Nevin Manimala

Med Phys. 2023 Aug 3. doi: 10.1002/mp.16645. Online ahead of print.

ABSTRACT

PURPOSE: The recently proposed sparsifying transform (ST) models incur low computational cost and have been applied to medical imaging. Meanwhile, deep models with nested network structure reveal great potential for learning features in different layers. In this study, we propose a network-structured ST learning approach for X-ray computed tomography (CT), which we refer to as multi-layer clustering-based residual sparsifying transform (MCST) learning. The proposed MCST scheme learns multiple different unitary transforms in each layer by dividing each layer’s input into several classes. We apply the MCST model to low-dose CT (LDCT) reconstruction by deploying the learned MCST model into the regularizer in penalized weighted least squares (PWLS) reconstruction.

METHODS: The proposed MCST model combines a multi-layer sparse representation structure with multiple clusters for the features in each layer that are modeled by a rich collection of transforms. We train the MCST model in an unsupervised manner via a block coordinate descent (BCD) algorithm. Since our method is patch-based, the training can be performed with a limited set of images. For CT image reconstruction, we devise a novel algorithm called PWLS-MCST by integrating the pre-learned MCST signal model with PWLS optimization.

RESULTS: We conducted LDCT reconstruction experiments on XCAT phantom data, Numerical Mayo Clinical CT dataset and “LDCT image and projection dataset” (Clinical LDCT dataset). We trained the MCST model with two (or three) layers and with five clusters in each layer. The learned transforms in the same layer showed rich features while additional information is extracted from representation residuals. Our simulation results and clinical results demonstrate that PWLS-MCST achieves better image reconstruction quality than the conventional filtered back-projection (FBP) method and PWLS with edge-preserving (EP) regularizer. It also outperformed recent advanced methods like PWLS with a learned multi-layer residual sparsifying transform (MARS) prior and PWLS with a union of learned transforms (ULTRA), especially for displaying clear edges and preserving subtle details.

CONCLUSIONS: In this work, a multi-layer sparse signal model with a nested network structure is proposed. We refer this novel model as the MCST model that exploits multi-layer residual maps to sparsify the underlying image and clusters the inputs in each layer for accurate sparsification. We presented a new PWLS framework with a learned MCST regularizer for LDCT reconstruction. Experimental results show that the proposed PWLS-MCST provides clearer reconstructions than several baseline methods. The code for PWLS-MCST is released at https://github.com/Xikai97/PWLS-MCST.

PMID:37535932 | DOI:10.1002/mp.16645

Altern Ther Health Med. 2023 Aug 4:AT9165. Online ahead of print.

ABSTRACT

BACKGROUND: Nephrotic syndrome is characterized by prolonged duration, frequent relapses, various comorbidities, and complex management. Although children with nephrotic syndrome generally adhere well to medical protocols during hospitalization under close supervision, post-discharge adherence to care plans often poses challenges.

OBJECTIVE: This study aims to investigate the impact of continuous home care on nursing compliance, immune function, and quality of life among pediatric patients diagnosed with nephrotic syndrome.

METHODS: A retrospective analysis was conducted on ninety-eight cases of discharged children with nephrotic syndrome admitted to our hospital from January 2020 to January 2023. Based on different nursing programs, the children were divided into two groups: 54 cases in the observation group and 54 cases in the comparison group. The observation group received continuous home care involving assessment of nursing problems, care, and effect evaluation, while the comparison group received conventional pre-discharge health education and regular telephone follow-up after discharge. Nursing care compliance, immune function, and quality of life were compared between the two groups.

RESULTS: The observation group demonstrated significantly higher compliance rates in areas such as diet, fluid intake, medication, dialysis regimen, daily life, and exercise compared to the control group (P < .05). Aftercare, the observation group showed greater disease cognitive ability, disease-related behaviors, beliefs about the disease, and overall scores compared to the control group, with statistical significance (P < .05). Moreover, the quality-of-life index scores of children in both groups improved aftercare, with the observation group showing higher scores in behavioral ability, physical function, psychological function, and social function compared to the control group, and these differences were statistically significant (P < .05).

