Nevin Manimala

Eur Spine J. 2022 Apr 18. doi: 10.1007/s00586-022-07215-w. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine the effect of endplate reduction on the final healing morphology and degenerative changes in intervertebral discs.

METHODS: Forty-eight patients with single-level thoracolumbar fractures with endplate injury were included. All patients underwent posterior reduction and pedicle screw fixation, and postoperative imaging was used to determine whether endplate reduction was successful. The healing morphology of the endplate was divided into three types: increased endplate curvature, irregular healing and traumatic Schmorl node. MRI was performed at baseline and at the last follow-up evaluation to observe changes in disc degeneration (disc height and nucleus pulposus signal) and Modic changes.

RESULTS: The reduction rate in the central area was significantly lower than that in the peripheral area (P = 0.017). In patients with successful reduction, 90.9% (20/22) of the endplates healed with increased curvature. In patients with an unsuccessful endplate reduction, 63.4% (26/41) of the endplates healed irregularly, and 34.1% (14/41) of the endplates formed traumatic Schmorl nodes. Endplate reduction was closely related to the final healing morphology of the endplate (P < 0.001), which had a significant protective effect on the degeneration of the intervertebral disc. At the last follow-up evaluation, there was no statistically significant correlation between different endplate healing morphologies and new Modic changes.

CONCLUSIONS: The reduction rate in the central area is significantly lower than that in the peripheral area. Although all of the intervertebral discs corresponding to fractured endplates had degenerated to different degrees, successful endplate fracture reduction can obviously delay the degeneration of intervertebral discs.

PMID:35435517 | DOI:10.1007/s00586-022-07215-w

Acta Neurochir (Wien). 2022 Apr 18. doi: 10.1007/s00701-022-05190-1. Online ahead of print.

ABSTRACT

PURPOSE: To externally validate the arteriovenous malformation-related intracerebral haemorrhage (AVICH), intracerebral haemorrhage (ICH), and novel haemorrhage presentation risk score (R2eD) in brain arteriovenous malformations.

METHODS: Adult patients diagnosed radiologically with an arteriovenous malformation (AVM) at a tertiary neurosurgical centre between 2007 and 2018 were eligible for inclusion. Both the AVICH and ICH scores were calculated for AVM-related symptomatic haemorrhage (SH) and compared against the modified Rankin scale (mRS) at discharge and last follow-up, with unfavourable outcome defined as mRS > 2. R2eD scores were stratified based on presentation with SH. External validity was assessed using Harrel’s C-statistic.

RESULTS: Two hundred fifty patients were included. Mean age at diagnosis was 46.2 years [SD = 16.5]). Eighty-seven patients (34.8%) had a SH, with 83 included in the analysis. Unfavourable mRS outcome was seen in 18 (21.6%) patients at discharge and 18 (21.6%) patients at last follow-up. The AVICH score C-statistic was 0.67 (95% confidence interval [CI], 0.53-0.80) at discharge and 0.70 (95% CI, 0.56-0.84) at last follow-up. The ICH score C-statistic was 0.78 (95% CI 0.67-0.88), at discharge and 0.80 (95% CI 0.69-0.91) at last follow-up. The R2eD score C-statistic for predicting AVM haemorrhage was 0.60 (95% CI, 0.53-0.67).

CONCLUSIONS: The AVICH score showed fair-poor performance, while the ICH score showed good-fair performance. The R2eD score demonstrated poor performance, and its clinical utility in predicting AVM haemorrhage remains unclear.

PMID:35435515 | DOI:10.1007/s00701-022-05190-1

Parasitol Res. 2022 Apr 18. doi: 10.1007/s00436-022-07522-7. Online ahead of print.

ABSTRACT

Parasitism is a dynamic ecological phenomenon that is constantly influenced by the environment and intrinsic factors of the host. We aimed to evaluate the influence of vegetation, environmental temperature, reproductive conditions, sex, and body condition (BC) on the detection of Trypanosoma spp. in the blood of Thrichomys fosteri in the Pantanal region, an enzootic area for trypanosomiasis. Whole blood was collected from the tip of the tail, and nPCR was performed for Trypanosoma spp. detection from the DNA extracted from the resultant blood clot. Statistical analyses were performed using generalized linear models. Our results showed that there is a greater probability of detection of Trypanosoma spp. in the bloodstream of animals with the highest BC values in periods with mild temperatures. Since T. fosteri is an abundant and common prey for carnivores, even in periods with low temperatures and consequent decrease in the reproduction and activities of the blood-sucking arthropod vectors, the maintenance of Trypanosoma spp. in the studied area would be guaranteed via predation (trophic network) of T. fosteri individuals with good BC and patent parasitemia. Furthermore, T. fosteri, which displays Trypanosoma spp. in the bloodstream, would be reproducing adequately because we found no influence between the reproductive condition and the detection of Trypanosoma spp. in T. fosteri. The caviomorph rodent T. fostei is an important species for the maintenance of Trypanosoma spp. in the Pantanal biome.

