Nevin Manimala

Vet Surg. 2022 Jun 8. doi: 10.1111/vsu.13837. Online ahead of print.

ABSTRACT

OBJECTIVE: To describe the mechanical characteristics of a novel angle-stable interlocking nail (NAS-ILN) and compare them to those of a locking compression plate (LCP) by using a gap-fracture model.

STUDY DESIGN: Experimental study.

SAMPLE POPULATION: Synthetic bone models.

METHODS: Synthetic bone models simulating a 50 mm diaphyseal comminuted canine tibial fracture were treated with either a novel angle-stable interlocking nail (NAS-ILN) or a locking compression plate (LCP). Maximal axial deformation and load to failure in compression and 4-point bending, as well as maximal angular deformation, slack, and torque to failure in torsion, were statistically compared (P < .05).

RESULTS: In compression, the maximal axial deformation was lower for NAS-ILN (0.11 mm ± 0.03) than for LCP (1.10 mm ± 0.22) (P < .0001). The ultimate load to failure was higher for NAS-ILN (803.58 N ± 29.52) than for LCP (328.40 N ± 11.01) (P < .0001). In torsion, the maximal angular deformation did not differ between NAS-ILN (22.79° ± 1.48) and LCP (24.36° ± 1.45) (P = .09). The ultimate torque to failure was higher for NAS-ILN (22.45 Nm ± 0.24) than for LCP (19.10 Nm ± 1.36) (P = .001). No slack was observed with NAS-ILN. In 4-point bending, the maximal axial deformation was lower for NAS-ILN (3.19 mm ± 0.49) than for LCP (4.17 mm ± 0.34) (P = .003). The ultimate bending moment was higher for NAS-ILN (25.73 Nm, IQR [23.54-26.86] Nm) than for LCP (16.29 Nm, IQR [15.66-16.47] Nm) (P = .002).

CONCLUSION: The NAS-ILN showed greater stiffness in compression and 4-point bending, and a greater resistance to failure in compression, torsion, and 4-point bending, than LCP.

CLINICAL IMPACT: Based on these results, NAS-ILNs could be considered as alternative implants for the stabilization of comminuted fractures.

PMID:35675144 | DOI:10.1111/vsu.13837

Clin Spine Surg. 2022 Jun 8. doi: 10.1097/BSD.0000000000001351. Online ahead of print.

ABSTRACT

STUDY DESIGN: This was a retrospective case series.

OBJECTIVE: The purpose of this study was to compare radiologic and clinical outcomes in patients with L4-L5 lumbar spinal stenosis (LSS) who had undergone either minimally invasive (MIS-) or open (O-) transforaminal lumbar interbody fusion (TLIF), especially with regard to the development of adjacent segment degeneration (ASDeg).

SUMMARY OF BACKGROUND DATA: ASDeg is defined as the degenerative changes at adjacent segments of a fused segment, with no obvious clinical symptoms.

MATERIALS AND METHODS: A total of 121 LSS patients with a minimum 5-year follow-up were included. Patients were divided into 2 groups according to the surgery performed (MIS-TLIF: 57 patients, O-TLIF: 64 patients). Preoperative and final follow-up radiologic parameters were determined. The incidence of ASDeg was evaluated and compared between the 2 groups. Visual Analog Scale score, Japanese Orthopaedic Association score, and Oswestry Disability Index were used to assess clinical outcomes.

RESULTS: Before surgery, no significant difference was found between MIS-TLIF and O-TLIF groups regarding demographic, radiologic, and clinical data. After a 5-year follow-up, the incidence of ASDeg in LSS patients was 47.1% (57/121). ASDeg was mostly located at the cranial segment of the fused level in each group. The most common type of ASDeg in both groups was intervertebral space collapse. There was a lower chance of ASDeg in MIS-TLIF group than that in O-TLIF group (33.3% vs. 59.4%, P<0.01). Postoperatively, both groups had significant improvement in clinical outcomes, and there were no statistically significant intergroup differences assessed by Visual Analog Scale, Japanese Orthopaedic Association, and Oswestry Disability Index scores.

