Nevin Manimala

Ann Clin Transl Neurol. 2022 Feb 21. doi: 10.1002/acn3.51515. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim was to study the evolution of disability in spinocerebellar ataxias (SCAs) type 1, 2, 3, and 6 (SCA1, 2, 3, 6).

METHODS: We analyzed data of two longitudinal cohorts (RISCA, EUROSCA) which recruited ataxic and non-ataxic SCA1, SCA2, SCA3, and SCA6 mutation carriers. To study disability, we used a five-stage system for ataxia defined by walking ability (stages 0-3) and death (stage 4). Transitions were analyzed using a multi-state model with proportional transition hazards. Based on the hazard estimates, transition probabilities and the expected lengths of stay in each stage were calculated. We further studied the effect of sex and CAG repeat length on progression.

RESULTS: Data of 3138 visits in 677 participants were analyzed. Median SARA scores for SCA1, SCA2, SCA3, and SCA6 ranged from 1.5 (interquartile range [IQR] = 0.0-3.5) to 3.5 (IQR = 1.4-6.1) in stage 0, 11.5 (IQR = 9.6-14.0) to 13.8 (IQR = 11.0-16.0) in stage 1, 19.0 (IQR = 17.0-21.0) to 23.8 (IQR = 19.5-27.0) in stage 2, and 28.5 (IQR = 26.0-32.5) to 34.0 (IQR = 32.6-37.1) in stage 3. Modeling allowed to calculate the subtype-specific probability to be in a certain stage at a given age and duration of each stage. CAG repeat length was associated with faster progression in SCA1 (HR, 95% CI: 1.1, 1.1-1.2), SCA2 (1.2, 1.1-1.3), and SCA3 (1.1, 1.0-1.2). In SCA6, female sex was associated with faster progression (1.7, 1.1-2.6).

INTERPRETATION: Our data are important for counselling of patients, assessment of the relevance of outcome markers, and design of clinical trials.

PMID:35188716 | DOI:10.1002/acn3.51515

J Magn Reson Imaging. 2022 Feb 21. doi: 10.1002/jmri.28122. Online ahead of print.

ABSTRACT

BACKGROUND: Nonenhanced MR angiography (MRA) studies are often used to manage acute and chronic large cervical artery disease, but lengthy scan times limit their clinical usefulness.

PURPOSE: To develop an accelerated cervical MRA and test its diagnostic performance.

STUDY TYPE: Prospective.

POPULATION: Patients with cervical artery disease (n = 32, 17 males).

FIELD STRENGTH/SEQUENCE: 3.0 T; accelerated two-point Dixon three-dimensional Cartesian spoiled gradient-echo (FLEXA) and conventional time-of-flight MRA (cMRA) sequences.

ASSESSMENT: All patients underwent FLEXA (1’28″) and cMRA (6’47″) acquisitions. Quantitative evaluation (artery-to-background signal ratio and a blur metric) and qualitative evaluation using diagnostic performance measured by the sensitivity, specificity, and positive/negative predictive values (PPV/NPV), and vessel and plaque visualization scores from three board-certified radiologists’ (with 10, 11, and 12 years of experience) independent readings using maximum intensity projection (MIP) for luminal diseases and axial images for plaque. The reference standards were contrast-enhanced angiography and fat-saturated T1-weighted images, respectively.

STATISTICAL TESTS: All measures were compared between FLEXA and cMRA using the paired t, Wilcoxon signed-rank, McNemar’s, or chi-squared test, as appropriate. Interreader agreement was assessed using Cohen’s κ. P < 0.05 was considered statistically significant.

RESULTS: The artery-to-background signal ratio was significantly higher for FLEXA (FLEXA: 7.20 ± 1.63 [fat]; 4.26 ± 0.52 [muscle]; cMRA: 2.57 ± 0.49 [fat]), while image blurring was significantly less (FLEXA: 0.24 ± 0.016; cMRA: 0.30 ± 0.029). In luminal disease detection, sensitivity (FLEXA: 0.97/0.91/0.91; cMRA:0.71/0.69/0.63), specificity (FLEXA: 0.98/0.93/0.98; cMRA:0.93/0.85/0.92), PPV (FLEXA: 0.92/0.86/0.86; cMRA: 0.64/0.5/0.58), and NPV (FLEXA: 0.99/0.98/0.98; cMRA: 0.92/0.91/0.9) were significantly higher for FLEXA. interreader agreement was substantial to almost perfect for FLEXA (κ = 0.82/0.86/0.78) and moderate to substantial for cMRA (κ = 0.67/0.56/0.57). MIP visualization scores were significantly higher for FLEXA, with substantial to almost perfect interreader agreement (FLEXA: κ = 0.83/0.86/0.82; cMRA: κ = 0.89/0.79/0.79). In plaque detection, sensitivity (FLEXA: 0.9/0.9/0.7; cMRA: 0.3/0.6/0.2) and specificity (FLEXA: 1/0.87/1; cMRA: 0.93/0.63/0.97) were significantly higher for FLEXA in two of three readers. The interreader plaque detection agreement was fair to substantial (FLEXA: κ = 0.63/0.69/0.48; cMRA: κ = 0.21/0.45/0.20). Side-by-side plaque and vessel wall visualization was superior for FLEXA in all readers, with moderate to substantial interreader agreement (plaque: κ = 0.73/0.73/0.77; vessel wall: κ = 0.57/0.40/0.39).

