Nevin Manimala

Int Arch Allergy Immunol. 2023 Dec 19:1-7. doi: 10.1159/000535414. Online ahead of print.

ABSTRACT

INTRODUCTION: The possible influence of sensitization to aeroallergens on omalizumab response in chronic spontaneous urticaria (CSU) has been insufficiently investigated. This study’s aim was to investigate atopy’s influence on omalizumab response in CSU patients.

METHOD: Retrospective study of CSU patients followed at a Portuguese Urticaria Center of Reference and Excellence (UCARE), treated with omalizumab for at least 6 months, between 2015 and 2022. At T0, all patients underwent quantification of specific immunoglobulin E (IgE) for total extract of most prevalent aeroallergens (ImmunoCAP Thermo Fisher Scientific®) and were divided in 2 groups, according to their response to omalizumab during the first 16 weeks of treatment: responders (R) (UAS7 <7) versus partial (PR) (UAS7 = 7-15) and nonresponders (UAS7 >15). R were further classified as fast (FR) (4-6 weeks) and slow responders (SR) (12-16 weeks). Total serum IgE, circulating eosinophil, and basophil counts were compared between groups at T0. p < 0.05 was considered statistically significant (SPSS® v25.0).

RESULTS: Ninety-six patients (80% female) were studied, mean age 49 ± 14 years. Median CSU duration pre-omalizumab was 3 (0.6-20) years and mean omalizumab treatment duration was 3.7 ± 2.3 years. 38 (40%) had concomitant chronic inducible urticaria and 72 (75%) angioedema. Based on positive results of the specific IgE assay, 35 patients (36%) were considered atopic. Most patients (n = 30; 86%) were sensitized to house dust mites (HDM) (Dermatophagoides farinae = 28, Dermatophagoides pteronyssinus = 27, Blomia tropicalis = 19, Lepidoglyphus destructor = 17), followed by pollens (n = 12; 34%) (mixture of grasses = 10, Olea europaea = 7, Parietaria officinalis = 6), epithelia (n = 9; 26%) (dog = 8, cat = 7), and fungi (Alternaria alternata = 4; 11%). Eight patients (23%) were monosensitized to HDM and 4 (11%) to pollens. No significant association was found between aeroallergen sensitization and CSU duration, concomitant chronic inducible urticaria, or angioedema. Atopic patients featured significantly higher levels of baseline total serum IgE than nonatopic (469 vs. 94 U/mL, respectively; p = 0.0009). Mean baseline counts of eosinophils and basophils were not significantly different between atopic and non-atopic, respectively: eosinophils (128 vs. 121/mm3) and basophils (26 vs. 28/mm3). Regarding response to omalizumab, most patients (58; 60%) were responders: FR – 46 (79%); SR – 12 (21%). There was no significant association between aeroallergen sensitization and omalizumab response or speed of response.

CONCLUSIONS: As far as we know, this is the first study exploring the influence of atopy sensitization pattern on omalizumab response in CSU. According to our results, presence of atopy/sensitization pattern does not influence omalizumab response in CSU patients.

PMID:38113870 | DOI:10.1159/000535414

Ophthalmologica. 2023 Dec 19. doi: 10.1159/000535865. Online ahead of print.

ABSTRACT

PURPOSE: Submacular haemmorhage (SMH) is a vision threatening complication of neovascular age related macular degeneration (AMD). The exact treatment scheme is not established yet. The aim of the current study is to describe surgical results and fundus autofluorescence (FAF) patterns after pars plana vitrectomy ppV + subretinal tissue plasminogen activator (tPA) + anti-vascular endothelial growth factor (VEGF) and intravitreal tPA + anti-VEGF + sulfur hexafluoride (SF6) tamponade and to compare them to intravitreal TPA + anti-VEGF + SF6 in the treatment of SMH in the course of AMD.

MATERIAL AND METHODS: We performed FAF imaging in patients with a previous SMH in the course of AMD with a duration of <60 days treated with vitrectomy with subretinal anti-VEGF and TPA and intravitreal anti-VEGF, TPA and SF6 administration (group 1) or intravitreal TPA + anti-VEGF + SF6 (group 2). In all eyes a throughout ophthalmic examination, fluorescein angiography and spectral domain optical coherence tomography (SD-OCT) were done for diagnosis. SD-OCT was performed monthly during treatment.

