Category: Nevin Manimala

Laryngoscope Investig Otolaryngol. 2023 Jan 17;8(1):296-302. doi: 10.1002/lio2.1010. eCollection 2023 Feb.

ABSTRACT

OBJECTIVES: Access to cochlear implantation may be negatively influenced by extended travel time to a cochlear implant (CI) center or lower socioeconomic status (SES) for the individual. There is a critical need to understand the influence of these variables on patient appointment attendance for candidacy evaluations, and CI recipients’ adherence to post-activation follow-up recommendations that support optimal outcomes.

METHODS: A retrospective chart review of adult patients referred to a CI center in North Carolina for initial cochlear implantation candidacy evaluation between April 2017 and July 2019 was conducted. Demographic and audiologic data were collected for each patient. Travel time was determined using geocoding. SES was proxied using ZCTA-level Social Deprivation Index (SDI) information. Independent samples t tests compared variables between those who did and did not attend the candidacy evaluation. Pearson correlations assessed the association of these variables and the duration of time between initial CI activation and return for first follow-up visit.

RESULTS: Three hundred and ninety patients met the inclusion criteria. There was a statistically significant difference between SDI of those who attended their candidacy evaluation versus those who did not. Age at referral or travel time did not show statistical significance between these two groups. There was no significant correlation with age at referral, travel time, or SDI with the duration of time (days) between initial activation and the 1-month follow-up.

CONCLUSIONS: Our findings suggest that SES may influence a patient’s ability to attend a cochlear implantation candidacy evaluation appointment and may further impact the decision to pursue cochlear implantation.Level of evidence: 4 – Case Series.

PMID:36846426 | PMC:PMC9948562 | DOI:10.1002/lio2.1010

Laryngoscope Investig Otolaryngol. 2023 Jan 20;8(1):25-33. doi: 10.1002/lio2.1012. eCollection 2023 Feb.

ABSTRACT

BACKGROUND: Sudden chemosensory changes were considered an early predictor of COVID-19. Here, the effects of comorbidities on changes in taste and smell in COVID-19 patients were investigated based on a worldwide study.

METHODS: Data analyzed here were collected from the Global Consortium for Chemosensory Research (GCCR) core questionnaire, including questions regarding preexisting disease conditions. Overall, the final sample of 12,438 participants who were diagnosed with COVID-19 included patients with preexisting conditions. Mixed linear regression models were used to test our hypothesis, and the p-value of interaction was examined.

RESULTS: A total of 61,067 participants completed the GCCR questionnaire, including 16,016 participants had preexisting diseases. The multivariate regression analysis showed that individuals with high blood pressure, lung disease, or sinus problems, or neurological diseases exhibited worse self-reported smell loss (p < .05), but no apparent significant differences in the smell or taste recovery. COVID-19 patients with seasonal allergy/hay fever lost their olfactory ability more than patients who did not have it (with 11.90 [9.67, 14.13] vs. without 6.97 [6.04, 7.91], p < .0001). The taste ability, smell loss and taste loss after COVID-19 recovery also decreased in the COVID-19 patients with seasonal allergy/hay fever (p < .001). Preexisting condition of diabetes did not worsen to chemosensory disorder but also had no obvious impact on the chemosensory recovery after acute infection. Preexisting diseases also affected the type of smell change in the COVID-19 patients with seasonal allergy/hay fever or sinus problems (p < .05).

CONCLUSIONS: COVID-19 patients with high blood pressure, lung disease, or sinus problems, or neurological diseases exhibited worse self-reported smell loss, but no differences in the smell or taste recovery. COVID-19 patients with seasonal allergy/hay fever had greater loss of smell and taste, poorer smell and taste recovery.

LEVEL OF EVIDENCE: 4.

PMID:36846410 | PMC:PMC9948579 | DOI:10.1002/lio2.1012

Laryngoscope Investig Otolaryngol. 2022 Nov 28;8(1):113-119. doi: 10.1002/lio2.962. eCollection 2023 Feb.

