Nevin Manimala

JBRA Assist Reprod. 2021 Nov 23. doi: 10.5935/1518-0557.20210062. Online ahead of print.

ABSTRACT

OBJECTIVE: This current survey investigated the role of the Forkhead 3 box protein (foxp3) gene and serum vitamin D levels in women with recurrent spontaneous abortion (RSA).

METHODS: The mRNA level of the foxp3 gene in peripheral blood was evaluated in women with a history of RSA (N=40) and in controls (N=40) via quantitative polymerase chain reaction. We employed the enzyme-linked immunosorbent assay to assess the serum levels of 1,25-dihydroxyvitamin D3 (1,25(OH)2 D) in both groups. The Mann-Whitney U test and Pearson’s correlation coefficient were used to statistically compare study groups between and within themselves, respectively.

RESULTS: Although mRNA levels of foxp3 were higher in women with RSA than in controls, we observed no significant change in mRNA levels of foxp3 between the two groups (p=0.16). An important positive correlation was observed between foxp3 mRNA levels and 1,25(OH)2 D in controls (p=0.003). In contrast, the correlation between foxp3 expression and 1,25(OH)2 D was not significant in the case group (p=0.14). Serum vitamin D levels were lower in women with RSA than in controls (p<0.001).

CONCLUSIONS: Our findings demonstrated that 1,25Vitamin D3 along with other molecules might help prevent RSA by providing for an anti-inflammatory state not necessarily through foxp3 expression or T cell differentiation.

PMID:34812598 | DOI:10.5935/1518-0557.20210062

Ther Apher Dial. 2021 Nov 23. doi: 10.1111/1744-9987.13764. Online ahead of print.

ABSTRACT

INTRODUCTION: Quantitative measurement of anti-A/-B antibody titers is important during ABO-incompatible living kidney transplantation (ABOi-LKT).

METHODS: We conducted a multi-institutional study to measure the antibody titers using the automated column agglutination technique (auto-CAT) and tube test (TT) method in ABOi-LKT recipients. Statistical analysis was performed to evaluate the two methods.

RESULTS: We examined 111 samples from 35 ABOi-LKT recipients at four institutions. The correlation coefficient of the two methods was >0.9; the concordance rate and clinically acceptable concordance rate for the IgG titers were 60.4% and 88.3%, respectively. Perioperative status did not influence the statistical significance. Parallel changes were observed in the IgG antibody titers measured using the auto-CAT or TT technique by desensitizing therapy in time-course monitoring.

CONCLUSION: Auto-CAT is comparable with the TT technique and is feasible for IgG anti-A/B antibody titration in ABOi-LKT recipients. This article is protected by copyright. All rights reserved.

PMID:34812590 | DOI:10.1111/1744-9987.13764

Clin Otolaryngol. 2021 Nov 23. doi: 10.1111/coa.13898. Online ahead of print.

ABSTRACT

OBJECTIVE: Epistaxis is the most common otolaryngological emergency and up to one third of patients in treated on an inpatient basis take oral anticoagulants (OAC). Direct oral anticoagulants (DOAC), an OAC subgroup, have been on the market since 2010 and are being increasingly prescribed due to the cardiologic and hematologic guidelines that favour them over vitamin K antagonists (VKA), the older of the OAC subgroups. The present study aims to investigate which subgroup of epistaxis patients taking OACs has a more favourable outcome.

DESIGN/SETTING: A systematic review and meta-analysis were performed according to the PRISMA 2020 statement using the PubMed and Cochrane Library databases. Continuous data was analysed and standardized mean difference (SMD) was calculated according to Hedges’ g. Dichotomous data was analysed and the Mantel-Haenszel method was applied to establish the odds ratio (OR). Heterogeneity was assessed according to the I² statistics.

MAIN OUTCOME/RESULTS: A total of 8 reports covering 1390 patients were included in the final synthesis. The pooled analysis demonstrated significantly shorter hospital stays in the DOAC group (SMD= -0.22, 95% CI -0.42 to -0.02, P= .03) and a significantly higher rate of posterior bleeding in the VKA group (OR= .39, 95% CI .23 to .68, P= .001). No statistically significant differences with regard to recurrence rates, admission rates, the need for transfusion, or surgical intervention (P= .57, .12, .57 and .38 respectively) were found.

