Nevin Manimala

Am J Kidney Dis. 2023 Oct 13:S0272-6386(23)00859-4. doi: 10.1053/j.ajkd.2023.08.017. Online ahead of print.

ABSTRACT

RATIONALE & OBJECTIVE: Head-to-head data comparing the effectiveness and safety of oral anticoagulants in patients with atrial fibrillation (AF) and advanced CKD are lacking. We compared the safety and effectiveness of warfarin or rivaroxaban vs. apixaban in patients with AF and non-dialysis CKD stages 4-5.

STUDY DESIGN: Propensity score matched cohort study.

SETTING: & Participants: Two nationwide U.S. claims databases, Medicare and Optum’s de-identified Clinformatics® Data Mart Database (01/01/2013-03/31/2022). New initiators of warfarin vs. apixaban (N = 12,488) and rivaroxaban vs. apixaban (N = 5720) with nonvalvular AF and CKD stage 4-5.

EXPOSURES: Warfarin, rivaroxaban or apixaban.

OUTCOMES: Primary outcomes included major bleeding and ischemic stroke. Secondary outcomes included all-cause mortality, major gastrointestinal bleeding, and intracranial bleeding.

ANALYTICAL APPROACH: Cox regression was used to estimate hazard ratios (HR) and 1:1 propensity score matching was used to adjust for 80 potential confounders.

RESULTS: Compared with apixaban, warfarin initiation was associated with a higher rate of major bleeding (HR 1.85; 95% CI 1.59-2.15), including major gastrointestinal bleeding (1.86; 1.53-2.25) and intracranial bleeding (2.15; 1.42-3.25). Rivaroxaban vs. apixaban was also associated with a higher rate of major bleeding (1.69; 1.33-2.15). All-cause mortality was similar for warfarin (1.08; 0.98-1.18) or rivaroxaban (0.94; 0.81-1.10) vs. apixaban. Furthermore, no statistically significant differences for ischemic stroke were observed for warfarin (1.14; 0.83-1.57) or rivaroxaban (0.71; 0.40-1.24) vs. apixaban, although confidence intervals were wide. Similar results were observed for warfarin vs. apixaban in the positive control cohort of patients with CKD stage 3, consistent with randomized trial findings.

LIMITATIONS: Few ischemic stroke events, potential residual confounding.

CONCLUSIONS: In patients with AF and advanced CKD, rivaroxaban and warfarin were associated with a higher rate of major bleeding compared with apixaban, suggesting a superior safety profile for apixaban in this high-risk population.

PMID:37839687 | DOI:10.1053/j.ajkd.2023.08.017

J Hepatol. 2023 Oct 13:S0168-8278(23)05144-9. doi: 10.1016/j.jhep.2023.09.017. Online ahead of print.

NO ABSTRACT

PMID:37839676 | DOI:10.1016/j.jhep.2023.09.017

Acta Trop. 2023 Oct 13:107040. doi: 10.1016/j.actatropica.2023.107040. Online ahead of print.

ABSTRACT

Anaplasma species are obligate intracellular rickettsial pathogens that cause significant diseases in animals and humans. Despite their importance, limited information on Anaplasma infections in Algeria has been published thus far. This study aimed to assess the infection rate, characterize Anaplasma species, and identify associated risk factors in selected sheep farms across Oum El Bouaghi region in Algeria. In 2018, we collected 417 blood samples from sheep and performed molecular characterization of Anaplasma species infecting these animals. This characterization involved the use of 16S rRNA, msp2, rpoB, and msp5 genes, which were analyzed through nested PCR, qPCR, cPCR, DNA sequencing, and subsequent phylogenetic analysis. Our findings revealed infection rates of 12.7% for Anaplasma species detected, with Anaplasma ovis at 10.8%, Anaplasma marginale at 1.7%, and Anaplasma platys at 0.2%. Interestingly, all tested animals were found negative for Anaplasma phagocytophilum. Statistical analyses, including the Chi-square test and Fisher exact test, failed to establish any significant relationships (p>0.05) between A. ovis and A. platys infections and variables such as age, sex, sampling season, and tick infestation level. However, A. marginale infection exhibited a significant association with age (p<0.05), with a higher incidence observed in lambs (5.2%) compared to other age groups. Remarkably, this study represents the first molecular detection of A. platys and A. marginale in Algerian sheep. These findings suggest that Algerian sheep may serve as potential reservoirs for these pathogens. This research contributes valuable insights into the prevalence and characteristics of Anaplasma infections in Algerian sheep populations, emphasizing the need for further investigation and enhanced surveillance to better understand and manage these diseases.

PMID:37839669 | DOI:10.1016/j.actatropica.2023.107040

Exp Eye Res. 2023 Oct 13:109678. doi: 10.1016/j.exer.2023.109678. Online ahead of print.

ABSTRACT

Progressive loss of retinal ganglion cells (RGCs) caused by retinal ischemia-reperfusion (IR) injury can lead to irreversible vision impairment, with neuroinflammatory responses playing an important role in this process. COG1410, a mimetic peptide of apolipoprotein E, has demonstrated protective potential in the central nervous system, but its effects on retinal IR injury remain unexplored. In this study, we established a mouse model of retinal IR injury to investigate the effects of COG1410 on retinal microglia and RGCs. We observed CD16/32-marked and CD206-marked microglia and RGCs using immunofluorescence staining, detected the expression of inflammatory factors by PCR, and evaluated retinal apoptosis with TUNEL staining. We further investigated the potential mechanism by detecting the expression of key proteins via western blot. The results reveal that COG1410 decreased the number of CD16/32-marked microglia and increased the number of CD206-marked microglia, alleviated the expression of IL-1β and TNF-α, and reduced the loss of RGCs by inhibiting the mitochondrial-related apoptotic pathway. COG1410 was found to increase the expression of ERK1/2 and Nr4a1 but decrease the expression of NF-κB. The expression of TREM2 showed an increasing trend after COG1410 administration, but it was not statistically significant. In conclusion, COG1410 regulates microglial states and protects RGCs in retinal IR injury, showing promising potential for the treatment of eye diseases.

