Category: Nevin Manimala

Stroke. 2023 Mar 14. doi: 10.1161/STROKEAHA.122.040759. Online ahead of print.

ABSTRACT

BACKGROUND: Multidelay arterial spin labeling (ASL) is a novel perfusion method of ASL, with arterial transit time (ATT) calculated by multiple postlabeling delays to correct cerebral blood flow (CBF). We verify the accuracy of multidelay ASL in evaluating the ischemic penumbra and perfusion levels in patients with acute ischemic stroke, compared with computed tomography perfusion (CTP).

METHODS: Patients with acute ischemic stroke with anterior circulation large vessel occlusion received baseline CTP, multidelay ASL, and diffusion-weighted imaging (DWI) in succession. Multidelay ASL image was processed to reconstruct ATT, CBF without ATT correction, and CBF corrected by ATT. The consistency of hypoperfusion and ischemic penumbra volume calculated by CTP and multidelay ASL were quantified by intraclass correlation coefficient (ICC) in 2-way mixed effects, absolute agreement, and single measure. Wilcoxon signed-rank test was used to compare the difference in penumbra volume between CTP, corrected ASL, and uncorrected ASL.

RESULTS: Thirty patients were included. Hypoperfusion volume based on multidelay ASL with different thresholds were 117.95 (87.77-151.49) mL for corrected relative CBF<40%, 130.29 (85.99-249.37) mL for CBF corrected by ATT<20 mL·100g^-1·min^-1, no statistical difference (P>0.05) compared with the volume of CTP, and consistency was almost excellent (ICC, 0.91) and substantial consistent (ICC, 0.727). The volumes of ischemic penumbra were 91.00 (42.68-125.27) mL for corrected relative CBF<40%-DWI, 108.94 (62.03-150.86) mL for CBF corrected by ATT<20 mL·100 g^-1·min^-1-DWI, which showed no statistical difference compared with the penumbra volume of CTP (P>0.05). The consistency was excellent (ICC, 0.822) and moderate (ICC, 0.501), respectively. The volume of uncorrected relative CBF <40%-DWI was 209.57 (123.21-292.45) mL, statistically larger than corrected relative CBF <40%-DWI (P<0.001) and CTP (P<0.001). The volume of uncorrected CBF<20 mL·100g^-1·min^-1-DWI was 186.23 (86.56-298.22) mL, statistically larger than CBF corrected by ATT<20 mL·100g^-1·min^-1-DWI (P<0.001) and CTP(P<0.001).

CONCLUSIONS: The volume of ischemic penumbra determined by CBF/DWI mismatch based on multidelay ASL is consistent with CTP. The penumbra volume calculated by CBF adjusted by ATT is more accurate.

PMID:36916272 | DOI:10.1161/STROKEAHA.122.040759

Ear Nose Throat J. 2023 Mar 14:1455613231163737. doi: 10.1177/01455613231163737. Online ahead of print.

ABSTRACT

OBJECTIVES: While surgeries to correct the anatomical malformations that cause nasal airway obstruction (NAO) are generally successful, the outcomes of such procedures are often unsatisfactory. The aim of the present study was to assess the value of opening the middle meatus in patients with NAO.

METHODS: Thirty-four patients with nasal obstruction due to nasal septal deviation were included in this study. After randomization, the middle meatus was either opened or not opened during septoplasty. The patients were evaluated through pre- and postoperative rhinomanometry and acoustic rhinometry. The Visual Analog Scale (VAS) scores of subjective symptoms along with responses to the 20-item Sinonasal Outcome Test (SNOT-20) were obtained before surgery and three months after surgery.

RESULTS: The VAS scores and SNOT-20 responses improved significantly in both groups after surgery. The effective treatment rate based on the nasal congestion score (NCS) was 64.7% in the single group (septoplasty alone) and 100% in the combined group (septoplasty in conjunction with opening the middle meatus), and the difference was statistically significant (P = .018). In both groups, surgery significantly improved nasal flow, resistance, minimal cross-sectional area, cross-sectional area 6 cm (CA6) from the anterior nostril and nasal volume. Nasal volume and CA6 after surgery were statistically different between the 2 groups (P = .004 and .019, respectively).

CONCLUSIONS: Opening the middle meatus may further improve the subjective perception of patency on the basis of septoplasty.

