Category: Nevin Manimala

J Nucl Med. 2023 Dec 7:jnumed.123.266273. doi: 10.2967/jnumed.123.266273. Online ahead of print.

ABSTRACT

Cerebral blood flow (CBF) may be estimated from early-frame PET imaging of lipophilic tracers, such as amyloid agents, enabling measurement of this important biomarker in participants with dementia and memory decline. Although previous methods could map relative CBF, quantitative measurement in absolute units (mL/100 g/min) remained challenging and has not been evaluated against the gold standard method of [¹⁵O]water PET. The purpose of this study was to develop and validate a minimally invasive quantitative CBF imaging method combining early [¹⁸F]florbetaben (eFBB) with phase-contrast MRI using simultaneous PET/MRI. Methods: Twenty participants (11 men and 9 women; 8 cognitively normal, 9 with mild cognitive impairment, and 3 with dementia; 10 β-amyloid negative and 10 β-amyloid positive; 69 ± 9 y old) underwent [¹⁵O]water PET, phase-contract MRI, and eFBB imaging in a single session on a 3-T PET/MRI scanner. Quantitative CBF images were created from the first 2 min of brain activity after [¹⁸F]florbetaben injection combined with phase-contrast MRI measurement of total brain blood flow. These maps were compared with [¹⁵O]water CBF using concordance correlation (CC) and Bland-Altman statistics for gray matter, white matter, and individual regions derived from the automated anatomic labeling (AAL) atlas. Results: The 2 methods showed similar results in gray matter ([¹⁵O]water, 55.2 ± 14.7 mL/100 g/min; eFBB, 55.9 ± 14.2 mL/100 g/min; difference, 0.7 ± 2.4 mL/100 g/min; P = 0.2) and white matter ([¹⁵O]water, 21.4 ± 5.6 mL/100 g/min; eFBB, 21.2 ± 5.3 mL/100 g/min; difference, -0.2 ± 1.0 mL/100 g/min; P = 0.4). The intrasubject CC for AAL-derived regions was high (0.91 ± 0.04). Intersubject CC in different AAL-derived regions was similarly high, ranging from 0.86 for midfrontal regions to 0.98 for temporal regions. There were no significant differences in performance between the methods in the amyloid-positive and amyloid-negative groups as well as participants with different cognitive statuses. Conclusion: We conclude that eFBB PET/MRI can provide robust CBF measurements, highlighting the capability of simultaneous PET/MRI to provide measurements of both CBF and amyloid burden in a single imaging session in participants with memory disorders.

PMID:38071587 | DOI:10.2967/jnumed.123.266273

Inj Prev. 2023 Dec 8:ip-2023-045107. doi: 10.1136/ip-2023-045107. Online ahead of print.

ABSTRACT

BACKGROUND: Early identification of non-fatal strangulation in the context of intimate partner violence (IPV) is crucial due to its severe physical and psychological consequences for the individual experiencing it. This study investigates the under-reported and underestimated burden of IPV-related non-fatal strangulation by analysing assault-related injuries leading to anoxia and neck injuries.

METHODS: An IRB-exempt, retrospective review of prospectively collected data were performed using the National Electronic Injury Surveillance System All Injury Programme data from 2005 to 2019 for all assaults resulting in anoxia and neck injuries. The type and mechanism of assault injuries resulting in anoxia (excluding drowning, poisoning and aspiration), anatomical location of assault-related neck injuries and neck injury diagnosis by morphology, were analysed using statistical methods accounting for the weighted stratified nature of the data.

RESULTS: Out of a total of 24 493 518 assault-related injuries, 11.6% (N=2 842 862) resulted from IPV (defined as perpetrators being spouses/partners). Among 22 764 cases of assault-related anoxia, IPV accounted for 40.4%. Inhalation and suffocation were the dominant mechanisms (60.8%) of anoxia, with IPV contributing to 41.9% of such cases. Neck injuries represented only 3.0% of all assault-related injuries, with IPV accounting for 21% of all neck injuries and 31.9% of neck contusions.

CONCLUSIONS: The study reveals a significant burden of IPV-related anoxia and neck injuries, highlighting the importance of recognising IPV-related strangulation. Comprehensive screening for IPV should be conducted in patients with unexplained neck injuries, and all IPV patients should be screened for strangulation events.

PMID:38071575 | DOI:10.1136/ip-2023-045107

Arch Dis Child Fetal Neonatal Ed. 2023 Nov 23:fetalneonatal-2023-326333. doi: 10.1136/archdischild-2023-326333. Online ahead of print.

