CI For Difference Research Articles

Harnessing AI to Optimize Thought Records and Facilitate Cognitive Restructuring in Smartphone CBT: An Exploratory Study

BackgroundEffective cognitive restructuring (CR) requires identification of automatic thoughts that underlie experienced emotions. However, accurate recording of thoughts and emotions is challenging when CR is provided in internet cognitive-behavior therapy (iCBT). This study investigated the potential use of the artificial intelligence (AI) including the natural language processing (NLP) to facilitate CR offered in iCBT.MethodsWe applied the Japanese Text-to-Text Transfer Transformer (T5), one of the most advanced Large Language Models for the NLP,to records of thought-feeling pairs provided by participants in two randomized controlled trials of iCBT. We conducted threefold cross-validated prediction of self-reported feelings based on recorded thoughts. We examined the validity of the predictions by checking them against the human expert judgments and by the efficacy when the thought records were subjected to CR.Results1626 participants provided 4369 though-feeling records. The overall prediction accuracy was 73.5%. The self-reported feelings matched the human expert judgments more frequently when they were correctly predicted by the T5 than not (90% vs 37.5%, 95%CI of difference: 34.8 to 70.2%). When subjected to CR, the correctly predicted thought-feeling pairs led to greater reductions in negative feelings than the incorrectly predicted pairs (− 1.54 vs − 1.43 on a scale of 0 to 5, 95%CI of difference: 0.03 to 0.19).ConclusionsA new CR module of an iCBT application can incorporate this model and advise the users to revisit and revise their automatic thoughts to reflect their feelings more accurately. Whether such an iCBT application can ultimately lead to greater reductions in depression is to be examined in a future randomized trial.

Normal glymphatic system function in patients with new daily persistent headache using diffusion tensor image analysis along the perivascular space.

To investigate the glymphatic function in patients with new daily persistent headache (NDPH) using the diffusion tensor image analysis along the perivascular space (DTI-ALPS) method. NDPH, a rare and treatment-refractory primary headache disorder, is poorly understood. There is limited evidence to suggest that headaches are associated with glymphatic dysfunction. Thus far, no studies have evaluated glymphatic function in patients with NDPH. In this cross-sectional study conducted in the Headache Center of Beijing Tiantan Hospital, patients with NDPH and healthy controls were enrolled. All participants underwent brain magnetic resonance imaging examinations. Clinical characteristics and neuropsychological evaluation were examined in patients with NDPH. ALPS indexes for both hemispheres were measured to determine the glymphatic system function in patients with NDPH and healthy controls. In total, 27 patients with NDPH (14 males, 13 females; age [mean ± standard deviation (SD)]: 36.6 ± 20.6) and 33 healthy controls (15 males, 18 females; age [mean ± SD]: 36.0 ± 10.8) were included in the analysis. No significant differences between groups were observed in the left ALPS index (1.583 ± 0.182 vs. 1.586 ± 0.175, mean difference = 0.003, 95% confidence interval [CI] of difference = -0.089 to 0.096, p = 0.942), or right ALPS index (1.578 ± 0.230 vs. 1.559 ± 0.206, mean difference = -0.027, 95% CI of difference = -0.132 to 0.094, p = 0.738). Additionally, ALPS indexes were not correlated with clinical characteristics or neuropsychiatric scores. No glymphatic dysfunction was detected in patients with NDPH by means of the ALPS method. Additional studies with larger samples are needed to confirm these preliminary findings and improve the understanding of glymphatic function in NDPH.

Serum alpha and beta-CGRP levels in chronic migraine patients before and after monoclonal antibodies against CGRP or its receptor.

To analyse the evolution of alpha and beta-CGRP circulating levels throughout CGRP monoclonal antibodies (mAb) treatment in chronic migraine (CM) patients. We recruited CM patients beginning mAb along with sex and age paired healthy controls (HC). Blood was extracted before, two-weeks (M0.5) and three months (M3) after first dose of mAb, always in free-migraine periods, and once for HCs. Alpha and beta-CGRP serum levels were measured using ELISAs specific for each isoform. Baseline alpha-CGRP levels were significantly elevated in 103 CM patients (median [95% CI]: 50.3 [40.5-57.0] pg/mL) compared to 78 HC (37.5 [33.9-45.0] pg/mL; 95% CI of differences: 2.85-17.08 pg/mL) and significantly decreased (n=96) over the course of mAb treatment (M0.5: 40.4 [35.6-48.2] pg/mL; M3: 40.9 [36.3-45.9] pg/mL). Absolute decrease of alpha-CGRP throughout the treatment positively correlated with the decrease in monthly migraine days. Negative modulation of alpha-CGRP significantly associated with positive scores at the patient global impression of change scale and with analgesic overuse reversal. Beta-CGRP did not differ at baseline between CM patients (4.2 [3.0-4.8] pg/mL) and HC (4.4 [3.4-5.6] pg/mL; -1.09 to 0.60) nor was modulated by mAb treatment (n=96) (M0.5: 4.5 [3.5-5.2] pg/mL; M3: 4.6 [3.7-5.2] pg/mL). Treatment with mAb, regardless of its target, is able to progressively normalize basally increased alpha-CGRP levels in CM and this effect correlates with efficacy measures, which supports a role of this neuropeptide as the first CM biomarker. This article is protected by copyright. All rights reserved.

