Tag: nevin manimala

Ultrasound Med Biol. 2023 Jun 17:S0301-5629(23)00140-0. doi: 10.1016/j.ultrasmedbio.2023.04.013. Online ahead of print.

ABSTRACT

This study was aimed at analyzing the effectiveness of ultrasonography (US) and ultrasound elastography (UE) in evaluating longitudinal sliding and stiffness of nerves. In line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, we analyzed 1112 publications (range: 2010-2021) extracted from MEDLINE, Scopus and Web of Science focusing on specific outcomes, including shear wave velocity (m/s), shear modulus (kPa), strain ratio (SR) and excursion (mm). Thirty-three papers were included and evaluated for overall quality and risk of bias. From the analysis of data concerning 1435 participants, mean shear wave velocity (SWV) in the sciatic nerve was 6.70 ± 1.26 m/s in controls and 7.51 ± 1.73 m/s in participants presenting with leg pain; in the tibial nerve, mean SWV was 3.83 ± 0.33 m/s in controls and 3.42 ± 3.53 m/s in participants presenting with diabetic peripheral neuropathy (DPN). The mean shear modulus (SM) was 20.9 ± 9.33 kPa for sciatic nerve, whereas it was an average of 23.3 ± 7.20 kPa for the tibial nerve. Considering 146 subjects (78 experimental, 68 controls) no significant difference was observed in SWV when comparing participants with DPN with controls (standard mean difference [SMD]: 1.26, 95% confidence interval [CI]: 0.54, 1.97), whereas a significant difference was observed in the SM (SMD: 1.78, 95% CI: 1.32, 2.25); furthermore, we found significant differences between left and right extremity nerves (SMD:1.14. 95% CI: 0.45, 1.83) among 458 participants (270 with DPN and 188 controls). No descriptive statistics are available for excursion because of the variability in participants and limb positions, whereas SR is considered only a semiquantitative outcome and therefore not comparable among different studies. Despite the presence of some limitations in study designs and methodological biases, on the basis of our findings, we can conclude that US and UE are effective methods in assessing longitudinal sliding and stiffness of lower extremity nerves in both symptomatic and asymptomatic subjects.

PMID:37331920 | DOI:10.1016/j.ultrasmedbio.2023.04.013

Vet Anaesth Analg. 2023 May 24:S1467-2987(23)00084-3. doi: 10.1016/j.vaa.2023.05.003. Online ahead of print.

ABSTRACT

OBJECTIVE: To describe the gross and ultrasound anatomy of the parasacral region and an ultrasound-guided greater ischiatic notch (GIN) plane approach aimed at staining the lumbosacral trunk (LST) in canine cadavers. To evaluate if the ultrasound-guided GIN plane approach is non-inferior to the previously described ultrasound-guided parasacral approach at staining the LST.

STUDY DESIGN: Prospective, randomized, non-inferiority experimental anatomic study.

ANIMALS: A total of 17 (23.9 ± 5.2 kg) mesocephalic canine cadavers.

METHODS: Anatomic and echographic landmarks, and the feasibility of performing a GIN plane technique were evaluated using two canine cadavers. The remaining 15 cadavers had each hemipelvis randomly assigned to be administered either parasacral or GIN plane injection of 0.15 mL kg^-1 dye solution. The parasacral region was dissected after injections to assess the staining of LST, cranial gluteal nerve, pararectal fossa and pelvic cavity. The stained LST were removed and processed for histological evaluation of intraneural injections. A one-sided z-test for non-inferiority (non-inferiority margin -14%) was used to statistically evaluate the success of the GIN plane versus the parasacral approach. Data were considered statistically significant when p < 0.05.

RESULTS: The GIN plane and parasacral approach stained the LST in 100% and 93.3% of the injections, respectively. The success rate difference between treatments was 6.7% [95% confidence interval, -0.6 to 19.0%; p < 0.001 for non-inferiority]. The GIN plane and parasacral injections stained the LST for 32.7 ± 16.8 mm and 43.1 ± 24.3 mm, respectively (p = 0.18). No evidence of intraneural injection was found.

CONCLUSIONS AND CLINICAL RELEVANCE: The ultrasound-guided GIN plane technique resulted in nerve staining that was non-inferior to the parasacral technique and may be considered an alternative to the parasacral approach to block the LST in dogs.

