Nevin Manimala

J Clin Anesth. 2021 Jun 16;74:110375. doi: 10.1016/j.jclinane.2021.110375. Online ahead of print.

ABSTRACT

STUDY OBJECTIVE: Assess for a relationship between immediate preoperative glucose concentrations and postoperative complications.

DESIGN: Retrospective cohort study.

SETTING: Single large, tertiary care academic medical center.

PATIENTS: A five-year registry of all patients at our hospital who had a glucose concentration (plasma, serum, or venous/capillary/arterial whole blood) measured up to 6 h prior to a non-emergent surgery.

INTERVENTIONS: The glucose registry was cross-referenced with a database from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). We applied an outcomes review to the subset of patients for whom we had data from both registries (n = 1774).

MEASUREMENTS: Preoperative glucose concentration in the full population as well as the subgroups of patients with or without diabetes were correlated with adverse postsurgical outcomes using 1) univariable analysis and 2) full multivariable analysis correcting for 27 clinical factors available from the ACS NSQIP database. Logistic regression analysis was performed using glucose level either as a continuous variable or as a categorical variable according to the following classifications: mild (≥140 mg/dL; ≥7.8 mmol/L), moderate (≥180 mg/dL; ≥10 mmol/L), or severe (≥250 mg/dL; ≥13.9 mmol/L) hyperglycemia. A third analysis was performed correcting for 7 clinically important factors (age, BMI, predicted duration of procedure, sex, CKD stage, hypoalbuminemia, and diabetic status) identified by anesthesiologists and surgeons as immediately available and important for decision making.

MAIN RESULTS: Univariable analysis of all patients and the subgroups of patients without diabetes or with diabetes showed that immediate preoperative mild or moderate hyperglycemia correlates with postoperative complications. Statistical significance was lost in most groups using full multivariable analysis, but not when correcting for the 7 factors available immediately preoperatively. However, for all patients with diabetes, moderate hyperglycemia (≥180 mg/dL; ≥10 mmol/L) continued to significantly correlate with complications even in the full multivariable analysis [odds ratio (OR) 1.79; 95% Confidence Intervals (CI) 1.10, 2.92], and with readmission/reoperation within 30 days [OR 1.93; 95% CI 1.18, 3.13].

CONCLUSIONS: Preoperative hyperglycemia within 6 h of surgery is a marker of adverse postoperative outcomes. Among patients with diabetes in our study, a preoperative glucose level ≥ 180 mg/dL (≥10 mmol/L) independently correlates with risk of postoperative complications and readmission/reoperation. These results should encourage future work to determine whether addressing immediate preoperative hyperglycemia can improve complication rates, or simply serves as a marker of higher risk.

PMID:34147016 | DOI:10.1016/j.jclinane.2021.110375

Comput Biol Med. 2021 Jun 8;134:104559. doi: 10.1016/j.compbiomed.2021.104559. Online ahead of print.

ABSTRACT

Cervical cancer is still one of the most prevalent cancers in women and a significant cause of mortality. Cytokine gene variants and socio-demographic characteristics have been reported as biomarkers for determining the cervical cancer risk in the Indian population. This study was designed to apply a machine learning-based model using these risk factors for better prognosis and prediction of cervical cancer. This study includes the dataset of cytokine gene variants, clinical and socio-demographic characteristics of normal healthy control subjects, and cervical cancer cases. Different risk factors, including demographic details and cytokine gene variants, were analysed using different machine learning approaches. Various statistical parameters were used for evaluating the proposed method. After multi-step data processing and random splitting of the dataset, machine learning methods were applied and evaluated with 5-fold cross-validation and also tested on the unseen data records of a collected dataset for proper evaluation and analysis. The proposed approaches were verified after analysing various performance metrics. The logistic regression technique achieved the highest average accuracy of 82.25% and the highest average F1-score of 82.58% among all the methods. Ridge classifiers and the Gaussian Naïve Bayes classifier achieved the highest sensitivity-85%. The ridge classifier surpasses most of the machine learning classifiers with 84.78% accuracy and 97.83% sensitivity. The risk factors analysed in this study can be taken as biomarkers in developing a cervical cancer diagnosis system. The outcomes demonstrate that the machine learning assisted analysis of cytokine gene variants and socio-demographic characteristics can be utilised effectively for predicting the risk of developing cervical cancer.

