Nevin Manimala

Clin Nutr. 2021 Oct 8;40(11):5648-5654. doi: 10.1016/j.clnu.2021.09.042. Online ahead of print.

ABSTRACT

AIMS: Data about the influence of short-term lifestyle intervention in children with obesity on long-term follow-up body weight, adipokines and cardiometabolic risk parameters is scarce.

METHODS: In a subgroup of the LOGIC-trial (Long-term Effects of Lifestyle Intervention in Obesity and Genetic Influence in Children), we assessed anthropometry (BMI, BMI-SDS (Standard Deviation Score), adipokines (omentin-1, chemerin, leptin, adiponectin) and cardiometabolic risk parameters, (e.g. hsCRP) in children with overweight/obesity after 4 weeks of lifestyle intervention (n = 156, 14.0 ± 1.8 yrs) and after one year follow-up (n = 50). Data were compared to normal weight children (JuvenTUM school cohort; n = 152, 13.3 ± 0.7 yrs).

RESULTS: Short-term lifestyle intervention was associated with a significant reduction in BMI and BMI-SDS (p < 0.001), with significant reductions in hsCRP, leptin, and chemerin levels, and an increase in adiponectin and omentin-1 levels (p < 0.001 for all). After one year follow-up a significant reduction in BMI and BMI-SDS was observed in children from the LOGIC-trial (p < 0.001). Improvements in adiponectin (p = 0.025) and chemerin levels (p = 0.027) were seen in children with clear weight loss success (BMI-SDS reduction ≥ 0.2), whereas children with no or only mild weight loss success showed an increase in leptin levels (p < 0.001). An increase in omentin-1 levels was observed after 1 year independent of weight change (p < 0.001).

CONCLUSION: Effects of short-term weight reduction on mean BMI and BMI-SDS persist over one year. Improvements in omentin-1 levels were independent of short-term or long-term weight loss.

TRIAL REGISTRATION: ClinicalTrials.gov: LOGIC-trial: NCT01067157, JuvenTUM-trial: NCT00988754.

PMID:34666255 | DOI:10.1016/j.clnu.2021.09.042

J Biomech. 2021 Oct 11;129:110806. doi: 10.1016/j.jbiomech.2021.110806. Online ahead of print.

ABSTRACT

Subacromial shoulder pain (SSP) accounts for 44-65% of all cases of shoulder pain. Kinematic alterations in the upper limbs have been observed in individuals with SSP, although there is no consensus on such alterations in the literature. Therefore, the present study aimed to compare the three-dimensional kinematics of the scapula, trunk, and arm during shoulder flexion-extension and abduction-adduction movements in individuals with SSP and a control group using statistical parametric mapping (SPM). We evaluated 117 participants [61 with SSP and 56 in the control group (CG)]. The three-dimensional kinematic analysis was performed starting from arm extension/adduction (0%), moving to flexion/abduction, and ending returning to extension/adduction, respectively (100%) in both groups. SSP group flexed more their trunk (0-100%, p < 0.001) and rotated scapula internally (0-20%, p < 0.001 and 75-100%, p < 0.001); rotated upwards (17-32%, p < 0.005 and 58-87%, p < 0.003) and posteriorly tilted (28-79%,p < 0.001 and 81-95%,p < 0.006) less than CG group during arm abduction-adduction. Through arm flexion-extension, the SSP group flexed (38-82% p < 0.009) less their trunk, rotated upwards (5-10% p = 0.021) less their scapula, and posteriorly tilted scapula (0-100% p < 0.001) more than CG. Combining conventional variables used to describe motion in individuals with SSP, such as minimum and maximum values, range of motion, and results provided by SPM can furnish a detailed description of the compensations and limitations of the patient, enabling a better understanding of the function of the scapular girdle as well as improvements in the evaluation process and clinical decision making.

PMID:34666249 | DOI:10.1016/j.jbiomech.2021.110806

Cogn Psychol. 2021 Oct 16;131:101441. doi: 10.1016/j.cogpsych.2021.101441. Online ahead of print.

