Interventions for postburn pruritus.

BACKGROUND: Postburn pruritus (itch) is a common and distressing symptom experienced on healing or healed burn or donor site wounds. Topical, systemic, and physical treatments are available to control postburn pruritus; however, it remains unclear how effective these are. OBJECTIVES: To assess the effects of interventions for treating postburn pruritus in any care setting. SEARCH METHODS: In September 2022, we searched the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE (including In-Process & Other Non-Indexed Citations), Ovid Embase, and EBSCO CINAHL Plus. We also searched clinical trials registries and scanned references of relevant publications to identify eligible trials. There were no restrictions with respect to language, publication date, or study setting. SELECTION CRITERIA: Randomised controlled trials (RCTs) that enrolled people with postburn pruritus to compare an intervention for postburn pruritus with any other intervention, placebo or sham intervention, or no intervention. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane. We used GRADE to assess the certainty of the evidence. MAIN RESULTS: We included 25 RCTs assessing 21 interventions with 1166 randomised participants. These 21 interventions can be grouped into six categories: neuromodulatory agents (such as doxepin, gabapentin, pregabalin, ondansetron), topical therapies (such as CQ-01 hydrogel, silicone gel, enalapril ointment, Provase moisturiser, beeswax and herbal oil cream), physical modalities (such as massage therapy, therapeutic touch, extracorporeal shock wave therapy, enhanced education about silicone gel sheeting), laser scar revision (pulsed dye laser, pulsed high-intensity laser, fractional CO2 laser), electrical stimulation (transcutaneous electrical nerve stimulation, transcranial direct current stimulation), and other therapies (cetirizine/cimetidine combination, lemon balm tea). Most RCTs were conducted at academic hospitals and were at a high risk of performance, attrition, and detection bias. While 24 out of 25 included studies reported change in burn-related pruritus, secondary outcomes such as cost-effectiveness, pain, patient perception, wound healing, and participant health-related quality of life were not reported or were reported incompletely. Neuromodulatory agents versus antihistamines or placebo There is low-certainty evidence that doxepin cream may reduce burn-related pruritus compared with oral antihistamine (mean difference (MD) -2.60 on a 0 to 10 visual analogue scale (VAS), 95% confidence interval (CI) -3.79 to -1.42; 2 studies, 49 participants). A change of 2 points represents a minimal clinically important difference (MCID). Due to very low-certainty evidence, it is uncertain whether doxepin cream impacts the incidence of somnolence as an adverse event compared to oral antihistamine (risk ratio (RR) 0.64, 95% CI 0.32 to 1.25; 1 study, 24 participants). No data were reported on pain in the included study. There is low-certainty evidence that gabapentin may reduce burn-related pruritus compared with cetirizine (MD -2.40 VAS, 95% CI -4.14 to -0.66; 1 study, 40 participants). A change of 2 points represents a MCID. There is low-certainty evidence that gabapentin reduces the incidence of somnolence compared to cetirizine (RR 0.02, 95% CI 0.00 to 0.38; 1 study, 40 participants). No data were reported on pain in the included study. There is low-certainty evidence that pregabalin may result in a reduction in burn-related pruritus intensity compared with cetirizine with pheniramine maleate (MD -0.80 VAS, 95% CI -1.24 to -0.36; 1 study, 40 participants). A change of 2 points represents a MCID. There is low-certainty evidence that pregabalin reduces the incidence of somnolence compared to cetirizine (RR 0.04, 95% CI 0.00 to 0.69; 1 study, 40 participants). No data were reported on pain in the included study. There is moderate-certainty evidence that ondansetron probably results in a reduction in burn-related pruritus intensity compared with diphenhydramine (MD -0.76 on a 0 to 10 numeric analogue scale (NAS), 95% CI -1.50 to -0.02; 1 study, 38 participants). A change of 2 points represents a MCID. No data were reported on pain and adverse events in the included study. Topical therapies versus relevant comparators There is moderate-certainty evidence that enalapril ointment probably decreases mean burn-related pruritus compared with placebo control (MD -0.70 on a 0 to 4 scoring table for itching, 95% CI -1.04 to -0.36; 1 study, 60 participants). No data were reported on pain and adverse events in the included study. Physical modalities versus relevant comparators Compared with standard care, there is low-certainty evidence that massage may reduce burn-related pruritus (standardised mean difference (SMD) -0.86, 95% CI -1.45 to -0.27; 2 studies, 166 participants) and pain (SMD -1.32, 95% CI -1.66 to -0.98). These SMDs equate to a 4.60-point reduction in pruritus and a 3.74-point reduction in pain on a 10-point VAS. A change of 2 VAS points in itch represents a MCID. No data were reported on adverse events in the included studies. There is low-certainty evidence that extracorporeal shock wave therapy (ESWT) may reduce burn-related pruritus compared with sham stimulation (SMD -1.20, 95% CI -1.65 to -0.75; 2 studies, 91 participants). This equates to a 5.93-point reduction in pruritus on a 22-point 12-item Pruritus Severity Scale. There is low-certainty evidence that ESWT may reduce pain compared with sham stimulation (MD 2.96 on a 0 to 25 pressure pain threshold (PPT), 95% CI 1.76 to 4.16; 1 study, 45 participants). No data were reported on adverse events in the included studies. Laser scar revision versus untreated or placebo controls There is moderate-certainty evidence that pulsed high-intensity laser probably results in a reduction in burn-related pruritus intensity compared with placebo laser (MD -0.51 on a 0 to 1 Itch Severity Scale (ISS), 95% CI -0.64 to -0.38; 1 study, 49 participants). There is moderate-certainty evidence that pulsed high-intensity laser probably reduces pain compared with placebo laser (MD -3.23 VAS, 95% CI -5.41 to -1.05; 1 study, 49 participants). No data were reported on adverse events in the included studies. AUTHORS' CONCLUSIONS: There is moderate to low-certainty evidence on the effects of 21 interventions. Most studies were small and at a high risk of bias related to blinding and incomplete outcome data. Where there is moderate-certainty evidence, practitioners should consider the applicability of the evidence for their patients.

