Nevin Manimala

Am Surg. 2023 Aug 30:31348231199174. doi: 10.1177/00031348231199174. Online ahead of print.

ABSTRACT

AIM: In this study, it was aimed to evaluate the characteristic features and survival of secretory carcinoma of the breast (SCB), which is one of the rare malignant tumors of the breast.

METHODS: Data of patients with histopathological diagnosis of SCB between 2010 and 2019 were extracted from the SEER database. These patients were evaluated in terms of age, race, molecular subtype, grade, estrogen receptor (ER), progesterone receptor (PR), HER2 receptor, TNM stage, surgical status, chemotherapy and radiotherapy treatment. Overall survival (OS) and breast cancer-specific survival (BCSS) of the whole population and subgroups [in terms of surgery procedure (mastectomy/breast-conserving surgery), and hormone receptor status (positive/negative)] were analyzed.

RESULTS: 70 patients were included in the study. The mean age was 57 years (range 2-82). 32.9% of the patients were diagnosed under the age of 50. 97.1% of the patients were female; 2.9% were male. The vast majority of patients were white race (81.4%). Although the rates of localization were higher in the upper outer quadrant (31.4%), centrally located tumors (18.5%) were also quite common. The most frequently detected molecular subtype was hormone positive/HER2 negative. All patients were non-metastatic, 81.4% of patients did not have lymph node metastases, and most of the patients were stage IA. Median follow-up was 37 months (range 0-118 months). Considering all patients, OS was 76.3%, 5-year OS was 91.8%, and BCSS was 88%, 5-year BCSS was 97.8%. There was no statistically significant difference in OS and BCSS according to subgroups (P > .01).

CONCLUSION: SCB, a rare histopathologic type, has high OS and BCSS rates.

PMID:37648259 | DOI:10.1177/00031348231199174

BJGP Open. 2023 Aug 30:BJGPO.2023.0084. doi: 10.3399/BJGPO.2023.0084. Online ahead of print.

ABSTRACT

BACKGROUND: Lifetime risk of fragility fractures is 50% in post-menopausal women and 20% in men aged over 50 years. Identifying people at high risk facilitates early intervention and reduction of biopsychosocial morbidity associated with these fractures.

AIM: To explore if bone health assessment (BHA) rates differ between women and men aged 50 years and over with fragility fracture risk factors.

DESIGN & SETTING: A primary care-based cohort study METHOD: Patients were identified from the Consultations in Primary Care Archive (CiPCA) database between 2002 and 2014 with one or more fragility fracture risk factors (previous fractures, falls and prolonged steroid use). Evaluation of BHA within twelve months of presentation of the first risk factor was carried out by searching for codes for fracture risk assessment tools (FRAX/QFracture), bone density measurement, specialist service referral or if bone-protection medication was started.

RESULTS: 15,581 patients with risk factors were identified; men represented 40% of the cohort. 1,172 (7.5%) had BHA performed within one year of presentation. 8.9% of females and 5.5% of males had BHAs, which was found with strong statistical evidence (X ²=59.88, P=1 × 10^-14). This relationship prevailed after adjusting for other covariates such as co-morbidity and number of consultations with an odds ratio of 1.25 (95% Confidence Interval 1.08-1.43).

CONCLUSION: This study shows that rates of BHA were generally low and even lower in men. Primary care clinicians should be alert to fragility fracture risk factors in both men and women to enable early assessment and intervention.

PMID:37648258 | DOI:10.3399/BJGPO.2023.0084

Respirology. 2023 Aug 30. doi: 10.1111/resp.14588. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: The relative effectiveness of initial non-invasive respiratory strategies for acute respiratory failure using continuous positive airway pressure (CPAP) or high-flow nasal cannula (HFNC) is unclear.

METHODS: We conducted a multicenter, open-label, parallel-group randomized controlled trial to compare the efficacy of CPAP and HFNC on reducing the risk of meeting the prespecified criteria for intubation and improving clinical outcomes of acute hypoxemic respiratory failure. The primary endpoint was the time taken to meet the prespecified criteria for intubation within 28 days.

