Tag: nevin manimala

Int Urogynecol J. 2022 Apr 21. doi: 10.1007/s00192-022-05206-5. Online ahead of print.

ABSTRACT

INTRODUCTION AND HYPOTHESIS: Obstructive sleep apnea syndrome is associated with urological symptoms, including overactive bladder (OAB). This study aims to determine whether combined tolterodine and CPAP therapies are more effective for patients with OSAS than CPAP treatment only.

METHODS: Women who underwent polysomnography test and were diagnosed with moderate-to-severe OSAS with apnea-hypopnea index (AHI) were included in the study. Data were collected on AHI, OAB awareness-8-item tool (OAB-V8), incontinence questionnaire-urinary incontinence short form (ICIQ-UI-SF), total daily urine volume (DUV), and the Benefit, satisfaction with treatment and willingness (BSW) tool. Eligible patients were randomized to receive either CPAP treatment only or combined CPAP and tolterodine treatment for 3 months.

RESULTS: Among 103 participants, a total of 60 were included. Patients in both treatment arms showed significant improvements in OAB-V8, ICIQ-UI-SF, and total DUV compared to their baseline. The mean OAB-V8 was 15.7 at baseline and 5.6 at 3 months for the combined treatment arm and 16.6 and 7.6 at 3 months for the CPAP group only (mean baseline-adjusted between-group difference -1.1 [95% CI, -12.3 to -7.4]; p < 0.001). The improvement in the mean ICIQ-UI-SF was also statistically more significant in the combined therapy group than in the CPAP only arm (mean baseline-adjusted between-group difference -3.27 [95% CI, -4.6 to -1.59]; p < 0.001). No statistical significance was found in the improvement of total DUV between the groups.

CONCLUSIONS: In this study, combined use of tolterodine with CPAP provides beneficial effects to CPAP treatment only regarding OAB symptoms. Further research is required to confirm these findings in a large cohort.

PMID:35445808 | DOI:10.1007/s00192-022-05206-5

Int Wound J. 2022 Apr 21. doi: 10.1111/iwj.13814. Online ahead of print.

ABSTRACT

A meta-analysis was performed to assess the effect of surgical site wound infections and risk factors in neonates undergoing surgery. A systematic literature search up to January 2022 incorporated 17 trials involving 645 neonates who underwent surgery at the beginning of the trial; 198 of them had surgical site wound infections, and 447 were control for neonates. The statistical tools like the dichotomous or continuous method used within a random or fixed-influence model to establish the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) to evaluate the risk factors and influence of surgical site wound infections in neonates undergoing surgery. Surgical site wound infections had significantly higher mortality with OR value 2.03 at 95% CI 1.40-2.95 with P-value <0.001, the longer length of hospital stay (MD, 31.88; 95% CI, 18.17-45.59, P < 0.001), and lower birthweight of neonates (MD, -0.30; 95% CI, -0.53 to -0.07, P = 0.01) compared with neonates with no surgical site wound infections undergoing surgery. However, no remarkable change was observed with surgical site wound infections in the gestational age at birth of neonates (MD, -0.70; 95% CI, -1.46 to 0.05, P = 0.07), and the preoperative antibiotic prophylaxis (OR, 1.28; 95% CI, 0.57-2.87, P = 0.55) compared with no surgical site wound infections for neonates undergoing surgery. Surgical site wound infections had significantly higher mortality, a longer length of hospital stay, and lower birthweight of neonates. However, they had no statistically significant difference in the gestational age at birth of neonates and the preoperative antibiotic prophylaxis compared with no surgical site wound infections for neonates undergoing surgery. Furthermore, evidence is needed to confirm the outcomes.

PMID:35445789 | DOI:10.1111/iwj.13814

J Cardiovasc Surg (Torino). 2022 Apr;63(2):124-130. doi: 10.23736/S0021-9509.21.12203-7.

ABSTRACT

BACKGROUND: The aim of this study was to analyse the influence of true, false, and combined lumen perfusion of renal arteries on mid- and long-term kidney volume in patients with type B aortic dissection (TBAD).

METHODS: Retrospective analysis of patients diagnosed with a TBAD between 2008 and 2015 in a single high-volume European center. The origin of the renal arteries was evaluated on a dedicated 3D workstation (TeraRecon Inc., San Mateo, CA, USA) and coded as either arising from the true lumen (TL), false lumen (FL) or from a combination of both (CL). Additional evaluated anatomical parameters were renal volume, length, width, and depth of the kidneys. Measurements were recorded at the time of diagnosis (T0) and at 1-month (T1), 6-months (T2), 18-months (T3) and 36-month of follow-up time (T4).

