Nevin Manimala

J Voice. 2023 Sep 14:S0892-1997(23)00249-7. doi: 10.1016/j.jvoice.2023.08.008. Online ahead of print.

ABSTRACT

PURPOSE: Reinke’s edema (RE) is a pathological condition involving increased volume of the vocal folds and resulting in significant impact on speech, fundamental frequency, and vocal range. Literature reports few studies which analyze vocal features according to the severity of RE. The aims of this study were to investigate the aerodynamics, acoustic characteristics, and sound spectrograms of a group of RE patients and to assess whether there was any correlation with their endoscopic grading.

METHODS: A total of 98 patients were included in the study, 49 patients with RE and 49 healthy volunteers (HV). Multidimensional Voice Program was used to perform objective voice assessment. Maximum phonation time (MPT) and Voice Handicap Index (VHI) questionnaire were collected. The spectrograms of the vowel /a/ and of the word /aiuole/, which contains the five Italian vowels, of each patient were analyzed according to the classification of Yanaghiara modified by Ricci Maccarini and De Colle. Laryngological assessment was used to record vocal folds morphology according to Yonekawa’s classification. Univariate analysis was used to compare group outcomes. Bivariate analysis was used to compare endoscopic grading and voice analysis results.

RESULTS: Univariate analysis of the HV and RE groups revealed statistically significant differences (P < 0.05) for the following parameters: jitter%, shimmer%, harmonic-to-noise ratio (NHR), voice turbulence index (VTI), MPT, VHI except for soft phonation index. Spearman’s rank correlation showed a positive correlation between vocal parameters such as jitter%, shimmer%, NHR, VTI, and RE gradings. A negative correlation was found between MPT and RE gradings. Bivariate analysis indicated a strong positive correlation between RE grading and the spectrogram classification performed both with the vowel / a / (Rho 0.86; P = 0.0001) and with the word / aiuole / (Rho 0.81; P = 0.0001).

CONCLUSION: The present study demonstrates that patients with RE have different voice characteristics compared to HV. In particular, the voice analysis highlighted acoustic parameters that correlated to differing degrees of RE. In addition, spectrogram analysis should be considered for acoustic assessments before and after medical and surgical therapy and also in forensic medicine.

PMID:37716890 | DOI:10.1016/j.jvoice.2023.08.008

Chin J Traumatol. 2023 Sep 4:S1008-1275(23)00090-1. doi: 10.1016/j.cjtee.2023.09.002. Online ahead of print.

ABSTRACT

PURPOSE: Different arch structures may cause different foot function injuries. In the past, the arch structure and flexibility of the foot were often defined by the height of the arch, and there was no three-dimensional structure classification method. In order to form a more complete three-dimensional description, we propose a new classification system of arch volume flexibility, and then use this new classification system to investigate the relationship between the arch volume flexibility (AVF) and arch index (AI), and the arch height flexibility (AHF) and AI, respectively.

METHODS: It is proposed to recruit 180 young male adults for the test. We obtained arch volume and AI through three-dimensional scanning and obtained the navicular height through manual measurement. Based on these data, we calculated the AHF and the AVF. Using the quintile method, these arches are divided into very stiff, stiff, neutral, flexible, and very flexible. According to AI value, all arches were divided into cavus, rectus, and planus. The distribution of AVF was compared using χ² goodness of fit test. The spearman correlation test was used to compare the AHF and AVF. A p < 0.05 indicates that the difference is statistically significant.

RESULTS: All participants’ plantar data was obtained through three-dimensional scanning, but only 159 of them were complete, so only 318 feet had valid data. The left AHF is (21.23 ± 12.91) mm/kN, and the right AHF is (21.71 ± 12.69) mm/kN. The AVF of the left foot arch is (207.35 ± 118.28) m³/kg, while the right one is (203.00 ± 117.92) m³/kg, and the total AVF of the arch was (205.17 ± 117.94) m³/kg. There was no statistical difference in the AVF between the left and right feet for the same participant (n = 159, p = 0.654). In cavus, the percentage of arch with AVF is 21% (very stiff), 21% (stiff), 14% (neutral), 7% (flexible), and 36% (very flexible). In rectus, the percentage of arch with AVF is 24% (very stiff), 20% (stiff), 15% (neutral), 25% (flexible), and 17% (very flexible). In planus, the percentage of arch with AVF is 15% (very stiff), 21% (stiff), 27% (neutral), 16% (flexible), and 21% (very flexible). Moreover, the correlation between AHF and AVF is not significant (p = 0.060).

