Tag: pubmed

Zh Vopr Neirokhir Im N N Burdenko. 2021;85(6):26-35. doi: 10.17116/neiro20218506126.

ABSTRACT

BACKGROUND: One of the most difficult problems in surgical treatment of moyamoya disease is prevention of ischemic perioperative complications. The risk of these events is significantly higher compared to other cerebrovascular diseases (up to 30%).

OBJECTIVE: To identify unfavorable prognostic factors of perioperative cerebral ischemic complications, to determine the group of high-risk patients and to develop the guidelines for perioperative management of these patients.

MATERIAL AND METHODS: We analyzed clinical and diagnostic data and postoperative outcomes in 80 patients with various forms of moyamoya disease. These patients underwent 134 different interventions. Staged revascularization of both hemispheres was performed in 40 patients (80 surgeries). Most patients (n = 55) underwent combined brain revascularization (79 surgeries).

RESULTS: Persistent postoperative complications (ischemic stroke) developed in 7 cases (5.3%). Transient neurological impairment was observed in 36 cases (27%). Statistical analysis revealed the following risk factors of perioperative complications: critical stenosis/occlusion of posterior cerebral artery (OR 9.704), severe perfusion deficit (OR 5.393) and previous TIA or ischemic stroke within 3 months prior to surgery (OR 6.433). If at least two of these signs are present, sensitivity of prognosis for postoperative complications is 80.7% and 88.6%, respectively.

CONCLUSION: Patients with moyamoya disease are at high risk of perioperative complications due to complex rearrangement of collateral cerebral circulation and high sensitivity of brain to local and systemic hemodynamic changes. Patients with risk factors require careful perioperative management to exclude pathogenetic factors provoking ischemia. Early surgical treatment is advisable to reduce the risk of ischemic and hemorrhagic lesions following natural course of disease and severe perioperative complications.

PMID:34951757 | DOI:10.17116/neiro20218506126

J Biophotonics. 2021 Dec 24:e202100340. doi: 10.1002/jbio.202100340. Online ahead of print.

ABSTRACT

Optical coherence tomography angiography (OCTA) can map microvascular networks and quantify blood flow velocities with high resolution by calculating intensity standard deviations of time-series signals. However, statistical calculations of the standard deviations need much processing time and reduce the analysis efficiency. In this study, we proposed three optimized OCTA algorithms incorporating rapid estimations of the intensity standard deviations, including the range algorithm, the mean absolute error algorithm, and the maximum absolute error algorithm. The abilities of the optimized algorithms to quantify the flow velocities were validated by a flow phantom. After a rat cerebral cortex was imaged, the optimized OCTA algorithms were compared with the conventional relative standard deviation algorithm in the metrics of imaging quality and processing time. The results show that the optimized algorithms incorporating rapid estimations of the intensity standard deviations have faster processing speeds with equivalent image quality. This article is protected by copyright. All rights reserved.

PMID:34951745 | DOI:10.1002/jbio.202100340

Int J Dent Hyg. 2021 Dec 24. doi: 10.1111/idh.12572. Online ahead of print.

ABSTRACT

INTRODUCTION: Halitosis is a common oral health problem that significantly impacts the quality of life of the affected individuals. In most cases, poor oral hygiene is responsible for the problem. Orthodontic therapy aims to correct malocclusion using different devices. It has been suggested that orthodontic treatment can promote gingival health by facilitating daily oral hygiene measures. However, the treatment may harm gingival health as these appliances may lead to a more significant accumulation of plaque, increasing the microbial load in the subgingival environment leading to halitosis.

OBJECTIVE: The primary goal of this survey is to assess the prevalence of self-perceived halitosis in patients undergoing orthodontic treatment.

MATERIALS AND METHODS: An online questionnaire was randomly distributed to patients undergoing orthodontic treatment. A total of 289 subjects completed the questionnaire. It included questions about: demographic data, medical history, social habits, past dental treatment, and oral hygiene habits. Descriptive statistics as frequency distributions and percentages were calculated for the study variables.

RESULTS: The prevalence of self-perceived halitosis was 41.5%. The majority of participants started to notice this problem during and after orthodontic treatment (62.5%). A statistically significant correlation was found between the regular dental visits and halitosis in patients with fixed orthodontic appliances(p-value=0.010). Also, those patients had a substantial increase in tongue coating formation(p- value0.010).

