Nevin Manimala

Ann Ital Chir. 2021;92:190-195.

ABSTRACT

OBJECTIVES: To investigate the clinical effects of different anesthesia methods in lateral episiotomy. Providing the guidance of choosing the appropriate anesthesia method in clinical operation.

METHODS: A total of 300 primiparas with vaginal delivery were enrolled into this study. These primiparas were divided into three groups (n=100, each), according to the different methods of anesthesia: group A (pudendal nerve block anesthesia + stepwise dissection and incisional local anesthesia), group B (bilateral pudendal nerve block anesthesia), and group C (pudendal nerve block anesthesia + local infiltration anesthesia). The pain score of these primiparas at the time of perineal dissection and suturing, as well as suturing time and bleeding volume, were observed and compared among these three groups.

RESULTS: In respect of pain scores at the time of suturing in lateral episiotomy, maternal pain score was significantly lower in group A than in groups B and C; and the difference was statistically significant (P<0.05). In respect of the time required for suturing in lateral episiotomy, suturing time was shorter in group A than in groups B and C; and the difference was statistically significant (P<0.05). In respect of the bleeding volume in lateral episiotomy, maternal bleeding volume was lesser in group A than in groups B and C; and the difference was statistically significant (P<0.05).

CONCLUSIONS: Among these three commonly used methods of anesthesia in lateral episiotomy, the pudendal nerve block anesthesia + stepwise dissection and incisional local anesthesia method used in group A had the best analgesic effect, the shortest suturing time, and the lowest wound blood loss.

KEY WORDS: Lateral episiotomy, Pudendal nerve block anesthesia, Local anesthesia, Pain score.

PMID:34031278

J Complement Integr Med. 2021 May 25. doi: 10.1515/jcim-2020-0195. Online ahead of print.

ABSTRACT

OBJECTIVES: Injuries induced by the brain trauma from mild to life-threatening therefore prevents these complications need psychological, environmental, and physical support. Acupressure by reduces muscle tension, improves blood circulation and stimulates endorphins secretion naturally reduce pain in these patients therefore the aim of this study was to evaluate effect of acupressure on the level of the blood pressure, respiratory rate, and heart rate in patients with the brain contusion under mechanical ventilation.

METHODS: The present study was a clinical trial with a sample size of 64 brain contusion patients who were selected based on available sampling and then randomly assigned to control and experimental groups. Demographic information and check list of blood pressure, heart rate, and respiratory rate were recorded before intervention in two groups then acupressure at the p6 point for 10 min in both hands at the morning and evening for two consecutive days is done in intervention group while in control group this pressure was applied at the same time point at an inactive point such as thumb hands. After acupressure for both groups, physiological index was measured immediately, half and 1 h after every acupressure. Data were collected using a demographic questionnaire and physiological sheet. Data was analyzed using SPSS 21 software and analytical statistical tests (independent t-test, chi-square, Fisher’s exact test).

RESULTS: The mean of blood pressure, heart rate, and respiratory rate before acupressure there was no significant statistical difference between two groups (p>0.05). but the mean of two consecutive days of blood pressure, heart rate, and respiratory rate after acupressure in the intervention group than control group was significantly different (p<0/05). Therefore, physiologic index before acupressure than after acupressure in the intervention group was significant statistical difference (p<0.001). The mean difference before the intervention than 12 h after the last intervention between two group was significant statistical difference (p<0/05) which that detected the stability of the effect of acupressure.

CONCLUSIONS: The results indicate that p6 point acupressure in the brain contusion patients under mechanical ventilation has been associated with improved blood pressure, pulse rate, and respiratory rate. While confirmation of these results requires further studies, but use of complementary medicine in recovery the physical condition and strengthening of the effect of nursing care of these patients should be considered.

PMID:34030219 | DOI:10.1515/jcim-2020-0195

J Child Psychol Psychiatry. 2021 May 24. doi: 10.1111/jcpp.13430. Online ahead of print.

