Nevin Manimala

Acta Chir Orthop Traumatol Cech. 2023;90(4):251-258.

ABSTRACT

PURPOSE OF THE STUDY Total arthroplasty of the first metatarsophalangeal joint is one of the surgical treatment options for patients with advanced hallux rigidus. This study evaluates the pressure changes in the propulsion phase of the gait cycle using dynamic pedobarography after the total arthroplasty of the first metatarsophalangeal joint by Medin PH-Flex and their comparison with the control groups of patients with hallux rigidus and with asymptomatic patients. MATERIAL AND METHODS Dynamic pedobarograph was used to evaluate 15 first MTP joint replacements by Medin PH-Flex implants in 12 female patients, the average time since joint replacement was 3.5 years (1.5 to 5.5 years). The control group consisted of 13 forefeet in 12 patients with hallux rigidus of Grade 3 and Grade 4 according to the Coughlin classification and 17 healthy patients with no clear foot deformity, i.e. of a total of 34 forefeet. A zone for each metatarsal (M1-M5) and the big toe area (T1) were defined with the use of an integrated software. The difference between the pressure under the big toe area and the first metatarsal bone – hallux stiffness (T1-M1) and the forefoot balance parameter, i.e. the difference between the pressures under the medial and lateral half of the forefoot ((M1+M2)-(M3+M4+M5)), was obtained. The parameters were evaluated for each group during the propulsion phase of the gait, i.e. from 55% to 100% of the stance phase and from 75% to 100% of the stance phase, i.e. that part of propulsion when the greatest pressure is exerted on the big toe. RESULTS For the HS parameter (T1-M1) in 55% to 100% of the stance phase, the median value was -0.66 ± 1.22 (-1.90 to 1.45) in the control group, -0.85 ± 1.94 (-1.40 to 3.80) in patients with hallux rigidus, and -0.10 ± 1.48 (-1.30 to 2.40) in patients after the first MTP joint replacement. The median forefoot balance parameter from 55% of the stance phase was -3.48 ± 2.45 (-6.90 to 0.68) in healthy patients and -4.43 ± 2.72 (-6.98 to 0.23) in hallux rigidus patients. In patients after the joint replacement, the value was -3.00 ± 2.46 (-6.20 to 0.40). The data were statistically analysed by the Dunnett’s and Tukey’s multiple comparison tests. The hallux stiffness parameter showed a significant improvement after the joint replacement compared to patients with hallux rigidus (p<0.0001). No statistical significance was confirmed when comparing the joint replacement cases and the healthy patients from the control group (p=0.0007 and p=0.0010, respectively). As concerns the forefoot balance parameter, a significant difference was reported in patients with joint replacement compared to healthy patients from the control group and patients with hallux rigidus (p <0.0001). DISCUSSION The published pedobarographic studies differ in terms of the methodology used, the patient population and the parameters examined. The pedobarographic studies after the replacement of the first MTP joint or after its arthrodesis present inconclusive outcomes. According to the available literature, the joint replacement has the potential to improve mediolateral forefoot loading and to partially restore the weight-bearing function of the first ray. Our analysis of the HS parameter suggests that the MTP joint replacement can improve the big toe function compared to patients with hallux rigidus but fails to achieve the functional outcomes of healthy patients. When evaluating the forefoot balance (FB) parameter, we can observe less loading on the lateral half of the forefoot in the propulsion phase compared to hallux rigidus. Nonetheless, the joint replacement is unable to restore the physiological loading of the foot. CONCLUSIONS The first MTP joint replacement has the potential to improve forefoot function and to bring it closer to that of a healthy person, even though achieving physiological loading of the forefoot is unrealistic. Additional studies will be needed to confirm that the indication for the first MTP joint replacement is justified in hallux rigidus in terms of the effect on forefoot biomechanics. Key words: hallux rigidus, total replacement of the first MTP joint, dynamic pedobarography, footscan.

PMID:37690038

Acta Chir Orthop Traumatol Cech. 2023;90(4):239-250.

