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Biomechanical strength comparison of pedicle screw augmentation using poly-dicalcium phosphate dihydrate (P-DCPD) and polymethylmethacrylate (PMMA) cements.
Criado, A, Yokhana, S, Rahman, T, McCarty, S, Andrecovich, C, Ren, W, Yassir, WK
Spine deformity. 2020;(2):165-170
Abstract
STUDY DESIGN A basic science, hypothesis-driven experimental study of the biomechanics of two bone cements in their ability to augment pedicle screws in bone foam. OBJECTIVE The purpose of our study was to compare the pullout and torque resistance of conventional pedicle screws (CPS) augmented with either polymethylmethacrylate (PMMA) or poly-dicalcium phosphate dihydrate (P-DCPD) cement in polyurethane foam blocks mimicking osteoporotic bone. P-DCPD cement has attractive safety characteristics such as non-exothermic curing and drug-eluting capacity. PMMA cement lacks these safety features yet is the current standard in pedicle screw augmentation. METHODS Standardized low-density polyurethane open-cell foam blocks were instrumented with conventional pedicle screws and categorized into three groups of six each. Group 1 was the control group and no cement was used. Groups 2 and 3 were augmented with PMMA and P-DCPD, respectively. An Instron machine applied an axial load to failure at a rate of 2 mm/min for 3 min and a torsional load to failure at a rate of 1°/s. Failure was defined by an evident drop in the load after maximum value. RESULTS Maximal pullout load for PMMA and P-DCPD was significantly greater than control (p < 0.0001). Interestingly, there was no significant difference in the pullout load to failure for the PMMA and P-DCPD groups. Analysis showed significant difference in torsional resistance between PMMA and P-DCPD, with PMMA having greater resistance (p = 0.00436). CONCLUSIONS No difference was observed between PMMA and P-DCPD in pullout load to failure conducted in low-density open-cell, rigid foam blocks. Although a significant difference did exist in our torque analysis, the clinical significance of such a load on a native spine is questionable. Further investigation is warranted for this promising compound that seems to be comparable in pullout resistance to PMMA and offers attractive safety features. LEVEL OF EVIDENCE Basic science, not applicable.
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Evaluation of miR-181b and miR-126-5p expression levels in T2DM patients compared to healthy individuals: Relationship with NF-κB gene expression.
Dehghani, M, Aghaei Zarch, SM, Vahidi Mehrjardi, MY, Nazari, M, Babakhanzadeh, E, Ghadimi, H, Zeinali, F, Talebi, M
Endocrinologia, diabetes y nutricion. 2020;(7):454-460
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a progressive metabolic disorder whose prevalence is rising very fast across the world. Diagnosis of this disease in early stages (pre-diabetic stage) plays an important role in reducing mortality associated with this disorder. miRNAs, as key players in the pathogenesis of T2DM, have been investigated in several studies. Furthermore, their expression profile changes in the early stages of diabetes mellitus in body fluids such as serum, peripheral blood, and peripheral blood mononuclear cell (PBMC) have been studied. Due to their high stability and the presence of non-invasive sensitive methods for their measurement, such as real-time PCR, they can be used for early diagnosis of T2DM as a biomarker. In this experimental study, the expression levels of miR-181b, miR-126-5p, and NF-κB were measured in patients with T2DM, pre-diabetic subjects, and healthy controls in a Yazd population. MATERIAL AND METHOD Ninety asymptomatic subjects including 30 T2DM, 30 pre-diabetic, and 30 healthy subjects (diagnosis based on WHO criteria) were included in this study. Real-time PCR was used to measure the expression levels of miR-181b and miR-126-5p. Moreover, the NF-κB expression level was also measured to determine its relationship with these two microRNAs. RESULT In this study, the expression level of miR-181b and miR-126-p decreased gradually in pre-diabetic as well as T2DM subjects compared to healthy controls. Furthermore, our study showed a significant negative correlation between these two miRNAs and NF-κB for the first time. CONCLUSION These results introduce these anti-inflammatory miRNAs as powerful tools for early diagnosis of T2DM.
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Manual Physical Therapy in the Treatment of Functional Constipation in Children: A Pilot Randomized Controlled Trial.
