Tag: nevin manimala

Rheumatol Int. 2022 Apr 21. doi: 10.1007/s00296-022-05128-x. Online ahead of print.

ABSTRACT

The management of acute gout in the hospital setting may be challenging since most patients are elderly with multiple unstable comorbidities. However, there are no prospective clinical trials for hospitalized patients with gout to guide optimal management. Evidence indicates that steroids or adrenocorticotropic hormone (ACTH) may be effective and safe therapeutic options for these patients. This study aimed at directly comparing the efficacy and safety of ACTH vs betamethasone for the treatment of gout in hospitalized patients. This is the first prospective clinical trial for hospitalized patients with gout. We designed a randomized, open label study to assess the efficacy and safety of a single intramuscular injection of either ACTH or betamethasone in hospitalized patients with acute gout. Primary efficacy endpoints were the change in intensity of pain as recorded using a Visual Analogue Scale (VAS) at baseline compared to 24 h (ΔVAS24h), and 48 h. Moreover, we assessed safety and effects on the hypothalamic-pituitary-adrenal (HPA) axis, glucose and lipid homeostasis, bone metabolism, electrolytes and renal function. 38 patients were recruited. Both treatments were highly effective. The mean ± SE ΔVAS24h and ΔVAS48h for ACTH was 4.48 ± 0.29 and 5.58 ± 0.26, respectively. The mean ± SE ΔVAS24h and ΔVAS48h for betamethasone was 4.67 ± 0.32 and 5.67 ± 0.28, respectively. Direct comparison between the two groups at 24 h and 48 h did not show statistically significant differences. Both treatments were well tolerated and safe. The effects on all metabolic parameters were mostly minimal and transient for both treatments. However, ACTH may affect less the HPA axis and bone metabolism compared to betamethasone, thus leading to the conclusion that. ACTH and betamethasone are effective and safe for the management of acute gout in hospitalized patients but that ACTH may associate with less disturbance of the HPA axis and bone metabolism. Our data support the use of both drugs as first line treatments for hospitalized patients with gout.Clinical trial registration: ClinicalTrials.gov NCT04306653.

PMID:35445840 | DOI:10.1007/s00296-022-05128-x

Int Urogynecol J. 2022 Apr 21. doi: 10.1007/s00192-022-05195-5. Online ahead of print.

ABSTRACT

INTRODUCTION AND HYPOTHESIS: To determine whether delayed administration of CXCL12 alters anorectal manometric pressures and histology in rats following anal sphincterotomy compared to primary surgical repair alone.

METHODS: Adult female rats were divided into three groups: A, a control group that did not undergo surgery; B, anal sphincterotomy with primary surgical repair; C, anal sphincterotomy with primary surgical repair and intra-sphincteric injection of CXCL12 at 6 weeks post-injury. All rats underwent anal manometry measurements at baseline and at 6 and 12 weeks post-injury. Histologic analysis of the anal sphincters was also performed.

RESULTS: At baseline and 6 weeks, there were no statistically significant differences among D, T_max and P∆ of Groups A, B and C. At 12-week manometry, the total duration of contractions on anal manometry was significantly less in Group C compared to Groups A and B (3.65, 5.5, 5.3 p < 0.01) as was time to peak of contraction at 12 weeks (1.6, 2.1, 3.1, p < 0.01); however, group C had a significantly higher P∆ at 12 weeks compared to Groups A and B (2.25, 1.4, 0.34, p < 0.01). There were no statistically significant differences in the ratio of muscle to collagen at the site of injury; however, muscle fibers were significantly smaller in group C and less per bundle than the other groups.

CONCLUSIONS: Administration of chemokine therapy at 6 weeks post-repair using CXCL12 enhanced the magnitude of anal sphincter contractions in a rat model of anal sphincter injury but decreased overall duration of contraction. Increased anal sphincter contraction magnitude was not explained by histologic differences in explanted specimens.

