Nevin Manimala

Medicine (Baltimore). 2023 Mar 24;102(12):e33320. doi: 10.1097/MD.0000000000033320.

ABSTRACT

BACKGROUND: Difficult peripheral venous access, especially in obese people, is challenging for novices. We conducted a randomized cross-over study to examine whether near-infrared venous imaging or ultrasound guidance is more useful for novice operators to obtain difficult peripheral venous access.

METHODS: Medical students were recruited as participants. After receiving basic training using commercial simulators, participants were randomly assigned to obtain simulated venous access using a difficult venous access simulator with near-infrared venous imaging or ultrasound guidance in a randomized cross-over design. A difficult venous access simulator was newly developed with deep and narrow vessels to simulate an obese patient. The primary outcome measure of the study was the first-time success rate (%), and the secondary outcome measures included procedure time (seconds) and the number of 3 consecutive successful attempts, to represent proficiency with the procedure. Pearson chi-square test, the Wilcoxon signed-rank test, and generalized estimating equations were used for statistical analysis.

RESULTS: Forty-one medical students with no experience performing peripheral venous access were enrolled in this study. The rate of successful first attempts did not differ between the 2 groups (70% for near-infrared; 65% for ultrasound guidance; P = .64). The duration of the procedure for the first attempt was significantly shorter using near-infrared imaging (median: 14; interquartile range: 12-19) compared to ultrasound guidance (median 46; interquartile range: 26-52; P = .007). The number of attempts until 3 consecutive successes was not significantly different comparing the 2 approaches (near-infrared: 3 (3, 7.25), ultrasound guidance: 3 (3, 6.25), P = .63).

CONCLUSION: There was no difference in success rate of first-time attempts or acquiring proficiency for the 2 methods. However, duration of the first attempt was significantly shorter with near-infrared imaging than with ultrasound guidance. Near-infrared imaging may require less training than ultrasound guidance. Near-infrared venous imaging may be useful for novices to obtain difficult peripheral venous access in obese patients.

PMID:36961182 | DOI:10.1097/MD.0000000000033320

Turk J Orthod. 2023 Mar 21;36(1):10-14. doi: 10.4274/TurkJOrthod.2022.2021.0220.

ABSTRACT

OBJECTIVE: Operator experience and scanner type may influence the time taken and obtained accuracy of intraoral scanning. This study aimed to evaluate the influence of operator experience on the scanning time and correlate the accuracy of the scans taken with two different intraoral scanners (TRIOS 3, 3Shape and i500, Medit).

METHODS: In this trial, a total of 20 subjects who required intraoral scanning for orthodontic treatment were included. Intraoral scanning was done with two different scanners, TRIOS 3 and i500. One operator each with high (group 1), medium (group 2) and low (group 3) levels of experience performed intra-oral scanning with two different intraoral scanners. A One-Way ANOVA test was performed to assess the intergroup difference in scanning time and Kendall’s tau’s correlation test to determine the correlation between the experience of the operator and accuracy among the three groups using the two scanners. Also Independent samples t-test were performed to assess the intragroup differences in scanning time with two different scanners.

RESULTS: The scanning time was influenced by the type of intraoral scanner and operator experience (p<0.05). No significant correlation between operator experience and scanning accuracy in the three groups was noted (p>0.05). Statistically significant intragroup differences in scanning time between the two scanners were noted (p<0.05).

CONCLUSION: Less experienced operators took more time to scan a subject. Accuracy of scanning among three groups using two scanners was not influenced by the experience of the operator. Scanning with i500 IOS took more time than TRIOS.

PMID:36960781 | DOI:10.4274/TurkJOrthod.2022.2021.0220

OTJR (Thorofare N J). 2023 Mar 24:15394492231158375. doi: 10.1177/15394492231158375. Online ahead of print.

ABSTRACT

This rater-blinded, randomized control trial (RCT) investigated the effectiveness of a Glove Rehabilitation Application for Stroke Patients (GRASP) virtual reality home exercise program (HEP) for upper extremity (UE) motor recovery following stroke. The GRASP system facilitates the use of the affected UE in simulated instrumental activities of daily living (IADLs). Participants were asked to use the system at home in asynchronous telehealth sessions 4 times per week over 8 weeks. A non-blinded occupational therapist (OT) provided synchronous telehealth visits biweekly. Analysis comparing pre- and post-assessment results for the Fugl-Meyer UE assessment (FMUE) shows a clinically important and statistically significant between-group difference for participants completing the GRASP HEP protocol compared with usual and customary care controls. Statistically significant and clinically important differences were also found in Motor Activity Log (MAL) scores. This evidence provides support for the effectiveness of home-based, IADL-focused, virtual reality therapy with telehealth support.

