Nevin Manimala

Br J Sports Med. 2024 Jul 16:bjsports-2024-108211. doi: 10.1136/bjsports-2024-108211. Online ahead of print.

ABSTRACT

OBJECTIVES: This cohort study reported descriptive statistics in athletes engaged in Summer and Winter Olympic sports who sustained a sport-related concussion (SRC) and assessed the impact of access to multidisciplinary care and injury modifiers on recovery.

METHODS: 133 athletes formed two subgroups treated in a Canadian sport institute medical clinic: earlier (≤7 days) and late (≥8 days) access. Descriptive sample characteristics were reported and unrestricted return to sport (RTS) was evaluated based on access groups as well as injury modifiers. Correlations were assessed between time to RTS, history of concussions, the number of specialist consults and initial symptoms.

RESULTS: 160 SRC (median age 19.1 years; female=86 (54%); male=74 (46%)) were observed with a median (IQR) RTS duration of 34.0 (21.0-63.0) days. Median days to care access was different in the early (1; n_SRC=77) and late (20; n_SRC=83) groups, resulting in median (IQR) RTS duration of 26.0 (17.0-38.5) and 45.0 (27.5-84.5) days, respectively (p<0.001). Initial symptoms displayed a meaningful correlation with prognosis in this study (p<0.05), and female athletes (52 days (95% CI 42 to 101)) had longer recovery trajectories than male athletes (39 days (95% CI 31 to 65)) in the late access group (p<0.05).

CONCLUSIONS: Olympic athletes in this cohort experienced an RTS time frame of about a month, partly due to limited access to multidisciplinary care and resources. Earlier access to care shortened the RTS delay. Greater initial symptoms and female sex in the late access group were meaningful modifiers of a longer RTS.

PMID:39013617 | DOI:10.1136/bjsports-2024-108211

Br J Sports Med. 2024 Jul 16:bjsports-2023-108043. doi: 10.1136/bjsports-2023-108043. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate if daily treatment with glyceryl trinitrate (GTN) ointment, over 24 weeks combined with a 12-week eccentric exercise programme is more effective for chronic mid-portion Achilles tendinopathy than placebo ointment and eccentric exercise.

METHODS: This was a single-site randomised double-blind placebo-controlled trial at an acute hospital, Dublin, Ireland. Patients with chronic mid-portion Achilles tendinopathy were randomised to either 24 weeks of daily GTN ointment or placebo ointment. Both groups received an identical 12-week eccentric exercise programme. The primary outcome measure was the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire at 24 weeks, which measures pain, function and activity. Secondary outcomes included pain severity, self-reported physical function, calf muscle function, pressure pain thresholds and ultrasound changes. Statistical analyses were performed according to intention-to-treat principles.

RESULTS: 76 patients (30 women; 46 men, mean age±SD, 45.6±8.2 years) were recruited for the trial. Significant improvements in VISA-A scores occurred in both groups at 6-week, 12-week and 24-week follow-up. The increase was not significantly different between groups, adjusted mean between-group difference from baseline to week 6, -1.33 (95% CI -6.96 to 4.31); week 12, -1.25 (95% CI -8.0 to 5.49) and week 24, -3.8 (95% CI -10.6 to 3.0); negative values favour GTN. There was no significant between-group difference in any of the secondary outcome measures at 6, 12 and 24 weeks.

CONCLUSIONS: Adding daily GTN ointment over 24 weeks to a 12-week eccentric exercise programme did not improve pain, function and activity level in patients with chronic mid-portion Achilles tendinopathy when compared with placebo ointment.

PMID:39013615 | DOI:10.1136/bjsports-2023-108043

BMJ. 2024 Jul 16;386:q1107. doi: 10.1136/bmj.q1107.

NO ABSTRACT

PMID:39013563 | DOI:10.1136/bmj.q1107

BMJ. 2024 Jul 16;386:q1577. doi: 10.1136/bmj.q1577.

NO ABSTRACT

PMID:39013562 | DOI:10.1136/bmj.q1577

Korean J Ophthalmol. 2024 Jul 16. doi: 10.3341/kjo.2024.0020. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to determine the incidence and visual outcomes of pachychoroid neovasculopathy (PNV) in patients initially diagnosed with central serous chorioretinopathy (CSC).

METHODS: In this study, 144 patients aged 20-55 years with treatment-naïve chronic CSC, defined as the persistence of subretinal fluid (SRF) for 6 months, were retrospectively enrolled. Patients with PNV at the initial evaluation were categorized as Group 1, whereas those who developed new-onset PNV during follow-up were categorized as Group 2. Patients without PNV until the end of the follow-up were categorized as Group 3.