CONCLUSION: According to this meta-analysis, epistaxis patients taking DOACs have a more favourable outcome than patients taking VKAs.

PMID:34812585 | DOI:10.1111/coa.13898

Orthop Surg. 2021 Nov 22. doi: 10.1111/os.13172. Online ahead of print.

ABSTRACT

OBJECTIVES: To explore the difference between tracheostomy and non-tracheostomy and identify the risk factors associated with the need for tracheostomy after traumatic cervical spinal cord injury (TCSCI).

METHODS: The demographic and injury characteristics of 456 TCSCI patients, treated in the Xinqiao Hospital from 2010 to 2019, were retrospective analyzed. Patients were divided into the tracheostomy group (n = 63) and the non-tracheostomy group (n = 393). Variables included were age, gender,smoking history, mechanism of injury, concomitant injury, American Spinal Injury Association (ASIA) Impairment Scale, the neurological level of injury, Cervical Spine Injury Severity Score (CSISS), surgery, and length of stay in ICU and hospital. SPSS 25.0 (SPSS, Chicago, IL) was used for statistical analysis and ROC curve drawing. Chi-square analysis was applied to find out the difference of variables between the tracheostomy and non-tracheostomy groups. Univariate logistic regression analysis (ULRA) and multiple logistic regression analysis (MLRA) were used to identify risk factors for tracheostomy. The area under the ROC curve (AUC) was used to evaluate the performance of these risk factors.

RESULTS: Of 456 patients who met the inclusion criteria, 63 (13.8%) underwent tracheostomy. There were differences in age (χ² = 6.615, P = 0.032), mechanism of injury (χ² = 9.87, P = 0.036), concomitant injury (χ² = 6.131, P = 0.013),ASIA Impairment Scale (χ² = 123.08, P < 0.01), the neurological level of injury (χ² = 34.74, P < 0.01), and CSISS (χ² = 19.612, P < 0.01) between the tracheostomy and non-tracheostomy groups. Smoking history, CSISS ≥ 7, AIS A and, NLI ≥ C5 were identified as potential risk factors for tracheostomy by ULRA. Smoking history (OR = 2.960, 95% CI: 1.524-5.750, P = 0.001), CSISS ≥ 7 (OR = 4.599, 95% CI: 2.328-9.085, P = 0.000), AIS A (OR = 14.213, 95% CI: 6.720-30.060, P = 0.000) and NLI ≥ C5 (OR = 8.312, 95% CI: 1.935-35.711, P = 0.004) as risk factors for tracheostomy were determined by MLRA. The AUC for the risk factors of tracheostomy after TCSCI was 0.858 (95% CI: 0.810-0.907).

CONCLUSIONS: Smoking history, CSISS ≥ 7, AIS A and, NLI ≥ C5 were identified as risk factors needing of tracheostomy in patients with TCSCI. These risk factors may be important to assist the clinical decision of tracheostomy.

PMID:34812567 | DOI:10.1111/os.13172

J Orthop Res. 2021 Nov 23. doi: 10.1002/jor.25230. Online ahead of print.

ABSTRACT

Metal on polyethylene (MoP) total hip arthroplasty prostheses are known to release metal debris. Basic science studies suggest that metal implants induce a pro-inflammatory response that ultimately chemoattracts leukocytes including macrophages and neutrophils to the surgical site. This raises concern of higher risk of infection with these prosthesis through the “trojan horse” mechanism by which neutrophils and macrophages transport intracellular pathogens from a remote site. This study compared the infection occurrence between MoP and ceramic on polyethylene (CoP) implants to determine if a higher infection rate in MoP is present. We reviewed a consecutive series of 6,052 CoP and 4,550 MoP primary total hip arthroplasty (THA) patients from 2015-2019. The occurrence of periprosthetic joint infection at two years was defined according to the 2018 ICM definition. Statistical analysis consisted of descriptive statistics, univariate analysis, and regression modeling. When compared to CoP, MoP patients were older, included more females, had a higher body mass index, and more commonly affected by comorbidities according to Elixhauser score. Total revisions were higher in the MoP group (3.19% vs 2.41%) The absolute incidence of PJI was higher in MoP (2.40% vs 1.64%). When we adjusted for confounding factors, MoP was found independently associated with a higher PJI risk. Despite MoP and CoP both being widely used for primary THA, we found a higher incidence of PJI in MoP patients. The association remained significant when controlled for possible confounders. We hypothesize that leukocyte recruitment to these implants may play a role and should be further investigated. This article is protected by copyright. All rights reserved.

