Tag: pubmed

Med Phys. 2022 Mar 27. doi: 10.1002/mp.15625. Online ahead of print.

ABSTRACT

PURPOSE: The unpredictable interplay between dynamic proton therapy delivery and target motion in the thorax can lead to severe dose distortions. A fraction-wise four-dimensional (4D) dose reconstruction workflow allows for the assessment of the applied dose after patient treatment while considering the actual beam delivery sequence extracted from machine log files, the recorded breathing pattern and the geometric information from a 4D computed tomography scan (4DCT). Such an algorithm capable of accounting for amplitude-sorted 4DCTs was implemented and its accuracy as well as its sensitivity to input parameter variations was experimentally evaluated.

METHODS: An anthropomorphic thorax phantom with a movable insert containing a target surrogate and a radiochromic film was irradiated with a monoenergetic field for various 1D target motion forms (sin, sin4) and peak-to-peak amplitudes (5/10/15/20/30 mm). The measured characteristic film dose distributions were compared to the respective sections in the 4D reconstructed doses using a 2D γ-analysis (3mm, 3%); γ-pass rates were derived for different dose grid resolutions (1mm/3mm) and deformable image registrations (DIR, automatic/manual) applied during the 4D dose reconstruction process. In an additional analysis, the sensitivity of reconstructed dose distributions against potential asynchronous timing of the motion and machine log files was investigated for both a monoenergetic field and more realistic 4D robustly optimized fields by artificially introduced offsets of ± 1/5/25/50/250 ms. The resulting dose distributions with asynchronized log files were compared to those with synchronized log files by means of a 3D γ-analysis (1mm, 1%) and the evaluation of absolute dose differences.

RESULTS: The induced characteristic interplay patterns on the films were well reproduced by the 4D dose reconstruction with 2D γ-pass rates ≥95% for almost all cases with motion magnitudes ≤15 mm. In general, the 2D γ-pass rates showed a significant decrease for larger motion amplitudes and increase when using a finer dose grid resolution but were not affected by the choice of motion form (sin, sin4). There was also a trend, though not statistically significant, towards the manually defined DIR for better quality of the reconstructed dose distributions in the area imaged by the film. The 4D dose reconstruction results for the monoenergetic as well as the 4D robustly optimized fields were robust against small asynchronies between motion and machine log files of up to 5 ms, which is in the order of potential network latencies.

CONCLUSIONS: We have implemented a 4D log file-based proton dose reconstruction that accounts for amplitude-sorted 4DCTs. Its accuracy was proven to be clinically acceptable for target motion magnitudes of up to 15 mm. Particular attention should be paid to the synchronization of the log file generating systems as the reconstructed dose distribution may vary with log file asynchronies larger than those caused by realistic network delays. This article is protected by copyright. All rights reserved.

PMID:35342943 | DOI:10.1002/mp.15625

Muscle Nerve. 2022 Mar 27. doi: 10.1002/mus.27539. Online ahead of print.

ABSTRACT

INTRODUCTION/AIMS: Guillain-Barré syndrome (GBS) is generally considered to be monophasic, but some patients experience recurrences. The purpose of this study was to clarify the possible link between thyroid parameters and recurrent GBS (RGBS) patients in China.

METHODS: This retrospective study enrolled patients who were admitted to the Department of Neurology of the First Affiliated Hospital of Zhengzhou University from 2014 to 2020 and fulfilled the diagnostic criteria of GBS or Miller Fisher syndrome (MFS). We evaluated clinical characteristics, cerebrospinal fluid (CSF) parameters, serum levels of thyroid-stimulating hormone (TSH), free thyroxine (FT4) and free triiodothyronine (FT3) in 320 individuals, including 302 with monophasic GBS and 18 with recurrent GBS.

RESULTS: Serum levels of TSH in monophasic GBS patients were significantly lower than those in RGBS patients (P<0.001), whereas FT3 levels were higher in the monophasic GBS group (P=0.022). Age at onset, incidence of antecedent illness, time from onset to nadir, proportion of acute inflammatory demyelinating polyradiculoneuropathy (AIDP), and Hughes Functional Grading Scale (HFGS) at nadir were statistically significant between monophasic GBS patients and RGBS patients (P<0.05). The multivariate regression analysis revealed that antecedent illness, AIDP and high TSH were independent risk factors for RGBS. Our ROC curve analysis showed that the risk of recurrence in GBS patients increases when the TSH concentration is higher than 3.87uIU/mL.

