1
|
Roth C, Yavuz R, Maschita C, Ferbert A, Matthaei J. Chronic basilar artery occlusion: a retrospective monocentric study. J Neurol 2024:10.1007/s00415-024-12375-4. [PMID: 38676723 DOI: 10.1007/s00415-024-12375-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/05/2024] [Accepted: 04/07/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Acute basilar artery occlusion is a life-threatening medical emergency with a highly elevated mortality rate when left untreated. Little is known about symptoms and clinical progression of chronic occlusions. The aim of this study was to systematically analyze the clinical presentation of patients with chronic basilar artery occlusion (CBAO). METHODS Monocentric retrospective analysis of adult patients with CBAO was treated between 2015 and 2023 in the Department of Neurology, Klinikum Kassel. Inclusion criteria were basilar artery occlusion without brainstem infarction as well as patients with a basilar artery occlusion in whom revascularization could not be achieved and a follow-up period of at least 3 months. RESULTS A total of 15 patients were found. In five patients basilar artery occlusion was diagnosed as an incidental finding, four patients had neurological symptoms but no proven brainstem infarction (3 × transient ischemic attack, 1 × isolated posterior artery infarct) and six patients presented with acute basilar artery occlusion and a follow-up > 3 months. The most common site of occlusion was midbasilar (80%, n = 12), isolated (n = 7) or in combination with other locations (n = 5). In all cases collateralization could be demonstrated by the posterior communicating arteries. The most common vascular risk factors (VRF) were hypertension (100%) and hypercholesterolemia (67%). CONCLUSIONS Patients with CBAO may present with only mild symptoms or may even be asymptomatic. This condition may be survived for a long time. The high percentage of vascular risk factors and further cerebral vessel occlusions suggest arteriosclerosis as the major causing factor of CBAO.
Collapse
Affiliation(s)
- Christian Roth
- Departement of Neurology, Klinikum Kassel, Mönchebergstraße 41-43, 34125, Kassel, Germany.
- Departement of Neurology, Philipps-Marburg University, Marburg, Germany.
| | - Rosa Yavuz
- Kassel School of Medicine, Kassel, Germany
| | | | - Andreas Ferbert
- Departement of Neurology, Klinikum Kassel, Mönchebergstraße 41-43, 34125, Kassel, Germany
| | - Johannes Matthaei
- Departement of Neurology, Klinikum Kassel, Mönchebergstraße 41-43, 34125, Kassel, Germany
| |
Collapse
|
2
|
Qi F, Cui SL, Zhang B, Li HN, Yu J. T-2 toxin-induced damage to articular cartilage in rats coincided with impaired autophagy linked to the HIF-1α/AMPK signaling axis. Toxicon 2024; 243:107735. [PMID: 38670500 DOI: 10.1016/j.toxicon.2024.107735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/15/2024] [Accepted: 04/22/2024] [Indexed: 04/28/2024]
Abstract
T-2 toxin is one of the most toxic mycotoxins. People are primarily exposed to T-2 toxin through the consumption of spoiled food, typically over extended periods and at low doses. T-2 toxin can cause damage to articular cartilage. However, the exact mechanism is not fully understood. In this experiment, 36 male rats were divided into a control group, a solvent control group, and a T-2 toxin group. The rats in the T-2 toxin group were orally administered the toxin at a dosage of 100 ng/g BW/Day. The damage to articular cartilage and key proteins associated with the autophagy process and the HIF-1α/AMPK signaling axis was assessed at 4, 8, 12, and 16 weeks. Our findings indicate that T-2 toxin-induced damage to articular cartilage in rats coincided with impaired autophagy linked to the HIF-1α/AMPK signaling pathway. This study offers novel insights into the precise mechanism underlying T-2 toxin-induced damage to articular cartilage.
Collapse
Affiliation(s)
- Fang Qi
- Institute for Kashin-Beck Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, 150081, Heilongjiang, China; National Healthy Commission and Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University (23618504), Heilongjiang Provincial Laboratory of Trace Element and Human Health, Harbin Medical University, Harbin, 150081, China
| | - Si-Lu Cui
- Institute for Kashin-Beck Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, 150081, Heilongjiang, China; National Healthy Commission and Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University (23618504), Heilongjiang Provincial Laboratory of Trace Element and Human Health, Harbin Medical University, Harbin, 150081, China
| | - Bing Zhang
- Institute for Kashin-Beck Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, 150081, Heilongjiang, China; National Healthy Commission and Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University (23618504), Heilongjiang Provincial Laboratory of Trace Element and Human Health, Harbin Medical University, Harbin, 150081, China; School of Public Health, Beihua University, Jilin, 132013, Jilin, China
| | - Hao-Nan Li
- Institute for Kashin-Beck Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, 150081, Heilongjiang, China; National Healthy Commission and Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University (23618504), Heilongjiang Provincial Laboratory of Trace Element and Human Health, Harbin Medical University, Harbin, 150081, China
| | - Jun Yu
- Institute for Kashin-Beck Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, 150081, Heilongjiang, China; National Healthy Commission and Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University (23618504), Heilongjiang Provincial Laboratory of Trace Element and Human Health, Harbin Medical University, Harbin, 150081, China.
| |
Collapse
|
3
|
Wang ZH, Zhu L, Xue HD, Jin ZY. Quantitative MR imaging biomarkers for distinguishing inflammatory pancreatic mass and pancreatic cancer-a systematic review and meta-analysis. Eur Radiol 2024:10.1007/s00330-024-10720-9. [PMID: 38639911 DOI: 10.1007/s00330-024-10720-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/09/2024] [Accepted: 03/14/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVES To evaluate the diagnostic performance of quantitative magnetic resonance (MR) imaging biomarkers in distinguishing between inflammatory pancreatic masses (IPM) and pancreatic cancer (PC). METHODS A literature search was conducted using PubMed, Embase, the Cochrane Library, and Web of Science through August 2023. Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) was used to evaluate the risk of bias and applicability of the studies. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were calculated using the DerSimonian-Laird method. Univariate meta-regression analysis was used to identify the potential factors of heterogeneity. RESULTS Twenty-four studies were included in this meta-analysis. The two main types of IPM, mass-forming pancreatitis (MFP) and autoimmune pancreatitis (AIP), differ in their apparent diffusion coefficient (ADC) values. Compared with PC, the ADC value was higher in MFP but lower in AIP. The pooled sensitivity/specificity of ADC were 0.80/0.85 for distinguishing MFP from PC and 0.82/0.84 for distinguishing AIP from PC. The pooled sensitivity/specificity for the maximal diameter of the upstream main pancreatic duct (dMPD) was 0.86/0.74, with a cutoff of dMPD ≤ 4 mm, and 0.97/0.52, with a cutoff of dMPD ≤ 5 mm. The pooled sensitivity/specificity for perfusion fraction (f) was 0.82/0.68, and 0.82/0.77 for mass stiffness values. CONCLUSIONS Quantitative MR imaging biomarkers are useful in distinguishing between IPM and PC. ADC values differ between MFP and AIP, and they should be separated for consideration in future studies. CLINICAL RELEVANCE STATEMENT Quantitative MR parameters could serve as non-invasive imaging biomarkers for differentiating malignant pancreatic neoplasms from inflammatory masses of the pancreas, and hence help to avoid unnecessary surgery. KEY POINTS • Several quantitative MR imaging biomarkers performed well in differential diagnosis between inflammatory pancreatic mass and pancreatic cancer. • The ADC value could discern pancreatic cancer from mass-forming pancreatitis or autoimmune pancreatitis, if the two inflammatory mass types are not combined. • The diameter of main pancreatic duct had the highest specificity for differentiating autoimmune pancreatitis from pancreatic cancer.
Collapse
Affiliation(s)
- Zi-He Wang
- School of Medicine, Anhui Medical University, Hefei, China
| | - Liang Zhu
- Department of Radiology, Peking Union Medical College Hospital, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China.
| | - Hua-Dan Xue
- Department of Radiology, Peking Union Medical College Hospital, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China.
| | - Zheng-Yu Jin
- Department of Radiology, Peking Union Medical College Hospital, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| |
Collapse
|
4
|
Jafari-Golestan N, Dalvandi A, Hosseini M, Fallahi-Khoshknab M, Ebadi A, Rahgozar M, Souraya S. Designing and validating of a questionnaire measuring perceived self-care ability (PSCA) in chronic stroke patients at home. BMC Neurol 2024; 24:125. [PMID: 38622553 PMCID: PMC11017699 DOI: 10.1186/s12883-024-03612-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/26/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Patients with a stroke often cannot care for themselves after hospital discharge. Assessment of their self-care ability is the first step in planning post-discharge home care. This study aimed to design and validate a measure of perceived self-care ability (PSCA) in stroke patients. METHODS A sequential-exploratory mixed method was conducted in Tehran, Iran, in 2020-2021. The qualitative phase involved in-depth semi-structured interviews with 12 participants. Transcripts were content analyzed. The results guided the development of 81 items. psychometric properties such as face validity (Impact Score > 1.5), content validity ratio (CVR > 0.63), content validity index (Item Content Validity Index: ICVI > 0.78, Scale Content Validity Index/Average: SCVI/Ave > 0.8) and Kappa value (Kappa > 0.7), internal consistency (Cronbach's alpha > 0.7), relative reliability (ICC: inter class correlation coefficient), absolute reliability (Standard Error of Measurement: SEM and Minimal Detectable Changes: MDC), convergent validity (Correlation Coefficient between 0.4-0.7), interpretability, responsiveness, feasibility, and ceiling and floor effects were assessed. RESULTS Content analysis of the qualitative interviews yielded 5 major categories and 9 subcategories that reflected "Perceptual stability", "Cognitive fluctuations", "Sensory, Motor and Physical health"," The subjective nature" and "The dynamic nature" of PSCA. Results of face and content validity reduced the number of items to 32, capturing three dimensions of PSCA in chronic stroke patients; these dimensions included perceptual ability, threatened health status, and sensory, motor, and cognitive ability. The findings supported the reliability and validity of the measure. CONCLUSIONS The PSCA questionnaire was developed and validated within the Iranian culture. It is useful in assessing the self-care of patients with stroke and in informing practice.
Collapse
Affiliation(s)
- Nasrin Jafari-Golestan
- Faculty of Nursing, Department of Nursing Management, Aja University of Medical Sciences, Tehran, IR, Iran
| | - Asghar Dalvandi
- Department of Midwifery, Faculty of Nursing and Midwifery, Islamic Azad University, Tehran, IR, Iran.
- Department of Nursing Education, University of Social Welfare and Rehabilitation Sciences, Tehran, IR, Iran.
| | - Mohammadali Hosseini
- Department of Nursing Education, University of Social Welfare and Rehabilitation Sciences, Tehran, IR, Iran
| | - Masoud Fallahi-Khoshknab
- Department of Nursing Education, University of Social Welfare and Rehabilitation Sciences, Tehran, IR, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, IR, Iran
- Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, IR, Iran
| | - Mahdi Rahgozar
- Department of Biomedical Statistics, University of Social Welfare and Rehabilitation Sciences, Tehran, IR, Iran
| | - Sidani Souraya
- School of Nursing, Toronto Metropolitan University, Toronto, Canada
| |
Collapse
|
5
|
Kotsalis G, Giatroudakis K, Ladogianni M, Fandridis E. Functional reconstruction of chronic acromioclavicular joint separation using a double suture technique combined with semitendinosus autograft. Eur J Orthop Surg Traumatol 2024; 34:1635-1645. [PMID: 38368580 DOI: 10.1007/s00590-024-03850-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 01/25/2024] [Indexed: 02/19/2024]
Abstract
PURPOSE We present the functional and clinical results of a combined surgical technique that functionally restores chronic Acromioclavicular Joint Instability (AJI). The method combines a double-looped suture fixation augmented with a semitendinosus autograft. METHODS Between 2017 and 2021, 15 patients were treated using the surgical technique. All patients suffered an Acromioclavicular Joint Separation that remained untreated for at least 6 (6-16) weeks after the initial injury. Four Ethibond sutures were passed below the coracoid process and through a 4.5 drill hole in the clavicle. The sutures provided adequate horizontal and vertical reduction and stabilization of the clavicle. A semitendinosus autograft was passed below the coracoid process and looped around the clavicle. The remaining graft limbs were used to reconstruct the acromioclavicular capsule. Patients were radiologically evaluated with bilateral anteroposterior (AP), Zanca, and Alexander views. The clinical evaluation was based on the Acromioclavicular Joint Instability Score and the Constant-Murley Score. RESULTS The mean follow-up period was 31.2 months (17-61). The mean last ACJIS and CMS scores were 96 (90-100) and 97.67 (87-100), respectively. Reduction of the clavicle was radiologically confirmed in all cases throughout the follow-up period. AC arthritis was reported in 1 case without associated clinical symptoms. No significant complications were reported, and all patients returned to the pre-injury activity level. CONCLUSION The presented functional reconstruction of the AC joint disruption in chronic cases is an effective and secure method with low complication rates and good clinical results. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- Giannis Kotsalis
- A Orthopedic Department, General Hospital of Athens G. Gennimatas, Athens, Greece.
| | | | - Maria Ladogianni
- Upper Limb & Microsurgery Department, KAT General Hospital, Athens, Greece
| | | |
Collapse
|
6
|
Foppen M, Lodewijkx R, Bandral HV, Yah K, Slot KM, Vandertop W, Verbaan D. Factors associated with success of conservative therapy in chronic subdural hematoma: a single-center retrospective analysis. J Neurol 2024:10.1007/s00415-024-12307-2. [PMID: 38554149 DOI: 10.1007/s00415-024-12307-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/02/2024] [Accepted: 03/04/2024] [Indexed: 04/01/2024]
Abstract
INTRODUCTION Conservative therapy is a viable option for patients with chronic subdural hematoma (cSDH) who express no, or only mild symptoms. It is not clear which factors are associated with success of conservative therapy. This study aims to determine conservative therapy's success rate and to identify features possibly associated with success. METHODS A monocenter retrospective cohort study, including cSDH patients treated conservatively (wait-and-watch) from 2012 to 2022, was performed. The primary outcome was success of conservative therapy, defined as 'no crossover to surgery' during the follow-up period. Secondary outcomes were (1) factors associated with success, analyzed with univariate and multivariable logistic regression analyses, (2) 30-day mortality (3) time to crossover and (4) reasons for crossover. RESULTS We included 159 patients. Conservative therapy was successful in 96 (60%) patients. Hematoma volume (OR 0.79, 95% CI 0.69-0.92) and hypodense hematoma type (OR 3.57, 95% 1.38-9.23) were associated with success. Thirty-day mortality rate was 5% and the median duration between diagnosis and surgery was 19 days (IQR 8-39). Clinical deterioration was the most frequent reason for crossover (in 61/63 patients, 97%) and was accompanied by radiological hematoma progression in 42 patients (67%). CONCLUSION In this selected group of patients, conservative therapy was successful in 60%. Smaller hematoma volume and hypodense hematoma type were associated with success. As time until crossover was approximately three weeks, deploying conservative therapy as primary treatment seems safe and could be rewarding as surgical complications can be avoided. Improvement in patient selection in future cohorts remains warranted.
