Nevin Manimala

J Stroke Cerebrovasc Dis. 2021 Mar 3;30(5):105683. doi: 10.1016/j.jstrokecerebrovasdis.2021.105683. Online ahead of print.

ABSTRACT

OBJECTIVES: To develope and validate a nomogram to predict the probability of deep venous thrombosis (DVT) in patients after acute stroke during the first 14 days with clinical features and easily obtainable biochemical parameters.

METHODS: This is a single-center prospective cohort study. The potential predictive variables for DVT at baseline were collected, and the presence of DVT was evaluated using ultrasonography within the first 14 days. Data were randomly assigned to either a modeling data set or a validation data set. Univariable and Multivariate logistic regression analysis was used to develop risk scores to predict DVT in the modeling data set and the area under the receiver operating characteristic curve to validate the score in the test data set, and nomogram and calibration curve were constructed by R project.

RESULTS: A total of 1651 patients with acute stroke were enrolled in the study. The overall incidence of DVT after acute stroke within two weeks was 14.4%. Multivariable analysis detected older age (≥65 years),female gender, hemorrhagic stroke, malignancy, lower limb muscle strength<3 grade, Albumin<40 g·L^-1 and D-dimer>0.5 mg·L^-1 were highly predictive of 14-day risk of DVT. The AUC of the nomogram with these above-mentioned independent risk factors to predict the 14-day risk of DVT was 0.756 (95% CI, 0.712-0.812) and 0.811 (95%CI, 0.762-0.859) for the modeling cohort and external validation cohort, respectively. Moreover, the calibration of the nomogram showed a nonsignificant Hosmer-Lemeshow test statistic in the modeling (P = 0.250) and validation sets (P = 0.995). With respect to decision curve analyses, the nomogram exhibited preferable net benefit gains than the staging system across a wide range of threshold probabilities.

CONCLUSION: This nomogram had a good performance in predictive accuracy, discrimination capability, and clinical utility, which was helpful for clinicians to identify high-risk groups of DVT and formulate relevant prevention and treatment measures.

PMID:33676327 | DOI:10.1016/j.jstrokecerebrovasdis.2021.105683

Knee. 2021 Mar 3;29:262-270. doi: 10.1016/j.knee.2021.01.024. Online ahead of print.

ABSTRACT

BACKGROUND: Bone-cartilage mismatch is a variation in which the surface curvature of the articular cartilage is incongruent with the curvature of the underlying subchondral bone. The purpose of this study is to investigate the prevalence of this variant in the medial tibial plateau (MTP) and examine potential association with clinical findings and intra-articular derangements using MRI.

METHODS: A quantitative and qualitative retrospective analysis of 98 knee MRI studies was performed. Bone and cartilage depths of the MTP were measured to assess bone-cartilage morphology and classified into congruent (concave bone-concave cartilage) and incongruent (concave bone-convex cartilage) patterns. Associations between bone-cartilage mismatch and clinical findings and other MRI changes were assessed using Fisher’s exact test.

RESULTS: By quantitative assessment, four individuals (4%) had MTP incongruent morphology (bone-cartilage mismatch). The mean bone depth ± standard deviation (SD) was 2.3 ± 0.6 mm concave in the congruent group, and 1.4 ± 0.6 mm concave in the incongruent group. The mean cartilage depth ± SD was 0.7 ± 0.7 mm concave in the congruent group, and 0.9 ± 0.5 mm convex in the incongruent group. By qualitative assessment, three individuals (3%) had incongruent morphology. Although not statistically significant, a higher proportion of individuals (3 of 4; 75%) with incongruent cartilage demonstrated chondromalacia patellae compared to those with congruent cartilage (38 of 94; 40%).

CONCLUSION: Bone-cartilage mismatch was present in 3-4% of the knees. Individuals with incongruent cartilage demonstrated a trend of a higher proportion of chondromalacia patellae. Larger studies are needed to evaluate this further.

PMID:33676321 | DOI:10.1016/j.knee.2021.01.024

J Psychosom Res. 2021 Feb 26;144:110410. doi: 10.1016/j.jpsychores.2021.110410. Online ahead of print.

ABSTRACT

OBJECTIVE: Cognitive empathy might decrease during medical school. Factors associated with its evolution remain poorly understood, as well as whether such factors could moderate the effect of an intervention to preserve cognitive empathy. The aim was to explore the associations between personality traits and both cognitive empathy at baseline and its changes at follow-up. The possible effect of an intervention depended upon personality traits was also examined.

