Category: Nevin Manimala

Eur Urol Focus. 2023 Apr 7:S2405-4569(23)00090-1. doi: 10.1016/j.euf.2023.03.021. Online ahead of print.

ABSTRACT

BACKGROUND: Nerve-sparing (NS) radical prostatectomy (RP) results in better functional outcomes. Intraoperative neurovascular structure-adjacent frozen section examination (NeuroSAFE) significantly increases the frequency of NS surgery. The effect of NeuroSAFE on postoperative erectile function (EF) and continence is not yet clear.

OBJECTIVE: To describe EF and continence outcomes for men undergoing RP with the NeuroSAFE technique.

DESIGN, SETTING, AND PARTICIPANTS: Between September 2018 and February 2021, 1034 men underwent robot-assisted RP. Data for patient-reported outcomes were collected via validated questionnaires.

INTERVENTION: NeuroSAFE technique for RP.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Continence was assessed using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) or Expanded Prostate Cancer Index Composite short form (EPIC-26) and defined as use of 0-1 pads/d. EF was evaluated using EPIC-26 or the International Index of Erectile Function short form (IIEF-5), with data converted according to the Vertosick method and categorized. Descriptive statistics were used to asses and describe tumor characteristics and continence and EF outcomes.

RESULTS AND LIMITATIONS: Of the 1034 men who underwent RP after introduction of the NeuroSAFE technique, 63% and 60% completed a preoperative and at least one postoperative questionnaire on continence and EF, respectively. Of the men who underwent unilateral or bilateral NS surgery, use of 0-1 pads/d was reported by 93% after 1 yr and 96% after 2 yr; the corresponding rates for men who underwent non-NS surgery were 86% and 78%. Overall, use of 0-1 pads/d was reported by 92% of the men at 1 yr and by 94% at 2 yr after RP. Men in the NS group had a good or intermediate Vertosick score after RP more often than the non-NS group. Overall, 44% of the men had a good or intermediate Vertosick score at 1 and 2 yr after RP.

CONCLUSIONS: After introduction of the NeuroSAFE technique, the continence rate was 92% at 1 yr and 94% at 2 yr after RP. The NS group had a greater percentage of men with an intermediate or good Vertosick score and a higher continence rate after RP in comparison to the non-NS group.

PATIENT SUMMARY: Our study shows that after introduction of the NeuroSAFE technique during removal of the prostate, the continence rate among patients was 92% at 1 year and 94% at 2 years after surgery. Some 44% of the men had a good or intermediate score for erectile function 1 and 2 years after surgery.

PMID:37032279 | DOI:10.1016/j.euf.2023.03.021

Surgery. 2023 Apr 7:S0039-6060(23)00124-1. doi: 10.1016/j.surg.2023.03.002. Online ahead of print.

ABSTRACT

OBJECTIVE: To introduce an innovative elastic compression hemostasis technique for extremity excision in extensively burnt patients and investigate its effectiveness.

METHODS: Ten patients were included and divided into 2 groups: the control group (4 patients, 12 extremities) receiving the conventional hemostasis technique and the experimental group (6 patients, 14 extremities) receiving the innovative technique. General data of the patients were collected, excision size measured, hemostasis time recorded, average blood loss per 1% total body surface area of the excised wound calculated, incidence of subcutaneous hematoma and take rate determined.

RESULTS: The 2 groups had no statistical difference in the baseline data. Average blood loss per 1% total body surface area of the excised wound in the upper and the lower extremities was (62.1 ± 11.5) mL and (35.6 ± 11.0) mL in the experimental group, significantly less than (94.3 ± 6.9) mL and (82.3 ± 6.2) mL in the control group; a reduction of 34.1% and 56.8% respectively. Hemostasis time in the upper and the lower extremities were (5.0 ± 0.7) min/1% total body surface area and (2.6 ± 0.3) min/1% total body surface area, respectively, in the experimental group, significantly less than (7.4 ± 0.6) min/1% total body surface area and (4.0 ± 0.9) min/1% total body surface area in the control group; a reduction of 31.8% and 34.9% respectively. The incidences of subcutaneous hematoma were 7.1% and 8.3%, and the take rate (85.9 ± 6.0)% and (86.5 ± 4.8)% in the experimental and the control group, respectively, with no statistically significant differences.

CONCLUSION: The innovative elastic compression hemostasis technique is a reliable new method that significantly reduces blood loss during extremity excision in patients with extensive burns and is worth wider understanding and application.

PMID:37032269 | DOI:10.1016/j.surg.2023.03.002

J Surg Educ. 2023 Apr 7:S1931-7204(23)00094-6. doi: 10.1016/j.jsurg.2023.03.001. Online ahead of print.

