RA Group Research Articles

Regional Anesthesia for Carotid Endarterectomy in Patients with Acute Ischemic Stroke (Pilot Study)

Objective. The aim of this study is to assess the safety of the use of regional anesthesia for performing carotid endarterectomy (CEA) in patients in the acute phase of ischemic stroke.Material and methods. The study included 66 patients in the acute phase of ischemic stroke (atherothrom-botic subtype according to the TOAST classification) who underwent carotid endarterectomy. The inclusion criteria for the study were as follows: acute phase of atherothrombotic ischemic stroke (first 28 days), ipsilateral symptomatic ≥ 50% stenosis of the internal carotid artery, 1-4 points neurological deficit according to the modified Rankin Scale (mRS), 1-13 points neurological deficit according to the National Institutes of Health Stroke Scale (NIHSS), size of the cerebral ischemic lesion ≤ 4 cm. This single-center prospective cohort study compared two anesthetic approaches, regional anesthesia (RA, 46 patients) and general anesthesia (GA, 20 patients). The RA techniques included ultrasound-guided superficial and deep cervical plexus blocks on the side of the surgery.Results. The study found no significant differences in the baseline patient characteristics, surgery techniques and clinical outcomes between the groups. There were no neurological or cardiovascular toxic reactions to the local anesthetics. Conversions from RA to GA were not performed. In the RA group, recurrent ipsilateral ischemic strokes, myocardial infarctions, wound hemorrhagic complications and lethal outcomes did not occur.Conclusion. This pilot study has demonstrated the safety of RA for performing CEA in patients in the acute phase of ischemic stroke. RA provides adequate neuromonitoring and timely intraoperative recognition of «new» ischemic complications. To compare the efficacy of RA and GA for performing CEA in patients with acute ischemic stroke, large randomized controlled trials are needed.

Exploring the Subclinical Atherosclerotic Load in Patients With Rheumatoid Arthritis: A Cross-Sectional Study.

Atherosclerosis is the majoretiopathogenic factor that decides cardiovascular mortality and morbidity. While inflammation is the putative mechanism for atherosclerosis in various experimental studies, chronic inflammatory state (e.g. in rheumatoid arthritis [RA])is often neglected as a contributing factor for the development of atherosclerosis. RApatients have two to four times more risk of fatal or non-fatal cardiovascular events, whichis not explained by traditional risk factors alone. For example, low-density lipoprotein (LDL) cholesterollevels may not convey the true atherosclerotic risk in RA patients - "the lipid paradox". Thus, for better risk stratification of future cardiovascular events in RA, the traditionalparameters like diabetes, hypertension, and dyslipidemiamay not suffice. Newer parameters like carotid intimal-medial thickness (CIMT), coronary calcification scores, and C-reactive protein (CRP)may be needed. This study determined subclinical atherosclerotic load in groups of RA and non-RA patients with comparable Framingham risk scores using CIMT values. In this hospital-based cross-sectional study, the RA study group had 64 patients withRA (disease duration > 1 year) and 64 controls were patients with at least one traditional risk factor of cardiovascular disease (e.g., hypertension, cigarette smoking, dyslipidemia, and diabetes mellitus). They were all analyzed for CIMT. The aim was to compare if there was a difference in CIMT scores between groups of RA and non-RA patients, with comparableFramingham score cardiovascularrisk categories. CIMT was significantly higher in the study population compared to controls, indicating increased subclinical atherosclerotic load in the former. Mean CIMT was higher in all age groups in RA patients when compared to the control population (statistically significant in age groups 40-49 years 0.66 ± 0.07 mm vs 0.64 ± 0.06 mm, P < 0.026 and 50-59 years 0.8 ± 0.05 mm vs 0.76 ± 0.05 mm, P < 0.047). CIMT was significantly higher in theintermediate-risk groups (based onthe Framingham risk score) in the RA study population when compared with the same risk categories of the control population. Atherogenic indices such as LDL/high-density lipoprotein (HDL) ratio, atherogenic index, and CIMT were significantly higher in theRA patients with more than five years of disease duration than those with a duration of fewer than five years. Subclinical atherosclerotic load is higher in RA versus controls. The mean CIMT was higher in all age groups in RA compared to the controls. CIMT was significantly higher in theintermediate-risk subgroup (by Framingham risk score) when compared between RA and controls. RA subgroup comparisonsbased on seropositivity/seronegativity, high/normal CRP, and disease activity (low, intermediate, and high) for CIMT were not found to have statistically significant differences. RA group had lower HDL cholesterol and comparable LDL cholesterol values compared to controls.