CONCLUSION: Self-perceived halitosis is a common problem in patients receiving orthodontic treatment.

PMID:34951749 | DOI:10.1111/idh.12572

Acta Anaesthesiol Scand. 2021 Dec 24. doi: 10.1111/aas.14023. Online ahead of print.

ABSTRACT

BACKGROUND: Respiratory failure is the main cause of mortality and morbidity among ICU patients with coronavirus disease 2019 (COVID-19). In these patients, supplemental oxygen therapy is essential, but there is limited evidence the optimal target. To address this, the ongoing handling oxygenation targets in COVID-19 (HOT-COVID) trial was initiated to investigate the effect of a lower oxygenation target (partial pressure of arterial oxygen (PaO₂ ) of 8 kPa) vs a higher oxygenation target (PaO₂ of 12 kPa) in the ICU on clinical outcome in patients with COVID-19 and hypoxaemia.

METHODS: The HOT-COVID is planned to enrol 780 patients. This paper presents the protocol and statistical analysis plan for the conduct of a secondary Bayesian analysis of the primary outcome of HOT-COVID being days alive without life-support at 90 days and the secondary outcome 90-day all-cause mortality. Further, both outcomes will be investigated for the presence heterogeneity of treatment effects based on four baseline parameters being sequential organ failure assessment score, PaO₂ /fraction of inspired oxygen ratio, highest dose of norepinephrine during the 24 hours before randomisation, and plasma concentration of lactate at randomisation.

CONCLUSION: The results of this pre-planned secondary Bayesian analysis will complement the primary frequentist analysis of the HOT-COVID trial and may facilitate a more nuanced interpretation of the trial results.

PMID:34951717 | DOI:10.1111/aas.14023

Zoo Biol. 2021 Dec 24. doi: 10.1002/zoo.21660. Online ahead of print.

ABSTRACT

The global reach of zoos has enormous potential to raise awareness of conservation issues such as the amphibian extinction crisis. One mechanism of achieving this is through targeted, time-limited campaigns. However, the longer-term impact of such campaigns on conservation outcomes is rarely evaluated. The goal of this study is to evaluate how zoos view “The Year of The Frog,” a campaign launched by zoos in 2008, with the aim of raising awareness of the global amphibian crisis and generating funds to support amphibian conservation initiatives. A questionnaire-based survey of 43 zoos from fourteen countries was used to evaluate how zoo practitioners believed the campaign influenced amphibian conservation some 10 years after its launch. Survey results showed that the campaign not only contributed to the improvement of research into amphibian husbandry in zoos but also increased support of in situ conservation of amphibians. Zoos focused on exotic species, but developed countries led most of the actions of the campaign. The campaign has inspired and encouraged some zoos and other ex situ conservation organizations to embrace amphibian conservation. The next step is to increase collaboration with more organizations through, for example, AArk and IUCN SSC/ASG, particularly in countries that have high amphibian biodiversity.

PMID:34951730 | DOI:10.1002/zoo.21660

J Am Geriatr Soc. 2021 Dec 24. doi: 10.1111/jgs.17633. Online ahead of print.

ABSTRACT

BACKGROUND: Lower urinary tract symptoms (LUTS) are associated with frailty phenotype, a risk factor for functional decline. Our objective was to determine the association between baseline LUTS and 2-year risk of new functional limitation among older men.

METHODS: We analyzed data from the Osteoporotic Fractures in Men (MrOS) study with baseline at Year 7 and follow-up through Year 9. Participants included 2716 community-dwelling men age ≥ 71 years without any baseline self-reported functional limitation. LUTS severity (American Urologic Association Symptom Index) was classified as none/mild (score 0-7), moderate (8-19), and severe (20-35). At baseline and follow-up, men reported their ability to complete several mobility, activities of daily living (ADLs), and cognition-dependent tasks. Risk was estimated for 3 incident functional limitation outcomes: (1) mobility (any difficulty walking 2-3 blocks or climbing 10 steps), (2) ADL (any difficulty bathing, showering, or transferring), and (3) cognition-dependent (any difficulty managing money or medications). We used Poisson regression with a robust variance estimator to model adjusted risk ratios (ARR) and 95% CIs controlling for age, site, and comorbidities; other demographic/lifestyle factors did not meet criteria for inclusion.

