Nevin Manimala

Spine (Phila Pa 1976). 2021 Aug 11. doi: 10.1097/BRS.0000000000004197. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective study on 185 patients with 490 cervical disc herniation (CDH).

OBJECTIVE: To compare the changes in volumes of CDH in patients with degenerative cervical myelopathy (DCM) surgically-treated by expansive open-door laminoplasty (EOLP) or cervical microendoscopic laminoplasty (CMEL).

SUMMARY OF BACKGROUND DATA: Spontaneous resorption of CDH was shown in patients with DCM after conservation treatment, but very few in surgically-treated patients. Our previous study identified the clinical efficiency of CMEL to treat DCM but how CDH sized postoperatively, as well as comparing to EOLP, was unknown.

METHODS: Consecutive patients with DCM from Dec 2015 to Dec 2019, who underwent MRI evaluation, receiving CMEL or EOLP, and repeat MRI in follow-up were included. The volume of CDH were monitored using the picture archiving and communication system, further calculating the incidence of CDH with volume regression and the percentage changes of CDH volume. The correlations of possible determines with CDH volume changes were analyzed by Spearman rank correlation coefficient.

RESULTS: A total of 89 patients (215 CDHs, EOLP-group) and 96 patients (275 CDHs, CMEL-group) was surveyed respectively. Resultantly, volume of CDH was decreased post-operatively in both EOLP and CMEL cases. But this CDH volume regression was more profound in CMEL groups (incidence of 81.2% from 223/275, median volume change ratio of -26.7%, occurring from one month after CMEL), statistically different from EOLP group (50.2% from 108/215, median volume change ratio of -5.4%, none-appearance within one month). Patients information as gender, age and follow-up time, not CDH significant, was significantly correlated with CDH volume changes.

CONCLUSION: Patients who underwent CMEL developed a postoperative reduction of CDH volume, with more popularity, greater degree and earlier-staged than EOLP-patients. Young females with longer follow-up time were more likely occur.Level of Evidence: 4.

PMID:34381000 | DOI:10.1097/BRS.0000000000004197

Ophthalmic Plast Reconstr Surg. 2021 Aug 10. doi: 10.1097/IOP.0000000000002024. Online ahead of print.

ABSTRACT

PURPOSE: Intravenous ketorolac (IVK) is an effective and safe medication to reduce postoperative pain in the setting of oculofacial surgery. This study was undertaken to determine the impact of timing of IVK administration in orbital surgery on the reduction of postoperative pain score and opioid requirement.

METHODS: Patients either received IVK immediately before (n = 50), during (n = 50) or after (n = 50) orbital surgery or acted as controls (n = 50). Pain scores were assessed via an analog scale immediately after surgery and on the first postoperative day. The requirements for opioid analgesics were recorded. Statistical analyses were performed via a dedicated computerized software package.

RESULTS: One hundred fifty patients received IVK; 50 before incision (28 males, 22 females, mean age 52.2), 50 intraoperatively (20 males, 30 females, mean age 49.8) and 50 in the immediate postoperative period (26 males, 24 females, mean age = 55.3). Additionally, 50 patients acted as controls (26 males, 24 females, mean age 54). Immediately after surgery, administration of IVK resulted in statistically significant reduction in pain score regardless of the timing of dosing as compared with control patients (prior = 2.36, intraoperative = 2.34, postoperative = 2.46 vs. control 5.44, p < 0.0001). Eleven patients (22%) in the control group required opioids, whereas, in the IVK cohorts, only 2 (4%-preoperative), 1 (2%-intraoperative), and 1 (2%-postoperative) patients needed these medications (p = 0.0039).

CONCLUSIONS: In the setting of orbital surgery, IVK reduced pain scores and opioid requirement, regardless of the timing of administration, as compared with patients that did not receive the medication.

PMID:34380997 | DOI:10.1097/IOP.0000000000002024

J Pediatr Orthop B. 2021 Aug 9. doi: 10.1097/BPB.0000000000000906. Online ahead of print.

ABSTRACT

We questioned whether indications of Achilles tenotomy and standards of equinus correction as used for infants/young children hold true for use of the classical Ponseti technique in older children as well. Children aged 2-12 years with previously untreated unilateral/bilateral idiopathic clubfeet were included. For the purpose of this study, the subjects were treated by the classic Ponseti technique and underwent percutaneous tenotomy when talar head was reduced. A successful outcome and braceable feet were considered to be achieved when there was at least 10 degrees of ankle dorsiflexion post-tenotomy. The feet were classified into success and failure groups based on the above outcome and compared statistically. Furthermore, we documented the overall foot abduction and ankle dorsiflexion achieved post-tenotomy in older children. Final evaluations were done in 27 patients (39 feet; bilateral 12). Post-tenotomy, 16 feet (41%) constituted the success group. The average age (3.3 versus 5.8 years), foot abduction (39.4 versus 28.7 degrees) and ankle dorsiflexion (14.7 versus 4.1 degrees) for the success group were statistically different from the failure group. There were several residual foot deformities post-tenotomy, chiefly empty heel, varus, equinus and rotation. The reduction of lateral head of talus was not a reliable indicator for planning Achilles tenotomy in the older child. A 10-degree ankle dorsiflexion postclassical Ponseti method was achievable in only 41% feet for older children. Further, several residual deformities were present in treated feet post-tenotomy.

