Nevin Manimala

Gait Posture. 2021 May 9;88:94-104. doi: 10.1016/j.gaitpost.2021.05.008. Online ahead of print.

ABSTRACT

BACKGROUND: Postural control requires the interaction of somatosensory, vestibular and visual systems to prevent disequilibrium. Children with strabismus have an impaired visual input which can lead to postural control deficits.

RESEARCH QUESTION: Does strabismus affect sensory organization for postural control in children?

METHODS: A systematic comprehensive search of multiple electronic databases for relevant articles was performed using a predetermined search strategy. Peer-reviewed journal publications that assessed sensory organization and postural performance in children with strabismus were included in this review. Methodological quality of the articles was evaluated using the modified Downs and Black quality assessment tool. A total of 10 articles were included in this review.

RESULTS: Eight of the 10 articles reviewed were included in the meta-analysis. Meta-analysis for Centre of Pressure CoP velocity (n = 3) (eyes open, stable support), was statistically significant (P = 0.01) in favor of controls over children with strabismus (MD, 3.08; 95 % CI -0.66, 5.51). Meta-analysis for CoP surface area (n = 5) (eyes open, stable support) was also statistically significant (P < 0.001) in favor of the control group (MD, 130.14; 95 % CI 70.01, 190.260). Meta-analysis with standardized mean difference (n = 6) for eyes open vs closed, stable support was statistically significant (P = 0.02) in favor of eyes open (MD, -0.94; 95 % CI, -1.74, -0.15). Overall, there was a high level of heterogeneity throughout the studies.

SIGNIFICANCE: This is the first systematic review of its kind to collate and synthesize evidence on the effect of strabismus on postural control in children. This review suggests that postural control performance in children with strabismus is inferior to that of age-matched control children. Further investigation is needed to understand the influence of the three sensory systems.

PMID:34015547 | DOI:10.1016/j.gaitpost.2021.05.008

Pract Radiat Oncol. 2021 May 17:S1879-8500(21)00121-1. doi: 10.1016/j.prro.2021.04.006. Online ahead of print.

ABSTRACT

OBJECTIVES: In patients with node-positive endometrial cancer, adjuvant radiotherapy with chemotherapy decreases local-regional recurrence compared to chemotherapy alone. However, optimal radiation field borders and extent of nodal coverage have not been well studied. In a multi-institutional cohort, survival outcomes and sites of failure were analyzed for patients with FIGO IIIC endometrioid endometrial cancer treated with pelvic (PRT) versus extended-field radiotherapy (EFRT), which encompassed high para-aortic lymph nodes.

METHODS: In a multi-institutional retrospective study, 143 patients with FIGO IIIC1 or IIIC2 endometrioid endometrial cancer treated with adjuvant radiotherapy from 2000-2016 were identified. Patient subgroups were classified by substage and radiation field extent: IIIC1 receiving EFRT, IIIC1 PRT, and IIIC2 EFRT. Recurrence-free (RFS), overall survival (OS) and out-of-field recurrence were calculated by Kaplan-Meier method. Multivariate analysis was performed by Cox proportional hazard. Sites of failure were categorized as within or outside the radiation field.

RESULTS: Median follow-up was 59 months; 87% received chemotherapy. Five-year RFS and OS rates were 73% and 87%, respectively. By subgroup, 5-year RFS rates were: 79% IIIC1 EFRT, 73% IIIC1 PRT and 69% IIIC2 EFRT (p=0.4). On MVA, recurrence risk was highest for IIIC2 EFRT, although not statistically significant (adjusted hazard ratio 2.0, p=0.4). In-field vaginal and nodal recurrences were observed in 2 (1%) and 4 (3%) patients, respectively. Of 78 stage IIIC1 patients treated with PRT, 5 (6%) had isolated para-aortic nodal relapse outside the radiation field; 3 were long-term survivors more than 6 years after salvage therapy. For patients with para-aortic recurrence, most had lymphovascular invasion (86%), ≥50% myometrial invasion (71%) and/or grade 3 disease (57%).

CONCLUSIONS: Adjuvant chemoradiotherapy results in excellent survival outcomes for patients with FIGO IIIC endometrioid endometrial cancer. For patients with positive pelvic nodes, isolated para-aortic relapse outside the PRT field was uncommon and amenable to salvage therapy.

PMID:34015544 | DOI:10.1016/j.prro.2021.04.006

Cochrane Database Syst Rev. 2021 May 20;5:CD011710. doi: 10.1002/14651858.CD011710.pub3.

