Nevin Manimala

Brain Behav. 2022 Apr 16:e2576. doi: 10.1002/brb3.2576. Online ahead of print.

ABSTRACT

BACKGROUND: There are gaps in our neurobiological understanding of functional movement disorder (FMD).

OBJECTIVES: We investigated gray matter volumetric profiles in FMD, and related findings to resting-state functional connectivity (rsFC) profiles using Human Connectome Project data.

METHODS: Volumetric differences between 53 FMD patients and 50 controls were examined, as well as relationships between individual differences in FMD symptom severity and volumetric profiles. Atrophy network mapping was also used to probe whether FMD-related structural alterations preferentially impacted brain areas with dense rsFC.

RESULTS: Compared to controls without neurological comorbidities (albeit with mild depression and anxiety as a group), the FMD cohort did not show any volumetric differences. Across patients with FMD, individual differences in symptom severity negatively correlated with right supramarginal and bilateral superior temporal gyri volumes. These findings remained significant adjusting for FMD subtype or antidepressant use, but did not remain statistically significant adjusting for depression and anxiety scores. Symptom severity-related structural alterations mapped onto regions with dense rsFC-identifying several disease epicenters in default mode, ventral attention, and salience networks.

CONCLUSIONS: This study supports that FMD is a multinetwork disorder with an important role for the temporoparietal junction and its related connectivity in the pathophysiology of this condition. More research is needed to explore the intersection of functional neurological symptoms and mood.

PMID:35429407 | DOI:10.1002/brb3.2576

J Infect Dis. 2022 Apr 16:jiac136. doi: 10.1093/infdis/jiac136. Online ahead of print.

ABSTRACT

INTRODUCTION: This study aims to examine the worldwide prevalence of post COVID-19 condition, through a systematic review and meta-analysis.

METHODS: PubMed, Embase, and iSearch were searched on July 5, 2021 with verification extending to March 13, 2022. Using a random effects framework with DerSimonian-Laird estimator, we meta-analyzed post COVID-19 condition prevalence at 28+ days from infection.

RESULTS: 50 studies were included, and 41 were meta-analyzed. Global estimated pooled prevalence of post COVID-19 condition was 0.43 (95% CI: 0.39,0.46). Hospitalized and non-hospitalized patients have estimates of 0.54 (95% CI: 0.44,0.63) and 0.34 (95% CI: 0.25,0.46), respectively. Regional prevalence estimates were Asia- 0.51 (95% CI: 0.37,0.65), Europe- 0.44 (95% CI: 0.32,0.56), and North America- 0.31 (95% CI: 0.21,0.43). Global prevalence for 30, 60, 90, and 120 days after infection were estimated to be 0.37 (95% CI: 0.26,0.49), 0.25 (95% CI: 0.15,0.38), 0.32 (95% CI: 0.14,0.57) and 0.49 (95% CI: 0.40,0.59), respectively. Fatigue was the most common symptom reported with a prevalence of 0.23 (95% CI: 0.17,0.30), followed by memory problems (0.14 [95% CI: 0.10,0.19]).

DISCUSSION: This study finds post COVID-19 condition prevalence is substantial; the health effects of COVID-19 appear to be prolonged and can exert stress on the healthcare system.

PMID:35429399 | DOI:10.1093/infdis/jiac136

J Clin Endocrinol Metab. 2022 Apr 16:dgac233. doi: 10.1210/clinem/dgac233. Online ahead of print.

ABSTRACT

PURPOSE: People characterized as late chronotype have elevated type 2 diabetes and cardiovascular disease risk compared to early chronotype. It is unclear how chronotype is associated with insulin sensitivity, metabolic flexibility, or plasma TCA cycle intermediates concentration, amino acids (AA), and/or beta-oxidation.

METHODS: The Morning-Eveningness Questionnaire (MEQ) was used to classify adults with metabolic syndrome (ATP III Criteria) as either early (n=15 (13F), MEQ = 64.7±1.4) or late (n=19 (16F), MEQ = 45.5±1.3) chronotype. Fasting bloods determined hepatic (HOMA-IR) and adipose insulin resistance (Adipose-IR) while a 120 min euglycemic clamp (40 mU/m 2/min, 5 mmoL/L) was performed to test peripheral insulin sensitivity (glucose infusion rate (GIR)). Carbohydrate (CHOOX) and fat oxidation (FOX) as well as non-oxidative glucose disposal (NOGD) were also estimated (indirect calorimetry). Plasma TCA intermediates, AA, and acyl-carnitines were measured along with VO2max and body composition (DXA).

