Category: Nevin Manimala

Coron Artery Dis. 2022 Dec 23. doi: 10.1097/MCA.0000000000001207. Online ahead of print.

ABSTRACT

OBJECTIVE: Obstructive sleep apnea (OSA) in patients with the acute coronary syndrome (ACS) were at high risk for cardiovascular events, but the results are currently inconclusive. We aimed to conduct a systematic review to determine the incidence of cardiovascular events among ACS patients with OSA by a meta-analysis of observational studies.

METHODS: PubMed, Embase, and Cochrane Library were searched for studies related to the association between OSA and the risk of cardiovascular events in patients with ACS. Risk of bias in observational studies was assessed according to the Risk Of Bias In the Non-randomized Studies-Of Interventions tool.We performed a meta-analysis using a random-effects model to calculate estimates of pooled hazard ratios (HR) with 95% confidence intervals (CI), and heterogeneity was assessed using the statistics.

RESULTS: A total of 12 studies evaluating ACS patients with OSA were included in the meta-analysis. OSA was related to the increased risk of MACE (HR = 2.2; 95% CI, 1.274-3.805, I2 = 76.1%). The effect of OSA on MACCE (HR = 1.921; 95% CI, 1.45-2.546; I2 = 19.1%) and readmission for unstable angina (HR = 3.137, 95% CI, 1.06-9.283; I2 = 52.4%) were statistically significant in the pooled analysis. All of the outcomes in the included studies had a serious risk of bias and the Grading of Recommendation, Assessment, Development, and Evaluation evidence level of all the evaluation results were very low.

CONCLUSIONS: OSA was associated with a significant increase in the risk of cardiovascular events for patients with ACS. Additional randomized controlled trial studies are required to confirm the results and to prove the treatment of OSA can change the prognosis.

PMID:36762648 | DOI:10.1097/MCA.0000000000001207

Transfusion. 2023 Feb 10. doi: 10.1111/trf.17259. Online ahead of print.

ABSTRACT

BACKGROUND: Low-titer group O whole blood (LTOWB) is increasingly used for emergency transfusion. We studied whether initial release of LTOWB compared with packed red blood cells (pRBCs) reduced overall blood requirements for patients needing emergency transfusion. Secondary outcomes examined included survival and non-lethal adverse clinical outcomes.

STUDY DESIGN AND METHODS: A retrospective, single-center, before-versus-after study compared patients transfused with emergency-release, uncrossmatched pRBC followed by component therapy (2016-2019) versus patients transfused with emergency-release, uncrossmatched LTOWB followed by component therapy (2019-2022).

RESULTS: Outcomes were available for 602 patients in the pRBC group versus 749 in the whole blood group. The two groups were similar for age, sex, race, estimated blood volume, ABO blood groups, and underlying diagnosis. Use of LTOWB was associated with increased blood product use at 24 h (4.0 (2.0-12.0) in pRBC group versus 6.5 (4.2-12.7) in LTOWB group, p < .0001) and at 7 days (5.5 (3.0-13.0) in pRBC group versus 7.3 (4.3-14.3) in LTOWB group, p < .0001). Initial use of LTOWB was not associated with improved 24 h or 30 day survival nor lower incidence of non-lethal adverse clinical outcomes compared with pRBC.

DISCUSSION: Our study showed a statistically significant increase in total blood use and blood acquisition costs for patients receiving initial emergency transfusion with LTOWB compared with pRBC. The initial use of LTOWB offered no advantage over component therapy for 30 day survival or selected non-lethal adverse outcomes.

PMID:36762627 | DOI:10.1111/trf.17259

ACS Appl Mater Interfaces. 2023 Feb 10. doi: 10.1021/acsami.2c20944. Online ahead of print.

