Nevin Manimala

BDJ Open. 2021 Jun 17;7(1):22. doi: 10.1038/s41405-021-00077-2.

ABSTRACT

INTRODUCTION: Lateral cephalometric analysis continues to be one of the gold standard diagnostic aids in orthodontics, with various software available to enhance this.

AIM: This study was done to evaluate the accuracy and reliability of linear and angular measurements obtained from OneCeph digital cephalometric tracing and manual tracings in lateral cephalometry.

METHODOLOGY: This is a cross-sectional study done on twenty pre-treatment lateral cephalometric radiographs of subjects who reported to the postgraduate orthodontic clinic for orthodontic treatment over one month. Cephalometric tracings were done using OneCeph digital software and manual tracing method to evaluate nine parameters of Steiner’s cephalometric analysis. An Independent T-sample test was done between the mean values of manual and OneCeph tracing. Intra operator reliability was evaluated by paired T-test after a week.

RESULTS: No significant statistical difference was observed as the p-value was greater than 0.05 for all the parameters in the two groups.

CONCLUSION: The reliability and accuracy of OneCeph software application was found to be at par with manual cephalometric tracing.

PMID:34140466 | DOI:10.1038/s41405-021-00077-2

Clin Transl Gastroenterol. 2021 Jun 18;12(6):e00376. doi: 10.14309/ctg.0000000000000376.

ABSTRACT

INTRODUCTION: Hepatic encephalopathy (HE) is a major complication of transjugular intrahepatic portosystemic shunt (TIPS) creation. This study was aimed to determine whether underdilated TIPS with 8-mm polytetrafluoroethylene-covered stents could reduce the risk of HE and liver damage yet maintain clinical and hemodynamic efficacy.

METHODS: This retrospective case-controlled study included 134 patients treated with TIPS from March 2017 to November 2019. All the TIPS procedures were created using 8-mm covered stents, and according to the diameter of expansion balloon catheters, the patients were divided into 2 groups, an underdilated group (6-mm balloon catheter, n = 73) and a control group (8-mm balloon catheter, n = 61).

RESULTS: The Kaplan-Meier analysis indicated that the cumulative incidence of overt HE in the underdilated group was significantly lower than that in the control group (11.0% vs 29.5%, log rank P = 0.007), but no statistical differences were found toward variceal rebleeding, shunt dysfunction, and survival between groups. In multivariate analysis, the independent risk factors for overt HE were identified as age (hazard ratio [HR] = 1.036, 95% confidence interval [CI] = 1.003-1.069, P = 0.032), Child-Pugh score (HR = 1.519, 95% CI = 1.212-1.905, P < 0.001), and group assignment (HR = 0.291, 95% CI = 0.125-0.674, P = 0.004).

DISCUSSION: Underdilated TIPS with 8-mm polytetrafluoroethylene-covered stents could reduce the risk of HE and liver function impairment compared with completely dilated TIPS, but not increase the risk of variceal rebleeding, shunt dysfunction, and death.

PMID:34140457 | DOI:10.14309/ctg.0000000000000376

J Phys Act Health. 2021 Jun 17:1-6. doi: 10.1123/jpah.2020-0746. Online ahead of print.

ABSTRACT

BACKGROUND: Both genetic and environmental influences have been shown to contribute to the association between physical activity and overall academic performance. The authors examined whether leisure-time physical activity (LTPA) shares genetic and environmental variances between spelling, essay writing, reading aloud, reading comprehension, and mathematics in early adolescence. Moreover, they investigated whether genetic polymorphisms associated with physical activity behavior affect these academic skills.

METHODS: Participants were 12-year-old Finnish twins (n = 4356-4370 twins/academic skill, 49% girls). Academic skills were assessed by teachers, and LTPA was self-reported. Polygenic scores for physical activity behavior were constructed from the UK Biobank. Quantitative genetic modeling and linear regression models were used to analyze the data.

RESULTS: The trait correlations between LTPA and academic skills were significant but weak (r = .05-.08). The highest trait correlation was found between LTPA and mathematics. A significant genetic correlation was revealed between LTPA and essay writing (rA = .14). Regarding polygenic scores of physical activity, the highest correlations were found with reading comprehension, spelling, and essay writing, but these results only approached statistical significance (P values = .09-.15).

CONCLUSIONS: The authors’ results suggest that reading and writing are the academic skills that most likely share a common genetic background with LTPA.

PMID:34140420 | DOI:10.1123/jpah.2020-0746

Science. 2021 Jun 18;372(6548):eabf3736. doi: 10.1126/science.abf3736.

ABSTRACT

Brain regions communicate with each other through tracts of myelinated axons, commonly referred to as white matter. We identified common genetic variants influencing white matter microstructure using diffusion magnetic resonance imaging of 43,802 individuals. Genome-wide association analysis identified 109 associated loci, 30 of which were detected by tract-specific functional principal components analysis. A number of loci colocalized with brain diseases, such as glioma and stroke. Genetic correlations were observed between white matter microstructure and 57 complex traits and diseases. Common variants associated with white matter microstructure altered the function of regulatory elements in glial cells, particularly oligodendrocytes. This large-scale tract-specific study advances the understanding of the genetic architecture of white matter and its genetic links to a wide spectrum of clinical outcomes.

