Tag: nevin manimala

Pediatr Neonatol. 2022 Aug 24:S1875-9572(22)00187-5. doi: 10.1016/j.pedneo.2022.06.007. Online ahead of print.

ABSTRACT

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is the most common neuropsychiatric disorder in schoolchildren. ADHD diagnoses are generally made based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The diagnosis is made clinically based on observation and information provided by parents and teachers, which is highly subjective and can lead to disparate results. Considering that hyperactivity is one of the main symptoms of ADHD, the inaccuracy of ADHD diagnosis based on subjective criteria necessitates the identification of a method to objectively diagnose ADHD.

METHODS: In this study, a medical chair containing a piezoelectric material was applied to objectively analyze movements of patients with ADHD, which were compared with those of patients without ADHD. This study enrolled 62 patients-31 patients with ADHD and 31 patients without ADHD. During the clinical evaluation, participants’ movements were recorded by the piezoelectric material for analysis. The variance, zero-crossing rate, and high energy rate of movements were subsequently analyzed.

RESULTS: The results revealed that the variance, zero-crossing rate, and high energy rate were significantly higher in patients with ADHD than in those without ADHD. Classification performance was excellent in both groups, with the area under the curve as high as 98.00%.

CONCLUSION: Our findings suggest that the use of a smart chair equipped with piezoelectric material is an objective and potentially useful method for supporting the diagnosis of ADHD.

PMID:36089537 | DOI:10.1016/j.pedneo.2022.06.007

Eur Urol. 2022 Sep 8:S0302-2838(22)02532-5. doi: 10.1016/j.eururo.2022.07.018. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with nonmetastatic castration-resistant prostate cancer (nmCRPC) have a high risk of progression to metastatic disease, particularly if their prostate-specific antigen doubling time (PSADT) is ≤6 mo. However, patients remain at a high risk with a PSADT of >6 mo.

OBJECTIVE: To evaluate the efficacy and safety of darolutamide versus placebo in patients stratified by PSADT >6 or ≤6 mo.

DESIGN, SETTING, AND PARTICIPANTS: A planned subgroup analysis of a global multicenter, double-blind, randomized, phase 3 trial in men with nmCRPC and PSADT ≤10 mo was conducted.

INTERVENTION: Patients were randomized 2:1 to oral darolutamide 600 mg twice daily or placebo, while continuing androgen-deprivation therapy.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary endpoint was metastasis-free survival (MFS). Secondary endpoints were overall survival (OS) and times to pain progression, first cytotoxic chemotherapy, and symptomatic skeletal events. Quality of life (QoL) was measured using validated prostate-relevant tools. Safety was recorded throughout the study.

RESULTS AND LIMITATIONS: Of 1509 patients enrolled, 469 had PSADT >6 mo (darolutamide n = 286; placebo n = 183) and 1040 had PSADT ≤6 mo (darolutamide n = 669; placebo n = 371). Baseline characteristics were balanced between subgroups. Darolutamide significantly prolonged MFS versus placebo in both subgroups (unstratified hazard ratio [95% confidence interval]: PSADT >6 mo, 0.38 [0.26-0.55]; PSADT ≤6 mo, 0.41 [0.33-0.52]). OS and other efficacy and QoL endpoints favored darolutamide with significant improvement over placebo in both subgroups. The incidence of adverse events, including events commonly associated with androgen receptor inhibitors (fractures, falls, hypertension, and mental impairment), and discontinuations due to adverse events were low and similar to placebo. Limitations include small subgroup populations.

CONCLUSIONS: In patients with nmCRPC and PSADT >6 mo (maximum 10 mo), darolutamide provided a favorable benefit/risk ratio, characterized by significant improvements in MFS, OS, and other clinically relevant endpoints; maintenance of QoL; and favorable tolerability.

PATIENT SUMMARY: In patients with prostate cancer that has stopped responding to standard hormonal therapy (indicated by an increase in prostate-specific antigen [PSA] levels), there is a risk that the cancer will spread to other parts of the body. This risk is highest when the time it takes for the PSA level to double (ie, “PSA doubling time” [PSADT]) is less than 6 mo. However, there is still a risk that the cancer will spread even if the PSADT is longer than 6 mo. In a group of patients whose PSADT was more than 6 mo but no more than 10 mo, treatment with darolutamide slowed the cancer spread and allowed them to live longer than patients who received placebo (inactive drug). Darolutamide treatment did not cause many side effects and helped maintain patients’ quality of life without disruptions.

