Category: Nevin Manimala

Nat Commun. 2023 Feb 10;14(1):761. doi: 10.1038/s41467-022-35712-5.

ABSTRACT

The anticipation of progression of Alzheimer’s disease (AD) is crucial for evaluations of secondary prevention measures thought to modify the disease trajectory. However, it is difficult to forecast the natural progression of AD, notably because several functions decline at different ages and different rates in different patients. We evaluate here AD Course Map, a statistical model predicting the progression of neuropsychological assessments and imaging biomarkers for a patient from current medical and radiological data at early disease stages. We tested the method on more than 96,000 cases, with a pool of more than 4,600 patients from four continents. We measured the accuracy of the method for selecting participants displaying a progression of clinical endpoints during a hypothetical trial. We show that enriching the population with the predicted progressors decreases the required sample size by 38% to 50%, depending on trial duration, outcome, and targeted disease stage, from asymptomatic individuals at risk of AD to subjects with early and mild AD. We show that the method introduces no biases regarding sex or geographic locations and is robust to missing data. It performs best at the earliest stages of disease and is therefore highly suitable for use in prevention trials.

PMID:36765056 | DOI:10.1038/s41467-022-35712-5

BDJ Open. 2023 Feb 10;9(1):5. doi: 10.1038/s41405-023-00131-1.

ABSTRACT

OBJECTIVES: To determine the overall estimated financial impact and related expenses incurred over the duration of the undergraduate Dental Degree in Thailand.

METHODS: A cross-sectional survey was conducted among all 658 dental undergraduates in Mahidol University, Thailand. Data was collected through a self-administered questionnaire, including the following information: (1) “Background and Demographics”: household income, hometown, residence during study and source(s) of any financial aid received; (2) “Living Expenses”: Living costs including food, transportation, rent, utility bills, and recreational expenses; (3) “Education related expenses”: Including textbooks, stationeries, uniforms, and student activities fees. A cost-median was used as a baseline representation for the actual cost of each item. The mean differences of all expenses between groups before estimation was assessed by using the analysis of variance (ANOVA) method. The statistically significant differences were identified at p < 0.001.

RESULTS: The estimated adjusted cost of becoming a dentist in Thailand is THB1,265,027 (36,143.63 USD) for students living at home and THB1,823,027 (52,086.49 USD) for those renting accommodation. Students who rented accommodation incurred significantly higher yearly living expenses than those who were living at home. (p < 0.001). The majority of participants (78.4%) were in households having a middle-to-high socioeconomic status. Ninety-five percentages of the participants’ received 100% financial support from their families with no additional source of income, which reflects no real diversity in the socioeconomic background of Dental Degree students.

CONCLUSION: The cost of a higher education Dental Degree in Thailand can be a significant barrier to entry and financial burden, especially for students from disadvantaged socioeconomic backgrounds. Government and Educational Policy makers need to pay more attention to this issue in order to provide equal opportunities for obtaining a University Dental Degree for all Thai students wishing to pursue this career path.

PMID:36765031 | DOI:10.1038/s41405-023-00131-1

J Occup Environ Med. 2023 Feb 11. doi: 10.1097/JOM.0000000000002807. Online ahead of print.

ABSTRACT

OBJECTIVE: This prospective case-control study aimed to investigate the forms and conditions of respiratory effects in workers working in an Aluminum Profile Factory.

METHODS: All male (42 person, mean age: 32.2 ± 6.9) workers working in an Aluminum Profile Factory were compared with 33 controls.

RESULTS: The urinary aluminum levels of the workers were significantly higher than the control group. Complaints of cough, sputum, shortness of breath and wheezing were statistically significantly higher than the control group. In aluminum workers, those with dyspnea had a significantly higher urinary Al level than those without dyspnea.

CONCLUSION: It is thought that primary and secondary prevention are both important in the workplaces with aluminum exposure. Urinary aluminum level monitoring could be key to protecting the respiratory health of the workers.

PMID:36765029 | DOI:10.1097/JOM.0000000000002807

Pain Ther. 2023 Feb 10. doi: 10.1007/s40122-023-00479-0. Online ahead of print.

ABSTRACT

Acute low back pain (LBP) stands as a leading cause of activity limitation and work absenteeism, and its associated healthcare expenditures are expected to become substantial when acute LBP develops into a chronic and even refractory condition. Therefore, early intervention is crucial to prevent progression to chronic pain, for which the management is particularly challenging and the most effective pharmacological therapy is still controversial. Current guideline treatment recommendations vary and are mostly driven by expertise with opinion differing across different interventions. Thus, it is difficult to formulate evidence-based guidance when the relatively few randomized clinical trials have explored the diagnosis and management of LBP while employing different selection criteria, statistical analyses, and outcome measurements. This narrative review aims to provide a critical appraisal of current acute LBP management by discussing the unmet needs and areas of improvement from bench-to-bedside, and proposes multimodal analgesia as the way forward to attain an effective and prolonged pain relief and functional recovery in patients with acute LBP.

