Nevin Manimala

Cochrane Database Syst Rev. 2022 Apr 4;4:CD011136. doi: 10.1002/14651858.CD011136.pub3.

ABSTRACT

BACKGROUND: Tracheal intubation is a common procedure performed to secure the airway in adults undergoing surgery or those who are critically ill. Intubation is sometimes associated with difficulties and complications that may result in patient harm. While it is traditionally achieved by performing direct laryngoscopy, the past three decades have seen the advent of rigid indirect videolaryngoscopes (VLs). A mounting body of evidence comparing the two approaches to tracheal intubation has been acquired over this period of time. This is an update of a Cochrane Review first published in 2016.

OBJECTIVES: To assess whether use of different designs of VLs in adults requiring tracheal intubation reduces the failure rate compared with direct laryngoscopy, and assess the benefits and risks of these devices in selected population groups, users and settings.

SEARCH METHODS: We searched MEDLINE, Embase, CENTRAL and Web of Science on 27 February 2021. We also searched clinical trials databases, conference proceedings and conducted forward and backward citation searches.

SELECTION CRITERIA: We included randomized controlled trials (RCTs) and quasi-RCTs with adults undergoing laryngoscopy performed with either a VL or a Macintosh direct laryngoscope (DL) in any clinical setting. We included parallel and cross-over study designs.

DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. We collected data for the following outcomes: failed intubation, hypoxaemia, successful first attempt at tracheal intubation, oesophageal intubation, dental trauma, Cormack-Lehane grade, and time for tracheal intubation.

MAIN RESULTS: We included 222 studies (219 RCTs, three quasi-RCTs) with 26,149 participants undergoing tracheal intubation. Most studies recruited adults undergoing elective surgery requiring tracheal intubation. Twenty-one studies recruited participants with a known or predicted difficult airway, and an additional 25 studies simulated a difficult airway. Twenty-one studies were conducted outside the operating theatre environment; of these, six were in the prehospital setting, seven in the emergency department and eight in the intensive care unit. We report here the findings of the three main comparisons according to videolaryngoscopy device type. We downgraded the certainty of the outcomes for imprecision, study limitations (e.g. high or unclear risks of bias), inconsistency when we noted substantial levels of statistical heterogeneity and publication bias. Macintosh-style videolaryngoscopy versus direct laryngoscopy (61 studies, 9883 participants) We found moderate-certainty evidence that a Macintosh-style VL probably reduces rates of failed intubation (risk ratio (RR) 0.41, 95% confidence interval (CI) 0.26 to 0.65; 41 studies, 4615 participants) and hypoxaemia (RR 0.72, 95% CI 0.52 to 0.99; 16 studies, 2127 participants). These devices may also increase rates of success on the first intubation attempt (RR 1.05, 95% CI 1.02 to 1.09; 42 studies, 7311 participants; low-certainty evidence) and probably improve glottic view when assessed as Cormack-Lehane grade 3 and 4 (RR 0.38, 95% CI 0.29 to 0.48; 38 studies, 4368 participants; moderate-certainty evidence). We found little or no clear difference in rates of oesophageal intubation (RR 0.51, 95% CI 0.22 to 1.21; 14 studies, 2404 participants) but this finding was supported by low-certainty evidence. We were unsure of the findings for dental trauma because the certainty of this evidence was very low (RR 0.68, 95% CI 0.16 to 2.89; 18 studies, 2297 participants). We were not able to pool data for time required for tracheal intubation owing to considerable heterogeneity (I² = 96%). Hyperangulated videolaryngoscopy versus direct laryngoscopy (96 studies, 11,438 participants) We found moderate-certainty evidence that hyperangulated VLs probably reduce rates of failed intubation (RR 0.51, 95% CI 0.34 to 0.76; 63 studies, 7146 participants) and oesophageal intubation (RR 0.39, 95% CI 0.18 to 0.81; 14 studies, 1968 participants). In subgroup analysis, we noted that hyperangulated VLs were more likely to reduce failed intubation when used on known or predicted difficult airways (RR 0.29, 95% CI 0.17 to 0.48; P = 0.03 for subgroup differences; 15 studies, 1520 participants). We also found that these devices may increase rates of success on the first intubation attempt (RR 1.03, 95% CI 1.00 to 1.05; 66 studies, 8086 participants; low-certainty evidence) and the glottic view is probably also improved (RR 0.15, 95% CI 0.10 to 0.24; 54 studies, 6058 participants; data for Cormack-Lehane grade 3/4 views; moderate-certainty evidence). However, we found low-certainty evidence of little or no clear difference in rates of hypoxaemia (RR 0.49, 95% CI 0.22 to 1.11; 15 studies, 1691 participants), and the findings for dental trauma were unclear because the certainty of this evidence was very low (RR 0.51, 95% CI 0.16 to 1.59; 30 studies, 3497 participants). We were not able to pool data for time required for tracheal intubation owing to considerable heterogeneity (I² = 99%). Channelled videolaryngoscopy versus direct laryngoscopy (73 studies, 7165 participants) We found moderate-certainty evidence that channelled VLs probably reduce rates of failed intubation (RR 0.43, 95% CI 0.30 to 0.61; 53 studies, 5367 participants) and hypoxaemia (RR 0.25, 95% CI 0.12 to 0.50; 15 studies, 1966 participants). They may also increase rates of success on the first intubation attempt (RR 1.10, 95% CI 1.05 to 1.15; 47 studies, 5210 participants; very low-certainty evidence) and probably improve glottic view (RR 0.14, 95% CI 0.09 to 0.21; 40 studies, 3955 participants; data for Cormack-Lehane grade 3/4 views; moderate-certainty evidence). We found little or no clear difference in rates of oesophageal intubation (RR 0.54, 95% CI 0.17 to 1.75; 16 studies, 1756 participants) but this was supported by low-certainty evidence. We were unsure of the findings for dental trauma because the certainty of the evidence was very low (RR 0.52, 95% CI 0.13 to 2.12; 29 studies, 2375 participants). We were not able to pool data for time required for tracheal intubation owing to considerable heterogeneity (I² = 98%).

