Category: Nevin Manimala

Ann Surg Oncol. 2021 Aug 7. doi: 10.1245/s10434-021-10551-8. Online ahead of print.

ABSTRACT

BACKGROUND: Breast cancer-related lymphedema (BCRL) is a source of postoperative morbidity for breast cancer survivors. Lymphatic microsurgical preventive healing approach (LYMPHA) is a technique used to prevent BCRL at the time of axillary lymph node dissection (ALND). We report the 5-year experience of a breast surgeon trained in LYMPHA and investigate the outcomes of patients who underwent LYMPHA following ALND for treatment of cT1-4N1-3M0 breast cancer.

METHODS: A retrospective review of patients with cT1-4N1-3M0 breast cancer was performed in patients who underwent ALND with and without LYMPHA. Diagnosis of BCRL was made by certified lymphedema therapists. Descriptive statistics and lymphedema surveillance data were analyzed using results of Fisher’s exact or Wilcoxon rank-sum tests. Logistic regression and propensity matching were performed to assess the reduction of BCRL occurrence following LYMPHA.

RESULTS: In a 5-year period, 132 patients met inclusion criteria with 76 patients undergoing LYMPHA at the time of ALND and 56 patients undergoing ALND alone. Patients who underwent LYMPHA at the time of ALND were significantly less likely to develop BCRL than those who underwent ALND alone (p = 0.045). Risk factors associated with BCRL development were increased patient age (p = 0.007), body mass index (BMI) (p = 0.003), and, in patients undergoing LYMPHA, number of positive nodes (p = 0.026).

CONCLUSIONS: LYMPHA may be successfully employed by breast surgeons trained in lymphatic-venous anastomosis at the time of ALND. While research efforts should continue to focus on prevention and surveillance of BCRL, LYMPHA remains an option to reduce BCRL and improve patient quality of life.

PMID:34365563 | DOI:10.1245/s10434-021-10551-8

Eur Arch Paediatr Dent. 2021 Aug 7. doi: 10.1007/s40368-021-00655-w. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to evaluate in vitro, the shear bond strength (SBS) and adhesive remnant index (ARI) of pit and fissure sealants (PFS) after enamel conditioning with different new-generation self-etching (SE) agents; additionally, enamel etching patterns were assessed.

METHODS: Healthy unerupted third molars surgically removed for therapeutic reasons (n = 25p/g), were randomly assigned to six groups. Conventional etching (CE) or SE was applied prior to pit and fissure sealants bonding. Enamel conditioned surfaces were evaluated by SEM at × 500, × 1000, and × 2000 magnification to determine etching patterns. Subsequently, 25 PFS blocks (3 × 2 × 1.5 mm) p/g were bonded to enamel surface. Samples were stored in water at 37 °C for 24 h, previous to SBS and ARI test. One-way ANOVA and Tamhane statistic tests were used for SBS; while Mann-Whitney U and Kruskal-Wallis were employed for ARI (p ≤ 0.05).

RESULTS: For SBS test, CE_PFS_3M and SE1_PFS_Shofu groups showed the lowest values (8.74 ± 4.02 and 8.75 ± 3.90, respectively). The highest scores were observed in SE_PFS_Kuraray group (13.46 ± 5.83). Significant differences in SBS and ARI assessments were found. All experimental groups showed type 1 etching pattern.

CONCLUSION: The etching pattern was less pronounced in self-etching groups, which showed an equal or superior in vitro performance compared to conventional etching agents. The clinical use of self-etching agents could be recommended before pit and fissure sealants application in new dental protocols. The best in vitro performance was observed when both applied materials, self-etching agent and pit and fissure sealant have 10-methacryloyloxydecyl dihydrogen phosphate in their chemical composition.

PMID:34365570 | DOI:10.1007/s40368-021-00655-w

J Membr Biol. 2021 Aug 7. doi: 10.1007/s00232-021-00197-8. Online ahead of print.

ABSTRACT

Bound cholesterol molecules are emerging as important hallmarks of GPCR structures. In this commentary, we analyze their statistical prevalence and biological relevance.

PMID:34365520 | DOI:10.1007/s00232-021-00197-8

World J Surg. 2021 Aug 7. doi: 10.1007/s00268-021-06220-2. Online ahead of print.

ABSTRACT

BACKGROUND: Enhanced recovery programs (ERP) demonstrated decreased postoperative complication rate and reduced length of stay (LOS). Recently, data on the financial impact revealed cost reduction for colorectal, liver and pancreatic surgery. The present study aimed to assess the cost-effectiveness of ERP in gastric surgery.

METHODS: ERP based on enhanced recovery after surgery (ERAS®) society guidelines was implemented in our institution, in June 2014. Consecutive patients undergoing gastric surgery after ERP implementation (n = 71) were compared to a control group of consecutive patients operated before ERP implementation (n = 58). Primary endpoint was cost-effectiveness including detailed perioperative costs. Secondary endpoints were postoperative complications and LOS. Standard statistical testing (means, Mann-Whitney Fisher’s exact T test or Pearson Chi-square test) was used.