PMID:35435514 | DOI:10.1007/s00436-022-07522-7

Clin Oral Investig. 2022 Apr 18. doi: 10.1007/s00784-022-04412-1. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate the effect of four different finishing procedures on the fatigue strength of a fully stabilized zirconia (5Y-FSZ) material.

MATERIALS AND METHODS: Disc-shaped specimens of a 5Y-FSZ (Katana UTML, Kuraray Noritake) were made (ISO 6872-2015), grinded with 600- and 1200-grit silicon carbide paper, sintered as recommended, and randomly assigned into four groups according to the finishing technique: C (control, as-sintered), P (polished with polishing rubbers), G (glaze application – powder/liquid technique), and PG (polished with polishing rubbers + glaze application – powder/liquid). Then fatigue strength (staircase method), X-ray diffraction (XRD), and scanning electron microscopy (SEM) analyses were performed.

RESULTS: The C group presented the lowest fatigue strength, while the PG group presented the highest. The P and G groups presented intermediate behavior, presenting similar statistical results. XRD showed similar crystalline phase patterns for all groups. SEM images revealed some changes in the zirconia surface, with the P group presenting some scratches on the surface, while the scratches in the PG group were filled with the glaze material.

CONCLUSION: None of the techniques analyzed in this study impaired the fatigue strength of fully stabilized zirconia. Importantly, the polishing rubbers combined with glaze application (PG group) improved its fatigue strength.

CLINICAL RELEVANCE: The polishing rubbers followed by glaze application improve the fatigue strength in ultra-translucent zirconia.

PMID:35435492 | DOI:10.1007/s00784-022-04412-1

J Cancer Res Clin Oncol. 2022 Apr 18. doi: 10.1007/s00432-022-03925-2. Online ahead of print.

ABSTRACT

OBJECTIVE: The levels of platelet-related inflammation indicators and sarcopenia have been reported to affect the survival of patients with cancer. To evaluate the prognostic influence of platelet count (PLT), platelet lymphocyte ratio (PLR), and systemic immune inflammation index (SII), and SII combined with sarcopenia on the survival of patients with gastric cancer (GC).

METHODS: A total of 1133 patients with GC (812 male and 321 female, average age: 59.43 years) were evaluated. Receiver-operating characteristic curves were used to determine the best cutoff values of PLT, PLR, and SII, and univariate and multivariate Cox risk regression models were used to evaluate whether SII is an independent predictor of overall survival (OS). The prognostic SS (SII-sarcopenia) was established based on SII and sarcopenia. Finally, a comprehensive analysis of the prognostic SS was performed.

RESULTS: SII had the strongest prognostic effect. The SII and OS of patients with GC were in an inverted U-shape (adjusted HR = 1.07; 95% CI 0.97-1.19; adjusted P = 0.179). In patients with SII > 1800, SII was negatively correlated with OS (adjusted HR = 0.57; 95% CI 0.29-1.12; adjusted P = 0.102), however, there is no statistical difference. Interestingly, a high SS was associated with a poorer prognosis. The higher the SS score was, the worse the OS (P < 0.001).

CONCLUSION: SII is an independent prognostic indicator of GC, and high SII is related to poor prognosis. A higher SS score had worse survival. Thus, the prognostic SS is a reliable predictor of OS in patients with GC.

PMID:35435489 | DOI:10.1007/s00432-022-03925-2

Arch Gynecol Obstet. 2022 Apr 18. doi: 10.1007/s00404-022-06555-8. Online ahead of print.

ABSTRACT

BACKGROUND: Preliminary evidence suggests that women with cervical oss insufficiency may have an increased risk to develop pelvic organ prolapse later in life, suggesting a common underlying collagen-oriented mechanism.

OBJECTIVE: The objective of this study was to determine the association between cervical oss insufficiency and the subsequent development of pelvic organ prolapse.

STUDY DESIGN: A matched, case-control study, including women who delivered at the Soroka University Medical Center. Cases were women diagnosed or treated with pelvic organ prolapse (n = 1463), and controls were a representative sample of women of the same age group without pelvic organ prolapse (n = 5637). The association between pelvic organ prolapse and prior preterm birth was tested. Univariate analysis was performed using a conditional logistic regression to assess the association between preterm labor and pelvic organ prolapse. Statistically and clinically significant variables in the univariate analysis were included in the multivariable regression.

