Category: Nevin Manimala

Neurourol Urodyn. 2023 Feb 24. doi: 10.1002/nau.25155. Online ahead of print.

ABSTRACT

INTRODUCTION: Midurethral tapes (MUTs) were the most common surgical treatment for stress urinary incontinence (SUI) between 2008 and 2017. Transobturator tapes were introduced as a novel way to insert MUTs. Some women have experienced life-changing complications, and opt to undergo a total excision of transobturator tape (TETOT). There is a paucity in evidence about the outcomes of TETOT, which is a complex operation. This study aims to report clinical outcomes of all women who underwent TETOT in a specialist mesh center.

METHODS: All women between 2017 and 2022 who underwent TETOT in one mesh center were reviewed. Background demographics and preoperative symptoms were recorded retrospectively. Outcome data were collected using patient global impression of improvement (PGI-I) scales via telephone review and analyzed using SPSS 25.

RESULTS: Forty-five women underwent telephone review in May 2022, on average 27.9 months (range: 3-60) after TETOT. Mean age was 55 and body mass index (BMI): 30; 82% were postmenopausal, 20% were smokers, and 73.3% had recurrent SUI before excision. Indications for excision were infection (4%), vaginal exposure (24%), urethral perforation (9%), and chronic pain not associated with other complications (60%). Two women with recurrent SUI opted for a concomitant fascial sling; both reported a PGI of “very much improved” regarding SUI postoperatively. Only 12 women (26.5%) did not have SUI before excision; of these 9 (75%) reported new SUI postoperatively. Pain improved for 57.8%, but worsened for 24.4%. Although not statistically significant (p = 0.055), more women who underwent TETOT for pain alone reported worsening pain than those with pain with an additional complication (37% vs. 5.55%). Overall, 62.2% women felt “better” after their excision, 17.8% felt “worse.”

DISCUSSION: After TETOT, 62% of women felt better. Improvement in pain was reported by 58%-those with chronic pain without another complication reported improvement in pain less frequently (48% vs. 72%) and worsening pain more frequently (37% vs. 6%). Existing SUI worsened in 65% of women and 75% developed new SUI. There appears to be discordance between reporting global improvement with worsening of commonly measured clinical outcomes.

CONCLUSION: Outcome data are important for counseling women about the risks and benefits of TETOT. Women and clinicians may have different attitudes to the possible benefits of TETOT, as evidenced by women reporting feeling better despite continuing pain or SUI. Conventional outcome measures do not adequately capture all outcomes that are important to patients.

PMID:36825383 | DOI:10.1002/nau.25155

Plant Biol (Stuttg). 2023 Feb 24. doi: 10.1111/plb.13514. Online ahead of print.

ABSTRACT

Volcanic acidification creates extreme soil conditions, where rhizotoxicity of extremely low pH (2-3) and high Al³⁺ strongly inhibit plant growth. Carex angustisquama is a dominant extremophyte in highly acidic solfatara fields, where no other vascular plants can survive, and here we investigated the key abiotic stressor determining the survivorship of this extremophyte. Soil analyses and topographical surveys were conducted to examine the effects of low pH and Al³⁺ , two major abiotic stressors in acidic soils, on the occurrence of C. angustisquama in solfatara fields. Hydroponic culture experiments were also performed to test its growth responses to these stressors. In the field surveys, the spatial distribution of soil pH was consistent with vegetation zonation within a solfatara field. In contrast, soil exchangeable Al content was overall low due to strong eluviation. Statistical analysis also supported the significant role of soil pH in determining the distribution of C. angustisquama in a solfatara field. Furthermore, hydroponic culture experiments revealed a higher tolerance of C. angustisquama to low pH than the sister species, especially in the range of pH 2-3, corresponding with the pH values of the actual habitats of C. angustisquama. Conversely, no significant interspecific difference was detected in Al³⁺ tolerance, indicating that both species had a high Al³⁺ tolerance. The study suggested that low pH is a critical abiotic stressor leading to the formation of the extremophyte in highly acidic solfatara fields. In contrast, C. angustisquama displayed high tolerance to Al³⁺ toxicity, probably acquired prior to speciation.

