Nevin Manimala

Nat Commun. 2022 Dec 24;13(1):7930. doi: 10.1038/s41467-022-35571-0.

ABSTRACT

Heat extremes have grown disproportionately since the advent of industrialization and are expected to intensify further under unabated greenhouse warming, spreading unevenly across the globe. However, amplification mechanisms are highly uncertain because of the complex interplay between regional physical responses to human forcing and the statistical properties of atmospheric temperatures. Here, focusing on the latter, we explain how and to what extent the leading moments of thermal distributions sway the future trajectories of heat extremes. Crucially, we show that daily temperature variability is the key to understanding global patterns of change in the frequency and severity of the extremes and their exacerbation in many places. Variability accounts for at least half of the highly differential regional sensitivities and may well outweigh the background warming. These findings provide fundamental insights for assessing the reliability of climate models and improving their future projections.

PMID:36566208 | DOI:10.1038/s41467-022-35571-0

BMC Musculoskelet Disord. 2022 Dec 24;23(1):1126. doi: 10.1186/s12891-022-06109-8.

ABSTRACT

BACKGROUND: A safe and effective technique for anterolateral portal placement in elbow arthroscopy is significant. We compared the outcomes of patients who underwent elbow arthroscopy using different ultrasound-assisted techniques.

METHODS: From May 2016 to June 2021 a retrospective analysis on all patients who underwent elbow arthroscopy in our department was performed. Patients were separated into three groups: non-ultrasound; preoperative ultrasound; and intraoperative ultrasound. The minimum follow-up period was 1 year. Nerve injuries, visual analog scale (VAS), Mayo elbow-performance score (MEPS), Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH), and range of motion (ROM) of the elbow were evaluated for comparison among the three groups pre- and post-operatively.

RESULTS: All 55 patients completed a 1-year follow-up: non-ultrasound (n = 20); preoperative ultrasound (n = 17); and intraoperative ultrasound (n = 18). There were 3 cases (15.0%) of transient radial nerve palsy in the non-ultrasound group. No nerve complications occurred in preoperative ultrasound and intraoperative ultrasound groups. The probability of postoperative radial nerve injury in the three groups was statistically different (P < 0.05). There was no significant difference in the VAS score, MEPS, DASH score, and ROM among the three groups at the follow-up evaluation (P > 0.05).

CONCLUSION: Performing anterolateral portal placement during elbow arthroscopy with ultrasound-assisted techniques successfully avoided radial nerve injury.

PMID:36566206 | DOI:10.1186/s12891-022-06109-8

BMC Urol. 2022 Dec 24;22(1):211. doi: 10.1186/s12894-022-01158-6.

ABSTRACT

BACKGROUND: To assess the characteristics, predictive risk factors, and prognostic effect of secondary bladder cancer (SBCa) following radical nephroureterectomy (RNU) in upper tract urothelial carcinoma (UTUC).

METHODS: Using the Surveillance, Epidemiology, and End Results database, the authors analyzed clinicopathologic characteristics and survival data from 472 UTUC patients with SBCa after RNU, between 2004 and 2017. Cox’s proportional hazard regression model was implemented to identify independent predictors associated with post-recurrence outcomes. The threshold for statistical significance was p < 0.05.

RESULTS: In total, 200 Ta-3N0M0 localized UTUC patients with complete data were finally included. With a median follow-up of 71.0 months (interquartile ranges [IQR] 36.0 -103.8 months), 52.5% (n = 105) had died, with 30.5% (n = 61) dying of UTUC. The median time interval from UTUC to SBCa was 13.5 months (IQR 6.0-40.8 months). According to multivariable Cox regression analysis, patients with SBCa located at multiple sites, advanced SBCa stage, higher SBCa grade, elderly age and a shorter recurrence time, encountered worse cancer-specific survival (CSS), all p < 0.05.

CONCLUSION: For primary UTUC patients with SBCa after radical surgery, advanced age, multiple SBCa sites, shorter recurrence time, higher SBCa stage, and grade proved to be significant independent prognostic factors of CSS. We ought to pay more attention to SBCa prevention as well as to earlier signs which may increase the likelihood of early detection. Having the ability to manage what may be seen as the superficial SBCa signs may enable us to improve survival but further research is required.

PMID:36566200 | DOI:10.1186/s12894-022-01158-6

BMC Oral Health. 2022 Dec 24;22(1):638. doi: 10.1186/s12903-022-02676-3.

