Tag: nevin manimala

Transplant Proc. 2023 Apr 6:S0041-1345(23)00141-0. doi: 10.1016/j.transproceed.2023.03.008. Online ahead of print.

ABSTRACT

BACKGROUND: Because of the organ shortage, donation after cardiac death (DCD) kidney transplantation (KTx) is an alternative way of achieving KTx using brain-dead donors (BDs). Although the prognosis of DCD-KTx is improving, the graft suffers from delayed graft function (DGF), the management of which is essential. With progress in understanding the characteristics of cell-free DNA (CF-DNA), we consider plasma total CF-DNA (tCF-DNA) to be a useful biomarker for predicting DGF in DCD-KTx.

STUDY DESIGN AND METHOD: Consecutive patients from living donors (LDs; n = 9), BDs (n = 8), or DCD donors (n = 13) were enrolled. Plasma samples were collected after KTx and on postoperative days 3 and 5. CF-DNA was isolated, and tCF-DNA was quantified using the TapeStation 2200 software program.

RESULTS: The tCF-DNA levels after BD-KTx and DCD-KTx were higher than those after LD-KTx (LD, 78 ± 27 (ng/mL); BD, 99 ± 20; DCD, 150 ± 23); the difference between DCD-KTx and LD-KTx was statistically significant (P < .05). The tCF-DNA levels declined at postoperative day 5 (LD, 45 ± 10; BD, 51 ± 11; DCD, 66 ± 13). tCF-DNA levels were significantly increased in patients with DGF after KTx (DGF, 139 ± 22; immediate function, 91 ± 18; P < .05). The tCF-DNA level was correlated with the duration of DGF (r = 0.5825, P < .05).

CONCLUSION: Although the mechanism underlying DNA release from transplanted grafts into the recipient circulation remains unclear, cell death by apoptosis or necrosis and the active secretion of the immune system may play important roles in DGF. These data suggest that monitoring tCF-DNA may help predict graft recovery after DCD-KTx.

PMID:37031037 | DOI:10.1016/j.transproceed.2023.03.008

Foot Ankle Surg. 2023 Mar 29:S1268-7731(23)00067-X. doi: 10.1016/j.fas.2023.03.006. Online ahead of print.

ABSTRACT

INTRODUCTION: Distal Anterior Tibial Guided Growth has been shown to be useful to correct recurrent equinus deformity after open surgical release for Congenital Talipes Equinovarus. This has not been evaluated in a recurrence after use of the Ponseti method, where soft tissue releases are currently understood as the mainstay of treatment.

METHODS: Patients with recurrence of equinus component of CTEV, who underwent DATGG with at least 6-month follow-up were identified retrospectively. The criteria for performing this procedure were (1) equinus not correctable to neutral passively (2) the feeling of a bony block to dorsiflexion clinically as evidenced by a supple Achilles’ tendon at maximum dorsiflexion and (3)a finding of a flat-top talus radiologically. Successful treatment was defined by the achievement of heel strike on observation of gait. Details of the index procedure including concurrent procedures, any complications and their treatment, past and subsequent treatment episodes were retrieved from electronic patient records. Pre-op and last available post-op X-rays were evaluated for change in the anterior distal tibial angle and for flat-top talus deformity.

RESULTS: We identified 22 feet in 16 patients, with an average follow-up was 25 (8.8-47.3) months. The mean aDTA changed from 88.9 (82.3-94.5) to 77.0 (65.0-83.9) degrees, which was statistically significant (p < 0.0001) using the Paired t-test. Clinically, 17 feet (77 %) obtained a plantigrade foot with a normal heel strike. Complications were identified in 5 feet and include staple migration, oversized staple, superficial infection, iatrogenic varus deformity. Recurrence after completed treatment was noted in one foot.

CONCLUSION: This procedure should form a part of the armamentarium of procedures for treating equinus component of CTEV recurrences even in feet not treated previously by open procedures. When used in patients without significant surgical scarring it helps to address bony and soft-tissue factors, leading to effective treatment.

LEVEL OF EVIDENCE: Therapeutic Level IV.

PMID:37031009 | DOI:10.1016/j.fas.2023.03.006

J Cardiothorac Vasc Anesth. 2023 Mar 6:S1053-0770(23)00136-2. doi: 10.1053/j.jvca.2023.02.044. Online ahead of print.

ABSTRACT

OBJECTIVES: The purpose of this study was to identify barriers to improving diversity within adult cardiothoracic anesthesiology (ACTA) and to provide possible strategies that could be implemented by evaluating the demographics of current ACTA fellows, examining motivating factors to pursue the sub-specialty, and assessing perceptions of unconscious biases during their application process and training.

