Low Circulating Monocytes Is in Parallel With Lymphopenia Which Predicts Poor Outcome in Anti-melanoma Differentiation-Associated Gene 5 Antibody-Positive Dermatomyositis-Associated Interstitial Lung Disease

Anti-melanoma differentiation-associated gene 5 (MDA5) antibody-positive dermatomyositis (DM)-associated interstitial lung disease (ILD) may progress rapidly and lead to high mortality within 6 or 12 months. Except for reported prognostic factors, simple but powerful prognostic biomarkers are still in need in practice. In this study, we focused on circulating monocyte and lymphocyte counts and their variation tendency in the early stage of ILD. A total of 351 patients from two inception anti-MDA5 antibody-positive cohorts were included in this study, with various treatment choices. Lymphocyte count remained lower in the first month after admission in the non-survivor patients. Although baseline monocyte count showed no significant differences, average monocyte count in the following 4 weeks was also lower in the non-survivor group. Based on the C-index and analysis by the “survminer” R package in the discovery cohort, we chose 0.24 × 109/L as the cutoff value for Mono W0-2, 0.61 × 109/L as the cutoff value for lymph W0-2, and 0.78 × 109/L as the cutoff value for peripheral blood mononuclear cell (PBMC) W0-2, to predict the 6-month all-cause mortality. The Kaplan–Meier survival curves and adjusted hazard ratio with age, gender, and the number of immunosuppressants used all validated that patients with lower average monocyte count, lower average lymphocyte count, or lower average PBMC count in the first 2 weeks after admission had higher 6-month death risk, no matter in the validation cohort or in the pooled data. Furthermore, flow cytometry figured out that non-classical monocytes in patients with anti-MDA5 antibody-positive DM were significantly lower than healthy controls and patients with DM without anti-MDA5 antibodies. In conclusion, this study elucidated the predictive value of monocyte and lymphocyte counts in the early stage and may help rheumatologists to understand the possible pathogenesis of this challenging disease.

Complication Differences Between the Tumescent and Non-Tumescent Dissection Techniques for Mastectomy: A Meta-Analysis

PurposeWe conducted a systematic literature search and pooled data from studies to compare the incidence of complications between the tumescent and non-tumescent techniques for mastectomy.MethodsWe searched PubMed, Embase, BioMed Central, Ovid, and CENTRAL databases for studies comparing the two mastectomy techniques up to November 1st, 2020. We used a random-effects model to calculate odds ratios (OR) with 95% confidence intervals (CI).ResultsNine studies were included with one randomized controlled trial (RCT). Meta-analysis indicated no statistically significant difference in the incidence of total skin necrosis (OR 1.18 95% CI 0.71, 1.98 I2 = 82% p=0.52), major skin necrosis (OR 1.58 95% CI 0.69, 3.62 I2 = 71% p=0.28), minor skin necrosis (OR 1.11 95% CI 0.43, 2.85 I2 = 72% p=0.83), hematoma (OR 1.19 95% CI 0.80, 1.79 I2 = 4% p=0.39), and infections (OR 0.87 95% CI 0.54, 1.40 I2 = 54% p=0.56) between tumescent and non-tumescent groups. Analysis of studies using immediate alloplastic reconstruction revealed no statistically significant difference in the incidence of explantation between the two groups (OR 0.78 95% CI 0.46, 1.34 I2 = 62% p=0.37). Multivariable-adjusted ORs on total skin necrosis were available from three studies. Pooled analysis indicated no statistically significant difference between tumescent and non-tumescent groups (OR 1.72 95% CI 0.72, 4.13 I2 = 87% p=0.23).ConclusionLow-quality evidence derived mostly from non-randomized studies is indicative of no difference in the incidence of skin necrosis, hematoma, seroma, infection, and explantation between the tumescent and non-tumescent techniques of mastectomy. There is a need for high-quality RCTs to further strengthen the evidence.

