EF Group Research Articles

Early versus Delayed Initiation of Oral Feeds among Mothers after Caesarean Delivery: A Comparative Study

Introduction: It is a common practice to keep a patient ‘nil’ per oral, till the return of bowel sounds, after any laparotomy. Enhanced Recovery After Surgery (ERAS) society, now recommends evidenced-based guidelines for postoperative early oral feeding after an uncomplicated Caesarean Delivery (CD), as opposed to the delayed (conventional) initiation of oral feeds. Aim: To compare the effects of early feeding versus delayed oral feeding in women undergoing CD. Materials and Methods: This prospective study was conducted in Department of Obstetrics and Gynaecology at MVJ Medical College and Research Hospital, Bengaluru, Karnataka, India, from November 2020 to October 2021. Total of 148 women with uncomplicated singleton pregnancy undergoing CD, under spinal anaesthesia, were allocated into two groups. Early Feeding group (n=70) (EF) where feeding was started within 2-8 hours of surgery and Delayed feeding group (n=78) (DF) where feeding was started between 18-24 hours of CD. The outcome measures were maternal satisfaction, and the effect on gastrointestinal function (return of bowel sounds, passage of flatus and stool), mobilisation of patient and complications in postoperative period. Student’s t-test and Chi-square test were used as appropriate, and p-value <0.05 was determined to be statistically significant. Results: The mean age of women in DF was 24.79±4.37 years and in EF group was 25.09±3.86 years. Overall, the maternal satisfaction was high in both the groups; DF (80%) and in EF (98.57%). There was an early return of bowel sounds in EF group 4.71±1.83 hours versus 13.72±3.08 hours in DF group. Participants in EF group recorded. early passage of flatus (9.89±3.00 hours versus 13.72±3.08 hours), and early ambulation (9.57±1.62 versus 14.95±3.9 hours) when compared to DF group participants. Conclusion: The ERAS strategy is a safe and effective approach for postoperative care for women undergoing caesarean delivery and results in overall high patient satisfaction.

Expression and variation of serum cytokines in mouse model with different types of bacteremia

Abstract To investigate the expression and variation of MIP-1β, MIP-2, IL-12p40 and IL-12p70 in mice with bloodstream infection caused by four types of bacteria. ICR mouse models of bloodstream infection with Staphylococcus aureus (Sa), Enterococcus faecalis (Ef), Escherichia coli (Ec) and Klebsiella pneumonia (Kp) were established. Mice were infected by bacteria for 0.5h, 1h, 3h, 6h, 12h, 24h and 48h, while mice in control group was injected with PBS. MIP-1β, MIP-2, IL-12p40 and IL-12p70 in serum were detected by Luminex xMAP assay and were compared among different groups at different time points. MIP-1β increased significantly after bacteria were injected for each time point (p < 0.05). MIP-1β and MIP-2 in Ec and Kp groups were significantly higher than those in Sa and Ef groups (p < 0.01). IL-12p40 peaked at 3h after injection and remained at high level for12h in four groups. IL-12p70 in Sa group increased significantly and reached the maximum value 6h after infection, while in the other three groups, it increased significantly 3h after infection (P < 0.05).

Endometrial asynchrony in pathogenesis of implantation impairment in women with infertility associated with endometriosis

There is a statistically significant difference in the frequency of implantation in the group of patients with endometriosis associated with infertility compared with the control group. This has been confirmed by a number of different studies. The aim of the study to expand the understanding of the pathogenesis of implantation failures in patients with infertility associated with endometriosis Materials and research methods: The present study included 83 women aged 29 to 43 years (the average age was 33 ± 3.2 years) with a diagnosis of endometriosis (ICD10 code N80.9 Endometriosis, unspecified), as well as infertility (ICD10 code N 97.8, Female infertility of other origin) and repeated implantation failures. All patients of the studied cohort underwent an immunohistochemical study of endometrial biopsy samples taken by the pipel-biopsy of the endometrium during the period of the supposed “implantation window”. Research results: Significant decrease in the immunological labeling of VEGF-A in samples from the ERIF group by ∼2.7 times in comparison with EF group (p < .05), the indices of expression of the proapoptotic protein CASP3 are increased in the samples of the ERIF group in comparison with the EF group (by ∼2.7 times, p < .05) and significant decrease in the expression of HOXA10 in the stromal and glandular compartments (2.4 times; 57.2 vs. 23.5%, p < .05). Conclusion: On the basis of the obtained results of the study, it should be concluded that the basis of implantation impairment in patients with repeated implantation failures associated with endometriosis lies in angiogenetic and apoptotic disorders and leads to implantation failure in the eutopic endometrium due to desynchronous transformation of the epithelial-mesenchymal compartment and disruption of endometrial trophism.

