Tag: pubmed

ISA Trans. 2021 Nov 10:S0019-0578(21)00550-4. doi: 10.1016/j.isatra.2021.10.029. Online ahead of print.

ABSTRACT

This paper proposes the tuning approach of the event-triggered controller (ETCTA) for the robotic system stabilization task where the reduction of the stabilization error and the data broadcasting of the control update are simultaneously considered. This approach is stated as a dynamic optimization problem, and the best controller parameters are obtained by using fourteen different bio-inspired optimization algorithms. The statistics results reveal that, among the tested bio-inspired optimization algorithms, the most reliable algorithm in the proposed tuning problem is the differential evolution variant DE/Best/1/Exp. The obtained result is validated both in numerical simulation as well as using a laboratory prototype. The simulation results indicate that the obtained control parameters can also deal with disturbances and reference changes not considered in the ETCTA’s optimization problem formulation without significantly worsening the control design objective. Experimental results disclose that the proposed event-triggered control tuning approach provides the best trade-off between the number of control signal updates and the position error among other tuning approaches, decreasing the data broadcasting of the control update by around 86.33% with a non-significant increase in the stabilization error of around 26.53%.

PMID:34802703 | DOI:10.1016/j.isatra.2021.10.029

Mayo Clin Proc. 2021 Nov 18:S0025-6196(21)00624-8. doi: 10.1016/j.mayocp.2021.08.006. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate a potential association between beta-blocker exposure and survival in patients with transthyretin amyloid cardiomyopathy (ATTR-CM).

METHODS: In this real-world prospective registry of 128 consecutive patients with ATTR-CM recruited in 7 institutions in Galicia (Spain), survival of 65 patients who received beta blockers on registry enrollment was compared with that of 63 untreated controls by means of both unweighted Cox regression and Cox regression with inverse probability of treatment weighting. Tolerance to and adverse effects of beta blockers were recorded. Median study follow-up was 520 days.

RESULTS: Patients with ATTR-CM who received beta blockers showed statistically significant lower all-cause mortality than untreated controls as evaluated by either unweighted Cox regression (hazard ratio, 0.31; 95% CI, 0.12 to 0.79) or Cox regression with inverse probability of treatment weighting (hazard ratio, 0.18; 95% CI, 0.08 to 0.41; P<.001). Several sensitivity analyses confirmed the internal validity of these results. The overall frequency of beta-blocker suspension due to adverse effects was 25% (95% CI, 15.5% to 34.5%).

CONCLUSION: In this real-world, prospective, multi-institutional registry, patients with ATTR-CM who received beta blockers had lower all-cause mortality than untreated controls.

PMID:34802727 | DOI:10.1016/j.mayocp.2021.08.006

Int J Geriatr Psychiatry. 2021 Nov 21. doi: 10.1002/gps.5660. Online ahead of print.

ABSTRACT

OBJECTIVE: To estimate the incidence of dementia in a community-dwelling older population from São Paulo city, Brazil.

METHODS: /Design This two-phase prospective cohort study evaluated a representative cluster sample of 1,370 individuals aged 60 years old and over from three different socioeconomic levels. The community screening phase consisted of a tested combination of cognitive and functional tests administered among the subjects and informants. In the hospital diagnosis phase, the Cambridge Examination was performed; the diagnosis of dementia and dementia subtypes was made according to DSM IV criteria. Incidence rates were expressed in person-years, multiplied by 1,000. The risk of developing dementia was calculated using Cox regression.

RESULTS: Among 1,370 eligible subjects, 678 were accessed, and 489 completed the evaluation. Forty-two subjects were diagnosed with dementia. The incidence rate of dementia and Alzheimer’s disease (AD) were 11.2 (95% CI: 8.0 – 15.1) and 8.9 (95% CI: 6.1 – 12.5) per 1,000 person-years, respectively; there were high age-specific rates of dementia among younger individuals. There was a trend of a higher risk of developing AD for women than for men. Multivariate analysis showed that older age, the presence of diabetes and the presence of amnestic MCI increased the risk of developing dementia. Conclusions The age-specific rates in younger individuals were expressively higher than in worldwide studies and supposedly affected by cardiovascular morbidity. The higher risk in women in a younger sample corroborated the interaction between sex and AD. The increased risk of amnestic MCI reinforced its contribution to the progression to dementia and AD. This article is protected by copyright. All rights reserved.

