Tag: pubmed

Neurosurg Focus. 2022 Oct;53(4):E2. doi: 10.3171/2022.7.FOCUS22338.

ABSTRACT

OBJECTIVE: Racial and ethnic disparities in healthcare have gained significant importance since the Institute of Medicine published its report on disparities in healthcare. There is a lack of evidence on how race and ethnicity affect access to advanced treatment of pediatric medically intractable epilepsy. In this context, the authors analyzed the latest Kids’ Inpatient Database (KID) for racial/ethnic disparities in access to surgical treatment of epilepsy.

METHODS: The authors queried the KID for the years 2016 and 2019 for the diagnosis of medically intractable epilepsy.

RESULTS: A total of 29,292 patients were included in the sample. Of these patients, 8.9% (n = 2610) underwent surgical treatment/invasive monitoring. The mean ages in the surgical treatment and nonsurgical treatment groups were 11.73 years (SD 5.75 years) and 9.5 years (SD 6.16 years), respectively. The most common insurance in the surgical group was private/commercial (55.9%) and Medicaid in the nonsurgical group (47.7%) (p < 0.001). White patients accounted for the most common population in both groups, followed by Hispanic patients. African American patients made up 7.9% in the surgical treatment group compared with 12.9% in the nonsurgical group. African American (41.1%) and Hispanic (29.9%) patients had higher rates of emergency department (ED) utilization compared with the White population (24.6%). After adjusting for all covariates, the odds of surgical treatment increased with increasing age (OR 1.06, 95% CI 1.053-1.067; p < 0.001). African American race (OR 0.513, 95% CI 0.443-0.605; p < 0.001), Hispanic ethnicity (OR 0.681, 95% CI 0.612-0.758; p < 0.001), and other races (OR 0.789, 95% CI 0.689-0.903; p = 0.006) had lower surgical treatment odds compared with the White population. Medicaid/Medicare was associated with lower surgical treatment odds than private/commercial insurance (OR 0.603, 0.554-0.657; p < 0.001). Interaction analysis revealed that African American (OR 0.708, 95% CI 0.569-0.880; p = 0.001) and Hispanic (OR 0.671, 95% CI 0.556-0.809; p < 0.001) populations with private insurance had lower surgical treatment odds than White populations with private insurance. Similarly, African American patients, Hispanic patients, and patients of other races with nonprivate insurance also had lower surgical treatment odds than their White counterparts after adjusting for all other covariates.

CONCLUSIONS: Based on the KID, African American and Hispanic populations had lower surgical treatment rates than their White counterparts, with higher utilization of the ED for pediatric medically intractable epilepsy.

PMID:36183182 | DOI:10.3171/2022.7.FOCUS22338

Neurosurg Focus. 2022 Oct;53(4):E8. doi: 10.3171/2022.7.FOCUS22296.

ABSTRACT

OBJECTIVE: Hypothalamic hamartoma (HH) is a rare, nonmalignant, heterotopic developmental malformation that consists of a mixture of normal neurons and glial cells. Resection of HHs has been associated with high rates of mortality and morbidity. Therefore, minimally invasive ablation methods could be the best treatment option for HH. The most frequently used minimally invasive options for HH ablation are radiofrequency thermocoagulation (RFT), laser ablation (LA), and stereotactic radiosurgery.

METHODS: To investigate three minimally invasive procedures in the treatment of refractory seizures related to HH, the authors conducted a systematic search in March 2022 in the MEDLINE, Embase, Scopus, and Web of Science databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Seizure freedom was the primary outcome of interest. The authors defined seizure freedom as Engel class I or International League Against Epilepsy class 1 or 2 or as the reported term “seizure freedom.” The secondary outcome was long-term complications reported in studies. Both random- and fixed-effects models were used to calculate the pooled proportion of seizure freedom and complication rate with 95% confidence intervals. A modified version of the Joanna Briggs Institute (JBI) Critical Appraisal to assess the risk of bias was used.

