Nevin Manimala

Surg Technol Int. 2021 Nov 4;39:sti39/1508. Online ahead of print.

ABSTRACT

INTRODUCTION: Anastomotic leakage (AL) following colorectal resection is a devastating complication affecting morbidity, mortality, and quality of life of patients in the long term. Different tissue sealants and biologic glues were tested showing conflicting results regarding their influence on anastomotic healing and leak prevention. Application of autologous platelet-rich fibrin (Vivostat A/S, Alleroed, Denmark), which acts as a source of angiogenic growth factors and cytokines, showed promising results in an in-vivo porcine model. Herein, we present the first human study of stapled colorectal anastomoses supplemented with an autologous-derived platelet-rich fibrin matrix (Obsidian ASG®, Rivolution GmbH, Rosenheim, Germany and Vivostat A/S, Alleroed, Denmark).

MATERIALS AND METHODS: A retrospective analysis of prospectively accumulated data was performed in two colorectal centers (Linz, Vienna) on patients undergoing left-sided colorectal or coloanal stapled anastomosis between October 2018 and December 2019. The Obsidian ASG® Matrix was applied to the rectal stump, and after closure with the circular stapling device, at the circumference of anastomosis in every single case. Anastomoses were supplemented with intra- and extra-anastomotic application (IAA-intra-anastomotic application developed by Rivolution GmbH, Rosenheim, Germany) of Obsidian ASG® Matrix. The primary endpoints were incidence of perioperative complications and anastomotic leak rate.

RESULTS: Two-hundred-sixty-one (138 female) patients underwent left-sided colonic (n=177) or rectal resection (n=84). In 253 (96.9%) cases, a laparoscopic or robotic-assisted approach was used. There were no complications attributable to the intraoperative application of the Obsidian ASG® Matrix. All intraoperative leak tests were negative. Overall, anastomotic leak rate accounted for 2.3% (6/261). AL following colonic and rectal resection was seen in 2.3% (4/177) and 2.4% (2/84), respectively. Complication and leak rate was similar in the two participating centers. Postoperative fever and elevated CRP levels were significantly correlated to AL. There was no significant risk factor for AL on multivariate analysis.

CONCLUSION: Application of an autologous-derived platelet-rich fibrin matrix (Obsidian ASG®) at anastomotic site following colorectal resection is safe and associated with a low rate of anastomotic leakage.

PMID:34736288

Obstet Gynecol. 2021 Nov 4. doi: 10.1097/AOG.0000000000004599. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate whether per-procedure work relative value units (RVUs) have changed over time and to compare time-based compensation for female-specific procedures compared with male-specific procedures.

METHODS: Using the National Surgical Quality Improvement Program files for 2015-2018, we compared operative time and RVUs for 12 pairs of sex-specific procedures. Procedures were matched to be anatomically and technically similar. Procedure-assigned RVUs in 2015 were compared with 1997. Procedure compensation was determined using median dollars per RVU provided in SullivanCotter’s 2018 Physician Compensation and Productivity Survey. This was compared with specialty-specific McGraw-Hill per-RVU data from 1994. Statistical analysis was performed with chi-square and Kruskal-Wallis tests.

RESULTS: A total of 12,120 patients underwent 6,217 male-specific procedures and 5,903 female-specific procedures. Male-specific procedures had a median (interquartile range) RVU of 25.2 (21.4-25.2), compared with 7.5 (7.5-23.4) for female-specific procedures (P<.001). Male-specific procedures were 79 minutes longer (median [interquartile range] 136 minutes [98-186] vs 57 minutes [25-125], P<.001). Female-specific procedures were reimbursed at a higher hourly rate (10.6 RVU/hour [7.2-16.2] vs 9.7 RVU/hour [7.4-12.8], P<.001). However, male-specific procedures were better reimbursed ($599/h [$457-790] vs $555/h [$377-843], P<.001). Overall, per-procedure RVUs for male-specific surgeries have increased 13%, whereas, for female-specific surgeries, per-procedure RVUs have increased 26%. Reimbursement per RVU for male-specific procedures has decreased 8% ($67.30 to $61.65), whereas for female-specific procedures it has increased 14% ($44.50 to $52.02).

CONCLUSION: Increases in RVUs and specialty-specific compensation have resulted in more equitable reimbursement for female-specific procedures. However, even with these changes, there is a lower relative value of work, driven by specialty-specific compensation rates, for procedures performed for women-only compared with equivalent men-only procedures.

PMID:34736273 | DOI:10.1097/AOG.0000000000004599

Obes Facts. 2021 Nov 4. doi: 10.1159/000520661. Online ahead of print.

