Category: Nevin Manimala

ANZ J Surg. 2023 Apr 3. doi: 10.1111/ans.18441. Online ahead of print.

ABSTRACT

BACKGROUND: Secondary aorto-enteric fistulae (SAEF) are a rare, complex and life-threatening complication following aortic repair. Traditional treatment strategy has been with open aortic repair (OAR), with emergence of endovascular repair (EVAR) as a potentially viable initial treatment option. Controversy exists over optimal immediate and long-term management.

METHODS: An observational, retrospective, multi-institutional study of patients who had been treated for SAEF between 2003 and 2020 was performed using a standardized database. Baseline characteristics, presenting features, microbiological, operative and post-operative variables were recorded. The primary outcome was short and mid-term mortality. Descriptive statistics, Kaplan-Meier, Cox age-adjusted survival analysis and binomial regression analysis were performed.

RESULTS: There were 47 patients treated for SAEF identified, with a median (range) age at presentation of 74 (48-93) and 7 were females. Initially, there were 24 (51%) treated with OAR, 15 (32%) with EVAR and 8 (17%) non-operatively. The 30-day and 1-year mortality for all cases that underwent intervention was 21% and 46% respectively. Age-adjusted survival analysis revealed no statistically significant difference in mortality in the EVAR-first group compared to the OAR-first group, HR 0.99 (95% CI 0.94-1.03, P = 0.61).

CONCLUSION: In this study there was no difference in all-cause survival in patients who had OAR or EVAR as first line treatment for SAEF. In the acute setting, alongside broad-spectrum antimicrobial therapy, EVAR can be considered as an initial treatment for patients with SAEF, as a primary treatment or a bridge to definitive OAR.

PMID:37012584 | DOI:10.1111/ans.18441

Environ Sci Pollut Res Int. 2023 Apr 3. doi: 10.1007/s11356-023-26661-7. Online ahead of print.

ABSTRACT

Carbon prices are important for promoting a low-carbon transformation of the economy. The fluctuation of energy prices affects carbon prices through supply and demand chains, thus affecting the achievement of emission reduction targets through carbon pricing tools. Based on daily time series data, a mediating effect model is constructed to study the impact of energy prices on carbon prices. We analyze how energy prices impact carbon prices using four different transmission paths and then test the resulting differences. The main findings are as follows. First, an increase in energy prices significantly negatively affects carbon prices through economic fluctuation, investment demand, speculative demand, and transaction demand. Second, energy price fluctuations mainly affect carbon emission prices through economic fluctuations. The impacts of the remaining transmission paths are in the order of speculative demand, investment demand, and transaction demand. This paper provides theoretical and practical support for reasonably responding to energy price fluctuations and forming effective carbon prices to address climate change.

PMID:37012564 | DOI:10.1007/s11356-023-26661-7

Mycopathologia. 2023 Apr 3. doi: 10.1007/s11046-023-00725-1. Online ahead of print.

ABSTRACT

OBJECTIVE: Aspergillus fumigatus (A. fumigatus) has emerged as a significant pathogen in patients with cystic fibrosis (CF) and currently is within the top five isolated organisms reported in several international CF patient registries. A. fumigatus has been attributed to disease progression, although its role remains controversial. There is a paucity of reports on its infection dynamics, it was the aim of this study to examine time to first laboratory reports of A. fumigatus acquisition and to correlate this with patient gender and cystic fibrosis transmembrane conductance regulator (CFTR) mutation type.

METHODS: One hundred adult (≥ 18 years) CF patients were examined (50 females, 50 males; mean age 24.6 years ± 6.25 (SD), median age 24 years; maximum age 76 years). CFTR mutation groups consisted (i) F508del/F508del homozygous (n = 45), (ii) F508del/other heterozygous (n = 45) and (iii) others (n = 10). CFTR mutation type, patient gender, presence/absence of A. fumigatus and time (months) to first isolation of A. fumigatus were examined.

