Tag: nevin manimala

BMC Pregnancy Childbirth. 2022 Nov 26;22(1):877. doi: 10.1186/s12884-022-05203-y.

ABSTRACT

BACKGROUND: Pregnant women expecting twins are more likely to experience stress, which can lead to anxiety and depression. Our aim was to investigate the prevalence of prenatal anxiety and depressive symptoms in women with twin pregnancies and the associated factors.

METHODS: In a cross-sectional survey, 210 women with twin pregnancies who satisfied the inclusion and exclusion criteria in two tertiary centers in Southwestern China were asked to complete a basic information form, the Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS). To compare statistics with normal distribution in distinct characteristic groups, a paired t-test, and one-way ANOVA were utilized. Binary logistic step regression was used to analyze the associated factors of antenatal anxiety and depressive symptoms.

RESULTS: The 210 women with twin pregnancies (age = 30.8 ± 4.2 years) were between 7 and 37 gestational weeks (29.2 ± 1.2 weeks), were typically well-educated (72.4% had a post-high-school degree), and reasonably affluent (88.1% were above the low-income cutoff). Among them, 34.8% had symptoms associated with clinical levels of anxiety, and 37.1% had symptoms indicating possible depression. The prevalence of co-morbid anxiety and depressive symptoms was 24.3%. Binary stepwise logistic regression analysis showed that previous health status and sleep disturbance during pregnancy were the associated factors of anxiety symptoms in women with twin pregnancies (P < 0.05), whereas age, previous health status, negative life events, and physical activity during pregnancy were the associated factors of depressive symptoms in women with twin pregnancies (P < 0.05).

CONCLUSION: About one-third of women with twin pregnancies had symptoms of anxiety or depression; these were most strongly predicted by some modifiable factors, suggesting that early preventive mind-body interventions may be a promising strategy to protect against mental health issues for women with twin pregnancies.

PMID:36435754 | DOI:10.1186/s12884-022-05203-y

Eur Urol Oncol. 2022 Nov 23:S2588-9311(22)00178-X. doi: 10.1016/j.euo.2022.10.008. Online ahead of print.

ABSTRACT

BACKGROUND: Optimising therapeutic strategies of intermediate-risk non-muscle-invasive bladder cancer (IR-NMIBC) is needed.

OBJECTIVE: To compare recurrence-free survival (RFS) with adjuvant intravesical mitomycin C (MMC) at normothermia or hyperthermia using the COMBAT bladder recirculation system at 43 °C for 30 and 60 min.

DESIGN, SETTING, AND PARTICIPANTS: A prospective open-label, phase 3 randomised controlled trial (HIVEC-1) accrued across 13 centres between 2014 and 2020 in Spain. After complete transurethral resection of the bladder and immediate postoperative MMC instillation, patients with IR-NMIBC were randomised (1:1:1) to four weekly followed by three monthly 40-mg MMC instillations at normothermia (control; n = 106), 43 °C for 30 min (n = 107), or 43 °C for 60 min (n = 106) were investigated. Therapeutic compliance was defined as four or more instillations.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcome was RFS at 24 mo in the intention-to-treat (ITT) and per-protocol (PP) populations. The secondary outcomes included progression-free survival at 24 mo, safety outcome measures, and changes in health-related quality of life. Log-rank, Fisher, χ², and analysis of variance tests were used.

RESULTS AND LIMITATIONS: The ITT 24-mo RFS was 77% for control, 82% for 43 °C-30 min, and 80% for 43 °C-60 min (p = 0.6). The PP 24-mo RFS was 77% for control, 83% for 43 °C-30 min, and 80% for 43 °C-60 min (p = 0.59). Six patients progressed to muscle-invasive disease in the ITT population (four in the control, 43 °C-30 min, and 43 °C-60 min groups each) and four in the PP population (all controls). Serious adverse events occurred in 26 patients (8.1%), and we were unable to demonstrate a difference between groups (p = 0.5). Adverse events, mainly dysuria and spasms, occurred in 124 patients (33% in control, 35% in 43 °C-30 min, and 48% in 43 °C-60 min; p = 0.05). The total International Prostate Symptom Score worsened by 1.2 ± 7.3 points, similarly across groups (p = 0.29). The Functional Assessment of Cancer Therapy-Bladder domains and indexes showed no significant change.

CONCLUSIONS: Four-month adjuvant hyperthermic MMC using the COMBAT system for 30 and 60 min in IR-NMIBC is well tolerated, but we did not find it to be superior to normothermic MMC at 24 mo.