RESULTS: Both groups were comparable regarding demographic details. Mean (SD) overall costs per patient were lower in the ERP group (€33,418 (17,901) vs €39,804 (27,288), P = 0.027). Lower costs were found for anesthesia and operating room (-€2 356), intensive or intermediate care (-€8 629), medication (-€1 196)), physiotherapy (-€611), laboratory (-€1 625)) and blood transfusion (-€977). Overall complication rates in ERP and control group (51% vs 62%, P = 0.176) were similar. Mean length of stay (SD) (14(13) days vs 17(11) days, P = 0.037) was shorter in the ERP group.

CONCLUSION: ERP significantly reduces overall, preoperative and postoperative costs in patients undergoing major gastric surgery.

PMID:34365531 | DOI:10.1007/s00268-021-06220-2

Psychiatr Pol. 2021 Apr 30;55(2):275-286. doi: 10.12740/PP/OnlineFirst/112004. Epub 2021 Apr 30.

ABSTRACT

OBJECTIVES: The aim of the study was to assess efficacy of psychoeducation in limiting body mass gain in patients with schizophrenia undergoing atypical antipsychotics monotherapy treatment.

METHODS: Education program Caring for Health and Silhouette, commissioned by Moneo Pharma Group, was implemented for patients with schizophrenia. The aim of the program was providing patients with information regarding lifestyle and nutrition.

RESULTS: The one-year follow-up was completed by 7,541 patients. The mean BMI (body mass index) gain in one-year follow-up was 0.56 and the difference between men (0.52) and women (0.60) was statistically significant (p < 0.001). The mean one-year body mass gain was 1.63 kg, whilst the mean one-year increase in waist circumference was 1.25 cm. There were no statistically significant differences between sexes. The subjective evaluation of patient compliance increased systematically with every visit, both for men and women. High-compliance patients less frequently experienced body mass gain (p < 0.001), while obese patients experienced the greatest decrease in BMI.

CONCLUSIONS: Education program resulted in a decrease of body mass gain in obese patients treated with atypical antipsychotics. Patients with BMI ≥30 more often than other patients experienced the reduction of body mass during education program. The quality of cooperation during the first and second visit has a predictive value for the estimation of body mass changes during education program. This method of education is easy to implement in clinical practice.

PMID:34365479 | DOI:10.12740/PP/OnlineFirst/112004

Health Policy Plan. 2021 Aug 7:czab096. doi: 10.1093/heapol/czab096. Online ahead of print.

ABSTRACT

We used big data analytics for exploring the relationship between government response policies, human mobility trends and numbers of coronavirus disease 2019 (COVID-19) cases comparatively in Poland, Turkey and South Korea. We collected daily mobility data of retail and recreation, grocery and pharmacy, parks, transit stations, workplaces, and residential areas. For quantifying the actions taken by governments and making a fairness comparison between these countries, we used stringency index values measured with the ‘Oxford COVID-19 government response tracker’. For the Turkey case, we also developed a model by implementing the multilayer perceptron algorithm for predicting numbers of cases based on the mobility data. We finally created scenarios based on the descriptive statistics of the mobility data of these countries and generated predictions on the numbers of cases by using the developed model. Based on the descriptive analysis, we pointed out that while Poland and Turkey had relatively closer values and distributions on the study variables, South Korea had more stable data compared to Poland and Turkey. We mainly showed that while the stringency index of the current day was associated with mobility data of the same day, the current day’s mobility was associated with the numbers of cases 1 month later. By obtaining 89.3% prediction accuracy, we also concluded that the use of mobility data and implementation of big data analytics technique may enable decision-making in managing uncertain environments created by outbreak situations. We finally proposed implications for policymakers for deciding on the targeted levels of mobility to maintain numbers of cases in a manageable range based on the results of created scenarios.

PMID:34365501 | DOI:10.1093/heapol/czab096

Ann Work Expo Health. 2021 Aug 8:wxab062. doi: 10.1093/annweh/wxab062. Online ahead of print.

ABSTRACT

BACKGROUND: The spread of severe acute respiratory coronavirus 2 (SARS-CoV-2) among active workers is poor known. The aim of our study was to evaluate the seroprevalence of immunoglobulin G (IgG) among a convenience sample of workers and to identify high-risk job sectors during the first pandemic way.

METHODS: We conducted a cross-sectional study among workers tested for SARS-CoV-2 between 28 March and 7 August 2020, recorded by a private healthcare center located in North-West Italy. Association among seroprevalence and demographic and occupational variables was evaluated using chi square test and the seroprevalence and 95% confidence intervals (CI) were calculated.

RESULTS: We collected the results for 23568 serological tests from a sample of 22708 workers from about 1000 companies. Median age was 45 years and about 60% of subjects were male. The overall seroprevalence was 4.97% [95%CI 4.69-5.25]. No statistical difference was found among gender while seroprevalence was associated with subjects’ age, geographical location, and occupational sector. Significantly higher values of positivity were observed for the logistics sector (31.3%), weaving factory (12.6%), nursing homes (9.8%), and chemical industry (6.9%) workers. However, we observed some clusters of cases in single companies independently from the sector.Then, a detailed focus on 940 food workers shown a seroprevalence of 5.21% [95%CI 3.79-6.63] and subjects who self-reported COVID-19 symptoms and who worked during lockdown had a higher probability of being infected (p < 0.001).

