Tag: pubmed

J Magn Reson Imaging. 2024 Jul 12. doi: 10.1002/jmri.29531. Online ahead of print.

ABSTRACT

BACKGROUND: Turbo spin-echo (TSE) diffusion-weighted imaging (DWI) sequences may reduce susceptibility artifacts and image distortion in sellar region, allowing better visualization of small pituitary lesions, and may be used to assist in the diagnosis of pituitary microadenomas.

PURPOSE: To explore the application value of conventional MRI combined with DWI sequences in the diagnosis of microprolactinomas.

STUDY TYPE: Prospective.

POPULATION: Thirty-four patients in microprolactinomas with high signal on T₂WI (HT₂-PRL) group (34 females, 34 ± 7 years), 26 patients in microprolactinomas with equal or low signal on T₂WI (ELT₂-PRL) group (21 females, 34 ± 7 years), 35 patients with hyperprolactinemia (33 females, 32 ± 8 years), and 30 normal controls (25 females, 31 ± 7 years).

FIELD STRENGTH/SEQUENCE: TSE sequence at 3 T.

ASSESSMENT: Pituitary morphological parameters (such as length and volume), dynamic contrast-enhanced parameters (such as time to peak) and the apparent diffusion coefficients (ADCs) were measured in each group.

STATISTICAL TESTS: ANOVA and Mann-Whitney U test were used to compare parameters among groups. Spearman’s coefficient was used to evaluate the correlation between variables. ROC analysis was used to assess the performance of the parameters. A P-value <0.05 was considered statistically significant.

RESULTS: The pituitary volume of patients in HT₂-PRL, ELT₂-PRL, and hyperprolactinemia group were 831.00 (747.60, 887.60), 923.63 ± 219.34, and 737.20 (606.40, 836.80) mm³. The pituitary maximum height in these three groups were 7.03 (6.43, 8.63), 8.03 ± 1.41, and 6.63 ± 1.28 mm, respectively. The lesion ADC value was significantly correlated with T₂ relative signal intensity (the ratio of signal intensity of microprolactinoma or anterior pituitary to left temporal cortex) (r = 0.821). Compared with patients with hyperprolactinemia, the diagnostic efficacy of T₂ relative signal intensity was higher in HT₂-PRL group, with an AUC of 0.954, whereas the ADC value was the highest in ELT₂-PRL group, with an AUC of 0.924.

CONCLUSION: DWI sequences can be used to assist in the diagnosis of pituitary microadenomas.

EVIDENCE LEVEL: 1 TECHNICAL EFFICACY: Stage 2.

PMID:38996369 | DOI:10.1002/jmri.29531

Dermatol Surg. 2024 Jul 12. doi: 10.1097/DSS.0000000000004305. Online ahead of print.

ABSTRACT

BACKGROUND: Patient-reported outcome measures (PROMs) are necessary to assess the value of skin cancer treatment and to better compare therapeutic options.

OBJECTIVE: To develop and validate the Oxford Skin Cancer Treatment (OxSCanTr) scale, evaluating health-related quality of life and satisfaction after skin cancer treatment.

MATERIALS AND METHODS: After qualitative patient interviews, international expert consultation, and item reduction, 2 separate patient samples were used to assess the factor structure of the scale. Exploratory factor analysis with categorical variables and a polychoric correlation matrix followed by promax oblique rotation was performed to establish a factor structure on Group A. Confirmatory factor analysis with a Satorra-Bentler scaled test statistic evaluating the root mean squared error of approximation (RMSEA), standardized root mean squared residual (SRMR), and comparative fit index (CFI) was conducted on Group B. Reliability as internal consistency was assessed using McDonald omega. Convergent and discriminant validity were assessed using the Pearson correlation coefficient.

RESULTS: A total of 480 subjects returned completed surveys (completion rate 96%). A 12-item scale was developed encompassing 4 domains: aesthetic satisfaction, treatment choice satisfaction, treatment experience, and future concerns regarding recurrence/spread. Confirmatory factor analysis showed excellent goodness-of-fit characteristics, with RMSEA = 0.048, SRMR = 0.051, and CFI = 0.962 using the 4-factor model. Reliability was very good (McDonald omega 0.81-0.82), as was convergent validity with the FACE-Q skin cancer module appraisal of scars subscale (r = 0.55). Discriminant validity with a single question regarding being conservative was similarly excellent (r = -0.02).