ABSTRACT

BACKGROUND: Therapist-delivered trauma-focused psychological therapies are effective for post-traumatic stress disorder (PTSD) and have become the accepted first-line treatments. Despite the established evidence-base for these therapies, they are not always widely available or accessible. Many barriers limit treatment uptake, such as the number of qualified therapists available to deliver the interventions; cost; and compliance issues, such as time off work, childcare, and transportation, associated with the need to attend weekly appointments. Delivering Internet-based cognitive and behavioural therapy (I-C/BT) is an effective and acceptable alternative to therapist-delivered treatments for anxiety and depression.

OBJECTIVES: To assess the effects of I-C/BT for PTSD in adults.

SEARCH METHODS: We searched MEDLINE, Embase, PsycINFO and the Cochrane Central Register of Controlled Trials to June 2020. We also searched online clinical trial registries and reference lists of included studies and contacted the authors of included studies and other researchers in the field to identify additional and ongoing studies.

SELECTION CRITERIA: We searched for RCTs of I-C/BT compared to face-to-face or Internet-based psychological treatment, psychoeducation, wait list, or care as usual. We included studies of adults (aged over 16 years), in which at least 70% of the participants met the diagnostic criteria for PTSD, according to the Diagnostic and Statistical Manual (DSM) or the International Classification of Diseases (ICD).

DATA COLLECTION AND ANALYSIS: Two review authors independently assessed abstracts, extracted data, and entered data into Review Manager 5. The primary outcomes were severity of PTSD symptoms and dropouts. Secondary outcomes included diagnosis of PTSD after treatment, severity of depressive and anxiety symptoms, cost-effectiveness, adverse events, treatment acceptability, and quality of life. We analysed categorical outcomes as risk ratios (RRs), and continuous outcomes as mean differences (MD) or standardised mean differences (SMDs), with 95% confidence intervals (CI). We pooled data using a fixed-effect meta-analysis, except where heterogeneity was present, in which case we used a random-effects model. We independently assessed the included studies for risk of bias and we evaluated the certainty of available evidence using the GRADE approach; we discussed any conflicts with at least one other review author, with the aim of reaching a unanimous decision.

MAIN RESULTS: We included 13 studies with 808 participants. Ten studies compared I-C/BT delivered with therapist guidance to a wait list control. Two studies compared guided I-C/BT with I-non-C/BT. One study compared guided I-C/BT with face-to-face non-C/BT. There was substantial heterogeneity among the included studies. I-C/BT compared with face-to-face non-CBT Very low-certainty evidence based on one small study suggested face-to-face non-CBT may be more effective than I-C/BT at reducing PTSD symptoms post-treatment (MD 10.90, 95% CI 6.57 to 15.23; studies = 1, participants = 40). There may be no evidence of a difference in dropout rates between treatments (RR 2.49, 95% CI 0.91 to 6.77; studies = 1, participants = 40; very low-certainty evidence). The study did not measure diagnosis of PTSD, severity of depressive or anxiety symptoms, cost-effectiveness, or adverse events. I-C/BT compared with wait list Very low-certainty evidence showed that, compared with wait list, I-C/BT may be associated with a clinically important reduction in PTSD post-treatment (SMD -0.61, 95% CI -0.93 to -0.29; studies = 10, participants = 608). There may be no evidence of a difference in dropout rates between the I-C/BT and wait list groups (RR 1.25, 95% CI 0.97 to 1.60; studies = 9, participants = 634; low-certainty evidence). I-C/BT may be no more effective than wait list at reducing the risk of a diagnosis of PTSD after treatment (RR 0.53, 95% CI 0.28 to 1.00; studies = 1, participants = 62; very low-certainty evidence). I-C/BT may be associated with a clinically important reduction in symptoms of depression post-treatment (SMD -0.51, 95% CI -0.97 to -0.06; studies = 7, participants = 473; very low-certainty evidence). Very low-certainty evidence also suggested that I-C/BT may be associated with a clinically important reduction in symptoms of anxiety post-treatment (SMD -0.61, 95% CI -0.89 to -0.33; studies = 5, participants = 345). There were no data regarding cost-effectiveness. Data regarding adverse events were uncertain, as only one study reported an absence of adverse events. I-C/BT compared with I-non-C/BT There may be no evidence of a difference in PTSD symptoms post-treatment between the I-C/BT and I-non-C/BT groups (SMD -0.08, 95% CI -0.52 to 0.35; studies = 2, participants = 82; very low-certainty evidence). There may be no evidence of a difference between dropout rates from the I-C/BT and I-non-C/BT groups (RR 2.14, 95% CI 0.97 to 4.73; studies = 2, participants = 132; I² = 0%; very low-certainty evidence). Two studies found no evidence of a difference in post-treatment depressive symptoms between the I-C/BT and I-non-C/BT groups (SMD -0.12, 95% CI -0.78 to 0.54; studies = 2, participants = 84; very low-certainty evidence). Two studies found no evidence of a difference in post-treatment symptoms of anxiety between the I-C/BT and I-non-C/BT groups (SMD 0.08, 95% CI -0.78 to 0.95; studies = 2, participants = 74; very low-certainty evidence). There were no data regarding cost-effectiveness. Data regarding adverse effects were uncertain, as it was not discernible whether adverse effects reported were attributable to the intervention.