Collapse
Affiliation(s)
- Merijn Foppen
- Department of Neurosurgery, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Room H2-241, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, The Netherlands.
| | - Roger Lodewijkx
- Department of Neurosurgery, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Room H2-241, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, The Netherlands
| | - Harssh Verdan Bandral
- Department of Neurosurgery, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Room H2-241, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, The Netherlands
| | - Kevin Yah
- Department of Neurosurgery, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Room H2-241, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, The Netherlands
| | - K Mariam Slot
- Department of Neurosurgery, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Room H2-241, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, The Netherlands
| | - William Vandertop
- Department of Neurosurgery, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Room H2-241, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, The Netherlands
| | - Dagmar Verbaan
- Department of Neurosurgery, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Room H2-241, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, The Netherlands
| |
Collapse
|
7
|
Tsetseri MN, Keene DJ, Silman AJ, Dakin SG. Exploring the burden, prevalence and associated factors of chronic musculoskeletal pain in migrants from North Africa and Middle East living in Europe: a scoping review. BMC Public Health 2024; 24:769. [PMID: 38475746 PMCID: PMC10935970 DOI: 10.1186/s12889-023-17542-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 12/19/2023] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Immigrants are exposed to numerous risk factors that may contribute to the development of chronic musculoskeletal pain. Recent political and environmental crises in North Africa and the Middle East have led to an increase in immigration to Europe that has challenged the healthcare system and especially the management of chronic conditions. OBJECTIVE The aims of this scoping review are to investigate the burden, prevalence, and associated factors of chronic musculoskeletal pain in immigrants from North Africa and the Middle East in Europe during the last decade. The intentions of the review are to inform healthcare policymakers, to identify gaps in the literature, and aid the planning of future research. DESIGN Online databases Medline, Embase, PubMed and Web of Science were used to identify epidemiological studies published from2012-2022 examining chronic pain in populations from North Africa and the Middle East with a migration background residing in Europe. RESULTS In total eleven studies were identified conducted in Norway (n = 3), Denmark (n = 3), Germany (n = 1), Austria (n = 1), Sweden (n = 1), and Switzerland (n = 1). Among the identified studies, eight studies were cross-sectional (n = 8), two were prospective cohort studies (n = 2) and one was a retrospective cohort study (n = 1). Data suggested that chronic pain is more prevalent, more widespread, and more severe in people with than without a migration background. Furthermore, immigrants who have resided in the destination country for a longer period experience a higher prevalence of chronic pain compared to those in the early phases of migration. The following factors were found to be associated with chronic pain in this population: female gender, lower education, financial hardship, being underweight or obese, time in transit during migration, experience of trauma, immigration status, anxiety, depression, and post-traumatic stress disorder. CONCLUSION Several gaps in the literature were identified. Research is limited in terms of quantity and quality, does not reflect actual immigration trends, and does not account for immigration factors. Prospective cohort studies with long follow-ups would aid in improving prevention and management of chronic pain in populations with a migration background. In particular, they should reflect actual immigration trajectories, account for immigration factors, and have valid comparison groups in the countries of origin, transit and destination.
Collapse
Affiliation(s)
- Maria-Nefeli Tsetseri
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, B4495, Headington, Oxford, OX3 7LD, UK.
| | - David J Keene
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, B4495, Headington, Oxford, OX3 7LD, UK
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Alan J Silman
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, B4495, Headington, Oxford, OX3 7LD, UK
| | - Stephanie G Dakin
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, B4495, Headington, Oxford, OX3 7LD, UK
| |
Collapse
|
8
|
Kim EJ, Jeong HS, Kwon E, Jeong SH, Kim JS. Muscle mass and chronic dizziness: a cross-sectional study of a Korean population. J Neurol 2024; 271:1213-1223. [PMID: 37910251 DOI: 10.1007/s00415-023-12014-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/15/2023] [Accepted: 09/16/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Weight gain is associated with imbalance in older people. In contrast, overweightness or mild obesity is less common in patients with chronic dizziness. This paradox may be, at least in part, related to differences in the body composition indices adopted in the previous studies. This study aimed to determine any association between the predicted body composition and chronic dizziness or imbalance of unknown causes. METHODS We measured the lean body mass, body fat mass, and appendicular skeletal mass in 9243 people who participated in the Korean National Health and Nutrition Examination Survey 2019-2021. Sarcopenia was defined according to the Asian Working Group for Sarcopenia's guidelines. Obesity was defined as a body fat percentage of ≥ 25% for men and ≥ 35% for women. RESULTS The participants with chronic dizziness had a lower body mass index than those without (p = 0.001). Furthermore, sarcopenia was more common in those with chronic dizziness. In contrast, the degree of obesity was comparable in both groups. Multiple logistic regression analysis showed that sarcopenia was associated with a higher risk of chronic dizziness (odds ratio = 1.6, 95% confidence interval: 1.1-2.5; p = 0.026). DISCUSSION Given the association of sarcopenia with chronic dizziness or imbalance, muscle mass may play a role in maintaining balance and stability. Physical exercise could be recommended to increase muscle mass in patients with chronic dizziness/imbalance and sarcopenia. Additional research is required to establish a causal relationship between chronic dizziness and sarcopenia.
Collapse
Affiliation(s)
- Eun Ji Kim
- Department of Neurology, Chungnam National University Hospital, Daejeon, Korea
| | - Hye Seon Jeong
- Department of Neurology, Chungnam National University Hospital, Daejeon, Korea
| | - Eunjin Kwon
- Department of Neurology, Chungnam National University Hospital, Daejeon, Korea
| | - Seong-Hae Jeong
- Department of Neurology, Chungnam National University Hospital, Daejeon, Korea.
- Department of Neurology, Chungnam National University Hospital, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Korea.
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
- Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| |
Collapse
|
9
|
Wang Q, Wen M, Hou G, Zhao S, Yao Z, Tu Z, Huang P, Ye B, Xie F, Luo Z, Hu X. Chronic cauda equina syndrome decompression surgery recovery is very "bad"? Based on patient self-assessment. Eur Spine J 2024; 33:932-940. [PMID: 37947889 DOI: 10.1007/s00586-023-07984-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/31/2023] [Accepted: 10/02/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Symptoms of cauda equina syndrome (CES) secondary to degenerative lumbar spine diseases are sometimes mild and tend to be ignored by patients, resulting in delayed treatment. In addition, the long-term efficacy of surgery is unclear. OBJECTIVE To determine the predictive factors of CES and post-operative recovery in patients with symptoms lasting > 3 months. METHODS From January 2011 to December 2020, data of 45 patients with CES secondary to lumbar disk herniation/lumbar spinal stenosis were collected from a single center. The patients had bladder, bowel or sexual dysfunction and decreased perineal sensation that lasted for > 3 months. A 2-year post-operative follow-up was conducted to evaluate recovery outcomes, which were measured by validated self-assessment questionnaires conducted by telephone and online. RESULTS Overall, 45 CES patients (57.8% female; mean age, 56 years) were included. The duration of pre-operative CES symptoms was 79.6 weeks (range, 13-730 weeks). The incidence of saddle anesthesia before decompression was 71.1% (n = 32), bladder dysfunction 84.4% (n = 38), bowel dysfunction 62.2% (n = 28) and sexual dysfunction 64.4% (n = 29). The overall recovery rate of CES after a 2-year follow-up was 64.4%. The rates of the residual symptoms at the last follow-up were as follows: saddle anesthesia 22.2%, bladder dysfunction 33.3%, bowel dysfunction 24.4% and sexual dysfunction 48.9%. Pre-operative saddle anesthesia, overactive bladder and sexual dysfunction were risk factors for poor prognosis after decompression. CONCLUSION CES patients with symptoms lasting > 3 months may recover after surgery. Sexual dysfunction has a high residual rate and should not be ignored during diagnosis and treatment.
Collapse
Affiliation(s)
- Qiushi Wang
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Mengyuan Wen
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Guangdong Hou
- Department of Urology, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Shixian Zhao
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Zhou Yao
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Zhipeng Tu
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Peipei Huang
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Bin Ye
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Fang Xie
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Zhuojing Luo
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China.
| | - Xueyu Hu
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China.
| |
Collapse
|
10
|
Yeldan I, Canan GD, Akinci B. Biofeedback Sensor vs. Physiotherapist Feedback During Core Stabilization Training in Patients with Chronic Nonspecific Low Back Pain. Appl Psychophysiol Biofeedback 2024; 49:103-113. [PMID: 37878122 DOI: 10.1007/s10484-023-09606-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2023] [Indexed: 10/26/2023]
Abstract
Core stabilization training utilizes principles of motor learning to retrain control of the trunk muscles and lead to improvements in chronic non-specific low back pain (CNLBP). To compare the effects of biofeedback sensor and conventional physiotherapist (PT) feedback during core stabilization and activity training in patients with CNLBP. Thirty-eight patients with CNLBP were randomly assigned to Biofeedback (n = 19) or PT feedback (n = 19) groups. Patients continued 12 sessions of combined core stabilization and activity training. An auditory and tactile biofeedback was given using a validated tilt sensor integrated with an application in the Biofeedback group. An experienced PT provided verbal and tactile feedback to maintain the neutral position in the PT Feedback group. The outcomes were; disability (Revised Oswestry Disability Index-RODI), muscle activity (m.transversus abdominis and m.multifidus), pain (Visual Analog Scale-VAS), proprioception error of the trunk, patient beliefs (Fear Avoidance Beliefs Questionnaire-FABQ) and presence of depressive symptoms (Beck Depression Index-BDI), and quality of life (Short Form (SF)-36). The main effect of time were statistically significant on VAS, RODI, m.transversus abdominis and m.multifidus muscle activities, flexion, and extension proprioception error of the trunk, FABQ, BDI, and SF-36 scores in Biofeedback and PT feedback groups (p < 0.05 for all). The time X group interaction was significant on flexion and extension proprioception error of the trunk PT feedback group (consecutively; p = 0.004, p = 0.022). Biofeedback sensor or PT feedback during core stabilization training equally improves pain, disability, muscle activity, depressive symptoms, patient beliefs, and quality of life in patients with CNLBP.
Collapse
Affiliation(s)
- Ipek Yeldan
- Graduate Education Institue, Department of Physiotherapy and Rehabilitation, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Gulvin Dilan Canan
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Buket Akinci
- Department of Physiotherapy and Rehabilitation (English), Faculty of Health Sciences, Biruni University, Istanbul, Turkey
| |
Collapse
|
11
|
Pulikottil-Jacob R, Dehipawala S, Smith B, Athavale A, Gusto G, Chandak A, Khachatryan A, Banon T, Fournier M, Guillonneau S, Pollissard L, Munoz-Rojas MV. Survival of patients with chronic acid sphingomyelinase deficiency (ASMD) in the United States: A retrospective chart review study. Mol Genet Metab Rep 2024; 38:101040. [PMID: 38188692 PMCID: PMC10767269 DOI: 10.1016/j.ymgmr.2023.101040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024] Open
Abstract
Background Acid sphingomyelinase deficiency (ASMD), historically known as Niemann-Pick disease type A, A/B, and B, is a rare lysosomal storage pathology with multisystemic clinical manifestations. The aims of this study were to estimate the survival probability in patients in the United States with chronic ASMD (ASMD types B and A/B), and to describe the disease characteristics of these patients. Methods This observational retrospective study included medical chart records of patients with chronic ASMD with retrievable data abstracted by 69 participating physicians from 25 medical centers in the United States. Included patients had a date of ASMD diagnosis or first presentation to a physician for ASMD symptoms (whichever occurred first) between January 01, 1990, and February 28, 2021. Medical chart records were excluded if patients were diagnosed with ASMD type A. Eligible medical chart records were abstracted to collect demographic, medical and developmental history, and mortality data. Survival outcomes were analyzed using Kaplan-Meier survival analyses from birth until death. Results The overall study population (N = 110) included 69 patients with ASMD type B, nine with type A/B, and 32 with ASMD "non-type A" (ASMD subtype was unknown, but patients were confirmed as not having ASMD type A). The majority of patients were male with a median age at diagnosis of 3.8 years. Thirty-eight patients died during the study observation period, at a median age of 6.8 years. The median (95% confidence interval) survival age from birth was 21.3 (10.2; 60.4) years. At diagnosis or first presentation, 42.7% patients had ≥1 ASMD-related complication; splenic (30.0%) and hepatobiliary (20.9%) being the most common, and 40.9% required ≥1 medical visit due to complications. Conclusion Patients with chronic ASMD in the United States have poor survival and significant burden of illness.
Collapse
|
12
|
Luo Y, Song Q, Li J, Fu S, Yu W, Shao X, Li J, Huang Y, Chen J, Tang Y. Effects of uric acid-lowering therapy (ULT) on renal outcomes in CKD patients with asymptomatic hyperuricemia: a systematic review and meta-analysis. BMC Nephrol 2024; 25:63. [PMID: 38395818 PMCID: PMC10893702 DOI: 10.1186/s12882-024-03491-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/04/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND It is well known that asymptomatic hyperuricemia and gout play an important role in patients with chronic kidney disease (CKD). However, the effect of uric acid-lowering therapy (ULT) on the prognosis of CKD patients with asymptomatic hyperuricemia remains controversial. Therefore, we aim to investigate the influence of ULT on renal outcomes in these patients. METHODS Comprehensive searches were conducted in PubMed, EMBASE, China National Knowledge Internet (CNKI), and the Cochrane Library, up until January 2024. We included randomized controlled trials (RCTs) that evaluated the effects of ULT on renal outcomes in CKD patients with asymptomatic hyperuricemia. RESULTS A total of 17 studies were included in the meta-analysis. Compared with placebo or no treatment, ULT preserved the loss of estimated glomerular filtrating rate (eGFR) (Weighted mean difference [WMD] and its 95% confidence intercal(CI): 2.07 [0.15,3.98] mL/min/1.73m2) at long-term subgroup. At the same time, short-term subgroup also proved the preserved loss of eGFR (WMD 5.74[2.09, 9.39] mL/min/1.73m2). Compared with placebo or no treatment, ULT also reduced the increase in serum creatinine (Scr) at short-term (WMD -44.48[-84.03,-4.92]μmol/L) subgroup and long-term (WMD -46.13[-65.64,-26.62]μmol/L) subgroup. ULT was associated with lower incidence of the events of doubling of Scr without dialysis (relative risk (RR) 0.32 [0.21, 0.49], p < 0.001). However, no difference was found for lower incidence of acute kidney injury (AKI) (p = 0.943). CONCLUSIONS According to our study, ULT is beneficial for slowing CKD progression both in short to long-term follow-ups. Additionally, in patients younger than 60 years old, the protective effect of ULT on renal outcome is more pronounced. However, it showed no significant difference in the incidence of AKI. These findings underscore the importance of considering ULT in clinical strategies for CKD patients with asymptomatic hyperuricemia.
Collapse
Affiliation(s)
- Yuxin Luo
- Department of Nephrology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Qirong Song
- Department of Nephrology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Jiaxiao Li
- Department of Nephrology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Sha Fu
- Department of Nephrology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Wenjuan Yu
- Department of Nephrology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Xiaofei Shao
- Department of Nephrology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Jinxiang Li
- Department of Nephrology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Yuliang Huang
- Department of Nephrology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Junzhe Chen
- Department of Nephrology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China.
| | - Ying Tang
- Department of Nephrology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China.
| |
Collapse
|
13
|
Maniaci A, Vaira LA, Cammaroto G, Favier V, Lechien JR. Gastroesophageal reflux disease, laryngopharyngeal reflux, and nasopharyngeal reflux in chronic rhinosinusitis patients. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08510-6. [PMID: 38358508 DOI: 10.1007/s00405-024-08510-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 01/24/2024] [Indexed: 02/16/2024]
Affiliation(s)
- Antonino Maniaci
- Research Committee of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS-IFOS), Paris, France
- Department of Medicine and Surgery, "Kore" University of Enna, Enna, Italy
| | - Luigi A Vaira
- Research Committee of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS-IFOS), Paris, France
- Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
- Biomedical Science Department, PhD School of Biomedical Science, University of Sassari, Sassari, Italy
- Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Giovanni Cammaroto
- Research Committee of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS-IFOS), Paris, France
- Department of Otolaryngology-Head and Neck Surgery, Forli Hospital, Forli, Italy
| | - Valentin Favier
- Research Committee of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS-IFOS), Paris, France
- Department of Otolaryngology-Head and Neck Surgery, CHU de Montpellier, Montpellier, France
| | - Jerome R Lechien
- Research Committee of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS-IFOS), Paris, France.
