Tag: pubmed

J Colloid Interface Sci. 2021 Mar 2;593:21-31. doi: 10.1016/j.jcis.2021.02.076. Online ahead of print.

ABSTRACT

HYPOTHESIS: The objective is to noninvasively probe the local hydrocarbon dynamics at asphaltene/maltene interfaces to reveal the global characteristics of bitumen at increasing temperatures and under various mechanical constraints.

EXPERIMENTS: We propose multidimensional (1D and 2D) nuclear magnetic relaxation (NMR) experiments to characterize the dynamic properties of hydrocarbons for a set of bitumen from 40 to 180 °C. The convergence towards universal theoretical modelling of NMR relaxation experiments gives a comprehensive understanding of hydrocarbon transport in these very weakly permeable samples. Moreover, a multivariate statistical analysis allows for correlating these NMR relaxation data for all bitumen samples to the main empirical parameters by qualifying the bitumen grading, such as the penetrability, softening and fragility points over a large range of temperatures.

FINDINGS: These new experimental and theoretical multiscale approaches link hydrocarbon interfacial dynamics to the global characteristics of various bitumen types. This is critical for grading these universally encountered materials.

PMID:33730653 | DOI:10.1016/j.jcis.2021.02.076

Clin Psychol Rev. 2021 Feb 27;85:102003. doi: 10.1016/j.cpr.2021.102003. Online ahead of print.

ABSTRACT

People with psychosis are reported to be one of the most stigmatised minority groups in society. Mental health stigma can have a detrimental impact on quality of life (QoL), which is a meaningful outcome for service users experiencing psychosis and using mental health services. This paper provides the first systematic literature review, meta-analysis and quality appraisal of studies examining the association between stigma and subjective QoL in non-affective psychosis. An electronic database search identified 45 articles for inclusion. A random-effects meta-analysis of 37 independent samples (n = 5795) found a statistically significant association between higher stigma and lower subjective QoL of medium strength (r = -0.40, 95% CI: -0.45, -0.35). Separate meta-analyses demonstrated medium-to-large negative pooled effects for self-stigma (k = 25, r = -0.44, 95% CI:-0.49, -0.38), perceived stigma (k = 10, r = -0.32, 95% CI:-0.42, -0.21) and experienced stigma (k = 6, r = -0.30, 95% CI:-0.35, -0.24). A narrative summary of 12 studies suggested psychological mechanisms relating to self-concept and social networks may play an important mediating role in the association between stigma and QoL in psychosis. Psychological interventions should target improvements in these psychological processes to reduce the negative impact of stigma on QoL in psychosis. Further longitudinal research is needed to test theoretical models of causal pathways and explanatory mechanisms.

PMID:33730660 | DOI:10.1016/j.cpr.2021.102003

J Med Internet Res. 2021 Mar 16. doi: 10.2196/25504. Online ahead of print.

ABSTRACT

BACKGROUND: Preoperative anxiety is a common occurrence among children and is associated with a host of maladaptive post-operative behaviors. Consequently, increased attention has been placed on interventions to reduce preoperative anxiety and its associated outcomes. Child Life preparation prior to surgery includes evidence-based practices such as age-appropriate distraction and therapeutic play. Virtual reality (VR) is a promising addition to the Child Life toolbox to address anxiety prior to surgery. The current study evaluates the implementation and feasibility of a VR experience, “Doc McStuffins: Doctor for a Day Virtual Reality Experience” (DocVR), developed by Disney Junior in collaboration with Children’s Hospital Los Angeles, to target pediatric preoperative anxiety.

OBJECTIVE: The primary aim of this study was to examine the feasibility and efficacy of DocVR for preoperative anxiety. A secondary aim is to improve patient, caregiver, and healthcare provider satisfaction with the preoperative experience.

METHODS: Fifty-one patients (age 6 to 14 years) scheduled for surgery in the Ambulatory Surgery Center (ASC) and the main Operating Room (OR) at Children’s Hospital Los Angeles were approached for participation in Disney’s DocVR experience. The patients played the DocVR experience for an average of 18 minutes (3 to 55 minutes). Irrespective of surgical procedure, patients and their families were eligible, as long as they had no known marked cognitive or visual impairments, which would interfere with completing the survey and engaging in the DocVR experience.

RESULTS: Patients who tried the DocVR experience (n=51) responded overwhelmingly positively to both the VR technology and to the game itself. Patients experienced a statistically significant decrease in anxiety following DocVR game play (Z = -3.26, P = .001). On the Facial Affective Scale, the percentage of patients who chose the face with the most positive facial expression to represent their affect increased from 24% pre-VR to 49% post-VR. Furthermore, 97% of patients reported feeling more comfortable at the hospital and 74% reported feeling less scared at the hospital after playing the game. 94% of patients enjoyed the game, and 88% of patients reported feeling both ‘Interested’ and ‘Involved’ in the game.

