Tag: nevin manimala

JAMA Netw Open. 2022 May 2;5(5):e229968. doi: 10.1001/jamanetworkopen.2022.9968.

ABSTRACT

IMPORTANCE: In recent years, specialized musculoskeletal urgent care centers (MUCCs) have opened across the US. Uninsured patients may increasingly turn to these orthopedic-specific urgent care centers as a lower-cost alternative to emergency department or general urgent care center visits.

OBJECTIVE: To assess out-of-pocket costs and factors associated with these costs at MUCCs for uninsured and underinsured patients in the US.

DESIGN, SETTING, AND PARTICIPANTS: In this survey study, a national secret shopper survey was conducted in June 2019. Clinics identified as MUCCs in 50 states were contacted by telephone by investigators using a standardized script and posing as uninsured patients seeking information on the out-of-pocket charge for a new patient visit.

EXPOSURES: State Medicaid expansion status, clinic Medicaid acceptance status, state Medicaid reimbursement rate, median income per zip code, and clinic region.

MAIN OUTCOMES AND MEASURES: The primary outcome was each clinic’s out-of-pocket charge for a level 3 visit, defined as a new patient office visit requiring medical decision-making of low complexity. Linear regression was used to examine correlations of price with clinic policy against accepting Medicaid, median income per zip code, and Medicaid reimbursement for a level 3 visit.

RESULTS: Of 565 MUCCs identified, 558 MUCCs were able to be contacted (98.8%); 536 of the 558 MUCCs (96.1%) disclosed a new patient visit out-of-pocket charge. Of those, 313 (58.4%) accepted Medicaid insurance and 326 (60.8%) were located in states with expanded Medicaid at the time of the survey. The mean (SD) price of a visit to an MUCC was $250 ($110). Clinic policy against accepting Medicaid (β, 22.91; 95% CI, 12.57-33.25; P < .001), higher median income per zip code (β, 0.00056; 95% CI, 0.00020-0.00092; P = .003), and increased Medicaid reimbursement for a level 3 visit (β, 0.737; 95% CI, 0.158-1.316; P = .01) were positively correlated with visit price. The overall regression was statistically significance (R2 = 0.084; P < .001).

CONCLUSIONS AND RELEVANCE: In this survey study, MUCCs charged a mean price of $250 for a new patient visit. Medicaid acceptance policy, median income per zip code, and Medicaid reimbursement for a level 3 visit were associated with differences in out-of-pocket charges. These findings suggest that accessibility to orthopedic urgent care at MUCCs may be limited for underinsured and uninsured patients.

PMID:35503219 | DOI:10.1001/jamanetworkopen.2022.9968

Sleep Breath. 2022 May 3. doi: 10.1007/s11325-022-02613-2. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to analyze the relationship between serum amyloid A (SAA) concentrations in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and their magnetic resonance imaging (MRI) of resting brain function.

METHODS: Male patients with OSAHS were enrolled from January to June 2019 in Suzhou Ninth People’s Hospital Affiliated to Soochow University, and nineteen healthy male volunteers were selected as the normal control group. The patients with OSAHS were divided into mild, moderate, and severe groups according to their apnea-hypopnea index (AHI). Early in the morning after the polysomnography (PSG), blood samples were collected and serum levels of serum amyloid A (SAA) were measured by enzyme-linked immunosorbent assay. All subjects were scored by the Auditory Verbal Learning Test (AVLT) scale. Resting brain function images of healthy male volunteers and patients in the severe group were collected by 3.0 T magnetic resonance scanner. SPSS25.0 software was used for statistical analysis.

RESULTS: The SAA of the OSAHS group (n = 43) were higher than those of control group (n = 19). The scores of AVLT-immediate and AVLT-delay in the severe OSAHS group were lower than those in the control group (P < 0.05), and it was negatively correlated with SAA. In the severe OSAHS group, the rest state Function Connection (rsFC) in temporal lobe, marginal lobe, and frontal lobe was lower than that in the control group (P < 0.05) and was significantly negatively correlated with SAA. The rsFC in bilateral parietal lobes was higher than that in the control group (P < 0.05), was significantly positively correlated with SAA, and was negatively correlated with AVLT-delay.

CONCLUSIONS: The significant increase in SAA concentration in patients with OSAHS correlated with brain rsFC intensity, providing a reference role for the diagnosis, treatment, and prognosis of cognitive dysfunction in patients with OSAHS.

PMID:35503197 | DOI:10.1007/s11325-022-02613-2

World J Urol. 2022 May 3. doi: 10.1007/s00345-022-04016-0. Online ahead of print.

ABSTRACT

PURPOSE: To systematically review the published literature on surgical margins as a risk factor for local recurrence (LR) in patients undergoing partial nephrectomy (PN) for pT1 renal cell carcinomas (RCC).

