Tag: pubmed

Phys Med Biol. 2021 Sep 1. doi: 10.1088/1361-6560/ac22dc. Online ahead of print.

ABSTRACT

Brain-shift during neurosurgery compromises the accuracy of tracking the boundaries of the tumor to be resected. Although several studies have used various finite element models (FEMs) to predict inward brain-shift, evaluation of their accuracy and efficiency based on public benchmark data has been limited. This study evaluates several FEMs proposed in the literature (various boundary conditions, mesh sizes, and material properties) by using intraoperative imaging data (the public REtroSpective Evaluation of Cerebral Tumors [RESECT] database). Four patients with low-grade gliomas were identified as having inward brain-shifts. We computed the accuracy (using target registration error) of several FEM-based brain-shift predictions and compared our findings. Since information on head orientation during craniotomy is not included in this database, we tested various plausible angles of head rotation. We analyzed the effects of brain tissue viscoelastic properties, mesh size, craniotomy position, cerebrospinal fluid drainage level, and rigidity of meninges and then quantitatively evaluated the trade-off between accuracy and central processing unit time in predicting inward brain-shift across all models with second-order tetrahedral FEMs. The mean initial Target Registration Error (TRE) was 5.78±3.78 mm with rigid registration. FEM prediction (edge-length, 5 mm) with non-rigid meninges led to a mean TRE correction of 1.84±0.83 mm assuming heterogeneous material. Results show that, for the low-grade glioma patients in the study, including non-rigid modeling of the meninges was significant statistically. In contrast including heterogeneity was not significant. To estimate the optimal head orientation and CSF drainage, an angle step of 5° and an CSF height step of 5 mm were enough leading to <0.26mm TRE fluctuation.

PMID:34469879 | DOI:10.1088/1361-6560/ac22dc

Am J Ther. 2021 Aug 19. doi: 10.1097/MJT.0000000000001422. Online ahead of print.

ABSTRACT

BACKGROUND: This study aims to compare the poisoned patients who could not be administered activated charcoal because of its unavailability with the poisoned patients who were administered charcoal in the later period and to reveal the results about its effectiveness.

STUDY QUESTION: Is the use of activated charcoal effective against poisoning caused by oral medication?

STUDY DESIGN: This retrospective cohort study with historical control was planned at a tertiary hospital. Patients older than 18 years were admitted to the emergency department because of oral drug poisoning during the study periods. A total of 1159 patients who were not given activated charcoal and 877 patients who were given activated charcoal were included in this study.

MEASURES AND OUTCOMES: The frequency of clinical findings secondary to the drug taken, the frequency of antidote use, the frequency of intubation, and the hospitalization length were determined as clinical outcome parameters.

RESULTS: There was no statistically significant difference in the development of central nervous system findings, cardiovascular system findings, frequency of intubation, and blood gas disorders, as well as the length of hospitalization periods according to the activated charcoal application. Hepatobiliary system findings and electrolyte disturbances were found to be less common in patients given activated charcoal. The frequency of tachycardia, speech impairment, coma, and respiratory acidosis was found to be statistically higher in patients who were administered activated charcoal. The hospitalization period of the patients who were given activated charcoal was longer in patients with drug findings; however, there was no difference in the hospitalization periods of the patients who were given an antidote.

CONCLUSIONS: The use of activated charcoal in poisoned patients may not provide sufficient clinical benefits. However, clinical studies with strong evidence levels are needed to determine activated charcoal’s clinical efficacy, which is still used as a universal antidote.

PMID:34469920 | DOI:10.1097/MJT.0000000000001422

Neuroimage. 2021 Aug 29;243:118518. doi: 10.1016/j.neuroimage.2021.118518. Online ahead of print.

ABSTRACT

Null models are useful for assessing whether a dataset exhibits a non-trivial property of interest. These models have recently gained interest in the neuroimaging community as means to explore dynamic properties of functional Magnetic Resonance Imaging (fMRI) time series. Interpretation of null-model testing in this context may not be straightforward because (i) null hypotheses associated to different null models are sometimes unclear and (ii) fMRI metrics might be ‘trivial’, i.e. preserved under the null hypothesis, and still be useful in neuroimaging applications. In this commentary, we review several commonly used null models of fMRI time series and discuss the interpretation of the corresponding tests. We argue that, while null-model testing allows for a better characterization of the statistical properties of fMRI time series and associated metrics, it should not be considered as a mandatory validation step to assess their relevance in representing brain functional dynamics.

