Nevin Manimala

J Neuroradiol. 2023 May 2:S0150-9861(23)00200-6. doi: 10.1016/j.neurad.2023.05.001. Online ahead of print.

ABSTRACT

PURPOSE: To explore the intrinsic alteration of cerebral 18F-FDG metabolism in acute/subacute seropositive autoimmune encephalitis (AE) and to propose a universal classification model based on 18F-FDG metabolic patterns to predict AE.

METHODS: Cerebral 18F-FDG PET images of 42 acute/subacute seropositive AE patients and 45 healthy controls (HCs) were compared using voxelwise and region of interest (ROI)-based schemes. The mean standardized uptake value ratios (SUVRs) of 59 subregions according to a modified Automated Anatomical Labeling (AAL) atlas were compared using a t-test. Subjects were randomly divided into a training set (70%) and a testing set (30%). Logistic regression models were built based on the SUVRs and the models were evaluated by determining their predictive value in the training and testing sets.

RESULTS: The 18F-FDG uptake pattern in the AE group was characterized by increased SUVRs in the brainstem, cerebellum, basal ganglia, and temporal lobe, and decreased SUVRs in the occipital, and frontal regions with voxelwise analysis (false discovery rate [FDR] p<0.05). Utilizing ROI-based analysis, we identified 15 subareas that exhibited statistically significant changes in SUVRs among AE patients compared to HC (FDR p<0.05). Further, a logistic regression model incorporating SUVRs from the calcarine cortex, putamen, supramarginal gyrus, cerebelum_10, and hippocampus successfully enhanced the positive predictive value from 0.76 to 0.86 when compared to visual assessments. This model also demonstrated potent predictive ability, with AUC values of 0.94 and 0.91 observed for the training and testing sets, respectively.

CONCLUSIONS: During the acute/subacute stages of seropositive AE, alterations in SUVRs appear to be concentrated within physiologically significant regions, ultimately defining the general cerebral metabolic pattern. By incorporating these key regions into a new classification model, we have improved the overall diagnostic efficiency of AE.

PMID:37142216 | DOI:10.1016/j.neurad.2023.05.001

Environ Pollut. 2023 May 2:121757. doi: 10.1016/j.envpol.2023.121757. Online ahead of print.

ABSTRACT

Nonylphenol (NP), Octylphenol (OP), and their ethoxylates (NPEO and OPEO) have been the subject of considerable scientific and regulatory attention, primarily due to concerns about their aquatic toxicity and endocrine activity. Environmental monitoring has been conducted and reported for these substances in the United States (U.S.) for several decades. This paper develops an updated statistically based meta-analysis of the occurrence and ecological relevance of these substances in fresh and marine surface waters and sediments in the U.S. between 2010 and 2020. The overall objectives of this study were: (1) to evaluate the impact of analytical detection limits (DLs) and treatment of censored or non-detected (ND) samples on reported results, (2) to summarize and evaluate recent (2010-2020) occurrence and concentrations of these substances in surface waters and sediments, (3) to conduct an ecological screening assessment of the potential risks of these substances to aquatic organisms in surface waters and sediments for this same period, and (4) to examine temporal trends of these substances in surface waters and sediments relative to previous investigations. Given that a large proportion of all NP, NPEO, OP and OPEO samples in recent (2010-2019) U.S. monitoring studies were below their respective method Limit of Detection/Limit of Quantification (LOD/LOQ) detection frequency ranging from 0 to 24%), proxy values were imputed using robust regression of order statistics (ROS). Nationally, NP and OP concentrations in fresh surface waters and sediments have decreased from 2010 to 2019. In contrast, changes in NP and OP concentrations in marine waters and sediments were more variable with some increases noted. A screening environmental risk assessment indicated that less than 1% of all samples exceeded U.S. or Canadian environmental quality guidelines. No exceedances were noted after 2016 which indicates a low potential for risk to aquatic organisms.

PMID:37142212 | DOI:10.1016/j.envpol.2023.121757

Am J Obstet Gynecol MFM. 2023 May 2:100994. doi: 10.1016/j.ajogmf.2023.100994. Online ahead of print.

ABSTRACT

BACKGROUND: The composition of the infant microbiome can have a variety of short- and long-term implications for health. It is unclear if maternal probiotic supplementation in pregnancy can impact infant gut microbiome.

