Nevin Manimala

Mod Rheumatol. 2022 Jun 4:roac057. doi: 10.1093/mr/roac057. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the efficacy and safety of intravenous immunoglobulin (IVIG) in the treatment of dermatomyositis (DM) and polymyositis (PM).

METHODS: A comprehensive systematic review was conducted in accordance with the guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews And Meta-analyses). PubMed, Embase, and China National Knowledge Infrastructure (CNKI) were searched to find articles published between July 1919 and May 2021 concerning IVIG therapy in PM/DM. We analyzed continuum data through mean difference and the estimated pooled improvement rate through Log transformation. We calculated all the effect measures with a 95% confidence interval. The I²statistic was calculated to assess statistical heterogeneity across the studies. I²values of 25%, 50% and 75% were defined as low, moderate and high, respectively. All analyses were conducted using R Studio, Version 3.6.3.

RESULTS: Seventeen papers pertinent to our questions were found: three case-control studies, fourteen non-randomized studies. We evaluated the efficacy of IVIG in DM/PM by the indicators of creatine kinase (CK), Manual Muscle Test (MMT) scores, Medical Research Council (MRC) scale, the Activities of Daily Living (ADL) scale and the pooled improvement rate. In a meta-analysis, we found that IVIG significantly improved the level of CK (SMD -0.69, 95%CI -0.93, -0.46; P<0.0001), MMT (SMD 1.12; 95%CI 0.77, 1.47; P<0.00001), MRC (SMD 1.59; 95%CI 0.86, 2.33; P<0.00001), ADL (SMD 1.07; 95%CI 0.59, 1.56; P<0.0001). The CK levels in DM and PM were also significantly improved after IVIG (SMD = -0.73, 95%CI -1.12, -0.34; P=0.0002; and SMD = -3.29, 95%CI -5.82, -0.76; P < 0.0001, respectively). The meta-analysis of three RCTs showed that there was a statistically significant improvement after IVIG (SMD 0.63; 95%CI 0.22, 1.03; P=0.002). In a random effects model pooled muscle power improvement rate was 77% (95% CI: 66.0-87.0%). Meta-analyses of IVIG as first-line therapy showed a significant improvement of CK level (SMD -0.71; 95%CI -1.12, -0.30; P=0.0007). In three studies, the polled improvement rate of esophageal disorders was 88% (95% CI: 80.0-95.0%). There was no statistically significant difference in the rate of improvement between the number of courses < 2 and ≥ 2 (0.80 vs. 0.80 %, P = 0.9). The corticosteroid-sparing effect of IVIG was also well demonstrated, with the proportion of corticosteroid-sparing success reaching 81.8% (72/88). Adverse reactions included headache, fever, Hypotension and dizzy and so on. Mild cortical stroke, staphylococcal septicaemia, asymptomatic myocardial infarction, cerebral infarction, deep vein thrombosis and subendocardial ischemia as severe adverse events were found in seven cases.

CONCLUSION: IVIG seems to be an effective drug for DMPM, improving muscle strength, CK levels and esophageal involvement, and it is well tolerated by patients.

PMID:35660927 | DOI:10.1093/mr/roac057

J Nutr. 2022 Jun 6:nxac131. doi: 10.1093/jn/nxac131. Online ahead of print.

ABSTRACT

BACKGROUND: Evidence on the association between phylloquinone status and cardiovascular diseases is scarce and conflicting. These inconsistencies may be due to differences in individual characteristics of the study populations, which may modify the association.

OBJECTIVE: This study aimed to evaluate the association between plasma phylloquinone and the risk of first total stroke and its subtypes, and to examine potential effect modifications by body mass index (BMI) in patients with hypertension.

METHODS: We performed a nested case-control study including 604 first stroke cases and 604 matched controls. The mean age was 62.2 years (range, 45 to 75). Lower BMI was defined as <25 kg/m2, and higher BMI was defined as ≥25 kg/m2. The risks of the first stroke were estimated by odds ratios (ORs) and 95% confidence intervals (CI) using conditional logistic regression. The primary outcome was total stroke or ischemic stroke.

