Nevin Manimala

JAMA Netw Open. 2024 Dec 2;7(12):e2452661. doi: 10.1001/jamanetworkopen.2024.52661.

ABSTRACT

IMPORTANCE: Serial circulating tumor DNA (ctDNA) has emerged as a routine surveillance strategy for patients with resected colorectal cancer, but how serial ctDNA monitoring is associated with potential curative outcomes has not been formally assessed.

OBJECTIVE: To examine whether there is a benefit of adding serial ctDNA assays to standard-of-care imaging surveillance for potential curative outcomes in patients with resected colorectal cancer.

DESIGN, SETTING, AND PARTICIPANTS: In this single-center (City of Hope Comprehensive Cancer Center, Duarte, California), retrospective, case cohort study, patients with stage II to IV colorectal cancer underwent curative resection and were monitored with serial ctDNA assay and National Cancer Center Network (NCCN)-guided imaging surveillance from September 20, 2019, to April 3, 2024. The median duration of follow-up was 26 months (range, 2-54 months).

INTERVENTIONS: Serial ctDNA assays were performed every 3 months for 2 years and every 6 months for the 3 following years in conjunction with NCCN-guided radiographic surveillance.

MAIN OUTCOMES AND MEASURES: The primary outcome was the proportion of patients with clinical benefit from ctDNA testing, defined as the proportion of patients with a newly positive ctDNA assay and negative scheduled imaging (most recent or concurrent) that subsequently led to early imaging confirmation of recurrence, followed by curative-intent intervention with no evidence of recurrence at the time of data cutoff. Recurrence was categorized by ctDNA recurrence, radiographic recurrence, or concurrent ctDNA and imaging recurrence. Salvage resections and associated durable remissions were described within each of the 3 categories. Descriptive statistics were used to characterize the patient population.

RESULTS: In total, 184 patients (median age, 59 years [range, 32-88 years]; 97 female [52.7%]) were included in this study, and 129 (70.1%) had stage II to III disease. Forty-five patients (24.5%) had ctDNA or imaging-confirmed recurrence. Of these 45 patients, 14 had radiographic recurrence with negative ctDNA, and 11 had concurrent ctDNA and imaging recurrence. Twenty of 45 patients had ctDNA positivity with negative imaging at first ctDNA positivity; 6 had reflex imaging that was positive for recurrence, and 14 continued with serial imaging and ctDNA monitoring. Ten of 14 patients had subsequent recurrent disease, 3 patients had a spontaneous clearance of ctDNA, and 1 patient remained imaging negative 7 months after positive ctDNA, after which she was lost to follow-up. Altogether, 11 of 20 patients with ctDNA recurrence without initial concurrent imaging recurrence had subsequent metastasectomy, and only 3 were disease-free at the cutoff date in April 2024, representing 1.6% of the surveilled population.

CONCLUSIONS AND RELEVANCE: In this cohort study of patients with stage II to IV colorectal cancer who underwent curative-intent resection, the addition of serial tumor-informed ctDNA assay to the standard NCCN-recommended surveillance had limited clinical benefits. Additional prospective research is needed to clarify the value of ctDNA testing in the surveillance setting.

PMID:39729315 | DOI:10.1001/jamanetworkopen.2024.52661

Int J Environ Health Res. 2024 Dec 27:1-11. doi: 10.1080/09603123.2024.2446522. Online ahead of print.

ABSTRACT

Research on geographic and socioeconomic disparities of NO₂ attributed mortality burden is limited. This study aims to quantify the geographic and socioeconomic differences in the association between long-term exposure to NO₂ and mortality burden in China. We estimated the all-cause mortality burden of adults over 16 years old attributable to NO₂ exposure above 10 µg/m³ for 231 Chinese cities from 2015 to 2019, and geographic and socioeconomic differences . Attributed fraction (AF), attributed deaths (AD), attributed mortality rate (AMR) and total value of statistical life lost (VSL) were used as the mortality burden measurements. Between 2015 and 2019, we estimated 1356.3 thousand deaths (95% CI: 513.7-2050.7) attributed to NO₂ exposure above 10 µg/m³ per year and VSL of 958.2 billion USD (95% CI: 362.9-1448.8). Cities in the northern region, cities with high levels of GDP per capita (PGDP) and urbanization suffered the highest mortality burden and corresponding economic loss. Consequently, significant geographic and socioeconomic disparities of NO₂ attributed mortality burden exist across cities in China.

