Nevin Manimala

Sci Prog. 2023 Jan-Mar;106(1):368504221149798. doi: 10.1177/00368504221149798.

ABSTRACT

In numerous industrial procedures, the main concern of design engineers is ensuring adequate heat and mass transfer, such as in the heating and cooling practices of solar water heaters, geothermal systems, extrusion of metal, insulation of buildings, electronics, turbines, aerodynamics, electronics, paper manufacturing, and glass fiber production. The unsteady double-diffusive mixed convection flow of boundary layer nanofluids above a vertical region near stagnation point flow is developed and examined here. The Brownian motion and thermophoresis effects are incorporated by using Buongiorno’s model. In the thermal energy equations, diffusion of regular and cross types is also used. By the use of the local similarity method along with suitable similarity transformations, nonlinear unsteady partial differential equations are converted to nonlinear ordinary differential equations and are numerically solved by the Keller-Box method. The investigation expresses that these profiles of solute concentration and nanoparticle concentration, temperature, and velocity in their boundary layers, respectively, depending on several parameters. A graphic analysis of all these parameters’ possessions on nature’s boundary layers is depicted. The highest rate of heat transfer is obtained with negligible thermophoresis effect. Furthermore, it is perceived that an increase in Nc and Nt results in a reduction in the reduced Sherwood number of nanoparticles, whereas addition results in an increase in the Nb number. There is a reverse effect on the temperature field and layer thickness for heat generation. In the wake of the above-mentioned potential applications, the current study of fluid flow has been found to be very interesting and innovative in the analysis of the influence of Brownian motion and thermophoresis effects near stagnation point flow, which will further make revolutions in industrial fields. Moreover, Buongiorno’s model predicts the characteristics of double-diffusive fluids in enhancing heat transfers. This investigation has been established as a result of the numerous industrial applications mentioned above.

PMID:36651004 | DOI:10.1177/00368504221149798

CNS Neurosci Ther. 2023 Jan 17. doi: 10.1111/cns.14094. Online ahead of print.

ABSTRACT

MAIN PROBLEM: Inflammation plays an important role in the pathological progress associated with stroke. Serum uric acid (SUA) to lymphocyte ratio (ULR), a novel inflammatory biomarker, has been considered as a better risk stratification tool of adverse outcomes than SUA or lymphocyte alone. This study aimed to investigate whether ULR produced more predictive value for stroke and explore the potential mediators of the associations.

METHODS: This study enrolled 93,023 Chinese participants without stroke and myocardial infarction at baseline. Cox proportional hazard models were used to analyze the associations of ULR with stroke and subtypes. Mediation analyses were conducted to explore potential mediators of the associations.

RESULTS: During a median follow-up of 13.00 years, 6081 cases of incident stroke occurred, including 5048 cases of ischemic stroke (IS) and 900 cases of hemorrhagic stroke (HS). After adjustment for confounders, the Q4 group was associated with a higher risk of HS (HR, 1.25; 95% CI, 1.03-1.50), but not with total stroke (HR, 1.07; 95% CI, 1.03-1.13) or IS (HR, 1.04; 95% CI, 0.97-1.12). No significant associations were found between SUA or lymphocyte and any stroke. ULR outperformed SUA or lymphocytes alone in predicting stroke. Additionally, the significant association between ULR and HS was partially mediated by systolic blood pressure (20.32%), diastolic blood pressure (11.18%) and estimated glomerular filtration rate (9.19%).

CONCLUSIONS: ULR was significantly associated with the risk of HS, but not with IS. Systolic blood pressure, diastolic blood pressure and estimated glomerular filtration rate were potential mediators for the association.

PMID:36650955 | DOI:10.1111/cns.14094

Hum Fertil (Camb). 2023 Jan 17:1-7. doi: 10.1080/14647273.2023.2164869. Online ahead of print.

