Category: Nevin Manimala

Med Sci Sports Exerc. 2021 May 24. doi: 10.1249/MSS.0000000000002699. Online ahead of print.

ABSTRACT

INTRODUCTION: Physical activity has beneficial effects on both cardiovascular and neurocognitive parameters, and these 2 modalities are known to interact at rest. However, findings on their interaction during exercise are inconclusive.

PURPOSE: Therefore, this longitudinal study aimed to investigate the effects of different forms of exercise (training period, marathon race, recovery period) on both parameters and their interaction.

METHODS: We included 100 marathon runners (MA) (mean [SD] age: 43.6 [10.0] years, 80 male) and 46 age- and sex-matched sedentary controls (SC, for baseline comparison). Over the 6-month study period with 6 visits (12 and 2 weeks before the marathon; immediately, 24 hours, 72 hours and 12 weeks after the marathon), we assessed cognitive parameters by evaluating 1-to 3-back d prime, the d2 task, and the Trail Making Test A (TMTA) and B (TMTB); retinal vessel parameters by assessing arteriolar-to-venular ratio (AVR), central retinal arteriolar and venular equivalents (CRAE/CRVE).

RESULTS: In the long-term analysis, 3-back d prime correlated positively with AVR (P = 0.024, B = 1.86,SE = 0.824) and negatively with CRVE (P = 0.05,B = -0.006,SE = 0.003) and TMTB correlated negatively with CRAE (P = 0.025,B = -0.155,SE = 0.069), even after correcting for age and systolic blood pressure as possible confounders. Acute effects were inconsistent with maximal cognitive improvement 24 hours after the marathon. AVR was significantly smaller in SC compared to MA.

CONCLUSION: Chronic exercise seems to prime the central nervous system for acute, intensive bouts of exercise. Our findings indicate a possible relationship between cognitive performance in high-demand tasks and retinal vasculature and support the idea of a neuroplastic effect of exercise.

PMID:34033620 | DOI:10.1249/MSS.0000000000002699

J Med Internet Res. 2021 Apr 16. doi: 10.2196/27132. Online ahead of print.

ABSTRACT

BACKGROUND: Perinatal mental health symptoms commonly remain underdiagnosed and undertreated in maternity care settings in the UK, with outbreaks of disease, like the coronavirus (COVID-19) pandemic, further disrupting access to adequate mental health support. Digital technologies may offer an innovative way to support the mental health needs of women and their families throughout the perinatal period, as well as assist midwives in the recognition of perinatal mental health concerns. However, little is known about the acceptability and perceived benefits and barriers to using such technologies.

OBJECTIVE: To conduct a mixed methods evaluation of the current state of perinatal mental healthcare provision in the UK, as well as users’ (women and partners) and midwives’ interest in using a digital mental health assessment throughout the perinatal period.

METHODS: Eight hundred and twenty-nine women, 103 partners, and 90 midwives participated in the study, which entailed completing an online survey. Quantitative data were explored using descriptive statistics. Open-ended response data were first investigated using thematic analysis. Resultant themes were then mapped onto the components of the Capability, Opportunity, and Motivation Model of Behavior (COM-B model) and summarized using descriptive statistics.

RESULTS: The provision of adequate perinatal mental healthcare support was limited, with experiences varying significantly across respondents. There was a strong interest in using a digital mental health assessment to screen, diagnose, and triage perinatal mental health concerns, particularly among women and midwives. The digital assessment was seen to be well placed within maternity healthcare settings, with in-person only and blended care (i.e., in-person and remote support) approaches being preferred by women and partners in the event of further care being advised. Identified benefits and barriers mainly related to physical opportunity (e.g., accessibility), psychological capability (e.g., cognitive skills) and automatic motivation (e.g., emotions).

CONCLUSIONS: This study provides proof-of-concept support for the development and implementation of a digital mental health assessment to inform clinical decision-making in the assessment of perinatal mental health concerns in the UK.

PMID:34033582 | DOI:10.2196/27132

IEEE Trans Biomed Eng. 2021 May 25;PP. doi: 10.1109/TBME.2021.3083580. Online ahead of print.

