Tag: nevin manimala

J Neurotrauma. 2023 Apr 21. doi: 10.1089/neu.2022.0433. Online ahead of print.

ABSTRACT

Traumatic brain injury (TBI) is a leading cause of death and disability in the United States. Early triage and treatment after TBI have been shown to improve outcome. However, identifying patients at risk for increased intracranial pressure (ICP) via baseline computed tomography (CT) has not previously been validated in a prospective dataset. We hypothesized that acute CT findings of elevated ICP, combined with direct ICP measurement, hold prognostic value in terms of 6-month patient outcome after TBI. Data were obtained from the Progesterone for Traumatic Brain Injury, Experimental Clinical Treatment (ProTECTIII) multicenter clinical trial. Baseline CT scans for 881 participants were individually reviewed by a blinded central neuroradiologist. Five signs of elevated ICP were measured (sulcal obliteration, lateral ventricle compression, 3rd ventricle compression, midline shift, and herniation). Associations between signs of increased ICP and outcomes (6-month functional outcome and mortality) were assessed. Secondary analyses of 354 patients with recorded ICP monitoring data available explored the relationships between hemorrhage phenotype/anatomic location, sustained ICP ≥ 20mmHg, and surgical intervention(s). Univariate and multivariate logistic / linear regressions were performed; p<0.05 is defined as statistically significant. Imaging characteristics associated with ICP in this cohort include sulcal obliteration (p=0.029) and third ventricular compression (p=0.039). Univariate regression analyses indicated that increasing combinations of the five defined signs of elevated ICP were associated with mortality, poor functional outcome, and time to death. There was also an increased likelihood of mortality if patients required craniotomy (OR=4.318, 95% Confidence Interval [1.330-16.030]) or hemicraniectomy (OR=2.993 [1.109-8.482]). On multivariate regression analyses, hemorrhage location was associated with mortality (posterior fossa, OR=3.208 [1.120-9.188] and basal ganglia, OR=3.079 [1.178-8.077]). Volume of hemorrhage > 30cc was also associated with increased mortality, OR=3.702 [1.575-8.956]). The proportion of patient hours with sustained ICP ≥20 mmHg, and maximum ICP ≥20 mmHg, were also directly correlated with increased mortality (OR=64.99 [7.731-635.51]; and OR=1.025 [1.004-1.047]), but not with functional outcome. Poor functional outcome was predicted by concurrent presence of all five radiographic signs of elevated ICP (OR=4.44 [1.514-14.183]) and presence of frontal lobe (OR=2.951 [1.265-7.067]), subarachnoid (OR=2.231 [1.067-4.717]), or intraventricular (OR=2.249 [1.159-4.508]) hemorrhage. Time to death was modulated by total patient days of elevated ICP ≥20 mmHg (Effect Size = 3.424 [1.500, 5.439]) in the first two weeks of hospitalization. Sulcal obliteration and third ventricular compression, radiographic signs of elevated ICP, were significantly associated with measurements of ICP ≥20mmHg. These radiographic biomarkers were significantly associated with patient outcome. There is potential utility of ICP-related imaging variables in triage and prognostication for patients following moderate-severe TBI.

PMID:37082956 | DOI:10.1089/neu.2022.0433

Pediatr Dev Pathol. 2023 Apr 21:10935266231165636. doi: 10.1177/10935266231165636. Online ahead of print.

ABSTRACT

Rhabdomyosarcoma with TFCP2 rearrangement is a newly introduced spindle cell neoplasm showing predilection for craniofacial bones exhibiting highly aggressive nature and poor prognosis. Therefore, an attempt was made to delineate the entity for improved understanding and treatment outcomes through comprehensive analysis of the clinicopathological and molecular characteristics. An electronic search was carried out using MEDLINE by PubMed, Scopus, Google scholar, Cochrane library, and EMBASE databases. Original articles and case reports involving intraosseous rhabdomyosarcoma arising in head and neck region with TFCP2 fusion were included. Data were compiled and risk of bias was analyzed using JBI tool. Thirteen eligible articles were included for the quantitative analysis, which revealed 33 cases with TFCP2 fusion. Majority of the affected individuals were females (58%) with mandible being the common site. Most of the patients died within few months after diagnosis demonstrating a low mean survival rate (30 months). Odds ratio, overall survival and disease-free survival were calculated and analyzed statistically concluding that intraosseous rhabdomyosarcomas harboring TFCP2 fusion are found to be novel and dreadful neoplasms. The predilection for young age with poor prognosis exhibited by these lesions demand early diagnosis and specific treatment planning to curtail mortality.

PMID:37082926 | DOI:10.1177/10935266231165636

Pediatrics. 2023 Apr 21:e2022058729. doi: 10.1542/peds.2022-058729. Online ahead of print.

