Tag: nevin manimala

Am J Clin Nutr. 2023 Jun 13:S0002-9165(23)65969-6. doi: 10.1016/j.ajcnut.2023.06.007. Online ahead of print.

ABSTRACT

BACKGROUND: Diets dense in fruits and vegetables are associated with a reduced risk of preeclampsia, but pathways underlying this relationship are unclear. Dietary antioxidants may contribute to the protective effect.

OBJECTIVE: We determined the extent to which the effect of dietary fruit and vegetable density on preeclampsia is due to high intakes of dietary vitamin C and carotenoids.

DESIGN: We used data from 7572 participants in the Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be (8 US medical centers, 2010‒2013). Usual daily periconceptional intake of total fruits and total vegetables was estimated from a food frequency questionnaire. We estimated the indirect effect of ≥2.5 cups/1000 kcal of fruits and vegetables through vitamin C and carotenoid on the risk of preeclampsia. We estimated these effects using targeted maximum likelihood estimation and an ensemble of machine learning algorithms, adjusting for confounders including other dietary components and health behaviors, and psychological, neighborhood, and sociodemographic factors.

RESULTS: Participants who consumed ≥2.5 cups of fruits and vegetables per 1000 kcal were less likely than those who consumed <2.5 cups/1000 kcal to develop preeclampsia (6.4% versus 8.6%). After confounder adjustment, we observed that higher fruit and vegetable density was associated with 2 fewer cases of preeclampsia (risk difference -2.0, 95% CI -3.9, -0.1) per 100 pregnancies compared with lower density diets. High dietary vitamin C and carotenoid intake was not associated with preeclampsia. The protective effect of high fruit and vegetable density on the risk of preeclampsia and late-onset preeclampsia were not mediated through dietary vitamin C and carotenoids CONCLUSIONS: Evaluating other nutrients and bioactives in fruits and vegetables and their synergy is worthwhile, along with characterizing the effect of individual fruits or vegetables on preeclampsia risk.

PMID:37321543 | DOI:10.1016/j.ajcnut.2023.06.007

Transfus Clin Biol. 2023 Jun 13:S1246-7820(23)00066-6. doi: 10.1016/j.tracli.2023.06.001. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the influence of restrictive and liberal red blood cell suspension (RBCs) transfusions on the prognosis of premature infants and to analyze the influencing factors to provide a reference for the transfusion strategy of preterm infants.

METHODS: Retrospective analysis was conducted on 85 cases of anemic premature infants treated in our center, including 63 cases in the restrictive transfusion group and 22 in the liberal transfusion group.

RESULTS: RBCs transfusions were effective in both groups, and there were no statistically significant differences in post-transfusion hemoglobin and hematocrit between the two groups (P>0.05). The outcome events: the duration of ventilatory support was statistically prolonger in the restrictive group compared with the liberal group (P<0.001); however, the differences in mortality, the increased weight before discharge, and length of stay in the hospital within the two groups were not statistically significant (P=0.237, 0.36 and 0.771, respectively). Univariate survival analysis showed that age, birth weight, Apgar 1 min and Apgar 10 min scores were the influencing factors for death, with P values of 0.035, 0.004, <0.001, and 0.013, respectively; COX regression analysis showed that Apgar 1 min score was an independent factor of the survival time of preterm infants (P=0.002).

CONCLUSION: Compared with the restrictive transfusion group, liberal transfusion patients presented a shorter duration of ventilatory support, which is more beneficial to the prognosis of premature infants.

PMID:37321534 | DOI:10.1016/j.tracli.2023.06.001

J Arthroplasty. 2023 Jun 13:S0883-5403(23)00567-3. doi: 10.1016/j.arth.2023.05.044. Online ahead of print.

ABSTRACT

BACKGROUND: Anterior quadratus lumborum block (AQLB) is one of the compartment blocks and has recently attracted attention as a new method of analgesia for postoperative hip surgery analgesia. This study aimed to compare the analgesic efficacy of AQLB in patients undergoing primary THA.

METHODS: There were 120 patients undergoing primary THA under general anesthesia randomly allocated to receive a femoral nerve block (FNB) or an AQLB. The primary outcome was total morphine consumption over the initial 24-hour postoperative period. Secondary outcomes included the pain score evaluation while at rest and during active and passive motion over the two days following surgery and the manual muscle testing of the quadriceps femoris. The numerical rating scale (NRS) score was used for evaluating the postoperative pain score.