Automated segmentation and classification of hand thermal images in rheumatoid arthritis using machine learning algorithms: A comparison with quantum machine learning technique

The aims and objectives of the study were to i) perform image segmentation using a color-based k-means clustering algorithm and feature extraction using binary robust invariant scalable key points (BRISK), maximum stable extremal regions (MSER), features from accelerated segment test (FAST), Harris, and orientated FAST and rotated BRIEF (ORB); ii) compare the performance of classical machine learning techniques such as LogitBoost, Bagging, and SVM with a quantum machine learning technique. For the proposed study, 240 hand thermal images were acquired in the dorsal view and ventral view of both the right and left-hand regions of RA and normal subjects. The hot spot regions from the thermograms were segmented using a color-based k-means clustering technique. The features from the segmented hot spot region were extracted using different feature extraction methods. Finally, normal and RA groups were categorized using LogitBoost, Bagging, and support vector machine (SVM) classifiers. The proposed study used two testing methods, such as 10-fold cross-validation and a percentage split of 80–20%. The LogitBoost classifier outperformed with an accuracy of 93.75% using the 10-fold cross-validation technique compared to other classifiers. Also, the quantum support vector machine (QSVM) obtained a prediction accuracy of 92.7%. Furthermore, the QSVM model reduces the computational cost and training time of the model to classify the RA and normal subjects. Thus, thermograms with classical machine learning and quantum machine learning algorithms could be considered a feasible technique for classifying normal and RA groups.

Relevance of Routine Postoperative CT Scans Following Aneurysm Clipping—A Retrospective Multicenter Analysis of 423 Cases

Postoperative head computed tomography (POCT) is routinely performed in numerous medical institutions, mainly to identify possible postsurgical complications. This study sought to assess the clinical appropriateness of POCT in asymptomatic and symptomatic patients after ruptured or unruptured aneurysm clipping. This is a retrospective multicenter study involving microsurgical procedures of ruptured (RA) and unruptured intracranial aneurysm (UA) surgeries performed in the Centers associated with the Pomeranian Department of the Polish Society of Neurosurgeons. A database of surgical procedures of intracranial aneurysms from 2017 to 2020 was created. Only patients after a CT scan within 24 h were included. A total of 423 cases met the inclusion criteria for the analysis. Age was the only significant factor associated with postoperative blood occurrence on POCT. A total of 37 (8.75%) cases of deterioration within 24 h with urgent POCT were noted, 3 (8.1%) required recraniotomy. The highest number necessary to predict (NNP) one recraniotomy based on patient deterioration was 50 in the RA group. We do not recommend POCTs in asymptomatic patients after planned clipping. New symptom onset requires radiological evaluation. Simultaneous practice of POCT after ruptured aneurysm treatment within 24 h is recommended.

A Comparative Evaluation of Enamel Surface Roughness of Two Different Bonding Adhesives After Debonding With Atomic Force Microscopy

Introduction The debonding procedures should restore the enamel surface to its pre-treatment state as much as possible after removing orthodontic attachments and all remaining adhesive remnants from the surface of the tooth. The orthodontic attachments are bonded commonly by a light-cured composite system. Light-cured glass ionomer cement has been developed as an alternative to the composite as a bonding agent for orthodontic brackets. There are different methods for cleaning the residual adhesive after the removal of orthodontic attachments. The study aims to evaluate and compare the enamel surface roughness of teeth between two different adhesive systems - light cure composite and glass ionomer cement adhesives - after debonding followed by the removal of resin remnants with a tungsten carbide (TC) bur.A null hypothesis is proposed that there exists no difference in the enamel surface roughness between the two adhesive systems. Materials and methods The test sample of 40 freshly extracted human premolar teeth(n = 40) for orthodontic purposes was taken up for this in vitro study based on the inclusion and exclusion criteria. The sample was randomly assigned into two equal groups, with metal brackets bonded in Group-I (n = 20) by light cure adhesive (Trans bond XT, 3M Unitek, Monrovia, CA)and Group-II(n = 20) with light glass ionomer cement (GC Fuji Ortho LC, Tokyo, Japan). All samples were stored in water at room temperature for 24 hand brackets were debonded with a debonding plier. The removal of cement adhesive remnants was performed with a TC bur with a low-speed handpiece. The three surface roughness parameters, average roughness (Ra), root mean square roughness (Rq), and maximum roughness depth (Rmax), were measured at T1 (before bonding) and at T2 (after debonding and finishing) and the values were compared. The mode of bond failure was assessed by a modifiedadhesive remnant index (ARI) and the time required for the clean-up of adhesive was also noted. Statistical analysis The continuous quantitative data were statistically analyzed usingSPSS Statistics v. 25.0 (IBM Corp., Armonk, NY). Student's independent t-test/independent-samples t-test is an inferential statistical test for analyzing the difference between the two groups. Paired t-test was used for comparison within the group. The ARIbetween the groups was analyzed by a chi-square test. The probability (p) value for statistical significance was 0.05 or less for the difference between any two groups for all the analytical tests. Results A comparison of enamel surface roughness before bonding and after debonding for both groups revealed that there was a statistically significant difference within each group. The surface roughness values of composite resin- Ra (98.75 ± 0.96), Rq (120.38 ±1.06), Rmax (650.14 ± 1.12) - and glass ionomer cement group - Ra (98.75 ± 0.96), Rq (62.76 ± 1.32), Rmax (434.36 ± 1.60) - showthat there was a statistically significant difference between the groups with p <0.01. Conclusion There was a significant increase in the surface roughness of enamel after debonding of brackets and finishing with a TC bur with both the light cure and the glass ionomer cement adhesive systems. The light cure group showed more enamel surface roughness when compared to the glass ionomer cement group. In this study, the null hypothesis was rejected as there is a significant difference between the groups tested.

