Nevin Manimala

J Eur Acad Dermatol Venereol. 2022 Aug 26. doi: 10.1111/jdv.18564. Online ahead of print.

ABSTRACT

BACKGROUND: Pediatric atopic dermatitis (AD) has been linked to neuropsychiatric comorbidities such as depression, anxiety, and attention-deficit/hyperactivity disorder (ADHD). However, longitudinal data are limited and the effect of AD severity on neuropsychiatric outcomes requires further characterization.

OBJECTIVES: To determine the risk of several major neuropsychiatric conditions in children with AD METHODS: We analyzed UK health records data in a population-based cohort study. Each patient <18 years old with AD was matched to up to 5 unaffected patients on age, practice, and index date. Treatments served as proxies for AD severity, which was analyzed in a time-updated manner. Outcomes were incident anxiety, depression, bipolar disorder, schizophrenia, ADHD, autism, obsessive-compulsive disorder (OCD), suicidal ideation or attempt, and completed suicide.

RESULTS: 409,431 children with AD (93.2% mild, 5.5% moderate, 1.3% severe) were compared to 1,809,029 children without AD. In Cox regression models adjusted for age, sex, socioeconomic status and other atopic comorbidities, no statistically significant relationships were observed between AD and incident anxiety (HR 1.01, 95% CI 0.99-1.03), ADHD (1.02, 0.97-1.06), autism (1.02, 0.98-1.06), bipolar disorder (1.08, 0.85-1.36), suicidal ideation/attempt (0.98, 0.95-1.01), or completed suicide (0.85, 0.64-1.14). Children with AD were less likely to develop depression (0.93, 0.91-0.95) or schizophrenia (0.72, 0.54-0.95) but more likely to develop OCD (1.26, 1.16-1.37). However, there was substantial variation by AD severity and age in both the direction and magnitude of effect for many of the neuropsychiatric conditions examined.

CONCLUSIONS: The was no substantial impact of AD on the overall risk of many neuropsychiatric conditions in children, but disease severity and age may be important modifying factors. Additional research is needed to further dissect the complex relationship between pediatric AD and neuropsychiatric comorbidities.

PMID:36018560 | DOI:10.1111/jdv.18564

Pain Ther. 2022 Aug 26. doi: 10.1007/s40122-022-00427-4. Online ahead of print.

ABSTRACT

INTRODUCTION: Total knee arthroplasty (TKA) is frequently associated with severe, prolonged postsurgical pain, and therefore local anesthetic-based peripheral nerve blocks are commonly used for postoperative analgesia. Cryoneurolysis involves the use of freezing temperatures to provide a reversible sensory (and motor) block with a duration measured in weeks and months, more commensurate with the typical period of post-TKA pain. We therefore conducted a randomized controlled pilot study to evaluate the use of this modality for the treatment of pain following TKA to (1) determine the feasibility of and optimize the study protocol for a subsequent definitive clinical trial; and (2) estimate analgesia and opioid reduction within the first 3 postoperative weeks.

METHODS: A convenience sample of 16 patients undergoing primary TKA with a single-injection and/or continuous adductor canal nerve block were randomized to receive either active cryoneurolysis or a sham procedure targeting the infrapatellar branch of the saphenous nerve, in a participant-masked fashion. This was a pilot study with a relatively small number of participants, and therefore resulting data were not analyzed statistically.

RESULTS: Compared with participants receiving sham, the active treatment group reported slightly lower average and worst pain scores as well as opioid consumption and sleep disturbances due to pain at a majority of postoperative time points between postoperative days (POD) 4-21.

CONCLUSIONS: Preoperative ultrasound-guided cryoneurolysis of the infrapatellar branch of the saphenous nerve is feasible and may provide analgesic benefits for multiple weeks following TKA. A definitive randomized controlled trial appears warranted.

PMID:36018541 | DOI:10.1007/s40122-022-00427-4

Ann Surg Oncol. 2022 Aug 26. doi: 10.1245/s10434-022-12390-7. Online ahead of print.

ABSTRACT

BACKGROUND: Veteran populations have five times the incidence of hepatocellular carcinoma (HCC) compared with the general population. The incidence of HCC has increased in the Veteran’s Affairs Health System (VAHS), primarily due to the increased prevalence of cirrhosis. This study aimed to characterize differences in treatment patterns and overall survival rates across the five VAHS geographic regions.

