Tag: pubmed

J Neurointerv Surg. 2023 Jul 4:jnis-2023-020564. doi: 10.1136/jnis-2023-020564. Online ahead of print.

ABSTRACT

BACKGROUND: Tarlov cysts are perineural collections of cerebrospinal fluid most often affecting sacral nerve roots, which may cause back pain, extremity paresthesias and weakness, bladder/bowel dysfunction, and/or sexual dysfunction. The most effective treatment of symptomatic Tarlov cysts, with options including non-surgical management, cyst aspiration and injection of fibrin glue, cyst fenestration, and nerve root imbrication, is debated.

METHODS: Retrospective chart review was conducted for 220 patients with Tarlov cysts seen at our institution between 2006 and 2021. Logistic regression analysis was conducted to determine the association between treatment modality, patient characteristics, and clinical outcome.

RESULTS: Seventy-two (43.1%) patients with symptomatic Tarlov cysts were managed non-surgically. Of the 95 patients managed interventionally, 71 (74.7%) underwent CT-guided aspiration of the cyst with injection of fibrin glue; 17 (17.9%) underwent cyst aspiration alone; 5 (5.3%) underwent blood patching; and 2 (2.1%) underwent more than one of the aforementioned procedures. Sixty-six percent of treated patients saw improvement in one or more symptoms, with the most improvement in patients after aspiration of cyst with injection of fibrin glue; however, this association was not statistically significant on logistic regression analysis.

CONCLUSION: Although the subtype of percutaneous treatment was not significantly associated with optimal or suboptimal patient outcomes, cyst aspiration both with and without injection of fibrin glue may serve as a useful diagnostic tool to (1) determine symptom etiology and (2) identify patients who might have achieved temporary improvement between the time of cyst aspiration and refill with cerebrospinal fluid as potential candidates for neurosurgical intervention of cyst fenestration and nerve root imbrication.

PMID:37402574 | DOI:10.1136/jnis-2023-020564

Anat Cell Biol. 2023 Jul 5. doi: 10.5115/acb.22.242. Online ahead of print.

ABSTRACT

Increased tortuosity of vessel is associated with high incidence of plaque formation leading to atherosclerosis. Surgical procedures are done after analyzing morphology of middle cerebral artery (MCA). However, literature describing MCA morphology using computed tomography angiography (CTA) is limited, so this study was planned to determine its incidence in Indian population. Datasets of CTA from 289 patients (180 males and 109 females), average age: 49.29±16.16 years (range: 11 to 85 years), from a tertiary care hospital were systematically reviewed for morphology of MCA. Cases involving aneurysms and infarcts were excluded. Four shapes of MCA were recognized: straight, U, inverted U, and S-shaped. MCA was straight in 44% (254/578), U-shaped in 37% (215/578), S shaped in 15% (89/578) and inverted U-shaped in 3% (20/578) cases. In males, MCA was straight in 46% (166/360), U-shaped in 37% (134/360), S-shaped in 16% (58/360) and inverted U-shaped in 4% (14/360) cases. In females, MCA was straight in 42% cases (92/218), U-shaped in 37% (81/218), S-shaped in 17% (36/218) and inverted U-shaped in 4% (9/218). On comparing shape with various age groups using chi square test, U shaped (P≤0.001) and S-shaped (P=0.003) MCA were found to be statistically significant. The incidence of straight shape was higher in advanced age group (>60 years). Knowledge of MCA shape will be useful for clinicians and surgeons in successful endovascular recanalization. Also, this data would help surgeons during neurointerventional procedures.

PMID:37402565 | DOI:10.5115/acb.22.242

Can J Surg. 2023 Jul 4;66(4):E348-E355. doi: 10.1503/cjs.013721. Print 2023 Jul-Aug.

ABSTRACT

BACKGROUND: Compared to younger age, older age (≥ 65 yr) is associated with worse outcomes after severe traumatic brain injury (TBI). We sought to describe the association of older age with in-hospital death and aggressiveness of intervention.