PMID:35445812 | DOI:10.1007/s00192-022-05195-5

Eur Radiol. 2022 Apr 21. doi: 10.1007/s00330-022-08746-y. Online ahead of print.

ABSTRACT

OBJECTIVES: To compare the diagnostic performance of scapholunate gap (SLG) measurements acquired with dart throwing (DT), radio-ulnar deviation (RUD), and clenching fist (CF) maneuvers on 4D CT for the identification of scapholunate instability.

METHODS: In this prospective study, 47 patients with suspected scapholunate interosseous ligament (SLIL) tears were evaluated from March 2015 to March 2020 with semiautomatic quantitative analysis on 4D CT. Five parameters (median, maximal value, range, and coefficient of variation) for SLG, lunocapitate angle (LCA), and radioscaphoid angle (RSA) obtained during DT maneuver were evaluated in patients with and without SLIL tears. CT arthrography was used as the gold standard for the SLIL status. The SLG values obtained were also compared with those obtained during CF and RUD maneuvers.

RESULTS: Significant differences in all SLG- and LCA-derived parameters are found between patients with and without SLIL tears with DT (p < 0.003). The best diagnostic performance for the diagnosis of SLIL tears was obtained with median and maximal SLG values (sensitivity and specificity of 86-89% and 95%) and with maximal and range LCA values (sensitivity and specificity of 86% and 74%). No significant differences were observed for RSA values (p > 0.275). The SLG range obtained with DT maneuver was the only dynamic parameter statistically different between patients with partial and complete torn SLIL (p = 0.037).

CONCLUSION: 4D CT of the wrist during DT showed a similar performance than RUD and a better performance than CF for the differentiation between patients with and without SLIL tears.

KEY POINTS: • Four-dimensional computed tomography can dynamically assess scapholunate instability. • The best results for differentiating between patients with and without SLIL tears were obtained with SLG median and maximal values. • The dart throwing and radio-ulnar deviation maneuvers yielded the best results for the dynamic evaluation of scapholunate instability.

PMID:35445824 | DOI:10.1007/s00330-022-08746-y

Int Urogynecol J. 2022 Apr 21. doi: 10.1007/s00192-022-05100-0. Online ahead of print.

ABSTRACT

INTRODUCTION AND HYPOTHESIS: Translabial ultrasound is currently regarded as one of the most promising modalities in the evaluation of female pelvic organ prolapse. However, abnormal bladder descent on pelvic floor ultrasound has not been established among Chinese women. This study aimed to establish optimal cutoffs for defining bladder prolapse among Chinese women using translabial ultrasound.

METHODS: In this prospective multicenter study, 674 women with symptoms of lower urinary tract dysfunction and/or pelvic floor dysfunction were finally included and underwent interview, Pelvic Organ Prolapse Quantification (POP-Q) examinations and 4D translabial ultrasound. The receiver-operating characteristic (ROC) statistic was used to assess accuracy and define the optimal cutoffs.

RESULTS: The mean patient age was 42.6 (range, 19-82) years. Multivariable analysis showed that both POP-Q assessment and translabial ultrasound findings for anterior compartment were significantly associated with prolapse symptoms. The ROC statistics suggested an optimal cutoff value of 10 mm below the symphysis pubis of bladder position on Valsalva for predicting prolapse symptoms, with an area under the curve (AUC) of 0.73. Compared to translabial ultrasound, POP-Q stage showed similar accuracy for predicting prolapse symptoms (AUC: 0.74; P = 0.79), with an optimal cutoff of POP-Q stage ≥ 2.

CONCLUSIONS: This study proposed that the descent of the bladder to ≥ 10 mm below the symphysis pubis on Valsalva should be proposed as an optimal cutoff value for defining abnormal bladder prolapse on translabial ultrasound among the Chinese population. These cutoff values are nearly identical to those previously established in mainly Caucasian women.

PMID:35445811 | DOI:10.1007/s00192-022-05100-0

Int Urogynecol J. 2022 Apr 21. doi: 10.1007/s00192-022-05206-5. Online ahead of print.