Chronic intermittent hypoxia worsens brain damage and sensorimotor behavioral abnormalities after ischemic stroke: Effect on autonomic nervous activity and sleep patterns

ObjectiveSleep apnea (SA) is characterized by intermittent hypoxia (IH), which increases sympathetic activity and sleep fragmentation, thus increasing the risk of stroke. SA is a highly prevalent disease and can worsen prognosis in patients with stroke. However, the correlation of changes in the cardiac autonomic nervous system and sleep patterns under IH with sensorimotor behavior and cerebral infarction after stroke remains unclear. We hypothesized that dysregulated autonomic activity and unstable sleep patterns induced by IH and correlated with cerebral infarction and abnormal sensorimotor behavior after middle cerebral artery occlusion (MCAO). MethodsWistar–Kyoto rats (WKY) were divided into IH (hypoxia: 5 % O2, 8 h/day) and RA group (room air) for 2 weeks and both groups were subjected to MCAO. After MCAO, the IH group was continuously exposed to IH for 1 week. The 24-h physiological signals, blood pressure, and sensorimotor behavior were recorded at baseline (Bas), the first and second weeks during IH (RA/IH1W and RA/IH2W, respectively), and poststroke. ResultsBefore MCAO, IH caused sympathetic activity during sleep and parasympathetic activity of active waking (AW) to increase. Moreover, IH reduced the accumulated time and duration of paradoxical sleep (PS) and increased the interruption during sleep. After MCAO, IH increased blood pressure, more severe brain damage, and poor sensorimotor performance. Moreover, IH reduced autonomic activity after MCAO and decreased sympathetic activity was associated with poor sensorimotor performance. ConclusionAutonomic activity and sleep patterns affected by IH were correlated with increased cerebral infarction and poor sensorimotor behavior after MCAO.

Comparison of 90-day complication rates and readmissions of primary total elbow arthroplasty in elective and traumatic cases: a single center experience.

The purpose of this study is to compare the 90day complication rates of primary Total Elbow Arthroplasty (TEA) performed for arthritis (primary-OA; rheumatoid arthritis-RA) versus those performed for distal humerus fractures (DHF). Patients who underwent a TEA from 2015 to 2021 were identified from our institutional database and placed into cohorts based on surgical indications (TEA-OA, TEA-RA and TEA-DHF). Chart review was conducted to analyze the prevalence of complications, emergency department (ED) visits, readmissions, and secondary procedures in the first 90day post-operative period. Complications included but were not limited to wound complications, hematoma, infection (superficial or deep), nerve palsy, periprosthetic fracture/failure and others. 49 patients who underwent TEA were included in this study: (DHF = 19, OA = 14, RA = 16). Six complications occurred within the first 90days of surgery. There were two periprosthetic joint infections (PJI) in the OA group, requiring irrigation and debridement (I & D) within the first 90days of surgery. There were three post-operative ulnar nerve palsies and one PJI requiring I & D in the TEA-RA group. Compared to the TEA-DHF and TEA-OA groups, the RA group had higher rates of all-cause complications (p = 0.03) and nerve palsy (p = 0.03). There were no significant differences between groups in readmissions (p = 0.27) or secondary interventions (p = 0.27). The 90-day complication/readmission rates of TEA preformed for DHFs is lower than those preformed for OA and RA. These differences could be related to the underlying chronic inflammatory etiology and side effect of treatments (intraarticular steroid injection, and biologics) received by patients with arthritis. Retrospective Cohort Study, level IV.

Primary unilateral incomplete cleft lip repair by a modified rotational advancement technique

PurposeThis study aimed to describe a modified technique for primary unilateral incomplete cleft lip repair together with postoperative outcomes assessment. Study designA Retrospective study. Participants and settingPhotos of 64 consecutive patients with nonsyndromic primary unilateral incomplete cleft lip were reviewed. Of the 64 participants for the study sample, 32 patients had received Millard rotational advancement technique (RA), while the other 32 had modified rotational advancement technique (MRA) with preserving the nasal sill intact. It was conducted at a university-affiliated tertiary hospital between 2013 and 2021. Main measuresThe lip measures were represented by lip height and width, vermillion height, midline-philtrum angle, and angle of Cupid's bow peaks. The nasal measures involved columella length and angle, nostril height and width, and ala width. Both descriptive and comparative data analyses were calculated. ResultsSymmetrical lip height, lip width, philtrum angle, Cupid's bow, as well columellar length, and alar width were obtained following the MRA technique. No significant difference was found between the MRA and RA groups concerning the preoperative lip height, Cupid's bow angle, columellar length and angle. However, the postoperative lip height, width and columellar length were greater in MRA group than RA group (P= .001, 0.004 and 0.002, respectively). On the other hand, the MRA group had significantly smaller columellar and Cupid's bow peaks angles than RA group (0.53±0.36 vs 1.21±0.91 and 1.34±1.84 vs 3.14 ± 2.97, respectively). ConclusionsThe MRA technique has obtained satisfactory lip and nasal outcomes in terms of lip height, lip width, philtrum angle, Cupid's bow, columellar length, and alar width while keeping the nasal sill intact.

