Nevin Manimala

Cerebrovasc Dis. 2021 Dec 2:1-9. doi: 10.1159/000520052. Online ahead of print.

ABSTRACT

INTRODUCTION: Serum potassium abnormality is a risk factor of incident stroke, but whether it is associated with recurrent stroke in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) remains unknown. This study aimed to investigate the association of serum potassium with the risk of recurrent stroke in patients with AIS or TIA.

METHODS: We included 12,425 patients from the China National Stroke Registry III. Patients were classified into 3 groups according to tertiles of potassium. The outcomes were recurrence of stroke and combined vascular events at 1 year. Cox proportional hazards regression was adopted to explore the associations by calculating hazard ratios (HRs) and their 95% confidence intervals (CIs).

RESULTS: Among 12,425 enrolled patients, the median (interquartile range) of potassium was 3.92 (3.68-4.19) mmol/L. Compared with the highest tertile, after adjusted for confounding factors, the lowest tertile potassium was associated with increased risk of recurrent stroke at 1 year. The adjusted HR with 95% CI was 1.21 (1.04-1.41). There was an independent, linear association between serum potassium and stroke recurrence. Per 1 mmol/L decrease of potassium was associated with 19% higher risk of recurrent stroke (HR, 1.19; 95% CI, 1.04-1.37). Similar trends were found in ischemic stroke and combined vascular events.

CONCLUSIONS: Lower serum potassium level was independently associated with elevated risk of recurrent stroke in patients with AIS or TIA. The finding suggested that monitoring serum potassium may help physicians to identify patients at high risk of recurrent stroke and to stratify risk for optimal management.

PMID:34856549 | DOI:10.1159/000520052

J Clin Anesth. 2021 Nov 29;77:110614. doi: 10.1016/j.jclinane.2021.110614. Online ahead of print.

ABSTRACT

STUDY OBJECTIVE: Oxidative stress plays a pivotal role in the development and aggravation of cardiovascular diseases. The influence of intraoperative inspired oxygen concentrations on oxidative stress is still not entirely known. Therefore, we evaluated in this sub-study if supplemental oxygen affects the oxidation-reduction potential in patients at-risk for cardiovascular complications undergoing moderate- to high-risk major abdominal surgery.

DESIGN: Sub-study of a prospective parallel-arm double-blinded single-center superiority randomized trial.

SETTING: Operating room and postoperative recovery area.

INTERVENTION: Administration of 0.8 FiO₂ versus 0.3 FiO₂ throughout surgery and for the first two postoperative hours.

MEASUREMENTS: The primary outcome was the static oxidation-reduction potential (sORP) and the oxidation-reduction potential capacity (cORP) between both groups. The secondary outcome was the trend of sORP and cORP in the overall study population. We assessed sORP and cORP before induction of anesthesia, 2 h after induction of anesthesia, within 2 h after surgery and on the first and third postoperative day.

MAIN RESULTS: 258 patients were analyzed. 128 patients were randomly assigned to the 80% oxygen group and 130 patients were randomly assigned to the 30% oxygen group. Postoperative sORP values did not differ significantly between the 80% and 30% oxygen group (effect estimate: -1.162 mV,95% CI: -2.584 to 0.260; p = 0.109). On average, we observed a change in sORP of 5.288 mV (95% CI:4.633 to 5.913, p < 0.001) per day. cORP values did not differ significantly between the 80% and 30% oxygen group (effect estimate: -0.015μC, (95%CI: -0.062 to 0.032; p = 0.524). On average, we observed a change in cORP values of -0.170μC (95%CI: -0.194 to -0.147, p < 0.001) per day.

CONCLUSION: In contrast to previous reports, we could not find any evidence of an association between intraoperative supplemental oxygen and perioperative oxidative stress assessed by sORP and cORP.

TRIAL REGISTRATION: clinicaltrials.gov: NCT03366857https://clinicaltrials.gov/ct2/show/NCT03366857?term=vienna&cond=oxygen&draw=2&rank=1.

