Category: Nevin Manimala

Minerva Pediatr (Torino). 2023 May 8. doi: 10.23736/S2724-5276.23.07213-0. Online ahead of print.

ABSTRACT

BACKGROUND: The pathogenesis of bronchopulmonary dysplasia (BPD) is attributed to the arrested lung development in premature infants. Studies showed the negative impact of inflammatory markers on the developing lung with higher levels of IL1, 6 and 8. Platelets contribute to the acute phase response of inflammation and are a direct source of IL-1β.

METHODS: We conducted a retrospective data review of all preterm babies with gestational age (GA) <32 weeks admitted to NICU to assess the relationship between platelet parameters in the first 2 weeks of life with the incidence and severity of BPD in very low birth weight (VLBW) neonates.

RESULTS: Of 114 screened newborns, 92 were included after exclusion criteria. Of these, 62 (67.3%) developed BPD. Mean platelet count (PC) (P=0.008) and mean platelet mass index (PMI) (P=0.027) were significantly lower and mean platelet volume (MPV) (P=0.016) was significantly higher in the BPD group. The highest difference between groups was observed at 2^nd week of life for PC and PMI and at 1^st week for MPV. Using multivariate logistic analysis, only PC (P=0.017) showed statistical significance. MPV and PMI showed a positive interaction but did not achieve significance (P=0.066 for both).

CONCLUSIONS: We concluded that platelet parameters in the first 2 weeks of life were associated with the incidence of BPD in VLBW neonates. PC may also predict the severity of BPD in these infants.

PMID:37155211 | DOI:10.23736/S2724-5276.23.07213-0

JAMA Intern Med. 2023 May 8. doi: 10.1001/jamainternmed.2023.1116. Online ahead of print.

ABSTRACT

IMPORTANCE: Low-dose computed tomography (LDCT) lung screening has been shown to reduce lung cancer mortality. Significant incidental findings (SIFs) have been widely reported in patients undergoing LDCT lung screening. However, the exact nature of these SIF findings has not been described.

OBJECTIVE: To describe SIFs reported in the LDCT arm of the National Lung Screening Trial and classify SIFs as reportable or not reportable to the referring clinician (RC) using the American College of Radiology’s white papers on incidental findings.

DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective case series study of 26 455 participants in the National Lung Screening Trial who underwent at least 1 screening examination with LDCT. The trial was conducted from 2002 to 2009, and data were collected at 33 US academic medical centers.

MAIN OUTCOMES AND MEASURES: Significant incident findings were defined as a final diagnosis of a negative screen result with significant abnormalities that were not suspicious for lung cancer or a positive screen result with emphysema, significant cardiovascular abnormality, or significant abnormality above or below the diaphragm.

RESULTS: Of 26 455 participants, 10 833 (41.0%) were women, the mean (SD) age was 61.4 (5.0) years, and there were 1179 (4.5%) Black, 470 (1.8%) Hispanic/Latino, and 24 123 (91.2%) White individuals. Participants were scheduled to undergo 3 screenings during the course of the trial; the present study included 75 126 LDCT screening examinations performed for 26 455 participants. A SIF was reported for 8954 (33.8%) of 26 455 participants who were screened with LDCT. Of screening tests with a SIF detected, 12 228 (89.1%) had a SIF considered reportable to the RC, with a higher proportion of reportable SIFs among those with a positive screen result for lung cancer (7632 [94.1%]) compared with those with a negative screen result (4596 [81.8%]). The most common SIFs reported included emphysema (8677 [43.0%] of 20 156 SIFs reported), coronary artery calcium (2432 [12.1%]), and masses or suspicious lesions (1493 [7.4%]). Masses included kidney (647 [3.2%]), liver (420 [2.1%]), adrenal (265 [1.3%]), and breast (161 [0.8%]) abnormalities. Classification was based on free-text comments; 2205 of 13 299 comments (16.6%) could not be classified. The hierarchical reporting of final diagnosis in NLST may have been associated with an overestimate of severe emphysema in participants with a positive screen result for lung cancer.