ABSTRACT

INTRODUCTION: In young adults, the metabolic syndrome is rare. To better assess the risks for future cardiovascular disease, a cardiometabolic score can be used, ranking the disease risk in each subject. The score is a continuous variable summarising the individual z-scores for waist circumference, blood pressure, blood levels of glucose, triglycerides and HDL-cholesterol. Our main aim was to assess the association between early childhood growth and the cardiometabolic score in young adults.

METHODS: Study participants were recruited among subjects in the longitudinal population-based GrowUp 1990 Gothenburg study. Those with information on weight and length at birth, as well as weight, height, waist circumference, and parental BMI at ten years of age were invited to participate in a health survey at 18-20 years of age. 513 young adults (female 51%) were included. Multivariable linear stepwise regression analysis was applied.

RESULTS: The mean (SD) BMI was 22.2 (3.26) in males and 21.3 (2.69) kg/m² in females; the cardiometabolic score was 0.24 (3.12) and -0.22 (3.18), respectively. A statistically significantly higher score (p<0.001) was seen in individuals with metabolic syndrome, as defined by IDF. After controlling for adult lifestyle features, BMI z-score at ten years of age was significant risk factor in both sexes for an elevated cardiometabolic score in early adulthood, mean(SE) beta 0.47(0.19), p=0.014 in males, 0.82(017) p<0.0001 in females. In males, high maternal BMI and low age at adiposity rebound and in females high birth weight were also associated with a statistically significant risk. Additionally, contraceptive use in females was a risk factor for elevated cardiometabolic score and, in males a high lifestyle related index score showed a protective association with the cardiometabolic score.

CONCLUSION: A high BMI z-score at ten years of age is a risk factor for the cardiometabolic state in young adults, an outcome points to the preventive potential of monitoring BMI in ten-year-old schoolchildren. This finding must however be validated in a new large cohort. Moreover, in young adults in whom metabolic syndrome is rare, a cardiometabolic score seems to be a promising approach and potentially a more powerful tool to detect risks for cardiovascular disease later in life, than using metabolic syndrome categorisation.

PMID:34736266 | DOI:10.1159/000520661

Dement Geriatr Cogn Disord. 2021 Nov 4:1-9. doi: 10.1159/000519766. Online ahead of print.

ABSTRACT

BACKGROUND: Subjective cognitive decline (SCD) is a self-perceived cognitive worsening without objective cognitive impairment. Due to its heterogeneity and potential risk of Alzheimer’s disease (AD), baseline biomarkers to predict progression are clinically important. In the present study, cognitive trajectories during a 24-month period were compared between amyloid-positive SCD (A+SCD) and amyloid-negative SCD (A-SCD) subjects, and biomarkers associated with memory decline were investigated.

METHODS: Data from a prospective cohort study in Korea between 2016 and 2019 were analyzed. SCD subjects ≥50 years of age were eligible. All participants underwent neuropsychological tests, brain magnetic resonance imaging, and florbetaben positron emission tomography scans. Amyloid burden and regional volumes were measured. Cognitive changes corrected for age were compared between A+SCD and A-SCD groups. Biomarkers associated with memory decline were assessed.

RESULTS: Forty-seven SCD subjects (69.9 ± 6.7 years, mini-mental state examination (MMSE) score 27.5) were enrolled, and 31 completed at least 1 annual follow-up (mean follow-up: 24.7 months). Baseline characteristics except age, hippocampal atrophy, and white matter hyperintensities were similar between A+SCDs (n = 12, 25.6%) and A-SCDs (n = 35). A+SCD subjects showed greater decline in the verbal memory function compared with the A-SCD subjects after adjustment for age. MMSE scores decreased more in the A+SCD (1.1 in the A+SCD; 0.55 in the A-SCD), although it was not statistically significant. Amyloid burden and baseline memory score were associated with memory decline.

CONCLUSIONS: Within SCD, A+SCD subjects showed faster memory decline compared with the A-SCD subjects and amyloid burden might be associated with future memory decline in SCD.

PMID:34736258 | DOI:10.1159/000519766

Nanotechnology. 2021 Nov 4. doi: 10.1088/1361-6528/ac3689. Online ahead of print.