METHODS: The cohort consisted of fourth year medical students and the associations between personality traits, using the Short Big Five Inventory, and cognitive empathy changes at 3-month, using the Jefferson Scale of Empathy-Student version (JSE-S), were examined. A randomization in two groups (Balint groups versus no intervention) allowed examining whether the effect of the intervention depended upon personality traits. Linear regressions were adjusted for gender, anticipated specialty choice, parental education, living status, financial insecurity, randomization group and baseline JSE-S.

RESULTS: The cohort included 311 participants from October 2015 to December 2016 at Paris Diderot and Paris Descartes University. At follow-up, there was a JSE-S total score increase of 1.22(SD:9.10) in the intervention group, compared to a decrease of 1.64(SD:10.74) in the other group. Baseline JSE-S was positively associated with Extraversion and Conscientiousness and negatively with Neuroticism. In contrast, we found no associations between baseline personality traits and JSE-S change. There were no interactions between personality traits and randomization group.

CONCLUSION: Although personality might be linked with cognitive empathy, medical students may benefit from strategies designed for improving cognitive empathy regardless of their personality.

PMID:33676151 | DOI:10.1016/j.jpsychores.2021.110410

Vision Res. 2021 Mar 3;183:41-52. doi: 10.1016/j.visres.2021.01.011. Online ahead of print.

ABSTRACT

How non-symbolic numerosity is visually extracted remains a matter of intense debate. Most evidence suggests that numerosity is directly extracted on individual objects following Weber’s law, at least for a moderate numerical range. Alternative accounts propose that, whatever the range, numerosity is indirectly derived from summary texture-statistics of the raw image such as spatial frequency (SF). Here, to disentangle these accounts, we tested whether the well-known behavioural signature of numerosity encoding (ratio effect) is preserved despite the equalisation of the SF content. In Experiment 1, participants had to select the numerically larger of two briefly presented moderate-range numerical sets (i.e., 8-18 dots) carefully matched for SF; the ratio between numerosities was manipulated by levels of increasing difficulty (e.g., 0.66, 0.75, 0.8). In Experiment 2, participants performed the same task, but they were presented with both the original and SF equalised stimuli. In both experiments, the results clearly showed a ratio-dependence of the performance: numerosity discrimination became harder and slower as the ratio between numerosities increased. Moreover, this effect was found to be independent of the stimulus type, although the overall performance was better with the original rather than the SF equalised stimuli (Experiment 2). Taken together, these findings indicate that the power spectrum per se cannot explain the main behavioural signature of Weber-like encoding of numerosities (the ratio effect), at least over the tested numerical range, partially challenging alternative indirect accounts of numerosity processing.

PMID:33676137 | DOI:10.1016/j.visres.2021.01.011

J Environ Manage. 2021 Mar 3;286:112254. doi: 10.1016/j.jenvman.2021.112254. Online ahead of print.

ABSTRACT

In this study, the pure terephthalic acid sludge was treated by a drying process which was an economical and environmentally method. The water change and metabolic pathways for bacterial community function prediction were analyzed. The microbial community changes were studied by high-throughput sequencing to draw the dynamic succession model. Then multiple statistics was used to determine the key factors of the reduction. The results showed that the main stage of water loss in the PTA sludge drying process was the high temperature period where the water lost by evaporation accounted for more than 90% of the total removal. The main metabolic pathways for bacterial community function were amino acid (7.72%-8.71% of Kyoto encyclopedia of genes and genomes relative abundance and 8.26%-9.51% of Cluster of orthologous groups of proteins relative abundance) and carbohydrate metabolism. The model describing the dynamic succession of microbial communities showed that the dominant bacteria changed from Nitrospira, Novosphingobium and Azohydromonas to Pseudomonas, Paeniglutamicibac and Pelotomaculum. The key factors for water loss were Gemmatimonas, Novosphingobium and Azohydromonas with the correlation coefficients of 0.887, 0.772, 0.783, respectively; the key factors for dry matter loss were Pelotomaculum, total organic matter, dissovlved organic carbon and carbon/nitrogen ratio; the key factors for toxic substance loss were Brevundimonas, Novosphingobium and Gemmatimonas. These results provided theoretical support for the application and demonstration for hazardous waste sludge reduction.

PMID:33676131 | DOI:10.1016/j.jenvman.2021.112254

Clin Imaging. 2021 Feb 3;77:122-129. doi: 10.1016/j.clinimag.2021.01.033. Online ahead of print.

ABSTRACT

PURPOSE: To identify CT parameters useful for assessment of pulmonary hypertension (PH) in patients with severe aortic stenosis (AS).

