Category: Nevin Manimala

Clin Breast Cancer. 2023 Feb 11:S1526-8209(23)00032-0. doi: 10.1016/j.clbc.2023.02.002. Online ahead of print.

ABSTRACT

BACKGROUND: Currently, the standard tracing method is to use blue dyes and radioisotope as the tracer for sentinel lymph node biopsy (SLNB). However, there are variations in the choice of tracer in different countries and regions. Some new tracers are also gradually applied in clinical practice, but there is still a lack of long-term follow-up data to confirm their clinical application value.

PATIENTS AND METHODS: Clinicopathological and postoperative treatment follow-up data were collected from patients with early-stage cTis-2N0M0 breast cancer who underwent SLNB using a dual-tracer method of ICG combined with MB. Statistical indicators including the identification rate, the number of sentinel lymph nodes (SLNs), regional lymph node recurrence, disease-free survival (DFS) and overall survival (OS) were analyzed.

RESULTS: Among the 1574 patients, SLNs were successfully detected during surgery in 1569 patients, with a detection rate of 99.7%; the median number of SLNs removed was 3. A total of 1531 patients were included in the survival analysis, with a median follow-up of 4.7 (0.5-7.9) years. In total, patients with positive SLNs had a 5-year DFS and OS of 90.6% and 94.7%, respectively. The 5-year DFS and OS of patients with negative SLNs were 95.6% and 97.3%, respectively. The postoperative regional lymph node recurrence rate was 0.7% in patients with negative SLNs.

CONCLUSION: Indocyanine green combined with methylene blue dual-tracer method is safe and effective in sentinel lymph node biopsy in patients with early breast cancer.

PMID:36907808 | DOI:10.1016/j.clbc.2023.02.002

J Formos Med Assoc. 2023 Mar 10:S0929-6646(23)00060-8. doi: 10.1016/j.jfma.2023.02.006. Online ahead of print.

ABSTRACT

BACKGROUND: The rate of induction of labour has increased over the decades and numerous medications are available in the market. This study compares the efficacy and safety between dinoprostone slow-release pessary (Propess) and dinoprostone tablet (Prostin) for labour induction at term in nulliparous women.

METHODS: This was a prospective single-blind randomized controlled trial conducted in a tertiary medical centre in Taiwan from September 1, 2020 to February 28, 2021. We recruited nulliparous women at term with a singleton pregnancy, fetus in cephalic presentation, an unfavourable cervix, and the cervical length had been measured by transvaginal sonography three times during labour induction. The main outcomes are duration from induction of labour to vaginal delivery, vaginal delivery rate, maternal and neonatal complication rates.

RESULTS: In both groups, Prostin and Propess, 30 pregnant women were enrolled. The Propess group had higher vaginal delivery rate but it did not meet statistically significant difference. The Prostin group had significantly higher rate of adding oxytocin for augmentation (p = 0.0002). No significant difference was observed in either labouring course, maternal or neonatal outcomes. The probability of vaginal delivery was independently related to the cervical length measured by transvaginal sonography 8 h after Prostin or Propess administration as well as neonatal birth weight.

CONCLUSION: Both Prostin and Propess can be used as cervical ripening agents with similar efficacy and without significant morbidity. Propess administration was associated with higher vaginal delivery rate and less need to add oxytocin. Intrapartum measurement of cervical length is helpful in predicting successful vaginal delivery.

PMID:36907791 | DOI:10.1016/j.jfma.2023.02.006

Clin Lymphoma Myeloma Leuk. 2023 Feb 21:S2152-2650(23)00063-0. doi: 10.1016/j.clml.2023.02.005. Online ahead of print.

ABSTRACT

Current frontline therapies for newly diagnosed multiple myeloma patients have significantly prolonged progression-free survival (PFS). This has led to interest in minimal residual disease negativity (MRDng) as an efficacy-response biomarker and possible surrogate endpoint. A meta-analysis was conducted to explore the surrogacy of MRD for PFS and quantify the relationship between MRDng rates and PFS at the trial level. A systematic search was conducted on phase II and III trials reporting MRDng rates along with median PFS (mPFS) or PFS hazard ratios (HR). Weighted linear regressions were conducted relating mPFS to MRDng rates, and relating PFS HRs to either odds ratios (OR) or rate differences (RD) for MRDng in comparative trials. A total of 14 trials were available for the mPFS analysis. log(MRDng rate) was moderately associated with log (mPFS), with a slope of β = 0.37 (95% CI, 0.26-0.48) and R² = 0.62. A total of 13 trials were available for the PFS HR analysis. Treatment effects on MRDng rates were correlated with the corresponding effects on PFS: log (PFS HR) and log (MRDng OR) had a moderate association with β = -0.36 (95% CI, -0.56 to -0.17) and R² = 0.53 (95% CI, 0.21-0.77); log (PFS HR) and the MRDng RD had a stronger association with slope β = -0.03 (95% CI, -0.04 to -0.02) and R² = 0.67 (95% CI, 0.31 to 0.86). MRDng rates moderately associate with PFS outcomes. MRDng RDs are more strongly associated with HRs than MRDng ORs, with evidence suggestive of potential surrogacy.