DATA CONCLUSION: FLEXA enhanced visualization of the cervical arterial system and improved diagnostic performance for luminal abnormalities and plaques in patients with cervical artery diseases.

LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY STAGE: 2.

PMID:35188699 | DOI:10.1002/jmri.28122

J Magn Reson Imaging. 2022 Feb 21. doi: 10.1002/jmri.28081. Online ahead of print.

ABSTRACT

BACKGROUND: Diastolic dysfunction (DD) frequently occurs in dialysis patients; however, the risk factors of DD remain to be further explored in such a population. Epicardial adipose tissue (EAT) volume has proven to be an independent clinical risk factor for multiple cardiac disorders.

PURPOSE: To assess whether EAT volume is an independent risk factor for DD in dialysis patients.

STUDY TYPE: Case-control study.

POPULATION: A total of 113 patients (mean age: 54.5 ± 14.4 years; 41 women) who had underwent dialysis for at least 3 months due to uremia.

FIELD STRENGTH: A 3 T, steady-state free precession (SSFP) sequence for cine imaging, modified Look-Locker imaging (MOLLI) for T1 mapping and gradient-recalled-echo for T2*.

ASSESSMENT: All participants were performed cardiac magnetic resonance imaging (MRI) and echocardiogram. For MRI images analysis, borders of the EAT were manually delineated, as well as, pericardial adipose tissue (PeAT) and paracardial adipose tissue (PaAT), T1 mapping, T2* mapping, global longitudinal strain (GLS), and left atrial strain. For echocardiogram assessments, the thickness of PaAT, e’ velocity, E velocity, E/e ratio, A velocity, and deceleration time were measured.

STATISTICAL TESTS: Univariate and multivariate logistic regressions were performed to explore the independent risk factors for DD. P value less than 0.05 was considered as significant.

RESULTS: Compared with the DD(-) group, the DD(+) group had significantly more epicardial tissue fat (18.5 ± 1.3 vs. 30.9 ± 2.3) In addition, EAT volumes increased significantly with the grades of DD (grade 1 vs. grade 2 and 3: 27.9 ± 15.9 vs. 35.4 ± 13.1). Moreover, EAT had significant correlations with T1 mapping, T2* mapping, GLS, left atrial strain, e’ velocity, and E/e ratio. EAT accumulation added an independent risk for DD (Odds Ratio = 1.03) over conventional clinical risk factors including age, diabetes mellitus, and hemodialysis.

DATA CONCLUSION: EAT was associated with diastolic function, and its accumulation may be an independent risk factor for DD among dialysis patients.

EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 2.

PMID:35188692 | DOI:10.1002/jmri.28081

Stat Med. 2022 Feb 21. doi: 10.1002/sim.9291. Online ahead of print.

NO ABSTRACT

PMID:35188678 | DOI:10.1002/sim.9291

Acta Psychiatr Scand. 2022 Feb 21. doi: 10.1111/acps.13417. Online ahead of print.

ABSTRACT

BACKGROUND: We report the psychometric properties of the Patient-Reported Impact of Symptoms in Schizophrenia Scale (PRISS), which assesses the impact of subjective experiences or qualia in outpatients with this condition.

METHODS: A cross-sectional study was carried out in 162 patients diagnosed with schizophrenia in Spain. The PRISS measures the presence, frequency, concern and interference with daily life of self-reported experiences related to the main symptoms observed in these patients. The psychometric analysis included test-retest reliability, internal consistency and structural and convergent validity.

RESULTS: The 28-item PRISS showed good test-retest reliability as 64.3% of the intraclass correlation coefficient values were between 0.40 and 0.79, which were statistically significant (p<0.01). Analysis of the structural validity revealed a three-factor structure, 1) productive subjective experiences, 2) affective-negative subjective experiences and 3) excitation, which accounted for 56.11% of the variance. Of the Pearson’s correlation coefficients analysed between the PRISS and the Positive and Negative Syndrome Scale (PANSS), Scale for Assessment of Negative Symptoms (SANS) and World Health Organization Disability Assessment Schedule (WHO-DAS), 72.2% were statistically significant (p<0.05) and ranged from: 0.38-0.42, 0.32-0.42 and 0.40-0.42 respectively.