CONCLUSIONS: DocVR is a feasible and beneficial VR experience to relieve pediatric preoperative anxiety and improve satisfaction in the preoperative area. The VR experience resulted in a decrease in overall anxiety and an increase in overall positive affect during the preoperative time. Patients also responded positively to the game, confirming their interest in the content and affirming the quality of the DocVR experience. The positive response to the game indicates that DocVR has the potential to make the overall preoperative experience less anxiety-producing and more comfortable, which leads to improved patient satisfaction. Naturally, improved patient outcomes lead to improved caregiver and healthcare provider satisfaction.

PMID:33730687 | DOI:10.2196/25504

Int J Pediatr Otorhinolaryngol. 2021 Mar 11;144:110671. doi: 10.1016/j.ijporl.2021.110671. Online ahead of print.

ABSTRACT

OBJECTIVES: Post tonsillectomy hemorrhage (PTH) is a common complication of tonsillectomy. Our objectives were to: 1) Examine the postoperative course of patients presenting to St. Christopher’s Hospital for Children (SCHC) with PTH; 2) Compare patients with and without a blood clot visualized in the tonsillar fossa at time of presentation to determine if outcomes regarding return to the operating room (OR) differ.

METHODS: This was a retrospective chart review conducted at an academic, tertiary, pediatric hospital in an urban setting. Pediatric patients who underwent a tonsillectomy with concurrent adenoidectomy and were admitted for observation following secondary post tonsillectomy hemorrhage were reviewed. The effects of age, gender, indication, and clinical exam findings on admission on the rate of eventual return to the OR for control of hemorrhage were also analyzed. Chi-square analysis and Fisher’s exact test were used to compare the significance of categorical frequencies.

RESULTS: The rate of blood clot presence in our cohort was 50.9% (28/55). Return to OR rates were defined as patients who began actively hemorrhaging following admission for observation, further stratified by presence or absence of clot on admission physical exam. There was a statistically significant higher rate of return to OR in patients who presented with a clot (46.6%) on clinical exam versus no clot (18.5%) after resolved post tonsillectomy hemorrhage (p < .027). Furthermore, patients with a blood clot present were significantly more likely to require OR sooner (21.31 h from admission) than those without a clot (100.75 h from admission) (p < .012). There was no statistically significant higher rate of blood clot presence or rate of return to OR in groups based on age, gender, or indication.

DISCUSSION: Pediatric patients presenting after resolved secondary PTH with a blood clot visualized in the tonsillar fossa are more likely to require return to the OR for hemostasis and cautery than are those without a blood clot, and this is more likely to occur within 24 h of admission. Thus, patients with a blood clot on initial presentation may benefit from admission for a 24-h observation period, while a similar observation period may be unproductive for patients without a blood clot.

CONCLUSIONS: Patients who present with a resolved secondary PTH and a blood clot present on clinical exam require return to the OR more often than patients presenting without a blood clot. While previously controversial, we feel that this demonstrates that a 24-h observation of a patient with a clot on exam is reasonable.

PMID:33730604 | DOI:10.1016/j.ijporl.2021.110671

Clin Neurol Neurosurg. 2021 Mar 11;203:106598. doi: 10.1016/j.clineuro.2021.106598. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to summarize the surgical strategies for subdural effusion secondary to decompressive craniectomy (SESDC) and discuss the applicable scenarios of effusion-peritoneal shunt (EP shunt).

METHODS: A total of 53 consecutive patients with SESDC were screened out of 7569 cases. The SESDC was divided into five types, and the treatment methods of each type were analyzed and compared. According to the implementation strategy of cranioplasty (CP), patients were divided into CP-first and delayed-CP groups. The differences in surgical methods were compared between the two groups.

RESULTS: All patients with SESDC in this cohort had undergone cranioplasty. Subcutaneous puncture and aspiration (SPAA) proved ineffective. Only 2/30 patients in the CP-first group used EP shunt, while 6/19 patients in the delayed-CP group used EP shunt; the difference was statistically significant (P = 0.03). A significant difference was found in the use of EP shunt among type 1, type 2, and type 5 SESDC (χ² = 6.778, P = 0.034).

CONCLUSIONS: CP combined with other treatments could cure most SESDC. EP shunt should be used preferentially in some specific scenarios in which CP cannot be performed first, rather than as a backup measure that can only be used when other preceding treatments fail.

