Category: Nevin Manimala

Lasers Med Sci. 2023 Apr 19;38(1):105. doi: 10.1007/s10103-023-03770-w.

ABSTRACT

The current international guidelines identify tumescent ablative techniques such as laser thermal ablation (EVLA) and radiofrequency (RFA) to be the gold standard in varicose vein surgery. New-generation lasers have been introduced, which have high wavelengths (1940 and 2000 nm) and therefore with a greater affinity for water than the old generation (980- and 1470-nm lasers). The purpose of the study was to evaluate the biological effect and the temperatures produced during the use of lasers with different wavelengths (980, 1470, and 1940 nm) and with optical fibers with different emission (radial diverging at 60° and radial with cylindrical mono-ring) on in vitro model. Porcine liver was used as an in vitro model. The laser control units used had 3 different wavelengths: 980, 1470, and 1940 nm. The optical fibers used were 2: the Corona 360 fiber (mono-ring radial fiber) and the infinite fiber (cylindrical mono-ring fiber). The laser operating parameters used included the delivery of 6 W in continuous wave (CW) mode with a standard 10 s/cm pull-back. Eleven measurements were made for each fiber and for each laser, for a total of 66 measurements. We performed measurements of the maximum transverse diameter produced with laser irradiation to evaluate the biological effectiveness of the treatment. During laser irradiation, we performed measurements of both of the temperatures reached on the external surface of the porcine tissue, near the tip of the laser catheter, and the temperatures reached inside the irradiated tissue by using a digital laser infrared thermometer with apposite probe. The calculation of the statistical significance (p-value) was obtained with the ANOVA method with two between factors. The comparison study of the maximum transverse diameter (DTM) of the lesion produced on the target tissue demonstrated the absence of statistically significant differences between the 1470-nm laser and the 1940-nm laser regardless of the type of fiber used. It was not possible to perform measurements of the maximum transverse diameter produced with the 980-nm laser as this produced no visible effect on the model. The comparison study of the temperatures developed during and immediately after the treatment instead showed higher maximum surface temperatures (TSM) and a higher thermal increase (IT) regardless of the type of fiber used in a statistically significant way (respectively, p 0.002 and 0.012) when using the 980-nm laser versus the 1940-nm laser. Comparing instead the 980-nm laser with 1470 nm, there were no differences in TI recorded during the procedure but a significantly higher VTI (p 0.029). The experiment conducted with the new generation laser, compared with those of the first and second generation, shows how this works overall at lower temperatures with the same effectiveness.

PMID:37072644 | DOI:10.1007/s10103-023-03770-w

Funct Integr Genomics. 2023 Apr 19;23(2):129. doi: 10.1007/s10142-023-01057-5.

ABSTRACT

Psoriasis is a complex genetic skin disorder typically manifested by red, scaly, and itchy plaques most commonly over the scalp, trunk, elbows, and knees. Histopathological features include thickening of the epidermal layer due to hyper-proliferation and abnormal differentiation of epidermal keratinocytes along with infiltration of immune cells in the psoriatic skin. It is a chronic inflammatory relapsing disease, and there is currently no permanent cure for psoriasis. Proper medications can reduce the severity of the disease and improve the quality of life of the patients. While the genetic components of psoriasis pathogenesis are well explored, the full understanding of its epigenetic component remains elusive. Non-coding RNAs (ncRNAs) are documented to regulate various epigenetic processes that lead to the pathogenesis of different diseases including psoriasis. In this review, we have discussed the molecular interplay of different ncRNAs in psoriasis pathogenesis. The roles of microRNAs (miRNAs) in psoriasis are pretty well studied, whereas the roles of long noncoding RNAs (lncRNAs) and circular RNAs (circRNAs) are emerging. This review provides ideas covering some of the latest findings of different modes of functions played by those different ncRNAs documented in the literature. As an ever-evolving topic, some works are still ongoing as well as there are several fields that need rigorous scientific ventures. We have proposed the areas which claim more explorations to better understand the roles played by the ncRNAs in psoriasis pathogenesis.