PMID:34380987 | DOI:10.1097/BPB.0000000000000906

J Pediatr Orthop B. 2021 Aug 9. doi: 10.1097/BPB.0000000000000902. Online ahead of print.

ABSTRACT

This study was undertaken to determine the incidence, need for intervention, and time to resolution of pseudosubluxation of the shoulder in pediatric proximal humerus fractures. One hundred and ninety-nine radiographs (199 x-rays) were analyzed for pseudosubluxation of the shoulder following pediatric proximal humeral fractures. Pseudosubluxation occurs when the center of the humeral head aligns with the inferior one-fourth of the glenoid. Fourteen patients met the inclusion criteria for pseudosubluxation. The nonoperative cohort consisted of 100 females and 93 males and the operative cohort consisted of 3 males and 3 females. Total 14 children out of 199 had pseudosubluxation. Ten pseudosubluxations were seen 7 days postinjury and four were noted immediately after injury. Pseudosubluxation was seen in nine boys (64%) and five girls (36%) in the nonoperative group. Increased relative risk (RR) was associated with: fall >3 m (RR = 25.7; 95% CI, 2.7-244.0), motorized transport (RR = 11.7; 95% CI, 1.41-96.03) and sports injuries (RR = 11.0, 95% CI, 1.2-100). No statistical analysis was conducted on the operative group given the small sample. This study establishes incidence, risk factors and expected clinical course for pseudosubluxation following proximal humerus fractures. The overall incidence in the nonoperative cohort was 7.3%, radiographic evidence of pseudosubluxation resolution was available for (n = 10) patients with 100% resolution by 6 weeks. There were no readmissions or complications in the 14 patients. Pseudosubluxation occurrence was significantly increased in four mechanisms: falls >3 m, sports trauma and motor transportation. This study provides the natural history and risk factors for pseudosubluxation following proximal humerus fractures. Pseudosubluxation is more likely to occur in higher energy fracture mechanisms and will resolve without treatment. Level of Evidence: Level III, retrospective cohort.

PMID:34380986 | DOI:10.1097/BPB.0000000000000902

Nurs Res. 2021 Aug 9. doi: 10.1097/NNR.0000000000000548. Online ahead of print.

ABSTRACT

BACKGROUND: The gut microbiome is an important determinant of health and disease in preterm infants.

OBJECTIVES: The objective of this paper is to share our current protocol for other neonatal intensive care units to potentially expand their existing protocols aiming to characterize the relationship between the intestinal microbiome and health outcomes in preterm infants.

METHODS: This prospective, longitudinal study planned to recruit 160 preterm infants born <32 weeks’ gestational age or weighing <1,500 grams and admitted to one of two-level III/IV neonatal intensive care units. During the neonatal intensive care unit period, the primary measures included events of early life pain/stress, gut microbiome, host genetic variations, and neurobehavioral assessment. During follow-up visits, gut microbiome, pain sensitivity, and medical, growth, and developmental outcomes at 4-, 8-12-, and 18-24-month corrected age (CA) were measured.

DISCUSSION: As of February 14, 2020, 214 preterm infants have been recruited. We hypothesize that infants who experience greater levels of pain/stress will have altered gut microbiome, including potential adverse outcomes such as necrotizing enterocolitis (NEC) and host genetic variations, feeding intolerance, and/or neurodevelopmental impairments. These will differ from the intestinal microbiome of preterm infants that do not develop these adverse outcomes. To test this hypothesis, we will determine how alterations in the intestinal microbiome affect the risk of developing NEC, feeding intolerance, and neurodevelopmental impairments in preterm infants. In addition, we will examine the interaction between the intestinal microbiome and host genetics in the regulation of intestinal health and neurodevelopmental outcomes.

PMID:34380978 | DOI:10.1097/NNR.0000000000000548

Cancer Nurs. 2021 Aug 11. doi: 10.1097/NCC.0000000000000996. Online ahead of print.

ABSTRACT

BACKGROUND: Depressive symptoms in Arab women with breast cancer (AWBC) in Saudi Arabia can be influenced by spirituality, religiosity, social support, and breast cancer’s stigma. Understanding the role of these factors can raise awareness and help create policies to improve care for breast cancer patients. Yet, there is limited research addressing the impact of these factors on depressive symptoms in AWBC.

OBJECTIVE: The aim of this study was to investigate factors influencing depressive symptoms in AWBC in Saudi Arabia.

METHODS: A cross-sectional design and convenience sampling were used to recruit 59 AWBC from oncology departments in Jeddah, Saudi Arabia, who were receiving active treatment to participate in this study. Participants completed an online survey or paper-based survey including questions on sociodemographics, social support, spirituality, religiosity, depressive symptoms, and breast cancer’s stigma. Pearson correlation and multiple regression analysis were used to examine the influence of numerous factors on depressive symptoms in AWBC; Student t test statistic was used to distinguish the depressive symptom scores between online and paper-based survey.

