Nevin Manimala

Nutr Metab Cardiovasc Dis. 2024 Nov 9:103789. doi: 10.1016/j.numecd.2024.103789. Online ahead of print.

ABSTRACT

AIMS: Atherosclerosis is a life-threatening disease that develops when a plaque builds up inside an artery and progresses silently. Identifying the early pathological changes and the biomarkers of atherosclerosis deserves attention. We aimed to systematically study and integrate the various metabolites of atherosclerosis in the level of disease to provide more evidences to support early prevention and treatment of atherosclerosis.

DATA SYNTHESIS: The protocol was registered with PROPSERO (CRD42023441845). We searched 14,985 records via EMBASE, PubMed, Web of Science, WanFang data, VIP data, and CNKI databases. The collected metabolites were for qualitative and quantitative meta-analysis. The I² statistic estimated heterogeneity, with over 50 % considered to adopt the random-effects model. A total of 49 articles were included in the meta-analysis. We finally integrated 83 and 16 metabolites presented more than two times in inclusion studies, respectively in blood (plasma and serum) and urine. Among them, the level of citric acid (SMD = -10.35 [95%CI -15.03, -5.67], p < 0.001), lactic acid (SMD = 6.32 [95%CI 0.12, 12.52], p < 0.001) and TMAO (SMD = 1.40 [95%CI 0.27, 2.53], p < 0.001) had significant differences between atherosclerosis and controls. And we observed blood stasis syndrome of atherosclerosis patients present arterial ischemia and energy disorder obviously.

CONCLUSIONS: The study provides an in-depth understanding of the roles of metabolites on atherosclerosis progression and prediction primarily in Chinese population, which contributing to development of prevention and therapeutic potential in the future.

PMID:39690044 | DOI:10.1016/j.numecd.2024.103789

Jt Comm J Qual Patient Saf. 2024 Nov 2:S1553-7250(24)00330-1. doi: 10.1016/j.jcjq.2024.10.012. Online ahead of print.

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic affected quality improvement work that was key to hospital-acquired infection (HAI) prevention efforts for many hospitals. Central line-associated bloodstream infection (CLABSI) standardized infection ratios (SIRs) were highly affected by the pandemic.

METHODS: After seeing an increase in CLABSI SIRs through early 2021, a health care system including 12 acute care hospitals in the midwestern United States focused on processes and process measures for CLABSI prevention. Each hospital was asked to identify a medical provider, nursing, and infection prevention lead to champion the work (identified as a CLABSI triad). CLABSI triads emphasized best practice expectations, standardized technology and products, and implemented reporting and trending of compliance. Work started in July 2021, with multiple initiatives rolled out through the end of 2022. CLABSI SIRs and standardized utilization ratios (SURs) were analyzed with interrupted time series analysis; changes in several process measures were analyzed using Wilcoxon rank sum exact testing.

RESULTS: A 47.5% decrease was seen in CLABSI SIR through the study period, with SIR = 0.61 from 2023 to April 2024. The slope of the trend line for CLABSI SIR and central line utilization had a significant downward trend in the intervention time frame (p = 0.04 and p < 0.01, respectively). CLABSI prevention best practices improved statistically during the study period.

CONCLUSION: Intense focus by leadership on key CLABSI prevention process measures was associated with lower CLABSI SIRs.

PMID:39690035 | DOI:10.1016/j.jcjq.2024.10.012

Clin Ther. 2024 Dec 16:S0149-2918(24)00371-0. doi: 10.1016/j.clinthera.2024.11.023. Online ahead of print.

ABSTRACT

PURPOSE: Down syndrome regression disorder (DSRD) is a rare neuropsychiatric condition affecting otherwise healthy individuals with Down syndrome. Multiple studies on DSRD have revealed that immunotherapy with intravenous immunoglobulin (IVIg) is both safe and effective, although site of infusion has never been studied. This study sought to evaluate the safety and tolerability of IVIg in individuals with DSRD receiving home-based infusions.

METHODS: A single-center, retrospective chart review evaluating infusion reactions was performed for individuals meeting criteria for DSRD and having received IVIg infusions between 2019 and 2024. Adverse events (AEs) were evaluated for severity and need for alterations in infusion plan. A cohort of individuals receiving home-based infusions was compared with a cohort of individuals receiving infusions at an academic medical center.

FINDINGS: A total of 315 individuals (162 institutional infusions [51%] and 153 home infusions [49%]) met the inclusion criteria. There were no statistical differences between the demographic and clinical features of the cohorts. Individuals receiving home infusions had the same rate of AE during an infusion (P = 0.14), although they did have a lower number of total AEs (P < 0.001). Individuals receiving home infusions experienced a lower number of behavioral issues with infusions (P = 0.03) and had significantly lower discontinuations of infusions secondary to behavioral issues (P = 0.04).

