Category: Nevin Manimala

Plast Reconstr Surg. 2022 Oct 18. doi: 10.1097/PRS.0000000000009783. Online ahead of print.

ABSTRACT

BACKGROUD: Despite clinical concerns associated with pediatric traumatic brain injuries (TBIs), they remain grossly underreported. This is the first retrospective study to characterize concomitant pediatric TBI and CMF trauma patients, including frequency, presentation, documentation, and outcomes.

METHODS: An IRB-approved retrospective cohort study was performed to identify all pediatric patients presenting with CMF fractures at a high volume, tertiary trauma center between the years 1990 and 2010. Patient charts were reviewed for demographic information, presentation, operative management, length of stay, mortality at two years, dentition, CMF fracture patterns, and concomitant TBIs. Data was analyzed using two-tailed Student’s t-tests and chi square analysis. A P value ≤ 0.05 was considered statistically significant.

RESULTS: Of the 2966 pediatric CMF trauma patients identified and included for analysis (mean age of 7 ± 4.7 years old, predominantly Caucasian [59.8%], and male [64.0%]), 809 had concomitant TBI (frequency of 27.3%). Only 1.6% of the TBI cases were documented in charts. Mortality at two years, length of stay in hospital, and time to follow up significantly increased from mild to severe TBIs. Concomitant TBI were more common with skull & upper third fractures than CMF trauma without TBI (81.8% vs 61.1%, P < 0.05).

CONCLUSIONS: Concomitant TBI injuries were present in a significant number of pediatric CMF trauma cases but was not documented for most cases. Craniomaxillofacial surgeons should survey all pediatric CMF trauma patients for TBI and manage with neurology and/or neurosurgery teams. Future prospective studies are necessary to characterize and generate practice guiding recommendations.

PMID:36251865 | DOI:10.1097/PRS.0000000000009783

Adv Clin Exp Med. 2022 Oct 17. doi: 10.17219/acem/153417. Online ahead of print.

ABSTRACT

INTRODUCTION: The kangaroo mother care (KMC) technique for preterm and low-birthweight (LBW) neonates, which consists of skin-to-skin contact, is thought to have a beneficial impact on clinical outcomes. Hence, the current meta-analysis aims to evaluate the influence of KMC on neonatal mortality and length of hospitalization compared with conventional care.

MATERIAL AND METHODS: A systematic literature search of studies published between 1988 and 2021 found 24 trials involving 19,980 participants, of which 10,354 received KMC and 9626 were controls under conventional care. To measure the impact of applying KMC in preterm LBW neonates on mortality and the length of hospital stay, statistical analysis using dichotomous and continuous analysis methods was performed employing fixed and random models to calculate odds ratios (ORs) with 95% confidence intervals (95% CIs).

RESULTS: Compared to the control group, the application of KMC in preterm LBW neonates resulted in significantly lower mortality (OR: 0.65, 95% CI: 0.44-0.97, p = 0.03) in a short term (within 2 months, I2 = 71%) and long term (3-12 months) (OR: 0.72, 95% CI: 0.59-0.87, p = 0.0007, I2 = 0%), and had no significant impact on the length of hospital stay (OR: -1.43, 95% CI: -2.88-0.02, p = 0.05, I2 = 86%).

CONCLUSION: In comparison with the control group, the implementation of KMC in preterm LBW neonates resulted in significantly lower mortality but had no significant impact on the length of hospitalization. More studies are needed to confirm the current findings.

PMID:36251794 | DOI:10.17219/acem/153417

Andrology. 2022 Oct 17. doi: 10.1111/andr.13321. Online ahead of print.

ABSTRACT

BACKGROUND: Male circumcision is a well know old surgery, and several recently developed techniques have been scaled up, including the introduction of laser technology, as alternative approaches to overcome morbidity of conventional surgery scalpel/suture method OBJECTIVES: We aimed to perform a systematic review and meta-analysis of studies comparing laser circumcision versus conventional circumcision technique in terms of perioperative outcomes and efficacy (complications, unacceptable appearance, reoperation rate) both in children and adults.

MATERIALS AND METHODS: This review was performed following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Continuous variables were analyzed using the inverse variance of the mean difference (MD) with a random effect, 95% Confidence Interval (CI), and p-values. The incidence of complications, unacceptable appearance, and reoperation rate were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and reported as Odds Ratio (OR), 95% CI, and p-values. Significance was set at p-value ≤0.05 and 95%CI.

