Nevin Manimala

J Shoulder Elbow Surg. 2023 Oct 13:S1058-2746(23)00732-2. doi: 10.1016/j.jse.2023.09.007. Online ahead of print.

ABSTRACT

BACKGROUND: There is still no consensus among surgeons on whether to perform a one or two-stage surgical revision in infected shoulder arthroplasties. The aim of this systematic review and meta-analysis is to rigorously synthesize published studies evaluating the clinical outcomes, recurrence of infection and other clinical complications, in order to discuss which is the best strategy for treating periprosthetic joint infection (PJI) after shoulder arthroplasty.

METHODS: Upon research using PubMed, SCOPUS and Web of Science databases, on November 2022, studies which presented one or two-stage surgical revision as a treatment for PJI after shoulder arthroplasty and assessed the reinfection rate on these patients, as well as other clinical outcomes, with a minimum follow-up of 12 months, were included. Study quality was evaluated using the MINORS score. Reinfection and complication rates were extracted and pooled estimates were calculated using the random-effect model.

RESULTS: After careful screening, 44 studies were included, 5 reporting on one-stage, 30 on two-stage revisions and 9 assessing both strategies. There were 185 shoulders reported in one-stage revision studies, and 526 shoulders in two-stage. The overall pooled random-effects reinfection rate was 6.68% (95%CI: 3.76-10.13), with low heterogeneity (I²=28%, p=0.03). One-stage revision showed a reinfection rate of 1.14% (95%CI:0.00-4.88) and two-stage revision analysis revealed a reinfection rate of 8.81% (95%CI:4.96-13.33). There were significant statistical differences between one and two-stage reinfection rates (p=0.04). The overall pooled rate for other clinical complications was 16.76% (95%CI:9.49-25.15), with high heterogeneity (I²=70%, p<0.01). One-stage revision had a complication rate of 6.11% (95%CI:1.58-12.39) and the two-stage revision complication rate was 21.26% (95%CI:11.51-32.54). This difference was statistically significant (p=0.03).

CONCLUSIONS: This is the first systematic review and meta-analysis showing significant statistical differences between one and two-stage surgical revision in infected shoulder arthroplasties. Provided the right conditions exist, one-stage revision shows better results in infection control, with lower clinical complications and possible better clinical outcomes.

PMID:37839627 | DOI:10.1016/j.jse.2023.09.007

J Theor Biol. 2023 Oct 13:111634. doi: 10.1016/j.jtbi.2023.111634. Online ahead of print.

ABSTRACT

Polarization is the process by which a macrophage cell commits to a phenotype based on external signal stimulation. To know how this process is affected by random fluctuations and events within a cell is of utmost importance to better understand the underlying dynamics and predict possible phenotype transitions. For this purpose, we develop a stochastic modeling approach for the macrophage polarization process. We classify phenotype states using the Robust Perron Cluster Analysis and quantify transition pathways and probabilities by applying Transition Path Theory. Depending on the model parameters, we identify four bistable and one tristable phenotype configuration. We find that bistable transitions are fast but their states less robust. In contrast, phenotype transitions in the tristable situation have a comparatively long time duration, which reflects the robustness of the states. The results indicate parallels in the overall transition behavior of macrophage cells with other heterogeneous and plastic cell types, such as cancer cells. Our approach allows for a probabilistic interpretation of macrophage phenotype transitions and biological inference on phenotype robustness. In general, the methodology can easily be adapted to other systems where random state switches are known to occur.

PMID:37839584 | DOI:10.1016/j.jtbi.2023.111634

World Neurosurg. 2023 Oct 13:S1878-8750(23)01449-3. doi: 10.1016/j.wneu.2023.10.044. Online ahead of print.

ABSTRACT

BACKGROUND: Cardiac complications are related to poor prognosis after spontaneous intracerebral hemorrhage (ICH). This study aims to predict the cardiac complications arising from small intracranial hematoma at ultra-early stage.

