Tag: nevin manimala

JAMA Netw Open. 2022 Sep 1;5(9):e2232672. doi: 10.1001/jamanetworkopen.2022.32672.

ABSTRACT

IMPORTANCE: Language development builds on speech perception, with early disruptions increasing the risk for later language difficulties. Although a major postpartum depressive episode is associated with language development, this association has not been investigated among infants of mothers experiencing a depressed mood at subclinical levels after birth, even though such a mood is frequently present in the first weeks after birth. Understanding whether subclinical depressed maternal mood after birth is associated with early language development is important given opportunities of coping strategies for subclinical depressed mood.

OBJECTIVE: To examine whether depressed maternal mood at subclinical levels 2 months after birth is associated with infant speech perception trajectories from ages 2 to 6.5 months.

DESIGN, SETTING, AND PARTICIPANTS: In this longitudinal cohort study conducted between January 1, 2018, and October 31, 2019, 46 healthy, monolingual German mother-infant dyads were tested. The sample was recruited from the infants database of the Max Planck Institute for Human Cognitive and Brain Sciences. Initial statistical analysis was performed between January 1 and March 31, 2021; the moderation analysis (results reported herein) was conducted between July 1 and July 31, 2022.

EXPOSURES: Mothers reported postpartum mood via the German version of the Edinburgh Postnatal Depression Scale (higher scores indicated higher levels of depressed mood, with a cutoff of 13 points indicating a high probability of clinical depression) when their infants were 2 months old.

MAIN OUTCOMES AND MEASURES: Electrophysiological correlates of infant speech perception (mismatch response to speech stimuli) were tested when the infants were aged 2 months (initial assessment) and 6.5 months (follow-up).

RESULTS: A total of 46 mothers (mean [SD] age, 32.1 [3.8] years) and their 2-month-old children (mean [SD] age, 9.6 [1.2] weeks; 23 girls and 23 boys) participated at the initial assessment, and 36 mothers (mean [SD] age, 32.2 [4.1] years) and their then 6.5-month-old children (mean [SD] age, 28.4 [1.5 weeks; 18 girls and 18 boys) participated at follow-up. Moderation analyses revealed that more depressed maternal subclinical postpartum mood (mean [SD] Edinburgh Postnatal Depression Scale score, 4.8 [3.6]) was associated with weaker longitudinal changes of infants’ electrophysiological brain responses to syllable pitch speech information from ages 2 to 6.5 months (coefficient: 0.68; 95% CI, 0.03-1.33; P = .04).

CONCLUSIONS AND RELEVANCE: The results of this cohort study suggest that infant speech perception trajectories are correlated with subclinical depressed mood in postpartum mothers. This finding lays the groundwork for future research on early support for caregivers experiencing depressed mood to have a positive association with children’s language development.

PMID:36129707 | DOI:10.1001/jamanetworkopen.2022.32672

Anesthesiology. 2022 Sep 21. doi: 10.1097/ALN.0000000000004378. Online ahead of print.

ABSTRACT

BACKGROUND: Improper endotracheal tube (ETT) positioning is frequently observed and potentially hazardous in the intensive care unit. We developed a deep learning-based automatic detection algorithm detecting the ETT tip and carina on portable supine chest radiographs to measure the ETT-carina distance. This study investigated the hypothesis that the algorithm might be more accurate than frontline critical care clinicians in ETT tip detection, carina detection, and ETT-carina distance measurement.

METHODS: A deep learning-based automatic detection algorithm was developed using 1,842 portable supine chest radiographs of 1,842 adult intubated patients, where two board-certified intensivists worked together to annotate the distal ETT end and tracheal bifurcation. The performance of the deep learning-based algorithm was assessed in 4-fold cross-validation (1,842 radiographs), external validation (216 radiographs), and an observer performance test (462 radiographs) involving 11 critical care clinicians. The performance metrics included the errors from the ground truth in ETT tip detection, carina detection, and ETT-carina distance measurement.

RESULTS: During 4-fold cross-validation and external validation, the median errors (IQR) of the algorithm in ETT-carina distance measurement were 3.9 (1.8-7.1) mm and 4.2 (1.7-7.8) mm, respectively. During the observer performance test, the median errors (IQR) of the algorithm were 2.6 (1.6-4.8) mm, 3.6 (2.1-5.9) mm, and 4.0 (1.7-7.2) mm in ETT tip detection, carina detection, and ETT-carina distance measurement, significantly superior to that of 6, 10, and 7 clinicians (all p<0.05), respectively. The algorithm outperformed 7/3/0, 9/6/4, and 5/5/3 clinicians (all p<0.005) regarding the proportions of chest radiographs within 5-mm/10-mm/15-mm error in ETT tip detection, carina detection, and ETT-carina distance measurement, respectively. No clinician was significantly more accurate than the algorithm in any comparison.