ABSTRACT

PURPOSE OF THE STUDY Dislocation is one of the most common early complications of total hip arthroplasty (THA). In this manuscript, 20 years of experience with the management of this complication are presented, particularly in relation to the type of instability. MATERIAL AND METHODS In the period between January 1999 and December 2020, at least one dislocation occurred in 157 of 8 286 (1.9%) THA patients, of which 117 dislocations (1.6%) in primary and 40 (3.4%) in revision THAs. Almost all patients were operated on from the anterolateral approach during the follow-up period. The type of dislocation was evaluated using the modified Dorr classification. In the first dislocations, conservative approach was usually opted for, except for cases with a clear malposition, irreducible or unstable hips after the reduction. The minimum follow-up period was 18 months (18-240). The success rate of the chosen treatment approach was assessed by means of standard statistical methods. RESULTS The total dislocation rate in the follow-up period was 1.6% for primary THAs and 3.4% for revision THAs. The dislocation rate was slightly higher between 1999 and 2009 compared to the following decade (2.1% versus 1.3% for primary THAs; p=0.009). The most common type of dislocation was the positional dislocation (62%), followed by dislocations due to a combination of causes (17%) and component malposition (11%). Treatment of dislocation was successful in a total of 130 patients (130/157; 83%). Even though a stable hip was achieved in 21 patients (13%), the functional outcome was unsatisfactory, and in 6 patients (4%) we failed to achieve a stable hip. In the positional type of dislocation, the success rate of closed reduction following the first-time dislocation was 86.4% and a similar success rate was reported for reoperations in the first-time dislocations due to the malpositioned components (85.7%). In the second-time dislocation, the surgical therapy was significantly more reliable compared to closed reduction regardless of the type of dislocation (78.6% versus 46%). The treatment of dislocations following primary THAs showed comparable outcomes to those of the treatment of dislocations following revision THAs. Overall, the worst outcomes were achieved in patients with a combined type of dislocation. In total, the THA had to be removed in 11.5% of hips (18/157). The probability of final THA removal increased with the increasing order of dislocation. DISCUSSION In our group of patients, the dislocation rate in THA was comparable or lower than the published data. With the use of preventive measures, i.e. dual mobility cup or larger head diameters in high-risk patients, we managed to reduce the dislocation rate over time. The positional type of dislocation prevails in our group of patients just as in the previously published series, followed by instability from malposition of components. The modified Dorr classification is used to guide the treatment since it allows us not only to make good decision about the treatment modality but to some extent also to estimate the final outcome, particularly with respect to restoring a functional and stable hip. CONCLUSIONS The total dislocation rate was 1.6% for primary THAs and 3.4% for revision THAs. The first-time dislocation of the positional type shall be treated conservatively. Conversely, in the other types of dislocations and in recurrent dislocations, surgical treatment is more likely to achieve a good clinical outcome. The worst outcomes are to be expected in an instability due to combination of multiple causes, which leads to the removal of THA more often than in other types of dislocations. Also, the benefit of preventive measures in high-risk patients over time has been confirmed. Key words: total hip arthroplasty, dislocation, Dorr’s classification, treatment strategy, outcomes, complications.

PMID:37690037

Environ Monit Assess. 2023 Sep 10;195(10):1180. doi: 10.1007/s10661-023-11646-3.

ABSTRACT

The air quality index (AQI) prediction is important to evaluate the effects of air pollutants on human health. The airborne pollutants have been a major threat in Delhi both in the past and coming years. The air quality index is a figure, based on the cumulative effect of major air pollutant concentrations, used by Government agencies, for air quality assessment. Thus, the main aim of the present study is to predict the daily AQI one year in advance through three different neural network models (FF-NN, CF-NN and LR-NN) for the year 2020 and compare them. The models were trained using AQI values of previous year (2019). In addition to main air pollutants like PM₁₀/PM_2.5, O₃, SO₂, NOx, CO and NH₃, the non-criteria pollutants and meteorological data were also included as input parameter in this study. The model performances were assessed using statistical analysis. The key air pollutants contributing to high level of daily AQI were found to be PM_2.5/PM₁₀, CO and NO₂. The root mean square error (RMSE) values of 31.86 and 28.03 were obtained for the FF-NN and CF-NN models respectively whereas the LR-NN model has the minimum RMSE value of 26.79. LR-NN algorithm predicted the AQI values very closely to the actual values in almost all the seasons of the year. The LR-NN performance was also found to be the best in post-monsoon season i.e., October and November (maximum R² = 0.94) with respect to other seasons. The study would aid air pollution control authorities to predict AQI more precisely and adopt suitable pollution control measures. Further research studies are recommended to compare the performance of LR-NN model with statistical, numerical and computational models for accurate air quality assessment.

