Category: Nevin Manimala

JAMA Netw Open. 2022 Nov 1;5(11):e2243653. doi: 10.1001/jamanetworkopen.2022.43653.

ABSTRACT

IMPORTANCE: Studies have suggested a rise in opioid- and stimulant-involved overdoses in recent years in North America. This risk may be acute for individuals who have had contact with the criminal justice system, who are particularly vulnerable to overdose risk.

OBJECTIVE: To examine the association of opioid and/or stimulant use disorder diagnoses with overdose (fatal and nonfatal) among people with histories of incarceration.

DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, population-based health and corrections data were retrieved from the British Columbia Provincial Overdose Cohort, which contains a 20% random sample of residents of British Columbia. The analysis included all people in the 20% random sample who had a history of incarceration between January 1, 2010, and December 31, 2014. Outcomes were derived from 5-years of follow-up data (January 1, 2015, to December 31, 2019). Statistical analysis took place from January 2022 to June 2022.

EXPOSURES: Substance use disorder diagnosis type (ie, opioid use disorder, stimulant use disorder, both, or neither), sociodemographic, health, and incarceration characteristics.

MAIN OUTCOMES AND MEASURES: Hazard ratios (HRs) are reported from an Andersen-Gill model for recurrent nonfatal overdose events and from a Fine and Gray competing risk model for fatal overdose events.

RESULTS: The study identified 6816 people (5980 male [87.7%]; 2820 aged <30 years [41.4%]) with histories of incarceration. Of these, 293 (4.3%) had opioid use disorder only, 395 (6.8%) had stimulant use disorder only, and 281 (4.1%) had both diagnoses. During follow-up, 1655 people experienced 4026 overdoses including 3781 (93.9%) nonfatal overdoses, and 245 (6.1%) fatal overdoses. In adjusted analyses, the hazard of both fatal (HR, 2.39; 95% CI, 1.48-3.86) and nonfatal (HR, 2.45; 95% CI, 1.94-3.11) overdose was highest in the group with both opioid and stimulant use disorder diagnoses.

CONCLUSIONS AND RELEVANCE: This cohort study of people with a history of incarceration found an elevated hazard of fatal and nonfatal overdose among people with both opioid and stimulant use disorder diagnoses. This study suggests an urgent need to address the service needs of individuals who have had contact with the criminal justice system and who co-use opioids and stimulants.

PMID:36416821 | DOI:10.1001/jamanetworkopen.2022.43653

Epidemiologia (Basel). 2022 Nov 8;3(4):502-517. doi: 10.3390/epidemiologia3040038.

ABSTRACT

Since the outbreak of COVID-19, vaccination against the virus has been implemented and has progressed among various groups across all ethnicities, genders, and almost all ages in the United States. This study examines the impacts of socioeconomic status and political preference on COVID-19 vaccination in over 443 counties in the southwestern United States. Regression analysis was used to examine the association between a county’s vaccination rate and one’s personal income, employment status, education, race and ethnicity, age, occupation, residential area, and political preference. The results were as follows: First, counties with higher average personal income tend to have a higher vaccination rate (p &lt; 0.001). Second, county-level vaccination is significantly associated with the percentage of Democrat votes (β = 0.242, p &lt; 0.001). Third, race and ethnicity are vaccine-influencing factors. Counties with more Black residents have lower vaccine acceptance (β = -0.419, p &lt; 0.001), while those where more Hispanics or Native Americans reside are more likely to accept vaccines for health protection (β = 0.202, p &lt; 0.001; β = 0.057, p = 0.008, respectively). Lastly, pertaining to the age difference, seniors aged 65 and older show substantial support for vaccination, followed by the median age group (all p &lt; 0.001).

PMID:36416793 | DOI:10.3390/epidemiologia3040038

J Periodontol. 2022 Nov 23. doi: 10.1002/JPER.22-0414. Online ahead of print.

