Nevin Manimala

Cochrane Database Syst Rev. 2022 Nov 18;11:CD013760. doi: 10.1002/14651858.CD013760.pub2.

ABSTRACT

BACKGROUND: Endophthalmitis is a sight-threatening emergency that requires prompt diagnosis and treatment. The condition is characterised by purulent inflammation of the intraocular fluids caused by an infective agent. In exogenous endophthalmitis, the infective agent is foreign and typically introduced into the eye through intraocular surgery or open globe trauma.

OBJECTIVES: To assess the potential role of combined pars plana vitrectomy and intravitreal antibiotics in the acute management of exogenous endophthalmitis, versus the standard of care, defined as vitreous tap and intravitreal antibiotics.

SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL; which contains the Cochrane Eyes and Vision Trials Register; 2022, Issue 5); Ovid MEDLINE; Ovid Embase; the International Standard Randomised Controlled Trial Number registry; ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. There were no restrictions to language or year of publication. The date of the search was 5 May 2022.

SELECTION CRITERIA: We included randomised controlled trials (RCTs) that compared pars plana vitrectomy and intravitreal injection of antibiotics versus intravitreal injection of antibiotics alone, for the immediate management of exogenous endophthalmitis.

DATA COLLECTION AND ANALYSIS: We used standard methods expected by Cochrane. Two review authors independently screened search results and extracted data. We considered the following outcomes: visual acuity improvement and change in visual acuity at three and six months; additional surgical procedures, including vitrectomy and cataract surgery, at any time during follow-up; quality of life and adverse effects. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: We identified a single RCT that met our inclusion criteria. The included RCT enrolled a total of 420 participants with clinical evidence of endophthalmitis, within six weeks of cataract surgery or secondary intraocular lens implantation. Participants were randomly assigned according to a 2 x 2 factorial design to either treatment with vitrectomy (VIT) or vitreous tap biopsy (TAP) and to treatment with or without systemic antibiotics. Twenty-four participants did not have a final follow-up: 12 died, five withdrew consent to be followed up, and seven were not willing to return for the visit. The study did not report visual acuity according to the review’s predefined outcomes. At three months, 41% of all participants achieved 20/40 or better visual acuity and 69% had 20/100 or better acuity. The study authors reported that there was no statistically significant difference in visual acuity between treatment groups (very low-certainty evidence). There was low-certainty evidence of a similar requirement for additional surgical procedures (risk ratio RR 0.90, 95% confidence interval 0.66 to 1.21). Adverse effects included: VIT group: dislocated intraocular lens (n = 2), macular infarction (n = 1). TAP group: expulsive haemorrhage (n = 1). Quality of life and mean change in visual acuity were not reported. AUTHORS’ CONCLUSIONS: We identified a single RCT (published 27 years ago) for the role of early vitrectomy in exogenous endophthalmitis, which suggests that there may be no difference between groups (VIT vs TAP) for visual acuity at three or nine months’ follow-up. We are of the opinion that there is a clear need for more randomised studies comparing the role of primary vitrectomy in exogenous endophthalmitis. Moreover, since the original RCT study, there have been incremental changes in the surgical techniques with which vitrectomy is performed. Such advances are likely to influence the outcome of early vitrectomy in exogenous endophthalmitis.

PMID:36398614 | DOI:10.1002/14651858.CD013760.pub2

Am J Reprod Immunol. 2022 Nov 18. doi: 10.1111/aji.13654. Online ahead of print.

ABSTRACT

PROBLEM: Dysregulation of factors vital to the survival B cells and/or plasma cells, such as BAFF and APRIL, could be detrimental to a pregnancy.

METHOD OF STUDY: Serially collected first-, second-, and third-trimester serum samples were measured for BAFF and APRIL by ELISA from 150 pregnant women (71 healthy + 79 with a chronic medical disease) at a single medical center. Postpartum serum samples were also collected from the majority of these women. Matched third-trimester and cord blood samples were collected from 168 women (86 healthy + 82 with a chronic medical disease). Data were analyzed by chi-square statistic, unpaired t test, paired t test, Mann-Whitney rank sum test, Wilcoxon signed rank test, Spearman rank order correlation, and receiver operator characteristic (ROC) curve analyses as appropriate.

RESULTS: Maternal serum BAFF levels declined as the pregnancies progressed and rebounded postpartum, whereas serum APRIL levels remained relatively flat throughout pregnancy and postpartum. Cord BAFF and APRIL levels correlated positively with gestation age and were considerably greater than the corresponding maternal third-trimester serum BAFF and APRIL levels, respectively. In women who developed preeclampsia, third-trimester BAFF levels were greater, rather than lower, than their corresponding second-trimester BAFF levels. ROC curve analysis suggested a potential role for third-trimester serum BAFF level as a biomarker of preeclampsia.

