Nevin Manimala

Cornea. 2021 May 21. doi: 10.1097/ICO.0000000000002756. Online ahead of print.

ABSTRACT

PURPOSE: The aims of this study were 1) to compare area of cell loss (ACL) on trypan staining with ACL on specular imaging and 2) to evaluate the use of automated software for measuring ACL on trypan staining.

METHODS: Donor corneas with transplant-grade endothelium were mechanically injured with an 18-gauge cannula and a Fogla deep anterior lamellar keratoplasty dissector tip to create an easily identifiable “bullseye” pattern of cell death. Each cornea was then stained with trypan blue 0.06% for 90 seconds and imaged at 2× magnification. ACL on staining was measured using manual (ImageJ, National Institute of Health, Bethesda, MD) versus automated software tools (custom-built Aphelion macro, ADCIS, S.A., Saint-Contest, France). The bullseye was then imaged using specular microscopy, and ACL was measured by tracing the dead cell borders. ACL was then compared between both modalities.

RESULTS: Eleven donor corneas were evaluated. Both manual (0.42 mm2) and automated (0.45 mm2) measurements of ACL after trypan staining underestimated mean ACL on specular imaging (0.54 mm2) (P < 0.01). However, on regression analysis, there was a good predictive correlation between automated trypan measurements and specular imaging (R2 = 0.99, residual SE = 0.0044, P < 0.01). When ACL on specular imaging was measured by tracing cell nuclei along the margin of injury (rather than cell borders) (0.45 mm2), there was no statistically significant difference between specular and automated trypan measurements (P = 0.95).

CONCLUSIONS: Trypan-assisted automated measurements of ACL correlated well with ACL on specular imaging, suggesting that automated software may be a useful tool for evaluating endothelium in donor corneas.

PMID:34029236 | DOI:10.1097/ICO.0000000000002756

Holist Nurs Pract. 2021 May 20. doi: 10.1097/HNP.0000000000000450. Online ahead of print.

ABSTRACT

This pilot study explored whether Reiki delivered by family caregivers to cancer patients in a home setting was feasible in reducing cancer symptoms and enhancing health-related outcomes. An explanatory sequential mixed-methods study design was applied using pre-/post-Reiki questionnaires and post-Reiki interviews. Six patient-caregiver dyads from an outpatient clinic and cancer support facilities in northeast America performed daily Reiki at home for 3 weeks. Differences with symptoms, mental well-being, health-related quality of life, and satisfaction with at-home Reiki as well as qualitative content analyses were evaluated. Positive feedback was reported after at-home Reiki practice. Large statistical effects were identified for improving fatigue, memory, mood, nausea, and emotional well-being (P < .10, r = 0.51-0.59). All participants were satisfied and 83.3% of them would recommend self-practice home Reiki. High involvement and adherence to the intervention protocol illustrated intervention fidelity. The qualitative data revealed 2 major categories, perceived benefits and barriers. Overall Reiki benefits outweighed barriers in relation to time commitment and place distractions/positioning. Our preliminary findings support that the at-home Reiki protocol had potential benefits and was feasible and acceptable by both community-dwelling patients and their family caregivers in promoting cancer-related outcomes. Further studies with larger samples are warranted to examine the effectiveness of home-based Reiki for a patient-centered cancer care modality.

PMID:34029232 | DOI:10.1097/HNP.0000000000000450

Ann Surg. 2021 May 24. doi: 10.1097/SLA.0000000000004954. Online ahead of print.

ABSTRACT

OBJECTIVE: To study the impact of a standardized postoperative anesthesia visit on 30-day mortality in medium to high-risk elective surgical patients.

BACKGROUND: Postoperative complications are the leading cause of perioperative morbidity and mortality. While modified early warning scores (MEWS) were instituted to monitor vital functions and improve postoperative outcome, we hypothesized that complementary anesthesia expertise is needed to adequately identify early deterioration.

METHODS: In a prospective, multicenter, stepped-wedge cluster randomized interventional study in nine academic and non-academic hospitals in the Netherlands, we studied the impact of adding standardized postoperative anesthesia visits on day one and three to routine use of MEWS in 5473 patients undergoing elective non-cardiac surgery. Primary outcome was 30-day mortality. Secondary outcomes included: incidence of postoperative complications, length of hospital stay and intensive care unit (ICU) admission.

RESULTS: Patients were enrolled between October 2016 and August 2018. Informed consent was obtained from 5473 patients of which 5190 were eligible for statistical analyses, 2490 in the control and 2700 in the intervention group. Thirty-day mortality was 0·56% (n = 14) in the control and 0·44% (n = 12) in the intervention group (odds ratio 0·74, 95%confidence interval 0·34-1·62). Incidence of postoperative complications did not differ between groups except for renal complications which was higher in the control group (1·7% (n = 41) vs. 1·0% (n = 27), p = 0·014). Median length of hospital stay did not differ significantly between groups. During the post-anesthesia visits, for 16% (n = 437) and 11% (n = 293) of patients recommendations were given on day one and three, respectively, of which 67% (n = 293) and 69% (n = 202) were followed up.