AUTHORS’ CONCLUSIONS: While the review found some beneficial effects of I-C/BT for PTSD, the certainty of the evidence was very low due to the small number of included trials. This review update found many planned and ongoing studies, which is encouraging since further work is required to establish non-inferiority to current first-line interventions, explore mechanisms of change, establish optimal levels of guidance, explore cost-effectiveness, measure adverse events, and determine predictors of efficacy and dropout.

PMID:34015141 | DOI:10.1002/14651858.CD011710.pub3

J Burn Care Res. 2021 May 20:irab083. doi: 10.1093/jbcr/irab083. Online ahead of print.

ABSTRACT

The incidence of pediatric treadmill hand friction burns has been increasing every year. The injuries are deeper than thermal hand burns, the optimal treatment remains unclear. This was a retrospective study of children who received surgery for treadmill hand friction burns from January 1, 2015, to December 31, 2019, in a single burn center. A total of 22 children were surveyed. The patients were naturally divided into two groups: the wound repair group (13 patients), which was admitted early to the hospital after injury and received debridement and vacuum sealing drainage initially, and a full-thickness skin graft later; and the scar repair group (9 patients), in which a scar contracture developed as a result of wound healing and received scar release and skin grafting later. The Modified Michigan Hand Questionnaire score in the wound repair group was 116.31 ± 10.55, and the corresponding score in the scar repair group was 117.56 ± 8.85 (P>0.05), no statistically significant difference. The Vancouver Scar Scale score in the wound repair group was 4.15 ± 1.21, and the corresponding score in the scar repair group was 7.22 ± 1.09 (P<0.05). Parents were satisfied with the postoperative appearance and function of the hand. None in the two groups required secondary surgery. If the burns are deep second degree, third degree, or infected, early debridement, vacuum sealing drainage initially, and a full-thickness skin graft can obviously relieve pediatric pain, shorten the course of the disease, and restore the function of the hand as soon as possible.

PMID:34015124 | DOI:10.1093/jbcr/irab083

J Clin Endocrinol Metab. 2021 May 20:dgab346. doi: 10.1210/clinem/dgab346. Online ahead of print.

ABSTRACT

AIMS: We aimed to assess the association between gut bacterial biomarkers during early pregnancy and subsequent risk of gestational diabetes mellitus (GDM) in Chinese pregnant women.

METHODS: Within the Tongji-Shuangliu Birth Cohort study, we conducted a nested case-control study among 201 incident GDM cases and 201 matched controls. Fecal samples were collected during early pregnancy (at 6-15 weeks), and GDM was diagnosed at 24-28 weeks of pregnancy. Community DNA isolated from fecal samples and V3-V4 region of 16S rRNA gene amplicon libraries were sequenced.

RESULTS: In GDM cases versus controls, Rothia, Actinomyces, Bifidobacterium, Adlercreutzia, and Coriobacteriaceae, and Lachnospiraceae spp. were significantly reduced, while Enterobacteriaceae, Ruminococcaceae spp. and Veillonellaceae were over-represented. In addition, the abundance of Staphylococcus relative to Clostridium, Roseburia and Coriobacteriaceae as reference microorganisms were positively correlated with fasting blood glucose, 1-h and 2-h postprandial glucose levels. Adding microbial taxa to the base GDM prediction model with conventional risk factors increased the C-statistic significantly (P<0.001) from 0.69 to 0.75.

CONCLUSIONS: Gut microbiota during early pregnancy was associated with subsequent risk of GDM. Several beneficial and commensal gut microorganisms showed inverse relations with incident GDM, while opportunistic pathogenic members were related to higher risk of incident GDM and positively correlated with glucose levels on OGTT.

