Nevin Manimala

J Endourol. 2022 Sep 15. doi: 10.1089/end.2022.0233. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the effects of CO2 pneumoperitoneum on venous hemodynamics and cardiopulmonary function during transperitoneal or retroperitoneal laparoscopic surgery.

METHODS: A single institution prospective study. 43 patients with renal cell carcinoma undergoing retroperitoneal (22) or transperitoneal (21) laparoscopic partial nephrectomy were enrolled. Hemodynamic functions were monitored by Swan-Ganz and radial artery catheters. Transesophageal echocardiography was used to measure the diameter and blood flow of the inferior vena cava (IVC). Measured parameters were recorded at baseline, 10 min, 30 min, 60 min following insufflation to 14 mmHg and 10 min following desufflation.

RESULTS: For hemodynamic changes in transperitoneal laparoscopic group (TPL) and retroperitoneal laparoscopic group (RPL), transperitoneal CO2 insufflation resulted in a rapid parallel increase in central intravenous pressure (CVP), peak airway pressure (AWP) and IVC blood flow velocity after the first 30 minutes of pneumoperitoneum (p＜0.05). In contrast, CVP, AWP and IVC blood flow velocity increased progressively in RPL. The variation of those parameters was significantly lower than that of TRL (p＜0.001；p=0.002；p=0.004). The mean maximum CVP in the two groups was 20 and 16 mmHg, respectively. The IVC diameter at the cavoatrial junction was significantly reduced in TPL after 10 minutes of insufflation, but it remained unchanged in RPL throughout the surgery. For cardiopulmonary function changes, heart output decreased after a short period of pneumoperitoneum, but no statistical differences were observed between the two groups. The increments of partial pressure of arterial carbon dioxide and end-tidal carbon dioxide tension were significantly higher in RPL than TPL (p＜0.001; p＜0.001).

CONCLUSIONS: Compared with retroperitoneal pneumoperitoneum, transperitoneal pneumoperitoneum has significantly effects on IVC hemodynamics. Elevated intraabdominal pressure (IAP) causes higher AWP and venous return resistance, which lead to the significantly increase of CVP during transperitoneal approach. Adjusting the balance between IAP and CVP might be an effect way to control intravenous bleeding.

PMID:36106602 | DOI:10.1089/end.2022.0233

Health Serv Res. 2022 Sep 15. doi: 10.1111/1475-6773.14065. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine the effects of Medicare eligibility and enrollment on the use of high-value and low-value care services.

DATA SOURCES/STUDY SETTING: The 2002-2019 Medical Expenditure Panel Survey.

STUDY DESIGN: We employed a regression discontinuity design, which exploits the discontinuity in eligibility for Medicare at age 65 years and compares individuals just before and after age 65. Our primary outcomes included use of high-value care services (eight services) and low-value care services (seven services). To examine the effects of Medicare eligibility, we conducted a regression discontinuity analysis. To examine the effects of Medicare enrollment, we used the discontinuity in the probability of having Medicare coverage around the age eligibility cutoff and conducted an instrumental variable analysis.

DATA COLLECTION/EXTRACTION METHODS: N/A.

PRINCIPAL FINDINGS: Medicare eligibility and enrollment led to statistically significant increases in the use of only two high-value services: cholesterol measurement [2.1 percentage points (95%: 0.4-3.7) (2.2% relative change) and 2.4 percentage points (95%: 0.4-4.4)] and receipt of the influenza vaccine [3.0 percentage points (95%: 0.3-5.6) (6.0% relative change) and 3.6 percentage points (95%: 0.4-6.8)]. Medicare eligibility and enrollment led to statistically significant increases in the use of two low-value services: antibiotics for acute upper respiratory infection [6.9 percentage points (95% CI: 0.8-13.0) (24.0% relative change) and 8.2 percentage points (95% CI: 0.8-15.5)] and radiographs for back pain [4.6 percentage points (95% CI: 0.1-9.2) (36.8% relative change) and 6.2 percentage points (95% CI: 0.1-12.3)]. However, there was no significant change in the use of other high-value and low-value care services.

CONCLUSION: Medicare eligibility and enrollment at age 65 years led to increases in the use of some high-value and low-value care services, but there were no changes in the use of the majority of other services. Policymakers should consider refining the Medicare program to enhance the value of care delivered.

PMID:36106508 | DOI:10.1111/1475-6773.14065

J Pediatr Endocrinol Metab. 2022 Sep 16. doi: 10.1515/jpem-2022-0232. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to determine the prevalence and predictors of euthyroid sick syndrome (ESS) in pediatric intensive care, and to establish a link between thyroid function tests and mortality.

