Nevin Manimala

Age Ageing. 2022 Sep 2;51(9):afac190. doi: 10.1093/ageing/afac190.

ABSTRACT

Approximately two-thirds of hospital admissions are older adults and almost half of these are likely to have some form of dementia. People with dementia are not only at an increased risk of adverse outcomes once admitted, but the unfamiliar environment and routinised practices of the wards and acute care can be particularly challenging for them, heightening their confusion, agitation and distress further impacting the ability to optimise their care. It is well established that a person-centred care approach helps alleviate some of the unfamiliar stress but how to embed this in the acute-care setting remains a challenge. In this article, we highlight the challenges that have been recognised in this area and put forward a set of evidence-based ‘pointers for service change’ to help organisations in the delivery of person-centred care. The DEMENTIA CARE pointers cover areas of: dementia awareness and understanding, education and training, modelling of person-centred care by clinical leaders, adapting the environment, teamwork (not being alone), taking the time to ‘get to know’, information sharing, access to necessary resources, communication, involving family (ask family), raising the profile of dementia care, and engaging volunteers. The pointers extend previous guidance, by recognising the importance of ward cultures that prioritise dementia care and institutional support that actively seeks to raise the profile of dementia care. The pointers provide a range of simple to more complex actions or areas for hospitals to help implement person-centred care approaches; however, embedding them within the organisational cultures of hospitals is the next challenge.

PMID:36057987 | DOI:10.1093/ageing/afac190

Dent Traumatol. 2022 Sep 4. doi: 10.1111/edt.12786. Online ahead of print.

ABSTRACT

BACKGROUND/AIM: Treatment delays in the management of mandible fractures are often unavoidable and, as a result, the timing of treatment of mandibular fractures has remained a contentious issue in clinical practice as the optimal treatment delay for minimizing complications remains unknown. The aim of this study was to determine the rate and types of complications between two cohorts of patients designated as early and late treatment groups and estimate an optimal time threshold for treatment delay after closed reduction and maxillomandibular fixation.

MATERIAL AND METHODS: Demographic and clinical data were collected retrospectively about patients who were treated for isolated, unilateral, favorable, and compound mandibular body fractures between 1999 and 2019 to answer the question of whether treatment delay is an independent variable impacting post-operative mandible body fracture complications. Descriptive and bivariate statistics were computed.

RESULTS: One hundred and seventy subjects were evaluated (n = 87 in the control/early group and n = 83 in the study/late group). The mean time lapses from injury to treatment were: early (5.8 ± 0.4 days) and late (10.3 ± 0.7 days). The overall complication rate was 14.1%. However, the complication rates of the early and late groups were 13.8% and 14.5%, respectively, with no significant difference (p = 0.89).

CONCLUSIONS: There was no difference between early and late treatment groups. Treatment delay was not an independent variable impacting post-operative mandible body fracture complications if treatment is done between 3 and 12 days after the injury.

PMID:36057967 | DOI:10.1111/edt.12786

Andrology. 2022 Sep 4. doi: 10.1111/andr.13289. Online ahead of print.

ABSTRACT

BACKGROUND: The cellular and molecular mechanisms of the events that help spermatozoa acquire their fertilizing capability during capacitation and acrosome reaction are not completely understood.

OBJECTIVE: This study was performed with a postulation that identification of sperm proteins and their changes during in vitro capacitation and acrosome reaction will unravel unknown molecular aspects of fertilization that impact male fertility.

MATERIALS AND METHODS: Spermatozoa collected from sequential conditions, i.e. separation of ejaculated spermatozoa by Percoll gradient centrifugation, in vitro capacitation, and acrosome reaction were processed for tandem mass spectrometric analysis, followed by protein identification, label-free quantitation, and statistical analysis.

RESULTS AND DISCUSSION: Collectively, a total of 1088 sperm proteins were identified. In comparison to ejaculated spermatozoa, 44 and 141 proteins were differentially expressed in capacitated and acrosome reacted spermatozoa, respectively. A large number of proteins were found downregulated, including clusterin, pyruvate dehydrogenase E1 component, semenogelin-1 and 2, heat shock protein 90, beta-microseminoprotein and keratin. It was expected as sperm-membrane-associated proteins are removed during capacitation. There were significant proteomic alterations in asthenozoospermia (AZS) compared to normozoospermia (NZS); however, variation was more noticeable among proteins of acrosome reacted spermatozoa and those released during the acrosome reaction. The processes enriched among downregulated proteins in AZS included acrosome assembly, binding of sperm to zona pellucida, nucleosome assembly, flagellated sperm motility, protein folding, oxidative phosphorylation, TCA cycle, chromatin silencing, gluconeogenesis, glycolytic process, and glycolysis.