CONCLUSIONS: The combination of MEWS and a postoperative anesthesia visit did not reduce 30-day mortality. Whether a postoperative anesthesia visit with strong adherence to the recommendations provided and in a high-risk population might have a stronger impact on postoperative mortality remains to be determined.

TRIAL REGISTRATION: Netherlands Trial Registration, NTR5506/ NL5249, https://www.trialregister.nl/trial/5249.

PMID:34029230 | DOI:10.1097/SLA.0000000000004954

IEEE Trans Neural Netw Learn Syst. 2021 May 24;PP. doi: 10.1109/TNNLS.2021.3079627. Online ahead of print.

ABSTRACT

Due to the complementary properties of different types of sensors, change detection between heterogeneous images receives increasing attention from researchers. However, change detection cannot be handled by directly comparing two heterogeneous images since they demonstrate different image appearances and statistics. In this article, we propose a deep pyramid feature learning network (DPFL-Net) for change detection, especially between heterogeneous images. DPFL-Net can learn a series of hierarchical features in an unsupervised fashion, containing both spatial details and multiscale contextual information. The learned pyramid features from two input images make unchanged pixels matched exactly and changed ones dissimilar and after transformed into the same space for each scale successively. We further propose fusion blocks to aggregate multiscale difference images (DIs), generating an enhanced DI with strong separability. Based on the enhanced DI, unchanged areas are predicted and used to train DPFL-Net in the next iteration. In this article, pyramid features and unchanged areas are updated alternately, leading to an unsupervised change detection method. In the feature transformation process, local consistency is introduced to constrain the learned pyramid features, modeling the correlations between the neighboring pixels and reducing the false alarms. Experimental results demonstrate that the proposed approach achieves superior or at least comparable results to the existing state-of-the-art change detection methods in both homogeneous and heterogeneous cases.

PMID:34029198 | DOI:10.1109/TNNLS.2021.3079627

Int Forum Allergy Rhinol. 2021 May 24. doi: 10.1002/alr.22806. Online ahead of print.

NO ABSTRACT

PMID:34029005 | DOI:10.1002/alr.22806

Pediatr Blood Cancer. 2021 May 24:e29117. doi: 10.1002/pbc.29117. Online ahead of print.

ABSTRACT

INTRODUCTION: ¹³¹ I-meta-iodobenzylguanidine (¹³¹ I-MIBG) is effective in relapsed neuroblastoma. The Children’s Oncology Group (COG) conducted a pilot study (NCT01175356) to assess tolerability and feasibility of induction chemotherapy followed by ¹³¹ I^– MIBG therapy and myeloablative busulfan/melphalan (Bu/Mel) in patients with newly diagnosed high-risk neuroblastoma.

METHODS: Patients with MIBG-avid high-risk neuroblastoma were eligible. After the first two patients to receive protocol therapy developed severe sinusoidal obstruction syndrome (SOS), the trial was re-designed to include an ¹³¹ I-MIBG dose escalation (12, 15, and 18 mCi/kg), with a required 10-week gap before Bu/Mel administration. Patients who completed induction chemotherapy were evaluable for assessment of ¹³¹ I-MIBG feasibility; those who completed ¹³¹ I-MIBG therapy were evaluable for assessment of ¹³¹ I-MIBG + Bu/Mel feasibility.

RESULTS: Fifty-nine of 68 patients (86.8%) who completed induction chemotherapy received ¹³¹ I-MIBG. Thirty-seven of 45 patients (82.2%) evaluable for ¹³¹ I-MIBG + Bu/Mel received this combination. Among those who received ¹³¹ I-MIBG after revision of the study design, one patient per dose level developed severe SOS. Rates of moderate to severe SOS at 12, 15, and 18 mCi/kg were 33.3%, 23.5%, and 25.0%, respectively. There was one toxic death. The ¹³¹ I-MIBG and ¹³¹ I-MIBG+Bu/Mel feasibility rates at the 15 mCi/kg dose level designated for further study were 96.7% (95% CI: 83.3%-99.4%) and 81.0% (95% CI: 60.0%-92.3%).

CONCLUSION: This pilot trial demonstrated feasibility and tolerability of administering ¹³¹ I-MIBG followed by myeloablative therapy with Bu/Mel to newly diagnosed children with high-risk neuroblastoma in a cooperative group setting, laying the groundwork for a cooperative randomized trial (NCT03126916) testing the addition of ¹³¹ I-MIBG during induction therapy.

PMID:34028986 | DOI:10.1002/pbc.29117

Clin Implant Dent Relat Res. 2021 May 24. doi: 10.1111/cid.13008. Online ahead of print.

ABSTRACT

OBJECTIVE: Compare the dimensional changes of the peri-implant soft and hard tissues clinically and radiographically around single immediate implants in the esthetic zone with socket shield technique versus filling the buccal gap with xenograft.