PATIENT SUMMARY: We were unable to demonstrate the effectiveness of hyperthermia using the COMBAT system in intermediate-risk non-muscle-invasive bladder cancer. Further evaluation of long-term recurrence and progression, and maintenance regimens appears mandatory.

PMID:36435738 | DOI:10.1016/j.euo.2022.10.008

J Surg Educ. 2022 Nov 23:S1931-7204(22)00295-1. doi: 10.1016/j.jsurg.2022.10.011. Online ahead of print.

ABSTRACT

OBJECTIVE: In March 2020, COVID-19 was declared a pandemic by the World Health Organization. This led to the outright cancellation of away rotations and in person residency interviews for the class of 2021. This study aims to identify the geographic relationships in the orthopedic match and further explore COVID-19’s effect on these geographic relationships. Furthermore, we aim to compare the home program match rates before and after COVID-19.

SETTING: Southern Illinois University School of Medicine, Department of Orthopedic Surgery (tertiary, university-based).

DESIGN AND PARTICIPANTS: Residency websites and social media sites were used to record basic residency information as well as each resident’s year, matriculated medical school, and matriculated medical school geographic data. This information was used to evaluate the proportion of orthopedic residents from “home program” medical schools and evaluate the geographic relationship of matched orthopedic residents. 202 Orthopedic residencies were initially identified and 134 allopathic and nonmilitary residency programs met the inclusion criteria. In all, 3253 of the 3931 (82.7%) current U.S orthopedic residents were included in the analysis.

RESULTS: In the 4 orthopedic surgery residency classes before the pandemic (2017-2020), 21.8% of residency slots were filled by home program students. During the pandemic match cycle (2021), this number jumped to 28.2% (p < 0.0006). The increase was observed consistently across residency subgroup analysis: class size, doximity rank, and doximity research rank. Correspondingly, there was a statistically significant increase from 34.7% (2017-2020) to 39.3% (2021) (p = 0.0318) in residencies matching with same state medical students. Regional trends stayed consistent. Our study showed that residency programs matched applicants who went to same region medical schools during the 2020 to 2021 cycle at nearly the exact same rate as they did pre-pandemic (63.6%, up from 63.3%).

CONCLUSIONS: Our study demonstrates that despite widespread virtual away rotations and virtual open houses, residency programs showed an increased preference for their home program students. This trend was significant and widespread, highlighting the generalized nationwide hesitation of both residency programs and students on the virtual interview process.

PMID:36435733 | DOI:10.1016/j.jsurg.2022.10.011

Urol Oncol. 2022 Nov 23:S1078-1439(22)00427-6. doi: 10.1016/j.urolonc.2022.10.026. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate whether a restaging transurethral resection of bladder tumor (TURBT) is necessary in high-risk nonmuscle invasive bladder cancer (NMIBC) if the initial TURBT was performed using blue light (BL) technology.

METHODS AND MATERIALS: Using the multi-institutional Cysview registry between 2014 and 2021, all consecutive adult patients with known NMIBC (Ta and T1 disease) who underwent TURBT followed by a restaging TURBT within 8 weeks were reviewed. Patients were stratified according to their initial TURBT, BL vs. white light (WL), and compared to determine rates of residual disease and upstaging. Univariate analysis was performed using Mann-Whitney U and chi-square tests, with P < 0.05 considered significant.

RESULTS: Overall, 115 patients had TURBT for NMIBC followed by a restaging TURBT within 8 weeks and were included in the analysis. Patients who underwent BL compared to WL for their initial TURBT had higher rates of benign pathology on restaging TURBT, although this was not statistically significant (47% vs. 30%; P = 0.08). Of patients with residual tumors on restaging TURBT, there were no differences in rates of Ta (22% vs. 26.5%; P = 0.62), T1 (22% vs. 26.5%; P = 0.62), or CIS (5.5% vs. 13%; P = 0.49) when the initial TURBT was done using BL compared to WL. Rates of upstaging to muscle invasive disease were also not different when initial TURBT was performed using BL compared to WL (3% vs. 4%; P = 0.78).

CONCLUSIONS: TURBT using BL does not reduce rates of residual disease or risk of upstaging on restaging TURBT in Ta or T1 disease. Thus, a restaging TURBT is still necessary even if initial TURBT was performed using BL.

PMID:36435710 | DOI:10.1016/j.urolonc.2022.10.026

Br J Anaesth. 2022 Nov 23:S0007-0912(22)00593-1. doi: 10.1016/j.bja.2022.10.022. Online ahead of print.

