Nevin Manimala

J Vasc Access. 2022 Sep 14:11297298221122115. doi: 10.1177/11297298221122115. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate in vivo the feasibility, safety, and paclitaxel (PTX) deliverability of a newly developed non-commercially available Paclitaxel-Coated Balloon (PCB) catheter in the swine healthy peripheral vein model.

MATERIALS AND METHODS: In total 12 PCBs were deployed in 12 venous segments. Primary feasibility endpoint was the successful application of the devices to the veins of the animals. Primary efficacy endpoint was the determination of the drug content in the venous tissue at 24 h and 7 days after balloon expansion, as assessed by analysis of the vein tissue with High Performance Liquid Chromatography (HPLC) coupled with tandem mass spectrometry. Primary safety endpoint was freedom from any major adverse event. Secondary endpoint was the investigation of any independent factor affecting the primary endpoints.

RESULTS: Paclitaxel was detected in five out of six tissue samples 24 h post-intervention and five out of six tissues at 7 days following the procedure (10 tissue samples out of 12). The mean weight of tissue that was examined was 0.20604 ± 0.29822 g (range: 1.02823-0.03377 g) and the mean PTX concentration detected was 8.4 ± 13.1 μg/g (range: 0-36.1 μg/g). The average drug content detected at 24 h (17.1 ± 17.1 μg/g) was numerically superior, but non-statistically significant, compared to 7 days (3.1 ± 3.6 μg/g). An average of 33.8% of the drug remained on the balloon after retrieval. According to the multiple linear regression analysis, there was no significant correlation between transition time, PTX remaining on the balloon, time of analysis (24 h/7 days) and PTX tissue concentration. No abnormalities were noted during autopsy.

CONCLUSION: The newly developed PCB successfully delivered within the healthy venous wall a dose of Paclitaxel that inhibits neointimal hyperplasia. No safety issues were raised at short-term follow-up.

PMID:36113056 | DOI:10.1177/11297298221122115

Hand (N Y). 2022 Sep 16:15589447221120849. doi: 10.1177/15589447221120849. Online ahead of print.

ABSTRACT

BACKGROUND: We aimed to evaluate the efficacy of abductor pollicis longus (APL) suspension arthroplasty with trapeziectomy combined with first and second metacarpal fixation using suture button device.

METHODS: Thirteen patients (14 thumbs) who underwent APL suspension arthroplasty combined with suture button device for osteoarthritis of the carpometacarpal joint of the thumb (Eaton grade III: 6 and IV: 8 thumbs) at our institution between 2015 and 2019 and were followed up for more than 24 months were included in the study. Preoperative and postoperative range of motion (ROM) of radial and palmar abduction, grip and key pinch strength, visual analog scale (VAS) scores for pain, and the trapezial space ratio (TSR) on radiographic images before and after surgery were statistically examined.

RESULTS: The mean age of the patients was 59.6 ± 8.1 years, and the mean follow-up period was 45.4 ± 12.2 months. While grip and pinch strength did not significantly change between preoperative and final follow-up measurements, the ROM of radial and palmar abduction and the VAS score at the latest follow-up were significantly better than the preoperative values (P < .05). The mean TSR immediately after surgery and at the latest follow-up was 0.28 ± 0.089 and 0.22 ± 0.084, respectively, indicating a mean reduction rate of 23.3 ± 15.2%.

CONCLUSIONS: This surgical technique showed significant improvement in the ROM of radial and palmar abduction and the VAS score for pain, and the combined fixation of the first and second metacarpals with suture button device suppressed the subsidence of the first metacarpal.

PMID:36113054 | DOI:10.1177/15589447221120849

Psychol Sci. 2022 Sep 15:9567976221100264. doi: 10.1177/09567976221100264. Online ahead of print.

ABSTRACT

Identifying predictors of cognitive decline in old age helps us understand its mechanisms and identify those at greater risk. Here, we examined how cognitive change from ages 11 to 70 is associated with cognitive change at older ages (70 to 82 years) in the Lothian Birth Cohort 1936 longitudinal study (N = 1,091 at recruitment). Using latent-growth-curve models, we estimated rates of change from ages 70 to 82 in general cognitive ability (g) and in three cognitive domains: visuospatial, memory, and processing speed. We found that g accounted for 71.3% of interindividual change variance. Greater cognitive gain from ages 11 to 70 predicted slower decline in g over 12 subsequent years (β = 0.163, p = .001), independently of cognitive level in childhood and at age 70, and domain-specific change beyond g. These results contribute to the goal of identifying people at higher risk of age-related cognitive decline.

PMID:36113037 | DOI:10.1177/09567976221100264

J Health Psychol. 2022 Sep 15:13591053221120968. doi: 10.1177/13591053221120968. Online ahead of print.

