Nevin Manimala

Skeletal Radiol. 2023 Apr 12. doi: 10.1007/s00256-023-04327-2. Online ahead of print.

ABSTRACT

OBJECTIVES: Determine whether MR imaging findings or demographics predict surgical management in patients with first MTP joint injuries.

MATERIALS AND METHODS: Retrospective study of 161 forefoot MRs for traumatic first MTP injury (M:F 92:69, mean age 33 ± 13 yrs.). Two radiologists reviewed imaging for ligamentous, osseous, and tendinous injuries. Ligaments and tendons were graded as 0:normal, 1:sprain or strain, 2:partial tear, 3:complete tear. Osseous injuries were classified as edema, fracture, or cartilage injury. Clinical data obtained included sex, age, injury acuity, sport participation, level of sport, and treatment. Imaging findings and demographic data were assessed to determine predictive factors for surgical management. Statistics included kappa, chi-squared, Fisher’s exact, and logistic regression.

RESULTS: Logistic regression (odds ratio [95% CI], p-value) showed that grade 2 or 3 injuries of the plantar ligamentous complex (2.87, [1.10, 7.48], p = 0.031), grade 2 or 3 injuries of the medial collateral ligament (3.24, [1.16, 9.08], p = 0.025), and participation in collegiate or professional sports (4.34 [1.64, 11.52], p = 0.003) were associated with an increased rate of surgical intervention. k = ligamentous injury (0.71-0.83), osseous trauma (0.88-0.95), and tendon injury (0.78). All other imaging findings and demographic factors were not significant predictors of surgery (p > 0.05).

CONCLUSION: Participation in collegiate or professional sports and tears of the plantar ligamentous complex or medial collateral ligament predicted surgical management in patients with first MTP trauma.

PMID:37043019 | DOI:10.1007/s00256-023-04327-2

Ophthalmologie. 2023 Apr 12. doi: 10.1007/s00347-023-01839-z. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to analyze the effect of corneal cross-linking (CXL) on corneal biomechanics and visual acuity.

PATIENTS AND METHODS: The examination results before and after CXL in 56 eyes of 56 patients between 2017 and 2021 were evaluated retrospectively. The last preoperative examination was compared to the postoperative follow-up values after 6 and 12 months. The main outcome measures included various biomechanical parameters from the Corvis ST (CST), Pentacam and the visual acuity (logMAR, “logarithm of the Minimal Angle of Resolution”). For longitudinal evaluation, a general linear model for repeated measurements was used. A p-value of less than 0.05 was considered to show a statistically significant result. Bonferroni correction was applied for multiple comparisons.

RESULTS: The maximum corneal refractive power K_max decreased slightly without statistical significance from 57.1 ± 6.1 diopters (dpt) to 56.6 ± 6.3 dpt after 6 months (p = 0.076) and 56.8 ± 6.6 dpt after 12 months (p = 0.443). The Pentacam parameter Belin/Ambrósio Enhanced Ectasia Total Deviation Display (BAD D) showed a statistically significant increase from the preoperative value of 8.4 ± 3.7 to the postoperative value of 9.1 ± 3.6 after 6 months (p < 0.001) and to 8.9 ± 3.5 after 12 months (p = 0.051). The CST parameter Ambrósio’s relational thickness to horizontal profile (ARTh) decreased statistically significantly from 229.9 ± 109.6 to 204.8 ± 84.9 at 6 months (p = 0.017) and 205.3 ± 93.7 at 12 months (p = 0.022). The CST parameter stiffness parameter A1 (SP A1) increased slightly from the preoperative value 69.9 ± 17.2 to 70.4 ± 17.2 after 6 months (p = 1) and 71 ± 18.2 after 1 year (p = 1). Mean best-corrected visual acuity (logMAR) showed an improvement from 0.39 ± 0.3 to 0.34 ± 0.3 at 6 months (p = 0.286) and to 0.31 ± 0.3 at 12 months (p = 0.077). Regarding the ABCD classification, the parameters were determined preoperatively with an average of A2B3C1D2. They showed the same value of A2B3C1D2 after 6 and 12 months.

CONCLUSION: In progressive keratoconus, corneal cross-linking has the potential to positively influence the biomechanics of the cornea and visual acuity as a low complication treatment option.