PMID:36960762 | DOI:10.1177/15394492231158375

Biotechnol Genet Eng Rev. 2023 Mar 24:1-19. doi: 10.1080/02648725.2023.2193484. Online ahead of print.

ABSTRACT

To explore how to control the estrogen level in vivo by regulating the activity of the estrogen receptor in the development of breast cancer drugs, multiple-featured evaluation methods were first applied to screen the molecular descriptors of compounds according to the information of antagonist ERα provided in this study. Combining the methods of Extreme Gradient Boost (XGBoost), Light Gradient Boosting Machine (LightGBM) and Random Forest (RF), a stacking-integrated regression model for quantitatively predicting the ERα (estrogen receptors alpha) activity of breast cancer candidate drug was constructed, which considered the compounds acting on the target and their biological activity data, a series of molecular structure descriptors as the independent variables, and the biological activity values as the dependent variables. Then, three classification methods of XGBoost, LightGBM, and Gradient Boosting Decision Tree (GBDT) were selected and the voting strategy was applied to build five ADMET (Absorption, Distribution, Metabolism, Excretion, and Toxicity) classification prediction models. Finally, two schemes based on genetic algorithm (GA) were used to optimize the model and provide predictions for optimizing the biological activity and ADMET properties of ERα antagonists simultaneously. Results showed that the model prediction has strong practical significance, which can guide the structural optimization of existing active compounds and improve the activity of anti-breast cancer candidate drugs.

PMID:36960749 | DOI:10.1080/02648725.2023.2193484

Korean J Orthod. 2023 Mar 25;53(2):116-124. doi: 10.4041/kjod22.229.

ABSTRACT

OBJECTIVE: The absence of a guideline to refer to developing malocclusions appropriately, may be a contributing factor to the inadequacy of timely interceptive orthodontics provision. This study aimed to develop and validate a new orthodontic grading and referral index to be used by dental frontliners to prioritize the orthodontic referral of developing malocclusion in children based on its severity.

METHODS: A cross-sectional study involving clinical assessment with 413 schoolchildren aged between 8.1 and 11.9 years was conducted in 2018. All the presenting malocclusion was listed and graded based on a few dental guidelines to produce the draft index. The validity and reliability of the draft index were tested using twenty study models. Face and content validation was carried out using the content validation index and Modified Kappa Statistics.

RESULTS: Fourteen dental and occlusal anomalies were identified as components of malocclusion and three grades of referral (monitor, standard, urgent) were included in the final index. The scale-level content validity index average value of 0.86 and 0.87 was obtained for content and face validation, respectively. There was moderate to excellent agreement in the Modified Kappa Statistics for both validations. Excellent inter- and intra-assessor agreement was obtained. The new index displayed valid and reliable scores.

CONCLUSIONS: The Index for Interceptive Orthodontics Referral was developed and validated for the dental frontliners to identify and prioritize the developing malocclusion in children based on its severity and refer for orthodontic consultation to increase the possibility for interceptive orthodontics.

PMID:36960722 | DOI:10.4041/kjod22.229

Korean J Orthod. 2023 Mar 25;53(2):106-115. doi: 10.4041/kjod22.179.

ABSTRACT

OBJECTIVE: To evaluate the null hypothesis that there is no difference in a set of clinical predictors of potentially impacted canines between low-risk patients with and without displaced canines.

METHODS: The normal canine position group consisted of 30 patients with 60 normally erupting canines ranked in sector I (age, 9.30 ± 0.94 years). The displaced canine group comprised 30 patients with 41 potentially impacted canines ranked in sectors II to IV (age, 9.46 ± 0.78 years). Maxillary lateral incisor crown angulation, inclination, rotation, width, height, and shape, as well as palatal depth, arch length, width, and perimeter composed a set of clinical predictors, which were evaluated on digital dental casts. Statistical analyses consisted of group comparisons and variable correlations (p < 0.05).

RESULTS: There was a significant association between sex and mesially displaced canines. Unilateral canine displacement was more prevalent than bilateral displacement. The crown of the maxillary lateral incisors was significantly angulated more mesially and rotated mesiolabially in low-risk patients with displaced canines, who also had a shallower palate and shorter anterior dental arch length. Lateral incisor crown angulation and rotation, as well as palatal depth and arch length, were significantly correlated with the canine displacement severity.

