Contemporary outcomes of traumatic popliteal artery injury repair from the popliteal scoring assessment for vascular extremity injury in trauma study.

OBJECTIVE: Traumatic popliteal artery injuries are associated with the greatest risk of limb loss of all peripheral vascular injuries, with amputation rates of 10% to 15%. The purpose of the present study was to examine the outcomes of patients who had undergone operative repair for traumatic popliteal arterial injuries and identify the factors independently associated with limb loss. METHODS: A multi-institutional retrospective review of all patients with traumatic popliteal artery injuries from 2007 to 2018 was performed. All the patients who had undergone operative repair of popliteal arterial injuries were included in the present analysis. The patients who had required a major lower extremity amputation (transtibial or transfemoral) were compared with those with successful limb salvage at the last follow-up. The significant predictors (P < .05) for amputation on univariate analysis were included in a multivariable analysis. RESULTS: A total of 302 patients from 11 institutions were included in the present analysis. The median age was 32 years (interquartile range, 21-40 years), and 79% were men. The median follow-up was 72 days (interquartile range, 20-366 days). The overall major amputation rate was 13%. Primary repair had been performed in 17% of patients, patch repair in 2%, and interposition or bypass in 81%. One patient had undergone endovascular repair with stenting. The overall 1-year primary patency was 89%. Of the patients who had lost primary patency, 46% ultimately required major amputation. Early loss (within 30 days postoperatively) of primary patency was five times more frequent for the patients who had subsequently required amputation. On multivariate regression, the significant perioperative factors independently associated with major amputation included the initial POPSAVEIT (popliteal scoring assessment for vascular extremity injury in trauma) score, loss of primary patency, absence of detectable immediate postoperative pedal Doppler signals, and lack of postoperative antiplatelet therapy. Concomitant popliteal vein injury, popliteal injury location (P1, P2, P3), injury severity score, and tibial vs popliteal distal bypass target were not independently associated with amputation. CONCLUSIONS: Traumatic popliteal artery injuries are associated with a significant rate of major amputation. The preoperative POPSAVEIT score remained independently associated with amputation after including the perioperative factors. The lack of postoperative pedal Doppler signals and loss of primary patency were highly associated with major amputation. The use of postoperative antiplatelet therapy was inversely associated with amputation, perhaps indicating a protective effect.

Popliteal scoring assessment for vascular extremity injuries in trauma study.

OBJECTIVE: Traumatic popliteal vascular injuries are associated with the highest risk of limb loss of all peripheral vascular injuries. A method to evaluate the predictors of amputation is needed because previous scores could not be validated. In the present study, we aimed to provide a simplified scoring system (POPSAVEIT [popliteal scoring assessment for vascular extremity injuries in trauma]) that could be used preoperatively to risk stratify patients with traumatic popliteal vascular injuries for amputation. METHODS: A review of patients sustaining traumatic popliteal artery injuries was performed. Patients requiring amputation were compared with those with limb salvage at the last follow-up. Of these patients, 80% were randomly assigned to a training group for score generation and 20% to a testing group for validation. Significant predictors of amputation (P < .1) on univariate analysis were included in a multivariable analysis. Those with P < .05 on multivariable analysis were assigned points according to the relative value of their odds ratios (ORs). Receiver operating characteristic curves were generated to determine low- vs high-risk scores. An area under the curve of >0.65 was considered adequate for validation. RESULTS: A total of 355 patients were included, with an overall amputation rate of 16%. On multivariate regression analysis, the risk factors independently associated with amputation in the final model were as follows: systolic blood pressure <90 mm Hg (OR, 3.2; P = .027; 1 point), associated orthopedic injury (OR, 4.9; P = .014; 2 points), and a lack of preoperative pedal Doppler signals (OR, 5.5; P = .002; 2 points [or 1 point for a lack of palpable pedal pulses if Doppler signal data were unavailable]). A score of ≥3 was found to maximize the sensitivity (85%) and specificity (49%) for a high risk of amputation. The receiver operating characteristic curve for the validation group had an area under the curve of 0.750, meeting the threshold for score validation. CONCLUSIONS: The POPSAVEIT score provides a simple and practical method to effectively stratify patients preoperatively into low- and high-risk major amputation categories.

A comparison of electronically-delivered and face to face cognitive behavioural therapies in depressive disorders: A systematic review and meta-analysis.