Incidence of new-onset in-hospital and persistent diabetes in COVID-19 patients: comparison with influenza.

This study investigated the incidences and risk factors associated with new-onset persistent type-2 diabetes during COVID-19 hospitalization and at 3-months follow-up compared to influenza. This retrospective study consisted of 8216 hospitalized, 2998 non-hospitalized COVID-19 patients, and 2988 hospitalized influenza patients without history of pre-diabetes or diabetes in the Montefiore Health System in Bronx, New York. The primary outcomes were incidences of new-onset in-hospital type-2 diabetes mellitus (I-DM) and persistent diabetes mellitus (P-DM) at 3 months (average) follow-up. Predictive models used 80%/20% of data for training/testing with five-fold cross-validation. I-DM was diagnosed in 22.6% of patients with COVID-19 compared to only 3.3% of patients with influenza (95% CI of difference [0.18, 0.20]). COVID-19 patients with I-DM compared to those without I-DM were older, more likely male, more likely to be treated with steroids and had more comorbidities. P-DM was diagnosed in 16.7% of hospitalized COVID-19 patients versus 12% of hospitalized influenza patients (95% CI of difference [0.03,0.065]) but only 7.3% of non-hospitalized COVID-19 patients (95% CI of difference [0.078,0.11]). The rates of P-DM significantly decreased from 23.9% to 4.0% over the studied period. Logistic regression identified similar risk factors predictive of P-DM for COVID-19 and influenza. The adjusted odds ratio (0.90 [95% CI 0.64,1.28]) for developing P-DM was not significantly different between the two viruses. The incidence of new-onset type-2 diabetes was higher in patients with COVID-19 than influenza. Increased risk of diabetes associated with COVID-19 is mediated through disease severity, which plays a dominant role in the development of this post-acute infection sequela. None.

Readmission Rates and Episode Costs for Alzheimer Disease and Related Dementias Across Hospitals in a Statewide Collaborative

There has been a paucity of research examining the risk and cost of readmission among patients with Alzheimer disease and related dementias (ADRD) after a planned hospitalization for a broad set of medical and surgical procedures. To examine 30-day readmission rates and episode costs, including readmission costs, for patients with ADRD compared with their counterparts without ADRD across Michigan hospitals. This retrospective cohort study used 2012 to 2017 Michigan Value Collaborative data across different medical and surgical services stratified by ADRD diagnosis. A total of 66 676 admission episodes of care that occurred between January 1, 2012, and June 31, 2017, were identified for patients with ADRD using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnostic codes for ADRD, along with 656 235 admission episodes in patients without ADRD. Using a generalized linear model framework, this study risk adjusted, price standardized, and performed episode payment winsorization. Payments were risk adjusted for age, sex, Hierarchical Condition Categories, insurance type, and prior 6-month payments. Selection bias was accounted for using multivariable logistic regression with propensity score matching without replacement using calipers. Data analysis was performed from January to December 2019. Presence of ADRD. Main outcomes were 30-day readmission rate at the patient and county levels, 30-day readmission cost, and 30-day total episode cost across 28 medical and surgical services. The study included 722 911 hospitalization episodes, of which 66 676 were related to patients with ADRD (mean [SD] age, 83.4 [8.6] years; 42 439 [63.6%] female) and 656 235 were related to patients without ADRD (mean [SD] age, 66.0 [15.4] years; 351 246 [53.5%] female). After propensity score matching, 58 629 hospitalization episodes were included for each group. Readmission rates were 21.5% (95% CI, 21.2%-21.8%) for patients with ADRD and 14.7% (95% CI, 14.4%-15.0%) for patients without ADRD (difference, 6.75 percentage points; 95% CI, 6.31-7.19 percentage points). Cost of 30-day readmission was $467 higher (95% CI of difference, $289-$645) among patients with ADRD ($8378; 95% CI, $8263-$8494) than those without ($7912; 95% CI, $7776-$8047). Across all 28 service lines examined, total 30-day episode costs were $2794 higher for patients with ADRD vs patients without ADRD ($22 371 vs $19 578; 95% CI of difference, $2668-$2919). In this cohort study, patients with ADRD had higher readmission rates and overall readmission and episode costs than their counterparts without ADRD. Hospitals may need to be better equipped to care for patients with ADRD, especially in the postdischarge period. Considering that any type of hospitalization may put patients with ADRD at a high risk of 30-day readmission, judicious preoperative assessment, postoperative discharge, and care planning are strongly advised for this vulnerable patient population.

