Nevin Manimala

J Osteopath Med. 2021 Jul 27. doi: 10.1515/jom-2021-0052. Online ahead of print.

ABSTRACT

CONTEXT: Emergency medicine (EM) physicians commonly stabilize patients with acute psychiatric distress, such as suicidal ideation. Research has shown that suicidal ideation is difficult to manage in emergency department (ED) settings and that patients in psychiatric distress are often “boarded” in the ED while awaiting more definitive care.

OBJECTIVES: To examine the attitudes and experiences of emergency physicians regarding the care of patients in psychiatric distress. Special attention is given to suicidal ideation due to its prevalence in the United States.

METHODS: A 19 question anonymous survey was sent via email to 55 emergency medicine residency directors throughout Michigan, Ohio, Indiana, and Illinois, who were identified using an Internet search of residency programs in the region. The program directors were asked to distribute the survey to their colleagues and residents. The intent of this procedure was to generate as many survey responses as possible, while obscuring the identities of the respondents. Responses were gathered from October 29, 2019 until January 16, 2020. The survey was designed to assess respondents’ self-reported demographic data as well as their experiences with the boarding process, initial examination, final disposition, reevaluation of the patient, physician training and resources, and follow up care. Statistical analysis was performed using a Mann-Whitney U test, significance was set at p<0.01.

RESULTS: In total, 47 EM physicians responded to the survey; however, not all of the respondents completed all 19 questions. Ten of 44 respondents (22.7%) reported that they do not perform the initial psychiatric examination themselves and instead defer to a nurse or social worker. Twenty-two of 44 respondents (50.0%) reported that they defer to a social worker when determining the final disposition of psychiatric patients. Respondents reevaluated patients in psychiatric distress statistically significantly less often (p=0.01) compared with patients with cardiac pathology. Additionally, 15 of 38 respondents (39.5%) reported that they did not feel adequately trained to handle psychiatric emergencies, and 36 of 39 respondents (92.3%) of physicians felt that their facility would benefit from additional mental health resources. Thirty five of 39 respondents (89.7%) reported that their facility did not have a system in place to follow up with suicidal patients upon discharge.

CONCLUSIONS: Caring for patients who are acutely suicidal or in psychiatric distress is complex and more research is needed to optimize treatment strategies. The results of this study indicate that EM physicians may regularly defer to nonphysician providers when evaluating and treating patients in psychiatric distress. A perceived lack of training in psychiatry may contribute to this practice. The results of this study are in accord with previous research that indicated a need for additional psychiatry training in EM residencies.

PMID:34315193 | DOI:10.1515/jom-2021-0052

Oncol Res Treat. 2021 Jul 27:1-9. doi: 10.1159/000517409. Online ahead of print.

ABSTRACT

OBJECTIVES: FOLFIRINOX, gemcitabine/nab-paclitaxel (gem-nab/P), and gemcitabine-capecitabine (gem-cap) demonstrated superiority over gemcitabine monotherapy for pancreatic cancer (PC). It is still unclear which chemotherapy regimen is the most optimal. This study aimed to conduct a systematic review (SR) and indirect comparison to compare safety and efficacy of FOLFIRINOX versus gem-nab/P and gem-cap in PC.

METHODS: An SR was conducted in several databases from inception to November 2020. RCTs investigating resectable or advanced PC were included. Primary outcomes including overall survival (OS), disease-free survival (DFS)/progression-free survival (PFS)/relapse-free survival (RFS), and grade 3/4 adverse events (AEs) were pooled using a random effects model. Indirect comparisons were done to compare FOLFIRINOX versus gem-cap and gem-nab/P. Heterogeneity was evaluated using Cochran’s Q test and I2 statistics.

RESULTS: Nine studies were identified involving 6,564 patients. Indirect comparisons showed FOLFIRINOX had significantly better OS (resectable: HR 0.78 [0.61-0.99]; advanced: HR 0.71 [0.60-0.85]) and RFS/DFS/PFS (resectable: HR 0.67 [0.55-0.82]; advanced: HR 0.65 [0.57-0.74]) compared to gem-cap as well as OS (resectable: HR 0.78 [0.61-1.00]; advanced: HR 0.73 [0.54-0.98]) and DFS/PFS (resectable: HR 0.66 [0.53-0.82]; advanced: HR 0.64 [0.49-0.83]) compared to gem-nab/P. FOLFIRINOX increased grade 3/4 AE risk compared to gem-cap and gem-nab/P.

CONCLUSIONS: FOLFIRINOX is associated with significant survival benefits compared to gem-nab/P and gem-cap. However, it is important to consider the increased grade 3/4 AE risk associated with FOLFIRINOX.

