Nevin Manimala

Thorac Cardiovasc Surg. 2021 Dec 11. doi: 10.1055/s-0041-1740322. Online ahead of print.

ABSTRACT

INTRODUCTION: Chest drains are placed following pulmonary resection to promote lung re-expansion. The superiority of two chest drains at preventing postoperative complications has not been established, and practice remains largely dictated by surgeon preference. We sought to compare patient outcomes based on number of chest drains used.

METHODS: This is a retrospective analysis including patients undergoing lobectomies and segmentectomies between March 2016 and April 2020. Patients were categorized based on number of chest drains placed and were matched 1:1 using the nearest neighbor (greedy) technique. Our primary outcome was opioid prescriptions at discharge (in morphine equivalent daily dose [MEDD]). Associations were tested using multilevel mixed-effects regression to account for variability between surgeons.

RESULTS: A total of 1,094 patients met inclusion criteria. Single chest drain was used in 922 patients, whereas 172 had two chest tubes. After matching, there were 111 patients in each group. In multilevel mixed-effects logistic regression, patients treated with a single chest drain received fewer opioid prescriptions (β: -194 MEDD, 95% confidence interval [CI]: -302 to -86 MEDD, p < 0.01), were more likely to be opioid-free at hospital discharge (odds ratio [OR] = 2.11, 95% CI: 1.08-4.12, p = 0.03), and had lower readmission rates within 30 days (OR = 0.33, 95% CI: 0.13-0.84, p = 0.02). Single chest drain practice did not affect the risk of pulmonary complications and there was no statistically significant difference in length of hospital stay (3 days [interquartile range: 2-5] vs. 4 days [3-6], p = 0.08).

CONCLUSION: Single chest drain practice in lobectomies and segmentectomies was associated with less opioid prescription requirement without any increase in complications.

PMID:34894636 | DOI:10.1055/s-0041-1740322

Thorac Cardiovasc Surg. 2021 Dec 11. doi: 10.1055/s-0041-1736246. Online ahead of print.

ABSTRACT

BACKGROUND: Controversy exists about left ventricular systolic function recovery after coronary artery bypass grafting in patients with ischemic cardiomyopathy. The aim of this study is to evaluate the temporal evolvement of left ventricular systolic function after coronary artery bypass surgery in patients with ischemic cardiomyopathy.

PATIENTS AND METHODS: A total of 50 patients with coronary artery disease and left ventricular ejection fraction (LVEF) ≤35% underwent isolated coronary artery bypass grafting in a single center in the period 2017 to 2019. We performed a retrospective analysis of the echocardiographic and clinical follow-up data at 3 months and 1 year postoperatively.

RESULTS: Median LVEF preoperatively was 25% (20-33%), mean patient age was 66 ± 8.2 years, 33 (66%) patients were operated off-pump, and 22 (44%) procedures were non-elective. There was no in-hospital myocardial infarction, stroke, and repeat revascularization. Three (6%) patients underwent re-exploration for bleeding or tamponade. In-hospital mortality was 8% and 1-year mortality was 12%. At 1 year postoperatively, there was no repeat revascularization, no myocardial infarction, 1 (2.6%) patient had a transient ischemic attack, and 10 (20%) patients required an implantable defibrillator. There was a statistically significant median ejection fraction increase at 3 months (15% [5-22%], p < 0.0001) and 1 year (23% [13-25%], p < 0.0001) postoperatively, with an absolute increase ≥10% in 32 (74.4%) and 30 (78.9%) patients at 3 months and 1 year, respectively.

CONCLUSION: Patients with ischemic cardiomyopathy undergoing coronary artery bypass surgery show continuous recovery of left ventricular systolic function in the first postoperative year.

PMID:34894634 | DOI:10.1055/s-0041-1736246

Thorac Cardiovasc Surg. 2021 Dec 11. doi: 10.1055/s-0041-1736245. Online ahead of print.

ABSTRACT

BACKGROUND: Atrial fibrillation (AF), a condition that might occur after a heart bypass procedure, has caused differing estimates of its occurrence and risk. The current study analyses the possible risk factors of post-coronary artery bypass grafting (post-CABG) AF (postoperative AF [POAF]) and presents a software for preoperative POAF risk prediction.

