Nevin Manimala

Sci Bull (Beijing). 2024 Mar 6:S2095-9273(24)00150-6. doi: 10.1016/j.scib.2024.03.006. Online ahead of print.

ABSTRACT

Recent advances in open neuroimaging data are enhancing our comprehension of neuropsychiatric disorders. By pooling images from various cohorts, statistical power has increased, enabling the detection of subtle abnormalities and robust associations, and fostering new research methods. Global collaborations in imaging have furthered our knowledge of the neurobiological foundations of brain disorders and aided in imaging-based prediction for more targeted treatment. Large-scale magnetic resonance imaging initiatives are driving innovation in analytics and supporting generalizable psychiatric studies. We also emphasize the significant role of big data in understanding neural mechanisms and in the early identification and precise treatment of neuropsychiatric disorders. However, challenges such as data harmonization across different sites, privacy protection, and effective data sharing must be addressed. With proper governance and open science practices, we conclude with a projection of how large-scale imaging resources and collaborations could revolutionize diagnosis, treatment selection, and outcome prediction, contributing to optimal brain health.

PMID:38519398 | DOI:10.1016/j.scib.2024.03.006

J Pediatr Surg. 2024 Mar 1:S0022-3468(24)00097-6. doi: 10.1016/j.jpedsurg.2024.02.015. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: As survival rates in childhood cancer progress significantly, health outcomes in adulthood are pivotal to quality of life (QoL). Female patients undergoing chemotherapy and radiation for childhood cancer may experience adverse effects such as gonadotoxicity-related ovarian insufficiency. Ovarian tissue cryopreservation (OTC) is well studied in adults, but has only recently started to be explored in an effort to preserve fertility in young patients with childhood cancer. This systematic review aims to critically highlight contemporary outcomes of cryopreservation in female pediatric cancer patients.

METHODS: A systematic search was conducted in PubMed, Embase, and Web of Science databases to identify English-language full text articles and abstracts published between 2004 and 2022 describing cryopreservation among female children (0-21 years old) with cancer. Abstracts and full-text articles were screened for inclusion. Subsequently, data from eligible studies was extracted and analyzed. Descriptive statistics were utilized to estimate overall outcomes of cryopreservation.

RESULTS: Of 104 abstracts and 34 full-text articles, 12 studies were included. Data was collected from 7 world countries and involved some 612 pediatric and adolescent patients with malignant disease. Most common cancers included hematological malignant disease (81%), CNS nervous system malignant tumors (56%), and sarcomas (39%). Of the 6 studies with full reporting, OTC was undertaken in 501 patients, and 5.9% (30/501) of these patients underwent ovarian tissue transplantation (OTT). After OTT, 27 patients desired pregnancy and 33% (9/27) became pregnant. Six of these 9 patients (67%) had live births.

CONCLUSIONS: Preliminary analysis showed that OTC has been successfully performed but not yet studied thoroughly in pediatric cancer patients in a longitudinal manner. This study has further shown that cryopreservation outcomes are mainly reported among adult patients living in high income countries, demonstrating a crucial need for long-term outcome studies focused on pediatric and prepuberal OTC, subsequent OTT, and potential pregnancy. This work is considered critical to aid standardize recommendations of fertility preservation in childhood cancer patients and to better inform the efficacy of these procedures to benefit patients in world nations of all fiscal income levels.

LEVEL OF EVIDENCE: Level III.

PMID:38519388 | DOI:10.1016/j.jpedsurg.2024.02.015

J Pediatr Surg. 2024 Feb 29:S0022-3468(24)00075-7. doi: 10.1016/j.jpedsurg.2024.01.043. Online ahead of print.

ABSTRACT

PURPOSE: Given the paucity of data on pediatric spontaneous pneumomediastinum (SPM), management is largely informed by extrapolation from adult studies or personal clinical experience, resulting in significant heterogeneity. The purpose of this study was to describe how pediatric patients with SPM are clinically managed at our institution and propose a treatment algorithm.

METHODS: Retrospective chart review of pediatric patients with SPM from April 2002 to December 2021 at a single Canadian tertiary care center. Data on medical history, presentation characteristics, clinical management, and complications were gathered. Descriptive and inferential statistics were used to analyze data.

