Category: Nevin Manimala

Fertil Steril. 2023 Apr 28:S0015-0282(23)00316-3. doi: 10.1016/j.fertnstert.2023.04.031. Online ahead of print.

ABSTRACT

Uncertainty is a common element when designing a study and assumptions made around this uncertainty inform the statistical analysis to be performed. Sensitivity analyses provide confidence in the primary analytic results obtained from the study by probing at the assumptions and uncertainty. Researchers are strongly encouraged to consider sensitivity analyses during the design phase of the study and include them in the manuscript to increase confidence in the conclusions.

PMID:37121566 | DOI:10.1016/j.fertnstert.2023.04.031

Clin Gastroenterol Hepatol. 2023 Apr 28:S1542-3565(23)00317-8. doi: 10.1016/j.cgh.2023.04.017. Online ahead of print.

ABSTRACT

BACKGROUND & AIMS: Little is known about the potential impact of statins on progression of non-cirrhotic chronic liver diseases (CLD) to severe liver disease.

METHODS: Using liver histopathology data in a nationwide Swedish cohort, we identified 3,862 non-cirrhotic individuals with CLD and statin exposure, defined as a statin prescription filled for ≥30 cumulative defined daily doses. Statin users were matched to 3,862 (statin) non-users with CLD through direct 1:1 matching followed by propensity score matching. Cox regression was used to estimate hazard ratios (HRs) for the primary outcome of incident severe liver disease (a composite of cirrhosis, hepatocellular carcinoma (HCC), and liver transplantation/liver-related mortality).

RESULTS: 45.3% of CLD patients had non-alcoholic fatty liver disease (NAFLD), 21.9% alcohol-related liver disease (ALD), 17.7% viral hepatitis and 15.1% autoimmune hepatitis (AIH). During follow-up, 234 (6.1%) of statin users vs. 276 (7.1%) of non-users developed severe liver disease. Statin use was associated with a decreased risk of developing severe liver disease (HR=0.60; 95%CI=0.48-0.74). Statistically significantly lower rates of severe liver disease were seen in ALD (HR=0.30; 0.19-0.49) and NAFLD (HR=0.68; 0.45-1.00), but not in viral hepatitis (HR=0.76; 0.51-1.14) or AIH (HR=0.88; 0.48-1.58). Statin use had a protective association in both pre-fibrosis and fibrosis stages at diagnosis. Statin use was associated with lower rates of progression to cirrhosis (HR=0.62; 0.49-0.78), HCC (HR=0.44; 0.27-0.71), and liver-related mortality (HR=0.55; 0.36-0.82).

CONCLUSIONS: Among individuals with non-cirrhotic CLD, incident statin use was linked to lower rates of severe liver disease suggesting a potential disease modifying role.

PMID:37121528 | DOI:10.1016/j.cgh.2023.04.017

World Neurosurg. 2023 Apr 28:S1878-8750(23)00583-1. doi: 10.1016/j.wneu.2023.04.097. Online ahead of print.

ABSTRACT

BACKGROUND: The neutrophil-to-lymphocyte ratio (NLR) is a simple, cost-effective index of inflammation that can be measured by peripheral blood count. This study aimed to reveal that a high NLR value could be a prognostic marker for mortality risk in preterm babies born with IVH.

METHODS: Preterm babies who had been followed up in the neonatal ICU between 2018 and 2020 were included in the study. These patients were examined in 2 groups, those who had had IVH and those who had not. The patients were evaluated by the week of birth, gender, first-minute APGAR score and NLR obtained from the first postnatal peripheral blood sample.

RESULTS: A total of 113 babies had been born preterm and had been treated in the NICU were included in the study. IVH was observed in 26 (23%) of the infants, and a total of 14 (12.4%) died, with the mortality rate being higher among those with IVH than those without (p=0.026). There was also a statistically significant difference in the NLR between infants with IVH who died and those who did not (p<0.001). NLR above 1.5 had 33.7 times higher risk of mortality compared to those with an NLR of 1.5 or below.

CONCLUSIONS: This was the first study to examine the relationship between the NLR and mortality in preterm babies with IVH. This study showed that a high NLR was strongly associated with mortality in premature infants with low APGAR scores and having IVH.

PMID:37121506 | DOI:10.1016/j.wneu.2023.04.097

J Arthroplasty. 2023 Apr 28:S0883-5403(23)00350-9. doi: 10.1016/j.arth.2023.04.005. Online ahead of print.