ABSTRACT

BACKGROUND: Pharyngocutaneous fistula (PCF) and salivary leaks are well known complications of head and neck surgery. The medical management of PCF has included the use of octreotide without a well-defined understanding of its therapeutic mechanism. We hypothesized that octreotide induces alterations in the saliva proteome and that these alterations may provide insight into the mechanism of action underlying improved PCF healing. We undertook an exploratory pilot study in healthy controls that involved collecting saliva before and after a subcutaneous injection of octreotide and performing proteomic analysis to determine the effects of octreotide.

METHODS: Four healthy adult participants provided saliva samples before and after subcutaneous injection of octreotide. A mass-spectrometry based workflow optimized for the quantitative proteomic analysis of biofluids was then employed to analyze changes in salivary protein abundance after octreotide administration.

RESULTS: There were 3076 human, 332 Streptococcus mitis, 102 G. haemolyans, and 42 Granulicatella adiacens protein groups quantified in saliva samples. A paired statistical analysis was performed using the generalized linear model (glm) function in edgeR. There were and ~300 proteins that had a p < .05 between the pre- and post-octreotide groups ~50 proteins with an FDR-corrected p < .05 between pre- and post-groups. These results were visualized using a volcano plot after filtering on proteins quantified by 2 more or unique precursors. Both human and bacterial proteins were among the proteins altered by octreotide treatment. Notably, four isoforms of the human cystatins, belonging to a family of cysteine proteases, that had significantly lower abundance after treatment.

CONCLUSION: This pilot study demonstrated octreotide-induced downregulation of cystatins. By downregulation of cystatins in the saliva, there is decreased inhibition of cysteine proteases such as Cathepsin S. This results in increased cysteine protease activity that has been linked to enhanced angiogenic response, cell proliferation and migration that have resulted in improved wound healing. These insights provide first steps at furthering our understanding of octreotide’s effects on saliva and reports of improved PCF healing.

PMID:36846407 | PMC:PMC9948565 | DOI:10.1002/lio2.962

Nutr Metab Cardiovasc Dis. 2023 Jan 5:S0939-4753(23)00002-9. doi: 10.1016/j.numecd.2022.12.025. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Cardio-metabolic diseases has been shown to be strongly associated with obesity. The aim of this study was to compare the predictive value of traditional and novel anthropometric measurement indices for cardio-metabolic diseases risk and evaluate whether new indicators can provide important information in addition to traditional indicators.

METHODS AND RESULTS: China Health and Nutrition Survey (CHNS) data were obtained for this study. Baseline information for healthy participants was gathered from 1997 to 2004. The incidence of cardio-metabolic diseases was collected from 2009 to 2015 for cohort analysis. The predictive ability of each index for the risk of cardio-metabolic diseases was evaluated with time-dependent ROC analysis. Body mass index (BMI) showed the greatest predictive ability for cardio-metabolic disease incidence among all traditional and novel indices (Harrell’s C statistic (95% CI): 0.7386 (0.7266-0.7507) for hypertension, 0.7496 (0.7285-0.7706) for diabetes, 0.7895 (0.7593-0.8196) for stroke and 0.7581 (0.7193-0.7969) for myocardial infarction). The addition of novel indices separately into the BMI model did not improve the predictive ability. Novel anthropometric measurement indices such as a body shape index (ABSI), abdominal volume index (AVI) and triponderal mass index (TMI), had a certain prediction ability for adults with BMI <24 kg/m² compared to those with BMI ≥24 kg/m².

CONCLUSION: No strong evidence supports novel anthropometric measurement indices were better than BMI in the prediction of cardio-metabolic diseases incidence among Chinese adults. Novel anthropometric measurement indices, mainly for abdominal obesity, may have a high predictive effect for adults with BMI <24 kg/m².

PMID:36842959 | DOI:10.1016/j.numecd.2022.12.025

Nutr Metab Cardiovasc Dis. 2023 Jan 5:S0939-4753(23)00003-0. doi: 10.1016/j.numecd.2022.12.028. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Chronic exposure to hyperglycemia is a significant risk factor for cardiovascular disease (CVD). Advanced glycation end products (AGES) result from multiple sugar-dependent reactions interacting with proteins and their receptors, generating endothelial dysfunction and CVD. However, there is little epidemiological data about its impact on CVD risk. We aimed to assess the association between circulating AGES and CVD risk in the Mexican population.