METHODS: We conducted a retrospective cohort study of adult (age ≥ 16 yr) patients with severe TBI admitted to a single academic tertiary care neurotrauma centre between January 2014 and December 2015. We collected data through chart review as well as from our institutional administrative database. We provided descriptive statistics and used multivariable logistic regression to evaluate the independent association of age with the primary outcome, in-hospital death. The secondary outcome was early withdrawal of life-sustaining therapy.

RESULTS: There were 126 adult patients (median age 67 yr [Q1-Q3, 33-80 yr]) with severe TBI during the study period who met our eligibility criteria. The most common mechanism was high-velocity blunt injury (55 patients [43.6%]). The median Marshall score was 4 (Q1-Q3, 2-6), and the median Injury Severity Score was 26 (Q1-Q3, 25-35). After controlling for confounders including clinical frailty, pre-existing comorbidity, injury severity, Marshall score and neurologic examination at admission, we observed that older patients were more likely than younger patients to die in hospital (odds ratio 5.10, 95% confidence interval 1.65-15.78). Older patients were also more likely to experience early withdrawal of life-sustaining therapy and less likely to receive invasive interventions.

CONCLUSION: After controlling for confounding factors relevant to older patients, we observed that age was an important and independent predictor of in-hospital death and early withdrawal of life-sustaining therapy. The mechanism by which age influences clinical decision-making independent of global and neurologic injury severity, clinical frailty and comorbidities remains unclear.

PMID:37402559 | DOI:10.1503/cjs.013721

Stat Med. 2023 Jul 4. doi: 10.1002/sim.9838. Online ahead of print.

ABSTRACT

Two large-scale randomized clinical trials compared fenofibrate and placebo in diabetic patients with pre-existing retinopathy (FIELD study) or risk factors (ACCORD trial) on an intention-to-treat basis and reported a significant reduction in the progression of diabetic retinopathy in the fenofibrate arms. However, their analyses involved complications due to intercurrent events, that is, treatment-switching and interval-censoring. This article addresses these problems involved in estimation of causal effects of long-term use of fibrates in a cohort study that followed patients with type 2 diabetes for 8 years. We propose structural nested mean models (SNMMs) of time-varying treatment effects and pseudo-observation estimators for interval-censored data. The first estimator for SNMMs uses a nonparametric maximum likelihood estimator (MLE) as a pseudo-observation, while the second estimator is based on MLE under a parametric piecewise exponential distribution. Through numerical studies with real and simulated datasets, the pseudo-observations estimators of causal effects using the nonparametric Wellner-Zhan estimator perform well even under dependent interval-censoring. Its application to the diabetes study revealed that the use of fibrates in the first 4 years reduced the risk of diabetic retinopathy but did not support its efficacy beyond 4 years.

PMID:37402505 | DOI:10.1002/sim.9838

Jpn J Nurs Sci. 2023 Jul 4:e12551. doi: 10.1111/jjns.12551. Online ahead of print.

ABSTRACT

AIM: This study identified the correlates of delirium care competency among shift leader nurses in acute medical wards in Japan.

METHODS: A cross-sectional study was conducted from November 2019 to February 2020. We sent request letters to a random sample of 381 general acute care hospitals in Japan. Of these, 68 agreed to participate and distributed 735 self-administered questionnaires to shift leader nurses working in their acute medical wards. The questionnaire included the Self-rated Delirium Care Competency Scale for Shift Leader Nurses in Acute Medical Wards (DCSL-M), developed by the authors. It gathered data on the respondents’ demographics and delirium care competency, and investigated a total of 25 variables. We calculated descriptive statistics and examined associations between delirium care competency and the demographics using multiple logistic regression analysis.

RESULTS: Of the total, 301 (40.9%) questionnaires were returned. Delirium care competency was high among shift leader nurses who: (1) had experience as a clinical practice preceptor for nursing students; (2) had experience attending training related to dementia or delirium care; (3) worked at a hospital/ward that charged additional medical fees for dementia care; and (4) had access to consulting psychiatrists to refer patients with delirium.

