Am J Obstet Gynecol MFM. 2023 Aug 11:101130. doi: 10.1016/j.ajogmf.2023.101130. Online ahead of print.
NO ABSTRACT
PMID:37574048 | DOI:10.1016/j.ajogmf.2023.101130
Tag: nevin manimala
Am J Obstet Gynecol MFM. 2023 Aug 11:101123. doi: 10.1016/j.ajogmf.2023.101123. Online ahead of print.
ABSTRACT
BACKGROUND: The estimation of fetal weight (EFW) by fetal magnetic resonance imaging (MRI) is a simple and rapid method, with a high sensitivity to predict birthweight (BW) in comparison to ultrasound (US). Several national and international growth charts are currently in use but there is substantial heterogeneity among these charts due to: variations in the selected populations from which they were derived, different methodologies and statistical analysis of data.
OBJECTIVE: The purpose of this study was to compare the performance of MRI and US for the prediction of BW using three commonly used fetal growth charts: INTERGROWTH-21st (IG-21) project, World Health Organization (WHO), and Fetal Medicine Foundation (FMF).
STUDY DESIGN: Data derived from a prospective, single center, blinded cohort study that compared the performance of MRI and US between 36+0/7 to 36+6/7 weeks of gestation (WG) for the prediction of BW ≥ 95th percentile was reanalyzed. EFW were categorized as > or < 5th, > or < 10th, > or < 90th, and > or < 95th percentile according to the three growth charts. BW was similarly categorized according to the BW standards of each chart. The performances of US and MRI for the prediction of BW < 5th, < 10th, > 90th, and > 95th percentile using the different growth charts were compared. Data were analysed with R software version 4.1.2. The comparison of sensitivity and specificity was done by McNemar and exact binomial tests. A p-value < 0.05 was considered as statistically significant.
RESULTS: 2378 women were eligible for final analysis. US and MRI were performed at a median gestational age of 36+3/7 WG, delivery occurred at a median gestational age of 39+3/7 WG, and median BW was 3380 grams. The incidences of BW < 5th and < 10th percentiles were highest with the FMF chart and lowest with the IG-21 chart, whereas the incidences of BW > 90th and > 95th percentiles were lowest with the FMF chart and highest with the IG-21 chart. The sensitivity of MRI with an EFW > 95th percentile in the prediction of BW > 95th percentile was significantly higher than that of US across the three growth charts, however, its specificity was slightly lower than that of US. In contrast, the sensitivity of MRI with an EFW <10th percentile for predicting BW <10th percentile was significantly lower than US in the IG-21 and FMF charts, whereas the specificity and positive predictive value (PPV) of MRI were significantly higher than US for the three charts. Findings for the prediction of BW > 90th percentile were close to those of BW > 95th percentile, and findings for the prediction of BW < 5th percentile were close to those of BW < 10th percentile.
CONCLUSION: The sensitivity of MRI is superior to US for the prediction of large for gestational age (LGA) fetuses and inferior to US for the prediction of small for gestational age (SGA) fetuses across the three different growth charts. The reverse is true for the specificity of MRI in comparison to the specificity of US.
PMID:37574047 | DOI:10.1016/j.ajogmf.2023.101123
Int J Cardiol. 2023 Aug 11:131257. doi: 10.1016/j.ijcard.2023.131257. Online ahead of print.
ABSTRACT
BACKGROUND: Hyperkalemia (HK) is a life-threatening condition that is frequently evaluated by electrocardiogram (ECG). ECG changes in severe HK (≥ 6.3 mEq/L) are not well-characterized. This study sought to compare and correlate ECG metrics in severe HK to baseline normokalemic ECGs and serum potassium.
METHODS: A retrospective analysis of 340 severe HK encounters with corresponding normokalemic ECGs was performed.
RESULTS: Various ECG metrics were analyzed. P wave amplitude in lead II, QRS duration, T wave slope, ratio of T wave amplitude: duration, and ratios of T wave: QRS amplitudes were significantly different between normokalemic and HK ECGs. P wave amplitude attenuation in lead II correlated better with serum potassium than in V1. T wave metrics that incorporated both T wave and QRS amplitudes correlated better than metrics utilizing T wave metrics alone.
CONCLUSION: Multiple statistically significant and quantifiable differences among ECG metrics were observed between normokalemic and HK ECGs and correlated with increasing degrees of serum potassium and along the continuum of serum potassium. When incorporated into a logistic regression model, the ability to distinguish HK versus normokalemia on ECG improved significantly. These findings could be integrated into an ECG acquisition system that can more accurately identify severe HK.
PMID:37574026 | DOI:10.1016/j.ijcard.2023.131257
Clin Gastroenterol Hepatol. 2023 Aug 11:S1542-3565(23)00626-2. doi: 10.1016/j.cgh.2023.08.004. Online ahead of print.