CONCLUSIONS: Implementing ongoing home care for children diagnosed with nephrotic syndrome significantly enhances their overall quality of life, particularly in terms of familial dynamics, self-perception, and adherence to medical treatment.

PMID:37535920

Altern Ther Health Med. 2023 Aug 4:AT8581. Online ahead of print.

ABSTRACT

OBJECTIVE: Narrative nursing intervention was given to patients after bone and joint replacement to analyze the emotional effects of the intervention on patients after bone and joint replacement.

METHOD: Retrospective analysis was performed on the clinical information of 50 patients who underwent bone and joint replacement and were admitted to our hospital between January 2021 and February 2022. Depending on various nursing techniques, fifty patients who had undergone joint and bone replacements were randomly assigned into two groups consisting of 25 individuals each. One group served as the control group, while the other group acted as the observation group. Various nursing techniques were employed for both groups. Scores for quality of life, compliance with nursing standards, overall nursing satisfaction, complication rates, and anxiety and depression before and after nursing were compared between the two groups. Additionally, the pain scores before and 3 days, one week, and two weeks after nursing were compared between the two groups.

RESULTS: Before the nursing intervention, the differences in each observed index between the two groups were not significant. Following the nursing intervention, the observation group’s nursing compliance, total nursing satisfaction rate, and quality of life score were higher than those of the control group, and there was a statistically significant difference between the groups when comparing the corresponding data, with P < .05. After nursing, the observation group’s index of complication rate was lower than that of the control group, with P < .05. Three days, one week, and two weeks after nursing, both groups’ pain, anxiety, and depression scores decreased. The changing trend in the observation group after the nursing intervention compared to before was more significant, and there was a statistical difference when compared to the corresponding data in the control group with P < .05.

CONCLUSIONS: Patients benefited from narrative nursing interventions following the implementation of bone or joint replacement because they increased nurse compliance and satisfaction, significantly improved quality of life, decreased complication rates, and decreased pain levels, all of which helped to stabilize the patient’s emotional state.

PMID:37535918

Altern Ther Health Med. 2023 Aug 4:AT8582. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to investigate the effectiveness of levosimendan in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection complicated by cardiac insufficiency and myocardial injury.

METHODS: A total of 22 patients with SARS-CoV-2 infection and myocardial injury, admitted to the Cardiology Department of our hospital between December 2022 and February 2023, are randomly divided into two groups: a dobutamine general treatment group and a levosimendan observation treatment group. The treatment outcomes of the two groups are compared and analyzed.

RESULTS: The overall improvement rate in the general treatment group is 80%, while the levosimendan treatment group shows a 100% improvement rate. There is a statistically significant difference between the two groups (P < .05). Post-treatment, the left ventricular ejection fraction for the general treatment group and the levosimendan treatment group are (48 ± 7)% and (54 ± 6)%, respectively. Additionally, the left ventricular end-diastolic diameter is (55.0 ± 3.0) mm in the general treatment group and (51 ± 5.0) mm in the levosimendan group, with a statistically significant difference (P < .05). After active treatment, the plasma levels of B-type natriuretic peptide (Brain Natriuretic Peptide, NT-proBNP) are significantly lower in the levosimendan treatment group than in the general treatment group (P < .05). Moreover, the plasma levels of interleukin-6 (IL-6) and C-reactive protein (CRP) in the levosimendan group decrease slightly faster than those in the general treatment group, with a statistically significant difference (P < .05). The length of hospital stay in the levosimendan group is (12 ± 3) days, significantly lower than the general treatment group (16 ± 5) days, with a statistically different result (P < .05).

CONCLUSIONS: Levosimendan demonstrates significant efficacy in patients with novel coronavirus infection complicated by myocardial injury, resulting in improved clinical symptoms, enhanced cardiac function, shorter hospital stays, early discharge, and cost savings.

PMID:37535909

JCO Glob Oncol. 2023 Aug;9:e2300057. doi: 10.1200/GO.23.00057.

