Nevin Manimala

J Clin Sleep Med. 2021 Jul 27. doi: 10.5664/jcsm.9566. Online ahead of print.

ABSTRACT

STUDY OBJECTIVES: The aim of this study is to determine the extent of agreement between self-reported measurements of total sleep time (TST) and actigraphy in the fire and emergency services occupation.

METHODS: Twenty-four firefighters participated in an 18-day study. Four measurements were used to assess TST: PSQI, a newly developed habitual Extended Sleep Survey, a newly developed daily Emergency Services Sleep Diary (ESSD), and actigraphy. The Extended Sleep Survey and ESSD were constructed to address the specific job-related characteristics of fire and emergency services that other measurements cannot achieve (e.g., multiple sleep bouts in a single night).

RESULTS: The PSQI TST is least accurate compared to actigraphy. The Extended Sleep Survey TST shows improvement over PSQI TST, but was statistically different from actigraphy TST. No difference in mean TST was found between ESSD TST and Actigraphy TST. Furthermore, ESSD TST and Actigraphy TST correlated strongly together.

CONCLUSIONS: Without modification, traditional self-reported measures may not be appropriate in the fire and emergency service occupation. This study suggests that the ESSD may serve as a useful alternative to actigraphy to measure TST.

PMID:34314350 | DOI:10.5664/jcsm.9566

J Clin Sleep Med. 2021 Jul 27. doi: 10.5664/jcsm.9564. Online ahead of print.

ABSTRACT

STUDY OBJECTIVES: We determined the relationship of cardiovascular risk factors (CRF), cardiovascular diseases (CVD), nocturnal blood pressure (NBP) and nocturnal blood pressure fluctuations (NBPFs) with the severity of obstructive sleep apnea (OSA). We also investigated the effect of short-term continuous positive airway pressure (CPAP) therapy on NBP parameters.

METHODS: This retrospective study included 548 patients from our cardiac clinic with suspected OSA. Patients underwent polysomnography and continuous NBP measurement using the pulse transit time (PTT). According to their apnea-hypopnea index (AHI), patients were subclassified: Controls (AHI < 5/h), mild (AHI 5 – < 15/h), moderate (AHI 15 – < 30/h) and severe OSA (AHI ≥ 30/h). 294 patients received CPAP therapy.

RESULTS: Analysis of covariance (ANCOVA) showed that NBP and the frequency of NBPFs were the highest in severe followed by moderate and mild OSA (all p < 0.001). Multivariable regression analysis revealed a significant association of NBPFs with AHI, BMI, systolic NBP and lowest SpO₂. The severity of OSA is also associated with the frequency of obesity, hypertension, diabetes mellitus, atrial fibrillation, heart failure (all p < 0.001) and coronary artery disease (p = 0.035). Short-term CPAP decreased the frequency of NBPFs in all OSA groups and the systolic NBP in severe and moderate but not in mild OSA.

CONCLUSIONS: The severity of OSA is associated with an increase in NBP and NBPFs. CPAP reduces NBP parameters already after the first night. In addition to BP, the diagnosis and therapy of NBPFs should be considered in patients with OSA.

CLINICAL TRIAL REGISTRATION: Registry: German Clinical Trials Register; Title: Nocturnal blood pressure and nocturnal blood pressure fluctuations associated with the severity of obstructive sleep apnea; Identifier: DRKS00024087; URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024087.

PMID:34314347 | DOI:10.5664/jcsm.9564

Scand J Gastroenterol. 2021 Jul 27:1-6. doi: 10.1080/00365521.2021.1955965. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Fecal calprotectin (fCP) has been shown to correlate with endoscopic disease activity in Crohn’s disease (CD). The aim of this study was to evaluate its role in predicting early endoscopic recurrence in postoperative CD.

METHODS: Patients who underwent CD-related intestinal resection with ileocolonic anastomosis were prospectively followed up until ileocolonoscopy was performed around 12 months post-surgery. Endoscopic recurrence (ER) was defined as modified Rutgeerts score i2b or higher. Endoscopic still images were reviewed by 2 independent reviewers blinded to fCP results. Stool specimens were collected 6 months post-surgery and a multivariate logistic regression model was established to explore the predictive value of fCP for ER.

