Nevin Manimala

PLoS One. 2022 Apr 8;17(4):e0265815. doi: 10.1371/journal.pone.0265815. eCollection 2022.

ABSTRACT

Mathematical models of infectious diseases exhibit robust dynamics, such as stable endemic, disease-free equilibriums or convergence of the solutions to periodic epidemic waves. The present work shows that the accuracy of such dynamics can be significantly improved by including global effects of host movements in disease models. To demonstrate improved accuracy, we extended a standard Susceptible-Infected-Recovered (SIR) model by incorporating the global dynamics of the COVID-19 pandemic. The extended SIR model assumes three possibilities for susceptible individuals traveling outside of their community: • They can return to the community without any exposure to the infection. • They can be exposed and develop symptoms after returning to the community. • They can be tested positively during the trip and remain quarantined until fully recovered. To examine the predictive accuracy of the extended SIR model, we studied the prevalence of the COVID-19 infection in six randomly selected cities and states in the United States: Kansas City, Saint Louis, San Francisco, Missouri, Illinois, and Arizona. The extended SIR model was parameterized using a two-step model-fitting algorithm. The extended SIR model significantly outperformed the standard SIR model and revealed oscillatory behaviors with an increasing trend of infected individuals. In conclusion, the analytics and predictive accuracy of disease models can be significantly improved by incorporating the global dynamics of the infection.

PMID:35395018 | DOI:10.1371/journal.pone.0265815

PLoS One. 2022 Apr 8;17(4):e0266138. doi: 10.1371/journal.pone.0266138. eCollection 2022.

ABSTRACT

Scorpion envenomation is a significant public health concern in São Paulo, Brazil, and its incidence and mortality have increased in recent decades. The present study analyzed documented scorpion envenomation notifications from 2008 to 2018 throughout the 645 municipalities of São Paulo. Annual incidence and mortality rates were calculated and stratified according to sex and age. The local empirical Bayesian method and Getis-Ord Gi* statistic were used to represent standardized incidence rates in the municipalities and to identify high- and low-risk agglomerates. The incidence rate of scorpion envenomation quintupled between 2008 and 2018. Overall, the risk was higher for man, and increased with age. Deaths due to envenomation, however, were concentrated almost entirely in children 0-9 years of age. Incidence maps showed that the risk of envenomation increased in almost all regions and municipalities of São Paulo throughout the study period. The highest incidence rates were found in the western, northwestern and northern regions of the state, in contrast to the São Paulo metropolitan area and southern and coastal regions. Hot spots were identified in the Presidente Prudente, Barretos, São José do Rio Preto, and Araçatuba regional health districts, which over time formed a single high-risk cluster. In spatial terms, however, deaths were randomly distributed. In this study, we identified areas and populations at risk of scorpion envenomation and associated-fatalities, which can be used to support decision-making by health services to reduce human contact with these arachnids and avoid fatalities, especially in children.

PMID:35395017 | DOI:10.1371/journal.pone.0266138

Graefes Arch Clin Exp Ophthalmol. 2022 Apr 8. doi: 10.1007/s00417-022-05644-3. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the dynamics of Bruch’s membrane opening-based morphometrics of the optic nerve head (ONH) using spectral-domain optical coherence tomography (SD-OCT) during the first week after glaucoma surgery by trabeculectomy with mitomycin C.

METHODS: Prospective, longitudinal analysis of 25 eyes of 25 patients treated by trabeculectomy. Twenty-four eyes had evaluable postoperative SD-OCT examinations. Bruch’s membrane opening minimum rim width (BMO-MRW) and peripapillary retinal nerve fiber layer (RNFL) thickness were analyzed at baseline before surgery, 1 day, 2 to 3 days, and 1 week after surgery. Changes compared to baseline were correlated to intraocular pressure (IOP).

RESULTS: One day after surgery, the mean BMO-MRW changed by + 26.17 µm, p = 0.001 (mean IOP reduction by 17.01 mmHg). This increase persisted on day 2-3 with a mean increase of BMO-MRW of + 25.33 µm, p = 0.001 (mean IOP reduction by 20.46 mmHg) and by week 1 with a mean BMO-MRW increase of + 33.17 µm, p < 0.001 (mean IOP reduction by 22.55 mmHg). The increase in BMO-MRW correlated significantly with the reduction of IOP on day 1 (Spearman’s rho ρ = 0.656, p = 0.003) and d2-3 (Spearman’s rho ρ = 0.479, p = 0.038). There was no statistically significant correlation found between the IOP and the increase in BMO-MRW in week 1. RNFL thickness showed no significant changes at day 1 as well as days 2-3 (p ≥ 0.078, respectively). It showed a small but significant increase in week 1 by 3.94 µm, p = 0.015.

