Tag: pubmed

Zhongguo Zhen Jiu. 2023 Jul 12;43(7):743-6. doi: 10.13703/j.0255-2930.20220903-k0003.

ABSTRACT

OBJECTIVE: To observe the effect of buccal acupuncture on pain after lumbar spinal fusion.

METHODS: Sixty patients undergoing lumbar spinal fusion were randomly divided into an observation group (30 cases, 1 case dropped off) and a control group (30 cases, 1 case was eliminated). The patients in the control group were treated with routine anesthesia. On the basis of the control group, the patients in the observation group were treated with buccal acupuncture at bilateral back point, waist point, and sacral point for 30 min per treatment. The first acupuncture was given before anesthesia induction, and then once a day postoperation for two days, totally 3 treatments. The dosage of sufentanil, the number of remedial analgesia, and the incidence of nausea and vomiting within 48 h after surgery were compared between the two groups; rest and motion visual analogue scale (VAS) scores at 2 (T1), 8 (T2), 12 (T3), 24 (T4), and 48 (T5) h after surgery were observed; the quality of recovery-15 scale (QoR-15) at 24 and 48 h after surgery were evaluated.

RESULTS: The dosage of sufentanil and the number of remedial analgesia within 48 h after surgery in the observation group were lower than those in the control group (P<0.01). There was no significant statistically difference in rest and motion VAS scores between the two groups in T1, T2, T3, T4 and T5 (P>0.05). The QoR-15 scores in the observation group at 24 and 48 h after surgery were higher than those in the control group (P<0.01). The incidence of nausea in the observation group was lower than that in the control group (P<0.05).

CONCLUSION: Buccal acupuncture could reduce the amount of postoperative analgesic drugs of patients after lumbar spinal fusion, and promote early postoperative recovery.

PMID:37429651 | DOI:10.13703/j.0255-2930.20220903-k0003

BMJ Open Qual. 2023 Jul;12(3):e002141. doi: 10.1136/bmjoq-2022-002141.

ABSTRACT

Neonatal hyperbilirubinaemia requiring phototherapy treatment is a common problem impacting the length of hospital stay and rates of hospital readmission. Previous guidelines included guidance for initiating phototherapy treatment but not for discontinuing phototherapy treatment during initial newborn admission.In response to dissatisfaction from trainees, staff and families regarding the variable approach to discontinuing phototherapy among attending nursery providers, we used quality improvement methodologies to increase utilisation of a rebound hyperbilirubinaemia calculator as a more consistent method for guiding the timing of phototherapy discontinuation. The aim was to increase utilisation of the rebound hyperbilirubinaemia calculator for newborns treated with phototherapy in two newborn nurseries to >90% within 2 years.Sequential interventions focused on increasing provider awareness of the rebound hyperbilirubinaemia calculator and making the calculator simple to access and use.At the university medical centre nursery, the use of the calculator increased from 8.7% to 100%, exceeding the project goal. In the community hospital nursery, there was a statistically significant increase in the rate of utilisation from 3.7% to 79.4%, but this fell slightly below the goal of >90%.Electronic Health Record integration, along with education and addition of prompts to providers, increased utilisation of a rebound hyperbilirubinaemia calculator as a consistent approach for guiding decisions about discontinuing phototherapy treatment in newborns.

PMID:37429640 | DOI:10.1136/bmjoq-2022-002141

CMAJ. 2023 Jul 10;195(26):E897-E904. doi: 10.1503/cmaj.230262.

ABSTRACT

BACKGROUND: Body mass index (BMI) may affect the response to platelet P2Y₁₂ receptor inhibitors. We aimed to explore whether BMI influenced the efficacy and safety of ticagrelor and clopidogrel for secondary prevention of minor ischemic stroke or transient ischemic attack (TIA) among patients enrolled in the CHANCE-2 (Ticagrelor or Clopidogrel with Aspirin in High-Risk Patients with Acute Nondisabling Cerebrovascular Events II) trial.

