Tag: nevin manimala

Altern Ther Health Med. 2023 Aug 11:AT8583. Online ahead of print.

ABSTRACT

CONTEXT: Peripherally inserted central catheters (PICCs) have a high incidence of catheter occlusion, but research exploring the risk factors for such an occlusion for patients in intensive care units (ICUs) is lacking.

OBJECTIVE: The study intended to examine the impact of multiple risk factors on the occurrence of PICC catheter occlusion to find evidence that can help clinical medical staff identify patients at an early stage who are at high risk of a catheter occlusion.

DESIGN: The research team performed a retrospective, observational clinical study.

SETTING: The study took place at a tertiary general hospital, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University in Wenzhou, China.

PARTICIPANTS: Participants were 300 patients with a PICC who received treatment in the hospital’s adult ICU between January 2019 and April 2022.

GROUPS: According to the time of catheterization, the research team numbered the 1~300 participants and then selected one starting number to divided them into two groups according to the random number table. These two groups were: (1) a training group with 225 participants and (2) validation group with 75 participants.

OUTCOME MEASURES: The main outcome measure was the evaluation of the factors impacting patients who had had a PICC occlusion during catheter retention, including complete and incomplete occlusions, to build a risk prediction model of PICC occlusion. A secondary outcome measure was the occurrence of extubation of the PICC discharge of the ICU patient. The research team performed a univariate analysis of the training group’s data and a multivariate logistic regression analysis of the risk factors. The team: (1) built a risk prediction model of PICC occlusion using the independent risk factors for catheter occlusion for PICC patients in an ICU and (2) used the Hosmer-Lemeshow goodness-of-fit test to test the prediction model. A two tailed using p>0.05 indicated that the model had a good fit. Then, the team applied the model to the validation group and evaluated the model’s predictive ability using a receiver operating characteristic (ROC) curve. The team considered an area under the curve (AUC) >0.5 to have predictive value. The larger the area was, the better the predicted value was. The incidence of PICC occlusion in the training group was 18.22%, including 10 participants with complete occlusion and 31 with partial occlusion. The team used the SPSS 22.0 and R software for statistical analysis.

RESULTS: The univariate analysis showed that 13 factors were associated with PICC occlusion, including: (1) an age ≥65 years (P < .001), a BMI of ≥24 kg/m2 (P < .001), (2) a BMI of ≥24kg/m2 (P = .002), (3) diabetes (P < .001), (4) stroke (P < .001), (5) hypertension (P < .001), (6) malignant tumors (P < .001), (7) a history of deep vein thrombosis (P < .001), (8) limb activity (P < .001), (10) flushing and sealing pipe frequency of Q8h (P = .035), (11) retention time (P < .001), (12) an increased platelet count (P = .036), (13) blood transfusions (P < .001), and (14) intravenous nutrition (P < .001). The independent risk factors for PICC occlusion included: (1) age ≥65 years-OR=1.224, P = .028; (2) BMI ≥24 kg/m2-OR=1.679, P = .004; (3) diabetes-OR=1.343, P = .017; (4) malignant tumors-OR=2.736, P < .001; (5) blood transfusions-OR=1.947, P < .001), and (6) intravenous nutrition-OR=2.021, P < .001. The frequency of flushing and sealing the pipe (Q8h)-OR=-2.145, P = .002-was a protective factor. In the training group, the area under the curve (AUC) for predicting a PICC occlusion was 0.917. The Hosmer-Lemeshow test of the prediction model showed that no significant differences existed in the test results within the model (χ2 = 5.830, P = .666), indicating that the model passed the internal validation. The ideal and calibration curves of the prediction model were highly coincident, and the model was well calibrated. The Hosmer-Lemeshow test of the validation group showed that no significant differences existed in the test results outside the model, suggesting that the model had high consistency.

