Category: Nevin Manimala

J Endourol. 2022 Feb 8. doi: 10.1089/end.2021.0644. Online ahead of print.

ABSTRACT

PURPOSE: Robotic partial nephrectomies by their nature are associated with renal volume loss. Our goal from this study is to examine renal volume loss over time post partial nephrectomy.

MATERIALS AND METHODS: Fifty patients were followed for 1-year post robotic partial nephrectomy with two-layer renorrhaphy and the sliding clip technique. This was done with a preoperative computed tomography (CT) scan to assess renal mass and location. Post robotic partial nephrectomy patients were imaged at time points 3-days, 6-months, and 12-months.

RESULTS: Patient demographics were 82% male with a median (IQR) age of 57 (45-67) and all were of Japanese descent. The medians (IQR) for warm ischemia time: 18 minutes (14-22), total operative time: 181.5 minutes (169.3-218.5), and estimated blood loss: 20 mL (10-50). The tumor characteristics had a median (IQR) diameter of 2.8 cm (2.5-3.4) with a RENAL score of 7 (6-8). The renal CT volumes showed median (IQR) volume losses at 3-days: -1% (-7.1, 1.8), 6-months: -15.3% (-20.6, -11.2), and 12-months: -16.3% (-19.0, -12.8). Significance was seen at the 3-days to 6-months comparison for volume loss (p<0.0001). Mean (SD) eGFR losses were as follows: at discharge 0.5% (12.9), 1-month -6.4% (11.8), 6-months -4.6% (9.8), and 12-months -3.6% (11.9). Statistical analysis showed significance for GFR loss at the comparison between discharge to 1-month and 6-months (p=0.01, p=0.04).

CONCLUSION: The initial volume loss seen post-surgery from resected healthy tissue was not significant and only became relevant at longer time points suggesting that loss could be from atrophy. Volume loss over time supports the hypothesis that suture renorrhaphy is a primary cause of volume loss when warm ischemia time is <25minutes.

PMID:35132882 | DOI:10.1089/end.2021.0644

J Am Heart Assoc. 2022 Feb 8:e022232. doi: 10.1161/JAHA.121.022232. Online ahead of print.

ABSTRACT

Background While peripheral artery disease (PAD) is associated with increased cardiovascular morbidity with mortality remaining high and challenging to predict, accurate understanding of serial PAD-specific health status around the time of diagnosis may prognosticate long-term mortality risk. Methods and Results Patients with new or worsening PAD symptoms enrolled in the PORTRAIT Registry across 10 US sites from 2011 to 2015 were included. Health status was assessed by the Peripheral Artery Questionnaire (PAQ) Summary score at baseline, 3-month, and change from baseline to 3-month follow-up. Kaplan-Meier using 3-month landmark and hierarchical Cox regression models were constructed to assess the association of the PAQ with 5-year all-cause mortality. Of the 711 patients (mean age 68.8±9.6 years, 40.9% female, 72.7% white; mean PAQ 47.5±22.0 and 65.9±25.0 at baseline and 3-month, respectively), 141 (19.8%) died over a median follow-up of 4.1 years. In unadjusted models, baseline (HR, 0.90 per-10-point increment; 95% CI, 0.84-0.97; P=0.008), 3-month (HR [95% CI], 0.87 [0.82-0.93]; P<0.001) and change in PAQ (HR [95% CI], 0.92 [0.85-0.99]; P=0.021) were each associated with mortality. In fully adjusted models including combination of scores, 3-month PAQ was more strongly associated with mortality than either baseline (3-month HR [95% CI], 0.85 [0.78-0.92]; P<0.001; C-statistic, 0.77) or change (3-month HR [95% CI], 0.79 [0.72-0.87]; P<0.001). Conclusions PAD-specific health status is independently associated with 5-year survival in patients with new or worsening PAD symptoms, with the most recent assessment being most prognostic. Future work is needed to better understand how this information can be used proactively to optimize care.

