Tag: nevin manimala

Zhongguo Gu Shang. 2021 Apr 25;34(4):327-32. doi: 10.12200/j.issn.1003-0034.2021.04.006.

ABSTRACT

OBJECTIVE: To compare the efficacy of microscope assisted anterior cervical discectomy and fusion with conventional surgical approach in the treatment of single-segment cervical spondylotic myelopathy.

METHODS: The clinical data of 89 patients with single-segment cervical spondylotic myelopathy treated from March 2015 to March 2019 were retrospectively analyzed. There were 55 males and 34 females, with an average of (52.00±11.36) years old. Among the patients, 34 cases were treated with conventional anterior cervical discectomy with fusion (conventional group), including C_3,4 in 3 cases, C_4,5 in 10 cases, C_5,6 in 15 cases, C_6,7 in 6 cases; 55 cases were treated with microscopeassisted anterior cervical discectomy with fusion (microscope group), including C_3,4 in 5 cases, C_4,5 in 23 cases, C_5,6 in 20 cases, C_6,7 in 7 cases. Operative time, intraoperative blood loss, hospital stay and complications were compared between two groups. Clinical efficacy was assessed by visual analogue scale(VAS), Japanese Orthopaedics Association (JOA) scores, Oswestry Disability Index(ODI) during follow-up period (postoperative 1 week, 3 months and 12 months).

RESULTS: Intraoperative blood loss and hospital stay in microscope group were less than those in conventional group (P<0.05), and operative time of conventional group was shorter than that of microscope group (P<0.05). Postoperative JOA, VAS and ODI were significantly improved in each groups (P<0.05). VAS scores of microscope group were better than that of conventional group at 1 week and 3 months after operation(P<0.05), but there was no statistically significant difference between two groups at 12 months after operation (P>0.05). JOA scores of microscope group at each postoperative follow-up were better than that of conventional group (P<0.05). ODI scores of microscope group at 3, 12 months after operation were better than that of conventional group (P<0.05).

CONCLUSION: Both methods can achieve satisfactory effect in treating single-segment cervical spondylotic myelopathy. However, microscope-assisted anterior cervical discectomy and fusion has advantages of clear vision, less bleeding and fewer intraoperative complications.

PMID:33896130 | DOI:10.12200/j.issn.1003-0034.2021.04.006

Zhongguo Gu Shang. 2021 Apr 25;34(4):333-6. doi: 10.12200/j.issn.1003-0034.2021.04.007.

ABSTRACT

OBJECTIVE: To explore the relationship between lumbar degenerative spondylolisthesis and T2WI high signal in the interspinous ligament in MRI in order to improve the understanding of the signal changes of the interspinous ligament.

METHODS: The clinical data of 43 patients with clinically diagnosed lumbar degenerative spondylolisthesis were collected from March 2018 to March 2020, there were 19 males and 24 females, aged 50 to 92 years with an average of 69 years old. Using picture archiving and communication systems (PACS) to access images and record the distribution and incidence of T2WI high signal in the interspinous ligament between the slipped and non-slipped segments. Using Spearman correlation analysis to explore the relationshipbetween the T2WI high signal of the interspinous ligament and the degree of lumbar spondylolisthesis.

RESULTS: Except for 8 ligaments that were not included in the statistical results due to poor image quality, 43 patients with a total of 207 lumbar vertebrae and interspinous ligaments were included in the study. According to the Meyerding classification method, 43 patients had a total of 48 segments with spondylolisthesis, 41 segments in grade Ⅰ and 7 segments in grade Ⅱ. There were 30 cases of MRI T2WI high signal in the interspinous ligament corresponding to spondylolisthesis segment, including 3 cases on L_2,3 segment, 3 cases on L_3,4 segment, 20 cases on L_4,5 segment, and 4 cases on L₅S₁ segment. And there were 53 cases of MRI T2WI hyperintensity in 159 non slipped interspinous ligaments, of which 6 cases were at L_1,2, 6 were at L_2,3, 13 were on L_3,4, 7 were on L_4,5, and 21 were on L₅S₁. Compared with the non slipped segment, the incidence of high signal on the T2WI of the interspinous ligament was 62.5% and 33.3%, respectively, and the difference was statistically significant (χ²= 13.06, P<0.05). Spearman correlation analysis showed that the presence of T2WI hyperintensity of interspinous ligament was positively correlated with the degree of lumbar spondylolisthesis (r=0.264, P<0.05).