RESULTS: We identified 63 patients for inclusion, median age was 15 years. Twenty-nine patients were transferred from another facility. Most common presenting symptoms were chest pain (72.3%), shortness of breath (44.6%), and subcutaneous emphysema (21.5%). Initial workup included chest x-ray (93.6%), CT scan (20.6%), and upper GI series (7.9%). There was no difference in the number of initial tests between admitted and discharged patients (p = 0.10). Of admitted patients (n = 35), 31.4% had primary SPM (no underlying comorbidity/inciting event) and 68.8% were secondary SPM (underlying comorbidity/inciting event). No patients with primary SPM developed complications or recurrences. In contrast, 16.7% of those with secondary SPM developed complications and 54.2% had at least one additional intervention after admission.

DISCUSSION: There is significant variability in diagnostic investigation and treatment of pediatric SPM at our center. Amongst primary SPM, additional tests did not change complication rate or recurrence, including those transferred from another facility. An expeditious treatment algorithm is warranted.

TYPE OF STUDY: Retrospective Cohort Study.

LEVEL OF EVIDENCE: III.

PMID:38519387 | DOI:10.1016/j.jpedsurg.2024.01.043

Ultrasound Med Biol. 2024 Mar 21:S0301-5629(24)00113-3. doi: 10.1016/j.ultrasmedbio.2024.02.015. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the diagnostic accuracy of ultrasound secondary signs of fractures in pediatric patients aged 5-15 y presenting to the emergency department with a clinically non-deformed distal forearm injury.

METHODS: This diagnostic study was conducted in South East Queensland, Australia. Emergency clinicians performed point-of-care ultrasound on eligible patients and recorded secondary signs of fractures (pronator quadratus hematoma [PQH] sign, periosteal hematoma, visible angulation) or physeal fractures (fracture-to-physis distance [FPD], physis alteration). The reference standard was the final fracture diagnosis determined by expert panel. The primary outcome was the diagnostic accuracy of secondary signs for cortical breach and physeal fractures. Diagnostic statistics were reported for each relevant secondary sign.

RESULTS: A total of 135 participants were enrolled. The expert panel diagnosed 48 “no” fracture, 52 “buckle” fracture and 35 “other” fracture. All “other” fractures were cortical breach fractures and included 15 Salter-Harris II fractures. The PQH sign demonstrated high sensitivity and moderate specificity to diagnose cortical breach fractures (91%, 95% Confidence Interval [CI] 78%-97% and 82%, 73%-88%). Poor sensitivity but high specificity was observed for the visible angulation and periosteal hematoma secondary signs. FPD <1cm showed perfect sensitivity and moderate specificity (100%, 80%-100% and 85%, 78%-90%) for diagnosis of Salter-Harris II fracture. Conversely, physis alteration showed poor sensitivity but excellent specificity (40%, 20%-64% and 99%, 95%-100%) for the diagnosis of Salter-Harris II fractures.

CONCLUSION: Ultrasound secondary signs showed good diagnostic accuracy for both cortical breach fractures and Salter-Harris II fractures. Future research should consider optimal use of secondary signs to improve diagnostic accuracy.

PMID:38519361 | DOI:10.1016/j.ultrasmedbio.2024.02.015

Vaccine. 2024 Mar 21:S0264-410X(24)00331-1. doi: 10.1016/j.vaccine.2024.03.044. Online ahead of print.

ABSTRACT

BACKGROUND: Despite some progress in pneumococcal immunization, the global burden of pneumococcal infection remains high, and pneumococcal disease remains a public health concern. Studies in China and abroad have found that 23-valent pneumococcal polysaccharide vaccine (PPV23) vaccination can effectively prevent invasive pneumococcal disease. This phase Ⅰ clinical study assessed the safety and immunogenicity of a PPV23 vaccine candidate.

METHODS: All subjects were randomly assigned to receive one dose intramuscular injection of experimental vaccine or control vaccine at a ratio of 1:1. The incidence of any adverse events was observed within 30 min, 0-7 days and 8-28 days post vaccination and the incidence of abnormal blood biochemical and blood routine indicators were tested on the 4th day post vaccination, the incidence of serious adverse events (SAEs) at 6 months post vaccination was recorded. Blood samples were collected prior to vaccination and on the 28th day post vaccination, and serum antibodies were detected by enzyme linked immunosorbent assay (ELISA).

RESULTS: The most common adverse reaction was pain at the injection site, followed by erythema. There was no significant difference of the incidence of systemic adverse reactions between the two vaccine groups. The adverse reactions observed in the trial were all common vaccination-related reactions, and no serious adverse reactions were observed. Compared to pre-vaccination, the (geometric mean concentrations) GMCs of IgG (immunoglobulin G) specific antibody against each serotype were all increased in the experimental group and the control group, there were statistical differences in seroconversion rates of serotypes 4 and 20 between the two vaccine groups.