RESULTS: The relationship between log-transformed phylloquinone concentration and stroke or ischemic stroke was modified by BMI. Higher phylloquinone levels were associated with lower stroke risk in those with higher BMI. When plasma phylloquinone was assessed as tertiles, the adjusted ORs of first stroke and ischemic stroke for participants with high BMI in tertile 2-3 were 0.70 (95% CI: 0.46,1.08) and 0.57 (95% CI: 0.35,0.92) compared to those in tertile 1, respectively. However, there was no significant association between plasma phylloquinone and risk of first total stroke or ischemic stroke for those with lower BMI. Patients with higher BMI and lower phylloquinone levels had the highest risk of ischemic stroke and showed a statistically significant difference compared to the reference group with lower BMI and higher phylloquinone (OR = 1.80, 95% CI: 1.06, 3.10; P-interaction: 0.017).

CONCLUSIONS: In Chinese patients with hypertension, there was an inverse association between baseline plasma phylloquinone and risk of first ischemic stroke among those with higher BMI.

PMID:35660920 | DOI:10.1093/jn/nxac131

Occup Med (Lond). 2022 Jun 5:kqac052. doi: 10.1093/occmed/kqac052. Online ahead of print.

ABSTRACT

BACKGROUND: Work-related stress may lead to mental and physical illnesses. Emergency physicians may be particularly vulnerable to developing such diseases due to their extreme emotional working environment.

AIMS: The purpose of the study was to analyse the hormonal stress burden of emergency physicians in the airborne rescue service to create an empirical basis for developing appropriate measures against chronic stress in the rescue service.

METHODS: Three salivary cortisol samples were collected after awakening in 15 min intervals-each on a flight rescue day, a clinic day and a free day-to calculate the extent of the hormonal stress load of the emergency physicians. A nested linear mixed-model analysis was used in 40 cases to investigate hormonal stress. Furthermore, professional years and gender were included in the calculations.

RESULTS: The mixed model showed neither a main effect for measurement time nor for day but a significant interaction effect (P = 0.002). The cortisol level rises strongly on the flight rescue and the clinic day, while on the free day it shows a moderate increase. Professional years and gender also proved to be statistically significant for the cortisol level of emergency physicians (P < 0.001).

CONCLUSIONS: The results show a significantly higher cortisol increase on working days compared with a free day, which indicates a stronger stress burden on working days of emergency physicians in the airborne rescue service. Future studies should examine the stress level of emergency physicians in more detail to prove whether the working conditions of emergency physicians need to be modified.

PMID:35660919 | DOI:10.1093/occmed/kqac052

J Crit Care. 2022 Jun 2;71:154079. doi: 10.1016/j.jcrc.2022.154079. Online ahead of print.

ABSTRACT

PURPOSE: To compare the effect of conservative vs. liberal oxygen therapy in mechanically ventilated adults in the intensive care unit (ICU) with non-hypoxic ischemic encephalopathy (HIE) acute brain pathologies.

MATERIALS AND METHODS: Post-hoc analysis of data from 217 patients with non-HIE acute brain pathologies included in the ICU Randomized Trial Comparing Two Approaches to OXygen therapy (ICU-ROX).

RESULTS: Patients allocated to conservative oxygen spent less time with oxygen saturation ≥ 97% (50.5 [interquartile range (IQR), 18.5-119] vs. 82 h [IQR, 38-164], absolute difference, -31.5 h; 95%CI, -59.6 to -3.4). At 180 days, 38 of 110 conservative oxygen patients (34.5%) and 28 of 104 liberal oxygen patients (26.9%) had died (absolute difference, 7.6 percentage points; 95%CI, -4.7 to 19.9 percentage points; P = 0.23; interaction P = 0.02 for non-HIE acute brain pathologies vs. HIE; interaction P = 0.53 for non-HIE acute brain pathologies vs. non-neurological conditions).

CONCLUSIONS: In this post-hoc analysis, patients admitted to the ICU with non-HIE acute brain pathologies treated with conservative oxygen therapy did not have significantly lower mortality than those treated with liberal oxygen. A trial with adequate statistical power is needed to determine whether our day 180 mortality point estimate of treatment effect favoring liberal oxygen therapy indicates a true effect.

PMID:35660843 | DOI:10.1016/j.jcrc.2022.154079

Ann Diagn Pathol. 2022 May 18;60:151976. doi: 10.1016/j.anndiagpath.2022.151976. Online ahead of print.