CONCLUSION: In patients with degenerative lumbar spondylolisthesis, the MRI T2WI hyperintensity is more common in the interspinous ligament. The occurrence of T2WI high signal is positively correlated with the degree of spondylolisthesis, which should be payed enough attention in imaging diagnosis.

PMID:33896131 | DOI:10.12200/j.issn.1003-0034.2021.04.007

Pain Pract. 2021 Apr 25. doi: 10.1111/papr.13022. Online ahead of print.

ABSTRACT

OBJECTIVES: The use of magnesium sulfate (MgSO₄ ) as an adjunct in different anesthetic regimens for cesarean section (CS) delivery often reports conflicting results. This study aimed to review the effectiveness of magnesium sulfate on improving postoperative analgesia after CS systematically.

METHODS: PubMed, Embase, and the Cochrane library were searched for randomized controlled trials (RCTs) published from inception to February 2020.

RESULTS: A total of 880 women were included (440 in each group). MgSO₄ had a statistically significant effect compared to the control group on the highest VAS (WMD=-0.74, 95%CI: -1.03, -0.46, P<0.001; I² =91.7%, P_{heterogeneity} <0.001) and the last VAS (WMD=-0.47, 95%CI: -0.71, -0.23, P<0.001; I² =95.0%, P_{heterogeneity} <0.001). MgSO₄ prolonged the time to the first use of analgesia compared to the control group (SMD=-3.03 min, 95%CI: -4.32, -1.74, P<0.001; I² =96.3%, P_{heterogeneity} <0.001). MgSO₄ decreased the consumption of analgesia compared to the control group (SMD=-3.20 mg of IV morphine equivalent, 95%CI: -5.45, -0.95, P=0.005; I² =97.6%, P_{heterogeneity} <0.001).

DISCUSSION: MgSO₄ decreases the highest VAS in women who underwent general anesthesia, spinal anesthesia, or epidural for CS (all P<0.05). Additional MgSO₄ significantly reduces postoperative pain in women undergoing CS.

PMID:33896098 | DOI:10.1111/papr.13022

Zhongguo Gu Shang. 2021 Apr 25;34(4):304-4. doi: 10.12200/j.issn.1003-0034.2021.04.003.

ABSTRACT

OBJECTIVE: To explore the clinical value and safety of unilateral pedicle screw fixation combined with contralateral translaminar facet screw fixation and interbody fusion by muscle-splitting approach treatment of recurrent lumbar disc herniation.

METHODS: The clinical data of 51 patients with recurrent lumbar disc herniation treated from June 2012 to December 2017 were retrospectively analyzed. There were 32 males and 19 females, aged 34 to 64 years with an average of (51.11± 7.28) years. Lesions invoved L_4,5 in 38 cases and L₅S₁ in 13 cases. All patients had a history of lower back pain and radiation pain of lower limbs(3 bilateral and 48 unilateral)and underwent unilateral pedicle screw combined with contralateral translaminar facet screw fixation and interbody fusion, among which 24 patients were treated through median incision approach (median incision group);other 27 patients were treated through muscle-splitting approach with channel-assisted exposure(muscle-splitting approach group). Operation time, intraoperative blood loss, postoperative drainage and incision length of the two groups were recorded. Visual analogue scale (VAS) was used to score the pain of lumbar incision at 72 h after operation, and JOA low back pain scoring system was used to evaluate the lumbar function preoperatively and at final follow-up. Imaging data were analyzed, including the changes in the height of intervertebral space of diseased segment before operation, 3 to 5 days after operation, and at final follow-up;Cobb angle changes in the coronal and sagittal planes of lumbar spine preoperatively and at final follow-up;multifidus area and multifidus fatty tissue deposition grade before and 12 months after operation; postoperative pedicle screw and laminar process screw position and intervertebral fusion condition. The complications of the two groups were compared.