PMID:37331905 | DOI:10.1016/j.vaa.2023.05.003

Reprod Biomed Online. 2023 Mar 15:S1472-6483(23)00161-X. doi: 10.1016/j.rbmo.2023.03.008. Online ahead of print.

ABSTRACT

RESEARCH QUESTION: Does the time interval between oocyte retrieval and frozen embryo transfer (FET) affect pregnancy outcomes after a freeze-all strategy?

DESIGN: Retrospective study including a total of 5995 patients who underwent their first FET following a freeze-all cycle between 1 January 2017 and 31 December 2020. Patients were divided into immediate (the interval between oocyte retrieval and the day of first FET ≤40 days), delayed (>40 days but ≤180 days) and overdue groups (>180 days). Pregnancy and neonatal outcomes were analysed, and multivariable regression analysis was used to study the effect of FET timing on the live birth rate (LBR) in the entire cohort and the different subgroups.

RESULTS: The LBR was significantly lower in the overdue group than in the delayed group (34.9% versus 42.8%, P = 0.002); however, after adjusting for confounding factors, the difference was not statistically significant. The immediate group had a comparable LBR (36.9%) to the other two groups in both the crude and adjusted analyses. Multivariable regression analysis showed no impact of FET timing on LBR in the whole cohort or in the subgroups according to ovarian stimulation protocol, trigger type, insemination method, reason for freezing all, FET protocol or transferred embryo stage.

CONCLUSIONS: The time interval between oocyte retrieval and FET does not impact reproductive outcomes. Unnecessary delays in FET should be avoided to shorten the time to live birth.

PMID:37331893 | DOI:10.1016/j.rbmo.2023.03.008

Schizophr Res. 2023 Jun 16:S0920-9964(23)00219-0. doi: 10.1016/j.schres.2023.06.002. Online ahead of print.

ABSTRACT

BACKGROUND: In the last two decades, much neuroscientific research has been done on the pathomechanisms of catatonia. However, catatonic symptoms have mainly been assessed with clinical rating scales based on observer ratings. Although catatonia is often associated with strong affective reactions, the subjective domain of catatonia has simply been neglected in scientific research.

METHODS: The main objective of this study was to modify, extend and translate the original German version of the Northoff Scale for Subjective Experience in Catatonia (NSSC) and to examine its preliminary validity and reliability. Data were collected from 28 patients diagnosed with catatonia associated with another mental disorder (6A40) according to ICD-11. Descriptive statistics, correlation coefficients, internal consistency and principal component analysis were employed to address preliminary validity and reliability of the NSSC.

RESULTS: NSSC showed high internal consistency (Cronbach’s alpha = 0.92). NSSC total scores were significantly associated with Northoff Catatonia Rating Scale (r = 0.50, p < .01) and Bush Francis Catatonia Rating Scale (r = 0.41, p < .05) thus supporting its concurrent validity. There was no significant association between NSSC total score and Positive and Negative Symptoms Scale total (r = 0.26, p = .09), Brief Psychiatric Rating Scale (r = 0.29, p = .07) and GAF (r = 0.03, p = .43) scores.

CONCLUSION: The extended version of the NSSC consists of 26 items and was developed to assess the subjective experience of catatonia patients. Preliminary validation of the NSSC revealed good psychometric properties. NSSC is a useful tool for everyday clinical work to assess the subjective experience of catatonia patients.

PMID:37331880 | DOI:10.1016/j.schres.2023.06.002

J Dairy Sci. 2023 Jun 16:S0022-0302(23)00350-8. doi: 10.3168/jds.2022-22847. Online ahead of print.

