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Nevin Manimala Statistics

Effect of Educational Interventions to Reduce Readmissions due to Heart Failure Decompensation in Adults: a Systematic Review and Meta-analysis

Invest Educ Enferm. 2021 Jun;39(2). doi: 10.17533/udea.iee.v39n2e05.

ABSTRACT

OBJECTIVES: To estimate the combined effect of educational interventions (EI) on decreased readmissions and time of hospital stay in adults with heart failure, compared with usual care.

METHODS: Systematic review (SR) and meta-analysis (MA) of randomized controlled trials that followed the recommendations of the PRISMA statement. The protocol was registered on PROSPERO (CRD42019139321). Searches were made from inception until July 2019 in the databases of PubMed/Medline, Embase, Cochrane CENTRAL, Lilacs, Web of Science, and Scopus. The MA was conducted through the random effects model. The effect measure used for the dichotomous outcomes was relative risk (RR) and for continuous outcomes the mean difference (MD) was used, with 95% confidence intervals (CI). Heterogeneity was evaluated through the inconsistency statistic (I2).

RESULTS: Of 2369 studies identified, 45 were included in the SR and 43 in the MA. The MA of studies with follow-up at six months showed a decrease in readmissions of 30% (RR: 0.70; 95% CI: 0.58 to 0.84; I2: 0%) and the 12-month follow-up evidenced a reduction of 33% (RR: 0.67; 95% CI: 0.58 to 0.76; I2: 52%); both analyses in favor of the EI group. Regarding the time of hospital stay, a reduction was found of approximately two days in patients who received the EI (MD: -1.98; 95% CI: -3.27 to -0.69; I2: 7%).

CONCLUSIONS: The findings support the benefits of EI to reduce readmissions and days of hospital stay in adult patients with heart failure.

PMID:34214282 | DOI:10.17533/udea.iee.v39n2e05

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Impulse Configuration in Hypoglossal Nerve Stimulation in Obstructive Sleep Apnea: The Effect of Modifying Pulse Width and Frequency

Neuromodulation. 2021 Jul 2. doi: 10.1111/ner.13490. Online ahead of print.

ABSTRACT

OBJECTIVES: Hypoglossal nerve stimulation is an effective treatment option for obstructive sleep apnea (OSA) in positive airway pressure therapy failure. Nonetheless, data regarding the functional effect of modifying stimulation parameters within each electrode configuration are limited.

MATERIALS AND METHODS: In a retrospective study of 76 patients with 12 months or more follow-up, functional tongue protrusion thresholds were compared for pulse width and frequency configurations of 90 μsec 33 Hz vs 120 μsec 40 Hz. The number of tolerated voltage amplitude steps between sensation, functional, and subdiscomfort thresholds were assessed for both settings as well as impedances.

RESULTS: The overall cohort showed improvement in OSA metrics: median apnea-hypopnea index from 30.0/hour to 18.6/hour and Epworth Sleepiness Scale from 13.5 to 7.6. For both bipolar and unipolar electrode configurations, the stimulation amplitude required for functional tongue protrusion was significantly reduced when the pulse width and frequency were converted from 90 μsec 33 Hz to 120 μsec 40 Hz (p < 0.001). Nevertheless, the number of voltage amplitude steps from sensation, functional, to subdiscomfort thresholds did not differ between the two settings. The ratio of automatically derived impedances between bipolar and unipolar electrode configurations was relevantly correlated with the ratio of functional thresholds at these parameters.

CONCLUSION: Changing the stimulation parameters may lower the voltage requirements while maintaining the same effect on tongue protrusion. Changing these stimulation parameters does not affect the range of tolerated impulse steps between functional and subdiscomfort thresholds. Future technical appliances could help estimate functional thresholds at different electrode configurations for each patient by automatically measuring impedances.

PMID:34214238 | DOI:10.1111/ner.13490

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Electrophysiological and ECG Effects of Perhexiline, A Mixed Cardiac Ion Channel Inhibitor, Evaluated in Non-clinical Assays and in Healthy Subjects

J Clin Pharmacol. 2021 Jul 2. doi: 10.1002/jcph.1934. Online ahead of print.

