Category: Nevin Manimala

Eur J Obstet Gynecol Reprod Biol. 2023 Apr 18;285:153-158. doi: 10.1016/j.ejogrb.2023.04.012. Online ahead of print.

ABSTRACT

OBJECTIVE(S): To measure the success rate of primary medical therapy in managing retained products of conception (RPOC) in women with secondary postpartum haemorrhage (PPH) and to identify factors associated with need for surgical management.

STUDY DESIGN: Postpartum patients presenting to a tertiary women’s hospital Emergency Department between July 2020 and December 2022 with secondary PPH and evidence of RPOC on ultrasound were recruited. Clinical information relating to the presentation was collected prospectively. Antenatal and intrapartum data were collected from medical record and Birthing Outcome System database review. The primary outcome was the success of medical management for RPOC, defined by the implementation of medical or expectant management without subsequent need for surgical intervention.

RESULTS: Forty-one patients with RPOC underwent primary medical or expectant management. Twelve patients (29%) were managed successfully with medical management, while twenty-nine (71%) proceeded to surgical management. Medical management involved antibiotics (n = 37, 90%), prostaglandin E1 analogue (n = 14, 34%) and other uterotonics (n = 3, 7%). A greater endometrial thickness on ultrasound was significantly associated with a requirement for secondary surgical intervention (p < 0.05). There was an association approaching statistical significance between a higher sonographic volume of RPOC and the failure of medical management (p = 0.07). There was no statistically significant association between the mode of delivery or the number of days postpartum with the success of medical management.

CONCLUSION(S): For patients presenting with secondary PPH and sonographic RPOC, over two thirds required surgical management. Increased endometrial thickness was associated with an increased requirement for surgical management.

PMID:37120911 | DOI:10.1016/j.ejogrb.2023.04.012

Poult Sci. 2022 Oct 22;102(6):102281. doi: 10.1016/j.psj.2022.102281. Online ahead of print.

ABSTRACT

The aim of the study was to analyze some slaughter traits in 3 breeds of geese: the commercial hybrids of White Kołuda (W-31), and birds of conservative flocks of Pomeranian (Po) and Kielecka (Ki) geese depending on sex and length of rearing period, and to determine the relationships between the analyzed traits and factors. A total of 19 traits divided into 2 groups-measured and calculated traits-were statistically analyzed. The measured traits (g) included 11 parameters: preslaughter weight, carcass weight, weights of breast muscle, thigh and drumstick, abdominal fat, skin with subcutanenous fat, neck without skin, skeleton with dorsal muscles, wings with skin, total muscles as the sum of all breast and leg muscles, and the trait broth elements as the total weight of neck, skin, skeleton and wings. The calculated traits included 8 parameters (%): dressing percentage-carcass weight to preslaughter weight, meatiness-total breast and leg muscle weight to carcass weight, abdominal fat weight to carcass weight, weight of skin with subcutaneous fat to carcass weight, weight of neck without skin to carcass weight, weight of skeleton with dorsal muscles to carcass weight, weight of wings with skin to carcass weight, as well as total weight of neck, skin, skeleton, and wings. The presented results concerning the analysis of selected slaughter traits of the Kielecka, Pomeranian and White Kołuda geese indicate that these birds exhibit good slaughter value (dressing percentage from 60.80 to 66.50%). The selected values of this parameter were influenced mainly by genotype and to a lesser extent by sex. The White Kołuda geese were characterized by significantly higher values of the majority of the analyzed slaughter traits, both measured and calculated ones. In turn, the lighter domestic geese of regional breeds were characterized by significantly higher carcass meat content (from 31.69 to 35.13 % vs. from 29.28 to 31.80 %) and lower carcass fatness (abdominal fat and skin with subcutaneous fat from 21.26 to 25.45 % vs. from 30.81 to 33.14 %). This points to the possibility of using these breeds of geese in breeding work aimed to produce a hybrid characterized by medium body weight (intermediate between these values for the White Kołuda geese and Kielecka or Pomeranian geese), good dressing percentage as well as high carcass meat content and low carcass fatness.

