Tag: nevin manimala

J Clin Ultrasound. 2022 Jul 8. doi: 10.1002/jcu.23268. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the application value of combined intravenous contrast-enhanced ultrasound (IV-CEUS) with intrabiliary contrast-enhanced ultrasound (IB-CEUS) in the preoperative evaluation of hilar cholangiocarcinoma (HCCA) resectability.

METHODS: Clinical data from 82 patients with HCCA confirmed by surgery and pathology were retrospectively analyzed. Preoperative IV-CEUS + IB-CEUS and magnetic resonance cholangiopancreatography (MRCP) were performed and the results were compared with surgical and pathological findings.

RESULTS: The accuracy of the Bismuth-Corlette classification confirmed by IV-CEUS + IB-CEUS and MRCP was 95.12% (78/82) and 87.8% (72/82), respectively. The diagnostic precision of IV-CEUS + IB-CEUS was better than MRCP (p = 0.001). The sensitivity, specificity, and precision of CEUS for diagnosing lymph node metastases (72.7%, 93.3%, and 87.8%), intrahepatic metastases (78.6%, 98.5%, and 93.9%), invasion of the hepatic artery (92.9%, 98.5%, and 97.6%) and invasion of the portal vein (93.8%, 98.5%, and 97.6%) of HCCA were, respectively. The consistency between the preoperative evaluation of resectability confirmed by IV-CEUS +IB-CEUS and MRCP was 85.4% (70/82) and 78.0% (64/82), respectively. In addition, the evaluations did not have statistically significant differences (p > 0.05). There were no significant differences between the two evaluations (p = 0.266).

CONCLUSION: IV-CEUS combined with IB-CEUS has significant value in classifying HCCA and evaluating the resectability of lymph node metastases, liver metastases, and vessel invasion.

PMID:35808898 | DOI:10.1002/jcu.23268

J Hand Surg Asian Pac Vol. 2022 Jun;27(3):466-472. doi: 10.1142/S242483552250045X.

ABSTRACT

Background: Bony deformities and arthropathies have been noticed in thalassemia patients. The aim of this study is to compare the arc of motion and radiological parameters of the wrist and patient rated wrist evaluation (PRWE) between adult transfusion-dependent thalassemics and normal subjects. Methods: An observational cross-sectional study was done in the department of orthopaedics over a period of 2 years where a total of 30 skeletally mature thalassemia major patients (group A) were assessed. The data was then compared with the data of demographically matched 30 healthy adults (group B). Arc of motion of the dominant wrist that included flexion, extension, radial and ulnar deviation, pronation and supination was measured using a handheld goniometer for both groups. Radiographs of the dominant wrist were obtained in both groups and used to determine the radial height, radial articular angle and carpal slip. PRWE was used to assess the function of the wrist. A p-value of <0.05 was considered statistically significant. Results: Clinical abnormalities at the wrist joint were found in 80% of thalassaemia patients. There was a statistically significant increase in ulnar deviation, wrist extension and decrease in wrist flexion in group A compared to group B. Radiological abnormalities were found in 100% of thalassaemia patients. All the radiological parameters were significantly increased in group A compared to group B. There were no differences in PRWE scores between both groups. Conclusion: Clinical and radiological changes of wrist joint occur in skeletally mature thalassaemia major patients due to shortened ulna compared to healthy adults. This may be due to disease itself, bone marrow expansion, osteopenia, drug (chelating agent) or iron toxicity. Understanding the changes at the wrist in patients with thalassemia major is important to increasing the life expectancy of these patients. Level of Evidence: Level IV (Diagnostic).

PMID:35808882 | DOI:10.1142/S242483552250045X

J Hand Surg Asian Pac Vol. 2022 Jun;27(3):453-458. doi: 10.1142/S2424835522500473.

