bluuebunny/crossref_metadata_2025 huggingface dataset:
Neonatal Outcomes After Delivery in Water
Authors: Lanier Ariel L. , Wiegand Samantha L. , Fennig Kathleen , Snow E. Kaye , Maxwell Rose A. , McKenna David
Published: September 2021

OBJECTIVE:

To assess neonatal intensive care unit (NICU) admissions and neonatal outcomes after water birth or land birth in an alternative birthing center.

METHODS:

We conducted a prospective observational study of preselected low-risk parturients separated into three groups depending on their location for labor and delivery: land–land, water–land, and water–water. Delivery outcomes, labor length, maternal pain assessment, need for newborn resuscitation, and NICU admission and diagnoses were collected. The primary outcome was admission to the NICU.

RESULTS:

There were 2,077 total deliveries from April 2015 to December 2019, consisting of 458 land–land deliveries, 730 water–land deliveries, and 889 water–water deliveries. The rate of NICU admission was 2.8% (95% CI 1.5–4.8%) for land–land deliveries, 4.1% (2.8–5.8%) for water–land deliveries, and 2.0% (1.2–3.2%) for water–water deliveries. A post hoc power analysis revealed a 70% power to detect a 2.1% difference in NICU admissions between the water–land and water–water groups.

CONCLUSION:

In this cohort of low-risk pregnant women, births in water and on land were associated with similar rates of admission to the NICU.
Core needle biopsy diagnosis of musculoskeletal tumors at a small regional treatment center and at sarcoma referral centers are equally effective and accurate: a retrospective case series
Authors: McGraw Jessica A. , Wooldridge Adam N. , Brindley George
Published: September 2021

Background:

Although incisional biopsy (IB) is the gold standard for diagnosing musculoskeletal tumors, core needle biopsy (CNB) is becoming common. Many large sarcoma referral centers have evaluated the accuracy of CNB, but its accuracy at smaller centers is unknown.

Methods:

After IRB approval, a retrospective study of patients undergoing CNB and IB for musculoskeletal tumor diagnosis at Texas Tech University Health Sciences Center from 2006 to 2018 was performed. All patients underwent surgical excision of their tumor. Final pathology was the gold standard for analysis. Biopsy effectiveness and accuracy for determining malignancy and pathology was determined. Complications from biopsies and diagnostic errors were evaluated.

Results:

Efficacy of CNB was 83.1% for bone and 97.7% for soft-tissue tumors; IB was 100% effective. Accuracy of determining malignancy of bone tumors was 89.8% for CNB and 100% for IB, while that for soft-tissue tumors was 92.9% with CNB and 100% with IB. Accuracy of CNB determining pathology of bone tumors was 73.1% for malignant and 42.4% for benign tumors, while IB determined pathology of 100% of malignant and 75% of benign tumors. For soft-tissue tumors, CNB accurately diagnosed 88.9% of malignant and 52% of benign tumors while IB accurately diagnosed 100% of malignant and benign soft-tissue tumors. There were no procedural complications related to biopsy.

Conclusions:

The data in this study show that CNB and IB performed at a small treatment center are effective and accurate for diagnosis of musculoskeletal tumors.

Level of Evidence:

Level IV.
Environmental triggers for connective tissue disease: the case of COVID-19 associated with dermatomyositis-specific autoantibodies
Authors: De Santis Maria , Isailovic Natasa , Motta Francesca , Ricordi Caterina , Ceribelli Angela , Lanza Ezio , Azzolini Elena , Badalamenti Salvatore , Voza Antonio , Selmi Carlo
Published: September 2021

Purpose of review

The aim of the present review is to analyze the link between autoimmune diseases and environmental factors, in particular severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (COVID-19) as it shares numerous features with the interstitial lung disease associated with connective tissue diseases positive for rare autoantibodies directed at highly specific autoantigens (i.e., MDA5 and RIG1) among the intracellular sensors of SARS-CoV-2 in the innate response against viruses.

Recent findings

As shown in recent publications and in our original data, specific autoantibodies may be functionally relevant to COVID-19 infection. We evaluated sera from 35 hospitalized patients with COVID-19 to identify antinuclear antibodies and autoantibodies directed against specific antigenic targets, and we identified anti-nuclear antibodies (ANA) in 20/35 of patients with COVID-19 (57%), in patients with need for supplemental oxygen (90% vs. 20% in ANA-negative cases; P < 0.0001). In 7/35 COVID-19 sera, we detected anti-MJ/NXP2 (n = 3), anti-RIG1 (n = 2), anti-Scl-70/TOPO1 (n = 1), and anti-MDA5 (n = 1), overall associated with a significantly worse pulmonary involvement at lung computerized tomography scans. Eleven (31%) patients were positive for antibodies against the E2/E3 subunits of mitochondrial pyruvate dehydrogenase complex.

Viral infections such as COVID-19 are associated with ANA and autoantibodies directed toward antiviral signaling antigens in particular in patients with worse pulmonary involvement.
Cost-analysis of Surgical Intraocular Pressure Management in Glaucoma
Authors: Elhusseiny Abdelrahman M. , Yannuzzi Nicolas A. , Khodeiry Mohamed M. , Lee Richard K. , Smiddy William E.
Published: September 2021

Précis:

The multiplicity of treatment options for lowering intraocular pressure (IOP) is both a blessing and a challenge. Some attention to cost-analysis might assist in choosing an optimal therapy, especially in a cost-constrained, international setting.

