Category: Nevin Manimala

Turk Neurosurg. 2022 Sep 27. doi: 10.5137/1019-5149.JTN.41657-22.2. Online ahead of print.

ABSTRACT

AIM: To present our series of cerebellopontine angle (CPA) meningiomas and to provide some innovative surgical steps for safe removal of these tumors.

MATERIAL AND METHODS: The clinical, radiological and surgical characteristics of 32 patients with meningioma in the CPA were retrospectively analyzed. Statistical analysis was performed to determine the factors that affect the incidence of complication.

RESULTS: The mean age was 49.5 years and 87.5% of patients were male. 87.5% of patients had WHO grade I meningioma and the others had WHO grade II tumors. The mean tumor volume was 33.98 ml and 65.6% of the patients underwent gross total resection. Preoperative tumor size/extension and extent of resection were related with the development of complications.

CONCLUSION: CPA meningiomas are challeging tumors for a safe removal. Tumor size and extent of resection are important risk factors for the development of postoperative complications.

PMID:36799278 | DOI:10.5137/1019-5149.JTN.41657-22.2

Oncol Rep. 2023 Mar;49(3):61. doi: 10.3892/or.2023.8498. Epub 2023 Feb 17.

ABSTRACT

The present study aimed to investigate the histological changes caused by neoadjuvant chemotherapy (NAC) for pancreatic ductal adenocarcinoma (PDAC), and to demonstrate the use of time‑density curves (TDCs) of dynamic contrast‑enhanced computed tomography (CECT) for determination of the histological therapeutic effects of NAC for PDAC. A total of 96 patients with PDAC were examined; 46 underwent NAC (NAC group) and 50 did not undergo NAC (non‑NAC group). Based on histological therapeutic effect and using the area of residual tumor (ART) grading system, the NAC group was divided into low‑responders and high‑responders. Histological analysis was used to evaluate the densities of cancer cells, cancer‑associated fibroblasts (CAFs), microvessels and stromal collagen fibers in the NAC and non‑NAC groups. Radiological analysis was used to evaluate the TDCs of three slopes of the NAC group, namely slopes between the non‑contrast and arterial phases (δ1 and δ1′), between the arterial and portal phases (δ2 and δ2′), and between the portal and equilibrium phases (δ3 and δ3′). δ1‑δ3 were before NAC, whereas δ1’‑δ3′ were after NAC. Changes in δ1, δ2 and δ3 before and after NAC were denoted as δδ1 (=δ1’‑δ1), δδ2 (=δ2’‑δ2) and δδ3 (=δ3’‑δ3). ART grading system, histological examination and radiological examination data were also statistically analyzed. Histological examination revealed a significant decrease in cancer cells and CAFs, and a significant increase in stromal collagen fibers due to NAC (P<0.01). Radiological examination revealed that δ1′ was significantly higher than δ1 in low‑responders (P<0.05), whereas δ2′ was significantly lower than δ2 in high‑responders (P<0.01). δδ2 was significantly lower and δδ3 was significantly higher in high‑responders than in low‑responders (P<0.01 and P<0.05, respectively). Receiver operating characteristic curve showed that δδ2 and δδ3 were effective indicators of the histological therapeutic effect of NAC. In conclusion, the TDC of dynamic CECT may be useful for determining the histological therapeutic effect of NAC for PDAC.

PMID:36799183 | DOI:10.3892/or.2023.8498

J Dermatol. 2023 Mar;50(3):327-336. doi: 10.1111/1346-8138.16642. Epub 2022 Nov 22.