MATERIALS AND METHODS: Retrospective study of 165 patients who had undergone right heart catheterization (RHC), and CTA of the thorax for preoperative aortic valve replacement (TAVR) planning. These were divided into groups based on mean pulmonary artery (PA) pressure (mPAP) of 25 mm Hg on RHC (85 cases and 80 controls). Diameters of main pulmonary artery diameter (MPAD), left pulmonary artery (LPA), right pulmonary artery (RPA), and maximal long axis and short axis diameters of the right atrium (RA) and ventricle (RV) were measured on the axial plane. Univariate and multivariate statistical analysis was utilized to identify metrics predictive of PH.

RESULTS: MPAD, LPA, and RPA were higher in subjects with mPAP >25 mm Hg (p < 0.0001 for all). Thresholds of 30.5 mm for MPAD (68.4% sensitivity, 82.7% specificity), and 27.5 mm for LPA and RPA (LPA: 51.9% sensitivity, 78.8% specificity; RPA: 62.0% sensitivity, 78.8% specificity) provided the best discrimination of elevated mPAP. Compared to literature values for MPAD (28.9 mm in men and 26.9 mm in women), these thresholds provide lower sensitivity but greatly increased specificity. Inclusion of RA enlargement to MPAD increased specificity to 98.5%, while inclusion of RV enlargement increased specificity to 100%.

CONCLUSION: Threshold to identify PH in patients with AS using PA enlargement is higher than previously reported range for normal. Inclusion of RA and RV enlargement improves the ability of CT to more accurately identify PH in patients with AS.

PMID:33676129 | DOI:10.1016/j.clinimag.2021.01.033

Eur J Obstet Gynecol Reprod Biol. 2021 Feb 24;259:146-152. doi: 10.1016/j.ejogrb.2021.02.023. Online ahead of print.

ABSTRACT

OBJECTIVE: During the past three decades, applying IVF for infertility treatment PCOS women has increased significantly, and the landscape of treatment strategies has changed dramatically. However, early review of IVF on PCOS have insufficiently accounted for efficacy and safety of the technic. With abundant studies in recent years, there is a need to reconcile these new data.

MATERIAL AND METHODS: To compare reproductive and obstetric outcomes of IVF between women with and without PCOS, a meta-analysis of 95 studies involving more than 21289 PCOS patients and 43036 controls was performed.

RESULTS: Despite longer stimulation duration (WMD = 0.34 day, 95 % CI: 0.09, 0.59) and lower dose of Gn required (WMD = -361.3 IU, 95 % CI: -442.3, -280.4), more oocytes (WMD = 3.67, 95 % CI: 3.14-4.21) and matured oocytes (WMD = 2.16, 95 % CI: 1.52-2.80) per cycle were obtained from PCOS women. There were no statistically significant differences for cleavage, high-grade embryo and implantation rate. Although similar pregnancy and live birth rates per cycle were achieved in PCOS and non-PCOS women after IVF, women with PCOS still suffered from significantly increased risks of miscarriage (OR = 1.44, 95 % CI: 1.20-1.72), biochemical pregnancy loss (OR = 1.89, 95 % CI: 1.48-2.41), and OHSS (OR = 3.58, 95 % CI: 2.86-4.48), in addition to lower fertilization rate (OR = 0.79, 95 % CI: 0.71-0.88). Adverse obstetric outcomes including ectopics pregnancy and multiple pregnancies are comparable between two groups. The overall cycle cancellation rate was significantly higher among PCOS women with OR of 2.55 (95 % CI: 1.67-3.89), and concern over OHSS or hyper-response constitute the main cause. Similar results were also observed after stratified analysis.

CONCLUSIONS: Our results support the effectiveness of IVF for infertility treatment among PCOS patients. However, options to minimize adverse outcomes regarding to lower fertilization, miscarriage, biochemical pregnancy loss and OHSS are required. Further studies elucidating detailed mechanism underlying these adverse outcomes could be of great importance to improve the experience of IVF treatment.

PMID:33676123 | DOI:10.1016/j.ejogrb.2021.02.023

Mar Pollut Bull. 2021 Mar 3;166:112040. doi: 10.1016/j.marpolbul.2021.112040. Online ahead of print.

ABSTRACT

Levrier Bay is an important fishing area which is under growing anthropogenic pressures seriously threatening this treasure. Among these pressures Polycyclic Aromatic Hydrocarbon are of great environmental concern. Therefore, 16 EPA-PAHs were analyzed using GC-MS in Perna perna species and sediment. Comparison with Dakar (Senegal) and Moroccan coasts shows that PAHs levels are strikingly lower than that of heavily polluted Dakar coast (2474 μg/kg); nevertheless, comparable to Moroccan Casablanca and Tangier coasts (245 and 351 μg/kg, respectively). Ratio analysis indicates the predominance of pyrogenic sources and partial contribution of automotive traffic for the half of 4 sites. Furthermore, statistical analys shows that there are no significative differences, except for Benzo(b)Fluorentene in P. perna tissue and 4 PAHs (Fluorene; Fluorenthene; Pyrene; diBenzo(ah)Anthracene and dBahANT) in sediment for sites samples. Furthermore, bioconcentration indicates that P. perna is an excellent PAHs bioindicator. This points the necessity for immediate introduction of a sound Pollutants monitoring system.