- Division of Laryngology and Broncho-Esophagology, Department of Otolaryngology-Head and Neck Surgery, EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, Paris Saclay University, Paris, France.
| |
Collapse
|
14
|
Ullah S, Naveed M, Ali A, Bibi S, Idrees W, Rafique S, Idrees M, Waqas M, Uddin J, Jan A, Khan A, Al-Harrasi A. Assessment of ubiquitin specific Peptidase-18 gene in peripheral blood of chronic hepatitis C patients treated with direct-acting antiviral drugs. Heliyon 2024; 10:e24581. [PMID: 38298711 PMCID: PMC10828700 DOI: 10.1016/j.heliyon.2024.e24581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/30/2023] [Accepted: 01/10/2024] [Indexed: 02/02/2024] Open
Abstract
Hepatitis C virus (HCV) infection remains one of the leading causes of liver complications globally. Ubiquitin Specific Peptidase-18 (USP18) is a ubiquitin-specific protease that cleaves interferon-stimulated gene 15 (ISG15) from ISGylated protein complexes and is involved in regulating interferon responsiveness. To study the effect of direct-acting antivirals (DAAs) on the USP18 gene using qPCR, 132 participants were recruited and classified into different groups based on treatment duration. USP18 expression was raised compared to rapid virologic response (RVR) and early virologic response (EVR) groups with P = 0.0026 and P = 0.0016, respectively. USP18 was found to be 7.36 folds higher in naïve patients than those with RVR and sustained viral response (SVR). In RVR and SVR groups where patients had cleared HCV RNA after treatment with direct-acting antiviral agents (DAA) therapy, the expression of USP18 was found to be low, with a fold change of 1.3 and 1.4 folds, respectively. Expression of USP18 was significantly higher in the non-RVR group than in the RVR group. In the No EVR group, gene expression was significantly higher than in the EVR group. It is concluded that targeting HCV proteins using DAAs can cause USP18 expression to be normalized more effectively. Moreover, USP18 is a vital marker indicating treatment resistance and distinguishing responders from non-responders during DAA therapy.
Collapse
Affiliation(s)
- Sami Ullah
- Molecular Virology laboratory Centre for Applied Molecular Biology (CAMB), 87-West Canal Bank Road Thokar Niaz Baig, University of the Punjab, Lahore, Pakistan
| | - Mariam Naveed
- Molecular Virology laboratory Centre for Applied Molecular Biology (CAMB), 87-West Canal Bank Road Thokar Niaz Baig, University of the Punjab, Lahore, Pakistan
| | - Amjad Ali
- Molecular Virology laboratory Centre for Applied Molecular Biology (CAMB), 87-West Canal Bank Road Thokar Niaz Baig, University of the Punjab, Lahore, Pakistan
- Department of Biotechnology and Genetic Engineering, Hazara University Mansehra, Khyber Pakhtunkhwa, Pakistan
| | - Sadia Bibi
- Department of Botany, University of Malakand Chakdara, Dir lower, Khyber Pakhtunkhwa, Pakistan
| | - Wafa Idrees
- Khyber Medical College, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Shazia Rafique
- Division of Molecular Virology, Centre of Excellence in Molecular Biology (CEMB), 87-West Canal Bank Road Thokar Niaz Baig, University of the Punjab, Lahore, Pakistan
| | - Muhammad Idrees
- Division of Molecular Virology, Centre of Excellence in Molecular Biology (CEMB), 87-West Canal Bank Road Thokar Niaz Baig, University of the Punjab, Lahore, Pakistan
- Vice Chancellor, University of Peshawar, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Muhammad Waqas
- Department of Biotechnology and Genetic Engineering, Hazara University Mansehra, Khyber Pakhtunkhwa, Pakistan
- Natural and Medical Sciences Research Center, University of Nizwa, Birkat-ul-Mouz 616, Nizwa, Sultanate of Oman
| | - Jalal Uddin
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Khalid University, Abha, 62529, Kingdom of Saudi Arabia
| | - Afnan Jan
- Department of Biochemistry, Faculty of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia
| | - Ajmal Khan
- Natural and Medical Sciences Research Center, University of Nizwa, Birkat-ul-Mouz 616, Nizwa, Sultanate of Oman
| | - Ahmed Al-Harrasi
- Natural and Medical Sciences Research Center, University of Nizwa, Birkat-ul-Mouz 616, Nizwa, Sultanate of Oman
| |
Collapse
|
15
|
Özdemir Ö. Chronic spontaneous urticaria after COVID-19 vaccination. Therapie 2024:S0040-5957(24)00007-6. [PMID: 38320893 DOI: 10.1016/j.therap.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/25/2023] [Indexed: 02/08/2024]
Affiliation(s)
- Öner Özdemir
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Sakarya University, Research and Training Hospital of Sakarya University, Adnan Menderes Cad., Sağlık Sok., No: 195 Adapazarı, Sakarya, Türkiye.
| |
Collapse
|
16
|
Wang H, Zhao Z, Cao Q, Ning J. A review of 17 cases of mesenteric panniculitis in Zhengzhou Ninth People's Hospital in China. BMC Gastroenterol 2024; 24:48. [PMID: 38267839 PMCID: PMC10809466 DOI: 10.1186/s12876-024-03136-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 01/15/2024] [Indexed: 01/26/2024] Open
Abstract
PURPOSE Mesenteric panniculitis (MP) represents the uncommon, benign and chronic inflammatory disorder affecting the mesenteric adipose tissues. Its etiology, diagnosis and treatment remain unnoticed. Our report focused on shedding more lights on this condition. PATIENTS AND METHODS Seventeen MP patients were identified by searching the electronic medical record system in the Zhengzhou Ninth People's Hospital using the search terms "Mesenteric panniculitis" from October 2015 to March 2023. All cases were diagnosed with MP through computed tomography (CT). Their clinical features and treatments were analyzed. RESULTS There were altogether 17 cases enrolled for this analysis. The male to female ratio was 8:9, and the median age at diagnosis was 64 (range: 37-96) years. There were 15 patients (88.2%) showing abdominal pain to varying degrees. The proportions of symptoms of nausea, vomiting and fever were 23.5%, 23.5% and 41.2%, respectively. Neoplastic disease was present in 3 patients (17.6%). Meanwhile, 9 patients (52.9%) had gallstones, 3 (17.6%) had cholecystitis and 1 (5.9%) had gallbladder polyps. Six patients (35.3%) received antibiotics treatment only and 1 (5.9%) received oral antibiotics and prednisone. One patient (5.9%) received antibiotics followed by prednisone treatment, because the symptoms were significantly relieved after antibiotic treatment, while the disease recurred soon after, and the symptoms improved again after prednisone treatment. The abdominal pain in 9 patients (52.9%) was relieved spontaneously. Two patients (11.8%) died, including one due to respiratory failure caused by pneumonia and the other one because of pancreatic cancer with lung and liver metastases. CONCLUSION MP is a poorly understood chronic inflammatory disease. Patients often have abdominal pain as the main symptom, accompanied by comorbidities in the gallbladder, and the prognosis is usually good after correct diagnosis and treatment, Therefore, the present report aims to promote the awareness among clinicians of patients with non-classic abdominal symptoms, so as to avoid misdiagnosis or missed diagnosis.
Collapse
Affiliation(s)
- Hongyan Wang
- Geriatric Center, Zhengzhou Ninth People's Hospital, 25 Sha Kou Road, 450008, Zhengzhou, Henan, China
| | - Zhenyu Zhao
- Radiology, Zhengzhou Ninth People's Hospital, 25 Sha Kou Road, 450008, Zhengzhou, Henan, China
| | - Qiucai Cao
- Geriatric Center, Zhengzhou Ninth People's Hospital, 25 Sha Kou Road, 450008, Zhengzhou, Henan, China
| | - Jing Ning
- Geriatric Center, Zhengzhou Ninth People's Hospital, 25 Sha Kou Road, 450008, Zhengzhou, Henan, China.
| |
Collapse
|
17
|
Conway MJ, Yang H, Revord LA, Novay MP, Lee RJ, Ward AS, Abel JD, Williams MR, Uzarski RL, Alm EW. Chronic shedding of a SARS-CoV-2 Alpha variant in wastewater. BMC Genomics 2024; 25:59. [PMID: 38218804 PMCID: PMC10787452 DOI: 10.1186/s12864-024-09977-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/04/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Central Michigan University (CMU) participated in a state-wide SARS-CoV-2 wastewater monitoring program since 2021. Wastewater samples were collected from on-campus sites and nine off-campus wastewater treatment plants servicing small metropolitan and rural communities. SARS-CoV-2 genome copies were quantified using droplet digital PCR and results were reported to the health department. RESULTS One rural, off-campus site consistently produced higher concentrations of SARS-CoV-2 genome copies. Samples from this site were sequenced and contained predominately a derivative of Alpha variant lineage B.1.1.7, detected from fall 2021 through summer 2023. Mutational analysis of reconstructed genes revealed divergence from the Alpha variant lineage sequence over time, including numerous mutations in the Spike RBD and NTD. CONCLUSIONS We discuss the possibility that a chronic SARS-CoV-2 infection accumulated adaptive mutations that promoted long-term infection. This study reveals that small wastewater treatment plants can enhance resolution of rare events and facilitate reconstruction of viral genomes due to the relative lack of contaminating sequences.
Collapse
Affiliation(s)
- Michael J Conway
- Foundational Sciences, Central Michigan University, College of Medicine, Mt. Pleasant, MI, USA.
- Institute for Great Lakes Research, Central Michigan University, Mt. Pleasant, MI, USA.
| | - Hannah Yang
- Foundational Sciences, Central Michigan University, College of Medicine, Mt. Pleasant, MI, USA
| | - Lauren A Revord
- Foundational Sciences, Central Michigan University, College of Medicine, Mt. Pleasant, MI, USA
| | - Michael P Novay
- Foundational Sciences, Central Michigan University, College of Medicine, Mt. Pleasant, MI, USA
| | - Rachel J Lee
- Foundational Sciences, Central Michigan University, College of Medicine, Mt. Pleasant, MI, USA
| | - Avery S Ward
- Foundational Sciences, Central Michigan University, College of Medicine, Mt. Pleasant, MI, USA
| | - Jackson D Abel
- Foundational Sciences, Central Michigan University, College of Medicine, Mt. Pleasant, MI, USA
| | - Maggie R Williams
- School of Engineering & Technology, Central Michigan University, Mt. Pleasant, MI, USA
- Institute for Great Lakes Research, Central Michigan University, Mt. Pleasant, MI, USA
| | - Rebecca L Uzarski
- Department of Biology and Herbert H. and Grace A. Dow College of Health, Professions, Central Michigan University, Mt. Pleasant, MI, USA
| | - Elizabeth W Alm
- Department of Biology, Central Michigan University, Mt. Pleasant, MI, USA
- Institute for Great Lakes Research, Central Michigan University, Mt. Pleasant, MI, USA
| |
Collapse
|
18
|
Huang X, Niu X, Ma Y, Wang X, Su T, He Y, Lu F, Gao J, Chang Q. Hierarchical double-layer microneedles accomplish multicenter skin regeneration in diabetic full-thickness wounds. J Adv Res 2024:S2090-1232(24)00002-X. [PMID: 38218581 DOI: 10.1016/j.jare.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 12/12/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024] Open
Abstract
INTRODUCTION Managing large chronic wounds presents significant challenges because of inadequate donor sites, infection, and lack of structural support from dermal substitutes. Hydrogels are extensively used in various forms to promote chronic wound healing and provide a three-dimensional spatial structure, through growth factors or cell transport. OBJECTIVES We present a novel multicenter regenerative model that is capable of regenerating and merging simultaneously to form a complete layer of skin. This method significantly reduces wound healing time compared to the traditional centripetal healing model. We believe that our model can improve clinical outcomes and pave the way for further research into regenerative medicine. METHODS We prepared a novel multi-island double-layer microneedle (MDMN) using gelatin-methacryloylchitosan (GelMA-CS). The MDMN was loaded with keratinocytes (KCs) and dermal fibroblasts (FBs). Our aim in this study was to explore the therapeutic potential of MDMN in a total skin excision model. RESULTS The MDMN model replicated the layered structure of full-thickness skin and facilitated tissue regeneration and healing via dual omni-bearing. Multi-island regeneration centres accomplished horizontal multicentric regeneration, while epidermal and dermal cells migrated synchronously from each location. This produced a healing area approximately 4.7 times greater than that of the conventional scratch tests. The MDMN model exhibited excellent antibacterial properties, attributed to the chitosan layer. During wound healing in diabetic mice, the MDMN achieved earlier epidermal coverage and faster wound healing through multi-island regeneration centres and the omnidirectional regeneration mode. The MDMN group displayed an accelerated wound healing rate upon arrival at the destination (0.96 % ± 0.58 % vs. 4.61 % ± 0.32 %). Additionally, the MDMN group exhibited superior vascularization and orderly collagen deposition. CONCLUSION The present study presents a novel skin regeneration model using microneedles as carriers of autologous keratinocytes and dermal fibroblasts, which allows for omni-directional, multi-center, and full-thickness skin regeneration.
Collapse
Affiliation(s)
- Xiaoqi Huang
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, 1838 Guangzhou North Road, Guangzhou 510515, Guangdong, China
| | - Xingtang Niu
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, 1838 Guangzhou North Road, Guangzhou 510515, Guangdong, China
| | - Yuan Ma
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, 1838 Guangzhou North Road, Guangzhou 510515, Guangdong, China
| | - Xinhui Wang
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, 1838 Guangzhou North Road, Guangzhou 510515, Guangdong, China
| | - Ting Su
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, 1838 Guangzhou North Road, Guangzhou 510515, Guangdong, China
| | - Yu He
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, 1838 Guangzhou North Road, Guangzhou 510515, Guangdong, China
| | - Feng Lu
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, 1838 Guangzhou North Road, Guangzhou 510515, Guangdong, China
| | - Jianhua Gao
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, 1838 Guangzhou North Road, Guangzhou 510515, Guangdong, China
| | - Qiang Chang
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, 1838 Guangzhou North Road, Guangzhou 510515, Guangdong, China.
| |
Collapse
|
19
|
Ames H, Hestevik CH, Briggs AM. Acceptability, values, and preferences of older people for chronic low back pain management; a qualitative evidence synthesis. BMC Geriatr 2024; 24:24. [PMID: 38182977 PMCID: PMC10768085 DOI: 10.1186/s12877-023-04608-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 12/16/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Chronic primary low back pain (CPLBP) and other musculoskeletal conditions represent a sizable attribution to the global burden of disability, with rates greatest in older age. There are multiple and varied interventions for CPLBP, delivered by a wide range of health and care workers. However, it is not known if these are acceptable to or align with the values and preferences of care recipients. The objective of this synthesis was to understand the key factors influencing the acceptability of, and values and preferences for, interventions/care for CPLBP from the perspective of people over 60 and their caregivers. METHODS We searched MEDLINE, CINAHL and OpenAlex, for eligible studies from inception until April 2022. We included studies that used qualitative methods for data collection and analysis; explored the perceptions and experiences of older people and their caregivers about interventions to treat CPLBP; from any setting globally. We conducted a best fit framework synthesis using a framework developed specifically for this review. We assessed our certainty in the findings using GRADE-CERQual. RESULTS All 22 included studies represented older people's experiences and had representation across a range of geographies and economic contexts. No studies were identified on caregivers. Older people living with CPLBP express values and preferences for their care that relate to therapeutic encounters and the importance of therapeutic alliance, irrespective of the type of treatment, choice of intervention, and intervention delivery modalities. Older people with CPLBP value therapeutic encounters that validate, legitimise, and respect their pain experience, consider their context holistically, prioritise their needs and preferences, adopt a person-centred and tailored approach to care, and are supported by interprofessional communication. Older people valued care that provided benefit to them, included interventions beyond analgesic medicines alone and was financially and geographically accessible. CONCLUSIONS These findings provide critical context to the implementation of clinical guidelines into practice, particularly related to how care providers interact with older people and how components of care are delivered, their location and their cost. Further research is needed focusing on low- and middle-income settings, vulnerable populations, and caregivers.
