Tag: nevin manimala

Rheumatology (Oxford). 2023 May 15:kead221. doi: 10.1093/rheumatology/kead221. Online ahead of print.

ABSTRACT

OBJECTIVE: To study whether multimodal brain magnetic resonance imaging (MRI) comprising permeability and perfusion measures coupled with machine learning could predict neurocognitive function in young patients with systemic lupus erythematosus (SLE) without neuropsychiatric manifestation.

METHODS: SLE patients and healthy controls (HCs) (age ≤ 40 years) underwent multimodal structural brain MRI that comprised voxel-based morphometry (VBM), magnetization transfer ratio (MTR) and dynamic contrast-enhanced (DCE) MRI in this cross-sectional study. Neurocognitive function assessed by Automated Neuropsychological Assessment Metrics was reported as the total throughput score (TTS). Olfactory function was assessed. A machine-learning based model (i.e. glmnet) was constructed to predict TTS.

RESULTS: Thirty SLE patients and 10 HCs were studied. Both groups had comparable VBM, MTR, olfactory bulb volume (OBV), olfactory function and TTS. While after correction for multiple comparisons the uncorrected increase in the blood-brain barrier (BBB) permeability parameters compared with HCs did not remain evident in SLE patients, DCE-MRI perfusion parameters, notably an increase in right amygdala perfusion, was positively correlated with TTS in SLE patients (r = 0.636, FDR p< 0.05). A machine-learning trained multimodal MRI model comprising alterations of VBM, MTR, OBV and DCE-MRI parameters mainly in the limbic system regions predicted TTS in SLE patients (r = 0.644, p< 0.0005).

CONCLUSION: Multimodal brain MRI demonstrated increased right amygdala perfusion that was associated with better neurocognitive performance in young SLE patients without statistically-significant BBB leakage and microstructural abnormalities. A machine learning-constructed multimodal model comprising microstructural, perfusion and permeability parameters accurately predicted neurocognitive performance in SLE patients.

PMID:37184855 | DOI:10.1093/rheumatology/kead221

JAMA Netw Open. 2023 May 1;6(5):e2313359. doi: 10.1001/jamanetworkopen.2023.13359.

ABSTRACT

IMPORTANCE: Despite the expansion of published prediction models for acute kidney injury (AKI), there is little evidence of uptake of these models beyond their local derivation nor data on their association with patient outcomes.

OBJECTIVE: To systematically review published AKI prediction models across all clinical subsettings.

DATA SOURCES: MEDLINE via PubMed (January 1946 to April 2021) and Embase (January 1947 to April 2021) were searched using medical subject headings and text words related to AKI and prediction models.

STUDY SELECTION: All studies that developed a prediction model for AKI, defined as a statistical model with at least 2 predictive variables to estimate future occurrence of AKI, were eligible for inclusion. There was no limitation on study populations or methodological designs.

DATA EXTRACTION AND SYNTHESIS: Two authors independently searched the literature, screened the studies, and extracted and analyzed the data following the Preferred Reporting Items for Systematic Review and Meta-analyses guideline. The data were pooled using a random-effects model, with subgroups defined by 4 clinical settings. Between-study heterogeneity was explored using multiple methods, and funnel plot analysis was used to identify publication bias.

MAIN OUTCOMES AND MEASURES: C statistic was used to measure the discrimination of prediction models.

RESULTS: Of the 6955 studies initially identified through literature searching, 150 studies, with 14.4 million participants, met the inclusion criteria. The study characteristics differed widely in design, population, AKI definition, and model performance assessments. The overall pooled C statistic was 0.80 (95% CI, 0.79-0.81), with pooled C statistics in different clinical subsettings ranging from 0.78 (95% CI, 0.75-0.80) to 0.82 (95% CI, 0.78-0.86). Between-study heterogeneity was high overall and in the different clinical settings (eg, contrast medium-associated AKI: I2 = 99.9%; P < .001), and multiple methods did not identify any clear sources. A high proportion of models had a high risk of bias (126 [84.4%]) according to the Prediction Model Risk Of Bias Assessment Tool.

CONCLUSIONS AND RELEVANCE: In this study, the discrimination of the published AKI prediction models was good, reflected by high C statistics; however, the wide variation in the clinical settings, populations, and predictive variables likely drives the highly heterogenous findings that limit clinical utility. Standardized procedures for development and validation of prediction models are urgently needed.

PMID:37184837 | DOI:10.1001/jamanetworkopen.2023.13359

Obes Surg. 2023 May 15. doi: 10.1007/s11695-023-06634-y. Online ahead of print.

ABSTRACT

PURPOSE: Metabolic and bariatric surgery (MBS) can exert effective function on glycemic control. The present study aimed to estimate the risk of MACE among obese patients with diabetes after MBS.

