Nevin Manimala

World Neurosurg. 2023 Sep 9:S1878-8750(23)01288-3. doi: 10.1016/j.wneu.2023.09.020. Online ahead of print.

ABSTRACT

The topic of current research is the development of a new approach to the diagnosis and treatment tactics of severe brain injury, considering its main pathophysiological mechanism – intracranial hypertension syndrome. Transcranial doppler imaging is a perspective method, which allows quick and noninvasive assessment of the intracerebral blood flow dynamics right at the patient’s bedside. Due to the operator-dependent nature of this method, clinical interpretation can often be contradictory. As a result, no clear criteria for therapy correction have yet been formulated based on this neuroimaging method. This predefines the goal of the study – to identify Doppler patterns of unfavorable craniocerebral injury conditions to form a consistent algorithm of treatment measures on their basis, which will reduce secondary brain damage in patients with severe craniocerebral trauma. Analysis of the therapy performed allowed authors to specify the options for the hyperosmolar solutions for the correction of IIH syndrome and demonstrated no statistically significant difference in effectiveness between mannitol and hypertonic saline solutions.

PMID:37696434 | DOI:10.1016/j.wneu.2023.09.020

J Vasc Interv Radiol. 2023 Sep 9:S1051-0443(23)00663-2. doi: 10.1016/j.jvir.2023.09.007. Online ahead of print.

ABSTRACT

PURPOSE: To develop a reproducible in vitro model simulating central venous catheter (CVC) exchange with high potential for air embolization and test the hypothesis that a closed catheter clamp over Glidewire exchange technique will significantly reduce the volume of air introduced during CVC exchange.

MATERIALS & METHODS: The model consisted of a 16 Fr valved sheath, 240 mL container, and pressure transducer submerged in water in a 1200 mL suction canister system. Continuous wall suction was applied to the canister to maintain negative pressure at-7 mmHg or -11 mmHg. Each trial consisted of 0.035″ hydrophilic Glidewire introduction, over-the-wire catheter exchange, and wire removal following clinical protocol. A total of 256 trials were performed, 128 trials at each pressure with the catheter clamp open (n = 64) or closed (n = 64) around the Glidewire.

RESULTS: There was a statistically significant lower volume of air introduced with closed clamp over-the-wire exchanges compared to open clamp exchanges at both pressures (two-tailed t-test, p < 0.001). At -7 mmHg, 48.0 mL ± 9.3 of air was introduced with open clamp and 20.6 mL ± 4.7 with closed clamp. At -11 mmHg, 97.8 mL ± 11.9 of air was introduced with open clamp and 37.8 mL ± 6.3 with closed clamp.

CONCLUSION: This study demonstrates the use of a reproducible in vitro model mimicking conditions causing air embolism during CVC exchange. Results show that CVC exchange using closed catheter clamp over Glidewire exchange technique significantly reduces the volume of air introduced per exchange.

PMID:37696430 | DOI:10.1016/j.jvir.2023.09.007

Hellenic J Cardiol. 2023 Sep 9:S1109-9666(23)00155-0. doi: 10.1016/j.hjc.2023.09.006. Online ahead of print.

ABSTRACT

BACKGROUND: – Tricuspid regurgitation (TR) adversely affects prognosis following mitral transcatheter edge-to-edge repair (TEER). We aimed to derive a risk stratification tool for patients undergoing TEER for mitral regurgitation while exhibiting significant TR.

METHODS: – This is a single-center, retrospective analysis of 217 consecutive individuals referred to an isolated mitral TEER who had moderate-to-severe or greater TR at baseline. The primary outcome was the 1-year composite of all-cause mortality or heart failure hospitalizations. The cohort was randomly split in a 75%-to-25% ratio, creating train (n=163) and test (n=54) datasets. Model development, discrimination and calibration were based on the train dataset. Internal validation was applied to the test dataset.

RESULTS: – Overall, 81 (37.3%) patients experienced the primary outcome. After multivariable analysis, a score for predicting the primary outcome was constructed that utilized a 0-to-3 scale, in which each point represented one of three baseline variables independently associated with this combined endpoint: serum B-natriuretic peptide (BNP) level >1,000 pg/mL, qualitative right ventricular (RV) dysfunction on transthoracic echocardiogram, and cardiac implantable electronic device (CIED). C-statistic of the model was 0.66 (95% CI, 0.57-0.75, p=0.002) and 0.75 (95% CI, 0.61-0.89, p=0.004) in the train and test datasets, respectively – representing comparable performance to current, more complex tools. Neither this BNP-RV-CIED (BRC) score nor other models were prognostically meaningful in 32 patients excluded from the main analysis who underwent a combined mitral-tricuspid TEER.

