Category: Nevin Manimala

Neonatology. 2021 Jun 10:1-9. doi: 10.1159/000516372. Online ahead of print.

ABSTRACT

INTRODUCTION: Neonatal tracheal intubation (TI) outcomes have been assessed by role, but training level may impact TI success and safety. Effect of physician training level (PTL) on the first-attempt success, adverse TI-associated events (TIAEs), and oxygen desaturation was assessed.

METHODS: Prospective cohort study in 11 international NEAR4NEOS sites between October 2014 and December 2017. Primary TIs performed by pediatric/neonatal physicians were included. Univariable analysis evaluated association between PTL, patient/practice characteristics, and outcomes. Multivariable analysis with generalized estimating equation assessed for independent association between PTL and outcomes (first-attempt success, TIAEs, and oxygen desaturation ≥20%; attending as reference).

RESULTS: Of 2,608 primary TIs, 1,298 were first attempted by pediatric/neonatal physicians. PTL was associated with patient age, weight, comorbidities, TI indication, difficult airway history, premedication, and device. First-attempt success rate differed across PTL (resident 23%, fellow 53%, and attending 60%; p < 0.001). There was no statistically significant difference in TIAEs (resident 22%, fellow 20%, and attending 25%; p = 0.34). Desaturation occurred more frequently with residents (60%), compared to fellows and attendings (46 and 53%; p < 0.001). In multivariable analysis, adjusted odds ratio of the first-attempt success was 0.18 (95% CI: 0.11-0.30) for residents and 0.80 (95% CI: 0.51-1.24) for fellows. PTL was not independently associated with adjusted odds of TIAEs or severe oxygen desaturation.

CONCLUSION: Higher PTL was associated with increased first-attempt success but not TIAE/oxygen desaturation. Identifying strategies to decrease adverse events during neonatal TI remains critical.

PMID:34111869 | DOI:10.1159/000516372

Blood Purif. 2021 Jun 10:1-7. doi: 10.1159/000514059. Online ahead of print.

ABSTRACT

BACKGROUND: Arteriovenous fistula (AVF) is considered to be the best choice of vascular access, but the maturation rate and patency rate of AVF are not satisfactory. Many studies have explored the influencing factors of AVF failure but do not involve the direct relationship between monocyte count and AVF failure. This study aims to explore the relationship between monocyte count and AVF dysfunction related to stenosis.

METHODS: From September 2017 to September 2018, basic clinical data and laboratory parameters of patients were collected. All included patients were followed up to September 2019. The stenosis-related AVF failure events that occurred after the patient included in the study and the time of their occurrence were recorded. All patients were divided into 3 groups based on the tertile of monocyte count. Kaplan-Meier method was used to compare the patency rate of AVF in each group. The effects of variables on AVF failure were analyzed. A multivariate Cox regression model with p < 0.05 was included in the univariate Cox regression analysis.

RESULTS: A total of 120 patients were included in this study. According to the recorded baseline monocyte count levels, they were divided into 3 groups according to their tertiles, 34 cases in the T1 group (T1 < 0.32 × 109/L), 44 cases in the T2 group (0.32 ≤ T2 < 0.51 × 109/L), and 42 cases in T3 group (T3 ≥0.51 × 109/L). After a median follow-up of 20 months, a total of 31 AVF failure events occurred. Kaplan-Meier survival curves showed that patients with a baseline monocyte count ≥0.51 × 109/L had the lowest patency rate of AVF (log-rank test χ2 = 7.525, p = 0.023). After adjusting to basic clinical data and biochemical indicators, there were statistically significant differences in patency rates of the 3 groups (hazard ratio = 2.774, 95% CI = 1.092-7.043).

CONCLUSION: Monocyte count ≥0.51 × 109/L is an independent risk factor for AVF failure, and AVF failure caused by monocytes may be driven by inflammation.

PMID:34111871 | DOI:10.1159/000514059

Nanotechnology. 2021 Jun 10. doi: 10.1088/1361-6528/ac0a13. Online ahead of print.