DESIGN: A survey was created by the authors and distributed electronically by the Society of Cardiovascular Anesthesiologists to the ACTA Fellows from April to June 2022.

SETTING: A multicenter survey.

PARTICIPANTS: Recent 2021 to 2022 ACTA fellows.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: A total of 68 fellows were included in the analytical sample; 37.3% were women, and 58.2% were men. Half of the participants in the sample were White race (47%), 26% were Asian, 8% Hispanic or Latinx, 5% Black, and 2% were Pacific Islander or Native Hawaiian. Most fellows indicated that the complexity of cases and/or competency in transesophageal echocardiography was “very important” in their motivating factor (74.0%). When examining sex differences, female fellows reported (p value <0.05) that their experience was impacted negatively by sex and was more often treated with less respect and courtesy. There were no statistically significant differences in perceived discrimination by race and/or ethnicity.

CONCLUSIONS: This study identified several motivators to pursue ACTA and the perceptions of unconscious biases during the fellowship. Female fellows felt unconscious bias and a negative impact against them due to sex. Due to the small number of undergraduate enrollments, the results should be interpreted cautiously. Additionally, this provides support to complete further studies. Implicit bias training is one strategy that can be implemented to decrease unconscious bias experienced by ACTA fellows.

PMID:37030989 | DOI:10.1053/j.jvca.2023.02.044

J Prosthet Dent. 2023 Apr;129(4):598.e1-598.e10. doi: 10.1016/j.prosdent.2023.01.034.

ABSTRACT

STATEMENT OF PROBLEM: Whether direct coronal restorations of endodontically treated teeth with short fiber-reinforced composite combined with polyethylene fibers provide adequate mechanical strength is unclear.

PURPOSE: The purpose of this in vitro study was to compare the fracture strength of endodontically treated premolars with standardized mesio-occluso-distal (MOD) preparations restored with short fiber-reinforced composite (SFRC) combined with polyethylene Ribbond fibers (PRFs).

MATERIAL AND METHODS: A total of 40 premolars were selected and distributed into 4 groups (n=10) as follows: group restored with SFRC (EverX Posterior), group restored with PRF (Ribbond fibers), and group restored with the combination PRF+SFRC, all followed by a conventional composite resin (IPS Empress Direct). MOD preparations and endodontic treatments were prepared except in the control group (intact teeth). MOD preparations and endodontic treatments were prepared except in the control group (intact teeth). Specimens were loaded using a universal testing machine until fracture occurred at a crosshead speed of 0.5 mm/min, and the failure type and fracture patterns was reported descriptively. The mean values of the groups were analyzed by using the Shapiro-Wilk test and 1-way ANOVA tests (α=.05).

RESULTS: Restoration with PRF+SFRC provided the highest mean ±standard deviation fracture resistance (288.2 ±73.5 N). Restoration with just PRF had the lowest values (192.4 ±25.4 N), which were statistically different from those of SFRC and PRF+SFRC (P<.05). The predominant mode of failure was mixed, and all fracture patterns were favorable.

CONCLUSIONS: Reinforcing endodontically treated premolars with MOD cavities with Ribbond fibers followed by a conventional composite resin enhanced fracture resistance and may be suitable for the direct coronal restoration of large posterior cavities in stress-bearing areas.

PMID:37030918 | DOI:10.1016/j.prosdent.2023.01.034

Vet Parasitol. 2023 Apr 6;318:109930. doi: 10.1016/j.vetpar.2023.109930. Online ahead of print.

ABSTRACT

Canine leishmaniasis (CanL) is a disease caused by Leishmania infantum that can vary from a subclinical infection to a severe disease. Dogs affected with CanL present varying degrees of renal dysfunction. Unfortunately, traditional biomarkers such as urea and creatinine detect renal damage in advanced stages of the disease, so more accurate biomarkers are needed. Hence, we aimed to study how urinary cystatin C (CysC) and N-acetyl-beta-D-glucosaminidase (NAG), behave in dogs with CanL at different stages of the disease. Eighty-six CanL infected dogs were classified according to LeishVet stages: LI (16 dogs), LIIa (12 dogs), LIIb (12 dogs), LIII (16 dogs) and LIV (30 dogs); as a control, 17 healthy dogs were studied. Blood samples were collected for complete haematological and biochemistry analysis including plasma cystatin C. Urine analysis included urine specific gravity (USG), urine protein to creatinine ratio (UPC), CysC and NAG expressed as a ratio with creatinine uCysCc (μg/g) and uNAGc (IU/g). The haematological, biochemical and urinary analysis coincided with the LeishVet guidelines. The statistical study of the uCysCc ratio and the uNAGc, showed significant increase when compared against control starting from group LI (p < 0.05). Interestingly, when the cut-off values were calculated using the ROC curve, uCysCc (258.85 µg/g) and uNAGc (2.25 IU/g) 75 % of the dogs included in LI groups surpassed the threshold. Hence our study indicates that uCysCc and uNAGc, could help to detect early renal damage in CanL affected dogs.

