Tag: pubmed

Phys Med Biol. 2024 Jul 9. doi: 10.1088/1361-6560/ad6119. Online ahead of print.

ABSTRACT

Objective We propose a nonparametric figure of merit, the contrast equivalent
distance CED, to measure contrast directly from clinical images.
Approach A relative brightness distance δ is calculated by making use of the order
statistic of the pixel values. By multiplying δ with the grey value range R, the mean
brightness distance MBD is obtained. From the MBD, the CED and the distance-to-
noise ratio DNR can be derived. The latter is the ratio of the MBD and a previously
suggested nonparametric measure τ for the noise.
Since the order statistic is independent of the spatial arrangement of the pixel
values, the measures can be obtained directly from clinical images. We apply the new
measures to mammography images of an anthropomorphic phantom and of a phantom
with a step wedge as well as to CT images of a head phantom.
Main results For low-noise images of a step wedge, the MBD is equivalent to the
conventional grey value distance. While this measure permits the evaluation of clinical
images, it is sensitive to noise. Therefore, noise has to be quantified at the same time.
When the ratio σ/τ of the noise standard deviation σ to τ is available, validity limits
for the CED as a measure of contrast can be established. The new figures of merit
can be calculated for entire images as well as on regions of interest (ROI) with an edge
length not smaller than 32 px.
Significance The new figures of merit are suited to quantify the quality of clinical
images without relying on the assumption of a linear, shift-invariant system. They can
be used for any kind of greyscale image, provided the ratio σ/τ can be estimated. This
will hopefully help to achieve the optimisation of image quality vs dose required by
radioprotection laws.

PMID:38981591 | DOI:10.1088/1361-6560/ad6119

J Oral Maxillofac Surg. 2024 Jun 24:S0278-2391(24)00578-0. doi: 10.1016/j.joms.2024.06.166. Online ahead of print.

ABSTRACT

BACKGROUND: Virtual surgical planning (VSP) for composite microvascular free flaps has become standard of care for oncologic head and neck reconstruction. Controversy remains as to the use of three-dimensional (3D)-printed titanium patient-specific implants (PSIs) versus hand-bent stock reconstruction plates. Proponents of PSIs cite improved surgical accuracy, reduced operative times, and improved clinical outcomes. Detractors purport increased cost associated with PSIs and presumed equivalent accuracy with less expensive stock plates.

PURPOSE: The study purpose was to measure and compare the 3D-volumetric accuracy of PSI versus stock reconstruction plates among subjects undergoing VSP-guided mandibular fibular free flap reconstruction.

STUDY DESIGN, SETTING, SAMPLE: A retrospective cohort study of subjects undergoing VSP-guided fibular free flap reconstructions at Mayo Clinic between 2016 and 2023 was performed. Subjects were excluded for non-VSP guidance, midfacial reconstruction, nonfibular free flaps, and lack of requisite study variables.

PREDICTOR VARIABLE: The primary predictor was the type of reconstruction plate utilized (PSI vs stock plate).

MAIN OUTCOME VARIABLE: The main outcome was volumetric surgical accuracy of the final reconstruction compared to the preoperative surgical plan by root mean square error (RMSE) calculation. Lower RMSE values indicated a higher surgical accuracy.

COVARIATES: Covariates included age, sex, race, smoking status, American Society of Anesthesiologists Physical Status Classification System, Charlson Comorbidity Index, preoperative diagnosis, and number of fibular segments.

ANALYSES: Differences in surgical accuracy were assessed between preoperative and postoperative segmented scans using volumetric overlays from which RMSE values were calculated. Univariate and multivariate modeling of plate type to RMSE calculation was performed. Statistical significance set to P < .05.

