Nevin Manimala

Medicine (Baltimore). 2022 Nov 18;101(46):e31395. doi: 10.1097/MD.0000000000031395.

ABSTRACT

Primary biliary cholangitis (PBC) is an autoimmune cholestatic liver disease. The clinical effectiveness of ursodeoxycholic acid (UDCA) plus glucocorticoids and/or immunosuppressants remains controversial in PBC patients. The study aimed to compare the efficacy of monotherapy and combination therapy in patients with PBC and to assess the factors affecting the efficacy. In this retrospective study, 266 patients diagnosed with PBC were divided into monotherapy group (UDCA), double therapy group (UDCA plus glucocorticoids or immunosuppressants), and triple therapy group (UDCA plus glucocorticoids and immunosuppressants) according to different treatments. Demographic characteristics, immune parameters, biochemistry profiles, and other indicators were evaluated at baseline, 6 months, and 1 year following treatment. The prognosis was evaluated using the Paris II standard. The liver transplant-free survival at 3, 5, 10, and 15 years was predicted by GLOBE score. All statistical analyses were conducted using SPSS (version 24) software (SPSS Inc, Chicago, IL). The long-term survival rate of the triple therapy group was significantly improved compared with the monotherapy group (P = .005). In addition, multivariate analysis showed that abnormal platelet count, alkaline phosphatase, and albumin levels were risk factors for poor response. When IgG levels were elevated but below twice the upper limit of normal, the clinical benefit was not significant compared with monotherapy (P > .05). Compared with monotherapy and double therapy, triple therapy may improve the long-term survival rate of PBC patients. Abnormal platelet count, alkaline phosphatase, and albumin levels were associated with a poor prognosis.

PMID:36401422 | DOI:10.1097/MD.0000000000031395

Medicine (Baltimore). 2022 Nov 18;101(46):e31297. doi: 10.1097/MD.0000000000031297.

ABSTRACT

Sepsis and septic shock are the most common causes of death in non-cardiac surgical intensive care units (ICU). Adequate analgesia is essential to achieve positive outcomes. There were differences in pain management between patients with and without sepsis or septic shock. The release of inflammatory mediators, especially cytokines, in sepsis or septic shock decreases the pain threshold. Septic intensive care patients probably require higher doses of opioids than do non-septic patients. A retrospective observational study was carried out in an anesthesiologic intensive care unit from January 1, 2014 to June 30, 2016. Patients were divided into 4 groups according to the following criteria: sepsis (“yes/no” and communication ability “yes/no”). After adjusting for the number of cases using the pairing method, a total of 356 patients were recruited. The endpoint of our study was defined as the “total opioid dose”. Statistical evaluations were performed using t tests and 2-factor analysis of variance. There was a significant difference in opioid doses between communicative and non-communicative ICU patients F(1, 352) = 55.102, P < .001). This effect was observed in the ICU patients with and without sepsis. The mean sufentanil dose was significantly higher in non-communicative patients than in communicative patients group (E(1, 352) = 51.435, P < .001, partial ƞ2 = 0.144). The effect of higher opioid- (F(1, 352) = 1.941, P = .161) and sufentanil (F(1, 352) = 1.798, P = .342) requirement was not statistically significant due to sepsis. The hypothesis that sepsis decreases the pain threshold could not be proven in this study. The effect of a higher opioid requirement is not directly caused by sepsis but by communication ability. Furthermore, we were able to show through our investigations and especially through the data of the pain recording instruments that the septic and non-septic intensive care patients receive sufficient pain therapy treatment in our ICU. Regular pain evaluations should be performed on patients in the ICUs who are able to communicate and those who are not.

PMID:36401417 | DOI:10.1097/MD.0000000000031297

Medicine (Baltimore). 2022 Nov 18;101(46):e31853. doi: 10.1097/MD.0000000000031853.

ABSTRACT

The abnormal gait of stroke patients not only severely limits the recovery of their walking ability, but also seriously affects their quality of daily life. Previous observational studies have focused too much on the observation of single degree of freedom and axial knee motion angles in stroke patients. Changes in the multi-degree of freedom and multi-axial joint angles of the knee have been less frequently observed, leading to somewhat limited conclusions. Therefore, the aim of this study was to use the Opti-knee motion test to analyze in real time the motion of the knee in all directions on the healthy side of stroke patients and to compare it with normal gait to provide a clinical basis for subsequent rehabilitation. In a cross-sectional study, 120 subjects (60 stroke patients were as the observation group and 60 healthy subjects as the control group) were studied. Both groups of subjects were tested for Opti-Knee tri-axial angles of motion of the healthy side of the knee, including flexion and extension, internal and external rotation, internal and external turning, anterior and posterior displacement, superior and inferior displacement, left and right displacement, maximum extension angle and maximum flexion angle. Compared with the control group, there were significant changes in the joint angles of flexion and extension, internal and external rotation, internal and external turning, maximum extension and maximum flexion of the knee on the healthy side in the observation group, and the differences were statistically significant [95%(37.22, 45.13), P = .01], [95%(9.51,13.67), P = .018], [95%(4.82,7.57), P = .049], [95%(4.12, 8.63), P = .019], [95%(51.68, 57.28), P = .0001]. However, there was no significant change in the angle of motion of the healthy side of the knee for anterior-posterior displacement, superior-inferior displacement and internal-external displacement in either group and the differences were not statistically significant [95%(1.16, 1.78), P = .72], [95%(0.85,1.32), P = .32], [95%(0.57, 0.88), P = .36]. This study confirms the importance of changes in the angle of motion of the knee on the side of the stroke patient in maintaining the stability of the knee joint. Therefore, their bilateral lower limb symmetry training should be paid attention to in the subsequent rehabilitation treatment.