PMID:34802177 | DOI:10.1002/gps.5660

J Med Radiat Sci. 2021 Nov 21. doi: 10.1002/jmrs.559. Online ahead of print.

ABSTRACT

INTRODUCTION: While studies have investigated influences on graduate practice locations of other health professionals, especially medicine, none have investigated practice locations of medical radiation science (MRS) graduates. This study aimed to explore factors influencing the registered principal place of practice (PPP) of diagnostic radiography, radiation therapy and nuclear medicine graduates from the University of Newcastle (UON), Australia, in their second post-graduate year.

METHODS: Data were extracted from the UON enrolment and clinical placement databases and linked to Australian Health Practitioners Regulation Agency (Ahpra) registration data for PPP location in 2019 for 187 graduates who completed their studies in 2017. Explanatory variables included age at enrolment, gender, MRS discipline, location of origin, socio-economic index for location of origin, and locations and duration of undergraduate professional placements. Descriptive statistics, tests of association and logistic regression compared rural and non-rural origin, and professional placement locations with Ahpra PPP.

RESULTS: Factors related to non-metropolitan PPP were location of origin (P = 0.002), number (P = 0.002) and duration (P = 0.007) of rural placements, and MRS discipline (P = 0.033). Controlling for other variables, location of origin and MRS discipline remained significant. Graduates of rural origin had up to 3.54 (95%CI = 1.51-8.28) times the odds of a rural PPP. Diagnostic radiography graduates had up to 5.46 (95%CI = 1.55-19.20) times the odds of nuclear medicine of a rural PPP.

CONCLUSION: To help reduce the gap between rural and metropolitan medical radiation service availability, there is a need for targeted recruitment of rural origin students. Further investigation of the effect of rural undergraduate MRS placements is justified.

PMID:34802192 | DOI:10.1002/jmrs.559

Vet Rec. 2021 Nov 21:e1118. doi: 10.1002/vetr.1118. Online ahead of print.

ABSTRACT

BACKGROUND: Little is published regarding topical NSAID effect on corneal healing in dogs. This retrospective cohort study aimed to compare healing times and complications in dogs with spontaneous chronic corneal epithelial defects (SCCED) treated with and without topical non-steroidal anti-inflammatory drugs (NSAID).

METHODS: Medical records of 66 dogs (71 eyes) diagnosed with SCCED between 2008 and 2019 were included. Eyes were divided into: (1) those receiving topical NSAIDs (n = 33) versus (2) those not receiving topical NSAID (n = 38). Follow-up until healed, such as comfortable eye, negative fluorescein stain was required. Use of topical or systemic anti-inflammatories outside of NSAID or presence of ocular disorders or systemic endocrinopathies that may contribute to delayed healing resulted in study exclusion.

RESULTS: Healing times were significantly longer in eyes that received topical NSAID (p = 0.008), however, the use of more topical medications for treatment was also associated with longer healing times (p = 0.001). The majority of eyes in the NSAID group received multiple medications, compared to the non-NSAID group, so it was not possible to separate the effects of NSAID from a number of medications. Complications occurred in three eyes of three dogs within the NSAID group.

CONCLUSIONS: In these canine SCCED eyes, the use of more topical medications, including NSAID, was associated with significantly delayed healing time.

PMID:34802145 | DOI:10.1002/vetr.1118

Arch Gynecol Obstet. 2021 Nov 21. doi: 10.1007/s00404-021-06331-0. Online ahead of print.

ABSTRACT

PURPOSE: To compare resected cone mass and resection margin status when performing Large Loop Excision of the Transformation Zone (LLETZ) using video colposcopy (LLETZ-VC) versus a headlight (LLETZ-HL) in women with cervical dysplasia.