PMID:36825368 | DOI:10.1111/plb.13514

Liver Int. 2023 Feb 24. doi: 10.1111/liv.15553. Online ahead of print.

ABSTRACT

Budd-Chiari syndrome (BCS) is a rare and potentially life-threatening disorder characterized by obstruction of the hepatic outflow tract. It is unknown whether patients with BCS represent a high risk for severe disease and mortality from coronavirus disease 2019 (COVID-19). Thus, we aimed to assess hospitalization rates, severe disease, all-cause mortality, intensive care unit (ICU) requirement, and acute kidney injury (AKI) from COVID-19 diagnoses. We identified 467 patients with BCS with COVID-19, 96427 non-chronic liver disease (CLD), and 9652 non-BCS CLD. The BCS and non-CLD cohorts (n= 467 each) and BCS and non-BCS CLD (n=440 each) were well balanced after propensity matching. When compared to the non-CLD cohort, the BCS group had a higher risk of all-cause mortality (5.1% vs. 2.4%, HR 2.18; 95% CI, 1.08-4.40), severe disease (6.0% vs. 2.4%, HR 2.20; 95% CI, 1.09-4.43), hospitalization (24.6% vs. 13.1%, HR 1.77; 95% CI, 1.30-2.42), and AKI (7.9% vs. 2.8%, HR 2.57; 95% CI, 1.37-4.85), but no significant differences in ICU requirements (2.4% vs. 2.1%, HR 0.75; 95% CI, 0.27-2.08) at 60-days time points. When compared to the non-BCS CLD cohort, the BCS group had a higher risk of all-cause mortality (3.6% vs. 2.5%, HR 3.94; 95% CI, 1.31-11.79), hospitalization (29.8% vs. 21.6%, HR 1.43; 95% CI, 1.09-1.86), but differences in ICU requirements (HR 0.90 (0.38-2.12)), AKI (HR 1.41 (0.86-2.30)) or severe disease (HR 1.92 (0.99-3.71)) did not reach statistical significance at 60-day follow up. In conclusion, COVID-19 infection in patients with BCS is associated with poor outcomes. Patients with BCS infected with COVID-19 carry a significantly higher risk of hospitalization and all-cause mortality and a possible effect on severe disease and AKI compared with COVID-19 patients without CLD or with non-BCS-CLD.

PMID:36825357 | DOI:10.1111/liv.15553

Int J Gynaecol Obstet. 2023 Feb 23. doi: 10.1002/ijgo.14743. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the effectiveness of prophylactic carbetocin with prophylactic oxytocin for preventing severe postpartum hemorrhage (PPH) following vaginal delivery.

METHODS: This before-and-after cohort study took place between 2020-2021 in a university maternity hospital. In 2021, protocol for PPH prevention immediately after vaginal delivery changed: oxytocin (5IU)IV was replaced by carbetocin (100μg)IV. All patients with vaginal births were included, with two groups compared: patients who received prophylactic oxytocin in 2020 and those who received prophylactic carbetocin in 2021. The primary outcome was severe PPH, defined as one or more of the following: estimated blood loss ≥ 1500 mL, transfusion≥4 units of red blood cells, Bakri balloon use, embolization, vascular ligation, hysterectomy, maternal death.

RESULTS: Among 4832 women included: 2417 received oxytocin and 2415 carbetocin. The rate of severe PPH was similar in both groups (0.5% vs 0.6%; aOR 0.8; 95% CI 0.4-1.8). The rate of PPH ≥ 500 mL was lower in the carbetocin group (4% versus 5.8%; P = 0.004).

CONCLUSION: Although prophylactic carbetocin was associated with a reduction in the rate of PPH ≥ 500 mL, carbotocin is non-inferiors to oxytocine at preventing severe post-partum hemorrhage due atony after vaginal delivery.

PMID:36825331 | DOI:10.1002/ijgo.14743

Pathol Oncol Res. 2023 Feb 7;29:1610909. doi: 10.3389/pore.2023.1610909. eCollection 2023.

