J Geriatr Oncol. 2024 Oct 23:102131. doi: 10.1016/j.jgo.2024.102131. Online ahead of print.
NO ABSTRACT
PMID:39448360 | DOI:10.1016/j.jgo.2024.102131
Eur Urol Oncol. 2024 Oct 23:S2588-9311(24)00223-2. doi: 10.1016/j.euo.2024.09.014. Online ahead of print.
ABSTRACT
BACKGROUND: Avelumab first-line maintenance treatment was approved for patients with advanced urothelial carcinoma (aUC) without progression following platinum-based chemotherapy (PBC), based on the results from the JAVELIN Bladder 100 phase 3 trial.
OBJECTIVE: To report the results from AVENANCE, a real-world study of avelumab first-line maintenance treatment.
DESIGN, SETTING, AND PARTICIPANTS: This is a retrospective and prospective, noninterventional study (NCT04822350). Eligible patients with aUC without progression on first-line PBC were enrolled at 82 centers in France between July 2021 and May 2022. The effectiveness population included 595 patients. The median follow-up was 26.3 mo.
INTERVENTION: Previous, ongoing, or planned avelumab first-line maintenance treatment.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Overall survival (OS) from avelumab initiation (primary endpoint) and safety were evaluated.
RESULTS AND LIMITATIONS: The median age was 73.0 yr, and performance status was 0/1 in 91% of patients and ≥2 in 9.3%. The most common prior first-line chemotherapy regimen was carboplatin plus gemcitabine (61%). At data cutoff (December 7, 2023), the median duration of avelumab treatment was 5.6 mo, 125 patients remained on avelumab, and 55% had received second-line treatment. The median OS from avelumab initiation was 21.3 mo (95% confidence interval [CI], 17.6-24.6), and the median progression-free survival was 5.7 mo (95% CI, 5.2-6.5). In exploratory analyses of this population without disease progression on PBC, the median OS from the start of first-line PBC was 26.5 mo overall, and in subgroups that received second-line enfortumab vedotin (n = 55) or PBC (n = 79), it was 41.5 and 24.5 mo, respectively.
CONCLUSIONS: Real-world data from AVENANCE confirm the effectiveness and safety of avelumab first-line maintenance treatment in a heterogeneous population, supporting its recommendation for cisplatin-eligible and cisplatin-ineligible patients with aUC who are progression free after first-line PBC. In an exploratory analysis, a small subgroup that received a treatment sequence of first-line PBC without disease progression followed by avelumab first-line maintenance and second-line enfortumab vedotin had a median OS of >3 yr.
PATIENT SUMMARY: A French real-world study, called AVENANCE, looked at avelumab maintenance treatment in people with advanced urothelial cancer whose tumor disappeared, shrank, or stopped growing with chemotherapy. Overall, results were consistent with those seen in a previous clinical trial, and on average, people treated with avelumab maintenance lived for 26.5 mo from the start of chemotherapy. Analyses of different groups of people found that survival varied, with people living for an average of 18-42 mo depending on what treatment they received after they finished avelumab treatment.
PMID:39448350 | DOI:10.1016/j.euo.2024.09.014
Ann Chir Plast Esthet. 2024 Oct 23:S0294-1260(24)00162-6. doi: 10.1016/j.anplas.2024.09.002. Online ahead of print.
ABSTRACT
INTRODUCTION: The success of surgeries involving free flaps largely depends on accurate preoperative mapping of perforator arteries. Various imaging techniques, such as Doppler ultrasound and CT angiography, are typically used, each having its advantages and disadvantages in terms of cost, accuracy, and patient risk. The main objective of our study is to compare the effectiveness of the FLIR One device for detecting these arteries compared with traditional methods. Thermal imaging appears to be a simpler, less expensive, and less invasive alternative for surgical planning.
MATERIAL AND METHOD: The study, conducted at the Regional Hospital Center of Nancy, included 25 free flaps (DIEP) on an exclusively female cohort of 22 patients, with follow-up from 2022 to 2023. Before the procedure, an abdominal-pelvic CT angiography was performed, followed by additional evaluation with thermal imaging using FLIR One and acoustic Doppler examination on the eve of the operation. This approach aimed to provide precise mapping of vascular perforators for each patient. Three different operators performed these markings, and the results were then compared with intraoperative observations. The imaging protocol also included a Doppler examination to validate the results of the thermal imaging. Statistical analyses with intraclass correlation coefficients (ICC) were performed to evaluate the correlation between different preoperative localization methods of perforating vessels.