ABSTRACT

Perhexiline has been used to treat hypertrophic cardiomyopathy. In addition to its effect on carnitine-palmitoyltransferase-1, it has mixed ion channel effects through inhibition of several cardiac ion currents. Effects on cardiac ion channels expressed in mammalian cells were assayed using manual patch-clamp technique, action potential duration (APD) were measured in ventricular trabeculae of human donor hearts, and ECG effects were evaluated in healthy subjects in a thorough QT (TQT) study. Perhexiline blocked several cardiac ion currents at concentrations within the therapeutic range (150 – 600 ng/mL) with IC50 for hCav1.2 ∼ hERG < late hNav1.5. A significant APD shortening was observed in perhexiline treated cardiomyocytes. The TQT study was conducted with a pilot part in 9 subjects to evaluate a dosing schedule that would achieve therapeutic and supratherapeutic perhexiline plasma concentrations on Day 4 and 6, respectively. Guided by the results from the pilot, 104 subjects were enrolled in a parallel designed part with a nested cross-over comparison for the positive control. Perhexiline caused QTc prolongation, with a largest effect on ΔΔQTcF of 14.7 msec at therapeutic and 25.6 msec at supratherapeutic concentrations and a positive and statistically significant slope of the concentration-ΔΔQTcF relationship: 0.018 msec per ng/mL; 90% CI: 0.0119 to 0.0237. In contrast, the JTpeak interval was shortened with a negative concentration-JTpeak relationship, a pattern consistent with multichannel block. Further studies are needed to evaluate whether this results in a low proarrhythmic risk.

PMID:34214210 | DOI:10.1002/jcph.1934

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Comparison of the Efficacy of Fractional Radiofrequency Microneedling alone and in combination with platelet rich plasma in neck rejuvenation a clinical and optical coherence tomography study

J Cosmet Dermatol. 2021 Jul 2. doi: 10.1111/jocd.14331. Online ahead of print.

ABSTRACT

BACKGROUND: Aesthetic improvement of the neck and cervicomental angle remains one of the most challenging aspects of rejuvenation. Fractional radiofrequency microneedling demonstrated significant skin tightening and lifting of lower third of the face.

AIM OF WORK: To evaluate and compare fractional radiofrequency microneedling alone and in combination with autologous platelet rich plasma (PRP) in neck rejuvenation.

METHODS: 20 patients with mild to moderate neck laxity were randomized to receive 3 sessions of either fractional radiofrequency microneedling + PRP (group A) or fractional radiofrequency microneedling monotherapy (group B). Evaluation was done using optical coherence tomographgy to detect dermis thickness, measurement of cervicomental angle, a score done by two investigators blinded to used modality (GAIS) and patient satisfaction score.

RESULTS: Both Groups showed a statistically significant improvement in all parameters. Comparing the two groups the mean dermal thickness after treatment was higher in group A compared to B but was found statistically insignificant. More favorable results were reported in group A according to GAIS. Other parameters showed comparable results.

CONCLUSION: Fractional micro-needle radiofrequency with insulated microneedles offers a safe and effective modality for mild to moderate neck laxity when used alone or in combination with PRP. It remains questionable whether combining fr-RF microneedling with PRP provides more favorable results in terms of efficacy and side effects.

PMID:34214220 | DOI:10.1111/jocd.14331

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Loneliness mediates the relationships between perceived neighborhood characteristics and cognition in middle-aged and older adults

Int J Geriatr Psychiatry. 2021 Jul 2. doi: 10.1002/gps.5595. Online ahead of print.

ABSTRACT

OBJECTIVES: We aimed to examine whether loneliness mediates these associations among middle-aged and older adults.

METHODS: Data from wave 10 (2010-2012) to wave 13 (2016-2017) of the Health and Retirement Study (HRS) were analyzed. Perceived neighborhood characteristics were self-reported. Loneliness was measured by Revised University of California Los Angeles (R-UCLA) Loneliness Scale. Cognition was evaluated by the modified version of Telephone Interview for Cognitive Status (TICS). Baron and Kenny’s causal steps and multiple linear regression models based on Karlson/Holm/Breen (KHB) method were used to examine the mediating effect.

RESULTS: At baseline, 15,142 participants had no cognitive impairment, and 11,413 individuals were finally included in our analysis after 6-year follow-up. Multiple linear regression models suggested that lower perceived neighborhood physical disorder (β=0.073, P=0.033) and greater perceived neighborhood safety (β=0.350, P=0.009) were associated with better cognition. KHB test identified the significant mediating effect of loneliness on the relationships between perceived neighborhood physical disorder (β=0.011, P=0.016) and perceived neighborhood safety (β=0.023, P=0.026) and cognition.