ABSTRACT

OBJECTIVE: Traditional education of clinical training mainly relies on a single mode of lecture-based learning (LBL), in which the teacher lectures and the students listen, and the teaching effect is often unsatisfactory. This study aims to explore the effect of simulation-based learning (SBL) combined with case and problem-based learning (CPBL) teaching mode in the clinical education of joint surgery.

DESIGN: Through objective evaluation of joint surgery students’ theoretical knowledge and clinical skills, and subjective evaluation of teaching quality by anonymous questionnaire, the teaching effects of LBL teaching mode, CPBL teaching mode and SBL combined with CPBL teaching mode in clinical teaching of joint surgery were compared.

SETTING AND PARTICIPANTS: Sixty students who participated in the standardized training of residents in the Center for Joint Surgery, Southwest Hospital, Army University, China from March 2020 to September 2021 were selected and randomly divided into groups A, B, and C, with 20 students in each group. Group A adopted traditional LBL mode, group B adopted CPBL mode, and group C adopted SBL combined with CPBL mode.

RESULTS: The scores of theoretical knowledge, clinical skills and total score of group C were (86.40 ± 9.76), (92.15 ± 4.49), (88.70 ± 5.75) points respectively, which were significantly higher than (78.80 ± 10.50), (86.60 ± 8.79), (81.92 ± 6.97) points in group B, and (80.50 ± 6.64), (85.35 ± 7.99), (82.44 ± 5.97) points in group A, the difference was statistically significant (p < 0.05). The scores of 5 self-evaluation items, i.e., learning interest, self-learning ability, problem-solving ability, clinical skills and comprehensive competency were (18.90 ± 1.22), (18.85 ± 1.01), (18.75 ± 1.13), (18.90 ± 1.22), (18.50 ± 1.02), (18.80 ± 0.81) points in group C, which were higher than (15.90 ± 1.41), (14.30 ± 2.47), (13.95 ± 2.01), (14.50 ± 1.63), (14.70 ± 1.38) points in group B, and (11.65 ± 2.90), (10.05 ± 1.69), (9.75 ± 1.67), (14.35 ± 1.90), (12.75 ± 2.12) points in group A, the difference was statistically significant (p <0.05). The satisfaction of students in group C (95.00%) was significantly better than that in group B (80.00%) and group A (65.00%), and the difference was statistically significant (p < 0.05).

CONCLUSION: SBL combined with CPBL teaching mode can effectively improve the theoretical knowledge and clinical skills of the students, which could improve self-assessment and teaching satisfaction rate, and is worthy of application and promotion in the clinical teaching of joint surgery.

PMID:37032261 | DOI:10.1016/j.jsurg.2023.03.001

Neural Netw. 2023 Mar 27:S0893-6080(23)00170-3. doi: 10.1016/j.neunet.2023.03.035. Online ahead of print.

ABSTRACT

In domain adaptation, when there is a large distance between the source and target domains, the prediction performance will degrade. Gradual domain adaptation is one of the solutions to such an issue, assuming that we have access to intermediate domains, which shift gradually from the source to the target domain. In previous works, it was assumed that the number of samples in the intermediate domains was sufficiently large; hence, self-training was possible without the need for labeled data. If the number of accessible intermediate domains is restricted, the distances between domains become large, and self-training will fail. Practically, the cost of samples in intermediate domains will vary, and it is natural to consider that the closer an intermediate domain is to the target domain, the higher the cost of obtaining samples from the intermediate domain is. To solve the trade-off between cost and accuracy, we propose a framework that combines multifidelity and active domain adaptation. The effectiveness of the proposed method is evaluated by experiments with real-world datasets.

PMID:37032243 | DOI:10.1016/j.neunet.2023.03.035

Arch Med Res. 2023 Apr 7:S0188-4409(23)00054-1. doi: 10.1016/j.arcmed.2023.03.008. Online ahead of print.

NO ABSTRACT

PMID:37032233 | DOI:10.1016/j.arcmed.2023.03.008

Clin Genitourin Cancer. 2023 Mar 11:S1558-7673(23)00063-0. doi: 10.1016/j.clgc.2023.03.004. Online ahead of print.

ABSTRACT

BACKGROUND: Studies about perioperative complications and all-cause mortality in frail patients requiring radical cystectomy (RC) are scarce. We aimed to assess the short- and long-term effect of RC in frail patients with bladder cancer.

PATIENTS AND METHODS: We performed a retrospective, cohort study including patients who underwent open RC due to bladder cancer from November 2013 to June 2022. Patients were considered frail when they fulfilled one of the following criteria: i) age ≥ 75 years; ii) Charlson Comorbidity Index ≥ 9; iii) American Society of Anesthesiologists classification ≥ 4; or iv) Clinical Frailty Scale score ≥ 5. We evaluated all-cause mortality and complications in frail versus nonfrail patients. The effect of urinary diversion with ileal conduit versus ureterocutaneostomy in frail patients was also assessed via a Cox regression analysis.