ABSTRACT

Neutral detergent fiber (NDF) is the most commonly reported metric for fiber in dairy cattle nutrition. An empirical method, NDF is defined by the procedure used to measure it. The current definitive method for NDF treated with amylase (aNDF) is AOAC Official Method 2002.04 performed on dried samples ground through the 1-mm screen of a cutting mill with refluxing and then filtration through Gooch crucibles without (AOAC-; reference method) or with (AOAC+) a glass fiber filter filtration aid. Other methods in use include grinding materials through the 1-mm screen of an abrasion mill, using filtration through a Buchner funnel with a glass fiber filter (Buch), and use of the ANKOM system (ANKOM Technology, Macedon, NY) that simultaneously extracts and filters samples through filter bags with larger (F57) or smaller (F58) particle size retentions. Our objective was to compare the AOAC and alternative methods using samples ground through the 1-mm screens of cutting or abrasion mills. Materials analyzed were 2 alfalfa silages, 2 corn silages, dry ground and high-moisture corn grains, mixed grass hay, ryegrass silage, soybean hulls, calf starter, and sugar beet pulp. Samples were run in duplicate in replicate analytical runs performed on different days by experienced technicians. Compared with cutting mill-ground samples, the aNDF% of dry matter results from abrasion mill-ground samples were or tended to be lower for 8 of 11 samples. Method affected aNDF% results for all materials, with method × grind interactions for 6 of 11 samples. For ash-free aNDF% assessed with cutting mill-ground materials, a priori selected contrasts showed that the number of materials for which methods differed or tended to differ from the AOAC methods were 4 (Buch), 8 (F57), and 3 (F58); and 3 for AOAC- versus AOAC+. However, statistically different does not necessarily mean substantially different. For a given feed and grind, a positive value for the absolute difference between the AOAC- mean and an alternative method mean minus 2 times the standard deviation of AOAC- suggests that values for the alternative method fall outside of the range of results likely to be observed for the reference method. The number of observed positive values for materials processed with cutting and abrasion mills, respectively, were 0 and 2 (AOAC+); 2 and 2 (Buch); 8 and 10 (F57); 4 and 7 (F58); and 0 and 4 (AOAC-). With the materials tested, methods in order of agreement with the reference method were Buch, F58, and F57, which often gave lower values. The AOAC+ gave results similar to AOAC-, substantiating it as an allowed modification of AOAC-. Best agreement between the reference method and variant NDF methods was achieved with the 1-mm screen cutting mill grind. The 1-mm abrasion mill grind produced more aNDF% results that were lower than the reference method but with fewer differences when filter particle retention size was smaller. The use of filters that retain finer particles could be explored to improve comparability of variant NDF methods and grinds. Further evaluation with an expanded set of materials is warranted.

PMID:37331877 | DOI:10.3168/jds.2022-22847

Acad Radiol. 2023 Jun 16:S1076-6332(23)00280-5. doi: 10.1016/j.acra.2023.05.025. Online ahead of print.

ABSTRACT

RATIONALE AND OBJECTIVES: To investigate whether machine learning (ML) approaches using breast magnetic resonance imaging (MRI)-derived multiparametric and radiomic features could predict axillary lymph node metastasis (ALNM) in stage I-II triple-negative breast cancer (TNBC).

MATERIALS AND METHODS: Between 2013 and 2019, 86 consecutive patients with TNBC who underwent preoperative MRI and surgery were enrolled and divided into ALNM (N = 27) and non-ALNM (n = 59) groups according to histopathologic results. For multiparametric features, kinetic features using computer-aided diagnosis (CAD), morphologic features, and apparent diffusion coefficient (ADC) values at diffusion-weighted images were evaluated. For extracting radiomic features, three-dimensional segmentation of tumors using T2-weighted images (T2WI) and T1-weighted subtraction images were respectively performed by two radiologists. Each predictive model using three ML algorithms was built using multiparametric features or radiomic features, or both. The diagnostic performances of models were compared using the DeLong method.

RESULTS: Among multiparametric features, non-circumscribed margin, peritumoral edema, larger tumor size, and larger angio-volume at CAD were associated with ALNM in univariate analysis. In multivariate analysis, larger angio-volume was the sole statistically significant predictor for ALNM (odds ratio = 1.33, P = 0.008). Regarding ADC values, there were no significant differences according to ALNM status. The area under the receiver operating characteristic curve for predicting ALNM was 0.74 using multiparametric features, 0.77 using radiomic features from T1-weighted subtraction images, 0.80 using radiomic features from T2WI, and 0.82 using all features.

CONCLUSION: A predictive model incorporating breast MRI-derived multiparametric and radiomic features may be valuable in predicting ALNM preoperatively in patients with TNBC.

