Nevin Manimala

Gerontology. 2021 Apr 13:1-9. doi: 10.1159/000515161. Online ahead of print.

ABSTRACT

INTRODUCTION: The Multidimensional Prognostic Index (MPI) is a validated tool for assessing mortality risk in hospitalised patients. We aimed to evaluate whether the MPI predicted mortality and the risk of developing diverticular disease (DD) complications in older patients.

METHODS: This is a multicentre study conducted in January 2016-March 2018. All patients with DD aged 65 years and older were included. Patients were stratified into three groups according to MPI groups (1, low risk; 2, moderate risk; 3, high risk). Risk of developing DD complications and mortality rate were assessed. Bivariate models were fitted.

RESULTS: One hundred hospitalised patients with DD (mean age 77.9 ± 10.6 years, 53 female patients) were included. Patients with higher MPI groups were more likely to develop DD complications. In particular, 12 (46.2%), 21 (52.5%), and 28 (82.4%) patients with complicated DD were distributed to the MPI 1, MPI 2, and MPI 3 groups (p = 0.0063), respectively. Two patients died in the MPI 1, 4 in the MPI 2, and 29 in the MPI 3 group, with mortality rates of 4.0 per 100 person-year (95% confidence interval [CI] 1.0-15.9), 5.6 (95% CI 2.1-15.0), and 89.2 (95% CI 62-130), respectively (log-rank test p < 0.001). In bivariate analysis, after adjustment for age >80 years, Charlson Comorbidity Index >4, DD complications, and the presence of thromboembolism, higher MPI group was independently associated with higher mortality. Those in the MPI 3 group experienced a greater risk of 1-year hospital readmission (p < 0.001).

CONCLUSION: MPI predicted mortality in patients with DD and also correlated with the risk of developing DD complications. Studies focussing on possible pathophysiological mechanisms between DD complications and MPI are needed.

PMID:33849017 | DOI:10.1159/000515161

Acta Haematol. 2021 Apr 13:1-9. doi: 10.1159/000514907. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this study was to determine the expression of G protein-coupled receptors (GPCRs) in platelets from adult patients with chronic immune thrombocytopenic purpura (ITP).

METHODS: Peripheral blood samples were collected from 40 patients with chronic ITP in the Second Affiliated Hospital of Shantou University Medical College, and 40 peripheral blood samples from healthy volunteers were collected; expressions of the adenosine diphosphate receptors (P2Y1 and P2Y12), alpha-2A adrenergic receptor (α2A-AR), and thromboxane A2 receptor (TP) in platelets were detected by flow cytometry. Gα protein, protease-activated receptor 1 (PAR1), and protease-activated receptor 4 (PAR4) were analyzed by Western blot and analyzed statistically.

RESULTS: Flow cytometry measurements of mean fluorescence intensities showed platelets from patients with chronic ITP, compared to healthy individuals, had significantly higher levels of P2Y1 (31.4 ± 2.2 vs. 7.8 ± 0.8), P2Y12 (29.6 ± 2.1 vs. 7.2 ± 1.3), α2A-AR (25.8 ± 2.9 vs. 9.8 ± 0.9), and TP (39.8 ± 3.1 vs. 4.7 ± 0.6) (all p < 0.01). Similarly, integrated optical density analysis of Western blots showed that platelets from patients with chronic ITP had significantly higher levels of Gα (1046.3 ± 159.96 vs. 254.49 ± 39.51), PAR1 (832.98 ± 98.81 vs. 203.92 ± 27.47), and PAR4 (1518.80 ± 272.45 vs. 431.27 ± 41.86) (all p < 0.01).

CONCLUSION: Expression of GPCRs is increased in platelets from patients with chronic ITP, suggesting that platelets of chronic ITP may participate in the complicated biological process by means of GPCR-mediated signaling pathways.

PMID:33849009 | DOI:10.1159/000514907

J Neural Eng. 2021 Apr 13. doi: 10.1088/1741-2552/abf772. Online ahead of print.

ABSTRACT

OBJECTIVE: To explore the viability of developing a computer-aided diagnostic system for Parkinsonian syndromes using dynamic [11C]raclopride PET and T1-weighted MRI data.

