Tag: nevin manimala

Ultrasound Obstet Gynecol. 2023 Mar 27. doi: 10.1002/uog.26206. Online ahead of print.

ABSTRACT

OBJECTIVES: The human umbilical cord normally inserts in the central region of the placental disc. There is conflicting evidence about whether or not peripheral cord insertions (<3.0 cm from the placental edge) are associated with adverse pregnancy outcomes. The relative importance of peripheral cord insertions and pathology within the placenta in mediating adverse outcomes has not been fully established.

METHODS: Sonographic measurement of the cord insertion and detailed placental pathology was performed in 309 participants. Associations between cord insertion site, placental pathology and adverse pregnancy outcomes (preeclampsia, preterm birth, small for gestational age) were examined.

RESULTS: Ninety-three participants (30%) were identified by pathological examination to have a peripheral cord insertion site. Only 41 of the 93 peripheral cords (44%) were detected by prenatal ultrasound. Peripherally inserted cords were associated with diagnostic placental pathology (p<0.0001), most commonly with maternal vascular malperfusion, within which 85% had an adverse pregnancy outcome. In cases of isolated peripheral cords, without placental pathology, the incidence of adverse outcomes was not statistically different compared to those with central cord insertions and no placental pathology (31% vs. 18%, p=0.3). A peripheral cord with an abnormal umbilical artery pulsatility index (UA PI) corresponded to an adverse outcome in 96% of the cases compared to 29% when the UA PI was normal.

CONCLUSIONS: This study demonstrates that peripheral cord insertion often is part of the spectrum of findings of maternal vascular malperfusion disease and is associated with adverse pregnancy outcomes. However, adverse outcomes were uncommon when there was an isolated peripheral cord insertion and no placental pathology. Therefore additional sonographic and biochemical features of maternal vascular malperfusion should be sought when a peripheral cord is observed. This article is protected by copyright. All rights reserved.

PMID:36971026 | DOI:10.1002/uog.26206

Transfusion. 2023 Mar 27. doi: 10.1111/trf.17327. Online ahead of print.

ABSTRACT

OBJECTIVE: The safety of Low Titer Group O Whole Blood (LTOWB) transfusion has not been well-studied in small children.

METHODS: This is a single-center retrospective cohort study of pediatric recipients of RhD- LTOWB (June 2016-October 2022) who weigh less than 20 kilograms. Biochemical markers of hemolysis (lactate dehydrogenase, total bilirubin, haptoglobin, and reticulocyte count) and renal function (creatinine and potassium) were recorded on the day of LTOWB transfusion and post-transfusion days 1 and 2. Group O and non-Group O recipients were compared.

RESULTS: Twenty-one children were included. Their median (IQR) weight was 12 kg (12-18) with minimum 2.8 kg, and median (IQR) age was 3 years (1.75-5.00) with minimum 0.08 years (29 days old). The most common indication for transfusion was trauma (17/21; 81%). The median (IQR) volume of LTOWB transfused was 30 mL/kg (20-42). There were 9 non-group O and 12 group O recipients. There were no statistically significant differences in the median concentrations of any of the biochemical markers of hemolysis or the renal function markers between the non-group O and the group O recipients at any of the three time points (p>0.05 for all comparisons). There were also no statistically significant differences in demographic parameters or clinical outcomes including 28-day mortality, length of stay, ventilator days, and venous thromboembolism between the groups. No transfusion reactions were reported in either group.

CONCLUSION: These data suggest LTOWB use is safe in children weighing less than 20 kg. Further multi-centre studies and larger cohorts are needed to confirm these results.

PMID:36971012 | DOI:10.1111/trf.17327

Scand J Gastroenterol. 2023 Mar 27:1-8. doi: 10.1080/00365521.2023.2194009. Online ahead of print.

ABSTRACT

BACKGROUND: Response evaluation after induction therapy with ustekinumab (UST) in Crohn’s disease (CD) is important for decisions on maintenance therapy. We aimed to assess the potential of fecal calprotectin (FC) levels to predict endoscopic response at week 16.

