Nevin Manimala

J Minim Access Surg. 2023 Jul 5. doi: 10.4103/jmas.jmas_168_22. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective is to investigate if laparoscopic-dominant abdominoperineal resection (LDAPR) with individualised levator ani resection inhibits local recurrence (LR) and prolongs survival as compared to laparoscopic abdominoperineal resection (APR).

MATERIALS AND METHODS: Rectal cancer surgery cases were retrospectively identified from September 2014 to December 2019. LDAPR-treated group (55 patients) and the APR-treated group (71 patients) were included in the study. The operation time, circumferential resection margin (CRM), intraoperative tumor surgery (ITP), post-operative complications, the 2-year overall survival (OS) and LR were compared in the two groups.

RESULTS: The CRM and ITP were significantly reduced in the LDAPR as compared to the APR group (3.6% vs. 16.9%, t = 5.522, P = 0.019; 3.6% vs. 14.1%, t = 3.926, P = 0.048). In terms of post-operative complications, the incidence of urinary retention in LDAPR was significantly reduced than the APR group (10.9% vs. 25.4%, χ² = 4.139, P = 0.041). Similarly, perineal pain at 6 months or 1 year after surgery was significantly down-regulated in LDAPR than in the APR group (72.7% vs. 88.7%, χ² = 5.320, P = 0.021; 18.2% vs. 43.2%, χ² = 8.288, P = 0.004). However, there was no statistically significant difference in the post-operative complications between the LDAPR and APR groups. Finally, LDAPR led to a significantly improved 2-year OS and a reduced LR compared to APR.

CONCLUSION: LDAPR reduces CMR, ITP and LR and simplified the perineum operation, subsequently protecting the pelvic autonomic nerves. Compared to the conventional APR, LDAPR is a promising procedure worth adopting for rectal cancer treatment.

PMID:37706404 | DOI:10.4103/jmas.jmas_168_22

Ann Card Anaesth. 2023 Apr-Jun;26(2):183-189. doi: 10.4103/aca.aca_68_22.

ABSTRACT

BACKGROUND: Aortic stenosis (AS) grading discrepancies exist between pre-cardiopulmonary (pre-CPB) transesophageal echocardiography (TEE) and preoperative transthoracic echocardiography (TTE). Prior studies have not systematically controlled blood pressure.

AIMS: We hypothesized that normalizing arterial blood pressure during pre-CPB TEE for patients undergoing valve replacement for AS would result in equivalent grading measurements when compared to TTE.

SETTING: Single University Hospital.

DESIGN: Prospective, Interventional.

METHODS: Thirty-five adult patients underwent procedures for valvular AS between February 2017 and December 2020 at Medical University of South Carolina. Study participants had a TTE within 90 days of their procedure that documented blood pressure, peak velocity (V_p), mean gradient (PG_m), aortic valve area (AVA), and dimensionless index (DI). During pre-CPB TEE, if a patient’s mean arterial pressure (MAP) fell more than 20% below their baseline blood pressure obtained during TTE, measurements were recorded as “out of range.” Phenylephrine was administered to restore MAP to the baseline range and repeat TEE measurements were recorded as “in-range.”

STATISTICAL ANALYSIS: Differences between imaging modalities and grading parameters were examined using a series of linear mixed models. P values were Bonferroni-adjusted to account for multiple comparisons.

MAIN RESULTS: Significant discrepancies between TEE and TTE were observed for V_p, PG_m, and DI despite blood pressure normalization across all subjects and for out-of-range measures and corrected measures. There were no statistically significant differences between TEE and TTE for AVA.

CONCLUSIONS: Blood pressure normalization during pre-CPB TEE is not sufficient to avoid AS grading discrepancies with preoperative TTE.

PMID:37706384 | DOI:10.4103/aca.aca_68_22

Indian J Med Res. 2023 Sep 14. doi: 10.4103/ijmr.ijmr_3629_21. Online ahead of print.

ABSTRACT

BACKGROUND & OBJECTIVES: Cerebral contusion (CC) results in a release of catecholamines, autonomic dysfunction and neural stimulation that can lead to a number of cardiac adverse events, so it is critical to determine these. So the objective of this study was to investigate the prognostic significance of electrocardiographic changes, particularly the effects of a prolonged corrected QT (QTc) interval in CC.

METHODS: In this retrospective cohort study, 110 patients with CC were evaluated. Age, sex, concomitant diseases, Glasgow Coma Scale on admission, radiological assessment of the contusion (location, size, course and presence of cerebral oedema), need for surgical intervention, length of hospital stay and the extended Glasgow Outcome Scale (GOS-E) were statistically analysed within the QTc interval by routine electrocardiography (ECG) on admission.