METHODS: The data of this work was derived from the Risk Stratification and Minimally Invasive Surgery in Acute Intracerebral Hemorrhage Patients (Risa-MIS-ICH) study (ClinicalTrials.gov Identifier: NCT03862729). This work included patients with ICH but without brain herniation, as confirmed by a brain computed tomography (CT) scan within 48 hours of symptom onset. Every Patient’s information recorded at the emergent department, including clinical, laboratory, electrocardiogram (ECG), and medical records, was derived from the electronic data capture (EDC). Cardiac complications were defined as the occurrence of myocardial damage, arrhythmias, and ischemic electrocardiogram changes during hospitalization. Variables associated with cardiac complications were filtrated by univariate and multivariate regression analyses. Independent risk factors were used to form the early predictive model. The restricted cubic splines were employed to investigate the non-linear associations in a more sophisticated and scholarly manner.

RESULTS: A total of 587 ICH patients were enrolled in this work, including 72 patients who suffered from cardiac complications after ICH. Out of the 78 variables, 24 were found to be statistically significant in the univariate logistic regression analysis. These significant variables were then subjected to multivariate logistic regression analysis and utilized for constructing risk models. Multivariate logistic regression analysis showed high plasma FIB level [odds ratio (OR) per standard deviation (SD) 1.327, 95% confidence intervals (CI) 1.037-1.697; P = 0. 024) ] and older age (OR per SD 1.777, 95% CI 1.344-2.349; P ＜0.001) were associated with a higher incidence of cardiac complications after ICH. High admission pulse rate (OR 0.620, 95% CI 0.451-0.853; P = 0. 003) was considered a protective factor for cardiac complications after ICH. In the restricted cubic spline regression model, FIB and cardiac complications following ICH were positively correlated and almost linearly (P for non-linearity = 0.073). The reference point for FIB in predicting cardiac complications after ICH was 2.64 g/L.

CONCLUSIONS: Emergent factors, including plasma FIB level, age, and pulse rate, might be independently associated with cardiac complications after ICH, which warrants attention in the context of treatment.

PMID:37839573 | DOI:10.1016/j.wneu.2023.10.044

Iran J Kidney Dis. 2023 Sep;17(5):263-270.

ABSTRACT

INTRODUCTION: With the development of information technology in medical treatment, mobile medical treatment has become a new way to seek treatment, follow-up, extended care, popular science, disease prevention and access to disease expertise. The application of mobile medical treatment is relatively mature in the management of chronic diseases. Currently, mobile medical intervention is also introduced in the self-management of patients after Renal Transplantation. Compared with traditional intervention methods, mobile medical treatment has the advantages of convenience, speed, low cost and no geographical restriction, and it is easy to be used by KT recipients in self-management and has good feasibility. Therefore, we conducted self-management intervention for patients after Renal Transplantation based on mobile medical procedures, so as to improve patients’ satisfaction, medication compliance, follow-up rate, and ease patients’ anxiety about the disease.

METHODS: A total of 160 discharged patients with stable recovery of transplanted Renal function who underwent renal transplantation surgery in our hospital from January 2021 to January 2023 were selected for retrospective analysis. According to the different intervention plan, the patients were divided into the intervention group and the comparison group, 80 cases each. Among them, the intervention group used the mobile medical application selfmanagement behavior intervention, and the comparison group used the conventional self-management behavior intervention. The differences of self-management behavior score, quality of life score, Basel score and anxiety score between the two groups of patients after Renal Transplantation were analyzed and compared.

RESULTS: After intervention, there were statistically significant differences in the scores of self-management behavior scale, Quality of life related rating scale, Basel Assessment scale and Self-rating Anxiety Scale between the intervention group and the control group (P < .05).

CONCLUSION: Mobile health intervention tools can provide efficient, comprehensive and accurate remote health intervention and professional support for patients, optimize the medical service system, and meet the social medical needs of high-quality nursing services. DOI: 10.52547/ijkd.7693.

PMID:37838936

Sci Rep. 2023 Oct 14;13(1):17477. doi: 10.1038/s41598-023-44790-4.

