Category: Nevin Manimala

Anesthesiology. 2022 Feb 1. doi: 10.1097/ALN.0000000000004133. Online ahead of print.

ABSTRACT

BACKGROUND: The lack of reliable data on gastric emptying of solid food during labor has led to some discrepancies between current guidelines regarding fasting for solid food in the parturient. This prospective comparative study aimed to test the hypothesis that the gastric emptying rate of a light meal would be reduced in parturients receiving epidural analgesia and with no labor analgesia compared with nonpregnant and pregnant women.

METHODS: Ten subjects were enrolled and tested in each group: nonpregnant women, term pregnant women, parturients with no labor analgesia, and parturients with epidural labor analgesia. After a first ultrasound examination was performed to ensure an empty stomach, each subject ingested a light meal (125 g yogurt; 120 kcal) within 5 min. Then ultrasound measurements of the antral area were performed at 15, 60, 90, and 120 min. The rate of gastric emptying at 90 min was calculated as [(antral area90 min / antral area15 min) – 1] × 100, and half-time to gastric emptying was also determined. For the Parturient-Epidural group, the test meal was ingested within the first hour after the induction of epidural analgesia.

RESULTS: The median (interquartile range) rate of gastric emptying at 90 min was 52% (46 to 61), 45% (31 to 56), 7% (5 to 10), and 31% (17 to 39) for nonpregnant women, pregnant women, parturients without labor analgesia, and parturients with labor epidural analgesia, respectively (P < 0.0001). The rate of gastric emptying at 90 min was statistically significant and lower in the Parturient-Epidural group than in the Nonpregnant and Pregnant Control groups. In addition, the rate of gastric emptying at 90 min was statistically significant and lower in the Parturient-No-Epidural group than in the Parturient-Epidural group.

CONCLUSIONS: Gastric emptying in parturients after a light meal was delayed, and labor epidural analgesia seems not to worsen but facilitates gastric emptying. This should be taken into consideration when allowing women in labor to consume a light meal.

PMID:35103759 | DOI:10.1097/ALN.0000000000004133

JAMA Netw Open. 2022 Feb 1;5(2):e2146331. doi: 10.1001/jamanetworkopen.2021.46331.

ABSTRACT

IMPORTANCE: The application of precision medicine principles for the treatment of depressive disorders in adolescents requires an examination of the variables associated with depression outcomes in randomized clinical trials (RCTs).

OBJECTIVE: To describe predictors, moderators, and mediators associated with outcomes in RCTs for the treatment of depressive disorders in adolescents.

EVIDENCE REVIEW: A scoping review of RCTs for the treatment of depression in adolescents was conducted. Databases searched included MEDLINE, Embase, APA PsycInfo, and CINAHL. Included publications tested predictors, moderators, and/or mediators associated with depression symptom outcomes (eg, symptom reduction, response, remission) in RCTs pertaining to the treatment of adolescents, ages 13 to 17 years. Predictors were defined as variables that were associated with depression outcomes, independent of treatment group. Moderators were defined as baseline variables that were associated with differential outcomes between treatment groups. Mediators were defined by a formal mediation analysis. In duplicate, variables were extracted and coded with respect to analysis type (univariable or multivariable), statistical significance, direction of effect size, reporting of a priori hypotheses, and adjustment for multiple comparisons. Aggregated results were summarized by variable domain and RCT sample.

FINDINGS: Eighty-one articles reporting on variables associated with outcomes across 33 RCTs were identified, including studies of biological (10 RCTs), psychosocial (18 RCTs), and combined (4 RCTs) treatments as well as a service delivery model (1 RCT). Fifty-three variable domains were tested as baseline predictors of depression outcome, 41 as moderators, 19 as postbaseline predictors, and 5 as mediators. Variable domains that were reported as significant in at least 3 RCTs included age, sex/gender, baseline depression severity, early response to treatment, sleep changes, parent-child conflict, overall psychopathology, suicidal ideation, hopelessness, functional impairment, attendance at therapy sessions, and history of trauma. Two publications reported a priori hypotheses and adjustment for multiple comparisons, both finding that baseline depression severity and family conflict were associated with poorer outcomes.

CONCLUSIONS AND RELEVANCE: This review identified commonly researched variables requiring more scrutiny as well as underresearched variables to inform future study designs. Further efforts to discover predictors, moderators, and mediators associated with treatment response have great potential to optimize care for adolescents with depression.

PMID:35103789 | DOI:10.1001/jamanetworkopen.2021.46331

Opt Lett. 2022 Feb 1;47(3):653-656. doi: 10.1364/OL.445388.