Effect of repeated eccentric exercise on muscle damage markers and motor unit control strategies in arm and hand muscle

To examine the contralateral repeated bout effect (CL-RBE) on muscle damage markers and motor unit (MU) control strategies, seventeen healthy adults performed two bouts of 60 eccentric contractions with elbow flexor (EF group; n ​= ​9) or index finger abductor (IA group; n ​= ​8) muscles, separated by 1 week. All participants randomly performed eccentric exercise on either the right or left arm or hand muscles, and muscle damage markers and submaximal trapezoid contraction tests were conducted pre, post, 1- and 2-day post eccentric protocol. One week after the first bout, the same exercise protocol and measurements were performed on the contralateral muscles. Surface electromyographic (EMG) signals were collected from biceps brachii (BB) or first dorsal interosseous (FDI) during maximal and submaximal tests. The linear regression analyses were used to examine MU recruitment threshold versus mean firing rate and recruitment threshold versus derecruitment threshold relationships. EMG amplitude from BB (bout 1 vs. bout 2 ​= ​65.71% ​± ​22.92% vs. 43.05% ​± ​18.97%, p ​= ​0.015, d ​= ​1.077) and the y-intercept (group merged) from the MU recruitment threshold versus derecruitment threshold relationship (bout 1 vs. bout 2 ​= ​−7.10 ​± ​14.20 vs. 0.73 ​± ​16.24, p ​= ​0.029, d ​= ​0.513) at 50% MVIC were significantly different between two bouts. However, other muscle damage markers did not show any CL-RBE in both muscle groups. Therefore, despite changes in muscle excitation and MU firing behavior, our results do not support the existence of CL-RBE on BB and FDI muscles.

Effects of higher protein formula with improved fat blend on growth, feeding tolerance and nutritional biomarkers in preterm infants: A double-blind, randomized, controlled clinical trial

Preterm formulas containing greater protein:energy ratio are beneficial for non-breastfed infants, since protein is critical for promoting catch-up growth and synthesis of lean body mass. Additionally, formulas containing enriched sn-2 palmitate (sn-2) and reduced medium chain triglycerides (MCTs) may support better feeding tolerance and nutrient utilization. The objective of this randomized, controlled, double-blinded clinical trial is to evaluate growth, feeding tolerance and nutritional biomarkers of preterm infants with birth weight ≤2000g and gestational age ≤33wks from one neonatal unit in Vietnam receiving experimental formula (EF, n=80) containing higher protein level of 3.4g/100kcal and improved fat blend with enriched sn-2 and modified level of MCTs or isocaloric control formula (CF, n=80) containing protein level of 2.9g/100kcal and standard fat blend. The differences in weight gain (g/d; primary endpoint) from day 1 (D1) of full enteral feeding (FEF) until D21 between groups was evaluated for non-inferiority (margin=-2.5g/d) and superiority (margin=0g/d). Mean weight gain was 3.09g/d greater in EF than CF; the lower limit of 95% CI (0.31g/d) exceeded both non-inferiority and superiority margins. There was no significant difference in length-for-age and head circumference-for-age z-score. By D79, the mean change in weight-for-age z-scores from D1 in EF group (+0.76 SDs) surpassed the criteria for catch-up growth (+0.67 SDs). Infants in the EF group (vs. CF) tended to have softer stools (EF=3.2±0.59 vs. CF=3.4±0.58; P=0.07) based on 5-point scale (1=watery, 5=hard). Difference in blood urea nitrogen and biomarkers for bone mineral status (i.e., plasma phosphorus, alkaline phosphatase and urinary calcium/phosphorus ratio) between EF and CF on FEF Day 21 reached statistical significance (P<0.05) but all mean values stayed within normal clinical ranges for both groups. Preterm formula with greater protein:energy ratio and new fat blend is safe, nutritionally suitable, well-tolerated, and improves catch-up weight gain of preterm infants. Clinical trial registry identifier is NCT03055052 (ClinicalTrials.gov).