PMID:34856530 | DOI:10.1016/j.jclinane.2021.110614

Forensic Sci Int. 2021 Nov 12;330:111100. doi: 10.1016/j.forsciint.2021.111100. Online ahead of print.

ABSTRACT

This work evaluated the accuracy of 3D models generated by a DJI Mavic Pro drone with 3DF Zephyr software photogrammetry. The models were compared to models generated by a Trimble X7 laser scanner. The tests were performed in the outdoor area of a vehicle parking inbound to simulate the characteristics of a crime scene. Ground control points (GCPs) were distributed in ten positions within the surroundings. In manual flight, the drone performed nadiral photographs from one side to the other side and with an elliptical 45° center pointed. Three altitudes where tested: 10 m, 20 m and 40 m. The Trimble X7 laser scanner performed six scans and generated one set of point clouds. Drone photogrammetry returned eligible data for distances of 20 m and 40 m with errors of ~0.25 mm. To increase the overlay in the photogrammetry procedure, all photographs from distances of 10-40 m were processed, returning an error of ~0.53 mm. The results of the measured distances, which were manually picked from the GCPs, from the 3D-scanned model and photogrammetric 3D models were then statistically analyzed. The Trimble X7 laser scanner showed an average error of 3 cm, which was approximately equivalent to the results obtained with all images or when using a known scale value for the drone photographs, presenting no significant differences among the evaluated methods.

PMID:34856522 | DOI:10.1016/j.forsciint.2021.111100

J Reprod Immunol. 2021 Nov 23;149:103454. doi: 10.1016/j.jri.2021.103454. Online ahead of print.

ABSTRACT

The over expression of Indoleamine 2, 3-Dioxygenase (IDO1), an immune checkpoint inhibitor, is well known in cervical cancer. However, its association with chemokine signals promoting cellular infiltration in the cervical tumor microenvironment, is unknown. In the current study, we evaluated the expression and enzymatic activity of IDO1. We also profiled the expression of chemokine ligand-receptors- CCR4-CCL22, CXCR3-CXCL10, CXCR4-CXCL12, and CCR7-CCL19 using immunohistochemistry (IHC), and studied their association with IDO1, statistically. After getting an informed consent, punch biopsy samples were obtained from 105 patients diagnosed with cervical cancer. HPV typing by Sanger sequencing, realtime PCR for quantifying IDO1 mRNA expression, HPLC for determining the K/T ratio and IHC for all the above chemokine receptor-ligand pairs along with IDO1 were performed. We found a significant increase in the expression of IDO1 and K/T levels in early and locally advanced stages when compared to Stage IV disease. Among the chemokine ligand -receptor pairs profiled, we found that high CCL19 marker expression was a good prognostic indicator of patients’ disease-free (p = 0.013) and overall survival (p = 0.043). Although we could not identify IDO1 as an independent prognostic factor, we found that high levels of IDO1 expression may further reduce survival outcomes in patients with low CCL19 expression. This could be vital for designing immuno therapeutic interventions targeting IDO1.

PMID:34856521 | DOI:10.1016/j.jri.2021.103454

Eur J Radiol. 2021 Nov 24;146:110070. doi: 10.1016/j.ejrad.2021.110070. Online ahead of print.

ABSTRACT

PURPOSE: To assess the image quality (IQ) of low tube voltage coronary CT angiography (CCTA) images reconstructed with deep learning image reconstruction (DLIR).

METHODS: According to body mass index (BMI), eighty patients who underwent 70kVp CCTA (Group A, N = 40, BMI ≤ 26 kg/m2) or 80kVp CCTA (Group B, N = 40, BMI > 26 kg/m2) were prospectively included. All images were reconstructed with four algorithms, including filtered back-projection (FBP), adaptive statistical iterative reconstruction-Veo at a level of 50% (ASiR-V50%), and DLIR at medium (DLIR-M) and high (DLIR-H) levels. Image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and edge rise distance (ERD) within aorta root and coronary arteries were calculated. The IQ was subjectively evaluated by using a 5-point scale.

