Nevin Manimala

J Neurosurg Pediatr. 2022 Aug 12:1-8. doi: 10.3171/2022.7.PEDS22178. Online ahead of print.

ABSTRACT

OBJECTIVE: Pediatric spinal injuries in all-terrain vehicle (ATV) and dirt bike crashes are relatively uncommon but may be associated with significant morbidity. There are no recent studies examining these injuries, their management, and outcomes. Therefore, a retrospective study was performed to characterize pediatric spinal injuries related to ATV and dirt bike crashes over the last decade.

METHODS: Data on all patients involved in ATV or dirt bike crashes evaluated at a regional level 1 pediatric trauma center over a 10-year period (2010-2019) were analyzed. Descriptive statistics were analyzed and chi-square, Fisher exact, and Mann-Whitney U-tests were performed comparing the demographics, injury characteristics, and clinical outcomes in patients with versus those without spinal injuries.

RESULTS: Of 680 patients evaluated, 35 (5.1%) were diagnosed with spinal injuries. Over the study period, both spinal injuries and emergency department visits related to ATV or dirt bike crashes increased in frequency. All spinal injuries were initially diagnosed on CT scans, and 57.9% underwent spinal MRI. Injuries were most commonly thoracic (50%), followed by cervical (36.8%). The injuries of most patients were classified as American Spinal Injury Association (ASIA) grade E on presentation (86.8%), while 2 (5.3%) had complete spinal cord injuries (ASIA grade A) and 3 patients (8.6%) were ASIA grade B-D. Operative management was required for 13 patients (28.9%). Nonoperative management was used in 71.1% of injuries, including bracing in 33% of all injuries. Patients with spinal injuries were older than those without (13.4 ± 3.35 vs 11.5 ± 3.79 years, p = 0.003). Spinal injuries occurred via similar crash mechanisms (p = 0.48) and in similar locations (p = 0.29) to nonspinal injuries. Patients with spinal injuries more frequently required admission to the intensive care unit (ICU; 34.2% vs 14.6%, p = 0.011) and had longer hospital stays (mean 4.7 ± 5.5 vs 2.7 ± 4.0 days, p = 0.0025).

CONCLUSIONS: Although infrequent among young ATV and dirt bike riders, spinal injuries are associated with longer hospital stays, increased ICU use, and required operative intervention in 29%. Increasing awareness among ATV and dirt bike riders about the severity of riding-related injuries may encourage safer riding behaviors.

PMID:35962971 | DOI:10.3171/2022.7.PEDS22178

J Neurosurg. 2022 Aug 12:1-10. doi: 10.3171/2022.6.JNS22733. Online ahead of print.

ABSTRACT

OBJECTIVE: Coupled with stereo-electroencephalography (SEEG), radiofrequency thermocoagulation (RFTC) has emerged as a therapeutic alternative for patients with refractory focal epilepsy, with proven safe but highly variable results across studies. The authors aimed to describe the outcomes and safety of SEEG-RFTC, focusing on patients with MRI-negative epilepsy.

METHODS: A retrospective observational study was conducted on patients evaluated by SEEG in the authors’ center. Of 84 total cases, 55 underwent RFTC, with 31 MRI-negative epilepsies that were ultimately included in the study. The primary outcome was freedom from disabling seizures at last follow-up. Secondary outcomes were reduction in seizure frequency (RFTC response = seizure frequency reduction > 50%), peri-interventional complications, and neuropsychological outcomes. Potential factors influencing post-RFTC outcome were considered by comparing different variables between responders and nonresponders.

RESULTS: The mean follow-up period was 30.9 months (range 7.1-69.8 months). Three patients underwent subsequent resection/laser interstitial thermal therapy within the 1st year after RFTC failure. All other patients completed a minimum follow-up period of 1 year. Fourteen patients (45.2%) showed at least a 50% reduction in seizure frequency (responders), and 8 were seizure free (25.8% of the whole cohort). One case showed a permanent complication not directly related to thermolesions. Most patients (76%) showed no significant cognitive decline. Electrically elicited seizures (EESs) were observed in all seizure-free patients and were more frequent in responders (p = 0.038). All patients who were seizure free at the 6-month visit maintained their status during long-term follow-up.