Retrospective evaluation of radiological and clinical outcomes after surgical treatment of proximal femoral fractures utilizing PFNA and PFNA augmented.

INTRODUCTION: The primary aim of this study was to evaluate the clinical and radiological outcomes after surgical treatment of proximal femoral fractures utilizing the Proximal Femoral Nail Antirotation (PFNA), with the main focus on complications and reoperations. The secondary aim was to compare the outcomes of patients with and without cement augmentation of the cephalomedullary nails. MATERIALS AND METHODS: All patients with an acute proximal femoral fracture consequently treated with a PFNA between January 2011 and Dezember  2018 were evaluated. Clinical and radiological data were assessed for intra- and postoperative complications, including treatment failure. In addition, intra- and postoperative radiographs were used to determine the position of the implant, and any migration, via Tip-Apex-Distance (TAD) and the caput-collum-diaphyseal angle (CCD). The accuracy of the fracture reduction was rated according to Baumgaertners criteria. RESULTS: Two hundred sixty-four consecutive patients (mean age 78.8 ± 12.0; 73.1% female) were included. The predominant OTA/AO fracture classification was 31A1 (153 cases, 58.0%). The average duration of surgery was 63.1 ± 28.0 min and showed no significant differences between PFNA and PFNA with augmentation. The implant positioning was rated as good in 222 cases (84.1%). Two hundred sixty-three patients (99.6%) showed evidence of healing within the time frame of three months postoperatively, one case of delayed union healed after secondary dynamization. During the observational period, 18 patients (6.8%) required a total of 23 additional surgeries. Overall, a lower reoperation rate was observed following the use of the augmentation option (2/86 patients (2.3%) vs. 16/178 patients (9.0%), p = 0.04). In particular, there were no cases of cut-out or cut-through among patients who underwent augmentation as part of osteosynthesis. CONCLUSIONS: Overall reoperation rate after surgical treatment of proximal femoral fractures utilizing the Proximal Femoral Nail Antirotation (PFNA) was 6.8%, with 23 additional surgeries performed in 18 patients. The usage of the PFNA with augmentation showed equally good implant positioning, excellent healing rates and fewer postoperative complications compared to the PFNA implant alone with a similar overall duration of surgery.

