Tag: pubmed

Int Urogynecol J. 2022 Sep 29. doi: 10.1007/s00192-022-05366-4. Online ahead of print.

ABSTRACT

INTRODUCTION AND HYPOTHESIS: This study aimed to compare the difference in levator ani muscle (LAM) volumes between ‘normal’ and those with sonographically visualized LAM defects. We hypothesized that the ‘muscle damage’ group would have a significantly lower muscle volume.

METHODS: The study included patients who had undergone a 3D endovaginal ultrasound. The normal (NM) and damage (DM) muscle groups’ architectural changes were evaluated based on anterior-posterior (AP), left-right (LR) diameter, and minimal levator hiatus (MLH) area. The puboanalis-puboperinealis (PA), puborectalis (PR), and pubococcygeus-iliococcygeus (PC) were manually segmented using 2.5 vs. 1.0 mm to find the optimal sequence and to compare the volumes between NM and DM groups. POPQs were compared between the NM and DM groups.

RESULTS: The 1.0-mm segmentation volumes created superior volume analysis. Comparing NM to the DM group showed no significant difference in LAM volume. Respectively, the mean total LAM volumes were 17.27 cm³ (SD = 3.97) and 17.04 cm³ (SD = 4.32), p = 0.79. The mean MLH measurements for both groups respectively were 10.06 cm² (SD = 2.93) and 12.18 cm² (SD = 2.93), indicating a significant difference (p = 0.01). POPQ analysis demonstrated statistically significant differences at Ba and Bp parameters suggesting that the DM group had worse prolapse (p = 0.05, 0.01, respectively).

CONCLUSIONS: While LAM volumes are similar, there is a significant difference in the physical architecture of the LAM and the POPQ parameters in muscle-damaged patients compared to the normal group.

PMID:36173426 | DOI:10.1007/s00192-022-05366-4

Exp Brain Res. 2022 Sep 29. doi: 10.1007/s00221-022-06462-z. Online ahead of print.

ABSTRACT

Previous history of activity and learning modulates synaptic plasticity and can lead to saturation of synaptic connections. According to the synaptic homeostasis hypothesis, neural oscillations during slow-wave sleep play an important role in restoring plasticity within a functional range. However, it is not known whether slow-wave oscillations-without the concomitant requirement of sleep-play a causal role in human synaptic homeostasis. Here, we aimed to answer this question using transcranial alternating current stimulation (tACS) to induce slow-oscillatory activity in awake human participants. tACS was interleaved between two plasticity-inducing interventions: motor learning, and paired associative stimulation (PAS). The hypothesis tested was that slow-oscillatory tACS would prevent homeostatic interference between motor learning and PAS, and facilitate plasticity from these successive interventions. Thirty-six participants received sham and active fronto-motor tACS in two separate sessions, along with electroencephalography (EEG) recordings, while a further 38 participants received tACS through a control montage. Motor evoked potentials (MEPs) were recorded throughout the session to quantify plasticity changes after the different interventions, and the data were analysed with Bayesian statistics. As expected, there was converging evidence that motor training led to excitatory plasticity. Importantly, we found moderate evidence against an effect of active tACS in restoring PAS plasticity, and no evidence of lasting entrainment of slow oscillations in the EEG. This suggests that, under the conditions tested here, slow-oscillatory tACS does not modulate synaptic homeostasis in the motor system of awake humans.

PMID:36173425 | DOI:10.1007/s00221-022-06462-z

Disabil Rehabil. 2022 Sep 29:1-10. doi: 10.1080/09638288.2022.2127937. Online ahead of print.

ABSTRACT

PURPOSE: Recent RCTs and meta-analyses compare the effectiveness of different types of exercise for chronic whiplash associated disorder (WAD). This study aimed to verify whether the results of these studies translate to statistically significant and clinically meaningful effects in individual participants.

MATERIALS AND METHODS: A series of replicated randomised single case experimental design studies (SCEDs) with A-B design (A: baseline, B: intervention). Eight participants with chronic WAD (8 female, mean [SD] age 47 [10] years) were randomised into one of four baseline durations (5, 8, 11, and 14 days) and to one of two eight-week exercise interventions (aerobic or strengthening). Daily measures of pain intensity, bothersomeness, and interference were collected during the baseline phase and the intervention phase.