ABSTRACT

Background: Few overlaps between prognostic biomarkers are observed among different independently performed genomic studies of esophageal squamous cell carcinoma (ESCC). One of the reasons for this is the insufficient cohort size. How many cases are needed to prognostic genes analysis in ESCC? Methods: Here, based on 387 stage II/III ESCC cases analyzed by whole-genome sequencing from one single center, effects of cohort size on prognostic genes analysis were investigated. Prognostic genes analysis was performed in 100 replicates at each cohort size level using a random resampling method. Results: The number of prognostic genes followed a power-law increase with cohort size in ESCC patients with stage II and stage III, with exponents of 2.27 and 2.25, respectively. Power-law curves with increasing events number were also observed in stage II and III ESCC, respectively, and they almost overlapped. The probability of obtaining statistically significant prognostic genes shows a logistic cumulative distribution function with respect to cohort size. To achieve a 100% probability of obtaining statistically significant prognostic genes, the minimum cohort sizes required in stage II and III ESCC were approximately 95 and 60, respectively, corresponding to a number of outcome events of 33 and 36, respectively. Conclusion: In summary, the number of prognostic genes follows a power-law growth with the cohort size or events number in ESCC. The minimum events number required to achieve a 100% probability of obtaining a statistically significant prognostic gene is approximately 35.

PMID:36825282 | PMC:PMC9941191 | DOI:10.3389/pore.2023.1610909

Atten Percept Psychophys. 2023 Feb 23. doi: 10.3758/s13414-023-02667-8. Online ahead of print.

ABSTRACT

Previous studies have shown that during visual search, participants are able to implicitly learn across-trial regularities regarding target locations and use these to improve search performance. The present study asks whether such across-trial visual statistical learning also extends to the location of salient distractors. In Experiments 1 and 2, distractor regularities were paired so that a specific distractor location was 100% predictive of another specific distractor location on the next trial. Unlike previous findings that employed target regularities, the current results show no difference in search times between predictable and unpredictable trials. In Experiments 3-5 the distractor location was presented in a structured order (a sequence) for one group of participants, while it was presented randomly for the other group. Again, there was no learning effect of the across-trial regularities regarding the salient distractor locations. Across five experiments, we demonstrated that participants were unable to exploit across-trial spatial regularities regarding the salient distractors. These findings point to important boundary conditions for the modulation of visual attention by statistical regularities and they highlight the need to differentiate between different types of statistical regularities.

PMID:36823261 | DOI:10.3758/s13414-023-02667-8

Atten Percept Psychophys. 2023 Feb 23. doi: 10.3758/s13414-023-02670-z. Online ahead of print.

ABSTRACT

The aim of this report was to analyze reaction times and accuracy in children with a vision impairment performing a feature-based visual search task using a multiverse statistical approach. The search task consisted of set sizes 4, 16, and 24, consisting of distractors (circle) and a target (ellipse) that were presented randomly to school-aged individuals with or without a vision impairment. Interactions and main effects of key variables relating to reaction times and accuracy were analyzed via a novel statistical method blending GAMLSS (generalized additive models for location, scale, and shape) and distributional regression trees. Reaction times for the target-present and target-absent conditions were significantly slower in the vision impairment group with increasing set sizes (p < .001). Female participants were significantly slower than were males for set sizes 16 and 24 in the target-absent condition (p < .001), with male participants being significantly slower than females in the target-present condition (p < .001). Accuracy was only significantly worse (p = .03) for participants less than 14 years of age for the target-absent condition with set sizes 16 and 24. There was a positive association between binocular visual acuity and search time (p < .001). The application of GAMLSS with distributional regression trees to the analysis of visual search data may provide further insights into underlying factors affecting search performance in case-control studies where psychological or physical differences may influence visual search outcomes.

PMID:36823260 | DOI:10.3758/s13414-023-02670-z

Cogn Affect Behav Neurosci. 2023 Feb 23. doi: 10.3758/s13415-023-01063-x. Online ahead of print.

