Tag: nevin manimala

J Pediatr Orthop. 2023 Jul 26. doi: 10.1097/BPO.0000000000002481. Online ahead of print.

ABSTRACT

BACKGROUND: Tibial tuberosity to trochlear groove distance (TT-TG) has been reported to have different values according to imaging modalities, usually higher in computed tomography (CT) than in magnetic resonance imaging (MRI). This difference is thought to be caused by the degree of knee flexion during imaging, but few studies have aimed to elucidate the cause.

METHODS: Five hundred eight patients with knee CT or MRI performed between ages of 6 to 16 years without underlying diseases affecting the musculoskeletal system were included. This study was conducted in 2 statistical ways. (1) Propensity score matching was performed for the imaging modality, and the bony TT-TG was compared between the 2 matched groups. (2) A regression model was fitted with 484 patients with either CT or MRI (a training set), and validation of the fitted model was performed with 24 patients with both CT and MRI simultaneously taken within a week (a test set). The predicted TT-TG values were compared with the measured values.

RESULTS: (1) Eighty-one patients were successfully matched by propensity score (all the standardized mean differences < 0.1) for each modality. In the matched patients, there was no significant difference in TT-TG according to the imaging modality (11.3 ± 3.7 mm for CT, 10.4 ± 3.8 mm for MRI, P = 0.126). (2) For the model fitting, different linear models were fitted before and after 10 degrees of knee flexion angle because there was a sharp change in TT-TG when the knee flexion angle was <10 degrees. The predicted TT-TG values did not significantly differ from the measured values (10.2 ± 4.3 mm vs. 9.0 ± 5.1 mm, P = 0.124).

CONCLUSIONS: This study is the first to statistically prove that the difference between TT-TG in MRI and CT originates from the different degrees of knee flexion. In addition, although more studies are needed, authors recommend imaging to be performed with the knee flexed at least 10 degrees for more reliable measurements because TT-TG changes sharply if the knee flexion angle is <10 degrees.

LEVEL OF EVIDENCE: III.

PMID:37493032 | DOI:10.1097/BPO.0000000000002481

Int J Gynaecol Obstet. 2023 Jul 26. doi: 10.1002/ijgo.15016. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the aspartate aminotransferase to platelet ratio (APRI) score as a predictive and prognostic test in intrahepatic cholestasis of pregnancy (ICP).

METHODS: This study was conducted in 198 patients diagnosed with ICP and 204 healthy pregnant women who presented to a tertiary center between 2019 and 2022. APRI scores; laboratory findings in the first, second, and third trimesters; and perinatal outcomes were compared between the two groups. The ICP group was evaluated for correlation between APRI scores and composite adverse outcomes. Two different receiver operating characteristic analyses were performed to determine optimal cutoff values of predictive APRI score of ICP and composite adverse outcomes in patients with ICP.

RESULTS: Aspartate aminotransferase values and APRI scores were significantly higher in the ICP group in all trimesters (P < 0.001). The optimal cutoff values of APRI scores to predict ICP for the first, second, and third trimesters were 0.101 (79.7% sensitivity, 79.6% specificity), 0.103 (78.4% sensitivity, 76.3% specificity), and 0.098 (72.5% sensitivity, 72% specificity), respectively. APRI scores were statistically higher in patients with ICP with composite adverse outcomes in all trimesters (P values of 0.03, 0.04, and 0.01, respectively).

CONCLUSION: APRI score was found to be a valuable predictor of ICP and its adverse outcomes during the entire pregnancy.

PMID:37493015 | DOI:10.1002/ijgo.15016

Glob Chang Biol. 2023 Jul 26. doi: 10.1111/gcb.16891. Online ahead of print.