RESULTS: The authors included 15 studies with 422 patients (RFT, n = 190; LA, n = 171; and Gamma Knife Radiosurgery [GKRS], n = 61). Generally, the mean incidences of overall seizure freedom after minimally invasive procedures were 77% (95% CI 0.74-0.81) and 68% (95% CI 0.57-0.79) using fixed- and random-effects models, respectively. The mean incidence of overall seizure freedom after RFT was 69% (95% CI 0.63-0.75), and the mean incidences of overall seizure freedom after LA and GKRS were 87% (95% CI 0.82-0.92) and 44% (95% CI 0.32-0.57), respectively. The total complication rate with minimally invasive procedures was 13% (95% CI 0.01-0.26). The complication rate in each treatment was as follows: 5% (95% CI 0.0-0.12) for RFT, 20% (95% CI 0.0-0.47) for LA, and 22% (95% CI 0-0.65) for GKRS. Meta-regression analysis showed an association between older age and higher complication rates in the LA group.

CONCLUSIONS: In this meta-analysis, LA showed superiority in seizure freedom over the other two methods. The complication rate associated with RFT was less than those in the other two methods; however, this difference was not statistically significant.

PMID:36183177 | DOI:10.3171/2022.7.FOCUS22296

Neurosurg Focus. 2022 Oct;53(4):E6. doi: 10.3171/2022.7.FOCUS21731.

ABSTRACT

OBJECTIVE: In the histopathological examination of treatment-resistant epilepsy, focal cortical dysplasia (FCD) is the most common diagnosis in the pediatric group. FCD is classified histopathologically according to the International League Against Epilepsy (ILAE) classification. In the last decade since the ILAE classification has been released, molecular genetic studies have revealed mTOR pathway-related mutations as a major etiology. The objective of this study was to determine the incidence of FCD in treatment-resistant epilepsy patients, explore histomorphological and immunohistochemical features, examine clinicopathological correlation, demonstrate mTOR pathway activation using a pS6 antibody immunohistochemically, and try to introduce a candidate for possible targeted therapies.

METHODS: Paraffin blocks and slides of tissue from patients with treatment-resistant epilepsy were reexamined retrospectively. Histopathological subtypes of FCD were determined according to the ILAE classification. NeuN and neurofilament H (NF-H) staining were performed, and additionally a pS6 antibody was used to demonstrate mTOR pathway activation.

RESULTS: In 32 cases diagnosed with FCD, or 17.5% of 183 surgical epilepsy materials, there were no significant differences in the statistical analysis of clinical variables between the ILAE FCD subtypes. Recommended antibody NeuN revealed microcolumnar alignment in the FCD type Ia and IIIa groups and the loss of lamination in the type Ib group. Another recommended antibody, NF-H, was not found to be useful in discriminating between normal and dysmorphic neurons. pS6 expression, showing mTOR pathway activation, was observed in dysmorphic neurons and balloon cells in all FCD type II cases.

CONCLUSIONS: Significant pS6 expression in FCD type II represents the genomic nature of the disease noted in the literature. Nevertheless, the known MTOR gene and mTOR pathway-related mutations remain behind proportionally to explain the mTOR pathway activation in all FCD type II cases. Clinicopathologically and genetically integrated classification and usage of mTOR pathway inhibitors in treatment are expected as a recent evolution.

PMID:36183176 | DOI:10.3171/2022.7.FOCUS21731

Immunology. 2022 Oct 1. doi: 10.1111/imm.13586. Online ahead of print.