CONCLUSIONS: BAFF and APRIL are differentially regulated in the mother during and following pregnancy, whereas each is upregulated in the developing fetus. An increase in third-trimester serum BAFF level may portend development of preeclampsia. This article is protected by copyright. All rights reserved.

PMID:36398594 | DOI:10.1111/aji.13654

Euro Surveill. 2022 Nov;27(46). doi: 10.2807/1560-7917.ES.2022.27.46.2200082.

ABSTRACT

BackgroundSurveillance of antimicrobial resistance (AMR) and antimicrobial use (AMU) in Europe is currently annual.AimTo study the feasibility and scalability of a quarterly AMR/AMU surveillance system in the European Union/European Economic Area (EU/EEA).MethodsWe conducted a longitudinal study within the scope of the EU-JAMRAI project. Seventeen partners from 11 EU/EEA countries prospectively collected 41 AMU and AMR indicators quarterly from September 2017 to May 2020 for the hospital sector (HS) and primary care (PC). Descriptive statistics and coefficients of variation (CV) analysis were performed.ResultsData from 8 million hospital stays and 45 million inhabitants per quarter were collected at national (n = 4), regional (n = 6) and local (n = 7) levels. Of all partners, five were able to provide data within 3 months after each preceding quarter, and eight within 3-6 months. A high variability in AMU was found between partners. Colistin was the antibiotic that showed the highest CV in HS (1.40; p < 0.0001). Extended-spectrum beta-lactamase-producing Escherichia coli presented the highest incidence in HS (0.568 ± 0.045 cases/1,000 bed-days per quarter), whereas ciprofloxacin-resistant E. coli showed the highest incidence in PC (0.448 ± 0.027 cases/1,000 inhabitants per quarter). Barriers and needs for implementation were identified.ConclusionThis pilot study could be a first step towards the development of a quarterly surveillance system for AMU and AMR in both HS and PC in the EU/EEA. However, committed institutional support, dedicated human resources, coordination of data sources, homogeneous indicators and modern integrated IT systems are needed first to implement a sustainable quarterly surveillance system.

PMID:36398580 | DOI:10.2807/1560-7917.ES.2022.27.46.2200082

Zhongguo Dang Dai Er Ke Za Zhi. 2022 Nov 15;24(11):1195-1201. doi: 10.7499/j.issn.1008-8830.2204120.

ABSTRACT

OBJECTIVES: To investigate the influence of early-stage hypotension defined as mean arterial pressure (MAP)<gestational age (weeks) or MAP<30 mmHg on the short-term prognosis of preterm infants with a gestational age of <32 weeks.

METHODS: A total of 320 preterm infants who were admitted to Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology from April 2020 to August 2021 and met the inclusion criteria were enrolled in this prospective study. Blood pressure within 72 hours was monitored. The definition of hypotension and grouping were as follows: (1) Of the 320 preterm infants, those with MAP<gestational age in 2 consecutive measurements served as the hypotension group (n=104), and the others (n=216) served as the control group; (2) Of the 320 preterm infants, those with MAP<30 mmHg in 2 consecutive measurements served as the hypotension group (n=114), and the others served as the control group (n=206). Perinatal data and clinical data during hospitalization were collected.Poor short-term prognosis was defined as death during hospitalization and/or grade Ⅲ-Ⅳ periventricular-intraventricular hemorrhage identified within 1 week after birth. The multivariate logistic regression analysis was used to investigate the influence of hypotension based on the above two definitions on the short-term prognosis of preterm infants.

RESULTS: Compared with the control group, the hypotension group based on the above two definitions had higher incidence rates of the clinical manifestations of hypoperfusion, poor prognosis, hemodynamically significant patent ductus arteriosus, and pulmonary hemorrhage (P<0.05). In addition, compared with the control group, the hypotension group defined by MAP<30 mmHg had higher incidence rates of periventricular-intraventricular hemorrhage and bronchopulmonary dysplasia and mortality rate during hospitalization (P<0.05). The incidence of poor short-term prognosis in the hypotension group defined by MAP<30 mmHg was higher than that in the hypotension group defined by MAP<gestational age (18.4% vs 12.5%), but the difference was not statistically significant (P>0.05).The univariate analysis showed that the poor short-term prognosis was related to birth of cesarean section, gestational age, an Apgar score of ≤ 5 at 5 minutes, use of vasoactive drugs within 72 hours, mechanical ventilation within 72 hours, and hypotension under the two definitions (P<0.05).The multivariate logistic regression showed that hypotension based on either definition was not an independent risk factor for poor prognosis (P>0.05).

