Tag: nevin manimala

Am J Respir Crit Care Med. 2022 Jun 10. doi: 10.1164/rccm.202112-2745OC. Online ahead of print.

ABSTRACT

RATIONALE: The role of obesity-associated insulin resistance (IR) in airflow limitation in asthma is uncertain.

OBJECTIVES: Using data in the Severe Asthma Research Program 3 (SARP-3), we evaluated relationships between homeostatic measure of IR (HOMA-IR), lung function (cross sectional and longitudinal analyses) and treatment responses to bronchodilators and corticosteroids.

METHODS: HOMA-IR values was categorized as without (< 3.0), moderate (3.0-5.0), or severe (>5.0). Lung function included forced expired volume in one second (FEV1) and forced vital capacity (FVC) measured before and after treatment with inhaled albuterol and intramuscular triamcinolone acetonide (TA) and yearly for 5 years.

MEASUREMENTS AND MAIN RESULTS: Among 307 participants in SARP-3, 170 (55%) were obese and 140 (46%) had IR. Compared to patients without IR, those with IR had significantly lower values for forced expired volume in one second (FEV1) and forced vital capacity (FVC), and these lower values were not attributable to obesity effects. Compared to patients without IR, those with IR had lower FEV1 responses to beta adrenergic agonists and systemic corticosteroids. The annualized decline in FEV1 was significantly greater in patients with moderate IR (-41 mLs/year) and severe IR (-32 mLs/year,) than in patients without IR (-13mLs/year, p< 0.001 for both comparisons).

CONCLUSION: IR is common in asthma and is associated with lower lung function, accelerated loss of lung function, and suboptimal lung function responses to bronchodilator and corticosteroid treatments. Clinical trials in patients with asthma and IR are needed to determine if improving IR might also improve lung function.

PMID:35687105 | DOI:10.1164/rccm.202112-2745OC

Chin J Dent Res. 2022 Jun 10;25(2):131-137. doi: 10.3290/j.cjdr.b3086349.

ABSTRACT

OBJECTIVE: To investigate the relationship between chewing sugar-free gum (SFG) and dental caries status in China.

METHODS: A total of 860 teenagers (aged 12 to 15 years) and 490 adults (aged ≥ 18 years) were recruited using a multistage stratified cluster method from economically developed areas (Beijing, Guangdong) and less economically developed areas (Hubei, Xinjiang). Each participant completed a questionnaire including oral health-related knowledge of SFG and chewing habits of SFG and agreed to undertake a clinical assessment. Potential factors associated with chewing conditions were analysed through a chi-square statistical test. A negative binominal regression analysis was performed to quantify the relationship between dental caries and consumption of SFG.

RESULTS: The overall percentage of the survey population who consumed SFG was 43.4%, and SFG-related knowledge and awareness was only 19.4%. For decayed, missing and filled permanent teeth (DMFT), the mean value was 1.63 ± 2.41 and 2.29 ± 3.65 in the chewing group and non-chewing group, respectively. According to the negative binominal regression analysis, the caries status in the SFG chewing group was better than in the non-chewing group (adjusted prevalence rate ratio [PRR] 0.73; 95% confidence interval [CI] 0.62-0.87).

CONCLUSION: The chewing condition and oral health-related knowledge and awareness of SFG is low. Chewing SFG is related to a better dental caries status, so regular consumption of SFG should be recommended when promoting oral health.

PMID:35686593 | DOI:10.3290/j.cjdr.b3086349

Chin J Dent Res. 2022 Jun 10;25(2):125-130. doi: 10.3290/j.cjdr.b3086347.

ABSTRACT

OBJECTIVE: To evaluate the change in demineralisation depth (DD)and mineral density (MD) over time in primary teeth exposed to a demineralisation protocol with microcomputed tomography (microCT).

METHODS: Caries lesions were artificially induced on the labial surfaces of 9 primary incisors by way of a demineralisation protocol using 0.1 M lactic acid with 10% methylcellulose gel for 7 and 14 days. The specimens were scanned with microCT and CTAn software (Bruker, Billerica, MA, USA) was used to analyse the changes in DD and MD. Statistical analyses were performed using SPSS software (IBM, Armonk, NY, USA). Repeated analysis of variance (ANOVA) test and Pearson bivariate correlation were used and the level of significance was set at P < 0.05.