PMID:37690033 | DOI:10.1007/s10661-023-11646-3

Top Stroke Rehabil. 2023 Sep 10:1-12. doi: 10.1080/10749357.2023.2253629. Online ahead of print.

ABSTRACT

BACKGROUND: Post stroke, motor paresis has usually been considered to be a crucial factor responsible for the disability; other impairments such as somatosensory deficits may also play a role.

OBJECTIVE: To determine the relation between the sensory deficits (paretic and non-paretic upper limbs) and the motor recovery of the paretic upper limb and to predict the potential of motor recovery based on the sensory deficits among stroke subjects.

METHODS: The study was a cross-sectional study conducted in a rehabilitation institute. Ninety-five poststroke hemiparetic subjects having sensory impairment in any of the modalities were considered for this study. Sensory deficits were assessed on both the upper limbs (paretic and non-paretic) primarily using Erasmus MC modification of the revised version of Nottingham Sensory Assessment (Em-NSA) and Nottingham Sensory Assessment (Stereognosis) (NSA-S). The motor recovery was assessed using the Fugl-Meyer assessment (FMA).

RESULTS: The measures of sensory deficits exhibited weak but significant correlation [the paretic (Em-NSA and NSA; r = .38 to .58; p < .001) and the non-paretic (Em-NSA and NSA; r = .24 to .38; p = .03 to .001)] with the motor recovery of the paretic upper limb as measured by FMA. The potential of favorable recovery of the paretic upper limb may be predicted using the cutoff scores of Em-NSA (30, 21, and 24) and NSA-S (5, 8, and 5) of the paretic side.

CONCLUSION: In stroke, sensory deficits relate weakly with the recovery of the paretic upper limb and can predict recovery potential of the paretic upper limb.

PMID:37690032 | DOI:10.1080/10749357.2023.2253629

JPEN J Parenter Enteral Nutr. 2023 Sep 10. doi: 10.1002/jpen.2560. Online ahead of print.

ABSTRACT

BACKGROUND: Patients in the intensive care unit (ICU) are at high risk for refeeding syndrome (RFS), yet there is uncertainty regarding how RFS should be operationalized in the ICU. We evaluated different definitions for RFS and tested how they associated with patient-centered outcomes in the ICU.

METHODS: This was a retrospective comparison study. Patients age ≥ 18 were eligible if they were newly initiated on enteral feeding while hospitalized in the ICU. Eight definitions for RFS were operationalized, including that from the American Society of Parenteral and Enteral Nutrition (ASPEN), all based on electrolyte levels from immediately before until up to 5 days after initiation of enteral nutrition. Patients were followed for death or for ICU-free days, a measure of healthcare utilization.

RESULTS: 2,123 patients were identified including 406 (19.1%) who died within 30 days of ICU admission and 1,717 (80.9%) who did not. Prevalence of RFS varied from 1.5% to 88% (ASPEN definition) depending on the RFS definition used. The excess risk for death associated with RFS varied from 33% to 92% across definitions. Development of RFS based on the ASPEN definition was associated with a greater decrease in ICU-free days compared to other definitions, but the relationship was not statistically significant.

CONCLUSION: Eight definitions for RFS were evaluated, none of which showed strong associations with death or ICU-free days. It may be challenging to achieve a standardized definition for RFS that is based upon electrolyte values and predicts mortality or ICU-free days. This article is protected by copyright. All rights reserved.

PMID:37689982 | DOI:10.1002/jpen.2560

Food Res Int. 2023 Oct;172:113191. doi: 10.1016/j.foodres.2023.113191. Epub 2023 Jun 28.