Early Use of Biologics Reduces Healthcare Costs in Crohn's Disease: Results from a United States Population-Based Cohort.

Early initiation of biologics in moderate-to-severe Crohn's disease (CD) may significantly alter disease progression, resulting in better patient outcomes. Limited real-world data exist on the impact of early biologic use in patients with CD in the United States. We aimed to characterize biologic initiation and subsequent healthcare resource utilization (HCRU) in adults with recently diagnosed CD. Patients with CD who initiated biologic treatment within 2years of diagnosis (index date) were identified from medical and pharmacy claims (Merative L.P. MarketScan Database from 2010 to 2016) and classified as early (≤ 12months post-index) or late (> 12-24months post-index) biologic initiators. Propensity score matching balanced patient characteristics up to 1year post-index. Differences in HCRU frequency and costs 1-2years post-index were compared between the matched groups. After propensity score matching, 672 pairs of early and late biologic initiators were identified. Patients who initiated biologics early had fewer outpatient visits (15.5 vs 19.8, 95% confidence interval [CI] for difference: 2.7, 6.1) and lower total medical costs ($13,646.20 vs $22,180.70, 95% CI for difference: 4748.9, 12,320.1) 1-2years post-index than late biologic initiators. Early biologic initiators had higher medication costs 1-2years post-index ($33,766.30 vs $30,580.70, 95% CI: 546.1, 5825.1) but lower combined medical and medication costs ($47,412.50 vs $52,761.50, 95% CI: 801.5, 9896.40). While biologic treatments are costly, patients initiating biologics sooner after diagnosis appear to have better HCRU outcomes and require fewer healthcare resources at 1-2years post-index, potentially leading to overall cost savings.

Comparison of Perimetric Outcomes from a Tablet Perimeter, Smart Visual Function Analyzer, and Humphrey Field Analyzer

The tablet-based Melbourne Rapid Fields (MRF) visual field (VF) test and the IMOvifa Smart Visual Function Analyzer (SVFA) are portable perimeters that may allow for at-home monitoring and more frequent testing. We compared tablet and SVFA results with outputs from the Humphrey Field Analyzer (HFA) 24-2 Swedish Interactive Threshold Algorithm Standard program. Observational cross-sectional study. Adult participants with a diagnosis of glaucoma, suspected glaucoma, or ocular hypertension seen in the Massachusetts Eye and Ear glaucoma clinic were enrolled. All participants were reliable and experienced HFA testers. Participants were tested with the SVFA and HFA. The study staff also trained participants on the MRF tablet with instructions to take weekly tests at home for 3 months. Visual field results from the 3 devices were compared. Mean deviation (MD), pattern standard deviation (PSD), reliability parameters, and point sensitivity. Overall, 79 participants (133 eyes) with a mean age of 61±13 years (range, 26-79 years) were included; 59% of the participants were female, and the mean HFA MD was-2.7±3.9 dB. The global indices of MD and PSD did not significantly vary between HFA and the 2 novel devices, except that the tablet VF reported a 0.6 dB higher PSD compared with HFA. However, tablet and SVFA sensitivities significantly differed from those of the HFA at 36 and 39 locations, respectively, out of 52 locations. Relative to HFA, the tablet overestimated light sensitivity in the nasal field while underestimating the temporal field. The SVFA generally underestimated light sensitivity, but its results were more similar to HFA results compared with the tablet. Although average MD values from the 2 novel devices suggest that they provide similar results to the HFA, point-by-point comparisons highlight notable deviations. Differences in specific point sensitivity values were significant, especially between the tablet and the other 2 devices. These differences may in part be explained by differences in the devices' normative databases as well as how MD is calculated. However, the tablet had substantial differences based on location, indicating that the tablet design itself may be responsible for differences in local sensitivities. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Effects of combined interventions to optimize recovery during high-intensity exercises in trained individuals

