Tag: pubmed

Int J Pediatr Otorhinolaryngol. 2021 Mar 10;144:110674. doi: 10.1016/j.ijporl.2021.110674. Online ahead of print.

ABSTRACT

INTRODUCTION: Tonsillar microenvironment is thought to contribute to innate immune dysregulation responsible for the periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) because of beneficial effects of tonsillectomy on treatment of the syndrome. Accordingly previous studies reported altered lymphocyte frequency, cytokine level and microbial composition in PFAPA tonsils. The aim of our study is to monitor expression levels of pro-inflammatory cell surface Toll-like receptors (TLRs) which have important role in induction of inflammation and maintaining tissue haemostasis.

MATERIALS AND METHODS: Seven patients with PFAPA syndrome, and eight patients with group A beta-hemolytic streptococcal (GAβHS) recurrent tonsillitis were included in our study. Tonsillar expression levels of TLR-1, -2, -4, -5, and -6 were monitored by immunohistochemistry (IHC). Expression levels were scored using semi-quantitative analysis method and were statistically analyzed by Two-Way Repeated Measures Analysis of Variance test.

RESULTS: IHC analysis demonstrated expression of all TLRs in tonsillar surface epithelium (SE) and lymphoid interior (LI) except for TLR-6 which was not present in the former. There has not been any statistically significant difference in TLR expression levels between PFAPA and GAβHS tonsils, except for TLR-1 and TLR-2 which were higher on LI and lower on SE of PFAPA tonsils, respectively, than that of the GAβHS samples.

CONCLUSIONS: Altered TLR expression levels may be involved in PFAPA pathogenesis. Future studies with higher patient number, uninflamed tonsils and cellular markers are required to further enlighten the role of TLRs in the development of syndrome.

PMID:33725589 | DOI:10.1016/j.ijporl.2021.110674

Shock. 2021 Jan 20. doi: 10.1097/SHK.0000000000001728. Online ahead of print.

ABSTRACT

BACKGROUND: Supplemental oxygen is administered routinely in the clinical setting to relieve or prevent tissue hypoxia, but excessive exposure may induce oxidative damage or disrupt essential homeostatic functions. It is speculated that oxidative stress in leukocytes and platelets may contribute to vascular diseases by promoting inflammation and cell aggregation.

METHODS: In this pilot study thirty healthy male volunteers (18 to 65 years) were exposed to high oxygen concentration (non-rebreather mask, 8L/min, 100% O2) and synthetic air (non-rebreather mask, 8L/min, 21% O2) in a cross-over design for 20 min at a 3-week interval. Venous blood samples were obtained at baseline and 1, 3 and 6 h post-intervention. Primary outcome was generation of reactive oxygen species in leukocytes as measured by the redox-sensitive fluorescent dye dihydrorhodamine 123. Additional outcomes were oxidative stress in platelets and platelet aggregation as measured by thromboelastography (ROTEM®) and Multiplate analyses.

FINDINGS: High oxygen exposure induced oxidative stress in leukocytes as evidenced by significantly higher mean fluorescence intensity (MFI) compared with synthetic air at 3 hours post-intervention (47% higher, P = 0.015) and 6 h post-intervention (37% higher, P = 0.133). Oxidative stress was also detectable in platelets (33% higher MFI in comparison with synthetic air at 6 h, P = 0.024; MFI 20% above baseline at 3 h, P = 0.036; 37% above baseline at 6 h, P = 0.002). ROTEM® analyses demonstrated reduced mean clotting time 1 h post-intervention compared with baseline (-4%, P = 0.049), whereas there were no significant effects on other surrogate coagulation parameters.

CONCLUSION: Clinically relevant oxygen exposure induces oxidative stress in leukocytes and platelets, which may influence the immune and clotting functions of these cells.

PMID:33725433 | DOI:10.1097/SHK.0000000000001728

Clin Neurol Neurosurg. 2021 Mar 11;203:106597. doi: 10.1016/j.clineuro.2021.106597. Online ahead of print.

ABSTRACT

OBJECTIVES: Intra-operative fluorescein video angiography (FL-VA) has been given increasing attention recently and several studies reported its high utility in neurovascular surgery. The aim of this study was to evaluate the safety of FL-VA in a prospective, single-center cohort of patients operated due to cerebral aneurysms.