IMPLICATIONS: Rates of AEs and serious AEs in those with DSRD were the same regardless of site of infusion. These data should be considered in policy regarding the appropriateness of home-based infusions as a safe alternative, when suitable for patients and caregivers, for individuals with DSRD.

PMID:39690018 | DOI:10.1016/j.clinthera.2024.11.023

Surgery. 2024 Dec 16:108937. doi: 10.1016/j.surg.2024.09.050. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic lymphocytic thyroiditis is an autoimmune thyroid disorder and the most common cause of hypothyroidism in women. Many studies suggest that chronic lymphocytic thyroiditis contributes to a diagnostic challenge in thyroid nodules and may increase the risk of developing papillary thyroid cancer. This study examines preoperative clinical factors and tumor characteristics associated with papillary thyroid cancer among patients with chronic lymphocytic thyroiditis.

METHODS: A retrospective review of prospectively collected data of patients who underwent total thyroidectomy between 2009 and 2020 at a tertiary institution was performed. Sociodemographic factors, comorbidities, surgeon-performed ultrasound, fine needle aspiration, tumor characteristics, and final histopathology were studied. Patients were subdivided into 2 groups based on final histopathology: chronic lymphocytic thyroiditis alone and chronic lymphocytic thyroiditis with papillary thyroid cancer. χ² tests were used for independence among categorical variables, and comparisons were based on t tests.

RESULTS: Of 2,200 total thyroidectomy patients, the majority of 250 patients with chronic lymphocytic thyroiditis were women (90.4%) and had a mean age of 50 (±13) years. All patients with chronic lymphocytic thyroiditis underwent preoperative ultrasound, 89.2% (n = 223) underwent fine needle aspiration preoperatively, and 25.2% (n = 63) presented with obstructive symptoms, whereas 53.6% (n = 134) had papillary thyroid cancer on final histopathology and 74.8% (n = 187) underwent central neck lymph node removal. When comparing patients with chronic lymphocytic thyroiditis alone with those with chronic lymphocytic thyroiditis and papillary thyroid cancer, no differences for sex, race, nodule density, nodule size, echogenicity, irregular borders, and number of nodules were identified, but there was a statistically significant difference for obstructive symptoms (37.1% vs 14.9%), multinodular goiter (55.8% vs 32.3%), microcalcifications (18.4% vs 36.6%), Bethesda III fine needle aspiration results (41.4% vs 27.4%), and central neck lymph node removal (58.6% vs 88.8%), respectively (P < .05). Preoperative fine needle aspiration in patients with chronic lymphocytic thyroiditis for papillary thyroid cancer had a positive predictive value of 92.9%, negative predictive value of 83.3%, false positive rate of 13.8%, and false negative rate of 8.8%.

CONCLUSION: Although thyroid ultrasound features may have limited utility for malignancy, fine needle aspiration of index thyroid nodules still demonstrates a high positive predictive value in stratifying patients with chronic lymphocytic thyroiditis with papillary thyroid cancer. A higher level of suspicion preoperatively may be needed to avoid unnecessary lymph node removal for patients with chronic lymphocytic thyroiditis.

PMID:39690015 | DOI:10.1016/j.surg.2024.09.050

Aust Crit Care. 2024 Dec 16:101147. doi: 10.1016/j.aucc.2024.101147. Online ahead of print.

ABSTRACT

BACKGROUND: The provision of end-of-life care (EOLC) is an ongoing component of practice in intensive care units (ICUs). Interdisciplinary, multicomponent interventions may enhance the quality of EOLC for patients and the experience of family members and ICU clinicians during this period.

OBJECTIVES: This study aimed to assess the impact of a multicomponent intervention on EOLC practices in the ICU and family members’ and clinicians’ perceptions of EOLC.

METHODS: A before-and-after interventional study design was used. Interventions comprising of EOLC guidelines, environmental and memory-making resources, EOLC education day for nurses, web-based resources, and changes to EOLC documentation processes were implemented in a 30-bed adult tertiary ICU from September 2020 onwards. Data collection included electronic health record audits of care provided post initiation of EOLC and family and clinician surveys. Open-ended survey questions were analysed using content analysis. Data from before and after the intervention were compared using the Chi-squared test for categorical variables, unpaired two-sample t-tests for normally distributed continuous measurements, and Mann-Whitney U tests for non-normally distributed data.