PMID:34140357 | DOI:10.1126/science.abf3736

BMJ Open. 2021 Jun 17;11(6):e050717. doi: 10.1136/bmjopen-2021-050717.

ABSTRACT

INTRODUCTION: People who are homeless experience higher morbidity and mortality than the general population. These outcomes are exacerbated by inequitable access to healthcare. Emerging evidence suggests a role for peer advocates-that is, trained volunteers with lived experience-to support people who are homeless to access healthcare.

METHODS AND ANALYSIS: We plan to conduct a mixed methods evaluation to assess the effects (qualitative, cohort and economic studies); processes and contexts (qualitative study); fidelity; and acceptability and reach (process study) of Peer Advocacy on people who are homeless and on peers themselves in London, UK. People with lived experience of homelessness are partners in the design, execution, analysis and dissemination of the evaluation.

ETHICS AND DISSEMINATION: Ethics approval for all study designs has been granted by the National Health Service London-Dulwich Research Ethics Committee (UK) and the London School of Hygiene and Tropical Medicine’s Ethics Committee (UK). We plan to disseminate study progress and outputs via a website, conference presentations, community meetings and peer-reviewed journal articles.

PMID:34140346 | DOI:10.1136/bmjopen-2021-050717

AJNR Am J Neuroradiol. 2021 Jun 17. doi: 10.3174/ajnr.A7156. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: The developing nervous system is particularly vulnerable to late adverse effects of cranial radiation therapy, such as leukoencephalopathy, microbleeds, and cavernomas. Cystlike lesions have been rarely described and characterized in the literature. We aimed to characterize cystlike lesions, their risk factors, and association with other late adverse effects.

MATERIALS AND METHODS: Children treated for brain tumors during a 30-year period (n = 139) were included. We documented imaging findings, focusing on cystlike lesion development and its relationship with clinical history and other imaging findings. Multivariable analysis was performed using logistic regression and negative binomial regression models.

RESULTS: Cystlike lesions developed in 16.5% of patients treated with radiotherapy, with a median of 2 years until the development of the first lesion. For every 4-year age increase, there were 50% decreased odds of developing lesions and a 50% decrease in the average count of lesions. Females demonstrated a 4.00 rate ratio of developing a higher number of lesions. Patients who underwent chemoradiotherapy had 3.20 increased odds of developing cystlike lesions compared with patients with radiation therapy alone. A larger proportion of patients treated with methotrexate (25%) developed cystlike lesions, but this was not statistically significant. Cystlike lesions tended to develop in cerebral locations where leukoencephalopathy was worse. A strong relationship was found between the development of cystlike lesions and leukoencephalopathy severity.

CONCLUSIONS: Cystlike lesions are frequent and under-reported late adverse effects of cranial radiation therapy in children. Younger age, chemoradiotherapy, and the severity of leukoencephalopathy represent risk factors for the development of cystlike lesions.

PMID:34140275 | DOI:10.3174/ajnr.A7156

Oral Surg Oral Med Oral Pathol Oral Radiol. 2021 May 6:S2212-4403(21)00422-3. doi: 10.1016/j.oooo.2021.04.054. Online ahead of print.

ABSTRACT

OBJECTIVE: We examined whether steroid ointment (0.1% dexamethasone) is an effective treatment for mucoceles.

STUDY DESIGN: Using a retrospective cohort study design, a statistical study was conducted of 91 patients diagnosed with mucoceles at the Department of Dental and Oral Surgery, Saga University Hospital, Saga, Japan, between January 2006 and December 2016. The patients’ age and sex; shape, size, and site of the lesion; duration; and treatment response rate were evaluated.

RESULTS: The most frequent site of mucoceles was the lower labial mucosa, and several were <10 mm in size. The age of onset was often <20 years, with no sex-based differences. The treatment response rate was 65.8% for steroid ointment and 100% for surgical removal. In the subgroup analysis according to each clinical factor, some subgroups showed statistically nonsignificant differences compared with the surgery group. Among them, the older age and short disease duration subgroups showed small risk differences, suggesting that application of ointment may lead to a response in these subgroups.

CONCLUSIONS: Although its response rate was lower than that of surgical removal, topical steroid application is a noninvasive and useful treatment method that can be used for patients in whom surgical treatment is infeasible.

PMID:34140272 | DOI:10.1016/j.oooo.2021.04.054

Rev Esp Anestesiol Reanim (Engl Ed). 2021 Jun 14:S2341-1929(21)00087-1. doi: 10.1016/j.redare.2020.11.004. Online ahead of print.

ABSTRACT

BACKGROUND: Breast cancer is the most commonly occurring cancer among women. Among its treatment sequelae is chronic neuropathic pain after breast surgery (CNPBS). Pain management is difficult and classicaly consists in a pharmacological approach, however recent studies have advocated the use of locoregional techniques as adjuvants. Serratus plane block (SPB) has recently emerged as a potential tool for the control of CNPBS. This study aims to evaluate the efficacy and potencial role of the ultrasound-guided SPB on CNPBS.

