Category: Nevin Manimala

Dermatol Surg. 2023 Apr 26. doi: 10.1097/DSS.0000000000003784. Online ahead of print.

ABSTRACT

BACKGROUND: Actinic keratoses (AKs) are common and some may evolve into squamous cell carcinoma. Photodynamic therapy (PDT), imiquimod, cryotherapy, and other methods have been reported to have good effects. However, which treatment is the most effective with the best cosmetic results and fewest complications is uncertain.

OBJECTIVE: To evaluate which method has the best efficacy and cosmetic results with less adverse events and recurrence rate.

MATERIALS AND METHODS: All relevant articles up to July 31, 2022 were searched from Cochrane, Embase, and PubMed databases. Extract and analyze the data of efficacy, cosmetic results, local reactions, and adverse effects.

RESULTS: Twenty-nine articles with 3,,850 participants and 24,747 lesions were included. Quality of evidence was generally high. The efficacy of PDT was better in complete response (CR) (lesions CR; risk ratio (RR) 1.87; 95% confidence interval (CI) 1.55-1.87/patient CR; RR 3.07; 95% CI 2.07-4.56), overall preference, and cosmetic results. The time cumulative meta-analysis showed that the curative effect was gradually increasing before 2004, and then gradually stabilizing. Two groups showed no statistically significant differences in recurrence.

CONCLUSION: Compared with other methods, PDT is significantly more effective for AK with excellent cosmetic results and reversible adverse effects.

PMID:37134239 | DOI:10.1097/DSS.0000000000003784

Dermatol Surg. 2023 Apr 26. doi: 10.1097/DSS.0000000000003811. Online ahead of print.

ABSTRACT

BACKGROUND: Medical spa and cosmetic procedure markets have grown substantially in recent years. The lack of consistent medical oversight at medical spas raises safety concerns.

OBJECTIVE: To understand how the public views medical spas compared with physician’s offices as places to receive cosmetic procedures with a focus on safety.

METHODS: 1,108 people were surveyed on an internet platform about their perceptions of the safety of receiving cosmetic procedures at medical spas and physician’s offices. Respondents were grouped by their past experiences. Chi-squared and analysis of variance models were used to determine statistically significant differences between groups at the 0.05 level.

RESULTS: Respondents who had only received cosmetic procedures at physician’s offices or had never received a cosmetic procedure cared more about being treated by a physician (p < .001) and rated safety as more important (p = .03). Total complication rates were numerically higher at medical spas compared with physician’s offices (p = .41). Minimally invasive skin tightening (0.77 vs 0.0, p < .001) and nonsurgical fat reduction (0.80 vs 0.36, p = .04) had higher complication rates at medical spas.

CONCLUSION: There were concerns among the public about the safety of cosmetic procedures at medical spas, and some procedures demonstrated higher complication rates in this setting.

PMID:37134224 | DOI:10.1097/DSS.0000000000003811

Big Data. 2023 May 3. doi: 10.1089/big.2022.0082. Online ahead of print.

ABSTRACT

With the acceleration of urbanization, air pollution, especially PM_2.5, has seriously affected human health and reduced people’s life quality. Accurate PM_2.5 prediction is significant for environmental protection authorities to take actions and develop prevention countermeasures. In this article, an adapted Kalman filter (KF) approach is presented to remove the nonlinearity and stochastic uncertainty of time series, suffered by the autoregressive integrated moving average (ARIMA) model. To further improve the accuracy of PM_2.5 forecasting, a hybrid model is proposed by introducing an autoregressive (AR) model, where the AR part is used to determine the state-space equation, whereas the KF part is used for state estimation on PM_2.5 concentration series. A modified artificial neural network (ANN), called AR-ANN is introduced to compare with the AR-KF model. According to the results, the AR-KF model outperforms the AR-ANN model and the original ARIMA model on the predication accuracy; that is, the AR-ANN obtains 10.85 and 15.45 of mean absolute error and root mean square error, respectively, whereas the ARIMA gains 30.58 and 29.39 on the corresponding metrics. It, therefore, proves that the presented AR-KF model can be adopted for air pollutant concentration prediction.

PMID:37134205 | DOI:10.1089/big.2022.0082

J Am Acad Orthop Surg Glob Res Rev. 2023 May 2;7(5). doi: 10.5435/JAAOSGlobal-D-22-00195. eCollection 2023 May 1.

