Category: Nevin Manimala

JAMA Ophthalmol. 2023 Oct 26. doi: 10.1001/jamaophthalmol.2023.4716. Online ahead of print.

ABSTRACT

IMPORTANCE: Patients with retinal artery occlusions (RAOs) are recommended to have emergent stroke workup, although the true risk of death and subsequent vascular events post-RAO is not clear.

OBJECTIVE: To determine short-term and long-term rates of stroke, myocardial infarction (MI), and death in patients after RAO compared with a control cohort.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used aggregated electronic health records from January 1, 2003, through April 14, 2023, from TriNetX, a network with data from more than 111 million patients. Patients with RAO and a cataract control group were identified and matched for age, sex, race, and comorbidities, including hypertension, diabetes, hyperlipidemia, and smoking status. Patients were excluded if they had a stroke or MI within 2 years before the diagnosis of RAO or cataract.

EXPOSURE: International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, diagnosis code for RAO or age-related cataract.

MAIN OUTCOMES AND MEASURES: Rate of death, stroke, and MI at 2 weeks, 30 days, 1 year, 5 years, and 10 years after RAO compared with matched controls.

RESULTS: There were a total of 34 874 patients with at least 1 year of follow-up in the RAO cohort. The mean (SD) age at the RAO event was 66 (15.2) years. The rate of death after RAO diagnosis was higher than after cataract diagnosis at 2 weeks (0.14% vs 0.06%; relative risk [RR], 2.45; 95% CI, 1.46-4.12; risk difference [RD], 0.08%; 95% CI, 0.04%-0.13%; P < .001), 30 days (0.29% vs 0.14%; RR, 2.10; 95% CI, 1.49-2.97; RD, 0.15%; 95% CI, 0.08%-0.22%; P < .001), 1 year (3.51% vs 1.99%; RR, 1.78; 95% CI, 1.61-1.94; RD, 1.41%; 95% CI, 1.17%-1.66%; P < .001), 5 years (22.74% vs 17.82%; RR, 1.28; 95% CI, 1.23-1.33; RD, 4.93%; 95% CI, 4.17%-5.68%; P < .001), and 10 years (57.86% vs 55.38%; RR, 1.05; 95% CI, 1.02-1.07; RD, 2.47%; 95% CI, 1.25%-3.69%; P < .001). Risk of stroke after RAO was higher at 2 weeks (1.72% vs 0.08%; RR, 21.43; 95% CI, 14.67-31.29; RD, 1.64%; 95% CI, 1.50%-1.78%; P < .001), 30 days (2.48% vs 0.18%; RR, 14.18; 95% CI, 10.94-18.48; RD, 2.31%; 95% CI, 2.14%-2.47%; P < .001), 1 year (5.89% vs 1.13%; RR, 5.20; 95% CI, 4.67-5.79; RD, 4.64%; 95% CI, 4.37%-4.91%; P < .001), 5 years (10.85% vs 4.86%; RR, 2.24; 95% CI, 2.09-2.40; RD, 6.00%; 95% CI, 5.50%-6.50%; P < .001), and 10 years (14.59% vs 9.18%; RR, 1.59; 95% CI, 1.48-1.70; RD, 5.41%; 95% CI, 4.62%-6.21%; P < .001). Risk of MI after RAO was higher at 2 weeks (0.16% vs 0.06%; RR, 3.00; 95% CI, 1.79-5.04; RD, 0.11%; 95% CI, 0.06%-0.16%; P < .001), 30 days (0.27% vs 0.10%; RR, 2.61; 95% CI, 1.78-3.83; RD, 0.17%; 95% CI, 0.10%-0.23%; P < .001), 1 year (1.66% vs 0.97%; RR, 1.72; 95% CI, 1.51-1.97; RD, 0.59%; 95% CI, 0.42%-0.76%; P < .001), 5 years (6.06% vs 5.00%; RR, 1.21; 95% CI, 1.12-1.31; RD, 1.07%; 95% CI, 0.64%-1.50%; P < .001), and 10 years (10.55% vs 9.43%; RR, 1.12; 95% CI, 1.04-1.21; RD, 1.13%; 95% CI, 0.39%-1.87%; P = .003).