Background
 Team sports such as ice hockey offer the opportunity of recovery breaks between high-intensity work intervals. Strategies aiming to mitigate fatigue during intermittent physical activity are seldom investigated in combination, although several different mechanisms of action exist, which might be cumulative and therefore beneficial for athletes. This study examined the effects of seven combined recovery interventions (enhanced recovery package, ERP) on exercise capacity during intermittent high-intensity cycling.
 Methods
 Sixteen trained men (age: 24.8 ± 3.4 y; maximal power output: 5.0 ± 0.5 W･kg-1) completed a repeated sprint exercise (RSE) protocol consisting of six 30-s cycling sprints with 3-min breaks between each sprint. The first sprint was always performed at a similar load, while sprints 2-6 were performed with the ergometer in cadence dependent mode (0.075 kg･kg-1). During the breaks, the ERP, Placebo, or Control protocols were applied, all on different days. The ERP condition combined 1) 3-min ice gel packs to the neck; 2, 3) 5-s mouth rinsing of a 10% carbohydrate and caffeine (6 mg･kg-1), 4) ingestion of 50 ml of a 6% carbohydrate solution, 5, 6) 30 s of all-out hyperventilation while breathing 100% O2 (hyperoxia); and finally, 7) potentiation maneuvers via performance of 3 half-squats at 75% of one maximal repetition. The placebo intervention masked the interventions except for the ice packs and potentiation maneuvers. Participants were told they were performing a simplified version with only the known beneficial interventions. Power output, heart rate, blood lactate concentration, rate of perceived exertion and gas exchange were compared between the ERP and Placebo conditions.
 Results
 Mean power output (W) was significantly higher for the ERP condition compared to Placebo (570 ± 74 W vs. 560 ± 71 W, t(15) = 4.603, P < 0.001, 95% CI diff = 5 – 14 W, dz = 1.15). The rate of power decrement over sprints 2-6 was very similar between trials (ERP -14.2 W per sprint, 95% CI = -21.6 – -6.8 W; Placebo -17.4 W per sprint, 95% CI = -24.7 – -10.2 W per sprint, P = 0.407). Mean heart rate was higher (3 ± 4 bpm, P = 0.012) for the ERP compared to the Placebo condition, as was breathing frequency (2.4 ± 4.0 breaths･min-1, P = 0.028) and respiratory exchange ratio (0.12 ± 0.06, P < 0.001). Oxygen uptake was 80 ± 109 ml･min-1 (P = 0.013) lower for ERP. No differences were found with regards to the rate of perceived exertion or blood lactate concentration.
 Conclusion
 ERP optimized recovery when applied during the breaks of a high-intensity repeated sprint exercise and shows a small but consistent increase in mean power output. It is possible that the ERP prevented a loss of aerobic efficiency. A top-down approach when tailoring packages for individual athletes might overcome the issue of small improvements that are difficult to detect when strategies are tested in isolation.

Efficacy of an aid (gastric tube insertion guide) for oral insertion of a gastric tube: a randomized controlled trial

PurposeInsertion of a gastric tube orally may be more difficult than its insertion nasally, and thus, any aid to facilitate its insertion may be useful. Gastric tube insertion guide (Fuji Medical Corporation, Tokyo, Japan) has recently become commercially available. We felt that this device might be useful in facilitating oral insertion of a gastric tube, but there has been no formal study assessing its efficacy. The main aim of this study was to assess whether or not this “tube guide” would facilitate insertion of an orogastric tube.MethodsAs a randomized controlled clinical study, we planned to study 40 patients, to assess the hypothesis that the success rate of insertion of an orogastric tube would be higher with the use of the “tube guide” than without. Patients were recruited when they were 20 years old, or older, and allocated randomly to one of two groups (20 people each group). In one group, the conventional “blind” insertion method was used and in the other group the “tube guide” insertion method.ResultsThe success rate was significantly higher for the “tube guide” method than the “blind” insertion method (P = 0.0012, 95% CI for difference: 23–67%).ConclusionWe have shown that the use of the gastric tube insertion guide® facilitates insertion of an orogastric tube.

Abstract WMP51: Baseline Ct Perfusion Parameters Differ In Large Vessel Occlusion Stroke Patients With Reduced Left Ventricular Ejection Fraction

Introduction: Reduced left ventricular ejection fraction (EF) is associated with worse outcomes after stroke. CT perfusion (CTP) is widely used in acute stroke evaluation; its reliability in patients with reduced EF is unknown. We hypothesized that patients with reduced EF would have abnormal dose-time curves that may impair standard perfusion maps and reduce their quality. Methods: A retrospective database of all patients presenting to Stanford University for large vessel occlusion (LVO) stroke between 2010-2019 was used. CTPs were post-processed using RAPID software. Concentration-time curve metrics—width of the venous output function (VOF) at half maximum amplitude and VOF peak amplitude—were assessed automatically for each case. A reader blinded to EF visually evaluated the VOF curve for evidence of truncation (yes/no) and graded the quality of the time to maximum (Tmax) map on a scale from 0 (excellent) to 3 (poor), based on the degree of “speckling” present on the map. Continuous parameters were compared using the t-test or Mann-Whitney test and dichotomous parameters with the Fisher’s exact or Chi-square test, where appropriate. Results: 160 patients with sufficient quality baseline CTP and in-hospital echocardiogram were evaluated; 34 had EF <50%. Mean age, scan time, and cumulative contrast dose did not differ; men were more prevalent in the reduced EF group (68% vs 44%; p=0.016). Compared to patients with normal EF, patients with low EF more often had truncation of the VOF (11.8% vs 0.8%; p=0.007), had a lower VOF peak amplitude (mean 245.04 HU vs 299.07; p=0.013, 95% CI for difference 11.61 to 96.45), had wider VOF at half maximum amplitude (mean 17.84 seconds vs 14.56; p<0.0001, 1.9 to 4.65), and had worse Tmax quality (median 2 (IQR 1-3) vs 1 (0-2); p=0.002). Conclusion: Patients with reduced EF have dispersion of the contrast bolus as evidenced by a VOF curve that is wider and has a lower peak. Consequently, the quality of the Tmax map in patients with low EF is reduced, which may render automated CTP results unreliable. Additional studies are needed to determine to what extent poor CTP image quality in patients with low EF affects treatment decisions.