Radial arterial access is a safe alternative to brachial artery and femoral artery access for endovascular lower extremity peripheral arterial disease

ObjectiveRadial artery access is a well-described technique that has proven to be safe and efficacious in percutaneous cardiac intervention. This technique has been used with increased frequency in the treatment of lower extremity peripheral arterial disease (LE-PAD); however, the overall safety has not yet been well described in the vascular surgery literature. We sought to evaluate the safety of this technique compared with retrograde femoral artery access and brachial artery access (BA) in the treatment of PAD. MethodsThe Vascular Quality Initiative database was used to identify all patients who underwent single site percutaneous access (retrograde femoral access [FA], BA, radial access [RA]) for treatment of LE-PAD from September 2016 through September 2019. Patients who underwent multiple access sites for intervention were excluded. Primary outcome was significant access site complications (ASCs), defined as those requiring treatment (blood transfusion, interventional treatment, or surgical treatment). Minor ASCs were also reported. ResultsThe cohort comprised 61,203 patients (270 RA, 1210 BA, and 59,723 FA) with an average age of 68 years and who were 59.6% male. The RA and BA groups had higher rates of prior endarterectomy or bypass compared with the FA group (66.7% RA; 86.0% BA; 50.2% FA; P < .001). RA was more often used for single-segment treatments (82% vs 74% [P < .020] and more aortoiliac arterial segments (59.6% vs 21.0% [P < .001]). ASC occurred in 1329 patients (2.7%), including minor ASC (996 [1.6%]) and significant ASC (333 [0.54%]). Significant ASC were less common after FA and RA compared with BA (RA, 1 [0.37%]; FA, 307 [0.51%]; BA, 25 [2.1%]; P < .001). On multivariate analysis, BA was the strongest predictor of significant ASC (odds ratio, 2.75; 95% confidence interval, 1.73-4.36; P < .001). Significant ASC was no different after RA compared with FA (odds ratio, 0.60; 95% confidence interval, 0.08-4.33; P = .616). Other factors independently associated with significant ASC were sex, age, diabetes, chronic obstructive pulmonary disease, dialysis, and closure device use. ConclusionsRA as the primary access vessel for endovascular treatment of LE-PAD is safe when compared with other traditional access sites. When FA is not possible or desirable, the radial approach may provide suitable access to treatment with a better safety profile than BA.

The prevalence of thyroid dysfunction and autoimmune thyroid disease in patients with rheumatoid arthritis

BackgroundRheumatoid arthritis (RA) is one of the most common chronic non-organ-specific autoimmune diseases; meanwhile, autoimmune thyroid disease (AITD) is the most common organ-specific autoimmune disease that can lead to hypo or hyperthyroidism. Although the etiology of both diseases is complex with a combination of genetic and environmental factors, there are overlaps in genes contributing to the pathogenesis of both diseases. Numerous studies found a correlation between thyroid abnormality and RA in different populations, yet some didn’t. This study is aimed to evaluate the prevalence of thyroid dysfunction, AITD, and anti-thyroid peroxidase (anti-TPO) positively in Iranian patients with RA.MethodsA total of 250 RA patients and 248 patients with non-inflammatory rheumatologic disease were included in this case–control study. All participants underwent complete clinical and laboratory assessments. Participants were also assessed for thyroid function testing, including anti-TPO antibodies.ResultsThyroid dysfunction was twice as common in RA patients as in controls (OR = 2.16; P-value > 0.001). Overt hypothyroidism was the most common thyroid dysfunction among RA patients (58 out of 84). Anti-TPO positivity was also significantly more common in RA compared with controls (OR = 2.65; P-value > 0.001). The proportion of controls and RA patients with AITD were 9 and 21.5%, respectively. AITD was found 2.8 times more common in RA group than controls (OR = 2.77; P-value > 0.001).ConclusionIt was demonstrated that RA was an independent factor associated with thyroid dysfunction and AITD.

Feasibility of repeated ipsilateral anatomical pulmonary resection.