CONCLUSIONS: Perceived neighborhood characteristics are associated with cognition among middle-aged and older American adults. Loneliness mediated associations between perceived neighborhood physical disorder and perceived neighborhood safety and cognition. This article is protected by copyright. All rights reserved.

PMID:34214209 | DOI:10.1002/gps.5595

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Ultrasound-Guided Micro-Invasive Trigger Finger Release Technique Using an 18-Gauge Needle with a Blade at The Tip: A Prospective Study

PM R. 2021 Jul 2. doi: 10.1002/pmrj.12665. Online ahead of print.

ABSTRACT

INTRODUCTION: Open surgical trigger finger release has limited success with complications; however, percutaneous techniques have a successful alternative. There is limited understanding of the success of percutaneous trigger finger release.

OBJECTIVE: To prospectively evaluate the functional outcomes of patients with Green classification Grade 2 to 4 trigger finger treated with an ultrasound-guided micro-invasive trigger finger release using a special 18-gauge needle with a blade at the tip.

DESIGN: prospective, case-series study SETTING: This study took place at an academic institution by one sports medicine physician (REC) with subspecialty training and certification in musculoskeletal ultrasound.

PATIENTS: Sixty patients (79 cases) met criteria and agreed to participate in this study; 19 patients had multiple fingers treated. Average patient age was 62.8 years (SD10.2). Average trigger finger severity diagnosis was Grade 3.

INTERVENTIONS: Patients were treated with an ultrasound-guided micro-invasive trigger finger release using a special 18-gauge needle with a blade at the tip.

MAIN OUTCOME MEASUREMENTS: QuickDASH, NRS, and Nirschl scores were captured pre-procedure, at various time points, and at final follow-up. Changes between pre-procedure and final follow-up were analyzed by paired t-test (p<0.05). Differences were also analyzed between finger, grade level, and sex by repeated measures ANOVA’s (p<0.05).

RESULTS: No adverse events were documented peri-operatively or post-operatively. Average follow-up time was 18.4 months (SD 4.6). At final follow-up, 100% of patients reported no recurrence of catching/locking, 97% had complete resolution of symptoms and significant improvement in QuickDASH scores, and 99% required no further treatment. All measurements showed a decrease in pain and symptoms over time. The improvements in QuickDASH score, NRS and Nirschl scale, and the resolution of mechanical symptoms were all statistically significant.

CONCLUSION: Ultrasound-guided release using the 18-gauge needle with a blade provides significant functional improvement and full resolution of mechanical symptoms with minimal adverse events. This article is protected by copyright. All rights reserved.

PMID:34213082 | DOI:10.1002/pmrj.12665

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Single-molecule electrophoresis: renewed understanding of nanopore electrochemistry

Se Pu. 2020 Sep 8;38(9):993-998. doi: 10.3724/SP.J.1123.2020.05001.