CONCLUSION: In cavus, rectus, and planus, different AVF accounts different percentage, but the difference is not statistically significant. AVF is evenly distributed in the arches of the feet at different heights. We further found the relationship between AHF and AVF is not significant. As a three-dimensional index, AVF may be able to describe the flexibility of the arch more comprehensively than AHF.

PMID:37716873 | DOI:10.1016/j.cjtee.2023.09.002

Injury. 2023 Sep 12:111033. doi: 10.1016/j.injury.2023.111033. Online ahead of print.

ABSTRACT

BACKGROUND: Resuscitative thoracotomy (RT) is a salvage procedure following traumatic cardiac arrest. We aim to evaluate RT trends and outcomes in adults with cardiac arrest following penetrating trauma to determine the effect on mortality in this population. Further, we aim to estimate the effect of hospital teaching status on the performance of resuscitative thoracotomies and mortality.

METHODS: We reviewed the National Trauma Data Bank (2017-2021) for adults (≥16 years old) with penetrating trauma and prehospital cardiac arrest, stratified by the performance of a RT. We performed multivariable logistic regressions to estimate the effect of RT on mortality and the effect of hospital teaching status on the performance of resuscitative thoracotomies and mortality.

RESULTS: 13,115 patients met our inclusion criteria. RT occurred in 12.7% (n = 1,664) of patients. Rates of RT trended up over the study period. Crude mortality was similar in RT and Non-RT patients (95.6% vs. 94.5%, p = 0.07). There was no statistically significant difference in the adjusted odds of mortality based on RT status (OR 0.82, 95%CI 0.56-1.21). University-teaching hospitals had an adjusted odds ratio of 1.68 (95% CI 1.31-2.17) for performing a RT than non-teaching hospitals. There was no difference in the adjusted odds of mortality in patients that underwent RT based on hospital teaching status.

CONCLUSION: Despite up-trending rates, a resuscitative thoracotomy may not improve mortality in adults with penetrating, traumatic cardiac arrest. University teaching hospitals are nearly twice as likely to perform a RT than non-teaching hospitals, with no subsequent improvement in mortality.

PMID:37716863 | DOI:10.1016/j.injury.2023.111033

Curr Probl Diagn Radiol. 2023 Aug 26:S0363-0188(23)00124-X. doi: 10.1067/j.cpradiol.2023.08.008. Online ahead of print.

ABSTRACT

RATIONALE AND OBJECTIVES: Professional development is important to academic radiologists. We developed, implemented, and assessed an internal professional development lecture series focusing on the non-interpretative themes of Quality, Research, Education, and Wellness (QREW).

MATERIALS AND METHODS: The faculty of a 29-member abdominal radiology division at an academic hospital were invited to deliver 1-hour virtual lectures on noninterpretative topics to division colleagues. Topics were curated by division leadership based on the perceived needs of faculty. Anonymous feedback was collected from attendees for quality improvement purposes and analyzed using descriptive statistics and Fisher’s exact test.

RESULTS: Over 17 months, 13 QREW lectures were delivered. In total, 91 feedback forms were completed by faculty (mean 7 forms, range 2-12 per session). Of these, 57 responses (63%) were by those <7 years post training (“junior faculty”), 34 responses (37%) by those ≥ 7 years from training (“senior faculty”). Most respondents reported low levels of prior instruction (80/90, 89%) and personal knowledge (49/91, 54%) on topics. Compared to senior faculty, a greater proportion of junior faculty reported less prior instruction (73% vs 98%, P < 0.001) and less personal knowledge (32% vs 65%, P < 0.01). Most respondents agreed or strongly agreed that the topics were important to their clinical practice (87/90, 97%), professional development (86/90, 96%), and personal well-being (82/91, 90%). Faculty identified the QREW program as a major contributor to their professional development.

CONCLUSION: A noninterpretative professional development lecture series delivered by radiology faculty in a virtual, interactive format is feasible and effective, particularly for junior faculty.

PMID:37716856 | DOI:10.1067/j.cpradiol.2023.08.008

Glob Health Promot. 2023 Sep 16:17579759231195561. doi: 10.1177/17579759231195561. Online ahead of print.