ABSTRACT

OBJECTIVES: Cisgender girls and boys report trading sex for something of value at roughly equal proportions; yet, boys are understudied and underserved. We compare boys who reported trading sex to those who never traded sex to address this gap in knowledge and practice.

METHODS: The study is a secondary analysis of the Minnesota Student Survey, a triannual, census-style survey. The sample included 32 311 cisgender boy students in ninth and 11th grades who answered a question about sex trading. Bivariate descriptive statistics and multivariate logistic models were used to identify associated factors and determine the odds of trading sex on the basis of specific experiences.

RESULTS: We found that 1.2% of boys reported trading sex. In bivariate analyses, boys who reported trading sex were more likely than those who did not to: identify as Black or Indigenous; report a marginalized gender identity or sexual expression; have had sexual intercourse; have experienced sexual harassment and harassment on the basis of sexual identity and race, ethnicity, and national origin; and to have experienced homelessness, food insecurity, foster care, and substance treatment (P < .001). In multivariate models, we found increased odds of trading sex for some variables, including a marginalized sexual identity, identifying as Black, and experiences of unstable housing, foster care, substance treatment, sexual harassment, and harassment based on gender (P < .001).

CONCLUSIONS: These findings contribute new knowledge about boys who trade sex using a large, population-based sample and counter false assumptions and stereotypes. These data suggest new avenues of research, intervention, and prevention.

PMID:37082916 | DOI:10.1542/peds.2022-058729

Acta Otolaryngol. 2023 Apr 21:1-6. doi: 10.1080/00016489.2023.2200437. Online ahead of print.

ABSTRACT

BACKGROUND: Acquired cholesteatoma secondary to pars tensa perforation was rare in clinic.

OBJECTIVES: In this study, we explored factors related to acquired cholesteatoma in chronic otitis media patients with pars tensa perforation.

MATERIAL AND METHODS: 262 adults (296 ears) with pars tensa perforation were divided into four groups: anterior perforation group, posterior perforation group, central perforation group, and marginal perforation group. Analysis was carried out in terms of cholesteatoma formation, adhesion of perforation edges, mastoid pneumatization, and the function of eustachian tube.

RESULTS: Cholesteatoma was found in 34% (18 in 53 ears) in posterior perforation group, 14.3% (14 in 98 ears) in marginal perforation group, and 2.5% (2 in 80 ears) in anterior perforation group. For subjects with adhesion in perforation edges, cholesteatoma was approved in 94% of posterior perforation, 42% of marginal perforation and 25% of anterior perforation groups. The adhesion in perforation edges and function of eustachian tube instead of mastoid pneumatization were statistically significant for cholesteatoma formation.

CONCLUSIONS AND SIGNIFICANCE: Acquired cholesteatoma was mostly found in patients with posterior and marginal perforation, followed by anterior perforation. Adhesion of perforation edges was another risk factor for cholesteatoma formation. Eustachian tube also functioned by influencing the ventilation of middle ear.

PMID:37082904 | DOI:10.1080/00016489.2023.2200437

Exp Dermatol. 2023 Apr 21. doi: 10.1111/exd.14814. Online ahead of print.

ABSTRACT

Despite recent developments in managing metastatic melanomas, patients’ overall survival remains low. Therefore, the current study aims to understand better the proteome-wide changes associated with melanoma metastasis that will assist with identifying targeted therapies. The latest development in mass spectrometry-based proteomics, together with extensive bioinformatics analysis, was used to investigate the molecular changes in 60 formalin-fixed and paraffin-embedded samples of primary and lymph nodes (LN) and distant organ metastatic melanomas. A total of 4631 proteins were identified, of which 72 and 453 were significantly changed between the LN and distant organ metastatic melanomas compared to the primary lesions (adj. p-value <0.05). An increase in proteins such as SLC9A3R1, CD20 and GRB2 and a decrease in CST6, SERPINB5 and ARG1 were associated with regional LN metastasis. By contrast, increased metastatic activities in distant organ metastatic melanomas were related to higher levels of CEACAM1, MC1R, AKT1 and MMP3-9 and decreased levels of CDKN2A, SDC1 and SDC4 proteins. Furthermore, machine learning analysis classified the lesions with up to 92% accuracy based on their metastatic status. The findings from this study provide up to date proteome-level information about the progression of melanomas to regional LN and distant organs, leading to the identification of protein signatures with potential for clinical translation.

PMID:37082900 | DOI:10.1111/exd.14814

Phys Chem Chem Phys. 2023 Apr 21. doi: 10.1039/d2cp05839a. Online ahead of print.