METHODS: Using the VA Corporate Data Warehouse, the authors built a comprehensive national dataset of Veteran patients with HCC diagnosed between 2001 and 2015 to compare patients across VAHS regions. A multivariable Cox proportional hazards model was used to identify factors associated with 5-year all-cause mortality. Kaplan-Meier curves were used to visualize the patient survival function, and the log-rank test was applied to test statistical significance.

RESULTS: This retrospective study analyzed 13,434 patients. The West region had the highest rate of overall treatment receipt (63.6%), and the Southwest had the lowest rate (52.9%). After adjustment for demographic, clinicopathologic, treatment, and hospital factors, treatment in a non-West region continued to be significantly associated with a 10% to 13% increased risk of 5-year mortality (Midwest: hazard ratio [HR], 1.11; 95% confidence interval [CI], 1.03-1.17; Northeast: HR, 1.10; 95% CI, 1.03-1.17; Southeast: HR, 1.13; 95% CI, 1.06-1.21; Southwest: HR, 1.11; 95% CI, 1.03-1.19) (p < 0.01).

CONCLUSIONS: Treatment patterns and overall survival rates of HCC patients differ significantly across VAHS geographic regions. Targeted interventions to increase the rate of treatment in the non-West regions are needed to improve survival of HCC Veterans and provide uniformly high-quality care across VAHS facilities.

PMID:36018517 | DOI:10.1245/s10434-022-12390-7

Acta Parasitol. 2022 Aug 26. doi: 10.1007/s11686-022-00610-9. Online ahead of print.

ABSTRACT

BACKGROUND: Protozoans of Entamoeba spp. are one of the most common enteric parasites that infect humans and diverse animals including deer.

PURPOSE: However, data regarding the prevalence and species/genotypes of Entamoeba spp. in deer in China is scarce. This study investigated the prevalence and species distribution of Entamoeba spp. in sika deer (Cervus nippon) in Anhui Province.

METHODS: In our survey, 336 fecal samples were collected from five sika deer farms in different regions of Anhui Province. All samples were examined for the presence of Entamoeba spp. by PCR and phylogenetic analysis of the conserved 18S rRNA gene.

RESULTS: 106/336 (31.5%) fecal samples were positive for Entamoeba spp. A statistically significant difference in the prevalence of Entamoeba spp. infection was observed between sampling farms (p < 0.001), and the prevalence of Entamoeba spp. in male and female sika deer showed no significant difference (p > 0.05). Sequence and phylogenetic analysis revealed the single species, E. bovis, was identified in this study.

CONCLUSION: This is the first report about the identification of E. bovis in farm-raised sika deer in China, and these results expand our understanding of host range and species distribution of Entamoeba spp. in ruminants.

PMID:36018470 | DOI:10.1007/s11686-022-00610-9

Breast Cancer Res Treat. 2022 Aug 26. doi: 10.1007/s10549-022-06694-1. Online ahead of print.

ABSTRACT

AIM OF THE STUDY: The study aims to evaluate the performance of selected, high-volume, highly specialized, Italian Breast Centers at the time of COVID-19 pandemic (year 2020), compared to pre-pandemic time (year 2019), highlighting differences in terms of clinical presentation of breast cancer (BC) and therapeutic strategies.

METHODS: Patients’ data were provided by the Senonetwork data warehouse Senonet. In order to examine changes in the surgical and oncological management of BC patients during different phases of COVID-19 pandemic, we took advantage of a selection quality indicators (QIs). We performed the analyses in two time-frames, from July to September (Jul-Sep) (2019 versus 2020) and from October to December (Oct-Dec) (2019 versus 2020).

RESULTS: Our analysis did not show any statistically significant difference in terms of diagnosis, surgical, oncological and radiation therapy procedures between the two trimesters 2019 and 2020. Nevertheless, we observed statistically significant differences, favoring 2020, when analyzing time-to surgery and time-to radiotherapy. On the other hand, we observed a significant reduction of neoadjuvant chemotherapy and we did not recollect any data on a major use of neoadjuvant endocrine therapy.

CONCLUSIONS: In Italian Breast Centers, partners of Senonetwork, we could not observe any treatment delay or change in standard clinical practice for BC care during the 2020 pandemic year, compared to 2019 pre-pandemic year. This finding is in contrast with the globally reported decrease in the performance of the Italian Breast Centers due to the COVID-19 pandemic, and has to be linked to the sharp selection of Senonetwork Breast Centers.

