Nevin Manimala

J Chin Med Assoc. 2023 Feb 1;86(2):155-165. doi: 10.1097/JCMA.0000000000000840. Epub 2022 Nov 4.

ABSTRACT

BACKGROUND: It is unclear whether hydroxymethylglutaryl-CoA reductase inhibitor (statin) therapy decreases the risk of mortality and cardiovascular disease (CVD) in patients undergoing peritoneal dialysis (PD).

METHODS: We performed a literature search of PubMed, Cochrane Library, Embase, and other databases for research publications up to June 2022. The outcomes of interest were fatal and nonfatal CVDs, all-cause mortality, and changes in the biochemical profiles. Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled and synthesized using a random-effects model. The certainty of the evidence was determined using Grading of Recommendations, Assessment, Development, and Evaluation.

RESULTS: Nine studies, including 2,933 patients undergoing PD, were included. Among them, three studies, including 2,099 patients, reported all-cause mortality, and three, including 1,571 patients, reported CVDs. In these patients, pooling results of two observational studies (very low-certainty evidence) showed that statin therapy significantly reduced CVDs (HR = 0.67; 95% CI = 0.54-0.84; p = 0.0004). Moreover, statin therapy was associated with significantly reduced low-density lipoprotein cholesterol, total cholesterol, and C-reactive protein levels (very low certainty of evidence). However, the effects of statin therapy on triglyceride, high-density lipoprotein, and albumin levels were not statistically significant.

CONCLUSION: Although statin therapy was associated with significantly reduced low-density lipoprotein cholesterol, total cholesterol, and C-reactive protein levels, the probable beneficial effect of statins on CVD risk in patients undergoing PD could not be concluded firmly. Additional high-quality studies are required to assess the potential beneficial effects of statin therapy in PD patients.

PMID:36652565 | DOI:10.1097/JCMA.0000000000000840

Int J Low Extrem Wounds. 2023 Jan 18:15347346221144937. doi: 10.1177/15347346221144937. Online ahead of print.

ABSTRACT

Objective: Through clinical trials, this study observes the therapeutic effect of platelet-rich plasma (platelet-rich plasma, PRP) on diabetic foot ulcers and explored the relationship between the relationship between PRP and autophagy. Methods: Thirty patients with diabetic foot ulcer who met the relevant criteria were randomly divided into PRP treatment group and control group. In the PRP treatment group, the formed PRP gel was coated and bandaged on the diabetic foot ulcer wound, and the PRP treatment was repeated on the seventh day. The control group was covered with normal saline sterile gauze. Observe the healing rate of the wound in 7 days, 14 days and 21 days, the pain in 5 consecutive days and the healing time of the wound after treatment, collect wound granulation tissues before and twenty-first days after treatment then detect the expression of autophagy-related proteins (LC-3, P62) and inflammatory factors (IL-6, IL-10) in diabetic foot ulcer wound to investigate the potential relationship between PRP treatment of diabetic foot ulcers and autophagy and inflammatory responses. Results: The wound healing rate of diabetic foot ulcer patients in the PRP treatment group was higher than that in the control group on the seventh, 14th and 21st days, the healing time (31.40 ± 4.47) was better than that in the control group (43.20 ± 5.03) days, and the pain improvement was better than that in the control group (P < .05). The results of Western blot analysis and quantitative PCR of autophagy-related proteins (LC-3 and p62) in granulation tissue showed that the values of LC3 and LC3-II/LC3-I and the expression of LC3 gene in wound granulation tissue of PRP group were significantly higher than those before treatment (P < .05). The value and gene expression of P62 protein were lower than those before treatment (P < .05). In the control group, there was no significant difference in LC3 and P62 protein gray level and gene expression before and after treatment (P > .05). The level of autophagy in the wound of PRP group increased after treatment, while there was no statistical significance in the control group. The results of ELISA showed that the concentration of IL-6 in granulation tissue of the PRP treatment group was lower than that before treatment (P < .05), while there was no significant difference in IL-6 in the control group after treatment. The concentration of IL-10 increased in both groups after treatment, but the concentration in PRP group was higher than that in control group (P < .05). Conclusions: This study shows that PRP gel has advantages in accelerating wound healing, relieving pain, shortening healing time and reducing inflammatory response in treating diabetic foot ulcers wound, which may be related to autophagy, and provides new ideas for the treatment of diabetic foot ulcers.