CONCLUSIONS: SEEG-RFTC is a safe procedure and leads to a good response in many cases of MRI-negative focal epilepsies. One-quarter of the patients were seizure free and almost one-half were responders at the last follow-up. Although these results are still far from those achieved through conventional resection, a nonnegligible proportion of patients may benefit from this one-stage and much less invasive approach. Factors associated with seizure outcome remain to be elucidated; however, responders were significantly more frequent among patients with EESs, and achieving 6 months of seizure freedom appears to predict a good long-term response. In addition, the positive predictive value of RFTC response may be a valuable factor in the decision to proceed to subsequent surgery.

PMID:35962969 | DOI:10.3171/2022.6.JNS22733

J Perinat Med. 2022 Aug 15. doi: 10.1515/jpm-2022-0203. Online ahead of print.

ABSTRACT

OBJECTIVES: In fetal growth restriction (FGR), Doppler ultrasound is the most important method for the detection and management. However, additional parameters are needed to improve the distinction between constitutionally small fetuses and fetuses affected by FGR.

METHODS: A total of 445 singleton pregnancies between 23 and 40 weeks of gestation were included in our retrospective study, of which 67 with FGR and 378 normal fetuses. A 2D-plane of the fetal adrenal gland was obtained and the adrenal gland ratio was measured. Spearman’s correlation coefficient was calculated to assess the association of fetal Doppler and adrenal gland ratio with outcome parameters. Logistic regression analysis was performed to assess the statistical significance of “PI of the umbilical artery” and “adrenal gland ratio” as prognostic factors for intrauterine growth restriction (IUGR).

RESULTS: PI of the umbilical artery was shown to correlate with outcome parameters (WG_Delivery: r=-0.125, p=0.008; birth weight: r=-0.268, p<0.001; birth weight centile: r=-0.248, p<0.001; APGAR at 5 min: r=-0.117, p=0.014). Adrenal gland ratio showed no correlation with any of the outcome parameters. In logistic regression however, both PI of the umbilical artery and the adrenal ratio were shown to be significantly associated with fetal IUGR. When combining the two parameters, predictive value was superior to the predictive value of each individual parameter (AUC 0.738 [95% CI 0.670; 0.806]).

CONCLUSIONS: The adrenal gland ratio can be a useful addition to Doppler ultrasound when it comes to the detection of fetal FGR. Prospective studies are needed to establish references ranges and cut-off values for clinical decision-making.

PMID:35962947 | DOI:10.1515/jpm-2022-0203

J Clin Sleep Med. 2022 Aug 15. doi: 10.5664/jcsm.10228. Online ahead of print.

ABSTRACT

STUDY OBJECTIVES: To describe the outcomes of central sleep apnea (CSA) requiring home supplemental oxygen therapy in otherwise healthy term infants.

METHODS: All children <1 year of age undergoing polysomnography (PSG) between 2015-2020 at the Queensland Children’s Hospital were retrospectively studied. Children with gestational age <37 weeks, underlying syndrome, cleft palate, those with obstructive apnea-hypopnea index (OAHI) >50% of total apnea-hypopnea index (AHI) or with underlying cardiac or pulmonary parenchymal pathology were excluded. PSG parameters were extracted for periods both on and off supplemental oxygenation.

RESULTS: Fifty-two [mean (SD) age at PSG 32.6 (34.7) days; 21F] term infants were included. There was a statistically significant improvement in AHI on supplemental oxygen [Mean (SD) in room air 50.2 (36.3) vs 11.6 (9), p< 0.001 on supplemental oxygen], in both rapid eye movement (REM) and non-rapid eye movement (NREM) sleep, as well as in mean oxygen saturations (96.6% in room air to 98.9% on oxygen; p<0.001). There was no statistically significant change in transcutaneous carbon dioxide levels or sleep duration. Oxygenation was prescribed for a median (interquartile range=IQR) age of 197 (127) days.

CONCLUSIONS: CSA in term infants who are otherwise healthy generally has a good prognosis, with oxygen therapy prescribed for around six months. Oxygen therapy was associated with improved saturations and decrease in AHI when assessed with PSG.

