Nevin Manimala

Orthop Surg. 2022 Sep 19. doi: 10.1111/os.13477. Online ahead of print.

ABSTRACT

OBJECTIVE: During PCL reconstruction surgery, precise and personalized positioning of the graft tunnel is very important. In order to obtain patient-specific anatomical data, we established a three-dimensional knee joint fusion model to provide a unified imaging strategy, as well as anatomical information, for individualized and accurate posterior cruciate ligament (PCL) reconstruction.

METHODS: This is an exploration study. From January 2019 to January 2020, 20 healthy adults randomly were enrolled and assessed via CT and MRI imaging. A three-dimensional fusion model of the knee joint was generated using the modified MIMIMICS and image fusion software. On the fused image, the areas of the femoral and tibial PCL footprint of both knees were measured. The anatomical center of the PCL footprint was measured at the femoral and tibial ends. The relevant bony landmarks surrounding the PCL femoral and tibial attachment were also measured. Paired t-tests were employed for all statistical analyzes, and p < 0.05 was considered as statistically significant.

RESULTS: All 20 subjects achieved successful image fusion modeling and measurement, with an average duration of 12 h. The lengths of the LF1-LF3 were 32.1 ± 1.8, 6.8 ± 2.5, and 23.3 ± 2.1 mm, respectively. The lengths of the LT1-LT3 were 37.3 ± 3.3, 45.6 ± 5.3, and 6.0 ± 1.2 mm, respectively. The distances between the tibial PCL center of the left knee to the medial groove, champagne-glass drop-off, and the apex of the medial intercondylar were 8.4 ± 2.4, 9.2 ± 1.8, and 15.3 ± 1.4 mm, respectively, and the corresponding distances from the right knee were 8.0 ± 2.0, 9.4 ± 2.2, and 16.1 ± 1.8 mm, respectively. We observed no difference between the bilateral sides, in terms of the distance from the PCL center to the PCL attachment-related landmark, under arthroscopic guidance. The area of the femoral and tibial PCL footprints on the left knee were 115.3 ± 33.5 and 146.6 ± 24.4 mm² , respectively, and the corresponding areas on the right knee were 121.8 ± 35.6 and 142.8 ± 19.5 mm² , respectively. There was no difference between the bilateral sides in terms of the PCL footprint areas.

CONCLUSION: In the fusion image, the PCL attachment center and relevant bony landmarks which can be easily identified under arthroscopy can be accurately measured. The model can also obtain personalized anatomical data of the PCL on the unaffected side of the patient, which can guide clinical PCL reconstruction.

PMID:36120826 | DOI:10.1111/os.13477

Orthop Surg. 2022 Sep 19. doi: 10.1111/os.13497. Online ahead of print.

ABSTRACT

OBJECTIVE: How to restrict sliding of cephalomedullary nail and rigid reconstruct medial support for unstable intertrochanteric fractures remains a challenge. This study aims to explore the feasibility of a novel cephalomedullary nail for restriction sliding and reconstruction of medial femoral support to prevent failure in unstable trochanteric fractures through finite element analysis.

METHODS: The DICOM files of a unilateral femur spiral computed tomography (CT) scans from a elderly female were converted into STL files, and the most common clinical trochanteric fracture model with the absence of medial support, AO/OTA 31-A2.3 was simulated by removing the posterior medial femur. The model of a novel medial sustain nail (MSN-II) and a widely used nail (proximal femoral nail anti-rotation PFNA-II) were modeled according to the manufacturer-provided engineering drawing. Different loads were applied to the femoral head to simulate the postoperative weight bearing gait. The sliding distance of helical blade in femoral neck, maximum stress of femur and nail, displacement of proximal fragment were analyzed to revealing the mechanical stability of unstable trochanteric fracture stabilized by different implant.

RESULTS: The sliding distance of helical blade in the femoral neck, the maximum stress on the femur and nail, the displacement of proximal fragment in MSN-II under 2100N axial load were 0.65 mm, 689 MPa, 1271 MPa, 16.84 mm respectively, while that were 1.43 mm, 720.8 MPa, 1444 MPa, 18.18 mm, respectively in PFNA-II. The difference between the two groups was statistically significant (P < 0.05) and the stress was mainly distributed in medial distal side of nail but helical blade and the proximal aperture for the nail in MSN-II. Compared to PFNA-II, MSN-II demonstrates biomechanical merit against femur medialization, cut-out and coax varus.