Collapse
Affiliation(s)
- Heather Ames
- The Norwegian Institute of Public Health, PO Box 222, 0213, Oslo, Skøyen, Norway.
| | | | - Andrew M Briggs
- Ageing and Health Unit, Department of Maternal, Newborn, Child & Adolescent Health and Ageing, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland
- Faculty of Health Sciences, Curtin University, PO Box U1987, Perth, 6845, Western Australia
| |
Collapse
|
20
|
Stedman W, Donaldson L, Garside T, Green S, Donoghoe SF, Whitfield VE, Bass F, Delaney A, Hammond N. The feasibility and acceptability of a physician-led ICU follow-up service: A prospective cohort study. Aust Crit Care 2024; 37:3-11. [PMID: 38065794 DOI: 10.1016/j.aucc.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/24/2023] [Accepted: 10/11/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Increased recognition of post-intensive care syndrome has led to widespread development of intensive care follow-up services internationally. OBJECTIVE The objective of this study was to determine the feasibility and acceptability of an intensive care unit (ICU) follow-up clinic in Australia for patients and their caregivers and to describe satisfaction with this service. METHODS This was a prospective cohort study in a mixed tertiary ICU in Australia. Eligible patients were adults admitted to the ICU for 7 days or more and/or ventilated for 48 h or more, as well as their primary caregiver. Patients and their primary caregivers were invited to attend a follow-up clinic 4-8 weeks after hospital discharge. The clinic appointment was attended by an ICU physician and nurse, with multidisciplinary support. Feasibility and acceptability were defined as the proportion of clinic attendance and frequency of interventions initiated at the clinic. Satisfaction was measured by a 5-point satisfaction survey (very dissatisfied to very satisfied). The burden of ongoing disease was reported via multiple validated instruments. RESULTS From April 2020-July 2021, 386 patients met the inclusion criteria. Only 146 patients were approached for consent due to site staffing limitations. Eighty-three patients and 32 caregivers consented to attend the clinic. Seventy percent (54/77) of patients attended scheduled appointments and 50% (16/32) of caregivers. For patients, 23 medical referrals were made, 8 patients had medication changes, and 10 patients were offered social work support. Satisfaction surveys were completed by 65% (35/54) of attending patients; 97% (34) patients reported either being 'very satisfied' or 'satisfied' with the service. All responding caregivers (10) were either 'very satisfied' or 'satisfied' with the clinic. CONCLUSION There were a large number of patients meeting the inclusion criteria to the ICU follow-up clinic, and clinic attendance was moderate for patients but lower for caregivers. Reported satisfaction with the service was high for both patients and their caregiver.
Collapse
Affiliation(s)
- Wade Stedman
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, Australia.
| | - Lachlan Donaldson
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, Australia; Critical Care Program, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Australia
| | - Tessa Garside
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, Australia; Northern Clinical School, Sydney Medical School, University of Sydney, Australia
| | - Sarah Green
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, Australia; Pharmacy Department, Royal North Shore Hospital, Sydney, Australia
| | - Stephanie F Donoghoe
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Victoria E Whitfield
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Frances Bass
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, Australia; Critical Care Program, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Australia
| | - Anthony Delaney
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, Australia; Critical Care Program, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Australia; Northern Clinical School, Sydney Medical School, University of Sydney, Australia
| | - Naomi Hammond
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, Australia; Critical Care Program, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Australia
| |
Collapse
|
21
|
Algharib A, van Dortmont LMC, Hendrix MGR, Riedel S, Möller R, Koning GG. Innovative biochemisurgical treatment for stabilisation of an end-stage chronic wound in a complex vascular compromized patient. Int J Surg Case Rep 2024; 114:109103. [PMID: 38103319 PMCID: PMC10770582 DOI: 10.1016/j.ijscr.2023.109103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/26/2023] [Accepted: 12/02/2023] [Indexed: 12/19/2023] Open
Abstract
INTRODUCTION Treating advanced peripheral arterial occlusive disease (e.g. PAOD IV) poses a significant challenge, as conventional treatments quite often fall short at this stage. However, a range of interventions can be considered to postpone amputation. This study presents an example of advanced stage of Peripheral Artery Occlusive Disease (PAOD) stage IV, encompassing a history of a high thigh amputation on the left side, coupled with pronounced wound healing disorders. PRESENTATION OF CASE Our patient, 55 years old, smoker and ASA Class III is in a left sided above-the knee-amputation situation. He presented to our outpatient clinic with blistering in the stump area, caused by non-proportinate pressure from the prosthesis. With an emerging septic course and advanced peripheral arterial occlusive disease (PAOD) at Fontaine class IV, revascularization was unfeasible in the left iliac artery axis and groin arteries. Additionally, a stage PAOD IV presents itself with poorly healing wounds on the right side which our patient still uses to support his transfers in and out bed and his wheelchair. Multiple surgical stump revisions and femur shortenings and diverse wound treatments were performed all were unsatisfying for patient and practitioners. We introduced a novel biochemisurgical treatment in our teaching hospital. DISCUSSION Desiccating-agent-A is an innovative dehydrating agent with potent desiccating characteristics upon application to organic substances. Its formulation involves blending 83% methane sulfonic acid with proton acceptors and dimethyl sulfoxide, as outlined in patent application. The case description results in an illustrated follow up period of 16 months and is presented in line with the recommendations of the consensus-based surgical case reporting guideline development. CONCLUSION The goal of achieving a secondary healing trend is to establish stability within the wound area or achieve complete healing. This endeavor becomes particularly intricate when severe blood circulation compromise exists. Nonetheless, progress in wound treatment measures has made it feasible to achieve this aim by fostering the formation of dry and clean necrotic tissue. This dry and clean wound is now manageable in a patient's home situation, allowing for effective care and a better chance at preventing further severe complications.
Collapse
Affiliation(s)
- A Algharib
- Department of Vascular & Endovascular Surgery, EUREGIO Hospital, Albert-Schweitzer-Straße 10, 48527 Nordhorn, Niedersachsen, Germany.
| | - L M C van Dortmont
- Department of Vascular & Endovascular Surgery, EUREGIO Hospital, Albert-Schweitzer-Straße 10, 48527 Nordhorn, Niedersachsen, Germany
| | - M G R Hendrix
- Department of Medical Microbiology, EUREGIO Hospital, Albert-Schweitzer-Straße 10, 48527 Nordhorn, Niedersachsen, Germany
| | - S Riedel
- Department of Vascular & Endovascular Surgery, EUREGIO Hospital, Albert-Schweitzer-Straße 10, 48527 Nordhorn, Niedersachsen, Germany
| | - R Möller
- Department of Vascular & Endovascular Surgery, EUREGIO Hospital, Albert-Schweitzer-Straße 10, 48527 Nordhorn, Niedersachsen, Germany
| | - G G Koning
- Department of Vascular & Endovascular Surgery, EUREGIO Hospital, Albert-Schweitzer-Straße 10, 48527 Nordhorn, Niedersachsen, Germany
| |
Collapse
|
22
|
Wattanapisit A, Pankamnerd N, Wattanapisit S. Iatrogenic Chronic Abdominal Pain in a Geriatric Patient: A Case Report. Prague Med Rep 2024; 125:87-91. [PMID: 38380457 DOI: 10.14712/23362936.2024.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Abstract
Chronic abdominal pain is a challenging problem in clinical practice, with several pathophysiological mechanisms underlying its aetiologies. This case report presents a geriatric patient with multiple comorbidities who had experienced intermittent abdominal pain for over 10 years. Alarming symptoms were ruled out, and a functional gastrointestinal disorder was determined as the most likely cause. The patient's medical history and previous treatments were thoroughly reviewed, revealing that long-term use of metformin and an oral iron supplement was the iatrogenic symptom triggers. The abdominal pain resolved upon discontinuation of these two medications. This case report highlights the significance of reviewing iatrogenic causes and periodically assessing chronic medical conditions to identify potential contributing factors of chronic abdominal pain.
Collapse
Affiliation(s)
- Apichai Wattanapisit
- School of Medicine, Walailak University, Nakhon Si Thammarat, Thailand.
- Walailak University Hospital, Nakhon Si Thammarat, Thailand.
| | | | | |
Collapse
|
23
|
Papineni VRK, Mariathas M, Sidhu SS, Chari B. Imaging modalities for non-acute pathologies of the foot and ankle. J Clin Orthop Trauma 2024; 48:102329. [PMID: 38299021 PMCID: PMC10826320 DOI: 10.1016/j.jcot.2023.102329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 12/30/2023] [Indexed: 02/02/2024] Open
Abstract
Chronic foot and ankle pain, in contrast to acute traumatic injuries, presents a diagnostic challenge due to its diverse underlying causes. Accurate diagnosis often necessitates the utilization of various imaging modalities, emphasizing the importance of selecting the most appropriate one. The intricate structure of the foot, composed of multiple bones and supported by soft tissues like ligaments and plantar fascia, gives rise to a spectrum of mechanical disorders, including stress fractures, plantar fasciitis, Morton's neuroma, and more. In addition to mechanical issues, non-acute abnormalities encompass inflammatory diseases affecting tendons and joints, benign tumors, tumor-like lesions, vascular abnormalities, and others. This article reviews the indispensable role of imaging in the assessment of these conditions, with a focus on plain radiography, computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine studies, tailored to the specific clinical presentation. By providing insights into the selection and interpretation of imaging modalities, this article aims to assist clinicians in achieving accurate diagnoses and optimizing patient care for nonacute foot and ankle pathologies.
Collapse
Affiliation(s)
- Vijay Ram Kumar Papineni
- Consultant Musculoskeletal Radiologist, Sheikh Shakhbout Medical City (Mayo Clinic), Abu Dhabi, United Arab Emirates
| | - Matthew Mariathas
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Sandeep Singh Sidhu
- Consultant Musculoskeletal Radiologist, Prince Court Medical Centre, Kuala Lumpur, Malaysia
| | - Basavaraj Chari
- Consultant Musculoskeletal Radiologist, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| |
Collapse
|
24
|
Harvey EA, Hong W, Sheehy EJ, do Amaral RJ, Khampang P, Runge CL, O'Leary C, O'Brien FJ, Kerschner JE. Chronic tympanic membrane perforation repair with a collagen-based scaffold: An in vivo model. Int J Pediatr Otorhinolaryngol 2024; 176:111807. [PMID: 38134588 DOI: 10.1016/j.ijporl.2023.111807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 10/24/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE The aim of this study was to assess the in vivo efficacy of a novel regenerative collagen-based scaffold developed by the Royal College of Surgeons in Ireland in a chronic tympanic membrane perforation (TMP) using a chinchilla model. METHODS Bilateral TMPs were induced in 17 mixed gender chinchillas using tympanic membrane resection followed by a mixture of topical Mitomycin C and dexamethasone for 3 days. These were monitored with weekly otoscopy for 8 weeks. Animals were excluded if signs of infection developed in the follow up period (n = 8). At 8 weeks, intervention began and 18 TMPs were assigned to either treatment with the collagen-based scaffold (treated group) or spontaneous healing (control group). Animals were euthanized 6 weeks post-intervention. Otoscopic imaging and auditory brain response (ABR) were conducted at baseline, 8 weeks post-TMP induction and 6 weeks post-intervention. All TMPs were then evaluated at 6 weeks post-intervention and bullae underwent histologic evaluation. RESULTS At 6 weeks post-intervention, otoscopic imaging demonstrated various degrees of healing in the treated ears. The treated group was noted to have an increased rate of healing when compared to the control group. Histologic evaluation demonstrated a variation in the degree of perforation healing within groups, with some animals in the treated group showing high levels of perforation healing. At 8 weeks after the TMP procedure, most of the animals had worsened hearing response. At 6-week post the collagen-based scaffold treatment, about 50 % (4/8) of the treated ears had improved in hearing response as compared to those of non-treated ears. CONCLUSION Given the initial histologic evidence of partial healing in scaffold-treated ears, the post-intervention period should be extended to monitor the potential for complete healing. Given the overall positive findings related to healing with the scaffold-treated ears, this material warrants further investigation.
Collapse
Affiliation(s)
- Erin A Harvey
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, USA.
| | - Wenzhou Hong
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, USA
| | - Eamon J Sheehy
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland; Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland; Advanced Materials and Bioengineering Research (AMBER) Centre, Royal College of Surgeons in Ireland and Trinity College Dublin, Dublin, Ireland
| | - Ronaldo Jfc do Amaral
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland; Laboratory of Cell Proliferation and Differentiation, Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Brazil; Advanced Materials and Bioengineering Research (AMBER) Centre, Royal College of Surgeons in Ireland and Trinity College Dublin, Dublin, Ireland
| | - Pawjai Khampang
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, USA
| | - Christina L Runge
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, USA
| | - Cian O'Leary
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland; Advanced Materials and Bioengineering Research (AMBER) Centre, Royal College of Surgeons in Ireland and Trinity College Dublin, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Fergal J O'Brien
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland; Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland; Advanced Materials and Bioengineering Research (AMBER) Centre, Royal College of Surgeons in Ireland and Trinity College Dublin, Dublin, Ireland
| | - Joseph E Kerschner
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, USA
| |
Collapse
|
25
|
Kimura M, Nakase J, Yoshimizu R, Kanayama T, Yanatori Y, Tsuchiya H. The use of ultrasonography as an effective screening tool for chronic posterior cruciate ligament injuries. J Med Ultrason (2001) 2024; 51:109-115. [PMID: 37740864 PMCID: PMC10894112 DOI: 10.1007/s10396-023-01366-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/26/2023] [Indexed: 09/25/2023]
Abstract
PURPOSE We aimed to explore the applicability and validity of ultrasonography for diagnosing chronic posterior cruciate ligament (PCL) injuries. METHODS PCL thickness was measured at 2 cm proximal to the tibia insertion site. Using the same ultrasonography image, the angle tangent to the PCL from the tibia insertion site was also measured. These data were analyzed by plotting the receiver operating curve (ROC), and the sensitivity and specificity were calculated according to the optimal cut-off point. Ultrasonography data from the PCLinjured knee were compared with those from the contralateral uninjured knee of the same patient. RESULTS Twelve men and six women, with a mean age of 28.8 ± 14.0 years, were included in this study. The mean time from injury to medical examination was 10.0 ± 6.7 months. The mean thickness of the PCL was 8.1 ± 1.9 mm on the affected side and 5.8 ± 1.2 mm on the uninjured side, with the affected side being significantly thicker. ROC analysis revealed that the optimal cut-off value for the thickness of chronic PCL injuries was 6.5 mm (sensitivity 83.3%, specificity 77.8%, area under the curve [AUC] = 0.87). The optimal cut-off value for the angle was 20° (sensitivity 88.9%, specificity 94.4%, AUC = 0.96). CONCLUSION Ultrasonography is useful as a screening tool for chronic PCL injuries. The optimal cut-off point was 6.5 mm for thickness and 20° for angle. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Mitsuhiro Kimura
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-0934, Japan
- Department of Orthopedic Surgery, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan
| | - Junsuke Nakase
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-0934, Japan.
| | - Rikuto Yoshimizu
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-0934, Japan
| | - Tomoyuki Kanayama
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-0934, Japan
| | - Yusuke Yanatori
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-0934, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-0934, Japan
| |
Collapse
|
26
|
Xiao L, Tang K, Fu T, Yuan X, Seery S, Zhang W, Ji Z, He Z, Yang Y, Zhang W, Jia W, Liang C, Tang H, Wang F, Ye Y, Chen L, Shao Z. Cytokine profiles and virological markers highlight distinctive immune statuses, and effectivenesses and limitations of NAs across different courses of chronic HBV infection. Cytokine 2024; 173:156442. [PMID: 37995395 DOI: 10.1016/j.cyto.2023.156442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 11/06/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE The characteristics of cytokine/chemokine(CK) profiles across different courses of chronic hepatitis B virus infection and the effects of NAs antiviral therapy on cytokine profiles remain unclear. METHODS This report provides evidence from 383 patients with chronic HBV infection. The Luminex multiple cytokine detection technology was used to detect CK profiles. The predictive power of CKs across course of disease was assessedusing univariate analyses and with receiver operating characteristic (ROC) curves. RESULTS Compared to healthy control (HC), expression levels of interleukin 6 (IL)-6, IL-8, IL-21, matrix metalloproteinases (MMP)-2 and tumor necrosis factor receptor (TNFR)-1 showed a significant increasing trend during chronic HBV infection. IL-23 and IL-33 increased respectively in chronic hepatitis B patients (CHB). interferon (IFN)-gamma and TNF-α changed significantly only in liver cirrhosis (LC) patients. Whereas, myeloid-related markers decreased dramatically in those with hepatocellular carcinoma (HCC). The ROC result suggests that combining IL-6, IL-8, CXCL9 and CXCL13 into a nomogram has closely correlation with HCC during chronic HBV infection. In addition, nucleotide analogues (NAs) antiviral treatments are capable of recoveringnormal liver functions and significantly reducing the viral loads, however, they seem to have a limited effect in changing CKs, especially specific antiviral factors. CONCLUSION The differential CK and virological markers may serve as potential indicators of distinct immune statuses in chronic HBV infection. They also underscore the varying efficacy and limitations of NAs antiviral therapies. This next step would to break new ground in the optimization of current anti-HBV treatment programs although this requires further research.
