Nevin Manimala

Eur J Radiol. 2021 Oct 26;144:110006. doi: 10.1016/j.ejrad.2021.110006. Online ahead of print.

ABSTRACT

BACKGROUND: The combination treatment regimen of thermal ablation (TA) and transarterial chemoembolization (TACE) has gained a place in treatment of hepatocellular carcinoma (HCC) lesions > 3 cm unsuitable for surgery. Despite a high heterogeneity in the currently used treatment protocols, the pooled results of combined treatments seem to outperform those of TA or TACE alone. TACE preceding TA has been studied extensively, while results of the reverse treatment sequence are lacking. In this retrospective cohort study we compared the two treatment sequences.

PATIENTS AND METHODS: 38 patients (median age: 68.5 yrs (range 40-84), male: 34, liver cirrhosis: 33, early stage HCC: 21, intermediate stage HCC: 17) were included in two tertiary referral centers, of whom 27 were treated with TA and adjuvant TACE (TA + TACE). The other 11 patients received TA with neoadjuvant TACE (TACE + TA). Overall survival (OS), time to progression (TTP) and local tumor progression (LTP) free survival were determined for the entire cohort and compared between the two treatment sequences.

RESULTS: The median OS of all patients was 52.7 months and the median time to LTP was 11.5 months (censored for liver transplantation). No differences were found with respect to OS between the two treatment sequences. Median time to LTP for TACE + TA was 23.6 months and 8.1 months for TA + TACE (p = 0.19).

DISCUSSION: No statistical differences were found for OS, TTP and time to LTP between patients treated with TA combined with neoadjuvant or adjuvant TACE.

PMID:34717187 | DOI:10.1016/j.ejrad.2021.110006

Nurse Educ Pract. 2021 Oct 21;57:103231. doi: 10.1016/j.nepr.2021.103231. Online ahead of print.

ABSTRACT

AIM: The aim of this study was to examine and describe predictors of self-confidence among nursing students attending multiple simulation-based education sessions during a bachelor program.

DESIGN: This was a randomized controlled longitudinal study.

METHODS: Participants (n = 146) were randomly assigned to a single or double set of acute care scenarios in each session. Participants attended 4 days of simulation sessions throughout a 3-year bachelor program. At four separate time points, both groups answered a survey including the Self-confidence scale and The Kolb Learning Style Inventory version 3.1. Descriptive statistics, cross-tabulations and linear models were employed to analyze the data.

RESULTS: No significant interaction effects were found between the students’ self-confidence at the end of the educational program and predictive factors favoring a double set of simulation scenarios. Most third-year students (n = 52, 85%) preferred a concrete learning mode at baseline.

CONCLUSIONS: No significant predictive factors increasing self-confidence in favor of a double set of simulation scenarios could be demonstrated in this study. Hence, the continuous search for how to effectively implement SBE is of major importance for the development of SBE as a pedagogical method and remains a challenge.

PMID:34717169 | DOI:10.1016/j.nepr.2021.103231

Nurse Educ Pract. 2021 Oct 16;57:103243. doi: 10.1016/j.nepr.2021.103243. Online ahead of print.

ABSTRACT

AIM: The present study aimed to evaluate the effect of an empowerment program on the moral sensitivity and caring behaviors of nurses in emergency departments in Iran.

BACKGROUND: Emergency department is often a high stress environment. Nurses who worked in the emergency departments are expected to work under pressure to many standards, guidelines and protocols related to patient care. It will expose emergency department nurses to psychological pressures and moral conflicts. A nurse’s sensitivity to ethical issues is necessary to provide humane care; it is considered to be a professional competence for nurses.

METHODS: This study had a controlled quasi-experimental design. Data were collected before, immediately after, and 1 month after the intervention using a moral sensitivity questionnaire and a caring behavior questionnaire. A total of 131 emergency department nurses from 4 teaching hospitals were divided into an intervention group and a control group. The intervention group received six 60-minute training sessions; the control group did not receive the training.

RESULTS: The mean moral sensitivity and caring behavior scores for both groups increased significantly immediately and 1 month after the intervention. However, the significance was higher in the intervention group than in the control group. A comparison of the mean moral sensitivity and caring behavior scores between the groups immediately and 1 month after the intervention did not show a statistically significant difference.

CONCLUSIONS: Implementing a training program on ethical issues could thus have a significant impact on the clinical performance of nurses, which could be maintained through follow-up.

