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World Journal of Gastrointestinal... May 2024Most endoscopic anti-reflux interventions for gastroesophageal reflux disease (GERD) management are technically challenging to practice with inadequate data to support...
BACKGROUND
Most endoscopic anti-reflux interventions for gastroesophageal reflux disease (GERD) management are technically challenging to practice with inadequate data to support it utility. Therefore, this study was carried to evaluate the effectiveness and safety newer endoscopic full-thickness fundoplication (EFTP) device along with Argon Plasma Coagulation to treat individuals with GERD.
AIM
To evaluate the effectiveness and safety newer EFTP device along with Argon Plasma Coagulation to treat individuals with GERD.
METHODS
This study was a single-center comparative analysis conducted on patients treated at a Noble Institute of Gastroenterology, Ahmedabad, hospital between 2020 and 2022. The research aimed to retrospectively analyze patient data on GERD symptoms and proton pump inhibitor (PPI) dependence who underwent EFTP using the GERD-X system along with argon plasma coagulation (APC). The primary endpoint was the mean change in the total gastroesophageal reflux disease health-related quality of life (GERD-HRQL) score compared to the baseline measurement at the 3-month follow-up. Secondary endpoints encompassed enhancements in the overall GERD-HRQL score, improvements in GERD symptom scores at the 3 and changes in PPI usage at the 3 and 12-month time points.
RESULTS
In this study, patients most were in Hill Class II, and over half had ineffective esophageal motility. Following the EFTP procedure, there were significant improvements in heartburn and regurgitation scores, as well as GERD-HRQL scores ( < 0.001). PPI use significantly decreased, with 82.6% not needing PPIs or prokinetics at end of 1 year. No significant adverse events related to the procedures were observed in either group.
CONCLUSION
The EFTP along with APC procedure shows promise in addressing GERD symptoms and improving patients' quality of life, particularly for suitable candidates. Moreover, the application of a lone clip with APC yielded superior outcomes and exhibited greater cost-effectiveness.
PubMed: 38813575
DOI: 10.4253/wjge.v16.i5.250 -
Frontiers in Aging Neuroscience 2024Early Alzheimer's disease (AD) diagnosis remains challenging, necessitating specific biomarkers for timely detection. This study aimed to identify such biomarkers and...
OBJECTIVE
Early Alzheimer's disease (AD) diagnosis remains challenging, necessitating specific biomarkers for timely detection. This study aimed to identify such biomarkers and explore their associations with cognitive decline.
METHODS
A cohort of 1759 individuals across cognitive aging stages, including healthy controls (HC), mild cognitive impairment (MCI), and AD, was examined. Utilizing nine biomarkers from structural MRI (sMRI), diffusion tensor imaging (DTI), and positron emission tomography (PET), predictions were made for Mini-Mental State Examination (MMSE), Clinical Dementia Rating Scale Sum of Boxes (CDRSB), and Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS). Biomarkers included four sMRI (e.g., average thickness [ATH]), four DTI (e.g., mean diffusivity [MD]), and one PET Amyloid-β (Aβ) measure. Ensemble regression tree (ERT) technique with bagging and random forest approaches were applied in four groups (HC/MCI, HC/AD, MCI/AD, and HC/MCI/AD).
RESULTS
Aβ emerged as a robust predictor of cognitive scores, particularly in late-stage AD. Volumetric measures, notably ATH, consistently correlated with cognitive scores across early and late disease stages. Additionally, ADAS demonstrated links to various neuroimaging biomarkers in all subject groups, highlighting its efficacy in monitoring brain changes throughout disease progression. ERT identified key brain regions associated with cognitive scores, such as the right transverse temporal region for Aβ, left and right entorhinal cortex, left inferior temporal gyrus, and left middle temporal gyrus for ATH, and the left uncinate fasciculus for MD.
CONCLUSION
This study underscores the importance of an interdisciplinary approach in understanding AD mechanisms, offering potential contributions to early biomarker development.