CONCLUSIONS AND RELEVANCE: This study showed an increased risk of death, stroke, and MI in patients with RAO at both short-term and long-term intervals after RAO compared with a matched control population diagnosed with cataract. These findings suggest a potential need for multidisciplinary evaluation and long-term systemic follow-up of patients post-RAO.

PMID:37883068 | DOI:10.1001/jamaophthalmol.2023.4716

J Exp Psychol Learn Mem Cogn. 2023 Oct 26. doi: 10.1037/xlm0001284. Online ahead of print.

ABSTRACT

Evidence for implicit aversive learning effects has been criticized for its lack of experimental rigor and statistical reliability. Here we examine whether attentional emotional responses to aversive conditioned stimuli can occur in the absence of stimulus-outcome contingency awareness, and use a novel Bayesian tool to reliably perform a post hoc categorization of awareness. Across two experiments (n = 40 and 69) participants completed an aversive conditioning task. A novel Bayesian awareness categorization tool was applied to sensitively measure contingency awareness. Finally, attentional and subjective responses toward conditioned stimuli were measured. For participants unaware of contingencies, conditioned stimuli generated attentional avoidance, but only aware participants showed subjective learning effects. For both experiments, awareness scores for unaware participants did not regress above chance level on a subsequent awareness check, revealing a reliable determination of unawareness states. These findings provide evidence for the existence of aversive learning in the absence of contingency awareness, as demonstrated via conditioned attentional responses, and build an analytical framework that can be extrapolated to other implicit paradigms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PMID:37883055 | DOI:10.1037/xlm0001284

J Exp Psychol Learn Mem Cogn. 2023 Oct 26. doi: 10.1037/xlm0001275. Online ahead of print.

ABSTRACT

It has been reported that visual statistical learning (VSL) is facilitated in skewed distributions. However, it remains unclear whether enhancement of VSL in Zipfian distributions is due to consciousness of the regularities presented at high frequency. This study addressed this issue. We measured participants’ subjective confidence in regularities and awareness of regularities during familiarization by combining a previously reported procedure for VSL with a postdecision wagering task and posttest questionnaire. The results demonstrated that Zipfian distribution enhanced not only VSL but also metacognitive sensitivity, particularly for high-frequency regularities, as the effects of consciousness on VSL were limited to high-frequency regularities. Moreover, the results indicated that awareness during familiarization mediated VSL enhancement in the Zipfian distribution. These results suggest that VSL for events with high-frequency regularities plays an important role in the cognition of events with low-frequency regularities via awareness. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PMID:37883051 | DOI:10.1037/xlm0001275

J Exp Psychol Learn Mem Cogn. 2023 Oct 26. doi: 10.1037/xlm0001293. Online ahead of print.

ABSTRACT

Mental model (Johnson-Laird, 2001) and probabilistic theories (Oaksford & Chater, 2009) claim to provide distinct explanations of human reasoning. However, the dual strategy model of reasoning suggests that this distinction corresponds to different reasoning strategies, termed counterexample and statistical, respectively. There is clear evidence that most people have a preference for a given strategy, and that this predicts performance on a variety of forms of reasoning and judgment (Thompson & Markovits, 2021). To date, however, the evidence for this conclusion has been correlational in nature; in the current studies, we manipulated strategy use. To this end, we gave people (N = 885) explicit instructions to reason either using a counterexample strategy or a probabilistic strategy. In two studies, we observed that the ability to follow these instructions was constrained by people’s spontaneous strategy use, and that the effect of instructions carried over to two subsequent forms of reasoning (a) belief-biased inferences and (b) base-rate judgments. Finally, the ability to follow instructions was correlated with reasoning accuracy on both tasks. These results provide strong evidence for the underlying reality of the dual strategy model and show that explicit instructions to reason differently can modify performance on different forms of reasoning. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PMID:37883048 | DOI:10.1037/xlm0001293

Clin Nucl Med. 2023 Oct 26. doi: 10.1097/RLU.0000000000004912. Online ahead of print.