PMID:36652558 | DOI:10.1177/15347346221144937

Stat Methods Med Res. 2023 Jan 18:9622802231151204. doi: 10.1177/09622802231151204. Online ahead of print.

ABSTRACT

Advances in biologic technology enable researchers to obtain a huge amount of genetic and genomic data, whose dimensions are often quite high on both phenotypes and variants. Testing their association with multiple phenotypes has been a hot topic in recent years. Traditional single phenotype multiple variant analysis has to be adjusted for multiple testing and thus suffers from substantial power loss due to ignorance of correlation across phenotypes. Similarity-based method, which uses the trace of product of two similarity matrices as a test statistic, has emerged as a useful tool to handle this problem. However, it loses power when the correlation strength within multiple phenotypes is middle or strong, for some signals represented by the eigenvalues of phenotypic similarity matrix are masked by others. We propose a divided-and-combined omnibus test to handle this drawback of the similarity-based method. Based on the divided-and-combined strategy, we first divide signals into two groups in a series of cut points according to eigenvalues of the phenotypic similarity matrix and combine analysis results via the Cauchy-combined method to reach a final statistic. Extensive simulations and application to a pig data demonstrate that the proposed statistic is much more powerful and robust than the original test under most of the considered scenarios, and sometimes the power increase can be more than 0.6. Divided-and-combined omnibus test facilitates genetic association analysis with high-dimensional data and achieves much higher power than the existing similarity based method. In fact, divided-and-combined omnibus test can be used whenever the association analysis between two multivariate variables needs to be conducted.

PMID:36652550 | DOI:10.1177/09622802231151204

J Sports Sci. 2023 Jan 18:1-9. doi: 10.1080/02640414.2023.2167257. Online ahead of print.

ABSTRACT

This study aimed to report the goal patterns in cerebral palsy (CP) football for a better understanding of the performance of this para-sport. All goals (270) of the 48 2019 IFCPF World Cup matches were analysed through match reports, and 65% of them were analysed by video footage. The results showed 5.6 goals per match. Teams that scored more and conceded fewer goals correlated to a better ranking position in the championship (r= 0.72-0.73; p< 0.01). The distribution of goals scored was not biased by halves (49.3% vs 50.7%; χ²= 0.1; p= 0.88) nor by 15-min periods (26.3% vs 23.0% vs 23.3% vs 27.4%; χ²= 0.5; p= 0.92). In 91.7% of the matches, the team which scored the first goal went on to win the match (χ²= 81.5; p< 0.01). FT3 players scored more goals by player (χ²= 22.1; p< 0.01), while there were no statistical differences in the distribution of goals conceded by goalkeepers according to their sport class (χ²= 4.7; p= 0.09). The goals were scored mainly from organized attacks (74.4%), from the penalty area (52.5%) and through individual action (51.9%). All this information could be crucial for coaches in CP football to plan their game strategies.

PMID:36652545 | DOI:10.1080/02640414.2023.2167257

Sci Adv. 2023 Jan 18;9(3):eadd5667. doi: 10.1126/sciadv.add5667. Epub 2023 Jan 18.

ABSTRACT

The life span of leaves increases with their mass per unit area (LMA). It is unclear why. Here, we show that this empirical generalization (the foundation of the worldwide leaf economics spectrum) is a consequence of natural selection, maximizing average net carbon gain over the leaf life cycle. Analyzing two large leaf trait datasets, we show that evergreen and deciduous species with diverse construction costs (assumed proportional to LMA) are selected by light, temperature, and growing-season length in different, but predictable, ways. We quantitatively explain the observed divergent latitudinal trends in evergreen and deciduous LMA and show how local distributions of LMA arise by selection under different environmental conditions acting on the species pool. These results illustrate how optimality principles can underpin a new theory for plant geography and terrestrial carbon dynamics.

PMID:36652527 | DOI:10.1126/sciadv.add5667

Proc Natl Acad Sci U S A. 2023 Jan 24;120(4):e2217937120. doi: 10.1073/pnas.2217937120. Epub 2023 Jan 18.