PMID:34812555 | DOI:10.1002/jor.25230

J Orthop Res. 2021 Nov 23. doi: 10.1002/jor.25227. Online ahead of print.

ABSTRACT

Developmental dysplasia of the hip (DDH) is commonly described as reduced femoral head coverage due to anterolateral acetabular deficiency. Although reduced coverage is the defining trait of DDH, more subtle and localized anatomic features of the joint are also thought to contribute to symptom development and degeneration. These features are challenging to identify using conventional approaches. Herein, we assessed the morphology of the full femur and hemi-pelvis using an articulated statistical shape model (SSM). The model determined the morphological and pose-based variations associated with DDH in a population of Japanese females and established which of these variations predict coverage. Computed tomography images of 83 hips from 47 patients were segmented for input into a correspondence-based SSM. The dominant modes of variation in the model initially represented scale and pose. After removal of these factors through individual bone alignment, femoral version and neck-shaft angle, pelvic curvature, and acetabular version dominated the observed variation. Femoral head oblateness and prominence of the acetabular rim and various muscle attachment sites of the femur and hemi-pelvis were found to predict 3D CT-based coverage measurements (R² =0.5-0.7 for the full bones, R² =0.9 for the joint). STATEMENT OF CLINICAL SIGNIFICANCE: Currently, clinical measurements of DDH only consider the morphology of the acetabulum. However, the results of this study demonstrated that variability in femoral head shape and several muscle attachment sites were predictive of femoral head coverage. These morphological differences may provide insight into improved clinical diagnosis and surgical planning based on functional adaptations of patients with DDH. This article is protected by copyright. All rights reserved.

PMID:34812545 | DOI:10.1002/jor.25227

Microsurgery. 2021 Nov 23. doi: 10.1002/micr.30844. Online ahead of print.

ABSTRACT

INTRODUCTION: Physiologic microsurgical procedures to treat lymphedema include vascularized lymph node transfer (VLNT) and lymphovenous bypass (LVB). The purpose of this study was to assess 30-day outcomes of VLNT and LVB using the National Surgical Quality Improvement Program (NSQIP) database.

METHODS: NSQIP was queried (2012-2018) for lymphatic procedures for upper extremity lymphedema after mastectomy. Prophylactic lymphatic procedures and those for lower extremity lymphedema were excluded. Outcomes were assessed for three groups: LVB, VLNT, and patients who had procedures simultaneously (VLNA+LVB). Primary outcomes measured were operative time, 30-day morbidities, and hospital length of stay.

RESULTS: The study included 199 patients who had LVB (n = 43), VLNT (n = 145), or VLNT+LVB (n = 11). There was no difference in co-morbidities between the groups (p = 0.26). 30-day complication rates including unplanned reoperation (6.9% VLNT vs. 2.3% LVB) and readmission (0.69% VLNT vs. none in LVB) were not statistically significant (p = 0.54). Surgical site infection, wound complications, deep vein thromboembolism, and cardiac arrest was also similar among the three groups. Postoperative length of stay for VLNT (2.5 days± 2.3), LVB (1.9 days± 1.9), and VLNT+LVB (2.8 days± 0.3) did not differ significantly (p = 0.20). Operative time for LVB (305.4 min ± 186.7), VLNT (254 min ± 164.4), and VLNT+LVB (295.3 min ± 43.2) was not significantly different (p = 0.21).