RESULTS: Three FAF patterns were observed in both groups. Pattern one (normal autofluorescence) was observed in 5/18 in group one and 5/21 group two. Pattern two was observed in 6/18 in group one and 7/21 in group two. Pattern three was noted in 7/18 in group one and 5/21 in group two. Improvement in visual acuity (VA) was statistically significant for both groups. 0.01 Snellen (2.0 logMAR) to 0.11 Snellen (0.96 logMAR) in group one (p=0.019), and 0.11 Snellen (0.96 logMAR) to 0.33 Snellen (0.48 logMAR) in group two (p=0.0007). Central retinal thickness (CRT) also decreased with statistical significance for both groups (p<0.05).

CONCLUSION: FAF patterns did not depend on the treatment used, but solely on the duration of SMH before treatment. SMH if not treated prompt enough might cause long- standing photoreceptor and retinal pigment epithelium (RPE) defect, which is represented by hypo- and hyperautofluorescence. Performing a subretinal injection of TPA and anti-VEGF does not cause any defects associated with the injection site. That might be associated with previous local internal limiting membrane (ILM) peeling, which reduces the injection pressure. Not only prompt treatment of SMH, but also further continuation of anti-VEGF treatment is mandatory to maintain vision.

PMID:38113868 | DOI:10.1159/000535865

Cell Rep Methods. 2023 Dec 18;3(12):100664. doi: 10.1016/j.crmeth.2023.100664.

ABSTRACT

Flow cytometry (FCM) is a common method for characterizing extracellular particles (EPs), including viruses and extracellular vesicles (EVs). Frameworks such as MIFlowCyt-EV exist to provide reporting guidelines for metadata, controls, and data reporting. However, tools to optimize FCM for EP analysis in a systematic and quantitative way are lacking. Here, we demonstrate a cohesive set of methods and software tools that optimize FCM settings and facilitate cross-platform comparisons for EP studies. We introduce an automated small-particle optimization (SPOT) pipeline to optimize FCM fluorescence and light scatter detector settings for EP analysis and leverage quantitative FCM (qFCM) as a tool to further enable FCM optimization of fluorophore panel selection, laser power, pulse statistics, and window extensions. Finally, we demonstrate the value of qFCM to facilitate standardized cross-platform comparisons, irrespective of instrument configuration, settings, and sensitivity, in a cross-platform standardization study utilizing a commercially available EV reference material.

PMID:38113854 | DOI:10.1016/j.crmeth.2023.100664

J Mech Behav Biomed Mater. 2023 Dec 15;150:106324. doi: 10.1016/j.jmbbm.2023.106324. Online ahead of print.

ABSTRACT

OBJECTIVES: Short fiber-reinforced composite (SFRC) materials make it possible to reinforce root canal treated teeth with individualized, directly layered intraradicular posts (the Bioblock technique). The question arises, however, as to whether the photopolymerization of the material is sufficient deep within the root canal space and if it can be improved through different light-conducting options. Our study aimed to investigate the hardness of intraradicular SFRC material applied using the Bioblock technique and cured with various illumination methods, as measured through nanoindentation.

MATERIALS AND METHODS: For this investigation, thirty plastic artificial teeth that had undergone root canal treatment were selected. These teeth were randomly divided into six study groups (Group 1-6; each group consisting of 5 teeth). The restoration procedures involved the use of SFRC or conventional composite materials, placed 6 mm apically from the root canal orifice. In Group 1 and 2, a conventional composite was used, whereas in Group 3-6, SFRC was employed for interradicular reinforcement (with a layered technique in Group 3 and 4 and a bulk-fill technique in Group 5 and 6). A modified light source was utilized for photopolymerization in Group 2, 4, and 6, whereas in Group 3 and 5, the polymerization light was directed through a prefabricated glass fiber posts. The control group (Group 1) utilized conventional composite material with a standard light-curing method. Following embedding and sectioning, the hardness of the composite materials was measured at 2 mm intervals within the root canal (1st, 2nd, 3rd measurements, in the coronal to apical direction).