RESULTS: There were no significant differences between the two groups concerning morphine consumption within 24 hours after surgery (P = 0.72). The NRS score at rest and passive motion were similar at all time points (P > .05). However, there was a statistically significant difference in pain reported during the active motion for the FNB group compared to the AQLB (P = 0.04). No significant differences were found between the two groups concerning muscle weakness incidence.

CONCLUSION: Both AQLB and FNB demonstrated adequate efficacy for postoperative analgesia at rest in THA. However, based on our study, whether AQLB is inferior or non-inferior to FNB as an analgesic method for THA was inconclusive.

PMID:37321519 | DOI:10.1016/j.arth.2023.05.044

J Allergy Clin Immunol Pract. 2023 Jun 13:S2213-2198(23)00655-4. doi: 10.1016/j.jaip.2023.06.011. Online ahead of print.

ABSTRACT

BACKGROUND: Little is known regarding the impact of race, ethnicity, and socioeconomic status on the health outcomes of children with Eosinophilic esophagitis (EoE).

OBJECTIVE: To 1) identify demographic characteristics of children diagnosed with EoE in a large tertiary care center, and 2) determine associations between a patient’s demographics and depth of evaluation or treatment choices.

METHODS: This retrospective cohort study included children 0-18 years old seen in Children’s Hospital Colorado between January 1, 2009 and December 31, 2020. Demographics were extracted from the electronic medical record. Rural-Urban Commuting Area taxonomy codes were used to classify urbanization. Area Deprivation Index (ADI) scores were used to categorize neighborhood advantage/disadvantage. Data were analyzed using descriptive statistics and regression analysis.

RESULTS: The study included 2,117 children with EoE. Children with higher state ADI scores (greater neighborhood disadvantage) had less radiographic evaluation of their disease (OR (95% CI) per unit increase in state ADI = 0.93 (0.89, 0.97), p=.0002) and had esophageal dilations at younger ages (r = -0.24, p=.007). Black children when compared to White children were younger at diagnosis (8.3 versus 10.0 years, p=.002). Children from rural areas were seen less by feeding therapy (3.9% versus 9.9%, p=.02) but were younger at their visits (2.3 versus 4.3 years old, p<.001).

CONCLUSION: In this study of children with EoE cared for in a large tertiary care center, we found differences in presentation and care depending on race, urbanization, and socioeconomic status.

PMID:37321391 | DOI:10.1016/j.jaip.2023.06.011

Magn Reson Imaging. 2023 Jun 13:S0730-725X(23)00100-5. doi: 10.1016/j.mri.2023.06.005. Online ahead of print.

ABSTRACT

Chemical exchange saturated transfer (CEST) MRI has biomarker potential to assess tissue microenvironment in brain tumors. Multi-pool Lorentzian or spinlock models provides useful insights into the CEST contrast mechanism. However, T₁ contribution to the complex overlapping effects of brain tumors is difficult under the non-equilibrium state. Therefore, this study evaluated T₁ contributions on multi-pool parameters with quasi-steady-state (QUASS) algorithm reconstructed equilibrium data. MRI scans were performed in rat brain tumor models, including relaxation, diffusion, and CEST imaging. A pixel-wise seven-pool spinlock-model was employed to fit QUASS reconstructed CEST Z-spectra and evaluated the magnetization transfer (MT), amide, amine, guanidyl, and nuclear-overhauled effect (NOE) signals in tumor and normal tissues. In addition, T₁ was estimated from the spinlock-model fitting and compared with measured T₁. We observed tumor had a statistically significant increase in the amide signal (p < 0.001) and decreases in the MT and NOE signals (p < 0.001). On the other hand, the differences in amine and guanidyl between the tumor and contralateral normal regions were not statistically significant. The differences between measured and estimated T₁ values were 8% in the normal tissue and 4% in the tumor. Furthermore, the isolated MT signal strongly correlated with R₁ (r = 0.96, P < 0.001). In summary, we successfully unraveled multi-factorial effects in the CEST signal using spinlock-model fitting and QUASS method and demonstrated the effect of T₁ relaxation on MT and NOE.

PMID:37321379 | DOI:10.1016/j.mri.2023.06.005

Magn Reson Imaging. 2023 Jun 13:S0730-725X(23)00101-7. doi: 10.1016/j.mri.2023.06.003. Online ahead of print.