ABSTRACT

The present study sought to explore the factors associated with the odds of having probable depression and posttraumatic stress disorder (PTSD) related to traumatic COVID-19 experiences and their impact on health care workers in distinct categories. In this cross-sectional study, 1843 health care workers (nurses, nurse technicians, physicians, physical therapists, and other healthcare workers) were recruited via convenience sampling. A survey was administered to obtain information regarding sociodemographic, occupational, and mental health status. Descriptive statistics and multivariable logistic regression were used for the analyses. Being a nurse technician was associated with an odds ratio of 1.76 for probable PTSD. No relation was observed between health care worker categories and the odds of probable depression. Additionally, being female and not receiving adequate PPE were related to greater odds of having probable PTSD and depression.

PMID:36113021 | DOI:10.1177/13591053221120968

J Orthop Surg (Hong Kong). 2022 Sep-Dec;30(3):10225536221125951. doi: 10.1177/10225536221125951.

ABSTRACT

INTRODUCTION: Generalized joint hypermobility (GJH) is a hereditary connective tissue disease in which the range of motion (ROM) of multiple joints exceeds the normal range, and the ROM varies with age, gender, and ethnicity. At present, the six-degree-of-freedom (6-DOF) of ankle kinematics among people with GJH have not been studied. To investigate the kinematic characteristics in the ankle during treadmill gait of university students with generalized joint hypermobility compared to normal participants. We hypothesized that compared to the participants in the control group, those with GJH would exhibit kinematic characteristics of poorer active motion stability in the ankle during treadmill gait.

METHODS: Healthy university student volunteers aged 18-24 (excluding those with a history of ankle trauma, etc.) were recruited and divided into a control group (50 volunteers) and a GJH group (Beighton score ≥4, 50 volunteers). Data of the 6-DOF kinematics of ankle was collected using a 3D gait analysis system. Variables were evaluated using independent t-tests and Wilcoxon signed-rank tests.

RESULTS: In the proximal/distal parameter, proximal displacement was significantly increased in the GJH group compared with the control group during 4-9% and 96-97% of the gait phase (loading response and terminal swing phase), with an increase of (0.1-0.2 cm, p < .05). Regarding the proximal/distal, internal/external, plantarflexion/dorsiflexion, and anterior/posterior parameters, the participants with GJH exhibited greater ROM than those in the control group throughout the gait cycle (0.24 ± 0.22 cm vs. 0.19 ± 0.15 cm, p = 0.047, 5.56 ± 2.90° vs. 4.48 ± 3.30°, p = .020, 23.05 ± 5.75° vs. 20.36 ± 4.91°, p < .001, 0.65 ± 0.30 cm vs. 0.55 ± 0.27 cm, p = .018). However, ROM of inversion/eversion translation was found to be decreased in the GJH group compared to the control group (8.92 ± 1.59° vs. 9.47 ± 1.37°, p = .009). In addition, there was no statistical difference between the GJH group and the control group in ROM of medial/lateral translation (0.05 ± 0.06 cm vs. 0.04 ± 0.05 cm, p = .131).

CONCLUSION: Our results confirm that our hypothesis is not valid. Although there were a few differences in each gait parameter of the ankle between the GJH group and the control group, the difference was not significant. These results indicate that the presence of GJH has less effect on ankle kinematics and enhance our knowledge of the relationship between GJH and 6-DOF of ankle kinematics.

PMID:36113013 | DOI:10.1177/10225536221125951

J Int Med Res. 2022 Sep;50(9):3000605221121962. doi: 10.1177/03000605221121962.

ABSTRACT

OBJECTIVE: To investigate the effect of compound betamethasone on pain points of the supraspinatus tendon by local blocking therapy after repair surgery.

METHODS: This non-randomised controlled trial included patients who underwent arthroscopic repair of supraspinatus tendon tears and who had long-term pain. At 3 months following surgery, patients were assigned to an experimental group, whose pain points were treated with compound betamethasone, or a control group who did not receive compound betamethasone. Visual analogue scale (VAS) score, Pittsburgh Sleep Quality Index (PSQI) and Constant shoulder score for pain were determined at 3, 4, 5 and 6 months following surgery and analysed retrospectively.

RESULTS: Of 38 included patients, there were no statistically significant between-group differences in VAS score, PSQI or Constant shoulder scores at 3 months following surgery. At 4, 5 and 6 months after surgery, the VAS score and PSQI were significantly lower, and the Constant shoulder score was significantly higher, in the experimental group versus controls.

CONCLUSIONS: Using compound betamethasone to locally block pain points after supraspinatus tendon repair surgery may significantly alleviate pain, improve sleep quality, facilitate functional shoulder exercise and achieve good shoulder function.