PMID:34015117 | DOI:10.1210/clinem/dgab346

J Antimicrob Chemother. 2021 May 20:dkab138. doi: 10.1093/jac/dkab138. Online ahead of print.

ABSTRACT

INTRODUCTION: The optimal method for implementing hospital-level restrictions for antibiotics that carry a high risk of Clostridioides difficile infection has not been identified. We aimed to explore barriers and facilitators to implementing restrictions for fluoroquinolones and third/fourth-generation cephalosporins.

METHODS: This mixed-methods study across a purposeful sample of 15 acute-care, geographically dispersed Veterans Health Administration hospitals included electronic surveys and semi-structured interviews (September 2018 to May 2019). Surveys on stewardship strategies were administered at each hospital and summarized with descriptive statistics. Interviews were performed with 30 antibiotic stewardship programme (ASP) champions across all 15 sites and 19 additional stakeholders at a subset of 5 sites; transcripts were analysed using thematic content analysis.

RESULTS: The most restricted agent was moxifloxacin, which was restricted at 12 (80%) sites. None of the 15 hospitals restricted ceftriaxone. Interviews identified differing opinions on the feasibility of restricting third/fourth-generation cephalosporins and fluoroquinolones. Some participants felt that restrictions could be implemented in a way that was not burdensome to clinicians and did not interfere with timely antibiotic administration. Others expressed concerns about restricting these agents, particularly through prior approval, given their frequent use, the difficulty of enforcing restrictions and potential unintended consequences of steering clinicians towards non-restricted antibiotics. A variety of stewardship strategies were perceived to be effective at reducing the use of these agents.

CONCLUSIONS: Across 15 hospitals, there were differing opinions on the feasibility of implementing antibiotic restrictions for third/fourth-generation cephalosporins and fluoroquinolones. While the perceived barrier to implementing restrictions was frequently high, many hospitals were effectively using restrictions and reported few barriers to their use.

PMID:34015115 | DOI:10.1093/jac/dkab138

Med Ultrason. 2021 May 20. doi: 10.11152/mu-2906. Online ahead of print.

ABSTRACT

AIM: This study aimed to evaluate whether a quantitative contrast-enhanced ultrasonography (CEUS) study is feasible to diagnose middle hepatic venous occlusion after living donor liver transplantation (LDLT).

MATERIALS AND METHODS: From December 2018 to July 2019, the CEUS study on the first postoperative day had been conducted in patients who underwent LDLT. 46 patients were finally included in the study. To obtain CEUS parameters from time-intensity curves (TICs) on the hepaticparenchyma, the two regions of interests (ROIs) were located in the right hepatic vein (RHV) territory and middle hepatic vein (MHV) territory of the right hepatic graft. The measured CEUS parameters were wash-in slope (WIS), peak intensity (PI), time to peak (TTP), and area under the curve (AUC). The subjects were classified into the occlusion and non-occlusion groups. In each group, the parameters measured in the RHV and MHV territories were compared with paired-sample Student’st-tests.

RESULTS: Hepatic venous occlusion was diagnosed in 25 patients (54%). The WIS, TTP, and AUC of the MHV territory (2.95 dB/sec; 22.39 sec; 204.27 dB·sec, respectively) were significantly different from those of the RHV territory (2.16 dB/sec; 25.81 sec; 165.66 dB·sec; all p<0.05). There were no statistically significant differences in PI between the MHV and RHV territories (19.08 dB vs. 18.27 dB, respectively; p=0.259). In the non-occlusion group, there was no parameter which was significantly different between MHV and RHV territories (p>0.05).

CONCLUSION: The parametric analysis of CEUS can help diagnose middle hepatic venous occlusion after LDLT.

PMID:34015077 | DOI:10.11152/mu-2906

PLoS One. 2021 May 20;16(5):e0251782. doi: 10.1371/journal.pone.0251782. eCollection 2021.

ABSTRACT

BACKGROUND: Early life exposure to adverse environments, and maternal stress in particular, has been shown to increase risk for metabolic diseases and neurobehavioral disorders. While many studies have examined the hypothalamic-pituitary-adrenal axis (HPA axis) as the primary mechanism behind these relationships, emerging research on the brain-gut axis suggests that the microbiome may play a role. In this study, we tested the relationships among maternal precarity and HPA axis dysregulation during the peripartum period, infant gut microbiome composition, and infant HPA axis functioning.

METHODS: Data come from 25 mother-infant dyads in the Galápagos, Ecuador. Women completed surveys on precarity measures (food insecurity, low social support, depression, and stress) and gave salivary cortisol samples during and after pregnancy. Infant salivary cortisol and stool were collected in the postpartum. Statistical significance of differences in microbial diversity and relative abundance were assessed with respect to adjusted linear regression models.

