Tag: pubmed

Psychiatry Res. 2023 Jul 11;326:115343. doi: 10.1016/j.psychres.2023.115343. Online ahead of print.

ABSTRACT

Anxiety disorders are a group of prevalent and heritable neuropsychiatric diseases. We previously conducted a genome-wide association study (GWAS) which identified genomic loci associated with anxiety; however, the biological consequences underlying the genetic associations are largely unknown. Integrating GWAS and functional genomic data may improve our understanding of the genetic effects on intermediate molecular phenotypes such as gene expression. This can provide an opportunity for the discovery of drug targets for anxiety via drug repurposing. We used the GWAS summary statistics to determine putative causal genes for anxiety using MAGMA and colocalization analyses. A transcriptome-wide association study was conducted to identify genes with differential genetically regulated levels of gene expression in human brain tissue. The genes were integrated with a large drug-gene expression database (Connectivity Map), discovering compounds that are predicted to “normalise” anxiety-associated expression changes. The study identified 64 putative causal genes associated with anxiety (35 genes upregulated; 29 genes downregulated). Drug mechanisms adrenergic receptor agonists, sigma receptor agonists, and glutamate receptor agonists gene targets were enriched in anxiety-associated genetic signal and exhibited an opposing effect on the anxiety-associated gene expression signature. The significance of the project demonstrated genetic links for novel drug candidates to potentially advance anxiety therapeutics.

PMID:37473490 | DOI:10.1016/j.psychres.2023.115343

Clin Neurol Neurosurg. 2023 Jul 10;232:107887. doi: 10.1016/j.clineuro.2023.107887. Online ahead of print.

ABSTRACT

OBJECTIVE: To gauge resident knowledge in the socioeconomic aspects of neurosurgery and assess the efficacy of an asynchronous, longitudinal, web-based, socioeconomics educational program tailored for neurosurgery residents.

METHODS: Trainees completed a 20-question pre- and post-intervention knowledge examination including four educational categories: billing/coding, procedure-specific concepts, material costs, and operating room protocols. Structured data from 12 index cranial neurosurgical operations were organized into 5 online, case-based modules sent to residents within a single training program via weekly e-mail. Content from each educational category was integrated into the weekly modules for resident review.

RESULTS: Twenty-seven neurosurgical residents completed the survey. Overall, there was no statistically significant difference between pre- vs post-intervention resident knowledge of billing/coding (79.2 % vs 88.2 %, p = 0.33), procedure-specific concepts (34.3 % vs 39.2 %, p = 0.11), material costs (31.7 % vs 21.6 %, p = 0.75), or operating room protocols (51.7 % vs 35.3 %, p = 0.61). However, respondents’ accuracy increased significantly by 40.8 % on questions containing content presented more than 3 times during the 5-week study period, compared to an increased accuracy of only 2.2 % on questions containing content presented less often during the same time period (p = 0.05).

CONCLUSIONS: Baseline resident knowledge in socioeconomic aspects of neurosurgery is relatively lacking outside of billing/coding. Our socioeconomic educational intervention demonstrates some promise in improving socioeconomic knowledge among neurosurgery trainees, particularly when content is presented frequently. This decentralized, web-based approach to resident education may serve as a future model for self-driven learning initiatives among neurosurgical residents with minimal disruption to existing workflows.

PMID:37473488 | DOI:10.1016/j.clineuro.2023.107887

Clin Neurol Neurosurg. 2023 Jul 16;232:107898. doi: 10.1016/j.clineuro.2023.107898. Online ahead of print.

ABSTRACT

OBJECTIVE: It is unknown whether adjunctive intra-arterial thrombolysis (IAT) during mechanical thrombectomy (MT) improves outcomes in patients with large vessel occlusion (LVO) stroke. This systematic review and meta-analysis aimed to compare the safety and efficacy of MT with and without IAT for the treatment of LVO stroke.

METHODS: A systematic literature search of PubMed, Embase, and the Cochrane Library was conducted to identify studies that compared rates of 3-month functional independence (modified Rankin Scale score 0-2), successful revascularization, symptomatic intracranial hemorrhage, and 3-month mortality for MT+IAT and MT alone. Meta-analyses were performed using random effects models, and effect sizes were expressed as odds ratios (ORs) and 95% confidence intervals (CIs). Heterogeneity was assessed with Cochran’s Q test and I² statistic.