ABSTRACT

Dysregulation of matrix metalloproteinase (MMP) is strongly implicated in tumor invasion and metastasis. Nanomaterials can interact with proteins and have impacts on protein activity, which provides a potential strategy for inhibiting tumor invasion and metastasis. However, the regulation of MMP activity by nanomaterials has not been fully determined. Herein, we have found that gold nanorods (Au NRs) are able to induce the change of the secondary structure of MMP-9 and thereby inhibit their activity. Interestingly, the inhibition of MMP-9 activity is highly dependent on the aspect ratio of Au NRs, and an aspect ratio of 3.3 shows the maximum inhibition efficiency. Molecular dynamics simulations combined with mathematical statistics algorithm reveal the binding behaviors and interaction modes of MMP-9 with Au NRs in atomic details and disclose the mechanism of aspect ratio-dependent inhibition effect of Au NRs on MMP-9 activity. Au NRs with an aspect ratio of 3.3 successfully suppress the X-ray-activated invasion and metastasis of tumor by inhibiting MMP-9 activity. Our findings provide important guidance for the modulation of MMP-9 activity by tuning key parameters of nanomaterials and demonstrate that gold nanorods could be developed as potential MMP inhibitors.

PMID:36762612 | DOI:10.1021/acsami.2c20944

Minerva Surg. 2023 Feb 10. doi: 10.23736/S2724-5691.22.09689-7. Online ahead of print.

ABSTRACT

INTRODUCTION: Metabolic surgery is a more effective manner to manage weight loss for morbidly obese patients than conservative therapy. There are many surgical and endoscopic modalities to choose which represents a real challenge for bariatric surgeons. LGCP is a restrictive procedure, the greater curvature of stomach is folded into the gastric lumen in one or two layers. Endoscopic bariatric and metabolic therapies (EBMTs) are evolving methods in metabolic interventions’ inventory. There are two methods imitating LGCP (endoscopic sleeve gastroplasty and primary obesity surgery endoluminal).

EVIDENCE ACQUISITION: We have conducted wide literature searches in Pubmed database in order to perform meta-analysis comparing endoscopic and surgical treatment modalities (EBMTs vs. LGCP). Safety and weight-loss outcomes were measured.

EVIDENCE SYNTHESIS: A number of 3585 patients for EBMTs and 2350 cases for LGCP were enrolled to final analysis. Comparison of complications (Clavien Dindo grade 1-5) showed almost equal risk. Percent of excess of weight loss was well matched at all follow-up timepoints, however, percent of total weight loss was in favor of LGCP. Changes of BMI were compared and showed similar efficacy for both methods.

CONCLUSIONS: EBMTs appeared to be superior to LGCP regarding safety but differences did not reach statistical threshold. Weight loss outcomes were favorable after each method. EBMTs imitating LGCP are promising safe and effective methods.

PMID:36762602 | DOI:10.23736/S2724-5691.22.09689-7

Int J Gynaecol Obstet. 2023 Feb 10. doi: 10.1002/ijgo.14720. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate surgical outcomes of using a double uterine segment tourniquet in obstetric hysterectomy for bleeding control in patients with placenta accreta spectrum.

METHODS: A retrospective case-control study was conducted at the Central Hospital of San Luis Potosi- Mexico. Patients with the diagnosis of placenta accreta spectrum who underwent obstetric hysterectomy were included. Two groups were formed: In the first group, a double uterine segment tourniquet was used; in the second group, the hysterectomy was performed without a tourniquet. Primary Surgical outcomes were compared RESULTS: Forty patients in each group were included. The use of a double uterine segment tourniquet had lower total blood loss than non- tourniquet group (1054.00 + 467.02 ml vs 1528.75 + 347.12 ml p= 0.0171, Lower drop in Haemoglobin 1.74 + 1.10 (mg/dl) versus 2.60 + 1.25. (mg/dl) p = 0.0486. In the group of the double tourniquet, 10 patients (23.80%) required blood transfusion, and 26 (65.00%) in the other group p-value 0.0003. Surgical time did not show a statistical difference between groups.

CONCLUSION: The use of uterine segment tourniquet in obstetric hysterectomy may improve surgical outcomes in patients with placenta accreta spectrum with no difference in surgical time and urinary tract lesions.

PMID:36762582 | DOI:10.1002/ijgo.14720

Obesity (Silver Spring). 2023 Feb 10. doi: 10.1002/oby.23663. Online ahead of print.

ABSTRACT

OBJECTIVE: Little is known about sex differences in response to lifestyle interventions among pediatric populations. The purpose of this analysis was to evaluate sex differences in adiposity following lifestyle interventions among children and adolescents with overweight or obesity aged 6 to 18 years old.

