Category: Nevin Manimala

Pulmonology. 2022 May 11:S2531-0437(22)00105-2. doi: 10.1016/j.pulmoe.2022.03.012. Online ahead of print.

ABSTRACT

INTRODUCTION AND OBJECTIVE: Left-heart dysfunction and pulmonary vasculopathy are increasingly recognized as contributing factors of exercise capacity limitation in interstitial fibrosing lung disease (IFLD). Moreover, the clinical significance of exercise pulmonary hypertension (ePH) in pulmonary and cardiac diseases has been documented, representing a risk factor for decreased exercise capacity and survival, progression to resting pulmonary hypertension (PH) and overall clinical worsening. We conducted a prospective study aiming at: (a) assessing the prevalence of PH and ePH in a cohort of 40 functionally limited patients with IFLD, (b) determining the post-capillary (postC) or pre-capillary (preC) etiology of either PH or ePH in this cohort, and (c) examining the correlations between invasively and non-invasively measured exercise variables among hemodynamic groups.

PATIENTS AND METHODS: 40 IFLD patients underwent cardiopulmonary evaluation, including: clinical examination, lung function tests, 6-minute walking test, heart ultrasonography, cardiopulmonary exercise test and, finally, right heart catheterization (RHC). Resting hemodynamic evaluation was followed by the exercise protocol proposed by Herve et al, using a bedside cycle ergometer in the supine position. Abnormal elevation of mean pulmonary artery pressure (mPAP) above 30mmHg during exercise, with respect to abnormal elevation of cardiac output (CO) below 10 L/min (mPAP-CO ratio ⩾3 mmHg·min·L^-1) was used to define ePH (Herve et al, 2015). Secondary hemodynamic evaluation involved detection of abnormal pulmonary arterial wedge pressure (PAWP) increase at peak exercise in relation to CO. Specifically, ΔPAWP/ΔCO >2 mmHg/L per minute determined an abnormal PAWP elevation (Bentley et al, 2020).

RESULTS: Among the 40-patient cohort, 25% presented postC PH, 37.5% preC PH, 27.5% ePH, with the remaining 10% recording normal hemodynamics. PAWP evaluation during exercise revealed a postC etiology in 4 out of the 11 patients presenting ePH, and a postC etiology in 6 out of the 15 patients presenting resting preC PH. Mean values of non-invasive variables did not display statistically significant differences among hemodynamic groups, except for: diffusing capacity for carbon monoxide (DLCO), carbon monoxide transfer coefficient (KCO) and the ratio of functional vital capacity to DLCO (FVC%/DLCO%), which were lower in both ePH and PH groups (p < 0.05). Resting values of CO, cardiac index (CI), stroke volume (SV) and pulmonary vascular compliance (PVC) were significantly impaired in ePH, preC-PH and postC-PH groups when compared to the normal group.

CONCLUSIONS: Both PH and ePH were highly prevalent within the IFLD patient group, suggesting that RHC should be offered more frequently in functionally limited patients. Diffusion capacity markers must thus guide decision making, in parallel to clinical evaluation. ePH was associated to lower resting CO and PVC, in a similar way to resting PH, indicating the relevance of cardiopulmonary function to exercise limitation. Finally, the use of the ΔPAWP/ΔCO>2 criterion further uncovered PH of postcapillary etiology, highlighting the complexity of hemodynamics in IFLD.

CLINICALTRIALS: gov ID: NCT03706820.

PMID:35568651 | DOI:10.1016/j.pulmoe.2022.03.012

J Pediatr Health Care. 2022 May 11:S0891-5245(22)00085-2. doi: 10.1016/j.pedhc.2022.04.004. Online ahead of print.

ABSTRACT

INTRODUCTION: This study examined parent satisfaction with care provided to their children by Pediatric Nurse Practitioners (PNPs) in specialty areas at a tertiary care pediatric hospital.

METHOD: A convenience sample of parents of children cared for by 19 PNPs in different specialty settings completed a confidential survey consisting of demographic information and the Parents’ Perception of Satisfaction with Care from the Pediatric Nurse Practitioners Instrument (PPSC-PNP). Data were analyzed using SPSS (IBM, Armonk, NY).

RESULTS: The overall PPSC-PNP mean score was 129.82/140. Mean subscale scores ranged from 27.15 to 28.51/30. The general satisfaction score showed a mean score of 18.31/20. No statistical difference was found in parental satisfaction when scores were analyzed by the child’s age, parent participant, or patient setting.