RESULTS: During the 1st measurement, light curing conducted through the glass fiber posts (Group 3 and 5) led to markedly higher hardness levels compared to the groups restored with conventional composite (control group with p = 0.002, p = 0.001, and Group 2 with p = 0.043, p = 0.034, respectively). In the 2nd measurement, only Group 5 demonstrated significantly greater hardness in comparison to the control group (p = 0.003) and Group 2 (p = 0.015). However, in the 3rd measurement, no statistically significant differences were observed among the groups.

CONCLUSION: light curing through the glass fiber post provides outstanding hardness for the SFRC material in the apical layer in the root canal.

PMID:38113823 | DOI:10.1016/j.jmbbm.2023.106324

J Mech Behav Biomed Mater. 2023 Dec 14;150:106308. doi: 10.1016/j.jmbbm.2023.106308. Online ahead of print.

ABSTRACT

OBJECTIVES: The present investigation is aimed at evaluating the effect of styrene butadiene rubber, glass fibre, nylon fibre and hybrid reinforcement of glass and nylon fibre with 0.5 and 1.0 wt% on the impact, flexural, and compressive properties.

METHODS: A total of 19 groups were formed, including one control group and 18 study groups. All specimens were fabricated according to the standards and tests were performed. The enhancement of strengths were characterised by using scanning electron micrographs, FTIR results, XRD, and DMA tests. The degradability was studied using TGA/DTA analysis. The results were analysed using one-way ANOVA and Dunnett’s post hoc multiple comparison test at p ≤ 0.05.

RESULTS: The maximum impact, flexural, and compressive strength were found to be 3.234 ± 0.202 kJ/m², 70.07 ± 0.7 MPa, and 84.929 ± 0.85 MPa for hybrid reinforcement of 0.5 wt% nylon fiber and 0.5 wt% glass fiber with 1.0 wt% of styrene butadiene rubber (SBR) mixed PMMA denture base material. Statistical analysis shows that the maximum mean impact strength, flexural strength, and compressive strength are about 84%, 58%, and 67% higher than the pure PMMA (control group). The maximum flexural modulus and compressive modulus are 914.4 MPa and 407.847 MPa for denture base material made of 1.0 wt% SBR, 1.0 wt% nylon fiber, 0.5 wt% glass fiber, and 0.5 wt% SBR, 0.5 wt% nylon fiber, respectively. The storage moduli of 1.0 wt% SBR, 1.0 wt% nylon fiber, and 0.5 wt% glass fiber-reinforced denture base material and pure PMMA are 0.096 and 0.422 at 79 °C, respectively, which indicates significant crosslinking of fiber and PMMA. The failure surfaces are characterized by a homogeneous distribution of fiber with increased surface roughness and fiber pullout, strong bonding, and well-dispersed SBR.

PMID:38113822 | DOI:10.1016/j.jmbbm.2023.106308

Comput Methods Programs Biomed. 2023 Dec 12;244:107977. doi: 10.1016/j.cmpb.2023.107977. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Pulmonary embolism (PE) is a complex disease with high mortality and morbidity rate, leading to increasing society burden. However, current diagnosis is solely based on symptoms and laboratory data despite its complex pathology, which easily leads to misdiagnosis and missed diagnosis by inexperienced doctors. Especially, CT pulmonary angiography, the gold standard method, is not widely available. In this study, we aim to establish a rapid and accurate screening model for pulmonary embolism using machine learning technology. Importantly, data required for disease prediction are easily accessed, including routine laboratory data and medical record information of patients.

METHODS: We extracted features from patients’ routine laboratory results and medical records, including blood routine, biochemical group, blood coagulation routine and other test results, as well as symptoms and medical history information. Samples with a feature loss rate greater than 0.8 were deleted from the original database. Data from 4723 cases were retained, 231 of which were positive for pulmonary embolism. 50 features were retained through the positive and negative statistical hypothesis testing which was used to build the predictive model. In order to avoid identification as majority-class samples caused by the imbalance of sample proportion, we used the method of Synthetic Minority Oversampling Technique (SMOTE) to increase the amount of information on minority samples. Five typical machine learning algorithms were used to model the screening of pulmonary embolism, including Support Vector Machines, Logistic Regression, Random Forest, XGBoost, and Back Propagation Neural Networks. To evaluate model performance, sensitivity, specificity and AUC curve were analyzed as the main evaluation indicators. Furthermore, a baseline model was established using the characteristics of the pulmonary embolism guidelines as a comparison model.