DISCUSSION: Our results demonstrate an association between TSH and RGBS. Oxidative stress is one of the possible interpretations for this association.

PMID:35342963 | DOI:10.1002/mus.27539

Eur J Clin Invest. 2022 Mar 28:e13782. doi: 10.1111/eci.13782. Online ahead of print.

ABSTRACT

There are no widely accepted, quantitative definitions for the end of a pandemic like COVID-19. The end of the pandemic due to a new virus and the transition to endemicity may be defined based on a high proportion of the global population having some immunity from natural infection or vaccination. Other considerations include diminished death toll, diminished pressure on health systems, reduced actual and perceived personal risk, removal of restrictive measures, and diminished public attention. A threshold of 70% of the global population having being vaccinated or infected was probably already reached in the second half of 2021. Endemicity may still show major spikes of infections and seasonality, but typically less clinical burden, although some locations are still hit more than others. Death toll and ICU occupancy figures are also consistent with a transition to endemicity by end 2021/early 2022. Personal risk for the vast majority of the global population was already very small by end 2021, but perceived risk may still be grossly over-estimated. Restrictive measures of high stringency have persisted in many countries by early 2022. The gargantuan attention in news media, social media, and even scientific circles should be tempered. Public health officials need to declare the end of the pandemic. Mid- and long-term consequences of epidemic waves and of adopted measures on health, society, economy, civilization, and democracy may perpetuate a pandemic legacy long after the pandemic itself has ended.

PMID:35342941 | DOI:10.1111/eci.13782

J Am Coll Emerg Physicians Open. 2022 Mar 17;3(2):e12705. doi: 10.1002/emp2.12705. eCollection 2022 Apr.

ABSTRACT

OBJECTIVE: Physician Orders for Life-Sustaining Treatment (POLST) forms exist in some form in all 50 states. This study evaluates emergency medical service (EMS) practitioners interpretation of the POLST in cardiopulmonary arrest.

METHODS: This study used a prospective convenience sample of California Bay Area EMS practitioners who reviewed 6 fictional scenarios of patients in cardiopulmonary arrest and accompanying California POLST forms. Based on the cases and POLST, EMS practitioners identified patient preference for “attempt resuscitation,” “do not attempt resuscitation/DNR,” or “unsure” and subsequently selected medical interventions (ie, chest compressions, defibrillation, and so on). They also rated their confidence in POLST use and interpretation.

RESULTS: In scenarios of cardiopulmonary arrest and POLST that indicated do not resuscitate (DNR)/do not attempt resuscitation (DNAR) and full treatment, only 45%-65% of EMS practitioners correctly identified the patient as DNR/DNAR. EMS practitioners were more likely to interpret the POLST correctly in scenarios where patients were DNR/DNAR but indicated selective treatment (86%; 168/196) or comfort-focused treatment (86%; 169/196). In cardiopulmonary arrest scenarios where the patient was correctly identified as DNR/DNAR, EMS practitioners frequently selected defibrillation, advanced airway, or epinephrine as appropriate treatment. For all 6 scenarios, there was no statistical difference in response selection with level of training (emergency medical technician/paramedics) or type of EMS personnel (fire based/private).

CONCLUSION: The POLST is a powerful tool to convey medical treatment preferences; however, there is significant variation in the interpretation and application by EMS practitioners. To improve the POLST effectiveness, the authors suggest more EMS input into POLST development, concise language that defines resuscitation, and more EMS education about clinical application.

PMID:35342899 | PMC:PMC8931303 | DOI:10.1002/emp2.12705

Perspect Behav Sci. 2021 May 13;45(1):259-294. doi: 10.1007/s40614-021-00289-9. eCollection 2022 Mar.

