Nevin Manimala

Arch Orthop Trauma Surg. 2023 Nov 23. doi: 10.1007/s00402-023-05121-4. Online ahead of print.

ABSTRACT

INTRODUCTION: Ankle osteoarthritis is more commonly posttraumatic. Consequently, dealing with hardware removal is quite frequent when performing a total ankle arthroplasty (TAA). The purpose of this study is to compare outcomes regarding either a staged or concurrent hardware removal when performing TAA.

MATERIALS AND METHODS: 275 consecutive patients with TAA previously treated with internal fixation were retrospectively reviewed. Finally, 57 patients were enrolled based on exclusion criteria, and were differentiated into two groups considering the timing of hardware removal (staged-group A vs concurrent-group B) to compare: neurovascular and wound complications, time to recover full weight bearing, scar-tissue esthetic, and surgical time. Moreover, a subgroup comparison considering the surgical approach (single approach, minor additional approach, major additional approach) was performed between the group A and group B.

RESULTS: No statistically significant difference other that longer surgical time (p < 0.05) was observed between group A and group B. When considering surgical approach subgroups, statistically significant higher surgical wound complications and revision rate were reported in group B (concurrent) major additional approach subgroup, and a statistically significant shorter time to full weight bearing was reported in group A (staged) major additional approach subgroup.

CONCLUSIONS: When performing TAA requiring hardware removal, no clear superiority of staged over concurrent hardware removal was observed. However, when considering a subgroup of patients requiring a separate major incision, a staged approach has shown reduced surgical time, less risk of wound complications, and shorter recovery to full weight bearing.

LEVEL OF EVIDENCE: III.

PMID:37994945 | DOI:10.1007/s00402-023-05121-4

Int J Legal Med. 2023 Nov 23. doi: 10.1007/s00414-023-03128-5. Online ahead of print.

ABSTRACT

Different studies have established that the mineralization stages of the second mandibular molar can be used in forensic age estimation. Nowadays, the estimate’s accuracy is an ethical concern, producing as few false positives (individuals incorrectly classified as older than a determined threshold) and false negatives (individuals incorrectly classified as younger than a determined threshold) as possible. Some have hypothesized that changes in teeth number may influence tooth mineralization, altering the age estimate process. This paper analyzes whether third molar agenesis affects the second mandibular molar mineralization time frame. To do so, 355 orthopantomograms were evaluated for third molar agenesis, and the second mandibular molar mineralization stage was assessed using the Demirjian stages. Student’s t-test was used to compare the difference in the mean age at which the various stages of 37 mineralization were reached in the groups with and without third molar agenesis. The level of statistical significance was set at 5%. The results pointed to a delay in second mandibular molar mineralization in the case of agenesis, suggesting the need to consider this when estimating age using dental techniques.

PMID:37994924 | DOI:10.1007/s00414-023-03128-5

Elife. 2023 Nov 23;12:e86037. doi: 10.7554/eLife.86037.

ABSTRACT

Participant-specific, functionally defined brain areas are usually mapped with functional localizers and estimated by making contrasts between responses to single categories of input. Naturalistic stimuli engage multiple brain systems in parallel, provide more ecologically plausible estimates of real-world statistics, and are friendly to special populations. The current study shows that cortical functional topographies in individual participants can be estimated with high fidelity from naturalistic stimuli. Importantly, we demonstrate that robust, individualized estimates can be obtained even when participants watched different movies, were scanned with different parameters/scanners, and were sampled from different institutes across the world. Our results create a foundation for future studies that allow researchers to estimate a broad range of functional topographies based on naturalistic movies and a normative database, making it possible to integrate high-level cognitive functions across datasets from laboratories worldwide.

PMID:37994909 | DOI:10.7554/eLife.86037

Zh Nevrol Psikhiatr Im S S Korsakova. 2023;123(11):105-110. doi: 10.17116/jnevro2023123111105.

ABSTRACT

OBJECTIVE: To explore the potential use of magnetic resonance spectroscopy (MRS) in the diagnosis of pre-dementia cognitive disorders in elderly people.

