Category: Nevin Manimala

J Biomed Mater Res B Appl Biomater. 2022 Nov 26. doi: 10.1002/jbm.b.35206. Online ahead of print.

ABSTRACT

This study evaluated the effect of resin cement coating with high and low viscosities on the flexural fatigue strength of machined lithium disilicate glass-ceramic. Discs (IPS e.max CAD; Ivoclar Vivadent) were prepared and divided according to the surface condition (machining [M]-CEREC inLab; and polishing [P]-laboratory procedures), resin cement coating (with or without), and cement viscosity (high [H] and low [L]). The ceramic bonding surface was etched/primed by a one-step primer application followed by resin cement application (Variolink N base + high or low viscosity catalyst; Ivoclar Vivadent). Biaxial flexural fatigue strength was evaluated on a piston-on-three-ball set by the step-test method (n = 15) (initial stress: 60 MPa; incremental steps: 20 MPa; 10,000 cycles/step, at 20 Hz). Weibull statistics were used for fatigue data. Contact angle, topographic, and fractographic analysis were also performed. Machining produced statistically lower contact angle than polishing and a significant detrimental effect on the fatigue behavior (σ₀ M = 247.2 [246.9-268.3]; σ₀ P = 337.4 [297.8-382.4]). Machined groups followed by resin cement coating (σ₀ MH = 297.9 [276.0-321.5]; σ₀ Ml = 301.2 [277.1-327.4]) behaved similarly to the polished and coated groups (σ₀ PH = 342.0 [308.9-378.5]; σ₀ PL = 357.3 [324.7-393.1]), irrespective of the cement viscosity. Therefore, cement coating has able to revert the detrimental effects of the machining on the fatigue strength of lithium disilicate glass-ceramic. High and low viscosity cements behaved similarly in the improvement of CAD-CAM lithium disilicate fatigue strength.

PMID:36434818 | DOI:10.1002/jbm.b.35206

Med Phys. 2022 Nov 26. doi: 10.1002/mp.16122. Online ahead of print.

ABSTRACT

PURPOSE: The use of convolution neural networks (CNN) to accurately predict dose distributions can accelerate intensity-modulated radiation therapy (IMRT) planning. The purpose of our study is to develop a novel deep learning architecture for precise voxel-level dose prediction on brain tumors.

METHODS: A dataset of 120 patients with brain tumors is built for the retrospective study. The dose distributions are predicted by a designed end-to-end model called TS-Net, in which the transformer encoder module is utilized to obtain abundant global features by learning long-range correlations of the input sequence. In addition, semantic field alignment (SFA) block is proposed in decoding path to ensure effective propagation of strong semantic information from deep to shallow. Five images from different channels are fed into the architecture including a computed tomography (CT) image, a planning target volumes (PTV) image, an organs-at-risk (OARs) image, a beam configuration image, and a distance image, and the predicted dose distributions are taken as outputs. We use different evaluation metrics to evaluate the performance of the model and discuss the role of the auxiliary beam configuration information provided by non-modulated dose distributions.

RESULTS: The TS-Net prediction accuracies in terms of mean absolute error (MAE) are 2.98% for PTV, 7.19% for brainstem, 1.88% for left len, 2.48% for right len, 9.61% for left optic nerve, 9.10% for right optic nerve, 8.99% for optic chiasma, and 8.28% for pituitary. There is no statistically significant difference between the predicted results and clinical dose distributions for clinical indexes including homogeneity index (HI), D50, and D95 for PTV; V40, mean dose, and max dose for OARs; except for conformation index (CI) and D2 for PTV. The model has dice similarity coefficient (DSC) values of above 0.91 for most isodose volumes, clearly outperforming HD U-Net, and being slightly better than U-Net and DCNN.

CONCLUSION: The proposed TS-Net with beam configuration input can achieve accurate voxel-level dose prediction for brain tumors, and is a usable tool for improving the efficiency and quality of radiotherapy. This article is protected by copyright. All rights reserved.