RESULTS: There were no statistical differences in age, BMI, fat-free mass, VO2max or ATP III criteria between groups. Early chronotype, however, had higher peripheral insulin sensitivity (P=0.009) and lower HOMA-IR (P=0.02) and Adipose-IR (P=0.05) compared to late chronotype. Further, early chronotype had higher NOGD (P=0.008) and greater insulin-stimulated CHOOX (P=0.02). While fasting lactate (P=0.01), TCA intermediates (isocitrate, ꭤ-ketoglutarate, succinate, fumarate, malate (all P≤0.04)) and some AA (proline, isoleucine (P=0.003-0.05)) were lower in early chronotype, other AA (threonine, histidine, arginine (all P≤0.05)) and most acyl-carnitines were higher (P≤0.05) compared to late chronotype.

CONCLUSIONS: Greater insulin sensitivity and metabolic flexibility relates to plasma TCA concentration in early chronotype.

PMID:35429387 | DOI:10.1210/clinem/dgac233

Liver Transpl. 2022 Apr 16. doi: 10.1002/lt.26482. Online ahead of print.

ABSTRACT

Excellent short-term survival after paediatric liver transplantation has shifted attention toward the optimization of long-term outcomes. Despite considerable progress in imaging and other non-invasive modalities, liver biopsies continue to be required to monitor allograft health and to titrate immunosuppression. However, a standardized approach to the detailed assessment of long-term graft histology is currently lacking. The aim of this study was to formulate a list of histopathological features relevant for the assessment of long-surviving liver allograft health and to develop an approach for assessing the presence and severity of these features in a standardised manner. Whole slide digital images from 31 biopsies obtained ≥ 4 years post-transplant to determine eligibility for an immunosuppression withdrawal trial were selected to illustrate a range of typical histopathological findings seen in children with clinically stable grafts, including those associated with alloantibodies. Fifty histological features were independently assessed and, where appropriate, scored semi-quantitatively by 6 pathologists to determine inter- and intra-observer reproducibility of the histopathological features using unweighted and weighted kappa statistics; the latter metric enabled distinction between minor and major disagreements in parameter severity scoring. Weighted inter-observer kappa statistics showed a high level of agreement for various parameters of inflammation, interface activity, fibrosis, and microvascular injury. Intra-observer agreement for these features was even more substantial. The results of this study will help to standardize the assessment of biopsies from long-surviving liver allografts, aid the recognition of important histological features and facilitate international comparisons and clinical trials aiming to improve outcomes for children undergoing liver transplantation.

PMID:35429359 | DOI:10.1002/lt.26482

Int J Cancer. 2022 Apr 16. doi: 10.1002/ijc.34031. Online ahead of print.

ABSTRACT

We analyzed long-term incidence trends in liver cancer (including hepatocellular carcinoma and intrahepatic cholangiocarcinoma) with an aim to interpret the changes in terms of known risk factors and hypothesize that historical exposure to Thorotrast, a radiographic contrast medium emitting alpha particles, has changed population rates. The NORDCAN database was used to collect cancer registry data from Denmark (DK), Finland (FI), Norway (NO) and Sweden (SE), which we used from 1953 (DK, FI, NO) and 1960(SE) through 2019. Thorotrast, which caused a 100-fold risk of liver cancer was used in DK and SE, and probably also in FI between 1930 and 1950, but not in NO. The incidence trend for liver cancer showed a broad maximum at around 1980, most prominent and statistically significant in SE and DK men and women, and in all countries a a steadily increasing trend towards the end of follow-up. Incidence for NO was lower than for the other countries and the rates showed no peaking at around 1980. Birth cohort analysis identified a transient risk which could be dated to a period between 1930 and 1950 in countries other than NO. Considering a lag time between Thorotrast use and liver cancer appearance, the large incidence peak around 1980 in DK and DE was probably contributed by Thorotrast but considering the ecological nature of the findings, the association should be considered cautiously as hypothesis generating. The late increase in liver cancer risk is most likely life-style related and largely preventable.

