Nevin Manimala

J Tradit Chin Med. 2022 Oct;42(5):671-680. doi: 10.19852/j.cnki.jtcm.2022.05.001.

ABSTRACT

OBJECTIVE: To investigate the effectiveness and safety of tripterygium glycosides (TG) tablet for the treatment of Lupus nephritis (LN).

METHODS: Several databases were systematically searched including PubMed, Embase, Cochrane, Wiley, China National Knowledge Infrastructure Database, SinoMed and Wanfang Library till June 20, 2020. Revman5.3 was utilized to analyze the data according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement.

RESULTS: In total, 8 randomized controlled trials involving 583 participants were identified. Meta-analyses showed that, compared with glucocorticoids (GC) alone, the combination with TG tablet provided a statistically significant improvement in total remission (TR) ( = 1.27, 95% : 1.08-1.50, = 0.004), complete remission (CR) ( = 1.61, 95% : 1.05-2.47, = 0.03) and C3 levels ( = 0.27, 95% : 0.14-0.39, < 0.000 1), C4 levels ( = 0.12, 95% : 0.07-0.17, < 0.000 01). No significant differences were seen in TR, CR, proteinuria, serum creatinine, C3 and C4 (TR: = 1.00, 95% : 0.87-1.16, = 0.95; CR: = 1.10, 95% : 0.78-1.56, = 0.58; proteinuria levels: = -0.06, 95% : -0.13 to 0.01, = 0.10; serum creatinine levels: = -0.01, 95%: -7.36 to 7.35, = 1.00; C3 levels: = 0.01, 95%: -0.06 to 0.07, = 0.84; C4 levels: = -0.01, 95%: -0.03 to 0.01, = 0.49) between azathioprine (AZA) / leflomit (LEF) + GC and TG tablet + GC. Adverse events (hepatic dysfunction, nausea, vomitting) showed no statistical differences between the TG tablet + GC group and the GC group. There were more new onset of irregular menstruation in the TG tablet + GC group than those in the AZA + GC ( = 3.57, 95% : 1.40-9.11, = 0.008) /LEF+ GC ( = 6.69, 95% : 2.42-18.46, = 0.000 2) group, but leucopenia lower than those in AZA + GC group ( = 0.38, 95% : 0.17-0.85, = 0.02) and alopecia ( = 0.14, 95% : 0.03-0.77, = 0.02) and rash ( = 0.09, 95% : 0.01-0.69, = 0.02) lower than those in LEF + GC group.

CONCLUSIONS: This review indicates that TG tablet maybe effective in LN treatment. Nevertheless, adverse events cannot be ignored. Large sample, multi-center, high-quality clinical studies are needed to verify the exact effects and safety of TG tablet in treatment of LN.

PMID:36083472 | DOI:10.19852/j.cnki.jtcm.2022.05.001

Spine Deform. 2022 Sep 9. doi: 10.1007/s43390-022-00571-z. Online ahead of print.

ABSTRACT

STUDY DESIGN: Assessment of sagittal lordosis distribution on mechanical proximal junctional failure-related risks through computer-based biomechanical models.

OBJECTIVE: To biomechanically assess how lordosis distribution influences radiographical and biomechanical indices related to Proximal Junctional Failure (PJF). The “optimal” patient-specific targets to restore the sagittal balance in posterior spinal fusion are still not known. Among these, the effect of the lumbar lordosis correction strategy on complications such as PJF remain uncertain.

METHODS: In this computational biomechanical study, five adult spinal deformity patients who underwent posterior spinal fixation were retrospectively reviewed. Their surgery, first erect posture and flexion movement were simulated with a patient-specific multibody model. Three pedicle subtraction osteotomy (PSO) levels (L3, L4, and L5) were simulated, with consistent global lordosis for a given patient and pelvic tilt adjusted accordingly to the actual surgery. Computed loads on the anterior spine and instrumentation were analyzed and compared using Kruskal-Wallis statistical tests and Spearman correlations.

RESULTS: In these models, no significant correlations were found between the lordosis distribution index (LDI), PSO level and biomechanical PJF-related indices. However, increasing the sagittal vertical axis (SVA) and thoracolumbar junction angle (TLJ) and decreasing the sacral slope (SS) increased the bending moment sustained by the rods at the proximal instrumented level (r = 0.52, 0.57, – 0.56, respectively, p < 0.05). There was a negative correlation between SS and the bending moment held by the adjacent proximal segment (r = – 0.71, p < 0.05).