ABSTRACT

INTRODUCTION: The impact of age on patient outcomes after total knee arthroplasty (TKA) remains controversial. Age has shown no effect on outcome in some studies, while others have reported better or worse outcome in younger patients. The aims of this study were to determine the differences in pain, function, and quality of life reported one-year after TKA across different age groups.

METHODS: A prospective, multi-center cohort of 11,602 unilateral primary TKA patients was evaluated. Demographic data, comorbid conditions, and patient-reported outcome measures (PROMs) including the knee injury and osteoarthritis outcome score (KOOS), KOOS-12, KOOS JR, and Short-Form health survey (12-item) were collected pre- and at one-year postoperatively. Descriptive statistics were generated, stratified by age [< 55 years (younger adult), 55 to 64 years (older adult), 65 to 74 years (early elder), and ≥ 75 years (late elder)], and differences in pain, function, and quality of life among the four age groups were evaluated using Chi-square and Kruskal-Wallis tests. Multivariate regression models with 95% confidence interval (CI) were performed to determine if age was predictive for KOOS pain and function scores.

RESULTS: Prior to surgery, younger patients (< 55 years) reported worse KOOS pain (39), function (50), and quality of life (18) scores with poor mental health score (47) than other older patient groups. The mean pre-op score differences across the age groups in the KOOS total score (9.37), KOOS pain (11.61), KOOS-12 pain (10.14), and KOOS/KOOS-12 QoL (12.60) reached the calculated minimal clinically important difference (MCID). At one-year after TKA, younger patients (< 55 years) reported lower KOOS pain, function, and quality of life scores when compared to older patients (≥ 75 years). The differences in one-year postop scores among the 4 age groups (ranging from 4.0 to 12.2) reached the MCID for pain (10.4) and quality of life (12.2). Younger patients (< 55 years) achieved higher baseline to one-year pain (36.8 points), function (30.3 points), and quality of life (40.7 points) score changes when compared to older patients ≥ 75 years. Although statistically significant, the differences in score changes among the age groups were clinically irrelevant. The multivariate regression analyses showed that age was a significant predictor for pain, but not for function at one year where KOOS pain score was predicted to be higher (less pain) (β =6.17; 95% CI (4.12- 8.22) (P<0.001) in older patients (≥ 75 years) when compared to younger patients (< 55 years).

CONCLUSION: A TKA provides a dramatic improvement in pain, function, and quality of life in all age groups. However, there are age-related clinically significant differences in pre-operative pain, quality of life, and mental health and in final post-operative pain and quality of life scores with younger patients (< 55 years) reporting more pain, less quality of life, and worse pre-operative mental health. The PROM data presented here can be used clinically to improve shared decision making and patient expectations prior to TKA.

PMID:37121490 | DOI:10.1016/j.arth.2023.04.005

Appetite. 2023 Apr 28:106583. doi: 10.1016/j.appet.2023.106583. Online ahead of print.

ABSTRACT

Establishing behavior change toward appetitive foods can be crucial to improve people’s health. Food go/no-go training (GNG), in which people respond to some food items and not to other food items depending on the presentation of a go or no-go cue, is a means to establish behavior change. GNG changes the perceived value of food items and food consumption. After GNG, no-go items are rated as less attractive than go and/or untrained items, an empirical phenomenon called the NoGo-devaluation-effect. This effect is not always found, however. One theory-based explanation for these inconsistent results may be found in the timing of the go and no-go cues, which is also inconsistent across studies. Hence, in the present work we conducted two experiments to examine the possible role of go and no-go cue presentation timing in eliciting the NoGo-devaluation-effect. In Experiment 1, we presented the food items before the presentation of go/no-go cues, whereas we reversed this order in Experiment 2. As predicted, the NoGo-devaluation-effect was obtained in Experiment 1. This effect was absent in Experiment 2. Moreover, recognition memory for stimulus-action contingencies moderated the devaluation effect in Experiment 1, but not in Experiment 2. These results show that NoGo devaluation is dependent on the timing of the NoGo cue, which has theoretical and applied implications for understanding how and when go/no-go training influences food consumption. We propose that the value of food items is updated during go/no-go training to minimize prediction errors, and that this updating process is boosted by attention.

PMID:37121485 | DOI:10.1016/j.appet.2023.106583

Curr Probl Cardiol. 2023 Apr 28:101772. doi: 10.1016/j.cpcardiol.2023.101772. Online ahead of print.

ABSTRACT

BACKGROUND: Systemic arterial hypertension (SAH) is one of the principal risk factors for developing cardiovascular disease. When a hypertensive woman becomes pregnant, new hemodynamic condition is installed, with addition from chronic pressure overload to chronic volume overload. This new hemodynamic condition can provide greater myocardial hypertrophy(LVH), whose postpartum evolution has been little studied in the literature.

