Category: Nevin Manimala

Int J Comput Assist Radiol Surg. 2023 Feb 13. doi: 10.1007/s11548-023-02837-x. Online ahead of print.

ABSTRACT

PURPOSE: Endoscopy implies high demanding procedures, and their practice requires structured formation curricula supported by adequate training platforms. Physical platforms are the most standardised solution for surgical training, but over the last few years, virtual platforms have been progressively introduced. This research work presents a new hybrid, physic-virtual, endoscopic training platform that exploits the benefits of the two kind of platforms combining realistic tools and phantoms together with the capacity of measuring all relevant parameters along the execution of the exercises and of providing an objective assessment performance.

METHODS: The developed platform, EndoTrainer, has been designed to train and assess surgical skills in hysteroscopy and cystoscopy following a structured curricula. The initial development and validation is focused on hysteroscopic exercises proposed in the Gynaecological Endoscopic Surgical Education and Assessment (GESEA) Certification Programme from The Academy and European Society for Gynaecological Endoscopy (ESGE) and analyses the obtained results of an extensive study with 80 gynaecologists executing 30 trials of the standard 30 degree endoscope navigation exercise.

RESULTS: The experiments demonstrate the benefits of the presented hybrid platform. Multi-variable statistical analysis points out that all subjects have obtained statistically significant improvement in all relevant parameters: shorter and safer trajectories, improved 30-degree endoscope navigation, accurate positioning over the targets and reduction of the execution time.

CONCLUSION: This paper presents a new hybrid approach for training, and evaluating whether it provides an objectivable improvement of camera navigation endoscopic basic skills. The obtained results demonstrate the initial hypothesis: all subjects have improved their camera handling and navigation skills.

PMID:36781742 | DOI:10.1007/s11548-023-02837-x

Methods Mol Biol. 2023;2632:299-319. doi: 10.1007/978-1-0716-2996-3_21.

ABSTRACT

RNA modifications regulate multiple aspects of cellular function including RNA splicing, translation, export, decay, stability, and phase separation. One of the comprehensive ways to detect such modifications is by the recent advancement of direct RNA sequencing from Oxford Nanopore Technologies (ONT). However, this method obtains a large amount of data with high complexity in the form of raw current signal that poses a new informatics challenge to accurately detect those modifications. Here, we provide nanoDoc2, a software to detect multiple types of RNA modification from nanopore direct RNA sequencing data. The nanoDoc2 includes a novel signal segmentation algorithm based on the trace value-a base probability feature that is added by the Guppy basecalling program from ONT during processing of the raw signal. The core of nanoDoc2 includes a machine learning algorithm in which a 6-mer segmented raw current signal is analyzed by deep one-class classification using a WaveNet-based neural network. As an output, an RNA modification is detected by a statistical score in each candidate position. Herein, we describe the detailed instructions on how to use nanoDoc2 for signal segmentation, train/test the neural network, and finally predict RNA modifications present in nanopore direct RNA sequencing data.

PMID:36781737 | DOI:10.1007/978-1-0716-2996-3_21

Egypt Heart J. 2023 Feb 13;75(1):11. doi: 10.1186/s43044-023-00331-y.

ABSTRACT

BACKGROUND: Trastuzumab and trastuzumab emtansine are specific antibody and antibody-drug conjugates used in the treatment of human epidermal growth factor receptor 2 (HER2) positive metastatic breast cancer. The aim of this study was to test their effect on the QTc interval duration and left ventricular ejection fraction (LVEF) in our patients, two parameters used in evaluation of cardiotoxicity. From May 2015 to October 2017, 26 patients with preserved LVEF were included in the study. All of them were previously treated with standard paclitaxel and cisplatin-based chemotherapy regimens. Electrocardiogram (ECG) was recorded just before each trastuzumab dose application and six months after the last dose. Echocardiography with LVEF measurement was performed several days before the application of the initial dose, and six months after the last cycle. Later, 24 patients with metastatic disease received additional treatment with trastuzumab emtansine after six months and the same ECG and echocardiography protocol was performed again. Due to reduction in LVEF, two patients were discontinued from additional treatment.

RESULTS: A statistically significant QTc prolongation was found after each drug dose application, with an increase in mean QTc duration with every successive application, reaching the peak QTc values just before the fifth cycle of treatment. The QTc interval returned to its initial value six months after the last cycle (p < 0.001). These results were similar for both drugs. Mean LVEF before both treatment protocols was significantly higher compared to LVEF value after the treatment. LVEF before trastuzumab emtansine treatment was non-significantly higher than LVEF after trastuzumab treatment.