RESULTS: The rate of spontaneous preterm birth did not differ between the study groups [pelvic organ prolapse – 4.0% (59/1463) vs. non- pelvic organ prolapse – 4.9% (276/5637), p = 0.16]. The median number of preterm births was higher among women without pelvic organ prolapse (controls) than in those with pelvic organ prolapse (cases) (p = 0.004). Among those who delivered preterm, the individual proportion of preterm deliveries was higher among the controls’ group (p = 0.03). Similarly, the rate of cesarean deliveries was also higher among the controls group (p = 0.003). The rate of small for gestational age neonates was higher in the controls group (p = 0.0007), while that of large for gestational age neonates was higher in the case group (p = 0.02). In the univariate analysis, birthweight, vaginal delivery, and prior surgery were associated with subsequent development of pelvic organ prolapse. The multivariable analysis exhibited the same association- having birthweight, vaginal delivery, and all types of prior surgery independently associated with subsequent development of pelvic organ prolapse.

CONCLUSIONS: Obstetrics characteristics associated with pelvic organ prolapse included vaginal delivery and birthweight along with non-obstetrical factors such as prior surgery. There was no association between preterm birth and subsequent development of pelvic organ prolapse. Our findings suggest that the effort during labor at term required for the delivery of appropriate for gestational age or large for gestational age newborns affects the pelvic floor and is a major contributor for the subsequent development of pelvic organ prolapse.

PMID:35435482 | DOI:10.1007/s00404-022-06555-8

Knee Surg Sports Traumatol Arthrosc. 2022 Apr 18. doi: 10.1007/s00167-022-06973-w. Online ahead of print.

ABSTRACT

PURPOSE: There is a lack of consensus regarding need for Venous Thrombo Embolism (VTE) prophylaxis following arthroscopic knee surgery and open soft tissue knee reconstruction. Clear cut guidelines like ones for trauma surgery and arthroplasty do not exist and the published literature is limited to case reports with a few society guidelines. Given this lack of consensus, we conducted a modified Delphi questionnaire of international experts to provide recommendations on this topic.

METHODS: The consensus statements were generated using an anonymised 3 round modified Delphi questionnaire, sent to an international panel of 38 knee surgeons, with an 80% agreement being set as the limit for consensus. The responses were analysed using descriptive statistics with measures like mode, median and box plots. Feedback was provided to all panelists based on responses from the previous rounds to help generate the consensus.

RESULTS: Six consensus statements were generated after the three rounds of Delphi. Patient factors, prolonged surgery duration and family history of thrombogenic events emerged as the main points to be taken into consideration for prophylaxis.

CONCLUSION: It was established through this study, that there exists a select group of patients undergoing arthroscopic surgery that justify the usage of VTE prophylaxis. The expert responses to most of the questions in different scenarios favoured usage of VTE prophylaxis based on patient factors like advanced age, past history of VTE, smoking, oral contraceptive use etc. LEVEL OF EVIDENCE: Level V.

PMID:35435469 | DOI:10.1007/s00167-022-06973-w

Appl Microbiol Biotechnol. 2022 Apr 18. doi: 10.1007/s00253-022-11921-2. Online ahead of print.

ABSTRACT

It was previously believed that the microbial community in the esophagus was relatively stable, but it has been reported that different esophageal diseases have different microbial community characteristics. In this study, we recruited patients with esophageal squamous cell carcinoma (ESCC) and collected 51 pairs of tumor and adjacent non-tumor tissues for full-length 16S rDNAsequencing and qPCR to compare the differences in microbial community structure. The results of sequencing in 19 pairs of tissues showed that Proteobacteria, Firmicutes, Bacteroidetes, Deinococcus-Thermus, and Actinobacteria were the main bacteria in tumor and adjacent non-tumor tissues. At the genus level, the bacteria with the highest relative proportion in tumor and adjacent non-tumor tissues were Streptococcus and Labrys, respectively. At the same time, it was observed that the complexity of microbial interactions in tumor tissues was weaker than that of adjacent non-tumor tissues. The results also found that the relative abundance of 24 taxa was statistically different between tumor and adjacent non-tumor tissues. The findings of qPCR in 32 pairs of tissues further evidence that the relative proportions of Blautia, Treponema, Lactobacillus murinus, Peptoanaerobacter stomatis, and Fusobacteria periodonticum were statistically different in tumor and adjacent non-tumor tissues. The findings of PIRCUSt2 indicated the lipopolysaccharide biosynthesis and biotin metabolism in the microbiome of cancer tissues are more significant. This study supplements the existing information on the structure, function, and interaction of microorganisms in the esophagus in situ and provides a direction for the further exploration of the relationship between esophageal in situ microorganisms and esophageal squamous cell carcinoma. KEY POINTS: • The structure of the microbial community in esophageal cancer tissue and adjacent non-tumor tissues at the phylum level is similar • Streptococcus and Labrys are the most important bacteria in esophageal tumor tissues and adjacent non-tumor tissues, respectively • Microbial interactions in tumor tissues are stronger than in adjacent non-tumor tissues.

