Tag: nevin manimala

Liver Int. 2022 Mar 27. doi: 10.1111/liv.15261. Online ahead of print.

ABSTRACT

BACKGROUND & AIMS: We used real-world data to evaluate the efficacy and safety of tenofovir alafenamide (TAF) compared with tenofovir disoproxil fumarate (TDF) in treatment-naïve patients with CHB.

METHODS: We analyzed 2,747 patients with CHB under TAF (n=502) or TDF (n=2,245) treatments. Virological responses (VR: HBV DNA <15 IU/mL), on-treatment ALT normalization, the incidence of HCC, renal function, and lipid profiles were compared between these groups. Propensity score matching of 495 pairs was conducted for these comparisons.

RESULTS: The mean age of the total cohort was 48.6 years and 58.2% of the subjects were male. Cirrhosis had a 33.3% prevalence in the population. VRs at 12-, 24-, and 36 months were achieved in 70.3%, 81.2%, and 83.3% of the TAF and 67.9%, 84.3% and 86.1% in the TDF cases, respectively (P>0.05 for all). Normalized ALT, as determined by local laboratory criteria (<40 U/L), occurred in 79.7%, 90.6%, and 86.2% of TAF the group and 78.2%, 85.8%, and 85.7% of the TDF group at 12-, 24-, and 36 months, respectively (P>0.05 for all). The HCC risk did not statistically differ across the entire cohort or in the PS-matched cohort. The TAF group showed a lower median increase in serum creatinine from baseline during the early study period. Compared with the TAF, the TDF group showed significant decreases in total cholesterol, triglyceride, and HDL, but not in LDL.

CONCLUSIONS: Real-word data indicate that TAF has comparable efficacies to TDF in terms of VR and ALT normalization, with no higher risk of HCC.

PMID:35343041 | DOI:10.1111/liv.15261

J Magn Reson Imaging. 2022 Mar 27. doi: 10.1002/jmri.28174. Online ahead of print.

ABSTRACT

BACKGROUND: Methods for accurate quantification of lung fluid in heart failure (HF) are needed. Dynamic contrast-enhanced (DCE)-MRI may be an appropriate modality.

PURPOSE: DCE-MRI evaluation of fraction of fluid volume in the interstitial lung space (v_e ) and vascular permeability (K^trans ).

STUDY TYPE: Prospective, single-center method validation.

POPULATION: Seventeen evaluable healthy volunteers (HVs), 12 participants with HF, and 3 with acute decompensated HF (ADHF).

FIELD STRENGTH/SEQUENCE: T₁ mapping (spoiled gradient echo variable flip angle acquisition) followed by dynamic series (three-dimensional spoiled gradient-recalled echo acquisitions [constant echo time, repetition time, and flip angle at 1.5 T]).

ASSESSMENT: Three whole-chest scans were acquired: baseline (Session 1), 1-week later (Session 2), following exercise (Session 3). Extended Tofts model quantified v_e and K^trans (voxel-wise basis); total lung median measures were extracted and fitted via repeat measure analysis of variance (ANOVA) model. Patient tolerability of the scanning protocol was assessed.

STATISTICAL TESTS: This was constructed as an experimental medicine study.

PRIMARY ENDPOINTS: K^trans and v_e at baseline (HV vs. HF), change in K^trans and v_e following exercise, and following lung congestion resolution (ADHF). K^trans and v_e were fitted separately using ANOVA. Secondary endpoint: repeatability, that is, within-participant variability in v_e and K^trans between sessions (coefficient of variation estimated via mixed effects model).

RESULTS: There was no significant difference in mean K^trans between HF and HV (P ≤ 0.17): 0.2216 minutes^-1 and 0.2353 minutes^-1 (Session 1), 0.2044 minutes^-1 and 0.2567 minutes^-1 (Session 2), 0.1841 minutes^-1 and 0.2108 minutes^-1 (Session 3), respectively. v_e was greater in the HF group (all scans, P ≤ 0.02). Results were repeatable between Sessions 1 and 2; mean values for HF and HV were 0.4946 and 0.3346 (Session 1), 0.4353 and 0.3205 (Session 2), respectively. There was minimal difference in K^trans or v_e between scans for participants with ADHF (small population precluded significance testing). Scanning was well tolerated.