PMID:34147008 | DOI:10.1016/j.compbiomed.2021.104559

Placenta. 2021 May 31;111:26-32. doi: 10.1016/j.placenta.2021.05.004. Online ahead of print.

ABSTRACT

INTRODUCTION: Thanks to shared circulation in monochorionic twins, single intrauterine fetal death (IUD) may lead to acute feto-fetal transfusion (aFFTR). The objective of the study was to describe our model of aFFTR simulation after IUD in monochorionic (MC) twins.

METHODS: Prospective study analyzed 99 fresh MC placentas with the physiological course. A specially designed protocol was used for the preparation and analysis of the placentas. A pair of infusion sets fixed together using a mechanical mercury sphygmomanometer cuff was connected to the cannulated umbilical arteries. The tonometer was pressurized up to 30 and 40 mmHg. A positive finding of aFFTR was determined as the amount exceeding 1 ml of dye flowed out of the umbilical cord simulating a dead fetus. The number and types of anastomoses, types, and distances between cords insertions, and the size of the placental areas for each fetus were also statistically analyzed. The placental angioarchitecture with and without proven aFFTR was statistically compared, odds ratio (OR) and multivariable logistic analysis were performed.

RESULTS: A total of 49/99 (49.5%) cases of aFFTR was proven, and the average transfusion time of 1 ml was 30 s (19-46 s). aFFTR was present in 49/78 (62.8%) of placentas with arterio-arterial (AA) anastomosis. The median diameter of AA anastomoses with the present, and absent aFFTRF was 2.0 mm and 1.0 mm, respectively. The proven interfetal transfusion was 8%, 31%, and 61% in AA anastomoses with a diameter below 0,5 mm, 0,5-1,5 mm, and above 1,5 mm, respectively (p < 0,001). AA anastomoses diameter >1.5 mm had OR of 44.2 (95% CI 5.54-352.39). In the case of coexistence of AA anastomosis and umbilical cord distance ≤5th percentile, the aFFTRF occurred in 90.9%.

DISCUSSION: The potential risk of aFFTR in monochorionic twins is mainly due to the presence and nature of AA anastomoses. The diameter and length of the vessels play a crucial role, which is clinically related to the distance of the umbilical cords insertions.

PMID:34146967 | DOI:10.1016/j.placenta.2021.05.004

J Environ Manage. 2021 Jun 16;294:113002. doi: 10.1016/j.jenvman.2021.113002. Online ahead of print.

ABSTRACT

Methanogenesis involves several enzymes with trace metal components that catalyze major metabolic pathways and, therefore, requires a sufficient supply of micronutrients such as iron, nickel or cobalt. The statistically-based Plackett-Burman experimental design was adopted in this study to identify which trace metal have a statistically significant effect on the maximum methane production from domestic sewage. The addition of Barium (Ba), Cobalt (Co), Copper (Cu), Iron (Fe), Manganese (Mn), Nickel (Ni) and Selenium (Se) was tested in batch reactors using domestic sewage as the substrate and sewage sludge as the inoculum. The results showed that the addition of Fe was statistically significant, positively affecting the maximum CH₄ production (p-value 0.05). The results are expressed in L of CH₄ per g of Chemical Oxygen Demand added, increasing it from 0.10 to 0.13 LCH₄ gCOD_add^-1. In L of CH₄ per g of Volatile Solids, increased it from 0.031 to 0.040 LCH₄ gVS^-1. The addition of Se was statistically significant, but with a negative effect on the maximum methane production (p-value 0.002), which decreased from 0.13 to 0.10 LCH₄.gCOD_add^-1. Moreover, six different Fe concentrations (0, 40, 80, 120, 160 and 200 mgL^-1) were tested, showing that the addition of 120 mgL^-1 had the greatest effect for statistically improving the maximum methane production, with 33% improvement (0.12 ± 0.003 to 0.16 ± 0.012 LCH₄ gCOD_add^-1) compared to no addition of Fe and the specific CH₄ production to 0.040 ± 0.001 LCH₄ gVS^-1.