PMID:34469853 | DOI:10.1016/j.neuroimage.2021.118518

J Affect Disord. 2021 Aug 24;295:183-191. doi: 10.1016/j.jad.2021.08.025. Online ahead of print.

ABSTRACT

BACKGROUND: Rhythms And You (RAY) is an online intervention for bipolar disorders (BD) based on Interpersonal and Social Rhythm Therapy. We examined RAY’s feasibility and acceptability for individuals with BD recruited from primary care. Because online interventions may be more effective when paired with human support, we evaluated RAY with and without weekly brief (∼5 min) calls from clinical helpers (CH).

METHODS: Participants (n = 47) meeting criteria for BD I, II or other specified BD, presenting for primary care, were randomly assigned to RAY, RAY-CH, or Adjunctive Reading Material (ARM) control. RAY consisted of 12 weekly online modules. ARM consisted of 12 weekly emails. Participants were assessed at baseline, 4, 8, and 12 weeks.

RESULTS: RAY showed high completion rates and Client Satisfaction Questionnaire scores (36/47, 77% and 25.1 ± 5.5, respectively; no group differences). Effect sizes for RAY- CH ranged from small [Internal State Scale-Activation Subscale (ISS-ACT); d = 0.3] to large [SF-12 Mental Health Composite Score (SF-12 MHC); d = 1.3]. ARM also showed moderate effects (ISS-ACT d = 0.7; Quick Inventory of Depressive Symptoms, d = 0.8). SF-12 MHC scores showed a time*group interaction (F = 2.38, df = 6,32, p = 0.05) favoring RAY-CH. Number of logins trended toward significant association with improved social rhythm regularity (F = 4.09, df = 1, 17, p = 0.06).

LIMITATIONS: Sample size is small, limiting conclusions that can be drawn.

CONCLUSIONS: Remote delivery of RAY for individuals with BD is feasible and acceptable. More time spent engaged in RAY was associated with greater improvement in social rhythm regularity. Preliminary evidence suggests adding brief human support to RAY may yield better outcomes.

PMID:34469857 | DOI:10.1016/j.jad.2021.08.025

Neurosurg Focus. 2021 Sep;51(3):E9. doi: 10.3171/2021.6.FOCUS21112.

ABSTRACT

OBJECTIVE: This prospective study was designed to confirm the role of atorvastatin in collateral circulation formation induced by encephaloduroarteriosynangiosis (EDAS) in patients with moyamoya disease (MMD).

METHODS: Patients who were diagnosed with MMD at the Department of Neurosurgery in the Fifth Medical Center of Chinese PLA General Hospital, Beijing, China, between June 2017 and May 2018 were included. Blood samples were obtained from an antecubital vein and were analyzed using flow cytometry. Endothelial progenitor cells (EPCs) were defined as CD34brCD133+CD45dimKDR+. All patients included in the study underwent EDAS. Patients voluntarily chose whether to undergo atorvastatin treatment after EDAS. The correlation between atorvastatin and good postoperative collateral circulation was evaluated.

RESULTS: A total of 106 patients with MMD were included in this study. Fifty-three patients (50%) received atorvastatin treatment. The baseline characteristics did not display statistically significant differences between the atorvastatin-treated and non-atorvastatin groups. Seventy-eight (42.9%) of the 182 hemispheres investigated postoperatively were classified as grade A collateral circulation, 47 (25.8%) as grade B, and 57 (31.3%) as grade C. Multivariate analysis revealed that only atorvastatin was significantly correlated with good collateral circulation after EDAS (p = 0.041).

CONCLUSIONS: The results of this prospective clinical trial have indicated that atorvastatin administered at 20 mg daily is safe and effective for the formation of postoperative collateral induced by EDAS.

PMID:34469867 | DOI:10.3171/2021.6.FOCUS21112

Psychiatry Res. 2021 Aug 21;305:114173. doi: 10.1016/j.psychres.2021.114173. Online ahead of print.

