Tag: pubmed

Thromb Haemost. 2021 Dec 1. doi: 10.1055/a-1711-1395. Online ahead of print.

ABSTRACT

BACKGROUND: Protease-activated receptor 4 (PAR4) is a platelet thrombin receptor important for thrombosis and a target of anti-platelet drug development. A frequently occurring single nucleotide polymorphism (SNP; rs773902) causes a PAR4 sequence variant (NC_000019.10:p.Ala120Thr) whereby platelets from Thr120-expressing individuals are hyper-responsive to PAR4 agonists versus platelets from Ala120-expressing individuals. However, whether this enhanced platelet responsiveness translates to increased thrombotic risk or decreased bleeding risk remains unknown.

OBJECTIVES: To examine the association of rs773902 with adjudicated cardiovascular events and aspirin use in a randomized trial population of healthy older individuals.

PATIENTS/METHODS: We analyzed 13,547 participants in the ASPirin in Reducing Events in the Elderly (ASPREE) trial. Participants had no previous cardiovascular events at enrollment and were randomized to either 100 mg daily aspirin or placebo for a median follow-up of 4.7 years. Total genotypes were 8,761 (65%) GG (Ala120 variant), 4,303 (32%) heterozygotes, and 483 (4%) AA (Thr120 variant). Cox proportional hazard regression tested the relationship between rs773902 and thrombotic events (major adverse cardiovascular events [MACE] and ischemic stroke [IS]) and bleeding (major hemorrhage [MHEM] and intracranial bleeding [ICB]).

RESULTS: No statistically significant association was observed overall or by treatment group between rs773902 and any thrombotic or bleeding event examined. Further, there was no significant interaction between rs773902 and treatment for any of MACE, IS, MHEM, or ICB.

CONCLUSIONS: This post-hoc analysis of a prospective cohort study suggests that, despite sensitizing platelet activation, the rs773902 PAR4 variant is not associated with thrombotic cardiovascular or bleeding events in a healthy older population.

PMID:34852379 | DOI:10.1055/a-1711-1395

Neurosurg Focus. 2021 Dec;51(6):E5. doi: 10.3171/2021.9.FOCUS21420.

ABSTRACT

OBJECTIVE: Surgical decompression via a posterior interlaminar approach is widely used for treating lumbar central canal stenosis (LCCS). However, this surgical approach poses a challenge for elderly patients with comorbidities. Thus, the authors tried a new surgical decompression via the unilateral intervertebral foraminal approach with local anesthesia to treat such patients. The aim of this study was to evaluate the safety and effectiveness of surgical decompression via the unilateral intervertebral foraminal approach with local anesthesia for patients with LCCS.

METHODS: Patients with LCCS who underwent surgical decompression, performed by a single surgeon, between January 2016 and March 2019 were retrospectively analyzed. All patients received decompression via the unilateral intervertebral foraminal approach with local anesthesia. Visual analog scale (VAS) scores, Oswestry Disability Index (ODI) scores, modified Macnab criteria, walking distance, and Schizas classification were used as outcome predictors. Additionally, a decompression evaluation method was designed for use after spinal endoscopic surgery.

RESULTS: Overall, 23 patients with a mean age of 69 years were included in this study, with a mean follow-up of 28 months. Low-back and leg pain were significantly improved after decompression surgery. Postoperative ODI scores and walking distances were statistically significantly better than before surgery. Postoperatively, the Schizas classification for all patients was improved by at least 1 grade compared with the preoperative grade. No complications occurred during the follow-up period. According to the novel decompression evaluation method, all patients had at least achieved decompression in part 123+B.

CONCLUSIONS: Surgical decompression via the unilateral intervertebral foraminal approach with local anesthesia showed promising outcomes in the treatment of elderly patients with LCCS. Additionally, a proposed postoperative decompression evaluation method can help guide surgical decompression.

PMID:34852321 | DOI:10.3171/2021.9.FOCUS21420

J Neurosurg. 2021 Apr 23;135(6):1789-1798. doi: 10.3171/2020.10.JNS202323.

ABSTRACT

OBJECTIVE: Gamma Knife radiosurgery (GKRS) is an established surgical option for the treatment of trigeminal neuralgia (TN), particularly for high-risk surgical candidates and those with recurrent pain. However, outcomes after three or more GKRS treatments have rarely been reported. Herein, the authors reviewed outcomes among patients who had undergone three or more GKRS procedures for recurrent TN.

METHODS: The authors conducted a multicenter retrospective analysis of patients who had undergone at least three GKRS treatments for TN between July 1997 and April 2019 at two different institutions. Clinical characteristics, radiosurgical dosimetry and technique, pain outcomes, and complications were reviewed. Pain outcomes were scored on the Barrow Neurological Institute (BNI) scale, including time to pain relief (BNI score ≤ III) and recurrence (BNI score > III).