RESULTS: Overall, 184 individuals underwent RC (95 frail and 89 nonfrail). A total of 130 patients (80%) presented at least one perioperative complication. This proportion was even higher among frail patients (86%). Similarly, severe perioperative complications were more common in frail patients based on the Clavien-Dindo classification (P = 0.044). Regarding disease progression and long-term complications, no statistically significant differences were observed between frail and nonfrail patients. The survival analysis with Kaplan-Meier curves demonstrated that the risk of death was increased in frail patients (log-rank test = 0.027). Based on the multivariate Cox regression analysis adjusting for major risk factors, urinary diversion with ureterocutaneostomy was significantly associated with increased mortality in frail patients compared to ileal conduit (Hazard Ratio: 3.5, 95% Confidence Interval: 1.3-9.4, P = 0.01).

CONCLUSIONS: RC is feasible in frail patients but is associated with increased perioperative morbidity and mortality. Preoperative frailty screening should be implemented to counsel and carefully select patients eligible for RC.

PMID:37032231 | DOI:10.1016/j.clgc.2023.03.004

J Emerg Med. 2023 Mar 21:S0736-4679(23)00049-5. doi: 10.1016/j.jemermed.2023.02.003. Online ahead of print.

ABSTRACT

BACKGROUND: Nationally, in states where cannabis has been legalized, increases in cannabis-related hospitalizations and emergency department (ED) visits have also been observed.

OBJECTIVES: This study aims to: 1) Describe the sociodemographic characteristics of cannabis users presenting to two academic EDs in California; 2) Assess cannabis-related behaviors; 3) Assess perceptions of cannabis; 4) Identify and describe reasons for cannabis-related ED utilization.

METHODS: This is a cross-sectional study of patients visiting one of two academic EDs between February 16, 2018 and November 21, 2020. Eligible participants completed a novel questionnaire developed by the authors. Basic descriptive statistics, Pearson correlation coefficients, and logistic regression were used for statistical analysis of responses.

RESULTS: The questionnaire was completed by 2577 patients. A quarter were categorized as Current Users (n = 628, 24.4%). Current, Regular Users were evenly divided across gender, were relatively younger (18-34 years, 48.1%), and were largely non-Hispanic Caucasian. Over half of all respondents believed that the use of cannabis was less harmful than tobacco or alcohol use (n = 1537, 59.6%). One in five Current Users (n = 123, 19.8%) reported driving while using cannabis in the past month. A small proportion (n = 24, 3.9%) of Current Users reported ever visiting the ED for a cannabis-related chief complaint.

CONCLUSIONS: Overall, many ED patients are currently using cannabis; few report utilizing the ED due to cannabis-related problems. Current, Irregular Users may represent the ideal target group for ED-based educational efforts aimed at improving knowledge of safe cannabis use.

PMID:37032203 | DOI:10.1016/j.jemermed.2023.02.003

Clin Nutr. 2023 Mar 31;42(5):800-809. doi: 10.1016/j.clnu.2023.03.019. Online ahead of print.

ABSTRACT

BACKGROUND: Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder which affects a great number of patients globally. Clinical trials and meta-analyses have evaluated different therapies for IBS. Some of them have shown that probiotics play a significant role in the management of IBS-patients. Nevertheless, results are controversial, and the efficacy of the administration of probiotics remains to be confirmed, especially in regard to which type of probiotic-strains are beneficial.

AIM: The aim of the present meta-analysis is to assess the efficacy and safety of the administration of probiotics to IBS-patients with a diagnosis based on Rome IV criteria, which is performed for the first time.

METHODS: Electronic databases (Pubmed, Scopus and Cochrane) were searched until 26.01.2023 for randomized controlled trials (RCTs) studying the administration of probiotics in adult IBS-patients, who were categorized according to the Rome IV criteria. The risk of bias was assessed using the Cochrane Risk of Bias tool (ROB) 2.0. Weighted and standardized mean difference with the 95% confidence intervals were used for the synthesis of the results. Primary outcomes were the decrease of IBS-Symptom Severity Score (IBS-SSS) and decrease of abdominal pain. The secondary outcomes were the improvement in quality of life (QoL) and the decrease of bloating. Lastly, the adverse effects of probiotics were evaluated. The protocol of the study has been registered at protocols.io (DOI dx.doi.org/10.17504/protocols.io.14egn218yg5d/v1).