RESULTS: Twelve studies met eligibility criteria, comprising one randomized controlled trial and 11 observational cohort studies involving 2584 patients. Compared to MT alone, MT+IAT had a 43% higher odds of 3-month functional independence (OR 1.43, 95% CI 1.11-1.83; I² =21%) and a 23% decrease in odds for 3-month mortality (OR 0.77, 95% CI 0.60-0.99; I² =0%). There were no differences in successful revascularization (OR 1.39, 95% CI 0.89-2.17; I² =57%) or symptomatic intracranial hemorrhage (OR 0.87, 95% CI 0.56-1.35; I² =6%) between the two groups.

CONCLUSIONS: The present study has demonstrated that, compared with MT alone, the use of adjunct IAT during MT in patients with LVO stroke resulted in better functional outcomes and lower mortality.

PMID:37473487 | DOI:10.1016/j.clineuro.2023.107898

Clin Neurophysiol. 2023 Jul 5;153:88-101. doi: 10.1016/j.clinph.2023.06.015. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the diagnostic accuracy of electromagnetic source imaging (EMSI) in localizing spikes and predict surgical outcome in children with drug resistant epilepsy (DRE) due to focal cortical dysplasia (FCD).

METHODS: We retrospectively analyzed magnetoencephalography (MEG) and high-density (HD-EEG) data from 23 children with FCD-associated DRE who underwent intracranial EEG and surgery. We localized spikes using equivalent current dipole (ECD) fitting, dipole clustering, and dynamical statistical parametric mapping (dSPM) on EMSI, electric source imaging (ESI), and magnetic source imaging (MSI). We calculated the distance from the seizure onset zone (D_SOZ) and resection (D_RES). We estimated receiver operating characteristic (ROC) curves with Youden’s index (J) to predict outcome.

RESULTS: EMSI presented shorter D_SOZ (15.18 ± 9.06 mm) and D_RES (8.56 ± 6.24 mm) compared to ESI (D_SOZ: 25.04 ± 16.20 mm, p < 0.009; D_RES: 18.88 ± 17.30 mm, p < 0.03) and MSI (D_SOZ: 23.37 ± 8.98 mm, p < 0.03; D_RES: 15.51 ± 10.11 mm, p < 0.02) for clustering in patients with good outcome. Clustering showed shorter D_SOZ and D_RES compared to ECD fitting and dSPM (p < 0.05). EMSI had higher performance as outcome predictor (J = 70.63%) compared to ESI (J = 41.27%) and MSI (J = 33.33%) for clustering.

CONCLUSIONS: EMSI provides superior localization and improved predictive performance than individual modalities.

SIGNIFICANCE: EMSI can help the surgical planning and facilitate the localization of epileptogenic foci.

PMID:37473485 | DOI:10.1016/j.clinph.2023.06.015

Talanta. 2023 Jul 13;266(Pt 1):124943. doi: 10.1016/j.talanta.2023.124943. Online ahead of print.

ABSTRACT

Near-infrared (NIR) spectroscopy is a rapid, non-invasive and cost-effective technique, for which sample pre-treatment is often not required. It is applied for both qualitative and quantitative analyses in various application fields. Often, large calibration sets are used, from which informative subsets can be selected without a loss of meaningful information. In this study, a new approach for sample subset selection is proposed and evaluated. The global PLS model, obtained with the original large global calibration set after FCAM-SIG variable selection, is used for the selection of the best fitting subset of calibration samples with optimally predictive ability. This best fitting calibration subset is called the optimally predictive calibration subset (OPCS). After ranking the global calibration samples according to increasing residuals, different enlarging fractions of the ranked calibration set are selected. For each fraction, the optimal predictive ability and the corresponding optimal PLS complexity are determined by cross model validation (CMV). After performing CMV with all fractions, the fraction with the best fitting samples and optimally predictive ability, i.e. the OPCS, is determined. The use of the best fitting samples from the global PLS model results in an OPCS-based model which is similar to the global PLS model and has a similar predictive ability. Because the best fitting samples do not need to be representative for the global calibration set, but only need to support the OPCS-based model, the number of samples in the OPCS model is mostly smaller than that selected by a traditional representative sample subset selection method. The new OPCS approach is tested on three real life NIR data sets with twelve X-y combinations to model. The results show that the number of selected samples obtained by the OPCS approach is statistically significantly lower than (i) that of the most suitable and widely used representative sample selection method of Kennard and Stone, and (ii) that suggested by the guideline that the optimal sample size N for reduced calibration sets should surpass the PLS model complexity A by a factor 12. An additional advantage of the OPCS approach is that no outliers are included in the subset because only the best fitting calibration samples are selected. In the new OPCS approach, two additional innovations are built in: (i) CMV is for the first time applied for sample selection and (ii) in CMV, the “one standard error rule”, adopted from “Repeated Double Cross Validation”, is for the first time used for the determination of the optimal PLS complexity of the OPCS-based models.

