Nevin Manimala

J Vasc Access. 2021 May 13:1129729820976260. doi: 10.1177/1129729820976260. Online ahead of print.

ABSTRACT

PURPOSE: To review the incidence and type of tunneled hemodialysis catheter (THC) complications in a large cohort of patients with end-stage renal disease. Additionally, the longevity of the THC and factors predicting high risk for catheter complications were assessed.

MATERIAL AND METHODS: Between August 2009 and December 2016, a cohort of 538 patients underwent primary THC insertion; in 119 patients, THC was inserted after failed arteriovenous fistula or graft. Patients without available clinical follow-up data (n = 67) were excluded for further analysis. The Charlson comorbidity index (CCI) was calculated for each patient. The cumulative incidence function (CIF) was used for THC overall longevity, while Cox proportional hazards models were used for risk factor analysis.

RESULTS: In 352 patients, THC was inserted in a virgin neck. THC-related complications were observed in n = 104 (29.55%) of the patients. Infection occurred in n = 38 (10.80%) and malfunction, related to thrombosis or mechanical damage, in n = 45 (12.78%). Removal of the THC for the purpose of switching to alternative dialysis methods was planned in n = 135 (38.4%). The remaining patients were still alive with a functioning THC (n = 18; 5.11%) or died (n = 95; 27%) with a functioning THC. The THC survival rate was 82.67%, 78.13%, 74.15%, 72.96%, 71.02%, and 70.63% on follow-up after 6 months, and after 1-5 years, respectively. Gender, CCI, age, and site of placement of the catheter were found not to affect the life of the catheter.

CONCLUSION: The overall complication rate in primary inserted THC was nearly 30% and mainly related to infection and malfunction. THC survival was more than 70% after 5 years, which supports its use for permanent dialysis access, irrespective of gender, CCI, age, and jugular side of THC placement.

PMID:33983083 | DOI:10.1177/1129729820976260

J Urol. 2021 May 13:101097JU0000000000001844. doi: 10.1097/JU.0000000000001844. Online ahead of print.

ABSTRACT

PURPOSE: We investigated 2019 and 2020 US News and World Report (USNWR) methodologies of assessing pediatric urology surgical revision rates for distal hypospadias, pyeloplasty, and ureteral reimplantation to evaluate statistical power and misclassification risks.

METHODS: Median annual volumes of distal hypospadias, pyeloplasty, and ureteral reimplantation procedures by hospital from 2016-2018 were calculated using the Pediatric Health Information Systems database. USNWR 2019 and 2020 methodologies were assessed to calculate power required to detect differences between hospitals and risk of hospital misclassifications.

RESULTS: Median (IQR) annual hospital procedure volume was 72 (43-97) for distal hypospadias procedures, 19 (9-34) for pyeloplasties, and 35 (19-50) for ureteral reimplantations. Based on 2019 methodology, in order to achieve 80% power 764 cases/hospital are required to distinguish between a 1% vs. 3% surgical revision rate, 1,500 cases/hospital are required to distinguish between a 3% vs. 5% revision rate, and 282 cases/hospital are required to distinguish between a 1% vs. 5% revision rate. Based on 2020 methodology, 98.0% of hospitals do not have adequate ureteral reimplantation volume to achieve full points even when reporting no revisions; similarly, 66.0% do not have adequate pyeloplasty volume, and 10.9% do not have adequate distal hypospadias volume. Risks of misclassification exceed 50% in several instances among hospitals reporting distal hypospadias and pyeloplasty revisions using both 2019 and 2020 methodology.

CONCLUSIONS: Based on median-volume hospitals, current USNWR methods for classifying revision rates for distal hypospadias, pyeloplasty, and ureteral reimplantation have insufficient power and are at high risk for misclassification.

PMID:33983039 | DOI:10.1097/JU.0000000000001844

ACS Nano. 2021 May 13. doi: 10.1021/acsnano.1c02907. Online ahead of print.

