Tag: pubmed

Clin Rehabil. 2023 Jul 11:2692155231187203. doi: 10.1177/02692155231187203. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate whether tailoring the speed of the Modified Tardieu Scale to reflect an individual’s joint angular velocity during walking influences spasticity assessment outcomes.

DESIGN: Observational trial.

SETTING: Inpatient and outpatient neurological hospital department.

SUBJECTS: Ninety adults with lower-limb spasticity.

INTERVENTIONS: N/A.

MAIN MEASURES: The Modified Tardieu Scale was used to assess the gastrocnemius, soleus, hamstrings and quadriceps. The V1 (slow) and V3 (fast) movements were completed as per standardised testing. Two additional assessments were completed, reflecting joint angular velocities during walking based on (i) a healthy control database (controlled velocity) and (ii) the individual’s real-time joint angular velocities during walking (matched velocity). The agreement was compared using Cohen’s and Weighted Kappa statistics, sensitivity and specificity.

RESULTS: There was poor agreement when rating trials as spastic or not spastic at the ankle joint (Cohen’s Kappa = 0.01-0.17). Trials were classified as spastic during V3 and not spastic during the controlled conditions in 81.6-85.1% of trials when compared to stance phase dorsiflexion angular velocities and 48.0-56.4% when compared to swing phase dorsiflexion angular velocities. The severity of muscle reaction demonstrated poor agreement at the ankle (Weighted Kappa = 0.01-0.28). At the knee, there was a moderate-excellent agreement between the V3 and controlled conditions when rating a trial as spastic or not spastic (Cohen’s Kappa = 0.66-0.84) and excellent agreement when comparing severity (Weighted Kappa = 0.73-0.94).

CONCLUSION: The speed of assessment impacted spasticity outcomes. It is possible that the standardised protocol may overestimate the impact spasticity has on walking, especially at the ankle.

PMID:37431534 | DOI:10.1177/02692155231187203

BJOG. 2023 Jul 11. doi: 10.1111/1471-0528.17598. Online ahead of print.

ABSTRACT

OBJECTIVE: Investigate cost-effectiveness of first trimester pre-eclampsia screening using the Fetal Medicine Foundation (FMF) algorithm and targeted aspirin prophylaxis in comparison with standard care.

DESIGN: Retrospective observational study.

SETTING: London tertiary hospital.

POPULATION: 5957 pregnancies screened for pre-eclampsia using the National Institute for Health and Care Excellence (NICE) method.

METHODS: Differences in pregnancy outcomes between those who developed pre-eclampsia, term pre-eclampsia and preterm pre-eclampsia were compared by the Kruskal-Wallis and Chi-square tests. The FMF algorithm was applied retrospectively to the cohort. A decision analytic model was used to estimate costs and outcomes for pregnancies screened using NICE and those screened using the FMF algorithm. The decision point probabilities were calculated using the included cohort.

MAIN OUTCOME MEASURES: Incremental healthcare costs and QALY gained per pregnancy screened.

RESULTS: Of 5957 pregnancies, 12.8% and 15.9% were screen-positive for development of pre-eclampsia using the NICE and FMF methods, respectively. Of those who were screen-positive by NICE recommendations, aspirin was not prescribed in 25%. Across the three groups, namely, pregnancies without pre-eclampsia, term pre-eclampsia and preterm pre-eclampsia there was a statistically significant trend in rates of emergency caesarean (respectively 21%, 43% and 71.4%; P < 0.001), admission to neonatal intensive care unit (NICU) (5.9%, 9.4%, 41%; P < 0.001) and length of stay in NICU. The FMF algorithm was associated with seven fewer cases of preterm pre-eclampsia, cost saving of £9.06 and QALY gain of 0.00006/pregnancy screened.

CONCLUSIONS: Using a conservative approach, application of the FMF algorithm achieved clinical benefit and an economic cost saving.

PMID:37431533 | DOI:10.1111/1471-0528.17598

Iran Endod J. 2023;18(3):152-158. doi: 10.22037/iej.v18i3.39798.

ABSTRACT

INTRODUCTION: The present study aimed to evaluate the effects of adding chicken eggshell powder (CESP) to calcium-enriched mixture (CEM) cement on its compressive strength (CS), solubility, and setting time.