METHODS: CD patients with FC >100 µg/g and endoscopic active disease (SES-CD> 2, Rutgeerts’ score ≥ i2) at initiation of UST therapy were enrolled. FC was determined at weeks 0, 2, 4, 8 and 16 and patients underwent a colonoscopy at week 16. The primary outcome was an endoscopic response at week 16 (SES-CD score ≥50% decrease or a decrease of ≥1 points in Rutgeerts’ score). The optimal cut-off levels of FC and change in FC to predict endoscopic response were determined using ROC statistics.

RESULTS: 59 CD patients were included. Endoscopic response was observed in 21/59 (36%) patients. The diagnostic accuracy for FC levels at week 8 to predict endoscopic response at week 16 showed a predictive value of 0.71. A decrease in FC levels ≥500 µg/g between baseline at week 8 indicates endoscopic response (PPV = 89%), whereas absence of any decrease indicates endoscopic non-response after induction (NPV = 81%).

CONCLUSIONS: Continuation of UST therapy without endoscopic response evaluation may be considered in patients with a decrease in FC levels of ≥500 µg/g at week 8. The decision on continuation of UST therapy or therapy optimization needs reconsideration in patients without a decrease of FC level. In all other patients, endoscopic response evaluation of induction therapy remains essential for therapeutic decisions.

PMID:36970968 | DOI:10.1080/00365521.2023.2194009

Technol Health Care. 2023 Mar 23. doi: 10.3233/THC-220664. Online ahead of print.

ABSTRACT

BACKGROUND: Gastric cancer (GC) is the fifth most common cancer worldwide and the third leading cause of cancer death. Due to the low rate of early diagnosis, most patients are already in the advanced stage and lose the chance of radical surgery.

OBJECTIVE: To investigate the clinical value of computed tomography (CT) spectral imaging in preoperative evaluation of pathological types of gastric cancer patients.

METHODS: 121 patients with gastric cancer were selected. CT energy spectrum imaging was performed on the patients. The water and iodine concentration of the lesion were measured, and the standardized iodine concentration ratio was calculated. The iodine concentration, iodine concentration ratio and water concentration level of different pathological types were analyzed and compared.

RESULTS: The iodine concentration and iodine concentration ratio of gastric mucinous carcinoma patients in venous phase and parenchymal phase were lower than those of gastric non-mucinous carcinoma patients, and the differences were statistically significant (P< 0.05). The iodine concentration and iodine concentration ratio of patients with mucinous adenocarcinoma in venous phase and parenchymal phase were lower than those of patients with choriocarcinoma, and the differences were statistically significant (P< 0.05). The iodine concentration and iodine concentration ratio of middle and high differentiated adenocarcinoma patients in venous phase and parenchymal phase were lower than those of low differentiated adenocarcinoma patients, and the differences were statistically significant (P< 0.05). However, there was no significant difference in water concentration levels among venous, arterial, and parenchymal phases in all pathological types of gastric cancer patients (P> 0.05).

CONCLUSION: CT spectral imaging plays an important role in the preoperative evaluation of patients with gastric cancer. The pathological types of gastric cancer are different, and the iodine concentration will change accordingly. CT spectral imaging can effectively evaluate the pathological types of gastric cancer and has high clinical application value.

PMID:36970925 | DOI:10.3233/THC-220664

Technol Health Care. 2023 Mar 23. doi: 10.3233/THC-220600. Online ahead of print.

ABSTRACT

BACKGROUND: With the development of modern technology, the use of software-based applications in the field of health has become increasingly widespread. For this reason, computer-assisted personal registration forms have been developed using software programs.

OBJECTIVE: The aim of this study was to compare surface contamination during the filling of orthodontic anamnesis-consent forms, traditionally on paper and digitally on a tablet equipped with a software application, measured in confined spaces using the 3M Clean-Trace Luminometer device.