CONCLUSION: The clinical effect of MIS-TLIF and O-TLIF were similar, but the incidence of ASDeg was significantly lower after MIS-TLIF at 5-year follow-up.

PMID:35675143 | DOI:10.1097/BSD.0000000000001351

Clin Nucl Med. 2022 Jul 1;47(7):575-582. doi: 10.1097/RLU.0000000000004190. Epub 2022 Apr 27.

ABSTRACT

PURPOSE: Vaccination against coronavirus disease 2019 (COVID-19) is currently under worldwide deployment. The consequences of this vaccination can be seen in radiology and nuclear medicine explorations with visualization of axillary lymph nodes (LNs), as observed on ultrasonography, MRI, or 18F-FDG PET/CT.We aimed to evaluate on PET/CT the incidence of vaccine-related LNs and their characteristics after COVID-19 vaccination, using several radiopharmaceuticals different from 18F-FDG.

PATIENTS AND METHODS: Between February and July 2021, all consecutive patients undergoing a whole-body PET/CT for any indication using a different radiopharmaceutical from 18F-FDG were eligible for inclusion if they had received at least 1 dose of the COVID-19 vaccine. The radiopharmaceutical administered and vaccine type were recorded for each patient. The incidence of positive vaccine-related axillary and supraclavicular LNs on PET/CT was our primary finding, along with the nodes characteristics. Statistical analyses were performed for patients with prostate cancer (PCa) to determine certain interaction factors that were associated with the detection of vaccine-related LNs.

RESULTS: Of the 226 patients in our cohort study, 120 patients underwent an 18F-fluorocholine PET/CT, 79 a 68Ga-PSMA-11 PET/CT, 6 an 18F-FDOPA PET/CT, and 21 a 68Ga-DOTATOC PET/CT. A total of 67.3% of patients (152/226) received BNT162b2mRNA (Pfizer-BioNTech), 26.5% (60/226) ChAdOx1-S (AstraZeneca), 4.9% (11/226) mRNA-1273 (Moderna), and 1.3% (3/226) Ad26.COV2.S (Janssen). The incidence of positive vaccine-related axillary and supraclavicular LNs was 42.5% (51/120 patients) on PET/CT using 18F-fluorocholine and 12.7% (10/79 patients) with 68Ga-PSMA-11. None of our patients undergoing 18F-FDOPA or 68Ga-DOTATOC PET/CT presented any vaccine-related lymphadenopathy. Vaccine-related LNs were statistically associated with the nature of the radiopharmaceutical (P < 10-4), with the number of vaccine doses received (P = 0.041), with a short delay between vaccination and PET/CT realization (P < 10-5), and with a higher prostate-specific antigen level for patients with PCa (P = 0.032), but not with age or vaccine type. The vaccine-related nodes appeared in 85% of the cases, in the 30 days after vaccine injection, were limited in size and uptake, and were most often limited to the axilla level 1 area.

CONCLUSIONS: Detecting positive LNs after COVID-19 vaccination is not an exclusive 18F-FDG PET/CT pattern but is common on 18F-fluorocholine and possible on 68Ga-PSMA-11 PET/CT. Confronting PET/CT findings with clinical data (such as date and site of injection) seems essential in the current pandemic context, just as it does for the radiopharmaceuticals used in PCa to avoid PET/CT misinterpretation and incorrect patient treatment. For 18F-FDOPA or 68Ga-DOTATOC PET/CT, this seems to have a lesser impact.

PMID:35675134 | DOI:10.1097/RLU.0000000000004190

J Prosthodont. 2022 Jun 8. doi: 10.1111/jopr.13553. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this systematic review and meta-analysis was to evaluate the effect of using additive manufacturing (AM) for dental ceramic fabrication in comparison with subtractive manufacturing (SM), and to evaluate the effect of the type of AM technology on dental ceramic fabrication.