METHODS: In a multicentre, randomized, double-blind, placebo-controlled trial, conducted in China, we randomized patients with minor stroke or TIA who carried the CYP2C19 loss-of-function allele to receive either ticagrelor-acetylsalicylic acid (ASA) or clopidogrel-ASA. We classified patients into obese (BMI ≥ 28) or nonobese (BMI < 28) groups. The primary efficacy outcome was stroke within 90 days, and the primary safety outcome was severe or moderate bleeding within 90 days.

RESULTS: Among 6412 patients, 876 were classified as obese and 5536 were classified as nonobese. Compared with clopidogrel-ASA, ticagrelor-ASA was associated with a significantly lower rate of stroke within 90 days among patients with obesity (25 [5.4%] v. 47 [11.3%]; hazard ratio [HR] 0.51, 95% confidence interval [CI] 0.30-0.87), but not among those in the nonobese group (166 [6.0%] v. 196 [7.0%]; HR 0.84, 95% CI 0.69-1.04) The interaction of treatment and BMI group was significant (p for interaction = 0.04). We did not observe any difference by BMI group in rates of severe or moderate bleeding (9 [0.3%] v. 10 [0.4%] in the nonobese group; 0 [0.0%] v. 1 [0.2%] in the obese group; p for interaction = 0.99).

INTERPRETATION: In this secondary analysis of a randomized controlled trial involving patients with minor ischemic stroke or TIA, compared with clopidogrel-ASA, patients with obesity received more clinical benefit from ticagrelor-ASA therapy than those without obesity.

TRIAL REGISTRATION: Clinicaltrials.gov, no. NCT04078737.

PMID:37429630 | DOI:10.1503/cmaj.230262

Res Synth Methods. 2023 Jul 10. doi: 10.1002/jrsm.1655. Online ahead of print.

ABSTRACT

Recent years have seen the development of many novel scoring tools for disease prognosis and prediction. To become accepted for use in clinical applications, these tools have to be validated on external data. In practice, validation is often hampered by logistical issues, resulting in multiple small-sized validation studies. It is therefore necessary to synthesize the results of these studies using techniques for meta-analysis. Here we consider strategies for meta analyzing the concordance probability for time-to-event data (“C-index”), which has become a popular tool to evaluate the discriminatory power of prediction models with a right-censored outcome. We show that standard meta-analysis of the C-index may lead to biased results, as the magnitude of the concordance probability depends on the length of the time interval used for evaluation (defined e.g., by the follow-up time, which might differ considerably between studies). To address this issue, we propose a set of methods for random-effects meta-regression that incorporate time directly as covariate in the model equation. In addition to analyzing nonlinear time trends via fractional polynomial, spline, and exponential decay models, we provide recommendations on suitable transformations of the C-index before meta-regression. Our results suggest that the C-index is best meta-analyzed using fractional polynomial meta-regression with logit-transformed C-index values. Classical random-effects meta-analysis (not considering time as covariate) is demonstrated to be a suitable alternative when follow-up times are small. Our findings have implications for the reporting of C-index values in future studies, which should include information on the length of the time interval underlying the calculations.

PMID:37429580 | DOI:10.1002/jrsm.1655

Bioresour Technol. 2023 Jul 8:129464. doi: 10.1016/j.biortech.2023.129464. Online ahead of print.

ABSTRACT

In this study, the effects of pumice, expanded perlite, and expanded vermiculite on nitrogen loss were examined for industrial sludge composting using the Box-Behnken experimental design. The independent factors and their levels were selected as amendment type, amendment ratio, and aeration rate, and codded as x₁, x₂, and x₃ at 3 levels (low, center, and high). The statistical significance of independent variables and their interactions were determined at 95% confidence limits by Analysis of Variance. The quadratic polynomial regression equation produced to predict the responses was solved and the optimum values of the variables were predicted by analyzing the three-dimensional response surfaces plots. The optimum conditions for minimum nitrogen loss by the regression model were as pumice of amendment type, 40% of amendment ratio, and 6 L/min of aeration rate. In this study, it was observed that time-consuming and laborious laboratory work can be minimized with the Box-Behnken experimental design.

PMID:37429554 | DOI:10.1016/j.biortech.2023.129464

Ann Thorac Surg. 2023 Jul 8:S0003-4975(23)00693-8. doi: 10.1016/j.athoracsur.2023.06.024. Online ahead of print.