RESULTS: The prolonged QTc interval was found to be associated with a higher incidence of cerebral oedema and a significantly higher risk of needing surgery. Patients with a prolonged QTc interval had a significantly larger contusion volume, greater midline shift and longer hospital stay, so their GOS-E score was significantly lower. A prolonged QTc interval on admission resulted in a hospital stay of more than eight days (sensitivity: 0.97 and specificity: 0.86), a higher risk of midline shift of more than 0.45 cm (P=0.006, sensitivity: 0.80 and specificity: 0.99) and a GOS-E score of <7 (sensitivity: 0.97 and specificity: 0.85).

INTERPRETATION & CONCLUSIONS: ECG changes on admission showing a prolonged QTc interval have prognostic significance in CC. This simple and easily applicable information should be taken into consideration at the time of clinical decision making which may prevent an adverse events survivor.

PMID:37706372 | DOI:10.4103/ijmr.ijmr_3629_21

J Clin Nurs. 2023 Sep 14. doi: 10.1111/jocn.16872. Online ahead of print.

ABSTRACT

AIM: To examine the multidimensional properties of caregiver burden among family caregivers of patients with advanced cancer in a palliative context.

DESIGN: A sequential, explanatory, mixed-method study was performed.

METHODS: Family caregivers of patients diagnosed with advanced cancer were recruited from a palliative care department of a third-level hospital in Sichuan Province, China. The Caregiver Burden Inventory, Social Support Rating Scale and Connor-Davidson Resilience Scale were used to collect quantitative data, and a total of 150 caregivers were recruited from January 2022 to September 2022. Qualitative data were collected through semi-structured interviews, and a total of 22 caregivers were interviewed from October 2022 to November 2022. Survey data were analysed using descriptive statistics, and the factors of caregiver burden were identified using the Mann-Whitney U test, Kruskal-Wallis H test and Spearman correlations. Interpretative phenomenological analysis was performed to analyse the interview data to initially explore the multidimensions of caregiver burden. The following-a-thread method and convergence coding matrix were used for triangulation to examine the multidimensional properties of caregiver burden.

RESULTS: The participants experienced a moderate level of caregiver burden (32.97 ± 13.09). Through triangulation, six meta-themes and nine meta-subthemes were identified as multidimensional properties of caregiver burden, including physical (too many caring tasks and poor health condition), emotional (strong negative emotions resulting from patients’ suffering and insufficient and ineffective family communication), social (less social interaction and social role conflict) and economic burdens, factors that aggravate burden (prevention and control of COVID-19 and spousal relationship with patients) and factors that mitigate burden (social support).

CONCLUSION: Multiple dimensions of caregiver burden were experienced by family caregivers of patients with advanced cancer in the palliative context. Family-centred palliative care must be further developed.

IMPLICATIONS FOR THE PROFESSION: It is important to develop family-centred palliative care. Therefore, the focus must be on developing a rational understanding of palliative care in public and a culture-oriented death education in palliative units.

IMPACT: This study adopted a mixed-method approach to comprehensively understand the phenomenon of and factors in caregiver burden in the Chinese palliative oncology context. Our findings suggest that family caregivers in palliative oncology experience a moderate level of caregiver burden, with dimensions including physical, emotional, social and economic burdens, among which emotional burden is the most prominent. The findings of this study provide policy makers and nurse practitioners with targets to be addressed in family-centred care in Chinese palliative units.

REPORTING METHOD: The results of this study are reported based on the guidelines of the Mixed-Methods Article Reporting Standards.

PATIENT OR PUBLIC CONTRIBUTION: Eligible caregivers were invited to participate in the study and semi-structured interviews. Nurse managers of the palliative unit helped us access the patient-management system.

PMID:37706353 | DOI:10.1111/jocn.16872

Aesthet Surg J. 2023 Sep 14:sjad303. doi: 10.1093/asj/sjad303. Online ahead of print.

ABSTRACT

BACKGROUND: Textured implants and expanders are associated with an increased risk of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). As a result, plastic surgeons are utilizing smooth expanders, but many perceive these produce undesirable outcomes including infection, seroma, and lateral displacement.

OBJECTIVES: To compare clinical outcomes of smooth and textured expanders.

METHODS: We retrospectively reviewed breast reconstruction patients from January 2018 to May 2021. Included patients underwent placement of tissue expanders at the time of mastectomy. Primary outcomes included postoperative seroma, infection, malposition, days to final reconstruction, explantation, and need for capsulorrhaphy.