ABSTRACT

We leverage metadata on over 36 million journal articles and reviews indexed by Scopus in order to estimate migration of scholars based on information on changes in their institutional affiliations over time. We produce a database of yearly international migration flows of scholars, for all countries from 1998 to 2017. We use the open-access database to provide descriptive evidence on the relationship between economic development and the emigration propensity of scholars. Statistical analysis using generalized additive mixed models reveals that emigration rates initially decrease as GDP per capita increases. Then, starting from around 25,000 dollars (2017 constant international dollars at purchasing power parity), the trend reverses and emigration propensity increases as countries get richer. This U-shaped pattern contrasts with what has been found in the literature for emigration rates for the general population and calls for theoretical frameworks to understand the heterogeneous responses of migration to development.

PMID:36652474 | DOI:10.1073/pnas.2217937120

PLoS One. 2023 Jan 18;18(1):e0279204. doi: 10.1371/journal.pone.0279204. eCollection 2023.

ABSTRACT

BACKGROUND: Previous clinical and in vitro investigations have supported the efficacy of a glycerol throat spray containing cold-adapted cod trypsin (ColdZyme) against respiratory viruses causing the common cold bycreating a protective mucosal barrier shown to deactivate common cold virus in vitro and decrease pharyngeal rhinovirus load.

METHODS AND FINDINGS: This was a double-blind, randomized, parallel-group, placebo-controlled study conducted at 10 German sites to evaluate the efficacy of the medical device ColdZyme, a glycerol mouth spray containing cold-adapted cod trypsin for a naturally occurring common cold versus placebo spray. Adults experiencing a minimum of three common colds during the previous year, but otherwise healthy, were enrolled to begin treatment with the mouth spray or placebo six times daily at first sign of a common cold. Jackson’s symptom scale and the 9-item Wisconsin Upper Respiratory Symptom Survey-21 (WURSS-21) quality of life (QoL) domain and a sore throat scale were recorded daily by subjects, as well as any use of allowed rescue treatment. Between January and April 2019, 701 subjects were enrolled and randomly assigned to the ColdZyme group (n = 351) or the placebo group (n = 350). Of the 701 subjects, 438 (62.5%) subjects developed symptoms typical of common cold, and all 438 started study treatment (n = 220 in the ColdZyme group and n = 218 in the placebo group). The demographic profile of the treatment groups were comparable with 68.1% female and almost all subjects being Caucasian (98.4%). The age ranged between 18 and 70 years with a mean age of 41.3 (±14.4) years. There were no differences between the groups in primary and major secondary endpoints, however, the assessment using the WURSS-21 QoL domain and Jackson score suggests a slightly faster recovery with ColdZyme as symptoms and complaints affecting the quality of life were shortened by about 1 day. The beneficial effect of ColdZyme was particularly noticeable on the fifth day of the common cold. A positive difference between treatment groups was also seen for the subjects’ assessments of global efficacy of the investigational product A robust safety profile for ColdZyme was demonstrated throughout the study.

CONCLUSION: The safety and tolerability of ColdZyme have been confirmed in a large study population and further establishes evidence of a faster recovery from common cold symptoms. Early self-diagnosis and early use of ColdZyme mouth spray is a safe alternative for treatment of naturally occurring colds.

PMID:36652464 | DOI:10.1371/journal.pone.0279204

PLoS One. 2023 Jan 18;18(1):e0280349. doi: 10.1371/journal.pone.0280349. eCollection 2023.

ABSTRACT

In this study, we propose a generalized Marshall-Olkin exponentiated exponential distribution as a submodel of the family of generalized Marshall-Olkin distribution. Some statistical properties of the proposed distribution are examined such as moments, the moment-generating function, incomplete moment, and Lorenz and Bonferroni curves. We give five estimators for the unknown parameters of the proposed distribution based on maximum likelihood, least squares, weighted least squares, and the Anderson-Darling and Cramer-von Mises methods of estimation. To investigate the finite sample properties of the estimators, a comprehensive Monte Carlo simulation study is conducted for the models with three sets of randomly selected parameter values. Finally, four different real data applications are presented to demonstrate the usefulness of the proposed distribution in real life.

PMID:36652462 | DOI:10.1371/journal.pone.0280349

Acad Med. 2023 Jan 16. doi: 10.1097/ACM.0000000000005153. Online ahead of print.

ABSTRACT

PROBLEM: Ability to set goals and work with coaches can support individualized, self-directed learning. Understanding the focus and quality of graduating medical student and first-year resident goals and the influence of coaching on goal-setting can inform efforts to support learners through the transition from medical school to residency.