PMID:37839665 | DOI:10.1016/j.exer.2023.109678

J Thorac Cardiovasc Surg. 2023 Oct 13:S0022-5223(23)00968-6. doi: 10.1016/j.jtcvs.2023.10.012. Online ahead of print.

ABSTRACT

OBJECTIVE: Guideline recommendations for mechanical or bioprosthetic (BP) valve for MVR by age remains controversial. We sought to determine bovine pericardial valve durability by age, and risk of reintervention.

METHODS: This retrospective study between 2 large university-based cardiac surgery programs examined patients who underwent BP MVR from 2004 to 2020. Follow-up was obtained through June 2022. Durability outcomes involving structural valve deterioration (SVD) were compared by age decile.

RESULTS: Of 1544 available patients, mean age was 66±13 years and 652 (42%) were < 65 years old. Indications for MVR were: MR>2+ 53% [n=813]; mitral stenosis 44% [n=650]; endocarditis 18% [n=277] and reoperation in 39% [n=602]. Concomitant procedures were AVR 28% [n=426]; Tricuspid valve 36% [n=550]; CAB 19% [n=290]. Thirty-day mortality was 5.4%. In follow-up (clinical: median [IQR] 75 [25-129] months) reoperation for endocarditis, and new stroke were low (0.30 and 1.06 per 100 patient/years, respectively). The cumulative incidence of MV reintervention for SVD among all patients was 6.2% at 10 years 9.0% at 12 years with no statistical difference in SVD among patients between the ages of 40 and 70 years (p=0.1). Among 90 patients with MV reintervention, 30-day mortality after reintervention was 4.7% (n=2) for 43 MViV and 6.4% (n=3) among 47 reoperation patients.

CONCLUSIONS: Bovine pericardial MVR is a durable option for younger patients. The opportunity to avoid anticoagulation and the associated risks with mechanical MVR may be of benefit to patients. These insights may provide data needed to revise the current guidelines.

PMID:37839657 | DOI:10.1016/j.jtcvs.2023.10.012

J Shoulder Elbow Surg. 2023 Oct 13:S1058-2746(23)00717-6. doi: 10.1016/j.jse.2023.09.006. Online ahead of print.

ABSTRACT

BACKGROUND: Several risk factors have been identified for the development of postoperative shoulder stiffness, and there has been increasing interest in orthopedic literature regarding patient-reported allergy (PRA) as an identifiable risk factor for adverse outcomes. The purpose of this study is to determine whether PRAs are associated with subsequent rates of diagnosis of adhesive capsulitis (AC) or return to the operating room for postoperative shoulder stiffness within two years following arthroscopic rotator cuff repair (ARCR).

METHODS: Patients were retrospectively identified using Current Procedural Terminology surgical billing codes to identify patients who underwent ARCR at a single urban academic institution from January 2012 to December 2020 with minimum 2-year follow-up. Lysis of adhesions (LOA), MUA, and adhesive capsulitis of the shoulder were further queried within two years postoperatively for the ipsilateral shoulder. Patients were excluded if they had undergone ipsilateral MUA/LOA or received a diagnosis of AC prior to the index procedure. Demographic characteristics and medical comorbidities (hypertension, diabetes, hyperlipidemia, hypothyroidism) were extracted from electronic medical records. Baseline characteristics were compared between patients with and without PRAs. Multivariate logistic regression analyses were performed to determine the association of the presence of PRAs overall, as well as presence one, two, or three or more PRAs, with subsequent MUA/LOA or diagnosis of AC within two years postoperatively.

RESULTS: Of 7,057 patients identified in the study period, 6,583 patients were eligible for the final analysis. The mean age was 56.6±11.7 years and the mean BMI was 29.1±5.6. Overall, 19.3% of patients (n=1,271) reported at least one allergy and 7.1% (n=469) had >1 PRA. 44 patients (0.7%) underwent subsequent ipsilateral MUA/LOA within two years postoperatively, while 93 patients (1.4%) received a diagnosis of ipsilateral AC in the same time frame. PRAs were significantly associated with subsequent diagnosis of AC (OR 2.39; 95% CI [1.45-3.92]; p<.001), but not MUA/LOA (OR 1.97, 95% CI [1.26-3.61]; p=0.133). Patients with two PRAs had greater odds of being diagnosed with AC than patients with one PRA (OR: 2.74; 95% CI [1.14-5.99]; p=0.012). While this association was non-significant for MUA/LOA, patients with 2 PRAs (OR: 2.67; 95% CI [0.96-8.80]; p=0.059) demonstrated a similar statistical trend.

CONCLUSION: Patient-reported allergies are associated with increased odds of receiving a diagnosis of adhesive capsulitis within two years following arthroscopic rotator cuff repair, but were not found to be associated with return to the operating room for postoperative stiffness.

PMID:37839628 | DOI:10.1016/j.jse.2023.09.006

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