DATA CONCLUSION: While no differences were detected in K^trans , v_e was greater in chronic HF patients vs. HV, augmented beyond plasma and intracellular volume. DCE-MRI is a valuable diagnostic and physiologic tool to evaluate changes in fluid volume in the interstitial lung space associated with symptomatic HF.

LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY STAGE: 2.

PMID:35343008 | DOI:10.1002/jmri.28174

J Oral Rehabil. 2022 Mar 28. doi: 10.1111/joor.13325. Online ahead of print.

ABSTRACT

OBJECTIVE: The literature on orofacial myofunctional therapy (OMT) in children and adults with obstructive sleep apnea (OSA) was systematically reviewed to investigate the effects of OMT on patients with OSA by age and disease severity to verify the effect of OMT on OSA.

DATA SOURCES: All the comparative literature was retrieved from the PubMed, Embase, and Cochrane libraries.

METHOD: We searched the articles published up to February 12, 2022 and followed the preferred reporting project for systematic review and meta-analysis of reports. The quality of the studies was evaluated using the Newcastle-Ottawa scale.

RESULTS: Of the primary indicators for evaluating OSA, 13 studies reported on the apnea index (AHI), showing a decrease in the mean standard deviation of AHI from before OMT to after OMT (P < 0.00001). The lowest oxygen saturation was reported in nine studies, and the mean standard deviation of the lowest oxygen saturation increased from before to after OMT (P = 0.0009). Ten studies reported the Epworth Sleepiness Scale (ESS), indicating that the mean standard deviation of the ESS decreased from before to after OMT (P < 0.00001). The subgroup analysis showed that the AHI scores indicating mild and moderate OSA were significantly reduced, and the AHI scores indicating severe OSA also decreased, but this was not statistically significant. The lowest oxygen saturation increased obviously in patients with both mild and moderate and severe OSA. Of the secondary indicators of OSA, there was a statistically significant improvement in snoring intensity (P = 0.0002).

CONCLUSION: Oral and facial muscular function therapy can be used as a simple and non-invasive new technique to improve the AHI, minimum oxygen saturation, ESS, and snoring intensity in patients with mild and moderate OSA and the lowest oxygen saturation in patients with severe OSA.

PMID:35342989 | DOI:10.1111/joor.13325

Hippocampus. 2022 Mar 28. doi: 10.1002/hipo.23417. Online ahead of print.

ABSTRACT

Preconditioning is a mechanism in which injuries induced by non-lethal hypoxia or seizures trigger cellular resistance to subsequent events. Norwood et al., in a 2010 study, showed that an 8-h-long period of electrical stimulation of the perforant pathway in rats is required for the induction of hippocampal sclerosis. However, in order to avoid generalized seizures, status epilepticus (SE), and death, a state of resistance to seizures must be induced in the hippocampus by a preconditioning paradigm consisting of two daily 30-min stimulation periods. Due to the importance of the subiculum in the hippocampal formation, this study aims to investigate differential gene expression patterns in the dorsal and ventral subiculum using RNA-sequencing, after induction of a preconditioning protocol by electrical stimulation of the perforant pathway. The dorsal (dSub) and ventral (vSub) subiculum regions were collected by laser-microdissection 24 h after preconditioning protocol induction in rats. RNA sequencing was performed in a Hiseq 4000 platform, reads were aligned using the STAR and DESEq2 statistics package was used to estimate gene expression. We identified 1176 differentially expressed genes comparing control to preconditioned subiculum regions, 204 genes were differentially expressed in dSub and 972 in vSub. The gene ontology enrichment analysis showed that the most significant common enrichment pathway considering up-regulated genes in dSub and vSub was steroid metabolism. In contrast, the most significant enrichment pathway considering down-regulated genes in vSub was axon guidance. Our results indicate that preconditioning induces changes in the expression of genes related to synaptic reorganization, increased cholesterol metabolism, and astrogliosis in both dSub and vSub. Both regions also presented a decrease in the expression of genes related to glutamatergic transmission and an increase in expression of genes related to complement system activation and GABAergic transmission. The down-regulation of proapoptotic and axon guidance genes in the ventral subiculum suggests that preconditioning may induce a neuroprotective environment in this region.