PMID:37072609 | DOI:10.1007/s10142-023-01057-5

Pulm Ther. 2023 Apr 19. doi: 10.1007/s41030-023-00222-2. Online ahead of print.

ABSTRACT

INTRODUCTION: Long-term treatment of pulmonary sarcoidosis with glucocorticoids has been associated with toxicity and other adverse events, highlighting the need for alternative therapies. The goal of this study was to evaluate the efficacy and safety of repository corticotropin injection (RCI, Acthar^® Gel) in patients with pulmonary sarcoidosis and to validate endpoints for use in future clinical trials.

METHODS: In this multicenter, randomized, placebo-controlled trial, subjects received subcutaneous RCI (80 U) twice weekly or matching placebo through 24 weeks in a double-blind treatment phase, followed by an optional 24-week open-label extension. Efficacy was measured by glucocorticoid tapering, pulmonary function tests, chest imaging, patient-reported outcomes, and a novel sarcoidosis treatment score (STS). Safety was assessed by adverse events, physical examinations, vital signs, clinical laboratory abnormalities, and imaging. The study was terminated early due to low enrollment caused by the COVID-19 pandemic, thereby precluding statistical analysis.

RESULTS: Fifty-five subjects were randomized to receive either RCI (n = 27) or placebo (n = 28). Mean STS at week 24 showed greater improvement with RCI (1.4) compared with placebo (0.7). At week 48, those who remained on RCI had an STS of 1.8 compared with 0.9 in those who switched from placebo to RCI. More subjects in the RCI group discontinued glucocorticoids at week 24 compared to the placebo group. Glucocorticoid discontinuation was comparable at week 48 for those who switched from placebo to RCI and those who continued RCI. Similar trends in favor of RCI over placebo were observed with the other efficacy endpoints. No new or unexpected safety signals were identified.

CONCLUSIONS: RCI was safe and well tolerated, with trends in efficacy data suggesting greater improvement with RCI compared to placebo in patients receiving standard-of-care therapy for pulmonary sarcoidosis. The study also provided validation of efficacy endpoints that may be used in larger trials for pulmonary sarcoidosis.

TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03320070.

PMID:37072607 | DOI:10.1007/s41030-023-00222-2

Lasers Med Sci. 2023 Apr 19;38(1):104. doi: 10.1007/s10103-023-03762-w.

ABSTRACT

Photobiomodulation therapy (PBMT) causes stimulatory effects that raise cell metabolism. The study aimed to evaluate the effects of PBMT on the endothelial function of healthy individuals. It was a controlled, randomized, crossover, triple-blind trial with 22 healthy volunteers (female: 77.3%), aged 25.45 years which were randomly divided into three groups. PBMT with gallium-aluminum-arsenide (GaAlAs) diode laser (810 nm, continuous-wave mode, 1000 mW, 0.28 cm²) was applied over the radial and ulnar artery regions in two parallel spots: group 1-30 J (n = 22, 107 J/cm²) per spot; group 2-60 J (n = 22, 214 J/cm²) per spot; and group 3-placebo (n = 22, sham). The endothelial function was measured before and immediately after PBMT by the flow-mediated dilation technique (%FMD) with high-resolution ultrasound. Statistical analysis was made with ANOVA for repeated measures, the effect size was measured by Cohen’s d, and results are presented as mean and standard error (or 95% confidence intervals). A p-value < 0.05 was considered statistically significant. The %FMD increases 10.4% with 60 J (mean difference = 0.496 mm, 95% CI = 0.42 to 0.57, p < 0.001), 7.3% with 30 J (mean difference = 0.518 mm, 95% CI = 0.44 to 0.59, p < 0.001), and 4.7% with placebo (mean difference = 0.560 mm, 95% CI = 0.48 to 0.63, p < 0.001). We found a small effect size (p = 0.702; d de Cohen = 0.24) without statistical difference between interventions. PBMT with the energy density of 60 J and 30 J did not improve endothelial function.Trial registration number: NCT03252184 (01/09/2017).