AUTHORS’ CONCLUSIONS: VLs of all designs likely reduce rates of failed intubation and result in higher rates of successful intubation on the first attempt with improved glottic views. Macintosh-style and channelled VLs likely reduce rates of hypoxaemic events, while hyperangulated VLs probably reduce rates of oesophageal intubation. We conclude that videolaryngoscopy likely provides a safer risk profile compared to direct laryngoscopy for all adults undergoing tracheal intubation.

PMID:35373840 | DOI:10.1002/14651858.CD011136.pub3

Soft Matter. 2022 Apr 4. doi: 10.1039/d2sm00200k. Online ahead of print.

ABSTRACT

Understanding the process-property relations of helical polymers using molecular simulations has been an attractive research field over the years. Specifically, isotactic polypropylene still remains a challenge for current computational experimentation, as it exhibits phenomena such as crystallization that emerge on large spatial and temporal scales. Coarse-graining is an efficient technique for approaching such phenomena, although previous coarse-grained models lack in preserving important atomistic and structural details. In this paper we develop a new coarse-grained model, based on the popular MARTINI force field, that is able to reproduce the helical behavior of isotactic polypropylene. To test the model, the predicted statistical and structural properties (characteristic ratio, density, entanglement molecular weight, solubility parameter in the melt) are compared with previous simulation results and available experimental data. For the development of the new coarse-grained force field, a single unperturbed chain Monte Carlo algorithm has been implemented: an efficient algorithm which samples conformations representative of a melt by simulating just a single chain.

PMID:35373807 | DOI:10.1039/d2sm00200k

Ital J Dermatol Venerol. 2022 Apr 4. doi: 10.23736/S2784-8671.22.07280-2. Online ahead of print.

ABSTRACT

BACKGROUND: Diffuse Connective Tissue Diseases (DCTD) are autoimmune diseases that can cause comorbidities, influencing physical and psychological aspects and increase stress. The latter may also be related to the practice of physical activity (PPA). Although evidence shows that it can contribute to patients’ health, the level of PPA can decrease after the diagnosis.

AIMS: to evaluate the basic emotions, perceived stress (PS) and PPA levels of patients with DCTD.

METHODS: This is a field study.

