Tag: pubmed

Ophthalmol Retina. 2022 Mar 9:S2468-6530(22)00089-6. doi: 10.1016/j.oret.2022.03.002. Online ahead of print.

ABSTRACT

PURPOSE: To compare nonmydriatic and mydriatic handheld retinal imaging with standard ETDRS 7-field color fundus photography (ETDRS photos) for the assessment of diabetic retinopathy (DR) and diabetic macular edema (DME).

DESIGN: Prospective, comparative, instrument validation study SUBJECTS: 225 eyes from 116 patients with diabetes mellitus METHODS: Following a standardized protocol, nonmydriatic and mydriatic images were acquired using handheld retinal cameras [Nonmydriatic (NM): Aurora (AUNM), Smartscope (SSNM), RetinaVue-700 (RVNM); Mydriatic (MD): Aurora (AUMD), Smartscope (SSMD), RetinaVue-700 (RVMD), iNview (NVMD)] and dilated ETDRS photos. Grading was performed at a centralized reading center using the International Clinical Classification for DR and DME. Kappa statistics [simple (K), weighted (Kw)] assessed the level of agreement for DR and DME. Sensitivity and specificity were calculated for any DR, referable DR (refDR) and vision-threatening DR (vtDR).

MAIN OUTCOME MEASURES: Agreement for DR and DME, sensitivity and specificity for any DR, refDR and vtDR, ungradable rates RESULTS: Severity by ETDRS photos: no DR 33.3%, mild NPDR 20.4%, moderate 14.2%, severe in 11.6%, proliferative DR 20.4%; no DME 68.0%, DME 9.3%, ciDME 17.3%, ungradable 5.3%. For nonmydriatic handheld retinal imaging, Kw was 0.70 to 0.73 for DR and 0.76 to 0.83 for DME. For mydriatic handheld retinal imaging, Kw was 0.68 to 0.75 for DR and 0.77 to 0.91 for DME. Thresholds for sensitivity (0.80) and specificity (0.95) were met by SSNM, AUMD and RVMD for anyDR, and by AUMD and RVMD for refDR. Thresholds for sensitivity and specificity were met by AUMD and RVMD for DME. Nonmydriatic and Mydriatic ungradable rate for DR was 15.1% to 38.3% and 0% to 33.8%, respectively.

CONCLUSIONS: Following standardized protocols, nonmydriatic and mydriatic handheld retinal imaging devices have substantial agreement levels for DR and DME. With mydriasis, not all handheld retinal imaging devices meet standards for sensitivity and specificity in identifying any DR and refDR. None of the handheld devices met the established 95% specificity for vtDR, suggesting that lower referral thresholds should be used if handheld devices must be utilized. When using handheld devices, the ungradable rate is significantly reduced with mydriasis and DME sensitivity thresholds are only achieved following dilation.

PMID:35278726 | DOI:10.1016/j.oret.2022.03.002

Neuroimage. 2022 Mar 9:119083. doi: 10.1016/j.neuroimage.2022.119083. Online ahead of print.