Enhancing Bone Infection Diagnosis with Raman Handheld Spectroscopy: Pathogen Discrimination and Diagnostic Potential.

Osteomyelitis is a bone disease caused by bacteria that can damage bone. Raman handheld spectroscopy has emerged as a promising diagnostic tool for detecting bone infection and can be used intraoperatively during surgical procedures. This study involved 120 bone samples from 40 patients, with 80 samples infected with either Staphylococcus aureus or Staphylococcus epidermidis. Raman handheld spectroscopy demonstrated successful differentiation between healthy and infected bone samples and between the two types of bacterial pathogens. Raman handheld spectroscopy appears to be a promising diagnostic tool in bone infection and holds the potential to overcome many of the shortcomings of traditional diagnostic procedures. Further research, however, is required to confirm its diagnostic capabilities and consider other factors, such as the limit of pathogen detection and optimal calibration standards.

Glucosinolate Hydrolytic Products-A Multi-Arm Warrior.

BACKGROUND: Glucosinolates are the most controversial yet ignored class of phytochemicals. These are the middleman phytochemicals which have low bioactivity. But once there is any injury in the plant-manmade, insect caused, or natural-a magic happens. The compound is broken down into smaller phytochemicals referred to as glucosinolate hydrolytic products (nitriles, isothiocyanates, and thiocyanates). These hydrolytic products are like show stopper of fashion industry. These compounds have one of the highest bioactivity in the nature. These have been associated with a varied range of bioactivities (anticancer, antioxidant, insecticidal, weedicide, etc) by researchers across the globe. OBJECTIVE: The objective of the current article is to provide a critical review to highlight some of the important bioactivities of these ignored compounds and for promoting researchers to atleast give these compounds a chance-to glow in the dark. METHODS: This review has been written from analysis of accessible literature mostly from the last 5 years (2018-2023), with some critically essential exceptions. RESULTS: The review highlighted brief background of glucosinolates and its hydrolysis. Effort were made to include most of the biological properties of the compound. Special emphasis has been given to the anticancer activities of the compound with details of involved mechanism. CONCLUSION: Considering the wide array of bioactivities of glucosinolate hydrolytic products, it is essential to consider it as a prospective medicinal compound. More glucosinolate hydrolytic products-in similar manner as sulforaphane-can be proceeded to phase trials. HIGHLIGHTS: The mechanistic pathway for production of glucosinolate hydrolytic products and related biological activities have been discussed in details. The bioactivities have been further explained using the involved mechanism.

Glucosinolates and Their Hydrolytic Products-A Love Story of Environmental, Biological and Chemical Conditions.

