Tag: pubmed

Ann Clin Transl Neurol. 2024 Nov 22. doi: 10.1002/acn3.52238. Online ahead of print.

ABSTRACT

OBJECTIVE: Poststroke aphasia (PSA) has a high prevalence and requires a long recovery period, severely impairing life and work. Its existing behavioral interventions, principally speech and language therapy, are limited by numerous factors. The aims of this study are to evaluate the efficacy and safety of DL-3-N-butylphthalein (NBP) and explore its mechanism in the treatment of ischemic PSA.

METHODS: Patients hospitalized in the Second Hospital of Hebei Medical University in China were randomly administered NBP soft capsules or placebo orally for 6 months from July 1, 2021, to February 25, 2023. Language skills were assessed using the Western Aphasia Battery-Aphasia Quotient (WAB-AQ). We collected plasma samples and detected neurotransmitters by liquid chromatography-mass spectrometry.

RESULTS: In total, 118 out of 124 patients were included in the outcome analysis. Compared with the control group, AQ values in the NBP group significantly improved at 6 months (U = 1187.5, p = 0.003). After eliminating baseline interference, NBP treatment was independently associated with the 6-month AQ improvement [mean difference (MD) 0.106, 95% confidence interval (CI) 0.018, 0.195, p = 0.019]. We observed no statistically significant difference between the groups in abnormal liver function at 1 month [relative risk (RR) 1.07, 95% CI 0.89, 1.28] and 6 months [RR 0.99, 95% CI 0.86, 1.42]. Statistically significant differences were observed in tyrosine (p = 0.043) and 5-hydroxytryptophan (p = 0.041) between the two groups.

INTERPRETATION: NBP treatment might promote the recovery of WAB-AQ in patients with ischemic PSA by increasing levels of monoamine neurotransmitters.

PMID:39575649 | DOI:10.1002/acn3.52238

Biometrics. 2024 Oct 3;80(4):ujae129. doi: 10.1093/biomtc/ujae129.

ABSTRACT

We consider estimation of measures of model performance in a target population when covariate and outcome data are available from a source population and covariate data, but not outcome data, are available from the target population. In this setting, identification of measures of model performance is possible under an untestable assumption that the outcome and population (source or target) are independent conditional on covariates. In practice, this assumption is uncertain and, in some cases, controversial. Therefore, sensitivity analysis may be useful for examining the impact of assumption violations on inferences about model performance. Here, we propose an exponential tilt sensitivity analysis model and develop statistical methods to determine how measures of model performance are affected by violations of the assumption of conditional independence between outcome and population. We provide identification results and estimators for the risk in the target population under the sensitivity analysis model, examine the large-sample properties of the estimators, and apply them to data on lung cancer screening.

PMID:39575627 | DOI:10.1093/biomtc/ujae129

Nucl Med Commun. 2024 Nov 21. doi: 10.1097/MNM.0000000000001933. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to assess the usefulness of thyroglobulin (Tg) after radioiodine (RAI) therapy in predicting excellent response (ER) to therapy in postoperative differentiated thyroid cancer (DTC).

METHODS: A retrospective observational study was conducted on postoperative DTC patients who underwent RAI from August 2018 to December 2022. Various factors were analyzed to predict ER to treatment. This involved Tg under stimulation (sTg) before RAI, Tg immediately (imTg) 112 h post-RAI and imTg/sTg(rTg). Based on the efficacy of RAI, patients were categorized into two groups: ER and non-ER (NER). Univariate logistic analysis was utilized to compare parameters between the two groups, followed by binary logistic regression analysis on factors associated with ER. Receiver operating characteristic (ROC) curves were employed to evaluate the sensitivity, specificity, and optimal diagnostic cutoff points for parameters affecting ER.

RESULTS: The analysis included 45 ER patients and 56 NER patients. Statistical significance was found in the binary logistic regression analysis for the number of lymph nodes in the lateral cervical region (P = 0.016), sTg (P = 0.021), and rTg (P ≤ 0.001) concerning ER. ROC curve analysis revealed that the rTg area under the curve was 0.845, with an optimal cutoff value of 11.78, sensitivity of 82.6%, and specificity of 74.5%.

CONCLUSION: Post-RAI therapy, significant value is demonstrated by rTg with high sensitivity and specificity. This provides a foundation for the evaluation and decisions about DTC treatment in advance.

PMID:39575624 | DOI:10.1097/MNM.0000000000001933

Obstet Gynecol. 2024 Nov 21. doi: 10.1097/AOG.0000000000005727. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate whether transcutaneous electric nerve stimulation (TENS) decreases pain at the time of outpatient endometrial biopsy.