PMID:34717168 | DOI:10.1016/j.nepr.2021.103243

J Trace Elem Med Biol. 2021 Oct 25;69:126880. doi: 10.1016/j.jtemb.2021.126880. Online ahead of print.

ABSTRACT

BACKGROUND: This updated and comprehensive meta-analysis study sought to explore the changes of seven essential trace elements, including selenium (Se), iron (Fe), zinc (Zn), manganese (Mn), fluorine (F), iodine (I) and copper (Cu) in Kashin-Beck disease (KBD) patients compared with healthy individuals. The findings of the current study will provide a valuable reference for implementation of early clinical intervention and prevention of KBD.

METHODS: All related articles included in this review were retrieved from the following databases: Chinese National Knowledge Infrastructure (CNKI), Wan Fang Data, China Biology Medicine disc (CBM disc), PubMed and Web of Science up to April 30, 2020. The following combination keywords were used as the search criteria: “(Kashin-Beck disease OR KBD) AND ((selenium OR iron OR zinc OR manganese OR fluorine OR iodine OR copper) OR (Se OR Fe OR Zn OR Mn OR F OR I OR Cu))”. All statistical analyses were performed using RevMan 5.3 and Stata 16.0 software.

RESULTS: A total of 55 articles were included in the current study. Meta-analysis showed that the levels of serum Se (SMD = -2.37, 95 % CI: -1.58 to -0.72, P < 0.00001), hair Se (SMD = -2.19, 95 % CI: -3.05 to -1.33, P < 0.00001), urinary Se (SMD = -2.36, 95 % CI: -3.26 to -1.46, P < 0.00001) and erythrocyte Se (SMD = -5.12, 95 % CI: -9.55 to -0.69, P = 0.02) were significantly lower in KBD patients compared with the levels in healthy controls. Then, the findings showed that the levels of serum F (SMD = -0.58, 95 % CI: -1.04 to -0.12, P = 0.01) and hair I (SMD = -0.57, 95 % CI: -1.06 to -0.08, P = 0.02) in patients were substantially lower than that in controls. Analysis showed that the levels of hair Zn (SMD = 0.26, 95 % CI: 0.04 to 0.49, P = 0.02) and hair Mn (SMD = 0.55, 95 % CI: 0.24 to 0.85, P = 0.0005) were markedly higher in patients compared with the levels in healthy controls. Notably, urinary Se (AUC = 0.7851, P = 0.0235, Sensitivity = 81.82 %, Specificity = 81.82 %) showed a good diagnostic value for KBD.

CONCLUSIONS: The findings of the current study showed that the levels of Se, serum F and hair I were lower in patients with KBD compared with those in healthy controls, whereas the levels of hair Zn and hair Mn were higher in KBD patients compared with the levels in controls. This outcome would be further validated in our future studies. Of note, these results indicated that Se, F and I deficiencies were associated with the pathogenesis of KBD.

PMID:34717166 | DOI:10.1016/j.jtemb.2021.126880

J Biomech. 2021 Oct 24;129:110820. doi: 10.1016/j.jbiomech.2021.110820. Online ahead of print.

ABSTRACT

Joint moments are commonly calculated in biomechanics research and provide an indirect measure of muscular behaviors and joint loads. However, joint moments cannot be easily quantified clinically or in the field, primarily due to challenges measuring ground reaction forces outside the laboratory. The present study aimed to compare the accuracy of three different machine learning (ML) techniques – functional regression [ ML_fregress ], a deep neural network (DNN) built from scratch [ ML_DNN ], and transfer learning [ ML_TL ], in predicting joint moments during running. Data for this study came from an open-source dataset and two studies on running with and without external loads. Three-dimensional (3D) joint moments of the hip, knee, and ankle, were derived using inverse dynamics. 3D joint angle, velocity, and acceleration of the three joints served as predictors for each of the three ML techniques. Prediction performance was generally the best using ML_DNN, and the worse using ML_fregress. Absolute predictive performance was the best for sagittal plane moments, which ranged from a RMSE of 0.16 Nm/kg at the ankle using ML_DNN, to a RMSE of 0.49Nm/kg at the knee using ML_fregress. ML_DNN resulted in the greatest improvement in relative prediction performance (relRMSE) by 20% compared to ML_fregress for the ankle adduction-abduction moment. DNN with or without transfer learning was superior in predicting joint moments using kinematic inputs compared to functional regression. Synergizing ML with kinematic inputs has the potential to solve the constraints of obtaining high fidelity biomechanics data normally only possible during laboratory studies.

