Controlled Patients Research Articles

Comparing mechanochemical endovenous ablation using Flebogrif with endovenous laser ablation in the treatment of primary great saphenous vein incompetence: protocol for a multicentre, open-label, non-inferiority, observer-blinded, randomised controlled trial (REBORN trial)

IntroductionEndovenous laser ablation (EVLA) is associated with an excellent outcome in the treatment of great saphenous vein (GSV) incompetence. However, the use of thermal ablation requires tumescent anaesthesia and is...

Olanzapine as Antiemetic Prophylaxis in Moderately Emetogenic Chemotherapy

The role of olanzapine has not been adequately evaluated in moderately emetogenic chemotherapy (MEC) regimens with or without neurokinin-1 receptor antagonists. To evaluate whether addition of olanzapine to an MEC regimen reduces nausea, vomiting, and use of nausea rescue medications among patients with solid malignant tumors. This multicenter, open-label phase 3 randomized clinical trial included patients aged 18 years or older with solid malignant tumors who were receiving oxaliplatin-, carboplatin-, or irinotecan-based chemotherapy. The trial was conducted at 3 institutes in India from March 26, 2019, to August 26, 2023; the final cutoff date for analysis was September 10, 2023. Patients were randomized 1:1 to dexamethasone, aprepitant, and palonosetron with olanzapine (experimental group) or without olanzapine (observation group). The experimental group received 10 mg of olanzapine orally once at night on days 1 through 3 of the chemotherapy regimen. The primary end point was complete response (CR), defined as the proportion of patients with no vomiting, no significant nausea (scored as <5 on a visual analog scale of 1 to 100), and no use of rescue medications for nausea. Secondary end points included the proportion of patients experiencing nausea and chemotherapy-induced nausea and vomiting (CINV), receiving rescue medications, and experiencing adverse events. A total of 560 patients (259 [64%] male; median age, 51 years [range, 19-80 years]) were randomized. The analysis included 544 patients with evaluable data (274 assigned to olanzapine and 270 to observation). Baseline characteristics were evenly matched between the 2 groups. The proportion of patients with CR was significantly greater in the group with (248 [91%]) than without (222 [82%]) olanzapine in the overall 120-hour treatment period (P = .005). Likewise, there were significant differences between the olanzapine and observation groups for nausea control (264 [96%] vs 234 [87%]; P < .001) and CINV (262 [96%] vs 245 [91%]; P = .02) during the overall assessment period, and the proportion of patients receiving rescue medications significantly increased in the observation group (30 [11%]) compared with the olanzapine group (11 [4%]) (P = .001). Grade 1 somnolence was reported by 27 patients (10%) following administration of chemotherapy and olanzapine and by no patients in the observation group. In this randomized clinical trial, the addition of olanzapine significantly improved CR rates as well as nausea and vomiting prevention rates in chemotherapy-naive patients who were receiving MEC regimens containing oxaliplatin, carboplatin, or irinotecan. These findings suggest that use of olanzapine should be considered as one of the standards of care in these chemotherapy regimens. Clinical Trials Registry-India (CTRI) Identifier: CTRI/2018/12/016643.

A comparative cross-platform analysis of cuproptosis-related genes in human nonobstructive azoospermia: An observational study.

This study aimed to identify novel biomarkers associated with cuproptosis in human nonobstructive azoospermia (NOA). We obtained 4 NOA microarray datasets (GSE145467, GSE9210, GSE108886, and GSE45885) from the NCBI Gene Expression Omnibus database and merged them into training set. Another NOA dataset (GSE45887) was used as validation set. Differentially expressed cuproptosis-related genes were identified from training set. Gene Ontology function and Kyoto Encyclopedia of Genes and Genomes pathway analyses were conducted. Least absolute shrinkage and selection operator regression and support vector machine-recursive feature elimination were used to identify hub cuproptosis-related genes. We calculated the expression of the hub cuproptosis-related genes in both validation set and patients with NOA. Gene set variation analysis was used to explore their potential biological functions. The risk prediction model was built by logistic regression analysis and was evaluated in the validation set. Finally, we constructed a competing endogenous RNA network. The training set included 29 patents in the control group and 92 in the NOA group, and 10 cuproptosis-related differentially expressed genes were identified. Subsequently, we screened 6 hub cuproptosis-related genes (DBT, GCSH, NFE2L2, NLRP3, PDHA1, and SLC31A1) by least absolute shrinkage and selection operator regression and support vector machine-recursive feature elimination. GCSH, NFE2L2, NLRP3, and SLC31A1 expressed higher in NOA group than in control group (P < .05) in the validation set (4 patients in control and 16 in NOA groups), while the expression levels of GCSH, NFE2L2, NLRP3, PDHA1, and SLC31A1 were higher in NOA group than in control group (P < .05) in our patients (3 patients in control and 4 in NOA groups). The model based on the 6-gene signature showed superior performance with an AUC value of 0.970 in training set, while 1.0 in validation set. Gene set variation analysis revealed a higher enrichment score of "homologous recombination" in the high expression groups of the 6 hub genes. Finally, we constructed a competing endogenous RNA network and found hsa-miR-335-3p and hsa-miR-1-3p were the most frequently related to the 6 hub genes. DBT, GCSH, NFE2L2, NLRP3, PDHA1, and SLC31A1 may serve as predictors of cuproptosis and play important roles in the NOA pathogenesis.