CONCLUSIONS: Age ≥65 years, BMI ≥24 kg/m2, diabetes, malignant tumors, blood transfusions, and intravenous nutrition were independent risk factors for PICC occlusion, while the frequency of flushing and sealing pipe (Q8h) was a protective factor. This prediction model had an outstanding ability to discriminate in identifying patients with a high-risk of PICC occlusion in the ICU.

PMID:37573601

Altern Ther Health Med. 2023 Aug 11:AT875. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to investigate the potential of mustard oil-induced reduction in acetylcholine expression as a means to delay the progression of colon cancer within the internal environment.

METHODS: The study design in this research involved both in vitro cellular experiments and in vivo animal experiments to employ mustard oil to modulate acetylcholine expression levels and evaluate its impact on colon cancer. Cellular experiments involved the introduction of six concentrations of acetylcholine (10-2, 10-3, 10-4, 10-5, 10-6, and 10-7 mol/L) into colon cancer cell cultures to monitor cell proliferation. Animal experiments encompassed the subcutaneous CT26 colon cancer cells implantation into 28 Balb/c mice, divided into experimental and control groups. After tumor establishment, both groups were fed standard diets for two weeks. Serum acetylcholine concentrations were measured from eye blood samples. Additionally, Balb/c mice were inoculated with CT26-derived colon cancer cells and further categorized into experimental and control groups. A total of 14 mice comprised each group, with experimental mice fed mustard oil and control mice fed soybean oil. Post two weeks, serum acetylcholine expression in both groups was assessed. After sacrifice, subcutaneous tumors were excised, and tumor dimensions were measured using a Vernier scale.

RESULTS: Acetylcholine concentration augmentation in the culture medium corresponded to gradual cell proliferation escalation, peaking at 10-5 mol/L, exhibiting statistical significance. Comparative analysis revealed significantly elevated relative acetylcholine expression levels in Balb/c mice with tumor-bearing colon cancers compared to normal Balb/c mice. Experimental group mice exhibited substantially lower serum acetylcholine concentrations than control group mice. Mustard oil administration effectively curtailed acetylcholine expression in normal Balb/c mice, consequently retarding tumor growth. These findings underscore mustard oil’s potential to diminish serum acetylcholine expression, thereby delaying colon cancer progression.

CONCLUSIONS: This study suggests that mustard oil’s modulation of acetylcholine expression within the internal environment holds the potential for impeding colon cancer growth.

PMID:37573596

Altern Ther Health Med. 2023 Aug 11:AT8577. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the effects of bone grafting versus non-bone grafting on implant stability and new bone formation in patients undergoing maxillary sinus floor lift combined with placement of a Bicon short dental implant.

METHODS: We recruited 60 patients with posterior maxillary tooth loss and insufficient jaw bone mass from December 2017 to December 2019, and the patients were divided into 2 groups in accordance with the surgical method: the bone grafted group (n = 32) and the non-bone grafted group (n = 28). Both groups underwent maxillary sinus floor elevation combined with Bicon short dental implant placement. No bone-grafting materials were used in the non-bone grafted group, and autologous bone chips mixed with Bicon bone substitute were used for bone grafting in the bone grafted group. The 2 groups were compared for their peri-implant index and periodontal bleeding index immediately after the operation, as well as at 3, 6, and 12 months postoperatively. The study also compared the sub-sinus-membrane height, peri-implant bone density, implant stability quotient, and alveolar bone height in the implant area at 3, 6, and 12 months after the operation, as well as the implant survival rate and complications (infection, bleeding, mucosal perforation, sinus-floor cyst, and bone-graft displacement) 12 months after the operation.

