Nevin Manimala

Anesthesiology. 2023 Apr 4. doi: 10.1097/ALN.0000000000004570. Online ahead of print.

ABSTRACT

BACKGROUND: COVID-19 forced healthcare systems to make unprecedented changes in clinical care processes. We hypothesized that the COVID-19 pandemic adversely impacted timely access to care, perioperative processes, and clinical outcomes for pediatric patients undergoing primary appendectomy.

METHODS: We conducted a retrospective, international, multicenter study using matched cohorts within participating centers of the international PEdiatric Anesthesia COVID-19 Collaborative (PEACOC). Patients < 18 years old were matched using age, ASA-PS status, and sex. The primary outcome was the difference in hospital length of stay of patients undergoing primary appendectomy during a 2-month period early in the COVID-19 pandemic (April-May 2020) compared to pre-pandemic (April-May 2019). Secondary outcomes included time to appendectomy and the incidence of complicated appendicitis.

RESULTS: 3351 cases from 28 institutions were available with 1684 cases in the pre-pandemic cohort matched to 1618 in the pandemic cohort. Hospital length of stay was statistically significantly different between the two groups: 29 hours (IQR: 18, 67) in the pandemic cohort versus 28 hours (IQR: 18, 79) in the pre-pandemic cohort (adjusted coefficient, 1; 95% CI 0.39 to 1.61, P<0.001), but this difference was small. Eight centers demonstrated a statistically significantly longer hospital length of stay in the pandemic period compared to the pre-pandemic period, while 13 were shorter and 7 did not observe a statistically significant difference. During the pandemic period, there was a greater occurrence of complicated appendicitis, pre-pandemic 313 (18.6%) versus pandemic 389 (24.1%), absolute difference of 5.5% (adjusted OR, 1.32; [95% CI 1.1 to 1.59]; P=0.003). Preoperative SARS CoV-2 testing was associated with significantly longer time-to-appendectomy, 720 minutes (IQR: 430, 1112) with testing versus 414 minutes (IQR: 231, 770) without testing, adjusted coefficient, 306 minutes, (95% CI 241 to 371, P <0.001), and longer hospital length of stay, 31 hours (IQR: 20, 83) with testing versus 24 hours (IQR: 14, 68) without testing, adjusted coefficient, 7.0, (95% CI 2.7 to 11.3, P=0.002).

DISCUSSION: For children undergoing appendectomy, the COVID-19 pandemic did not significantly impact hospital length of stay.

PMID:37014980 | DOI:10.1097/ALN.0000000000004570

Arch Pathol Lab Med. 2023 Apr 5. doi: 10.5858/arpa.2022-0338-OA. Online ahead of print.

ABSTRACT

CONTEXT.—: End-stage kidney disease (ESKD) is defined as renal impairment requiring renal replacement therapy to sustain life. With a 1-year mortality of ∼20% to 30%, many die of complications related to this disease.

OBJECTIVE.—: To determine the percentage of autopsy cases of decedents with ESKD in which the contribution of ESKD to death is accurately reflected in the final report.

DESIGN.—: Autopsy case records were retrospectively reviewed at 4 institutions (Yale New Haven Hospital, University of Chicago Medical Center, University of Illinois at Chicago Hospital, University of Iowa Hospital). Clinical, macroscopic, and microscopic autopsy findings were reviewed, with attention to renal disease findings.

RESULTS.—: One hundred sixty decedents with documented ESKD and premortem dialysis were identified who underwent autopsy assessment. ESKD was implicated as a cause of death (CoD) or significant contributing factor in 44 cases (28%), but not in the remaining 116 cases (72%). Cardiovascular disease was the most common CoD in ESKD. There was significant interpathologist variation in the inclusion of ESKD as a CoD across institutions. These rates ranged from 85% correlation (23 of 27 cases), to 13% (4 of 31 and 8 of 62 cases at 2 institutions), and 22.5% (9 of 40 cases) across the 4 participating institutions.

