Nevin Manimala

Eur Arch Otorhinolaryngol. 2022 Jul 23. doi: 10.1007/s00405-022-07537-x. Online ahead of print.

ABSTRACT

PURPOSE: We aimed to clarify the clinical features of delayed-onset swelling around cochlear implants (CI), and to present our experience on how to avoid and address this problem.

METHODS: We performed a retrospective review of all CI cases at our institution between June 2001 and June 2020. Information on postoperative complications of swelling in the receiver area > 3 months after implantation were analyzed, and clinical data sheets were drawn.

RESULTS: Twenty-six of 1425 patients (1.82%) with an age at implantation ranging from 1 to 9 years experienced delayed-onset swelling around the implant. Swelling episodes occurred as early as 4 months, and as late as 178 months after implantation (median, 79.7 months). The predisposing factor in 12 cases was unclear, 7 cases were caused by trauma at the implantation site, 5 cases were without predisposing factors, and 2 cases were related to infection. We found the frequency of delayed-onset swelling after cochlear implantation with different incision was statistically insignificant (P = 0.423). Nineteen patients (73.1%) were cured after one treatment, and five patients (19.2%) relapsed. Follow-up examinations at least 18 months after surgery revealed that all patients experienced a complete recovery.

CONCLUSIONS: Delayed-onset swelling at the receiver site is a long term but not exactly uncommon complication after cochlear surgery and long-term follow-up is eagerly required. It can recur more than once, causing more complex treatment strategies in clinical practice. Conservative treatment first recommended, while needle aspiration should initially be considered in recurrent cases also when the effusion swelling is > 3 ml.

PMID:35870003 | DOI:10.1007/s00405-022-07537-x

Surg Radiol Anat. 2022 Jul 23. doi: 10.1007/s00276-022-02992-x. Online ahead of print.

ABSTRACT

BACKGROUND: Recent studies have described the finding of the Arc of Riolan (AoR) crossing the inferior mesenteric vein (IMV) seen during high ligation of IMV while performing minimally invasive colectomies. However, the AoR usually has a medial course, and this variant AoR anatomic course and the clinical importance of its preservation during splenic flexure takedown in anterior resection remains controversial.

METHODS: After institutional approval (QA-5775), radiological identification of and mapping of the vessel horizontally crossing the IMV under the pancreas, when present, was performed at a single institution (Westmead Hospital, New South Wales, Australia). One hundred consecutive computed tomographic (CT) mesenteric angiograms conducted in 2018 were reviewed retrospectively to determine the presence of a vessel horizontally crossing the IMV. 3D reconstructions were used to map out its course to understand its origin and full course. Baseline characteristics, including demographic and comorbidity data, were obtained from the medical record.

RESULTS: On 3D mesenteric angiogram reconstructions, a vessel crossing anterior to the IMV was present in 11 of 98 cases (11.2%). Two cases were excluded as the presence of this vessel was indeterminate. Eight of 11 patients (72.7%) were male, and the mean age was 49.3 years (range: 21-80 years). There was no statistically significant difference in age and comorbidities between the groups. Importantly, in all 11 cases, there was an arterial vessel crossing the IMV originating from the SMA and communicating with the IMA or a branch of the IMA, proving definitively that this vessel was by definition the AoR.

CONCLUSION: This 3D mesenteric angiogram mapping study has shown definitively that the vessel horizontally crossing anterior to the IMV and inferior to the pancreas is an arterial vessel from the SMA to IMA, and by definition the Arc of Riolan. When present, identification and preservation of this collateral arterial vessel during splenic flexure takedown in anterior resection may be important in reducing the risk of post-operative bowel ischaemia.

PMID:35870000 | DOI:10.1007/s00276-022-02992-x

Graefes Arch Clin Exp Ophthalmol. 2022 Jul 23. doi: 10.1007/s00417-022-05774-8. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to compare the results of vitrectomy performed in patients’ worse eyes with diabetic macular edema to the results of continuous anti-VEGF treatment performed in patients’ fellow eyes.

METHODS: A retrospective interventional study of 14 patients with diabetic macular edema in both eyes. The better eye was always qualified for aflibercept injections (group 1), and the worse eye was scheduled for vitrectomy (group 2). The follow-up lasted 12 months. The following parameters were measured: visual acuity (V), central retinal thickness (CRT), maximum retinal thickness (MRT), central choroidal thickness (CCT), superficial fovea avascular zone (sFAZ) and deep fovea avascular zone (dFAZ), and vessel density at the level of superficial (sVD) and deep (dVD) retinal vessels.