Purpose:

The aim of this study was to quantify and to analyze the relative cost of various glaucoma surgical procedures and selective laser trabeculoplasty surgery per mm Hg IOP reduction ($/mm Hg) since standard cost-utility methods are not well suited to the study of glaucoma which characteristically only claims visual acuity in its end stages.

Methods:

Published glaucoma treatment studies were reviewed to quantitate the reduction of mean IOP and glaucoma medications for a given treatment modality. A US perspective was adopted, using Medicare allowable costs were used to calculate a newly introduced parameter—cost per mm Hg IOP reduction—at 1 year postoperatively.

Results:

The cost per mm Hg IOP reduction after 1 year of treatment ranged from $190/mm Hg for trabeculectomy to $1376/mm Hg for iStent. For reference, the cost of selective later trabeculoplasty surgery was $121/mm Hg. After the first year, cost/mm Hg ranged from $12 to $61/mm Hg.

Conclusions:

Conventional glaucoma surgeries and selective laser trabeculoplasty surgery were the most cost-efficient surgical methods to lower IOP compared with the various minimally invasive glaucoma surgeries options. They may be more appropriate management when cost is an important issue.
Childhood Cancers Misdiagnosed as Tuberculosis in a High Tuberculosis Burden Setting
Authors: van Heerden Jennifer K. , van Zyl Anel , Schaaf Hendrik Simon , Frigati Lisa J. , Goussard Pierre , Rabie Helena
Published: September 2021

Background:

Tuberculosis (TB) and childhood cancers have overlapping presentations and malignancies may be misdiagnosed as TB in high TB-burden settings.

Methods:

This retrospective study investigated the diagnosis of TB in children with cancer registered in the Tygerberg Hospital Childhood Tumor Registry from 2008 to 2018. We studied children on anti-tuberculosis treatment (ATT) at cancer diagnosis or diagnosed with TB within 1 month of cancer diagnosis. We describe the circumstances and extent of this misdiagnosis, quantify the delay in therapy and document the outcomes of these children.

Results:

Twenty-seven of 539 (5%) children in the registry started ATT before cancer diagnosis. Both pulmonary and extrapulmonary TB complicated the cancer diagnosis. Of the 27 patients on ATT at cancer diagnosis, 22 (81%) had contact with a TB case and in 6 of 12 children (50%) a tuberculin skin test was positive. At cancer diagnosis, 16/27 (59%) children had chest radiograph changes interpreted as TB with 11/27 (41%) regarded as suggestive of TB on expert review. The median diagnostic delay between TB and cancer diagnoses was 25 days (interquartile range 3.5–58). Of 539 children with cancer, 204 (38%) died of cancer, including 18/30 (60%) children on ATT at cancer diagnosis or diagnosed with TB within 1 month of cancer diagnosis (odds ratio 2.6; 95% confidence interval: 1.2–5.4; P = 0.012).

Conclusions:

The clinical and radiologic overlap of TB and cancer causes diagnostic confusion in a significant number of children with cancer and may contribute to increased mortality.
APTA Cross Sections and Academies Recommendations for COVID-19 Core Outcome Measures
Authors: Wells Chris L. , Kegelmeyer Deb , Mayer Kirby P. , Kumble Sowmya , Reilley Anne , Campbell Angela , Martin Rebecca
Published: September 2021

Purpose:

The novel coronavirus (COVID-19) emerged as a major health concern within the United States in early 2020. Because this is a novel virus, little guidance exists for best practice to evaluate this population within the field of physical therapy.

Methods:

An expert task force appointed by the leadership of 9 different academies or sections of the American Physical Therapy Association was formed to develop recommendations for a set of core outcome measures for individuals with or recovering from COVID-19.

Results:

This perspective provides guidance on a best practice recommendation to physical therapists and researchers regarding the use of core outcome measures for individuals with or recovering from COVID-19. The process for the selection of core measures for this population is presented and discussed.

Conclusions:

Core outcome measures improve the ability to track progress and change across the continuum of care at both the patient and population levels.
The Impact of Physicians’ COVID-19 Pandemic Occupational Experiences on Mental Health
Authors: Schwartz Rebecca M. , McCann-Pineo Molly , Bellehsen Mayer , Singh Vansha , Malhotra Prashant , Rasul Rehana , Corley Samantha S. , Jan Sophia , Parashar Nidhi , George Sonia , Yacht Andrew C. , Young John Q.
Published: September 2021

Objective:

To examine the association between a number of negative COVID-19 occupational experiences and probable anxiety, depression, and PTSD among physicians.

Methods:

Cross-sectional examination of longitudinal registry data consisting of physician personal and occupational well-being. Multivariable logistic regressions were performed to determine the association between negative COVID-19 experiences and outcomes.

Results:

Of the 620 eligible physicians, approximately half were female (49%), and 71% white with a mean age of 46.51 (SD = 13.28). A one-point increase in negative experience score was associated with a 23% increase in probable anxiety (OR = 1.23, 95% CI: 1.14–1.34), a 23% increase in probable depression (OR = 1.23, 95% CI: 1.13–1.33), and a 41% increase in probable PTSD (OR = 1.41, 95% CI: 1.30–1.52).

Conclusions:

Negative pandemic experiences were strongly associated with adverse mental health outcomes while greater resilience was protective.
Exploring Vestibular/Ocular and Cognitive Dysfunction as Prognostic Factors for Protracted Recovery in Sports-Related Concussion Patients Aged 8 to 12 Years
Authors: Price August M. , Knell Gregory , Caze Todd J. , Abt John P. , Loveland Dustin , Burkhart Scott O.
Published: September 2021

Objective:

To explore the prognostic ability of the vestibular/ocular motor screening (VOMS), King–Devick (K-D) Test, and C3 Logix Trails A and B to identify protracted recovery from sports-related concussion (SRC) in patients aged 8 to 12 years.