FINDINGS: A reduction in documented observations and medications and an increased removal of invasive devices unrelated to EOLC were observed post the intervention. The mean overall satisfaction of family members improved from 4.5 to 5 (out of 5); however, this was not statistically significant. Statistically significant improvements in clinicians’ perception of overall quality of EOLC (mean difference = 0.28, 95% confidence interval: 0.18, 0.37; t₂₈₂ = 5.8, P < 0.01) were found. Although statistically significant improvements were evident in all subscales measured, clinicians’ work stress related to EOLC and support for staff, patients, and their families were identified as needing further improvement.

CONCLUSIONS: The development and implementation of a multicomponent interdisciplinary intervention successfully improved EOLC quality, as measured by chart audit and family and clinician perceptions. Continuing interdisciplinary collaboration is needed to drive further change to continue to support high-quality EOLC for patients, families, and clinicians in the ICU.

PMID:39689996 | DOI:10.1016/j.aucc.2024.101147

Semin Thromb Hemost. 2024 Dec 17. doi: 10.1055/s-0044-1800980. Online ahead of print.

ABSTRACT

An increasing number of Mendelian randomization (MR) studies have evaluated the causal link between smoking and venous thromboembolism (VTE). However, previous studies often rely on single genetic variants related to smoking quantity and exhibit various other shortcomings, making them prone to pleiotropy and potentially leading to imprecise causal estimates. Thus, the deeper causal mechanisms remain largely unexplored. This MR study reassessed the causal relationship between smoking and VTE, including its subtypes-deep vein thrombosis (DVT) and pulmonary embolism (PE). Data on VTE were sourced from the FinnGen consortium with nonoverlapping sample sizes. The smoking phenotypes analyzed included smoking initiation, lifetime smoking, the number of cigarettes smoked per day by both current and former smokers (CigDay), and total pack-years of smoking in adulthood. The primary analytical method was inverse-variance-weighted (IVW), supplemented by multiple verification methods to ensure robust results. Statistical rigor was ensured through LDtrait pruning and Steiger filtering for reverse causation, with comprehensive sensitivity analyses including RadialMR confirming the findings’ robustness. After Bonferroni correction, this study demonstrates significant causal evidence linking lifetime smoking with the incidence of VTE (odds ratio [OR]_IVW = 1.50, 95% confidence interval [CI] 1.21-1.85, p = 1.75 × 10^-4) and PE (OR_IVW = 1.69, 95% CI 1.25-2.28, p = 6.55 × 10^-4), and suggestive evidence with DVT, consistent in direction with previous studies but showing considerable differences in effect sizes and significance. Additionally, CigDay (past and current) increases the risks of VTE and DVT, while no causal link was found between smoking initiation and VTE or its subtypes (p < 0.05), both directly contradicting previous conclusions. Furthermore, our study is the first to suggest a causal link between pack-years and an increased risk of VTE. This MR study employed rigorous statistical pruning of its instrumental variables, using the most comprehensive smoking phenotype to date. It successfully mitigated biases such as winner’s curse, yielding causal effect results distinct from previous studies.

PMID:39689867 | DOI:10.1055/s-0044-1800980

Angle Orthod. 2025 Jan 1;95(1):35-42. doi: 10.2319/050224-349.1.

ABSTRACT

OBJECTIVES: To compare the biomechanics of labial and lingual fixed orthodontic treatment options for a simulated curve of Spee malocclusion.

MATERIALS AND METHODS: An in vitro electromechanical orthodontic simulator was used to measure the three-dimensional forces and moments on each tooth of a mandibular arch. Labial and lingual brackets, both with 0.018-inch slot sizes, were bonded to mechanical teeth. Three archwire forms were considered: labial straight, lingual straight, and lingual mushroom. The simulator was set in a passive levelled position with 0.016-inch × 0.022-inch stainless steel archwires, then teeth were moved to a curve of Spee maloclussion with the first premolar intruded 1.5 mm and the canine and second premolar intruded 0.75 mm. Two-way mixed multivariate analysis of variance (α = 0.05) was used to compare forces and moments generated among the three archwires.

RESULTS: Statistical differences were found in 55 of 63 comparisons of forces and moments between archwire types for each tooth around the arch. The lowest force magnitudes were measured for labial straight archwires at each tooth position. The lateral incisor experienced the largest gingival forces with all archwire forms. The first premolar and first molar experienced labial-lingual crown tipping moments in opposite directions between labial and the two lingual archwire forms.

CONCLUSIONS: Biomechanical differences between labial, lingual straight, and lingual mushroom treatment modalities for the correction of curve of Spee misalignments were elucidated. Labial straight archwire exerted the lowest force magnitudes overall. For both lingual archwire forms, the labial-lingual inclination of the first premolar could be highly variable during levelling.