RESULTS: In 22 patients undergoing 25 DIEP flaps for breast reconstructions, three imaging techniques were used to identify vascular perforators: thermal imaging with FLIR, acoustic Doppler, and CT angiography. FLIR identified the most perforators (n=137), followed by acoustic Doppler (n=128) and CT angiography (n=126). Comparing these with intraoperative results, 66% of perforators identified by FLIR were confirmed, 70% for acoustic Doppler, and 95% for CT angiography. The ICCs shows a significant correlation between these imaging techniques and intraoperative results. FLIR demonstrated a strong correlation with intraoperative observations (ICC of 0.74, P<0.001), followed by a moderate correlation with acoustic Doppler (ICC of 0.56, P<0.03) and CT angiography (ICC of 0.52, P<0.006).
CONCLUSION: The study concludes that thermal imaging with FLIR is a reliable and effective tool for locating vascular perforators. Although the study and FLIR have their own limitations, the tool presents several advantages such as ease of use, speed, and affordability. These characteristics make FLIR particularly attractive as a complement to traditional detection methods, such as acoustic Doppler and CT angiography.
PMID:39448346 | DOI:10.1016/j.anplas.2024.09.002
Ann Chir Plast Esthet. 2024 Oct 23:S0294-1260(24)00172-9. doi: 10.1016/j.anplas.2024.09.008. Online ahead of print.
ABSTRACT
Autologous breast reconstruction, especially using the deep inferior epigastric artery perforator (DIEP) flap, is increasingly seen as a reliable, safe, and long-term alternative to implant-based reconstruction. Despite the recognized advantages of the DIEP flap for breast reconstruction, successful realization demands excellent anatomical knowledge, a thorough understanding of autologous breast reconstruction concepts and advanced microsurgical skills. Given that the porcine model is widely employed in microsurgical training, our study aims to assess this model using validated outcomes, with the objective of evaluating the enhancement in a surgeon’s learning curve following training with this model. Forty DIEP flaps were harvested on 20 swines by a single surgeon in “Pius Branzeu Center” (Timisoara, RO) and “Drazan Institute” (University of veterinary of Brno, CZ) laboratories for microsurgical training in 6months (January 2015-June 2015). Then we analyzed data from 40 DIEP flaps harvested by the same surgeon on first 20 consecutive patients undergoing DIEP flap breast reconstruction. Perforator dissection time, surgeon-determined dissection difficulty score (DDS) and venous congestion rate were collected for each flap in porcine model and in patients, then compared and analyzed. The mean of DDS score analysis in first and second swines group dissection resulted as statistically significant (P-value 0.0001), while it was not statistically significant between those analyzed in the second group of swines dissected and patients (P-value 0.8037). Reduction in perforator dissection time between the two swines’ groups and in venous congestion rates from the first swines groups to the second to the human group resulted statistically significant too (P-value respectively 0.0001 and 0.0079). The porcine model has been used for a long time together with other animal models for microsurgical training. Our study confirms and objective by validated scores that it is a valid and reliable model, comparable to the human one and which mimics the dissection of human perforating vessels.
PMID:39448343 | DOI:10.1016/j.anplas.2024.09.008
Nutr Metab Cardiovasc Dis. 2024 Sep 19:S0939-4753(24)00352-1. doi: 10.1016/j.numecd.2024.09.003. Online ahead of print.
ABSTRACT
BACKGROUND AND AIMS: Hypertension depends on renin-angiotensin system dysfunction; however, little is known about its implications in the outcomes of neurogenic hypertension induced by peri-pubertal insults. This study aimed to evaluate whether hypertension induced by a peri-pubertal low-protein diet is related to renin-angiotensin system dysfunction in adult male Wistar rats.