PMID:33730617 | DOI:10.1016/j.clineuro.2021.106598

Adv Med Sci. 2021 Mar 14;66(1):215-220. doi: 10.1016/j.advms.2021.03.002. Online ahead of print.

ABSTRACT

PURPOSE: The long-term clinical outcome of adjuvant stereotactic radiotherapy (SRT) in neovascular age-related macular degeneration (nAMD) patients was evaluated.

METHODS: This case-control study included patients with unilateral nAMD, who underwent SRT complementary to standard anti-VEGF treatment. Only patients with monthly follow-up over at least three years were considered. Number of intravitreal injections, visual acuity (VA), central retinal thickness (CRT), and subfoveal choroidal thickness (SFCT) were evaluated and compared to baseline as well as to an age- and gender-matched control group, who received anti-VEGF monotherapy.

RESULTS: Twenty patients were irradiated and had complete follow-up. Cumulatively, SRT patients needed significantly less injections than non-irradiated ones over three years (14 vs. 18, p ​= ​0.014), while median VA did not show statistically significant changes (0.4 logMAR at baseline to 0.65 logMAR at final follow-up, p ​= ​0.061). CRT remained steady, but SFCT showed a continuous thinning of almost 50 ​μm (p ​= ​0.031) in irradiated patients over three years. Multiple linear regression analysis revealed that SFCT and VA at time of irradiation are significant prognostic factors of VA change in SRT patients over the following three years (F(2,17) ​= ​23.946, p<0.001, R² of 0.738).

CONCLUSIONS: SRT significantly reduced the cumulative anti-VEGF treatment burden over three years, however, this was mainly driven by the results of the first year after irradiation. A thinner SFCT at time of irradiation was associated with poorer visual outcome. While further research and investigation are warranted to elucidate the underlying pathogenesis, SFCT could be a potential biomarker when evaluating a patient’s suitability for SRT.

PMID:33730635 | DOI:10.1016/j.advms.2021.03.002

Lung Cancer. 2021 Feb 19;155:53-60. doi: 10.1016/j.lungcan.2021.02.021. Online ahead of print.

ABSTRACT

OBJECTIVES: This post hoc analysis assessed the safety of pemetrexed and platinum in combination with pembrolizumab, including time-to-onset and time-to-resolution of all-cause any-grade and grade ≥3 adverse events (AEs) and renal AEs.

MATERIALS AND METHODS: Patient-level data from KEYNOTE-189 were analyzed in the all-subjects-as-treated population (pembrolizumab arm, n = 405; placebo arm, n = 202), and among patients who received ≥5 cycles of pemetrexed (pemetrexed/pembrolizumab/platinum arm, n = 310; pemetrexed/placebo/platinum arm, n = 135). All-cause AEs were selected based on ≥2 % incidence from previously reported KEYNOTE-189 data and included neutropenia, febrile neutropenia, anemia, thrombocytopenia, asthenia, fatigue, dyspnea, diarrhea, nausea, vomiting, pneumonitis, and renal events. Descriptive statistics summarized all-cause AEs. Medians and interquartile ranges were used to examine time-to-onset and time-to-resolution. The data cutoff was November 8, 2017.

RESULTS: In both treatment arms, most non-hematologic (nausea, vomiting, diarrhea, and asthenia), and hematologic (febrile neutropenia, thrombocytopenia, and neutropenia) grade ≥3 AEs with ≥2 % incidence had a median time-to-onset within the first 4 cycles, and a median time-to-resolution of within 2 weeks from onset. A small number of AEs had longer median time-to-onset (pneumonitis and fatigue) and median time-to-resolution (pneumonitis, fatigue, acute kidney injury, and anemia). Among patients who received ≥5 cycles of pemetrexed, the incidence of any-grade renal toxicity in the pemetrexed/pembrolizumab/platinum arm was 2.3 % in Cycles 1-4, 4.8 % in Cycles 5-8, 2.6 % in Cycles 9-12, and 2.5 % in Cycles ≥13; and, in the pemetrexed/placebo/platinum arm, 0.7 % in Cycles 1-4, 1.5 % in Cycles 5-8, 1.3 % in Cycles 9-12, and 2.0 % in Cycles ≥13.

CONCLUSION: Pemetrexed/pembrolizumab/platinum has manageable toxicity with longer duration of treatment. While the incidence of renal toxicity was slightly higher in the pembrolizumab combination as compared to pemetrexed, the incidence did not increase in later treatment cycles. These results support the safe use of the KEYNOTE-189 regimen in clinical practice.

CLINICAL TRIAL REGISTRATION NUMBER: NCT02578680 (clinicaltrials.gov).