PMID:35962944 | DOI:10.5664/jcsm.10228

J Clin Sleep Med. 2022 Aug 15. doi: 10.5664/jcsm.10232. Online ahead of print.

ABSTRACT

STUDY OBJECTIVES: To evaluate (determinants of) treatment success of mandibular advancement device (MAD) application in a selected phenotype of patients with obstructive sleep apnea (OSA).

METHODS: 90 non-obese patients with moderate OSA (obstructive apnea-hypopnea index (OAHI) ≥ 15 and < 30/h) without comorbidities were prospectively included. Polysomnography (PSG) was performed at baseline and with MAD. A drug-induced sleep endoscopy (DISE) with jaw thrust was performed in 83%.

RESULTS: OAHI reduction ≥ 50% was observed in 73%, OAHI reduction ≥ 50% with OAHI < 10/h in 70%, complete OSA resolution (OAHI < 5/h) in 40%. Patients with non-positional OSA showed a significantly higher rate of complete OSA resolution: post-test probability increased to 67%. In patients with total disappearance of collapse at velum level and at all levels during DISE with jaw thrust, the drop in OAHI was impressive with an infinitively high positive likelihood ratio. However, the proportion of patients having non-positional OSA or the DISE-characteristics as described above was < 20%. The change in snoring disturbance based on a Visual Analogue Scale was 76% (IQR 40-89%, p<0.001) and a statistically significant amelioration in Epworth Sleepiness Scale (especially in somnolent subjects) was observed. High adherence was reported.

CONCLUSIONS: In this pre-defined OSA phenotype, MAD was effective in reduction of OAHI and in amelioration of symptoms. Stratification by non-positional OSA and findings on DISE with jaw thrust increased treatment success defined as reduction in OAHI. However, the clinical relevance can be questioned because only a small number of patients demonstrated these characteristics.

PMID:35962942 | DOI:10.5664/jcsm.10232

Pain Ther. 2022 Aug 13. doi: 10.1007/s40122-022-00424-7. Online ahead of print.

ABSTRACT

INTRODUCTION: A recent phase 3, randomized, placebo- and tramadol-controlled trial (56-week treatment/24-week safety follow-up) demonstrated efficacy of tanezumab 10 mg in patients with chronic low back pain (CLBP) and a history of inadequate response to standard-of-care analgesics. Here, we report on the clinical meaningfulness of treatment response in this study, focused on secondary measures of pain, interference with daily functions, overall disease status, and satisfaction with treatment.

METHODS: Patients received placebo (up to week 16; n = 406), subcutaneously administered (SC) tanezumab 5 mg (every 8 weeks; n = 407), SC tanezumab 10 mg (every 8 weeks; n = 407), or orally administered tramadol prolonged-release (100-300 mg/day; n = 605) for 56 weeks. Patient’s global assessment of low back pain (PGA-LBP), Brief Pain Inventory-short form (BPI-sf), Treatment Satisfaction Questionnaire for Medication (TSQM), and modified Patient-Reported Treatment Impact (mPRTI) were assessed at weeks 16 and 56.

RESULTS: At week 16, significant (p < 0.05) improvements over placebo were evident with tanezumab for the PGA-LBP (10 mg) and most BPI-sf (both doses), TSQM (both doses), and mPRTI (both doses) items assessed. Improvements over baseline persisted for the PGA-LBP and BPI-sf at week 56. However, the magnitude of improvements was modestly lower at week 56 relative to week 16. Tramadol did not improve PGA-LBP or BPI-sf scores versus placebo at week 16. Most differences between tanezumab and tramadol at week 56 did not reach the level of statistical significance for all endpoints.

CONCLUSIONS: The totality of the evidence as captured by measures of pain, interference with daily function, patient overall assessment of disease status, and satisfaction with treatment demonstrates the clinically meaningful benefit of tanezumab for some patients with CLBP compared with placebo.

CLINICALTRIALS: gov: NCT02528253.

PMID:35962939 | DOI:10.1007/s40122-022-00424-7

Med Biol Eng Comput. 2022 Aug 13. doi: 10.1007/s11517-022-02631-y. Online ahead of print.