CONCLUSIONS.—: The recognition at autopsy of ESKD as a CoD or contributing CoD at autopsy in patients undergoing dialysis remains low (28%). The detrimental impact of ESKD is not reflected in hospital autopsy reports, which carries implications for collection of vital statistics and allocation of research funding for kidney diseases.

PMID:37014976 | DOI:10.5858/arpa.2022-0338-OA

J Cardiopulm Rehabil Prev. 2023 Apr 5. doi: 10.1097/HCR.0000000000000789. Online ahead of print.

ABSTRACT

PURPOSE: Exercise performance and quality of life (QoL) of left ventricular assist device (LVAD) patients improve after early cardiac rehabilitation (CR). The purpose of this study was to examine the efficacy of multiprofessional long term phase 3 outpatient CR, and whether cardiopulmonary exercise testing (CPX) and 6-min walk testing (6MWT) post-LVAD implantation predict hospital readmission.

METHODS: This retrospective observational cohort study included 29 LVAD patients (58.6 ± 7.7 yr, female: 13.8%, body mass index: 29.4 ± 3.3 kg/m2). Functional performance tests (CPX, 6MWT, sit-to-stand test), QoL, and psychological surveys (Kansas City Cardiomyopathy Questionnaire, hospital anxiety and depression scale, and Control Convictions about Disease and Health [KKG]) were performed at baseline and at the end of CR.

RESULTS: The CR was initiated at a median (IQR) of 159 (130-260) d after LVAD implantation for a duration of 340 (180-363) d with 46.8 ± 23.2 trainings. The 6MWT (408.4 ± 113.3 vs 455.4 ± 115.5 m, P = .003) and sit-to-stand test (16.7 ± 6.9 vs 19.0 ± 5.3 repetitions, P = .033) improved, but relative peak oxygen uptake (V˙o2peak: 9.4 [8.2-14.4] vs 9.3 [7.8-13.4] mL/min/kg, P = .57) did not change. Using receiver operating characteristic curve analysis, baseline V˙o2peak values were associated with readmission 1-yr after CR onset (C-statistic = 0.88) with a cutoff value of V˙o2peak < 9.15 mL/min/kg (100% sensitivity, 78% specificity, P < .001). The Kansas City Cardiomyopathy Questionnaire self-efficacy and knowledge (+6.3 points), QoL (+5.0 points), and social limitation (+7.1 points) demonstrated clinically important changes. In addition, the hospital anxiety and depression scale showed a significant reduction in anxiety (4.6 ± 3.2 vs 2.6 ± 2.4, P = .03).

CONCLUSIONS: Long-term CR is safe and LVAD outpatients showed improvement of QoL, anxiety, and submaximal exercise performance. In addition, V˙o2peak and 6MWT have prognostic value for readmission.

PMID:37014949 | DOI:10.1097/HCR.0000000000000789

J Am Chem Soc. 2023 Apr 4. doi: 10.1021/jacs.3c01726. Online ahead of print.

ABSTRACT

While the oxidative addition of Ni(I) to aryl iodides has been commonly proposed in catalytic methods, an in-depth mechanistic understanding of this fundamental process is still lacking. Herein, we describe a detailed mechanistic study of the oxidative addition process using electroanalytical and statistical modeling techniques. Electroanalytical techniques allowed rapid measurement of the oxidative addition rates for a diverse set of aryl iodide substrates and four classes of catalytically relevant complexes (Ni(^MeBPy), Ni(^MePhen), Ni(Terpy), and Ni(BPP)). With >200 experimental rate measurements, we were able to identify essential electronic and steric factors impacting the rate of oxidative addition through multivariate linear regression models. This has led to a classification of oxidative addition mechanisms, either through a three-center concerted or halogen-atom abstraction pathway based on the ligand type. A global heat map of predicted oxidative addition rates was created and shown applicable to a better understanding of the reaction outcome in a case study of a Ni-catalyzed coupling reaction.

PMID:37014945 | DOI:10.1021/jacs.3c01726

JBRA Assist Reprod. 2023 Apr 4. doi: 10.5935/1518-0557.20220046. Online ahead of print.