RESULTS: Overall, the 2-year risk was 15% for mobility, 10% for ADLs, and 4% for cognition-dependent task limitations. Compared to none/mild LUTS, risk of incident mobility limitations was increased for moderate (ARR = 1.35, 95% CI: 1.12, 1.63) and severe LUTS (ARR = 1.98, 95% CI: 1.48, 2.64). Men were also at higher risk for incident ADL limitations if they reported moderate (ARR = 1.32, 95% CI: 1.05, 1.67) and severe LUTS (ARR = 1.62, 95% CI: 1.07,2.43). Results were somewhat attenuated after adjusting for the frailty phenotype but remained statistically significant. LUTS were not associated with incident cognition-dependent task limitations.

CONCLUSIONS: LUTS severity is associated with incident mobility and ADL limitations among older men. Increased clinical attention to risk of functional limitations among older men with LUTS is likely warranted.

PMID:34951697 | DOI:10.1111/jgs.17633

Acta Anaesthesiol Scand. 2021 Dec 24. doi: 10.1111/aas.14022. Online ahead of print.

ABSTRACT

BACKGROUND: Intubation, laryngoscopy and extubation are considered highly aerosol-generating procedures, and additional safety protocols are used during COVID-19 pandemic in these procedures. However, previous studies are mainly experimental and have neither analyzed staff exposure to aerosol generation in the real-life operating room environment nor compared the exposure to aerosol concentrations generated during normal patient care. To assess operational staff exposure to potentially infectious particle generation during general anesthesia, we measured particle concentration and size distribution with patients undergoing surgery with Optical Particle Sizer.

METHODS: A single-center observative multidisciplinary clinical study in Helsinki University Hospital with 39 adult patients who underwent general anesthesia with tracheal intubation. Mean particle concentrations during different anesthesia procedures were statistically compared with cough control data collected from 37 volunteers to assess the differences in particle generation.

RESULTS: This study measured 25 preoxygenations, 30 mask ventilations, 28 intubations and 24 extubations. The highest total aerosol concentration of 1153 particles (p)/cm³ was observed during mask ventilation. Preoxygenations, mask ventilations and extubations as well as uncomplicated intubations generated mean aerosol concentrations statistically comparable to coughing. It is noteworthy that difficult intubation generated significantly fewer aerosols than either uncomplicated intubation (p=0.007) or coughing (p=0.006).

CONCLUSIONS: Anesthesia induction generates mainly small (<1 µm) aerosol particles. Based on our results, general anesthesia procedures are not highly aerosol-generating compared with coughing. Thus, their definition as high-risk aerosol-generating procedures should be re-evaluated due to comparable exposures during normal patient care.

PMID:34951703 | DOI:10.1111/aas.14022

MAGMA. 2021 Dec 24. doi: 10.1007/s10334-021-00990-5. Online ahead of print.

ABSTRACT

OBJECTIVE: We tried to reveal how the normal appearing white matter (NAWM) was affected in patients with glioblastoma treated with chemo-radiotherapy (CRT) in the period following the treatment, by multiparametric MRI.

MATERIALS AND METHODS: 43 multiparametric MRI examinations of 17 patients with glioblastoma treated with CRT were examined. A total of six different series or maps were analyzed in the examinations: Apparent Diffusion Coefficient (ADC) and Fractional Anisotropy (FA) maps, Gradient Echo (GRE) sequence, Dynamic susceptibility contrast (DSC) and Arterial spin labeling (ASL) perfusion sequences. Each sequence in each examination was examined in detail with 14 Region of Interest (ROI) measurements. The obtained values were proportioned to the contralateral NAWM values and the results were recorded as normalized values. Time dependent changes of normalized values were statistically analyzed.