PMID:37473472 | DOI:10.1016/j.talanta.2023.124943

Eur J Cancer. 2023 Jun 29;191:112961. doi: 10.1016/j.ejca.2023.112961. Online ahead of print.

ABSTRACT

PURPOSE: Primary tumour resection (PTR) is still a selection for patients with low tumour burden and good condition, especially with conversion therapy purpose for colorectal liver-limited metastases (CRLMs). The objective was to evaluate whether pre-PTR chemotherapy could improve progression-free survival (PFS) for patients with asymptomatic synchronous unresectable CRLMs.

PATIENTS AND METHODS: Patients with asymptomatic synchronous unresectable CRLMs were randomly assigned to receive pre-PTR chemotherapy (arm A) or upfront PTR (arm B). Chemotherapy regimens of mFOLFOX6 plus cetuximab, mFOLFOX6 plus bevacizumab or mFOLFOX6 alone were chosen according to the RAS genotype. The primary end-point was PFS; secondary end-points included overall survival (OS), tumour response, disease control rate (DCR), liver metastases resection rate, surgical complications and chemotherapy toxicity.

RESULTS: Three hundred and twenty patients were randomly assigned to arm A (160 patients) and arm B (160 patients). Patients in arm A had significantly improved the median PFS compared with arm B (10.5 versus 9.1 months; P = 0.013). Patients in arm A also had significantly better DCR (84.4% versus 75.0%; P = 0.037). The median OS (29.4 versus 27.2 months; P = 0.058), objective response rate (ORR) (53.1% versus 45.0%; P = 0.146) and liver metastases resection rate (21.9% versus 18.1%; P = 0.402) were not significantly different. The Clavien-Dindo 3-4 complications post PTR (4.5% versus 3.8%, P = 0.759) and the incidence of grade 3/4 chemotherapy events (42.2% versus 40.4%, P = 0.744) reached no statistical significance.

CONCLUSIONS: For asymptomatic synchronous unresectable CRLMs, Pre-PTR chemotherapy improved the PFS compared with upfront PTR.

PMID:37473466 | DOI:10.1016/j.ejca.2023.112961

Otolaryngol Head Neck Surg. 2023 Jul 20. doi: 10.1002/ohn.431. Online ahead of print.

ABSTRACT

OBJECTIVE: To explore how gender and low-income status independently influence general health care access in patients with hearing loss.

STUDY DESIGN: Cross-sectional study.

SETTING: National database.

METHODS: Patients with a diagnosis of sensorineural hearing loss from the National Institutes of Health All of Us database were included. Data entered from May 2018 to November 2022 was analyzed. Patient demographics such as age, gender, educational level, and insurance status were assessed. Multivariate logistic regressions were performed for statistical evaluation.

RESULTS: A subset of 8875 patients (48.3% male, mean age 69) were evaluated. After multivariate analysis, female participants were more likely than male participants to report difficulty affording prescribed medications (odds ratio [OR]: 1.7, p < .0005) and specialists (OR: 1.4, p < 0.005). Female patients were also more likely to delay care due to elder care responsibilities (OR: 2.6, p < .0005), employment obligations (OR: 1.7, p < .0005), and feelings of apprehension in seeing a provider (OR: 1.7, p < .0005). Finally, female participants reported feeling less likely to be involved in their own medical care compared to males (OR: 1.2, p < .005). Low-income (<$25,000) participants reported less likely to feel respected (OR: 3.2, p < .0005) and delivered understandable health information (OR: 2.3, p < .0005) by providers compared to participants of higher income.

CONCLUSION: This work suggests that patients with hearing loss, female gender, and lower socioeconomic status independently introduce barriers to health care access and utilization. These factors should be considered in efforts to promote equity in the care of patients with hearing loss.

PMID:37473437 | DOI:10.1002/ohn.431

Otolaryngol Head Neck Surg. 2023 Jul 20. doi: 10.1002/ohn.430. Online ahead of print.