PMID:35343006 | DOI:10.1002/hipo.23417

Echocardiography. 2022 Mar 27. doi: 10.1111/echo.15345. Online ahead of print.

ABSTRACT

BACKGROUND: Little data exist regarding interreader variability of diastolic measurements and their application by the 2016 American Society of Echocardiography left ventricular (LV) diastolic function guidelines.

METHODS: Volunteers (n = 49) were recruited from an outpatient cardiology practice. The presence and grade of diastology dysfunction (DD) was determined by the 2016 LV diastology guideline algorithm. We determined the mean, standard deviation, coefficient of variation, and intraclass correlation coefficient (ICC) for each measurement and Fleiss K-statistic to define differences in grading DD. We determined predictors associated with disagreement of DD grade using odds ratios.

RESULTS: The mean LVEF was 56%, LAVI 32 ml/m² , and peak TR velocity was 2.3 m/s. The ICC for mitral inflow and tissue Doppler velocities were >.90, for LV volumes were .80-.86, and for LA volume was .56. The Fleiss K-value for the agreement of the presence of DD was .68 and for DD grade was .59. Variables with increased odds of disagreement were (1) at least one reader considering a TR signal uninterpretable (OR 12.0; 95% CI 1.3-109.6), (2) at least one reader assessing both LVEF 50%-55% and LAVI 29-39 ml/m² (OR 9.3; 95% CI 1.0-87), and (3) at least one reader assessing LVEF 50-55% (OR 3.8; 95% CI 1.1-13.4).

CONCLUSIONS: Using the 2016 ASE/EACVI diastology guidelines, we found excellent interrater reliability of Doppler measurements, moderate-good interrater reliability of volumetric measurements, and moderate-good but not excellent agreement for diastology grade.

PMID:35342988 | DOI:10.1111/echo.15345

J Oral Rehabil. 2022 Mar 28. doi: 10.1111/joor.13320. Online ahead of print.

ABSTRACT

BACKGROUND: Conflicting results exist between somatosensory profiles of patients with temporomandibular myalgia (TMDm). The objective of this review was to examine whether adults with TMDm show altered responses to dynamic quantitative sensory tests compared with healthy controls.

METHODS: We searched five electronic databases for studies, excluding those without suitable controls or where TMDm was associated with confounding non-musculoskeletal disorders. Risk of bias was assessed with the SIGN case-control study checklist. Findings were structured around dynamic quantitative sensory tests and their localization. Where possible, we performed meta-analysis with a random inverse variance model to compare patients with TMDm and healthy controls. Statistical heterogeneity was estimated with Chi² test and inconsistency index, I².

RESULTS: We extracted data from 23 studies comprising 1284 adults with chronic TMDm and 2791 healthy controls. Risk of bias was assessed as high for 20 studies. Mechanical temporal summation, the most studied phenomenon (14 studies), is increased in the upper limb of patients with TMDm (SMD = .43; 95% CI: .11 to .75; p = .0001) but not in the jaw area (p = .09) or in the cervical area (p = .29). Very little evidence for altered thermal temporal summation (five studies), conditioned pain modulation (seven studies), exercise-induced hypoalgesia (two studies), placebo analgesia (two studies), stress-induced hypoalgesia (one study) and offset analgesia (one study) was found.

DISCUSSION: A major limitation of this review was the risk of bias of included studies. Future studies would benefit from following methodological guidelines and consideration of confounding factors.