PMID:35132874 | DOI:10.1161/JAHA.121.022232

Cancer Commun (Lond). 2022 Feb 7. doi: 10.1002/cac2.12265. Online ahead of print.

NO ABSTRACT

PMID:35132829 | DOI:10.1002/cac2.12265

J Korean Med Sci. 2022 Feb 7;37(5):e36. doi: 10.3346/jkms.2022.37.e36.

ABSTRACT

BACKGROUND: This study aimed to assess the clinical relevance of the parsimonious Eurolung risk scoring system for predicting postoperative morbidity, mortality, and long-term survival in Korean patients with surgically resected non-small cell lung cancer.

METHODS: This retrospective analysis used the data of patients who underwent anatomical resection for non-small cell lung cancer between 2004 and 2018 at a single institution. The parsimonious aggregate Eurolung score was calculated for each patient. The Cox regression model was used to determine the ability of the Eurolung scoring system for predicting long-term outcomes.

RESULTS: Of the 7,278 patients in the study, cardiopulmonary complications and mortality occurred in 687 (9.4%) and 53 (0.7%) patients, respectively. The rate of cardiopulmonary complications and mortality gradually increased with the increase in the Eurolung risk scores (all P < 0.001). When risk scores were grouped into four categories, the Eurolung scoring system showed a stepwise deterioration of overall survival with the increase in risk scores, and this association was statistically significant (P < 0.001). Multivariate Cox analysis showed that the Eurolung scoring system, classified into four categories, was a significant prognostic factor of overall survival even after adjusting for covariates such as tumor histology and pathological stage (P < 0.001).

CONCLUSION: Stratification based on the parsimonious Eurolung scoring system showed good discriminatory ability for predicting postoperative morbidity, mortality, and long-term survival in South Korean patients with surgically resected non-small cell lung cancer. This might help clinicians to provide a detailed prognosis and decide the appropriate treatment option for high-risk patients with non-small cell lung cancer.

PMID:35132842 | DOI:10.3346/jkms.2022.37.e36

Jpn J Nurs Sci. 2022 Feb 7:e12472. doi: 10.1111/jjns.12472. Online ahead of print.

ABSTRACT

AIM: Transitional care is important for improving the quality of life of patients discharged from hospitals. Patient-reported experience measures help improve transitional care quality. Thus, this literature review aimed to identify and appraise measurement tools that assess transitional care quality from the patient’s perspective and identify its components.

METHODS: Development and validation studies were systematically searched in the PubMed and CINAHL databases. The review team appraised the methodological quality and statistical results of measurement properties using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology.

RESULTS: A total of 30 studies and seven instruments were identified. The target population was patients discharged from hospital to a home or nursing home (mean age = 52-84 years). The measurement time was before or after the discharge. The number of items in the original versions of the measures ranged from eight to 41, with short versions ranging from three to 12. The overall methodological quality of structural validity, internal consistency, and hypotheses testing was mostly “very good or adequate,” according to COSMIN criteria. However, content validity and development were mostly “inadequate or doubtful” or not reported. The main components of included measures comprised “self-care after discharge,” “providing information to the patient,” “patient engagement in the care plan,” and “dealing with patient’s concerns.”

CONCLUSION: The quality appraisal results and identified components are useful for choosing measurement tools in clinical practice and research. The Care Transitions Measure is the most widely validated measurement tool.

PMID:35132783 | DOI:10.1111/jjns.12472

Eur Eat Disord Rev. 2022 Feb 7. doi: 10.1002/erv.2888. Online ahead of print.

ABSTRACT

OBJECTIVE: Mentalisation-based treatment (MBT) aims to improve reflective functioning. There is a growing evidence base outlining positive clinical outcomes for the use of MBT in eating disorder patients with co-morbid borderline personality disorder (BPD). The use of MBT has not been studied for eating disorder patients without BPD. This pilot study is an exploratory randomised controlled trial in which outcomes from MBT are compared with standard clinical management in a cohort of patients diagnosed with an eating disorder but not BPD. The main objectives were two-fold-to explore the use of MBT as a therapeutic modality and to test the acceptability and feasibility of the protocol design.

