Tag: pubmed

JAMA Neurol. 2022 Oct 3. doi: 10.1001/jamaneurol.2022.3094. Online ahead of print.

ABSTRACT

IMPORTANCE: Patients with dementia may be at an increased suicide risk. Identifying groups at greatest risk of suicide would support targeted risk reduction efforts by clinical dementia services.

OBJECTIVES: To examine the association between a dementia diagnosis and suicide risk in the general population and to identify high-risk subgroups.

DESIGN, SETTING, AND PARTICIPANTS: This was a population-based case-control study in England conducted from January 1, 2001, through December 31, 2019. Data were obtained from multiple linked electronic records from primary care, secondary care, and the Office for National Statistics. Included participants were all patients 15 years or older and registered in the Office for National Statistics in England with a death coded as suicide or open verdict from 2001 to 2019. Up to 40 live control participants per suicide case were randomly matched on primary care practice and suicide date.

EXPOSURES: Patients with codes referring to a dementia diagnosis were identified in primary care and secondary care databases.

MAIN OUTCOMES AND MEASURES: Odds ratios (ORs) were estimated using conditional logistic regression and adjusted for sex and age at suicide/index date.

RESULTS: From the total sample of 594 674 patients, 580 159 (97.6%) were controls (median [IQR] age at death, 81.6[72.0-88.4] years; 289 769 male patients [50.0%]), and 14 515 (2.4%) died by suicide (median [IQR] age at death, 47.4 [36.0-59.7] years; 10 850 male patients [74.8%]). Among those who died by suicide, 95 patients (1.9%) had a recorded dementia diagnosis (median [IQR] age at death, 79.5 [67.1-85.5] years; median [IQR] duration of follow-up, 2.3 [1.0-4.4] years). There was no overall significant association between a dementia diagnosis and suicide risk (adjusted OR, 1.05; 95% CI, 0.85-1.29). However, suicide risk was significantly increased in patients diagnosed with dementia before age 65 years (adjusted OR, 2.82; 95% CI, 1.84-4.33), in the first 3 months after diagnosis (adjusted OR, 2.47; 95% CI, 1.49-4.09), and in patients with dementia and psychiatric comorbidity (adjusted OR, 1.52; 95% CI, 1.21-1.93). In patients younger than 65 years and within 3 months of diagnosis, suicide risk was 6.69 times (95% CI, 1.49-30.12) higher than in patients without dementia.

CONCLUSIONS AND RELEVANCE: Diagnostic and management services for dementia, in both primary and secondary care settings, should target suicide risk assessment to the identified high-risk groups.

PMID:36190708 | DOI:10.1001/jamaneurol.2022.3094

JAMA Pediatr. 2022 Oct 3. doi: 10.1001/jamapediatrics.2022.3611. Online ahead of print.

ABSTRACT

IMPORTANCE: There is limited evidence for therapeutic options for pediatric COVID-19 outside of multisystem inflammatory syndrome in children (MIS-C).

OBJECTIVE: To determine whether the use of steroids within 2 days of admission for non-MIS-C COVID-19 in children is associated with hospital length of stay (LOS). The secondary objective was to determine their association with intensive care unit (ICU) LOS, inflammation, and fever defervescence.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed data retrospectively for children (<18 years) who required hospitalization for non-MIS-C COVID-19. Data from March 2020 through September 2021 were provided by 58 hospitals in 7 countries who participate in the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) COVID-19 registry.

EXPOSURE: Administration of steroids within 2 days of admission.

MAIN OUTCOMES AND MEASURES: Length of stay in the hospital and ICU. Adjustment for confounders was done by mixed linear regression and propensity score matching.

