Nevin Manimala

Environ Pollut. 2023 Aug 14:122382. doi: 10.1016/j.envpol.2023.122382. Online ahead of print.

ABSTRACT

Assessing natural background levels (NBLs) in groundwater is a global concern. Knowledge on groundwater NBLs in urbanized areas is challenging due to the impact of complex human activities. Preselection related methods are common ones for assessing groundwater NBLs. The present study used three preselection related methods to assess groundwater heavy metals (lead, zinc, barium) NBLs in four groundwater units of the Pearl River Delta (PRD) where urbanization continues, and to identify the best one for assessing groundwater NBLs in urbanized areas. Here, methods include a preselection method (method-P), a preselection dominated method (method-PD), and a statistic dominated method (method-SD). Results showed that the method-PD was better than other two methods for assessing groundwater NBLs of heavy metals in the PRD. This is supported by the evidence that differences among heavy metals concentrations in various land-use types in residual datasets formed by the method-PD were insignificant. NBLs of lead in groundwater units I to IV assessed by the method-PD were 2.8 μg/L, 5.9 μg/L, 5.8 μg/L, and 2.6 μg/L, respectively. NBLs of zinc in groundwater units I to IV assessed by the method-PD were 30 μg/L, 180 μg/L, 160 μg/L, and 100 μg/L, respectively. NBLs of barium in groundwater units I to IV assessed by the method-PD were 120 μg/L, 120 μg/L, 90 μg/L, and 50 μg/L, respectively. Compared to the method-PD, the method-SD often underestimates groundwater NBLs of heavy metals because of using the experiential evaluation for residual datasets. The method-P also has an inaccurate evaluation of groundwater NBLs of heavy metals in comparison with the method-PD, owing to both of using the experiential evaluation and the absence of a function for outliers test. The method-P combining with an outliers test would be better than itself for assessing groundwater NBLs. Therefore, the method-PD is the first choice to be recommended for assessing groundwater NBLs in urbanized areas such the PRD. However, this method should not be taken into account for assessing groundwater NBLs in areas where groundwater Cl/Br mass ratios are invalid. Instead, the method-SD and the method-P combining with one outliers test may be choices, because no constraint for these two methods.

PMID:37586681 | DOI:10.1016/j.envpol.2023.122382

Clin Immunol. 2023 Aug 14:109740. doi: 10.1016/j.clim.2023.109740. Online ahead of print.

ABSTRACT

Anti-fibroblast antibodies (AFA) have been reported in systemic sclerosis (SSc) and are known to promote fibroblast activation. Aim of this study was to characterize the fine specificity of AFA and to analyze any correlations with clinical parameters associated to fibrosis. To this end, AFA were affinity-purified from a patient with diffuse cutaneous SSc (dcSSc) and interstitial lung disease (ILD). Panning of a phage display peptide library with purified AFA identified the motif <KxywxQ>. The peptide p121, bearing the AFA-specific motif, was used in ELISA to screen sera from 186 SSc patients and 81 healthy donors. Anti-p121 Ab serum levels were statistically higher in SSc than in healthy groups, and directly associated with dcSSc, reduced FVC (FVC < 70), and ILD. Given these clinical correlates, this study lays the groundwork for the identification of the antigen recognized by anti-p121 Ab, which might represent a novel therapeutic target for ILD.

PMID:37586673 | DOI:10.1016/j.clim.2023.109740

J Ren Nutr. 2023 Aug 14:S1051-2276(23)00114-0. doi: 10.1053/j.jrn.2023.07.004. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to evaluate the effect of an adaptive nutritional and educational intervention for patients on hemodialysis in a routine care setting, using real-world data from electronic health records.

METHODS: Decentralized clinical trial of seven hemodialysis facilities recruited patients who have been on hemodialysis for over 3 months (N=153) for an 8-week adaptive intervention protocol. Patients were divided into four groups: (1) control (2) education intervention (3) meal intervention (4) education and meal interventions. Educational contents were digitally delivered via mobile phones and pre-made meals tailored on laboratory findings were home-delivered. Changes in serum electrolytes and malnutrition inflammation score (MIS) were analyzed.

RESULTS: Meal intervention statistically significantly stabilized serum phosphorus level (β = -0.81 mg/dL, 95% Confidence Interval (C.I.)=[-1.40, -0.22]) at week 8, with increased likelihood of being within target serum value range (Odds ratio = 1.21, 95% C.I.=[1.04, 1.40]). Meal group showed better nutritional status (MIS=3.65) than the education group (MIS=5.10) at week 8 (adjusted p<0.05). No significant changes were observed in serum potassium level, depression, and self-efficacy.