STEMI with mid-range ejection fraction: a group of intermediate risk not to be forgotten

Abstract Background Reduced left ventricular ejection fraction (LVEF) &amp;lt;40% is an important negative prognostic factor in the setting of ST-elevation acute myocardial infarction (STEMI). On the other hand, data concerning mid-range LVEF (mrEF) post-STEMI are scarce. Consequently, recommendations regarding reassessment of LVEF or administration of neurohormonal medication in this group of patients (pts) are also lacking. Purpose To assess the current treatment and prognosis of STEMI with mrEF. Methods Retrospective study including all consecutive pts hospitalized for STEMI and submitted to primary percutaneous coronary intervention in a Cardiology centre in 2018. Pts were divided into 3 groups according to LVEF assessed before hospital discharge: preserved EF (pEF: LVEF ≥50%), mid-range EF (mrEF: LVEF 40–49%) and reduced EF (rEF: LVEF &amp;lt;40%). We analysed clinical characteristics, treatment, evolution of LVEF post-STEMI and clinical outcomes - death, myocardial infarction (MI) and hospitalization for heart failure (HF) – of the mrEF group and compared it with pEF. Results 188 pts with a mean age of 61 years were admitted for STEMI in 2018. The majority (58%, n=109) had pEF; 29% (n=55) had mrEF and 13% (n=24) were in the rEF group. Pts in the mrEF group had similar baseline characteristics to the others. However, compared with pEF, culprit-lesion was more often located in left main or left anterior descending arteries (80% vs 35%, p&amp;lt;0.001) and NT-proBNP levels were higher in mrEF pts (2270 vs 881 pg/mL, p&amp;lt;0.001). At discharge, all mrEF patients were medicated with a renin-angiotensin-aldosterone blocker and 91% with a beta-blocker. After a median of 8 months, LVEF improved a mean of 4% (± 9%) in the mrEF group. However, in 12.5% LVEF worsened to &amp;lt;40% (vs 0 in the pEF group, p=0.006). At a median follow-up of 2.6 years, there was an increase in mortality according to the EF group (pEF 4% vs mrEF 13% vs rEF 48%, log-rank: p&amp;lt;0.001 – fig. 1) with a hazard ratio (adjusted for age) of 3.75 (95% CI 1.1–12.8, p=0.035) for mrEF vs pEF. There was also a non-significant tendency to higher rates of the composite endpoint of MI and hospitalization for HF in the mrEF group vs pEF (8.2% vs 2.9%, p=0.213). Conclusions This study confirms previous reports of the worse prognosis of STEMI with mrEF and suggests the existence of a continuum of risk of adverse clinical outcomes according to LVEF. Therefore, this group of intermediate risk might also benefit from neurohormonal medication, which is only specifically recommended for rEF in current STEMI guidelines. It also highlights the importance of a closer follow-up (with reassessment of LVEF) of mrEF pts since a non negligeable proportion ultimately progress to rEF and may require additional medical treatment or even an implantable cardioverter defibrillator. Further research with larger samples is required to identify predictors of worsening LVEF and assess the impact of neurohormonal modulation in this population. Funding Acknowledgement Type of funding sources: None. Kaplan-Meier Survival Analysis

Effect of Cognitive Training on Lower Limb Muscular Activity in Older Adults With Balance Impairment During Walking

Purpose: The purpose of this study was to compare the effects of two different approaches of dual-task training and executive training on lower limb muscular activity in older adults with balance impairment. Methods: This was a quasi-experimental study performed with a pre-test and post-test method. Thirty old adults (Mean±SD age=73.8±4.6 y, height=1.65±0.06 m, weight=69.17±12.67 kg) were randomly assigned to one of the three groups: two experimental groups included Cognitive Dual-Task training (CDT; participants did exercises under the dual-task condition with cognitive tasks, such as forward counting, simple visual search task, etc.) and Executive Function training (EF; included a mixture of 20 tasks involving working memory tasks, inhibitory and speed of processing tasks), and a control group. The training session lasted 45 min and was held three times a week for eight weeks. Gait muscle activity under single-task and Dual-Task (DT) conditions was recorded before and after training. Results: during the stance phase of normal walking, the amplitude of Electromyography (EMG) activity of right Tibialis Anterior (TA) muscle in the post-test was about 32% lower than that in the pre-test in the CDT group (P=0.011), and no statistically significant change was between pre- and post-training in the EF and control groups (P&gt;0.05). During the swing phase of DT walking, the amplitude of EMG activity of the right Vastus Lateralis (VL) muscle in the post-test was about 15.5% higher than that in the pre-test in the CDT group (P=0.013), and in the right VL muscle during the post-test was lower than that in the pre-test in the EF group (P=0.01). In the CDT group, right ankle co-contraction during the stance phase in the post-test was statistically different from that in the pre-test. In all three groups, muscular EMG asymmetry demonstrated no statistically significant change between pre- and post-training measures (P&gt;0.05). Conclusion: Overall, both training groups showed similar muscular activity in the post-test than pre-test; however, in the EF training group, walking velocity improved more than that in the CDT group. Therefore, because of improvements in both walking velocity and muscle activities after EF training, this training mode is suggested for older adults.