PMID:37043004 | DOI:10.1007/s00347-023-01839-z

Exp Brain Res. 2023 Apr 12. doi: 10.1007/s00221-023-06614-9. Online ahead of print.

ABSTRACT

This experiment investigated the role of anticipatory and reflexive compensatory neuromotor control in catching errors occurring under load uncertainty. Participants performed 64 trials of a one-handed ball catching task using visually identical balls of four different weights without knowing the weight of the ball on each trial. Anticipatory and reflexive compensatory muscle activation were recorded in five muscles (anterior deltoid, biceps brachii, wrist flexors group, triceps brachii, lumbar erector spinae) using the EMG integral. In each muscle, the anticipatory and reflexive compensatory muscle activation were compared between successful catches and catching errors for the lightest ball and the heaviest ball. Anticipatory muscle activation was not implicated in errors made with the lightest ball. However, reflexive compensatory muscle activation in the anterior deltoid, biceps brachii, and wrist flexors were implicated in errors made with the lightest ball. Specifically, catching errors with the lightest ball were characterized by elevated reflexive compensatory muscle activation. In the case of the heaviest ball, both anticipatory (anterior deltoid, wrist flexors) and reflexive compensatory muscle activation (anterior deltoid, biceps brachii, wrist flexors) were implicated in catching errors. That is, catching errors with the heaviest ball were characterized by lower anticipatory and reflexive compensatory muscle activation. Results are considered in the context of the likely influence of limb compliance in catching under load uncertainty.

PMID:37042997 | DOI:10.1007/s00221-023-06614-9

Ginekol Pol. 2023 Apr 12. doi: 10.5603/GP.a2023.0024. Online ahead of print.

ABSTRACT

OBJECTIVES: In many countries, various anti-pandemic interventions were adopted in 2020, which also affected obstetric practices. The aim of this study is to determine their effect on the frequency of caesarean section (CR) according to Robson classification (RC).

MATERIAL AND METHODS: Deliveries in 2019 and 2020 were retrospectively analysed. Mothers were grouped according to RC, and the frequency of CR in the different groups were compared.

RESULTS: We found a statistically significant increase in the frequency of CR in the pandemic year (20.0% vs 17.8%, p = 0.0242). When classified into RC groups, the increase in the different groups lost statistical significance. Nevertheless, the increase was most important in Robson group 5 due to maternal rejection of vaginal delivery after CR and in Robson group 2b with elective CR. In spite of our expectations, the frequency of caesarean section performed due to indication of protracted labour was not increased.

CONCLUSIONS: Interventions that were implemented during the first and second waves of the pandemic were associated with increased frequency of planned caesarean sections.

PMID:37042331 | DOI:10.5603/GP.a2023.0024

Ginekol Pol. 2023 Apr 12. doi: 10.5603/GP.a2023.0032. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this study was to evaluate the trial of labor after caesarean (TOLAC) outcomes and determine its reliability by comparing it with elective repeat caesarean delivery (ERCD) and vaginal delivery.

MATERIAL AND METHODS: For this purpose, the outcomes of patients aged 18-40 years who had 57 TOLACs, 72 vaginal deliveries, and 60 elective caesarean sections in Ankara Koru Hospital between January 1, 2019, and January 1, 2022 were compared.

RESULTS: Gestational age was lower in the normal vaginal delivery (NVD) group than in the elective caesarean section and vaginal birth after caesarean delivery (VBAC) groups (p < 0.0005). The birth weight was statistically significantly lower in the NVD group than in the elective caesarean section and VBAC groups (p < 0.0002). No statistically significant correlation was found between the BMI values in all three groups (p < 0.586). There was no statistically significant difference between the groups in terms of pre- and post-natal haemoglobin and APGAR scores (p < 0.575)(p < 0.690)(p < 0.747). The rate of epidural and oxytocin use was higher in the NVD group than in the VBAC group (p < 0.001) (p < 0.037). There was no statistically significant correlation between the birth weights of the infants in the TOLAC group and failed VBAC (p < 0.078). No statistically significant correlation was observed between the use of oxytocin for induction and failed VBAC (p < 0.842). There was no statistically significant correlation between epidural anaesthesia and failed VBAC (p < 0.586). A statistically significant correlation was found between gestational age and caesarean section as a result of a failed VBAC (p < 0.020).