RESULTS: Seven studies were included. In comparison to the conventional circumcision, laser circumcision shoved lower visual analogue score at 24-hour, and 7 days after surgery, a lower rate of overall complication rate (OR 0.33, 95% CI 0.24 – 0.47, p<0.001), scarring (OR 0.09, 95% CI 0.02,0.41, p = 0.002) and unacceptable appearance (OR 0.09, 95% CI 0.05, 0.15, p<0.001). We found no statistically significant difference in surgical time, and incidence of bleeding, infection, wound dehiscence, and reoperation rate.

DISCUSSION AND CONCLUSION: Our review infers that laser-assisted circumcision is certainly a safe and strong contender as the procedure of choice in both children and adult populations. This article is protected by copyright. All rights reserved.

PMID:36251782 | DOI:10.1111/andr.13321

J Clin Endocrinol Metab. 2022 Oct 17:dgac602. doi: 10.1210/clinem/dgac602. Online ahead of print.

ABSTRACT

CONTEXT: Gestational diabetes (GDM) imposes long-term adverse health effects on the mother and fetus. The role of magnetic resonance imaging (MRI) during early gestation in GDM has not been well-studied.

OBJECTIVE: To investigate the role of quantitative MRI measurements of placental volume and perfusion, with distribution of maternal adiposity, during early-gestation in GDM.

DESIGN: ∼200 pregnant women recruited in the first trimester were followed temporally through pregnancy until parturition.

SETTING: Outpatient antenatal obstetrics clinics.

INTERVENTIONS: Two placental MRI scans were prospectively performed at 14-16 weeks and 19-24 weeks gestational age (GA). Placental volume and blood flow (PBF) were calculated from placental regions of interest; maternal adiposity distribution was assessed by subcutaneous fat area ratio (SFAR) and visceral fat area ratio (VFAR). Statistical comparisons were performed using the two-tailed t-test. Predictive logistic regression modeling was evaluated by area under the curves (AUC).

RESULTS: Of a total 186 subjects, 21 subjects (11.3%) developed GDM. VFAR was higher in GDM versus the control group, at both time points (p < 0.001 each). Placental volume was greater in GDM versus the control group at 19-24 weeks GA (p = 0.01). Combining VFAR, placental volume and perfusion, improved the AUCs to 0.83 at 14-16 weeks (PPV = 0.77, NPV = 0.83), and 0.81 at 19-24 weeks GA (PPV = 0.73, NPV = 0.86).

CONCLUSION: A combination of MRI-based placental volume, perfusion and visceral adiposity during early pregnancy demonstrates significant changes in GDM and provides a proof of concept for predicting the subsequent development of GDM.

PMID:36251771 | DOI:10.1210/clinem/dgac602

ACS Nano. 2022 Oct 17. doi: 10.1021/acsnano.2c07240. Online ahead of print.

ABSTRACT

We demonstrate DNA translocations through silicon nitride pores formed by simple chemical etching on glass substrates using microscopic amounts of hydrofluoric acid. DNA translocations and transmission electron microscopy (TEM) prove the fabrication of nanopores and allow their characterization. From ionic measurements on 318 chips, we report the effective pore diameters ranging from zero (pristine membranes) and sub-nm to over 100 nm, within 50 μm diameter membranes. The combination of ionic conductance, DNA current blockades, TEM imaging, and electron energy loss spectroscopy (EELS) provides comprehensive information about the pore area and number, from single to few pores, and pore structure. We also show the formation of thinned membrane regions as precursors of pores. The average pore density, about 5 × 10^-4 pores/μm², allows pore number adjustment statistically (0, 1, or more). This simple and affordable chemical method for making solid-state nanopores accelerates their adoption for DNA sensing and characterization applications.

PMID:36251751 | DOI:10.1021/acsnano.2c07240

Med Sci Sports Exerc. 2022 Oct 12. doi: 10.1249/MSS.0000000000003062. Online ahead of print.

ABSTRACT

BACKGROUND: High impact loads have been linked with running injuries. Fatigue has been proposed to increase impact loads, but this relationship has not been rigorously examined, including the associated role of muscle strength, power, and endurance.

PURPOSE: To investigate the effect of fatigue on impact loading in runners, and the role of muscle function in mediating changes in impact loading with fatigue.

METHODS: Twenty-eight trained endurance runners performed a fixed-intensity time to exhaustion test at 85% of V̇O2max. Tibial accelerations were measured using leg-mounted inertial measurement units (IMUs) and sampled every minute until volitional exhaustion. Tests of lower-limb muscle strength, power, and endurance included maximal isometric strength (soleus, knee extensors, knee flexors), single leg hop for distance, and the one leg rise test. Changes in peak axial tibial acceleration (PTA, g) were compared between time-points throughout the run (0, 25, 50, 75 and 100%). Associations between the change in PTA and lower limb muscle function tests were assessed (Spearman’s rho [rs]).

