Nevin Manimala

Eur J Radiol. 2021 Apr 30;140:109747. doi: 10.1016/j.ejrad.2021.109747. Online ahead of print.

ABSTRACT

PURPOSE: The primary aim was to develop and validate a novel mammography positioning measure, specifically incorporating parameters which might relate to mammography pain. We then explored relationships between the new adverse positioning score and (1) pain; (2) patient and technique factors.

METHODS: A 15-item instrument incorporating positioning features with potential to relate to mammography pain was developed. Participants’ mammograms (n = 310) were reviewed for presence of these features. Validity was investigated using the Rasch model. Scores produced by the resultant measure were investigated for associations with patients’ pain scores and relevant patient and technique factors, using Pearson correlation, analysis of variance, and multiple linear regression.

RESULTS: Statistical indices within the Rasch measurement framework provided good evidence that the measure reflected a coherent construct of adverse positioning. Thus, the scores produced with the measurement instrument were valid for use in further statistical analysis. There is, however, scope for improvement of the measure’s discriminatory properties. Adverse positioning scores were higher for greater breast volumes (r = 0.12, p=.0391) and body mass index (BMI) (r = 0.13, p=.0349), and varied by mammographer (F(11,298) 2.38, p = .0078). The relationships with BMI and mammographer persisted in regression modelling. No relationship was found between adverse positioning and pain.

CONCLUSIONS: Evidence from Rasch analysis suggests that this novel measure is valid for quantifying a coherent “adverse positioning” construct in mammography. Adverse positioning scores varied by mammographer and were related to higher patient BMI but not to mammography pain. The measure warrants expansion, further refinement, and testing in larger studies.

PMID:34000597 | DOI:10.1016/j.ejrad.2021.109747

Prim Care Companion CNS Disord. 2021 Apr 8;23(2):19m02493. doi: 10.4088/PCC.19m02493.

ABSTRACT

OBJECTIVE: To define sex differences in cardiometabolic indice changes over 12 months in patients on antipsychotics and to describe treatment complexity, interventions, and patient satisfaction of pharmacist comprehensive medication management (CMM) services.

METHODS: Secondary analyses of time effect-associated sex differences in cardiometabolic indices within and between study groups were done at baseline and 12 months. Each group consisted of 60 subjects who received full pharmacist CMM services (PCS) and 60 subjects who received either modified or no CMM services (NCS). Pharmacist CMM services are a team-based practice of providing direct patient care.

RESULTS: Significant sex differences in mean change score were observed from baseline to 12 months in the combined PCS and NCS subjects. Compared to men, women had greater body weight (P = .003) and waist measurement (P = .02) reductions and increased serum level of high-density lipoproteins (P < .001). In contrast, men had greater systolic (P < .001) and diastolic (P = .005) blood pressure levels, more hypertension diagnoses (P = .01), and less dyslipidemia diagnoses (P = .001) compared to women at 12 months. Significant sex differences were observed in combined PCS and NCS groups for glycated hemoglobin (HgbA_1c) (women: -0.33%, P = .02) and low-density lipoprotein (men: -21.63 mg/dL, P = .04) at 12 months. In PCS women, a significant (P = .02) reduction in mean HgbA_1c percentages (-0.46%) compared to PCS men (0.28%) was observed at 12 months. A higher percentage (62%, n = 28/45) of PCS women compared to PCS men (38%, n = 17/45) at 12 months continued to receive CMM services. Satisfaction survey results positively favored CMM services; however, the response rate was only 25% (n = 18/72).

CONCLUSIONS: Women on antipsychotics appear more likely to keep follow-up visits, return satisfaction surveys, reduce abdominal weight, and improve both HgbA_1c percentages and high-density lipid levels compared to men over 12 months. Women were satisfied overall with CMM services. Recognition of sex differences can promote a more personalized patient-centered care approach among patients prescribed antipsychotics.

TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02029989.

PMID:34000112 | DOI:10.4088/PCC.19m02493

Catheter Cardiovasc Interv. 2021 May 17. doi: 10.1002/ccd.29772. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to assess the predictive ability of the Global Registry of Acute Coronary Events (GRACE) risk score 2.0 in contemporary acute coronary syndrome (ACS) patients, and its relation to antiplatelet strategies.