Efficacy of Tranexamic Acid in Pediatric Craniofacial and Orthognathic Surgery: A Meta-Analysis

Craniofacial and orthognathic surgery are high risk procedures for surgical blood loss. Significant blood loss leads to increased rates of blood product transfusion which may be associated with increased morbidity to the patient. The use of anti-fibrinolytics such as tranexamic acid has become popular in these procedures. However, the evidence to support its use in pediatric craniofacial and orthognathic surgery is sparse. This review analyzes the current randomized control trials assessing the use of tranexamic acid in craniofacial and orthognathic surgery. The study reviewed published literature up until December 20th, 2020. Six trials were included in this analysis. Pooled data showed that patients who received tranexamic acid during craniofacial or orthognathic surgery have less blood loss compared to those in control groups (mean difference—5.47 ml/kg [CI -7.02-3.82], P value <.05). Hence, rate of blood product transfusion in patients who received tranexamic acid is lower than control group by 2.01 ml/kg (CI 95%, 1.27-2.74, P value <.05). In summary, this review showed that craniofacial and orthognathic surgery patients who receive tranexamic acid might have lower estimated blood loss and receive less volume of blood products transfusion.

Unifying the Ability-as-Compensator and Ability-as-Enhancer Hypotheses

Spatial abilities have been found to interact with the design of visualizations in educational materials in different forms: (1) spatial abilities enhanced learning with optimized visual design (ability-as-enhancer) or (2) spatial abilities compensated for suboptimal visual design (ability-as-compensator). A brief review of pertinent studies suggests that these two forms are viewed as mutually exclusive. We propose a novel unifying conceptualization. This conceptualization suggests that the ability-as enhancer interaction will be found in the low-medium range of a broad ability continuum whereas the ability-as-compensator interaction will be found in the medium-high range. The largest difference in learning outcomes between visual design variations is expected for medium ability. A corresponding analytical approach is suggested that includes nonlinear quadratic interactions. The unifying conceptualization was confirmed in an experiment with a consistent visual-spatial task. In addition, the conceptualization was investigated with a reanalysis of pooled data from four multimedia learning experiments. Consistent with the conceptualization, quadratic interactions were found, meaning that interactions depended on ability range. The largest difference between visual design variations was obtained for medium ability, as expected. It is concluded that the unifying conceptualization is a useful theoretical and methodological approach to analyze and interpret aptitude-treatment interactions that go beyond linear interactions.

Effects of Neoadjuvant Radiotherapy on Postoperative Complications in Rectal Cancer: A Meta-Analysis

Objective. Neoadjuvant radiotherapy (nRT) is an important treatment approach for rectal cancer. The relationship, however, between nRT and postoperative complications is still controversial. Here, we conducted a meta-analysis to evaluate such concerns. Methods. The electronic literature from 1983 to 2021 was searched in PubMed, Embase, and Web of Science. Postoperative complications after nRT were included in the meta-analysis. The pooled odds ratio (OR) was calculated by the random-effects model. Statistical analysis was conducted by Review Manager 5.3 and STATA 14. Results. A total of 23,723 patients from 49 studies were included in the meta-analysis. The pooled results showed that nRT increased the risk of anastomotic leakage (AL) compared to upfront surgery (OR = 1.23; 95% CI, 1.07–1.41; p = 0.004 ). Subgroup analysis suggested that both long-course (OR = 1.20, 95% CI 1.03–1.40; p = 0.02 ) and short-course radiotherapy (OR = 1.25, 95% CI, 1.02–1.53; p = 0.04 ) increased the incidence of AL. In addition, nRT was the main risk factor for wound infection and pelvic abscess. The pooled data in randomized controlled trials, however, indicated that nRT was not associated with AL (OR = 1.01; 95% CI 0.82–1.26; p = 0.91 ). Conclusions. nRT may increase the risk of AL, wound infection, and pelvic abscess compared to upfront surgery among patients with rectal cancer.

Appraisal of Cluster Front Line Demonstration on Rapeseed and Mustard in Biharand Jharkhand

Performance of ten varieties of rapeseed and mustard were assessed through cluster frontline demonstration (CFLD) under different agro-climatic condition of Bihar and Jharkhandcontinuously for four years (2017-18 to 2020-21) by the KVKs of Bihar and Jharkhand.Among the agro-climatic zones of Bihar, highest yield was recorded in the demonstratedplot from zone III (B) i.e. South-West alluvial plain in case of variety RH 0749 (15.29 q/ha) and in Jharkhand state from zone I (Central and North astern plateau) with varietyNRCHB 101 (13.31 q/ha). Lowest technology index was observed for variety RajendraSufalam in all the zone (-4.96, 5.53, 7.18 and 22.92 % in zone I, III (B), III (A) & II) ofBihar and NRCHB 101 (23.15% in zone I) in Jharkhand. The range of extension gapwas1.38 to 4.37 and 1.13 to 4.86 q/ha under the agro-climatic zone of Bihar and Jharkhand,respectively. Pooled data shows that in Bihar, maximum net return (Rs. 46986 /ha) wasobtained in variety Rajendra Sufalam in agro-climatic zone III A of Bihar with benefit costratio 3.85:1 whereas under agro-climatic condition of Jharkhand maximum net return (Rs.39598 /ha) was recoded from variety NRCHB 101 with benefit cost ratio 2.80:1