PMID:36089529 | DOI:10.1016/j.eururo.2022.07.018

Eur Urol Oncol. 2022 Sep 8:S2588-9311(22)00141-9. doi: 10.1016/j.euo.2022.08.002. Online ahead of print.

ABSTRACT

BACKGROUND: According to the recent American Urological Association (AUA) guideline on hematuria, patients are stratified into groups with low, intermediate, and high risk of urothelial carcinoma (UC). These risk groups are based on clinical factors and do not incorporate urine-based tumor markers.

OBJECTIVE: To evaluate whether a urine-based genomic assay improves the redefined AUA risk stratification for hematuria.

DESIGN, SETTING, AND PARTICIPANTS: We selected patients with complete biomarker status, as assessed on urinary DNA, from a previously collected prospective Dutch hematuria cohort (n = 838). Patients were stratified into the AUA risk categories on the basis of sex, age, and type of hematuria. Biomarker status included mutation status for the FGFR3, TERT, and HRAS genes, and methylation status for the OTX1, ONECUT2, and TWIST1 genes.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary endpoint was the diagnostic model performance for different hematuria risk groups. Further analyses assessed the pretest and post-test UC probability in the hematuria subgroups using a Fagan nomogram.

RESULTS AND LIMITATIONS: Overall, 65 patients (7.8%) were classified as low risk, 106 (12.6%) as intermediate risk, and 667 (79.6%) as high risk. The UC incidence differed significantly between the gross hematuria (21%, 98/457) and microscopic hematuria (4%, 14/381) groups (p < 0.001). All cancer cases were in the high-risk group, which had UC incidence of 16.8% (112/667). Application of the diagnostic model revealed robust performance among all risk groups (area under the receiver operating characteristic curve 0.929-0.971). Depending on the risk group evaluated, a negative urine assay was associated with post-test UC probability of 0.3-2%, whereas a positive urine assay was associated with post-test UC probability of 31-42%.

CONCLUSIONS: This study shows the value that a urine-based genomic assay adds to the AUA guideline stratification for patients with hematuria. It seems justified to safely withhold cystoscopy for patients with AUA low risk who have a negative urine assay. In addition, evaluation should be expedited for patients with AUA intermediate or high risk and a positive urine assay.

PATIENT SUMMARY: Patients who have blood in their urine (hematuria) can be classified as having low, intermediate, or high risk of having cancer in their urinary tract. We found that use of a urine-based genetic test improves the accuracy of predicting which patients are most likely to have cancer. Patients with a negative test may be able to avoid invasive tests, while further tests could be prioritized for patients with a positive test.

PMID:36089502 | DOI:10.1016/j.euo.2022.08.002

Trends Cogn Sci. 2022 Sep 8:S1364-6613(22)00185-1. doi: 10.1016/j.tics.2022.08.003. Online ahead of print.

ABSTRACT

Understanding Theory of Mind should begin with an analysis of the problems it solves. The traditional answer is that Theory of Mind is used for predicting others’ thoughts and actions. However, the same Theory of Mind is also used for planning to change others’ thoughts and actions. Planning requires that Theory of Mind consists of abstract structured causal representations and supports efficient search and selection from innumerable possible actions. Theory of Mind contrasts with less cognitively demanding alternatives: statistical predictive models of other people’s actions, or model-free reinforcement of actions by their effects on other people. Theory of Mind is likely used to plan novel interventions and predict their effects, for example, in pedagogy, emotion regulation, and impression management.

PMID:36089494 | DOI:10.1016/j.tics.2022.08.003

Oral Surg Oral Med Oral Pathol Oral Radiol. 2022 Jul 16:S2212-4403(22)01055-0. doi: 10.1016/j.oooo.2022.07.008. Online ahead of print.

ABSTRACT

OBJECTIVE: The introduction of minimally invasive surgical procedures has significantly reduced the rate of major salivary gland removal. This study aimed to assess these procedures in relieving patients’ complaints and their impact on quality of life using the newly introduced Multidisciplinary Salivary Gland Society questionnaire.

STUDY DESIGN: Between January 2021 and October 2021, a case series was treated with minimally invasive surgical procedures. Data such as stone size, number and location, surgical approach, symptoms relief, and improvement of quality of life were collected and analyzed. Thirty-six patients were included (22 males and 14 females); 28 had stones in the submandibular gland and 8 in the parotid gland with largest stone diameter ranging from 0.2 to 2.8 cm. The approach was selected according to stone size and location, so 17 patients were treated with sialendoscopy (alone or using a combined approach), and 19 patients were treated without sialendoscopy using a transoral approach.

