Tag: nevin manimala

J Surg Res. 2021 Apr 10;264:462-468. doi: 10.1016/j.jss.2021.02.044. Online ahead of print.

ABSTRACT

BACKGROUND: Using the platform of morbidity and mortality conference, we developed and executed a combined faculty-resident intervention called “Education M&M” to discuss challenges faced by both parties in the operating room (OR), identify realistic solutions, and implement action plans. This study aimed to investigate the impact of this intervention on resident OR training.

MATERIALS AND METHODS: Two resident case presentations were followed by audience discussion and recommendations regarding actionable solutions aimed at improving resident OR training from an expert faculty panel. Postintervention surveys were completed by participants immediately and 2 mo later to assess perceived short and long-term impact on OR teaching and/or learning and the execution of two recommended solutions. Descriptive statistical analysis was applied.

RESULTS: Immediate post-intervention surveys (n = 44) indicated that 81.8% of participants enjoyed the M&M “a lot”; 90.1% said they would use some or a lot of the ideas presented. Awareness of OR teaching/learning challenges before and after the M&M improved from 3.0 to 3.7 (P = 0.00001) for faculty and 3.0 to 3.9 for trainees (P = 0.00004). Understanding of OR teaching and/or learning approaches improved from 3.1 to 3.7 for faculty (P = 0.00004) and 2.7 to 3.9 for trainees (P = 0.00001). In 2-mo post-intervention surveys, most residents had experienced two recommended solutions (71% and 88%) in the OR, but self-reported changes to faculty behavior did not reach statistical significance.

CONCLUSIONS: A department-wide education M&M could be an effective approach to enhance mutual communication between faculty members and residents around OR teaching/learning by identifying program-specific challenges and potential actionable solutions.

PMID:33848846 | DOI:10.1016/j.jss.2021.02.044

Epilepsy Behav. 2021 Apr 10;118:107946. doi: 10.1016/j.yebeh.2021.107946. Online ahead of print.

ABSTRACT

OBJECTIVE: This study was aimed to analyze the effectiveness of sodium channel blockers (SCBs) in CDKL5 deficiency disorder (CDD)-related epilepsy.

METHODS: A retrospective, observational study was performed, including patients with CDD diagnosis evaluated between 2016 and 2019 at three tertiary Epilepsy Centers. Demographic, electroclinical and genetic features, as well as ASM treatments and their outcomes were analyzed, with special focus on SCBs.

RESULTS: Twenty-one patients evaluated at three tertiary Epilepsy Centers were included, of which 19 presented with epilepsy (90.5%); all had pathogenic mutations of CDKL5. Six patients (31.6%) were classified as SCB responders (more than 50% reduction), four being currently seizure free (mean seizure-free period of 8 years). Most frequent SCB drugs were oxcarbazepine (OXC), carbamazepine (CBZ), and lacosamide (LCM). None of them presented relevant adverse events. In contrast, three patients showed seizure aggravation in the non-responder group. When comparing both groups, responders had statistically significant younger age at SCB treatment and epilepsy onset, higher proportion of focal epileptiform activity and less frequent history of West syndrome.

CONCLUSIONS: The results of this study indicate that treatment with SCBs might be effective and safe in a subset of patients with CDD-related epilepsy.

PMID:33848848 | DOI:10.1016/j.yebeh.2021.107946

Seizure. 2021 Apr 6;88:125-129. doi: 10.1016/j.seizure.2021.04.005. Online ahead of print.

ABSTRACT

Purpose To quantify the influence of prior knowledge about the patient and the EEG circumstances on the EEG-based seizure detection rate. Methods A sample of 95 EEGs with epileptic seizure patterns matched with 95 seizure-free control sequences were extracted from EEG video monitoring data. They were stripped of all additional information. These plain EEG recordings were evaluated by two board certified EEG reviewers. The results were compared with the interpretations of the original video monitoring evaluations. Results Using the plain EEG sequences, epileptic seizure patterns were detected with a sensitivity and specificity of 0.758 and 0.958, respectively. The classification of the seizure pattern localization and lateralization differed in 56% and 50%, respectively, from the results of the video monitoring evaluations. Conclusion Additional information about the patient and the events during an EEG recording leads to a clinically and statistically significant increase in the seizure detection rates. These results imply that the human evaluation of a plain EEG without further information may not be seen as the gold standard in EEG evaluation. The performance estimation of automated EEG evaluation methods should take this into account.