RESULTS: A total of 1163 patients met inclusion criteria and had a median (IQR) age of 7 years (0.9-14.3). Almost half of all patients (601/1163, 51.7%) were male, 33.8% (392/1163) were non-Hispanic White, and 27.9% (324/1163) were Hispanic. Of the study population, 184 patients (15.8%) received steroids within 2 days of admission, and 979 (84.2%) did not receive steroids within the first 2 days. Among 1163 patients, 658 (56.5%) required respiratory support during hospitalization. Overall, patients in the steroids group were older and had greater severity of illness, and a larger proportion required respiratory and vasoactive support. On multivariable linear regression, after controlling for treatment with remdesivir within 2 days, country, race and ethnicity, obesity and comorbidity, number of abnormal inflammatory mediators, age, bacterial or viral coinfection, and disease severity according to ICU admission within first 2 days or World Health Organization ordinal scale of 4 or higher on admission, with a random intercept for the site, early steroid treatment was not significantly associated with hospital LOS (exponentiated coefficient, 0.94; 95% CI, 0.81-1.09; P = .42). Separate analyses for patients with an LOS of 2 days or longer (n = 729), those receiving respiratory support at admission (n = 286), and propensity score-matched patients also showed no significant association between steroids and LOS. Early steroid treatment was not associated with ICU LOS, fever defervescence by day 3, or normalization of inflammatory mediators.

CONCLUSIONS AND RELEVANCE: Steroid treatment within 2 days of hospital admission in a heterogeneous cohort of pediatric patients hospitalized for COVID-19 without MIS-C did not have a statistically significant association with hospital LOS.

PMID:36190706 | DOI:10.1001/jamapediatrics.2022.3611

JAMA Pediatr. 2022 Oct 3. doi: 10.1001/jamapediatrics.2022.3456. Online ahead of print.

ABSTRACT

IMPORTANCE: The risk and benefits of COVID-19 vaccination during pregnancy are under investigation. Pooled evidence regarding neonatal and maternal outcomes in association with COVID-19 vaccination during pregnancy is scarce.

OBJECTIVE: To evaluate the association between COVID-19 vaccination during pregnancy and peripartum outcomes.

DATA SOURCES: PubMed and EMBASE databases were searched on April 5, 2022. Language restrictions were not applied.

STUDY SELECTION: Prospective trials and observational studies comparing the individuals who received at least 1 COVID-19 vaccination during pregnancy with those who did not and reporting the neonatal outcomes, including preterm birth, small for gestational age, low Apgar score, neonatal intensive care units (NICU) admission, and intrauterine fetal death (IFD).

DATA EXTRACTION AND SYNTHESIS: Two independent investigators extracted relevant data from each study. Odds ratios (ORs) were calculated using a random-effects model. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines.

MAIN OUTCOMES AND MEASURES: The primary outcomes were the neonatal outcomes, including preterm birth, small for gestational age, low Apgar score, NICU admission, and IFD. The secondary outcomes were maternal outcomes, including maternal SARS-CoV-2 infection, cesarean delivery, postpartum hemorrhage, and chorioamnionitis.

RESULTS: Nine observational studies involving 81 349 vaccinated (mean age, 32-35 years) and 255 346 unvaccinated individuals during pregnancy (mean age, 29.5-33 years) were included. COVID-19 vaccination during pregnancy was associated with lower risk of NICU admission (OR, 0.88; 95% CI, 0.80-0.97) and IFD (OR, 0.73; 95% CI, 0.57-0.94), whereas there was no statistically significant association with preterm birth (OR, 0.89; 95% CI, 0.76-1.04), small for gestational age (OR, 0.99; 95% CI, 0.94-1.04), and low Apgar score (OR, 0.94; 95% CI, 0.87-1.02). COVID-19 vaccination during pregnancy was associated with a lower risk of maternal SARS-CoV-2 infection (OR, 0.46; 95% CI, 0.22-0.93), whereas it was not associated with increased risk of cesarean delivery (OR, 1.05; 95% CI, 0.93-1.20), postpartum hemorrhage (OR, 0.95; 95% CI, 0.83-1.07), and chorioamnionitis (OR, 0.95; 95% CI, 0.83-1.07).

CONCLUSIONS AND RELEVANCE: COVID-19 vaccination during pregnancy was not associated with an increase in the risk of peripartum outcomes, was associated with a decreased risk of NICU admission, IFD, and maternal SARS-CoV-2 infection. Thus, COVID-19 vaccination should be encouraged for pregnant individuals.

PMID:36190704 | DOI:10.1001/jamapediatrics.2022.3456

Mol Neurobiol. 2022 Oct 3. doi: 10.1007/s12035-022-03054-4. Online ahead of print.

