Tag: nevin manimala

Am J Perinatol. 2023 Jun 20. doi: 10.1055/a-2113-8528. Online ahead of print.

ABSTRACT

OBJECTIVE: Cerebral sonography through the anterior fontanelle is a neonatal brain imaging method that has become an integral part of modern neonatal bedside care for both screening and diagnostic purposes. Premature infants with cognitive delay have a reduction in cerebellar size at term corrected age on MRI. We aimed to determine the level of agreement between postnatal MRI and cerebral sonography for cerebellar biometry and to determine the level of agreement within one and between different examiners.

STUDY DESIGN: Cerebellar sonography and MRI measurements of the cerebellum from 30 term infants was assessed by Bland-Altman plots. Measurements between both modalities were compared using Wilcoxon Signed-Rank Test. A p-value < 0.01 was considered statistically significant. Intra-class correlation coefficients (ICC) for intra-rater and inter-rater reliability of cerebral sonography measurements were calculated.

RESULTS: There was no statistically significant difference between cerebral sonography and MRI for linear measurements, but the measurements of perimeter and surface area differed significantly between the two techniques. There was a systematic bias between both modalities for most measurements except for anterior-posterior width and vermis height. For measurements that were not statistically different from MRI we found excellent intra-rater ICC for the anterior-posterior width, vermis height and cerebellar width. The inter-rater ICC was excellent for the anterior-posterior width and vermis height, but poor for the transverse cerebellar width.

CONCLUSIONS: With a strict imaging protocol cerebellar measurements of the anterior-posterior width and the vermis height can be used as an alternative to MRI for diagnostic-screening purposes in a neonatal department where multiple clinicians perform bedside cerebral sonography.

PMID:37339678 | DOI:10.1055/a-2113-8528

Am J Perinatol. 2023 Jun 20. doi: 10.1055/a-2113-2892. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to determine if pregnant patients with both pyelonephritis and anemia are at an increased risk of adverse maternal outcomes compared to those with pyelonephritis without anemia.

STUDY DESIGN: We conducted a retrospective cohort study utilizing the Nationwide Readmissions Database (NRD). Patients with antepartum pyelonephritis-associated hospitalizations from 10/15-12/18 were included. International Classification of Diseases codes were used to identify pyelonephritis, anemia, maternal comorbidities, and severe maternal morbidities. The primary outcome was a composite of severe maternal morbidity, as defined by Centers for Disease Control criteria. Univariate statistical methods, weighted to account for complex survey methods in the NRD, were used to assess for associations between anemia, baseline characteristics, and patient outcomes. Weighted logistic and Poisson regressions were used to assess for associations between anemia and outcomes, adjusting for clinical co-morbidities and other confounding factors.

RESULTS: In total, 29,296 pyelonephritis admissions were identified, corresponding to a weighted national estimate of 55,135 admissions. Of these, 11,798 (21.3%) were anemic. The rate of severe maternal morbidity was higher among anemic patients than non-anemic patients (27.8% vs 8.9%, respectively, p<0.001), and remained higher after adjustment (adjusted relative risk (aRR) 2.86 (95% CI: 2.67, 3.06)). Rates of individual components of severe maternal morbidities, including acute respiratory distress syndrome (4.0% vs 0.6%,aRR 3.97 (95% CI: 3.10, 5.08), sepsis (22.5% vs 7.9%,aRR 2.64 (95% CI: 2.45, 2.85)), shock (4.5% vs 0.6%,aRR 5.48 (95% CI: 4.32, 6.95)), and acute renal failure (2.9% vs 0.8%,aRR 1.99 (95% CI: 1.55, 2.55)) were all higher for anemic pyelonephritis. The mean length of stay was also longer (25% average increase, (95% CI: 22%, 28%)).

CONCLUSION: Among pregnant patients with pyelonephritis, those with anemia are at greater risk of severe maternal morbidity and longer hospital stay.

PMID:37339672 | DOI:10.1055/a-2113-2892

Am J Perinatol. 2023 Jun 20. doi: 10.1055/a-2113-3284. Online ahead of print.

ABSTRACT

OBJECTIVE: Nasal high-frequency oscillatory ventilation (nHFOV) and synchronized nasal intermittent positive pressure ventilation (sNIPPV) yield a lower partial pressure of CO₂ (pCO₂) after extubation than nasal continuous positive airway pressure. Our aim was to clarify which of the two was superior.