ABSTRACT

Multiple quantitative methods for single-case experimental design data have been applied to multiple-baseline, withdrawal, and reversal designs. The advanced data analytic techniques historically applied to single-case design data are primarily applicable to designs that involve clear sequential phases such as repeated measurement during baseline and treatment phases, but these techniques may not be valid for alternating treatment design (ATD) data where two or more treatments are rapidly alternated. Some recently proposed data analytic techniques applicable to ATD are reviewed. For ATDs with random assignment of condition ordering, the Edgington’s randomization test is one type of inferential statistical technique that can complement descriptive data analytic techniques for comparing data paths and for assessing the consistency of effects across blocks in which different conditions are being compared. In addition, several recently developed graphical representations are presented, alongside the commonly used time series line graph. The quantitative and graphical data analytic techniques are illustrated with two previously published data sets. Apart from discussing the potential advantages provided by each of these data analytic techniques, barriers to applying them are reduced by disseminating open access software to quantify or graph data from ATDs.

PMID:35342876 | PMC:PMC8894511 | DOI:10.1007/s40614-021-00289-9

Lancet Reg Health Eur. 2022 Mar 22;15:100344. doi: 10.1016/j.lanepe.2022.100344. eCollection 2022 Apr.

NO ABSTRACT

PMID:35342893 | PMC:PMC8943426 | DOI:10.1016/j.lanepe.2022.100344

Perspect Behav Sci. 2021 May 24;45(1):53-75. doi: 10.1007/s40614-021-00290-2. eCollection 2022 Mar.

ABSTRACT

Functional analysis (FA) is an integral component of behavioral assessment and treatment given that clinicians design behavioral treatments based on FA results. Unfortunately, the interrater reliability of FA data interpretation by visual analysis can be inconsistent, potentially leading to ineffective treatment implementation. Hall et al. (2020) recently developed automated nonparametric statistical analysis (ANSA) to facilitate the interpretation of FA data and Kranak et al. (2021) subsequently extended and validated ANSA by applying it to unpublished clinical data. The results of both Hall et al. and Kranak et al. support ANSA as an emerging statistical supplement for interpreting FA data. In the present article, we show how ANSA can be applied to interpret FA data collected in clinical settings in multielement and pairwise designs. We provide a detailed overview of the calculations involved, how to use ANSA in practice, and recommendations for its implementation. A free web-based application is available at https://ansa.shinyapps.io/ansa/.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40614-021-00290-2.

PMID:35342875 | PMC:PMC8894515 | DOI:10.1007/s40614-021-00290-2

Perspect Behav Sci. 2021 Sep 1;45(1):13-35. doi: 10.1007/s40614-021-00304-z. eCollection 2022 Mar.

ABSTRACT

This study investigated the power of two-level hierarchical linear modeling (HLM) to explain variability in intervention effectiveness between participants in context of single-case experimental design (SCED) research. HLM is a flexible technique that allows the inclusion of participant characteristics (e.g., age, gender, and disability types) as moderators, and as such supplements visual analysis findings. First, this study empirically investigated the power to estimate intervention and moderator effects using Monte Carlo simulation techniques. The results indicate that larger values for the true effects and the number of participants resulted in a higher power. The more moderators added to the model, the more participants needed to detect the effects with sufficient power (i.e., power ≥.80). When a model includes three moderators, at least 20 participants are required to capture the intervention effect and moderator effects with sufficient power. For that same condition, but only including one moderator, seven participants are sufficient. Specific recommendations for designing a SCED study with sufficient power to estimate intervention and moderator effects were provided. Second, this study introduced a newly developed user-friendly point and click Shiny tool, PowerSCED. This tool assists applied SCED researchers in designing a SCED study that has sufficient power to detect intervention and moderator effects. To end, the use of HLM with the inclusion of moderators was demonstrated using two previously published SCED studies in the journal School Psychology Quarterly.

PMID:35342874 | PMC:PMC8894540 | DOI:10.1007/s40614-021-00304-z

Zhonghua Wei Chang Wai Ke Za Zhi. 2022 Mar 25;25(3):235-241. doi: 10.3760/cma.j.cn441530-20210729-00305.