ABSTRACT

This retrospective study was performed to investigate the predictive power of the Ovarian Sensitivity Index (OSI) for IVF/ICSI outcomes in infertile patients who were of normal expected ovarian response. A total of 912 infertile patients who underwent GnRH antagonist protocol between January 2017 to August 2019 at the Medical Center for Human Reproduction, Beijing Chao-Yang Hospital were included. All patients completed the full oocyte retrieval cycle and either had a live birth or had no embryos left. OSI was significantly lower in patients with a live birth (196.0 ± 120.4 in the live birth group vs 276.4 ± 235.7 in the non-live birth group, p < 0.001) while follicular output rate (FORT, defined as the ratio of pre-ovulatory follicle count on hCG day x 100/small antral follicle count at baseline) showed no significant difference. Patients were divided into low, average and high OSI groups and analysed in tertiles. From the low to the high OSI group, the cumulative live birth rate (CLBR) decreased dramatically (72.7 vs 67.2 vs 54.8%, p < 0.001). Multivariate regression analysis showed that OSI was an independent factor affecting CLBR (OR: 0.996, 95%CI: 0.995-0.998, p < 0.001) in our study population. In conclusion, OSI can be used as an independent indicator to distinguish fecundity in infertile patients with normal expected ovarian response and is probably more sensitive than FORT.

PMID:36650952 | DOI:10.1080/14647273.2023.2164869

Interv Neuroradiol. 2023 Jan 17:15910199221150470. doi: 10.1177/15910199221150470. Online ahead of print.

ABSTRACT

BACKGROUND: Computed tomography (CT) angiography collateral score (CTA-CS) is an important clinical outcome predictor following mechanical thrombectomy for ischemic stroke with large vessel occlusion (LVO). The present multireader study aimed to evaluate the performance of e-CTA software for automated assistance in CTA-CS scoring.

MATERIALS AND METHODS: Brain CTA images of 56 patients with anterior LVO were retrospectively processed. Twelve readers of various clinical training, including junior neuroradiologists, senior neuroradiologists, and neurologists graded collateral flow using visual CTA-CS scale in two sessions separated by a washout period. Reference standard was the consensus of three expert readers. Duration of reading time, inter-rater reliability, and statistical comparison of readers’ performance metrics were analyzed between the e-CTA assisted and unassisted sessions.

RESULTS: e-CTA assistance resulted in significant increase in mean accuracy (58.6% to 67.5%, p = 0.003), mean F1 score (0.574 to 0.676, p = 0.002), mean precision (58.8% to 68%, p = 0.007), and mean recall (58.7% to 69.9%, p = 0.002), especially with slight filling deficit (CTA-CS 2 and 3). Mean reading time was reduced across all readers (103.4 to 59.7 s, p = 0.001), and inter-rater agreement in CTA-CS assessment was increased (Krippendorff’s alpha 0.366 to 0.676). Optimized occlusion laterality detection was also noted with mean accuracy (92.9% to 96.8%, p = 0.009).

CONCLUSION: Automated assistance for CTA-CS using e-CTA software provided helpful decision support for readers in terms of improving scoring accuracy and reading efficiency for physicians with a range of experience and training backgrounds and leading to significant improvements in inter-rater agreement.

PMID:36650942 | DOI:10.1177/15910199221150470

Clin Appl Thromb Hemost. 2023 Jan-Dec;29:10760296221151164. doi: 10.1177/10760296221151164.

ABSTRACT

AIM: To develop and validate a risk assessment model (RAM) of venous thromboembolism (VTE) in hospitalized Chinese patients.

METHODS: We reviewed data from 300 patients with VTE and 300 non-VTE patients at Beijing Shijitan Hospital. The risk factors related to VTE were analyzed, and the VTE RAM (Shijitan (SJT) version) was developed according to the weight of each risk factor. A total of 407 patients with VTE and 533 non-VTE patients were enrolled for external validation. The sensitivity, specificity, Youden index, receiver operating curve (ROC), and area under the ROC curve (AUC) were used to evaluate the performance of VTE RAM (SJT version) compared with Caprini RAM and Padua RAM.