Anatomical Features of the Lamina Cribrosa and Optic Disc in Ocular Hypertension, Glaucoma and Healthy Eyes.

Central lamina cribrosa thickness was found to be higher in eyes with ocular hypertension, compared to primary open angle glaucoma and healthy controls. To evaluate the anatomical features of lamina cribrosa (LC) and the optic disc (OD) using swept-source optical coherence tomography (OCT) in eyes with ocular hypertension (OHT). Treatment naive eyes with OHT and primary open angle glaucoma (POAG) and healthy eyes were included. All eyes underwent a complete ophthalmological examination in addition to swept-source OCT of optic disc. Anatomical features of LC, including central LC thickness(LCT), LC depth (LCD), prelaminar depth (PLD), pre-laminar tissue thickness (PLTT) were measured manually using the internal caliper function of the OCT device and compared within groups. Optic disc ovality, disc-foveal angle and optic disc torsion were measured on colored photographs, using imageJ software. Seventy one eyes of 37 patients in OHT group, 41 eyes of 26 patients in POAG group and 30 eyes of 30 patients in healthy control (HCs) group were enrolled in the study. Groups were similar for age and gender distribution. Central LCT was significantly higher in OHT group, compared to HCs (333.8±50.5µm vs. 304.5±46.3µm, P=0.02) and POAG group (286.7±140.4, P=0.001). PLD and LCD were both highest in POAG (282.3±145.5µm and 471.3±195.2µm) followed by OHT (244.8±30.2µm and 440.7±18.7µm) and HCs(170.1±152.6 µm and 412.8±80µm), only the difference between POAG and HCs in PLD was statistically significant(P=0.03). PLTT, OD torsion, disc-foveal angle and disc-ovality showed no significant difference. LC was significantly thicker in eyes with OHT, compared to POAG and HCs. This finding may be relevant to optic nerve protection from high intraocular pressure in patients with ocular hypertension.

Plasma G72 protein in schizophrenia: A comparative analysis of drug-naive schizophrenia patients, patients in acute exacerbation and healthy controls

ObjectivesSchizophrenia is a complex psychiatric disorder with an unclear etiopathogenesis. This study investigates the plasma G72 protein levels in drug-naive schizophrenia patients (DNS), those in acute psychotic episodes (AES), and healthy controls (HC). It also examines the correlation between the plasma G72 protein levels and Positive and Negative Syndrome Scale (PANSS) scores. MethodsThe study included 138 schizophrenia patients (84 DNS, 54 AES) and 83 HCs. Plasma G72 protein levels were measured by ELISA. Statistical analyses, including log-transformation and correlation analysis, were conducted. ResultsSchizophrenia patients had significantly lower plasma G72 levels than HCs (4.39 ± 5.38 vs. 8.06 ± 10.27 ng/mL, p < 0.001), while DNS and AES groups did not differ significantly. Log-transformed data confirmed these differences. Negative correlation was found between plasma G72 levels and age (r = −0.258, p = 0.02), PANSS-G (r = −0.249, p = 0.004), and total PANSS scores (r = −0.226, p = 0.008). ROC analysis showed poor discrimination between schizophrenia patients and controls (AUC: 0.587, p = 0.031). ConclusionsThis study's novel findings reveal that plasma G72 protein levels are significantly lower in schizophrenia patients and inversely correlated with age and symptom severity. However, the poor diagnostic accuracy observed in the ROC analysis suggests that G72 may not be a reliable biomarker for schizophrenia at this stage. These results underscore the need for further research to explore the potential clinical implications of these findings.

Relationship of adhesion molecules (ICAM-1 and E-selectin) with ABO blood groups in patients hospitalized with acute myocardial infarction.