PMID:34717160 | DOI:10.1016/j.jbiomech.2021.110820

Thromb Res. 2021 Oct 21;208:66-70. doi: 10.1016/j.thromres.2021.10.004. Online ahead of print.

ABSTRACT

BACKGROUND: Isolated distal deep vein thrombosis (IDDVT) is a common subtype of deep vein thrombosis (DVT). Consensus guidelines provide conflicting recommendations for IDDVT management; some recommend anticoagulant treatment, while others suggest serial compression ultrasonography (CUS) monitoring for patients not at “high risk” of proximal extension. The purpose of this study was to describe outcomes of serial CUS-monitored IDDVT and identify risk factors for proximal thrombus extension or anticoagulant treatment initiation.

METHODS: A retrospective descriptive study was conducted using electronic data from University of Utah Health. Adult subjects with objectively confirmed, serial CUS-monitored IDDVT were included. Subjects were followed for 30 days for occurrence of a composite outcome of proximal thrombus extension or anticoagulant treatment initiation. Descriptive statistics were used to summarize characteristics of the study population. Characteristics were compared across outcome groups using inferential statistics.

RESULTS: A total of 182 subjects were included, with 53 subjects (29.1%) experiencing the composite outcome. Of these, 12 (22.6%) experienced proximal thrombus extension and 41 (77.4%) initiated anticoagulant treatment. A prior history of venous thromboembolism (VTE) was significantly higher in those who experienced the composite outcome than in those who did not.

CONCLUSIONS: Our results suggest that 70% of patients with serial CUS-monitored IDDVT did not experience thrombus extension or require anticoagulant treatment within 30 days of diagnosis, regardless of risk factors for proximal extension. Serial CUS monitoring may be a useful management strategy for IDDVT. A history of VTE may identify patients more likely to experience proximal thrombus extension or require anticoagulation.

PMID:34717132 | DOI:10.1016/j.thromres.2021.10.004

J Environ Manage. 2021 Oct 27;302(Pt A):113990. doi: 10.1016/j.jenvman.2021.113990. Online ahead of print.

ABSTRACT

Many factors can affect microplastics (MPs) behaviors in aquatic environments. The effects of seasonal and meteorological conditions on MPs are not well understood. This study demonstrates the impacts of seasonality on the fate and transport, and the efficacy of MPs removal by a wastewater treatment plant. The fate and transport of MPs at a WWTP in Nonthaburi, Thailand were tracked during the dry and wet seasons of 2019-2020. Polypropylene (PP), polyethylene (PE), and toothpaste formulations were the most abundant MP types observed. Total detected MP quantities ranged between 76 and 192 particles L^-1 during the dry season, and only 36-68 particles L^-1 during the wet season, indicating runoff dilution effects. T-test analysis found a statistically significant difference between MP concentrations between the dry and wet seasons of 2019-2020. Spearman’s correlation showed statistically strong negative relationships between MP concentrations versus wastewater flow, and MP concentrations versus precipitation; a positive correlation between MP abundance versus temperature in the treatment system was observed. During the dry seasons, MPs were mostly found in the aeration process, and were mostly rayon or polyester particles in the shape of fibers. Contrarily, in the wet seasons, MPs were detected in both the raw influent and aeration process, with PE, polyacrylate, and polyethylene terephthalate fragments dominating the make-up. MPs were also detected in the return activated sludge, thus calling for proper sludge age and drainage management. No MPs were detected in the plant’s effluent during the wet season, suggesting that the plant had sufficient MPs removal capability during normal wet-season conditions. Overall, this study suggests that municipalities should focus on increasing MPs removal efficiency of wastewater treatment plants for dry seasons, while properly managing the water flows of combined sewage systems to prevent overflows that may inevitably become point-sources of MPs release into water bodies during wet seasons.

PMID:34717107 | DOI:10.1016/j.jenvman.2021.113990

Nurse Educ Today. 2021 Oct 23;108:105184. doi: 10.1016/j.nedt.2021.105184. Online ahead of print.

ABSTRACT

BACKGROUND: Complex physiological processes are often difficult for midwifery students to comprehend when using traditional teaching and learning approaches. Face to face instructional workshops using simulation have had some impact on improving understanding. However, in the 21st century new technologies offer the opportunity to provide alternative learning approaches.

AIM: To investigate the impact of using three-dimensional (3D) visualisation in midwifery education on student’s experience of learning, and retention of knowledge at three points in time.