RESULTS: Eighty-five patients were randomly assigned to the CPAP or HFNC group. Eleven (28.9%) in the CPAP group and twenty (42.6%) in the HFNC group met the criteria for intubation within 28 days. Compared with HFNC, CPAP reduced the risk of meeting the intubation criteria (hazard ratio [HR], 0.327; 95% CI, 0.148-0.724; p = 0.006). There were no significant between-group differences in the intubation rates, in-hospital and 28-day mortality rates, ventilator-free days, duration of the need for respiratory support, or duration of hospitalization for respiratory illness. Pulmonary oxygenation was significantly better in the CPAP group, with significantly lower pH and higher partial pressure of carbon dioxide, but there were no differences in the respiratory rate between groups. CPAP and HFNC were associated with few possibly causal adverse events.

CONCLUSION: CPAP is more effective than HFNC at reducing the risk of meeting the intubation criteria in patients with acute hypoxemic respiratory failure.

PMID:37648252 | DOI:10.1111/resp.14588

Oncologist. 2023 Aug 30:oyad223. doi: 10.1093/oncolo/oyad223. Online ahead of print.

ABSTRACT

BACKGROUND: Adjuvant therapies have been approved for resected melanoma based on improved recurrence-free survival. We present early findings from a real-world study on adjuvant treatments for melanoma.

METHODS: A comprehensive chart review was conducted for patients receiving adjuvant systemic therapy for resected high-risk stages III and IV melanoma. Statistical analysis was performed to assess recurrence-free survival and subgroup differences.

RESULTS: A total of 149 patients (median age = 58.0 years, 61.1% men, 49.7% with BRAF V600E/K genotypes) were included, with 94.6% having resected stage III melanoma. Anti-PD-1 immunotherapy was received by 86.5% of patients, while 13.4% received BRAF-targeted therapy. At a median follow-up of 22.4 months, the recurrence rate was 31.5%, with 1-year and 2-year recurrence-free survival rates of 79% and 62%, respectively. Similar recurrence rates were observed between anti-PD-1 immunotherapy and BRAF-targeted therapy. Long-term toxicity affected 27.4% of patients, with endocrinopathies and late-emergent immune-related adverse events being common.

CONCLUSIONS: Real-world adjuvant systemic therapy aligns with clinical trial practice. Recurrence rates remain high despite treatment, and long-term toxicities, including endocrinopathies and chronic inflammatory conditions, are not uncommon.

PMID:37648247 | DOI:10.1093/oncolo/oyad223

World Neurosurg. 2023 Aug 28:S1878-8750(23)01206-8. doi: 10.1016/j.wneu.2023.08.093. Online ahead of print.

ABSTRACT

OBJECTIVE: What effects did the COVID-19 pandemic have on United States neurosurgery resident attrition? This study reports on changes in resident attrition due to transfers, withdrawal, or dismissal from program training during the COVID-19 pandemic.

METHODS: Neurosurgery resident attrition data published by the American Council of Graduate Medical Education (ACGME) for the academic year starting in July of 2007 up to the academic year ending in June of 2022 was collected and the rate of attrition was calculated. Individual post-graduate year program transfer rates were also calculated for the past 7 consecutive academic years. The attrition rates for the academic years prior to the pandemic were then compared to those during the pandemic.

RESULTS: A total of 465 residents did not graduate from neurosurgical training over the last 15 academic years, 3 of which took place at least partially during the COVID-19 pandemic resulting in a mean attrition rate of 2.5%. The attrition rates during the pandemic were lower than those prior to the pandemic 1.7% vs 2.7% (<0.001), driven largely by a nearly 2-fold decrease in withdraw rate of 0.67% vs 1.2% (p =0.003). Bivariate regression between withdraw and attrition rate showed a statistically significant correlation, r = .809, p < 0.001 r2 = .654. The first full year of the pandemic saw the most dramatic changes with a z score for attrition of -1.9. Linear regression of the impact of training under COVID-19 on attrition was statistically significant, r = 0.563, p = 0.029 r2 = 0.317. Rate of withdrawal was most affected by training during the pandemic, r = 0.594, p = .010 r2 = 0.353.