BACKGROUND: The predictive value of the GRACE risk score in the contemporary ACS cohort and the appropriate antiplatelet regimen according to the risk remain unclear.

METHODS: This is a subgroup analysis of the all-comers, randomized GLOBAL LEADERS trial, comparing ticagrelor monotherapy versus conventional dual-antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI). The GRACE risk score 2.0 with 1-year mortality prediction was implemented. The randomized antiplatelet effect was assessed in predefined three GRACE risk-groups; low-risk (GRACE <109), moderate-risk (GRACE 109-140), and high-risk (GRACE >140).

RESULTS: The GRACE risk score was available in 6,594 out of 7,487 ACS patients among whom 1,743, 2,823, and 2,028 patients were classified as low-risk, moderate-risk, and high-risk, respectively. At 1 year, all-cause mortality occurred in 120 patients (1.8%). The discrimination ability of the GRACE model was moderate (C-statistic = 0.742), whereas 1-year mortality risk was overestimated (mean predicted mortality rate: 3.9%; the Hosmer-Lemeshow chi-square: 21.47; p = 0.006). There were no significant interactions between the GRACE risk strata and effects of the ticagrelor monotherapy on ischemic or bleeding outcomes at 1 year compared to the reference strategy.

CONCLUSION: The GRACE risk score 2.0 is valuable in discriminating high risk ACS patients, however, the recalibration of the score is recommended for better risk stratification. There is no significant differences in efficacy and safety of ticagrelor monotherapy across the three GRACE risk strata.

PMID:34000088 | DOI:10.1002/ccd.29772

Am J Hematol. 2021 May 17. doi: 10.1002/ajh.26239. Online ahead of print.

NO ABSTRACT

PMID:34000073 | DOI:10.1002/ajh.26239

J Sci Food Agric. 2021 May 17. doi: 10.1002/jsfa.11320. Online ahead of print.

ABSTRACT

BACKGROUND: Stevia leaves were subjected to convective hot-air, infrared, and vacuum drying at 40, 60, and 80 °C, followed by an assessment of thermophysical properties and microstructure, along with drying kinetics modelling and evaluation of energy features for all drying operations.

RESULTS: Effective moisture diffusivity (D_eff ) showed dependency on temperature with values ranging from 1.08×10^-12 to 7.43×10^-12 m² s^-1 for convective drying, from 0.71×10^-12 to 6.60×10^-12 m² s^-1 for infrared drying, and from 1.29×10^-12 to 5.39×10^-12 m² s^-1 for vacuum drying. The thermal properties of the dried Stevia leaves under different drying conditions, showed values of density, specific heat, thermal diffusivity, thermal conductivity, and thermal effusivity ranging from 95.6 to 116.2 kg m^-3 , 3050 to 3900 J kg^-1 K^-1 , 4.28×10^-7 to 5.60×10^-7 m² s^-1 , 0.16 to 0.23 W m^-1 K^-1 and 244 to 305 W s^0.5 m^-2 K^-1 respectively. As for microstructure, the convective hot-air drying showed better preserved leaves characteristics, compared to infrared- and vacuum-drying, whereby SEM image analysis also revealed noticeable differences at higher temperatures. Statistical analysis showed that the Midilli-Kuçuk model fitted best the experimental data of drying curves (0.961<r² <0.999, 0.000064<SSE<0.005359, and 0.000074<χ² <0.006278). Comparison of the drying methods with respect to energy features, showed that convective drying at 80 °C led to lowest specific energy consumption (61.86 kWh kg^-1 ) with highest efficiency (8.5%).

CONCLUSION: The results of this study contribute to a better understanding of the drying behaviour and showed that thermophysical properties of dried Stevia leaves and energy features are affected by drying methods. This article is protected by copyright. All rights reserved.

PMID:34000065 | DOI:10.1002/jsfa.11320

J Sci Food Agric. 2021 May 17. doi: 10.1002/jsfa.11323. Online ahead of print.