METHOD: Thirty-two participants were randomised to receive either MBT or standard treatment during an inpatient eating disorders program. All patients enrolled in the study were diagnosed with an eating disorder but did not meet DSM-5 criteria for BPD. On admission patients were categorised as very underweight (BMI 15.0-16.4 kg/m² ), underweight (BMI 16.5-18.4 kg/m² ) or healthy weight range (BMI ≥ 18.5-24.9 kg/m² ). Upon discharge participants were further categorised as weight restored (BMI ≥ 18.5 kg/m² ) or non-weight restored (BMI < 18.5 kg/m² ). The primary outcome was the subscale score on the Reflective Functioning Questionnaire (RFQ-8). Secondary outcomes were subscale scores on the Eating Disorder Examination Questionnaire and the Depression, Anxiety and Stress Scale (DASS)-21. Participants were assessed at baseline and on discharge. Statistical significance was determined using repeated measurements analysis of variance (ANOVA).

RESULTS: Both groups experienced improvements in eating disorder symptoms and measures of psychological well-being. Participants within the MBT group exhibited greater improvements in reflective capacity as defined by the RFQ-8 however these benefits appeared to be limited to patients who achieved weight restoration at discharge. The eligibility criteria-which excluded comorbid BPD-led to challenges in recruitment which limited the power of the study analysis. As participants with a range of different eating disorder diagnoses were included this led to complexities in estimating the treatment effect within a defined cohort.

CONCLUSIONS: Although the small sample size must be noted as a limitation-the finding that weight restoration appears to be associated with improvements in reflective capacity in MBT would be worth exploring in a subsequent larger study. Modification of eligibility criteria and recruitment from a defined cohort may increase the efficiency of a future study.

PMID:35132749 | DOI:10.1002/erv.2888

Int J Lab Hematol. 2022 Feb 7. doi: 10.1111/ijlh.13805. Online ahead of print.

ABSTRACT

INTRODUCTION: Increased antiphospholipid antibodies (aPL) have been described in human immunodeficiency virus (HIV) infection. However, the association between aPL and the increased risk of thrombosis in HIV requires further clarification.

METHODS: We reviewed the medical records of 215 consecutive women with a history of thrombosis and/or obstetric complications (158 HIV-uninfected and 57 HIV-infected) between July 2017 and March 2021. Participants (n = 215) without clinical criteria manifestations for antiphospholipid syndrome were included as matched controls. Testing for lupus anticoagulant (LAC), anticardiolipin (aCL) and anti-beta2-glycoprotein1 (aβ2GP1) IgM and IgG was performed.

RESULTS: Thirty-two (10.1%) HIV-uninfected and 15 (13.2%) HIV-infected participants were positive at baseline for one of the five criteria aPL, with no statistically significant difference. The profile of the HIV-infected participants with thrombosis (n = 11) included LAC in 15.8%, aCL IgG in 3.5% and aβ2GP1 IgG in 1.8%. In contrast, the HIV-infected controls (n = 4), included aCL IgM in 1.8% and aβ2GP1 IgM in 5.3%. Only LAC was significantly associated with thrombosis (p < 0.003). On repeat testing, in a HIV-infected sub-population, 2/7 with thrombosis were positive, while 3/3 controls tested negative.

CONCLUSION: In contrast to earlier reports, the prevalence and expression of aPL in HIV-infected women with a history of thrombosis in the present study, in the era of antiretroviral therapy, were similar to HIV-uninfected women. Baseline LAC positivity was associated with a significantly increased risk for thrombosis in HIV. Future studies are recommended to explore additional coagulation abnormalities in HIV.

PMID:35132770 | DOI:10.1111/ijlh.13805

J Cosmet Dermatol. 2022 Feb 7. doi: 10.1111/jocd.14757. Online ahead of print.