RESULTS: The VTE RAM (SJT version) contained six risk factors (age >60 years, lower limb edema, chronic obstructive pulmonary disease (COPD), central venous catheterization (CVC), VTE history, and D dimer). In the external validation group, for medical patients, the AUC value of SJT RAM (0.82 ± 0.03) is significantly higher than Caprini RAM (0.76 ± 0.04; P < 0.05), SJT RAM has a higher sensitivity, specificity, and Youden index than Caprini RAM (P < 0.05), which means that the SJT RAM has a much better predictive value than Caprini RAM. While SJT RAM and Padua RAM have the similar predictive value for medical patients (P > 0.05). For surgical patients, the AUC value of SJT RAM (0.72 ± 0.04) is significantly higher than the value of Padua RAM (0.66 ± 0.04; P < 0.05), SJT RAM has a higher sensitivity, specificity, and Youden index than Padua RAM (P < 0.05), which shows that the VTE RAM has better predictive value than Padua RAM. While SJT RAM and Caprini RAM have the similar predictive value for surgical patients (P > 0.05).

CONCLUSION: The SJT RAM derived from general hospitalized Chinese patients will be time-saving for physicians and has a better predictive ability for patients at risk of VTE.

PMID:36650933 | DOI:10.1177/10760296221151164

Cancer Med. 2023 Jan 17. doi: 10.1002/cam4.5530. Online ahead of print.

ABSTRACT

Pancreaticobiliary tract cancer has a poor prognosis with unmet needs in a new target treatment. Some studies have reported that an enhancement of T-cell immunity is associated with a good prognosis. The aim of this study is to investigate the immunoprofile as a prognostic marker of pancreaticobiliary tract cancers. Unresectable pancreatic ductal adenocarcinoma (PDAC, n = 80) and biliary tract cancer (BTC, n = 74) diagnosed between January 2012 and December 2018 in Samsung Medical Center were analyzed. Expression levels of CD8, FOXP3, PD-1, PD-L1, and CXCL13 in PDAC and BTC tissue samples were examined with immunohistochemical staining, which was evaluated with various clinical factors. In PDAC, higher degree of PD-L1 expression was significantly associated with shorter overall survival (OS) (p = 0.0095). On the other hand, higher infiltrations of PD-1⁺ immune cells (p = 0.0002) and CD8⁺ T cells (p = 0.0067) were associated with longer OS. In BTC, higher FOXP3⁺ (p = 0.0343) and CD8⁺ (p = 0.0028) cell infiltrations were associated with better survival. Low infiltration of CD8⁺ (p = 0.0148), FOXP3⁺ (p = 0.0208), PD-1⁺ (p = 0.0318) cells in PDAC, and FOXP3⁺ cells (p = 0.005) in BTC were considerably related to metastasis. In a combined evaluation of clinical factors and immunoprofiles, univariate analysis revealed that operation after chemotherapy (p < 0.0001), mass size (p = 0.0004), metastasis (p = 0.006), PD-L1 (p < 0.0001), PD-1 (p = 0.003) and CD8 (p = 0.0063) was significantly associated with OS in PDAC, and CD8 (p = 0.007) was statistically related to OS in BTC. In multivariate analysis, prognostic factors were operation after chemotherapy (p = 0.021) in PDAC and CD8 (p = 0.037) in BTC. Therefore, immunoprofile analysis of cells expressing CD8, FOXP3, PD-1, and PD-L1 might have prognostic values in patients with pancreaticobiliary tract cancers.

PMID:36650632 | DOI:10.1002/cam4.5530

J Matern Fetal Neonatal Med. 2023 Dec;36(1):2166400. doi: 10.1080/14767058.2023.2166400.

ABSTRACT

OBJECTIVES: We aim to assess if implementation of an educational video module can improve patient adherence to recommended weight gain guidelines. Secondarily, we investigated if patients’ knowledge about gestational weight gain was improved with use of the video, as well as if there was a difference in maternal and neonatal outcomes, and patient satisfaction.