Design:

Retrospective cohort analysis.

Setting:

Specialty pediatric sports concussion clinic.

Participants:

A total of 114 youth athletes aged 8 to 12 years who were diagnosed with an SRC within 7 days of injury.

Independent Variables:

A positive screen on the VOMS, K-D, and C3 Logix Trails A and Trails B. Combined positive screens on multiple tests (ie, 2, 3, or all 4 positive screens of 4 possible).

Main Outcome Measures:

Recovery time in days and protracted recovery (recovery time ≥30-days) were the primary outcomes of interest.

Results:

A positive VOMS screen was associated with 1.31 greater days to SRC recovery (P = 0.02) than a negative VOMS screen. The K-D and C3 Logix tests were not significantly associated with recovery time, nor were any combinations of tests (P > 0.05). The VOMS demonstrated moderate prognostic ability to predict normal recovery (negative predictive value = 80.78% [95% CI = 63.73-90.95]). Overall predictive accuracy of normal versus protracted recovery was strongest when a participant screened positive on all 4 tests (Accuracy = 76.32% [95% CI = 67.45-83.78]).

Conclusions:

The VOMS was associated with overall recovery time and proved to be a useful test to identify those who would experience a normal recovery time. Combining the 4 tests improved the prognostic accuracy of the protocol in predicting protracted versus normal recovery. These findings suggest that combining multiple, varied assessments of cognition and vestibular/ocular functions may better explain factors contributing to protracted recovery.
Rapid On-site Evaluation and Final Cytologic Diagnoses Correlation During Endobronchial Ultrasonography
Authors: Iliaz Sinem , Caglayan Benan , Bulutay Pinar , Armutlu Ayse , Uzel Isil , Ozturk Ayse B.
Published: September 2021

Background:

The cost-effectiveness and low rate of inadequate sampling with the use of rapid on-site evaluation (ROSE) along with endobronchial ultrasonography (EBUS) is well established. Our aim in this study was to evaluate the correlation of ROSE during EBUS and final cytologic diagnosis and also to see if ROSE might predict the subtype of lung cancer.

Patients and Methods:

All consecutive subjects who attended our clinic between January 2016 and January 2019 for the evaluation of pathologic mediastinal and/or hilar lymph nodes (LNs)/mass using EBUS were enrolled into our prospective study. ROSE was performed in the same operating room with EBUS. ROSE results during EBUS were recorded. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ROSE compared with the final cytologic diagnosis were evaluated.

Results:

We enrolled 684 LN/mass lesions belonging to 328 patients into this study. When we compared ROSE results and final cytologic diagnosis, these procedures agreed on 91.6% of the LNs (P<0.001). The sensitivity of ROSE and final cytologic diagnosis for granulomatous inflammation was 72.5%, and for lung cancer, it was 89.2% (P<0.001). The sensitivity of ROSE for the adenocarcinoma subtype of lung cancer was 67.7%, and it was 70% for small cell lung cancer.

Conclusion:

ROSE may help to recognize non–small cell lung cancer during EBUS, especially the adenocarcinoma subtype of lung cancer, which will help ensure having sufficient material for molecular analysis.
Combination treatment with trastuzumab and crizotinib in metastatic gastric cancer harboring Her-2 amplification and c-MET amplification
Authors: Liu Mingsheng
Published: September 2021

Abstact

Rationale:

Metastatic gastric cancer patients with poor eastern cooperative oncology group performance status (PS) (≥3) were lack of effective anti-tumor strategies. They always lived with poor PS, severe and multiple symptoms, and usually resulted in extremely limited survival time. Herein, we reported a patient diagnosed with gastric cancer metastasized to multiple bones, along with lymphangitis carcinomatosa in lungs, harboring Her-2 and c-MET amplification with poor PS, positively responded to combinational therapy with trastuzumab and crizotinib.

Patient concerns:

The patient complained of persistent cough and fatigue for 2 months, otherwise, she denied smoking, alcohol history, or any other medical or family history.

Diagnosis:

With the biopsy results from gastroscopy, as well as computer tomography for chest and abdomen, the patient was diagnosed as gastric adenocarcinoma, with metastasis on lungs, left adrenal gland, retroperitoneal lymph nodes, and multiple bones.

Interventions:

Because of the poor PS (PS = 3), as well as Her-2 and c-MET amplification, the patient received combination treatment with trastuzumab and crizotinib as salvage strategy.

Outcomes:

After 2 months’ exposure of trastuzumab and crizotinib, symptoms including persistent cough, and chest distress were alleviated significantly. Simultaneously, chest computer tomography showed significant dissipation of lymphangitis carcinomatosa, as well as apparent reduction of pleural effusion. No adverse reactions including nausea, vomiting, diarrhea, or hypertension was observed during the following 2 months.

Lessons:

The present case suggested that combinational therapy with trastuzumab and crizotinib might be effective in metastatic gastric cancer patients harboring Her-2 and c-MET amplification, even with a poor PS. It was also implied that gene sequencing might be valuable, especially in patients with limited treatment strategies.
Efficacy and safety of acupuncture in the treatment of postherpetic neuralgia
Authors: Zhao Jian , Zhou Zhongguang , He Xin , Yuan Yin , Wang Di
Published: September 2021

Background:

It is simple, convenient, inexpensive, proven, extensive, and safe for acupuncture in the treatment of postherpetic neuralgia (PHN). However, there are no comparisons between various acupuncture therapies that can directly and effectively provide specific guidance to clinicians. The development of a guideline for the optimization of acupuncture for PHN is of great importance for the development of clinical acupuncture. Therefore, we attempted to design a study protocol for a network meta-analysis of randomized controlled trials of acupuncture for PHN to provide evidence to support the treatment of acupuncture for PHN.

