Category: Nevin Manimala

Expert Rev Mol Diagn. 2023 Apr 15. doi: 10.1080/14737159.2023.2203815. Online ahead of print.

ABSTRACT

BACKGROUND: Pathology-supported genetic testing (PSGT) enables transitioning of risk stratification from the study population to the individual.

RESEARCH DESIGN AND METHODS: We provide an overview of the translational research performed in postmenopausal breast cancer patients at increased risk of osteoporosis due to aromatase inhibitor therapy, as the indication for referral. Both tumour histopathology and blood biochemistry levels were assessed to identify actionable disease pathways using whole exome sequencing (WES).

RESULTS: The causes and consequences of inadequate vitamin D levels as a modifiable risk factor for bone loss were highlighted in 116 patients with hormone receptor-positive breast cancer. Comparison of lifestyle factors and WES data between cases with vitamin D levels at extreme upper and lower ranges identified obesity as a major discriminating factor, with the lowest levels recorded during winter. Functional polymorphisms in the vitamin D receptor gene contributed independently to therapy-related osteoporosis risk. In a patient with invasive lobular carcinoma, genetic counselling facilitated investigation of the potential modifying effect of a rare CDH1 variant co-occurring withBRCA1 c.66dup (p.Glu23ArgfsTer18).

CONCLUSION: Validation of PSGT as a three-pronged pharmacodiagnostics tool for generation of adaptive reports and data reinterpretation during follow-up represents a new paradigm in personalised medicine, exposing significant limitations to overcome.

PMID:37060281 | DOI:10.1080/14737159.2023.2203815

Addiction. 2023 Apr 15. doi: 10.1111/add.16207. Online ahead of print.

ABSTRACT

AIMS: Alcohol biosensors, including the BACtrack Skyn, provide an objective and passive method of continuously assessing alcohol consumption in the natural environment. Despite the many strengths of the Skyn, six key challenges in the collection and processing of data include (1) identifying consumed alcohol; (2) identifying environmental alcohol; (3) identifying and determining the source of missing or invalid data; (4) achieving high participant adherence; (5) integrating Skyn and self-report data, and (6) implications for statistical inference. In this report we outline these challenges, provide recommendations to address them, and identify future needs.

DESIGN AND SETTINGS: Procedures from several laboratory and field-based pilot studies are presented to demonstrate practical recommendations for Skyn use. Data from a pilot study including a 7-day ecological momentary assessment period are also presented to evaluate effects of environmental alcohol on BACtrack Skyn readings.

CONCLUSIONS: To address challenges in the collection and processing of data from the BACtrack Skyn alcohol biosensor , researchers should identify goals in advance of data collection to anticipate the processing necessary to interpret Skyn data. The Transdermal Alcohol Sensor Data Macro (TASMAC) Version 2.0 software can help process data rapidly; identify drinking events, missing data, and environmental alcohol; and integrate the sensor with self-report data. Thorough participant orientation and regular contact in field studies can reduce missing data and enhance adherence. Many recommended methods for Skyn use are applicable to other alcohol sensors and wearable devices.

PMID:37060272 | DOI:10.1111/add.16207

Clin Oral Implants Res. 2023 Apr 15. doi: 10.1111/clr.14071. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this study was to assess the survival rate of dental implants inserted in an alveolar cleft area where one or more bone graft procedures were performed and to identify possible factors that affect the survival rate.

MATERIALS AND METHODS: The available data from 78 implants placed in 64 patients with grafted alveolar clefts were retrospectively analysed. Statistical analyses were performed using Kaplan-Meier survival analysis, log-rank tests and univariable Cox proportional hazard models.

RESULTS: The median follow-up period from insertion to the last follow-up appointment was 46 months (IQR: 29-79.3). In five patients, a single implant failed. This resulted in a cumulative survival rate of 95.0% at median follow-up. The factors investigated in this study did not have a significant effect on implant survival.

CONCLUSIONS: Dental implants placed in patients with alveolar clefts are a reliable treatment option for dental rehabilitation.

