Tag: nevin manimala

Oral Oncol. 2021 Aug 23;121:105501. doi: 10.1016/j.oraloncology.2021.105501. Online ahead of print.

ABSTRACT

OBJECTIVES: Adenoid cystic carcinoma (ACC) is the malignancy most likely to spread perineurally. Delayed diagnosis often leads to undetected perineural spread (PNS). Better understanding of diagnostic processes, clinical and imaging features in ACC may allow earlier diagnoses.

MATERIALS AND METHODS: A retrospective records search of the University of Washington Radiology archive identified patients with palatal ACC diagnosis and pre-treatment MDCT and/or MRI. Demographic data, clinical findings, diagnostic workup history and image features including the presence of PNS were recorded.

RESULTS: 44 patients met inclusion and exclusion criteria. Symptoms included pain, mass, numbness, and sinonasal congestion. The most common finding on clinical examination was visible or palpable palatal mass. 55% of patients were evaluated by a dentist pre-diagnosis. Most common initial impressions were infection and/or dental disease. PNS was identified in 81.8% of patients, most commonly at pterygopalatine fossa, palatine foramina/canals, Vidian canal, or foramen rotundum. PNS was statistically significantly associated with paresthesia (p = 0.003) but not with tumor size, age, gender, or tobacco history. 44% of patients were diagnosed ≥1 year from initial symptoms, with a mean delay of 18.3 (range < 1-72) months.

CONCLUSIONS: This study represents the first analysis of the nature of the diagnostic process of palatal ACC. Majorities of patients were evaluated by a general dentist pre-diagnosis. PNS was identified in a majority of patients and all the patients who presented with paresthesia had evidence of PNS. Despite patients presenting with paresthesia, palatal ACC is often initially misdiagnosed resulting in delayed diagnosis.

PMID:34438281 | DOI:10.1016/j.oraloncology.2021.105501

Bioresour Technol. 2021 Aug 17;341:125764. doi: 10.1016/j.biortech.2021.125764. Online ahead of print.

ABSTRACT

Microbial fermentation plays important roles in hydrogen production. Various methods to promote hydrogen production are being developed. Here, different magnetic field intensities (2.7 mT, 3.2 mT and 9.1 mT) were applied to the glucose fermentation system of Clostridium pasteurianum to evaluate the feasibility and effect of statistic magnetic field on hydrogen production. The results showed that the magnetic field intensity of 3.2 mT effectively enhanced the hydrogen production. The total glucose consumption reached 0.64 ± 0.010 mmol, the maximum hydrogen yield reached 2.34 ± 0.020 mol H₂/mol glucose, and the maximum hydrogen production rate reached 0.065 ± 0.002 mmol/h. Compared with the control, the maximum biomass, carbon conversion efficiency and energy conversion efficiency were elevated by 366%, 114%, and 26.8%, respectively. Our results provide a new way for promotion of hydrogen production, better understanding of the interaction mechanism between magnetic field and microorganisms and for optimizing the hydrogen production.

PMID:34438289 | DOI:10.1016/j.biortech.2021.125764

J Forensic Leg Med. 2021 Aug 20;83:102242. doi: 10.1016/j.jflm.2021.102242. Online ahead of print.

ABSTRACT

A prospective study was undertaken of 150 medicolegal cases where five or more tattoos were identified in anatomically separate areas. All cases were the subject of full police and coronial investigations with examination by forensic pathologists. There were 120 males and 30 females (M:F = 4:1) with an age range of 22-86 years (mean = 48.1 years). 78 cases were found where deaths were due to natural diseases (52%) (age range 27-82 years; mean 55.3 years; M:F = 4.2:1). 72 cases (48%) were found where deaths were classified as unnatural – 23 drug/alcohol related, 37 suicides, 12 accidents and 0 homicides (age range 20-66 years; mean 39.8 years; M:F = 3.8:1). This distribution was not shown to be statistically different to a control group of 100 non-tattooed individuals where there were 56 natural and 44 unnatural deaths (p = 0.3). Thus, although certain types of tattoos may be associated with an increased number of unnatural deaths in a medicolegal environment, the actual number of tattoos appears to have minimal effect.

PMID:34438228 | DOI:10.1016/j.jflm.2021.102242

Int J Pediatr Otorhinolaryngol. 2021 Aug 20;150:110893. doi: 10.1016/j.ijporl.2021.110893. Online ahead of print.