ABSTRACT

Schizophrenia (SZ) is a mental disorder with a strong genetic basis as well as epigenetic aspects. Siblings of patients with SZ can share certain endophenotypes with the patients, suggesting that siblings may be important for distinguishing between trait and state markers. In the current study, we aimed to characterize the balance between pro-BDNF/mature BDNF and its receptors p75NTR/TrkB, which are tPA-BDNF pathways proteins and are thought to play a role in synaptic pruning, as a possible endophenotype of schizophrenia. Forty drug-naïve patients with first-episode psychosis (FEP) matched for age, gender, and level of education, 40 unaffected siblings (UAS) of patients with FEP, and 67 healthy controls (HC) were included in the study. Blood samples were collected from all participants to determine BDNF, pro-BDNF, TrkB and p75NTR, PAI1, tPA, ACTH, and cortisol levels. We showed that levels of proteins of the tPA-BDNF pathway as well as the pro-BDNF/m-BDNF and p75NTR/TrkB ratios could successfully differentiate FEP and their siblings from the HCs by using ROC analysis. Plasma levels of m-BDNF were found to be the lowest in the healthy siblings and highest in the HCs with statistically significant differences between all 3 groups. The plasma level of pro-BDNF in the HC group was similar to the FEP patients, the same in the healthy siblings of the FEP patients. Our data support the hypothesis that imbalance between neurotrophic and apoptotic proteins might occur in SZ and this imbalance could be an endophenotype of the disease.

PMID:36190691 | DOI:10.1007/s12035-022-03054-4

J Magn Reson Imaging. 2022 Aug 17. doi: 10.1002/jmri.28391. Online ahead of print.

ABSTRACT

BACKGROUND: Dual-phenotype hepatocellular carcinoma (DPHCC) is highly aggressive and difficult to distinguish from hepatocellular carcinoma (HCC).

PURPOSE: To develop and validate clinical and radiomics models based on contrast-enhanced MRI for the preoperative diagnosis of DPHCC.

STUDY TYPE: Retrospective.

POPULATION: A total of 87 patients with DPHCC and 92 patients with non-DPHCC randomly divided into a training cohort (n = 125: 64 non-DPHCC; 61 DPHCC) and a validation cohort (n = 54: 28 non-DPHCC; 26 DPHCC).

FIELD STRENGTH/SEQUENCE: A 3.0 T; dynamic contrast-enhanced MRI with time-resolved T1-weighted imaging sequence.

ASSESSMENT: In the clinical model, the maximum tumor diameter and hepatitis B virus (HBV) were independent risk factors of DPHCC. In the radiomics model, a total of 1781 radiomics features were extracted from tumor volumes of interest (VOIs) in the arterial phase (AP) and portal venous phase (PP) images. For feature reduction and selection, Pearson correlation coefficient (PCC) and recursive feature elimination (RFE) were used. Clinical, AP, PP, and combined radiomics models were established using machine learning algorithms (support vector machine [SVM], logistic regression [LR], and logistic regression-least absolute shrinkage and selection operator [LR-LASSO]) and their discriminatory efficacy assessed and compared.

STATISTICAL TESTS: The independent sample t test, Mann-Whitney U test, Chi-square test, regression analysis, receiver operating characteristic curve (ROC) analysis, Pearson correlation analysis, the Delong test. A P value < 0.05 was considered statistically significant.

RESULTS: In the validation cohort, the combined radiomics model (area under the curve [AUC] = 0.908, 95% confidence interval [CI]: 0.831-0.985) showed the highest diagnostic performance. The AUCs of the PP (AUC = 0.879, 95% CI: 0.779-0.979) and combined radiomics models were significantly higher than that of clinical model (AUC = 0.685, 95% CI: 0.526-0.844). There were no significant differences in AUC between AP or PP radiomics model and combined radiomics model (P = 0.286, 0.180 and 0.543).

CONCLUSION: MRI radiomics models may be useful for discriminating DPHCC from non-DPHCC before surgery.

EVIDENCE LEVEL: 4 TECHNICAL EFFICACY: Stage 2.

PMID:36190656 | DOI:10.1002/jmri.28391

J Clin Psychol Med Settings. 2022 Oct 3. doi: 10.1007/s10880-022-09912-6. Online ahead of print.