METHODS: Between January 2015 and March 2020, children admitted to our pediatric intensive care unit (PICU) and tested for free triiodothyronine (fT3), free thyroxine (fT4), and thyrotropin (TSH) levels were included. Patients with decreased fT3, with normal or decreased fT4, and normal or decreased TSH levels were assigned to the ESS group. The association between biochemical indicators and ESS, as well as the relationship between fT3 and mortality, were examined.

RESULTS: A total of 141 (36%) of 386 children included to study were classified in the ESS group. The ESS group had a higher rate of 28-day mortality (12 [8.5%] vs. 9 [3.7%]). Blood urea nitrogen (BUN), albumin, platelet, lactate, and pediatric index of mortality 3 [PIM3 (%)] were significantly associated with ESS (odds ratios in order: 1.024, 0.422, 0.729, 1.208, 1.013). Multivariate regression analysis showed that BUN, albumin, platelet, and lactate were independently associated with ESS progression. The area under curve (AUC [95%CI]) for fT3 was 0.644 (0.555-0.789) to detect mortality. Children with a fT3 level lower than 2.31 pg/mL had significantly higher 28-day mortality (log rank test, p=0.001).

CONCLUSIONS: Our study identified BUN, albumin, lactate, and platelet count as independent risk factors for ESS progression in children. Furthermore, our findings indicated a correlation between fT3 and mortality, which makes fT3 an ideal candidate to be included in mortality indices.

PMID:36106490 | DOI:10.1515/jpem-2022-0232

J Phys Chem B. 2022 Sep 15. doi: 10.1021/acs.jpcb.2c04899. Online ahead of print.

ABSTRACT

Classical molecular dynamics simulations are a versatile tool in the study of biomolecular systems, but they usually rely on a fixed bonding topology, precluding the explicit simulation of chemical reactivity. Certain modifications can permit the modeling of reactions. One such method, multiscale reactive molecular dynamics, makes use of a linear combination approach to describe condensed-phase free energy surfaces of reactive processes of biological interest. Before these simulations can be performed, models of the reactive moieties must first be parametrized using electronic structure data. A recent study demonstrated that gas-phase electronic structure data can be used to derive parameters for glutamate and lysine which reproduce experimental pK_a values in both bulk water and the staphylococcal nuclease protein with remarkable accuracy and transferability between the water and protein environments. In this work, we first present a new model for aspartate derived in similar fashion and demonstrate that it too produces accurate pK_a values in both bulk and protein contexts. We also describe a modification to the prior methodology, involving refitting some of the classical force field parameters to density functional theory calculations, which improves the transferability of the existing glutamate model. Finally and most importantly, this reactive molecular dynamics approach, based on rigorous statistical mechanics, allows one to specifically analyze the fundamental physical causes for the marked pK_a shift of both aspartate and glutamate between bulk water and protein and also to demonstrate that local steric and electrostatic effects largely explain the observed differences.

PMID:36106487 | DOI:10.1021/acs.jpcb.2c04899

Hosp Pediatr. 2022 Sep 15:e2022006567. doi: 10.1542/hpeds.2022-006567. Online ahead of print.

ABSTRACT

OBJECTIVES: To compare the effectiveness of dexamethasone versus prednisone or prednisolone on hospital resource utilization for children hospitalized with acute croup.

METHODS: This is a retrospective cohort study of the Pediatric Health Information System database on children aged 6 months to <6 years who were hospitalized with acute croup between January 1, 2015 and December 31, 2019. Children with a chronic complex condition, transferred from outside hospital, and/or received direction admission to ICU were excluded. Propensity score matching was used to compare length of stay (in hours), escalation of care to ICU, and the need for bronchoscopy with exposure to dexamethasone versus prednisone or prednisolone. We also compared rates of 7 day return to the emergency department and readmissions.

RESULTS: A total of 11 740 hospitalizations met inclusion criteria; dexamethasone was used in 95.9%; prednisone or prednisolone was used in 4.1%. In the matched cohort (n = 960), the length of stay was not significantly different between the dexamethasone and prednisone or prednisolone groups (21.3 vs 18.5 hours, P = .35). Although the rates bronchoscopy did not differ between the 2 groups, the dexamethasone cohort was more likely to require ICU transfer (P = .007). The rates of 7-day emergency department returns (2.3% vs 1.3%, P = .24) and readmissions (3.1% vs. 2.1%, P = .37) were low and not statistically different.