PMID:37060266 | DOI:10.1111/clr.14071

Trop Med Int Health. 2023 Apr 15. doi: 10.1111/tmi.13877. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyse the spatial, temporal and spatial-temporal patterns of infant mortality associated with congenital toxoplasmosis in Brazil between the years 2000 and 2020.

METHODS: Ecological study of time series, with spatial analysis and spatiotemporal scan of infant mortality associated with congenital toxoplasmosis from the records of deaths of the Mortality Information System of the Brazilian Ministry of Health. The rates were smoothed by the Local Empirical Bayesian model. The Global Moran Index, Global Geary’s Contiguity and Getis-Ord General statistics were calculated for spatial autocorrelation assessment. The trends were evaluated by the Joinpoint method.

RESULTS: We identified 1183 infant deaths associated with congenital toxoplasmosis in Brazil between 2000 and 2020. The predominant characteristics were male sex (52.1%), post-neonatal age group (51.9%), white race/colour (45.7%), and Southeast region of residence (40.0%). The infant mortality rate associated with congenital toxoplasmosis showed an increasing trend in the country in the years analysed. The spatial analysis showed heterogeneous distribution of mortality in the Brazilian territory and found no evidence of spatial autocorrelation; but spatial-temporal analysis identified three risk clusters involving 703 municipalities.

CONCLUSION: Infant mortality associated with congenital toxoplasmosis is a persistent public health problem in Brazil. The risk factors male sex, indigenous race/colour, early neonatal age, North and Northeast regions and risk clusters mapped in this study should be observed for future analysis and planning of health care policies in the control of infant deaths associated with congenital toxoplasmosis. Health surveillance strategies and public health policies need to be strengthened.

PMID:37060253 | DOI:10.1111/tmi.13877

Psychooncology. 2023 Apr 14. doi: 10.1002/pon.6137. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to develop a Resilience Scale for Parents of Children with Cancer (RSP-CC) designed specifically for parents of children with cancer and to evaluate its psychometric properties.

METHODS: Based on the Resilience Model for Families of Children with Cancer, items were created after an extensive literature review and evaluated through expert consultation and a pilot study. Psychometric evaluation was conducted with the parents of 601 children with cancer in the pediatric hematology oncology services of different hospitals in the Ankara and Kayseri provinces in Turkey.

RESULTS: A 4-factor structure was illustrated by exploratory factor analysis and confirmed by confirmatory factor analysis, explaining 62.192% of the total variance. In the reliability analysis of the scale, Interclass correlation = 0.993 and Cronbach’s alpha = 0.994 were found for the scale. Robust correlation coefficients were found between test-retest, and the correlation between the two measurements was statistically significant (r = 0.990; p ˂ 0.001). As a result, the validity of a 24-item scale structure consisting of 4 dimensions was validated.

CONCLUSIONS: It may be said that the RSP-CC meets the necessary criteria to examine the resilience in parents of children aged 0-18 with a cancer diagnosis, and its psychometric properties are reasonable sufficient.

PMID:37060214 | DOI:10.1002/pon.6137

Dent Traumatol. 2023 Apr 14. doi: 10.1111/edt.12847. Online ahead of print.

ABSTRACT

BACKGROUND/AIM: The clinical management of growing patients with missing teeth in the anterior maxilla can be challenging due to limited treatment options and high esthetic demands. Tooth autotransplantation (AT) is a viable option for these cases. The selection of donor teeth has been reported to be driven by root development, existing malocclusion, and esthetics. The aim of this study was to add to the evidence base of tooth selection criteria for AT by examining candidate donor teeth root width and crown-root angles, two factors arguably important for surgical planning and esthetics.

MATERIAL AND METHODS: Cementoenamel junction (CEJ) tooth width and crown-root angle measurements were made using cone-beam computed tomography (CBCT) images of 30 children and adolescents of European descent (mean age = 13 years, range = 10-17 years; 63% male) from a private orthodontic practice. Measurements of maxillary central and lateral incisors (index teeth) were compared with measurements of maxillary second premolars, mandibular central incisors, and mandibular first and second premolars (candidate donor teeth). Analyses relied on descriptive statistics of mean within-subject differences between index and donor teeth and the proportion of individuals without clinically important differences (i.e., >1.5 mm width deficit and > 15 degrees crown-root angle difference).