ABSTRACT

A photo-thermal absorption distribution probability curve based on a normal distribution model was proposed to describe the distribution of absorptive defects on fused silica surfaces under different processing conditions. Simultaneously, the maximum distribution probability absorption coefficient (MPA) and absorption distribution deviation (ADD) were used to quantitatively describe the overall absorption level and the uniformity of the absorption distribution on the fused silica surface. Based on this, the MPA (μ) and ADD (δ) were used to establish a statistical numerical relationship with the surface damage density of fused silica. The results showed that when μ ≤ 0.095 ± 0.015 and δ ≤ 0.045 ppm, the fused silica optics met the manufacturing process requirements for high laser-induced damage performance. Thus, a non-destructive approximate evaluation of the laser-induced damage density on the fused silica surface was achieved. This evaluation method provides a new, to the best of our knowledge, technology for evaluating the manufacturing process quality related to the damage performance of fused silica optics in high-power solid-state laser facilities and is an important supplement to popular destructive laser-induced damage testing methods.

PMID:35103696 | DOI:10.1364/OL.445388

Plast Reconstr Surg. 2022 Jan 31. doi: 10.1097/PRS.0000000000008895. Online ahead of print.

ABSTRACT

BACKGROUND: Since its first description in 2012, the Goldilocks procedure has become an option for immediate breast reconstruction, particularly for obese patients who are poor candidates for traditional implant or autologous reconstruction. In this work, the authors performed a longitudinal study of patients who underwent mastectomy with Goldilocks reconstruction to assess the incidence of additional surgical procedures, and to assess surgical outcomes and patient satisfaction.

METHODS: A retrospective review of patients who underwent mastectomy with the Goldilocks procedure only at Mayo Clinic Rochester between January of 2012 and September of 2019 was performed. Demographics, complications, additional breast procedures performed to attain the final results, and patient-reported outcomes using the BREAST-Q were recorded. Univariate and multivariable analyses were performed to identify statistical associations and risk factors.

RESULTS: Sixty-three patients (108 breasts) were included. Mean age was 57.8 years. Mean body mass index was 37.6 kg/m2. Median follow-up time after the mastectomy with the Goldilocks procedure was 15 months. The major complication rate within the first 30 days was 9.3 percent. Forty-four breasts (40.7 percent) underwent additional surgery. Dyslipidemia was significantly associated with an increased risk of additional surgery (adjusted hazard ratio, 2.00; p = 0.045). Scores in the four BREAST-Q domains were not statistically different between patients who had additional procedures and those who did not.

CONCLUSIONS: Based on the results, the authors recommend a thorough preoperative discussion with patients who are candidates for the Goldilocks procedure to explore all options for reconstruction and their expectations, because it is crucial to reduce the necessity for additional operations in this high-risk population.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

PMID:35103645 | DOI:10.1097/PRS.0000000000008895

Med Image Comput Comput Assist Interv. 2021 Sep-Oct;12902:166-176. doi: 10.1007/978-3-030-87196-3_16. Epub 2021 Sep 21.

ABSTRACT

A long-standing challenge in multimodal brain network analyses is to integrate topologically different brain networks obtained from diffusion and functional MRI in a coherent statistical framework. Existing multimodal frameworks will inevitably destroy the topological difference of the networks. In this paper, we propose a novel topological learning framework that integrates networks of different topology through persistent homology. Such challenging task is made possible through the introduction of a new topological loss that bypasses intrinsic computational bottlenecks and thus enables us to perform various topological computations and optimizations with ease. We validate the topological loss in extensive statistical simulations with ground truth to assess its effectiveness of discriminating networks. Among many possible applications, we demonstrate the versatility of topological loss in the twin imaging study where we determine the extend to which brain networks are genetically heritable.

PMID:35098263 | PMC:PMC8797159 | DOI:10.1007/978-3-030-87196-3_16

Biomed Res Int. 2022 Jan 21;2022:9971780. doi: 10.1155/2022/9971780. eCollection 2022.

ABSTRACT

BACKGROUND: Most patients with drug-resistant epilepsy (DRE) have cognitive impairment and sleep disturbance. There was a significant correlation between sleep disorders and cognitive dysfunction. This study performed surgical treatment on patients with DRE and observed seizures, sleep, and cognition in patients with DRE in 6th month after operation to clarify the correlation between sleep and cognition in DRE patients.

METHODS: 21 individuals with DRE were recruited to enroll in this trial. Each participant completed epileptic focus resection. Seizure frequency was the principle index; the mean seizure frequency was 1 month before surgery and six months after surgery. Cognitive function was assessed by MMSE, and sleep status was assessed by PSQI and ActiGraph; assessments were performed before and 6 months after surgery.