APPROACH: The biological heterogeneity of Parkinsonian syndromes renders their statistical classification a challenge. The unique combination of structural and molecular imaging data allowed different classifier designs to be tested. Datasets from dynamic [11C]raclopride PET and T1-weighted MRI scans were acquired from six groups of participants: healthy controls (CTRL n=15), patients with Parkinson’s disease (PD n=27), multiple system atrophy (MSA n=8), corticobasal degeneration (CBD n=6), and dementia with Lewy bodies (DLB n=5). MSA, CBD, and DLB patients were classified into one category designated as atypical parkinsonism (AP). The distribution volume ratio (DVR) kinetic parameters obtained from PET data were used to quantify the reversible tracer binding to D2/D3 receptors in the subcortical regions of interest (ROI). Grey matter (GM) volumes obtained from the MRI data were used to quantify GM atrophy across cortical, subcortical, and cerebellar ROI.

RESULTS: The classifiers CTRL vs PD and CTRL vs AP achieved the highest balanced accuracy combining DVR and GM (DVR-GM) features (96.7%, 92.1%, respectively), followed by the classifiers designed with DVR features (93.3%, 88.8%, respectively), and GM features (69.6%, 86.1%, respectively). In contrast, the classifier PD vs AP showed the highest balanced accuracy (78.9%) using DVR features only. The integration of DVR-GM (77.9%) and GM features (72.7%) produced inferior performances. The classifier CTRL vs PD vs AP showed high weighted balanced accuracy when DVR (80.5%) or DVR-GM features (79.9%) were integrated. GM features revealed poorer performance (59.5%).

SIGNIFICANCE: This work was unique in its combination of structural and molecular imaging features in binary and triple category classifications. We were able to demonstrate improved binary classification of healthy/diseased status (concerning both PD and AP) and equate performance to DVR features in multiclass classifications.

PMID:33848996 | DOI:10.1088/1741-2552/abf772

Child Abuse Negl. 2021 Apr 10;117:105069. doi: 10.1016/j.chiabu.2021.105069. Online ahead of print.

ABSTRACT

BACKGROUND: Adult substance use contributes to high rates of child maltreatment, adverse parenting, and poor child well-being outcomes. The Children’s Bureau in the Administration for Children and Families, U.S. Department of Health and Human Services funded the Regional Partnership Grant (RPG) program to improve safety, well-being, and permanency outcomes for children at risk of or in out-of-home placements because of caregivers’ substance use.

OBJECTIVE: This study estimates the effect of the RPG program on adult parenting and recovery outcomes, as well as child safety, permanency, and well-being outcomes.

PARTICIPANTS AND SETTING: This study included samples from three RPG projects funded in 2014. A total of 437 families were included in the evaluation: 198 enrolled in RPG and 239 in the comparison group.

METHODS: Outcomes included both administrative data and standardized instruments collected at program entry and exit. Impacts were calculated by comparing regression-adjusted differences between RPG participants and a well-matched comparison group.

RESULTS: The RPG program showed two favorable and statistically significant impacts on adult outcomes: reduced trauma symptoms (ES = -0.25, p = 0.02), and depressive symptoms (ES = -0.25, p = 0.03). In addition, children enrolled in RPG had reduced behavior problems (ES = -0.31, p = 0.02) and reduced executive functioning deficits (ES = -0.31, p = 0.04). There were no significant impacts observed for child safety and permanency outcomes.

CONCLUSIONS: The RPG approach has produced several favorable impacts on key mental health needs of caregivers and children, establishing foundational evidence of program effectiveness. Additional evaluation research is necessary to understand the effectiveness on additional outcomes with a larger, more generalizable sample.

PMID:33848956 | DOI:10.1016/j.chiabu.2021.105069

J Environ Manage. 2021 Apr 10;289:112522. doi: 10.1016/j.jenvman.2021.112522. Online ahead of print.