PMID:39729307 | DOI:10.1080/09603123.2024.2446522

JAMA Health Forum. 2024 Dec 6;5(12):e244594. doi: 10.1001/jamahealthforum.2024.4594.

ABSTRACT

IMPORTANCE: More than one-quarter of US residents live in states or localities that restrict sales of flavored electronic nicotine delivery systems (ENDS), often as a means to reduce youth vaping. Yet, how these policies affect young adult vaping and smoking remains unclear.

OBJECTIVE: To estimate the effects of ENDS flavor restrictions on ENDS use and cigarette smoking among young adults (age 18-29 years) in the US.

DESIGN, PARTICIPANTS, AND SETTING: This quasi-experimental analysis used annual survey data from the 2016 to 2023 Behavioral Risk Factor Surveillance System (BRFSS), a series of nationally- and state-representative, repeated cross-sectional surveys of noninstitutionalized civilian adults in the US. Two-way fixed-effects specifications were estimated to assess how ENDS flavor restrictions affect young adults’ use of ENDS and cigarettes. Analyses were adjusted for potential confounders including concurrent tobacco control policies, respondent demographic characteristics, and socioeconomic factors. Data analyses were conducted in November 2023 and repeated in October 2024 to incorporate newly released 2023 survey data.

MAIN OUTCOMES AND MEASURES: Current and daily use of ENDS and of cigarettes as measured in the BRFSS.

RESULTS: Balanced panel analyses of 242 154 individuals aged 18 to 29 years consistently found that state ENDS flavor restrictions were associated with statistically significant reductions in daily vaping and increases in daily cigarette smoking. Estimates were similar across robustness checks, with the main specification showing 3.6 (95% CI, -5.0 to -2.1) percentage point (ppt) reductions in daily vaping and 2.2 ppt increases in daily cigarette smoking (95% CI, 1.0 to 3.4) relative to changes in states without restrictions. These estimates are equivalent to an 80% reduction in daily vaping and 22% increase in daily smoking compared with 2018 mean rates.

CONCLUSIONS AND RELEVANCE: The findings of this quasi-experimental analysis of BRFSS survey data indicate that state restrictions on flavored ENDS sales were associated with reduced vaping among young adults but may have unintentionally increased cigarette smoking, potentially offsetting public health gains. These findings suggest that alleviating the burden of tobacco-related disease will require regulatory strategies that balance reducing vaping with preventing increases in more lethal, combustible tobacco use.

PMID:39729302 | DOI:10.1001/jamahealthforum.2024.4594

Anesthesiology. 2024 Dec 27. doi: 10.1097/ALN.0000000000005354. Online ahead of print.

ABSTRACT

BACKGROUND: Postoperative nausea and vomiting (PONV) are common complications after gynecological laparoscopic surgery. Pyridoxine has been recommended as a first-line drug to prevent and treat nausea and vomiting during pregnancy; however, its efficacy in preventing PONV remains unclear.

METHODS: Patients of 18 to 65 years old, who received elective gynecological laparoscopic surgery under general anesthesia, were randomized into either the pyridoxine or control group. The pyridoxine group received 0.2g vitamin B6 before anesthesia induction, and the control group received normal saline intravenously. Both groups received a similar regimen of combined intravenous and inhalation general anesthesia. All patients received dexamethasone(intravenous) after anesthesia induction and ondansetron(intravenous) before surgery completion. PONV occurrence was recorded according to the patients’ self-reported data. Other clinical data were collected from hospital system, and concentrations of blood interleukin-6 and substance P were measured by ELISA.

