Tag: pubmed

Disaster Med Public Health Prep. 2022 Mar 25:1-7. doi: 10.1017/dmp.2022.42. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective was to describe a feasible, multidisciplinary pediatric mass casualty event (MCE) simulation format that was less than 2 h within emergency department space and equipment constraints.

METHODS: This was a prospective cohort study of an MCE in situ simulation program from June-October 2019. Participants rotated through 3 modules: (1) triage, (2) caring for a critical patient in an MCE setting, and (3) being in a disaster leadership role. Triage accuracy, knowledge, self-evaluation of preparedness, and MCE skills by means of pre- and post-test surveys were measured. Wilcoxon matched pairs signed rank test scores and McNemar’s matched pair chi-squared test were performed to evaluate for statistically significant differences.

RESULTS: Forty-six physicians (MD), 1 physician’s assistant (PA), and 22 nurses participated over 4 simulation d. Among the MD/PA group, there was a statistically significant 7% knowledge increase (95% confidence interval [CI], 3%-11%). Nurses did not show a statistically significant knowledge difference (0.04, 95% CI, 0.04%, 14%). There was a statistically significant increase in triage and resource use preparedness (P < 0.01) for all participants.

CONCLUSION: This efficient, feasible model for a multidisciplinary ED disaster drill provides a multi-modular exposure while improving both MD and PA knowledge and all staff preparedness for MCE.

PMID:35332862 | DOI:10.1017/dmp.2022.42

Arch Esp Urol. 2022 Mar;75(2):95-102.

ABSTRACT

OBJECTIVE: The aim of this article is to review and illustrate the attributes that analyze the performance of a predictive model, suchas discrimination, calibration and clinical utility.

MATERIAL AND METHODS: To illustrate a biomarkervalidation process, we analyzed 216 patientsrecruited in the Miguel Servet University Hospital Zaragoza, Spain. The outcome of the study was clinicallysignificant prostate cancer (Gleason ≥ 7). A newbiomarker was built using logistic regression modelfrom age, prostate-specific antigen, prostate volumeand digital rectal exam variables. To analyze the discriminationability, the receiver operating characteristiccurve, its area under the curve (AUC), and Youdenindex were estimated. In addition, the calibration wasanalyzed through calibration curve, intercept and slope;and the clinical utility was studied by means of decisionand clinical utility curves.

RESULTS: The discrimination ability was good:AUC 0.790 (0.127-0.853 95% C.I.), Youden index cutoffpoint 0.431 (specificity 0.811, sensitivity 0.697).The Intercept was 0 and Slope 1 showing a perfect calibration.Decision curve showed good net benefit in athreshold probability range 25%-80%. Clinical utilitycurve showed that for a 18% cutoff point, a minimum4.5% of CsPCa patients are wrongly classified belowthe cutoff point, saving 18.5% biopsies.

CONCLUSIONS: A complete validation process isnecessary to analyze the performance of a biomarkerin oncology, based on their discrimination ability, theconcordance between predicted and actual occurrenceof the outcome, and its applicability in clinical practice.

PMID:35332878

Semin Cardiothorac Vasc Anesth. 2022 Mar 25:10892532221080382. doi: 10.1177/10892532221080382. Online ahead of print.

ABSTRACT

INTRODUCTION: This study aimed to investigate whether mortality following cardiac surgery was associated with the pulmonary artery pulsatility index (PAPi): pulmonary artery pulse pressure divided by central venous pressure (CVP), and a novel index: mean pulmonary artery pressure (mPAP) minus CVP.

METHODS: This retrospective analysis investigated all cardiac surgery patients in the Society of Thoracic Surgeons registry at a single academic medical center from January 2017 through March 2020 (n = 1510). The primary and secondary outcomes were mortality at 1 year and serum creatinine increase during index surgical admission, respectively. CVP, mPAP, PAPi, mPAP-CVP gradient, mean arterial pressure (MAP), and cardiac index (CI) were sampled continually from invasive hemodynamic monitors post-operatively. Associations with mortality were tested with univariate and multivariate analyses. The relationship with serum creatinine was investigated with Pearson’s correlation at alpha = .05.