CONCLUSIONS AND RELEVANCE: This case series study found that SIFs were commonly reported in the LDCT arm of the National Lung Screening Trial, and most of these SIFs were considered reportable to the RC and likely to require follow-up. Future screening trials should standardize SIF reporting.

PMID:37155190 | DOI:10.1001/jamainternmed.2023.1116

J Dig Dis. 2023 May 8. doi: 10.1111/1751-2980.13174. Online ahead of print.

ABSTRACT

OBJECTIVES: Autoimmune hepatitis (AIH) is an aberrant autoimmune condition mediated by T cell abnormality, which can drive fulminant liver failure or persistent liver injury. The study is undertaken to disclose the histopathological and functional engagement of cytokine IL-26, a potent inflammation mediator, in AIH disease progression.

METHODS: We conducted immunochemistry staining on collected liver biopsy samples to evaluate intrahepatic expression of IL-26. Cellular sources of hepatic IL-26 were detected by confocal microscopy. Flow cytometric was employed to determine the immunological alterations of CD4⁺ and CD8⁺ T cells following in vitro IL-26 treatment on primary peripheral blood mononuclear cells from healthy volunteers.

RESULTS: We present a statistically significant increase of IL-26 in AIH (n=48) liver lesions in comparison with chronic hepatitis B (n=25), non-alcoholic liver diseases (n=18) and healthy controls (n=10). Numbers of intrahepatic IL-26⁺ cells suggested a positive correlation with disease severity and serological indices. Immunofluorescence study indicated that infiltrating CD4⁺ , CD8⁺ T cells and CD68⁺ macrophages orchestrated IL-26 secretion in AIH. Lastly, both CD4⁺ and CD8⁺ T cell delineations demonstrated effective activation, lytic and pro-inflammation functions upon IL-26 stimulation.

CONCLUSIONS: We scrutinized elevated IL-26 in AIH liver which fostered T cell activation, migration and cytotoxic capacity, indicating a therapeutic potential of IL-26 intervention in AIH. This article is protected by copyright. All rights reserved.

PMID:37155188 | DOI:10.1111/1751-2980.13174

JAMA Netw Open. 2023 May 1;6(5):e239739. doi: 10.1001/jamanetworkopen.2023.9739.

ABSTRACT

IMPORTANCE: Although racial and ethnic minority patients with sepsis and acute respiratory failure (ARF) experience worse outcomes, how patient presentation characteristics, processes of care, and hospital resource delivery are associated with outcomes is not well understood.

OBJECTIVE: To measure disparities in hospital length of stay (LOS) among patients at high risk of adverse outcomes who present with sepsis and/or ARF and do not immediately require life support and to quantify associations with patient- and hospital-level factors.

DESIGN, SETTING, AND PARTICIPANTS: This matched retrospective cohort study used electronic health record data from 27 acute care teaching and community hospitals across the Philadelphia metropolitan and northern California areas between January 1, 2013, and December 31, 2018. Matching analyses were performed between June 1 and July 31, 2022. The study included 102 362 adult patients who met clinical criteria for sepsis (n = 84 685) or ARF (n = 42 008) with a high risk of death at the time of presentation to the emergency department but without an immediate requirement for invasive life support.

EXPOSURES: Racial or ethnic minority self-identification.

MAIN OUTCOMES AND MEASURES: Hospital LOS, defined as the time from hospital admission to the time of discharge or inpatient death. Matches were stratified by racial and ethnic minority patient identity, comparing Asian and Pacific Islander patients, Black patients, Hispanic patients, and multiracial patients with White patients in stratified analyses.