ABSTRACT
BACKGROUND & AIMS: Individual risk prediction of liver-related events (LRE) is needed for the clinical assessment of NAFLD/NASH patients. We aimed at providing point-of-care validated liver stiffness measurement (LSM)-based risk prediction models for the development of LRE in patients with NAFLD, focusing on selecting patients for clinical trials at risk of clinical events.
METHODS: Two large multicenter cohorts were evaluated, 2638 NAFLD patients covering all LSM values as derivation cohort and 679 more advanced patients as validation cohort. We used Cox regression to develop and validate risk prediction models based on LSM alone, and the ANTICIPATE and ANTICIPATE-NASH models for clinically significant portal hypertension. The main outcome of the study was the rate of LRE in the first 3 years after initial assessment.
RESULTS: The 3 predictive models had a similar performance in the derivation cohort with a very high discriminative value (c-statistics 0·87-0·91). In the validation cohort, the LSM-LRE alone model had a significant inferior discrimination (c-statistic 0·75) than the other 2 models, while the ANTICIPATE-NASH-LRE model (0·81) was significantly better than the ANTICIPATE-LRE (0·79). In addition, the ANTICIPATE-NASH-LRE presented a very good calibration in the validation cohort (integrated calibration index 0·016), better than the ANTICIPATE-LRE.
CONCLUSIONS: The ANTICIPATE-LRE models, and especially the ANTICIPATE-NASH-LRE model, could be valuable validated clinical tools to individually assess the risk of LRE at 3 years in patients with NAFLD/NASH.
PMID:37573987 | DOI:10.1016/j.cgh.2023.08.004
Altern Ther Health Med. 2023 Aug 11:AT8583. Online ahead of print.
ABSTRACT
CONTEXT: Peripherally inserted central catheters (PICCs) have a high incidence of catheter occlusion, but research exploring the risk factors for such an occlusion for patients in intensive care units (ICUs) is lacking.
OBJECTIVE: The study intended to examine the impact of multiple risk factors on the occurrence of PICC catheter occlusion to find evidence that can help clinical medical staff identify patients at an early stage who are at high risk of a catheter occlusion.
DESIGN: The research team performed a retrospective, observational clinical study.
SETTING: The study took place at a tertiary general hospital, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University in Wenzhou, China.
PARTICIPANTS: Participants were 300 patients with a PICC who received treatment in the hospital’s adult ICU between January 2019 and April 2022.
GROUPS: According to the time of catheterization, the research team numbered the 1~300 participants and then selected one starting number to divided them into two groups according to the random number table. These two groups were: (1) a training group with 225 participants and (2) validation group with 75 participants.
OUTCOME MEASURES: The main outcome measure was the evaluation of the factors impacting patients who had had a PICC occlusion during catheter retention, including complete and incomplete occlusions, to build a risk prediction model of PICC occlusion. A secondary outcome measure was the occurrence of extubation of the PICC discharge of the ICU patient. The research team performed a univariate analysis of the training group’s data and a multivariate logistic regression analysis of the risk factors. The team: (1) built a risk prediction model of PICC occlusion using the independent risk factors for catheter occlusion for PICC patients in an ICU and (2) used the Hosmer-Lemeshow goodness-of-fit test to test the prediction model. A two tailed using p>0.05 indicated that the model had a good fit. Then, the team applied the model to the validation group and evaluated the model’s predictive ability using a receiver operating characteristic (ROC) curve. The team considered an area under the curve (AUC) >0.5 to have predictive value. The larger the area was, the better the predicted value was. The incidence of PICC occlusion in the training group was 18.22%, including 10 participants with complete occlusion and 31 with partial occlusion. The team used the SPSS 22.0 and R software for statistical analysis.
RESULTS: The univariate analysis showed that 13 factors were associated with PICC occlusion, including: (1) an age ≥65 years (P < .001), a BMI of ≥24 kg/m2 (P < .001), (2) a BMI of ≥24kg/m2 (P = .002), (3) diabetes (P < .001), (4) stroke (P < .001), (5) hypertension (P < .001), (6) malignant tumors (P < .001), (7) a history of deep vein thrombosis (P < .001), (8) limb activity (P < .001), (10) flushing and sealing pipe frequency of Q8h (P = .035), (11) retention time (P < .001), (12) an increased platelet count (P = .036), (13) blood transfusions (P < .001), and (14) intravenous nutrition (P < .001). The independent risk factors for PICC occlusion included: (1) age ≥65 years-OR=1.224, P = .028; (2) BMI ≥24 kg/m2-OR=1.679, P = .004; (3) diabetes-OR=1.343, P = .017; (4) malignant tumors-OR=2.736, P < .001; (5) blood transfusions-OR=1.947, P < .001), and (6) intravenous nutrition-OR=2.021, P < .001. The frequency of flushing and sealing the pipe (Q8h)-OR=-2.145, P = .002-was a protective factor. In the training group, the area under the curve (AUC) for predicting a PICC occlusion was 0.917. The Hosmer-Lemeshow test of the prediction model showed that no significant differences existed in the test results within the model (χ2 = 5.830, P = .666), indicating that the model passed the internal validation. The ideal and calibration curves of the prediction model were highly coincident, and the model was well calibrated. The Hosmer-Lemeshow test of the validation group showed that no significant differences existed in the test results outside the model, suggesting that the model had high consistency.