RESULTS: Total of 130 subjects were identified, 105 PSI and 25 stock plates. Calculated mean RMSE in millimeters (mm) for stock plates was 1.46 (standard deviation: 0.33) and 1.15 (standard deviation: 0.36) for PSIs. Univariate modeling demonstrated a statistically significant difference in RMSE of 0.31 (95% confidence interval: 0.16-0.47) (P < .001) equating to a 21.2% (P < .001) improved volumetric surgical accuracy for PSIs. The association of improved volumetric accuracy with PSIs has been maintained in all multivariate models controlling for confounding.

CONCLUSION AND RELEVANCE: In modern era VSP-guided head and neck fibular free flap reconstruction, patient-specific 3D-printed titanium implants confer a statistically significant improvement in volumetric surgical accuracy over stock reconstruction plates.

PMID:38981580 | DOI:10.1016/j.joms.2024.06.166

Neurosci Biobehav Rev. 2024 Jul 7:105807. doi: 10.1016/j.neubiorev.2024.105807. Online ahead of print.

ABSTRACT

The efficacy and acceptability of various non-invasive brain stimulation (NIBS) interventions for autism spectrum disorder remain unclear. We carried out a systematic review for randomized controlled trials (RCTs) regarding NIBS for reducing autistic symptoms (INPLASY202370003). Sixteen articles (N = 709) met the inclusion criteria for network meta-analysis. Effect sizes were reported as standardized mean differences (SMDs) or odds ratios with 95% confidence intervals (CIs). Fourteen active NIBS interventions, including transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation, and transcranial pulse stimulation were analyzed. Only anodal tDCS over the left dorsolateral prefrontal cortex paired with cathodal tDCS over an extracephalic location (atDCS_F3+ctDCS_E) significantly improved autistic symptoms compared to sham controls (SMD = -1.40, 95%CIs = -2.67 to -0.14). None of the NIBS interventions markedly improved social-communication symptoms or restricted/repetitive behaviors in autistic participants. Moreover, no active NIBS interventions exhibited significant dropout rate differences compared to sham controls, and no serious adverse events were reported for any intervention.

PMID:38981573 | DOI:10.1016/j.neubiorev.2024.105807

Acta Trop. 2024 Jul 7:107317. doi: 10.1016/j.actatropica.2024.107317. Online ahead of print.

ABSTRACT

BACKGROUND: Tuberculosis (TB) as a foremost infectious disease adds massive burden to morbidity and mortality rate, despite of well-structured TB control programs around the globe. Inappropriate health care management system and poor implementation on standard in relevance to TB, remain some reasons causative to TB prevalence and its rising antimicrobial resistance. Health Care Workers (HCWs) laboring as a part of TB control system, are the vital warriors in achieving the goals of TB End Strategy by 2035. Their performance is influenced by their knowledge, attitude, and practices (KAP) toward this infectious disease. This study aimed to signify the role of KAP score of health care Workers in the better control and prevention of TB in the Islamabad Capital Territory (ICT), Pakistan.

METHODS: A cross-sectional study on Knowledge, Attitude and Practice study of Tuberculosis (TB) among health care Workers, was done in ICT, which is the capital of Pakistan. The KAP of TB was collected for the 306 Health Care Workers from all the Islamabad TB referring health facilities which refer the TB patients for testing to the National Reference Laboratory, Islamabad Pakistan. Eligible health care workers were requested to respond on KAP questionnaire after informed consent. KAP questionnaire comprised of knowledge, attitude, and practices section including demographic information. All the data was analyzed using IBM SPSS statistics 21. One Way Analysis of Variance (ANOVA) was applied to calculate KAP mean score against different variables. On the significant data sets of ANOVA output, Tukey’s Multiple Comparison Test was applied for pairwise comparison. Pearson correlation coefficient was utilized to explore the association between two qualitative variables. The non-parametric tests were applied to evaluate difference of KAP score in relation to demographic covariates individually.