RESULTS: Among 102 362 patients, the median (IQR) age was 76 (65-85) years; 51.5% were male. A total of 10.2% of patients self-identified as Asian American or Pacific Islander, 13.7% as Black, 9.7% as Hispanic, 60.7% as White, and 5.7% as multiracial. After matching racial and ethnic minority patients to White patients on clinical presentation characteristics, hospital capacity strain, initial intensive care unit admission, and the occurrence of inpatient death, Black patients experienced longer LOS relative to White patients in fully adjusted matches (sepsis: 1.26 [95% CI, 0.68-1.84] days; ARF: 0.97 [95% CI, 0.05-1.89] days). Length of stay was shorter among Asian American and Pacific Islander patients with ARF (-0.61 [95% CI, -0.88 to -0.34] days) and Hispanic patients with sepsis (-0.22 [95% CI, -0.39 to -0.05] days) or ARF (-0.47 [-0.73 to -0.20] days).

CONCLUSIONS AND RELEVANCE: In this cohort study, Black patients with severe illness who presented with sepsis and/or ARF experienced longer LOS than White patients. Hispanic patients with sepsis and Asian American and Pacific Islander and Hispanic patients with ARF both experienced shorter LOS. Because matched differences were independent of commonly implicated clinical presentation-related factors associated with disparities, identification of additional mechanisms that underlie these disparities is warranted.

PMID:37155170 | DOI:10.1001/jamanetworkopen.2023.9739

JAMA Netw Open. 2023 May 1;6(5):e2312140. doi: 10.1001/jamanetworkopen.2023.12140.

ABSTRACT

IMPORTANCE: During the first year of the COVID-19 pandemic, there was a substantial increase in the rate of death in the United States. It is unclear whether those who had access to comprehensive medical care through the Department of Veterans Affairs (VA) health care system had different death rates compared with the overall US population.

OBJECTIVE: To quantify and compare the increase in death rates during the first year of the COVID-19 pandemic between individuals who received comprehensive medical care through the VA health care system and those in the general US population.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study compared 10.9 million enrollees in the VA, including 6.8 million active users of VA health care (those with a visit in the last 2 years), with the general population of the US, with deaths occurring from January 1, 2014, to December 31, 2020. Statistical analysis was conducted from May 17, 2021, to March 15, 2023.

MAIN OUTCOMES AND MEASURES: Changes in rates of death from any cause during the COVID-19 pandemic in 2020 compared with previous years. Changes in all-cause death rates by quarter were stratified by age, sex, race and ethnicity, and region, based on individual-level data. Multilevel regression models were fit in a bayesian setting. Standardized rates were used for comparison between populations.

RESULTS: There were 10.9 million enrollees in the VA health care system and 6.8 million active users. The demographic characteristics of the VA populations were predominantly male (>85% in the VA health care system vs 49% in the general US population), older (mean [SD], 61.0 [18.2] years in the VA health care system vs 39.0 [23.1] years in the US population), and had a larger proportion of patients who were White (73% in the VA health care system vs 61% in the US population) or Black (17% in the VA health care system vs 13% in the US population). Increases in death rates were apparent across all of the adult age groups (≥25 years) in both the VA populations and the general US population. Across all of 2020, the relative increase in death rates compared with expected values was similar for VA enrollees (risk ratio [RR], 1.20 [95% CI, 1.14-1.29]), VA active users (RR, 1.19 [95% CI, 1.14-1.26]), and the general US population (RR, 1.20 [95% CI, 1.17-1.22]). Because the prepandemic standardized mortality rates were higher in the VA populations prior to the pandemic, the absolute rates of excess mortality were higher in the VA populations.

CONCLUSIONS AND RELEVANCE: In this cohort study, a comparison of excess deaths between populations suggests that active users of the VA health system had similar relative increases in mortality compared with the general US population during the first 10 months of the COVID-19 pandemic.

PMID:37155169 | DOI:10.1001/jamanetworkopen.2023.12140

J Urban Health. 2023 May 8. doi: 10.1007/s11524-023-00728-9. Online ahead of print.