MATERIALS AND METHODS: A search was conducted electronically in MEDLINE (via PubMed), EBSCOhost, Scopus, and Cochran Library databases, and also by other methods (table of contents screening, backward and forward citations, and grey literature search) up to February 12, 2022, to identify records evaluating additive manufacturing of ceramics for dental purposes in comparison with subtractive manufacturing. A minimum of 2 review authors conducted study selection, quality assessment, and data extraction. Quality assessment was performed with Joanna Briggs Institute tool, and the quantitative synthesis was performed with the Comprehensive Meta-Analysis program (CMA, Biostat Inc). Hedges’s g for effect size was calculated, with 0.2 as small, 0.5 as medium, and 0.8 as large. Heterogeneity was assessed with I² and prediction interval (PI) statistics. Publication bias was investigated with funnel plots and grey literature search. Certainty of evidence was assessed with the Grading of Recommendations: Assessment, Development, and Evaluation (GRADE) tool.

RESULTS: A total of 28 studies were included for the qualitative and quantitative synthesis; 11 in vitro studies on accuracy, 1 in vivo study on color, and 16 in vitro studies on physical and mechanical properties. Meta-analysis showed overall higher accuracy for SM compared with AM, with medium effect size (0.679, CI: 0.173-1.185, p = .009) and also for marginal (g = 1.05, CI: 0.344 to 1.760, p = .004), occlusal (g = 2.24, CI: 0.718 to 3.766, p = .004), and total (g = 4.544, CI: -0.234 to 9.323, p = .062) with large effect size; whereas AM had higher accuracy than SM with small effect size for the external (g = -0.238, CI: -1.215-0.739), p = .633), and internal (g = -0.403, CI: -1.273 to 0.467, p = .364) surfaces. For technology, self-glazed zirconia protocol had the smallest effect size (g = -0.049, CI: -0.878 to 0.78, p = .907), followed by stereolithography (g = 0.305, CI: -0.289 to 0.9, p = .314), and digital light processing (g = 1.819, CI: 0.662 to 2.976, p = .002) technologies. Flexural strength was higher for ceramics made by SM in comparison to AM with large effect size (g = -2.868, CI: -4.371 to -1.365, p< .001). Only 1 study reported on color, favoring ceramics made through AM.

CONCLUSIONS: Subtractive manufacturing had better overall accuracy, particularly for the marginal and occlusal areas, higher flexural strength, and more favorable hardness, fracture toughness, porosity, fatigue, and volumetric shrinkage; whereas AM had more favorable elastic modulus and wettability. Both methods had favorable biocompatibility. All studies on accuracy and mechanical properties were in vitro, with high heterogeneity and low to very low certainty of evidence. There is a lack of studies on color match and esthetics. This article is protected by copyright. All rights reserved.

PMID:35675133 | DOI:10.1111/jopr.13553

Acad Med. 2022 Jun 7. doi: 10.1097/ACM.0000000000004775. Online ahead of print.

ABSTRACT

PURPOSE: As the last examination in the United States Medical Licensing Examination (USMLE) sequence, Step 3 provides a safeguard prior to physicians’ entry into unsupervised practice. There is, however, little validity research focusing on Step 3 scores beyond examining its associations with other educational and professional assessments thought to cover similar content. This study examines the associations between Step 3 scores and subsequent receipt of disciplinary action taken by state medical boards for problematic behavior in practice. It analyzes Step 3 total, Step 3 computer-based case simulation (CCS), and Step 3multiple-choice question (MCQ) scores.

METHOD: The final sample included 275,392 board-certified physicians who graduated from MD-granting medical schools and who passed Step 3 between 2000 and 2017. Cross-classified multilevel logistic regression models were used to examine the effects of Step 3 scores on the likelihood of receiving a disciplinary action, controlling for other USMLE scores and accounting for jurisdiction and specialty.

RESULTS: Results showed that physicians with higher Step 3 total, CCS, and MCQ scores tended to have lower chances of receiving a disciplinary action, after accounting for other USMLE scores. Specifically, a 1-standard-deviation increase in Step 3 total, CCS, and MCQ score was associated with a 23%, 11%, and 17% decrease in the odds of receiving a disciplinary action, respectively.The effect of Step 2 CK score on the likelihood of receiving a disciplinary action was statistically significant, while the effect of Step 1 score became statistically non-significant when other Step scores were included in the analysis.

CONCLUSIONS: Physicians who perform better on Step 3 are less likely to receive a disciplinary action from a state medical board for problematic behavior in practice. These findings provide some validity evidence for the use of Step 3 scores when making medical licensure decisions in the United States.