RESULTS: The DD ranged from 0.00 to 0.99 μm (mean ± standard deviation [SD] 0.70 ± 0.43 μm) at baseline, 11.18 to 29.5 μm (18.15 ± 5.23 μm) at 7 days and 18.00 to 55.30 μm (34.20 ± 8.70 μm) at 14 days. The MD for all specimens (n = 9) ranged from 1.48 to 1.76 g/cm3 (1.65 ± 0.08 g/cm3) at baseline, from 1.47 to 1.74 g/cm3 (1.62 ± 0.08 g/cm3) at 7 days demineralisation and 1.33 to 1.72 g/cm3 (1.54 ± 0.13 g/cm3) at 14 days. There were statistically significant differences in DD (P < 0.001) and MD (P = 0.016) between different durations of demineralisation.

CONCLUSION: DD and MD change with time after being exposed to demineralising solution. MicroCT is a nondestructive method that allows repeated MD evaluations of the same sample.

PMID:35686592 | DOI:10.3290/j.cjdr.b3086347

Asia Pac J Clin Oncol. 2022 Jun 10. doi: 10.1111/ajco.13803. Online ahead of print.

ABSTRACT

AIMS: Durvalumab (Durva) administration after chemoradiation therapy (CRT) in locally advanced non-small-cell lung cancer (NSCLC) is the standard of care, associated with relatively prolonged progression-free (PFS) and overall survival. However, pneumonitis occurs in 73.6% of Japanese patients. This retrospective study aimed to identify factors associated with Durva efficacy and safety, specifically, the risk of pneumonitis.

METHODS: This study included data from 26 consecutive patients with locally advanced NSCLC who underwent CRT followed by Durva. The rates of adverse events and PFS were examined.

RESULTS: The median PFS time was 15.6 months (95% confidence interval [CI]: 8.7-not available). Patients developed pneumonitis of grade 1, 2, 3, and 4 at the rate of 62%, 27%, 12%, and 0%, respectively. The median PFS time was 6.4 months for patients with programmed death ligand 1 (PD-L1) expression level of <50% and not reached for patients with PD-L1 expression level of ≥50% (hazard ratio [HR], 0.19; 95% CI: 0.04-0.89), which was significantly prolonged. The cumulative incidence of pneumonitis grade 2 or above was significantly higher when the time between the last day of thoracic radiotherapy (TRT) and the start of Durva therapy was within 14 days compared to >14 days (HR: 0.19; 95% CI: 0.06-0.59). This association was statistically significant in multivariate analysis.

CONCLUSIONS: The initiation of Durva therapy within 14 days after TRT may increase the risk of pneumonitis grade 2 or above. Careful observation and suitable treatment are recommended.

PMID:35686586 | DOI:10.1111/ajco.13803

Nanoscale. 2022 Jun 10. doi: 10.1039/d2nr01277d. Online ahead of print.

ABSTRACT

Bacterial endotoxin, a major component of the Gram-negative bacterial outer membrane leaflet, is a lipopolysaccharide shed from bacteria during their growth and infection and can be utilized as a biomarker for bacterial detection. Here, the surface enhanced Raman scattering (SERS) spectra of eleven bacterial endotoxins with an average detection amount of 8.75 pg per measurement have been obtained based on silver nanorod array substrates, and the characteristic SERS peaks have been identified. With appropriate spectral pre-processing procedures, different classical machine learning algorithms, including support vector machine, k-nearest neighbor, random forest, etc., and a modified deep learning algorithm, RamanNet, have been applied to differentiate and classify these endotoxins. It has been found that most conventional machine learning algorithms can attain a differentiation accuracy of >99%, while RamanNet can achieve 100% accuracy. Such an approach has the potential for precise classification of endotoxins and could be used for rapid medical diagnoses and therapeutic decisions for pathogenic infections.

PMID:35686584 | DOI:10.1039/d2nr01277d

Clin J Pain. 2022 Jul 1;38(7):492-501. doi: 10.1097/AJP.0000000000001046.