OBJECTIVE: The aim of our study was to investigate if maternal supplementation of a formulation of Bifidobacterium breve 702258 from early pregnancy until three months postpartum could transfer to the infant gut.

STUDY DESIGN: This was a double-blinded placebo controlled randomised-controlled trial of B. breve 702258 (minimum 1 × 10⁹ colony forming units) or placebo taken orally from 16-weeks’ gestation until three-months postpartum in healthy pregnant women. The primary outcome was presence of the supplemented strain in infant stool up to 3 months of life, detected by at a least two of three methods, i.e., strain specific PCR, shotgun metagenomic sequencing, or genome sequencing of cultured B. breve. 120 individual infants’ stool samples were required for 80% power to detect a difference in strain transfer between groups. Rates of detection were compared using Fishers exact test.

RESULTS: 160 pregnant women with average age 33.6 (3.9) years, mean BMI of 24.3 (22.5, 26.5) kg/m² and 43% with nulliparity (n=58) were recruited from September 2016 to July 2019. Neonatal stool samples were obtained from 135 infants (65 in intervention and 70 in control). The presence of the supplemented strain was detected through at least two methods (PCR and culture) in two infants in the intervention group (n=2/65, 3.1%) and none in the control group (n=0, 0%), p = 0.230.

CONCLUSION: Direct strain transfer from mothers to infants of B. breve 772058 occurred, albeit infrequently. This study highlights potential for maternal supplementation to introduce microbial strains into the infant microbiome.

PMID:37142190 | DOI:10.1016/j.ajogmf.2023.100994

Am J Obstet Gynecol MFM. 2023 May 2:101004. doi: 10.1016/j.ajogmf.2023.101004. Online ahead of print.

NO ABSTRACT

PMID:37142189 | DOI:10.1016/j.ajogmf.2023.101004

Am J Ophthalmol. 2023 May 2:S0002-9394(23)00184-8. doi: 10.1016/j.ajo.2023.04.010. Online ahead of print.

ABSTRACT

PURPOSE: To compare long-term visual outcomes in the two arms of the Early Manifest Glaucoma Trial (EMGT) and determine if delayed treatment was associated with a penalty in terms of visual function.

DESIGN: Long-term follow-up of a prospective, randomized controlled clinical trial.

METHODS: EMGT was carried out at two centers in Sweden; 255 subjects with newly detected, untreated glaucoma were randomized to immediate treatment with topical betaxolol and argon laser trabeculoplasty or to no initial treatment as long as no progression was detected. Subjects were followed prospectively with standard automated perimetry, visual acuity measurements and tonometry for up to 21 years. Outcomes included vision impairment (VI), the perimetric Mean Deviation (MD) index and rate of progression, and visual acuity.

RESULTS: At study end percentages of eyes with VI or blindness were slightly higher in the treated group than in the untreated control group, 12.1% versus 11.0%, and 9.4.% versus 6.1% respectively, as were subjects with VI≥1 eye, 19.5% versus 18.7%. The differences were not statistically significant, nor were cumulative incidences of VI in at least one eye. The control group had more field loss than the treatment group, with median MD in the worse eye of -14.73 dB versus -12.85 dB, and rate of progression of -0.74 versus -0.60 dB/year; not statistically significant. Differences in visual acuity were minimal.

CONCLUSIONS: Delaying treatment did not result in serious penalties. VI occurred at similar proportions in both treatment arms with a slight preponderance in the treatment group, while visual field damage was slightly higher in the control group.

PMID:37142174 | DOI:10.1016/j.ajo.2023.04.010

Arthroscopy. 2023 May 2:S0749-8063(23)00376-6. doi: 10.1016/j.arthro.2023.04.012. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the outcomes of arthroscopic superior capsular reconstruction (SCR) and arthroscopic assisted lower trapezius tendon transfer (LTT) for posterosuperior irreparable rotator cuff tears (IRCT).

METHODS: Over a 6-year period (2015 – 2021), all patients who underwent an IRCT surgery with a 12-month minimum follow-up were identified. For patients with a substantial active external rotation (ER) deficit or lag sign, LTTs were preferentially selected. Patient-reported outcome scores (PROS) included visual analog scale (VAS) for pain, strength, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), Single Assessment Numerical Evaluation (SANE), and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores.