ABSTRACT

Climate change is one of the top three global threats to seabirds, particularly species that visit polar regions. Arctic terns migrate between both polar regions annually and rely on productive marine areas to forage, on sea ice for rest and foraging, and prevailing winds during flight. Here, we report 21st-century trends in environmental variables affecting arctic terns at key locations along their Atlantic/Indian Ocean migratory flyway during the non-breeding seasons, identified through tracking data. End-of-century climate change projections were derived from Earth System Models and multi-model means calculated in two Shared Socioeconomic Pathways: ‘middle-of-the-road’ and ‘fossil-fuelled development’ scenarios. Declines in North Atlantic primary production emerge as a major impact to arctic terns likely to affect their foraging during the 21st century under a ‘fossil-fuelled development’ scenario. Minimal changes are, however, projected at three other key regions visited by arctic terns (Benguela Upwelling, Subantarctic Indian Ocean and the Southern Ocean). Southern Ocean sea ice extent is likely to decline, but the magnitude of change and potential impacts on tern survival are uncertain. Small changes (<1 m s^-1 ) in winds are projected in both scenarios, but with minimal likely impacts on migration routes and duration. However, Southern Ocean westerlies are likely to strengthen and contract closer to the continent, which may require arctic terns to shift routes or flight strategies. Overall, we find minor effects of climate change on the migration of arctic terns, with the exception of poorer foraging in the North Atlantic. However, given that arctic terns travel over huge spatial scales and live for decades, they integrate minor changes in conditions along their migration routes such that the sum effect may be greater than the parts. Meeting carbon emission targets is vital to slow these end-of-century climatic changes and minimise extinction risk for a suite of polar species.

PMID:37492997 | DOI:10.1111/gcb.16891

Cancer Med. 2023 Jul 26. doi: 10.1002/cam4.6377. Online ahead of print.

ABSTRACT

BACKGROUND: HPV infection can cause cancer, and standard treatments often result in recurrence. The extent to which liquid biopsy using HPV circulating tumor DNA (HPV ctDNA) can be used as a promising marker for predicting recurrence in HPV-related cancers remains to be validated. Here we conducted a systematic review and meta-analysis to assess its effectiveness in predicting treatment response.

METHODS: We conducted a systematic literature search of online databases, including PubMed, Embase, Scopus, and the Cochrane Library, up to December 2022. The goal was to identify survival studies that evaluated the potential of plasma HPV ctDNA at baseline and end-of-treatment (EoT) in predicting recurrence of related cancers. Hazard ratios were estimated directly from models or extracted from Kaplan-Meier plots.

RESULTS: The pooled effect of HPV ctDNA presence on disease recurrence was estimated to be HR = 7.97 (95% CI: [3.74, 17.01]). Subgroup analysis showed that the risk of recurrence was HR = 2.17 (95% CI: [1.07, 4.41]) for baseline-positive cases and HR = 13.21 (95% CI: [6.62, 26.36]) for EoT-positive cases. Significant associations were also observed between recurrence of oropharyngeal squamous cell carcinoma (HR = 12.25 (95% CI: [2.62, 57.36])) and cervical cancer (HR = 4.60 (95% CI: [2.08, 10.17])) in plasma HPV ctDNA-positive patients.

CONCLUSIONS: The study found that HPV ctDNA detection can predict the rate of relapse or recurrence after treatment, with post-treatment measurement being more effective than baseline assessment. HPV ctDNA could be used as a surrogate or incorporated with other methods for detecting residual disease.

PMID:37492996 | DOI:10.1002/cam4.6377

Birth Defects Res. 2023 Jul 26. doi: 10.1002/bdr2.2225. Online ahead of print.

ABSTRACT

BACKGROUND: Given the lack of a national, population-based birth defects surveillance program in the United States, the National Birth Defects Prevention Network (NBDPN) has facilitated important studies on surveillance, research, and prevention of major birth defects. We sought to summarize NBDPN peer-reviewed publications and their impact.

METHODS: We obtained and reviewed a curated list of 49 NBDPN multistate collaborative publications during 2000-2022, as of December 31, 2022. Each publication was reviewed and classified by type (e.g., risk factor association analysis). Key characteristics of study populations and analytic approaches used, along with publication impact (e.g., number of citations), were tabulated.

RESULTS: NBDPN publications focused on prevalence estimates (N = 17), surveillance methods (N = 11), risk factor associations (N = 10), mortality and other outcomes among affected individuals (N = 6), and descriptive epidemiology of various birth defects (N = 5). The most cited publications were those that reported on prevalence estimates for a spectrum of defects and those that assessed changes in neural tube defects (NTD) prevalence following mandatory folic acid fortification in the United States.