RESULTS: The peri-implant index and periodontal bleeding index immediately after the operation in the bone grafted group were higher than those in the non-bone grafted group (all P < .05), but there were no significant differences in the 2 indices between the 2 groups at 3, 6, and 12 months after the operation (all P > .05). The sub-sinus-membrane height, peri-implant bone density, implant stability quotient, and alveolar bone height in the bone grafted area were higher in the bone grafted group than in the non-bone grafted group at 3, 6, and 12 months after the operation (all P < .05). Although the implant survival rate in the bone grafted group was slightly higher than that in the non-bone grafted group at 12 months after the operation, the difference was not statistically significant (P > .05). One case of mucosal perforation occurred in the bone grafted group, but there was no significant difference in the complication rate between the 2 groups (P > .05).

CONCLUSION: The findings of this study support the use of autologous bone chips mixed with Bicon bone substitute in maxillary sinus floor elevation combined with Bicon short dental implant placement for improved implant stability and new bone formation. Further research is needed to evaluate long-term outcomes and potential complications associated with this technique.

PMID:37573595

J Appl Clin Med Phys. 2023 Aug 13:e14114. doi: 10.1002/acm2.14114. Online ahead of print.

ABSTRACT

BACKGROUND: Whereas filtered back projection algorithms for voxel-based CT image reconstruction have noise properties defined by the filter, iterative algorithms must stop at some point in their convergence and do not necessarily produce consistent noise properties for images with different degrees of heterogeneity.

PURPOSE: A least-squares iterative algorithm for proton CT (pCT) image reconstruction converges toward a unique solution for relative stopping power (RSP) that optimally fits the protons. We present a stopping criterion that delivers solutions with the property that correlations of RSP noise between voxels are relatively low. This provides a method to produce pCT images with consistent noise properties useful for proton therapy treatment planning, which relies on summing RSP along lines of voxels. Consistent noise properties will also be useful for future studies of image quality using metrics such as contrast to noise ratio, and to compare RSP noise and dose of pCT with other modalities such as dual-energy CT.

METHODS: With simulated and real images with varying heterogeneity from a prototype clinical proton imaging system, we calculate average RSP correlations between voxel pairs in uniform regions-of-interest versus distance between voxels. We define a parameter r, the remaining distance to the unique solution relative to estimated RSP noise, and our stopping criterion is based on r falling below a chosen value.

RESULTS: We find large correlations between voxels for larger values of r, and anticorrelations for smaller values. For r in the range of 0.5-1, voxels are relatively uncorrelated, and compared to smaller values of r have lower noise with only slight loss of spatial resolution.

CONCLUSIONS: Iterative algorithms not using a specific metric or rationale for stopping iterations may produce images with an unknown and arbitrary level of convergence or smoothing. We resolve this issue by stopping iterations of a least-squares iterative algorithm when r reaches the range of 0.5-1. This defines a pCT image reconstruction method with consistent statistical properties optimal for clinical use, including for treatment planning with pCT images.

PMID:37573575 | DOI:10.1002/acm2.14114

Eur J Orthop Surg Traumatol. 2023 Aug 13. doi: 10.1007/s00590-023-03679-8. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to compare radiological and functional outcomes and complication rates between intramedullary nailing (IMN) and plate fixation for diaphyseal forearm fractures in adolescents via an age-matched analysis.

METHODS: Data were collected from medical records at 11 hospitals from 2009 to 2019, and the age-matched study was conducted between IMN and plate fixation. Functional outcomes, radiographic outcomes, and postoperative complication rates were compared.

RESULTS: The IMN group (Group N) and plate fixation group (Group P) each comprised 26 patients after age matching. The mean age after matching was 13.42 years old. Bone maturities at the wrist of the radius and ulna were not significantly different between the two groups (p = 0.764 and p = 1). At the last follow-up period, functional outcomes using the Price criteria were over 90% in both groups, and the rotational range of motion was comparable to that of the healthy side. Over 70% of cases in Group N were performed by closed reduction, and operation time was half that of Group P. Postoperative neurological symptoms and refractures were more common in Group P than in Group N, although not statistically significantly so.