Automated detection of cardiac rest period for trigger delay calculation for image-based navigator coronary magnetic resonance angiography

BackgroundCoronary magnetic resonance angiography (coronary MRA) is increasingly being considered as a clinically viable method to investigate coronary artery disease (CAD). Accurate determination of the trigger delay to place the acquisition window within the quiescent part of the cardiac cycle is critical for coronary MRA in order to reduce cardiac motion. This is currently reliant on operator-led decision making, which can negatively affect consistency of scan acquisition. Recently developed deep learning (DL) derived software may overcome these issues by automation of cardiac rest period detection. MethodsThirty individuals (female, n = 10) were investigated using a 0.9 mm isotropic image-navigator (iNAV)-based motion-corrected coronary MRA sequence. Each individual was scanned three times utilising different strategies for determination of the optimal trigger delay: (1) the DL software, (2) an experienced operator decision, and (3) a previously utilised formula for determining the trigger delay. Methodologies were compared using custom-made analysis software to assess visible coronary vessel length and coronary vessel sharpness for the entire vessel length and the first 4 cm of each vessel. ResultsThere was no difference in image quality between any of the methodologies for determination of the optimal trigger delay, as assessed by visible coronary vessel length, coronary vessel sharpness for each entire vessel and vessel sharpness for the first 4 cm of the left mainstem, left anterior descending or right coronary arteries. However, vessel length of the left circumflex was slightly greater using the formula method. The time taken to calculate the trigger delay was significantly lower for the DL-method as compared to the operator-led approach (106 ± 38.0 s vs 168 ± 39.2 s, p < 0.01, 95% CI of difference 25.5–98.1 s). ConclusionsDeep learning-derived automated software can effectively and efficiently determine the optimal trigger delay for acquisition of coronary MRA and thus may simplify workflow and improve reproducibility.

Prehospital vital sign monitoring in paediatric patients: an interregional study of educational interventions

BackgroundPrehospital vital sign documentation in paediatric patients is incomplete, especially in patients ≤ 2 years. The aim of the study was to increase vital sign registration in paediatric patients through specific educational initiatives.MethodsProspective quasi-experimental study with interrupted time-series design in the North Denmark and South Denmark regions. The study consecutively included all children aged < 18 years attended by the emergency medical service (EMS) from 1 July 2019 to 31 December 2021. Specific educational initiatives were conducted only in the North Denmark EMS and included video learning and classroom training based on the European Paediatric Advanced Life Support principles. The primary outcome was the proportion of patients who had their respiratory rate, peripheral capillary oxygen saturation, heart rate and level of consciousness recorded at least twice. We used a binomial regression model stratified by age groups to compare proportions of the primary outcome in the pre- and post-intervention periods in each region.ResultsIn North Denmark, 7551 patients were included, while 15,585 patients from South Denmark were used as a reference. Virtually all of the North Denmark EMS providers completed the video learning (98.7%). The total study population involved patients aged ≤ 2 months (5.5%), 3–11 months (7.4%), 1–2 years (18.8%), 3–7 years (16.2%) and ≥ 8 years (52.1%). In the intervention region, the primary outcome increased from the pre- to the post-intervention period from 35.3% to 40.5% [95% CI for difference 3.0;7.4]. There were large variations in between age groups with increases from 18.8% to 27.4% [95% CI for difference 5.3;12.0] among patients aged ≤ 2 years, from 33.5% to 43.7% [95% CI for difference 4.9;15.5] among patients aged 3–7 years and an insignificant increase among patients aged ≥ 8 years (from 46.4% to 47.9% [95% CI for difference − 1.7;4.7]). In the region without the specific educational interventions, proportions were steady for all age groups throughout the entire study period.ConclusionsMandatory educational initiatives for EMS providers were associated with an increase in the extent of vital sign registration in paediatric patients ≤ 7 years. Incomplete vital registration was associated with, but not limited to non-urgent cases.