METHODS: We conducted a randomized, double-blind trial of active TENS compared with placebo TENS at the time of endometrial biopsy. The primary outcome was pain measured on a 0- to 100-mm visual analog scale immediately after biopsy, with secondary outcomes including satisfaction and tolerability of TENS and pain scores at other procedural time points. To detect a 15-mm reduction in pain with a 30-mm SD, 80.0% power, and a significance level of 0.05, 64 participants were required in each arm.

RESULTS: From December 2022 to December 2023, 135 participants were randomized with 67 in the placebo TENS arm and 68 in the active TENS arm. Baseline demographic and clinical characteristics were similar between groups. The median (interquartile range) pain score immediately after biopsy was 50 mm (20-80 mm) in the active TENS group and 60 mm (40-100 mm) in the placebo TENS group (P=.039). Pain scores at other time intervals were not statistically significantly different. In a subset analysis, participants with higher-than-median baseline anxiety had postprocedural pain scores (interquartile range) of 50 mm (40-80 mm) in the active TENS group compared with 80 mm (50-100 mm) in the placebo TENS group. Overall satisfaction (interquartile range) with pain control (with 100 mm representing completely satisfied) was 87.5 mm (60-100 mm) for active TENS and 70 mm (41-100 mm) for placebo TENS; 85.3% of active TENS participants would use TENS in a future endometrial biopsy. Minimal side effects were associated with TENS, with one participant reporting itching at the pad sites.

CONCLUSION: Despite a statistical difference in pain scores, a clinical difference was not seen between active and placebo TENS for pain during endometrial biopsy. Satisfaction was higher in the active TENS group, and there were overall minimal side effects associated with TENS.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT05472740.

PMID:39575620 | DOI:10.1097/AOG.0000000000005727

J Glob Health. 2024 Nov 22;14:05040. doi: 10.7189/jogh.14.05040.

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic had substantially disrupted maternal health care provision and utilisation in Bangladesh. However, the extent of geographical disparities in service utilisation and how the health system withstood these challenges have not been studied. This study explores the divisional disparities in trends and disruptions in maternal health service utilisation caused by the COVID-19 pandemic.

METHODS: Data was extracted from the District Health Information Software of Bangladesh from January 2017 to December 2021. We assessed the trend of first antenatal care visit, institutional delivery and number of caesarean sections over these years. We explored both the yearly and monthly trends to see the variations in the number of utilisations. Segmented regression with Poisson distribution was used to assess changes in service utilisation during the COVID-19 period. We reported incidence rate ratio (IRR) of service utilisation with a 95% confidence interval (CI) in different divisions during COVID-19 (2020-2021) compared to the reference period (2017-2019).

RESULTS: Initially, a notable decline in maternal health care utilisation was observed in 2020 compared to the pre-pandemic period of 2017-2019. Divisional disparities were observed in this trend. Overall, compared to the pre-pandemic period, we observed around 30% decline in all three selected indicators of maternal health care. The lowest value was observed in Chattogram in 2020 (IRR = 0.66; 95% CI = 0.55-0.79) and Rajshahi in 2021 (IRR = 0.71; 95% CI = 0.60-0.82). For institutional delivery, Barishal division had the lowest IRR (0.64; 95% CI = 0.60-0.68) in 2020 and, in 2021 Rajshahi had the lowest IRR (0.71; 95% CI = 0.60-0.82). For caesarean section, the lowest value was observed in Barishal division (IRR = 0.48; 95% CI = 0.44-0.53) in 2020 and in Mymensingh (IRR = 0.37; 95% CI = 0.32-0.43) in 2021. By 2021, the three maternal health care utilisation indicators demonstrated recovery.

CONCLUSIONS: The effect of the pandemic, including lockdown, on the selected maternal service utilisation was observed in Bangladesh though there were substantial geographic disparities. These disruptions slightly recovered after the initial shock. These results will support the government in preparing the national and regional health systems for future epidemics in Bangladesh.

PMID:39575613 | DOI:10.7189/jogh.14.05040

Nutr Hosp. 2024 Nov 12. doi: 10.20960/nh.05421. Online ahead of print.

ABSTRACT

INTRODUCTION: patients with congenital heart disease are considered to be at high nutritional risk due to alterations in the metabolism of the underlying pathology and extracardiac factors. The STAMP (Screening Tool for the Assessment of Malnutrition in Paediatrics) is the only tool validated in our country in a pediatric population for nutritional screening.