Methods:

A search of 8 databases, Chinese Scientific Journal Database, China National Knowledge Infrastructure Database, Wanfang, China Biomedical Literature Database, PubMed, Cochrane Library, Embase, and Web of Science, was conducted to collect randomized controlled trials about acupuncture for PHN. RevMan 5.3 and Stata 14.0 software were used for data analysis.

Results:

This meta-analysis will provide additional and more robust evidence for acupuncture treatment of PHN. Our findings will assist clinicians in making treatment decisions.

Conclusion:

This study will provide comprehensive and reliable evidence-based evidence for the treatment of PHN with acupuncture.
The protein arginine methyltransferases (PRMTs) PRMT1 and CARM1 as candidate epigenetic drivers in prostate cancer progression
Authors: Grypari Ioanna Maria , Logotheti Souzana , Zolota Vasiliki , Troncoso Patricia , Efstathiou Eleni , Bravou Vasiliki , Melachrinou Maria , Logothetis Christopher , Tzelepi Vasiliki
Published: September 2021

Epigenetic changes are implicated in prostate cancer (PCa) progression and resistance to therapy. Arginine residue methylation is an understudied histone post-translational modification that is increasingly associated with cancer progression and is catalyzed by enzymes called protein arginine methyltransferases (PRMTs). The molecular consequences of aberrant expression of PRMTs in PCa and the relationship between PRMTs and PCa progression are largely unknown. Using immunohistochemistry, we examined the expression of PRMT1 and CARM1, two of the best-studied PRMTs, in 288 patients across the spectrum of PCa and correlated them with markers of androgen receptor (AR) signaling, and milestones of carcinogenesis. Our findings indicate that PRMT1 and CARM1 are upregulated early in PCa progression, and that CARM1 is further upregulated after therapy. In addition, a correlation of CARM1 with AR post-translational modifications was noted in the setting of therapy resistance, highlighting CARM1 as one of the adaptation mechanisms of PCa cells in an androgen-depleted environment. Finally, CARM1 correlated with markers of cell cycle regulation, and both CARM1 and PRMT1 correlated with markers of epithelial-to-mesenchymal transition signaling. Taken together these findings indicate that an epigenetic network drives PCa progression through enhancement of milestone pathways including AR signaling, the cell cycle, and epithelial-to-mesenchymal transition.
COVID-19 related discrimination in Japan
Authors: Suzuki Reina , Iizuka Yusuke , Lefor Alan Kawarai
Published: September 2021

To assess the general Japanese population's thoughts on coronavirus disease of 2019 related discrimination by Tweets.

Tweets were retrieved from search queries using the keywords “health care providers and discrimination (no hashtags)” and “corona and rural area (no hashtags)” via the Twitter application programming interface. Subsequently, a text-mining analysis was conducted on tokenized text data. R version 4.0.2 was used for the analysis.

In total, 51,906 tweets for “corona and health care providers”, 59,560 tweets for “corona and rural” were obtained between the search period of July 29, 2020 and September 30, 2020. The most common 20 words from the tokenized text data were translated to English. Word clouds with the original Japanese words are presented.

Tweets for corona and health care providers did not suggest significant evidence of discrimination toward health care providers on Twitter. Results for corona and rural area, however, showed the unexpected word “murahachibu” (an outmoded word meaning ostracism), suggesting persistent strong social pressure to prevent bringing the disease to the community. This kind of pressure may not be supported by scientific facts. These results demonstrate the need for continued educational efforts to disseminate factual information to the public.
Determinants of prognosis in geriatric patients followed in respiratory ICU; either infection or malnutrition
Authors: Eraslan Doganay Guler , Cirik Mustafa Ozgur
Published: September 2021

Severity of illness, age, malnutrition, and infection are the important factors determining intensive care unit (ICU) survival.

The aim of the study is to determine the relations between Geriatric Nutritional Risk Index (GNRI), C-reactive protein/albumin (CAR), and prognosis-mortality of geriatric patients (age of ≥65 years) admitted to intensive care unit.

The study with 10/15/2020, 697 approval date, and number retrospectively registered. Between January 1, 2018 and December 31, 2019, 413 geriatric patients admitted to ICU. The patients were divided into three groups according to their age.

The age group, gender, Charlson comorbidity index, intensive care scores (Acute Physiology And Chronic Health Evaluation II and Sequential Organ Failure Assessment), the infection markers (white blood cell, procalcitonin, CAR levels), malnutrition tools for each patient (body mass index, Nutrition Risk in Critically ill score, and GNRI scores) were analyzed retrospectively. Also length of stay (LOS) ICU, length of stay hospital, and 30-day mortality were recorded.

Geriatric patients number of 403 was included in the study. Forty-nine (12.3%) patients had a history of malignancy, 272 (67.5%) patients had Chronic Obstructive Pulmonary Disease comorbidity. There was no difference in mortality between age groups.

In patients with mortality, body mass index, had being Chronic Obstructive Pulmonary Disease history, GNRI, length of stay hospital, and albumin were significantly lower; malignancy comorbidity rate, inotrope use, modified Nutrition Risk in Critically ill score, mechanical ventilation duration, LOS ICU, Sequential Organ Failure Assessment, Acute Physiology And Chronic Health Evaluation II, Charlson comorbidity index, C-reactive protein, procalcitonin, and CAR were significantly higher.