ABSTRACT

Machine learning methods exploiting multi-parametric biomarkers, especially based on neuroimaging, have huge potential to improve early diagnosis of dementia and to predict which individuals are at-risk of developing dementia. To benchmark algorithms in the field of machine learning and neuroimaging in dementia and assess their potential for use in clinical practice and clinical trials, seven grand challenges have been organized in the last decade: MIRIAD (2012), Alzheimer’s Disease Big Data DREAM (2014), CADDementia (2014), Machine Learning Challenge (2014), MCI Neuroimaging (2017), TADPOLE (2017), and the Predictive Analytics Competition (2019). Based on two challenge evaluation frameworks, we analyzed how these grand challenges are complementing each other regarding research questions, datasets, validation approaches, results and impact. The seven grand challenges addressed questions related to screening, clinical status estimation, prediction and monitoring in (pre-clinical) dementia. There was little overlap in clinical questions, tasks and performance metrics. Whereas this aids providing insight on a broad range of questions, it also limits the validation of results across challenges. The validation process itself was mostly comparable between challenges, using similar methods for ensuring objective comparison, uncertainty estimation and statistical testing. In general, winning algorithms performed rigorous data pre-processing and combined a wide range of input features. Despite high state-of-the-art performances, most of the methods evaluated by the challenges are not clinically used. To increase impact, future challenges could pay more attention to statistical analysis of which factors (i.e., features, models) relate to higher performance, to clinical questions beyond Alzheimer’s disease, and to using testing data beyond the Alzheimer’s Disease Neuroimaging Initiative. Grand challenges would be an ideal venue for assessing the generalizability of algorithm performance to unseen data of other cohorts. Key for increasing impact in this way are larger testing data sizes, which could be reached by sharing algorithms rather than data to exploit data that cannot be shared. Given the potential and lessons learned in the past ten years, we are excited by the prospects of grand challenges in machine learning and neuroimaging for the next ten years and beyond.

PMID:35278709 | DOI:10.1016/j.neuroimage.2022.119083

Pract Radiat Oncol. 2022 Mar 9:S1879-8500(22)00078-9. doi: 10.1016/j.prro.2022.02.013. Online ahead of print.

ABSTRACT

PURPOSE: Radiotherapy is a standard part of limb conserving therapy for extremity soft tissue sarcoma (STS) at high risk of recurrence. Toxicities increase with radiation dose and volume of normal tissue irradiated. This study sought to compare dosimetry of volumetric modulated arc radiotherapy (VMAT), with intensity modulated radiotherapy (IMRT) and to investigate the optimal planning technique.

METHODS AND MATERIALS: Twenty patients with extremity STS who underwent preoperative radiotherapy (50 Gy in 25 fractions) between 2016 and 2020 at a sarcoma specialist centre were included. The original treatment techniques were sliding window IMRT or 3D conformal. VMAT plans were retrospectively generated according to the original tumour and organ at risk constraints. Quality assurance was performed as per departmental protocol. Wilcoxon signed-rank test was used to compare dosimetric parameters (for planning target volume, in-field bone, and soft tissue structures), monitor units (MU) and treatment time.

RESULTS: Median patient age was 65 years and majority were male (n=14, 70%). Commonest subtype was undifferentiated pleomorphic sarcoma (n=14, 70%) and most tumours were located on the thigh (n=12, 60%). Median PTV volume was 1110 cm³ and median volume of in-field bone 236 cm³. VMAT plans had significantly lower average MU (480 vs 862 MU, p<0.001) and overall treatment time (300 vs 153 seconds, p<0.001). PTV coverage favoured VMAT, with marginally higher mean, minimum, and maximum doses, and higher Conformity Index. However, differences were not statistically significant. Dose to infield bone and soft tissue structures were similar or slightly lower with VMAT.

CONCLUSIONS: In extremity soft tissue sarcoma, VMAT plans demonstrated a favourable trend toward tumour coverage and dose conformity compared to IMRT along with significantly lower monitor units and half the overall treatment time.

PMID:35278718 | DOI:10.1016/j.prro.2022.02.013

Mol Ther. 2022 Mar 9:S1525-0016(22)00158-7. doi: 10.1016/j.ymthe.2022.03.002. Online ahead of print.

ABSTRACT

As mediators of intercellular communication, extracellular vesicles containing molecular cargo such as microRNAs, are secreted by cells and taken up by recipient cells to influence their cellular phenotype and function. Here, we report that cardiac stress-induced differential microRNA content, with miR-200c-3p being one of the most enriched, in cardiomyocyte-derived extracellular vesicles mediates functional crosstalk with endothelial cells. Silencing of miR-200c-3p in mice subjected to chronic increased cardiac pressure overload resulted in attenuated hypertrophy, smaller fibrotic areas, higher capillary density and preserved cardiac ejection fraction. Interestingly, we were able to maximal rescue microvascular and cardiac function with very low doses of antagomir, which specifically silences miR-200c-3p expression in the non-myocyte cells. Our results reveal vesicle transfer of miR-200c-3p from cardiomyocytes to cardiac endothelial cells, underlining the importance of cardiac intercellular communication in the pathophysiology of heart failure.