RESULTS: The average age of participants was 49 years (SD = 8.31). The mean (SD) of depressive symptoms was 20.52 (12.36). Pearson correlation analyses indicated that cancer patients with high levels of depressive symptoms were associated with low levels of spiritualty and religiosity, and high levels of breast cancer stigma.

CONCLUSIONS: Religiosity and spirituality work as protective factors against depressive symptoms in AWBC.

IMPLICATIONS FOR PRACTICE: Including religiosity and spirituality in the intervention plan should be considered when caring for AWBC.

PMID:34380962 | DOI:10.1097/NCC.0000000000000996

ASAIO J. 2021 Aug 10. doi: 10.1097/MAT.0000000000001548. Online ahead of print.

ABSTRACT

This study presents an edge detection and speckle tracking (EDST) based algorithm to calculate distensibility as percentage of change of vessel diameter during cardiac cycles. Canny edge detector, Vandermonde matrix representation, Kanade Lucas Tomasi algorithm with pyramidal segmentation, and penalized least squares technique identifies the vessel lumen edge, track the vessel diameter, detrend the signal and find peaks and valleys when the vessel is fully distended or contracted. An upper extremity artery from 10 patients underwent an ultrasound examination as part of preoperative evaluation before arteriovenous fistula surgery. Three studies were performed to evaluate EDST with automatic peak and valley selection versus manual speckle selection of expert users using manual peak and valley selection. Results demonstrate the effectiveness of the proposed methodology, to obtain comparable results as those obtained by expert-users, and considerably reducing the variability associated with external factors such as excessive motion, fluctuations in stroke volume, beat-to-beat blood pressure changes, breathing cycles, and arm-transducer pressure.

PMID:34380948 | DOI:10.1097/MAT.0000000000001548

Proc Jpn Acad Ser B Phys Biol Sci. 2021;97(7):337-370. doi: 10.2183/pjab.97.019.

ABSTRACT

The Subaru Telescope^a) is an 8.2 m optical/infrared telescope constructed during 1991-1999 and has been operational since 2000 on the summit area of Maunakea, Hawaii, by the National Astronomical Observatory of Japan (NAOJ). This paper reviews the history, key engineering issues, and selected scientific achievements of the Subaru Telescope. The active optics for a thin primary mirror was the design backbone of the telescope to deliver a high-imaging performance. Adaptive optics with a laser-facility to generate an artificial guide-star improved the telescope vision to its diffraction limit by cancelling any atmospheric turbulence effect in real time. Various observational instruments, especially the wide-field camera, have enabled unique observational studies. Selected scientific topics include studies on cosmic reionization, weak/strong gravitational lensing, cosmological parameters, primordial black holes, the dynamical/chemical evolution/interactions of galaxies, neutron star mergers, supernovae, exoplanets, proto-planetary disks, and outliers of the solar system. The last described are operational statistics, plans and a note concerning the culture-and-science issues in Hawaii.

PMID:34380914 | DOI:10.2183/pjab.97.019

Neural Regen Res. 2022 Mar;17(3):557-558. doi: 10.4103/1673-5374.320984.

NO ABSTRACT

PMID:34380888 | DOI:10.4103/1673-5374.320984

Saudi J Gastroenterol. 2021 Aug 11. doi: 10.4103/sjg.sjg_673_20. Online ahead of print.

ABSTRACT

BACKGROUND: There has been recent debate comparing the efficacy of gastric electrical stimulation (GES) with pyloric intervention, but medical literature lacks clear indications for when to perform GES or pyloric intervention. This study aims to assess the effect of sociodemographic factors and hospital characteristics on the surgical technique chosen for the treatment of gastroparesis.

METHODS: Data was extracted from the National Inpatient Sample between the years 2012 and 2014, using any discharge diagnosis of gastroparesis. For comparison of analysis between GES and pyloric surgical intervention, pyloroplasty, endoscopic pyloric dilation, and pyloromyotomy were considered to be pyloric interventions. The study population was divided into two groups, one which received GES and the other receiving pyloric intervention, to compare socioeconomic factors and hospital characteristics.

RESULTS: In total, 737,930 hospitalizations had a discharge diagnosis of gastroparesis between 2012 and 2014. On weighted multivariant analysis of patients undergoing GES or pyloric intervention for gastroparesis, being female (odds ratio (OR) 1.49, 95% confidence interval (CI) 1.25-1.78; P < 0.001), being Hispanic (OR 1.75, 95%CI; P < 0.001), being in urban teaching (OR 1.41, 95%CI 1.15-1.72; P < 0.001), and nonteaching hospitals (OR 2.93, 95%CI 2.4-3.58; P < 0.001), early satiety (OR 6.70, 95%CI 1.54-31.25; P = 0.01), and diabetes mellitus (OR 2.14, 95%CI 1.78-2.56; P < 0.001) were each statistically significantly correlated with receiving GES intervention compared to pyloric intervention.

CONCLUSION: The racial difference, payer source, and hospital location affected the surgical intervention (GES or pyloric intervention) that patients with gastroparesis would receive.

PMID:34380871 | DOI:10.4103/sjg.sjg_673_20