ABSTRACT

Deficits in neural reward processing have been implicated in the etiology of depression and have been observed in high-risk individuals. However, depression is a heterogeneous disorder, and not all depressed individuals exhibit blunted neural reward response, suggesting the need to examine more specific depression phenotypes. Early-onset depression, a well-defined phenotype, has been associated with greater intergenerational transmission of depression and appears more closely linked to neural reward processing deficits. The present study examined whether a maternal history of early-onset depression was associated with neural reward response among mothers and their daughters. Mothers with and without a history of depression, as well as their biological, adolescent daughters (N = 109 dyads), completed a monetary reward guessing task while electroencephalogram was collected. Analyses focused on the Reward Positivity (RewP), an event-related potential following reward receipt. Adjusting for current depressive symptoms, maternal early-onset depression was associated with a blunted RewP in the mothers and a numerically smaller RewP in their never-depressed, adolescent daughters. Maternal adult-onset depression was not statistically associated with a blunted RewP in mothers or daughters. Thus, a blunted RewP appears to be a trait-like vulnerability marker for depression that emerges before depression onset and relates to more specific depression phenotypes (e.g., early-onset depression). These findings have implications for early identification of individuals at risk of depression and for developing more targeted interventions.

PMID:36823246 | DOI:10.3758/s13415-023-01063-x

Sci Rep. 2023 Feb 23;13(1):3178. doi: 10.1038/s41598-023-29436-9.

ABSTRACT

The combination of noradrenergic (reboxetine) plus antimuscarinic (oxybutynin) drugs (reb-oxy) reduced obstructive sleep apnea (OSA) severity but no data are available on its effects on cardiac autonomic modulation. We sought to evaluate the impact of 1-week reb-oxy treatment on cardiovascular autonomic control in OSA patients. OSA patients were randomized to a double-blind, crossover trial comparing 4 mg reboxetine plus 5 mg oxybutynin to a placebo for OSA treatment. Heart rate (HR) variability (HRV), ambulatory blood pressure (BP) monitoring (ABPM) over 24 h baseline and after treatment were performed. Baroreflex sensitivity was tested over beat-to-beat BP recordings. 16 subjects with (median [interquartile range]) age 57 [51-61] years and body mass index 30 [26-36]kg/m² completed the study. The median nocturnal HR was 65 [60-69] bpm at baseline and increased to 69 [64-77] bpm on reb-oxy vs 66 [59-70] bpm on placebo (p = 0.02). The mean 24 h HR from ABPM was not different among treatment groups. Reb-oxy administration was not associated with any modification in HRV or BP. Reb-oxy increased the baroreflex sensitivity and did not induce orthostatic hypotension. In conclusion, administration of reb-oxy did not induce clinically relevant sympathetic overactivity over 1-week and, together with a reduction in OSA severity, it improved the baroreflex function.

PMID:36823241 | DOI:10.1038/s41598-023-29436-9

Sci Rep. 2023 Feb 23;13(1):3156. doi: 10.1038/s41598-023-29819-y.

ABSTRACT

Non-compliance to intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy can result in increased disease activity in neovascular age-related macular degeneration (nAMD). Our study aims to determine effects of unplanned delay in anti-VEGF injection treatment for nAMD. This retrospective observational study included patients with delays in receiving intravitreal injections for nAMD treatment from March to May 2020 by at least 21 days. Baseline demographic and clinical characteristics, visual acuity (VA), central macular thickness (CMT) measured on optical coherence tomography (OCT), and duration of delayed treatment were analyzed for 3 time points, the pre-delay visit (v1) and post-delay visits (v2 and v3). Data were compared to age-matched controls treated for nAMD in 2019 without delay. Demographic characteristics were compared using two-sample t-tests for continuous variables and Pearson’s chi-square tests for categorical variables. For the two primary outcomes of interest, VA and CMT, means and standard deviations were reported for each combination of group and time. Each outcome was modeled using a linear mixed model with the group, time and group-time interaction as fixed effects. A total of 69 patients (99 eyes) in the treatment delay group and 44 patients (69 eyes) in the control group were identified. Statistically significant differences between control and delayed groups were detected for VA (difference in mean logMAR = 0.16; 95% CI 0.06, 0.27; p = 0.002) and CMT (difference in mean CMT = 29; 95% CI 12, 47; p = 0.001) at v2. No differences were detected for v1 and v3 time points for both outcomes. An unplanned delay in intravitreal injection treatment for nAMD resulted in an increase in CMT and worsening of VA compared to controls observed at v2. At v3, CMT and VA recovered to near v1 levels. This study demonstrates that a one-time, brief interruption in treatment for nAMD results in reversible, temporary worsening.

PMID:36823223 | DOI:10.1038/s41598-023-29819-y