Tag: pubmed

Anesthesiology. 2021 Mar 19. doi: 10.1097/ALN.0000000000003745. Online ahead of print.

ABSTRACT

BACKGROUND: Pain management is important for ensuring early mobilization after hip arthroplasty; however, the optimal components remain controversial. Recently, the quadratus lumborum block has been proposed as an analgesic option. The current study tested the hypothesis that the posterior quadratus lumborum block combined with multimodal analgesia decreases morphine consumption after hip arthroplasty.

METHODS: This study was a prospective, randomized, double-blind, placebo-controlled trial. Before general anesthesia, 100 participating patients scheduled for elective total hip arthroplasty were randomly allocated to receive a 30-ml injection posterior to the quadratus lumborum muscle with either 0.33% ropivacaine (n = 50) or normal saline (n = 50). For all patients, multimodal analgesia included systematic administration of acetaminophen, ketoprofen, and a morphine intravenous patient-controlled analgesia. The primary outcome was total intravenous morphine consumption in the first 24 h. Secondary outcomes recorded intraoperative sufentanil consumption; morphine consumption in the postanesthesia care unit; pain scores at extubation and at 2, 6, 12, and 24 h; motor blockade; time to first standing and ambulation; hospital length of stay; and adverse events.

RESULTS: There was no significant difference in the 24-h total morphine consumption (ropivacaine group, median [interquartile range], 13 [7 to 21] versus saline group, 16 [9 to 21] mg; median difference, -1.5; 95% CI, -5 to 2; P = 0.337). Pain scores were not different between the groups (β = -0.4; 95% CI, -0.9 to 0.2; P = 0.199). There was no statistical difference between the two groups in intraoperative sufentanil consumption, morphine consumption in the postanesthesia care unit, motor blockade, times to first standing (median difference, 0.83 h; 95% CI, -1.7 to 3.4; P = 0.690) and ambulation (median difference, -1.85 h; 95% CI, -4.5 to 0.8; P = 0.173), hospital length of stay, and adverse events.

CONCLUSIONS: After elective hip arthroplasty, neither morphine consumption nor pain scores were reduced by the addition of a posterior quadratus lumborum block to a multimodal analgesia regimen.

PMID:33740816 | DOI:10.1097/ALN.0000000000003745

Andrology. 2021 Mar 19. doi: 10.1111/andr.13002. Online ahead of print.

ABSTRACT

BACKGROUND: Automated sperm analysis has wide applications in infertility diagnosis. Existing systems are not able to measure sperm count and both motility and morphology of individual live sperm. Morphology measurement requires invasive staining, making the sperm after morphology measurement not applicable to infertility treatment.

OBJECTIVE: To evaluate the reproducibility and reliability of automated measurement of individual live sperm’s motility and morphology.

MATERIALS AND METHODS: Fresh semen samples were obtained from twenty male partners attending for fertility investigations. The system firstly measured motility for all the sperm within the field of view under a low magnification (20×), then a sperm of interest is selected by the user and automatically relocated by the system after switching to a high magnification (100×) for morphology measurement. Reproducibility of sperm measurements was evaluated by intraclass correlation coefficients on consecutive measurement. Reliability of motility and morphology measurement was evaluated by tracking error rate and limits of agreement, respectively, with manual measurement as benchmark.

RESULTS: Measurement of all motility and morphology parameters had intraclass correlation coefficients higher than 0.94. Sperm motility measurement had a tracking error rate of 2.1%. Limit of agreement analysis indicated that automated measurement and manual measurement of sperm morphology were interchangeable. Automated measurement of all morphology parameters was not statistically different from manual measurement, as confirmed by the paired sample t-test.

DISCUSSION: Automated motility and morphology measurement of single sperm revealed high reproducibility and reliability. The system also achieved a high efficiency for motility and morphology measurement. In addition to the intracytoplasmic sperm injection (ICSI) samples with polyvinylpyrrolidone (PVP), the developed sperm measurement technique is also effective for analyzing semen and washed samples. The system provides a valuable tool for quantitative measurement and selection of single sperm for ICSI. It can also be used for sperm motility and morphology analysis in andrology labs.

PMID:33740840 | DOI:10.1111/andr.13002

Knee. 2021 Mar 16;29:432-440. doi: 10.1016/j.knee.2021.01.002. Online ahead of print.

