Tag: nevin manimala

Arch Orthop Trauma Surg. 2021 Apr 21. doi: 10.1007/s00402-021-03911-2. Online ahead of print.

ABSTRACT

INTRODUCTION: Anterior distal femoral hemiepiphysiodesis using intra-articular plates for correction of pediatric fixed knee flexion deformities (FKFD) has two documented complications: postoperative knee pain and implant loosening. The aim of this study is to investigate the mechanical properties of a novel extra-articular technique for anterior distal femoral hemiepiphysiodesis in patients with FKFD and to compare them to the conventional technique.

MATERIALS AND METHODS: Sixteen femoral sawbones were osteotomized at the level of the distal femoral physis and fixed by rail frames to allow linear distraction simulating longitudinal growth. Each sawbone was tested twice: first using the conventional technique with eight plates placed anteriorly just medial and lateral to the femoral sulcus (group A) and then with plates inserted in the proposed novel location at the most anterior part of the medial and lateral surfaces of the femoral condyles with screws in the coronal plane (group B). Gradual linear distraction was performed, and the resulting angular correction was measured. Strain gauges were attached to the plates, and the amount of strain (and equivalent stress) over the plates in response to linear distraction was recorded. The two groups were compared using the Wilcoxon signed-rank test.

RESULTS: The amount of angular correction was statistically higher in group B (extra-articular plates) at 5, 10-, and 15-mm of distraction (p < 0.001). As regards stress over the plates, the maximum stress and the area under the curve (sum of all stresses measured throughout the distraction process) were significantly higher when the plates were inserted at the conventional position (group A) (p < 0.001).

CONCLUSIONS: During anterior distal femoral hemiepiphysiodesis, the fixation of the eight plates in the coronal plane at the anterior part of the femoral condyles may produce a greater amount of correction and a lower degree of stress over the implants as compared to the conventional technique.

PMID:33881593 | DOI:10.1007/s00402-021-03911-2

Eur Arch Otorhinolaryngol. 2021 Apr 21. doi: 10.1007/s00405-021-06811-8. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to assess the functional head impulse test on migraine patients without vertigo. fHIT is a new vestibular test which evaluates the ability to see and read clearly during head movement as a functional measurement of the vestibulo-ocular reflex.

MATERIALS AND METHODS: The study included 20 patients suffering from migraine without vertigo between the ages of 20 and 30-years-old who were diagnosed by a neurologist and 20 individuals with non-migraine headaches (control group), with similar demographic characteristics. The functional head impulse test was applied to both groups, and the migraine disability assessment test was applied to migraine patients.

RESULTS: There was no statistically significant difference in the general fHIT results between the migraine group and the control group (p > 0.05). However, a statistically significant decrease was obtained in migraine patients in the left lateral (p = 0.018) and right posterior (p = 0.029) semicircular canals at 4000 Hz and the right anterior semicircular canal at 6000 Hz (p = 0.019). When compared by the degree of migraine disability assessment test, no significant difference in the fHIT results were observed (p > 0.05).

CONCLUSION: The semicircular canals may be affected at high head acceleration (4000-6000 Hz) in migraine patients without a history of vertigo. It should be considered that fHIT results between 4000 and 6000 Hz in migraine patients without vertigo can be pathologic.

PMID:33881576 | DOI:10.1007/s00405-021-06811-8

Arch Gynecol Obstet. 2021 Apr 21. doi: 10.1007/s00404-021-06069-9. Online ahead of print.

ABSTRACT

OBJECTIVE: In preeclampsia, there are excessive complement components expressed due to increased complement activation; therefore, this study investigated the concentration of adipsin and C9 in HIV-associated preeclampsia.

METHOD: The study population (n = 76) was stratified by pregnancy type (normotensive pregnant and preeclampsia) and by HIV status. Serum was assayed for the concentration of adipsin and C9 using a Bioplex immunoassay procedure.

RESULTS: Maternal weight did not differ (p = 0.1196) across the study groups. The concentration of adipsin was statistically different between the PE vs normotensive pregnant groups, irrespective of HIV status (p = 0.0439). There was no significant difference in adipsin concentration between HIV-negative vs HIV-positive groups, irrespective of pregnancy type (p = 0.6290). Additionally, there was a significant difference in adipsin concentration between HIV-negative normotensive vs HIV-negative preeclampsia (p < 0.05), as well as a difference between HIV-negative preeclampsia vs HIV-positive preeclampsia (p < 0.05). C9 protein expression was not statistically different between the normotensive and PE groups, regardless of HIV status (p = 0.5365). No statistical significance in C9 expression was found between HIV-positive vs HIV-negative groups, regardless of pregnancy type (p = 0.3166). Similarly, no statistical significance was noted across all study groups (p = 0.0774).

