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Nevin Manimala Statistics

Intracerebral Electrographic Activity Following a Single Dose of Diazepam Nasal Spray: A Pilot Study

Epilepsia Open. 2023 Dec 22. doi: 10.1002/epi4.12890. Online ahead of print.

ABSTRACT

OBJECTIVE: Rescue benzodiazepine medication can be used to treat seizure clusters, which are intermittent, stereotypic episodes of frequent seizure activity that are distinct from a patient’s usual seizure pattern. The NeuroPace RNS® System is a device that detects abnormal electrographic activity through intracranial electrodes and administers electrical stimulation to control seizures. Reductions in electrographic activity over days to weeks have been associated with the longer-term efficacy of daily antiseizure medications (ASMs). In this pilot study, electrographic activity over hours to days was examined to assess the impact of a single dose of a proven rescue therapy (diazepam nasal spray) with a rapid onset of action.

METHODS: Adult volunteers (>18 years old) with clinically indicated RNS (stable settings and ASM usage) received a weight-based dose of diazepam nasal spray in the absence of a clinical seizure. Descriptive statistics for number of detections and sum of durations of detections at 10-minute, hourly, and 24-hour intervals during the 7-day (predose) baseline period were calculated. Post-dose detections at each time interval were compared with the respective baseline-detection intervals using a 1 SD threshold. The number of long episodes that occurred after dosing also were compared with baseline.

RESULTS: Five participants were enrolled, and 4 completed the study; the excluded participant had recurrent seizures during the study. There were no consistent changes (difference >1 SD) in detections between post-dose and mean baseline values. Although variability was high (1 SD was often near or exceeded the mean), 3 participants showed possible trends for reductions in one or more electrographic variables following treatment.

SIGNIFICANCE: RNS-assessed electrographic detections and durations were not shown to be sensitive measures of short-term effects associated with a single dose of rescue medication in this small group of participants. It is possible the variability of detections may have masked a measurable drug effect.

PMID:38131286 | DOI:10.1002/epi4.12890

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A multi-centre survey of New Zealand cancer patients’ preferences for radiation treatment information

J Med Radiat Sci. 2023 Dec 22. doi: 10.1002/jmrs.745. Online ahead of print.

ABSTRACT

INTRODUCTION: Patients undergoing radiation therapy have a diverse range of information needs, however, there is a lack of data specific to the needs of New Zealand patients. This cross-sectional survey captured New Zealand cancer patients’ preferences for radiation treatment information. Preferences were assessed regarding the scope of information needs and the satisfaction with which these needs were being met.

METHODS: A custom survey was offered to 275 eligible patients undergoing radiation treatment at six of 10 departments across New Zealand over a 2-day period. The survey captured patient demographics as well as information needs and satisfaction across five distinct domains using Likert scales and one free-text question. Responses were analysed using descriptive statistics and directed content analysis.

RESULTS: Over 80% of participants rated all information domains as extremely or very important. Over 90% of participants were extremely satisfied or very well satisfied in four of the five domains. Information on what happens after radiation treatment had the lowest satisfaction at 78%. No demographic subcategories were clearly associated with differences in information needs or satisfaction. 59% of participants indicated their willingness to engage in online education. The qualitative analysis strongly corroborated the quantitative results.

CONCLUSION: The New Zealand cancer patients surveyed in this study demonstrated high levels of importance and satisfaction with the information provided during radiation treatment. Information on what happens after completing radiation treatment had the lowest satisfaction. These findings support further exploration of New Zealand cancer patients’ information needs following radiation treatment as well as strategies to address them.

PMID:38131264 | DOI:10.1002/jmrs.745

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Evaluation of the clinical outcome of hypercalcemia of malignancy and concurrent azotemia in dogs with lymphoma

J Vet Intern Med. 2023 Dec 22. doi: 10.1111/jvim.16974. Online ahead of print.

ABSTRACT

BACKGROUND: Hypercalcemia of malignancy (HM) secondary to lymphoma in dogs has the potential to cause renal injury.

HYPOTHESIS/OBJECTIVES: Characterize outcomes related to acute kidney injury (AKI) secondary to HM. We hypothesized that dogs do suffer AKI regardless of HM severity at the time of lymphoma diagnosis or relapse.