Collapse
Affiliation(s)
- Lixin Xiao
- Department of Epidemiology, School of Public Health, Air Force Medical University, Xi'an, 710032, People's Republic of China; Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Air Force Medical University, Xi'an, 710032, People's Republic of China
| | - Kang Tang
- Department of Immunology, Air Force Medical University, Xi'an, 710032, People's Republic of China
| | - Ting Fu
- Department of Epidemiology, School of Public Health, Air Force Medical University, Xi'an, 710032, People's Republic of China; Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Air Force Medical University, Xi'an, 710032, People's Republic of China
| | - Xiaojie Yuan
- Department of Epidemiology, School of Public Health, Air Force Medical University, Xi'an, 710032, People's Republic of China; Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Air Force Medical University, Xi'an, 710032, People's Republic of China
| | - Samuel Seery
- Faculty of Health and Medicine, Division of Health Research, Lancaster University, Lancaster, LA1 4YW, United Kingdom
| | - Weilu Zhang
- Department of Epidemiology, School of Public Health, Air Force Medical University, Xi'an, 710032, People's Republic of China; Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Air Force Medical University, Xi'an, 710032, People's Republic of China
| | - Zhaohua Ji
- Department of Epidemiology, School of Public Health, Air Force Medical University, Xi'an, 710032, People's Republic of China; Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Air Force Medical University, Xi'an, 710032, People's Republic of China
| | - Zhen He
- Department of Epidemiology, School of Public Health, Air Force Medical University, Xi'an, 710032, People's Republic of China; Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Air Force Medical University, Xi'an, 710032, People's Republic of China
| | - Yan Yang
- Department of Immunology, Air Force Medical University, Xi'an, 710032, People's Republic of China
| | - Wenhua Zhang
- Hepatobiliary Center, Gansu Wuwei Tumor Hospital, Wuwei, People's Republic of China
| | - Wenling Jia
- Hepatobiliary Center, Gansu Wuwei Tumor Hospital, Wuwei, People's Republic of China
| | - Chunhui Liang
- Hepatobiliary Center, Gansu Wuwei Tumor Hospital, Wuwei, People's Republic of China
| | - Haitao Tang
- Hepatobiliary Center, Gansu Wuwei Tumor Hospital, Wuwei, People's Republic of China
| | - Fengmei Wang
- Hepatobiliary Center, Gansu Wuwei Tumor Hospital, Wuwei, People's Republic of China
| | - Yancheng Ye
- Clinical Drug Experiment Institution, Gansu Wuwei Tumor Hospital, Wuwei, People's Republic of China
| | - Lihua Chen
- Department of Immunology, Air Force Medical University, Xi'an, 710032, People's Republic of China.
| | - Zhongjun Shao
- Department of Epidemiology, School of Public Health, Air Force Medical University, Xi'an, 710032, People's Republic of China; Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Air Force Medical University, Xi'an, 710032, People's Republic of China.
| |
Collapse
|
27
|
Narikiyo K, Tanabe M, Higashi M, Kawano Y, Inoue A, Kiyoyama H, Kamamura N, Kobayashi T, Ueda T, Ito K. Longitudinal changes in renal volumes evaluated by automated three-dimensional volumetric computed tomography of the whole kidney: The association with the renal function and disease progression. Eur J Radiol 2024; 170:111245. [PMID: 38042018 DOI: 10.1016/j.ejrad.2023.111245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/20/2023] [Accepted: 11/27/2023] [Indexed: 12/04/2023]
Abstract
PURPOSE To clarify the changes in the total renal volume over time with changes of the renal function using automated 3D volumetric CT of the whole kidney and to evaluate the usefulness of the total renal volume CT measurement in predicting chronic kidney disease (CKD) grade progression. METHODS A total of 961 patients who underwent abdominal CT at least twice (an interval of more than 4 years) were included. The automated 3D volumetric CT measurement of the whole kidney was performed at the initial and latest CT examination. Patients with CKD grade G2 at the time of the initial CT were divided into two groups: a progression group (CKD grade progressed to G3-G5) and a non-progression group. Changes in the renal volume over time were compared between the two groups. RESULTS The volume of both kidneys measured on initial CT was positively correlated with eGFR (ρ = 0.490, p < 0.001). There was a significant difference in the initial volume of both kidneys among CKD grades (p < 0.001, G1:318.7 ± 60.5 ml, G2:275.5 ± 53.5 ml, G3:233.7 ± 46.9 ml, G4:183.2 ± 22.5 ml, G5:157.7 ± 77.4 ml). When comparing the progression and non-progression groups, the initial volume of both kidneys was significantly smaller in the progression group, compared with the non-progression group (252.0 ± 50.6 ml vs. 278.9 ± 53.7 ml). In addition, the annual reduction volume in both the right and left kidneys was significantly greater in the progression group than in the non-progression group (p < 0.001). CONCLUSION The automated 3D volumetric CT measurement of the whole kidney has the potential to monitor changes in renal volume over time with changes of the renal function.
Collapse
Affiliation(s)
- Koji Narikiyo
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | - Masahiro Tanabe
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.
| | - Mayumi Higashi
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | - Yosuke Kawano
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | - Atsuo Inoue
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | - Haruka Kiyoyama
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | - Naohiko Kamamura
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | - Taiga Kobayashi
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | - Takaaki Ueda
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | - Katsuyoshi Ito
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| |
Collapse
|
28
|
Celis M, Navarro Y, Serrano N, Martínez D, Nieto W. B-cell lymphocytosis in relatives of Colombian patients with chronic B-cell lymphoproliferative disorders. Biomedica 2023; 43:66-78. [PMID: 38207149 PMCID: PMC10895924 DOI: 10.7705/biomedica.7099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/06/2023] [Indexed: 01/13/2024]
Abstract
Introduction. Monoclonal B-cell lymphocytosis generally precedes chronic lymphocytic leukemia, affecting about 12% of the healthy adult population. This frequency increases in relatives of patients with chronic B-cell lymphoproliferative disorders. Objective. To determine the frequency of monoclonal B-cell lymphocytosis in relatives of patients with chronic B-cell lymphoproliferative disorders, their immunophenotypic/cytogenetic characteristics, a possible relationship with infectious agents, and short-term follow-up in the Colombian population. Materials and methods. Fifty healthy adults with a family history of chronic B-cell lymphoproliferative disorders were studied using multiparametric flow cytometry, cytogenetic/serological testing, lifestyle survey, and 2-year follow-up. Results. The frequency of monoclonal B-cell lymphocytosis found was 8%, with a predominance of female gender and advanced age, increasing to 12.5% for individuals with a family history of chronic lymphocytic leukemia. Three out of four individuals presented chronic lymphocytic leukemia-type immunophenotype, all with low counts. In turn, a significantly higher number of cells/μl is observed in these individuals in T lymphocyte subpopulations, together with a greater predisposition to the disease. The described clonal populations increase over time in a non-significant manner. Conclusions. The frequency and behavior of monoclonal B-cell lymphocytosis in patients with family history of chronic B-cell lymphoproliferative disorders are like those found in related studies, which suggests that there is no involvement of more relevant genes that can trigger uncontrolled clonal proliferation, but that generates immunological deregulation that could justify a greater risk of serious infection in these individuals.
Collapse
Affiliation(s)
- Mike Celis
- Doctorado en Ciencias Biomédicas, Facultad de Salud, Universidad del Valle, Cali, Colombia; Instituto de Investigación Masira, Facultad de Ciencias Médicas y de la Salud, Universidad de Santander, Bucaramanga, Colombia.
| | - Yohanna Navarro
- Grupo de Investigación Biomédica Traslacional, Hospital Internacional de Colombia, Floridablanca, Colombia.
| | - Norma Serrano
- Grupo de Investigación Biomédica Traslacional, Hospital Internacional de Colombia, Floridablanca, Colombia.
| | - Daniel Martínez
- Instituto de Investigación Masira, Facultad de Ciencias Médicas y de la Salud, Universidad de Santander, Bucaramanga, Colombia.
| | - Wendy Nieto
- Grupo de Investigación Biomédica Traslacional, Hospital Internacional de Colombia, Floridablanca, Colombia.
| |
Collapse
|
29
|
Nakasujja N, Nawagi F, Aujo BT, Ajambo A. Equipping undergraduate medical and nursing students with elderly health care assessment skills at Makerere University, College of Health Sciences, Uganda. BMC Geriatr 2023; 23:857. [PMID: 38097967 PMCID: PMC10722738 DOI: 10.1186/s12877-023-04561-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 12/03/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Elderly health care training and aging science remain the least prioritized discipline of medical education in many African countries. With scant scientific evidence on elderly health care in low-income countries, coupled with limited exposure to elderly health care training, this project aimed to equip undergraduate health professional students with elderly health care assessment skills and research through an online course and a clinical placement. METHODS Students (3rd year) underwent online elderly health care training through the Alison courses published by the Advanced Learning Academy in Ireland. The students were then subjected to an online exam with a pass mark of 80%. Students were also trained on standard elderly health care assessment tools through a one-day session. For practical skills on data collection, each student assessed 15 elderly patients at the Mulago National Referral Hospital Assessment Centre. All tools once filled in were assessed for completion. A one-day reflection session was held with students, faculty and the project leads to share findings from the various tools used to assess elderly individuals. The students shared their experiences and provided feedback on the online training as well as the hardships they may have experienced while administering the tools. A certificate of participation was provided to the students at the end of the project. RESULTS All the students (10) gained knowledge on elderly assessment skills, the impact of aging on various body systems, and how to manage common occurrences among elderly individuals. The average score in the post-exam was 82% (standard deviation ± 2.01). All students (10) reported having had this as their first training on the assessment of functionality among elderly individuals. CONCLUSIONS The students gained knowledge of elderly health assessments as well as the impact of aging on various body systems. They also gained insight into how to care for the elderly holistically with an added understanding of how to manage spinal and traumatic brain injuries.
Collapse
Affiliation(s)
- Noeline Nakasujja
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Faith Nawagi
- Department of International Public Health, Euclid University Global Health Institute, Washington, DC, USA
| | - Blessed Tabitha Aujo
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Aidah Ajambo
- PMTCT program, Makerere University Johns Hopkins Research Collaboration, Kampala, Uganda
| |
Collapse
|
30
|
Abstract
Chronic diarrhea is still an important cause of morbidity and mortality in children. There are several causes of chronic diarrhea which may be due to intestinal, extra-intestinal or underlying systemic diseases. The etiology varies depending on the age of onset and may include both common and uncommon disorders. In this article some of the uncommon disorders such as immune deficiencies, intestinal lymphangiectasias, drug induced diarrhea, eosinophilic gastrointestinal disorders, endocrinopathies, neuroendocrine secretory tumors, malignancy and factitious diarrhea have been included. Though these disorders are uncommon it is essential that they are considered in select situations as detailed below and evaluated so that definitive therapy may be offered.
Collapse
Affiliation(s)
- Malathi Sathiyasekaran
- Department of Pediatric Gastroenterology & Hepatology, Rainbow Children's Hospital, Chennai, 600015, Tamil Nadu, India
| | - R Ganesh
- Department of General Pediatrics & Inherited Metabolic Diseases, Rainbow Children's Hospital, Chennai, 600015, Tamil Nadu, India.
| | - Suresh Natarajan
- Department of General Pediatrics & Pediatric Allergy, Rainbow Children's Hospital, Chennai, 600015, Tamil Nadu, India
| |
Collapse
|
31
|
Lai TS, Tsao HM, Chou YH, Liang SL, Chien KL, Chen YM. A competing risk predictive model for kidney failure in patients with advanced chronic kidney disease. J Formos Med Assoc 2023:S0929-6646(23)00476-X. [PMID: 38044210 DOI: 10.1016/j.jfma.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/15/2023] [Accepted: 11/21/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND/PURPOSE Predictive modeling aids in identifying patients at high risk of adverse events. Using routinely collected data, we report a competing risk prediction model for kidney failure. METHODS A total of 5138 patients with CKD stages 3b-5 were included and randomized into the development and validation cohorts at a ratio of 7:3. The outcome was end-stage kidney disease, defined as the initiation of dialysis or kidney transplantation. All patients were followed-up until December 31, 2020. A Fine and Gray model was applied to estimate the sub-hazard ratio of kidney failure, with death as a competing event. RESULTS In the development cohort, the mean age was 67.6 ± 13.9 years and 60 % were male. The mean index eGFR and median urinary protein-creatinine ratio (UPCR) were 26.5 ± 12.8 mL/min/1.73 m2 and 1051 mg/g, respectively. The median follow-up duration was 1051 days. The proportion of patients with kidney failure and death was 25.4 % and 14.1 %, respectively. Four models were applied, including eGFR, age, sex, UPCR, systolic and diastolic blood pressure, serum albumin, phosphate, uric acid, haemoglobin, and potassium levels had the best goodness of fit. All models had good discrimination with time-to-event c statistics of 0.89-0.95 in the development cohort and 0.86-0.95 in the validation cohort. The prediction models showed excellent and fairly good calibration at 2 and 5-year risk, respectively. CONCLUSION Using real-world data, our competing risk model can accurately predict progression to kidney failure over 2 years in patients with advanced CKD.
Collapse
Affiliation(s)
- Tai-Shuan Lai
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsiao-Mei Tsao
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Hsiang Chou
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shu-Ling Liang
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuo-Liong Chien
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University Hospital, Taipei, Taiwan
| | - Yung-Ming Chen
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Bei-Hu branch, Taipei, Taiwan.
| |
Collapse
|
32
|
Pesqué D, March-Rodríguez Á, Curto-Barredo L, Soto D, Gimeno R, Pujol RM, Giménez-Arnau AM. Autoimmune Diseases and Low Baseline IgE in Chronic Spontaneous Urticaria: A Clinical and Therapeutic Prospective Analysis in Real-Life Clinical Practice. J Allergy Clin Immunol Pract 2023; 11:3763-3771.e5. [PMID: 37716526 DOI: 10.1016/j.jaip.2023.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 08/11/2023] [Accepted: 09/01/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Autoimmunity contributes to the pathogenesis of chronic spontaneous urticaria (CSU). The subtyping of CSU has revealed an autoimmune form of CSU. Despite autoimmune diseases having been associated with CSU, there are few prospective studies that have evaluated the characteristics and biomarkers of patients with CSU and autoimmune disease in a real-life practice setting. OBJECTIVE To evaluate the presence of specific biomarkers for the presence of autoimmune disease in CSU and to analyze the clinical and therapeutic features of patients with CSU and autoimmune disease. METHODS The clinical, laboratory, and therapeutic features of patients with CSU at a tertiary-level center were prospectively collected. Data obtained were compared in function of the presence/absence of autoimmune disease and typified according to IgE levels. RESULTS Patients with CSU who had associated autoimmune disease corresponded to middle-aged women with a common pattern of blood test findings: both low baseline IgE and high-affinity receptor of IgE expression, basopenia, eosinopenia, higher baseline erythrocyte sedimentation rate and D-dimer, increased presence of antinuclear antibodies, IgG against thyroid peroxidase, and positive autologous serum skin test result. Total baseline IgE less than or equal to 43.8 IU/mL was both the optimal cutoff to predict autoimmune disease in the CSU cohort and a significant risk factor for the presence of autoimmune disease in the regression analysis. CONCLUSIONS In real-life clinical practice, characteristics of patients with CSU and autoimmune disease share common features with type IIb autoimmune CSU. Total baseline IgE less than or equal to 43.8 IU/mL has been detected as a possible biomarker of autoimmune disease in patients with CSU.