ABSTRACT

BACKGROUND: Family mindfulness-based intervention (MBI) for child attention-deficit/hyperactivity disorder (ADHD) targets child self-control, parenting and parental mental health, but its effectiveness is still unclear.

METHODS: MindChamp is a pre-registered randomised controlled trial comparing an 8-week family MBI (called ‘MYmind’) in addition to care-as-usual (CAU) (n = 55) with CAU-only (n = 48). Children aged 8-16 years with remaining ADHD symptoms after CAU were enrolled together with a parent. Primary outcome was post-treatment parent-rated child self-control deficits (BRIEF); post hoc, Reliable Change Indexes were explored. Secondary child outcomes included ADHD symptoms (parent/teacher-rated Conners’ and SWAN; teacher-rated BRIEF), other psychological symptoms (parent/teacher-rated), well-being (parent-rated) and mindfulness (self-rated). Secondary parent outcomes included self-ratings of ADHD symptoms, other psychological symptoms, well-being, self-compassion and mindful parenting. Assessments were conducted at post-treatment, 2- and 6-month follow-up.

RESULTS: Relative to CAU-only, MBI+CAU resulted in a small, statistically non-significant post-treatment improvement on the BRIEF (intention-to-treat: d = 0.27, p = .18; per protocol: d = 0.33, p = .11). Significantly more children showed reliable post-treatment improvement following MBI+CAU versus CAU-only (32% versus 11%, p < .05, Number-Needed-to-Treat = 4.7). ADHD symptoms significantly reduced post-treatment according to parent (Conners’ and SWAN) and teacher ratings (BRIEF) per protocol. Only parent-rated hyperactivity impulsivity (SWAN) remained significantly reduced at 6-month follow-up. Post-treatment group differences on other secondary child outcomes were consistently favour of MBI+CAU, but mostly non-significant; no significant differences were found at follow-ups. Regarding parent outcomes, significant post-treatment improvements were found for their own ADHD symptoms, well-being and mindful parenting. At follow-ups, some significant effects remained (ADHD symptoms, mindful parenting), some additional significant effects appeared (other psychological symptoms, self-compassion) and others disappeared/remained non-significant.

CONCLUSIONS: Family MBI+CAU did not outperform CAU-only in reducing child self-control deficits on a group level but more children reliably improved. Effects on parents were larger and more durable. When CAU for ADHD is insufficient, family MBI could be a valuable addition.

PMID:34030214 | DOI:10.1111/jcpp.13430

Br J Pharmacol. 2021 May 24. doi: 10.1111/bph.15574. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: Neuropathic pain places a devastating health burden, with effective therapies or drugs being scarce. We aimed to investigate the potential antiallodynic and antihyperalgesic effects of apigenin, a natural flavonoid with monoamine oxidase (MAO) inhibitory activity, against neuropathic pain and probe mechanism(s).

EXPERIMENTAL APPROACH: The neuropathic pain model was produced by chronic constriction injury (CCI) of sciatic nerves in male C57BL/6J mice, with pain-related behaviours being assayed by von-Frey test and Hargreaves test. The 5-hydroxytryptamine (5-HT) and 5-HT_1A receptor related mechanisms were investigated in vivo and in vitro.

KEY RESULTS: Repeated apigenin treatment (p.o., once per day for two weeks) ameliorated allodynia and hyperalgesia in CCI mice in a dose-associated manner (3, 10 and 30 mg·kg^-1 ). These pain-relieving effects seem serotonergically dependent, because (I) the antihyperalgesia and antiallodynia were attenuated by chemical depletion of 5-HT with p-chlorophenylalanine (PCPA), but potentiated by 5-hydroxytryptophan (5-HTP), (II) apigenin-treated CCI mice displayed increased level of spinal 5-HT, with diminished MAO activity. In vivo antagonist tests revealed that apigenin-evoked antiallodynia and antihyperalgesia were offset by 5-HT_1A receptor antagonist WAY-100635 delivered spinally or systematically. In vitro, apigenin behaved as a positive allosteric modulator (PAM) to increase the efficacy (stimulation of [³⁵ S] GTPγS binding) of the 5-HT_1A receptor agonist 8-OH-DPAT. Beneficially, apigenin confered neuroprotection by attenuating neuronal derangement of sciatic nerve in CCI mice, without causing hypertensive crisis.