RESULTS: A total of 442 patients were screened and 240 patients were equally randomized to the pyridoxine or control group. The incidence of PONV was statistically significant lower in the pyridoxine group than in the control group (16.7% [20/120] vs. 35.8% [43/120]; relative risk (RR) = 0.47 [95% CI: 0.29, 0.74]; absolute risk reduction (ARR) = 0.20 [95% CI: 0.08, 0.30]; P = 0.001), and pyridoxine decreased the incidence of postoperative nausea (12.5% [15/120] vs. 35% [42/120]; RR = 0.36 [95% CI: 0.21, 0.61]; ARR = 0.23 [95% CI: 0.12, 0.33]; P < 0.001). There were no statistical differences in postoperative vomiting, time to the first PONV occurrence, pain, serum interleukin-6 and substance P, and white blood cell and neutrophil counts.

CONCLUSION: In this single center randomized trial, pyridoxine plus dexamethasone and ondansetron reduced the incidence of PONV in patients undergoing elective gynecological laparoscopic surgery under general anesthesia. These findings need to be validated in multicenter studies in diverse populations to ensure generalizability.

PMID:39729294 | DOI:10.1097/ALN.0000000000005354

World J Urol. 2024 Dec 27;43(1):50. doi: 10.1007/s00345-024-05415-1.

ABSTRACT

PURPOSE: To evaluate stone free rate (SFR) predictivity of three different scoring systems in patients with kidney stones larger than 20 millimeters undergoing retrograde intrarenal surgery(RİRS).

METHODS: Digital records of a total of 166 patients were reviewed retrospectively. Epidemiological characteristics (age, gender, medical history) of the patients, stone and affected kidney characteristics (size, volume, location, density, opaque, presence of urinary system anomaly, presence of stones in different calyx, number of stones, lower pole stone, renal infundibulopelvic angle (IPA), renal infundibulopelvic length (RIL), hydronephrosis), and operative characteristics (preoperative ureteral stent, operation duration, postoperative residual fragments, hospitalization time and complications were recorded. Each patient was scored separately according to the Resorlu-Unsal Scoring System (RUSS), the modified Seoul National University Renal Stone Complexity (S-ReSC) and R.I.R.S scoring systems based on the stone characteristics seen on CT.

RESULTS: All three methods had statistically acceptable sensitivity and specificity values. Sensitivity for R.I.R.S nomogram is 62.3%, specificity is 77.1% (cut-off: 7.5 points, area under the curve (AUC):0.735, p < 0.001), sensitivity for RUSS nomogram is 60.7%, specificity is 77.9% (cut off: 2.5, AUC = 0.749, p < 0.001), sensitivity for the Modified S-ReSC nomogram was determined as 65.6% and specificity as 71.2% (cut off: 2.5, AUC = 0.743, p < 0.001). The residual stone ratio was found to be higher in the presence of lower pole stone. While the cut-off value for IPA was 44.5°, this value was calculated as 24.5 mm for RIL.

CONCLUSION: Three scoring systems demonstrate accceptable sensitivity and specificity in predicting stone free rate(SFR) with stones ≥ 20 mm. Multivariate analysis highlighted the superiority of the R.I.R.S. scoring system for SFR predictivity. In the presence of lower pole stones, IPA and RIL are important factors in predicting surgical success.

PMID:39729283 | DOI:10.1007/s00345-024-05415-1

J Cancer Res Clin Oncol. 2024 Dec 27;151(1):24. doi: 10.1007/s00432-024-06069-7.

ABSTRACT

PURPOSE: The objective of the current research was to assess the clinicopathological characteristics and long-term prognosis of triple-negative breast cancer (TNBC) patients with human epidermal growth factor receptor 2 (HER2)-low status following breast surgery.

METHODS: A total of 202 TNBC patients treated at Qingdao Central Hospital from January 2010 to December 2019 were included, comprising 71 HER2-low and 131 HER2-zero patients. Propensity score matching (PSM) was applied to minimize differences between the cohorts.