BACKGROUND: Glucosinolates play important role in providing defense to plants and helps them in coping against various biotic as well as abiotic stress. Many living beings including humans, animals, and even some herbivores have adapted themselves to use this defense mechanism for their own use. More than 120 glucosinolates are distributed within a large number of plants. Many factors are known to influence the GSL composition in a plant. Among these, cofactors, myrosinase isozymes, heavy metals and the environmental conditions such as light, CO2 and temperature are important in the regulation. These factors ensure that different glucosinolate composition could be produced by the plants, thus impacting the defense mechanism. OBJECTIVE: The objective of the current review is to highlight the importance of factors responsible for affecting glucosinolate composition and concentration. METHODS: The review has been compiled using accessible literature from Pubmed, Scopus, and Google scholar. Efforts have been made to restrict the literature to the last 5 years (2018-2023), with some exceptions. RESULTS: The current critical review acts as a resource for all the researchers working on this essential compound. It provides information on the factors that may influence the glucosinolate production. It also gives them an opportunity to modify the glucosinolate composition of a plant using the given information. CONCLUSION: Glucosinolates have long been an ignored class of biomolecule. The plethora of biological activities of the compounds can be useful. Though there are some harmful components such as goitrin and progoitrin, these can be easily removed by modulating some of the factors highlighted in the review. HIGHLIGHTS: The current review has touched base on almost all the factors that have the ability to modify glucosinolate composition and concentration. The mechanistic action of these factors have also been discussed using the current available literature.

[Basic principles of surgical treatment of distal radius fractures]. / Grundprinzipien der operativen Versorgung der distalen Radiusfraktur.

Distal radius fractures are one of the most frequent fractures of the upper extremities. The decision for conservative or surgical treatment is made after appropriate diagnostics using conventional radiographic and usually computed tomography imaging examinations. If the indications for surgical treatment are present, various options for reduction and fixation are available. The spectrum ranges from closed to open procedures up to accompanying arthroscopic support. Appropriate preoperative patient education about the procedure and the planned postinterventional treatment is essential. The goal of treatment is to restore wrist function while maintaining mobility and strength with a low risk of complications. All surgical procedures share the principle of reduction to restore anatomical relationship followed by fixation. Closed procedures include fixation with Kirschner wires and the construction of an external fixator. Volar locking plate osteosynthesis has become established in recent years as the method of choice for the majority of the fractures to be treated. For special fracture patterns and the treatment of accompanying injuries, arthroscopic support can be indicated. There is no uniform consensus on the best choice of procedure. This article discusses the possible procedures including the approaches, fixation techniques and specific follow-up treatment.

Long-Term Comparison of Two- and Three-Dimensional Computed Tomography Analyses of Cranial Bone Defects in Severe Parietal Thinning.

Parietal thinning was detected in a 72-year-old with recurrent headaches. Quantification of bone loss was performed applying two- and three-dimensional methods using computerized tomographies. Two-dimensional methods provided accurate measurements using single-line analyses of bone thicknesses (2.13 to 1.65 and 1.86 mm on the left and 4.44 to 3.08 and 4.20 mm on the right side), single-point analyses of bone intensities (693 to 375 and 403 on the left and 513 to 393 and 411 Houndsfield Units on the right side) and particle-size analyses of low density areas (16 to 22 and 12 on the left and 18 to 23 and 14 on the right side). Deteriorations between days 0 and 220 followed by bone stability on day 275 were paralleled using the changed volumes of bone defects to 1200 and finally 1133 mm3 on the left side and to 331 and finally 331 mm3 on the right side. Interfolding as measurement of the bones' shape provided changes to -1.23 and -1.72 mm on the left and to -1.42 and -1.30 mm on the right side. These techniques suggest a stabilizing effect of corticosteroids between days 220 and 275. Reconstruction of computerized tomographies appears justified to allow for quantification of bone loss during long-term follow-up.

Deep Convolutional Neural Networks Provide Motion Grading for High-Resolution Peripheral Quantitative Computed Tomography of the Scaphoid.