CONCLUSIONS AND IMPLICATIONS: These findings demonstrate the antiallodynic and antihyperalgesic efficacies of apigenin against neuropathic pain, with spinal 5-HT_1A receptors being crucially involved.

PMID:34030210 | DOI:10.1111/bph.15574

J Am Acad Audiol. 2021 May 24. doi: 10.1055/s-0041-1722948. Online ahead of print.

ABSTRACT

PURPOSE: The study is concern with the distinguishing of the stimuli containing high frequency information with the frequency compression feature at the cortical level using the acoustic change complex (ACC) and the comparison of such with the ACC answers of individuals with normal hearing.

RESEARCH DESIGN: This is a case-control study.

STUDY SAMPLE: Thirty adults (21 males and nine females) with normal hearing, ranging in age between 16 and 63 years (mean: 36.7 ± 12.9 years) and 20 adults (16 males and four females) with hearing loss ranging in age between 16 and 70 years (mean:49.0 ± 19.8 years) have been included in this study.

DATA COLLECTION AND ANALYSIS: A total of 1,000 ms long stimulus containing 500 and 4,000 Hz tonal stimuli was used for ACC recording. The start frequency (SF) and compression ratio (CR) parameters of the hearing aids were programmed according to the default settings (SFd, CRd) in the device software, the optimal setting (SFo, CRo), and the extra compression (SFe, CRe) requirements and ACC has been recorded for each condition. Evaluation has been performed according to P1-N1-P2 wave complex and ACC complex wave latencies. Independent samples t-test was used to test the significance of the differences between the groups.

RESULTS: In all individuals ACC has been observed. There was a significant difference between the wave latencies in normal hearing- and hearing-impaired groups. All wave latency averages of the individuals with hearing impairment were longer than the individuals with normal hearing. There were statistically significant differences between SFd-SFo, SFd-SFe, and SFo-SFe parameters. But there was no difference between CRd, CRo, and CRe in terms of CRs.

CONCLUSION: In order to discriminate high frequency information at the cortical level we should not rely on default settings of the SF and CR of the hearing aids. Optimal bandwidth must be adjusted without performing insufficient compression or over-compression. ACC can be used besides the real ear measurement for hearing aid fitting.

PMID:34030193 | DOI:10.1055/s-0041-1722948

J Neurol Surg A Cent Eur Neurosurg. 2021 May 24. doi: 10.1055/s-0041-1726110. Online ahead of print.

ABSTRACT

OBJECTIVE: Intraneural perineurioma is a rare tumor entity. It is a benign, very slow growing peripheral nerve sheath tumor that typically occurs in children and young adults. Motor deficits and muscle atrophy are classic presenting symptoms, while sensory deficits are rare at the onset of the disease. Recommended treatment strategies are lacking. We have evaluated the clinical follow-up and our experience with treatment of this rare entity.

METHODS: A total of 30 patients with intraneural perineuriomas were assessed retrospectively. Demographic data, clinical symptoms, diagnostic examinations, therapy strategies, and clinical outcome were analyzed. Descriptive statistical methods were used for evaluation.

RESULTS: The mean age was 22 years. Eleven women and 19 men were affected. The lesion occurred in the area of the upper extremity in 16 patients and in the area of the lower extremity in 14 patients. The most frequently affected nerve was the sciatic nerve, followed by the radial nerve. All patients showed a motor deficit to some extent. Seventy percent (n = 21) revealed atrophy, 43.3% (n = 13) had sensitive deficits, and 17% (n = 5) suffered of pain. Fascicle biopsies were performed in 26 patients (87%). In four patients (13%), the tumor was completely resected and then reconstructed via nerve grafts. Seventy percent of the patients (n = 21) received a magnetic resonance imaging (MRI) within 5 years postoperatively, in which no progress was shown.