ABSTRACT

In this work, we studied the impact of magnetic nanoparticles (MNPs) interactions with HeLa cells when they are exposed to high frequency alternating magnetic field (AMF). Specifically, we measured the nanobiomechanical properties of cell interfaces by using Atomic Force Microscopy (AFM). The Magnetite (Fe₃O₄) MNPs were synthesized by coprecipitation and encapsulated with silica (SiO₂): Fe₃O₄@SiO₂and functionalized with amino groups (-NH₂): Fe₃O₄@SiO₂-NH₂, by sonochemical processing. HeLa cells were incubated or not with MNPs, then exposed or not to AMF at 37 °C. A biomechanical analysis was then performed through AFM, providing the Young’s modulus and stiffness of the cells. The statistical analysis (p < 0.001) showed that AMF application or MNPs interaction modify the biomechanical behavior of the cell interfaces. Interestingly, the most significant difference was found for HeLa cells incubated with Fe₃O₄@SiO₂-NH₂and exposed to AMF, showing that local heat of these MNPs modify elasticity and stiffness.

PMID:34111853 | DOI:10.1088/1361-6528/ac0a13

Physiol Meas. 2021 Jun 10. doi: 10.1088/1361-6579/ac0a34. Online ahead of print.

ABSTRACT

OBJECTIVE: Filtering can change the timing of pulse feature points on photoplethysmography (PPG) signals. We aim to quantitatively investigate the effect of measurement site and type of pulse feature on the filtering-induced time shift (TS).

APPROACH: 60-second PPG signals were measured from six body sites [finger, wrist under (volar), wrist upper (dorsal), earlobe, and forehead] of 36 healthy adults. Using infinite impulse response digital filters, PPG signals were prefiltered (band-pass, pass and stop bands: >0.5Hz and <0.2Hz for high-pass filter, <20Hz and >30Hz for low-pass filter) then filtered (low-pass, pass and stop bands: <3Hz and >5Hz). Four pulse features (peak, valley, maximal first derivative, and maximal second derivative) were extracted. For each subject, overall TS and intra-subject TS variability in feature points were calculated as the mean and standard deviation of TS between prefiltered and filtered PPG signals in 50 cardiac cycles. Statistical test was performed to investigate the effect of measurement site and type of pulse feature on overall TS and intra-subject TS variability.

RESULTS: Measurement site, type of pulse feature, and their interaction had significant impacts on the overall TS and intra-subject TS variability (p<0.001 for all). Valley and maximal second derivative showed higher overall TS than peak and maximal first derivative. Finger has higher overall TS and lower intra-subject TS variability than other measurement sites.

SIGNIFICANCE: Measurement site and type of pulse feature can significantly influence the timing of feature point on filtered PPG signals. Filtering parameters should be quoted to support the reproducibility of PPG-related studies.

PMID:34111855 | DOI:10.1088/1361-6579/ac0a34

J Breath Res. 2021 Jun 10. doi: 10.1088/1752-7163/ac09fa. Online ahead of print.

ABSTRACT

Objective Traffic-related air pollution exposure (TRAP) is a major public health problem. The effects of TRAP exposure on oxidative biomarkers of exhaled breath condensate (EBC) of adults are not much studied. We compared the oxidative EBC biomarkers in a group of individuals exposed to TRAP with those unexposed to TRAP.

MATERIAL AND METHODS: We conducted a case-control study at Bhopal City (Madhya Pradesh, India). Adults with a history of exposure to TRAP were enrolled as cases and adults with less exposure to TRAP as control. Based on respiratory symptoms and smoking habits, study subjects were stratified into six subgroups. EBC was collected by TURBO14 (Medivac SRL, Italy) at -50 c. EBC pH was measured after gas standardization with Argon. EBC hydrogen peroxide (H2O2), Cystenine Leukotrienes (Cys-LTs), 8-isoprostane were measured by commercial ELISA kit.

RESULTS: Total 250 consecutive adults (male: 194) subjects were recruited. Among them, 133 were TRAP-exposed (Male: 128) and 117 were non-TRAP-exposed (male: 66). The respiratory symptoms between TRAP-exposed and non-TRAP-exposed were not different. The post-gas standardized EBC pH (median: 7.72; IQR: 7.15-7.94 vs. median: 7.60, IQR: 6.72-7.87; p=0.09) and EBC H2O2 (median: 2.20 µmol/l; IQR: 1.46-3.51 vs. median: 1.99, IQR: 1.41-3.10; p=0.29) in TRAP-exposed subjects were statistically not different from the non-TRAP-exposed. The EBC Cys-LTs (median: 69.81; IQR: 57.0-83.38 vs. median: 47.21 pg/ml; IQR: 39.90-54.87, p<0.001) and EBC 8-isoprostane (median: 12.55 pg/ml; IQR: 5.51-18.09 vs. median: 7.12; IQR: 4.60-16.04, p=0.026) in TRAP-exposed subjects were higher compared to non-TRAP-exposed. The subgroup analysis showed TRAP-exposed, irrespective of their smoking habits and respiratory symptoms had higher EBC Cys-LTs compared to the non-TRAP-exposed.