RESULTS: There was no statistical difference in operation time between two groups (P>0.05). Muscle-splitting approach group was better than median incision group in light of incision length, intraoperative blood loss and postoperative drainage volume (P<0.05). VAS score of lumbar incision pain at 72 h after operation was 1.61±0.54 in median incision group and 0.76±0.28 in muscle-splitting approach group(P<0.05). All patients were followed up for 12 to 84 (43.50±15.84) months. At final follow-up, the JOA scores of the two groups were significantly improved compared with those before operation(P<0.05). The rate of pedicle screw malposition was 6.25%(3/48) in medianincision group and 9.26%(5/54) in muscle-splitting approach group, there was no statistically significant difference between two groups (P>0.05). Rate of translaminar facet screw malposition in median incision group (12.50%) was significant less than the muscle-splitting approach group (18.52%)(P< 0.05). The height of the intervertebral space of the two groups was significantly restored 3 to 5 days after operation (P<0.05), and there was also a significant loss of height at final follow-up (P<0.05). At final follow-up, the balance of lumbar coronal plane and sagittal plane in two groups were improved very well (P<0.05). The comparison of the area and grade of the multifidus muscle in two groups 12 months after operation showed that obvious damage to the multifidus muscle were present in the median incision, while the multifidus muscle was less damaged by muscle-splitting approach (P<0.05). The fusion rate was 91.7%(22/24) in the median incision group and 92.6%(25/27) in muscle-splitting approach group(P>0.05). In median incision group, there were 1 case of intraoperative pedicle entry point fracture, 1 case of intraoperative dural tear and 1 case of postoperative nerve root injury;in muscle-splitting approach group, there were 1 case of intraoperative pedicle entry point fracture, 2 cases of intraoperative dural tear, 1 case of postoperative nerve root injury, 2 cases of incision epidermal necrosis and 1 case of poor incision healing. Nerve root injuries in the two groups were caused by incorrect positions of pedicle screws, the screws were immediately adjusted upon discovery. The nerve root symptoms were completely recovered 3 and 6 months after surgery. No incision infection was occurred in two groups. During the follow-up, no pedicle screw and laminar facet screw were loosened, displaced, broken, or intervertebral fusion cage moved forward and backward. The complication rate of 25.93% in muscle-splitting approach group was higher than 12.50% in the median incision group (P<0.05).

CONCLUSION: Muscle-splitting approach is feasible for thetreatment of recurrent lumbar disc herniation with pedicle screw fixation combined with contralateral translaminar facet screw fixation and interbody fusion. Compared with the median incision approach, the muscle-splitting approach has the advantages of small incision, less trauma, less bleeding, rapid recovery. Also it can protect multifidus and do not increase the incidence of serious complications. Thus, it can be used as a choice for fixation and fusion of recurrent lumbar disc herniation.

PMID:33896127 | DOI:10.12200/j.issn.1003-0034.2021.04.003

J Nurs Manag. 2021 Apr 25. doi: 10.1111/jonm.13344. Online ahead of print.

ABSTRACT

AIMS: This study described the development and psychometric testing of the competency inventory for nurse managers across all levels in Taiwan.

BACKGROUND: The competency-based approach to develop nursing leadership and management competencies for the healthcare context is still insufficiently explored in terms of professional development in nursing administration.