OBJECTIVE: to evaluate nutritional risk by STAMP screening in pediatric patients according to type of congenital heart disease.

MATERIAL AND METHODS: an analytical cross-sectional study in 2023 in a pediatric reference hospital. Nutritional status was determined by Z scores based on WHO 2006/CDC 2000 child growth standards. The STAMP questionnaire was administered to establish nutritional risk. Inferential statistics with the Chi-squared and Mann-Whitney U-test were used. Spearman’s correlation coefficient was used. Analyses were carried out using the SPSS V25 statistical package.

RESULTS: 113 patients were included, male (n = 57, 50.4 %) and female (n = 56, 49.6 %). The most common age group was that of infants (n = 47, 45 %). Acute or chronic nutritional status impairment affected n = 50 (44.3 %) subjects. Cyanogenous congenital heart diseases had a greater impact on weight, height, average arm circumference and height/age, WBC/age indices. Two nutritional risk groups were established by STAMP: intermediate risk, n = 74 (65.5 %), and high risk, n = 39 (34.5 %). The greatest impact on anthropometric parameters was associated with elevated risk by STAMP, p = 0.000. The type of congenital heart disease was not associated with a greater increase in nutritional risk by STAMP (p = 0.76). There was no correlation of STAMP score with biochemical parameters.

CONCLUSION: patients with congenital heart disease will have an intermediate risk per STAMP. The type of congenital heart disease is not related to a greater increase in nutritional risk due to STAMP.

PMID:39575608 | DOI:10.20960/nh.05421

Psychol Med. 2024 Nov 22:1-11. doi: 10.1017/S0033291724001715. Online ahead of print.

ABSTRACT

BACKGROUND: Cannabis use and familial vulnerability to psychosis have been associated with social cognition deficits. This study examined the potential relationship between cannabis use and cognitive biases underlying social cognition and functioning in patients with first episode psychosis (FEP), their siblings, and controls.

METHODS: We analyzed a sample of 543 participants with FEP, 203 siblings, and 1168 controls from the EU-GEI study using a correlational design. We used logistic regression analyses to examine the influence of clinical group, lifetime cannabis use frequency, and potency of cannabis use on cognitive biases, accounting for demographic and cognitive variables.

RESULTS: FEP patients showed increased odds of facial recognition processing (FRP) deficits (OR = 1.642, CI 1.123-2.402) relative to controls but not of speech illusions (SI) or jumping to conclusions (JTC) bias, with no statistically significant differences relative to siblings. Daily and occasional lifetime cannabis use were associated with decreased odds of SI (OR = 0.605, CI 0.368-0.997 and OR = 0.646, CI 0.457-0.913 respectively) and JTC bias (OR = 0.625, CI 0.422-0.925 and OR = 0.602, CI 0.460-0.787 respectively) compared with lifetime abstinence, but not with FRP deficits, in the whole sample. Within the cannabis user group, low-potency cannabis use was associated with increased odds of SI (OR = 1.829, CI 1.297-2.578, FRP deficits (OR = 1.393, CI 1.031-1.882, and JTC (OR = 1.661, CI 1.271-2.171) relative to high-potency cannabis use, with comparable effects in the three clinical groups.

CONCLUSIONS: Our findings suggest increased odds of cognitive biases in FEP patients who have never used cannabis and in low-potency users. Future studies should elucidate this association and its potential implications.

PMID:39575607 | DOI:10.1017/S0033291724001715

Orthop Surg. 2024 Nov 22. doi: 10.1111/os.14289. Online ahead of print.

ABSTRACT

OBJECTIVE: Pseudo-patella baja (PPB) was one of the complications after total knee arthroplasty (TKA). This complication may be closely related to the occurrence of knee joint movement limitation and pain after TKA. This study aimed to investigate whether PPB affects clinical outcomes after TKA and to study the biomechanical effects of PPB after TKA.

METHODS: This study was a retrospective case series of 462 eligible patients (563 knees). Clinical evaluation was performed using the visual analogue scale (VAS), the Hospital for Special Surgery (HSS), the Western Ontario McMaster University Osteoarthritis Index (WOMAC) scoring systems, the 5-Level EuroQol Generic Health Index (EQ-5D-5L), the Forgotten Joint Score-12 (FJS-12), and patient satisfaction. CT and MRI scans of two healthy left knees and TKA prostheses were taken; 3D models including PPB, True patella baja (TPB), normal patella, and patella alta (PA) were created in FEA and applied load along the direction of quadriceps femoris. T-test, Mann-Whitney U-test, chi-squared (χ²) test, and analysis of variance (ANOVA) were performed using GraphPad Prism (Version 8, GraphPad Software, USA). A statistically significant difference was considered at p < 0.05 with bilateral α.