CONCLUSION: The dynamic information generated about proteomic alterations in spermatozoa during capacitation and acrosome reaction and their variability in AZS will contribute not only towards enhancing our understanding of processes that prepare spermatozoa to acquire fertilization capability but also help in deciphering novel factors of male infertility. This article is protected by copyright. All rights reserved.

PMID:36057948 | DOI:10.1111/andr.13289

Qual Life Res. 2022 Sep 4. doi: 10.1007/s11136-022-03210-2. Online ahead of print.

ABSTRACT

PURPOSE: We investigated how quality of life (QoL) changed between 2018 and 2020, and how its related factors, i.e., communication with friends and family, loneliness, and sleeping difficulties changed amid the early-phase COVID-19 pandemic among Finnish older people.

METHODS: This study utilizes data from a repeated cross-sectional, population-based FinSote survey in 2018 and 2020. Participants were community-dwelling people aged 75 years or older (N = 9781 in 2018 and N = 9919 in 2020). QoL was assessed with the EUROHIS-QoL-8 scale. Changes in QoL-related factors were self-evaluated in 2020. Statistical methods included t test, Cohen’s D, and chi-square test. To identify potential risk groups, all analyses were stratified by socio-demographic features including sex, age, economic deprivation, living alone, and difficulties in Instrumental Activities of Daily Living (IADL).

RESULTS: QoL improved slightly from 2018 to 2020 (means 3.68 and 3.81, respectively). Only those reporting economic deprivation demonstrated a slight decrease in QoL (3.24 vs. 3.14). Of respondents, 63% reported having less communication with friends and family, 42% having felt lonelier, and 20% having more sleeping difficulties amid the pandemic. Negative changes were more often reported by women, the oldest old, those living alone, reporting economic deprivation, or manifesting IADL difficulties.

CONCLUSION: Finnish older people’s QoL was not affected as much as expected amid the pandemic, although some population groups were, however, more susceptible to the negative effects of the pandemic on QoL-related factors. Results imply that various socio-demographic features may shape the effects of a global pandemic and its control measures on wellbeing.

PMID:36057938 | DOI:10.1007/s11136-022-03210-2

Radiol Med. 2022 Sep 4. doi: 10.1007/s11547-022-01543-z. Online ahead of print.

ABSTRACT

PURPOSE: Bone Strain Index (BSI) is a recently developed dual-energy X-ray absorptiometry (DXA) software, applying a finite element analysis on lumbar spine and femoral DXA scans. BSI is a parameter of bone deformation, providing information on bone resistance to applied loads. BSI values indicate the average bone strain in the explored site, where a higher strain (higher BSI values) suggests a higher fracture risk. This study reports the distributional characteristics of lumbar BSI (L-BSI) in women with normal bone mass, osteopenia or osteoporosis and their relationships with BMD, weight, height and BMI.

MATERIAL AND METHODS: Two-hundred-fifty-nine consecutive unfractured women who performed DXA were divided into three groups based on BMD T-score: normal bone mass (n = 43, 16.6%), osteopenia (n = 82, 31.7%) and osteoporosis (n = 134, 51.7%). The distribution of L-BSI was evaluated with conventional statistical methods, histograms and by calculating parametric and nonparametric 95% confidence intervals, together with the 90%, 95% and 99% bilateral tolerance limits with a 95% confidence.

RESULTS: Ninety percent bilateral tolerance limits with 95% confidence for L-BSI distribution are 1.0-2.40, 0.95-2.63 and 0.84-3.15 in the group of patients with normal bone mass, 1.34-2.78, 1.24-2.95 and 1.05-3.32 in the osteopenic group and 1.68-3.79, 1.58-4.15 and 1.40-4.96 in the osteoporotic group.

CONCLUSION: In women without vertebral fractures at baseline, L-BSI values from 1.68 (osteoporotic group) and 2.40 (upper of the normal bone mass group) can be tentatively chosen as a lower and upper threshold to stratify postmenopausal women according to their bone resistance to loads.