PMID:34146930 | DOI:10.1016/j.jenvman.2021.113002

J Environ Manage. 2021 Jun 16;294:113059. doi: 10.1016/j.jenvman.2021.113059. Online ahead of print.

ABSTRACT

The accumulation of carbon dioxide in the atmosphere has surged over the years as a consequence of diverse humans activities such as deforestation and farming, in particular. The rapidly growing agriculture and farm mechanization have contributed to substantial increases in energy use and carbon dioxide emissions across the globe. It is hypothesized that agriculture significantly contributes to a country’s economy to which China is no exception. Hence, the main intention of the current study was to explore the asymmetrical influences of cereal crop production, forestry production, and economic progress on CO₂ emissions in China between 1970 and 2017. The non-linear ARDL (Autoregressive Distributed Lag) bounds testing method was used to determine the short- and long-run dynamics linked with positive and negative shocks to the explanatory variables. The findings indicate that positive shocks to cereal crop production deteriorate the atmospheric quality by intensifying carbon dioxide emissions only in the long run, while the impacts of negative shocks in this regard are statistically insignificant. Ironically, shocks to forestry do not exhibit any significant impact on China’s carbon dioxide emission levels. Moreover, carbon dioxide emissions demonstrate a strong progressive association with the positive shocks to energy resources utilized within the Chinese economy. Additionally, positive and negative shocks to economic progress are evidenced to boost and reduce the carbon dioxide emission figures in the long run. Lastly, negative shocks to livestock production are witnessed to increase carbon dioxide emissions only in the short run. Hence, for achieving the Chinese carbon-neutrality agenda, it is recommended to prioritize the use of renewable energy resources, particularly for producing cereal crops, in order to curb carbon dioxide emissions in China. Simultaneously, the Chinese economic growth policies should integrate environmentally-friendly schemes to counter the adversative environmental influences related to the economic progress in China.

PMID:34146929 | DOI:10.1016/j.jenvman.2021.113059

Am J Emerg Med. 2021 Jun 9;49:226-232. doi: 10.1016/j.ajem.2021.05.071. Online ahead of print.

ABSTRACT

BACKGROUND: Point-of-care ultrasound (POCUS) is useful in the evaluation of early pregnancy by confirming intrauterine pregnancy and recognizing hemorrhage from ectopic pregnancy. We sought to determine whether transabdominal POCUS by itself or in conjunction with consultative radiology ultrasound (RADUS), reduces Emergency Department (ED) treatment time for patients with ectopic pregnancy requiring operative care, when compared to RADUS alone. A secondary objective was to determine whether the incorporation of POCUS reduces time to operative care for patients with ruptured ectopic pregnancy specifically, when compared to RADUS alone.

METHODS: We performed a retrospective review of patients admitted for operative management of ectopic pregnancy. We excluded patients with known ectopic pregnancy and/or imaging prior to arriving to the treatment area, found not to have an ectopic pregnancy, or did not undergo operative care. Descriptive statistics, classical and nonparametric statistical analysis, and linear regression were performed.