ABSTRACT

Observation studies have postulated that atopic eczema is associated with a risk of inflammatory bowel disease in the East Asian population; however, this association does not obviate the biases resulting from confounding effects and reverse causation. This study aimed to determine whether this association is causal in the East Asian population using a bidirectional two-sample Mendelian randomization design. Independent genetic variants obtained from public genome-wide association studies for atopic eczema (4296 cases, 163 807 controls) were extracted to estimate the causal effects on inflammatory bowel disease (2824 cases, 3719 controls) and its two main conditions: Crohn’s disease (1690 cases, 3719 controls) and ulcerative colitis (1134 cases, 3719 controls). Atopic eczema was found to be strongly associated with inflammatory bowel disease (odds ratio [95% confidence interval]: 1.520 [1.179, 1.959]; p = 0.001), but not vice versa. Subtype analyses revealed that atopic eczema is significantly associated with Crohn’s disease (1.650 [1.293, 2.106]; p = 0.000) but not with ulcerative colitis. Both Crohn’s disease and ulcerative colitis were found to be causally related to atopic eczema; Crohn’s disease could reduce the risk of atopic eczema (0.866 [0.807, 0.930]; p = 0.000) while ulcerative colitis could increase the risk of atopic eczema (1.112 [1.021, 1.212]; p = 0.015). In conclusion, this study revealed that statistically causal relationships are present between atopic eczema and inflammatory bowel disease in the East Asian population. These findings are significant for guiding the treatment of atopic eczema and inflammatory bowel disease in clinical practice.

PMID:36799178 | DOI:10.1111/1346-8138.16642

Clin Endocrinol (Oxf). 2023 Feb 17. doi: 10.1111/cen.14895. Online ahead of print.

ABSTRACT

BACKGROUND: To compare OCs(oral contraceptives) + metformin and OCs alone for metabolic effects in non-obese PCOS patients.

METHODS: The search was performed in PubMed, EMBASE, the Cochrane Library, and clinicaltrials.gov for all published studies up to April 30, 2022 and was limited to English language articles. All randomized controlled trials (RCTs) comparing OCs + metformin and OCs alone for reproductive-age women with PCOS were included. Data were processed using Revman 5.3 software.

RESULTS: Of 396 studies identified, 14 RCTs were included for analysis comprising 707 women. OCs+metformin significantly modified fasting glucose[MD=-0.21(95%CI=-0.31,-0.12),p<0.00001]and fasting insulin[MD= -2.54(95%CI=-4.04,-1.04),p=0.0009] at study completion compared with OCs alone in non-obese PCOS subjects. There was no statistic difference in the homeostasis model assessment of insulin resistance (HOMA-IR), high density lipoprotein (HDL), low density lipoprotein (LDL), total cholesterol or triglycerides at study end between the two groups.

CONCLUSIONS: Metformin, via its positive effects on insulin clearance, in combination with OCs, improved glucose metabolism and offered a good treatment alternative in non-obese women with PCOS. This article is protected by copyright. All rights reserved.

PMID:36799083 | DOI:10.1111/cen.14895

Cancer Med. 2023 Feb 17. doi: 10.1002/cam4.5628. Online ahead of print.

ABSTRACT

BACKGROUND: Quantitative methods of Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) interpretation, including the percent change in FDG uptake from baseline (ΔSUV), are under investigation in lymphoma to overcome challenges associated with visual scoring systems (VSS) such as the Deauville 5-point scale (5-PS).

METHODS: In CALGB 50303, patients with DLBCL received frontline R-CHOP or DA-EPOCH-R, and although there were no significant associations between interim PET responses assessed centrally after cycle 2 (iPET) using 5-PS with progression-free survival (PFS) or overall survival (OS), there were significant associations between central determinations of iPET ∆SUV with PFS/OS. In this patient cohort, we retrospectively compared local vs central iPET readings and evaluated associations between local imaging data and survival outcomes.

RESULTS: Agreement between local and central review was moderate (kappa = 0.53) for VSS and high (kappa = 0.81) for ∆SUV categories (<66% vs. ≥66%). ∆SUV ≥66% at iPET was significantly associated with PFS (p = 0.03) and OS (p = 0.002), but VSS was not. Associations with PFS/OS when applying local review vs central review were comparable.

CONCLUSIONS: These data suggest that local PET interpretation for response determination may be acceptable in clinical trials. Our findings also highlight limitations of VSS and call for incorporation of more objective measures of response assessment in clinical trials.

PMID:36799072 | DOI:10.1002/cam4.5628

J Endourol. 2023 Feb 17. doi: 10.1089/end.2022.0736. Online ahead of print.