METHODS AND RESULTS: Thirty-day-old male Wistar rats were fed a low-protein diet (4 % casein) for 30 days and subsequently fed a 20.5 % normal protein diet for a 60-day dietary recovery (LP group). Control animals (NP group) were fed a 20.5 % protein diet throughout their lives. Cardiovascular and renin-angiotensin system functions were evaluated on postnatal day 120 (6-24 animals per group). Statistical analyses were performed using the Student’s t-test. Animals with LP show increased arterial blood pressure. The angiotensin 2 dose-response curve of LP animals showed an increase in the pressor response at a lower dose (50 ng/kg) and a reduction in the pressor response at a higher dose (400 ng/kg) compared with NP animals. Angiotensin 2 type 1 receptor mRNA levels were increased in the hearts of LP animals; however, angiotensin 2 type 2 receptor and MAS receptor mRNA levels were reduced. In the aorta, AT1 and AT2 mRNA levels were increased in LP animals, whereas MAS receptor mRNA levels were decreased in comparison to NP animals.
CONCLUSION: The renin-angiotensin system is disrupted in hypertension induced by protein restriction exposure during peri-pubertal life.
PMID:39448316 | DOI:10.1016/j.numecd.2024.09.003
Urol Oncol. 2024 Oct 23:S1078-1439(24)00688-4. doi: 10.1016/j.urolonc.2024.10.007. Online ahead of print.
ABSTRACT
BACKGROUND: Numerous studies indicate that the gut microbiome is closely associated with prostate cancer (PCa), however, owing to various confounding factors, the causal relationship between gut microbiota and PCa remains unclear.
METHODS: A 2-sample Mendelian randomization (MR) analysis utilized genome-wide association study (GWAS) data on the gut microbiota of 18,340 participants and GWAS summary statistics on PCa involving 46,3010 participants. Inverse variance weighted (IVW) served as the primary method, complemented by the MR-Egger method, weighted median method (WME), simple mode method (SM), and weighted mode method (WM). Finally, to confirm the robustness of the results, heterogeneity test, pleiotropy test, and leave-one-out sensitivity test were conducted.
RESULTS: IVW analysis revealed that 12 specific gut microbial taxa were potentially causally associated with PCa; the genera Victivallis, Akkermansia, Odoribacter, Butyrivibrio, and the families Enterobacteriaceae, Verrucomicrobiaceae, as well as the orders Verrucomicrobiales, Enterobacteriales and the class Verrucomicrobiae, were found to be positively associated with PCa risk. Conversely, the genera Eubacterium ruminantium group, Candidatus Soleaferrea, and RuminococcaceaeUCG003 were negatively associated with PCa risk.
CONCLUSIONS: Our MR study’s results support a genetically predicted causal relationship between the gut microbiota and PCa, and we identified 12 specific gut microbial taxa. These findings could offer new targets for PCa screening and treatment.
PMID:39448300 | DOI:10.1016/j.urolonc.2024.10.007
Oral Surg Oral Med Oral Pathol Oral Radiol. 2024 Aug 5:S2212-4403(24)00403-6. doi: 10.1016/j.oooo.2024.07.013. Online ahead of print.
ABSTRACT
PURPOSE: The aim of this study was to investigate the characteristics of illicit cocaine and opioid drug-related facial trauma and determine whether the presence of cocaine or opioid drug use in facial trauma patients influenced the cause of injury, morbidity, or management.
METHODS: A retrospective observational cohort study was performed using records from a state-wide database of all patients who presented to a Victorian hospital with a facial fracture between 2004 and 2014. Data collected included demographics, concomitant opioid and cocaine use, mechanism of injury, facial injuries, and management. Statistical analysis was done using chi-square test, Student’s t tests, binary logistic regression analysis, and multivariable linear regression analysis. Results were considered statistically significant if P < .05.
RESULTS: A total of 54,613 patient presentations for facial trauma were analyzed with 363 patients in the cocaine and opioid-related group, and 54,250 patients in the nondrug-related group. Patients with illicit drug use were more likely to have facial fractures caused by interpersonal violence when compared with nondrug users (47.9% vs 23.5%, OR = 2.23, P < .001). Opioid and cocaine users had 0.3 more total fractures per presentation, which included more midface and skull fractures, and more facial lacerations (P < .001). There was no statistically significant difference in the need for surgical management between the two groups. Opioid and cocaine affected patients also on average had a longer hospital stay of 3.4 days and required 0.9 more allied health inputs during their admission when compared with nondrug users (P < .05). This effect was similarly reflected when controlling for confounding variables (P < .001).