ABSTRACT

Not only are many Mycobacteria pathogens, but they can act as strong nonspecific immunopotentiators, generating beneficial effects on the pathogenesis of some diseases. However, there has been no direct evidence of the effect of mycobacterial species on colorectal cancer (CRC). Herein, we showed that there may be a meaningful inverse correlation between the incidence of tuberculosis and CRC based on global statistics and that heat-killed M. tuberculosis and live M. bovis (BCG strain) could ameliorate CRC development. In particular, using a fecal microbiota transplantation and a comparison between separate housing and cohousing, we demonstrated that the gut microbiota is involved in the protective effects. The microbial alterations can be elucidated by the modulation of antimicrobial activities including those of the Reg3 family genes. Furthermore, interleukin-22 production by T helper cells contributed to the anti-inflammatory activity of Mycobacteria. Our results revealed a novel role of Mycobacteria involving gut microbial alterations in dampening inflammation-associated CRC and an immunological mechanism underlying the interaction between microbes and host immunity. This article is protected by copyright. All rights reserved.

PMID:36183156 | DOI:10.1111/imm.13586

Dermatol Ther. 2022 Oct 1:e15888. doi: 10.1111/dth.15888. Online ahead of print.

ABSTRACT

BACKGROUND: Atrophic acne scars are the most common cutaneous seqaule of acne vulgaris, representing 80-90% of all acne scars. Ablative fractional carbon dioxide (FCO2) laser is the gold standard treatment for atrophic scars. Additionally, platelet-rich plasma (PRP) is suggested to accelerate the healing process and collagen synthesis. The aim of the present systematic review and meta-analysis was to determine the efficacy and safety of PRP combined with Ablative FCO2 laser in the treatment of moderate to severe atrophic acne scars.

METHODS: Randomized controlled trials (RCTs) that have compared PRP in combination with ablative FCO2 laser to ablative FCO2 laser alone with respect to the efficacy and safety measures were included. We have systematically explored Embase, Medline, and CENTRAL databases via Ovid. The outcomes that our systematic review saught to evaluate were clinical improvement, patient satisfaction, and Goodman and Baron’s qualitative acne scar score. The dichotomous outcomes were presented as odds ratio (OR) while the continuous outcomes were presented as standardized mean difference (SMD).

RESULTS: 11 RCTs that represents 313 participants were included. The combined use of laser and PRP showed a statistically significant clinical improvement and patient satisfaction compared to the use of laser alone (OR=2.56, 95% CI 1.37 to 4.78 and OR=3.38, 95% CI 1.80 to 6.34, respectively). Also, a significant improvement in Goodman and Baron’s score was achieved by combining PRP with laser (SMD = -0.40, 95% CI -0.65 to -0.14).

CONCLUSION: The combined treatment of laser and PRP was highly synergistic, effective, and safe in treating moderate to severe atrophic acne scars. This article is protected by copyright. All rights reserved.

PMID:36183145 | DOI:10.1111/dth.15888

Addict Sci Clin Pract. 2022 Oct 1;17(1):54. doi: 10.1186/s13722-022-00335-0.

ABSTRACT

BACKGROUND: Alcohol consumption is a major public health challenge; the majority of employees consume alcohol regularly and a considerable proportion of employees can be characterized as risky drinkers in need of interventions. Occupational health services (OHS) are uniquely positioned for implementing alcohol prevention interventions targeting employees, but rarely do so. Studies have shown that lack of knowledge among OHS personnel is a barrier to alcohol prevention activity. This study aimed to explore OHS personnels’ levels of theoretical and practical alcohol knowledge, and whether these two ways of knowing were differentially associated with alcohol prevention activity.

METHODS: In this cross-sectional study, survey data were collected from 322 OHS personnel in Norway in 2018 (response rate = 53.6%). The survey included variables of two ways of knowing (theoretical and practical) and three types of doing (intervention frequency, conducting individual interventions, and conducting group interventions). Data were analyzed with descriptive statistics, paired sample t-tests, bivariate correlations, and adjusted linear and logistic regression analyses.

RESULTS: OHS personnel rated their theoretical alcohol knowledge higher than their practical knowledge (η² = 0.33, p < 0.001). Higher reported levels of practical knowledge were associated with higher intervention frequency (b = 0.39, β = 0.60, p < 0.001) and greater likelihood of conducting individual interventions (OR = 1.60, p < .001) as well as group interventions (OR = 1.84, p < 0.001). Theoretical knowledge was not associated with conducting interventions, and there was no evidence of an interaction between the two ways of knowing in their association with doing. Sensitivity analyses did not indicate clustering effects of OHS personnel being employed within different units.