CONCLUSION: Based on these biomechanical simulations, there was no correlation between the lordosis distribution and PJF-associated biomechanical factors. However, increasing SS and flattening the TLJ, as postural adjustment strategies required by a more distal PSO, did decrease such PJF-related factors. Sagittal restoration and PJF risks remain multifactorial, and the use of patient-specific biomechanical models may help to better understand the complex interrelated mechanisms.

PMID:36083462 | DOI:10.1007/s43390-022-00571-z

Spine Deform. 2022 Sep 9. doi: 10.1007/s43390-022-00574-w. Online ahead of print.

ABSTRACT

STUDY DESIGN: Assessment of different proximal instrumentation stiffness features to minimize the mechanical proximal junctional failure-related risks through computer-based biomechanical models.

OBJECTIVE: To biomechanically assess variations of proximal instrumentation and loads acting on the spine and construct to minimize proximal junctional failure (PJF) risks. The use of less-stiff fixation such as hooks or tensioned bands, compared to pedicle screws, at the proximal instrumentation level are considered to allow for a gradual transition in stiffness with the adjacent levels, but the impact of such flexible fixation on the loads balance and complications such as PJF remain uncertain.

METHODS: Six patients with adult spine deformity who underwent posterior spinal instrumentation were used to numerically model and simulate the surgical steps, erected posture, and flexion functional loading in patient-specific multibody analyses. Three types of upper-level fixation (pedicle screws (PS), supralaminar hooks (SH), and sublaminar bands (SB) with tensions of 50, 250, and 350 N) and rod stiffness (CoCr/6 mm, CoCr/5.5 mm, Ti/5.5 mm) were simulated. The loads acting on the spine and implants of the 90 simulated configurations were analyzed using Kruskal-Wallis statistical tests.

RESULTS: Simulated high-tensioned bands decreased the sagittal moment at the adjacent level proximal to the instrumentation (1.3 Nm at 250 N; 2.5 Nm at 350 N) compared to screws alone (PS) (15.6 Nm). At one level above, the high-tensioned SB increased the sagittal moment (17.7 Nm-SB vs. 15.5 Nm-PS) and bending moment on the rods (5.4 Nm and 5.7 Nm vs. 0.6 Nm) (p < 0.05). SB with 50 N tension yielded smaller changes in load transition compared to higher tension, with moments of 8.1 Nm and 16.8 Nm one and two levels above the instrumentation. The sagittal moment at the upper implant-vertebra connection decreased with the rod stiffness (1.0 Nm for CoCr/6 mm vs. 0.7 Nm for Ti/5.5 mm; p < 0.05).

CONCLUSION: Simulated sublaminar bands with lower tension produced smaller changes in the load transition across proximal junctional levels. Decreasing the rod stiffness further modified these changes, with a decrease in loads associated with bone failure, however, lower stiffness did increase the rod breakage risk.

LEVEL OF EVIDENCE: N/A.

PMID:36083461 | DOI:10.1007/s43390-022-00574-w

Methods Mol Biol. 2022;2569:343-359. doi: 10.1007/978-1-0716-2691-7_17.

ABSTRACT

Effective population size (N_e) determines the amount of genetic diversity and the fate of genetic variants in a species and thus is an essential parameter in evolutionary genetics. There are standard approaches to determine the N_e of evolving species. For example, the long-term N_e of an extant species is calculated based on its unbiased global mutation rate and the neutral genetic diversity of the species. However, approaches for inferring N_e of ancestral lineages are less known. Here, we introduce an evolutionary genetic statistic and an analytical procedure to assess the efficiency of natural selection for deep nodes by calculating rates of nonsynonymous nucleotide substitutions leading to radical (d_R) and conservative (d_C) amino acid replacements, respectively. Given that radical variants are more likely to be deleterious than conservative ones, an elevated d_R/d_C ratio in gene families across the genome means an accelerated genome-wide accumulation of the more deleterious type of mutations (i.e., radical variants), which indicates that natural selection is less efficient and genetic drift becomes more powerful. Earlier approaches that calculate d_R/d_C do not consider the impact of nucleotide composition (G+C content) on the d_R/d_C result, which is partially accounted for in more recent methods. Here, we use these methods to demonstrate that genetic drift may have driven the early evolution of Prochlorococcus, the most abundant carbon-fixing photosynthetic bacteria in the ocean.