CONCLUSIONS: Our analysis of the NSQIP data revealed that VLNT and LVB are procedures with no significant difference in perioperative morbidity. Our results support that choice of VLNT versus LVB can be justifiably made per the surgeon’s preference and experience as the operations have similar complication rates.

PMID:34812535 | DOI:10.1002/micr.30844

J Adv Nurs. 2021 Nov 23. doi: 10.1111/jan.15093. Online ahead of print.

ABSTRACT

AIMS: To (1) describe experiences of home from a well-being perspective, (2) describe participant characteristics and well-being measures in relation to housing type (3) and how the aforementioned aspects may affect well-being in very old persons.

DESIGN: Cross-sectional, convergent parallel-results mixed method design with semi-structured interviews analysed by qualitative content analysis, in relation to descriptive statistics and specific well-being outcome measures related to home.

METHODS: A total of 50 persons 80 years or older living in ordinary housing were interviewed (July 2017 to November 2018) about home in relation to well-being, along with collection of participant characteristics and well-being measures related to home.

RESULTS: Participants described how home had become increasingly important as it provided autonomy and acted as a social and occupational hub. However, autonomy was not unconditional, and home could also be perceived as a place of inactive solitude. Results were interpreted as relating to being in the margins of home and had a major impact on well-being. Housing type seemed of importance with higher measures of well-being for participants in single-living housing compared with those living in apartment.

CONCLUSION: Home is increasingly central to well-being in old age; however, very old persons also have to relate to being physically and mentally in the margins of being able to remain in the home. These aspects of home potentially have a major impact on well-being.

IMPACT: As very old persons living in ordinary housing will constitute a larger segment of society in coming years, aspects of home can potentially have a considerable impact on well-being for this age-group. This study describes aspects of home that contribute to, or has adverse impact on well-being. These aspects need thorough consideration in policy-making and planning of health care that can affect experiences of home.

PMID:34812517 | DOI:10.1111/jan.15093

J Dent Educ. 2021 Nov 23. doi: 10.1002/jdd.12826. Online ahead of print.

ABSTRACT

ISSUE: Almost all dental educational research describes statistically significant changes using a one-time intervention at a single program. It is hoped that the most significant of these interventions will transfer to other schools.

APPROACH: But the research logic of context-specific investigations does not always generalize with the same impact to new situations. This is the transfer problem. There is virtually no systematic research exploring the extent to which transfer from the dental educational literature is attempted, how successful it is, and what factors improve transfer.

IMPACT: The paper discusses some of the more prominent issues in transferability such as (a) the meaning of “identical” conditions upon which inductive statistics are based, (b) isolation of causal factors, (c) generalizability, (d) reliability and validity, (e) measures of effect, (f) statistical versus practical significance, and (g) the need to build theory in discussion sections. Eight suggestions are offered for making dental educational research more transferable.

PMID:34812494 | DOI:10.1002/jdd.12826

J Emerg Manag. 2021 Sep-Oct;19(5):505-511. doi: 10.5055/jem.0586.

ABSTRACT

Many outdoor gardens are designed for plants to grow in soil. Few gardens are designed for plants to be hydroponically grown outside with energy and water capture technologies. The feasibility of a selfsufficient, adaptive hydroponic garden harnessing energy from multiple renewable energy (solar and wind) and rainwater collection techniques while producing food has been considered. This study’s primary objective is to conduct a comparative analysis between a traditional soil garden bed and an outdoor hydroponic system, called Pangea. The study findings suggest no significant statistical difference between the plants grown in traditional soil and a Pangea system. Additional objectives of this study include a comparative analysis of water and energy differentials between a standard garden and Pangea. This study’s energy findings suggest that the Pangea system produces 0.05 kWh of energy to 0 kWh of energy production in the classic soil over a month timespan. The water production findings indicate that a Pangea system produces 198.01 L of water and a classic soil of 69 L for a timespan of 1 month, concluding a positive water differential of 288.12 L and a negative water differential of 414 L after 6 months. The study findings suggest the combination of sustainable practices can limit the negative effects of weather-related events to create a positive differential for producing food, water, and energy.

PMID:34812485 | DOI:10.5055/jem.0586