Nevin Manimala

Neurosci Biobehav Rev. 2024 Jun 22:105774. doi: 10.1016/j.neubiorev.2024.105774. Online ahead of print.

ABSTRACT

To provide an overview of treatments in the pipeline for adults with attention-deficit/hyperactivity disorder (ADHD), we searched https://clinicaltrials.gov/and and https://www.clinicaltrialsregister.eu/ from 01/01/2010-10/18/2023 for ongoing or completed phase 2 or 3 randomised controlled trials (RCTs), assessing pharmacological or non-pharmacological interventions for adults with ADHD with no current regulatory approval. We found 90 eligible RCTs. Of these, 24 (27%) reported results with statistical analysis for primary efficacy endpoints. While several pharmacological and non-pharmacological interventions had evidence of superiority compared to the control condition from a single RCT, centanafadine (norepinephrine, dopamine, and serotonin re-uptake inhibitor) was the only treatment with evidence of efficacy on ADHD core symptoms (small effect size=0.28-0.40) replicated in at least one additional RCT, alongside reasonable tolerability. Overall, the body of ongoing RCTs in adults with ADHD is insufficient, without any intervention on the horizon to match the efficacy of stimulant treatment or atomoxetine and with better tolerability profile. Additional effective and well tolerated treatments for adults with ADHD require development and testing.

PMID:38914177 | DOI:10.1016/j.neubiorev.2024.105774

Toxicol Appl Pharmacol. 2024 Jun 22:117014. doi: 10.1016/j.taap.2024.117014. Online ahead of print.

ABSTRACT

The OECD has approved two similar methods for testing the phototoxic potency of chemicals. The first method, OECD 432, is based on the cytotoxicity properties of materials to the mouse 3 T3 (clone A31) cell line (fibroblasts) after exposure to light. The second method, OECD 498, is based on the same properties but using reconstructed human epidermis – EpiDerm (stratified keratinocytes). The aim of this study was to compare these two methods using statistical tests (specificity, sensitivity, negative predictive value, positive predictive value and accuracy) and non-statistical characteristics (e.g. price and experimental duration, amount of material, level of complications, cell type, irradiation dose). Both tests were performed according to the relevant guidelines using the same 11 control substances. Higher performance values were observed for OECD 432 in both phototoxic and non-phototoxic classifications. The accuracy of OECD 432 was 90.9%, while that of OECD 498 was 72.7%. OECD 432 was also shorter and less expensive. On the other hand, OECD 498 was less complicated, and used human cells with stratum corneum, which better reflects real skin. This method can also be used with oily substances that are poorly soluble in water. However, both methods are important for testing the phototoxic properties of materials, and can be used alone or in a tiered strategy.

PMID:38914165 | DOI:10.1016/j.taap.2024.117014

J Arthroplasty. 2024 Jun 22:S0883-5403(24)00647-8. doi: 10.1016/j.arth.2024.06.048. Online ahead of print.

ABSTRACT

BACKGROUND: Unicompartmental knee arthroplasty (UKA) is an alternative to total knee arthroplasty for localized osteoarthritis. Recent advancements in UKA implant design and expanding patient criteria may have increased its utilization. However, few studies have examined the use of UKA in the United States. Thus, this study assessed the current and projected future trends of UKA and robotic UKA in the United States through 2035, along with postoperative outcomes.

METHODS: A collaborative healthcare research network was queried to identify patients who had undergone UKA. Primary outcomes measured included prevalence (P), incidence proportion (IP), and incidence rate (IR) from 2012 to 2022. Chi-square analyses were done to compare outcomes across categorical data. Regression modeling was performed to project UKA to the year 2035. Statistical significance was held at P < 0.05 for all analyses.

RESULTS: In 2022, 1,662 UKAs were performed within the network, a 590% increase from 2012 (241 performed). The incidence proportion increased on an average annual basis by 41.8%, the incidence rate by 50%, and the prevalence by 51.3%. A year following UKA, conversion to total knee arthroplasty was the most common orthopaedic complication (39.9%). As of 2022, there were 68 robotic UKAs performed, a 518% increase from the 11 performed in 2012. Regression analysis for UKA through 2035 showed that IP will be 0.04%, IR will be 1.75 x 10^-6 cases/person-day, and prevalence will be 0.3%.

CONCLUSION: These findings are consistent with prior studies indicating a higher utilization of UKA over the past decade. Reported complications were not uncommon, as nearly 40% of patients required a conversion to a total knee arthroplasty. Further research is needed to optimally identify criteria for appropriate patients and determine the benefits robotic UKA may provide, specifically reducing the risk of conversion to a TKA.

PMID:38914143 | DOI:10.1016/j.arth.2024.06.048

World Neurosurg. 2024 Jun 22:S1878-8750(24)01060-X. doi: 10.1016/j.wneu.2024.06.101. Online ahead of print.

