Category: Nevin Manimala

JAMA Netw Open. 2023 Mar 1;6(3):e233079. doi: 10.1001/jamanetworkopen.2023.3079.

ABSTRACT

IMPORTANCE: Social determinants of health (SDOHs) are known to be associated with increased risk of suicidal behaviors, but few studies use SDOHs from unstructured electronic health record notes.

OBJECTIVE: To investigate associations between veterans’ death by suicide and recent SDOHs, identified using structured and unstructured data.

DESIGN, SETTING, AND PARTICIPANTS: This nested case-control study included veterans who received care under the US Veterans Health Administration from October 1, 2010, to September 30, 2015. A natural language processing (NLP) system was developed to extract SDOHs from unstructured clinical notes. Structured data yielded 6 SDOHs (ie, social or familial problems, employment or financial problems, housing instability, legal problems, violence, and nonspecific psychosocial needs), NLP on unstructured data yielded 8 SDOHs (social isolation, job or financial insecurity, housing instability, legal problems, barriers to care, violence, transition of care, and food insecurity), and combining them yielded 9 SDOHs. Data were analyzed in May 2022.

EXPOSURES: Occurrence of SDOHs over a maximum span of 2 years compared with no occurrence of SDOH.

MAIN OUTCOMES AND MEASURES: Cases of suicide death were matched with 4 controls on birth year, cohort entry date, sex, and duration of follow-up. Suicide was ascertained by National Death Index, and patients were followed up for up to 2 years after cohort entry with a study end date of September 30, 2015. Adjusted odds ratios (aORs) and 95% CIs were estimated using conditional logistic regression.

RESULTS: Of 6 122 785 veterans, 8821 committed suicide during 23 725 382 person-years of follow-up (incidence rate 37.18 per 100 000 person-years). These 8821 veterans were matched with 35 284 control participants. The cohort was mostly male (42 540 [96.45%]) and White (34 930 [79.20%]), with 6227 (14.12%) Black veterans. The mean (SD) age was 58.64 (17.41) years. Across the 5 common SDOHs, NLP-extracted SDOH, on average, retained 49.92% of structured SDOHs and covered 80.03% of all SDOH occurrences. SDOHs, obtained by structured data and/or NLP, were significantly associated with increased risk of suicide. The 3 SDOHs with the largest effect sizes were legal problems (aOR, 2.66; 95% CI, 2.46-2.89), violence (aOR, 2.12; 95% CI, 1.98-2.27), and nonspecific psychosocial needs (aOR, 2.07; 95% CI, 1.92-2.23), when obtained by combining structured data and NLP.

CONCLUSIONS AND RELEVANCE: In this study, NLP-extracted SDOHs, with and without structured SDOHs, were associated with increased risk of suicide among veterans, suggesting the potential utility of NLP in public health studies.

PMID:36920391 | DOI:10.1001/jamanetworkopen.2023.3079

J Vis. 2023 Mar 1;23(3):7. doi: 10.1167/jov.23.3.7.

ABSTRACT

Ensemble perception refers to the visual system’s ability to efficiently represent groups of similar objects as a unified percept using their summary statistical information. Most studies focused on extraction of current trial averages, giving little attention to prior experience effects, although a few recent studies found that ensemble mean estimations contract toward previously presented stimuli, with most of these focusing on explicit perceptual averaging of simultaneously presented item ensembles. Yet, the time element is crucial in real dynamic environments, where we encounter ensemble items over time, aggregating information until reaching summary representations. Moreover, statistical information of objects and scenes is learned over time and often implicitly and then used for predictions that shape perception, promoting environmental stability. Therefore, we now focus on temporal aspects of ensemble statistics and test whether prior information, beyond the current trial, biases implicit perceptual decisions. We designed methods to separate current trial biases from those of previously seen trial ensembles. In each trial, six circles of different sizes were presented serially, followed by two test items. Participants were asked to choose which was present in the sequence. Participants unconsciously rely on ensemble statistics, choosing stimuli closer to the ensemble mean. To isolate the influence of earlier trials, the two test items were sometimes equidistant from the current trial mean. Results showed membership judgment biases toward current trial mean, when informative (largest effect). On equidistant trials, judgments were biased toward previously experienced stimulus statistics. Comparison of similar conditions with a shifted stimulus distribution ruled out a bias toward an earlier, presession, prototypical diameter. We conclude that ensemble perception, even for temporally experienced ensembles, is influenced not only by current trial mean but also by means of recently seen ensembles and that these influences are somewhat correlated on a participant-by-participant basis.