CONCLUSION: Trastuzumab and trastuzumab emtansine cardiotoxicity manifested as a significant and progressive QTc prolongation after successive drug applications, reaching the peak value just before the fifth cycle of both drugs. Both medications also caused statistically significant but asymptomatic LVEF reduction. Complete reversibility of cardiotoxic effects of both drugs was confirmed by QTc interval and LVEF normalisation after the treatment discontinuation.

PMID:36781707 | DOI:10.1186/s43044-023-00331-y

Matern Child Health J. 2023 Feb 13. doi: 10.1007/s10995-023-03618-3. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to determine the predictors of Knowledge, Attitude and Practice (KAP) towards Family Planning (FP) among pregnant Fijian women.

METHODS: A cross-sectional study was conducted over two months in 2019 with adult pregnant women attending the Antenatal Clinic (ANC) at Ba Mission Hospital (BMH), Fiji. Data was collected using a self-administrated questionnaire. Statistical analysis included correlation tests and regression analysis in determining predictors of KAP.

RESULTS: 240 pregnant women participated in this study with a mean age of 26.02 (± SD = 4.13). The results showed a moderate level of knowledge (mean 14.95, SD ± 3.15), positive attitude (mean 20.56, SD ± 5.68), and good practice (mean 4.97, SD ± 1.73). Linear regression identified that women with more than seven children had a knowledge score of 3.65, lower than null parity (t value = -2.577, p = 0.011). Women aged 20 to 24 had a 6.47 lower attitude score than women aged 18 to 19 (t value = -2.142, p = 0.033). Women in defacto relationships had a 2.12 lower attitude score compared to the married category (t value = -2.128, p = 0.034). Fijian women of Indian descent had a 1.98 lower attitude score than the I Taukei women (t value = -2.639, p = 0.009). Women aged 30-34 had 2.41 lower practice scores than those aged 18-19 (t value = -2.462, p = 0.015).

CONCLUSION: This study found a medium knowledge of FP among pregnant women. These findings support a recommendation for further research to implement effective strategies.

PMID:36781695 | DOI:10.1007/s10995-023-03618-3

Matern Child Health J. 2023 Feb 13. doi: 10.1007/s10995-023-03603-w. Online ahead of print.

ABSTRACT

BACKGROUND: An episiotomy is a surgical technique that widens the perineum during the second stage of childbirth. Therefore, the goal of this study was to assess the prevalence of episiotomy and the variables that affect it among women who gave birth in the town of Debre Tabor, in 2021.

METHODS: In the Debre Tabor municipality’s four designated health center regions, 402 women who gave birth were included in a cross-sectional study. Systematic random selection was used to choose the study subjects. In SPSS version 23, data were entered, cleaned up, and analyzed using descriptive and inferential statistics. The use of binary and multivariable logistic regression models allowed the researchers to identify characteristics related to episiotomy magnitude. Using a 0.05 p value, the level of statistically significant variables was also calculated.

RESULT: Out of a total of 402 deliveries for this inquiry, the magnitude of the episiotomy was calculated to be 35.1% of those deliveries. About 127 women, or the bulk of respondents, were between the ages of 25 and 29 (33.1%). Face presentation was 4.7 times more common among primiparous women than breech and vertex presentation, and midwifery professionals and midwifery students were 5.5 times higher than internship medicine and health officer students. The odds of performing an episiotomy were 3.7 times higher among primiparous women compared to multiparous women (AOR = 3.754 (1.382-15.108)).

CONCLUSION: The magnitude of episiotomy in this study was somewhat larger than the World Health Organization’s recommendation of 10% .Instrumental delivery, neonatal presentation, experts allocated to the delivery ward, and the mother’s parity were all shown to be strongly linked with the practice of episiotomy.

PMID:36781696 | DOI:10.1007/s10995-023-03603-w

Matern Child Health J. 2023 Feb 13. doi: 10.1007/s10995-023-03596-6. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess changes in mental health and social risk factors in pregnant women in counties affected by Hurricane Michael (October 2018).

METHODS: Data from the Universal Perinatal Risk Screen (UPRS) and vital statistics for the state of Florida were obtained. Prenatal risk factors (unplanned pregnancy, mental health services, high stress, use of tobacco or alcohol, young children at home or with special needs, trouble paying bills) were compared in the year before and year after Hurricane Michael in affected counties (n = 18,887). Log-Poisson regression with robust variance was used for binary outcomes, adjusting for maternal age, race, BMI, and education.

RESULTS: A smaller proportion of pregnant women were screened in the months after the hurricane. No changes were seen in overall scores. The proportion referred was lower in the 1 month after Michael compared to that in 1 month before Michael (RR 0.78, 95% CI = 0.71, 0.86), but greater in the year after (RR = 1.07, 95% CI: 1.04, 1.10). Most individual risk factors on the screener did not change significantly, except having an illness that required ongoing medical care was less common in the short term (3 months after vs. 3 months before: aRR = 0.76, 95% CI: 0.66, 0.87), and more common in the longer term (1 year after vs. 1 year before, aRR = 1.09, 95% CI: 1.02, 1.18). Birth certificate data suggested smoking during pregnancy was higher among women who experienced Michael during their pregnancies (aRR = 1.15, 95% CI: 1.01, 1.32).