CONCLUSIONS: Hospital resource utilization did not differ significantly for children receiving dexamethasone or prednisone or prednisolone for acute croup. Both corticosteroids may be considered reasonable choices for the treatment of children hospitalized with acute croup.

PMID:36106471 | DOI:10.1542/hpeds.2022-006567

Physiol Rep. 2022 Sep;10(17):e15435. doi: 10.14814/phy2.15435.

ABSTRACT

Autonomic modulation is critical during various physiological activities, including orthostatic stimuli and primarily evaluated by heart rate variability (HRV). Orthostatic stress affects people differently suggesting the possibility of identification of predisposed groups to autonomic dysfunction-related disorders in a healthy state. One way to understand this kind of variability is by using Ayurvedic approach that classifies healthy individuals into Prakriti types based on clinical phenotypes. To this end, we explored the differential response to orthostatic stress in different Prakriti types using HRV. HRV was measured in 379 subjects(Vata = 97, Pitta = 68, Kapha = 68, and Mixed Prakriti = 146) from two geographical regions(Vadu and Delhi NCR) for 5 min supine (baseline), 3 min head-up-tilt (HUT) at 60°, and 5 min resupine. We observed that Kapha group had lower baseline HRV than other two groups, although not statistically significant. The relative change (%Δ_1&2 ) in various HRV parameters in response to HUT was although minimal in Kapha group. Kapha also had significantly lower change in HR, LF (nu), HF (nu), and LF/HF than Pitta in response to HUT. The relative change (%Δ₁ ) in HR and parasympathetic parameters (RMSSD, HF, SD1) was significantly greater in the Vata than in the Kapha. Thus, the low baseline and lower response to HUT in Kapha and the maximum drop in parasympathetic activity of Vata may indicate a predisposition to early autonomic dysfunction and associated conditions. It emphasizes the critical role of Prakriti-based phenotyping in stratifying the differential responses of cardiac autonomic modulation in various postures among healthy individuals across different populations.

PMID:36106418 | DOI:10.14814/phy2.15435

Orthop Surg. 2022 Sep 15. doi: 10.1111/os.13396. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the clinical efficacy of the treatment of scoliosis with a pedicle screw system through paraspinal intermuscular approach (PIA).

METHODS: This is a retrospective case series study. A total of 10 patients diagnosed with scoliosis had surgical indications and treated with a pedicle screw system in one-stage posterior surgery by PIA from March 2013 to April 2015 at the First Hospital of Jilin University were enrolled in this study. The average age of the patients was 14.9 years, including one male and nine females. The operative information and surgical results, including Cobb angle correction, correction loss, global balance (including Frontal Plane Balance [FPB] and Sagittal Plane Balance [SPB]), and fusion rate were reviewed. Functional outcomes including visual analog scale (VAS) back pain score, leg pain score, and Scoliosis Research Society-22 questionnaire (SRS-22) were used to evaluate the quality of life of patients preoperatively and at last follow-up.

RESULTS: Each patient was followed up at least six times. The average follow-up time was 43.2 months. Mean scoliosis and kyphosis improved from 68.5° ± 18.1°to 18.7° ± 11.8° and from 34.4° ± 17.9°to 24.0° ± 6.7°, respectively (p < 0.05); at last follow-up, it was 20.1° and 24.7°, respectively (p > 0.05). During the follow-up, mean coronal and sagittal correction loss was 1.4° ± 1.2°and 0.7° ± 0.8°, respectively (p > 0.05). Mean FPB improved from 32.7 to 11.7 mm (p < 0.05); Mean SPB changed from 0.3 to -0.7 mm (p > 0.05). No dural tears were observed during the corrective surgery or wound infection or implant-related complications. No pseudoarthrosis was identified according to the last follow-up three-dimensional (3D) CT scan. All the domains in SRS-22 questionnaire show statistically significant improvement at the last follow-up (p < 0.05). The VAS back pain scores improved from a mean preoperative score of 1.7 to a mean postoperative score of 0.2 (p < 0.05).

CONCLUSION: This original one-stage posterior PIA is safe and effective in the treatment of scoliosis, which is characterized with less blood loss, shorter operation time, and satisfactory bony fusion.

PMID:36106388 | DOI:10.1111/os.13396

Teach Learn Med. 2022 Sep 14:1-11. doi: 10.1080/10401334.2022.2119569. Online ahead of print.