CONCLUSION: This clinical study showed good safety of the PPV23 vaccine candidate produced by Ab&b Biotechnology Co., Ltd.JS had good safety after vaccination in people aged 2 years and older. At the same time, good immunogenicity was also demonstrated.

PMID:38519344 | DOI:10.1016/j.vaccine.2024.03.044

J Voice. 2024 Mar 21:S0892-1997(24)00064-X. doi: 10.1016/j.jvoice.2024.02.025. Online ahead of print.

ABSTRACT

OBJECTIVES: Silk-hyaluronic acid (silk-HA) is a novel vocal fold augmentation material used in humans since July 2020. We aim to describe indications, voice outcomes, and longevity data for silk-HA injectable when used for vocal fold injection (VFI) augmentation in a large cohort of patients with longer-term follow-up than preliminary clinical studies.

METHODS: Retrospective chart review of Silk-HA injections for glottic insufficiency (GI) and follow-up between July 2020 and November 2023. Subject demographics, diagnoses, volume of material injected, VHI-10 data, time from injection, need for reinjection, and complications were collected. Blinded perceptual voice analysis of randomly selected pre- and post-intervention voice samples for unilateral vocal fold paralysis patients was performed by three voice-specialized speech-language pathologists, and changes in VHI-10 determined at various time intervals up to 1year and beyond.

RESULTS: A total of 160 silk-HA injection procedures were performed: 59% female, with a mean age of 66± 13 (range 21-90) years. Ninety-four subjects had unilateral paralysis (58.4%); the remainder had scar, atrophy, paresis, or a combination thereof. Mean volume of silk-HA injected was 0.24± 0.14 cc. Major complications were rare, most notable for laryngoscopic evidence of hemilaryngeal edema (n = 6, 3.8%), with a readmission rate to hospital of 1.3% (n = 2). There was a statistically significant decrease in paired ΔVHI-10 and CAPE-V ratings for each of the postoperative follow-up intervals. A total of 24 (27.2%) repeat medialization procedures were recommended following silk-HA injection for unilateral paralysis.

CONCLUSIONS: This study demonstrates that silk-HA is a safe product for VFI augmentation, and effective injectable for the treatment of GI due to unilateral vocal fold paralysis. Based on the current data, it is reasonable to counsel patients that they should expect benefit for several months following the injection. If patients reach 1year from their injection with a stable and satisfactory outcome, the majority experience ongoing benefit without need for additional procedures, however, the final duration of clinical effect appears to be years, but it is yet to be determined.

PMID:38519334 | DOI:10.1016/j.jvoice.2024.02.025

J Voice. 2024 Mar 21:S0892-1997(24)00053-5. doi: 10.1016/j.jvoice.2024.02.014. Online ahead of print.

ABSTRACT

OBJECTIVE: There are very diverse approaches for voice therapy, and the application of voice quality used in vocal arts in voice therapy can also be seen. However, there is little research on the application of opera voice quality in voice therapy. This study explored the applications of our Opera Voice Quality Exercise in the field of voice therapy and investigated the impacts of this exercise on pitch, intensity, voice quality, and vocal ability.

METHODS: Sixty-two healthy subjects, defined as those with no discomfort in their voice and no appearance of organic lesions on the larynx via stroboscopic laryngoscopy were included in the study. The subjects were randomly divided into an experimental group of 31 subjects and a control group of 31 subjects. The experimental group received a voice health education and weekly coaching sessions of Opera Voice Quality Exercise, whereas the subjects in the control group only had the former. The acoustic and aerodynamic parameters were evaluated before and after the experimental interventions.

RESULTS: When producing [a] at comfortable speech pitch and intensity, the experimental group compared to the control group showed statistically significant improvement (P < 0.05) in the irregularity component (IC) parameter for males. When producing [a] at loudest intensity at a higher pitch in the normal speech pitch range, the experimental group compared to the control group showed statistically significant increase (P < 0.01) in sound pressure level (SPL) as well as improvements (P < 0.05) in shimmer and IC parameters for males. There was a statistically significant increase (P < 0.05) in SPL for females. During continuous speech, the experimental group compared to the control group showed statistically significant increase (P < 0.01) in SPLmax (maximum sound pressure level) for both males and females. There was a statistically significant increase in highest pitch (P < 0.01) and lowest pitch (P < 0.05) for males.