ANIMALS: Retrospective study. Twenty-nine dogs with lymphoma, HM, and azotemia (International Renal Interest Society [IRIS] grade II or higher AKI) that underwent chemotherapy were identified at 2 veterinary institutions.

METHODS: Logistic regression and descriptive statistical analysis were performed to evaluate data for potential prognostic factors.

RESULTS: After initiating treatment, resolution of hypercalcemia and azotemia occurred in 100% (29/29) and 79.3% (23/29) of dogs, respectively. Resolution of azotemia was influenced by serum creatinine concentration (odds ratio [OR], 0.148; Confidence interval [CI], 0.03-0.734; P = .02) and total hypercalcemia (OR, 0.36; CI, 0.14-0.93; P = .04) at diagnosis, whereas blood urea nitrogen concentration, IRIS grade, sex, and whether or not dogs were hospitalized were not significant factors. At data analysis, 13.8% (4/29) of dogs were alive or lost to follow-up. Of those dead, 4 dogs (15%) had renal disease at the time of death, 2/4 having concurrent lymphoma progression.

CONCLUSIONS AND CLINICAL IMPORTANCE: Although AKI may be of clinical concern in dogs with HM secondary to lymphoma at diagnosis, death secondary to renal impairment appears to be infrequent.

PMID:38131263 | DOI:10.1111/jvim.16974

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Comparative analysis of self-cure and dual cure-dental composites on their physico-mechanical behaviour

Aust Dent J. 2023 Dec 22. doi: 10.1111/adj.13004. Online ahead of print.

ABSTRACT

BACKGROUND: Clinical practitioners may have become familiar with the rapid transformation of dental composites. However, they may not scientifically understand the factors influencing the mechanical and physical properties. Scientific knowledge of filler-resin interaction can significantly improve clinical understanding of resin composites. Several independent studies have examined the mechanical and physico-mechanical properties of dental resin composites; however, no comprehensive study has examined the influence of fillers and resin materials on the physico-mechanical properties of both self-cure and dual-cure composites.

METHODS: This study performed investigations on the physico-mechanical behaviour of four commercially available dual-cure dental composites (Bioactive, Fill Up!, Surefil One, Cention N) and two commercially available self-cure dental composites (Stela Capsule and Stela Automix). Test specimens for flexural and compressive strength, microhardness, fracture toughness, and hydrolytic behaviour were prepared and tested as per respective standards. The data sets were statistically analysed using one-way ANOVA and Tukey’s post-hoc comparison.

RESULTS: There was a substantial variation in flexural strength and modulus values in this study, ranging from 32.0 to 113.4 MPa and 2.36 to 12.07 GPa, respectively. Similarly, there were significant differences in compressive strength between the materials in this study, ranging from 119.3 to 223.5 MPa. The highest fracture toughness value was found to be 1.41 MPa.m0.5 , while the lowest value was 0.43 MPa.m0.5 . Variations in surface microhardness were significant (24.11-68.0 N/mm2 ), which correlated with the filler content. Water sorption and solubility demonstrated high variations among materials, with Surefil One exceeding ISO 4049 thresholds significantly.

CONCLUSIONS: A linear correlation can be established between surface microhardness (HV) and flexural and compressive moduli, as well as filler content (wt.%). However, both flexural and compressive strengths are impacted by the resin’s constituent monomers and the resin-filler matrix’s cross-linking capability. Additionally, factors such as filler size, shape, and the cross-linking ability of the resin-filler matrix play a crucial role in fracture toughness and the propagation of cracks within the restoration. Also, resin monomers and filler particle size affect the hydrolytic degradation characteristics of composites, which can also affect their mechanical properties. © 2023 Australian Dental Association.

PMID:38131257 | DOI:10.1111/adj.13004

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Plaque Evolution and Vessel Wall Remodeling of Intracranial Arteries: A Prospective, Longitudinal Vessel Wall MRI Study

J Magn Reson Imaging. 2023 Dec 22. doi: 10.1002/jmri.29185. Online ahead of print.