ABSTRACT

Knowing the level of behavioral intention and tooth-brushing practices is crucial for the implementation of the intervention. However, such studies are too limited in Ethiopia. The current study employed a health behavior model to identify predictors that can serve to support primary school children’s attitudes, intentions, knowledge, environmental constraints, and practices of tooth brushing. Thus, this study aimed to assess tooth brushing practices and their predictors among primary school children in Bahir Dar city, Ethiopia. An Institutional based cross-sectional study was conducted among primary school children in Bahir Dar city. A multi-stage sampling technique was used to select 610 participants. Data were collected using pre-tested interviewer-administered questionnaires. Questionnaires adapted from items’ previous literature were used for integrated behavioral model constructs incorporated with elicitation study results. Data were entered into Epi data and then analyzed by Stata. Descriptive statistics were done. Confirmatory factor analysis was performed to check the convergent validity of the measurement. The Internal reliability of the items was also checked using composite reliability. Multivariable logistic regression was used to predict the role of independent variables in toothbrushing practices. Moreover, path analysis was performed to check the causal effect of integrated behavioral model constructs on toothbrushing practices. The goodness of fit of the final model was checked using the Hosmer and Lemeshow test of best fit with a large p value = 0.97 and Area under receiver operating characteristics curve = 0.98. The overall prevalence of the current practice of toothbrushing among the respondents was 45.4%. The prevalence of brushing frequency was 243 (89.01%), 27 (9.89%), and 3 (1.09%) brushed once a day, twice a day, and more than twice a day respectively. Female child’s [AOR 3.23, 95% CI 1.48-7.02], mothers’ education [AOR 4.6; 95% CI 1.22-17.44], past experience of toothbrushing [AOR 0.042; CI 0.018-0.101], knowledge about tooth brushing practices [AOR 1.3; 95% CI 1.09-1.60], behavioral intention [AOR 2.01; 95% CI 1.74-2.32], experiential attitude [AOR 1.09; 95% CI 1.01-1.17],instrumental attitude [AOR 1.02; 95% CI 1.01-1.03], and descriptive norm [AOR 1.07; 95% CI 1.01-1.14] were predictors of toothbrushing practices. The findings indicate that the practice of toothbrushing practices among primary school students was low. Sex, mother’s education, knowledge, intention, experience, experiential attitude, instrumental attitude, and descriptive norm, have significant effects on toothbrushing practices; indicating that the integrated behavioral model showed adequate utility in predicting toothbrushing practices in the study area. School-based toothbrushing practices change interventions such as communication strategy.

PMID:36566198 | DOI:10.1186/s12903-022-02676-3

BMC Pediatr. 2022 Dec 24;22(1):734. doi: 10.1186/s12887-022-03804-2.

ABSTRACT

BACKGROUND: Noonan syndrome (NS) is a clinically and genetically heterogeneous disorder. Since its clinical phenotype is often mild and difficult to differentiate from other syndromes, its diagnosis can be challenging and its prevalence in the pediatric population is most certainly underestimated. The difficulty in identifying Noonan syndrome is also increased by the fact that genetic tests are currently not able to detect an underlying mutation in around 10% of the cases.

METHODS: This is a retrospective, observational study conducted at the Institute for Maternal and Child “Burlo Garofolo” in Trieste, Italy. We recruited all the patients with clinical and/or genetic diagnosis of NS who were evaluated at the Department of Pediatrics between October 2015 and October 2020. Statistical analyses were performed with IBM SPSS Statistics software. The association between discrete variables has been evaluated through chi-squared test, indicating statistically significant p with Pearson test or Fischer test for variables less than 5.

RESULTS: We recruited a total of 35 patients affected by Noonan syndrome. In 24 patients (75%) we identified an underlying genetic substrate: 17 patients had a mutation on PTPN11 (61%), 2 in SOS1, KRAS and SHOC2 (7% each) and only 1 in RAF1 (4%). 25% of the subjects did not receive a genetic confirm. As for the phenotype of the syndrome, our study identified the presence of some clinical features which were previously unrelated or poorly related to NS. For example, renal and central nervous system abnormalities were found at a higher rate compared to the current literature. On the contrary, some features that are considered very suggestive of NS (such as lymphatic abnormalities and the classical facial features) were not frequently found in our population.

CONCLUSIONS: In our analysis, we focused on the main phenotypic features of NS, identifying various clinical manifestation that were not associated with this genetic condition before. This could be helpful in raising the knowledge of NS’s clinical spectrum, facilitating its diagnosis.

PMID:36566191 | DOI:10.1186/s12887-022-03804-2

BMC Cancer. 2022 Dec 24;22(1):1353. doi: 10.1186/s12885-022-10410-z.

ABSTRACT

BACKGROUND: Women living with metastatic breast cancer (MBC) are at risk of significantly impaired quality of life (QOL), symptom burden, distress and fear of progression, and unmet needs, yet they face barriers to accessing evidence-based psychosocial treatments. Our group therefore developed Finding My Way-Advanced (FMW-A), a web-based self-guided psychosocial program for women with MBC. This study aims to assess its efficacy in improving mental and other QOL domains, distress, fear of progression, unmet needs, and health service utilisation.