METHODS AND RESULTS: We used longitudinal data from waves 2004-2006 and 2010-2012 of 1195 participants from the Health Workers Cohort Study. Circulating AGES were assessed by radioimmunoassay, and cardiovascular risk (CVR) was computed with the Framingham risk score. Linear and logistic fixed-effects regression models were used to assess the interest association, adjusting for confounding factors. An increase in 200 μU/ml of AGES was associated with a 0.18% increased risk of CVD (95% CI 0.05-0.31%). After adjusting for physical activity and smoking status, individuals who increased their AGES category had higher odds of middle-high CVR (low to medium AGES: OR 1.83, 95% CI 1.11-3.20; low to high AGES: OR 2.61, 95% CI 1.51-4.50). The associations remained statistically significant when we further adjusted for insulin resistance, dietary intake of AGES, and total daily calorie intake.

CONCLUSION: Our data show that circulating AGES are associated with the Framingham CVD risk score, independently of other major risk factors for CVD in the Mexican population.

PMID:36842957 | DOI:10.1016/j.numecd.2022.12.028

J Prosthet Dent. 2023 Feb 24:S0022-3913(23)00072-0. doi: 10.1016/j.prosdent.2022.11.029. Online ahead of print.

ABSTRACT

STATEMENT OF PROBLEM: Dental cobalt-chromium (Co-Cr) alloy manufactured by selective laser melting (SLM) is not recommended for clinical applications before annealing because of excessive residual stress. However, limited information is available regarding the relationship between annealing temperature and the metal-ceramic bond properties of SLM Co-Cr alloys.

PURPOSE: The purpose of this in vitro study was to investigate the effects of annealing temperature on the metal-ceramic bond properties of SLM Co-Cr alloys.

MATERIAL AND METHODS: Four groups with different annealing temperatures (850 °C; 950 °C; 1050 °C; 1150 °C) were prepared by using SLM techniques. Bond strengths were measured by using a 3-point bend test; subsequently, debonded surface morphologies and elements were assessed by using a scanning electron microscopy (SEM) coupled with energy-dispersive X-ray spectroscopy (EDS). The area fraction of adherence porcelain (AFAP) value was introduced to analyze fracture characteristics. Microstructural and interfacial characteristics were characterized by SEM/EDS and X-ray diffraction analysis. The coefficient of thermal expansion (CTE) test was used to analyze thermal matching. A 1-way ANOVA and the Tukey honestly significant difference tests were used to analyze bond strengths and AFAP values statistically (α=.05).

RESULTS: The mean ±standard deviation values of the metal-ceramic bond strengths were 40.68 ±4.34 MPa for the 850 °C group, 37.54 ±5.34 MPa for the 950 °C group, 45.97 ±2.18 MPa for the 1050 °C group, and 50.79 ±1.79 MPa for the 1150 °C group. Significant differences (P<.05) were observed among all groups. Debonded surfaces and AFAP analysis displayed a mixed fracture mode of adhesive and cohesive fracture, and 1150 °C-annealing specimens exhibited better fracture characteristics close to cohesive fractures. As the temperature increased, native oxide film thicknesses remained unchanged; the 850 °C group had the thinnest diffusion layer, while the other 3 groups had similar thicknesses. Although the 1050 °C and 1150 °C groups displayed higher CTE values, their microstructures were more conducive to atomic diffusion and improved chemical bonding. Microstructure analysis found that ε phase and second-phase precipitates jointly affected metal-ceramic bond strength.

CONCLUSIONS: Annealing temperatures affected the metal-ceramic bond strengths of SLM Co-Cr porcelain specimens. 1150 °C annealing SLM Co-Cr specimens displayed higher bond strengths and improved fracture and interface characteristics among the 4 groups.

PMID:36842952 | DOI:10.1016/j.prosdent.2022.11.029

Am J Orthod Dentofacial Orthop. 2023 Feb 24:S0889-5406(23)00066-5. doi: 10.1016/j.ajodo.2022.11.012. Online ahead of print.