CONCLUSIONS: Age ≥65 years, BMI ≥24 kg/m2, diabetes, malignant tumors, blood transfusions, and intravenous nutrition were independent risk factors for PICC occlusion, while the frequency of flushing and sealing pipe (Q8h) was a protective factor. This prediction model had an outstanding ability to discriminate in identifying patients with a high-risk of PICC occlusion in the ICU.
PMID:37573601
Altern Ther Health Med. 2023 Aug 11:AT875. Online ahead of print.
ABSTRACT
OBJECTIVE: This study aims to investigate the potential of mustard oil-induced reduction in acetylcholine expression as a means to delay the progression of colon cancer within the internal environment.
METHODS: The study design in this research involved both in vitro cellular experiments and in vivo animal experiments to employ mustard oil to modulate acetylcholine expression levels and evaluate its impact on colon cancer. Cellular experiments involved the introduction of six concentrations of acetylcholine (10-2, 10-3, 10-4, 10-5, 10-6, and 10-7 mol/L) into colon cancer cell cultures to monitor cell proliferation. Animal experiments encompassed the subcutaneous CT26 colon cancer cells implantation into 28 Balb/c mice, divided into experimental and control groups. After tumor establishment, both groups were fed standard diets for two weeks. Serum acetylcholine concentrations were measured from eye blood samples. Additionally, Balb/c mice were inoculated with CT26-derived colon cancer cells and further categorized into experimental and control groups. A total of 14 mice comprised each group, with experimental mice fed mustard oil and control mice fed soybean oil. Post two weeks, serum acetylcholine expression in both groups was assessed. After sacrifice, subcutaneous tumors were excised, and tumor dimensions were measured using a Vernier scale.
RESULTS: Acetylcholine concentration augmentation in the culture medium corresponded to gradual cell proliferation escalation, peaking at 10-5 mol/L, exhibiting statistical significance. Comparative analysis revealed significantly elevated relative acetylcholine expression levels in Balb/c mice with tumor-bearing colon cancers compared to normal Balb/c mice. Experimental group mice exhibited substantially lower serum acetylcholine concentrations than control group mice. Mustard oil administration effectively curtailed acetylcholine expression in normal Balb/c mice, consequently retarding tumor growth. These findings underscore mustard oil’s potential to diminish serum acetylcholine expression, thereby delaying colon cancer progression.
CONCLUSIONS: This study suggests that mustard oil’s modulation of acetylcholine expression within the internal environment holds the potential for impeding colon cancer growth.
PMID:37573596
Altern Ther Health Med. 2023 Aug 11:AT8577. Online ahead of print.
ABSTRACT
OBJECTIVE: To compare the effects of bone grafting versus non-bone grafting on implant stability and new bone formation in patients undergoing maxillary sinus floor lift combined with placement of a Bicon short dental implant.
METHODS: We recruited 60 patients with posterior maxillary tooth loss and insufficient jaw bone mass from December 2017 to December 2019, and the patients were divided into 2 groups in accordance with the surgical method: the bone grafted group (n = 32) and the non-bone grafted group (n = 28). Both groups underwent maxillary sinus floor elevation combined with Bicon short dental implant placement. No bone-grafting materials were used in the non-bone grafted group, and autologous bone chips mixed with Bicon bone substitute were used for bone grafting in the bone grafted group. The 2 groups were compared for their peri-implant index and periodontal bleeding index immediately after the operation, as well as at 3, 6, and 12 months postoperatively. The study also compared the sub-sinus-membrane height, peri-implant bone density, implant stability quotient, and alveolar bone height in the implant area at 3, 6, and 12 months after the operation, as well as the implant survival rate and complications (infection, bleeding, mucosal perforation, sinus-floor cyst, and bone-graft displacement) 12 months after the operation.