CONCLUSIONS: Data obtained might be useful for future public health decision; more than occupation sector, it seems that failure on prevention system in single companies increase the SARS-CoV-2 transmission.

PMID:34365502 | DOI:10.1093/annweh/wxab062

Nutrition. 2021 Jun 24;91-92:111397. doi: 10.1016/j.nut.2021.111397. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to examine the association between sarcopenia and recovery of independence in urination and defecation in patients undergoing convalescent rehabilitation.

METHODS: This single-center, retrospective cohort study included post-acute rehabilitation patients. Sarcopenia was diagnosed using the muscle mass index and handgrip strength according to the updated criteria of the Asian Working Group for Sarcopenia 2019. Study outcomes and the recovery of independence in urination and defecation were evaluated using the sphincter control items of the Functional Independence Measure (FIM) at discharge: urination (FIM-Bladder) and defecation (FIM-Bowel), respectively. Multivariate regression analyses were used to determine whether sarcopenia at baseline was associated with the study outcomes. Statistical significance was set at P < 0.05.

RESULTS: After enrollment, 917 patients (mean age 74.7 ± 13.5 y; 58% women) were included in the final analyses. Sarcopenia was present in 451 patients (49.2%). The median FIM-Bladder and FIM-Bowel scores at admission were 5 [2-7] and 5 [3-7], respectively. Multivariate analyses showed that the presence of sarcopenia at admission was independently and negatively associated with FIM-Bladder and FIM-Bowel at discharge (all P < 0.001), respectively, after adjusting for potential confounders including baseline outcome variables, FIM, and disease.

CONCLUSIONS: Sarcopenia was negatively associated with the recovery of independence in urination and defecation in a post-acute rehabilitation setting. This relationship was independent of physical and cognitive level and disease. Early detection of sarcopenia and treatment by rehabilitation nutrition should be implemented to predict and maximize improvement in toileting independence in this population.

PMID:34364264 | DOI:10.1016/j.nut.2021.111397

Diabetes Metab Syndr. 2021 Jul 30;15(5):102238. doi: 10.1016/j.dsx.2021.102238. Online ahead of print.

ABSTRACT

AIMS: To evaluate the dose-effect association between COVID-19 vaccination and probability of turning RT-PCR positive and to assess the correlation between disease severity and vaccination status.

METHODS: A single centre cross-sectional study was conducted amongst 583 individuals presenting to COVID-19 testing clinic and 55 hospitalized COVID-19 patients. Vaccination status was assessed by the number of doses and duration since the last dose. Disease severity was evaluated by the requirement of hospitalisation and ICU admission/death. The association between the vaccination status and development of disease and its severity were statistically analyzed.

RESULTS: The mean age of the population was 36.6 years and 82.6% had no comorbidities. The odds of turning RT-PCR positive was 0.17(95% CI: 0.11-0.27) among the clinical suspects who had taken both doses of the vaccine at least 14 days before (fully vaccinated). The odds of hospitalisation was 0.12(95% CI: 0.03-0.45) and ICU admission/death was 0.07(95% CI: 0.01-0.36) among fully vaccinated individuals. The protective role of vaccination was observed to start 14 days after receiving the first dose.

CONCLUSIONS: COVID-19 vaccination provides dose-dependent protection against the development of the disease. It also lowers the risk of hospitalisation and ICU admission/death in RT-PCR positive patients in a dose-dependent manner.

PMID:34364299 | DOI:10.1016/j.dsx.2021.102238

Phys Med. 2021 Aug 4;89:114-128. doi: 10.1016/j.ejmp.2021.07.014. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: The development, control and optimisation of new x-ray breast imaging modalities could benefit from a quantitative assessment of the resulting image textures. The aim of this work was to develop a software tool for routine radiomics applications in breast imaging, which will also be available upon request.

METHODS: The tool (developed in MATLAB) allows image reading, selection of Regions of Interest (ROI), analysis and comparison. Requirements towards the tool also included convenient handling of common medical and simulated images, building and providing a library of commonly applied algorithms and a friendly graphical user interface. Initial set of features and analyses have been selected after a literature search. Being open, the tool can be extended, if necessary.

RESULTS: The tool allows semi-automatic extracting of ROIs, calculating and processing a total of 23 different metrics or features in 2D images and/or in 3D image volumes. Computations of the features were verified against computations with other software packages performed with test images. Two case studies illustrate the applicability of the tool – (i) features on a series of 2D ‘left’ and ‘right’ CC mammograms acquired on a Siemens Inspiration system were computed and compared, and (ii) evaluation of the suitability of newly proposed and developed breast phantoms for x-ray-based imaging based on reference values from clinical mammography images. Obtained results could steer the further development of the physical breast phantoms.

CONCLUSIONS: A new image analysis toolbox was realized and can now be used in a multitude of radiomics applications, on both clinical and test images.

PMID:34364255 | DOI:10.1016/j.ejmp.2021.07.014