ABSTRACT

BACKGROUND: Multilayer perceptron (MLP) feed-forward artificial neural networks (ANN) and first order Takagi-Sugeno type adaptive neuro-fuzzy inference systems (ANFIS) are utilized to model the fluidized bed drying process of Echium amoenum Fisch. & C. A. Mey. The moisture ratio evolution is calculated based on the drying temperature, airflow velocity and process time. Different ANN topologies are examined by evaluating the neuron number (3 to 20), the activation functions and the addition of a second hidden layer. Respectively, different number (2 to 5) and shapes of membership functions are examined for the ANFIS, using the grid partitioning method. The models with the best performance in terms of prediction accuracy as evaluated by the statistical indices, are compared with the best fit thin-layer model and the available data from the experimental cases of 40, 50 and 60°C temperatures at 0.5, 0.75 and 1 ms^-1 airflow velocity.

RESULTS: The best performed ANFIS model, comprised by 5-2-2 of π-shaped and triangular membership functions for time, temperature and airflow velocity inputs respectively, was able to describe the moisture ratio evolution of Echium amoenum more precisely than the best ANN topology with R² =0.9992, RMSE=0.0078 and SSE=1.06·10^-2 . Best thin-layer model involving six adjustable parameters, managed to describe experimental data with R² =0.9996, RMSE=0.0057 and SSE=7.3·10^-4 .

CONCLUSION: The results of the comparative study indicate that empirical regression models with increased number of adjustable parameters, constitute a simpler and more accurate modeling approach for estimating the moisture ratio of Echium amoenum Fisch. & C. A. Mey under fluidized bed drying. This article is protected by copyright. All rights reserved.

PMID:34000064 | DOI:10.1002/jsfa.11323

Interact Cardiovasc Thorac Surg. 2021 May 17:ivab119. doi: 10.1093/icvts/ivab119. Online ahead of print.

ABSTRACT

OBJECTIVES: The newly proposed N subclassification (new-N) was compared with the combined anatomical location and ratio of the number of metastatic lymph nodes to the total number of resected lymph nodes (anatomic-LNR) in terms of prognosis in resected lung cancer patients.

METHODS: Between 2005 and 2018, 961 patients who underwent lung cancer resection were catergorized into the pN1-single (N1a; n = 281), pN1-multiple (N1b; n = 182), pN2-single with skip metastasis (N2a1; n = 116), pN2-single with N1 metastasis (N2a2; n = 222) and pN2-multiple (N2b; n = 160) groups based on new-N. The optimal cut-off points for survival in pN1 and pN2 patients were determined using the best sensitivity and specificity scores, calculated using receiver operating characteristic analysis.

RESULTS: The difference in survival between N1a and N1b patients was statistically significant (P = 0.001), but there was no significant difference in the survival rates of N1b and N2a1 (P = 0.52). The survival curves for N2a1 and N2a2 patients almost overlapped (P = 0.143). N2a2 patients showed a better survival rate than N2b patients, with no significant difference (P = 0.132). The cut-off points for LNR were 0.10 and 0.25 for pN1 and pN2 patients, respectively, according to receiver operating characteristic analysis for survival. Based on receiver operating characteristic analysis, pN patients were categorized into the N1-lowLNR (n = 232), N1-highLNR (n = 231), N2-lowLNR (n = 266) and N2-highLNR (n = 232) groups. The 5-year survival rate was 62.9%, 49.8%, 41.1% and 27.1% for N1-lowLNR, N1-highLNR, N2-lowLNR and N2-highLNR, respectively (P < 0.001).

CONCLUSIONS: LowLNR is associated with better survival than highLNR in resected lung cancer patients. Anatomic-LNR shows a high discriminatory power for prognosis.

PMID:34000035 | DOI:10.1093/icvts/ivab119

Nanoscale. 2021 May 17. doi: 10.1039/d0nr06865a. Online ahead of print.