RESULTS: A total of 30 patients were identified, including 16 women and 14 men. Median pain duration prior to the first GKRS treatment was 10 years. Three patients (10%) had multiple sclerosis. Time to pain relief was longer after the third treatment (p = 0.0003), whereas time to pain recurrence was similar across each of the successive treatments (p = 0.842). Complete or partial pain relief was achieved in 93.1% of patients after the third treatment. The maximum pain relief achieved after the third treatment was significantly better among patients with no prior percutaneous procedures (p = 0.0111) and patients with shorter durations of pain before initiation of GKRS therapy (p = 0.0449). New or progressive facial sensory dysfunction occurred in 29% of patients after the third GKRS treatment and was reported as bothersome in 14%. One patient developed facial twitching, while another experienced persistent lacrimation. No statistically significant predictors of adverse effects following the third treatment were found. Over a median of 39 months of follow-up, 77% of patients maintained complete or partial pain relief. Three patients underwent a fourth GKRS treatment, including one who ultimately received five treatments; all of them reported sustained pain relief at the extended follow-up.

CONCLUSIONS: The authors describe the largest series to date of patients undergoing three or more GKRS treatments for refractory TN. A third treatment may produce outcomes similar to those of the first two treatments in terms of long-term pain relief, recurrence, and adverse effects.

PMID:34852325 | DOI:10.3171/2020.10.JNS202323

Neuroimage. 2021 Nov 28:118749. doi: 10.1016/j.neuroimage.2021.118749. Online ahead of print.

ABSTRACT

Neurite orientation dispersion and density imaging (NODDI) estimates microstructural properties of brain tissue relating to the organisation and processing capacity of neurites, which are essential elements for neuronal communication. Descriptive statistics of NODDI tissue metrics are commonly analysed in regions-of-interest (ROI) to identify brain-phenotype associations. Here, the conventional method to calculate the ROI mean weights all voxels equally. However, this produces biased estimates in the presence of CSF partial volume. This study introduces the tissue-weighted mean, which calculates the mean NODDI metric across the tissue within an ROI, utilising the tissue fraction estimate from NODDI to reduce estimation bias. We demonstrate the proposed mean in a study of white matter abnormalities in young onset Alzheimer’s disease (YOAD). Results show the conventional mean induces significant bias that correlates with CSF partial volume, primarily affecting periventricular regions and more so in YOAD subjects than in healthy controls. Due to the differential extent of bias between healthy controls and YOAD subjects, the conventional mean under- or over-estimated the effect size for group differences in many ROIs. This demonstrates the importance of using the correct estimation procedure when inferring group differences in studies where the extent of CSF partial volume differs between groups. These findings are robust across different acquisition and processing conditions. Bias persists in ROIs at higher image resolution, as demonstrated using data obtained from the third phase of the Alzheimer’s disease neuroimaging initiative (ADNI); and when performing ROI analysis in template space. This suggests that conventional ROI means of NODDI metrics are biased estimates under most contemporary experimental conditions, the correction of which requires the proposed tissue-weighted mean. The tissue-weighted mean produces accurate estimates of ROI means and group differences when ROIs contain voxels with CSF partial volume. In addition to NODDI, the technique can be applied to other multi-compartment models that account for CSF partial volume, such as the free water elimination method. We expect the technique to help generate new insights into normal and abnormal variation in tissue microstructure of regions typically confounded by CSF partial volume, such as those in individuals with larger ventricles due to atrophy associated with neurodegenerative disease.

PMID:34852276 | DOI:10.1016/j.neuroimage.2021.118749

Bioresour Technol. 2021 Nov 28:126440. doi: 10.1016/j.biortech.2021.126440. Online ahead of print.

ABSTRACT

Detailed analysis of thermo-kinetics, reaction mechanism, and estimation of thermodynamic parameters are imperative for the design of reactor systems in thermochemical conversion processes. Present investigation was aimed at exploring the pyrolysis potential of pigeon pea stalk (PPS) by thermogravimetric experiments at 10, 20, and 30 °C/min heating rates. Maximum devolatilization of PPS was found to take place below 480 °C. The average activation energy for PPS pyrolysis was found to be 95.97, 100.74, 96.24, and 96.64 kJ/mol by Kissinger-Akahira-Sunose, Flynn-Wall-Ozawa, Starink, and Friedman method, respectively. Statistical analysis by one way analysis of variance method by employing Tukey test revealed that the difference in activation energy estimated from different methods was insignificant. Thermodynamic parameters (ΔH, ΔS_, and ΔG) together with reaction mechanisms were also evaluated. Difference in the activation energy and enthalpy was found to be <5 kJ/mol. R2 and R3 models were found best fitted with experimental PPS pyrolysis data.