ABSTRACT

The study aimed to evaluate the effect of sleep deprivation on postural stability among physically active young adults. The study involved 22 physical education students. Average velocities and spatial distribution of the center of pressure displacements were taken as indicators of postural stability (double and one-leg standing). Two-way ANOVA with two factors of repeated measurements-“session” (control-experimental) and “daytime” (evening-morning)-was used. For indicators of the spatial distribution of the center of pressure in double stance with eyes open and eyes closed, and for average velocities for measurements with eyes closed, statistically significant interaction effects were found (at least p < 0.01, ƞ² > 0.36, power statistics > 0.90) with the general tendency of higher results in the morning in the session with sleep deprivation than in the control session. In one-leg standing, an increase of average velocities was observed in the control session, and no differences in the session with sleep deprivation (interaction effect: at least p < 0.01, ƞ² > 0.37, power statistics > 0.90). Besides spatial distribution indicators in double stance, there were no statistical differences between evening-morning tests in the session with sleep deprivation. Despite significant interaction effects, only the results of spatial distribution indicators in double stance were higher in the morning than in the evening in the session with sleep deprivation. So, no clear decline in postural stability after sleep deprivation was observed. This may suggest that sleep deprivation prevents natural regeneration rather than significantly worsening postural stability among physically active adults. It’s possible that systematic physical activity might be one of the factors decreasing the risk of accidents among people exposed to sleep deprivation.

PMID:37838825 | DOI:10.1038/s41598-023-44790-4

Sci Rep. 2023 Oct 14;13(1):17452. doi: 10.1038/s41598-023-43707-5.

ABSTRACT

The safety of prolonged high-altitude stays and exercise for physically fit post-myocardial infarction (MI) patients is unclear. Myocardial tissue hypoxia and pulmonary hypertension can affect cardiac function and electrophysiology, possibly contributing to arrhythmias. We included four non-professional male athletes, clinically stable after left ventricular MI (three with ST-segment elevation MI and one with non-ST-segment elevation MI) treated with drug-eluting stents for single-vessel coronary artery disease. Oxygen levels were reduced to a minimum of 11.8%, then restored to 20.9%. We conducted electrocardiography (ECG), ergometry, and echocardiography assessments in normoxic and hypoxic conditions. With an average age of 57.8 ± 3.3 years and MI history 37 to 104 months prior, participants experienced a significant increase in QTc intervals during hypoxia using Bazett’s (from 402 ± 13 to 417 ± 25 ms), Fridericia’s (from 409 ± 12 to 419 ± 19 ms), and Holzmann’s formulas (from 103 ± 4 to 107 ± 6%) compared to normoxia. This effect partially reversed during recovery. Echocardiographic signs of pulmonary hypertension during normobaric hypoxia correlated significantly with altered QTc intervals (p < 0.001). Despite good health and complete revascularization following MI, susceptibility to hypoxia-induced QTc prolongation and ventricular ectopic beats persists, especially during physical activity. MI survivors planning high-altitude activities should consult cardiovascular specialists with high-altitude medicine expertise.

PMID:37838799 | DOI:10.1038/s41598-023-43707-5

NPJ Precis Oncol. 2023 Oct 14;7(1):104. doi: 10.1038/s41698-023-00459-9.

ABSTRACT

Pancreatic ductal adenocarcinoma (PDAC) responds poorly to systemic treatment, including new immunotherapeutic approaches. Biomarkers are urgently needed for early disease detection, patient stratification for treatment, and response prediction. The role of soluble CD40 (sCD40) is unknown in PDAC. In this study, we performed a quantitative multiplex analysis of 17 immune checkpoint proteins in serum samples from patients with various stages of PDAC in a discovery study (n = 107) and analyzed sCD40 by ELISA in a validation study (n = 317). Youden’s J statistic was used for diagnostic cut-off optimization. A Cox proportional hazards regression model was applied in an empiric approach for prognostic threshold optimization. Kaplan-Meier estimator and multivariable Cox regression analyses were used for survival analysis. sCD40 was significantly increased in the serum of patients with PDAC compared to healthy cohorts and patients with IPMN. In the validation cohort, the area under the receiver operating characteristic (ROC) c-statistic was 0.8, and combining sCD40 with CA19-9 yielded a c-statistic of 0.95. sCD40 levels were independent of the tumor stage. However, patients who received neoadjuvant chemotherapy had significantly lower sCD40 levels than those who underwent upfront surgery. Patients with a sCD40 level above the empirical threshold of 0.83 ng/ml had a significantly reduced overall survival with a hazard ratio of 1.4. This observation was pronounced in patients after neoadjuvant chemotherapy. Collectively, soluble CD40 may be considered as both a diagnostic and prognostic non-invasive biomarker in PDAC.

