Nevin Manimala

Physiol Meas. 2021 Mar 18. doi: 10.1088/1361-6579/abf01e. Online ahead of print.

ABSTRACT

OBJECTIVE: Clinical assessment of upper limb hemiparesis in acute stroke involves repeated manual examination of hand movements during instructed tasks. This process is labour-intensive and prone to human errors while also being strenuous for the patient. Wearable motion sensors can automate the process by measuring characteristics of hand activity. Existing work in this direction either use multiple sensors or complex instructed movements, or analyze only the quantity of upper limb motion. These methods are obtrusive and strenuous for acute stroke patients and also sensitive to noise. In this work, we propose to use only two wrist-worn accelerometer sensors to study the quality of completely spontaneous upper limb motion and investigate correlation with clinical scores for acute stroke care.

APPROACH: Velocity time series estimated from acquired acceleration data during spontaneous motion is decomposed into smaller movement elements. Measures of density, duration and smoothness of these component elements are extracted and their disparity is studied across the two hands.

MAIN RESULTS: Spontaneous upper limb motion in acute stroke can be decomposed into movement elements that resemble point-to-point reaching tasks. These elements are smoother and sparser in the normal hand than the hemiparetic hand, and the amount of smoothness correlates with hemiparetic severity. Features characterizing the disparity of these movement elements between two hands show statistical significance in differentiating mild-to-moderate and severe hemiparesis. Using data from 67 acute stroke patients, the proposed method can classify the two levels of hemiparetic severity with 85% accuracy. Additionally, compared to activity based features, the proposed method is robust to the presence of noise in acquired data.

SIGNIFICANCE: This work demonstrates that the quality of upper limb motion can characterize and identify hemiparesis in stroke survivors. This is clinically significant towards continuous automated assessment of hemiparesis in acute stroke using minimally intrusive wearable sensors.

PMID:33735840 | DOI:10.1088/1361-6579/abf01e

Int J Med Inform. 2021 Mar 5;149:104437. doi: 10.1016/j.ijmedinf.2021.104437. Online ahead of print.

ABSTRACT

BACKGROUND: Accurate recording of ethnicity in electronic healthcare records is important for the monitoring of health inequalities. Yet until the late 1990s, ethnicity information was absent from more than half of records of patients who received inpatient care in England. In this study, we report on the usefulness of a names-based ethnicity classification, Ethnicity Estimator (EE), for addressing this gap in the hospital records.

MATERIALS AND METHODS: Data on inpatient hospital admissions were obtained from Hospital Episode Statistics (HES) between April 1999 and March 2014. The data were enhanced with ethnicity coding of participants’ surnames using the EE software. Only data on the first episode for each patient each year were included.

RESULTS: A total of 111,231,653 patient-years were recorded between April 1999 and March 2014. The completeness of ethnicity records improved from 59.5 % in 1999 to 90.5 % in 2013 (financial year). Biggest improvement was seen in the White British group, which increased from 55.4 % in 1999 to 73.9 % in 2013. The correct prediction of NHS-reported ethnicity varied by ethnic group (2013 figures): White British (89.8 %), Pakistani (81.7 %), Indian (74.6 %), Chinese (72.9 %), Bangladeshi (63.4 %), Black African (57.3 %), White Other (50.5 %), White Irish (45.0 %). For other ethnic groups the prediction success was low to none. Prediction success was above 70 % in most areas outside London but fell below 40 % in parts of London.

CONCLUSION: Studies of ethnic inequalities in hospital inpatient care in England are limited by incomplete data on patient ethnicity collected in the 1990s and 2000s. The prediction success of a names-based ethnicity classification tool has been quantified in HES for the first time and the results can be used to inform decisions around the optimal analysis of ethnic groups using this data source.

PMID:33735828 | DOI:10.1016/j.ijmedinf.2021.104437

Epilepsy Behav. 2021 Mar 15;118:107918. doi: 10.1016/j.yebeh.2021.107918. Online ahead of print.

ABSTRACT

BACKGROUND: Psychogenic nonepileptic seizures (PNES) are major challenges for diagnosis and management. The heterogeneity of psychogenic seizures is attributed to diverse psychopathological comorbidities, and the causal relationship between PNES and underlying psychopathologies is still enigmatic.