DISCUSSION: Perinatal screening and referral declined in the short-term aftermath of Hurricane Michael.

PMID:36781693 | DOI:10.1007/s10995-023-03596-6

Acad Med. 2023 Feb 10. doi: 10.1097/ACM.0000000000005170. Online ahead of print.

ABSTRACT

PURPOSE: Simulation-based mastery learning (SBML) is a rigorous form of competency-based learning. Components of SBML include a pretest, deliberate practice, and a posttest; all learners must meet or exceed a minimum passing standard (MPS) on the posttest before completing training. The authors aimed to explore whether a modified SBML curriculum (without a pretest assessment) was as effective as the standard SBML curriculum (with a pretest assessment).

METHOD: The authors performed a randomized controlled trial of internal medicine residents who participated in an internal jugular central venous catheter insertion SBML curriculum at a tertiary care academic medical center in Chicago, Illinois, from December 2018 through December 2021. Residents were randomly assigned to complete the usual SBML intervention (pretest group) or to complete a modified SBML intervention without a pretest (no pretest group). The authors compared initial posttest performance and training time between groups.

RESULTS: Eighty-nine of 120 eligible residents (74.1%) completed the study: 43 in the pretest group and 46 in the no pretest group. Median (IQR) initial posttest scores were not statistically different between the pretest group (96.6 [93.1-100]) and the no pretest group (96.6 [92.4-100]). However, all 43 residents (100%) in the pretest group reached the MPS at the initial posttest compared with 41 of the 46 (89%) in the no pretest group (p = .06). Residents in the pretest group required 16.5 hours more faculty and learning time than the no pretest group.

CONCLUSIONS: More residents who completed a pretest reached the MPS at initial posttest. However, incorporating a pretest during the internal jugular central venous catheter SBML curriculum required substantially more learner and faculty time without clear performance benefits.

PMID:36780693 | DOI:10.1097/ACM.0000000000005170

N Engl J Med. 2023 Feb 9;388(6):489-498. doi: 10.1056/NEJMoa2212083.

ABSTRACT

BACKGROUND: The increased detection of small-sized peripheral non-small-cell lung cancer (NSCLC) has renewed interest in sublobar resection in lieu of lobectomy.

METHODS: We conducted a multicenter, noninferiority, phase 3 trial in which patients with NSCLC clinically staged as T1aN0 (tumor size, ≤2 cm) were randomly assigned to undergo sublobar resection or lobar resection after intraoperative confirmation of node-negative disease. The primary end point was disease-free survival, defined as the time between randomization and disease recurrence or death from any cause. Secondary end points were overall survival, locoregional and systemic recurrence, and pulmonary functions.

RESULTS: From June 2007 through March 2017, a total of 697 patients were assigned to undergo sublobar resection (340 patients) or lobar resection (357 patients). After a median follow-up of 7 years, sublobar resection was noninferior to lobar resection for disease-free survival (hazard ratio for disease recurrence or death, 1.01; 90% confidence interval [CI], 0.83 to 1.24). In addition, overall survival after sublobar resection was similar to that after lobar resection (hazard ratio for death, 0.95; 95% CI, 0.72 to 1.26). The 5-year disease-free survival was 63.6% (95% CI, 57.9 to 68.8) after sublobar resection and 64.1% (95% CI, 58.5 to 69.0) after lobar resection. The 5-year overall survival was 80.3% (95% CI, 75.5 to 84.3) after sublobar resection and 78.9% (95% CI, 74.1 to 82.9) after lobar resection. No substantial difference was seen between the two groups in the incidence of locoregional or distant recurrence. At 6 months postoperatively, a between-group difference of 2 percentage points was measured in the median percentage of predicted forced expiratory volume in 1 second, favoring the sublobar-resection group.

CONCLUSIONS: In patients with peripheral NSCLC with a tumor size of 2 cm or less and pathologically confirmed node-negative disease in the hilar and mediastinal lymph nodes, sublobar resection was not inferior to lobectomy with respect to disease-free survival. Overall survival was similar with the two procedures. (Funded by the National Cancer Institute and others; CALGB 140503 ClinicalTrials.gov number, NCT00499330.).

PMID:36780674 | DOI:10.1056/NEJMoa2212083

Ann Am Thorac Soc. 2023 Feb 13. doi: 10.1513/AnnalsATS.202207-577OC. Online ahead of print.