PMID:37030024 | DOI:10.1016/j.vetpar.2023.109930

Oral Oncol. 2023 Apr 6;140:106391. doi: 10.1016/j.oraloncology.2023.106391. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to demonstrate the temporal trend in incidence of head and neck cancer (HNC) in Taiwan.

MATERIALS AND METHODS: Patients with a HNC were retrieved from the Taiwan’s Health Insurance Database. We identified 16,894 patients aged ≥20 years who had received a first-time diagnosis of cancer of the oral cavity, oropharynx, larynx, hypopharynx, nasopharynx, sinonasal, salivary gland or thyroid gland between 2010 and 2018. We calculated the annual incidence rate per 100,000 population, overall, and classified by gender and cancer type. We also used the annual percent change (APC) to characterize trends in head and neck cancer rates over time.

RESULTS: The incidence rate showed a gradual decline during this period from 2010 to 2018 with an APC of -2.81% (p < 0.001). Within gender groups, the decline was not statistically significant among females (APC = -1.69, 95% CI = -3.58 ∼ 0.23, p = 0.080). Within cancer types, strikingly high magnitude and statistically significant declines were observed in respect of cancer of the nasopharynx (APC = -7.89%, 95% CI = -9.43%∼-6.31%, p < 0.001), sinonasal cancer (APC = -10.08%, 95% CI = -16.66%∼-2.99%, p = 0.012) and oropharyneal cancer (APC = -9.47%, 95% CI = -15.15%∼-3.42%, p = 0.013) over the study period. In contrast, there was a statistically significant increase in incidence on thyroid cancer over the study period with an APC of 4.75% (95% CI = -2.81%∼6.75%, p < 0.001).

CONCLUSIONS: HNCs in Taiwan are showing a decreasing trend, led by the upper respiratory and oropharyngeal cancers. However, there was a concurrent increasing trend of the incidence on thyroid cancer. These trends may be attributable to changing lifestyles and behavioral choices in Taiwan.

PMID:37030023 | DOI:10.1016/j.oraloncology.2023.106391

J Pediatr Nurs. 2023 Apr 6;71:79-87. doi: 10.1016/j.pedn.2023.03.012. Online ahead of print.

ABSTRACT

PURPOSE: A prerequisite for successful pain management is identifying the pain and assessing its intensity. The aim of this study was to describe parents’ perceptions of their child’s pain assessment in hospital care.

DESIGN AND METHODS: This study was a descriptive cross-sectional study. A questionnaire was completed by parents (n = 261) whose child was hospitalized in one of the pediatric units (n = 6) of the University Hospital in Finland. Quantitative data were analyzed using statistical methods; open-ended data were analyzed using inductive content analysis.

RESULTS: Parents reported that their children experienced moderate (36%) to severe pain (42%) during hospitalization. The most intense pain experienced by the children was associated with needle-related procedures (41%). A large proportion of parents (83%) were involved in their child’s pain assessment. Parents were satisfied with their child’s pain assessment but perceived some shortcomings. Parents hoped that a variety of methods would be used to assess their child’s pain and that the parents’ and child’s views on pain would be taken into account.

CONCLUSIONS: Most children experience moderate to severe pain during hospitalization. Parents are often involved in pain assessment but are rarely instructed to use pain scales.

PRACTICE IMPLICATIONS: Child’s pain should be assessed regularly and frequently enough. It is important that the child and parents are involved in shared decision-making about pain assessment and treatment, and they have opportunities to ask questions. Guidance should be offered to parents about the use of pain assessment scales.

PMID:37030017 | DOI:10.1016/j.pedn.2023.03.012

Schizophr Bull. 2023 Apr 8:sbad041. doi: 10.1093/schbul/sbad041. Online ahead of print.

ABSTRACT

BACKGROUND: Psychosis is related to neurochemical changes in deep-brain nuclei, particularly suggesting dopamine dysfunctions. We used an magnetic resonance imaging-based technique called quantitative susceptibility mapping (QSM) to study these regions in psychosis. QSM quantifies magnetic susceptibility in the brain, which is associated with iron concentrations. Since iron is a cofactor in dopamine pathways and co-localizes with inhibitory neurons, differences in QSM could reflect changes in these processes.