PMID:36401410 | DOI:10.1097/MD.0000000000031853

Medicine (Baltimore). 2022 Nov 18;101(46):e31243. doi: 10.1097/MD.0000000000031243.

ABSTRACT

IMPORTANCE: As one of the chronic neurological degenerative diseases with the highest incidence of amnesia and dementia, Alzheimer’s disease (AD) carried out the clinical treatment based on the 2 traditional Chinese medicine (TCM) of Chinese herbal compound and acupuncture (AP). With the vigorous development of TCM, doctors are facing the problem of choosing TCM or western medicine in clinical work. Hence there is an urge to make pairwise comparisons among these interventions to provide evidence for clinical practice.

OBJECTIVE: The used efficacy of the 2 TCM methods and combined with donepeziline were compared to compile the best treatment through network meta-analysis.

METHODS: Patients diagnosed with AD were included in the randomized clinical trial, who were treated with tonifying kidney decoction (TKD) or AP combined with donepezil hydrochloride (DH) as an intervention measure, while the control group was treated with DH. The total effective rate was the primary outcome, and mini-mental state examination (MMSE) score and activities of daily living (ADCS-ADL) scores were the secondary indicators.

RESULTS: Eventually 30 studies reporting 2236 patients underwent TKD or AP combined with DH were enrolled. In terms of total efficiency, compared with TKD and DH, TKD + DH was significantly preferable. In addition, TKD were classified into 2 categories, namely tonifying kidney with reducing phlegm formulas (TKRP) and tonifying kidney with filling lean marrow (TKFLM). Regarding to MMSE score of TKD, of the 3 interventions, only TKRP + DH (standard mean difference [SMD] = 4.84, 95% confidence interval [CI]: 0.86-8.82) and TKFLM + DH (SMD = 3.93, 95% CI: 1.06-6.80) had significant efficacy over TKFLM (SMD = 4.25, 95%CI: -2.58 to 11.08). Although no difference between TKRP and other groups, its effectiveness was higher than TKFLM + DH and TKFLM (surface under the cumulative ranking curve (SUCRA) = 61.5%). For the ADL score, compared with TKFLM + DH and DH, TKRP + DH had more effective (SUCRA = 70.2%). Regarding to the total effective rates, AP + DH was more statistically better than AP, and AP was statistically better than DH.

CONCLUSION: TKD or AP in combination with DH are significantly superior in treating AD.

PMID:36401402 | DOI:10.1097/MD.0000000000031243

ASAIO J. 2022 Nov 18. doi: 10.1097/MAT.0000000000001844. Online ahead of print.

ABSTRACT

The standard method for cardiac allograft preservation for the past 50 years has been static storage using crushed ice. A heart transplant transportation system designed to improve preservation quality with temperature monitoring, the Paragonix SherpaPak Cardiac Transport System (SCTS), was evaluated for its impact on postoperative costs relative to conventional ice storage. Observational US multicenter registry data collected during the August 2015 to November 2021 timeframe from 12 transplant hospitals were analyzed using logistic regression analysis and propensity matching to balance measured baseline covariates and to reduce selection bias. Hospital cost and outcome data post-transplant were then evaluated using various statistical methods. One hundred seventy-four (174) patients were identified resulting in 87 matches. Baseline characteristics were similar between groups. The SCTS group had a significantly lower proportion of ICU days on post-transplant mechanical circulatory support (p < 0.0001); significantly fewer patients on extracorporeal membrane oxygenation (p = 0.017); and significantly fewer patients experiencing severe primary graft dysfunction (PGD) (p = 0.03). Overall hospital plus mechanical circulatory support post-transplant costs were significantly lower by $26.7K in the CTS cohort (p = 0.03). Use of the SCTS is associated with improved clinical outcomes resulting in significantly lower overall hospital care costs.

PMID:36399786 | DOI:10.1097/MAT.0000000000001844

J Pediatr Gastroenterol Nutr. 2022 Nov 18. doi: 10.1097/MPG.0000000000003657. Online ahead of print.