RESULTS: None of the analyzed factors differed between groups with statistical significance at any timepoint. The time of recovery of vision was identical in both eyes (F = 0.91, p = 0.449). The final sFAZ was significantly smaller for group 2 (median 196 μm) than for group 1 (median 375 μm; U = 101.0; p = 0.022; r = 0.44).

CONCLUSION: Both techniques resulted in similar improvements in visual acuity and decreases in CRT after 1 year. sFAZ decreased in all eyes, with a higher extent after vitrectomy.

PMID:35869998 | DOI:10.1007/s00417-022-05774-8

Rheumatol Int. 2022 Jul 23. doi: 10.1007/s00296-022-05168-3. Online ahead of print.

ABSTRACT

Despite many approaches, diagnosis of fibromyalgia (FM) remains a difficult clinical task, especially in the case of comorbidity of FM with other rheumatic diseases, such as ankylosing spondylitis (AS). The prevalence of FM among the population is 2.9-4.7%; whereas in patients with AS, it increases to 12.6-28.5%. The aim of the study was to evaluate the prevalence of FM in AS patients according to different criteria and to characterize them. 143 patients with AS, according to the modified New York Criteria, were examined. The FiRST used for screening of a possible FM. The FM was detected using the ACR 1990 criteria, mARC 2010, ACR 2016 and AAPT 2019 diagnostic criteria. All data were analyzed using IBM Statistics SPSS 22 software. The study was carried out in compliance with bioethical standards. According to ACR 1990, mACR 2010, ACR 2016, and AAPT 2019, the prevalence of FM in patients with AS ranged from 21.0% to 35.7%. The strongest correlation was observed in the mACR 2010 and ACR 2016 criteria (Cohen’s κ = 0.871, p < 0.001); ACR 1990 and mACR 2010 as well as ACR 2016 criteria also demonstrated quite a strong level of agreement (Cohen’s κ = 0.675 and 0.684, p < 0.001). Our results showed a high prevalence of FM in AS patients. mACR 2010 and ACR 2016 criteria are optimal for clinical practice to diagnose FM in AS patients.

PMID:35869993 | DOI:10.1007/s00296-022-05168-3

Psychopharmacology (Berl). 2022 Jul 23. doi: 10.1007/s00213-022-06172-y. Online ahead of print.

ABSTRACT

RATIONALE: Oral tobacco-derived nicotine products include on!® nicotine pouches (NPs) which are tobacco-leaf free and available in multiple flavors and nicotine levels. Switching completely to NPs from cigarettes and moist smokeless tobacco (MST) has the potential to reduce harm for adult tobacco consumers. However, the dependence potential of NPs is not established. Therefore, we characterized the abuse potential of NPs with different nicotine levels compared to cigarettes and MST.

OBJECTIVES: To evaluate nicotine pharmacokinetics (PK) and subjective effects of NPs (ranging from 1.5 to 8 mg nicotine) compared to own brand cigarettes (OBCs) and MST (OBMST).

METHODS: We used a randomized, in-clinic, partial single-blind, 7-way crossover design to assess nicotine PK and subjective effects in dual users of cigarettes and MST.

RESULTS: The mean nicotine C_max for NPs increased with nicotine level, ranging from 3.5 ng/mL (1.5 mg NP) to 15.4 ng/mL (8 mg NP), compared with 12.2 ng/mL for OBCs and 9.8 ng/mL for OBMST. Nicotine t_max was much longer for all NPs and OBMST (32.5-34.4 min) compared to OBCs (8.5 min). Reductions in urges to smoke after use of the 2 mg, 3.5 mg, and 8 mg NPs were not statistically different (p > 0.05) relative to OBC. Also, NPs resulted in lower ratings of positive subjective effects relative to OBCs and OBMST.

CONCLUSIONS: Overall, based on the study results and literature reported nicotine PK values for cigarettes and MST, the abuse potential of NPs is not likely to be higher than OBCs and OBMST. NPs may be potentially acceptable switching products for users of cigarettes and MST products.