RESULTS: Microbiological data was examined from 100 patients from birth to present (31/12/2021), equating to 2455 patient years. A. fumigatus was isolated from 66/100 (66%) adult CF patients; (i) F508del/F508del homozygous (82%; 37/45), (ii) F508del/other heterozygous (56%; 25/45) and (iii) others (40%; 4/10). Within the F508del/other heterozygous group, 14 mutations were noted on the second allele, with R560T and R117H collectively accounting for 36% of the second mutations. Four unique allele/allele mutations were noted in the Other Mutations category. There was a trend to a higher A. fumigatus acquisition in F508del/F508del homozygous patients than with F508del/other patients (p = 0.0529). Of the 66 patients who were positive for A. fumigatus, 35(53%) were male and 31(47%) were female. The median and mean time to first isolation of A. fumigatus in all A. fumigatus-positive patients was 119.5 months and 128 months, respectively, shortest time was 12 months, longest time 288 months. There was a statistical significance in time-to-first isolation in relation to CFTR mutation group (p = 0.0272), whereby F508del homozygous individuals had their first isolation of A. fumigatus at 116.8 ± 7.9 months (mean ± standard error of the mean (SEM)) and F508del heterozygous patients had their first isolate of A. fumigatus at 150.4 months ± 13.7 months (mean ± SEM), approximately 2.75 years after their F508del homozygous peers. There was no significant difference (p = 0.12) in time to first acquisiton between males and females, whereby males had their first A. fumigatus isolate at 118 ± 9.4 months, whereas females had their first A. fumigatus isolate at 140 ± 10.8 months. The highest rate of first A. fumigatus isolation was from 4 years until 16 years and by the age of 16 years, approximately 85% of A. fumigatus-positive patients had recorded their first A. fumigatus isolate.

CONCLUSION: To minimise the risk of first acquisition of A. fumigatus, it is important that infection prevention educational messaging is delivered in the paediatric clinic, to enhance health literacy around A. fumigatus acquisition.

PMID:37012557 | DOI:10.1007/s11046-023-00725-1

J Nucl Cardiol. 2023 Apr 3. doi: 10.1007/s12350-023-03255-x. Online ahead of print.

ABSTRACT

BACKGROUND: Myocardial flow reserve (MFR) and the extent of myocardial ischemia identify patients at high risk of major adverse cardiovascular events (MACEs). Associations between positron emission tomography (PET)-assessed extent of ischemia, MFR, and MACEs is unclear.

METHOD: Overall, 640 consecutive patients with suspected or known coronary artery disease undergoing ¹³N-ammonia myocardial perfusion PET were followed-up for MACEs. Patients were categorized into three groups based on myocardial ischemia severity: Group I (n = 335), minimal (myocardial ischemia < 5%); Group II (n = 150), mild (5-10%); and Group III (n = 155), moderate-to-severe (> 10%).

RESULTS: Cardiovascular death and MACEs occurred in 17 (3%) and 93 (15%) patients, respectively. Following statistical adjustment for confounding factors, impaired MFR (global MFR < 2.0) was revealed as an independent predictor of MACEs in Groups I (hazard ratio [HR], 2.89; 95% confidence interval [CI], 1.48-5.64; P = 0.002) and II (HR, 3.40; 95% CI 1.37-8.41; P = 0.008) but was not significant in Group III (HR, 1.15; 95% CI 0.59-2.26; P = 0.67), with a significant interaction (P < 0.0001) between the extent of myocardial ischemia and MFR.

CONCLUSION: Impaired MFR was significantly associated with increased risk of MACEs in patients with ≤ 10% myocardial ischemia but not with those having > 10% ischemia, allowing a clinically effective risk stratification.

PMID:37012523 | DOI:10.1007/s12350-023-03255-x

Neurol Sci. 2023 Apr 3. doi: 10.1007/s10072-023-06774-0. Online ahead of print.

ABSTRACT

INTRODUCTION: Evaluation of apathy in non-clinical populations is relevant to identify individuals at risk for developing cognitive decline in later stages of life, and it should be performed with questionnaires specifically designed for healthy individuals, such as the Apathy-Motivation Index (AMI); therefore, the aim of the present study was to validate the AMI in a healthy Italian population, and to provide normative data of the scale.

MATERIALS AND METHODS: Data collection was performed using a survey completed by 500 healthy participants; DAS, MMQ-A, BIS-15, PHQ-9, and GAD-7 were used to investigate convergent and divergent validity. Internal consistency and factorial structure were also evaluated. A regression-based procedure and receiver operating characteristics (ROC) analyses were used to evaluate the influence of socio-demographic variables on AMI scores and to provide adjusting factors and three cut-offs for the detection of mild, moderate, and severe apathy.

RESULTS: The Italian version of the AMI included 17 items (one item was removed because it was not internally consistent) and demonstrated good psychometric properties. The three-factor structure of AMI was confirmed. Multiple regression analysis revealed no effect of sociodemographic variables on the total AMI score. ROC analyses revealed three cut-offs of 1.5, 1.66, and 2.06 through the Youden’s J statistic to detect mild, moderate, and severe apathy, respectively.