PMID:33848791 | DOI:10.1016/j.seizure.2021.04.005

Nutrition. 2021 Mar 4;89:111228. doi: 10.1016/j.nut.2021.111228. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this study was to understand the diet-related behaviors of Hainan centenarians and to analyze dietary factors that affect their nutritional status.

METHODS: Data were collected from the China Hainan Centenarian Cohort Study, a full sample survey including questionnaires, physical examinations, and physiologic indices of the centenarian population. The study included 1002 centenarians. The diet-related behaviors were assessed using the food frequency questionnaire; nutritional status was determined according to the Mini Nutritional Assessment – short form scale scores. We used logistic regression models to analyze the main dietary risk factors of malnutrition.

RESULTS: Of all the centenarians, 94.6% maintained regular meals, 80.4% had three meals a day, 53.4% ate each meal until 80% full, 88.7% ate vegetables daily, and 70% drank one to two cups of water daily. Centenarians ate rice-based staple foods; eggs, dairy, legumes, nuts, and poultry were not popular. The main sources of meat were red meat and seafood. None liked fried food, and 19.3% preferred sweet flavors. People with normal nutritional status accounted for 12.3% of the population, whereas those with malnutrition comprised 20.8%. Dietary factors that affected nutritional status included three meals a day (odds ratio [OR], 0.366; 95% confidence interval [CI], 0.173-0.778), tea drinking (OR, 0.236; 95% CI, 0.087-0.641), and the frequency of poultry (OR, 0.261; 95% CI, 0.088-0.771), seafood (OR, 0.247; 95% CI, 0.110-0.554), nuts (OR, 0.381; 95% CI, 0.150-0.965), and pastry (OR, 0.219; 95% CI, 0.080-0.600) consumption.

CONCLUSION: This was the first study on the dietary behaviors and nutritional status of centenarians using survey data. We highlighted the factors affecting nutritional status and provided scientific support for dietary strategies that may improve the nutritional status of the elderly population.

PMID:33848822 | DOI:10.1016/j.nut.2021.111228

Surg Oncol. 2021 Apr 5;37:101565. doi: 10.1016/j.suronc.2021.101565. Online ahead of print.

ABSTRACT

BACKGROUND: We compared the curettage/bone grafting and the curettage/bone graft substitutes surgical techniques in their relation to functional outcomes, oncologic outcome (recurrence, malignant transformation), the rate of postsurgical complications, durations of surgery and of postsurgical immobilization for hand-localized cases of solitary and multiple enchondromas.

METHODS: The current prospective randomized trial analyzed 200 adult patients (2012-2017) with enchondroma who underwent surgical intervention. The cases were randomly divided into Group 1 (n = 100; F 56, M 44) for surgeries with curettage and autogenous bone grafting, and Group 2 (n = 100; F 55, M 45) for surgeries with curettage and bone graft substitutes. The placebo control Group 3 consisted of cases operated by curettage only (n = 56; F 31, M 25). The follow-up period was set at 30 months.

RESULTS: The duration of surgery was 51 ± 4 min in Group 1 and 27 ± 1 min in Group 2 (p = 0.008). In Group 1, the rate of recurrence was 6% against 1% in Group 2 (p = 0.005). No other statistically significant differences in postsurgical outcomes between three involved groups were noted.

CONCLUSION: In cases of enchondroma of the hand, postsurgical functional outcomes, the rate of postsurgical complications, the duration of immobilization, and the time to complete recovery are not influenced by the type of chosen grafting material. The implementation of HAp-collagen bone substitutes in granules instead of autogenous bone grafting reduces the duration of surgery. The implementation of autogenous bone grafting may increase the rate of tumor recurrence.

PMID:33848764 | DOI:10.1016/j.suronc.2021.101565

Leg Med (Tokyo). 2021 Apr 7;51:101877. doi: 10.1016/j.legalmed.2021.101877. Online ahead of print.

