Nevin Manimala

Cytopathology. 2022 Sep 23. doi: 10.1111/cyt.13182. Online ahead of print.

ABSTRACT

OBJECTIVE: Cytology histology correlation (CHC) is gold standard quality assurance in cytology laboratories to ensure appropriate patient treatment and as an educational tool for cytology laboratory personnel. If cervical pap smears (CP) and cervical biopsies (CB) are performed at different institutions, these benefits may be lost.

METHODS: All CB performed at our institution from 1/1/2019 to 12/31/2019 with adequate CP performed in six months prior to CB were included in this retrospective review. We compared CHC for CP and CB performed at a single institution compared to CHC for CP and CB performed at different institutions, with a focus on proportion of overcalls on CP, as those are most challenging discrepant CHC to manage clinically. We used the American Society of Cytology guidelines for our discrepancy assessment grid. Chi-squared test was used to compare proportions of populations. P-value was set at <0.05.

RESULTS: Of 305 CB in our study population, 69 had CP performed at our institution and 236 had CP performed at an outside institution. CHC for CB and CP performed at a single institution had statistically significantly less disagreement than for those performed at different institutions (p<0.05). Further, CB and CP performed at as single institution had statistically significantly fewer overcalls than CB and CP performed at different institutions (p<0.05).

CONCLUSION: This study further supports the use of CHC and encourages performance of CP and CB as the same institution. If performing CP and CB at the same institution is not feasible, prospective consultation review of CP by institution performing CB should be strongly considered. Further study, including evaluation of reason for discrepancy in discordant cases may be considered to better elucidate reasons for better CHC agreement when CP and CB are performed at the same institution.

PMID:36148769 | DOI:10.1111/cyt.13182

J Clin Neurosci. 2022 Sep 20;105:109-114. doi: 10.1016/j.jocn.2022.09.001. Online ahead of print.

ABSTRACT

When neurosurgical care is needed, the distance to a facility staffed with a neurosurgeon is critical. This work utilizes geospatial analysis to analyze access to neurosurgery in the Medicare population and relevant socioeconomic factors. Medicare billing and demographic data from 2015 to 2019 were combined with national National Provider Identifier (NPI) registry data to identify the average travel distance to reach a neurosurgeon as well as the number of neurosurgeons in each county. This was merged with U.S. Census data to capture 23 socioeconomic attributes. Moran’s I statistic was calculated across counties. Socioeconomic variables were compared using ANOVA. Hotspots with the highest neurosurgeon access were predominantly located in the Mid-Atlantic region, central Texas, and southern Montana. Coldspots were found in the Great Plains, Midwest, and Southern Texas. There were statistically significant differences (p < 0.05) between high- and low-access counties, including: stroke prevalence, poverty, median household income, and total population density. There were no statistically significant differences in most races or ethnicities. Overall, there exist statistically significant clusters of decreased neurosurgery access within the United States, with varying sociodemographic characteristics between access hotspots and coldspots.

PMID:36148727 | DOI:10.1016/j.jocn.2022.09.001

J Clin Neurosci. 2022 Sep 20;105:103-108. doi: 10.1016/j.jocn.2022.09.002. Online ahead of print.

ABSTRACT

BACKGROUND: Post-stroke cognitive impairment (PSCI) seriously affects the quality of life of patients. Identifying early predictors of PSCI to realize timely intervention of PSCI can provide effective information for patient rehabilitation and follow-up treatment, and has important clinical significance for delaying its progression to dementia.

METHODS: Montreal Cognitive Assessment (MoCA) and National Institutes of Health Stroke Scale (NIHSS) were used to assess patients’ cognitive and neurological function separately. ELISA was used to analyze serum tissue inhibitor of metalloproteinase 1 (TIMP 1) and matrix metalloproteinase 9 (MMP 9) levels of patients on admission.

RESULTS: 180 patients with first-ever acute ischemic stroke (AIS) were included in the study. After three months of follow-up, 78 patients were diagnosed with PSCI, and 102 patients did not have PSCI. MMP 9 and TIMP 1 were elevated in PSCI patients on admission relative to non-PSCI groups, and they were positively correlated with patients’ NIHSS scores on admission (p < 0.001). Serum levels of MMP 9 and TIMP 1 in PSCI patients were negatively correlated with MoCA scores at the end of the 3-month follow-up (p < 0.001). Serum MMP 9 (p < 0.001), TIMP 1 (p = 0.02) and combined detection (p < 0.001) of AIS patients at admission appear to have predictive value for the diagnosis of PSCI three months later.