ABSTRACT

BACKGROUND: This study introduced the root plastique technique (RPT), the aim of which is to modify the gingival phenotype of sites with gingival recessions (GRs) associated with Non-Carious Cervical Lesions (NCCLs) prior to surgical treatment.

METHODS: RPT was performed in 22 subjects with 53 RT1 A/B + GRs. Changes in keratinized tissue thickness (KTT), keratinized tissue width (KTW), relative gingival recession (RGR), relative clinical attachment level (RCAL) and probing pocket depth (PPD) were measured at baseline (T0) and 2 months (T1) after the procedure was performed. All analyses were performed by means of hierarchical models.

RESULTS: The study revealed statistically significant changes (p<0.01) in KTT (0.45 ± 0.04 mm), RGR (0.80 ± 0.13mm), KTW (0.67 ± 0.07mm), RCAL (-0.72 ± 0.16mm) and KTW (0.67 ± 0.07). No changes in PPD (p>0.05) were observed. Regression analyses of KTT increase and RGR reduction at T0 showed statistically significant correlation between the 2 variables (p<0.05). All the teeth with a KTT of <0.8mm at T0 (N = 14) reached or surpassed this threshold at T1.

CONCLUSION: RPT increases KTT and KTW. In most of the sites, a reduction in GR was also achieved. This article is protected by copyright. All rights reserved.

PMID:36416786 | DOI:10.1002/JPER.22-0414

J Neuroophthalmol. 2022 Nov 1. doi: 10.1097/WNO.0000000000001734. Online ahead of print.

ABSTRACT

BACKGROUND: Idiopathic intracranial hypertension (IIH) is uncommon in men. Previous studies reported on high frequency of obstructive sleep apnea (OSA) in men with IIH, but the pathophysiology of this association remains unclear. One possible culprit for increased intracranial pressure in patients with OSA is hypercapnia. The purpose of this study was to compare the rate of hypercapnia during polysomnography (PSG) study in men with and without IIH and to report on the rate and severity of OSA in men with IIH compared with control subjects of similar age and body mass index (BMI).

METHODS: Prospective case-control study of male patients diagnosed with IIH underwent PSG with continuous oxygen and carbon dioxide monitoring overnight. Healthy control subjects with similar age and BMI also underwent PSG. The incidence of OSA diagnosis, rate of hypercapnia and hypoxia, and apnea hypopnea index (AHI) were compared between 2 groups.

RESULTS: Eleven subjects with IIH and 10 controls underwent PSG. Both groups were similar regarding age and BMI on the Mann-Whitney U test (P = 0.072 for age, P = 0.251 for BMI). Subjects for whom carbon dioxide data were not available for more than 50% of total sleep time were excluded from hypercapnia analysis. The mean age was 41.9 years, and the mean BMI was 33.8 kg/m2 in subjects and controls. OSA was diagnosed in 9 of 11 men with IIH and 4 of 10 controls. There was no statistically significant difference in the rate of hypercapnia and hypoxia between 2 groups for whom the data were available. All patients with BMI over 30 kg/m2 (7 of 7) and 50% (2 of 4) controls with BMI over 30 kg/m2 were diagnosed with OSA compared with 50% (2 of 4) of cases and 33% (2 of 6) of controls with BMI less than 30 kg/m2. BMI was a significant predictor of total AHI (P = 0.042) and OSA severity (P = 0.023), but IIH diagnosis was not (P > 0.05).

CONCLUSIONS: There was no difference in hypercapnia rate between men with IIH and controls; thus, hypercapnia is an unlikely causative factor in pathophysiology of IIH. OSA on PSG was almost 2 times as prevalent in patients with IIH compared with controls; however, BMI was the strongest predictor of OSA diagnosis, and most patients (9 of 11) with BMI over 30 kg/m2 had OSA on PSG. In men with BMI less than 30, the rate of OSA on PSG study was higher in men with IIH. Based on these data, we recommend that all men with the diagnosis of IIH should undergo PSG study.

