Tag: nevin manimala

Transpl Int. 2021 Aug 19. doi: 10.1111/tri.14012. Online ahead of print.

ABSTRACT

Post-transplant malignancy is diagnosed in approximately 18% of heart transplant patients and is a leading cause of death post-transplant. One modifiable risk factor is the type and amount of immunosuppression received. Contemporary rabbit anti-thymocyte globulin (rATG) dosing strategy using T-cell-guided dosing, and its effect on malignancy in heart transplant patients is unclear. This was a single-center, retrospective chart review of heart transplant recipients receiving rATG for induction. Patients diagnosed with malignancy post-transplant were matched 1:2 to controls using a nested case-control design. The primary endpoint was to determine the relative risk of rATG exposure with the actual incidence of malignancy post-transplant. The secondary endpoint was the impact of maintenance immunosuppression on malignancy risk. Of the 126 patients included in the study, 25 developed malignancy and were matched to 50 control patients. The median cumulative rATG dose in milligrams (mg) between groups was 365mg in malignancy cases and 480mg in controls (OR 0.90, 95% CI 0.75 – 1.08, p=0.28). In both the univariate and multivariable analysis, there was no statistically significant difference in malignancy risk found with any maintenance immunosuppressant. The results of this study showed that patient-tailored rATG dosing strategies may not be associated with malignancy development as previously thought.

PMID:34411345 | DOI:10.1111/tri.14012

Acta Paediatr. 2021 Aug 19. doi: 10.1111/apa.16076. Online ahead of print.

ABSTRACT

AIM: This study examined trends in absolute and relative socioeconomic, gender and geographical inequalities in the coverage of polio immunisation in Guinea, West Africa, from 1999-2016.

METHODS: Data from the 1999, 2005 and 2012 Guinea Demographic and Health Survey and the 2016 Guinea Multiple Indicator Cluster Survey were analysed using the World Health Organization’s health equity assessment toolkit. We disaggregated polio immunisation coverage using five equity stratifiers: household economic status, maternal educational level, place of residence, child’s gender and region. The four summary measures used were the difference, ratio, population attributable risk and population attributable fraction. A 95% confidence interval (CI) was constructed around point estimates to measure statistical significance.

RESULTS: A total of 4,778 one-year-old children were included. Polio immunisation coverage in 1999, 2005, 2012 and 2016 were 43.4%, 50.7%, 51.2% and 38.6%, respectively. Socioeconomic and geographical inequalities in polio immunisation favoured children with educated mothers who came from richer families living in urban areas. There were also differences in the eight regions over the 1999-2016 study period.

CONCLUSION: Targeting children from disadvantaged subgroups must be prioritised to ensure equitable immunisation services that help to eradicate polio in Guinea.

PMID:34411347 | DOI:10.1111/apa.16076

Neural Comput. 2021 Jun 11;33(7):1751-1817. doi: 10.1162/neco_a_01389.

ABSTRACT

Time series data sets often contain heterogeneous signals, composed of both continuously changing quantities and discretely occurring events. The coupling between these measurements may provide insights into key underlying mechanisms of the systems under study. To better extract this information, we investigate the asymptotic statistical properties of coupling measures between continuous signals and point processes. We first introduce martingale stochastic integration theory as a mathematical model for a family of statistical quantities that include the phase locking value, a classical coupling measure to characterize complex dynamics. Based on the martingale central limit theorem, we can then derive the asymptotic gaussian distribution of estimates of such coupling measure that can be exploited for statistical testing. Second, based on multivariate extensions of this result and random matrix theory, we establish a principled way to analyze the low-rank coupling between a large number of point processes and continuous signals. For a null hypothesis of no coupling, we establish sufficient conditions for the empirical distribution of squared singular values of the matrix to converge, as the number of measured signals increases, to the well-known Marchenko-Pastur (MP) law, and the largest squared singular value converges to the upper end of the MP support. This justifies a simple thresholding approach to assess the significance of multivariate coupling. Finally, we illustrate with simulations the relevance of our univariate and multivariate results in the context of neural time series, addressing how to reliably quantify the interplay between multichannel local field potential signals and the spiking activity of a large population of neurons.