ABSTRACT

Scientific evidence reveals a high prevalence of health risk behaviour among university students. This calls for the creation of educational programmes that promote more knowledge about health. However, knowledge alone is not enough to change behaviours; other factors should be considered, including attitudes towards health. The objective of this cross-sectional study was to analyse the relationship between knowledge, attitudes and health risk behaviours among university students. For this, a previously validated self-report questionnaire was applied to a stratified sample of 840 students, by year of study (first- and third-year students) and their scientific area. In addition to sociodemographic issues, the questionnaire contains a health-related knowledge scale, an attitudes towards health scale, and questions about health risk behaviours. Students displayed poor knowledge about health, correctly answering 17.77 (SD = 4.59) questions out of a total of 36, and moderate scores concerning attitudes towards health (M = 2.61, SD = 0.48, range: 1-5). Students reported always engaging in, on average, 3.88 (SD = 1.45) of the seven behaviours subject to the analysis. Mediation analyses indicated that knowledge about health and attitudes towards health were statistically significant predictors of risky behaviours. Furthermore, it was indicated that attitudes towards health have a mediating effect between health knowledge and health risk behaviours. Findings from this study indicate that public health and education policies should promote healthy behaviours among university students, taking into account not only the level of knowledge but essentially the development of positive attitudes when facing behaviours which put health at risk.

PMID:37715622 | DOI:10.1177/17579759231195561

Turk Neurosurg. 2023;33(5):799-803. doi: 10.5137/1019-5149.JTN.40697-22.2.

ABSTRACT

AIM: To compare tissue levels of the regulatory enzymes related to the Krebs cycle between low, and high-grade supratentorial gliomas.

MATERIAL AND METHODS: Forty patients who underwent surgery for supratentorial gliomas (19 with low-grade and 21 with high-grade gliomas) were evaluated. The regulatory enzymes directly involved in the Krebs cycle, namely pyruvate dehydrogenase, citrate synthase, ?-ketoglutarate dehydrogenase, and isocitrate dehydrogenase, and two enzymes that indirectly regulate the Krebs cycle, namely glutamate dehydrogenase and glutaminase, were quantitatively studied in tumor tissues using ELISA. The results were compared between the two groups.

RESULTS: The levels of all enzymes were higher in the high-grade glioma group but only pyruvate dehydrogenase, citrate synthase, and isocitrate dehydrogenase levels showed statistical significance. Moreover, all enzymes showed higher tissue levels in grade- II compared to grade-I gliomas, but only two enzymes, glutamate dehydrogenase and glutaminase, reached significantly higher levels. In the high-grade glioma group, all enzymes again showed higher tissue levels in grade-IV gliomas than in grade-III gliomas, but none showed statistical significance.

CONCLUSION: Regulatory enzymes of the Krebs cycle are increased in high-grade gliomas compared to low-grade gliomas. Glutaminolysis enzymes, namely glutamate dehydrogenase and glutaminase, which are required for resupplying the Krebs cycle, are also increased in order to meet the high energy demand in high-grade gliomas.

PMID:37715603 | DOI:10.5137/1019-5149.JTN.40697-22.2

Turk Neurosurg. 2023;33(5):790-798. doi: 10.5137/1019-5149.JTN.40346-22.4.

ABSTRACT

AIM: To examine the morphometric properties of the vessels forming the Willis polygon (WP) in patients with type 2 diabetes mellitus (T2DM) and hypertension (HT) and compare them with healthy individuals.

MATERIAL AND METHODS: Cranial Tomography Angiography (CTA) of 168 individuals were analyzed retrospectively. The individuals included in the study were divided into four groups according to the diagnosis. Group 1 included 40 individuals who were diagnosed with HT, Group 2 included 43 individuals who were diagnosed with DM, Group 3 included 42 individuals who were diagnosed with DM and HT, and Group 4 was the control group and included 43 individuals. The diameter and length measurements of the vessels forming the WP were included in our study.

RESULTS: According to the results of the Kruskal Wallis H test, in female patients statistically significant differences were detected in the diameter measurements of the right and left A1 segment of the ACA, the diameter measurement of the left A2 segment, the diameter measurements of the right and left P1 and P2 segments of the ACP, the diameter measurements of the right and left AComP. (p < 0.05), in male patients statistically significant differences were found in the diameter of the right A1 segment of the ACA, the diameter and segment length measurements of the right and left P1 segments of the ACP, of the right and left P2 diameter measurements, and segment length measurements of the left AComP (p < 0.05).

CONCLUSION: We also found that the vessel diameters were similar in the HT, DM and HT+DM groups, and smaller than the control group. In addition, we think that knowing WP morphometric measurements will both guide the radio-anatomical evaluations to be made and increase the level of microanatomical knowledge in surgical treatment.

PMID:37715602 | DOI:10.5137/1019-5149.JTN.40346-22.4

Clin Transplant. 2023 Sep 16:e15136. doi: 10.1111/ctr.15136. Online ahead of print.