Both malnutrition and infection affect mortality in geriatric patients in intensive care. The GNRI is better than CAR at predicting mortality.
Usefulness of 123I-BMIPP and 201TlCl nuclide scintigraphy in evaluation of myocarditis in patients with polymyositis or dermatomyositis
Authors: Okada Yukinori , Takakuwa Yukiko , Ooka Seido , Ogawa Yukihisa , Kawahata Kumito , Kobayashi Yasuyuki , Yamaguchi Keiichiro , Akashi Yoshihiro
Published: September 2021

To investigate the usefulness of 123I-BMIPP/201TlCl scintigraphy for evaluating the presence of myocarditis in patients with polymyositis (PM) or dermatomyositis (DM).

We performed a retrospective study of 26 patients diagnosed with new-onset active PM/DM who underwent 123I-BMIPP/201TlCl scintigraphy between 01 April 2010 and 20 March 2015. We determined the 123I-BMIPP/201TlCl ratio and grouped the patients according to presence or absence of a mismatch. We evaluated the relationship between mismatch and the laboratory and echocardiographic findings.

Mismatch was found in 13 (50%) patients. There was no statistically significant difference in age, cardiac troponin T, myoglobin, myosin light chain, aldolase levels, E wave/A wave ratio, right ventricular systolic pressure between the mismatch and non-mismatch groups. Left ventricular end-diastolic and end-systolic dimensions were significantly greater in the mismatch group (45.0 vs 42.5 mm, P =  < .01 and 29.5 mm vs 25.0 mm, P < .01). Left ventricular ejection fraction was significantly lower in the mismatch group (63.5% vs 71.5%, P = .04). Significant inverse correlation (r = −0.44, P = .03) was observed between left ventricular ejection fraction and mismatch ratio.

The use of 123I-BMIPP/ 201TlCl scintigraphy may be considered for evaluating myocarditis in patients with PM/DM.
Long non-coding RNA SNHG16 as a potential biomarker in hepatocellular carcinoma
Authors: Liu Qiuli , Gao Po , Li Qingling , Xu Chao , Qu Kai , Zhang Jie
Published: September 2021

Small nucleolar RNA host gene 16 (SNHG16) has recently been reported as a potential biomarker in various cancers. However, the prognostic value of SNHG16 in hepatocellular carcinoma (HCC) has not been investigated yet. Therefore, the purpose of this study was to reveal the association between SNHG16 expression and clinicopathological characteristics of HCC.

Standards-compliant literature was retrieved from multiple public databases, and data on overall survival, disease-free survival, and clinicopathological characteristics related to SNGH16 were extracted and meta-analysis was performed. Additionally, the Cancer Genome Atlas data were analyzed through the gene expression profiling interactive analysis database to verify previous results.

A total of 5 reports involving 410 patients with HCC were enrolled. The high expression of SNHG16 indicated worse overall survival (hazard ratio, 2.10; 95% CI, 1.22–3.60; P = .007) and disease-free survival (hazard ratio, 3.38; 95% CI, 1.10–10.40; P = .03). Additionally, the high expression of SNHG16 predicted a larger tumor size, metastasis, and advanced TNM stage.

SNHG16 could serve as a potential biomarker of poor prognosis in HCC.
Immediate breast reconstruction is oncologically safe for node-positive patients
Authors: Oda Goshi , Nakagawa Tsuyoshi , Uemura Noriko , Mori Hiroki , Mori Mio , Fujioka Tomoyuki , Onishi Iichiroh , Uetake Hiroyuki
Published: September 2021

The oncological safety of immediate breast reconstruction (IBR) in lymph node-positive patients is unclear. In the present study, the impact of IBR on recurrence based on data of patients with axillary lymph node metastases only was examined.

The subjects were 232 patients who underwent breast surgery. The patients were grouped into 2 cohorts: non-IBR patients who underwent mastectomy with axillary lymph node dissection; and IBR patients with tissue expander or flap transfer and axillary lymph node dissection. The Non-IBR group included 165 patients, and the IBR group included 67 patients. For the comparison of oncological outcomes between the 2 groups, propensity score matching was performed. The propensity scores were calculated by logistic regression analysis, including age, tumor staging, human epidermal growth factor receptor 2 status, and estrogen receptor status. There was no difference in locoregional recurrence-free survival (LRRFS) between the non-IBR and IBR groups. The 5-year LRRFS rate was 78.9% in the non-IBR group and 85.1% in the IBR group. There was no difference in recurrence-free survival (RFS) between the non-IBR and IBR groups. The 5-year RFS rate was 75.6% in the non-IBR group and 78.8% in the IBR group. In all patients, the 5-year LRRFS rate was 77.3%, and the RFS rate was 70.5%. Multivariate Cox regression analysis to identify factors affecting RFS in all patients showed that estrogen receptor status and high nuclear grade were significant prognostic factors; IBR was irrelevant.

This is the first report of an analysis using propensity score matching limited to node-positive breast cancer patients, and it showed that IBR is relatively safe in such patients.
Diagnostic and prognostic factors, and two nomograms for endometrial cancer patients with bone metastasis
Authors: Yang Fengkai , Zhao Ruhan , Huang Xiaohui , Wang Yucheng
Published: September 2021

Patients with endometrial cancer (EC) who develop bone metastasis (BM) always imply a poorer prognosis. However, reliable predictive models associated with BM from EC are currently limited.

