Nevin Manimala

Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2023 Apr;37(4):258-262. doi: 10.13201/j.issn.2096-7993.2023.04.004.

ABSTRACT

Objective:To explore the relationship between sleep status and the disease in children with recurrent vertigo（RVC） by analyzing the objective sleep condition of children with recurrent vertigo. Methods:According to the diagnostic criteria of RVC, 50 children with RVC and 20 normal controls without RVC were selected. According to the vertigo questionnaire score, the RVC group was divided into mild, moderate and severe groups according to severity. Continuous polysomnography（PSG） was performed for all participants, and SPSS 25.0 statistical software was used to analyze the monitoring results. Results:①There were significant differences in sleep time of each period, total sleep time and sleep efficiency between RVC group and control group（P<0.05）, but there was no significant difference in sleep latency（P>0.05）. The specific manifestations were that the proportion of sleep time in N1 and N2 phases increased, the proportion of sleep time in N3 and REM phases decreased, the total sleep time and sleep efficiency decreased in RVC group. ②The abnormal rate of sleep apnea hypopnea index, that is, the proportion of AHI≥5 times/h and the abnormal rate of lowest blood oxygen saturation in RVC group were higher than those in normal control group. There was significant difference between the two groups（P<0.05）. ③There were significant differences in the proportion of AHI≥5 times/h and lowest SpO2 among mild group, moderate group and severe group（P<0.05）. ④There was no significant correlation between the degree of vertigo and the abnormal rate of AHI in children with RVC, but there was a negative correlation between the degree of vertigo and the abnormal rate of lowest SpO2 in children with RVC. Conclusion:Children with RVC are often accompanied by sleep disorders, clinicians should pay attention to both the symptoms of vertigo and sleep condition in children. Polysomnography is non-invasive and operable, providing a new idea to the auxiliary examination of RVC in children. It is of certain clinical significance for the comprehensive treatment of children with RVC to actively improve vertigo symptoms and pay attention to improving sleep quality.

PMID:36987954 | DOI:10.13201/j.issn.2096-7993.2023.04.004

Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2023 Apr;37(4):252-257. doi: 10.13201/j.issn.2096-7993.2023.04.003.

ABSTRACT

Objective:To evaluate the efficacy of glucocorticoid sinus stents implanted 2 weeks after functional endoscopic sinus surgery（FESS） for the treatment of chronic rhinosinusitis with nasal polyps（CRSwNP）. Methods:CRSwNP patients with similar bilateral lesions were randomly divided into two groups, with a stent group of 25 patients and a control group of 24 patients. Patients in the stent group had glucocorticoid sinus stents implanted into the bilateral ethmoid sinuses 2 weeks after FESS, while the control group underwent postoperative debridement only. Follow-up assessments occurred at postoperative weeks 2, 4, 8, and 12. Patients were asked to assess their sensation of nasal symptoms using a 10-point visual analog scale. Efficacy was assessed by endoscopic evaluations. Sinus obstruction, crusting/coagulation, polyp formation, middle turbinate position, adhesions, mucosa epithelialization, and postoperative intervention were assessed as efficacy outcomes. GraphPad Prism 9 was applied for statistical analysis. Results:At 4 and 8 weeks postoperatively, the stent group showed significant improvement in VAS scores of nasal congestion and runny nose compared with the control group（P<0.05）. No significant difference was observed in the VAS scores of head and facial stuffiness, loss of smell, or nasal dryness/crusting between the two groups（P>0.05）. Compared with the control group, the stent group had a lower rate of polypoid formation at 4, 8, and 12 weeks postoperatively. At postoperative week 12, the rate of mucosal epithelialization in the ethmoid cavity was significantly higher in the stent group. During the follow-up, the frequency of postoperative intervention was significantly lower in the stent group than in the control group（P<0.05）. Besides, a lower incidence of middle turbinate lateralization was found in the stent group at 8 and 12 weeks postoperatively. At 8 weeks postoperatively, the stent group had a percentage of adhesion lower than that of the control group（all P<0.05）. Conclusion:Implantation of glucocorticoid sinus stents after FESS can maintain sinus cavity patency, improve the inflammatory status of the operative cavity, reduce postoperative interventions, and promote benign regression of the operative cavity.