ABSTRACT

BACKGROUND: Progression of intracranial atherosclerotic disease (ICAD) is associated with ischemic stroke events and can be quantified with three-dimensional (3D) intracranial vessel wall (IVW) MRI. However, longitudinal 3D IVW studies are limited and ICAD evolution remains relatively unknown.

PURPOSE: To evaluate ICAD changes longitudinally and to characterize the imaging patterns of atherosclerotic plaque evolution.

STUDY TYPE: Prospective.

POPULATION: 37 patients (69 ± 12 years old, 12 females) with angiography confirmed ICAD.

FIELD STRENGTH/SEQUENCE: 3.0T/3D time-of-flight gradient echo sequence and T1- and proton density-weighted fast spin echo sequences.

ASSESSMENT: Each patient underwent baseline and 1-year follow-up IVW. Then, IVW data from both time points were jointly preprocessed using a multitime point, multicontrast, and multiplanar viewing workflow (known as MOCHA). Lumen and outer wall of plaques were traced and measured, and plaques were then categorized into progression, stable, and regression groups based on changes in plaque wall thickness. Patient demographic and clinical data were collected. Culprit plaques were identified based on cerebral ischemic infarcts.

STATISTICAL TESTS: Generalized estimating equations-based linear and logistic regressions were used to assess associations between vascular risk factors, medications, luminal stenosis, IVW plaque imaging features, and longitudinal changes. A two-sided P-value<0.05 was considered statistically significant.

RESULTS: Diabetes was significantly associated with ICAD progression, resulting in 6.6% decrease in lumen area and 6.7% increase in wall thickness at 1-year follow-up. After accounting for arterial segments, baseline contrast enhancement predicted plaque progression (odds ratio = 3.61). Culprit plaques experienced an average luminal expansion of 10.9% after 1 year. 74% of the plaques remained stable during follow-up. The regression group (18 plaques) showed significant increase in minimum lumen area (from 7.4 to 8.3 mm2 ), while the progression group (13 plaques) showed significant decrease in minimum lumen area (from 5.4 to 4.3 mm2 ).

DATA CONCLUSION: Longitudinal 3D IVW showed ICAD remodeling on the lumen side. Culprit plaques demonstrated longitudinal luminal expansion compared with their non-culprit counterparts. Baseline plaque contrast enhancement and diabetes mellitus were found to be significantly associated with ICAD changes.

EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 3.

PMID:38131254 | DOI:10.1002/jmri.29185

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Tumor Multiregional Mean Apparent Propagator (MAP) Features in Evaluating Gliomas-A Comparative Study With Diffusion Kurtosis Imaging (DKI)

J Magn Reson Imaging. 2023 Dec 22. doi: 10.1002/jmri.29202. Online ahead of print.

ABSTRACT

BACKGROUND: Glioma classification affects treatment and prognosis. Reliable imaging methods for preoperatively evaluating gliomas are essential.

PURPOSE: To evaluate tumor multiregional mean apparent propagator (MAP) features in glioma diagnosis and to compare those with diffusion-kurtosis imaging (DKI).

STUDY TYPE: Retrospective study.

SUBJECTS: 70 untreated glioma patients (31 LGGs (low-grade gliomas), 34 women; mean age, 47 ± 12 years, training (60%, n = 42) and testing cohorts (40%, n = 28)).

FIELD STRENGTH/SEQUENCE: 3-T, diffusion-MRI using q-space Cartesian grid sampling with 11 different b-values.

ASSESSMENT: Tumor multiregional MAP (mean squared displacement (MSD); q-space inverse variance (QIV); non-Gaussianity (NG); axial/radial non-Gaussianity (NGAx, NGRad); return-to-origin/axis/plane probability (RTOP, RTAP, and RTPP)); and DKI metrics (axial/mean/radial kurtosis (AK, MK, and RK)) on tumor parenchyma (TP) and peritumoral areas (PT) in histopathologically gliomas grading and genotyping were assessed.

STATISTICAL TESTS: Mann-Whitney U; Kruskal-Wallis; Benjamini-Hochberg; Bonferroni-correction; receiver operating curve (ROC) and area under curve (AUC); DeLong’s test; Random Forest (RF). P value<0.05 was considered statistically significant after multiple comparisons correction.