PMID:36765012 | DOI:10.1007/s40122-023-00479-0

Environ Sci Pollut Res Int. 2023 Feb 11. doi: 10.1007/s11356-023-25720-3. Online ahead of print.

ABSTRACT

Karnataka state has the second highest rainfed agricultural land in India, where agricultural output relies heavily on rainfall. The Shimsha basin, a sub-basin of Cauvery in the state, comes under a semi-arid region and predominantly consists of rainfed agricultural land. Rainfall patterns have changed dramatically with time resulting in frequent floods and droughts. Understanding the spatiotemporal distribution of rainfall and its change patterns in the area would benefit sustainable agriculture planning and water resources management practices. The current study aims to determine the variability and trend in rainfall. The daily rainfall data of the Shimsha basin from 1989 to 2018 is collected, and the annual, seasonal, and monthly rainfall totals and the number of rainy days are derived. All the time series are subjected to statistical methods to examine rainfall variability and trend. The mean, standard deviation, coefficient of variation (CV), and Standardized Anomaly Index are used for the preliminary and variability analysis, while the coefficient of skewness and kurtosis are used to understand the rainfall distribution characteristics. The homogenous and serially independent series are identified by homogeneity and serial correlation tests. The trend in the homogenous and serially independent series is identified by Mann-Kendall and Spearman’s rank correlation tests, while the magnitude of the trend is quantified using the Sen’s slope technique, and the trend change point is evaluated using the sequential Mann-Kendall test. Based on the study, the average rainfall in the study area is 801.86 mm, with CV ranging from 43.3 to 22.27%. The southwest monsoon (SWM) season brings the greatest rain to the basin, followed by the post-monsoon (PM), summer, and winter seasons. In the annual time frame, except one station, all other stations have shown significant or insignificant increasing trends. The seasonal rainfall has shown insignificant rising trends during the summer and winter seasons while insignificant increasing and decreasing trends during the PM season. The SWM season has indicated significant increasing trends, insignificant increasing and decreasing trends. Overall, the study area has noticed an increased annual and seasonal rainfall except for the post-monsoon season, during which the rainfall showed a considerable decline. The findings of the study are helpful in water resource management, agricultural planning, and socioeconomic development in the study area.

PMID:36764993 | DOI:10.1007/s11356-023-25720-3

J Neural Eng. 2023 Feb 10. doi: 10.1088/1741-2552/acbb2b. Online ahead of print.

ABSTRACT

OBJECTIVE: Suboptimal electrode placement during subthalamic deep brain stimulation (STN DBS) surgery may arise from several sources, including frame-based targeting errors and intraoperative brain shift. We present a computer algorithm that can accurately localize intraoperative microelectrode recording (MER) tracks on preoperative magnetic resonance imaging (MRI) in real-time, thereby predicting deviation between the surgical plan and the MER trajectories.

APPROACH: Random forest (RF) modeling was used to derive a statistical relationship between electrophysiological features on intraoperative MER and voxel intensity on preoperative T2-weighted MR imaging. This model was integrated into a larger algorithm that can automatically localize intraoperative MER recording tracks on preoperative MRI in real-time. To verify accuracy, targeting error of both the planned intraoperative trajectory (“planned”) and the algorithm-derived trajectory (“calculated”) was estimated by measuring deviation from the final DBS lead location on postoperative high-resolution computed tomography (“actual”).

MAIN RESULTS: MR imaging and MERs were obtained from 24 STN DBS implant trajectories. The cross-validated RF model could accurately distinguish between gray and white matter regions along MER trajectories (AUC 0.84). When applying this model within the localization algorithm, the calculated MER trajectory estimate was found to be significantly closer to the actual DBS lead when compared to the planned trajectory recorded during surgery (1.04 mm vs 1.52 mm deviation, p<0.002), with improvement shown in 19/24 cases (79%). When applying the algorithm to simulated DBS trajectory plans with randomized targeting error, up to 4 mm of error could be resolved to <2 mm on average (p<0.0001).

SIGNIFICANCE: This work presents an automated system for intraoperative localization of electrodes during STN DBS surgery. This neuroengineering solution may enhance the accuracy of electrode position estimation, particularly in cases where high-resolution intraoperative imaging is not available.

PMID:36763997 | DOI:10.1088/1741-2552/acbb2b

J Sex Med. 2023 Jan 30:qdac027. doi: 10.1093/jsxmed/qdac027. Online ahead of print.