We retrospectively analyzed data on 54,077 patients diagnosed with primary EC in the Surveillance, Epidemiology, and End Results database. Multivariate logistic regression analysis was used to determine independent predictors of BM from EC. Univariate and multivariate Cox regression analyses were used to determine independent prognostic factors for EC with BM. Based on independent predictors and prognostic factors, we constructed a diagnostic nomogram and prognostic nomogram separately. Besides, calibration curves, receiver operating characteristic curves, and decision curve analysis were used to evaluate the models.

A total of 54,077 patients with EC from the Surveillance, Epidemiology, and End Results database were included in this study, 364 of whom had BM. Multivariate analysis in the logistic model showed that lung metastasis, liver metastasis, brain metastasis, N stage, T stage, histologic grade, and race were risk factors for BM from EC. Multivariate analysis in the Cox model showed that liver metastasis, brain metastasis, chemotherapy, surgery, and histologic type had a significant effect on overall survival. Moreover, the receiver operating characteristic curve, calibration curve, and decision curve analysis indicated the good performance of both diagnostic and prognostic nomograms.

Two clinical prediction model was constructed and validated to predict individual risk and overall survival for EC with BM, respectively. Diagnostic nomogram and prognostic nomogram are complementary, improving the clinician's ability to assess the patient's prognosis and enhancing prognosis-based decision making.
Evaluation of the correlation between preoperative airway assessment tests, anthropometric measurements, and endotracheal intubation difficulty in obesity class III patients undergoing bariatric surgery
Authors: Emik Emre , Gümüs-Özcan Funda , Demirgan Serdar , Selcan Aysin
Published: September 2021

In this study, we investigated the correlation between airway assessment tests, anthropometric measurements, and the Modified Cormack– Lehane Classification (MCLC) assessed by videolaryngoscopy in patients undergoing bariatric surgery.

This study included 121 morbidly obese patients undergoing bariatric surgery. The body mass index, Modified Mallampati Score (MMS), thyromental distance, sternomental distance, interincisor distance, and neck, waist, and chest circumferences were recorded. The correlation between the airway assessment tests, anthropometric parameters, and the MCLC were analyzed. The time required for endotracheal intubation (EI) and the attempt required for EI were also recorded.

Thirty-three patients were found to be at risk of a difficult EI. The MMS, neck circumference, waist circumference, chest circumference, the time required for EI, and the number of attempts for EI were positively correlated with MCLC (all P < .05). As the MMS increased, the risk of a difficult EI increased (P < .001). The cutoff values of neck, waist, and chest circumference for the risk of a difficult EI were 41.5, 153.5, and 147.5 cm, respectively (P < .05).

This study indicates that the high MMS, as well as increased neck, waist, and chest circumference, should be considered EI difficulty in obese patients, even if a videolaryngoscopy is used.
Update on robotic cystectomy
Authors: Grauer Ralph , Wiklund N. Peter
Published: September 2021

Purpose of review

This article aims to discuss recently published (2019–2021) studies on robot-assisted radical cystectomy (RARC) with attention to evidence comparing intracorporeal (ICUD) and extracorporeal urinary diversion (ECUD) in terms of intraoperative and perioperative metrics.

Recent findings

RARC produces equivalent oncological outcomes compared to open radical cystectomy (ORC). The benefits of RARC are most pronounced perioperatively. ICUD has been increasingly used at centers of excellence as it reduces intestinal exposure, which may incrementally minimize morbidity compared to ECUD or ORC. As the learning curve for ICUD diversion has flattened, retrospective analyses have emerged that suggest this technique may hold benefit over both ORC and RARC with ECUD, though current data is conflicting, and a randomized controlled study is forthcoming.

ORC is the current ‘gold standard’ management for muscle-invasive bladder cancer. Based on the premise of the minimization of perioperative morbidity, the development of RARC, most recently with ICUD, seeks to improve patient outcomes. Despite a protracted learning curve, many expert bladder cancer centers have adopted an intracorporeal approach. As more centers adopt, refine, and climb the learning curve for ICUD, a clearer insight of its effect on morbidity will be revealed—informing further adoption of the technique.
The Opinions of Turkish Older Adults Related to Frailty
Authors: Canbolat Seyman Cigdem , Sara Yasemin
Published: September 2021

Frailty is a geriatric syndrome characterized by decreased daily living activity, weight loss, weakness, and dependency caused by the cumulative decline in many physiological systems over the life span. This study examined older adults' perceptions of frailty. The study used a descriptive qualitative design. Data were collected using semistructured interviews with 14 older adults admitted to the geriatrics outpatient clinic in one Turkish institution from September to December 2019. The interviews were transcribed and analyzed using the MAXQDA data analysis software. Codes were combined into themes. The respondents were aged 74.5 ± 8.7 years. Two themes emerged from the qualitative data: (i) the conceptualization of frailty; and (ii) coping with frailty. Some of the participants self-identified as frail, a natural consequence of aging. Another group of participants emphasized the feelings of hopelessness and hopefulness in coping with frailty in their remaining lives. This study provides insights into older Turkish adults' opinions regarding frailty, including the development of frailty and its relationship with health status and daily life. This understanding may be used to detect frailty in older adults and to improve frail older adults' care interventions.
Mobility and Depressive Symptoms in Persons With Mild Cognitive Impairment and Alzheimer Dementia
Authors: Flugon Susannah Julie , Jøranson Nina , Tangen Gro Gujord
Published: September 2021

Background and Purpose:

Persons with mild cognitive impairment (MCI) and Alzheimer dementia (AD) often experience gait and balance disturbances and depressive symptoms alongside their cognitive impairment. The aim of this study was to explore the relationship between mobility and depressive symptoms in community-dwelling persons with MCI and mild to moderate AD.

