Category: Nevin Manimala

Retina. 2022 Aug 12. doi: 10.1097/IAE.0000000000003594. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the impact of baseline vitreomacular interface (VMI) status on treatment outcomes in patients treated with three different anti-vascular endothelial growth factors (anti-VEGF) for diabetic macular edema (DME).

METHODS: Post-hoc analysis from patients enrolled in the DRCR.net Protocol T study. Optical coherence tomography images were analyzed at baseline and at the end of follow-up to identify the presence of complete vitreomacular adhesion (VMA), partial vitreomacular adhesion, vitreomacular traction syndrome and complete posterior vitreous detachment (PVD).

RESULTS: Six hundred twenty-nine eyes were eligible for the study based on the study criteria. Complete adhesion eyes gained on average +3.7 more ETDRS letters compared to the complete PVD group at the end of the 12 months follow-up (p < 0.001). Baseline VMI status had no significant influence on CST at 12 months (p=0.144). There was no difference between the treatment arms based on effect of baseline VMI status on BCVA gain.

CONCLUSIONS: This study provides evidence that VMI status affects functional outcomes in DME patients treated with anti-VEGF injections. The presence of complete or partial VMA at baseline might be associated with a larger treatment benefit than those with complete PVD.

PMID:35962998 | DOI:10.1097/IAE.0000000000003594

J Perinat Med. 2022 Aug 15. doi: 10.1515/jpm-2022-0291. Online ahead of print.

ABSTRACT

OBJECTIVES: Racial and ethnic disparities in obstetrics are prevalent in the United States (US). We aimed to assess whether the success rate of external cephalic version (ECV) is affected by maternal race/ethnicity.

METHODS: We conducted a retrospective analysis based on the CDC Natality Live Birth database for 2016-2018. We compared the success rates of ECV across US pregnant women of different racial/ethnic groups (non-Hispanic Whites, non-Hispanic Blacks, non-Hispanic Asians, and Hispanics) using the Pearson chi-square test and used multivariate logistic regression to control for confounding variables. Statistical signiciance was determined as p<0.05 and results were displayed as adjusted odds ratios (aOR) with 95% confidence intervals (95% CI).

RESULTS: Of the 11,150,527 births, 26,255 women underwent an ECV and met inclusion criteria. The overall ECV success rate was 52.75% (13,850 women). Non-Hispanic Blacks had the highest ECV success rate (64.52%), followed by Hispanics (59.21%) and non-Hispanic Asians (55.51%). These rates were significantly higher than those of non-Hispanic Whites (49.27%, p<0.001). Non-Hispanic Blacks were associated with the highest success rate compared to non-Hispanic Whites (adjusted OR 1.95, 95% CI 1.77-2.15).

CONCLUSIONS: The success rate of ECV varies among different maternal racial/ethnic groups. Non-Hispanic White women have the lowest ECV success rate, while non-Hispanic Black women have the highest ECV success rate.

PMID:35962994 | DOI:10.1515/jpm-2022-0291

Bioinformatics. 2022 Aug 13:btac558. doi: 10.1093/bioinformatics/btac558. Online ahead of print.

ABSTRACT

MOTIVATION: Predicting pathological complete response (pCR) to neoadjuvant chemotherapy (NAC) in triple-negative breast cancer (TNBC) patients accurately is direly needed for clinical decision making. pCR is also regarded as a strong predictor of overall survival. In this work, we propose a deep learning system to predict pCR to NAC based on serial pathology images stained with hematoxylin and eosin (H&E) and two immunohistochemical biomarkers (Ki67 and PHH3). To support human prior domain knowledge based guidance and enhance interpretability of the deep learning system, we introduce a human knowledge derived spatial attention mechanism to inform deep learning models of informative tissue areas of interest. For each patient, three serial breast tumor tissue sections from biopsy blocks were sectioned, stained in three different stains, and integrated. The resulting comprehensive attention information from the image triplets is used to guide our prediction system for prognostic tissue regions.

RESULTS: The experimental dataset consists of 26,419 pathology image patches of 1,000×1,000 pixels from 73 TNBC patients treated with NAC. Image patches from randomly selected 43 patients are used as a training dataset and images patches from the rest 30 are used as a testing dataset. By the maximum voting from patch-level results, our proposed model achieves a 93% patient-level accuracy, outperforming baselines and other state-of-the-art systems, suggesting its high potential for clinical decision making.

AVAILABILITY: The codes, the documentation, and example data are available on an open source at: https://github.com/jkonglab/PCR_Prediction_Serial_WSIs_biomarkers.

PMID:35962988 | DOI:10.1093/bioinformatics/btac558

Int J Epidemiol. 2022 Aug 13:dyac158. doi: 10.1093/ije/dyac158. Online ahead of print.