IMMEDIATE AND 4-YEAR OUTCOME OF PATIENTS WITH ACUTE CORONARY SYNDROME UNDERGOING PERCUTANEOUS CORONARY INTERVENTION FOR LEFT MAIN CORONARY ARTERY DISEASE

Background: The treatment of LMCAD has shifted from coronary artery bypass grafting (CABG) to Percutaneous coronary intervention (PCI). However, data on long-term outcomes of PCI for LMCA disease, especially in patients with acute coronary syndrome (ACS) remains limited and conicting. This study aims to nd the association of the immediate and 4-year mortality in ACS patients with LMCA disease treated by PCI based on ejection fractions at admission. Methods: A retrospective analytical study was conducted. Patients were divided at admission into those with reduced left ventricular ejection fraction and those with preserved ejection fraction. Results: Forty (58.8%) of the patients presented with preserved EF. The mean age of the patients was 71.6±7.1 years. The mean LVEF of the preserved group was 61.6±4.3% and signicantly higher than that of the reduced group. Age and cardiovascular risk factor prole was similar between the two groups. Patients with reduced ejection fraction had signicantly higher levels of serum creatinine and signicantly lower levels of Hb and HDL. Mean hospital stay was signicantly longer for patients with preserved EF. In-hospital deaths were also similar between the two groups. The reduced EF group had a signicantly higher allcause mortality in the 4-year follow-up period. The mean years of follow-up for all participants was 4.2±1.3 years. Conclusion: It was seen that in patients presenting with ACS and undergoing PCI due to LMCAD, LVEF at admission, singly and in in multivariate regression is an important predictor of in hospital and 4-year mortality

Heat-Killed and Live Enterococcus faecalis Attenuates Enlarged Prostate in an Animal Model of Benign Prostatic Hyperplasia.

In the present study, we investigated the inhibitory effect of heat-killed Enterococcus faecalis (E. faecalis) and live E. faecalis on benign prostatic hyperplasia (BPH). The BPH rat model was established by administering male rats with testosterone propionate (TP, 5 mg/kg, in corn oil) via subcutaneous injections daily for four weeks after castration. The rats were divided into five groups: Con, corn oil-injected (s.c.) + DW administration; BPH, TP (5 mg/kg, s.c.) + DW administration; BPH+K_EF, TP (5 mg/kg, s.c.) + heat-killed E. faecalis (7.5 × 1012 CFU/g, 2.21 mg/kg) administration; BPH+L_EF, TP (5 mg/kg, s.c.) + live E. faecalis (1 × 1011 CFU/g, 166 mg/kg) administration; BPH+Fi, TP (5 mg/kg, s.c.) + finasteride (1 mg/kg) administration. In both of BPH+K_EF and BPH+L_EF groups, the prostate weight decreased and histological changes due to TP treatment recovered to the level of the Con group. Both of these groups also showed regulation of androgen-signaling factors, growth factors, and apoptosis-related factors in prostate tissue. E. faecalis exhibited an inhibitory effect on benign prostatic hyperplasia, and even heat-killed E. faecalis showed similar efficacy on the live cells in the BPH rat model. As the first investigation into the effect of heat-killed and live E. faecalis on BPH, our study suggests that heat-killed E. faecalis might be a food additive candidate for use in various foods, regardless of heat processing.