EVIDENCE ACQUISITION: A systematic literature search of relevant databases (MEDLINE, Embase and the Cochrane Library) was performed according to the PRISMA criteria up to February 2022. The hypothesis was developed using the PPO method (Patients = patients with pT1 RCC undergoing PN, Prognostic factor = positive surgical margins (PSM) detected on final pathology versus negative surgical margins (NSM) and Outcome = LR diagnosed on follow-up imaging). The primary outcome was the rate of PSM and LR. The risk of bias was assessed by the QUIPS tool.

EVIDENCE SYNTHESIS: After assessing 1525 abstracts and 409 full-text articles, eight studies met the inclusion criteria. The percentage of PSM ranged between 0 and 34.3%. In these patients with PSM, LR varied between 0 and 9.1%, whereas only 0-1.5% of LR were found in the NSM-group. The calculated odds ratio (95% confident intervals) varied between 0.04 [0.00-0.79] and 0.27 [0.01-4.76] and was statistically significant in two studies (0.14 [0.02-0.80] and 0.04 [0.00-0.79]). The quality analysis of the included studies resulted in an overall intermediate to high risk of bias and the level of evidence was overall very low. A meta-analysis was considered unsuitable due to the high heterogeneity between the included studies.

CONCLUSION: PSM after PN in patients with pT1 RCC is associated with a higher risk of LR. However, the evidence has significant limitations and caution should be taken with the interpretation of this data.

PMID:35503118 | DOI:10.1007/s00345-022-04016-0

J Math Biol. 2022 May 3;84(6):47. doi: 10.1007/s00285-022-01746-y.

ABSTRACT

The evolutionary relationships among organisms have traditionally been represented using rooted phylogenetic trees. However, due to reticulate processes such as hybridization or lateral gene transfer, evolution cannot always be adequately represented by a phylogenetic tree, and rooted phylogenetic networks that describe such complex processes have been introduced as a generalization of rooted phylogenetic trees. In fact, estimating rooted phylogenetic networks from genomic sequence data and analyzing their structural properties is one of the most important tasks in contemporary phylogenetics. Over the last two decades, several subclasses of rooted phylogenetic networks (characterized by certain structural constraints) have been introduced in the literature, either to model specific biological phenomena or to enable tractable mathematical and computational analyses. In the present manuscript, we provide a thorough review of these network classes, as well as provide a biological interpretation of the structural constraints underlying these networks where possible. In addition, we discuss how imposing structural constraints on the network topology can be used to address the scalability and identifiability challenges faced in the estimation of phylogenetic networks from empirical data.

PMID:35503141 | DOI:10.1007/s00285-022-01746-y

Am J Sports Med. 2022 May 3:3635465221092144. doi: 10.1177/03635465221092144. Online ahead of print.

ABSTRACT

BACKGROUND: Hip arthroscopy for femoroacetabular impingement (FAI) in athletes, including military servicemembers, has resulted in variable outcomes. The prevalence of low back pain (LBP) and psychiatric disorders (PSYs) is high among patients undergoing hip arthroscopy.

PURPOSE: To determine the effect of LBP, PSYs, and the combination of both on outcomes in servicemembers treated arthroscopically for FAI.

STUDY DESIGN: Cohort study; Level of evidence, 2.

METHODS: Between April 2016 and June 2020, a total of 108 consecutive active-duty servicemembers underwent hip arthroscopy by a single surgeon at a single military medical center. Servicemembers were grouped according to the presence of preoperative LBP (Group LBP), a PSY (Group PSY), or both (Group Both), and outcomes were compared with those of servicemembers without these comorbidities (Group None). The minimum follow-up was 6 months. The primary outcome measure was return to duty (RTD). Secondary outcomes included the Nonarthritic Hip Score (NAHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL) subscale, and Hip Outcome Score-Sports (HOS-S) subscale.

RESULTS: All servicemembers’ final duty status was confirmed, with a mean follow-up of 2 years (range, 6 months-4.3 years). The prevalence of preoperative LBP and PSY was 27% and 39%, respectively. RTD was 59% (10/17) in Group LBP, 10% (3/30) in Group PSY, 0% (0/12) in Group Both, and 47% (23/49) in Group None. Compared with Group None, the risk of discontinuing military service was statistically higher in Group PSY (relative risk [RR], 1.70 [95% CI, 1.41-1.99]) and Group Both (RR, 1.88 [95% CI, 1.62-2.15]) but not in Group LBP (RR, 0.78 [95% CI, 0.15-1.40]). The mean preoperative secondary outcomes all significantly improved postoperatively in Group None (NAHS, 58 to 75 [P < .001]; HOS-ADL, 63 to 74 [P < .001]; HOS-S, 44 to 57 [P < .001]). Among the comorbid groups, the mean HOS-S did not significantly improve (Group LBP, 45 to 48 [P = .71]; Group PSY, 36 to 44 [P = .22]; Group Both 43 to 45 [P = .75]), and <50% of these servicemembers achieved HOS-S meaningful clinical benefit metrics.