ABSTRACT

OBJECTIVE: To systematically review and meta-analyse the effect of late surfactant administration versus placebo in reducing the incidence of death or bronchopulmonary dysplasia (BPD) in preterm infants.

DESIGN: PubMed, EMBASE, CINAHL and Cochrane CENTRAL were searched until 30 May 2023, for randomised controlled trials (RCTs) comparing administration of surfactant after 48 hours of age versus placebo in preterm ventilator-dependent neonates. The primary outcome was incidence of death or BPD at 36 weeks’ postmenstrual age (PMA). Secondary outcomes included incidence of BPD at 36 weeks PMA, pre-discharge mortality, use of postnatal steroids, post-discharge respiratory support, treatment with steroids or hospitalisation prior to 1-year corrected age.

RESULTS: Pooled analyses of four RCTs (N=850) showed no statistically significant difference between groups in the incidence of death or BPD at 36 weeks’ PMA (relative risk (RR) 0.99; 95% CI 0.90 to 1.10; Grades of Recommendation, Assessment, Development and Evaluation (GRADE): moderate). Late surfactant administration significantly decreased the need for post-discharge respiratory support prior to 1-year corrected age (two RCTs; N=522; RR 0.72; 95% CI 0.59 to 0.89; GRADE: low). Other secondary outcomes did not differ significantly between the groups.

CONCLUSIONS: Administration of late surfactant does not improve the rates of death or BPD at 36 weeks when administered to preterm infants with prolonged respiratory insufficiency. Additional adequately powered trials are needed to establish the efficacy of late surfactant therapy in preterm infants.

PROSPERO REGISTRATION NUMBER: CRD42023432463.

PMID:38071552 | DOI:10.1136/archdischild-2023-326333

Arch Dis Child Fetal Neonatal Ed. 2023 Dec 6:fetalneonatal-2023-326340. doi: 10.1136/archdischild-2023-326340. Online ahead of print.

ABSTRACT

This paper critically examines ‘kitchen sink regression’, a practice characterised by the manual or automated selection of variables for a multivariable regression model based on p values or model-based information criteria. We highlight the pitfalls of this method, using examples from perinatal/neonatal medicine, and propose more robust alternatives. The concept of directed acyclic graphs (DAGs) is introduced as a tool for describing and analysing causal relationships. We highlight five key issues with ‘kitchen sink regression’: (1) the disregard for the directionality of variable relationships, (2) the lack of a meaningful causal interpretation of effect estimates from these models, (3) the inflated alpha error rate due to multiple testing, (4) the risk of overfitting and model instability and (5) the disregard for content expertise in model building. We advocate for the use of DAGs to guide variable selection for models that aim to examine associations between a putative risk factor and an outcome and emphasise the need for a more thoughtful and informed use of regression models in medical research.

PMID:38071518 | DOI:10.1136/archdischild-2023-326340

Int J Ment Health Nurs. 2023 Dec 10. doi: 10.1111/inm.13275. Online ahead of print.

ABSTRACT

The high prevalence of mental health problems and underutilization of mental health treatment are more severe among the Native Hawaiian and Other Pacific Islander (NHPI) populations and remain misunderstood and understudied. Examining mental health literacy (MHL) – the knowledge and beliefs about mental disorders – aids their recognition, management, or prevention – has been shown to identify barriers to seeking and receiving care. This study aimed to assess the level of MHL in NHPIs and identify associated demographic variables. Data for this cross-sectional study were collected from 298 US NHPIs via an online questionnaire of the Mental Health Literacy Scale (MHLS). The overall mean MHLS score was 121 (SD = 17.3), with statistically significant higher scores in female participants, >31 years old, Tongan, more educated, and with higher income. This study demonstrated that overall MHL is comparable among NHPI compared to the current literature. However, NHPI men ≤30 years old and with lower income had lower MHL, which may be linked to the mental health disparities specific to this population. Current interventions should focus on increasing knowledge of risk factors, causes, self-treatments, and available professional help regarding mental disorders. Efforts to improve the MHL of NHPI should target men ≤30 years with lower income (<$50 000).

PMID:38071505 | DOI:10.1111/inm.13275

ANZ J Surg. 2023 Dec 10. doi: 10.1111/ans.18816. Online ahead of print.