ABSTRACT

OBJECTIVE: The aim of this study was to investigate if somatosensory profiles can differentiate pain and psychophysiological symptoms among young adults with irritable bowel syndrome (IBS).

METHODS: We performed a cluster analysis of data collected from a randomized clinical trial of 80 IBS patients and 21 age-matched healthy controls (HCs) to stratify pain and symptoms among young adults with IBS by their peripheral sensory profiles. Data of quantitative sensory testing and IBS-related pain and symptoms were collected at baseline and 6-week and 12-week follow-ups.

RESULTS: Using the K-means method, IBS patients were classified into 2 clusters, the “IBS normal threshold” (IBS-NT) and the “IBS increased threshold” (IBS-IT). The IBS-NT cluster had a similar pain threshold as the HCs, and the IBS-IT cluster had an increased threshold of somatic pain perception (lower cold pain threshold, higher heat pain threshold, and higher pressure pain threshold, all P<0.001) than HCs. Compared with the IBS-NT cluster, the IBS-IT cluster reported higher levels of IBS-related pain intensity, anxiety, fatigue, and sleep disturbance over the 3 visits (all P<0.05).

DISCUSSION: Young adults with IBS fell into 2 clusters, one with a similar sensory threshold as the HCs and another with an increased pain threshold, who reported higher pain intensity and more severe symptoms. Somatic sensory profiles should be integrated into further personalized self-management intervention among patients with IBS.

PMID:35686579 | DOI:10.1097/AJP.0000000000001046

Clin J Pain. 2022 Jul 1;38(7):502-509. doi: 10.1097/AJP.0000000000001047.

ABSTRACT

OBJECTIVES: This systematic review examined studies that used mediation analysis to investigate the mechanisms of action of cognitive-behavioral, mind-body, and exercise-based interventions for pain and disability in people with chronic primary musculoskeletal pain.

MATERIALS AND METHODS: We searched 5 electronic databases for articles that conducted mediation analyses of randomized controlled trials to either test or estimate indirect effects.

RESULTS: We found 17 studies (n=4423), including 90 mediation models examining the role of 22 putative mediators on pain or disability, of which 4 had partially mediated treatment effect; 8 had mixed results, and 10 did not mediate treatment effect. The conditions studied were chronic whiplash-associated pain, chronic low back pain, chronic knee pain, and mixed group of chronic primary musculoskeletal pain.

DISCUSSION: We observed that several of the studies included in our systematic review identified similar mechanisms of action, even between different interventions and conditions. However, methodological limitations were common. In conclusion, there are still substantial gaps with respect to understanding how cognitive-behavioral, mind-body, and exercise-based interventions work to reduce pain and disability in people with chronic primary musculoskeletal pain.

PMID:35686580 | DOI:10.1097/AJP.0000000000001047

Clin J Pain. 2022 Jul 1;38(7):476-483. doi: 10.1097/AJP.0000000000001043.

ABSTRACT

OBJECTIVES: The aim was to examine the responsiveness, presence of floor or ceiling effects, and minimal clinically important differences (MCIDs) for 2 new measures of pain-related catastrophizing and self-efficacy in individuals with chronic low back pain.

METHODS: A total of 183 individuals with chronic low back pain recruited from physical therapy clinics in Thailand completed the Thai versions of the 6-item University of Washington Concerns About Pain scale (T-UW-CAP6) and 6-item University of Washington Pain-Related Self-Efficacy scale (T-UW-PRSE6) at baseline and at 4 weeks follow-up. Perceived change in low back symptom was assessed at 4 weeks using a 7-point measure of Global Perceived Effect (GPE). Responsiveness of the T-UW-CAP6 and the T-UW-PRSE6 scale scores were evaluated by computing the effect sizes and standardized response means for change over time, and examining these as a function of the GPE ratings. Floor and ceiling effects were examined by evaluating the score distributions. Scale core MCIDs were estimated by computing a half a SD and SE of measurement statistics for each scale.

RESULTS: Responsiveness of the scales to pain treatment was supported by differences found in the mean change scores as a function of the treatment response categories. No significant floor or ceiling effects were found for either measure. Changes of 4.38 and 3.68 appeared to be the smallest change score perceived as clinical meaningful for the T-UW-CAP6 and T-UW-PRSE 6 scale scores, respectively.

