Category: Nevin Manimala

Dermatol Ther (Heidelb). 2024 May 11. doi: 10.1007/s13555-024-01159-3. Online ahead of print.

ABSTRACT

INTRODUCTION: The treatment options for moderate to severe psoriasis (msPsO) in China have been greatly increased with the approvals of biologics. However, the unmet needs and treatment preferences of systemic treatments for msPsO in China remain unclarified.

METHODS: Fifty dermatologists and 300 patients with msPsO (41% with severe psoriasis) were surveyed for effectiveness, safety, treatment convenience, and treatment preferences (using a choice-based conjoint questionnaire). Descriptive statistics and conjoint simulation analyses were employed to summarize survey information and assess treatment preferences.

RESULTS: Both patients and dermatologists reported shorter treatment duration for oral drugs (2.7-6.2 months) than that for biologics (9.5-17.0 months). The most frequently reported treatment discontinuation reasons by the surveyed patients and dermatologists were unsatisfactory effectiveness (average 84.5%) for oral drugs and loss of efficacy over time (average 68.5%) for biologics. Commonly reported treatment inconveniences included regular lab tests for traditional oral drugs (average 71.5%) and administration assistance for biologics (average 58.0%). Injection site reactions (average 51.5%) and needle fear (average 35.5%) were frequently reported for biologics among the surveyed patients and dermatologists. Once-daily oral treatment was preferred over biweekly subcutaneous injection treatment when the two had comparable attributes (average in patients 87.1% vs. 12.9%; average in dermatologists 93.4% vs. 6.6%).

CONCLUSIONS: Unmet needs of systemic treatments remain for msPsO in China. Once-daily oral treatment is preferred over biweekly subcutaneous injections to treat msPsO when other treatment attributes are comparable.

PMID:38733512 | DOI:10.1007/s13555-024-01159-3

J Clin Monit Comput. 2024 May 11. doi: 10.1007/s10877-024-01173-y. Online ahead of print.

ABSTRACT

BACKGROUND: Postoperative sore throat (POST) is a common complication following endotracheal tube removal, and effective preventive strategies remain elusive. This trial aimed to determine whether actively regulating intraoperative cuff pressure below the tracheal capillary perfusion pressure threshold could effectively reduce POST incidence in patients undergoing gynecological laparoscopic procedures.

METHODS: This single-center, randomized controlled superiority trial allocated 60 patients scheduled for elective gynecological laparoscopic procedures into two groups: one designated for cuff pressure measurement and adjustment (CPMA) group, and a control group where only cuff pressure measurement was conducted without any subsequent adjustments. The primary outcome was POST incidence at rest within 24 h post-extubation. Secondary outcomes included cough, hoarseness, postoperative nausea and vomiting (PONV) incidence, and post-extubation pain severity.

RESULTS: The incidence of sore throat at rest within 24 h after extubation in the CPMA group was lower than in the control group, meeting the criteria for statistically significant superiority based on a one-sided test (3.3% vs. 26.7%, P < 0.025). No statistically significant differences were observed in cough, hoarseness, or pain scores within 24 h post-extubation between the two groups. However, the CPMA group had a higher incidence of PONV compared to the control group. Additionally, the control group reported higher sore throat severity scores within 24 h post-extubation.

CONCLUSIONS: Continuous monitoring and maintenance of tracheal tube cuff pressure at 18 mmHg were superior to merely monitoring without adjustment, effectively reducing the incidence of POST during quiet within 24 h after tracheal tube removal in gynecological laparoscopic surgery patients.

TRIAL REGISTRATION: The study was registered at www.chictr.org.cn (ChiCTR2200064792) on 18/10/2022.

PMID:38733506 | DOI:10.1007/s10877-024-01173-y

Updates Surg. 2024 May 11. doi: 10.1007/s13304-024-01870-y. Online ahead of print.