ABSTRACT

Extra virgin olive oil (EVOO) is a basic food of the Mediterranean diet and an important source of bioactive compounds, especially phenolic substances. The culinary techniques to which the oil is subjected before consumption cause the migration of these compounds, hence the importance of studying their stability before and after culinary treatment. We determined the behaviour of the phenols present in EVOO and its total antioxidant capacity before and after the use of various culinary techniques such as deep frying, boiling (in a water/oil mixture (W/O) and sauteing, observing that the study parameters varied according to the variety of oil and the culinary technique used. Significant statistical differences were observed between the different varieties of EVOO according to the culinary technique used. But this was not the case with respect to polyphenol content, for which no statistically significant differences were observed among the different varieties of EVOO according to the culinary techniques employed (p > 0.05), except with the Arbequina variety (p < 0.05). With respect to the individual polyphenols – tyrosol, p-vainillin, vanillic acid, gallic acid, trans-caffeic acid, ferulic acid and luteolin – our analysis shows that although there were differences in content between raw EVOO and EVOO treated with each of the culinary techniques, these differences were not statistically significant (p > 0.05). There were significant losses of oleocanthal with the W/O boiling technique, but content increases were observed following sauteing and deep frying with respect to raw EVOO. Total antioxidant capacity presented a similar pattern in all samples, with increases after sauteing and decreases after W/O boiling and deep frying. ABTS was the most suitable technique for determining antioxidant capacity in EVOO. In short, the behaviour of the bioactive compounds in EVOO depends on the temperature and the cooking medium used.

PMID:37689948 | DOI:10.1016/j.foodres.2023.113191

Food Res Int. 2023 Oct;172:113187. doi: 10.1016/j.foodres.2023.113187. Epub 2023 Jun 28.

ABSTRACT

Cranberry (poly)phenols may have potential health benefits. Circulating (poly)phenol metabolites can act as mediators of these effects, but they are subjected to an extensive inter-individual variability. This study aimed to quantify both plasma and urine (poly)phenol metabolites following a 12-week intake of a cranberry powder in healthy older adults, and to investigate inter-individual differences by considering the existence of urinary metabotypes related to dietary (poly)phenols. Up to 13 and 67 metabolites were quantified in plasma and urine respectively. Cranberry consumption led to changes in plasma metabolites, mainly hydroxycinnamates and hippuric acid. Individual variability in urinary metabolites was assessed using different data sets and a combination of statistical models. Three phenolic metabotypes were identified, colonic metabolism being the main driver for subject clustering. Metabotypes were characterized by quali-quantitative differences in the excretion of some metabolites such as phenyl-γ-valerolactones, hydroxycinnamic acids, and phenylpropanoic acids. Metabotypes were further confirmed when applying a model only focused on flavan-3-ol colonic metabolites. 5-(3′,4′-dihydroxyphenyl)-γ-valerolactone derivatives were the most relevant metabolites for metabotyping. Metabotype allocation was well preserved after 12-week intervention. This metabotyping approach for cranberry metabolites represents an innovative step to handle the complexity of (poly)phenol metabolism in free-living conditions, deciphering the existence of metabotypes derived from the simultaneous consumption of different classes of (poly)phenols. These results will help contribute to studying the health effects of cranberries and other (poly)phenol-rich foods, mainly considering gut microbiota-driven individual differences.

PMID:37689939 | DOI:10.1016/j.foodres.2023.113187

Food Res Int. 2023 Oct;172:113141. doi: 10.1016/j.foodres.2023.113141. Epub 2023 Jun 20.