PMID:36920389 | DOI:10.1167/jov.23.3.7

J Orthop Trauma. 2023 Mar 6. doi: 10.1097/BOT.0000000000002595. Online ahead of print.

ABSTRACT

OBJECTIVE: Evaluate the species distribution and resistance patterns of bacterial pathogens causing surgical site infection (SSI) after operative fracture repair, with and without the use of intrawound powdered antibiotic (IPA) prophylaxis during the index surgery.

DESIGN: Retrospective cohort study.

SETTING: Academic, level 1 trauma center, 2018-2020.Patients/Participants: 59 deep SSIs were identified in a sample of 734 patients with 846 fractures (IPA [n=320], control [n=526]; open [n=157], closed fractures [n=689]) who underwent orthopaedic fracture care. Among SSIs, 28 (48%) patients received IPA prophylaxis and 25 (42%) of the fractures were open.

INTERVENTION: Intrawound powdered vancomycin and tobramycin.

MAIN OUTCOME MEASUREMENTS: Distribution of bacterial species and resistance patterns causing deep surgical site infections requiring operative debridement.

RESULTS: Zero patients developed infections caused by resistant strains of streptococci, enterococci, gram-negative enterics, Pseudomonas, or Cutibacterium species. The only resistant strains isolated were MRSA (19%) and oxacillin-resistant coagulase-negative staphylococci (16%). There was no associated statistical difference in the proportion of bacterial species isolated, their resistance profiles, or rate of polymicrobial infections between the IPA and control group. The vast majority (93%) of cases using IPAs included both vancomycin and tobramycin powders. There were 59 SSIs; 28 (9%) in the IPA cohort and 31 (6%) in the control cohort (p=0.13).

CONCLUSION: The use of local antibiotic prophylaxis resulted in no measurable increase in the proportion of infections caused by resistant bacterial pathogens after operative treatment of fractures. However, the small sample size and limited time frame of these preliminary data require continued investigation into their role as an adjunct to SSI prophylaxis.

PMID:36920373 | DOI:10.1097/BOT.0000000000002595

JAMA Dermatol. 2023 Mar 15. doi: 10.1001/jamadermatol.2023.0061. Online ahead of print.

ABSTRACT

IMPORTANCE: Racial and ethnic differences in skin cancer outcomes are understudied. Delineating these differences in Merkel cell carcinoma (MCC) is needed to better understand this rare disease.

OBJECTIVE: To determine how MCC presentation and outcomes differ across racial and ethnic groups.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included patients diagnosed with MCC and followed up from 2000 through 2018 in the 18 population-based cancer registries of the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program. Patients without follow-up data were excluded. Data analysis occurred from March 12 to November 30, 2022.

MAIN OUTCOMES AND MEASURES: A Cox proportional hazards regression was conducted to determine associations between demographic variables (race and ethnicity, age, sex, and income) and clinical variables (stage at diagnosis, primary site, and diagnosis year) with MCC-specific survival.

RESULTS: Of the 9557 patients with MCC identified (6758 [70.7%] aged ≥70 years; 6008 [62.9%] male), 222 (2.3%) were Asian American or Pacific Islander, 146 (1.5%) Black, 541 (5.7%) Hispanic, and 8590 (89.9%) White. Hispanic patients had improved MCC-specific survival compared with White patients (hazard ratio, 0.82; 95% CI, 0.67-0.99; P = .04). Black patients had the lowest MCC-specific survival, but it was not statistically different from White patients (hazard ratio, 1.19; 95% CI, 0.86-1.60; P = .28). Hispanic and Black patients were less likely to present with a primary site of the head and neck than White patients (183 of 541 [33.8%] Hispanic patients and 45 of 146 [30.8%] Black patients vs 3736 of 8590 [43.5%] White patients; P < .001 and P = .002, respectively). Black patients presented more often than White patients with advanced disease at diagnosis (59 of 146 [40.4%] vs 2510 of 8590 [29.2%]; P = .004).