Adhesion molecules, sICAM-1 and sE-selectin appear to have a major role in the pathogenesis of coronary artery disease (CAD). The focus of this study was to investigate the relationship of sICAM-1 and sE-selectin with ABO blood groups in Pakistani patients hospitalized with acute myocardial infarction (AMI). In a case-control study, 116 patients of acute myocardial infarction (AMI) and 116 healthy controls (age range for both: 30 years to 70 years; both males and females) were randomly selected from the Aga Khan University and National Institute of Cardiovascular Diseases, Karachi with informed consent. The blood samples were obtained and analyzed for ABO blood groups and serum levels of sICAM-1 and sE-selectin using kit methods. Statistical tests including independent sample t-test and Two-way ANOVA were used to study the association of these adhesion molecules with blood groups in AMI patients and healthy controls. Duration of the study was from July 2021 to June 30, 2023. Mean serum levels of sICAM-1 were significantly higher in AMI patients compared to healthy controls (342±159 mg/dl vs. 227±104 mg/dl; p-value<0.001). Similarly, serum levels of sE-selectin were also significantly higher in AMI patients compared to healthy controls (53.6±26.9 mg/dl vs. 40.7± mg/dl; p-value<0.001). Moreover, mean concentrations of sICAM-1 and sE-selectin for the interaction between subject type (cases and control) and blood groups were statistically significant (p-value = 0.007 and p-value = 0.035, respectively). There is an association of adhesion molecules, sICAM-1 and sE-selectin with ABO blood groups in Pakistani patients hospitalized with AMI.

Risk Factors for Treatment Transition in Patients with Low-Risk Atrial Fibrillation Patients Undergoing Anticoagulation Monotherapy: A Large Claims Database Study in Japan.

The global prevalence of atrial fibrillation (AF) is rising, paralleling increased life expectancy. Early rhythm control benefits AF management. However, in low-risk, often asymptomatic, AF patients, anticoagulant monotherapy is the selected treatment, aligning with current guidelines. However, early AF progression in these low-risk individuals is not well-understood. Thus, this study aims to: 1) determine the proportion of low-risk AF patients who worsen within a year of initial AF diagnosis and 2) identify risk factors such treatment transitions. We analyzed data from 18623 AF patients, spanning January 2005 to June 2017. Low-risk patients were those on anticoagulant monotherapy ± rate control, following the JCS/JHRS 2020 Guideline on Pharmacotherapy of Cardiac Arrhythmias. We defined 2 patterns of treatment transition for 1) initiating ablation or antiarrhythmic drug therapy and 2) solely using antiarrhythmic drugs. This retrospective cohort study was employed a 12-month study, following a 6-month screening period. We included 1874 patients for all rhythm control (analysis 1) and 1503 for only medication-based control (analysis 2). The primary endpoint, treatment transition of AF under monotherapy, occurred in 28.4% of patients in analysis 1 and 10.8% in analysis 2. Risk factors common to both scenarios were male gender, baseline rate control drug use, and rivaroxaban selection, as identified by multiple logistic regression. These findings suggest a higher AF treatment transition trend in patients starting rivaroxaban, calling for further research. The study highlights the importance of informed early rhythm control initiation decisions in clinical settings.

Altering adult Hippocampal Neurogenesis in the dentate gyrus through varying glucocorticoid receptor concentrations

Adult Hippocampal Neurogenesis, short for AHN, is an essential yet foundational process of producing new nerve cells in the dentate gyrus of the hippocampus. It is a fact that increasing AHN will enhance peoples ability to learn, memorize, regulate mood, etc. Therefore, scientists strive to pursue the factors which influence AHN. Until now, research had proved that GR activity is associated with the degree of AHN. Additionally, a high GR activity will potentially reduce the level of ANH and an optimal level of GR activity will create the optimized level of AHN. Consequently, how a low level of GR activity will possibly influence AHN will be examined in this paper. For Experiment 1, the GR antagonist reduces the GR activity in 8-year-old male mice: C57BL/6 and BrdU highlights the newly generated neurons in the dentate gyrus. As an ideal result compared to the control group, low GR activity will lead to a decrease in the AHN. For Experiment 2, 3 minor experiments will be constructed to test the GR activity and AHN of the mice in 3 different conditions (low, controllable, and uncontrollable stress). And Nanobit Assay that is separately attached to the GR and the ligands will present fluorescent when combined. Additionally, the method of CRISPR-CAS9 is used to knock down either GR or GR when the other one is measured, and BrdU is also used to light up the neurons to measure the degree of AHN. The ideal result will present a number greater than 1 for the ratio between GR/GR and AHN decreases for the low-stress group and uncontrollable-stress group. Oppositely, the ratio will be smaller than 1 for the controllable stress group, meaning AHN increases. Conclusively, the output will demonstrate a reversed U shape with the x-axis being the level of GR activity and the y-axis presenting the level of AHN. Despite the experiments that have proceeded on mice, the significance of them is people will have certain references to the influences of AHN to prevent those conditions or stress which will negatively affect AHN.