STUDY DESIGN: We performed a crossover randomized study to evaluate pCO₂ level among 102 participants from July 2020 to June 2022. Intubated preterm and term neonates with arterial lines were randomly allocated to nHFOV-sNIPPV or sNIPPV-nHFOV sequences; their pCO₂ levels were measured after 2 h in each mode. Subgroup analyses were performed for preterm (gestational age <37 weeks) and very preterm (gestational age <32 weeks) neonates. Results The mean gestational age (nHFOV-sNIPPV, 32.8 vs sNIPPV-nHFOV, 33.5 weeks) and median birth weight (1,850 vs 1,930 g) did not differ between the sequences. The mean ± standard deviation pCO₂ level after nHFOV (38.7 ± 8.8 mmHg) was significantly higher than that after sNIPPV (36.8 ± 10.2 mmHg; mean difference: 1.9 mmHg; 95% confidence interval: 0.3-3.4; treatment effect [p = 0.007] but no sequence [p = 0.92], period [p = 0.53], or carryover [p = 0.94] effects). However, the difference of pCO₂ level between the sequences was not statistically significant in the subgroup analyses of preterm and very preterm neonates. Conclusion After neonatal extubation, the sNIPPV mode was associated with a lower pCO₂ level than the nHFOV mode with no significant difference in preterm and very preterm neonates.

PMID:37339671 | DOI:10.1055/a-2113-3284

Aktuelle Urol. 2023 Jun 20. doi: 10.1055/a-2090-5199. Online ahead of print.

ABSTRACT

BACKGROUND: Currently, 959 men in Germany and 67 in Austria are diagnosed with penile cancer each year, with an increase of approximately 20% in the last decade [RKI 2021, Statcube.at 2023]. Despite the rising incidence, the number of cases per hospital remains low. The median annual number of penile cancer cases at university hospitals in the DACH region was 7 patients (IQR 5-10) in 2017 [E-PROPS group 2021]. The compromised institutional expertise due to low case numbers is compounded with inadequate adherence to penile cancer guidelines, as shown in several studies. The centralization, which is rigorously implemented in countries such as the UK, enabled a significant increase in organ-preserving primary tumor surgery and stage-adapted lymphadenectomies, as well as improved patient survival in cases of penile cancer, resulting in a claim for a similar centralization in Germany and Austria. The aim of this study was to determine the current effects of case volume on penile cancer related treatment options at university hospitals in Germany and Austria.

MATERIALS AND METHODS: In January 2023, a survey was sent to the heads of 48 urological university hospitals in Germany and Austria, including questions regarding case volume in 2021 (total number of inpatient and penile cancer cases), treatment options for primary tumors and inguinal lymphadenectomy (ILAE), the availability of a designated penile cancer surgeon, and the professional responsibility for systemic therapies in penile cancer. Correlations and differences related to case volume were statistically analyzed without adjustments.

RESULTS: The response rate was 75% (n=36/48). In total, 626 penile cancer patients were treated at the 36 responding university hospitals in 2021, representing approximately 60% of the expected incidence in Germany and Austria. The annual median total number of cases was 2807 (IQR 1937-3653), and for penile cancer, it was 13 (IQR 9-26). There was no significant correlation between the total inpatient and penile cancer caseloads (p=0.34). The number of organ-preserving therapy procedures for the primary tumor, the availability of modern ILAE procedures, the presence of a designated penile cancer surgeon, and the responsibility for systemic therapies were not significantly influenced by the total inpatient or penile cancer case volume of the treating hospitals, regardless of whether the case volumes were dichotomized at the median or upper quartile. No significant differences between Germany and Austria were observed.

CONCLUSION: Despite a significant increase in the annual number of penile cancer cases at university hospitals in Germany and Austria compared to 2017, we found no case volume-related effects on structural quality with respect to penile cancer therapy. In the light of the proven benefits of centralization, we interpret this result as an argument for the necessity of establishing nationally organized penile cancer centers with even higher case volumes compared to the status quo, in light of the proven benefits of centralization.

PMID:37339667 | DOI:10.1055/a-2090-5199

Rev Bras Ginecol Obstet. 2023 May;45(5):242-252. doi: 10.1055/s-0043-1770126. Epub 2023 Jun 20.

ABSTRACT

OBJECTIVE: Evaluate the effect of combined training on body image (BI), body composition and functional capacity in patients with breast cancer. As also the relationship of BI with body composition and functional capacity.