ABSTRACT

COVID-19 pandemic has caused profound impacts on human life and the environment including freshwater ecosystems globally. Despite the various impacts, the pandemic has improved the quality of the environment and thereby creating an opportunity to restore the degraded ecosystems. This study presents the imprints of COVID-19 lockdown on the surface water quality and chemical characteristics of the urban-based Bagmati River Basin (BRB), Nepal. A total of 50 water samples were collected from 25 sites of BRB during the monsoon season, in 2019 and 2020. The water temperature, pH, electrical conductivity, total dissolved solids, dissolved oxygen (DO), and turbidity were measured in-situ, while the major ions, total hardness, biological oxygen demand (BOD), and chemical oxygen demand (COD) were analyzed in the laboratory. The results revealed neutral to mildly alkaline waters with relatively moderate mineralization and dissolved chemical constituents in the BRB. The average ionic abundance followed the order of Ca²⁺ > Na⁺ > Mg²⁺ > K⁺ > NH₄⁺ for cations and HCO₃^–> Cl^– > SO₄^2- > NO₃^– > PO₄^3- for anions. Comparing to the pre-lockdown, the level of DO was increased by 1.5 times, whereas the BOD and COD were decreased by 1.5 and 1.9 times, respectively during the post-lockdown indicating the improvement of the quality water which was also supported by the results of multivariate statistical analyses. This study confirms that the remarkable recovery of degraded aquatic ecosystems is possible with limiting anthropic activities.

PMID:33848878 | DOI:10.1016/j.jenvman.2021.112522

Epilepsy Behav. 2021 Apr 10;118:107946. doi: 10.1016/j.yebeh.2021.107946. Online ahead of print.

ABSTRACT

OBJECTIVE: This study was aimed to analyze the effectiveness of sodium channel blockers (SCBs) in CDKL5 deficiency disorder (CDD)-related epilepsy.

METHODS: A retrospective, observational study was performed, including patients with CDD diagnosis evaluated between 2016 and 2019 at three tertiary Epilepsy Centers. Demographic, electroclinical and genetic features, as well as ASM treatments and their outcomes were analyzed, with special focus on SCBs.

RESULTS: Twenty-one patients evaluated at three tertiary Epilepsy Centers were included, of which 19 presented with epilepsy (90.5%); all had pathogenic mutations of CDKL5. Six patients (31.6%) were classified as SCB responders (more than 50% reduction), four being currently seizure free (mean seizure-free period of 8 years). Most frequent SCB drugs were oxcarbazepine (OXC), carbamazepine (CBZ), and lacosamide (LCM). None of them presented relevant adverse events. In contrast, three patients showed seizure aggravation in the non-responder group. When comparing both groups, responders had statistically significant younger age at SCB treatment and epilepsy onset, higher proportion of focal epileptiform activity and less frequent history of West syndrome.

CONCLUSIONS: The results of this study indicate that treatment with SCBs might be effective and safe in a subset of patients with CDD-related epilepsy.

PMID:33848848 | DOI:10.1016/j.yebeh.2021.107946

J Surg Res. 2021 Apr 10;264:462-468. doi: 10.1016/j.jss.2021.02.044. Online ahead of print.

ABSTRACT

BACKGROUND: Using the platform of morbidity and mortality conference, we developed and executed a combined faculty-resident intervention called “Education M&M” to discuss challenges faced by both parties in the operating room (OR), identify realistic solutions, and implement action plans. This study aimed to investigate the impact of this intervention on resident OR training.

MATERIALS AND METHODS: Two resident case presentations were followed by audience discussion and recommendations regarding actionable solutions aimed at improving resident OR training from an expert faculty panel. Postintervention surveys were completed by participants immediately and 2 mo later to assess perceived short and long-term impact on OR teaching and/or learning and the execution of two recommended solutions. Descriptive statistical analysis was applied.

RESULTS: Immediate post-intervention surveys (n = 44) indicated that 81.8% of participants enjoyed the M&M “a lot”; 90.1% said they would use some or a lot of the ideas presented. Awareness of OR teaching/learning challenges before and after the M&M improved from 3.0 to 3.7 (P = 0.00001) for faculty and 3.0 to 3.9 for trainees (P = 0.00004). Understanding of OR teaching and/or learning approaches improved from 3.1 to 3.7 for faculty (P = 0.00004) and 2.7 to 3.9 for trainees (P = 0.00001). In 2-mo post-intervention surveys, most residents had experienced two recommended solutions (71% and 88%) in the OR, but self-reported changes to faculty behavior did not reach statistical significance.

CONCLUSIONS: A department-wide education M&M could be an effective approach to enhance mutual communication between faculty members and residents around OR teaching/learning by identifying program-specific challenges and potential actionable solutions.

