Category: Nevin Manimala

J Clin Anesth. 2021 Nov 27;77:110596. doi: 10.1016/j.jclinane.2021.110596. Online ahead of print.

ABSTRACT

STUDY OBJECTIVE: To develop individualized dynamic predictions for the occurrence of acute kidney injury (AKI) during the first postoperative week after cardiac surgery.

DESIGN: Observational retrospective cohort study.

SETTING: Single university teaching hospital in Madrid, Spain.

PATIENTS: 3960 cases of major cardiac surgery performed from January 2002 to December 2013.

MEASUREMENTS: Baseline demographic and clinical characteristics, intraoperative risk factors, and repeated postoperative estimated glomerular filtration rates (eGFR). The primary outcome was AKI during the first postoperative week (stage 1 or higher of the Acute Kidney Injury Network). The dataset was split in two random samples (exploratory and validation). By combining time-to-event outcomes (AKI), and longitudinal data (repeated postoperative eGFR), we developed two different joint models for patients with normal and high baseline levels of serum creatinine (sCr).

MAIN RESULTS: AKI occurred in 1105 patients (31%, 95% confidence interval [CI] 29.5-32.5) in the exploratory sample and 128 (32.2%, 95% CI 27.6-36.8) in the validation sample. For high baseline sCr patients, the risk of an AKI event was associated with the eGFR trajectory (hazard ratio [HR] 0.91, 95% CI 0.90-0.92), as well as with age, and cardiopulmonary bypass time. The normal baseline sCr model incorporated the same covariates and intraoperative transfusion. In this second model, the risk of an AKI event was associated with both the eGFR trajectory (HR 0.91, 95% CI 0.91-0.92, for the current value of eGFR), and with its slope at that point (HR 0.96, 95% CI 0.94-0.99). So AKI risk decreased when the eGFR values increased, in accordance with the speed of this rise. Internal validation showed good discrimination and calibration of both joint models. The AUCs were always higher than 0.7.

CONCLUSIONS: The joint models obtained combining both patient risk factors and postoperative eGFR values, are useful to predict individualized risk of cardiac surgery-associated AKI. Predictions can be updated as new information is gathered.

PMID:34847490 | DOI:10.1016/j.jclinane.2021.110596

Waste Manag. 2021 Nov 27;138:19-29. doi: 10.1016/j.wasman.2021.11.034. Online ahead of print.

ABSTRACT

The objective of this study was to evaluate the impacts of leachate co-treatment on a full-scale municipal WWTPby comparing plant performance at varying levels of leachate contributions and hydraulic loadings.Leachate BOD:COD ratio was 0.08 ± 0.07 and indicated a stabilized, old matrix and concentrations of zinc, iron, aluminum, chloride and sulfate were 0.174, 38, 1.47, 1803 and 119.1 mg/L, respectively. The average volumetric leachate ratio (VLR%) was approximately 0.01% corresponding to a daily volume of 30 m³ but reaching a maximum of 270 m³(VLR% = 0.1%) and fluctuating on a daily-basis. A cluster analysis revealed 5 VLR% groupings that were used for subsequent analyses:no leachate, 0 < Low ≤ 0.001, 0.001 < Medium ≤ 0.02, 0.02 < High ≤ 0.05, 0.05 < Very high ≤ 0.2. Treated effluent concentrations of TKN, ammonia, fecal coliforms (FC),E. coli(EC), TSS and TP experienced atrend where effluent quality was improved at low and medium VLR%compared to no leachate addition, but deteriorated in high and very high VLR%.Treated effluent UVT% and EC were not statistically significantly different at varying VLR%, but FC was.Plant hydraulic had a significant impact on removal rates.Ammonia removals and nitrite concentrations improved inhigh flow conditions, whileTP, BOD and cBODremovals deteriorated. Finally,VLR%, leachate COD, TKN ammonia, chloride and arsenic had significant relationships with plant performance. Thus,for leachate with comparable age and strength, VLR% should not exceedlow to medium contributions(0 and 0.02%)during co-treatment at this WWTP.

PMID:34847466 | DOI:10.1016/j.wasman.2021.11.034

Nucl Med Biol. 2021 Nov 11;104-105:22-27. doi: 10.1016/j.nucmedbio.2021.11.002. Online ahead of print.

ABSTRACT

INTRODUCTION: ⁴⁴Sc is of great interest as a positron emission tomography (PET) radionuclide due to its suitable nuclear characteristics: E_β⁺max = 1.47 MeV, branching ratio 94.3% and convenient half-life of 3.97 h. Here, ⁴⁴Sc was produced via the widely used reaction ⁴⁴Ca (p,n)⁴⁴Sc using natural calcium as a target.

METHODS: The irradiation was performed at TRIUMF using the 13 MeV cyclotron. The separation consisted of a combination of DGA branched resin and Dowex 50Wx8 (200-400 mesh). The distribution coefficients of Sc³⁺ on Dowex 50Wx8 (NH₄⁺ form, 200-400 mesh) with ammonium α-hydroxyisobutyrate (pH = 4.8) medium were determined in this study.