OBJECTIVES: To evaluate LVH in hypertensive women in the third trimester of pregnancy and six months postpartum and to establish which clinical variables are associated with elevated risk of LVH.

METHODS: Prospective longitudinal study including 41 pregnant women beyond 35 gestational weeks and with previous SAH. They were submitted to clinical and echocardiographic evaluation at the gestational period and six months postpartum.

STATISTICAL ANALYSIS: multivariate logistic regression with the exposures most strongly associated with maintenance of hypertrophy in univariate analysis. Significance level:p<0.05.

RESULTS: The mean age was 29±6.2 years. The majority of the women were white(85.4%). Before pregnancy 23(59%) women used anti-hypertensive drugs and 28(71.8%) used during pregnancy. At the end of gestation, all women presented LVH, 79% maintained hypertrophy six months postpartum. In multivariate analysis, exposures significantly associated with hypertrophy maintenance: systolic blood pressure(SBP) at the end of gestation, OR=1.16(1.03-1.30);p=0.013 and SBP increase at six months postpartum in relation to end of gestation, OR=22.9(1.8-294);p=0.016.

CONCLUSIONS: In hypertensive pregnant women, LVH frequency is elevated at the end of pregnancy, and recovery frequency of this hypertrophy, at six months postpartum, is very low. The increase of SBP six months postpartum was associated with maintenance of hypertrophy.

PMID:37121455 | DOI:10.1016/j.cpcardiol.2023.101772

Curr Probl Cardiol. 2023 Apr 28:101776. doi: 10.1016/j.cpcardiol.2023.101776. Online ahead of print.

ABSTRACT

Pulmonary hypertension (PH) is a progressive disease with a high morbidity and mortality. The treatment is based on the type of PH. Prognosis still remains poor despite the use of different medications. Pulmonary artery denervation (PADN) has been studied as a novel therapeutic option in these patients. PUBMED, EMBASE and COCHRANE databases were searched by two investigators until January 2023. Information was analyzed for the following outcomes: 6-minute walk distance (6MWD), mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR) and cardiac output. Subgroup analysis comparing pre and post PADN in different PH groups was done. Statistical analysis was performed with the Review Manager version 5.4 This meta- analysis included 6 controlled trials and 6 single-arm prospective studies with a total of 616 patients. Our pooled analysis showed a significant reduction in mPAP [WMD -6.51, 95% CI (-9.87, -3.15), p = 0.0001], PVR [WMD -3.69, 95% CI (-6.74, -0.64), p = 0.02] and increased cardiac output [WMD -0.37, 95% CI (0.08, 0.65), p = 0.01]. Subgroup analysis pre and post PADN demonstrated a significant improvement in 6MWD in the WHO group 1 [WMD 99.53, 95% CI (19.60, 179.47), p = 0.01], group 2 [WMD: 69.96, 95% CI (36.40, 103.51), p = <0.0001] and group 4 [WMD: 99.54, 95% CI (21.80, 177.28), p = 0.01]. This meta-analysis supports PADN as a therapeutic option for patients with PH, regardless of group class. Further randomized trials are still needed to evaluate safety and efficacy.

PMID:37121454 | DOI:10.1016/j.cpcardiol.2023.101776

Biol Psychiatry Cogn Neurosci Neuroimaging. 2023 Apr 28:S2451-9022(23)00102-7. doi: 10.1016/j.bpsc.2023.04.007. Online ahead of print.

ABSTRACT

OBJECTIVE: Integrating multiple neuroimaging modalities to identify clusters of individuals, and then associating these clusters with psychopathology, is a promising approach for understanding neurobiological mechanisms that underlie psychopathology and the extent to which these features are associated with clinical symptoms.

METHOD: We leveraged neuroimaging data from T1-weighted, diffusion-weighted, and resting-state functional magnetic resonance images from the Adolescent Brain and Cognitive Development Study (N=8035) and used Similarity Network Fusion and spectral clustering to identify subgroups of participants. We examined neuroimaging measures as a function of clustering profiles using one, two, or three imaging modalities (i.e., data combinations), calculated the stability of the clustering assignment in each respective data combination, and compared the consistency of clusters across different data combinations. We then compared the extent to which clusters were associated with overall psychopathology, at the baseline assessment, and two-yearly follow-up visits.