RESULTS: A total of 131 renal arteries and kidneys were evaluated in 69 patients. Mean age was 64±13 years and 77% were male. The absolute number and percentage of assessed renal arteries/kidneys was 131 (100%) at T0, 89 (68%) at T1, 73 (56%) at T2, 57 (44%) at T3 and 43 (44%) at T4. At the time of diagnosis, 71.6% renal arteries originated from the TL, 19.1% from the FL and 9.2% from a CL. TEVAR was performed in 92.7% patients and nine patients had additional renal artery stenting. At T0 the mean renal volume was 212.1±70.9cm³, 178±61.2 in women versus 222.2±70.6 in men (P=0.002). Forty-three percent of the patients had a renal volume reduction ≥15% from T0 to their last available CTA. Mixed model analysis showed a significant overall renal volume reduction of 13.7cm³ from T0 to T4 (P<0.05). No significant differences in renal-volume reduction were observed depending on origin of the renal artery, though an estimated reduction of renal volume from T0 to T4 of 40.8 cm³ was seen when the kidneys were perfused by a CL, while TL perfusion only caused a reduction of 15.6 cm³ and no relevant volume change over time was observed when the renal artery originated from FL. Alongside a renal volume reduction, mixed model analysis also showed a significant serum-creatinine increase, from 0.8618mg/at T0 to 1.38±0.56 mg/dL at T4 (P<0.001), as well as a significant glomerular filtration rate reduction over time, from > 60mL/min at T0 to 49±13 mL/min at T4 (P<0.001). A negative correlation was observed between creatinine values and renal volume change, while a positive correlation was observed between GFR and renal volume change (P<0.001).

CONCLUSIONS: There is a significant mid-term renal-volume reduction in patients with TBAD, independent of the origin of the renal arteries. Albeit not statistically significant, combined renal artery perfusion may lead to a greater volume reduction, potentially secondary to a relevant dynamic compression by the dissection membrane. Further multicentre studies are warranted to determine the effect on long-term renal function and on possible preventive strategies.

PMID:35445805 | DOI:10.23736/S0021-9509.21.12203-7

Paediatr Anaesth. 2022 Apr 21. doi: 10.1111/pan.14466. Online ahead of print.

ABSTRACT

BACKGROUND: Failure to complete surgery within the scheduled timeframe impairs operating room efficiency leading to patient dissatisfaction and unplanned labor costs. We sought to improve timely completion (within 30 minutes of scheduled time) of first-case spine fusion surgery (for idiopathic scoliosis) from a baseline of 25% to 80% over 12 months. We also targeted timely completion of perioperative stages within predetermined target completion times.

METHODS: The project was conducted in three overlapping phases over 16 months. A simplified process map outlining five sequential perioperative stages, preintervention baselines (N=24) and time targets were defined. A multidisciplinary team conducted a series of tests of change addressing the aims. The key drivers included effective scheduling, team communications, family engagement, data collection veracity, standardized pathways, and situational awareness. Data collected by an independent data collector and from electronic medical records were analyzed using control charts and statistical process control methods.

RESULTS: Post-intervention, timely case completion increased from 25% to 68% (N=49) (95% CI 15.1-62.7, (p=0.003) and was sustained (N=14). Implementation of prediction model for case-scheduling decreased difference between scheduled and actual case end-time (33 vs 53 minutes (baseline)) and variance [lower/upper control limits [(-26, 51) vs (-109, 216) minutes (baseline)]. Average start time delay decreased from 6 to 2 minutes and on-time surgical starts improved from 50% to 70% (95% CI 3.2-41.6%). Timely completion increased for anesthesia induction (60% to 85%), surgical procedure (26% to 48%) and emergence from anesthesia (44% to 80%) but not for intraoperative patient preparation (30% to 25%) perioperative stages. Families reported satisfaction with preoperative processes (N=14) and no untoward intraoperative safety events occurred.

CONCLUSIONS: Application of QI methodology reduced time variation of several tasks and improved timely completion of spine surgery. Beyond the study period, sustained team behavior, adaptive changes and vigilant monitoring are imperative for continued success.

PMID:35445776 | DOI:10.1111/pan.14466

Int J Geriatr Psychiatry. 2022 Apr 13;37(5). doi: 10.1002/gps.5718. Online ahead of print.

ABSTRACT

OBJECTIVES: The impact of neuropsychiatric symptoms (NPS) on cognitive performance has been reported, and this impact was better defined in the aging population. Yet the potential of using the impact of NPS on brain and cognitive performance in a longitudinal setting, as prediction of conversion – have remained questionable. This study proposes to establish a predictive model of conversion to Alzheimer’s disease (AD) and mild cognitive impairment (MCI) based on current cognitive performance, NPS and their associations with brain morphology.