PMID:36907767 | DOI:10.1016/j.clml.2023.02.005

J Dairy Sci. 2023 Mar 10:S0022-0302(23)00115-7. doi: 10.3168/jds.2022-22496. Online ahead of print.

ABSTRACT

Staphylococcus aureus is a major mastitis pathogen in dairy cattle worldwide, responsible for substantial economic losses. Environmental factors, milking routine, and good maintenance of milking equipment have been described as important factors to prevent intramammary infections (IMI). Staphylococcus aureus IMI can be widespread within the farm or the infection can be limited to few animals. Several studies have reported that Staph. aureus genotypes differ in their ability to spread within a herd. In particular, Staph. aureus belonging to ribosomal spacer PCR genotype B (GTB)/clonal complex 8 (CC8) is associated with high within-herd prevalence of IMI, whereas other genotypes are generally associated with individual cow disease. The adlb gene seems to be strictly related to Staph. aureus GTB/CC8, and is a potential marker of contagiousness. We investigated Staph. aureus IMI prevalence in 60 herds in northern Italy. In the same farms, we assessed specific indicators linked to milking management (e.g., teat condition score and udder hygiene score) and additional milking risk factors for IMI spread. Ribosomal spacer-PCR and adlb-targeted PCR were performed on 262 Staph. aureus isolates, of which 77 underwent multilocus sequence typing. In most of the herds (90%), a predominant genotype was identified, especially Staph. aureus CC8 (30%). In 19 of 60 herds, the predominant circulating Staph. aureus was adlb-positive and the observed IMI prevalence was relevant. Moreover, the adlb gene was detected only in genotypes of CC8 and CC97. Statistical analysis showed a strong association between the prevalence of Staph. aureus IMI, the specific CCs, and carriage of adlb, with the predominant circulating CC and presence of the gene alone explaining the total variation. Interestingly, the difference in the odds ratio obtained in the models for CC8 and CC97 suggests that it is carriage of the adlb gene, rather than the circulation of these CCs per se, that leads to higher within-herd prevalence of Staph. aureus. In addition, the model showed that environmental and milking management factors had no or minimal effect on Staph. aureus IMI prevalence. In conclusion, the circulation of adlb-positive Staph. aureus strains within a herd has a strong effect on the prevalence of IMI. Thus, adlb can be proposed as a genetic marker of contagiousness for Staph. aureus IMI in cattle. However, further analyses using whole-genome sequencing are required to understand the role of genes other than adlb that may be involved in the mechanisms of contagiousness of Staph. aureus strains associated with high prevalence of IMI.

PMID:36907760 | DOI:10.3168/jds.2022-22496

Vaccine. 2023 Mar 10:S0264-410X(23)00255-4. doi: 10.1016/j.vaccine.2023.03.008. Online ahead of print.

ABSTRACT

BACKGROUND: The role of vaccine hesitancy on influenza vaccination is not clearly understood. Low influenza vaccination coverage in U.S. adults suggests that a multitude of factors may be responsible for under-vaccination or non-vaccination including vaccine hesitancy. Understanding the role of influenza vaccination hesitancy is important for targeted messaging and intervention to increase influenza vaccine confidence and uptake. The objective of this study was to quantify the prevalence of adult influenza vaccination hesitancy (IVH) and examine association of IVH beliefs with sociodemographic factors and early-season influenza vaccination.

METHODS: A four-question validated IVH module was included in the 2018 National Internet Flu Survey. Weighted proportions and multivariable logistic regression models were used to identify correlates of IVH beliefs.