CONCLUSIONS: Treatment outcomes for age-matched adolescent diaphyseal forearm fractures were excellent with IMN, as well as with plate fixation in many cases despite fewer complications, better cosmesis, and shorter operative times with IMN. IMN for diaphyseal forearm fractures is a useful treatment option even in adolescents although the indications for the best procedure to perform should be considered depending on individual patient needs.

LEVEL OF EVIDENCE IV: Multicenter retrospective study.

PMID:37573542 | DOI:10.1007/s00590-023-03679-8

Spine Deform. 2023 Aug 13. doi: 10.1007/s43390-023-00748-0. Online ahead of print.

NO ABSTRACT

PMID:37573537 | DOI:10.1007/s43390-023-00748-0

Int J Bipolar Disord. 2023 Aug 13;11(1):28. doi: 10.1186/s40345-023-00308-5.

ABSTRACT

BACKGROUND: We tested the hypothesis that, after initial improvement with intravenous ketamine in patients with bipolar disorder (BD) with severe depression and acute suicidal thinking or behavior, a fixed-dose combination of oral D-cycloserine (DCS) and lurasidone (NRX-101) can maintain improvement more effectively than lurasidone alone.

METHODS: This was a multi-center, double-blind, twostage, parallel randomized trial. Adult BD patients with depression and suicidal ideation or behavior were infused with ketamine or saline (Stage 1); those who improved were randomized to a fixed-dose combination of DCS and lurasidone vs. lurasidone alone (Stage 2) to maintain the improvement achieved in Stage 1. Depression was measured by the Montgomery Åsberg Depression Rating Scale (MADRS), and suicidal thinking and behavior was measured by the Columbia Suicide Severity Rating Scale (C-SSRS); global improvement was measured by the clinical global severity scale (CGI-S).

CLINICALTRIALS: gov NCT02974010; Registered: November 22, 2016.

RESULTS: Thirty-seven patients were screened and 22 were enrolled, randomized, and treated. All 22 patients treated in Stage 1 (17 with ketamine and 5 with saline) were enrolled into Stage 2, and 11 completed the study. The fixed-dose combination of DCS and lurasidone was significantly more effective than lurasidone alone in maintaining improvement in depression (MADRS LMS Δ-7.7; p = 0.03) and reducing suicidal ideation, as measured by C-SSRS (Δ-1.5; p = 0.02) and by CGI-SS (Δ-2.9; p = 0.03), and with a non-statistically significant decrease in depressive relapse (0% vs. 40%; p = 0.07). This sequential treatment regimen did not cause any significant safety events and demonstrated improvements in patient-reported side effects.

CONCLUSIONS: Sequential treatment of a single infusion of ketamine followed by NRX-101 maintenance is a promising therapeutic approach for reducing depression and suicidal ideation in patients with bipolar depression who require hospitalization due to acute suicidal ideation and behavior. On the basis of these findings, Breakthrough Therapy Designation was awarded, and a Special Protocol Agreement was granted by the FDA for a registrational trial.

PMID:37573534 | DOI:10.1186/s40345-023-00308-5

Knee Surg Sports Traumatol Arthrosc. 2023 Aug 13. doi: 10.1007/s00167-023-07528-3. Online ahead of print.

ABSTRACT

PURPOSE: The long-term changes in the dynamics of the medial meniscus after transtibial pullout repair for medial meniscus posterior root tears (MMPRTs) are not completely understood. Thus, the aim of this study was to investigate the effects of transtibial pullout repair on MMPRTs and whether the effects would be sustained.

METHODS: Nineteen knees with MMPRTs that were treated by trans-tibial pullout repair were enrolled in this study. Medial meniscus extrusion (MME) was measured by ultrasonography during knee extension (no weight-bearing with the knee at 0° extension: NW0°) and 90° flexion (no weight-bearing with the knee at 90° flexion: NW90°) with the patient in the supine position and with full weight-bearing (FW0°) preoperatively and at 3 and 12 months postoperatively. The clinical outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score, Lysholm score, and International Knee Documentation Committee score.