MATERIALS AND METHODS: In this study, CESP was added at weight percentages of 3% and 5% to the powder component of the CEM cement. To measure the CS, a total of 36 samples (height, 6 mm; diameter, 4 mm) were tested in a universal testing machine. The setting time was assessed for 18 disk-shaped samples (diameter, 10 mm; height, 1 mm). Additionally, solubility test was performed on 18 samples (diameter, 8 mm; height, 1 mm) after 24 hours, 72 hours, seven days, and 14 days under dehydration conditions by calculating the weight changes; the results were then subjected to a normality test. Next, for the comparison of different test groups, parametric ANOVA test and post-hoc Tukey’s multiple comparison test were performed at a significance level of 0.05.

RESULTS: The addition of 5% CESP to the CEM cement significantly reduced its setting time and water solubility (P=0.02 and P=0.01, respectively). Moreover, it significantly increased the CS over a 21-day period (P<0.001). Additionally, the addition of 3% CESP also resulted in a significant increase in CS (P<0.001). While 3% CESP reduced setting time and water solubility, the difference was not statistically significant.

CONCLUSION: The findings suggest that the addition of 5% CESP to CEM cement has the potential to improve its sealing ability, durability, and ability to withstand chewing forces in endodontic treatments. These results highlight the relevance of CESP as an additive for cement modifications and indicate its potential clinical implications.

PMID:37431529 | PMC:PMC10329759 | DOI:10.22037/iej.v18i3.39798

Iran Endod J. 2023;18(3):159-164. doi: 10.22037/iej.v18i3.31364.

ABSTRACT

INTRODUCTION: The purpose of this in vitro study was to investigate the effect of incorporating silver nanoparticles (AgNPs) of herbal origin into mineral trioxide aggregate (MTA) on the push-out bond strength (PBS) and compressive strength (CS) in simulated furcal area perforations.

MATERIALS AND METHODS: In this in vitro study, simulated furcal area perforations (1.3 mm in diameter and 2 mm in depth) were created in 40 extracted human lower molar teeth, which were divided into two groups (n=20): MTA alone and MTA combined with AgNPs (2% wt). Using a universal testing machine, PBS was evaluated by performing push-out tests, while CS was assessed using cylindrical specimens. The normal distribution of data was checked using the Kolmogorov-Smirnov test, and statistical analysis was performed using two-way ANOVA.

RESULTS: The CS results showed no significant difference between the MTA group at 4 and 21 days (P=0.297), but a significant difference was observed in the nanosilver/MTA group (P=0.013). However, there was no significant difference in the push-out bond strength among the study groups (P>0.05).

CONCLUSION: The incorporation of herbal origin silver nanoparticles did not significantly affect the PBS or CS of MTA.

PMID:37431522 | PMC:PMC10329756 | DOI:10.22037/iej.v18i3.31364

Patient Prefer Adherence. 2023 Jul 5;17:1573-1589. doi: 10.2147/PPA.S415593. eCollection 2023.

ABSTRACT

PURPOSE: To explore the factors associated with self-management of Peritoneal Dialysis (PD) patients and methods of acquiring PD knowledge.

DESIGN: Cross-sectional survey design.

SETTING: Urumqi, Xinjiang, China.

PATIENTS: 131 Chinese maintenance Peritoneal Dialysis (PD) patients.

METHODS: This cross-sectional study was conducted from October 2019 to March 2020 in the First Affiliated Hospital of Xinjiang Medical University of China. 131 PD patients were recruited. Data were collected, including demographic characteristics, clinical dialysis data, self-management ability scale, and methods to obtain PD knowledge. A self-management questionnaire was used for the evaluation of self-management ability.

RESULTS: The score of the self-management ability of PD patients in Xinjiang, China, was (57.6±13.7) points, which was at the middle level in China. There was no statistically significant difference in the self-management ability scores of patients with different ages, sex, ethnicity, marital status, pre-dialysis status, PD time, PD procedures, self-care ability, PD satisfaction, and 24-hour average urine output (P>0.05). There were significant differences in the self-management ability scores of patients with different education levels, occupations, and medical insurance forms (P<0.05). The self-management ability of PD patients was positively correlated with the disease course of uremia and attending lectures on PD knowledge (P<0.05). The main factor affecting self-management ability was education level. There 73.28% of patients considered that it was necessary to establish a WeChat group for PD patients, and 65.7% believed that establishing a WeChat group for PD patients could facilitate communication between patients and enhance treatment confidence.

CONCLUSION: The study surveyed PD patients who have certain self-management ability. For patients with different education levels, different health education methods should be adopted to promote the improvement of patients’ self-management ability. Furthermore, WeChat is essential for Chinese PD patients to obtain disease-related information.

PMID:37431511 | PMC:PMC10329827 | DOI:10.2147/PPA.S415593

HIV AIDS (Auckl). 2023 Jul 5;15:411-421. doi: 10.2147/HIV.S406372. eCollection 2023.