PMID:36987953 | DOI:10.13201/j.issn.2096-7993.2023.04.003

Epidemiol Prev. 2023 Jan-Apr;47(1-2):In press. doi: 10.19191/EP23.1-2.A473.017.

ABSTRACT

OBJECTIVES: to assess the clinical care impact resulting from the lack of a regional reference Centre for Paediatric Poisoning in Liguria Region (Northern Italy) and to describe the demographic and clinical characteristics of paediatric patients who accessed the Emergency Department of the ‘Gaslini’ Paediatric Hospital (Genoa, Liguria Region) for intoxication.

DESIGN: retrospective cohort study.

SETTING AND PARTICIPANTS: patients’ cases of both sexes, <18 years old, who accessed the Emergency Department of the ‘Gaslini’ Paediatric Hospital between January 2017 and December 2019 for intoxication.

MAIN OUTCOME MEASURES: the Poisoning Severity Score (PSS), a simple and reliable scoring system to describe poisonings and define their severity, was used. The primary objective was pursued by investigating the percentage of cases of intoxication which followed, in the study period, a clinical care pathway inconsistent with the degree of severity ascertained through the retrospective application of the PSS. Clinical-demographic data, triage tag color-coding, and causes of intoxication of cases were also collected. Descriptive statistics were used to summarize results.

RESULTS: a total of 172 cases were identified over the study period; 28 did not meet the inclusion criteria. The final analysis involved 144 cases of intoxication, 70 were from females and 74 from males, with a median age of 3 years-old; 60% of study cases followed a clinical care pathway consistent with the intoxication severity ascertained trough the PSS, in 40% of study cases the clinical care pathway was inconsistent with PSS. The triage tag colour-code assigned was green in 16% of accesses, yellow in 82%, and red in only 2%. Out of the total of accesses, 40% of cases were attributed to drug intoxication in which the agents most involved were analgesics and sedative-hypnotic drugs, 30% to carbon monoxide and fumes poisoning, 23% to food/other substance intoxication, and 7% to alcohol intoxication.

CONCLUSIONS: implementing a referral Centre for Paediatric Poisoning could potentially affect 40% of access to the Emergency Department. Further analysis should be carried out to clarify whether an integrated Telemedicine Service could guide the correct management of intoxicated paediatric patients by referring them, through the Poisoning Severity Score system, for home monitoring or immediate hospitalization, if necessary.

PMID:36987931 | DOI:10.19191/EP23.1-2.A473.017

Diagn Interv Radiol. 2023 Mar 29;29(2):276-282. doi: 10.5152/dir.2022.21749. Epub 2023 Jan 27.

ABSTRACT

PURPOSE: The inflammation of the heart muscle is referred to as acute myocarditis. Cardiac magnetic resonance imaging (CMR) has become the primary method for a non-invasive assessment of myocardial inflammation. However, there are several drawbacks of CMR. During the last decade, dual energy computed tomography (DECT) has been used in cardiac imaging. The current study aims to assess the efficacy and feasibility of DECT in acute myocarditis and compare the results to CMR.

METHODS: This prospective study included patients who had myocarditis but no coronary artery pathology. Two observers evaluated the patients for acute myocarditis using DECT and CMR. CMR was performed on 22 patients within 24 hours of DECT, which was administered within 12 hours following the onset of chest pain. Inter-observer agreement was tested with Cohen’s Kappa coefficient, and Spearman’s correlation was used to examine the possible correlations. A P value of <0.050 was accepted as statistically significant.

RESULTS: The DECT and CMR agreement was significant for transmural diagnoses, excellent for subepicardial and intramyocardial diagnoses, and perfect for nodular and band-like patterns.