This study aimed to elucidate the feasibility of repeated ipsilateral anatomical pulmonary resection. The subjects of this retrospective analysis were 50 patients who underwent ipsilateral anatomical pulmonary resection after major lung surgery. The patients were divided into two groups according to the type of primary operation performed: a repeated anatomical pulmonary resection group (RA group; n = 24) and an anatomical pulmonary resection after wedge resection group (AW group; n = 26). We compared the perioperative outcomes of the two groups. Completion lobectomy was performed in 9 of the 24 patients (38%) from the RA group and adhesion of the pulmonary hilum was more severe in this group (P = 0.004). Although the operative time was significantly longer in the RA group (P = 0.030), there was no significant difference in the amount of blood loss (P = 0.217) between the groups. A significantly higher rate of severe postoperative complications was observed in the RA group (42%) than in the AW group (12%) (P = 0.024). None of the patients who underwent repeated surgery died within 90days postoperatively. Although repeated anatomical pulmonary resection is a more challenging procedure than anatomical resection after wedge resection, it does not increase short-term mortality; therefore, it is a feasible treatment option.

Regulation of the autophagy plays an important role in acute kidney injury induced acute lung injury

Aim This study aimed to investigate the regulatory role of autophagy in acute kidney injury (AKI) induced acute lung injury (ALI). Methods The male Sprague–Dawley rats were divided into four groups: normal saline-treated sham rats (sham group), normal saline-treated ischemia-reperfusion injury rats (IRI group), 3-methyladenine-treated IRI rats (3-MA group), and rapamycin-treated IRI rats (RA group). The rats in the IRI rat model received the nephrectomy of the right kidney and was subjected to 60 mins of left renal pedicle occlusion, followed by 12, 24, 48, and 72 h of reperfusion. The levels of Scr, BUN, wet-to-dry ratio of lung, inflammatory cytokines, and oxidative stress were determined. The damage to tissues was detected by histological examinations. The western blot and immunohistochemistry methods were conducted to determine the expression of indicated proteins. Results Renal IRI could induce the pulmonary injury after AKI, which caused significant increases in the function index of pulmonary and renal, the levels of inflammatory cytokines, and biomarkers of oxidative stress. In comparison to the IRI group, the RA group showed significantly decreased P62 and Caspase-3 expression and increased LC-II/LC3-I, Beclin-1, Bcl-2, and unc-51-like autophagy activating kinase 1 expression. Meanwhile, by suppressing the inflammation and oxidative stress, as well as inhibiting the pathological lesions in kidney and lung tissues, the autophagy could effectively ameliorate IRI-induced AKI and ALI. Conclusions Autophagy plays an important role in AKI-induced ALI, which could be used as a new target for AKI therapy and reduce the mortality caused by the complication.

The change of plasma metabolic profile and gut microbiome dysbiosis in patients with rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory joint disease, which is associated with progressive disability, systemic complications, and early death. But its etiology and pathogenesis are not fully understood. We aimed to investigate the alterations in plasma metabolite profiles, gut bacteria, and fungi and their role of them in the pathogenesis of RA. Metabolomics profiling of plasma from 363 participants including RA (n = 244), systemic lupus erythematosus (SLE, n = 50), and healthy control (HC, n = 69) were performed using the ultra-high performance liquid chromatography-quadrupole time-of-flight mass spectrometry. The differentially expressed metabolites were selected among groups and used to explore important metabolic pathways. Gut microbial diversity analysis was performed by 16S rRNA sequencing and ITS sequencing (RA = 195, HC = 269), and the specific microbial floras were identified afterward. The diagnosis models were established based on significant differential metabolites and microbial floras, respectively. There were 63 differential metabolites discovered between RA and HC groups, mainly significantly enriched in the arginine and proline metabolism, glycine, serine, and threonine metabolism, and glycerophospholipid metabolism between RA and HC groups. The core differential metabolites included L-arginine, creatine, D-proline, ornithine, choline, betaine, L-threonine, LysoPC (18:0), phosphorylcholine, and glycerophosphocholine. The L-arginine and phosphorylcholine were increased in the RA group. The AUC of the predictive model was 0.992, based on the combination of the 10 differential metabolites. Compared with the SLE group, 23 metabolites increased and 61 metabolites decreased in the RA group. However, no significant metabolic pathways were enriched between RA and SLE groups. On the genus level, a total of 117 differential bacteria genera and 531 differential fungal genera were identified between RA and HC groups. The results indicated that three bacteria genera (Eubacterium_hallii_group, Escherichia-Shigella, Streptococcus) and two fungal genera (Candida and Debaryomyces) significantly increased in RA patients. The AUC was 0.80 based on a combination of six differential bacterial genera and the AUC was 0.812 based on a combination of seven differential fungal genera. Functional predictive analysis displayed that differential bacterial and differential fungus both were associated with KEGG pathways involving superpathway of L-serine and glycine biosynthesis I, arginine, ornithine, and proline interconversion. The plasma metabolism profile and gut microbe profile changed markedly in RA. The glycine, serine, and threonine metabolism and arginine and proline metabolism played an important role in RA.