CONCLUSION: Our results indicate that the PRISS appears to be a brief, reliable and valid scale to measure subjective experiences in schizophrenia and provides valuable information complementary to clinical evaluation.

PMID:35188673 | DOI:10.1111/acps.13417

Laryngoscope. 2022 Feb 21. doi: 10.1002/lary.30054. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to evaluate functional and aesthetic patient-reported outcomes using validated metrics after component dorsal hump reduction (DHR) with spreader graft placement, which have not been previously reported.

STUDY DESIGN: Prospective cohort study.

METHODS: This prospective cohort study was conducted in a tertiary care medical center. Participants underwent septorhinoplasty (SRP) with spreader graft placement with cosmetic, component DHR (cosmetic DHR), or SRP with spreader graft placement without dorsal hump reduction (noncosmetic, non-DHR). The Nasal Obstruction Symptom Evaluation (NOSE) scale and the FACE-Q Satisfaction with Nose, Nostrils, and Social Functioning scales were administered to patients preoperatively and postoperatively (at 2, 4, 6, and/or 12 months). Pre- and postoperative NOSE and FACE-Q scores were compared.

RESULTS: A total of 226 patients underwent SRP with spreader graft placement; 113 (50.0%) with cosmetic DHR and 113 (50.0%) noncosmetic, non-DHR (control). Patients who completed the NOSE and FACE-Q surveys preoperatively and at least at one postoperative time point were included. Both cohorts had a statistically and clinically significant improvement in NOSE and FACE-Q scores. There were similar improvements in NOSE scores in both cohorts. Postoperative FACE-Q scores were higher in the cosmetic DHR cohort despite lower preoperative FACE-Q scores when compared to the control cohort.

CONCLUSIONS: Although there are multiple techniques for DHR, component DHR with spreader graft placement has long been considered the standard. Therefore, it is important to note the significant postoperative cosmetic and functional improvements reported by patients who have undergone this procedure to compare to newer techniques as they evolve.

LEVEL OF EVIDENCE: 3 Laryngoscope, 2022.

PMID:35188669 | DOI:10.1002/lary.30054

Pediatr Blood Cancer. 2022 Feb 21:e29616. doi: 10.1002/pbc.29616. Online ahead of print.

ABSTRACT

PURPOSE: We sought to analyze biologic, clinical, and prognostic differences according to pattern of failure at the time of first relapse in neuroblastoma.

PATIENTS AND METHODS: Children <21 years diagnosed with neuroblastoma between 1989 and 2017 with known site of first relapse (isolated local vs. distant only vs. combined local and distant sites) were identified from the International Neuroblastoma Risk Group (INRG) database. Data were compared between sites of relapse according to clinical features, biologic features, initial treatment, time to first relapse, and overall survival (OS) from time of first relapse.

RESULTS: Pattern of first relapse among 1833 children was 19% isolated local; 65% distant only; and 16% combined sites. All evaluated clinical and biologic variables with exception of tumor diagnosis differed statistically by relapse pattern, with patients with isolated local failure having more favorable prognostic features. Patients with stage 3 disease were more likely to have isolated local failure compared to all other stages (49% vs. 16%; p < .001). OS significantly differed by relapse pattern (5-year OS ± SE): isolated local: 64% ± 3%; distant only: 23% ± 2%; and combined: 26% ± 4% (p < .001). After controlling for age, stage, and MYCN status, patients with isolated local failure (adjusted hazard ratio [HR] = 0.46; 95% confidence interval [CI]: 0.33-0.62; p < .001) and distant-only failure (adjusted HR = 0.57; 95% CI: 0.45-0.71; p < .001) remained at decreased risk for death as compared to patients with combined failure.

CONCLUSION: Patients with distant-only and combined failures have a higher proportion of unfavorable clinical and biological features, and a lower survival than those with isolated local relapse.

PMID:35188340 | DOI:10.1002/pbc.29616

Catheter Cardiovasc Interv. 2022 Feb 21. doi: 10.1002/ccd.30134. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate transcatheter aortic valve replacement (TAVR) operator procedural volumes, and describe temporal and geographic trends.

BACKGROUND: TAVR is the standard of care for most patients with severe symptomatic aortic stenosis. Despite an association between operator procedural volume and outcomes, nationwide TAVR operator volumes have been incompletely described.

METHODS: We queried the National Medicare Provider Utilization and Payment Database for transfemoral TAVRs from 2014 to 2018. Annual operator volume, state and regional volumes, and longitudinal trends were extracted and analyzed using descriptive statistics.