PMID:33676109 | DOI:10.1016/j.marpolbul.2021.112040

Am J Emerg Med. 2021 Feb 24;45:80-85. doi: 10.1016/j.ajem.2021.02.046. Online ahead of print.

ABSTRACT

BACKGROUND: Children with traumatic head injury are often transferred from community Emergency Departments (ED) to a Pediatric Emergency Department (PED). The primary objective of this study was to describe the outcomes of minor head injury (MHI) transfers to a PED. The secondary objective was to report Computed Tomography (CT) utilization rates for MHI.

METHODS: We conducted a retrospective study of children aged ≤18 years transferred to our PED for MHI from 2013 to 2018. Patients with Glasgow Coma Scale (GCS) < 14, coagulopathies, history of brain mass/shunt and suspected non-accidental trauma were excluded. Data collected included demographics, interventions performed, and disposition. MHI risk stratification and clinically important traumatic brain injury (ciTBI) were defined per the Pediatric Emergency Care Applied Research Network (PECARN) head injury guidelines. Descriptive statistics were reported using general measures of frequency and central tendency.

RESULTS: A total of 1078 children with MHI were analyzed based on eligibility criteria. The majority of patients were male (62%) and ≥ 2 years of age (69.3%). Subspecialist consultation (57.2%) and neuroimaging (27.4%) were the most commonly performed interventions in the PED. Only 14 children (1.3%) required neurosurgical intervention. One-third of the transferred patients required no additional work-up. Two-thirds of the patients (66.6%) were directly discharged from the PED. Though the total number of MHI transfers per year declined steadily during the study period (from 271/year to 119/year), CT head utilization remained relatively similar across the study years (60.3% to 70.8%). A higher proportion of children received CT in the ED when compared to the PED for low-risk (28.9% vs 15.8%) and intermediate-risk groups (42.8% vs 29.4%).

CONCLUSIONS: The majority of pediatric MHI transfers are discharged home following a subspecialty consultation and/or neuroimaging. Despite guidelines and a low incidence of ciTBI, CT utilization remains high in the intermediate and low risk MHI groups, especially in the community settings. Targeted interventions are needed to reduce the potentially avoidable transfers and low-value performance of CT in children with MHI.

PMID:33676080 | DOI:10.1016/j.ajem.2021.02.046

Ophthalmol Glaucoma. 2021 Mar 3:S2589-4196(21)00043-0. doi: 10.1016/j.ogla.2021.02.003. Online ahead of print.

ABSTRACT

PURPOSE: To compare the characteristics of the peripapillary choroid (PPC) between the two eyes of patients with unilateral treatment-naïve normal tension glaucoma (NTG).

DESIGN: Observational case series.

PARTICIPANTS: Sixty-nine patients (138 eyes) with treatment-naive unilateral NTG.

METHODS: The characteristics of PPC vasculature were evaluated by measuring PPC thickness and assessing the presence of parapapillary deep-layer microvasculature dropout (MvD). PPC thickness was measured by enhanced depth imaging optical coherence tomography (OCT). MvD was assessed using OCT angiography. The area and maximum radial width of β-zone parapapillary atrophy (PPA) were measured on infra-red images using the built-in caliper tool of the Spectralis OCT.

MAIN OUTCOME MEASURES: Between-eye differences in PPC thickness, MvD frequency, and the area and maximum width of β-zone PPA.

RESULTS: Eyes with NTG had higher intraocular pressure (IOP), longer axial length, thinner PPC, larger area and maximum radial width of the β-zone PPA, and more frequent MvD (P < 0.01 each) than contralateral healthy eyes. Multivariate conditional logistic regression analysis revealed that higher IOP, thinner PPC, larger maximum radial width of β-zone PPA, and the presence of MvD were independently associated with the risk of NTG (P < 0.03 each). MvD location and retinal nerve fiber layer defect were topographically correlated in eyes with NTG.

CONCLUSIONS: PPC vasculature characteristics are significantly more compromised in eyes with NTG than in contralateral healthy eyes of patients with unilateral NTG.

PMID:33676067 | DOI:10.1016/j.ogla.2021.02.003