RESULTS: From June to July 2023, we conducted TB KAP study among Health Care Workers of ICT, Pakistan. The average age was 33 years (range 26-30 years). Majority of the recruited subjects were not being trained for dealing with TB infection. The results demonstrated that Health Care Workers working were lacking their knowledge about mode of TB transmission, best diagnostic technique, and contraction of TB infections. The mean knowledge, attitude and practices mean scores were 15.05 (SD =3.96), 83.68 (SD =15.74) and 6.31 (SD =2.21) respectively. Mean knowledge score of Health Care Workers were significantly related to their educational level and occupation while no significant association was declared with working experience as TB staff. Pearson coefficient of attitude score with knowledge of Health Care Workers was of weak level (0.28). Practice mean score was correlated to knowledge mean score at a moderate level (r =0.40). On the other hand, practice score was r =0.29 with attitude mean score had shown weak level correlation. A number of demographic factors were strongly linked to each of the mean score of knowledge, attitude, and practices.

CONCLUSION: These findings highlighted the significant involvement of education, profession, and professional trainings in the better knowledge, attitude, and practices of the TB related health care Workers. For a better management system of infectious diseases like TB, a well-trained and professionally competent staff of Health Care Workers is important so as to achieve the goal of TB-End strategy by 2035 from Pakistan, which is the 5th highest burden country for TB.

PMID:38981566 | DOI:10.1016/j.actatropica.2024.107317

Clin Chim Acta. 2024 Jul 7:119855. doi: 10.1016/j.cca.2024.119855. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Bladder cancer (BCa) is a highly aggressive malignancy of the urinary system. Timely detection is imperative for enhancing BCa patient prognosis.

MATERIALS AND METHODS: This study introduces a novel approach for detecting long non-coding RNA (lncRNA) Mitochondrial RNA Processing Endoribonuclease (RMRP) in urine exosomes from BCa patients using the reverse transcription recombinase-aided amplification (RT-RAA) and clustered regularly interspaced short palindromic repeats and associated Cas12a proteins (CRISPR/Cas12a) technique. Various statistical methods were used to evaluate its diagnostic value for BCa.

RESULTS: The specificity of urine exosomal RMRP detection for BCa diagnosis was enhanced by using RT-RAA combined with CRISPR/Cas12a. The testing process duration was reduced to 30 min, which supports rapid detection. Moreover, this approach allows the identification of target signals in real-time using blue light, facilitating immediate detection. In clinical sample analysis, this methodology exhibited a high level of diagnostic efficacy. This was evidenced by larger area under the curve values with receiver operating characteristic curve analysis compared with using traditional RT-qPCR methods, indicating superior diagnostic accuracy and sensitivity. Furthermore, the combined analysis of RMRP expression in urine exosomes detected by RT-RAA-CRISPR/Cas12a and NMP-22 expression may further enhance diagnostic accuracy.

CONCLUSIONS: The RT-RAA-CRISPR/Cas12a technology is a swift, sensitive, and uncomplicated method for nucleic acid detection. Because of its convenient and non-invasive sampling approach, user-friendly operation, and reproducibility, this technology is very promising for automated detection and holds favorable application possibilities within clinical environments.

PMID:38981565 | DOI:10.1016/j.cca.2024.119855

Prog Cardiovasc Dis. 2024 Jul 7:S0033-0620(24)00096-3. doi: 10.1016/j.pcad.2024.06.008. Online ahead of print.

ABSTRACT

INTRODUCTION: Critical limb-threatening ischemia (CLTI) is a severe manifestation of peripheral artery disease (PAD) that can lead to limb amputation and significantly reduce the quality of life. In addition to guideline-directed medical therapy (GDMT), endovascular therapy and surgical revascularization are the two revascularization options for CLTI. In recent years, there has been an ongoing debate about the best approach for CLTI patients. The purpose of this meta-analysis is to examine the current evidence and compare the clinical outcomes of endovascular therapy and surgical revascularization for CLTI.