DISCUSSION: The T-UW-CAP6 and T-UW-PRSE6 demonstrated good ability to detect perceived changes over time in patients with chronic low back pain. The MCIDs values provide a benchmark for assessing individual improvement in this clinical context.

PMID:35686577 | DOI:10.1097/AJP.0000000000001043

Euro Surveill. 2022 Jun;27(23). doi: 10.2807/1560-7917.ES.2022.27.23.2100497.

ABSTRACT

BackgroundNon-pharmaceutical interventions (NPIs) were implemented worldwide to control the spread of SARS-CoV-2.AimTo evaluate the impact of tiered NPIs and a nationwide lockdown on reduction of COVID-19 incidence during the second and third epidemic waves in Portugal.MethodsSurveillance data on laboratory-confirmed COVID-19 cases were used to conduct an interrupted time series analysis to estimate changes in daily incidence during a second wave tiered NPI period (9 November-18 December 2020), and a third wave lockdown period without (15-21 January 2021) and with school closure (22 January-10 February 2021).ResultsSignificant changes in trends were observed for the overall incidence rate; declining trends were observed for tiered NPIs (-1.9% per day; incidence rate ratio (IRR): 0.981; 95% confidence interval (CI): 0.973-0.989) and a lockdown period without (-3.4% per day; IRR: 0.966; 95% CI: 0.935-0.998) and with school closure (-10.3% per day, IRR: 0.897; 95% CI: 0.846-0.951). Absolute effects associated with tiered NPIs and a lockdown on a subsequent 14-day period yielded 137 cases and 437 cases per 100,000 population potentially averted, respectively.ConclusionOur results indicate that tiered NPIs implemented during the second wave caused a decline in COVID-19 incidence, although modest. Moreover, a third wave lockdown without school closure was effective in reducing COVID-19 incidence, but the addition of school closure provided the strongest effect. These findings emphasise the importance of early and assertive decision-making to control the pandemic.

PMID:35686568 | DOI:10.2807/1560-7917.ES.2022.27.23.2100497

Stroke. 2022 Jun 10:101161STROKEAHA121038374. doi: 10.1161/STROKEAHA.121.038374. Online ahead of print.

ABSTRACT

BACKGROUND: Randomized controlled trials for the use of alteplase in acute ischemic stroke have excluded or had little representation of patients with prestroke disability, and the benefit of alteplase in this population remains uncertain. We performed a systematic review and meta-analysis to examine the outcomes of thrombolysis in patients with premorbid disability.

METHODS: We performed a systematic review in accordance with the Meta-Analysis of Observational Studies in Epidemiology guidelines and retrieved studies reporting intravenous thrombolysis (IVT) in patients with prestroke disability (modified Rankin Scale score, 3-5) with acute ischemic stroke, either compared with untreated patients or treated patients without premorbid disability. The primary outcome was the return to premorbid disability at 90 days. Secondary outcomes included rate and odds ratio of favorable functional outcome at 90 days (modified Rankin Scale score 0-2 or return to premorbid modified Rankin Scale), symptomatic intracerebral hemorrhage (sICH), and 90-day mortality.

RESULTS: Eight articles were included involving 103 988 patients. Patients with disability treated with IVT had better odds of returning to baseline function compared with those who did not receive IVT (odds ratio, 7.26 [95% CI, 2.51-21.02]). Mortality and rates of sICH were not significantly different between patients with disability treated with IVT and those not treated, although there were numerically more sICHs in the IVT group. Return to baseline function was not significantly different between patients with and without prestroke disability (odds ratio, 1.46 [95% CI, 0.75-2.83]). The rates of sICH were not significantly different in patients with and without premorbid disability. However, mortality was 3× higher in patients with premorbid disability than in those without premorbid disability (38.2% versus 12.6%).

CONCLUSIONS: The use of IVT in patients with disability was associated with better outcomes compared with patients who did not receive IVT without statistically significant added risks of sICH or mortality. When compared with those without disability, there was no significant difference in the return to baseline function or sICH. High-quality data comparing treated versus untreated patients with premorbid disability are needed to clarify this issue.

REGISTRATION: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42021240499.

PMID:35686556 | DOI:10.1161/STROKEAHA.121.038374