CONCLUSION: The findings of this study showed that the dark areas on the color-coded iodine map created with DECT were strongly correlated with CMR in acute cases of myocarditis. In addition, DECT is a robust imaging method that can also be used in the diagnosis of acute myocarditis. Furthermore, it provides information about coronary arteries faster and more reliably than magnetic resonance imaging without any limitations.

PMID:36987908 | DOI:10.5152/dir.2022.21749

Diagn Interv Radiol. 2023 Mar 29;29(2):260-267. doi: 10.5152/dir.2022.211047. Epub 2023 Jan 24.

ABSTRACT

PURPOSE: High-risk breast lesions (HRLs) are associated with future risk of breast cancer. Considering the pathological subtypes, malignancy upgrade rate differs according to each subtype and depends on various factors such as clinical and radiological features and biopsy method. Using artificial intelligence and machine learning models in breast imaging, evaluations can be made in terms of risk estimation in different research areas. This study aimed to develop a machine learning model to distinguish HRL cases requiring surgical excision from lesions with a low risk of accompanying malignancy.

METHODS: A total of 94 patients who were diagnosed with HRL by image-guided biopsy between January 2008 and March 2020 were included in the study. A structured database was created with clinical and radiological characteristics and histopathological results. A machine learning prediction model was created to make binary classifications of lesions as malignant or benign. Random forest, decision tree, K-nearest neighbors, logistic regression, support vector machine (SVM), and multilayer perceptron machine learning algorithms were used. Among these algorithms, SVM was the most successful. The estimations of malignancy for each case detected by artificial intelligence were combined and statistical analyses were performed.

RESULTS: Considering all cases, the malignancy upgrade rate was 24.5%. A significant association was observed between malignancy upgrade rate and lesion size (P = 0.004), presence of mammography findings (P = 0.022), and breast imaging-reporting and data system category (P = 0.001). A statistically significant association was also found between the artificial intelligence prediction model and malignancy upgrade rate (P < 0.001). With the SVM model, an 84% accuracy and 0.786 area-underthe- curve score were obtained in classifying the data as benign or malignant.

CONCLUSION: Our artificial intelligence model (SVM) can predict HRLs that can be followed up with a lower risk of accompanying malignancy. Unnecessary surgeries can be reduced, or second line vacuum excisions can be performed in HRLs, which are mostly benign, by evaluating on a case-by-case basis, in line with radiology-pathology compatibility and by using an artificial intelligence model.

PMID:36987868 | DOI:10.5152/dir.2022.211047

Diagn Interv Radiol. 2023 Mar 29;29(2):244-250. doi: 10.5152/dir.2022.21562. Epub 2023 Feb 27.

ABSTRACT

PURPOSE: To investigate the diagnostic efficiency of the kinetic curves of enhanced lesions on contrast-en-hanced spectral mammography (CESM) and whether they were similar to those of magnetic resonance imaging (MRI).

METHODS: Two hundred and twelve patients with 222 enhanced lesions were included in this prospective study. Single-view craniocaudal of an affected breast was acquired at 3, 5, and 7 min after contrast media injection. The kinetic patterns of each lesion were evaluated and classified as elevated (type I), steady (type II), and depressed (type III). Statistical comparison used the chi-squared test, the receiver operating characteristic (ROC) curve, and Cohen’s kappa.

RESULTS: Of 222 enhanced lesions, 140 were breast cancers, and 82 were benign lesions. The distribution of the kinetic curves for breast cancer was type I, 3.57%, type II, 35.71%, and type III, 60.72%. As for benign lesions, the distribution was type I, 43.90%, type II, 45.12%, and type III, 10.98%. The difference in the enhancement patterns between benign lesions and breast cancers was significant (P < 0.001). The likelihood of breast cancer related to a type I, II, and III curve was 12.20%, 57.47%, and 90.43%, respectively. For the enhancement intensity, the area under curve (AUC) of the ROC curves was 0.702 ± 0.036; for enhancement patterns, the AUC increased to 0.819 ± 0.030. Cohen’s kappa coefficient was 0.752 (P < 0.001) regarding the kinetic curves for CESM and MRI.