METHODS: This was an IRB-approved, prospective cohort study conducted from February 2019 to October 2019. Patients were recruited from a large academic practice during their first trimester of pregnancy. Patients in the control cohort received routine care. Patients in the video cohort watched a 5-min educational video module about gestational weight gain. Pre-pregnancy weight and baseline demographics were recorded. All patients took a baseline questionnaire assessing gestational weight gain knowledge upon enrollment, and again 4 weeks later. Pre and post score differences were calculated. On admission to the hospital for delivery, all patients’ gestational weight gain was calculated, and the overall gestational weight gain differences between the two groups were calculated. Maternal and neonatal delivery outcomes were also collected. T-tests, Mann-Whitney U tests, and Chi-square analyses were used to compare groups, and a p-value of <.05 was deemed statistically significant.

RESULTS: During the study period, 155 patients were recruited, with 79 in control cohort and 76 in video cohort, respectively. There was no significant difference in the percentage of patients who gained the appropriate amount of weight between the two groups; 25% (18/74) of patients in the control vs. 25% (17/68) of patients in video cohort (p = .926). There was no difference in the improvement of the pre and post assessment scores when compared between the two cohorts; the average score improvement was 1.72 ± 15.09% for the control, vs. 6.20 ± 12.51% for video cohort (p = .129). There was no difference in maternal or neonatal outcomes between the two groups. Patients were overall satisfied with the video module, with 67.6% (n = 45) reporting the video to be very educational.

CONCLUSIONS: Use of a video module did not improve GWG outcomes or knowledge in our study. Future work can focus on use of a recurring intervention throughout pregnancy, either with app-based technology or multiple videos.

PMID:36650631 | DOI:10.1080/14767058.2023.2166400

Clin J Pain. 2023 Feb 1;39(2):68-75. doi: 10.1097/AJP.0000000000001091.

ABSTRACT

OBJECT: To estimate the contrast dispersion short-term clinical efficacy and safety of ultrasound (US)-guided transforaminal steroid injection (TFSI) compared with computed tomography (CT) guidance for the treatment of cervical radicular pain.

METHOD: A total of 430 patients with cervical radicular pain from cervical herniated disk or cervical spondylosis were recruited in the randomized, single-blind, controlled, noninferiority trial. The patients were randomly assigned to receive either the US-guided or CT-guided TFSI for 1 affected cervical nerve. The dispersion pattern of contrast was monitored at the time of TFSI in both groups, using CT. Patients were assessed for pain intensity by numeric rating scale (NrS) and functional disability by Neck Disability Index (NDI) at baseline, 1 and 3 months after the intervention. Complications were also recorded.

RESULTS: The satisfactory rate of contrast distribution was respectively 92.1% in US group and 95.8% in CT group. Pain reduction and functional improvement were showed in both groups during follow-up. Statistical difference was not observed in the decrease in NRS pain scores and NDI scores between 2 groups with F=1.050, P=0.306 at 1 month and F=0.103, P=0.749 at 3 months after intervention. No permanent and severe complications were observed.

CONCLUSIONS: This study demonstrated that US provided a noninferior injectate spread pattern and similar improvement of radicular pain and functional status when compared with CT-guided TFSI. US may be advantageous during this procedure because it allows visualization of critical vessels and avoids radiation exposure.

PMID:36650602 | DOI:10.1097/AJP.0000000000001091

Trials. 2023 Jan 17;24(1):35. doi: 10.1186/s13063-023-07085-7.

ABSTRACT

BACKGROUND: Using functional foods in the prevention and treatment of type 2 diabetes mellitus (T2DM) has increased across the world owing to their availability, cultural acceptability, and lower side effects. The present study will aim to examine the impact of bitter almond (Amygdalus communis L. var. Amara) gum as a functional food on metabolic profile, inflammatory markers, and mental health in women with T2DM.