ABSTRACT

Background: The aims of this study were to investigate the impact of diabetes mellitus on patient-reported functional outcome measures (PROMs) and satisfaction following surgical treatment of Dupuytren contracture. Methods: Preoperative and 1-year postoperative PROMs were collected prospectively over 6 years (2013-2019). Patients completed the QuickDASH score and were asked ‘how normal is your hand?’, recording responses on a 100-point visual analogue scale. Patient satisfaction was also self-reported. Results: Paired responses were available for 520 hands (478 patients; 72% follow-up rate). There were 62 patients with diabetes (12%). Pre (12.5 vs. 9.1; p = 0.01) and postoperative (11.4 vs. 6.8; p = 0.02) QuickDASH scores were significantly, but not clinically, worse in diabetic patients. Patient satisfaction was high in both groups. A large and significant improvement in self-perceived hand normality was observed in both groups (p < 0.05). No significant differences were observed in preoperative or change in hand normality between the groups, but the postoperative normal hand score was significantly higher in non-diabetic patients (94 vs. 90; p = 0.02). Conclusion: Our study has demonstrated statistically significantly worse disability in diabetic patients with Dupuytren contracture both pre- and postoperatively, though the observed differences were far below the minimum clinically important difference for the QuickDASH. Both groups reported a large and statistically significant improvement in self-perceived hand normality following surgery. Level of Evidence: Level III (Therapeutic).

PMID:35808876 | DOI:10.1142/S2424835522500473

J Hand Surg Asian Pac Vol. 2022 Jun;27(3):421-429. doi: 10.1142/S2424835522300043.

ABSTRACT

Interpreting research is an important skill to ensure one can maintain their practise with current evidence. The technicalities of statistics can be daunting and thus, this article aims to provide a clear overview of key statistical tests that a surgeon will encounter. It highlights the various study designs, summary statistics and comparative tests that are used in clinical research. Furthermore, it provides a guide to determine which statistical method is most appropriate for various study designs. Overall, it aims to act as an introductory text to supplement further reading into the more advanced statistical methodologies. Level of Evidence: Level V.

PMID:35808879 | DOI:10.1142/S2424835522300043

Biol Rev Camb Philos Soc. 2022 Jul 8. doi: 10.1111/brv.12876. Online ahead of print.

ABSTRACT

Disturbances alter biodiversity via their specific characteristics, including severity and extent in the landscape, which act at different temporal and spatial scales. Biodiversity response to disturbance also depends on the community characteristics and habitat requirements of species. Untangling the mechanistic interplay of these factors has guided disturbance ecology for decades, generating mixed scientific evidence of biodiversity responses to disturbance. Understanding the impact of natural disturbances on biodiversity is increasingly important due to human-induced changes in natural disturbance regimes. In many areas, major natural forest disturbances, such as wildfires, windstorms, and insect outbreaks, are becoming more frequent, intense, severe, and widespread due to climate change and land-use change. Conversely, the suppression of natural disturbances threatens disturbance-dependent biota. Using a meta-analytic approach, we analysed a global data set (with most sampling concentrated in temperate and boreal secondary forests) of species assemblages of 26 taxonomic groups, including plants, animals, and fungi collected from forests affected by wildfires, windstorms, and insect outbreaks. The overall effect of natural disturbances on α-diversity did not differ significantly from zero, but some taxonomic groups responded positively to disturbance, while others tended to respond negatively. Disturbance was beneficial for taxonomic groups preferring conditions associated with open canopies (e.g. hymenopterans and hoverflies), whereas ground-dwelling groups and/or groups typically associated with shady conditions (e.g. epigeic lichens and mycorrhizal fungi) were more likely to be negatively impacted by disturbance. Across all taxonomic groups, the highest α-diversity in disturbed forest patches occurred under moderate disturbance severity, i.e. with approximately 55% of trees killed by disturbance. We further extended our meta-analysis by applying a unified diversity concept based on Hill numbers to estimate α-diversity changes in different taxonomic groups across a gradient of disturbance severity measured at the stand scale and incorporating other disturbance features. We found that disturbance severity negatively affected diversity for Hill number q = 0 but not for q = 1 and q = 2, indicating that diversity-disturbance relationships are shaped by species relative abundances. Our synthesis of α-diversity was extended by a synthesis of disturbance-induced change in species assemblages, and revealed that disturbance changes the β-diversity of multiple taxonomic groups, including some groups that were not affected at the α-diversity level (birds and woody plants). Finally, we used mixed rarefaction/extrapolation to estimate biodiversity change as a function of the proportion of forests that were disturbed, i.e. the disturbance extent measured at the landscape scale. The comparison of intact and naturally disturbed forests revealed that both types of forests provide habitat for unique species assemblages, whereas species diversity in the mixture of disturbed and undisturbed forests peaked at intermediate values of disturbance extent in the simulated landscape. Hence, the relationship between α-diversity and disturbance severity in disturbed forest stands was strikingly similar to the relationship between species richness and disturbance extent in a landscape consisting of both disturbed and undisturbed forest habitats. This result suggests that both moderate disturbance severity and moderate disturbance extent support the highest levels of biodiversity in contemporary forest landscapes.