OBJECTIVE: Our objective was to study psychiatric comorbidities and personality constructs in patients with PNES and compare them to a control group of patients with epilepsy.

METHOD: We randomly recruited 33 patients with PNES and 33 patients with epilepsy. All patients completed the Mini-International Neuropsychiatric Interview (MINI) to screen for psychiatric comorbidities, the Structured Clinical Interview for psychiatric disorders in Axis II (SCID II) to screen for personality disorders, and Goldberg’s International Personality Item Pool (IPIP) Big Five personality questionnaire to study the psychological constructs of extroversion-introversion, agreeableness, conscientiousness, emotional stability-neuroticism, and intellect.

RESULT: Mood and anxiety disorders were highly prevalent in patients with PNES (72.7% and 54.5%, respectively); however, the prevalence of only cluster B personality disorder was higher in patients with PNES (69.7%) compared to 33.3% among patients with epilepsy (p < 0.05). Screening for personality disorders using SCID II showed that the prevalence of borderline and depressive personality disorders was significantly higher in patients with PNES (p < 0.001). Patients with psychogenic seizures were more likely to be receiving polydrug therapy (75.8%) compared to patients with epileptic seizures (45.5%); this difference was statistically significant (p < 0.05).

CONCLUSION: Psychiatric comorbidities are highly prevalent among patients with PNES.

PMID:33735815 | DOI:10.1016/j.yebeh.2021.107918

ESMO Open. 2021 Mar 15;6(2):100078. doi: 10.1016/j.esmoop.2021.100078. Online ahead of print.

ABSTRACT

BACKGROUND: To stratify the prognosis of patients with programmed cell death-ligand 1 (PD-L1) ≥ 50% advanced non-small-cell lung cancer (aNSCLC) treated with first-line immunotherapy.

METHODS: Baseline clinical prognostic factors, the neutrophil-to-lymphocyte ratio (NLR), PD-L1 tumour cell expression level, lactate dehydrogenase (LDH) and their combination were investigated by a retrospective analysis of 784 patients divided between statistically powered training (n = 201) and validation (n = 583) cohorts. Cut-offs were explored by receiver operating characteristic (ROC) curves and a risk model built with validated independent factors by multivariate analysis.

RESULTS: NLR < 4 was a significant prognostic factor in both cohorts (P < 0.001). It represented 53% of patients in the validation cohort, with 1-year overall survival (OS) of 76.6% versus 44.8% with NLR > 4, in the validation series. The addition of PD-L1 ≥ 80% (21% of patients) or LDH < 252 U/l (25%) to NLR < 4 did not result in better 1-year OS (of 72.6% and 74.1%, respectively, in the validation cohort). Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 2 [P < 0.001, hazard ratio (HR) 2.04], pretreatment steroids (P < 0.001, HR 1.67) and NLR < 4 (P < 0.001, HR 2.29) resulted in independent prognostic factors. A risk model with these three factors, namely, the lung immuno-oncology prognostic score (LIPS)-3, accurately stratified three OS risk-validated categories of patients: favourable (0 risk factors, 40%, 1-year OS of 78.2% in the whole series), intermediate (1 or 2 risk factors, 54%, 1-year OS 53.8%) and poor (>2 risk factors, 5%, 1-year OS 10.7%) prognosis.

CONCLUSIONS: We advocate the use of LIPS-3 as an easy-to-assess and inexpensive adjuvant prognostic tool for patients with PD-L1 ≥ 50% aNSCLC.

PMID:33735802 | DOI:10.1016/j.esmoop.2021.100078

Cortex. 2021 Feb 25;138:241-252. doi: 10.1016/j.cortex.2021.02.009. Online ahead of print.

ABSTRACT

Some eye diseases, especially macular degeneration, can cause central vision loss (CVL), impairing goal-driven guidance of attention. Does CVL also affect implicit, experience-driven attention? We investigated how simulated central scotomas affected young adults’ ability to prioritize locations frequently containing visual search targets (location probability learning). Participants searched among distractor letter ‘L’s for a target ‘T’ that appeared more often in one screen quadrant than others. To dissociate potential impairments to statistical learning of target locations and attentional guidance, two experiments each included search with and without simulated scotomas. Experiment 1 successfully induced probability learning in a no-scotoma phase. When participants later searched both with and without simulated scotomas, they showed persistent, statistically equivalent spatial biases in both no-scotoma and scotoma search. Experiment 2 trained participants with a central scotoma. While Experiment 1’s participants acquired probability learning regardless of their self-reported awareness of the target’s location probability, in Experiment 2 only aware participants learned to bias attention to the high probability region. Similarly, learning with a scotoma affected search with no scotoma in aware but not unaware participants. Together, these results show that simulated central vision loss interferes with the acquisition of implicitly learned location probability learning, supporting a role of central vision in implicit spatial attentional biases.