ABSTRACT

INTRODUCTION: Hip fractures in geriatric populations constitute a heavy burden on the healthcare system. The study goal was to identify patient, hospital, and surgical factors associated with hospital length of stay (LOS) for geriatric patients with hip fractures requiring surgical intervention in a community hospital setting.

METHODS: This was a cross-sectional retrospective chart review of geriatric hip fractures that underwent surgical fixation at a community hospital between 2017 and 2019. The scope of the surgeries was limited to cephalomedullary device fixation or hemiarthroplasty hip fracture surgeries. Sliding hip screw or total hip arthroplasty procedures and patients who died during the index hospitalization were excluded. Median tests were conducted to examine differences between the groups. Unadjusted and adjusted truncated negative binomial regression models were used to examine the factors associated with LOS.

RESULTS: Bivariate analyses revealed results that the factors associated with a longer LOS were preoperative anemia (P = 0.029), blood transfusion (P = 0.022), and the number of days between admission and surgery (P = 0.001). The adjusted regression model results suggested that older patients, patients who underwent surgery more than one day after admission, current smokers, malnourished patients, patients with sepsis, and patients with a history of a thromboembolic event had statistically significant (P < 0.05) longer LOS. However, patients who live in institutions (nursing homes or assisted living) had a shorter LOS than those who live at home alone or with family (P < 0.05).

DISCUSSION: Older adult patients who underwent surgery with a cephalomedullary device or hip hemiarthroplasty for a hip fracture and had preoperative anemia, postoperative blood transfusions, and increased days between admission and surgery had a longer LOS. Additional factors positively associated with a longer LOS included current smokers, malnourishment, admission with sepsis, and patients with a history of a thromboembolic event. Of interest, institutionalized patients had a shorter LOS than those living at home alone or with family.

PMID:37134192 | DOI:10.5435/JAAOSGlobal-D-22-00195

Sci Adv. 2023 May 3;9(18):eadg1971. doi: 10.1126/sciadv.adg1971. Epub 2023 May 3.

ABSTRACT

The extreme precision of optical atomic clocks has led to an anticipated redefinition of the second by the International System of Units. Furthermore, accuracies pushing the boundary of 1 part in 10¹⁸ and beyond will enable new applications, such as in geodesy and tests of fundamental physics. The ¹S₀ to ³D₁ optical transition in ¹⁷⁶Lu⁺ has exceptionally low sensitivity to external perturbations, making it suitable for practical clock implementations with inaccuracy at or below 10^-18. Here, we perform high-accuracy comparisons between two ¹⁷⁶Lu⁺ references using correlation spectroscopy. A comparison at different magnetic fields is used to obtain a quadratic Zeeman coefficient of -4.89264(88) Hz/mT for the reference frequency. With a subsequent comparison at low field, we demonstrate agreement at the low 10^-18 level, statistically limited by the averaging time of 42 hours. The evaluated uncertainty in the frequency difference is 9 × 10^-19 and the lowest reported in comparing independent optical references.

PMID:37134164 | DOI:10.1126/sciadv.adg1971

J Magn Reson Imaging. 2023 May 3. doi: 10.1002/jmri.28763. Online ahead of print.

ABSTRACT

BACKGROUND: Venous tumor thrombus (VTT) consistency of renal cell carcinoma (RCC) is an important consideration in nephrectomy plus thrombectomy. However, evaluation of VTT consistency through preoperative MR imaging is lacking.

PURPOSE: To evaluate VTT consistency of RCC through intravoxel incoherent motion-diffusion weighted imaging (IVIM-DWI) derived parameters (D_t , D_p , f, and ADC) and the apparent diffusion coefficient (ADC) value.

STUDY TYPE: Retrospective.

POPULATION: One hundred and nineteen patients (aged 55.8 ± 11.5 years, 85 male) with histologically-proven RCC and VTT who underwent radical resection.

FIELD STRENGTH/SEQUENCES: 3.0-T; two-dimensional single-shot diffusion-weighted echo planar imaging sequence at 9 b-values (0-800 s/mm² ).

ASSESSMENT: IVIM parameters and ADC values of the primary tumor and the VTT were calculated. The VTT consistency (friable vs. solid) was determined through intraoperative findings of two urologists. The accuracy of VTT consistency classification based on the individual IVIM parameters of primary tumors and of VTT, and based on models combining parameters, was assessed. Type of operation, intra-operative blood loss, and operation length were recorded.

STATISTICAL TESTS: Shapiro-Wilk test; Mann-Whitney U test; Student’s t-test; Chi-square test; Receiver operating characteristic (ROC) analysis. Statistical significance level was P < 0.05.