CONCLUSIONS: The results suggest the need for efforts to improve delirium care competency among shift leader nurses who work in hospitals that do not charge additional medical fees for dementia care or that do not have consulting psychiatrists to refer patients with delirium.

PMID:37402502 | DOI:10.1111/jjns.12551

Acta Ortop Mex. 2022 Sep-Oct;36(5):286-291.

ABSTRACT

INTRODUCTION: rotator cuff tears are one of the most common shoulder injuries. The treatment of choice is arthroscopic repair with the use of anchors. The modified Mason-Allen technique, which combines the benefits of suture bridge and mattress sutures, has shown satisfactory results. This study aims to report and analyze the clinical results using these suture techniques in rotator cuff tears.

RESULTS: preoperative mean active flexion 126o, 169o at three months, 175o at 12 months (p < 0.0001), active abduction 98o, 159o at three months and 167o at 12 months (p < 0.0001), internal rotation preoperative value 4.4 ± 3, at three months 7.1 ± 1.7 (p < 0.05) and 12 months 7.6 ± 1.1 (p < 0.001). Constant score 45.76 ± 16.35 (p < 0.0001) at three months 87.27 ± 10.94 and 12 months 91.30 ± 6.00. SSV 41.30 ± 20.89, three months 81.43 ± 18.31 and 12 months 94.37 ± 6.90 (p = 0.0001). Initial mean VAS 6.6 ± 1.6 and 12 months 0.63 ± 1.02 (p < 0.0001).

CONCLUSION: in rotator cuff tears, using a single row with the modified Mason-Allen technique is a recommended and replicable option with satisfactory results and statistically significant clinical improvement at three and 12 months post-surgery.

PMID:37402494

Acta Ortop Mex. 2022 Sep-Oct;36(5):274-280.

ABSTRACT

Multiligament injuries of the knee joint are characterized by the involvement of two or more major ligaments, anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), lateral collateral ligament (LCL), posteromedial corner (PMC) and posterolateral corner (PLC). Statistically, multiligament injuries are rare as they are found in less than 0.02% of all traumatic knee injuries; however, different aggregate injuries are what make this pathology a serious health and functional condition. Taking into account that most of the patients are young people of highly productive age, it is of vital importance to observe their short and long term evolution, as well as their reincorporation to their daily life. It has been reported that vascular lesions are present in approximately 32% of cases, meniscal lesions in 35% and up to 60% with some type of bone lesion. These injuries mainly affect the male sex most commonly between the third and fourth decade of life, which makes this type of injury of great importance, since this group of patients are in their greatest period of labor production. The main objective of the treatment of these injuries, in addition to resolving the aggregate damage that usually aggravates the state of health, is to achieve a speedy recovery and subsequent reincorporation to their work activities and in some cases sports.

PMID:37402492

J Child Health Care. 2023 Jul 4:13674935231187716. doi: 10.1177/13674935231187716. Online ahead of print.

ABSTRACT

To determine the effectiveness and safety of prophylactic phototherapy compared with conventional phototherapy for the prevention of neonatal jaundice. We included clinical trials comparing prophylactic phototherapy to conventional phototherapy to prevent jaundice in premature newborns. We searched Embase, MEDLINE, LILACS, Central, and others. The statistical analysis was performed in RevMan (Review Manager 5.3). Outcomes were analyzed according to the type of variable: risk difference (RD) and mean difference (MD). A random effects model was used due to heterogeneity. We reported results in forest plots. Risk of bias was evaluated, and a sensitivity analysis was made. 1127 articles were found, and six studies (2332 patients) were included in the meta-analysis. Five studies evaluated the need for exchange transfusion as the primary outcome RD -0.01, 95% CI [-0.05 to 0.03]. One study evaluated bilirubin encephalopathy RD -0.04, 95% CI [-0.09 to 0.00]. Five studies evaluated the duration of phototherapy, MD 38.47, 95% CI [1.28 to 55.67]. Four studies evaluated levels of bilirubin (MD -1.23, 95% CI [-2.25 to -0.21]. Two studies evaluated mortality, RD 0.01, 95% CI [-0.03 to 0.04]. As a conclusion, compared to conventional phototherapy, prophylactic phototherapy decreases the last measured level of bilirubin, as well as the probability of neurodevelopmental disturbances. However, it increases phototherapy duration.