ABSTRACT

New or enlarged lesions in malignant gliomas after surgery and chemoradiation can be associated with tumor recurrence or treatment effect. Due to similar radiographic characteristics, conventional-and even some advanced MRI techniques-are limited in distinguishing these two pathologies. Amide proton transfer-weighted (APTw) MRI, a protein-based molecular imaging technique that does not require the administration of any exogenous contrast agent, was recently introduced into the clinical setting. In this study, we evaluated and compared the diagnostic performances of APTw MRI with several non-contrast-enhanced MRI sequences, such as diffusion-weighted imaging, susceptibility-weighted imaging, and pseudo-continuous arterial spin labeling. Thirty-nine scans from 28 glioma patients were obtained on a 3 T MRI scanner. A histogram analysis approach was employed to extract parameters from each tumor area. Statistically significant parameters (P < 0.05) were selected to train multivariate logistic regression models to evaluate the performance of MRI sequences. Multiple histogram parameters, particularly from APTw and pseudo-continuous arterial spin labeling images, demonstrated significant differences between treatment effect and recurrent tumor. The regression model trained on the combination of all significant histogram parameters achieved the best result (area under the curve = 0.89). We found that APTw images added value to other advanced MR images for the differentiation of treatment effect and tumor recurrence.

PMID:37321378 | DOI:10.1016/j.mri.2023.06.003

Exp Eye Res. 2023 Jun 13:109541. doi: 10.1016/j.exer.2023.109541. Online ahead of print.

ABSTRACT

Ocular diseases and treatment related to rhegmatogenous retinal detachment (RRD) are highly correlated with retinal adhesion behavior. Therefore, this paper proposes to study the adhesion behavior of the intact retina. This can provide theoretical guidance for the treatment and research of retinal detachment (RD) related diseases. To systematically analyze this aspect, two experiments were performed on the porcine retina. The pull-off test combined with the modified JKR theory was used to study the adhesion behavior of the vitreoretinal interface, while the peeling test was used to study the adhesion behavior of the chorioretinal interface. In addition, the adhesion phase involved in the pull-off test was simulated and analyzed by building the corresponding finite element method (FEM). The experimental results of adhesion force on the vitreoretinal interface were obtained by pull-off test with five sizes of rigid punch. The experimental value of the pull-off force F_PO tends to increase gradually with increasing punch radius in the range of 0.5-4 mm. A comparison of the experimental results with the simulation results shows that they are in a well agreement. And there is no statistical difference between the experimental and theoretical values of the pull-off force F_PO. In addition, the values of retinal adhesion work were also obtained by pull-off test. Interestingly, there is a significant scale effect of the retinal work of adhesion. Finally, the peeling test gave a maximum peeling strength T_Max of about 13 mN/mm and a stable peeling strength T_D of about 11 mN/mm between the retina and the choroid. The pull-off test well shows the process of retinal traction by the diseased vitreous at the beginning of RRD. A comparison of the experimental results with the finite element results verifies the accuracy of the simulation. The peeling test well investigated the adhesion behavior between the retina and the choroid and obtained key biomechanical data (peeling strength, etc.). The combination of the two experiments allows a more systematic study of the whole retina. This research can provide more complete material parameters for finite element modeling of retina-related diseases, and it also can provide the theoretical guidance for individualized design of retinal repair surgery.

PMID:37321365 | DOI:10.1016/j.exer.2023.109541

Vasc Endovascular Surg. 2023 Jun 15:15385744231184654. doi: 10.1177/15385744231184654. Online ahead of print.

ABSTRACT

OBJECTIVES: The present study aimed to compare the effects of medical therapy (MT), systemic thrombolysis (ST), and pharmacomechanical thrombolysis (PMT) methods used in our clinic for the treatment of deep venous thrombosis (DVT) on symptom reduction, the incidence of post-thrombotic syndrome (PTS) development, and quality of life.

METHODS: Data from160 patients diagnosed with acute DVT between January 2012 and May 2021 and treated and followed up in our clinic were retrospectively analyzed. The patients were divided into three groups according to treatment method. The patients who received MT treatment were defined as Group 1, anticoagulant treatment after ST as Group 2, and anticoagulant treatment after PMT as Group 3. The patients were called to the outpatient clinic, informed consent was obtained, EuroQol-5D-3 L (EQ-5D-3 L) scoring and Villalta scoring were performed, and anamnesis was taken.

RESULTS: A total of 160 patients were included, with 71 (44.4%) patients in Group 1, 45 (28.1%) in Group 2, and 44 (27.5%) in Group 3. The mean age was 48.9 ± 14.9 years for Group 1, 42.2 ± 10.8 for Group 2, and 29.0 ± 7.2 for Group 3. When the time to return to normal life and the EQ-5D-3 L score index were compared, the differences between Groups 1 and 2 and between Groups 1 and 3 were statistically significant (P = .000 and P = .000, respectively). However, the differences between Groups 2 and 3 were statistically insignificant (P = .213 andp = .074, respectively). When Villalta scores and EQ Visual Analogue Scale (EQ-VAS) scores were compared between groups, the difference between all groups was statistically significant (P = .000).