ABSTRACT

PURPOSE: We aimed to make a general comparison between the safety and feasibility of a novel robotic platform, da Vinci® SP system with conventional robotic multi-port (MP) and laparoendoscopic single-site (LESS) systems (da Vinci® Xi or Si) in three upper urinary tract procedures including robot-assisted partial nephrectomy (RAPN), robot-assisted pyeloplasty (RAP) and robotic adrenalectomy (RA).

MATERIALS AND METHODS: After systematically searched the literature up to August 2022 in PubMed®, Web of Science™ and the Cochrane Library and Scopus® database, we extracted and processed the data in eligible literature for operative time, warm ischemia time (WIT), morphine milligram equivalent (MME), postoperative complications and positive surgical margins (PSM).

RESULTS: A total of 738 patients who underwent robotic surgery for SP or MP from 10 articles were included in this meta-analysis. There was no statistically significant difference in operative time for either RAPN (SMD -0.16, 95% CI -0.39 to 0.08) or RA (SMD -0.51, 95% CI -1.08 to 0.06). However, for RALP, SP can save operation time (SMD -0.73, 95% CI -1.24 to -0.22).There was no difference in the incidence of postoperative complications after RAPN (OR 0.81, 95% CI 0.35 to 1.89), nor in the incidence of PSM (OR 1.09, 95% CI 0.49 to 2.41) between the two procedures. It is worth noting that although the SP system increases WIT (SMD 0.45, 95% CI0.27 to 0.63), which may be partly due to the learning curve, the SP has the benefit of reducing intraoperative pain in RAPN in regard of MME (SMD -0.40, 95% CI -0.71 to -0.09).

CONCLUSIONS: Due to issues with SP surgical instruments, such as the need for an additional robotic arm to manipulate the bulldog clamp, SP will increase WIT during RAPN procedure. Surgeons may extend the learning curve to overcome the growing warm ischemic injury.

PMID:36799070 | DOI:10.1089/end.2022.0736

J Glob Health. 2023 Feb 17;13:01003. doi: 10.7189/jogh.13.01003.

ABSTRACT

We reflect on our experiences of using Generative Pre-trained Transformer ChatGPT, a chatbot launched by OpenAI in November 2022, to draft a research article. We aim to demonstrate how ChatGPT could help researchers to accelerate drafting their papers. We created a simulated data set of 100 000 health care workers with varying ages, Body Mass Index (BMI), and risk profiles. Simulation data allow analysts to test statistical analysis techniques, such as machine-learning based approaches, without compromising patient privacy. Infections were simulated with a randomized probability of hospitalisation. A subset of these fictitious people was vaccinated with a fictional vaccine that reduced this probability of hospitalisation after infection. We then used ChatGPT to help us decide how to handle the simulated data in order to determine vaccine effectiveness and draft a related research paper. AI-based language models in data analysis and scientific writing are an area of growing interest, and this exemplar analysis aims to contribute to the understanding of how ChatGPT can be used to facilitate these tasks.

PMID:36798998 | DOI:10.7189/jogh.13.01003

J Clin Sleep Med. 2023 Feb 17. doi: 10.5664/jcsm.10514. Online ahead of print.

ABSTRACT

STUDY OBJECTIVES: Several studies have shown that patients with short sleep duration show a poor response to cognitive behavioral therapy for insomnia (CBT-I) but such studies have not included patients with comorbid conditions. The current study was conducted to determine whether pre-treatment sleep duration moderates the response of patients with major depression (MDD) and insomnia (ID) disorders to a combined CBT-I and antidepressant medication treatment.

METHODS: This study comprised a secondary analysis of a larger randomized trial that tested combined CBT-I/antidepressant medication treatment of patients with MDD and ID. Participants (N=99; 70 women; M_age = 47.712.4 yrs.) completed pre-treatment polysomnography and then were randomly assigned to a 12-week treatment with antidepressant medication combined with CBT-I or a sham therapy (CTRL). Short and longer sleepers were defined using total sleep time cutoffs of <5, <6 and <7 hours for short sleep. Insomnia and depression remission ascertained respectively from the Insomnia Severity Index and Hamilton Rating Scale for Depression were used to compare treatment responses of short and longer sleepers defined by the cutoffs mentioned.