ABSTRACT

Distributional models of lexical semantics have proven to be powerful accounts of how word meanings are acquired from the natural language environment (Günther, Rinaldi, & Marelli, 2019; Kumar, 2020). Standard models of this type acquire the meaning of words through the learning of word co-occurrence statistics across large corpora. However, these models ignore social and communicative aspects of language processing, which is considered central to usage-based and adaptive theories of language (Tomasello, 2003; Beckner et al., 2009). Johns (2021) recently demonstrated that integrating social and communicative information into a lexical strength measure allowed for benchmark fits to be attained for lexical organization data, indicating that the social world contains important statistical information for language learning and processing. Through the analysis of the communication patterns of over 330,000 individuals on the online forum Reddit, totaling approximately 55 billion words of text, the findings of the current article demonstrates that social information about word usage allows for unique aspects of a word’s meaning to be acquired, providing a new pathway for distributional model development.

PMID:34666227 | DOI:10.1016/j.cogpsych.2021.101441

J Surg Res. 2021 Aug 30;270:145-150. doi: 10.1016/j.jss.2021.08.020. Online ahead of print.

ABSTRACT

BACKGROUND: On March 17, 2020 the Association of American Medical Colleges recommended dismissal of medical students from clinical settings due to the COVID-19 pandemic. Third-year (M3) and fourth-year (M4) medical students were at home, M4s were interested in teaching, and residents and faculty had fewer clinical responsibilities due to elective surgery cancellations. To continue M3 access to education, we created a virtual surgery elective (VSE) that aimed to broaden students’ exposure to, and elicit interest in, general surgery (GS).

METHODS: Faculty, surgical residents, and M4s collaborated to create a 2-wk VSE focusing on self-directed learning and direct interactions with surgery faculty. Each day was dedicated to a specific pathology commonly encountered in GS. A variety of teaching methods were employed including self-directed readings and videos, M4 peer lectures, case-based learning and operative video review with surgery faculty, and weekly surgical conferences. A VSE skills lab was also conducted to teach basic suturing and knot-tying. All lectures and skills labs were via Zoom videoconference (Zoom Video Communications Inc). A post-course anonymous survey sent to all participants assessed changes in their understanding of GS and their interest in GS and surgery overall.

RESULTS: Fourteen M3s participated in this elective over two consecutive iterations. The survey response rate was 79%. Ninety-one percent of students believed the course met its learning objectives “well” or “very well.” Prior to the course, 27% reported a “good understanding” and 0% a “very good” understanding of GS. Post-course, 100% reported a “good” or “very good” understanding of GS, a statistically significant increase (P = 0.0003). Eighty-two percent reported increased interest in GS and 64% reported an increase in pursuing GS as a career.

CONCLUSIONS: As proof of concept, this online course successfully demonstrated virtual medical student education can increase student understanding of GS topics, increase interest in GS, and increase interest in careers in surgery. To broaden student exposure to GS, we plan to integrate archived portions of this course into the regular third-year surgery clerkship and these can also be used to introduce GS in the preclinical years.

PMID:34666220 | DOI:10.1016/j.jss.2021.08.020

Eur J Cancer. 2021 Oct 16;158:133-143. doi: 10.1016/j.ejca.2021.09.018. Online ahead of print.

ABSTRACT

AIM: This study investigated how material deprivation in Italy influences the stage of hepatocellular carcinoma (HCC) at diagnosis and the chance of cure.

METHODS: 4114 patients from the Italian Liver Cancer database consecutively diagnosed with HCC between January 2008 and December 2018 were analysed about severe material deprivation (SMD) rate tertiles of the region of birth and region of managing hospitals, according to the European Statistics on Income and Living Conditions. The main outcomes were HCC diagnosis modalities (during or outside surveillance), treatment adoption and overall survival.

RESULTS: In more deprived regions, HCC was more frequently diagnosed during surveillance, while the incidental diagnosis was prevalent in the least deprived. Tumour characteristics did not differ among regions. The proportion of patients undergoing potentially curative treatments progressively decreased as the SMD worsened. Consequently, overall survival was better in less deprived regions. Patients who moved from most deprived to less deprived regions increased their probability of receiving potentially curative treatments by 1.11 times (95% CI 1.03 to 1.19), decreasing their mortality likelihood (hazard ratio 0.78 95% CI 0.67 to 0.90).

CONCLUSIONS: Socioeconomic status measured through SMD does not seem to influence HCC features at diagnosis but brings a negative effect on the chance of receiving potentially curative treatments. Patient mobility from the most deprived to the less deprived regions increased the access to curative therapies, with the ultimate result of improving survival.