METHODS: We scanned 83 patients with first-episode psychosis and 64 healthy subjects. We reassessed 22 patients and 21 control subjects after 3 months. Mean susceptibility was measured in 6 deep-brain nuclei. Using linear mixed models, we analyzed the effect of case-control differences, region, age, gender, volume, framewise displacement (FD), treatment duration, dose, laterality, session, and psychotic symptoms on QSM.

RESULTS: Patients showed a significant susceptibility reduction in the putamen and globus pallidus externa (GPe). Patients also showed a significant R2* reduction in GPe. Age, gender, FD, session, group, and region are significant predictor variables for QSM. Dose, treatment duration, and volume were not predictor variables of QSM.

CONCLUSIONS: Reduction in QSM and R2* suggests a decreased iron concentration in the GPe of patients. Susceptibility reduction in putamen cannot be associated with iron changes. Since changes observed in putamen and GPe were not associated with symptoms, dose, and treatment duration, we hypothesize that susceptibility may be a trait marker rather than a state marker, but this must be verified with long-term studies.

PMID:37030007 | DOI:10.1093/schbul/sbad041

Isotopes Environ Health Stud. 2023 Apr 8:1-14. doi: 10.1080/10256016.2023.2195175. Online ahead of print.

ABSTRACT

The authors studied the atmospheric radon concentration with associated meteorological parameters variation during the dust events from July to November 2017. We obtained the meteorological parameters data in weather station of Sulaymaniyah city, Iraq. In the environmental monitoring plan, the atmospheric radon fluctuated from 15 to 48 Bq m^-3 around the mean value of 31.5 ± 7 Bq m^-3 within the summer. In autumn, varied from 22 to 46 Bq m^-3 with a mean value of 34 ± 12 Bq m^-3. We employed this to determine the radon level anomalously. Using the modified statistical coefficients, such as the residual deviation (RD), residual fluctuation ratio (RFR), F-test, and p-value coefficients. Among the atmospheric radon fluctuation values, particularly one anomalous (42 Bq m^-3) on 25 July was determined because the excessive value of the RD was 1.9 σ, and the RFR value was 66 %. Corresponding to our coefficients criteria, the minimum level of atmospheric radon (22 Bq m^-3) does not consider anomalous because of increasing wind speed. Based on this, our method for determining the atmospheric radon anomalies that are influenced by the missed factors beyond the mentioned meteorological parameters is accurate.

PMID:37029986 | DOI:10.1080/10256016.2023.2195175

J Wound Care. 2023 Apr 1;32(Sup4):S5-S13. doi: 10.12968/jowc.2023.32.Sup4.S5.

ABSTRACT

OBJECTIVE: The use of negative pressure wound therapy (NPWT) is ubiquitous in the management of complex wounds. Extending beyond the traditional utility of NPWT, it has been used after reconstructive flap surgery in a few case series. The authors sought to investigate the outcomes of NPWT use on flap reconstruction in a case-control study.

METHOD: Patients who underwent flap reconstruction between November 2017 and January 2020 were reviewed for inclusion in the study, and divided into an NPWT group and a control group. For patients in the NPWT group, NPWT was used directly over the locoregional flap immediately post-surgery for 4-7 days, before switching to conventional dressings. The control group used conventional dressing materials immediately post-surgery. Outcome measures such as flap necrosis, surgical site infections (SSIs), wound dehiscence as well as time to full functional recovery and hospitalisation duration were evaluated.

RESULTS: Of the 138 patients who underwent flap reconstruction, 37 who had free flap reconstructions were excluded, and 101 patients were included and divided into two groups: 51 patients in the NPWT group and 50 patients in the control group. Both groups had similar patient demographics, and patient and wound risk factors for impaired wound healing. Results showed that there was no statistically significant difference between flap necrosis, SSIs, wound dehiscence, hospitalisation duration as well as functional recovery rates. Cost analysis showed that the use of NPWT over flaps for the first seven postoperative days may potentially be more cost effective in our setting.

CONCLUSION: In this study, the appropriate use of NPWT over flaps was safe and efficacious in the immediate postoperative setting, and was not inferior to the conventional dressings used for reconstructive flap surgery. The main benefits of NPWT over flaps include better exudate management, oedema reduction and potential cost savings. Further studies would be required to ascertain any further benefit.

PMID:37029982 | DOI:10.12968/jowc.2023.32.Sup4.S5