ABSTRACT

This study aims to understand nanopore technology from the standpoint of capillary electrophoresis separation. The nanopore electrochemical measurements could be regarded as “single molecule electrophoresis”. Similar to the case of capillary electrophoresis, the single target molecules migrate inside a nanopore under an external electric field. The recognition ability of the nanopore mainly depends on the charge, shape, and size of the target molecules under the electric force. The confined space of an Aerolysin nanopore matches the size of single biomolecule, while the amino acid residues along the inner wall of the nanopore facilitate electrokinetic regulation inside the nanopore. Under the applied voltage, each molecule enters the nanopore, generating the characteristic migration velocity and trajectory. Therefore, statistical analysis of the current amplitude, duration, frequency, and shape of the electrochemical signals would help differentiate and identify a single analyte from the mixture. Herein, we used an Aerolysin nanopore for identifying the oligonucleotides of 5′-CAA-3′ (CA2), 5′-CAAA-3′ (CA3), and 5′-CAAAA-3′ (CA4), which differ in length only by one nucleotide, as the model system to demonstrate single-molecule electrophoresis. The diameter of the Aerolysin nanopore is around 1 nm, and the pore length is approximately 10 nm. Under an applied voltage of 80 mV, the nanopore experiences a high electric field strength of about 80 kV/cm. The phosphate groups of the nucleotides carry negative charges in an electrolyte buffer solution of 1.0 mol/L KCl, at pH 8. Therefore, CA2, CA3, and CA4 carry 2, 3, and 4 negative charges, respectively. During nanopore sensing, CA2, CA3, and CA4 are subjected to electrophoretic forces and thus move inside the nanopore. Because the Aerolysin nanopore is anion selective, the direction of electroosmotic flow through the nanopore is consistent with the anion flow direction. Under the combined effects of the electrophoretic force and electroosmotic flow, CA2, CA3, CA4 will transverse through the Aerolysin nanopore at different migration velocities. Note that the oligonucleotide shows strong electrostatic interaction with the two sensitive regions of Aerolysin, which comprises polar amino acids around R220 and K238. The strong interaction between the sensitive region of Aerolysin and the analyte would further modulate the translocation of oligonucleotides. Therefore, each oligonucleotide follows a different migration trajectory as it individually transverses through the nanopore. The migration speed and migration trajectory are recorded as ionic blockages in nanopore electrochemistry. The scatter plots of the blockage current and blockage duration of the mixed sample of CA2, CA3, and CA4 show three characteristic distributions assigned to each type of oligonucleotide. Since the net charge increases with increasing length of the oligonucleotide, CA3 and CA4 experience a stronger electrophoretic force than does CA2 inside the nanopore, leading to higher migration velocity. Therefore, the blockage duration of CA3 and CA4 is 5 times longer than that of CA2. By Gaussian fitting, the fitted blockage currents of CA2, CA3, and CA4 are 20.7, 15.7, and 12.7 pA, respectively. Similar to our previous results, the blockage current increases with the chain length when the oligonucleotides comprise not more than 14 nucleotides. Therefore, nanopore-based single-molecule electrophoresis allows for the electrochemical identification of CA2, CA3, and CA4 that differ in a length by only one nucleotide. Understanding the “single-molecule electrophoresis” concept would promote the application of electrochemically confined effects in single-molecule electrophoresis separation. The combination of single-molecule electrophoresis with a microfluidic system and a nanopore array is expected to aid the separation and identification of single molecules.

PMID:34213265 | DOI:10.3724/SP.J.1123.2020.05001

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Analysis of metabolomics and proteomics based on capillary electrophoresis-mass spectrometry

Se Pu. 2020 Sep 8;38(9):1013-1021. doi: 10.3724/SP.J.1123.2020.02025.

ABSTRACT

Capillary electrophoresis-mass spectrometry (CE-MS) has the advantages of higher sensitivity, higher efficiency, and less sample consumption. Moreover, it possesses obvious advantages during the analysis of strongly charged and highly polar samples. CE-MS has been widely applied in life sciences, medicine, and pharmacology. In the past ten years, the main factors affecting its application were system stability, reproducibility, and data accuracy. In order to solve the existing problems of CE-MS, researchers have invested significant effort in technology innovation to further expand CE-MS application. In the fields of medicine and analytical chemistry, substantial research indicates that CE-MS is superior compared to other metabolomic and proteomic approaches. This study aims at reviewing the latest methods and applications developed in the fields of medicine and analytical chemistry since 2015. Furthermore, it also aims at enhancing the technology development-related application value of CE-MS and serving as a reference for future development. Further development of the CE-MS technology is discussed from the aspects of coating-sample interaction, interface types, and data processing methods. Concerning the coating types, neutral coatings had been applied extensively in CE-MS and there should be no limitation to the charge of the analyte. The coating decreased sample adsorption on the inner wall by covering the surface charge, greatly reducing the electroosmotic flow (EOF). A charged capillary coating could modify such an EOF direction. The cationic coating could reduce the hydrophobic interaction between the sample and the capillary column, resulting in higher EOF. If it is applied to the sheathless interface, the resolution could be improved by extending the capillary length. Anionic coatings are predominant among the anionic compounds, shortening the separation time by reducing the interaction between the anionic compounds and the capillary. The coating type should be chosen relative to the analyte characteristics. Concerning the interface technology, all interfaces should be simple, practical, and non-dependent on sheath liquid and background electrolytes. As far as data processing methods are concerned, it is necessary to design and develop a practical method for span space data comparison and processing. The optimized experimental conditions have effectively improved separation efficiency and data comparison analysis. Furthermore, they established a solid foundation for its application development. CE-MS analysis of complex samples in the fields of metabolomics and proteomics (e. g., of tissues, cells, body fluids, etc.) could provide a visualization method for future clinical analysis. It contributes to the development of cancer pathological analysis, drug development, disease surveillance, etc. The characteristic analysis of small molecule metabolites and protein biomarkers directly reflects on enzymatic activity in the biological systems. It could be associated with the development of various diseases/complications. Omics analysis also has an important directive to disease detection and surveillance with obvious advantages in disease diagnosis, staged treatment, drug development, and patient treatment progress. CE-MS is useful in detecting complications and promoting personalized medicine. It provides technical support for future clinical developments. In addition to a comprehensive review of the recent advances of CE-MS research, this paper also indicates the development directions of CE-MS. In order to avoid the problem of omics analysis and obtain the optimized analysis results, future analysis should be improved from the following three aspects:(i) The analysis conditions should be optimized concerning sample preparation methods and separation techniques. (ii) The analytic techniques should be supported to adjust to capillary coating and interface technology. (iii) New ideas should be developed in the fields of clinical research and statistical analysis.