Screening for depressive symptoms in patients with rheumatoid arthritis: relationship with pain severity, disease activity, and sleep quality

BackgroundRheumatoid arthritis (RA) is an autoimmune systemic condition that primarily affects all synovial joints, eventually leading to deformity and clinical disability. Much progress has been made in the evaluation of inflammation and disease activity in recent years; however, other factors that can influence these patients’ quality of life, including depression, stress, fatigue, sleep problems, fibromyalgia, sexual activity, and obesity, are often not evaluated by rheumatologists. Our purpose was to explore depressive symptoms in patients with RA and determine how they connected to other aspects of the disease, including pain severity, disease activity, and sleep quality.ResultsA cross-sectional study including 1200 patients with RA was performed. Paints with RA were classified into two groups based on the presence or absence of depressive symptoms using the Beck Depression Inventory-II (BDI-II). Group 1 included patients with both RA and depressive symptoms of varying severity; group 2 included patients with RA but without depressive symptoms. The patients underwent clinical evaluation and application of the Pittsburgh Sleep Quality Index (PSQI), Health Assessment Questionnaire for pain (HAQ-pain), and the Multidimensional Assessment of Fatigue scale (MAF). RA disease activity was evaluated using the DAS28 score. Depressive symptoms of varying severity were prevalent in 96% of our patients with RA, of whom 43.3% had minimal depression, while 13.7% had severe depression. The RA group with depression had a longer duration of disease, prolonged morning stiffness, and high disease activity measured by the DAS28 score than patients with only RA. In RA patients with concomitant depression, pain, sleep, and fatigue scores were also worse.ConclusionsThe presence of depression among patients with RA was associated with worse DAS28, HAQ, PASQI, and fatigue scores. Screening and recognition of such psychosocial disorders may help patients achieve optimal disease control and a good outcome.

A lipid metabolite lipidomics assay for prediction and severity evaluation of rotator cuff injury.

ObjectiveRotator cuff injury can be caused by local inflammation and fibrosis of musculotendinous cuff. Hypercholesterolemia can lead to physiological changes of rotator cuff that resemble rotator cuff injury. However, the relationship between lipid metabolism and rotator cuff injury and its potential pathological mechanism remain unclear. Herein, we aimed to investigate the correlation between the plasma lipidome, rotator cuff injury, and successive fatty infiltration pathology, and hoped to identify biomarkers for predicting higher risk or higher severity rotator cuff injury by assessing metabolic perturbations and dyslipidemia using lipidomics.MethodsWe quantitatively analyzed 60 lipids species of seven lipids classes and subclasses from 66 subjects using lipidomics. Subjects were divided into four groups: (1) normal rotator cuff with normal clinical routine serum lipid test results (NN group = 13); (2) normal rotator cuff with abnormal clinical routine serum lipid test results (NA group = 10); (3) rotator cuff tear with normal routine serum lipid test results (RN group = 30); (4) rotator cuff tear with abnormal routine serum lipid test results (RA group = 13). Independent-sample t-tests and Kruskal-Wallis tests were used to compare lipid metabolite levels in serum between different groups in patients with rotator cuff tears. The orthogonal partial least squares-discriminant analysis (OPLS-DA) model was used to verify the ability of five lysophosphatidylcholines (LPCs) to distinguish rotator cuff injuries. In the rotator cuff tear group, magnetic resonance imaging (MRI) was used to classify fatty infiltration according to Goutallier's classification. Kruskal-Wallis tests were used to analyze molecular differences between high-grade (grade 3–4) and low-grade (grade 0–2) fatty infiltration groups. Receiver operator characteristic (ROC) curves were drawn for each diagnostic method via different metabolites. The area under the curve (AUC), cutoff, specificity, sensitivity, and accuracy of each diagnostic criterion were calculated.ResultsOur results showed that some rotator cuff injury patients yielded unique lipidomic profiles. Based on Kruskal-Wallis tests, our results showed significant differences in three lipid molecules, 17:1 Lyso PI, 18:0–22:6 PE, and 18:3 (Cis) PC, among all four groups independent of clinical blood lipid levels. Also, independent of clinical blood lipid levels, two lipid molecules, 22:0 Lyso PC and 24:0 Lyso PC, were significantly different between the two groups based on Independent sample t-tests. Kruskal-Wallis test results showed that in the rotator cuff tear group, two metabolites (24:0 SM and 16:0 ceramide) differed between high-grade and low-grade fatty infiltration. The AUC values for 22:0 Lyso PC, 24:0 Lyso PC, 18:0–22:6 PE, 24:0 SM, and 16:0 ceramide were 0.6036, 0.6757, 0.6712, 0.8333, and 0.8981, respectively.ConclusionThe results provide insight into how the metabolic mechanisms associated with dyslipidemia impact rotator cuff diseases. Five lipid molecules, 17:1 Lyso PI, 18:0–22:6 PE, 18:3 (Cis) PC, 22:0 Lyso PC, and 24:0 Lyso PC, were closely related to rotator cuff tear based on two statistical analysis methods, independent of clinical routine serum lipid test results, which indicates that lipidomics assays are more sensitive than conventional lipid tests, and more suitable for studying rotator cuff lipid metabolism. In addition, two lipid metabolites, 24:0 SM and 16:0 ceramide, are potentially useful for predicting fatty infiltration severity. Further research with a larger number of samples is needed to verify whether these two metabolites can serve as potential markers of severe fatty infiltration. The findings illuminate how metabolic mechanisms associated with dyslipidemia affect rotator cuff disease.