ABSTRACT

Heroin-related mortality is a complex phenomenon involving several factors that make an individual more susceptible to opioid toxicity. Among these, pre-existing pathological conditions play an important role. The current paper reviewed 51 autopsied cases performed over the last 30 years, each subject (“frequent heroin user”) having taken heroin intravenously alone before death. For each case, total blood morphine concentration determined by gas chromatography-mass spectrometry (GC-MS) was obtained from the archives. For histopathological evaluation we examined microscopic sections of the heart, lung, brain, liver and kidney, and for each organ a score table with a numerical value from 1 to 5, as an indicator of increasing severity, was drawn up. Finally, we created a scoring system based on the Injury Severity Score (ISS), generated by the sum of the squares of the three highest organ scores. We investigated the relationship between total blood morphine value (mg/l) and pathological score by inserting the two variables in a linear regression model: Score = a + b·Morphinemia (p-value <0.001). The results demonstrated a statistically significant correlation between the two variables: individuals with low total blood morphine values tended to have a higher pathological score. Our study provides useful assessment tools for forensic practice, confirming the need to combine two important disciplines in drug death investigation: forensic pathology and toxicology.

PMID:33848788 | DOI:10.1016/j.legalmed.2021.101877

Soc Sci Med. 2021 Apr 3;277:113898. doi: 10.1016/j.socscimed.2021.113898. Online ahead of print.

ABSTRACT

CONTEXT: Prior research suggests the potential for political campaign advertisements to increase psychological distress among viewers. The current study tests relationships between estimated exposure to campaign advertising and the odds of respondents reporting that a doctor told them they have anxiety, depression, insomnia, or (as a negative control) cancer.

METHODS: A secondary analysis of U.S. data on televised campaign ad airings from January 2015 to November 2016 (n = 4,659,038 airings) and five waves of a mail survey on television viewing patterns and self-reported medical conditions from November 2015 to March 2017 (n = 28,199 respondents from n = 16,204 unique households in the U.S.).

FINDINGS: A 1 percent increase in the estimated volume of campaign advertising exposure was associated with a 0.06 [95% CI 0.03-0.09] percentage point increase in the odds of a respondent being told by a doctor that they have anxiety in the past 12 months. We observed this association regardless of the political party of the ad sponsor, the political party of the respondent, or their statistical interaction. We also observed this association for both Presidential campaign ads and non-Presidential (including local, state, and U.S. congressional election) campaign ads, providing evidence that these relationships were not driven by the unique divisiveness of the race between Donald Trump and Hilary Clinton. Some topic-specific models offered additional evidence of association between estimated volume of campaign advertising exposure and the odds of being told by a doctor that they have depression or insomnia, but these patterns were less consistent across models that utilized different categories of campaign exposure. Campaign ad exposure was not associated with cancer, which served as a negative control comparison.

CONCLUSIONS: There was a consistent positive association between the volume of campaign advertising exposure and a reported diagnosis of anxiety among American adults.

PMID:33848716 | DOI:10.1016/j.socscimed.2021.113898

Comput Med Imaging Graph. 2021 Mar 31;90:101911. doi: 10.1016/j.compmedimag.2021.101911. Online ahead of print.

ABSTRACT

Appropriate treatment of bladder cancer (BC) is widely based on accurate and early BC staging. In this paper, a multiparametric computer-aided diagnostic (MP-CAD) system is developed to differentiate between BC staging, especially T1 and T2 stages, using T2-weighted (T2W) magnetic resonance imaging (MRI) and diffusion-weighted (DW) MRI. Our framework starts with the segmentation of the bladder wall (BW) and localization of the whole BC volume (V_t) and its extent inside the wall (V_w). Our segmentation framework is based on a fully connected convolution neural network (CNN) and utilized an adaptive shape model followed by estimating a set of functional, texture, and morphological features. The functional features are derived from the cumulative distribution function (CDF) of the apparent diffusion coefficient. Texture features are radiomic features estimated from T2W-MRI, and morphological features are used to describe the tumors’ geometric. Due to the significant texture difference between the wall and bladder lumen cells, V_t is parcelled into a set of nested equidistance surfaces (i.e., iso-surfaces). Finally, features are estimated for individual iso-surfaces, which are then augmented and used to train and test machine learning (ML) classifier based on neural networks. The system has been evaluated using 42 data sets, and a leave-one-subject-out approach is employed. The overall accuracy, sensitivity, specificity, and area under the receiver operating characteristics (ROC) curve (AUC) are 95.24%, 95.24%, 95.24%, and 0.9864, respectively. The advantage of fusion multiparametric iso-features is highlighted by comparing the diagnostic accuracy of individual MRI modality, which is confirmed by the ROC analysis. Moreover, the accuracy of our pipeline is compared against other statistical ML classifiers (i.e., random forest (RF) and support vector machine (SVM)). Our CAD system is also compared with other techniques (e.g., end-to-end convolution neural networks (i.e., ResNet50).