DISCUSSION: These findings indicate that parents are highly satisfied with the care their children receive from PNPs across various subspecialties regardless of the child’s age and clinical setting.

PMID:35568623 | DOI:10.1016/j.pedhc.2022.04.004

Oral Surg Oral Med Oral Pathol Oral Radiol. 2022 Mar 27:S2212-4403(22)00888-4. doi: 10.1016/j.oooo.2022.03.011. Online ahead of print.

ABSTRACT

OBJECTIVE: This clinical trial was performed to evaluate the effect of nasal tube stabilization (NTS) on the pressure between tube and nose (PTN) in both supine and neck extension positions.

STUDY DESIGN: This prospective randomized controlled trial recruited 24 American Society of Anesthesiologists physical status I or II adult patients who underwent oral and maxillofacial surgeries requiring nasotracheal intubation. Patients were randomly assigned to intubate with either wire-reinforced or RAE (Ring-Adair-Elwyn) tube. A thin-film pressure sensor was used to measure PTN before and after NTS in both supine and neck extension positions. Statistical analysis was performed with the GraphPad Prism 9.0 software package.

RESULTS: The PTN of wire-reinforced tubes was 51 mmHg higher than that of RAE tubes in supine position before NTS (P = .005). In the wire-reinforced tube group before NTS, neck extension position increased the PTN compared with supine position (P = .0005). After NTS, the PTN in supine and neck extension positions was comparable (P = .1514). NTS significantly reduced PTN in both supine (P = .0005) and extension positions (P = .0005). In the RAE tube group, the PTN in supine and neck extension positions was comparable, either before (P = .3394) or after NTS (P = .7910). NTS also significantly reduced PTN in both supine (P = .0005) and extension positions (P = .0005).

CONCLUSIONS: NTS effectively reduced the PTN of both wire-reinforced and RAE tubes, regardless of the supine or neck extension position. RAE tubes also significantly reduced the PTN compared with wire-reinforced tubes.

PMID:35568638 | DOI:10.1016/j.oooo.2022.03.011

J Heart Lung Transplant. 2022 Mar 31:S1053-2498(22)01882-4. doi: 10.1016/j.healun.2022.03.019. Online ahead of print.

ABSTRACT

BACKGROUND: Outcome prediction following heart transplant is critical to explaining risks and benefits to patients and decision-making when considering potential organ offers. Given the large number of potential variables to be considered, this task may be most efficiently performed using machine learning (ML). We trained and tested ML and statistical algorithms to predict outcomes following cardiac transplant using the United Network of Organ Sharing (UNOS) database.

METHODS: We included 59,590 adult and 8,349 pediatric patients enrolled in the UNOS database between January 1994 and December 2016 who underwent cardiac transplantation. We evaluated 3 classification and 3 survival methods. Algorithms were evaluated using shuffled 10-fold cross-validation (CV) and rolling CV. Predictive performance for 1 year and 90 days all-cause mortality was characterized using the area under the receiver-operating characteristic curve (AUC) with 95% confidence interval.

RESULTS: In total, 8,394 (12.4%) patients died within 1 year of transplant. For predicting 1-year survival, using the shuffled 10-fold CV, Random Forest achieved the highest AUC (0.893; 0.889-0.897) followed by XGBoost and logistic regression. In the rolling CV, prediction performance was more modest and comparable among the models with XGBoost and Logistic regression achieving the highest AUC 0.657 (0.647-0.667) and 0.641(0.631-0.651), respectively. There was a trend toward higher prediction performance in pediatric patients.

CONCLUSIONS: Our study suggests that ML and statistical models can be used to predict mortality post-transplant, but based on the results from rolling CV, the overall prediction performance will be limited by temporal shifts inpatient and donor selection.

PMID:35568604 | DOI:10.1016/j.healun.2022.03.019

Am J Orthod Dentofacial Orthop. 2022 May 11:S0889-5406(22)00222-0. doi: 10.1016/j.ajodo.2021.03.027. Online ahead of print.

ABSTRACT

INTRODUCTION: This cross-sectional study aimed to investigate the crown and root characteristics of impacted central incisors compared with spontaneously erupted contralateral incisors and the influence of etiologic and local factors on their dimensions.

METHODS: Forty-five patients (22 boys, 23 girls) who underwent orthodontic treatment for unilateral impaction of maxillary central incisors were referred for cone-beam imaging. Dimensions of the impacted and contralateral incisors were assessed using Dolphin 3D software (Dolphin Imaging & Management Solutions, Chatsworth, Calif). Paired t test and linear regression were used to compare the characteristics of the impacted and contralateral teeth.