CONCLUSIONS: Different ways of knowing about alcohol among OHS personnel were dissimilarly associated with conducting alcohol prevention interventions in occupational health settings. For doing, knowing how seems to be more important than knowing that. Training programs for OHS personnel should emphasize knowledge about how to deal with alcohol-related issues and how to conduct prevention interventions, rather than focus on detrimental effects of alcohol.

PMID:36183127 | DOI:10.1186/s13722-022-00335-0

Int J Retina Vitreous. 2022 Oct 1;8(1):73. doi: 10.1186/s40942-022-00420-1.

ABSTRACT

BACKGROUND: To describe the anatomical and functional outcomes and late complications in patients who developed inferior proliferative vitreoretinopathy (PVR) in silicone oil-filled eyes and who required reoperation with large inferior retinectomy.

METHODS: This is a single-center, retrospective, interventional case series analysis. The study involved 18 individuals with tractional retinal re-detachment due to PVR development inferiorly in eyes who had undergone prior pars plana vitrectomy and silicone oil as a tamponade. All patients included in the study underwent secondary surgery with large inferior retinectomy (from 120° to 270°) and silicone oil filling.

RESULTS: The mean follow-up period was 44.0 ± 31.5 (± SD) months (range: 4 to 96 months. The anatomical success, defined as the complete reattachment of the retina until the last follow-up, was observed in 88.9% of the cases. The postoperative visual acuity ranged from 20/100 to hand motion at 60 cm. Only two cases (11.1%) did not achieve anatomical success at the last follow-up due to recurrent PVR and retinal re-detachment (one including hypotony). All of the patients were pseudophakic. The PVR grade, as well as the presence of PVR prior to primary surgery, showed no statistical correlation with BCVA, the extent of retinectomies, and final macular status. There was a statistically significant correlation between “Final BCVA” and “Initial BCVA” (r = 0.654) and between “Final BCVA” and “Extent of Retinectomy” (r = 0.615).

CONCLUSIONS: Reoperation in eyes filled with silicone oil may be required when PVR is developed. Secondary surgery in these cases with large inferior retinectomy and silicone oil implantation may reach good anatomical success with low rates of late complications, besides improving visual acuity. A better BCVA at the time of re-RD diagnosis and cases of retinectomies with greater extensions showed a positive correlation with better functional outcomes. Trial registration Research Ethics Committee of the Suel Abujamra Institute reviewed and approved this study protocol (approval number, 5.404.961).

PMID:36183118 | DOI:10.1186/s40942-022-00420-1

Arthroplasty. 2022 Oct 2;4(1):43. doi: 10.1186/s42836-022-00143-6.

ABSTRACT

AIMS: Debate continues as to the optimal orientation of the acetabular component in total hip arthroplasty (THA) and how to reliably achieve this. The primary objective of this study was to compare functional CT-based planning and patient-specific instruments with conventional THA using 2D templating.

METHODS: A pragmatic single-center, patient-assessor blinded, randomized control trial of patients undergoing THA was performed. 54 patients (aged 18-70) were recruited to either Corin Optimized Positioning System (OPS) or conventional THA. All patients received a cementless acetabular component. All patients underwent pre- and postoperative CT scans, and four functional X-rays. Patients in the OPS group had a 3D surgical plan and bespoke guides made. Patients in the conventional group had a surgical plan based on 2D templating X-rays. The primary outcome measure was the mean error in acetabular anteversion as determined by postoperative CT scan.

RESULTS: There was no statistically significant difference in the mean error in angle of acetabular anteversion when comparing OPS and conventional THA. In the OPS group, the achieved acetabular anteversion was within 10° of the planned anteversion in 96% of cases, compared with only 76% in the conventional group. The clinical outcomes were comparable between the groups.