ABSTRACT

PURPOSE: Medical imaging artifacts compromise image quality and quantitative analysis and might confound interpretation and misguide clinical decision-making. The present work envisions and demonstrates a new paradigm PET image Quality Assurance NETwork (PET-QA-NET) in which various image artifacts are detected and disentangled from images without prior knowledge of a standard of reference or ground truth for routine PET image quality assurance.

METHODS: The network was trained and evaluated using training/validation/testing data sets consisting of 669/100/100 artifact-free oncological 18F-FDG PET/CT images and subsequently fine-tuned and evaluated on 384 (20% for fine-tuning) scans from 8 different PET centers. The developed DL model was quantitatively assessed using various image quality metrics calculated for 22 volumes of interest defined on each scan. In addition, 200 additional 18F-FDG PET/CT scans (this time with artifacts), generated using both CT-based attenuation and scatter correction (routine PET) and PET-QA-NET, were blindly evaluated by 2 nuclear medicine physicians for the presence of artifacts, diagnostic confidence, image quality, and the number of lesions detected in different body regions.

RESULTS: Across the volumes of interest of 100 patients, SUV MAE values of 0.13 ± 0.04, 0.24 ± 0.1, and 0.21 ± 0.06 were reached for SUVmean, SUVmax, and SUVpeak, respectively (no statistically significant difference). Qualitative assessment showed a general trend of improved image quality and diagnostic confidence and reduced image artifacts for PET-QA-NET compared with routine CT-based attenuation and scatter correction.

CONCLUSION: We developed a highly effective and reliable quality assurance tool that can be embedded routinely to detect and correct for 18F-FDG PET image artifacts in clinical setting with notably improved PET image quality and quantitative capabilities.

PMID:37883015 | DOI:10.1097/RLU.0000000000004912

J Robot Surg. 2023 Oct 26. doi: 10.1007/s11701-023-01742-4. Online ahead of print.

ABSTRACT

Robotic-assisted surgical systems hold promise in enhancing total knee arthroplasty (TKA) outcomes and patients’ quality of life. This study aims to comprehensively analyze the literature on robot-assisted total knee arthroplasty (r-TKA), providing insights into its current development, clinical application, and research trends. A systematic search was conducted in the Web of Science Core Collection (WOSCC) to identify relevant articles. Data were collected from the top 100 highly cited articles. Article evidence levels were assessed following established guidelines. Statistical analyses and visualizations were performed to reveal publication trends, citations, research hotspots, and collaborative networks. The analysis covered 100 highly cited articles meeting the research criteria, with a focus on the last five years. The United States emerged as a major contributor, with most publications and citations in the Journal of Knee Surgery and Knee Surgery Sports Traumatology Arthroscopy. Research priorities revolved around clinical outcomes, accuracy, and alignment of r-TKA. Notably, higher evidence levels correlated with more citations, indicating greater attention. Interest in and research on r-TKA is steadily increasing, with a few countries at the forefront of these endeavors. While numerous studies have already reported short- to medium-term follow-up results, it is crucial to conduct longer-term investigations to gain a more comprehensive understanding of the clinical benefits that r-TKA offers compared to conventional techniques. Through ongoing research and a greater embrace of robotic technology, we can continue to improve the quality of life for patients undergoing knee arthroplasty.

PMID:37882976 | DOI:10.1007/s11701-023-01742-4

Updates Surg. 2023 Oct 26. doi: 10.1007/s13304-023-01674-6. Online ahead of print.