ABSTRACT

Despite there being studies that have investigated the effects of human augmentation using a knee exoskeleton, comparing different assistance schemes on a single knee exoskeleton has not been studied. Using a light-weight, low-profile bilateral knee exoskeleton system, this study examined and compared the biomechanical effects of three common assistance strategies (biological torque, impedance, and proportional myoelectric controllers) exhibiting different levels of flexibility for the user to control the assistance. Nine subjects walked on a 15% gradient incline surface at 1.1 m/s in the three powered conditions and with the exoskeleton unpowered. All the assistance strategies significantly reduced the metabolic cost of the users compared to the unpowered condition by 3.0% on average across strategies (p < 0.05), led by the significant reduction in the biological knee kinetic effort and knee extensor muscle activation (p < 0.05). Between assistance strategies, the metabolic cost and biomechanics displayed no statistically significant differences. The metabolic and biomechanical results indicate that powered extension assistance during early stance can improve performance compared to the unpowered condition. However, the users ability to control the assistance may not be significant for human augmentation when walking on an inclined surface with a knee exoskeleton.

PMID:34033531 | DOI:10.1109/TBME.2021.3083580

IEEE Trans Cybern. 2021 May 25;PP. doi: 10.1109/TCYB.2021.3070677. Online ahead of print.

ABSTRACT

Recently, the correlation filter (CF) and Siamese network have become the two most popular frameworks in object tracking. Existing CF trackers, however, are limited by feature learning and context usage, making them sensitive to boundary effects. In contrast, Siamese trackers can easily suffer from the interference of semantic distractors. To address the above problems, we propose an end-to-end target-insight correlation network (TICNet) for object tracking, which aims at breaking the above limitations on top of a unified network. TICNet is an asymmetric dual-branch network involving a target-background awareness model (TBAM), a spatial-channel attention network (SCAN), and a distractor-aware filter (DAF) for end-to-end learning. Specifically, TBAM aims to distinguish a target from the background in the pixel level, yielding a target likelihood map based on color statistics to mine distractors for DAF learning. SCAN consists of a basic convolutional network, a channel-attention network, and a spatial-attention network, aiming to generate attentive weights to enhance the representation learning of the tracker. Especially, we formulate a differentiable DAF and employ it as a learnable layer in the network, thus helping suppress distracting regions in the background. During testing, DAF, together with TBAM, yields a response map for the final target estimation. Extensive experiments on seven benchmarks demonstrate that TICNet outperforms the state-of-the-art methods while running at real-time speed.

PMID:34033563 | DOI:10.1109/TCYB.2021.3070677

Arch Endocrinol Metab. 2021 May 18;64(5):575-583. doi: 10.20945/2359-3997000000223.

ABSTRACT

OBJECTIVE: This study aimed to establish the utility values of different health states associated with diabetic retinopathy in a Brazilian sample to provide input to model-based economic evaluations.

METHODS: This cross-sectional study was performed in a sample of patients with type 2 diabetes mellitus (T2D) who underwent teleophthalmology screening at a primary care service from 2014 to 2016. Five diabetic retinopathy health states were defined: absent, non-sight-threatening, sight-threatening, and bilateral blindness. Utility values were estimated using the Brazilian EuroQol five dimensions (EQ-5D) tariffs. Descriptive statistics were calculated. Analysis of covariance was performed to adjust the utility values for potential confounders.

RESULTS: The study included 206 patients. The mean (± standard deviation [SD]) utility value was 0.765 ± 0.19 (95% confidence interval [CI], 0.740-0.790). The adjusted mean utility value was 0.748 (95% CI, 0.698-0.798) in patients without diabetic retinopathy, 0.752 (95% CI, 0.679-0.825) in those with non-sight-threatening state, 0.628 (95% CI, 0.521-0.736) in those with sight-threatening state, and 0.355 (95% CI, 0.105-0.606) in those with bilateral blindness. A significant utility decrement was found between patients without diabetic retinopathy and those with a sight-threatening health state (0.748 vs. 0.628, respectively, p = 0.04).

CONCLUSION: The findings suggest that a later diabetic retinopathy health state is associated with a decrement in utility value compared with the absence of retinopathy in patients with T2D. The results may be useful as preliminary input to model-based economic evaluations. Further research is needed to investigate the impact of diabetic retinopathy on health-related quality of life in a sample more representative of the Brazilian population.

PMID:34033298 | DOI:10.20945/2359-3997000000223

J Urol. 2021 May 25:101097JU0000000000001895. doi: 10.1097/JU.0000000000001895. Online ahead of print.

ABSTRACT

INTRODUCTION: Prediction of potency recovery following RARP is useful for better patient counselling and post-operative treatment strategies. In this study we propose a pre-operative and post-operative nomogram to predict post-operative potency recovery following RARP.