Blanco Díaz, M, Bousoño García, C, Segura Ramírez, DK, Rodríguez Rodriguez, ÁM
Journal of alternative and complementary medicine (New York, N.Y.). 2020;(7):620-627
Abstract
Objectives: Make a preliminary assessment of the efficacy of manual physical therapy (MPT) compared to conventional pharmacologic treatment (CPT) in chronic pediatric functional constipation (CPC). Design: A pilot randomized and controlled trial was conducted. Settings/Location: Subjects were recruited in a tertiary university hospital in the north of Spain. Subjects: Forty-seven children (2-14 years) were included. Participants were assessed by Pediatric Gastroenterologist. They were recruited in a tertiary university hospital. Subjects were randomly allocated. MPT was performed in a private clinic. Interventions: Control group (CG) received CPT and intervention group (IG) received MPT, consisting in nine sessions of MPT with a 45-min initial session and 30 min for the rest of sessions distributed weekly during the first and second months and biweekly in the third month. Outcome Measures: At times 0-1-3 months and 5 years, results obtained were checked and compared, according to the defecatory pattern ("Symptom Severity Score" SSS), quality of life (Pediatric Quality of Life Inventory Scale), Bristol Stool Form Scale (BSFS), and the defecation frequency (DF). Results: Results from SSS, BSFS, and DF revealed no statistically significant differences between groups in median values at any follow-up. However, there were significant changes over time. The full sample median for SSS was reduced from baseline 24 (interquartile range 20-27) to 11 (6-13) at month 1, 7 (3-13) at month 3, (8 CG; 5 IG), and 5 (1-12) at year 5. The BSFS scale increased from 2 (1-3) at baseline to 4 (3-4) at month 1 and year 5. DF increases progressively from 1 per week to 5 in the fifth year. Higher rates of quality of life were observed at month 3 in IG for the total, physical, and emotional functioning scores and at fifth year for total, emotional, social, and school functioning scores. Conclusions: This study gives preliminary evidence of no difference between MPT and CPT for improvement in measures of CPC, although there was some advantage for MPT in quality of life. Study results justify the conduct of a full-scale efficacy trial of MPT, as well as a noninferiority trial comparing MPT and CPT.
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Optical Coherence Tomography Biomarkers of the Outer Blood-Retina Barrier in Patients with Diabetic Macular Oedema.
Damian, I, Nicoara, SD
Journal of diabetes research. 2020;:8880586
Abstract
BACKGROUND Numerous studies confirmed the main role of the inner blood-retinal barrier in the development of Diabetic Macular Oedema (DMO). Lately, the focus of research shifted towards the external retinal barrier with potential involvement in the pathogenesis of DMO. OBJECTIVE We aim to identify the OCT changes of the external blood-retinal barrier in patients with DMO and to define them as biomarkers with predictive value. Materials and method. We set up retrospectively 3 groups of patients diagnosed with nonproliferative diabetic retinopathy (NPDR) and DMO, proliferative diabetic retinopathy (PDR) and DMO, and controls. We compared the RPE thickness in every quadrant between groups and performed correlations between best-corrected visual acuity (BCVA) and the thickness of the retinal layers. The Social Science Statistics platform was used for statistical tests. RESULTS The NPDR-DMO group consisted of 18 eyes, the PDR-DMO group consisted of 19 eyes, and the control group included 36 eyes. In the PDR-DMO group, RPE thickness was decreased in almost all quadrants (p < 0.001); in the NPDR-DMO group, only the central minimum and central maximum values of the RPE thickness were significantly different from the control group. We did not find any strong correlation between BCVA and the thickness of the retinal layers. CONCLUSION The thickness of the RPE layer is an OCT biomarker able to predict the functioning of the outer BRB. Eyes with PDR-DMO exhibited decreased thickness of the RPE layer in almost all quadrants, highlighting the degenerative changes occurring in a hypoxic environment. The thickness of a specific layer could not be identified as a biomarker to correlate significantly with BCVA, most likely because we did not analyze specific morphologic features, such as continuity and reflectivity. The analysis of the RPE thickness could clarify the unexplained decrease of BCVA and predict early the evolution of DR.
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Comparing Sleep Quality in Patients Before and After Kidney Transplantation.