ABSTRACT

BACKGROUND: Hyaluronic acid (HA) is an effective dermal filler for facial rejuvenation. This study aimed to observe the clinical efficacy of HA injection for lip augmentation in Chinese patients.

METHODS: From May 2019 to April 2020, 70 patients with lip fullness scale (LPS) ≤3 underwent local HA injection using the “three-point” injection technique. All patients were followed up to observe the clinical efficacy, LPS, adverse events, and complications.

RESULTS: All 70 patients were followed up for 12 months. Statistically significant improvements were observed in the height of lips within 6-9 months post-treatment (p < 0.05). The LFS improved significantly at follow-up compared with baseline (p < 0.05). Local redness occurred in two patients, and serious swelling occurred in three patients. These adverse events were generally tolerated and disappeared gradually within 1 week. No other serious adverse events and complications were reported in the remaining patients.

CONCLUSIONS: Hyaluronic acid injection can be used for lip augmentation in the Chinese population. The “three-point” technique is simple, safe, and effective and does not cause serious complications.

PMID:35132743 | DOI:10.1111/jocd.14757

Ultrasound Obstet Gynecol. 2022 Feb 8. doi: 10.1002/uog.24875. Online ahead of print.

ABSTRACT

INTRODUCTION: While visualization of fetal anatomy is one of the primary purposes of diagnostic ultrasound, the application of statistical analysis to biological measurements of fetal structures such as the head, abdomen, long bones, and heart, requires equations that compute changes in these measurements over time. One of the challenges for the investigator who desires to compute reference intervals for a fetal measurement is selecting the best equation for the measurements of interest. Fractional polynomial regression equations have been used to describe changes in fetal measurements over time and consists of 44 equations for the investigator to select. Since it would be laborious to analyze each equation to identify the best fit of the data, software programs have been developed for such analysis. However, depending upon the software program, potential errors can occur when translating the coefficients of a complex equation to a format that can be used by the clinician to create reference interval tables and graphs.

METHODS: This study reviews the requirements for statistical output that allows the investigator to generate reference interval tables and graphs using Excel.

RESULTS: A step-by-step sequence is explained that enables the investigator to minimize the possibility of errors when reporting complex equations and their associated graphs that result from fractional polynomial regression analysis.

CONCLUSION: Using the techniques described in this opinion paper should decrease the potential for reporting erroneous equations used to compute reference interval tables and graphs. This article is protected by copyright. All rights reserved.

PMID:35132716 | DOI:10.1002/uog.24875

Int J Methods Psychiatr Res. 2022 Feb 7:e1906. doi: 10.1002/mpr.1906. Online ahead of print.

ABSTRACT

OBJECTIVE: One of the primary tools in the assessment of individual-level patient outcomes is Jacobson and Truax, (1991’s) Reliable Change Index (RCI). Recent efforts to optimize the RCI have revolved around three issues: (a) extending the RCI beyond two timepoints, (b) estimating the RCI using scale scores from item response theory or factor analysis and (c) estimation of person- and time-specific standard errors of measurement.

METHOD: We present an adaptation of a two-stage procedure, a measurement error-corrected multilevel model, as a tool for RCI estimation (with accompanying Statistical Analysis System syntax). Using DASS-21 data from a community-based mental health center (N = 379), we illustrate the potential for the model as unifying framework for simultaneously addressing all three limitations in modeling individual-level RCI estimates.

RESULTS: Compared to the optimal-fitting RCI model (moderated nonlinear factor analysis scoring with measurement error correction), an RCI model that uses DASS-21 total scores produced errors in RCI inferences in 50.8% of patients; this was largely driven by overestimation of the proportion of patients with statistically significant improvement.

CONCLUSION: Estimation of the RCI can now be enhanced by the use of latent variables, person- and time-specific measurement errors, and multiple timepoints.

PMID:35132724 | DOI:10.1002/mpr.1906