ABSTRACT

BACKGROUND: Patient user embracement involves behaviours of including and listening to the patient, appreciating their complaints, and identifying their needs, whether individual or collective. The aim of this study was to evaluate the influence of a user embracement protocol (SPIKES protocol) for patients with knee osteoarthritis (OA) immediately before intra-articular injection (IAI) relative to procedure tolerance and its effectiveness in the immediate, short and medium terms.

METHODS: This was a randomized controlled trial. Patients received IAIs with triamcinolone hexacetonide (40 mg) preceded or not by the SPIKES protocol. The outcomes measured were: visual analogue scale for pain at rest, pain on movement and joint swelling; morning stiffness; Western Ontario McMaster Universities Index Functional Questionnaire (WOMAC); pain catastrophizing scale; McGill pain questionnaire; SF-36 questionnaire on quality of life; Trace State Anxiety Inventory (IDATE); and a Timed Up and Go functional test.

RESULTS: One hundred patients were randomized in the user embracement group (n = 50) or the control group (n = 50); 89% were women and 60% white, mean age was 67.1 (±7.3) years, and mean disease time was 6.3 (±6.2) years. No statistically significant differences were found between the groups for any variables at pre-procedure time, nor did the groups differ in their tolerance to the procedure or during the 12 weeks of follow up for any evaluated variables.

CONCLUSIONS: No benefit was identified by applying a user embracement protocol to patients with knee OA prior to IAI with corticosteroid, neither to tolerance at the time of the procedure nor to its effectiveness in the immediate, short, and medium terms.

PMID:33740751 | DOI:10.1016/j.knee.2021.01.002

J Neurosurg Pediatr. 2021 Mar 19:1-8. doi: 10.3171/2020.9.PEDS20748. Online ahead of print.

ABSTRACT

OBJECTIVE: The role of tunneling an external ventricular drain (EVD) more than the standard 5 cm for controlling device-related infections remains controversial.

METHODS: This is a randomized, double-blind, 3-arm controlled trial done in the Children’s Medical Center in Tehran, Iran. Pediatric patients (< 18 years old) with temporary hydrocephalus requiring an EVD and no evidence of CSF infection or prior EVD insertion were enrolled. Patients were randomly assigned (1:1:1) into the following arms: 5-cm (standard; group A); 10-cm (group B); or 15-cm (group C) EVD tunnel lengths. The investigators, parents, and person performing the analysis were masked. The surgeon was informed of the length of the EVD by the monitoring board just before operation. Patients were followed until the EVD’s fate was established. Infection rate and other complications related to EVDs were assessed.

RESULTS: A total of 105 patients were enrolled in three random groups (group A = 36, group B = 35, and group C = 34). The EVD was removed because there was no further need in most cases (67.6%), followed by conversion to a new EVD or ventriculoperitoneal shunt (15.2%), infection (11.4%), and spontaneous discharge without further CSF diversion requirement (5.7%). No statistical difference was found in infection rate (p = 0.47) or EVD duration (p = 0.81) between the three groups. No group reached the efficacy point sooner than the standard group (group B: hazard ratio 1.21, 95% CI 0.75-1.94, p = 0.429; group C: hazard ratio 1.03, 95% CI 0.64-1.65, p = 0.91).

CONCLUSIONS: EVD tunnel lengths of 5 cm and longer did not show a difference in the infection rate in pediatric patients. Indeed, tunneling lengths of 5 cm and greater seem to be equally effective in preventing EVD infection. Clinical trial registration no.: IRCT20160430027680N2 (IRCT.ir).

PMID:33740757 | DOI:10.3171/2020.9.PEDS20748

J Trauma Acute Care Surg. 2021 Apr 1;90(4):738-743. doi: 10.1097/TA.0000000000003062.

ABSTRACT

INTRODUCTION: As the prevalence of geriatric trauma patients has increased, protocols are being developed to address the unique requirements of this demographic. However, categorical definitions for geriatric patients vary, potentially creating confusion concerning which patients should be cared for according to geriatric-specific standards. The aim of this study was to identify data-driven cut points for mortality based on age to support implementation of age-driven guidelines.

METHODS: Adults aged 18 to 100 years with blunt or penetrating injury were selected from 95 hospitals’ trauma registries. Change point analysis techniques were used to detect inflection points in the proportion of deaths at each age. Based on these calculated points, patients were allocated into age groups, and their characteristics and outcomes were compared. Logistic regression was used to estimate risk-adjusted in-hospital mortality controlling for sex, race, Injury Severity Score, Glasgow Coma Scale, and number of comorbidities.

