Nevin Manimala

Am J Infect Control. 2021 Oct 2:S0196-6553(21)00640-4. doi: 10.1016/j.ajic.2021.09.020. Online ahead of print.

ABSTRACT

INTRODUCTION: The purpose of this study is to assess the impact of a germicidal ultraviolet light-emitting diode (LED) on the contamination level of a back table in the operating room (OR) during total joint arthroplasty (TJA) procedures.

METHODS: Eight Tryptic Soy Agar (TSA) petri plates were placed on a table located near the operative field and exposed to air. One plate was removed on the hour over an 8-hour time span. The back table had either an UV-LED for disinfection or a sham UV-LED. This process was repeated in 12 different ORs (6 with UV light, 6 with sham device). The plates were then incubated for 48 hours at 36° +/- 1° C. Colony forming units (CFU) were recorded 24 and 48 hours after incubation.

RESULTS: There was a statistically significant difference in total CFUs between the intervention vs. sham at 24-hours (27 vs. 95, p=0.0001) and 48-hours (38 vs. 122, p<0.0001). The multivariate analysis revealed that the 24-hour and 48-hour count, the predictors UV light (p=0.002) and hour of plate removal (p=0.050) were statistically significantly associated with CFU counts. Together, the predictor variables explained 15.8% and 23.0% of the variance in CFU counts at 24- and 48-hours, respectively.

CONCLUSIONS: A back table UV-LED may decrease environmental contamination near the operative field. This has potential to lead to a decrease in joint infection.

PMID:34610393 | DOI:10.1016/j.ajic.2021.09.020

Q J Exp Psychol (Hove). 2021 Oct 5:17470218211053472. doi: 10.1177/17470218211053472. Online ahead of print.

ABSTRACT

By leveraging Phonology-to-Semantics Consistency (PSC, Amenta, Marelli & Sulpizio, 2017), which quantifies form-meaning systematicity as the semantic similarity between a target word and its phonological nearest neighbors, wedocument a unique effect of systematicity on Age of Acquisition (AoA). This effect is also found after controlling for theeffect of neighbourhood density measured for word forms and lexical semantics and several other standard predictorsof AoA. Moreover, we show that the effect of systematicity is not reducible to iconicity. Finally, we extensively probethe reliability of this finding by testing different statistical models, analyzing systematicity in phonology and orthographyand implementing random baselines, reporting a robust, unique negative effect of systematicity on AoA, such thatmore systematic words tend to be learned earlier. We discuss the findings in the light of studies on non-arbitrary form-meaning mappings and their role in language learning, focusing on the analogical process at the interface of form andmeaning upon which PSC is based and how it could help children infer the semantics of novel words when context isscarce or uninformative, ultimately speeding up word learning.

PMID:34609218 | DOI:10.1177/17470218211053472

Radiology. 2021 Oct 5:211746. doi: 10.1148/radiol.2021211746. Online ahead of print.

ABSTRACT

Background Data on the long-term pulmonary sequelae in COVID-19 are lacking. Purpose To assess symptoms and functional impairment and residual pulmonary abnormalities on serial chest CT in COVID-19 survivors discharged from hospital at up to 1-year follow-up. Materials and Methods Adult patients with COVID-19 discharged between March 2020 and June 2020 were prospectively evaluated at 3 months and 1 year, through systematic assessment of symptoms, functional impairments, and thoracic CT as part of the PHENOTYPE study, an observational cohort study in COVID-19 survivors. Lung function testing was limited to participants with CT abnormalities and/or persistent breathlessness. All statistical analyses were performed using Graphpad PRISM Version 9.0 (86) for Mac, GraphPad Software, (www.graphpad.com); Bonferroni corrected p values are stated. Results Eighty participants (mean age, 59 ±13 years; 53 men) were assessed. Persistent breathlessness 37 (46%) and cough 17 (21%) were reported at outpatient review (median 97 days [IQR 86-121]). CT scans in 73 participants post-discharge (median 105 days [IQR 95-141]) revealed persistent abnormalities in 41/73 participants (56%), with ground-glass opacification (35/73 [48%]) and bands (27/73 [37%]) predominating. Unequivocal signs indicative of established fibrosis (i.e. volume loss +/- traction bronchiectasis) were present in 9/73 (12%) participants. Higher admission serum C-reactive protein (mg/L), fibrinogen (g/dl), urea (mmol/L) and creatinine (micromol/L), longer hospital stay (days), older age (years) and requirement for invasive ventilation were associated with CT abnormalities at 3-month follow-up. 32/41 (78%) of participants with abnormal 3-month follow-up CT underwent repeat imaging at a median of 364 (360-366) days, with 26/32 (81%) showing further radiological improvement (median 18% [IQR 10-40%]). Conclusion CT abnormalities were common at 3 months after COVID-19 but with signs of fibrosis in a minority. More severe acute disease was linked with CT abnormalities at 3 months. However, radiologic improvement was seen in the majority at 1-year follow-up. ClinicalTrials.gov Identifier: NCT04459351.