NO ABSTRACT

PMID:36435666 | DOI:10.1016/j.bja.2022.10.022

J Am Geriatr Soc. 2022 Nov 26. doi: 10.1111/jgs.18134. Online ahead of print.

ABSTRACT

BACKGROUND: CT head is commonly performed in the setting of delirium and altered mental status (AMS), with variable yield. We aimed to evaluate the yield of CT head in hospitalized patients with delirium and/or AMS across a variety of clinical settings and identify factors associated with abnormal imaging.

METHODS: We included studies in adult hospitalized patients, admitted to the emergency department (ED) and inpatient medical unit (grouped together) or the intensive care unit (ICU). Patients had a diagnosis of delirium/AMS and underwent a CT head that was classified as abnormal or not. We searched Medline, Embase and other databases (informed by PRISMA guidelines) from inception until November 11, 2021. Studies that were exclusively performed in patients with trauma or a fall were excluded. A meta-analysis of proportions was performed; the pooled proportion of abnormal CTs was estimated using a random effects model. Heterogeneity was determined via the I² statistic. Factors associated with an abnormal CT head were summarized qualitatively.

RESULTS: Forty-six studies were included for analysis. The overall yield of CT head in the inpatient/ED was 13% (95% CI: 10.2%-15.9%) and in ICU was 17.4% (95% CI: 10%-26.3%), with considerable heterogeneity (I² 96% and 98% respectively). Heterogeneity was partly explained after accounting for study region, publication year, and representativeness of the target population. Yield of CT head diminished after year 2000 (19.8% vs. 11.1%) and varied widely depending on geographical region (8.4%-25.9%). The presence of focal neurological deficits was a consistent factor that increased yield.

CONCLUSION: Use of CT head to diagnose the etiology of delirium and AMS varied widely and yield has declined. Guidelines and clinical decision support tools could increase the appropriate use of CT head in the diagnostic etiology of delirium/AMS.

PMID:36434820 | DOI:10.1111/jgs.18134

J Biomed Mater Res B Appl Biomater. 2022 Nov 26. doi: 10.1002/jbm.b.35206. Online ahead of print.

ABSTRACT

This study evaluated the effect of resin cement coating with high and low viscosities on the flexural fatigue strength of machined lithium disilicate glass-ceramic. Discs (IPS e.max CAD; Ivoclar Vivadent) were prepared and divided according to the surface condition (machining [M]-CEREC inLab; and polishing [P]-laboratory procedures), resin cement coating (with or without), and cement viscosity (high [H] and low [L]). The ceramic bonding surface was etched/primed by a one-step primer application followed by resin cement application (Variolink N base + high or low viscosity catalyst; Ivoclar Vivadent). Biaxial flexural fatigue strength was evaluated on a piston-on-three-ball set by the step-test method (n = 15) (initial stress: 60 MPa; incremental steps: 20 MPa; 10,000 cycles/step, at 20 Hz). Weibull statistics were used for fatigue data. Contact angle, topographic, and fractographic analysis were also performed. Machining produced statistically lower contact angle than polishing and a significant detrimental effect on the fatigue behavior (σ₀ M = 247.2 [246.9-268.3]; σ₀ P = 337.4 [297.8-382.4]). Machined groups followed by resin cement coating (σ₀ MH = 297.9 [276.0-321.5]; σ₀ Ml = 301.2 [277.1-327.4]) behaved similarly to the polished and coated groups (σ₀ PH = 342.0 [308.9-378.5]; σ₀ PL = 357.3 [324.7-393.1]), irrespective of the cement viscosity. Therefore, cement coating has able to revert the detrimental effects of the machining on the fatigue strength of lithium disilicate glass-ceramic. High and low viscosity cements behaved similarly in the improvement of CAD-CAM lithium disilicate fatigue strength.

PMID:36434818 | DOI:10.1002/jbm.b.35206

Med Phys. 2022 Nov 26. doi: 10.1002/mp.16122. Online ahead of print.

ABSTRACT

PURPOSE: The use of convolution neural networks (CNN) to accurately predict dose distributions can accelerate intensity-modulated radiation therapy (IMRT) planning. The purpose of our study is to develop a novel deep learning architecture for precise voxel-level dose prediction on brain tumors.

METHODS: A dataset of 120 patients with brain tumors is built for the retrospective study. The dose distributions are predicted by a designed end-to-end model called TS-Net, in which the transformer encoder module is utilized to obtain abundant global features by learning long-range correlations of the input sequence. In addition, semantic field alignment (SFA) block is proposed in decoding path to ensure effective propagation of strong semantic information from deep to shallow. Five images from different channels are fed into the architecture including a computed tomography (CT) image, a planning target volumes (PTV) image, an organs-at-risk (OARs) image, a beam configuration image, and a distance image, and the predicted dose distributions are taken as outputs. We use different evaluation metrics to evaluate the performance of the model and discuss the role of the auxiliary beam configuration information provided by non-modulated dose distributions.

