, superoxide dismutase activity and the production of auto-antibodies against superoxide dismutase, in the blood of Tunisian patients with corona virus. To evaluate lipid peroxidation, plasma malondialdehyde and conjugated dienes, have been determined in 69 corona virus patients and 30 controls. To determine protein oxidation the thiol level was measured. Plasma superoxide dismutase activity has been measured in 30 corona virus patients and 30 controls on one hand. Utilizing a standard enzyme-linked immunosorbent assay, the level of immunoglobulin G (IgG), and M (IgM) directed against superoxide dismutase was evaluated. To investigate the implication of auto-antibody production in COVID-19 patients in the generation of oxidative stress, a correlation study between auto-antibodies production and oxidative stress parameters was performed. High levels of both malondialdehyde and conjugated dienes were found in the plasma of patients (p < 0.001, respectively). Protein oxidation was confirmed by the high level of thiol (p < 0.001). Superoxide dismutase activity was not significantly lower in COVID-19 patients (p > 0.05). The level of immunoglobulin G (IgG), and M (IgM) directed against superoxide dismutase is significantly higher in COVID-19 patients than in control group (p < 0.001 respectively). Statistical analyses have demonstrated a positive correlation between superoxide dismutase activity and IgM and IgG isotypes antibodies level against superoxide dismutase (p < 0.001). A strong positive correlation was observed between IgG and malondialdehyde level in all cases (r = 0.368; p ≤ 0.01). In addition, a significant positive correlation was noted between IgM and malondialdehyde (r = 0.290; p = 0.024). Similarly, two significant positive relationship was found between IgG / conjugated dienes (r = 0.356; p = 0.005) and between IgM / conjugated dienes (r = 0.285; p = 0.027).

PMID:39711970 | PMC:PMC11655737 | DOI:10.1007/s10616-024-00683-6

Front Oncol. 2024 Dec 6;14:1450388. doi: 10.3389/fonc.2024.1450388. eCollection 2024.

ABSTRACT

PURPOSE: The aim of this study was to evaluate the diagnostic value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) derived kinetic parameters with high spatiotemporal resolution in discriminating malignant from normal prostate tissues.

METHODS: Fifty patients with suspicious of malignant diseases in prostate were included in this study. Regions of interest (ROI) were manually delineated by experienced radiologists. Voxel-wise kinetic parameters were produced with the following tracer kinetic models (TKMs): Tofts model, extended Tofts model (ETM), Brix’s conventional two-compartment model (Brix), adiabatic tissue homogeneity model (ATH), and distributed parameter model (DP). The initial area under the signal-time curve (IAUC) with an uptake integral approach was also included. Mann-Whitney U test and receiver operating characteristic (ROC) curves were used to evaluate the capability of distinguishing tumor lesions from normal tissues. A p-value of 0.05 or less is considered statistically significant. ROI based parameters correlation analysis between DP and ETM were performed.

RESULTS: 624 lesions and 269 normal tissue ROIs were obtained. Thirty parameters were derived from the six kinetic models. Except for PS from Brix, statistically significant differences between lesions and normal tissues (P<0.05) were observed in other parameters.Ve from DP, ATH and Brix and PS from ATH have AUC values less than 0.6 in the ROC analysis. MTT, Vp and PS from DP, Ktrans from ETM and Tofts, E and PS from ATH, IAUC parameters and F from Brix have AUC values larger than 0.8. Ve and Vp from DP and ETM are correlated (r> 0.65). The correlation coefficient between Ktrans from ETM and PS from DP is 0.751.

CONCLUSION: MTT, Vp and PS from DP, Ktrans from ETM and Tofts, E and PS from ATH, F from Brix and IAUC parameters can be used to differentiate malignant lesions from normal tissues in the prostate.

PMID:39711955 | PMC:PMC11659129 | DOI:10.3389/fonc.2024.1450388

Front Oncol. 2024 Dec 6;14:1491943. doi: 10.3389/fonc.2024.1491943. eCollection 2024.

ABSTRACT

INTRODUCTION: Central nervous system (CNS) tumors are the second most prevalent malignant neoplasms in childhood, with surgical resection as the primary therapeutic approach. The immediate postoperative period following CNS tumor resection requires intensive care to mitigate complications associated with high morbidity and mortality.

OBJECTIVE: The primary aim of this study is to comprehensively describe the postoperative complications observed in pediatric patients who underwent primary CNS tumor resection and were subsequently admitted to the pediatric intensive care unit (PICU) at Hospital Universitario Fundación Valle del Lili in Colombia.

METHODS: We conducted a cross-sectional observational analysis of pediatric patients who underwent surgery for CNS tumors and were admitted to our PICU from January 2011 to December 2021. Clinical, histopathologic, and postoperative complication data were collected. A descriptive statistical analysis was performed using measures of dispersion and central tendency with a 95% confidence interval.

RESULTS: A total of 114 patients were included, of whom 55.3% were male. The median PICU stay was 4 days (2-7). The most common tumor type was embryonal (25.4%), followed by low-grade glioma (20.1%) and high-grade glioma (14.9%). Mechanical ventilation was required in 24.5% of patients, with a median extubation time of 3 days (2-9). In the immediate postoperative period, 6.14% of patients experienced CNS hemorrhage and 3.5% experienced intracranial hypertension. Common complications included motor deficits, facial paralysis, and sensory deficits. The mortality rate was 3.5%.

CONCLUSION: This study describes the postoperative complications, clinical challenges, and interventions observed in pediatric patients after CNS tumor resection in a resource-limited country. Our findings emphasize the importance of tailored interventions and multidisciplinary collaboration to optimize clinical outcomes. Future data comparison from centers sharing similar characteristics will play a crucial role in identifying best practices and enhancing outcomes globally.

PMID:39711949 | PMC:PMC11659208 | DOI:10.3389/fonc.2024.1491943