METHODS: A retrospective analysis was performed on 30 patients with CNPBS refractory to drug therapy, who underwent SPB between 2017-2019. The following parameters were analyzed: basal pain, pain at 24 h, 1 week and at 1 month. The Mann-Whitney test was applied. Statistical significance was considered at the level of p < 0.05. All statistical analysis was performed with SPSS 20.

RESULTS: 3 patients were excluded. At 24 h, we report pain improvement (at least 30% reduction on basal pain score) on 20 patients and after 1 week on 12. At 1 month after, 22 patients had improved, from these: 11 improved with no therapeutic adjustment; 11 patients improved with therapeutic adjustment (8 in gabapentinoid monotherapy, 3 with introduction of polytherapy). 5 patients didn’t improve.

CONCLUSION: Our study demonstrated SPB as a valid alternative for CNPBS management when pharmacologic therapy has been proven insufficient, with no side effects reported. Randomized studies are needed to assess the magnitude of SPB on CNPBS and to identify the patients who benefit the most from SPB.

PMID:34140270 | DOI:10.1016/j.redare.2020.11.004

Actas Urol Esp (Engl Ed). 2021 Jun 14:S2173-5786(21)00074-3. doi: 10.1016/j.acuroe.2020.09.008. Online ahead of print.

ABSTRACT

BACKGROUND: Repeat prostate biopsy (PBx) is recommended under persistent suspicion of prostate cancer (PCa) or in the face of the following findings: atypical small acinar proliferation (ASAP); extense (≥3 biopsy sites) high-grade prostatic intraepithelial neoplasia (HGPIN); or HGPIN with atypical glands; suspicious for adenocarcinoma (PIN-ATYP). Nowadays; multiparametric magnetic resonance imaging (mpMRI) and mpMRI targeted PBx (MRI-TBx) are recommended in repeat PBx. Our objective was to analyze the current value of ASAP; mHGPIN; PIN-ATYP and other histological findings to predict clinically significant PCa (csPCa) risk.

METHODS: Retrospective analysis of 377 repeat PBxs. MRI-TBx was performed when Prostate Imaging-Reporting and Data System (PI-RADS) score >3 and 12-core transrectal ultrasound (TRUS) systematic PBx when ≤2. ASAP; HGPIN; mHGPIN; PIN-ATYP; and 8 other histological findings were prospectively reported in negative PBx. CsPCa was defined as ISUP group grade >2.

RESULTS: Incidence of ASAP; multifocal HGPIN (mHGPIN) and PINATYP was 4.2%; 39.7% and 3.7% respectively; and csPCa rate was statistically similar among men with these histological findings. However; the rate of csPCa was 22.2% when proliferative inflammatory atrophy (PIA) was present; and 36.1% when it was not. PIA was the only histological finding which predicted lower risk of csPCa; with an OR of 0.54 (95%CI: 0.308-0.945; P = .031). In addition; PIA was an independent predictor of a model combining clinical variables and mpMRI which reached area under de ROC curve of 0.86 (95%CI: 0.83-0.90).

CONCLUSION: PIA emerged as the only predictive histological finding of csPCa risk and can contribute to a predictive model. mHGPIN failed to predict csPCa risk. The low incidence of ASAP (4.2%) and PIN-ATYP (3.7%) prevented us from drawing conclusions.

PMID:34140257 | DOI:10.1016/j.acuroe.2020.09.008

J Cyst Fibros. 2021 Jun 14:S1569-1993(21)00162-4. doi: 10.1016/j.jcf.2021.05.011. Online ahead of print.

ABSTRACT

BACKGROUND: Non-invasive ventilation (NIV) is an established treatment option for cystic fibrosis (CF) patients with type 2 respiratory failure but the benefits of this therapy remain unclear. This study examined the long-term outcomes and response to NIV in a large adult CF cohort.

METHODS: All patients attending a UK adult CF Centre receiving NIV as treatment for hypercapnic respiratory failure over a nine-year period were studied prospectively. Detailed clinical data was recorded and longitudinal data measurements were examined for the three years pre and post NIV initiation to assess effect of this intervention.

RESULTS: 94 patients, mean age 29.9 (SD 9.7) years, percent predicted FEV₁ 21.5 (7.3), received NIV. All patients commenced NIV in a hospital setting. 21 remain alive, 24 received double lung transplant, 49 died without lung transplantation. NIV use was associated with a stabilisation and improvement in both FEV₁ and FVC from NIV set up to three years post follow-up, in addition to an increase in body mass index and attenuation of PCO₂ (all p<0.001). No single parameter was found to predict long-term NIV response but baseline PCO₂ (p=0.005), CRP (p=0.004) and age (p=0.009) were identified as independent predictors of mortality.

CONCLUSIONS: NIV use in CF adults is associated with improvements in lung function and attenuation of hypercapnia which is maintained for up to three years post NIV initiation. Outcomes for CF patients with severe pulmonary disease commenced on NIV have significantly improved with fifty percent of patients expected to survive for approximately five years.

PMID:34140250 | DOI:10.1016/j.jcf.2021.05.011