METHODS: We will conduct a randomized, triple-blind, placebo-controlled trial. A total of 44 women with T2DM will be randomly allocated into two groups: an intervention group (n = 20) and a placebo group (n = 20). Patients will receive either 5 g/d of bitter melon gum or a placebo for 8 weeks. Clinical and biochemical outcome parameters which include glycemic indices, lipid profile, inflammatory markers, oxidative stress indices, tryptophan (Trp), kynurenine (KYN), cortisol, glucagon-like peptide 1 (GLP-1), leptin, adiponectin, ghrelin, peroxisome proliferator-activated receptor (PPAR) gene expression, brain-derived neurotrophic factor (BDNF), endothelial cell adhesion molecules, plasminogen, cluster deference 4 (CD4), cluster deference 8 (CD8), anthropometric indices, blood pressure, dietary intake, and mental health will be measured at the baseline and end of the study. Statistical analysis will be conducted using the SPSS software (version 24), and P value less than 0.05 will be considered statistically significant.

DISCUSSION: The present randomized controlled trial will aim to investigate any beneficial effects of bitter almond gum supplementation on the cardio-metabolic, immune-inflammatory, and oxidative stress biomarkers, as well as mental health in women with T2DM.

ETHICS AND DISSEMINATION: The study protocol was approved by the Ethical Committee of the Tabriz University of Medical Sciences (IR.TBZMED.REC.1399.726).

TRIAL REGISTRATION: Iranian Registry of Clinical Trials ( www.irct.ir/IRCT20150205020965N7 ).

PMID:36650599 | DOI:10.1186/s13063-023-07085-7

Crit Care. 2023 Jan 17;27(1):21. doi: 10.1186/s13054-023-04315-x.

ABSTRACT

BACKGROUND: In patients with acute respiratory distress syndrome undergoing mechanical ventilation, positive end-expiratory pressure (PEEP) can lead to recruitment or overdistension. Current strategies utilized for PEEP titration do not permit the distinction. Electric impedance tomography (EIT) detects and quantifies the presence of both collapse and overdistension. We investigated whether using EIT-guided PEEP titration leads to decreased mechanical power compared to high-PEEP/FiO2 tables.

METHODS: A single-center, randomized crossover pilot trial comparing EIT-guided PEEP selection versus PEEP selection using the High-PEEP/FiO₂ table in patients with moderate-severe acute respiratory distress syndrome. The primary outcome was the change in mechanical power after each PEEP selection strategy. Secondary outcomes included changes in the 4 × driving pressure + respiratory rate (4 ΔP, + RR index) index, driving pressure, plateau pressure, PaO₂/FiO₂ ratio, and static compliance.

RESULTS: EIT was consistently associated with a decrease in mechanical power compared to PEEP/FiO₂ tables (mean difference – 4.36 J/min, 95% CI – 6.7, – 1.95, p = 0.002) and led to lower values in the 4ΔP + RR index (- 11.42 J/min, 95% CI – 19.01, – 3.82, p = 0.007) mainly driven by a decrease in the elastic-dynamic power (- 1.61 J/min, – 2.99, – 0.22, p = 0.027). The elastic-static and resistive powers were unchanged. Similarly, EIT led to a statistically significant change in set PEEP (- 2 cmH₂O, p = 0.046), driving pressure, (- 2.92 cmH2O, p = 0.003), peak pressure (- 6.25 cmH₂O, p = 0.003), plateau pressure (- 4.53 cmH₂O, p = 0.006), and static respiratory system compliance (+ 7.93 ml/cmH₂O, p = 0.008).

CONCLUSIONS: In patients with moderate-severe acute respiratory distress syndrome, EIT-guided PEEP titration reduces mechanical power mainly through a reduction in elastic-dynamic power. Trial registration This trial was prospectively registered on Clinicaltrials.gov (NCT03793842) on January 4th, 2019.

PMID:36650593 | DOI:10.1186/s13054-023-04315-x