Nevin Manimala

J Neurosurg. 2021 Aug 20:1-11. doi: 10.3171/2021.2.JNS203463. Online ahead of print.

ABSTRACT

OBJECTIVE: Femoral nerve palsy results in significant impairment of lower extremity function due to the loss of quadriceps muscle function. The authors have previously described their techniques utilizing the anterior obturator and sartorius nerves for transfer in cases of femoral nerve palsy presenting within 1 year of injury. In the current study, the authors discuss their updated techniques, results, and approach to partial and complete femoral nerve palsies using femoral nerve decompression and nerve transfers.

METHODS: They conducted a retrospective review of patients with femoral nerve palsies treated with their technique at the Washington University School of Medicine in 2008-2019. Primary outcomes were active knee extension Medical Research Council (MRC) grades and visual analog scale (VAS) pain scores.

RESULTS: Fourteen patients with femoral nerve palsy were treated with femoral nerve decompression and nerve transfer: 4 with end-to-end (ETE) nerve transfers, 6 with supercharged end-to-side (SETS) transfers, and 4 with ETE and SETS transfers, using the anterior branch of the obturator nerve, the sartorius branches, or a combination of both. The median preoperative knee extension MRC grade was 2 (range 0-3). The average preoperative VAS pain score was 5.2 (range 1-9). Postoperatively, all patients attained an MRC grade 4 or greater and subjectively noted improved strength and muscle bulk and more natural gait. The average postoperative pain score was 2.3 (range 0-6), a statistically significant improvement (p = 0.001).

CONCLUSIONS: Until recently, few treatments were available for high femoral nerve palsy. A treatment strategy involving femoral nerve decompression and nerve transfers allows for meaningful functional recovery and pain relief in cases of partial and total femoral nerve palsy. An algorithm for the management of partial and complete femoral nerve palsies and a detailed description of surgical techniques are presented.

PMID:34416726 | DOI:10.3171/2021.2.JNS203463

J Neurosurg Spine. 2021 Aug 20:1-7. doi: 10.3171/2021.2.SPINE202133. Online ahead of print.

ABSTRACT

OBJECTIVE: Postoperative infection remains prevalent after spinal surgical procedures. Institutional protocols for infection prevention have improved rates of infection after spine surgery. However, prior studies have focused on only elective surgical patients. The aim of this study was to determine the efficacy of a multiinstitutional intraoperative sodium oxychlorosene-based infection prevention protocol for decreasing rate of infection after instrumented spinal surgery.

METHODS: A retrospective analysis was performed at two tertiary care institutions with level I trauma programs, and patients who underwent posterior instrumented spinal fusion between January 1, 2011, and May 31, 2019, were included. Postoperative deep wound infection rates were captured before and after implementation of a multiinstitutional infection prevention protocol. Possible adverse outcomes related to infection prevention techniques were also examined. In addition, consecutive patients treated from January 1, 2018, to May 31, 2019, were prospectively included in a database to collect preoperative and postoperative spine-specific quality of life measures and to assess the impact of postoperative infection on quality of life.

RESULTS: A total of 5047 patients fit the inclusion criteria. Of these, 1043 patients underwent surgery prior to protocol implementation. The infection rate of this cohort (3.5%) decreased significantly after protocol implementation (1.2%, p < 0.001). Postoperative sterile seroma rates did not differ between the preprotocol and postprotocol groups (0.7% vs 0.7%, p = 0.5). In the 1031 patients who underwent surgery between January 2018 and May 2019, the fusion rate was 89.2%. Quality of life outcomes between patients with infection and those without infection were similar, although statistical power was limited owing to the low rate of infection. Notably, 2 of 10 patients who developed deep wound infection died of infection-related complications.

CONCLUSIONS: An intraoperative sodium oxychlorosene-based infection prevention protocol helped to significantly decrease the rate of infection after spine surgery without negatively impacting other postoperative procedure-related metrics. Postoperative wound infection may be associated with higher-than-expected rate of postoperative mortality.

PMID:34416716 | DOI:10.3171/2021.2.SPINE202133

J Hazard Mater. 2021 Aug 8;422:126849. doi: 10.1016/j.jhazmat.2021.126849. Online ahead of print.