CONCLUSION: – The BRC score is a simple clinical prediction tool that may aid in the triage of isolated mitral TEER candidates with significant pre-existing TR.

PMID:37696418 | DOI:10.1016/j.hjc.2023.09.006

Sci Total Environ. 2023 Sep 9:166960. doi: 10.1016/j.scitotenv.2023.166960. Online ahead of print.

ABSTRACT

Gully erosion possess a serious hazard to critical resources such as soil, water, and vegetation cover within watersheds. Therefore, spatial maps of gully erosion hazards can be instrumental in mitigating its negative consequences. Among the various methods used to explore and map gully erosion, advanced learning techniques, especially deep learning (DL) models, are highly capable of spatial mapping and can provide accurate predictions for generating spatial maps of gully erosion at different scales (e.g., local, regional, continental, and global). In this paper, we applied two DL models, namely a simple recurrent neural network (RNN) and a gated recurrent unit (GRU), to map land susceptibility to gully erosion in the Shamil-Minab plain, Hormozgan province, southern Iran. To address the inherent black box nature of DL models, we applied three novel interpretability methods consisting of SHaply Additive explanation (SHAP), ceteris paribus and partial dependence (CP-PD) profiles and permutation feature importance (PFI). Using the Boruta algorithm, we identified seven important features that control gully erosion: soil bulk density, clay content, elevation, land use type, vegetation cover, sand content, and silt content. These features, along with an inventory map of gully erosion (based on a 70 % training dataset and 30 % test dataset), were used to generate spatial maps of gully erosion using DL models. According to the Kolmogorov-Smirnov (KS) statistic performance assessment measure, the simple RNN model (with KS = 91.6) outperformed the GRU model (with KS = 66.6). Based on the results from the simple RNN model, 7.4 %, 14.5 %, 18.9 %, 31.2 % and 28 % of total area of the plain were classified as very-low, low, moderate, high and very-high hazard classes, respectively. According to SHAP plots, CP-PD profiles, and PFI measures, soil silt content, vegetation cover (NDVI) and land use type had the highest impact on the model’s output. Overall, the DL modelling techniques and interpretation methods used in this study proved to be helpful in generating spatial maps of soil erosion hazard, especially gully erosion. Their interpretability can support watershed sustainable management.

PMID:37696396 | DOI:10.1016/j.scitotenv.2023.166960

Orthop Traumatol Surg Res. 2023 Sep 9:103683. doi: 10.1016/j.otsr.2023.103683. Online ahead of print.

ABSTRACT

BACKGROUND: The Non-Arthritic Hip Score (NAHS) used to evaluate the hip in younger patients is a self-administered questionnaire with 20 items in four sections: pain, symptoms, function, and activities. Although used in France, no transcultural version had been validated. The objective of this study was to translate the NAHS into French then assess the validity, reliability, and sensitivity to change of the French-language version (NAHS-Fr) in younger patients with hip conditions other than osteoarthritis.

HYPOTHESIS: The NAHS-Fr demonstrates good validity and reliability when used in younger French-speaking patients with hip pain.

MATERIAL AND METHODS: We conducted a prospective observational study in 105 patients (62 males and 43 females) scheduled for surgery on one or both hips (113 hips in total) to treat cam-type femoro-acetabular impingement or labral lesions. Before and 6 months after surgery, each patient completed the NAHS-Fr and Western Ontario and McMaster Osteoarthritis Index (WOMAC). Statistical tests were done to evaluate validity, reliability, and sensitivity to change, as recommended by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN).

RESULTS: The response rate was 100%, confirming that the NAHS-Fr was easy to use. The NAHS-Fr was both valid and reliable. No ceiling or floor effect was detected for the total NAHS-Fr score. All items had Cronbach alpha coefficients greater than 0.8, indicating good internal consistency. External consistency between the NAHS-Fr and WOMAC was negative (-0.676) due to inversely proportional score indexing. Before surgery, the NAHS-Fr and WOMAC scores were strongly and significantly correlated (p<0.0001). The effect size was greater than 0.8, indicating good sensitivity to the change induced by surgery.

DISCUSSION: These results confirm the study hypothesis: the NAHS-Fr has the same good psychometric characteristics as does the original version and versions in other languages. The NAHS-Fr is useful for evaluating younger patients with non-osteoarthritic hip pain and can be used by French-speaking surgeons in everyday clinical practice.

LEVEL OF EVIDENCE: IV, prospective observational non-comparative cohort study.

