Nevin Manimala

Chaos. 2022 Dec;32(12):123102. doi: 10.1063/5.0122184.

ABSTRACT

Key features of biological activity can often be captured by transitions between a finite number of semi-stable states that correspond to behaviors or decisions. We present here a broad class of dynamical systems that are ideal for modeling such activity. The models we propose are chaotic heteroclinic networks with nontrivial intersections of stable and unstable manifolds. Due to the sensitive dependence on initial conditions, transitions between states are seemingly random. Dwell times, exit distributions, and other transition statistics can be built into the model through geometric design and can be controlled by tunable parameters. To test our model’s ability to simulate realistic biological phenomena, we turned to one of the most studied organisms, C. elegans, well known for its limited behavioral states. We reconstructed experimental data from two laboratories, demonstrating the model’s ability to quantitatively reproduce dwell times and transition statistics under a variety of conditions. Stochastic switching between dominant states in complex dynamical systems has been extensively studied and is often modeled as Markov chains. As an alternative, we propose here a new paradigm, namely, chaotic heteroclinic networks generated by deterministic rules (without the necessity for noise). Chaotic heteroclinic networks can be used to model systems with arbitrary architecture and size without a commensurate increase in phase dimension. They are highly flexible and able to capture a wide range of transition characteristics that can be adjusted through control parameters.

PMID:36587320 | DOI:10.1063/5.0122184

Chaos. 2022 Dec;32(12):123124. doi: 10.1063/5.0125949.

ABSTRACT

While it is well known that the probability density for conventional stochastic differential equations can be obtained by numerically solving the corresponding Fokker-Planck equations, no feasible approaches have been reported to compute the probability density for stochastic differential equations with time delays. Lacking efficient algorithms to compute the probability density has greatly restricted the application of stochastic differential equations with time delays. A numerical method is developed in this paper to compute the probability density for stochastic differential equations with multiple time delays. It is shown that the proposed numerical method is of first order convergence with respect to time step. Numerical examples are presented to verify and illustrate the proposed method.

PMID:36587317 | DOI:10.1063/5.0125949

Chaos. 2022 Dec;32(12):123135. doi: 10.1063/5.0131433.

ABSTRACT

This paper focuses on the averaging principle of Caputo fractional stochastic differential equations (SDEs) with multiplicative fractional Brownian motion (fBm), where Hurst parameter 1/2<H<1 and the integral of fBm as a generalized Riemann-Stieltjes integral. Under suitable assumptions, the averaging principle on Hölder continuous space is established by giving the estimate of Hölder norm. Specifically, we show that the solution of the original fractional SDEs converges to the solution of the proposed averaged fractional SDEs in the mean square sense and gives an example to illustrate our result.

PMID:36587315 | DOI:10.1063/5.0131433

Acad Emerg Med. 2023 Jan 1. doi: 10.1111/acem.14651. Online ahead of print.

ABSTRACT

BACKGROUND: Reported risk of bleeding complications after central catheter access in patients with thrombocytopenia is highly variable. Current guidelines recommend routine prophylactic platelet transfusion before central venous catheter placement in patients with severe thrombocytopenia. Nevertheless, strength of such recommendations is weak and supported by observational studies including few patients with very low platelet counts (PLT < 20×10⁹ /L). This study aims to assess the risk of bleeding complications related to using or not using prophylactic platelet transfusion before ultrasound-guided central venous access in patients with very low platelet counts.

METHODS: This was a retrospective cohort study of patients with very low PLT counts (PLT< 20×10⁹ /L) subjected to ultrasound-guided central venous catheterization between January 2011 and November 2019 in a university hospital. Bleeding complications were graded according to the Common Terminology Criteria for Adverse Events. A multivariate logistic regression was conducted to assess the risk of major and minor bleeding complications comparing patients who did or did not receive prophylactic platelet transfusion for the procedure. Multiple imputation by chained equations was used to handle missing data. A 2-tailed P < .05 was considered statistically significant.

RESULTS: Among 221 patients with very low platelets, 72 received prophylactic platelet transfusions while 149 did not. Baseline characteristics were similar between transfused and non-transfused patients. No major bleeding events were identified, while minor bleeding events were recognized in 35.7% of patients. Multivariate logistic regression analysis showed no significant differences in bleeding complications between patients who received prophylactic platelet transfusions and those who did not (OR 0.83, 95% CI 0.45-1.55, p= 0.567). Additional complete case and sensitivity analyses yielded similar results to the main analysis.