METHODS AND MATERIAL: random approach of 55 participants. We used a clinical and sociodemographic profile form, for the verification of emotions, a picture with emojis of the basic emotions, the PSS-14 and the IPAQ-Brief.

STATISTICAL ANALYSIS USED: dada were analysed with Mann-Whitney U and Kruskal-Wallis tests; with 5% of significance.

RESULTS: The average age was 49.1 ± 12.9, mostly female (58.7%). High PS was reported by 54.5%; emotions such as joy (38.2%) and anxiety/fear (25.5%], as well as sadness (7.3%), were reported. About 87.3% were classified as having insufficient levels of PPA. Female patients (U=137.0; p<0.05) and insufficient PPA levels (U=86.5%; p<0.05) had higher PS scores, as well as those feeling sadness (X2 =19.0; p<0.05).

CONCLUSIONS: The results point to the need for care with the emotional domain of these patients and suggest studies that analyze the impact of implementing PPA for this population.

PMID:35373782 | DOI:10.23736/S2784-8671.22.07280-2

Ital J Dermatol Venerol. 2022 Apr 4. doi: 10.23736/S2784-8671.22.07275-9. Online ahead of print.

ABSTRACT

BACKGROUND: The mechanisms involved in mycosis fungoides and Sezary Syndrome progression are largely unknown. Over the last decade the interest in immune system contrast of neoplasm has grown owing to the introduction of immunotherapy. PD-1 and its ligand (PD-L1) are the target of several immunotherapy treatment. In the literature reports on the expression of PD-1 and PD-L1 have provided contrasting results.

METHODS: In our analysis we investigated PD-1 expression in neoplastic cells and in tumour infiltrating lymphocytes (TILs) as well as PD-L1 expression in tumour cells and in tumour associated macrophages (TAMs). PD-L1 and PD-1 positive cells were counted in 5 high-power fields (HPF) and scored as the average number of positive neoplastic cells/TILs/TAMs per HPF.

RESULTS: From databases of two institutions (Bologna and Florence) thirty-five patients corresponding to 43 biopsies were retrieved. In seven instances sequential biopsies were present. No statistically significant expression was observed comparing early to advanced stages by analysing PD-1 by tumour cells and TILs and of PD-L1 by tumour cells and TAMs.

CONCLUSIONS: Our results corroborate that PD-1 and PD-L1 expression is not stage-dependent in mycosis fungoides and Sezary syndrome. However, PD-1 and PD-L1 expression in affected patients provides a rationale to schedule anti PD-1/PD-L1 drugs.

PMID:35373781 | DOI:10.23736/S2784-8671.22.07275-9

Sports Biomech. 2022 Apr 3:1-17. doi: 10.1080/14763141.2022.2054856. Online ahead of print.

ABSTRACT

Thigh muscle weakness prevails following anterior cruciate ligament (ACL) injury, as usually evaluated by peak concentric quadriceps strength. Assessment throughout the range of motion (ROM), and for antagonists may provide more comprehensive information. We evaluated angle-specific torque profiles and ratios of isokinetic thigh muscle strength in 70 individuals 23 ± 2 years post-ACL injury (44males, 46.9 ± 5.4 years); 33 treated with ACL-reconstruction (ACL-R), and 37 treated only with physiotherapy (ACL-PT), and 33 controls. Quadriceps and hamstrings torques for concentric/eccentric contractions (90°/s) and ratios between hamstrings/quadriceps strength (HQ) were compared between and within groups using inferential functional data methods. The injured ACL-R leg had lower concentric and eccentric quadriceps strength compared to non-injured leg throughout the ROM, and lower concentric (interval 70-79°) and eccentric (64-67°) quadriceps strength compared to controls. The injured ACL-PT leg showed lower eccentric quadriceps strength (53-77°) than non-injured leg and lower concentric (41-79°) and eccentric (52-81°) quadriceps and eccentric hamstrings (30-77°) strength than controls. There were no group differences for HQ-ratios. The injured ACL-R leg had higher HQ-ratio (34-37°) than non-injured leg. Angle-specific torque profiles revealed strength deficits, masked if using only peak values, and seem valuable for ACL-injury rehabilitation.

PMID:35373714 | DOI:10.1080/14763141.2022.2054856

Small Methods. 2022 Apr 3:e2200029. doi: 10.1002/smtd.202200029. Online ahead of print.