CONCLUSION: The sliding distance of helical blade in femoral neck, the maximum stress on the femur and nail, and the displacement of proximal fragment of MSN-II were less than those of PFNA-II in the treatment of unstable intertrochanteric fractures. Therefore MSN-II has better stability than PFNA-II and it may have the potential to avoid femur medialization and cut out. It might be an option in unstable trochanteric fracture because of its superiority in restricted sliding and medial support reconstruction.

PMID:36120825 | DOI:10.1111/os.13497

J Cosmet Dermatol. 2022 Sep 19. doi: 10.1111/jocd.15397. Online ahead of print.

ABSTRACT

BACKGROUND: Keloid (KD) treatment is challenging for both physicians and patients. It can be functional debilitating and psychologically distressing. Available current therapeutics modalities give inconsistently effective results.

OBJECTIVES: To evaluate the efficacy and safety of innovative cold atmospheric plasma (CAP) technology in the treatment of keloid METHODS: This prospective, randomized control trial, the assessor-blinded trial, includes 18 patients with keloids. The keloid lesion was divided into two halves. One side was randomly treated with CAP technology biweekly on the same treated side for five sessions with a follow-up 30 days after finishing the final treatment. Another half was left untreated as a control. Efficacy assessment using POSAS, VSS, Patients’ satisfaction scale, Antera 3D® skin imaging system. The safety assessment using VAS and adverse effects monitoring was completed.

RESULTS: Objective assessment using Antera 3D® skin imaging system (Miravex, Dublin, Ireland) showed statistically significant improvement (p-value <0.05) on the treated side compared to the untreated side in all parameters, color, melanin, hemoglobin, texture, except for volume. POSAS, patient and observer overall opinion score, and patient and observer total score in the summary of all rated characteristics, comparing the treated and untreated areas, showed a statistically significant reduction in all parameters after two treatments (*P-value < 0.05). VSS showed statistically significant improvement after the second treatment and continued to the last follow-up. Most patients rated satisfaction scales up to 72.2% as moderate improvement, 11.1% as great improvement, 11.1% as slight improvement, and 5.6 % as no change. The adverse effect was only a small scab in one patient.

CONCLUSION: CAP technology could be considered an alternative treatment for keloid offering mild to moderate improvement with minimal side effects.

PMID:36120805 | DOI:10.1111/jocd.15397

J Alzheimers Dis. 2022 Sep 15. doi: 10.3233/JAD-220373. Online ahead of print.

ABSTRACT

BACKGROUND: The high cost, limited availability, and perceived invasiveness of amyloid PET and cerebrospinal fluid biomarkers limit their use for the diagnosis of Alzheimer’s disease.

OBJECTIVE: The present study aimed to assess the associations of mild cognitive impairment (MCI) with circulating amyloid-β (Aβ), methionine circulating metabolites (MCMs), and their downstream products, and to develop a nomogram based on these easily accessible blood indexes for the individualized prediction of MCI risk in older adults.

METHODS: In this nested case-control study, we recruited 74 MCI patients and, for each, 3 matched controls (n = 222) within the context of the Tianjin Elderly Nutrition and Cognition (TENC) cohort, a population-based prospective study in China. Concentrations of Aβ, MCMs, and their circulating downstream factors (i.e., leukocyte telomere length and inflammatory cytokines) were evaluated in fasting blood sample using standard procedures. We constructed a nomogram for MCI harnessed multivariable logistic models incorporating variables selected in the Lasso regression.

RESULTS: Among the many biomarkers examined, the final prediction nomogram retained only 3 factors: Aβ 42/Aβ 40 ratio, Hcy, and SAM/SAH ratio. The model achieved favorable discrimination, with a C-statistic of 0.75 (95% confidence interval 0.69-0.81) in internal validation after adjustment of optimism. The calibration accuracy was satisfactory; the Brier score of the model was 0.161 in internal validation after adjustment of optimism.

CONCLUSION: his study presents an individualized prediction nomogram incorporating only three blood biomarkers (i.e., Aβ 42/Aβ 40 ratio, Hcy, and SAM/SAH ratio), which can be conveniently utilized to facilitate early identification and the development of high-risk prevention strategies for MCI in older adults.

PMID:36120779 | DOI:10.3233/JAD-220373

Clin Hemorheol Microcirc. 2022 Sep 12. doi: 10.3233/CH-221512. Online ahead of print.