MATERIALS AND METHODS: Forty-two patients with a single non-restorable tooth in the esthetic zone replaced with an immediate implant were randomly assigned either to the socket shield technique (test) or to grafting the buccal gap with xenograft (control). The vertical and horizontal buccal bone resorption were measured 6-months following implant placement. The esthetic outcomes were evaluated by assessing the Pink Esthetic Score (PES) and the amount of midfacial mucosal alteration, in addition to patient satisfaction assessment through a Visual Analogue Scale (VAS) based questionnaire 1-year following implant restoration.

RESULTS: The present study showed that the socket shield group yielded significantly less vertical and horizontal buccal bone resorption of 0.35 (±0.62) mm and 0.29 (±0.34) mm compared to 1.71 (±1.02) mm and 1.45 (±0.72) mm in the xenograft group respectively. Also, there was a significantly greater midfacial mucosal recession in the xenograft group of 0.466 (±0.58) mm compared to midfacial mucosal coronal migration of 0.45 (±0.75) mm in the socket shield group. However, there was no statistically significant difference regarding the total PES and patient satisfaction in both treatment groups.

CONCLUSION: The socket shield technique can preserve hard and soft peri-implant tissues following immediate implant placement. (ClinicalTrials.gov Identifier: NCT03684356).

PMID:34028974 | DOI:10.1111/cid.13008

Intern Med J. 2021 May 24. doi: 10.1111/imj.15396. Online ahead of print.

ABSTRACT

BACKGROUND: The anion gap (AG) is often used to evaluate acid-base disorders. The reference interval for normal AG is used to differentiate between raised (gap) or normal AG (non-gap) acidosis. Historically accepted AG values may not be valid with the evolution of modern analytical techniques and the reference interval requires revalidation.

AIMS: To determine the reference interval for AG based on current laboratory techniques.

METHODS: During a health-screening exercise, 284 participants with no major illnesses volunteered surplus blood for analysis. The samples were tested in an internationally-accredited clinical laboratory. AG was calculated by (Na⁺ ) – (Cl^– ) – (HCO3^– ) and AG_K by (Na⁺ ) + (K⁺ ) – (Cl^– ) – (HCO₃^– ). The reference interval was determined at 2.5th-97.5th percentiles. Analysis was further undertaken for a sub-cohort of 156 individuals with no sub-optimal health indicators.

RESULTS: Median age was 35 years, BMI 23.4 kg/m² and glomerular filtration rate 106 mL/min/1.73m² . Median AG was 13 mmol/L and the reference interval for normal AG is 10-18 mmol/L with a 99% level of confidence. Statistically significant differences in AG were detected for sex, race, obesity and serum albumin but the difference was 1 mmol/L between subgroups. The reference interval was the same for the sub-cohort of 156 individuals. Median AG_K was 17.7 mmol/L and reference interval was 14.6-22.5 mmol/L.

CONCLUSIONS: The AG reference interval of 10-18 mmol/L is valid for laboratories with similar reference intervals for electrolytes. Lower values expected with current laboratory techniques were not observed. The median AG of 13 mmol/L may be used to differentiate gap acidosis, non-gap acidosis or mixed acid-base disorders. This article is protected by copyright. All rights reserved.

PMID:34028972 | DOI:10.1111/imj.15396

J Appl Clin Med Phys. 2021 May 24. doi: 10.1002/acm2.13271. Online ahead of print.

ABSTRACT

PURPOSE: Helical tomotherapy (HT) is a form of intensity-modulated radiation therapy that is employed in total body irradiation (TBI). Because TBI targets the whole body, accurate setup positioning at the edge of the treatment volume is made difficult by the whole-body rotational posture. The purpose of this study is to clarify the tolerance for rotational setup error (SE) in the vertical direction. In addition, we perform a retrospective analysis of actually irradiated dose distributions using previous patients’ irradiation data.

METHODS: To clarify the effects of rotational SE on the dose distribution, the planned CT images of 10 patients were rotated by 1-5° in the vertical (pitch) direction to create a pseudo-rotational SE image. Then, the effect of the magnitude of the rotational SE on the dose distribution was simulated. In addition, the irradiated dose to the patients was analyzed by obtaining recalculated dose distributions using megavoltage CT images acquired before treatment.

RESULTS: The simulation results showed that the average value of the lung volume receiving at least 10 Gy did not exceed the allowable value when the SE value was ≤2°. When the rotational SE was ≤3°, it was possible to maintain the clinical target volume dose heterogeneity within ±10% of the prescribed dose, which is acceptable according to the guidelines. A retrospective analysis of previous patients’ irradiation data showed their daily irradiation dose distribution. The dose to the clinical target volume was reduced by up to 3.4% as a result of the residual rotational SE. Although whole-course retrospective analyses showed a statistically significant increase in high-dose areas, the increase was only approximately 1.0%.

CONCLUSIONS: Dose errors induced by rotational SEs of ≤2° were acceptable in this study.

PMID:34028944 | DOI:10.1002/acm2.13271