ABSTRACT

OBJECTIVE: The use of donor oocytes in assisted reproduction has seen a significant rise worldwide in the last two decades. Postponement of motherhood and premature ovarian insufficiency are the main reasons for the increase in the number of in vitro fertilization cycles with donor oocytes. The present study aims to characterize donor oocyte cycles to analyze factors that may have an effect on live births and clinical pregnancy outcomes.

METHODS: Data were obtained from a single Assisted Reproduction Center in southern Brazil. Recipient demographics (n=148 patients) and cycle characteristics (n=213 cycles; 50 patients did more than one IVF attempt) were analyzed. Statistical analysis was performed using chi-squared and t-test as appropriate.

RESULTS: On average, recipients that reached gestation were significantly younger than the ones that did not. We also observed a significant positive effect of constant dose estrogen therapy on pregnancies.

CONCLUSIONS: Patient age and response to estradiol therapy are important factors in the attainment of the best possible outcomes in cycles with donor oocytes.

PMID:37014939 | DOI:10.5935/1518-0557.20220046

Wound Manag Prev. 2023 Mar;69(1):32-48.

ABSTRACT

BACKGROUND: Pain management is important for patient comfort in the treatment of partial-thickness burn wounds. The topical application of ibuprofen provides analgesic and anti-inflammatory effects.

PURPOSE: To evaluate the efficacy of ibuprofen-containing foam dressing in partial-thickness burns.

METHODS: The study included 50 patients with superficial second-degree burn wounds. Ibuprofen-containing foam dressing was used in 25 patients and paraffin gauze dressing in 25 patients as controls. The visual analogue score (VAS) was evaluated 30 min after dressing. On the 90th day following wound healing, the Vancouver scar scale (VSS) was administered to the patients to evaluate healing and scar formation.

RESULTS: The rate of wound healing significantly increased in the study (ibuprofen-containing foam dressing) group compared to control group (8.84±2.97 vs 11.32±4.39, P = 0.010), and the frequency of dressing change significantly decreased in the study group vs control group (1.36±0.49 vs 5.68±2.07, P = 0.000). The oral analgesic needs and VAS scores of the patients were also found to be statistically significantly lower in the study group (5.04 ± 2.44) than for the control group (8.64 ± 1.29, P = 0.000). In the evaluation of the VSS, the total score was lower in the study group, but no statistically significant difference was observed.

CONCLUSION: The use of ibuprofen-containing foam dressing in patients with superficial second-degree burns eligible for outpatient follow-up provides effective pain management and increases patient comfort. It does not have a negative effect on wound healing. We consider that ibuprofen-containing foam dressing can be safely used in partial-thickness burns.

PMID:37014935

Wound Manag Prev. 2023 Mar;69(1):14-24.

ABSTRACT

BACKGROUND: Pressure injuries are associated with skin temperature changes, but little is known about skin temperature characteristics of the Kennedy Lesion (KL).

PURPOSE: The purpose of this study was to describe early skin temperature changes in KLs using long-wave infrared thermography.

METHODS: KLs were identified from chart review in 10 ICU patients. Skin assessments were performed within 24 hours of new skin discoloration. Temperature measurements were performed using a long-wave infrared thermography imaging system. Relative Temperature Differential (RTD) between the discolored area and a selected control point was calculated. RTDs of > +1.2 degrees C and < -1.2 degrees C were considered abnormal. Demographic data and observable characteristics of the KL were collected when available. Descriptive statistics (Mean plus/minus SD; % ) were used.

RESULTS: The major finding of this study was that there were no early skin temperature differences between the KLs and surrounding skin.

CONCLUSION: The early stage of the KL may be limited to microvascular injury which results in a normal skin temperature. More studies are needed to verify this finding and to ascertain whether KL skin temperature changes over time. The study also supports the bedside use of thermography in skin temperature assessment.

PMID:37014934

PLoS One. 2023 Apr 4;18(4):e0283811. doi: 10.1371/journal.pone.0283811. eCollection 2023.