PMID:35675131 | DOI:10.1097/ACM.0000000000004775

Endocr Relat Cancer. 2022 Jun 1:ERC-22-0115. doi: 10.1530/ERC-22-0115. Online ahead of print.

ABSTRACT

DNA methylation and demethylation regulate the transcription of genes. DNA methylation-associated gene expression of adrenal steroidogenic enzymes may regulate cortisol production in cortisol-producing adenoma (CPA). We aimed to determine the DNA methylation levels of all genes encoding steroidogenic enzymes involved in CPA. Additionally, the aims were to clarify the DNA methylation-associated gene expression and evaluate the difference of CPA genotype from others using DNA methylation data. Twenty-five adrenal CPA and six nonfunctioning adrenocortical adenoma (NFA) samples were analyzed. RNA sequencing and DNA methylation array were performed. The methylation levels at 118 methylation sites of the genes were investigated, and their methylation and mRNA levels were subsequently integrated. Among all the steroidogenic enzyme genes studied, CYP17A1 gene was mainly found to be hypomethylated in CPA compared to that in NFA, and the Benjamini-Hochberg procedure demonstrated that methylation levels at two sites in the CYP17A1 gene body were statistically significant. PRKACA mutant CPAs predominantly exhibited hypomethylation of CYP17A1 gene compared with the GNAS mutant CPAs. Inverse associations between CYP17A1 methylation in three regions of the gene body and its mRNA levels were observed in the NFAs and CPAs. In applying clustering analysis using CYP17A1 methylation and mRNA levels, CPAs with PRKACA mutation were differentiated from NFAs and CPAs with a GNAS mutation. We demonstrated that CPAs exhibited hypomethylation of the CYP17A1 gene body in CPA, especially in the PRKACA mutant CPAs. Methylation of CYP17A1 gene may influence its transcription levels.

PMID:35675123 | DOI:10.1530/ERC-22-0115

JMIR Form Res. 2022 Jun 8;6(6):e33734. doi: 10.2196/33734.

ABSTRACT

BACKGROUND: eHealth interventions have become a topic of interest in the field of mental health owing to their increased coordination and integration of different elements of care, in treating and preventing mental ill health in patients with somatic illnesses. However, poor usability, learnability, and user engagement might affect the effectiveness of an eHealth intervention. Identifying different sociodemographic characteristics that might be associated with higher perceived usability can help improve the usability of eHealth interventions.

OBJECTIVE: This study aimed to identify the sociodemographic characteristics that might be associated with the perceived usability of the NEVERMIND (Neurobehavioural Predictive and Personalised Modelling of Depressive Symptoms During Primary Somatic Diseases) eHealth system, comprising a mobile app and a sensorized shirt, in reducing comorbid depressive symptoms in patients with breast or prostate cancer.

METHODS: The study included a total of 129 patients diagnosed with breast (n=80, 62%) or prostate (n=49, 38%) cancer, who received a fully automated mobile app and sensorized shirt (NEVERMIND system). Sociodemographic data on age, sex, marital status, education level, and employment status were collected at baseline. Usability outcomes included the System Usability Scale (SUS), a subjective measure that covers different aspects of system usability; the user version of the Mobile App Rating Scale (uMARS), a user experience questionnaire; and a usage index, an indicator calculated from the number of days patients used the NEVERMIND system during the study period.

RESULTS: The analysis was based on 108 patients (n=68, 63%, patients with breast cancer and n=40, 37%, patients with prostate cancer) who used the NEVERMIND system for an average of 12 weeks and completed the study. The overall mean SUS score at 12 weeks was 73.4 (SD 12.5), which indicates that the NEVERMIND system has good usability, with no statistical differences among different sociodemographic characteristics. The global uMARS score was 3.8 (SD 0.3), and women rated the app higher than men (β=.16; P=.03, 95% CI 0.02-0.3), after adjusting for other covariates. No other sociodemographic characteristics were associated with higher uMARS scores. There was a statistical difference in the use of the NEVERMIND system between women and men. Women had significantly lower use (β=-0.13; P=.04, 95% CI -0.25 to -0.01), after adjusting for other covariates.