CONCLUSIONS: The null hypothesis was rejected. Maxillary lateral incisor angulation inconsistent with the “ugly duckling” stage as well as a shallow palate and short arch length are clinical predictors that can significantly contribute to the early screening of ectopic canines in low-risk patients.

PMID:36960721 | DOI:10.4041/kjod22.179

Korean J Orthod. 2023 Mar 25;53(2):99-105. doi: 10.4041/kjod22.077.

ABSTRACT

OBJECTIVE: The study aimed to evaluate the changes in mandibular width after sagittal split ramus osteotomy (SSRO) in patients with mandibular asymmetric prognathism using cone-beam computed tomography (CBCT).

METHODS: Seventy patients who underwent SSRO for mandibular setback surgery were included in two groups, symmetric (n = 35) and asymmetric (n = 35), which were divided according to the differences in their right and left setback amounts. The mandibular width was evaluated three-dimensionally using CBCT images taken immediately before surgery (T1), 3 days after surgery (T2), and 6 months after surgery (T3). Repeated measures analysis of variance was applied to verify the differences in mandibular width statistically.

RESULTS: Both groups showed a significant increase in the mandibular width at T2, followed by a significant decrease at T3. No significant difference was observed between T1 and T3 in any of the measurements. No significant differences were found between the two groups (p > 0.05).

CONCLUSIONS: After mandibular asymmetric setback surgery using SSRO, the mandibular width increased immediately but returned to its original width 6 months after surgery.

PMID:36960720 | DOI:10.4041/kjod22.077

Med Phys. 2023 Mar 24. doi: 10.1002/mp.16383. Online ahead of print.

ABSTRACT

BACKGROUND: Stereotactic radiotherapy (SRT) has been widely used for the treatment of brain metastases and early stage non-small-cell lung cancer (NSCLC). Excellent SRT plans are characterized by steep dose fall-off, making it critical to accurately and comprehensively predict and evaluate dose fall-off.

PURPOSE: A novel dose fall-off index was proposed to ensure high-quality SRT planning.

METHODS: The novel gradient index (NGI) had two different modes: NGIx V for three-dimensions and NGIx r for one-dimension. NGIx V and NGIx r were defined as the ratios of the decreased percentage dose (x%) to the corresponding isodose volume and equivalent sphere radii, respectively. A total of 243 SRT plans at our institution between April 2020 and March 2022 were enrolled, including 126 brain and 117 lung SRT plans. Measurement-based verifications were performed using SRS MapCHECK. Ten plan complexity indexes were calculated. Dosimetric parameters related to radiation injuries were also extracted, including the normal brain volume exposed to 12 Gy (V₁₂ ) and 18 Gy (V₁₈ ) during single-fraction SRT (SF-SRT) and multi-fraction SRT (MF-SRT), respectively and the normal lung volume exposed to 12 Gy (V₁₂ ). The performance of NGI and other common dose fall-off indexes, gradient index (GI), R_50% and D_2cm were evaluated using Spearman correlation analysis to explore their correlations with the PTV size, gamma passing rate (GPR), plan complexity indexes and dosimetric parameters.

RESULTS: There were statistically significant correlations between NGI and PTV size (r = -0.98, p < 0.01 for NGI50 V and r = -0.93, p < 0.01 for NGI50 r), which were the strongest correlations compared with GI (r = 0.11, p = 0.13), R_50% (r = -0.08, p = 0.19) and D_2cm (r = 0.84, p < 0.01). The fitted formulas of NGI50 V = 23.86V^-1.00 and NGI50 r = 113.5r^-1.05 were established. The GPRs of enrolled SRT plans were 98.6 ± 1.7%, 94.2 ± 4.7% and 97.1 ± 3.1% using the criteria of 3%/2 mm, 3%/1 mm and 2%/2 mm, respectively. NGI50 V achieved the strongest correlations with various plan complexity indexes (|r| ranged from 0.67 to 0.91, p < 0.01). NGI50 V also showed the highest r values with V₁₂ (r = -0.93, p < 0.01) and V₁₈ (r = -0.96, p < 0.01) of the normal brain during SF-SRT and MF-SRT, respectively and V₁₂ (r = -0.86, p < 0.01) of the normal lung during lung SRT.

CONCLUSIONS: Compared with GI, R_50% and D_2cm , the proposed dose fall-off index, NGI, had the strongest correlations with the PTV size, plan complexity and V₁₂ /V₁₈ of the normal tissues. These correlations established on NGI are more helpful and reliable for SRT planning, quality control and reducing the risk of radiation injuries. This article is protected by copyright. All rights reserved.