PMID:34315166 | DOI:10.1159/000517409

Physiol Meas. 2021 Jul 27. doi: 10.1088/1361-6579/ac184c. Online ahead of print.

ABSTRACT

OBJECTIVE: The physiological activity of the heart is controlled and modulated mostly by the parasympathetic and sympathetic nervous systems. Heart rate variability (HRV) analysis is therefore used to observe fluctuations that reflect changes in the activity in these two branches. Knowing that acceleration and deceleration patterns in heart rate fluctuations are asymmetrically distributed, the ability to analyze heart rate variability asymmetry was introduced into MMA.

APPROACH: The new method is called Asymmetric Multiscale Multifractal Analysis (AMMA) and the analysis involved six groups: 61 healthy persons, 104 cases with aortic valve stenosis, 42 with hypertrophic cardiomyopathy, 36 with atrial fibrillation, 70 patients with coronary artery disease and 19 with congestive heart failure.

MAIN RESULTS: Analyzing the results obtained for the 6 groups of patients based on the AMMA method, i.e. comparing the Hurst surfaces for heart rate decelerations and accelerations, it was noticed that these surfaces differ significantly. And differences occur in most groups for large fluctuations (multifractal parameter q>0). In addition, a similarity was found for all groups for the AMMA Hurst surface for decelerations to the MMA Hurst surface – heart rate decelerations (lengthening of the RR intervals) appears to be the main factor determining the shape of the complete Hurst surface and so the multifractal properties of heart rate variability. The differences between the groups, especially for coronary artery disease, hypertrophic cardiomyopathy and aortic valve stenosis, are more visible if the Hurst surfaces are analyzed separately for accelerations and decelerations.

SIGNIFICANCE: The AMMA results presented here may provide additional input for heart rate variability analysis and create a new paradigm for future medical screening. Note that the heart rate variability analysis using MMA (without distinguishing accelerations from decelerations) gave satisfactory screening statistics in our previous studies.

PMID:34315141 | DOI:10.1088/1361-6579/ac184c

Biomed Phys Eng Express. 2021 Jul 27. doi: 10.1088/2057-1976/ac182e. Online ahead of print.

ABSTRACT

Insulin signaling pathways in muscle tissue play a major role in maintaining glucose homeostasis. Dysregulation in these pathways results in the onset of serious metabolic disorders like type 2 diabetes. Robustness is an essential characteristic of insulin signaling pathways that ensures reliable signal transduction in the presence of perturbations as a result of several feedback mechanisms. Integral control, according to control engineering, provides reliable setpoint tracking and disturbance rejection. The presence of negative feedback and integrating process is crucial for biological processes to achieve integral control. The existence of an integral controller leads to the rejection of perturbations which resulted in the robust regulation of biochemical entities within acceptable levels. In the present in silico research work, the presence of integral control in the protein kinase C ζ – insulin receptor substrate-1 (PKC ζ-IRS1) pathway is identified, verified mathematically and model is simulated in Cell Designer. The data is exported to Minitab software and robustness analysis is carried out statistically using the Mann-Whitney test. The p-value of the results obtained with given parameters perturbed by ±1% is greater than the significance level of 0.05 (0.2132 for 1% error in k7(rate constant of IRS1 phosphorylation), 0.2096 for -1% error in k7, 0.9037 for both ±1% error in insulin and 0.9037 for ±1% error in k1(association rate constant of the first molecule of insulin to bind the insulin receptor), indicated that our hypothesis is proved The results satisfactorily indicate that even when perturbations are present, glucose homeostasis in muscle tissue is robust due to the presence of integral regulation in the PKC ζ-IRS1 insulin signaling pathways. In this paper, we have analysed the findings from the framework of robust control theory, which has allowed us to examine that how PKC ζ-IRS1 insulin signaling pathways produces desired output in presence of perturbations.

PMID:34315137 | DOI:10.1088/2057-1976/ac182e

Phys Med Biol. 2021 Jul 27. doi: 10.1088/1361-6560/ac1834. Online ahead of print.