ABSTRACT

High-quality computed tomography (CT) images are key to clinical diagnosis. However, the current quality of an image is limited by reconstruction algorithms and other factors and still needs to be improved. When using CT, a large quantity of imaging data, including intermediate data and final images, that can reflect important physical processes in a statistical sense are accumulated. However, traditional imaging techniques cannot make full use of them. Recently, deep learning, in which the large quantity of imaging data can be utilized and patterns can be learned by a hierarchical structure, has provided new ideas for CT image quality improvement. Many researchers have proposed a large number of deep learning algorithms to improve CT image quality, especially in the field of image postprocessing. This survey reviews these algorithms and identifies future directions.

PMID:35962932 | DOI:10.1007/s11517-022-02631-y

Environ Sci Pollut Res Int. 2022 Aug 13. doi: 10.1007/s11356-022-22524-9. Online ahead of print.

ABSTRACT

Herein, an iron-doped ZIF-8-loaded multi-walled carbon nanotube (FZM) was synthesized and its adsorption performance on tetracycline (TC) was investigated. The experimental conditions (solution pH, temperature, adsorbent dose) were optimized by Box-Behnken design (BBD) in response surface methodology (RSM). The results show that the adsorption effect of TC by FZM is optimal under the conditions of temperature = 298 K, pH = 6, and contact time = 360 min. The adsorption processes of TC by FZM follow the pseudo-second-order (PSO) kinetic and Freundlich isotherm models, indicating that chemisorption is the dominant factor and the adsorption reaction is multi-layer, with a theoretical maximum saturation capacity of 1111.11 mg/g at 298 K. The adsorption thermodynamic results indicate that the adsorption of TC by FZM is a spontaneous and endothermic process. The mechanism of TC adsorption by FZM possibly occurs through hydrogen bonding, surface complexation, π-π interaction, and electrostatic interaction. From the statistical results, the optimal adsorption capacity of TC by FZM is 599.78 mg/g at a pH of 7.1, a temperature of 312.5 K, and an adsorbent dose of 64.43 mg/L, with a deviation of 1.73% from the actual value. Furthermore, regeneration experiments demonstrate that FZM has excellent reusability with a 15% loss of adsorption capacity after four cycles. This study provides some insights to study the adsorption behavior of TC by MOFs and the optimization of the adsorption experimental conditions, and also shows the potential of FZM for TC removal.

PMID:35962890 | DOI:10.1007/s11356-022-22524-9

Lifetime Data Anal. 2022 Aug 13. doi: 10.1007/s10985-022-09571-7. Online ahead of print.

ABSTRACT

Dynamic (or varying) covariate effects often manifest meaningful physiological mechanisms underlying chronic diseases. However, a static view of covariate effects is typically adopted by standard approaches to evaluating disease prognostic factors, which can result in depreciation of some important disease markers. To address this issue, in this work, we take the perspective of globally concerned quantile regression, and propose a flexible testing framework suited to assess either constant or dynamic covariate effects. We study the powerful Kolmogorov-Smirnov (K-S) and Cramér-Von Mises (C-V) type test statistics and develop a simple resampling procedure to tackle their complicated limit distributions. We provide rigorous theoretical results, including the limit null distributions and consistency under a general class of alternative hypotheses of the proposed tests, as well as the justifications for the presented resampling procedure. Extensive simulation studies and a real data example demonstrate the utility of the new testing procedures and their advantages over existing approaches in assessing dynamic covariate effects.

PMID:35962886 | DOI:10.1007/s10985-022-09571-7

Acta Biotheor. 2022 Aug 13;70(4):22. doi: 10.1007/s10441-022-09446-2.

ABSTRACT

Causal pluralism can be defended not only in respect to causal concepts and methodological guidelines, but also at the finer-grained level of causal inference from a particular source of evidence for causation. An argument for this last variety of pluralism is made based on an analysis of causal inference from randomized experiments (RCTs). Here, the causal interpretation of a statistically significant association can be established via multiple paths of reasoning, each relying on different assumptions and providing distinct elements of information in favour of a causal interpretation.

PMID:35962877 | DOI:10.1007/s10441-022-09446-2