METHODS: 156 participants with MCI from the Alzheimer’s Disease Neuroimaging Initiative database cognitively stable after a 4-year follow-up were compared to 119 MCI participants who converted to AD. Each participant underwent a neuropsychological assessment evaluating verbal memory, language, executive and visuospatial functions, a neuropsychiatric inventory evaluation and a 3 Tesla MRI. The statistical analyses consisted of 1) baseline comparison between the groups; 2) analysis of covariance model (controlling demographic parameters including functional abilities) to specify the variables that distinguish the two subgroups and; 3) used the significant ANCOVA variables to construct a binary logistic regression model that generates a probability equation to convert to a lower cognitive performance state.

RESULTS: Results showed that MCI who converted to AD in comparison to stable MCI, exhibited a higher NPS prevalence, a lower cognitive performance and a higher number of involved brain structures. Functional abilities, memory performance and the sizes of inferior temporal, hippocampal and amygdala sizes were significant predictors of MCI to AD conversion. We also report two models of conversion that can be implemented on an individual basis for calculating the percentage risk of conversion after 4 years.

CONCLUSION: These analytical methods might be a good way to anticipate cognitive and brain declines.

PMID:35445762 | DOI:10.1002/gps.5718

Plant Cell Environ. 2022 Apr 21. doi: 10.1111/pce.14337. Online ahead of print.

ABSTRACT

Canola varieties exhibit discernible variation in drought avoidance and drought escape traits, reflecting adaptation to water-deficit environments. Our understanding of underlying genes and their interaction across environments in improving crop productivity is limited. A doubled haploid (DH) population was analysed to identify QTL associated with water use efficiency (WUE) related traits. High WUE in the vegetative phase was associated with low seed yield. Based on the resequenced parental genome data, we developed sequence-capture-based markers and validated their linkage with carbon isotope discrimination (Δ¹³ C) in an F₂ population. mRNA-Seq was performed to determine the expression of candidate genes underlying Δ¹³ C QTL. QTL contributing to main and QTL × Environment interaction effects for Δ¹³ C and yield were identified. One multiple-trait QTL for Δ¹³ C, days to flower, plant height, and seed yield was identified on chromosome A09. Interestingly, this QTL region overlapped with a homoeologous exchange event (HE), suggesting its association with the multiple traits. Transcriptome analysis revealed 121 significantly differentially expressed genes underlying Δ¹³ C QTL on A09 and C09, including in HE regions. Sorting out the negative relation between vegetative WUE and seed yield is a priority. Genetic and genomic resources and knowledge so developed could improve canola WUE and yield. This article is protected by copyright. All rights reserved.

PMID:35445756 | DOI:10.1111/pce.14337

Risk Anal. 2022 Apr 21. doi: 10.1111/risa.13925. Online ahead of print.

ABSTRACT

Data mining (DM) has been applied in many advanced science and technology fields, but it has still not been used for domino effect risk management to explore minimum risk scenarios. This work investigates the feasibility of DM in minimizing the risk of fire-induced domino effects in chemical processing facilities. Based on DM, an evidential failure mode and effects analysis (E-FMEA), which could bridge chemical facilities’ operational reliability and domino effect risk, is combined with fault tree analysis (FTA) for the occurrence risk modeling of loss of containment (LOC) event of chemical facilities, which is often the triggering point of fire-induced domino effects. Industry specific data such as reliability data, inspection records, and maintenance records are of great value to model the potential occurrence criticality of LOC. The data are used to characterize the LOC risk priority number (RPN) of chemical facilities through FTA and E-FMEA, search and statistics rules are proposed to mine inspection records to assess LOC risk factors. According to the RPN scores of facilities, inherent safety strategies to minimize risk via inventory control are proposed, and their effectiveness is tested using a well-known probit model. In this way, the approach proposes a unit-specific evidence-based risk minimization strategy for fire-induced domino effects. A case study demonstrates the capability of DM in the risk minimization of fire-induced domino effects.

PMID:35445761 | DOI:10.1111/risa.13925

Sleep. 2022 Apr 21:zsac088. doi: 10.1093/sleep/zsac088. Online ahead of print.

ABSTRACT

STUDY OBJECTIVES: Obstructive sleep apnea (OSA), sleep fragmentation and short sleep duration (SD) have been associated with chronic kidney disease (CKD). However, these potential mechanisms for CKD have not been compared in the same cohort. This study investigated the independent and combined impact of OSA and insomnia with short sleep duration on the risk of CKD progression in a sleep clinic population.