PMID:39689862 | DOI:10.2319/050224-349.1

J Pain. 2024 Dec 15:104759. doi: 10.1016/j.jpain.2024.104759. Online ahead of print.

ABSTRACT

Minimum clinically important differences (MCIDs) in acute pain intensity have not been well established. Conventional approaches for estimating MCIDs require an independent reference scale, with a threshold that must be presumed to accurately classify meaningful change in pain for all study participants, to serve as an anchor. The double stopwatch technique is the gold standard for measuring the time to meaningful relief, where participants actively press the second stopwatch when they experience pain relief that is meaningful to them. This technique eliminates the problem of misclassification with arbitrary anchors at a single time point, but the censored nature of the data is not amenable for determining MCIDs using standard methods. We propose a stopwatch-based MCID methodology that employs the double stopwatch technique to identify individualized thresholds for meaningful change in pain. This approach enables direct classification of changes in pain for each participant based on whether they perceived the change as meaningful and whether it exceeded the study cut-off being tested. Pain values of participants who do not achieve meaningful relief are incorporated into the analysis to address censoring and avoid bias. The performance (e.g., sensitivity, specificity) of different thresholds to serve as an MCID can be estimated using standard approaches with variance estimates derived by cluster bootstrapping. The advantages of the stopwatch-based MCID methodology are illustrated relative to a conventional approach using data from a randomized trial in third molar extraction. PERSPECTIVE: This article describes a methodology for determining MCIDs using the double stopwatch technique, the gold standard for assessing meaningful changes in acute pain. This methodology can be used to establish MCIDs in different acute pain settings, providing a useful basis to evaluate the meaningfulness of clinical trial results. DATA AVAILABILITY: The participant-level data included in this study as an illustrative example were submitted to the FDA by an industry sponsor and may not be publicly released. R statistical code is provided for a simulated dataset to illustrate the proposed method as a supplementary appendix.

PMID:39689766 | DOI:10.1016/j.jpain.2024.104759

Food Chem. 2024 Dec 6;468:142370. doi: 10.1016/j.foodchem.2024.142370. Online ahead of print.

ABSTRACT

Currently, the identification and quantification of complex adulteration of high-value vegetable oils are still challenging. In this study, the extreme vertex design method was adopted to design representative multivariate adulterated camellia oil samples. Thereafter, 11 characteristic lipid species were identified by considering the statistically significant difference and categorical contribution. A discriminant method and linear regression model were established based on 11 key lipids. The accuracy rate of the model was 100 %, which could correctly discriminate the camellia oil with an adulteration ratio as low as 2.5 %. The root mean square error (RMSE) of the regression equation was close to 0, and the coefficient of determination (R²_P) was 0.9054. This method has been successfully applied to commercially available samples for validation purposes, detecting 27.3 % of camellia oil adulteration. Overall, the results indicate that the discriminating method and content prediction model can provide a potential strategy for authentication of multivariate vegetable oils.

PMID:39689496 | DOI:10.1016/j.foodchem.2024.142370

Poult Sci. 2024 Dec 5;104(1):104645. doi: 10.1016/j.psj.2024.104645. Online ahead of print.

ABSTRACT

Food production needs to expand by 70% to keep up with the expected considerable increase in the world population by 2050. As a major source of high-quality protein, poultry products are essential to the world’s food supply. Nonetheless, problems with industrial mechanization, pollution, animal welfare, and antibiotic resistance affect the poultry industry. The objective of this study was to assess the impact of adding Jasminum sambac leaf powder (JSLP) to the feed of broiler chickens on their growth performance, coliform bacterial levels, and immunological function. During a 42-day period, 100 day-old Ross broiler chicks were randomly allocated to one of four treatment groups, each consisting of 25 replicates: T0 (control) with no additives, T1 supplemented with 3% JSLP, T2 with 6% JSLP, and T3 with 9% JSLP. One-way ANOVA was used to determine statistical inference among groups. Feeding JSLP resulted in a significant increase in body weight (BW), body weight gain (BWG), and feed intake (P<0.05), while faecal coliforms were significantly reduced (P<0.01). Further, haemoglobin concentration and red blood cell counts (RBC) on days 14, 28, and 42, were significantly increased(P<0.01). Additionally, significant differences in differential leucocyte counts (DLC) were observed between the JSLP-treated groups (P<0.001). Overall, JSLP supplementation positively influenced broiler chicken growth indices and haematological profiles, though its impact on immunological parameters warrants further investigation.

PMID:39689481 | DOI:10.1016/j.psj.2024.104645