PMID:37402472 | DOI:10.1177/13674935231187716

Clin Exp Otorhinolaryngol. 2023 Jun 26. doi: 10.21053/ceo.2023.00129. Online ahead of print.

ABSTRACT

OBJECTIVES: Ménière’s disease (MD) is an idiopathic disorder that affects patients’ hearing and the inner ear balance. Intratympanic gentamicin (ITG) is also considered an effective treatment for uncontrolled MD characterized by persistent vertigo attacks despite therapy. The video head impulse test (vHIT) and the skull vibration-induced nystagmus (SVIN) are both validated test to assess the vestibular function. A progressive linear relationship has also been described between the slow-phase velocity (SPV) of SVIN with a skull vibrator at 100 Hz and the gain difference (healthy ear/affected ear) measured in vHIT. The objective of this study was to determine whether the SPV of the SVIN was correlated with the restoration of vestibular function after ITG and, consequently, whether the SVIN can predict the appearance of new vertigo attacks in patients with MD treated with ITG.

METHODS: A prospective longitudinal case-control study was conducted. We recorded several variables after ITG and during the follow-up and statistical analyses were performed. Two groups were compared, those who presented vertigo attacks 6 months after ITG and those who did not.

RESULTS: Our sample included 88 patients with definite MD who were treated with ITG. Among the 18 patients who experienced vertigo attacks again, 15 showed recovery of the gain of the affected ear, while all 18 showed a reduction in the SPV of the SVIN.

CONCLUSION: SPV of SVIN may have more sensitivity than vHIT for detecting recovery of vestibular function after intratympanic gentamicin (ITG) administration. To the best of our knowledge, this is the first study to describe the association between decreased SPV and the probability of vertigo attacks in patients with MD treated with ITG.

PMID:37402470 | DOI:10.21053/ceo.2023.00129

Anim Biosci. 2023 Jun 23. doi: 10.5713/ab.23.0111. Online ahead of print.

ABSTRACT

OBJECTIVE: Pigment production and distribution are controlled through multiple proteins, resulting in different coat color phenotypes of sheep.

METHODS: The expression distribution of vimentin (VIM) and transthyretin (TTR) in white and black sheep skins was detected by liquid chromatography-electrospray ionization tandem MS (LC-ESI-MS/MS), Gene Ontology (GO) statistics, immunohistochemistry, Western blot, and Quantitative real time polymerase chain reaction (qRT-PCR) to evaluate their role in the coat color formation of sheep.

RESULTS: LC-ESI-MS/MS results showed VIM and TTR proteins in white and black skin tissues of sheep. Meanwhile, GO functional annotation analysis suggested that VIM and TTR proteins were mainly concentrated in cellular components and biological process, respectively. Further research confirmed that VIM and TTR proteins were expressed at significantly higher levels in black sheep skins than in white sheep skins by Western blot, respectively. Immunohistochemistry notably detected VIM and TTR in hair follicle, dermal papilla, and outer root sheath of white and black sheep skins. qRT-PCR results also revealed that the expression of VIM and TTR mRNAs was higher in black sheep skins than in white sheep skins.

CONCLUSION: The expression of VIM and TTR were higher in black sheep skins than in white sheep skins and the transcription and translation were unanimous in this study. VIM and TTR proteins were expressed in hair follicle of white and black sheep skins. These results suggested that VIM and TTR were involved in the coat color formation of sheep.

PMID:37402463 | DOI:10.5713/ab.23.0111