MATERIALS AND METHODS: Systematic search of PubMed, Embase, Medline, and Web of Science was performed for studies published before 20th February 2023. The odds ratio (OR) corresponding to the 95% confidence interval (95% CI) was used to assess the outcome. The statistical heterogeneity among studies was assessed with the Q-test and I² statistics.

RESULTS: Fifteen cohort studies with 122,361 obese patients with diabetes were available for analysis. Our meta-analysis found significantly decreased morbidity and mortality of MACE (OR = 0.65, 95% CI = 0.59-0.72, I² = 62.8% for morbidity, OR = 0.49, 95% CI = 0.36-0.67, I² = 68.7% for mortality). Subgroup analysis revealed MBS decreased cerebrovascular disease, coronary artery disease, atrial fibrillation, heart failure, myocardial infarction, and stroke risk.

CONCLUSION: Our meta-analysis indicated that MBS for obese patients with diabetes is beneficial to decreasing MACE risk. Moreover, further studies estimating the functional effect may eventually provide a better and comprehensive understanding of the effect on different populations.

PMID:37184826 | DOI:10.1007/s11695-023-06634-y

Eur J Drug Metab Pharmacokinet. 2023 May 15. doi: 10.1007/s13318-023-00829-5. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Lu-177 DOTATATE (Lutathera^®) is a radiolabeled analog of somatostatin administered intravenously in patients with somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumors. Biodistribution of Lu-177 DOTATATE in tumor and healthy tissues can be monitored by serial post-injection scintigraphy imaging. Patient exposure to the drug is variable with the recommended fixed dosage, and hence there is a variable response to treatment. The aim of this work was to study the pharmacokinetics of Lu-177 DOTATATE by a population modeling approach, based on single-photon emission computed tomography (SPECT)/computed tomography (CT) images used as surrogate of plasma concentrations to study the interindividual variability and finally optimize an individual dosage.

METHODS: From a retrospective study, SPECT/CT images were acquired at 4 h, 24 h, 72 h, and 192 h postadministration. From these images, volumic activities were calculated in blood and bone marrow. An individual non-compartmental pharmacokinetic analysis was performed, and the mean pharmacokinetic parameters of each tissue were compared together and with reference data. Blood volumic activities were then used to perform a population pharmacokinetic analysis (NONMEM).

RESULTS: The pharmacokinetic parameters (non-compartmental analysis) obtained from blood (clearance [CL] = 2.65 L/h, volume of distribution at steady state [Vss] = 309 L, elimination half-life [t_1/2] = 86.3 h) and bone marrow (CL =1.68 L/h, Vss = 233 L, t_1/2 = 98.8 h) were statistically different from each other and from reference values (CL = 4.50 L/h, Vss = 460 L, t_1/2 = 71.0 h) published in the literature. SPECT/CT blood images were used as a surrogate of plasma concentrations to develop a population pharmacokinetic model. Weight was identified as covariate on volume of the central compartment, reducing the interindividual variability of all population pharmacokinetic parameters.

CONCLUSION: This study is a proof of concept that obtaining pharmacokinetic parameters with image-based blood concentration is possible. Obtaining observed concentrations from SPECT/CT images, without the need for blood sampling, is a real advantage for the patient and the drug monitoring. Pharmacokinetic modeling could be combined with a deep learning model for automatic contouring and allow precise patient-specific dose adjustment in a non-invasive manner.

PMID:37184824 | DOI:10.1007/s13318-023-00829-5

Environ Monit Assess. 2023 May 15;195(6):670. doi: 10.1007/s10661-023-11206-9.

ABSTRACT

This study integrates multivariate statistical analysis and hydrogeochemical modeling to investigate the processes controlling the groundwater composition of a shallow aquifer where increased pumping rates and anthropogenic impacts were prevalent. Eighteen groundwater samples were collected and analyzed for major elements and selected heavy metals. The data were classified on the basis of multivariate statistical analysis into three clusters: C1 (Na-Cl facies), C2 (Ca-SO₄ facies), and C3 (Ca-HCO₃ facies). The application of factor analysis gave four factors affecting the groundwater chemistry, namely the salinization factor, anthropogenic/secondary enrichment factor, the secondary and the micro-nutrient fertilizers, and the aluminum fertilizer factor. The hydrogeochemical study of the groundwater revealed that the processes controlling the groundwater chemistry in the study area are mainly affected by the groundwater occurrence either to the east or to the west of Bahr Youssef Canal. Generally, the dominant hydrogeochemical processes affecting the groundwater are silicate weathering, ion exchange, irrigation return flow, gypsum applications in soil, and evaporation. The groundwater quality evaluation shows that water quality varies from fair to excellent for drinking purposes, where the best water is located in the northern and central parts of the study area. The suitability of groundwater for irrigation was evaluated using several indices indicating that groundwater is suitable for irrigation in the northwest and western parts of the study area. As some groundwater samples lie in high salinity classes on the US Salinity diagram, it is recommended to use this water for plants with good salt tolerance under good drainage conditions. The integration between the statistical and geochemical tools helps reveal the dominant processes through data reduction and classification.