ABSTRACT

GaSb is considered as an attractive p-type channel material for future III-V metal-oxide-semiconductor (MOS) technologies, but the processing conditions to utilize the full device potential such as low power logic applications and RF applications still need attention. In this work, applying rapid thermal annealing (RTA) to nanoscale GaSb vertical nanowire p-type MOSFETs, we have improved the average peak transconductance (g_m,peak) by 50% among 28 devices and achieved 70µS/µm atV_DS= – 0.5 V in a device with 200-nm gate length. In addition, a low subthreshold swing down to 144 mV/dec as well as an off-current below 5 nA/µm which refers to the off-current specification in low-operation-power (LOP) condition has been obtained. Based on the statistical analysis, the results show a great enhancement in both on- and off-state performance with respect to previous work mainly due to the improved electrostatics and contacts after RTA, leading to a potential in low-power logic applications. We have also examined a short channel device withL_g= 80 nm in RTA, which shows an increased gm,peak up to 149µS/µm atV_DS= – 0.5 V as well as a low on-resistance of 4.7 kΩ·µm. The potential of further enhancement ing_mvia RTA offer a good alternative to obtain high-performance devices for RF applications which have less stringent requirement for off-state performance. Our results indicate that post-fabrication annealing provides a great option to improve the performance of GaSb-based p-type devices with different structures for various applications.

PMID:34736238 | DOI:10.1088/1361-6528/ac3689

Comput Methods Programs Biomed. 2021 Oct 9;212:106458. doi: 10.1016/j.cmpb.2021.106458. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: The number of end-stage renal disease (ESRD) patients treated with hemodialysis (HD) has significantly increased, but the prognosis remains poor. Time-series features have been included in only a few studies to predict HD patient survival, and how to utilize such features effectively remains unclear. This article aims to develop a more accurate, interpretable, and clinically practical personalized survival prediction model for HD patients.

METHODS: This study proposed and evaluated an attention-based Bi-GRU network using time-series features for survival prediction. A distance-based loss function was proposed to improve performance. We used data from 1232 ESRD patients who received regular hemodialysis treatment for ≥ 3 months from 2007 to 2016 at the First Affiliated Hospital of Zhejiang University. The proposed model was compared with representative sequence modeling deep learning architectures and existing survival analysis methods in terms of the C-index and IBS value. Post hoc tests were used to test statistical significance. The attention map was used to assess feature importance over time. The impact of time-series changes on survival was investigated after controlling initial values (using BMI as an example).

RESULTS: The proposed method outperformed other sequence modeling architectures and the state-of-the-art survival analysis approaches in terms of the C-index and the integrated Brier score (IBS) value. Our method achieved a C-index of 0.7680 (95% confidence intervals [CI]: 0.7645, 0.7716) and an IBS of 0.1302 (95% confidence intervals [CI]: 0.1292, 0.1313), showing an improvement of up to 5.4% in terms of the C-index and a decrease of 3.2% in terms of the IBS value. The addition of the distance-based loss function improved the performance. The predicted risk and actual risk levels closely agreed. This study also found that even after controlling the initial body mass index (BMI) values, different 3-month BMI trends could produce different survival outcomes.

CONCLUSIONS: This study proposed a more effective and interpretable method to use time-series information in survival analysis. The proposed method may help promote personalized medicine and improve patient prognosis.

PMID:34736175 | DOI:10.1016/j.cmpb.2021.106458

Comput Methods Programs Biomed. 2021 Oct 22;212:106484. doi: 10.1016/j.cmpb.2021.106484. Online ahead of print.

ABSTRACT

BACKGROUND: Mobile health (mHealth) have significantly advanced evaluating neurocognitive functions; but, few reports have documented whether they validate neurocognitive impairments as well as paper-and-pencil neuropsychological tests.

OBJECTIVE: To meta-analyze the correlation between mobile applications for neuropsychological tests and validated paper-and-pencil neuropsychological tests for evaluating neurocognitive impairments.

METHOD: We used PubMed, Embase, Cochrane, Web of Science, and IEEE Explorer through January 2020 to identify studies that compared mobile applications for neuropsychological tests vs. paper-and-pencil neurophysiological tests. We used random-effects models via the DerSimonian and Laird method to extract pooled Pearson’s correlation coefficients and we stratified by study design.

RESULT: Nine out of 4639 screened articles (one RCT and eight prospective longitudinal case series) were included. For the observational studies, there was a statistically significant strong and direct correlation between mobile applications for neuropsychological test scores and validated paper-and-pencil neuropsychological assessment scores (r = 0.70; 95% CI 0.59, 0.79; I² = 74.5%; p- heterogeneity <0.001). Stronger results were seen for the RCT (r = 0.92; 95% CI 0.77, 0.97).