RESULTS: In 2018, the mean annual operator volume was 23.6 TAVRs. The highest 1% of operators by volume performed 7.6% of total TAVR procedures in the United States, while 35.7% of operators performed 10 or fewer TAVRs per year. From 2014 to 2018, there was a 53.9% annualized increase in TAVRs, and the mean annual volume per operator grew from 12.5 to 23.6. There was more than five-fold variability in the density of operators (range 0.35-1.79 operators per 100,000 population) and mean operator volume by state (range 14.2-52.4 TAVRs per operator).

CONCLUSIONS: In this nationally representative study of operators performing transfemoral TAVRs among Medicare patients, we found the mean annual volume of TAVR in 2018 to be 23.6 and has increased since 2014. There was considerable variability in operator density and procedural volumes, with a significant proportion of operators performing 10 or fewer TAVRs per year. Ambiguity remains in regard to the optimal balance of procedural requirements to sustain high efficacy outcomes and ensure critical access to TAVR therapies.

PMID:35188321 | DOI:10.1002/ccd.30134

Vet Radiol Ultrasound. 2022 Feb 21. doi: 10.1111/vru.13072. Online ahead of print.

ABSTRACT

Magnetic resonance imaging is increasingly available for evaluation of horses with suspected pituitary adenomas; however, published studies describing the MRI features of normal equine pituitary glands are currently lacking. This retrospective, descriptive, anatomic study describes the MRI appearance and size of presumed normal equine pituitary glands and assesses potential correlations between pituitary size, brain size, and patient weight. These findings serve as a reference for MRI evaluation of the equine pituitary gland. Inclusion criteria consisted of adult horses (2-15 years old), over 300 kg with no evidence of Pituitary pars intermedia dysfunction (PPID) and no pituitary abnormalities identified with MRI, yielding 27 horses. Histology was available on seven pituitary glands; all were considered normal by a board-certified anatomic pathologist. Imaging features of the glands were evaluated on T2-weighted and pre- and postcontrast T1-weighted images. Pituitary length, width, and height and brain height and width were measured by two authors on transverse and mid-sagittal plane postcontrast T1 weighted images. The mean ± SD pituitary gland width was 21.0 ± 2.4 mm, height: 10.4 ± 1.9 mm, and length: 24.5 ± 2.7 mm. There were no significant correlations using a Pearson’s correlation coefficient between pituitary and brain measurements, pituitary measurement, and body weight, or between brain measurements and body weight. A statistical difference was not identified using an unpaired t-test (p > 0.05) in pituitary and brain measurements between necropsied and non-necropsied horses. Relative to the cerebral white matter, all pituitary glands were isointense to slightly hyperintense on T1-weighted images and isointense on T2-weighted images, with the exception of a focal T1-weighted hyperintensity that was present in the caudal aspect of the pituitary gland in 88% of horses. All pituitary glands were homogenously contrast enhancing. Pituitary dimensions did not correlate with either brain size or body weight in horses.

PMID:35188303 | DOI:10.1111/vru.13072

Environ Toxicol Chem. 2022 Feb 21. doi: 10.1002/etc.5312. Online ahead of print.

ABSTRACT

Understanding the bioaccumulation of engineered nanomaterials (ENMs) is essential for regulatory decisions on potential environmental risks. Research in the field of ENMs bioaccumulation has increased in recent years, but the compilation and statistical analysis of the available experimental data has not been updated. We therefore performed a meta-analysis of the existing literature on the bioaccumulation of eight types of non-dissolvable ENMs (TiO₂ , Al₂ O₃ , Au, C₆₀ , fullerenes, carbon nanotubes, FeO_x , graphene, polystyrene) in non-mammalian freshwater aquatic organisms across three trophic levels including phytoplankton, zooplankton and fish. Three typical endpoints were used to assess the bioaccumulation potential: the bioconcentration factor (BCF), the bioaccumulation factor (BAF) and the biomagnification factor (BMF). Our results suggest that zooplankton has greater mean logarithmic BCF and BAF values than phytoplankton (3.31 vs. 1.42) and fish (2.04). ENMs are biomagnified in zooplankton with a mean BMF of 17.4 whereas trophic transfer from primary consumers (zooplankton) to secondary consumers (fish) is not observed (mean BMF of 0.13). No clear dependency was identified between the physico-chemical characteristics of ENMs (e.g. primary particle size, zeta potential, or shape) and bioaccumulation, except for coated vs. uncoated particles accumulated in phytoplankton. Carbonaceous ENMs were found to be more bioaccumulated than the other considered ENMs, except TiO₂ . The meta-analysis of bioaccumulation data can i) deepen the understanding of bioconcentration, bioaccumulation and biomagnification of ENMs, ii) be used to support grouping strategies as a basis for a safer-by-design approach for ENMs, iii) be integrated into comprehensive hazard and risk assessments, iv) promote the standardization of testing guidelines, and v) enhance the future kinetic bioaccumulation modelling. This article is protected by copyright. All rights reserved. © 2022 SETAC.

PMID:35188281 | DOI:10.1002/etc.5312