METHODS: Prospective, randomised trial (monocentric) at a specialised cervical dysplasia unit in a University Hospital. Women with a biopsy-proven CIN2 + or persisting CIN1 or diagnostic LLETZ were recruited and randomised. LLETZ was performed either under video colposcopic vision or using a standard surgical headlight. The primary endpoint was resected cone mass. Secondary endpoints were the rate of involved margins, fragmentation of the specimen, procedure time, time to complete haemostasis (TCH), blood loss, pain, intra- and postoperative complications, and surgeon preference.

RESULTS: LLETZ-VC and LLETZ-HL (109 women each) had comparable cone masses (1.57 [0.98-2.37] vs. 1.67 [1.15-2.46] grams; P = 0.454). TCH was significantly shorter in the LLETZ-VC arm (60 [41-95.2] vs. 90 [47.2-130.2] seconds; P = 0.008). There was no statistically significant difference in involved resection margins (6/87 [6.5%] vs. 16/101 [13.7%], P = 0.068) and postoperative complications (13/82 [13.7%] vs. 22/72 [23.4%], P = 0.085). Patient-reported outcomes favoured LLETZ-VC with a lower use of analgesics (6/80 [7.0%] vs. 17/87 [16.3%]; P = 0.049). However, LLETZ-VC was more difficult to perform with significantly lower ratings for handling (7 [5-9] vs. 9 [8-10]; P < 0.001) and general satisfaction (7.5 [5-9] vs. 10 [8-10]; P < 0.001).

CONCLUSION: Intraoperative video colposcopy for LLETZ has minimal benefits at the cost of surgeons’ satisfaction.

CLINICAL TRIAL REGISTRATION: NCT04326049 (ClinicalTrials.gov).

PMID:34802113 | DOI:10.1007/s00404-021-06331-0

Eur Spine J. 2021 Nov 20. doi: 10.1007/s00586-021-07056-z. Online ahead of print.

ABSTRACT

BACKGROUND: Major lumbar spine surgery causes severe pain in the postoperative period. There are few studies regarding the effect of erector spinae plane block (ESPB) effect on lumbar surgery and its effect is still controversial. Therefore, the study aimed to investigate the effect of ultrasound-guided low thoracic ESPB on opioid consumption and postoperative pain score.

MATERIAL AND METHODS: Seventy-eight patients undergoing elective open lumbar spine surgery were randomized into two groups. In ESPB group (n = 35) received ultrasound-guided ESPB and in the control group (n = 35), there was no block. Postoperative opioid consumption as morphine equivalent dose, numerical rating scale, mobilization time, discharge time and side effects, bolus deliveries, rescue analgesia doses were evaluated.

RESULTS: Total opioid consumption as morphine equivalent was higher in the control group than the ESPB group (p = 0.000). Compare with the control group, the numeric rating scale scores were lower in the ESPB group at the 6th, 12th, and 24th hours (p < 0.05). The patient-controlled analgesia button pressing number in the postoperative 24-h period was lower in the ESPB group (p = 0.000). In the postoperative 24-h period, the need for paracetamol in the ESPB group was lower and the difference between the groups was statistically significant (p = 0.008). Rescue analgesia (diclofenac) doses were higher in the control group (p < 0.05). There was no statistically significant difference in terms of side effects and mobilization times.

CONCLUSION: ESPB is adequate for postoperative analgesia in patients undergoing lumbar spine surgery and can reduce opioid consumption compared with standard analgesia.

PMID:34802140 | DOI:10.1007/s00586-021-07056-z

Sleep Breath. 2021 Nov 20. doi: 10.1007/s11325-021-02528-4. Online ahead of print.

ABSTRACT

PURPOSE: To observe the effectiveness of preoperative drug-induced sleep endoscopy in improving surgical results of patients undergoing single-level barbed pharyngoplasty surgery for OSA, using a prospective randomized model.

METHODS: A single-center randomized controlled trial with two prospective arms was carried out to compare functional results in patients treated with barbed reposition pharyngoplasty (BRP) surgery without a preoperative drug-induced sleep endoscopy (DISE) evaluation vs patients treated with BRP surgery performed after DISE evaluation of sites/patterns of collapse.