RESULTS: Compared with FBP, ASiR-V50% and DLIR-M, DLIR-H led to the lowest noise (Group A: 24.7 ± 5.0HU; Group B, 21.6 ± 2.8 HU), highest SNR (Group A, 24.9 ± 5.0; Group B, 28.0 ± 5.8), CNR (Group A, 42.2 ± 15.2; Group B, 43.6 ± 10.5) and lowest ERD (Group A, 1.49 ± 0.30 mm; Group B, 1.50 ± 0.22 mm) with statistical significance (all P < 0.05). For the objective assessment, the percentages of 4 and 5 IQ scores were significantly higher for DLIR-H (Group A, 93.8%; Group B,90.0%) and DLIR-M (Group A, 85.6%; Group B,86.9 %) compared to ASiR-V50% (Group A, 58.8%; Group B, 58.8%) and FBP (Group A, 34.4%; Group B, 33.1%) algorithms (all P < 0.05).

CONCLUSION: The application of DLIR significantly improves both objective and subjective IQ in low tube voltage CCTA compared with ASiR-V and FBP, which may promote a further radiation dose reduction in CCTA.

PMID:34856519 | DOI:10.1016/j.ejrad.2021.110070

Accid Anal Prev. 2021 Nov 29;165:106507. doi: 10.1016/j.aap.2021.106507. Online ahead of print.

ABSTRACT

Numerous evaluation studies have been conducted on a variety of road safety measures. However, the issue of treatment heterogeneity, defined as the variation in treatment effects, has rarely been investigated before. This paper contributes to the literature by introducing generalized random forests (GRF) for estimation of heterogeneous treatment effects (HTEs) in road safety analysis. GRF has high functional flexibility and is able to search for complex treatment heterogeneity. We first perform a series of simulation experiments to compare GRF with three causal methods that have been used in road safety studies, i.e., outcome regression method, propensity score method, and doubly robust estimation method. The simulation results suggest that GRF is superior to these three methods in terms of model specification, especially with the existence of nonlinearity and nonadditivity. On the other hand, a large dataset is required for accurate GRF estimation. Then we conduct a case study on the UK’s speed camera program. Our results indicate significant reductions in the number of road accidents at speed camera sites. And the heterogeneity in treatment effects is found to be statistically significant. We further consider the associations between the baseline accident records, traffic volume, local socio-economic characteristics, and the safety effects of speed cameras. In general, the effect of speed cameras is larger at the sites with more baseline accident records, higher traffic volume, and in more densely-populated and deprived areas. Several policy suggestions are provided based on these findings. The evaluation of HTEs likely offers more comprehensive information to local authorities and policy makers, and improves the performance of speed camera programs. Moreover, GRF can be a promising approach for revealing treatment effect heterogeneity in road safety analysis.

PMID:34856506 | DOI:10.1016/j.aap.2021.106507

Nurse Educ Pract. 2021 Nov 25;58:103259. doi: 10.1016/j.nepr.2021.103259. Online ahead of print.

ABSTRACT

AIM: The purpose of the study was to explore the relationship between face-implicating factors and faculty’s likelihood of failing students in the clinical setting who do not meet passing criteria.

BACKGROUND: Clinical nursing faculty members struggle to assign failing grades to underperforming students in the clinical setting; this is known as failure to fail. Qualitative literature has revealed common factors for failure to fail; however, quantitative studies are required to determine the extent to which those factors affect faculty’s decision-making process.

DESIGN: A quantitative, descriptive design was used.

METHODS: Snowball sampling was used to recruit participants from CCNE- and ACEN-accredited nursing programs to complete an online survey. There were 353 responses to the survey (a 30% return rate) and 327 usable responses. Eligibility criteria included pre-licensure nursing faculty members who had taught in the clinical setting within the past three years. The tool used for the study was adapted from Dibble’s (2014) tool, which explored face-implicating factors’ impact on the transmission of bad news.

RESULTS: Respondents who did not commit failure to fail (F2FN) disagreed more strongly with every survey item than those who committed failure to fail (F2FY). The differences in mean scores were compared and 64% of those differences were statistically significant (p < 0.05). Respondents who did not commit failure to fail were less affected by the face-implicating factors than those who committed failure to fail.