PMID:37120890 | DOI:10.1016/j.psj.2022.102281

Breast. 2023 Apr 24;69:410-416. doi: 10.1016/j.breast.2023.04.006. Online ahead of print.

ABSTRACT

This overview provides the historical perspective of external beam breast hypofractionation over the last 50 years. It highlights the serious harm suffered by patients with breast cancer in the 1970’s and 1980’s because of new hypofractionation regimens based on a theoretical radiobiology model being adopted into clinical practice to solve a resource issue without testing within clinical trials and without the essential radiotherapy quality assurance. It then describes the high-quality clinical trials comparing 3-week with 5-week standard of care regimens that were initiated based on a strong scientific rationale for hypofractionation in breast cancer. Today, there are still challenges with universal implementation of the results of these moderate hypofractionation studies, but there is now a substantial body of evidence to support 3-week breast radiotherapy with several large randomised trials still to report. The limit of breast hypofractionation is then explored and randomised trials investigating 1-week radiotherapy are described. This approach is now standard of care in many countries for whole or partial breast radiotherapy and chest wall radiotherapy without immediate reconstruction. It also has the advantage of reducing burden of treatment for patients and providing cost-effective care. Further research is needed to establish the safety and efficacy of 1-week breast locoregional radiotherapy and following immediate breast reconstruction. In addition, clinical studies are required to determine how a tumour bed boost for patients with breast cancer at higher risk of relapse can be incorporated simultaneously into a 1-week radiotherapy schedule. As such, the breast hypofractionation story is still unfolding.

PMID:37120889 | DOI:10.1016/j.breast.2023.04.006

J Geriatr Oncol. 2023 Apr 28;14(5):101499. doi: 10.1016/j.jgo.2023.101499. Online ahead of print.

ABSTRACT

INTRODUCTION: The aim of this study was to investigate risk factors for nutritional risk in older adults with gastrointestinal tumours.

MATERIALS AND METHODS: A total of 170 eligible hospitalised older adults with gastrointestinal tumours were included. Their clinical characteristics were collected, their nutritional risk was screened by NRS 2002, and then patients were divided into a nutritional risk group and a non-nutritional risk group. The observation indicators included body mass index (BMI), muscle mass, muscle strength, and calf circumference. The third lumbar skeletal muscle index (L3 SMI) was calculated using abdominal computed tomography (CT) scan results, and grip strength/muscle strength, 6-m walking speed and calf circumference were measured. Sarcopenia was diagnosed according to the criteria of the Asian Sarcopenia Working Group (AWGS). Finally, we analysed the relationship between nutritional risk and sarcopenia and other related factors (BMI, calf circumference, L3 SMI, grip strength/muscle strength, 6-m walking speed) in older adults with gastrointestinal tumours by multivariate logistic regression analysis.

RESULTS: Older adults with gastrointestinal tumours who were at nutritional risk accounted for 51.8% of patients in this study. The differences between sex, tumour stage, age, BMI, calf circumference, L3 SMI, grip strength/muscle strength, 6-m walking speed, and prevalence of sarcopenia were statistically significant in two groups (all P < 0.05). Multivariate logistic regression analysis showed that age, BMI, grip strength/muscle strength, and sarcopenia were risk factors of nutritional risk in older adults with gastrointestinal tumours (all P < 0.05).

DISCUSSION: Older adults with gastrointestinal cancer had a higher proportion of nutritional risk, and L3 SMI, grip strength/muscle strength were independent risk factors for nutritional risk. In clinical practice, attention to nutritional risk screening and sarcopenia development in older adults with gastrointestinal cancer is warranted.