CONCLUSION: Regardless of gender, there is the greatest impact of Opera Voice Quality Exercise on phonation intensity. Furthermore, for males, this exercise causes the voice quality to be improved and the speech pitch to raise. Therefore, there may be applications of Opera Voice Quality Exercise in voice problems with weak voice such as nonorganic hypofunctional dysphonia, vocal fold paresis and paralysis, and voice problems related to Parkinson and age.

PMID:38519332 | DOI:10.1016/j.jvoice.2024.02.014

Acad Radiol. 2024 Mar 22:S1076-6332(24)00151-X. doi: 10.1016/j.acra.2024.03.009. Online ahead of print.

ABSTRACT

RATIONALE AND OBJECTIVES: To evaluate the value of dual-energy CT (DECT) virtual noncalcium (VNCa) images in the diagnosis of wrist bone marrow edema (BME) in patients with rheumatoid arthritis (RA).

MATERIALS AND METHODS: 43 patients with wrist involvement in active RA prospectively underwent DECT and MRI. Functional DECT images reconstruction yielded VNCa images. MRI served as the reference standard for diagnosing BME. BME diagnosis differences between VNCa images and MRI were compared. Differences in CT values between BME and normal bone marrow were assessed. The optimal CT value for detecting BME in VNCa images was determined through ROC curve analysis. The correlation between VNCa images scores and RA disease activity was evaluated.

RESULTS: There was a high agreement between VNCa images and MRI in diagnosing BME (Kappa=0.831). VNCa images showed a significant difference in CT values between BME and normal bone marrow (P < 0.001). A cut-off value of – 54.8 HU yielded a sensitivity, specificity, and accuracy of 90.72%, 94.30%, and 93.33%, respectively, for detecting BME on VNCa images. The area under the ROC curve was 0.937 for distinguishing BME from normal bone marrow. Conventional CT images showed no statistically significant difference (P = 0.174) in CT values between BME and normal bone marrow. The VNCa images BME scores were positively correlated with RA disease activity (r = 0.399).

CONCLUSION: The DECT VNCa technique demonstrates its potential for diagnosing wrist BME in patients with RA and provides a valuable tool for assessing disease activity in RA.

IMPORTANT FINDINGS: The DECT VNCa technique has the ability to distinguish between BME and normal bone marrow. The VNCa images BME scores were positively correlated with the disease activity in RA.

PMID:38519303 | DOI:10.1016/j.acra.2024.03.009

Acad Radiol. 2024 Mar 21:S1076-6332(24)00089-8. doi: 10.1016/j.acra.2024.02.019. Online ahead of print.

ABSTRACT

PURPOSE: To characterize how the adoption of virtual residency interviews (2020-2021 cycle) has impacted the geographic distribution of radiology resident matches.

METHODS: University-based interventional (IR) and diagnostic radiology (DR) residency programs from 2017 to 2021 were identified using a national residency database (FRIEDA). Public applicant data were obtained from official residency program websites. Medical schools and residency programs were categorized by US census regions. Geographic applicant distribution before and after the initiation of virtual interviews was statistically assessed using Chi-square tests. The effect of virtual interviews on the probability of matching within the same geographic region as one’s medical school was evaluated with multivariate logistic regression.

RESULTS: 4358 radiology residents (88% diagnostic, 12% interventional) matched at 102 radiology programs during the study period. 71% (n = 3115 residents) had data available for analysis. 56.3% of DR and 49.3% of IR residents matched in the same geographic region as their medical school. The geographic distribution of applicants who matched at Southern IR residency programs significantly changed after implementation of virtual interviews (p < 0.0001). Virtual interviews did not increase the odds of matching in the same region as one’s medical school for IR (OR 1.11, p = 0.08) or DR (OR 1.01, p = 0.58) applicants. Top-20 ranked DR programs had lower odds of in-region matches (OR 0.87, p < 0.001).

CONCLUSION: With few exceptions, shifting to virtual residency interviews did not significantly affect the geographic distribution of IR or DR residency matches. Top-ranked DR programs match more regionally diverse applicants.

PMID:38519299 | DOI:10.1016/j.acra.2024.02.019

Public Health. 2024 Mar 21:S0033-3506(24)00084-2. doi: 10.1016/j.puhe.2024.02.019. Online ahead of print.

NO ABSTRACT

PMID:38519288 | DOI:10.1016/j.puhe.2024.02.019