CONCLUSION: There was a statistically significant decline in the rate of neurosurgery resident attrition during the COVID-19 pandemic, most notable during the first full academic year (2020-2021). These findings were largely driven by a drop in residents withdrawing from training programs. This contrasts with the overall trend towards resignation seen amongst healthcare workers during the pandemic. It is unclear what enduring ramifications this will have on neurosurgery residencies moving forward and whether we will see higher attrition rates as we transition towards a new normal. Future studies should look to examine trends in attrition rates post-pandemic and determine the long-term effects of decreased attrition rates of residents during the pandemic.

PMID:37648202 | DOI:10.1016/j.wneu.2023.08.093

Environ Res. 2023 Aug 28:116864. doi: 10.1016/j.envres.2023.116864. Online ahead of print.

ABSTRACT

BACKGROUND: Inconsistent results have been found in the literature on associations of greenness, or vegetation quantity, and physical activity. However, few studies have assessed associations between mobility-based greenness and physical activity from mobile health data from smartphone and wearable devices with fine spatial and temporal resolution.

METHODS: We assessed mobility-based greenness exposure and wearable accelerometer data from participants in the US-based prospective Nurses’ Health Study 3 cohort Mobile Health (mHealth) Substudy (2018-2020). We recruited 500 female participants with instructions to wear devices over four 7-day sampling periods equally spaced throughout the year. After restriction criteria there were 337 participants (mean age 36 years) with n = 639,364 unique observations. Normalized Difference Vegetation Index (NDVI) data were derived from 30 m x 30 m Landsat-8 imagery and spatially joined to GPS points recorded every 10 min. Fitbit proprietary algorithms provided physical activity summarized as mean number of steps per minute, which we averaged during the 10-min period following a GPS-based greenness exposure assessment. We utilized Generalized Additive Mixed Models to examine associations (every 10 min) between greenness and physical activity adjusting for neighborhood and individual socioeconomic status, Census region, season, neighborhood walkability, daily mean temperature and precipitation. We assessed effect modification through stratification and interaction models and conducted sensitivity analyses.

RESULTS: Mean 10-min step count averaged 7.0 steps (SD 14.9) and greenness (NDVI) averaged 0.3 (SD 0.2). Contrary to our hypotheses, higher greenness exposure was associated non-linearly with lower mean steps per minute after adjusting for confounders. We observed statistically significant effect modification by Census region and season.

DISCUSSION: We utilized objective physical activity data at fine temporal and spatial scales to present novel estimates of the association between mobility-based greenness and step count. We found higher levels of greenness were inversely associated with steps per minute.

PMID:37648192 | DOI:10.1016/j.envres.2023.116864

Fertil Steril. 2023 Aug 28:S0015-0282(23)01721-1. doi: 10.1016/j.fertnstert.2023.08.953. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine whether peak estradiol (E₂) levels above the usual physiologic range (300-500 pg/mL) will impact programmed frozen embryo transfer (FET) outcomes in an ideal study population of those using good-quality single euploid blastocysts.

DESIGN: Retrospective cohort study SUBJECTS: Single euploid programmed FET done at a single academic institution from January 2016 to December 2019. The population was divided into three groups based on peak serum E₂ levels during endometrial preparation: group A (E₂ <300 pg/mL), group B (300-500 pg/mL), and group C (>500 pg/mL). Group B was used as the reference range for statistical analysis.

MAIN OUTCOME: The primary outcome was live birth rate. Secondary outcomes included implantation, biochemical, ectopic, and miscarriage rates.