RESULTS: Of the enrolled 119 patients, 33 patients (27.7%) had friable VTT. Patients with friable VTT were significantly more likely to experience open surgery, have significantly more intraoperative blood loss, and significantly longer operative duration. The area under the ROC curve (AUC) values of D_t of the primary tumor and VTT in classifying VTT consistency were 0.758 (95% CI 0.671-0.832) and 0.712 (95% CI 0.622-0.792), respectively. The AUC value of the model combining D_p and D_t of VTT was 0.800 (95% CI 0.717-0.868). Furthermore, the AUC of the model combining D_p and D_t of VTT and D_t of the primary tumor was 0.886 (95% CI 0.814-0.937).

CONCLUSION: IVIM-derived parameters had the potential to predict VTT consistency of RCC.

EVIDENCE LEVEL: 3 Technical Efficacy: Stage 2.

PMID:37134147 | DOI:10.1002/jmri.28763

Spine (Phila Pa 1976). 2023 Apr 27. doi: 10.1097/BRS.0000000000004695. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective study.

SUMMARY OF BACKGROUND DATA: Research has shown that the use of NSAIDs and COX-2 inhibitors increases the risk of pseudoarthrosis following spinal fusion surgery. Pseudoarthrosis can lead to complications such as chronic pain and the need for additional surgeries.

OBJECTIVE: The purpose of this study was to examine the relationship between NSAID and COX-2 inhibitor use and pseudarthrosis, hardware complications, and revision surgeries in patients undergoing posterior spinal instrumentation and fusion.

METHODS: We queried the PearlDiver database using CPT and ICD-10 codes to identify patients between the ages of 50 and 85 who underwent posterior spinal instrumentation between 2016 and 2019 and experienced pseudarthrosis, hardware failure, or revision surgery. Information regarding age, Charlson Comorbidity Index (CCI), tobacco use, osteoporosis, and obesity were extracted from the database along with COX-2 or NSAID use during the first 6-week post-surgery period. Logistic regression was used to identify associations while adjusting for confounders.

RESULTS: There were 178,758 patients included in the cohort; 9,586 experienced pseudarthrosis (5.36%), 2,828 (1.58%) experienced hardware failure, and 10,457 (5.85%) patients underwent revision fusion surgery. Of these patients 23,602 (13.2%) filled NSAID and 5,278 (2.95%) filled COX-2 prescriptions. A significantly higher proportion of patients using NSAIDs experienced pseudarthrosis, hardware failure, and revision surgery compared to patients not taking NSAIDs. COX-2 inhibitors were also associated with a significantly higher rate of pseudarthrosis, hardware failure, and revision surgery. Postoperative ketorolac use was not associated with these complications. Regression models demonstrated that both NSAIDs and COX-2 inhibitors were associated with statistically higher pseudarthrosis, hardware failure, and revision surgery rates.

CONCLUSIONS: Both NSAID and COX-2 inhibitor use in the early post-surgical period may be associated with increased rates of pseudarthrosis, hardware failure, and revision surgery in patients undergoing posterior spinal instrumentation and fusion.

PMID:37134137 | DOI:10.1097/BRS.0000000000004695

Arthritis Rheumatol. 2023 May 3. doi: 10.1002/art.42556. Online ahead of print.

ABSTRACT

OBJECTIVE: Interindividual variability in response to rituximab remains unexplored in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides. Rituximab pharmacokinetics (PK) and pharmacodynamics (PD) as well as genetic polymorphisms could contribute to variability. This ancillary study of the MAINRITSAN 2 trial aimed to explore the relationship between rituximab plasma concentration, genetic polymorphisms in PK/PD candidate genes, and clinical outcomes.

METHODS: Patients included in the MAINRITSAN2 trial (NCT01731561) were randomized to receive a 500 mg fixed-schedule RTX infusion or an individually-tailored regimen. Rituximab plasma concentrations at month 3 (C_M3 ) were assessed. DNA samples (n = 53) were genotyped for single nucleotide polymorphisms within 88 putative PK/PD candidate genes. The relationship between PK/PD outcomes and genetic variants was investigated using logistic linear regression in additive and recessive genetic models.