METHODS: This study used mixed methods, including qualitative study for generating the preliminary inventory and a cross-sectional survey of 573 nurse managers for psychometric properties of the inventory.

RESULTS: Exploratory factor analysis revealed four domains with 23 items that explained 58.21% of the overall variance. The overall Cronbach’s alpha coefficient was 0.93. Confirmatory factor analysis showed a well-fitting goodness-of-fit statistics. The construct validity was adequate, with an average variance extracted of 0.68 and composite reliability of 0.90.

CONCLUSIONS: Across different levels, nurse managers have 23 essential competencies. The competency inventory demonstrates adequate psychometric properties with good construct validity and internal consistency, thereby reliable and valid for guiding the competency development of nurse managers.

IMPLICATIONS FOR NURSING MANAGEMENT: The essential competencies of the inventory can serve as a criterion-referenced measurement for competence proficiency in professional development of nursing administration and contribute to performance improvement of nurse managers in practice.

PMID:33896074 | DOI:10.1111/jonm.13344

Nurs Forum. 2021 Apr 24. doi: 10.1111/nuf.12584. Online ahead of print.

ABSTRACT

BACKGROUND/AIM: This study aims to determine the importance of the “Ethics and Deontology in Nursing” course in nursing education for the purpose of revealing the level of moral sensitivity of nursing students.

MATERIALS AND METHODS: In our research, which is a descriptive study, data were collected from 461 nursing students who studied at the Faculty of Health Sciences. In the study, the Personal Information Form and Moral Sensitivity Questionnaire (MSQ) were used as data collection forms. The findings from the study were evaluated with SPSS 22.00 package software, and the level of significance in all analyses was accepted as p < 0.05.

RESULTS: The average age of the students participating in the study was 20.83 ± 1.55. Also, 51.8% of the students took the course “Ethics and Deontology in Nursing.” The total mean score of the MSQ of students was determined as 83.32 ± 16.79. A statistically significant difference was found between the students’ total scores of autonomy, benefit, holistic approach, conflict, practice, orientation, and moral sensitivity, depending on whether they took the course “Ethics and Deontology in Nursing.”

CONCLUSION: It was concluded that moral sensitivity in nursing students was positively influenced by the ethical education they received.

PMID:33896007 | DOI:10.1111/nuf.12584

Br J Clin Pharmacol. 2021 Apr 25. doi: 10.1111/bcp.14774. Online ahead of print.

ABSTRACT

AIMS: Out-of-hospital cardiac arrest (OHCA) mostly results from ventricular tachycardia/ventricular fibrillation (VT/VF), often triggered by acute myocardial infarction (AMI). Sulfonylurea (SU) antidiabetics can block myocardial ATP-regulated K⁺ channels (K_ATP channels), activated during AMI, thereby modulating action potential duration (APD). We studied whether SU drugs impact on OHCA risk, and whether these effects are related to APD changes.

METHODS: We conducted a population-based case-control study in 219 VT/VF-documented OHCA cases with diabetes and 697 non-OHCA controls with diabetes. We studied the association of SU drugs (alone or in combination with metformin) with OHCA risk compared to metformin monotherapy, and of individual SU drugs compared to glimepiride, using multivariable logistic regression analysis. We studied the effects of these drugs on APD during simulated ischaemia using patch-clamp studies in human induced pluripotent stem cell-derived cardiomyocytes.

RESULTS: Compared to metformin, use of SU drugs alone or in combination with metformin was associated with reduced OHCA risk (OR_{SUdrugs-alone} 0.6 [95% CI 0.4-0.9], OR_{SUdrugs + metformin} 0.6 [95% CI 0.4-0.9]). We found no differences in OHCA risk between SU drug users who suffered OHCA inside or outside the context of AMI. Reduction of OHCA risk compared to glimepiride was found with gliclazide (OR_adj 0.5 [95% CI 0.3-0.9]), but not glibenclamide (OR_adj 1.3 [95% CI 0.6-2.7]); for tolbutamide, the association with reduced OHCA risk just failed to reach statistical significance (OR_adj 0.6 [95% CI 0.3-1.002]). Glibenclamide attenuated simulated ischaemia-induced APD shortening, while the other SU drugs had no effect.