ABSTRACT

INTRODUCTION: It is frequently quoted in mainstream media that the clitoris has “8000 nerve endings.” However, no study has yet quantified the number of nerve fibers (axons) innervating the human clitoris. The dorsal nerves of the clitoris (DNCs) are the primary source of sensation and somatic clitoral innervation. Therefore, reporting the number of axons in the DNCs is an important step in our understanding of clitoral innervation and sexual response with implications for many fields of medical practice. The purpose of this study is to quantify the mean number of axons in the human DNCs and to report the approximate mean number of nerve fibers that innervate the human glans clitoris.

METHODS: DNC samples were obtained from 7 transmasculine patients undergoing gender-affirming phalloplasty surgery. At the time of nerve coaptation, a small excess of the DNC (5 mm) was collected for analysis at the proximal level of the clitoral body, just distal of the emergence of the DNCs from underneath the pubic symphysis. Samples were placed into 3% glutaraldehyde fixative, postfixed in 1% osmium tetroxide, and serially dehydrated in ethanol and toluene. Samples were then embedded in araldite, sectioned on an ultramicrotome into 1-μm cross sections, and counterstained with 1% toluidine blue. Histomorphometric evaluation was performed at 1000x magnification with a Leitz Laborlux S microscope and image analysis software (Clemex Vision Professional) to obtain an axon counts. Descriptive statistics were performed to yield a mean and standard deviation of the number of axons in the DNCs. Assuming anatomic symmetry between bilateral DNCs, mean total number of somatic nerve fibers innervating the human glans clitoris was obtained by doubling the mean count of the DNCs.

RESULTS: Seven sample DNCs were collected. Of those, 5 were analyzed as 2 did not have sufficient nerve tissue present. The mean number of nerve fibers in the human DNCs was 5140 (SD = 218.4). The mean number of myelinated nerve fibers innervating the human clitoris was 10,281 (SD = 436.8).

CONCLUSION: This study is the first to report the number of axons in the human DNC, at a mean 5140. Given the bilateral nature of clitoral innervation and symmetry of anatomic structures, the approximate mean number of myelinated axons that innervate the human glans clitoris is 10,280. When the uncaptured unmyelinated fibers and contributions from the cavernosal innervation are accounted for, it is clear that far Moree than 8000 axons innervate the human clitoris.

PMID:36763957 | DOI:10.1093/jsxmed/qdac027

J Sex Med. 2023 Jan 23:qdac038. doi: 10.1093/jsxmed/qdac038. Online ahead of print.

ABSTRACT

BACKGROUND: Sexual dysfunction is the most common and most distressing consequence of prostate cancer (PCa) treatment and has been shown to directly affect the sexual function and quality of life of survivors’ partners. There are currently no established therapies to treat the emotional and psychological burden that sexual issues impose on the couple after PCa.

AIM: Our study examined the impact of 2 therapies-cognitive behavioral therapy (CBT) and mindfulness therapy-on sexual, relational, and psychological outcomes of PCa survivor and partner couples.

METHODS: PCa survivors (n = 68) who self-reported current sexual problems after PCa treatments and their partners were randomized to 4 consecutive weeks of couples’ mindfulness therapy, couples’ CBT, or no treatment (control).

OUTCOMES: Couples’ sexual distress, survivors’ sexual satisfaction, and couples’ relationship satisfaction, quality of life, psychological symptoms (anxiety and depression), and trait mindfulness were measured at baseline, 6 weeks after treatment, and 6 months after treatment.

RESULTS: Sexual distress and sexual satisfaction were significantly improved 6 weeks after the CBT and mindfulness interventions as compared with the control group, but only sexual distress remained significantly improved at 6 months. Relationship satisfaction decreased and more so for partners than survivors. There were increases in domains of quality of life for survivors vs their partners 6 months after treatments and an overall increase in general quality of life for couples 6 weeks after mindfulness. There were no significant changes in psychological symptoms and trait mindfulness. Qualitative analysis showed that the mindfulness intervention led to greater personal impact on couple intimacy after the study had ended.

CLINICAL IMPLICATIONS: CBT and mindfulness can be effective treatments for helping couples adapt to and cope with changes to their sexual function after PCa treatments and could help improve the most common concern for PCa survivors-that is, couples’ sexual intimacy-after cancer, if added to routine clinical care.

STRENGTHS AND LIMITATIONS: We used established standardized treatment manuals and highly sensitive statistical methodology and accounted for covariable factors and moderators of primary outcomes. Due to difficulty in recruitment, we had a smaller control group than treatment, reducing our power to detect between-group differences. Our sample was mostly White, heterosexual, and affluent, thereby limiting the generalizability.

