Nevin Manimala

Lab Chip. 2022 Mar 8. doi: 10.1039/d1lc01175h. Online ahead of print.

ABSTRACT

The digital polymerase chain reaction (dPCR) is an irreplaceable variant of PCR techniques due to its capacity for absolute quantification and detection of rare deoxyribonucleic acid (DNA) sequences in clinical samples. Image processing methods, including micro-chamber positioning and fluorescence analysis, determine the reliability of the dPCR results. However, typical methods demand high requirements for the chip structure, chip filling, and light intensity uniformity. This research developed an image-to-answer algorithm with single fluorescence image capture and known image-related error removal. We applied the Hough transform to identify partitions in the images of dPCR chips, the 2D Fourier transform to rotate the image, and the 3D projection transformation to locate and correct the positions of all partitions. We then calculated each partition’s average fluorescence amplitudes and generated a 3D fluorescence intensity distribution map of the image. We subsequently corrected the fluorescence non-uniformity between partitions based on the map and achieved statistical results of partition fluorescence intensities. We validated the proposed algorithms using different contents of the target DNA. The proposed algorithm is independent of the dPCR chip structure damage and light intensity non-uniformity. It also provides a reliable alternative to analyze the results of chip-based dPCR systems.

PMID:35258048 | DOI:10.1039/d1lc01175h

Blood Press Monit. 2022 Mar 7. doi: 10.1097/MBP.0000000000000595. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this study is to determine the accuracy of the G.LAB MD41A0 upper-arm oscillometric blood pressure (BP) monitor for self/home BP measurement in patients with diabetes according to the Association for the Advancement of Medical Instrumentation /European Society of Hypertension /International Organization for Standardization (AAMI/ESH/ISO) Universal Standard (ISO 81060-2:2018).

METHODS: Patients with diabetes were recruited according to AAMI/ESH/ISO Universal Standard using the same arm sequential BP measurement method. The standard cuff of the test device was used for arm circumference 22-44 cm.

RESULTS: A total of 92 patients with diabetes were recruited and 85 were analyzed with an average age of 55.1 ± 17.7 years, 48 men, and arm circumference of 32.0 ± 6.0 cm. For the validation Criterion 1, the mean ± SD of the differences between the test device and reference BP readings was 0.89 ± 6.04/-0.84 ± 5.11 mmHg (systolic/diastolic). For Criterion 2, the SD of the averaged BP differences between the test device and reference BP per subject was 4.23/4.19 mmHg (systolic/diastolic).

CONCLUSION: The G.LAB MD41A0 upper arm BP monitor fulfilled all the requirements of the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018) in patients with diabetes and can be recommended for self/home use.

PMID:35258022 | DOI:10.1097/MBP.0000000000000595

Blood Press Monit. 2022 Mar 7. doi: 10.1097/MBP.0000000000000589. Online ahead of print.

ABSTRACT

OBJECTIVE: We aimed to evaluate the effects of blood pressure (BP) values obtained by 24-h ambulatory BP monitoring (ABPM) of hypertensive children and adolescents on left ventricular mass index (LVMI).

METHODS: Patients diagnosed with HT with BP measurements confirmed with ABPM and evaluated with echocardiography for LVMI were included. The patients were divided into two groups according to their BMI as obese and nonobese. SDSs of ABPM parameters were compared between the groups.

RESULTS: A total of 158 children with HT were included in the study. Ninety of these patients were obese. In obese and nonobese cases, mean SDS levels were similar in ABPM parameters, whereas LVMI was significantly higher in obese patients (P = 0.049). There was a significant correlation between LVMI and 24-h SBP SDS, daytime SBP SDS, 24-h SBP load and daytime BP load. In obese cases, there was a statistically significant correlation between LVMI and 24-h SBP SDS, daytime SBP SDS, 24-h SBP load, daytime SBP load as well as nighttime SBP SDS and nighttime SBP load. When the whole group was evaluated, 24-h SBP SDS was the most effective parameter influencing LVMI (P = 0.001). Similarly, the most effective ABPM parameter on LVMI in obese patients was 24-h SBP SDS (P = 0.001).