ABSTRACT

BACKGROUND: Ethnic differences in the risk of severe COVID-19 may be linked to household composition. We quantified the association between household composition and risk of severe COVID-19 by ethnicity for older individuals.

METHODS: With the approval of NHS England, we analysed ethnic differences in the association between household composition and severe COVID-19 in people aged 67 or over in England. We defined households by number of age-based generations living together, and used multivariable Cox regression stratified by location and wave of the pandemic and accounted for age, sex, comorbidities, smoking, obesity, housing density and deprivation. We included 2 692 223 people over 67 years in Wave 1 (1 February 2020-31 August 2020) and 2 731 427 in Wave 2 (1 September 2020-31 January 2021).

RESULTS: Multigenerational living was associated with increased risk of severe COVID-19 for White and South Asian older people in both waves [e.g. Wave 2, 67+ living with three other generations vs 67+-year-olds only: White hazard ratio (HR) 1.61 95% CI 1.38-1.87, South Asian HR 1.76 95% CI 1.48-2.10], with a trend for increased risks of severe COVID-19 with increasing generations in Wave 2. There was also an increased risk of severe COVID-19 in Wave 1 associated with living alone for White (HR 1.35 95% CI 1.30-1.41), South Asian (HR 1.47 95% CI 1.18-1.84) and Other (HR 1.72 95% CI 0.99-2.97) ethnicities, an effect that persisted for White older people in Wave 2.

CONCLUSIONS: Both multigenerational living and living alone were associated with severe COVID-19 in older adults. Older South Asian people are over-represented within multigenerational households in England, especially in the most deprived settings, whereas a substantial proportion of White older people live alone. The number of generations in a household, number of occupants, ethnicity and deprivation status are important considerations in the continued roll-out of COVID-19 vaccination and targeting of interventions for future pandemics.

PMID:35962974 | DOI:10.1093/ije/dyac158

J Neurosurg Pediatr. 2022 Aug 12:1-8. doi: 10.3171/2022.7.PEDS22178. Online ahead of print.

ABSTRACT

OBJECTIVE: Pediatric spinal injuries in all-terrain vehicle (ATV) and dirt bike crashes are relatively uncommon but may be associated with significant morbidity. There are no recent studies examining these injuries, their management, and outcomes. Therefore, a retrospective study was performed to characterize pediatric spinal injuries related to ATV and dirt bike crashes over the last decade.

METHODS: Data on all patients involved in ATV or dirt bike crashes evaluated at a regional level 1 pediatric trauma center over a 10-year period (2010-2019) were analyzed. Descriptive statistics were analyzed and chi-square, Fisher exact, and Mann-Whitney U-tests were performed comparing the demographics, injury characteristics, and clinical outcomes in patients with versus those without spinal injuries.

RESULTS: Of 680 patients evaluated, 35 (5.1%) were diagnosed with spinal injuries. Over the study period, both spinal injuries and emergency department visits related to ATV or dirt bike crashes increased in frequency. All spinal injuries were initially diagnosed on CT scans, and 57.9% underwent spinal MRI. Injuries were most commonly thoracic (50%), followed by cervical (36.8%). The injuries of most patients were classified as American Spinal Injury Association (ASIA) grade E on presentation (86.8%), while 2 (5.3%) had complete spinal cord injuries (ASIA grade A) and 3 patients (8.6%) were ASIA grade B-D. Operative management was required for 13 patients (28.9%). Nonoperative management was used in 71.1% of injuries, including bracing in 33% of all injuries. Patients with spinal injuries were older than those without (13.4 ± 3.35 vs 11.5 ± 3.79 years, p = 0.003). Spinal injuries occurred via similar crash mechanisms (p = 0.48) and in similar locations (p = 0.29) to nonspinal injuries. Patients with spinal injuries more frequently required admission to the intensive care unit (ICU; 34.2% vs 14.6%, p = 0.011) and had longer hospital stays (mean 4.7 ± 5.5 vs 2.7 ± 4.0 days, p = 0.0025).

CONCLUSIONS: Although infrequent among young ATV and dirt bike riders, spinal injuries are associated with longer hospital stays, increased ICU use, and required operative intervention in 29%. Increasing awareness among ATV and dirt bike riders about the severity of riding-related injuries may encourage safer riding behaviors.

PMID:35962971 | DOI:10.3171/2022.7.PEDS22178

J Neurosurg. 2022 Aug 12:1-10. doi: 10.3171/2022.6.JNS22733. Online ahead of print.

ABSTRACT

OBJECTIVE: Coupled with stereo-electroencephalography (SEEG), radiofrequency thermocoagulation (RFTC) has emerged as a therapeutic alternative for patients with refractory focal epilepsy, with proven safe but highly variable results across studies. The authors aimed to describe the outcomes and safety of SEEG-RFTC, focusing on patients with MRI-negative epilepsy.