ABSTRACT

INTRODUCTION: Regarding the key role of the maxillary canine in dynamic occlusion and smile esthetics, this study investigated the relation between smile esthetics and maxillary canine torque and vertical position from the viewpoint of orthodontists, general dentists, and laypersons.

METHODS: In this descriptive cross-sectional study, the close-up smile images have been changed using Adobe Photoshop (Adobe Systems, San Jose, Calif). Then, groups of 21 orthodontists, 20 general dentists, and 33 laypersons evaluated the smile attractiveness of the images using a digital version of a visual analog scale. Statistical analysis was performed using SPSS software (version 25; IBM, Armonk, Calif) and Shapiro-Wilk, analysis of variance, and Tukey post-hoc statistical tests. The significance level was set at 0.05.

RESULTS: There was no significant difference in the mean score between the 3 groups of observers regarding the changes in the canine vertical position in none of the variations (P >0.05). Regarding variations in torque, there was a significant difference between the 3 groups of observers in the bilateral 5° torque change. (P = 0.020).

CONCLUSIONS: Unilateral changes in the vertical position had lower scores, which shows that symmetry is very important in smile esthetics. In addition, laypersons did not find torque changes ranging between -15° to 15° a significant factor in smile esthetics. Overall, some adherence to these values will be acceptable in dental treatments.

PMID:36842948 | DOI:10.1016/j.ajodo.2022.11.012

Eur Urol Oncol. 2023 Feb 24:S2588-9311(23)00031-7. doi: 10.1016/j.euo.2023.01.012. Online ahead of print.

ABSTRACT

BACKGROUND: The comparative efficacy and health-related quality of life (HRQoL) outcomes of nivolumab plus cabozantinib versus pembrolizumab plus axitinib as first-line treatments for advanced renal cell carcinoma (aRCC) have not been assessed in head-to-head trials.

OBJECTIVE: To assess the efficacy and HRQoL outcomes of nivolumab plus cabozantinib versus pembrolizumab plus axitinib.

DESIGN, SETTING, AND PARTICIPANTS: Patient-level data for nivolumab plus cabozantinib from the CheckMate 9ER trial and published data for pembrolizumab plus axitinib from the KEYNOTE-426 trial were used. CheckMate 9ER data were reweighted to match the key baseline characteristics as reported in KEYNOTE-426.

INTERVENTION: Nivolumab (240 mg every 2 wk) plus cabozantinib (40 mg once daily) and pembrolizumab (200 mg every 3 wk) plus axitinib (5 mg twice daily, initially).

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Hazard ratios (HRs) for progression-free survival (PFS), duration of response, overall survival (OS), and deterioration in HRQoL were assessed using weighted Cox proportional-hazard models, with sunitinib as a common anchor. Objective response rates (ORRs) and changes in HRQoL scores from baseline were assessed as difference-in-differences for the two treatments relative to sunitinib.

RESULTS AND LIMITATIONS: After balancing patient characteristics between the trials, nivolumab plus cabozantinib was associated with significantly improved PFS (HR [95% confidence interval {CI}] 0.70 [0.53-0.93]; p = 0.01) and a significantly decreased risk of confirmed deterioration in HRQoL (Functional Assessment of Cancer Therapy-Kidney Symptom Index-Disease-related Symptoms: HR [95% CI] 0.48 [0.34-0.69]) versus pembrolizumab plus axitinib. OS was similar between treatments (HR [95% CI] 0.99 [0.67-1.44]; p = 0.94). Nivolumab plus cabozantinib was associated with numerically greater ORRs (difference-in-difference [95% CI] 8.4% [-1.7 to 18.4]; p = 0.10) and longer duration of response (HR [95% CI] 0.79 [0.47-1.31]; p = 0.36) than pembrolizumab plus axitinib. Comparative studies using data with a longer duration of follow-up are warranted.

CONCLUSIONS: Nivolumab plus cabozantinib significantly improved PFS and HRQoL compared with pembrolizumab plus axitinib as first-line treatment for aRCC.