PMID:36916238 | DOI:10.1177/01455613231163737

J Clin Psychol. 2023 Mar 14. doi: 10.1002/jclp.23504. Online ahead of print.

ABSTRACT

OBJECTIVE: There is a relatively small body of research on the cost-of-illness of personality disorders (PDs). Most studies only include borderline PD. The aim of this study was to investigate mean societal costs, including its components, (direct) health service costs and (indirect) productivity loss, among treatment-seeking patients with the broad range of all PDs according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

METHODS: Cross-sectional data from 911 patients diagnosed with at least 1 PD were retrieved from the quality register of the Norwegian Network for Personality Disorders-a collaboration of PD treatment units within specialist mental health services. The patients were referred in the time period 2017-2020. Estimation of costs was based on a bottom-up approach, using information from a structured interview covering the 6-month period before assessment, whereas unit costs were retrieved from public reports, public records, or public agencies. The human capital approach was used to calculate productivity loss. Diagnoses were determined by semi-structured diagnostic interviews (Structured Clinical Interview for DSM-5-PD [SCID-5-PD]).

RESULTS: The mean societal costs were €20.260 during the 6-month period before specialized treatment. The largest cost component was productivity loss (65%), whereas health service costs constituted 35%. The main contributors to societal costs from the underlying health service cost components were inpatient treatment (20.5%) and individual outpatient treatment (10.5%).

CONCLUSION: Societal costs were substantial among treatment-seeking patients with the broad range of DSM-5 PDs, comparable to the societal costs of schizophrenia, and significantly higher than the societal costs of both depression and anxiety disorders. The cost estimates converged with recent, register-based cost-of-illness studies of different PDs but exceeded previous findings from other bottom-up studies. Furthermore, the results underscore the importance of implementing effective and specialized treatment for patients with a broad range of PDs, not only to alleviate individual suffering but also to reduce the level of societal costs. The emphasis on productivity loss as a main contributor to the overall societal costs is substantiated, hence underlining the relevance of interventions focusing on improving occupational functioning.

PMID:36916214 | DOI:10.1002/jclp.23504

Environ Mol Mutagen. 2023 Mar 14. doi: 10.1002/em.22538. Online ahead of print.

ABSTRACT

Genetic toxicology tests are used to categorize substances as genotoxic and potentially carcinogenic. In general, test results are designated as mutagenic, not mutagenic, or inconclusive and, depending on its potential use and applicable regulations, a mutagenic result can restrict or remove a substance from further development, or assign limits to its use. In these tests, mutation responses form a continuum without a clear delineation between an increase over the background, untreated, mutant frequency and a frequency that would define the test substance as a mutagen and a potential carcinogenic hazard. This situation is illustrated using the Salmonella mutagenicity (Ames) test which is the initial, and often only, test used to characterize substances as mutagenic or nonmutagenic. It has its widest use by industry and regulatory authorities to identify potential carcinogens among chemicals in development. The OECD Test Guideline No. 471 has been adopted by regulatory agencies internationally, and describes the minimum requirements for a negative response, but does not provide a specific approach for evaluating the test data. The most widely used criterion for making yes-or-no mutagenicity decisions is a 2- or 3-fold increase over the background (solvent) mutant frequency. Other approaches rely on formal statistics and/or expert judgment. These approaches and recently proposed modifications are evaluated here. Recommendations are made that are in conformity with the OECD guideline and are based on biological relevance and the biology of the mutagenic response rather than on arbitrary decision points (e.g., ≥ 2-fold increase or p ≤ .05).

PMID:36916210 | DOI:10.1002/em.22538

Intern Med J. 2023 Mar 14. doi: 10.1111/imj.16074. Online ahead of print.

ABSTRACT

BACKGROUND: In 2014, infliximab (IFX) was listed on the Australian Pharmaceutical Benefits Scheme for acute severe ulcerative colitis (ASUC) and is now the preferred option for medical salvage, superseding cyclosporin (CsA). Optimal dosing schedules for IFX remain unknown.

AIM: We aim to evaluate the effect of changing from predominantly CsA to almost exclusively IFX for the treatment of steroid refractory ASUC on colectomy rates.

METHODS: A retrospective review was performed of patients admitted with ASUC between 2012-2020. Patients were categorised into two groups according to year of presentation – either “historical treatment” cohort (2012-2014), when CsA was primarily used, or “contemporary treatment” cohort (2014-2020) when IFX was mostly prescribed, in either standard or intensive doses.