CONCLUSION: The OxSCanTr scale is a parsimonious, feasible, and valid PROM for the holistic assessment of the experience of patients who have undergone skin cancer treatment.

PMID:38996368 | DOI:10.1097/DSS.0000000000004305

Fam Med. 2024 Jul;56(7):442-446. doi: 10.22454/FamMed.2024.562790.

ABSTRACT

BACKGROUND AND OBJECTIVES: Learning to provide long-acting reversible contraception (LARC) during family medicine residency is an important step in building capacity for the primary care workforce to meet the reproductive health care needs of communities. We aimed to measure the impact of adding a contraceptive visit type (CVT) allowing for rapid access to contraception (RAC) on family medicine resident LARC procedure numbers.

METHODS: Our program created a CVT in which patients were seen only for contraceptive services. We added the CVT to third-year family medicine resident continuity clinic schedules and a block of CVTs (the RAC clinic) to the third-year gynecology rotation. Residents self-reported LARC procedure numbers performed throughout residency, and the totals were compared for graduating residents from 2023 (post-RAC cohort) to 2022 graduates and 2018-2022 graduates (pre-RAC cohort).

RESULTS: Post-RAC cohort residents reported a statistically significant increase in intrauterine device (IUD; P=.015) and contraceptive implant (P=.010) removals compared to the 2022 pre-RAC cohort. Insertions of IUDs and contraceptive implants were unchanged when compared to the pre-RAC cohort. IUD removals (P=.004) and insertions (P=.034), and contraceptive implant removals (P=.028) were significantly increased for post-RAC compared to 2022 graduates, with no difference in contraceptive implant insertions (P=.211).

CONCLUSIONS: The addition of the CVT and RAC clinic contributed to an increase in LARC removals in both comparisons, and IUD insertions between 2022 and 2023. This clinic model offers an opportunity for other family medicine residency programs to improve access to contraceptive services and increase resident training in LARC management.

PMID:38996355 | DOI:10.22454/FamMed.2024.562790

Dermatol Surg. 2024 Jul 12. doi: 10.1097/DSS.0000000000004319. Online ahead of print.

ABSTRACT

BACKGROUND: Although lidocaine is widely used in dermatologic surgery, no formal standard concentration is established. Previous research indicates that more dilute concentrations may offer equally effective anesthesia while potentially reducing toxicity risks. In addition, diluting commercially available lidocaine conserves supplies-a significant benefit during periods of lidocaine shortage.

OBJECTIVE: To evaluate the efficacy of 0.25% lidocaine compared with that of 0.5% lidocaine in achieving anesthesia in cutaneous surgery.

MATERIALS AND METHODS: A prospective, double-blind study with 100 patients undergoing cutaneous surgery (Mohs surgery or excision) randomized to receive either 0.25% or 0.5% lidocaine for their percutaneous anesthesia. Patients completed a postoperative survey assessing pain level, satisfaction, and willingness to undergo future dermatologic surgery.

RESULTS: This study revealed no statistically significant differences between the 0.25% and 0.5% lidocaine groups regarding pain scores, patient satisfaction, total lidocaine volume, rescue lidocaine volume, or willingness to undergo the procedure again.

CONCLUSION: 0.25% lidocaine is a safe and effective option for achieving anesthesia during Mohs surgery and standard excisions. The results suggest that 0.25% lidocaine can be used to optimize high-value care and enhance patient safety in dermatologic surgery.

PMID:38996348 | DOI:10.1097/DSS.0000000000004319

ACS Nano. 2024 Jul 12. doi: 10.1021/acsnano.4c04775. Online ahead of print.