ABSTRACT

GeSn on Si has attracted much research interest due to its tunable direct bandgap for mid-infrared applications. Recently, short-range order (SRO) in GeSn alloys has been theoretically predicted, which profoundly impacts the band structure. However, characterizing SRO in GeSn is challenging. Guided by physics-informed Poisson statistical analyses of k-nearest neighbors (KNN) in atom probe tomography (APT), a new approach is demonstrated here for 3D nanoscale SRO mapping and semi-quantitative strain mapping in GeSn. For GeSn with ≈14 at. % Sn, the SRO parameters of Sn-Sn 1NN in 10 × 10 × 10 nm³ nanocubes can deviate from that of the random alloys by ±15 %. The relatively large fluctuation of the SRO parameters contributes to band-edge softening observed optically. Sn-Sn 1NN also tends to be more favored toward the surface, less favored under strain relaxation or tensile strain, while almost independent of local Sn composition. An algorithm based on least square fit of atomic positions further verifies this Poisson-KNN statistical method. Compared to existing macroscopic spectroscopy or electron microscopy techniques, this new APT statistical analysis uniquely offers 3D SRO mapping at nanoscale resolution in a relatively large volume with millions of atoms. It can also be extended to investigate SRO in other alloy systems.

PMID:35373530 | DOI:10.1002/smtd.202200029

Int Wound J. 2022 Apr 3. doi: 10.1111/iwj.13809. Online ahead of print.

ABSTRACT

Amniotic membranes are known to be rich in growth factors, cytokines, and matrix proteins, which can help support wound closure and may improve patient outcomes in foot and ankle surgical interventions. In this Institutional Review Board (IRB) approved clinical study, 21 consecutive patients undergoing lower extremity soft tissue and bone reconstruction surgery received dehydrated human amnion and chorion allograft (dHACA) placed as a covering over the deep layers of the surgical wound during closure. Wound healing complications were assessed and American Orthopaedic Foot and Ankle Society (AOFAS) scores were compiled from over a 1-year follow-up period. Summary statistics were calculated for average pain, function, and alignment. The average overall AOFAS pre-treatment score was 35.8 ± 23.0 and the post-treatment score significantly improved to 87.5 ± 6.4 (P = 3.7 × 10^-10 ). The pain-score improved from pre-treatment at 10.0 ± 11.0 to post-treatment at 36.7 ± 4.8 (P = 5.0 × 10^-5 ). The pre-treatment function score was 18.7 ± 12.9 and at post-treatment increased to 38.5 ± 5.7 (P = 5.8 × 10^-5 ). Lastly, the alignment score at pre-treatment was 7.1 ± 4.4 and at post-treatment was 12.4 ± 2.6 (P = .001). These improvements in functional scores were accompanied with clinical observations of reduced surgical complications including a lack of wound dehisance in the cohort. These clinical findings suggest that the application of aseptically processed dHACA may reduce wound complications and as such may aide in clinical improvements in foot and ankle surgical interventions however a larger comparative trial should be considered to validate these initial findings.

PMID:35373506 | DOI:10.1111/iwj.13809

ANZ J Surg. 2022 Apr 3. doi: 10.1111/ans.17669. Online ahead of print.

ABSTRACT

BACKGROUND: Interhospital transfers in Australia facilitate access to acute surgical services, however transfer delays can occur. The aims of this study were to examine Australian mortality audit data on acute surgical patients who were transferred after presenting with a surgical emergency, and to identify modifiable predictors of transfer delay.

METHODS: Surgical admissions between 1 January 2001 and 18 August 2020 were retrospectively extracted from the Australian and New Zealand Audit of Surgical Mortality database. Relevant factors and themes of interest were collated. Results were presented as odds ratios (OR) and 95% confidence intervals (CI), with statistical significance defined as P <0.05.