RESULTS: Over a mean follow-up period of 49.9 ± 39.9 months, new-onset PNV was diagnosed in 11.8% of patients with CSC. The time taken to reach the initial resolution was longest in Group 1 (11.13 ± 10.70, 8.14 ± 7.90, and 7.32 ± 9.55 months in Groups 1, 2, and 3, respectively), although these differences were not statistically significant. The numbers of injections needed to achieve initial resolution were 3.76 ± 5.90, 1.64 ± 2.06, and 1.74 ± 4.33 in Groups 1, 2, and 3, respectively, with no significant differences. SRF recurrence was recorded in 7 (29.2%) patients in Group 1, 9 (64.3%) in Group 2, and 28 (26.7%) in Group 3. The recurrence rates were significantly higher in Group 2 than those in Group 1 or Group 3. At the end of the follow-up period, significant improvements in best-corrected visual acuity were achieved in Groups 1 and 3, compared with baseline, but not in Group 2.

CONCLUSIONS: Patients with chronic CSC with new-onset PNV exhibited higher SRF recurrence and worse visual outcomes compared to those with initial PNV or those with chronic CSC without PNV. Our study emphasizes the importance of routine screening for prompt diagnoses of new-onset PNV in individuals with chronic CSC.

PMID:39013560 | DOI:10.3341/kjo.2024.0020

Nurs Health Sci. 2024 Sep;26(3):e13142. doi: 10.1111/nhs.13142.

ABSTRACT

Nursing preceptors play a crucial role in supporting and educating clinical students. Understanding the perceptions and needs of nurse preceptors is essential to enhance their role as preceptors and to improve their teaching practices. This study aimed to explore preceptorship in diverse settings and specific contexts. Content analysis was performed to analyze open-ended responses from a questionnaire based on nurses’ perceptions of preceptorship with undergraduate nursing students. Data were collected from two university hospitals, with different healthcare provision levels. Of the 370 responses, 295 (96%) were those of women, and 34.5% were in the age group of 41-50 years. Three main themes were identified: (1) the role of preceptorship as a key component in learning, (2) challenges in student preceptorship, and (3) personal recognition and compensation for teaching work. This study highlights the positive experiences and provides valuable insights into the challenges and opportunities faced by nurse preceptors in their teaching roles, and emphasizes the need for institutional support and educational programs to enhance their teaching responsibilities. Improving communication and collaboration among stakeholders is crucial for improving learning outcomes and satisfaction.

PMID:39013556 | DOI:10.1111/nhs.13142

Nurs Health Sci. 2024 Sep;26(3):e13144. doi: 10.1111/nhs.13144.

ABSTRACT

Moderate physical activity is related to reduced mortality in hemodialysis patients. However, most hemodialysis patients have low physical activity levels for complex reasons. This study investigated the determinants of moderate-to-high physical activity levels and whether psychosocial correlates are associated with engagement in moderate-to-high physical activity among hemodialysis patients. A cross-sectional survey was conducted with 134 hemodialysis outpatients, aged 64.7 years, in three hemodialysis centers in Taiwan. Data on sociodemographics, comorbidities, lifestyles, and psychosocial correlates, including perceived benefits, barriers, and self-efficacy of physical activity, were collected. Multiple logistic regression analyses were performed. Results showed that patients with moderate-to-high physical activity levels constituted a significantly lower proportion of current smokers and had fewer perceived physical activity barriers and higher self-efficacy of physical activity compared with those with low levels. After adjusting for potential sociodemographic covariates, current employment, nonsmoking status, and high self-efficacy of physical activity were significantly associated with moderate-to-high physical activity levels. Developing strategies to improve the self-efficacy of physical activity, support employment, and enhance anti-smoking campaigns in hemodialysis patients can help them engage in moderate-to-high levels of physical activity.

PMID:39013554 | DOI:10.1111/nhs.13144

Contemp Clin Trials. 2024 Jul 14:107633. doi: 10.1016/j.cct.2024.107633. Online ahead of print.

ABSTRACT

BACKGROUND: Early preterm birth (ePTB) – born before 34 weeks of gestation – poses a significant public health challenge. Two randomized trials indicated an ePTB reduction among pregnant women receiving high-dose docosahexaenoic acid (DHA) supplementation. One of them is Assessment of DHA on Reducing Early Preterm Birth (ADORE). A survey employed in its secondary analysis identified women with low DHA levels, revealing that they derived greater benefits from high-dose DHA supplementation. This survey’s inclusion in future trials can provide critical insights for informing clinical practices.

OBJECTIVE: To optimize a Phase III trial design, ADORE Precision, aiming at assessing DHA supplement (200 vs. 1000 mg/day) on reducing ePTB among pregnant women with a low baseline DHA.

METHODS: We propose a Bayesian Hybrid Response Adaptive Randomization (RAR) Design utilizing a finite mixture model to characterize gestational age at birth. Subsequently, a dichotomized ePTB outcome is used to inform trial design using RAR. Simulation studies were conducted to compare a Fixed Design, an Adaptive Design with early stopping, an ADORE-like Adaptive RAR Design, and two new Hybrid Designs with different hyperpriors.