CONCLUSION: This study demonstrates that there is a strong correlation between the up-regulation of adipsin and PE and that adipsin is a promising biomarker to use as a diagnostic tool for PE.

PMID:33881585 | DOI:10.1007/s00404-021-06069-9

Eur Radiol. 2021 Apr 21. doi: 10.1007/s00330-021-07934-6. Online ahead of print.

ABSTRACT

OBJECTIVE: The non-invasive discrimination of significant fibrosis (≥ F2) in patients with chronic liver disease (CLD) is clinically critical but technically challenging. We aimed to develop an updated deep learning radiomics model of elastography (DLRE2.0) based on our previous DLRE model to achieve significantly improved performance in ≥ F2 evaluation.

METHODS: This was a retrospective multicenter study with 807 CLD patients and 4842 images from three hospitals. All of these patients have liver biopsy results as referenced standard. Multichannel deep learning radiomics models were developed. Elastography images, gray-scale images of the liver capsule, gray-scale images of the liver parenchyma, and serological results were gradually integrated to establish different diagnosis models, and the optimal model was selected for assessing ≥ F2. Its accuracy was thoroughly investigated by applying different F0-1 prevalence cohorts and independent external test cohorts. Analysis of receiver operating characteristic (ROC) curves was performed to calculate the area under the ROC curve (AUC) for significance of fibrosis (≥ F2) and cirrhosis (F4).

RESULTS: The AUC of the DLRE2.0 model significantly increased to 0.91 compared with the DLRE model (AUC 0.83) when evaluating ≥ F2 (p = 0.0167). However, it did not show statistically significant differences as integrating gray-scale images and serological data into the DLRE2.0 model. AUCs of DLRE and DLRE2.0 increased, when there was higher F0-1 prevalence. All radiomics models had good robustness in the independent external test cohort.

CONCLUSIONS: DLRE2.0 was the most suitable model for staging significant fibrosis while considering the balance of diagnostic accuracy and clinical practicability.

KEY POINTS: • The non-invasive discrimination of significant fibrosis (≥ F2) in patients with chronic liver disease (CLD) is clinically critical but technically challenging. • We aimed to develop an updated deep learning radiomics model of elastography (DLRE2.0) based on our previous DLRE model to achieve significantly improved performance in ≥ F2 evaluation. • Our study based on 807 CLD patients and 4842 images with liver biopsy found that DLRE2.0 was the most suitable model for staging significant fibrosis while considering the balance of diagnostic accuracy and clinical practicability.

PMID:33881568 | DOI:10.1007/s00330-021-07934-6

Demography. 2021 Apr 21:9164021. doi: 10.1215/00703370-9164021. Online ahead of print.

ABSTRACT

The extent to which siblings resemble each other measures the omnibus impact of family background on life chances. We study sibling similarity in cognitive skills, school grades, and educational attainment in Finland, Germany, Norway, Sweden, the United Kingdom, and the United States. We also compare sibling similarity by parental education and occupation within these societies. The comparison of sibling correlations across and within societies allows us to characterize the omnibus impact of family background on education across social landscapes. Across countries, we find larger population-level differences in sibling similarity in educational attainment than in cognitive skills and school grades. In general, sibling similarity in education varies less across countries than sibling similarity in earnings. Compared with Scandinavian countries, the United States shows more sibling similarity in cognitive skills and educational attainment but less sibling similarity in school grades. We find that socioeconomic differences in sibling similarity vary across parental resources, countries, and measures of educational success. Sweden and the United States show greater sibling similarity in educational attainment in families with a highly educated father, and Finland and Norway show greater sibling similarity in educational attainment in families with a low-educated father. We discuss the implications of our results for theories about the impact of institutions and income inequality on educational inequality and the mechanisms that underlie such inequality.

PMID:33881509 | DOI:10.1215/00703370-9164021

Strahlenther Onkol. 2021 Apr 21. doi: 10.1007/s00066-021-01776-3. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to compare the quality of images resulting from magnetic resonance imaging of patients who underwent intracranial MRI simulation using two different setups (treatment position with mask immobilization and standard diagnostic setup). Due to a larger number of channels and lack of mask immobilization in the standard diagnostic setup, we would like to evaluate whether this is an appropriate technique for MRI treatment planning.