PMID:35808863 | DOI:10.1111/brv.12876

Glob Chang Biol. 2022 Jul 8. doi: 10.1111/gcb.16336. Online ahead of print.

ABSTRACT

Extreme precipitation and drought events are predicted to become more intense and more frequent over the Amazon rainforest. Because changes in forest dynamics could prompt strong feedback loops to the global climate, it is of crucial importance to gain insight into the response of tropical forests to these recurring extreme climatic events. Here, we evaluated the Amazon forest stability (resistance and resilience) to drought in the context of past dry and wet climatic events using MODIS EVI satellite imagery and cumulative water deficit anomalies. We observed large spatial differences in the occurrence of extreme climatic events from 1980 to 2019, with an increase in drought frequency in the central and northern Amazon and drought intensity in the southern Amazon basin. An increasing trend in the occurrence of wet events was found in the western, southern, and eastern Amazon. Furthermore, we found significant legacy effects of previous climatic events on the forest drought response. An extreme drought closely preceding another drought decreased forest resilience, while the occurrence of a recent drier-than-usual event also decreased the forest resistance to later droughts. Both wetter-than-usual and extreme wet events preceding an extreme drought increased the resistance of the forest, and with similar effects sizes as dry events, indicating that wet and dry events have similarly sized legacy effects on the drought response of tropical forests. Our results indicate that the predicted increase in drought frequency and intensity can have negative consequences for the functioning of the Amazon forest. However, more frequent wet periods in combination with these droughts could counteract their negative impact. Finally, we also found that more stable forests according to the alternative stable states theory are also more resistant and resilient to individual droughts, showing a positive relationship between the equilibrium and non-equilibrium stability dynamics.

PMID:35808855 | DOI:10.1111/gcb.16336

Clin Transl Sci. 2022 Jul 8. doi: 10.1111/cts.13369. Online ahead of print.

ABSTRACT

Coronavirus disease 2019 (Covid-19) is associated with endothelial dysfunction. Pharmacologically targeting the different mechanisms of endothelial dysfunction may improve clinical outcomes and lead to reduced morbidity and mortality. In this pilot, double-blind, placebo-controlled, randomized clinical trial we assigned patients who were admitted to the hospital with mild, moderate, or severe COVID-19 infection to receive, on top of optimal medical therapy, either an endothelial protocol consisting of (Nicorandil, L-arginine, Folate, Nebivolol, and Atorvastatin) or placebo for up to 14 days. The primary outcome was time to recovery, measured by an 8 category ordinal scale and defined by the time to being discharged from the hospital or hospitalized for infection-control or other nonmedical reasons. Secondary outcomes included the composite outcome of ICU admission or the need for mechanical ventilation, all-cause mortality, and the occurrence of side effects. Of 42 randomized patients, 37 were included in the primary analysis. The mean age of the patients was 57 years; the mean BMI of study participants was 29.14. History of hypertension was present in 27% of the patients, obesity in 45%, and Diabetes Mellitus in 21.6%. The median(Interquartile range) time to recovery was not significantly different between the endothelial protocol group (6 [4-12] days) and the placebo group (6 [5-8]days)(p-value = 0.854). Furthermore, there were no statistically significant differences in the need for mechanical ventilation or ICU admission, all-cause mortality, and the occurrence of side effects between the endothelial protocol group and the placebo group. Among patients hospitalized with mild, moderate, or severe COVID-19 infection, targeting endothelial dysfunction by administering Nicorandil, L-arginine, Folate, Nebivolol, and Atorvastatin on top of optimal medical therapy did not decrease time to recovery. Based on this study findings, targeting endothelial dysfucntion did not result in a clinically significant improvement in outcome and as such larger trials targeting this pathway are not recommended.

PMID:35808843 | DOI:10.1111/cts.13369

J Int Med Res. 2022 Jul;50(7):3000605221105344. doi: 10.1177/03000605221105344.