ABSTRACT

Using a hybrid simulation method that combines a non-linear conjugate gradient (NCG) method for solving large-scale unconstrained optimization problems with a Brownian dynamics (BD) model for polymer chains, we investigate the pre-equilibrium simulation of charged polymers in different dielectric systems from an energy minimization perspective. We propose an improved NCG coefficient (βLPRPk) that satisfies a sufficient descent condition with a greater parameter under a strong Wolfe line search and converges globally for nonconvex minimization. Furthermore, preliminary numerical results show that the βLPRPk coefficient is more efficient than many existing NCG coefficients for a large number of practical test problems from our model. We further compare the performance of the improved NCG method with that of other mainstream numerical methods in energy minimization, and the simulation results suggest that the NCG method is more competitive in terms of cost-effectiveness. Importantly, we apply the geometrically optimized configuration obtained by performing the NCG method to the pre-equilibrium simulation, and the numerical results show that it increases the computational efficiency of a pure solvent and biomolecule-solution systems at most by about 32 and 70 times, respectively, with the relative energy errors being controlled below 1 × 10^-2 and 4.5 × 10^-3, respectively. More importantly, the final pre-equilibrium configuration of the BD simulation that performs energy minimization and the traditional BD simulation matched closely.

PMID:37082884 | DOI:10.1039/d2cp05839a

Int Forum Allergy Rhinol. 2023 Apr 21. doi: 10.1002/alr.23171. Online ahead of print.

ABSTRACT

BACKGROUND: Quality-of-life (QOL) for individuals with sinonasal malignancy (SNM) is significantly understudied yet critical for counseling and may impact treatment. This study evaluated the how patient, treatment, and disease factors impact sinonasal-specific and generalized QOL using validated metrics in a large cohort over a 5-year post-treatment timeframe.

METHODS: Patients with SNM who underwent definitive treatment with curative intent were enrolled into a prospective, multi-site, longitudinal observational study. QOL was assessed using the Sinonasal Outcome Test-22 (SNOT-22) and University of Washington Quality of Life Questionnaire (UWQOL) instruments at pre-treatment baseline and multiple follow-ups through 5 years post-treatment. Multivariable modelling was used to determine demographic, disease, and treatment factors associated with disease-specific and generalized physical and social/emotional function QOL.

RESULTS: 194 patients with SNM were analyzed. All QOL indices were impaired at pre-treatment baseline and improved post-treatment. SNOT-22 scores improved 3 months and UWQOL scores improved 6-9 months post-treatment. Patients who underwent open compared to endoscopic tumor resection had worse generalized QOL (p<0.001), adjusted for factors including T stage. Pterygopalatine fossa (PPF) involvement was associated with worse QOL (SNOT-22, p<0.001; UWQOL-Physical, p = 0.02). Adjuvant radiation was associated with worse disease-specific QOL (p = 0.03). Neck dissection was associated with worse generalized physical function QOL (p = 0.01). Positive margins were associated with worse generalized social/emotional function QOL (p = 0.01).

CONCLUSIONS: Disease-specific and generalized QOL is impaired at baseline in patients with SNM and improves following treatment. Endoscopic resection is associated with better QOL. PPF involvement, adjuvant radiation, neck dissection, and positive margins were associated with worse QOL post-treatment. This article is protected by copyright. All rights reserved.

PMID:37082883 | DOI:10.1002/alr.23171

Andrology. 2023 Apr 21. doi: 10.1111/andr.13443. Online ahead of print.

ABSTRACT

BACKGROUND: The causal relationship between obesity-related anthropometric indicators/body composition and erectile dysfunction (ED) has not been established in previous observational studies.

METHOD: We screened single nucleotide polymorphisms significantly associated with exposure from genome-wide association studies (GWAS) as instrumental variables (IVs) (P < 5.0 × 10^-8 ). The summary statistics for ED were collected from a GWAS with a sample size of 223,805. Exposure and outcome populations included are of European ancestry. We used univariate and multivariate Mendelian randomization (MR) (i) to investigate the causal relationship between genetically predicted obesity-related anthropometric indicators/body composition and ED (ii) to examine the mediating role of coronary artery disease (CAD). MR analysis was conducted using an inverse variance weighted method. A series of sensitivity analyses validated the results of the MR analysis. Causal estimates are expressed as odds ratios (OR) with 95% confidence intervals (CI).