ABSTRACT

BACKGROUND: We aim to longitudinally compare expanded-polytetrafluoroethylene (ePTFE) valved vs pulmonary homograft (PH) conduits after right ventricular outflow tract reconstruction in the Ross procedure.

METHODS: We identified patients undergoing a Ross procedure from June 2004 to December 2021. Echocardiographic data, catheter-based interventions or conduit replacement as well as time to first reintervention or replacement were comparatively assessed between handmade ePTFE-valved and PH conduits.

RESULTS: A total of 90 patients were identified. The median age, and weight were 13.8 years (IQR 8.08-17.80) and 48.3 kg (IQR 26.8-68.7). There were 66% (n=60) ePTFE-valved conduits and 33% (n=30) PH. The median size was 22 mm (IQR 18-24) for ePTFE-valved conduits and 25 mm (IQR 23-26) for PH conduits (p<0.001). Conduit type has no differential effect in the gradient evolution or the odds of presenting with severe regurgitation in the last follow-up echocardiogram. Out of the 26 first reinterventions, 81% were catheter-based interventions, without statistically significant differences between the groups (69% PH vs. 83% ePTFE). The overall surgical conduit replacement was 15% (n=14), being higher in the homograft group (30% vs 8%; p=0.008). However, conduit type was not associated with increased hazard for reintervention or reoperation after adjusting for covariates.

CONCLUSIONS: RVOT reconstruction using handmade ePTFE-valvedconduits after a Ross procedure provides encouraging midterm results, without a differential effect in hemodynamic performance or valve function compared to PH. These results reassure the utilization of handmade valved conduits in pediatric population and young adults. Longer follow-up of tricuspid conduits will complement valve competency assessment.

PMID:37429515 | DOI:10.1016/j.athoracsur.2023.06.024

J Biomed Inform. 2023 Jul 8:104440. doi: 10.1016/j.jbi.2023.104440. Online ahead of print.

ABSTRACT

The imputation of missing values in multivariate time series (MTS) data is a critical step in ensuring data quality and producing reliable data-driven predictive models. Apart from many statistical approaches, a few recent studies have proposed state-of-the-art deep learning methods to impute missing values in MTS data. However, the evaluation of these deep methods is limited to one or two data sets, low missing rates, and completely random missing value types. This survey performs six data-centric experiments to benchmark state-of-the-art deep imputation methods on five time series health data sets. Our extensive analysis reveals that no single imputation method outperforms the others on all five data sets. The imputation performance depends on data types, individual variable statistics, missing value rates, and types. Deep learning methods that jointly perform cross-sectional (across variables) and longitudinal (across time) imputations of missing values in time series data yield statistically better data quality compared to traditional imputation methods. Although computationally expensive, deep learning methods are practical given the current availability of high-performance computing resources, especially when data quality and sample size are highly important in healthcare informatics. Our findings highlight the importance of data-centric selection of imputation methods to optimize data-driven predictive models.

PMID:37429511 | DOI:10.1016/j.jbi.2023.104440

J Endod. 2023 Jul 8:S0099-2399(23)00391-6. doi: 10.1016/j.joen.2023.07.002. Online ahead of print.

ABSTRACT

INTRODUCTION: This study evaluated the effects of diabetes mellitus (DM) on the nanostructure of root canal dentin using high-resolution transmission electron microscopy (HRTEM) and inductively coupled plasma mass spectrometry (ICP-MS).

METHODS: Twenty extracted human premolars from diabetic and non-diabetic patients (n=10 in each group) were decoronated and sectioned horizontally into forty 2-mm-thick dentin discs, with each disc designated for a specific test. ICP-MS was used to determine the different elemental levels of Cu, Li, Zn, Se, Sr, Mn, and Mg in diabetic and non-diabetic specimens. HRTEM was used to analyze the shape and quantity of the apatite crystals in diabetic and non-diabetic dentin at the nanostructural level. Statistical analysis was performed using Kolmogorov-Smirnov and student’s t-test (p<0.05).