RESULTS: Contralateral and impacted central incisors showed statistically significant differences for root length (95% confidence interval [CI], 2.32-3.46; P <0.001), mesiodistal crown-root angulation (95% CI, 4.09-15.95; P = 0.001), and labiolingual crown-root angulation (95% CI, -18.69 to -4.70; P = 0.002). Etiologic factors did not alter the dimensions of incisors (95% CI, -1.17 to 0.76; P = 0.672). According to the multiple linear regression the independent variables associated with root length of contralateral and impacted incisors were sex (β = -0.904; 95% CI, -1.62 to – 0.19; P = 0.014) and the presence of impaction (β = -2.87; 95% CI, -3.67 to -2.07; P <0.001).

CONCLUSIONS: Regardless of their etiology, the impacted incisors showed roots that were 2.89 mm shorter than the contralateral incisors and had greater angulation in the mesiodistal and labiolingual directions. Girls showed a reduction of 0.904 mm (7.6%) on the lengths of roots of both impacted and contralateral central incisors. The presence of impaction led to a reduction of 25% in incisor root lengths. Approximately 30% of the impacted teeth showed crown-root angulations >20° resulting in an increased distal and labial angulation of the root apical portion.

PMID:35568599 | DOI:10.1016/j.ajodo.2021.03.027

J Chem Phys. 2022 May 14;156(18):184501. doi: 10.1063/5.0088388.

ABSTRACT

The effect of trimethylamine-N-oxide (TMAO) on hydrophobic solvation and hydrophobic interactions of methane has been studied with Molecular Dynamics simulations in the temperature range between 280 and 370 K at 1 bar ambient pressure. We observe a temperature transition in the effect of TMAO on the aqueous solubility of methane. At low temperature (280 K), methane is preferentially hydrated, causing TMAO to reduce its solubility in water, while above 320 K, methane preferentially interacts with TMAO, causing TMAO to promote its solubility in water. Based on a statistical-mechanical analysis of the excess chemical potential of methane, we find that the reversible work of creating a repulsive methane cavity opposes the solubility of methane in TMAO/water solution more than in pure water. Below 320 K, this solvent-excluded volume effect overcompensates the contribution of methane-TMAO van der Waals interactions, which promote the solvation of methane and are observed at all temperatures. These van der Waals interactions with the methyl groups of TMAO tip the balance above 320 K where the effect of TMAO on solvent-excluded volume is smaller. We furthermore find that the effective attraction between dissolved methane solutes increases with the increasing TMAO concentration. This observation correlates with a reduction in the methane solubility below 320 K but with an increase in methane solubility at higher temperatures.

PMID:35568566 | DOI:10.1063/5.0088388

J Chem Phys. 2022 May 14;156(18):184304. doi: 10.1063/5.0088017.

ABSTRACT

Gaussian process (GP) emulator has been used as a surrogate model for predicting force field and molecular potential, to overcome the computational bottleneck of ab initio molecular dynamics simulation. Integrating both atomic force and energy in predictions was found to be more accurate than using energy alone, yet it requires O((NM)³) computational operations for computing the likelihood function and making predictions, where N is the number of atoms and M is the number of simulated configurations in the training sample due to the inversion of a large covariance matrix. The high computational cost limits its applications to the simulation of small molecules. The computational challenge of using both gradient information and function values in GPs was recently noticed in machine learning communities, whereas conventional approximation methods may not work well. Here, we introduce a new approach, the atomized force field model, that integrates both force and energy in the emulator with many fewer computational operations. The drastic reduction in computation is achieved by utilizing the naturally sparse covariance structure that satisfies the constraints of the energy conservation and permutation symmetry of atoms. The efficient machine learning algorithm extends the limits of its applications on larger molecules under the same computational budget, with nearly no loss of predictive accuracy. Furthermore, our approach contains an uncertainty assessment of predictions of atomic forces and energies, useful for developing a sequential design over the chemical input space.

PMID:35568561 | DOI:10.1063/5.0088017

J Chem Phys. 2022 May 14;156(18):184118. doi: 10.1063/5.0085006.