ABSTRACT

Urbanization is accelerating in developing countries, which are simultaneously experiencing a rise in the prevalence of overnutrition (i.e., overweight and obesity), specifically among women. Since urbanization is a dynamic process, a continuous measure may better represent it when examining its association with overnutrition. However, most previous research has used a rural-urban dichotomy-based urbanization measure. This study utilized satellite-based night-time light intensity (NTLI) data to measure urbanization and evaluate its association with body weight in reproductive-aged (15-49) women in Bangladesh. Multilevel models estimated the association between residential area NTLI and women’s body mass index (BMI) or overnutrition status using data from the latest Bangladesh Demographic and Health Survey (BDHS 2017-18). Higher area-level NTLI was associated with a higher BMI and increased odds of being overweight and obese in women. Living in areas with moderate NTL intensities was not linked with women’s BMI measures, whereas living in areas with high NTL intensities was associated with a higher BMI or higher odds of being overweight and obese. The predictive nature of NTLI suggests that it could be used to study the relationship between urbanization and overnutrition prevalence in Bangladesh, though more longitudinal research is needed. This research emphasizes the necessity for preventive efforts to offset the expected public health implications of urbanization.

PMID:37155139 | DOI:10.1007/s11524-023-00728-9

Can J Anaesth. 2023 May 8. doi: 10.1007/s12630-023-02426-1. Online ahead of print.

ABSTRACT

PURPOSE: Ancillary tests are frequently used in death determination by neurologic criteria (DNC), particularly when the clinical neurologic examination is unreliable. Nevertheless, their diagnostic accuracy has not been extensively studied. Our objective was to synthesize the sensitivity and specificity of commonly used ancillary tests for DNC.

SOURCE: We performed a systematic review and meta-analysis by searching MEDLINE, EMBASE, Cochrane databases, and CINAHL Ebsco from their inception to 4 February 2022. We selected cohort and case-control studies including patients with 1) clinically diagnosed death by neurologic criteria or 2) clinically suspected death by neurologic criteria who underwent ancillary testing for DNC. We excluded studies without a priori diagnostic criteria and studies conducted solely on pediatric patients. Accepted reference standards were clinical examination, four-vessel conventional angiography, and radionuclide imaging. Data were directly extracted from published reports. We assessed the methodological quality of studies with the QUADAS-2 tool and estimated ancillary test sensitivities and specificities using hierarchical Bayesian models with diffuse priors.

PRINCIPAL FINDINGS: Overall, 137 records met the selection criteria. One study (0.7%) had a low risk of bias in all QUADAS-2 domains. Among clinically diagnosed death by neurologic criteria patients (n = 8,891), ancillary tests had similar pooled sensitivities (range, 0.82-0.93). Sensitivity heterogeneity was greater within (σ = 0.10-0.15) than between (σ = 0.04) ancillary test types. Among clinically suspected death by neurologic criteria patients (n = 2,732), pooled ancillary test sensitivities ranged between 0.81 and 1.00 and specificities between 0.87 and 1.00. Most estimates had high statistical uncertainty.

CONCLUSION: Studies assessing ancillary test diagnostic accuracy have an unclear or high risk of bias. High-quality studies are required to thoroughly validate ancillary tests for DNC.

STUDY REGISTRATION: PROSPERO (CRD42013005907); registered 7 October 2013.

PMID:37155120 | DOI:10.1007/s12630-023-02426-1

Phys Eng Sci Med. 2023 May 8. doi: 10.1007/s13246-023-01265-0. Online ahead of print.