ABSTRACT

Objective: To summarize short-term postoperative complications of transanal total mesorectal excision (taTME) in the treatment of middle-low rectal cancer. Methods: A descriptive case series of cases was constructed. Clinical data of consecutive 83 patients with mid-low rectal cancer who received taTME treatment from November 2016 to April 2021 at Department of General Surgery of Beijing Friendship Hospital, Capital Medical University were collected. Among 83 patients, 58 (69.9%) were males, with a mean age of (61.4±11.8) years; 42 (50.6%) were low rectal cancer, 41 (49.4%) were middle rectal cancer. Short-term postoperative complication was defined as complication occurring within 30 days after operation. The complication was graded according to the Clavien-Dindo classification. At the same time, the morbidity of short-term postoperative complication in the first 40 patients and that in the last 43 patients were compared to understand the differences before and after passing the taTME learning curve. Results: Two patients (2.5%) were converted to laparotomy ; 78 (94.0%) completed anastomosis.While 5 (6.0%) underwent permanent stoma. The total operation time of transabdominal+ transanal procedure was (246.9±85.0) minutes, and the median intraoperative blood loss was 100 (IQR: 100) ml. Seventy-five cases (75 /78, 96.2%) underwent defunctioning stoma, including 74 cases of diverting ileostomy, 1 case of diverting transverse colostomy and 3 cases without stoma. The morbidity of complication within 30 days after operation was 38.6% (32/83), and the morbidity of complication after discharge was 8.4% (7/83). Minor complications accounted for 31.3% (26/83) and major complications accounted for 7.2% (6/83). No patient died within 30 days after operation. The incidence of anastomotic leakage was 15.4% (12/78). Eight patients (9.6%) were hospitalized again due to complications after discharge. The median postoperative hospital stay was 7 (IQR: 3) days. All the patients with minor (I-II) complications received conservative treatment. One patient with grade C anastomotic leakage was transferred to intensive care unit and received a second operation due to sepsis and multiple organ dysfunction. Two patients with paralytic ileus (Clavien-Dindo IIIa) underwent endoscopic ileus catheter placement. There were 3 patients with Clavien-Dindo III or above respiratory complications, including 1 patient with pleural effusion and ultrasound-guided puncture, 2 patients with respiratory failure who were improved and discharged after anti-infection and symptomatic treatment. One patient underwent emergency ureteral stent implantation due to urinary infection (Clavien-Dindo IIIb). The morbidity of postoperative complication in the first 40 cases was 50.0% (20/40), and that in the latter 43 cases decreased significantly (27.9%, 12/43), whose difference was statistically significant (χ(2)=4.270, P=0.039). Conclusions: The procedure of taTME has an acceptable morbidity of short-term postoperative complication in the treatment of mid-low rectal cancer. The accumulation of surgical experience plays an important role in reducing the morbidity of postoperative complication.

PMID:35340173 | DOI:10.3760/cma.j.cn441530-20210729-00305

HIV Med. 2022 Mar 27. doi: 10.1111/hiv.13306. Online ahead of print.

ABSTRACT

OBJECTIVE: Our objective was to describe and compare the occurrence of neurological outcomes and neurosyphilis in people living with HIV with incident syphilis and no neurological symptoms who underwent early screening for asymptomatic neurosyphilis (ANS) or regular clinical management without a lumbar puncture.

METHODS: This was a retrospective cohort study in a single referral centre of Sao Paulo, Brazil. Patients with incident syphilis diagnosed between January 2000 and August 2016 and meeting the adapted criteria for ANS investigation suggested by Marra et al. (CD4⁺ T-cell counts ≤350 cells/mm³ and/or venereal disease research laboratory test results ≥1:16) were identified. Those with no neurological symptoms and immediately referred for lumbar puncture were categorized as group 1, and those not referred for cerebrospinal fluid collection were categorized as group 2. We compared the occurrence of neurological symptoms and neurosyphilis diagnoses between the groups using incidence rates and Kaplan-Meier curves.

RESULTS: We included 425 participants with a median follow-up of 6 years. The incidence rate of neurological symptoms was 36.5/1000 person-years in group 1 and 40.6/1000 person-years in group 2 (incidence rate ratio [IRR] 0.90; 95% confidence interval [CI] 0.57-1.39; p = 0.62). The incidence rate of neurosyphilis was 15.0 cases/1000 person-years in group 1 and 6.7 cases/1000 person-years in group 2 (IRR 2.26; 95% CI 0.93-5.68; p = 0.05).

CONCLUSIONS: We found no statistically significant differences between groups in the incidence rates of neurological symptoms and neurosyphilis. Our findings support the current guidelines, which suggest a less invasive approach regarding ANS investigation among people living with HIV with incident syphilis.

PMID:35340123 | DOI:10.1111/hiv.13306