PMID:37331865 | DOI:10.1016/j.acra.2023.05.025

Asian J Surg. 2023 Jun 16:S1015-9584(23)00738-8. doi: 10.1016/j.asjsur.2023.05.068. Online ahead of print.

ABSTRACT

OBJECTIVE: Unilateral laminotomy for bilateral decompression (ULBD) has been adopted widely to treat lumbar spinal stenosis (LSS). The objective of the study is to investigate clinical and radiological outcomes of the biportal endoscopic ULBD (BE-ULBD) and uniportal endoscopic ULBD (UE-ULBD).

METHODS: We collected retrospectively 65 patients’ data who met the inclusion criteria (July 2019-June 2021). 33 patients underwent BE-ULBD surgery, and 32 patients underwent the UE-ULBD surgery, and were followed up for at least 1 year. The following preoperative and postoperative outcomes were compared between groups: the visual analog scale (VAS) for pain, the Oswestry disability index (ODI) for nerve function, and modified Macnab criteria for satisfaction, the cross-sectional area of the dural sac (DSCSA), the mean angle of facetectomy.

RESULTS: Age, BMI, gender, levels of involvement and duration of symptoms were not significantly different at baseline in this study. Clinical data showed that postoperative ODI, VAS scores and Modified Macnab Criteria were not statistically different between the two groups. The BE-ULBD group had a shorter operation time than the UE-ULBD group (P < 0.001). Patients in the BE-ULBD group had a larger postoperative expansion of DSCSA expansion postoperatively (85.58 ± 3.16 mm² VS 71.43 ± 3.35 mm², P < 0.001) and a larger contralateral facetectomy angle (63.95 ± 3.34° vs 57.80 ± 3.43°, P < 0.001) compared with patients in the UE-ULBD group. There were no statistical differences in the incidence of postoperative complications between the two groups.

CONCLUSION: Both the BE-ULBD and the UE-ULBD yielded clinical improvement in terms of pain and stenosis symptoms. The BE-ULBD technique has the advantages of the shorter operation time, larger DSCSA expansion and larger contralateral facetectomy angle.

PMID:37331857 | DOI:10.1016/j.asjsur.2023.05.068

J Pediatr Urol. 2023 May 27:S1477-5131(23)00221-8. doi: 10.1016/j.jpurol.2023.05.015. Online ahead of print.

ABSTRACT

BACKGROUND: Decisional conflict surrounding the topic of circumcision in the newborn male is assumed in some parents but has not been quantified or qualified. It is known that parents often base their decision on cultural and social factors and that physician discussions do affect ultimate decision-making. Information on parents’ decision-making surrounding newborn circumcision and ways to mitigate conflict or uncertainty around the decision-making process is needed to better counsel them appropriately.

OBJECTIVES: To identify the presence or absence of decisional conflict in parents-to-be deciding whether or not to circumcise their child as well as to identify determinants of this conflict to direct future educational measures.

STUDY DESIGN: Parents presenting to obstetrics clinic as well as contacted by institutional email were recruited using convenience sampling and completed the validated Decisional Conflict Scale (DCS). A smaller subset of subjects were recruited via institutional email to complete semi-structured interviews regarding the decision-making process and specifically uncertainty regarding the decision. Descriptive statistics and unpaired t tests were used for analysis of survey data. For interview data, an iterative, grounded theory methodology was used.

RESULTS: 173 subjects completed the DCS. 12% of all participants had high decisional conflict. Intuitively, those who had not yet decided whether to circumcise had the highest proportion of high DCS (69%), followed by those who had decided to circumcise (9.3%) and those who had decided not to circumcise (1.7%). 24 subjects were interviewed, and based on their DCS scores and interview responses were classified as low, intermediate and high conflict. Three primary themes emerged delineating the high from low conflict groups. There were notable differences in the feelings of subjects regarding knowledge and feeling informed, the importance of particular values and clarity of the roles of these values in decision-making, and feelings of supported decision-making. These themes were used to create a visual model depicting the individual needs of each decision-maker (Fig. 1).

DISCUSSION: This study highlights the need for decision support for parents that is not only information-based but focuses on values clarity and supported decision-making. This study provides a jumping-off point for creation of shared decision-making tools directed at individual needs. The limitations of this study are a single institution design and homogeneous population, so when designing materials, additional unrecognized needs will likely be identified.