PMID:33735796 | DOI:10.1016/j.cortex.2021.02.009

Environ Pollut. 2021 Mar 3;278:116868. doi: 10.1016/j.envpol.2021.116868. Online ahead of print.

ABSTRACT

Air pollution has been an important risk factor for female reproductive health. However, epidemiological evidence of ambient air pollution on the predictor for ovarian reserve (antral follicle count, AFC) is deficient. We aim to comprehensively evaluate the association of long-term exposure to ambient air pollution with AFC among women of reproductive age in Shanxi of north China. 600 women with spontaneous menstrual cycle, not using controlled ovarian stimulation, were enrolled in the retrospective study. Two distinct periods of antral follicle development were designed as exposure windows. Generalized linear model was employed to estimate the change of AFC associated with exposure of atmospheric pollutants (SO₂, NO₂, PM₁₀, PM_2.5, CO and O₃). Stratification analysis based on age (<30, ≥30 years), university degree (yes, no), years of exposure (2013-2016, 2017-2019) and duration of infertility (<2, 2-5, >5 years) along with two pollutants model were employed to further illustrate the association. We found every 10 μg/m³ increase in SO₂ concentration level during the entire development stage of antral follicle was associated with a -0.01 change in AFC (95% confidence interval: -0.016, -0.002) adjusting for the confounders including age, BMI, parity and infertility diagnosis factors. The significant association of increased SO₂ level with decreased AFC was particularly observed during the early transition from primary follicle to preantral follicle stage by 10 μg/m³ increase in SO₂ exposure level with a -0.01 change (95% CI: -0.015, -0.002) in AFC. The negative association was pronounced among women aged ≥30 years old, and also significant in two pollutants model after adjusting the confounders. No significant associations between other air pollutants and AFC were observed. Our finding suggests that long-term exposure to air pollutant SO₂ is associated with lower AFC, raising our concern that atmospheric SO₂ exposure may have potential adverse impact on women ovarian reserve.

PMID:33735795 | DOI:10.1016/j.envpol.2021.116868

Comput Biol Med. 2021 Mar 6;132:104309. doi: 10.1016/j.compbiomed.2021.104309. Online ahead of print.

ABSTRACT

In this study, a method that will aid in the visualization of vein topology on a target area on the body of a human subject is demonstrated. An external cooling means is configured to cool the left forearm of fourteen study participants, effecting an active thermal change or recovery in the target area upon removal of cooling. An infrared (IR) thermal camera was used to capture a series of transient thermal images. These images were then processed to extract Dynamic synthetic images (SI) throughout the active thermal change or recovery process. Dynamic SI was calculated using a quantitative parameter called tissue activity ratio (TAR), which is defined by the rate of rewarming to the rate of cooling at each pixel of interest. A fixed step size of rewarming temperature (0.5 °C) was used to progressively extract multiple synthetic images throughout the whole recovery process. Compared to a Static SI extraction method, where only a single SI results from the whole active dynamic thermography (ADT) sequence, this study demonstrates a live feed of high contrast vein visualizations by using the Dynamic SI method. Furthermore, the dependency of Dynamic SI contrast on the temperature of the external cooling stimulation was investigated. Three cooling stimulation temperatures (5 °C, 8 °C, and 11 °C) were tested, where no statistically significant difference in the resulting SI contrast was found. Lastly, a discussion is put forth on assisting venipuncture or cannulation-based clinical applications, through the incorporation of the proposed method with a projection system.

PMID:33735761 | DOI:10.1016/j.compbiomed.2021.104309

Hepatology. 2021 Mar 18. doi: 10.1002/hep.31817. Online ahead of print.