In vivo high-resolution peripheral quantitative computed tomography (HR-pQCT) studies on bone characteristics are limited, partly due to the lack of standardized and objective techniques to describe motion artifacts responsible for lower-quality images. This study investigates the ability of such deep-learning techniques to assess image quality in HR-pQCT datasets of human scaphoids. In total, 1451 stacks of 482 scaphoid images from 53 patients, each with up to six follow-ups within one year, and each with one non-displaced fractured and one contralateral intact scaphoid, were independently graded by three observers using a visual grading scale for motion artifacts. A 3D-CNN was used to assess image quality. The accuracy of the 3D-CNN to assess the image quality compared to the mean results of three skilled operators was between 92% and 96%. The 3D-CNN classifier reached an ROC-AUC score of 0.94. The average assessment time for one scaphoid was 2.5 s. This study demonstrates that a deep-learning approach for rating radiological image quality provides objective assessments of motion grading for the scaphoid with a high accuracy and a short assessment time. In the future, such a 3D-CNN approach can be used as a resource-saving and cost-effective tool to classify the image quality of HR-pQCT datasets in a reliable, reproducible and objective way.

Handheld hyperspectral imaging as a tool for the post-mortem interval estimation of human skeletal remains.

In forensic medicine, estimating human skeletal remains' post-mortem interval (PMI) can be challenging. Following death, bones undergo a series of chemical and physical transformations due to their interactions with the surrounding environment. Post-mortem changes have been assessed using various methods, but estimating the PMI of skeletal remains could still be improved. We propose a new methodology with handheld hyperspectral imaging (HSI) system based on the first results from 104 human skeletal remains with PMIs ranging between 1 day and 2000 years. To differentiate between forensic and archaeological bone material, the Convolutional Neural Network analyzed 65.000 distinct diagnostic spectra: the classification accuracy was 0.58, 0.62, 0.73, 0.81, and 0.98 for PMIs of 0 week-2 weeks, 2 weeks-6 months, 6 months-1 year, 1 year-10 years, and >100 years, respectively. In conclusion, HSI can be used in forensic medicine to distinguish bone materials >100 years old from those <10 years old with an accuracy of 98%. The model has adequate predictive performance, and handheld HSI could serve as a novel approach to objectively and accurately determine the PMI of human skeletal remains.

Injury Incidence, Outcomes, and Return to Competition Times after Sports-Related Concussions during One Professional Ice Hockey Season: A Prospective Cohort Study.

OBJECTIVE: The objective of this study was to analyze the incidence and characteristics of sports-related concussions (SRCs) for a professional ice hockey team during one regular season in the International Central European Hockey League. BACKGROUND: Repeated concussions are a common cause of long periods of absence in team contact sports, with a wide range of potential short- and long-term consequences for the affected athlete. Questions mainly regarding early diagnosis and ideal follow-up treatment remain unanswered, especially regarding the timing of return to sports (RTS). METHOD: A prospective data analysis for a professional ice hockey team during a regular season was conducted. Firstly, concussions per 1000 athlete exposure (AE) and average time loss due to SRC were calculated. Secondly, the data from ImPACT Applications were analyzed for those players who were diagnosed with an SRC. RESULTS: Five SRCs were evaluated during the regular season, which resulted in 1.35 concussions/1000 AEs, a maximum of 17 missed games, and a median of three games per SRC. The average symptom count was 9.6, with the most common symptoms being headache, sensitivity to light, and dizziness. CONCLUSIONS: SRCs sustained in professional ice hockey are a common in-competition injury, while practices play a subsidiary role. The duration of RTS is highly individual and can be associated with symptoms lasting days to months.

Scaling Monte-Carlo-Based Inference on Antibody and TCR Repertoires.

Previously, it has been shown that maximum-entropy models of immune-repertoire sequence can be used to determine a person's vaccination status. However, this approach has the drawback of requiring a computationally intensive method to compute each model's partition function (Z), the normalization constant required for calculating the probability that the model will generate a given sequence. Specifically, the method required generating approximately 1010 sequences via Monte-Carlo simulations for each model. This is impractical for large numbers of models. Here we propose an alternative method that requires estimating Z this way for only a few models: it then uses these expensive estimates to estimate Z more efficiently for the remaining models. We demonstrate that this new method enables the generation of accurate estimates for 27 models using only three expensive estimates, thereby reducing the computational cost by an order of magnitude. Importantly, this gain in efficiency is achieved with only minimal impact on classification accuracy. Thus, this new method enables larger-scale investigations in computational immunology and represents a useful contribution to energy-based modeling more generally.

greylock: A Python Package for Measuring The Composition of Complex Datasets.