PMID:34852283 | DOI:10.1016/j.biortech.2021.126440

Urology. 2021 Nov 28:S0090-4295(21)01096-7. doi: 10.1016/j.urology.2021.10.038. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine the role of race in surgical outcomes of and complications after urethroplasty.

METHODS: A single institution, retrospective review was conducted from 2011-2019 on male patients ≥ 18 years of age who underwent urethroplasty. Exclusion criteria included previous urethral cancer, lack of follow up, or revision urethroplasty. Failure of urethroplasty was defined as requiring revision surgery or recurrence on imaging or cystoscopy. Risk factors for recurrence were determined using descriptive statistics, Wilcoxon comparisons, and multivariate logistic regression.

RESULTS: 307 patients were identified with 234 patients meeting inclusion criteria. 63.2% identified as White/Caucasian (CA), 32.5% Black/African American (AA), and 4.3% other race. Mean age was 49.4 years. Between CA and AA patients, there was no difference in mean age, BMI, smoking status, prior urethroplasty, or prior dilation/DVIU. CAs were more likely to have a fossa navicularis stricture compared to AAs (p=0.0094), but there were no significant differences in bulbar, penile, or posterior stricture rates (all p>0.05) or length (p=0.32). The overall stricture recurrence rate was 15.8% with a median of 242 days to recurrence and no significant difference by race for either outcome (p=0.83, p=.64). The only predictor of stricture recurrence was prior dilation/DVIU (p=0.0404, OR 2.3, 95% CI 1.0,5.6). Overall complication rate was 17.5%, with no difference between CA and AAs rates (p=0.83) or complication type (p=0.62).

CONCLUSIONS: There was no significant difference in the rate of surgical failure for urethral stricture repair based on race. The only predictor of surgical failure was having a prior urethral dilation/DVIU.

PMID:34852248 | DOI:10.1016/j.urology.2021.10.038

J Oral Maxillofac Surg. 2021 Nov 5:S0278-2391(21)01324-0. doi: 10.1016/j.joms.2021.10.014. Online ahead of print.

ABSTRACT

PURPOSE: Controversy exists among head and neck surgical specialties regarding management of Langerhan’s Cell Histiocytosis (LCH). The purpose of this study was to evaluate diagnosis, management, and treatment outcomes in children with LCH of the head and neck.

METHODS: This is a retrospective cohort study of children with LCH of the head and neck who presented to Children’s Healthcare of Atlanta hospital from 2009 to 2021. The independent variables were demographic information, lesion locations, clinical presentation, radiographic findings, diagnostic workup, treatment, and length of follow-up. The patients were grouped based on these variables. The outcome variable was disease reactivation. Descriptive statistics were calculated.

RESULTS: There were 3 presentations of LCH of the head and neck. Group 1 presented as a lesion in 1 system without CNS risk (SS-). There were 24 patients with an average age of 10 years. Lesions were located in calvaria and/or mandible. Majority of the patients were treated with only debridement. Two of the patients experienced reactivation. Group 2 presented as a lesion in 1 system with CNS risk (SS+). There were 30 patients with an average age of 6 years. Common locations were temporal bone and/or orbit. These patients present with recurrent ear infections and ptosis. Majority of the patients were treated with chemotherapy (n = 28). One patient had disease reactivation. Group 3 presented with multisystem involvement. There were 13 patients with an average age of 2 years. LCH was found in skin and the lymphatic system. Imagining demonstrated extracranial organ involvement. All of them were treated with chemotherapy. There was 40% reactivation of LCH.

CONCLUSIONS: Treatment of LCH depends on presentation. SS- subgroup can be adequately treated via surgical debridement. SS+ and multisystem groups benefit from an early disease diagnosis and require chemotherapy.

PMID:34852246 | DOI:10.1016/j.joms.2021.10.014

Sao Paulo Med J. 2021 Nov 29:S1516-31802021005028202. doi: 10.1590/1516-3180.2021.0111.R1.18052021. Online ahead of print.

ABSTRACT

BACKGROUND: Although autonomic dysfunction has been shown to be associated with liver cirrhosis, the prevalence and prognostic implications are unclear. Abnormal heart rate variability (HRV), a measure of autonomic function, has not been well investigated in cirrhosis.

OBJECTIVE: To evaluate the prevalence of high-risk HRV parameters in a cohort of cirrhotic patients and their association with cardiac dysfunction and mortality.