RESULTS: We included 32 SCRs and 72 LTTs. Preoperatively, LTTs had more advanced teres minor fatty infiltration (0.3 vs. 1.1; P = .009), global fatty infiltration index (1.5 vs. 1.9; P = .035), and a more common presence of an ER lag sign (15.6% vs. 48.6%; P < .001). At a mean follow-up of 2.9 ± 1.3 years (range, 1.0 – 6.3 years) no differences were observed in PROS. Postoperatively, SCRs had a lower VAS (0.3 vs. 1.1; P = .017), higher forward elevation (FE) (156° vs. 143°; P = .004), FE strength (4.8 vs. 4.5; P = .005), and a greater improvement in VAS (6.8 vs. 5.1; P = .009), FE (56° vs. 31°; P = .004), and FE strength (1.0 vs. 0.4; P < .001). LTTs had a better improvement in ER (17° vs. 29°; P = .026). There were no statistical cohort differences in complications (9.4% vs. 12.5%; P = .645) or reoperations (3.1% vs. 10%; P = .231)..

CONCLUSIONS: With adequate selection criteria, both SCR and LTT provided improved clinical outcomes for posterosuperior IRCTs. Additionally, SCR led to better pain relief and restoration of FE while LTT provided more reliable improvement in ER.

PMID:37142136 | DOI:10.1016/j.arthro.2023.04.012

Hand Surg Rehabil. 2023 May 2:S2468-1229(23)00077-4. doi: 10.1016/j.hansur.2023.04.007. Online ahead of print.

ABSTRACT

PURPOSE: Lacertus syndrome is defined as proximal median nerve entrapment at the lacertus fibrosus. We aimed to analyze change in pinch strengths in patients who underwent median nerve release at the lacertus fibrosus under WALANT (wide-awake local anesthesia, no tourniquet).

METHODS: Pinch strength was measured with a pinch gauge. Subjective DASH score and pain, numbness in the operated extremity and satisfaction on visual analog scales were analyzed before and 6 weeks after surgery.

RESULTS: There were 32 patients. Median nerve release under the lacertus fibrosus elicited statistically significant increases in tip-to-tip, lateral and tripod pinch strength at postoperative week 6. Improvements in DASH score, pain and paresthesia were also statistically significant.

CONCLUSIONS: For lacertus syndrome treatment, mini-incision release of the lacertus fibrosus under WALANT was satisfactory and increased pinch strength significatively.

LEVEL OF EVIDENCE: Therapeutic, Level IV – Case series.

PMID:37142123 | DOI:10.1016/j.hansur.2023.04.007

Comput Biol Med. 2023 Apr 24;160:106966. doi: 10.1016/j.compbiomed.2023.106966. Online ahead of print.

ABSTRACT

One of the worst diseases is a brain tumor, which is defined by abnormal development of synapses in the brain. Early detection of brain tumors is essential for improving prognosis, and classifying tumors is a vital step in the disease’s treatment. Different classification strategies using deep learning have been presented for the diagnosis of brain tumors. However, several challenges exist, such as the need for a competent specialist in classifying brain cancers by deep learning models and the problem of building the most precise deep learning model for categorizing brain tumors. We propose an evolved and highly efficient model based on deep learning and improved metaheuristic algorithms to address these challenges. Specifically, we develop an optimized residual learning architecture for classifying multiple brain tumors and propose an improved variant of the Hunger Games Search algorithm (I-HGS) based on combining two enhancing strategies: Local Escaping Operator (LEO) and Brownian motion. These two strategies balance solution diversity and convergence speed, boosting the optimization performance and staying away from the local optima. First, we have evaluated the I-HGS algorithm on the IEEE Congress on Evolutionary Computation held in 2020 (CEC’2020) test functions, demonstrating that I-HGS outperformed the basic HGS and other popular algorithms regarding statistical convergence, and various measures. The suggested model is then applied to the optimization of the hyperparameters of the Residual Network 50 (ResNet50) model (I-HGS-ResNet50) for brain cancer identification, proving its overall efficacy. We utilize several publicly available, gold-standard datasets of brain MRI images. The proposed I-HGS-ResNet50 model is compared with other existing studies as well as with other deep learning architectures, including Visual Geometry Group 16-layer (VGG16), MobileNet, and Densely Connected Convolutional Network 201 (DenseNet201). The experiments demonstrated that the proposed I-HGS-ResNet50 model surpasses the previous studies and other well-known deep learning models. I-HGS-ResNet50 acquired an accuracy of 99.89%, 99.72%, and 99.88% for the three datasets. These results efficiently prove the potential of the proposed I-HGS-ResNet50 model for accurate brain tumor classification.