PubMed: 38813532
DOI: 10.3389/fnagi.2024.1356656 -
Turkish Journal of Medical Sciences 2023The cause and treatment of electrical status epilepticus during sleep (ESES), one of the epileptic encephalopathies of childhood, is unclear. The aim of this study was...
BACKGROUND/AIM
The cause and treatment of electrical status epilepticus during sleep (ESES), one of the epileptic encephalopathies of childhood, is unclear. The aim of this study was to evaluate possible microstructural abnormalities in the brain using advanced magnetic resonance imaging (MRI) techniques in ESES patients with and without genetic mutations.
MATERIALS AND METHODS
This research comprised 12 ESES patients without structural thalamic lesions (6 with genetic abnormalities and 6 without) and 12 healthy children. Whole-exome sequencing was used for the genetic mutation analysis. Brain MRI data were evaluated using tractus-based spatial statistics, voxel-based morphometry, a local gyrification index, subcortical shape analysis, FreeSurfer volume, and cortical thickness. The data of the groups were compared.
RESULTS
The mean age in the control group was 9.05 ± 1.85 years, whereas that in the ESES group was 9.45 ± 2.72 years. Compared to the control group, the ESES patients showed higher mean thalamus diffusivity (p < 0.05). ESES patients with genetic mutations had lower axial diffusivity in the superior longitudinal fasciculus and gray matter volume in the entorhinal region, accumbens area, caudate, putamen, cerebral white matter, and outer cerebellar areas. The superior and middle temporal cortical thickness increased in the ESES patients.
CONCLUSION
This study is important in terms of presenting the microstructural evaluation of the brain in ESES patients with advanced MRI analysis methods as well as comparing patients with and without genetic mutations. These findings may be associated with corticostriatal transmission, ictogenesis, epileptogenesis, neuropsychiatric symptoms, cognitive impairment, and cerebellar involvement in ESES. Expanded case-group studies may help to understand the physiology of the corticothalamic circuitry in its etiopathogenesis and develop secondary therapeutic targets for ESES.
Topics: Humans; Status Epilepticus; Male; Child; Female; Magnetic Resonance Imaging; Brain; Sleep; Adolescent; Case-Control Studies; Thalamus
PubMed: 38813507
DOI: 10.55730/1300-0144.5754 -
Turkish Journal of Medical Sciences 2023To reveal the impacts of dapagliflozin, a sodium glucose transporter-2 inhibitor (SGLT-2i), on body weight and body composition, cardiovascular risk indices, and carotid...
BACKGROUND/AIM
To reveal the impacts of dapagliflozin, a sodium glucose transporter-2 inhibitor (SGLT-2i), on body weight and body composition, cardiovascular risk indices, and carotid intima-media thickness (CIMT).
MATERIALS AND METHODS
The data of patients with type-2 diabetes mellitus (T2DM) who applied to Department of Endocrinology and Metabolic Disorders between September 2019 and 2020, and had started dapagliflozin treatment along with their current medications were recorded retrospectively. Body weights, body compositions measured through bioelectrical impedance, and CIMT with T2DM receiving SGLT-2i treatment and medication were measured at weeks 1, 12, and 24 of 42. The visceral adiposity index (VAI), lipid accumulation product (LAP), and atherogenic index of plasma (AIP) were used to determine the lipid measurements and anthropometric values.
RESULTS
The mean change in the total body weight and total fat mass was -2.96 and -1.97 kg, respectively (p < 0.001). There was a reduction in total fat mass of 1.23 kg (from 31.4 to 29.3 kg, p < 0.001) and in body fat percentage of 2.5% (from 35.8% to 34.4%, p < 0.001) in the first 12 weeks. A mild increase was observed in both the total fat mass and body fat percentage between weeks 12 and 24, which was not statistically significant (p = 0.783 and p = 0.925, respectively), whereas there was a statistically significant reduction in high-sensitive C-reactive protein (hsCRP), AIP, and CIMT values (p = 0.006, p = 0.035, and p = 0.007, respectively). No changes were observed in the VAI and LAP values (p = 0.985 and p = 0.636, respectively).