METHODS: In order for the participants to complete the orthodontic anamnesis-consent forms, two separate identical cabins with standard flat surfaces were prepared. In the first cabin, the participants conventionally completed these forms on paper (conventional group), while in the second cabin, the other group used a tablet equipped with a software program for this purpose (digital group). After the form completion process, surface pollution of the predetermined areas was measured in both cabins using a 3M Clean-Trace Luminometer device.

RESULTS: Surface contamination was found to be statistically significantly higher in all measurement areas in the conventional group than in the digital group. Despite a statistically significant difference between the two groups in relation to the measurements performed using the pens (conventional or electronic), this was not as strong as those found for the remaining surfaces.

CONCLUSION: The completion of orthodontic anamnesis-consent forms over tablets significantly reduced surface contamination in the close environment. This study reflects the importance of digitization – which has become beneficial in many fields – in reducing the spread of infections.

PMID:36970922 | DOI:10.3233/THC-220600

Technol Health Care. 2023 Mar 23. doi: 10.3233/THC-220563. Online ahead of print.

ABSTRACT

BACKGROUND: Pedodontists and general practitioners may need support in planning the early orthodontic treatment of patients with mixed dentition, especially in borderline cases. The use of machine learning algorithms is required to be able to consistently make treatment decisions for such cases.

OBJECTIVE: This study aimed to use machine learning algorithms to facilitate the process of deciding whether to choose serial extraction or expansion of maxillary and mandibular dental arches for early treatment of borderline patients suffering from moderate to severe crowding.

METHODS: The dataset of 116 patients who were previously treated by senior orthodontists and divided into two groups according to their treatment modalities were examined. Machine Learning algorithms including Multilayer Perceptron, Linear Logistic Regression, k-nearest Neighbors, Naïve Bayes, and Random Forest were trained on this dataset. Several metrics were used for the evaluation of accuracy, precision, recall, and kappa statistic.

RESULTS: The most important 12 features were determined with the feature selection algorithm. While all algorithms achieved over 90% accuracy, Random Forest yielded 95% accuracy, with high reliability values (kappa = 0.90).

CONCLUSION: The employment of machine learning methods for the treatment decision with or without extraction in the early treatment of patients in the mixed dentition can be particularly useful for pedodontists and general practitioners.

PMID:36970921 | DOI:10.3233/THC-220563

Technol Health Care. 2023 Mar 23. doi: 10.3233/THC-220488. Online ahead of print.

ABSTRACT

BACKGROUND: The incidence of anxiety in patients with breast cancer is high, which seriously affects the physical and mental health of patients.

OBJECTIVE: This study aimed to investigate the effect of acupoint stimulation on the anxiety of patients with breast cancer during operations and in the waiting period for intraoperative frozen section analysis.

METHODS: Sixty patients with breast cancer experiencing anxiety who met the inclusion and exclusion criteria were randomly divided into the experimental group and the control group. The patients in the control group received routine nursing, and the patients in the experimental group were given acupoint stimulation on the basis of routine nursing. The HAMD scores, blood pressure readings, and heart rates were recorded before admission at one hour before the operation and in the waiting period for intraoperative frozen section analysis.

RESULTS: The HAMD scores, blood pressure readings, and heart rates of the two groups showed an upward trend at all time points, and the differences were statistically significant. Compared with the control group, there were significant differences in indices detected at one hour before the operation and in the waiting period for intraoperative frozen section analysis.

CONCLUSION: Acupoint stimulation therapy can effectively alleviate anxiety in patients with breast cancer.

PMID:36970919 | DOI:10.3233/THC-220488

Technol Health Care. 2023 Mar 23. doi: 10.3233/THC-220245. Online ahead of print.

ABSTRACT

BACKGROUND: Orbital blowout fracture is common in ocular trauma. Accurate measurement of orbital volume after fracture is key in improving intraocular correction.

OBJECTIVE: This study aims to explore the impact of 3D reconstruction technology in restoring normal exophthalmos in patients with old orbital wall fractures.

METHODS: A total of 31 patients were randomly divided into an experimental group (n= 15) and a control group (n= 16). For orbital wall repair and reconstruction, the conventional group used the conventional surgical scheme, and the 3D group used 3D printing technology.