PMID:37141655 | DOI:10.1016/j.compbiomed.2023.106966

Neuroimage Clin. 2023 Apr 29;38:103424. doi: 10.1016/j.nicl.2023.103424. Online ahead of print.

ABSTRACT

Substance use disorders are characterized by reduced control over the quantity and frequency of psychoactive substance use and impairments in social and occupational functioning. They are associated with poor treatment compliance and high rates of relapse. Identification of neural susceptibility biomarkers that index risk for developing a substance use disorder can facilitate earlier identification and treatment. Here, we aimed to identify the neurobiological correlates of substance use frequency and severity amongst a sample of 1,200 (652 females) participants aged 22-37 years from the Human Connectome Project. Substance use behaviour across eight classes (alcohol, tobacco, marijuana, sedatives, hallucinogens, cocaine, stimulants, opiates) was measured using the Semi-Structured Assessment for the Genetics of Alcoholism. We explored the latent organization of substance use behaviour using a combination of exploratory structural equation modelling, latent class analysis, and factor mixture modelling to reveal a unidimensional continuum of substance use behaviour. Participants could be rank ordered along a unitary severity spectrum encompassing frequency of use of all eight substance classes, with factor score estimates generated to represent each participant’s substance use severity. Factor score estimates and delay discounting scores were compared with functional connectivity in 650 participants with imaging data using the Network-based Statistic. This neuroimaging cohort excludes participants aged 31 and over. We identified brain regions and connections correlated with impulsive decision-making and poly-substance use, with the medial orbitofrontal, lateral prefrontal and posterior parietal cortices emerging as key hubs. Functional connectivity of these networks could serve as susceptibility biomarkers for substance use disorders, informing earlier identification and treatment.

PMID:37141645 | DOI:10.1016/j.nicl.2023.103424

J Radiat Res. 2023 May 4:rrad026. doi: 10.1093/jrr/rrad026. Online ahead of print.

ABSTRACT

This study aims to propose a novel treatment planning methodology for multi-isocenter volumetric modulated arc therapy (VMAT) craniospinal irradiation (CSI) using the special feasibility dose-volume histogram (FDVH)-guided auto-planning (AP) technique. Three different multi-isocenter VMAT -CSI plans were created, including manually based plans (MUPs), conventional AP plans (CAPs) and FDVH-guided AP plans (FAPs). The CAPs and FAPs were specially designed by combining multi-isocenter VMAT and AP techniques in the Pinnacle treatment planning system. Specially, the personalized optimization parameters for FAPs were generated using the FDVH function implemented in PlanIQ software, which provides the ideal organs at risk (OARs) sparing for the specific anatomical geometry based on the valuable assumption of the dose fall-off. Compared to MUPs, CAPs and FAPs significantly reduced the dose for most of the OARs. FAPs achieved the best homogeneity index (0.092 ± 0.013) and conformity index (0.980 ± 0.011), while CAPs were slightly inferior to the FAPs but superior to the MUPs. As opposed to MUPs, FAPs delivered a lower dose to OARs, whereas the difference between FAPs and CAPs was not statistically significant except for the optic chiasm and inner ear_L. The two AP approaches had similar MUs, which were significantly lower than the MUPs. The planning time of FAPs (145.00 ± 10.25 min) was slightly lower than that of CAPs (149.83 ± 14.37 min) and was substantially lower than that of MUPs (157.92 ± 16.11 min) with P < 0.0167. Overall, introducing the multi-isocenter AP technique into VMAT-CSI yielded positive outcomes and may play an important role in clinical CSI planning in the future.

PMID:37141634 | DOI:10.1093/jrr/rrad026