RESULTS: The peri-implant index and periodontal bleeding index immediately after the operation in the bone grafted group were higher than those in the non-bone grafted group (all P < .05), but there were no significant differences in the 2 indices between the 2 groups at 3, 6, and 12 months after the operation (all P > .05). The sub-sinus-membrane height, peri-implant bone density, implant stability quotient, and alveolar bone height in the bone grafted area were higher in the bone grafted group than in the non-bone grafted group at 3, 6, and 12 months after the operation (all P < .05). Although the implant survival rate in the bone grafted group was slightly higher than that in the non-bone grafted group at 12 months after the operation, the difference was not statistically significant (P > .05). One case of mucosal perforation occurred in the bone grafted group, but there was no significant difference in the complication rate between the 2 groups (P > .05).
CONCLUSION: The findings of this study support the use of autologous bone chips mixed with Bicon bone substitute in maxillary sinus floor elevation combined with Bicon short dental implant placement for improved implant stability and new bone formation. Further research is needed to evaluate long-term outcomes and potential complications associated with this technique.
PMID:37573595
J Appl Clin Med Phys. 2023 Aug 13:e14114. doi: 10.1002/acm2.14114. Online ahead of print.
ABSTRACT
BACKGROUND: Whereas filtered back projection algorithms for voxel-based CT image reconstruction have noise properties defined by the filter, iterative algorithms must stop at some point in their convergence and do not necessarily produce consistent noise properties for images with different degrees of heterogeneity.
PURPOSE: A least-squares iterative algorithm for proton CT (pCT) image reconstruction converges toward a unique solution for relative stopping power (RSP) that optimally fits the protons. We present a stopping criterion that delivers solutions with the property that correlations of RSP noise between voxels are relatively low. This provides a method to produce pCT images with consistent noise properties useful for proton therapy treatment planning, which relies on summing RSP along lines of voxels. Consistent noise properties will also be useful for future studies of image quality using metrics such as contrast to noise ratio, and to compare RSP noise and dose of pCT with other modalities such as dual-energy CT.
METHODS: With simulated and real images with varying heterogeneity from a prototype clinical proton imaging system, we calculate average RSP correlations between voxel pairs in uniform regions-of-interest versus distance between voxels. We define a parameter r, the remaining distance to the unique solution relative to estimated RSP noise, and our stopping criterion is based on r falling below a chosen value.
RESULTS: We find large correlations between voxels for larger values of r, and anticorrelations for smaller values. For r in the range of 0.5-1, voxels are relatively uncorrelated, and compared to smaller values of r have lower noise with only slight loss of spatial resolution.
CONCLUSIONS: Iterative algorithms not using a specific metric or rationale for stopping iterations may produce images with an unknown and arbitrary level of convergence or smoothing. We resolve this issue by stopping iterations of a least-squares iterative algorithm when r reaches the range of 0.5-1. This defines a pCT image reconstruction method with consistent statistical properties optimal for clinical use, including for treatment planning with pCT images.
PMID:37573575 | DOI:10.1002/acm2.14114
Eur J Orthop Surg Traumatol. 2023 Aug 13. doi: 10.1007/s00590-023-03679-8. Online ahead of print.
ABSTRACT
OBJECTIVE: This study aimed to compare radiological and functional outcomes and complication rates between intramedullary nailing (IMN) and plate fixation for diaphyseal forearm fractures in adolescents via an age-matched analysis.
METHODS: Data were collected from medical records at 11 hospitals from 2009 to 2019, and the age-matched study was conducted between IMN and plate fixation. Functional outcomes, radiographic outcomes, and postoperative complication rates were compared.
RESULTS: The IMN group (Group N) and plate fixation group (Group P) each comprised 26 patients after age matching. The mean age after matching was 13.42 years old. Bone maturities at the wrist of the radius and ulna were not significantly different between the two groups (p = 0.764 and p = 1). At the last follow-up period, functional outcomes using the Price criteria were over 90% in both groups, and the rotational range of motion was comparable to that of the healthy side. Over 70% of cases in Group N were performed by closed reduction, and operation time was half that of Group P. Postoperative neurological symptoms and refractures were more common in Group P than in Group N, although not statistically significantly so.
CONCLUSIONS: Treatment outcomes for age-matched adolescent diaphyseal forearm fractures were excellent with IMN, as well as with plate fixation in many cases despite fewer complications, better cosmesis, and shorter operative times with IMN. IMN for diaphyseal forearm fractures is a useful treatment option even in adolescents although the indications for the best procedure to perform should be considered depending on individual patient needs.
LEVEL OF EVIDENCE IV: Multicenter retrospective study.
PMID:37573542 | DOI:10.1007/s00590-023-03679-8
Spine Deform. 2023 Aug 13. doi: 10.1007/s43390-023-00748-0. Online ahead of print.
NO ABSTRACT
PMID:37573537 | DOI:10.1007/s43390-023-00748-0