Hasanzamani, B, Pourranjbar, E, Rezaei Ardani, A
Iranian journal of kidney diseases. 2020;(2):139-144
Abstract
INTRODUCTION The purpose of the present study was to identify the prevalence of sleep disturbances in ESRD, and to compare the sleep quality before and after kidney transplantation. METHODS A semi-experimental study was performed on 40 participants with ESRD from September 2017 to September 2018 in Mashhad, Iran. Participants were in the waiting list of kidney transplantation, aged 18-years-old or more, had no history of any major psychological problems. They were excluded from the study if new medical condition or psychiatric disorder was initiated throughout the study. Patients' medical information including the duration of dialysis and laboratory data was extracted from medical records. Their sleep quality was assessed with the Pittsburgh sleep quality index (PSQI) within1-month prior the kidney transplantation and at the 3rd and 6th months after it. Collected data was analyzed using SPSS-16. P < .05 considered as significant. RESULTS The frequency of poor sleepers was 37.5%, 37.5%, and 20.0%; before the kidney transplantation, 3 months and 6 months after the surgery; respectively. The average sleep quality score decreased significantly 6-month post-operation compared to pre-transplant phase (P < 0.05). We found a significant relationship between the gender and quality of sleep before transplant surgery, whereas no correlation was found between sleep quality and the age, type or duration of dialysis, serum phosphorus or hemoglobin level, and the cause of kidney failure (P < .05, > .05, > .05, > .05, > .05, > .05, and > .05; respectively). CONCLUSION Kidney transplantation has a positive effect on patients' sleep quality after 6 months.
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A randomized controlled trial comparing primary tumour resection plus chemotherapy with chemotherapy alone in incurable stage IV colorectal cancer: JCOG1007 (iPACS study).
Moritani, K, Kanemitsu, Y, Shida, D, Shitara, K, Mizusawa, J, Katayama, H, Hamaguchi, T, Shimada, Y, ,
Japanese journal of clinical oncology. 2020;(1):89-93
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Abstract
It is controversial whether chemotherapy with or without primary tumour resection is effective for the patients with incurable Stage IV colorectal cancer. A randomized controlled trial, initiated in Japan in 2012, is being conducted to evaluate the survival benefit and safety of primary tumour resection plus chemotherapy compared with chemotherapy alone in asymptomatic Stage IV colorectal cancer patients with unresectable metastatic disease. Patients are randomly assigned to either chemotherapy alone or primary tumour resection followed by chemotherapy. The primary endpoint is overall survival. Secondary endpoints are progression-free survival, incidence of adverse events, proportion of patients with R0 resection and proportion of palliative surgery for the chemotherapy-alone group. This trial was registered in June 2012 with the UMIN Clinical Trials Registry as UMIN000008147 [http://www.umin.ac.jp/ctr/index-j.htm]. In December 2017, the study protocol was amended for reducing sample size. A total of 280 patients will be enrolled over the course of 8.5 years.
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Greater risk of severe COVID-19 in Black, Asian and Minority Ethnic populations is not explained by cardiometabolic, socioeconomic or behavioural factors, or by 25(OH)-vitamin D status: study of 1326 cases from the UK Biobank.
Raisi-Estabragh, Z, McCracken, C, Bethell, MS, Cooper, J, Cooper, C, Caulfield, MJ, Munroe, PB, Harvey, NC, Petersen, SE
Journal of public health (Oxford, England). 2020;42(3):451-460
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The coronavirus disease 2019 (COVID-19) pandemic has to date resulted in over 6 million cases. Growing reports highlight men and Black, Asian and Minority Ethnic (BAME) cohorts as at higher risk of adverse COVID-19 outcomes. The aim of this study was to investigate whether differential patterns of COVID-19 incidence and severity, by sex and ethnicity, might be explained by cardiometabolic, socio-economic, lifestyle and behavioural exposures. This study is a prospective cohort study of over half a million men and women from across the UK. Results showed that male sex, BAME ethnicity, higher body mass index and greater household size were associated with significantly greater odds of a positive result. However, the sex and ethnicity differential pattern of COVID-19 is not adequately explained by variations in cardiometabolic factors, 25(OH)-vitamin D levels, socio-economic or behavioural factors. Authors conclude that investigation of alternative biological and genetic susceptibilities as well as more comprehensive assessment of the complex economic, social and behavioural differences should be prioritised.