RESULTS: Overall, 36.9% of adults were hesitant to receive an influenza vaccination; 18.6% expressed concerns about vaccination side effects; 14.8% personally knew someone with serious side effects; and 35.6% reported that their healthcare provider was not the most trusted source of information about influenza vaccinations. Influenza vaccination ranged from 15.3 to 45.2 percentage points lower among adults self-reporting any of the four IVH beliefs. Being female, age 18-49 years, non-Hispanic Black, having high school or lower education, being employed, and not having primary care medical home were associated with hesitancy.

CONCLUSIONS: Among the four IVH beliefs studied, being hesitant to receiving influenza vaccination followed by mistrust of healthcare providers were identified as the most influential hesitancy beliefs. Two in five adults in the United States were hesitant to receive an influenza vaccination, and hesitancy was negatively associated with vaccination. This information may assist with targeted interventions, personalized to the individual, to reduce hesitancy and thus improve influenza vaccination acceptance.

PMID:36907734 | DOI:10.1016/j.vaccine.2023.03.008

Arch Pediatr. 2023 Feb 7:S0929-693X(23)00016-7. doi: 10.1016/j.arcped.2023.01.006. Online ahead of print.

ABSTRACT

OBJECTIVES: COVID-19 and multisystem inflammatory syndrome in children (MIS-C) are associated with a risk of hypercoagulability and thrombotic events. We aimed (a) to evaluate the demographic, clinical, and laboratory findings as well as the incidence of thrombotic events of COVID-19 and MIS-C in children and (b) to determine the role of antithrombotic prophylaxis.

METHODS: A single-center retrospective study evaluated hospitalized children with COVID-19 or MIS-C.

RESULTS: The study group consisted of 690 patients, 596 (86.4%) diagnosed with COVID-19 and 94 (13.6%) diagnosed with MIS-C. Antithrombotic prophylaxis was used for 154 (22.3%) patients: 63 patients (10.6%) in the COVID-19 group and 91 (96.8%) patients in the MIS-C group. Use of antithrombotic prophylaxis was statistically higher in the MIS-C group (p<0.001). Patients who received antithrombotic prophylaxis were of older median age, were more commonly male, and had more frequent underlying diseases than those without prophylaxis (p<0.001, p<0.012, p<0.019, respectively). The most common underlying condition was obesity in patients who received antithrombotic prophylaxis. Thrombosis was observed in one (0.2%) patient in the COVID-19 group with a thrombus in the cephalic vein, two (2.1%) patients in the MIS-C group, with a dural thrombus in one patient and a cardiac thrombus in the other patient. The patients with thrombotic events were previously healthy and had mild disease.

CONCLUSION: In our study, thrombotic events were rare compared with previous reports. We used antithrombotic prophylaxis for most children with underlying risk factors; perhaps for this reason, we did not observe thrombotic events in children with underlying risk factors. We suggest that patients diagnosed with COVID-19 or MIS-C be closely monitored for thrombotic events.

PMID:36907731 | DOI:10.1016/j.arcped.2023.01.006

Eur J Cancer. 2023 Mar 10:S0959-8049(22)01776-2. doi: 10.1016/j.ejca.2022.11.027. Online ahead of print.

NO ABSTRACT

PMID:36907702 | DOI:10.1016/j.ejca.2022.11.027

Pain Manag Nurs. 2023 Mar 10:S1524-9042(23)00029-2. doi: 10.1016/j.pmn.2023.02.001. Online ahead of print.

ABSTRACT

BACKROUND: In the literature, the effect of TENS on acute pain has been investigated, and no study has been found on its effect on pain associated with VAC application. This randomized controlled trial was designed to assess the efficacy of TENS application in pain caused by vacuum applied in acute soft tissue trauma of the lower extremity.

DESIGN AND SETTINGS: The study included 40 patients: 20 in the control group, and 20 in the experimental group and was carried out in a university hospital’s plastic and reconstructive surgery clinic. Data for the study were gathered using the Patient Information form and the Pain Assessment form. Conventional TENS lasting 30 minutes was applied to the experimental group patients 1 hour before vacuum (vacuum assisted closure [VAC]) insertion and removal by the researcher, and TENS was not applied to the control group. The “Numerical Pain Scale” was used to assess pain in both groups before and after TENS application. In the statistical analysis of the data, the SPSS 23.0 package program was used. In all tests, p < .005 was considered statistically significant.

RESULTS: The experimental and control groups of the patients included in the study were homogeneous in terms of demographic characteristics (p > .05). Furthermore, when the pain levels of the groups were compared over time, it was discovered that the pain levels of the control group were significantly higher than the experimental group at the times of VAC insertion (T3) and VAC removal (T6) (p < .05). Bonferroni test, one of the post hoc tests, was used to determine in-group significance in both the experimental and control groups, and it was discovered that the difference was between T6 and all other times (T6-T1, T2, T3, T4, T5).