ABSTRACT

BACKGROUND: Of the 40% of breast cancer patients who have a mastectomy as part of their surgical treatment, only approximately 29% have a breast reconstruction. In 2016, Alfred Health established a multidisciplinary surgical clinic with breast and plastic surgeons, aiming to improve interdisciplinary collaboration. This study aimed to assess the provision of breast reconstruction at an Australian tertiary public hospital and examine whether the multidisciplinary surgical clinic have improved our reconstructive service provision.

METHODS: A retrospective cohort study of patients who underwent mastectomy at Alfred Health between October 2011 and September 2021 was conducted. Patients were divided into before and after groups, treated during the 5-year period before and after establishing the multidisciplinary clinic respectively. Demographic data, operative details, histopathology, and treatments were compared.

RESULTS: Over the 10-year period, 423 mastectomies were performed for 351 patients. Of those, 153 patients underwent breast reconstruction, providing an overall reconstruction rate of 43.6%. There was a statistically significant increase in the breast reconstruction rate from 36.5% before to 53.4% after the creation of the multidisciplinary surgical clinic. Patient factors such as age and tumour receptor status did not differ significantly between the groups.

CONCLUSION: The establishment of a surgical multidisciplinary clinic has led to a statistically significant increase in the rate of breast reconstruction from 36.5% to 53.4%, leading to improved healthcare provision for our patients. Factors identified to be associated with increased uptake in the reconstruction service include younger age and node negative disease.

PMID:38071497 | DOI:10.1111/ans.18816

J Biomech Eng. 2023 Dec 9:1-16. doi: 10.1115/1.4064213. Online ahead of print.

ABSTRACT

Many methods to computationally predict red blood cell damage have been introduced, and among these are Lagrangian methods which track the cells along their pathlines. Such methods typically do not explicitly include cell-cell interactions. Due to the high volume fraction of red blood cells in blood, these interactions could impact cell mechanics and thus, the amount of damage caused by the flow. To investigate this question, cell-resolved simulations of red blood cells in shear flow were performed for multiple interacting cells, as well as for single cells in unbounded flow at an effective viscosity. Simulations run without adjusting the bulk viscosity produced larger errors unilaterally and were not considered further for comparison. We show that a periodic box containing at least 8 cells and a spherical harmonic of degree larger than 10 are necessary to produce converged higher-order statistics. The maximum difference between the single-cell and multiple-cell cases in terms of peak strain was 3.7%. To achieve this, one must use the whole blood viscosity and average over multiple cell orientations when adopting a single-cell simulation approach. The differences between the models in terms of average strain was slightly larger (maximum difference of 6.9%). However, given the accuracy of the single-cell approach in predicting the maximum strain, which is useful in hemolysis prediction, and its computational cost that is orders of magnitude less than the multiple-cell approach, one may use it as an affordable cell-resolved approach for hemolysis prediction.

PMID:38071488 | DOI:10.1115/1.4064213

West Afr J Med. 2023 Dec 4;40(12 Suppl 1):S40.

ABSTRACT

BACKGROUND/AIM: Some estimates indicates that by 2021 ending, more people as a share of the vulnerable population in Africa, Nigeria inclusive, have died than elsewhere due to late and inadequate vaccination. With the pandemic phase of high daily deaths formally declared over, COVID-19 deaths before and after vaccination commenced were compared to observe how vaccination impacted COVID-19 deaths.

METHOD: COVID-19 cases, deaths and vaccination rates in World Health Organization databases up to 07 June 2023 and other variables of interest unavailable there but found in other open- sources were all extracted and examined. Case fatality rate (CFR) per 1,000 for the period prior to vaccination (CFR1) and the period after vaccination commenced (CFR2) was computed. Simple statistics were used in data analysis.

RESULTS: Between when the first case was documented and 05 June 2023, Nigeria recorded 3,155 COVID-19 deaths and majority (61.84%) occurred between 19 March 2020 and March 5, 2021 when vaccination commenced. COVID-19 deaths declined to 61.7% of pre-vaccination figure coinciding with vaccination that delivered partial, primary and booster rates of 39.94%, 33.86% and 5.97% respectively. The cumulative COVID-19 deaths by population size was 8.94/106 pre-vaccination while COVID-19 deaths in vaccination era added 5.510/106mortalities to the final mortality figure of 14. 44/106. The calculated CFR1 and CFR2 rebased were 1.24% and 1.04% respectively.

CONCLUSION: More COVID-19 deaths occurred before vaccination commenced than in over two years of ongoing vaccination.