PMID:34609195 | DOI:10.1148/radiol.2021211746

Acta Radiol. 2021 Oct 5:2841851211043835. doi: 10.1177/02841851211043835. Online ahead of print.

ABSTRACT

BACKGROUND: Rapid and accurate quantification of the supraspinatus outlet view (SOV) is a clinical challenge.

PURPOSE: To quantify the X-ray beam angle of the SOV using the horizontal angle of the subscapular spine line (SSSL) and to further verify the feasibility of this method.

MATERIAL AND METHODS: A total of 119 patients who underwent shoulder computed tomography (CT) examination were enrolled in the retrospective study. Three-dimensional (3D) CT reconstruction was performed and manually adjusted to provide the position similar to SOV. The rotation angle of the 3D image along the long axis of the human body (marked as β) was obtained. The horizontal angle of SSSL (marked as α) was measured on the anteroposterior localizer image of shoulder CT. Pearson correlation and linear regression correlation analysis were performed. In addition, the first-time success rate between the experience-based group and the measurement-based group were compared to verify the novel method.

RESULTS: We found a linear correlation between α and β (r = 0.962; P = 0.000). There was no significant correlation between the experience-based group and the measurement-based group in terms of age (P = 0.500), sex (P = 0.397), and side (P = 0.710), but there was a significant statistical difference in the first success rate between the two validation groups (χ² = 5.808^a, P = 0.016).

CONCLUSION: This novel quantitative measurement method for determining the X-ray beam angle of SOV using the horizontal angle of SSSL is feasible.

PMID:34609193 | DOI:10.1177/02841851211043835

Foot Ankle Int. 2021 Oct 5:10711007211049193. doi: 10.1177/10711007211049193. Online ahead of print.

ABSTRACT

BACKGROUND: The minimally invasive chevron-Akin (MICA) osteotomy is an increasingly popular technique for the correction of hallux valgus. However, there is a paucity of literature comparing it with traditional open techniques. The purpose of this study was to compare the clinical and radiological outcomes of the MICA osteotomy using a new-generation MICA screw and scarf-Akin osteotomy for hallux valgus correction.

METHODS: Thirty cases of MICA osteotomy were propensity score matched 1:1 with a control group of 30 scarf-Akin osteotomy cases. The groups were matched for age, sex, body mass index, preoperative visual analog scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS) metatarsophalangeal-interphalangeal (MTP-IP) score, 36-Item Short-Form Health Survey (SF-36) physical component score (PCS) and mental component score (MCS), preoperative hallux valgus angle (HVA) and intermetatarsal angle (IMA), and concomitant procedures. Outcomes were compared at 6 and 24 months postoperatively. Early postoperative VAS scores were also compared.

RESULTS: Both groups demonstrated significant improvements in VAS score, AOFAS score, and SF-36 PCS and MCS at 6 and 24 months postoperatively. For the MICA group, HVA improved from 23.5 to 7.7 degrees, and IMA improved from 13.5 to 7.5 degrees. For the scarf-Akin osteotomy group, HVA improved from 23.7 to 9.3 degrees, and IMA improved from 13.6 to 7.8 degrees. The first 24-hour postoperative VAS score was significantly lower in the MICA group compared with the scarf-Akin group (2.0 ± 2.0 vs 3.4 ± 2.6, P = .029). However, there was no significant difference in clinical or radiological outcomes between the groups at 6 and 24 months.

CONCLUSION: The MICA procedure with the new-generation MICA screw is an attractive option for the correction of hallux valgus, yielding similar midterm radiological and clinical outcomes compared with the well-established scarf-Akin osteotomy. The first 24-hour postoperative VAS score in the MICA group was also statistically lower, although its clinical significance remains to be determined.

LEVEL OF EVIDENCE: Level III, retrospective comparative study.

PMID:34609174 | DOI:10.1177/10711007211049193

JBRA Assist Reprod. 2021 Oct 5. doi: 10.5935/1518-0557.20210059. Online ahead of print.

ABSTRACT

OBJECTIVE: Data on the possible influence of women´s region of residence, within the same country, on the outcomes of medically assisted reproduction cycles are scarce. This study aims to assess the impact of the women’s region of residence on the results of in-vitro fertilization cycles.