PMID:36416758 | DOI:10.1097/WNO.0000000000001734

Chem Commun (Camb). 2022 Nov 23. doi: 10.1039/d2cc05589a. Online ahead of print.

ABSTRACT

We show for the first time glycosylation of recombinant metallothioneins (MTs) produced in E. coli. Interestingly, our results show that the glycosylation level of the recombinant MTs is inversely proportional to the degree of protein structuration, and reflects their different metal preferences.

PMID:36416731 | DOI:10.1039/d2cc05589a

Psychophysiology. 2022 Nov 23:e14223. doi: 10.1111/psyp.14223. Online ahead of print.

ABSTRACT

Independent components analysis (ICA) is an effective and ubiquitous tool for cleaning EEG. To reduce computation time, many analysis pipelines decrease EEG dimensionality prior to ICA. A 2018 report by Artoni and colleagues detailed the deleterious effects of such reduced-dimensionality ICA (rdICA) on the dipolarity and reliability of independent components. Though valuable for researchers interested in directly analyzing independent components, ICA is more commonly used for cleaning EEG. Thus, a direct examination of the impact of artifact removal via rdICA on EEG data quality is needed. We conducted a registered analysis of 128 electrode recordings of 43 healthy subjects performing an active auditory oddball task. We preprocessed each subject’s data under the following conditions: (1) ICA without dimension reduction, (2) ICA with only 64 electrodes included, (3) ICA preceded by PCA retaining 99% of the original data variance and (4) ICA preceded by PCA retaining 90% variance. We then quantified ERP data quality by measuring mean-amplitude, standardized measurement error (SME) of the single-trial mean-amplitudes, and split-half reliability of the N1 and P3 components. We then attempted to replicate our findings in an independent validation dataset. We observed statistically and practically significant changes in the mean amplitude of early sensory components for the 90% condition. Unexpectedly, the SME was only larger for the 64 electrode condition. Also unexpectedly, the effect of rdICA on split-half reliability was inconsistent between datasets. Based on the observed data, we argue that PCA-based rdICA is justifiable when used cautiously.

PMID:36416715 | DOI:10.1111/psyp.14223

Ann Plast Surg. 2022 Dec 1;89(6):684-693. doi: 10.1097/SAP.0000000000003314.

ABSTRACT

BACKGROUND: This study evaluated the potential of Wharton’s jelly mesenchymal stem cells with high tolerogenic properties in reducing immunosuppressive dosage and related adverse effects.

METHODS: A 4- to 6-week-old, 30-40 g weight, male inbred CD57BL/6 mice were used as skin allograft donors, whereas Balb/c mice with similar characteristics were used as recipients. Wharton’s jelly stem cells were obtained from a commercial kit sourced from human umbilical cord. Skin allografts were performed from CD57Bl6 to Balb/c mice (day 0). Group 1 (control) received no treatment. Group 2 received 15 mg/kg cyclosporin A on days 0 to 30. Group 3 received 5.7 × 106 and 10.3 × 106 cell/kg Wharton’s jelly stem cells on days 0 and 3, respectively. Groups 4, 5, and 6 received a combination of 15, 10, and 5 mg/kg per day cyclosporine A (days 0 to 30) with the same stem cell dose with group 3, respectively. Graft rejection was evaluated with digital photography and thermal imaging, histopathology (Banff grading, epithelialization scores, dermoepidermal dissociation), immunochemistry (Ki-67 and Bcl-2), and biochemical methods (interleukin 10, interleukin 2, interferon γ, tumor necrosis factor α) (day 10). Cumulative adverse effects of cyclosporin A occurring in the groups were revealed by histopathological evaluation of kidney and liver (a modified semiquantitative method of infiltration of inflammatory cells around the portal area and lobular region in liver; modification of the Banff rating of proximal tubules and hypertrophia of juxtaglomerular apparatus cells in kidney) (day 30).

