Nevin Manimala

Am J Epidemiol. 2021 Oct 20:kwab253. doi: 10.1093/aje/kwab253. Online ahead of print.

ABSTRACT

Social epidemiology aims to identify social structural risk factors thus informing targets and timing of interventions. Ascertaining which interventions will be most effective and when they should be implemented is challenging because social conditions vary across the life-course and are subject to time-varying confounding. Marginal Structural Models (MSMs) methods may be useful but can present unique challenges when studying social epidemiologic exposures over the life-course. We describe selected MSMs corresponding with common theoretical life-course models and identify key issues for consideration, related to time-varying confounding and late-study enrollment. Using simulated data mimicking a cohort study evaluating the effects of depression in early-, mid-, and late-life on late-life stroke risk, we examined whether and when specific study characteristics and analytic strategies may induce bias. In the context of time-varying confounding, inverse probability weighted estimation of correctly specified MSMs accurately estimated the target causal effects, while conventional regression models showed significant bias. When no measure of early-life depression is available, neither MSMs nor conventional models were unbiased, due to confounding by early-life depression. To inform interventions, researchers need to identify timing of effects and consider if missing data regarding exposures earlier in life may lead to biased estimates.

PMID:34668974 | DOI:10.1093/aje/kwab253

Surg Obes Relat Dis. 2021 Sep 25:S1550-7289(21)00457-3. doi: 10.1016/j.soard.2021.09.010. Online ahead of print.

ABSTRACT

BACKGROUND: Patients are increasingly referred for conversion of laparoscopic adjustable gastric band (LAGB) to laparoscopic Roux-en-Y gastric bypass (LRYGB) or sleeve gastrectomy (SG). The safety of a 1- versus 2-stage approach to this revision is debated.

OBJECTIVES: We examined the safety and efficacy of 1-stage conversion of LAGB to SG at our institution.

SETTING: University hospital.

METHODS: An institutional database was used to retrospectively identify patients who underwent single-stage LAGB-to-SG conversion between 2010 and 2018. Patients were matched 1:1 for age, sex, and body mass index with primary SG patients during this same period. Primary endpoints were operative time, complication rate, length of hospital say, and weight loss 12 months from surgery.

RESULTS: Two-hundred and twenty-nine patients undergoing conversion of LAGB to SG were identified. Median postoperative length of hospital stay was 2 days. Two patients (.8%) developed surgical site infection. One patient (.4%) developed a postoperative myocardial infarction. There were 4 total readmissions (1.7%) and 1 reoperation within 30 days (.4%). There were no statistically significant differences in 30-day complication rates between groups. Weight loss at 12 months was significantly different: Median body mass index loss for conversion patients was 5.1 kg/m² compared with 8.85 kg/m² for patients in the primary SG group (P < .0001).

CONCLUSION: Single-stage conversion of LAGB to SG is safe and effective. Patients may not experience the same extent of weight loss as those with primary SG. Our findings represent the largest single-institutional experience to date and support a 1-stage approach whenever feasible.

PMID:34666948 | DOI:10.1016/j.soard.2021.09.010

Diagn Interv Imaging. 2021 Oct 16:S2211-5684(21)00223-0. doi: 10.1016/j.diii.2021.09.010. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to test the feasibility of joint space width (JSW) measurement on Dixon MR images with the “India ink” artifact between cartilage and bone marrow as a landmark for the subchondral plate and to correlate it with radiographic JSW.

MATERIALS AND METHODS: Both hands of six volunteers (three women, three men; mean age, 36.7 ± 10.4 [SD] years) and 24 patients with early rheumatoid arthritis (16 women, 8 men; mean age, 45.7 ± 14.5 [SD] years) were imaged with MRI Dixon sequences and radiographs. Two radiologists (R1, R2) separately measured JSW in 11 joints per hand on all Dixon images in volunteers, on contrast-enhanced T1-weighted out-of-phase images in patients and on radiographs in both groups. Inter-technique, intra-observer and inter-observer agreements were assessed using intraclass correlation coefficient (ICC) and Bland Altman analysis.

RESULTS: In volunteers, agreement between JSW measurements on MRI and radiographs was the highest with T1-weighted Dixon out-of-phase images (mean ICC ranging from 0.69 to 0.76 for R1 and 0.65 to 0.74 for R2). In patients, median bias between JSW measurements at first and second readings was not statistically significantly different from 0 on T1-weighted Dixon out-of-phase images (mean bias of 0.00 and + 0.01 mm) and radiographs (mean bias of 0.00 and +0.01 mm). Median bias of the difference between measurements of R1 and R2 was statistically significantly different from 0 on T1-weighted Dixon out-of-phase images (mean bias of -0.11 and -0.09 mm; P < 0.039) and radiographs (mean bias of -0.24 and -0.20 mm; P < 0.035).