RESULTS: We found that XGBoost showed better performance compared to other models, with the highest sensitivity and specificity (0.99 and 0.99, respectively). Moreover, it showed significant improvement in performance compared to the baseline model (sensitivity and specificity were 0.76 and 0.76 respectively). More important, our model showed low missed diagnosis rate (0.46) and high AUC value (0.992). Finally, the calculation time of our model is only about 0.05 s to obtain the possibility of pulmonary embolism.

CONCLUSIONS: In this study, five machine learning classification models were established to assess the likelihood of patients suffering from pulmonary embolism, and the XGBoost model most significantly improved the precision, sensitivity, and AUC for pulmonary embolism screening. Collectively, we have established an AI-based model to accurately predict pulmonary embolism at early stage.

PMID:38113803 | DOI:10.1016/j.cmpb.2023.107977

J Psychosom Res. 2023 Dec 13;177:111568. doi: 10.1016/j.jpsychores.2023.111568. Online ahead of print.

ABSTRACT

BACKGROUND: Pediatric patients with hematologic malignancies (HM) and survivors are at high risk for numerous negative effects including decreased health-related quality of life (HRQOL). In order to understand the association between HM and QOL, we conducted this meta-analysis to systematically compare QOL between pediatric HM patients and survivors and controls.

METHOD: The PubMed, EMBASE, Web of Science and the Cochrane Library databases were systematically searched. Data were analyzed using the random-effects model.

RESULTS: Of 6586 unique articles identified, 30 were included in this meta-analysis. Studies described 12 different HRQOL tools. Different QOL measures varied in their association with quality of life. When compared with Non-HM group, the Pediatric Quality of Life Inventory (PedsQL) has a moderate effect size (standard mean difference, SMD = 0.50, 95% CI: 0.32, 0.68; P < 0.001). When compared with health controls, it has a large effect size (SMD = -1.00, 95% CI: -1.47, -0.53; P < 0.001). In addition, Health utilities index mark (HUI), and the Pediatric Oncology Quality of Life Scale (POQOLS) have a large (SMD = -0.81, 95% CI: -1.29, -0.33; P = 0.001) and a small (SMD = -0.10, 95% CI: -0.42, 0.22; P = 0.534) effect sizes when comparing overall controls.

CONCLUSION: Pediatric HM patients and survivors had lower QOL compared with healthy controls and higher QOL compared with Non-HM controls in most domains. Considering the negative impact of poor QOL on daily life and functional outcomes, future research should focus on proposing effective measures to improve QOL of this population.

PMID:38113797 | DOI:10.1016/j.jpsychores.2023.111568

Nurse Educ Today. 2023 Dec 5;133:106069. doi: 10.1016/j.nedt.2023.106069. Online ahead of print.

ABSTRACT

BACKGROUND: Nurse educators need a high level of professional competence to educate future health care professionals. Professional competence supports occupational well-being whilst high mental workload can undermine it. There is little existing research into nurse educators’ professional competence, occupational well-being, mental workload, and the relationships between them, particularly in the European context.

OBJECTIVES: To describe the professional competence, personal occupational well-being, and mental workload of nurse educators in four European countries, and to explore how the professional competence and mental workload of nurse educators relate to their personal occupational well-being.

DESIGN: Cross-sectional study design with quantitative survey data.

SETTING: Nurse educators from Finland, Spain, Slovakia, and Malta.

METHODS: The data were collected from 302 nurse educators through an online questionnaire which used the Health and Social Care Educator’s Competence (HeSoEduCo) instrument. This contains 43 items which measure areas of professional competence. Statistical analysis involved descriptive and multivariate analysis.

RESULTS: Nurse educators self-assessed their overall professional competence as high. Competence in evidence-based practice was assessed as the highest whilst cultural competence was perceived to be the lowest of the six competence areas. Nurse educators perceived their levels of personal occupational well-being and the balance of mental workload as moderate. However, these levels varied between the four countries. Professional competence, more specifically administrative and curriculum competence, and a balanced mental workload were positively related to personal occupational well-being.