HIV Care in Ukrainian Migrants in Two European Countries: All the Same?

Introduction: War in Ukraine prompted an enormous refugee influx into Europe, including approximately 4200 people with HIV. The unique healthcare features of Ukrainian refugees living with HIV were compared between two infectious disease departments in Bonn, Germany, and Szczecin, Poland. Methods: This is a retrospective study on 161 people living with HIV (PLWH) refugees from Ukraine seeking care in Bonn (n = 30) and Szczecin (n = 131) between April 2022 and May 2023. Demographic, virologic, immunologic, and coinfection data were analyzed. Results: The majority of the studied individuals were female: 64% (n = 84) in Szczecin and 60% (n = 18) in Bonn. The main HIV transmission mode was heterosexual sex in 73.5% (n = 114). All were on combined antiretroviral therapy (cART) on arrival, primarily on the TLD regimen (TDF/3TC/DTG) (68.4%, n = 106). In Germany, cART was most frequently switched to BIC/TAF/FTC in 83.4% (n = 25); in Poland, the most common combination was TDF/FTC + DTG (58%, n = 76). A prevalence of replicating hepatitis C was in 11.7% (n = 15), and that for chronic hepatitis B (HBV) was in 4.7% (n = 4). History of past tuberculosis was reported in 16.9% (n = 14, Poland, and n = 7, Germany). Follow-up after 6 months showed immunological reconstitution with a mean increase of CD4+ of 10 (IQR: -69.5-120.5) cells/µL in Poland and 51.5 (IQR: -22.5-135.5) cells/µL in Germany; p = 0.04. Virologic suppression (<40 HIV-RNA/mL) was high in care entry (n = 62; 98%) for Poland, and n = 26 (92.6%) for Germany, and suppression was achieved in the majority of patients in the 6-month control (89.7% in Poland vs. 95.7% in Germany). Conclusions: Health challenges posed by war migration extend beyond HIV to coinfections as HBV, HCV, and tuberculosis give an indication for a broader search for coinfections, often less common in the new country.

Balance Control Impairments in Usher Syndrome.

To explore postural disability in Usher Syndrome (USH) patients using temporal posturographic analysis to better elucidate sensory compensation strategies of deafblind patients for posture control and correlate the Activities-specific Balance Confidence (ABC) scale with posturographic variables. Thirty-four genetically confirmed USH patients (11 USH1, 21 USH2, 2 USH 4) from the Otolaryngology Outpatient Clinic and 35 controls were prospectively studied using both classical and wavelet temporal analysis of center of pressure (CoP) under different visual conditions on static and dynamic platforms. The functional impact of balance was assessed with the ABC scale. Classical data in the spatial domain, Sensorial Organization Test, and frequency analysis of the CoP were analyzed. On unstable surfaces, USH1 had greater CoP surface area with eyes open (38.51 ± 68.67) and closed (28.14 ± 31.64) versus controls (3.31 ± 4.60), p < 0.001 and (7.37 ± 7.91), p < 0.001, respectively. On an unstable platform, USH consistently showed increased postural sway, with elevated angular velocity versus controls with eyes open (USH1 [44.94 ± 62.54]; USH2 [55.64 ± 38.61]; controls [13.4 ± 8.57]) (p = 0.003; p < 0.001) and closed (USH1 [60.36 ± 49.85], USH2 [57.62 ± 42.36]; controls [27.31 ± 19.79]) (p = 0.002; p = 0.042). USH visual impairment appears to be the primary factor influencing postural deficits, with a statistically significant difference observed in the visual Sensorial Organization Test ratio for USH1 (80.73 ± 40.07, p = 0.04) and a highly significant difference for USH2 (75.48 ± 31.67, p < 0.001) versus controls (100). In contrast, vestibular (p = 0.08) and somatosensory (p = 0.537) factors did not reach statistical significance. USH exhibited lower visual dependence than controls (30.31 ± 30.08) (USH1 [6 ± 11.46], p = 0.004; USH2 [8 ± 14.15], p = 0.005). The postural instability index, that corresponds to the ratio of spectral power index and canceling time, differentiated USH from controls on unstable surface with eyes open USH1 (3.33 ± 1.85) p < 0.001; USH2 (3.87 ± 1.05) p < 0.002; controls (1.91 ± 0.85) and closed USH1 (3.91 ± 1.65) p = 0.005; USH2 (3.92 ± 1.05) p = 0.045; controls (2.74 ± 1.27), but not USH1 from USH2. The canceling time in the anteroposterior direction in lower zone distinguished USH subtypes on stable surface with optokinetic USH1 (0.88 ± 1.03), USH2 (0.29 ± 0.23), p = 0.026 and on unstable surface with eyes open USH1 (0.56 ± 1.26), USH2 (0.072 ± 0.09), p = 0.036. ABC scale could distinguish between USH patients and controls, but not between USH subtypes and it correlated with CoP surface area on unstable surface with eyes open only in USH1(ρ = 0.714, p = 0.047). USH patients, particularly USH1, exhibited poorer balance control than controls on unstable platform with eyes open and appeared to rely more on proprioceptive information while suppressing visual input. USH2 seems to use different multisensory balance strategies that do not align as well with the ABC scale. The advanced analysis provided insights into sensory compensation strategies in USH subtypes.