Abstract
BACKGROUND We examined whether the greater severity of coronavirus disease 2019 (COVID-19) amongst men and Black, Asian and Minority Ethnic (BAME) individuals is explained by cardiometabolic, socio-economic or behavioural factors. METHODS We studied 4510 UK Biobank participants tested for COVID-19 (positive, n = 1326). Multivariate logistic regression models including age, sex and ethnicity were used to test whether addition of (1) cardiometabolic factors [diabetes, hypertension, high cholesterol, prior myocardial infarction, smoking and body mass index (BMI)]; (2) 25(OH)-vitamin D; (3) poor diet; (4) Townsend deprivation score; (5) housing (home type, overcrowding) or (6) behavioural factors (sociability, risk taking) attenuated sex/ethnicity associations with COVID-19 status. RESULTS There was over-representation of men and BAME ethnicities in the COVID-19 positive group. BAME individuals had, on average, poorer cardiometabolic profile, lower 25(OH)-vitamin D, greater material deprivation, and were more likely to live in larger households and in flats/apartments. Male sex, BAME ethnicity, higher BMI, higher Townsend deprivation score and household overcrowding were independently associated with significantly greater odds of COVID-19. The pattern of association was consistent for men and women; cardiometabolic, socio-demographic and behavioural factors did not attenuate sex/ethnicity associations. CONCLUSIONS In this study, sex and ethnicity differential pattern of COVID-19 was not adequately explained by variations in cardiometabolic factors, 25(OH)-vitamin D levels or socio-economic factors. Factors which underlie ethnic differences in COVID-19 may not be easily captured, and so investigation of alternative biological and genetic susceptibilities as well as more comprehensive assessment of the complex economic, social and behavioural differences should be prioritised.
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Effect of Supplemental Parenteral Nutrition Versus Enteral Nutrition Alone on Clinical Outcomes in Critically Ill Adult Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Alsharif, DJ, Alsharif, FJ, Aljuraiban, GS, Abulmeaty, MMA
Nutrients. 2020;12(10)
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For individuals who are critically ill and cannot eat, the use of a tube through the mouth is the preferred way to ensure nutrition needs are met. However, complications such as diarrhoea and vomiting often means that these individuals still do not achieve optimal nutrition. In these instances, giving individuals nutrients directly into a vein alongside the feeding tube is an option to ensure they do not become nutrient deficient. This is known as a combination of enteral and parenteral nutrition. However, studies on the use of this combination are limited. This systematic review and meta-analysis of 5 studies aimed to determine the effects of a combination of enteral and parenteral feeding on clinical outcomes compared to a feeding tube alone. The results showed that compared to enteral feeding alone the combination decreased infections and intensive care unit (ICU) mortality. There was a very small effect on duration of ventilation and no effects were seen on length of hospital stay nor length of ICU stay. It was concluded that enteral feeding alone is insufficient to meet the nutritional needs of critically ill patients. Supplementing in parenteral nutrition may be of benefit to these individuals and help decrease infections and improve ICU mortality. This study could be used by healthcare professionals to understand that the health of patients who are being fed through a tube may be compromised through malnutrition and that supplemental ways of getting more nutrients into these individuals is of importance.
Abstract
Enteral nutrition (EN) is considered the first feeding route for critically ill patients. However, adverse effects such as gastrointestinal complications limit its optimal provision, leading to inadequate energy and protein intake. We compared the clinical outcomes of supplemental parenteral nutrition added to EN (SPN + EN) and EN alone in critically ill adults. Electronic databases restricted to full-text randomized controlled trials available in the English language and published from January 1990 to January 2019 were searched. The risk of bias was evaluated using the Jadad scale, and the meta-analysis was conducted using the MedCalc software. A total of five studies were eligible for inclusion in the systematic review and meta-analysis. Compared to EN alone, SPN + EN decreased the risk of nosocomial infections (relative risk (RR) = 0.733, p = 0.032) and intensive care unit (ICU) mortality (RR = 0.569, p = 0.030). No significant differences were observed between SPN + EN and EN in the length of hospital stay, hospital mortality, length of ICU stay, and duration of mechanical ventilation. In conclusion, when enteral feeding fails to fulfill the energy requirements in critically ill adult patients, SPN may be beneficial as it helps in decreasing nosocomial infections and ICU mortality, in addition to increasing energy and protein intakes with no negative effects on other clinical outcomes.
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Comparison of gut microbiota profile in celiac disease, non-celiac gluten sensitivity and irritable bowel syndrome: A systematic review.
Transeth, EL, Dale, HF, Lied, GA
The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology. 2020;31(11):735-745
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Dysbiosis refers to a disturbance in the quantity and composition of the gut microbiota, and this shift in the microbiota profile is associated with a variety of GI disorders including celiac disease (CD), irritable bowel syndrome (IBS) and non-celiac gluten sensitivity (NCGS). There is no current clinical distinction between IBS and NCGS although it is hypothesised the characteristics of gut microbiota of these clinical presentations may overlap. The aim of this review is to analyse the gut microbiota profile in these three diagnoses. Thirteen trials were included in this review and show the bacterial composition of the gut microbiota of patients with CD and IBS shared many similarities when compared to healthy controls, including an overall reduction in microbial abundance. There were fewer similarities between IBS and NCGS, in part due to the lack of existing literature. Based on these findings, the authors suggest the bacterial profiles of patients CD and IBS share certain disease-specific trends. While the current data is limited, the authors hope these suggested trends influence further research to examine the overlap between NCGS and IBS and distinguish differential diagnostic and treatment plans.