PMID:34411270 | DOI:10.1162/neco_a_01389

Neural Comput. 2021 Jun 11;33(7):1993-2032. doi: 10.1162/neco_a_01400.

ABSTRACT

The Potjans-Diesmann cortical microcircuit model is a widely used model originally implemented in NEST. Here, we reimplemented the model using NetPyNE, a high-level Python interface to the NEURON simulator, and reproduced the findings of the original publication. We also implemented a method for scaling the network size that preserves first- and second-order statistics, building on existing work on network theory. Our new implementation enabled the use of more detailed neuron models with multicompartmental morphologies and multiple biophysically realistic ion channels. This opens the model to new research, including the study of dendritic processing, the influence of individual channel parameters, the relation to local field potentials, and other multiscale interactions. The scaling method we used provides flexibility to increase or decrease the network size as needed when running these CPU-intensive detailed simulations. Finally, NetPyNE facilitates modifying or extending the model using its declarative language; optimizing model parameters; running efficient, large-scale parallelized simulations; and analyzing the model through built-in methods, including local field potential calculation and information flow measures.

PMID:34411272 | DOI:10.1162/neco_a_01400

J Clin Apher. 2021 Aug 19. doi: 10.1002/jca.21932. Online ahead of print.

ABSTRACT

BACKGROUND: Optimization of platelet (PLT) apheresis collection is a priority to satisfy the increasing demand of hemato-oncology patients. We assessed the performance of a plateletpheresis unit supporting hematology patients.

STUDY DESIGN AND METHODS: This descriptive retrospective study included 561 plateletpheresis collections from 2013 to 2018. For data analysis, descriptive statistics and receiver operating characteristic (ROC) curve were used. A 5-item satisfaction questionnaire was analyzed.

RESULTS: Ninety percent of the donors were males. The median plateletpheresis time was 89 minutes; its success rate was 92.5%; median donor PLT count was 232 × 10⁹ /L, women median PLT count was 247 × 10⁹ /L vs 231×10⁹ /L in men (P = .017). Seventy-seven percent donors were candidates for a double product and 24.5% were processed; 20.8% of these donors had a weight ≤75 and 79.2% >75 kg, P = .003, and 6.6% were women and 93.4% men, P = .161. Thirty-six of donors had ≥250 × 10⁹ /L and 16.8% was processed as a triple product. ROC analysis showed that with donor PLT counts ≥200 × 10⁹ /L the sensitivity for obtaining double products was 0.981 and specificity 0.714, with an area under the curve (AUC) = 0.877. The adverse effect rate was 4.3%. Of the potential donors, 6.3% were rejected. The cost of processing single or double products was 430 USD. Comfort and time spent during plateletpheresis were areas for improvement.

CONCLUSION: Platelet count and donor weight predicted PLT yield and obtaining double products. Women had higher PLT counts, but no significant difference was found between donor gender and processed products. Assessment of the apheresis unit can help to improve its performance.

PMID:34411330 | DOI:10.1002/jca.21932

QJM. 2021 Aug 19:hcab222. doi: 10.1093/qjmed/hcab222. Online ahead of print.

ABSTRACT

BACKGROUND: Calcium ion (Ca2+) is essential for human physiology by regulating various signal transduction pathways inside all cells and in the blood circulation.

AIM: We compared circulating Ca2+ levels in the healthy control against 48 different types of human diseases.

DESIGN: A total of 144,201 independent test results of Ca2+ levels from 48 clinically defined diseases and 141,679 independent test results of Ca2+ from healthy individuals who came to the hospital for annual physical examination were retrieved during the past five years.

METHODS: Ca2+ was determined by the standard “Arsenazo III method” in the clinical laboratory of Affiliated Hospital of Qingdao University. We analyzed all data using RStudio V.1.3.1073 and python libraries 3.8.