PMID:38071481

Sci Rep. 2023 Dec 9;13(1):21806. doi: 10.1038/s41598-023-49221-y.

ABSTRACT

In March 2020, the world went into lockdown to curb the spread of the novel coronavirus (SARS-CoV-2), with immediate impacts on wildlife across ecosystems. The strict 2-year long lockdown in Grand Cayman provided an unprecedented opportunity to assess how the ‘human confinement experiment’ influenced the community composition of reef fish. Using a suite of multivariate statistics, our findings revealed a stark increase in reef fish biomass during the 2 years of lockdown, especially among herbivores, including parrotfish, with drastic increases in juvenile parrotfishes identified. Additionally, when comparing baseline data of the community from 2018 to the 2 years during lockdown, over a three-fold significant increase in mean reef fish biomass was observed, with a clear shift in community composition. Our findings provide unique insights into the resilience of reef fish communities when local anthropogenic stressors are removed for an unprecedented length of time. Given the functional role of herbivores including parrotfish, our results suggest that reductions in human water-based activities have positive implications for coral reef ecosystems and should be considered in future management strategies.

PMID:38071390 | DOI:10.1038/s41598-023-49221-y

Sci Rep. 2023 Dec 9;13(1):21838. doi: 10.1038/s41598-023-49376-8.

ABSTRACT

Austria started its COVID-19-vaccination program in December 2020 with three different vaccines. As the vaccination program continues, we encountered increased 2-[18F] FDG-activity not only in axillary lymph nodes ipsilateral to the injection site but also in other organs. The aim of this retrospective study is to present results of the metabolic activity of ipsilateral axillary lymph nodes, liver, blood pool, spleen, and bone marrow after three different vaccines. To our knowledge, this is the first study to examine systemic response changes in relation to time after COVID-19 vaccination using three different vaccines. The collected data of 220 eligible vaccinated patients (127 with BioNTech/Pfizer BNT162b2, 61 with Moderna, and 32 with AstraZeneca) examined with 2-[18F] FDG-PET/CT were enrolled. The PET/CT examinations were evaluated from day 1 to day 135 (SD: 23.2, median: 26) after different vaccinations. Seventy-one out of these 220 patients underwent a pre-vaccination 2-[18F] FDG -PET/CT. SUVmax of axillary node(s), and blood pool, liver, spleen, and bone marrow as reference organs were calculated. The ratio of SUVmax activity of axillary lymph node to reference organs was also compared in all patients. The tracer activity dynamics were investigated in three different vaccines. After BioNTech/Pfizer vaccination 2-[18F] FDG activity in axillary lymph nodes shows a steady decrease in all patients. Ten days after vaccination the 2-[18F] FDG uptake was at its highest activity. Seventy days after vaccination, tracer activity is not different from the background activity of 2-[18F] FDG in the axillary region. This result also applies to other two vaccines; however, in the 4th week after Moderna vaccination SUVmax in lymph nodes showed the highest peak of tracer activity. With AstraZeneca the highest activity was at the earlier days. There was no significant statistical difference of SUVmax of lymph nodes or its ratios to other reference organs between three groups of vaccines. SUVmax in lymph nodes was statistically significant lower than SUVmax in the liver, spleen, and bone marrow with p-values of < 0.001, 0.044, and 0.001, respectively. In the group of 71 patients with a pre-vaccination PET/CT examination, the median SUVmax of lymph nodes increased significantly after vaccination from 0.82 (IQR 0.59-1.38) to 1.80 (IQR 1.07-3.89)(p < 0.001). In contrast median tracer activity in the liver decreased from 3.37 (IQR 2.83-3.91) to 3.11 (2.56-3.70) (p = 0.032). There was no significant change of tracer activity after vaccination in other reference regions (mediastinum, spleen, and bone marrow). In this group of 71 patients, there was also no significant difference in tracer activity in different types of vaccines. Local site and ipsilateral axillary lymph node activity in 2-[18F] FDG PET/CT after COVID19-vaccination is suggested in many studies. The main challenge is recognizing the changes in lymph nodes during time after vaccination to minimize false interpretation, foremost in patients with oncological diagnoses. Moreover, different vaccines cause different system metabolic changes. The knowledge of vaccine type, the time interval between vaccination and PET/CT scan is essential, especially in therapy evaluation.

PMID:38071353 | DOI:10.1038/s41598-023-49376-8