Category: Nevin Manimala

J Crohns Colitis. 2023 Mar 4:jjad038. doi: 10.1093/ecco-jcc/jjad038. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Perianal lesion is a refractory phenotype of Crohn’s disease (CD) with significantly diminished quality of life. We evaluated the clinical characteristics of perianal lesions in newly diagnosed CD patients and the impact of perianal lesions on the quality of life in Japanese patients with CD.

METHODS: Patients newly diagnosed with CD after June 2016 were included between December 2018 and June 2020 from the Inception Cohort Registry Study of Patients with CD (iCREST-CD).

RESULTS: Perianal lesions were present in 324 (48.2%) of 672 patients with newly diagnosed CD. 71.9% (233/324) were male. The prevalence of perianal lesions was higher in patients aged <40 years versus ≥40 years, and it decreased with age. Perianal fistula (59.9%) and abscess (30.6%) were the most common perianal lesions. In multivariate analyses, male sex, age <40 years, and ileocolonic disease location were significantly associated with a high prevalence of perianal lesions, whereas stricturing behaviour and alcohol intake were associated with low prevalence. Fatigue was more frequent (33.3% vs 21.6%) and, work productivity and activity impairment-work time missed (36.3% vs 29.5%) and activity impairment (51.9% vs 41.1%) were numerically higher in patients with than those without perianal lesions.

CONCLUSIONS: At the time of CD diagnosis, approximately half of the patients had perianal lesions; perianal abscesses and perianal fistulas were the most common. Young age, male sex, disease location, and behaviour are significantly associated with the presence of perianal lesions. The presence of perianal lesion was associated with fatigue and impairment of daily activities.

PMID:36869815 | DOI:10.1093/ecco-jcc/jjad038

J Endovasc Ther. 2023 Mar 4:15266028231157636. doi: 10.1177/15266028231157636. Online ahead of print.

ABSTRACT

PURPOSE: To systematically review existing evidence on outcomes of endovascular repair of abdominal atherosclerotic penetrating aortic ulcers (PAUs).

MATERIAL AND METHODS: Cochrane Central Registry of Registered Trials (CENTRAL), MEDLINE (via PubMed), and Web of Science databases were systematically searched. The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol (PRISMA-P 2020). The protocol was registered in the international registry of systematic reviews (PROSPERO CRD42022313404). Studies reporting on technical and clinical outcomes of endovascular PAU repair in 3 or more patients were included. Random effects modeling was used to estimate pooled technical success, survival, reinterventions, and type 1 and type 3 endoleaks. Statistical heterogeneity was assessed using the I² statistic. Pooled results are reported with 95% confidence intervals (CIs). Study quality was assessed using an adapted version of the Modified Coleman Methodology Score.

RESULTS: Sixteen studies including 165 patients with a mean/median age ranging from 64 to 78 years receiving endovascular therapy for PAU between 1997 and 2020 were identified. Pooled technical success was 99.0% (CI: 96.0%-100%). In all, 30-day mortality was 1.0% (CI: 0%-6.0%) with an in-hospital mortality of 1.0% (CI: 0.0%-13.0%). There were no reinterventions, type 1, or type 3 endoleaks at 30 days. Median/mean follow-up ranged from 1 to 33 months. Overall, there were 16 deaths (9.7%), 5 reinterventions (3.3%), 3 type 1 (1.8%), and 1 type 3 endoleak (0.6%) during follow-up. The quality of studies was rated low according to the Modified Coleman score at 43.4 (+/- 8.5) of 85 points.

CONCLUSION: There is low-level evidence on outcomes of endovascular PAU repair. While in the short-term endovascular repair of abdominal PAU seems safe and effective, mid-term and long-term data are lacking. Recommendations with regard to treatment indications and techniques in asymptomatic PAU should be made cautiously.

CLINICAL IMPACT: This systematic review demonstrated that evidence on outcomes of endovascular abdominal PAU repair is limited. While in the short-term endovascular repair of abdominal PAU seems safe and effective, mid-term and long-term data are lacking. In the context of a benign prognosis of asymptomatic PAU and lacking standardization in current reporting, recommendations with regard to treatment indications and techniques in asymptomatic PAUs should be made cautiously.

PMID:36869667 | DOI:10.1177/15266028231157636

Womens Health (Lond). 2023 Jan-Dec;19:17455057231155302. doi: 10.1177/17455057231155302.