PMID:35278675 | DOI:10.1016/j.ymthe.2022.03.002

J Shoulder Elbow Surg. 2022 Mar 9:S1058-2746(22)00269-5. doi: 10.1016/j.jse.2022.01.151. Online ahead of print.

ABSTRACT

BACKGROUND: The development of radioulnar synostosis secondary to posttraumatic injuries to the elbow or forearm can lead to debilitating outcomes. Several treatment options are available to hinder the progression and prevent reoccurrence. The authors used a combination of these treatments on a series of patients and observed the outcomes.

METHODS: A retrospective study was conducted on 10 patients with posttraumatic radioulnar synostosis (9 males and 1 female) that required surgical intervention in a tertiary orthopedic center. All of these patients were subjected to the same treatment combination (preoperative radiotherapy, tissue interposition post heterotopic ossification resection and adjuvant indomethacin Postoperatively). Improvement in range of motion (flexion, extension, and rotation) and Mayo score was performed and compared pre- and postoperatively via statistical analysis.

RESULTS: In comparison to their preoperative state that ranged from fair to poor, all 10 patients reported excellent Mayo score results post intervention with triple therapy combination with a mean of 36 ± 10.2 points. Flexion, extension, and rotation scores improved with means of 55.2° ± 38.7, 50.2° ± 34.0, and 47.9° ± 40.0, respectively. We had one complication that has subsided on follow-up.

CONCLUSION: The triple therapy combination has been noted to provide good functional and prophylactic results preventing recurrence.

PMID:35278681 | DOI:10.1016/j.jse.2022.01.151

J Vasc Surg. 2022 Mar 9:S0741-5214(22)00421-9. doi: 10.1016/j.jvs.2022.02.053. Online ahead of print.

ABSTRACT

OBJECTIVE: The Gore Excluder iliac branch endoprosthesis (IBE; W.L. Gore & Associates, Flagstaff, AZ) is the only iliac branch device approved in the United States to preserve blood flow to the external and internal iliac arteries (IIAs). Some surgeons have used the Gore Viabahn VBX balloon expandable endoprosthesis (VBX; W.L. Gore & Associates) in the IIA rather than the self-expanding endograft designed for the IBE, the internal iliac component (IIC). The objective of the present study was to examine outcomes in patients treated for aortoiliac artery aneurysms with the IBE using either the IIC or VBX stent.

METHODS: We performed a retrospective, single-center review of patients treated for aortoiliac artery aneurysms using the Gore IBE device, with either the IIC or VBX stent into the internal iliac artery from February 2016 to March 2021. Patient demographics, procedure details, 30-day morbidity and mortality, and 6-month and 1-year outcomes and mortality were analyzed. The categorical factors were summarized using frequencies and percentages. Continuous measures were summarized using mean ± standard deviation. A significance level of P = .05 was assumed for all test results. The analyses were performed using SAS software, version 9.4 (SAS Institute, Cary, NC).

RESULTS: Sixty-four patients underwent elective aortoiliac artery aneurysm repair with IBE. IIC was used exclusively in 35 patients (55%) and VBX in 29 (45%). Patients receiving VBX had higher American Society of Anesthesiologists class (P = .006). Upper extremity access was used for VBX delivery in 24.1% of the procedures. No return to the operating room was required in either group. No differences were found in technical success (97.1% IIC vs 93.1% VBX; P = .59), presence of endoleak upon completion (20.0% vs 6.9%; P = .17), readmission (97.1% vs 93.1%; P = .59), or mortality (1.6% vs 0%; P = .45) at 30 days. No differences were found in the requirement for any IBE reintervention after 30 days. No type Ia, Ib, or III endoleaks occurred in either group at any follow-up point. There was no significant difference in internal iliac limb primary patency (IIC 100% vs VBX 96.3%) between groups. A non-statistically significant trend was found toward fewer trunk-ipsilateral leg type II endoleaks in the VBX group during post-procedure follow-up.