CONCLUSIONS AND RELEVANCE: In this cohort study, there were differences between racial and ethnic groups in observed MCC outcomes and disease characteristics. Further investigations are warranted into the findings that, compared with White patients, Hispanic patients with MCC had improved outcomes and Black patients did not have worse outcomes despite presenting with more advanced disease.

PMID:36920369 | DOI:10.1001/jamadermatol.2023.0061

Expert Opin Drug Metab Toxicol. 2023 Mar 15. doi: 10.1080/17425255.2023.2192401. Online ahead of print.

ABSTRACT

INTRODUCTION: Antipsychotics (APs), during treatment or overdose, may be associated with respiratory aspiration.

AREAS COVERED: A PubMed search on September 30, 2022, provided 3 cases of respiratory aspiration during clozapine therapy and 1 case during an AP overdose. VigiBase records of respiratory aspiration associated with APs from inception until September 5, 2021, were reviewed. VigiBase, the World Health Organization’s global pharmacovigilance database, uses a statistical signal for associations called the information component (IC).

EXPERT OPINION: The ICs (and IC₀₂₅) were 2.1 (and 2.0) for APs, 3.2 (and 3.0) for clozapine, 2.6 (and 2.4) for quetiapine, and 2.5 (and 2.2) for olanzapine. Cases of respiratory aspiration associated with APs included: 137 overdose/suicide cases (64 fatal) and 609 cases during treatment (385 fatal) including 333 taking clozapine (238 fatal). In logistic regression models of fatal outcomes, the odds ratios, OR, and (95% confidence intervals, CI) of significant independent variables were: a) 2.3 – 2.6 for clozapine in 3 samples of AP treatment of varying size, b) 1.9 (CI 1.0 to 3.5) for geriatric age in 284 patients on clozapine treatment, and c) 1.8 (CI 1.1 – 3.2) for antidepressant co-medication in 276 patients on non-clozapine APs. Multiple AP pharmacological mechanisms may explain respiratory aspiration.

PMID:36920343 | DOI:10.1080/17425255.2023.2192401

Eur J Transl Myol. 2023 Mar 15. doi: 10.4081/ejtm.2023.11113. Online ahead of print.

ABSTRACT

Active Points Test on auricle was renamed Needle Contact Test (or NCT), considered an extremely effective method to select most efficient auricle acupoint for Auricular Acupuncture (or AA) therapy. Our aims were to evaluate NCT efficiency as viable diagnostic option to identify the most appropriate AA acupoints to be selected for SupraSpinatus Tendinopathy (SST) associated shoulder pain treatment and to evaluate which auricle area has greater concentration of NCT positive acupoints in subjects with SST shoulder pain, comparing results with available AA ear maps. 45 subjects with SST diagnosis were enrolled. On 30 subjects in treatment group, NCT was performed on acupoints of the auricle shoulder representation areas (i.e., Scaphoid Fossa), while in 15 subjects of control group, NCT was performed on auricle areas not shoulder associated. Statistically significant lower Numeric Pain Rating Scale scores were seen for study group over time and compared to control. A small sample showed statistically significant increase of SST shoulder maximum abduction range of Movements. NCT identified best SST shoulder pain AA acupoints in Scaphoid Fossa (or SF1 and SF2). In conclusion NCT is a viable tool to efficiently identify the best AA acupoints in SST shoulder pain treatment.

PMID:36920326 | DOI:10.4081/ejtm.2023.11113

Clin Oral Implants Res. 2023 Mar 15. doi: 10.1111/clr.14064. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to evaluate the effect of aging on the changes in implant stability over time following implant placement.

MATERIAL AND METHODS: A total of 104 patients in four age ranges (group 1: <60 years, group 2: 61-70 years, group 3: 71-80 years, and group 4: >80 years) were included. Bone level-tapered implants were placed without implementing any bone augmentation procedure. The final torque value displayed on the implant engine during implant insertion was recorded. Cone-beam computed tomography (CBCT) was performed immediately after surgery to analyze the bone quality around the implant. Implant stability was measured immediately after surgery and 2, 4, and 8 weeks after surgery.

RESULTS: In the CBCT image, higher grayscale values were observed in the order of group 1, group 2, and groups 3/4, with statistical significance (p<0.05). There was no significant difference in the insertion torque values between age groups (p≥0.05). Groups 1 and 2 showed lower implant stability values after 2 and 4 weeks compared to immediately and 8 weeks after surgery (p<0.05); however, groups 3 and 4 showed no significant difference between the results measured at different timepoints (p≥0.05).