ABSTRACT

BACKGROUND: Sinonasal mucosal melanoma (SNMM) is a rare tumour with a poor prognosis. The purpose of this study was to identify independent predictors of outcome in SNMM and to examine the expression of PD-L1 and the relationship between expression and clinicopathological characteristics.

METHODS: A total of 117 patients with SNMM were reviewed in the Department of Pathology of Beijing Tongren Hospital (115 cases) and Beijing Chuiyangliu Hospital (2 cases) from June 2007 to June 2018. We evaluated the expression of PD-L1 in SNMM and investigated whether there was an association between the expression of the marker and clinicopathological characteristics.

RESULTS: Sex, age, side, location, size, histological type, melanin particles, nuclear fission and tumour infiltrating lymphocytes (TILs) were not significantly related to survival. The median survival times at the T3, T4a, and T4b stages were 23, 19, and 6 months, respectively. The difference between overall survival (OS) and AJCC stages was statistically significant. The tumour cells (TCs) were PD-L1 positive in 14/117 (12.0%) cases, and tumour-associated immune cells (ICs) were PD-L1 positive in 23/117 (19.7%) cases. A statistically significant correlation was observed between the positive expression rate of PD-L1 in ICs and TILs grading; however, there was no significant correlation between the positive expression rate of PD-L1 in TCs and TILs grading.

CONCLUSION: The AJCC stages were the only independent predictors of survival. There was no correlation between the positive expression rate of PD-L1 and OS. A statistically significant correlation was observed between the positive expression rate of PD-L1 in ICs and TILs grading.

PMID:35660809 | DOI:10.1016/j.anndiagpath.2022.151976

Ann Diagn Pathol. 2022 May 28;60:151981. doi: 10.1016/j.anndiagpath.2022.151981. Online ahead of print.

ABSTRACT

This study aimed to evaluate immunohistochemical markers of pheochromocytoma/paraganglioma (PPGL) and the relationships between the grading system for adrenal pheochromocytoma and paraganglioma (GAPP) and the prognosis of PPGL in a Chinese population. A retrospective analysis was conducted on a cohort of 102 PPGL cases, from January 2012 to December 2019, with complete clinicopathological and follow-up data. Surgical pathology slides were re-reviewed. All histological parameters involved in GAPP were summarized. The relationship between clinical characteristics, expression of SDHB (succinate dehydrogenase), S-100 and Ki-67 as well as GAPP classifications and prognosis of PPGL was statistically analyzed. The 102 cases included 51 males (50%) and 51 females (50%) with a median age of 48.7 years. The median tumor size was 6.8 cm. Metastases or relapse developed in 23 (22.5%) cases. Larger tumor size, extra-adrenal location, and poorly differentiated PPGL according to GAPP were associated with metastases or relapse (P < 0.05). Histological parameters, including the appearance of large or fused cell nests, necrosis, vascular invasion, and capsular invasion, were more common in the cases with metastases or relapse (P < 0.01). Loss of SDHB or S-100 expression was more common in poorly differentiated PPGL and associated with metastases or relapse (P < 0.01). However, no significant difference in the Ki-67 index between the clinically malignant and benign group was observed. GAPP is thus helpful for evaluations of the biological behavior of PPGL.

PMID:35660808 | DOI:10.1016/j.anndiagpath.2022.151981

Neuropsychopharmacology. 2022 Jun 3. doi: 10.1038/s41386-022-01351-z. Online ahead of print.

ABSTRACT

Mapping individual differences in behavior is fundamental to personalized neuroscience, but quantifying complex behavior in real world settings remains a challenge. While mobility patterns captured by smartphones have increasingly been linked to a range of psychiatric symptoms, existing research has not specifically examined whether individuals have person-specific mobility patterns. We collected over 3000 days of mobility data from a sample of 41 adolescents and young adults (age 17-30 years, 28 female) with affective instability. We extracted summary mobility metrics from GPS and accelerometer data and used their covariance structures to identify individuals and calculated the individual identification accuracy-i.e., their “footprint distinctiveness”. We found that statistical patterns of smartphone-based mobility features represented unique “footprints” that allow individual identification (p < 0.001). Critically, mobility footprints exhibited varying levels of person-specific distinctiveness (4-99%), which was associated with age and sex. Furthermore, reduced individual footprint distinctiveness was associated with instability in affect (p < 0.05) and circadian patterns (p < 0.05) as measured by environmental momentary assessment. Finally, brain functional connectivity, especially those in the somatomotor network, was linked to individual differences in mobility patterns (p < 0.05). Together, these results suggest that real-world mobility patterns may provide individual-specific signatures relevant for studies of development, sleep, and psychopathology.