PMID:36434793 | DOI:10.1002/mp.16122

Eur Heart J Cardiovasc Pharmacother. 2022 Nov 26:pvac067. doi: 10.1093/ehjcvp/pvac067. Online ahead of print.

ABSTRACT

AIMS: The effect of a prasugrel versus a ticagrelor based strategy on total (including both first and recurrent) ischemic and bleeding events in patients with acute coronary syndromes (ACS) has not been evaluated. The aim of this analysis was to investigate the treatment effect of a prasugrel versus a ticagrelor based strategy in patients with ACS undergoing an invasive management strategy when both first and recurrent non-fatal ischemic and bleeding events are taken into account.

METHODS AND RESULTS: This is a post-hoc analysis of the ISAR-REACT-5 randomized control trial, including all 4 018 patients in the trial. The main clinical endpoints of interest included ischemic events (myocardial infarction (MI) and stroke) and bleeding events (Bleeding Academic Research Consortium (BARC) type 3 to 5 bleeding). An additional endpoint of interest was definite/probable stent thrombosis. The effect of the prasugrel versus ticagrelor based strategies on these endpoints was evaluated on both time-to-first event and total events analyses. Patients in the prasugrel group had a lower risk of MI in comparison to the ticagrelor group on both time-to-first event (hazard ratio [HR] = 0.61; 95% confidence interval 0.44-0.85) and total events (HR = 0.62 [0.45-0.86]) analysis. The risk of BARC type 3 to 5 bleeding was comparable between the prasugrel and ticagrelor groups on both time-to-first event (HR = 0.96 [0.75-1.25]) and total events (HR = 0.99 [0.76-1.31]) analysis.

CONCLUSION: A prasugrel based strategy was associated with a reduction in total MI events in comparison to a ticagrelor based strategy in patients with ACS undergoing invasive assessment. Total BARC type 3 to 5 bleeding events were comparable between the two groups. Given the importance of this topic, future studies to confirm these findings would be welcome.

PMID:36434779 | DOI:10.1093/ehjcvp/pvac067

Multivariate Behav Res. 2022 Nov 26:1-28. doi: 10.1080/00273171.2022.2135089. Online ahead of print.

ABSTRACT

The Ising model is a graphical model that has played an essential role in network psychometrics. It has been used as a theoretical model to conceptualize psychological concepts and as a statistical model to analyze psychological data. Using graphical models such as the Ising model to analyze psychological data has been heavily critiqued since these data often come from cross-sectional applications. An often voiced concern is the inability of the Ising model to express heterogeneity in the population. The idiographic approach has been posed as an alternative and aims to infer individual network structures. While idiographic networks overcome population heterogeneity, it is unclear how they aggregate into established cross-sectional phenomena. This paper establishes a formal bridge between idiographic and cross-sectional network approaches of the Ising model. We ascertain unique topological structures that characterize individuals and aggregate into an Ising model cross-sectionally. This new formulation supports population heterogeneity while being consistent with cross-sectional phenomena. The proposed theory also establishes a new statistical framework for analyzing populations of idiographic networks for binary variables. The Ising model and the divide and color model are special cases of this new framework. We introduce a Gibbs sampling algorithm to estimate models from this new framework.

PMID:36434773 | DOI:10.1080/00273171.2022.2135089

Scand J Med Sci Sports. 2022 Nov 26. doi: 10.1111/sms.14277. Online ahead of print.

ABSTRACT

BACKGROUND: University students often exhibit high levels of sedentary behavior that is negatively associated with cognition and mood. On the other hand, light-intensity physical activity (LIPA) may improve cognitive performance and mood. Therefore, this study investigated the acute effect of LIPA breaks during prolonged sitting on attention, executive functioning, and mood.