PMID:37696391 | DOI:10.1016/j.otsr.2023.103683

Osteoarthritis Cartilage. 2023 Sep 9:S1063-4584(23)00912-3. doi: 10.1016/j.joca.2023.08.012. Online ahead of print.

ABSTRACT

OBJECTIVE: To forecast the number of primary total shoulder replacements (TSR) in Australia to the year 2035, and associated costs.

METHODS: De-identified TSR data for 2009-2019 were obtained from the Australian Orthopaedic Association National Joint Replacement Registry. Population data, including population projections to 2035, were obtained from the Australian Bureau of Statistics. Three forecasting scenarios were used: constant TSR rates from 2019 onwards (Scenario 1, conservative); continued growth in TSR rates using negative binomial regression (Scenario 2, exponential); and continued growth using negative binomial regression with monotone B-splines (Scenario 3, moderate). Healthcare costs were estimated using TSR projections and average procedure costs, inflated to 2035 Australian dollars.

RESULTS: The use of TSR increased by 242% in Australia from 2009-2019 (from 1,983 to 6,789 procedures for people ≥40 years). Under Scenario 1, the incidence of TSR is conservatively projected to rise to 9,676 procedures by 2035 (43% increase from 2019), at a cost of $AUD 312.6 million to the health system. Under Scenario 2, TSR incidence would increase to 45,295 procedures by 2035 (567% increase), costing $AUD 1.46 billion. Under Scenario 3, 28,257 TSR procedures are forecast in 2035 (316% increase) at a cost of $913 million.

CONCLUSIONS: Recent growth in TSR likely relates to prosthesis improvements, greater surgeon proficiency, and expanded clinical indications. Under moderate and exponential scenarios that consider rising TSR rates and population projections, Australia would face three- to five-fold growth in procedures by 2035. This would have profound implications for the healthcare budget, clinical workforce, and infrastructure.

PMID:37696387 | DOI:10.1016/j.joca.2023.08.012

J Equine Vet Sci. 2023 Sep 9:104917. doi: 10.1016/j.jevs.2023.104917. Online ahead of print.

ABSTRACT

The study aimed to assess Apgar scores and collect data on clinical, hemato-biochemical, and venous blood gas parameters in seven mules during their first 48h of life. Apgar scores, heart rate (HR), respiratory rate (RR), body temperature (BT), body weight (BW), time to achieve sternal recumbency, stand, nurse, and pass meconium were recorded. Blood samples were collected at birth (T0), 6 (T6), 12 (T12), 24 (T24), 48 (T48)h of life. Data distribution was verified and differences in laboratory parameters over time assessed. One foal had an Apgar score of 6/8, thus excluded from the statistical analysis. Three foals had an Apgar score of 7/8, three had a score of 8/8. All foals showed suckling reflex within 20 min and raised the head within 1 min; six foals reached sternal recumbency within 2 min. Times to stand and nurse were 38.7±13.4 and 72.3±30.5 min, respectively. Five foals passed meconium spontaneously in 416.3±401.8 min. The mean HR, RR, and BT values were 92±16.1 bpm, 50.2±5.9 bpm, and 37.6±0.3°C, respectively. Creatinine and lactate decreased from birth to 48h. Blood glucose increased from 12h. Mg increased from 12 to 24h. Compared to horses and donkeys, mules showed an intermediate BW, shorter time to stand and nurse, longer time to pass meconium, intermediate HR and lower RR. Compared to donkey mules showed lower BT. Other dissimilarities from the parental species were found in laboratory parameters. Our findings emphasize the need for reference ranges for a comprehensive evaluation of newborn mules.

PMID:37696367 | DOI:10.1016/j.jevs.2023.104917

Ann Thorac Surg. 2023 Sep 9:S0003-4975(23)00932-3. doi: 10.1016/j.athoracsur.2023.08.031. Online ahead of print.

ABSTRACT

BACKGROUND: To assess the safety and efficacy of bronchopleural fistulae closure with Amplatzer occluder devices through our experience of over 14 years.

METHODS: Retrospective data review of patients from Rabin Medical Center who underwent Amplatzer occluder device placement between March 2007 and September 2021 for bronchopleural fistulae closure.

RESULTS: In total, 72 patients had 83 Amplatzer occluder devices implanted for bronchopleural fistulae closure. The median age was 65.5 (Q1, Q3; 56.0, 72.3). The primary diseases were lung malignancy and thoracic infection, 48(66.7%) and 9 (12.5%), respectively. Bronchopleural fistulae developed mainly following pneumonectomy (40.3%) and lobectomy (33.3%) with a median time from surgery to Amplatzer placement of 3.9 months (IQR 1.4 to 16.4). We encountered no procedural or immediate post-procedural complications or deaths. Six months following Amplatzer insertion, there were 7 (8.4%)Amplatzer removals and 11 (15.3%) fistula-related deaths.