PMID:37120888 | DOI:10.1016/j.jgo.2023.101499

Knee. 2023 Apr 28;42:289-296. doi: 10.1016/j.knee.2023.04.004. Online ahead of print.

ABSTRACT

BACKGROUND: Although bicruciate stabilized total knee arthroplasty (BCS-TKA) is expected to provide kinematics similar to those of the normal knee, there are limited data available for comparison of the kinematics of the knee after BCS-TKA with those of the normal knee. The purpose of this study was to confirm whether the knee after BCS-TKA are the same as those of the native knee.

METHODS: Seven fresh-frozen cadavers underwent TKA using a BCS-type prosthesis with navigation system. Anteroposterior translation of the femur and internal rotation of the tibia were evaluated using the navigation system.

RESULTS: There was no statistically significant difference in anteroposterior translation of the femur between the native knee and the knee after BCS-TKA in the early flexion phase (0°-30°) or in the deep flexion phase (over 100°). In the middle flexion phase (40°-90°), the knee after BCS-TKA was placed significantly more anteriorly than the native knee. The knee after BCS-TKA also showed a gradual internal rotation pattern similar to that of the native knee but the total tibial internal rotation angle was significantly smaller than that of the native knee. At each angle from 0° to 120° of flexion, internal rotation of the knee after BCS-TKA was significantly greater than that of the native knee.

CONCLUSION: Kinematics of BCS-TKA is close to that of the native knee. However, there is a statistically significant difference in AP position of the femur during mid flexion and initial rotational position of the tibia between the BCS-TKA knee and the native knee.

PMID:37120864 | DOI:10.1016/j.knee.2023.04.004

J Affect Disord. 2023 Apr 28;333:446. doi: 10.1016/j.jad.2023.04.018. Online ahead of print.

NO ABSTRACT

PMID:37120863 | DOI:10.1016/j.jad.2023.04.018

Stat Med. 2023 Apr 30. doi: 10.1002/sim.9751. Online ahead of print.

ABSTRACT

Basket trials are a novel clinical trial design in which a single intervention is investigated in multiple patient subgroups, or “baskets.” They offer the opportunity to share information between subgroups, potentially increasing power to detect treatment effects. Basket trials offer several advantages over running a series of separate trials, including reduced sample sizes, increased efficiency, and reduced costs. Primarily, basket trials have been undertaken in Phase II oncology settings, but could be a promising design in other areas where a shared underlying biological mechanism drives different diseases. One such area is chronic aging-related diseases. However, trials in this area frequently have longitudinal outcomes, and therefore suitable methods are needed to share information in this setting. In this paper, we extend three Bayesian borrowing methods for a basket design with continuous longitudinal endpoints. We demonstrate our methods on a real-world dataset and in a simulation study where the aim is to detect positive basketwise treatment effects. Methods are compared with standalone analysis of each basket without borrowing. Our results confirm that methods that share information can improve power to detect positive treatment effects and increase precision over independent analysis in many scenarios. In highly heterogeneous scenarios, there is a trade-off between increased power and increased risk of type I errors. Our proposed methods for basket trials with continuous longitudinal outcomes aim to facilitate their applicability in the area of aging related diseases. Choice of method should be made based on trial priorities and the expected basketwise distribution of treatment effects.

PMID:37120858 | DOI:10.1002/sim.9751

Top Stroke Rehabil. 2023 Apr 30:1-12. doi: 10.1080/10749357.2023.2207286. Online ahead of print.

ABSTRACT

BACKGROUND: Currently, little is known on the relationships between cardiorespiratory fitness (CF), physical activity (PA), and functional outcomes after stroke, especially in low- and middle-income countries.

OBJECTIVES: We examine the relationships between CF, PA, and functional outcomes in one-year poststroke in Benin, a lower middle-income country.