ABSTRACT

Existing therapeutic approaches to treat cholangiocarcinoma (CCA) have limited effectiveness, prompting further study to develop novel therapies for CCA. Here we report a novel mechanistic role for the heparan sulfate editing enzyme sulfatase 2 (SULF2) in CCA pathogenesis. In silico analysis revealed elevated SULF2 expression in human CCA samples, occurring partly through gain of SULF2 copy number. We examined the effects of knockdown or overexpression of SULF2 on tumor growth, chemoresistance, and signaling pathway activity in human CCA cell lines in vitro. Upregulation of SULF2 in CCA leads to increased PDGFRβ-YAP signaling activity, promoting tumor growth and chemotherapy resistance. To explore the utility of targeting SULF2 in the tumor microenvironment for CCA treatment, we tested an anti-SULF2 mouse monoclonal antibody 5D5 in a mouse CCA xenograft model. Targeting SULF2 by monoclonal antibody 5D5 inhibited PDGFRβ-YAP signaling and tumor growth in the mouse xenograft model. Conclusion: These results suggest that SULF2 monoclonal antibody 5D5 or related agents may be potentially promising new therapeutic agents in CCA.

PMID:33735525 | DOI:10.1002/hep.31817

Int J Paediatr Dent. 2021 Mar 18. doi: 10.1111/ipd.12787. Online ahead of print.

ABSTRACT

BACKGROUND: Local anesthesia (LA) administration provokes maximum dental anxiety in children. BrightHearts is a biofeedback relaxation application designed to reduce anxiety in children during pain inflicting procedural interventions.

AIM: To compare the effectiveness of biofeedback relaxation (BR) and audio visual distraction (AV) on dental anxiety among 7 – 12 year old children while administering LA DESIGN: A total of 70 children requiring dental treatment under LA for three visits were recruited for this single blinded randomized control trial. They were randomly divided into two equal groups. Group A received BR and the Group B received AV distraction during LA delivery in the first two visits and both groups did not receive any intervention during LA in third visit. Outcomes were measured using heart rate and a cartoon based anxiety measuring scale (Chotta Bheem Chutki (CBC) scale).

RESULTS: AV group had statistically significant higher mean heart rates than BR group (p<0.001) during needle penetration and post-intervention respectively. CBC scales showed no statistical differences between the groups.

CONCLUSION: Both the interventions are effective in reducing dental anxiety during LA administration. Based on objective measures, BR is found to be better than AV distraction. However subjective scores show no differences between the two.

PMID:33735517 | DOI:10.1111/ipd.12787

J Appl Clin Med Phys. 2021 Mar 18. doi: 10.1002/acm2.13209. Online ahead of print.

ABSTRACT

PURPOSE: Patient-specific quality assurance (QA) is very important in radiotherapy, especially for patients with highly conformed treatment plans like VMAT plans. Traditional QA protocols for these plans are time-consuming reducing considerably the time available for patient treatments. In this work, a new MC-based secondary dose check software (SciMoCa) is evaluated and benchmarked against well-established TPS (Monaco and Pinnacle³ ) by means of treatment plans and dose measurements.

METHODS: Fifty VMAT plans have been computed using same calculation parameters with SciMoCa and the two primary TPSs. Plans were validated with measurements performed with a 3D diode detector (ArcCHECK) by translating patient plans to phantom geometry. Calculation accuracy was assessed by measuring point dose differences and gamma passing rates (GPR) from a 3D gamma analysis with 3%-2 mm criteria. Comparison between SciMoCa and primary TPS calculations was made using the same estimators and using both patient and phantom geometry plans.

RESULTS: TPS and SciMoCa calculations were found to be in very good agreement with validation measurements with average point dose differences of 0.7 ± 1.7% and -0.2 ± 1.6% for SciMoCa and two TPSs, respectively. Comparison between SciMoCa calculations and the two primary TPS plans did not show any statistically significant difference with average point dose differences compatible with zero within error for both patient and phantom geometry plans and GPR (98.0 ± 3.0% and 99.0 ± 3.0% respectively) well in excess of the typical 95% clinical tolerance threshold.

CONCLUSION: This work presents results obtained with a significantly larger sample than other similar analyses and, to the authors’ knowledge, compares SciMoCa with a MC-based TPS for the first time. Results show that a MC-based secondary patient-specific QA is a clinically viable, reliable, and promising technique, that potentially allows significant time saving that can be used for patient treatment and a per-plan basis QA that effectively complements traditional commissioning and calibration protocols.

PMID:33735491 | DOI:10.1002/acm2.13209