CONCLUSION
It was observed that dapagliflozin not only contributes to weight and fat loss but also has positive impacts on cardiovascular and atherosclerotic indicators.
Topics: Humans; Glucosides; Benzhydryl Compounds; Diabetes Mellitus, Type 2; Male; Female; Middle Aged; Body Composition; Sodium-Glucose Transporter 2 Inhibitors; Body Weight; Retrospective Studies; Carotid Intima-Media Thickness; Cardiovascular Diseases; Adult; Aged; Heart Disease Risk Factors
PubMed: 38813008
DOI: 10.55730/1300-0144.5683 -
Turkish Journal of Medical Sciences 2023It is known that the correlation of pulmonary function tests (PFT) with muscle dysfunction is insufficient. Here, we aimed to evaluate the diaphragm functions in...
BACKGROUND/AIM
It is known that the correlation of pulmonary function tests (PFT) with muscle dysfunction is insufficient. Here, we aimed to evaluate the diaphragm functions in individuals with Friedreich's ataxia (FRDA) and to examine its relationship with respiratory parameters and disease severity.
MATERIALS AND METHODS
This prospective study, conducted between November and December 2022, at Erciyes University, included 14 individuals with genetically confirmed FRDA and an age- and gender-matched healthy control group of eight individuals. We examined pulmonary functions with spirometric methods and evaluated diaphragm excursion, and diaphragm thickness-expiratory (Tde) and - end of inspiration (Tdi) with ultrasonography during calm breathing. Thickening fraction (TF) calculated. Also, we examined PaCO2 at rest. The neurological status of individuals was assessed using the Scale for the Assessment and Rating of Ataxia (SARA).
RESULTS
The mean values of FEV1(lt), FEV1(%), FVC (lt), and FVC (%) were higher in the control group (p; <0.001, 0.013, <0.001, and 0.009, respectively). Also, mean Tdi, Tde, excursion and TF were lower in the FRDA group compared to the control group (p = 0.005, 0.294,0.005, and 0.019, respectively). The mean excursion value was 1.13 ± 0.54cm in the FRDA group and 1.71 ± 0.49cm in the control group. There is a strong, negative, and statistically significant correlation between SARA total score with excursion and TF (r = -0.7432, p = 0.002; r = -0.697, p = 0.008). There is no statistically significant relationship between excursion and BMI, standing-to-supine decrease in FVC, FEV1, and PaCO2. Also, the relationship between maximal inspiratory pressure (PImax) and excursion was moderate.
CONCLUSION
Diaphragm ultrasound may reveal respiratory dysfunction better than PFT. Diaphragm excursion and TF are associated with disease scores in individuals with FDRA. Further studies are needed regarding the detection of alveolar hypoventilation.
Topics: Humans; Friedreich Ataxia; Diaphragm; Male; Female; Ultrasonography; Prospective Studies; Adult; Respiratory Function Tests; Young Adult; Spirometry; Case-Control Studies
PubMed: 38812999
DOI: 10.55730/1300-0144.5696 -
Translational Vision Science &... May 2024The purpose of this study was to investigate the development of optical biometric components in children with hyperopia, and apply a machine-learning model to predict...
PURPOSE
The purpose of this study was to investigate the development of optical biometric components in children with hyperopia, and apply a machine-learning model to predict axial length.
METHODS
Children with hyperopia (+1 diopters [D] to +10 D) in 3 age groups: 3 to 5 years (n = 74), 6 to 8 years (n = 102), and 9 to 11 years (n = 36) were included. Axial length, anterior chamber depth, lens thickness, central corneal thickness, and corneal power were measured; all participants had cycloplegic refraction within 6 months. Spherical equivalent (SEQ) was calculated. A mixed-effects model was used to compare sex and age groups and adjust for interocular correlation. A classification and regression tree (CART) analysis was used to predict axial length and compared with the linear regression.
RESULTS
Mean SEQ for all 3 age groups were similar but the 9 to 11 year old group had 0.49 D less hyperopia than the 3 to 5 year old group (P < 0.001). With the exception of corneal thickness, all other ocular components had a significant sex difference (P < 0.05). The 3 to 5 year group had significantly shorter axial length and anterior chamber depth and higher corneal power than older groups (P < 0.001). Using SEQ, age, and sex, axial length can be predicted with a CART model, resulting in lower mean absolute error of 0.60 than the linear regression model (0.76).