ABSTRACT

OBJECTIVES: Community doulas, who provide culturally concordant, nonclinical support during and after pregnancy, are increasingly promoted as an evidence-based intervention to advance birth equity. As valued members of their communities, community doulas often provide extensive physical and emotional pregnancy, birth, and postpartum support at low or no cost to clients. However, neither community doulas’ scope of work nor the distribution of time among their different work activities has been clearly defined or enumerated; therefore, this project sought to describe the work activities and time use of doulas in one community-based doula organization.

METHODS: In a quality improvement project, we reviewed case management system client data and collected 1 month of time diary data from eight doulas employed full-time at SisterWeb San Francisco Community Doula Network. We calculated descriptive statistics for activities community doulas reported in their time diaries and each visit/interaction logged in the case management system.

RESULTS: SisterWeb doulas spent about half of their time in direct client care. For every hour that doulas spent with a client in prenatal and postpartum visits, on average, they spent an additional 2.15 h communicating with and supporting their clients in other ways. Overall, we estimate that SisterWeb doulas spend an average of 32 h providing care for a client receiving the standard course of care, including intake, prenatal visits, support during childbirth, and postpartum visits.

CONCLUSIONS: Results highlight the wide variety of work that SisterWeb community doulas do beyond direct client care. Acknowledgment of community doulas’ broad scope of work and appropriate compensation for all activities is necessary if doula care is to be advanced as a health equity intervention.

PMID:36869648 | DOI:10.1177/17455057231155302

Ann Med. 2023 Dec;55(1):800-807. doi: 10.1080/07853890.2022.2160490.

ABSTRACT

OBJECTIVE: Delayed extubation was commonly associated with increased adverse outcomes. This study aimed to explore the incidence and predictors and to construct a nomogram for delayed extubation after thoracoscopic lung cancer surgery.

METHODS: We reviewed medical records of 8716 consecutive patients undergoing this surgical treatment from January 2016 to December 2017. Using potential predictors to develop a nomogram and using a bootstrap-resampling approach to conduct internal validation. For external validation, we additionally pooled 3676 consecutive patients who underwent this procedure between January 2018 and June 2018. Extubation performed outside the operating room was defined as delayed extubation.

RESULTS: The rate of delayed extubation was 1.60%. Multivariate analysis identified age, BMI, FEV₁/FVC, lymph nodes calcification, thoracic paravertebral blockade (TPVB) usage, intraoperative transfusion, operative time and operation later than 6 p.m. as independent predictors for delayed extubation. Using these eight candidates to develop a nomogram, with a concordance statistic (C-statistic) value of 0.798 and good calibration. After internal validation, similarly good calibration and discrimination (C-statistic, 0.789; 95%CI, 0.748 to 0.830) were observed. The decision curve analysis (DCA) indicated the positive net benefit with the threshold risk range of 0 to 30%. Goodness-of-fit test and discrimination in the external validation were 0.113 and 0.785, respectively.

CONCLUSION: The proposed nomogram can reliably identify patients at high risk for the decision to delayed extubation after thoracoscopic lung cancer surgery. Optimizing four modifiable factors including BMI, FEV₁/FVC, TPVB usage, and operation later than 6 p.m. may reduce the risk of delayed extubation.Key Messages:This study identified eight independent predictors for delayed extubation, among which lymph node calcification and anaesthesia type were not commonly reported.Using these eight candidates to develop a nomogram, we could reliably identify high-risk patients for the decision to delayed extubation.Optimizing four modifiable factors, including BMI, FEV₁/FVC, TPVB usage, and operation later than 6 p.m. may reduce the risk of delayed extubation.

PMID:36869647 | DOI:10.1080/07853890.2022.2160490

Glob Health Promot. 2023 Mar 4:17579759231153130. doi: 10.1177/17579759231153130. Online ahead of print.