METHODS: We evaluated in-vitro fertilization cycles between 2010 and 2017, performed in a northern Portugal assisted reproduction center. We defined two groups: Douro Litoral (group 1; n=783), and Trás-os-Montes and Alto Douro (group 2; n=178). We analyzed demographics and cycle-related variables, and we calculated the rates for embryo transfer cycles. We used the Mann-Whitney and Chi-square tests and p<0.05 was considered statistically significant.

RESULTS: We included 961 cycles. The region of residence had no effect on the following variables: women´s age; body mass index; or duration of infertility (p>0.05). Group 2 had a statistical significant lower number of previous cycles than group 1 (1.3±0.5 and 1.5±0.7; p=0.005). In the sub-analysis of cycles with embryo transfer (n=781), group 1 obtained had rates of normal fertilization (62.5% vs. 57.5%; p=0.04), miscarriage rate (30.0 vs. 10.9%; p=0.007), and lower implantation rates compared to group 2 (33.3% vs. 50.0%; p<0.001).

CONCLUSIONS: Women from the region of Trás-os-Montes e Alto Douro had a lower number of previous cycles, compared to those from the Douro Litoral, despite the absence of statistical significant differences in terms of age or infertility duration. These findings reinforce the need to contemplate the sociodemographic and socioeconomic variables in this context.

PMID:34609110 | DOI:10.5935/1518-0557.20210059

J Korean Med Sci. 2021 Oct 4;36(38):e272. doi: 10.3346/jkms.2021.36.e272.

ABSTRACT

The proportion of population vaccinated cannot be directly translated into the herd immunity. We have to account for the age-stratified contact patterns to calculate the population immunity level, since not every individual gathers evenly. Here, we calculated the contact-adjusted population immunity against severe acute respiratory syndrome coronavirus 2 in South Korea using age-specific incidence and vaccine uptake rate. We further explored options to achieve the theoretical herd immunity with age-varying immunity scenarios. As of June 21, 2021, when a quarter of the population received at least one dose of a coronavirus disease 2019 (COVID-19) vaccine, the contact-adjusted immunity level was 12.5% under the social distancing level 1. When 80% of individuals aged 10 years and over gained immunity, we could achieve a 58.2% contact-adjusted immunity level. The pros and cons of vaccinating children should be weighed since the risks of COVID-19 for the young are less than the elderly, and the long-term safety of vaccines is still obscure.

PMID:34609093 | DOI:10.3346/jkms.2021.36.e272

J Korean Med Sci. 2021 Oct 4;36(38):e236. doi: 10.3346/jkms.2021.36.e236.

ABSTRACT

BACKGROUND: Fine particulate matter (PM_2.5) can easily penetrate blood vessels and tissues through the human respiratory tract and cause various health problems. Some studies reported that particular matter (PM) exposure during pregnancy is associated with low birth weight or congenital cardiovascular anomalies. This study aimed to investigate the correlation between the degree of exposure to PM ≤ 2.5 μm (PM_2.5) during pregnancy and congenital anomalies relevant to the field of pediatric surgery.

METHODS: Mother-infant dyads with registered addresses in the Metropolitan City were selected during 3 years. The electronic medical records of mothers and neonates were retrospectively analyzed, with a focus on maternal age at delivery, date of delivery, gestation week, presence of diabetes mellitus (DM) or hypertension, parity, the residence of the mother and infant, infant sex, birth weight, Apgar score, and presence of congenital anomaly. The monthly PM_2.5 concentration from the first month of pregnancy to the delivery was computed based on the mothers’ residences.

RESULTS: PM_2.5 exposure concentration in the second trimester was higher in the congenital anomaly group than in the non-congenital anomaly group (24.82 ± 4.78 µg/m³, P = 0.023). PM_2.5 exposure concentration did not affect the incidence of nervous, cardiovascular, and gastrointestinal anomalies. While statistically insignificant, the groups with nervous, cardiovascular, gastrointestinal, musculoskeletal, and other congenital anomalies were exposed to higher PM_2.5 concentrations in the first trimester compared with their respective counterparts. The effect of PM_2.5 concentration on the incidence of congenital anomalies was significant even after adjusting for the mother’s age, presence of DM, hypertension, and parity. The incidence of congenital anomalies increased by 26.0% (95% confidence interval of 4.3% and 49.2%) per 7.23 µg/m³ elevation of PM_2.5 interquartile range in the second trimester.

CONCLUSIONS: The congenital anomaly group was exposed to a higher PM_2.5 concentration in the second trimester than the non-congenital anomaly group. The PM_2.5 exposure concentration level in the first trimester tended to be higher in groups with anomalies than those without anomalies. This suggests that continuous exposure to a high PM_2.5 concentration during pregnancy influences the incidence of neonatal anomalies in surgical respects.