PMID:36057931 | DOI:10.1007/s11547-022-01543-z

Radiol Med. 2022 Sep 4. doi: 10.1007/s11547-022-01548-8. Online ahead of print.

ABSTRACT

PURPOSE: To develop a predictive model for liver metastases in patients with pancreatic ductal adenocarcinoma (PDAC) based on textural features of the primary tumor extracted by computed tomography (CT) images.

MATERIALS AND METHODS: Patients with a pathologically proved PDAC who underwent CT between December 2020 and January 2022 were retrospectively identified. Treatment-naïve patients were included. Sex, age, tumor size, vascular infiltration and 39 arterial and portal phase textural features were analyzed. The variables significantly correlated to tumor size according to the Pearson’s product-moment correlation test were excluded from analysis; the remaining variables were compared between metastatic (M +) and non-metastatic (M-) patients using Fisher’s or Mann-Whitney test. The features with a significant difference between groups were entered into a binomial logistic regression test to develop a predictive model for liver metastases.

RESULTS: This study included 220 patients. Eight variables (tumor size, arterial HU_MAX, arterial GLRLM_LRLGE, arterial GLZLM_SZHGE, arterial GLZLM_LZLGE, portal GLCM_CORRELATION, portal GLRLM_LRLGE, and portal GLZLM_SZHGE) were significantly different between groups. The logistic regression model was statistically significant (χ² = 81.6, p < .001) and correctly classified 80.9% of cases. Sensitivity, specificity, positive and negative predictive values of the model were 58.6%, 91.3%, 75.9% and 82.5%, respectively. The area under the ROC curve of the model was 0.850 (95% CI, 0.793-0.907). Tumor size, arterial HU_MAX, arterial GLZLM_SZHGE and portal GLCM_CORRELATION were significant predictors of the likelihood of liver metastases, with odds ratios of 1.1, 0.9, 1, and 1.49, respectively.

CONCLUSIONS: CT texture analysis of PDAC can identify features that may predict the likelihood of liver metastases.

PMID:36057929 | DOI:10.1007/s11547-022-01548-8

Int Ophthalmol. 2022 Sep 4. doi: 10.1007/s10792-022-02488-y. Online ahead of print.

ABSTRACT

PURPOSE: To examine whether there is a relationship between ocular pulse amplitude (OPA), intraocular pressure (IOP), and visual field (VF) deterioration among the patients diagnosed with aortic regurgitation (AR).

METHODS: Twenty-nine patients (average age of 62.06 ± 13.27 years) with AR diagnosis without glaucoma history as AR group and 32 healthy participants (average age 63.81 ± 6.42 years) as control group were included in the study. Routine ophthalmologic examination including VF test [mean deviation (MD), pattern standard deviation (PSD) and VF index (VFI) values were recorded], diurnal IOP and OPA measurements with Pascal dynamic contour tonometry (DCT) was conducted on the patients. VF deficits were classified by Glaucoma Staging System 2 (GSS 2) score.

RESULTS: Sixteen (50.0%) of 32 healthy subjects and 14 (48.3%) of 29 AR patients were female (p = 1.000). The measurement conducted at 15:30 among the diurnal IOP measurements performed with the Pascal DCT was found to be statistically significantly higher in the AR group (p = 0.009). While the MD and PSD values of the group diagnosed with AR were determined to be statistically significantly high, the VFI value was found to be significantly low. When the healthy cases and the patients diagnosed with AR were compared, it was observed that there was a statistically significant positive correlation in terms of the significant GSS 2 stage (p < 0.001).

CONCLUSION: Although there was no significant increase in IOP, VF deficits were detected in patients with AR. These VF pathologies may be due to the ocular perfusion disorder in AR. However, additional comprehensive studies that also examine perfusion are needed to further confirm this.

PMID:36057917 | DOI:10.1007/s10792-022-02488-y

Eur Spine J. 2022 Sep 4. doi: 10.1007/s00586-022-07374-w. Online ahead of print.

ABSTRACT

PURPOSE: To identify the ideal entry point for pediatric C2 pedicle screw and to obtain parameters of it for the indication of pediatric atlantoaxial fusion arthrodesis.

METHODS: The pediatric cervical CT images were reconstructed into the 3D digital models and the C2 vertebrae were separated. The location of ideal entry point and screw placement related linear and angular parameters were assessed on the 3D digital models.