CONCLUSIONS: A deep learning-based algorithm can match or even outperform frontline critical care clinicians in ETT tip detection, carina detection, and ETT-carina distance measurement.

PMID:36129686 | DOI:10.1097/ALN.0000000000004378

BMJ Open. 2022 Aug 5;12(8):e059644. doi: 10.1136/bmjopen-2021-059644.

ABSTRACT

INTRODUCTION: Previous studies on transoesophageal echocardiography in coronary artery bypass grafting mainly focused on whether to change the surgical plan rather than improve the clinical prognosis. Currently, there are sparse studies on the relationship between transoesophageal echocardiography indicators and the prognosis of patients undergoing coronary artery bypass grafting. The primary aim of this study is to explore the association between transoesophageal echocardiography monitoring indicators the respiratory variability of inferior vena cava diameter, tricuspid annular plane systolic excursion and the incidence of acute kidney injury in coronary artery bypass grafting patients.

METHODS AND ANALYSIS: We designed this prospective multicenter cohort study, which included approximately 150 adult patients (≥18 years) undergoing elective coronary artery bypass surgery. Different hospitals will be assessed to obtain information on the prevalence, risk factors, management strategies and outcomes in coronary artery bypass surgery. The cohort will be followed after the coronary artery bypass surgery period, up to 30 days after enrolment. The incidence of postoperative acute kidney injury and baseline data will be presented by descriptive statistics. We will use Freidman inspection and multivariable logistic regression to assess the association between transoesophageal echocardiography monitoring indicators and the incidence of acute kidney injury in coronary artery bypass grafting patients.

ETHICS AND DISSEMINATION: The study has been approved by the ethics committee of Shandong Provincial Qianfoshan Hospital, China (approval number: YXLL-KY-2021(067)). This is an observational study that poses no risk to the patients. All participants will obtain informed consent according to the ethics committee before patient enrolment. Funding sources will have no influence on data handling, analyses or writing of the manuscript. The article is planned for submission in an international peer-reviewed journal.

TRIAL REGISTRATION NUMBER: NCT05139108.

PMID:36129681 | DOI:10.1136/bmjopen-2021-059644

Prep Biochem Biotechnol. 2022 Sep 21:1-11. doi: 10.1080/10826068.2022.2119575. Online ahead of print.

ABSTRACT

Present study aims at sustainable utilization of sugarcane bagasse (SCB) for production of valuable prebiotic xylooligosaccharides (XOS) along with second generation ethanol. Fractionation of SCB into hemicellulose rich liquid fraction and cellulose rich solid residue was achieved using alkaline treatment. Carbohydrate rich precipitate obtained from liquid fraction was utilized for XOS production using inhouse produced endoxylanase. XOS production from SCB xylan was optimized by employing response surface methodology. Under optimized conditions, maximum XOS yield was 227.72 mg/g of carbohydrate rich precipitates. The solid residue obtained after alkaline pretreatment was used for ethanol fermentation by prehydrolysis and simultaneous saccharification and fermentation (P-SSF) process using cellulolytic enzyme cocktail and Saccharomyces cerevisiae SM1. Maximum ethanol concentration, productivity and yield were 79.76 ± 0.16 g/L, 0.83 g/L/h and 69.38%, respectively by employing P-SSF process. Based on the experimental data it can be predicted that bioconversion of 100 g raw SCB can yield 6.26 g of XOS (DP 2-DP 5), 15.95 g ethanol and 1.44 g of xylitol. Present investigation reports an integrated process for effective bioconversion of SCB into value added products by maximum utilization of cellulosic and hemicellulosic fractions simultaneously using indigenously produced fungal enzymes.

PMID:36129679 | DOI:10.1080/10826068.2022.2119575

Hormones (Athens). 2022 Sep 21. doi: 10.1007/s42000-022-00396-5. Online ahead of print.

ABSTRACT

PURPOSE: There is controversy regarding the optimal statistical method to interpret how robust is a statistically significant result. The fragility index (FI) and the reverse fragility index (RFI) are quantitative measures that can facilitate the appraisal of a clinical trial’s robustness. This study was performed to evaluate the FI and RFI of randomized controlled trials (RCTs) examining nutritional interventions in patients with diabetes mellitus, focusing on cardiovascular outcomes.

METHODS: A systematic search was conducted and relevant RCTs were identified in three databases. RCTs examining nutritional interventions (supplements or dietary patterns) in patients with DM with dichotomous primary endpoints involving cardiovascular outcomes were eligible. Data were extracted to compose 2 × 2 event tables and the FI and RFI were calculated for each comparison, using Fisher’s exact test. Risk of bias (RoB) of the included RCTs was assessed with the Cochrane RoB 2.0 tool.