METHODS: Searches were conducted in PubMed, Web of Science, and MEDLINE (from inception to March 2021), and references from included articles were examined. Eligibility criteria included children and adolescents aged 6 to 18 years with overweight or obesity, randomization to a lifestyle intervention versus a control group, and assessment of at least one adiposity measure. Corresponding authors were contacted to obtain summary statistics by sex (n = 14/49).

RESULTS: Of 89 full-text articles reviewed, 49 (55%) were included, of which 33 (67%) reported statistically significant intervention effects on adiposity. Only two studies (4%) evaluated sex differences in response to lifestyle intervention, reporting conflicting results. The results of the meta-regression models demonstrated no significant differences in the treatment effect between male and female youth for weight (beta = -0.05, SE = 0.18, z = -0.28, p = 0.8), BMI (beta = 0.03, SE = 0.14, z = 0.19, p = 0.85), BMI z score (beta = -0.04, SE = 0.18, z = -0.23, p = 0.82), percentage body fat (beta = -0.11, SE = 0.16, z = -0.67, p = 0.51), and waist circumference (beta = -0.30, SE = 0.25, z = -1.18, p = 0.24).

CONCLUSIONS: The meta-analysis revealed that youth with overweight or obesity do not demonstrate a differential response to lifestyle intervention in relation to adiposity-related outcomes.

PMID:36762579 | DOI:10.1002/oby.23663

J Med Virol. 2023 Feb 10. doi: 10.1002/jmv.28570. Online ahead of print.

ABSTRACT

PURPOSE: COVID-19 may cause a dysregulation of the immune system and has complex relationships with multiple autoimmune diseases, including rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). However, little is known about their common genetic architecture.

METHODS: Using the latest data from COVID-19 host genetics consortium and consortia on RA and SLE, we conducted a genome-wide cross-trait analysis to examine the shared genetic etiology between COVID-19 and RA/SLE and evaluated their causal associations using bi-directional Mendelian randomization.

RESULTS: The cross-trait meta-analysis identified 23, 28, and 10 shared genetic loci for severe COVID-19, COVID-19 hospitalization, and SARS-CoV-2 infection with RA, and 14, 17, and 7 shared loci with SLE, respectively. Co-localization analysis identified five causal variants in TYK2, IKZF3, PSORS1C1 and COG6 for COVID-19 with RA, and four in CRHR1, FUT2 and NXPE3 for COVID-19 with SLE, involved in immune function, angiogenesis and coagulation. Bi-directional Mendelian randomization analysis suggested RA is associated with a higher risk of COVID-19 hospitalization, and COVID-19 is not related to RA or SLE.

CONCLUSION: Our novel findings improved the understanding of the genetic aetiology shared by COVID-19, RA and SLE, and suggested an increased risk of COVID-19 hospitalization in people with higher genetic liability to RA. This article is protected by copyright. All rights reserved.

PMID:36762574 | DOI:10.1002/jmv.28570

Mol Inform. 2023 Feb 10:e2200198. doi: 10.1002/minf.202200198. Online ahead of print.

ABSTRACT

The main protease (M^pro ) is an essential enzyme for the life cycle of SARS-CoV-2 and a validated target for treatment of COVID-19 infection. Structure-based pharmacophore modeling combined with QSAR calculations were employed to identify new chemical scaffolds of M^pro inhibitors from natural products repository. Hundreds of pharmacophore models were manually built from their corresponding X-ray crystallographic structures. A pharmacophore model that was validated by receiver operating characteristic (ROC) curve analysis and selected using the statistically optimum QSAR equation was implemented as a 3D-search tool to mine AnalytiCon Discovery database of natural products. Captured hits that showed the highest predicted inhibitory activities were bioassayed. Three active M^pro inhibitors (pseurotin A, lactupicrin, and alpinetin) were successfully identified with IC₅₀ values in low micromolar range.

PMID:36762567 | DOI:10.1002/minf.202200198

Ann Surg. 2023 Feb 10. doi: 10.1097/SLA.0000000000005820. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to analyze overall survival of robotic-assisted lobectomy (RL), video-assisted thoracoscopic lobectomy (VATS) and open lobectomy (OL) performed by experienced thoracic surgeons across multiple institutions.