ABSTRACT

BACKGROUND: Prevention of Type 2 diabetes mellitus (T2DM) requires a modifying effect on the pathological processes inducing the β-cell dysfunction.

OBJECTIVES: the comprehensive study of the violation of rheological parameters in patients with different stages of diabetes and identification of possible links between these alterations with the intensity of the oxidative stress in the patient’s body.

METHODS: 60 patients with IR, prediabetes, T2DM and healthy volunteers were included. Full range of the rheological parameters of the patients’ blood – the indicators of erythrocytes aggregation index (EAI), the relative deformability of the erythrocytes membranes (ERDI), blood plasma viscosity (BPV), and oxidative stress intensity (OSI) were examined.

RESULTS: In patients with insulin resistance (IR), prediabetes, and T2DM the ERDI was statistically significantly lower and BPV – higher compared to control; a significant increase in EAI was detected in the patient group with prediabetes and T2DM compared to the control.

CONCLUSION: The level of rheological disorders in patients increases with the increase of the level of carbohydrate metabolism disorders and intensity of oxidative stress and reaches a maximum during manifested diabetes. Diagnosis of hemorheological disorders and OSI in T2DM can serve as an early marker of target organ damage possibility.

PMID:36120773 | DOI:10.3233/CH-221512

Cancer Biomark. 2022 Sep 9. doi: 10.3233/CBM-210539. Online ahead of print.

ABSTRACT

BACKGROUND: CD133 is a transmembrane glycoprotein and is considered the most common cell surface marker to identify cancer stem cells in hematological and solid tumors, including breast cancer.

OBJECTIVES: To evaluate the impact of immunohistochemical expression of CD133 on response rate and survival in metastatic breast cancer, as well as to correlate it with various demographics and clinicopathological characteristics.

METHODS: One-hundred metastatic breast cancer patients were prospectively recruited at the Medical Oncology Department at South Egypt Cancer Institute during the period from January 2018 to January 2020.

RESULTS: There was a statistically significant correlation between CD133 positive patients with various adverse clinicopathological parameters such as high grade (p= 0.013), higher tumor (p= 0.001), and nodal staging (p= 0.024) during a median follow-up time of 17 months. In addition, Cases with CD133 positive expression had a significantly lower survival time than those with negative expression (3-years OS 37.4% versus 85.5%, p= 0.024). Regarding the response rate, CD133 positive patients had a lower response rate than negative patients (50% versus 54%, p= 0.012).

CONCLUSIONS: Positive CD133 is correlated with poor prognosis in metastatic breast cancer patients.

PMID:36120770 | DOI:10.3233/CBM-210539

J Back Musculoskelet Rehabil. 2022 Sep 9. doi: 10.3233/BMR-220067. Online ahead of print.

ABSTRACT

BACKGROUND: Determining the association between radiographic spinal instability assessment and lower back lumbar diseases with lower limb symptoms can contribute to evidence-based assessment and treatment in clinical practice and rehabilitation. Therefore, radiological evidence of lumbar spine instability assessment, such as sagittal translation (ST) and segmental angulation (SA), is clinically important.

OBJECTIVE: To identify factors associated with the assessment of spinal instability in discogenic low back pain and lumbar disc herniation with leg pain using ST and SA.

METHODS: We examined 116 patients with discogenic low back pain and 112 with lumbar disc herniation with leg pain at our clinic from August 2016 to May 2021. Data on age, gender, sports activities, and occupation were collected from medical records. Additionally, ST and SA of L4 and L5 during maximum trunk flexion and extension were measured using radiography. Simple and multiple logistic regression analyses were used for statistical analysis.

RESULTS: Simple logistic regression analysis showed that ST and SA (odds ratio [OR]: 1.11; 95% confidence interval [CI]: 1.03-1.19) were associated with lumbar disc herniation. Multiple logistic regression analysis showed that only ST was associated with lumbar disc herniation (OR: 2.29; 95% CI: 1.78-3.00).

CONCLUSION: Multiple logistic regression analysis showed that ST was associated with lumbar disc herniation with leg pain and had a stronger association than SA.

PMID:36120768 | DOI:10.3233/BMR-220067

J Back Musculoskelet Rehabil. 2022 Sep 9. doi: 10.3233/BMR-220061. Online ahead of print.

ABSTRACT

BACKGROUND: Lateral elbow tendinopathy (LET) is one of the most common lesions of the upper extremity. The level of evidence from studies on LET treatment protocols is insufficient.