ABSTRACT

BACKGROUND CONTEXT: The aim of the current study was to compare the incidence of postoperative complications between MIS tubular, endoscopic and Robot-assisted TLIF techniques.

METHODS: Consecutive patients who underwent single or multi-level TLIF between 2020 and 2022. Pre-operative and post-operative patient reported outcomes (VAS Leg and ODI), demographic, and intra-operative variables were recorded. One way ANOVA with Bartlett’s equal-variance and Pearson chi-squared tests were used.

RESULTS: The current study included a total of 170 TLIF patients: 107 (63%) tubular, 42 (25%) endoscopic, and 21 (12%) robot-assisted. All three TLIF techniques had similar complication rates: tubular 6 (5.6%), endoscopic 2 (4.8%), and robot-assisted 1 (4.8%) all occurring within the first two weeks. Tubular TLIF reported the lowest incidence of new onset neurological symptoms, primarily radiculitis or numbness/tingling, at two weeks postoperatively (p<0.05) with 21 (20%) tubular, 17 (41%) endoscopic, and 9 (43%) robot-assisted patients. There were two revisions in the robot-assisted group, while tubular and endoscopic each had one within one year. There was no statistical difference in pre- or postoperative PROs between the TLIF groups.

CONCLUSIONS: The current study demonstrated that tubular, endoscopic, and robot-assisted TLIF procedures had similar complication rates. The tubular MIS TLIF reported less new neurological symptoms compared to endoscopic and robot-assisted TLIF procedures at two weeks postoperative, with all groups declining in symptom persistency at later time intervals. Average VAS scores continuously improved up to one year postoperatively amongst all groups.

PMID:38914133 | DOI:10.1016/j.wneu.2024.06.101

Int J Med Educ. 2024 Jun 21;15:66-79. doi: 10.5116/ijme.6667.2270.

ABSTRACT

OBJECTIVES: This study aims to assess the intercultural competence of general hospital workers in South Korea by examining their understanding of cultural diversity in healthcare and to identify factors influencing their intercultural competence.

METHODS: A cross-institutional survey was conducted with 439 participants from four South Korean general hospitals, employing inferential statistics such as one-way Analysis of Variance, Mann-Whitney U, and Kruskal-Wallis test followed by post-hoc, and multiple linear regression analyses.

RESULTS: While 85% (n = 362) of participants acknowledged the significance of multiculturalism in Korean society, only 11% (n = 49) felt competent in treating multicultural patients. Additionally, 72% (n = 315) experienced significant linguistic difficulties in medical communication. Multiple regression analysis identified advanced English competency, multicultural training experiences, and peer support with organizational awareness of multicultural importance as significant positive contributors to intercultural competence.

CONCLUSIONS: Despite recognizing the importance of multiculturalism, general hospital workers face significant language barriers and low self-efficacy in providing care to multicultural patients. To address these challenges, hospitals should designate resident translators for culturally appropriate communication. Furthermore, a tri-tiered training approach is proposed to enhance the five domains of intercultural competence among general hospital workers in Korea, including overarching multicultural training, occupation-specific courses, and long-term managerial programs aimed at managing cultural diversity effectively in healthcare settings.

PMID:38914074 | DOI:10.5116/ijme.6667.2270

Pain Med. 2024 Jun 24:pnae052. doi: 10.1093/pm/pnae052. Online ahead of print.

ABSTRACT

OBJECTIVE: The administration of local anaesthesia in intraperitoneal space as part of the multi-modal analgesic regimen has shown to be effective in reducing postoperative pain. Recent studies demonstrated that intraperitoneal lidocaine may provide analgesic effects. Primary objective was to determine the impact of intraperitoneal lidocaine on postoperative pain scores at rest.

DESIGN: We carried out a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

METHODS: Databases of MEDLINE, EMBASE, and CENTRAL were searched from their inception date until May 2023. Randomized clinical trials (RCT) comparing intraperitoneal lidocaine and placebo in adults undergoing surgery were included.

RESULTS: Our systematic review included 24 RCTs (n = 1,824). The intraperitoneal lidocaine group was significantly associated with lower postoperative pain scores at rest (MD: -0.87, 95% CI: -1.04 to -0.69) and at movement (MD: -0.50, 95% Cl: -0.93 to -0.08) among adult patients after surgery. Its administration also significantly decreased morphine consumption (MD: -6.42 mg, 95% Cl: -11.56 to -1.27), lowered the incidence of needing analgesia (OR: 0.22, 95% Cl: 0.14 to 0.35). Intraperitoneal lidocaine statistically reduced time to resume regular diet (MD: 0.16 days; 95% Cl: -0.31 to -0.01), and lowered postoperative incidence of nausea and vomiting (OR: 0.54, 95% Cl: 0.39 to 0.75).