METHODS: The multi-site randomised controlled trial (RCT) will enrol 370 Australian participants. Eligible participants are adult (18 years +) women diagnosed with MBC, with a life expectancy of 6 months or more, with sufficient English-language literacy to provide informed consent. Participants will be identified, screened and referred from one of 10 Australian sites, or via self-referral in response to advertisements. Participants complete four online questionnaires: prior to accessing their program (‘baseline’), 6 weeks later (‘post-intervention’), then 3 months and 6 months post-intervention. Consenting participants will be randomised to either FMW-A (intervention), or Breast Cancer Network Australia’s (BCNA) online/app resource My Journey (minimal intervention attention-control). This is a single-blind study, with randomisation computer-generated and stratified by site. FMW-A is a 6-module program addressing some of the most common issues experienced by women with MBC, with BCNA control resources integrated within the ‘resources’ section. All modules are immediately accessible, with an additional booster module released 10 weeks later. The primary outcome is mental QOL; statistical criteria for superiority is defined as a 4-point difference between groups at post-treatment. Secondary outcomes include other QOL domains, distress, fear of progression, health service use, intervention adherence, and user satisfaction.

DISCUSSION: This will be the first adequately powered RCT of a self-directed online intervention for women with MBC. If efficacious, FMW-A will help address two national key priorities for management of MBC – enhancing QOL and reducing symptom burden. FMW-A has the potential to address unmet needs and overcome access barriers for this overlooked population, while reducing health system burden.

TRIAL REGISTRATION: The study was registered prospectively with the ANZCTR on 29/10/2021. Trial ID ACTRN12621001482853p. https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382714&isReview=true.

PMID:36566189 | DOI:10.1186/s12885-022-10410-z

BMC Med Imaging. 2022 Dec 24;22(1):226. doi: 10.1186/s12880-022-00952-w.

ABSTRACT

BACKGROUND: We aimed to determine the performance of ¹⁸ F-FAPI PET/CT used for preprocedural assessment of glioblastoma before radiotherapy.

METHODS: Twelve glioblastoma patients having undergone incomplete surgical resection or biopsy were examined with ¹⁸ F-FAPI PET/CT and MRI scanning before radiotherapy. All patients had confirmed tumor residues according to findings of histopathological and/or long-term clinical and radiological follow-ups. Lesion characterization data, including SUV_max and tumor-to-background ratio (TBR) on PET/CT were attained. PET/CT and MRI findings were compared in terms of number of lesions. The correlation between immunohistochemistry, molecular expression, and PET/CT parameters was also evaluated.

RESULTS: ¹⁸ F-FAPI PET/CT detected 16 FAPI-avid out of 23 lesions in 12 patients described on MRI. MRI was statistically different from ¹⁸ F-FAPI PET/CT for lesion detection according to the exact McNemar statistical test (P = 0.0156). The SUV_max and TBR of the glioblastomas was 7.08 ± 3.55 and 19.95 ± 13.22, respectively. The sensitivity and positive predictive value (PPV) of ¹⁸ F-FAPI PET were 69.6% and 100%, respectively. Neither the Ki-67 index nor the molecular expression was correlated with the FAPI-PET/CT parameters.

CONCLUSION: ¹⁸ F-FAPI PET/CT detects glioblastomas at a lower rate than MRI. However, the 100% PPV of the examination may make it useful for differentiating controversial lesions detected on MRI. The ¹⁸ F-FAPI-avid lesions are displayed more clearly probably due to a higher TBR. ¹⁸ F-FAPI PET/CT imaging might find application in glioblastoma biopsy and radiotherapy planning.

PMID:36566187 | DOI:10.1186/s12880-022-00952-w

BMC Musculoskelet Disord. 2022 Dec 24;23(1):1127. doi: 10.1186/s12891-022-06029-7.

ABSTRACT

BACKGROUND: Western Ontario shoulder instability index (WOSI) is a widely used disease-specific self-assessment measurement tool for patients with shoulder instability. The main aim of this study was to translate and cross culturally adapt the WOSI into Finnish language and to test its measurement properties.

METHODS: WOSI was translated in Finnish and adapted into an electronic user interface. 62 male patients with traumatic anteroinferior shoulder instability, programmed for stabilizing shoulder surgery, answered the questionnaire twice preoperatively (2 and 0 weeks), and twice postoperatively (3 and 12 months). Additional scoring tools, such as satisfaction to treatment outcome, subjective shoulder value (SSV), Oxford shoulder instability index (OSIS) and Constant score (CS), were used as comparators. The reliability, validity and responsiveness of WOSI were investigated through statistical analysis.