ABSTRACT

Dichlorvos (DDVP) is an insecticide with neurotoxicity that is widely used in agricultural production and life. However, the effects of acute DDVP poisoning on brain tissue remain underinvestigated. The purpose of this study was to evaluate the differences within 15 min-6 h in plasma biochemical indexes, brain histology and metabolites among three groups of commercial broilers orally administered different dosages of DDVP one time: (1) high-dose group (11.3 mg/kg), (2) low-dose group (2.48 mg/kg) and (3) control group (0 mg/kg). The results of biochemical indexes showed that acute DDVP poisoning could cause hyperglycemia and oxidative stress in poisoned broilers. Histological examination showed that DDVP could induce brain edema, abnormal expression of glial fibrillary acidic protein (GFAP) and neuronal mitochondrial damage in broilers. Whole-brain metabolism showed that DDVP could significantly change the secretion of neurotransmitters, energy metabolism, amino acid metabolism and nucleotide metabolism. Correlation analysis showed that metabolites such as hypoxanthine, acetylcarnitine and glucose 6-phosphate were significantly correlated with blood glucose, biomarkers of oxidative stress and brain injury pathology. The results of this study provide new insights into the molecular mechanism of brain tissue responses to acute DDVP exposure in broilers and deliver important information for clinical research on neurodegenerative diseases caused by acute DDVP poisoning.

PMID:34416688 | DOI:10.1016/j.jhazmat.2021.126849

Waste Manag. 2021 Aug 17;134:52-56. doi: 10.1016/j.wasman.2021.08.010. Online ahead of print.

ABSTRACT

For minor metal recycling from electric parts, detachment without breakage (non-destructive detachment) of the electric parts from printed circuit boards (PCBs) is required. A cross-flow shredder (CFS), a drum-type chain mill, is often used in PCB recycling, but the effects of its individual features (e.g., chain thickness) on the non-destructive detachment of the PCB parts have yet to be understood. In this study, a CFS suited to the design-of-experiment (DoE) approach was developed; 27 different experimental conditions were evaluated, with three repetitions under each condition for a single PCB crushing, and the effect of nine CFS factors on the non-destructive detachment of parts from the PCBs of mobile phones was investigated. It was revealed that two factors (rotation rate and vent screen) have a statistically significant influence on such non-destructive detachment, and two other factors (chain-wall distance and crushing time) have a significant influence on related results such as the overcrushing of boards (PCBs after parts detachment) and powder generation. Based on these results, a future perspective on CFS improvement is presented.

PMID:34416670 | DOI:10.1016/j.wasman.2021.08.010

Forensic Sci Int Genet. 2021 Aug 8;55:102568. doi: 10.1016/j.fsigen.2021.102568. Online ahead of print.

ABSTRACT

Short tandem repeats of the nuclear genome have been the preferred markers for analyzing forensic DNA mixtures. However, when nuclear DNA in a sample is degraded or limited, mitochondrial DNA (mtDNA) markers provide a powerful alternative. Though historically considered challenging, the interpretation and analysis of mtDNA mixtures have recently seen renewed interest with the advent of massively parallel sequencing. However, there are only a few software tools available for mtDNA mixture interpretation. To address this gap, the Mitochondrial Mixture Deconvolution and Interpretation Tool (MMDIT) was developed. MMDIT is an interactive application complete with a graphical user interface that allows users to deconvolve mtDNA (whole or partial genomes) mixtures into constituent donor haplotypes and estimate random match probabilities on these resultant haplotypes. In cases where deconvolution might not be feasible, the software allows mixture analysis directly within a binary framework (i.e. qualitatively, only using data on allele presence/absence). This paper explains the functionality of MMDIT, using an example of an in vitro two-person mtDNA mixture with a ratio of 1:4. The uniqueness of MMDIT lies in its ability to resolve mixtures into complete donor haplotypes using a statistical phasing framework before mixture analysis and evaluating statistical weights employing a novel graph algorithm approach. MMDIT is the first available open-source software that can automate mtDNA mixture deconvolution and analysis. The MMDIT web application can be accessed online at https://www.unthsc.edu/mmdit/. The source code is available at https://github.com/SammedMandape/MMDIT_UI and archived on zenodo (https://doi.org/10.5281/zenodo.4770184).

PMID:34416654 | DOI:10.1016/j.fsigen.2021.102568

Prev Vet Med. 2021 Aug 17;195:105467. doi: 10.1016/j.prevetmed.2021.105467. Online ahead of print.