RESULTS: There was no statistical difference between the preoperative mean extraocular muscle volume of the healthy eye and the affected eye. However, the mean orbital volume (24.76 vs 27.11, P= 0.005) and mean retrobulbar fat volume (17.53 vs 16.42, P= 0.006) were significantly different between the healthy eye and the affected eye. After an average follow-up of 16 weeks, the differences in pre- and post-surgery exophthalmos in the two groups were 0.42 ± 0.08 mm and 1.63 ± 0.51 mm, respectively. The difference between the two groups was statistically significant (t= 4.42, P= 0.003). The complications were not statistically different.

CONCLUSION: Using 3D reconstruction technology preoperatively can significantly improve exophthalmos in patients with old orbital wall fractures.

PMID:36970917 | DOI:10.3233/THC-220245

J Alzheimers Dis. 2023 Mar 21. doi: 10.3233/JAD-221001. Online ahead of print.

ABSTRACT

BACKGROUND: Preclinical Alzheimer’s disease (AD) is one possible cause of subjective cognitive decline (SCD). Normal task performance despite ongoing neurodegeneration is typically considered as neuronal compensation, which is reflected by greater neuronal activity. Compensatory brain activity has been observed in frontal as well as parietal regions in SCD, but data are scarce, especially outside the memory domain.

OBJECTIVE: To investigate potential compensatory activity in SCD. Such compensatory activity is particularly expected in participants where blood-based biomarkers indicated amyloid positivity as this implies preclinical AD.

METHODS: 52 participants with SCD (mean age: 71.00±5.70) underwent structural and functional neuroimaging (fMRI), targeting episodic memory and spatial abilities, and a neuropsychological assessment. The estimation of amyloid positivity was based on plasma amyloid-β and phosphorylated tau (pTau181) measures.

RESULTS: Our fMRI analyses of the spatial abilities task did not indicate compensation, with only three voxels exceeding an uncorrected threshold at p < 0.001. This finding was not replicated in a subset of 23 biomarker positive individuals.

CONCLUSION: Our results do not provide conclusive evidence for compensatory brain activity in SCD. It is possible that neuronal compensation does not manifest at such an early stage as SCD. Alternatively, it is possible that our sample size was too small or that compensatory activity may be too heterogeneous to be detected by group-level statistics. Interventions based on the individual fMRI signal should therefore be explored.

PMID:36970895 | DOI:10.3233/JAD-221001

Perm J. 2023 Mar 27:1-10. doi: 10.7812/TPP/22.135. Online ahead of print.

ABSTRACT

Introduction Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive, infiltrative form of heart failure (HF). Nevertheless, ATTR-CM is a largely underrecognized and misdiagnosed condition. This study’s objective was to develop an efficient model to assess the chance of ATTR-CM in patients with HF. Methods This was an observational study of patients with HF who had a confirmed diagnosis of ATTR-CM and those with HF but without known ATTR-CM between January 1, 2019, and July 1, 2021. Patient characteristics were extracted from administrative and claims electronic databases and compared between the groups. A propensity score for having ATTR-CM was modeled. Samples of 50 control patients with the highest and lowest propensity scores were adjudicated to assess whether further workup to evaluate for ATTR-CM was warranted for each patient. The sensitivity and specificity of the model were calculated. Results Thirty-one patients with confirmed ATTR-CM and 7620 patients without known ATTR-CM were included in the study. Patients with ATTR-CM were more likely to be Black and to have atrial flutter/fibrillation, cardiomegaly, HF with preserved ejection fraction, pericardial effusion, carpal tunnel syndrome, joint disorders, and lumbar spinal stenosis and to use a diuretic (all p < 0.05). A propensity model with 16 inputs was developed (c-statistic = 0.875). The model’s sensitivity and specificity were 71.9% and 95.2%, respectively. Conclusion The propensity model developed in this study provided an efficient means for identifying patients with HF who are more likely to have ATTR-CM and may warrant further workup.

PMID:36970848 | DOI:10.7812/TPP/22.135