CONCLUSION: Measurement of hand JSW on T1-weighted Dixon out-of-phase images using India ink artifact as a landmark for the subchondral plate is repeatable and reproducible.

PMID:34666946 | DOI:10.1016/j.diii.2021.09.010

J Plast Reconstr Aesthet Surg. 2021 Sep 17:S1748-6815(21)00418-6. doi: 10.1016/j.bjps.2021.08.031. Online ahead of print.

ABSTRACT

BACKGROUND: This study sought to compare postoperative outcomes after scaphocapitate arthrodesis (SCA) for the treatment of late-stage Kienböck disease according to the amount of ulnar translation of the carpus and to identify surgical factors associated with carpal-ulnar translation.

METHODS: Thirty-nine patients diagnosed with Kienböck disease (Lichtman stages III-IV) and treated with SCA were retrospectively reviewed. They were divided into the translated group (n=28) and untranslated group (n=11) according to the presence of carpal-ulnar translation. The following surgical factors in the patients were assessed: excision of the lunate, postoperative carpal height ratio, and radioscaphoid angle (RSA). Pain Visual Analog scale (VAS) score, wrist range of motion, grip strength, modified Mayo wrist score (MMWS), the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, and progression of radioscaphoid osteoarthritis were also assessed.

RESULTS: All patients showed functional improvement after a mean postoperative follow-up period of 40 months (VAS: 4.1 vs. 1.1, p <0.001; grip strength, 42.3 vs. 51.2 lb., p = 0.002; MMWS, 52.6 vs. 69.5, p <0.001; QuickDASH, 33.7 vs. 21.5, p <0.001). No statistically significant differences were found between the two groups in terms of outcome measures. Among the assessed surgical factors, the mean postoperative RSA was significantly smaller in the translated group than in the untranslated group (34.8° vs. 46.8°, p = 0.008). The proportion of patients with postoperative RSA <30° was significantly higher in the translated group than in the untranslated group (54.5% vs. 0%, p<0.001).

CONCLUSION: These results suggest that sufficient pain relief and functional improvement can be achieved after SCA for the treatment of late-stage Kienböck disease disregarding the occurrence of carpal-ulnar translation. In this study, overcorrection to RSA <30° induced more frequent carpal-ulnar translation after SCA.

PMID:34666943 | DOI:10.1016/j.bjps.2021.08.031

Am J Orthod Dentofacial Orthop. 2021 Oct 16:S0889-5406(21)00550-3. doi: 10.1016/j.ajodo.2021.01.021. Online ahead of print.

ABSTRACT

INTRODUCTION: This retrospective study aimed to evaluate whether there are differences in the duration of treatment and the quality of treatment results between patients whose entire treatment process is carried out by a single operator and those patients who are transferred to a second operator.

METHODS: One hundred twenty-three patients whose fixed orthodontic treatments were completed and included in the study, and their posttreatment plaster models and panoramic radiographs were used. Fifty-nine of the subjects were transfer patients, and their treatment was administered by 2 residents (transfer group). For the remaining 64 patients, all the treatment was carried out by a single resident (control group). Each group was further divided into 2 groups according to the treatment modality, resulting in 4 groups (nonextraction transfer group [n = 27], extraction transfer group [n = 32], nonextraction control group [n = 32], and extraction control group [n = 32]). The quality of the treatment outcomes was evaluated and compared using the American Board of Orthodontics cast-radiograph evaluation (CRE).

RESULTS: The total mean CRE scores in the nonextraction transfer and nonextraction control groups were 35.74 and 29.88, respectively. The means of treatment duration in the nonextraction transfer and nonextraction control groups were 32.7 months and 17.25 months, respectively. The total mean CRE scores in the extraction transfer and extraction control groups were 39.53 and 31.41, respectively. The means of treatment duration in the extraction transfer and extraction control groups were 34.38 and 22.94 months, respectively. Differences between all the compared pairings were statistically significant.

CONCLUSIONS: The transferred patients had longer treatment times and poorer treatment quality than the control group patients.

PMID:34666925 | DOI:10.1016/j.ajodo.2021.01.021

Urol Oncol. 2021 Oct 16:S1078-1439(21)00414-2. doi: 10.1016/j.urolonc.2021.09.002. Online ahead of print.

ABSTRACT

PURPOSE: To assess the effects of variable adoption of Medicaid Expansion (ME) of the Affordable Care Act among different states on urologic malignancies using a new variable that defines ME status of patient’s residence in a nationwide cancer registry.