ABSTRACT

RATIONALE: Craniofacial and pharyngeal morphology are risk factors for Obstructive Sleep Apnea (OSA). Quantitative photography provides phenotypic information about these anatomic risk factors and is feasible in large samples. However, whether associations between morphology and OSA severity are influenced by genetic ancestry is unknown.

OBJECTIVE: The aim of this study was to examine this question in a large sample encompassing people from distinct ancestral backgrounds.

METHODS: Participants of the Sleep Apnea Global Interdisciplinary Consortium (SAGIC) cohort with available genomic data were included (N=2,393). Associations between photography-based measures and OSA severity were assessed using linear regression models, controlling for age, sex, and BMI. Statistical interaction tests were used to assess if genetically-determined ancestry (based on 1000 Genomes reference populations) influenced the relationship of anatomy with OSA severity.

RESULTS: Cluster analysis of genetic ancestry proportions identified four ancestry groups: East Asian (48.3%), European (33.6%), Mixed (11.7%) and African (6.4%). Multiple anatomic traits were associated with more severe OSA independent of ancestry, including larger cervicomental angle (standardized β [95%CI] = 0.11 [0.06, 0.16], p<0.001), mandibular width (0.15 [0.10, 0.20], p<0.001), and tongue thickness (0.06 [0.02, 0.10], p=0.001) and smaller airway width (-0.08 [-0.15, -0.002]). Other traits, including maxillary and mandibular depth angles and lower face height, demonstrated stronger/weaker associations with OSA severity based on genetic ancestry.

CONCLUSIONS: We confirm multiple facial and intraoral photographic measurements are associated with OSA severity independent of ancestral background, while others differ in their association.

PMID:36780658 | DOI:10.1513/AnnalsATS.202207-577OC

Georgian Med News. 2022 Dec;(333):77-85.

ABSTRACT

The purpose of the study – to conduct an analysis of the disability of ATO/JFO participants in 2014-2021 with a detailed comparative analysis of data of 2021 and determination of the needs of the mentioned contingent in rehabilitation devices. Operational information was collected according to the statistic form of ATO/OOS participants examined at the medical and social expert commissions: developed by the authors statistical form “Report on the causes of disability, indications for medical, professional and social rehabilitation in ATO participants for _____ year”, which was summarized and processed. Materials were collected from 2014 to 2021. More than a half of those recognized for the first time as disabled, 2,997 people in 2021 (86.0%), 2,624 people in 2020 (81.2%), 3,297 people in 2019 (79.3%), 2,848 people (75.5%) in 2018 and 1,859 people (65.0%) in 2017 – received the disability group not as a result of traumatic injuries, but for other unspecified reasons that did not have a traumatization factor. The main causes of disability were diseases of the circulatory system (47.9%), musculoskeletal system (13.4%), mental and behavioral disorders (7.2%), neoplasms (3.8%), diseases of the nervous system (3.3%), endocrine diseases, nutritional disorders, and metabolic disorders (3.2%), diseases of the digestive organs (2.0%), some infectious and parasitic diseases (1.6%), respiratory diseases (1.3%) and other reasons (0.7%). In 2021, less than ¼ (14.0%) of ATO/JFO participants were initially recognized as disabled due to various traumatic injuries, which is 25.5% less than in 2020. Among the patients with injuries of the musculoskeletal system, prevailed the victims with injuries of the lower extremities – 92 people, with injuries of the upper extremities – 44 people, polytraumas 38 people, combined injuries – 22 people. Traumatic lesions of the spinal cord led to the onset of disability in 7 persons, traumatic eye lesions in 12 persons. Medical rehabilitation services, including restorative treatment, reconstructive surgery, and orthotics, were the most needed among the examined ATO/JFO participants. More than half of the participants of ATO/JFO received the disability group due to other reasons that did not have a trauma factor, not traumatic injuries. Traumatic brain lesions accounted for 6.9% of the total number of ATO/JFO participants recognized as disabled, musculoskeletal injuries – 3.9%. 1.1% were recognized as disabled due to polytraumas, 0.2% due to combined injuries. Traumatic lesions of the spinal cord led to the onset of disability in 0.2%. With a traumatic eye injury, 0.3% were recognized as disabled. Complicated limb injuries with damage to peripheral nerves accounted for 0.1% and blood vessels – 0.1%. Medical rehabilitation services, including restorative treatment, reconstructive surgery, and orthotics, were the most needed among ATO/JFO participants examined. The increase in the number of ATO/JFO participants initially recognized as disabled due to reasons not related to traumatic lesions requires further careful analysis, determination of the reasons for such a situation and the development of effective measures for the prevention of disability and the return of lost functionality in the specified contingent, which will become the topic of further research.

PMID:36780628