CONCLUSION: TRAP exposure increases oxidative biomarkers of the EBC in adults.

PMID:34111861 | DOI:10.1088/1752-7163/ac09fa

J Sport Rehabil. 2021 Jun 10:1-6. doi: 10.1123/jsr.2020-0468. Online ahead of print.

ABSTRACT

CONTEXT: Performance in strength and assessment of patellar tracking is important for patients with arthrofibrosis after anterior cruciate ligament (ACL) reconstruction.

OBJECTIVE: The study was to examine the difference of patellofemoral kinematics between the affected and the contralateral limb and to evaluate the relationship between knee extensor strength and patellofemoral kinematics in patients with arthrofibrosis after ACL reconstruction.

DESIGN: Cohort study (diagnosis); level of evidence, 3.

SETTING: Laboratory.

PATIENTS: A prospective cohort of 20 patients with arthrofibrosis after ACL reconstruction was recruited.

INTERVENTIONS: A total of 20 patients who underwent arthroscopic reconstruction of the double-bundle ACL with a hamstring tendon autograft received standardized patellofemoral kinematics testing and knee extensor strength testing within 6 months after primary ACL reconstruction. Computed tomography and dual fluoroscopic imaging were used to evaluate in vivo patellofemoral kinematics of affected and contralateral knees during a lunge task. Knee extensor mechanism strength was measured using a handheld dynamometer.

MAIN OUTCOME MEASURES: A limb symmetry index of knee strength and patellar mobility was calculated and satisfactory performance defined as ≥90%.

RESULTS: There was a statistically significant decrease in the range of patellar inferior shift (P = .020; d = 0.81), flexion (P = .026; d = 0.95), lateral tilt (P = .001; d = 1.04), and lateral rotation (P < .001; d = 0.89) in the affected knee compared with the contralateral knee from 15° to 75° of knee flexion. There was a strong positive linear correlation between knee extensor strength and patellar inferior shift (r = .747; P = .008). A knee extensor strength limb symmetry index <90% was 89% sensitive and 9% specific for limited patellar inferior shift.

CONCLUSIONS: Patients with arthrofibrosis after ACL reconstruction presented decreased patellar mobility in the arthrofibrotic knee compared with the contralateral knee. The strong correlation between knee extensor strength and patellar inferior shift of the arthrofibrotic knee demonstrates the importance of knee extensor strength in the diagnosis and treatment of patients with knee arthrofibrosis. The knee extensor mechanism strength has high sensitivity but low specificity in identifying a decrease in patellar inferior shift in patients with arthrofibrosis after ACL reconstruction.

PMID:34111841 | DOI:10.1123/jsr.2020-0468

Stud Hist Philos Sci. 2021 Apr 11;87:125-135. doi: 10.1016/j.shpsa.2021.03.005. Online ahead of print.

ABSTRACT

Fitness contribution alone should not be the criterion of ‘function’ in molecular biology and genomics. Disagreement over the use of ‘function’ in molecular biology and genomics is still with us, almost eight years after publicity surrounding the Encyclopedia of DNA Elements project claimed that 80.4% of the human genome comprises “functional elements”. Recent approaches attempt to resolve or reformulate this debate by redefining genomic ‘function’ in terms of current fitness contribution. In its favour, this redefinition for the genomic context is in apparent conformity with predominant experimental practices, especially in biomedical research, and with ascription of function by selective maintenance. We argue against approaches of this kind, however, on the grounds that they could be seen as non-Darwinian, and fail to properly account for the diversity of non-adaptive processes involved in the origin and maintenance of genomic complexity. We examine cases of molecular and organismal complexity that arise neutrally, showing how purifying selection maintains non-adaptive genomic complexity. Rather than lumping different sorts of genomic complexity together by defining ‘function’ as fitness contribution, we argue that it is best to separate the heterogeneous contributions of preaptation, exaptation and adaptation to the historical processes of origin and maintenance for complex features.

PMID:34111815 | DOI:10.1016/j.shpsa.2021.03.005

Stud Hist Philos Sci. 2021 Apr 24;87:136-146. doi: 10.1016/j.shpsa.2021.04.006. Online ahead of print.