ABSTRACT

Patient safety and quality improvement (PS/QI) has become an integral part of the health care system, and the ability to effectively use data to track, understand, and communicate performance is essential to designing and implementing quality initiatives, as well as assessing their impact. Though many otolaryngologists are proficient in the methodologies of traditional research pursuits, educational gaps remain in the foundational principles of PS/QI measurement strategies. Part IV of this PS/QI primer discusses the fundamentals of measurement design and data analysis methods specific to PS/QI. Consideration is given to the selection of appropriate measures when designing a PS/QI project, as well as the method and frequency for collecting these measures. In addition, this primer reviews key aspects of tracking and analyzing data, providing an overview of statistical process control methods while highlighting the construction and utility of run and control charts. Lastly, this article discusses strategies to successfully develop and execute PS/QI initiatives in a way that facilitates the ability to appropriately measure their effectiveness and sustainability.

PMID:37473436 | DOI:10.1002/ohn.430

Obstet Gynecol. 2023 Aug 1;142(2):339-349. doi: 10.1097/AOG.0000000000005227. Epub 2023 Jul 5.

ABSTRACT

OBJECTIVE: To examine whether access to treatment for women with opioid use disorder (OUD) varied by race and ethnicity, community characteristics, and pregnancy status.

METHODS: We conducted a secondary data analysis of a simulated patient caller study of buprenorphine-waivered prescribers and opioid-treatment programs in 10 U.S. states. We conducted multivariable analyses, accounting for potential confounders, to evaluate factors associated with likelihood of successfully securing an appointment. Descriptive statistics and significance testing examined 1) caller characteristics and call outcome by assigned race and ethnicity and clinic type (combined, opioid-treatment programs, and buprenorphine-waivered prescribers) and 2) clinic and community characteristics and call outcome by community race and ethnicity distribution (majority White vs majority Black, Hispanic, Asian, American Indian, Alaska Native, Native Hawaiian, or Pacific Islander) and clinic type. A multiple logistic regression model was fitted to assess the likelihood of obtaining an appointment by callers’ race and ethnicity and pregnancy status with the exposure of interest being majority Black, Hispanic, Asian, American Indian, Alaska Native, Native Hawaiian, or Pacific Islander community distribution.

RESULTS: In total, 3,547 calls reached clinics to schedule appointments. Buprenorphine-waivered prescribers were more likely to be in communities that were more than 50% White (88.9% vs 77.3%, P<.001), and opioid-treatment programs were more likely to be in communities that were less than 50% White (11.1% vs 22.7%, P<.001). Callers were more likely to be granted appointments in majority Black, Hispanic, Asian, American Indian, Alaska Native, Native Hawaiian, or Pacific Islander communities (adjusted odds ratio [aOR] 1.06, 95% CI 1.02-1.10 per 10% Black, Hispanic, Asian, American Indian, Alaska Native, Native Hawaiian, or Pacific Islander community population) and at opioid-treatment programs (aOR 4.94, 95% CI 3.52-6.92) and if they were not pregnant (aOR 1.79, 95% CI 1.53-2.09).

CONCLUSION: Clinic distribution and likelihood of acceptance for treatment varied by community race and ethnicity distribution. Access to treatment for OUD remains challenging for pregnant people and in many historically marginalized U.S. communities.

PMID:37473410 | DOI:10.1097/AOG.0000000000005227

Obstet Gynecol. 2023 Aug 1;142(2):239-241. doi: 10.1097/AOG.0000000000005239. Epub 2023 Jul 5.

ABSTRACT

The ARRIVE (A Randomized Trial of Induction Versus Expectant Management) trial demonstrated lower rates of hypertensive disorders of pregnancy (HDP) among low-risk nulliparous patients undergoing labor induction at 39 weeks of gestation. We conducted a population-based cohort study in which we evaluated the association between the routinization of 39-week induction and the rate of HDP by comparing rates before and after the ARRIVE trial publication, using the National Vital Statistics System. Logistic regression models were used to project what the HDP rate would have been based on trends seen pre-ARRIVE. Despite an overall increase in the rate of HDP from pre-ARRIVE to post-ARRIVE (4.9% pre vs 6.3% post, adjusted odds ratio [aOR] 1.26, 95% CI 1.24-1.27), the HDP rate was significantly lower in the post-ARRIVE group among patients undergoing induction at 39 weeks of gestation (14.7% pre vs 14.1% post, aOR 0.91, 95% CI 0.90-0.93), decreasing by 12.0% per year (P<.001). The rate of HDP among all other delivering patients was higher in the post-ARRIVE group (4.1% pre vs 5.5% post, aOR1.32, 95% CI 1.30-1.34). Our findings may suggest that, as the overall HDP rate rises, the relative advantage of 39-week induction will rise similarly.

PMID:37473407 | DOI:10.1097/AOG.0000000000005239