CONCLUSIONS: The main reason for not preferring TOLAC continues to be uterine rupture. It can be recommended to eligible patients in tertiary centers. Because even when the factors increasing the success of VBAC were excluded, the rate of successful VBAC remained high.

PMID:37042325 | DOI:10.5603/GP.a2023.0032

Int J Surg. 2023 Apr 13. doi: 10.1097/JS9.0000000000000257. Online ahead of print.

ABSTRACT

BACKGROUND: Vacuum-assisted biopsy (VAB) and core needle biopsy (CNB) are both widely used methods in diagnosing breast lesions. We aimed to determine whether the Elite 10-gauge VAB achieves higher accuracy than the BARD spring-actuated 14-gauge CNB.

MATERIALS AND METHODS: This was a phase 3, open-label, parallel, randomized controlled trial (NCT04612439). In total, 1470 patients with ultrasound (US)-visible breast lesions requiring breast biopsy were enrolled from April to July 2021 and randomized at a 1:1 ratio to undergo VAB or CNB. All patients underwent surgical excision after needle biopsy. The primary outcome was accuracy, defined as the proportion of patients who had a consistent qualitative diagnosis between the biopsy and surgical pathology results. The underestimation rate, false-negative rate and safety evaluations were the secondary endpoints.

RESULTS: A total of 730 and 732 patients were evaluable for endpoints in the VAB and CNB groups, respectively. The accuracy of VAB surpassed that of CNB in the whole population (94.8% vs. 91.1%, P=0.009). The overall malignant underestimation rate was significantly lower in the VAB group than in the CNB group (21.4% vs. 30.9%, P=0.035). Additionally, significantly more false-negative events were noted in the CNB group (4.9% vs. 7.8%, P=0.037). In patients who presented with accompanying calcification, the accuracy of VAB surpassed that of CNB (93.2% vs. 88.3%, P=0.022). The potential superiority of VAB was indicated in patients with heterogeneous echo on US.

CONCLUSIONS: In general, the 10-G VAB procedure is a reasonable alternative to the 14-G CNB procedure with higher accuracy. We recommend the use of VAB for lesions with accompanying calcification or heterogeneous echo on US.

PMID:37042316 | DOI:10.1097/JS9.0000000000000257

Int J Surg. 2023 Apr 13. doi: 10.1097/JS9.0000000000000375. Online ahead of print.

ABSTRACT

BACKGROUND: The risk of reoperations after abdominal and pelvic surgery is multifactorial and difficult to predict. The risk of reoperation is frequently underestimated by surgeons as most reoperations are not related to the initial procedure and diagnosis. During reoperation, adhesiolysis is often required, and patients have an increased risk of complications. Therefore, the aim of this study was to provide an evidence-based prediction model based on the risk of reoperation.

MATERIALS AND METHODS: A nationwide cohort study was conducted including all patients undergoing an initial abdominal or pelvic operation between June 1st 2009 and June 30th 2011 in Scotland. Nomograms based on multivariable prediction models were constructed for the two- and five-year overall risk of reoperation and risk of reoperation in the same surgical area. Internal cross-validation was applied to evaluate reliability.

RESULTS: Of the 72 270 patients with an initial abdominal or pelvic surgery, 10 467 (14.5%) underwent reoperation within five years postoperatively. Mesh placement, colorectal surgery, diagnosis of inflammatory bowel disease, previous radiotherapy, younger age, open surgical approach, malignancy and female sex increased the risk of reoperation in all the prediction models. Intra-abdominal infection was also a risk factor for the risk of reoperation overall. Accuracy of the prediction model of risk of reoperation overall and risk for the same area was good for both parameters (c-statistic 0.72 and 0.72).

CONCLUSION: Risk factors for abdominal reoperation were identified and prediction models displayed as nomograms were constructed to predict the risk of reoperation in the individual patient. The prediction models were robust in internal cross-validation.

PMID:37042312 | DOI:10.1097/JS9.0000000000000375

Clin Nephrol. 2023 Apr 12. doi: 10.5414/CN110818. Online ahead of print.