ABSTRACT

Equine leishmaniasis is a neglected tropical disease caused by the protozoan of the Leishmania genus, and it has been reported in several countries around the world, especially Brazil. Therefore, the present investigation aims to conduct a cross-sectional study to determine the prevalence, spatial distribution, and associated factors with seropositivity for Leishmania spp. in draft horses from the Distrito Federal, Brazil. The serological survey was conducted on 411 animals, employing the Indirect Immunofluorescence Test (IFA) and Enzyme-Linked Immunosorbent Assay (ELISA). The Kappa (κ) and gross agreement indexes evaluated the Leishmania spp. seropositivity by IFA and ELISA test. The statistical analysis was performed using the Chi-square test and logistic regression. The spatial analysis showed the areas with the highest number of seropositive and the Moran autocorrelation analyses between the spatial distribution and the epidemiological model’s explanatory variables. A 27.01 % co-positivity was observed with a κ index of 52.64 %. The final model considered the variables: access to water bodies (p-value = 0.008, Odds Ratio (OR) = 2.26, Confidence Interval (CI) = 1.24-4.13), the absence of the use of ectoparasiticide (p-value = 0.008, OR = 1.93 CI = 1.18-3.15) and traveling animal (p-value = 0.059, OR = 1.54, CI = 0.98-2.41). The Kernel map showed hot areas with a high concentration of nine positive animals per area and some lighter areas ranging from five to seven positive animals per area where control measures should be performed. The Moran autocorrelation analysis was significant for the variables: traveling animal (Moran’s I = 0.540 and pseudo-p-value = 0.001) and the absence of use ectoparasiticide (Moran’s I = 0.259 and pseudo-p-value = 0.005). The current study exposes a high seroprevalence of Leishmania spp. in horses in the Distrito Federal, Brazil. Moreover, it proposes that traveling animal, the access to water bodies and the absence of the use of ectoparasiticide are significantly associated with seropositivity for Leishmania spp. in draft horses, which may contribute to the implementation of prophylactic and controls measures where leishmaniasis is already stalled.

PMID:34416652 | DOI:10.1016/j.prevetmed.2021.105467

Semin Arthritis Rheum. 2021 Aug 2;51(5):1045-1056. doi: 10.1016/j.semarthrit.2021.07.020. Online ahead of print.

ABSTRACT

BACKGROUND: Kawasaki disease (KD) is a form of self-limiting vasculitis that causes coronary artery abnormalities in children. Although clinical trials of monoclonal antibodies and anti-cytokine biologics that block cytokine cascades have been conducted, the studies have revealed contradictory results. To examine the effectiveness of treatment with monoclonal antibodies and anti-cytokine biologics for KD patients, we conducted this systematic review and meta-analysis.

METHODS: Relevant randomized controlled trials (RCTs) and observational studies (e.g., cohort studies, case-control studies, case-series, and case-reports) were included to summarize available evidence, both qualitatively and quantitatively. The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and ICUSHI were used for systematic research. Meta-analysis of the included studies was conducted using fixed-effect or random-effects models, depending on the degree of between-study heterogeneity. We assessed coronary artery and treatment outcomes of the interventions. The certainty of evidence and risk of bias were assessed using the GRADE and Cochrane risk of bias tool. The protocol of this review is registered with PROSPERO (CRD42016033079).

RESULTS: Results: Of all searched studies, 183 studies were qualitatively analyzed. We finally included four randomized controlled trials with 456 patients in quantitative syntheses. Monoclonal antibodies and anti-cytokine biologics did not reduce the frequency of CAA (risk ratio [RR], 0.93; 95% confidence interval [95%CI], 0.65 to 1.32, low certainty of evidence), compared with the conventional treatment with IVIG. However, the frequency of treatment resistance (RR, 0.60; 95%CI, 0.38 to 0.95, moderate certainty of evidence) was reduced by the antibodies. We found no statistical differences in either “any adverse event” (RR, 0.92; 95%CI, 0.80 to 1.06, low certainty of evidence) or “adverse events attributable to the administration of the medication” (RR, 1.10; 95%CI, 0.72 to 1.69, low certainty of evidence) between the two groups.

CONCLUSION: Conclusions: Although monoclonal antibodies and anti-cytokine biologics were not effective in reducing the frequency of CAA in KD patients, the frequency of treatment resistance might be reduced by those agents compared with conventional IVIG therapy alone.

PMID:34416626 | DOI:10.1016/j.semarthrit.2021.07.020

Chemosphere. 2021 Aug 13;286(Pt 3):131859. doi: 10.1016/j.chemosphere.2021.131859. Online ahead of print.

ABSTRACT

Three different innovative mathematical models were established to assess the volumetric nitrogen conversion rates of a lab-scale ANAMMOX upflow anaerobic sludge blanket reactor. Despite the vast technological and economical advantages of ANAMMOX, major challenges in process implementation call for mathematic simulations of the process, optimization of operating conditions, and kinetic/statistical analysis of the entire process. In this study, all developed mathematical models implemented via BioWin®, were calibrated and validated, with adequate representations of a bench-scale micro-granular ANAMMOX process, to understand the potential setbacks of ANAMMOX process start-up and stabilization. Fundamental calculations of the kinetic and stoichiometric constants were integrated in the BioWin® software, and the adjusted parameters based on experimental analysis were applied for the assessments. Based on the results from the statistical approach, one of the models (Model III) exhibited a precise prognosis of the effluent data for the entire operational phases with a mean relative error (MRE) of approximately 1.96, 4.36 and 2.54% for nitrogen removal efficiency, removal rate and loading rate, respectively. Evaluating alkalinity and pH during the operation, led to identifying an acceptable fit between the experiment and Model III results, with a MRE of -7.19 and -0.35%, correspondingly. This study confirms the reliability of ANAMMOX-based process modeling and high predictive ability with BioWin®. The presented simulation constants and modeling outline, can be further employed in full-scale applications design and development.