CONCLUSION: It was demonstrated that an adaptive meal intervention in a real-world care setting may benefit serum phosphorus control and nutritional status of patients on hemodialysis, without negative effect on depression levels or self-efficacy. More work is need to develop an effective educational intervention.

PMID:37586668 | DOI:10.1053/j.jrn.2023.07.004

Arthroscopy. 2023 Aug 14:S0749-8063(23)00651-5. doi: 10.1016/j.arthro.2023.07.054. Online ahead of print.

ABSTRACT

PURPOSE: To verify whether the distance from the hinge point to the tibial cortex affects the occurrence time and characteristics of the Lateral hinge fracture(LHF) in medial open wedge high tibial osteotomy(MOWHTO).

METHODS: We retrospectively reviewed 171 knees in 171 patients (121 women, 50 men; mean age, 53.9 years; range, 36-67 years) who had undergone MOWHTOwith locking plate fixation between January 2011 and December 2020. Osteotomy hinge point and LHFs were identified on intraoperative fluoroscopy and immediate postoperative radiographs. LHF type was classified as suggested by Takeuchi et al. Acute fracture was defined as a fracture that occurred during surgery, and delayed fracture was defined as a fracture observed after 1 month postoperatively. The nearest distances from osteotomy hinge point to lateral, distal, and proximal cortex were measured on postoperative radiographs. We compared the distance between the different types, and between acute and delayed LHFs.

RESULTS: There were 55 LHFs (32%) [type I, 40 knees; type II, 14 knees; type III, 1 knee] that occurred acutely in 41 knees and were found as delayed fractures in 14 knees. The patient demographics were not significantly different between non-LHFs and each type of LHFs. Proximal and distal distances were not statistically different among fracture types and between occurrence times. However, lateral distances were significantly shorter in type I LHFs (6.2±1.8 mm) and longer in type II LHFs (9.3±2.3 mm) than in non-LHFs (7.1±2.7 mm) (p=0.020 and 0.004, respectively). The lateral cortical distances were also different between acute LHFs (6.4±1.9 mm) and delayed LHF (9.0±2.7 mm) (p<0.001). In the case of fracture type, the frequency of of type I decreases with increase in the lateral distance, whereas that of type II increases with increase in the lateral cortical distance. In acute fracture, type I was dominant (85.4%), whereas in delayed fracture, type II was dominant (57.2%).

CONCLUSION: The lateral cortical distance from the hinge point was significantly associated with LHF occurrence. Shorter distance increased the risk for acute type I LHF, whereas longer distance increased the risk for delayed type II LHFs.

LEVEL OF EVIDENCE: Level III, retrospective comparative prognostic trial.

PMID:37586667 | DOI:10.1016/j.arthro.2023.07.054

Travel Med Infect Dis. 2023 Aug 14:102629. doi: 10.1016/j.tmaid.2023.102629. Online ahead of print.

ABSTRACT

INTRODUCTION: Human migration is an activity that affects society in economic and political aspects and as a social determinant because of its differential impact on individual’s health.

OBJECTIVE: To describe the situation of health and infectious diseases of vertical transmission risk in migrant pregnant women from an area of the Colombian Caribbean from 2019 to 2021.

METHODS: A descriptive cross-sectional study was carried out on pregnant irregular migrants in the Riohacha and Santa Marta municipalities in Colombia. Hemogram, uranalysis, toxoplasma, FTA-ABS, VDRL, rubella, hepatitis B, HIV (TORCHs), vaginal swab, basal glycemia, and transaminases, among other paraclinical tests, were done on pregnant women. Data was arranged, tabulated, and analyzed in SPSS v.23.0. A descriptive statistical analysis with measures of central tendency and dispersion for quantitative variables, and proportions analysis was done for qualitative variables.

RESULTS: A total of 555 clinical records were analyzed. Of the infectious agents with a risk of vertical transmission, syphilis was the most frequent with 3.6%. Regarding toxoplasmosis, 2.5% were IgM-positive. 4.2% of the pregnant women had IgG antibodies against Rubella and 2 women showed antibodies against HIV.

CONCLUSIONS: Our results reflect the need for the implementation of educational, prevention, and detection health programs with the aim to decrease the number of prenatal infections in the pregnant migrant population for preventing fatal complications both in mothers and newborns.

PMID:37586652 | DOI:10.1016/j.tmaid.2023.102629

J Endod. 2023 Aug 14:S0099-2399(23)00496-X. doi: 10.1016/j.joen.2023.08.006. Online ahead of print.

ABSTRACT

INTRODUCTION: To compare the biofilm-mimicking hydrogel removal efficiency of Laser-activated irrigation (LAI, AdvErl Evo, Morita) with five other irrigation techniques in simulated curved root canals with lateral canals.