ABSTRACT

Issue: Automatic item generation is a method for creating medical items using an automated, technological solution. Automatic item generation is a contemporary method that can scale the item development process for production of large numbers of new items, support building of multiple forms, and allow rapid responses to changing medical content guidelines and threats to test security. The purpose of this analysis is to describe three sources of validation evidence that are required when producing high-quality medical licensure test items to ensure evidence for valid test score inferences, using the automatic item generation methodology for test development. Evidence: Generated items are used to make inferences about examinees’ medical knowledge, skills, and competencies. We present three sources of evidence required to evaluate the quality of the generated items that is necessary to ensure the generated items measure the intended knowledge, skills, and competencies. The sources of evidence we present here relate to the item definition, the item development process, and the item quality review. An item is defined as an explicit set of properties that include the parameters, constraints, and instructions used to elicit a response from the examinee. This definition allows for a critique of the input used for automatic item generation. The item development process is evaluated using a validation table, whose purpose is to support verification of the assumptions related to model specification made by the subject-matter expert. This table provides a succinct summary of the content and constraints that were used to create new items. The item quality review is used to evaluate the statistical quality of the generated items, which often focuses on the difficulty and the discrimination of the correct and incorrect options. Implications: Automatic item generation is an increasingly popular item development method. The generated items from this process must be bolstered by evidence to ensure the items measure the intended knowledge, skills, and competencies. The purpose of this analysis is to describe these sources of evidence that can be used to evaluate the quality of the generated items. The important role of medical expertise in the development and evaluation of the generated items is highlighted as a crucial requirement for producing validation evidence.

PMID:36106359 | DOI:10.1080/10401334.2022.2119569

Psychol Health Med. 2022 Sep 14:1-15. doi: 10.1080/13548506.2022.2124292. Online ahead of print.

ABSTRACT

Studies show a connection between anxiety and stress, but with little differentiation between different domains of stress. In this article, we utilize a multi-dimensional approach to better understand the relationship between different chronic stress domains and anxiety. This will allow researchers to identify and address those areas of stress that are most relevant with regard to anxiety. We used data from a sub sample of the LIFE-Adult-Study (n = 1085) to analyze the association between nine different areas of chronic stress (Trier Inventory for Chronic Stress, TICS) and anxiety (General Anxiety Disorder 7, GAD-7), controlling for sociodemographic variables, personality, and social support. There was a significant and positive association between Work Overload, Pressure to Perform, Social Tensions, Social Isolation, Chronic Worrying, and anxiety. After including the control variables, only Work Overload and Chronic Worrying remained significant. By focusing on Work Overload and Chronic Worrying researchers, practitioners, and policy makers can help to mitigate anxiety and related health problems in the population in an efficient way.

PMID:36106349 | DOI:10.1080/13548506.2022.2124292

Front Nephrol. 2022;2:926635. doi: 10.3389/fneph.2022.926635. Epub 2022 Jul 22.

ABSTRACT

BACKGROUND: In hemodialysis patients, a third vaccination is frequently administered to augment protection against coronavirus disease 2019 (COVID-19). However, the newly emerged B.1.1.159 (Omicron) variant may evade vaccinal protection more easily than previous strains. It is of clinical interest to better understand the neutralizing activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants after booster vaccine or COVID-19 infection in these mostly immunocompromised patients.

METHODS: Hemodialysis patients from four dialysis centers were recruited between June 2021 and February 2022. Each patient provided a median of six serum samples. SARS-CoV-2 neutralizing antibodies (nAbs) against wild type (WT) or Omicron were measured using the GenScript SARS-CoV-2 Surrogate Virus Neutralization Test Kit.

RESULTS: Forty-two patients had three doses of mRNA1273. Compared to levels prior to the third dose, nAb-WT increased 18-fold (peak at day 23) and nAb-Omicron increased 23-fold (peak at day 24) after the third dose. Peak nAb-WT exceeded peak nAb-Omicron 27-fold. Twenty-one patients had COVID-19 between December 24, 2021, and February 2, 2022. Following COVID-19, nAb-WT and nAb-Omicron increased 12- and 40-fold, respectively. While levels of vaccinal and post-COVID nAb-WT were comparable, post-COVID nAb-Omicron levels were 3.2 higher than the respective peak vaccinal nAb-Omicron. Four immunocompromised patients having reasons other than end-stage kidney disease have very low to no nAb after the third dose or COVID-19.

CONCLUSIONS: Our results suggest that most hemodialysis patients have a strong humoral response to the third dose of vaccination and an even stronger post-COVID-19 humoral response. Nevertheless, nAb levels clearly decay over time. These findings may inform ongoing discussions regarding a fourth vaccination in hemodialysis patients.

PMID:36106337 | PMC:PMC9470295 | DOI:10.3389/fneph.2022.926635