Tag: pubmed

Updates Surg. 2023 Oct 13. doi: 10.1007/s13304-023-01666-6. Online ahead of print.

ABSTRACT

Seroma formation is one of the important postoperative problems in inguinal hernia surgery, especially after scrotal hernia surgery. The present study aimed to present primarily the incidence of seroma after reduction and transection of the hernia sac in endo-laparoscopic scrotal hernia repair, and secondarily the results of early postoperative complications. Patients were divided into two groups TAPP and TEP. These groups were also divided into transection and reduction subgroups. In the reduction group, the hernia sac was completely dissected and pulled to the peritoneal area, while in the transection group, the neck of the hernia sac was cut by ligating, and its distal part was fixed to the posterior abdominal wall. The groups were compared, and data were analyzed. The reduction was performed in 13 (43.33%) of the 30 patients included in the study, and transection in 17 (56.67%). Seroma developed in 2 (15.38%) of the reduction group and 7 (41.18%) of the transection group. There was no statistical difference between the groups (p = 0.229). Cord and testicular complications were seen in 6 (20%) patients, 5 (38.46%) in the reduction group, and 1 (5.88%) in the transection group. No statistical difference was detected between the groups (p = 0.061). Although not statistically significant, seroma was more common in transection, while cord and testicular complications were more common in reduction. If dissection of the hernia sac is difficult, the complete reduction should not be insisted on, and the neck of the sac should be transection by ligating, and its distal part should be fixed to the posterior abdominal wall.

PMID:37831327 | DOI:10.1007/s13304-023-01666-6

Brain Topogr. 2023 Oct 13. doi: 10.1007/s10548-023-01013-3. Online ahead of print.

ABSTRACT

We applied diffusion-tensor imaging (DTI) including measurements of fractional anisotropy (FA), a parameter of neuronal fiber integrity, mean diffusivity (MD), a parameter of brain tissue integrity, as well as voxel-based morphometry (VBM), a measure of gray and white matter volume, to provide a basis to improve our understanding of the neurobiological basis of dependent personality disorder (DPD). DTI was performed on young girls with DPD (N = 17) and young female healthy controls (N = 17). Tract-based spatial statistics (TBSS) were used to examine microstructural characteristics. Gray matter volume differences between the two groups were investigated using voxel-based morphometry (VBM). The Pearson correlation analysis was utilized to examine the relationship between distinct brain areas of white matter and gray matter and the Dy score on the MMPI. The DPD had significantly higher fractional anisotropy (FA) values than the HC group in the right retrolenticular part of the internal capsule, right external capsule, the corpus callosum, right posterior thalamic radiation (include optic radiation), right cerebral peduncle (p < 0.05), which was strongly positively correlated with the Dy score of MMPI. The volume of gray matter in the right postcentral gyrus and left cuneus in DPD was significantly increased (p < 0.05), which was strongly positively correlated with the Dy score of MMPI (r_1,2= 0.467,0.353; p_1,2 = 0.005,0.04). Our results provide new insights into the changes in the brain structure in DPD, which suggests that alterations in the brain structure might implicate the pathophysiology of DPD. Possible visual and somatosensory association with motor nerve circuits in DPD.

PMID:37831323 | DOI:10.1007/s10548-023-01013-3

Eur J Health Econ. 2023 Oct 13. doi: 10.1007/s10198-023-01630-6. Online ahead of print.

ABSTRACT

BACKGROUND: A Pay-for-Performance (P4P) programme, known as Prescribed Specialised Services Commissioning for Quality and Innovation (PSS CQUIN), was introduced for specialised services in the English NHS in 2013/2014. These services treat patients with rare and complex conditions. We evaluate the implementation of PSS CQUIN contracts between 2016/2017 and 2018/2019.

METHODS: We used a mixed methods evaluative approach. In the quantitative analysis, we used a difference-in-differences design to evaluate the effectiveness of ten PSS CQUIN schemes across a range of targeted outcomes. Potential selection bias was addressed using propensity score matching. We also estimated impacts on costs by scheme and financial year. In the qualitative analysis, we conducted semi-structured interviews and focus group discussions to gain insights into the complexities of contract design and programme implementation. Qualitative data analysis was based on the constant comparative method, inductively generating themes.