PMID:35435458 | DOI:10.1007/s00253-022-11921-2

Graefes Arch Clin Exp Ophthalmol. 2022 Apr 18. doi: 10.1007/s00417-022-05599-5. Online ahead of print.

ABSTRACT

PURPOSE: To propose an algorithm of the major and minor diagnostic criteria for macular myopic choroidal neovascularization (mCNV).

METHODS: This single-center, retrospective, cross-sectional study was based in Istituto Auxologico Italiano, Milan, Italy. Two authors evaluated the clinical and imaging parameters of eyes with high myopia (spherical equivalent of -6D or less) and suspected to have naïve, recurrent, or inactive mCNV. Recordings of the eyes that met the inclusion criteria were then independently evaluated by two other senior retinal specialists. Fluorescein angiography (FA), spectral domain optical coherence tomography (SD-OCT), and OCT angiography were used for multimodal imaging.

RESULTS: One-hundred and twenty-two eyes (n = 107; 39 men, 68 women) were included in the study. The mean patient age was 66 years (range, 22-89 years). There were 83 and 39 eyes in the active mCNV and control groups, respectively. The best diagnostic algorithm had positive- and negative-predictive values of 89% and 85%, respectively, and was based on four criteria: leakage/staining on FA, retinal thickening, fuzzy area on SD-OCT, and recent metamorphopsia. When excluding FA-derived findings, retinal pigment epithelium (RPE) features played a diagnostic role in 33 eyes (27%). Twenty-seven eyes with active mCNV (32%) did not have the fuzzy area. Taken singularly, no clinical or imaging parameter had both sensitivity and specificity greater than 78%. Matching of 2 or 3 biomarkers did not yield a sensitivity or specificity greater than 79%. Sensitivities and specificities ≥ 90% were found in ten criteria combinations that included four to five biomarkers. The most frequent were metamorphopsia, fuzzy area, retinal thickening, and leakage. Less frequently, they included hemorrhage, staining, and RPE features such as elevation, flattening, and focal interruption. For all the parameters, the agreement between the investigators was good (Cohen k ≥ 0.66), being the lowest when detecting the ELM interruption within the lesion.

CONCLUSIONS: A combination of at least four clinical and biological markers yielded the highest positive- and negative-predictive values. More (“major”) and less (“minor”) frequent diagnostic criteria are proposed.

PMID:35435447 | DOI:10.1007/s00417-022-05599-5

Ceylon Med J. 2021 Sep 30;65(3):144-150. doi: 10.4038/cmj.v66i3.9493.

ABSTRACT

BACKGROUND: Group B Streptococcus (GBS) causes significant morbidity and mortality in neonates, pregnant women and patients with underlying comorbidities. Intrapartum antibiotic prophylaxis (IAP) is currently the mainstay of prevention and effective vaccine against invasive GBS disease is under clinical trial.

OBJECTIVES: To describe the serotype distribution of invasive and colonizing GBS isolates in Sri Lanka.

METHODS: Probable GBS isolates from high vaginal swabs (HVS) and sterile body sites were collected from eight selected hospital laboratories. Following confirmation of the identification as group B Streptococcus by phenotypic methods including Lancefield grouping test (Plasmatic UK), isolates were tested for serotyping by latex agglutination test kit (STATEN serum institute, Denmark).

RESULTS: Out of the 145 probable GBS isolates only 100 from HVS and 37 from sterile body sites were confirmed as GBS. Serotype III was the most predominant in invasive GBS isolates followed by Ia, Ib, VI, II and V in the descending order of frequency. Serotype VI was the most predominant in HVS isolates followed by serotype III, V, Ia, II, Ib and IV. Difference of GBS serotype distribution between the invasive and HVS group was statistically significant (P value = 0.038).

CONCLUSION: Serotype distribution pattern of the study isolates was comparable to most of the other developing and developed countries and hence will be beneficial in future vaccine introduction. GBS vaccine which is currently under clinical trial (Ia, Ib and III) is potentially effective for preventing 68% of the early onset disease in neonates in this study setting.

PMID:35435437 | DOI:10.4038/cmj.v66i3.9493