METHODS: A randomized crossover design was used in this study. Twenty-one healthy adults (15 women, age=24 ± 3y, BMI=23 ± 2kg/m² ) completed three prolonged sitting conditions: (1) without a demanding cognitive task (SIT), (2) with a demanding cognitive task (COGN), and (3) with every 25 minutes sitting interrupted by a 5-minute walk (INTERRUPT). Attention, executive function (response inhibition, task shifting, and working memory updating), and mood were assessed before and after each condition.

RESULTS: Linear mixed models analyses showed that prolonged sitting frequently interrupted by LIPA (INTERRUPT) or with cognitively demanding activities (COGN) significantly improved task shifting compared to SIT. However, INTERRUPT did not significantly improve task shifting compared to COGN. No significant acute effects on attention, response inhibition, working memory updating, or mood were found.

CONCLUSIONS: Frequent LIPA breaks or cognitively demanding activities have a selective, acute positive impact on one aspect of cognitive performance compared to idle sitting. No evidence were found that LIPA breaks have an acute improvement on attention, executive function and mood compared to sitting with cognitive loading. To further investigate the effect of PA on cognitive performance, it is necessary to consider cognitive loading and control for the cognitive activity during sitting in the experimental design.

PMID:36434768 | DOI:10.1111/sms.14277

Transl Behav Med. 2022 Nov 26:ibac079. doi: 10.1093/tbm/ibac079. Online ahead of print.

ABSTRACT

Tobacco smoke exposure (TSE) adversely affects child health. Intervention research on reducing childhood TSE and uptake of evidence-based smoking cessation programs has had limited reach in high-risk communities. Intervening in clinics delivering the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) could address overlapping public health priorities essential for healthy child development-nutrition and smoke-free environments. The Babies Living Safe and Smokefree (BLiSS) trial addresses existing gaps by implementing and evaluating a WIC in-clinic evidence-based training based on Ask, Advise, and Refer (AAR) guidelines. WIC nutrition staff (n = 67) completed surveys pre- and post-training as part of the larger BLiSS trial. Staff sociodemographic data, knowledge, and attitudes about maternal smoking and child TSE prevention, and AAR practices in clinic were collected using self-administered surveys. Pre-post outcomes were assessed using bivariate statistics and multiple regression models. Controlling for baseline AAR-related practices and other covariates, nutrition managers were more likely to engage in post-training AAR practices than nutrition assistants. Sociodemographics and smoking status were not related to post-training AAR. Lower perceived barriers and higher reported frequency of tobacco intervention practices at baseline were associated with higher engagement in post-test AAR practices. WIC-system interventions aimed at reducing child TSE and maternal tobacco smoking may be more effective if nutrition management-level staff are involved in assessment and by addressing barriers related to TSE among nutrition assistants. Findings suggest that WIC in-clinic training may help to increase self-efficacy for staff engagement in brief screening, intervention, and referral practices.

PMID:36434752 | DOI:10.1093/tbm/ibac079

J Orthop Surg Res. 2022 Nov 24;17(1):513. doi: 10.1186/s13018-022-03407-8.

ABSTRACT

BACKGROUND: Open-door laminoplasty (ODL) and French-door laminoplasty (FDL) are the main laminoplasty techniques used to treat cervical ossification of the posterior longitudinal ligament (C-OPLL). However, few studies have compared the outcomes of ODL and modified FDL (mFDL) for C-OPLL. We explored the differences in outcomes between ODL and mFDL for C-OPLL and analyzed the technical efficacy of each procedure in patients with K-line (+) or (-) C-OPLL.

METHODS: From January 2010 to December 2015, 202 patients with K-line (+) or (-) C-OPLL were retrospectively recruited from 4 institutions. Clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) score, JOA score recovery rate, operative time, blood loss, and complications. Univariate analysis and binary logistic regression models were adjusted for confounding factors.