Methods:

Ninety-nine participants with MCI and AD from the memory clinic at Oslo University Hospital, Ullevål, Norway, were included. The Balance Evaluation Systems Test (BESTest), 10-m walk test regular (gait speed), and dual task (naming animals, dual-task cost in percent) were used to assess mobility. The Cornell Scale for Depression in Dementia, with validated cut-off 5/6 points, was used to assess presence of depressive symptoms. Multiple regression analysis was used to explore the relationship between mobility (3 separate models) and depressive symptoms, controlled for demographic factors, comorbidity, and Mini-Mental State Examination.

Results:

One-third of the participants had depressive symptoms, mean (SD) gait speed was 1.09 (0.3) m/s, and median (interquartile range) BESTest percent score was 81.5 (17.6). No statistically significant associations were found between depression and BESTest, gait speed or dual-task cost, neither in the simple models (P = 0.15-0.85), nor in the 3 multivariate models (P = 0.57-0.69).

Discussion and Conclusions:

In this study, we found no associations between mobility and depressive symptoms in persons with MCI and AD recruited at a memory clinic. Few participants had major symptoms of depression, which may have influenced the results. Longitudinal studies are needed to explore the long-time associations between mobility and depression.

Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A366).
A Pavlovian Intervention to Condition Comforting Effects of Fruits
Authors: Finch Laura E. , Cummings Jenna R. , Lee Sophie C. , Tomiyama A. Janet
Published: September 2021

Objective

Perceived stress, lower fruit intake, and comfort eating are all risk factors for chronic disease. The present pilot study aimed to simultaneously mitigate all three risk factors by applying Pavlovian conditioning to change the nature of comfort eating. Specifically, stressed participants underwent a Pavlovian conditioning intervention designed to elicit comforting effects of fruit intake and thereby reduce negative mood while promoting fruit intake.

Methods

We developed a seven-dose Pavlovian conditioning intervention wherein participants temporally paired together Progressive Muscle Relaxation (unconditioned stimulus) with fruit intake (conditioned stimulus) daily for 1 week. Participants (N = 100, mean [standard deviation] age = 20.7 [4.6] years; 74% female) with moderate to high levels of baseline perceived stress were randomized to the intervention or an active explicitly unpaired control group, wherein the Progressive Muscle Relaxation and fruit intake also occurred but were not temporally paired together. After the intervention, participants’ negative mood was assessed immediately before and after fruit intake to assess conditioning effects. Then, participants logged their regular food intake for 4 days using the MyFitnessPal smartphone app.

Results

After the intervention, fruit intake acutely improved negative mood to a greater extent among the intervention versus control group (F(1,98) = 3.99, p = .048,

= 0.039). However, there was not a significant between-group difference in intake of fruit or traditional comfort foods at postintervention.

Conclusions

Repeated pairing of fruit intake with a reliable distress-reducing activity led to the conditioning of comforting effects of fruit intake. Further refinement of the intervention design is necessary to translate this conditioned association to actual intake of fruit and other foods.
Out-of-Facility Multimonth Dispensing of Antiretroviral Treatment: A Pooled Analysis Using Individual Patient Data From Cluster-Randomized Trials in Southern Africa
Authors: Lopes John , Grimwood Ashraf , Ngorima-Mabhena Nicoletta , Tiam Appolinaire , Tukei Betty Bawuba , Kasu Tonderai , Mahachi Nyika , Mothibi Eula , Tukei Vincent , Chasela Charles , Lombard Carl , Fatti Geoffrey
Published: September 2021

Background:

Out-of-facility multi-month dispensing (MMD) is a differentiated service delivery model which provides antiretroviral treatment (ART) at intervals of up to 6 monthly in the community. Limited randomized evidence investigating out-of-facility MMD is available. We evaluated participant outcomes and compared out-of-facility MMD models using data from cluster-randomized trials in Southern Africa.

Setting:

Eight districts in Zimbabwe and Lesotho.

Methods:

Individual-level participant data from 2 cluster-randomized trials that included stable adults receiving ART at 60 facilities were pooled. Both trials had 3 arms: ART collected 3-monthly at healthcare facilities (3MF, control); ART provided three-monthly in community ART groups (CAGs) (3MC); and ART provided 6-monthly in either CAGs or on an individual provider-patient basis (6MC). Participant retention, viral suppression and incidence of unscheduled facility visits were compared.

Results:

Ten thousand one hundred thirty-six participants were included, 3817 (37.7%), 2893 (28.5%) and 3426 (33.8%) in arms 3MF, 3MC and 6MC, respectively. After 12 months, retention was non-inferior for 3MC (95.7%) vs. 3MF (95.0%) {adjusted risk difference (aRD) = 0.3 [95% confidence interval (CI): −0.8 to 1.4]}; and 6MC (95.1%) vs. 3MF [aRD = −0.2 (95% CI: −1.4 to 1.0)]. Retention was greater amongst intervention arm participants in CAGs versus 6MC participants not in CAGs, aRD = 1.5% (95% CI: 0.2% to 2.9%). Viral suppression was excellent (≥98%) and unscheduled facility visits were not increased in the intervention arms.

Conclusions:

Three and 6-monthly out-of-facility MMD was non-inferior versus facility-based care for stable ART patients. Out-of-facility 6-monthly MMD should incorporate small group peer support whenever possible.