RESULTS: The ten PSS CQUIN schemes had limited impact on the targeted outcomes. A statistically significant improvement was found for only one scheme: in the clinical area of trauma, the incentive scheme increased the probability of being discharged from Adult Critical Care within four hours of being clinically ready by 7%. The limited impact may be due to the size of the incentive payments, the complexity of the schemes’ design, and issues around ownership, contracting and flexibility.

CONCLUSION: The PSS CQUIN schemes had little or no impact on quality improvements in specialised services. Future P4P programmes in healthcare could benefit from lessons learnt from this study on incentive design and programme implementation.

PMID:37831298 | DOI:10.1007/s10198-023-01630-6

Neurosurg Rev. 2023 Oct 13;46(1):268. doi: 10.1007/s10143-023-02178-y.

ABSTRACT

Following meningioma removal, there are numerous methods available for reconstructing the orbital wall. This systematic review seeks to summarize the published data on the surgical treatment of cranioorbital meningiomas, and to analyze the effectiveness and safety of various techniques and materials used for the reconstruction of bony orbital walls. We conducted a search of the two databases and included original articles with a series of 10 or more cases. Descriptive statistics and meta-analysis of individual patient date were performed. The analysis included a total of 858 patients from 29 sources. No reconstruction of the orbital walls was performed in 525 patients (61.2%), while 333 observations (38.8%) involved resection followed by reconstruction. A relative improvement in eye position was achieved in 94.4% of cases with a 95% CI of (88.92%; 97.25%). However, normalization of eye position, regardless of reconstruction technique, was only present in 6.22% of cases with a 95% CI of (1.24%; 25.9%). The best results were observed with the use of autologous bone implants (64%, 95% CI [33.35%; 86.33%]) and titanium implants (55.78%, 95% CI [2.86%; 98.18%]). In cases of endoscopic resection and microsurgical resection without reconstruction, symmetrical eye position accounted for only 1.94% (95% CI [0%; 96.71%]) and 2.35% (95% CI [0.13%; 31.23%]), respectively. The frequency of normalization of eye position differed significantly (p < 0.01) among the subgroups. A total of 49 postoperative complications were registered, with wound infection (1.52%, 95% CI [0.86%; 2.65%]) and wound cerebrospinal fluid leak (1.32%, 95% CI [0.6%; 2.91%]) being the most frequent. No significant differences were found in the rates of complications among the different subgroups. One of the primary objectives of cranioorbital meningioma surgery is to correct the position of the eye. Simultaneous reconstruction of the bony orbital leads to better cosmetic outcomes. Postoperative complications did not depend on the reconstructive technique or the materials.

PMID:37831295 | DOI:10.1007/s10143-023-02178-y

Environ Monit Assess. 2023 Oct 13;195(11):1308. doi: 10.1007/s10661-023-11875-6.

ABSTRACT

The extent of aquatic pollution of Karachi Port Trust (KPT) coastal area located at the south of Pakistan coast has increased considerably in the last few decades due to unrestricted discharge of sanitary waste. The current study lays emphasis on the identification of vulnerable zones severely impacted by pollution in the KPT coastal area using laboratory monitoring, geospatial techniques, and statistical analysis. During 2019, sampling was conducted along the KPT coastal area, and 54 samples of seawater were collected during pre- and post-monsoon seasons. The outcomes of physical and chemical analysis revealed that the concentrations of BOD (biochemical oxygen demand), COD (chemical oxygen demand), nitrate, phosphate, phenol, cyanide, and oil and grease frequently exceeded the permitted limit of international norms and reached much greater levels. The levels of perilous metals in the seawater samples were in the order Ni>Cr>Cu>Pb>Cd>As in both phases and also reached to elevated levels as a consequence of the indiscriminate discharge of untreated industrial and domestic wastewater. Based on detailed examination during pre- and post-monsoon, six sites near KPT, Lyari River outfall, and Karachi Harbour were identified as highly polluted zones due to heavy discharge of sanitary effluents at these sites. In particular, the industrial zones present in the formal and informal sectors of Karachi are responsible for the deterioration of the KPT coastal area. Therefore, it is advised to design and build a submerged drainage system to transport and distribute massive amounts of treated municipal and industrial waste to the deep open sea in order to minimize the high pollutant levels in these locations.