PMID:36083457 | DOI:10.1007/978-1-0716-2691-7_17

J Assoc Physicians India. 2022 Aug;70(8):11-12. doi: 10.5005/japi-11001-0069.

ABSTRACT

BACKGROUND: Hypertension and cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients on dialysis. Blood pressure (BP) control is of paramount importance in reducing morbidity and mortality in this high-risk population, although there is no consensus on target BP. Ambulatory BP recording is considered gold standard in estimating the BP among patients on dialysis. But, ambulatory BP recording is cumbersome, not economical, and not easily available to Indian patients. Therefore, an easier and more convenient method has to be implemented to monitor the BP. Some studies demonstrated that home BP recordings may be promising in making a more accurate diagnosis of hypertension in hemodialysis patients. However, there is paucity of research that compares home-based BP monitoring with ambulatory BP recordings in patients on hemodialysis. The present study was thus planned to examine the hypothesis that out-of-dialysis unit BP measurement in the form of home-based measurement of BP is as efficacious as ambulatory BP monitoring (ABPM) in evaluating hypertension among patients on hemodialysis.

AIM: To assess the accuracy of home-based BP monitoring in comparison to ABPM among chronic kidney disease (CKD) patients on hemodialysis.

OBJECTIVE: To assess the ability of home-based BP monitoring to detect hypertension among CKD patients on hemodialysis.

MATERIALS AND METHODS: This was a prospective observational study carried out in the Department of Medicine in a tertiary care hospital. The total duration of the study was 24 months. Fifty-two CKD patients on hemodialysis fulfilling the eligibility criteria were taken up for the study after informed consent. Blood pressure was measured using a standardized BP measuring equipment at home, thrice a day for 3 days in the interdialysis period. Also, all these patients were subjected to 24 hours of ABPM in the interdialysis period. Home-based BP monitoring records are then compared with the one-time ABPM records. All statistical calculations were done using computer programs Microsoft Excel 2007 (Microsoft Corporation, NY, USA) and SPSS (Statistical Product and Service Solutions; SPSS Inc., Chicago, Illinois, USA) version 21.

RESULT: In our study, the mean awake, asleep, and average ABPM readings of systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 141.69/81.33, 139.39/80.04, and 141.23/80.67 mm Hg, respectively, while the mean SBP and DBP recorded on home-based measurements were 143.6 and 82.69 mm Hg, respectively. All the subjects showing mean SBP ≥140 mm Hg as per ABPM had home-based readings of above 140 mm Hg while 23 out of 27 patients (85.2%) with mean SBP &lt;140 mm Hg as per ABPM had similar observation by home-based monitoring (kappa 0.847; p&lt;0.01). All the subjects showing mean DBP ≥90 mm Hg as per ABPM had home-based readings of above 90 mm Hg while 42 out of 44 patients (95.5%) with mean DBP &lt;90 mm Hg as per ABPM had similar observation by home-based monitoring (kappa 0.866; p&lt;0.01).

CONCLUSION: Our study shows that there is no difference between BP readings as observed by ABPM and home-based BP monitoring. Also, home-based BP monitoring can detect hypertension as effectively as ABPM among patients on hemodialysis, thereby making home-based BP monitoring a safe and reliable method of BP measurement in clinical practice.

PMID:36082723 | DOI:10.5005/japi-11001-0069

J Assoc Physicians India. 2022 Aug;70(8):11-12. doi: 10.5005/japi-11001-0058.

ABSTRACT

INTRODUCTION: Herbicides are the chemical compounds used to control the growth of unwanted plants or to eliminate them. The common poisonous herbicides available in India are paraquat, glyphosate, pretilachlor, etc. Ingestion of herbicides with suicidal intention is common in rural India and West Bengal but very scanty literature is available.

METHODOLOGY: We conducted a unicentric, hospital-based, noninterventional, cross-sectional study comprising 50 consecutive patients to estimate the morbidity, case fatality, and clinical features of acute suicidal poisoning of different herbicides used in agricultural fields. Data were collected from history, clinical features, and laboratory findings. Proper statistical method was used for data analysis.

RESULTS: Most of the study population were from 26 to 40 years age group (48%), followed by 13-25 years age group (34%). Paraquat was ingested by 64%, followed by pretilachlor (20%) and glyphosate (16%). Common symptoms were vomiting (60%), abdominal pain (40%), throat discomfort (26%), oral ulcer (24%), decreased urination (50%), and respiratory distress (30%). In laboratory investigation, 64% patients had deranged liver enzymes, 58% patients had acute kidney injury, and 30% patients had alveolar damage. A total of 62% patients were discharged after recovery and 38% patients died. Case fatality rate of paraquat was 56.2%, glyphosate was 12.5%, and pretilachlor was nil (0%).