PMID:37838778 | DOI:10.1038/s41698-023-00459-9

Sci Rep. 2023 Oct 14;13(1):17468. doi: 10.1038/s41598-023-44577-7.

ABSTRACT

Pregnant women are at high risk for iron deficiency anemia due to increased nutrient requirements during pregnancy. Despite high coverage of iron and folic acid supplementation (IFAS), low compliance is reported. The study aimed to assess compliance with IFAS and its associated factors among antenatal care (ANC) attendees in Wondo District, Southern Ethiopia. A facility-based cross-sectional study was conducted among 400 pregnant women. Pregnant women were selected through systematic random sampling. Pre-tested structured questionnaire was used to collect data through face to face interview. Data were entered into Epi-info and exported to Statistical Package for Social Sciences for analysis. The variables with p-value < 0.25 in the bivariable analysis were entered into the multivariable logistic regression model. P values less than 0.05 were considered significant. Results were reported as crude and adjusted odds ratios with 95% confidence intervals. The prevalence of compliance to IFAS was (177, 44.3%). Factors significantly associated with compliance to IFAS were maternal age ≥ 25 years [AOR 2.27, 95% CI (1.21, 4.28)], maternal education [AOR 2.62, 95% CI (1.43, 4. 79)], husband’s education [AOR 3.60, 95% CI (2.07, 6.25)], knowledge of anemia [AOR 4.40, 95% CI (2.65, 7.30)], and knowledge of IFA [AOR 2.21, 95% CI (1.40, 3.50)]. This study showed that compliance to IFAS was low. Maternal age, maternal education, husband’s education, knowledge about anemia and iron folic acid was found to be significantly associated with adherence to IFAS. Emphasis should be placed on young, uneducated mothers and their husbands.

PMID:37838766 | DOI:10.1038/s41598-023-44577-7

Sci Rep. 2023 Oct 14;13(1):17465. doi: 10.1038/s41598-023-44788-y.

ABSTRACT

To further explore the pharmacological effect of pachymaran, this article studied the inhibition of pachymaran on oxidative stress and genetic damage induced by formaldehyde. 40 adult Kunming male mice were randomly divided into four groups with different interventions. One week later, the contents of serum SOD, GR, MDA, DNA-protein crosslink (DPC), 8-hydroxydeoxyguanosine (8-OHDG) and DNA adduct were determined by ELISA. The results showed that there were statistically significant differences in the contents of SOD, GR and MDA among the four groups (P < 0.01). The activity of SOD and GR increased along with the increase of pachymaran dosage (SOD: r_s = 0.912, P < 0.01; GR: r_s = 0.857, P < 0.01), while the content of MDA showing a significant negative correlation (r_s = – 0.893, P < 0.01). There were statistically significant differences in the levels of DPC, 8-OHDG and DNA adduct among the four groups (DPC and DNA adduct: P < 0.01, 8-OHDG: P < 0.05), the concentration decreased along with the increase of pachymaran dosage (DPC: r_s = – 0.855, P < 0.01; 8-OHDG:r_s = – 0.412, P < 0.05, DNA adduct: γ_s = – 0.869, P < 0.01). It can be inferred that pachymaran can inhibit oxidative stress and DNA damage induced by formaldehyde with the dose-effect relationship.

PMID:37838763 | DOI:10.1038/s41598-023-44788-y

Sci Rep. 2023 Oct 14;13(1):17439. doi: 10.1038/s41598-023-44706-2.

ABSTRACT

We used a partial Mueller matrix polarimeter to measure the corneal anisotropic properties at three pupil sizes (dilated, natural, and constricted). The geometrical parameters of first order isochromes were described by quadrilaterals. These parameters are statistically significantly different between the three pupil sizes. The pupillary size changes do not influence the azimuth angle distribution α. The retardation R and birefringence distributions show asymmetry in the nasal-temporal cross-section. There are differences between pupil sizes for both nasal and temporal parts of the cornea for these distributions. Iridial light scattering and diffraction might be the reason for these differences.

PMID:37838761 | DOI:10.1038/s41598-023-44706-2