Surveilling Sureties: How Privately Mediated Monetary Sanctions Enroll and Responsibilize Families

Abstract In the neoliberal age, ordinary people are increasingly responsible for taking up crime control and surveillance, what we might consider traditional state functions. This article situates commercial bail as a case of responsibilization and identifies monetary sanctions as a mechanism through which private companies offload pretrial risk management onto families. Drawing on ethnographic and interview data, I present this process via four stages. First, agents use cosigned bail bonds to selectively enroll people they perceive as suitable sureties and surveillants. Second, this monetary sanction is deployed with carceral and financial threats to encourage cosigners to embody the roles. Third, as surveillants, family members engage in invisible emotional labor to cope with or rationalize their deployment as an arm of the state. Last, through their involvement as instruments of surveillance, family members inadvertently become subjects of surveillance and carceral control. From enrollment to subjugation, this process of responsibilization is an uneven one as women, particularly women of color, are disproportionately burdened with risk management and any resulting repercussions.

Surgical treatment of mobile planovalgus deformation of feet using calcaneal osteotomy based on preoperative computer modeling in adolescent: a retrospective cohort study

Background: Evans calcaneal osteotomy is one of the recognized surgical techniques for the treatment of flat-valgus foot deformity in children over 12 years of age, which allows simultaneous multiplanar correction. Preoperative planning of the formed diastasis parameters to reduce the number of cases of hypo- and hypercorrection remains an urgent issue. AIM: To evaluate the results of Evans calcaneal osteotomy using the developed method of preoperative planning and fixation with the individual H-shaped reconstructive plate. MATERIALS AND METHODS: This study included 64 children aged 12–17 years with symptomatic planovalgus deformity, who were divided into two groups: in the main group, preoperative planning was used according to the developed method; in the control group for intraoperative control of correction was used only fluoroscopy and visual assessment. To study the effectiveness of the developed method, we used dynamic assessment of radiometric parameters and AOFAS questionnaire results before and after surgery. We also took into account the changes in the Foot Posture Index 6 and the Chippaux-Smirak and Stasheli podometric indices. RESULTS: In comparison with the control group, the main group showed a reduction in the swelling period after surgery, as well as the timing of the onset of full limb support, and a significant decrease in the incomplete correction. Similar dynamics was observed when studying the groups according to the Foot Posture Index 6 scale and podometric indices. CONCLUSION: The use of the developed method of preoperative planning during the Evans operation has shown its effectiveness for the treatment of flexible flatfoot deformity of the feet in adolescence.

When Usual Care Is Not So Usual: Protocol Violations and Generalizability in a Treat-to-Target Strategy Trial in Patients With Axial Spondyloarthritis.