ABSTRACT

INTRODUCTION AND HYPOTHESIS: Obstructive sleep apnea syndrome is associated with urological symptoms, including overactive bladder (OAB). This study aims to determine whether combined tolterodine and CPAP therapies are more effective for patients with OSAS than CPAP treatment only.

METHODS: Women who underwent polysomnography test and were diagnosed with moderate-to-severe OSAS with apnea-hypopnea index (AHI) were included in the study. Data were collected on AHI, OAB awareness-8-item tool (OAB-V8), incontinence questionnaire-urinary incontinence short form (ICIQ-UI-SF), total daily urine volume (DUV), and the Benefit, satisfaction with treatment and willingness (BSW) tool. Eligible patients were randomized to receive either CPAP treatment only or combined CPAP and tolterodine treatment for 3 months.

RESULTS: Among 103 participants, a total of 60 were included. Patients in both treatment arms showed significant improvements in OAB-V8, ICIQ-UI-SF, and total DUV compared to their baseline. The mean OAB-V8 was 15.7 at baseline and 5.6 at 3 months for the combined treatment arm and 16.6 and 7.6 at 3 months for the CPAP group only (mean baseline-adjusted between-group difference -1.1 [95% CI, -12.3 to -7.4]; p < 0.001). The improvement in the mean ICIQ-UI-SF was also statistically more significant in the combined therapy group than in the CPAP only arm (mean baseline-adjusted between-group difference -3.27 [95% CI, -4.6 to -1.59]; p < 0.001). No statistical significance was found in the improvement of total DUV between the groups.

CONCLUSIONS: In this study, combined use of tolterodine with CPAP provides beneficial effects to CPAP treatment only regarding OAB symptoms. Further research is required to confirm these findings in a large cohort.

PMID:35445808 | DOI:10.1007/s00192-022-05206-5

Int Wound J. 2022 Apr 21. doi: 10.1111/iwj.13814. Online ahead of print.

ABSTRACT

A meta-analysis was performed to assess the effect of surgical site wound infections and risk factors in neonates undergoing surgery. A systematic literature search up to January 2022 incorporated 17 trials involving 645 neonates who underwent surgery at the beginning of the trial; 198 of them had surgical site wound infections, and 447 were control for neonates. The statistical tools like the dichotomous or continuous method used within a random or fixed-influence model to establish the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) to evaluate the risk factors and influence of surgical site wound infections in neonates undergoing surgery. Surgical site wound infections had significantly higher mortality with OR value 2.03 at 95% CI 1.40-2.95 with P-value <0.001, the longer length of hospital stay (MD, 31.88; 95% CI, 18.17-45.59, P < 0.001), and lower birthweight of neonates (MD, -0.30; 95% CI, -0.53 to -0.07, P = 0.01) compared with neonates with no surgical site wound infections undergoing surgery. However, no remarkable change was observed with surgical site wound infections in the gestational age at birth of neonates (MD, -0.70; 95% CI, -1.46 to 0.05, P = 0.07), and the preoperative antibiotic prophylaxis (OR, 1.28; 95% CI, 0.57-2.87, P = 0.55) compared with no surgical site wound infections for neonates undergoing surgery. Surgical site wound infections had significantly higher mortality, a longer length of hospital stay, and lower birthweight of neonates. However, they had no statistically significant difference in the gestational age at birth of neonates and the preoperative antibiotic prophylaxis compared with no surgical site wound infections for neonates undergoing surgery. Furthermore, evidence is needed to confirm the outcomes.

PMID:35445789 | DOI:10.1111/iwj.13814

J Cardiovasc Surg (Torino). 2022 Apr;63(2):124-130. doi: 10.23736/S0021-9509.21.12203-7.

ABSTRACT

BACKGROUND: The aim of this study was to analyse the influence of true, false, and combined lumen perfusion of renal arteries on mid- and long-term kidney volume in patients with type B aortic dissection (TBAD).