RESULTS AND CONCLUSION: The tested scheme allows both a reliable separation of ⁴⁴Sc from the target material as well as from the other competitive metals and a final fraction with high specific activity. The achieved radiochemical yield was 95 ± 3%.

PMID:34847480 | DOI:10.1016/j.nucmedbio.2021.11.002

J Health Econ. 2021 Nov 16;81:102554. doi: 10.1016/j.jhealeco.2021.102554. Online ahead of print.

ABSTRACT

We analyze data from the Minnesota Twin Registry (MTR), combined with the Socioeconomic Survey of Twins (SST), and new mortality data, and contribute to two bodies of literature. First, we demonstrate a beneficial causal effect of education on health and longevity in contrast to other twin-based studies of the US population, which show little or no effect of education on health. Second, we present evidence that is consistent with parental compensation through education for differences in their children’s endowments that predict health, but find no evidence that parents reinforce differences in endowments that predict earnings. We argue that there is a bias towards detecting reinforcement both in this paper and in the literature. Despite this bias, we still find statistical evidence of compensating behavior. We account for observed and unobserved confounding factors, sample selection bias, and measurement error in education.

PMID:34847444 | DOI:10.1016/j.jhealeco.2021.102554

Comp Immunol Microbiol Infect Dis. 2021 Nov 17;80:101719. doi: 10.1016/j.cimid.2021.101719. Online ahead of print.

ABSTRACT

A retrospective antimicrobial resistance study of nontyphoidal Salmonella enterica isolates from India during 1990-2017 was conducted to study the microbial susceptibility to antibiotics. A total of 271 Salmonella enterica isolates from poultry (n = 146), farm animals (n = 55) and environmental sources (n = 70) were tested for susceptibility using 15 antimicrobial drugs. The drug classes include aminoglycosides, phenicols, cephalosporins, penicillins, carbapenems, fluoroquinolones, and sulphonamide-trimethoprim. Study revealed that overall, 133 (49.08%) of 271 isolates were resistant to ≥ 1 antimicrobial drugs and 81 (29.89%) out of 271 isolates were multidrug resistant (resistance to ≥ 3 drugs). Majority (68.96%) of Typhimurium serovars (n = 87) were susceptible to all antibiotics tested, whereas only 5% Kentucky serovars (n = 40) were pan susceptible. All the drugs revealed decreasing trend of susceptibility from 1990 towards 2017 except cephalosporins and carbapenems. Statistical analysis of association between time period and antimicrobial resistance revealed a significance of < 0.05. Molecular detection of genetic determinants associated with antimicrobial resistance revealed the presence of genes like class I integrons, sul1, sul2, catIII, cmlA, dfrA, bla_TEM, bla_AmpC in the resistant isolates. Furthermore, plasmid mediated quinolone resistant determinants like qnrD and qnrS were also reported in the current study.

PMID:34847457 | DOI:10.1016/j.cimid.2021.101719

Ann Diagn Pathol. 2021 Nov 25;56:151871. doi: 10.1016/j.anndiagpath.2021.151871. Online ahead of print.

ABSTRACT

Clear cell renal cell carcinoma (CCRCC) is well known for intratumor heterogeneity. An accurate mapping of the tumor is crucial for assessing prognosis, and perhaps this can be linked to potential success/failure of targeted therapies. We assembled a cohort of 7 CCRCCs with prominent vasculature and microvascular hyperplasia (ccRCCPV), resembling those seen in high grade gliomas. A control group of classic CCRCC with no variant morphologies was also included. Both groups were analyzed for clinicopathologic, morphologic, immunohistochemical, and molecular genetic features. No statistically significant differences in mRNA expression of studied genes between the two groups were found. Using NGS panel Trusight Oncology 500 (TSO500), only one clinically significant gene mutation, VHL c.263G > A, p. (Trp88Ter), was found. TMB (Tumor Mutation Burden) and MSI (MicroSatellite Instability) were low, and no copy number variations (CNVs) were detected in the study cohort. Prominent microvascular hyperplasia in CCRCC is a rare phenomenon. From molecular genetic point of view, these tumors do not appear to be different from classic CCRCC. Prognostically, they also demonstrated similar clinical behaviors.

PMID:34847388 | DOI:10.1016/j.anndiagpath.2021.151871

Eur J Radiol. 2021 Nov 24;146:110069. doi: 10.1016/j.ejrad.2021.110069. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the general rules and future trajectories of deep learning (DL) networks in medical image analysis through bibliometric and hot spot analysis of original articles published between 2012 and 2020.

METHODS: Original articles related to DL and medical imaging were retrieved from the PubMed database. For the analysis, data regarding radiological subspecialties; imaging techniques; DL networks; sample size; study purposes, setting, origins and design; statistical analysis; funding sources; authors; and first authors’ affiliation was manually extracted from each article. The Bibliographic Item Co-Occurrence Matrix Builder and VOSviewer were used to identify the research topics of the included articles and illustrate the future trajectories of studies.