PMID:35342987 | DOI:10.1111/joor.13320

Med Phys. 2022 Mar 27. doi: 10.1002/mp.15625. Online ahead of print.

ABSTRACT

PURPOSE: The unpredictable interplay between dynamic proton therapy delivery and target motion in the thorax can lead to severe dose distortions. A fraction-wise four-dimensional (4D) dose reconstruction workflow allows for the assessment of the applied dose after patient treatment while considering the actual beam delivery sequence extracted from machine log files, the recorded breathing pattern and the geometric information from a 4D computed tomography scan (4DCT). Such an algorithm capable of accounting for amplitude-sorted 4DCTs was implemented and its accuracy as well as its sensitivity to input parameter variations was experimentally evaluated.

METHODS: An anthropomorphic thorax phantom with a movable insert containing a target surrogate and a radiochromic film was irradiated with a monoenergetic field for various 1D target motion forms (sin, sin4) and peak-to-peak amplitudes (5/10/15/20/30 mm). The measured characteristic film dose distributions were compared to the respective sections in the 4D reconstructed doses using a 2D γ-analysis (3mm, 3%); γ-pass rates were derived for different dose grid resolutions (1mm/3mm) and deformable image registrations (DIR, automatic/manual) applied during the 4D dose reconstruction process. In an additional analysis, the sensitivity of reconstructed dose distributions against potential asynchronous timing of the motion and machine log files was investigated for both a monoenergetic field and more realistic 4D robustly optimized fields by artificially introduced offsets of ± 1/5/25/50/250 ms. The resulting dose distributions with asynchronized log files were compared to those with synchronized log files by means of a 3D γ-analysis (1mm, 1%) and the evaluation of absolute dose differences.

RESULTS: The induced characteristic interplay patterns on the films were well reproduced by the 4D dose reconstruction with 2D γ-pass rates ≥95% for almost all cases with motion magnitudes ≤15 mm. In general, the 2D γ-pass rates showed a significant decrease for larger motion amplitudes and increase when using a finer dose grid resolution but were not affected by the choice of motion form (sin, sin4). There was also a trend, though not statistically significant, towards the manually defined DIR for better quality of the reconstructed dose distributions in the area imaged by the film. The 4D dose reconstruction results for the monoenergetic as well as the 4D robustly optimized fields were robust against small asynchronies between motion and machine log files of up to 5 ms, which is in the order of potential network latencies.

CONCLUSIONS: We have implemented a 4D log file-based proton dose reconstruction that accounts for amplitude-sorted 4DCTs. Its accuracy was proven to be clinically acceptable for target motion magnitudes of up to 15 mm. Particular attention should be paid to the synchronization of the log file generating systems as the reconstructed dose distribution may vary with log file asynchronies larger than those caused by realistic network delays. This article is protected by copyright. All rights reserved.

PMID:35342943 | DOI:10.1002/mp.15625

Muscle Nerve. 2022 Mar 27. doi: 10.1002/mus.27539. Online ahead of print.

ABSTRACT

INTRODUCTION/AIMS: Guillain-Barré syndrome (GBS) is generally considered to be monophasic, but some patients experience recurrences. The purpose of this study was to clarify the possible link between thyroid parameters and recurrent GBS (RGBS) patients in China.

METHODS: This retrospective study enrolled patients who were admitted to the Department of Neurology of the First Affiliated Hospital of Zhengzhou University from 2014 to 2020 and fulfilled the diagnostic criteria of GBS or Miller Fisher syndrome (MFS). We evaluated clinical characteristics, cerebrospinal fluid (CSF) parameters, serum levels of thyroid-stimulating hormone (TSH), free thyroxine (FT4) and free triiodothyronine (FT3) in 320 individuals, including 302 with monophasic GBS and 18 with recurrent GBS.