ABSTRACT

Hernia recurrence is a common complication after inguinal hernia repair. Recent studies suggest that laparoscopic mesh repair with closure of direct hernia defects can reduce recurrence rates. Our study examines the effectiveness of this approach. A retrospective, multi-center cohort study was conducted on cases performed from January 2013 to April 2021. Patients with direct inguinal hernias (M3 according to EHS classification) undergoing TAPP were included. Three groups were present: closed-defect group, non-closed placing a standard-sized mesh group or non-closed placing an XL-sized mesh group. A 2-year follow-up was recorded. A total of 158 direct M3 inguinal hernias in 110 patients who underwent surgery were present. After propensity score matching at a 1:1 ratio, 22 patients for each group were analyzed. The mean age of patients was 62 years (41-84); with the majority being male (84.8%). 22 patients (40 hernias) underwent closure of the defect; 22 patients (39 hernias) did not undergo closure and used a standard-sized mesh; 22 patients (27 hernias) did not undergo closure and used an XL-sized mesh. There were 5 recurrences at 1 year post-operatively: all in the non-closure group with standard-sized mesh. This difference was statistically significant (p = 0.044). There were 7 recurrences (6.6%) at 2 years post-operatively: 6 in the non-closure group with standard-sized mesh and 1 in the non-closure group with XL-sized mesh (p = 0.007). Closing large direct inguinal hernia defects has shown promise in reducing early recurrence rates. However, conducting larger RCTs in the future could provide more conclusive evidence that might impact the way we approach laparoscopic inguinal hernia repair.

PMID:38733485 | DOI:10.1007/s13304-024-01870-y

Jpn J Radiol. 2024 May 11. doi: 10.1007/s11604-024-01561-z. Online ahead of print.

ABSTRACT

PURPOSE: To assess the performance of GPT-4 Turbo with Vision (GPT-4TV), OpenAI’s latest multimodal large language model, by comparing its ability to process both text and image inputs with that of the text-only GPT-4 Turbo (GPT-4 T) in the context of the Japan Diagnostic Radiology Board Examination (JDRBE).

MATERIALS AND METHODS: The dataset comprised questions from JDRBE 2021 and 2023. A total of six board-certified diagnostic radiologists discussed the questions and provided ground-truth answers by consulting relevant literature as necessary. The following questions were excluded: those lacking associated images, those with no unanimous agreement on answers, and those including images rejected by the OpenAI application programming interface. The inputs for GPT-4TV included both text and images, whereas those for GPT-4 T were entirely text. Both models were deployed on the dataset, and their performance was compared using McNemar’s exact test. The radiological credibility of the responses was assessed by two diagnostic radiologists through the assignment of legitimacy scores on a five-point Likert scale. These scores were subsequently used to compare model performance using Wilcoxon’s signed-rank test.

RESULTS: The dataset comprised 139 questions. GPT-4TV correctly answered 62 questions (45%), whereas GPT-4 T correctly answered 57 questions (41%). A statistical analysis found no significant performance difference between the two models (P = 0.44). The GPT-4TV responses received significantly lower legitimacy scores from both radiologists than the GPT-4 T responses.

CONCLUSION: No significant enhancement in accuracy was observed when using GPT-4TV with image input compared with that of using text-only GPT-4 T for JDRBE questions.

PMID:38733472 | DOI:10.1007/s11604-024-01561-z

Jpn J Radiol. 2024 May 11. doi: 10.1007/s11604-024-01591-7. Online ahead of print.

ABSTRACT

PURPOSE: To compare computed tomography (CT) pulmonary angiography and unenhanced CT to determine the effect of rapid iodine contrast agent infusion on tracheal diameter and lung volume.

MATERIAL AND METHODS: This retrospective study included 101 patients who underwent CT pulmonary angiography and unenhanced CT, for which the time interval between them was within 365 days. CT pulmonary angiography was scanned 20 s after starting the contrast agent injection at the end-inspiratory level. Commercial software, which was developed based on deep learning technique, was used to segment the lung, and its volume was automatically evaluated. The tracheal diameter at the thoracic inlet level was also measured. Then, the ratios for the CT pulmonary angiography to unenhanced CT of the tracheal diameter (TD_PAU) and both lung volumes (BLV_PAU) were calculated.

RESULTS: Tracheal diameter and both lung volumes were significantly smaller in CT pulmonary angiography (17.2 ± 2.6 mm and 3668 ± 1068 ml, respectively) than those in unenhanced CT (17.7 ± 2.5 mm and 3887 ± 1086 ml, respectively) (p < 0.001 for both). A statistically significant correlation was found between TD_PAU and BLV_PAU with a correlation coefficient of 0.451 (95% confidence interval, 0.280-0.594) (p < 0.001). No factor showed a significant association with TD_PAU. The type of contrast agent had a significant association for BLV_PAU (p = 0.042).

CONCLUSIONS: Rapid infusion of iodine contrast agent reduced the tracheal diameter and both lung volumes in CT pulmonary angiography, which was scanned at end-inspiratory level, compared with those in unenhanced CT.

PMID:38733470 | DOI:10.1007/s11604-024-01591-7

Eur J Epidemiol. 2024 May 11. doi: 10.1007/s10654-024-01127-3. Online ahead of print.