External fixation versus elastic stable intramedullary nailing in the treatment of open tibial shaft fractures in children

IntroductionExternal fixator (EF) is a popular choice for open tibial fractures, but pin tract infection (PTI) and refracture are common complications. Elastic stable intramedullary nail (ESIN) has been reported in the treatment for open tibial fractures. This study aims to compare the clinical outcomes of EF vs. ESIN in the treatment for open tibial shaft fracture in children retrospectively.MethodsPatients aged 5–11 years with Gustilo-Anderson II and IIIA tibial shaft fracture treated at our institute from January 2008 to January 2018 were reviewed retrospectively and categorized into EF and ESIN groups. Patients with pathological fracture, neuromuscular disorder, metabolic disease, previous tibial fracture or instrumentation, and polytrauma were excluded. Patients with follow-up < 24 months or incomplete medical records were also excluded.ResultsIn all, 55 patients (33 males, 22 females) were included in the EF group, whereas 37 patients (21 males, 16 females) were included in the ESIN group. There was no statistically significant difference between the two groups concerning sex, age, body weight, duration from injury to surgery, Gustilo-Anderson (GA) classification, and concomitant injuries. There was no case of nonunion and malunion in either group. The angulation at the latest follow-up was higher in the EF group than the ESIN group (P < 0.01). The radiological union was faster in the ESIN group (7.0 ± 0.9 weeks) than those in the EF group (9.0 ± 2.2 weeks) (P < 0.01). Limb length discrepancy (LLD) was more in the EF group (12.1 ± 4.4, mm) than in the ESIN group (7.3 ± 4.3, mm) (P < 0.01).ConclusionESIN is a viable option in selected patients of GA grade II and IIIA open tibial fractures with comparable clinical outcomes as external fixator. Pin tract infection is the most troublesome complication in the EF group while implant prominence is a nuisance in the ESIN group.

Altered trunk and lower extremity movement coordination after neuromuscular training with and without external focus instruction: a randomized controlled trial

BackgroundThis study sought to determine the effects of a 6-week neuromuscular training (NMT) and NMT plus external focus (NMT plus EF) programs on trunk and lower extremity inter-segmental movement coordination in active individuals at risk of injury.MethodsForty-six active male athletes (controls = 15, NMT = 16, NMT plus EF = 15) participated (age = 23.26 ± 2.31 years) in this controlled, laboratory study. Three-dimensional kinematics were collected during a drop vertical jump (DVJ). A continuous relative phase (CRP) analysis quantified inter-segmental coordination of the: (1) thigh (flexion/extension)—shank (flexion/extension), (2) thigh (abduction/adduction)—shank (flexion/extension), (3) thigh (abduction/adduction)—trunk (flexion/extension), and (4) trunk (flexion/extension)—pelvis (posterior tilt/anterior tilt). Analysis of covariance compared biomechanical data between groups.ResultsAfter 6 weeks, inter-segmental coordination patterns were significantly different between the NMT and NMT plus EF groups (p < 0.05). No significant differences were observed in CRP for trunk-pelvis coupling comparing between NMT and NMT plus EF groups (p = 0.134), while significant differences were observed CRP angle of the thigh-shank, thigh-trunk couplings (p < 0.05).ConclusionsTrunk and lower extremity movement coordination were more in-phase during DVJ in the NMT plus EF compared to NMT in active individuals at risk of anterior cruciate ligament injury.Trial registration: The protocol was prospectively registered at UMIN_RCT website with ID number: UMIN000035050, Date of provisional registration 2018/11/27.

Infant formula enriched with milk fat globule membrane, long-chain polyunsaturated fatty acids, synbiotics, gangliosides, nucleotides and sialic acid reduces infections during the first 18 months of life: The COGNIS study

• Breast milk is the gold standard for nutrition during the first 6 months of life. • Functional nutrients added in infant formulas might narrow the gap with breast milk. • Bioactive functional nutrients could reduce development of certain infections. • Decreased risk of infections might be due to a synergic effect of several nutrients. Functional nutrients like synbiotics or milk-fat globule membrane (MFGM) affect positively host immunity, modifying intestinal microbioma and reducing early childhood infections. We compared effects of an experimental enriched-infant formula with long chain polyunsaturated fatty acids, MFGM, synbiotics, sialic acid, nucleotides and gangliosides to a standard infant formula and breastfeeding regarding infections incidence and evolution in infants until 18 months of age. 170 healthy infants were enrolled in a RCT to receive either a bioactive functional nutrients enriched infant formula (EF, n = 85) or a standard formula (SF, n = 85). 50 breastfed (BF) infants were also enrolled. At age 12 months, EF group compared to SF and BF groups showed a lower incidence of infectious episodes. Moreover, they also presented less incidence of respiratory tract infections and gastrointestinal infections than SF infants, reducing risk by 30.2% and 32.5%, respectively. Infants fed with an EF seem to have reduced incidence of certain infections at 12 months of age.