RESULTS: Obesity-related anthropometric indicators/body composition were associated with an increased risk of ED in univariate MR analyses. For the 1-SD increase in BMI, the OR was 1.841 (95% CI: 1.049-1.355, P = 0.006). For the 1-SD increase in waist circumference and hip circumference, the ORs were 1.275 (95% CI: 1.101-1.478, P = 0.001) and 1.156 (95% CI: 1.015-1.317, P = 0.009), respectively. The OR for the 1-SD increase in whole body fat mass was 1.221 (95% CI: 1.047-1.388, P = 0.002). For the 1-SD increase in leg fat percentage (left & right), the ORs were 1.256 (95% CI: 1.006-1.567, P = 0.044) and 1.285 (95% CI: 1.027-1.608, P = 0.028), respectively. For the 1-SD increase in leg fat mass (left & right), the ORs were 1.308 (95% CI: 1.108-1.544, P = 0.001) and 1.290 (95% CI: 1.091-1.524, P = 0.003), respectively. For the 1-SD increase in arm fat mass (left & right), the ORs were 1.269 (95% CI: 1.113-1.447, P < 0.001) and 1.254, respectively. Multivariate MR analysis showed that after adjusting for CAD, some genetic predispositions to obesity-related anthropometric indicators and body composition were still associated with an increased risk of ED. Significant associations were found for waist circumference-ED (OR: 1.218, 95% CI: 1.036-1.432), leg fat percentage (left)-ED (OR: 1.245, 95% CI: 1.035-1.497), leg fat mass (left)-ED (OR: 1.264, 95% CI: 1.051-1.521), arm fat mass (right)-ED (OR: 1.186, 95% CI: 1.024-1.373), and arm fat mass (left)-ED (OR: 1.17, 95% CI: 1.018-1.360). Meanwhile, CAD mediated the effects of fat on ED, and the proportion of CAD-mediated cases ranged from 10% to 22%.

CONCLUSION: There is a potential causal relationship between obesity-related anthropometric indicators/body composition and ED. Higher waist circumference, leg fat percentage, and arm fat mass may increase the risk of ED, and CAD partly mediates this overall effect. Understanding the causal relationship between obesity and ED and the mediating role of CAD may provide more information for ED intervention and prevention strategies. This article is protected by copyright. All rights reserved.

PMID:37082877 | DOI:10.1111/andr.13443

J Cosmet Dermatol. 2023 Apr 21. doi: 10.1111/jocd.15776. Online ahead of print.

ABSTRACT

BACKGROUND: Acne vulgaris is a common skin disease that is more common in young population and it can be associated with some sequels after resolving the lesions. Post-inflammatory erythema is one of these complications that can be disturbing for patients and does not have any definite treatment. This study was aimed to evaluate the efficacy and safety of tranexamic acid (TA) as mesotherapy in treatment of post-acne erythema (PAE) treatment.

METHOD: This clinical trial study was performed in the dermatology clinic on 17 patients with persistent PAE (3 months after acne recovery). Two sessions of treatment were performed by a physician with 2-week intervals; TA was injected as mesotherapy into the right side of each patient’s face as the case group, while the opposite side was used as the control group. A Visioface device was used to compare before and after treatment photographs of each side of the face in color mode with quantitative measures such as lesions count, area, and area percent.

RESULTS: Finally, 15 patients completed treatment sessions. There were statistically significant differences in right side lesions before and after treatment with p-values of 0.047, 0.002, and 0.035 for count, area, and area percent, respectively. There was no significant difference before and after treatment in terms of count, area. and area-percent on the left side.

CONCLUSION: According to the results of this study, TA injection as mesotherapy for resolving PAE can be effective. However, due to small sample size, further studies are needed.

PMID:37082869 | DOI:10.1111/jocd.15776

Eur J Haematol. 2023 Apr 21. doi: 10.1111/ejh.13981. Online ahead of print.

ABSTRACT

BACKGROUND: No adequate data exist on the impact of multiple myeloma (MM) with extramedullary disease (EMD) after autograft and maintenance therapy.

METHODS: We identified 808 patients with newly diagnosed MM who received first autograft, of whom 107 had EMD (83 paraskeletal and 24 organ involvement), and who had been reported to the EBMT registry December 2018. Distribution according to type of involvement was similar between the treatment groups (p = .69). For EMD, 46 (40%) received thalidomide, 59 (51%) lenalidomide, and 11 (10%) bortezomib.

RESULTS: The median follow-up from maintenance start was 44 months. Three-year progression-free survival (PFS) was 52% (48%-57%) for no EMD, 56% (44%-69%) for paraskeletal involvement, and 45% (22%-68%) for organ involvement (p = .146). Early PFS (within first year) appeared to be significantly worse for organ involvement (hazard ratio, 3.40), while no significant influence was found after first year from maintenance start. Three-year overall survival (OS) was 81% (77%-84%), 88% (80%-96%), and 68% (47%-89%; p = .064), respectively. With thalidomide as reference, lenalidomide was significantly associated with better PFS and OS, whereas bortezomib appeared to improve outcome specifically in EMD.

CONCLUSION: Lenalidomide maintenance is standard of care for MM without EMD, whereas extramedullary organ involvement remains a significant risk factor for worse outcome, especially for early events after maintenance start.

PMID:37082839 | DOI:10.1111/ejh.13981