RESULTS: One-year mortality was observed in 44/1200 patients (3.7%). On univariate analysis, mortality was associated with minimums for mPAP, MAP, and CI and maximums for CVP, mPAP, PAPi, mPAP-CVP gradient, and CI (all P < .10). Model selection revealed that the only independently predictive parameters were minimum MAP (AOR = .880 [.819-.944]), maximum mPAP-CVP gradient (AOR = 1.082 [1.031-1.133]), and maximum CI (AOR = 1.421 [.928-2.068]), with model c-statistic = .770. A maximum mPAP-CVP gradient >20.5 predicted mortality with 54.5% sensitivity and 79.30% specificity, maintaining significance on survival analysis (P < .001). Peak increase in serum creatinine from baseline demonstrated a weak association with all parameters (max |r| = .33).

CONCLUSIONS: Mortality was not predicted by the post-operative PAPi; rather, it was independently predicted by the mPAP-CVP gradient, MAP, and CI.

PMID:35332827 | DOI:10.1177/10892532221080382

Biofouling. 2022 Mar 25:1-10. doi: 10.1080/08927014.2022.2056032. Online ahead of print.

ABSTRACT

This study sought to evaluate the physical and antimicrobial properties of a thermopolymerizable acrylic resin (PMMA) modified with metallic methacrylate monomers -zirconia (ZM), tin (TM), and di-n-butyl (DNTMB) methacrylates. Color stability was evaluated before and after immersion of samples in a staining solution by a digital spectrophotometer. The mechanical brushing test was evaluated by the roughness test. The flexural strength test used a mechanical testing machine. Human keratinocytes were used to assess cell viability and the biofilm formation assay was carried out for 5 days, in a microcosms model after one year of specimen storage. For statistical analysis, the method chosen was based on adherence to the normal distribution model and equality of variances (p < 0.05). The addition of DNTMB to PMMA promoted great antimicrobial action, acceptable cytocompatibility, without hampering the physical-mechanical properties of the commercial material. Therefore, the modified PMMA proved to be a promisor alternative to conventional resins.This study sought to evaluate the physical and antimicrobial properties of a thermopolymerizable acrylic resin (PMMA) modified with metallic methacrylate monomers -zirconia (ZM), tin (TM), and di-n-butyldimethacrylate-tin (DNTMB) methacrylates. Color stability was evaluated before and after immersion of samples in a staining solution using a digital spectrophotometer. The mechanical brushing test was evaluated by the roughness test. The flexural strength test used a mechanical testing machine. Human keratinocytes were used to assess cell viability and the biofilm formation assay was carried out for 5 days in a microcosm model after one year of specimen storage. For statistical analysis, the method chosen was based on adherence to the normal distribution model and equality of variances (p < 0.05). The addition of DNTMB to PMMA promoted great antimicrobial action, acceptable cytocompatibility, without hampering the physical-mechanical properties of the commercial material. Therefore, the modified PMMA proved to be a promising alternative to conventional denture base resins for dental use.

PMID:35332825 | DOI:10.1080/08927014.2022.2056032

Cephalalgia. 2022 Mar 25:3331024221089567. doi: 10.1177/03331024221089567. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine changes in the occurrence, severity, and symptoms of headache episodes in patients with chronic migraine following eptinezumab treatment.

METHODS: PROMISE-2 was a double-blind, placebo-controlled, parallel-group trial that randomized adults with chronic migraine to eptinezumab 100 mg, 300 mg, or placebo IV every 12 weeks for up to 24 weeks (2 infusions). Headache episodes (migraine and non-migraine) and their characteristics were reported in daily electronic diaries during the 28-day baseline and throughout the 24-week treatment period.

RESULTS: A total of 1072 patients were included in this post hoc analysis. Mean monthly headache days decreased by 8.9 (100 mg) and 9.7 (300 mg) compared to a 7.3 decrease in placebo over the first 4-week interval post initial dose and reductions were maintained throughout the 24-week treatment period. Mean monthly headache episodes also decreased by 8.4 (100 mg) and 9.0 (300 mg) compared to a decrease of 7.1 with placebo. The proportion of headache episodes that were migraine attacks decreased by 11.2% (100 mg), 12.4% (300 mg), and 3.9% (placebo), and among remaining headaches decreases in severe pain, nausea, phonophobia, photophobia, and physical activity limitations were numerically greater than placebo.

CONCLUSIONS: Patients with chronic migraine treated with eptinezumab decreased the monthly severity and frequency of headache days and episodes more than placebo. Beyond decreased headache frequency, patients treated with eptinezumab reported a reduction in the percent of remaining headache episodes that were migraine attacks, as well as a decrease in burdensome symptoms of headache episodes, indicating additional decreased headache severity after eptinezumab treatment.Trial registration: ClinicalTrials.gov Identifier: NCT02974153; registered November 23, 2016.