RESULTS: 79 patients were included. FCP was significantly associated with endoscopic recurrence (p = .036). A cut-off value of fCP of 267 µg/g at 6 months post-surgery predicted ER with a sensitivity of 61.8% and a specificity of 72.7% (AUC 0.669). A prediction model subsuming age at diagnosis and fCP 6 months post-surgery were significantly associated with ER (fCP at 6 months [p = .007] and age at diagnosis [p = .004], multivariate analysis).

CONCLUSIONS: FCP 6 months after surgery and age at diagnosis predict early ER at 1 year postoperatively. However, the low sensitivity of fCP still suggests the necessity of endoscopy as a gold standard for the assessment of postoperative recurrence of CD.KEY SUMMARYWhat is already known? Fecal calprotectin (fCP) correlates with endoscopic disease activity. Endoscopic recurrence occurs in up to 70% of patients after intestinal resection within 1 year.What are the significant and/or new findings of this study? Fecal calprotectin 6 months post-surgery and age at diagnosis significantly predict endoscopic recurrence at 1 year. Due to low sensitivity fCP cannot replace the necessity of endoscopy for accurate assessment of postoperative recurrence.

PMID:34314308 | DOI:10.1080/00365521.2021.1955965

Crit Rev Anal Chem. 2021 Jul 27:1-13. Online ahead of print.

ABSTRACT

Medicinal plants have been used and studied for ages, from very old registers to modern ethnopharmacology, which encompasses analytical chemistry, foods, and pharmacy. Based on international norms and governmental organizations of health, phytomedicine-for example, herbal drugs-needs to guarantee the quality control of products and identify contaminants, biomarkers, and chemical profiles, among other issues. In this sense, is necessary to develop advanced analytical methods that show interesting possibilities and obtain a great amount of data. In order to treat the data, a set of mathematical and statistical procedures named chemometrics is necessary. In terms of herbal drugs, chemometric tools may be used to identify the following in plants: parts, development stages, processing, geographic origin, authentication, and chemical markers. This review describes applications of chemometric pattern recognition tools to analyze herbal drugs in different conditions associated with analytical methods in the last six years (2015-2020).

PMID:34314279

Am J Speech Lang Pathol. 2021 Jul 27:1-11. doi: 10.1044/2021_AJSLP-20-00322. Online ahead of print.

ABSTRACT

Objective This review article aimed to explore the effect of oral motor intervention on oral feeding in preterm infants through a meta-analysis. Method Eligible studies were retrieved from four databases (PubMed, Embase, Cochrane Library, and Web of Science) up to July 2020 and screened based on established selection criteria. Thereafter, relevant data were extracted and heterogeneity tests were conducted to select appropriate effect models according to the chi-square test and I ² statistics. Assessment of risk of bias was performed among the included studies. Finally, a meta-analysis was carried out to evaluate the effect of oral motor intervention in preterm infants according to four clinical indicators: transition time for oral feeding, length of hospital stay, feeding efficiency, and weight gain. Results Eighteen randomized controlled trials with 848 participants were selected to evaluate the effect of oral motor intervention on preterm infants. The meta-analysis results revealed that oral motor intervention could effectively reduce the transition time to full oral feeds and the length of hospital stay as well as increase feeding efficiency and weight gain. Conclusions Oral motor intervention was an effective way to improve oral feeding in preterm infants. It is worthy to be used widely in hospitals to improve the clinical outcomes of preterm infants and reduce the economic burdens of families and society. Future studies should seek to identify detailed intervention processes and intervention durations for clinical application.

PMID:34314255 | DOI:10.1044/2021_AJSLP-20-00322

J Neurotrauma. 2021 Jul 27. doi: 10.1089/neu.2021.0102. Online ahead of print.