CONCLUSION: The Italian version of the AMI reported similar psychometric properties, factorial structure, and cut-offs to the original scale. This may help researchers and clinicians to identify people at risk and address them in specific interventions to lower their apathy levels.

PMID:37012520 | DOI:10.1007/s10072-023-06774-0

Mikrochim Acta. 2023 Apr 3;190(5):167. doi: 10.1007/s00604-023-05760-9.

ABSTRACT

A hairpin DNA-enabled ratiometric electrochemical aptasensor is reported for sensitive and reliable detection of malathion (MAL). The approach employs hairpin DNA (ferrocene-labeled, Fc-hDNA) as a carrier to hybridize MAL aptamers (methylene blue-labeled, MB-Apt) to form double-stranded DNA structures on an electrode. The presence of MAL induces the removal of aptamers, and hDNA re-forms hairpin structures, causing a decrease in the oxidation current of MB (I_MB) and an increase in the oxidation current of Fc (I_Fc). The ratiometric signal of I_Fc/I_MB responds quantitatively to MAL concentrations. To compare analytical performances, a linear single-stranded DNA (ssDNA) is also used to construct the ssDNA-based aptasensor. We demonstrate that hairpin DNA possessing a rigid two-dimensional structure can improve the assembly efficiency of aptamers and the stability of redox probes. The approach combines the advantages of the ratiometric electrochemical method with hairpin DNA-based conformational switching probes, enabling hDNA-based aptasensor with enhanced sensitivity and reliability, offering a linear range of 0.001 to 1.0 ng mL^-1. The platform was applied to detect MAL in lettuce, and the statistical analysis indicated that no significant differences were found between the developed platform and HPLC-MS.

PMID:37012478 | DOI:10.1007/s00604-023-05760-9

Nat Genet. 2023 Apr 3. doi: 10.1038/s41588-023-01343-9. Online ahead of print.

ABSTRACT

The timing of parturition is crucial for neonatal survival and infant health. Yet, its genetic basis remains largely unresolved. We present a maternal genome-wide meta-analysis of gestational duration (n = 195,555), identifying 22 associated loci (24 independent variants) and an enrichment in genes differentially expressed during labor. A meta-analysis of preterm delivery (18,797 cases, 260,246 controls) revealed six associated loci and large genetic similarities with gestational duration. Analysis of the parental transmitted and nontransmitted alleles (n = 136,833) shows that 15 of the gestational duration genetic variants act through the maternal genome, whereas 7 act both through the maternal and fetal genomes and 2 act only via the fetal genome. Finally, the maternal effects on gestational duration show signs of antagonistic pleiotropy with the fetal effects on birth weight: maternal alleles that increase gestational duration have negative fetal effects on birth weight. The present study provides insights into the genetic effects on the timing of parturition and the complex maternal-fetal relationship between gestational duration and birth weight.

PMID:37012456 | DOI:10.1038/s41588-023-01343-9

Ann Surg Oncol. 2023 Apr 3. doi: 10.1245/s10434-023-13366-x. Online ahead of print.

ABSTRACT

BACKGROUND: For breast-conserving surgery (BCS), several alternatives to wire localization (WL) have been developed. The newest, electromagnetic seed localization (ESL), provides three-dimensional navigation using the electrosurgical tool. This study assessed operative times, specimen volumes, margin positivity, and re-excision rates for ESL and WL.

METHODS: Patients who had ESL-guided breast-conserving surgery between August 2020 and August 2021 were reviewed and matched one-to-one with patients who had WL based on surgeon, procedure type, and pathology. Variables were compared between ESL and WL using Wilcoxon rank-sum and Fisher’s exact tests.

RESULTS: The study matched 97 patients who underwent excisional biopsy (n = 20) or partial mastectomy with (n = 53) or without (n = 24) sentinel lymph node biopsy (SLNB) using ESL. The median operative time for ESL versus WL for lumpectomy was 66 versus 69 min with SLNB (p = 0.76) and 40 versus 34.5 min without SLNB (p = 0.17). The median specimen volume was 36 cm³ using ESL versus 55 cm³ using WL (p = 0.001). For the patients with measurable tumor volume, excess tissue was greater using WL versus ESL (median, 73.2 vs. 52.5 cm³; p = 0.017). The margins were positive for 10 (10 %) of the 97 ESL patients and 18 (19 %) of the 97 WL patients (p = 0.17). In the ESL group, 6 (6 %) of the 97 patients had a subsequent re-excision compared with 13 (13 %) of the 97 WL patients (p = 0.15).