RESULTS: There were 220 patients admitted with ectopic pregnancy, 111 met exclusion criteria, yielding 109 for analysis. Of 109, 36 received POCUS (23/36 also had RADUS), while 73 received RADUS only. Among the POCUS group 31/36 (86%) were classified as ruptured versus 47/73 (64%) in the RADUS group. The average ED treatment time in the POCUS group for all admitted ectopic pregnancies was 157.9 min (standard deviation [SD] 101.3) versus 206.3 min (SD 76.6) in the RADUS group (p = 0.0141). The median time to operating room (OR) for ruptured ectopic pregnancies was 203.0 min (interquartile range [IQR] 159.0) in the POCUS group versus 293.0 min (IQR 139.0) in the RADUS group (p = 0.0002). Regression analysis of the primary outcome was limited by multiple interactions and sample size. When controlling for race, positive shock index and ED visit time, POCUS was found to be associated with a significantly shorter time to OR among ruptured ectopic pregnancies compared to RADUS (p = 0.0052).

CONCLUSION: Compared to RADUS alone, incorporation of POCUS was associated with significantly faster ED treatment time for all ectopic pregnancies and significantly faster time to OR for ruptured ectopic pregnancies, even when combined with RADUS. When controlling for clinical differences, time to OR was still faster for patients who underwent POCUS. The integration of POCUS should be considered to expedite care for patients with ectopic pregnancy requiring operative care.

PMID:34146921 | DOI:10.1016/j.ajem.2021.05.071

Meat Sci. 2021 Jun 12;181:108606. doi: 10.1016/j.meatsci.2021.108606. Online ahead of print.

ABSTRACT

The aim of this study was to explore the use of TD-NMR relaxometry and ¹H NMR spectroscopy-based for detecting differences in meat quality attributes. There was limited association between various TD-NMR signals and any physicochemical parameters of fresh and aged meat differing in tenderness ratings. Samples were then divided into three groups based on statistical changes in metabolite concentration. Group A samples possessed near linear increases in metabolite concentration over aging time; whereas samples assigned to Groups B and C were characterized by increases in metabolites that peaked between 7 and 14 days, and up to 14 days aging, respectively. ¹H NMR spectroscopy discriminated meat quality using changes in metabolites reflective of glycolysis, the citric acid cycle, protein degradation, amino acid generation and purine metabolisms. These data suggest segregation of meat quality is possible using both NMR technologies but additional work is necessary to understand fully their utility in a commercial industry setting.

PMID:34146920 | DOI:10.1016/j.meatsci.2021.108606

Eur J Radiol. 2021 Jun 3;141:109807. doi: 10.1016/j.ejrad.2021.109807. Online ahead of print.

ABSTRACT

PURPOSE: We evaluated respiratory triggered unidirectional single-shot echo-planar imaging (u-SSEPI) as a time-saving measure in diffusion imaging of the upper abdomen. Specifically, we compared the ADC values obtained from unidirectional DWI (u-SSEPI) and routine DWI (4t-SSEPI) and also the diagnostic accuracies of unidirectional and routine DWI sequences in the identification of focal liver lesions in the setting of chronic liver disease (CLD).

MATERIALS AND METHODS: This prospective, IRB approved study, included 48 patients of CLD who underwent-DCE-MRI on a 1.5 T scanner for hepatocellular carcinoma (HCC) workup. In addition to 4t-SSEPI, u-SSEPI was acquired with the diffusion sensitising gradient being applied in only one direction; keeping all other parameters same as 4t-SSEPI. Two blinded radiologists evaluated the DWI studies for image quality and detection of liver lesions. A composite gold standard was established using DCE-MRI, follow-up imaging and patient clinical details. The apparent diffusion coefficients (ADCs) of the liver, spleen and the lesions were compared between the two sequences. ROC analysis evaluated the diagnostic accuracy of ADC from both the sequences in identifying HCC.

RESULTS: Eighty-eight lesions were identified using the composite gold standard. u-SSEPI resulted in 3 times faster image acquisition. No statistically significant differences were demonstrated between the unidirectional and routine DWI sequences for image quality parameters and lesion detection rates. Lesion wise comparison of the ADC values from both the sequences was not statistically different (p = 0.8) with a coefficient of variation = 12-14 %. The Bland- Altman plots and the Passing-Bablock regression analysis demonstrated a systematic and proportional bias between the ADC values obtained. The AUC of the ROC curve, however, was 0.63-observer1; 0.62-oobserver2 for routine DWI and 0.65; 0.62 for unidirectional DWI when ADC was used to identify HCC (the AUCs were not statistically different (p = 0.6-0.8)).