RESULTS: Visual analyses indicated that three participants in the aerobic exercise group meaningfully improved. No improvements were found in the strengthening group. Effect sizes favoured the aerobic exercise group, yet randomisation tests of pooled effects did not show a difference in between-intervention effectiveness.

CONCLUSION: Contrary to our expectations, three out of four participants were nearly pain-free at the end of the aerobic exercise intervention, whereas none of the participants in the strengthening group improved meaningfully. This suggests that aerobic exercise may be favourable for WAD.Implications for RehabilitationOur results suggest that aerobic exercises are favourable over strengthening exercises and may be the preferred option for patients with chronic WAD.We found substantial variability in self-reported outcomes within participants, clinicians should be aware of this in the judgement of treatment effectiveness.

PMID:36173391 | DOI:10.1080/09638288.2022.2127937

Am J Clin Nutr. 2022 Sep 29:nqac281. doi: 10.1093/ajcn/nqac281. Online ahead of print.

ABSTRACT

BACKGROUND: Elevated brain choline is associated with better executive function in preadolescents. Manipulating dietary choline prospectively in preadolescents using egg supplementation could improve executive function via effects on brain cellular and neurotransmitter function.

OBJECTIVE: Test the 9-mo impact of egg supplementation on executive function. It was hypothesized that preadolescents who consumed meal/snack replacement products containing powder made from whole eggs would have the largest improvement in executive function after 9-mo compared to those consuming similar products with either added milk powder or gelatin as a placebo.

METHODS: A randomized, parallel groups, double-blinded, placebo-controlled trial design was used. The executive function of 122 preadolescents (58 females) aged 9-13 was analyzed before and after the 9-mo intervention. Primary outcomes were three National Institutes of Health Toolbox-Cognitive Battery measures of executive function: mental flexibility, working memory and selective attention/inhibitory control. Participants were randomized to consume food products with either: (i) whole egg powder, (ii) milk powder, or (iii) gelatin as a placebo, all matched on macronutrient content and used as replacements for commonly consumed foods (i.e., waffles, pancakes, macaroni and cheese, ice cream, and brownies). Hypothesis testing used mixed-effects models that included physical activity and sleep scores as covariates.

RESULTS: A statistically significant group by time interaction for selective attention and inhibitory control was found (p=0.049) for the milk group. This interaction resulted from no change for the placebo group and an improvement in selective attention and inhibitory control performance for the milk group by a T-score of 5.8; the effect size d was 0.44 standard deviation units. Other comparisons were statistically insignificant.

CONCLUSIONS: Consumption of foods with added milk powder as replacements for snacks or meals for 9-mo improves selective attention/inhibitory control in preadolescents. Replacement foods with added whole egg powder does not impact the 9-mo change in preadolescent executive function.This trial was registered at clinicaltrials.gov as NCT03739424.

PMID:36173384 | DOI:10.1093/ajcn/nqac281

J Esthet Restor Dent. 2022 Sep 29. doi: 10.1111/jerd.12968. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the effects of six whitening toothpastes with different whitening ingredients as follows: abrasives, polyphosphates, activated charcoal and hydrogen peroxide on the color, and shear bond strength (SBS) of enamel.

MATERIALS AND METHODS: Thirty-five extracted human molars were sectioned in mesiodistal direction, providing 70 enamel specimens and randomly divided into seven groups having different whitening ingredients (n = 10). After baseline color measurements, the specimens were brushed three times daily for the 30 s. At the end of 2 weeks, spectrophotometric readings were repeated, and color change parameters were calculated. Then, composite cylinders were built on the enamel surfaces and the specimens were subjected to SBS test. Failure modes were determined under a stereomicroscope (×10). One specimen from each group was examined with scanning electron microscope (SEM). The data were statistically analyzed using Kruskal-Wallis, Wilcoxon signed, one-way-ANOVA (p = 0.05).

RESULTS: Clinically acceptable color change was observed in all whitening toothpastes. There were no significant differences among the groups for Δa, ΔL, ΔE₀₀ , and ΔWI_D (p > 0.05). The differences among the groups were not significant regarding SBS and failure mode distributions (p > 0.05). SEM findings were in line with the SBS test and failure mode distribution results.