ABSTRACT

Using daily vital statistics data from the Japanese Ministry of Health, Labour and Welfare, we provide the first weekly and age-group-specific estimates of the additional suicide burden during the COVID-19 pandemic in Japan by gender, from January through November 2020. Our results indicate that compared with the previous five years, suicide cases in 2020 in Japan have increased from late July to November for women in all age groups and for men in the 20-29 and 80+ years age group. Targeted interventions based on age and gender might be more effective in reducing suicide during the COVID-19 pandemic in Japan.

PMID:34469804 | DOI:10.1016/j.psychres.2021.114173

J Minim Invasive Gynecol. 2021 Aug 29:S1553-4650(21)00404-0. doi: 10.1016/j.jmig.2021.08.018. Online ahead of print.

ABSTRACT

STUDY OBJECTIVE: To investigate the therapeutic efficacy of catheter-directed ethanol sclerotherapy (CDS) and its effect on ovarian reserve in patients with endometrioma at risk of decreased ovarian reserve.

DESIGN: A retrospective study.

SETTING: A teaching hospital.

PATIENTS: We evaluated 18 patients with ovarian endometrioma measuring ≥3 cm and pre-procedural serum anti-Müllerian hormone (AMH) levels of <2 ng/mL.

INTERVENTIONS: An 8.5-F catheter was inserted either transabdominally or transvaginally into the endometrioma. Following aspiration, sclerotherapy with 99% ethanol was performed, with subsequent 20-minute ethanol retention.

MEASUREMENTS AND MAIN RESULTS: Ultrasonography (US) was performed pre-procedurally and 6 months following CDS to evaluate any recurrence or changes in cyst size. Further, serum AMH levels, CA-125 levels, and the visual analog scale (VAS) scores for dysmenorrhea were obtained to analyze the ovarian reserve and treatment efficacy, pre-procedurally and at 6 months after CDS. The mean cyst size on US and serum CA-125 levels decreased 6 months after CDS (p < .001, and p = .001, respectively). All patients reported a decreased VAS score for dysmenorrhea (p < .001). However, the difference in serum AMH levels before and after CDS was statistically insignificant (p = .875).

CONCLUSION: CDS was efficacious in reducing pain and serum CA-125 levels in patients with low AMH levels without adversely affecting their ovarian reserve.

PMID:34469826 | DOI:10.1016/j.jmig.2021.08.018

Int J Drug Policy. 2021 Aug 29;98:103400. doi: 10.1016/j.drugpo.2021.103400. Online ahead of print.

ABSTRACT

BACKGROUND: The Ottawa Inner City Health’s Managed Opioid Program is the first, to our knowledge, to pair injectable opioid agonist hydromorphone treatment with assisted housing for people experiencing homelessness with severe opioid use disorder (OUD) and injection drug use. We aimed to describe this program and evaluate retention, health, and social wellbeing outcomes.

METHODS: We retrospectively assessed the first cohort of clients enrolled in the Managed Opioid Program between August 2017-2018. The primary outcome was retention at 12 months. Secondary outcomes included injectable and oral opioid dose titration, non-prescribed opioid use, overdoses, connection with behavioural health services, and social well-being. Descriptive statistics were used to summarize baseline demographics and secondary outcomes. Actuarial survival analysis was used to assess retention among participants.

RESULTS: The study sample included 26 participants: median age was 36 years, 14 were female, 22 were White, eight had alcohol use disorders, 25 had stimulant use disorders, and all had a history of concurrent psychiatric illness. Retention at 12 months was 77% (95% CI 62-95). Throughout the first-year participants’ opioid treatment doses increased. The median daily dose of injectable hydromorphone was 36 mg [17-54 mg] and 156 mg [108-188 mg] at enrollment and one year respectively. The median daily dose of oral opioid treatment was 120-milligram morphine equivalents [83-180 mg morphine equivalents] and 330-milligram morphine equivalents [285-428 mg morphine equivalents] at enrollment and one year respectively. Over half had no overdoses and there were no deaths among participants who remained enrolled. At one year, 45% stopped non-prescribed opioid use, 96% connected to behavioral health services, 73% reconnected with estranged families, and 31% started work or vocational programs.

CONCLUSION: Individuals with severe OUD engaged in injectable hydromorphone treatment and housing showed high retention in care and substantive improvements in patient-centered health and social well-being outcomes.