PMID:35429352 | DOI:10.1002/ijc.34031

Photochem Photobiol. 2022 Apr 16. doi: 10.1111/php.13635. Online ahead of print.

ABSTRACT

Fissure sealant application is an efficient method for dental caries prevention. Self-etch fissure sealants (SE-FS) eliminate the separate etching step for bonding. The present study investigated the micro-shear bond strength (μSBS) of a SE-FS (Prevent seal®, Itena©, France) to enamel pretreated with different methods including Er,Cr:YSGG laser, under non-contaminated and saliva-contaminated conditions. Sixty human premolars were sectioned into halves and randomly assigned into two groups of saliva-contaminated and non-contaminated. Each group was further divided into six subgroups (N=10) of different enamel pretreatment methods: (Laser+SE-FS), (Acid etch+SE-FS), (Laser+Acid-etch+SE-FS), (Mechanical preparation+SE-FS), (SE-FS), and (Acid-etch+Bonding+Conventional fissure sealant) as positive control. The μSBS of the sealant material to enamel was measured in all subgroups. Two-way ANOVA and Tukey tests were applied at p<0.05. Saliva contamination had a significant effect on μSBS (P<0.001), while pre-treatment with laser or acid etching did not significantly affect the μSBS (P=0.251). The μSBS of SE-FS to untreated enamel surface was significantly lower than the positive control (P=0.035). The μSBS value in the subgroup receiving laser+etching+SE-FS was significantly higher than the remaining five subgroups (P<0.001). Other pairwise comparisons were not statistically significant (P>0.05). Acid-etch and Er,Cr:YSGG laser exert a synergic effect on μSBS of Prevent Seal®, irrespective of saliva contamination.

PMID:35429351 | DOI:10.1111/php.13635

Int J Gynaecol Obstet. 2022 Apr 16. doi: 10.1002/ijgo.14225. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate if the implementation of a colorimetric quantitative blood loss (QBL) system during cesarean delivery improves clinical outcomes.

METHODS: We conducted a retrospective cohort analysis after cesarean section before and after implementation of the Triton based colorimetric QBL system. Prevalence of postpartum hemorrhage, amount of blood products transfused, length of hospitalization, and rates of intensive care unit (ICU) admission were compared.

RESULTS: A total of 2,221 patients were included. There were 1,192 patients in the pre-intervention group and 1,029 patients in the post-intervention group. There was no significant difference between groups in the prevalence of postpartum hemorrhage (8.6% vs. 9.3%, p = 0.57), amount of packed red blood cells (pRBCs) transfused (45 vs 30, p = 0.41) or average length of hospital stay in days (3.0 vs 3.0, p= 0.37). There was a statistically significant decrease in ICU admissions between the pre- and post-intervention groups (2.2% vs 1.0%, p= 0.02).

CONCLUSION: There was no effect of implementation of the colorimetric QBL application system on diagnosis of postpartum hemorrhage, amount of blood products transfused, or length of hospital stay. Although a significant decrease in ICU admissions was observed, we could not determine if these transfers were hemorrhage related.

PMID:35429349 | DOI:10.1002/ijgo.14225

Alzheimers Dement. 2022 Apr 16. doi: 10.1002/alz.12676. Online ahead of print.

ABSTRACT

INTRODUCTION: Studies investigating the relationship between blood pressure (BP) measurements from electronic health records (EHRs) and Alzheimer’s disease (AD) rely on summary statistics, like BP variability, and have only been validated at a single institution. We hypothesize that leveraging BP trajectories can accurately estimate AD risk across different populations.

METHODS: In a retrospective cohort study, EHR data from Veterans Affairs (VA) patients were used to train and internally validate a machine learning model to predict AD onset within 5 years. External validation was conducted on patients from Michigan Medicine (MM).

RESULTS: The VA and MM cohorts included 6860 and 1201 patients, respectively. Model performance using BP trajectories was modest but comparable (area under the receiver operating characteristic curve [AUROC] = 0.64 [95% confidence interval (CI) = 0.54-0.73] for VA vs. AUROC = 0.66 [95% CI = 0.55-0.76] for MM).