PMID:34416583 | DOI:10.1016/j.chemosphere.2021.131859

Eur J Obstet Gynecol Reprod Biol. 2021 Aug 8;265:7-17. doi: 10.1016/j.ejogrb.2021.08.001. Online ahead of print.

ABSTRACT

OBJECTIVE: In the absence of an effective screening test, women with a high genetic predisposition for ovarian cancer are recommended to undergo risk-reducing bilateral salpingo-oophorectomy (RRBSO) once childbearing is complete. This reduces the risk of ovarian cancer by up to 96%, but can result in undesirable side effects, including menopausal symptoms and sexual dysfunction. We have performed a systematic review and meta-analysis to investigate the effect of RRBSO on sexual function in women at high risk of breast/and or ovarian cancer.

METHODS: A literature search of the AMED (Allied and complementary medicine), Embase and Medline databases was performed, using search terms including sexual function, risk reducing and oophorectomy. Results were filtered according to the PRISMA protocol. Quality assessment of studies was performed using the Newcastle-Ottawa scale. Data were pooled in meta-analysis.

RESULTS: There were 21 eligible studies, 10 of which reported sufficient data for meta-analysis. Most studies were retrospective cohort or observational studies. Fifteen of the 21 studies (71%) reported a negative impact of RRBSO on sexual function. Participant numbers ranged from 37 to 1522. Meta-analysis was performed with studies including 3201 patients. This demonstrated that RRBSO has a statistically significant negative impact on sexual function (SMD -0.63, [-0.82, -0.44], p = 0.03). There was a trend towards reduced sexual pleasure and increased discomfort but this did not reach statistical significance. There was minimal change in the frequency of sex. There was a significant increase in vaginal dryness post-RRBSO (SMD 9.25, [3.66, 14.83], p < 0.00001). There was no significant difference in sexual function between pre-menopausal and post-menopausal RRBSO. Hormone replacement therapy (HRT) did not abolish this negative impact.

CONCLUSION: Sexual function declines post RRBSO, independent of menopausal status. Comprehensive pre-operative counselling regarding anticipated menopausal and sexual symptoms is key to setting realistic patient expectations and minimising post-operative distress. Information and support regarding management of these side effects should be available to all patients.

PMID:34416580 | DOI:10.1016/j.ejogrb.2021.08.001

Accid Anal Prev. 2021 Aug 17;161:106346. doi: 10.1016/j.aap.2021.106346. Online ahead of print.

ABSTRACT

This study aims to explore the associations between near-crash events and road geometry and trip features by investigating a naturalistic driving dataset and a corresponding roadway inventory dataset using an association rule mining method – the Apriori algorithm. To provide more insights into near-crash behavior, this study classified near-crash events into two severity levels: trivial near-crash events (-7.5 g ≤ deceleration rate ≤ -4.5 g) and non-trivial near-crash events (≤-7.5 g). From the perspective of descriptive statistics, the frequency of the itemsets, a set of categories of various variables, generated by the Apriori algorithm suggests that near-crash events are highly associated with several factors, including roadways without access control, driving during non-peak hours, roadways without a shoulder or a median, roadways with the minor arterial functional class, and roadways with a speed limit between 30 and 60 mph. By comparing the frequency of the occurrence of the itemset during trivial and non-trivial near-crash events, the results indicate that the length of the trip is a strong indicator of the near-crash event type. The results show that non-trivial near-crash events are more likely to occur if the trip is longer than 2 h. After applying the association rule mining algorithm, more interesting patterns for the two near-crash events were generated through the rules. The main findings include: 1) trivial near-crash events are more likely to occur on roadways without a median and shoulder that have a relatively lower functional class; 2) relatively higher functional roadways with relatively wide medians and shoulders could be an intriguing combination for non-trivial near-crash events; 3) non-trivial near-crash events often occur on long trips (more than 2 h); 4) congestion on roadways that have a lower functional class is a dominant rule associating with the high frequency of non-trivial near-crash events. This study associates near-crash events and the corresponding road geometry and trip features to provide a unique understanding of near-crash events.

PMID:34416576 | DOI:10.1016/j.aap.2021.106346