CONCLUSIONS: Results from multistate NBDPN publications have provided critical information not available through other sources, including US prevalence estimates of major birth defects, folic acid fortification and NTD prevention, and improved understanding of defect trends and surveillance efforts. Until a national birth defects surveillance program is established in the United States, NBDPN collaborative publications remain an important resource for investigating birth defects and informing decisions related to health services planning of secondary disabilities prevention and care.

PMID:37492989 | DOI:10.1002/bdr2.2225

J Crohns Colitis. 2023 Jul 26:jjad113. doi: 10.1093/ecco-jcc/jjad113. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: The benefit of continuing 5-aminosalicylic acid [5-ASA] treatment when escalating to advanced therapies in patients with inflammatory bowel disease [IBD] is unclear. Vedolizumab is a gut-selective monoclonal anti-α4β7-integrin antibody used to treat moderate to severe IBD. Clinical trial data were analysed post hoc to assess the impact of 5-ASA co-treatment on vedolizumab efficacy and safety in patients with IBD.

METHODS: Data were analysed from patients aged 18-80 years with moderate to severe ulcerative colitis [UC]/Crohn’s disease [CD] receiving intravenous [IV]/subcutaneous [SC] vedolizumab. Efficacy data were from four studies [GEMINI 1 and 2 and VISIBLE 1 and 2]; safety data were from seven studies [GEMINI 1‒3 and long-term, VISIBLE 1, 2 and open-label extension]. Impact of 5-ASA co-treatment on clinical and endoscopic outcomes at Weeks 6 and 52 was assessed using multivariate analysis (adjusted odds ratios [aORs] with 95% confidence intervals [CIs]).

RESULTS: There were no significant differences in UC clinical remission [Mayo score ≤2, no subscore >1] rates with versus without 5-ASA at Week 6 (20.7% vs 20.4%, respectively; aOR 0.77, 95% CI 0.43-1.38) or at Week 52 (45.1% vs 40.6%; aOR 1.14, 0.70-1.86), and in CD clinical remission [CD activity index score ≤150] rates at Week 6 (41.4% vs 35.1%; 1.26, 0.86-1.85) or at Week 52 (49.6% vs 37.8%; 1.35, 0.91-1.99). Incidence of enteric and all infections in vedolizumab IV/SC-treated patients was low with and without 5-ASA.

CONCLUSION: Continuation of concomitant oral 5-ASA after starting vedolizumab had no significant impact on clinical and endoscopic outcomes.

PMID:37492976 | DOI:10.1093/ecco-jcc/jjad113

Can J Aging. 2023 Jul 26:1-11. doi: 10.1017/S0714980823000314. Online ahead of print.

ABSTRACT

This mixed-methods complementarity study explored family members’, friends’, and health care providers’ perspectives of acceptability of group leisure activities as an intervention for loneliness experienced by older adults living with dementia. A sample of 25 family members, friends, and health care providers of people living with dementia in ON rated the acceptability of group leisure activities (adapted Treatment Perception and Preference questionnaire) and discussed their ratings in an interview. Quantitative (descriptive statistics) and qualitative (conventional content analysis) results were integrated to understand acceptability. Participants viewed group leisure activities as effective, logical, and suitable for use with people living with dementia. Participants described the need for flexible programs, careful facilitation, and attention to activity selection. Group leisure activities were seen as low risk, but stigmas related to dementia could prevent participation. The findings inform the design of acceptable group leisure activities, promoting their use to address loneliness in people living with dementia.

PMID:37492945 | DOI:10.1017/S0714980823000314

Pediatrics. 2023 Jul 26:e2023061513. doi: 10.1542/peds.2023-061513. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess the implementation and effectiveness of the augmented WE CARE social care system on low-income children’s health care utilization and child maltreatment outcomes.

METHODS: We conducted a type 1 hybrid effectiveness-implementation cluster randomized controlled trial at 6 community health centers. Full-term infants were followed from birth to age 3. The 3 experimental clinics implemented the augmented WE CARE system at well-child visits, consisting of a self-report screening instrument for 7 basic needs; an electronic health record-generated resource information referral system; and access to a peer patient navigator. Families at control community health centers received usual care; 1 control site was contaminated and removed from primary analysis. We analyzed results using generalized mixed-effects models.