PMID:36960718 | DOI:10.1002/mp.16383

J Endourol. 2023 Mar 24. doi: 10.1089/end.2022.0654. Online ahead of print.

ABSTRACT

Introduction Chronic urinary retention (CUR) is a major problem in elderly patients and leads to high levels of morbidity. CUR can be treated surgically with trans-urethral resection of the prostate (TURP), but surgery is frequently avoided in elderly patients due to increased peri-operative risks and the presence of detrusor activity (DU), which can lead to surgical failure. We report on contemporary outcomes for catheterised elderly patients undergoing TURP from a high-volume university teaching hospital. Patients and Methods Catheterised patients aged 80 years and older undergoing TURP for CUR at a university teaching hospital between 2012 and 2020 (9 years) were eligible. Those with neurogenic bladder, urethral stricture or prior TURP were excluded. Surgical success was defined as being catheter free at 3 month and 12-month follow up. Statistical analysis was performed using the Chi-squared test for grouped data and logistic regression modelling for continuous data. Results 147 patients were included and underwent TURP. Of these, 118 (80.3%) were completely catheter free or using intermittent self-catheterisation (ISC) at initial 3-month follow-up. 117 (79.6%) remained catheter-free at one year follow-up. PVR>1500ml prior to TURP (p=0.017); age ≥90 (p=0.0067); and WHO performance status ≥3 (p< 0.00001) were all identified as independent risk factors for surgical failure. A selected sub-set of patients excluding these risk factors showed overall catheter free rates of 88.8% at 3-month follow-up. Early and late complications were noted in 6.8% and 2.7% of patients. Conclusion Our contemporary series demonstrates high rates of successful post-operative voiding for selected elderly patients after TURP, with catheter free rates at 12 months of 88.8%. Overall complication rate was 9.5%, which may be justified given the alternative morbidity of long-term catheterisation. TURP remains an efficacious and cost-effective treatment for selected elderly patients who are catheterised for CUR.

PMID:36960708 | DOI:10.1089/end.2022.0654

Phys Chem Chem Phys. 2023 Mar 24. doi: 10.1039/d2cp05874j. Online ahead of print.

ABSTRACT

Formic acid (HCOOH) is one of the highly abundant acids in the troposphere. It is important in the formation of atmospheric aerosols and impacts the acidity of rainwater. In the present scenario, the model chemistry of HCOOH(FA) sources and sinks is poorly understood. In this work, we apply quantum chemical methods coupled with advanced statistical rate theories to understand the production of FA and its catalytic behavior under tropospheric conditions. The potential energy surfaces (PES) for O₂ + OH˙CHOH and O₂ + OH˙CHOH(+FA) reactions were constructed using the CCSD(T)/6-311++G(3df,3pd)//M06-2X/6-311++G(3df,3pd) level and rate constants for the production of FA were predicted using Rice-Ramsperger-Kassel-Marcus (RRKM)/master equation (ME) simulation with Eckart tunnelling and canonical variational transition state theory (CVT) with small curvature tunnelling (SCT) between the temperature range of 200-320 K and pressure range of 0.001 to 10 bar. The reaction follows the formation of cis and trans intermediates followed by spontaneous decomposition via concerted HO₂ elimination to form stable post intermediates, which then leads to the straight formation of cis and trans formic acid. The current study also helps understand the role of cis and trans contribution to the total rate constants. The results show that O₂ + OH˙CHOH is dominated by both cis and trans isomers; however, the trans isomer plays a more important role in the catalytic reaction. This result is due to the formation of a strong hydrogen-bonded complex in the trans isomer, which is dominated by the enthalpy factor rather than the entropy factor. The results predict that the catalytic effect of FA on the O₂ + OH˙CHOH reaction is important when the concentration of FA is not included in the calculations; however, it has no effect under tropospheric conditions, when the FA concentration is included in the calculation. As a result, the total effective reaction rate constants are smaller. This work provides experimental/theoretical confirmation of Franco et al. who predicted that methanediol is the precursor for the FA formation, resolving an open problem in the kinetics of the gas phase reaction. O₂ + OH˙CHOH and O₂ + OH˙CHOH(+FA) probably explain other diol systems, which can help explain the formation of other atmospheric acids that affect aerosol formation and cloud evolution.

PMID:36960665 | DOI:10.1039/d2cp05874j