METHODS: In total, 70 patients who underwent MR imaging of the brain at 1.5T were included in the study (48 for 6‑channel flex coil, 22 for 24-channel HNU face bill coil). Contrast-enhanced 3D T1w and T2 FLAIR images were acquired. Images were subjectively compared for artifact appearance and general image quality by three radiographers. Objective comparison of contrast rate, contrast-to-noise ratio, and signal-to-noise ratio was also performed.

RESULTS: FLAIR and contrast-enhanced 3D T1w images showed various artifacts, such as susceptibility and movement artifacts. There were no statistically significant differences regarding the evaluation of movement artifacts between two coils and two different immobilization methods. There were also no statistically significant differences (p > 0.05) between the 6‑channel flex coil and 24-channel HNU face bill coil regarding qualitative general image quality and objective measures.

CONCLUSION: There were no statistically significant differences between the occurrence of movement artifacts, overall image quality, and objective image quality in treatment position with mask immobilization and standard diagnostic setup. Based on this result, we can conclude that a standard diagnostic setup is also applicable in intracranial MRI treatment planning with no loss to image quality. Registration of the imaging plans was not performed in this study; therefore, it might still be necessary to perform measurements of tumor delineation matching and geometrical accuracy acceptance in our institution.

PMID:33881558 | DOI:10.1007/s00066-021-01776-3

Surg Radiol Anat. 2021 Apr 21. doi: 10.1007/s00276-021-02750-5. Online ahead of print.

ABSTRACT

PURPOSE: The aim of the present study is to describe in detail the morphology and innervation pattern of the anconeus muscle, bearing in mind clinical implications such as iatrogenic injuries during surgical elbow approaches.

METHODS: A cadaveric study was performed; 56 elbows from 28 formalin-fixed cadavers belonging to the Anatomy Department of Universidad Complutense of Madrid were dissected. The triceps-anconeus nerve was located and dissected. A second innervation to the anconeus muscle from a branch of the posterior interosseous nerve (PIN) was occasionally detected. Taking the lateral epicondyle as a landmark, the entry points of both nerves in the muscle were referenced, the triceps-anconeus nerve was referenced at 0°, 30°, 45°, 70° and 90° of elbow flexion, and the PIN branch at 0°.

RESULTS: Anconeus muscle was present in all specimens. The triceps-anconeus nerve was present in all of the dissected elbows. A branch from PIN to the anconeus muscle was present in 38 of the 54 elbows (70.4%). There were statistically significant differences in all measurements regarding the specimens’ gender, being higher for men.

CONCLUSIONS: There is evidence of a high frequency of a double innervation pattern for the anconeus muscle: the main branch of triceps-anconeus muscle depending on the radial nerve, which is liable to being damaged during posterior elbow approaches, and a secondary branch depending on the PIN. There are very few references to this finding in Anatomical literature and none with such a large sample size.

PMID:33881559 | DOI:10.1007/s00276-021-02750-5

JMIR Public Health Surveill. 2021 Apr 21;7(4):e24330. doi: 10.2196/24330.

ABSTRACT

BACKGROUND: Web-based technology has dramatically improved our ability to detect communicable disease outbreaks, with the potential to reduce morbidity and mortality because of swift public health action. Apps accessible through the internet and on mobile devices create an opportunity to enhance our traditional indicator-based surveillance systems, which have high specificity but issues with timeliness.

OBJECTIVE: The aim of this study is to describe the literature on web-based apps for indicator-based surveillance and response to acute communicable disease outbreaks in the community with regard to their design, implementation, and evaluation.

METHODS: We conducted a systematic search of the published literature across four databases (MEDLINE via OVID, Web of Science Core Collection, ProQuest Science, and Google Scholar) for peer-reviewed journal papers from January 1998 to October 2019 using a keyword search. Papers with the full text available were extracted for review, and exclusion criteria were applied to identify eligible papers.

RESULTS: Of the 6649 retrieved papers, 23 remained, describing 15 web-based apps. Apps were primarily designed to improve the early detection of disease outbreaks, targeted government settings, and comprised either complex algorithmic or statistical outbreak detection mechanisms or both. We identified a need for these apps to have more features to support secure information exchange and outbreak response actions, with a focus on outbreak verification processes and staff and resources to support app operations. Evaluation studies (6 out of 15 apps) were mostly cross-sectional, with some evidence of reduction in time to notification of outbreak; however, studies lacked user-based needs assessments and evaluation of implementation.