CONCLUSIONS: These data suggest that VBX is a reasonable substitute for IIC and has a comparable safety and efficacy profile. Given its inherent conformability, greater range of diameters, and longer working length, VBX offers expanded internal iliac artery branch options with IBE.

PMID:35278651 | DOI:10.1016/j.jvs.2022.02.053

Environ Pollut. 2022 Mar 8:119118. doi: 10.1016/j.envpol.2022.119118. Online ahead of print.

ABSTRACT

Sediment denitrification plays an important role in nitrogen removal in aquatic systems. However, the importance in nitrogen removal in reservoirs, with a focus on seasonal differences of conditions such as macrophyte beds and environmental factors, is less well understood. This study examined sediment denitrification rate (D_n), and their potential controlling factors were determined in both macrophyte beds and deeper waters in the subtropical reservoir. The mean D_n in the reservoir annually was 18.0 ± 6.3 (mean ± S.E.) mmol N m^-2 d^-1, with significant seasonal variation (p < 0.01), i.e. 43.2 ± 12.8, 6.7 ± 6.3, and 4.0 ± 2.2 mmol N m^-2 d^-1 in winter, spring and summer respectively. There were no statistical differences in D_n between shallow waters with macrophyte beds and deeper waters without macrophyte beds, although macrophyte beds had higher denitrification rates in summer. The D_n rates were significantly correlated with temperature, conductivity, dissolved oxygen, pH, nitrate-nitrogen concentration (NO₃^–-N) (p < 0.01) and turbidity (p < 0.05). Linear regression models demonstrated environmental variables explained between 36% and 76% of the variation in D_n. The correlation with NO₃^–-N concentrations suggests that it may be a limited factor for D_n. Annual nitrogen removal of the reservoir by a combination of sediment and water denitrification was totally estimated to be 370 t N with an annual removal efficiency of approximately 11%. Nitrogen removal was much higher in winter than other seasons, with about 305 t N removed, accounting for 12% of the total nitrogen inputs. Therefore, denitrification appears to play a minor role throughout much of the year, but in winter months when nitrate accumulates, it may play a more major role.

PMID:35278586 | DOI:10.1016/j.envpol.2022.119118

Ann Rehabil Med. 2022 Feb;46(1):45-52. doi: 10.5535/arm.21148. Epub 2022 Feb 28.

ABSTRACT

OBJECTIVE: To analyze how Pilates exercises affect standing, walking, and balance in children with diplegic cerebral palsy throughout a 10-week program.

METHODS: We included 40 children aged 7-9 years with diplegic cerebral palsy, and randomly allocated them into two groups of the same size: conventional therapy group (group A) and conventional therapy+Pilates group (group B). We administered the same conventional physical therapy program to both groups for 45 minutes, with group B receiving additional Pilates exercises for 45 minutes. Both groups attended the intervention program three times/week for 10 weeks. We used the Growth Motor Function Measure Scale (GMFM-88) to evaluate standing and walking (Dimensions D and E), and the Pediatric Balance Scale to evaluate balance function before and after treatment.

RESULTS: Comparison of the average values of all measured variables before and after therapy showed a statistically significant difference (p<0.05) between the two groups. All measured variables showed a significant difference between groups A and B, in favor of group B (p<0.05).

CONCLUSION: Pilates exercise in addition to conventional therapy is more effective in improving balance and gross motor function in children with diplegic cerebral palsy than the conventional therapy alone.

PMID:35272439 | DOI:10.5535/arm.21148

Ann Rehabil Med. 2022 Feb;46(1):1-8. doi: 10.5535/arm.22001. Epub 2022 Feb 28.

