Category: Nevin Manimala

J Neurointerv Surg. 2023 Mar 15:jnis-2023-020094. doi: 10.1136/jnis-2023-020094. Online ahead of print.

ABSTRACT

BACKGROUND: Cangrelor is an intravenous P2Y12 inhibitor with rapid onset and fast offset of antiplatelet action. Dose adjusted cangrelor based on platelet function testing is suggested to be advantageous for use during neuroendovascular procedures. In this study, we aimed to assess the efficacy and safety of this strategy.

METHODS: This retrospective study included consecutive patients who received low dose intravenous cangrelor (5 µg/kg; infusion 1 µg/kg/min) for ruptured (RIA) and unruptured (UIA) intracranial aneurysms, and acute ischemic stroke (AIS). Indications were acute stenting or intraluminal thrombus. Outcomes were assessed at 24 hours by brain CT and CT angiography. The primary efficacy outcome was the rate of stent occlusion or persistent intraluminal thrombus. The primary safety outcome was the rate of major hemorrhages.

RESULTS: 101 patients (56 men; median age (IQR) 59 (51-70) years) received low dose cangrelor for acute stenting (79/101 (78%)) and intraprocedural thrombus (22/101 (22%)). Overall, 5 (4.9%) patients experienced stent occlusion within 24 hours (RIA 3/28; AIS 2/52). There were no cases of failure among UIA patients. Stent mis-opening (fish mouthing or stenosis >50%) was significantly associated with stent occlusion (P<0.001). The overall rate of major hemorrhage was 2% (2/101), which occurred in AIS patients. Platelet reactivity unit (PRU) values were lower in those presenting with major hemorrhage (PRU 4 (SD 1.4) vs PRU 60 (SD 63); P=0.043). Mortality rate after cangrelor related hemorrhage was 1%.

CONCLUSIONS: Low dose cangrelor appears to be effective in preventing stent thrombosis and arterial patency with a low hemorrhagic risk.

PMID:36922032 | DOI:10.1136/jnis-2023-020094

Br J Haematol. 2023 Mar 15. doi: 10.1111/bjh.18734. Online ahead of print.

ABSTRACT

The Children’s Oncology Group AHOD0831 study used a positron emission tomography (PET) response-adapted approach in high-risk Hodgkin lymphoma, whereby slow early responders (SERs) received more intensive therapy than rapid early responders (RERs). We explored if baseline PET-based characteristics would improve risk stratification. Of 166 patients enrolled in the COG AHOD0831 study, 94 (57%) had baseline PET scans evaluable for quantitative analysis. For these patients, total body metabolic tumour volume (MTV), total lesion glycolysis (TLG), maximum standardized uptake value (SUV_max ) and peak SUV (SUV_peak ) were obtained. MTV/TLG thresholds were an SUV of 2.5 (MTV_2.5 /TLG_2.5 ) and 40% of the tumour SUV_max (MTV_40% /TLG_40% ). TLG_2.5 was associated with event-free survival (EFS) in the complete cohort (p = 0.04) and in RERs (p = 0.01), but not in SERs (p = 0.8). The Youden index cut-off for TLG_2.5 was 1841. Four-year EFS was 92% for RER/TLG_2.5 up to 1841, 60% for RER/TLG_2.5 greater than 1841, 74% for SER/TLG_2.5 up to 1841 and 79% for SER/TLG_2.5 greater than 1841. Second EFS for RER/TLG_2.5 up to 1841 was 100%. Thus, RERs with a low baseline TLG_2.5 experienced excellent EFS with less intensive therapy, whereas RERs with a high baseline TLG_2.5 experienced poor EFS. These findings suggest that patients with a high upfront tumour burden may benefit from intensified therapy, even if they achieve a RER.

PMID:36922022 | DOI:10.1111/bjh.18734

Otol Neurotol. 2023 Mar 14. doi: 10.1097/MAO.0000000000003847. Online ahead of print.

ABSTRACT

OBJECTIVE: Many but not all patients with idiopathic intracranial hypertension (IIH) have pulsatile tinnitus (PT). However, little is known about why some patients with IIH develop PT and others do not. The purpose of this study was to determine if any of the classic magnetic resonance imaging (MRI)-detectable markers of IIH differ between patients with and without PT, thereby shedding light on potential pathophysiology.