Moderate sedation by total intravenous remimazolam-alfentanil vs. propofol-alfentanil for third molar extraction: A prospective randomized controlled trial.

BackgroundOral dental treatment cause anxiety, fear, and physical stress. This study aimed to investigate the efficacy and safety of moderate sedation by remimazolam with alfentanil vs. propofol with alfentanil in third molar extraction.MethodsThis single-center, randomized, single-blind clinical trial included 100 adults who underwent third molar ambulatory extraction. All patients had continuous infusion of Alfentanil 0.2 μg/kg/min. Group remimazolam with alfentanil (group RA) had an induction dose of 80 μg/kg and maintenance dosage of 5 μg/kg/min. In group propofol with alfentanil (PA group), propofol was infused at an initial concentration of 1.8 μg/mL under target controlled infusion (TCI) mode and a maintenance concentration of 1.5 μg/mL. The incidence rates of adverse effects were recorded and compared. Depth of sedation was assessed using the modified observer alertness/sedation assessment (MOAA/S) and entropy index. Recovery characteristics were recorded and complications observed for next 24 h.ResultsThe incident of adverse events 6 (12%) in the group RA was lower than the group PA 25 (50%) [Mean difference 0.136 (95%CI, 0.049–0.377); P < 0.05], with no serious adverse events during the sedation procedure. The incidence of injection pain in group RA was significantly lower than that in group PA [4 vs. 26%, mean difference 0.119 (95%CI, 0.025–0.558); P = 0.004]. Before starting local anesthesia, the mean arterial pressure, heart rate, and respiratory rate of the PA group were lower than those of the RA group. None of the patients required further treatments for a decreased heart rate, blood pressure, or low SpO2. The rate of moderate sedation success was 100% in both groups. The MOAA/S score was similar between the groups indicating that the depth of sedation was effective. Group RA had significantly shorter recovery and discharge times than those of group PA.ConclusionsRemimazolam with alfentanil is a safer and more effective alternative for ambulatory sedation and can reduce recovery and discharge time and the incidence of perioperative adverse events compare with propofol.Clinical trial registrationhttp://www.chictr.org.cn/index.aspx, identifier: ChiCTR2200058106.

Identification of SLAMF1 as an immune-related key gene associated with rheumatoid arthritis and verified in mice collagen-induced arthritis model.

BackgroundRheumatoid arthritis (RA) is the most common inflammatory arthropathy. Immune dysregulation was implicated in the pathogenesis of RA. Thus, the aim of the research was to determine the immune related biomarkers in RA.MethodsWe downloaded the gene expression data of RA in GSE89408 and GSE45291 from Gene Expression Omnibus public database (GEO). Differentially expressed genes (DEGs) were identified between RA and control groups. Infiltrating immune cells related genes were obtained by ssGSEA and weighted gene co-expression network analysis (WGCNA). We performed functional enrichment analysis of differentially expressed immunity-related genes (DEIRGs) by “clusterProfiler” R package, key genes screening by protein-protein interaction (PPI) network of DEIRGs. And mice collagen-induced arthritis (CIA) model was employed to verify these key genes.ResultsA total of 1,885 up-regulated and 1,899 down-regulated DEGs were identified in RA samples. The ssGSEA analysis showed that the infiltration of 25 cells was significantly different. 603 immune related genes were obtained by WGCNA, and 270 DEIRGs were obtained by taking the intersection of DEGs and immune related genes. Enrichment analyses indicated that DEIRGs were associated with immunity related biological processes. 4 candidate biomarkers (CCR7, KLRK1, TIGIT and SLAMF1) were identified from the PPI network of DEIRGs and literature research.In mice CIA model, the immunohistochemical stain showed SLAMF1 has a significantly high expression in diseased joints. And flow cytometry analysis shows the expression of SLAMF1 on CIA mice-derived CTL cells, Th, NK cells, NKT cells, classical dendritic cell (cDCs) and monocytes/macrophages was also significantly higher than corresponding immune cells from HC mice.ConclusionOur study identified SMLAF1 as a key biomarker in the development and progression of RA, which might provide new insight for exploring the pathogenesis of RA.

Can surgeons rely on growth-related changes to achieve lip height and width symmetry in unilateral complete cleft lip repair?