BASIC PROCEDURES: The National Cancer Database was queried for urologic malignancies (bladder, prostate, kidney and testis) from 2011 to 2016, spanning the period surrounding the primary ME which took place in 2014. Trends in insurance status at time of diagnosis and effects on stage at presentation and survival after ME were evaluated using a difference-in-differences estimator and stratified Cox proportional hazards regression model.

MAIN FINDINGS: The percentage of patients with Medicaid coverage at the time of diagnosis increased significantly after adoption of ME in ME states across all urologic malignancies. Concurrently, there was a significant decrease in percentage of uninsured patients diagnosed with testis cancer, but not other urologic malignancies, in ME states. A change in the stage at presentation was not observed across all urologic malignancies for patients in ME states after adoption of ME. No difference in overall survival was noted among patients living in a ME state compared to non-ME states with adoption of ME in 2014.

PRINCIPAL CONCLUSIONS: Despite increases in the proportion of patients with Medicaid coverage after 2014 in states that enrolled in ME, there was not an associated change in stage at presentation or survival for patients with genitourinary malignancy.

PMID:34666919 | DOI:10.1016/j.urolonc.2021.09.002

ISA Trans. 2021 Sep 27:S0019-0578(21)00501-2. doi: 10.1016/j.isatra.2021.09.017. Online ahead of print.

ABSTRACT

Aided by a modified event-triggered communication policy (ETCP), this article addresses the dissipativity-based control synthesis problem for semi-Markovian switching systems (SMSSs) with simultaneous multiplicative probabilistic faults on sensors and actuators modules. The resulting model under consideration is more extensive, which covers semi-Markovian switching coefficients, transmission delays, and randomly occurring sensors and actuators faults in a unified systematic analytical framework instead of investigating separately in some existing works. More specifically, the probabilistic faults are assumed to happen on both the sensors and actuators modules simultaneously, and the distortion probability for each sensor and actuator is irrelevant, which can be characterized by multiplicate mutually independent stochastic variables that obeys certain statistical features and probabilistic distribution delineate on the interval [0,✠](✠≥1). To reduce the bandwidth usage, a novel event-triggered strategy is designed. Additionally, in the light of this newly developed ETCP, and considering the effects of the signal transmission delays and multitudinous probabilistic failures, a generalized and more realistic faulty pattern for SMSSs is presented, which is more fit for real applications. Hereby, the principal superiority of the established new type faulty pattern lies in its practicality and generality, which contains some previous faulty models as special scenarios. By constructing an appropriate semi-Markovian Lyapunov functional (SMLF) together with mathematical analysis technique and matrix inequality decoupling operation, sojourn-time-dependent sufficient conditions for determining both the control gain matrices and triggered configuration coefficients are developed and formulated in terms of a group of feasible linear matrix inequalities (LMIs). Eventually, several practical examples are exploited to substantiate the validity and practicability of the developed control design methodology.

PMID:34666899 | DOI:10.1016/j.isatra.2021.09.017

Transfus Apher Sci. 2021 Oct;60(5):103250. doi: 10.1016/j.transci.2021.103250. Epub 2021 Aug 17.

ABSTRACT

BACKGROUND AND OBJECTIVES: Acute toxic hepatitis can result in a different clinical course from a completely curable disease to subacute hepatitis, chronic hepatitis, and fulminant hepatitis failure, which is quite mortal. For this purpose, therapeutic plasma exchange (TPE) can be used for improving treatment outcomes by reducing the harmful substances caused with and/or without liver function in acute toxic hepatitis. We aimed to evaluate treatment outcomes in severe acute toxic hepatitis patients who applied early TPE procedure.

MATERIALS AND METHODS: A total of 335 patients who received TPE between 2010-2021 were retrospectively screened and 59 (male/female, 30/29; min/max-age, 22-84) patients with acute toxic hepatitis who underwent TPE in the first 24 h were included in the study. TPE was performed in patients who had high total bilirubin level (>10 mg/dL). Laboratory parameters of the patients before and after the TPE procedure, number of patients developed complications of acute toxic hepatitis and mortality rates were evaluated for effectiveness of TPE.

RESULTS: Acute toxic hepatitis was associated with hepatotoxic drugs in 44 (74.5 %), herbal medication 6 (10.2 %), mushroom poisoning 6 (10.2 %) and with substance abuse 3 (5.1 %) in patients. When the patients were compared based on INR, liver function tests, ammonia, lactate and Model For End-Stage Liver Disease (MELD) score at baseline, 48 h after TPE (independently of TPE number) and before final state a statistically significant decrease was observed in all parameters (p < 0.05). Fifty three (90 %) of patients improved without complications, the remaining 6 (10 %) patients were diagnosed with fulminant hepatitis. All these remaining patients died before liver transplantation (LTx) could be performed.