ABSTRACT

Among all road users, pedestrian behavior is most unpredictable, and our knowledge of pedestrian behavior and compliance in northern Iran is limited. The aim of the study was to determine the self-reporting behavior of pedestrians and related factors in northern Iran in 2021. This cross-sectional study’s research tool included demographic characteristics, social characteristics, and a pedestrian behavior questionnaire (PBS – 43 questions). Data collection was randomly performed in 30 different passages around Rasht (a city in the north of Iran). We used the Poisson regression model and statistical software STATA version 15 for data analysis. With increasing age, pedestrians showed better crossing behavior (p < 0.001, β = 0.202), and the behavior of female pedestrians was better than that of male pedestrians (p < 0.001, β -4.79). As pedestrians, those with private jobs had worse crossing behavior than others (p < 0.045, β = 9.380), and those pedestrians who mentioned they were motorcyclists before had worse crossing behavior than others (p < 0.045, β = 9.380). The findings of this study can be used to establish pedestrian safety and preventative planning. In behavior change intervention programs, it is best to target young male pedestrians aiming to walk to their workplace, a private business. In addition, the behavior of pedestrians whose predominant means of transportation is the motorcycle must be corrected. It is necessary to conduct information campaigns and educational programs for pedestrians with common high-risk behaviors, especially errors and violations.

PMID:36869640 | DOI:10.1177/17579759231153130

Stat Med. 2023 Mar 4. doi: 10.1002/sim.9695. Online ahead of print.

ABSTRACT

Rare binary events data arise frequently in medical research. Due to lack of statistical power in individual studies involving such data, meta-analysis has become an increasingly important tool for combining results from multiple independent studies. However, traditional meta-analysis methods often report severely biased estimates in such rare-event settings. Moreover, many rely on models assuming a pre-specified direction for variability between control and treatment groups for mathematical convenience, which may be violated in practice. Based on a flexible random-effects model that removes the assumption about the direction, we propose new Bayesian procedures for estimating and testing the overall treatment effect and inter-study heterogeneity. Our Markov chain Monte Carlo algorithm employs Pólya-Gamma augmentation so that all conditionals are known distributions, greatly facilitating computational efficiency. Our simulation shows that the proposed approach generally reports less biased and more stable estimates compared to existing methods. We further illustrate our approach using two real examples, one using rosiglitazone data from 56 studies and the other using stomach ulcers data from 41 studies.

PMID:36869639 | DOI:10.1002/sim.9695

Eur J Neurol. 2023 Mar 3. doi: 10.1111/ene.15764. Online ahead of print.

ABSTRACT

OBJECTIVE: Primary progressive apraxia of speech (PPAOS) is associated with imaging abnormalities in lateral premotor cortex (LPC) and supplementary motor area (SMA). It’s unknown whether relatively greater involvement of these regions in either hemisphere is associated with demographics, presenting, and/or longitudinal features.

METHODS: In 51 prospectively recruited PPAOS patients who completed [¹⁸ F]-fluorodeoxyglucose (FDG) PET we classified patients as left-dominant, right-dominant, or symmetric, based on visual assessment of the LPC and SMA on FDG-PET. SPM and statistical analysis of regional metabolic values were performed. Diagnosis of PPAOS was made if AOS was present and aphasia absent. Thirteen patients completed Ioflupane-123I (DAT) scans. We compared cross-sectional and longitudinal clinicopathological, genetic, and neuroimaging characteristics across the three groups, with area under the receiver operator curve (AUROC) determined as a measure of effect size.

RESULTS: 49% of the PPAOS patients were classified as left-dominant, 31% as right-dominant, and 20% as symmetric which was supported by results from the SPM and regional analyses. There were no differences in baseline characteristics. Longitudinally, right-dominant PPAOS showed faster rates of progression of ideomotor apraxia (AUROC=0.79), behavioral disturbances (AUROC=0.84), including disinhibition symptoms (AUROC=0.82) and negative behaviors (AUROC=0.82), and Parkinsonism (AUROC=0.75), compared to left-dominant PPAOS. Symmetric PPAOS showed faster rates of dysarthria progression compared to left-dominant (AUROC=0.89) and right-dominant PPAOS (AUROC=0.79). Five patients showed abnormal DAT uptake. Braak neurofibrillary tangle stage differed across groups (p=0.01).

CONCLUSIONS: Patients with PPAOS and a right-dominant pattern of hypometabolism on FDG-PET have fastest rates of decline of behavioral and motor features.

PMID:36869612 | DOI:10.1111/ene.15764

Brain Behav. 2023 Mar 3:e2865. doi: 10.1002/brb3.2865. Online ahead of print.

ABSTRACT

INTRODUCTION: The false discovery rate (FDR) procedure does not incorporate the geometry of the random field and requires high statistical power at each voxel, a requirement not satisfied by the limited number of participants in imaging studies. Topological FDR, threshold free cluster enhancement (TFCE), and probabilistic TFCE improve statistical power by incorporating local geometry. However, topological FDR requires specifying a cluster defining threshold and TFCE requires specifying transformation weights.