PATIENTS AND METHODS: This is an observational cohort study including 150 patients operated due to intracranial aneurysms. The study group consisted of 70 consecutive patients operated with the use of fluorescein video angiography. Post-operative acute kidney injury (AKI) occurrence as well as systemic adverse reactions were reported and further compared with 80 matched controls where FL-VA was not used. Statistical analysis was performed using non-parametric tests (Fisher’s exact test).

RESULTS: Post-operative AKI was observed in 17,1% of patients in the study group with only half presenting with acute functional impairment. All of these patients presented initially due to aneurysm rupture. Pre-existing renal dysfunction and hypertension occurred in 16,7% and 33,3%, respectively. No systemic complications following FL-VA were reported. When compared to matched controls, no statistically significant difference regarding AKI occurrence was observed between these two patient populations.

CONCLUSION: Intra-operative fluorescein video angiography proved to have a good safety profile in our cohort. The results of this study suggest that post-operative acute kidney injury observed in patients with subarachnoid hemorrhage is not related to fluorescein use.

PMID:33725507 | DOI:10.1016/j.clineuro.2021.106597

Seizure. 2021 Mar 3;87:75-80. doi: 10.1016/j.seizure.2021.02.032. Online ahead of print.

ABSTRACT

PURPOSE: To assess the spike characteristics and temporal spike evolution on serial EEG of children with childhood epilepsy with centrotemporal spikes (CECTS) treated with anti-seizure medication.

METHODS: The study cohort consisted of 127 children with CECTS divided into three groups based on anti-seizure medication responsiveness: group I: seizure-free with monotherapy (n: 61, 48%), group II: seizure-controlled with monotherapy (n: 52, 41%) and group III: seizure-controlled with dual therapy (n: 14, 11%). The clinical profiles and sequential four-year follow-up visual EEG recordings of the children were evaluated. Each EEG was reanalyzed with three spike characteristics on the epochs: (1) spike-wave rate, (2) spike topography, and (3) spike localization. We calculated the spike clearance velocity, which is defined as a decrease in the spike-wave rate over time in four-year sequential follow-up EEGs.

RESULTS: There was no statistical significance across the study groups with respect to initial EEG spike characteristics (spike-wave rate, spike localization, and spike topography). Seizure recurrence occurred in 15 patients (12.8%) who discontinued anti-seizure medication. There was no statistically significant difference between the spike characteristics on EEG just before the discontinuation of anti-seizure medication and seizure recurrence. However, the spike clearance velocity was significantly slower in group III than in group I in four-year sequential follow-up EEGs (p = 0.002). A statistically significant decrease in the mean spike-wave rate was observed in group I in the first year of anti-seizure medication (p<0.001). The spike clearance velocity was also more prominent during the second year of treatment in group II and the third year of treatment in group III. However, the spike clearance velocity was not different across the anti-seizure medication groups (oxcarbazepine, valproic acid, and levetiracetam).

CONCLUSION: Spike clearance velocity might be a valuable EEG marker to guide anti-seizure medication in children with CECTS.

PMID:33725524 | DOI:10.1016/j.seizure.2021.02.032

Lung Cancer. 2021 Mar 10;155:46-52. doi: 10.1016/j.lungcan.2021.03.003. Online ahead of print.

ABSTRACT

BACKGROUND: Participation in lung cancer CT-screening can be associated with a need for follow-up procedures. The screening and waiting for test results introduce the risk of experiencing psychosocial consequences. Therefore, the aims of this study were: 1) To investigate if the psychosocial consequences changed from before an annual screening round to before a three-month follow-up CT-scan in participants with a positive screening result. 2) To investigate potential differences in psychosocial consequences between false positives (FP) and true positives (TP). FP were defined as those where cancer was not confirmed in the follow-up CT-scan and TP where it was.

MATERIALS AND METHODS: This longitudinal study was based on data from the Danish Lung Cancer Screening Trial (DLCST). The Consequences of Screening – Lung cancer (COS-LC) questionnaire was used to measure psychosocial consequences among 130 participants who all received an abnormal CT-screening result at their annual screening round. Eligible participants completed the COS-LC before their annual CT-screening and before the three-month follow-up.