APPROACH: This observational study examined goal-setting among graduating medical students and first-year residents from April 2021-March 2022. The medical students set goals while participating in a Transition to Residency elective. The residents in internal medicine, obstetrics and gynecology, emergency medicine, orthopedics, and pathology set goals through meeting 1:1 with coaches. Raters assessed goals using a 3-point rubric on domains of specific, measurable, attainable, relevant, and timely (i.e., the SMART goal framework) and analyzed descriptive statistics, Mann-Whitney-U tests, and linear regressions.

OUTCOMES: Among 48 medical students, 30 (62.5%) set 108 goals for early residency. Among 134 residents, 62 (46.3%) entered goals. The residents met with coaches 2.8 times on average (range 0-8 meetings, median = 3). Goal quality was higher in residents than medical students (average score for S: 2.71 vs 2.06, P < .001; M: 2.38 vs 1.66, P < .001; A: 2.92 vs 2.64, P < .001; R: 2.94 vs 2.86, P = .002; T: 1.71 vs 1.31, P < .001). Linear regression showed the number of coaching meetings was associated with more specific and measurable goals (specific: F [1, 1.02] = 6.56, P = .01, R2 =.10; measurable: F [1, 1.49] = 4.74, P = .03, R2 =.07).

NEXT STEPS: Learners set realistic and attainable goals through the transition to residency, but the goals could be more specific, measurable, and timely. The residents set SMARTer goals, with coaching improving goal quality. Understanding how best to scaffold coaching and support goal-setting through this transition may improve trainees’ self-directed learning and well-being.

PMID:36652456 | DOI:10.1097/ACM.0000000000005153

Prehosp Emerg Care. 2023 Jan 18:1-13. doi: 10.1080/10903127.2022.2162648. Online ahead of print.

ABSTRACT

BACKGROUND: Medication dosing errors are common in prehospital pediatric patients. Prior work has shown the overall medication error rate by emergency medical services (EMS) in Michigan was 34.7%. To reduce these errors, the state of Michigan implemented a pediatric dosing reference in 2014 listing medication doses and volume to be administered.

OBJECTIVE: To examine changes in pediatric dosing errors by EMS in Michigan after implementation of the pediatric dosing reference.

METHODS: We conducted a retrospective review of the Michigan Emergency Medical Services Information System (MIEMSIS) of children ≤ 12 years of age from June 2016-May 2017 treated by 16 EMS agencies. Agencies were a mix of public, private, third-service, and fire-based. A dosing error was defined as >20% deviation from the weight-appropriate dose listed on the pediatric dosing reference. Descriptive statistics with confidence intervals and standard deviations are reported.

RESULTS: During the study period, there were 9,247 pediatric encounters, of whom 727 (7.9%) received medications and are included in the study. There were 1078 medication administrations, with 380 dosing errors (35.2% [95% CI 25.3-48.4]). The highest error rates were for dextrose 50% (3/4 or 75% [95% CI 32.57-100.0]) and glucagon (3/4 or 75% [95% CI 32.57-100.0]). The next highest proportions of incorrect doses were opioids: intranasal fentanyl (11/16 or 68.8% [95% CI 46.04-91.46]) and intravenous fentanyl (89/130 or 68.5% [95% CI 60.47-76.45]). Morphine had a much lower error rate (24/51 or 47.1% [95% CI 33.36-60.76]). Midazolam had the third highest error rate, for intravenous (27/50 or 54.0% [95% CI (40.19-67.81]) and intramuscular (25/68 or 36.8% [95% CI 40.19-67.81]) routes. Epinephrine 1 mg/10 ml had an incorrect dosage rate of 35/119 (29.4% [95% CI 20.64-36.99]). Asthma medications had the lowest rate of incorrect dosing (albuterol sulfate 9/247 or 3.6% [95% CI 1.31-5.98]).

CONCLUSIONS: Medications administered to prehospital pediatric patients continue to demonstrate dosing errors despite pediatric dosing reference implementation. Although there have been improvements in error rates in asthma medications, the overall error rate has increased. Continued work to build patient safety strategies to reduce pediatric medication dosing errors by EMS is needed.

PMID:36652452 | DOI:10.1080/10903127.2022.2162648