PMID:36113007 | DOI:10.1177/03000605221121962

Dermatitis. 2022 Sep-Oct 01;33(5):362-367. doi: 10.1097/DER.0000000000000806. Epub 2021 Dec 10.

ABSTRACT

BACKGROUND: The use of palladium (Pd) is increasing in metal objects after the banning of nickel in items in prolonged contact with the skin. The properties of Pd make this metal useful in various industrial fields.

OBJECTIVE: The aim of the study was to evaluate the prevalence of Pd sensitization in patients who underwent patch tests for suspected allergic contact dermatitis in the Triveneto region from 2013 to 2018.

METHODS: A total of 4816 patients with symptoms and/or signs of suspected contact allergic dermatitis were patch tested. Individual characteristics were assessed using a standardized questionnaire.

RESULTS: The overall prevalence of Pd sensitization was 7.6% and 10.8% using PdCl2 1% or 2% petrolatum, respectively, with a higher prevalence in women (odds ratio, 2.6; 95% confidence interval, 1.9-3.7) and in 26- to 55-year-old patients. Monosensitization occurred in 1%-1.5% of the patients tested. Health care workers and technicians were more sensitized to Pd than clerks, but the data did not reach statistical significance.

CONCLUSIONS: Palladium sensitization was high, but it was mainly associated with nickel sensitization. A possible occupational role was found for workers with potential contact with Pd-containing objects, but more data are needed to reach statistical significance.

PMID:36113001 | DOI:10.1097/DER.0000000000000806

Med Phys. 2022 Sep 16. doi: 10.1002/mp.15982. Online ahead of print.

ABSTRACT

PURPOSE: Task automation is essential for efficient and consistent image segmentation in radiation oncology. We report on a deep learning architecture, comprised of a U-Net and a variational autoencoder (VAE) for automatic contouring of the prostate gland incorporating inter-observer variation for radiotherapy treatment planning. The U-Net/VAE generates an ensemble set of segmentations for each image CT slice. A novel outlier mitigation (OM) technique was implemented to enhance the model segmentation accuracy.

METHODS: The primary source dataset (source_prim) consisted of 19,200 CT slices (from 300 patient planning CT image datasets) with manually contoured prostate glands. A smaller secondary source dataset (source_sec) was comprised of 640 CT slices (from 10 patient CT datasets), where prostate glands were segmented by five independent physicians on each dataset to account for inter-observer variability. Data augmentation via random rotation (< five degrees), cropping, and horizontal flipping was applied to each dataset to increase sample size by a factor of 100. A probabilistic hierarchical U-Net with VAE was implemented and pre-trained using the augmented source_prim dataset for 30 epochs. Model parameters of the U-Net/VAE were fine-tuned using the augmented source_sec dataset for 100 epochs. After the first round of training, outlier contours in the training dataset were automatically detected and replaced by the most accurate contours (based on Dice similarity coefficient, DSC) generated by the model. The U-Net/OM-VAE was re-trained using the revised training dataset. Metrics for comparison included DSC, Hausdorff distance (HD, mm), normalized cross-correlation coefficient (NCC), and center-of-mass distance (COM, mm).

RESULTS: Results for U-Net/OM-VAE with outliers replaced in the training dataset versus U-Net/VAE without outlier mitigation were as follows: DSC = 0.82±0.01 vs 0.80±0.02 (p = 0.019), HD = 9.18±1.22 vs 10.18±1.35 mm (p = 0.043), NCC = 0.59±0.07 vs. 0.62±0.06 and COM = 3.36±0.81 vs. 4.77±0.96 mm over the average of 15 contours. For the average of 15 highest accuracy contours, values were: DSC = 0.90±0.02 vs 0.85±0.02, and HD = 5.47±0.02 vs 7.54±1.36 mm, COM = 1.03±0.58 vs 1.46±0.68 mm (p < 0.03 for all metrics). Results for the U-Net/OM-VAE with outliers removed were: DSC = 0.78±0.01, HD = 10.65±1.95 mm, NCC = 0.46±0.10, COM = 4.17±0.79 mm for the average of 15 contours, and DSC = 0.88±0.02, HD = 7.00±1.17 mm, COM = 1.58±0.63 mm for the average of 15 highest accuracy contours. All metrics for U-Net/VAE trained on the source_prim and source_sec datasets via pre-training, followed by fine-tuning, show statistically significant improvement over that trained on the source_sec dataset only. Finally, all metrics for U-Net/VAE with or without outlier mitigation showed statistically significant improvement over those for the standard U-Net.