RESULTS: A total of 14,315 records were screened and 10 RCTs were included in the analyses. The median FI of the paired comparisons was 3 (IQR: 2-4) and the median RFI was 8 (IQR: 4.5-17). RoB and heterogeneity were low.

CONCLUSIONS: RCTs examining nutritional interventions and cardiovascular outcomes among patients with diabetes mellitus appear to be statistically fragile. Τhe FI and the RFI can be reported and interpreted as an additional perspective of a trial’s robustness.

HIGHLIGHTS: • In the evidence-healthcare era, assessing how robust statistically significant results are remains a matter of controversy. • Recently, the fragility index (FI) and reverse fragility index (RFI) were proposed to assess the robustness of randomized controlled trials (RCTs) with 2 × 2 comparisons. • When applying the FI and RFI, RCTs examining nutritional interventions and cardiovascular outcomes among patients with diabetes mellitus (DM) appear to be statistically fragile. • Τhe FI and the RFI can be reported and interpreted as an additional perspective of a trial’s robustness. • RCTs implementing nutrition interventions among patients with DM can improve their methodology.

PMID:36129664 | DOI:10.1007/s42000-022-00396-5

Updates Surg. 2022 Sep 21. doi: 10.1007/s13304-022-01384-5. Online ahead of print.

ABSTRACT

Total esophagogastric dissociation (TEGD) was proposed to treat gastroesophageal reflux disease (GERD) both as a rescue in case of fundoplication failure and as first-line surgery in neurologically impaired children (NIC). Aim of the study is to evaluate the impact of TEGD on the quality of life (QoL) of both NIC and their caregivers focusing on the parents’ point of view. A retrospective observational study was conducted on all NIC who underwent TEGD in our center between 2012 and 2022. A questionnaire centered on the parents’ point of view and investigating QoL of NIC and their caregivers was administered to all patients’ parents. Data were compared using Fisher exact test and Mann-Whitney test; a p-value < 0.05 was considered statistically significant. 12 patients were enrolled in the study. Parents reported improvements in weight gain (p = 0.03), sleep disorders, apnea, regurgitation and vomiting (p < 0.01). Caregivers also declared a decrease in number of hospitalizations, particularly related to severe respiratory infections and ab ingestis pneumonia (p = 0.01). We also documented a reduction of caregivers’ worries during food administration (p < 0.01). 50% of parents whose children were subjected to both fundoplication and TEGD would suggest TEGD as first line surgical treatment instead of fundoplication. According to parents’ point of view, TEGD improves significantly NIC QoL and 50% of them would enthusiastically suggest TEGD as first-line surgical approach to GERD in NIC.

PMID:36129620 | DOI:10.1007/s13304-022-01384-5

Neurol Sci. 2022 Sep 21. doi: 10.1007/s10072-022-06393-1. Online ahead of print.

ABSTRACT

INTRODUCTION: The safety and efficacy of a formulation high in cannabidiol (CBD) and low in ∆⁹-tetrahydrocannabinol (THC) to treat drug-resistant epilepsy have been examined previously in children, but not in adult population. The aim of this study was to evaluate whether CBD-rich oil, as an add-on treatment to conventional antiepileptic drugs, was effective, safe, and well-tolerated in adults with drug-resistant focal epilepsy (DRFE).

METHODS: An open-label, prospective cohort, single-center in adult patients with DRFE, were receiving stable doses of antiepileptic drugs (AEDs). A cannabis based-magistral formulation (CBMF) (100 mg/ml CBD and THC <1.9 mg/ml) was administrated 0.1 ml sublingually every 12 hours, up-titrated weekly. The primary outcome was to establish a reduction in seizures frequency >50% at 12 weeks. Adverse-drug reactions monitoring was done. p-value <0.05 was statistically significant.

RESULTS: Between August 2020 and July 2022, 44 (38.6%) patients completed >3 months of follow-up. The median daily dose of CBD was 200 mg, that of THC was 4 mg, and that of CBD per kilogram of weight was 3.7 mg. The median number of seizures per month before CBD treatment was 11, and after CBD treatment was 2.5 (p<0.001). A reduction in seizures >50% at 12 week was achieved in 79.5% of the patients. The median percentage change in seizure frequency per month was 84.1% at 12 weeks. Five patients reported any adverse-drug reactions.

CONCLUSION: The CBMF is a highly effective and safety therapy to treat adult patients with DRFE. The reduction in seizures frequency is maintained over time.

PMID:36129615 | DOI:10.1007/s10072-022-06393-1

Int Ophthalmol. 2022 Sep 21. doi: 10.1007/s10792-022-02519-8. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study is to investigate changes in choroidal and optic nerve morphological parameters following MicroShunt PreserFlo implantation. The secondary aim is to investigate how the structural changes relate to the decrease in intraocular pressure (IOP).