RESULTS: The most prominent changes in follow-up imaging occurred in the perilesional region. In perilesional NAWM, we found a decrease in normalized FA (nFA), rCBV (nrCBV), rCBF (nrCBF), ASL (nASL)values (p < 0.005) in the first 3 months after treatment, followed by a plateau and an increase approaching pretreatment values, although it did not reach. Similar but milder findings were present in other NAWM areas. In perilesional NAWM, nrCBV values were found to be positively high correlated with nrCBF and nASL, and negatively high correlated with nADC values (r: 0.963, 0.736, – 0.973, respectively). We also found high correlations between the mean values of nrCBV, nrCBF, nASL in other NAWM areas (r: 0.891, 0.864, respectively).

DISCUSSION: We showed that both DSC and ASL perfusion values decreased correlatively in the first 3 months and showed a plateau after 1 year in patients with glioblastoma treated with CRT, unlike the literature. Although it was not as evident as perfusion MRI, it was observed that the ADC values also showed a plateau pattern following the increase in the first 3 months. Further studies are needed to explain late pathophysiological changes. Because of the high correlation, our results support ASL perfusion instead of contrast enhanced perfusion methods.

PMID:34951690 | DOI:10.1007/s10334-021-00990-5

Eur J Epidemiol. 2021 Dec 24. doi: 10.1007/s10654-021-00817-6. Online ahead of print.

NO ABSTRACT

PMID:34951674 | DOI:10.1007/s10654-021-00817-6

Sports Med Open. 2021 Dec 24;7(1):100. doi: 10.1186/s40798-021-00395-7.

ABSTRACT

BACKGROUND: Cardiorespiratory fitness and fatness (notably central obesity) are mediating factors of the metabolic syndrome (MetS) and consequent cardiovascular disease (CVD)/mortality risk. The fitness-fatness index (FFI) combines these factors and has been reported to be a better indicator of CVD and all-cause mortality risk, beyond the capacity of either fitness or fatness alone.

OBJECTIVE: This study sought to investigate the effects of different exercise intensities on FFI in adults with MetS.

METHODS: This was a sub-study of the ‘Exercise in the prevention of Metabolic Syndrome’ (EX-MET) multicentre trial. Ninety-nine adults diagnosed with MetS according to the International Diabetes Federation criteria were randomized to one of the following 16-week exercise interventions: i) moderate-intensity continuous training (MICT) at 60-70% HRpeak for 30 min/session (n = 34, 150 min/week); ii) 4 × 4 min bouts of high-intensity interval training at 85-95% HRpeak, interspersed with 3-min active recovery at 50-70% HRpeak (n = 34, 38 min/session, 114 min/week); and iii) 1 × 4 min bout of HIIT at 85-95% HRpeak (n = 31, 17 min/session, 51 min/week). Cardiorespiratory fitness (peak oxygen uptake, V̇O₂peak) was determined via indirect calorimetry during maximal exercise testing and fatness was the ratio of waist circumference-to-height (WtHR). FFI was calculated as V̇O₂peak in metabolic equivalents (METs) divided by WtHR. A clinically meaningful response to the exercise intervention was taken as a 1 FFI unit increase.

RESULTS: Seventy-seven participants completed pre and post testing to determine FFI. While there was no significant between group difference (p = 0.30), there was a small group x time interaction effect on FFI [F(2, 73) = 1.226; η² = 0.01], with numerically greater improvements following HIIT (4HIIT, + 16%; 1HIIT, + 11%) relative to MICT (+ 7%). There was a greater proportion of participants who had a clinically meaningful change in FFI following high-volume HIIT (60%, 15/25) and low-volume HIIT (65%, 17/26) compared to MICT (38%, 10/26), but with no significant between-group difference (p = 0.12). A similar trend was found when a sub-analysis comparing the FFI between those with type 2 diabetes (MICT, 33%, 3/9; high-volume HIIT, 64%, 7/11; and low-volume HIIT, 58%, 7/12) and without type 2 diabetes (MICT, 41%, 7/17; high-volume HIIT, 57%, 8/14; low-volume HIIT, 71%, 10/14).

CONCLUSION: Although there were no statistically significant differences detected between groups, this study suggests that the response to changes in FFI in adults with MetS may be affected by exercise intensity, when numerical differences between exercise groups are considered. Further research is warranted. Trial registration number and date of registration: ClinicalTrials.gov NCT01676870; 31/08/2012.

PMID:34951682 | DOI:10.1186/s40798-021-00395-7