DISCUSSION: Simulation reveals several advantages of the RAR designs, such as higher allocation to the more promising dose and a trial duration reduction. The proposed Hybrid RAR Designs addresses the statistical power drop observed in Adaptive RAR. The new design model shows robustness to hyperprior choices. We recommend Hybrid RAR Design 1 for ADORE Precision, anticipating that it will yield precise determinations, which is crucial for advancing our understanding in this field.

PMID:39013543 | DOI:10.1016/j.cct.2024.107633

Mitochondrion. 2024 Jul 14:101938. doi: 10.1016/j.mito.2024.101938. Online ahead of print.

ABSTRACT

Protein function is dependent on charge interactions and charge biased regions, which are involved in a wide range of cellular and biochemical processes. We report the development of a new algorithm implemented in Python and its use to identify charge clusters CC (NegativeCC: NCC, PositiveCC: PCC and MixedCC: MCC) and compare their presence in mitochondrial proteins of plant groups. To characterize the resulting CC, statistical, structural and functional analyses were conducted. The screening of 105,399 protein sequences showed that 2.6 %, 0.48 % and 0.03 % of the proteins contain NCC, PCC and MCC, respectively. Mitochondrial proteins encoded by the nuclear genome of green algae have the biggest proportion of both PCC (1.6 %) and MCC (0.4 %) and mitochondrial proteins coded by the nuclear genome of other plants group have the highest portion of NCC (7.5 %). The mapping of the identified CC showed that that they are mainly located in the terminal regions of the protein. Annotation showed that proteins with CC are classified as binding proteins, are included in the transmembrane transport processes, and are mainly located in the membrane. The CC scanning revealed the presence of 2373 and 784 sites and 192 and 149 motif profiles within NCC and PCC, respectively. The investigation of CC within pentatricopeptide repeat-containing proteins revealed that they are involved in correct and specific RNA editing. CC were proven to play a key role in providing insightful structural and functional information of complex protein assemblies which could be useful in biotechnological applications.

PMID:39013535 | DOI:10.1016/j.mito.2024.101938

Radiother Oncol. 2024 Jul 14:110437. doi: 10.1016/j.radonc.2024.110437. Online ahead of print.

ABSTRACT

PURPOSE: Re-irradiation (reRT) is an effective treatment modality for patients with recurrent glioma. Data on dose escalation, the use of simulated integrated boost and concomitant therapy to reRT are still scarce. In this monocentric cohort of n = 223 patients we investigated the influence of reRT dose escalation as well as the concomitant use of bevacizumab (BEV) with regard to post-recurrence survival (PRS) and risk of radionecrosis (RN).

PATIENTS AND METHODS: Patients with recurrent glioma treated between July 2008 and August 2022 with reRT with BEV, reRT with temozolomide (TMZ) and reRT without concomitant systemic therapy were retrospectively analyzed. PRS and RN-free survival (RNFS) were calculated for all patients using the Kaplan-Meier estimator. Univariable and multivariable cox regression was performed for PRS and for RNFS. The reRT Risk Score (RRRS) was calculated for all patients.

RESULTS: Good, intermediate and poor risk of the RRRS translated into 11 months, 9 months and 7 months of median PRS (univariable: p = 0.008, multivariable: p = 0.013). ReRT was applied with a dose of ≤36 Gy (n = 140) or >36 Gy (n = 83). Concomitant bevacizumab (BEV) therapy was performed in n = 122 and concomitant temozolomide (TMZ) therapy in n = 32 patients. Median PRS was 10 months in patients treated with >36 Gy and 8 months in patients treated with ≤36 Gy (univariable: p = 0.032, multivariable: p = 0.576). Regarding concomitant TMZ therapy, median PRS was 14 months vs. 9 months for patients treated with or without TMZ (univariable: p = 0.041, multivariable: p = 0.019). No statistically significant influence on PRS was seen for concomitant BEV therapy in this series. RN was less frequent for reRT with concomitant BEV, (17/122; 13.9 %) than for reRT without BEV (30/101; 29.7 %). Regarding RNFS, the hazard ratio for reRT with BEV was 0.436 (univariable; p = 0.006) and 0.479 (multivariable; p = 0.023), respectively. ReRT dose did not show statistical significance in regards to RN (univariable: p = 0.073, multivariable: p = 0.404). RNFS was longer for patients receiving concomitant BEV to reRT than for patients treated with reRT only (mean 31.7 vs. 30.9 months, p = 0.004).

CONCLUSION: In this cohort, in patients treated with concomitant BEV therapy RN was less frequently detected and in patients treated with concomitant TMZ longer PRS was observed. Based on these results, the best concomitant therapy and the optimal dose should be decided on a patient-by-patient basis.

PMID:39013502 | DOI:10.1016/j.radonc.2024.110437