PMID:37072603 | DOI:10.1007/s10103-023-03762-w

Arch Gynecol Obstet. 2023 Apr 19. doi: 10.1007/s00404-023-06963-4. Online ahead of print.

ABSTRACT

PURPOSE: Fetal growth restriction (FGR) management and delivery planning is based on a multimodal approach. This meta-analysis aimed to evaluate the prognostic accuracies of the aortic isthmus Doppler to predict adverse perinatal outcomes in singleton pregnancies with FGR.

METHODS: PubMed, EMBASE, the Cochrane Library, ClinicalTrials.gov and Google scholar were searched from inception to May 2021, for studies on the prognostic accuracy of anterograde aortic isthmus flow compared with retrograde aortic isthmus flow in singleton pregnancy with FGR. The meta-analysis was registered on PROSPERO and was assessed according to PRISMA and Newcastle-Ottawa Scale. DerSimonian and Laird’s random-effect model was used for relative risks, Freeman-Tukey Double Arcsine for pooled estimates and exact method to stabilize variances and CIs. Heterogeneity was quantified using I² statistics.

RESULTS: A total of 2933 articles were identified through the electronic search, of which 6 studies (involving 240 women) were included. The quality evaluation of studies revealed an overall acceptable score for study group selection and comparability and substantial heterogeneity. The risk of perinatal death was significantly greater in fetuses with retrograde Aortic Isthmus blood flow, with a RR of 5.17 (p value 0.00001). Similarly, the stillbirth rate was found to have a RR of 5.39 (p value 0.00001). Respiratory distress syndrome had a RR of 2.64 (p value = 0.03) in the group of fetuses with retrograde Aortic Isthmus blood flow.

CONCLUSION: Aortic Isthmus Doppler study may add information for FGR management. However, additional clinical trial are required to assess its applicability in clinical practice.

PMID:37072584 | DOI:10.1007/s00404-023-06963-4

Soc Psychiatry Psychiatr Epidemiol. 2023 Apr 19. doi: 10.1007/s00127-023-02476-2. Online ahead of print.

ABSTRACT

PURPOSE: Mental health research has powerfully documented inequities related to characteristics, such as ethnicity and gender. Yet how and where disparities like unmet need occur have been more elusive. Drawing from a now modest body of research that deployed the Network Episode Model (NEM), we examine how individuals create patterns of response to mental health problems, influenced by the culture and resources embedded in their social networks.

METHODS: The Person-to-Person Health Interview Study (P2P; N ~ 2,700, 2018-2021) provides representative, community-based, NEM-tailored data. Both descriptive, latent class and multinomial regression analyses mark mental health care-seeking patterns, including individuals consulted and activities used, as well as the influence of the structure and cultural content of social networks.

RESULTS: Latent class analysis detected five pathways with good fit statistics. The Networked General Care Path (37.0%) and The Kin General Care Path (14.5%) differ only in whether friends are activated in using the general care sector. The Networked Multi-Sector Care Path (32.5%) and The Saturated Path (12.6%) involve family, friends, and both general and specialty care with only the latter expanding consultation to coworkers and clergy. The Null Path (3.3%), or no contacts, is not used as perceived problem severity increases. Network size and strength are associated with the more complex pathways that activate ties, respectively. Trust in doctors is associated with pathways that include specialty providers but not others at work or church. Race, age, and rural residence have specific pathway effects, while gender has no significant impact.

CONCLUSIONS: Social networks propel individuals with mental health problems into action. Tie strength and trust produce care responses that are fuller and more targeted. Considering the nature of homophily, results also suggest that majority status and college education are clearly implicated in networked pathways. Overall, findings support community-targeted rather than individually based efforts to increase service use.

PMID:37072564 | DOI:10.1007/s00127-023-02476-2

Eur Arch Otorhinolaryngol. 2023 Apr 19. doi: 10.1007/s00405-023-07946-6. Online ahead of print.