CONCLUSIONS: Public health officials designing new or improving existing disease outbreak web-based apps should ensure that outbreak detection is automatic and signals are verified by users, the app is easy to use, and staff and resources are available to support the operations of the app and conduct rigorous and holistic evaluations.

PMID:33881406 | DOI:10.2196/24330

JAMA Dermatol. 2021 Apr 21. doi: 10.1001/jamadermatol.2021.0179. Online ahead of print.

ABSTRACT

IMPORTANCE: Air pollution is a worldwide public health issue that has been exacerbated by recent wildfires, but the relationship between wildfire-associated air pollution and inflammatory skin diseases is unknown.

OBJECTIVE: To assess the associations between wildfire-associated air pollution and clinic visits for atopic dermatitis (AD) or itch and prescribed medications for AD management.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional time-series study assessed the associations of air pollution resulting from the California Camp Fire in November 2018 and 8049 dermatology clinic visits (4147 patients) at an academic tertiary care hospital system in San Francisco, 175 miles from the wildfire source. Participants included pediatric and adult patients with AD or itch from before, during, and after the time of the fire (October 2018 through February 2019), compared with those with visits in the same time frame of 2015 and 2016, when no large wildfires were near San Francisco. Data analysis was conducted from November 1, 2019, to May 30, 2020.

EXPOSURES: Wildfire-associated air pollution was characterized using 3 metrics: fire status, concentration of particulate matter less than 2.5 μm in diameter (PM2.5), and satellite-based smoke plume density scores.

MAIN OUTCOMES AND MEASURES: Weekly clinic visit counts for AD or itch were the primary outcomes. Secondary outcomes were weekly numbers of topical and systemic medications prescribed for AD in adults.

RESULTS: Visits corresponding to a total of 4147 patients (mean [SD] age, 44.6 [21.1] years; 2322 [56%] female) were analyzed. The rates of visits for AD during the Camp Fire for pediatric patients were 1.49 (95% CI, 1.07-2.07) and for adult patients were 1.15 (95% CI, 1.02-1.30) times the rate for nonfire weeks at lag 0, adjusted for temperature, relative humidity, patient age, and total patient volume at the clinics for pediatric patients. The adjusted rate ratios for itch clinic visits during the wildfire weeks were 1.82 (95% CI, 1.20-2.78) for the pediatric patients and 1.29 (95% CI, 0.96-1.75) for adult patients. A 10-μg/m3 increase in weekly mean PM2.5 concentration was associated with a 7.7% (95% CI, 1.9%-13.7%) increase in weekly pediatric itch clinic visits. The adjusted rate ratio for prescribed systemic medications in adults during the Camp Fire at lag 0 was 1.45 (95% CI, 1.03-2.05).

CONCLUSIONS AND RELEVANCE: This cross-sectional study found that short-term exposure to air pollution due to the wildfire was associated with increased health care use for patients with AD and itch. These results may provide a better understanding of the association between poor air quality and skin health and guide health care professionals’ counseling of patients with skin disease and public health practice.

PMID:33881450 | DOI:10.1001/jamadermatol.2021.0179

Blood Adv. 2021 Apr 27;5(8):2137-2141. doi: 10.1182/bloodadvances.2020001834.

ABSTRACT

The efficacy and safety of caplacizumab in individuals with acquired thrombotic thrombocytopenic purpura (aTTP) have been established in the phase 2 TITAN and phase 3 HERCULES trials. Integrated analysis of data from both trials was conducted to increase statistical power for assessing treatment differences in efficacy and safety outcomes. Caplacizumab was associated with a significant reduction in the number of deaths (0 vs 4; P < .05) and a significantly lower incidence of refractory TTP (0 vs 8; P < .05) vs placebo during the treatment period. Consistent with the individual trials, treatment with caplacizumab resulted in a faster time to platelet count response (hazard ratio, 1.65; P < .001), a 72.6% reduction in the proportion of patients with the composite end point of TTP-related death, TTP exacerbation, or occurrence of at least 1 treatment-emergent major thromboembolic event during the treatment period (13.0% vs 47.3%; P < .001), and a 33.3% reduction in the median number of therapeutic plasma exchange days (5.0 vs 7.5 days) vs placebo. No new safety signals were identified; mild mucocutaneous bleeding was the main safety finding. This integrated analysis provided new evidence that caplacizumab prevents mortality and refractory disease in acquired TTP and strengthened individual trial findings, with a confirmed favorable safety and tolerability profile. These trials were registered at www.clinicaltrials.gov as #NCT01151423 and #NCT02553317.

PMID:33881463 | DOI:10.1182/bloodadvances.2020001834