ABSTRACT

The surface of metal oxides is of technological importance and is extensively used as a substrate for various electronic and chemical applications. A real surface, however, is not a perfectly well-defined and clean surface, but rather contains a diverse class of atomistic defects. Here, we show the direct determination of the 3D surface atomic structure of SrTiO₃ (001) including termination layers and atomistic defects such as vacancies, adatoms, ledges, kinks, and their complex combinations, by using depth sectioning of atomic-resolution annular dark-field scanning transmission electron microscopy (ADF STEM). To overcome the poor depth resolution in STEM, we statistically analyze the column by column depth profiles of ADF STEM images with a Bayesian framework fitting algorithm, and we achieve depth resolution at the entrance surface of ±0.9 Å for 1518 individual atomic columns. The present atomic-resolution 3D electron microscopy at the surface will provide fertile ground especially in surface science.

PMID:33983030 | DOI:10.1021/acsnano.1c02907

Arthritis Rheumatol. 2021 May 13. doi: 10.1002/art.41799. Online ahead of print.

ABSTRACT

OBJECTIVE: A recent genome-wide association study (GWAS) reported a significant genetic association between rs34330 of cyclin-dependent kinase inhibitor 1B (CDKN1B) and risk of systemic lupus erythematosus (SLE) in Han Chinese. This study aims to validate the reported association and elucidate the biochemical mechanisms underlying the variant’s effect.

METHODS: We performed allelic association with SLE followed by meta-analysis across 11 independent cohorts (n=28,872). We applied in silico bioinformatics and experimental validation in SLE-relevant cell lines to determine the functional consequences of rs34330.

RESULTS: We replicated genetic association between SLE and rs34330 (P_meta =5.29×10^-22 , OR (95% CI)=0.84 (0.81-0.87)). Follow-up bioinformatics and eQTL analysis suggest that rs34330 is located in active chromatin and potentially regulates several target genes. Using luciferase and ChIP-qPCR, we demonstrated substantial allele-specific promoter and enhancer activity, and allele-specific binding of three histone marks (H3K27ac, H3K4me3, H3K4me1), RNA pol II, CTCF, and a critical immune transcription factor (IRF-1). Chromosome conformation capture (3C) detected long-range chromatin interactions between rs34330 and the promoters of neighboring genes APOLD1 and DDX47, and effects on CDKN1B and the other target genes were directly validated by CRISPR-based genome editing. Finally, CRISPR-dCas9-based epigenetic activation/silencing confirmed these results. Gene-edited cell lines also showed higher levels of proliferation and apoptosis.

CONCLUSION: Collectively, these findings suggest a mechanism whereby the rs34330 risk allele (C) influences the presence of histone marks, RNA pol II, and the IRF-1 transcription factor to regulate expression of several target genes linked to proliferation and apoptosis, which potentially underlie the association of rs34330 with SLE.

PMID:33982894 | DOI:10.1002/art.41799

Transbound Emerg Dis. 2021 May 13. doi: 10.1111/tbed.14133. Online ahead of print.

ABSTRACT

Surveillance data are key to informing decisions on the control and prevention of transboundary and emerging diseases. Here, we describe new methods for acquiring difficult to access, publicly available disease surveillance data. We use World Organisation for Animal Heath (OIE) data on African Swine Fever (ASF) outbreaks in European countries to showcase the importance of adequate disease surveillance data to inform decision-making. The data acquired using these methods allow for large scale, geospatial outbreak mapping and estimation of summary statistics for any listed terrestrial disease in the OIE World Animal Health Information System (WAHIS) database. These techniques will make valuable epidemiological data more accessible to the scientific community, aiding further insight into the occurrence and spread of transboundary and emerging diseases in a timely manner, fulfilling an important function of disease surveillance.

PMID:33982877 | DOI:10.1111/tbed.14133

BJOG. 2021 May 13. doi: 10.1111/1471-0528.16739. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess whether folic acid supplementation ameliorates hot flushes.

DESIGN: Double-blind, placebo-controlled randomised trial.