RESULTS: Overall, 878 children were followed until age 3. Implementation of WE CARE was poor with only 28.9% of visits having a WE CARE screener documented. WE CARE families received significantly more resource referrals than control families (43.1% vs 1.9%, adjusted odds ratio 4.6; 95% confidence interval, 2.0-5.6); 20% were referred to the patient navigator. WE CARE children had significantly higher immunization adherence ratios. Although there were no statistically significant differences with well-child visits, WE CARE children had higher rates of emergency department visits than control children. By age 3, WE CARE children had significantly higher hospitalization rates (14.1% vs 10.4%, adjusted odds ratio 1.3, 95% confidence interval: 1.03-1.7). There were no statistically significant differences with maltreatment outcomes.

CONCLUSIONS: We found poor implementation and mixed benefits for the augmented WE CARE system on immunization, health care utilization, and maltreatment outcomes in early childhood.

PMID:37492934 | DOI:10.1542/peds.2023-061513

Pediatr Allergy Immunol. 2023 Jul;34(7):e13992. doi: 10.1111/pai.13992.

ABSTRACT

BACKGROUND: Polyunsaturated fatty acids (PUFAs) in human milk are essential in immune system maturation and might play a role in the development of allergic conditions, such as atopic dermatitis (AD) in infants. Immune system responses are modulated by sex, but data on the sex-specific associations with PUFAs are limited. We therefore explored sex-specific differences in human milk PUFAs and their association with AD up to 2 years.

METHODS: PUFAs were measured in human milk samples from the Ulm SPATZ Health Study at 6 weeks (n = 512) and 6 months (n = 367). Associations with AD up to 2 years were evaluated using crude and multivariable logistic regression. Interactions between infant sex and PUFAs were explored by including the product term.

RESULTS: No significant associations were observed with 6-week data. At 6 months, the median relative proportion of docosahexaenoic acid (DHA) was significantly higher in milk for female than male infants (p = .001). Female infants whose milk was lower in quintile proportions of alpha-linolenic acid (ALA) at 6 months had lower odds of AD compared to males [first vs. fifth quintile OR (95% confidence interval): 0.13 (0.02, 0.66), p = .02]. This interaction was not significant when correcting for multiple testing (α threshold: p = .004). No other statistically significant associations were observed.

CONCLUSION: Individual quintile PUFA proportions in human milk were not associated with AD, overall and in a sex-specific manner. More comprehensive and statistically powered longitudinal studies are needed to determine whether potential sex differences in human milk, if any, could be of clinical relevance for infants including the investigation of mediating factors.

PMID:37492919 | DOI:10.1111/pai.13992

Pediatr Allergy Immunol. 2023 Jul;34(7):e13998. doi: 10.1111/pai.13998.

ABSTRACT

BACKGROUND: Skin barrier dysfunction is a key component of the pathogenesis of atopic dermatitis (AD). Recent research on barrier optimization to prevent AD has shown mixed results. The aim of this study was to assess the relationship between emollient bathing at 2 months and the trajectory of AD in the first 2 years of life in a large unselected observational birth cohort study.

METHODS: The Babies After SCOPE: Evaluating the Longitudinal Impact Using Neurological and Nutritional Endpoints Birth Cohort study enrolled 2183 infants. Variables extracted from the database related to early skincare, skin barrier function, parental history of atopy, and AD outcomes. Statistical analysis was performed to adjust for potential confounding variables.

RESULTS: One thousand five hundred five children had data on AD status available at 6, 12, and 24 months. Prevalence of AD was 18.6% at 6 months, 15.2% at 12 months, and 16.5% at 24 months. Adjusted for potential confounding variables, the odds of AD at any point were higher among infants who had emollient baths at 2 months (OR (95% CI): 2.41 (1.56 to 3.72), p < .001). Following multivariable analysis, the odds of AD were higher among infants who had both emollient baths and frequent emollient application at 2 months, compared with infants who had neither (OR (95% CI) at 6 months 1.74 (1.18-2.58), p = .038), (OR (95% CI) at 12 months 2.59 (1.69-3.94), p < .001), (OR (95% CI) at 24 months 1.87 (1.21-2.90), p = .009).

CONCLUSION: Early emollient bathing was associated with greater development of AD by 2 years of age in this population-based birth cohort study.

PMID:37492907 | DOI:10.1111/pai.13998