CONCLUSIONS: Hypotension based on either definition is not an independent risk factor for short-term poor prognosis in preterm infants with a gestational age of <32 weeks. Hypotension defined by MAP<30 mmHg might be more sensitive than that defined by MAP<gestational age in predicting short-term adverse outcomes, which needs further analysis by large sample studies.

PMID:36398543 | DOI:10.7499/j.issn.1008-8830.2204120

J Microbiol Biotechnol. 2022 Oct 24;32(12):1-10. doi: 10.4014/jmb.2209.09052. Online ahead of print.

ABSTRACT

In this study, we investigated the optimal conditions for 3D structure printing of alternative fats that have the textural properties of lard using beeswax (BW) oleogel-based alternative fat materials by an experimental statistical method. Products printed with over 15% BW oleogel at 50% and 75% infill level (IL) showed high printing accuracy with the lowest dimensional printing deviation for the designed model. The hardness, cohesion, and adhesion of printed samples were influenced by BW concentration and infill level. For multi-response optimization, fixed target values (hardness, adhesiveness, and cohesiveness) were applied with lard printed at 75% IL. The preparation parameters obtained as a result of multiple reaction prediction were 58.9% IL and 16.0% BW, and printing with this oleogel achieved fixed target values similar to those of lard. In conclusion, our study shows that 3D printing based on the BW oleogel system produces complex internal structures that allow adjustment of the textural properties of the printed samples, and BW oleogels could potentially serve as an excellent replacement for fat.

PMID:36398443 | DOI:10.4014/jmb.2209.09052

JPEN J Parenter Enteral Nutr. 2022 Nov 17. doi: 10.1002/jpen.2465. Online ahead of print.

ABSTRACT

BACKGROUND: Short bowel syndrome is the most common cause of intestinal failure (IF) in infants. We aimed to evaluate growth, nutritional intakes and predictors of weaning from parenteral nutrition (PN) of infants with IF.

METHODS: Clinical parameters, nutritional intakes and body weight and length z-scores were compared monthly from1st to 12th and at 18 and 24 months of life among infants on PN and those weaned. Logistic regression analysis was conducted to explore the predictors of weaning.

RESULTS: We included 23 infants (10/23 weaned). Median [range] birth weight and gestational age were: 1620 [590;3490] g and 31 [24;39] weeks respectively. All infants showed a growth retardation with similar median delta weight z-score from birth to discharge: -1.48 [-1.92;-0.94] in not-weaned and -1.18 [-2.70;0.31] in weaned infants, p=0.833 and a subsequent regain after the discharge: 0.20 [-3.47;3.25] and 0.84 [-0.03;2.58] respectively, p=0.518. No differences in length z-score were found among groups. After the sixth month, infants weaned from PN received lower PN energy and protein intakes compared to not-weaned. Infants weaned from PN showed lower parenteral nutrition dependency index (PNDI%) from 5 months onwards (45% for weaned and 113% for not-weaned infants at 5 months: p<0.001). The Belza’s score, a predictor of enteral autonomy computed at 6 months, is associated with being weaned from PN within 24 months (OR:1.906; p=0.039).

CONCLUSIONS: Infants weaned and not-weaned showed similar growth patterns. Our findings support the clinical relevance of Belza’s score and PNDI% as predictors of weaning from PN. Keywords This article is protected by copyright. All rights reserved.

PMID:36398420 | DOI:10.1002/jpen.2465

Paediatr Anaesth. 2022 Nov 17. doi: 10.1111/pan.14603. Online ahead of print.

NO ABSTRACT

PMID:36398409 | DOI:10.1111/pan.14603

Med Phys. 2022 Nov 17. doi: 10.1002/mp.16106. Online ahead of print.

ABSTRACT

BACKGROUND: Contouring of internal gross target volume (iGTV) is an essential part of treatment planning in radiotherapy to mitigate the impact of intra-fractional target motion. However, it is usually time-consuming and easily subjected to intra-observer and inter-observer variability. So far, few studies have been explored to directly predict iGTV by deep learning technique, because the iGTV contains not only the gross target volume (GTV) but also the motion information of the GTV.

PURPOSE: This work was an exploratory study to present a deep learning-based framework to segment iGTV rapidly and accurately in 4D CT images for lung cancers.

METHODS: Five models including 3D UNet, mmUNet with point-wise add merging approach (mmUNet-add), mmUNet with concatenate fusion strategy (mmUNet-cat), gruUNet with point-wise add fusion approach (gruUNet-add) and gruUNet with concatenate method (gruUNet-cat) were adopted for iGTV segmentation. All the models were originated from the 3D UNet network, with multi-channel multi-path and convolutional gated recurrent unit (GRU) added in the mmUNet and gruUNet networks, respectively. 70 patients with lung cancers were collected and 55 cases were randomly selected as the training set, and 15 cases as the testing set. In addition, the segmentation results of the five models were compared with the ground truths qualitatively and quantitatively.