CONCLUSIONS: Structural reversal of disc cupping in BMO-MRW occurs as early as 1 day after trabeculectomy and correlates to the extent of the IOP reduction. During the whole first week after surgery, a strong increase in BMO-MRW can be noted. The changes in BMO-based parameters need to be considered when evaluating patients’ longitudinal follow-up.

PMID:35394209 | DOI:10.1007/s00417-022-05644-3

Graefes Arch Clin Exp Ophthalmol. 2022 Apr 8. doi: 10.1007/s00417-022-05645-2. Online ahead of print.

ABSTRACT

PURPOSE: To compare the decompressive effect around the optic nerve canal among 3 different decompression procedures (medial, balanced, and inferomedial) using 3D printed models.

METHODS: In this experimental study, based on data obtained from 9 patients (18 sides) with dysthyroid optic neuropathy, a preoperative control model and 3 plaster decompression models were created using a 3D printer (total, 72 sides of 36 models). A pressure sensor was placed at the optic foramen, and the orbital space was filled with silicone. The surface of the silicone was pushed down directly, and changes in pressure were recorded at 2-mm increments of pushing.

RESULTS: At 10 mm of pushing, there was significantly lower pressure in the medial (19,782.2 ± 4319.9 Pa, P = 0.001), balanced (19,448.3 ± 3767.4 Pa, P = 0.003), and inferomedial (15,855.8 ± 4000.7 Pa, P < 0.001) decompression models than in the control model (25,217.8 ± 6087.5 Pa). Overall, the statistical results for each 2-mm push were similar among the models up to 10 mm of pushing (P < 0.050). At each push, inferomedial decompression caused the greatest reduction in pressure (P < 0.050), whereas there was no significant difference in pressure between the medial and balanced decompression models (P > 0.050).

CONCLUSION: All 3 commonly performed decompression procedures significantly reduced retrobulbar pressure. Because inferomedial decompression models obtained the greatest reduction in pressure on the optic nerve canal, inferomedial decompression should be considered the most reliable procedure for rescuing vision in dysthyroid optic neuropathy.

PMID:35394208 | DOI:10.1007/s00417-022-05645-2

Lung. 2022 Apr 8. doi: 10.1007/s00408-022-00531-4. Online ahead of print.

ABSTRACT

PURPOSE: Malignant pleural mesothelioma (MPM) is a malignant neoplasm of the pleura caused by asbestos exposure. For diagnosis of MPM, immunohistochemistry using multiple markers is recommended to rule out differential diagnoses, such as pulmonary adenocarcinoma. However, the specificity of currently used markers is not fully satisfactory. We previously developed a monoclonal antibody named S1, which recognizes 6-sulfo sialyl Lewis x, an L-selectin ligand expressed on high endothelial venules. During the screening process, we discovered that this antibody stained normal pleural mesothelium. This finding prompted us to hypothesize that the epitope recognized by S1 might serve as a new diagnostic marker for MPM.

METHODS: To test this hypothesis, we immunostained human MPM (n = 22) and lung adenocarcinoma (n = 25) tissues using S1 antibody.

RESULTS: 77.3% of MPM were S1 positive, and if limited to epithelioid type, the positivity rate was 100%, while that of lung adenocarcinoma was only 36.0%. Statistical analysis revealed a significant difference in the S1 positivity rate between each disease. Furthermore, immunohistochemistry using a series of anti-carbohydrate antibodies combined with glycosidase digestion revealed the structure of sulfated glycans expressed in MPM to be 6-sulfo sialyl N-acetyllactosamine attached to core 2-branched O-glycans.

CONCLUSION: We propose that the S1 glycoepitope could serve as a new diagnostic marker for MPM.

PMID:35394203 | DOI:10.1007/s00408-022-00531-4

Int J Legal Med. 2022 Apr 8. doi: 10.1007/s00414-022-02812-2. Online ahead of print.