PMID:35332807 | DOI:10.1177/03331024221089567

Toxicol Ind Health. 2022 Mar 25:7482337221086133. doi: 10.1177/07482337221086133. Online ahead of print.

ABSTRACT

Benzyl benzoate (BB), one of the benzyl derivates, is a component of brown aromatic resin in cinnamon oil and cough syrups and it is widely used in various fields in the perfume, pharmaceutical, and food industries. It is absorbed and hydrolyzed to benzoic acid and benzyl alcohol. Two different doses of BB (25 mg kg-1 body weight and 100 mg kg-1 body weight) were orally administered to 5-week old male rats for 90 days. Histopathological, morphological, hematological, and biochemical assays were performed in toxicological evaluations. Initial/final body weights, relative organ weights, and food and water consumptions of rats did not change significantly. There were statistically significant differences in terms of monocyte, neutrophil, lymphocyte %, and serum AST levels in control and BB treatment groups. Several histopathological findings were observed in liver, kidney, thymus, prostate, and epididymis tissues of the rats in the treatment groups. Immunohistochemical examinations were also performed in the tissues for fibronectin (FN), type IV collagen, transforming growth factor β (TGF-β), matrix metalloproteinase-2 (MMP-2), and tissue inhibitor of metalloproteinase-2 (TIMP-2). Alterations in immunolocalization of these markers were observed between the control and the treatment groups. No changes were detected in the sperm count, daily sperm production, and sperm morphology.

PMID:35332820 | DOI:10.1177/07482337221086133

Future Oncol. 2022 Mar 25. doi: 10.2217/fon-2021-1633. Online ahead of print.

ABSTRACT

Aim: To compare pembrolizumab with competing interventions for previously untreated, unresectable or metastatic microsatellite instability-high or mismatch repair-deficient colorectal cancer. Method: Trials were identified via a systematic literature review and synthesized using a Bayesian network meta-analysis with time-varying hazard ratios (HRs). Results: Using intention-to-treat data, HRs for overall survival were generally in favor of pembrolizumab but not statistically significant; however, statistical significance was reached versus all comparators by month 16 when accounting for crossover. Estimated HRs for progression-free survival significantly favored pembrolizumab versus all comparators by month 12. Pembrolizumab was also superior to all comparators in terms of grade ≥3 adverse events. Conclusion: These analyses suggest that pembrolizumab is a highly efficacious and safe treatment in this population.

PMID:35332802 | DOI:10.2217/fon-2021-1633

J Public Health Res. 2022 Mar 25;11(2). doi: 10.4081/jphr.2022.2748.

ABSTRACT

BACKGROUND: The outbreak of a novel coronavirus, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), or COVID-19, raised worldwide concern. The present study investigates the association between anti-contagion policies and the spread of COVID-19 across the United States.

DESIGN AND METHODS: We selected the most frequently implemented COVID-19 anti-contagion policies in all the U.S. states issued from 29 February 2020. Accordingly, we modified an epidemiological model and combined it with a comprehensive statistical analysis to evaluate the policies’ individual and overall likely impact.

RESULTS: For the first time, a novel index, evaluates the associations between policy implementation and COVID-19 spread at both statewide and national levels. Our results indicate that governmental policies requiring mask use, businesses social distancing, and quarantining travelers may be most effective for controlling COVID-19 spread. Simultaneously, widespread orders like school closure and safer-at-home that can be particularly disruptive to the economy and social fabric of society may be unnecessary given their lack of association with reducing infection.

CONCLUSIONS: The absence of any COVID-19 vaccines during the first several months of its pandemic necessitated using governmental policies to help stop the spread of this disease. Our index showed the association between implemented policies and COVID-19 spread, highlighting the specific policies with the greatest association – mandatory quarantine upon entering a state, businesses implementing social distancing, and mandatory mask use – and those with less association like school closure and safer-at-home orders. This study provided evidence to inform policy choices for the current global crisis and future pandemics.

PMID:35332753 | DOI:10.4081/jphr.2022.2748

Sichuan Da Xue Xue Bao Yi Xue Ban. 2022 Mar;53(2):321-326. doi: 10.12182/20220360206.