ABSTRACT

While linking records across large administrative datasets [“big data”] has the potential to revolutionize empirical social science research, many administrative data files do not have common identifiers and are thus not designed to be linked to others. To address this problem, researchers have developed probabilistic record linkage algorithms which use statistical patterns in identifying characteristics to perform linking tasks. Naturally, the accuracy of a candidate linking algorithm can be substantially improved when an algorithm has access to “ground-truth” examples-matches which can be validated using institutional knowledge or auxiliary data. Unfortunately, the cost of obtaining these examples is typically high, often requiring a researcher to manually review pairs of records in order to make an informed judgement about whether they are a match. When a pool of ground-truth information is unavailable, researchers can use “active learning” algorithms for linking, which ask the user to provide ground-truth information for select candidate pairs. In this paper, we investigate the value of providing ground-truth examples via active learning for linking performance. We confirm popular intuition that data linking can be dramatically improved with the availability of ground truth examples. But critically, in many real-world applications, only a relatively small number of tactically-selected ground-truth examples are needed to obtain most of the achievable gains. With a modest investment in ground truth, researchers can approximate the performance of a supervised learning algorithm that has access to a large database of ground truth examples using a readily available off-the-shelf tool.

PMID:37014897 | DOI:10.1371/journal.pone.0283811

PLoS One. 2023 Apr 4;18(4):e0283875. doi: 10.1371/journal.pone.0283875. eCollection 2023.

ABSTRACT

INTRODUCTION: The prevalence of atrial fibrillation (AF) is increasing as the elderly population continues to increase. Chronic kidney disease, diabetes, and hypertension are known risk factors for AF. Since multimorbidity exists in chronic kidney disease, it is difficult to determine the impact of hypertension alone. Furthermore, little is known about the impact of hypertension on predicting AF in diabetic end-stage renal disease (ESRD). Here, we evaluated the effect of differential blood pressure control on AF prevalence among the diabetic ESRD population.

METHODS: From the Korean National Health Insurance Service database, 2 717 072 individuals with diabetes underwent health examinations during 2005-2019. Exactly 13 859 individuals with diabetic ESRD without a prior history of AF were selected and included in the analysis. Based on blood pressure level and previous hypertension medication history, we subdivided them into five groups: normal (normotensive), pre-hypertension, new onset hypertension, controlled hypertension, and uncontrolled hypertension. AF risk according to the blood pressure groups was estimated using Cox proportional-hazards models.

RESULTS: Among the five groups, the new onset hypertension, controlled hypertension, and uncontrolled hypertension groups showed a higher AF risk. In patients on antihypertensives, diastolic blood pressure ≥100 mmHg was significantly associated with AF risk. High pulse pressure showed a significant risk for AF in patients on antihypertensives.

CONCLUSION: In patients with diabetic ESRD, overt hypertension and a history of hypertension impacts AF. AF risk was higher in the ESRD population with diastolic blood pressure ≥100 mmHg and pulse pressure >60 mmHg.

PMID:37014888 | DOI:10.1371/journal.pone.0283875

Proc Natl Acad Sci U S A. 2023 Apr 11;120(15):e2211807120. doi: 10.1073/pnas.2211807120. Epub 2023 Apr 4.

ABSTRACT

Intensity-based time-lapse fluorescence resonance energy transfer (FRET) microscopy has been a major tool for investigating cellular processes, converting otherwise unobservable molecular interactions into fluorescence time series. However, inferring the molecular interaction dynamics from the observables remains a challenging inverse problem, particularly when measurement noise and photobleaching are nonnegligible-a common situation in single-cell analysis. The conventional approach is to process the time-series data algebraically, but such methods inevitably accumulate the measurement noise and reduce the signal-to-noise ratio (SNR), limiting the scope of FRET microscopy. Here, we introduce an alternative probabilistic approach, B-FRET, generally applicable to standard 3-cube FRET-imaging data. Based on Bayesian filtering theory, B-FRET implements a statistically optimal way to infer molecular interactions and thus drastically improves the SNR. We validate B-FRET using simulated data and then apply it to real data, including the notoriously noisy in vivo FRET time series from individual bacterial cells to reveal signaling dynamics otherwise hidden in the noise.

PMID:37014867 | DOI:10.1073/pnas.2211807120