PMID:36018455 | DOI:10.1007/s10549-022-06694-1

Prog Orthod. 2022 Aug 26;23(1):40. doi: 10.1186/s40510-022-00424-5.

ABSTRACT

OBJECTIVES: To compare the clinical effectiveness of Hawley retainers (HRs) and modified vacuum-formed retainers (mVFRs) with palatal coverage in maintaining transverse expansion throughout a 24-month retention period and to assess the subjects’ perception toward the retainers.

MATERIALS AND METHODS: The trial accomplished blinding only by the outcome assessor and data analyst. Data were collected from post-orthodontic treatment patients who met the inclusion criteria. Thirty-five subjects were randomly allocated using a centralized randomization technique into either mVFR (n = 18) or HR group (n = 17). Dental casts of subjects were evaluated at debond (T0), 3-month (T1), 6-month (T2), 12-month (T3), and 24-month retention (T4). The intercanine width (ICW), interpremolar width (IPMW), interfirst molar mesiobuccal cusp width (IFMW1), and interfirst molar distobuccal cusp width (IFMW2) were compared between groups over time using Mixed ANOVA. A pilot-tested and validated questionnaire consisting of six items were given at T4. Subjects were instructed to rate their retainer in terms of fitting, speech, appearance, oral hygiene, durability, and comfort on a 100-mm Visual Analogue Scale (VAS).

RESULTS: No statistically significant differences in arch width were found between the two groups at ICW (P = .83), IPMW (P = 0.63), IFMW1 (P = .22), and IFMW2 (P = .46) during the 24-month retention period. Also, no statistically significant differences were found between perception of both retainers in terms of fitting, speech, oral hygiene, durability, and comfort (P > .05) after 24-month wear. The appearance of mVFRs was rated significantly higher compared to HRs (P < .05).

CONCLUSIONS: HR and mVFR have similar clinical effectiveness for retention of transverse expansion cases in a 24-month retention period. Both retainers were perceived to be equal in terms of fitting, speech, oral hygiene, durability, and comfort. Subjects in the mVFRs group found their retainers to be significantly more esthetic than those in HRs group.

PMID:36018418 | DOI:10.1186/s40510-022-00424-5

J Feline Med Surg. 2022 Aug 26:1098612X221115674. doi: 10.1177/1098612X221115674. Online ahead of print.

ABSTRACT

OBJECTIVES: The aims of this study were to describe the clinical features of cats presented for trauma in a first-opinion and referral teaching hospital in New Zealand, and to determine the relationship between those features and outcome.

METHODS: The electronic medical records of cats presented for trauma to the Massey University Pet Emergency Centre between September 2013 and January 2019 were examined, from which the signalment, clinical parameters and patient outcomes were extracted. Cases were assigned an Animal Trauma Triage (ATT) score and Modified Glasgow Coma Scale (MGCS) score. Variables were selected for inclusion in a logistic regression model to predict survival, and backward elimination was used to find the minimal significant model.

RESULTS: In total, 530 cats met the inclusion criteria. The cause of injury was not known in the majority of cases (38.0%). The most common location of injury was the hindlimbs/pelvis/tail (n = 247; 41%), and skin lacerations/abrasions were the most common specific injury. Multivariate analysis revealed altered mentation (odds ratio [OR] 0.31, P = 0.029), hypothermia (rectal temperature <37.8°C [<100.04°F]; OR 0.45, P = 0.015) and an ATT score ⩾5 (OR 0.13, P <0.001) to be statistically significantly associated with mortality.

CONCLUSIONS AND RELEVANCE: Altered mentation and hypothermia are easily measurable perfusion parameter abnormalities associated with mortality in cats presenting with trauma. The ATT score appears to be an accurate prognostic indicator in cats presenting with trauma in New Zealand. These results highlight the importance of incorporating a hands-on triage examination in each cat that presents as an emergency after trauma.

PMID:36018375 | DOI:10.1177/1098612X221115674

Anxiety Stress Coping. 2022 Aug 26:1-17. doi: 10.1080/10615806.2022.2110588. Online ahead of print.

ABSTRACT

BACKGROUND: People of lower social status tend to have greater emotional responses to stress. The present study assessed whether lower social status was related to greater emotional responses in anticipation of a naturalistic stressor: academic exams among college students.