RESULTS: We found a statistically significant increase in negative psychosocial consequences between the annual lung cancer CT-screening and the three-month follow-up CT-scan in four of nine psychosocial scales; Sense of dejection, Self-blame, Focus on airway symptoms and Harm of smoking. Furthermore, an increase, however not statistically significant, was identified in all remaining scales, except for the scale Stigmatisation which was slightly decreased. We found no evidence of an association between psychosocial consequences and diagnostic groups, FP and TP.

CONCLUSIONS: An increase in negative psychosocial consequences was observed between the annual lung cancer CT-screening and the three-month follow-up CT-scan. Since we found no statistically significant difference between the diagnostic groups, the increase in negative psychosocial consequences is interpreted as a nocebo effect of living three months in uncertainty not knowing if one’s positive CT-screening result was true or false.

PMID:33725548 | DOI:10.1016/j.lungcan.2021.03.003

Angew Chem Int Ed Engl. 2021 Mar 16. doi: 10.1002/anie.202102740. Online ahead of print.

ABSTRACT

Solid-state nuclear magnetic resonance (ssNMR) technique has received extensive attention in characterizing alkali-ion battery materials, due to it is highly sensitive for probing the local environment and dynamic information of atoms/ions. However, precise spectral assignment cannot be effectively carried out through conventional density functional theory (DFT) methodology for the high-rate battery materials at room temperature. Herein, combining DFT calculation of paramagnetic shift and deep potential molecular dynamics (DPMD) simulation to achieve the converged Na+ distribution at hundreds of nanoseconds, we obtain the statistically averaged paramagnetic shift which is in excellent agreement with ssNMR measurements. Accordingly, two 23Na shifts induced by different stacking sequences of transition metal layers are revealed in the fast chemically exchanged NMR spectra of P2-type Na2/3(Mg1/3Mn2/3)O2 for the first time. This new DPMD simulation auxiliary protocol presented in this work can be beneficial to a wide range of ssNMR analysis in the fast chemically exchanged material systems.

PMID:33725391 | DOI:10.1002/anie.202102740

Water Environ Res. 2021 Mar 16. doi: 10.1002/wer.1559. Online ahead of print.

ABSTRACT

Water scarcity in Egypt is an escalating challenge due to the ever-increasing water demands and limited resources. Economically, agricultural drainage water reuse in irrigation (ADWR) is an essential option to cope with freshwater shortage. However, it requires environmentally sound management to minimize possible risks on irrigated soils and human health. Consequently, this research aims at assessing and managing the reuse process by developing a statistically-based quality control model capable to investigate the observed and expected capability of the process. Additionally, complementary corrective actions and the decision models were proposed when the reuse processes operate in violation of the standards. These models were tested and validated using data collected from the year 2015 to 2019 at the Delengat pump station in the Western Nile Delta region which mixes the Delengat drain water with the El-Hager irrigation canal. After raising the awareness amongst the farmers and providing them adequate sanitation services, it was inferred that the ADWR process could provide safe drainage water to be mixed with fresh water. Based on the performed simulations, both models proved to be systematic, quantitative, suitable for computers, and helpful in making informed decisions concerning the sustainability of the reuse process under future water uncertainty.

PMID:33725400 | DOI:10.1002/wer.1559

Neuromodulation. 2021 Mar 16. doi: 10.1111/ner.13384. Online ahead of print.

ABSTRACT

OBJECTIVES: Patients eligible for spinal cord stimulation (SCS) generally experience excruciating pain, requiring more opioid consumption, which is usually an indication for SCS implantation. After final implantation, SCS has the ability to stabilize or decrease opioid usage in half of the patients. In this study, opioids were actively eliminated prior to implantation of any neuromodulation device with a standardized detoxification protocol. This pilot study aims to explore the feasibility, effectiveness, and safety of this opioid detoxification protocol prior to neuromodulation techniques.

MATERIALS AND METHODS: In this retrospective pilot study, 70 patients who were taking opioids and who were eligible for neuromodulation techniques, underwent the detoxification program. A combined in- and out-patient clinic protocol was applied, whereby clonidine was the main component of both parts of the program. A multidisciplinary team with pain physicians and psychologists was responsible for performing this detoxification program. Safety and feasibility were systematically recorded during the hospitalization.