PMID:35869988 | DOI:10.1007/s00213-022-06172-y

Health Soc Care Community. 2022 Jul 23. doi: 10.1111/hsc.13935. Online ahead of print.

ABSTRACT

Social prescribing (SP) has rapidly expanded over recent years. Previously a bottom-up, community-led phenomenon, SP is now a formal part of structured NHS policy and practice. This study was designed to ascertain how general practitioners and other primary healthcare professionals (HCPs) within one clinical commissioning group (CCG) perceive and engage with this new NHS model. The research comprised an online survey distributed to HCPs within a predominately rural, English CCG between June and August 2021. Qualitative data were gathered and analysed using reflexive thematic analysis. Positive portrayals of SP were found, although definitions and perceptions varied greatly. Many HCPs reported high levels of engagement with SP services; yet referral rates appeared to remain significantly lower than the previously estimated 20% of primary care attendees referred for social reasons. Moreover, 96% of HCPs reported signposting patients directly to community or external services, rather than referring them to SP. This signposting, which has been positioned as a model of SP, reflects engagement with SP in practice, which is likely to have pre-dated the introduction of the fuller NHS model. HCPs may be unaware that this could be classed as a social prescription, and this type of SP remains uncaptured within NHS statistics. These results indicate an underuse of the national system set up to deliver one particular model of SP, rather than that SP does not occur. Additionally, despite national guidance issued to accompany the NHS model, practices such as referral and feedback processes, and link worker presence within practices, were not uniform even within this single CCG. Nevertheless, understanding is increasing as SP becomes embedded within primary care. The lack of consistency in referrals between practices warrants further examination in terms of equity of service choices to patients, as does the very low self-reported referral rate to SP.

PMID:35869824 | DOI:10.1111/hsc.13935

Mol Ecol. 2022 Jul 23. doi: 10.1111/mec.16623. Online ahead of print.

ABSTRACT

Geologically recent radiations can shed light on speciation processes, but incomplete lineage sorting and introgressive gene flow render accurate evolutionary reconstruction and interpretation challenging. Independently evolving metapopulations of low-dispersal taxa may provide an additional level of phylogeographic information, given sufficiently broad sampling and genome-wide sequencing. Evolution in the marine brown algal genus Fucus in the south-eastern North Atlantic was shaped by Quaternary climate-driven range shifts. Over this timescale, divergence and speciation occurred against a background of expansion-contraction cycles from multiple refugia, together with mating-system shifts from outcrossing (dioecy) to selfing hermaphroditism. We tested the hypothesis that peripheral isolation of range edge (dioecious) F. vesiculosus led to parapatric speciation and radiation of hermaphrodite lineages. Species tree methods using 876 single-copy nuclear genes and extensive geographic coverage produced conflicting topologies with respect to geographic clades of F. vesiculosus. All methods, however, revealed a new and early diverging hermaphrodite species, Fucus macroguiryi sp. nov. Both the multispecies coalescent and polymorphism-aware models (in contrast to concatenation) support sequential paraphyly in F. vesiculosus resulting from distinct evolutionary processes. Our results support 1) peripheral isolation of the southern F. vesiculosus clade prior to parapatric speciation and radiation of hermaphrodite lineages – a “low latitude species pump”. 2) Directional introgressive gene flow into F. vesiculosus around the present-day secondary contact zone (sympatric-allopatric boundary) between dioecious/hermaphrodite lineages as hermaphrodites expanded northwards, supported by concordance analysis and statistical tests of introgression. 3) Species boundaries in the extensive sympatric range are likely maintained by reproductive system (selfing in hermaphrodites) and reinforcement.

PMID:35869812 | DOI:10.1111/mec.16623

Eur J Clin Invest. 2022 Jul 23:e13839. doi: 10.1111/eci.13839. Online ahead of print.