Reproductive outcomes after surgical sperm retrieval in couples with male factor subfertility: a 10-year retrospective national cohort

To determine any significant differences in the reproductive outcome from intracytoplasmic sperm injection (ICSI) with surgical sperm retrieval (SSR) between cycles using fresh and cryopreserved sperm and between cycles using epididymal and testicular sperm. A retrospective national cohort study using data from the UK Human Fertilisation and Embryology Authority, including all ICSI cycles performed in the United Kingdom over a 10-year period. Hospital. All nondonor ICSI cycles from 2008 to 2017 categorized by sperm source and cryopreservation status. Intracytoplasmic sperm injection with SSR using fresh or cryopreserved sperm and using ejaculated, testicular, and epididymal sperm. Live birth rate, pregnancy rate, and implantation rate. We analyzed data from 214,649 ICSI cycles, including 199,818 cycles of ejaculated sperm, 5,646 cycles of epididymal sperm, and 9,185 cycles of testicular sperm. Live births rates per ICSI cycle were 28.5%, 30.6%, and 28.7% for ejaculated, epididymal, and testicular sperm cycles, respectively. Epididymal sperm cycles had a higher live birth rate than that of testicular sperm cycles (odds ratio [OR], 1.067; 95% confidence interval [CI], 1.014-1.123). This was despite a higher mean male age (42.5 vs. 40.6 years; 95% CI of difference, 1.81-1.85 years) and female age (34.3 vs. 34.0 years; 95% CI of difference, 0.32-0.34 years) in epididymal cycles than in testicular cycles. Implantation (61.2% vs. 58.0%; OR, 1.086; 95% CI, 1.041-1.133) and clinical pregnancy rates (34.3% vs. 31.3%; OR, 1.085; 95% CI, 1.039-1.132) were also higher in epididymal cycles than in testicular cycles. There were no statistically significant differences in outcomes between cycles using fresh sperm and those using cryopreserved sperm for SSR-ICSI. Our study indicates that reproductive outcomes of SSR-ICSI are at least comparable with those of ICSI using ejaculated sperm and does not support the preferential use of fresh sperm over cryopreserved sperm in SSR-ICSI. Births per SSR-ICSI cycle were higher for cycles using epididymal sperm than for cycles using testicular sperm; however, the differences were small, which may provide reassurance to patients undergoing these procedures. The results must be interpreted with caution because multivariable analysis was not possible because of aggregation of data.

Impaired Speckle-Tracking-Derived Left Ventricular Longitudinal Strain Is Associated with Transposition of Great Arteries in Neonates: A Single-Center Study.

The transposition of great arteries (TGA) is one of the most frequent and severe congenital heart diseases. After newborn stabilization and while pending surgical correction, echocardiographic monitoring with a careful evaluation of left ventricle (LV) performance is warranted. In this study, our objectives were (i) to compare myocardial function, assessed via speckle-tracking echocardiography, between neonates with TGA and neonates without TGA and (ii) to identify a strain parameter with a good discriminatory ability for TGA. We conducted a retrospective, single-center study. A total of 90 neonates were examined, of whom 66 were included (16 comprised the TGA group and 50 comprised the control group). The results of a bivariate analysis showed that classic echocardiography parameters displayed no significant differences between the two studied groups (p = 0.785 for EF, p = 0.286 for MAPSE and p = 0.315 for TAPSE). We found a statistically significant difference between the two groups for the mean values of the LVpGLS parameter (adjusted p = 0.0047), with impaired LV myocardium function being observed in the TGA group after adjusting for other covariates. Regarding segmental strain, the mean medial and apical inter-ventricular septum strain values were found to be significantly lower in the neonates with TGA than in the controls (95% CI for difference in means: [-6.45, -0.65], [-8.56, -1.97]). The results of an ROC analysis showed that LVpGLS had a significant ability to differentiate between neonates with TGA and controls (AUC = 0.712, 95% CI: [0.52, 0.903], p = 0.011). In conclusion, LVpGLS is a parameter with a significant discriminatory ability for LV dysfunction, and it is useful in the evaluation of ventricular myocardial function in newborns with TGA.

STEP EXECUTION TIME: EXAMINING ITS RELIABILITY AND ASSOCIATION WITH PARTICIPATION IN OLDER ADULTS

Abstract The projected rise in the number of older adults warrants increased attention to selecting reliable and meaningful clinical assessments. Compared to more frequently used balance measures, step execution time (SET) has not been studied extensively. The purpose of the current study was twofold. First, we investigated the association of several balance measures [SET, Activities-specific Balance Confidence Scale (ABC-6), Five-times-sit-to-stand (5TSTS), Four-square step test (4SST), and maximum step length (MSL)] with participation (LIFE-H). Second, reliability of SET was investigated. The study included 32 community-dwelling older adults between the ages of 65 and 83 years (88% White, 66% female). Results indicated that SET was the only balance measure associated with both participation accomplishment (r = -.54, p = .001) and participation satisfaction (r = -.55, p = .001); 5TSTS (r = -.64, p &amp;lt; .001) and 4SST (r = .37, p = .039) were also significantly correlated with participation accomplishment while MSL (r = .37, p = .040) showed a significant association with participation satisfaction. SET demonstrated excellent test-retest reliability (ICC = .92). Bland-Altman analysis determined the 95% Limits of Agreement to be -258.5 ms to +271.5 ms (mean difference = 6.5 ms; 95% CI of difference = -43.1 to 56.1), suggesting that bias was not a concern. SEM (100.5 ms) and MDC95 (278.5 ms) for SET represented 9.3% and 25.8% of the mean, respectively. Collectively, findings suggest that SET may have clinical utility as a reliable assessment in older adults that relates to meaningful constructs, such as participation.