ABSTRACT

Cardiac radioablation offers non-invasive treatments for refractory arrhythmias. However, treatment delivery for this technique remains challenging. In this paper, we introduce the first method for real-time image guidance during cardiac radioablation for refractory atrial fibrillation on a standard linear accelerator. Our proposed method utilizes direct diaphragm tracking on intrafraction images to estimate the respiratory component of cardiac substructure motion. We compare this method to treatment scenarios without real-time image guidance using the 4D-XCAT digital phantom. Pre-treatment and intrafraction imaging was simulated for 8 phantoms with unique anatomies programmed using cardiorespiratory motion from healthy volunteers. As every voxel in the 4D-XCAT phantom is labelled precisely according to the corresponding anatomical structure, this provided ground-truth for quantitative evaluation. Tracking performance was compared to the ground-truth for simulations with and without real-time image guidance using the left atrium as an exemplar target. Differences in target volume size, mean volumetric coverage, minimum volumetric coverage and geometric error were recorded for each simulation. We observed that differences in target volume size were statistically significant (p < 0.001) across treatment scenarios and that real-time image guidance enabled reductions in target volume size ranging from 11 – 24%. Differences in mean and minimum volumetric coverage were statistically insignificant (both p = 0.35) while differences in geometric error were statistically significant (p = 0.039). The results of this study provide proof-of-concept for x-ray based real-time image guidance during cardiac radioablation.

PMID:34315136 | DOI:10.1088/1361-6560/ac1834

J Affect Disord. 2021 Jul 18;294:382-390. doi: 10.1016/j.jad.2021.07.020. Online ahead of print.

ABSTRACT

BACKGROUND: This study examined the global association between the Traditional Japanese Diet Score and suicide rate.

METHODS: Average food supply and energy supply by country were obtained from the Food and Agriculture Organization of the United Nations Statistics Division database (FAOSTAT). Traditional Japanese Diet Score (TJDS) was calculated from food group classifications. Age-standardized suicide rates per 100,000 people by country were obtained from the Global Burden of Disease 2017 database. The 26-year associations between TJDS and suicide rates were examined controlling for covariates using a mixed-effects model in 138 countries with populations of 1 million or greater.

RESULTS: A significant negative association was found in the analysis of the relationship between TJDS and the prevalence of suicide [β (se) = -0.126 (0.031), p < 0.001]. The interaction term between TJDS and year was also significant [β (se) = -0.011 (0.003), p < 0.001]. The change in the effect of TJDS on suicide rates by year was examined. The effect of TJDS was not significant from 1991 to 1999 but became significant after 2000; the slope of the TJDS to suicide rate in 2017 was -0.270 (95% confidence interval -0.382, -0.169, p < 0.001).

LIMITATIONS: This was a national ecological study and did not consider individual differences in sex, age, and lifestyle.

CONCLUSIONS: TJDS may be is a protective factor for depression, which may prevent suicide. The association between TJDS and suicide rates became stronger over time and was inversely associated with suicide rates after 2000.

PMID:34315100 | DOI:10.1016/j.jad.2021.07.020

Eur J Radiol. 2021 Jul 22;142:109867. doi: 10.1016/j.ejrad.2021.109867. Online ahead of print.

ABSTRACT

PURPOSE: We aimed to compare the diagnostic performance of PET/CT imaging performed with ⁶⁸Ga-DOTA-FAPI and ¹⁸FDG in detection of liver metastases in patients with gastrointestinal system (GIS) cancer.

METHODS: A total of 31 patients who underwent ⁶⁸Ga-DOTA-FAPI and ¹⁸F-FDG PET/CT examinations and diagnosed with GIS cancer (15 colorectal, 9 pancreas, 4 stomach and 3 other cancers) were included in the study. The presence of liver metastasis was decided based on histopathologic diagnosis, PET/CT, other radiologic examinations or tumor biomarker findings, and both PET/CT imaging findings were compared on the patient and lesion basis.

RESULTS: Of the 31 patients, 28 were found as true positive with ⁶⁸Ga-DOTA-FAPI-PET/CT and 17 with ¹⁸FDG-PET/CT. Of the 98 metastatic liver lesions determined according to our diagnostic criteria, 92 were found as true positive lesions with ⁶⁸Ga-DOTA-FAPI-PET/CT and 65 with ¹⁸FDG-PET/CT. There was a statistically significant difference between both imaging modalities in the patient and lesion based comparisons (p < 0.05). When semiquantitative values (SUVmax, mlr) obtained from the lesions were compared between the two imaging methods, mlr values showed statistically significant difference in all tumor subgroups (p < 0.05).

CONCLUSION: It was concluded that ⁶⁸Ga-DOTA-FAPI-PET/CT was superior over ¹⁸FDG-PET/CT in detection of liver metastases of GIS cancers and it can be a complementary method especially in negative cases with ¹⁸FDG-PET/CT.

PMID:34315086 | DOI:10.1016/j.ejrad.2021.109867

Chemosphere. 2021 Jul 8;286(Pt 1):131479. doi: 10.1016/j.chemosphere.2021.131479. Online ahead of print.