Surgeons face difficulties achieving simultaneous lip height and width symmetry while repairing unilateral complete cleft lip, so one is often sacrificed at the expense of the other. The aim of this study was to evaluate the effect of growth on lip height and width symmetry, to guide the surgeon to the best decision. The study patients (N = 105) were divided into two groups based on the treatment method: 42 were treated with the modified rotational advancement technique (MRA group) and 63 with the Millard rotation-advancement technique (RA group). Furthermore, based on lip height and width symmetry at 6 months postoperative, the patients were divided into three groups: 38 with symmetrical lip height and width (SL), 41 with horizontal lip width more symmetrical than lip height (RAW), and 26 with vertical lip height more symmetrical than lip width (RAH). Measurements were taken preoperatively (T0), 6 months (T1) and 5 years (T2) postoperatively. The MRA group had significantly more symmetrical lip height than the RA group at T1 (P = 0.003) and T2 (P = 0.002); however no statistically significant difference in lip width symmetry was observed between the two groups. In relation to the effects of growth, only lip width symmetry in the RAH group improved significantly between T1 and T2 (P = 0.023). In conclusion the improvement in lip width symmetry following 5 years of postoperative growth did not achieve the same symmetry as when lip width symmetry was achieved intraoperatively. Thus, the MRA technique could be used to obtain intraoperative symmetry of lip height and width.

Imbalance of Th17, Treg, and helper innate lymphoid cell in the peripheral blood of patients with rheumatoid arthritis

IntroductionRheumatoid arthritis (RA) is a chronic inflammatory disease involving a variety of immune cells, including adaptive T and B cells and innate lymphoid cells (ILCs). Understanding the pathogenic role of these immune cells in RA provides new insights into the intervention and treatment of RA.MethodsA total of 86 patients with RA (RA group) and 50 healthy controls (HC) were included in the study. The immune cells of CD4+, CD19+ B, NK, Th17, Treg, ILCs, and their subsets (i.e., ILC1s, ILC2s, and ILC3s) were characterized in peripheral blood mononuclear cells by flow cytometry. Cytokines (i.e., IFN-γ, IL-4, IL-10, IL-17A, IL-22, and IL-33) in sera were detected using ELISA. The above immune cells and cytokines were analyzed in patients with different disease activity status and positive ( +) or negative ( −) rheumatoid factor (RF)/anti-citrullinated protein antibodies (ACPA).ResultsPatients with RA had higher percentages of CD4+ T, CD19+ B, Th17, ILC2s, and ILC3s and lower percentages of Treg and ILC1s than HC. Patients with RA had elevated levels of IFN-γ, IL-4, IL-17A, and IL-22 and decreased level of IL-10. Compared with HC, patients with high disease activity had higher percentages of Th17, ILC2s, and ILC3s; lower percentages of ILC1s; and lower level of IL-10. The percentage of Treg cells in remission, low, moderate, and high disease activities decreased, whereas the level of IL-17A increased compared with HC. Furthermore, RF+ or ACPA+ patients exhibited elevated percentages of CD19+ B, ILC2s, and ILC3s and had decreased percentage of ILC1s and Treg cells than HC. The percentage of Th17 cells increased in RF−/ACPA− and RF+/ACPA+ patients. However, the above immune cells between RF or ACPA positive and negative patients were not significantly different.ConclusionTh17, Treg, and ILC subset dysregulations are present in patients with RA but may not be associated with conventionally defined seropositive RF and ACPA.Key Points• Th17, Treg, and ILC subset dysregulations are present in patients with RA but may reflect inflammation rather than specific diseases and stages.• No difference for the distribution of Th17, Treg, and ILC subsets between RF+and RF− patients and between ACPA+and ACPA− patients. The screening spectrum of RF and ACPA serology should be expanded to elucidate the role of immune cells in RA pathogenesis.

Effects of low-level laser therapy and therapeutic ultrasound on Freund's complete adjuvant-induced knee arthritis model in rats.

The aim of this study was to evaluate and monitor the effect of low-level laser therapy (LLLT) and therapeutic ultrasound (TU) alone, or combined with intra-articular prednisolone (P) in Freund's complete adjuvant (FCA)-induced knee arthritis model in rats. A total of 56 adult male Wistar rats were divided into seven groups: control (C), disease control (RA), P, TU, LLLT (L), P + TU (P+TU), P + LLLT (P+L) groups. The skin temperature, radiography, joint volume, serum rheumatoid factor (RF), interleukin (IL)-1β, serum tumor necrosis factor-alpha (TNF-α), and histopathological evaluation of joint were performed. Thermal imaging and radiographic examination provided results consistent with the severity of the disease. The mean joint temperature (°C) was the highest in the RA (36.2±1.6) group on Day 28. The P+TU and P+L groups significantly decreased radiological scores at the end of the study. The rat serum TNF-α, IL-1β, and RF levels in all groups were significantly higher compared to the C group (p<0.05). Compared to the RA group, serum TNF-α, IL-1β, and RF levels were significantly lower in the treatment groups (p<0.05). The P+TU and P+L group was showed minimal chondrocyte degeneration and cartilage erosion and mild cartilage fibrillation and mononuclear cell infiltration of synovial membrane compared to the P, TU, and L group. The LLLT and TU effectively reduced inflammation. In addition, a more effective result was obtained from the use of LLLT and TU combined with intra-articular P. This result may be due to insufficient dose of LLLT and TU, thus further studies should be focus on at higher dose ranges on FCA arthritis model in rats.