Category: Nevin Manimala

Gastrointest Endosc. 2023 May 5:S0016-5107(23)02505-1. doi: 10.1016/j.gie.2023.04.2091. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Endoscopic ultrasound (EUS)-guided interventions currently serve as first-line treatment for symptomatic pancreatic fluid collections (PFCs) but require high-level expertise and multidisciplinary care. Hospital caseload has not been fully examined in relation to clinical outcomes of patients with endoscopically managed PFCs.

METHODS: Using the Diagnosis Procedure Combination database, a Japanese nationwide inpatient database, we identified 4,053 patients receiving EUS-guided treatment of PFCs at 486 hospitals in 2010-2020 and examined an association of hospital volume (average annual number of cases at a hospital) with in-hospital mortality. Associations with bleeding, length of stay, and total costs were examined as secondary analyses. Multivariable logistic regression analysis was conducted with adjustment for potential confounders.

RESULTS: The hospital volume was inversely associated with the risk of in-hospital mortality (P_trend < .001). The adjusted odds ratio for in-hospital mortality comparing the extreme quintiles of hospital volume was 0.17 (95% confidence interval, 0.09-0.33). A restricted cubic spline analysis yielded no statistically significant evidence on the nonlinear relationship (P_nonlinearity = .19). The types of stents (plastic vs. lumen-apposing metal stent) appeared to have no effect modification on the volume-mortality relationship (P_interaction = .58). Higher hospital volume was also associated with lower risk of bleeding, shorter length of stay, and lower medical costs of inpatient care.

CONCLUSIONS: Higher hospital volume was associated with a lower risk of in-hospital mortality of patients receiving EUS-guided treatment of PFCs. A further investigation is warranted to justify the volume-based selective referral of the patients.

PMID:37150410 | DOI:10.1016/j.gie.2023.04.2091

J Control Release. 2023 May 5:S0168-3659(23)00310-3. doi: 10.1016/j.jconrel.2023.05.004. Online ahead of print.

ABSTRACT

The local fluid dynamics experienced by circulating microbubbles vary across different anatomical sites, which can influence ultrasound-mediated therapeutic delivery efficacy. This study aimed to elucidate the effect of fluid flow rate in combination with repeated short-pulse ultrasound on microbubble-mediated endothelial cell permeabilization. Here, a seeded monolayer of human umbilical (HUVEC) or brain endothelial cells (HBEC-5i) was co-perfused with a solution of microbubbles and propidium iodide (PI) at either a flow rate of 5 or 30 ml/min. Using an acoustically coupled inverted microscope, cells were exposed to 1 MHz ultrasound with 20-cycle bursts, 1 ms PRI, and 2 s duration at a peak negative pressure of 305 kPa to assess the role of flow rate on ultrasound-stimulated endothelial cell permeability, as well as Ca²⁺ modulation. In addition, the effect of inter-pulse delays (∆t = 1s) on the resulting endothelial permeability was investigated. Our results demonstrate that under an identical acoustic stimulus, fast-flowing microbubbles resulted in a statistically significant increase in cell membrane permeability, at least by 2.3-fold, for both endothelial cells. Likewise, there was a substantial difference in intracellular Ca²⁺ levels between the two examined flow rates. In addition, multiple short pulses rather than a single pulse ultrasound, with an equal number of bursts, significantly elevated endothelial cell permeabilization, at least by 1.4-fold, in response to ultrasound-stimulated microbubbles. This study provides insights into the design of optimal, application-dependent pulsing schemes to improve the effectiveness of ultrasound-mediated local therapeutic delivery.

PMID:37150403 | DOI:10.1016/j.jconrel.2023.05.004

Resuscitation. 2023 May 5:109821. doi: 10.1016/j.resuscitation.2023.109821. Online ahead of print.

ABSTRACT

BACKGROUND: Early Warning Scores (EWS) monitor inpatient deterioration predominantly using vital signs. We evaluated inpatient outcomes after implementing an Artificial Intelligence (AI) based intervention in our local EWS.

METHODS: A prior study calculated a Deterioration Index (DI) with logistic regression utilising demographics, vital signs, and laboratory results at multiple time points to predict any major adverse event (MAE-all cause mortality, ICU admission, or medical emergency team activation). The current study is a single hospital, pre-post study in Australia comparing the DI plus the existing EWS (Between the Flags-BTF) to only BTF. Data were collected on all eligible inpatients (≥ 16 years, admitted ≥ 24 hours, in general non-palliative wards). Controls were inpatients in the same hospital between January and December 2019. The DI was integrated into the electronic medical record and alerts were sent to senior ward nurse phones (July 2020 -April 2021).

RESULTS: We enrolled 28,639 patients (median age 73 years, IQR:60-83) with 52.3% female. The intervention and control groups did not show any statistically significant differences apart from reduced admissions via the emergency department in the intervention group (40.4% vs 41.6%, P=0.03). Risk for an MAE was lower in intervention than control (RR: 0.81; 95%CI: 0.74-0.89). Length of hospital stay was significantly reduced in the intervention group (3.74 days, IQR 1.84-7.26) compared to the control group (3.86 days, IQR 1.86-7.86, P=0.002) CONCLUSIONS: Implementing the DI in one hospital in Australia was associated with some improved patient outcomes. Future RCTs are needed for further validation.