CONCLUSION: The kinetic patterns on CESM show promise in differentiating between benign lesions and breast cancers, with good agreement, when compared with MRI.

PMID:36987842 | DOI:10.5152/dir.2022.21562

Diagn Interv Radiol. 2023 Mar 29;29(2):234-243. doi: 10.5152/dir.2022.21266. Epub 2023 Feb 6.

ABSTRACT

PURPOSE: This study aimed to determine the accuracy of texture analysis in differentiating adrenal lesions on unenhanced computed tomography (CT) images.

METHODS: In this single-center retrospective study, 166 adrenal lesions in 140 patients (64 women, 76 men; mean age 56.58 ± 13.65 years) were evaluated between January 2015 and December 2019. The lesions consisted of 54 lipid-rich adrenal adenomas, 37 lipid-poor adrenal adenomas (LPAs), 56 adrenal metastases (ADM), and 19 adrenal pheochromocytomas (APhs). Each adrenal lesion was segmented by manually contouring the borders of the lesion on unenhanced CT images. A texture analysis of the CT images was performed using Local Image Feature Extraction software. First-order and second-order texture parameters were assessed, and 45 features were extracted from each lesion. One-Way analysis of variance with Bonferroni correction and the Mann-Whitney U test was performed to determine the relationships between the texture features and adrenal lesions. Receiver operating characteristic curves were performed for lesion discrimination based on the texture features. Logistic regression analysis was used to generate logistic models, including only the texture parameters with a high-class separation capacity (i.e., P < 0.050). SPSS software was used for all statistical analyses.

RESULTS: First-order and second-order texture parameters were identified as significant factors capable of differentiating among the four lesion types (P < 0.050). The logistic models were evaluated to ascertain the relationships between LPA and ADM, LPA and APh, and ADM and APh. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the first model (LPA vs. ADM) were 85.7%, 70.3%, 81.3%, 76.4%, and 79.5%, respectively. The sensitivity, specificity, PPV, NPV, and accuracy of the second model (LPA vs. APh) were all 100%. The sensitivity, specificity, PPV, NPV, and accuracy of the third model (ADM vs. APh) were 87.5%, 82%, 36.8%, 98.2%, and 82.7%, respectively.

CONCLUSION: Texture features may help in the characterization of adrenal lesions on unenhanced CT images.

PMID:36987841 | DOI:10.5152/dir.2022.21266

Exp Clin Transplant. 2023 Mar;21(3):245-250. doi: 10.6002/ect.2022.0417.

ABSTRACT

OBJECTIVES: In right lobe living donor liver transplant, proper reconstruction of the segment 5 vein and segment 8 vein is essential. Herein, we compared 2 different techniques for segment 5 vein reconstruction.

MATERIALS AND METHODS: This prospective nonrandomized study included all recipients of modified right lobe living donor liver transplant who had reconstruction of the segment 5 vein, with or without segment 8 veins, from October 2018 to October 2021. Patients were grouped into group A (classical technique) and group B (modified technique). For group A, the segment 5 (and segment 8, if present) vein was anastomosed in an end-to-side fashion to a polytetrafluoroethylene synthetic graft positioned parallel to the cut surface of the liver graft; then, during implant, its proximal end was anastomosed to recipient’s middle hepatic or middle-left hepatic veins unified orifice. In group B (modified technique), the stumps of segment 5 (and segment 8 if present) were anastomosed in an end-to-end fashion to 2 different polytetrafluoroethylene grafts; then during implant, the other ends of the segment 5 grafts were anastomosed directly to the inferior vena cava. Postoperative segment 5 vein patency and graft recovery were compared.