ABSTRACT

INTRODUCTION: The COVID-19 pandemic allowed for the rapid implementation of telemedicine for kidney transplant patients; however, widespread adoption may worsen existing health care inequities among vulnerable populations. This study aimed to characterize telemedicine utilization by kidney transplant patients during the early pandemic with particular attention to healthcare equity.

METHODS: A retrospective analysis of kidney transplant patients interacting with telemedicine was performed. Patient demographic data and distance to the transplant center were obtained. The National Center for Health Statistics (NCHS) Urban-Rural Classification Scheme for Counties and Brokamp Neighborhood Deprivation Index (NDI) score were used to characterize patients’ counties of residence. Multivariable logistic regression evaluated associations between patient and community characteristics and the likelihood of an encounter being telemedicine.

RESULTS: This study included 1033 patients who participated in 3727 encounters from March 11 through October 2020. Characteristics associated with decreased likelihood of telemedicine use were increased age (OR = .993; 95% CI = .986-.999, P = .022), non-White vs. White race (OR = .826, 95% CI = .697-.979; P = .028), male vs. female sex (OR = .746, 95% CI = .632-.880; P < .001), and a higher Brokamp Neighborhood Deprivation Index score (OR = .159; 95% CI = .029-.873; P = .034). The effect of distance to the transplant center on the likelihood of a telemedicine encounter differed by NCHS Urban-Rural designation (interaction P = .018), with its likelihood increasing by 2%-3% with each 10-mile increment among persons residing in medium-, small-, and non-metropolitan counties compared to those residing in the most rural counties.

CONCLUSIONS: Telemedicine visits were less often completed by patients of older age, non-white race, male sex, and those residing in counties having higher NDI scores. While telemedicine has the potential to improve healthcare access and decrease costs, proactive efforts need to be taken to mitigate disparities in vulnerable populations.

PMID:37715601 | DOI:10.1111/ctr.15136

Stat Med. 2023 Sep 16. doi: 10.1002/sim.9903. Online ahead of print.

ABSTRACT

Physical activity (PA) guidelines recommend that PA be accumulated in bouts of 10 minutes or more in duration. Recently, researchers have sought to better understand how participants in PA interventions increase their activity. Participants can increase their daily PA by increasing the number of PA bouts per day while keeping the duration of the bouts constant; they can keep the number of bouts constant but increase the duration of each bout; or participants can increase both the number of bouts and their duration. We propose a novel joint modeling framework for modeling PA bouts and their duration over time. Our joint model is comprised of two sub-models: a mixed-effects Poisson hurdle sub-model for the number of bouts per day and a mixed-effects location scale gamma regression sub-model to characterize the duration of the bouts and their variance. The model allows us to estimate how daily PA bouts and their duration vary together over the course of an intervention and by treatment condition and is specifically designed to capture the unique distributional features of bouted PA as measured by accelerometer: frequent measurements, zero-inflated bouts, and skewed bout durations. We apply our methods to the Make Better Choices study, a longitudinal lifestyle intervention trial to increase PA. We perform a simulation study to evaluate how well our model is able to estimate relationships between outcomes.

PMID:37715594 | DOI:10.1002/sim.9903

Acta Ophthalmol. 2023 Sep 16. doi: 10.1111/aos.15765. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the changes in retinal arterial architecture after treatment with voretigene neparvovec in patients with retinal dystrophy caused by bi-allelic mutations in the RPE65 gene.

METHODS: Sixteen eyes treated with voretigene neparvovec at the University Eye Clinic in Tuebingen, Germany, underwent adaptive optics ophthalmoscopy (AO) imaging at baseline and 2 weeks, 1, 3, 6 and 12 months after treatment. Follow-up was performed in six eyes of four patients. For each eye, five different positions at arterial vessels were selected and the wall-to-lumen ratio (WLR), the lumen diameter (LD) and the wall cross-sectional area (WCSA) were measured by the manufacturer’s software over the observational period.

RESULTS: Vast retinal atrophy dominated all gained AO images. WLR fluctuated in the observation period without statistically significant change. LD and WCSA changed significantly after 2 weeks from the baseline examination and returned to values similar to baseline thereafter. There were no signs of inflammation such as macrophages or perivascular accumulated fluid visible.

CONCLUSION: AO imaging of the retinal vessels in RPE65-associated retinal dystrophies (IRD) is challenging. There was no change in the retinal arterial vasculature over the observation period of 12 months that would indicate inflammatory changes. Decrease of the LD and WCSA shortly after treatment might be caused by the perioperative prednisolone intake. AO of retinal vessels can be used as a diagnostic module to complement monitoring the disease and effects of genetic treatments if the acquisition is possible in selected cases.

PMID:37715554 | DOI:10.1111/aos.15765