PMID:37184807 | DOI:10.1007/s10661-023-11206-9

Int Ophthalmol. 2023 May 15. doi: 10.1007/s10792-023-02720-3. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the efficacy of a comprehensive surgical approach in rejuvenating the aging upper periorbita.

METHODS: Three hundred and twenty eyes of 160 patients who were treated for dermatochalasis(D), eyebrow ptosis (EP) and blepharoptosis (BP) were included in the study. One hundred and ninety-eight patients had only dermatochalasis, 74 patients had D and EP, 39 patients had D and BP, 7 patients had D, EP and BP and 2 patients had D, EP and blepharospasm. The patients were evaluated before surgery, at 1 week, 1 month and 6 months after surgery. Dermatochalasis was scored between 0 and 3 points according to upper lid laxity and IP drooping. EP was scored between 0 and 2 points as normal, lateral EP and total EP. Aging was classified as mild in those with a total score of less than 3 points, moderate in those with a score of 3-6 and severe in those above 6 points.

RESULTS: Of the patients, 121 were female and 39 were male, with a mean age of 52 (40-87) years. The surgeries were performed as follows: upper eyelid blepharoplasty (UEB) 197(61.6%) patients, UEB + browpexy(B) 77(24.1%) patients, UEB + B + levator resection(LR) 7(2.2%) and UEB + LR 39 (12.2%) patients. While a statistically significant improvement was observed in patients who underwent UEB + B (p < 0.001), postoperative improvements were not found statistically significant compared to preoperative scores in other surgeries. The postsurgical scores showed statistically significant improvement in all age groups (p < 0.001).

CONCLUSIONS: A comprehensive surgical treatment can provide effective results in upper periorbital rejuvenation for patients with varying degrees of upper periorbital aging.

PMID:37184806 | DOI:10.1007/s10792-023-02720-3

Environ Sci Pollut Res Int. 2023 May 15. doi: 10.1007/s11356-023-27499-9. Online ahead of print.

ABSTRACT

The construction of National Industrial Relocation Demonstration Zones (NIRDZ) is important for China’s industrial transfer, but its environmental influence cannot be neglected. This study explores the environmental effects of industrial transfers by studying China’s NIRDZ. By employing panel data of 284 cities in China between 2005 and 2019, we compare environmental quality changes over time in areas with and without demonstration zones based on the staggered difference-in-differences (DD) technique. The results demonstrate a 0.032 increase in the environmental quality level of industrial receivers after the implementation of demonstration zones. The effect of demonstration zones on environmental improvement is moderated by natural resources, capital accumulation, and technological innovation capabilities. This impact is more fully realized in cities with resource-based, low-capital accumulation, and high-tech innovation but is not statistically significant difference at various levels of human resources. The environmental improvement effect of the NIRDZ is powerful in central cities and small- and medium-sized cities instead of western regions and large-scale cities. Additionally, mediation analysis is adopted to assess the potential mechanism between the association of NIRDZ and the environment. The demonstration area negatively affects environmental quality through the economic scale effect while improving environmental quality through the technological innovation effect. We provide empirical evidence that the NIRDZ is positively correlated with the environment and identify the technology effect as one underlying driver of this correlation to help developing countries address its detrimental impacts.

PMID:37184795 | DOI:10.1007/s11356-023-27499-9

Ir J Med Sci. 2023 May 15. doi: 10.1007/s11845-023-03375-w. Online ahead of print.

ABSTRACT

BACKGROUND: Visceral Adiposity Index (VAI) is a gender-specific mathematical model based on BMI, waist circumference (WC) and lipid parameters. No study has yet examined the relationship between this index and the glycemic and metabolic parameters in children and adolescents with Type 1 Diabetes Mellitus (DM). The current study aims at examining the relationship between glycemic and metabolic control and VAI in children and adolescents with Type 1 DM.

METHODS: A total of 150 children and adolescents aged 6-18 years with Type 1 DM were included in this study. Anthropometric, glycemic and metabolic parameters were examined. VAI was calculated using gender-specific formulas. Statistical analysis was done by SPSS version 23.