RESULTS: Forty patients were included: 22 in group A and 18 group B. There were no significant differences in the demographic data or characteristics of donors, grafts, and recipients between the groups. There was better patency in segment 5 synthetic grafts in group A at all time points compared with group B, but this difference was statistically significant only at 1 month (18 [81.8%] vs 9 [50%, respectively; P = .046).There was no statistically significant difference in the markers of graft recovery in both groups.

CONCLUSIONS: Reconstruction of the segment 5 vein by polytetrafluoroethylene synthetic graft in a fashion to resemble the native middle hepatic vein in modified right lobe living donor liver transplant has better patency than anastomosis of the segment 5 vein in an end-to-end fashion to the synthetic graft and then to the inferior vena cava. Both techniques did not affect graft recovery.

PMID:36987800 | DOI:10.6002/ect.2022.0417

Exp Clin Transplant. 2023 Mar;21(3):211-215. doi: 10.6002/ect.2023.0028.

ABSTRACT

OBJECTIVES: Given the shortage of kidney donations relative to the ever-increasing demand, there is an ongoing need to utilize available donor organs efficiently and fairly. The purpose of the deceased donor Kidney Allocation System is to optimize and equalize organ access for candidates nationwide. We investigated the outcomes of kidney transplant cases before and after the new allocation placement in March 2021 and the effect of the new allocation system on these outcomes.

MATERIALS AND METHODS: We retrospectively reviewed the medical records of the recipients. Outcomes in recipients of renal allografts were compared before and after the changes in March 2021 to the Kidney Allocation System.

RESULTS: There were 333 (73.7%) renal allografts transplanted before the 2021 new allocation, and 119 (26.3%) recipients received their renal allografts after the new allocation. The rate of delayed graft function was 33.3% in the preallocation group and 38.65% in the postallocation group (P = .29). The rate for patient readmission within 30 days was compared between the groups and did not show a statistically significant difference (37.8% vs 39.5%; P = .75). The 1-year graft survival rate was 97.5% in the postallocation group and 95.5% in the preallocation group (P = .526). The 1-year patient survival rate was 98.3% in the postallocation group and 95.8% in the preallocation group (P = .499).

CONCLUSIONS: This study provides reassurance in finding no statistically significant differences between patient outcomes before and after the implementation of the March 2021 change to the Kidney Allocation System. However, the new allocation measures would help for a more equal distribution of the kidneys.

PMID:36987797 | DOI:10.6002/ect.2023.0028

J Health Popul Nutr. 2023 Mar 28;42(1):24. doi: 10.1186/s41043-023-00366-6.

ABSTRACT

BACKGROUND: A preponderance of evidence suggests that higher income inequality is associated with poorer population health, yet recent research suggests that this association may vary based on other social determinants, such as socioeconomic status (SES) and other geographic factors, such as rural-urban status. The objective of this empirical study was to assess the potential for SES and rural-urban status to moderate the association between income inequality and life expectancy (LE) at the census-tract level.

METHODS: Census-tract LE values for 2010-2015 were abstracted from the US Small-area Life Expectancy Estimates Project and linked by census tract to Gini index, a summary measure of income inequality, median household income, and population density for all US census tracts with non-zero populations (n = 66,857). Partial correlation and multivariable linear regression modeling was used to examine the association between Gini index and LE using stratification by median household income and interaction terms to assess statistical significance.

RESULTS: In the four lowest quintiles of income in the four most rural quintiles of census tracts, the associations between LE and Gini index were significant and negative (p between < 0.001 and 0.021). In contrast, the associations between LE and Gini index were significant and positive for the census tracts in the highest income quintiles, regardless of rural-urban status.

CONCLUSION: The magnitude and direction of the association between income inequality and population health depend upon area-level income and, to a lesser extent, on rural-urban status. The rationale behind these unexpected findings remains unclear. Further research is needed to understand the mechanisms driving these patterns.

PMID:36978201 | DOI:10.1186/s41043-023-00366-6