CONCLUSIONS: All the tested whitening toothpastes showed similar and clinically acceptable efficacy on the color change of the enamel and led to comparable SBS values.

CLINICAL SIGNIFICANCE: The tested whitening toothpastes had an acceptable whitening efficacy and did not have a negative effect on the bond strength to the enamel.

PMID:36173366 | DOI:10.1111/jerd.12968

J Magn Reson Imaging. 2022 Sep 29. doi: 10.1002/jmri.28445. Online ahead of print.

ABSTRACT

BACKGROUND: T₁ , T₂ , and T₂ * mappings are seldom performed in a single examination, and their values in evaluating symptomatic atherosclerosis are lacking.

PURPOSE: To perform three-dimensional (3D) quantitative T₁ , T₂ , and T₂ * mappings (SQUMA) multi-parametric imaging for carotid vessel wall and evaluate its reliability and value in assessing carotid atherosclerosis.

STUDY TYPE: Prospective.

SUBJECTS: Eight healthy subjects and 20 patients with symptomatic carotid atherosclerosis.

FIELD STRENGTH/SEQUENCE: 3 T, SQUMA imaging T₁ -, T₂ -, and T₂ *-mapping, multi-contrast vessel wall imaging including T₁ – and T₂ -weighted, time-of-flight, and SNAP sequences.

ASSESSMENT: SQUMA was acquired in all subjects and multi-contrast images were acquired in healthy subjects. T₁ , T₂ , and T₂ * values and lumen area (LA), wall area (WA), mean wall thickness (MeanWT), and normalized wall index (NWI) of carotid arteries were measured. SQUMA and multi-contrast measurements were compared in healthy subjects and differences in SQUMA measurements between healthy subjects and patients were assessed. The discriminative value of SQUMA measurements for symptomatic vessel was determined.

STATISTICAL TESTS: Paired t or Wilcoxon signed-rank test, independent t or Mann-Whitney U test, area under the receiver operating characteristic curve (AUC), intraclass correlation coefficients, and Bland-Altman plots. Statistically significant level, P < 0.05.

RESULTS: There were no significant differences in LA (P = 0.340), WA (P = 0.317), MeanWT (P = 0.088), and NWI (P = 0.091) of carotid arteries between SQUMA and multi-contrast vessel wall images. The values of T₂ (50.9 ± 2.9 msec vs. 44.5 ± 4.2 msec), T₂ * (28.2 ± 4.3 msec vs. 24.7 ± 2.6 msec), WA (23.7 ± 4.6 mm² vs. 36.2 ± 7.7 mm² ), MeanWT (0.99 ± 0.05 mm vs. 1.50 ± 0.28 mm), and NWI (40.7 ± 3.0% vs. 53.8 ± 5.4%) of carotid arteries in healthy subjects were significantly different from those in atherosclerotic patients. The combination of quantitative T₁ , T₂ , and T₂ * values and MeanWT showed greatest AUC (0.81; 95% CI: 0.65-0.92) in discriminating symptomatic vessels.

DATA CONCLUSION: Carotid MR 3D quantitative multi-parametric imaging of SQUMA enables acquisition of T₁ , T₂ , and T₂ * maps, reliably measuring carotid morphology and discriminating carotid symptomatic atherosclerosis.

LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY: Stage 2.

PMID:36173363 | DOI:10.1002/jmri.28445

Pediatr Emerg Care. 2022 Sep 30. doi: 10.1097/PEC.0000000000002854. Online ahead of print.

ABSTRACT

OBJECTIVE: Head trauma causes a significant number of deaths as well as temporary and permanent disabilities every year. In this study, the prevalence of attention-deficit/hyperactivity disorder (ADHD) in primary school children who visited the emergency department (ED) for mild head trauma and the role of ADHD in mild head trauma of this age group were investigated.