METHODS: 3D-printed root canal models (60°-curvature, radius 5mm; dimension 25/.06) with a total length of 20mm and lateral canals in all directions at 2, 5 and 8mm (diameter 0.2mm) from the apex were filled with a colored biofilm-mimicking hydrogel. The following protocols (each 3x20s continuous irrigation with distilled water 3ml/20s; n=20) were carried out: conventional needle irrigation (=NI); manual agitation (=MA, gutta-percha point 25/.06); EndoActivator (=SAI-EA, 25/.04); EDDY (=SAI-E; 25/.04); ultrasonically-activated irrigation (=UAI) and LAI (Er:YAG-laser; P400FL tip at canal entrance; 25pps, 50mJ, 300μs). Standardized photos were taken with a microscope and the removal of the hydrogel was determined as a percentage for the entire system, the main canal and the lateral canals. Statistical analysis was performed using ANOVA and Scheffé test (P=.05).

RESULTS: LAI (89.3±5.9%) showed the greatest hydrogel removal followed by SAI-E (65.5±3.3%) and UAI (59.1±4.7%), with significant differences between these groups (P<.05). NI, MA and SAI-EA performed equally (P>.05) and obtained the significantly lowest values (P<.05). LAI and SAI-E showed the significantly best hydrogel removal from the main canal (P<.05). At all three levels, LAI removed significantly more hydrogel from the lateral canals than all other techniques (P<.05).

CONCLUSION: LAI was superior to other techniques in both the entire system and the lateral canals in removing the hydrogel. SAI-E achieved comparable results in the main canal.

PMID:37586645 | DOI:10.1016/j.joen.2023.08.006

Int J Radiat Oncol Biol Phys. 2023 Aug 14:S0360-3016(23)07744-1. doi: 10.1016/j.ijrobp.2023.07.046. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine the benefit of an intensive locoregional treatment including an image-guided adaptive brachytherapy (IGABT) among cervical cancer patients with extrapelvic extension.

PATIENTS AND METHODS: Medical records of consecutive patients with a metastatic cervical cancer and receiving an external beam radiotherapy (EBRT) and IGABT boost in XXXXXX XXXXXX as part of their first line of treatment were examined. Depending on tumor sites, patients received a pelvic +/- para-aortic EBRT. For those with visceral or supradiaphragmatic lymph node metastases, chemoradiation was delivered after usually 3 cycles of chemotherapy. All patients received a brachytherapy boost, guided by magnetic resonance imaging and aimed at increasing the dose to the high risk clinical target volume (CTV_HR). Local control, patient overall (OS), progression-free (PFS) survival and radiotherapy-related side effects were examined and prognostic factors were searched.

RESULTS: 164 patients were included, 76.2% had para-aortic lymph node extension without distant metastasis (N2) and 23.8% had distant metastatic sites (M1). There was not statistically significant difference in survival between both groups. With a median follow-up of 36 months, OS, PFS, and LC at 3 years were 55.5% (CI95%: 48-64), 40.6% (CI95%: 38-54), and 90% (CI95%: 85-96), respectively. In multivariate analysis, a D₉₀CTV_HR dose ≥80 Gy was significant for better OS (HR=0.96, 95%CI: 0.94-0.98, p<0.001). Most toxicities were mild to moderate, with 2% of grade 3 late urinary toxicity, 7% late grade 2 vaginal sequelae, and one grade 3 proctitis. During follow-up, rectovaginal fistula occurred in two patients without local relapse.

CONCLUSION: IGABT permits dose escalation and high LC rates for cervical cancer patients with extrapelvic extension. Dose/effect relationships for survival were shown. Because of high frequency of distant events, systemic intensification should be tested more specifically among these patients.

PMID:37586615 | DOI:10.1016/j.ijrobp.2023.07.046

Int J Radiat Oncol Biol Phys. 2023 Aug 14:S0360-3016(23)07747-7. doi: 10.1016/j.ijrobp.2023.08.009. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to define the minimal clinically important difference (MCID) for the FACT Hepatobiliary (FACT-Hep) questionnaire, allowing meaningful evaluation of the effect of radiotherapy (RT) on quality of life (QOL) in patients treated for pancreatic cancer (PC).

METHODS AND MATERIALS: The cohort included patients with PC who received RT as a component of curative intent therapy, who completed the FACT-Hep at baseline and end of treatment (EOT). The MCID was determined for the FACT-Hep and subdomains using anchor-based and distribution-based approaches. In the anchor-based approach, improvement and deterioration in age-adjusted regression models for change in scores were defined using the overall health assessment item of the PROMIS-10 as the anchor. The MCID was calculated as 0.3 and 0.5 standard deviation (SD) for distribution-based analysis. MCID point estimate using 0.5 SD (range) was averaged across time points and by approach, and the ranges are reported as minimum and maximum values across methods.