RESULTS: In terms of Dice Similarity Coefficient (DSC), the proposed four networks (mmUNet-add, mmUNet-cat, gruUNet-add and gruUNet-cat) increased the DSC score of 3D UNet from 0.6945 to 0.7342, 0.7253, 0.7405 and 0.7365, respectively. However, the differences were not statistically significant (p>0.05). After a simple post-processing to remove the small isolated connected regions, the mean 95th percentile Hausdorff distances (HD_95s) of the 3D UNet, mmUNet-add, mmUNet-cat, gruUNet-add and gruUNet-cat networks were 19.70 mm, 15.75 mm, 15.84 mm, 15.61 mm and 15.83 mm, respectively, corresponding to 25.35 mm, 25.96 mm, 25.11 mm, 28.23 mm and 24.47 mm before the post-processing. With regard to runtime, significant elapsed time growths (about 70s and 230s) were observed both in the mmUNet and gruUNet architectures due to the increasing parameters. But the mmUNet structure showed less growth.

CONCLUSIONS: Our study demonstrated the ability of the deep learning technique to predict iGTVs directly. With the introduction of multi-channel multi-path and convolutional GRU, the segmentation accuracy was improved under certain conditions with a reduced segmentation efficiency and a further research topic when the 3D UNet network would lead to poor performance is elicited. Less efficiency degradation was observed in the mmUNet structure. Besides, the element-wise add fusing strategy was favorable to increase DSC. Whereas, HD_95 benefited from the concentrate merging approach. Nevertheless, the segmentation accuracy by deep learning still remains to be improved. This article is protected by copyright. All rights reserved.

PMID:36398404 | DOI:10.1002/mp.16106

Ann Clin Transl Neurol. 2022 Nov 17. doi: 10.1002/acn3.51702. Online ahead of print.

ABSTRACT

OBJECTIVE: We conducted a Mendelian randomization (MR) study to disentangle causal associations between women’s reproductive behaviors and ischemic stroke (IS) and investigate the roles of two modifiable risk factors (body mass index (BMI) and educational attainment (EA)) in these associations.

METHODS: Using summary-level data from large-scale genome-wide association studies, we performed univariable MR to examine whether there is genetic evidence that women’s reproductive traits are causally associated with IS and its subtypes. Multivariable MR and MR mediation analysis were used to investigate whether BMI and EA are common mechanisms or mediators for these associations. A set of sensitivity analyses were conducted to test valid MR assumptions.

RESULTS: We observed consistent and statistically significant associations across female and sex-combined analyses for earlier age at first birth (AFB) and age at first sexual intercourse (AFS) with a higher risk of IS and large-artery atherosclerotic stroke (LAS) risk in the primary analysis. The odds ratios of IS per 1 SD increase in genetically predicted early AFB and AFS were 0.93 (95% CI, 0.86-0.99; p = 0.046) and 0.83 (95% CI, 0.70-0.97, p = 0.020), respectively. Further analyses indicated that BMI played a shared role in AFS and IS/LAS while EA played a shared role in AFS/AFB and IS/LAS as well as a mediator in the path from AFS to IS/LAS.

INTERPRETATION: These findings may inform prevention strategies and interventions directed toward relative women’s reproductive behaviors and IS. Future studies are warranted to explore other factors related to EA which are responsible for these causalities.

PMID:36398399 | DOI:10.1002/acn3.51702

J Sex Marital Ther. 2022 Nov 17:1-12. doi: 10.1080/0092623X.2022.2146026. Online ahead of print.

ABSTRACT

Gender affirming surgery (GAS) helps individuals to achieve a physical presence consistent with their gender identity. In this study, we explored the decision, expectation, experience, satisfaction, and quality of life (QOL) of transgender women (TGWs) who have undergone GAS and compared their QOL with transfeminine individuals (TFs) who have not and are seeking to do so in Thailand. The median overall QOL score of the TGWs who have undergone GAS was slightly higher than that of the TFs who have not (95 (92-103) vs. 92 (86-98); p = 0.003), which was also reflected in the specific domains of psychological health, social relationships, and environmental health, the exception being physical health. Not being financially prepared was the most relevant reason for delaying undergoing GAS among the TFs who have not undergone it and want to do so. In addition, more than half of the TGWs who have undergone GAS regretted not being socially accepted after surgery. Although the difference between the QOLs of the two groups is statistically significant, the clinical significance should be further investigated to provide more insight. In addition, the higher QOL of TGWs might not solely be due to having undergone GAS.

PMID:36398380 | DOI:10.1080/0092623X.2022.2146026