RESULTS: There was no rejection in groups 2, 4, and 5 until the end of study. These were statistically different versus groups 1 (day 10 ± 0.71), 3 (day 11 ± 0.82), and 6 (day 11 ± 0.58) (all P’s < 0.05). Groups 4 and 5 have exhibited statistically similar findings in histopathological (4 epithelization score: 3.7 ± 1.3; 5 epithelization score: 3.5 ± 0.5; 4 Banff grading score: 0.8 ± 0.6; 5 Banff grading score: 1.0 ± 0.5; both P’s = 1.00), immunohistochemical (4 Bcl-2 score: 3.5 ± 0.5, P = 0.618; 5 Bcl-2 score: 3.4 ± 0.5, P = 1.00; 4 Ki-67 score: 3.7 ± 0.4, P = 1.00; 5 Ki-67 score: 3.5 ± 0.5, both P’s = 1.00), and levels of cytokines (both P’s = 1.00) versus group 2. Adverse effects on kidneys and liver were lowest and statistically similar in groups 3, 5, and 6 (all P’s = 00) versus group 1.

CONCLUSIONS: Wharton’s jelly mesenchymal stem cells alter bioavailability of cyclosporine, albeit at much lower doses and with fewer systemic adverse effects.

PMID:36416704 | DOI:10.1097/SAP.0000000000003314

Ann Plast Surg. 2022 Dec 1;89(6):670-674. doi: 10.1097/SAP.0000000000003332.

ABSTRACT

BACKGROUND: In complex abdominal wall reconstruction, maintenance and follow-up are vital to effective long-term patient care. This can present a challenge for individuals from a low-income household who may have less ability to afford time away from work or caring for dependents as well as challenges with transportation to and from follow-up appointments. Given the expenses and high complication rate in abdominal wall reconstruction, we elected to determine whether socioeconomic status had an impact on patient outcomes.

METHODS: After obtaining institutional review board approval, all patients who underwent complex abdominal wall reconstruction between 2002 and 2021 by the senior author were reviewed in a retrospective cohort analysis of a prospectively maintained database. Complications were classified into overall, major, infection, and delayed wound healing. Outcomes were classified into recurrence and reoperation. The cohort was divided by median household income (MHI) level and race.

RESULTS: A total of 478 patients received complex abdominal wall repair over a 19-year interval. A total of 324 patients identified MHI as <$75,000 (low MHI), and 154 patients identified MHI as > $75,000 (high MHI). Mean patient age was 53.9 (SD, 12.3) years. Mean patient body mass index (BMI) was 32.1 (SD, 7.8) kg/m2. There was no significant difference in age between the 2 MHI cohorts. There was a significant difference in BMI between MHI cohorts, with higher BMI among patients with low MHI (P = 0.0001). The majority of risk factors and surgical techniques were comparable. There was a statistically significant difference in hernia etiology, with higher rates of recurrent hernia repair among patients with low MHI (P = 0.007). The risk of overall complications (P = 0.0307) and delayed wound healing (P = 0.0263) was higher among patients with low MHI. Median household income was found to be an independent risk factor for complications after controlling for BMI, diabetes mellitus, and hernia etiology. There was no significant difference in follow-up time between cohorts.

CONCLUSION: Patients with low MHI who undergo complex abdominal wall reconstruction are at an increased risk for complications and poor outcomes, including delayed wound healing and hernia recurrence. This indicates the need to provide resources to address barriers to follow-up and maintenance following complex abdominal wall reconstruction in this patient cohort.

PMID:36416697 | DOI:10.1097/SAP.0000000000003332

Ann Plast Surg. 2022 Dec 1;89(6):637-642. doi: 10.1097/SAP.0000000000003299.