Tracheal tube cuff pressure during anesthesia for robotic-assisted laparoscopic prostatectomy and the efficacy of an automatic cuff pressure controller (SmartCuff): observational studies of 1-sample paired data.

The cuff pressure of a tracheal tube may increase during robot-assisted laparoscopic surgery for prostatectomy (RALP), which requires pneumoperitoneum in a steep head-down position, but there have been no studies which confirmed this. In study 1, we studied how frequently the cuff pressure significantly increased during anesthesia for the RALP. In study 2, we studied if the SmartCuff (Smiths Medical Japan, Tokyo) automatic cuff pressure controller would minimize the changes in the intracuff pressure. With approval of the study by the research ethics committee (approved number: 20115), we measured the cuff pressures in anesthetized patients undergoing RALP and in those undergoing gynecological laparotomy (as a reference cohort), with and without the use of the SmartCuff. In 21 patients undergoing RALP, a clinically meaningful increase (5 cmH2O or greater) was observed in all the 21 patients (P = 0.00; 95% CI for difference: 86-100%), whereas in 23 patients undergoing gynecological laparotomy, a clinically meaningful decrease (5 cmH2O or greater) was observed in 21 of 23 patients (91%, P < 0.0001; 95% CI for difference: 72-99%). With the use of the SmartCuff, there was no significant increase in the incidence of a clinically meaningful change in the intracuff pressure in either cohort. The cuff pressure of a tracheal tube would frequently increase markedly in patients undergoing RALP, whereas it would frequently decrease markedly in patients undergoing gynecological laparotomy. The SmartCuff may inhibit the changes in the cuff pressure during anesthesia.

A phase II, multicenter, open-label, randomized trial of pegfilgrastim for patients with alcohol-associated hepatitis.

SummaryBackgroundIn trials conducted in India, recombinant granulocyte colony stimulating factor (GCSF) improved survival in alcohol-associated hepatitis (AH). The aim of this trial was to determine the safety and efficacy of pegfilgrastim, a long-acting recombinant GCSF, in patients with AH in the United States.MethodsThis prospective, randomized, open label trial conducted between March 2017 and March 2020 randomized patients with a clinical diagnosis of AH and a Maddrey discriminant function score ≥32 to standard of care (SOC) or SOC+pegfilgrastim (0.6 mg subcutaneously) on Day 1 and Day 8 (clinicaltrials.gov NCT02776059). SOC was 28 days of either pentoxifylline or prednisolone, as determined by the patient's primary physician. The second injection of pegfilgrastim was not administered if the white blood cell count exceeded 30,000/mm3 on Day 8. Primary outcome was survival at Day 90. Secondary outcomes included the incidence of acute kidney injury (AKI), hepatorenal syndrome (HRS), hepatic encephalopathy, or infections.FindingsThe study was terminated early due to COVID19 pandemic. Eighteen patients were randomized to SOC and 16 to SOC+pegfilgrastim. All patients received prednisolone as SOC. Nine patients failed to receive a second dose of pegfilgrastin due to WBC > 30,000/mm3 on Day 8. Survival at 90 days was similar in both groups (SOC: 0.83 [95% confidence interval [CI]: 0.57–0.94] vs. pegfilgrastim: 0.73 [95% CI: 0.44–0.89]; p > 0.05; CI for difference: -0.18–0.38). The incidences of AKI, HRS, hepatic encephalopathy, and infections were similar in both treatment arms and there were no serious adverse events attributed to pegfilgrastim.InterpretationThis phase II trial found no survival benefit at 90 days among subjects with AH who received pegfilgrastim+prednisolone compared with subjects receiving prednisolone alone.Fundingwas provided by the United States National Institutes of Health and National Institute on Alcohol Abuse and Alcoholism U01-AA021886 and U01-AA021884.

COVID-19 CPR-Impact of Personal Protective Equipment during a Simulated Cardiac Arrest in Times of the COVID-19 Pandemic: A Prospective Comparative Trial.