ABSTRACT

American Indian (AI) mothers experience high rates of postpartum depression (PPD). We evaluated the factor structure of the Edinburgh Postnatal Depression Scale (EPDS) among AI mothers from a rural AI serving health system. We also investigated potential associations between EPDS scores and selected psychosocial factors (n = 315). Exploratory Factor Analysis (n = 157) showed that a one-factor structure best fits the data. A Confirmatory Factor Analysis was then conducted to examine the fit of the one-factor model (n = 158). Goodness-of-fit statistics showed overall poor model fit (RMSEA = .13) which may be suggestive of an indicator of depression among Natives not detected by the EPDS. Results of the multiple regression analysis were non-significant. The findings demonstrated that while the EPDS measured aspects of PPD, there may be additional aspects of depression specific to the AI women in our sample not captured by the EPDS. Limitations and directions for future research are discussed.

PMID:36190607 | DOI:10.1007/s10880-022-09912-6

Environ Monit Assess. 2022 Oct 3;194(12):847. doi: 10.1007/s10661-022-10489-8.

ABSTRACT

The present study aims to estimate the effects of PM_2.5 on the health and economy of Karaj city from 2012 to 2019. In this study, mortality attributed to long-term exposure to PM_2.5 and its spatial distribution in Karaj over the 2012-2019 period were estimated using the Global Exposure Mortality Model (GEMM) concentration-response function and BenMAP software. PM_2.5 hourly concentration data of air quality monitoring stations were used to estimate PM_2.5 for the whole city of Karaj. The economic effects of this pollutant were also assessed using the value of statistical life (VSL) method. The results showed that the annual average PM_2.5 concentration during the studied time increased and was higher than the air quality guideline levels recommended by the World Health Organization. Also, the annual number of deaths attributed to PM_2.5 in adults (older than 25 years) was estimated to be about 1200. The highest to lowest proportions of PM_2.5-related deaths were non-accidental mortality, ischemic heart attack, stroke, acute respiratory tract infection, chronic obstructive pulmonary disease (COPD), and lung cancer, in the order of their appearance. The results showed that the economic loss attributed to this pollutant was estimated at 380 to 504 million USD per year. Due to the effects of PM_2.5 on health and the economy in this city, we suggest conducting special planning to control and reduce the concentration of ambient air particulate matter by improving the public transportation system and updating industrial processes.

PMID:36190572 | DOI:10.1007/s10661-022-10489-8

Brain Struct Funct. 2022 Oct 3. doi: 10.1007/s00429-022-02573-z. Online ahead of print.

ABSTRACT

To systematically analyse and discuss whether suppressive heterogeneous brain tumours (BTs) belong to a common brain network and provide a theoretical basis for identifying BT patients with a high risk of depression and select therapeutic targets for clinical treatment. The PubMed database was systematically searched to obtain relevant case reports, and lesion locations were manually traced to standardised brain templates according to ITK-SNAP descriptive literature. Resting-state functional magnetic resonance imaging data sets were collected from 1,000 healthy adults aged 18-35 years. Each lesion location or functional connectivity area of the lesion network. Connectivity analysis was performed in an MN152 space, and Fisher z-transformation was applied to normalise the distribution of each value in the functional connectivity correlation map, and T maps of each tumour location network were calculated with the T score of individual voxels. This T score indicates the statistical significance of voxelwise connectivity at each tumour location. The lesion networks were thresholded at T = 7, creating binarised maps of brain regions connecting tumour locations, overlaying network maps to identify tumour-sensitive hubs and also assessing specific hubs with other conditional controls. A total of 18 patients describing depression following focal BTs were included. Of these cases, it was reported that depression-related tumours were unevenly distributed in the brain: 89% (16/18) were positively correlated with the left striatum, and the peak of the left striatum lesion network continuously overlapped. The depression-related tumour location was consistent with the tumour suppressor network (89%). These results suggest that sensitive hubs are aligned with specific networks, and specific hubs are aligned with sensitive networks. Brain tumour-related depression differs from acute lesion-related depression and may be related to the mapping of tumours to depression-related brain networks. It can provide an observational basis for the neuroanatomical basis of BT-related depression and a theoretical basis for identifying patients with BTs at high risk of depression and their subsequent clinical diagnosis and treatment.

PMID:36190539 | DOI:10.1007/s00429-022-02573-z

Int Orthop. 2022 Oct 3. doi: 10.1007/s00264-022-05591-y. Online ahead of print.