RESULTS: HER2-low TNBC patients had lower histological grade, lower Ki-67 expression levels, and a higher prevalence of hypertension compared to HER2-zero TNBC patients. Before and after PSM, the HER2-low group consistently exhibited a lower recurrence rate and longer RFS compared to HER2-zero TNBC patients. HER2-low status was validated as an independent low-risk factor for RFS both pre-PSM (HR 0.354, 95% CI 0.178-0.706, p = 0.003) and post-PSM (HR 0.405, 95% CI 0.185-0.886, p = 0.024). No statistically significant differences in mortality rate and OS were observed, both before and after PSM.

CONCLUSIONS: HER2-low and HER2-zero TNBC patients show significant clinicopathological differences. Compared to HER2-zero, HER2-low status is linked to better long-term prognosis and serves as an independent low-risk factor for RFS in TNBC patients.

PMID:39729247 | DOI:10.1007/s00432-024-06069-7

J Cancer Res Clin Oncol. 2024 Dec 27;151(1):25. doi: 10.1007/s00432-024-06035-3.

ABSTRACT

PURPOSE: The rarity of breast mucinous carcinoma (BMC) makes it challenging to study the prognosis of this disease across diverse racial populations. This study aimed to leverage epidemiological data on immigrant populations to elucidate the prognostic differences in BMC patients from various racial/ethnic backgrounds. The goal was to help formulate more personalized clinical practice guidelines for the management of this rare malignancy.

METHODS: The study included 208 BMC patients from China and 10,322 BMC patients from the SEER database. Clinicopathological data, treatment information, and survival outcomes were compared across different racial/ethnic groups using statistical analyses.

RESULTS: Asian American BMC patients were younger at diagnosis and had more favorable tumor grade and stage compared to other racial groups. After adjusting for clinicopathological factors and treatments, Asian American BMC patients exhibited significantly better overall survival (OS) than black (HR = 1.53, 95% CI: 1.05-2.22, P = 0.027) and white patients (HR = 1.41, 95% CI: 1.03-1.94, P < 0.001). Specifically, non-Chinese American patients had a worse OS compared to Chinese patients (adjusted HR = 2.59, 95% CI: 1.15-5.83, P = 0.022). Chemotherapy significantly improved OS only in black BMC patients (adjusted HR = 0.52, 95% CI: 0.27-0.98, p = 0.045), but not in other racial/ethnic groups.

CONCLUSION: Race is an independent prognostic factor for BMC. Compared with Chinese patients, black and white American patients have a worse prognosis in terms of OS. Treatment guidelines for BMC patients should be formulated with considerations of race factors. For patients with BMC originating from China, a more conservative treatment approach may be warranted.

PMID:39729234 | DOI:10.1007/s00432-024-06035-3

J Craniofac Surg. 2024 Dec 27. doi: 10.1097/SCS.0000000000010998. Online ahead of print.

ABSTRACT

BACKGROUND: The stent-assisted coiling (SAC) and flow-diverter stent (FDS) techniques are widely used in the endovascular treatment of paraclinoid aneurysms. This article compares the occlusion rate, periprocedural complications, and clinical outcomes of SAC and FDSs.

METHODS: Between January 2010 and December 2020, a systematic search of electronic databases identified 2283 articles for screening. After the application of inclusion and exclusion criteria, data were extracted for a meta-analysis of the proportions.

RESULTS: Of 23 articles containing 4 comparative studies, 27 cohorts were included, and 1208 patients with 1328 aneurysms were analyzed: In 10 cohorts, 381 (28.7%) patients were treated with SAC, whereas in 17 cohorts, 947 (71.3%) patients were treated with FDSs. In the comparative studies, no significance was observed between the 2 treatments. In the pooled cohorts, complete occlusion was achieved in 85% of aneurysms after treatment with FDSs (95% CI: 0.81-0.88, I2=34.7%) and 76% after treatment with SAC (95% CI: 0.70-0.81, I2=16.6%); the subgroup analysis was statistically significant (P=0.003). New visual complications were observed in 5% of the FDS-treated group (95% CI: 0.02-0.09, I2=76.9%) and in 1% of the SAC-treated group (95% CI: 0.00-0.02, I2=0%); the subgroup analysis was statistically significant (P=0.018). Other observational indices, including total procedure-related complications; hemorrhagic, thrombotic, and ischemic complications; permanent morbidities, and favorable neurological outcomes, showed no statistical significance between the groups.