METHODS: We conducted a systematic search of electronic databases (PubMed, Embase, Cochrane Library, and Web of Science) for studies comparing the outcomes of endovascular therapy versus surgery in patients with CLTI. The primary outcomes were major adverse limb events (MALE) and major adverse cardiovascular events (MACE), while secondary outcomes included risk of bleeding, wound complications, readmission, unplanned reoperation, acute renal failure, and length of hospital stay. Pooled data was analyzed using the fixed-effect model or the random-effect model in Review Manager 5.3. The Newcastle-Ottawa Scale and Cochrane risk of bias assessment tool were used to assess the bias of included studies.

RESULTS: A total of 16 studies (47,609 patients) were included in this meta-analysis. The overall effect favors surgery over endovascular intervention in terms of MALE [odds ratio (OR) 1.13, 95% CI (1.01-1.28), P = 0.04]. Endovascular therapy is associated with lower MACE rates compared to surgery [OR 0.62, 95% CI (0.51-0.76), P < 0.00001]. Furthermore, the risk of bleeding, wound complications, readmission, unplanned reoperation, acute renal failure as well as the length of hospital stay was lower for endovascular intervention. Finally, there was no statistically significant difference in 30-day mortality between the two groups [OR 0.94, 95% CI 0.79-1.12, P = 0.52; Fig. 3i], and the pooled studies were homogeneous [P = 0.39; I2 = 5%].

CONCLUSION: Surgery may be the preferred treatment option for CLTI patients, as it is associated with a lower risk of MALE than endovascular therapy. However, endovascular therapy may be associated with a lower risk of MACE and lower rates of bleeding, wound complications, readmission, unplanned reoperation, acute renal failure, and shorter hospital stays. There was no statistically significant difference in 30-day mortality between the two groups. Ultimately, the decision to use endovascular therapy or surgery as the primary treatment strategy should be based on a multi-disciplinary team approach with careful consideration of patient characteristics and anatomy.

PMID:38981532 | DOI:10.1016/j.pcad.2024.06.008

Asian J Psychiatr. 2024 Jul 5;99:104132. doi: 10.1016/j.ajp.2024.104132. Online ahead of print.

ABSTRACT

OBJECTIVES: Delirium is a significant health concern in acute stroke patients. We aim to systematically summarize existing evidence to conduct a meta-analysis to quantify the occurrence and risk factors for delirium after acute stroke.

METHOD: PubMed, EMBASE and MEDLINE were searched from inception to Feb. 2023 for prospective observational studies that reported the incidence or prevalence of post-stroke delirium and/or evaluated potential risk factors. The search strategy was created using controlled vocabulary terms and text words for stroke and delirium. We performed a meta-analysis of the estimates for occurrence and risk factors using random-effects models. Meta-regression and subgroup meta-analyses were conducted to explore the sources of heterogeneity. Study quality and quality of evidence were assessed using the customized Newcastle-Ottawa Scale and GRADE, respectively.

RESULTS: Forty-nine studies that enrolled 12383 patients were included. The pooled occurrence rate of post-stroke delirium was 24.4 % (95 %CI, 20.4 %-28.9 %, I²=96.2 %). The pooled occurrence of hyperactive, hypoactive, and mixed delirium was 8.5 %, 5.7 % and 5.0 %, respectively. Study location, delirium assessment method and stroke type independently affected the heterogeneity of the pooled estimate of delirium. Statistically significant risk factors were older age, low education level, cigarette smoking, alcohol drinking, atrial fibrillation, lower ADL level, higher pre-stroke mRS score, premorbid cognitive impairment or dementia, aphasia, total anterior circulation impairment, higher National Institute of Health Stroke Scale score and infection.

CONCLUSIONS: Delirium affected 1 in 4 acute stroke patients, although reported rates may depend on assessment method and stroke type. Timely prevention, recognition and intervention require prioritizing patients with dominant risk factors.

PMID:38981150 | DOI:10.1016/j.ajp.2024.104132

Arch Cardiol Mex. 2024 Jul 9. doi: 10.24875/ACM.23000217. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine the factors associated with left ventricular diastolic dysfunction (LVDD) in adults residing in a region of the Andes in Peru.