RESULTS: 139 patients were included; 37 in the historical treatment cohort and 102 in the contemporary treatment cohort. In the historical treatment cohort, 12/37 received salvage therapy, 8 (67%) with CsA. In the contemporary treatment cohort, 49/102 patents received salvage therapy, 40 (82%) with IFX, of whom 22 (53%) received intensified doses. Colectomy rates were similar at 30 days, 6 months and 12 months between historical and contemporary treatment cohorts (14% vs 12%, p = 0.77, 19% vs 18%, p >0.99; and 22% vs 18%, p = 0.63 respectively). Difference in 12-month colectomy rates between standard vs intensive IFX did not meet statistical significance (3/21 (14%) vs 9/22 (41%), respectively; p = 0.09).

CONCLUSION: There was no difference in 30-day, 6-month or 12-month colectomy rate between the historical treatment and contemporary treatment cohorts. The use of IFX, rather than CsA, even at intensified dosing has not appeared to reduce the colectomy rate observed in our patients. This article is protected by copyright. All rights reserved.

PMID:36916208 | DOI:10.1111/imj.16074

Pediatrics. 2023 Mar 14:e2022058552. doi: 10.1542/peds.2022-058552. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Representative enrollment of racial and ethnic minoritized populations in biomedical research ensures the generalizability of results and equitable access to novel therapies. Previous studies on pediatric clinical trial diversity are limited to subsets of journals or disciplines. We aimed to evaluate race and ethnicity reporting and representation in all US pediatric clinical trials on ClinicalTrials.gov.

METHODS: We performed a cross-sectional study of US-based clinical trials registered on ClinicalTrials.gov that enrolled participants aged <18 years old between October 2007 and March 2020. We used descriptive statistics, compound annual growth rates, and multivariable logistic regression for data analysis. Estimates of US population statistics and disease burden were calculated with the US Census, Kids’ Inpatient Database, and National Survey of Children’s Health.

RESULTS: Among 1183 trials encompassing 405 376 participants, race and ethnicity reporting significantly increased from 27% in 2007 to 87% in 2018 (P < .001). The median proportional enrollment of Asian American children was 0.6% (interquartile range [IQR], 0%-3.7%); American Indian, 0% (IQR, 0%-0%); Black, 12% (IQR, 2.9%-28.4%); Hispanic, 7.1% (IQR, 0%-18.6%); and white 66.4% (IQR, 41.5%-81.6%). Asian American, Black, and Hispanic participants were underrepresented relative to US population demographics. Compared with expected proportions based on disease prevalence and hospitalizations, Asian American and Hispanic participants were most consistently underrepresented across diagnoses.

CONCLUSIONS: While race and ethnicity reporting in pediatric clinical trials has improved, the representative enrollment of minoritized participants remains an ongoing challenge. Evidence-based and policy solutions are needed to address these disparities to advance biomedical innovation for all children.

PMID:36916197 | DOI:10.1542/peds.2022-058552

Nutr Health. 2023 Mar 14:2601060231163922. doi: 10.1177/02601060231163922. Online ahead of print.

ABSTRACT

AIM: This study aimed to evaluate the nutritional literacy levels of university academic and administrative staff.

METHODS: Data were collected with a questionnaire including sociodemographic variables, some eating habits, and the Nutritional Literacy Assessment Tool of Adults. A total of 413 individuals, 211 women (51.1%) and 202 men (48.9%), aged 23-64 (mean: 37.41 ± 10.04 years), were included in the study. The data obtained were evaluated with the SPSS 25.0 statistical package program.

RESULTS: It was found that the nutritional literacy level of 18.15% of the participants is at the borderline, 81.85 are sufficient. Women’s nutrition literacy scores are significantly higher than men’s (p = 0.034). A significant relationship was found between nutritional literacy, socioeconomic status, and some eating habits (p < 0.05). The average daily water consumption of individuals with sufficient nutritional literacy is statistically significantly higher than those with borderline nutritional literacy (p < 0.001). It was determined that individuals with borderline nutritional literacy skipped meals more frequently (p < 0.05).

CONCLUSION: The present study suggests that nutritional literacy may be effective in developing healthy eating behaviors. The study’s results can guide the determination of methods that will improve nutritional literacy and increase awareness in the future.