ABSTRACT

Social media and new tools for engagement offer democratic platforms for enhancing constructive scientific criticism which had previously been limited. Constructive criticism can now be massive, timely, and open. However, new options have also enhanced obsessive criticism. Obsessive criticism tends to focus on one or a handful of individuals and their work, often includes ad hominem aspects, and the critics often lack field-specific skills and technical expertise. Typical behaviors include: repetitive and persistent comments (including sealioning), lengthy commentaries/tweetorials/responses often longer than the original work, strong degree of moralizing, distortion of the underlying work, argumentum ad populum, calls to suspend/censor/retract the work or the author, guilt by association, reputational tarnishing, large gains in followers specifically through attacks, finding and positing sensitive personal information, anonymity or pseudonymity, social media campaigning, and unusual ratio of criticism to pursuit of one’s research agenda. These behaviors may last months or years. Prevention and treatment options may include awareness, identifying and working around aggravating factors, placing limits on the volume by editors, constructive pairing of commissioned editorials, incorporation of some hot debates from unregulated locations such as social media or PubPeer to the pages of scientific journals, preserving decency and focusing on evidence and arguments and avoiding personal statements, or (in some cases) ignoring. We need more research on the role of social media and obsessive criticism on an evolving cancel culture, the social media credibility, the use/misuse of anonymity and pseudonymity, and whether potential interventions from universities may improve or further weaponize scientific criticism.

PMID:35869811 | DOI:10.1111/eci.13839

Int Endod J. 2022 Jul 23. doi: 10.1111/iej.13802. Online ahead of print.

ABSTRACT

AIM: The aim of this study was to evaluate the IFI16 and IFN-α/β receptors expression during the genesis and development of experimental apical periodontitis (AP) in mice teeth.

METHODOLOGY: AP was induced in the lower first molars of 40 C57BL/6 mice. They were divided according to the experimental periods 2, 7, 14, 21 and 42 days (n=8 per group). Five animals were used as a control group (without AP). Specimens were submitted to histological processing for description of the inflammatory process, immunostaining for the presence/absence and localization of IFI16 and IFN-α/β receptors (qualitative and semi-quantitative analysis), and tartrate-resistant acid phosphatase (TRAP) histoenzimology.

RESULTS: The results showed a gradual development of AP over the experimental times. The expression of IFI16 was noticeably more exacerbated in the experimental early period (day 2) while the lowest expression was observed in the control group (p=0.02). For IFN-α/β receptors, a higher intensity staining was observed 42 days after AP induction, that was statistically different from the control group (p=0.02). Also, the number of TRAP positive cells was higher on the later periods (days 21 and 42) (p<0.001).

CONCLUSION: IFI16 protein expression was highest during the early periods after apical periodontitis induction in mice teeth, whilst IFN-α/β receptors expression was highest after apical periodontitis became established.

PMID:35869806 | DOI:10.1111/iej.13802

J Cosmet Dermatol. 2022 Jul 23. doi: 10.1111/jocd.15262. Online ahead of print.

ABSTRACT

Psoriasis (PsO) is a systemic autoimmune disease. Many pro-inflammatory and anti-inflammatory biomarkers have been associated with the pathogenetic process of psoriasis. IL-35 act as an anti-inflammatory cytokine through down regulation of TH-17 cell development and cytokine production. So, IL-35 might be utilized as potential future therapeutic agent for psoriasis.

AIMS: to investigate the association between Inflammatory (IL-17, TNF-α, IFN-γ) and anti-Inflammatory Cytokines (IL-35, TGF-β) in psoriasis patients.

PATIENTS AND METHODS: A case-control study enrolled two groups; (Group I: 40 patientswith psoriasis) and (Group II: 40 healthy age and sex matched subjects). Full history was taken from all cases along with full dermatologic examination. The assessment of psoriasis severity was conducted by using PASI score. Assessment of Inflammatory (IL-17, TNF-α, IFN-γ) and anti-Inflammatory Cytokines (IL-35, TGF-β) was performed by using ELISA technique.

RESULTS: There was a statistically significant increase of mean level of TNF-α, IL-17 and IFN-γ among psoriasis cases in comparison to controls. The mean level of TGF-β and IL-35 was statistically significantly reduced among the psoriasis cases in comparison to controls. TNF-α, IL-17 and IFN-γ showed a significant strong positive association in between and statistically significant strong negative relationship with IL-35 and TGF-β.

CONCLUSION: IL-35 has a significant role in the pathogenetic process of PsO, and it serves as a potential future therapeutic agent for psoriasis. The current results could be used as a clue for the utilization of inflammatory (IL-17, TNF-α, IFN-γ) versus anti-inflammatory Cytokines (IL-35, TGF-β) in psoriasis patients as a diagnostic biomarker for severity of cases with psoriasis.

PMID:35869799 | DOI:10.1111/jocd.15262