ABSTRACT

INTRODUCTION: Bioimpedance methods are currently used abundantly in patients on chronic hemodialysis. In this population, their most important role is to determine the level of fluid volume, respectively its intra- and extracellular components. There are several bioimpedance devices on the market. In this project, we compared two frequently used devices: Body Composition Monitor and InBody S10.

MATERIALS AND METHODS: We invited patients on chronic hemodialysis who are being treated in our institution. Inclusion criteria were: clinically stable condition, lack of artificial joints, pacemakers, or other implanted metal objects. The examinations were performed just prior to hemodialysis by both methods 5 minutes apart. Patients were examined in the supine position after 15 minutes at rest to stabilize body fluids. Studied parameters were those that are obtainable by both methods: total body water (TBW) (L), extracellular water (ECW) (L) and intracellular water (ICW) (kg), lean tissue mass (LTM) (L), and fat tissue mass (kg).

RESULTS: We included 14 participants (aged 64.4 ± 18.0 years). Statistically and clinically significant differences between data from compared devices were observed for all variables. Inbody S10 overestimated TBW by 2.58 ± 2.73 L and ICW by 4.56 ± 2.27 L in comparison to BCM. The highest difference (27%) was measured for LTM and ICW 22%. LTM, fat, and ECW were higher when measured by BCM (LTM by 8.54 ± 6.43 kg, p < 0.001; fat by 3.41 ± 4.22, p = 0.01; ECW by 2.01 ± 0.89 L, p < 0.001).

CONCLUSION: The differences between tested devices were significant not only statistically, but also clinically. These two devices cannot be used interchangeably for dry weight setting of hemodialysis patients.

PMID:37042273 | DOI:10.5414/CN110818

J Exp Biol. 2023 Apr 12:jeb.245286. doi: 10.1242/jeb.245286. Online ahead of print.

ABSTRACT

Skin provides functions such as protection and prevention of water loss. In some taxa the outer surface of skin has been modified to form structures that enable attachment to various surfaces. Constant interaction with surfaces is likely to cause damage to these attachment systems and reduce function. It seems logical that when skin is shed via ecdysis, its effectiveness may increase, through repair of damage or other rejuvenating mechanisms. We address two questions using three diplodactylid geckos as model species: (i) does repeated mechanical damage affect clinging ability in geckos to the point that they cannot support their own body weight? (ii) Does use without induced damage reduce effectiveness of the attachment system, and if so, does ecdysis restore clinging ability? We found that repeated damage reduced clinging ability in all three species, although at different rates. Additionally, use reduced clinging ability over time when no apparent damage was incurred. Clinging ability increased after ecdysis in all three species, both when damage was specially induced, and when it was not. After use without induced damage, the increase in clinging ability after ecdysis was statistically significant in two of three species. Our findings show that use decreases clinging ability, and mechanical damage also effects geckos’ capacity to exert shear forces consistently. Thus, ecdysis improves clinging ability, in both scenarios where damage is induced, and more generally. In addition to the physiological functions provided by skin, our study highlights an important function of ecdysis in a speciose vertebrate group.

PMID:37042266 | DOI:10.1242/jeb.245286

Home Health Care Serv Q. 2023 Apr 12:1-17. doi: 10.1080/01621424.2023.2195810. Online ahead of print.

ABSTRACT

In Taiwan, the Integrated Home Care (IHC) project was introduced for medically compromised patients living at home receiving Home Health Care (HHC) in 2016. The focus of the project was on organizing care teams and managing care for patients. The aim of this study was to investigate the benefits and impacts of IHC in Taiwan. The primary outcome measure was the mortality rate of patients who received IHC versus those who did not receive IHC (non-IHC). The secondary outcomes were medical utilization and expenditure. The results showed that IHC was associated with a statistically significant reduction in mortality compared to non-IHC for home-dwelling patients over 90-, 180-, and 365-days periods. Additionally, IHC users were less likely to be hospitalized and had shorter hospitalization times compared to non-IHC users. Furthermore, IHC was found to reduce medical expenditure compared to non-IHC.

PMID:37042246 | DOI:10.1080/01621424.2023.2195810