CONCLUSION: Serum MMP 9 and TIMP 1 levels in stroke patients were statistically predictive of PSCI.

PMID:36148726 | DOI:10.1016/j.jocn.2022.09.002

J Mech Behav Biomed Mater. 2022 Sep 14;135:105455. doi: 10.1016/j.jmbbm.2022.105455. Online ahead of print.

ABSTRACT

This study compared the flexural strength under monotonic (static – sσ) and cyclic load application (fatigue – fσ), hardness (H) and fracture toughness (K_IC) of different layers of a multi-layered zirconia (IPS e.max ZirCAD MT Multi, Ivoclar). Each layer was sectioned, classified into three groups according to yttria content (4-YSZ, 4/5-YSZ and 5-YSZ), and shaped on samples for flexural strength and fracture toughness tests (bars: 1.0 × 1.0 × 11 mm); and Vickers hardness test (plates: 1.5 × 4.0 × 5.0 mm). Flexural strength under monotonic load application (sσ; n = 10) was obtained through two different devices (three-point-bending and ball-in-hole device) and fatigue flexural strength (fσ; n = 15; initial load: 10 N; step-size: 5 N; 10,000 cycles/step) was assessed using a ball-in-hole device under cyclic load application. Vickers hardness test (n = 5), fracture toughness test (n = 10), and additional analyzes (Finite Element Analysis – FEA, Energy-dispersive X-ray spectroscopy – EDS and Scanning Electron Microscopy – SEM) were also performed. No differences were found between the different devices in the monotonic flexural strength test, and FEA showed similar tensile stress distribution for the two devices. 4-YSZ showed higher values of flexural strength under monotonic and cyclic load application modes (sσ = 1114.73 MPa; fσ = 798.84 MPa), and fracture toughness (K_IC = 3.90 MPa√m). 4/5-YSZ had an intermediate sσ; however, fσ was similar to 5-YSZ (404.00-429.36 MPa) and K_IC similar to 4-YSZ (K_IC = 3.66 MPa√m). No statistical differences were found for hardness and Weibull modulus for fatigue flexural strength data. The amount of yttria in the layer compositions increased from 4-YSZ to 5-YSZ, and larger zirconia crystals were observed in the topographic images of 5-YSZ. Failures in the flexural strength and toughness tests started from the face subjected to tensile stress. Different layers of the multi-layered zirconia blank presented distinct mechanical properties. 4-YSZ (cervical layer) presented the highest flexural strength under monotonic and cyclic loads (fatigue), and higher fracture toughness even similar to the transition layer (4/5-YSZ). Hardness was similar between the layers. The ball-in-hole device performed similarly to the three-point bending device and can be used as an alternative to the traditional method.

PMID:36148725 | DOI:10.1016/j.jmbbm.2022.105455

Res Vet Sci. 2022 Sep 11;152:458-464. doi: 10.1016/j.rvsc.2022.09.008. Online ahead of print.

ABSTRACT

Anaplasma capra is a tick-borne pathogen that was discovered for the first time in goats in China in 2012. The studies carried out from the first detection in China to the present have revealed the presence of this species in eight countries including Angola, France, Iranian, South Korea, Kyrgyzstan, Malaysia, Spain, and Türkiye in three continents (Africa, Asia, and Europe). It has also been determined that humans, sheep, cattle, dog, and wild animals are the hosts of A. capra. It was investigated whether water buffaloes were the host of A. capra using nested-PCR and DNA sequencing in this study. The prevalence of A. capra in Turkish water buffalo herds was investigated and phylogenetic analyzes were performed on the basis of gltA, groEL, and 16S rRNA genes. A total of 364 water buffalo blood samples were examined in terms of A. capra using gltA gene species-specific nested-PCR. A. capra were detected in 52 of 364 (14.28%) blood samples. There was no statistically significant difference between the prevalence, gender, and age parameters. The gltA, groEL, and 16S rRNA genes in randomly selected three positive samples were sequenced. A. capra isolates obtained from water buffaloes in this study shared 85.20-100%(gltA), 89.84-100%(groEL), and 99.82-100%(16S rRNA) nucleotide similarity with A.capra isolates present in GeneBank. Phylogenetic analyses of gtlA and groEL genes revealed that A. capra divided in two different genogroups. In conclusion, this study revealed that water buffalo is a new host of A. capra. However, comprehensive studies are needed to determine the pathogenicity, vectors, and biological properties of A. capra in this new host.