ABSTRACT

BACKGROUND: Even though there are many patients on second-line antiretroviral therapy (ART) in Ethiopia, there is a paucity of evidence on the rate of viral resuppression and its predictors. Therefore, this study aimed to determine a time to viral resuppression and identify predictors among adults on second-line ART in South Wollo public hospitals, northeast Ethiopia.

METHODS: A retrospective-cohort study design was employed using patients enrolled in second-line ART from August 28, 2016 to April 10, 2021. Data were collected using a structured data-extraction checklist with a sample size of 364 second-line ART patients from February 16 to March 30, 2021. EpiData 4.6 was used for data entry and Stata 14.2 was used for analysis. The Kaplan-Meier method was used for estimating time to viral resuppression. The Shönfield test was used to check the proportional-hazard assumption, and the “no interaction” stratified Cox assumption was checked using the likelihood-ratio test. A stratified Cox model was applied to identify predictors of viral resuppression.

RESULTS: Median time to viral re-suppression in patients on a second-line regimen was 10 (IQR 7-12) months. BeingFemale (AHR 1.31, 95% CI 1.01-1.69), low viral load count at switch (AHR 1.98, 95% CI 1.26-3.11), normal-range BMI at switch (AHR 1.42, 95% CI 1.03-1.95), and lopinavir-based second-line regimen (AHR 1.72, 95% CI 1.15-2.57) were significant predictors of early time to viral resuppression after stratification by WHO stage and adherence level.

CONCLUSION: Median time to viral re-suppression after switching to second-line ART was 10 months. In the stratified Cox model, female sex, baseline viral copies, second-line regimen type, and BMI at switch were statistically significant predictors of time to viral resuppression. Different stakeholders working on the HIV program should maintain viral resuppression by addressing significant predictors, and ART clinicians should consider ritonavir-boosted lopinavir based second-line ART for newly switched patients.

PMID:37431501 | PMC:PMC10329832 | DOI:10.2147/HIV.S406372

JCPP Adv. 2021 Dec 11;2(1):e12057. doi: 10.1002/jcv2.12057. eCollection 2022 Mar.

ABSTRACT

BACKGROUND: Early to middle adolescence is a critical period of development for mental health issues. Illuminating sex/gender differences in mental health trajectories in this period is important for targeting screening and preventive interventions; however, evidence to date on the extent and nature of sex/gender differences in common mental health issue trajectories in this period has produced mixed findings. There is a particular gap in our knowledge of sex/gender differences in the joint trajectories of commonly co-occurring mental health issues in adolescence, given the strong tendency for mental health issues to co-occur.

METHOD: We applied sex/gender-stratified latent class growth analysis to an age-heterogeneous cohort (age 10-15) derived from the population-representative UK Household Longitudinal Study. We explored sex/gender differences in attention deficit hyperactivity disorder (ADHD) symptoms, internalizing problems, and conduct problems individually and jointly.

RESULTS: We found indications of sex/gender differences in a number of areas. There were fewer classes in the optimal model to describe the heterogeneity in internalizing problems and conduct problems trajectories in males and females respectively. Further, for ADHD, affected males were more likely to enter adolescence with already elevated symptoms whereas affected female trajectories were characterized by an escalation of symptoms during adolescence.

CONCLUSIONS: There are sex/gender differences in the levels and trajectories of specific mental health symptoms in early to middle adolescence; however, in both males and females there is a strong tendency for multiple issues to co-occur.

PMID:37431498 | PMC:PMC10242831 | DOI:10.1002/jcv2.12057

Neurol Neuroimmunol Neuroinflamm. 2023 Jul 10;10(5):e200141. doi: 10.1212/NXI.0000000000200141. Print 2023 Sep.

ABSTRACT

BACKGROUND AND OBJECTIVES: Mechanisms of visual impairment in aquaporin 4 antibody (AQP4-IgG) seropositive neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody (MOG-IgG)-associated disorder (MOGAD) are incompletely understood. The respective impact of optic nerve demyelination and primary and secondary retinal neurodegeneration are yet to be investigated in animal models.

METHODS: Active MOG_35-55 experimental autoimmune encephalomyelitis (EAE) was induced in C57BL/6Jrj mice, and monoclonal MOG-IgG (8-18C5, murine), recombinant AQP4-IgG (rAb-53, human), or isotype-matched control IgG (Iso-IgG, human) was administered 10 days postimmunization. Mobility impairment was scored daily. Visual acuity by optomotor reflex and ganglion cell complex thickness (GCC, 3 innermost retinal layers) by optical coherence tomography (OCT) were longitudinally assessed. Histopathology of optic nerve and retina was investigated during presymptomatic, acute, and chronic disease phases for immune cells, demyelination, complement deposition, natural killer (NK) cell, AQP4, and astrocyte involvement, retinal ganglion cells (RGCs), and Müller cell activation. Groups were compared by nonparametric tests with a p value <0.05 indicating statistical significance.