CONCLUSIONS: The educators who perceive themselves to have very good professional competence and a balanced mental workload are more likely to report high occupational well-being. The findings suggest that nurse educators’ cultural competence needs to be strengthened and intervention research is needed to determine ways of reducing mental workload and increasing the occupational well-being of nurse educators.

PMID:38113794 | DOI:10.1016/j.nedt.2023.106069

J Environ Manage. 2023 Dec 18;351:119809. doi: 10.1016/j.jenvman.2023.119809. Online ahead of print.

ABSTRACT

Anthropogenic land use and land cover changes are major drivers of environmental degradation and declining soil health across heterogeneous landscapes in Central India. To examines the land cover changes and spatio-temporal variations in forest carbon stock and soil organic carbon (SOC) over the past 25 years in central India. Geospatial techniques, coupled with ground measurements were employed to detect changes in land cover, carbon stocks in vegetation, and soil carbon in various vegetation types. The results indicate that forested areas have decreased, while agriculture and habitation have expanded between 1997 and 2022. Vegetation C stocks varied significantly (P < 0.05) from 39.42 to 139.95 Mg ha^-1 and the SOC varied from 7.02 to 17.98 Mg ha^-1 under different soil profiles across vegetation types, which decreased with soil depth, while the pH and bulk density increased. The maximum bulk density in the soil was found at a depth of 40-60 cm (lower profile) in Bamboo Brake, while the minimum was observed under Dense Mixed Forest at a depth of 0-20 cm (top profile). The topsoil profile contributed 33.6%-39%, the middle profile (20-40 cm) was 33.6%-34.4%, and the lower profile was 26.5%-30.8% of soil organic carbon. The study site has experienced rapid carbon losses due to changes in land cover, such as illegal expansion of agriculture, encroachments into forest fringes, and activities like selective logging and overgrazing, which have degraded dense forests. The ecological engineering of degraded ecosystems poses a great challenge and application of complex biological, mechanical and engineering measures is highly cumbersome, expensive, uneconomical and practically not feasible for upscaling. Nevertheless, proposed nature-based solutions mimic natural reparation and processes provide sustainable interventions for the reclamation of ruined landscapes besides improving ecological integrity and rendering many co-benefits to ecosystems and human societies.

PMID:38113791 | DOI:10.1016/j.jenvman.2023.119809

Am J Otolaryngol. 2023 Dec 14;45(2):104197. doi: 10.1016/j.amjoto.2023.104197. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this study is to investigate the effect of a reduction in the prescribed post-operative ibuprofen dosage on frequency of post-tonsillectomy bleeding.

METHODS: A quality improvement study was conducted at a single tertiary care pediatric hospital with patients weighing >40 kg undergoing tonsillectomy. The intervention was limiting the post-operative ibuprofen dosage to a maximum of 400 mg per dose. Data was collected on all patients returning to the hospital with bleeding after tonsillectomy. The primary outcome was the rate of post-tonsillectomy bleeding. Statistical analysis was conducted using nonparametric comparisons and a run chart.

RESULTS: A total of 199 tonsillectomy patients >40 kg were included in the study. There were 119 (59.8 %) females and 80 (40.2 %) males total. The pre-intervention group had a total of 56 patients while the post-intervention group had a total of 143 patients. There was no statistical difference in age, weight, or sex between the pre- and post-intervention groups (p > .05). The post-tonsillectomy hemorrhage rate was 11/56 (19.6 %) before the intervention, and 11/143 (7.7 %) after the intervention (p = .016). Children who experienced a bleeding event were significantly older (mean 15.9 years, 95 % CI 14.5-17.3) than those who did not (13.5 years, 95 % CI 12.9-14.1; p = .011). The run chart revealed that the intervention resulted in a nonrandom decrease in rate of post-tonsillectomy bleeding.

CONCLUSIONS: Post-tonsillectomy bleeding rate decreased with a ceiling post-operative ibuprofen dose of 400 mg/dose in this quality improvement study. Further research is warranted.

PMID:38113775 | DOI:10.1016/j.amjoto.2023.104197