ABSTRACT

Anal fistula (AF) is a common disease with high prevalence and surgical operations are effective treatments in clinical work. There exist many well-known surgical techniques treating complex anal fistula (CAF), however, none is ideal. To compare the superiority of Anal fistula plug (AFP) and Endoanal advancement flap repair (EAFR) for complex anal fistula. We searched worldwide databases including Pubmed, Embase, Cochrane Library, Web of Science, CNKI, WanFang, VIP, and SinoMed from their inception to March 2023. Studies comparing the outcomes of AFP and EAFR were included according to the PICO principles. The indicators of the healing rate, recurrence rate, wound infection rate, and complication rate, et al. were extracted and compared between different surgical methods. 5 RCTS and 7 non-RCTs were included in the meta-analysis with a total of 847 patients (341 patients conducted with AFP and 506 patients with EAFR). By combining the total effect of the 12 articles, we found that there was a statistical difference reporting the healing rate of AFP 48.3% and EAFR 64.4% treating the CAF (OR 0.68, 95% CI 0.30,1.55, P = 0.03), and EAFR has a better healing rate. However, there was no significant difference in terms of the recurrence rate (OR 1.68, 95% CI 0.80,3.54, P = 0.17), the wound infection rate (OR 1.82, 95% CI 0.95,3.52, P = 0.07), and the complication rate (OR 1.06, 95% CI 0.70,1.61, P = 0.77) either in the 12 articles or in the subgroup. The meta-analysis indicated that the EAFR was superior to AFP in terms of the healing rate treating the CAF, however, there were no significant differences between the two groups when it came to the recurrence rate, the wound infection rate, and the complication rate. EAFR might be one initial treatment for the complex cryptoglandular anal fistulas compared with AFP.

PMID:37882975 | DOI:10.1007/s13304-023-01674-6

Neurosurg Rev. 2023 Oct 26;46(1):284. doi: 10.1007/s10143-023-02192-0.

ABSTRACT

Flow diversion with the pipeline embolization device (PED) is increasingly used to treat intracranial aneurysms with high obliteration rates and low morbidity. However, long-term (≥ 1 year) angiographic and clinical outcomes still require further investigation. The aim of this study was to compare the occlusion and complication rates for small (< 10 mm) versus large (10-25 mm) aneurysms at long-term following treatment with PED. A systematic review and meta-analysis were performed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We conducted a comprehensive search of English language databases including Ovid MEDLINE and Epub Ahead of Print, In-Process, and Daily, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. Our studies included a minimum of 10 patients treated with PED for small vs. large aneurysms and with at least 12 months of follow-up. The primary safety endpoint was the rate of clinical complications measured by the occurrence of symptomatic stroke (confirmed clinically and radiographically), intracranial hemorrhage, or aneurysmal rupture. The primary efficacy endpoint was the complete aneurysm occlusion rate. Our analysis included 19 studies with 1277 patients and 1493 aneurysms. Of those, 1378 aneurysms met our inclusion criteria. The mean age was 53.9 years, and most aneurysms were small (89.75%; N = 1340) in women (79.1%; N = 1010). The long-term occlusion rate was 73% (95%, CI 65 to 80%) in small compared to 84% (95%, CI 76 to 90%) in large aneurysms (p < 0.01). The symptomatic thromboembolic complication rate was 5% (95%, CI 3 to 9%) in small compared to 7% (95%, CI 4 to 13%) in large aneurysms (p = 0.01). The rupture rate was 2% vs. 4% (p = 0.92), and the rate of intracranial hemorrhage was 2% vs. 4% (p = 0.96) for small vs. large aneurysms, respectively; however, these differences were not statistically significant. The long-term occlusion rate after PED treatment is higher in large vs. small aneurysms. Symptomatic thromboembolic rates with stroke are also higher in large vs. small aneurysms. The difference in the rates of aneurysm rupture and intracranial hemorrhage was insignificant. Although the PED seems a safe and effective treatment for small and large aneurysms, further studies are required to clarify how occlusion rate and morbidity are affected by aneurysm size.