RESULTS: 233 patients were reviewed, and 167 patients met both inclusion and exclusion criteria. There was no statistically significant difference in poor outcomes comparing smooth and textured expanders. Days to final reconstruction was lower with smooth expanders per breast (p = 0.0424). The subpectoral group was associated with an increased likelihood of undergoing capsulorrhaphy (p = 0.004). Prepectoral placement was associated with more seromas (p = 0.0176) and infections (p = 0.0245). Demographic factors included older age as a protective factor for undergoing capsulorrhaphy (OR = 0.962, p = 0.038), obesity increased the risk of infection (OR = 5.683, p = 0.0279) and malposition (OR = 6.208, p = 0.0222) and radiation was associated with malposition (OR = 3.408, p = 0.0246).

CONCLUSIONS: There was no significant difference in poor outcomes comparing smooth and textured expanders. Patient demographics and anatomical plane placement had greater effects on infection, seroma and need for capsulorrhaphy compared to tissue expander texturing.

PMID:37706322 | DOI:10.1093/asj/sjad303

Twin Res Hum Genet. 2023 Sep 14:1-3. doi: 10.1017/thg.2023.37. Online ahead of print.

ABSTRACT

A simple model by which Hardy-Weinberg proportions are attained in a single generation while maintaining gene frequencies is stated and illustrated. The title ‘Quasi-random mating’ is proposed. Confusion about the Hardy-Weinberg principle can be avoided only if there is clear separation between the basic deterministic model and factors influencing a population’s structure. Eighty years passed before C. C. Li coined the term ‘pseudo-random mating’. The lesson taught by Li has not been taken on board.

PMID:37706311 | DOI:10.1017/thg.2023.37

Assessment. 2023 Sep 14:10731911231194996. doi: 10.1177/10731911231194996. Online ahead of print.

ABSTRACT

Researchers and clinicians working within the Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition, Text Rev (DSM-5-TR) framework face a difficult question: what does it mean to have an evidence-based assessment of a nonevidence-based diagnostic construct? Alternative nosological approaches conceptualize psychopathology as (a) hierarchical, allowing researchers to move between levels of description and (b) dimensional, eliminating artificial dichotomies between disorders and the dichotomy between mental illness and mental well-being. In this article, we provide an overview of ongoing efforts to develop validated measures of transdiagnostic nosologies (i.e., the Hierarchical Taxonomy of Psychopathology; HiTOP) with applications for measurement-based care. However, descriptive models like HiTOP, which summarize patterns of covariation among psychopathology symptoms, do not address dynamic processes underlying the problems associated with psychopathology. Ambulatory assessment, well-suited to examine such dynamic processes, has also developed rapidly in recent decades. Thus, the goal of the current article is twofold. First, we provide a brief overview of developments in constructing valid measures of the HiTOP model as well as developments in ambulatory assessment practices. Second, we outline how these parallel developments can be integrated to advance measurement-based treatment. We end with a discussion of some major challenges for future research to address to integrate advances more fully in transdiagnostic and ambulatory assessment practices.

PMID:37706296 | DOI:10.1177/10731911231194996

Aesthet Surg J. 2023 Sep 14:sjad297. doi: 10.1093/asj/sjad297. Online ahead of print.

ABSTRACT

BACKGROUND: As the prevalence of obesity increases, the number of patients seeing body contouring procedures after bariatric surgery for massive weight loss (MWL) is increasing. While the positive impact of bariatric surgery on physical and emotional health is well-described, few studies have investigated psychosocial well-being of patients undergoing body contouring procedures. Psychosocial well-being can impact patient satisfaction and maintenance of weight loss, and is an important area to study.

OBJECTIVE: The aim of this study was to characterize social and psychiatric factors of patients undergoing body contouring surgery, and to evaluate their impact on maintenance of weight loss.

METHODS: A retrospective review was performed of patients who presented to a single institution for body contouring procedures between 2002 and 2018. Demographic details, medical history, psychosocial support, and operative details were collected. Univariate analysis and multinomial logistic regressions were performed using R statistical software (Version 1.3.1093).

RESULTS: A total of 1,187 patients underwent at least one body contouring procedure during the study timeframe. Mean BMI at presentation was 31.21 ± 10.49 kg/m2. Patients diagnosed with obesity at age 18 or older had a significantly greater odds of suffering from Generalized Anxiety Disorder (OR: 1.08, 95% CI: [1.02, 1.15], p= 0.008). Patients with spousal support had 1.93 times higher odds of having maintained post-bariatric weight loss at their 6-month follow up (OR: 1.93, 95% CI: [1.84, 2.01], p= 0.028).