CONCLUSIONS
Despite similar values of refractive errors, ocular biometric parameters changed with age in hyperopic children, whereby axial length growth is offset by reductions in corneal power.
TRANSLATIONAL RELEVANCE
We provide references for optical components in children with hyperopia, and a machine-learning model for convenient axial length estimation based on SEQ, age, and sex.
Topics: Humans; Hyperopia; Male; Child; Female; Machine Learning; Biometry; Child, Preschool; Axial Length, Eye; Refraction, Ocular; Cornea; Anterior Chamber
PubMed: 38809529
DOI: 10.1167/tvst.13.5.25 -
Caspian Journal of Internal Medicine 2024Psoriasis is a common, chronic, immune-mediated inflammatory disease with a variety of skin manifestations. The aim of this study was to determine the...
BACKGROUND
Psoriasis is a common, chronic, immune-mediated inflammatory disease with a variety of skin manifestations. The aim of this study was to determine the prevalence of subclinical Achilles tendon disorder in cutaneous psoriasis patients and compare it with healthy controls.
METHODS
This was a cross-sectional case-control study conducted on psoriasis patients that were referred to dermatology clinic. Thirty patients in the case group and 30 healthy controls were included in the study. Thickness of Achilles tendon enthesis was scanned by an expert rheumatologist using ultrasound equipped with a 5-14 MHz linear prob bilaterally.
RESULTS
The mean age of the patient and control groups was 43.97±16.82 years and 38.87±12.71 years, respectively (P=0.190). The mean thickness of the Achilles tendon enthesis in the dominant limb was 4.31±0.86 mm in the patient group and 4.10±0.54 mm in the control group. There was no significant difference between the two groups in terms of thickness of the Achilles tendon enthesis in the dominant limb (P=0.276). The mean thickness of the Achilles tendon enthesis in the non-dominant limb was 4.44±0.91 mm in the patient group and 4.14±0.59 mm in the control group. There was no significant difference between the two groups in terms of thickness of Achilles tendon enthesis in the non-dominant limb (P = 0.134).
CONCLUSION
Although ultrasonography may be utilized for assessment of both structural and inflammatory changes, we revealed no difference in the mean thickness of Achilles tendon enthesis in patients with cutaneous psoriasis. Contradiction between clinical and ultrasonography features required further research.
PubMed: 38807726
DOI: 10.22088/cjim.15.2.313 -
Indian Journal of Ophthalmology Jun 2024To find a correlation between the clinical (vision-inflammation-strabismus-appearance [VISA] score) and radiological (apparent diffusion coefficient [ADC] values) scores... (Observational Study)
Observational Study Comparative Study
PURPOSE
To find a correlation between the clinical (vision-inflammation-strabismus-appearance [VISA] score) and radiological (apparent diffusion coefficient [ADC] values) scores for evaluating disease activity in patients with thyroid-associated orbitopathy.
DESIGN
A prospective comparative study.
METHODS
Our study was performed for consecutively diagnosed thyroid-associated orbitopathy (TAO) patients. Clinical evaluation included the VISA classification system with the basic thyroid workup. An inflammatory score of <4/8 was considered inactive and ≥4/8 as an active disease. Every included patient underwent a diffusion-weighted magnetic resonance imaging (DW-MRI) scan of the orbits. The orbital parameters evaluated on imaging included the proptosis, thickness, as well as the ADC values of extraocular muscles.
RESULTS
We studied 33 consecutive patients (23 females, 69.7%) with a mean age of 41.8 years. The majority (n = 27, 81.8%) were hyperthyroid, four were hypothyroid, and two were euthyroid. In the VISA classification, nine patients had active TAO (≥4/8 inflammation score), while 24 had inactive disease. There was a positive correlation between the inflammation score and ADC values of medial rectus (MR), inferior rectus (IR) and lateral rectus (LR). We had nine patients with inflammation scores ≥4. With receiver operating characteristic (ROC) curve analysis, we found that the ADC value of IR can predict disease activity with 68% sensitivity and MR-ADC can predict active TAO with 87% sensitivity.