CONCLUSION: A significantly higher rate of LVMI in obese patients suggests that obesity itself is an effective factor on LVMI. In addition, systolic hypertension is more effective on cardiac functions compared with DBP measurements and systolic-DBP dipping ratios.

PMID:35258018 | DOI:10.1097/MBP.0000000000000589

Allergol Immunopathol (Madr). 2022 Mar 1;50(2):1-6. doi: 10.15586/aei.v50i2.469. eCollection 2022.

ABSTRACT

BACKGROUND: In most cases, severe asthma in children has an allergic etiology, but allergen-specific immunotherapy (AIT) is contraindicated.

OBJECTIVE: This study aimed at analyzing the safety and efficacy of AIT in patients with severe asthma treated with omalizumab (OM).

METHODS: A descriptive real-life study was carried out by reviewing medical records. Effectiveness was measured by the degree of control (CAN questionnaire), number of hospitalizations per year, number of exacerbations per year, and maintenance treatment and lung function (FEV1). Some adverse reactions occurred (AAI-EAACI-WAO guidelines).

RESULTS: The retrospective study included 29 patients up to 18 years of age with severe asthma with OM plus AIT treatment. AIT treatment was started in a cluster schedule when patients treated with OM achieved disease control. Before starting AIT, patients were treated with OM for 1 year for achieving asthmatic control. AIT to mites (51%), Alternaria (37.9%), or pollens (10.3%) was administered. After one year with OM plus AIT,statistically significant differences in CAN scores and FEV1 measures were observed (P < 0.001). No patients under treatment with OM plus AIT required hospital admission. During the clustering schedule, only 3/64 doses showed systemic adverse reactions. During the AIT maintenance treatment, 348 doses were administered, with no significant adverse reactions.

CONCLUSION: In this population-based study in children with severe asthma, the combined treatment with OM plus AIT was safe and effective. This strategy allows these pediatric patients to be safely treated with AIT.

PMID:35257539 | DOI:10.15586/aei.v50i2.469

ESC Heart Fail. 2022 Mar 8. doi: 10.1002/ehf2.13872. Online ahead of print.

ABSTRACT

AIMS: This study aimed to profile the changes in non-invasive clinical, biochemical, and imaging markers during withdrawal of therapy in patients with recovered dilated cardiomyopathy, providing insights into the pathophysiology of relapse.

METHODS AND RESULTS: Clinical, biochemical, and imaging data from patients during phased withdrawal of therapy in the randomized or single-arm cross-over phases of TRED-HF were profiled. Clinical variables were measured at each study visit and imaging variables were measured at baseline, 16 weeks, and 6 months. Amongst the 49 patients [35% women, mean age 53.6 years (standard deviation 11.6)] who withdrew therapy, 20 relapsed. Increases in mean heart rate [7.6 beats per minute (95% confidence interval, CI, 4.5, 10.7)], systolic blood pressure [6.6 mmHg (95% CI 2.7, 10.5)], and diastolic blood pressure [5.8 mmHg (95% CI 3.1, 8.5)] were observed within 4-8 weeks of starting to withdraw therapy. A rise in mean left ventricular (LV) mass [5.1 g/m² (95% CI 2.8, 7.3)] and LV end-diastolic volume [3.9 mL/m² (95% CI 1.1, 6.7)] and a reduction in mean LV ejection fraction [-4.2 (95% CI -6.6, -1.8)] were seen by 16 weeks, the earliest imaging follow-up. Plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) fell immediately after withdrawing beta-blockers and only tended to increase 6 months after beginning therapy withdrawal [mean change in log NT-proBNP at 6 months: 0.2 (95% CI -0.1, 0.4)].

CONCLUSIONS: Changes in plasma NT-proBNP are a late feature of relapse, often months after a reduction in LV function. A rise in heart rate and blood pressure is observed soon after withdrawing therapy in recovered dilated cardiomyopathy, typically accompanied or closely followed by early changes in LV structure and function.

PMID:35257498 | DOI:10.1002/ehf2.13872

Australas J Ageing. 2022 Mar 8. doi: 10.1111/ajag.13051. Online ahead of print.

ABSTRACT

OBJECTIVES: To determine whether delirium prevention interventions reduce the risk of falls among older hospitalised patients.