CONCLUSION: Herbicides like paraquat and glyphosate are associated with high morbidity and case fatality. Paraquat has the highest case fatality rate. Pre-emergent herbicide pretilachlor is relatively safe.

PMID:36082722 | DOI:10.5005/japi-11001-0058

J Assoc Physicians India. 2022 Aug;70(8):11-12. doi: 10.5005/japi-11001-0062.

ABSTRACT

OBJECTIVES: Sepsis-3 criteria define sepsis as ≥2 points rise of Sequential Organ Failure Assessment (SOFA) score, either from zero or a known baseline. We compared the efficacies of quick Sequential Organ Failure Assessment (qSOFA), SOFA, and Systemic Inflammatory Response Syndrome (SIRS) scores to predict sepsis mortality.

METHODS: Prospective, hospital-based study was undertaken to determine the efficacies of various sepsis-scoring systems to predict mortality in sepsis. The “Sepsis-2” criteria of “severe sepsis” and “septic shock” were used as selection criteria as they correspond to “sepsis” and “septic shock” of “Sepsis-3”. Statistical analysis was done by SPSS Statistics version-16. Mortality predictions were made using receiver operator characteristic curve testing.

RESULTS: We included 122 sepsis patients diagnosed by “Sepsis-2” definition; 78.68% (n = 98) of whom met “Sepsis-3” criteria for sepsis. All-cause mortality was 50%. On univariate analysis, we found age over 60 years [odds ratio (OR) = 4.244, 95% confidence interval (CI) = 1.309-13.764, p = 0.016], invasive mechanical ventilation (OR = 7.0076, 95% CI = 3.053-16.0809, p&lt;0.0001), and presence of acute respiratory distress syndrome (ARDS) (OR = 2.757, 95% CI = 1.0091-7.535, p = 0.048) were significant predictors of mortality. The SOFA score yielded the best result with “area under the curve” (AUC) of “receiver operating characteristic” (ROC) curve of 0.868. On comparing AUCs between these scores difference between both SOFA and qSOFA was highly significant (p &lt; 0.0001) compared to SIRS. However, such statistical difference was not found between AUCs of SOFA and qSOFA.

CONCLUSIONS: Both SOFA and qSOFA are superior prognostication tools compared to SIRS to predict sepsis mortality; SOFA being better than qSOFA.

PMID:36082720 | DOI:10.5005/japi-11001-0062

Xi Bao Yu Fen Zi Mian Yi Xue Za Zhi. 2022 Sep;38(9):831-836.

ABSTRACT

Objective To investigate the expression of CD4⁺CD25⁺FOXP3⁺regulatory T cells(Tregs), IL-6 and TNF-α in patients with juvenile idiopathic arthritis (JIA) and its clinical significance. Methods The percentages of CD4⁺CD25⁺FOXP3⁺ Tregs in 58 children with JIA and 40 healthy controls were detected by flow cytometry. Serum levels of IL-6 and TNF-α in each patient was detected by chemiluminescence. The correlations between the expression of CD4⁺CD25⁺FOXP3⁺ Tregs and IL-6, TNF-α were analyzed by pearson correlation analysis. We measured the expression level of CD4⁺CD25⁺FOXP3⁺regulatory T cells, IL-6 and TNF-α of 18 cases six weeks after the treatment of tocilizumab (TCZ) in order to figure out the dynamic changes using methods above. Results The percentages of CD4⁺CD25⁺FOXP3⁺Tregs in juvenile idiopathic arthritis were significantly lower than those in 40 healthy volunteers, while levels of IL-6 and TNF-α were significantly higher. However, no obvious difference in the levels of CD4⁺CD25⁺FOXP3⁺Tregs, IL-6 or TNF-α was observed between patients with systemic and poly-articular JIA. Pearson correlation analysis showed that the percentages of CD4⁺CD25⁺FOXP3⁺Tregs negatively correlated with the levels of IL-6 and TNF-α, while levels of IL-6 positively correlated with the levels of TNF-α. Compared with pre-treatment of TCZ, levels of CD4⁺CD25⁺FOXP3⁺Tregs in post-treatment markedly increased, which however were still lower than control group while the levels of IL-6 significantly decreased, yet remained higher than control group. There was no statistical difference between post and pre-treatment in the levels of TNF-α. Conclusion The percentages of CD4⁺CD25⁺FOXP3⁺ Tregs in peripheral blood of JIA children decreases, and it has a negative correlation with IL-6 and TNF-α. Furthermore, the levels of CD4⁺CD25⁺FOXP3⁺ Tregs and IL-6 are partially restored after treatment with TCZ, which may be helpful to assess the activity of systemic JIA and the efficacy of therapy.