Abstract
Gut microbiota is vital for human health. Shifts in the microbial diversity can affect bacterial function, and dysbiosis is associated with a variety of gastrointestinal disorders, including celiac disease (CD) and irritable bowel syndrome (IBS). The distinction between IBS and non-celiac gluten sensitivity (NCGS) is unclear, and it is conceivable that the gut microbiota profile of these patients may overlap. To our knowledge, no existing literature has evaluated the microbial characteristics in CD, IBS, and NCGS. Hence, this systematic review aims to compare the gut microbiota profile in these three diagnoses. A literature search was conducted in PubMed (Medline) until April 2019. Studies investigating bacterial diversity in the gut of patients with CD, IBS, and NCGS were eligible. Inclusion criteria were observational studies and randomized controlled trials reporting bacterial profile at baseline. Ninety-one articles were identified, of which 13 trials were eligible for inclusion. Overall, the bacterial composition of the gut microbiota of patients with CD and those with IBS shared the many similarities. The microbial richness was correspondingly reduced in these patient-groups compared with healthy controls, but this was not reported for NCGS. Our findings suggest that the bacterial profiles of patients with IBS and CD share certain disease-specific trends. Fewer similarities were observed between the bacterial profiles of patients with IBS and NCGS. Notably, the data are limited; thus, no solid conclusions can be made on the basis of these findings alone. The suggested trends can be a valuable basis for further research.
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Comparing eating behaviours, and symptoms of depression and anxiety between Spain and Greece during the COVID-19 outbreak: Cross-sectional analysis of two different confinement strategies.
Papandreou, C, Arija, V, Aretouli, E, Tsilidis, KK, Bulló, M
European eating disorders review : the journal of the Eating Disorders Association. 2020;28(6):836-846
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Stress and mental health problems which may be induced by restrictions imposed during the Covid-19 pandemic can lead to unhealthy eating habits. Restrictions have varied amongst countries and this cross-sectional analysis aimed to compare eating behaviours and symptoms of stress experienced by 1841 individuals in countries with differing lockdown measures. The results showed that individuals in the country with higher lockdown measures showed lower restraint in eating, they were more likely to overeat if they saw or smelt food and reported increased anxiety. However, they did not display depression or overeating when experiencing negative feelings. It was concluded that both countries had a high frequency of depression and anxiety. Higher restrictions were associated with greater anxiety, lower restraint and overeating when confronted with food. This paper could be used by healthcare professionals to recognise the need to include dietary advice when dealing with patients who are reporting anxiety during the current Covid-19 pandemic.
Abstract
OBJECTIVE We compared eating behaviours, and depressive and anxiety symptoms in two countries with different confinement strictness strategies and different levels of COVID-19 pandemic. METHOD A web-based cross-sectional survey was administered during and shortly after the COVID-19 related lockdown in Spain and Greece. Multivariable linear regression analyses were performed to identify country differences associated with eating behaviour, and symptoms of depression and anxiety. RESULTS This study included 1,002 responders in Spain and 839 in Greece. The mean ± SD of restraint, emotional and external eating was 2.5 ± 0.79, 2.1 ± 0.81 and 2.6 ± 0.65 in Spain, whereas 2.7 ± 0.85, 2.3 ± 0.99 and 2.9 ± 0.74 in Greece. Spanish participants had lower average scores of restraint and external eating compared to Greek participants (p < .001), but no difference was seen for emotional eating. In Spain, 13.6%, and 12.3% of the survey respondents reported moderate to severe depressive and anxiety symptoms, respectively, whereas in Greece the respective values were 18.8 and 13.2%. After adjusting for several risk factors, a higher prevalence of anxiety symptoms was observed in Spain compared to Greece (p = .001), but no difference was seen for depressive symptoms. CONCLUSIONS This study demonstrated high scores of inappropriate eating behaviours and a high frequency of depressive and anxiety symptoms in two Mediterranean countries during the COVID-19 outbreak. Our findings revealed that compared to Greek participants, Spanish participants, that faced more severe COVID-19 pandemic and stricter lockdown measures, were associated with lower restraint and external eating and increased anxiety symptoms, but not with depressive symptoms or emotional eating.