RESULTS: There were significant differences between conditions on all outcome measures; after 6 months of surgery, compared with before treatment, the monthly average seizure frequency of DRE decreased, which was statistically significant (P < 0.001) compared with that before treatment. The MMSE score of DRE patients was significantly higher than before (P < 0.01), especially the ability of attention, calculation, and recall in MMSE score, which was significantly higher than before operation (respectively, P < 0.001 and P < 0.01). The subjective sleep evaluation index PSQI and objective measurement of sleep latency, total sleep time, and sleep efficiency of patients with DRE by ActiGraph were statistically significant (respectively, P < 0.01) compared with that before treatment. There was a correlation between seizure frequency and MMSE (r = -0.8887, P < 0.0001), PSQI (0.5515, P < 0.01), sleep latency (0.5353, P < 0.05), total sleep time (-0.7814, P < 0.0001), and sleep efficiency (-0.4380, P < 0.05).

CONCLUSIONS: Surgery can effectively reduce the epileptic seizures frequency in patients with DRE and indirectly improve the computational power, attention, recall ability, and sleep status of patients. However, this result did not show a correlation between improved cognitive function and sleep, so the patient’s cognitive function may be caused by surgery to improve the frequency of seizures. So, whether the improvement of patients’ sleep conditions can also significantly improve the frequency of attacks and cognitive function in patients with DRE needs further exploration.

PMID:35097128 | PMC:PMC8799343 | DOI:10.1155/2022/9971780

Biomed Res Int. 2022 Jan 21;2022:1775190. doi: 10.1155/2022/1775190. eCollection 2022.

ABSTRACT

OBJECTIVE: To investigate the serum cystatin (CysC), Chemerin, and gastrin-releasing peptide precursor (ProGRP) levels in patients with chronic renal failure (CRF).

METHODS: CRF patients admitted to our hospital from February 2019 to July 2019 were selected as the observation group, and 50 healthy patients were selected as the control group. The serum levels of CysC, Chemerin, ProGRP, and Scr of all subjects were detected. Patients with CRF were admitted for peritoneal dialysis (PD) treatment for 1 week, and continued treatment was performed. The survival rate of patients with CRF in nearly 1 year after continuous treatment was observed. Multivariate analysis of factors affecting survival time of CRF patients undergoing peritoneal dialysis was performed. The results were compared with those in the health group. The expression levels of CysC, Chemerin, ProGRP, and Scr in the observation group were all decreased, and the differences were statistically significant (P < 0.05). Pearson correlation analysis showed that Scr expression in CRF patients is positively correlated with CysC, Chemerin, and ProGRP (P < 0.001). The survival rate of 98 patients with CRF was 80.61% (79/98), and the mortality rate was 19.39% (19/98). Serum levels of CysC, Chemerin, ProGRP, and Scr in the death group are all higher than those in the survival group, and the differences are statistically significant (P < 0.05). CysC, Chemerin, ProGRP, and Scr are independent risk factors affecting survival time (P < 0.05). The AUC aspects of serum CysC, Chemerin, ProGRP, and Scr in predicting the survival rate of CRF patients in the treatment phase are 0.840, 0.775, 0.782, and 0.725, respectively.

CONCLUSION: The serum levels of CysC, Chemerin, and ProGRP of CRF patients are abnormally elevated and are positively correlated with serum Scr of patients, which can be used as a reliable indicator of pathogenesis and prognosis assessment of CRF patients.

PMID:35097109 | PMC:PMC8799334 | DOI:10.1155/2022/1775190

Int J Reprod Med. 2022 Jan 21;2022:8646724. doi: 10.1155/2022/8646724. eCollection 2022.

ABSTRACT

BACKGROUND: The World Health Organization Report noted that unintended pregnancy is the most common cause of maternal mortality in developing countries. Most unintended pregnancies occur where access to maternal care is limited, and because of this, many mothers lose their life. Therefore, this study was an attempt to assess the proportion of unintended pregnancy and associated factors among women who live in Ilu Gelan District, Western Ethiopia, 2021.

METHOD: A community-based cross-sectional study was conducted in the rural and urban kebeles of Ilu Gelan Woreda West Shoa Zone, Ethiopia, from March 1 to 30, 2021. The study population consists of 540 pregnant women who were living in Ilu Gelan Woreda for at least the last six months during the data collection period. Simple random sampling by lottery method was used to recruit the study subject. Data were checked, coded, entered to EpiData version 3, and then exported to SPSS version 25 for analysis. Both descriptive and analytical statistical procedures were utilized. Both bivariable and multivariable logistic regressions was implemented.