RESULTS: Two hundred patients (mFDL, n = 69; ODL, n = 131) with a median follow-up of 42 months (range 36-54 months) were included. The postoperative JOA score significantly improved in both groups (P < 0.05). After adjusting for confounding factors, there was a statistically significant difference in blood loss (≥ 300 mL) between the two groups (P = 0.005), but there was no significant difference in the postoperative JOA score (≥ 14) (P = 0.062), JOA score recovery rate (≥ 0.82) (P = 0.187), or operative time (≥ 90 min) (P = 0.925). C5 palsy tended to occur more often in the mFDL group, although the difference was not significant (P > 0.05). The stratified analysis of the K-line status showed more blood loss in K-line (+) patients who underwent mFDL, but there was no significant difference in the postoperative JOA score, JOA score recovery rate, or operative time between the ODL and mFDL groups. Additionally, there was no significant difference in blood loss, postoperative JOA score, JOA score recovery rate, or operative time among all patients with K-line (+) or (-) C-OPLL in both groups.

CONCLUSIONS: Both ODL and mFDL are effective for patients with C-OPLL. However, more blood loss tends to occur during mFDL. This study showed no significant difference in the operative time or incidence of complications between the two techniques. The efficacy of ODL and mFDL was not affected by the K-line status (+ or -) in patients with C-OPLL.

PMID:36434732 | DOI:10.1186/s13018-022-03407-8

Crit Care. 2022 Nov 25;26(1):362. doi: 10.1186/s13054-022-04245-0.

ABSTRACT

BACKGROUND: Mobilisation and exercise intervention in general are safe and feasible in critically ill patients. For patients requiring catecholamines, however, doses of norepinephrine safe for mobilisation in the intensive care unit (ICU) are not defined. This study aimed to describe mobilisation practice in our hospital and identify doses of norepinephrine that allowed a safe mobilisation.

METHODS: We conducted a retrospective single-centre cohort study of 16 ICUs at a university hospital in Germany with patients admitted between March 2018 and November 2021. Data were collected from our patient data management system. We analysed the effect of norepinephrine on level (ICU Mobility Scale) and frequency (units per day) of mobilisation, early mobilisation (within 72 h of ICU admission), mortality, and rate of adverse events. Data were extracted from free-text mobilisation entries using supervised machine learning (support vector machine). Statistical analyses were done using (generalised) linear (mixed-effect) models, as well as chi-square tests and ANOVAs.

RESULTS: A total of 12,462 patients were analysed in this study. They received a total of 59,415 mobilisation units. Of these patients, 842 (6.8%) received mobilisation under continuous norepinephrine administration. Norepinephrine administration was negatively associated with the frequency of mobilisation (adjusted difference -0.07 mobilisations per day; 95% CI – 0.09, – 0.05; p ≤ 0.001) and early mobilisation (adjusted OR 0.83; 95% CI 0.76, 0.90; p ≤ 0.001), while a higher norepinephrine dose corresponded to a lower chance to be mobilised out-of-bed (adjusted OR 0.01; 95% CI 0.00, 0.04; p ≤ 0.001). Mobilisation with norepinephrine did not significantly affect mortality (p > 0.1). Higher compared to lower doses of norepinephrine did not lead to a significant increase in adverse events in our practice (p > 0.1). We identified that mobilisation was safe with up to 0.20 µg/kg/min norepinephrine for out-of-bed (IMS ≥ 2) and 0.33 µg/kg/min for in-bed (IMS 0-1) mobilisation.

CONCLUSIONS: Mobilisation with norepinephrine can be done safely when considering the status of the patient and safety guidelines. We demonstrated that safe mobilisation was possible with norepinephrine doses up to 0.20 µg/kg/min for out-of-bed (IMS ≥ 2) and 0.33 µg/kg/min for in-bed (IMS 0-1) mobilisation.

PMID:36434724 | DOI:10.1186/s13054-022-04245-0

Subst Abuse Treat Prev Policy. 2022 Nov 24;17(1):77. doi: 10.1186/s13011-022-00504-z.