CONCLUSIONS: A VAE combined with a hierarchical U-Net and an outlier mitigation strategy (U-Net/OM-VAE) demonstrates promise towards capturing inter-observer variability and produces accurate prostate auto-contours for radiotherapy planning. The availability of multiple contours for each CT slice enables clinicians to determine trade-offs in selecting the “best fitting” contour on each CT slice. Mitigation of outlier contours in the training dataset improves prediction accuracy but one must be wary of reduction in variability in the training dataset. This article is protected by copyright. All rights reserved.

PMID:36112996 | DOI:10.1002/mp.15982

Cancer Control. 2022 Jan-Dec;29:10732748221125561. doi: 10.1177/10732748221125561.

ABSTRACT

BACKGROUND: Comorbid depression and anxiety in men with localised prostate cancer (CaP) largely go undiagnosed and untreated and their effects on health-related quality of life (HRQOL) in men with CaP should not be underestimated. We examined the prevalence of depression and anxiety and its association with HRQOL in men about to commence treatment for CaP and the differences between treatment groups, radical prostatectomy (RP) and radiation therapy (RT).

METHOD: One hundred and seven participants from a longitudinal prospective observational study assessing depression, anxiety and HRQOL in men with localised CaP (DAHCaP), were used in this cross-sectional analysis. Data were collected shortly before participants were scheduled to receive their treatment. The Centre for Epidemiologic Studies Depression Scale (CES-D), the State Trait Anxiety Inventory (STAI), the Memorial Anxiety Scale for Prostate Cancer (MAX-PC), the European Organisation for Research and Treatment in Cancer Quality of Life questionnaire (EORTC QLQ-C30) and (EORTC QLQ-PR25) were used in this analysis.

RESULTS: Symptoms of depression pre-treatment were noted in 39.3%, state anxiety 28%, trait anxiety 31.4% and prostate cancer anxiety in 12.1% of participants. Statistically significant correlations (P ≤ .05) with the CES-D and a cluster of symptoms on the EORTC QLQ-C30 domains for Global Health (r_s = -.35), fatigue (r_s = .38), pain (r_s = .32), dyspnoea (r_s = .28), insomnia (r_s = .30) and finance (r_s = .26) and EORTC QLQ-PR25 domains for urinary symptoms (r_s = .43), bowel (r_s = .43) and hormone replacement therapy (HRT) (r_s = .41) were observed.Statistically significant correlations were also noted between the STAI-S and EORTC QLQ-C30 and EORTC QLQ-PR25. No statistically significant difference was noted between treatments.

CONCLUSION: More men were depressed than anxious with significant associations with HRQOL prior to commencement of treatment. CaP treatments should focus not only on the prevailing indisposition but include a psychooncological and HRQOL assessment at pre-treatment in high-risk individuals.

PMID:36112984 | DOI:10.1177/10732748221125561

Ann Med. 2022 Dec;54(1):2470-2476. doi: 10.1080/07853890.2022.2121419.

ABSTRACT

OBJECTIVE: Patients with type 2 diabetes mellitus (T2DM) are often immunosuppressed and susceptible to infectious diseases. We investigated the mortality and related risk factors of active TB disease in patients with T2DM in Taiwan.

MATERIALS AND METHODS: The data of 1258 patients diagnosed with both T2DM and active TB disease from January 1 to December 31, 2002 (T2DM-TB group) were retrieved from the Taiwan National Health Insurance Research Database. Patients in the T2DM-TB group were matched by age, sex, and comorbidities to a control group of 10,064 T2DM patients without TB disease (T2DM group). Patients were followed up since TB diagnosis until death or 31 December 2011. Cox proportional-hazards regression analysis was employed to compare the risk of death between the T2DM group and the T2DM-TB group.

RESULTS: A total of 101,837 potentially eligible patients were included in the study. After 1:10 propensity score matching, 1,258 patients were classified in the T2DM-TB group and 10,064 patients in the T2DM group. After adjustment for age, sex and comorbidities, the T2DM-TB group showed a 2.16-fold higher mortality risk than the T2DM group (95% CI = 1.83-2.56, p < .001). The mortality risk remained higher after stratification by year. The log-rank test indicated that male sex, age ≥60 years, hypertension and heart failure were independent risk factors.

CONCLUSIONS: TB increases mortality risk in patients with T2DM on long-term follow-up. The independent risk factors for mortality in patients with concurrent T2DM and TB disease include male sex, age ≥60 years, hypertension and heart failure.KEY MESSAGESThe co-presentation of T2DM and TB is an important emerging issue, especially in Asia.This study showed mortality risk was significantly higher in the T2DM-TB group compared with the T2DM group on long-term follow-up.Increased medical attention is necessary for patients with T2DM and a history of TB disease.

PMID:36111539 | DOI:10.1080/07853890.2022.2121419