CONCLUSION: Large errors in acetabular orientation appear to be reduced when CT-based planning and patient-specific instruments are used compared to the standard technique but no significant differences were seen in the mean error.

PMID:36183111 | DOI:10.1186/s42836-022-00143-6

Parasit Vectors. 2022 Oct 1;15(1):351. doi: 10.1186/s13071-022-05460-y.

ABSTRACT

BACKGROUND: The control of the Asian tiger mosquito Aedes albopictus (Diptera: Culicidae) is crucial owing to its high vector competence for more than 20 arboviruses-the most important being dengue, chikungunya and Zika virus. Aedes albopictus has an enormous adaptive potential, and its invasive spreading across urban and suburban environments poses challenges for its control. Therefore, all suitable, cost-effective and eco-friendly control tools should be put into practice. In this context, cyclopoid copepods are already known as effective predators of mosquito larvae. This study reports an essential preliminary step towards the integration of copepods into the vector control strategy in Germany, in order to provide a sustainable tool in an integrated control strategy based on the elimination or sanitation of breeding sites, the use of formulations based on Bacillus thuringiensis israelensis (Bti.) and the sterile insect technique (SIT).

METHODS: The predatory potential of native cyclopoid copepods, namely the field-derived species Megacyclops viridis (Crustacea: Cyclopidae), was examined against the larvae of Ae. albopictus, and for comparison, against the larvae of the common house mosquito, Culex pipiens sensu lato (Diptera: Culicidae). The use of different larval instars as prey, and various predator-to-prey ratios, were examined under laboratory and semi-field conditions. The compatibility of Bti. applications along with the use of copepods was assessed in the laboratory.

RESULTS: High predation efficiency of M. viridis upon first-instar larvae of Ae. albopictus was observed under laboratory (up to 96%) and semi-field conditions (65.7%). The copepods did not prey upon stages further developed than the first instars, and in comparison with Ae. albopictus, the predation rates on the larvae of Cx. pipiens s.l. were significantly lower.

CONCLUSIONS: The results indicate a high predation potential of M. viridis against Ae. albopictus larvae, even though strong larval stage and mosquito species preferences were implicated. The integration of copepods as a promising biocontrol agent to the vector control strategy in Germany is therefore highly recommended, especially because of the excellent compatibility of copepods with the use of Bti. However, further research is required, concerning all the probable parameters that may impact the copepod performance under natural conditions.

PMID:36183110 | DOI:10.1186/s13071-022-05460-y

BMC Pregnancy Childbirth. 2022 Oct 1;22(1):736. doi: 10.1186/s12884-022-04993-5.

ABSTRACT

BACKGROUND: Many countries, including Cameroon, have found it challenging to estimate stillbirths, as there are limited available reports accurately. This analysis aimed to assess stillbirth rates and identify risk factors for stillbirth in Cameroon using successive Demographic and Health Survey data.

METHODS: We conducted a cross-sectional analysis of data collected during the Demographic and Health Surveys of 1998, 2004, and 2011. Data were analyzed using SPSS 20.0. Logistic regressions were used to identify factors associated with stillbirth through odds ratios (ORs) at 95% confidence intervals (CI). Results were considered statistically significant at p-value less than 0.05.

RESULTS: The crude stillbirth rate was 21.4 per 1,000 births in 2004 and 24 per 1,000 births in 2011, with respective standard errors of 1.8 and 1.3. The stillbirth rate increased with the mother’s age (p < 0.001). The stillbirth rate reduction was prolonged between 1998 and 2011, with an annual reduction rate of 1.6%. The study observed that residing in rural areas, low socioeconomic status, and low level of education were risk factors associated with stillbirths.

CONCLUSION: Cameroon’s stillbirth rate remains very high, with a slow reduction rate over the last 20 years. Although some efforts are ongoing, there is still a long way forward to bend the curve for stillbirths in Cameroon; supplementary strategies must be designed and implemented, especially among rural women, the poor, and the less educated.

PMID:36183095 | DOI:10.1186/s12884-022-04993-5