Tag: nevin manimala

Stereotact Funct Neurosurg. 2023 May 16:1-7. doi: 10.1159/000529763. Online ahead of print.

ABSTRACT

INTRODUCTION: Microvascular decompression (MVD) is an efficacious neurosurgical intervention for patients with medically intractable neurovascular compression syndromes. However, MVD may occasionally cause life-threatening or altering complications, particularly in patients unfit for surgical operations. Recent literature suggests a lack of association between chronological age and surgical outcomes for MVD. The Risk Analysis Index (RAI) is a validated frailty tool for surgical populations (both clinical and large database). The present study sought to evaluate the prognostic ability of frailty, as measured by RAI, to predict outcomes for patients undergoing MVD from a large multicenter surgical registry.

METHODS: The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database (2011-2020) was queried using diagnosis/procedure codes for patients undergoing MVD procedures for trigeminal neuralgia (n = 1,211), hemifacial spasm (n = 236), or glossopharyngeal neuralgia (n = 26). The relationship between preoperative frailty (measured by RAI and 5-factor modified frailty index [mFI-5]) for primary endpoint of adverse discharge outcome (AD) was analyzed. AD was defined as discharge to a facility which was not home, hospice, or death within 30 days. Discriminatory accuracy for prediction of AD was assessed by computation of C-statistics (with 95% confidence interval) from receiver operating characteristic (ROC) curve analysis.

RESULTS: Patients undergoing MVD (N = 1,473) were stratified by RAI frailty bins: 71% with RAI 0-20, 28% with RAI 21-30, and 1.2% with RAI 31+. Compared to RAI score 19 and below, RAI 20 and above had significantly higher rates of postoperative major complications (2.8% vs. 1.1%, p = 0.01), Clavien-Dindo grade IV complications (2.8% vs. 0.7%, p = 0.001), and AD (6.1% vs. 1.0%, p < 0.001). The rate of primary endpoint was 2.4% (N = 36) and was positively associated with increasing frailty tier: 1.5% in 0-20, 5.8% in 21-30, and 11.8% in 31+. RAI score demonstrated excellent discriminatory accuracy for primary endpoint in ROC analysis (C-statistic: 0.77, 95% CI: 0.74-0.79) and demonstrated superior discrimination compared to mFI-5 (C-statistic: 0.64, 95% CI: 0.61-0.66) (DeLong pairwise test, p = 0.003).

CONCLUSIONS: This was the first study to link preoperative frailty to worse surgical outcomes after MVD surgery. RAI frailty score predicts AD after MVD with excellent discrimination and holds promise for preoperative counseling and risk stratification of surgical candidates. A risk assessment tool was developed and deployed with a user-friendly calculator: <ext-link ext-link-type=”uri” xlink:href=”https://nsgyfrailtyoutcomeslab.shinyapps.io/microvascularDecompression” xmlns:xlink=”http://www.w3.org/1999/xlink”>https://nsgyfrailtyoutcomeslab.shinyapps.io/microvascularDecompression</ext-link>.

PMID:37232028 | DOI:10.1159/000529763

Stereotact Funct Neurosurg. 2023 May 24:1-10. doi: 10.1159/000530398. Online ahead of print.

ABSTRACT

BACKGROUND: Deep brain stimulation (DBS) is a neurosurgical treatment used for the treatment of movement disorders. Surgical and perioperative complications, although infrequent, can result in clinically significant neurological impairment.

OBJECTIVES: In this study, we evaluated the incidence and risk factors of intracranial bleeding in DBS surgery.

METHOD: Medline, EMBASE, and Cochrane were screened in line with PRISMA 2020 guidelines to capture studies reporting on the incidence of hemorrhagic events in DBS. After removing duplicates, the search yielded 1,510 papers. Abstracts were evaluated by two independent reviewers for relevance. A total of 386 abstracts progressed to the full-text screen and were assessed against eligibility criteria. A total of 151 studies met the criteria and were included in the analysis. Any disagreement between the reviewers was resolved by consensus. Relevant data points were extracted and analyzed in OpenMeta [Analyst] software.