DESIGN AND SETTING: Prospective observational study conducted in the Federal University of São Paulo.

METHOD: A cohort of 120 patients, comprising 17 healthy controls and 103 cirrhotic outpatients, was evaluated and followed for 10 months. HRV analysis was based on 24-hour Holter monitoring and defined using time-domain and frequency-domain parameters.

RESULTS: The HRV parameters were statistically lower in cirrhotic patients than in healthy subjects. High-risk HRV parameters were prevalent, such that 64% had at least one high-risk parameter. Time-domain parameters correlated with Child scores (P < 0.0001). In regression models, HRV parameters were independent predictors of diastolic dysfunction and mortality. During 10 months of follow-up, there were 11 deaths, all of patients with at least one high-risk HRV parameter. Kaplan-Meier analysis estimated low survival rates among patients with standard deviation of normal-to-normal RR intervals (SDNN) < 100.

CONCLUSION: Reduced HRV is prevalent in liver cirrhosis and is related to cardiac dysfunction, severity of liver disease and mortality. Abnormal high-risk HRV parameters are prevalent among cirrhotic patients and are also predictors of mortality. Our findings highlight the need for a more careful cardiac evaluation of cirrhotic patients.

PMID:34852170 | DOI:10.1590/1516-3180.2021.0111.R1.18052021

Arch Cardiol Mex. 2021;91(4):396-406. doi: 10.24875/ACM.20000505.

ABSTRACT

BACKGROUND: Family psychotherapy has been shown to have a positive impact on the evolution of patients with psychosomatic disorders, and in those with arterial hypertension it could improve the level of control of the disease.

OBJECTIVE: To evaluate the impact of an intervention in family psychotherapy in patients with uncontrolled systemic arterial hypertension.

METHOD: Study with comparative groups. 15 uncontrolled hypertensive patients, assigned to 2 groups: an intervention group of 10 patients who received family psychotherapy and a control group of 5 patients. In both groups, the pharmacological treatment indicated by experts was continued. Both groups were compared before and after the intervention regarding quality of life (InCaViSa), family functioning (Family Functioning Scale), systolic and diastolic blood pressure, body mass index and glucose, cholesterol, triglycerides, uric acid and creatinine.

RESULTS: There was qualitative improvement in the domains of the InCaViSa scale to estimate quality of life in the intervention group and there were no statistically significant changes between the groups in family functioning or in body weight. Among the biochemical variables, only cholesterol showed a significant reduction (p = 0.47). Greater mobility of the family towards more functional behaviors was found in the group that received the intervention, and also in this group, systolic and diastolic blood pressure values decreased (p < 0.001), and the use of antihypertensive, anxiolytic and antidepressant drugs, as well.

CONCLUSIONS: Family psychotherapeutic intervention can favor the control of blood pressure, reduce the doses of antihypertensive, anxiolytic and antidepressant drugs and it can help to transition to better functionally family states.

PMID:34852188 | DOI:10.24875/ACM.20000505

J Appl Oral Sci. 2021 Nov 29;29:e20210171. doi: 10.1590/1678-7757-2021-0171. eCollection 2021.

ABSTRACT

Some evidence in vitro suggested that amoxicillin and fluoride could disturb the enamel mineralization.

OBJECTIVE: To assess the effect of amoxicillin and of the combination of amoxicillin and fluoride on enamel mineralization in rats.

METHODOLOGY: In total, 40 rats were randomly assigned to four groups: control group (CG); amoxicillin group (AG – amoxicillin (500 mg/kg/day), fluoride group (FG – fluoridated water (100 ppm -221 mg F/L), and amoxicillin + fluoride group (AFG). After 60 days, the samples were collected from plasma and tibiae and analyzed for fluoride (F) concentration. The incisors were also collected to determine the severity of fluorosis using the Dental Fluorosis by Image Analysis (DFIA) software, concentration of F, measurements of enamel thickness, and hardness. The data were analyzed by ANOVA, Tukey’s post-hoc test, or Games-Howell post-hoc test (α=0.05).

RESULTS: Enamel thickness of the incisors did not differ statistically among the groups (p=0.228). Groups exposed to fluoride (AFG and FG) have higher F concentrations in plasma, bone and teeth than those not exposed to fluoride (CG and AG). The groups showed a similar behavior in the DFIA and hardness test, with the FG and AFG groups showing more severe fluorosis defects and significant lower hardness when compared with the AG and CG groups, with no difference from each other.

CONCLUSION: The rats exposed to fluoride or fluoride + amoxicillin developed dental fluorosis, while exposure to amoxicillin alone did not lead to enamel defects.

PMID:34852156 | DOI:10.1590/1678-7757-2021-0171