Collapse
Affiliation(s)
- David Pesqué
- Department of Dermatology, Hospital del Mar Research Institute, Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
| | - Álvaro March-Rodríguez
- Department of Dermatology, Hospital del Mar Research Institute, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Laia Curto-Barredo
- Department of Dermatology, Hospital del Mar Research Institute, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Dulce Soto
- Department of Dermatology, Hospital del Mar Research Institute, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Department of Immunology, Hospital del Mar Research Institute, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Ramón Gimeno
- Department of Immunology, Hospital del Mar Research Institute, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Ramon M Pujol
- Department of Dermatology, Hospital del Mar Research Institute, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Ana M Giménez-Arnau
- Department of Dermatology, Hospital del Mar Research Institute, Universitat Pompeu Fabra (UPF), Barcelona, Spain.
| |
Collapse
|
33
|
Peyvandi A, Gorgani-Firouzjaee T, Najafzadehvarzi H, Jafarzadeh J. Urtica dioica Extract Leads to Cyst Reduction, Enhanced Cell-Mediated Immune Response, and Antioxidant Activity in Experimental Toxoplasmosis. Acta Parasitol 2023; 68:880-890. [PMID: 37924457 DOI: 10.1007/s11686-023-00727-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 10/12/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Toxoplasmosis is a cosmopolitan parasitic infection caused by Toxoplasma gondii which is commonly treated by pyrimethamine (PYR) plus sulfadiazine (SDZ) with several adverse side effects. The present study evaluated the therapeutic effects of Urtica dioica L. aqueous extract (UDE) on acute and chronic toxoplasmosis in mice. METHODS For this purpose, mice were infected with 20 cysts (acute infection) or 10 cysts (chronic infection) of T. gondii (Me49 strain). The mice were treated with 200 mg/kg of UDE intraperitoneally (IP) and intragastric route (IG). The UDE-treated mice were compared with the PYR + SDZ treatment. The histopathological changes, cyst count, total antioxidant capacity (TAC), malondialdehyde (MDA) assay, and serum INF-γ were also evaluated. RESULTS In the acute toxoplasmosis, UDE by IP and IG administration significantly reduced the number of brain cysts by 93.74 and 92.55%, respectively, and increased the survival rate to 80% compared with 60% in untreated controls. In the chronic infection, cyst burden decreased at 88.2 and 83.4%, respectively, for IP and IG treatments. Moreover, UDE significantly increased INF- γ levels in acute and chronic toxoplasmosis. Tissue inflammatory lesions were reduced in the UDE-treated subgroups compared to the untreated group. UDE treatment significantly reduced MDA levels and elevated TAC in both acute and chronic infections. CONCLUSION The results show that U. dioica possesses significant immunostimulant and antioxidant activity with a higher cyst reduction in the brain during acute toxoplasmosis. Further studies are required to investigate the fractionations of UDE against T. gondii and its combination with other standard drugs.
Collapse
Affiliation(s)
- Ali Peyvandi
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Tahmineh Gorgani-Firouzjaee
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Ganj-Afroz Ave., Babol, Iran.
| | - Hossein Najafzadehvarzi
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, Babol University of Medical Sciences, Babol, Iran
| | - Jalal Jafarzadeh
- Department of Mycology and Parasitology, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| |
Collapse
|
34
|
Richards J, Henwood BF, Porter N, Kuhn R. Examining the Role of Duration and Frequency of Homelessness on Health Outcomes Among Unsheltered Young Adults. J Adolesc Health 2023; 73:1038-1045. [PMID: 37578404 PMCID: PMC10890810 DOI: 10.1016/j.jadohealth.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 04/20/2023] [Accepted: 06/10/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE We examined the impact of duration and number of homelessness episodes on health outcomes for unsheltered homeless young adults. METHODS We analyzed the 2018/2019 Los Angeles County homeless youth demographic surveys. We addressed five summary health outcomes: physical health, mental health, substance use disorder, tri-morbidity, and any condition. Respondents were classified into three homeless trajectory groups: (1) short-term-homeless < 1 year in one episode, (2) episodic-homeless < 1 year and multiple episodes, and (3) long-term-homeless continuously for > 1 year. Weighted bivariate and multivariate logistic regression models tested the relationship between homeless trajectory group and health, with controls for sociodemographic factors and structural exposures. RESULTS Mental health and substance use were high among unsheltered young adults compared to national rates. Long-term homeless respondents were significantly more likely than short-term to report a mental health condition (53.3% vs. 39.8%, p < .001), substance use disorder (25.5% vs. 18.3%, p < .001), and physical conditions (26.0% vs. 15.6%, p = .008). Episodic respondents were more likely to report a mental health condition (50.5%, p < .001). In multivariate models, long-term respondents had twice the odds of tri-morbidity (odds ratio [OR] = 2.14, p < .05) and any health condition (OR 2.00, p < .01) as short term and significantly higher odds of a physical health condition (OR = 1.64, p < .05). DISCUSSION Youth with longer durations and more frequent episodes of homelessness have substantially poorer health outcomes. The association of longer duration to poorer health persisted in multivariate models. Longer duration of unsheltered homelessness may drive the onset of physical and mental health problems.
Collapse
Affiliation(s)
- Jessica Richards
- Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Benjamin F Henwood
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
| | - Natalie Porter
- Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Randall Kuhn
- Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California.
| |
Collapse
|
35
|
Hinz M, Geyer S, Winden F, Braunsperger A, Kreuzpointner F, Irger M, Imhoff AB, Mehl J. Clinical and biomechanical outcomes following patellar tendon repair with suture tape augmentation. Eur J Orthop Surg Traumatol 2023; 33:3569-3576. [PMID: 37233797 PMCID: PMC10651537 DOI: 10.1007/s00590-023-03572-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 05/05/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE Patellar tendon ruptures (PTR) occur predominantly in middle-aged patients following indirect trauma. The aim of this study was to quantify the short-term results using a suture tape augmentation technique for the repair of PTR. METHODS All consecutive patients with acute (< 6 weeks) PTR who underwent suture tape augmentation between 03/2014 and 11/2019 at a single institution with a minimum follow-up of 12 months were retrospectively evaluated. Outcome measures included Visual Analog Scale (VAS) for pain, Tegner Activity Scale (TAS) and return to sport rates, Lysholm score, International Knee Documentation Committee subjective knee form (IKDC) as well as Knee Injury and Osteoarthritis Outcome Score (KOOS). Additionally, a standardized clinical examination and an isometric strength evaluation of knee extension and flexion were performed. It was hypothesized that high return to sport rates and good functional outcome would be observed and that the majority of patients would not present with a severe (> 20%) knee extension strength deficit when compared to the contralateral side. RESULTS A total of 7 patients (mean age 37.0 ± SD 13.5 years; 6 male/1 female) were available for final assessment at a median follow-up of 17.0 (25-75% IQR 16.0-77.0) months. Three injuries occurred during ball sports, two injuries occurred during winter sports, and one injury each occurred during a motorcycling and skateboarding accident. The average time between trauma and surgery was 4.7 ± 2.6 days. At follow-up, patients reported little pain (VAS: 0 [0-0.4]). Return to sport was possible for all patients 8.9 ± 4.0 months postoperatively at a high level (TAS: 7.0 [6.0-7.0]). Five patients (71.4%) returned to the preinjury level of play, and 2 (28.6%) did not return to the preinjury level of play. Patient-reported outcome measures were moderate to good (Lysholm score: 80.4 ± 14.5; IKDC: 84.2 ± 10.6; KOOS subscales: pain 95.6 ± 6.0, symptoms 81.1 [64.9-89.1], activities of daily living 98.5 [94.1-100], sport and recreation function 82.9 ± 14.1 and knee-related quality of life 75.9 ± 16.3). All patients were very satisfied (57.1%) or satisfied (42.9%) with the postoperative result. No postoperative complications were reported. Strength measurements revealed a severe knee extension deficit in 3 patients (42.9%), but no significant deficit of isometric knee extension or flexion strength in comparison with the contralateral side was observed overall (p > 0.05). CONCLUSION Suture tape augmentation in acute PTR repair leads to good functional outcome without major complications. Although a severe knee extension strength deficit may occur in some patients postoperatively, an excellent return to sports rate and high patient satisfaction can be expected nonetheless. LEVEL OF EVIDENCE Retrospective cohort study; III.
Collapse
Affiliation(s)
- Maximilian Hinz
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.
| | - Stephanie Geyer
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Felix Winden
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Alexander Braunsperger
- Department of Sport and Health Sciences, Prevention Center, Technical University of Munich, Munich, Germany
| | - Florian Kreuzpointner
- Department of Sport and Health Sciences, Prevention Center, Technical University of Munich, Munich, Germany
| | - Markus Irger
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Julian Mehl
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| |
Collapse
|
36
|
Giménez-Arnau AM, Manzanares N, Podder I. Recent updates in urticaria. Med Clin (Barc) 2023; 161:435-444. [PMID: 37537021 DOI: 10.1016/j.medcli.2023.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/23/2023] [Accepted: 06/23/2023] [Indexed: 08/05/2023]
Abstract
Urticaria is a skin-condition characterized by sudden-onset pruritic wheals with/without angioedema. Urticaria can be acute or chronic. Chronic urticaria may be spontaneous or inducible, based on absence/presence of specific triggers. Chronic spontaneous urticaria is most frequent (∼80%). Urticaria is primarily a mast-cell mediated histaminergic-disorder. Recently, other inflammatory cells and pro-inflammatory cytokines have been implicated. Deeper understanding has unmasked two endotypes - IgE-mediated type I autoimmunity/autoallergy and IgG-mediated type IIb autoimmunity. Current treatment recommendation involving second-generation H1-antihistamines, omalizumab and cyclosporine is effective in 60-80% patients. So, newer treatment options are being explored based on emerging targets. Despite being non-lethal, urticaria considerably impairs patient's quality-of-life and may be associated with extra-cutaneous comorbidities. Several "patient reported outcome measures" have been proposed to evaluate disease-activity, impact and control, for effective treatment modulation till complete disease control. This review discusses the current understanding about urticaria and its future directions, to facilitate optimum evidenced-based care.
Collapse
Affiliation(s)
- Ana M Giménez-Arnau
- Department of Dermatology, Hospital del Mar-IMIM, Universitat Pompeu Fabra de Barcelona, Spain.
| | - Nerea Manzanares
- Department of Dermatology, Hospital del Mar-IMIM, Universitat Pompeu Fabra de Barcelona, Spain
| | - Indrashis Podder
- Department of Dermatology, College of Medicine and Sagore Dutta Hospital, Kolkata 700058, West Bengal, India
| |
Collapse
|
37
|
Yang K, Wen Y, Zhu L, Bao JY, Li S, Wang YH, Feng J, Tian L, Jie Y. The Effect of Intense Pulsed Light Treatment for Chronic Hordeolum. Biomed Environ Sci 2023; 36:1005-1014. [PMID: 38098321 DOI: 10.3967/bes2023.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/22/2023] [Indexed: 12/18/2023]
Abstract
Objective To evaluate the effect of intense pulsed light (IPL) in the treatment of chronic hordeolum. Methods Patients with chronic hordeolum who underwent IPL treatment were enrolled in this study. According to the severity of hordeolum, the patients were treated with IPL 3 to 5 times. Patients' satisfaction and visual analog scale scores for ocular discomfort symptoms before and after treatment were collected. The number, congestion, long diameter, short diameter and area of nodules were also recorded and measured. Finally, eyelid margin signs, meibum quality, meibomian gland expressibility, meibomian gland dropout, tear meniscus height, and corneal fluorescein staining were scored. Results 20 patients were enrolled in this study. The eyelid margins were congestive and swollen, with blunt rounding or irregularity. The meibum was cloudy or toothpaste-like. The meibomian gland expressibility, meibomian gland dropout and tear meniscus height were reduced. The cornea showed scattered fluorescein staining. After treatment, score of visual analog scale, congestion and size of nodules were significantly reduced. Eyelid margin signs, meibum quality, meibomian gland expressibility, tear meniscus height and corneal fluorescein staining scores were improved. Meibomian gland dropout had no significant change. No side effects occurred during treatment. Conclusions IPL is beneficial for the treatment of chronic hordeolum.
Collapse
Affiliation(s)
- Ke Yang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing 100730, China
| | - Ya Wen
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing 100730, China
| | - Lei Zhu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing 100730, China
| | - Jia Yu Bao
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing 100730, China
| | - Shang Li
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing 100730, China
| | - Ying Hui Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing 100730, China
| | - Jun Feng
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing 100730, China
| | - Lei Tian
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing 100730, China
| | - Ying Jie
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing 100730, China
| |
Collapse
|
38
|
Bunæs-Næss H, Kvæl LAH, Nilsson BB, Heywood S, Heiberg KE. Aquatic high-intensity interval training (HIIT) may be similarly effective to land-based HIIT in improving exercise capacity in people with chronic conditions: a systematic review and meta-analysis. BMJ Open Sport Exerc Med 2023; 9:e001639. [PMID: 38022764 PMCID: PMC10649609 DOI: 10.1136/bmjsem-2023-001639] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2023] [Indexed: 11/19/2023] Open
Abstract
Objective To investigate the effect of aquatic high-intensity interval training (AHIIT) on exercise capacity in people with chronic conditions. Design Systematic review and meta-analysis. Participants Adults (age ≥18 years) with any chronic conditions (long duration, continuing health problems). Data sources The databases Medline, EMBASE, CINAHL, SPORTSDiscus, PEDro and The Cochrane Library were searched from inception to 11 August 2023. Eligibility criteria Randomised or non-randomised controlled trials of adults reporting one or more chronic conditions were included, comparing the effect of AHIIT with a non-exercising control group, land-based high-intensity interval training (LBHIIT) or aquatic moderate-intensity continuous training (AMICT). Results Eighteen trials with 868 participants with chronic musculoskeletal, respiratory, cardiovascular, metabolic or neurological conditions were included. Adherence to AHIIT was high, ranging from 84% to 100%. There was moderate certainty in evidence according to the Grading of Recommendations Assessment, Development and Evaluation system for a moderate beneficial effect on exercise capacity standardised mean differences (SMD) 0.78 (95% CI 0.48 to 1.08), p<0.00001) of AHIIT compared with a non-exercising control group. There was moderate certainty in evidence for no difference of effects on exercise capacity (SMD 0.28 (95% CI -0.04 to 0.60), p=0.08) of AHIIT compared with LBHIIT. There was moderate certainty in evidence for small effect on exercise capacity (SMD 0.45 (95% CI 0.10 to 0.80), p=0.01) of AHIIT compared with AMICT. Conclusion There are beneficial effects of AHIIT on exercise capacity in people with a range of chronic conditions. AHIIT has similar effects on exercise capacity as LBHIIT and may represent an alternative for people unable to perform LBHIIT. PROSPERO registration number CRD42022289001.