RESULTS: A total of 255,099 patients were identified (female, 45.7%; mean age, 59.3 years; mean Injury Severity Score, 8.69; blunt injury, 92.6%). Statistically significant increases in mortality rate were noted at ages 55, 77, and 82 years. Compared with the referent group (age, <55 years), adjusted odds ratios (AORs) showed increases in mortality if age 55 to 76 years (AOR, 2.42), age 77 to 81 years (AOR, 4.70), or age 82 years or older (AOR, 6.43). National Trauma Data Standard-defined comorbidities significantly increased once age surpassed 55 years, as the rate more than doubled for each of the older age categories (p < 0.001). As age increased, each group was more likely to be female, have dementia, sustain a ground level fall, and be discharged to a skilled nursing facility (p < 0.001).

CONCLUSION: This large multicenter analysis established a clinically and statistically significant increase in mortality at ages 55, 77, and 82 years. This research strongly suggests that trauma patients older than 55 years be considered for inclusion in geriatric trauma protocols. The other age inflection points identified (77 and 82 years) may also warrant additional specialized care considerations.

LEVEL OF EVIDENCE: Epidemiological study, level III; Care management, level IV.

PMID:33740785 | DOI:10.1097/TA.0000000000003062

Psychiatr Pol. 2020 Dec 31;54(6):1091-1107. doi: 10.12740/PP/OnlineFirst/111932. Epub 2020 Dec 31.

ABSTRACT

OBJECTIVES: The objective of the study was to evaluate the prevalence and severity of anxiety and depression in patients with primary hyperparathyroidism (PHPT), and to determine a relationship between the severity of these disorders and the serum calcium ion and parathyroid hormone level, as well as to evaluate the usefulness of self-rating scales in screening for depressive disorders in PHPT patients.

METHODS: Using the 17-item Hamilton Depression Rating Scale (HAM-D), Beck Depression Inventory-II (BDI-II) and Hospital Anxiety and Depression Scale (HADS), study was performed on a group of 101 patients with PHPT. A control group included 50 patients diagnosed with non-toxic thyroid goiter.

RESULTS: The HAM-D indicated higher prevalence and severity of depressive symptoms in the whole population of patients and in women with PHPT. Such a relationship was not observed in men. The BDI-II indicated higher prevalence and severity of depressive symptoms in the whole population of patients and in women with PHPT. Such a relationship was not observed in men. The HADS did not show significant differences in the prevalence of depressive and anxiety symptoms between the study and control groups in the whole population and after taking into account the gender division.

CONCLUSIONS: A relationship between PHPT and depression was confirmed. Such a relationship was not confirmed for anxiety. A relationship between the severity of depression and the serum calcium ion and parathyroid hormone level was also not confirmed. A statistically significant negative correlation between the severity of anxiety and the serum calcium ion level in the whole population of patients, and an additional positive correlation between the serum parathyroid hormone level and the severity of anxiety in women were confirmed. Self-rating tests are not sufficient for screening for depressive disorders in PHPT patients.

PMID:33740798 | DOI:10.12740/PP/OnlineFirst/111932

Parkinsonism Relat Disord. 2021 Mar 13;85:52-56. doi: 10.1016/j.parkreldis.2021.03.010. Online ahead of print.

ABSTRACT

INTRODUCTION: Cognitive impairment has now been recognised to be present in patients with several of spinocerebellar ataxias (SCAs). Cognitive impairment in patients with spinocerebellar ataxia type 12 has not been evaluated.

OBJECTIVE: To evaluate the cognitive impairment in patients diagnosed with spinocerebellar ataxia type 12 (SCA12).

METHODS: We conducted a cross sectional study and enrolled 30 (20 male and 10 female) genetically confirmed SCA12 patients and 30 healthy, age, gender and education matched individuals as controls. Cognitive domains were tested using a battery of validated neurocognitive tests.

RESULT: Mean age of patients was 51.6 ± 8.0 years and mean disease duration was 5.3 ± 3.0 years. Mean International Cooperative Ataxia Rating Scale (ICARS) score was 29.8 ± 12.5. SCA 12 patients scored significantly lower than controls in executive function and new learning ability. Other tested cognitive domains were also affected but did not reach statistical significance. Age, age at onset, severity of ataxia, disease duration and CAG repeat length did not correlate with cognitive impairment.

CONCLUSION: Cognitive impairment is a part of the spectrum of SCA12 and is characterized by dysfunction in executive function and new learning ability even early in the course of disease.

PMID:33740701 | DOI:10.1016/j.parkreldis.2021.03.010

Nurse Educ Today. 2021 Mar 11;100:104865. doi: 10.1016/j.nedt.2021.104865. Online ahead of print.