RESULTS: 750 FET cycles were included in this study. Poisson regression analysis showed a negative impact on higher peak E₂ on live birth rate (p=0.03). A decrease in live birth rate was noted between group C and referent group B (50.2% vs 63.4%, RR 0.79 [0.68-0.91], p<0.01) and group A and referent group B (42.5% vs 63.4%, RR 0.67 [0.46-0.98], p=0.04). Secondary outcomes were notable for a lower implantation rate when groups A and C were compared to group B, and a higher biochemical rate between group C and group B. There was no notable difference between groups in ectopic or miscarriage rate.

CONCLUSION: Limiting peak serum E₂ levels to 300-500 pg/mL during programmed FET cycles is associated with improved live birth rates compared to cycles with peak E₂ levels were <300 pg/mL or >500 pg/mL in an ideal study population.

PMID:37648142 | DOI:10.1016/j.fertnstert.2023.08.953

J Biomed Inform. 2023 Aug 28:104481. doi: 10.1016/j.jbi.2023.104481. Online ahead of print.

ABSTRACT

OBJECTIVE: Investigate the preliminary efficacy and feasibility of a personalized mobile health (mHealth) intervention based on social cognitive theory (SCT) to promote physical activity among type 2 diabetes patients via self-monitoring, goal setting, and automatic feedback.

METHODS: We conducted a pilot study involving 33 type 2 diabetes patients attending Mitsui Memorial Hospital in Japan using a pre-post evaluation design over 12 weeks. Participants measured daily step count, body weight, and blood pressure at home, with the measurements synchronized with the StepAdd application (app) automatically. Participants used the app to review daily results, update personalized step goals, identify individualized barriers to achieving the step goals, find coping strategies to overcome each barrier, and implement these strategies, thereby building effective coping skills to meet the goals. Pharmacists examined the usage of the app and provided coaching on lifestyle modifications. Ultimately, patients established skills to enhance diabetes self-care by using the app.

RESULTS: Daily step count increased dramatically with high statistical significance (p<0.0001), from a mean of 5,436 steps/day to 10,150 steps/day, an 86.7% increase. HbA1c (p=0.0001) and BMI (p = 0.0038) also improved. Diabetes self-care in diet, exercise, and foot care as well as self-management behavior, self-regulation, and self-efficacy in achieving daily step goals showed significant improvements. The retention rate of the study was very high, at 97.0% (n=32).

CONCLUSIONS: A personalized smartphone-based mHealth intervention based on SCT is feasible and effective at promoting physical activity among type 2 diabetes patients. The methodology of the intervention could be readily applied to other patient populations.

PMID:37648101 | DOI:10.1016/j.jbi.2023.104481

Phytomedicine. 2023 Aug 17;120:155038. doi: 10.1016/j.phymed.2023.155038. Online ahead of print.

ABSTRACT

OBJECTIVE: Traditional Chinese medicines (TCM) play an indispensable role during the pandemic of coronavirus disease 2019 (COVID-19), with an increasing number of randomized controlled trials (RCTs) designed and performed to evaluate the efficacy and safety of TCM for COVID-19. This study aimed to critically appraise the quality of currently available RCTs of TCM for COVID-19.

METHODS: RCTs of TCM for COVID-19 were searched from three databases by two investigators and selected according to pre-established inclusion and exclusion criteria. General information of included studies was presented by applying descriptive statistics. The methodological and reporting quality of eligible RCTs was critically evaluated based on the risk of bias assessment tool 2 (RoB2) and CONSORT Extension for TCM (CONSORT-CHM Formulas 2017), respectively. The differences of risks and main general information were compared between RCTs published in English and Chinese journals. Microsoft Excel 2019 and SPSS were used for the statistical analysis. A result with p < 0.05 was considered statistically significant.