PMID:37150397 | DOI:10.1016/j.resuscitation.2023.109821

Resuscitation. 2023 May 5:109822. doi: 10.1016/j.resuscitation.2023.109822. Online ahead of print.

ABSTRACT

AIM: The aim of this study was to explore associations between comorbidities and health-related quality of life (HRQoL) among in-hospital cardiac arrest (IHCA) survivors.

METHODS: This registry study is based on data from the Swedish Registry of Cardiopulmonary Resuscitation (SRCR) collected during 2014-2017. HRQoL was assessed using the EQ-5D-5L, the EQ Visual Analogue Scale (EQ VAS) and the Hospital Anxiety and Depression Scale (HADS). In total, 1,278 IHCA survivors were included in the study, 3-6 months after the cardiac arrest (CA). Data were analyzed with descriptive and inferential statistics. The comorbidities analysed in this study were the patients’ status for diabetes, previous myocardial infarction, previous stroke, respiratory insufficiency, and heart failure.

RESULTS: Overall, the IHCA survivors reported high levels of HRQoL, but there was great variation within the population, e.g., EQ VAS median (q1-q3)=70 (50-80). Survivors with one or more comorbidities reported worse HRQoL in 6 out of 8 outcomes (p<0.001). All studied comorbidities were each associated with worse HRQoL, but no comorbidity was associated with every outcome measure. Previous stroke and respiratory insufficiency were significantly associated with every outcome measure except for HADS Anxiety. The linear regression models explained 4-8 % of the total variance in HRQoL (p<0.001).

CONCLUSION: Since IHCA survivors with comorbidities report worse HRQoL compared to those without comorbidities, it is important to pay directed attention to them when developing and providing post-CA care, especially in those with respiratory insufficiency and previous stroke.

PMID:37150395 | DOI:10.1016/j.resuscitation.2023.109822

Resuscitation. 2023 May 5:109818. doi: 10.1016/j.resuscitation.2023.109818. Online ahead of print.

ABSTRACT

Context Deciding on “termination of resuscitation” (TOR) is a dilemma for any physician facing cardiac arrest. Due to the lack of evidence-based criteria and scarcity of the existing guidelines, crucial arbitration to interrupt resuscitation remains at the practitioner’s discretion.

AIM: Evaluate with a quantitative method the existence of a physician internal bias to terminate resuscitation.

METHOD: We extracted data concerning OHCAs managed between January 2013 and September 2021 from the RéAC registry. We conducted a statistical analysis using generalized linear mixed models to model the binary TOR decision. Utstein data were used as fixed effect terms and a random effect term to model physicians personal bias towards TOR.

RESULTS: 5,144 OHCAs involving 173 physicians were included. The cohort’s average age was 69 (SD 18) and was composed of 62% of women. Median no-flow and low-flow times were respectively 6 (IQR [0,12]) and 18 (IQR [10,26]) minutes. Our analysis showed a significant (p<0.001) physician effect on TOR decision. Odds ratio for the “doctor effect” was 2.48 [2.13-2.94] for a doctor one SD above the mean, lower than that of dependency for activities of daily living (41.18 [24.69-65.50]), an age of more than 85 years (38.60 [28.67-51.08]), but higher than that of oncologic, cardiovascular, respiratory disease or no-flow duration between 10 to 20 minutes (1.60 [1.26-2.00]).

CONCLUSIONS: We demonstrate the existence of individual physician biases in their decision about TOR. The impact of this bias is greater than that of a no-flow duration lasting ten to twenty minutes. Our results plead in favor developing tools and guidelines to guide physicians in their decision.

PMID:37150394 | DOI:10.1016/j.resuscitation.2023.109818

Int J Biol Macromol. 2023 May 5:124721. doi: 10.1016/j.ijbiomac.2023.124721. Online ahead of print.

ABSTRACT

This study presented for the first time the PHA-lipid interactions by circular dichroism (CD) spectroscopy, besides a sustainable PHA production strategy using a cost-effective microbial isolate. About 48 bacterial isolates were selected from multifarious Egyptian sites and screened for PHAs production. The Fe(AZU-A6) was the most potent isolate, and identified genetically as Priestia filamentosa AZU-A6, while the intracellular PHA granules were visualized by TEM. Sugarcane molasses (SCM) was used an inexpensive carbon source and the production conditions were optimized through a Factor-By-Factor strategy and a Plackett-Burman statistical model. The highest production (6.84 g L^-1) was achieved at 8.0 % SCM, pH 8.0, 35 °C, 250 rpm, and 0.5 g L^-1 ammonium chloride after 72 h. The complementary physicochemical techniques (e.g., FTIR, NMR, GC-MS, DSC, and TGA) have ascertained the structural identity as poly-3-hydroxybutyrate (P3HB) with a characteristic melting temperature of 174.5 °C. The circular dichroism analysis investigated the existence of interactions between the PHB and the different lipids, particularly 1,2-dimyristoyl-sn-glycero-3-phosphocholine. The ATR technique for the lipid-PHB films suggested that both the hydrophobic and electrostatic forces control the lipid-PHB interactions that might induce changes in the structuration of PHB.