CONCLUSION
The ADC parameters of DW-MRI are objective and less operator dependent than the clinical TAO activity scores like VISA classification. A randomized control trial may provide robust data on this correlation.
Topics: Humans; Graves Ophthalmopathy; Female; Prospective Studies; Male; Adult; Middle Aged; Oculomotor Muscles; Orbit; Diffusion Magnetic Resonance Imaging; Young Adult; Follow-Up Studies; Aged; Severity of Illness Index
PubMed: 38804801
DOI: 10.4103/IJO.IJO_1702_23 -
Clinics and Practice Apr 2024(1) Background: Full-thickness rotator cuff tears (RCTs) impact 25% of those over 60 and 50% over 80; however, minimal data exists on public understanding; (2) Methods:...
(1) Background: Full-thickness rotator cuff tears (RCTs) impact 25% of those over 60 and 50% over 80; however, minimal data exists on public understanding; (2) Methods: The primary outcome was to determine the public's baseline understanding of RCTs utilizing a 36-question survey regarding anatomy and function, risk factors, diagnosis and treatment options, and expectations. Secondarily, we evaluated the effect of an educational video and informational handout created by the authors to improve understanding. Participants ≥ 18 years were recruited from the senior author's clinic and online discussion platforms over a 5-month period; (3) Results: Baseline surveys were completed by 382 individuals: 56% men, 64% Caucasian, 27% with at least a master's degree, and 56% with very little or no RCT knowledge. Mean correct answer scores improved from 47% to 68% posteducational intervention ( < 0.001). Males, higher education level, healthcare experience, and a higher self-rated understanding of RCTs were significantly correlated with higher survey performance ( < 0.001); (4) Conclusions: The public's knowledge of RCTs at baseline was poor, with demographic factors correlating with survey performance. The educational intervention effectively enhanced participants' understanding. By focusing on common misconceptions, this data can help clinicians align patient expectations and enhance patient outcomes.
PubMed: 38804390
DOI: 10.3390/clinpract14030058 -
Heliyon May 2024Management of large irregular wounds in children had been confusing plastic and reconstructive surgeons. Herein, this study was aimed to propose a new treatment method...
OBJECTIVE
Management of large irregular wounds in children had been confusing plastic and reconstructive surgeons. Herein, this study was aimed to propose a new treatment method based on the principle of adapting different recipient zones to overcome the intractable wounds, simplifying and programing the design process of targeted flaps for covering large irregular soft-tissue defects.
PATIENTS AND METHODS
From January 2009 to December 2020, 31 children (9 girls and 22 boys) aged 3-16 years (mean 9.8 years) underwent multiple modular flaps with edge to edge splicing reconstruction of the lower extremities. All the wounds were large with non-adjacent defects and with or without a dead space. Several variants of flaps were harvested according to the needs and reconstruction requirements of patients.
RESULTS
A total of 71 flaps were harvested from 31 patients and all flaps donor sites received primary closure. Nine patients underwent split-thickness skin grafting, and three cases of flaps survived from vascular crisis by rebuilding the vessels and the rest accepting LD flap transplants. And five partial necrosis of the distal epidermis flaps recovered using skin grafting and dressing change. No major complication was encountered in other patients and donor sites, except one heel ulcer. During the follow-up (ranging from 16 to 38 months, mean 27.7 months), aesthetic and functional results of reconstructed limbs were satisfactory in all patients.
CONCLUSIONS
The Individualized design program of multiple flaps for adapting different recipient zones is an alternative for repairing large irregular soft-tissue defects in children, beneficial for plastic and reconstructive surgeons to simplify and program the process of designing and perform multiple flaps to achieve this goal.
LEVEL OF EVIDENCE
III, Retrospective.
PubMed: 38803926
DOI: 10.1016/j.heliyon.2024.e31179