ABSTRACT

The combination of visual assessment of whole body [¹⁸F]FDG PET images and evaluation of bone marrow samples by Multiparameter Flow Cytometry (MFC) or Next-Generation Sequencing (NGS) is currently the most common clinical practice for the detection of Measurable Residual Disease (MRD) in Multiple Myeloma (MM) patients. In this study, radiomic features extracted from the bone marrow biopsy locations are analyzed and compared to those extracted from the whole bone marrow in order to study the representativeness of these biopsy locations in the image-based MRD assessment. Whole body [¹⁸F]FDG PET of 39 patients with newly diagnosed MM were included in the database, and visually evaluated by experts in nuclear medicine. A methodology for the segmentation of biopsy sites from PET images, including sternum and posterior iliac crest, and their subsequent quantification is proposed. First, starting from the bone marrow segmentation, a segmentation of the biopsy sites is performed. Then, segmentations are quantified extracting SUV metrics and radiomic features from the [¹⁸F]FDG PET images and are evaluated by Mann-Whitney U-tests as valuable features differentiating PET+/PET- and MFC+ /MFC- groups. Moreover, correlation between whole bone marrow and biopsy sites is studied by Spearman ρ rank. Classification performance of the radiomics features is evaluated applying seven machine learning algorithms. Statistical analyses reveal that some images features are significant in PET+/PET- differentiation, such as SUV_max, Gray Level Non-Uniformity or Entropy, especially with a balanced database where 16 of the features show a p value < 0.001. Correlation analyses between whole bone marrow and biopsy sites results in significant and acceptable coefficients, with 11 of the variables reaching a correlation coefficient greater than 0.7, with a maximum of 0.853. Machine learning algorithms demonstrate high performances in PET+/PET- classification reaching a maximum AUC of 0.974, but not for MFC+/MFC- classification. The results demonstrate the representativeness of sample sites as well as the effectiveness of extracted features (SUV metrics and radiomic features) from the [¹⁸F]FDG PET images in MRD assessment in MM patients.

PMID:37155114 | DOI:10.1007/s13246-023-01265-0

Environ Sci Pollut Res Int. 2023 May 8. doi: 10.1007/s11356-023-27417-z. Online ahead of print.

ABSTRACT

Hotter and drier weather conditions due to climate change negatively affect water resources and agricultural production. For this reason, it is vital to analyze the change in potential evapotranspiration (PET) values, which is one of the most important parameters related to plant growth and agricultural irrigation planning. This study analyses the trends and changes in monthly and annual PET values between 1965 and 2018 at Erzincan, Bayburt and Gümüşhane meteorological stations in Turkey. For this purpose, monotonic trends in PET values were determined by Spearman’s rho (SR), Mann-Kendall (MK), Şen slope (SS), and innovative trend analysis (ITA) tests and change points were analyzed with the sequential MK (SQMK) test. The Hargreaves equation was used to calculate the PET values. As a result of the study, according to MK and SR tests, while increasing trends at 95% and 99% significance levels were dominant at Erzincan and Bayburt stations, no statistically significant trends were found at Gümüşhane station except in February. ITA generally detected more than 5% increasing trends in PET data’s low, medium, and high values. According to ITA slope analysis, there are significant increase trends in PET values at all periods, trend 1% significance level. According to the SQMK test, it was revealed that the trend started in PET values, especially in 1995, 2005, and 2010. The findings emphasized the importance of taking measures against decreased agricultural production and managing water resources effectively.

PMID:37155102 | DOI:10.1007/s11356-023-27417-z

Environ Sci Pollut Res Int. 2023 May 8. doi: 10.1007/s11356-023-27383-6. Online ahead of print.

ABSTRACT

Many studies have incorporated particular models with various methods and algorithms to resolve the site selection problem for electric vehicle charging stations (EVCS). This paper systematically reviews research that evaluates geographic information systems (GIS) based EVCS location techniques and the variables used for decision making. We classify and characterize those techniques and variables to determine important linkages within the literature. A variety of databases were referenced to extract research published from 2010 to March 2023 pertinent to this specific location optimization problem, and 74 papers were selected after thorough evaluation. The models used in each paper were examined along with the methods for selecting variables and ranking alternate locations. Site selection for EVCS requires a multi-criteria decision making approach to meet the sustainability, efficiency, and performance goals of communities adopting electric vehicle mobility. Our results indicate that map algebra and data overlay methods have been used more frequently with GIS-based analysis than other techniques, while geographic and demographic variables are commonly the most significant site selection characteristics. The reviewed methods have most often been applied to urban locations; however, the transfer of these techniques to a rural EVCS site selection problem has been rarely explored in the current literature. This research assessment contributes relevant guidance for the application of methodologies useful in policymaking and provides recommendations for future research based on these findings.

PMID:37155094 | DOI:10.1007/s11356-023-27383-6