ClinicalTrial Registration:

ClinicalTrials.gov NCT03238846 and NCT03438370.
Four Patterns of Abnormal Ring-Like Uptakes on Dedicated Breast PET
Authors: Sasada Shinsuke , Kai Azusa , Kimura Yuri , Masumoto Norio , Kadoya Takayuki
Published: September 2021

The high resolution of dedicated breast PET (dbPET) enables the visualization of small breast cancers and a heterogeneity of breast tumors. Some tumors present with a ring-like appearance, the central uptake defect possibly reflecting intratumoral fibrosis and necrosis, associated with high-grade malignancy, and a triple-negative subtype. However, a ring-like finding is not only found in high-grade breast cancers. We describe 4 representative patterns of ring-like uptakes on dbPET: high-grade invasive cancer, intracystic tumor, extended noninvasive carcinoma, and change after vacuum-assisted breast biopsy. Ring-like uptakes on dbPET should be evaluated in association with clinical information.
Long-term Outcomes of Firearm Injury Survivors in the United States
Authors: Orlas Claudia P. , Thomas Arielle , Herrera-Escobar Juan P. , Price Michelle A. , Haider Adil H. , Bulger Eileen M.
Published: September 2021

Summary Background/Objective:

To describe the current literature regarding long-term physical, mental, and social outcomes of firearm injury survivors in the United States.

Methods:

We systematically searched the PubMed/MEDLINE and Embase databases for articles published from 2013 to 2019 that involved survivors of acute physical traumatic injury aged 18 or older and reported health outcomes between 6 months and 10 years postinjury. Out of 747 articles identified, seven reported outcomes on United States-based civilian patients whose mechanism of injury involved firearms. We extended our publication date criteria from 1995 to 2020 and expanded the search strategy to include medical subject headings terms specific for firearm injury outcomes. Ultimately, ten articles met inclusion criteria.

Results:

When studied, a significant proportion of patients surviving firearm injury screened positive for posttraumatic stress disorder (49%–60%) or were readmitted (13%–26%) within 6 months postinjury. Most studies reported worse long-term outcomes for firearm injury survivors when compared both to similarly injured motor vehicle collision survivors and to the United States general population, including increased chronic pain, new functional limitations, and reduced physical health composite scores. Studies also reported high rates of posttraumatic stress disorder, reduced mental health composite scores, lower employment and return to work rates, poor social functioning, increased alcohol, and substance abuse.

Conclusions:

Research on the long-term health impact of firearm injury is scant, and heterogeneity in available studies limits the ability to fully characterize the outcomes among these patients. A better understanding of the long-term health impact of firearm injury would support systematic change in policy and patient care to improve outcomes.
Reoperative Surgery After Minimally Invasive Ivor Lewis Esophagectomy
Authors: Pather Keouna , Ghannam Alexander D. , Hacker Shoshana , Guerrier Christina , Mobley Erin M. , Esma Rhemar , Awad Ziad T.
Published: September 2021

Objective:

The aim of this study is to identify factors influencing reoperations following minimally invasive Ivor Lewis esophagectomy and associated mortality and hospital costs.

Materials and Methods:

Between 2013 and 2018, 125 patients were retrospectively analyzed. Outcomes included reoperations, mortality, and hospital costs. Multivariable logistic regression analyses determined factors associated with reoperations.

Results:

In-hospital reoperations (n=10) were associated with in-hospital mortality (n=3, P<0.01), higher hospital costs (P<0.01), and longer hospital stay (P<0.01). Conversely, reoperations after discharge were not associated with mortality. By multivariable analysis, baseline cardiovascular (P=0.02) and chronic kidney disease (P=0.01) were associated with reoperations. However, anastomotic leaks were not associated with reoperations nor mortality.

Conclusion:

The majority of reoperations occur within 30 days often during index hospitalization. Reoperations were associated with increased in-hospital mortality and hospital costs. Notably, anastomotic leaks did not influence reoperations nor mortality. Efforts to optimize patient baseline comorbidities should be emphasized to minimize reoperations following minimally invasive Ivor Lewis esophagectomy.
Prospective case-control study of dengue infection in some malaria and non-malaria patients consulting at the Bertoua Regional Hospital, East-Cameroon
Authors: Galani Tietcheu Borris Rosnay , Ayangma Elodie Ndeme , Wouatedem Sylvie , Meke Nguele Huguette Claire
Published: September 2021

In Cameroon, recent studies have documented several cases of dengue infection in some urban areas, but dengue-malaria coinfection malaria was little investigated, especially in the East region. From the 6th July to the 4th September 2020, a case-control study including 50 cases (malaria-positive subjects) and 90 controls (non-malaria subjects) was carried out at the Bertoua Regional Hospital. Participants were prospectively enrolled and administered with a questionnaire to record information such as age, sex, dwelling place, dengue knowledge, and the environment’s quality. Blood specimens were then collected and screened for dengue infection using the NS1/IgG/IgM rapid diagnostic tests and hematological parameters were measured using a MINDRAY-type hemacytometer. Of the malaria patients, 14% (7/50) were tested positive for dengue fever against 66.66% for the controls (60/90). Most malaria patients had a secondary dengue infection (57.14%, 4/7) while most of the non-malaria patients faced a primary infection (61.66%, 37/60). In both groups, women were more exposed than men to dengue and there was a significant association between the dwelling place and dengue seropositivity. Moreover, young subjects <16 years old were significantly more associated with dengue than 16-30 years old (OR=16.24, P=0.042 for cases vs, OR=21, P=0.0001 for controls). The analysis of hematological parameters showed a significant decrease (P<0.001) in platelets in cases compared to control. These results suggest that dengue fewer targets malaria- than non- malaria patients with different serological characteristics in Bertoua city. However, co-infected patients demonstrated a greater clinical vulnerability than monoinfected patients, urging the need for epidemiological surveillance.