RESULTS: After a 6-month follow-up, the questionnaire scores showed a statistically significant difference in comparison to preoperative ones.

CONCLUSIONS: Minimally invasive surgical procedures present an excellent option for sialolithotomy, after which the relief of symptoms, restoration of gland function, and a significant improvement in quality of life are achieved.

PMID:36089488 | DOI:10.1016/j.oooo.2022.07.008

J Plast Reconstr Aesthet Surg. 2022 Jun 22:S1748-6815(22)00386-2. doi: 10.1016/j.bjps.2022.06.069. Online ahead of print.

ABSTRACT

BACKGROUND: Melanoma is a common cancer that causes a severe socioeconomic burden. Patients usually turn to plastic surgeons to determine their prognosis after surgery.

METHODS: Data from hundreds of thousands of real-world patients were downloaded from the Surveillance, Epidemiology, and End Results database. Nine mainstream machine learning models were applied to predict 5-year survival probability and three survival analysis models for overall survival prediction. Models that outperformed were deployed online.

RESULTS: After manual review, 156,154 real-world patients were included. The deep learning model was chosen for predicting the probability of 5-year survival, based on its area under the receiver operating characteristic curve (0.915) and its accuracy (84.8%). The random survival forest model was chosen for predicting overall survival, with a concordance index of 0.894. These models were deployed at www.make-a-difference.top/melanoma.html as an online calculator with an interactive interface and an explicit outcome for everyone.

CONCLUSIONS: Users should make decisions based on not only this online prognostic application but also multidimensional information and consult with multidiscipline specialists.

PMID:36089473 | DOI:10.1016/j.bjps.2022.06.069

HPB (Oxford). 2022 Aug 25:S1365-182X(22)01556-8. doi: 10.1016/j.hpb.2022.08.009. Online ahead of print.

ABSTRACT

BACKGROUND: Anastomotic leak (AL) after bilioenteric reconstruction (BR) is a feared complication after bile duct resection, especially in combination with liver resection. Literature on surgical outcome is sparse. This study aimed to determine the incidence and risk factors for AL after combined liver and bile duct resection with a focus on operative or endoscopic reinterventions.

METHODS: Data from consecutive patients who underwent liver resection and BR between 2004 and 2018 in 11 academic institutions in Europe were collected from prospectively maintained databases.

RESULTS: Within 921 patients, AL rate was 5.4% with a 30d mortality of 9.6%. Pringle maneuver (p<0.001),postoperative external biliary (p=0.007) and abdominal drainage (p<0.001) were risk factors for clinically relevant AL. Preoperative biliary drainage (p<0.001) was not associated with a higher rate of AL. AL was more frequent in stented patients (76.5%) compared to PTCD (17.6%) or PTCD+stent (5.9%,p=0.017). AL correlated with increased incidence of postoperative liver failure (p=0.036), cholangitis, hemorrhage and sepsis (all p<0.001).

CONCLUSION: This multicenter data provides the largest series to date of LR with BR and could help in the management of these patients which are often challenging and hampering the patients’ postoperative course negatively.

PMID:36089466 | DOI:10.1016/j.hpb.2022.08.009

Heart Lung Circ. 2022 Sep 8:S1443-9506(22)01007-1. doi: 10.1016/j.hlc.2022.07.007. Online ahead of print.

ABSTRACT

AIM: The Occlutech duct occluder (ODO) with a novel design has been available for closure of patent ductus arteriosus (PDA) since 2011. Available data on initial experience with the ODO have shown that operators continue to choose device sizes based on their experience with conventional duct occluders (CDO). This study postulated that occlusion of the pulmonary arterial (PA) end of the ductus should achieve satisfactory PDA closure without additional complications. Accordingly, the size of the ODO was chosen such that the larger PA diameter in the new design exceeded the PA end of the ductus by 2-3 mm and 2-4 mm for normotensive and hypertensive ducts, respectively. It sought to examine the feasibility and safety of such an approach, and compared ODO and CDO devices with respect to device sizes deployed, to ascertain if the newer design had any advantages.