ABSTRACT

BACKGROUND: At present, it is still controversial whether lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLN) in papillary thyroid carcinoma (PTC) patients should be dissected. Failure to dissect metastatic lymph nodes results in continued metastasis from the positive lymph nodes to other regions. Our study aimed to establish a predictive model and predict the probability of metastasis of the lymph nodes posterior to the right recurrent laryngeal nerve (LNM-prRLN) in patients.

METHODS: A total of 309 patients underwent surgery for thyroid cancer between May 2019 and September 2022. The risk factors were identified by univariate and multivariate analyses, and statistically significant risk factors identified in the multivariate analysis were included in the nomogram. We used the calibration curve and the receiver operating characteristic (ROC) curve to verify the accuracy of the prediction model.

RESULTS: Multivariate analysis showed that irregular tumor margins (OR: 3.549, 95% CI 1.294-9.733, P = 0.014), extrathyroidal extension (OR: 4.507, 95% CI 1.694-11.993, P = 0.003), maximum tumor diameter > 1 cm (OR: 5.729, 95% CI 2.617-12.542, P < 0.001), overweight status (OR: 2.296, 95% CI 1.057-4.987, P = 0.036), high total cholesterol level (OR: 5.238, 95% CI 2.304-11.909, P < 0.001), and multifocality (OR: 11.954, 95% CI 5.233-27.305, P < 0.001) were independent risk factors for LNM-prRLN. The area under the ROC curve was 0.927. The calibration curve showed good agreement between the predicted and observed rates of LNM-prRLN.

CONCLUSION: The probability of LNM-prRLN could be predicted by a nomogram based on the statistically significant risk factors identified in the multivariate analysis. This nomogram can guide clinicians when preoperatively evaluating the status of the LN-prRLN with regard to LNM-prRLN in PTC patients. For patients at high risk for LNM-prRLN, the preventive dissection of LN-prRLNs can be considered.

PMID:37072557 | DOI:10.1007/s00405-023-07946-6

BMJ Open. 2023 Apr 18;13(4):e063614. doi: 10.1136/bmjopen-2022-063614.

ABSTRACT

OBJECTIVE: To assess the impact of menu calorie labelling on reducing obesity-associated cancer burdens in the USA.

DESIGN: Cost-effectiveness analysis using a Markov cohort state-transition model.

SETTING: Policy intervention.

PARTICIPANTS: A modelled population of 235 million adults aged ≥20 years in 2015-2016.

INTERVENTIONS: The impact of menu calorie labelling on reducing 13 obesity-associated cancers among US adults over a lifetime was evaluated for: (1) effects on consumer behaviours; and (2) additional effects on industry reformulation. The model integrated nationally representative demographics, calorie intake from restaurants, cancer statistics and estimates on associations of policy with calorie intake, dietary change with body mass index (BMI) change, BMI with cancer rates, and policy and healthcare costs from published literature.

MAIN OUTCOME MEASURES: Averted new cancer cases and cancer deaths and net costs (in 2015 US$) among the total population and demographic subgroups were determined. Incremental cost-effectiveness ratios from societal and healthcare perspectives were assessed and compared with the threshold of US$150 000 per quality-adjusted life year (QALY) gained. Probabilistic sensitivity analyses incorporated uncertainty in input parameters and generated 95% uncertainty intervals (UIs).

RESULTS: Considering consumer behaviour alone, this policy was associated with 28 000 (95% UI 16 300 to 39 100) new cancer cases and 16 700 (9610 to 23 600) cancer deaths averted, 111 000 (64 800 to 158 000) QALYs gained, and US$1480 (884 to 2080) million saved in cancer-related medical costs among US adults. The policy was associated with net cost savings of US$1460 (864 to 2060) million and US$1350 (486 to 2260) million from healthcare and societal perspectives, respectively. Additional industry reformulation would substantially increase policy impact. Greater health gains and cost savings were predicted among young adults, Hispanic and non-Hispanic Black individuals.