ABSTRACT

PURPOSE: Early integration of pediatric palliative care (PPC) for children with cancer is critical to improving the quality of life of both the patient and family. Understanding physician perceptions of palliative care and perceived barriers to early integration is necessary to develop PPC in Brazil.

METHODS: The Assessing Doctors’ Attitudes on Palliative Treatment survey was modified for use in Brazil. The survey was open from January 2022 to June 2022 and distributed to physicians of all specialties from participating institutions who treat children with cancer. Statistical analysis was complemented by qualitative analysis of open-ended responses.

RESULTS: A total of 272 respondents participated. Most respondents reported access to PPC experts for consultation (77.2%) and 34.5% indicated previous palliative care training. Physician knowledge of PPC was generally aligned with WHO guidance (median alignment, 93.0%; range, 80.5%-98.2%). However, about half (53.3%) felt comfortable addressing physical needs of patients receiving PPC, 35.3% addressing emotional needs, 25.8% addressing spiritual needs, and 33.5% addressing grief and bereavement needs. Most respondents (65.4%) felt palliative care should be involved from diagnosis, but only 10.3% stated that this occurred in their setting. The most important barriers identified were physician discomfort (89.0%), limited physician knowledge (88.6%), and lack of home-based services (83.8%).

CONCLUSION: Despite a strong understanding of the role of palliative care, physicians in Brazil reported low confidence delivering PPC to children with cancer. Additionally, physicians generally believed that PPC should be integrated earlier in the disease trajectory of children with cancer. This work will direct educational and capacity building initiatives to ensure greater access to high-quality PPC for children with cancer in Brazil to address patient and family suffering.

PMID:37535886 | DOI:10.1200/GO.23.00057

Sleep. 2023 Aug 3:zsad207. doi: 10.1093/sleep/zsad207. Online ahead of print.

ABSTRACT

Growing evidence linked inflammation with sleep. This study aimed to evaluate the associations and causal effects of sleep traits including insomnia, excessive daytime sleepiness (EDS) and sleep duration (short:<7h; normal:7-9h; long:≥9h), with levels of C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α) and interleukins. Standard procedures of quantitative analysis were applied to estimate the expression differences for each protein in compared groups. Then, a two-sample Mendelian randomization (MR) analysis was performed to explore their causal relationships with published GWAS summary statistics. The inverse-variance weighted (IVW) was used as the primary method, followed by several complementary approaches as sensitivity analyses. A total of 44 publications with 51879 participants were included in the quantitative analysis. Our results showed that the levels of CRP, IL-1β, IL-6 and TNF-α were higher from 0.36 to 0.58 (after standardization) in insomnia compared to controls, while there was no significant difference between participants with EDS and controls. Besides, there was a U/J-shaped expression of CRP and IL-6 with sleep durations. In MR analysis, the primary results demonstrated the causal effects of CRP on sleep duration (estimate:0.017; 95% CI, [0.003, 0.031]) and short sleep duration (estimate:-0.006; 95% CI, [-0.011, -0.001]). Also, IL-6 was found to be associated with long sleep duration (estimate:0.006; 95% CI, [0.000, 0.013]). These results were consistent in sensitivity analyses. There are high inflammatory profiles in insomnia and extremes of sleep duration. Meanwhile, elevated CRP and IL-6 have causal effects on longer sleep duration. Further studies can focus on related upstream and downstream mechanisms.

PMID:37535878 | DOI:10.1093/sleep/zsad207

ACS Nano. 2023 Aug 3. doi: 10.1021/acsnano.3c04147. Online ahead of print.