ABSTRACT

PURPOSE: This study compared the clinical and radiologic results of reverse shoulder arthroplasty (RSA) using either the subscapularis-sparing deltopectoral approach (SSDA) or traditional deltopectoral approach (TDA) in cuff tear arthropathy patients.

MATERIALS AND METHOD: We retrospectively evaluated 71 patients who underwent RSA for cuff tear arthropathy between July 2014 and December 2018. Patients were divided into two groups according to the surgical approach: TDA (34 cases) and SSDA (37 cases). The mean patient age was 78.6 years, and the mean (range) follow-up period was 23.5 (12-48) months. Clinical results were assessed using the Visual Analogue pain Scale (VAS), American Shoulder and Elbow Surgeon score (ASES), Korean Shoulder Scoring System (KSS), and Constant score. Radiographic indicators prosthesis-scapular neck angle (PSNA), peg-glenoid rim distance (PGRD), inferior overhang, acromion-greater tuberosity (AT) distance, and glenoid-greater tuberosity (GT) distance) were assessed, and notching severity was assessed according to the Nerot-Sirveaux classification.

RESULTS: The radiographic indicator results of the TDA and SSDA groups were as follows: PSNA (131.4° ± 17.2°, 136.1° ± 7.7°), PGRD (18.7 mm ± 2.9 mm, 21.4 mm ± 2.0 mm), AT distance (38.3 mm ±6.9 mm, 37.5 mm ± 6.8 mm), GT distance (51.6 mm ± 6.3 mm, 51.4 mm ± 5.3 mm), and inferior overhang (4.4 mm ± 2.2 mm, 2.9 mm ± 1.3 mm). PGRD and inferior overhang showed statistically significant differences between groups, but the clinical results showed no significant differences. There were no complications such as neurovascular injury, implant loosening, surgical site infection, or acromion fracture in either group.

CONCLUSION: SSDA for RSA showed no significant differences in clinical and radiological results compared with TDA. Therefore, SSDA is a viable alternative for RSA in cuff tear arthropathy.

PMID:36190532 | DOI:10.1007/s00264-022-05591-y

Eur Radiol. 2022 Oct 3. doi: 10.1007/s00330-022-09146-y. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate image quality and diagnostic confidence improvement using a thin slice and a deep learning image reconstruction (DLIR) in contrast-enhanced abdominal CT.

METHODS: Forty patients with hepatic lesions in enhanced abdominal CT were retrospectively analyzed. Images in the portal phase were reconstructed at 5 mm and 1.25 mm slice thickness using the 50% adaptive statistical iterative reconstruction (ASIR-V) (ASIR-V50%) and at 1.25 mm using DLIR at medium (DLIR-M) and high (DLIR-H) settings. CT number and standard deviation of the hepatic parenchyma, spleen, portal vein, and subcutaneous fat were measured, and contrast-to-noise ratio (CNR) was calculated. Edge-rise-slope (ERS) was measured on the portal vein to reflect spatial resolution and the CT number skewness on liver parenchyma was calculated to reflect image texture. Two radiologists blindly assessed the overall image quality including subjective noise, image contrast, visibility of small structures using a 5-point scale, and object sharpness and lesion contour using a 4-point scale.

RESULTS: For the 1.25-mm images, DLIR significantly reduced image noise, improved CNR and overall subjective image quality compared to ASIR-V50%. Compared to the 5-mm ASIR-V50% images, DLIR images had significantly higher scores in the visibility and contour for small structures and lesions; as well as significantly higher ERS and lower CT number skewness. At a quarter of the signal strength, the 1.25-mm DLIR-H images had a similar subjective noise score as the 5-mm ASIR-V50% images.

CONCLUSION: DLIR significantly reduces image noise and maintains a more natural image texture; image spatial resolution and diagnostic confidence can be improved using thin slice images and DLIR in abdominal CT.

KEY POINTS: • DLIR further reduces image noise compared with ASIR-V while maintaining favorable image texture. • In abdominal CT, thinner slice images improve image spatial resolution and small object visualization but suffer from higher image noise. • Thinner slice images combined with DLIR in abdominal CT significantly suppress image noise for detecting low-density lesions while significantly improving image spatial resolution and overall image quality.

PMID:36190531 | DOI:10.1007/s00330-022-09146-y