ABSTRACT

This study aimed to investigate whether early surgical decompression was associated with favourable neurological recovery in patients with traumatic spinal cord injury (tSCI). We searched PubMed and Embase from the database inception through December 2020 and selected studies comparing the impact of early versus late surgical decompression on neurological recovery as assessed by American Spinal Injury Association Impairment Scale (AIS) for adult patients sustaining tSCI. We pooled the effect estimates in random-effects models and quantified the heterogeneity by the I2 statistics. Subgroup analysis and meta-regression analysis was conducted to identify significant outcome moderator. We included 26 studies involving 3,574 patients in the meta-analysis. The pooled results demonstrated significant association between early surgical decompression and an improvement of at least one AIS grade (odds ratio [OR], 1.85; 95% confidence interval [CI], 1.41-2.41; I2, 48.06%). The benefits of early surgical decompression were consistently observed across different subgroups, including patients with cervical or thoracolumbar injury and patients with complete or incomplete injury. The meta-regression analysis indicated that cut-off timing defining early versus late decompression was a significant effect moderator, with early decompression performed before post-tSCI 8 or 12 h associated with greatest benefits (OR, 3.37; 95% CI, 1.74-6.50; I2, 53.52%). No obvious publication bias was detected by the funnel plot. In conclusion, early surgical decompression was associated with favourable neurological recovery for tSCI patients. However, there was a lack of high-quality evidence and the results need further examination.

PMID:34314253 | DOI:10.1089/neu.2021.0102

J Endourol. 2021 Jul 27. doi: 10.1089/end.2021.0416. Online ahead of print.

ABSTRACT

CONTEXT: Recently developed concepts for higher efficacy ESWL with low-pressure wide focus systems resulting in finer fragmentation of the calculi.

OBJECTIVE: To compare two different electromagnetic shock wave sources (low-pressure wide focus (XL) versus high-pressure small focus (SL)) by sound-field measurements and in-vitro fragmentation.

EVIDENCE ACQUISITION: The CS-2012A XX-ES lithotripter (self-focusing electromagnetic shock-wave generator with concave spherical curved electrical coil; Xinin Lithotripter = XL) was compared to the Siemens Lithoskop (= SL) (electromagnetic generator with a flat electric coil with an acoustical lens). Different sound-field measurements were performed using a fiber-optic hydrophone. Measurements at three different power settings (XL: 8.0kV, 9.3kV and 10.3kV; SL: Level 1, 5 and 8). 10 ATS-stones and 15 BegoStones (9.3 kV, Level 3) with a frequency of 90/minute (SL) and 20/minute (XL). Number of impulses to the first crack and for complete stone comminution (residual fragments <2mm) were documented.

RESULTS: The median number of shock waves for the first crack in ATS-stones with the XL was 12 (10-14), with the SL 7 (6-9). Complete disintegration was accomplished after 815 (782-824) shock waves with XL, 702 (688-712) with SL. The difference was not statistically significant. The median number of shock waves to produce the first crack in BegoStones was 524 (504-542) with XL and only 151 (137-161) with SL. Numbers of shock waves for complete disintegration did not differ significantly (XL:2518 vs SL:2287). Using a wide focus with low pressure shows more homogeneous disintegration.

CONCLUSION: Two stone models showed significant differences regarding form and time of the initial fragmentation. Impulses for stone comminution did not differ significantly. The advantages of a low-pressure wide focus-system include minimal trauma and a homogeneous fragment size but is more time consuming. High-pressure small focus systems are clinically effective.

PMID:34314251 | DOI:10.1089/end.2021.0416

J Endourol. 2021 Jul 27. doi: 10.1089/end.2021.0455. Online ahead of print.

ABSTRACT

PURPOSE: Aquablation, prostatic urethral lift (PUL), and transurethral water vapor therapy (TWVT) have demonstrated efficacy for the treatment of benign prostatic hyperplasia (BPH). Our objective was to describe device malfunctions and complications to help guide procedural selection and performance.

MATERIALS AND METHODS: The Manufacturer and User Facility Device Experience (MAUDE) database was examined for reports related to the use of these three procedures for the treatment of BPH between January 1, 2015 and July 1, 2020. Reports were evaluated for device malfunctions and surgical complications using a previously described externally validated classification system developed for the MAUDE database. Chi square analysis was used for statistical comparison between groups.