ABSTRACT

Numerous intrinsic and extrinsic factors influence bone remodelling rates and have shown to affect the accuracy of histological aging methods. The present study investigates the rib cortex from two Mediterranean skeletal collections exploring the development of population-specific standards for histomorphometric age-at-death estimation. Eighty-eight standard ribs from two samples, Cretans and Greek-Cypriots, were processed histologically. Thirteen raw and composite histomorphometric parameters were assessed and observer error tested. The correlation between age and the parameters and the differences between sex and population subsamples were explored through group comparisons and analysis of covariance. General linear models assessed through data fit indicators and cross-validation were generated from the total dataset, and by sex and population subsamples. Most of the histological variables showed a statistically significant correlation with age with some differences observed by sex and by sample. From the twelve models generated, the optimal model for the whole sample included osteon population density (OPD), osteon perimeter, and osteon circularity producing an error of 10.71 years. When sex and samples were separated, the best model selected included OPD and osteon perimeter producing an error of 8.07 years for Greek-Cypriots. This research demonstrates the feasibility of quantitative bone histology to estimate age, obtaining errors rates in accordance with macroscopic ageing techniques. Sex and sample population differences need further investigation and inter-population variation in remodelling rates is suggested. Moreover, this study contributes to the creation of population-specific standards for Cretans and Greek-Cypriots.

PMID:35394177 | DOI:10.1007/s00414-022-02812-2

Skeletal Radiol. 2022 Apr 8. doi: 10.1007/s00256-022-04051-3. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the predictive value of immediate pain-relief after CT-guided transforaminal epidural steroid injection (TFESI) including local anesthetics for longer-term pain relief and patients’ global impression of change (PGIC) after 4 weeks.

MATERIALS AND METHODS: One hundred ninety-three patients (age 55.4 ± 14.9) with single-level discogenic lumbar radiculopathy and subsequent TFESI were included. Pain scores were recorded before (NRS₀), 15 min (NRS_15min), and 4 weeks (NRS_4w) after treatment using a numerical-rating-scale (NRS; 0, no pain; 10, intolerable pain). Additionally, the PGIC was assessed after 4 weeks. Two fellowship-trained musculoskeletal radiologists evaluated nerve compression of the injected level and contrast dispersion. Spearman’s rank and point-biserial correlation were applied to assess associations between outcome variables and demographics/imaging findings. A p-value < 0.05 was considered to be statistically significant.

RESULTS: There was a significant positive correlation between immediate pain-relief and longer-term pain-reduction (r = 0.24, p = 0.001) with an odds ratio of 2.0 (CI: 1.1-3.6). A good short-term response (NRS_15min ≥ 50% reduction) was associated with a persistent longer-term good response (NRS_4w ≥ 50% reduction) in 59.7% (CI: 50.9-68.0%) of patients. There was no association between short-term pain-relief and PGIC after 4 weeks (p = 0.18). Extent and location of nerve compression and contrast dispersion during TFESI did not correlate with longer-term pain-relief (all p ≥ 0.07).

CONCLUSION: Our results indicate a significant positive correlation between immediate post-procedural and longer-term pain relief after TFESI in patients with lumbar radiculopathy; however, no effect of short-term pain relief is seen on PGIC after 4 weeks. Patients with good longer-term outcome (≥ 50% pain reduction) are twice as likely to have already shown good immediate pain reduction after TFESI.

PMID:35394165 | DOI:10.1007/s00256-022-04051-3

Psychopharmacology (Berl). 2022 Apr 8. doi: 10.1007/s00213-022-06114-8. Online ahead of print.

ABSTRACT

RATIONALE: Pre-ejection period (PEP) and T-wave amplitude (TWA) have been used to assess sympathetic nervous system (SNS) activity. Here we report two single-blinded, placebo-controlled intravenous (IV) drug application studies in which we pharmacologically modified SNS activity with epinephrine (study 1) as well as dexmedetomidine (alpha2-agonist) and yohimbine (alpha2-antagonist) (study 2). Restricted heart rate (HR) intervals were analyzed to avoid confounding effects of HR changes.

OBJECTIVE: Study 1 served to replicate previous findings and to validate our approach, whereas study 2 aimed to investigate how modulation of central SNS activity affects PEP and TWA.

METHODS: Forty healthy volunteers (58% females) participated in study 1 (between-subject design). Twelve healthy men participated in study 2 (within-subject design). TWA and PEP were derived from ECG and impedance cardiography, respectively.