PMID:36148715 | DOI:10.1016/j.rvsc.2022.09.008

J Environ Radioact. 2022 Sep 20;255:106968. doi: 10.1016/j.jenvrad.2022.106968. Online ahead of print.

ABSTRACT

In 2015 and 2016, atmospheric transport modeling challenges were conducted in the context of the Comprehensive Nuclear-Test-Ban Treaty (CTBT) verification, however, with a more limited scope with respect to emission inventories, simulation period and number of relevant samples (i.e., those above the Minimum Detectable Concentration (MDC)) involved. Therefore, a more comprehensive atmospheric transport modeling challenge was organized in 2019. Stack release data of Xe-133 were provided by the Institut National des Radioéléments/IRE (Belgium) and the Canadian Nuclear Laboratories/CNL (Canada) and accounted for in the simulations over a three (mandatory) or six (optional) months period. Best estimate emissions of additional facilities (radiopharmaceutical production and nuclear research facilities, commercial reactors or relevant research reactors) of the Northern Hemisphere were included as well. Model results were compared with observed atmospheric activity concentrations at four International Monitoring System (IMS) stations located in Europe and North America with overall considerable influence of IRE and/or CNL emissions for evaluation of the participants’ runs. Participants were prompted to work with controlled and harmonized model set-ups to make runs more comparable, but also to increase diversity. It was found that using the stack emissions of IRE and CNL with daily resolution does not lead to better results than disaggregating annual emissions of these two facilities taken from the literature if an overall score for all stations covering all valid observed samples is considered. A moderate benefit of roughly 10% is visible in statistical scores for samples influenced by IRE and/or CNL to at least 50% and there can be considerable benefit for individual samples. Effects of transport errors, not properly characterized remaining emitters and long IMS sampling times (12-24 h) undoubtedly are in contrast to and reduce the benefit of high-quality IRE and CNL stack data. Complementary best estimates for remaining emitters push the scores up by 18% compared to just considering IRE and CNL emissions alone. Despite the efforts undertaken the full multi-model ensemble built is highly redundant. An ensemble based on a few arbitrary runs is sufficient to model the Xe-133 background at the stations investigated. The effective ensemble size is below five. An optimized ensemble at each station has on average slightly higher skill compared to the full ensemble. However, the improvement (maximum of 20% and minimum of 3% in RMSE) in skill is likely being too small for being exploited for an independent period.

PMID:36148707 | DOI:10.1016/j.jenvrad.2022.106968

Phys Ther Sport. 2022 Sep 7;58:46-51. doi: 10.1016/j.ptsp.2022.08.002. Online ahead of print.

ABSTRACT

OBJECTIVES: Investigate the British Athletics Muscle Injury Classification (BAMIC) grading system as a predictor of return to play (RTP) following primary hamstring strain injury (HSI) and its agreement with the Peetron’s classification system in professional footballers.

METHODS: A retrospective cohort study of 39 hamstrings strains in a professional English football club were identified. Two musculoskeletal radiologists reviewed historical MRI’s and classified them against the BAMIC and Peetron’s grading system. Classification, oedema length and cross-sectional area were compared against RTP.

RESULTS: Pearson’s correlation coefficient demonstrated a weak but statistically significant correlation between BAMIC and RTP (r = 0.32; 95%CI 0.01 to 0.58; p = 0.05). Maximum length of intramuscular oedema demonstrated weak correlations with RTP (r = 0.3; 95%CI -0.02 to 0.56; p = 0.06). Percentage cross sectional demonstrated a weak correlation with RTP (r = 0.02; 95%CI -0.3 to 0.33; p = 0.91). Multiple regression demonstrated that 16% of the variance in RTP was explained by the model. Kappa for the agreement between BAMIC and Peetron’s was 0.21 (95%CI 0 to 0.42).

CONCLUSIONS: A significant association between the grade of HSI on the BAMIC system and RTP was found. Findings suggest BAMIC could provide valuable prognostic information on the RTP.

PMID:36148699 | DOI:10.1016/j.ptsp.2022.08.002

Hypertension. 2022 Sep 23:HYPERTENSIONAHA12219346. doi: 10.1161/HYPERTENSIONAHA.122.19346. Online ahead of print.