RESULTS: The average age of the participants was 12.2 ± 3.1 years (females 53.0%). The females had higher rates of VAI, microalbuminuria and hypertension than males. Participants of both gender with higher VAI quartiles had higher anthropometric measurements, insulin usage, low-density lipoprotein cholesterol (LDL-C), triglycerides and urine microalbumin and had poor glycemic control. Sex adjusted correlation analysis showed that VAI is negatively correlated with estimated glucose disposal rate (eGDR), and positively correlated with insulin dose, LDL-C, triglycerides, glycosylated hemoglobin (HbA1c) and microalbuminuria.

CONCLUSION: The present paper is the first study examining the relationship between Type 1 DM and VAI. Higher VAI values in children and adolescents with type 1 DM may adversely affect glycemic and metabolic control. VAI can be a useful and new method in evaluating glycemic and metabolic control in children and adolescents with Type 1 DM.

PMID:37184780 | DOI:10.1007/s11845-023-03375-w

Tech Coloproctol. 2023 May 15. doi: 10.1007/s10151-023-02812-3. Online ahead of print.

ABSTRACT

PURPOSE: Sarcopenia is associated with poor short- and long-term patient outcomes following colorectal surgery. Despite postoperative ileus (POI) being a major complication following colorectal surgery, the predictive value of sarcopenia for POI is unclear. We assessed the association between sarcopenia and POI in patients with colorectal cancer.

METHODS: Elective colorectal cancer surgery patients were retrospectively included (2018-2022). The cross-sectional psoas area was calculated using preoperative staging imaging at the level of the 3rd lumbar vertebrae. Sarcopenia was determined using gender-specific cut-offs. The primary outcome POI was defined as not achieving GI-2 by day 4. Demographics, operative characteristics, and complications were compared via univariate and multivariate analyses.

RESULTS: Of 297 patients, 67 (22.6%) were sarcopenic. Patients with sarcopenia were older (median 74 (IQR 67-82) vs. 69 (58-76) years, p < 0.001) and had lower body mass index (median 24.4 (IQR 22.2-28.6) vs. 28.8 (24.9-31.9) kg/m², p < 0.001). POI was significantly more prevalent in patients with sarcopenia (41.8% vs. 26.5%, p = 0.016). Overall rate of complications (85.1% vs. 68.3%, p = 0.007), Calvien-Dindo grade > 3 (13.4% vs. 10.0%, p = 0.026) and length of stay were increased in patients with sarcopenia (median 7 (IQR 5-12) vs. 6 (4-8) days, p = 0.013). Anastomotic leak rate was higher in patients with sarcopenia although the difference was not statistically significant (7.5% vs. 2.6%, p = 0.064). Multivariate analysis demonstrated sarcopenia (OR 2.0, 95% CI 1.1-3.8), male sex (OR 1.9, 95% CI 1.0-3.5), postoperative hypokalemia (OR 3.2, 95% CI 1.6-6.5) and increased opioid use (OR 2.4, 95% CI 1.3-4.3) were predictive of POI.

CONCLUSION: Sarcopenia demonstrates an association with POI. Future research towards truly identifying the predictive value of sarcopenia for postoperative complications could improve informed consent and operative planning for surgical patients.

PMID:37184771 | DOI:10.1007/s10151-023-02812-3

Neurosurg Rev. 2023 May 15;46(1):120. doi: 10.1007/s10143-023-02029-w.

ABSTRACT

Geniculate ganglion hemangioma (GGH) is rarely presented in the neurosurgical literature. It extends extradurally on the middle fossa floor and displaces the intratemporal part of the facial nerve. Surgical treatment is advisable at early symptoms. Proposed techniques include fascicular-sparing resection or nerve interruption with grafting. No definitive conclusions exist about the superiority of a certain technique in preserving facial nerve integrity and function. Through the description of a surgically managed symptomatic GGH, we herein discuss literature data about the surgical results of fascicular-sparing resection versus grafting. A PRISMA-based literature search was performed on the PubMed database. Only articles in English and published since 1990 were selected and furtherly filtered based on the best relevance. Statistical comparisons were performed with ANOVA. One hundred sixteen GGHs were collected, 56 were treated by fascicular-sparing resection, and 60 were treated by grafting. The facial function was improved, or unchanged, in 53 patients of the fascicular-sparing group and 30 patients of the grafting one. Sixty-five patients achieved a good (House-Brackmann (HB) grade III) postoperative facial outcome, of which 47 and 18 belonged to the fascicular-sparing and grafting group, respectively. Greater efficacy of the fascicular-sparing technique in the achievement of a better facial outcome was found (p = 0.0014; p = 0.0022). A surgical resection at the earliest symptoms is critical to preserve the facial nerve function in GGHs. Fascicular-sparing resection should be pursued in symptomatic cases with residual facial function (I-III HB). Conversely, grafting has a rationale for higher HB grades (V-VI). Broader studies are required to confirm these findings and turn them into new therapeutic perspectives.

PMID:37184718 | DOI:10.1007/s10143-023-02029-w