METHODS: Geometry-derived statistical significance (GDSS) procedure overcomes these limitations by combining voxelwise p-values for the test statistic with the probabilities computed from the local geometry for the random field, thereby providing substantially greater statistical power than the procedures currently used to control for multiple comparisons. We use synthetic data and real-world data to compare its performance against the performance of these other, previously developed procedures.

RESULTS: GDSS provided substantially greater statistical power relative to the comparator procedures, which was less variable to the number of participants. GDSS was more conservative than TFCE: that is, it rejected null hypotheses at voxels with much higher effect sizes than TFCE. Our experiments also showed that the Cohen’s D effect size decreases as the number of participants increases. Therefore, sample size calculations from small studies may underestimate the participants required in larger studies. Our findings also suggest effect size maps should be presented along with p-value maps for correct interpretation of findings.

CONCLUSIONS: GDSS compared with the other procedures provides considerably greater statistical power for detecting true positives while limiting false positives, especially in small sized (<40 participants) imaging cohorts.

PMID:36869597 | DOI:10.1002/brb3.2865

Biophys J. 2023 Mar 3:S0006-3495(23)00154-6. doi: 10.1016/j.bpj.2023.03.001. Online ahead of print.

ABSTRACT

Essential cellular processes such as metabolism, protein synthesis, and autophagy require the intracellular transport of membrane-bound vesicles. The importance of the cytoskeleton and associated molecular motors for transport is well-documented. Recent research has suggested that the endoplasmic reticulum (ER) may also play a role in vesicle transport through a tethering of vesicles to the ER. We use single particle tracking fluorescence microscopy and a Bayesian changepoint algorithm to characterize vesicle motility in response to the disruption of the ER, actin, and microtubules. This high-throughput changepoint algorithm allows us to efficiently analyze thousands of trajectory segments. We find that palmitate-mediated disruption of the ER leads to a significant decrease in vesicle motility. A comparison with the disruption of actin and microtubules shows that disruption of the ER has a significant impact on vesicle motility, greater than the disruption of actin. Vesicle motility was dependent on cellular region, with greater motility in the cell periphery than the perinuclear region, possibly due to regional differences in actin and the ER. Overall, these results suggest that the ER is an important factor in vesicle transport.

PMID:36869590 | DOI:10.1016/j.bpj.2023.03.001

Med Sci Monit. 2023 Mar 4;29:e938758. doi: 10.12659/MSM.938758.

ABSTRACT

BACKGROUND Delayed graft function (DGF) caused by ischemia-reperfusion injury is a common pathophysiological process that should be monitored by specific biomarkers in addition to serum creatinine. Thus, this single-center retrospective study aimed to investigate the association between levels of neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecular-1 (KIM-1), liver-type fatty acid binding protein (L-FABP), and interleukin-18 (IL-18) in DGF associated with acute kidney injury in kidney transplant recipients (KTRs) and estimated glomerular filtration rate (eGFR) at 3 years post-transplant. MATERIAL AND METHODS A total of 102 KTRs [14(13.7%) of DGF and 88(86.3%) of NON-DGF] were enrolled. DGF was defined as “dialysis is needed within 1 week after kidney transplantation”. NGAL, KIM-1, L-FABP, and IL-18 were obtained from perfusate samples of donation-after-cardiac-death (DCD) kidneys, and measured by ELISA. RESULTS Compared to the NON-DGF group, KTRs in the DGF group had a statistically significant increase in levels of NGAL (P<0.001) and KIM-1 (P<0.001). Multiple logistic regression analyses showed that NGAL (OR=1.204, 95% CI 1.057-1.372, P=0.005) and KIM-1 (OR=1.248, CI=1.065-1.463, P=0.006) could be regarded as independent risk factors. The accuracy of NGAL and KIM-1 was 83.3% and 82.1%, respectively, calculated using the area under the receiver operating characteristic curve. Furthermore, the eGFR at 3 years post-transplant had a moderate negative correlation with NGAL (r=-0.208, P=0.036) and KIM-1 (r=-0.260, P=0.008). CONCLUSIONS Our results support those from previous studies showing that perfusate levels of NGAL and KIM-1 are associated with DGF in KTRs and also with reduced eGFR at 3 years post-transplant.

PMID:36869580 | DOI:10.12659/MSM.938758