PMID:33848846 | DOI:10.1016/j.jss.2021.02.044

J Biomech. 2021 Apr 5;121:110417. doi: 10.1016/j.jbiomech.2021.110417. Online ahead of print.

ABSTRACT

A frog can jump several times higher than its own height and then land smoothly on the ground. During the buffering phase, both forelimbs touch the ground and compact quickly to absorb most of the impact energy. However, the adjustment of the joint angles of the forelimb and the induced cushioning effect during the landing process have not been thoroughly investigated. In this study, we statistically summarized the angular displacements of forelimb joints with respect to landing velocities by using a high-speed motion capture system. It is found many joint angles were linearly influenced by landing velocity at both ground touching moment and maximum compression moment. Moreover, the double-peak pattern of ground reactive force was measured, which attributes to the forelimb landing and the followed abdomen/hindlimb landing. Before the appearance of the first peak, the compression of the forelimb and the reactive force revealed a linear relationship regardless of velocity, implying that the forelimbs act as a constant stiffness spring in landing. Accordingly, a simple spring-mass model was proposed and verified by simulation for forelimb cushioning of the frog. We anticipate our achievements to inspire the design of future landing mechanisms.

PMID:33848828 | DOI:10.1016/j.jbiomech.2021.110417

Nutrition. 2021 Mar 4;89:111228. doi: 10.1016/j.nut.2021.111228. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this study was to understand the diet-related behaviors of Hainan centenarians and to analyze dietary factors that affect their nutritional status.

METHODS: Data were collected from the China Hainan Centenarian Cohort Study, a full sample survey including questionnaires, physical examinations, and physiologic indices of the centenarian population. The study included 1002 centenarians. The diet-related behaviors were assessed using the food frequency questionnaire; nutritional status was determined according to the Mini Nutritional Assessment – short form scale scores. We used logistic regression models to analyze the main dietary risk factors of malnutrition.

RESULTS: Of all the centenarians, 94.6% maintained regular meals, 80.4% had three meals a day, 53.4% ate each meal until 80% full, 88.7% ate vegetables daily, and 70% drank one to two cups of water daily. Centenarians ate rice-based staple foods; eggs, dairy, legumes, nuts, and poultry were not popular. The main sources of meat were red meat and seafood. None liked fried food, and 19.3% preferred sweet flavors. People with normal nutritional status accounted for 12.3% of the population, whereas those with malnutrition comprised 20.8%. Dietary factors that affected nutritional status included three meals a day (odds ratio [OR], 0.366; 95% confidence interval [CI], 0.173-0.778), tea drinking (OR, 0.236; 95% CI, 0.087-0.641), and the frequency of poultry (OR, 0.261; 95% CI, 0.088-0.771), seafood (OR, 0.247; 95% CI, 0.110-0.554), nuts (OR, 0.381; 95% CI, 0.150-0.965), and pastry (OR, 0.219; 95% CI, 0.080-0.600) consumption.

CONCLUSION: This was the first study on the dietary behaviors and nutritional status of centenarians using survey data. We highlighted the factors affecting nutritional status and provided scientific support for dietary strategies that may improve the nutritional status of the elderly population.

PMID:33848822 | DOI:10.1016/j.nut.2021.111228

Seizure. 2021 Apr 6;88:125-129. doi: 10.1016/j.seizure.2021.04.005. Online ahead of print.

ABSTRACT

Purpose To quantify the influence of prior knowledge about the patient and the EEG circumstances on the EEG-based seizure detection rate. Methods A sample of 95 EEGs with epileptic seizure patterns matched with 95 seizure-free control sequences were extracted from EEG video monitoring data. They were stripped of all additional information. These plain EEG recordings were evaluated by two board certified EEG reviewers. The results were compared with the interpretations of the original video monitoring evaluations. Results Using the plain EEG sequences, epileptic seizure patterns were detected with a sensitivity and specificity of 0.758 and 0.958, respectively. The classification of the seizure pattern localization and lateralization differed in 56% and 50%, respectively, from the results of the video monitoring evaluations. Conclusion Additional information about the patient and the events during an EEG recording leads to a clinically and statistically significant increase in the seizure detection rates. These results imply that the human evaluation of a plain EEG without further information may not be seen as the gold standard in EEG evaluation. The performance estimation of automated EEG evaluation methods should take this into account.

PMID:33848791 | DOI:10.1016/j.seizure.2021.04.005