METHODS: A retrospective observational study was conducted on patients evaluated by SEEG in the authors’ center. Of 84 total cases, 55 underwent RFTC, with 31 MRI-negative epilepsies that were ultimately included in the study. The primary outcome was freedom from disabling seizures at last follow-up. Secondary outcomes were reduction in seizure frequency (RFTC response = seizure frequency reduction > 50%), peri-interventional complications, and neuropsychological outcomes. Potential factors influencing post-RFTC outcome were considered by comparing different variables between responders and nonresponders.

RESULTS: The mean follow-up period was 30.9 months (range 7.1-69.8 months). Three patients underwent subsequent resection/laser interstitial thermal therapy within the 1st year after RFTC failure. All other patients completed a minimum follow-up period of 1 year. Fourteen patients (45.2%) showed at least a 50% reduction in seizure frequency (responders), and 8 were seizure free (25.8% of the whole cohort). One case showed a permanent complication not directly related to thermolesions. Most patients (76%) showed no significant cognitive decline. Electrically elicited seizures (EESs) were observed in all seizure-free patients and were more frequent in responders (p = 0.038). All patients who were seizure free at the 6-month visit maintained their status during long-term follow-up.

CONCLUSIONS: SEEG-RFTC is a safe procedure and leads to a good response in many cases of MRI-negative focal epilepsies. One-quarter of the patients were seizure free and almost one-half were responders at the last follow-up. Although these results are still far from those achieved through conventional resection, a nonnegligible proportion of patients may benefit from this one-stage and much less invasive approach. Factors associated with seizure outcome remain to be elucidated; however, responders were significantly more frequent among patients with EESs, and achieving 6 months of seizure freedom appears to predict a good long-term response. In addition, the positive predictive value of RFTC response may be a valuable factor in the decision to proceed to subsequent surgery.

PMID:35962969 | DOI:10.3171/2022.6.JNS22733

J Perinat Med. 2022 Aug 15. doi: 10.1515/jpm-2022-0203. Online ahead of print.

ABSTRACT

OBJECTIVES: In fetal growth restriction (FGR), Doppler ultrasound is the most important method for the detection and management. However, additional parameters are needed to improve the distinction between constitutionally small fetuses and fetuses affected by FGR.

METHODS: A total of 445 singleton pregnancies between 23 and 40 weeks of gestation were included in our retrospective study, of which 67 with FGR and 378 normal fetuses. A 2D-plane of the fetal adrenal gland was obtained and the adrenal gland ratio was measured. Spearman’s correlation coefficient was calculated to assess the association of fetal Doppler and adrenal gland ratio with outcome parameters. Logistic regression analysis was performed to assess the statistical significance of “PI of the umbilical artery” and “adrenal gland ratio” as prognostic factors for intrauterine growth restriction (IUGR).

RESULTS: PI of the umbilical artery was shown to correlate with outcome parameters (WG_Delivery: r=-0.125, p=0.008; birth weight: r=-0.268, p<0.001; birth weight centile: r=-0.248, p<0.001; APGAR at 5 min: r=-0.117, p=0.014). Adrenal gland ratio showed no correlation with any of the outcome parameters. In logistic regression however, both PI of the umbilical artery and the adrenal ratio were shown to be significantly associated with fetal IUGR. When combining the two parameters, predictive value was superior to the predictive value of each individual parameter (AUC 0.738 [95% CI 0.670; 0.806]).

CONCLUSIONS: The adrenal gland ratio can be a useful addition to Doppler ultrasound when it comes to the detection of fetal FGR. Prospective studies are needed to establish references ranges and cut-off values for clinical decision-making.

PMID:35962947 | DOI:10.1515/jpm-2022-0203

J Clin Sleep Med. 2022 Aug 15. doi: 10.5664/jcsm.10232. Online ahead of print.

ABSTRACT

STUDY OBJECTIVES: To evaluate (determinants of) treatment success of mandibular advancement device (MAD) application in a selected phenotype of patients with obstructive sleep apnea (OSA).

METHODS: 90 non-obese patients with moderate OSA (obstructive apnea-hypopnea index (OAHI) ≥ 15 and < 30/h) without comorbidities were prospectively included. Polysomnography (PSG) was performed at baseline and with MAD. A drug-induced sleep endoscopy (DISE) with jaw thrust was performed in 83%.