CONCLUSION: This is the first randomized clinical trial to test and demonstrate benefits among PCa survivors and partners’ sexual outcomes after CBT and mindfulness as compared with a nontreatment control group.

PMID:36763954 | DOI:10.1093/jsxmed/qdac038

J Sex Med. 2023 Jan 12:qdac020. doi: 10.1093/jsxmed/qdac020. Online ahead of print.

ABSTRACT

BACKGROUND: With the infrapubic approach (IPA) for penile prosthesis implantation, lateral corporotomies carry the risk of injury to the laterally coursing dorsal nerves.

AIM: We sought to describe for the first time Shaeer’s IPA, a modification of the IPA whereby malleable penile prosthesis cylinders are implanted through a single midline corporotomy in the bed of the deep dorsal vein, anatomically off the course of the dorsal nerves of the penis.

METHODS: We compared semirigid penile prosthesis implantation via the single midline corporotomy IPA (IPA-S, n = 11) to the classic IPA with laterally placed dual corporotomies (IPA-D, n = 11) and to the penoscrotal approach (PSA; n = 13). Shaeer’s IPA is performed through an infrapubic incision. A 3- to 5-cm length of the deep dorsal vein is stripped. A single 3- to 5-cm midline corporotomy is cut along the bed of the vein. Dilation, sizing, and implantation are performed through the single corporotomy on either side of the midline septum. Patients are discharged the same day and are allowed to bend the implant after 2 weeks and to commence intercourse after 3 weeks.

OUTCOMES: Operative time, postoperative satisfaction, International Index of Erectile Function 5 (IIEF-5), and possible complications were recorded.

RESULTS: There were no statistically significant differences in age, postimplantation IIEF-5, or satisfaction between the 3 groups. Average operative time for the IPA-S group was 21.8% shorter than that for the IPA-D group, and 34.5% shorter than for the PSA group. Those differences were statistically significant. No complications were recorded in the IPA-S group. Infection occurred in 1 PSA case, and partial hypoesthesia in 1 IPA-D case.

CLINICAL IMPLICATIONS: The midline corporotomy confers an anatomical advantage that may help avoid nerve injury, thereby increasing the safety of the IPA.

STRENGTHS AND LIMITATIONS: The main limitation of this study is the limited sample number, considering that this is a pilot study.

CONCLUSION: The Shaeer’s Midline-Corporotomy IPA is a minimally invasive technique for implantation of a semirigid penile prosthesis, with an anatomical advantage that may decrease the possibility of dorsal nerve injury.

PMID:36763924 | DOI:10.1093/jsxmed/qdac020

JCO Oncol Pract. 2023 Feb 10:OP2200349. doi: 10.1200/OP.22.00349. Online ahead of print.

ABSTRACT

PURPOSE: Fertility discussions are an integral part of comprehensive care for pediatric, adolescent, and young adult patients newly diagnosed with cancer and are supported by national guidelines. Current institutional practices are poorly understood.

METHODS: A cross-sectional survey was distributed to 220 Children’s Oncology Group member institutions regarding fertility discussion practices. Descriptive statistics were calculated for all variables. The association between specific practices and selected outcomes on the basis of sex was examined via multivariable logistic regression.

RESULTS: One hundred forty-four programs (65.5%) returned surveys. Of these, 65 (45.1%) reported routine discussions of fertility with all female patients and 55 (38.5%) all male patients (P = .25). Ninety-two (63.8%) reported no specific criteria for offering females fertility preservation (FP), compared with 40 (27.7%) for males (P < .001). Program characteristics associated with fertility discussions included reproductive endocrinology and infertility on site (females odds ratio [OR], 2.1; 95% CI, 1.0 to 4.3), discussion documentation mandate (females OR, 2.3; 95% CI, 1.0 to 5.5; males OR, 3.5; 95% CI, 1.4 to 8.7), and cumulative institution-based FP infrastructure (which included [1] routine practice of documentation, [2] template for documentation, [3] mandate for documentation, and [4] availability of FP navigation; females OR, 1.6; 95% CI, 1.1 to 2.3; males OR, 2.3; 95% CI, 1.6 to 3.4). Utilization of practices unsupported by guidelines included offering sperm banking after treatment initiation (39/135 programs; 28.9%), gonadotropin-releasing hormone analogs for ovarian suppression/FP (75/144 programs; 52.1%), ovarian tissue cryopreservation at diagnosis for patients with leukemia (19/64 programs; 29.7%), and testicular tissue cryopreservation (23/138 programs; 16.7%) not part of a clinical trial.

CONCLUSION: Despite recommended guidelines, fertility discussions with patients/families before treatment initiation are not routine at Children’s Oncology Group institutions. Standard criteria to determine which options should be offered to patients are more common for males than females.

PMID:36763922 | DOI:10.1200/OP.22.00349