RESULTS: Six double-blind (N = 970) placebo-control RCTs fulfilled the inclusion criteria and overall, nine different strains of probiotics were examined. No significant reduction in IBS-SSS (WMD -43.2, 95% CI -87.5 to 1.0, I² = 82.9%) was demonstrated, whereas a significant decrease regarding abdominal pain (SMD -0.94, 95% CI -1.53 to -0.35, I² = 92,2) was shown. Furthermore, no correlation between improvement of QoL and the use of probiotics (SMD -0.64, 95% CI -1.27 to 0.00, I² = 93,9%) was shown. However, probiotics were associated with a significant reduction in bloating (SMD -0.28, 95% CI -0.47 to -0.09, I² = 36,0%). A qualitative synthesis was conducted about adverse events and showed that the use of probiotics’ is safe without severe adverse events.

CONCLUSIONS: The administration of probiotics to IBS-patients demonstrated a positive effect on pain and bloating, but due to significant heterogeneity and confounding factors, that were not examined in the included studies, a definitive statement cannot be made. Moreover, probiotics did not lead to an improvement in other parameters. There is a need for larger RCTs in IBS-patients diagnosed according to Rome IV (not III) criteria and especially it is essential to be conducted RCTs which examine the administration of specific strains and have similar methodological characteristics.

PMID:37031468 | DOI:10.1016/j.clnu.2023.03.019

Egypt J Immunol. 2023 Apr;30(2):174-180.

ABSTRACT

Cancer colon is the second most prevalent cancer for females and the third for males. Vitamin D’s cellular impacts are achieved by 1,25 (OH) 2D binding to the Vitamin D receptor (VDR). This study aimed at assessing the relation between vitamin D receptor gene polymorphism and cancer colon. This case-control study included 50 colorectal cancer (CRC) cases which were candidates for colonoscopy and 50 controls with normal colonoscopy. The study was conducted in Suez Canal University hospitals. All cases were diagnosed with colonoscopy and confirmed with histopathology. Blood samples from study subjects were used for detection of vitamin D receptor FokI polymorphism. We found that more than two thirds of patients were males. Around half of the cases were over 60 years old. Most of the study participants were overweight (26%), obese (53%), non-alcoholics (99%), and non-smokers (72%). However, about one third of the patients were diabetic (31%). Noticeably, none of these factors was significantly variant among CRC group and normal colonoscopy group (p < 0.05). The most common presentation among cases with colon cancer was constipation (80%). Of the 100 studied cases, 74% had left-sided colon cancer, with a 66% of them were resectable. The odds ratio of VDR polymorphism between the cases and control groups was high (3 with 95% CI (0.3-31)), however it did not reach statistical significance (p= 0.3). Most of the cases with VDR polymorphism had colon cancer (75%). In conclusion, based on our findings, there was no correlation between colorectal cancer and vitamin D receptor gene polymorphism.

PMID:37031466

Cancer Med. 2023 Apr 9. doi: 10.1002/cam4.5857. Online ahead of print.

ABSTRACT

BACKGROUND: Despite aggressive treatment, more than 90% of glioblastoma (GBM) patients experience recurrences. GBM response to therapy is currently assessed by imaging techniques and tissue biopsy. However, difficulties with these methods may cause misinterpretation of treatment outcomes. Currently, no validated therapy response biomarkers are available for monitoring GBM progression. Metabolomics holds potential as a complementary tool to improve the interpretation of therapy responses to help in clinical interventions for GBM patients.

METHODS: Saliva and blood from GBM patients were collected pre and postoperatively. Patients were stratified conforming their progression-free survival (PFS) into favourable or unfavourable clinical outcomes (>9 months or PFS ≤ 9 months, respectively). Analysis of saliva (whole-mouth and oral rinse) and plasma samples was conducted utilising LC-QqQ-MS and LC-QTOF-MS to determine the metabolomic and lipidomic profiles. The data were investigated using univariate and multivariate statistical analyses and graphical LASSO-based graphic network analyses.

RESULTS: Altogether, 151 metabolites and 197 lipids were detected within all saliva and plasma samples. Among the patients with unfavourable outcomes, metabolites such as cyclic-AMP, 3-hydroxy-kynurenine, dihydroorotate, UDP and cis-aconitate were elevated, compared to patients with favourable outcomes during pre-and post-surgery. These metabolites showed to impact the pentose phosphate and Warburg effect pathways. The lipid profile of patients who experienced unfavourable outcomes revealed a higher heterogeneity in the abundance of lipids and fewer associations between markers in contrast to the favourable outcome group.

CONCLUSION: Our findings indicate that changes in salivary and plasma metabolites in GBM patients can potentially be employed as less invasive prognostic biomarkers/biomarker panel but validation with larger cohorts is required.

PMID:37031458 | DOI:10.1002/cam4.5857