CONCLUSIONS: Implant treatment in elderly patients is successful showing a settled implant stability over time following implant placement when the implant is appropriately engaged in the alveolar bone in the absence of bone augmentation.

PMID:36920314 | DOI:10.1111/clr.14064

J Exp Med. 2023 Jun 5;220(6):e20221392. doi: 10.1084/jem.20221392. Epub 2023 Mar 15.

ABSTRACT

The hallmark of tuberculosis (TB) is the formation of immune cell-enriched aggregates called granulomas. While granulomas are pathologically diverse, their tissue-wide heterogeneity has not been spatially resolved at the single-cell level in human tissues. By spatially mapping individual immune cells in every lesion across entire tissue sections, we report that in addition to necrotizing granulomas, the human TB lung contains abundant non-necrotizing leukocyte aggregates surrounding areas of necrotizing tissue. These cellular lesions were more diverse in composition than necrotizing lesions and could be stratified into four general classes based on cellular composition and spatial distribution of B cells and macrophages. The cellular composition of non-necrotizing structures also correlates with their proximity to necrotizing lesions, indicating these are foci of distinct immune reactions adjacent to necrotizing granulomas. Together, we show that during TB, diseased lung tissue develops a histopathological superstructure comprising at least four different types of non-necrotizing cellular aggregates organized as satellites of necrotizing granulomas.

PMID:36920308 | DOI:10.1084/jem.20221392

J Exp Med. 2023 Jun 5;220(6):e20212383. doi: 10.1084/jem.20212383. Epub 2023 Mar 15.

ABSTRACT

Cell competition has recently emerged as an important tumor suppressor mechanism in the thymus that inhibits autonomous thymic maintenance. Here, we show that the oncogenic transcription factor Lmo2 causes autonomous thymic maintenance in transgenic mice by inhibiting early T cell differentiation. This autonomous thymic maintenance results in the development of self-renewing preleukemic stem cells (pre-LSCs) and subsequent leukemogenesis, both of which are profoundly inhibited by restoration of thymic competition or expression of the antiapoptotic factor BCL2. Genomic analyses revealed the presence of Notch1 mutations in pre-LSCs before subsequent loss of tumor suppressors promotes the transition to overt leukemogenesis. These studies demonstrate a critical role for impaired cell competition in the development of pre-LSCs in a transgenic mouse model of T cell acute lymphoblastic leukemia (T-ALL), implying that this process plays a role in the ontogeny of human T-ALL.

PMID:36920307 | DOI:10.1084/jem.20212383

Adv Clin Exp Med. 2023 Mar 15. doi: 10.17219/acem/159756. Online ahead of print.

ABSTRACT

BACKGROUND: Carotid artery stenosis is often considered a stable clinical condition, and the underlying atherosclerosis is thought to have an inflammatory background.

OBJECTIVES: The aim of the study was to assess the value of different parameters obtained from whole blood counts for the prediction of advanced carotid artery atherosclerosis, including vessel occlusion, irrespective of symptom occurrence.

MATERIAL AND METHODS: The study group comprised 290 patients (84 (29%) females and 206 (71%) males) with a mean age of 68 ±8 years, who were admitted to the Vascular Surgery Department due to significant carotid artery disease. Patients were retrospectively divided into 2 subgroups regarding the presence or absence of artery occlusion. The demographic, clinical and laboratory preoperative data were compared between both groups.

RESULTS: We found significant differences in preoperative large unstained cell (LUC) counts between patients with and without carotid artery occlusion (p = 0.003), when analyzed with the Mann-Whitney test for independent samples. The receiver operating characteristic (ROC) curve showed that LUC count has prognostic properties for carotid artery occlusion, with an area under the curve (AUC) of 0.637 (p = 0.033), yielding a 69.70% sensitivity and a 51.75% specificity.

CONCLUSIONS: Large unstained cells represent an acute inflammatory state related to artery occlusion. An LUC count below the cutoff value of 0.16×109/L may be a predictor of carotid artery occlusion. Therefore, carotid artery occlusion should not be regarded as a chronic state, but as a clinical challenge being promoted by active inflammatory processes.

PMID:36920263 | DOI:10.17219/acem/159756