ABSTRACT

BACKGROUND: Concurrent opioid and stimulant use is on the rise in North America. This increasing trend of use has been observed in the general population, and among people released from prison in British Columbia (BC), who face an elevated risk of overdose post-release. Opioid agonist treatment is an effective treatment for opioid use disorder and reduces risk of overdose mortality. In the context of rising concurrent stimulant use among people with opioid use disorder, this study aims to investigate the impact of stimulant use disorder on opioid agonist treatment dispensation following release from prison in BC.

METHODS: Linked health and corrections records were retrieved for releases between January 1^st 2015 and December 29^th 2018 (N = 13,380). Hospital and primary-care administrative health records were used to identify opioid and stimulant use disorder and mental illness. Age, sex, and health region were derived from BC’s Client Roster. Incarceration data were retrieved from provincial prison records. Opioid agonist treatment data was retrieved from BC’s provincial drug dispensation database. A generalized estimating equation produced estimates for the relationship of stimulant use disorder and opioid agonist treatment dispensation within two days post-release.

RESULTS: Cases of release among people with an opioid use disorder were identified (N = 13,380). Approximately 25% (N = 3,328) of releases ended in opioid agonist treatment dispensation within two days post-release. A statistically significant interaction of stimulant use disorder and mental illness was identified. Stratified odds ratios (ORs) found that in the presence of mental illness, stimulant use disorder was associated with lower odds of obtaining OAT [(OR) = 0.73, 95% confidence interval (CI) = 0.64-0.84)] while in the absence of mental illness, this relationship did not hold [OR = 0.89, 95% CI = 0.70-1.13].

CONCLUSIONS: People with mental illness and stimulant use disorder diagnoses have a lower odds of being dispensed agonist treatment post-release compared to people with mental illness alone. There is a critical need to scale up and adapt opioid agonist treatment and ancillary harm reduction, and treatment services to reach people released from prison who have concurrent stimulant use disorder and mental illness diagnoses.

PMID:36434706 | DOI:10.1186/s13011-022-00504-z

Biopsychosoc Med. 2022 Nov 22;16(1):24. doi: 10.1186/s13030-022-00253-2.

ABSTRACT

BACKGROUND: Central sensitization syndrome (CSS) involves severe functional symptoms due to central sensitization. for patients with severe somatic symptoms and related disorders (SSRDs), central sensitization may be responsible for their functional symptoms. We hypothesized that screening for CSS in patients with SSRDs would identify those with severe disease. The Somatic Symptom Scale-8 (SSS-8) is a simple tool to assess medical conditions related to SSRDs, but the cut-off point to identify severe cases of comorbid CSS is unknown. This study aimed to determine the optimal cut-off point of SSS-8 for screening the CSS of patients with severe SSRDs.

METHODS: In total, 143 patients with SSRDs attending outpatient clinics of a university hospital in Japan were included in the study. The participants were evaluated using the SSS-8 for somatic symptoms, Hospital Anxiety and Depression Scale (HADS) for anxiety and depressive symptoms, Pain Catastrophizing Scale (PCS) for catastrophic thoughts, and Central Sensitization Inventory (CSI-A, B) for CSS. Receiver operating characteristic (ROC) curve analysis was performed using the propensity score. The area under the curve (AUC) was calculated using a propensity score considering PCS, age, sex, HADS, and CSI-B as confounders of SSS-8 and CSS to evaluate differences in diagnostic accuracy between patients with and without SSS-8. The sensitivity and specificity of the ROC analysis were then used to determine the cut-off point for discriminating severe cases of SSS-8.

RESULTS: Of the 143 participants, 126 responded (51 CSS group and 75 non-CSS group), with a valid response rate of 88.1 percent. In the ROC analysis, the propensity score including SSS-8 was statistically more accurate. The optimal cut-off point was 13, with an AUC of 0.88, sensitivity of 84.3 percent, and specificity of 77.3 percent.

CONCLUSIONS: The SSS-8 is a useful tool for discriminating severe cases of SSRDs comorbid with CSS.

PMID:36434700 | DOI:10.1186/s13030-022-00253-2