CONCLUSIONS: Study findings suggest that menu calorie labelling is associated with lower obesity-related cancer burdens and reduced healthcare costs. Policymakers may prioritise nutrition policies for cancer prevention in the USA.

PMID:37072239 | DOI:10.1136/bmjopen-2022-063614

Can Fam Physician. 2023 Apr;69(4):271-277. doi: 10.46747/cfp.6904271.

ABSTRACT

OBJECTIVE: To identify how graduating and incoming family medicine residents (FMR) experienced changes to their education during the early waves of the COVID-19 pandemic.

DESIGN: The Family Medicine Longitudinal Survey was modified with questions related to the impact of COVID-19 on FMR and their training. Short-answer responses underwent thematic analysis. Responses to Likert scale and multiple-choice questions were reported as summary statistics.

SETTING: Department of Family and Community Medicine at the University of Toronto in Ontario.

PARTICIPANTS: Graduating FMR in spring 2020 and incoming FMR in fall 2020.

MAIN OUTCOME MEASURES: Residents’ perceptions of the impact of COVID-19 on clinical skills acquisition and preparedness for practice.

RESULTS: Surveys response rates were 124 of 167 (74%) and 142 of 162 (88%) for graduating and incoming residents, respectively. Important themes for both cohorts included reduced access to clinical environments, reduced patient volumes, and lack of exposure to procedural skills. While the graduating cohort indicated they felt confident to begin practising family medicine, they described being impacted by the loss of a tailored learning environment, including canceled or altered electives. In contrast, incoming residents reported the loss of core skills, such as physical examination competency, as well as the loss of face-to-face communication, rapport, and relationship-building opportunities. However, both cohorts endorsed gaining new skills during the pandemic, including conducting telemedicine appointments, pandemic planning, and interfacing with public health.

CONCLUSION: Based on these results, residency programs can specifically tailor solutions and modifications to address common themes across cohorts to facilitate optimal learning environments in pandemic times.

PMID:37072215 | DOI:10.46747/cfp.6904271

BMJ. 2023 Apr 18;381:e073435. doi: 10.1136/bmj-2022-073435.

ABSTRACT

OBJECTIVE: To estimate the effect of denosumab compared with oral bisphosphonates on reducing the risk of type 2 diabetes in adults with osteoporosis.

DESIGN: Population based study involving emulation of a randomized target trial using electronic health records.

SETTING: IQVIA Medical Research Data primary care database in the United Kingdom, 1995-2021.

PARTICIPANTS: Adults aged 45 years or older who used denosumab or an oral bisphosphonate for osteoporosis.

MAIN OUTCOME MEASURES: The primary outcome was incident type 2 diabetes, as defined by diagnostic codes. Cox proportional hazards models were used to estimate adjusted hazard ratios and 95% confidence intervals, comparing denosumab with oral bisphosphonates using an as treated approach.

RESULTS: 4301 new users of denosumab were matched on propensity score to 21 038 users of an oral bisphosphonate and followed for a mean of 2.2 years. The incidence rate of type 2 diabetes in denosumab users was 5.7 (95% confidence interval 4.3 to 7.3) per 1000 person years and in oral bisphosphonate users was 8.3 (7.4 to 9.2) per 1000 person years. Initiation of denosumab was associated with a reduced risk of type 2 diabetes (hazard ratio 0.68, 95% confidence interval 0.52 to 0.89). Participants with prediabetes appeared to benefit more from denosumab compared with an oral bisphosphonate (hazard ratio 0.54, 0.35 to 0.82), as did those with a body mass index ≥30 (0.65, 0.40 to 1.06).

CONCLUSIONS: In this population based study, denosumab use was associated with a lower risk of incident type 2 diabetes compared with oral bisphosphonate use in adults with osteoporosis. This study provides evidence at a population level that denosumab may have added benefits for glucose metabolism compared with oral bisphosphonates.

PMID:37072150 | DOI:10.1136/bmj-2022-073435