ABSTRACT

OBJECTIVE: Chromodomain helicase DNA-binding 5 (CHD5) acts as a tumor suppressor gene in some cancers. CHD5 expression levels may affect an individual’s susceptibility to hepatocellular carcinoma (HCC). This study aimed to evaluate the methylation pattern of the CHD5 promoter region and the gene’s corresponding mRNA expression in HCC patients compared with healthy individuals.

METHODS: In this case-control study, CHD5 mRNA gene expression levels and DNA methylation patterns were analyzed in 81 HCC patients and 90 healthy individuals by quantitative reverse transcription polymerase chain reaction and methylation-specific polymerase chain reaction, respectively.

RESULTS: The CHD5 gene was hypermethylated in 61.8% of the HCC patients and 54.4% of the controls, and this difference was statistically significant. The CHD5 mRNA expression levels were significantly lower in the HCC patient group.

CONCLUSIONS: Hypermethylation of the CHD5 promoter region may significantly lower the expression of this gene, affecting the incidence and severity of HCC. The methylation status of CHD5 can also be further studied as a prognostic factor in HCC.

PMID:35808817 | DOI:10.1177/03000605221105344

J Healthc Manag. 2022 Jul 1;67(4):266-282. doi: 10.1097/JHM-D-21-00045.

ABSTRACT

GOAL: The national Baldrige program has supported performance excellence in healthcare since 1999. Previous studies have compared the performance of Baldrige hospital recipients to nonrecipients. This study, however, sought to address the question of whether the mere pursuit of the Baldrige award provides value.

METHODS: This study used propensity score matching with linear and quantile regression techniques to understand the impact of hospitals applying the Baldrige Excellence Framework across a comprehensive set of standardized industry performance measures, regardless of award recognition.

PRINCIPAL FINDINGS: The analysis demonstrated that Baldrige applicants outperformed non-Baldrige applicants in select operational measures of efficiency (such as inpatient average length of stay), patient experience, and financial measures (including return on net assets, days in accounts receivable, and expenses as a percentage of patient revenues). However, there was no statistically significant difference in clinical performance between Baldrige applicants and nonapplicants.

PRACTICAL APPLICATIONS: The findings from this study suggest that hospital leaders can realize significant gains with select operational and financial measures without compromising clinical outcomes when applying the Baldrige Excellence Framework to their organizations.

PMID:35802928 | DOI:10.1097/JHM-D-21-00045

Otol Neurotol. 2022 Jul 6. doi: 10.1097/MAO.0000000000003576. Online ahead of print.

ABSTRACT

OBJECTIVE: Comparison of outcomes and billing costs of patients treated at our institution using transmastoid (TM), middle cranial fossa (MCF), and combined approaches for repair of otogenic cerebrospinal fluid (CSF) leaks and encephaloceles.

STUDY DESIGN: Retrospective cohort review.

SETTING: Tertiary-care hospital.

PATIENTS: Seventy-seven cases of otogenic CSF leaks or encephaloceles.

INTERVENTIONS: Surgical repair of an otogenic encephalocele or CSF leak using either a TM, MCF, or combined approach.

MAIN OUTCOME MEASURES: Success of repair, length of operation, cost of operating room materials, postoperative need for intensive care, and postoperative length of stay.

RESULTS: Forty cases (52%) were performed by the TM approach, 27 (35%) by MCF, and 10 (13%) by combined TM/MCF. Mean length of stay was not statistically different amongst TM patients (2.1 d), MCF patients (3.3 d), and combined TM/MCF patients (3.70; p = 0.112). Only 3/40 TM cases required intensive care during their admission while all MCF and combined TM/MCF approach cases were admitted to the intensive care unit for at least one night (p < 0.001). On follow-up, CSF leak recurred in 3/77 (4%) cases: 3/27 (11%) MCF, 0/40 TM, and 0/10 combined TM/MCF patients (p = 0.056). The mean cost of operating room materials charged to the patient was significantly greater in the MCF group ($9,883) than the TM group ($3,748; p = 0.001).

CONCLUSIONS: In carefully selected patients, the TM approach is an effective and less costly alternative to MCF approaches for repair of otogenic CSF leaks and encephaloceles.

PMID:35802896 | DOI:10.1097/MAO.0000000000003576