CONCLUSIONS: The results obtained from our study showed that TENS reduced the pain caused by vacuum applied in acute soft tissue trauma of the lower extremity. It is thought that TENS may not replace traditional analgesics but may help reduce the level of pain and contribute to healing by increasing comfort during painful procedures.

PMID:36907690 | DOI:10.1016/j.pmn.2023.02.001

J Voice. 2023 Mar 10:S0892-1997(23)00005-X. doi: 10.1016/j.jvoice.2023.01.005. Online ahead of print.

ABSTRACT

OBJECTIVES: The primary aim was to compare two methods for perceptual evaluation of voice – paired comparison (PC) and visual analog scale (VAS) ratings. Secondary aims were to assess the correspondence between two dimensions of voice- overall severity of voice quality and resonant voice, and to investigate the influence of rater experience on perceptual rating scores and rating confidence scores.

STUDY DESIGN: Experimental design.

METHODS: Voice samples from six children (pre and post therapy) were rated by 15 Speech-Language Pathologists specialized in voice. Raters completed four tasks corresponding to the two rating methods and voice qualities: PC-severity, PC-resonance, VAS-severity, and VAS-resonance. For PC tasks, raters chose the better of two voice samples (better voice quality or better resonance, depending on the task) and indicated the degree of confidence in each choice. Rating and confidence score were combined to produce a number on a 1-10 scale (PC-confidence adjusted). VAS ratings involved rating voices on a scale for degree of severity and resonance, respectively.

RESULTS: PC-confidence adjusted and VAS ratings were moderately correlated for overall severity and also vocal resonance. VAS ratings were normally distributed and had greater rater consistency than PC-confidence adjusted ratings. VAS scores reliably predicted binary PC choices (choice of voice sample only). Overall severity and vocal resonance were weakly correlated and rater experience was not linearly related to rating scores or confidence.

CONCLUSIONS: Results suggest that the VAS rating method holds advantages over PC, including normally distributed ratings, superior consistency of ratings, and the ability to provide more finely grained detail regarding the auditory perception of voice. Overall severity and vocal resonance were not redundant in the current data set, suggesting that resonant voice and overall severity are not isomorphic. Finally, the number of years of clinical experience was not linearly related to perceptual ratings or rating confidence.

PMID:36907680 | DOI:10.1016/j.jvoice.2023.01.005

Am J Geriatr Psychiatry. 2023 Feb 15:S1064-7481(23)00215-4. doi: 10.1016/j.jagp.2023.02.041. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess 1) the longitudinal stability of the atypical, melancholic, combined atypical-melancholic and the unspecified subtypes of major depressive disorder (MDD) according to the diagnostic and statistical manual of mental disorders (DSM -IV) specifiers in older adults, and 2) the effect of mild cognitive impairment (MCI) on the stability of these subtypes.

DESIGN: Prospective cohort study with a 5.1 year-follow-up.

SETTING: Population-based cohort from Lausanne, Switzerland.

PARTICIPANTS: A total of 1,888 participants (mean age: 61.7 years, women: 69.2%) with at least two psychiatric evaluations, one after the age of 65 years.

MEASUREMENTS: Semistructured diagnostic interview to assess lifetime and 12-month DSM-IV Axis-1 disorders at each investigation and neuro-cognitive tests to identify MCI in participants aged 65 years and over. Associations between lifetime MDD status before and 12-month depression status after the follow-up were assessed using multinomial logistic regression. The effect of MCI on these associations was assessed by testing interactions between MDD subtypes and MCI status.

RESULTS: 1) Associations between depression status before and after the follow-up were observed for atypical (adjusted OR [95% CI] = 7.99 [3.13; 20.44]), combined (5.73 [1.50; 21.90]) and unspecified (2.14 [1.15; 3.98]), but not melancholic MDD (3.36 [0.89; 12.69]). However, there was a certain degree of overlap across the subtypes, particularly between melancholic MDD and the other subtypes. 2) No significant interactions were found between MCI and lifetime MDD subtypes regarding depression status after follow-up.

CONCLUSION: The strong stability of the atypical subtype in particular highlights the need for identifying this subtype in clinical and research settings, given its well-documented links to inflammatory and metabolic markers.

PMID:36907672 | DOI:10.1016/j.jagp.2023.02.041