The objective of this study was to evaluate the impact of protocol violations in the treat-to-target group in the Tight Control in Spondyloarthritis (TICOSPA) trial and to compare the proportion of patients optimally treated according to the Assessment of Spondyloarthritis International Society (ASAS)/EULAR 2016 recommendations for patients with axial spondyloarthritis (axSpA) between the treat-to-target versus usual care (UC) arms. This study was a cluster-randomized, controlled 48-week trial including patients with axSpA who fulfilled the ASAS criteria, had an Axial Spondyloarthritis Disease Activity Score >2.1, and were biologic disease-modifying antirheumatic drug naive. Eighteen axSpA expert centers were randomly allocated to one treatment arm: (a) treat-to-target prespecified management strategy (four-week visits), and (b) UC treatment decisions at the rheumatologist's discretion (12-week visits). Protocol violations in the treat-to-target arm and the fulfillment of the 2016 ASAS/EULAR recommendations in both arms were evaluated at every visit. ASAS Health Index (ASAS-HI) and disease activity outcomes at 48 weeks were compared between treat-to-target violators versus nonviolators. Patients treated according to the ASAS/EULAR recommendations were compared between both arms. A total of 160 patients initiated the trial (80 patients with treat to target; 80 patients with UC). In the treat-to-target arm, 51.2% patients violated the protocol at least once (62.2% of violations resulting in maintenance/reduction of treatment against protocol). After 48 weeks, treat-to-target violators versus nonviolators showed similar ratios of ASAS-HI improvement. The proportion of patients managed according to the ASAS/EULAR recommendations after the first 12 weeks were 63.9% versus 61.8% for the treat-to-target and UC arms, respectively. Protocol violations in the treat-to-target arm in the TICOSPA trial were frequent, although they did not have an impact on the rate of the primary outcome. The groups with UC was optimally treated, partly explaining the nonachievement of the primary objective in the TICOSPA trial.

Comparative evaluation of craving, sleep quality, sexual function and quality of life in opioid use disorder patients in remission with buprenorphine/naloxone maintenance treatment.

To compare opioid use disorder (OUD) patients who continue to use opioids and are in remission with buprenorphine-naloxone (B/N) in terms of some parameters and to evaluate the relationship between B/N dose and these parameters. We included 141 OUD patients in remission with B/N maintenance treatment for at least 6months, 141 who still used opioids, and 141 healthy volunteers. Substance Craving Scale (SCS), Pittsburgh Sleep Quality Index (PSQI), Arizona Sexual Experiences Scale (ASEX), and Short Form 36 (SF-36) were administered. PSQI scores and ASEX scores were higher in those who continued to use opiates than in OUD in remission, and in OUD in remission compared to controls. OUD patients with current opioid use also had lower SF-36 scores compared to both patients in remission and healthy controls. SCS, PSQI, ASEX, and SF-36 scores were similar when the three groups were examined based on the dosage of B/N (below 8, 8-15, and 16mg/day and above) use in OUD in remission. Quality of life, craving, sleep and sexual functions improved significantly with B/N; however, these effects are not dependent on B/N dosage.

Nitrogen configuration modulation of porous graphitic carbon nanosheets for superior capacitive energy storage

Carbon nanosheets with layer-stacked porous structures and surface functionalized groups are beneficial for efficient ion storage in supercapacitor electrode materials, but achieving high cost-effectiveness and controllable surface groups remains a significant challenge. Herein, the biomass-derived chitosan and sodium alginate are selected as raw materials for self-assembly reaction with phytic acid as a cross-linking agent. The protonated chitosan and sodium alginate form a cross-linked network structure through hydrogen bonding and electrostatic adsorption, which is subsequently carbonized and activated to synthesize porous graphitic carbon nanosheets (PNPCN-X). PNPCN-X realizes an efficient distribution of porous and graphitic structures. It's noteworthy that phytic acid facilitates the fixation of N atoms, and various N configurations can be adjusted by altering the content of phytic acid. Optimized PNPCN-1.5 exhibits a high content of structurally stable pyridinic-N and graphitic-N configurations, which are confirmed to serve as active sites substantially augmenting the ion adsorption capacity through Density Functional Theory (DFT) calculations. Benefiting from its exceptional physicochemical properties, PNPCN-1.5 achieves 322 F g−1 as electrode materials in the three-electrode system, while the symmetrical supercapacitor assembled with EMIMBF4 electrolyte attains 56.29 W h kg−1. Furthermore, various kinetic analyses extensively elucidate its capacitance distribution characteristics and ion diffusion rates.

Role of optical coherence tomography as a diagnostic marker for neurodegeneration in epilepsy: a cross-sectional analytical study