PMID:33730652 | DOI:10.1016/j.lungcan.2021.02.021

Am J Hum Genet. 2021 Mar 10:S0002-9297(21)00058-6. doi: 10.1016/j.ajhg.2021.02.016. Online ahead of print.

ABSTRACT

Tests of association between a phenotype and a set of genes in a biological pathway can provide insights into the genetic architecture of complex phenotypes beyond those obtained from single-variant or single-gene association analysis. However, most existing gene set tests have limited power to detect gene set-phenotype association when a small fraction of the genes are associated with the phenotype and cannot identify the potentially “active” genes that might drive a gene set-based association. To address these issues, we have developed Gene set analysis Association Using Sparse Signals (GAUSS), a method for gene set association analysis that requires only GWAS summary statistics. For each significantly associated gene set, GAUSS identifies the subset of genes that have the maximal evidence of association and can best account for the gene set association. Using pre-computed correlation structure among test statistics from a reference panel, our p value calculation is substantially faster than other permutation- or simulation-based approaches. In simulations with varying proportions of causal genes, we find that GAUSS effectively controls type 1 error rate and has greater power than several existing methods, particularly when a small proportion of genes account for the gene set signal. Using GAUSS, we analyzed UK Biobank GWAS summary statistics for 10,679 gene sets and 1,403 binary phenotypes. We found that GAUSS is scalable and identified 13,466 phenotype and gene set association pairs. Within these gene sets, we identify an average of 17.2 (max = 405) genes that underlie these gene set associations.

PMID:33730541 | DOI:10.1016/j.ajhg.2021.02.016

Ultrasonics. 2021 Mar 4;114:106411. doi: 10.1016/j.ultras.2021.106411. Online ahead of print.

ABSTRACT

This study investigated the application of dual-frequency type dynamic acoustic fields for size-selective particle separation on centimeter scale in a continuous flow. The 3D-printed X-shaped prototype has two inlets and two outlets. The dynamic acoustic field is generated by two transducers positioned under an angle of 60^° and operating at slightly different frequencies. The acoustic reflections are eliminated by placing sound-absorbing material inside the prototype and the non-resonant operation is confirmed by the electrical admittance measurements. Numerical calculations suggested that pressure generated by each transducer does not need to have equal amplitude. Computer simulations and lab experiments were carried out for different frequency differences and flow rates. The results demonstrated the ability of dual-frequency dynamic acoustic fields for size-selective particle filtration on centimeter scale, with a total flow rate up to.1Lh^-1.

PMID:33730595 | DOI:10.1016/j.ultras.2021.106411

J Stroke Cerebrovasc Dis. 2021 Mar 14;30(5):105672. doi: 10.1016/j.jstrokecerebrovasdis.2021.105672. Online ahead of print.

ABSTRACT

OBJECTIVES: The management of patients admitted with intracerebral hemorrhage (ICH) mostly occurs in an ICU. While guidelines recommend initial treatment of these patients in a neurocritical care or stroke unit, there is limited data on which patients would benefit most from transfer to a comprehensive stroke center where on-site neurosurgical coverage is available 24/7. As neurocritical units become more common in primary stroke centers, it is important to determine which patients are most likely to require neurosurgical intervention and transfer to comprehensive stroke centers.

MATERIALS AND METHODS: This is a retrospective observational cohort study conducted at an academic comprehensive stroke center in the United States. Four-hundred-fifty-nine consecutive patients transferred or directly admitted to the neurocritical care unit from 2016-2018 with the primary diagnosis of ICH were included. Univariate statistics and multivariate regression were used to identify clinical characteristics associated with neurosurgical intervention, defined as undergoing craniotomy, ventriculostomy, or endovascular embolization of an arteriovenous malformation (AVM).

RESULTS: The following variables were associated with neurosurgical intervention in multivariate analysis: age (OR 0.38, 95% CI 0.27-0.55), admission Glasgow Coma Scale (OR 0.29, 95% CI 0.18-0.48), the presence of intraventricular hemorrhage (OR 2.82, CI 1.71-4.65), infratentorial location of ICH (OR 2.28, 95% CI 1.20-4.31), previous antiplatelet use (OR 2.04, 95% CI 1.24-3.34), and an AVM indicated on CT Angiogram (OR 2.59, 95% CI 1.19-5.63) were independently associated with the need for neurosurgical intervention. This was translated into a scoring system to help make quick triage decisions, with high sensitivity (99%, 95% CI 97-99%) and negative predictive value (98%, 95% CI 89-99%).

CONCLUSIONS: Using previously well described predictors of severity in ICH patients, we were able to develop a scoring system to predict the need for neurosurgical intervention with high sensitivity and negative predictive value.

PMID:33730599 | DOI:10.1016/j.jstrokecerebrovasdis.2021.105672