CONCLUSIONS: The findings suggest that the NEVERMIND system has good usability according to the SUS and uMARS scores. There was a higher favorability of mobile apps among women than among men. However, men had significantly higher use of the NEVERMIND system. Despite the small sample size and low variability, there is an indication that the NEVERMIND system does not suffer from the digital divide, where certain sociodemographic characteristics are more associated with higher usability.

TRIAL REGISTRATION: German Clinical Trials Register RKS00013391; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013391.

PMID:35675116 | DOI:10.2196/33734

JMIR Form Res. 2022 Jun 8;6(6):e30630. doi: 10.2196/30630.

ABSTRACT

BACKGROUND: There has been an increase in personal health records with the increased use of wearable devices and smartphone apps to improve health. Traditional health promotion programs by human professionals have limitations in terms of cost and reach. Due to labor shortages and to save costs, there has been a growing emphasis in the medical field on building health guidance systems using artificial intelligence (AI). AI will replace advanced human tasks to some extent in the future. However, it is difficult to sustain behavioral change through technology alone at present.

OBJECTIVE: This study investigates whether AI alone can effectively encourage healthy behaviors or whether human interventions are needed to achieve and sustain health-related behavioral change. We examined the effectiveness of AI and human interventions to encourage dietary management behaviors. In addition, we elucidated the conditions for maximizing the effect of AI on health improvement. We hypothesized that the combination of AI and human interventions will maximize their effectiveness.

METHODS: We conducted a 3-month experiment by recruiting participants who were users of a smartphone diet management app. We recruited 102 participants and divided them into 3 groups. Treatment group I received text messages using the standard features of the app (AI-based text message intervention). Treatment group II received video messages from a companion, in addition to the text messages (combined text message and human video message intervention by AI). The control group used the app to keep a dietary record, but no feedback was provided (no intervention). We examine the participants’ continuity and the effects on physical indicators.

RESULTS: Combined AI and video messaging (treatment group II) led to a lower dropout rate from the program compared to the control group, and the Cox proportional-hazards model estimate showed a hazard ratio (HR) of 0.078, which was statistically significant at the 5% level. Further, human intervention with AI and video messaging significantly reduced the body fat percentage (BFP) of participants after 3 months compared to the control group, and the rate of reduction was greater in the group with more individualized intervention. The AI-based text messages affected the BMI but had no significant effect on the BFP.

CONCLUSIONS: This experiment shows that it is challenging to sustain participants’ healthy behavior with AI intervention alone. The results also suggest that even if the health information conveyed is the same, the information conveyed by humans and AI is more effective in improving health than the information sent by AI alone. The support received from the companion in the form of video messages may have promoted voluntary health behaviors. It is noteworthy that companions were competent, even though they were nonexperts. This means that person-to-person communication is crucial for health interventions.

PMID:35675107 | DOI:10.2196/30630

JAMA Cardiol. 2022 Jun 8. doi: 10.1001/jamacardio.2022.1437. Online ahead of print.

ABSTRACT

IMPORTANCE: Intimal hyperplasia and subsequent saphenous vein graft failure may have significant adverse clinical effects in patients undergoing coronary artery bypass surgery. External support of saphenous vein grafts has the potential to prevent vein graft dilation and hence slow the rate of intimal hyperplasia and increase long-term vein patency.

OBJECTIVE: To determine efficacy, as measured by intimal hyperplasia, and safety of an external saphenous vein graft support device in patients undergoing a coronary bypass graft procedure.

DESIGN, SETTING, AND PARTICIPANTS: This within-patient randomized, open-label, multicenter study was conducted at 17 Cardiothoracic Surgical Trials Network centers in North America. Between January 2018 and February 2019, 224 patients with multivessel coronary artery disease undergoing isolated bypass surgery were enrolled. For each patient, 1 of 2 vein grafts was randomized to receive external support or no support.

INTERVENTIONS: External vein graft support or no support.

MAIN OUTCOMES AND MEASURES: The primary efficacy end point was intimal hyperplasia area assessed by intravascular ultrasound at 12 months postrandomization for each study graft. Secondary confirmatory end points were lumen diameter uniformity assessed by angiography and graft failure (≥50% stenosis) by quantitative coronary angiography. Major cardiac and cerebrovascular events were collected through month 12.