PATIENT SUMMARY: This study was conducted to indirectly compare the results of two immunotherapy-based combinations-nivolumab plus cabozantinib versus pembrolizumab plus axitinib-for patients who have not received any treatment for advanced renal cell carcinoma. Patients who received nivolumab plus cabozantinib had a significant improvement in the length of time without worsening of their disease and in their perceived physical and mental health compared with pembrolizumab plus axitinib; patients remained alive for a similar length of time from the start of either treatment. This analysis further adds to our current knowledge of the relative benefits of these two treatment regimens and will help with physician and patient treatment decisions.

PMID:36842942 | DOI:10.1016/j.euo.2023.01.012

Surgeon. 2023 Feb 24:S1479-666X(23)00021-5. doi: 10.1016/j.surge.2023.02.002. Online ahead of print.

ABSTRACT

BACKGROUND: MRCS examiners are the face of the Royal College of Surgeons for early-career surgeons and should therefore represent the workforce they are examining as not to marginalise or negatively impact on the assessment experience of candidates from minoritised groups. This study aimed to explore the diversity of MRCS examiners and whether they represent the demographics of the MRCS candidates.

METHODS: A retrospective observational study including all active examiners and examination candidates who attempted MRCS Part A or Part B between January 2020 and July 2021. Self-declared demographic data collected by the Intercollegiate Committee for Basic Surgical Examinations (ICBSE) included gender, sexual orientation, disability status and ethnicity. Following data anonymisation, total group response frequencies were made available to the research team for statistical analysis.

RESULTS: Chi-squared analyses showed statistically significant differences in the representation of gender, disability and ethnicity between candidates and examiners (all p < 0.001). Men (83.9% (n = 1121) vs 70.9% (n = 6017) respectively), individuals without disability (98.7% (n = 917) vs 96.1% (n = 6847)) and individuals of White ethnicity (36.6% (n = 346) vs 20.4% (n = 1223)) were significantly overrepresented in the examiners compared to the examination candidates. There was no statistically significant difference in sexual orientation between examiners and candidates (p = 0.712).

CONCLUSIONS: Broadly speaking, the socio-demographic profile of MRCS examiners reflects that seen in senior and leadership positions in surgery in the UK – that is, predominantly male and White – but not that seen in early-career surgeons. Positive action is now required in examiner recruitment by the Royal Colleges to ensure that the cohort of MRCS examiners reflects the modern surgical workforce.

PMID:36842928 | DOI:10.1016/j.surge.2023.02.002

Prog Urol. 2023 Feb 24:S1166-7087(23)00044-1. doi: 10.1016/j.purol.2023.02.002. Online ahead of print.

ABSTRACT

PURPOSE: Bladder infusion, which involves filling the bladder with saline prior to catheter removal, has been associated with reduced time-to-discharge and increased success rates in trials without catheter (TWOCs) in perioperative setting. The objective of this study was to evaluate the applicability of this protocol in patients with acute urinary retention (AUR) related to benign prostatic hyperplasia (BPH).

METHODS: We conducted a retrospective single-center study comparing bladder infusion with at least 150mL of warm saline vs. standard catheter removal during TWOC in patients with BPH-related AUR between January and December 2021. The primary outcome was time to discharge. Secondary outcomes included: TWOC success, and early recurrence of urinary retention defined as recurrence within three months of successful TWOC.

RESULTS: A total of 75 men were included: 35 in the bladder infusion protocol and 40 in the standard protocol. Baseline characteristics were well balanced between groups. Overall, 35 patients (46.7%) had a successful TWOC without statistically significant difference between groups (P=0.10). Bladder infusion protocol was associated with a shorter median time to discharge (200 vs. 240min, P=0.003). However, patients in the bladder infusion group were associated with a higher risk of early recurrence of urinary retention (30% vs. 0%, P=0.02).

CONCLUSION: In patients with BPH-related AUR, the saline bladder infusion method reduced time-to-discharge with similar TWOC success rates. Larger studies are needed to properly analyze the risk of early recurrence of urinary retention before any clinical application.

LEVEL OF EVIDENCE: III.

PMID:36842924 | DOI:10.1016/j.purol.2023.02.002