B-PO05-156 ASSOCIATION AND PREDICTORS OF CARDIOMYOPATHY IN RATE-RELATED LEFT BUNDLE BRANCH BLOCK

Left bundle branch block (LBBB) has been identified as an independent cause of non-ischemic cardiomyopathy. Rate-related LBBB is an infrequent finding on stress tests (0.5% incidence) and has been associated with a higher all-cause mortality. However, the progression of rate-related LBBB to cardiomyopathy has not been well studied. We conducted a retrospective chart review to assess the characteristics of patients with rate-related LBBB and predictors of cardiomyopathy in this population. We identified all patients with LBBB during stress testing at our tertiary hospital from 2008-2020. Further we included those who developed rate-related LBBB and had transthoracic echocardiography (TTE) to assess their left ventricular ejection fraction (LVEF). Patients with right bundle branch block, resting LBBB, stress QRS<120 milliseconds, no TTE and ischemic cardiomyopathy were excluded. A total of 694 patients had LBBB on stress testing. Among these, 34 patients developed rate-related LBBB and met entry criteria. Females comprised 64.7%. Treadmill, dobutamine and vasodilator stress tests were performed in 23 (68%), 5 (15%) and 6 (17.6%) patients, respectively. Analysis of continuous variables showed moderate correlation (r=-0.4, p= 0.02) between LVEF and maximum stress QRS duration (maxQRS) and no significant correlation (r=0.3, p=0.08) with heart rate at which LBBB starts (HRstart). Patients with LVEF<40% had a wider maxQRS in rate-related LBBB than those with higher LVEF (157±11 vs 144±13, p=0.04). LBBB was noted earlier at a numerically lower mean HRstart in the LVEF<40% group but was not significantly different from the higher EF group (105±27 vs 116±28, p=0.45). Pre and post-stress QRS duration, sex, hypertension, coronary artery disease, beta blocker use and ACEi/ARB/ARNI use were not significant predictors of cardiomyopathy. Rate-related LBBB is not benign. Wider QRS duration during rate-related LBBB was associated with left ventricular dysfunction among these patients. Further prospective studies with larger sample size are needed to explore management options for patients with rate-related LBBB.

Fishmeal and scallop mantle subjected to enzymolysis by papain as a substitute for fishmeal could modulate the growth, antioxidant activity and non‐specific immune responses in juvenile sea cucumber ( Apostichopus japonicus )

The rapid development of aquaculture has led to an increase in price and high demand for fishmeal. Finding candidate protein sources for replacing fishmeal has become an urgent matter for the healthy and sustainable development of A. japonicus aquaculture. Therefore, we evaluated the effect of fishmeal subjected to enzymolysis (EF) and scallop mantle subjected to enzymolysis (ESM) by papain as a substitute for fishmeal on the growth, antioxidant activity and non-specific immune response of A. japonicus. The results showed that EF and ESM did not lead to a difference in the growth performance of A. japonicus. However, the activity of respiratory burst and phagocytic increased in ESM group. The expression of Lysozyme (LZM) increased in the intestine of the EF and ESM group, while the expression level of superoxide dismutase (SOD) was reduced in the intestine and respiratory tree of the EF and ESM group. In conclusion, EF and ESM have no effect on the growth performance but could modulate the non-specific immune responses of juvenile sea cucumber. Therefore, scallop mantle subjected to enzymolysis by papain is a candidate protein source for replacing fishmeal in the aquaculture of A. japonicus.

Electrofulguration-assisted dermabrasion is comparable to manual dermabrasion in patients undergoing autologous non-cultured epidermal cell suspension for treatment of stable vitiligo: A randomized controlled trial.

Recipient site preparation is a crucial step in non-cultured epidermal cell suspension (NCES) as it facilitates proper uptake of the grafted melanocytes. To compare the repigmentation rate of recipient sites prepared with manual dermabrasion (MD) versus electrofulguration-assisted dermabrasion (EF) in patients undergoing NCES for treatment of stable vitiligo. This was a prospective randomized study including 26 patients of stable vitiligo (VIDA 0 or -1), each having two patches of size greater than 3×3cm located symmetrically or at the same site or a single patch of 6×6cm or larger. After randomization of patches in the given patient, MD and EF were performed on recipient areas followed by NCES. The patients were followed up at 4weekly intervals up to 24weeks and assessed for extent of repigmentation and adverse effects if any. Greater than 75% repigmentation was observed in 69.3% of the patches prepared by MD as compared to 73.1% patches prepared by EF at the end of 24weeks (p=0.791). The mean improvement in target VASI was 64.0% in the MD group as compared to 68.8% in the EF group (p=0.21). Patches prepared by EF achieved successful repigmentation earlier as compared to patches prepared by MD (9.4weeks vs 11.4weeks, p=0.12). Both MD and EF have comparable outcomes with respect to all parameters.