METHODS: Retrospective analysis of patients diagnosed with a TBAD between 2008 and 2015 in a single high-volume European center. The origin of the renal arteries was evaluated on a dedicated 3D workstation (TeraRecon Inc., San Mateo, CA, USA) and coded as either arising from the true lumen (TL), false lumen (FL) or from a combination of both (CL). Additional evaluated anatomical parameters were renal volume, length, width, and depth of the kidneys. Measurements were recorded at the time of diagnosis (T0) and at 1-month (T1), 6-months (T2), 18-months (T3) and 36-month of follow-up time (T4).

RESULTS: A total of 131 renal arteries and kidneys were evaluated in 69 patients. Mean age was 64±13 years and 77% were male. The absolute number and percentage of assessed renal arteries/kidneys was 131 (100%) at T0, 89 (68%) at T1, 73 (56%) at T2, 57 (44%) at T3 and 43 (44%) at T4. At the time of diagnosis, 71.6% renal arteries originated from the TL, 19.1% from the FL and 9.2% from a CL. TEVAR was performed in 92.7% patients and nine patients had additional renal artery stenting. At T0 the mean renal volume was 212.1±70.9cm³, 178±61.2 in women versus 222.2±70.6 in men (P=0.002). Forty-three percent of the patients had a renal volume reduction ≥15% from T0 to their last available CTA. Mixed model analysis showed a significant overall renal volume reduction of 13.7cm³ from T0 to T4 (P<0.05). No significant differences in renal-volume reduction were observed depending on origin of the renal artery, though an estimated reduction of renal volume from T0 to T4 of 40.8 cm³ was seen when the kidneys were perfused by a CL, while TL perfusion only caused a reduction of 15.6 cm³ and no relevant volume change over time was observed when the renal artery originated from FL. Alongside a renal volume reduction, mixed model analysis also showed a significant serum-creatinine increase, from 0.8618mg/at T0 to 1.38±0.56 mg/dL at T4 (P<0.001), as well as a significant glomerular filtration rate reduction over time, from > 60mL/min at T0 to 49±13 mL/min at T4 (P<0.001). A negative correlation was observed between creatinine values and renal volume change, while a positive correlation was observed between GFR and renal volume change (P<0.001).

CONCLUSIONS: There is a significant mid-term renal-volume reduction in patients with TBAD, independent of the origin of the renal arteries. Albeit not statistically significant, combined renal artery perfusion may lead to a greater volume reduction, potentially secondary to a relevant dynamic compression by the dissection membrane. Further multicentre studies are warranted to determine the effect on long-term renal function and on possible preventive strategies.

PMID:35445805 | DOI:10.23736/S0021-9509.21.12203-7

Paediatr Anaesth. 2022 Apr 21. doi: 10.1111/pan.14466. Online ahead of print.

ABSTRACT

BACKGROUND: Failure to complete surgery within the scheduled timeframe impairs operating room efficiency leading to patient dissatisfaction and unplanned labor costs. We sought to improve timely completion (within 30 minutes of scheduled time) of first-case spine fusion surgery (for idiopathic scoliosis) from a baseline of 25% to 80% over 12 months. We also targeted timely completion of perioperative stages within predetermined target completion times.

METHODS: The project was conducted in three overlapping phases over 16 months. A simplified process map outlining five sequential perioperative stages, preintervention baselines (N=24) and time targets were defined. A multidisciplinary team conducted a series of tests of change addressing the aims. The key drivers included effective scheduling, team communications, family engagement, data collection veracity, standardized pathways, and situational awareness. Data collected by an independent data collector and from electronic medical records were analyzed using control charts and statistical process control methods.