RESULTS: Mandibular first premolars were the most compatible teeth for the replacement of maxillary central incisors based on both width (≥97% of individuals) and angle measurements (≥87% of individuals), followed closely by mandibular second premolars. Mandibular central incisors were the most compatible for the replacement of maxillary laterals, among all individuals based on width and ≥ 90% based on angle, whereas mandibular first premolars were somewhat less compatible.

CONCLUSIONS: The study offers evidence of within-person, CBCT-based root width dimension and crown-root angle compatibilities. This information can be considered in addition to existing tooth selection criteria for AT including Angle’s classification, midline deviation, crowding severity, root development, and esthetics.

PMID:37060204 | DOI:10.1111/edt.12847

Int Wound J. 2023 Apr 14. doi: 10.1111/iwj.14194. Online ahead of print.

ABSTRACT

In acute care facilities, the detection of pressure ulcers (PUs) relies on visual and manual examination of the patient’s skin, which has been reported to be inconsistent and may lead to misdiagnosis. In skin and wound research, various biophysical parameters have been extensively employed to monitor changes in skin health. Nonetheless, the transition of these measures into care settings as part of a routine clinical assessment has been limited. This study was designed to examine the spatial and temporal changes in skin biophysical parameters over the site of a category I PU, in a cohort of hospitalised patients. Thirty patients, each presenting with a category I PU, were enrolled in the study. Skin integrity was assessed at the PU-compromised site and two adjacent areas (5 and 10 cm away). Data was collected over three sessions to examine both temporal differences and longitudinal changes. Skin integrity was assessed using two biophysical parameters, namely, transepidermal water loss (TEWL) and stratum corneum (SC) hydration. In addition, the influence of intrinsic factors, namely, incontinence and mobility status, on the parameters was evaluated. TEWL values at the sites compromised by PU were statistically significantly greater (P < .001) than corresponding values at the adjacent control sites at 5 and 10 cm, which were consistent with a normative range (<20 g/h/m² ). By contrast, SC hydration values did not reveal clear distinctions between the three sites, with high inter-patient variation detected at the sites. Nevertheless, individual profiles were consistent across the three sessions, and the PU site was observed to be either abnormally dry or overhydrated in different individuals. No consistent temporal trend in either parameter was evident. However, intrinsic factors were shown to influence the parameters, with females, bedridden and incontinent patients presenting significantly higher TEWL and SC hydration values (P < .05). TEWL was able to identify differences in skin responses at skin sites compromised with a category I PU when compared to healthy adjacent skin sites. Accordingly, this parameter could be included in the clinical assessment for the identification of PU risk. Further studies are required to elucidate the role of hydration and skin barrier function in the development of PUs and their ability to monitor temporal changes in skin integrity.

PMID:37060199 | DOI:10.1111/iwj.14194

Adv Wound Care (New Rochelle). 2023 Apr 14. doi: 10.1089/wound.2022.0170. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this study is to characterize breath-hold induced oxygenation changes in diabetic foot ulcers (DFUs) and develop an oxygenation flow index (OFI) to discern non-healing from healing DFUs.

APPROACH: The imaging approach utilizes an innovative breath-hold (BH) stimulus that induces vasoconstriction and measures for altering oxygenation flow in and around the tissues of DFUs and controls. The modified Beer-Lambert law was utilized to calculate hemoglobin-based spatio-temporal oxygenation maps in terms of oxygen saturation.

RESULTS: We found controls had synchronous BH induced oxygenation changes across the dorsal (OFI: 29.0%) and plantar (OFI: 57.6%) aspects of the foot. Non-healing DFUs, however, had less synchronous BH-induced oxygenation changes (OFI <28%). In addition, two complicated healing DFU cases, or cases with underlying issues or poor long term healing outcomes, were observed to have OFIs <28%.