RESULTS: A total of 214 pedicles from 107 C2 digital models were analyzed. The average entry point for C2 was 3.80 ± 2.78 mm medial to the lateral notch (LN) and 2.57 ± 1.70 mm superior to the LN. The average pedicle diameter (PD) was 6.02 ± 1.31 mm, and the average pedicle screw length (PSL) was 25.63 ± 3.46 mm. Statistical differences were found between different sex for PD and PSL (P < 0.05). As patient age increases, using the most lateral and inferior edge of the lateral mass as a reference marker, the entry point tends to move medial and cephalad, when using the LN as a reference marker, the entry point tends to move medial and slightly caudad. Univariate linear regression analysis suggested that these linear parameters were associated with age (P < 0.01).

CONCLUSION: In this study, we found that the measurement results of C2 pedicle screw varied based on sex, laterality, and ages for children younger than 18 years. The entry point of the screws facilitating ideal trajectory tends to change in a linear way as a function of age. This information helps the surgeon to establish the specific anatomy related to C2 pedicle screw placement to facilitate fixation in the pediatric patients.

PMID:36057908 | DOI:10.1007/s00586-022-07374-w

World J Urol. 2022 Sep 4. doi: 10.1007/s00345-022-04108-x. Online ahead of print.

ABSTRACT

PURPOSE: Evaluate the percentage of patients with prostate cancer treated with luteinizing hormone-releasing hormone analogues (LHRHa) that develop castration resistance after a follow-up period of 3 years. The secondary objective is to evaluate the variables potentially related to the progression to castration resistant prostate cancer (CRPC).

METHODS: A post-authorization, nation-wide, multicenter, prospective, observational, and longitudinal study that included 416 patients treated with LHRHa between 2012 and 2017 is presented. Patients were followed for 3 years or until development of CRPC, thus completing a per-protocol population of 350 patients. A Cox regression analysis was carried out to evaluate factors involved in progression to CRPC.

RESULTS: After 3 years of treatment with LHRHa 18.2% of patients developed CRPC. In contrast, in the subgroup analysis, 39.6% of the metastatic patients developed CRPC, compared with 8.8% of the non-metastatic patients. The patients with the highest risk of developing CRPC were those with a nadir prostate-specific antigen (PSA) > 2 ng/ml (HR 21.6; 95% CI 11.7-39.8; p < 0.001) and those receiving concomitant medication, most commonly bicalutamide (HR 1.8; 95% CI 1-3.1, p = 0.0431).

CONCLUSIONS: The proportion of metastatic patients developing CRPC after 3 years of treatment with LHRHa is consistent with what has been previously described in the literature. In addition, this study provides new findings on CRPC in non-metastatic patients. Concomitant medication and nadir PSA are statistically significant predictive factors for the time to diagnosis of CRPC, the nadir PSA being the strongest predictor.

PMID:36057895 | DOI:10.1007/s00345-022-04108-x

Biotechnol Lett. 2022 Sep 4. doi: 10.1007/s10529-022-03297-0. Online ahead of print.

ABSTRACT

Ergosterol as a primary metabolite and precursor of vitamin D2, is the most plentiful mycosterols in fungal cell membrane. Process optimization to increase the yield and productivity of biological products is a topic of interest. Ultrasonic waves have many applications in biotechnology, like cell disruption, and enhancement of primary and secondary metabolites production. This study disclosed an optimal condition for ultrasound-assisted production (UAP) of ergosterol from Penicillium brevicompactum MUCL 19,011 using L₉ Taguchi statistical method. The intensity (IS), time of sonication (TS), treatment frequency (TF), and number of days of treatment (DT) were allocated to study the effects of ultrasound on ergosterol production. The results were analyzed using Minitab version 19. The maximum ergosterol, 11 mg/g cell dry weight (CDW), was produced on the tenth day while all factors were at a low level. The days of treatment with a contribution of 45.48% was the most significant factor for ergosterol production. For the first time, this study revealed the positive effect of ultrasound on the production of ergosterol. Ergosterol production increased 73% (4.63 mg/g CDW) after process optimization. Finally, a mathematical model of ultrasound factors with a regression coefficient of R² = 0.978 was obtained for the ergosterol production during ultrasound treatment.

PMID:36057882 | DOI:10.1007/s10529-022-03297-0