CONCLUSIONS: the null hypothesis was rejected; a direct connection was found between face-implicating factors and faculty’s likelihood of passing students in the clinical setting who do not meet passing criteria.

PMID:34856470 | DOI:10.1016/j.nepr.2021.103259

Comput Biol Med. 2021 Nov 26;140:105072. doi: 10.1016/j.compbiomed.2021.105072. Online ahead of print.

ABSTRACT

BACKGROUND: Carotid endarterectomy (CEA) remains the first-line treatment option of symptomatic and asymptomatic carotid stenosis, while stenting (CAS) is reserved for selected patients at high surgical risk. Here, we compare the vascular remodeling process in CEA- and CAS-treated patients with respect to morphological and hemodynamic features, because of their possible engagement in carotid atherosclerosis.

METHODS: Twelve (12) patients were included, half with patched CEA and half with CAS. Pre- and post-operative 3D image-based models of the carotid bifurcation were anatomically characterized in terms of flare, tortuosity, and curvature. Individual computational fluid dynamics simulations allowed to quantify the postoperative hemodynamic milieu in terms of (1) wall shear stress and (2) helical flow.

RESULTS: Carotid flare increased in all cases, but a more marked increase emerged after CEA compared to CAS. Tortuosity and curvature increased after CEA but decreased after CAS. CEA patients presented with significantly higher postoperative tortuosity than CAS patients. CEA was associated with a worse (non-statistically significant) score in all flow disturbance indicators vs. CAS.

CONCLUSION: The increased flare and tortuosity of the carotid bifurcation after CEA vs. CAS is a marked difference in the vascular remodeling process between the two modalities. CAS seems to induce a less pro-restenosis hemodynamic environment compared to CEA. The emerged differences stimulate further analysis on a larger cohort with long-term outcomes, to shed light on the clinical impact of the observations.

PMID:34856465 | DOI:10.1016/j.compbiomed.2021.105072

Ideggyogy Sz. 2021 Nov 30;74(11-12):389-396. doi: 10.18071/isz.74.0389.

ABSTRACT

BACKGROUND AND PURPOSE: We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients.

METHODS: This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine.

RESULTS: Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05-1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27-3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16-0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding.

CONCLUSION: Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

PMID:34856085 | DOI:10.18071/isz.74.0389

Ideggyogy Sz. 2021 Nov 30;74(11-12):397-407. doi: 10.18071/isz.74.0397.

ABSTRACT

BACKGROUND AND PURPOSE: Conventional parameters used in electrodiagnosis of ulnar neuropathy at elbow (UNE) are: (i) absolute across-elbow ulnar nerve motor conduction velocity (MCV), (ii) reduction rate of composed muscle action potential (CMAP) amplitude from above to below elbow stimulation, and (iii) MCV difference between forearm and across-elbow segment. We aimed to search the diagnostic accuracy values of these parameters on UNE, and their correlations with axonal dysfunction of ulnar nerve fibers.

METHODS: Arms with clinical signs of UNE and two-fold healthy controls were included. We detected the best cut off points of the measured parameters and their possible combinations. Their diagnostic accuracy values and correlations with parameters reflecting the axonal functions were analyzed, statistically.

RESULTS: Totally, 118 arms with UNE and 236 controls were included. Absolute across-elbow MCV yielded a higher accuracy than MCV difference and reduction rate of CMAP amplitude (p = 0.010 and p˂0.001, respectively). Besides, combining it with other parameters did not increase the diagnostic yield. Correlation analyses revealed that the only parameter having positive linear correlations with sensory nerve action potential amplitudes both in the control and the disease groups is the absolute across-elbow MCV. The absolute across-elbow MCVs have also positive linear correlation with CMAP amplitudes in disease group.

CONCLUSION: The absolute across-elbow MCV is the most valuable conventional parameter for the electrodiagnosis of UNE. It is also the most correlated parameter with the electrodiagnostic parameters reflecting the axonal functions of the ulnar nerve fibers.

PMID:34856084 | DOI:10.18071/isz.74.0397