ABSTRACT

The initial microbial community is critical for the production of volatile metabolites during traditional food fermentations. Selection of the initial community plays an important role in improving the quality of fermented foods. Here, we used high-throughput amplicon sequencing combined with multivariate statistical methods to explore the microbial succession in stacking and alcoholic fermentation stages in sesame flavor-type baijiu making. We proposed a selection strategy for the initial microbial community in the alcoholic fermentation stage, which determined the quality of baijiu. Results suggested that the microbial composition statistically differed between stacking and alcoholic fermentation stages (ANOSIM, Bacteria: R = 0.60, P = 0.001; Fungi: R = 0.53, P = 0.001). Microbial succession drove metabolic succession (Bacteria: r = 0.87, P < 0.05; Fungi: r = 0.56, P < 0.05) in alcoholic fermentation. The fermentation time of stacking fermentation determined the initial community for alcoholic fermentation, and it can be used as a criterion for selection of the initial microbial community for alcoholic fermentation. The succession distance of the microbial community was varied and reached the highest (Bacteria: 0.048, Fungi: 0.064) at 30 h in stacking fermentation. When we selected 30 h as stacking fermentation time, the concentration (4.58 mg/kg) and diversity (0.61) of volatile metabolites were highest at the end of alcoholic fermentation. This work developed a succession distance-guided approach to select the initial microbial community for the alcoholic fermentation of sesame flavor-type baijiu. This approach can be used to improve the quality of baijiu.

PMID:37689904 | DOI:10.1016/j.foodres.2023.113141

Food Res Int. 2023 Oct;172:113123. doi: 10.1016/j.foodres.2023.113123. Epub 2023 Jun 12.

ABSTRACT

Changes of volatile organic compounds (VOCs) patterns during 6 days of storage at +4 °C were investigated in different freshwater fish species, namely carp and trout, using dynamic headspace gas chromatography time-of-flight mass spectrometry (DHS-GC-TOFMS). DHS parameters were systematically optimized to establish optimum extraction and pre-concentration of VOCs. Moreover, different sample preparation methods were tested: mincing with a manual meat grinder, as well as mincing plus homogenization with a handheld homogenizer both without and with water addition. The addition of water during sample preparation led to pronounced changes of the volatile profiles, depending on the molecular structure and lipophilicity of the analytes, resulting in losses of up to 98 % of more lipophilic compounds (logP > 3). The optimized method was applied to trout and carp. Trout samples of different storage days were compared using univariate (Mann-Whitney U test, fold change calculation) and multivariate (OPLS-DA) statistics. 37 potential spoilage markers were selected; for 11 compounds identity could be confirmed via measurement of authentic standards and 10 compounds were identified by library spectrum match. 22 compounds were also found to be statistically significant spoilage markers in carp. Merging results of the different statistical approaches, the list of 37 compounds could be narrowed down to the 14 most suitable for trout spoilage assessment. This study comprises a systematic evaluation of the capabilities of DHS-GC coupled to high-resolution (HR) MS for studying spoilage in different freshwater fish species, including a comprehensive data evaluation workflow.

PMID:37689889 | DOI:10.1016/j.foodres.2023.113123

Food Res Int. 2023 Oct;172:113103. doi: 10.1016/j.foodres.2023.113103. Epub 2023 Jun 12.

ABSTRACT

Morchella sextelata is a precious and popular commercial edible fungus that was developed recently in China. This research aimed to characterize the volatile profiles of M. sextelata under three dehydration methods (freeze, hot air, and natural air drying). Comprehensive two-dimensional gas chromatography-time-of-flight mass spectrometry (GC × GC-ToF-MS) was shown to the best choice to discriminate the volatile profiles of M. sextelata Characteristic flavor substances of M. sextelata were eight-carbon-containing (C₈) compounds, hexanal, 2(5 h)-furanone, and benzaldehyde. Drying methods had significant influences on the volatile flavor profiles of M. sextelata, and 104 differential compounds were screened by multivariate statistical analysis. Freeze-dried samples had the most abundant volatile compounds and maintained more alcohols, ketones, aldehydes, and esters described as mushroom, sweet, and green flavor, like 1-octen-3-ol, 1-octen-3-one, nonanal, 2,3-butanedione, and so on. Hot air-drying promoted the production of heterocycles and ketones with roasted flavor due to the thermalreaction, such as 2-cyclohexen-1-one, furan, 3-phenyl-, etc. Natural air-drying resulted in acids releasing an unpleasant flavor, e.g., acetic acid, 2-methylbutanoic acid, etc. Overall, thermal reaction combined with vacuum conditions might be suitable for maintaining and enriching the aroma flavor of dried true morels.

PMID:37689871 | DOI:10.1016/j.foodres.2023.113103