RESULTS: The incidence of intracranial bleeding was 2.5% (95% CI: 2.2-2.8%) per each patient and 1.4% (95% CI: 1.2-1.6%) per each implanted lead. There was no statistically significant difference across implantation targets and clinical indications. Patients who developed an intracranial bleed were on average 5 years older (95% CI: 1.26-13.19), but no difference was observed between the genders (p = 0.891). A nonsignificant trend was observed for a higher risk of bleeding in patients with hypertension (OR: 2.99, 95% CI: 0.97-9.19) (p = 0.056). The use of microelectrode recording did not affect the rate of bleeding (p = 0.79).

CONCLUSIONS: In this review, we find that the rate of bleeding per each implanted lead was 1.4% and that older patients had a higher risk of hemorrhage.

PMID:37232022 | DOI:10.1159/000530398

Pediatr Neurosurg. 2023 May 24. doi: 10.1159/000531210. Online ahead of print.

ABSTRACT

Introduction Subependymal giant cell astrocytoma (SEGA) is the most common CNS tumor in patients with tuberous sclerosis complex (TSC). Although these are benign, their proximity to the foramen of Monroe frequently causes obstructive hydrocephalus, a potentially fatal complication. Open surgical resection has been the mainstay of treatment; however, this can cause significant morbidity. The development of mTOR inhibitors has changed the treatment landscape, but there are limitations to their use. Laser interstitial thermal therapy (LITT) is an emerging treatment modality that has shown promise in treatment of a variety of intracranial lesions, including SEGAs. We present a single institution, retrospective study of patients treated for SEGAs with LITT, open resection, mTOR inhibitors, or a combination of these modalities. The primary study outcome was tumor volume at most recent follow up compared with volume at treatment initiation. The secondary outcome was clinical complications associated with treatment modality. Methods Retrospective chart review was performed to identify patients with SEGAs treated at our institution from 2010-2021. Demographics, treatment information and complications were collected from the medical record. Tumor volumes were calculated from imaging obtained at initiation of treatment and at most recent follow up. Kruskal-Wallis non-parametric testing was used to assess differences in tumor volume and follow up duration between groups. Results Four patients underwent LITT (3 with LITT only), three underwent open surgical resection, and four were treated with mTOR inhibitors only. Mean percent tumor volume reduction for each group was 48.6 ± 13.8, 90.7 ± 39.8, and 67.1 ± 17.2%, respectively. No statistically significant difference was identified comparing percent tumor volume reduction between the three groups (p=0.0513). Additionally, there was no statistically significant difference in follow up duration between groups (p=0.223). Only 1 patient in our series required permanent CSF diversion and 4 discontinued or decreased the dose of mTOR inhibitor due to either cost or side effects. Conclusions Our study suggests that LITT could be considered as a treatment option for SEGAs, as it was effective in reducing tumor volume with very few complications. This modality is less invasive than open resection and may be an alternative for patients who are not candidates for mTOR inhibitors. We recommend an updated paradigm for SEGA treatment which includes LITT in select cases after consideration of patient-specific factors.

PMID:37232001 | DOI:10.1159/000531210

BMJ Open Respir Res. 2023 May;10(1):e001625. doi: 10.1136/bmjresp-2023-001625.

ABSTRACT

BACKGROUND: Krebs von den Lungen-6 (KL-6) is a known biomarker for diagnosis and monitoring of interstitial lung diseases. However, the role of serum KL-6 and the mucin 1 (MUC1) variant (rs4072037) in COVID-19 outcomes remains to be elucidated. We aimed to evaluate the relationships among serum KL-6 levels, critical outcomes and the MUC1 variant in Japanese patients with COVID-19.