CONCLUSIONS: In this review, our findings should be interpreted with caution. Future studies are warranted to determine the optimal dose of administering intraperitoneal lidocaine among adult patients undergoing surgery.

PMID:38913879 | DOI:10.1093/pm/pnae052

Network. 2024 Jun 24:1-57. doi: 10.1080/0954898X.2024.2367481. Online ahead of print.

ABSTRACT

The purpose of this paper is to test the performance of the recently proposed weighted superposition attraction-repulsion algorithms (WSA and WSAR) on unconstrained continuous optimization test problems and constrained optimization problems. WSAR is a successor of weighted superposition attraction algorithm (WSA). WSAR is established upon the superposition principle from physics and mimics attractive and repulsive movements of solution agents (vectors). Differently from the WSA, WSAR also considers repulsive movements with updated solution move equations. WSAR requires very few algorithm-specific parameters to be set and has good convergence and searching capability. Through extensive computational tests on many benchmark problems including CEC’2015 and CEC’2020 performance of the WSAR is compared against WSA and other metaheuristic algorithms. It is statistically shown that the WSAR algorithm is able to produce good and competitive results in comparison to its predecessor WSA and other metaheuristic algorithms.

PMID:38913877 | DOI:10.1080/0954898X.2024.2367481

J Natl Cancer Inst. 2024 Jun 24:djae141. doi: 10.1093/jnci/djae141. Online ahead of print.

ABSTRACT

We conducted a cross-sectional multi-center study to compare the demographics, clinical characteristics, and lung cancer screening (LCS) results among those eligible for LCS per 2013 vs 2021 US Preventive Services Task Force (USPSTF) recommendations. Statistical tests are two-sided, with p < .05 considered statistically significant. Among 17,702 screened individuals (85.2% 2013 Eligible, 14.8% 2021 Newly Eligible), a higher proportion of those screened per 2021 vs 2013 criteria were female (56.1% vs 48.1%, p < .0001) and non-Hispanic Black (19.3% vs 13.4%, p < .0001). The risk of developing and dying from lung cancer per 1000 was statistically significantly higher among those eligible per 2013 vs 2021 criteria. A higher proportion of LCS exams had an increased suspicion of lung cancer in the 2013 vs 2021 criteria groups. Our data suggest that, as intended, updated 2021 USPSTF recommendations are leading to a higher proportion of LCS exams among non-Hispanic Black individuals and women.

PMID:38913873 | DOI:10.1093/jnci/djae141

Eur J Cardiothorac Surg. 2024 Jun 24:ezae249. doi: 10.1093/ejcts/ezae249. Online ahead of print.

ABSTRACT

OBJECTIVES: The evaluation of Fontan-associated liver disease is often challenging. Diffusion-weighted magnetic resonance imaging can detect hepatic fibrosis from capillary perfusion and diffusion abnormalities from extracellular matrix accumulation. This study investigated its role for evaluation of liver disease in Fontan patients and explored possible diagnostic method for early detection of advanced liver fibrosis.

METHODS: Stable adult Fontan patients who could safely receive magnetic resonance examination were enrolled and blood biomarkers, transient elastography were also examined.

RESULTS: Forty-six patients received diffusion weighted imaging and 58.7% were with advanced liver fibrosis (severe liver fibrosis 37.0%, and cirrhosis 21.7%). Two parameters of hepatic dysfunction, platelet counts (Spearman’s ρ: -0.456, p = 0.001) and cholesterol levels (Spearman’s ρ: -0.383, p = 0.009), decreased with increasing severities of fibrosis. Using transient elastography, a cutoff value 14.2 kPa predicted presence of advanced liver fibrosis, but with a low positive predictive value. When we included platelet count, cholesterol, post-Fontan years and TE values as a composite, the prediction capability of advanced liver fibrosis was the most satisfactory (c statistic 0.817 ± 0.071, p < 0.001). A cutoff value of 5.0 revealed a sensitivity of 78% and a specificity of 82%.

CONCLUSIONS: In Fontan patients, diffusion-weighted imaging is helpful in detection of liver fibrosis that was correlated with hepatic dysfunction. A simple score was proposed for long-term surveillance and early detection of advanced liver disease in adult Fontan patients. For adult Fontan patients with calculated score > 5.0, we may consider timely diffusion-weight imaging and early management for liver complications.

PMID:38913856 | DOI:10.1093/ejcts/ezae249

Stroke. 2024 Jul;55(7):e187-e188. doi: 10.1161/STROKEAHA.124.046788. Epub 2024 Jun 24.

NO ABSTRACT

PMID:38913798 | DOI:10.1161/STROKEAHA.124.046788