RESULTS: The FACT-Hep domain with the lowest MCID was the emotional domain (deterioration 0.8-1.8). The hepatobiliary cancer subscale (HCS) has the highest and widest MCID range. A positive change of 2.9-4.3 in HCS should be considered a clinically relevant improvement. MCID estimates from 0.3 SD were in exact agreement with the anchor-based estimates for the physical domain (1.6-2.4). The MCID range for the Fact-Hep total score was 6.9-10.5 and 6.5-10.5 for improvement and deterioration, respectively.

CONCLUSION: The MCID for the FACT-Hep subdomains and totals were calculated using a combination of anchor- and distribution-based approaches. These findings are fundamental to determine whether there is meaningful improvement or deterioration in QOL for patients with PC receiving RT. Evaluating a different anchor for determining the MCID of the social domain is recommended.

PMID:37586614 | DOI:10.1016/j.ijrobp.2023.08.009

J Arthroplasty. 2023 Aug 14:S0883-5403(23)00825-2. doi: 10.1016/j.arth.2023.08.028. Online ahead of print.

ABSTRACT

INTRODUCTION: We aimed to determine if the use of augmented tibial fixation with stems in primary total knee arthroplasty (TKA) in obese patients was associated with a difference in the reason for revision, type of revision, or the overall revision rate.

METHODS: Data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) compared reason for revision, rate, and type of revision between primary TKA using stemmed tibial prostheses to non-stemmed prostheses, stratified by body mass index (BMI) and obesity. The cumulative percent revision (CPR) was obtained using the Kaplan-Meier method, and Cox proportional hazards models estimated hazard ratios (HRs) adjusted for age and sex, with 95% confidence intervals. All tests were two-tailed at 5% statistical significance (P<0.05). P values are capitalized and italicized throughout the manuscript and tables. There were 66,508 procedures were available for analyses.

RESULTS: Obese Class 2 (BMI 35 to 39.99) had higher rates of revision in the stemmed group compared to the no stem group (Hazards Ratio (HR) 1.44, 95% Confidence Interval (CI) 1.00, 2.05, P=0.047). There was no significant difference in revision rates between stemmed and non-stemmed tibial prostheses in any other BMI group. Primary TKA in obese patients (BMI ≥30), with a stem extension had a significantly higher rate of minor revisions compared to no stem extension (HR 1.31 95% CI 1.03, 1.66, P=0.025). There was no significant difference between stemmed and no stem groups for major revision in obese patients, and for minor or major revision in non-obese patients.

CONCLUSION: Using a tibial stem during primary TKA in obese patients is not associated with a lower rate of revision.

PMID:37586598 | DOI:10.1016/j.arth.2023.08.028

J Arthroplasty. 2023 Aug 14:S0883-5403(23)00823-9. doi: 10.1016/j.arth.2023.08.027. Online ahead of print.

ABSTRACT

BACKGROUND: The noise associated with ceramic-on-ceramic (CoC) total hip arthroplasty (THA) has been a concerning issue, while its underlying causes remain unclear.

METHODS: We conducted a retrospective analysis of 119 patients (174 primary CoC THAs) who had a mean follow-up of 28 months (range, 12 to 106). A questionnaire was designed to collect information on nature, frequency, onset, duration, and impact of the noise. Post-operative x-rays were evaluated. Clinical evaluations, including Harris and Oxford hip scores, were documented at follow-up time points (6 weeks, 3 months, 6 months, and 1 year).

RESULTS: Of the 174 hips, 31.6% reported noise, including 26 popping (14.9%), 24 clicking (12.1%), and 5 grinding (2.9%). No patients reported squeaking. Noisy hips had lower age (P=0.009) and body mass index (P=0.019). Among developmental dysplasia of the hip patients, 17 of 55 hips reported noise associated with smaller cup anteversion angle (P=0.004), greater body height (P=0.022), and larger acetabular cup size (P=0.049). Noise typically began at a mean of 193 days (range, 1 to 2,598) days after surgery and disappeared spontaneously in 50.9% of hips before final follow-up, with an average disappearance time of 211 days (range, 60 to 730) days. Noise did not affect daily life in 74.5% of patients, while 26.9% of patients who had popping reported painful sensations. One patient experienced joint dislocation, and another experienced a ceramic liner fracture during follow-up. No statistical difference was observed in outcome scores between noise and silent groups at four follow-up time points.

CONCLUSION: Incidence of noise after primary CoC THA is relatively high. Smaller cup anteversion and larger acetabular cup size were associated with noise production in patients who had DDH.

PMID:37586597 | DOI:10.1016/j.arth.2023.08.027