MATERIALS AND METHODS: Patients from development set (n=6502) were selected to develop the nomograms, and patients in validation set (n=2706) were used for validation. Cox regression models were fitted on the development cohort to predict potency recovery after RARP using as prognostic factors the covariates selected. Two nomograms were drawn using the regression coefficients of the pre- and post-operative Cox models.

RESULTS: The discrimination ability of the pre-operative model was evaluated on the development cohort using the ROC curves estimated at 3, 6, 12, and 24 months. The AUC at these time points was 0.726, 0.734, 0.754, and 0.778, respectively. The AUCs of the post-operative model at 3, 6, 12, and 24 months were 0.746, 0.756 and 0.777, and 0.801, respectively. Pre- and post-operative predictive models were validated using a separate set of 2706 patients. The AUCs of the pre-operative model at 3, 6, 12, and 24 months were 0.789, 0.772, 0.768, and 0.778, respectively. The ROC curves of the post-operative model at 3, 6, 12, and 24 months with AUCs of 0.807, 0.797, 0.793, and 0.798, respectively. Along with age and pre-operative sexual function, NS technique determines the potency outcomes justifying better AUC for post-operative model vs the pre-operative model.

CONCLUSION: The above nomograms help us to predict with good accuracy the probability of potency recovery within 3, 6,12- and 24-months following surgery taking into consideration pre-operative and post-operative factors. This is a novel tool for the care giver to predict realistic expectation of potency outcomes to the patients, while preoperative and immediate post-operative counselling.

PMID:34033495 | DOI:10.1097/JU.0000000000001895

Arch Endocrinol Metab. 2021 May 18;64(5):567-574. doi: 10.20945/2359-3997000000237.

ABSTRACT

OBJECTIVE: Prematurity and low birth weight predispose preterm infants to cardiovascular disease in later life. Is the metabolic profile of these children impacted by the relation between birth weight and gestational age (GA)? This study aimed to evaluate whether the relationship between birth weight and GA of preterm infants has a positive correlation with the metabolic profile from birth to the sixth month of corrected age.

METHODS: This is a longitudinal, prospective study with a cohort of 70 preterm and 54 term infants, who were enrolled in the study and shared into two groups: Appropriate for GA (AGA) and Small for GA (SGA), both classified at birth by Fenton and Kim curves. Longitudinal evaluation of anthropometry measures and blood samples of total cholesterol, glucose, triglycerides, and insulin were collected at birth, NICU discharge, and the sixth month of corrected age. Data were analyzed using descriptive and inferential statistical analysis (ANOVA, Fisher test, Shapiro-Wilk, and Cochran test). The effect size was 0.15, power was 0.92, and confidence interval 95%.

RESULTS: No significant statistical differences were observed in relation to biochemical tests between AGA and SGA groups. However, a significant increase in triglyceride results above the reference values for age in the SGA group was observed throughout the follow-up.

CONCLUSION: Changes observed in the preterm infant metabolic profile show no correlation with adequacy of birth weight. Preterm lipid profile requires continuous evaluation at follow-up, due to the increased cardiovascular risk in later life.

PMID:34033297 | DOI:10.20945/2359-3997000000237

Arch Endocrinol Metab. 2021 May 18;64(6):726-734. doi: 10.20945/2359-3997000000281.

ABSTRACT

OBJECTIVE: To determine the prevalence of vitamin D deficiency (VDD) in exclusively breastfed infants at the Aga Khan University Hospital Nairobi, Kenya (AKUHN). The relationships between 25-hydroxyvitamin D; 25OHD, parathyroid hormone (PTH), maternal vitamin D supplementation, and sunlight exposure were also determined.

METHODS: Blood from 98 infants was assayed for 25OHD, calcium, phosphate, and PTH. Socio-demographic and clinical characteristics were analyzed using descriptive statistics and inferential analysis (p < 0.05).

RESULTS: The prevalence of VDD (25OHD <12 ng/mL), vitamin D insufficiency (VDI, 25OHD 12-20 ng/mL) and vitamin D sufficiency (VDS, 25OHD >20 ng/mL) was 11.2% (95% CI 8.0%-14.4%), 12.2% (95% CI 8.9%-15.5%), and 76.5% (95% CI 72.3%-80.8%) respectively. There was no difference in the mean age, head circumference, length, or weight of infants in VDD, VDI, and VDS groups. PTH was elevated when 25OHD was <12 ng/mL and normal when 25OHD was between 12-20 ng/mL. 25OHD and PTH were normal in infants whose mothers received vitamin D supplements. Infants who received <30 minutes/day of exposure to sunlight were 5 times more likely to have VDI than infants who received ≥30 minutes/day (p = 0.042).