RESULTS: The TS-Net prediction accuracies in terms of mean absolute error (MAE) are 2.98% for PTV, 7.19% for brainstem, 1.88% for left len, 2.48% for right len, 9.61% for left optic nerve, 9.10% for right optic nerve, 8.99% for optic chiasma, and 8.28% for pituitary. There is no statistically significant difference between the predicted results and clinical dose distributions for clinical indexes including homogeneity index (HI), D50, and D95 for PTV; V40, mean dose, and max dose for OARs; except for conformation index (CI) and D2 for PTV. The model has dice similarity coefficient (DSC) values of above 0.91 for most isodose volumes, clearly outperforming HD U-Net, and being slightly better than U-Net and DCNN.

CONCLUSION: The proposed TS-Net with beam configuration input can achieve accurate voxel-level dose prediction for brain tumors, and is a usable tool for improving the efficiency and quality of radiotherapy. This article is protected by copyright. All rights reserved.

PMID:36434793 | DOI:10.1002/mp.16122

Eur Heart J Cardiovasc Pharmacother. 2022 Nov 26:pvac067. doi: 10.1093/ehjcvp/pvac067. Online ahead of print.

ABSTRACT

AIMS: The effect of a prasugrel versus a ticagrelor based strategy on total (including both first and recurrent) ischemic and bleeding events in patients with acute coronary syndromes (ACS) has not been evaluated. The aim of this analysis was to investigate the treatment effect of a prasugrel versus a ticagrelor based strategy in patients with ACS undergoing an invasive management strategy when both first and recurrent non-fatal ischemic and bleeding events are taken into account.

METHODS AND RESULTS: This is a post-hoc analysis of the ISAR-REACT-5 randomized control trial, including all 4 018 patients in the trial. The main clinical endpoints of interest included ischemic events (myocardial infarction (MI) and stroke) and bleeding events (Bleeding Academic Research Consortium (BARC) type 3 to 5 bleeding). An additional endpoint of interest was definite/probable stent thrombosis. The effect of the prasugrel versus ticagrelor based strategies on these endpoints was evaluated on both time-to-first event and total events analyses. Patients in the prasugrel group had a lower risk of MI in comparison to the ticagrelor group on both time-to-first event (hazard ratio [HR] = 0.61; 95% confidence interval 0.44-0.85) and total events (HR = 0.62 [0.45-0.86]) analysis. The risk of BARC type 3 to 5 bleeding was comparable between the prasugrel and ticagrelor groups on both time-to-first event (HR = 0.96 [0.75-1.25]) and total events (HR = 0.99 [0.76-1.31]) analysis.

CONCLUSION: A prasugrel based strategy was associated with a reduction in total MI events in comparison to a ticagrelor based strategy in patients with ACS undergoing invasive assessment. Total BARC type 3 to 5 bleeding events were comparable between the two groups. Given the importance of this topic, future studies to confirm these findings would be welcome.

PMID:36434779 | DOI:10.1093/ehjcvp/pvac067

Multivariate Behav Res. 2022 Nov 26:1-28. doi: 10.1080/00273171.2022.2135089. Online ahead of print.

ABSTRACT

The Ising model is a graphical model that has played an essential role in network psychometrics. It has been used as a theoretical model to conceptualize psychological concepts and as a statistical model to analyze psychological data. Using graphical models such as the Ising model to analyze psychological data has been heavily critiqued since these data often come from cross-sectional applications. An often voiced concern is the inability of the Ising model to express heterogeneity in the population. The idiographic approach has been posed as an alternative and aims to infer individual network structures. While idiographic networks overcome population heterogeneity, it is unclear how they aggregate into established cross-sectional phenomena. This paper establishes a formal bridge between idiographic and cross-sectional network approaches of the Ising model. We ascertain unique topological structures that characterize individuals and aggregate into an Ising model cross-sectionally. This new formulation supports population heterogeneity while being consistent with cross-sectional phenomena. The proposed theory also establishes a new statistical framework for analyzing populations of idiographic networks for binary variables. The Ising model and the divide and color model are special cases of this new framework. We introduce a Gibbs sampling algorithm to estimate models from this new framework.

PMID:36434773 | DOI:10.1080/00273171.2022.2135089