BackgroundProgressive neurodegeneration is a common consequence of epilepsy, which has a negative impact on the patient’s quality of life. This study aimed to predict neurodegeneration in patients with epilepsy (PwE) through assessment of the retinal nerve fiber layer (RNFL), ganglion cell complex (GCC) thickness, and central macular thickness (CMT) using optical coherence tomography (OCT).ResultsA cross-sectional study was done on 60 patients with idiopathic epilepsy and 30 healthy volunteers. They were subjected to a full neurological examination, ophthalmological assessment, and OCT for assessment of retinal layers, and cognitive examination using Addenbrooke’s scale. PwE had lower cognitive scores, including memory (13.97 ± 2.52), attention (15.95 ± 1.85), language (24.08 ± 1.71), and fluency (6.10 ± 2.05), compared to controls (20.53 ± 3.5), (17.13 ± 1.53), (24.83 ± 0.99), and (8.87 ± 2.39), respectively. There was a significant thinning in average RNFL thickness (84.27 ± 7.66), inferior RNFL thickness (99.33 ± 10.19), average GCC thickness (83.17 ± 9.76), and superior GCC thickness (84.83 ± 7.27) in the epilepsy group compared to controls (105.70 ± 8.73), (104.93 ± 9.75), (101.50 ± 4.84), and (100.53 ± 4.09), respectively. PwE had significantly higher focal macular volume loss (1.17 ± 1.22) versus (0.11 ± 0.21) and a higher insignificant global macular volume loss (1.88 ± 2.32) versus (1.37 ± 0.65) in controls, respectively. Superior GCC thickness was significantly lower in the uncontrolled patients (82.53 ± 6.23) compared to the controlled patients (87.13 ± 7.60), while CMT was significantly lower in the polytherapy group compared to the monotherapy group. There was a significant positive correlation between the age of epilepsy onset and verbal fluency (r = 0.382, p = 0.003). Epilepsy duration had significant negative correlations with memory (r = − 0.364, p = 0.004), inferior RNFL thickness (r = − 0.324, p = 0.012), perifoveal thickness (r = − 0.353, p = 0.006), and inferior (perifoveal) thickness (r = − 0.365, p = 0.004).ConclusionPwE receiving anti-seizure medications (ASMs) have reduced GCC, RNFL, and CMT and lower cognitive functions compared to controls. OCT may be a useful tool for detection of neurodegeneration in PwE.

Context-dependent reduction in corticomuscular coupling for balance control in chronic stroke survivors.

Balance control is an important indicator of mobility and independence in activities of daily living. How the functional coupling between the cortex and the muscle for balance control is affected following stroke remains to be known. We investigated the changes in coupling between the cortex and leg muscles during a challenging balance task over multiple frequency bands in chronic stroke survivors. Fourteen participants with stroke and ten healthy controls performed a challenging balance task. They stood on a computerized support surface that was either fixed (low difficulty condition) or sway-referenced with varying gain (medium and high difficulty conditions). We computed corticomuscular coherence between electrodes placed over the sensorimotor area (electroencephalography) and leg muscles (electromyography) and assessed balance performance using clinical and laboratory-based tests. We found significantly lower delta frequency band coherence in stroke participants when compared with healthy controls under medium difficulty condition, but not during low and high difficulty conditions. These differences were found for most of the distal but not for proximal leg muscle groups. No differences were found at other frequency bands. Participants with stroke showed poor balance clinical scores when compared with healthy controls, but no differences were found for laboratory-based tests. The observation of effects at distal but not at proximal muscle groups suggests differences in the (re)organization of the descending connections across two muscle groups for balance control. We argue that the observed group difference in delta band coherence indicates balance context-dependent alteration in mechanisms for the detection of somatosensory modulation resulting from sway-referencing of the support surface for balance maintenance following stroke.

A Comparative Study between Ultrasound Guided Interscalene and Ultrasound Guided Suprascapular Nerve Blocks in Postoperative Pain and Hand Motor Power Affection in Shoulder Scope Surgeries

Abstract Background Interscalene approach of brachial plexus nerve block is recognized as the gold standard technique for postoperative pain control after shoulder scope surgeries. However, it is associated with major adverse effects and patient discomfort due to paralysis of the hand muscles. The suprascapular nerve block is considered to be a safe and effective alternative to interscalene nerve block for shoulder surgery without affecting the motor function of the hand muscles and other serious complications of interscalene nerve block, especially in ambulatory surgery. Aim of the work The aim of this study is to compare interscalene and suprascapular nerve block in terms of postoperative pain, opioid consumption, and hand grip strength in shoulderscopic surgeries. Patients and Methods This prospective, randomized trial was done in Ain Shams University Hospitals. A sample of 50 patients; 25 patients in each group, namely Group ISB (interscalene approach of brachial plexus block) and Group SSNB (suprascapular nerve block). Visual Analogue Scale (VAS) was used to assess Shoulder pain at rest and upon flexion in the first 24 hours. The degree of hand motor power affection, the total amount of opioids used as rescue analgesia, and the incidence of complications were also recorded. Results The findings revealed no statistically significant difference between groups (p-value &amp;gt; 0.05) in pain control all over the 24 hours by VAS score at rest and at arm flexion. SSNB received a larger total narcotic dose (60±26.02) mg of pethidine than ISB (52±22.73). However, there was no statistical difference between them throughout the 24 hours regarding total narcotic consumption and 1st time for pethidine administration. The ISB group showed a statistically significant reduction in the hand power grip strength postoperatively (83.68±4.75 %). Conclusions The results of the present study favour SSNB as the first choice of pain control after shoulderscopic surgeries for a patient scheduled for early home discharge because of the complete recovery of the hand muscles’ motor power.