RESULTS: Peak tibial acceleration increased over the duration of the fatiguing run. Compared to baseline (0%) (9.1 g SD 1.6), there was a significant increase at 75% (9.9 g SD 1.7., p = 0.001) and 100% (10.1 g SD 1.8, p < 0.001), with no change at 25% (9.6 g SD 1.6, p = 0.142) or 50% (9.7 g SD 1.7, p = 0.053). Relationships between change in peak tibial acceleration and muscle function tests were weak and not statistically significant (rs = -0.153 to 0.142, all p > 0.05).

CONCLUSIONS: Peak axial tibial acceleration increased throughout a fixed-intensity run to exhaustion. The change in PTA was not related to performance in lower limb muscle function tests.

PMID:36251400 | DOI:10.1249/MSS.0000000000003062

JMIR Med Inform. 2022 Oct 17;10(10):e38936. doi: 10.2196/38936.

ABSTRACT

BACKGROUND: Despite the many opportunities data reuse offers, its implementation presents many difficulties, and raw data cannot be reused directly. Information is not always directly available in the source database and needs to be computed afterwards with raw data for defining an algorithm.

OBJECTIVE: The main purpose of this article is to present a standardized description of the steps and transformations required during the feature extraction process when conducting retrospective observational studies. A secondary objective is to identify how the features could be stored in the schema of a data warehouse.

METHODS: This study involved the following 3 main steps: (1) the collection of relevant study cases related to feature extraction and based on the automatic and secondary use of data; (2) the standardized description of raw data, steps, and transformations, which were common to the study cases; and (3) the identification of an appropriate table to store the features in the Observation Medical Outcomes Partnership (OMOP) common data model (CDM).

RESULTS: We interviewed 10 researchers from 3 French university hospitals and a national institution, who were involved in 8 retrospective and observational studies. Based on these studies, 2 states (track and feature) and 2 transformations (track definition and track aggregation) emerged. “Track” is a time-dependent signal or period of interest, defined by a statistical unit, a value, and 2 milestones (a start event and an end event). “Feature” is time-independent high-level information with dimensionality identical to the statistical unit of the study, defined by a label and a value. The time dimension has become implicit in the value or name of the variable. We propose the 2 tables “TRACK” and “FEATURE” to store variables obtained in feature extraction and extend the OMOP CDM.

CONCLUSIONS: We propose a standardized description of the feature extraction process. The process combined the 2 steps of track definition and track aggregation. By dividing the feature extraction into these 2 steps, difficulty was managed during track definition. The standardization of tracks requires great expertise with regard to the data, but allows the application of an infinite number of complex transformations. On the contrary, track aggregation is a very simple operation with a finite number of possibilities. A complete description of these steps could enhance the reproducibility of retrospective studies.

PMID:36251369 | DOI:10.2196/38936

JMIR Serious Games. 2022 Oct 17;10(4):e37938. doi: 10.2196/37938.

ABSTRACT

BACKGROUND: Although more people are experiencing cybersickness due to the popularization of virtual reality (VR), no official standard for the cause and reduction of cybersickness exists to date. One of the main reasons is that an objective method to assess cybersickness has not been established. To resolve this, research on evaluating cybersickness with physiological responses that can be measured in real time is required. Since research on deriving physiological responses that can assess cybersickness is at an early stage, further studies examining various physiological responses are needed.

OBJECTIVE: This study analyzed the effects of cybersickness caused by head-mounted display-based VR on physiological responses.

METHODS: We developed content that provided users with a first-person view of an aircraft that moved (with translation and combined rotation) over a city via a predetermined trajectory. In the experiment, cybersickness and the physiological responses of participants were measured. Cybersickness was assessed by the Simulator Sickness Questionnaire (SSQ). The measured physiological responses were heart rate, blood pressure, body temperature, and cortisol level.

RESULTS: Our measurement confirmed that all SSQ scores increased significantly (all Ps<.05) when participants experienced cybersickness. Heart rate and cortisol level increased significantly (P=.01 and P=.001, respectively). Body temperature also increased, but there was no statistically significant difference (P=.02). Systolic blood pressure and diastolic blood pressure decreased significantly (P=.001).