BACKGROUND: Cognitive behavioural therapy (CBT) is a widely used treatment for depression. However, limited resource availability poses several barriers to patients seeking access to care, including lengthy wait times and geographical limitations. This has prompted health care services to introduce electronically delivered CBT (eCBT) to facilitate access. Although previous reviews have compared the effects of eCBT to face-to-face CBT, there is an overall lack of adequately powered and up-to-date evidence in the literature to provide a reliable comparison between the two modes of administration. The purpose of this study is to evaluate the effects of eCBT compared to face-to-face CBT through a systematic review of the literature. METHODS: To be eligible for this review, studies needed to be randomized controlled trials evaluating the clinical effectiveness of any form of eCBT compared to face-to-face CBT. These encompassed studies evaluating a wide range of outcomes including severity of symptoms, adverse outcomes, clinically relevant outcomes, global functionality, participant satisfaction, quality of life, and affordability. There were no restrictions on participant age or sex.We searched MEDLINE, EMBASE, Psych Info, Cochrane CENTRAL and CINAHL databases from inception to February 20th, 2020 using a comprehensive search strategy. All stages of literature screening and data extraction were completed independently in duplicate. Data extraction and risk of bias analyses, including GRADE ratings, were conducted on studies meeting inclusion criteria. Qualitative measures are reported in a narrative summary. We pooled quantitative data in meta-analyses to provide an estimated summary effect. This review adheres to PRISMA reporting guidelines. FINDINGS: In total, we included 17 studies in our analyses. Our results demonstrated that eCBT was more effective than face-to-face CBT at reducing depression symptom severity (Standardized mean difference [SMD]: -1.73; 95% confidence interval [CI]: -2.72, -0.74; GRADE: moderate quality of evidence). There were no significant differences between the two interventions on participant satisfaction (SMD 0.13 95%; CI -0.32, 0.59; GRADE: low quality of evidence). One RCT reported eCBT to be less costly than face-to-face CBT (GRADE: low quality of evidence). Results did not differ when stratified by subgroups such as participant age and study location. INTERPRETATION: Although we found eCBT to have moderate evidence of effectiveness in reducing symptoms of depression, high heterogeneity among studies precludes definitive conclusions for all outcomes. With the current reliance and accessibility of technology to increasing number of people worldwide, serious consideration in utilizing technology should be given to maximize accessibility for depression treatments. Our results found eCBT is at least as effective as face to face CBT, thus eCBT should be offered if preferred by patients and therapists. FUNDING: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Chinese olive extract ameliorates hepatic lipid accumulation in vitro and in vivo by regulating lipid metabolism.

Chinese olive contains plenty of polyphenols, which possess a wide range of biological actions. In this study, we aimed to investigate the role of the ethyl acetate fraction of Chinese olive fruit extract (CO-EtOAc) in the modulation of lipid accumulation in vitro and in vivo. In cellular studies, CO-EtOAc attenuated oleic acid-induced lipid accumulation; we then elucidated the molecular mechanisms of CO-EtOAc in FL83B mouse hepatocytes. CO-EtOAc suppressed the mRNA levels of fatty acid transporter genes (CD36 and FABP) and lipogenesis genes (SREBP-1c, FAS, and ACC1), but upregulated genes that govern lipolysis (HSL) and lipid oxidation (PPARα, CPT-1, and ACOX). Moreover, CO-EtOAc increased the protein expression of phosphorylated AMPK, ACC1, CPT-1, and PPARα, but downregulated the expression of mature SREBP-1c and FAS. AMPK plays an essential role in CO-EtOAc-mediated amelioration of lipid accumulation. Furthermore, we confirmed that CO-EtOAc significantly inhibited body weight gain, epididymal adipose tissue weight, and hepatic lipid accumulation via regulation of the expression of fatty acid transporter, lipogenesis, and fatty acid oxidation genes and proteins in C57BL/6 mice fed a 60% high-fat diet. Therefore, Chinese olive fruits may have the potential to improve the metabolic abnormalities associated with fatty liver under high fat challenge.

Sleep quality of middle-aged Tai Chi practitioners.

AIM: This study aimed to assess the association between Tai Chi and sleep quality in middle-aged Tai Chi practitioners. METHODS: This cross-sectional descriptive study recruited a convenience sample of 250 middle-aged Tai Chi practitioners. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). Descriptive statistics such as frequency and percentage were used to describe the demographic characteristics of the subjects. Pearson's product-moment correlation was used to determine the relationship between sleep quality and duration of practicing Tai Chi. anova was used to compare difference in sleep quality among subjects practicing different styles of Tai Chi. Linear regression was conducted to determine the contribution of duration of practicing Tai Chi and the style of Tai Chi being practiced to explaining sleep quality. RESULTS: Subjects had practiced Tai Chi for 4.7 years. They reported a global PSQI score of 5.3. Among the subjects, 156 were classified as good sleepers (PSQI score, <5). No significant relationship was reported between sleep quality and duration of Tai Chi practice (P = 0.175). No significant differences in sleep quality were found among subjects who practiced different styles of Tai Chi (P = 0.876). Linear regression analysis indicated that the duration of practicing Tai Chi and the style of Tai Chi being practiced did not make a significant contribution to sleep quality. CONCLUSION: The present study represented an initial attempt to investigate the sleep quality among middle-aged Tai Chi practitioners. It serves to generate hypotheses for future testing.

Comparison of the early haemodynamics of stented pericardial and porcine aortic valves.