RESULTS: No serious safety issues were reported. At the start of the program, patients reported a mild sedative effect of clonidine. Additionally, most patients presented mild symptoms of opioid withdrawal, which were partially countered by the sedative effect of clonidine. Both patients and the medical staff found this protocol feasible in clinical practice. Concerning the effectiveness, a statistically significant decrease in median morphine milligram equivalents (MMEs) was found with a MME of 175 (Q1-Q3: 118.1-240) at baseline and at the last available follow-up visit the MME was 0 (Q1-Q3: 0-16.88).

CONCLUSIONS: This standardized detoxification program has proven its effectiveness, safety, and feasibility in this single-center experience pilot study in patients eligible for neuromodulation techniques.

PMID:33725401 | DOI:10.1111/ner.13384

Acta Anaesthesiol Scand. 2021 Mar 16. doi: 10.1111/aas.13816. Online ahead of print.

ABSTRACT

BACKGROUND: We set out to examine incidence of chronic headache and back pain in women with PDPH after accidental dural puncture during labor.

METHODS: Chronic headache, backache and disability were assessed 18-24 months postpartum. Women with PDPH treated with epidural blood patch (PDPH-EBP) were identified and matched with women who had a PDPH without epidural blood patch (PDPH-no EBP), with women with uncomplicated epidural analgesia and with women without epidural analgesia. Our primary outcome was incidence of chronic headache and backache. Secondary outcome was the effect of epidural blood patch on chronic pain development. We used Chi-square or Fisher’s exact test to calculate odds ratios.

RESULTS: There was no statistically significant difference in demographic characteristics between groups. In the no epidural group, no women reported chronic headache, 2/116 (1.7%) reported chronic backache. In the uncomplicated epidural group, no women reported chronic headache, 7/116 (6.0%) reported chronic backache. In the PDPH-no EBP group 9/56 (16.1%) women reported chronic headache, 10/56 (17.9%) reported chronic backache. In the PDPH-EBP group, 12/59 (20.3%) had chronic headache, 14/59 (23.7%) had chronic backache. No women in the no epidural or uncomplicated epidural group reported disability (chronic pain score of 3 or 4). High disability was reported by 8.9% of women in the PDPH-no EBP group and by 8.4% in the PDPH-EBP group.

CONCLUSION: Women with PDPH had a high incidence of chronic headache, back pain and disability. We did not find a statistically significant difference in chronic pain development between conservatively treated and EBP treated patients.

PMID:33725362 | DOI:10.1111/aas.13816

Artif Organs. 2021 Mar 16. doi: 10.1111/aor.13954. Online ahead of print.

ABSTRACT

BACKGROUND: Prognosis of patients suffering of acute respiratory distress syndrome (ARDS) is poor. This is especially true for immunosuppressed patients. If these patients should receive veno-venous extracorporeal membrane oxygenation (VV ECMO) is discussed controversial while evidence on this topic is sparse.

METHODS: We report retrospective data of a single-centre registry of patients with severe ARDS requiring ECMO support between 10/2010 and 06/2019. Patients were analysed by their status of immunosuppression. ECMO weaning success and hospital survival were analysed before and after propensity score matching (PSM). Moreover, ventilator free days (VFD) were compared.

RESULTS: A total of 288 patients were analysed (age 55years, 67%male), 88 (31%) presented with immunosuppression. Survival rates were lower in immunosuppressed patients (27%vs.53%, p<0.001 and 27%vs.48% after PSM, p=0.006). VFD (60 days) were lower for patients with immunosuppression (11.9vs.22.4, p<0.001) and immunosuppression was an independent predictor for mortality in multivariate analysis. Hospital survival was 20%, 14%, 35% and 46% for patients with oncological malignancies, solid organ transplantation, autoimmune diseases and HIV, respectively.

CONCLUSION: In this analysis immunosuppression was an independent predictor for mortality. However, there were major differences in the weaning and survival rates between the aetiologies of immunosuppression which should be considered in decision making.

PMID:33725377 | DOI:10.1111/aor.13954