PMID:34213267 | DOI:10.3724/SP.J.1123.2020.02025

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Effect of surface properties of ceramic materials on bacterial adhesion: A systematic review

J Esthet Restor Dent. 2021 Jul 2. doi: 10.1111/jerd.12799. Online ahead of print.

ABSTRACT

PURPOSE: The objective of this systematic review was to describe studies that report on whether surface characteristics such as electrostatic charge, surface free energy, and surface topography promote influence on bacterial adhesion on ceramic surfaces.

MATERIAL AND METHOD: Searches in the SCOPUS, PubMed/Medline, Web of Science, EMBASE, and Google Scholar databases were performed between December 2020 and January 2021 and updated in March 2021. In addition, a manual search of reference lists from relevant retrieved articles was performed. The criteria included: studies that evaluated ceramic surfaces, which described factors such as surface free energy, electrostatic charges, roughness, zeta potential, and their relationship with bacteria.

RESULTS: Database search resulted in 348 papers. Of the 24 studies selected for full reading, 17 articles remained in this systematic review. Another five studies were found in references of articles included, totaling 22 studies. These had a high heterogeneity making it difficult to perform statistical analysis, so a descriptive analysis was performed.

CONCLUSIONS: For dental ceramics, not enough results were found to demonstrate the influence of the electrostatic condition, and its relationship with bacterial adhesion. However, studies of this review show that there is a correlation between bacterial adhesion, surface free energy, and topography.

CLINICAL SIGNIFICANCE: The knowledge of ceramics with repulsive physical-chemical interactions would allow an environment suggestive of non-adhesion of pathogenic biofilm.

PMID:34213078 | DOI:10.1111/jerd.12799

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Classification of type 2 diabetes mellitus with or without cognitive impairment from healthy controls using high-order functional connectivity

Hum Brain Mapp. 2021 Jul 2. doi: 10.1002/hbm.25575. Online ahead of print.

ABSTRACT

Type 2 diabetes mellitus (T2DM) is associated with cognitive impairment and may progress to dementia. However, the brain functional mechanism of T2DM-related dementia is still less understood. Recent resting-state functional magnetic resonance imaging functional connectivity (FC) studies have proved its potential value in the study of T2DM with cognitive impairment (T2DM-CI). However, they mainly used a mass-univariate statistical analysis that was not suitable to reveal the altered FC “pattern” in T2DM-CI, due to lower sensitivity. In this study, we proposed to use high-order FC to reveal the abnormal connectomics pattern in T2DM-CI with a multivariate, machine learning-based strategy. We also investigated whether such patterns were different between T2DM-CI and T2DM without cognitive impairment (T2DM-noCI) to better understand T2DM-induced cognitive impairment, on 23 T2DM-CI and 27 T2DM-noCI patients, as well as 50 healthy controls (HCs). We first built the large-scale high-order brain networks based on temporal synchronization of the dynamic FC time series among multiple brain region pairs and then used this information to classify the T2DM-CI (as well as T2DM-noCI) from the matched HC based on support vector machine. Our model achieved an accuracy of 79.17% in T2DM-CI versus HC differentiation, but only 59.62% in T2DM-noCI versus HC classification. We found abnormal high-order FC patterns in T2DM-CI compared to HC, which was different from that in T2DM-noCI. Our study indicates that there could be widespread connectivity alterations underlying the T2DM-induced cognitive impairment. The results help to better understand the changes in the central neural system due to T2DM.

PMID:34213081 | DOI:10.1002/hbm.25575