RESULT: In this study, the proportion of unintended pregnancy was found to be 55%, at 95% CI: 50.7-59.3. Multivariable logistic regression results showed that married women (AOR = 0.117, CI: 0.04-0.38), monthly income less than 1000 Ethiopian Birr (AOR = 4.93, CI: 1.72-14.09), gravidity greater than or equal to five (AOR = 6.07, CI: 2.4-15.28), birth interval less than 2 years (AOR = 3.35 (1.44-7.8)), lack of awareness about contraceptive (AOR = 2.06 (1.03-4.15)), and husband decision-making on health care (AOR = 11.1 (2.07-59.51)) were significantly associated with unintended pregnancy. Conclusion and Recommendation. This study indicated that more than half of pregnant women reported that their current pregnancy was found to be unintended pregnancy. Married women, family monthly income less than 1000 Ethiopian Birr, gravidity greater than or equal to five, birth space less than two years, lack of contraceptive awareness, and health care decisions by husband only showed a significant association with unintended pregnancy. To decrease the current level of unintended pregnancy, all concerned stakeholders should emphatically consider those identified factors for intervention; specifically, Ilu Gelan District Health Bureau and health providers should empower women with health education about family planning and decision-making related to their health issues in the study area.

PMID:35097105 | PMC:PMC8799332 | DOI:10.1155/2022/8646724

J Transp Health. 2022 Mar;24:101292. doi: 10.1016/j.jth.2021.101292. Epub 2021 Dec 10.

ABSTRACT

BACKGROUND AND OBJECTIVE: No research to date has causally linked built environment data with health care costs derived from clinically assessed health outcomes within the framework of longitudinal intervention design. This study examined the impact of light rail transit (LRT) line intervention on health care costs after controlling for mode-specific objectively assessed moderateto-vigorous physical activity (MVPA), participant-level neighborhood environmental measures, demographics, attitudinal predispositions, and residential choices.

DATA AND METHODS: Based on a natural experiment related to a new LRT line in Portland – 282 individuals divided into treatment and control groups were prospectively followed during the pre- and post-intervention periods. For each individual, we harness high-resolution data on Electronic Medical Record (EMR) based health care costs, mode-specific MVPA, survey-based travel behavior, attitudinal/perception information, and objectively assessed built environment measures. Simulation-assisted longitudinal grouped random parameter models are developed to gain more accurate insights into the effects of LRT line intervention.

RESULTS: Regarding the “average effect” of the LRT line intervention, no statistically significant reductions in health care costs were observed for the treated individuals over time. However, substantial heterogeneity was observed not only in the magnitude of effects but its direction as well after controlling for the within- and between-individual variations. For a subgroup of treated individuals, the LRT line opening decreased health care costs over time relative to the control group. Further comparative analysis based on the findings of heterogeneity-based models revealed that the effect of LRT intervention for the treated individuals differed by individual characteristics, attitudes/perceptions, and neighborhood level environmental features.

CONCLUSIONS: The study revealed the presence of significant effect modifiers and distinct subgroup structures in the data related to the effects of LRT line intervention on health care costs. Severe implications of ignoring unobserved heterogeneity are highlighted. Limitations and potential avenues for future research are discussed.

PMID:35096526 | PMC:PMC8797061 | DOI:10.1016/j.jth.2021.101292

Int J Hypertens. 2022 Jan 21;2022:6912502. doi: 10.1155/2022/6912502. eCollection 2022.

ABSTRACT

BACKGROUND: Hypertension is one of the leading causes of cardiovascular mortality. Although the pathogenetic process involved is not yet fully understood, the disease involves endothelial damage and inflammation. Calprotectin is an inflammatory marker that rises in parallel with disease activity in conditions such as systemic inflammatory diseases, infection, and atherosclerosis. The purpose of this study was to evaluate inflammation through serum calprotectin levels in newly diagnosed primary hypertension patients.

METHODS: Forty-nine newly diagnosed hypertensive patients and 38 healthy adults were included in the study. Patients’ office blood pressure values, biochemical findings, and demographic characteristics were recorded. Serum calprotectin levels were measured using ELISA. Parameters affecting serum calprotectin levels and determinants of hypertension were evaluated.

RESULTS: Serum calprotectin levels were 242.8 (72.4-524) ng/mL in the control group and 112.6 (67.4-389.8) ng/mL in the hypertensive patient group, the difference being statistically significant (p=0.001). There was no correlation between serum calprotectin levels and other parameters (blood pressure values, age, gender, serum creatinine, uric acid, and calcium levels) in the hypertensive group. A lower serum calprotectin level was found to be independently related to hypertension (β = -0.009, p=0.005). Serum calprotectin at a cutoff level of 128.6 ng/mL differentiated hypertensives from healthy controls with a sensitivity of 69.4% and specificity of 68.4% (AUC = 0.767).

CONCLUSIONS: The results of this study were the opposite of our hypothesis that a higher calprotectin level may reflect subclinical endothelial damage in newly diagnosed hypertensive patients. Further comparative studies involving patients at different stages of hypertension may contribute to clarifying the relationship between calprotectin and hypertension. We conclude that molecular studies seem essential for understanding the place of calprotectin in hypertension-associated inflammation, a complex process.

PMID:35096423 | PMC:PMC8799354 | DOI:10.1155/2022/6912502