METHODS: A retrospective age-matched cohort study of patients with documented IIH (diagnosed by neuro-ophthalmologist) was performed. All patients had MRI performed around the time of diagnosis. MRIs were assessed for 16 variables known to be associated with IIH (e.g., pituitary displacement/empty sella, optic nerve tortuosity, transverse sinus stenosis, inferior cerebellar tonsils, arachnoid granulations, slit-like ventricles) by two blinded neuroradiologists. All binary variables were analyzed via χ2 test with Yates correction, or Fisher exact when appropriate. Continuous variables were analyzed via Student t test. Inter-rater reliability for binary variables was assessed by Cohen κ. For continuous variables, intraclass correlation coefficient was calculated.

RESULTS: Forty age-matched patients with IIH met the inclusion criteria (20 with PT, 20 without PT). For all known binary MRI findings associated with IIH, there were no statistically significant differences between groups. Likewise, there were no statistically significant differences for continuous variables.

CONCLUSIONS: The classic MRI findings associated with IIH do not differ between patients with and without PT, suggesting that systemic (rather than localized intrinsic or extrinsic) factors may play a critical role in the pathophysiology.

PMID:36922020 | DOI:10.1097/MAO.0000000000003847

Genome Res. 2023 Mar 15:gr.276992.122. doi: 10.1101/gr.276992.122. Online ahead of print.

ABSTRACT

While mutation rates have been extensively studied, variation in mutation rates throughout the genome is poorly understood. To understand patterns of genetic variation, it is important to understand how mutation rates vary. Chromatin modifications may be an important factor in determining variation in mutation rates in eukaryotic genomes. To study variation in mutation rates, we performed a mutation accumulation experiment in the filamentous fungus Neurospora crassa, and sequenced the genomes of the 40 MA lines that had been propagated asexually for approximately 1015 [1003, 1026] mitoses. We detected 1322 mutations in total, and observed that the mutation rate was higher in regions of low GC, in domains of H3K9 trimethylation, in centromeric regions, and in domains of H3K27 trimethylation. The rate of single nucleotide mutations in euchromatin was 2.46 [2.19, 2.77] × 10^-10 In contrast, the mutation rate in H3K9me3 domains was tenfold higher: 2.43 [2.25, 2.62] × 10^-9 We also observed that the spectrum of single nucleotide mutations was different between H3K9me3 and euchromatic domains. Our statistical model of mutation rate variation predicted a moderate amount of extant genetic variation, suggesting that the mutation rate is an important factor in determining levels of natural genetic variation. Furthermore, we characterized mutation rates of structural variants, complex mutations, and the effect of local sequence context on the mutation rate. Our study highlights that chromatin modifications are associated with mutation rates, and accurate evolutionary inferences should take variation in mutation rates across the genome into account.

PMID:36922001 | DOI:10.1101/gr.276992.122

J Am Med Inform Assoc. 2023 Mar 14:ocad036. doi: 10.1093/jamia/ocad036. Online ahead of print.

ABSTRACT

OBJECTIVE: To develop a computable representation for medical evidence and to contribute a gold standard dataset of annotated randomized controlled trial (RCT) abstracts, along with a natural language processing (NLP) pipeline for transforming free-text RCT evidence in PubMed into the structured representation.

MATERIALS AND METHODS: Our representation, EvidenceMap, consists of 3 levels of abstraction: Medical Evidence Entity, Proposition and Map, to represent the hierarchical structure of medical evidence composition. Randomly selected RCT abstracts were annotated following EvidenceMap based on the consensus of 2 independent annotators to train an NLP pipeline. Via a user study, we measured how the EvidenceMap improved evidence comprehension and analyzed its representative capacity by comparing the evidence annotation with EvidenceMap representation and without following any specific guidelines.

RESULTS: Two corpora including 229 disease-agnostic and 80 COVID-19 RCT abstracts were annotated, yielding 12 725 entities and 1602 propositions. EvidenceMap saves users 51.9% of the time compared to reading raw-text abstracts. Most evidence elements identified during the freeform annotation were successfully represented by EvidenceMap, and users gave the enrollment, study design, and study Results sections mean 5-scale Likert ratings of 4.85, 4.70, and 4.20, respectively. The end-to-end evaluations of the pipeline show that the evidence proposition formulation achieves F1 scores of 0.84 and 0.86 in the adjusted random index score.

CONCLUSIONS: EvidenceMap extends the participant, intervention, comparator, and outcome framework into 3 levels of abstraction for transforming free-text evidence from the clinical literature into a computable structure. It can be used as an interoperable format for better evidence retrieval and synthesis and an interpretable representation to efficiently comprehend RCT findings.

PMID:36921288 | DOI:10.1093/jamia/ocad036

J Laparoendosc Adv Surg Tech A. 2023 Mar 15. doi: 10.1089/lap.2022.0556. Online ahead of print.