ABSTRACT

BACKGROUND: Neck-related chief complaints are common in the pediatric Emergency Department (ED), and although the incidence of pathology such as retropharyngeal abscesses is rare, the ability to rule out abscesses requiring surgical/procedural intervention is essential. However, there are no clear clinical guidelines regarding work-up and diagnosis in this population, possibly contributing to an excess use of potentially harmful and costly computed tomography (CT) imaging.

OBJECTIVE: In this study we sought to identify historical, physical exam, and laboratory findings associated with surgically significant neck abscesses to better delineate CT neck imaging criteria.

METHODS: We conducted a retrospective chart review of all patients ≤18 years presenting to a pediatric ED between 2013 and 2017 who underwent CT neck imaging. Surgically significant abscesses (SSAs) were defined as abscesses ≥2 cm, retropharyngeal abscesses (RPA), parapharyngeal abscesses (PPA), or peritonsillar abscesses (PTA). Historical factors, physical exam findings, laboratory results, demographics, and CT results were analyzed using univariate statistical analysis and regression models.

RESULTS: A total of 718 patients received neck CTs and 153 SSAs were identified. In children younger than 6 years, factors associated with statistically significant increased odds of an SSA were reported throat pain (OR 1.18; 95% CI 1.05, 1.33), fussiness (OR 1.18; 1.01, 1.39), lethargy (OR 1.43; 1.07, 1.91), tonsillar enlargement (OR 1.17; 1.02, 1.34), C-reactive protein (CRP) > 10 (OR 1.22; 1.07, 1.40), and an ED visit within the preceding week (OR 1.18; 1.04, 1.33). In children older than 6 years, the factors associated with statistically significant increased odds of an SSA included current antibiotic use (OR 1.12; 1.02, 1.22) and a CRP >10 (OR 1.14; 1.03, 1.26).

CONCLUSION: Some historical, physical exam, and laboratory findings are associated with SSAs, and while not definitive in isolation, may be beneficial additions to routine SSA assessment, as a supplement to clinical judgement regarding CT and observation decisions. This may potentially allow for the identification of patients requiring CT versus those who may not, and thus the opportunity to safely reduce the use of CT imaging in select patients.

PMID:34438187 | DOI:10.1016/j.ijporl.2021.110893

Mult Scler Relat Disord. 2021 Aug 14;55:103205. doi: 10.1016/j.msard.2021.103205. Online ahead of print.

ABSTRACT

BACKGROUND: People with Multiple Sclerosis (PwMS) experience a wide range of symptoms that can alter function and limit activity and community participation. Symptoms including sensory changes, weakness, fatigue and others have been well documented. However, symptoms related to changes in vestibular related function, including gaze and postural stability have not been fully explored. While some recent studies have begun to provide insight into these deficits in PwMS and have explored the use of rehabilitation paradigms for their management, much remains unknown about the full extent of these deficits. Therefore, this study aimed to characterize the presence of gaze and postural stability deficits in measures across the World Health Organization International Classification of Functioning, Disability, and Health (WHO ICF) and to examine how deficits in domains of body structure and function and activity contribute to participation level limitations.

METHODS: Baseline data from 41 PwMS (mean(SD) age = 53.9(11.2), 78% female) enrolled as part of a randomized clinical trial were used in this analysis. Measures of gaze and postural stability from the ICF domains of body structure and function (Vestibular ocular reflex [VOR] gain and postural sway area), activity (computerized dynamic visual acuity [cDVA] and MiniBEST test), and participation (Dizziness handicap inventory [DHI] and Activities Balance Confidence [ABC] scale) along with demographic data were used to characterize the sample. To explore relationships between ICF domains for gaze and postural stability, univariate correlations were performed between measures from each domain using Pearson’s correlations. Separate multivariate regression models examined how measures from the body structure and function and activity domains contributed to the variance in the participation level outcomes. Variance explained by the models was quantified using R-squared statistic and contribution of the independent variables were quantified using the beta coefficient (p < 0.05).

RESULTS: Correlation analysis demonstrated significant relationships in the postural stability measures across domains. Specifically, between postural sway area on a firm surface and MiniBEST test score (r = -.48;p < 0.01) and MiniBEST test score and ABC score (r = 0.5;p < 0.01). Significant correlations were also found between the gaze stability measures of horizontal and vertical VOR gain (r = .68;p < 0.001), horizontal VOR gain and dynamic visual acuity (r = .38;p = 0.02), and vertical VOR gain and dynamic visual acuity (r = .54;p < 0.001). Regression models assessing postural stability, found that only the MiniBEST score significantly contributed to the variance in ABC score (p = 0.01) and the full model explained 34% of the variance in ABC score. Regression modeling of gaze stability outcomes did not produce any variable that significantly contributed to the variance in DHI score and the full model explained 18% of the variance in DHI score.