ABSTRACT

With rapid aging, the number of stroke survivors with disabilities in Korea is increasing even if mortality is declining. Despite coordinated efforts for quality improvement of stroke rehabilitation in Korea, the statistics of stroke rehabilitation were not well reported. This review aimed to provide contemporary and comprehensive statistics and recent changes in stroke rehabilitation in Korea. The Clinical Practice Guideline for Stroke Rehabilitation in Korea was developed in 2009 and updated in 2012 and 2016. Additionally, the representative databases for stroke rehabilitation include the Korean Brain Rehabilitation Database and the Korean Stroke Cohort for functioning and rehabilitation. These nationwide databases provided current information on stroke rehabilitation. Among Korean stroke survivors, one in three had motor impairment, one in four had cognitive impairment, one in three had speech impairment, one in four was dependent in ambulation, one in six had swallowing difficulty, and one in four was dependent in activities in daily living at 5 years after stroke. Comprehensive inpatient rehabilitation following transfer to the department of rehabilitation medicine significantly decreased stroke-related mortality and long-term disability. This review provides an improved understanding of stroke rehabilitation and guidance to implement timely, coordinated, evidence-based stroke rehabilitation services to relieve the socioeconomic burden of stroke.

PMID:35272435 | DOI:10.5535/arm.22001

Zhonghua Wai Ke Za Zhi. 2022 Apr 1;60(4):379-387. doi: 10.3760/cma.j.cn112139-20211210-00592. Online ahead of print.

ABSTRACT

Objective: To investigate the association between prealbumin and the long-term prognosis of patients with hilar cholangiocarcinoma(HCCA) following radical surgery. Methods: The clinical data of 262 HCCA patients who underwent radical surgery admitted from January 2010 to January 2017 at the First Affiliated Hospital of Army Medical University were collected,retrospectively. There were 158 males and 104 females; aged (57.6±9.9)years old(range:32 to 78 years). According to the preoperative serum prealbumin level(170 mg/L),the patients were divided into low prealbumin group(n=143) and normal prealbumin group(n=119). Follow-up until September 2020,the main research indicator was overall survival(OS), and the secondary research indicator was recurrence-free survival(RFS). The measurement data conforming to the normal distribution adopted the t test,the measurement data not conforming to the normal distribution adopted the Mann-Whitney U test,and the count data adopted the χ² test. The Kaplan-Meier method was used to calculate the cumulative survival rate. The Log-rank test was used for univariate analysis of the cumulative survival rate. Variables with P<0.10 in univariate analysis were included in the Cox proportional hazards model for multivariate analysis. Results: The 1-, 3-, and 5-year OS rate of the 262 patients was 73.4%, 32.1%, and 24.0%, respectively, and the 1-, 3-, and 5-year RFS rate was 54.6%, 25.2%, and 16.2%, respectively. Median OS and RFS were 21 months and 12 months for patients with low prealbumin and 25 months and 19 months for patients with normal prealbumin. The OS rate and RFS rate of patients in the low prealbumin group were lower than those in the normal prealbumin group, and the difference was statistically significant (both P<0.05). The results of univariate analysis indicated that low prealbumin, CA19-9>150 U/L, tumor infiltration length>3 cm, preoperative jaundice, macrovascular invasion, microvascular invasion, lymph node metastasis, and poor differentiation maybe the risk factors of OS,and low prealbumin,tumor invasion length>3 cm,macrovascular invasion, microvascular invasion,lymph node metastasis,and poor differentiation maybe the risk factors of RFS for postoperative for radical resection in patients with HCCA (all P<0.10). Multivariate results suggested that low prealbumin,tumor invasion length>3 cm,microvascular invasion,lymph node metastasis,and poor differentiation were independent risk factors affecting OS and RFS in patients with HCCA after radical operation all (P<0.05). Conclusion: Preoperative prealbumin level can predict the long-term prognosis of patients with hilar cholangiocarcinoma following radical surgery.

PMID:35272430 | DOI:10.3760/cma.j.cn112139-20211210-00592