CONCLUSIONS: Social support and age of obesity diagnosis impact psychological well-being and maintenance of weight loss following body contouring procedures.

PMID:37706281 | DOI:10.1093/asj/sjad297

J Magn Reson Imaging. 2023 Sep 14. doi: 10.1002/jmri.29013. Online ahead of print.

ABSTRACT

BACKGROUND: Carotid webs (CaWs) are fibromuscular projections in the internal carotid artery (ICA) that cause mild luminal narrowing (<50%), but may be causative in up to one-third of seemingly cryptogenic strokes. Understanding hemodynamic alterations caused by CaWs is imperative to assessing stroke risk. Time-Average Wall Shear Stress (TAWSS) and Oscillatory Shear Index (OSI) are hemodynamic parameters linked to vascular dysfunction and thrombosis.

PURPOSE: To test the hypothesis: “CaWs are associated with lower TAWSS and higher OSI than mild atherosclerosis or healthy carotid bifurcation.”

STUDY TYPE: Prospective study.

POPULATION: A total of 35 subjects (N = 14 bifurcations with CaW, 11F, age: 49 ± 10, 10 mild atherosclerosis 6F, age: 72 ± 9, 11 healthy 9F, age: 42 ± 13).

FIELD STRENGTH/SEQUENCE: 4D flow/STAR-MATCH/3D TOF/3T MRI, CTA.

ASSESSMENT: 4D Flow velocity data were analyzed in two ways: 1) 3D ROI in the ICA bulbar segment (complex flow patterns are expected) was used to quantify the regions with low TAWSS and high OSI. 2) 2D planes were placed perpendicular to the centerline of the carotid bifurcation for detailed analysis of TAWSS and OSI.

STATISTICAL TESTS: Independent-samples Kruskal-Wallis-H test with 0.05 used for statistical significance.

RESULTS: The percent surface area where low TAWSS was present in the ICA bulb was 12.3 ± 8.0% (95% CI: 7.6-16.9) in CaW subjects, 1.6 ± 1.9% (95% CI: 0.2-2.9) in atherosclerosis, and 8.5 ± 7.7% (95% CI: 3.6-13.4) in healthy subjects, all differences were statistically significant (ƞ² = 0.3 [95% CI: 0.05-0.5], P-value CaW vs. healthy = 0.2). OSI had similar values in the CCA between groups (ƞ² = 0.07 [95% CI: 0.0-0.2], P-value = 0.5), but OSI was significantly higher downstream of the bifurcation in CaW subjects compared to atherosclerosis and normal subjects. OSI returned to similar values between groups 1.5 diameters distal to the bifurcation (ƞ² = 0.03 [95% CI: 0.0-0.2], P-value = 0.7).

CONCLUSION: Lower TAWSS and higher OSI are present in the ICA bulb in patients with CaW when compared to patients with atherosclerotic or healthy subjects.

EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 2.

PMID:37706274 | DOI:10.1002/jmri.29013

Pediatrics. 2023 Sep 14:e2022061011. doi: 10.1542/peds.2022-061011. Online ahead of print.

ABSTRACT

BACKGROUND: The COVID-19 vaccine is important for children with sickle cell disease (SCD). This quality improvement project’s objective was to increase the proportion of children with SCD receiving ≥2 COVID-19 vaccine doses to ≥70% by June 2022.

METHODS: We used the Model for Improvement framework. We assessed COVID-19 vaccination rates biweekly. Three plan-do-study-act cycles focusing on patient education, provider awareness, and access were performed. Process measures included the outcome of outreach calls and educational video views. Missed clinic appointments was our balancing measure. Line graphs and statistical process control charts were used to track changes. Interrupted time series was used to model implementation rates while accounting for preexisting trends.

RESULTS: A total of 243 patients were included. During the preintervention (September 2021-January 2022) and intervention periods (February 2022-June 2022), overall vaccination rates increased from 33% to 41% and 41% to 64%, respectively. Mean vaccination rate in eligible children in each 2-week period increased from 2.1% to 7.2%. The achieved vaccination rate was 11% greater than predicted for patients with SCD. For the general population the achieved vaccination rate was 23% lower than predicted. The proportion of missed visits did not change (9.0% vs. 9.6%). During outreach calls, 10 patients (13.5%) booked a vaccine. Forty percent of patients watched the promotional video.

CONCLUSIONS: A significant number of patients with SCD are not vaccinated against COVID-19. Targeting misinformation and improving vaccine access aided in increasing vaccination. Additional interventions are needed as a large number of patients remain unvaccinated.

PMID:37706252 | DOI:10.1542/peds.2022-061011