PMID:37831294 | DOI:10.1007/s10661-023-11875-6

Environ Monit Assess. 2023 Oct 13;195(11):1314. doi: 10.1007/s10661-023-11912-4.

ABSTRACT

Underwater soundscape that spans a broad frequency band shows variability consistent with contributing noise sources and ocean environment. However, increased anthropogenic activities result in noise proliferation which can harm natural marine habitat. Continuous monitoring of background sound is useful to assess such spatio-temporal variability of soundscape. Standard noise level metrics, for instance, mean (μ), 90th percentiles (90P), standard deviation (σ), and kurtosis (β), are constructed from noise field measured from three coastal stations in Eastern Arabian Sea. These metrics are found to be suitable to describe the soundscape variability with respect to season, frequency, and depth. Mean and 90P are used to compare the seasonal variations while kurtosis metrics are exercised to check the impulsive nature of composite signal. Histogram representation and probability density function (PDF) were utilized to analyze the spectral variation in soundscape with respect to season. Analysis was carried out at 500-ms temporal window in two spectral bands corresponding to traffic and wind noise fields. Seasonal analysis shows that in summer, mean noise level decreases as hydrophone depth increases, while in winter, deeper depths have higher mean value with the presence of seasonal surface duct. This implication of sound speed profile on noise field has also been confirmed using appropriate noise model.

PMID:37831220 | DOI:10.1007/s10661-023-11912-4

Eur Phys J E Soft Matter. 2023 Oct 13;46(10):97. doi: 10.1140/epje/s10189-023-00355-x.

ABSTRACT

Strongly charged polyelectrolytes (PEs) demonstrate complex solution behavior as a function of chain length, concentrations, and ionic strength. The viscosity behavior is important to understand and is a core quantity for many applications, but aspects remain a challenge. Molecular dynamics simulations using implicit solvent coarse-grained (CG) models successfully reproduce structure, but are often inappropriate for calculating viscosities. To address the need for CG models which reproduce viscoelastic properties of one of the most studied PEs, sodium polystyrene sulfonate (NaPSS), we report our recent efforts in using Bayesian optimization to develop CG models of NaPSS which capture both polymer structure and dynamics in aqueous solutions with explicit solvent. We demonstrate that our explicit solvent CG NaPSS model with the ML-BOP water model [Chan et al. Nat Commun 10, 379 (2019)] quantitatively reproduces NaPSS chain statistics and solution structure. The new explicit solvent CG model is benchmarked against diffusivities from atomistic simulations and experimental specific viscosities for short chains. We also show that our Bayesian-optimized CG model is transferable to larger chain lengths across a range of concentrations. Overall, this work provides a machine-learned model to probe the structural, dynamic, and rheological properties of polyelectrolytes such as NaPSS and aids in the design of novel, strongly charged polymers with tunable structural and viscoelastic properties.

PMID:37831216 | DOI:10.1140/epje/s10189-023-00355-x

Egypt Heart J. 2023 Oct 13;75(1):87. doi: 10.1186/s43044-023-00414-w.

ABSTRACT

BACKGROUND: Dynamic functional substrate mapping of scar-related ventricular tachycardia offers better identification of ablation targets with limited ablation lesions. Several functional substrate mapping approaches have been proposed, including decrement-evoked potential (DEEP) mapping. The aim of our study was to compare the short- and long-term efficacy of a DEEP-guided versus a fixed-substrate-guided strategy for the ablation of scar-related ventricular tachycardia (VT).

RESULTS: Forty consecutive patients presenting for ablation of scar-related VT were randomized to either DEEP-guided or substrate-guided ablation. Late potentials were tagged and ablated in the non-DEEP group, while those in the DEEP group were subjected to RV extrastimulation after a drive train. Only potentials showing significant delay were ablated. Patients were followed for a median duration of 12 months. Twenty patients were allocated to the DEEP group, while the other 20 were allocated to the non-DEEP group. Twelve patients (60%) in the DEEP group had ischemic cardiomyopathy versus 10 patients (50%) in the non-DEEP group (P-value 0.525). Intraoperatively, the median percentage of points with LPs was 19% in the DEEP group and 20.6% in the non-DEEP group. The procedural time was longer in the DEEP group, approaching but missing statistical significance (P-value 0.059). VT non-inducibility was successfully accomplished in 16 patients (80%) in the DEEP group versus 17 patients (85%) in the non-DEEP group (P value 0.597). After a median follow-up duration of 12 months, the VT recurrence rate was 65% in both groups (P value 0.311), with a dropout rate of 10% in the DEEP group. As for the secondary endpoints, all-cause mortality rates were 20% and 25% in the DEEP and non-DEEP groups, respectively (P-value 0.342).