PMID:37882896 | DOI:10.1007/s10143-023-02192-0

Community Ment Health J. 2023 Oct 26. doi: 10.1007/s10597-023-01200-3. Online ahead of print.

ABSTRACT

In Italy, despite strong community-based mental health services, needs assessment is unsatisfactory. Using the Mental Health Clustering Tool (MHCT) we adopted a multidimensional and non-diagnosis dependent approach to assign mental health services users with similar needs to groups corresponding to resources required for effective care. We tested the MHCT in nine Departments of Mental Health in four Italian regions. After a brief training, 318 professionals assessed 12,938 cases with a diagnosis of schizophrenia, depression, bipolar disorder and personality disorder through the MHCT. 53% of cases were 40-59 years, half were females, 51% had a diagnosis of schizophrenia, 48% of cases were clinically severe. Clusters included different levels of clinical severity and diagnostic groups. The largest cluster was 11 (ongoing recurrent psychosis), with 18.9% of the sample, followed by cluster 3 (non-psychotic disorders of moderate severity). The MHCT could capture a variety of problems of people with mental disorders beyond the traditional psychiatric assessment, therefore depicting service population from a different standpoint. Following a brief training, MHCT assessment proved to be feasible. The automatic allocation of cases made the attribution to clusters easy and acceptable by professionals. To what extent clustering provide a sound base for care planning will be the matter of further research.

PMID:37882894 | DOI:10.1007/s10597-023-01200-3

Acta Anaesthesiol Scand. 2023 Oct 26. doi: 10.1111/aas.14341. Online ahead of print.

ABSTRACT

PURPOSE: The objective of this study was to compare the efficacy of a low-cost heat-preserving method in preventing intraoperative hypothermia with that of forced-air warming in a resource-limited setting.

METHODS: In this randomized controlled non-inferiority trial, we recruited children younger than 12 years scheduled for cranial neurosurgery in a large East-African hospital. Patients were block-randomized by age to intraoperative warming measures using Hibler’s method (intervention) or warm air (comparator). Hibler’s group patients were circumferentially wrapped in transparent plastic sheeting (providing a vapor-trap) over a layer of cotton blankets, then laid on an insulating foam mattress. Warm air group patients were treated with forced-air convection via an underlying Snuggle Warm™ Pediatric Full Body mattress. Allocated warming measures were initiated in the operating theatre and discontinued upon anesthesia emergence. Perioperative temperatures were measured using noninvasive forehead probes (SpotOn™). The primary outcome was incidence of hypothermia (core temperature < 36.0° for longer than 5 min). Our null hypothesis was that Hibler’s method is inferior in efficacy to the warm air method by a margin exceeding 20%. Among secondary outcomes were duration of hypothermia as proportion of surgical duration, incidence of postoperative shivering and rescue measure requirements.

RESULTS: We analyzed data for 77 participants (Hibler’s = 38; warm air = 39). There was no significant difference between the Hibler’s and warm air arms of the study in the primary outcome of incidence of hypothermia (59.0% vs. 60.5% respectively; OR 1.07; 95% CI 0.43-2.65; p = .890). However, the risk difference (1.55%; 95% CI -0.20 to -0.24) exceeded the 0.2 margin and non-inferiority could not be declared. There was considerable need for rescue measures in both groups (71.1 0% vs. 69.2%; OR 1.09; 95% CI 0.41-2.90; p = .861). There was no statistically significant difference between groups for any prespecified secondary outcome.

CONCLUSION: Although perioperative core temperatures were not significantly different, we could not declare an inexpensive heat-preserving method non-inferior to warm air convection in preventing intraoperative hypothermia in children undergoing anesthesia for cranial neurosurgery in a resource-limited setting. The extensive need for rescue measures may have masked important differences.

TRIAL REGISTRATION: US National Institutes of Health Clinicaltrials.gov database (ID no. NCT02975817).

PMID:37882145 | DOI:10.1111/aas.14341