METHODS: A systematic search of health-care databases was undertaken. Given the frequency of small sample sized trials, a trial sequential meta-analysis was conducted to present estimate summary effects to date. A Bayesian approach was used to estimate the posterior probability of the delirium prevention interventions reducing falls risk by various clinically relevant levels.

RESULTS: Five randomised controlled trials were included in our final meta-analysis. There was a 43% reduction in the risk of falls among participants in the delirium prevention intervention arm, compared to the control; however, confidence intervals were wide (RE RR = 0.57, 95% CI 0.32; 1.00, p = 0.05). This result was found to be statistically significant, according to traditional significance levels (z > 1.96) and the more conservative trial sequential analysis monitoring boundaries. The posterior probabilities of the delirium prevention intervention reducing the risk of falls by 10%, 20% and 30% were 0.86, 0.63 and 0.29 respectively.

CONCLUSIONS: The results of this systematic review and trial sequential meta-analysis suggest that delirium prevention trials may reduce the risk of in-hospital falls among older patients by 43%. However, despite significant risk reduction found upon meta-analysis, the variation among study populations and intervention components raised questions around its application in clinical practice. Further research is required to investigate what the necessary components of a multifactorial intervention are to reduce both delirium and fall incidence among older adult in-patients.

PMID:35257469 | DOI:10.1111/ajag.13051

Diabetes Obes Metab. 2022 Mar 8. doi: 10.1111/dom.14685. Online ahead of print.

ABSTRACT

AIM: To assess feasibility of a prototype insulin infusion set (IIS) for extended wear in adults with type 1 diabetes.

MATERIALS AND METHODS: The prototype Capillary Biomedical investigational extended-wear insulin infusion set (CBX IIS) incorporates a soft, flexible, reinforced kink-resistant angled nylon-derivative cannula with 1 distal and 3 proximal ports to optimise insulin delivery. Twenty type 1 diabetes adult participants established on insulin pump therapy used the CBX IIS for two 7-day test periods while wearing a Dexcom G5 continuous glucose monitor.

RESULTS: Participants were able to wear the CBX IIS for an average of 6.6±1.4 days. Eighty-eight percent (36/41) of sets were worn for 7 days. No serious adverse events were reported. Five infusion sets failed prematurely due to: unresolvable hyperglycaemia (3); hyperglycaemia with elevated ketones (1); or infection (1). Median time in range (3.9-10.0 mmol/L) was 62% [54–76]. Average glucose levels per day of infusion set wear showed a statistically significant increase over time (p<0.001).

CONCLUSIONS: Our preliminary observations confirm the tolerability of the prototype CBX IIS for extended wear, albeit with a deterioration in glucose control after the third day. This article is protected by copyright. All rights reserved.

PMID:35257468 | DOI:10.1111/dom.14685

J Prosthodont. 2022 Mar 8. doi: 10.1111/jopr.13503. Online ahead of print.

ABSTRACT

PURPOSE: Metal sleeves are commonly used in implant guides for guided surgery. Cost and sleeve specification limit the applications. This in vitro study examined the differences in the implant position deviations produced by a digitally designed surgical guide with no metal sleeve in comparison to a conventional one with a metal sleeve.

MATERIALS AND METHODS: The experiment was conducted in two steps for each step: n = 20 casts total, 10 casts each group; Step 1 to examine one guide from each group with ten implant placements in a dental cast, and Step 2 to examine one guide to one cast. Implant placement was performed using a guided surgical protocol. Postoperative cone-beam computed tomography images were made and were superimposed onto the treatment-planning images. The implant horizontal and angulation deviations from the planned position were measured and analyzed using t-test and F-test (p = 0.05).

RESULTS: For Step 1 and 2 respectively, implant deviations for the surgical guide with sleeve were -0.3 ±0.17 mm and 0.15 ±0.23 mm mesially, 0.60 ±1.69 mm and -1.50 ±0.99 mm buccolingual at the apex, 0.20 ±0.47 mm and -0.60 ±0.27 mm buccolingual at the cervical, and 2.73° ±4.80° and -1.49° ±2.91° in the buccolingual angulation. For Step 1 and 2 respectively, the implant deviations for the surgical guide without sleeve were -0.17 ±0.14 mm and -0.06 ±0.07 mm mesially, 0.35 ±1.04 mm and -1.619 ±1.03 mm buccolingual at the apex, 0.10 ±0.27 mm and -0.62 ±0.27 mm buccolingual at the cervical, and 1.73° ±3.66° and -1.64° ±2.26° in the buccolingual angulation. No statistically significant differences were found in any group except for mesial deviation of the Step 2 group (F-test, p<0.001).