ABSTRACT

Alloying offers an increasingly important handle in nanomaterials design in addition to the already widely explored size and geometry of nanostructures of interest. As the key trait, the mixing of elements at the atomic level enables nanomaterials with physical or chemical properties that cannot be obtained by a single element alone, and subtle compositional variations can significantly impact these properties. Alongside the great potential of alloying, the experimental scrutiny of its impact on nanomaterial function is a challenge because the parameter space that encompasses nanostructure size, geometry, chemical composition, and structural atomic-level differences among individuals is vast and requires unrealistically large sample sets if statistically relevant and systematic data are to be obtained. To address this challenge, we have developed a microshutter device for spatially highly resolved physical vapor deposition in the lithography-based fabrication of nanostructured surfaces. As we demonstrate, it enables establishing compositional gradients across a surface with single nanostructure resolution in terms of alloy composition, which subsequently can be probed in a single experiment. As a showcase, we have nanofabricated arrays of AuAg, AuPd, and AgPd alloy nanoparticles with compositions systematically controlled at the level of single particle rows, as verified by energy dispersive X-ray and single particle plasmonic nanospectroscopy measurements, which we also compared to finite-difference time-domain simulations. Finally, motivated by their application in state-of-the-art plasmonic hydrogen sensors, we investigated PdAu alloy gradient arrays for their hydrogen sorption properties. We found distinctly composition-dependent kinetics and hysteresis and revealed a composition-dependent contribution of a single nanoparticle response to the ensemble average, which highlights the importance of alloy composition screening in single experiments with single nanoparticle resolution, as offered by the microshutter nanofabrication approach.

PMID:37535838 | DOI:10.1021/acsnano.3c04147

J Laparoendosc Adv Surg Tech A. 2023 Aug 3. doi: 10.1089/lap.2023.0307. Online ahead of print.

ABSTRACT

Background: Perioperative blood transfusions are associated with increased morbidity and mortality. Each surgical specialty is associated with unique operative variables. Moreover, transfusion rates vary across specialty. This article seeks to elucidate variables both common and unique to surgical specialties. Materials and Methods: This study was a retrospective review of 5344 patients from the prospectively maintained Veterans Affairs Surgical Quality Improvement Project at a single-level 1A tertiary Veterans Affairs Medical Center. Data collected included demographic information, preoperative clinical variables, postoperative outcomes, and perioperative transfusion (within 72 hours of procedure). Patients were stratified based on whether they received a transfusion. Univariate and multivariate analyses were performed. P values <.05 were significant. Results: Of the 5344 patients included in the study, 153 required perioperative transfusion of at least one unit of packed red blood cells. Patients who underwent transfusion were more likely to be men, have an underlying bleeding disorder, and have more preoperative risk factors. Although unique risk factors were found within most specialties, there was no statistically significant difference in postoperative complications between surgical specialties. Patients requiring transfusion had higher rates of morbidity and mortality. Elevated preoperative hematocrit was significantly protective against requiring transfusion across most specialties. Conclusions: Specialty-based differences in transfusion requirement may be due to the proportion of older and more frail patients, hospital transfusion thresholds, and surgical complexity. Hematocrit, however, could be an effective target for mitigating cost and morbidity associated with transfusion. Preoperative hematocrit optimization through B12, folate, iron dosing, and erythropoietin supplementation could be a useful strategy.

PMID:37535822 | DOI:10.1089/lap.2023.0307

Pain Physician. 2023 Jul;26(4):E397-E403.

ABSTRACT

BACKGROUND: The high risk of developing postherpetic neuralgia (PHN) is associated with severe immunosuppressive diseases. A malignancy itself, as well as surgery, radiotherapy, and other treatments, can lead to changes in the immune status of the body and predispose patients with a malignancy to PHN.

OBJECTIVE: To investigate the risk factors of postherpetic neuralgia in herpes zoster (HZ) after a malignant tumor and to provide better preventive strategies for clinical practice.

STUDY DESIGN: A retrospective cohort study.

SETTING: The Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China.

METHODS: Patients who developed HZ after being diagnosed with a malignant tumor in the Affiliated Hospital of Southwest Medical University from September 2018 through March 2022 were included in the research. A total of 70 patients were included, including 31 men and 39 women, aged 18- 82 years old (mean, SD: 59.77 ± 13.95). According to the occurrence of PHN, they were divided into a non-PHN (n = 46) and a PHN group (n = 24). General information about the patients was collected, including clinical data, treatment status, and prognosis. Univariate and multivariate analyses were conducted of influencing factors.