RESULTS: Maternal precarity was associated with lower diversity and higher relative abundance of Enterobacteriaceae and Streptococcaceae and a lower relative abundance of Bifidobacterium and Lachnospiraceae. These patterns of colonization for Enterobacteriaceae and Bifidobacterium mirrored those found in infants with HPA axis dysregulation. Maternal HPA axis dysregulation during pregnancy was also associated with a greater relative abundance of Veillonella.

CONCLUSIONS: Overall, exposures to precarity and HPA axis dysregulation were associated with an increase in groups that include potentially pathogenic bacteria, including Enterobacteriaceae, Streptococcaceae, and Veillonella, and a decrease in potentially protective bacteria, including Bifidobacterium and Lachnospiraceae, as well as a decrease in overall diversity.

PMID:34015045 | DOI:10.1371/journal.pone.0251782

PLoS One. 2021 May 20;16(5):e0252091. doi: 10.1371/journal.pone.0252091. eCollection 2021.

ABSTRACT

In newborn screening, samples suspected for congenital adrenal hyperplasia (CAH), a potentially lethal inborn error of steroid biosynthesis, need to be confirmed using liquid chromatography-tandem mass spectrometry. Daily quality controls (QCs) for the 2nd-tier CAH assay are not commercially available and are therefore generally prepared within the laboratory. For the first time, we aimed to compare five different QC preparation approaches used in routine diagnostics for CAH on the concentrations of cortisol, 21-deoxycortisol, 11-deoxycortisol, 4-androstenedione and 17-hydroxyprogesterone in dried blood spots. The techniques from Prep1 to Prep5 were tested at two analyte concentrations by spiking aliquots of a steroid-depleted blood, derived from washed erythrocyte suspension and steroid-depleted serum. The preparation processes differed in the sequence of the preparation steps and whether freeze-thaw cycles were used to facilitate blood homogeneity. The five types of dried blood spot QCs were assayed and quantitated in duplicate on five different days using a single calibration row per day. Inter-assay variations less than 15% and concentrations within ±15% of the nominal values were considered acceptable. Results obtained by means of the four dried blood spot QC preparation techniques (Prep1, Prep2, Prep4 and Prep5) were statistically similar and remained within the ±15% ranges in terms of both reproducibility and nominal values. However, concentration results for Prep3 (spiking prior to three freeze-thaw cycles) were significantly lower than the nominal values in this setting, with differences exceeding the ±15% range in many cases despite acceptable inter-assay variations. These findings have implications for the in-house preparation of QC samples in laboratory developed tests for CAH, including 2nd-tier assays in newborn screening.

PMID:34015037 | DOI:10.1371/journal.pone.0252091

PLoS One. 2021 May 20;16(5):e0251935. doi: 10.1371/journal.pone.0251935. eCollection 2021.

ABSTRACT

BACKGROUND: Multiple psychological factors of suicidal behaviour have been identified so far; however, little is known about state-dependent alterations and the interplay of the most prominent components in a suicidal crisis. Thus, the combined effect of particular personality characteristics and decision-making performance was observed within individuals who recently attempted suicide during a major depressive episode.

METHODS: Fifty-nine medication-free major depressed patients with a recent suicide attempt (within 72 h) and forty-five healthy control individuals were enrolled in this cross-sectional study. Temperament and character factors, impulsivity and decision-making performance were assessed. Statistical analyses aimed to explore between-group differences and the most powerful contributors to suicidal behaviour during a depressive episode.

RESULTS: Decision-making and personality differences (i.e. impulsivity, harm avoidance, self-directedness, cooperativeness and transcendence) were observed between the patient and the control group. Among these variables, decision-making, harm avoidance and self-directedness were shown to have the strongest impact on a recent suicide attempt of individuals with a diagnosis of major depressive disorder according to the results of the binary logistic regression analysis. The model was significant, adequately fitted the data and correctly classified 79.8% of the cases.

CONCLUSIONS: The relevance of deficient decision-making, high harm avoidance and low self-directedness was modelled in the case of major depressed participants with a recent suicide attempt; meaning that these individuals can be described with the myopia for future consequences, a pessimistic, anxious temperament; and a character component resulting in the experience of aimlessness and helplessness. Further studies that use a within-subject design should identify and confirm additional characteristics specific to the suicidal mind.

PMID:34015015 | DOI:10.1371/journal.pone.0251935