CONCLUSIONS: Despite similar operative times, ESL is superior to WL, as evidenced by decreased specimen volume and excess tissue excised. Although the difference was not statistically significant, ESL resulted in fewer positive margins and re-excisions than WL. Further studies are needed to confirm that ESL is the most advantageous of the two methods.

PMID:37012435 | DOI:10.1245/s10434-023-13366-x

Int J Obes (Lond). 2023 Apr 3. doi: 10.1038/s41366-023-01303-7. Online ahead of print.

ABSTRACT

BACKGROUND/OBJECTIVES: Adverse effects of excess BMI (affecting 1 in 5 children in the US) on brain circuits during neurodevelopmentally vulnerable periods are incompletely understood. This study investigated BMI-related alterations in maturating functional networks and their underlying brain structures, and high-level cognition in early adolescence.

SUBJECTS/METHODS: Cross-sectional resting-state fMRI, structural sMRI, neurocognitive task scores, and BMI from 4922 youth [median (IQR) age = 120.0 (13.0) months, 2572 females (52.25%)] from the Adolescent Brain Cognitive Development (ABCD) cohort were analyzed. Comprehensive topological and morphometric network properties were estimated from fMRI and sMRI, respectively. Cross-validated linear regression models assessed correlations with BMI. Results were reproduced across multiple fMRI datasets.

RESULTS: Almost 30% of youth had excess BMI, including 736 (15.0%) with overweight and 672 (13.7%) with obesity, and statistically more Black and Hispanic compared to white, Asian and non-Hispanic youth (p < 0.01). Those with obesity or overweight were less physically active, slept less than recommended, snored more frequently, and spent more time using an electronic device (p < 0.01). They also had lower topological efficiency, resilience, connectivity, connectedness and clustering in Default-Mode, dorsal attention, salience, control, limbic, and reward networks (p ≤ 0.04, Cohen’s d: 0.07-0.39). Lower cortico-thalamic efficiency and connectivity were estimated only in youth with obesity (p < 0.01, Cohen’s d: 0.09-0.19). Both groups had lower cortical thickness, volume and white matter intensity in these networks’ constituent structures, particularly anterior cingulate, entorhinal, prefrontal, and lateral occipital cortices (p < 0.01, Cohen’s d: 0.12-0.30), which also mediated inverse relationships between BMI and regional functional topologies. Youth with obesity or overweight had lower scores in a task measuring fluid reasoning – a core aspect of cognitive function, which were partially correlated with topological changes (p ≤ 0.04).

CONCLUSIONS: Excess BMI in early adolescence may be associated with profound aberrant topological alterations in maturating functional circuits and underdeveloped brain structures that adversely impact core aspects of cognitive function.

PMID:37012426 | DOI:10.1038/s41366-023-01303-7

Cardiovasc Intervent Radiol. 2023 Apr 3. doi: 10.1007/s00270-023-03417-x. Online ahead of print.

ABSTRACT

PURPOSE: The OsteoCool Tumor Ablation Post-Market Study (OPuS One) was a prospective, multi-national, single-arm study to investigate safety and effectiveness of radiofrequency ablation (RFA) for palliation of painful lytic bone metastases with 12 months of follow-up. RFA has demonstrated effective palliation of osseous metastases in small clinical studies with short-term follow-up; however, a long-term assessment with robust subject numbers is lacking.

MATERIALS AND METHODS: Prospective assessments were conducted at Baseline, 3 days, 1 week, and 1, 3, 6, and 12-months. Pain and quality of life were measured prior to RFA and postoperatively using the Brief Pain Inventory, European Quality of Life-5 Dimension, and European Organization for Research and Treatment of Cancer Care Quality of Life Questionnaire for palliative care. Radiation, chemotherapy and opioid usage, and related adverse events were collected.

RESULTS: 206 subjects were treated with RFA at 15 institutions in OPuS One. Worst pain, average pain, pain interference and quality of life significantly improved at all visits starting 3 days post-RFA and sustained to 12 months (P < 0.0001). Post hoc analysis found neither systemic chemotherapy nor local radiation therapy at the index site of RFA influenced worst pain, average pain, or pain interference. Six subjects had device/procedure-related adverse events.

CONCLUSION: RFA for lytic metastases provides rapid (within 3 days) and statistically significant pain and quality of life improvements with sustained long-term relief through 12 months and a high degree of safety, independent of radiation.

LEVEL OF EVIDENCE: 2B, PROSPECTIVE, NON-RANDOMIZED, POST-MARKET STUDY: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

PMID:37012392 | DOI:10.1007/s00270-023-03417-x