CONCLUSION: Preoperative LBP, PSY, and a combination of both negatively affected outcomes after hip arthroscopy. Preoperative counseling is crucial in setting realistic outcome expectations.

PMID:35503098 | DOI:10.1177/03635465221092144

Ann Ital Chir. 2022;93:235-240.

ABSTRACT

OBJECTIVE: The present study aims to investigate the therapeutic effect and safety of radiofrequency ablation (RFA) of the great saphenous vein in the treatment of varicose veins of the lower extremities.

METHODS: Sixty-nine affected limbs of 45 patients were treated with RFA of the great saphenous vein. All patients underwent retrograde puncture of the distal great saphenous vein under the guidance of B-ultrasound. An RFA catheter was introduced 1 cm below the junction of the great saphenous vein and the femoral vein. A tumescent solution was injected around the femoral vein, and the great saphenous vein was ablated section by section from the upper part to the lower part. Twelve months after RFA, color Doppler ultrasound was used to evaluate the closure of great saphenous vein, and changes in the clinical class, etiology, anatomy, pathology (CEAP) classification before and after treatment were compared. The visual analogue score (VAS) was used to evaluate the local pain on the first and third day after operation. The incidence of complications (e.g., phlebitis, thrombosis, infection) was also evaluated.

RESULTS: The ablation of the 69 affected limbs in all the 45 patients was successful. Instant B-ultrasound revealed occlusion of the great saphenous vein and the disappearance of blood flow immediately after ablation. There was no reoccurrence in all patients at the 12 month follow-up. The CEAP classification grade after treatment was significantly lower than that before the treatment, and the difference was statistically significant (χ2 = 4.188, P<0.05). The VAS scores on the first and third days after operation were 1.85 ± 0.35 and 0.59 ± 0.21, respectively. Pain was mild, and only two patients required painkillers. No complications were noted, with the exception of five cases of local ecchymosis.

CONCLUSION: RFA of the great saphenous vein may represent an effective method for treating varicose veins of the lower extremities. RFA has the advantages of producing less trauma, fewer complications, and a lower incidence of recurrence.

KEY WORDS: B-ultrasonography, Pain, Radiofrequency ablation, Varicose veins.

PMID:35503057

Int Clin Psychopharmacol. 2022 May 2. doi: 10.1097/YIC.0000000000000413. Online ahead of print.

ABSTRACT

Posttraumatic stress symptoms (PTSS) develop as sequelae from traumatic injuries. Limited studies suggest that using opioids to reduce acute pain immediately after trauma may also reduce subsequent PTSS, but other pain medications rarely have been examined for preventing acute PTSS. The current study examined the effects of commonly used pain medications, opioid and nonsteroidal anti-inflammatory drugs (NSAIDs), on PTSS after acute traumatic injuries. Participants (n = 71) were categorized into opioid or NSAID group according to their medical records and self-reported medication use. Their PTSS were assessed using posttraumatic stress disorder checklist twice within 2 weeks after trauma. Participants’ pain levels reduced from pretreatment to follow-up in both groups, F(1, 55) = 6.696, P = 0.012, partial η2 = 0.109. Interestingly, a significant interaction between time and medication group on PTSS reached statistical significance, F(1, 69) = 6.014, P = 0.017, partial η2 = 0.080. Follow-up analyses revealed that this interaction was driven by a significant PTSS reduction only in opioid but not in NSAID group. These findings suggested that pain reduction alone is not sufficient to reduce acute PTSS in the NSAID group, highlighting the need to continue further investigations into the mechanisms by which opioids reduce PTSS in the early posttrauma period.

PMID:35503040 | DOI:10.1097/YIC.0000000000000413

Span J Psychol. 2022 May 3;25:e16. doi: 10.1017/SJP.2022.12.