ABSTRACT

OBJECTIVE: To explore the treatment outcome of the strategy of early extubation and then switching to non-invasive mechanical ventilation in children with acute respiratory failure, and the safety and feasibility of using the strategy to replace traditional methods.

METHODS: A total of 102 children, aged between 1 month to 14 years old, who had acute respiratory failure and were admitted to the pediatric ICU of West China Second University Hospital, Sichuan University between January 2019 and December 2020 were enrolled and randomly assigned to treatment group 1 (n=55) and treatment group 2 (n=47). In addition, 53 children who had the same condition in the 12 month prior to the beginning of the study were included in the control group. In the two treatment groups, the patients were extubated first, and then weaned off the ventilator. In group 1, when the patient met the invasive-non-invasive switching criteria, the tracheal tube was pulled out and non-invasive bi-level positive airway pressure (BiPAP) ventilation was used for respiratory support. In group 2, high-flow nasal cannula (HFNC) oxygen therapy was used for respiratory support. The traditional progressive weaning method was adopted for the control group (extubing and weaning were performed at the same time). The incidence of ventilator-associated pneumonia (VAP) during the period of tracheal intubation was compared and the mortality of the two groups was evaluated from the point when the patients were recruited. At the time of extubation in the treatment groups and extubation plus weaning in the control group, the pressure support levels, or PC above PEEP, intubation time, sequential time (between 2 treatment groups only), weaning failure rate, and the incidence of laryngeal edema and nasal pressure ulcer were compared.

RESULTS: The subjects of the study were predominantly infants (93 cases, 60%) and young children (31 cases, 20%). Among the 155 cases, 82 (53%) were male. There was no statistical difference in age distribution or gender among the groups. There was no significant difference in the clinical indicators among the three groups before tracheal intubation. At the time of extubation, the PC above PEEP in the two treatment groups was higher than that in the control group, and higher in group 1 than that of group 2, the difference being statistically significant (P<0.05). The intubation time of the two treatment groups was shorter than that of the control group, and shorter in group 1 than that of group 2 (P<0.05). The sequential time of group 2 was shorter than that of group 1 (P<0.05). The extubation failure rate and the incidence of VAP in the two treatment groups were lower than those in the control group, and there was no statistically significant difference between the two treatment groups. The incidence of nasal pressure ulcers in group 1 was higher than that in the other two groups (P<0.05). There was 1 death in treatment group 1, and no deaths in treatment group 2 or the control group. There was no significant difference in mortality or the incidence of laryngeal edema after extubation in the three groups.

CONCLUSION: Early extubation and then switching to non-invasive mechanical ventilation can be well tolerated by the patients, and can be used in clinical practice as an effective weaning method for children with acute respiratory failure.

PMID:35332737 | DOI:10.12182/20220360206

Clin Exp Dent Res. 2022 Mar 25. doi: 10.1002/cre2.561. Online ahead of print.

ABSTRACT

OBJECTIVES: The present study aims to describe the relationship between upper first molar roots and maxillary sinus, for the first time with a truly three-dimensional approach.

METHODS: From a retrospective cone-beam computed tomography (CBCT) sample of the upper jaw, a total of 105 upper first molars in contact with maxillary sinus from 74 patients (male 24, female 50, mean age 42) were included in the present study. Segmentation of the upper first molar and maxillary sinus in CBCT was performed utilizing a semiautomatic livewire segmentation tool in MeVisLab v.3.1. The segmentations were analyzed in 3-matic Medical 20.0 for root volume and the contact area between upper first molar roots and maxillary sinus. Analysis of variance test was applied to detect statistically significant differences between the roots.

RESULTS: The palatal root had the largest contact area with maxillary sinus 27.8 ± 21.4 mm² (20% of the root area) followed by the mesiobuccal 20.5 ± 17.9 mm² (17% of the root area) and distobuccal root 13.7 ± 12 mm² (14% of the root area). A significant difference in the contact area of the different roots of the upper first molar was seen.

CONCLUSIONS: This study showed that 70% of the upper first molars were in contact with the maxillary sinus. The palatal root had on average a fifth of its root surface in contact with the sinus, while for mesiobuccal this was a sixth of its root surface and distobuccal roots this was somewhat less. The true 3D relationship could help to better understand maxillary anatomy in relation to occurring pathologies and treatment planning in this area.

PMID:35332695 | DOI:10.1002/cre2.561