RESULTS: After exclusion, a final 8270 cases were analysed. Non-modifiable predictors identified were female gender (OR 1.34, 95% CI 1.05-1.70, P = 0.0184), comorbidities (OR 1.50, 95% CI 1.40-161, P <0.0001) and major non-trauma non-vascular specialty (OR 1.54 to 7.77, depending on specialty, P < 0.05). Modifiable predictors were inadequate clinical assessment (OR 49.48, 95% CI 32.91-74.38, P <0.0001), poor communication (OR 6.62, 95% CI 3.70-11.85, P <0.0001) and multiple transfers (OR 6.30, OR 95% 4.31-9.21, P <0.0001). Age, lack of bed and after-hours transfer did not predict transfer delays. Metropolitan transfers was protective against transfer delays (OR 0.64, 95% CI 0.47-0.86, P = 0.0035).

CONCLUSION: In the view of the receiving surgeon or assessor, all transfer delays potentially contributed to patient deaths, and may have been preventable. Strategies directed at modifiable factors could minimize delays. Increased surgical services in non-metropolitan regions could reduce need for transfer. Prospective data is required to examine if the same predictors are observed in surgical patients who survive.

PMID:35373494 | DOI:10.1111/ans.17669

Mol Inform. 2022 Apr 3. doi: 10.1002/minf.202200026. Online ahead of print.

ABSTRACT

A quantitative structure-property relationship (QSPR) modeling was carried out for predicting drug and drug-like compounds solubility in supercritical carbon dioxide. For the first time, a dataset of 148 drugdrug-like compounds, accounting for 3971 experimental data points (EDPs), was collected and used for modelling the relationship between selected molecular descriptors and solubility fraction data achieved by a nonlinear approached (Artificial neural network, ANN) based on molecular descriptors. Experimental solubility data for a given drug are published as a function of temperature and pressure. In this study, 11 significant PaDEL descriptors (AATS3v, MATS2e, GATS4c, GATS3v, GATS4e, GATS3s, nBondsM, AVP-0, SHBd, MLogP, and MLFER_S), the temperature and the pressure were statistically proved to be sufficient inputs. The architecture of the optimised model was found to be {13,10,1}. Validation of the model was checked using several recommended statistical metrics, including Average absolute relative deviation (AARD=3.7748%), Root Mean Square Error (RMSE=0.5162), Coefficient of Correlation (r=0.9761), Coefficient of Determination (R²=0.9528), and Robustise (Q²=0.9528). The model was also subjected to an external test by using 143 EDPs. Sensitivity analysis and domain of application were examined. The overall results confirm that the optimised ANN-QSPR model can be used reliably for the correlation and prediction of this property.

PMID:35373477 | DOI:10.1002/minf.202200026

Acad Emerg Med. 2022 Apr 3. doi: 10.1111/acem.14497. Online ahead of print.

ABSTRACT

BACKGROUND: Although more guideline-adherent care has been described in pediatric compared to adult trauma centers, we aimed to provide a more detailed characterization of management and resource utilization of children with intra-abdominal injury (IAI) within pediatric centers. Our primary objective was to describe the epidemiology, diagnostic evaluation, and management of children with IAI across U.S. children’s hospitals. Our secondary objective was to describe the inter-hospital variation in surgical management of children with IAI.

METHODS: We conducted a cross-sectional study of 33 hospitals in the Pediatric Health Information System. We included children aged <18 years evaluated in the emergency department from 2010-2019 with IAI, as defined by ICD coding, and who underwent an abdominal computed tomography (CT). Our primary outcome was abdominal surgery. We categorized IAI by organ system and described resource utilization data. We used generalized linear regression to calculate adjusted hospital-level proportions of abdominal surgery, with a random effect for hospital.

RESULTS: We studied 9,265 children with IAI. Median (IQR) age was 9.0 years (IQR: 6.0, 13.0). Abdominal surgery was performed in 16% (n=1,479) of children, with the lowest proportion of abdominal surgery observed in children aged <5 years. Liver (38.6%) and spleen (32.1%) were the most common organs injured. 3.1% of children with liver injuries and 2.8% with splenic injuries underwent abdominal surgery. Although there was variation in rates of surgery across hospitals (p<0.001), only 3 of 33 hospitals had rates that were statistically different from the aggregate mean of 16%.

CONCLUSIONS: Most children with IAI are managed non-operatively, and most children’s hospitals manage children with IAI similarly. These data can be used to inform future benchmarking efforts across hospitals to assess concordance with guidelines for the management of children with IAI.

PMID:35373473 | DOI:10.1111/acem.14497