PMID:36916177 | DOI:10.1177/02601060231163922

Interv Neuroradiol. 2023 Mar 14:15910199231163046. doi: 10.1177/15910199231163046. Online ahead of print.

ABSTRACT

INTRODUCTION: Subarachnoid hyperdensity is commonly seen on postoperative computed tomography scans within 24 h after mechanical thrombectomy. The impact on patients’ outcomes remains uncertain. We present a real-world experience evaluating periprocedural factors associated with the development of subarachnoid hemorrhage (SAH) and its impact on outcomes of patients with acute stroke undergoing mechanical thrombectomy.

METHODS: A single-center, retrospective analysis was performed between January 2016 and August 2021, including all consecutive patients who underwent thrombectomy. Our study aimed to evaluate periprocedural factors associated with subarachnoid hemorrhage within 24 h of the intervention, and the potential impact on patients’ outcome.

RESULTS: Of 781 patients, 44 patients (5.63%) demonstrated pure SAH within 24 h of the intervention. Patients from the SAH group were more likely to have tandem occlusion (15.9% vs. 5.2%, p = .003), aspiration using reperfusion pump system (81.4% vs. 66.8%, p = .047), intraoperative complications (9.1% vs. 0.9%; p < .001), longer puncture-to-recanalization times (45 min vs 29 min, p = .042) and a higher median number of passes to achieve recanalization (1 vs. 3, p = .002). There was no statistically significant difference in the long-term functional outcome between the groups.

CONCLUSION: We suggest that dual-energy computed tomography could better distinguish between blood and pure contrast stagnation. Still, SAH was not associated with an unfavorable outcome in stroke patients undergoing thrombectomy.

PMID:36916147 | DOI:10.1177/15910199231163046

CNS Neurosci Ther. 2023 Mar 13. doi: 10.1111/cns.14152. Online ahead of print.

ABSTRACT

AIMS: The monocyte to high-density lipoprotein cholesterol ratio (MHR) has emerged as a novel inflammatory biomarker of atherosclerotic cardiovascular disease. However, it has not yet been identified whether MHR can predict the long-term prognosis of ischemic stroke. We aimed to investigate the associations of MHR levels with clinical outcomes in patients with ischemic stroke or transient ischemic attack (TIA) at 3 months and 1 year.

METHODS: We derived data from the Third China National Stroke Registry (CNSR-III). Enrolled patients were divided into four groups by quartiles of MHR. Multivariable Cox regression for all-cause death and stroke recurrence and logistic regression for the poor functional outcome (modified Rankin Scale score 3-6) were used.

RESULTS: Among 13,865 enrolled patients, the median MHR was 0.39 (interquartile range, 0.27-0.53). After adjustment for conventional confounding factors, the MHR level in quartile 4 was associated with an increased risk of all-cause death (hazard ratio [HR], 1.45; 95% confidence interval [CI], 1.10-1.90), and poor functional outcome (odd ratio [OR], 1.47; 95% CI, 1.22-1.76), but not with stroke recurrence (HR, 1.02; 95% CI, 0.85-1.21) at 1 year follow-up, compared with MHR level in quartile 1. Similar results were observed for outcomes at 3 months. The addition of MHR to a basic model including conventional factors improved predictive ability for all-cause death and poor functional outcome validated by the C-statistic and net reclassification index (all p < 0.05).

CONCLUSIONS: Elevated MHR can independently predict all-cause death and poor functional outcome in patients with ischemic stroke or TIA.

PMID:36914580 | DOI:10.1111/cns.14152

J Natl Med Assoc. 2023 Mar 11:S0027-9684(22)00189-4. doi: 10.1016/j.jnma.2022.12.005. Online ahead of print.

ABSTRACT

The decision tree used a generating set of rules based on various correlated variables for developing an algorithm from the target variable. Using the training dataset this paper used boosting tree algorithm for gender classification from twenty-five anthropometric measurements and extract twelve significant variables chest diameter, waist girth, biacromial, wrist diameter, ankle diameter, forearm girth, thigh girth, chest depth, bicep girth, shoulder girth, elbow girth and the hip girth with an accuracy rate of 98.42%, by seven decision rule sets serving the purpose of dimension reduction.

PMID:36914542 | DOI:10.1016/j.jnma.2022.12.005