ABSTRACT

BACKGROUND: Inter Professional Education and Collaboration (IPEC) is grounded on mutual respect, enhances collaborative practice, and increases satisfaction among health care professionals.

PURPOSE: The study was conducted to assess the level of knowledge and readiness for IPEC among nursing students.

METHODS: The student’s level of knowledge was assessed using a 20 item questionnaire while their readiness for IPEC was measured using the Readiness for Interprofessional Learning Scale (RIPLS) comprising 19 items. A total of 125 nursing students participated in the study and data was analyzed using Statistical Package for the Social Sciences (SPSS) version 25 DISCUSSION: The mean level of knowledge was 44.41 with SD of 4.72. The mean readiness score was 79.09 with the SD of 11.77. There is no significant association between the knowledge and readiness of nursing students regarding IPEC and their demographic variables at 0.05 confidence level.

CONCLUSIONS: Majority of the students had moderately adequate knowledge about IPEC and high level of readiness towards IPEC. This implies that when appropriately implemented, the students will reap the benefits of IPEC, which has the potential to improve their ability to provide holistic nursing care to their patients.

PMID:33740703 | DOI:10.1016/j.nedt.2021.104865

Respir Med. 2021 Mar 13;180:106368. doi: 10.1016/j.rmed.2021.106368. Online ahead of print.

ABSTRACT

INTRODUCTION: Pulmonary function tests (PFTs) are the main objective measures used to assess asthma in children. However, PFTs provide a global measure of lung function. Hyperpolarised xenon-129 magnetic resonance imaging (129Xe-MRI) can assess lung function spatially. This cross-sectional cohort study aimed to evaluate the use of 129Xe-MRI in detecting ventilation abnormalities in children with well-controlled severe asthma pre- and post-bronchodilator (BD).

METHOD: Six healthy children (aged 11 ± 3) and six with well-controlled severe asthma (14 ± 1) underwent spirometry, multiple breath washout (MBW), and 129Xe-MRI. These tests were repeated post-BD in the asthma cohort. Image analysis was performed in MATLAB. Wilcoxon signed-rank test, repeated measures analysis of variance (ANOVA), and Spearman’s rank correlation coefficient were used for statistical analysis.

RESULTS: A significantly higher number of ventilation defects were found in the asthma cohort pre-BD compared to the healthy participants and post-BD within the asthma cohort (p = 0.02 and 0.01). A greater number of wedge-shaped defects were detected in the asthma cohort pre-BD compared to healthy participants and post-BD within the asthma cohort (p = 0.01 and 0.008, respectively). 129Xe ventilation defect percentage (VDP) and coefficient of variation (CoV) were significantly higher in the asthma cohort pre-BD compared to the healthy cohort (p = 0.006 for both). VDP and CoV were reduced significantly post-BD in the asthma cohort, to a level where there was no longer a significant difference between the two cohorts.

CONCLUSION: 129Xe-MRI is a sensitive marker of ventilation inhomogeneity in paediatric severe asthma and may potentially be used as a biomarker to assess disease progression and therapeutic response.

PMID:33740737 | DOI:10.1016/j.rmed.2021.106368

Environ Pollut. 2021 Mar 9;278:116872. doi: 10.1016/j.envpol.2021.116872. Online ahead of print.

ABSTRACT

This study reports the shapes, dimensional classes, types and counts of microplastics (MPs) found in 23 individuals of N. norvegicus collected from two wild populations of the Adriatic Sea (Mediterranean basin). The focus was on three different anatomical compartments (gut, hepatopancreas and tail), which were analysed separately. MPs were found in all the investigated individuals with an average of about 17 MPs/individual. Fragments were predominant over fibers with a ratio of about 3:1. The majority of MPs were in the dimensional range 50-100 μm. The predominant polymers were polyester, polyamide 6, polyvinyl chloride and polyethylene, which together constitute about 61% of all the MPs found. Fragments were more concentrated in the hepatopancreas, with no significant difference between gut and tail, while fibers were more concentrated in the gut than in the tail with hepatopancreas somehow in between. The dimensional class of the MPs influences their anatomical distribution. There were no statistical differences among individuals from the two sampling sites. Sex of the individual did not influence the level of retained MPs, while length had a very marginal effect. The information reported here contributes to understanding of the possible risks linked to human consumption of different tissues from contaminated Norway lobsters.

PMID:33740599 | DOI:10.1016/j.envpol.2021.116872