CONCLUSIONS: To diagnose perineurioma, it is essential to take a biopsy of an enlarged, nonfunctional fascicle. Furthermore, a long-distance epineuriotomy to decompress the hypertrophic fascicle is reasonable. To preserve the nerves’ residual function, a complete resection is not recommended. Results after grafting are poor. One reason for this might be residual tumor cells along the nerve that cannot be visualized. Malignant transformation is not yet reported and tumor growth is stable for years.

PMID:34030186 | DOI:10.1055/s-0041-1726110

J Am Acad Orthop Surg. 2021 May 24. doi: 10.5435/JAAOS-D-20-01252. Online ahead of print.

ABSTRACT

INTRODUCTION: Rehabilitation of trauma patients is facilitated by surgical stabilization permitting weight bearing (WB) of the fractured extremity. Both-bone forearm fracture (BBFx) plate osteosynthesis is an accepted technique with high union and low complication rates; yet, postoperative WB protocols have not been adequately investigated. There exists concern for increased complications in plated BBFx fractures for patients prescribed immediate WB. We hypothesized that immediate WB of surgically treated BBFxs results in acceptable rates of complications.

METHODS: Patients presenting to a Level-1 trauma center from 2007 to 2016 with a BBFx were identified retrospectively. Patients were skeletally mature, surgically treated with prescribed immediate WB protocol, and followed for 6 months or to fracture union. Collected data included demographics, fracture characteristics, associated injuries, and WB protocols for all extremities. Complications recorded included nonunion, hardware failure, and infection. Standard statistical comparisons were used to evaluate the risk of complication in polytrauma patients with modified lower extremity WB protocols (polytrauma group) and patients with no lower extremity WB restrictions (isolated group).

RESULTS: Two hundred thirteen patients were included with 75 (35%) females and 138 (65%) males. Mean age was 40 years and mean follow-up was 46 weeks. There were 142 (67%) patients in the poly-trauma and 71 (33%) patients in the isolated groups. In the poly-trauma group 21 (10%) patients had bilateral lower extremity WB restrictions. There were 11 (6%) complications noted: 2 non-unions, 4 hardware failures, and 5 infections. Demographics did not vary between the two groups. There was no difference in complications in the isolated (5.7%) versus poly-trauma groups (5.0%) (P = 0.75).

CONCLUSION: Immediate WB rehabilitation after BBFx plate osteosynthesis seems to be safe and associated with low nonunion and complication rates. Our results demonstrate that polytrauma patients using ambulatory aids for lower extremity injuries can immediately WB without increased risk compared with isolated BBFx patients.

PMID:34030171 | DOI:10.5435/JAAOS-D-20-01252

Phys Med Biol. 2021 May 24. doi: 10.1088/1361-6560/ac047e. Online ahead of print.

ABSTRACT

Clinical studies in the hypofractionated stereotactic body radiotherapy (SBRT) have shown a reduction in the probability of local tumor control with increasing initial tumor volume. In our earlier work, we obtained and tested an analytical dependence of the TCP (tumor control probability) on the total and hypoxic tumor volumes using conventional radiotherapy model with the linear-quadratic (LQ) cell survival. In this work, this approach is further refined and tested against clinical observations for hypofractionated radiotherapy treatment schedules. Compared to radiotherapy with conventional fractionation schedules, simulations of hypofractionated radiotherapy may require different models for cell survival and the Oxygen Enhancement Ratio (OER). Our TCP simulations in hypofractionated radiotherapy are based on the LQ model and the Universal Survival Curve (USC) developed for the high doses used in SBRT. The predicted trends in local control as a function of the initial tumor volume were evaluated in SBRT for non-small cell lung cancer. Our results show, that both LQ and USC based models cannot describe the TCP reduction for larger tumor volumes observed in the clinical studies if the tumor is considered completely oxygenated. The TCP calculations are in agreement with the clinical data if the subpopulation of radio-resistant hypoxic cells is considered with the volume that increases as initial tumor volume increases. There are two conclusions which follow from our simulations. First, the extent of hypoxia is likely a primary reason of the TCP reduction with increasing the initial tumor volume in SBRT for non-small cell lung cancer. Second, the LQ model can be an acceptable approximation for the TCP calculations in hypofractionated radiotherapy if the tumor response is defined primarily by the hypoxic fraction. The larger value of OER in the hypofractionated radiotherapy compared to the conventional radiotherapy effectively extends the applicability of the LQ model to larger doses.