CONCLUSIONS: PwMS in this sample demonstrated deficits in gaze and postural stability across the domains of the WHO ICF compared to past samples of PwMS and healthy cohorts. Correlation between measures in the different domains were present, but no strong relationship between measures of body structure and function, activity and participation level outcomes were observed. This lack of relationship across the domains is likely contributed to the relatively small sample size, the high level of variability observed in the outcomes, and the diverse presentation often seen in PwMS.

PMID:34438218 | DOI:10.1016/j.msard.2021.103205

J Forensic Leg Med. 2021 Aug 21;83:102244. doi: 10.1016/j.jflm.2021.102244. Online ahead of print.

ABSTRACT

BACKGROUND: Three-dimensional imaging is a rapidly growing technology that has revealed exciting insights in disparate fields of research, especially in medicine, forensics, and archaeology. Recent advancements in this technology have also made a remarkable impact in the field of anthropology and odontology. A major benefit of this technology is that they offer effective methods of creating digital records that can aid in physical documentation and can be digitally stored for later assessment and research.

AIM: The aim of the current study is to evaluate the metric accuracy of 3D models generated using three different 3D acquisition techniques for performing metric analytical procedures.

MATERIALS AND METHOD: Twenty standard craniometric linear measurements (using both sliding and spreading callipers) were taken on two craniums and eight standard measurements were taken on 2 mandibles (using sliding callipers and a mandibulometer); these measurements were then replicated on 3D digital models.

RESULTS: Statistical analysis of these dataset using Analysis of Variance (ANOVA) and post hoc Bonferroni test suggested that the physical and virtual measurements were accurate, comparable, and concordant (p > 0.05).

CONCLUSION: These findings open up numerous avenues for future study, especially in the fields of forensics and clinical studies. However, in order to overcome the limitations faced in using the digital method certain standardised protocols and guidelines must be established to record these data.

PMID:34438227 | DOI:10.1016/j.jflm.2021.102244

Sci Total Environ. 2021 Aug 13;801:149619. doi: 10.1016/j.scitotenv.2021.149619. Online ahead of print.

ABSTRACT

River systems have undergone a massive transformation since the Anthropocene. The natural properties of river systems have been drastically altered and reshaped, limiting the use of management frameworks, their scientific knowledge base and their ability to provide adequate solutions for current problems and those of the future, such as climate change, biodiversity crisis and increased demands for water resources. To address these challenges, a socioecologically driven research agenda for river systems that complements current approaches is needed and proposed. The implementation of the concepts of social metabolism and the colonisation of natural systems into existing concepts can provide a new basis to analyse the coevolutionary coupling of social systems with ecological and hydrological (i.e., ‘socio-ecohydrological’) systems within rivers. To operationalize this research agenda, we highlight four initial core topics defined as research clusters (RCs) to address specific system properties in an integrative manner. The colonisation of natural systems by social systems is seen as a significant driver of the transformation processes in river systems. These transformation processes are influenced by connectivity (RC 1), which primarily addresses biophysical aspects and governance (RC 2), which focuses on the changes in social systems. The metabolism (RC 3) and vulnerability (RC 4) of the social and natural systems are significant aspects of the coupling of social systems and ecohydrological systems with investments, energy, resources, services and associated risks and impacts. This socio-ecohydrological research agenda complements other recent approaches, such as ‘socio-ecological’, ‘socio-hydrological’ or ‘socio-geomorphological’ systems, by focusing on the coupling of social systems with natural systems in rivers and thus, by viewing the socioeconomic features of river systems as being just as important as their natural characteristics. The proposed research agenda builds on interdisciplinarity and transdisciplinarity and requires the implementation of such programmes into the education of a new generation of river system scientists, managers and engineers who are aware of the transformation processes and the coupling between systems.

PMID:34438150 | DOI:10.1016/j.scitotenv.2021.149619

J Am Coll Surg. 2021 Aug 23:S1072-7515(21)01927-X. doi: 10.1016/j.jamcollsurg.2021.07.687. Online ahead of print.

ABSTRACT

BACKGROUND: Peri-operative thromboprophylaxis guidelines offer conflicting recommendations on when to start thromboprophylaxis. As a result, there is significant variation in clinical practice which may lead to worse patient outcomes. The objective of this study was to evaluate the association between the start time of peri-operative thromboprophylaxis with venous thromboembolism (VTE) and bleeding outcomes.