CONCLUSIONS: A digitally designed surgical guide with no metal sleeve demonstrates similar accuracy but higher precision compared to a surgical guide with a metal sleeve. Metal sleeves may not be required for guided surgery. This article is protected by copyright. All rights reserved.

PMID:35257456 | DOI:10.1111/jopr.13503

J Rural Health. 2022 Mar 7. doi: 10.1111/jrh.12650. Online ahead of print.

ABSTRACT

PURPOSE: As the population ages, the number of people with cognitive impairment will rapidly increase. Although previous research has explored the rural-urban gap in physical health, few studies have analyzed cognitive health. The purpose of this study was to examine rural-urban differences in cognitive health, with a focus on the moderating effect of population decline.

METHODS: The study used individual-level nationally representative data from the 2000-2016 waves of the Health and Retirement Study (N = 152,444) merged to county-level contextual characteristics. Hierarchical linear models were used to predict the cognitive functioning of US adults aged 50 and over by rural-urban residence, county depopulation, and their interactions while controlling for individual-level and county-level demographic and contextual factors.

FINDINGS: Older adults living in rural counties had lower cognitive functioning than urban adults. The interaction between living in a rural and depopulated county was statistically significant (P < .001). The rural penalty in cognitive functioning was 40% larger for those who lived in counties that lost population between 1980 and 2010 compared to those who lived in stable or growing rural counties. These results were independent of race-ethnicity, gender, age, education, income, region, employment status, marital status, physical health, and depression as well as the county’s racial-ethnic composition, age structure, economic and educational disadvantage, and health care shortages.

CONCLUSIONS: The results have important implications for those seeking to reduce health disparities both between rural and urban older adults and among different groups of rural people. Interventions targeting those living in rural depopulating areas are particularly warranted.

PMID:35257439 | DOI:10.1111/jrh.12650

Addiction. 2022 Mar 8. doi: 10.1111/add.15866. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Hong Kong reduced beer and wine tax in 2007, eliminated taxes on beer and wine and strengthened drink-driving legislation in 2008, and increased police traffic enforcement after 2014 social unrest. This study aimed to measure the effects of implementing road safety policies on road traffic harm in the context of deregulated alcohol control policy in Hong Kong.

DESIGN: Population-based interrupted time series analysis using seasonal autoregressive integrated moving average (sARIMA) models. Multiple sensitivity analyses were conducted.

SETTING: Hong Kong, China and Singapore from January 2004 to December 2019.

CASES: 313,728 road traffic injuries in Hong Kong, and 163,773 road traffic injuries in Singapore as controls.

MEASUREMENTS: Monthly rates of road traffic injuries, non-fatal injuries, and serious/fatal injuries from Hong Kong and Singapore Police Force.

FINDINGS: The elimination of alcohol taxes and the enactment of road safety legislation in 2008 was associated with immediate reductions in total road traffic injuries of 6.71% (95% confidence interval [CI]: 1.99-11.20%), serious/fatal injuries of 13.80% (95% CI: 1.85-24.30%), and sustained declines in drink drivers and collisions involving drink drivers. The effects of the 2007 tax reduction were inconclusive. Progressively increasing traffic enforcement was associated with continuous reductions in road traffic injuries by 0.21% per month (95% CI: 0.13-0.30%), and serious/fatal injuries by 1.10% per month (95% CI: 0.85-1.35%). Effects at the corresponding time points in Singapore did not reach statistical significance; the results were inconclusive regarding confounding effects on both regions.

CONCLUSIONS: Despite weakened alcohol control and increased alcohol sales over the same period, road safety policies in Hong Kong are associated with net reductions in road traffic injuries, particularly serious/fatal injuries.

PMID:35257430 | DOI:10.1111/add.15866