PMID:34666215 | DOI:10.1016/j.ejca.2021.09.018

J Proteomics. 2021 Oct 16:104394. doi: 10.1016/j.jprot.2021.104394. Online ahead of print.

ABSTRACT

The beneficial role of yogurt on metabolic profile has been widely reported. Yet, few studies have intended to describe the integrated metabolic alterations in response to yogurt. Yogurt and milk (220 g/d) were given to 48 and 44 obese women with metabolic syndrome and nonalcoholic fatty liver disease for 24 weeks in a randomized controlled trial (registered at http://www.chictr.org.cn as ChiCTR-IPR-15006801). Fasting serum samples were collected before and after intervention for global, untargeted metabolomics based on ¹H nuclear magnetic resonance (NMR) and ultra-high-performance liquid chromatography coupled with electrospray ionization time-of-flight mass spectrometry (UPLC-Q-TOF-MS) (in positive and negative ion modes). Multivariable statistical analysis and pathway analysis were conducted. In both ¹H NMR and UPLC-Q-TOF-MS metabolomics, no clustering was observed between the two groups at baseline. While, a clear clustering was shown after intervention, and the yogurt group had significantly different metabolic status from the milk. The metabolites that contributed mostly to class separation were identified, and involved into pathway analysis. Pathways on amino acids metabolism, fatty acid oxidation, cholesterol catabolism and choline metabolism significantly changed after yogurt intervention. The study revealed the integrated metabolic alterations in response to yogurt via two metabolomics approaches, suggesting the potential mechanisms of yogurt against metabolic disorders. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR-IPR-15006801. Registered 20 July 2015, http://www.chictr.org.cn/ ChiCTR-IPR-15006801. SIGNIFICANCE: Both review from prospective studies and our randomized clinical trial showed the protective role of yogurt against multiple metabolic disorders. However, they were focus on targeted glucose, lipid, and other metabolic indicators, which were only part of human metabolism, failing to show an integrated metabolic feature on yogurt. Therefore, two global, untargeted metabolomics were applied in our current randomized clinical trial, trying to uncover the significant metabolic alterations characterizing the effects of yogurt on obese women with multiple metabolic disorders, and to explore the potential biological mechanisms of yogurt. The finding will shed light on a more comprehensive picture of how yogurt affects host metabolism, and provide theoretical foundation for dietary prevention of chronic diseases.

PMID:34666202 | DOI:10.1016/j.jprot.2021.104394

Photodiagnosis Photodyn Ther. 2021 Oct 16:102584. doi: 10.1016/j.pdpdt.2021.102584. Online ahead of print.

ABSTRACT

BACKGROUND: Antimicrobial photodynamic therapy (aPDT) and laser-activated irrigation (LAI) are adjunctive therapies developed to enhance the effectiveness of root canal disinfection. Sealer penetration into dentinal tubules is significant for preventing re-infection, and the sealer’s penetration ability is affected by the chemo-mechanical preparation of the root canal. This study aimed to evaluate the efficacy of aPDT and LAI on dentinal tubule penetration of MTA-based root canal sealer.

METHODS: Forty single-rooted mandibular premolars were divided into four groups (n=10): control, methylene blue 50 mg/L (MB50), curcumin 500 mg/L (C500), and Er,Cr:YSGG and sodium hypochlorite (LAI). The smear removal efficiency of the groups on intraradicular dentin was evaluated with a scanning electron microscope (SEM). Confocal laser scanning microscopy (CLSM) was performed to determine the depth of penetration of MTA Fillapex into dentinal tubules. Data were analyzed statistically.

RESULTS: The maximum penetration depth of the C500 group was significantly higher than that of the other groups in all three levels of root sections (p<0.05). Regarding mean penetration depth, the highest values were obtained from the C500 group. However, there was no statistically significant difference between the C500 and MB50 groups in the middle and coronal thirds of the root (p>0.05). The LAI group showed the lowest penetrated area percentage in the middle and coronal third of the root (p<0.05). The C500 and LAI groups were more effective in removing the smear layer than the control and MB50 groups.

CONCLUSION: aPDT could enhance the penetration of MTA-based root canal sealer into dentin tubules.

PMID:34666196 | DOI:10.1016/j.pdpdt.2021.102584

Spine J. 2021 Oct 16:S1529-9430(21)00950-5. doi: 10.1016/j.spinee.2021.09.011. Online ahead of print.