CONCLUSIONS: Based on the results of our analysis, the following conclusions were drawn: (1) cybersickness causes significant disorientation, and research on this topic should focus on factors that affect disorientation; and (2) the physiological responses that are suitable for measuring cybersickness are heart rate and cortisol level.

PMID:36251360 | DOI:10.2196/37938

JMIR Cardio. 2022 Oct 17;6(2):e37437. doi: 10.2196/37437.

ABSTRACT

Digital health is a promising tool to support people with an elevated risk for atherosclerotic cardiovascular disease (ASCVD) and patients with an established disease to improve cardiovascular outcomes. Many digital health initiatives have been developed and employed. However, barriers to their large-scale implementation have remained. This paper focuses on these barriers and presents solutions as proposed by the Dutch CARRIER (ie, Coronary ARtery disease: Risk estimations and Interventions for prevention and EaRly detection) consortium. We will focus in 4 sections on the following: (1) the development process of an eHealth solution that will include design thinking and cocreation with relevant stakeholders; (2) the modeling approach for two clinical prediction models (CPMs) to identify people at risk of developing ASCVD and to guide interventions; (3) description of a federated data infrastructure to train the CPMs and to provide the eHealth solution with relevant data; and (4) discussion of an ethical and legal framework for responsible data handling in health care. The Dutch CARRIER consortium consists of a collaboration between experts in the fields of eHealth development, ASCVD, public health, big data, as well as ethics and law. The consortium focuses on reducing the burden of ASCVD. We believe the future of health care is data driven and supported by digital health. Therefore, we hope that our research will not only facilitate CARRIER consortium but may also facilitate other future health care initiatives.

PMID:36251353 | DOI:10.2196/37437

Med Phys. 2022 Oct 17. doi: 10.1002/mp.16046. Online ahead of print.

ABSTRACT

PURPOSE: Determination of reliable change of radiomics feature over time is essential and vital in delta-radiomics, but has not yet been rigorously examined. This study attempts to propose a methodological approach of using reliable change index (RCI), a statistical metric to determine the reliability of quantitative biomarker changes by accounting for the baseline measurement standard error, in delta-radiomics. The use of RCI was demonstrated with the MRI data acquired from a group of prostate cancer (PCa) patients treated by 1.5 Tesla MRI-guided radiotherapy (MRgRT).

METHODS: Fifty consecutive PCa patients who underwent five-fractionated MRgRT were retrospectively included, and 1023 radiomics features were extracted from the clinical target volume (CTV) and planning target volume (PTV). The two MRI datasets acquired at the first fraction (MRI11 and MRI21) were used to calculate the baseline feature reliability against image acquisition using intraclass correlation coefficient (ICC). The RCI was constructed based on the baseline feature measurement standard deviation, ICC and feature value differences at two time points between the fifth (MRI51) and the first fraction MRI (MRI11). The reliable change of features was determined in each patient only if the calculated RCI was over 1.96 or smaller than -1.96. The feature changes between MRI51 and MRI11 were correlated to two patient-reported quality-of-life clinical endpoints of urinary domain summary score (UDSS) and bowel domain summary score (BDSS) in 35 patients using the Spearman correlation test. Only the significant correlations between a feature that was reliably changed in ≥7 patients (20%) by RCI and an endpoint were considered as true significant correlations.

RESULTS: 352 (34.4%) and 386 (37.7%) features among all 1023 features were determined by RCI to be reliably changed in more than five (10%) patients in the CTV and PTV, respectively. Nineteen features were found reliably changed in the CTV and 31 features in the PTV, respectively, in ten (20%) or more patients. These features were not necessarily associated with significantly different longitudinal feature values (group p-value <0.05). Most reliably changed features in more than 10 patients had excellent or good baseline test-retest reliability ICC, while none showed poor reliability. The RCI method ruled out the features to be reliably changed when substantial feature measurement bias was presented. After applying the RCI criterion, only four and five true significant correlations were confirmed with UDSS and BDSS in the CTV respectively, with low true significance correlation rates of 10.8% (4/37) and 17.9% (5/28). No true significant correlations were found in the PTV.

CONCLUSIONS: The RCI method was proposed for delta-radiomics and demonstrated using PCa MRgRT data. The RCI has advantages over some other statistical metrics commonly used in the previous delta-radiomics studies, and is useful to reliably identify the longitudinal radiomics feature change on an individual basis. This proposed RCI method should be helpful for the development of essential feature selection methodology in delta-radiomics. This article is protected by copyright. All rights reserved.

PMID:36251320 | DOI:10.1002/mp.16046