PMID:37150380 | DOI:10.1016/j.ijbiomac.2023.124721

Int J Biol Macromol. 2023 May 5:124759. doi: 10.1016/j.ijbiomac.2023.124759. Online ahead of print.

ABSTRACT

The amount of cellulosic materials is large and may lead to environmental pollution, so they can be converted into useful materials for use in food or energy. Statistical design (Plackett-Burman and Box-Behnken) was the main topic of this study and was used to optimize the effect of environmental factors on cellulase production by Aspergillus niger. Cellulase production using Plackett-Burman was 6.86-fold higher than the production of cellulase using the basal medium. B0X-Benken showed an increase in the cellulase production equal to 18 times compared to the basal medium, where the cellulase produced had an activity equal to 79.4 U/mL/min. Ammonium sulfate precipitation was applied to the crude enzyme, followed by sequential fractionation with an Amicon system. The Amicon was used to demonstrate the final volume, total enzyme activity, specific activity, purification fold, and yield of cellulase (partially purified enzyme). Numerous cellulolytic enzymes are abundant in Aspergillus species. All of the data showed that Aspergillus sp. might be a reliable source of industrially and economically useful cellulases. By statistically calculating the relevance of a large number of elements in one experiment using a multifactorial statistical design, time may be saved while still maintaining the validity of each component.

PMID:37150365 | DOI:10.1016/j.ijbiomac.2023.124759

New Phytol. 2023 May 7. doi: 10.1111/nph.18945. Online ahead of print.

ABSTRACT

Priming is an adaptive mechanism that fortifies plant defense by enhancing activation of induced defense responses following pathogen challenge. Microorganisms have signature microbe-associated molecular patterns (MAMPs) that induce the primed state. The lipopolysaccharide (LPS) MAMP isolated from the xylem-limited pathogenic bacterium, Xylella fastidiosa, acts as a priming stimulus in Vitis vinifera grapevines. Grapevines primed with LPS developed significantly less internal tyloses and external disease symptoms than naive vines. Differential gene expression analysis indicated major transcriptomic reprogramming during the priming and postpathogen challenge phases. Furthermore, the number of differentially expressed genes increased temporally and spatially in primed vines, but not in naive vines during the postpathogen challenge phase. Using a weighted gene co-expression analysis, we determined that primed vines have more genes that are co-expressed in both local and systemic petioles than naive vines indicating an inherent synchronicity that underlies the systemic response to this vascular pathogen specific to primed plants. We identified a cationic peroxidase, VviCP1, that was upregulated during the priming and postpathogen challenge phases in an LPS-dependent manner. Transgenic expression of VviCP1 conferred significant disease resistance, thus, demonstrating that grapevine is a robust model for mining and expressing genes linked to defense priming and disease resistance.

PMID:37149885 | DOI:10.1111/nph.18945

J Dent Child (Chic). 2022 Sep 15;89(3):155-161.

ABSTRACT

Purpose: To evaluate knowledge, perceptions and current practices regarding care-seeking behaviors and oral health in pregnant and non-pregnant adolescent and young adults, and to assess barriers to dental care during pregnancy.<br/>Methods: An 18-question survey was distributed to patients in three tertiary hospital clinics in Columbus, Ohio, USA. Statistical analyses used chi-square and Fisher’s exact tests, with significance at P <0.05.<br/>Results: Of 227 respondents, 197 were female and about 30 percent were pregnant. The mean and median age was 17 years. Almost half were African American, 69 percent had public insurance and over 75 percent had one or two annual dental check-ups. Less than one percent indicated pregnant females should never go to the dentist, although 63 percent of pregnant respondents had not sought dental care while pregnant and less than five percent had been to the dentist in the six months prior to pregnancy. The most reported barrier to seek dental care was the patient being too busy.<br/>Conclusions: Dental care among pregnant adolescents seems to be less utilized than their non-pregnant peers. The importance and safety of dental care during pregnancy are less understood among adolescents and young adults than in older, pregnant women. Most respondents, including males, stated that if a pregnant female has tooth pain, she should go to the dentist, but were unaware if materials used at the dentist were harmful to the baby. Interventions to improve knowledge and reduce barriers to dental care during pregnancy are needed for adolescents and young adults.

PMID:37149874

STAR Protoc. 2023 May 6;4(2):102290. doi: 10.1016/j.xpro.2023.102290. Online ahead of print.

ABSTRACT

Synaptopathy, which encompasses morphological deficits and any abnormal protein distribution of synapses, is a critical feature of many neurological diseases. We here provide a protocol using mice stably expressing a Thy1-YFP transgene to assess synaptic features in vivo. We describe steps for recording the entire morphology of projection neurons using confocal microscopy based on YFP signals. We detail assessment of the density and size of dendritic spines and the distributions of synaptic proteins using ImageJ and statistical analysis using Prism. For complete details on the use and execution of this protocol, please refer to Shih et al. (2020).¹.

PMID:37149854 | DOI:10.1016/j.xpro.2023.102290