ABSTRACT

Purpose: Transvesicoscopic ureteral reimplantation (TVUR) for vesicoureteral reflux (VUR) is a technically demanding operation. The technical difficulty is further increased by previous failed endoscopic injection, which causes intense fibrosis around the ureter. In this study, we compared primary TVUR with TVUR after previous failed endoscopic injection for VUR. Materials and Methods: The records of all children undergoing TVUR by a single surgeon over a 4-year period were analyzed. The children were divided into group 1 (primary TVUR, n = 50) and group 2 (TVUR after previous failed endoscopic treatment of Dextranomer/Hyaluronic Acid, n = 7). Demographic, clinical, radiologic, operative and follow-up data were compared between the two groups. The results were analyzed by statistical software; Mann-Whitney test and Fisher’s exact test were used where appropriate, and P < .05 was considered significant. Results: Both the groups were comparable with respect to age and mean VUR grade. The mean VUR grade was significantly higher in group 1 and mean operative time per ureter was significantly more for group 2 than group 1. The postoperative hospital stay, success of TVUR, and complications were not significantly different between the groups. Conclusions: To our knowledge, this is the first report of its kind. TVUR after previous failed endoscopic injection could be done safely with good success, but with longer operative time than primary TVUR even in expert hands. Hence, previous failed endoscopic injection is not a contraindication to TVUR.

PMID:36921282 | DOI:10.1089/lap.2022.0556

JCO Glob Oncol. 2023 Mar;9:e2200221. doi: 10.1200/GO.22.00221.

ABSTRACT

PURPOSE: To examine cancer patients’ perspectives on the impact of COVID-19 on teleoncology in Nigeria.

METHODS: Data from a multicenter survey conducted at 15 outpatient clinics to 1,097 patients with cancer from April and July 2020 were analyzed. The study outcome was telemedicine, defined as patients who reported their routine follow-up visits were converted to virtual visits because of COVID-19 (coded yes/no). Covariates included patient age, ethnicity, marital status, income, cancer treatment, service disruption, and cancer diagnosis/type. Stata/SE.v.17 (StataCorp, College Station, TX) was used to perform chi-square and logistic regression analyses. P values ≤ .05 were considered statistically significant.

RESULTS: The majority of the 1,097 patients with cancer were female (65.7%) and age 55 years and older (35.0%). Because of COVID-19, 12.6% of patients’ routine follow-ups were converted to virtual visits. More patients who canceled/postponed surgery (17.7% v 7.5%; P ≤ .001), radiotherapy (16.9% v 5.3%; P ≤ .001), and chemotherapy (22.8% v 8.5%; P ≤ .001), injection chemotherapy (20.6% v 8.7%; P ≤ .001) and those who reported being seen less by their doctor/nurse (60.3% v 11.4%; P ≤ .001) reported more follow-up conversions to virtual visits. In multivariate analyses, patients seen less by their doctors/nurses were 14.3 times more likely to have their routine follow-ups converted to virtual visits than those who did not (odds ratio, 14.33; 95% CI, 8.36 to 24.58).

CONCLUSION: COVID-19 caused many patients with cancer in Nigeria to convert visits to a virtual format. These conversions were more common in patients whose surgery, radiotherapy, chemotherapy, and injection chemotherapy treatments were canceled or postponed. Our findings suggest how COVID-19 affects cancer treatment services and the importance of collecting teleoncological care data in Nigeria.

PMID:36921242 | DOI:10.1200/GO.22.00221

JMIR Public Health Surveill. 2023 Mar 14. doi: 10.2196/45110. Online ahead of print.

ABSTRACT

BACKGROUND: Elderly people were regarded as the most impacted and most vulnerable social group during the COVID-19 epidemic. The community environment is vital for their health. The elderly people had to stay home during the implementation of the management and control of the COVID-19 epidemic. They lack resources and suffer from anxiety. Thus, determining environmental factors beneficial for their physical and mental health is very important.

OBJECTIVE: This study aims to assess the association between community cohesion and physical and mental health among elderly people and to identify the related community service and environmental factors that may promote community cohesion.

METHODS: This community-based cross-sectional study was designed during the COVID-19 epidemic. A multistage sampling method is applied to this study. A total of 2,036 participants aged ≥ 60 years were sampled from 27 locations in China. Data were collected through face-to-face interviews. The neighborhood cohesion instrument consisting of three-dimensional scales was used to assess community cohesion. Self-efficacy and life satisfaction, cognitive function and depression, and community service and environmental factors were also measured using standard instruments. Statistical analyses were restricted to 2,017 participants. Separate logistic regression analysis was conducted to assess the association between community cohesion and physical and mental health factors, as well as related community service and environmental factors, among elderly people.