RESULTS: A total of 391 adverse events were reported: Aquablation (n=102), PUL (n=132), and TWVT (n=157). There were 79 (78%) severe or life threatening adverse events for Aquablation vs. 69 (52%) for PUL vs. 24 (15%) for TWVT (p < 0.001). There were 4 cases of rectal perforation with Aquablation and 25 cases of the PUL implants needing to be removed or causing a problem with a later procedure. Blood transfusion frequencies were: Aquablation – 32 (31%), PUL – 21 (16%), TWVT – 1 (1%). The most common device malfunctions were: Aquablation – motion error (n=8), handpiece fracture/attachment malfunction (n=8); PUL – device misfire (n=27), needle fragmentation (n=21); TWVT – unresolvable error message (n=19).

CONCLUSIONS: In a national database, Aquablation and PUL had noteworthy complications or device related malfunctions such as rectal perforation and the improper placement or failed deployment of the PUL implants. Both patients and providers should be aware of potential risks when selecting these novel BPH treatments.

PMID:34314240 | DOI:10.1089/end.2021.0455

Stem Cells Transl Med. 2021 Jul 27. doi: 10.1002/sctm.21-0027. Online ahead of print.

ABSTRACT

Muscular dystrophies are genetically determined progressive diseases with no cause-related treatment and limited supportive treatment. Although stem cells cannot resolve the underlying genetic conditions, their wide-ranging therapeutic properties may ameliorate the consequences of the involved mutations (oxidative stress, inflammation, mitochondrial dysfunction, necrosis). In this study, we administered advanced therapy medicinal product containing umbilical cord-derived mesenchymal stem cells (UC-MSCs) to 22 patients with muscular dystrophies. Patients received one to five intravenous and/or intrathecal injections per treatment course in up to two courses every 2 months. Four standard doses of 10, 20, 30, or 40 × 10⁶ UC-MSCs per injection were used; the approximate dose per kilogram was 1 × 10⁶ UC-MSCs. Muscle strength was measured with a set of CQ Dynamometer computerized force meters (CQ Elektronik System, Czernica, Poland). Statistical analysis of muscle strength in the whole group showed significant improvement in the right upper limb (+4.0 N); left hip straightening (+4.5 N) and adduction (+0.5 N); right hip straightening (+1.0 N), bending (+7.5 N), and adduction (+2.5 N); right knee straightening (+8.5 N); left shoulder revocation (+13.0 N), straightening (+5.5 N), and bending (+6.5 N); right shoulder adduction (+3.0 N), revocation (+10.5 N), and bending (+5 N); and right elbow straightening (+9.5 N); all these differences were statistically significant. In six patients (27.3%) these changes led to improvement in gait analysis or movement scale result. Only one patient experienced transient headache and lower back pain after the last administration. In conclusion, UC-MSC therapy may be considered as a therapeutic option for these patients.

PMID:34313400 | DOI:10.1002/sctm.21-0027

Clin Teach. 2021 Jul 27. doi: 10.1111/tct.13402. Online ahead of print.

ABSTRACT

BACKGROUND: The American Academy of Pediatrics regards literacy promotion as essential. Medical professionals are in a key position to promote children’s early literacy, however this requires knowledge of existing literacy programmes. This study describes medical student training, awareness, experiences, and attitudes towards early literacy and the ‘Reach Out and Read’ (ROR) initiative.

METHODS: An anonymous online survey was sent to all medical students at a medical school in the Midwest with two campuses. Data were analysed using descriptive statistics.

RESULTS: We received data from 275 medical students. Almost half (46.5%) had completed their paediatric clerkship, 22.9% had observed ROR, and only 2.9% had received any training. Most (67%), wanted to learn more about early literacy, and 59% expressed a desire for more ROR training. Most respondents expressed preference for learning from residents and faculty in clinic followed by online training. 47% agreed that it was a role of medical students to assess and encourage reading.

DISCUSSION: Medical students understand the importance of early literacy in primary care and emphasising this during clinical encounters. Most are eager to learn more about early literacy promotion and ROR. This interest decreases during third and fourth year so targeting the first 2 years of medical school is an important strategy. Providing formal literacy promotion training and education for medical students should be considered during this critical time in their education.

PMID:34313383 | DOI:10.1111/tct.13402