METHODS: This prospective study enrolled 105 infants, children and a few adults with various duct morphologies and PA pressures for ductal closure using the ODO from 2018-2020. The control group consisted of 105 ducts closed with CDO. A comparison of the two groups with respect to duct diameter and implanted device sizes was performed using appropriate statistical software.

RESULTS: The study found that 40% of the ducts had moderate-to-severe pulmonary hypertension. Most ducts measured between 3-4 mm in both groups. The mean weight of the subjects in both groups was 12 kg. Although there was no change in the way that duct occluders were chosen in both groups (2-3 mm over the pulmonary artery diameter), ODO could be significantly downsized in most ducts measuring between 2.5-6.4 mm in diameter (p<0.05).

CONCLUSIONS: This study found successful closure of relatively larger PDA in infants and children using smaller ODO compared with CDO, without embolisation or aortic narrowing. It also demonstrated that a different device size selection technique may be safely employed with the ODO.

PMID:36089464 | DOI:10.1016/j.hlc.2022.07.007

Aust Crit Care. 2022 Sep 9:S1036-7314(22)00094-7. doi: 10.1016/j.aucc.2022.07.004. Online ahead of print.

ABSTRACT

BACKGROUND: Despite a growing body of research into end-of-life care (EOLC) in intensive care units (ICUs), few studies have concurrently explored the perspectives of families and clinicians.

OBJECTIVE: The objective of this study was to identify the characteristics of high-quality EOLC in the ICU from family and clinician perspectives and by examining the care documented in medical records.

METHODS: A convergent mixed-methods study incorporating electronic health record audits (n = 20), structured interview surveys with families (n = 20), clinician surveys (n = 189), and focus groups (n = 10) was undertaken at a 30-bed, level 3 ICU at a metropolitan public adult teaching hospital in Australia. Descriptive statistics were calculated from quantitative data, and inductive thematic analysis was used to analyse qualitative data.

RESULTS: Overall, families were very satisfied with EOLC and the quality of communication yet, felt that earlier, clearer communication that the patient was dying was required. Families spoke of the attentiveness, or lack thereof, by ICU clinicians and the opportunity to be present for the patient’s death. The majority of ICU clinicians felt EOLC could be improved. Nurses highlighted communication challenges when family meetings were delayed. Some nurses expressed a lack of clarity of how to withdraw care, resulting in hesitancy to cease potentially inappropriate care, and to provide EOLC outside ICU practice norms. In many instances, observations, invasive monitoring, and interventions were documented after EOLC commenced. A lack of documented personal cares was also noted.

CONCLUSIONS: This study provides new insights into EOLC from the dual perspectives of families and clinicians. There is a need for institutional guidelines to support ICU clinicians’ EOLC practices and education to improve clinician confidence with communication.

PMID:36089461 | DOI:10.1016/j.aucc.2022.07.004

Risk Anal. 2022 Sep 11. doi: 10.1111/risa.14018. Online ahead of print.

ABSTRACT

In this study, a new approach of machine learning (ML) models integrated with the analytic hierarchy process (AHP) method was proposed to develop a holistic flood risk assessment map. Flood susceptibility maps were created using ML techniques. AHP was utilized to combine flood vulnerability and exposure criteria. We selected Quang Binh province of Vietnam as a case study and collected available data, including 696 flooding locations of historical flooding events in 2007, 2010, 2016, and 2020; and flood influencing factors of elevation, slope, curvature, flow direction, flow accumulation, distance from river, river density, land cover, geology, and rainfall. These data were used to construct training and testing datasets. The susceptibility models were validated and compared using statistical techniques. An integrated flood risk assessment framework was proposed to incorporate flood hazard (flood susceptibility), flood exposure (distance from river, land use, population density, and rainfall), and flood vulnerability (poverty rate, number of freshwater stations, road density, number of schools, and healthcare facilities). Model validation suggested that deep learning has the best performance of AUC = 0.984 compared with other ensemble models of MultiBoostAB Ensemble (0.958), Random SubSpace Ensemble (0.962), and credal decision tree (AUC = 0.918). The final flood risk map shows 5075 ha (0.63%) in extremely high risk, 47,955 ha (5.95%) in high-risk, 40,460 ha (5.02%) in medium risk, 431,908 ha (53.55%) in low risk areas, and 281,127 ha (34.86%) in very low risk. The present study highlights that the integration of ML models and AHP is a promising framework for mapping flood risks in flood-prone areas.

PMID:36088657 | DOI:10.1111/risa.14018