Background: Guidelines of cardiopulmonary resuscitation (CPR) recommend the use of personal protective equipment (PPE) during the resuscitation of COVID-19 patients. Data on the effects of PPE on rescuers’ stress level and quality of CPR are sparse and conflicting. This trial investigated the effects of PPE on team performance in simulated cardiac arrests. Methods: During the pandemic period, 198 teams (689 participants) performed CPR with PPE in simulated cardiac arrests (PPE group) and were compared with 423 (1451 participants) performing in identical scenarios in the pre-pandemic period (control group). Video recordings were used for data analysis. The primary endpoint was hands-on time. Secondary endpoints included a further performance of CPR and the perceived task load assessed by the NASA task-load index. Results: Hands-on times were lower in PPE teams than in the control group (86% (83–89) vs. 90% (87–93); difference 3, 95% CI for difference 3–4, p < 0.0001). Moreover, PPE teams made fewer change-overs and delayed defibrillation and administration of drugs. PPE teams perceived higher task loads (57 (44–67) vs. 63 (53–71); difference 6, 95% CI for difference 5–8, p < 0.0001) and scored higher in the domains physical and temporal demand, performance, and effort. Leadership allocation had no effect on primary and secondary endpoints. Conclusions: Having to wear PPE during CPR is an additional burden in an already demanding task. PPE is associated with an increase in perceived task load, lower hands-on times, fewer change-overs, and delays in defibrillation and the administration of drugs. (German study register number DRKS00023184).

Pulmonary tuberculosis and diabetes mellitus: Clinical profile and outcomes.

India is endemic for Tuberculosis (TB), contributing to the world's highest number of active cases. Diabetes (DM), with its increasing burden in India, could contribute to adverse outcomes among patients with TB. Consecutive patients with sputum smear positive pulmonary tuberculosis were included in the study. We defined cases as those patients with diabetes at recruitment. Controls were non diabetics (NDM). Sputum samples for AFB smears, AFB culture and Xpert PCR along with blood samples for glycosylated Haemoglobin and glucose levels were collected at recruitment and at 6 months from patients with sputum positive pulmonary TB. Blood glucose levels and sputum smears were repeated at 2 months and monthly till they tested negative. The primary outcome studied was mortality at 6 month follow-up. The secondary outcomes included the time to conversion of sputum smears and cure rates between cases and controls. We recruited 124 patients of which 68 were cases. Mortality after therapy was 15% in cases and 7% in controls, however, the difference was not statistically significant. Equal proportions in each group (Diabetics: 9% vs. NDM 9%) had persistent smear positivity at 2 months. There was no association between delayed sputum conversion and uncontrolled diabetes. Only about 57% of cases and 50% of controls were documented to have completed treatment or been cured. A significant reduction in HbA1c after 6 months of Antituberculous therapy was noted among the cases. [Mean difference - 1.76, P-value - 0.001, 95% CI of difference - (1.01 - 2.52)]. Diabetes did not have adverse outcomes in the form of increased mortality or delayed sputum conversion rates. The high proportion of loss to follow-up seems to be a trend of concern, which should be addressed emergently.

Contributions of Circulating microRNAs for Early Detection of Lung Cancer.

Simple SummaryBlood-based cancer biomarkers are a minimally invasive means to achieve improved assessment of risk and/or earlier detection of lung cancer. Using serum samples from individuals that went on to develop lung cancer within one year following blood draw and from matched controls, we investigated 30 microRNAs for individual and combined utility to discriminate lung cancer cases from controls. We additionally assessed the contributions of top-performing microRNA candidates for improving on the performance of a previously validated four-protein marker panel for lung cancer detection. The results of this study indicate complementary performance of combining circulating microRNA and the four-protein-marker panel in assays for early detection of lung cancer.There is unmet need to develop circulating biomarkers that would enable earlier interception of lung cancer when more effective treatment options are available. Here, a set of 30 miRNAs, selected from a review of the published literature were assessed for their predictive performance in identifying lung cancer cases in the pre-diagnostic setting. The 30 miRNAs were assayed using sera collected from 102 individuals diagnosed with lung cancer within one year following blood draw and 212 controls matched for age, sex, and smoking status. The additive performance of top-performing miRNA candidates in combination with a previously validated four-protein marker panel (4MP) consisting of the precursor form of surfactant protein B (Pro-SFTPB), cancer antigen 125 (CA125), carcinoembryonic antigen (CEA) and cytokeratin-19 fragment (CYFRA21-1) was additionally assessed. Of the 30 miRNAs evaluated, five (miR-320a-3p, miR-210-3p, miR-92a-3p, miR-21-5p, and miR-140-3p) were statistically significantly (Wilcoxon rank sum test p < 0.05) elevated in case sera compared to controls, with individual AUCs ranging from 0.57–0.62. Compared to the 4MP alone, the combination of 3-miRNAs + 4MP improved sensitivity at 95% specificity by 19.1% ((95% CI of difference 0.0–28.6); two-sided p: 0.006). Our findings demonstrate utility for miRNAs for early detection of lung cancer in combination with a four-protein marker panel.