ABSTRACT

Simultaneous detection and structural characterization of protein variants on a single platform are highly desirable but technically challenging. Herein, we present a single-molecule spectral system based on a gold plasmonic nanopore for analyzing two peptides and their single-point mutated variants. The gold plasmonic nanopore enabled the high-throughput acquisition of surface-enhanced Raman scattering (SERS) spectra at the single-molecule level by electrically driving analytes into hot spots. Furthermore, a statistical method based on Boolean operations was developed to extract prominent features from fluctuated single-molecule SERS spectra. The effects of the single-amino acid substitutions on both the intramolecular interactions and the peptide conformations were directly characterized by the nanopore system, and the results agreed with the predictions by AlphaFold2. This study highlights the mutual benefits of spectroscopy and nanopore technology, whereby the gold plasmonic nanopore offers a powerful tool for the structural analysis of single-molecule proteins.

PMID:38996344 | DOI:10.1021/acsnano.4c04775

Clin Orthop Relat Res. 2024 Jul 12. doi: 10.1097/CORR.0000000000003159. Online ahead of print.

ABSTRACT

BACKGROUND: The acetabular version is crucial for hip function, and its accurate assessment is necessary for treating patients with hip disorders. Current studies reveal discrepancies in the precision of quantitative radiographic measurements versus CT measurements, but there is a lack of focused analysis on anteverted versus retroverted hips. This study aims to fill this gap by directly comparing the reliability of these two methods in assessing varied hip configurations.

QUESTIONS/PURPOSES: (1) How reliable are quantitative radiographic and CT methods in measuring the acetabular version angle? (2) Is there any difference in the reliability of acetabular version angle measurements using radiography compared with CT in anteverted and retroverted hips? (3) What is the extent of variation in acetabular version measurements when quantitative radiographic and CT methods are compared in anteverted and retroverted hips?

METHODS: We searched our image archives for patients who had received both radiographs and CT scans between January 2020 and June 2022 and found 84 patients who met the criteria. From these patients, we selected those who presented with hip pain of different causes and who had no previous elective and/or hip trauma surgery, no hip dysplasia, and results from adequate radiographic examinations. Accordingly, 73% (61 of 84) of the patients were included in this study, and angle measurements were performed on both hips of these patients (122 hips). Standardized positioning was meticulously verified for all plain radiographs and CT scans utilized in the measurement process. We measured quantitative angles and assessed qualitative signs of retroversion, including crossover, posterior wall, and ischial spine findings. We considered a hip with at least one of these findings a retroverted hip, and the hips without these findings were included in the anteverted hip group. Three clinicians took measurements independently. Measurement reliability and agreement were examined using intraobserver and interobserver intraclass correlation coefficients (ICCs), with statistical analyses including paired and independent t-tests. To investigate the reliability of quantitative radiographic and CT methods, we assessed both intraobserver and interobserver agreements. To explore the reliability disparities in measuring the acetabular version via radiography and CT in anteverted and retroverted hips, we analyzed the agreement between measurements from both modalities in the hip groups. Furthermore, to evaluate the degree of variation in acetabular version measurements when comparing quantitative radiographic and CT methods in anteverted and retroverted hips, we utilized paired and independent t-tests to examine the measurement differences within these hip categories. The difference between radiographic and CT measurements was also evaluated by Bland-Altman analysis.

RESULTS: Quantitative radiographic measurements showed intraobserver and interobserver reliabilities with ICCs of 0.87 (95% CI 0.84 to 0.91) and 0.78 (95% CI 0.75 to 0.82), respectively, and CT measurements demonstrated higher reliabilities with ICCs of 0.92 (95% CI 0.90 to 0.93) and 0.91 (95% CI 0.89 to 0.92), respectively. The reliability of measuring the acetabular version in anteverted hips was moderate, with an ICC of 0.59 (95% CI 0.49 to 0.68). In contrast, retroverted hips showed an ICC of -0.41 (95% CI -1.17 to 0.08), indicating a lack of consistency between quantitative radiographic and CT measurements. Variation in measurement on plain radiographs in anteverted hips was less than that of retroverted hips (mean ± SD absolute difference between anteverted hips and retroverted hips 3° ± 3° versus 6° ± 4°; p = 0.0001), indicating greater variability in the radiographic measurement of retroverted hips. According to Bland-Altman analysis, we observed that the difference between radiographic and CT measurements was well outside the CI, especially in retroverted hips.