CONCLUSIONS: Concomitant cocaine or opioid use in facial trauma patients leads to more violence-related injuries with higher morbidity and healthcare costs.
PMID:39448294 | DOI:10.1016/j.oooo.2024.07.013
Int J Oral Maxillofac Surg. 2024 Oct 23:S0901-5027(24)00405-3. doi: 10.1016/j.ijom.2024.10.008. Online ahead of print.
ABSTRACT
This retrospective study examined factors influencing labial bone resorption in the anterior maxilla 6 months after implant insertion with simultaneous guided bone regeneration. Involving 79 patients (118 implants), the study measured labial horizontal bone width and vertical dimensions using cone beam computed tomography scans taken immediately after surgery and at 6 months. A generalized linear mixed model analyzed potential influencing factors: age, sex, implant site, timing of placement, buccal bone width at the implant platform level post-surgery, implant connection, and bone defect morphology. Significant bone resorption was noted at 6 months. The statistical analysis revealed that buccal bone width at the implant platform, implant connection, and bone defect morphology significantly impacted labial bone resorption, while patient age, sex, timing of placement, and implant site did not. Implants with a buccal bone width ≥2 mm showed significantly less labial horizontal and vertical bone resorption (horizontal P < 0.001, vertical P = 0.001), and healing abutments reduced resorption compared to cover screws (horizontal P = 0.002, vertical P = 0.034). More significant vertical resorption occurred in non-contained bone defects after guided bone regeneration (P = 0.040).
PMID:39448289 | DOI:10.1016/j.ijom.2024.10.008
J Voice. 2024 Oct 23:S0892-1997(24)00305-9. doi: 10.1016/j.jvoice.2024.09.014. Online ahead of print.
ABSTRACT
OBJECTIVES: This study aims to evaluate Turkish patient-reported outcome measures (PROM) used in voice disorders using different readability formulas and to examine the relationship between text-based features and readability values.
STUDY DESIGN: A search was conducted to identify published Turkish PRO questionnaires related to dysphonia that are completed by patients.
METHODS: A search was conducted to identify published PROM related to dysphonia that are completed by patients in a self-administered format. Reading grade levels were analyzed for voice-related PROM using the Ateşman readability and the Bezirci-Yılmaz new readability formulas as computed by a readability calculations software package. Text-based quantitative features are obtained. Descriptive statistics were also computed across the questionnaires.
RESULTS: A total of 14 PROMs were found. In the analysis, the mean of the Ateşman readability values of the PROM was calculated as 70.66 (±5.55). This value is defined as “easy,” according to the Ateşman readability measures. The average Bezirci-Yılmaz new readability value is 6.03 (±1.07). This value corresponds to the sixth-grade reading level in the Turkish education system.
CONCLUSIONS: Results show that more than half of the PROMs in the Turkish language have the recommended reading level. PROMs allow health care professionals to objectively understand the patient’s symptoms, both qualitatively and quantitatively. Therefore, it is critical that patients accurately understand and respond to these outcome measures. This is why developers should consider reading as a testable structure. Speech and language therapists should consider the reading level required to understand a specific PROM to obtain the most useful information for treatment planning and outcome assessments.
PMID:39448277 | DOI:10.1016/j.jvoice.2024.09.014
Conscious Cogn. 2024 Oct 23;125:103768. doi: 10.1016/j.concog.2024.103768. Online ahead of print.
ABSTRACT
Does the likelihood of us experiencing inattentional blindness depend on whether the scenes are statistically regular (e.g., probable) or not? Previous studies have shown that observers find it harder to perceive real-world statistical irregularities, such as improbable (statistically irregular) scenes (e.g., scenes unlikely to take place in the real world) as opposed to probable (statistically regular) scenes. Moreover, high inattentional blindness rates have been observed for improbable stimuli (e.g., a gorilla on a college campus). However, no one has directly compared noticing rates for probable and improbable scenes. Here we ask if people are more likely to experience inattentional blindness for improbable than probable scenes. In two large-scale experiments in which one group of participants is presented, on the critical trial, with a probable scene and the other group with an improbable scene, we observed higher rates of inattention blindness for participants receiving improbable scenes than those receiving probable scenes.
PMID:39447236 | DOI:10.1016/j.concog.2024.103768