ABSTRACT

Trial emulations in observational data analyses can complement findings from randomized clinical trials, inform future trial designs, or generate evidence when randomized studies are not feasible due to resource constraints and ethical or practical limitations. Importantly, trial emulation designs facilitate causal inference in observational data analyses by enhancing counterfactual thinking and comparisons of real-world observations (e.g. Mendelian Randomization) to hypothetical interventions. In order to enhance credibility, trial emulations would benefit from prospective registration, publication of statistical analysis plans, and subsequent prospective benchmarking to randomized clinical trials prior to their publication. Confounding by indication, however, is the key challenge to interpreting observed intended effects of an intervention as causal in observational data analyses. We discuss the target trial emulation of the REDUCE-AMI randomized clinical trial (ClinicalTrials.gov ID NCT03278509; beta-blocker use in patients with preserved left ventricular ejection fraction after myocardial infarction) to illustrate the challenges and uncertainties of studying intended effects of interventions without randomization to account for confounding. We furthermore directly compare the findings, statistical power, and clinical interpretation of the results of the REDUCE-AMI target trial emulation to those from the simultaneously published randomized clinical trial. The complexity and subtlety of confounding by indication when studying intended effects of interventions can generally only be addressed by randomization.

PMID:38733447 | DOI:10.1007/s10654-024-01127-3

Curr Genet. 2024 May 11;70(1):6. doi: 10.1007/s00294-024-01290-w.

ABSTRACT

The gene products of PRS1-PRS5 in Saccharomyces cerevisiae are responsible for the production of PRPP (5-phospho-D-ribosyl-α-1-pyrophosphate). However, it has been demonstrated that they are also involved in the cell wall integrity (CWI) signalling pathway as shown by protein-protein interactions (PPIs) with, for example Slt2, the MAP kinase of the CWI pathway. The following databases: SGD, BioGRID and Hit Predict, which collate PPIs from various research papers, have been scrutinized for evidence of PPIs between Prs1-Prs5 and components of the CWI pathway. The level of certainty in PPIs was verified by interaction scores available in the Hit Predict database revealing that well-documented interactions correspond with higher interaction scores and can be graded as high confidence interactions based on a score > 0.28, an annotation score ≥ 0.5 and a method-based high confidence score level of ≥ 0.485. Each of the Prs1-Prs5 polypeptides shows some degree of interaction with the CWI pathway. However, Prs5 has a vital role in the expression of FKS2 and Rlm1, previously only documented by reporter assay studies. This report emphasizes the importance of investigating interactions using more than one approach since every method has its limitations and the use of different methods, as described herein, provides complementary experimental and statistical data, thereby corroborating PPIs. Since the experimental data described so far are consistent with a link between PRPP synthetase and the CWI pathway, our aim was to demonstrate that these data are also supported by high-throughput bioinformatic analyses promoting our hypothesis that two of the five PRS-encoding genes contain information required for the maintenance of CWI by combining data from our targeted approach with relevant, unbiased data from high-throughput analyses.

PMID:38733432 | DOI:10.1007/s00294-024-01290-w

Biodegradation. 2024 May 11. doi: 10.1007/s10532-023-10069-8. Online ahead of print.

ABSTRACT

Health and environmental protection are the development trend of household appliances, coupled with the impact of the COVID-19 epidemic in the past few years. Consumers have unprecedented concerns and expectations about the sterilization and disinfection functions of household appliances. As a washing and nursing equipment for household clothes, the anti-bacterial technology of washing machine has developed rapidly. The new models of washing machines in the market have basically added the function of sterilization. In order to thoroughly solve the problem of sterilization and bacteriostasis of washing machines from the source, the distribution of microbial contamination in washing machines should be fully investigated. At present, there is almost no systematic study on the microbial community structure in washing machines in China. Therefore, the purpose of this study is to analyze the bacterial community structure in Chinese household washing machines. To explore the key factors affecting the bacterial community structure of washing machines. Bacterial communities were comprehensively analyzed by high throughput sequencing. Using chao and shannon indexes as indicators, one-way ANOVA was used to explore the key factors affecting the bacterial community structure of washing machines. A total of 2,882,778 tags and 21,265 OTUs from 522 genera were sequenced from 56 washing machine samples. Genus Mycobacterium, Pseudomonas, Brevundimonas, Sphingomonas, Sphingobium, Enhydrobacter, Methylobacterium, Pseudoxanthomonas, Stenotrophomonas and Sphingopyxis were the top ten bacteria genera in abundance. The effects of sources, types, frequency of utilization, sampling locations and service life of washing machines on bacterial diversity in washing machine were systematically analyzed. The statistical analysis showed that service life was an important factor affecting bacterial diversity in washing machine. Our study lays a foundation for directional screening of characteristic microorganisms with targeted characters including malodor-producing, fouling, pathogenic and stress-resistance, the antibacterial evaluation, metabolic mechanism of key characteristic microorganisms as well as antibacterial materials development. At present, the sterilization technology of washing machines has not been fully in combination with the distribution survey of microorganisms in washing machines. According to the specific microorganism distribution condition of the washing machine, the key distribution positions and the types of specific microorganisms contained in different positions, conduct more targeted sterilization treatment. This will help to completely solve the problem of microbial growth in washing machines from the source.