PMID:34609089 | DOI:10.3346/jkms.2021.36.e236

J Cachexia Sarcopenia Muscle. 2021 Oct 5. doi: 10.1002/jcsm.12799. Online ahead of print.

ABSTRACT

BACKGROUND: Advanced pancreatic ductal adenocarcinoma (PDAC) is characterized by progressive weight loss and nutritional deterioration. This wasting has been linked to poor survival outcomes, alterations in host defenses, decreased functional ability, and diminished health-related quality of life (HRQOL) in pancreatic cancer patients. There are currently no standardized approaches to the management of pancreatic cancer cachexia. This study explores the feasibility and efficacy of enteral tube feeding of a peptide-based formula to improve weight stability and patient-reported outcomes (PROs) in advanced PDAC patients with cachexia.

METHODS: This was a single-institution, single-arm prospective trial conducted between April 2015 and March 2019. Eligible patients were adults (>18 years) diagnosed with advanced or locally advanced PDAC and cachexia, defined as greater than 5% unexplained weight loss within 6 months from screening. The study intervention included three 28 day cycles of a semi-elemental peptide-based formula, administered through a jejunal or gastrojejunal feeding tube. The primary outcome was weight stability at 3 months (Cycle 3), defined as weight change less than 0.1 kg/baseline BMI unit from baseline. Secondary outcomes included changes in lean body mass, appendicular lean mass, bone mineral density, fat mass, and percent body fat, as measured with a DEXA scan, HRQOL (EORTC QLQC30) and NIH PROMIS PROs assessed at each cycle. Daily activity (steps, distance, active minutes, heart rate, and sleep) were remotely monitored using a wearable activity monitor (Fitbit) over the 3 month study period.

RESULTS: Thirty-six patients were screened for eligibility, 31 patients consented onto study and underwent jejunal tube placement, and 16 patients completed treatment: mean age 67 years (SD 9.3), 43.8% male. Among evaluable patients (n = 16), weight stability was achieved in 10 patients (62.5%), thus completing the trial early. Increases in lean body mass (1273.1, SD: 4078, P = 0.01) and appendicular lean mass (0.45, SD: 0.6, P = 0.02) were observed. Statistically significant improvements at Cycle 3 from baseline were also observed for QLQC30 role function [mean difference (MD): 20.1, P = 0.03], appetite (MD: 27.4, P = 0.02), and global health scores (MD: 13.3, P = 0.05) as well as for NIH PROMIS t-scores for depression (MD: -10.4, P = 0.006) and pain interference (MD: -7.5, P = 0.05). Objectively monitored (Fitbit) activity levels increased, although statistical significance was not reached.

CONCLUSIONS: Our findings suggest that enteral nutrition support may improve weight stability, lean body mass, appendicular lean mass and PROs in PDAC patients with cachexia who completed treatment, representing a subsample of the study population. The feasibility and role of enteral feeding in routine care remain unclear, and larger and randomized controlled trials are warranted.

PMID:34609081 | DOI:10.1002/jcsm.12799

United European Gastroenterol J. 2021 Oct 5. doi: 10.1002/ueg2.12151. Online ahead of print.

ABSTRACT

AIM: To quantify lymphovascular invasion (LVI) and to assess the prognostic value in patients with pT1b esophageal adenocarcinoma.

METHODS: In this nationwide, retrospective cohort study, patients were included if they were treated with surgery or endoscopic resection for pT1b esophageal adenocarcinoma. Primary endpoint was the presence of metastases, lymph node metastases, or distant metastases, in surgical resection specimens or during follow-up. A prediction model to identify risk factors for metastases was developed and internally validated.

RESULTS: 248 patients were included. LVI was distributed as follows: no LVI (n = 196; 79.0%), 1 LVI focus (n = 16; 6.5%), 2-3 LVI foci (n = 21; 8.5%) and ≥4 LVI foci (n = 15; 6.0%). Seventy-eight patients had metastases. The risk of metastases was increased for tumors with 2-3 LVI foci [subdistribution hazard ratio (SHR) 3.39, 95% confidence interval (CI) 2.10-5.47] and ≥4 LVI foci (SHR 3.81, 95% CI 2.37-6.10). The prediction model demonstrated a good discriminative ability (c-statistic 0.81).

CONCLUSION: The risk of metastases is higher when more LVI foci are present. Quantification of LVI could be useful for a more precise risk estimation of metastases. This model needs to be externally validated before implementation into clinical practice.

PMID:34609076 | DOI:10.1002/ueg2.12151