RESULTS: Preoperative test-retest results were available for 49 patients, and 54 patients were available at final follow up. The mean WOSI was 57.8 (SD 20.3), 70.4 (SD 18.9), and 85.9 (SD 15.5), at baseline, 3, and 12 months, respectively. There was a statistically significant mean improvement of 28.8 (SD 24.5) in WOSI between baseline and 12 months (p < 0.0001). The intraclass correlation coefficient for the preoperative WOSI was excellent 0.91. At 12 months WOSI had an excellent Pearson’s correlation coefficient both with SSV (0.69), OSIS (-0.81), and poor with CS (0.25) scores, confirming our a priori hypothesis. There were no detected floor nor ceiling effects for WOSI pre- or postoperatively. The calculated minimal detectable change was 9.2 and the estimated minimal clinically important difference 13.4 to 18.1.

CONCLUSION: Finnish version of WOSI is a reliable and valid tool for assessing health state and improvement after operative treatment of shoulder instability in young male patients.

PMID:36566181 | DOI:10.1186/s12891-022-06029-7

BMC Oral Health. 2022 Dec 24;22(1):637. doi: 10.1186/s12903-022-02641-0.

ABSTRACT

BACKGROUND: The aim of the current study was to investigate current dental practice in operative dentistry in Jordan, and the relationship between evidence-based dentistry in caries research and decision making in clinical practice in operative dentistry.

MATERIALS AND METHODS: This cross-sectional study was conducted through a survey of dentists in Jordan. The survey aimed to explore the degree of knowledge and practice of evidence-based dentistry in caries research the dentists possess regarding clinical decision making in operative dentistry. The sample size was composed of (5811) dentists whom registered in Jordan Dental Association database. Descriptive statistics were generated and Chi-square test was used to examine associations between the different variables and the significance level was set at P < 0.05.

RESULTS: 4000 responses were collected from the web-survey, response rate (68.83%). Nearly half of the surveyed dentists focus on the chief complaint of their patients (n = 2032, 50.8%) rather than doing full mouth assessment. Nearly two-thirds of dentists (n = 2608, 65.2%) treat lesions confined to enamel with operative treatment. Half of dentists use operative treatment when asked about the routine management of radiographically detected proximal caries confined to enamel. When treating incipient lesions, the majority (n = 3220, 80.5%) use preventive treatment. Three-quarters of dentists (n = 2992, 74.8%) treat deep dentinal caries by removing just the soft infected carious dentin, and treated old failed restorations with replacement.

CONCLUSION: In operative dentistry, the evidence-based research is not implemented clinically. To optimize relationship between evidence-based dentistry and clinical decision-making, dental curriculum has to be updated and modified constantly.

PMID:36566180 | DOI:10.1186/s12903-022-02641-0

Respir Res. 2022 Dec 24;23(1):375. doi: 10.1186/s12931-022-02278-1.

ABSTRACT

We recently reported in the phase 3 PANAMO trial that selectively blocking complement 5a (C5a) with vilobelimab led to improved survival in critically ill COVID-19 patients. C5a is an important contributor to the innate immune system and can also activate the coagulation system. High C5a levels have been reported in severely ill COVID-19 patients and correlate with disease severity and mortality. Previously, we assessed the potential benefit and safety of vilobelimab in severe COVID-19 patients. In the current substudy of the phase 2 PANAMO trial, we aim to explore the effects of vilobelimab on various biomarkers of inflammation and coagulation. Between March 31 and April 24, 2020, 17 patients with severe COVID-19 pneumonia were enrolled in an exploratory, open-label, randomised phase 2 trial. Blood markers of complement, endothelial activation, epithelial barrier disruption, inflammation, neutrophil activation, neutrophil extracellular trap (NET) formation and coagulopathy were measured using enzyme-linked immunosorbent assay (ELISA) or utilizing the Luminex platform. During the first 15 days after inclusion, change in biomarker concentrations between the two groups were modelled with linear mixed-effects models with spatial splines and compared. Eight patients were randomized to vilobelimab treatment plus best supportive care (BSC) and nine patients were randomized to BSC only. A significant decrease over time was seen in the vilobelimab plus BSC group for C5a compared to the BSC only group (p < 0.001). ADAMTS13 levels decreased over time in the BSC only group compared to the vilobelimab plus BSC group (p < 0.01) and interleukin-8 (IL-8) levels were statistically more suppressed in the vilobelimab plus BSC group compared to the BSC group (p = 0.03). Our preliminary results show that C5a inhibition decreases the inflammatory response and hypercoagulability, which likely explains the beneficial effect of vilobelimab in severe COVID-19 patients. Validation of these results in a larger sample size is warranted.

PMID:36566174 | DOI:10.1186/s12931-022-02278-1