Collapse
Affiliation(s)
- Heidi Bunæs-Næss
- Department of Rehabilitation Science and Health Technology, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway
| | - Linda Aimée Hartford Kvæl
- Department of Rehabilitation Science and Health Technology, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway
- Centre for Welfare and Labour Research, Norwegian Social Research, Oslo Metropolitan University, Oslo, Norway
| | - Birgitta Blakstad Nilsson
- Department of Rehabilitation Science and Health Technology, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway
- Division of Medicine, Department of Clinical Services, Oslo University Hospital, Oslo, Norway
| | - Sophie Heywood
- Department of Physiotherapy, St Vincent's Hospital, St Vincent's Health Australia Ltd Fitzroy, Fitzroy, Victoria, Australia
- Department of Physiotherapy, University of Melbourne VCCC, Parkville, Victoria, Australia
| | - Kristi Elisabeth Heiberg
- Department of Rehabilitation Science and Health Technology, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway
| |
Collapse
|
39
|
Doran C, Duits A, Gerstenbluth I, Tami A, Bailey A. "What will the doctor give me, the same painkiller?": a qualitative study exploring health-care seeking and symptoms self-management among patients for the treatment of long-term chikungunya disease, in Curaçao. BMC Health Serv Res 2023; 23:1247. [PMID: 37957621 PMCID: PMC10641972 DOI: 10.1186/s12913-023-10254-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Long-term chikungunya disease, characterized by persistent disabling rheumatic symptoms, including poly-arthralgia/arthritis of severe pain intensity, can persist for years after infection with the re-emerging mosquito-borne chikungunya virus. Although persistent symptoms and pain severity are important determinants of health-care seeking and self-management of symptoms, research on these in relation to long-term chikungunya disease is scarce. This study aimed to explore the perceived benefits and perceived barriers concerning health-care seeking, based on the Health Belief Model, and the symptoms self-management strategies used for health outcome improvement among individuals affected by long-term chikungunya disease. METHODS An exploratory qualitative descriptive study was conducted with 20 purposively selected adults (17 females and 3 males) with persistent rheumatic symptoms, recruited from an ongoing longitudinal chikungunya cohort, in Curaçao. Semi-structured interviews were carried out, audio-recorded, and transcribed. An iterative coding process was used for themes identification through inductive thematic analyses. RESULTS No perceived benefits in health-care seeking were reported. Identified themes in relation to perceived barriers were: (1) health-care seeking at disease onset; (2) general practitioners (GPs) perceptions and awareness of persistent symptoms; (3) challenges for medical referrals and support; (4) no validation of symptoms and challenges accessing therapy; (5) health system restrictions; and (6) social stigmatization of psychological help. These perceived barriers have led participants to self-manage persistent symptoms. Over-the-counter pharmacological and/or non-pharmacological treatments were used without consulting GPs. Identified themes were: (1) self-medication of symptoms; and (2) self-management true non-pharmacological treatments. CONCLUSIONS To promote the benefits of long-term health-care seeking and subsequently reduce the possible harmful use of analgesics, a collaborative physician-patient therapeutic relationship need to be encouraged. To facilitate this, important shifts may be needed in chikungunya sequalae education of both patients and health-care professionals, and policy makers need to revise health systems for the long-term provision of multidisciplinary care to achieve beneficial health outcomes in long-term chikungunya disease.
Collapse
Affiliation(s)
- Churnalisa Doran
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Hanzeplein 1, Groningen, 9713 GZ, Netherlands.
| | - Ashley Duits
- Department of Immunology, Curaçao Biomedical and Health Research Institute, Pater Eeuwensweg 36, Willemstad, Curaçao, Curaçao
| | - Izzy Gerstenbluth
- Department of Epidemiology, Curaçao Biomedical and Health Research Institute, Pater Eeuwensweg 36, Willemstad, Curaçao, Curaçao
| | - Adriana Tami
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Hanzeplein 1, Groningen, 9713 GZ, Netherlands
| | - Ajay Bailey
- Department of Human Geography and Spatial Planning, University of Utrecht, Heidelberglaan 8, Utrecht, 3584 CS, Netherlands
| |
Collapse
|
40
|
Liu M, Chen H, Xu F. Dermoscopy of cutaneous sarcoidosis: a cross-sectional study. An Bras Dermatol 2023; 98:750-754. [PMID: 37487766 PMCID: PMC10589496 DOI: 10.1016/j.abd.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/04/2022] [Accepted: 12/19/2022] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Although traditionally used for the diagnosis of skin tumors, in the past few years dermoscopy as a clinical diagnostic aid for inflammatory and infectious skin manifestations has also received more and more attention. The clinical variability of cutaneous sarcoidosis (CS) often makes its correct diagnosis challenging. Dermoscopy can be used as an auxiliary examination method. OBJECTIVE Our aim was to evaluate the role of dermoscopy in the diagnosis and differential diagnosis of CS. METHODS This was a retrospective analysis of 39 CS clinical and dermoscopic images collected in the Department of Dermatology, Huashan Hospital Affiliated with Fudan University from August 2013 to February 2021. RESULTS Retrospective dermoscopic evaluation revealed small grouped, translucent orange globular structures in all 39 cases. Variable diameter linear vessels were found in 38 cases. A central scar-like area was seen in 26 cases. Bright white streaks were seen in 30 cases. The follicular plugs were seen in 15 cases. STUDY LIMITATIONS First, the number of cutaneous sarcoidosis cases the authors collected is small. Second, due to the lack of a control group, the sensitivity and specificity of the proposed criteria were not calculated. Finally, since our study mainly includes suspicious lesions that were biopsied for diagnostic purposes, there may be a selection bias. CONCLUSION Lesions showing on dermoscopy grouped translucent orange ovoid structures associated with linear vessels should raise the suspicion of CS. Central scar-like areas and bright white streaks are also helpful in the diagnosis of CS.
Collapse
Affiliation(s)
- Mengguo Liu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Huyan Chen
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Feng Xu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China.
| |
Collapse
|
41
|
Lawn T, Sendel M, Baron R, Vollert J. Beyond biopsychosocial: The keystone mechanism theory of pain. Brain Behav Immun 2023; 114:187-192. [PMID: 37625555 DOI: 10.1016/j.bbi.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/13/2023] [Accepted: 08/20/2023] [Indexed: 08/27/2023] Open
Abstract
Pain is a deeply personal experience, with interindividual differences in its chronification and treatment presenting a formidable healthcare challenge. The biopsychosocial model (BPSm) has been hugely influential within nascent attempts at precision pain medicine, steering the field away from a reductionist biomechanical viewpoint and emphasising complex interactions of biological, psychological, and social factors which shape the individuality of pain. However, despite offering a strong theoretical foundation and holistic perspective, we contend that the BPSm remains limited in its capacity to deliver truly mechanistically informed treatment of pain. We therefore propose the keystone model of pain which offers a pragmatic balance between the dimensionality expansive BPSm and overly reductive approaches, providing both theoretical and practical advantages for the transition from treating populations to individual people.
Collapse
Affiliation(s)
- Timothy Lawn
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Manon Sendel
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - Jan Vollert
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany; Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Germany; Pain Research, Department of Surgery and Cancer, Imperial College, London, UK; Neurophysiology, Mannheim Centre for Translational Neuroscience MCTN, Medical Faculty Mannheim, Ruprecht Karls University, Heidelberg, Germany
| |
Collapse
|
42
|
Ioannidou E, Tsakiris C, Goulis DG, Christoforidis A, Zafeiriou D. The association of serum vitamin D concentrations in paediatric migraine. Eur J Paediatr Neurol 2023; 47:60-66. [PMID: 37738749 DOI: 10.1016/j.ejpn.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/11/2023] [Indexed: 09/24/2023]
Abstract
INTRODUCTION Migraine is a neurologic condition characterized by hypersensitivity to auditory, olfactory, visual, and cutaneous stimuli; vomiting and nausea; and severe headache. It is the most frequent headache syndrome in children and can be categorized in chronic and/or episodic. Multiple dietary supplements have been inaugurated for the management of migraine, the most prevalent of which is vitamin D. BACKGROUND In recent years, vitamin D deficiency has been a global public health problem, with 30-80% of the worldwide population having vitamin D deficiency. The significant role of vitamin D in neurological disorders is underlined by its key role in the brain function of the central nervous system (CNS). Current approaches in paediatric neurology include nonsteroidal anti-inflammatory drugs (NSAID) for the treatment of paediatric migraine, among others. Vitamin D is one of the dietary factors that has been linked to migraine, however, this association has mostly been examined in the adult population. OBJECTIVE The aim of this study is to investigate the association between serum vitamin D and paediatric migraine by conducting a review of existing literature. The main question is described with the PICO format (population, intervention, control, and outcomes), while the assessment of the present research is under the PRISMA guidelines for systematic reviews. RESULTS/CONCLUSION A systematic review of the literature reveals a remarkable association between vitamin D and migraine presentation in the paediatric population, affecting the frequency and duration of the episodes. That being the case, vitamin D supplementation could potentially improve the quality of life of paediatric patients suffering from migraine headaches.
Collapse
Affiliation(s)
- Evangelia Ioannidou
- Paediatric Specialty Trainee RCPCH, Aristotle University of Thessaloniki | AUTH, MSc Medical Research and Methodology, Greece
| | - Charalampos Tsakiris
- Core Surgical Trainee RCSEng, Aristotle University of Thessaloniki | AUTH, MSc Medical Research and Methodology, Greece.
| | - Dimitrios G Goulis
- Reproductive Endocrinology, Medical School, Aristotle University of Thessaloniki, Greece
| | | | - Dimitrios Zafeiriou
- Aristotle University of Thessaloniki | AUTH, Department of Paediatrics I, Greece
| |
Collapse
|
43
|
Yan Z, Wan J, Liu J, Yao B, Lu Y, Guo Z, Li Y. α-lipoic acid ameliorates hepatotoxicity induced by chronic ammonia toxicity in crucian carp (Carassius auratus gibelio) by alleviating oxidative stress, inflammation and inhibiting ERS pathway. Ecotoxicol Environ Saf 2023; 266:115533. [PMID: 37806127 DOI: 10.1016/j.ecoenv.2023.115533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/23/2023] [Accepted: 09/26/2023] [Indexed: 10/10/2023]
Abstract
High environment ammonia (HEA) poses a deadly threat to aquatic animals and indirectly impacts human healthy life, while nutritional regulation can alleviate chronic ammonia toxicity. α-lipoic acid exhibits antioxidative effects in both aqueous and lipid environments, mitigating cellular and tissue damage caused by oxidative stress by aiding in the neutralization of free radicals (reactive oxygen species). Hence, investigating its potential as an effective antioxidant and its protective mechanisms against chronic ammonia stress in crucian carp is highly valuable. Experimental fish (initial weight 20.47 ± 1.68 g) were fed diets supplemented with or without 0.1% α-lipoic acid followed by a chronic ammonia exposure (10 mg/L) for 42 days. The results revealed that chronic ammonia stress affected growth (weight gain rate, specific growth rate, and feed conversion rate), leading to oxidative stress (decreased the activities of antioxidant enzymes catalase, superoxide dismutase, glutathione peroxidase; decreased total antioxidant capacity), increased lipid peroxidation (accumulation of malondialdehyde), immune suppression (decreased contents of nonspecific immune enzymes AKP and ACP, 50% hemolytic complement, and decrease of immunoglobulin M), impaired ammonia metabolism (reduced contents of Glu, GS, GSH, and Gln), imbalance of expression of induced antioxidant-related genes (downregulation of Cu/Zu SOD, CAT, Nrf2, and HO-1; upregulation of GST and Keap1), induction of pro-apoptotic molecules (transcription of BAX, Caspase3, and Caspase9), downregulation of anti-apoptotic gene Bcl-2 expression, and induction of endoplasmic reticulum stress (upregulation of IRE1, PERK, and ATF6 expression). The results suggested that the supplementation of α-lipoic acid could effectively induce humoral immunity, alleviate oxidative stress injury and endoplasmic reticulum stress, and ultimately alleviate liver injury induced by ammonia poisoning (50-60% reduction). This provides theoretical basis for revealing the toxicity of long-term ammonia stress and provides new insights into the anti-ammonia toxicity mechanism of α-lipoic acid.
Collapse
Affiliation(s)
- Zihao Yan
- College of Veterinary Medicine, Jilin Agricultural University, Changchun 130118, China; College of Animal Science and Technology, Jilin Agricultural University, Changchun 130118, China
| | - Jiwu Wan
- Jilin Provincial Aquatic Technology Extension Center, Changchun 130118, China
| | - Jia Liu
- College of Veterinary Medicine, Jilin Agricultural University, Changchun 130118, China; College of Animal Science and Technology, Jilin Agricultural University, Changchun 130118, China
| | - Baolan Yao
- College of Veterinary Medicine, Jilin Agricultural University, Changchun 130118, China; College of Animal Science and Technology, Jilin Agricultural University, Changchun 130118, China
| | - Yuqian Lu
- College of Veterinary Medicine, Jilin Agricultural University, Changchun 130118, China; College of Animal Science and Technology, Jilin Agricultural University, Changchun 130118, China
| | - Zhengyao Guo
- College of Veterinary Medicine, Jilin Agricultural University, Changchun 130118, China; College of Animal Science and Technology, Jilin Agricultural University, Changchun 130118, China
| | - Yuehong Li
- College of Veterinary Medicine, Jilin Agricultural University, Changchun 130118, China; College of Animal Science and Technology, Jilin Agricultural University, Changchun 130118, China.
| |
Collapse
|
44
|
McNabb KC, Bergman AJ, Smith-Wright R, Seltzer J, Slone SE, Tomiwa T, Alharthi A, Davidson PM, Commodore-Mensah Y, Ogungbe O. "It was almost like it's set up for people to fail" A qualitative analysis of experiences and unmet supportive needs of people with Long COVID. BMC Public Health 2023; 23:2131. [PMID: 37904110 PMCID: PMC10617090 DOI: 10.1186/s12889-023-17033-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/20/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Almost twenty percent of adults with COVID-19 develop Long COVID, leading to prolonged symptoms and disability. Understanding the supportive needs of people with Long COVID is vital to enacting effective models of care and policies. DESIGN/METHODS This qualitative sub-study explored the experiences of people with Long COVID and their unmet needs. Participants enrolled in a larger study to evaluate the post-acute cardiovascular impacts of COVID-19 were invited to participate in subsequent in-depth interviews. Participants were enrolled purposively until saturation at 24 participants. Data were analyzed using thematic content analysis. RESULTS Participants focused on adaptations to life with Long COVID and their unmet needs in different life spheres. Three domains, 1) occupational and financial; 2) healthcare-related; and 3) social and emotional support, emerged as areas affecting quality of life. Although participants were motivated to return to work for financial and personal reasons, Long COVID symptoms often resulted in the inability to perform tasks required by their existing jobs, and unemployment. Those who maintained employment through employer accommodations still needed additional support. Participants encountered diagnostic challenges, challenges in accessing specialty appointments, insurance loopholes, high healthcare costs, and medical skepticism. Existing social networks provided support for completing daily tasks; however, those with Long COVID typically turned to others with similar lived experiences for emotional support. Participants found government support programs inadequate and difficult to access in all three domains. DISCUSSION We propose a five-pronged policy approach to support persons with Long COVID. These overarching recommendations are (1) improve public awareness of Long COVID; (2) improve clinical care quality and access; (3) implement additional school and workplace accommodations; (4) strengthen socioeconomic benefits and social services; and (5) improve research on Long COVID.