METHODS: This is a secondary analysis of a multicentre retrospective study using data from the Japan COVID-19 Task Force collected from February 2020 to November 2021, including 2226 patients with COVID-19 whose serum KL-6 levels were measured. An optimal serum KL-6 level cut-off to predict critical outcomes was determined and used for multivariable logistic regression analysis. Furthermore, the relationship among the allele dosage of the MUC1 variant, calculated from single nucleotide polymorphism typing data of genome-wide association studies using the imputation method, serum KL-6 levels and COVID-19 critical outcomes was evaluated.

RESULTS: Serum KL-6 levels were significantly higher in patients with COVID-19 with critical outcomes (511±442 U/mL) than those without (279±204 U/mL) (p<0.001). Serum KL-6 levels ≥304 U/mL independently predicted critical outcomes (adjusted OR (aOR) 3.47, 95% CI 2.44 to 4.95). Moreover, multivariable logistic regression analysis with age and sex indicated that the MUC1 variant was independently associated with increased serum KL-6 levels (aOR 0.24, 95% CI 0.28 to 0.32) but not significantly associated with critical outcomes (aOR 1.11, 95% CI 0.80 to 1.54).

CONCLUSION: Serum KL-6 levels predicted critical outcomes in Japanese patients with COVID-19 and were associated with the MUC1 variant. Therefore, serum KL-6 level is a potentially useful biomarker of critical COVID-19 outcomes.

PMID:37230764 | DOI:10.1136/bmjresp-2023-001625

RMD Open. 2023 May;9(2):e003120. doi: 10.1136/rmdopen-2023-003120.

ABSTRACT

BACKGROUND: Ongoing education of health professionals in rheumatology (HPR) is critical for high-quality care. An essential factor is education readiness and a high quality of educational offerings. We explored which factors contributed to education readiness and investigated currently offered postgraduate education, including the European Alliance of Associations for Rheumatology (EULAR) offerings.

METHODS AND PARTICIPANTS: We developed an online questionnaire, translated it into 24 languages and distributed it in 30 European countries. We used natural language processing and the Latent Dirichlet Allocation to analyse the qualitative experiences of the participants as well as descriptive statistics and multiple logistic regression to determine factors influencing postgraduate educational readiness. Reporting followed the Checklist for Reporting Results of Internet E-Surveys guideline.

RESULTS: The questionnaire was accessed 3589 times, and 667 complete responses from 34 European countries were recorded. The highest educational needs were ‘professional development’, ‘prevention and lifestyle intervention’. Older age, more working experience in rheumatology and higher education levels were positively associated with higher postgraduate educational readiness. While more than half of the HPR were familiar with EULAR as an association and the respondents reported an increased interest in the content of the educational offerings, the courses and the annual congress were poorly attended due to a lack of awareness, comparatively high costs and language barriers.

CONCLUSIONS: To promote the uptake of EULAR educational offerings, attention is needed to increase awareness among national organisations, offer accessible participation costs, and address language barriers.

PMID:37230762 | DOI:10.1136/rmdopen-2023-003120

J Neurointerv Surg. 2023 May 25:jnis-2023-020241. doi: 10.1136/jnis-2023-020241. Online ahead of print.

ABSTRACT

BACKGROUND: The presence of blebs increases the rupture risk of intracranial aneurysms (IAs).

OBJECTIVE: To evaluate whether cross-sectional bleb formation models can identify aneurysms with focalized enlargement in longitudinal series.

METHODS: Hemodynamic, geometric, and anatomical variables derived from computational fluid dynamics models of 2265 IAs from a cross-sectional dataset were used to train machine learning (ML) models for bleb development. ML algorithms, including logistic regression, random forest, bagging method, support vector machine, and K-nearest neighbors, were validated using an independent cross-sectional dataset of 266 IAs. The models’ ability to identify aneurysms with focalized enlargement was evaluated using a separate longitudinal dataset of 174 IAs. Model performance was quantified by the area under the receiving operating characteristic curve (AUC), the sensitivity and specificity, positive predictive value, negative predictive value, F1 score, balanced accuracy, and misclassification error.