SETTING: Nine hospitals in England.

POPULATION: Postmenopausal women experiencing ≥50 hot flushes weekly.

METHODS: Women (n=164) were randomly assigned in a 1:1 ratio to receive folic acid 5mg tablet or placebo daily for 12 weeks. Participants recorded frequency and severity of hot flushes in Sloan Diary daily and completed Greene Climacteric and Utian Quality of Life (UQoL) Scales at 4-weekly intervals.

MAIN OUTCOME MEASURES: The change in daily Hot Flush Score at week-12 from randomisation based on Sloan Diary Composite Score B calculation.

RESULTS: Data of 143 (87%) women was available for the primary outcome. The mean change (SD) in Hot Flush Score at week-12 was -6.98 (10.30) and -4.57 (9.46) for folic acid and placebo group, respectively. The difference between groups in the mean change was -2.41 (95% CI: -5.68, 0.87), p=0.149 and in the adjusted mean change was -2.61 (95% CI: -5.72, 0.49), p=0.098. Analysis of secondary outcomes indicated an increased benefit in the folic acid group regarding changes in total and emotional UQoL scores at week-8 when compared with placebo. The difference in the mean change from baseline was 5.22 (95% CI: 1.16, 9.28) and 1.88 (95% CI: 0.23, 3.52) for total and emotional score, respectively.

CONCLUSIONS: The study was not able to demonstrate that folic acid had a statistically significant greater benefit in reducing Hot Flush Score over 12 weeks in postmenopausal women when compared with placebo.

PMID:33982872 | DOI:10.1111/1471-0528.16739

Aust J Rural Health. 2021 Apr;29(2):211-225. doi: 10.1111/ajr.12740.

ABSTRACT

INTRODUCTION: Psychology workforce shortages in geographically rural or remote contexts have highlighted the need to understand the supervisory experiences of psychologists practising in these locations, and the models of supervision employed to support their practice and improve client safety.

OBJECTIVE: To review the models of remote professional supervision and the supervisory experiences of psychologists practising in rural and remote locations.

DESIGN: Using the Joanna Briggs Institute methodology for mixed-methods systematic review, 8 health and education databases were searched using keyword and subject heading searches.

FINDINGS: The initial search identified 413 studies. A full-text review identified 4 papers that met the inclusion criteria and were subjected to a methodological appraisal by 2 reviewers. Three studies included qualitative data, with 2 using transcribed interviews. Two studies reported quantitative data, with only one study including a statistical analysis of the outcomes.

DISCUSSION: The results for the efficacy of the current models of remote supervision being used within the allied health and psychology professions are limited, with methodological limitations cautioning generalisability of results. The experiences of psychologists engaged in remote supervision do not appear to have changed over the past decade despite technological advances.

CONCLUSIONS: Quality professional supervision is critical for the sustainability of the psychology workforce in rural and remote locations, reducing professional isolation, and for improved patient outcomes. This review identified a need for improved evidence for remote supervision models for psychologists working in geographically rural and remote locations. Lessons can be learned from other health professions’ models of remote supervision.

PMID:33982844 | DOI:10.1111/ajr.12740

Luminescence. 2021 May 13. doi: 10.1002/bio.4083. Online ahead of print.

ABSTRACT

A water-soluble and highly stable N,S-doped CQDs (N,S-CQDs) have been synthesized by a low-cost strategy using citric acid (CA) and thiosemicarbazide (TSC) in one-step as a fluorescent nanosensor. The achieved N, S-CQDs have strong emission at 446 nm upon excitation at 370 nm and a high quantum yield of 58.5%. The quenching effect on the prepared N,S-CQDs has been utilized for determination of Trimetazidine (TMZ) spectrofluorimetrically in a wide linear range of 0.04-0.5μM (0.0106-0.133 μg mL^-1 ) and low limit of detection of 0.01μM (0.002 μg mL^-1 ). Furtherer, CDs was used to determine TMZ in its pharmaceutical formulations as well as in human plasma as a simple and rapid fluorescent probe. The method was tested in compliance with the ICH guidelines. The results obtained were statistically compared to those given by a reported method showing no significant variations regards accuracy and precision.