CONCLUSION: Compared with SAC, treatment with FDSs may have a higher complete occlusion rate at follow-up. The similarly low rates for procedure-related complications and permanent morbidities indicate that both treatments are safe. A higher rate of new visual complications was noted in the FDS-treated group. Further research is required for direct comparisons along with a complete ophthalmological examination.

PMID:39729232 | DOI:10.1097/SCS.0000000000010998

J Craniofac Surg. 2024 Dec 27. doi: 10.1097/SCS.0000000000011037. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to evaluate the osseointegration properties of titanium bone implants coated with carob-mediated calcium hydroxide nanoparticles biomechanically, radiographically, and histologically on rabbit tibias.

MATERIAL AND METHODS: Forty coated and forty uncoated titanium alloy bone implants were inserted into 20 New Zealand rabbits; each tibia received 2 implants. The rabbits were sacrificed after 4 or 8 weeks, and samples were retrieved for biomechanical evaluation through removal torque test to assess the bond between implant and bone, radiographic evaluation through microcomputed tomography analysis to compare the bone-to-implant contact percentage and bone volume of the peri-implant area, scanning electron microscopic and histologic evaluation through hematoxylin and eosin stain. Statistical analyses between pairs of means were conducted using the independent t test. Multiple comparisons between the study groups across time intervals were performed using a 2-way analysis of variance. P-values ≤0.05 were considered statistically significant.

RESULTS: Higher removal torque values (P<0.01) were needed to remove the coated implants when biomechanically tested. In addition, the microcomputed tomography evaluation revealed a higher bone-to-implant contact percentage (P<0.05) in favor of coated implants. In addition, the 4-week healing interval of the coated implants showed no significant difference when compared with the 8-week healing interval of the uncoated implants biomechanically and radiographically, suggesting early osseointegration.

CONCLUSIONS: The findings of this study imply that coating titanium implants with carob-mediated calcium hydroxide nanoparticles improved and fastened osseointegration and bone ingrowth, resulting in early osteogenesis and shortening the treatment time.

PMID:39729227 | DOI:10.1097/SCS.0000000000011037

J Ultrasound. 2024 Dec 27. doi: 10.1007/s40477-024-00980-y. Online ahead of print.

ABSTRACT

OBJECTIVES: Despite advancements in modern medicine, the effectiveness of in vitro fertilization (IVF) remains low. This study aimed to assess the impact of specific features of T-shaped uterine cavity malformation and its intermediate forms on reproductive function and the effectiveness of assisted reproductive technology (ART), particularly on IVF results and pregnancy outcomes.

METHODS: A prospective cohort study included 388 somatically healthy patients undergoing 3D ultrasound (US) examination of the uterine cavity before embryonic transfer for IVF treatment. Patients were evaluated for morphometric parameters using standardized US protocols. Statistical analysis was performed using SPSS statistics.

RESULTS: The study revealed that patients with T-shaped uterus and intermediate forms had higher rates of miscarriages, and unfavorable pregnancy outcomes compared to those with normal uterine cavities. The frequency of pregnancy occurrence in T-shaped and Intermediate groups was statistically similar with the “Normal uterus” group. Morphometric parameters such as T-angle, lateral angle, and myometrial thickness significantly influenced IVF outcomes.

CONCLUSION: The study highlights the importance of morphometric parameters in predicting IVF success and pregnancy outcomes in patients with T-shaped uterine cavity malformation. These parameters can guide clinical decision-making and may serve as predictors for reproductive outcomes in ART procedures. Further research is warranted to validate these findings and explore additional ultrasound markers for better prediction of reproductive outcomes in patients with uterine cavity malformations.

PMID:39729217 | DOI:10.1007/s40477-024-00980-y