RESULTS: Post-intervention, timely case completion increased from 25% to 68% (N=49) (95% CI 15.1-62.7, (p=0.003) and was sustained (N=14). Implementation of prediction model for case-scheduling decreased difference between scheduled and actual case end-time (33 vs 53 minutes (baseline)) and variance [lower/upper control limits [(-26, 51) vs (-109, 216) minutes (baseline)]. Average start time delay decreased from 6 to 2 minutes and on-time surgical starts improved from 50% to 70% (95% CI 3.2-41.6%). Timely completion increased for anesthesia induction (60% to 85%), surgical procedure (26% to 48%) and emergence from anesthesia (44% to 80%) but not for intraoperative patient preparation (30% to 25%) perioperative stages. Families reported satisfaction with preoperative processes (N=14) and no untoward intraoperative safety events occurred.

CONCLUSIONS: Application of QI methodology reduced time variation of several tasks and improved timely completion of spine surgery. Beyond the study period, sustained team behavior, adaptive changes and vigilant monitoring are imperative for continued success.

PMID:35445776 | DOI:10.1111/pan.14466

Int J Geriatr Psychiatry. 2022 Apr 13;37(5). doi: 10.1002/gps.5718. Online ahead of print.

ABSTRACT

OBJECTIVES: The impact of neuropsychiatric symptoms (NPS) on cognitive performance has been reported, and this impact was better defined in the aging population. Yet the potential of using the impact of NPS on brain and cognitive performance in a longitudinal setting, as prediction of conversion – have remained questionable. This study proposes to establish a predictive model of conversion to Alzheimer’s disease (AD) and mild cognitive impairment (MCI) based on current cognitive performance, NPS and their associations with brain morphology.

METHODS: 156 participants with MCI from the Alzheimer’s Disease Neuroimaging Initiative database cognitively stable after a 4-year follow-up were compared to 119 MCI participants who converted to AD. Each participant underwent a neuropsychological assessment evaluating verbal memory, language, executive and visuospatial functions, a neuropsychiatric inventory evaluation and a 3 Tesla MRI. The statistical analyses consisted of 1) baseline comparison between the groups; 2) analysis of covariance model (controlling demographic parameters including functional abilities) to specify the variables that distinguish the two subgroups and; 3) used the significant ANCOVA variables to construct a binary logistic regression model that generates a probability equation to convert to a lower cognitive performance state.

RESULTS: Results showed that MCI who converted to AD in comparison to stable MCI, exhibited a higher NPS prevalence, a lower cognitive performance and a higher number of involved brain structures. Functional abilities, memory performance and the sizes of inferior temporal, hippocampal and amygdala sizes were significant predictors of MCI to AD conversion. We also report two models of conversion that can be implemented on an individual basis for calculating the percentage risk of conversion after 4 years.

CONCLUSION: These analytical methods might be a good way to anticipate cognitive and brain declines.

PMID:35445762 | DOI:10.1002/gps.5718

Plant Cell Environ. 2022 Apr 21. doi: 10.1111/pce.14337. Online ahead of print.

ABSTRACT

Canola varieties exhibit discernible variation in drought avoidance and drought escape traits, reflecting adaptation to water-deficit environments. Our understanding of underlying genes and their interaction across environments in improving crop productivity is limited. A doubled haploid (DH) population was analysed to identify QTL associated with water use efficiency (WUE) related traits. High WUE in the vegetative phase was associated with low seed yield. Based on the resequenced parental genome data, we developed sequence-capture-based markers and validated their linkage with carbon isotope discrimination (Δ¹³ C) in an F₂ population. mRNA-Seq was performed to determine the expression of candidate genes underlying Δ¹³ C QTL. QTL contributing to main and QTL × Environment interaction effects for Δ¹³ C and yield were identified. One multiple-trait QTL for Δ¹³ C, days to flower, plant height, and seed yield was identified on chromosome A09. Interestingly, this QTL region overlapped with a homoeologous exchange event (HE), suggesting its association with the multiple traits. Transcriptome analysis revealed 121 significantly differentially expressed genes underlying Δ¹³ C QTL on A09 and C09, including in HE regions. Sorting out the negative relation between vegetative WUE and seed yield is a priority. Genetic and genomic resources and knowledge so developed could improve canola WUE and yield. This article is protected by copyright. All rights reserved.

PMID:35445756 | DOI:10.1111/pce.14337