MATERIAL AND METHODS: A total of 65 elderly individuals (37 individuals with mild cognitive impairment (MCI) according to NIA-AA criteria, mean age 67.2 years; 28 controls, mean age 65.2 years) underwent MRS (3.0 T) with posterior cingulate cortex as the region of interest. Absolute concentrations of metabolites (tCr, NAA, Glx, mI, Cho, NAA) were calculated based on their signal intensities. Statistical analysis was performed to assess intergroup differences and correlations.

RESULTS: Statistically significant differences were observed between the clinical and control groups in the absolute concentrations of metabolites: mI (MCI 4.97±0.13; controls 4.76±0.15; p=0.04) and NAA/mI (MCI 1.61±0.04; controls 1.73±0.04; p=0.04), as well as in the intensities of the choline-containing compounds signal (MCI 0.215±0.015; controls 0.205±0.005; p=0.04) in the posterior cingulate cortex region. No significant correlations between these changes and age were observed, suggesting the predominant role of neurodegeneration in the pathological process under investigation.

CONCLUSION: The findings highlight the promising nature of MRS as a tool to find the neurodegeneration biomarker.

PMID:37994895 | DOI:10.17116/jnevro2023123111105

Zh Nevrol Psikhiatr Im S S Korsakova. 2023;123(11):82-89. doi: 10.17116/jnevro202312311182.

ABSTRACT

OBJECTIVE: To analyze the socio-demographic, clinical and psychological characteristics of patients with residual schizophrenia, to identify variants of residual states and to determine measures for psychosocial rehabilitation on this basis.

MATERIAL AND METHODS: At the time of investigation, 91 patients with the diagnosis of residual schizophrenia (F20.5xx according to ICD-10) were under dispensary supervision in the psychoneurological dispensary No. 18 of Moscow. A study of the medical records of all these patients was carried out. Twenty-three patients consented to face-to-face examination. The Positive and negative syndrome scale (PANSS), the Symptom Checklist-90-Revised (SCL-90-R), the Brief Assessment of Cognitive Functions in Schizophrenia (BACS) and the author’s questionnaire concerning the opinion of psychiatrists on the clinical and social characteristics of patients with residual schizophrenia were used. Mathematical and statistical methods implemented in the STATISTICA 12.1 software and the Excel office suite were used. The method of stochastic nesting of neighbors («T-distributed Stochastic Neighbor Embedding», t-SNE) implemented in the Python program to cluster cases and identify variants of residual states was used.

RESULTS: The patients with residual schizophrenia belonged to the cohort of elderly patients (mean age 66.3±13.28 years) with a predominance of females (62.22%). At the time of examination, the course of the schizophrenic process had a negative impact on the social life and professional activities of patients, which led to disability of 74.72% patients and 91.55% of them had disability due to a mental disorder. The analysis showed that patients with residual schizophrenia was a heterogeneous group with a predominant presence of negative symptoms in the clinical picture (the composite score on the PANSS negative subscale was17.79±6.67). Three variants of residual states were identified using clustering by the t-SNE method of individual PANSS indicators. Deficiency symptoms with features of pseudoorganic syndrome prevailed in the first variant. In the second variant, patients had mild positive symptoms, mainly in the form of paranoia and residual delirium, as well as a psychopathic syndrome. The third, small group, included patients with the most favorable variant of remission, having a fairly high level of social adaptation, mainly with personality changes.

CONCLUSION: The obtained data were correlated with the results of a psychological examination. It was revealed that patients with residual schizophrenia were not sufficiently included in the process of psychosocial treatment and rehabilitation. Taking into account the identified variants of residual states, the directions of possible psychosocial interventions were determined.

PMID:37994892 | DOI:10.17116/jnevro202312311182

Zh Nevrol Psikhiatr Im S S Korsakova. 2023;123(11):75-81. doi: 10.17116/jnevro202312311175.

ABSTRACT

OBJECTIVE: To study the efficacy and safety of activity-dependent neuromodulation using transcranial magnetic stimulation with intermittent theta flashes (iTBS) as priming stimulation with multimodal parameters of the virtual environment (VR) for the treatment of adynamic depression in comparison with psychopharmacotherapy (PFT).

MATERIAL AND METHODS: The comparative study included 85 patients with adynamic depression who were randomized into four groups: iTBS + VR + PFT (n=19), iTBS + PFT (n=19), VR + PFT (n=23), PFT (n=24). The duration of therapy was 20 days, the procedures were carried out daily, with a break for weekends, followed by an assessment of side-effects and control over compliance with the patient’s drinking regimen. The study was conducted by clinical, standardized and statistical methods.