METHODS: Prospective observational study on 15 eyes with glaucoma requiring MicroShunt implantation. Optical coherence tomography was used to measure macular choroidal thickness (MCT), peripapillary choroidal thickness (PCT), lamina cribrosa depth (LCD), cup depth and prelaminar tissue thickness (PLT), before and one day after surgery. Results were expressed in median and interquartile range (IQR) and correlated with IOP results.

RESULTS: The IOP decreased from a median of 25 (IQR = 11) mmHg to 8 (IQR = 2) mmHg the day after surgery. Median MCT increased after MicroShunt implantation from 252.1 (IQR = 156.4) µm to a postoperative value of 318.1 (IQR = 166.6) µm (p < 0.001), with a median increase of + 87.7 µm (+ 26.4%). PCT increased from 157.2 (IQR = 109.1) µm before surgery to 206.0 (IQR = 136.1) µm after surgery (p < 0.001). Moreover, we found a significant post-operative decrease in cup depth (median reduction of – 29.3 µm, p < 0.001) and an increase in PLT (median increase of 27.3 µm, p = 0.028). On the other side, LCD reduction 24 h after surgery didn’t reach any statistical significance.

CONCLUSION: PreserFlo implantation determines retinal structural changes which appear similar to those caused by traditional filtering surgery, confirming the effectiveness of this device, meantime carrying a much smaller complications rate when compared to trabeculectomy.

PMID:36129605 | DOI:10.1007/s10792-022-02519-8

Sleep Breath. 2022 Sep 21. doi: 10.1007/s11325-022-02695-y. Online ahead of print.

ABSTRACT

PURPOSE: We aimed to study the effect of obstructive sleep apnea (OSA) on cancer risk.

METHODS: We searched PubMed, Embase, and Cochrane databases for relevant studies. The qualities of included studies were assessed using Newcastle-Ottawa Scale (NOS). Unadjusted and adjusted analyses were performed. We also conducted subgroup analyses stratified by gender, severity of OSA, study design, and cancer type.

RESULTS: After literatures search, 18 studies were included in the present study. In the unadjusted analysis, we discovered an increased cancer risk in patients with OSA with a pooled relative risk (RR) in the OSA group of 1.49 (95% confidence interval (CI): 1.32-1.69, I² = 32%, P = 0.15). In adjusted analysis, OSA correlated with cancer risk (RR: 1.36, 95% CI: 1.18-1.56, I² = 54%, P < 0.01). In subgroup stratified by gender and OSA severity, OSA statistically with cancer risk in females (RR: 1.27, 95% CI: 1.06-1.51) and moderate to severe OSA groups (RR: 2.62, 95% CI: 1.64; 4.19). In subgroup stratified by study design, a trend toward statistically significant differences was observed in prospective studies (RR: 1.21, 95% CI: 0.99-1.48) and cross-sectional studies (RR: 1.81, 95% CI: 0.96-3.41). Patients with OSA in the retrospective study group had a statistically higher chance of developing cancer (RR: 1.41, 95% CI: 1.11-1.79). When stratified by cancer group, statistically significant differences was observed in many types of cancer (breast cancer: RR: 1.32, 95% CI: 1.03-1.70; central nervous system cancer: RR: 1.71, 95% CI: 1.06-2.75; kidney cancer: RR: 1.81, 95% CI: 1.20-2.74; liver cancer: RR: 1.19, 95% CI: 1.10-1.29; and pancreatic cancer: RR: 1.23, 95% CI: 1.14-1.33).

CONCLUSIONS: This systematic review and meta-analysis suggests that obstructive sleep apnea may increase risk of cancer.

PMID:36129602 | DOI:10.1007/s11325-022-02695-y

Int J Biometeorol. 2022 Sep 21. doi: 10.1007/s00484-022-02369-0. Online ahead of print.

ABSTRACT

The global burden of neurodegenerative disorders is significantly increasing as life expectancy rises but currently there is no cure for these conditions. An extensive search on MEDLINE (PubMed) and PEDro databases was conducted selecting clinical trials, Randomized Controlled Trials, and longitudinal studies published in the last 20 years in order to highlight what evidence there is for a role of spa rehabilitative interventions for patients with neurodegenerative diseases, in terms of motor function, symptoms, and quality of life (QoL) improvement and cost-effectiveness. A total of 225 publications were analyzed. Only three manuscripts were selected for review because they matched the inclusion criteria. These studies demonstrated statistically significant differences in the outcomes evaluated among patients affected by Parkinson’s disease after thermal rehabilitative treatments: motor function, balance, QoL, and psychological well-being statistically improved. In addition, rehabilitation in the spa setting seemed to be cost-effective for these patients. However, further studies are needed to define the role of spa rehabilitative interventions for these patients as the literature is still limited.

PMID:36129582 | DOI:10.1007/s00484-022-02369-0