CONCLUSION: Approaches that directly leverage BP trajectories from EHR data could aid in AD risk stratification across institutions.

PMID:35429343 | DOI:10.1002/alz.12676

J Clin Monit Comput. 2022 Apr 16. doi: 10.1007/s10877-022-00857-7. Online ahead of print.

ABSTRACT

The risk of pulmonary complications is high after major abdominal surgery but may be reduced by prophylactic postoperative noninvasive ventilation using continuous positive airway pressure (CPAP). This study compared the effects of intermittent mask CPAP (ICPAP) and continuous helmet CPAP (HCPAP) on oxygenation and the risk of pulmonary complications following major abdominal surgery. Patients undergoing open abdominal aortic aneurysm repair or pancreaticoduodenectomy were randomized (1:1) to either postoperative ICPAP or HCPAP. Oxygenation was evaluated as the partial pressure of oxygen in arterial blood fraction of inspired oxygen ratio (PaO₂/FIO₂) at 6 h, 12 h, and 18 h postoperatively. Pulmonary complications were defined as X-ray verified pneumonia/atelectasis, clinical signs of pneumonia, or supplementary oxygen beyond postoperative day 3. Patient-reported comfort during CPAP treatment was also evaluated. In total, 96 patients (ICPAP, n = 48; HCPAP, n = 48) were included, and the type of surgical procedure were evenly distributed between the groups. Oxygenation did not differ between the groups by 6 h, 12 h, or 18 h postoperatively (p = 0.1, 0.08, and 0.67, respectively). Nor was there any difference in X-ray verified pneumonia/atelectasis (p = 0.40) or supplementary oxygen beyond postoperative day 3 (p = 0.53). Clinical signs of pneumonia tended to be more frequent in the ICPAP group (p = 0.06), yet the difference was not statistically significant. Comfort scores were similar in both groups (p = 0.43), although a sensation of claustrophobia during treatment was only experienced in the HCPAP group (11% vs. 0%, p = 0.03). Compared with ICPAP, using HCPAP was associated with similar oxygenation (i.e., PaO₂/FIO₂ ratio) and a similar risk of pulmonary complications. However, HCPAP treatment was associated with a higher sensation of claustrophobia.

PMID:35429325 | DOI:10.1007/s10877-022-00857-7

Breast Cancer Res Treat. 2022 Apr 16. doi: 10.1007/s10549-022-06579-3. Online ahead of print.

ABSTRACT

PURPOSE: Breast-conserving surgery (BCS) followed by whole breast radiation therapy (BCS-WBRT) or total mastectomy without WBRT (TM-no-WBRT) is the primary treatment for early stage breast cancer patients. Our study aimed to identify which early stage breast cancer treatment strategies had a subsequent lower incidence rate of mood disorder over a period of 10 years after the primary treatment.

METHODS: This retrospective cohort study consisted of newly diagnosed early stage breast cancer patients in Taiwan from 2000 to 2013 using the National Health Insurance Research Database in Taiwan. We used a 1:1 propensity score matching by age to enrol patients into the BCS-WBRT and TM-no-WBRT groups. Statistical analyses were performed to calculate the hazard ratio and cumulative incidence rate.

RESULTS: Our study consisted of 876 BCS-WBRT patients and 1949 TM-no-WBRT patients. After propensity score matching, each study group included 876 patients. The results showed that the mood disorder incidence rate was lower in the BCS-WBRT group than in the TM-no-WBRT group. Multivariate Cox regression analysis revealed that the BCS-WBRT group had a decreased risk of developing mood disorder (adjusted hazard ratio 0.69, 95% CI 0.53-0.90, p < 0.01). Furthermore, the Kaplan-Meier analysis showed that the BCS-WBRT group had a lower cumulative incidence rate of mood disorder, especially depression, after undergoing 10 years of primary treatment (p = 0.004).

CONCLUSION: Our results indicated that BCS-WBRT was associated with a lower risk of development of mood disorder over a 10-year period compared to TM-no-WBRT in early stage breast cancer patients. Our findings may provide helpful information, along with other clinical data, for breast cancer patients as they choose the type of appropriate surgery for treatment.

PMID:35429320 | DOI:10.1007/s10549-022-06579-3