PMID:34469781 | DOI:10.1016/j.drugpo.2021.103400

J Neurophysiol. 2021 Sep 1. doi: 10.1152/jn.00181.2021. Online ahead of print.

ABSTRACT

Huntington’s disease (HD) is a fatal, hereditary neurodegenerative disorder that predominantly affects striatal medium-sized spiny neurons and cortical pyramidal neurons (CPNs). It has been proposed that perturbations in Ca²⁺ homeostasis could play a role in CPN alterations. To test this hypothesis, we used the R6/2 mouse model of juvenile HD at different stages of disease progression; presymptomatic, early symptomatic, and late symptomatic. We combined whole-cell patch clamp recordings of layer 2/3 CPNs with two-photon laser scanning microscopy to image somatic and dendritic Ca²⁺ transients associated with evoked action potentials (APs). We found that the amplitude of AP-induced Ca²⁺ transients recorded at the somata of CPNs was significantly reduced in presymptomatic and late symptomatic R6/2 mice compared to wildtype (WT) littermates. However, reduced amplitudes were compensated by increases in decay times, so that Ca²⁺ transient areas were similar between genotypes. AP-induced Ca²⁺ transients in CPN proximal dendrites were variable and differences did not reach statistical significance, except for reduced areas in the late symptomatic group. In late symptomatic mice, a specific store-operated Ca²⁺ channel antagonist, EVP4593, reduced somatic Ca²⁺ transient amplitude similarly in WT and R6/2 CPNs. In contrast, dantrolene, a ryanodine receptor (RyR) antagonist, and nifedipine, an L-type Ca²⁺ channel blocker, significantly reduced both somatic Ca²⁺ transient amplitude and area in R6/2 but not WT CPNs. These findings demonstrate that perturbations of Ca²⁺ homeostasis and compensation occur in CPNs before and after the onset of overt symptoms, and suggest RyRs and L-type Ca²⁺ channels as potential targets for therapeutic intervention.

PMID:34469694 | DOI:10.1152/jn.00181.2021

Environ Res. 2021 Aug 29:111977. doi: 10.1016/j.envres.2021.111977. Online ahead of print.

ABSTRACT

STUDY OBJECTIVES: The neurobiological processes involved in establishing sleep regulation are vulnerable to environmental exposures as early as seven weeks of gestation. Studies have linked. in utero pesticide exposure to childhood sleep-disordered breathing. However, the impact of in utero pesticide exposure on the sleep health of adolescents remains unexplored.

MATERIALS AND METHODS: Data from 137 mother-adolescent pairs from a Mexico City cohort were analyzed. We used maternal urinary 3-phenoxybenzoic acid (3-PBA, pyrethroid metabolite) and 3, 5, 6-trichloro-2-pyridinol (TCPy, chlorpyrifos metabolite) from trimester three to estimate in utero pesticide exposure. Among adolescents, we obtained repeated measures of objectively assessed sleep duration, midpoint, and fragmentation using wrist-actigraphy devices for 7 consecutive days in 2015 and 2017. Unstratified and sex-stratified associations between maternal urinary 3-PBA and TCPy and adolescent sleep measures were examined using linear mixed models. We also examined the interactive effects of maternal pesticide exposure and offspring sex on sleep outcomes.

RESULTS: 3-PBA and TCPy were detected in 44.4% and 93% of urine samples, respectively. In adjusted models, we observed monotonic associations between TCPy with longer sleep duration and later sleep midpoint. Adjusted findings demonstrated that higher exposure to maternal TCPy was associated with longer sleep duration (p, trend = 0.01), and later sleep timing (p = 0.07). Findings from interaction tests between exposure and offspring sex were not statistically significant. Adjusted sex-stratified findings showed that the association between TCPy with duration and midpoint was evident only among female offspring; those in the highest tertile of exposure had a 59 min (95% CI: 12.2, 104.8) (p, trend = 0.004) longer sleep duration and a 0.6 h (95% CI: 0.01, 1.3) (p, trend = 0.01) later sleep midpoint. We found no significant associations between 3-PBA and sleep outcomes.

CONCLUSION: Although findings from interaction tests were not statistically significant, effect estimates demonstrated that associations between maternal pesticide exposure and longer sleep duration and later sleep timing were stronger in female offspring.

PMID:34469742 | DOI:10.1016/j.envres.2021.111977