CONCLUSION: No significant differences were demonstrated in the diagnostic accuracies of unidirectional and routine DWI in the diagnosis of HCC. Unidirectional diffusion may be further evaluated in other organs where diffusion is isotropic, especially in respiratory triggered sequences where the imaging time dividend is significant.

PMID:34146912 | DOI:10.1016/j.ejrad.2021.109807

Eur J Radiol. 2021 Jun 10;141:109823. doi: 10.1016/j.ejrad.2021.109823. Online ahead of print.

ABSTRACT

PURPOSE: No comparative study on evaluating performance of radiological criteria has been investigated in metastatic colorectal cancer (mCRC) patients treated with the combination of Regorafenib and anti-programmed cell death 1(PD-1) antibody. We aimed to compare the performance of different radiological criteria in evaluating response in mCRC patients treated with the combination of Regorafenib plus anti-PD-1 antibody.

METHOD: We retrospectively recruited patients treated with Regorafenib and anti-PD-1 antibody in a single institution. Baseline and the first tumor evaluation of contrast-enhanced computed tomography (CE-CT) were assessed by three evaluation criteria: RECIST 1.1, Choi, modified Choi (mChoi). Overall survival (OS) was defined as endpoint event.

RESULTS: Twenty-three mCRC patients [age: 58.8 ± 10.6 years, 18 (78.3 %) males] were assessed. The median overall survival was 11.8 months. According to RECIST 1.1, 8 (34.8 %) patients were stable disease (SD) and 15 (65.2 %) were progressive disease (PD). According to Choi and mChoi, 5 (21.7 %) and 1(4.3 %) patient was responders, respectively. All non-PD patients showed significantly better overall survival than PD patients by all criteria. According to Choi, those identified as responders showed better overall survival than non-responders though significant statistics were not reached (P=0.262).

CONCLUSIONS: RECIST 1.1, Choi and mChoi criteria could identify survival benefit from Regorafenib plus anti-PD-1 antibody in mCRC patients. However, the value of responders detected by Choi remains to be validated in further studies.

PMID:34146911 | DOI:10.1016/j.ejrad.2021.109823

J Affect Disord. 2021 Jun 8;292:464-470. doi: 10.1016/j.jad.2021.05.125. Online ahead of print.

ABSTRACT

INTRODUCTION: There is growing concern about the effect of lockdown and social distancing on mental health. Subjective feelings related to social relationships such as detachment have shown a strong effect on mental health, whereas objective factors might have a moderating role in that association.

OBJECTIVE: To investigate whether social support and living situation have a moderating effect on the association between detachment and affective disorder symptoms during the COVID-19 lockdown.

METHODS: 3,305 Spanish adults were interviewed by phone at the end of the COVID-19 lockdown (May-June 2020). Detachment during confinement was assessed with a single-item frequency question. Anxiety symptoms were measured through GAD-7, depressive symptoms through PHQ-9, and social support through the Oslo Social Support Scale (OSSS). Associations with anxiety and depressive symptoms were tested through Tobit regression models. Interactions of detachment with living situation and social support were tested as independent variables.

RESULTS: People living alone showed significantly lower levels of anxiety whereas people living with another (but not as a couple) showed higher levels of depression. Detachment was strongly associated with both affective disorders. Social support had a statistically significant moderating effect on that association. Those with a low level of social support and a high level of detachment reported means of depression and anxiety above major depression (10.5 CI 95% 9.6, 11.4 at OSSS=10) and generalized anxiety disorders (10.1 CI 95% 9.2, 11.0 at OSSS=9) cut offs CONCLUSION: Interventions centered on improving social support could alleviate feelings of detachment and prevent affective disorders during lockdowns.

PMID:34146897 | DOI:10.1016/j.jad.2021.05.125