PMID:35660803 | DOI:10.1038/s41386-022-01351-z

Sci Rep. 2022 Jun 3;12(1):9304. doi: 10.1038/s41598-022-13346-3.

ABSTRACT

Disseminated intravascular coagulation (DIC) is one of the major organ dysfunctions associated with sepsis. This retrospective secondary analysis comprised data from a prospective multicenter study to investigate the age-related differences in the survival benefit of anticoagulant therapy in sepsis according to the DIC diagnostic criteria. Adult patients with severe sepsis based on the Sepsis-2 criteria were enrolled and divided into the following groups: (1) anticoagulant group (patients who received anticoagulant therapy) and (2) non-anticoagulant group (patients who did not receive anticoagulant therapy). Patients in the former group were administered antithrombin, recombinant human thrombomodulin, or their combination. The increases in the risk of hospital mortality were suppressed in the high-DIC-score patients aged 60-70 years receiving anticoagulant therapy. No favorable association of anti-coagulant therapy with hospital mortality was observed in patients aged 50 years and 80 years. Furthermore, anticoagulant therapy in the lower-DIC-score range increased the risk of hospital mortality in patients aged 50-60 years. In conclusion, anticoagulant therapy was associated with decreased hospital mortality according to a higher DIC score in septic patients aged 60-70 years. Anticoagulant therapy, however, was not associated with a better outcome in relatively younger and older patients with sepsis.

PMID:35660774 | DOI:10.1038/s41598-022-13346-3

Comput Methods Programs Biomed. 2022 May 19;221:106893. doi: 10.1016/j.cmpb.2022.106893. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: The fetal face is an essential source of information in the assessment of congenital malformations and neurological anomalies. Disturbance in early stages of development can lead to a wide range of effects, from subtle changes in facial and neurological features to characteristic facial shapes observed in craniofacial syndromes. Three-dimensional ultrasound (3D US) can provide more detailed information about the facial morphology of the fetus than the conventional 2D US, but its use for pre-natal diagnosis is challenging due to imaging noise, fetal movements, limited field-of-view, low soft-tissue contrast, and occlusions.

METHODS: In this paper, we propose the use of a novel statistical morphable model of newborn faces, the BabyFM, for fetal face reconstruction from 3D US images. We test the feasibility of using newborn statistics to accurately reconstruct fetal faces by fitting the regularized morphable model to the noisy 3D US images.

RESULTS: The results indicate that the reconstructions are quite accurate in the central-face and less reliable in the lateral regions (mean point-to-surface error of 2.35 mm vs 4.86 mm). The algorithm is able to reconstruct the whole facial morphology of babies from US scans while handle adverse conditions (e.g. missing parts, noisy data).

CONCLUSIONS: The proposed algorithm has the potential to aid in-utero diagnosis for conditions that involve facial dysmorphology.

PMID:35660764 | DOI:10.1016/j.cmpb.2022.106893

Sci Rep. 2022 Jun 3;12(1):9312. doi: 10.1038/s41598-022-13015-5.

ABSTRACT

Machine learning is increasingly being used to predict clinical outcomes. Most comparisons of different methods have been based on empirical analyses in specific datasets. We used Monte Carlo simulations to determine when machine learning methods perform better than statistical learning methods in a specific setting. We evaluated six learning methods: stochastic gradient boosting machines using trees as the base learners, random forests, artificial neural networks, the lasso, ridge regression, and linear regression estimated using ordinary least squares (OLS). Our simulations were informed by empirical analyses in patients with acute myocardial infarction (AMI) and congestive heart failure (CHF) and used six data-generating processes, each based on one of the six learning methods, to simulate continuous outcomes in the derivation and validation samples. The outcome was systolic blood pressure at hospital discharge, a continuous outcome. We applied the six learning methods in each of the simulated derivation samples and evaluated performance in the simulated validation samples. The primary observation was that neural networks tended to result in estimates with worse predictive accuracy than the other five methods in both disease samples and across all six data-generating processes. Boosted trees and OLS regression tended to perform well across a range of scenarios.

PMID:35660759 | DOI:10.1038/s41598-022-13015-5