CONCLUSIONS: In this single center retrospective cohort study of ultrasound-guided central venous access in patients with very low platelet counts, no major bleeding was identified, and prophylactic platelet transfusions did not significantly decrease minor bleeding events.

PMID:36587310 | DOI:10.1111/acem.14651

Cephalalgia. 2023 Jan;43(1):3331024221131331. doi: 10.1177/03331024221131331.

ABSTRACT

OBJECTIVE: To compare clinical features in youth with continuous headache from migraine, persistent post-traumatic headache, and new daily persistent headache to determine if they are similar, contrary to their distinction in the International Classification of Headache Disorders.

METHODS: We pursued a single center age- and sex-matched observational study comparing the clinical characteristics of 150 youth (11 – 17 years old) with continuous headache from migraine, persistent post-traumatic headache, and new daily persistent headache. A diagnostic algorithm based on international classification of headache disorders criteria was used to identify those with migraine (headache features of migraine with gradual onset), and persistent post-traumatic headache and new daily persistent headache (based on the circumstances of headache onset regardless of headache features). Fifty participants each with migraine, persistent post-traumatic headache, and new daily persistent headache were matched by age and sex. Participant survey responses on headache characteristics were compared.

RESULTS: Median usual headache severity was 6.0 [95%CI 6.0, 6.0] and was not different across diagnostic groups (H statistic = 1.2, p = 0.55). Headache exacerbation frequency, disability, associated symptoms, and most triggers were not significantly different across groups. The majority of persistent post-traumatic headache and new daily persistent headache had headache features consistent with a diagnose of migraine (72% and 62%, respectively).

CONCLUSION: Our findings suggest that most persistent post-traumatic headache and new daily persistent headache may represent abrupt onset of migraine.

PMID:36587297 | DOI:10.1177/03331024221131331

Bone Joint J. 2023 Jan;105-B(1):47-55. doi: 10.1302/0301-620X.105B1.BJJ-2022-0522.R1.

ABSTRACT

AIMS: The aim of this study was to identify variables associated with time to revision, demographic details associated with revision indication, and type of prosthesis employed, and to describe the survival of hinge knee arthroplasty (HKA) when used for first-time knee revision surgery and factors that were associated with re-revision.

METHODS: Patient demographic details, BMI, American Society of Anesthesiologists (ASA) grade, indication for revision, surgical approach, surgeon grade, implant type (fixed and rotating), time of revision from primary implantation, and re-revision if undertaken were obtained from the National Joint Registry data for England, Wales, Northern Ireland, and the Isle of Man over an 18-year period (2003 to 2021).

RESULTS: There were 3,855 patient episodes analyzed with a median age of 73 years (interquartile range (IQR) 66 to 80), and the majority were female (n = 2,480, 64.3%). The median time to revision from primary knee arthroplasty was 1,219 days (IQR 579 to 2,422). Younger age (p < 0.001), decreasing ASA grade (p < 0.001), and indications for revision of sepsis (p < 0.001), unexplained pain (p < 0.001), non-polyethylene wear (p < 0.001), and malalignment (p < 0.001) were all associated with an earlier time to revision from primary implantation. The median follow-up was 4.56 years (range 0.00 to 17.52), during which there were 410 re-revisions. The overall unadjusted probability of re-revision for all revision HKAs at one, five, and ten years after surgery were 2.7% (95% confidence interval (CI) 2.2 to 3.3), 10.7% (95% CI 9.6 to 11.9), and 16.2% (95% CI 14.5 to 17.9), respectively. Male sex (p < 0.001), younger age (p < 0.001), revision for septic indications (p < 0.001) or implant fracture (p = 0.010), a fixed hinge (p < 0.001), or surgery performed by a non-consultant grade (p = 0.023) were independently associated with an increased risk of re-revision.

CONCLUSION: There were several factors associated with time to first revision. The re-revision rate was 16.2% at ten years; however, the risk factors associated with an increased risk of re-revision could be used to counsel patients regarding their outcome.Cite this article: Bone Joint J 2023;105-B(1):47-55.