RESULTS: All 48 types of diseases had decreased Ca2+ levels than the healthy control based on either mean or median values. Patients suffering from preeclampsia had the lowest Ca2+ levels among all 48 diseases. The perfect AUC, sensitivity, and specificity values of 1.0, 0.96, and 0.96 indicated that Ca2+ was an excellent biomarker for diagnosing preeclampsia. Extremely low Ca2+ was present in patients suffering kidney-related diseases. Since the correlation between each disease on the statistical features is proportional to their vector distance, the two-component analysis revealed that preeclampsia, sepsis, and chronic obstructive pulmonary disease were closely related among 48 diseases.

CONCLUSIONS: All human diseases were associated with reduced circulating Ca2+ levels, where the decreased Ca2+ was a perfect biomarker for preeclampsia. Kidney-related conditions were related to over-down-regulation of Ca2+ levels. The resemblance of preeclampsia to sepsis and chronic obstructive pulmonary disease based on two-component analysis suggested that the three unrelated diseases might share a similar mechanism of the circulating Ca2+ regulation.

PMID:34411257 | DOI:10.1093/qjmed/hcab222

Neurosurgery. 2021 Aug 19:nyab301. doi: 10.1093/neuros/nyab301. Online ahead of print.

ABSTRACT

BACKGROUND: Postoperative prophylactic antibiotics are commonly used in pituitary surgery, but evidence supporting their use is lacking, which has implications for antibiotic stewardship.

OBJECTIVE: To evaluate whether receipt of postoperative oral antibiotics results in superior sinonasal quality of life (QOL) compared with placebo among patients who undergo endoscopic endonasal transsphenoidal pituitary surgery.

METHODS: Patients were randomized to receive either oral placebo or cefdinir (trimethoprim-sulfamethoxazole in patients intolerant to cefdinir) for 7 d after surgery. They were monitored for 12 wk. The primary outcome measure was sinonasal QOL at 2 wk on the Anterior Skull Base Nasal Inventory-12. Supplementary end points included sinonasal QOL reported on the Sinonasal Outcome Test-22 and objective endoscopy scores to assess nasal healing according to the Lund-Kennedy method.

RESULTS: A total of 461 patients were screened, 131 were randomized, and 113 (placebo arm: 55; antibiotic arm: 58) were analyzed. There was no clinically meaningful or statistically significant difference in sinonasal QOL at any measured time point (P ≥ .24) using either instrument. Nasal cavity endoscopy scores were not significantly different at 1 to 2 wk after surgery (P = .25) or at 3 to 4 wk after surgery (P = .08).

CONCLUSION: Postoperative prophylactic oral antibiotics did not result in superior sinonasal QOL compared with placebo among patients who underwent standard endoscopic transsphenoidal surgery.

PMID:34411264 | DOI:10.1093/neuros/nyab301

Oper Dent. 2021 Aug 19. doi: 10.2341/20-062-C. Online ahead of print.

ABSTRACT

CLINICAL RELEVANCE: Repairing defective crown margins can extend the functional life of existing crowns.

SUMMARY: Objective: The objective of this study was to determine the survival time of crown margin repairs (CMRs) with glass ionomer and resin-modified glass ionomer cements on permanent teeth using electronic dental record (EDR) data.Methods: We queried a database of EDR (axiUm; Exan Group, Coquitlam, BC, Canada) in the Indiana University School of Dentistry (IUSD), Indianapolis, IN, USA, for records of patients who underwent CMRs of permanent teeth at the Graduate Operative Dentistry Clinic. Two examiners developed guidelines for reviewing the records and manually reviewed the clinical notes of patient records to confirm for CMRs. Only records that were confirmed with the presence of CMRs were retained in the final dataset for survival analysis. Survival time was calculated by Kaplan-Meier statistics, and a Cox proportional hazards model was performed to assess the influence of age, gender, and tooth type on survival time (a<0.05).Results: A total of 214 teeth (115 patients) with CMR were evaluated. Patient average age was 69.4 ± 11.7 years old. Posterior teeth accounted for 78.5% (n=168) of teeth treated. CMRs using glass ionomer cements had a 5-year survival rate of 62.9% and an annual failure rate (AFR) of 8.9%. Cox proportional-hazards model revealed that none of the factors examined (age, gender, tooth type) affected time to failure.Conclusion: The results indicate the potential of CMRs for extending the functional life of crowns with defective margins, thus reducing provider and patient burden of replacing an indirect restoration. We recommend future studies with a larger population who received CMR to extend the generalizability of our findings and to determine the influence of factors such as caries risk and severity of defects on survival time.