RESULTS: The final model, with three hemodynamic and four geometrical variables, along with aneurysm location and morphology, identified strong inflow jets, non-uniform wall shear stress with high peaks, larger sizes, and elongated shapes as indicators of a higher risk of focal growth over time. The logistic regression model demonstrated the best performance on the longitudinal series, achieving an AUC of 0.9, sensitivity of 85%, specificity of 75%, balanced accuracy of 80%, and a misclassification error of 21%.

CONCLUSIONS: Models trained with cross-sectional data can identify aneurysms prone to future focalized growth with good accuracy. These models could potentially be used as early indicators of future risk in clinical practice.

PMID:37230750 | DOI:10.1136/jnis-2023-020241

Soc Sci Res. 2023 Jul;113:102829. doi: 10.1016/j.ssresearch.2022.102829. Epub 2022 Nov 18.

ABSTRACT

The question of whether economic recessions increase or decrease the earnings gap between the working and upper-middle class is debated. We study this issue and examine the Great Recession period using two different analytical strategies: three-level multilevel models and multivariate analysis over time. Based on EU Statistics on Income and Living Conditions (EU-SILC) data in 23 countries from 2004 to 2017, our results under both analytical strategies provide robust evidence that, by and large, the Great Recession widened the earnings gap between the working and upper-middle class. The effect magnitude is sizable; an increase of 5 percentage points in the unemployment rate is associated with an increase in the class earnings gap of approximately 0.10 log points.

PMID:37230715 | DOI:10.1016/j.ssresearch.2022.102829

J Nutr. 2022 Dec;152(12):2956-2965. doi: 10.1093/jn/nxac195. Epub 2023 Feb 10.

ABSTRACT

BACKGROUND: The fecal metabolome is affected by diet and includes metabolites generated by human and microbial metabolism. Advances in -omics technologies and analytic approaches have allowed researchers to identify metabolites and better utilize large data sets to generate usable information. One promising aspect of these advancements is the ability to determine objective biomarkers of food intake.

OBJECTIVES: We aimed to utilize a multivariate, machine learning approach to identify metabolite biomarkers that accurately predict food intake.

METHODS: Data were aggregated from 5 controlled feeding studies in adults that tested the impact of specific foods (almonds, avocados, broccoli, walnuts, barley, and oats) on the gastrointestinal microbiota. Fecal samples underwent GC-MS metabolomic analysis; 344 metabolites were detected in preintervention samples, whereas 307 metabolites were detected postintervention. After removing metabolites that were only detected in either pre- or postintervention and those undetectable in ≥80% of samples in all study groups, changes in 96 metabolites relative concentrations (treatment postintervention minus preintervention) were utilized in random forest models to 1) examine the relation between food consumption and fecal metabolome changes and 2) rank the fecal metabolites by their predictive power (i.e., feature importance score).

RESULTS: Using the change in relative concentration of 96 fecal metabolites, 6 single-food random forest models for almond, avocado, broccoli, walnuts, whole-grain barley, and whole-grain oats revealed prediction accuracies between 47% and 89%. When comparing foods with one another, almond intake was differentiated from walnut intake with 91% classification accuracy.

CONCLUSIONS: Our findings reveal promise in utilizing fecal metabolites as objective complements to certain self-reported food intake estimates. Future research on other foods at different doses and dietary patterns is needed to identify biomarkers that can be applied in feeding study compliance and clinical settings.

PMID:37230693 | DOI:10.1093/jn/nxac195

J Nutr. 2022 Dec;152(12):2865-2876. doi: 10.1093/jn/nxac230. Epub 2023 Feb 10.