ABSTRACT

Reducing the burden of non-communicable diseases (NCDs) is one of the top priorities of public health policies worldwide. One of the recognized means of achieving this objective is to improve the diet quality. The Nutri-Score (N-S) is a [five-color – A, B, C, D, E letters] front-of-pack labelling logo intended to help consumers quickly identify the healthier prepackaged foods within a food category. Available studies have shown that the N-S is an efficient tool to achieve this aim in terms of consumers’ awareness, perception, understanding and purchasing and that its use may help to reduce the prevalence of NCDs. The N-S is currently implemented on a voluntary basis in seven European countries and a discussion is underway within the European Commission to achieve a harmonized mandatory label. However, no study on the putative impact of the N-S on children’s dietary patterns and health is available. The N-S is not applicable to infants’ and young children’s formulas and to specific baby foods, the compositions of which are already laid down in European Union regulations. The N-S does not replace age-appropriate dietary guidelines. As children consume an increasing number of adult type and processed foods, the relevance of the N-S for children should be evaluated considering the children’s high specific requirements, especially in younger children. This is especially necessary for fitting fat and iron requirements, whereas protein-rich foods should be better framed. Moreover, efforts should be made to inform on how to use the N-S and in education on healthy diets.

PMID:36399776 | DOI:10.1097/MPG.0000000000003657

Phys Rev Lett. 2022 Nov 4;129(19):190402. doi: 10.1103/PhysRevLett.129.190402.

ABSTRACT

We realize a turbulent cascade of wave excitations in a homogeneous 2D Bose gas and probe on all relevant time and length scales how it builds up from small to large momenta, until the system reaches a steady state with matching energy injection and dissipation. This all-scales view directly reveals the two theoretically expected cornerstones of turbulence formation-the emergence of statistical momentum-space isotropy under anisotropic forcing and the spatiotemporal scaling of the momentum distribution at times before any energy is dissipated.

PMID:36399756 | DOI:10.1103/PhysRevLett.129.190402

Phys Rev Lett. 2022 Nov 4;129(19):198003. doi: 10.1103/PhysRevLett.129.198003.

ABSTRACT

Combinatorial problems arising in puzzles, origami, and (meta)material design have rare sets of solutions, which define complex and sharply delineated boundaries in configuration space. These boundaries are difficult to capture with conventional statistical and numerical methods. Here we show that convolutional neural networks can learn to recognize these boundaries for combinatorial mechanical metamaterials, down to finest detail, despite using heavily undersampled training sets, and can successfully generalize. This suggests that the network infers the underlying combinatorial rules from the sparse training set, opening up new possibilities for complex design of (meta)materials.

PMID:36399748 | DOI:10.1103/PhysRevLett.129.198003

Phys Rev Lett. 2022 Nov 4;129(19):195501. doi: 10.1103/PhysRevLett.129.195501.

ABSTRACT

While deeply supercooled liquids exhibit divergent viscosity and increasingly heterogeneous dynamics as the temperature drops, their structure shows only seemingly marginal changes. Understanding the nature of relaxation processes in this dramatic slowdown is key for understanding the glass transition. Here, we show by atomistic simulations that the heterogeneous dynamics of glass-forming liquids strongly correlate with the local residual plastic strengths along soft directions computed in the initial inherent structures. The correlation increases with decreasing temperature and is maximum in the vicinity of the relaxation time. For the lowest temperature investigated, this maximum is comparable with the best values from the literature dealing with the structure-property relationship. However, the nonlinear probe of the local shear resistance in soft directions provides here a real-space picture of relaxation processes. Our detection method of thermal rearrangements allows us to investigate the first passage time statistics and to study the scaling between the activation energy barriers and the residual plastic strengths. These results shed new light on the nature of relaxations of glassy systems by emphasizing the analogy between the thermal relaxations in viscous liquids and the plastic shear transformation in amorphous solids.

PMID:36399740 | DOI:10.1103/PhysRevLett.129.195501

Phys Rev Lett. 2022 Nov 4;129(19):190401. doi: 10.1103/PhysRevLett.129.190401.

ABSTRACT

We investigate the compression of quantum information with respect to a given set M of high-dimensional measurements. This leads to a notion of simulability, where we demand that the statistics obtained from M and an arbitrary quantum state ρ are recovered exactly by first compressing ρ into a lower-dimensional space, followed by some quantum measurements. A full quantum compression is possible, i.e., leaving only classical information, if and only if the set M is jointly measurable. Our notion of simulability can thus be seen as a quantification of measurement incompatibility in terms of dimension. After defining these concepts, we provide an illustrative example involving mutually unbiased bases, and develop a method based on semidefinite programming for constructing simulation models. In turn we analytically construct optimal simulation models for all projective measurements subjected to white noise or losses. Finally, we discuss how our approach connects with other concepts introduced in the context of quantum channels and quantum correlations.

PMID:36399736 | DOI:10.1103/PhysRevLett.129.190401