ABSTRACT

Recovery from alcohol use disorder involves achieving certain resources for positive lifestyle changes, well-being, and long-term abstinence. The present study aims to translate and validate the Assessment Capital Recovery (ARC) in a Spanish clinical sample of individuals with alcohol use disorder, in abstinence. The participants were 184 patients who attended outpatient treatments. They were evaluated with the adapted version of the ARC (Spanish abbreviation: “Valoración del Capital de Recuperación, VCR”) and by WHOQOL-BREF (quality of life scale), in one session. Statistical analysis included the calculation of reliability, convergent validity (relationship with WHOQOL-BREF), specificity and sensitivity, as well as validity based on internal structure (confirmatory factor analysis). VCR scores show appropriate values for reliability (α = .90), and a low convergent validity with WHOQOL-BREF (Rho = .33-.53). The VCR appears to distinguish between patients with early and stable sobriety (χ2 = 20.55, p < .01). The ROC curve indicates significant discrimination values (p < .05) for stable recovery (5 years of abstinence) and sensitivity of 85.2% and specificity of 71.2%. Further, confirmatory factor analysis suggests the presence of a single factor, with relatively acceptable values of goodness of fit and factor loadings. We used ULS parameter estimation to study VCR properties, an appropriate tool for assessing recovery in clinical populations of individuals with alcohol use disorder in abstinence.

PMID:35503039 | DOI:10.1017/SJP.2022.12

Mov Disord. 2022 May 3. doi: 10.1002/mds.29037. Online ahead of print.

ABSTRACT

BACKGROUND: There is a lack of large multicenter Parkinson’s disease (PD) cohort studies and limited data on the natural history of PD in China.

OBJECTIVES: The objective of this study was to launch the Chinese Parkinson’s Disease Registry (CPDR) and to report its protocol, cross-sectional baseline data, and prospects for a comprehensive observational, longitudinal, multicenter study.

METHODS: The CPDR recruited PD patients from 19 clinical sites across China between January 2018 and December 2020. Clinical data were collected prospectively using at least 17 core assessment scales. Patients were followed up for clinical outcomes through face-to-face interviews biennially.

RESULTS: We launched the CPDR in China based on the Parkinson’s Disease & Movement Disorders Multicenter Database and Collaborative Network (PD-MDCNC). A total of 3148 PD patients were enrolled comprising 1623 men (51.6%) and 1525 women (48.4%). The proportions of early-onset PD (EOPD, age at onset ≤50 years) and late-onset PD (LOPD) were 897 (28.5%) and 2251 (71.5%), respectively. Stratification by age at onset showed that EOPD manifested milder motor and nonmotor phenotypes and was related to increased probability of dyskinesia. Comparison across genders suggested a slightly older average age at PD onset, milder motor symptoms, and a higher rate of developing levodopa-induced dyskinesias in women.

CONCLUSIONS: The CPDR is one of the largest multicenter, observational, longitudinal, and natural history studies of PD in China. It offers an opportunity to expand the understanding of clinical features, genetic, imaging, and biological markers of PD progression. © 2022 International Parkinson and Movement Disorder Society.

PMID:35503029 | DOI:10.1002/mds.29037

J Appl Microbiol. 2022 May 3. doi: 10.1111/jam.15607. Online ahead of print.

ABSTRACT

AIMS: To produce tin oxide (SnO₂ ) nanoparticles (NP) with microalga for use in azo dye polluted wastewater treatment and to optimize the conditions to synthesize as small NPs as possible.

METHODS AND RESULTS: The green microalga Chlorella vulgaris mediated NPs were synthesized after an optimization process utilizing the statistical response surface methodology (RSM). The optimized synthesis conditions were 200 W microwave power, 0.5 mM SnCl₂ concentration, and 200 °C calcination temperature. Methyl orange (MO) was studied for its photocatalytic degradation with UV. Antibacterial activity against four pathogenic bacteria was studied using the well diffusion method. Cytotoxicity was measured using the MMT assay with lung cancer cell line A549, and antioxidant activity using DPPH radical scavenging. Following the optimization of their production, the produced crystalline SnO₂ NPs were on average 32.2 nm (by XRD) with a hydrodynamic size of 52.5 nm (by LDS). Photocatalytic degradation of MO under UV was nearly complete (94% removal) after 90 min and the particles could be reused for 5 cycles retaining 80% activity. The particles had antibacterial activity towards all five tested bacterial pathogens with the minimum inhibitory concentrations ranging from 22 to 36 μg/ml. The minimum bactericidal NP concentration varied between 83 and 136 μg/ml. Antioxidant activity was concentration dependent. A cytotoxicity was determined towards A549 cells with an LD50 of 188 μg/ml after 24 h of incubation, a concentration that is much higher than the active concentration for dye removal ranging from 22 to 36 μg/ml.

CONCLUSIONS: After optimization, SnO2 nanoparticles produced with C. vulgaris displayed high photocatalytic activity at concentrations below their antibacterial and cytotoxic activity.

SIGNIFICANCE AND IMPACT OF THE STUDY: The SnO₂ nanoparticles produced with the help of microalgae are suitable for the removal of MO dye from wastewater. Further applications of this green technology can be expected.

PMID:35503005 | DOI:10.1111/jam.15607