ABSTRACT

BACKGROUND: As by definition, mean arterial pressure equals the product of cardiac output (CO) and total vascular resistance (TPR), we hypothesized that, irrespective of thresholds to define hypertension, a CO-TPR imbalance might exist in first-trimester normotensive pregnancies with altered risks for adverse gestational outcomes.

METHODS: A standard protocol was used for automated blood pressure measurement combined with impedance cardiography assessment of CO and TPR (NICCOMO). First-trimester normotensive pregnant women were categorized into 3 groups relative to the reference 75th percentile (P75) of CO and TPR: (1) normal CO and TPR, (2) high CO, and (3) high TPR. These subgroups were compared at blood pressure thresholds 140/90, 130/85, and 130/80 mmHg. The gestational outcome was categorized after birth according to International Society for Studies of Hypertension in Pregnancy criteria.

RESULTS: Compared with pregnancies with normal CO and TPR (≤P75), women with high TPR at blood pressure <140/90 mmHg are at risk for developing gestational hypertension (odds ratio, 3.795 [1.321-10.904]; P<0.010), late-onset preeclampsia (odds ratio, 3.137 [1.060-9.287]; P<0.050), and neonates small for gestational age (odds ratio, 1.780 [1.056-2.998]; P<0.050).

CONCLUSIONS: Cardiovascular imbalance can present in normotensive women in the first trimester and is associated with increased risks for adverse gestational outcomes. This study illustrates the relevance of CO and TPR assessments as an adjunct to blood pressure measurement and invites for further exploring their value in screening algorithms for gestational hypertensive disorders and/or small for gestational age.

PMID:36148652 | DOI:10.1161/HYPERTENSIONAHA.122.19346

Int Wound J. 2022 Sep 23. doi: 10.1111/iwj.13925. Online ahead of print.

ABSTRACT

This study aimed to explore the clinical application and efficacy of traditional Chinese medicine (TCM) powder in the treatment of acute and chronic wounds. Eighty patients with a wound infection were randomly and equally divided into a control group and an observation group. Gauze padding containing furacilin was used to dress the infected wounds of the control group. TCM powder was used to treat the wounds of the observation group. The total response rate of the observation group was significantly higher than the control group (P = .017). The colour and exudate volume scores in the observation group were lower than the control group, and the differences between the two groups were statistically significant (P < .05). The time to the appearance of new epithelium and time to the wound healing of the burns in the observation group were shorter than the control group, and the differences were statistically significant (P < .05). The TCM powder absorbed a large amount of necrotic tissue and exudate from the wound surface, cleared heat and toxins, and activated blood circulation. It also resolved blood stasis, eliminated pus, and allowed for new skin growth, as well as regenerating muscle.

PMID:36148625 | DOI:10.1111/iwj.13925

J Med Radiat Sci. 2022 Sep 23. doi: 10.1002/jmrs.618. Online ahead of print.

ABSTRACT

INTRODUCTION: Contouring organs at risk (OARs) is a time-intensive task that is a critical part of radiation therapy. Atlas-based automatic segmentation has shown some success at reducing this time burden on practitioners; however, this method often requires significant manual editing to reach a clinically accurate standard. Deep learning (DL) auto-segmentation has recently emerged as a promising solution. This study compares the accuracy of DL and atlas-based auto-segmentation in relation to clinical ‘gold standard’ reference contours.

METHODS: Ninety CT datasets (30 head and neck, 30 thoracic, 30 pelvic) were automatically contoured using both atlas and DL segmentation techniques. Sixteen critical OARs were then quantitatively measured for accuracy using the Dice similarity coefficient (DSC) and Hausdorff distance (HD). Qualitative analysis was performed to visually classify the accuracy of each structure into one of four explicitly defined categories. Additionally, the time to edit atlas and DL contours to a clinically acceptable level was recorded for a subset of 9 OARs.

RESULTS: Of the 16 OARs analysed, DL delivered statistically significant improvements over atlas segmentation in 13 OARs measured with DSC, 12 OARs measured with HD, and 12 OARs measured qualitatively. The mean editing time for the subset of DL contours was 50%, 23% and 61% faster (all P < 0.05) than that of atlas segmentation for the head and neck, thorax, and pelvis respectively.

CONCLUSIONS: Deep learning segmentation comprehensively outperformed atlas-based contouring for the majority of evaluated OARs. Improvements were observed in geometric accuracy and visual acceptability, while editing time was reduced leading to increased workflow efficiency.

PMID:36148621 | DOI:10.1002/jmrs.618