RESULTS: We compared 50 patients who underwent BRP without a preoperative DISE evaluation (Group A) and 42 patients (Group B) treated with BRP surgery but preoperatively selected by means of a preoperative DISE. In this second group of patients, after DISE evaluation, 70% of patients were selected for single-level BRP surgery because they showed an isolated velopharyngeal collapse at the DISE evaluation, without obstruction at other upper airway levels evaluated. Both groups of patients showed a statistically significant difference between preoperative and postoperative values of AHI, ODI, and LOS (p<0.05 in all cases). Comparing Group A and Group B patients, the therapeutic success rate was found to be 60% in patients treated without preoperative DISE evaluation and 83% in patients treated with preoperative DISE (p = 0.02).

CONCLUSION: DISE appears to improve the surgical results of single-level velopharyngeal surgery due to the possibility of excluding patients with obstruction of the base of the tongue, the hypopharynx, and the epiglottis/larynx.

PMID:34802107 | DOI:10.1007/s11325-021-02528-4

Environ Sci Pollut Res Int. 2021 Nov 20. doi: 10.1007/s11356-021-17589-x. Online ahead of print.

ABSTRACT

Apnea is a common problem observed among obese individuals, affecting the quality of sleep and increasing cardiovascular risk and mortality. The current study monitored the risk of obstructive sleep apnea (OSA) following diet therapy and sports-associated diet therapy in patients with metabolic syndrome (MS) and hypothyroidism. The subjects included in the study were divided into 3 groups: control group (CG) (n=36), diet therapy group (DG) (including patients following a personalized diet therapy program) (n=76), and diet therapy and sports group (DSG) (which considered patients doing sports in addition to following a personalized diet therapy program) (n=80). The evaluation methods included body analysis (body mass index, fat mass, and visceral fat), paraclinical analysis (homeostasis model assessment of insulin resistance), assessment of difficulty in breathing, stress monitoring, hypothyroidism, and risk of OSA. The OSA index was assessed using the Berlin Questionnaire of Sleep Apnea and Epworth Sleepiness Scale. The correlation between OSA with body mass index (BMI), homeostasis model assessment of insulin resistance (HOMA-IR) index, fat mass, and visceral fat showed a statistically significant positive ratio (p<0.05; F=3.871). The obtained results indicated that diet therapy and physical activity reduced the OSA risk by 78.72%.

PMID:34802081 | DOI:10.1007/s11356-021-17589-x

Dysphagia. 2021 Nov 20. doi: 10.1007/s00455-021-10382-5. Online ahead of print.

ABSTRACT

Fluoroscopic barium swallow examinations are a commonly performed radiologic study in the evaluation of dysphagia. These studies remain essential in the diagnostic work-up despite the increasing utilization of endoscopy, but current residents are often less experienced with fluoroscopy. Structured reporting has been demonstrated to improve comprehensiveness of reports in multiple settings, but has not been evaluated for barium swallow examinations. A retrospective review identified patients who underwent barium swallow examinations pre-structured reporting in 2017 and followed a multidisciplinary proposal for and adoption of an optional structured report in 2020. Reports were assessed for comprehensiveness by evaluating presence/absence each element (total of 10 elements). Differences in report elements between groups and multiple subgroups was performed utilizing a Mann-Whitney U test. χ² tests were also utilized to evaluate inclusion of each individual element of the report. A total of 487 reports from 2020 and 757 reports from 2017 were analyzed. Certain elements showed substantial differences in reporting, with greater than 90% of structured reports including them, but much lower numbers including them in non-structured reports from 2017 and 2020. Reports generated in 2020 had a statistically significant increase in report elements included when compared to 2017 (p < 0.01). This statistically significant increase was also observed in comparison of structured reports and non-structured reports from either period (p < 0.01). Adoption of structured reporting for fluoroscopic barium swallow examinations led to significant increase in report comprehensiveness and should be considered after a multidisciplinary approach to development.

PMID:34802084 | DOI:10.1007/s00455-021-10382-5