Collapse
Affiliation(s)
- Katherine C McNabb
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University School of Nursing, 525 N. Wolfe St., Baltimore, MD, 21205, USA.
| | - Alanna J Bergman
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University School of Nursing, 525 N. Wolfe St., Baltimore, MD, 21205, USA
| | | | - Jaime Seltzer
- Stanford University, Stanford School of Medicine, Palo Alto, USA
- The Myalgic Encephalomyelitis Action Network, Santa Monica, USA
| | - Sarah E Slone
- Johns Hopkins University, Johns Hopkins School of Nursing, Baltimore, USA
| | - Tosin Tomiwa
- Johns Hopkins University, Johns Hopkins Institute for Clinical and Translational Research, Baltimore, USA
| | - Abeer Alharthi
- Johns Hopkins University, Johns Hopkins School of Nursing, Baltimore, USA
| | | | - Yvonne Commodore-Mensah
- Johns Hopkins University, Johns Hopkins School of Nursing, Baltimore, USA
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, USA
| | - Oluwabunmi Ogungbe
- Johns Hopkins University, Johns Hopkins School of Nursing, Baltimore, USA
- Johns Hopkins University, Johns Hopkins School of Medicine, Baltimore, USA
| |
Collapse
|
45
|
Danese D, Goss D, Romano C, Gupta C. Qualitative assessment of the patient experience of primary hyperoxaluria type 1: an observational study. BMC Nephrol 2023; 24:319. [PMID: 37884879 PMCID: PMC10604408 DOI: 10.1186/s12882-023-03365-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Without effective intervention, primary hyperoxaluria type 1 (PH1) causes oxalate-induced kidney damage, leading to end-stage kidney disease and serious complications throughout the body. Although PH1 carries a heavy burden that impacts quality of life, literature on the experiences of those living with PH1 and caring for patients with PH1 is limited. This study aimed to describe the diagnostic journey in PH1 and characterize patients' and caregivers' self-reported experiences throughout the disease course. METHODS This was an observational study involving in-depth, semi-structured telephone interviews. Dominant trends were assessed using constant comparative analysis to identify themes in interviewees' descriptions of their experiences. Individuals aged ≥ 12 years and caregivers of children aged 6-17 years with genetically confirmed PH1 were eligible. Informed consent/assent and ability to read and speak English were required. RESULTS Interviewees (16 patients, 12 caregivers) reported a prolonged diagnostic journey due to low disease awareness, among other factors. Upon diagnosis, PH1 was frequently symptomatic, typically involving kidney stone-related symptoms but also potentially symptoms arising beyond the kidneys. PH1 most commonly led to worry and social impairment in adolescents, impaired physical function in adults, and a range of impacts on caregivers. In late-stage disease, dialysis was the most burdensome aspect of living with PH1 (due to time requirements, limitations from living with a catheter, etc.), and this burden was exacerbated by the COVID-19 pandemic. Benefits desired from PH1 management included reductions in laboratory measures of oxalate burden, kidney stone and urination frequency, and oxalate-related skin ulcers. CONCLUSIONS PH1 greatly impacts patients' and caregivers' lives, primarily due to burdensome disease manifestations and associated emotional, physical, and practical impacts, as well as disease management challenges - particularly those related to dialysis in late-stage disease.
Collapse
Affiliation(s)
- David Danese
- Alnylam Pharmaceuticals, 675 West Kendall St, Cambridge, MA, 02142, USA.
| | - Diana Goss
- Research Triangle Institute, Research Triangle Park, NC, USA
| | - Carla Romano
- Research Triangle Institute, Research Triangle Park, NC, USA
| | - Catherine Gupta
- Research Triangle Institute, Research Triangle Park, NC, USA
| |
Collapse
|
46
|
Sánchez-Rodríguez C, Gago-Veiga AB, García-Azorín D, Guerrero-Peral ÁL, Gonzalez-Martinez A. Potential Predictors of Response to CGRP Monoclonal Antibodies in Chronic Migraine: Real-World Data. Curr Pain Headache Rep 2023:10.1007/s11916-023-01183-6. [PMID: 37874459 DOI: 10.1007/s11916-023-01183-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE OF REVIEW Real-world data (RWD) has identified potential predictors of response to anti-CGRP therapies in patients with chronic migraine (CM). This review aims to synthesize the most remarkable findings published to date regarding this topic. RECENT FINDINGS Migraine features such as unilateral pain and positive triptan response and chronic features such as daily headache or medication overuse (MO) emerge as predictors of positive outcomes, potentially linked to elevated baseline serum anti-calcitonin gene-related peptide (anti-CGRP) levels. Demographic and baseline characteristics, encompassing obesity, psychiatric comorbidities, and prior refractoriness to prophylactic treatments, are associated with poor responses in both treatment-naïve patients and after-switch scenarios. Nevertheless, the consistency of these predictors across diverse populations requires further investigation. Recent RWD literature highlights emerging predictors of response of different sources among patients with CM receiving anti-CGRP therapies. Comprehending these predictors and identifying novel biomarkers of response hold the potential to refine treatment strategies for CM patients, enhancing their management and therapeutic outcomes.
Collapse
Affiliation(s)
- Carmen Sánchez-Rodríguez
- Headache Unit, Hospital Universitario de la Princesa & Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Diego de León 62, 28006, Madrid, Spain
| | - Ana Beatriz Gago-Veiga
- Headache Unit, Hospital Universitario de la Princesa & Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Diego de León 62, 28006, Madrid, Spain
| | - David García-Azorín
- Headache Unit, Hospital Clínico Universitario de Valladolid & Department of Medicine, University of Valladolid, Valladolid, Spain
| | - Ángel Luis Guerrero-Peral
- Headache Unit, Hospital Clínico Universitario de Valladolid & Department of Medicine, University of Valladolid, Valladolid, Spain
| | - Alicia Gonzalez-Martinez
- Headache Unit, Hospital Universitario de la Princesa & Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Diego de León 62, 28006, Madrid, Spain.
| |
Collapse
|
47
|
Kurihara K, Sasaki M, Nagahama H, Obara H, Fukushi R, Hirota R, Yoshimoto M, Teramoto A, Kocsis JD, Yamashita T, Honmou O. Repeated intravenous infusion of mesenchymal stem cells enhances recovery of motor function in a rat model with chronic spinal cord injury. Brain Res 2023; 1817:148484. [PMID: 37442249 DOI: 10.1016/j.brainres.2023.148484] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/05/2023] [Accepted: 07/10/2023] [Indexed: 07/15/2023]
Abstract
Spinal cord injury (SCI) can cause paralysis with a high disease burden with limited treatment options. A single intravenous infusion of mesenchymal stem cells (MSCs) improves motor function in rat SCI models, possibly through the induction of axonal sprouting and remyelination. Repeated infusions (thrice at weekly intervals) of MSCs were administered to rats with chronic SCI to determine if multiple-dosing regimens enhance motor improvement. Chronic SCI rats were randomized and infused with vehicle (vehicle), single MSC injection at week 6 (MSC-1) or repeatedly injections of MSCs at 6, 7, and 8 weeks (MSC-3) after SCI induction. In addition, a single high dose of MSCs (HD-MSC) equivalent to thrice the single dose was infused at week 6. Locomotor function, light and electron microscopy, immunohistochemistry and ex vivo diffusion tensor imaging were performed. Repeated infusion of MSCs (MSC-3) provided the greatest functional recovery compared to single and single high-dose infusions. The density of remyelinated axons in the injured spinal cord was the greatest in the MSC-3 group, followed by the MSC-1, HD-MSC and vehicle groups. Increased sprouting of the corticospinal tract and serotonergic axon density was the greatest in the MSC-3 group, followed by MSC-1, HD-MSC, and vehicle groups. Repeated infusion of MSCs over three weeks resulted in greater functional improvement than single administration of MSCs, even when the number of infused cells was tripled. MSC-treated rats showed axonal sprouting and remyelination in the chronic phase of SCI.
Collapse
Affiliation(s)
- Kota Kurihara
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan; Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
| | - Masanori Sasaki
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan; Department of Neurology, Yale University School of Medicine, New Haven, CT 06510, USA.
| | - Hiroshi Nagahama
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan; Division of Radioisotope Research, Biomedical Research, Education and Instrumentation Center, Sapporo Medical University School of Medicine, Sapporo, Hokkaido 060-8556, Japan
| | - Hisashi Obara
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan; Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
| | - Ryunosuke Fukushi
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan; Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
| | - Ryosuke Hirota
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan; Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
| | - Mitsunori Yoshimoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
| | - Jeffery D Kocsis
- Department of Neurology, Yale University School of Medicine, New Haven, CT 06510, USA; Department of Neuroscience, Yale University School of Medicine, New Haven, CT 06510, USA; Center for Neuroscience and Regeneration Research, VA Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
| | - Osamu Honmou
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan; Department of Neurology, Yale University School of Medicine, New Haven, CT 06510, USA
| |
Collapse
|
48
|
Song S, Druschel LN, Chan ER, Capadona JR. Differential expression of genes involved in the chronic response to intracortical microelectrodes. Acta Biomater 2023; 169:348-362. [PMID: 37507031 PMCID: PMC10528922 DOI: 10.1016/j.actbio.2023.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 07/13/2023] [Accepted: 07/23/2023] [Indexed: 07/30/2023]
Abstract
Brain-Machine Interface systems (BMIs) are clinically valuable devices that can provide functional restoration for patients with spinal cord injury or improved integration for patients requiring prostheses. Intracortical microelectrodes can record neuronal action potentials at a resolution necessary for precisely controlling BMIs. However, intracortical microelectrodes have a demonstrated history of progressive decline in the recording performance with time, inhibiting their usefulness. One major contributor to decreased performance is the neuroinflammatory response to the implanted microelectrodes. The neuroinflammatory response can lead to neurodegeneration and the formation of a glial scar at the implant site. Historically, histological imaging of relatively few known cellular and protein markers has characterized the neuroinflammatory response to implanted microelectrode arrays. However, neuroinflammation requires many molecular players to coordinate the response - meaning traditional methods could result in an incomplete understanding. Taking advantage of recent advancements in tools to characterize the relative or absolute DNA/RNA expression levels, a few groups have begun to explore gene expression at the microelectrode-tissue interface. We have utilized a custom panel of ∼813 neuroinflammatory-specific genes developed with NanoString for bulk tissue analysis at the microelectrode-tissue interface. Our previous studies characterized the acute innate immune response to intracortical microelectrodes. Here we investigated the gene expression at the microelectrode-tissue interface in wild-type (WT) mice chronically implanted with nonfunctioning probes. We found 28 differentially expressed genes at chronic time points (4WK, 8WK, and 16WK), many in the complement and extracellular matrix system. Further, the expression levels were relatively stable over time. Genes identified here represent chronic molecular players at the microelectrode implant sites and potential therapeutic targets for the long-term integration of microelectrodes. STATEMENT OF SIGNIFICANCE: Intracortical microelectrodes can record neuronal action potentials at a resolution necessary for the precise control of Brain-Machine Interface systems (BMIs). However, intracortical microelectrodes have a demonstrated history of progressive declines in the recording performance with time, inhibiting their usefulness. One major contributor to the decline in these devices is the neuroinflammatory response against the implanted microelectrodes. Historically, neuroinflammation to implanted microelectrode arrays has been characterized by histological imaging of relatively few known cellular and protein markers. Few studies have begun to develop a more in-depth understanding of the molecular pathways facilitating device-mediated neuroinflammation. Here, we are among the first to identify genetic pathways that could represent targets to improve the host response to intracortical microelectrodes, and ultimately device performance.
Collapse
Affiliation(s)
- Sydney Song
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, United States; Advanced Platform Technology Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106, United States
| | - Lindsey N Druschel
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, United States; Advanced Platform Technology Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106, United States
| | - E Ricky Chan
- Cleveland Institute for Computational Biology, Case Western Reserve University, Cleveland, OH 44106, United States
| | - Jeffrey R Capadona
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, United States; Advanced Platform Technology Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106, United States.
| |
Collapse
|
49
|
Nijhuis HJA, Hofsté WJ, Krabbenbos IP, Dietz BE, Mugan D, Huygen F. First Report on Real-World Outcomes with Evoked Compound Action Potential (ECAP)-Controlled Closed-Loop Spinal Cord Stimulation for Treatment of Chronic Pain. Pain Ther 2023; 12:1221-1233. [PMID: 37481774 PMCID: PMC10444915 DOI: 10.1007/s40122-023-00540-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/30/2023] [Indexed: 07/25/2023] Open
Abstract
INTRODUCTION A novel closed-loop spinal cord stimulation (SCS) system has recently been approved for use which records evoked compound action potentials (ECAPs) from the spinal cord and utilizes these recordings to automatically adjust the stimulation strength in real time. It automatically compensates for fluctuations in distance between the epidural leads and the spinal cord by maintaining the neural response (ECAP) at a determined target level. This data collection was principally designed to evaluate the performance of this first closed-loop SCS system in a 'real-world' setting under normal conditions of use in a single European center. METHODS In this prospective, single-center observational data collection, 22 patients were recruited at the outpatient pain clinic of the St. Antonius Hospital. All candidates were suffering from chronic pain in the trunk and/or limbs due to PSPS type 2 (persistent spinal pain syndrome). As standard of care, follow-up visits were completed at 3 months, 6 months, and 12 months post-device activation. Patient-reported outcome data (pain intensity, patient satisfaction) and electrophysiological and device data (ECAP amplitude, conduction velocity, current output, pulse width, frequency, usage), and patient interaction with their controller were collected at baseline and during standard of care follow-up visits. RESULTS Significant decreases in pain intensity for overall back or leg pain scores (verbal numerical rating score = VNRS) were observed between baseline [mean ± SEM (standard error of the mean); n = 22; 8.4 ± 0.2)], 3 months (n = 12; 1.9 ± 0.5), 6 months (n = 16; 2.6 ± 0.5), and 12 months (n = 20; 2.0 ± 0.5), with 85.0% of the patients being satisfied at 12 months. Additionally, no significant differences in average pain relief at 3 months and 12 months between the real-world data (77.2%; 76.8%) and the AVALON (71.2%; 73.6%) and EVOKE (78.1%; 76.7%) studies were observed. CONCLUSIONS These initial 'real-world' data on ECAP-controlled, closed-loop SCS in a real-world clinical setting appear to be promising, as they provide novel insights of the beneficial effect of ECAP-controlled, closed-loop SCS in a real-world setting. The presented results demonstrate a noteworthy maintenance of pain relief over 12 months and corroborate the outcomes observed in the AVALON prospective, multicenter, single-arm study and the EVOKE double-blind, multicenter, randomized controlled trial. TRIAL REGISTRATION The data collection is registered on the International Clinical Trials Registry Platform (Trial NL7889).
Collapse
Affiliation(s)
- Harold J. A. Nijhuis
- St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Willem-Jan Hofsté
- St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
| | - Imre P. Krabbenbos
- St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
| | | | - Dave Mugan
- Saluda Medical Europe Ltd, Harrogate, United Kingdom
| | - Frank Huygen
- Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
50
|
Brock J, Jayaraju U, Trickett RW. Surgical Interventions for Chronic Ulnar Collateral Ligament Injuries of the Thumb: A Systematic Review. J Hand Surg Asian Pac Vol 2023; 28:548-554. [PMID: 37905362 DOI: 10.1142/s2424835523500637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Background: There is no consensus for the appropriate surgical management of symptomatic chronic ulnar collateral ligament (UCL) injuries of the thumb. The aim of this study is to systematically review the treatment of chronic thumb metacarpophalangeal (MCP) joint UCL injuries to determine the optimal approach to treatment. Methods: A systematic review of PubMed, Medline, Embase and ePub Ahead of Print was performed in accordance with Preferred Reporting of Items in Systematic Review and Meta-Analysis (PRISMA) guidelines. Results: Data from 11 studies using various surgical techniques in 245 thumbs were heterogenous and meta-analysis of results not possible. These data were qualitatively assessed. Direct repair, reconstruction with free tendon grafts and arthrodesis all demonstrated favourable outcomes with patient-reported outcome measures (PROMs). Conclusions: Direct repair can be safely performed more than 2 months following injury. Arthrodesis may be considered in heavy manual labourers or those with osteoarthrosis. Tendon grafting is safe, yet the optimal type and configuration are yet to be determined for reconstructive methods. Level of Evidence: Level III (Therapeutic).
Collapse
Affiliation(s)
- James Brock
- Trauma & Orthopaedic Surgery, University Hospital of Wales, Cardiff, UK
| | - Ullas Jayaraju
- Trauma & Orthopaedic Surgery, University Hospital of Wales, Cardiff, UK
| | - Ryan W Trickett
- Trauma & Orthopaedic Surgery, University Hospital of Wales, Cardiff, UK
| |
Collapse
|