METHODS: A case-control study was carried out in northern Benin. Twenty-one participants with chronic strokes were matched to 42 controls according to sex and age. PA patterns and associated energy expenditure (EE) were assessed with a BodyMedia’s senseWear armband. CF was evaluated with the Physical Working Capacity at 75% of the predicted maximal heart rate index. The functional outcomes were evaluated using the modified Rankin scale (mRS) and the ACTIVLIM-Stroke scale.

RESULTS: Both people with stroke and the healthy pairs spent much time in sedentary behavior (median [P25; P75]: 672 [460; 793] min vs 515 [287; 666] min, p = 0.006). Although people with chronic stroke performed fewer steps compared to healthy controls (median: 2767 vs 5524, p = 0.005), results showed that total EE was not statistically significant in either group (median: 7166 Kcal vs 8245 Kcal, p = 0.07). In addition, the mRS score (r = 0.47, p = 0.033) and the ACTIVLIM-Stroke measure (r = 0.52, p = 0.016) were moderately associated with the CF index of people with chronic stroke.

CONCLUSION: The study showed clear trends for lower levels of PA in both people with chronic stroke and health controls. A correlation exists between CF, disability, and functional outcomes among stroke patients.

PMID:37120850 | DOI:10.1080/10749357.2023.2207286

Soc Work Health Care. 2023 Apr 30:1-17. doi: 10.1080/00981389.2023.2207614. Online ahead of print.

ABSTRACT

Consumer credit score has been used as an indicator of financial strain that could potentially impact health. Subjective financial well-being, or one’s feelings about one’s expectations, preferences, and satisfaction with their financial situation, is related to financial strain. This study examined whether subjective financial well-being mediates the association between credit score and self-reported physical health in a national representative sample. Using structural equation modeling (SEM), we test whether a mediating association exists between self-rated credit score and self-rated physical health. Results suggest that, after controlling for sociodemographic variables, those who reported higher credit scores have better health (β = 0.175, p < .001) and higher financial well-being (β = 0.469, p < .001), and those who reported higher financial well-being have better health (β = 0.265, p < .001). The mediation effect of financial well-being on the association between credit and physical health is also positive and statistically significant (β = 0.299, p < .001). Thus, subjective feelings about one’s financial situation would enhance the observed positive association between credit and health. Practice and policy implications are included.

PMID:37120849 | DOI:10.1080/00981389.2023.2207614

Clin Exp Hypertens. 2023 Dec 31;45(1):2205050. doi: 10.1080/10641963.2023.2205050.

ABSTRACT

PURPOSE: This study intends to investigate the correlation between blood pressure variability (BPV) levels and the use of optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) to measure retinal microvasculature in hypertensive patients.

METHODS: All individuals in the study had 24-hour ambulatory blood pressure monitoring and bilateral OCT and OCTA exams, and only data from the right eye were analyzed statistically.

RESULTS: The study included 170 individuals, with 60 in the control group. The experimental group was separated into two groups based on the average real variability (ARV) median, with 55 in the low ARV group and 55 in the high ARV group. The mean thicknesses of the Retinal Nerve Fiber Layer (RNFL), internal limiting membrane-retinal pigment epithelial cell layer (ILM-RPE), vessel density (VD), and perfusion density (PD) in the high-ARV group were substantially lower in the low-ARV and control groups (p＜0.05). Multiple linear regression analysis revealed that disease duration, age, and 24 h diastolic standard deviation all affected RNFL mean thickness (p＜0.05). VD and PD were influenced by disease duration, systolic-ARV, daytime systolic blood pressure, intraocular pressure(IOP), and best-corrected visual acuity (BCVA) (p＜0.05). And the change in VD was connected to best-corrected visual acuity.

CONCLUSION: Hypertensive retinopathy is related to BPV. In clinical practice, we can assess the degree of BPV and retinopathy in hypertensive patients to track the progression of hypertension-mediated organ damage (HMOD). Correction of BPV may help treat or postpone the progression of HOMD.

PMID:37120839 | DOI:10.1080/10641963.2023.2205050