ABSTRACT

We derive a systematic and general method for parameterizing coarse-grained molecular models consisting of anisotropic particles from fine-grained (e.g., all-atom) models for condensed-phase molecular dynamics simulations. The method, which we call anisotropic force-matching coarse-graining (AFM-CG), is based on rigorous statistical mechanical principles, enforcing consistency between the coarse-grained and fine-grained phase-space distributions to derive equations for the coarse-grained forces, torques, masses, and moments of inertia in terms of properties of a condensed-phase fine-grained system. We verify the accuracy and efficiency of the method by coarse-graining liquid-state systems of two different anisotropic organic molecules, benzene and perylene, and show that the parameterized coarse-grained models more accurately describe properties of these systems than previous anisotropic coarse-grained models parameterized using other methods that do not account for finite-temperature and many-body effects on the condensed-phase coarse-grained interactions. The AFM-CG method will be useful for developing accurate and efficient dynamical simulation models of condensed-phase systems of molecules consisting of large, rigid, anisotropic fragments, such as liquid crystals, organic semiconductors, and nucleic acids.

PMID:35568534 | DOI:10.1063/5.0085006

J Clin Hypertens (Greenwich). 2022 May 14. doi: 10.1111/jch.14500. Online ahead of print.

ABSTRACT

The authors aimed to explore the association between visit-to-visit blood pressure variability (BPV) in pregnant women and adverse neonatal outcomes. The study included 52 891 pregnant women. BPV was calculated as standard deviation (SD) and coefficient of variation (CV) of systolic blood pressure (SBP) or diastolic blood pressure (DBP). All participants were divided into four groups by the quartiles of BPV. When comparing the highest quartiles to the lowest quartiles of DBP SD in all participants, the fully adjusted ORs were 1.19 (95% CI 1.11-1.27, p for trend < .001) for fetal distress, 1.32 (95% CI 1.14-1.54, p for trend < .001) for small for gestational age, 1.32 (95% CI 1.06-1.63, p for trend = .003) for 1-min Apgar score ≤ 7. When comparing the highest quartiles to the lowest quartiles of DBP CV, ORs were 1.22 (95% CI 1.14-1.30, p for trend < .001) for fetal distress, 1.38 (95% CI 1.17-1.61, p for trend < .001) for small for gestational age, 1.43 (95% CI 1.14-1.79, p for trend < .001) for 1-min Apgar score ≤ 7. ORs for preterm birth and 5-min Apgar score ≤ 7 were not statistically significant. However, in participants with gestational hypertension or preeclampsia, ORs for preterm birth were 2.80 (95% CI 1.99-3.94, p for trend < .001) in DBP SD and 3.25 (95% CI 2.24-4.72, p for trend < .001) in DBP CV when extreme quartiles were compared. In conclusion, higher visit-to-visit BPV was associated with adverse neonatal outcomes.

PMID:35567772 | DOI:10.1111/jch.14500

Diagn Cytopathol. 2022 May 14. doi: 10.1002/dc.24978. Online ahead of print.

ABSTRACT

BACKGROUND: The histological classifications of invasive lung adenocarcinoma subtypes are considered to predict patient prognosis after surgical treatment. The objectives of this study were to evaluate cytomorphological characteristics and proliferative activities among the histological predominant patterns by performing cytomorphometric and flow cytometric analyses using liquid-based cytology materials.

METHODS: Cytological samples fixed by liquid-based cytology preservatives from 53 surgically-resected lung adenocarcinoma specimens were obtained between August 2018 and November 2019. The Papanicolaou-stained and paired Ki-67-stained slides were analyzed for calculating nuclear morphology (nuclear area, nuclear perimeter and nuclear circularity) and Ki-67 labeling index using software. The cell proliferation index (CPIx) was calculated and cellular information including cell cycle stage of tumor cells was obtained by flow cytometry.

RESULTS: The 53 cases included papillary (n = 29), acinar (n = 8), lepidic (n = 5), and solid (n = 4) subtypes, and invasive mucinous adenocarcinoma (n = 7) were also included. In the lepidic pattern, nuclear area (79.6 ± 28.8 μm² ) and perimeter (34.1 ± 6.1 μm) were relatively larger and longer than those of the other predominant patterns. The Ki-67 labeling index of the solid pattern (27.9 ± 12.5%) was highest compared with those of other predominant patterns. There were statistically significant differences in the lepidic versus solid patterns and the papillary versus solid patterns (p = .013 and p = .039, respectively). The calculated mean CPIx of the lepidic and the acinar patterns were approximately two-fold higher than those of the other predominant patterns.

CONCLUSION: By revealing the differences of cytomorphological characteristics, these methodologies might be used for diagnosing cytopathological materials using digital cytopathology.

PMID:35567786 | DOI:10.1002/dc.24978