RESULTS: Compared with LGGs, MSD, and QIV were significantly lower in TP, whereas NG, NGAx, NGRad, RTOP, RTAP, RTPP, and DKI metrics were significantly higher in HGGs (high-grade gliomas) (P ≤ 0.007), as well as in isocitrate-dehydrogenase (IDH)-mutated than IDH-wildtype gliomas (P ≤ 0.039). These trends were reversed for PT (tumor grades, P ≤ 0.011; IDH-mutation status, P ≤ 0.012). ROC analysis showed that, in TP, DKI metrics performed best in TP (AUC 0.83), whereas in PT, RTPP performed best (AUC 0.77) in glioma grading. AK performed best in TP (AUC 0.77), whereas MSD and RTPP performed best in PT (AUC 0.73) in IDH genotyping. Further RF analysis with DKI and MAP demonstrated good performance in grading (AUC 0.91, Accuracy 82%) and IDH genotyping (AUC 0.87, Accuracy 79%).

DATA CONCLUSION: Tumor multiregional MAP features could effectively evaluate gliomas. The performance of MAP may be similar to DKI in TP, while in PT, MAP may outperform DKI.

LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY: Stage 2.

PMID:38131220 | DOI:10.1002/jmri.29202

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Urinary microalbumin/creatinine ratio is a predictor of the occurrence and severity of leukoaraiosis

Neuro Endocrinol Lett. 2023 Dec 12;44(8):528-536. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the correlation between the urinary microalbumin/creatinine ratio (UACR) and the occurrence and severity of leukoaraiosis.

METHODS: A total of 323 patients were retrospectively recruited. Demographic, clinical, and laboratory data were collected at the time of admission, and the UACR was calculated based on the levels of urinary microalbumin and creatinine. All patients showed improvement in cranial magnetic resonance imaging (MRI) examination. The subjects were divided into leukoaraiosis and non-leukoaraiosis groups according to the results of the cranial MRI examination. According to the Fazekas standard score, the patients in the leukoaraiosis group were divided into the mild leukoaraiosis group: Fazekas (1-2 points), moderate leukoaraiosis group: Fazekas (3-4points); and severe leukoaraiosis group: Fazekas (5-6 points).

RESULTS: A regression analysis was performed to adjust for confounding factors. (1) Compared with the non-leukoaraiosis group, UACR level was higher in the leukoaraiosis group at admission, and the difference between the groups was statistically significant (p < 0.05). (2) In the multivariate logistic regression analysis, UACR was correlated with the occurrence of leukoaraiosis, which may be an independent risk factor. (3) The UACR levels increased gradually in the mild, moderate and severe leukoaraiosis groups, and the difference was statistically significant (p< 0.05). (4) In the ordered multi-category logistic regression analysis, UACR was correlated with the severity of leukoaraiosis, which may be an independent risk factor.

CONCLUSION: UACR is associated with the occurrence and severity of leukoaraiosis, and may be an independent risk factor.

PMID:38131176

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Standard low-resolution electromagnetic tomography imaging of brain for the analysis of mental fatigue during a simulated air traffic control task

Neuro Endocrinol Lett. 2023 Dec 12;44(8):491-499. Online ahead of print.

ABSTRACT

BACKGROUND: Standard low-resolution electromagnetic tomography (sLORETA) was used to accurately detect EEG changes in mental fatigue of air traffic controllers (ATCo) under a simulated air traffic control (ATC) task. We explored the changes in standard current density, activated cortical intensity, and brain source location.

METHODS: The participants were instructed to use the tower flight command simulation training system for three hours of uninterrupted ATC task. The 3-hour EEG signal was divided into four stages: task start, 1st hour, 2nd hour, and task end. Each stage was preprocessed for 3 minutes to explore the EEG changes and then processed by sLORETA in a statistical non-parametric mapping analysis.