A Comparative Study between Vacuum-Assisted Closure (VAC) versus Plaletets Rich Plasma (PRP) for Dressing of Diabetic Foot Ulcers

Abstract Background Diabetic foot ulcers are among the most generally perceived troubles of patients who have diabetes mellitus which isn't particularly controlled. It is commonly the outcome of poor glycemic control, stowed away neuropathy, periphery vascular sickness, or sad foot care. It is similarly one of the typical justification for osteomyelitis of the foot and evacuation of lower uttermost focuses. These ulcers are ordinarily in the space of the foot which encounters repetitive injury and strain sensations. Objective To evaluate the effect of plasma rich platelets versus vacuum-assisted-closure dressing in the improvement of the healing process in diabetic foot ulcer. Patients and Methods The survey included 40 patients who had continuous diabetic foot ulcer and were treated at the piece of Vascular and General an operation, Ain Scams School Facilities and Luxor Overall Crisis center, Cairo, Egypt. Starting from December 2021 to May 2022. Results Larger piece of the patients in both control and cases had discharge. (Patients with sickness or purulent delivery were barred from study). In our examination of 40 patients the ulcer size went from 6 to 15 cm2. The mean size in pack (A) was 9.48±1.91 cm2 and among Get-together (B) 9.56 ±1.87 cm2. In our survey we saw that recovering in cases or exploratory get-together took in a general sense less time when differentiated and bundle (A). The mean length of retouching in control pack was 7.3 ±1.91 weeks and mean term of recovering for pack (B) was 4.38±1.94 weeks. The probability regard (p regard) gained ensuing to applying unpaired t test for the above data arises to be 0.0001 which is really gigantic. Conclusion Our case series showed that PRP and VAC is a secured and strong treatment technique for consistent non-retouching ulcers. Using PRP to treat persevering wounds/ulcers might further develop patching, yet also thwart lower limit evacuations achieved by non-recovering injuries. Appropriately, further investigation and randomized controlled clinical starters on greater patient people are essential to endorse the results.

Intravascular Ultrasound Enhances the PETTICOAT Technique in Endovascular Therapy for Complicated Type B Aortic Dissection with Malperfusion Syndrome

ObjectiveTo present the value of intravascular ultrasound (IVUS) in diagnosis and treatment of complicated type B aortic dissection (TBD) with malperfusion (MP). Especially the value of IVUS regarding the treatment strategy, reoperation rate, acute kidney injury (AKI) and false lumen thrombosis (FLT) was investigated. MethodsRetrospective analysis of 25 TBD cases with MP treated with endovascular therapy from April 2019 to August 2022. In 17 cases angiography & IVUS were applied during the operation (IVUS group) and in 8 cases angiography was used without IVUS (control group) for final intraoperative control. IVUS was used to assess the true lumen collapse and to decide if additional bare stenting was necessary or not. Details from patients’ charts and documentation from surgeries were analyzed. The endovascular technique included thoracic endovascular aortic repair (TEVAR) with primary entry sealing and -if needed- bare stenting of the true lumen distal of the entry tears using the PETTICOAT (Provisional Extension To Induce Complete Attachment) technique. ResultsAll patients presented with pain localized mostly (48%) in thorax and abdomen. In all patients the proximal entry tear of the dissection was covered using TEVAR. The PETTICOAT technique was applied in 13 cases (52%), whereas most combined procedures were applied in the IVUS group (12 compared to 1; p=0,02). A total of 3 patients (1 in the control group; 12,5% and 2 in the IVUS group; 11,8%) underwent a bowel resection. Totally 8 patients (32%) underwent a reoperation in aorta (3 during the hospital stay). There were no statistical differences between IVUS and control group regarding the preoperative findings, the reoperation rates and the postoperative complications. 5 patients died (4 during the hospital stay), 1 in control and 4 in IVUS group; p=0,53. The follow up included a clinical and a computed tomography angiography (CTA) examination. No statistically significant difference regarding occurrence and extension of FLT was observed between the two groups. ConclusionsThe IVUS and control groups showed no difference in survival rates. The use of IVUS extended the indication for PETTICOAT technique with statistically significant difference. A milder form of AKI presented in the IVUS group compared to the control group. In addition, a stronger correlation between IVUS and the avoidance of an aorta reoperation was observed, though it did not reach statistical significance.