RESULTS: Serum levels of TSH in monophasic GBS patients were significantly lower than those in RGBS patients (P<0.001), whereas FT3 levels were higher in the monophasic GBS group (P=0.022). Age at onset, incidence of antecedent illness, time from onset to nadir, proportion of acute inflammatory demyelinating polyradiculoneuropathy (AIDP), and Hughes Functional Grading Scale (HFGS) at nadir were statistically significant between monophasic GBS patients and RGBS patients (P<0.05). The multivariate regression analysis revealed that antecedent illness, AIDP and high TSH were independent risk factors for RGBS. Our ROC curve analysis showed that the risk of recurrence in GBS patients increases when the TSH concentration is higher than 3.87uIU/mL.

DISCUSSION: Our results demonstrate an association between TSH and RGBS. Oxidative stress is one of the possible interpretations for this association.

PMID:35342963 | DOI:10.1002/mus.27539

Eur J Clin Invest. 2022 Mar 28:e13782. doi: 10.1111/eci.13782. Online ahead of print.

ABSTRACT

There are no widely accepted, quantitative definitions for the end of a pandemic like COVID-19. The end of the pandemic due to a new virus and the transition to endemicity may be defined based on a high proportion of the global population having some immunity from natural infection or vaccination. Other considerations include diminished death toll, diminished pressure on health systems, reduced actual and perceived personal risk, removal of restrictive measures, and diminished public attention. A threshold of 70% of the global population having being vaccinated or infected was probably already reached in the second half of 2021. Endemicity may still show major spikes of infections and seasonality, but typically less clinical burden, although some locations are still hit more than others. Death toll and ICU occupancy figures are also consistent with a transition to endemicity by end 2021/early 2022. Personal risk for the vast majority of the global population was already very small by end 2021, but perceived risk may still be grossly over-estimated. Restrictive measures of high stringency have persisted in many countries by early 2022. The gargantuan attention in news media, social media, and even scientific circles should be tempered. Public health officials need to declare the end of the pandemic. Mid- and long-term consequences of epidemic waves and of adopted measures on health, society, economy, civilization, and democracy may perpetuate a pandemic legacy long after the pandemic itself has ended.

PMID:35342941 | DOI:10.1111/eci.13782

J Am Coll Emerg Physicians Open. 2022 Mar 17;3(2):e12705. doi: 10.1002/emp2.12705. eCollection 2022 Apr.

ABSTRACT

OBJECTIVE: Physician Orders for Life-Sustaining Treatment (POLST) forms exist in some form in all 50 states. This study evaluates emergency medical service (EMS) practitioners interpretation of the POLST in cardiopulmonary arrest.

METHODS: This study used a prospective convenience sample of California Bay Area EMS practitioners who reviewed 6 fictional scenarios of patients in cardiopulmonary arrest and accompanying California POLST forms. Based on the cases and POLST, EMS practitioners identified patient preference for “attempt resuscitation,” “do not attempt resuscitation/DNR,” or “unsure” and subsequently selected medical interventions (ie, chest compressions, defibrillation, and so on). They also rated their confidence in POLST use and interpretation.

RESULTS: In scenarios of cardiopulmonary arrest and POLST that indicated do not resuscitate (DNR)/do not attempt resuscitation (DNAR) and full treatment, only 45%-65% of EMS practitioners correctly identified the patient as DNR/DNAR. EMS practitioners were more likely to interpret the POLST correctly in scenarios where patients were DNR/DNAR but indicated selective treatment (86%; 168/196) or comfort-focused treatment (86%; 169/196). In cardiopulmonary arrest scenarios where the patient was correctly identified as DNR/DNAR, EMS practitioners frequently selected defibrillation, advanced airway, or epinephrine as appropriate treatment. For all 6 scenarios, there was no statistical difference in response selection with level of training (emergency medical technician/paramedics) or type of EMS personnel (fire based/private).

CONCLUSION: The POLST is a powerful tool to convey medical treatment preferences; however, there is significant variation in the interpretation and application by EMS practitioners. To improve the POLST effectiveness, the authors suggest more EMS input into POLST development, concise language that defines resuscitation, and more EMS education about clinical application.

PMID:35342899 | PMC:PMC8931303 | DOI:10.1002/emp2.12705