OBJECTIVE: The aim of this study was to compare the acute effects of mobilization with movement (MWM) and muscle energy technique (MET) on pain, grip strength, and functionality in patients diagnosed with LET.

METHODS: Forty-five patients with LET aged 30-55 years were enrolled in this study. Patients were divided into three groups: MWM, MET, and control group. The control group received a 4-week home exercise program. In addition to the home exercise program in the MWM group, 12 sessions of MWM and 12 sessions of MET were performed in the MET group. Participants’ pain, grip strength, and functionality were assessed before and after the study.

RESULTS: After the treatment period, greater improvement in pain, grip strength, finger strength, and functionality were observed in the MWM and MET groups than in the control group (p< 0.05), but no statistically significant difference was found between the MWM and MET groups (p> 0.05).

CONCLUSIONS: This study shows that MWM and MET, used in addition to home exercises, can be used to relieve pain and increase grip strength, finger strength, and functionality.

PMID:36120766 | DOI:10.3233/BMR-220061

J Am Geriatr Soc. 2022 Sep 18. doi: 10.1111/jgs.18030. Online ahead of print.

ABSTRACT

BACKGROUND: Opioids are frequently prescribed to alleviate pain in older adults, yet the relationships between prescription opioids and long-term cognitive function are unclear.

METHODS: In this analysis of the Mayo Clinic Study of Aging, a longitudinal population-based cohort study of older adults with formal neuropsychological testing and cognitive evaluations performed every 15 months, the associations between prescription opioids, global and domain-specific cognitive function, and mild cognitive impairment were evaluated through time-dependent linear mixed effects and Cox proportional hazards models.

RESULTS: Four thousand two hundred eighteen participants (51% male) were included with enrollment between 11/1/2004 and 4/1/2019 and median age of 76 (interquartile range 72, 82) years. Two thousand nine hundred seventy-seven subjects (71%) received at least 1 opioid prescription during a median follow-up of 7.5 (5.0, 10.7) years. Overall, there was an estimated 0.096 reduction in the global cognitive Z-score per year, including decreases of 0.050 in memory, 0.080 in language, 0.044 in visual-spatial cognition, and 0.112 in attention. In multivariable analyses, each receipt of an opioid prescription resulted in an additional -0.007 (95% CI -0.009, -0.005) change in global cognitive Z-score (p < 0.001), with significant effects seen in the domains of memory (-0.005, 95% CI -0.007, -0.003; p < 0.001), language (-0.002, 95% CI -0.003, 0.000; p = 0.024) and attention (-0.004, 95% CI -0.006, -0.002; p < 0.001) but not visual-spatial function (0.000, 95% CI -0.001, 0.001; p = 0.897). Opioid prescriptions were associated with incident mild cognitive impairment (MCI) in adjusted analysis (hazard ratio 1.21, 95% CI 1.04, 1.42; p = 0.014).

CONCLUSION: Prescription opioids are associated with small but statistically significant declines in long-term cognitive function in older adults, which may represent effects of opioids or other related factors.

PMID:36117241 | DOI:10.1111/jgs.18030

Stat Med. 2022 Sep 18. doi: 10.1002/sim.9580. Online ahead of print.

ABSTRACT

The primary analysis in two-arm clinical trials usually involves inference on a scalar treatment effect parameter; for example, depending on the outcome, the difference of treatment-specific means, risk difference, risk ratio, or odds ratio. Most clinical trials are monitored for the possibility of early stopping. Because ordinarily the outcome on any given subject can be ascertained only after some time lag, at the time of an interim analysis, among the subjects already enrolled, the outcome is known for only a subset and is effectively censored for those who have not been enrolled sufficiently long for it to be observed. Typically, the interim analysis is based only on the data from subjects for whom the outcome has been ascertained. A goal of an interim analysis is to stop the trial as soon as the evidence is strong enough to do so, suggesting that the analysis ideally should make the most efficient use of all available data, thus including information on censoring as well as other baseline and time-dependent covariates in a principled way. A general group sequential framework is proposed for clinical trials with a time-lagged outcome. Treatment effect estimators that take account of censoring and incorporate covariate information at an interim analysis are derived using semiparametric theory and are demonstrated to lead to stronger evidence for early stopping than standard approaches. The associated test statistics are shown to have the independent increments structure, so that standard software can be used to obtain stopping boundaries.

PMID:36117235 | DOI:10.1002/sim.9580