RESULTS: Visual acuity decreased from baseline to chronic phase in MOG-IgG (mean ± standard error of the mean: 0.54 ± 0.01 to 0.46 ± 0.02 cycles/degree, p < 0.05) and AQP4-IgG EAE (0.54 ± 0.01 to 0.43 ± 0.02, cycles/degree, p < 0.05). Immune cell infiltration of optic nerves started in presymptomatic AQP4-IgG, but not in MOG-IgG EAE (5.85 ± 2.26 vs 0.13 ± 0.10 macrophages/region of interest [ROI] and 1.88 ± 0.63 vs 0.15 ± 0.06 T cells/ROI, both p < 0.05). Few NK cells, no complement deposition, and stable glial fibrillary acid protein and AQP4 fluorescence intensity characterized all EAE optic nerves. Lower GCC thickness (Spearman correlation coefficient r = -0.44, p < 0.05) and RGC counts (r = -0.47, p < 0.05) correlated with higher mobility impairment. RGCs decreased from presymptomatic to chronic disease phase in MOG-IgG (1,705 ± 51 vs 1,412 ± 45, p < 0.05) and AQP4-IgG EAE (1,758 ± 14 vs 1,526 ± 48, p < 0.01). Müller cell activation was not observed in either model.

DISCUSSION: In a multimodal longitudinal characterization of visual outcome in animal models of MOGAD and NMOSD, differential retinal injury and optic nerve involvement were not conclusively clarified. Yet optic nerve inflammation was earlier in AQP4-IgG-associated pathophysiology. Retinal atrophy determined by GCC thickness (OCT) and RGC counts correlating with mobility impairment in the chronic phase of MOG-IgG and AQP4-IgG EAE may serve as a generalizable marker of neurodegeneration.

PMID:37429715 | DOI:10.1212/NXI.0000000000200141

Br J Clin Pharmacol. 2023 Jul 10. doi: 10.1111/bcp.15843. Online ahead of print.

ABSTRACT

Big data in drug development may not satisfactorily address the demands of precision medicine in a rare disease population, making the use of smaller clinical trials necessary. Consequently, the use of innovative design and analysis of these clinical trials using model-informed approaches have become indispensable. This requires informative exposure-outcome analysis, together with formal statistical analysis, which should include the strength of evidence for a study outcome. We demonstrate how knowledge can be gained, with supporting strength of evidence, from a small (data) clinical trial with a low dose of blarcamesine in the treatment of Rett syndrome (RTT). Based on a small data paradigm, pharmacometrics item response theory modeling and Bayes factor analysis were used to show that blarcamesine is efficacious in RTT.

PMID:37429704 | DOI:10.1111/bcp.15843

BMJ Open. 2023 Jul 10;13(7):e072170. doi: 10.1136/bmjopen-2023-072170.

ABSTRACT

OBJECTIVES: The aim of this study was to explore the current situation of kinesiophobia in patients with coronary heart disease, classify it based on potential profile analysis and explore the relevant factors of kinesiophobia in different categories of patients with coronary heart disease.

DESIGN: Cross-sectional study.

SETTING: Patients with coronary heart disease in China.

PARTICIPANTS: Adult (aged >18 years) patients with coronary heart disease in China; 252 participants in this study answered the questionnaire.

PRIMARY AND SECONDARY OUTCOME MEASURES: The study investigated the scores of Tampa Scale for Kinesiophobia Heart, and collected information on the patient’s age, gender, monthly household income, education level, place of residence, marital status, occupational status, hypertension, diabetes, heart failure and body mass index (BMI).

RESULTS: Kinesiophobia in patients with coronary heart disease can be divided into low fear type (C1), intermediate fear type (C2) and high fear type (C3). Elderly patients were classified as type C3. Women and patients with a normal BMI were classified as type C1; patients with a normal BMI and patients with an overweight BMI were classified as type C2.

CONCLUSION: Kinesiophobia of patients with coronary heart disease can be divided into three categories, and intervention measures are implemented according to their different demographic characteristics to reduce kinesiophobia of patients and promote the participation of patients in exercise rehabilitation.

PMID:37429691 | DOI:10.1136/bmjopen-2023-072170