SUMMARY BACKGROUND DATA: Surgeons have increasingly adopted RL for resection of early-stage lung cancer. Comparative survival data following these approaches is largely from single-institution case series or administrative datasets.

METHODS: Retrospective data was collected from 21 institutions from 2013-2019. Consecutive cases performed for clinical stage IA-IIIA lung cancer were included. Induction therapy patients were excluded. The propensity-score method of inverse-probability of treatment weighting (IPTW) was used to balance baseline characteristics. Overall survival (OS) was estimated using the Kaplan-Meier method. Multivariable Cox proportional hazard models were used to evaluate association among OS and relevant risk factors.

RESULTS: A total of 2,789 RL, 2,661 VATS, and 1,196 OL cases were included. The unadjusted 5-year overall survival rate was highest for OL (84%) followed by RL (81%) and VATS (74%); P=0.008. Similar trends were also observed after IPTW adjustment (RL 81%; VATS 73%, OL 85%, P=0.001). Multivariable Cox regression analyses revealed that OL and RL were associated with significantly higher overall survival compared to VATS (OL vs. VATS: HR 0.64, P<0.001 and RL vs. VATS: HR 0.79; P=0.007).

CONCLUSIONS: Our finding from this large multicenter study suggests that patients undergoing RL and OL have statistically similar OS, while the VATS group was associated with shorter OS. Further studies with longer follow-up are necessary to help evaluate these observations.

PMID:36762564 | DOI:10.1097/SLA.0000000000005820

Circulation. 2023 Feb 10. doi: 10.1161/CIRCULATIONAHA.122.060687. Online ahead of print.

ABSTRACT

BACKGROUND: The benefit-risk profile of direct oral anticoagulants (DOACs) compared with warfarin, and between DOACs in patients with atrial fibrillation (AF) and chronic liver disease is unclear.

METHODS: We conducted a new-user, retrospective cohort study of patients with AF and chronic liver disease who were enrolled in a large, US-based administrative database between January 1, 2011, and December 31, 2017. We assessed the effectiveness and safety of DOACs (as a class and individually) compared with warfarin, and between DOACs in patients with AF and chronic liver disease. The primary outcomes were hospitalization for ischemic stroke/systemic embolism and hospitalization for major bleeding. Inverse probability treatment weights were used to balance the treatment groups on measured confounders.

RESULTS: Overall, 10 209 participants were included, with 4421 (43.2%) on warfarin, 2721 (26.7%) apixaban, 2211 (21.7%) rivaroxaban, and 851 (8.3%) dabigatran. The incidence rates per 100 person-years for ischemic stroke/systemic embolism were 2.2, 1.4, 2.6, and 4.4 for DOACs as a class, apixaban, rivaroxaban, and warfarin, respectively. The incidence rates per 100 person-years for major bleeding were 7.9, 6.5, 9.1, and 15.0 for DOACs as a class, apixaban, rivaroxaban, and warfarin, respectively. After inverse probability treatment weights, the risk of hospitalization for ischemic stroke/systemic embolism was significantly lower between DOACs as a class (hazard ratio [HR], 0.64 [95% CI, 0.46-0.90]) or apixaban (HR, 0.40 [95% CI, 0.19-0.82]) compared with warfarin, but not significantly different between rivaroxaban versus warfarin (HR, 0.76 [95% CI, 0.47-1.21]) or rivaroxaban versus apixaban (HR, 1.73 [95% CI, 0.91-3.29]). Compared with warfarin, the risk of hospitalization for major bleeding was lower with DOACs as a class (HR, 0.69 [95% CI, 0.58-0.82]), apixaban (HR, 0.60 [95% CI, 0.46-0.78]), and rivaroxaban (HR, 0.79 [95% CI, 0.62-1.0]). However, the risk of hospitalization for major bleeding was higher for rivaroxaban versus apixaban (HR, 1.59 [95% CI, 1.18-2.14]).

CONCLUSION: Among patients with AF and chronic liver disease, DOACs as a class were associated with lower risks of hospitalization for ischemic stroke/systemic embolism and major bleeding versus warfarin. However, the incidence of clinical outcomes among patients with AF and chronic liver disease varied between individual DOACs and warfarin, and in head-to-head DOAC comparisons.

PMID:36762560 | DOI:10.1161/CIRCULATIONAHA.122.060687