ABSTRACT

BACKGROUND CONTEXT: Cutibacterium acnes (C. acnes) is a gram-positive facultative anaerobe found in the deep sebaceous follicles of the skin on the shoulder and back. C. acnes has been increasingly recognized as a pathogen in spinal surgical site infection (SSI) especially in the presence of instrumentation.

PURPOSE: This study assesses whether a silver carboxylate-doped titanium dioxide-polydimethylsiloxane (TiO₂-PDMS) coating can decrease C. acnes adherence and biofilm formation on PEEK and four other commonly used spinal implant materials, Stainless Steel, Cobalt Chromium, Titanium, and Titanium Alloy.

STUDY DESIGN: We compared the adherence of C. acnes over 24 hours between uncoated, 95:5 TiO₂ to PDMS ratio with 10x silver carboxylate coating and a 100% silver carboxylate coating on each implant material, which were uniformly saw cut and sterilized. Implants were then subjected to scanning electron microscopy (SEM) and confocal scanning laser microscopy (CSLM).

METHODS: Samples were coated using 95:5 TiO₂-PDMS 10x silver carboxylate, 100% silver carboxylate, or left uncoated. C. acnes was applied onto the samples and allowed to adhere for periods of 4, 8, 12, 16, or 20 hours. Non-adherent bacteria were then washed from the samples. These samples were then allowed to continue incubating for a total of 24 hours. SEM and CLSM were used to visualize all samples for the presence of biofilm and quantification of C. acnes adherence at each time point.

RESULTS: The 95:5 TiO₂-PDMS 10x silver carboxylate coating was able to significantly decrease C. acnes adherence on PEEK after 8, 12, 16, and 20 hours of adherence. No statistical difference was found between the 95:5 TiO₂-PDMS 10x silver carboxylate coating and the 100% silver carboxylate positive control. We previously observed extensive C. acnes biofilm formation on uncoated PEEK, but none on PEEK coated with either the 95:5 TiO₂-PDMS 10x silver carboxylate or 100% Ag coating [1]. Furthermore, no biofilm formation was observed on Stainless Steel, Cobalt Chromium, Titanium, and Titanium Alloy coated with 95:5 TiO₂-PDMS 10x silver carboxylate or 100% Ag coating.

CONCLUSION: A 95:5 TiO₂-PDMS 10x silver carboxylate coating decreases C. acnes adhesion and prevents biofilm formation on PEEK and other common orthopedic implant materials.

CLINICAL SIGNIFICANCE: A 95:5 TiO₂-PDMS 10x silver carboxylate coating may help decrease spinal SSI due to C. acnes, especially in procedures with instrumentation.

PMID:34666180 | DOI:10.1016/j.spinee.2021.09.011

Spine J. 2021 Oct 16:S1529-9430(21)00952-9. doi: 10.1016/j.spinee.2021.10.002. Online ahead of print.

ABSTRACT

BACKGROUND CONTEXT: The use of spinal image guidance systems (IGS) has increased patient safety, accuracy, operative efficiency, and reduced revision rates in pedicle screw placement procedures. Traditional intraoperative 3D fluoroscopy or CT imaging produces potentially harmful ionizing radiation and increases operative time to register the patient. An IGS, FLASH Navigation, uses machine vision through high resolution stereoscopic cameras and structured visible light to build a 3D topographical map of the patient’s bony surface anatomy enabling navigation use without ionizing radiation.

PURPOSE: We aimed to compare FLASH navigation system to a widely used 3D fluoroscopic navigation (3D) platform by comparing radiation exposure and pedicle screw accuracy.

DESIGN: A randomized prospective comparative cohort study of consecutive patients undergoing open posterior lumbar instrumented fusion.

PATIENT SAMPLE: Adults diagnosed with spinal pathology requiring surgical treatment and planning for open posterior lumbar fusion with pedicle screws implanted into 1-4 vertebral levels.

OUTCOME MEASURES: Outcome measures included mean intraoperative fluoroscopy time and dose, mean CT dose length product (DLP) for preoperative and day 2 CT, pedicle screw accuracy by CT, estimated blood loss and revision surgery rate.

METHODS: Consecutive patients were randomized 1:1 to FLASH or 3D and underwent posterior lumbar instrumented fusion. Radiation doses were recorded from pre- and postoperative CT and intraoperative 3D fluoroscopy. Two independent blinded radiologists reviewed pedicle screw accuracy on CT.