PMID:33848756 | DOI:10.1016/j.compmedimag.2021.101911

Surg Oncol. 2021 Apr 2;37:101554. doi: 10.1016/j.suronc.2021.101554. Online ahead of print.

ABSTRACT

INTRODUCTION: The rate of adrenal disease diagnosed is progressively increasing due to the diagnostic tools improvement. We analysed patients that underwent to adrenalectomy in our centre for different adrenal pathologies and we tried to established guidelines for the surgical therapy.

METHODS: Demographic and clinical data were prospectively entered in a computerized endocrine surgery registry for all patients who underwent surgery for adrenal lesions at our institution over a 35-year period and statistical analyses was performed.

RESULTS: Between 1986 and 2020, 502 patients underwent adrenalectomy: open adrenalectomy (OA) was performed in 104 patients (28,6%), laparoscopic adrenalectomy (LA) in 398 patients (71,4%). The rate of conversion to OA was 5,9% (21 patients). The mean operating time in laparoscopic approach was 84.3 min (range 40-180) while in open approach was 121.9 min (40-210). The average length of stay (LOS) for LA was 3.6 days, while for OA was 7.4 days. The time to return to normal activity for LA was 21 days while for OA was 37 days.

CONCLUSIONS: The progressive increase in the number of adrenalectomies performed is due more to a better understanding of adrenal disease than to the availability of minimally invasive techniques. The choice of a laparoscopic approach should depend on the surgeon’s experience, regardless the dimension of the lesion. Considering our long experience, we suggest OA for lesion of more of 6 cm, for malignant lesion with a diameter higher than 3 cm or with a pre-operatory evidence of invasion of the surrounding tissue.

PMID:33848760 | DOI:10.1016/j.suronc.2021.101554

J Anim Physiol Anim Nutr (Berl). 2021 Apr 13. doi: 10.1111/jpn.13545. Online ahead of print.

ABSTRACT

This study was conducted to investigate the effects of dietary rice brewer waste (RBW) on growth performance, nutrient utilization and nitrogen balance in growing rabbits. Thirty growing rabbits (758 ± 25.7 g initial body weight) were randomly assigned to control and four treatment groups (containing RBW) in a completely randomized design with six rabbits per group. The study lasted 6 weeks for measurements of feed intake and growth performance followed by a five-day metabolic trial to determine nutrient digestibility and nitrogen balance. The five diets contained RBW at 0% RBW (control group), unsterilized RBW at 10% and 20% and sterilized RBW at 10% and 20% in the concentrates. The average daily body weight gain (ADG) in the 20% unsterilized RBW group was higher (p < 0.01) than the control group. No statistically significant difference (p = 0.089) of ADG was observed for the control vs. the sterilized groups, but the overall ADG was better (p = 0.044) in the unsterilized RBW groups than the sterilized RBW groups. The daily dry matter intake in unsterilized and sterilized RBW groups was higher (p < 0.01) than the control group. However, no difference (p = 0.22) was found between the unsterilized and sterilized RBW. The feed conversion ratio (FCR) was lower for the unsterilized RBW groups vs. the control group (p = 0.041), but there was no difference of FCR in the control vs. sterilized RBW groups (p = 0.37) and the unsterilized RBW groups vs. unsterilized RBW groups (p = 0.14). The digestibility of organic matter, crude protein and crude fibre was greater (p < 0.01) in the unsterilized and sterilized RBW groups than the control group. The nitrogen balance and efficiency of nitrogen utilization were also higher in the unsterilized and sterilized RBW groups than the control group (p < 0.01). The study showed that the dietary RBW could improve growth performance and nutrient utilization in growing rabbits with superior responses for the unsterilized RBW.

PMID:33848037 | DOI:10.1111/jpn.13545