ABSTRACT

BACKGROUND: Nasal bone fractures are the most common type of facial fracture. Nasal bone fractures often occur in combination with septal cartilage fractures, because the nasal septal cartilage acts as a vertical strut and provides structural support for the nose and bilateral nasal airway. However, the treatment for nasal septal cartilage fracture remains controversial, and if untreated, nasal septal cartilage fracture can lead to various complications, such as nasal obstruction and posttraumatic nasal and septal deformity. This study aimed to evaluate the effectiveness and safety of our procedure in which septal cartilage fractures were treated with septoplasty using an absorbable plate as an internal splint.

METHODS: Between January 2017 and November 2020, 21 patients with nasal septal cartilage fractures were treated with septoplasty using an absorbable plate as an internal splint. The severity of the septal cartilage fracture was graded from 0 to 3 according to the computed tomography septal grading system. The numeric graded scale of nasal septal cartilage fracture was evaluated preoperatively and 6 months postoperatively using a computed tomography scan.

RESULTS: Of 21 patients with septal cartilage fractures, 12 were treated with a polycaprolactone (PCL) mesh plate, and 9 were treated with a polydioxanone (PDS) plate. In the PDS plate group, the preoperative numeric scale of nasal septal cartilage fracture was 2.50 (2.00-3.00), whereas the postoperative numeric scale was 1.00 (1.00-1.25, P = 0.023). In the PCL mesh plate group, the preoperative numeric scale of nasal septal cartilage fracture was 2.00 (2.00-3.00), whereas the postoperative numeric scale was 1.00 (1.00-1.50, P = 0.034). The effectiveness of the PCL mesh plate and that of the PDS plate group according to the septal grading scale were 1.45 (SD, 0.522) and 1.18 (SD, 0.603), respectively. However, these differences were not statistically significant.

CONCLUSIONS: Our study shows that septoplasty using absorbable plates provides satisfactory and safe clinical outcomes in patients with nasal septal cartilage fractures.

PMID:36416690 | DOI:10.1097/SAP.0000000000003299

Ann Plast Surg. 2022 Dec 1;89(6):e11-e17. doi: 10.1097/SAP.0000000000003313.

ABSTRACT

INTRODUCTION: Partial breast reconstruction with oncoplastic reduction can provide breast cancer patients with improved aesthetic outcomes after breast conservation therapy. This study evaluates the implications of simultaneous oncoplastic reduction with lumpectomy on complication rates, time to adjuvant radiation therapy, and rates of margin reexcision compared with lumpectomy alone.

METHODS: The Clinformatics Data Mart Database is a national deidentified commercial claims data warehouse. From 2003 to 2020, adult female patients were queried to identify patients with a breast cancer diagnosis with International Classification of Disease codes. Among those, current procedural terminology codes were used to identify those who underwent lumpectomy alone versus lumpectomy with oncoplastic reduction. Patient demographics, complications, adjuvant oncologic therapies, and need for reexcision were recorded. Patients not continuously enrolled for at least 6 months before and after the index procedure were excluded. Multivariable regression and χ2 tests were used for statistical analysis.

RESULTS: Of 53,165 patients meeting criteria (mean age, 61.4 ± 11.6 years), 1552 (2.9%) underwent oncoplastic reduction. Diagnoses of most nonsurgical complications (seroma, wound dehiscence, postoperative infection, fat necrosis, tissue necrosis, and nonspecified complications of surgical care) were significantly higher in the oncoplastic reduction group, as were rates of some surgical complications (hematoma, seroma, and tissue debridement). However, undergoing oncoplastic reduction did not impact time to adjuvant radiation (P = 0.194) and protected against positive margins requiring repeat lumpectomy or completion mastectomy (P < 0.001).

CONCLUSIONS: In patients undergoing breast conservation therapy, simultaneous oncoplastic reduction decreased occurrence of positive margins and did not impact time to adjuvant radiation therapy despite increased rates of surgical and nonsurgical complications.

PMID:36416687 | DOI:10.1097/SAP.0000000000003313