METHODS: In a cross-sectional study design, adults with suspected OSA completed an overnight sleep study and a questionnaire that included the Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI). They also provided blood and urine samples for measurement of the glomerular filtration rate and urine albumin:creatinine ratio, from which the risk of CKD progression was determined.

RESULTS: Participants (n=732, 41% female, 55±13y) were categorized into four groups: no/mild OSA without insomnia (NM-OSA, n=203), insomnia with SD without OSA (Insomnia-SD, n=104), moderate-to-severe OSA without insomnia (MS-OSA, n=242), and comorbid insomnia and OSA with SD (COMISA-SD, n=183). After stratification, 12.8% of NM-OSA, 15.4% of Insomnia-SD, 28.9% of MS-OSA and 31.7% of the COMISA-SD participants had an increased risk of CKD progression. Compared to NM-OSA, the odds ratio (OR) for an increased risk of CKD progression was not increased in Insomnia-SD (OR 0.95, CI:0.45-1.99) and was increased to the same degree in MS-OSA (OR 2.79, CI:1.60-4.85) and COMISA-SD (OR 3.04, CI:1.69-5.47). However, the ORs were similar between the MS-OSA and COMISA-SD groups across all statistical models (p≥0.883).

CONCLUSION: In a sleep clinic population, insomnia with short sleep duration does not increase the risk of CKD progression; nor does it further increase the risk of CKD progression associated with moderate-to-severe OSA.

PMID:35445715 | DOI:10.1093/sleep/zsac088

Bioinformatics. 2022 Apr 21:btac191. doi: 10.1093/bioinformatics/btac191. Online ahead of print.

ABSTRACT

MOTIVATION: Live-cell microscopy has become an essential tool for analyzing dynamic processes in various biological applications. Thereby, high-throughput and automated tracking analyses allow the simultaneous evaluation of large numbers of objects. However, to critically assess the influence of individual objects on calculated summary statistics, and to detect heterogeneous dynamics or possible artifacts, such as misclassified or -tracked objects, a direct mapping of gained statistical information onto the actual image data would be necessary.

RESULTS: We present VisuStatR as a platform independent software package that allows the direct visualization of time-resolved summary statistics of morphological characteristics or motility dynamics onto raw images. The software contains several display modes to compare user-defined summary statistics and the underlying image data in various levels of detail.

AVAILABILITY: VisuStatR is a free and open-source R-package, containing a user-friendly graphical-user interface and is available via GitHub at https://github.com/grrchrr/VisuStatR/ under the MIT+ license.

SUPPLEMENTARY INFORMATION: Examples and additional information are available online and on the project’s webpage.

PMID:35445697 | DOI:10.1093/bioinformatics/btac191

Eur J Cardiothorac Surg. 2022 Apr 21:ezac268. doi: 10.1093/ejcts/ezac268. Online ahead of print.

ABSTRACT

OBJECTIVES: To compare biological versus mechanical aortic valve replacement.

METHODS: We searched MEDLINE, Scopus, and Cochrane Library databases for randomized clinical trials and propensity-score matched studies published by October 14th, 2021 according to PRISMA statement. Individual patient data on overall survival were extracted. One- and two-stage survival analyses, and random-effects meta-analyses were conducted.

RESULTS: 25 studies were identified, incorporating 8,721 bioprosthetic and 8,962 mechanical valves:. In the one-stage meta-analysis, mechanical valves cumulatively demonstrated decreased hazard for mortality (Hazard Ratio [HR] : 0.79, 95% Confidence interval [CI] : 0.74-0.84, p < 0.0001). Overall survival was similar between the compared arms for patients <50 years old (HR: 0.88, 95% CI : 0.71-1.1, p = 0.216), increased in the mechanical valve arm for patients 50-70 years old (HR : 0.76, 95% CI : 0.70-0.83, p < 0.0001), and increased in the bioprosthetic arm for patients >70 years old (HR : 1.35, 95% CI : 1.17-1.57, p < 0.0001). Meta-regression analysis revealed that the survival in the 50-70 years old group was not influenced by the publication year of the individual studies. No statistically significant difference was observed regarding in-hospital mortality, post-operative strokes and post-operative reoperation. All-cause mortality was found decreased in the mechanical group, cardiac mortality was comparable between the two groups, major bleeding rates were increased in the mechanical valve group, and reoperation rates were increased in the bioprosthetic valve group.

CONCLUSIONS: Survival rates seem to not be influenced by the type of prosthesis in patients <50 years old. A survival advantage in favour of mechanical valves is observed in patients 50-70 years old, while in patients >70 years old bioprosthetic valves offer better survival outcomes.

PMID:35445694 | DOI:10.1093/ejcts/ezac268