PMID:34030139 | DOI:10.1088/1361-6560/ac047e

Transl Oncol. 2021 May 21;14(8):101121. doi: 10.1016/j.tranon.2021.101121. Online ahead of print.

ABSTRACT

BACKGROUND: Lorlatinib is a novel potent ALK inhibitor, with only a few studies reporting the results of its clinical use.

METHODS: This study describes the outcomes of lorlatinib treatment for 35 non-small cell lung cancer patients with ALK rearrangements, who had 2 (n = 5), 1 (n = 26) or none (n = 4) prior tyrosine kinase inhibitors and received lorlatinib mainly within the compassionate use program.

RESULTS: Objective tumor response (OR) and disease control (DC) were registered in 15/35 (43%) and 33/35 (94%) patients, respectively; brain metastases were particularly responsive to the treatment (OR: 22/27 (81%); DC: 27/27 (100%)). Median progression free survival (PFS) was estimated to be 21.8 months, and median overall survival (OS) approached to 70.1 months. Only 4 out of 35 patients experienced no adverse effects; two of them were the only subjects who had no clinical benefit from lorlatinib. PFS and OS in the no-adverse-events lorlatinib users were strikingly lower as compared to the remaining patients (1.1 months vs. 23.7 months and 10.5 months vs. not reached, respectively; p < 0.0001 for both comparisons). ALK translocation variants were known for 28 patients; there was no statistical difference between patients with V.1 and V.3 rearrangements with regard to the OS or PFS.

CONCLUSION: Use of lorlatinib results in excellent disease outcomes, however caution must be taken for patients experiencing no adverse effects from this drug.

PMID:34030112 | DOI:10.1016/j.tranon.2021.101121

Psychoneuroendocrinology. 2021 May 17;129:105274. doi: 10.1016/j.psyneuen.2021.105274. Online ahead of print.

ABSTRACT

Left censoring in salivary bioscience data occurs when salivary analyte determinations fall below the lower limit of an assay’s measurement range. Conventional statistical approaches for addressing censored values (i.e., recoding as missing, substituting or extrapolating values) may introduce systematic bias. While specialized censored data statistical approaches (i.e., Maximum Likelihood Estimation, Regression on Ordered Statistics, Kaplan-Meier, and general Tobit regression) are available, these methods are rarely implemented in biobehavioral studies that examine salivary biomeasures, and their application to salivary data analysis may be hindered by their sensitivity to skewed data distributions, outliers, and sample size. This study compares descriptive statistics, correlation coefficients, and regression parameter estimates generated via conventional and specialized censored data approaches using salivary C-reactive protein data. We assess differences in statistical estimates across approach and across two levels of censoring (9% and 15%) and examine the sensitivity of our results to sample size. Overall, findings were similar across conventional and censored data approaches, but the implementation of specialized censored data approaches was more efficient (i.e., required little manipulations to the raw analyte data) and appropriate. Based on our review of the findings, we outline preliminary recommendations to enable investigators to more efficiently and effectively reduce statistical bias when working with left-censored salivary biomeasure data.

PMID:34030086 | DOI:10.1016/j.psyneuen.2021.105274