INNOVATION: An OFI was developed to differentiate non-healing DFUs from healing DFUs using a single, non-contact, near infrared optical scanner for spatio-temporal oxygenation monitoring. The OFI has potential to provide immediate feedback on the microcirculation in DFUs, via hemoglobin-based oxygenation parameters.

CONCLUSION: A preliminary threshold (OFI<28%) could differentiate non-healing and complicated DFUs from healing DFUs. The overall oxygenation flow pattern was less synchronous (or the OFI value reduced) in the non-wound areas of the feet that were non-healing. In other words, the reduced OFI value (<28%) in the entire foot excluding the wound region is a possible indicator that the wound may not heal.

PMID:37060195 | DOI:10.1089/wound.2022.0170

J Cosmet Dermatol. 2023 Apr 14. doi: 10.1111/jocd.15771. Online ahead of print.

ABSTRACT

BACKGROUND: Thread lifting is a common procedure in minimally invasive esthetic techniques and can also be used to raise the drooping soft tissue of the forehead by vertically inserting threads into the forehead.

AIMS: This study aimed to examine the effect of forehead thread lifting on enhancing upper eyelid opening.

METHODS: Fifteen patients were included in this study, all of whom underwent eyebrow thread lifting with MINT LIFT® UP. Photographs of the patients were taken before, immediately after, and 1 and 12 weeks after surgery. Changes in the position of the eyebrows and eyelids were measured. The paired t-test was used to determine the statistical significance of differences.

RESULTS: At 1 week after surgery, the eyebrows were at a lower level compared with before surgery, and no significant changes in eye-opening were observed. However, at 12 weeks after surgery, the eyebrows and upper eyelids were both significantly elevated when compared to the preoperative state.

CONCLUSIONS: Eyebrow lifting can be performed using multidirectional thread lifting.

PMID:37060183 | DOI:10.1111/jocd.15771

Epilepsia. 2023 Apr 14. doi: 10.1111/epi.17607. Online ahead of print.

ABSTRACT

OBJECTIVES: The factors that influence seizure timing are poorly understood, and seizure unpredictability remains a major cause of disability. Work in chronobiology has shown that cyclical physiological phenomena are ubiquitous, with daily and multiday cycles evident in immune, endocrine, metabolic, neurological, and cardiovascular function. Additionally, work with chronic brain recordings has identified that seizure risk is linked to daily and multiday cycles in brain activity. Here, we provide the first characterization of the relationships between the cyclical modulation of a diverse set of physiological signals, brain activity, and seizure timing.

METHODS: In this cohort study, fourteen subjects underwent chronic ambulatory monitoring with a multimodal wrist worn sensor (recording heart rate, accelerometry, electrodermal activity, temperature) and an implanted responsive neurostimulation system (recording interictal epileptiform abnormalities (IEA) and electrographic seizures). Wavelet and filter-Hilbert spectral analyses characterized circadian and multiday cycles in brain and wearable recordings. Circular statistics assessed electrographic seizure timing and cycles in physiology.

RESULTS: Ten subjects met inclusion criteria. The mean recording duration was 232 days. Seven subjects had reliable EEG seizure detections (mean 76 seizures). Multiday cycles were present in all wearable device signals across all subjects. Seizure timing was phase locked to multiday cycles in five (temperature), four (heart rate, phasic electrodermal activity), and three (accelerometry, heart rate variability, tonic electrodermal activity) subjects. Notably, after regression of behavioral covariates from heart rate, six of seven subjects had seizure phase locking to the residual heart rate signal.

SIGNIFICANCE: Seizure timing is associated with daily and multiday cycles in multiple physiological processes. Chronic multimodal wearable device recordings can situate rare paroxysmal events, like seizures, within a broader chronobiology context of the individual. Wearable devices may advance the understanding of factors that influence seizure risk and enable personalized time-varying approaches to epilepsy care.

PMID:37060170 | DOI:10.1111/epi.17607