RESULTS: The results showed that high levels of community cohesion were associated with good self-perceived health status and life satisfaction and high levels of self-efficacy and psychological resilience, and their odds ratios (ORs) were 1.27 (95% CI, 1.01-1.59) and 1.20 (95% CI, 1.15-1.27) and 1.09 (95% CI, 1.05-1.13) and 1.05 (95% CI, 1.03-1.06), respectively. The length of stay in the community and the level of physical activity were positively associated with community cohesion scores, whereas the educational level was negatively associated with the community cohesion scores (P < .05). Community cohesion was also associated with low level of depression and high level of cognitive function. The community cohesion was significantly associated with community services and environmental factors from four dimensions. High levels of community cohesion were associated with transportation service, rental of rehabilitation equipment, high levels of satisfaction for community doctors’ technical level and community waste disposal, and their ORs were 3.14 (95% CI, 1.87-5.28), 3.62 (95% CI, 2.38-5.52), 1.37 (95% CI, 1.08-1.73), and 1.23 (95% CI, 1.01-1.50), respectively.

CONCLUSIONS: Community cohesion was associated with the physical and mental health of elderly people. Our research suggests that enhancing community services and environmental management may be an effective strategy to increase community cohesion during the epidemic period of major infectious diseases.

PMID:36921236 | DOI:10.2196/45110

Orthopedics. 2023 Mar 15:1-4. doi: 10.3928/01477447-20230310-03. Online ahead of print.

ABSTRACT

Subchondroplasty is a relatively new minimally invasive procedure that has been used to treat bone marrow edema associated with osteoarthritis. Subchondroplasty as treatment for early stage osteonecrosis of the knee has not been extensively studied. The authors hypothesized that subchondroplasty may be an effective treatment for relieving pain, improving function, and preventing collapse in osteonecrosis. In this study, a retrospective review of 11 cases of subchondroplasty of the distal femur was conducted. There were no surgical complications with the procedure, and patients reported statistically significant improvement in pain and function. The mean Knee injury and Osteoarthritis Outcome Score for Joint Replacement improved from 44.3±4.9 preoperatively to 65.73±17.2 postoperatively. The mean visual analog scale score for knee pain was 7.8±1.18 preoperatively and 3.7±1.57 postoperatively. There has been one case of recurrence of osteonecrosis and no cases of joint collapse since the procedures occurred between 2018 and 2021. Previously, subchondroplasty for the treatment of osteonecrosis of the talus as well as of the knee joint showed positive results. This study affirms that subchondroplasty may also be a useful treatment option for relieving pain, improving function, and preventing joint collapse in osteonecrosis of the knee. [Orthopedics. 202x;4x(x):xx-xx.].

PMID:36921231 | DOI:10.3928/01477447-20230310-03

Orthopedics. 2023 Mar 15:1-7. doi: 10.3928/01477447-20230310-08. Online ahead of print.

ABSTRACT

In 2018, periprosthetic joint infection (PJI) criteria were revised to include a new category labeled “inconclusive.” The purpose of this study was to characterize and describe the fate of the inconclusive PJI workup and to analyze preoperative factors associated with outcomes. We reviewed all PJI workups at our institution during a 3-year period (426 patients). Patients were labeled “infected,” “not infected,” or “inconclusive” according to 2018 PJI preoperative criteria. In addition to standard diagnostic variables, the presence or absence of clinical elements that increase the pretest probability of infection were collected. Patients with any missing preoperative diagnostic test results and those with clinical follow-up less than 30 days were excluded. Logistic regression was used to identify the factors associated with infection. Two hundred ninety-six workups remained after exclusion criteria were applied, consisting of 66 (22.2%) with a preoperative score of 6 or greater defined as infected, 52 (17.6%) inconclusive (score 2-5), and 178 (60.1%) not infected (score 0-1). Postoperative re-scoring of the inconclusive group based on intraoperative findings as per the 2018 criteria identified 6 of 52 (11.5%) as infected, 12 (23.1%) inconclusive, and 34 (65.4%) not infected. Among those preoperatively scored as inconclusive, variables statistically correlated with the presence of infection included history of PJI, factors that increase skin barrier penetration (eg, psoriasis and venous stasis), and presence of comorbidities predisposing to infection. For patients labeled inconclusive, clinical elements of the pretest probability for infection (eg, history of prior PJI) were as reliable as any diagnostic test, including alpha-defensin, in the diagnosis of PJI. [Orthopedics. 202x;4x(x):xx-xx.].

PMID:36921226 | DOI:10.3928/01477447-20230310-08