RESULTS: The VAS, HSS, WOMAC, EQ-5D-5L, FJS-12, and patient satisfaction scores in the PPB and TPB groups were significantly worse than those in the patella normal (PN) group (p < 0.05). The PPB group found a positive correlation between Blackburne-Peel index (BPI) and FJS-12 score. PPB showed lower contact stress of patellofemoral joint compared to TPB when knee flexion was less than < 90° (p < 0.01), but no significant difference when flexion was more than > 90° (p > 0.05) in the finite element model with Patella baja (PB). The contact area of the patellofemoral joint tended to increase with the deepening of knee flexion, and decreased after reaching the peak value. The contact area of the patellofemoral joint tended to decrease with the increase in patellar height. There was no significant difference in the contact area of the patellofemoral joint among different patellar heights and different degrees of knee flexion (p > 0.05).

CONCLUSION: PPB after TKA may increase patellofemoral joint stress and postoperative complications like anterior knee pain.

PMID:39575599 | DOI:10.1111/os.14289

Ann Thorac Surg. 2023 Feb;115(2):329-337. doi: 10.1016/j.athoracsur.2022.10.017. Epub 2022 Oct 29.

ABSTRACT

BACKGROUND: Previous studies have identified postoperative complications as being associated with readmission after lobectomy. However, these studies have not adequately accounted for the timing of complications or accounted for institutional effects. Our objectives were to examine readmission rates after lobectomy and identify factors associated with readmission.

METHODS: Patients aged >18 years undergoing lobectomy for lung cancer between 2015 and 2019 were identified from a statewide database. Patients with in-hospital mortality, missing data regarding discharge status, 30-day readmission status, and discharge location were excluded. Data regarding The Society of Thoracic Surgeons postoperative complications were abstracted by hospital data managers to determine the timing of occurrence (index admission vs readmission). Logistic mixed-model analysis, with hospitals as the random intercept to account for clustering data structure and assess hospital-specific effect on readmission, was performed.

RESULTS: The overall readmission rate was 6.9% (184 of 2686). The most common complication was air leak ≥5 days in 17.4% (467 of 2686). Variables significantly predictive of more readmission were predischarge postoperative complications and Zubrod score ≥1. Variables predictive of less readmission were increasing length of stay and having been operated on at institutions with higher cumulative volume or having postdischarge follow-up visit protocol ≤7 days from discharge. The C statistic for the final model was 0.80.

CONCLUSIONS: Patients who experience postoperative complications are at increased risk for readmission, whereas follow-up ≤7 days was predictive of less risk for readmission. Efforts at reducing readmissions should focus on decreasing postoperative complication rates, the timing of discharge for patients experiencing complications, as well as decreasing length of time between discharge and clinic follow-up.

PMID:39575522 | DOI:10.1016/j.athoracsur.2022.10.017

CNS Spectr. 2024 Nov 22:1-5. doi: 10.1017/S1092852924000361. Online ahead of print.

ABSTRACT

OBJECTIVE: Hoarding disorder studies are primarily based on persons who seek treatment and demonstrate good insight. The aim of the present study is to evaluate whether there are differences between community and treatment-seeking samples of individuals with hoarding disorder (HD).

METHODS: Fourteen people with HD from the community and twenty treatment-seeking people with HD were assessed by a battery of instruments to evaluate HD features and other associated characteristics.

RESULTS: Compared to the treatment-seeking sample, the HD community sample was older, had poorer insight, and had a lower prevalence of comorbid obsessive-compulsive disorder (OCD). There were no differences in gender, education, presence of psychiatric comorbidities, quality of life, and hoarding behavior characteristics between the samples. The final logistic regression model with the Dimensional Obsessive-Compulsive Scale (DOCS) as the single predictor of treatment-seeking status was statistically significant, indicating that it was able to distinguish between the two samples. The model explained between 20.7% and 27.9% of the variance of subjects, and correctly classified 67.6% of cases.

CONCLUSIONS: Our results indicate that there appear to be few differences between the treatment-seeking and community samples of individuals with HD. The presence of comorbid OCD in treatment-seeking groups seems to be more frequent than in HD community samples.

PMID:39575521 | DOI:10.1017/S1092852924000361