RESULTS: The current density distribution of δ and α oscillations differed significantly during the four tasks, while θ, β and γ oscillations did not. Changes in δ oscillations of the brain during mental fatigue were detected mainly in the postcentral gyrus (BA2 and BA3), precentral gyrus (BA4 and BA6), inferior temporal gyrus (BA20), and superior temporal gyrus (BA38). The α oscillations were found mainly decreased in the postcentral gyrus (BA2) and inferior parietal lobule (BA40) when the task was in progress compared with the end of the task.

CONCLUSION: The superior temporal gyrus and somatosensory cortex were the main activated cortical regions during the simulated ATC task. The α and δ oscillations showed contrasting activity during simulated ATC task, which might reflect the release of task-relevant brain’s areas from inhibition and enhance the neural activity.

PMID:38131172

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Pharmacists’ Medication Counseling Practices and Knowledge and Satisfaction of Patients With an Outpatient Hospital Pharmacy Service

Inquiry. 2023 Jan-Dec;60:469580231219457. doi: 10.1177/00469580231219457.

ABSTRACT

The degree of communication between patients and pharmacists has a significant impact on the process of medication counseling. The purpose of this study was to evaluate pharmacists’ practices of medication counseling and to assess patients’ knowledge of medications and satisfaction with pharmacy services at Woldia Comprehensive Specialised Hospital (WCSH). A cross-sectional study involving 23 pharmacists and 339 patients was carried out between February and May 2022 at WCSH. A self-administered structured questionnaire was used to assess the medication counseling activities of pharmacists, whereas interview-based questionnaires were used to evaluate patients’ knowledge of the drugs prescribed to them and their level of satisfaction with outpatient hospital pharmacy services. The Statistical Package for Social Sciences (SPSS) Version 25.0 was used to analyze the data. Around two-thirds of pharmacy professionals (73.9%) agreed that they were satisfied with their counseling activities. But a very low number of them always provided counseling regarding the purpose of medications (13%), major drug-drug interactions (26.1%), possible side effects (30.4%), the importance of compliance (30.4%), storage conditions (34.8%), and drug-food interactions (39.1%). Among the 339 patients involved in the study, less than half (46.3%) of them had sufficient knowledge of their dispensed medication at the exit interview. Only nearly half of the patients (54.3%) agreed that they were satisfied with the pharmacy service. Despite the fact that a significant proportion of the pharmacy professionals agreed that they were satisfied with their counseling practices, their level of involvement in major counseling activities was limited, which impacted the knowledge of patients about their medication and patients’ satisfaction with pharmacy services. This might be because of potential barriers in terms of workload and lack of resources. The findings may indicate that pharmacy services need to improve through identifying potential gaps and tackling barriers.

PMID:38131171 | DOI:10.1177/00469580231219457

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Suitability of machine learning for atrophy and fibrosis development in neovascular age-related macular degeneration

Acta Ophthalmol. 2023 Dec 22. doi: 10.1111/aos.16616. Online ahead of print.

ABSTRACT

PURPOSE: To assess the suitability of machine learning (ML) techniques in predicting the development of fibrosis and atrophy in patients with neovascular age-related macular degeneration (nAMD), receiving anti-VEGF treatment over a 36-month period.

METHODS: An extensive analysis was conducted on the use of ML to predict fibrosis and atrophy development on nAMD patients at 36 months from start of anti-VEGF treatment, using only data from the first 12 months. We use data collected according to real-world practice, which includes clinical and genetic factors.

RESULTS: The ML analysis consistently identified ETDRS as a relevant factor for predicting the development of atrophy and fibrosis, confirming previous statistical analyses. Also, it was shown that genetic variables did not demonstrate statistical relevance in the prediction. Despite the complexity of predicting macular degeneration, our model was able to obtain a balance accuracy of 63% and an AUC of 0.72 when predicting the development of atrophy or fibrosis at 36 months.

CONCLUSION: This study demonstrates the potential of ML techniques in predicting the development of fibrosis and atrophy in nAMD patients receiving long-term anti-VEGF treatment. The findings highlight the importance of clinical factors, particularly ETDRS (early treatment diabetic retinopathy study) visual acuity test, in predicting these outcomes. The lessons learned from this research can guide future ML-based prediction tasks in the field of ophthalmology and contribute to the design of data collection processes.

PMID:38131161 | DOI:10.1111/aos.16616