Nevin Manimala

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

Obstet Gynecol. 2023 May 4. doi: 10.1097/AOG.0000000000005176. Online ahead of print.

ABSTRACT

OBJECTIVE: To describe the clinical profile, management, and potential preventability of maternal cardiovascular deaths.

METHODS: We conducted a retrospective, descriptive study of all maternal deaths resulting from a cardiovascular disease during pregnancy or up to 1 year after the end of pregnancy in France from 2007 to 2015. Deaths were identified through the nationwide permanent enhanced maternal mortality surveillance system (ENCMM [Enquête Nationale Confidentielle sur les Morts Maternelles]). Women were classified into four groups based on the assessment of the national experts committee: those who died of a cardiac condition and those who died of a vascular condition and, within these two groups, whether the condition was known before the acute event. Maternal characteristics, clinical features and components of suboptimal care, and preventability factors, which were assessed with a standard evaluation form, were described among those four groups.

RESULTS: During the 9-year period, 103 women died of cardiac or vascular disease, which corresponds to a maternal mortality ratio from these conditions of 1.4 per 100,000 live births (95% CI 1.1-1.7). Analyses were conducted on 93 maternal deaths resulting from cardiac (n=70) and vascular (n=23) disease with available data from confidential inquiry. More than two thirds of these deaths occurred in women with no known pre-existing cardiac or vascular condition. Among the 70 deaths resulting from a cardiac condition, 60.7% were preventable, and the main preventability factor was a lack of multidisciplinary prepregnancy and prenatal care for women with a known cardiac disease. For those with no known pre-existing cardiac condition, preventability factors were related mostly to inadequate prehospital care of the acute event, in particular an underestimation of the severity and inadequate investigation of the dyspnea. Among the 23 women who died of a vascular disease, three had previously known conditions. For women with no previously known vascular condition, 47.4% of deaths were preventable, and preventability factors were related mostly to wrong or delayed diagnosis and management of acute intense chest or abdominal pain in a pregnant woman.

CONCLUSION: Most maternal deaths attributable to cardiac or vascular diseases were potentially preventable. The preventability factors varied according to the cardiac or vascular site and whether the condition was known before pregnancy. A more granular understanding of the cause and related risk factors for maternal mortality is crucial to identify relevant opportunities for improving care and training health care professionals.

PMID:37141627 | DOI:10.1097/AOG.0000000000005176

Obstet Gynecol. 2023 May 4. doi: 10.1097/AOG.0000000000005171. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate whether preterm birth rates changed in relation to the onset of the coronavirus disease 2019 (COVID-19) pandemic and whether any change depended on socioeconomic status.

METHODS: This is an observational cohort study of pregnant individuals with a singleton gestation who delivered in the years 2019 and 2020 at 1 of 16 U.S. hospitals of the Maternal-Fetal Medicine Units Network. The frequency of preterm birth for those who delivered before the onset of the COVID-19 pandemic (ie, in 2019) was compared with that of those who delivered after its onset (ie, in 2020). Interaction analyses were performed for people of different individual- and community-level socioeconomic characteristics (ie, race and ethnicity, insurance status, Social Vulnerability Index (SVI) of a person’s residence).

RESULTS: During 2019 and 2020, 18,526 individuals met inclusion criteria. The chance of preterm birth before the COVID-19 pandemic was similar to that after the onset of the pandemic (11.7% vs 12.5%, adjusted relative risk 0.94, 95% CI 0.86-1.03). In interaction analyses, race and ethnicity, insurance status, and the SVI did not modify the association between the epoch and the chance of preterm birth before 37 weeks of gestation (all interaction P>.05).

CONCLUSION: There was no statistically significant difference in preterm birth rates in relation to the COVID-19 pandemic onset. This lack of association was largely independent of socioeconomic indicators such as race and ethnicity, insurance status, or SVI of the residential community in which an individual lived.

PMID:37141586 | DOI:10.1097/AOG.0000000000005171

Am J Public Health. 2023 May 4:e1-e6. doi: 10.2105/AJPH.2023.307287. Online ahead of print.

ABSTRACT

Medicaid is the primary payor for nearly half of all births in the United States and plays a disproportionate role in covering maternity care for low-income people, rural people, and minoritized racial groups. Newly available, modernized Medicaid claims data-the Transformed Medicaid Statistical Information System Analytic Files (TAF)-offer a significant opportunity to conduct novel research that can drive the development of evidence-based programs and policies for Medicaid beneficiaries before, during, and after pregnancy. Yet, the public health research community has so far underused the TAF for maternal health research. We provide an overview of the TAF and how they compare to other major data sets available to study maternal health. We highlight some major limitations of the TAF and offer strategies to maximize the potential of these novel data to accelerate timely, rigorous research to improve maternal health and health equity. (Am J Public Health. Published online ahead of print May 4, 2023:e1-e6. https://doi.org/10.2105/AJPH.2023.307287).

PMID:37141557 | DOI:10.2105/AJPH.2023.307287

Am J Public Health. 2023 May 4:e1-e4. doi: 10.2105/AJPH.2023.307298. Online ahead of print.

ABSTRACT

Objectives. To estimate county-level cigarette smoking prevalence in Virginia and examine cigarette use disparities by rurality, Appalachian status, and county-level social vulnerability. Methods. We used 2011-2019 Virginia Behavioral Risk Factor Surveillance System proprietary data with geographical information to estimate county-level cigarette smoking prevalence using small area estimation. We used the Centers for Disease Control and Prevention’s social vulnerability index to quantify social vulnerability. We used the 2-sample statistical t test to determine the differences in cigarette smoking prevalence and social vulnerability between counties by rurality and Appalachian status. Results. The absolute difference in smoking prevalence was 6.16 percentage points higher in rural versus urban counties and 7.52 percentage points higher in Appalachian versus non-Appalachian counties in Virginia (P < .001). Adjusting for county characteristics, a higher social vulnerability index is associated with increased cigarette use. Rural Appalachian counties had 7.41% higher cigarette use rates than did urban non-Appalachian areas. Tobacco agriculture and a shortage of health care providers were significantly associated with higher cigarette use prevalence. Conclusions. Rural Appalachia and socially vulnerable counties in Virginia have alarmingly high rates of cigarette use. Implementation of targeted intervention strategies could reduce cigarette use, ultimately reducing tobacco-related health disparities. (Am J Public Health. Published online ahead of print May 4, 2023:e1-e4. https://doi.org/10.2105/AJPH.2023.307298).

PMID:37141556 | DOI:10.2105/AJPH.2023.307298