CONCLUSIONS: The medical treatment alone was observed to be insufficient in terms of symptomatic improvement, development of PTS, quality of life, and long-term complications. When the ST and PMT groups were compared, it was determined that PMT treatment was more advantageous in terms of EQ-VAS score and PTS development, although there was no statistical difference regarding complications, such as return to normal life and long-term quality of life, the incidence of recurrent DVT development, and pulmonary thromboembolism incidence.

PMID:37321364 | DOI:10.1177/15385744231184654

Can J Cardiol. 2023 Jun 13:S0828-282X(23)00455-5. doi: 10.1016/j.cjca.2023.06.005. Online ahead of print.

ABSTRACT

BACKGROUND: Lipid-rich plaque detected by near-infrared spectroscopy (NIRS) and attenuated plaque detected by intravascular ultrasound (IVUS) predict periprocedural myocardial injury (MI) following percutaneous coronary intervention (PCI). Although echolucent plaque by IVUS was reported to be associated with a no-reflow phenomenon in acute myocardial infarction, it remains unclear whether echolucent plaque is predictive of periprocedural MI following elective PCI. We aimed to elucidate whether echolucent plaque is independently associated with periprocedural MI following elective PCI and whether the predictive ability for periprocedural MI is improved by the combination of NIRS and IVUS.

METHODS: This retrospective study included 121 lesions of 121 patients who underwent elective NIRS-IVUS-guided stent implantation. Periprocedural MI was defined as post-PCI cardiac troponin-T >70 ng/L. Maximum 4-mm lipid core burden index >457 was regarded as lipid-rich plaque. Echolucent plaque and attenuated plaque were defined as the presence of an echolucent zone and an attenuation arc >90° on IVUS, respectively.

RESULTS: Periprocedural MI occurred in 39 lesions. In multivariable analysis, echolucent plaque, attenuated plaque, and lipid-rich plaque were independent predictors of periprocedural MI. Adding echolucent plaque and attenuated plaque to lipid-rich plaque improved the predictive performance (C-statistics: 0.825 vs. 0.688; p=0.001). Periprocedural MI increased with the number of predictors (3% [1/39], 29% [10/34], 47% [14/30], and 78% [14/18] for 0, 1, 2, and 3 predictors, respectively; p<0.001).

CONCLUSIONS: Echolucent plaque is a major predictor of periprocedural MI, independent of lipid-rich plaque and attenuated plaque. Compared with NIRS alone, the combination of NIRS with IVUS signatures improves the predictive ability.

PMID:37321347 | DOI:10.1016/j.cjca.2023.06.005

J Dent. 2023 Jun 13:104582. doi: 10.1016/j.jdent.2023.104582. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate the efficiency and accuracy of a deep learning-based automatic segmentation method for zygomatic bones from cone-beam computed tomography (CBCT) images.

METHODS: One hundred thirty CBCT scans were included and randomly divided into three subsets (training, validation, and test) in a 6:2:2 ratio. A deep learning-based model was developed, and it included a classification network and a segmentation network, where an edge supervision module was added to increase the attention of the edges of zygomatic bones. Attention maps were generated by the Grad-CAM and Guided Grad-CAM algorithms to improve the interpretability of the model. The performance of the model was then compared with that of four dentists on 10 CBCT scans from the test dataset. A p value <.05 was considered statistically significant.

RESULTS: The accuracy of the classification network was 99.64%. The Dice coefficient (Dice) of the deep learning-based model for the test dataset was 92.34 ± 2.04%, the average surface distance (ASD) was 0.1 ± 0.15 mm, and the 95% Hausdorff distance (HD) was 0.98 ± 0.42 mm. The model required 17.03 seconds on average to segment zygomatic bones, whereas this task took 49.3 minutes for dentists to complete. The Dice score of the model for the 10 CBCT scans was 93.2 ± 1.3%, while that of the dentists was 90.37 ± 3.32%.

CONCLUSIONS: The proposed deep learning-based model could segment zygomatic bones with high accuracy and efficiency compared with those of dentists.

CLINICAL SIGNIFICANCE: The proposed automatic segmentation model for zygomatic bone could generate an accurate 3D model for the preoperative digital planning of zygoma reconstruction, orbital surgery, zygomatic implant surgery, and orthodontics.

PMID:37321334 | DOI:10.1016/j.jdent.2023.104582