METHODS: This was a Controlled Clinical Trial study, this study including 26 patients with breast cancer (30 to 59 years). The training group (n = 13) underwent 12 weeks of training, including three 60-min sessions of aerobic exercise and resistance training, and two sessions of flexibility training per week; each flexibility exercise lasted 20s. The Control Group (n = 13) received only the standard hospital treatment. Participants were evaluated at baseline and after 12 weeks. BI (primary outcomes) was assessed using the Body Image After Breast Cancer Questionnaire; Body composition was estimated with the indicators: Body mass index; Weight, Waist hip Ratio; Waist height ratio; Conicity index; Reciprocal ponderal index; Percentage of fat; Circumference of the abdomen and waist; Functional capacity by cardiorespiratory fitness (cycle ergometer) and strength (manual dynamometer). The statistic was performed in the Biostatistics and Stata 14.0 (α = 5%).

RESULTS: The patients in the training group showed a reduction in the limitation dimension (p = 0.036) on BI, However, an increase in waist circumference was observed in both groups. In addition an increase in VO2max (p < 0.001) and strength in the right (p = 0.005) and left arms (p = 0.033).

CONCLUSION: Combined training demonstrates to be an effective and non-pharmacological strategy to patients with breast cancer, with improvement on BI and functional capacity, changing related variables negatively when there is no physical training.

PMID:37339643 | DOI:10.1055/s-0043-1770126

J Neural Eng. 2023 Jun 20. doi: 10.1088/1741-2552/acdffd. Online ahead of print.

ABSTRACT

Recent event-based analyses of transient, intermittent burst-like activities in the beta and gamma frequency ranges have characterized the oscillatory bursts as a neural signature that bridges dynamic neural states to cognition and behavior. While a precise detection of burst events is crucial for inferring their relations to behaviors, large variations of the background noise in the signal poses challenges for precisely identifying their onsets. Here, we examined several classic burst detection algorithms and their robustness to noise by comparing their ability to extract bursts under different conditions of signal-to-noise ratio and event duration using synthesized signals containing bursts of multiple frequencies. Our findings revealed that the detection of bursts is heavily influenced by event duration, while the precise identification of burst onsets is relatively more susceptible to the noise level. Given that burst properties in real signals are typically unknown in advance, we proposed a selection rule that utilizes the empirical cumulative distribution function and its associated area under the curve as potential criteria for determining the most suitable algorithm for a given dataset. To validate our rule, we applied the selected algorithm to theta, beta, and gamma activities in the basolateral amygdala of male mice during exposure to a spider robot-induced threat. The chosen method exhibited high detection and temporal accuracy, although statistical significance was not consistently observed between the different algorithms across frequency bands. Notably, the algorithm selected by human visual screenings did not always align with the algorithm recommended by our selection rule, indicating a mismatch between human priors and mathematical assumptions embedded in the algorithms. Consequently, our proposed rule offers a potential solution for algorithm selection in burst detection; however, its implementation also exposes the limitations of these algorithms, highlighting their variable performance depending on the dataset and cautioning against relying solely on heuristic-based approaches.

PMID:37339619 | DOI:10.1088/1741-2552/acdffd

Netw Neurosci. 2023 Jan 1;7(1):299-321. doi: 10.1162/netn_a_00284. eCollection 2023.

ABSTRACT

Executive functioning (EF) is a higher order cognitive process that is thought to depend on a network organization facilitating integration across subnetworks, in the context of which the central role of the fronto-parietal network (FPN) has been described across imaging and neurophysiological modalities. However, the potentially complementary unimodal information on the relevance of the FPN for EF has not yet been integrated. We employ a multilayer framework to allow for integration of different modalities into one ‘network of networks.’ We used diffusion MRI, resting-state functional MRI, MEG, and neuropsychological data obtained from 33 healthy adults to construct modality-specific single-layer networks as well as a single multilayer network per participant. We computed single-layer and multilayer eigenvector centrality of the FPN as a measure of integration in this network and examined their associations with EF. We found that higher multilayer FPN centrality, but not single-layer FPN centrality, was related to better EF. We did not find a statistically significant change in explained variance in EF when using the multilayer approach as compared to the single-layer measures. Overall, our results show the importance of FPN integration for EF and underline the promise of the multilayer framework toward better understanding cognitive functioning.

PMID:37339322 | PMC:PMC10275212 | DOI:10.1162/netn_a_00284

Dis Colon Rectum. 2023 Jun 20. doi: 10.1097/DCR.0000000000002686. Online ahead of print.

ABSTRACT

BACKGROUND: The association of micropapillary pattern with oncologic outcomes has not been fully studied in patients with colon cancer.

OBJECTIVE: We evaluated the prognostic value of micropapillary pattern, especially for patients with stage II colon cancer.

DESIGN: A retrospective comparative cohort study using propensity score matching.

SETTING: This study was conducted at a single tertiary center.