ABSTRACT

Thermodynamics has a clear arrow of time, characterized by the irreversible approach to equilibrium. This stands in contrast to the laws of microscopic theories, which are invariant under time-reversal. Foundational discussions of this “problem of irreversibility” often focus on historical considerations, and do therefore not take results of modern physical research on this topic into account. In this article, I will close this gap by studying the implications of dynamical density functional theory (DDFT), a central method of modern nonequilibrium statistical mechanics not previously considered in philosophy of physics, for this debate. For this purpose, the philosophical discussion of irreversibility is structured into five problems, concerned with the source of irreversibility in thermodynamics, the definition of equilibrium and entropy, the justification of coarse-graining, the approach to equilibrium and the arrow of time. For each of these problems, it is shown that DDFT provides novel insights that are of importance for both physicists and philosophers of physics.

PMID:34111817 | DOI:10.1016/j.shpsa.2021.04.006

Sci Total Environ. 2021 May 28;790:148067. doi: 10.1016/j.scitotenv.2021.148067. Online ahead of print.

ABSTRACT

Many areas around the world are affected by Groundwater Level rising (GWLr). One of the most severe consequences of this phenomenon is Groundwater Flooding (GF), with serious impacts for the human and natural environment. In Europe, GF has recently received specific attention with Directive 2007/60/EC, which requires Member States to map GF hazard and propose measures for risk mitigation. In this paper a methodology has been developed for Groundwater Flooding Susceptibility (GFS) assessment, using for the first time Spatial Distribution Models. These Machine Learning techniques connect occurrence data to predisposing factors (PFs) to estimate their distributions. The implemented methodology employs aquifer type, depth of piezometric level, thickness and hydraulic conductivity of unsaturated zone, drainage density and land-use as PFs, and a GF observations inventory as occurrences. The algorithms adopted to perform the analysis are Generalized Boosting Model, Artificial Neural Network and Maximum Entropy. Ensemble Models are carried out to reduce the uncertainty associated with each algorithm and increase its reliability. GFS is mapped by choosing the ensemble model with the best predictivity performance and dividing occurrence probability values into five classes, from very low to very high susceptibility, using Natural Breaks classification. The methodology has been tested and statistically validated in an area of 14,3 km² located in the Metropolitan City of Naples (Italy), affected by GWLr since 1990 and GF in buildings and agricultural soils since 2007. The results of modeling show that about 93% of the inventoried points fall in the high and very high GFS classes, and piezometric level depth, thickness of unsaturated zone and drainage density are the most influencing PFs, in accordance with field observations and the triggering mechanism of GF. The outcomes provide a first step in the assessment of GF hazard and a decision support tool to local authorities for GF risk management.

PMID:34111794 | DOI:10.1016/j.scitotenv.2021.148067

Knee. 2021 Jun 7;31:46-53. doi: 10.1016/j.knee.2021.05.001. Online ahead of print.

ABSTRACT

BACKGROUND: Mobile-bearing medial-unicompartmental knee arthroplasty (mUKA) has a documented learning curve. New instrumentation has been designed with the aim of reducing the technical challenges of this procedure. The primary aim of this study was to evaluate the technical performance of mUKA using new (Microplasty) versus older (Phase III) instrumentation, performed by expert surgeons and trainees. Secondary aims were to evaluate functional outcome and mid-term survivorship.

METHODS: A time-based comparative cohort study was performed between 2009 and 2015 at a high-volume centre. 273 patients (273 knees, 49.5% female) of mean age 67.8 (standard deviation 10.1) years underwent mUKA. 153 (56.0%) procedures used Microplasty instruments and 120 procedures (44.0%) used Phase III instruments.

RESULTS: Non-optimal bearing usage was less frequent with Microplasty than Phase III instruments (24 knees [15.7%] versus 33 knees [27.5%], p = 0.024), with differences due to improved trainee performance. Femoral component sagittal alignment outliers were less frequent with Microplasty, but this was not statistically significant (9 knees [5.9%] versus 13 knees [10.8%], p = 0.18). Post-operative Oxford Knee Scores (OKS) were better with Microplasty (median 42 points [interquartile range 38-44]) compared to Phase III (median 39.5 points [IQR 33-44]), which was statistically significant (p = 0.023), but not clinically meaningful. The overall 5-year Kaplan-Meier (KM) survival estimate was 99.3% (95% CI 97.0-99.8%), with no differences between Microplasty and Phase III instrumentation.

CONCLUSIONS: New instrumentation improved the reliability of the proximal tibial resection in trainees. Further research is warranted to investigate whether Microplasty instrumentation shortens the learning curve for medial UKA.

PMID:34111801 | DOI:10.1016/j.knee.2021.05.001