RESULTS: The study included 2685 original articles. The number of publications on DL and medical imaging has increased substantially since 2017, accounting for 97.2% of all included articles. We evaluated the rules of the application of 47 DL networks to eight radiological tasks on 11 human organ sites. Neuroradiology, thorax, and abdomen were frequent research subjects, while thyroid was under-represented. Segmentation and classification tasks were the primary purposes. U-Net, ResNet, and VGG were the most frequently used Convolutional neural network-derived networks. GAN-derived networks were widely developed and applied in 2020, and transfer learning was highlighted in the COVID-19 studies. Brain, prostate, and diabetic retinopathy-related studies were mature research topics in the field. Breast- and lung-related studies were in a stage of rapid development.

CONCLUSIONS: This study evaluates the general rules and future trajectories of DL network application in medical image analyses and provides guidance for future studies.

PMID:34847395 | DOI:10.1016/j.ejrad.2021.110069

Neuro Endocrinol Lett. 2021 Nov 30;42(7). Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the efficacy and safety of acupuncture and moxibustion for bell’s palsy in the acute phase compared with the non-acute phase.

METHODS: Computer retrieval of PubMed, Embase, The Cochrane Library, Web of Science, China National Knowledge Internet (CNKI), Wanfang data, were conducted. According to the inclusion and exclusion criteria, the quality of literature was evaluated, and useful data was extracted. All statistical analyses were performed by RevMan5.3 software.

RESULTS: 17 eligible RCTs with a total of 2644 patients were included in this meta-analysis. The meta-analysis results demonstrated the cure rate of acupuncture and moxibustion for Bell’s palsy in the acute phase were lower than that in the non-acute phase (P<0.05). The time to cure of acupuncture and moxibustion for Bell’s palsy in the acute phase was shorter than that in the non-acute phase (P<0.05), and the incidence of sequelae during the treatment period of acupuncture and moxibustion for Bell’s palsy in the acute phase were lower than that in non-acute phase (P<0.05).

CONCLUSIONS: Acupuncture and moxibustion were safe and effective stimulation for Bell’s palsy in the acute phase compared with the non-acute phase, improving the cure rate of Bell’s palsy, shorten the time to cure, and reduce the occurrence of sequelae. However, more multicenter RCTs with a large sample number and high quality should verify the conclusion mentioned above.

PMID:34847316

Catheter Cardiovasc Interv. 2021 Nov 30. doi: 10.1002/ccd.30024. Online ahead of print.

ABSTRACT

OBJECTIVES: We aimed to compare clinical characteristics and procedural outcomes of left main percutaneous interventions (LM-PCI) by transradial (TRA) versus transfemoral (TFA) approach in the VA healthcare system.

BACKGROUND: TRA for percutaneous coronary intervention (PCI) is steadily increasing. However, the frequency and efficacy of TRA for LM-PCI remain less studied.

METHODS: All LM-PCIs performed in the VA healthcare system were identified for fiscal year 2008 through 2018. Patients’ baseline characteristics and procedure-related variables were compared by access site. Both short- and long-term clinical outcomes were analyzed using propensity score matching.

RESULTS: A total of 4004 LM-PCI were performed in the VA via either radial or femoral access from 2008 to 2018. Among these, 596 (14.9%) LM PCIs were performed via TRA. Use of TRA for LM-PCI increased from 2.2% to 31.5% over the study period. Propensity matched outcome analysis, comparing TRA versus TFA, showed a similar procedural success (98.4% for TRA vs. 97.8% for TFA; RR: 1.01 [0.98, 1.03]) and 1-year major adverse cardiovascular events (MACE) (25.9% for TRA vs. 26.8% TFA; RR: 0.96 [0.74, 1.25]). There were no statistically significant differences among secondary outcomes analyses including major bleeding.

CONCLUSION: Use of TRA for LM-PCI has been steadily increasing in the VA healthcare system. These findings demonstrate similar procedural success and 1-year MACE across access strategies, suggesting an opportunity to continue increasing TRA use for LM-PCI.

PMID:34847279 | DOI:10.1002/ccd.30024

Undersea Hyperb Med. 2021 Fourth-Quarter;48(4):425-430.

ABSTRACT

Central retinal artery occlusion (CRAO) is a condition that causes sudden vision loss due to obstruction of the retinal artery, typically from a thrombotic or embolic source. It is often associated with atherosclerotic risk factors, including cardiovascular disease, diabetes, hyperlipidemia, and a history of cerebrovascular disease. CRAO often leads to a poor visual outcome as well as neovascularization of the iris, retina, and optic disc, which can exacerbate vision loss and cause pain. While there are several treatment modalities for CRAO, few have been proven to be effective in decreasing the effects of neovascularization. The use of hyperbaric oxygen (HBO2) therapy is often used in the treatment of CRAO due to its ease of use and relatively benign side effect profile. This study aims to assess the degree of improvement in visual acuity (VA) and neovascularization following HBO2. Our data ultimately shows that 20% of patients developed neovascularization after HBO2 compared to 29.8% of those who did not undergo HBO2 (p<.05). Our findings suggest that HBO2 has a statistically significant protective effect against neovascularization and may improve long-term visual acuity.

PMID:34847306