PMID:36082714

Hum Brain Mapp. 2022 Sep 9. doi: 10.1002/hbm.26065. Online ahead of print.

ABSTRACT

Self-control is of vital importance for human wellbeing. Hare et al. (2009) were among the first to provide empirical evidence on the neural correlates of self-control. This seminal study profoundly impacted theory and empirical work across multiple fields. To solidify the empirical evidence supporting self-control theory, we conducted a preregistered replication of this work. Further, we tested the robustness of the findings across analytic strategies. Participants underwent functional magnetic resonance imaging while rating 50 food items on healthiness and tastiness and making choices about food consumption. We closely replicated the original analysis pipeline and supplemented it with additional exploratory analyses to follow-up on unexpected findings and to test the sensitivity of results to key analytical choices. Our replication data provide support for the notion that decisions are associated with a value signal in ventromedial prefrontal cortex (vmPFC), which integrates relevant choice attributes to inform a final decision. We found that vmPFC activity was correlated with goal values regardless of the amount of self-control and it correlated with both taste and health in self-controllers but only taste in non-self-controllers. We did not find strong support for the hypothesized role of left dorsolateral prefrontal cortex (dlPFC) in self-control. The absence of statistically significant group differences in dlPFC activity during successful self-control in our sample contrasts with the notion that dlPFC involvement is required in order to effectively integrate longer-term goals into subjective value judgments. Exploratory analyses highlight the sensitivity of results (in terms of effect size) to the analytical strategy, for instance, concerning the approach to region-of-interest analysis.

PMID:36082693 | DOI:10.1002/hbm.26065

Stroke. 2022 Sep 9:101161STROKEAHA121037493. doi: 10.1161/STROKEAHA.121.037493. Online ahead of print.

ABSTRACT

BACKGROUND: In patients with coronary artery disease and concomitant asymptomatic severe carotid stenosis, combined simultaneous coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA) has been widely performed despite lack of evidence from randomized trials. We recently showed that the risk of stroke or death within 30 days was higher following CABG+CEA compared with CABG alone. Here, we report long-term outcomes following CABG with versus without CEA.

METHODS: The CABACS (Coronary Artery Bypass Graft Surgery in Patients With Asymptomatic Carotid Stenosis Study) is a randomized, controlled, multicenter, open trial. Patients with asymptomatic severe (≥70%) carotid stenosis undergoing CABG were allocated either CABG+CEA or CABG alone, and follow-up was 5 years. Major secondary end points included nonfatal stroke or death, any death and any nonfatal stroke. Due to low recruitment, the study was stopped prematurely after randomization of 127 patients in 17 centers.

RESULTS: By 5 years, the rate of stroke or death did not significantly differ between groups (CABG+CEA 40.6% [95% CI, 0.285-0.536], CABG alone 35.0% [95% CI, 0.231-0.484]; P=0.58). Higher albeit statistically nonsignificant rates of nonfatal strokes occurred at any time following CABG+CEA versus CABG alone (1 year: 19.3% versus 7.1%, P=0.09; 5 years: 29.4% versus 18.8%, P=0.25). All-cause mortality up to 5 years was similar in both groups (CABG+CEA: 25.4% versus CABG alone: 23.3%, hazard ratio, 1.148 [95% CI, 0.560-2.353]; P=0.71). Subgroup analyses did not reveal any significant effect of age, sex, preoperative modified Rankin Scale and center on outcome events.

CONCLUSIONS: During 5-years follow-up, combined simultaneous CABG+CEA was associated with a higher albeit statistically nonsignificant rate of stroke or death compared with CABG alone. This was mainly due to a nonsignificantly higher perioperative risk following CABG+CEA. Since the power of our study was not sufficient, no significant effect of either procedure could be observed at any time during follow-up.

REGISTRATION: http://www.controlled-trials.com; ISRCTN13486906.

PMID:36082667 | DOI:10.1161/STROKEAHA.121.037493