METHODS: This retrospective research was performed on 1,667 patients who underwent CABG surgery using the hospital database. The associations between the variables of the patients and AF risk factors after CABG were examined using multivariable logistic regression (LR) after preprocessing the relevant data. The tool was designed to predict POAF risk using Shiny, an R package, to develop a web-based software.

RESULTS: The overall proportion of post-CABG AF was 12.2%. According to the results of univariate tests, in terms of age (p < 0.001), blood urea nitrogen (p = 0.005), platelet (p < 0.001), triglyceride (p = 0.0026), presence of chronic obstructive pulmonary disease (COPD; p = 0.01), and presence of preoperative carotid artery stenosis (PCAS; p < 0.001), there were statistically significant differences between the POAF and non-POAF groups. Multivariable LR analysis disclosed the independent risk factors associated with POAF: PCAS (odds ratio [OR] = 2.360; p = 0.028), COPD (OR = 2.243; p = 0.015), body mass index (OR = 1.090; p = 0.006), age (OR = 1.054, p < 0.001), and platelet (OR = 0.994, p < 0.001).

CONCLUSION: The experimental findings from the current research demonstrate that the suggested tool (POAFRiskScore v.1.0) can help clinicians predict POAF risk development in the preoperative period after validated on large sample(s) that can represent the related population(s). Simultaneously, since the updated versions of the proposed tool will be released periodically based on the increases in data dimensions with continuously added new samples and related factors, more robust predictions may be obtained in the subsequent stages of the current study in statistical and clinical terms.

PMID:34894632 | DOI:10.1055/s-0041-1736245

Int J Sports Physiol Perform. 2021 Dec 11:1-9. doi: 10.1123/ijspp.2021-0126. Online ahead of print.

ABSTRACT

PURPOSE: The study of load and recovery gained significant interest in the last decades, given its important value in decreasing the likelihood of injuries and improving performance. So far, findings are typically reported on the group level, whereas practitioners are most often interested in applications at the individual level. Hence, the aim of the present research is to examine to what extent group-level statistics can be generalized to individual athletes, which is referred to as the “ergodicity issue.” Nonergodicity may have serious consequences for the way we should analyze, and work with, load and recovery measures in the sports field.

METHODS: The authors collected load, that is, rating of perceived exertion × training duration, and total quality of recovery data among youth male players of a professional football club. This data were collected daily across 2 seasons and analyzed on both the group and the individual level.

RESULTS: Group- and individual-level analysis resulted in different statistical outcomes, particularly with regard to load. Specifically, SDs within individuals were up to 7.63 times larger than SDs between individuals. In addition, at either level, the authors observed different correlations between load and recovery.

CONCLUSIONS: The results suggest that the process of load and recovery in athletes is nonergodic, which has important implications for the sports field. Recommendations for training programs of individual athletes may be suboptimal, or even erroneous, when guided by group-level outcomes. The utilization of individual-level analysis is key to ensure the optimal balance of individual load and recovery.

PMID:34894630 | DOI:10.1123/ijspp.2021-0126

J Sport Rehabil. 2021 Dec 11:1-7. doi: 10.1123/jsr.2021-0095. Online ahead of print.

ABSTRACT

CONTEXT: Gluteus medius (GMed) weakness is a common impairment seen across multiple lower-extremity pathologies. Greater GMed weakness is moderately associated with greater frontal plane motion, often termed dynamic knee valgus during functional tasks which may increase risk of lower-extremity injury. Neuromuscular electrical stimulation (NMES) superimposed to targeted muscles has emerged in clinical practice; however, NMES superimposed to the GMed in unknown. It is essential to assess the safety, credibility, and expectancy of NMES superimposed to the GMed prior to implementation in clinical practice. The objective of this study was to evaluate feasibility, safety, credibility, and expectancy of improvement with a 2-week intervention with or without NMES to the GMed in females with dynamic knee valgus.

DESIGN: Feasibility study.

METHODS: A total of 22 adult females with dynamic knee valgus (age = 21.8 [1.4] y, mass = 76.9 [18.8] kg, height = 1.7 [0.1] m) completed a 2-week intervention with NMES or a sham treatment superimposed to the GMed during all therapeutic exercises. Feasibility was assessed by recruitment and completion rate, while safety was assessed by the total number of adverse events. Treatment credibility and expectancy was assessed with the Credibility Expectancy Questionnaire. Mixed-measure analysis of variance were used for statistical analysis (P ≤ .05).