PATIENTS: The patients with primary colon cancer undergoing curative resection from October 2013 to December 2017 were enrolled. The patients were grouped into micropapillary pattern (+) or micropapillary pattern (-).

MAIN OUTCOME MEASUREMENTS: Disease-free survival and overall survival.

RESULTS: Of the eligible 2,192 patients, 334 (15.2%) were micropapillary pattern (+). After 1:2 propensity score matching, 668 patients with micropapillary pattern (-) were selected. Micropapillary pattern (+) group showed significantly worse 3-year disease-free survival (77.6% vs. 85.1%, p = 0.007). Three-year overall survival of micropapillary pattern-positive and micropapillary pattern-negative did not show a statistically significant difference (88.9% vs. 90.4%, p = 0.480). In multivariable analysis, micropapillary pattern -positive was an independent risk factor for poor disease-free survival (hazard ratio 1.547, p = 0.008). In the subgroup analysis for 828 patients with stage II disease, 3-year disease-free survival deteriorated significantly in micropapillary pattern (+) patients (82.6% vs. 93.0, p < 0.001). Three-year overall survival was 90.1% and 93.9% in micropapillary pattern (+) and micropapillary pattern (-), respectively (p = 0.082). In the multivariable analysis for patients with stage II disease, micropapillary pattern (+) was an independent risk factor for poor disease-free survival (hazard ratio 2.003, p = 0.031).

LIMITATIONS: Selection bias due to the retrospective nature of the study.

CONCLUSIONS: Micropapillary pattern (+) may serve as an independent prognostic factor for colon cancer, especially for patients with stage II disease.

PMID:37339285 | DOI:10.1097/DCR.0000000000002686

J Clin Endocrinol Metab. 2023 Jun 20:dgad371. doi: 10.1210/clinem/dgad371. Online ahead of print.

ABSTRACT

BACKGROUND: Thyroid function has been associated with metabolic syndrome (MetS) in a number of observational studies. In spite of that, the direction of effects and the exact causal mechanism of this relationship is still unknown.

METHODS: We performed a two-sample bidirectional Mendelian randomization (MR) study using summary statistics from the most comprehensive genome-wide association studies (GWAS) of thyroid-stimulating hormone (TSH, n = 119,715), free thyroxine (fT4, n = 49,269), MetS (n = 291,107), as well as components of MetS: waist circumference (n = 462,166), fasting blood glucose (n = 281,416), hypertension (n = 463,010), triglycerides (TG, n = 441,016) and high-density lipoprotein cholesterol (HDL-C, n = 403,943). We chose the multiplicative random-effects inverse variance weighted (IVW) method as the main analysis. Sensitivity analysis included weighted median and mode analysis, as well as MR-Egger and Causal Analysis Using Summary Effect estimates (CAUSE).

RESULTS: Our results suggest that higher fT4 levels lower the risk of developing MetS (OR = 0.96, P = 0.037). Genetically predicted fT4 was also positively associated with HDL-C (β=0.02, P = 0.008), while genetically predicted TSH was positively associated with TG (β=0.01, P = 0.044). These effects were consistent across different MR analyses and confirmed with the CAUSE analysis. In the reverse direction MR analysis, genetically predicted HDL-C was negatively associated with TSH (β=-0.03, P = 0.046) in the main IVW analysis.

CONCLUSIONS: Our study suggests that variations in normal-range thyroid function are causally associated with the diagnosis of MetS and with lipid profile, while in the reverse direction, HDL-C has a plausible causal effect on reference-range TSH levels.

PMID:37339283 | DOI:10.1210/clinem/dgad371

Proc Natl Acad Sci U S A. 2023 Jul 4;120(27):e2303168120. doi: 10.1073/pnas.2303168120. Epub 2023 Jun 20.

ABSTRACT

We briefly review the majorization-minimization (MM) principle and elaborate on the closely related notion of proximal distance algorithms, a generic approach for solving constrained optimization problems via quadratic penalties. We illustrate how the MM and proximal distance principles apply to a variety of problems from statistics, finance, and nonlinear optimization. Drawing from our selected examples, we also sketch a few ideas pertinent to the acceleration of MM algorithms: a) structuring updates around efficient matrix decompositions, b) path following in proximal distance iteration, and c) cubic majorization and its connections to trust region methods. These ideas are put to the test on several numerical examples, but for the sake of brevity, we omit detailed comparisons to competing methods. The current article, which is a mix of review and current contributions, celebrates the MM principle as a powerful framework for designing optimization algorithms and reinterpreting existing ones.

PMID:37339185 | DOI:10.1073/pnas.2303168120