CONCLUSION: This meta-analysis showed a statistically significant correlation between mobile applications and the validated paper-and-pencil neuropsychological assessments analyzed for the evaluation of neurocognitive impairments.

PMID:34736169 | DOI:10.1016/j.cmpb.2021.106484

Cell Calcium. 2021 Oct 21;100:102494. doi: 10.1016/j.ceca.2021.102494. Online ahead of print.

ABSTRACT

We previously described that cell-wide cytosolic Ca²⁺ transients evoked by inositol trisphosphate (IP₃) are generated by two modes of Ca²⁺ liberation from the ER; ‘punctate’ release via an initial flurry of transient Ca²⁺ puffs from local clusters of IP₃ receptors, succeeded by a spatially and temporally ‘diffuse’ Ca²⁺ liberation. Those findings were derived using statistical fluctuation analysis to monitor puff activity which is otherwise masked as global Ca²⁺ levels rise. Here, we devised imaging approaches to resolve individual puffs during global Ca²⁺ elevations to better investigate the mechanisms terminating the puff flurry. We find that puffs contribute about 40% (∼90 attomoles) of the total Ca²⁺ liberation, largely while the global Ca²⁺ signal rises halfway to its peak. The major factor terminating punctate Ca²⁺ release is an abrupt decline in puff frequency. Although the amplitudes of large puffs fall during the flurry, the amplitudes of more numerous small puffs remain steady, so overall puff amplitudes decline only modestly (∼30%). The Ca²⁺ flux through individual IP₃ receptor/channels does not measurably decline during the flurry, or when puff activity is depressed by pharmacological lowering of Ca²⁺ levels in the ER lumen, indicating that the termination of punctate release is not a simple consequence of reduced driving force for Ca²⁺ liberation. We propose instead that the gating of IP₃ receptors at puff sites is modulated such that their openings become suppressed as the bulk [Ca²⁺] in the ER lumen falls during global Ca²⁺ signals.

PMID:34736161 | DOI:10.1016/j.ceca.2021.102494

Parkinsonism Relat Disord. 2021 Oct 12;92:94-100. doi: 10.1016/j.parkreldis.2021.10.007. Online ahead of print.

ABSTRACT

INTRODUCTION: Individuals with progressive supranuclear palsy (PSP) experience cognitive changes that are challenging to follow without a validated neuropsychological test battery to measure progression. This study describes a composite measure to evaluate cognition in individuals with PSP.

METHODS: Baseline cognitive test data from 486 participants with PSP in the PASSPORT (NCT03068468) study included the Repeatable Battery for Assessment of Neuropsychological Status (RBANS), Color Trails Test (CTT) parts 1 and 2, letter-number sequencing, and letter fluency. Data were analyzed using summary statistics and a matrix of Pearson correlations. A hypothetical factor structure was constructed and validated.

RESULTS: Observed correlations were highest for scores between story memory and story recall (correlation coefficient = 0.78) and lowest for scores between letter fluency and picture naming (correlation coefficient = 0.11), and picture naming and figure copy (correlation coefficient = 0.12). After excluding picture naming and Color Trails Test (CTT) parts 1 and 2, a 3-factor structure was hypothesized for the remaining 13 tests. Confirmatory factor analysis demonstrated goodness of fit within acceptable limits (comparative fit index and Tucker-Lewis index = 0.98, standardized root-mean-square residual and root-mean-square error of approximation = 0.05-0.06). Mixed-model repeated-measures analysis of change from baseline to week 52 in RBANS and PSP cognitive composite score produced mean-to-standard-deviation ratios of 0.418 and 0.780, respectively.

CONCLUSIONS: This novel composite endpoint, based on RBANS and designed to account for motor impairments in PSP, improves on current cognitive assessments PSP.

PMID:34736158 | DOI:10.1016/j.parkreldis.2021.10.007

Health Place. 2021 Oct 30;72:102692. doi: 10.1016/j.healthplace.2021.102692. Online ahead of print.

ABSTRACT

Spatially varying baseline data can help identify and prioritise actions directed to determinants of intra-urban health inequalities. Twenty-seven years (1990-2016) of cause-specific mortality data in British Columbia, Canada were linked to three demographic data sources. Bayesian small area estimation models were used to estimate life expectancy (LE) at birth and 20 cause-specific mortality rates by sex and year. The gaps in LE for males and females ranged from 6.9 years to 9.5 years with widening inequality in more recent years. Inequality ratios increased for almost all causes, especially for HIV/AIDS and sexually transmitted infections, maternal and neonatal disorders, and neoplasms.

PMID:34736154 | DOI:10.1016/j.healthplace.2021.102692