RESULTS: This study finally included 64 RCTs with a total of 10858 participants investigating TCM for COVID-19. All 64 RCTs were evaluated as moderate-to-low RoB including 27 RCTs with high bias, 26 RCTs with some concerns, and 11 with low bias. Results of reporting quality appraisal by CONSORT-CHM Formulas 2017 showed that 61 (95%) RCTs reported more than 18 (50%) items, and 14 (22%) RCTs reported more than 26 (70%) items among all 38 items. Forty-two RCTs were approved by ethics committees and 47 RCTs reported the informed consent information. Twenty-five RCTs and 39 RCTs provided information on trial registration and funding resources, respectively. The quality of 44 RCTs published in Chinese was significantly worse than that of 20 RCTs published in English, especially in the following considerations including the overall RoB, ethics approved, informed consent, trial register, and reporting quality with CONSORT-CHM Formulas 2017.

CONCLUSION: The overall quality of RCTs investigating TCM for COVID-19 was appraised as moderate-to-high that was substandard and needs to be continuously improved, especially for RCTs published in Chinese, in the future.

PMID:37647671 | DOI:10.1016/j.phymed.2023.155038

Phytomedicine. 2023 Aug 14;120:155022. doi: 10.1016/j.phymed.2023.155022. Online ahead of print.

ABSTRACT

BACKGROUND: Traditional Chinese Medicine (TCM) system is a medical system that has been expanding for thousands of years that was formed by the extensive clinical practice experience of many physicians and the accumulation of personal medication habits in China. In TCM, there is a history of long-term medication for epilepsy, the main treatment for epilepsy is TCM drugs and its prescription, supplemented by TCM modalities such as acupuncture therapy, moxibustion therapy, tuina, emotion adjustment therapy, etc. PURPOSE: With the modernization of TCM, the active ingredients and molecular mechanisms of TCM for epilepsy treatment have been gradually revealed. This review aimed to comprehensively summarize the TCM treatment of epilepsy, focusing on the current TCM drugs and some TCM formulae for the treatment of epilepsy, and to discuss the research progress of TCM for the treatment of epilepsy, and to provide a reference to develop future related studies in this field.

MATERIALS AND METHODS: The mechanism of action of antiepileptic drugs (AEDs) was interpreted from different perspectives by searching online databases and querying various materials identify drugs used in both modern medicine and TCM systems for the treatment of epilepsy. We collected all relevant TCM for epilepsy literature published in the last 30 years up to December 2022 from electronic databases such as PubMed, CNKI and Web of Science, and statistically analyzed the literature for the following keyword information. The search terms comprise the keywords “TCM”, “phytochemistry”, “pharmacological activity”, “epilepsy” and “traditional application” as a combination. Scientific plant names were provided by “The Plant List” (www.theplantlist.org).

RESULTS: Epilepsy is a complex and serious disease of the brain and nervous system. At present, the treatment of epilepsy in modern medicine is mainly surgery and chemotherapy, but there are many serious side effects. By summarizing the treatment of epilepsy in TCM, it is found that there are various methods to treat epilepsy in TCM, mainly TCM drugs and its formulae. Many TCM drugs have antiepileptic effects. Now found that the main effective TCM drugs for the treatment of epilepsy are Curcumae Longae Rhizoma, Scorpio, Acori Tatarinowii Rhizoma, Uncariae Ramulus Cum Uncis and Ganoderma, etc. And the main compounds that play a role in the treatment of epilepsy are curcumin, gastrodin, ligustrazine, baicalin and rhynchophylline, etc. These TCM drugs have played an important role in the treatment of epilepsy in TCM clinic. However, the chemically active components of these TCM drugs are diverse and their mechanisms of action are complex, which are not fully understood and need to be further explored.

CONCLUSIONS: TCM treats epilepsy in a variety of ways, and with the discovery of a variety of potential bioactive substances for treatment of epilepsy. With the new progress in the research of other TCM treatment methods for epilepsy, TCM will have greater potential in the clinical application of epilepsy.

PMID:37647670 | DOI:10.1016/j.phymed.2023.155022