RESULTS: After 4 weeks of therapy, a final analysis of efficacy and safety indicators was performed. When testing the main statistical hypothesis of the study, the combined therapy of adynamic depression with the use of traditional PFT, iTBS and VR technologies proved to be more effective than traditional PFT. A significant decrease in the parameters of adynamic depression after 4 weeks on the Hamilton psychiatric rating scale for depression by 76%, according to the Clinical Global Impression scale – by the severity of the disorder by 65%, the dynamics of the overall improvement by 76% versus 55% (p=0.0199), 37%, (p=0.0033) 43% (p=0.0047), respectively, in the PFT group.

CONCLUSION: Activity-dependent neuromodulation using transcranial magnetic stimulation with intermittent theta flashes (iTBS) as priming stimulation with multimodal parameters of the virtual environment is an effective and safe way to treat adynamic depression, having an advantage over traditional psychopharmacotherapy.

PMID:37994891 | DOI:10.17116/jnevro202312311175

J Glob Health. 2023 Nov 24;13:04157. doi: 10.7189/jogh.13.04157.

ABSTRACT

BACKGROUND: Chronic fatigue syndrome (CFS) is a global public health concern. We performed this systematic review of randomised controlled trials (RCTs) to evaluate the effects and safety of traditional Chinese mind-body exercises (TCME) for patients with CFS.

METHODS: We comprehensively searched MEDLINE, Embase, Web of Science, PsycINFO, Cochrane Library, CNKI, VIP databases, and Wanfang Data from inception to October 2022 for eligible RCTs of TCME for CFS management. We used Cochran’s Q statistic and I² to assess heterogeneity and conducted subgroup analyses based on different types of TCME, background therapy, and types of fatigue. We also assessed the quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach.

RESULTS: We included 13 studies (n = 1187) with a maximal follow-up of 12 weeks. TCME included Qigong and Tai Chi. At the end of the treatment, compared with passive control, TCME probably reduces the severity of fatigue (standardised mean differences (SMD) = 0.85; 95% confidence interval (CI) = 0.64, 1.07, moderate certainty), depression (SMD = 0.53; 95% CI = 0.34, 0.72, moderate certainty), anxiety (SMD = 0.29; 95% CI = 0.11, 0.48, moderate certainty), sleep quality (SMD = 0.34; 95% CI = 0.10, 0.57, low certainty) and mental functioning (SMD = 0.90; 95% CI = 0.50, 1.29, low certainty). Compared with other active control therapies, TCME results in little to no difference in the severity of fatigue (SMD = 0.08; 95% CI = -0.18, 0.34, low certainty). For long-term outcomes, TCME may improve anxiety (SMD = 1.74; 95% CI = 0.44, 3.03, low certainty) compared to passive control. We did not identify TCME-related serious adverse events.

CONCLUSIONS: In patients with CFS, TCME probably reduces post-intervention fatigue, depression, and anxiety and may improve sleep quality and mental function compared with passive control, but has limited long-term effects. These findings will help health professionals and patients with better clinical decision-making.

REGISTRATION: PROSPERO: CRD42022329157.

PMID:37994837 | DOI:10.7189/jogh.13.04157

Int J Oral Implantol (Berl). 2023 Nov 23;16(4):315-324.

ABSTRACT

PURPOSE: To evaluate the survival of and incidence of mechanical complications with single- and multiple-unit cement-retained posterior implant-supported restorations with custom CAD/CAM Atlantis titanium abutments (Dentsply Sirona, Charlotte, NC, USA).

MATERIALS AND METHODS: This retrospective clinical study analysed 196 Astra Tech OsseoSpeed TX Internal Hexagon implants (Dentsply Sirona) placed in 85 patients between January 2011 and January 2021. Customised Atlantis titanium abutments and cement-retained metal-ceramic crowns were employed. The clinical outcomes recorded were implant and abutment survival rates, and mechanical complications. The results were analysed according to implant length and diameter, arch, implant position and single- or multiple-unit restoration.