ABSTRACT

DNA has become a powerful platform to design functional nanodevices. DNA nanodevices are often composed of self-assembled DNA building blocks that differ significantly from the structure of native DNA. In this study, we present Flow Force Microscopy as a massively parallel approach to study the nanomechanics of DNA self-assemblies on the single-molecular level. The high-throughput experiments performed in a simple microfluidic channel enable statistically meaningful studies with nanometer scale precision in a time frame of several minutes. A surprisingly high flexibility was observed for a typical construct used in DNA origami, reflected in a persistence length of 10.2 nm, a factor of five smaller than for native DNA. The enhanced flexibility is attributed to the discontinuous backbone of DNA self-assemblies that facilitate base pair opening by thermal fluctuations at the end of hybridized oligomers. We believe that the results will contribute to the fundamental understanding of DNA nanomechanics and help to improve the design of DNA nanodevices with applications in biological analysis and clinical research.

PMID:33999986 | DOI:10.1039/d0nr06865a

PLoS One. 2021 May 17;16(5):e0251549. doi: 10.1371/journal.pone.0251549. eCollection 2021.

ABSTRACT

PURPOSE: To assess potential changes in pupil size during femtosecond laser-assisted cataract surgery (FLACS) using a low-energy laser system.

METHODS: The pupil sizes of eyes undergoing FLACS were measured using the Ziemer LDV Z8 by extracting images from the laser software after each of the following steps: application of suction, lens fragmentation, and capsulotomy. Furthermore, the pupil diameters were measured based on preoperative surgical microscope images and after releasing the suction. Paired t-test and the two one-sided tests (TOST) procedure were used for statistical analyses. The horizontal and vertical pupil diameters were compared in each of the steps with preoperative values.

RESULTS: Data were available for 52 eyes (52 patients, mean age 73.4 years, range 51-87 years). The equivalence between mean preoperative pupil size and status immediately after femtosecond laser treatment was confirmed (p<0.001; 95% confidence interval [-0.0637, 0.0287] for horizontal and p<0.001; 95% CI [-0.0158, 0.0859] for vertical diameter). There was statistically significant horizontal and vertical enlargement of pupil diameters between 0.15 and 0.24 mm during the laser treatment steps as compared with preoperative values (all p values <0.001).

CONCLUSIONS: No progressive pupil narrowing was observed using low-energy FLACS. Although a suction-induced, slight increase in pupil area became apparent, this effect was completely reversible after removing the laser interface.

PMID:33999970 | DOI:10.1371/journal.pone.0251549

PLoS One. 2021 May 17;16(5):e0251653. doi: 10.1371/journal.pone.0251653. eCollection 2021.

ABSTRACT

Behavioral genetics in non-model organisms is currently gated by technological limitations. However, with the growing availability of genome editing and functional genomic tools, complex behavioral traits such as social behavior can now be explored in diverse organisms. Here we present a minimally invasive neurosurgical procedure for a classic behavioral, ecological and evolutionary system: threespine stickleback (Gasterosteus aculeatus). Direct brain injection enables viral-mediated transgenesis and pharmaceutical delivery which bypasses the blood-brain barrier. This method is flexible, fast, and amenable to statistically powerful within-subject experimental designs, making it well-suited for use in genetically diverse animals such as those collected from natural populations. Developing this minimally invasive neurosurgical protocol required 1) refining the anesthesia process, 2) building a custom surgical rig, and 3) determining the normal recovery pattern allowing us to clearly identify warning signs of failure to thrive. Our custom-built surgical rig (publicly available) and optimized anesthetization methods resulted in high (90%) survival rates and quick behavioral recovery. Using this method, we detected changes in aggression from the overexpression of either of two different genes, arginine vasopressin (AVP) and monoamine oxidase (MAOA), in outbred animals in less than one month. We successfully used multiple promoters to drive expression, allowing for tailored expression profiles through time. In addition, we demonstrate that widely available mammalian plasmids work with this method, lowering the barrier of entry to the technique. By using repeated measures of behavior on the same fish before and after transfection, we were able to drastically reduce the necessary sample size needed to detect significant changes in behavior, making this a viable approach for examining genetic mechanisms underlying complex social behaviors.

PMID:33999965 | DOI:10.1371/journal.pone.0251653