CONCLUSION: A small, but real proportion of parents-to-be experience significant uncertainty around the decision to circumcise their newborn boys. Identified needs of parents include feeling informed, feeling supported and clarification of important values related to the problem.

PMID:37331851 | DOI:10.1016/j.jpurol.2023.05.015

Clin Lymphoma Myeloma Leuk. 2023 May 29:S2152-2650(23)00182-9. doi: 10.1016/j.clml.2023.05.013. Online ahead of print.

ABSTRACT

BACKGROUND: The Follicular lymphoma international prognostic index (FLIPI) risk score and POD24 have previously been shown to have prognostic value in follicular lymphoma (FL), but the extent to which they can inform prognosis at the time of subsequent relapse is uncertain.

PATIENTS AND METHODS: We conducted a longitudinal cohort study of individuals diagnosed with FL between 2004 and 2010 in Alberta, Canada who received front-line therapy and subsequently relapsed. FLIPI covariates were measured prior to the initiation of front-line therapy. Median overall survival (OS), progression-free survival (PFS2), and time to next treatment (TTNT2) were estimated from the time of relapse.

RESULTS: A total of 216 individuals were included. The FLIPI risk score was highly prognostic at the time of relapse for OS (c-statistic = 0.70; HR_{[High vs. Low]} = 7.38; 95% CI: 3.05-17.88), PFS2 (c-statistic = 0.68; HR_{[High vs. Low]} = 5.84; 95% CI: 2.93-11.62) and TTNT2 (c-statistic = 0.68; HR_{[High vs. Low]} = 5.72; 95% CI: 2.87-11.41). POD24 was not prognostic at the time of relapse for either OS, PFS2, or TTNT2 (c-statistic = 0.55).

CONCLUSION: The FLIPI score measured at diagnosis may help with the risk stratification of individuals with relapsed FL.

PMID:37331847 | DOI:10.1016/j.clml.2023.05.013

Urol Oncol. 2023 Jun 16:S1078-1439(23)00160-6. doi: 10.1016/j.urolonc.2023.05.002. Online ahead of print.

ABSTRACT

INTRODUCTION: While surgical management of renal cell carcinoma (RCC) is curative for many patients, others may relapse and could benefit from adjuvant treatments. Immune checkpoint inhibitors (ICI) have been proposed as a potential adjuvant therapy for improving survival in these patients, but the benefit/risk ratio of ICI in the perioperative setting remains unclear.

METHODS: A systematic review and a meta-analysis of phase III trials of perioperative ICI (anti PD1/PD-L1 alone or in combination with anti-CTLA4 agents) in RCC was conducted.

RESULTS: The analysis included results from 4 phase III trials, comprising 3,407 patients. ICI did not show a significant increase in disease-free survival (Hazard Ratio [HR] 0.85; 95% confidence interval [CI] 0.69-1.04; p: 0.11) or overall survival [OS] (HR 0.73; 95% CI 0.40-1.34; p: 0.31). High-grade adverse events were more frequent in the immunotherapy arm (OR 2.65; 95% CI 1.53-4.59; p: <0.001), and high-grade treatment-related adverse events were 8 times more frequent in the experimental arm (OR: 8.07; 95% CI: 3.14-20.75; p: <0.001). Subgroup analyses showed statistically significant differences favoring the experimental arm in females (HR: 0.71; 95 CI 0.55-0.92; p: 0.009), in sarcomatoid differentiation (HR: 0.60 95% CI 0.41-0.89; p: 0.01), and PD-L1 positive tumors (HR HR: 0.74; 95% CI 0.61-0.90; p: 0.003). No significant effect was found in patients according to age, type of nephrectomy (radical vs. partial), and stage (M1 without evidence of disease vs. M0 patients).

CONCLUSION: Our comprehensive meta-analysis generally suggests that immunotherapy does not confer a survival advantage in the perioperative setting for RCC, with the exception of one positive study. While the overall results are not statistically significant, individual patient factors and other variables may play a role in determining who benefits from immunotherapy. Therefore, despite the mixed findings, immunotherapy may still be a viable treatment option for certain patients, and further studies are needed to determine which patient subgroups would be most likely to benefit.

PMID:37331822 | DOI:10.1016/j.urolonc.2023.05.002