PMID:38733426 | DOI:10.1007/s10532-023-10069-8

Clin Transl Allergy. 2024 May;14(5):e12357. doi: 10.1002/clt2.12357.

ABSTRACT

BACKGROUND: Asthma is the most common chronic disease among children and poses a significant threat to their health. This study aims to assess the relationship between various plasma proteins and childhood asthma, thereby identifying potential therapeutic targets.

METHODS: Based on publicly available genome-wide association study summary statistics, we employed a two-sample Mendelian randomization (MR) approach to elucidate the causal relationship between plasma proteins and asthma. Mediation analysis was then conducted to evaluate the indirect influence of plasma proteins on childhood asthma mediated through risk factors. Comprehensive analysis was also conducted to explore the association between plasma proteins and various phenotypes using the UK Biobank dataset.

RESULTS: MR analysis uncovered a causal relationship between 10 plasma proteins and childhood asthma. Elevated levels of seven proteins (TLR4, UBP25, CBR1, Rac GTPase-activating protein 1 [RGAP1], IL-21, MICB, and PDE4D) and decreased levels of three proteins (GSTO1, LIRB4 and PIGF) were associated with an increased risk of childhood asthma. Our findings further validated the connections between reported risk factors (body mass index, mood swings, hay fever or allergic rhinitis, and eczema or dermatitis) and childhood asthma. Mediation analysis revealed the influence of proteins on childhood asthma outcomes through risk factors. Furthermore, the MR analysis identified 73 plasma proteins that exhibited causal associations with at least one risk factor for childhood asthma. Among them, RGAP1 mediates a significant proportion (25.10%) of the risk of childhood asthma through eczema or dermatitis. Finally, a phenotype-wide association study based on these 10 proteins and 1403 diseases provided novel associations between these biomarkers and multiple phenotypes.

CONCLUSION: Our study comprehensively investigated the causal relationship between plasma proteins and childhood asthma, providing novel insights into potential therapeutic targets.

PMID:38730525 | DOI:10.1002/clt2.12357

World J Surg. 2024 May 10. doi: 10.1002/wjs.12202. Online ahead of print.

ABSTRACT

BACKGROUND: Acute appendicitis remains the most common surgical emergency worldwide. There has been a low uptake of laparoscopic appendicectomy in the South African public sector. Preoperative identification of cases of uncomplicated appendicitis that are amenable to a laparoscopic approach may facilitate the implementation of laparoscopic appendicectomy programs in training hospitals. With limited access to preoperative imaging, alternative strategies for this preoperative prediction are needed.

METHODS: A retrospective audit of patients over the age of 12 years with a histologically confirmed diagnosis of acute appendicitis over a 5-year period was performed. Patients were categorized as uncomplicated or complicated appendicitis and C-reactive protein (CRP) and white cell count (WCC) reviewed. Receiver operating characteristics curves were constructed for these blood tests and acute appendicitis severity. Youden’s J statistic was used to determine optimal cut off values for diagnosing complicated appendicitis.

RESULTS: 358 patients had confirmed appendicitis and complete blood results. Of these, 189 (52.79%) had complicated appendicitis with a 40.22% perforation rate. Median CRP in uncomplicated and complicated groups were 68 mg/L (IQR 19-142) and 216 mg/L (IQR 103-313) with an area under the curve (AUC) of 0.75 (95% CI: 0.70-0.80). The median WCC in the two groups were 12.6 × 10⁹ cells/L (IQR 9.9-15.6) and 14.4 × 10⁹ cells/L (IQR 11.5-18.28) with an AUC of 0.61 (95% CI: 0.56-0.67). The optimal cut off value for CRP was found to be 110 mg/L with a sensitivity of 74.74% and specificity of 69.23%.

CONCLUSION: A cutoff value of 110 mg/dl CRP can distinguish patients with early appendicitis from those with complicated disease and when used in conjunction with clinical assessment may help identify patients in whom laparoscopic appendicectomy is appropriate.

PMID:38730515 | DOI:10.1002/wjs.12202