ABSTRACT

BACKGROUND: Two indexes have been used to describe dietary inflammatory potential: the experiment-based dietary total antioxidant capacity (TAC) and the literature-derived dietary inflammatory index (DII). How robustly each index represents dietary inflammatory potential and the risk of nonalcoholic fatty liver disease (NAFLD) has not yet been established.

OBJECTIVES: We investigated the relation between dietary inflammatory potential and NAFLD, and compared the abilities of the TAC and DII scores to predict NAFLD in US adults.

METHODS: Cross-sectional data from 12,410 participants aged 20-80 y in the NHANES from 2011 to 2018 were identified. TAC and DII scores were calculated using 2 d of 24-h dietary recall data. We examined the association between dietary index and risk of NAFLD using linear and logistic regression models.

RESULTS: Higher energy-adjusted TAC (E-TAC) and inversely energy-adjusted DII (IE-DII) scores (both representing more anti-inflammatory diets) were associated with lower hepatic steatosis index (HSI) and US fatty liver index (USFLI) values after adjusting for potential covariates, and the association for each SD increase in the IE-DII was stronger than the E-TAC (β estimates for HSI: -0.39 compared with -0.25; P-difference = 0.036). In modeling the risk of NAFLD, we observed that participants with IE-DII scores in the highest quartile had the lowest ORs for NAFLD as assessed by either the HSI (OR: 0.77; 95% CI: 0.62, 0.96; P-trend = 0.023) or USFLI (OR: 0.48; 95% CI: 0.35, 0.68; P-trend <0.0001). TAC scores were also associated with NAFLD as assessed by the USFLI.

CONCLUSIONS: An anti-inflammatory diet is beneficial for reducing the risk of NAFLD in US adults. The DII is a stronger predictor of hepatic measures than the TAC, and we recommend that future hepatic health studies use the DII to estimate dietary inflammatory potential.

PMID:37230684 | DOI:10.1093/jn/nxac230

J Nutr. 2022 Dec;152(12):2802-2807. doi: 10.1093/jn/nxac187. Epub 2023 Feb 10.

ABSTRACT

BACKGROUND: Nonesterified fatty acids (NEFAs) play key roles in the pathophysiology of diabetes and cardiovascular disease.

OBJECTIVES: We sought to determine whether macronutrient content differences affect NEFA concentrations in a randomized crossover trial.

METHODS: Total NEFAs were measured from postintervention specimens of participants in the OMNI Heart trial (Optimal Macronutrient Intake Trial to Prevent Heart Disease). OMNI Heart compared 3 healthful diets to evaluate their effect on systolic blood pressure and serum LDL cholesterol: carbohydrate-rich diet (58% carbohydrate); protein-rich diet (25% protein), about half from plant sources; and a diet rich in unsaturated fatty acids (21% unsaturated fat), predominantly monounsaturated. The trial included 164 participants who consumed the 3 diets, each for 6 wk. Data were analyzed from the 156 participants with unthawed serum available from the week 6 visit for all diet periods. We used ANCOVA and generalized estimating equations (GEEs) to compare serum NEFA concentrations across the 3 diet periods.

RESULTS: The mean ± SD age of study participants was 52.9 ± 10.6 y and mean BMI was 30.3 ± 6.1 kg/m². Fifty-five percent of participants were women and 55% were African American. Comparisons of adjusted mean serum NEFA concentrations after each diet intervention identified no statistically significant differences (58% carbohydrate: 0.144 ± 0.083 mEq/L; 25% protein: 0.143 ± 0.076 mEq/L; 21% unsaturated fat: 0.143 ± 0.084 mEq/L; ANCOVA, P = 0.99). Likewise, we observed no significant serum NEFA concentration difference by diet in adjusted GEE models. In adjusted models, serum NEFA concentrations were positively associated, as anticipated, with female sex and higher BMI.

CONCLUSIONS: In this randomized crossover trial, we observed nearly identical serum NEFA concentrations after each of 3 healthful diets, regardless of macronutrient content.

PMID:37230677 | DOI:10.1093/jn/nxac187