ABSTRACT

The present work investigates for the first time the presence and isolation of the thermophilic fungi from hydrothermal spring situated at the locality of Guelma, in the Northeast of Algeria. The production of the thermostable proteases and the optimization of culture conditions under agro-wastes solid-state fermentation to achieve optimal production capacity were explored. A statistical experimental approach consisting of two designs was used to determine the optimum culture conditions and to attain the greatest enzyme production. Besides, different agricultural wastes were initially evaluated as a substrate, whereby wheat bran was selected for enzyme production by the isolate under solid-state conditions. The isolate thermophilic fungi were identified as Mycothermus thermophilus by sequencing the ITS region of the rDNA (NCBI Accession No: MK770356.1). Among the various screened variables: the temperature, the inoculum size, and the moisture were proved to have the most significant effects on protease activity. Employing two-level fractional Plackett-Burman and a Box-Behnken designs statistical approach helped in identifying optimum values of screened factors and their interactions. The analysis showed up 6.17-fold improvement in the production of proteases (~1187.03 U/mL) was achieved under the optimal conditions of moisture content 47%, inoculum 5 × 10⁵ spores/g, and temperature at 42 °C. These significant findings highlight the importance of the statistical design in isolation of Mycothermus thermophilus species from a specific location as well as identifying the optimal culture conditions for maximum yield.

PMID:34315081 | DOI:10.1016/j.chemosphere.2021.131479

Chemosphere. 2021 Jul 23;286(Pt 1):131660. doi: 10.1016/j.chemosphere.2021.131660. Online ahead of print.

ABSTRACT

Biochar mediated pollutant removal is gaining attention because of high efficiency of the process. However, effective recycling avenues of the pollutant-saturated biochars are scarce in the knowledge base; while such materials can be a new source of long-range contamination. Therefore, potential of vermitechnology for eco-friendly recycling of pollutant-loaded biochar was assessed by using arsenic-saturated native (NBC) and exfoliated (EBC) biochars as feedstocks for the first time. Interestingly, the bioavailable arsenic fractions (water soluble and exchangeable) considerably reduced by 22-44 % with concurrent increment (~8-15 %) of the recalcitrant (residual and organic bound) fractions in the biochar-based feedstocks. Consequently, ~2-3 folds removal of the total arsenic was achieved through vermicomposting. The earthworm population growth (2.5-3 folds) was also highly satisfactory in the biochar-based feedstocks. The results clearly imply that Eisenia fetida could compensate the arsenic-induced stress to microbial population and greatly augmented microbial biomass, respiration and enzyme activity by 3-12 folds. Moreover, biochar-induced alkalinity was significantly neutralized in the vermibeds, which remarkably balanced the TOC level and nutrient (N, P, and K) availability particularly in EBC + CD vermibeds. Overall, the nutrient recovery potential and arsenic removal efficiency of vermitechnology was clearly exhibited in NBC/EBC + CD (12.5:87.5) feedstocks. Hence, it is abundantly clear that vermitechnology can be a suitable option for eco-friendly recycling of pollutant-saturated sorbing agents, like biochars.

PMID:34315078 | DOI:10.1016/j.chemosphere.2021.131660

Clin Neurophysiol. 2021 Jul 3;132(9):2232-2239. doi: 10.1016/j.clinph.2021.06.012. Online ahead of print.

ABSTRACT

OBJECTIVE: To explore relationship between EEG theta activity and clinical data that imply the degree of genetic determination of epilepsy.

METHODS: Clinical data of interest were epilepsy diagnosis and positive / negative family history of epilepsy. Study groups were: idiopathic generalized epilepsy (IGE), focal epilepsy (FE); FE of unknown etiology (FEUNK), FE of postnatal-acquired etiology (FEPA); all patients with positive / negative family history of epilepsy (FAPALL, FANALL, respectively), disregarding of the syndrome; FAP patients with 1st degree affected relative (FAP1) and those with 2nd degree epileptic relative only (FAP2). Quantitative EEG analysis assessed amount of theta (3.5-7.0 Hz) activity in 180 seconds of artifact-free waking EEG background activity for each patient and group. Group comparison was carried out by nonparametric statistics.

RESULTS: Differences of theta activity were: FAPALL > FANALL (p = 0.01); FAP1 > FAP2 (p = 0.2752). IGE > FE (p = 0.02); FEUNK > FEPA (p = 0.07).

CONCLUSIONS: This was the first attempt to explore and quantitatively ascertain relationship between an EEG variable and clinical data that imply greater or lesser degree of genetic determination in epilepsy.

SIGNIFICANCE: Theta activity is endophenotype that bridges the gap between epilepsy susceptibility genes and clinical phenotypes. Amount of theta activity is indicative of degree of genetic determination of the epilepsies.

PMID:34315064 | DOI:10.1016/j.clinph.2021.06.012