METHOD: A case-control study was conducted on adults living at an altitude of more than 3000 meters in Peru. Cases consisted of patients diagnosed with LVDD through echocardiography, whereas controls were adults without LVDD, as confirmed by echocardiography.

RESULTS: A total of 50 cases and 100 controls were included in the study. Among them, 38.7% had high blood pressure, and 41.3% were overweight. Upon adjusted analysis, age 60 or older (aOR: 4.06; 95%CI: 1.29-12.8), female sex (aOR: 2.24; 95%CI: 1.01-4.96) and left ventricular hypertrophy (aOR: 3.17; 95%CI: 1.41-7.17) were identified as statistically significant factors associated with LVDD.

CONCLUSIONS: The risk of LVDD is associated with older adults, female gender, and left ventricular hypertrophy among individuals residing above 3000 meters altitude in a region of the Andes, in Peru.

PMID:38981138 | DOI:10.24875/ACM.23000217

Appl Physiol Nutr Metab. 2024 Jul 9. doi: 10.1139/apnm-2024-0059. Online ahead of print.

ABSTRACT

Snacking is nearly universal among children but there is growing concern around snacking patterns and energy contribution. This study aimed to characterize temporal snacking patterns among Canadian children and adolescents. A cross-sectional analysis drew on data from 5,209 respondents aged 4 to 18 years from the 2015 Canadian Community Health Survey Nutrition, using one 24-hour dietary recall. Descriptive statistics estimated proportions of morning, afternoon and evening snackers, the mean caloric contribution of each snacking period to total daily energy intake, and the top food categories consumed as snacks (kcal per capita). Snacking was nearly universal and accounted for one of every four calories consumed. Morning snacks were more popular among children vs. adolescents and contributed significantly less energy than afternoon or evening snacking periods for both age groups (P<0.001). The top food groups consumed as snacks were the same for children and adolescents, although the ranking order varied. Fruits was the leading food group in terms of per capita energy for children, and second for adolescents. Aside from fruits and milks, all other top per capita energy contributors were generally more energy-dense, nutrient-poor foods such as cookies, biscuits and cereal bars, and other breads. Among children, morning snacks were higher in desirable nutrients compared with afternoon snacks. Not all snacking periods are equal in terms of energy and nutrients. A better understanding of how time of day may influence the quality of snack foods can inform meal-based guidance and help children achieve the recommended daily amounts of foods and nutrients.

PMID:38981135 | DOI:10.1139/apnm-2024-0059

Ann Work Expo Health. 2024 Jul 9:wxae043. doi: 10.1093/annweh/wxae043. Online ahead of print.

ABSTRACT

This study evaluates the effectiveness of self-assessed exposure (SAE) data collection for characterization of hydrogen sulfide (H2S) risks in water and wastewater management, challenging the adequacy of traditional random or campaign sampling strategies. We compared 3 datasets derived from distinct strategies: expert data with activity metadata (A), SAE without metadata (B), and SAE with logbook metadata (C). The findings reveal that standard practices of random sampling (dataset A) fail to capture the sporadic nature of H2S exposure. Instead, SAE methods enhanced by logbook metadata and supported by reliable detection and calibration infrastructure (datasets B and C) are more effective. When assessing risk, particularly peak exposure risks, it is crucial to adopt measures that capture exposure variability, such as the range and standard deviations. This finer assessment is vital where high H2S peaks occur in confined spaces. Risk assessment should incorporate indices that account for peak exposure, utilizing variability measures like range and standard or geometric standard deviation to reflect the actual risk more accurately. For large datasets, a histogram is just as useful as statistical measures. This approach has revealed that not only wastewater workers but also water distribution network workers, can face unexpectedly high H2S levels when accessing confined underground spaces. Our research underscores the need for continuous monitoring with personal electrochemical gas detector alarm systems, particularly in environments with variable and potentially hazardous exposure levels.

PMID:38981129 | DOI:10.1093/annweh/wxae043