CONCLUSION: Although quantitative radiographic measurement demonstrates acceptable intraobserver and interobserver reliabilities, its precision is lower than that of CT-based measurements. Specifically, quantitative radiographic methods are prone to a larger margin of error in retroverted hips. For more precise assessments of acetabular version, especially in retroverted hips, we recommend using CT measurement instead of the radiographic method.

LEVEL OF EVIDENCE: Level III, diagnostic study.

PMID:38996337 | DOI:10.1097/CORR.0000000000003159

JMIR Mhealth Uhealth. 2024 Jul 12;12:e51216. doi: 10.2196/51216.

ABSTRACT

BACKGROUND: Wearable activity trackers have become key players in mobile health practice as they offer various behavior change techniques (BCTs) to help improve physical activity (PA). Typically, multiple BCTs are implemented simultaneously in a device, making it difficult to identify which BCTs specifically improve PA.

OBJECTIVE: We investigated the effects of BCTs implemented on a smartwatch, the Fitbit, to determine how each technique promoted PA.

METHODS: This study was a single-blind, pilot randomized controlled trial, in which 70 adults (n=44, 63% women; mean age 40.5, SD 12.56 years; closed user group) were allocated to 1 of 3 BCT conditions: self-monitoring (feedback on participants’ own steps), goal setting (providing daily step goals), and social comparison (displaying daily steps achieved by peers). Each intervention lasted for 4 weeks (fully automated), during which participants wore a Fitbit and responded to day-to-day questionnaires regarding motivation. At pre- and postintervention time points (in-person sessions), levels and readiness for PA as well as different aspects of motivation were assessed.

RESULTS: Participants showed excellent adherence (mean valid-wear time of Fitbit=26.43/28 days, 94%), and no dropout was recorded. No significant changes were found in self-reported total PA (dz<0.28, P=.40 for the self-monitoring group, P=.58 for the goal setting group, and P=.19 for the social comparison group). Fitbit-assessed step count during the intervention period was slightly higher in the goal setting and social comparison groups than in the self-monitoring group, although the effects did not reach statistical significance (P=.052 and P=.06). However, more than half (27/46, 59%) of the participants in the precontemplation stage reported progress to a higher stage across the 3 conditions. Additionally, significant increases were detected for several aspects of motivation (ie, integrated and external regulation), and significant group differences were identified for the day-to-day changes in external regulation; that is, the self-monitoring group showed a significantly larger increase in the sense of pressure and tension (as part of external regulation) than the goal setting group (P=.04).

CONCLUSIONS: Fitbit-implemented BCTs promote readiness and motivation for PA, although their effects on PA levels are marginal. The BCT-specific effects were unclear, but preliminary evidence showed that self-monitoring alone may be perceived demanding. Combining self-monitoring with another BCT (or goal setting, at least) may be important for enhancing continuous engagement in PA.

TRIAL REGISTRATION: Open Science Framework; https://osf.io/87qnb/?view_only=f7b72d48bb5044eca4b8ce729f6b403b.

PMID:38996332 | DOI:10.2196/51216

J Med Internet Res. 2024 Jul 12;26:e51506. doi: 10.2196/51506.

ABSTRACT

BACKGROUND: Hospitalization in psychiatric wards is a necessary step for many individuals experiencing severe mental health issues. However, being hospitalized can also be a stressful and unsettling experience. It is crucial to understand and address the various needs of hospitalized individuals with psychiatric disorders to promote their overall well-being and support their recovery.

OBJECTIVE: Our objectives were to identify and describe individual needs related to mental hospitals through peer-to-peer interactions on Polish web-based forums among individuals with depression and anxiety disorders and to assess whether these needs were addressed by peers.

METHODS: We conducted a search of web-based forums focused on depression and anxiety and selected samples of 160 and 176 posts, respectively, until we reached saturation. A mixed methods analysis that included an in-depth content analysis, the Pearson χ² test, and φ coefficient was used to evaluate the posts.