RESULTS: OAHI reduction ≥ 50% was observed in 73%, OAHI reduction ≥ 50% with OAHI < 10/h in 70%, complete OSA resolution (OAHI < 5/h) in 40%. Patients with non-positional OSA showed a significantly higher rate of complete OSA resolution: post-test probability increased to 67%. In patients with total disappearance of collapse at velum level and at all levels during DISE with jaw thrust, the drop in OAHI was impressive with an infinitively high positive likelihood ratio. However, the proportion of patients having non-positional OSA or the DISE-characteristics as described above was < 20%. The change in snoring disturbance based on a Visual Analogue Scale was 76% (IQR 40-89%, p<0.001) and a statistically significant amelioration in Epworth Sleepiness Scale (especially in somnolent subjects) was observed. High adherence was reported.

CONCLUSIONS: In this pre-defined OSA phenotype, MAD was effective in reduction of OAHI and in amelioration of symptoms. Stratification by non-positional OSA and findings on DISE with jaw thrust increased treatment success defined as reduction in OAHI. However, the clinical relevance can be questioned because only a small number of patients demonstrated these characteristics.

PMID:35962942 | DOI:10.5664/jcsm.10232

J Clin Sleep Med. 2022 Aug 15. doi: 10.5664/jcsm.10228. Online ahead of print.

ABSTRACT

STUDY OBJECTIVES: To describe the outcomes of central sleep apnea (CSA) requiring home supplemental oxygen therapy in otherwise healthy term infants.

METHODS: All children <1 year of age undergoing polysomnography (PSG) between 2015-2020 at the Queensland Children’s Hospital were retrospectively studied. Children with gestational age <37 weeks, underlying syndrome, cleft palate, those with obstructive apnea-hypopnea index (OAHI) >50% of total apnea-hypopnea index (AHI) or with underlying cardiac or pulmonary parenchymal pathology were excluded. PSG parameters were extracted for periods both on and off supplemental oxygenation.

RESULTS: Fifty-two [mean (SD) age at PSG 32.6 (34.7) days; 21F] term infants were included. There was a statistically significant improvement in AHI on supplemental oxygen [Mean (SD) in room air 50.2 (36.3) vs 11.6 (9), p< 0.001 on supplemental oxygen], in both rapid eye movement (REM) and non-rapid eye movement (NREM) sleep, as well as in mean oxygen saturations (96.6% in room air to 98.9% on oxygen; p<0.001). There was no statistically significant change in transcutaneous carbon dioxide levels or sleep duration. Oxygenation was prescribed for a median (interquartile range=IQR) age of 197 (127) days.

CONCLUSIONS: CSA in term infants who are otherwise healthy generally has a good prognosis, with oxygen therapy prescribed for around six months. Oxygen therapy was associated with improved saturations and decrease in AHI when assessed with PSG.

PMID:35962944 | DOI:10.5664/jcsm.10228

Pain Ther. 2022 Aug 13. doi: 10.1007/s40122-022-00424-7. Online ahead of print.

ABSTRACT

INTRODUCTION: A recent phase 3, randomized, placebo- and tramadol-controlled trial (56-week treatment/24-week safety follow-up) demonstrated efficacy of tanezumab 10 mg in patients with chronic low back pain (CLBP) and a history of inadequate response to standard-of-care analgesics. Here, we report on the clinical meaningfulness of treatment response in this study, focused on secondary measures of pain, interference with daily functions, overall disease status, and satisfaction with treatment.

METHODS: Patients received placebo (up to week 16; n = 406), subcutaneously administered (SC) tanezumab 5 mg (every 8 weeks; n = 407), SC tanezumab 10 mg (every 8 weeks; n = 407), or orally administered tramadol prolonged-release (100-300 mg/day; n = 605) for 56 weeks. Patient’s global assessment of low back pain (PGA-LBP), Brief Pain Inventory-short form (BPI-sf), Treatment Satisfaction Questionnaire for Medication (TSQM), and modified Patient-Reported Treatment Impact (mPRTI) were assessed at weeks 16 and 56.

RESULTS: At week 16, significant (p < 0.05) improvements over placebo were evident with tanezumab for the PGA-LBP (10 mg) and most BPI-sf (both doses), TSQM (both doses), and mPRTI (both doses) items assessed. Improvements over baseline persisted for the PGA-LBP and BPI-sf at week 56. However, the magnitude of improvements was modestly lower at week 56 relative to week 16. Tramadol did not improve PGA-LBP or BPI-sf scores versus placebo at week 16. Most differences between tanezumab and tramadol at week 56 did not reach the level of statistical significance for all endpoints.

CONCLUSIONS: The totality of the evidence as captured by measures of pain, interference with daily function, patient overall assessment of disease status, and satisfaction with treatment demonstrates the clinically meaningful benefit of tanezumab for some patients with CLBP compared with placebo.

CLINICALTRIALS: gov: NCT02528253.

PMID:35962939 | DOI:10.1007/s40122-022-00424-7