Supervised Analysis for Phenotype Identification: The Case of Heart Failure Ejection Fraction Class.

Artificial Intelligence is creating a paradigm shift in health care, with phenotyping patients through clustering techniques being one of the areas of interest. Objective: To develop a predictive model to classify heart failure (HF) patients according to their left ventricular ejection fraction (LVEF), by using available data from Electronic Health Records (EHR). Subjects and methods: 2854 subjects over 25 years old with a diagnosis of HF and LVEF, measured by echocardiography, were selected to develop an algorithm to predict patients with reduced EF using supervised analysis. The performance of the developed algorithm was tested in heart failure patients from Primary Care. To select the most influentual variables, the LASSO algorithm setting was used, and to tackle the issue of one class exceeding the other one by a large amount, we used the Synthetic Minority Oversampling Technique (SMOTE). Finally, Random Forest (RF) and XGBoost models were constructed. Results: The full XGBoost model obtained the maximum accuracy, a high negative predictive value, and the highest positive predictive value. Gender, age, unstable angina, atrial fibrillation and acute myocardial infarct are the variables that most influence EF value. Applied in the EHR dataset, with a total of 25,594 patients with an ICD-code of HF and no regular follow-up in cardiology clinics, 6170 (21.1%) were identified as pertaining to the reduced EF group. Conclusion: The obtained algorithm was able to identify a number of HF patients with reduced ejection fraction, who could benefit from a protocol with a strong possibility of success. Furthermore, the methodology can be used for studies using data extracted from the Electronic Health Records.

Fixation Characteristics of Severe Amblyopia with Eccentric Fixation and Central Fixation Assessed by the MP-1 Microperimeter

ABSTRACT Objectives To investigate the fixation patterns in severe amblyopia with eccentric or central fixation by the MP-1 microperimeter. Design Fixation test was performed on 38 patients with severe amblyopia using the MP-1 microperimeter, 20 patients with eccentric fixation (EF group), and 18 patients with central fixation (CF group). Fixation location and fixation stability were quantified by preferred fixation eccentricity and bivariate contour ellipse area (BCEA, deg2) respectively. Comparisons of BCEA between amblyopic and fellow eyes (FE) in both groups and between amblyopic eyes (AE) in both groups were analyzed. Linear regression analysis was used to investigate the risk factors for fixation instability in patients with eccentric fixation. Results In EF group, the BCEA of AE was 14.68 ± 19.21 deg2, which was significantly larger than that of FE (1.294 ± 1.840, F = 9.243, p = .007). Linear regression analysis showed that only preferred fixation eccentricity (β = 6.536, 95% CI: 2.665 ~ 10.406, p < .005) was correlated with BCEA of AE. The BCEA of AE in the EF group was significantly larger than that of AE in the CF group (4.95 ± 3.44 deg2, t = 2.227,p < .05), although the BCVA was not significantly different between two groups (t = 0.129, p = .898). Conclusions The fixation ability in amblyopia with eccentric fixation was found to be significantly worse than those with central fixation and preferred fixation eccentricity was the only predictor for the instability. MP-1 is an effective tool to quantify fixation features for diagnosis and follow-up of eccentric amblyopia patients.

Neurodevelopment and growth until 6.5 years of infants who consumed a low-energy, low-protein formula supplemented with bovine milk fat globule membranes: a randomized controlled trial