RESULTS: Each data combination resulted in optimal clusters, ranging from two to four subgroups for each data combination. Clusters were stable across sub-sampling of the ABCD cohort. Widespread structural measures (surface area, fractional anisotropy, and mean diffusivity) were important features contributing to clustering across different data combinations. Five of the seven data combinations were associated with overall psychopathology, at baseline and over time (d=0.08-0.41). Generally, lower global cortical volume and surface area, widespread reduced fractional anisotropy, and increased radial diffusivity were associated with increased overall psychopathology.

CONCLUSION: Profiles constructed from neuroimaging data combinations are associated with concurrent and future psychopathology trajectories.

PMID:37121399 | DOI:10.1016/j.bpsc.2023.04.007

Chest. 2023 Apr 28:S0012-3692(23)00635-9. doi: 10.1016/j.chest.2023.04.034. Online ahead of print.

ABSTRACT

BACKGROUND: The ability of high-definition (HD) videobronchoscopy to detect airway involvement in sarcoidosis was not evaluated previously.

RESEARCH QUESTION: What is the role of HD videobronchoscopy in the identification of sarcoidosis-associated airway abnormalities (AA)? What are the patterns of AA more commonly observed and more frequently associated with the detection of granulomas in endobronchial biopsy (EBB)?

STUDY DESIGN AND METHODS: In this prospective, international, multicenter cohort study, consecutive patients with suspected sarcoidosis underwent airway inspection with a HD videobronchoscope and EBB using a standardized workflow. AA were classified according to six patterns defined “a priori”: nodularity, cobblestoning, thickening, plaque, increased vascularity, and miscellaneous. We assessed diagnostic yield of EBB, prevalence of AA, diagnostic yield of EBB and interobserver agreement for different patterns of AA.

RESULTS: AA were identified in 64/134 (47.8%) sarcoidosis patients, with nodularity (23, 17.2%), plaque (19, 14.2%) and increased vascularity (19, 14.2%) being the most prevalent. The diagnostic yield of EBB was 36.6%. AA were significantly more prevalent in patients with than in those without non-necrotizing granulomas in EBB (67.4% VS 36.5%, P=0.001). Likewise, parenchymal disease on CT was significantly more common in patients with than in those without non-necrotizing granulomas in EBB (79.6% VS 54.1%, P=0.003). On a per-lesion analysis, non-necrotizing granulomas were seen especially in EBB taken from areas of cobblestoning (9/10, 90%) and nodularity (17/29, 58.6%). The overall diagnostic yield of random EBB was low (31/134, 23.1%). The interobserver agreement for the different patterns of AA was fair (Fleiss k=0.34).

INTERPRETATION: In a population with a large prevalence of white Europeans, HD videobronchoscopy detected AA in approximately half of sarcoidosis patients. The diagnostic yield of EBB was higher in patients with parenchymal involvement on CT and in those with airway abnormalities, especially if manifesting as cobblestoning and nodularity.

CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov, identifier NCT4743596.

PMID:37121391 | DOI:10.1016/j.chest.2023.04.034

Cryobiology. 2023 Apr 28:S0011-2240(23)00031-7. doi: 10.1016/j.cryobiol.2023.04.002. Online ahead of print.

ABSTRACT

This study focused on the biomechanical properties and microstructural changes in dentin of teeth in different age groups after cryopreserved for different durations. Ninety third molars from three age groups (youth group, middle-age group, and elderly group), were collected and randomly divided into three groups according to freezing time at -196 °C (7 days, 30 days, and 90 days). Control group was shored at ordinary temperature. After rewarming, the compressive strength and elastic modulus of the dentin were measured with an electronic universal tester. Scanning electron microscopy was used to evaluate the microstructure of dentin after cryopreservation. After cryopreservation, the compressive strength of the teeth in each experimental group was not significantly different from control group. With the increase of freezing time and age, dentin’s elastic modulus showed a decreasing trend. There were statistically significances between the control group and freezing 90d group, freezing 7d and 90d group, youth and middle-aged group, youth and elderly group (P < 0.05). Both freezing time and age factors were significant for the elastic modulus of dentin(P＜0.05). There was no interaction effect for age and freezing time. In transverse sections of scanning electron microscopy, the dentinal tubule became narrower, partially occluded, and more easily adhered to impurities in the long freezing time and elderly group. In longitudinal sections, with freezing time and age, the inner wall of the dentinal tubules became rough especially in the aged group cryopreserved for 90 days. No significant microcracks exited in any of the longitudinal sections of dentin.

PMID:37121387 | DOI:10.1016/j.cryobiol.2023.04.002