PMID:34411254 | DOI:10.2341/20-062-C

Mil Med. 2021 Aug 19:usab322. doi: 10.1093/milmed/usab322. Online ahead of print.

ABSTRACT

INTRODUCTION: The coronavirus-2019 (COVID-19) pandemic has significantly impacted global healthcare delivery. Brooke Army Medical Center (BAMC) is the DoD’s largest hospital and a critical platform for maintaining a ready medical force. We compare temporal trends in patient volumes and characteristics in the BAMC emergency department (ED) before versus during the pandemic.

MATERIALS AND METHODS: We abstracted data on patient visits from the BAMC ED electronic medical record system. Data included patient demographics, visit dates, emergency severity index triage level, and disposition. We visually compared the data from January 1, 2019 to November 30, 2019 versus January 1, 2020 to November 30, 2020 to assess the period with the most apparent differences. We then used descriptive statistics to characterize the pre-pandemic control period (1 March-November 30, 2019) versus the pandemic period (1 March-November 30, 2020).

RESULTS: Overall, when comparing the pre-pandemic and pandemic periods, the median number of visits per day was 232 (Interquartile Range (IQR) 214-250, range 145-293) versus 165 (144-193, range 89-308, P < .0001). Specific to pediatric visits, we found the median number of visits per day was 39 (IQR 33-46, range 15-72) versus 18 (IQR 14-22, range 5-61, P < .001). When comparing the median number of visits by month, the volumes were lower during the pandemic for all months, all of which were strongly significant (P < .001 for all).

CONCLUSIONS: The BAMC ED experienced a significant decrease in patient volume during the COVID-19 pandemic starting in March 2020. This may have significant implications for the capacity of this facility to maintain a medically ready force.

PMID:34411255 | DOI:10.1093/milmed/usab322

Int J Oral Maxillofac Implants. 2021 Jul-Aug;36(4):762-770. doi: 10.11607/jomi.8682.

ABSTRACT

PURPOSE: The aim of this study was to investigate the influence of different clinical parameters on the primary stability of a variable thread tapered implant system with a focus on surgical undersizing protocols.

MATERIALS AND METHODS: This retrospective study evaluated patients who received NobelActive implants in a single institution. The relationship between the independent variables, bone quality, implant diameter, implant length, implantation time, region of the jaw, and surgical undersizing protocol, and the dependent variable, maximum insertion torque, was investigated. Statistical analysis was conducted using analysis of variance (ANOVA) and multiple linear regression.

RESULTS: A total of 1,292 implants placed in 574 fully or partially edentulous patients were evaluated. For the total sample size, without further differentiation between bone qualities, statistically significantly higher primary stability values were shown for an 8% to 9% undersized group (50.33 ± 17.16 Ncm), compared with a 16% undersized group (41.88 ± 17.63 Ncm), a 20% undersized group (33.65 ± 15.78 Ncm), a 26% to 28% undersized group (34.53 ± 15.49 Ncm), and a 35% to 44% undersized group (32.78 ± 18.80 Ncm). No statistical differences were found for undersizing protocols in bone quality 4. Bone quality had the highest influence on primary stability (Welch-Test F(3, 65.57) = 119.48, P < .001, η² = .20). Contrary to the other investigated independent variables, no statistically significant differences in primary stability were found for the different implantation times.

CONCLUSION: Undersizing protocols exceeding 8% to 9% do not seem to enhance primary stability values. Further studies are needed to investigate the biologic consequences of undersizing, including the impact of implant design characteristics.

PMID:34411218 | DOI:10.11607/jomi.8682