METHODS: It was performed with 134 children of primary school age (6-12 years) who were admitted to the ED with mild head trauma and 134 children (control group) who presented with complaints other than head trauma. Turgay DSM-IV-Based Child and Adolescent Behavioral Disorders Screening and Rating Scale (T-DSM-IV-S) was used to evaluate the children for suspected ADHD. According to this scale, some children were referred to the child and adolescent psychiatry department (CAPD) for further evaluation. At the CAPD outpatient clinics, the children who were referred from the ED were examined in detail according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, for possible diagnosis of ADHD. After evaluation of their sociodemographic characteristics and the ADHD test scores that were recorded, the diagnosis of ADHD in these children was established or ruled out.

RESULTS: It was observed that 41 of the 134 children (30.60%) who presented to the ED with mild head trauma and 12 of the 134 children (8.96%) in the control group were diagnosed with ADHD (P = 0.0001). When ADHD is corrected for sex, 29 of the 41 cases (70.7%) diagnosed with ADHD were boys and 12 (29.3%) were girls (P = 0.000). According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, when the patients who had been diagnosed with ADHD were grouped according to the ages of the children, no statistically significant difference was found between the groups in terms of ADHD (P = 0.097).

CONCLUSIONS: The prevalence of ADHD has been found to be higher in children of primary school age who present to the ED with mild head trauma. Hence, it can be deduced that the diagnosis of childhood ADHD increases the risk of presenting to the ED with head trauma. We believe that it is very important to keep the possible diagnosis of ADHD in mind and to refer that cases to the CAPD in case of high clinical suspicion, especially in primary school boys who are admitted to the ED with mild head trauma. We believe that in this way, morbidity and mortality due to head trauma in this age group can be significantly reduced.

PMID:36173338 | DOI:10.1097/PEC.0000000000002854

Int J Epidemiol. 2022 Sep 28:dyac188. doi: 10.1093/ije/dyac188. Online ahead of print.

ABSTRACT

BACKGROUND: Cardiovascular disease (CVD) has a disproportionate effect on mortality among the poorest people. We assessed the impact on CVD and all-cause mortality of the world’s largest conditional cash transfer, Brazil’s Bolsa Família Programme (BFP).

METHODS: We linked administrative data from the 100 Million Brazilian Cohort with BFP receipt and national mortality data. We followed individuals who applied for BFP between 1 January 2011 and 31 December 2015, until 31 December 2015. We used marginal structural models to estimate the effect of BFP on all-age and premature (30-69 years) CVD and all-cause mortality. We conducted stratified analyses by levels of material deprivation and access to healthcare. We checked the robustness of our findings by restricting the analysis to municipalities with better mortality data and by using alternative statistical methods.

RESULTS: We studied 17 981 582 individuals, of whom 4 855 324 were aged 30-69 years. Three-quarters (76.2%) received BFP, with a mean follow-up post-award of 2.6 years. We detected 106 807 deaths by all causes, of which 60 893 were premature; and 23 389 CVD deaths, of which 15 292 were premature. BFP was associated with reductions in premature all-cause mortality [hazard ratio (HR) = 0.96, 95% CI = 0.94-0.98], premature CVD (HR = 0.96, 95% CI = 0.92-1.00) and all-age CVD (HR = 0.96, 95% CI = 0.93-1.00) but not all-age all-cause mortality (HR = 1.00, 95% CI = 0.98-1.02). In stratified and robustness analyses, BFP was consistently associated with mortality reductions for individuals living in the two most deprived quintiles.

CONCLUSIONS: BFP appears to have a small to null effect on premature CVD and all-cause mortality in the short term; the long-term impact remains unknown.

PMID:36172959 | DOI:10.1093/ije/dyac188

J Am Heart Assoc. 2022 Sep 29:e024964. doi: 10.1161/JAHA.121.024964. Online ahead of print.