Income inequality, regional characteristics and household’s conspicuous consumption: An empirical study in developing market

This study aims to analyze the effect of income inequality and regional characteristics such as ethnicity and religion on conspicuous consumption for visible and invisible good types of households in the Indonesian regions by dividing regions into regions with low and high-income inequality levels based on the value median Gini index in Indonesia. The data set deployed in this study were pooled data collected from households provided by the Indonesian Central Bureau of Statistics 2017 and 2018. Employing the OLS method, we find that 1) income inequality has a negative effect on visible goods, and positive effect on invisible goods, 2) ethnicity and religion give an effect on visible and invisible goods. The government should pay attention to the phenomena of conspicuous consumption because numerous problems will likely arise if this conspicuous consumption is ignored. High conspicuous consumption would tend to lead to a materialistic lifestyle causing a higher inequality. In addition, the crime rate could equally increase given the high risk of conspicuous consumption in attracting others’ attention to individuals’ wealth.

Effect of magnesium fertilization on yield and nutrient status of rice in kole lands

The field experiments were conducted in farmer's field at five locations each of kole lands to study the effect of Magnesium (Mg) on yield and soil and plant nutrient status of rice during 2012-2013 and 2013-2014. The experiment was laid out in randomized block design with three replications. The treatments comprised of different levels of Mg viz; 40, 60, 80, 100, and 120 kg Magnesium sulphate(MgSO4)/ha along with control. Observations on growth characters yield attributes, yield and soil and plant nutrient status were recorded. The results revealed that application of 100 kg MgSO4 / ha recorded the maximum number of panicles/m2 (419.13), number of grains/panicle (109.36), thousand grain weight (28.78 g), grain (9.27 t/ha) and straw yield (9.04 t/ha) of rice. The results of pooled data on plant and soil nutrient status revealed that application of magnesium had a positive effect on nutrient content and availability of nutrients in soil. A significant positive correlation was also noticed between Mg application, yield attributes, yield and nutrient contents. The study concluded that application of 100 kg MgSO4 / ha was found to be optimum for correcting the deficiency in Mg deficient areas of kole lands under below sea level farming.

Neurophysiological Characterization of Posteromedial Hypothalamus in Anaesthetized Patients

Deep brain stimulation (DBS) requires a precise localization, which is especially difficult at the hypothalamus, because it is usually performed in anesthetized patients. We aimed to characterize the neurophysiological properties posteromedial hypothalamus (PMH), identified by the best neurophysiological response to electrical stimulation. We obtained microelectrode recordings from four patients with intractable aggressivity operated under general anesthesia. We pooled data from 1.5 mm at PMH, 1.5 mm upper (uPMH) and 1.5 mm lower (lPMH). We analyzed 178 units, characterized by the mean action potential (mAP). Only 11% were negative. We identified the next types of units: P1N1 (30.9%), N1P1N2 (29.8%), P1P2N1 (16.3%), N1P1 and N1N2P1 (6.2%) and P1N1P2 (5.0%). Besides, atypical action potentials (amAP) were recorded in 11.8%. PMH was highly different in cell composition from uPMH and lPMH, exhibiting also a higher percentage of amAP. Different kinds of cells shared similar features for the three hypothalamic regions. Although features for discharge pattern did not show region specificity, the probability mass function of inter-spike interval were different for all the three regions. Comparison of the same kind of mAP with thalamic neurons previously published demonstrate that most of cells are different for derivatives, amplitude and/or duration of repolarization and depolarization phases and also for the first phase, demonstrating a highly specificity for both brain centers. Therefore, the different properties described for PMH can be used to positively refine targeting, even under general anesthesia. Besides, we describe by first time the presence of atypical extracellular action potentials.