Data comparing the haemodynamic performance of stented pericardial and porcine aortic valves are conflicting. Hence, we performed a systematic review and meta-analysis comparing the early haemodynamic parameters of stented pericardial and porcine valves in patients undergoing isolated aortic valve replacement. Medline, EMBASE and Web of Science were queried for English language original publications from 2000 to 2013. Studies comparing porcine (PoV) and pericardial (PeV) with regard to their haemodynamic parameters were included in this review. Continuous data were pooled using the mean difference (MD) or the standardized mean difference (SMD). A random-effect inverse weighted analysis was conducted; a P-value<0.05 is considered statistically significant. Results are presented with 95% confidence intervals. Thirteen studies (1265 PeV patients and 871 PoV patients) were included in this analysis. The pooled transvalvular mean gradient was lower for PeV [MD -4.6 (-6.45 to -2.77) mmHg; P<0.01]. Limiting this analysis to small valves (19 and 21 mm; eight studies; 714 patients) revealed that the PeV gradients were significantly lower [MD -4.5 (-5.7 to -3.2); P=0.001]. The corresponding effective orifice area of PeV was significantly larger than PoV [SMD 0.42 (0.15-0.69); P<0.01]. A sensitivity analysis comprising only randomized controlled trials did not significantly alter results. When compared with porcine valves, stented pericardial aortic valves have lower mean transvalvular gradients early after implant. Even pericardial valves in smaller sizes (19 and 21 mm) have a better haemodynamic profile when compared with their counterparts.

Residual periodontal pockets are a risk indicator for peri-implantitis in patients treated for periodontitis.

OBJECTIVES: The aim of this retrospective study was to compare the clinical outcomes of implant treatment in periodontally compromised and periodontally healthy patients (PHP), with a minimum follow-up period of 5 years. METHODS: Thirty treated periodontally compromised patients (PCP) and 30 PHP, with a total of 117 Straumann implants (PCP = 56, PHP = 61) were matched for age, gender, smoking and implant characteristics. The PCP group was further stratified with patients having at least one periodontal pocket ≥6 mm at follow-up examination allocated to a "residual periodontitis" (RP) group, while the remaining patients were assigned to a "no residual periodontitis" (NRP) group. These groups were compared with respect to probing pocket depth (PPD), bleeding on probing (BOP) and marginal bone loss. RESULTS: The mean follow-up period in the PCP and PHP groups was 7.99 years (range 5.04-14.40) and 8.20 years (range 5.00-13.46) respectively. There was no difference in mean PPD between the PCP and PHP groups, but the prevalence of implants with PPD ≥5 mm + BOP was greater in the PCP group than in the PHP group, at both implant- (27% vs. 13%) and patient- (37% vs. 17%) level analyses. Mean implant PPD was significantly greater in the RP group (3.18 mm) than in both the NRP (2.67 mm) and PHP (2.81 mm) groups. Mean bone loss was also significantly greater in the RP group (0.68 mm) than in the NRP (0.23 mm) and PHP groups (0.26 mm). The prevalence of bone loss and PPD ≥5 mm + BOP at the implant level was significantly greater for the RP group compared with both the NRP and PHP groups. CONCLUSIONS: Implants in PCP with residual pocketing at follow-up had increased PPD and bone loss compared with implants placed in PHP and PCP without residual pocketing. Hence, it is the maintenance of periodontal health rather than a previous history of periodontitis that is the critical determinant of increased risk of peri-implantitis, highlighting the importance of effective periodontal therapy and maintenance in patients with a history of periodontitis.

CpG-containing immunostimulatory DNA sequences elicit TNF-alpha-dependent toxicity in rodents but not in humans.

CpG-containing immunostimulatory DNA sequences (ISS), which signal through TLR9, are being developed as a therapy for allergic indications and have proven to be safe and well tolerated in humans when administrated via the pulmonary route. In contrast, ISS inhalation has unexplained toxicity in rodents, which express TLR9 in monocyte/macrophage lineage cells as well as in plasmacytoid DCs (pDCs) and B cells, the principal TLR9-expressing cells in humans. We therefore investigated the mechanisms underlying this rodent-specific toxicity and its implications for humans. Mice responded to intranasally administered 1018 ISS, a representative B class ISS, with strictly TLR9-dependent toxicity, including lung inflammation and weight loss, that was fully reversible and pDC and B cell independent. Knockout mouse experiments demonstrated that ISS-induced toxicity was critically dependent on TNF-alpha, with IFN-alpha required for TNF-alpha induction. In contrast, human PBMCs, human alveolar macrophages, and airway-derived cells from Ascaris suum-allergic cynomolgus monkeys did not produce appreciable TNF-alpha in vitro in response to ISS stimulation. Moreover, sputum of allergic humans exposed to inhaled ISS demonstrated induction of IFN-inducible genes but minimal TNF-alpha induction. These data demonstrate that ISS induce rodent-specific TNF-alpha-dependent toxicity that is absent in humans and reflective of differential TLR9 expression patterns in rodents versus humans.