Machine-learning datasets are typically characterized by measuring their size and class balance. However, there exists a richer and potentially more useful set of measures, termed diversity measures, that incorporate elements' frequencies and between-element similarities. Although these have been available in the R and Julia programming languages for other applications, they have not been as readily available in Python, which is widely used for machine learning, and are not easily applied to machine-learning-sized datasets without special coding considerations. To address these issues, we developed greylock, a Python package that calculates diversity measures and is tailored to large datasets. greylock can calculate any of the frequency-sensitive measures of Hill's D-number framework, and going beyond Hill, their similarity-sensitive counterparts (Greylock is a mountain). greylock also outputs measures that compare datasets (beta diversities). We first briefly review the D-number framework, illustrating how it incorporates elements' frequencies and between-element similarities. We then describe greylock's key features and usage. We end with several examples - immunomics, metagenomics, computational pathology, and medical imaging - illustrating greylock's applicability across a range of dataset types and fields.

Polyphenols From Cutch Tree ( Acacia catechu Willd.): Normalize In Vitro Oxidative Stress and Exerts Antiproliferative Activity

ABSTRACT Oxidative stress, being the main cause of most of the human diseases, has always been the highlight of research worldwide. This stress can be overcome by administration of natural polyphenols. The Acacia catechu Willd. has many refrences available in Ayurveda as important disease curative plant. Its leaves are investigated for ameliorating oxidative stress in present work. Leaves of A. catechu were extracted with 80% methanol to get methanol extract (AME). It was assessed for antioxidant activity using DPPH, ABTS, CUPRAC, ferric ion reducing, superoxide scavenging and peroxyl radical scavenging assays. DNA protective activity was also investigated using plasmid nicking assay. Further, antiproliferative activity was determined using MTT assay in various human cancer cell lines. The quantification of polyphenols was done by UHPLC analysis. Results confirmed that polyphenols of A. catechu were successful in normalizing oxidative stress. AME was found to be most effective in scavenging ABTS radicals while least effective in scavenging ferric ions. UHPLC analysis showed abundance of ellagic acid, rutin and quercetin in AME. Further, AME showed maximum antiproliferative activity against Hep G2 cancer cells. It is concluded that the polyphenols from A. catechu effectively remediates oxidative stress and hence can be used in curing numerous dreadful diseases.

Polyphenols From Cutch Tree (Acacia catechu Willd.): Normalize In Vitro Oxidative Stress and Exerts Antiproliferative Activity

ABSTRACT Oxidative stress, being the main cause of most of the human diseases, has always been the highlight of research worldwide. This stress can be overcome by administration of natural polyphenols. The Acacia catechu Willd. has many refrences available in Ayurveda as important disease curative plant. Its leaves are investigated for ameliorating oxidative stress in present work. Leaves of A. catechu were extracted with 80% methanol to get methanol extract (AME). It was assessed for antioxidant activity using DPPH, ABTS, CUPRAC, ferric ion reducing, superoxide scavenging and peroxyl radical scavenging assays. DNA protective activity was also investigated using plasmid nicking assay. Further, antiproliferative activity was determined using MTT assay in various human cancer cell lines. The quantification of polyphenols was done by UHPLC analysis. Results confirmed that polyphenols of A. catechu were successful in normalizing oxidative stress. AME was found to be most effective in scavenging ABTS radicals while least effective in scavenging ferric ions. UHPLC analysis showed abundance of ellagic acid, rutin and quercetin in AME. Further, AME showed maximum antiproliferative activity against Hep G2 cancer cells. It is concluded that the polyphenols from A. catechu effectively remediates oxidative stress and hence can be used in curing numerous dreadful diseases.