RESULTS: Recruitment was completed in 5 months with 100% completion rate and no adverse events. There was no difference in treatment credibility between groups (NMES = 23.7 [2.3], sham = 21.7 [3.4], P = .12); however, the NMES group demonstrated a greater expectancy score (NMES = 20.0 [3.8], sham = 15.9 [5.1], P = .045).

CONCLUSION: Resistance training with NMES superimposed to the GMed is a feasible and safe intervention that resulted in greater expectance of success. Clinicians may consider superimposing NMES to the gluteal muscles when addressing muscle weakness in individuals with dynamic knee valgus.

PMID:34894628 | DOI:10.1123/jsr.2021-0095

Econ Hum Biol. 2021 Dec 2;44:101091. doi: 10.1016/j.ehb.2021.101091. Online ahead of print.

ABSTRACT

The epidemiological literature has widely documented the importance of social distancing interventions in containing the spread of the COVID-19 pandemic. However, the epidemiological measure of virus reproduction, R₀, provides a myopic view of containment, especially when the absolute number of cases is still high. The paper investigates cross-country variations concerning the impact of social distancing interventions on COVID-19 incidence by employing a statistical measure of containment, which models the daily number of cases as a structural time-series, state-space vector. Countries that adopt strict lockdown policies and provide economic support in the form of income augmentations and debt relief improve the response towards the pandemic. Countries like China and South Korea have been most influential in containing the spread of infections. European nations of France, Italy, Spain and the UK are witnessing a second wave of the virus, indicating that re-opening the European economy perhaps has instigated an exponential spread.

PMID:34894622 | DOI:10.1016/j.ehb.2021.101091

Epilepsy Res. 2021 Dec 6;179:106841. doi: 10.1016/j.eplepsyres.2021.106841. Online ahead of print.

ABSTRACT

INTRODUCTION: Epileptic discharges occurring during seizure may affect many systems in the ictal, postictal, and interictal periods. Autonomic dysfunction and its negative impacts on the heart may cause life-threatening clinical manifestations, cardiac arrhythmias, and sudden cardiac death in epileptic patients. This study investigated the impact of levetiracetam (LEV) therapy on cardiac electrical activity in children with epilepsy.

MATERIAL AND METHODS: Our study included a total of 120 cases, comprising 40 newly diagnosed epilepsy patients, 40 epilepsy patients who had been receiving LEV therapy for at least 6 months, and 40 healthy individuals. Age at diagnosis, duration of LEV treatment, and familial history of cardiac disease were recorded in a standardized form. Electrocardiogram (ECG) parameters were calculated for all cases, echocardiography (ECHO) findings were noted, and the obtained data were compared using statistical methods.

RESULTS: A comparison of the ECG parameters showed that the Tpeak-Tend (Tp-e) interval, and the Tp-e/QT dispersion (QTd) and Tp-e/QTc dispersion (QTcd) ratios, of the newly diagnosed epilepsy patients were statistically significantly increased compared with the other two groups (p = <0.001, p = 0.001, and p = 0.007, respectively). There were no statistically significant differences between the three groups in terms of QTd and QTcd.

DISCUSSION: The repolarization differences in children with newly diagnosed epilepsy may have reflected early subclinical findings associated with the disease. We concluded that LEV monotherapy may make a positive contribution to early repolarization differences.

PMID:34894618 | DOI:10.1016/j.eplepsyres.2021.106841

Phys Ther Sport. 2021 Dec 5;53:97-104. doi: 10.1016/j.ptsp.2021.12.001. Online ahead of print.

ABSTRACT

This study aimed to compare the angle-specific (AS) and non-angle-specific (NAS) hamstring to quadriceps conventional and functional ratios between healthy, hamstring- and ACL-injured elite soccer players. One hundred and eleven players (27.42 ± 8.01 years, 182.11 ± 6.79 cm, 75.93 ± 7.25 kg) completed a series of concentric knee flexor and extensor strength in addition to eccentric knee flexor strength was measured at an angular velocity of 60°.s^-1. Normalized and raw peak torque values, and the torque-angle profiles were extracted for analysis. Conventional and functional NAS (peak values) and AS (waveform ratios) hamstring to quadriceps ratios were calculated and compared between the groups. Healthy players produced greater functional and conventional ratios compared to players with either ACL or hamstring injury. Players with hamstring injury produced a lower AS functional ratios between 46° and 54° of knee flexion. Players suffering from ACL injury depicted a lower value for the AS functional ratio between 33° and 56° of knee flexion. Although NAS can identify soccer players with previous hamstring or ACL injury, the range where there is a strength deficiency is eluded. With the use of AS the range where the deficiency is present can be identified, and clinicians can benefit from this analysis to design robust rehabilitation protocols.