CONCLUSIONS: Amplatzer occluders are a safe modality for non-surgical bronchopleural fistulae management with ease of placement under moderate sedation and flexible bronchoscopy with good short- and long-term effectivity.

PMID:37696352 | DOI:10.1016/j.athoracsur.2023.08.031

Environ Res. 2023 Sep 9:117107. doi: 10.1016/j.envres.2023.117107. Online ahead of print.

ABSTRACT

Previous studies found inconsistent associations between ambient temperature during pregnancy and the risk of preeclampsia. If such associations are causal, they may impact the future burden of preeclampsia in the context of climate change. We used a historical cohort of 129,009 pregnancies (5074 preeclampsia cases) from southern Israel that was merged with temperature assessments from a hybrid satellite-based exposure model. Distributed-lag and cause-specific hazard models were employed to study time to all preeclampsia cases, followed by stratification according to early (≤34 weeks) and late (>34 weeks) onset disease and identify critical exposure periods. We found a positive association between temperature and preeclampsia during gestation, which was stronger in the 3rd trimester. For example, during week 33, compared to the reference temperature of 22.4 °C, the cause-specific hazard ratio (HR_CS) of preeclampsia was 1.01 (95% confidence interval (CI): 1.01-1.02) when exposed to 30 °C, 1.05 (95%CI: 1.03-1.08) at 35 °C, and 1.07 (95%CI: 1.04-1.10) at 37 °C. The associations existed with both early- and late-onset preeclampsia; however, the associations with the early-onset disease were somewhat stronger, limited to the first weeks of pregnancy and the third trimester, and with larger confidence intervals. The HR_CS for early preeclampsia onset, when exposed to 37 °C compared to 22.4 °C during week 33, was 1.12 (95%CI: 0.96-1.30), and for late-onset preeclampsia, the HR_CS was 1.09 (95%CI: 1.05-1.13). To conclude, exposure to high temperatures at the beginning and, particularly, the end of gestation is associated with an increased risk of preeclampsia in southern Israel.

PMID:37696321 | DOI:10.1016/j.envres.2023.117107

Psychol Sport Exerc. 2023 Sep 9:102536. doi: 10.1016/j.psychsport.2023.102536. Online ahead of print.

ABSTRACT

BACKGROUND: Children naturally seek risk in play and adventurous play outdoors confers many benefits, including the potential to increase moderate-to-vigorous physical activity (MVPA). This study aimed to investigate the relationship between parent attitudes to risk and injury, and their elementary school-aged child’s daily adventurous play and MVPA.

METHODS: A panel sample of 645 Australian parents/guardians completed an online survey consisting of several validated measures of risk and injury attitudes, and physical activity and play behaviour. Data were analysed via descriptive statistics, univariate and multivariable regressions using Stata 17. A series of exploratory univariate logistic regressions were conducted, followed by a series of multivariable logistic regressions fitted to test the association between parent risk and injury attitudes and (i) children’s MVPA, (ii) active play and (iii) adventurous play, while adjusting for socio-demographic factors.

RESULTS: Most adult participants (81%) were female. The mean age of the child participants (53% male) was 8.6 years (SD = 2.4). On average, parents were positive about children’s engagement with risk, however, 78% of parents had low tolerance of risk when presented with specific play scenarios, and attitudes towards injuries varied, with mothers more concerned than fathers. After adjusting for confounders, children with parents who were tolerant of risk in play were more likely to meet the MVPA guideline of ≥60 min daily (OR 2.86, CI: 1.41, 5.82, p < 0.004) and spend more time playing adventurously (OR 3.03, CI: 1.82, 5.06, p < 0.001). Positive associations for MVPA and adventurous play were observed across all models examining parent attitudes to risk and injury. Younger children engaged in more play and physical activity, however, more positive parent attitudes appeared to moderate the age-related influences.

CONCLUSIONS: We found a divergence between the outcomes parents desire for their children through engagement with risk and the play activities they are comfortable with in practice. Parent attitudes to risk and injury are potentially modifiable factors that may increase children’s affordances for adventurous play and physical activity. Parent education interventions that provide practical approaches to address injury concerns and support children’s risk-taking in play outdoors are recommended.

PMID:37696315 | DOI:10.1016/j.psychsport.2023.102536