RESULTS: Over the observation period (up to 10 years), implant and abutment survival rates were 98.5% and 100.0%, respectively. The mean observation period for the single- and multiple-unit implant-supported restorations was 106.00 ± 20.84 months, with a minimum of 41 months and a maximum of 120 months. For the 67 single-unit and 129 multiple-unit posterior implant-supported restorations, four mechanical complications were recorded: two cases of screw loosening, one case of chipping or fracture of veneering materials, and one case of crown decementation. No screw or abutment fractures were observed.

CONCLUSIONS: According to the results of this retrospective clinical study, cement-retained posterior implant-supported restorations with custom CAD/CAM Atlantis titanium abutments showed high survival rates over a follow-up period of up to 10 years. No statistically significant differences were recorded when comparing implant position, implant diameter, implant length, single- versus multiple-unit restoration and arch.

PMID:37994819

Cancer Sci. 2023 Nov 23. doi: 10.1111/cas.16028. Online ahead of print.

ABSTRACT

Advances in diagnostic techniques and treatment modalities have impacted head and neck cancer (HNC) prognosis, but their effects on subsite-specific prognosis remain unclear. This study aimed to assess subsite-specific trends in mid- and long-term survival for HNC patients diagnosed from 1993 to 2011 using data from population-based cancer registries in Japan. We estimated the net survival (NS) for HNC by subsite using data from 13 prefectural population-based cancer registries in Japan. Changes in survival over time were assessed by multivariate excess hazard model of mortality. In total, 68,312 HNC patients were included in this analysis. We observed an overall improvement in 5-year NS for HNC patients in Japan. However, survival varied among subsites of HNC, with some, such as naso-, oro- and hypopharyngeal cancers, showing significant improvement in both 5- and 10-year NS, whereas others such as laryngeal cancer showed only a slight improvement in 5-year NS and no significant change in 10-year NS after adjustment for age, sex and stage. In conclusion, the study provides insights into changing HNC survival by site at the population level in Japan. Although advances in diagnostic techniques and treatment modalities have improved survival, these improvements are not shared equally among subsites.

PMID:37994633 | DOI:10.1111/cas.16028

Endokrynol Pol. 2023 Nov 23. doi: 10.5603/ep.95139. Online ahead of print.

ABSTRACT

INTRODUCTION: Adrenal incidentaloma (AI) secreting small amounts of glucocorticoids may cause morphological and functional changes in the blood vessels. Early stages of cardiovascular remodeling may be observed among asymptomatic patients with AI. But it is unclear whether the nonfunctional adrenal incidentalomas (NFAI) may also be a risk factor for cardiovascular diseases. The aim of this study was to determine the relationship between NFAI, carotid intima-media thickness (CIMT), and cardiovascular risk (CVR) based on Systematic Coronary Risk Evaluation (SCORE) prediction models for Europe.

MATERIAL AND METHODS: This study from a single centre in Poland included 48 NFAI patients and 44 individuals in the control group matched for age, sex, and body mass index (BMI). All participants underwent adrenal imaging, biochemical evaluation, measurement of CIMT, and assessment of the 10-year risk of cardiovascular mortality based on the SCORE algorithm. Hormonal evaluation was conducted in AI patients.

RESULTS: The NFAI group showed significantly higher sodium (p = 0.02) and glucose levels in the 2-h oral glucose tolerance test (OGTT) (p = 0.04), a higher CIMT (p < 0.01), and a higher CVR calculated according to the SCORE algorithm (p = 0.03). The estimated glomerular filtration rate (eGFR) was higher in the NFAI group (p = 0.015). Hypertension (p < 0.01) and IGT (p = 0.026) were more common in the NFAI group. Statistically significant positive correlations were found between CIMT and age (r = 0.373, p = 0.003), waist circumference (r = 0.316, p = 0.029), diastolic blood pressure (r = 0.338, p = 0.019), and CVR based on the SCORE algorithm (r = 0.43, p = 0.004). There was a statistically significant positive correlation between CIMT and serum cortisol levels after 1 mg dexamethasone suppression test (r = 0.33, p = 0.02).

CONCLUSION: Non-functional adrenal adenomas are associated with increased CIMT and CVR. Early stages of cardiovascular remodelling can be observed in asymptomatic NFAI patients.

PMID:37994583 | DOI:10.5603/ep.95139