RESULTS: Epinephrine shortened PEP and induced statistically significant biphasic TWA changes. However, although the two alpha2-drugs significantly affected PEP as expected, no effects on TWA could be detected.

CONCLUSION: PEP is better suited to reflect SNS activity changes than TWA.

PMID:35394159 | DOI:10.1007/s00213-022-06114-8

J Orofac Orthop. 2022 Apr 8. doi: 10.1007/s00056-022-00387-6. Online ahead of print.

ABSTRACT

PURPOSE: The present study aims to compare the M‑mode ultrasound findings of different skeletal malocclusions and to evaluate whether sonographic parameters can be used for the diagnosis of malocclusions.

METHODS: Tongue movements of 36 adolescents aged between 10.37 and 17.29 years (mean 14.25 ± 1.78 years) were assessed using simultaneous two-dimensional real-time B‑mode and M‑mode sonography. The swallowing patterns of the subjects were visualized recording the motion of the tongue surface in the ultrasound images utilizing a fixed scan line through the middle of the tongue. M‑mode scans of tongue motion during empty deglutition were recorded. The parameters range, duration, and speed were computed for the entirety of the swallowing process using M‑mode examination. Findings were evaluated and statistically analyzed.

RESULTS: No clear intraindividual repeatability in the M‑mode imaging of the subjects’ swallowing process could be observed. Considering the setup used in the study, it was not always possible to distinguish individual swallowing stages in the M‑mode images with regard to the chosen reference points. The average duration, range of motion, and speed of swallowing were found to be 2.43 s, 24.06 mm, and 10.34 mm/s, respectively. The findings showed both intra- and intersubject variability during empty swallowing.

CONCLUSION: With the help of the metrics that could be calculated based on the M‑mode images, it was not possible to differentiate the swallowing acts of different skeletal malocclusion types. It remains unclear whether M‑mode imaging can accurately visualize the swallowing pattern. Therefore, further progress in technology and multidisciplinary work is needed in order to establish diagnostic references regarding swallowing.

PMID:35394138 | DOI:10.1007/s00056-022-00387-6

Knee Surg Sports Traumatol Arthrosc. 2022 Apr 8. doi: 10.1007/s00167-022-06957-w. Online ahead of print.

ABSTRACT

PURPOSE: The number of primary total knee arthroplasties (TKA) is expected to rise constantly. For patients and healthcare providers, the early identification of risk factors therefore becomes increasingly fundamental in the context of precision medicine. Others have already investigated the detection of risk factors by conducting literature reviews and applying conventional statistical methods. Since the prediction of events has been moderately accurate, a more comprehensive approach is needed. Machine learning (ML) algorithms have had ample success in many disciplines. However, these methods have not yet had a significant impact in orthopaedic research. The selection of a data source as well as the inclusion of relevant parameters is of utmost importance in this context. In this study, a standardized approach for ML in TKA to predict complications during surgery and an irregular surgery duration using data from two German arthroplasty-specific registries was evaluated.

METHODS: The dataset is based on two initiatives of the German Society for Orthopaedics and Orthopaedic Surgery. A problem statement and initial parameters were defined. After screening, cleaning and preparation of these datasets, 864 cases of primary TKA (2016-2019) were gathered. The XGBoost algorithm was chosen and applied with a hyperparameter search, a cross validation and a loss weighting to cope with class imbalance. For final evaluation, several metrics (accuracy, sensitivity, specificity, AUC) were calculated.

RESULTS: An accuracy of 92.0%, sensitivity of 34.8%, specificity of 95.8%, and AUC of 78.0% were achieved for predicting complications in primary TKA and 93.4%, 74.0%, 96.3%, and 91.6% for predicting irregular surgery duration, respectively. While traditional statistics (correlation coefficient) could not find any relevant correlation between any two parameters, the feature importance revealed several non-linear outcomes.

CONCLUSION: In this study, a feasible ML model to predict outcomes of primary TKA with very promising results was built. Complex correlations between parameters were detected, which could not be recognized by conventional statistical analysis. Arthroplasty-specific data were identified as relevant by the ML model and should be included in future clinical applications. Furthermore, an interdisciplinary interpretation as well as evaluation of the results by a data scientist and an orthopaedic surgeon are of paramount importance.

LEVEL OF EVIDENCE: Level IV.

PMID:35394135 | DOI:10.1007/s00167-022-06957-w