PMID:34894617 | DOI:10.1016/j.ptsp.2021.12.001

Phys Ther Sport. 2021 Dec 3;53:105-114. doi: 10.1016/j.ptsp.2021.11.012. Online ahead of print.

ABSTRACT

OBJECTIVES: To present a new knee isokinetic assessment procedure linked to noncontact knee injury mechanisms and examine correlations between variables relevant to noncontact knee injury prevention screening (peak torque [PT, Nm], time-to-peak torque [TTPT, ms], angle-of-peak torque [APT, °], mean PT [MPT, Nm]).

DESIGN: Cross-sectional.

SETTING: Sports medicine laboratory.

PARTICIPANTS: Thirty-four agility-sport athletes (male/female n = 18/16, age 24.1 ± 3.5yr, height 171.8 ± 9.6 cm, mass 70.6 ± 12 kg).

MAIN OUTCOME MEASURES: Pearson’s/Spearman’s correlation (r/r_s), coefficient of determination (r²/r_s²).

RESULTS: Most correlations were statistically non-significant or statistically-significant with only weak-to-moderate coefficients. For both knee extension and flexion, PT and MPT were significantly and strongly correlated (r = 0.99, r² = 0.98, p = 0.001). Graphical analyses revealed two datapoint clusters for knee flexion TTPT and APT. One cluster indicated some participants could generate knee flexor PT rapidly (<150 ms) at low knee flexion angles (<45°) and the other cluster indicated that other participants could not (>200 ms, >50°).

CONCLUSIONS: In this study, most isokinetic variables represented distinct knee neuromuscular characteristics. For both knee extension and flexion, only PT or MPT need be used to represent isokinetic maximal strength. Knee flexion TTPT and APT may have utility in noncontact knee injury prevention screening with amateur adult agility-sport athletes.

PMID:34894616 | DOI:10.1016/j.ptsp.2021.11.012

Forensic Sci Int. 2021 Nov 27;330:111125. doi: 10.1016/j.forsciint.2021.111125. Online ahead of print.

ABSTRACT

This article presents key factors affecting the analysis of particle profiles as used for discrimination and classification among items commonly collected at crime scenes. Identification of these factors is a necessary step to enable systematic improvement, optimization, and transition to practice. Prior research, employing reasonable initial choices of analytical and statistical parameters, has (1) demonstrated the presence of highly discriminating sets of very small particles (VSP) on the surfaces of items commonly collected at crime scenes, (2) developed statistically rigorous measurements of correspondence between VSP profiles, and (3) produced objective measures for the resulting probative value. In the present work the analytical and statistical parameters were examined more critically, identifying key factors affecting method performance. Experiments were conducted using scanning electron microscopy (SEM) with energy dispersive x-ray elemental analysis (EDS) to characterize the elemental composition of thousands of individual particles within each specimen. The experiments studied: Reproducibility of VSP analyses at given parameters Effects of the SEM/EDS parameters used for the detection of each particle Effects of SEM/EDS x-ray analysis parameters used for elemental analysis of each particle Effects of the number and choice of elements used in the elemental analysis Effects of particle size on the strength of correspondence between particle sets Effects of data filtration parameters on the strength of correspondence between particle sets The experiments confirmed the presence of abundant, highly discriminating VSP on items commonly collected at crime scenes. The numbers of particles available for analysis was not a limiting factor: many more particles (usually greater than 50 times more) were present than were used for the analysis. A very high level of reproducibility was observed. Many of the parameters tested had no measurable effect on particle combination analysis performance and others had minor or interactive effects. Four factors were identified as having significant impact on the strength of correspondence between particle profiles, three factors were identified as having a significant impact on the numbers of particles detected and nine factors were identified as having a significant impact on analytical time and costs. The approach in its current state of development offers crime laboratories an additional capability suitable for high priority cases. The identification of key factors affecting performance of the VSP analytical protocol allows existing methods to be further developed and systematically improved to facilitate transition to routine practice.

PMID:34894614 | DOI:10.1016/j.forsciint.2021.111125