RESULTS: Logistic regression analyses showed that statistically significant results were obtained only when the cutoff of <5 hours of sleep was used to define “short sleep.” Both the CBT-I recipients with < 5 hours of sleep (OR = 0.053; 95% CI = 0.006 – 0.499) and the CTRL group with ≥ 5 hours of sleep (OR = 0.149; 95% CI = 0.045 – 0.493) were significantly less likely to achieve insomnia remission than were CBT-I recipients with ≥ 5 hours of sleep. The shorter sleeping CBT-I group (OR = 0.118; 95% CI = 0.020 – 0.714) and longer sleeping CTRL group (OR = 0.321; 95% CI = 0.105 – 0.983) were also less likely to achieve insomnia and/or depression remission than was the longer sleeping CBT-I group with ≥ 5 hours of sleep.

CONCLUSIONS: Sleeping <5 hours may dispose comorbid MDD/ID patients to a poor response to combined CBT-I/medication treatments for their insomnia and depression. Future studies to replicate these findings and explore mechanisms of treatment response seem warranted.

CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Title: Treatment of Insomnia and Depression (TRIAD); Identifier: NCT00767624; URL: https://clinicaltrials.gov/ct2/show/results/NCT00767624.

PMID:36798983 | DOI:10.5664/jcsm.10514

J Clin Sleep Med. 2023 Feb 17. doi: 10.5664/jcsm.10516. Online ahead of print.

ABSTRACT

STUDY OBJECTIVES: Chronic noncancer pain (CP) commonly co-occurs with obstructive sleep apnea (OSA) and may contribute to greater symptom burden. The study aims were to (1) characterize CP among veterans with OSA; and (2) examine differences in sleepiness (Epworth Sleepiness Scale, ESS), insomnia symptoms (Insomnia Severity Index [ISI]), and quality of life (Short Form Health Survey 20, SF-20) in veterans with OSA with or without pre-existing CP.

METHODS: An observational, cross-sectional, study of 111 veterans with newly diagnosed, untreated OSA was conducted. Descriptive statistics characterized the sample and comorbid CP outcomes. Regression analyses were performed to investigate associations between self-reported CP and sleep-related symptoms or quality of life while controlling for potential confounders.

RESULTS: CP was reported by 69.5% (95% CI: 61.8, 76.2) of participants. Having CP was associated with increased ESS (12.7 ± 5.5 vs 10.2 ± 5.2; p = 0.021) and ISI scores (18.1 ± 6.2 vs. 13.7 ± 7.4; p = 0.002), and worse quality of life across all SF-20 domains.

CONCLUSIONS: There is a high prevalence of CP among veterans with OSA and symptom burden is higher in patients with OSA and CP. Future investigations should address symptom response and burden to OSA treatment in comorbid OSA and CP to guide outcome expectancies and residual OSA symptom treatment plans.

PMID:36798982 | DOI:10.5664/jcsm.10516

Oral Dis. 2023 Feb 16. doi: 10.1111/odi.14543. Online ahead of print.

ABSTRACT

OBJECTIVE: The possible association between hypertension and periodontitis and the effect of hypertension on periodontal treatment were investigated by evaluating salivary and gingival crevicular fluid (GCF) interleukin (IL)-6 and C reactive protein (CRP) levels.

METHODS: Forty-two healthy individuals without any previously diagnosed systemic disease [10 periodontally healthy (control) and 10 periodontitis (CP)] and subjects with hypertension [13 periodontally healthy (HP) and 9 with periodontitis (CP + HP)] participated in the study. GCF and saliva samples were obtained at baseline and four weeks after Phase I periodontal treatment. Biochemical parameters were analyzed using ELISA.

RESULTS: Before the periodontal treatment, significantly higher GCF IL-6 and CRP levels were detected in CP+HP and CP groups compared to HP and control groups (p<0.01). Salivary CRP level in CP+HP group was found to be higher than the control group (p<0.05). Statistically significant gingival and plaque index measurements (p<0.01) might suggest a possible effect of hypertension on periodontal status. Periodontal treatment significantly improved the clinical indices, however biochemical parameters did not change after the treatment.

CONCLUSION: The association of hypertension with periodontitis through local salivary and GCF inflammatory mediators might be possible in disease process.

PMID:36798972 | DOI:10.1111/odi.14543