PMID:36587261 | DOI:10.1302/0301-620X.105B1.BJJ-2022-0522.R1

Bone Joint J. 2023 Jan;105-B(1):72-81. doi: 10.1302/0301-620X.105B1.BJJ-2022-0595.R1.

ABSTRACT

AIMS: The aim of this study was to compare the functional and radiological outcomes and the complication rate after nail and plate fixation of unstable fractures of the ankle in elderly patients.

METHODS: In this multicentre study, 120 patients aged ≥ 60 years with an acute unstable AO/OTA type 44-B fracture of the ankle were randomized to fixation with either a nail or a plate and followed for 24 months after surgery. The primary outcome measure was the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score. Secondary outcome measures were the Manchester-Oxford Foot Questionnaire, the Olerud and Molander Ankle score, the EuroQol five-dimension questionnaire, a visual analogue score for pain, complications, the quality of reduction of the fracture, nonunion, and the development of osteoarthritis.

RESULTS: At 24 months, the median AOFAS score was equivalent in the two groups (nail 90 (interquartile range (IQR) 82 to 100), plate 95 (IQR 87 to 100), p = 0.478). There were statistically more complications and secondary operations after nail than plate fixation (p = 0.024 and p = 0.028, respectively). There were no other significant differences in the outcomes between the two groups.

CONCLUSION: The functional outcome after nail and plate fixation was equivalent; however, the complication rate and number of secondary operations was significantly higher after nail fixation. These results suggest that plate fixation should usually be the treatment of choice for unstable ankle fractures in the elderly.Cite this article: Bone Joint J 2023;105-B(1):72-81.

PMID:36587258 | DOI:10.1302/0301-620X.105B1.BJJ-2022-0595.R1

Bone Joint J. 2023 Jan;105-B(1):17-20. doi: 10.1302/0301-620X.105B1.BJJ-2022-1119.

ABSTRACT

Economic evaluation provides a framework for assessing the costs and consequences of alternative programmes or interventions. One common vehicle for economic evaluations in the healthcare context is the decision-analytic model, which synthesizes information on parameter inputs (for example, probabilities or costs of clinical events or health states) from multiple sources and requires application of mathematical techniques, usually within a software program. A plethora of decision-analytic modelling-based economic evaluations of orthopaedic interventions have been published in recent years. This annotation outlines a number of issues that can help readers, reviewers, and decision-makers interpret evidence from decision-analytic modelling-based economic evaluations of orthopaedic interventions.Cite this article: Bone Joint J 2023;105-B(1):17-20.

PMID:36587252 | DOI:10.1302/0301-620X.105B1.BJJ-2022-1119

Plant Dis. 2022 Dec 31:PDIS08221788A. doi: 10.1094/PDIS-08-22-1788-A. Online ahead of print.

NO ABSTRACT

PMID:36587246 | DOI:10.1094/PDIS-08-22-1788-A

BMC Complement Med Ther. 2022 Dec 31;23(1):1. doi: 10.1186/s12906-022-03814-8.

ABSTRACT

BACKGROUND AND OBJECTIVE: Restless legs syndrome/Willis-Ekbom Disease (RLS/WED) is one of the most prevalent sleep disorders. There are contradicting data about the effectiveness of magnesium and vitamin B6 in alleviating the symptoms of this condition. Therefore, this study aimed to assess the efficacy of magnesium and vitamin B6 in alleviating the symptoms of RLS/WED.

METHODS: A single-blind study was conducted on individuals with this illness for at least three months. Randomly, 75 patients were assigned into three groups: magnesium, vitamin B6, and placebo. The experimental group received daily doses of 40 mg vitamin B6 or 250 mg magnesium oxide. While others in the control group merely received a placebo. Patients’ disease severity and sleep quality were evaluated three times using standard questionnaires (at the beginning of the study, one and two months after therapy). Utilizing SPSS22 software and the ANOVA, t-test, and repeated measure tests, statistical analysis was conducted.

RESULTS: The mean and standard deviation of sleep quality and disease severity at the beginning of the trial and throughout the first month following the intervention did not differ statistically between the three groups. In the second month following the intervention, the mean and standard deviation of sleep quality and disease severity were significantly different (P = 0.001).

CONCLUSION: Taking magnesium and vitamin B6 supplements can reduce the severity of symptoms of RLS/WED patients and improve their sleep quality.

PMID:36587225 | DOI:10.1186/s12906-022-03814-8