RESULTS: A total of 19 factors, including gender, age, and white blood cell count, were included. A univariate analysis showed that there were differences in age, tumor stage, Numeric Rating Scale (NRS-11) score, and the use of antiviral drugs between the 2 groups; these differences were statistically significant, P <0.05. A multifactorial analysis revealed that the acute phase NRS-11 score (odds ratio [OR] = 4.21; 95% CI, 1.59-2.24, P = 0.004), antiviral drug use (OR = 0.28; 95% CI, 0.10-0.82, P = 0.020), and tumor stage (OR = 0.28, 95% CI, 0.08-0.98, P = 0.047) were statistically significant for the effect of PHN occurring in postmalignancy HZ. There was a statistically significant difference between the group with severe pain in the acute phase NRS-11 score and the group with mild and moderate pain, P < 0.05. There was a statistically significant difference between the group treated with 2 antivirals and the group not treated with antivirals, P < 0.05.

LIMITATIONS: There are some limitations in our research. It was conducted at a single center, with a single race, and had a small sample size. A larger-scale study should be conducted to analyze the influencing factors of PHN in patients with herpes zoster after a malignant tumor.

CONCLUSIONS: The NRS-11 score in the acute phase, whether the use of antiviral drugs in sufficient quantities, and tumor staging are the influencing factors of PHN after malignant tumors.

PMID:37535787

Pain Physician. 2023 Jul;26(4):E363-E373.

ABSTRACT

BACKGROUND: Neuropathic mechanisms largely contribute to radicular Low Back Pain (LBP) and an increase in oxidative stress is recognized as one of the possible causes of nerve damage, inducing axonal degeneration and myelin degradation of nerve fibers.

OBJECTIVES: We investigated whether a combination of nutraceutical supplements and oxygen-ozone (O2-O3) therapy might reduce disability and improve clinical effects of pharmacological therapy in patients with acute radicular LBP.

STUDY DESIGN: This is a prospective, open-label, comparative observational study approved by the Institutional Review Board of the Sapienza University of Rome (RS 6285/2021).

SETTING: Physical Medicine and Rehabilitation Unit of Sant’Andrea Hospital.

METHODS: Within the scope of this study, 62 patients with acute radicular LBP diagnosed with disc herniation were assigned into 4 groups. The first group was assigned pharmacological therapy (n = 16), the second group was assigned pharmacological therapy and nutraceutical supplements (n = 15), the third group was assigned pharmacological therapy and O2-O3 therapy (n = 15), and the fourth group was assigned pharmacological therapy, nutraceutical supplements, and O2-O3therapy (n = 16). All patients who participated in the study were evaluated at the beginning of the study, 2 weeks, and 4 weeks (T2) after the beginning of treatment using the Numeric Rating Scale (NRS-11), Oswestry Disability Index (ODI), and 12-item Short-Form Health Survey. Opioid analgesic intake was noted from baseline to end of treatment (T2).

RESULTS: In each group was observed a statistically significant difference for all measures compared to the baseline. At the T2 evaluation time between groups for the Mann-Whitney U test, a statistically significant difference was found: in the ODI scale between groups B and A (P = 0.004), groups C and A (P < 0.001), and groups D and A (P < 0.001); in the NRS-11 between groups B and A (P = 0.017), groups C and A (P = 0.002), and groups D and A (P < 0.001); in the 12-item Physical Component Summary score between groups B and A (P = 0.003), groups C and A (P = 0.002), and groups D and A (P < 0.001), while no significant differences between groups were observed in the 12-item Mental Component Summary score. The average days of opioid usage were similar in the 4 groups (8.33 in group A, 8.33 in group B, 8.33 in group C, and 8.75 in group D). However, the percentage of patients requiring adjuvant opioid therapy differed remarkably: 60% in group A, 40% in group B, 20% in group C, and 25% in group D.

LIMITATIONS: A small number of patients were recruited, and we did not perform long-term follow-up.

CONCLUSIONS: This study supports a multimodal approach combining nutraceutical supplements and O2-O3 therapy with pharmacological therapy in the treatment of acute radicular LBP secondary to disc herniation. The combination of neurotrophic and antioxidant therapies represents an etiopathogenetic approach, not purely symptomatic, that reduces symptomatology and avoids progression of the nerve damage.

PMID:37535783