RESULTS: ICP-MS revealed significant differences in trace element concentrations between the diabetic and non-diabetic specimens (p<0.05), with lower levels of Mg, Zn, Sr, Li, Mn, and Se (p<0.05), and higher levels of Cu in diabetic specimens (p<0.05). HRTEM revealed that diabetic dentin exhibited a less compact structure with smaller crystallites and significantly more crystals in the 2500 nm² area (p<0.05).

CONCLUSION: Diabetic dentin exhibited smaller crystallites and altered elemental levels than non-diabetic dentin, which could explain the higher root canal treatment failure rate in diabetic patients.

PMID:37429496 | DOI:10.1016/j.joen.2023.07.002

Clin Biomech (Bristol, Avon). 2023 Jul 6;107:106040. doi: 10.1016/j.clinbiomech.2023.106040. Online ahead of print.

ABSTRACT

BACKGROUND: Rotator cuff muscles are responsible for humeral rotation. Moment arms of different regions of these muscles during humeral rotation were analyzed in neutral and abducted positions.

METHODS: In eight cadaveric shoulders, subregions of the rotator cuff muscles were identified and their excursion during humeral rotation was measured in neutral and abducted positions from an internal rotation of 30° to an external rotation of 45°, with 15° increments, using a 3-D digitizing system. Statistical tests were used to assess differences between subregions within a single muscle.

FINDINGS: The posterior-deep subregion of the supraspinatus muscle had greater moment arms compared to the anterior-superficial and anterior-middle subregions in both positions (p < 0.001). The middle and inferior subregions of the infraspinatus muscle and the teres minor muscle showed differences in moment arms compared to the superior region in an abducted position (p < 0.042). The superior subregion of the subscapularis muscle showed differences in moment arms compared to the middle and inferior subregions in an abducted position (p < 0.001).

INTERPRETATION: The posterior-deep subregion of the supraspinatus muscle behaved similar to the infraspinatus muscle, as an external rotator. The anterior-superficial and anterior-middle subregions of the supraspinatus muscle showed a biphasic behavior during rotation at a neutral position, but acted as pure external rotators during rotation at an abducted position. Inferior subregions of the infraspinatus and subscapularis muscles showed the largest moment arms compared to superior subregions. These findings support distinct functional roles of the rotator cuff muscle subregions.

PMID:37429101 | DOI:10.1016/j.clinbiomech.2023.106040

Am J Cardiol. 2023 Jul 8;202:119-130. doi: 10.1016/j.amjcard.2023.06.066. Online ahead of print.

ABSTRACT

Iron deficiency is an independent risk factor for heart failure (HF) exacerbation. We aim to study the safety and efficacy of intravenous (IV) iron therapy in patients with HF with reduced ejection fraction (HFrEF). A literature search was conducted on MEDLINE (Embase and PubMed) using a systematic search strategy by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) until October 2022. CRAN-R software (The R Foundation for Statistical Computing, Vienna, Austria) was used for statistical analysis. The quality assessment was performed using the Cochrane Risk of Bias and Newcastle-Ottawa Scale. We included 12 studies with a total of 4,376 patients (IV iron n = 1,985 [45.3%]; standard of care [SOC] n = 2,391 [54.6%]). The mean age was 70.37 ± 8.14 years and 71.75 ± 7.01 years in the IV iron and SOC groups, respectively. There was no significant difference in all-cause mortality and cardiovascular mortality (risk ratio [RR] 0.88, 95% confidence interval [CI] 0.74 to 1.04, p <0.15). However, HF readmissions were significantly lower in the IV iron group (RR 0.73, 95% CI 0.56 to 0.96, p = 0.026). Non-HF cardiac readmissions were not significantly different between the IV iron and SOC groups (RR 0.92, 95% CI 0.82 to 1.02, p = 0.12). In terms of safety, there was a similar rate of infection-related adverse events in both arms (RR 0.86, 95% CI 0.74 to 1, p = 0.05). IV iron therapy in patients with HFrEF is safe and shows a significant reduction in HF hospitalizations compared with SOC. There was no difference in the rate of infection-related adverse events. The changing landscape of HFrEF pharmacotherapy in the last decade may warrant a re-demonstration of the benefit of IV iron with current SOC. The cost-effectiveness of IV iron use also needs further study.

PMID:37429060 | DOI:10.1016/j.amjcard.2023.06.066