CONCLUSION: The prevalence of VDD in exclusively breastfed infants at AKUHN is low. The current national policy that recommends exclusive breastfeeding of infants in the first 6 months of life appears to be effective in staving off vitamin D deficiency but those infants with < 30 minutes sunlight exposure may benefit from low dose supplemental vitamin D during times of low sunlight exposure.

PMID:34033282 | DOI:10.20945/2359-3997000000281

Arch Endocrinol Metab. 2021 May 18;64(6):735-742. doi: 10.20945/2359-3997000000283.

ABSTRACT

OBJECTIVE: Ultrasonography (US) is the most accurate and cost-effective imaging method in diagnosis of thyroid nodules. A practical thyroid imaging reporting and data system (TIRADS) for thyroid nodules has been proposed to classify nodules of the thyroid gland to solve the problem of nodule selection for fine needle aspiration cytology (FNAC). Real-time elastography and strain ratio (SR) is a method used to assess the stiffness and predict the malignancy of thyroid nodules. The objective of this study was to assess the role of elastography and SR and the TIRADS scoring system in discriminating malignant from benign thyroid nodules.

METHODS: From 2015 to 2018 at Cairo University Hospital, a series of 409 patients with thyroid nodules was referred to undergo thyroid ultrasound. Categorization of each nodule according to the TIRADS ranged from 1 to 5. The qualitative elastography score and semiquantitative SR of the nodules were evaluated. Final diagnosis was done by either post-thyroidectomy histopathological examination or US-guided FNAC.

RESULTS: Our study included 409 patients with thyroid nodules. Their mean age was 39 ± 10 SD; 36 were males and 373 were females. There were 22 malignant nodules and 387 benign nodules. There were statistical differences between benign and malignant nodules regarding TIRADS classification, SR, anteroposterior/transverse ratio, degree of echogenicity, border, presence of calcification, and absence of halo sign (P < 0.001). The elastic properties of thyroid nodules proved to be a good discriminator between malignant and benign nodules (P- < 0.001) at a cut off value of > 2.32 with 95.2% sensitivity and 86.5% specificity. For every unit increase in SR, the risk of malignancy increased by nearly 2 times. Patients with irregular borders had nearly 17 times increased risk of malignancy than those with regular borders.

CONCLUSION: Elastography and SR proved to be of high significant value in discriminating benign from malignant nodules, so we recommend adding it to the TIRADS classification.

PMID:34033283 | DOI:10.20945/2359-3997000000283

Arch Endocrinol Metab. 2021 May 18;64(6):758-763. doi: 10.20945/2359-3997000000287.

ABSTRACT

OBJECTIVE: The aim of the present study was to examine the influence of body composition and insulin resistance on the magnitude of postprandial lipemia in patients with Turner’s syndrome receiving oral versus transdermal estrogen replacement.

METHODS: Twenty-five patients with Turner’s syndrome receiving oral or transdermal estrogen replacement were evaluated for body mass index, waist-to-hip and waist-to-height ratios, fasting glycemia, insulin, body composition (dual-energy X-ray absorptiometry), and postprandial lipid metabolism. For statistical analysis, we used parametric tests to compare numeric variables between the two subgroups.

RESULTS: We observed no difference in postprandial triglyceride levels between patients receiving oral versus transdermal hormone replacement therapy. The postprandial triglycerides increment correlated positively with the percentage of total fat mass (p=0.02) and android fat mass (p=0.02) in the transdermal group. In the oral estrogen group, a positive correlation was observed between the increment in postprandial triglycerides and waist-to-hip (p=0.15) and waist-to-height (p=0.009) ratios. No association was observed between the estrogen replacement route and insulin resistance evaluated by the homeostatic model assessment-insulin resistance (HOMA-IR) index (p=0.19 and p=0.65 for the oral and transdermal groups, respectively).

CONCLUSION: We concluded that body composition and anthropometric characteristics possibly affect the extent of postprandial lipemia independently from the route of estrogen replacement.

PMID:34033286 | DOI:10.20945/2359-3997000000287