PMID:33982840 | DOI:10.1002/bio.4083

Transpl Infect Dis. 2021 May 13:e13634. doi: 10.1111/tid.13634. Online ahead of print.

ABSTRACT

BACKGROUND: Neutropenia is a serious complication following heart transplantation (OHT) however risk factors for its development and its association with outcomes is not well described. We sought to study the prevalence of neutropenia, risk factors associated with its development and its impact on infection, rejection and survival.

METHODS: A retrospective single center analysis of adult OHT recipients from July 2004 to December 2017 was performed. Demographic, laboratory, medication, infection, rejection and survival data were collected for 1 year post-OHT. Baseline lab measurements were collected within the 24 hours before OHT. Neutropenia was defined as absolute neutrophil count ≤1000 cells/mm3. Cox proportional hazards models explored associations with time to first neutropenia. Associations between neutropenia, analyzed as a time-dependent covariate, with secondary outcomes of time to infection, rejection or death were also examined.

RESULTS: Of 278 OHT recipients, 84 (30%) developed neutropenia at a median of 142 days (range 81-228) after transplant. Factors independently associated with increased risk of neutropenia included lower baseline WBC (HR 1.12; 95% CI 1.11 – 1.24), pre-OHT ventricular assist device (1.63; 1.00 – 2.66), high risk CMV serostatus [donor positive, recipient negative] (1.86; 1.19 – 2.88), and having a previous CMV infection (4.07; 3.92 – 13.7).

CONCLUSIONS: Neutropenia is a fairly common occurrence after adult OHT. CMV infection was associated with subsequent neutropenia, however no statistically significant differences in outcomes were found between neutropenic and non-neutropenic patients in this small study. It remains to be determined in future studies if medication changes in response to neutropenia would impact patient outcomes.

PMID:33982834 | DOI:10.1111/tid.13634

Br J Clin Pharmacol. 2021 May 13. doi: 10.1111/bcp.14897. Online ahead of print.

ABSTRACT

AIM: To test if 6 months’ intervention with dietary nitrate and spironolactone could affect carotid subclinical atherosclerosis and stiffness, respectively, versus placebo/doxazosin, to control for blood pressure (BP).

METHODS: A subgroup of participants in our double-blind, randomized-controlled, factorial VaSera trial had carotid imaging. Patients with hypertension and with/at risk of type 2 diabetes were randomized to active nitrate-containing beetroot juice or placebo nitrate-depleted juice, and spironolactone or doxazosin. Vascular ultrasound for carotid diameter (CD, mm) and intima-media thickness (CIMT, mm) was performed at baseline, 3- and 6-months. Carotid local stiffness (CS, m/s) was estimated from aortic pulse pressure (Arteriograph®) and carotid lumen area. Data was analysed by modified intention to treat and using mixed-model effect, adjusted for confounders.

RESULTS: 93 subjects had a baseline evaluation and 86% had follow-up data. No statistical interactions occurred between the juice and drug arms and BP was similar between the juices and between the drugs. Nitrate-containing versus placebo juice significantly lowered CIMT [-0.06 (95% Confidence Interval -0.12, -0.01), p=0.034], an overall difference of ~8% relative to baseline; but had no effect on carotid diameter (CD) or carotid stiffness (CS). Doxazosin appeared to reduce CS from baseline [-0.34 (-0.62, -0.06)] however, no difference was detected versus spironolactone [-0.15 (-0.46, 0.16)]. No differences were detected between spironolactone or doxazosin on CIMT and CD.

CONCLUSION: Our results show that 6 months’ intervention with dietary nitrate influences vascular remodelling, but not carotid stiffness or diameter. Neither spironolactone nor doxazosin had a BP-independent effect on carotid structure and function.

PMID:33982797 | DOI:10.1111/bcp.14897