STUDY DESIGN: EMBASE, MEDLINE and CENTRAL databases were searched on October 23, 2020. Randomized controlled trials that evaluated VTE and/or bleeding between groups receiving the initial dose of pharmacological thromboprophylaxis at different times pre-operatively, intra-operatively or post-operatively were included. Only trials that randomized patients to the same medication between groups were eligible. Studies on any type of surgery were included. The PRISMA guidelines were followed. The Cochrane Collaboration Risk of Bias tool was used. The review was registered with PROSPERO (CRD42019142079). The outcomes of interest were VTE and bleeding. Pre-specified subgroup analyses of studies including orthopedic and non-orthopedic surgery were performed.

RESULTS: A total of 22 trials (n=17,124 patients) met eligibility criteria. Pooled results showed a non-statistically significant decrease in the rate of VTE with pre-operative initiation of thromboprophylaxis when compared to post-operative initiation (RR 0.77, 95% CI 0.55-1.08, I²=0%, n=1,933). There was also a non-statistically significant increase in the rate of bleeding with pre-operative initiation compared to post-operative (RR 1.17, 95% CI 0.94-1.46, I²=35%, n=2,752). The risk of bias was moderate. Heterogeneity between studies was low (I² 0-35%).

CONCLUSIONS: This meta-analysis found a non-statistically significant decrease in the rate of VTE and increase in the rate of bleeding when thromboprophylaxis was initiated pre-operatively compared to post-operatively.

PMID:34438079 | DOI:10.1016/j.jamcollsurg.2021.07.687

J Acad Consult Liaison Psychiatry. 2021 Aug 23:S2667-2960(21)00144-0. doi: 10.1016/j.jaclp.2021.08.004. Online ahead of print.

ABSTRACT

PURPOSE: Psychological distress and manifest mental disorders are overlooked in 30 to 50% of patients with cancer. Accordingly, international cancer treatment guidelines recommend routine screening for distress in order to provide psychological support to those in need. Yet, institutional and patient related factors continue to hinder implementation. This study aims to investigate factors, which are associated with no screening for distress in cancer patients.

METHODS: Using machine learning, factors associated with lack of distress screening were explored in 6,491 patients with cancer between 2011 and 2019 at a large cancer treatment center. Parameters were hierarchically ordered based on statistical relevance. Nested resampling and cross validation were performed to avoid overfitting and to comply with assumptions for machine learning approaches.

RESULTS: Patients unlikely to be screened were not discussed at a tumor board, had inpatient treatment of less than 28 days, did not consult with a psychiatrist or clinical psychologist, had no (primary) nervous system cancer, no head and neck cancer, and did have breast or skin cancer. The final validated model was optimized to maximize sensitivity at 83.9% and achieved a balanced accuracy of 68.9, AUC of 0.80, and specificity of 53.9%.

CONCLUSION: Findings of this study may be relevant to stakeholders at both a clinical and institutional level in order to optimize distress screening rates.

PMID:34438098 | DOI:10.1016/j.jaclp.2021.08.004

World Neurosurg. 2021 Aug 23:S1878-8750(21)01243-2. doi: 10.1016/j.wneu.2021.08.073. Online ahead of print.

ABSTRACT

BACKGROUND: Serum biomarkers have gained significant popularity as an adjunctive measure in the evaluation and prognostication of traumatic brain injury (TBI). However, a concise and clinically oriented report of the major markers in function of TBI severity is lacking.

OBJECTIVE: This systematic review aims to report current data on the diagnostic and prognostic utility of blood-based biomarkers across the spectrum of TBI.

METHODS: A literature search of the PubMed/Medline electronic database was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. We excluded systematic reviews and meta-analyses that did not provide novel data. The American College of Cardiology/American Heart Association criteria were used to assess levels of evidence.

RESULTS: An initial 1463 studies were identified. 115 full-text articles reporting on 94 distinct biomarkers met the inclusion criteria. Glasgow Coma Scale scores, computed tomography/magnetic resonance imaging abnormalities, and injury severity scores were the most used clinical diagnostic variables. Glasgow Outcome Scores, 1, 3, and 6-month mortality were the most used clinical prognostic variables. Several biomarkers significantly correlated with these variables and had statistically significant different levels in TBI subjects when compared to healthy, orthopedic, and polytrauma controls. The biomarkers also displayed significant variability across mild, moderate, and severe TBI categories, as well as in concussion cases.

CONCLUSION: This review summarizes existing high-quality evidence that supports the use of severity-specific biomarkers in the diagnostic and prognostic evaluation of TBI. This data can be used as a launching platform for the validation of upcoming clinical studies.

PMID:34438102 | DOI:10.1016/j.wneu.2021.08.073