CONCLUSIONS: SU drugs were associated with reduced OHCA risk compared to metformin monotherapy, with gliclazide having a lower risk than glimepiride. The differential effects of SU drugs are not explained by differential effects on APD.

PMID:33896015 | DOI:10.1111/bcp.14774

J Card Surg. 2021 Apr 24. doi: 10.1111/jocs.15561. Online ahead of print.

ABSTRACT

OBJECTIVE: The present study aimed to compare the rate of wound site infection in patients <1 year of age who underwent sternotomy using electrocautery, a routinely performed procedure in our clinic, with those reported in the literature.

METHODS: This double-center study included patients <1 year of age who underwent cardiac surgery via sternotomy performed with electrocautery for congenital heart disease between January 2017 and June 2019. Patient’s data were retrospectively obtained from the hospital records.

RESULTS: In our study, seven patients developed SSI, which was superficial in six (1.3%) patients and in the form of mediastinitis in one (0.2%) patient.

CONCLUSION: Sternotomy with electrocautery, which we consider an easy and safe method, was also not found to be statistically different from the other methods in terms of SWI.

PMID:33896040 | DOI:10.1111/jocs.15561

Brain Imaging Behav. 2021 Apr 24. doi: 10.1007/s11682-021-00474-z. Online ahead of print.

ABSTRACT

This prospective study aimed to explore the white matter microstructural alterations in Alzheimer’s disease (AD) and amnestic mild cognitive impairment (aMCI) using the Tract-based Spatial Statistics (TBSS) method of diffusion kurtosis imaging (DKI).Diffusion images were collected from 45 AD patients, 42 aMCI patients, and 35 healthy controls (HC). The differences of DKI-derived parameters, including kurtosis fractional anisotropy (KFA), mean kurtosis (MK), fractional anisotropy (FA), and mean diffusivity (MD), were compared across the three groups using the TBSS method. Correlation between the altered DKI-derived parameters and the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores were analyzed. A receiver operating characteristic curve (ROC) was used to evaluate the diagnostic performance of different white matter parameters with the strongest correlations. As a result, compared with the HC group, KFA values decreased significantly in the aMCI group. Compared with both the HC and aMCI groups, the FA, KFA, and MK values decreased significantly and the MD value increased significantly in the AD group. FA, MD, KFA, and MK values of many white matter fiber tracts were significantly correlated with MMSE and MoCA scores. The area under the ROC curve (AUC) for the splenium of corpus callosum KFA values were highest for the diagnosis of aMCI and AD patients. In conclusion, the compactness and complexity of white matter microstructures were reduced in AD and aMCI patients. DKI can provide information about the severity of AD progression, and KFA might be more sensitive for the detection of white matter microstructural alterations.

PMID:33895943 | DOI:10.1007/s11682-021-00474-z

Lifetime Data Anal. 2021 Apr 24. doi: 10.1007/s10985-021-09521-9. Online ahead of print.

ABSTRACT

Current status data occur in many fields including demographical, epidemiological, financial, medical, and sociological studies. We consider the regression analysis of current status data with latent variables. The proposed model consists of a factor analytic model for characterizing latent variables through their multiple surrogates and an additive hazard model for examining potential covariate effects on the hazards of interest in the presence of current status data. We develop a borrow-strength estimation procedure that incorporates the expectation-maximization algorithm and correlated estimating equations. The consistency and asymptotic normality of the proposed estimators are established. A simulation study is conducted to evaluate the finite sample performance of the proposed method. A real-life study on the chronic kidney disease of type 2 diabetic patients is presented.

PMID:33895961 | DOI:10.1007/s10985-021-09521-9