ABSTRACT

Background Transcarotid artery revascularization (TCAR) was approved by the Food and Drug Administration in 2015 for patients with carotid artery stenosis. However, no randomized trial to evaluate TCAR has been performed to date, and previous reports have important limitations. Accordingly, we measured stroke or death after TCAR compared with carotid endarterectomy (CEA) and transfemoral carotid artery stenting (TF-CAS). Methods and Results We used the Vascular Quality Initiative registry to study patients who underwent TCAR, CEA, or TF-CAS from September 2016 to June 2021. Our primary outcomes were perioperative and 1-year stroke or death. We used logistic regression for risk adjustment for perioperative outcomes and Cox regression for risk adjustment for 1-year outcomes. We used a 2-stage residual inclusion instrumental variable (IV) method to adjust for selection bias and other unmeasured confounding. Our instrument was a center’s preference to perform TCAR versus CEA or TF-CAS. We performed a subgroup analysis stratified by presenting neurologic symptoms. We studied 21 234 patients who underwent TCAR, 82 737 who underwent CEA, and 14 595 who underwent TF-CAS across 662 centers. The perioperative rate of stroke or death was 2.0% for TCAR, 1.7% for CEA, and 3.7% for TF-CAS (P<0.001). Compared with TCAR, the IV-adjusted odds ratio of perioperative stroke or death for CEA was 0.74 (95% CI, 0.55-0.99) and for TF-CAS was 1.66 (95% CI, 0.99-2.79). Results were similar among both symptomatic and asymptomatic patients. The 1-year rate of stroke or death was 6.4% for TCAR, 5.2% for CEA, and 9.7% for TF-CAS (P<0.001). Compared with TCAR, the IV-adjusted hazard ratio of 1 year stroke or death for CEA was 0.97 (95% CI, 0.80-1.17), and for TF-CAS was 1.45 (95% CI, 1.04-2.02). IV analysis further demonstrated that symptomatic patients with carotid stenosis had the lowest 1-year likelihood of stroke or death with TCAR (compared with TCAR, symptomatic IV-adjusted hazard ratio for CEA: 1.30 [95% CI, 1.04-1.64], and TF-CAS: 1.86 [95% CI, 1.27-2.71]). Conclusions Perioperative stroke or death was greater following TCAR when compared with CEA. However, at 1 year there was no statistically significant difference in stroke or death between the 2 procedures. TCAR performed favorably compared with TF-CAS at both time points. Although CEA remains the gold standard procedure for patients with carotid stenosis, TCAR appears to be a safe alternative to CEA and TF-CAS when used selectively and may be useful when treating symptomatic patients.

PMID:36172943 | DOI:10.1161/JAHA.121.024964

J Feline Med Surg. 2022 Sep 29:1098612X221121893. doi: 10.1177/1098612X221121893. Online ahead of print.

ABSTRACT

OBJECTIVES: The aims of this study were to evaluate the prevalence and to describe the clinical and diagnostic imaging features of the different types of feline intervertebral disc herniation (IVDH).

METHODS: Medical records and imaging studies were retrospectively reviewed for cats diagnosed with IVDH between January 2008 and October 2020. Information obtained from the clinical records included signalment, clinical presentation, the presence of spinal hyperaesthesia and neurolocalisation. Diagnostic imaging findings, including type (ie, intervertebral disc extrusion [IVDE], intervertebral disc protrusion [IVDP] or acute non-compressive nucleus pulposus extrusion (ANNPE), site and number of IVDHs, were recorded. The association between breed, age, sex, duration and severity of neurological signs, the presence of spinal pain and MRI features was evaluated.

RESULTS: Forty-three cats were included. A total of 50 IVDHs were identified: 39 cats were diagnosed with a single IVDH and four with multiple IVDHs. The most common type of IVDH was ANNPE (n = 22), followed by IVDP (n = 19) and IVDE (n = 9). Neuroanatomical localisation included L4-S3 (n = 19/43), T3-L3 (n = 18/43) and C1-C5 (n = 6/43). Cats with a single IVDH were statistically significantly associated with a diagnosis of ANNPE (P = 0.023) compared with cats with multiple IVDHs affected by IVDP (P = 0.004). Males were more commonly affected by IVDE (P = 0.020) and females by ANNPE (P = 0.020). Cats with IVDP had a longer duration of clinical signs (P <0.001) than cats with ANNPE and demonstrated milder neurological deficits (P = 0.005). IVDEs were statistically significantly associated with spinal hyperaesthesia (P = 0.013), while ANNPEs were not (P = 0.014).

CONCLUSIONS AND RELEVANCE: ANNPE, IVDP and IVDE are each associated with distinctive clinical scenarios. Thoracolumbar and mid-to-caudal lumbar regions are the most affected, followed by the cranial cervical spine segment.

PMID:36172921 | DOI:10.1177/1098612X221121893