DESIGN: A pilot study involving a two-armed parallel Randomised Controlled Trial (RCT) comparing the retention of knowledge scores between the control and intervention groups.

SETTING: An Australian University in the Northern Territory.

PARTICIPANTS: The sample included second year Bachelor of Midwifery students (n = 38). All received traditional midwifery education before being randomly allocated to either the intervention (n = 20) or control (n = 18) group.

METHODS: A new immersive virtual environment was introduced to complement existing traditional midwifery education on the third stage of labour. This intervention was evaluated using a demographic survey and multiple-choice questionnaire to collect baseline information via Qualtrics. To measure change in knowledge and comprehension, participants completed the same multiple-choice knowledge questionnaire at three time points; pre, immediately post and at 1 month post intervention. In addition, the intervention group completed a 3D student satisfaction survey.

RESULTS: Baseline knowledge scores were similar between the groups. A statistically significant increase in knowledge score was evident immediately post intervention for the intervention group, however there was no significant difference in knowledge score at one month.

CONCLUSIONS: The results support the creation of further three-dimensional visualisation teaching resources for midwifery education. However, a larger randomised controlled study is needed to seek generalisation of these findings to confirm enhanced student learning and retention of knowledge post 3DMVR, beyond the immediate exposure time.

PMID:34717099 | DOI:10.1016/j.nedt.2021.105184

J Hepatobiliary Pancreat Sci. 2021 Oct 30. doi: 10.1002/jhbp.1067. Online ahead of print.

ABSTRACT

BACKGROUND: Pancreatoduodenectomy (PD) is an only curative therapy for distal cholangiocarcinoma (dCC). There has been no study to compare outcomes between minimally invasive pancreatoduodenectomy (MIPD) and open pancreatoduodenectomy (OPD) for dCC. The aim of the study is to compare the two operation types for dCC in terms of postoperative and oncologic outcomes.

METHODS: Data from 426 patients who underwent MIPD (n=91) or OPD (n=335) for dCC from January 2012 to December 2019 at two tertiary hospitals were retrospectively reviewed. After 1:2 propensity score matching, postoperative and oncologic outcomes were compared.

RESULTS: MIPD group showed more favorable results than OPD group in terms of blood loss (MIPD vs. OPD, 250[150-400] vs. 400[200-600], ml, p<0.001), and length of hospital stay (19.8±11.3 vs. 26.6±14.3, days, p<0.001). OPD group showed more favorable results than MIPD group in terms of operation time (MIPD vs. OPD, 457±70 vs. 398±85, min., p<0.001), and harvested lymph nodes (14.9±7.8 vs. 20.7±11.5, p<0.001). There was no statistical difference between the 2 groups in the R0 resection rate and complications. In long-term survival analysis, there was no significant difference between the 2 groups.

CONCLUSION: MIPD showed comparable postoperative complications and long-term oncologic survival with OPD in the treatment of dCC.

PMID:34717038 | DOI:10.1002/jhbp.1067

Clin Transplant. 2021 Oct 30:e14456. doi: 10.1111/ctr.14456. Online ahead of print.

ABSTRACT

Histologic findings on 1-year biopsies such as inflammation with fibrosis and transplant glomerulopathy predict renal allograft loss by 5 years. However, almost half of the patients with graft loss have a 1-year biopsy that is either normal or has only interstitial fibrosis. The goal of this study was to determine if there was a gene expression profile in these relatively normal 1-year biopsies that predicted subsequent decline in renal function. Using transcriptome microarrays we measured intragraft mRNA levels in a retrospective Discovery cohort (170 patients with a normal/minimal fibrosis 1-year biopsy, 54 with progressive decline in function/graft loss and 116 with stable function) and developed a nested 10-fold cross-validated gene classifier that predicted progressive decline in renal function (positive predictive value = 38 ± 34%%; negative predictive value = 73 ± 30%, c-statistic = 0.59). In a prospective, multicenter Validation cohort (270 patients with Normal/Interstitial Fibrosis [IF]), the classifier had a 20% positive predictive value, 85% negative predictive value and 0.58 c-statistic. Importantly, the majority of patients with graft loss in the prospective study had 1-year biopsies scored as Normal or IF. We conclude predicting graft loss in many renal allograft recipients (i.e. those with a relatively normal 1-year biopsy and eGFR >40) remains difficult. This article is protected by copyright. All rights reserved.

PMID:34717009 | DOI:10.1111/ctr.14456