We previously reported results from a randomized controlled trial in which we found that Swedish infants consuming an experimental low-energy, low-protein formula (EF) supplemented with bovine milk fat globule membranes (MFGMs) until 6 mo of age had several positive outcomes, including better performance in the cognitive domain of Bayley Scales of Infant and Toddler Development 3rd Edition at 12 mo of age, and higher plasma cholesterol concentrations during the intervention, than infants consuming standard formula (SF). We aimed to evaluate neurodevelopment, growth, and plasma cholesterol status at 6 and 6.5 y of age in the same study population. We assessed cognitive and executive functions using the Wechsler Intelligence Scale for Children 4th Edition (WISC-IV), Brown Attention-Deficit Disorder Scales for Children and Adolescents (Brown-ADD), and Quantified Behavior (Qb) tests, and behavior using the Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF), at 6.5 y of age. Anthropometrics and plasma lipids were assessed at 6 y of age. There were no differences between the EF and SF groups in any of the subscales in WISC-IV or Brown-ADD at 6.5 y of age, in the proportion of children with scores outside the normal range in the Qb test, nor in clinical or borderline indications of problems in adaptive functioning from parental and teacher's scoring using the CBCL and TRF. There were no differences between the EF and SF groups in weight, length, or head or abdominal circumferences, nor in plasma concentrations of homocysteine, lipids, insulin, or glucose. Among children who as infants consumed a low-energy, low-protein formula supplemented with bovine MFGMs, there were no effects on neurodevelopment, growth, or plasma cholesterol status 6-6.5 y later.

IF NEEDED TO BE SURGICALLY INTERVENED UPON, IN THE PAEDIATRIC DIAPHYSEAL FRACTURES, WHICH IS THE BETTER AMONG THE AVAILABLE FIXATION DEVICES-A CASE SERIES CONSIDERATION.

Humeral fractures, in the paediatric age group, have two peaks of incidence. It has a high incidence in babies below three years of age, and again also in children, above 10 years of age. The objective of our study, was to compare the most popular operative techniques for handling humeral diaphyseal fractures, in the paediatric age group, such as Plate Osteosynthesis (Locking Compression Plate), Elastic Stable Intramedullary Nailing System (ESIS), and the External Fixation devices (EF). This prospective study was conducted at Chettinad Hospital and Research Institute (CH&amp;RI), Kelambakkam, from July 2017 to June 2020. A total of 15 patients were a part of this study, of which, 8 were males and 7 were females. The functional outcomes were assessed using the DASH, the Borberg and Morrey scoring system and the radiographic assessment was done using Stan's Radiographic Grading system, in all the three methods of treatment. The Follow up period was for a minimum of twelve months. The Broberg and Morrey Score points were 88.4 (74-95) for LCP, 80.67 for ESIS (70- 91) and 83.87 (80-87) for EF (p value&gt;0.05). In the DASH score, the average was 19.2 in the LCP group, 21.17 and 21.10, respectively, in the ESIS and EF groups. Stan's Radiographic Grading showed Grade 2 to 3 fracture union status, in all the xation modalities of our study. The prudence of the surgeon, his surgical experience, the age of the patient, the geometry of the fracture and the nature of the humeral diaphyseal fracture, all needs to be carefully weighed, analyzed and on a case-to-case basis, the decision has to be taken, regarding which xation device is best suited for that very particular fracture. All the three modalities have been showcased to highlight their pros and cons, not with-standing the fact that, all the three modalities have faired superiorly in giving good to excellent result outcomes.

Effect of left ventricular ejection fraction on the prognostic impact of chronic total occlusion in a non-infarct-related artery in patients with acute myocardial infarction.

BackgroundChronic total occlusion (CTO) in a non-infarct-related artery (IRA) in patients with acute coronary syndrome (ACS) is associated with a poor prognosis. However, whether the prognostic impact of non-IRA CTO differs according to left ventricular ejection fraction (LVEF) is unclear.Methods and resultsA total of 2060 consecutive acute myocardial infarction (AMI) patients who underwent primary percutaneous coronary intervention (PCI) were classified into 2 groups according to their LVEF (reduced EF: LVEF < 50%, preserved EF: LVEF ≥ 50%) and further subdivided according to the presence of concomitant non-IRA CTO. In the reduced EF group, patients with CTO had a higher 1-year all-cause death rate (20.3% vs. 34.3%, P = 0.001) and major adverse cardiac event rate (MACE: 19.6% vs. 39.6%, P < 0.001) compared to those without CTO, but they were similar between patients with and without CTO in the preserved EF group. Non-IRA CTO was an independent predictor of all-cause death (HR 1.58, 95% CI 1.06–2.33, P = 0.02) and MACE (HR 1.67, 95% CI 1.14–2.46, P = 0.009) only in the reduced EF group. In addition, the outcomes of successful CTO-PCI seemed to be similar to those without CTO in the reduced EF group.ConclusionsCTO in a non-IRA may contribute to a poor prognosis only in AMI patients with reduced LVEF.