RESULTS: The difference in MME with NW0° was not statistically significant between the preoperative (3.4 ± 1.0 mm) and 12-month postoperative (3.7 ± 0.6 mm) time points. The MME with NW90° at 3 (2.1 ± 0.7 mm) and 12 months (2.9 ± 0.6 mm) postoperatively were significantly lower than the preoperative values (3.4 ± 0.8 mm) (P < 0.05). However, the value significantly increased from 3 to 12 months postoperatively (P < 0.05). The MME with FW0° at 12 months postoperatively (4.3 ± 0.6 mm) was significantly larger than that at pre-operatively (3.6 ± 0.9 mm) (P < 0.05). All the patients’ clinical conditions were significantly improved at 12 months postoperatively when compared to their preoperative clinical conditions.

CONCLUSION: Surgery did not reduce the extrusion in the no weight-bearing and weight-bearing positions at knee extension, and these values increased in the postoperative period. In addition, while the surgery reduced the extrusion in the knee flexion position, the restoration achieved by the surgery was not sustained in the long term.

LEVEL OF EVIDENCE: Level IV.

PMID:37573532 | DOI:10.1007/s00167-023-07528-3

Expert Rev Anticancer Ther. 2023 Aug 13:1-6. doi: 10.1080/14737140.2023.2247565. Online ahead of print.

ABSTRACT

INTRODUCTION: Up to 30% of patients with stage IIB and 50% of stage IIC melanoma experience recurrence within 5 years after radical surgery. Adjuvant treatment is expected to improve this prognosis.

AREAS COVERED: Pembrolizumab (MK-3475) is a humanized monoclonal antibody that acts against the programmed cell death 1 (PD-1) receptor. Pembrolizumab was first approved in monotherapy for the treatment of unresectable/metastatic melanoma based on the results of the prospective KEYNOTE-001, KEYNOTE-002, and KEYNOTE-006 trials. KEYNOTE-716 is the randomized phase III trial of pembrolizumab treatment in resected stage II melanoma. Treatment with pembrolizumab is statistically significant, reducing the risk of recurrence as well as distant metastases risk after primary tumor resection. Pembrolizumab treatment has a 24-month RFS rate of 81.2% (HR 0.64 vs placebo) and a DMFS rate of 88.1%.

EXPERT OPINION: 1-year adjuvant pembrolizumab treatment of stage IIB/C melanoma patients significantly reduces recurrence or death risk. The safety profile of adjuvant treatment is not different from previously reported and is manageable. Longer follow-up is required to fully understand the efficacy and safety of adjuvant therapy for stage II melanoma, as the number of patients needed to treat is twice as high as for stage III patients.

PMID:37573515 | DOI:10.1080/14737140.2023.2247565

Dev Neurorehabil. 2023 Aug 13:1-10. doi: 10.1080/17518423.2023.2242483. Online ahead of print.

ABSTRACT

AIM: Investigation of the perspectives of paediatric health care professionals (PHCPs) in Switzerland regarding factors that influence participation in physical activity programs for children and adolescents with disabilities or chronic conditions (CADCCs). Evaluation of self-reported exercise counselling behavior of those professionals.

METHOD: A cross-sectional survey was used to collect the opinions of 171 PHCPs working with CADCCs using a structured questionnaire. The information obtained was evaluated by performing a combined quantitative and qualitative statistical analysis.

RESULTS: PHCPs in Switzerland think that CADCC do not get enough physical activity and see the underlying reasons in lacking information/knowledge and organizational factors. We found that the level of knowledge about disability sports opportunities among PHCPs has a positive influence on their exercise counselling behaviour.

CONCLUSIONS: We propose three approaches to increase the level of physical activity in CADCC: Establishing personalized exercise counseling, intensifying information about disability sports programmes towards PHCPs, and improving inclusion and integration in PE lessons or regular sports clubs.

PMID:37573511 | DOI:10.1080/17518423.2023.2242483