RESULTS: Among 224 patients (mean [SD] age, 65.8 [8.3] years; 178 [79.5%] male), 203 (90.6%) were eligible for intravascular ultrasound, of which 85 (41.9%) had at least 1 study graft occluded or severely diseased at 12 months (55 supported, 56 unsupported). After imputation of data missing because of graft occlusion or severe disease, the estimated mean (SE) intimal hyperplasia area was 5.11 (0.16) mm2 in supported grafts and 5.79 (0.20) mm2 in unsupported grafts (P = .07). In a sensitivity analysis of 113 patients with both grafts imaged, the mean intimal hyperplasia area was 4.58 (0.18) mm2 and 5.12 (0.23) mm2 in supported and unsupported grafts, respectively (P = .04). By 12 months, 5 patients (2.2%) died and 16 patients (7.1%) experienced a major cardiac or cerebrovascular event.

CONCLUSIONS AND RELEVANCE: The 12-month difference in intimal hyperplasia area between supported and unsupported grafts did not achieve statistical significance. Cumulative mortality and major cardiac or cerebrovascular events rates were similar to those in other randomized coronary artery bypass trials. Further investigation to assess the effect of external graft support devices on long-term graft patency and clinical outcomes is warranted.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03209609.

PMID:35675092 | DOI:10.1001/jamacardio.2022.1437

JAMA Cardiol. 2022 Jun 8. doi: 10.1001/jamacardio.2022.1378. Online ahead of print.

ABSTRACT

IMPORTANCE: De novo hypertensive disorders of pregnancy (HDP) are associated with adverse maternal and offspring outcomes. Heterogeneity among racial and ethnic subgroups may be masked with aggregate reporting of race and ethnicity, such as Asian or Pacific Islander or Hispanic.

OBJECTIVE: To determine patterns in de novo HDP rates among individuals in Asian and Hispanic subgroups with a first live birth in the United States in the period 2011 through 2019.

DESIGN, SETTING, AND PARTICIPANTS: This serial cross-sectional analysis used data from 2011 through 2019 for individuals aged 15 to 44 years with singleton first live births obtained from the US National Center for Health Statistics natality database.

EXPOSURES: Stratification by self-report of maternal race and ethnicity: Hispanic/Latina (overall and Hispanic/Latina subgroups [Central/South American, Cuban, Mexican, and Puerto Rican]), non-Hispanic Asian and Pacific Islander (overall and non-Hispanic Asian subgroups [Asian Indian, Chinese, Filipina, Japanese, Korean, and Vietnamese]), non-Hispanic Black, non-Hispanic White.

MAIN OUTCOMES AND MEASURES: De novo HDP was defined as new-onset hypertension during pregnancy (gestational hypertension or preeclampsia). Age-standardized rates of HDP (per 1000 live births) and respective mean annual percent change in race and ethnicity groups and subgroups were calculated.

RESULTS: Among 13 238 918 individuals, the mean (SD) age was 26.3 (5.8) years. Overall, HDP rates increased 7.3% per year (95% CI, 6.5%-8.1%), from 57.2 (95% CI, 56.8-57.6) per 1000 live births in 2011 to 99.7 (95% CI, 99.2-100.2) per 1000 live births in 2019. Rates of HDP significantly increased in all racial and ethnic groups and subgroups over the study period. The highest HDP prevalence among non-Hispanic Asian subgroups in 2019 was in Filipina individuals (92.5 [95% CI, 86.3-98.8] per 1000 live births), and the highest among Hispanic/Latina subgroups in 2019 was in Puerto Rican individuals (98.6 [95% CI, 94.2-102.9] per 1000 live births) with significant heterogeneity observed among subgroups across the study period.

CONCLUSIONS AND RELEVANCE: Rates of HDP among individuals with a singleton first live birth increased in the United States from 2011 to 2019 across all race and ethnicity subgroups, with considerable heterogeneity in HDP rates in non-Hispanic Asian and Hispanic/Latina subgroups.

PMID:35675084 | DOI:10.1001/jamacardio.2022.1378