CONCLUSION: TPE is a safe, tolerable therapy option and early TPE may improve treatment outcomes in severe acute toxic hepatitis.

PMID:34666895 | DOI:10.1016/j.transci.2021.103250

J Clin Sleep Med. 2021 Nov 1;17(11):2171-2178. doi: 10.5664/jcsm.9342.

ABSTRACT

STUDY OBJECTIVES: Lower therapeutic positive airway pressure (PAP) levels are associated with improved response to non-PAP therapies in the treatment of obstructive sleep apnea. The aim of this study was to evaluate the prevailing notion that patients with apnea-predominant obstructive sleep apnea require higher therapeutic PAP levels compared to patients with hypopnea-predominant obstructive sleep apnea.

METHODS: An institutional review board-approved retrospective review was performed using strict inclusion criteria: presence of type I or III sleep study, apnea-hypopnea index > 10 events/h, and adherence to auto-adjusting continuous positive airway pressure. Patients were stratified by apnea (> 50% apneas) or hypopnea (≤ 50% apneas) predominance, and PAP data were compared. Statistical analyses were performed using Student’s t test and linear regression modeling.

RESULTS: Between January 1, 2018 and January 1, 2020, 500 patients met inclusion criteria. Two hundred twenty-one (44.1%) patients were apnea-predominant and 279 (55.8%) were hypopnea-predominant. Apnea-predominant patients had a slightly greater mean PAP (9.01 vs 8.36, P = .002) than hypopnea-predominant patients. Univariable and multivariable linear regression of 7 variables (obstructive apnea percentage, age, sex, body mass index, apnea-hypopnea index, O₂ nadir, mask type) showed obstructive apnea percentage was the weakest predictor of therapeutic PAP levels.

CONCLUSIONS: Apnea-predominant individuals demonstrated a clinically insignificant difference in PAP level compared to hypopnea-predominant individuals; moreover, obstructive apnea percentage was not a strong predictor of therapeutic PAP levels. Of the modeled variables, the strongest predictor of PAP level was apnea-hypopnea index. Further studies are needed to explore these relationships as well as additional variables that may contribute to predicting therapeutic PAP levels.

CITATION: Yu JL, Liu Y, Tangutur A, et al. Influence of apnea vs hypopnea predominance in predicting mean therapeutic positive airway pressures among patients with obstructive sleep apnea. J Clin Sleep Med. 2021;17(11):2171-2178.

PMID:34666884 | DOI:10.5664/jcsm.9342

Chin Med Sci J. 2021 Sep 30;36(3):225-233. doi: 10.24920/003834.

ABSTRACT

Objective This study aimed to assess the protective value of adiponectin (APN) in pancreatic islet injury induced by chronic intermittent hypoxia (CIH). Methods Sixty rats were randomly divided into three groups: normal control (NC) group, CIH group, and CIH with APN supplement (CIH+APN) group. After 5 weeks of CIH exposure, we conducted oral glucose tolerance tests (OGTT) and insulin released test (IRT), examined and compared the adenosine triphosphate (ATP) levels, mitochondrial membrane potential (MMP) levels, reactive oxygen species (ROS) levels, enzymes gene expression levels of Ant1, Cs, Hmox1, and Cox4i1 which represented mitochondrial tricarboxylic acid cycle function, the protein and gene expression levels of DRP1, FIS1, MFN1, and OPA1 which represented mitochondrial fusion and division, and the protein expression levels of BAX, BCL-2, cleaved Caspase-3, and cleaved PARP which represented mitochondrial associated apoptosis pathway of pancreatic islet. Results OGTT and IRT showed blood glucose and insulin levels had no differences among the NC, CIH and CIH+APN groups (both P>0.05) at 0 min, 20 min, 30 min, 60 min, 120 min. However, we found that compared to NC group, CIH increased the ROS level, reduced ATP level and MMP level. The islets of CIH exposed rats showed reduced gene expression levels of Ant1, Cs, Hmox1, and Cox4i1, decreased protein and gene expression levels of MFN1 and OPA1, increased protein and gene expression levels of DRP1 and FIS1, increased protein expression levels of cleaved Caspase-3 and cleaved PARP, with lower ratio of BCL-2/BAX at protein expression level. All the differences among three groups were statistically significant. APN treated CIH rats showed mitigated changes in the above measurements associated with islet injuries. Conclusion APN may ameliorate the pancreatic islet injury induced by CIH via inhibiting the imbalance in mitochondrial fusion and division.

PMID:34666876 | DOI:10.24920/003834