RESULTS: One hundred and thirty-five patients were included. The frequency of underexposed patients (<4 μg/mL) in the fixed-schedule group was statistically lower compared to that in the tailored-infusion group (2.0% vs. 18.0%; p = 0.02, respectively). Low RTX plasma concentration at 3 months (C_M3 <4 μg/mL) was an independent risk factor for major relapse (odds ratio = 6.56; 95% CI 1.26-34.09; p = 0.025) at month 28 (M28). A sensitivity survival analysis also identified C_M3 <4 μg/mL as an independent risk factor for major relapse (Hazard ratio [HR] = 4.81; 95% CI 1.56-14.82; p = 0.006) and relapse (HR = 2.70; 95% CI 1.02-7.15; p = 0.046). STAT4 rs2278940 and PRKCA rs8076312 were significantly associated with C_M3 but not with major relapse onset at M28.

CONCLUSION: These results suggest that drug monitoring could be useful to individualize the schedule of rituximab administration within the maintenance phase. This article is protected by copyright. All rights reserved.

PMID:37134130 | DOI:10.1002/art.42556

PLoS One. 2023 May 3;18(5):e0284052. doi: 10.1371/journal.pone.0284052. eCollection 2023.

ABSTRACT

INTRODUCTION: Despite the burden of cardiovascular disease (CVD) continuing to increase globally, no comprehensive meta-analyses have been conducted quantifying premature CVD mortality. This paper reports the protocol for a systematic review and meta-analysis to derive updated estimates of premature CVD mortality.

METHODS AND EXPECTED OUTPUTS: This review will include the studies that reported premature CVD mortality based on standard premature mortality indicators, including years of life lost (YLL), age standardized mortality rate (ASMR) or standardised mortality ratio (SMR). PUBMED, Scopus, Web of Science (WoS), CINAHL, and Cochrane Central Register of Controlled Trials (CENTRAL) will be used as the literature databases. The study selection as well as the evaluation of the quality of the included articles will be done independently by two reviewers. Pooled estimates of YLL, ASMR, and SMR will be computed by applying random-effects meta-analysis. Heterogeneity among selected studies will be assessed using the I2 statistic and Q statistic with associated p-values. A funnel plot analysis and Egger’s test will be conducted to assess the potential impact of publication bias. Depending on data availability, we propose to conduct subgroup analyses by sex, geographic location, main CVD types, and study time. Reporting of our findings will follow the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines.

CONCLUSION: Our meta-analysis will provide a comprehensive synthesis of the available evidence on premature CVD mortality, which is a major public health concern worldwide. The results of this meta-analysis will have important implications for clinical practice and public health policy, providing insights into strategies to prevent and manage premature CVD mortality.

TRIAL REGISTRATION: Systematic review registration: PROSPERO CRD42021288415. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021288415.

PMID:37134125 | DOI:10.1371/journal.pone.0284052

J Clin Psychiatry. 2023 May 1;84(3):22m14655. doi: 10.4088/JCP.22m14655.

ABSTRACT

Objective: The suicide crisis syndrome (SCS), an acute negative affect state predictive of near-term suicidal behavior, is currently under review for inclusion as a suicide-specific diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM). While the predictive validity of the SCS for near-term suicidal behavior is well documented, its real-world clinical utility has yet to be evaluated. As such, this study evaluated how implementation of a novel assessment tool, the Abbreviated SCS Checklist (A-SCS-C), into the electronic medical records (EMRs) influenced disposition decisions in the emergency departments (EDs) of a large urban health system.

Methods: Logistic regression analyses evaluated the impact of SCS diagnosis on 212 admission/discharge decisions after accounting for chief complaints of suicidal ideation (SI), suicidal behavior (SB), and psychosis/agitation.

Results: The A-SCS-C was concordant with 86.9% of all non-psychotic disposition decisions. In multivariable analysis, the A-SCS-C had an adjusted odds ratio (AOR) of 65.9 (95% confidence interval: 18.79-231.07) for inpatient admission, whereas neither suicidal ideation nor behavior was a significant predictor. The effect size remained very high in 3 sensitivity analyses, the first using information from a different section of the EMR, the second in patients younger than 18 years, and the third in males and females separately (AORs > 30).

Conclusions: SCS diagnosis, when implemented in ED EMRs alongside SI and SB, was strongly predictive of clinician decision making with regard to admission/discharge, particularly in non-psychotic patients, while SI and SB were noncontributory. Overall, our results show that the SCS, as a diagnostic entity, demonstrates robust clinical utility and may reduce the limitations of relying on self-reported SI as a primary basis of suicide risk assessment.

PMID:37134117 | DOI:10.4088/JCP.22m14655