METHODS: College students in an introductory statistics class (N = 252; 75.81% female; 18.41% Latino, 25.10% White, 43.93% Asian, 12.56% different racial backgrounds) completed two course exams as part of this naturalistic prepost-experimental design. They provided four reports of positive, depressive, and anxious emotion – one the day before and one immediately after each exam.

RESULTS: As hypothesized, multilevel models (ratings nested within participants) predicting emotion indicated that students with lower mother’s education had less positive emotion, more depressive emotion, and more anxious emotion the day prior to academic exams than students with higher mother’s education (proportional reductions in variance [PRV] = .013-.020). Specifically, lower mother’s education was associated with poorer well-being before but not after the exam. Exploratory models revealed that differences in emotion by mother’s education were strongest for students with lower exam scores (PRV = .030-.040).

CONCLUSIONS: Socioeconomic status may influence college students’ anticipatory distress prior to academic exams, which may impact health and academic performance.

PMID:36018365 | DOI:10.1080/10615806.2022.2110588

Eur J Nucl Med Mol Imaging. 2022 Aug 26. doi: 10.1007/s00259-022-05949-9. Online ahead of print.

ABSTRACT

PURPOSE: Sparse inverse covariance estimation (SICE) is increasingly utilized to estimate inter-subject covariance of FDG uptake (FDG_cov) as proxy of metabolic brain connectivity. However, this statistical method suffers from the lack of robustness in the connectivity estimation. Patterns of FDG_cov were observed to be spatially similar with patterns of structural connectivity as obtained from DTI imaging. Based on this similarity, we propose to regularize the sparse estimation of FDG_cov using the structural connectivity.

METHODS: We retrospectively analyzed the FDG-PET and DTI data of 26 healthy controls, 41 patients with Alzheimer’s disease (AD), and 30 patients with frontotemporal lobar degeneration (FTLD). Structural connectivity matrix derived from DTI data was introduced as a regularization parameter to assign individual penalties to each potential metabolic connectivity. Leave-one-out cross validation experiments were performed to assess the differential diagnosis ability of structure weighted SICE approach. A few approaches of structure weighted were compared with the standard SICE.

RESULTS: Compared to the standard SICE, structural weighting has shown more stable performance in the supervised classification, especially in the differentiation AD vs. FTLD (accuracy of 89-90%, while unweighted SICE only 85%). There was a significant positive relationship between the minimum number of metabolic connection and the robustness of the classification accuracy (r = 0.57, P < 0.001). Shuffling experiments showed significant differences between classification score derived with true structural weighting and those obtained by randomized structure (P < 0.05).

CONCLUSION: The structure-weighted sparse estimation can enhance the robustness of metabolic connectivity, which may consequently improve the differentiation of pathological phenotypes.

PMID:36018359 | DOI:10.1007/s00259-022-05949-9

Eur Arch Otorhinolaryngol. 2022 Aug 26. doi: 10.1007/s00405-022-07611-4. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aims to evaluate Eustachian tube (ET) function tests and their impact on outcomes of tympanoplasty in patients with inactive chronic suppurative otitis media.

MATERIALS AND METHODS: A prospective study was conducted involving patients diagnosed with chronic suppurative otitis media (CSOM) and having a central dry perforation. Assessment of the ET function was done for all included cases by three tests; pressure swallow equalization test, saccharine test and methylene blue test. The primary outcome is the graft success rate defined as intact graft without any residual perforation at 6 months postoperatively. Secondary outcomes include hearing assessment and possible associated complications.

RESULTS: 64 patients were included in the study with an average age of 36.59 ± 11.96 years. All patients underwent assessment of the ET function by saccharine test, methylene blue test and pressure equalization test (PET) followed by microscopic post-auricular tympanoplasty. Successful tympanoplasty is achieved in 93.75% of cases with residual perforation in four patients. Mean air-bone gap is significantly improved from 23.73 ± 2.80 preoperatively to 10.93 ± 5.46 postoperatively. Results of Methylene blue test has no statistical impact on graft take rate (p value = 0.379), while saccharine test and pressure equalization test results have statistically significant correlation with graft success (p value ≤ 0.001).

CONCLUSIONS: Saccharine and Pressure equalization tests have a good positive correlation with the graft healing in tympanoplasty, while methylene blue test was found to have no correlation with the success rate.

PMID:36018358 | DOI:10.1007/s00405-022-07611-4