CONCLUSIONS: DEEP-assisted ablation of scar-related ventricular tachycardia is a feasible strategy with comparable short- and long-term outcomes to a fixed-substrate-based strategy with more specific ablation targets, albeit relatively longer but non-significant procedural times and higher procedural deaths. The imbalance between the study groups in terms of epicardial versus endocardial mapping, although non-significant, warrants the prudent interpretation of our results. Further large-scale randomized trials are recommended.

TRIAL REGISTRATION: clinicaltrials.gov, registration number: NCT05086510, registered on 28th September 2021, record https://classic.

CLINICALTRIALS: gov/ct2/show/NCT05086510.

PMID:37831212 | DOI:10.1186/s43044-023-00414-w

Lasers Med Sci. 2023 Oct 13;38(1):233. doi: 10.1007/s10103-023-03900-4.

ABSTRACT

Myofascial pain dysfunction syndrome (MPDS) is one of the most common sources of orofacial pain. There are different types of physical therapy for patients with MPDS, but there is insufficient evidence that any one treatment method is superior. This study aimed to compare the clinical efficacy of transcutaneous electrical nerve stimulation (TENS) and laser acupuncture (LA) using a 940-nm diode on MPDS improvement. In this randomized clinical trial, 22 MPDS patients were randomly assigned to TENS (180 HZ, 300 µs, 20 min) and LA (940 nm, continuous wave, 0. 5 w, 40 s, 105 J/cm2) groups. Data on overall facial pain, tenderness in the masticatory muscles, deviation, joint sound, and maximum mouth opening without pain (MMO) were collected from all patients at baseline, before and after each treatment session, and 1 month after the end session. Data were analyzed using an independent t-test, repeated measures ANOVA, and Fisher’s exact test at a significance level of P < 0.05. The decreases in overall facial pain (P = 0.000), muscle tenderness (P = 0.000), and increase in MMO (P = 0.01, P = 0.001) were statistically significant compared to the baseline in the TENS and AL groups. No significant differences were detected between TENS and LA for overall facial pain, muscle tenderness, or MMO at 1 month follow-up (P > 0.05). Both LA and TENS are effective physical therapies with promising effects on sign and symptom improvements in MPDS patients.

PMID:37831208 | DOI:10.1007/s10103-023-03900-4

J Burn Care Res. 2023 Oct 13:irad156. doi: 10.1093/jbcr/irad156. Online ahead of print.

ABSTRACT

Indocyanine green angiography (ICGA) has been widely employed for quantitative evaluation of the rat comb burn model, but the imaging equipment, imaging protocol, and fluorescence data interpretation of ICGA remain unsatisfactory. The aim of this study is to provide better solutions for the application of ICGA on perfusion analysis. The rat comb burn model was established under a series of different comb contact durations including 10, 20, 25, 30, 35, and 40 s. ICGA was used to analyze wound perfusion. Sixteen rats were divided into ibuprofen and control groups for the burn model, and their perfusion was compared. Sixteen identical models were divided into standard and high-dose ICG groups, and ICGA was conducted to investigate the dynamic change in wound fluorescence. Escharectomy was performed under real-time fluorescence mapping and navigation. The results showed that a comb contact duration of 30 s was optimum for the burn model. ICGA could accurately evaluate the histologically determined depth of thermal injury and wound perfusion in the rat comb model. Digital subtraction of residual fluorescence was necessary for multiple comparisons of perfusion. Dynamic changes in fluorescence and necrotic tissues were observed more clearly by high-dose (0.5 mg/kg) ICG in angiography. In conclusion, perfusion analysis by ICGA can be used to assess the histologically determined depth of thermal injury and the impact of a specific treatment on wound perfusion. ICGA can help to identify necrotic tissue. Above findings and related imaging protocols lay the foundation for future research.

PMID:37830308 | DOI:10.1093/jbcr/irad156