RESULTS: The most frequently identified needs were the same for depression and anxiety forums and involved informational (105/160, 65.6% and 169/393, 43%, respectively), social life (17/160, 10.6% and 90/393, 22.9%, respectively), and emotional (9/160, 5.6% and 66/393, 16.8%, respectively) needs. The results show that there is no difference in the expression of needs between the analyzed forums. The needs were directly (42/47, 89% vs 98/110, 89.1% of times for depression and anxiety, respectively) and not fully (27/47, 57% vs 86/110, 78.2% of times for depression and anxiety, respectively) addressed by forum users. In quantitative analysis, we found that depression-related forums had more posts about the need for informational support and rectification, the expression of anger, and seeking professional support. By contrast, anxiety-related forums had more posts about the need for emotional support; social life; and information concerning medications, hope, and motivation. The most common co-occurrence of expressed needs was between sharing own experience and the need for professional support, with a strong positive association. The qualitative analysis showed that users join web-based communities to discuss their fears and questions about psychiatric hospitals. The posts revealed 4 mental and emotional representations of psychiatric hospitals: the hospital as an unknown place, the ambivalence of presumptions and needs, the negative representation of psychiatric hospitals, and the people associated with psychiatric hospitals. The tone of the posts was mostly negative, with discussions revolving around negative stereotypes; traumatic experiences; and beliefs that increased anxiety, shock, and fright and deterred users from hospitalization.

CONCLUSIONS: Our study demonstrates that web-based forums can provide a platform for individuals with depression and anxiety disorders to express a wide range of needs. Most needs were addressed by peers but not sufficiently. Mental health professionals can benefit from these findings by gaining insights into the unique needs and concerns of their patients, thus allowing for more effective treatment and support.

PMID:38996331 | DOI:10.2196/51506

Phys Rev Lett. 2024 Jun 28;132(26):260402. doi: 10.1103/PhysRevLett.132.260402.

ABSTRACT

The state of an open quantum system undergoing an adiabatic process evolves by following the instantaneous stationary state of its time-dependent generator. This observation allows one to characterize, for a generic adiabatic evolution, the average dynamics of the open system. However, information about fluctuations of dynamical observables, such as the number of photons emitted or the time-integrated stochastic entropy production in single experimental runs, requires controlling the whole spectrum of the generator and not only the stationary state. Here, we show how such information can be obtained in adiabatic open quantum dynamics by exploiting tools from large deviation theory. We prove an adiabatic theorem for deformed generators, which allows us to encode, in a biased quantum state, the full counting statistics of generic time-integrated dynamical observables. We further compute the probability associated with an arbitrary “rare” time history of the observable and derive a dynamics which realizes it in its typical behavior. Our results provide a way to characterize and engineer adiabatic open quantum dynamics and to control their fluctuations.

PMID:38996317 | DOI:10.1103/PhysRevLett.132.260402

Phys Rev Lett. 2024 Jun 28;132(26):268001. doi: 10.1103/PhysRevLett.132.268001.

ABSTRACT

We identify the thermodynamic conditions necessary to observe indefinite growth in homogeneous open chemical reaction networks (CRNs) satisfying mass action kinetics. We also characterize the thermodynamic efficiency of growth by considering the fraction of the chemical work supplied from the surroundings that is converted into CRN free energy. We find that indefinite growth cannot arise in CRNs chemostatted by fixing the concentration of some species at constant values, or in continuous-flow stirred tank reactors. Indefinite growth requires a constant net influx from the surroundings of at least one species. In this case, unimolecular CRNs always generate equilibrium linear growth, i.e., a continuous linear accumulation of species with equilibrium concentrations and efficiency one. Multimolecular CRNs are necessary to generate nonequilibrium growth, i.e., the continuous accumulation of species with nonequilibrium concentrations. Pseudounimolecular CRNs-a subclass of multimolecular CRNs-always generate asymptotic linear growth with zero efficiency. Our findings demonstrate the importance of the CRN topology and the chemostatting procedure in determining the dynamics and thermodynamics of growth.

PMID:38996287 | DOI:10.1103/PhysRevLett.132.268001