RESULTS: A total of 429 (n=210 FLASH, n=219 3D) pedicle screws were placed in 90 patients (n=45 FLASH, n=45 3D) over the 18-month study period. Mean age and indication for surgery were similar between both groups, with a non-significantly higher ratio of males in the 3D group. Mean intraoperative fluoroscopy time and doses were significantly reduced in FLASH compared to 3D (4.51±3.71s vs 79.6±23.0s, p<0.001 and 80.9±68.1cGycm² vs 3704.1±3442.4 cGycm², p<0.001, respectively). This represented a relative reduction of 94.3% in the total intraoperative radiation time and a 97.8% reduction in the total intraoperative radiation dose. Mean preoperative CT DLP and mean day 2 postoperative CT DLP were significantly reduced in FLASH compared to 3D (662.0±440.4mGy-cm vs 1008.9±616.3 mGy-cm, p<0.001 and 577.9±294.3 mGy-cm vs 980.7±441.6 mGy-cm, p<0.001, respectively). This represented relative reductions of 34.4% and 41.0% in the preoperative CT dose and postoperative total DLP, respectively. The FLASH group required an average of 1.2 registrations in each case with an average of 2447 (±961.3) data points registered with a mean registration time of 106s (±52.1). A rapid re-registration mechanism was utilized in 22% (n=10/45) of cases and took 22.7s (±11.3). Re-registration was used in 7% (n=3/45) in the 3D group. Pedicle screw accuracy was high in FLASH (98.1%) and 3D (97.3%) groups with no pedicle breach >2mm in either group (p<0.001). EBL was not statistically different between the groups (p=0.38). No neurovascular injuries occurred, and no patients required return to theatre for screw repositioning.

CONCLUSIONS: FLASH and 3D IGS demonstrate high accuracy for pedicle screw placement. FLASH showed significant reduction in intraoperative radiation time and dose with lower but non-significant blood loss. FLASH showed significant reduction in preoperative and postoperative radiation, but this may be associated to the lower number of males/females preponderance in this group. FLASH provides similar accuracy to contemporary IGS without requiring 3D-fluoroscopy or radiolucent operating tables. Reducing registration time and specialized equipment may reduce costs.

PMID:34666179 | DOI:10.1016/j.spinee.2021.10.002

Ocul Surf. 2021 Oct 16:S1542-0124(21)00120-8. doi: 10.1016/j.jtos.2021.10.003. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the alteration in lipid composition of meibum, objective clinical signs, and subjective symptoms associated with aging and meibomian gland (MG) dysfunction (MGD).

METHODS: In 10 MGD patients [4 males/6 females, mean age: 65.6 ± 7.9 years (range: 50-79 years)] and 24 healthy volunteer subjects [young subjects: 6 males/6 females, mean age: 25.7 ± 3.8 years (range: 20-35 years), elderly subjects: 6 males/6 females, mean age: 58.4 ± 7.5 years (range: 50-79 years)], three objective clinical signs were evaluated: MG orifice obstruction, meibum score, and tear film lipid layer interference pattern. Subjective symptoms were analyzed via a 15-item questionnaire. After careful collection of meibum samples, comprehensive lipid analysis was performed via liquid chromatography-mass spectrometry. Data was analyzed via JMP® ver. 13 (SAS Institute, Inc., Cary, NC) statistical analysis software.

RESULTS: In the MGD patients and elderly subjects, there was a significant decrease in non-polar lipids such as cholesterol esters (ChEs), while a significant increase in polar lipids [cholesterol (Ch), (O-acyl)-ω-hydroxy fatty acid (OAHFA), and free fatty acid (FA)] in total lipids (Tukey-Kramer test: p < 0.05). Triglyceride was significantly increased only in MGD patients (p < 0.05). Symptom scores representative of vision quality (i.e., blurred vision/haziness) were significantly negatively-correlated with the ratio of the non-polar lipid ChE, while significantly positively correlated with the polar lipids Ch, OAHFA, and FA (Spearman’s rank correlation coefficient: p < 0.05).

CONCLUSIONS: Our findings revealed that both MGD and aging affect the composition ratio of major meibum lipids, resulting in the appearance of subjective symptoms.

PMID:34666148 | DOI:10.1016/j.jtos.2021.10.003