Nevin Manimala

Hua Xi Kou Qiang Yi Xue Za Zhi. 2022 May 25;40(3):328-334. doi: 10.7518/hxkq.2022.03.013.

ABSTRACT

OBJECTIVES: This study aims to identify risk factors of postoperative dysphagia in patients with oral cancer by systematic review.

METHODS: Cohort studies in Chinese or English on risk factors of postoperative dysphagia in patients with oral cancer were searched from CNKI, Wanfang database, VIP Chinese Journal Database, China Biomedical Literature Service System, Chinese Clinical Trial Registry, PubMed, Cochrane Library, EMBASE, Web of Science, and Clinical Trials from the beginning to June 30, 2021. Subject words combined with free words were used to retrieve related articles. The included studies were evaluated, and the effective data were processed with Revman 5.3.

RESULTS: Ten studies were selected, and they included 1 241 patients consisting of 473 patients in the exposed group and 768 patients in the control group. After the meta-analysis, the risk factors with statistical significance were as follows: age>60 years, tumor located in oropharynx or mouth floor, tumor size of T3 or T4, TNM stage of Ⅳ, resection involving suprahyoid muscle or tongue resection>50%, combination of neck dissection, tracheotomy, or reconstruction, and postoperative radiotherapy.

CONCLUSIONS: Age>60 years, tumor in oropharynx or mouth floor, tumor size of T3 or T4, TNM stage of Ⅳ, resection involving suprahyoid muscle or tongue resection>50%, combination of neck dissection, tracheotomy, or reconstruction, and postoperative radiotherapy were significant risk factors of postoperative dysphagia in patients with oral cancer.

PMID:38597015 | DOI:10.7518/hxkq.2022.03.013

Br J Ophthalmol. 2024 Apr 9:bjo-2023-323860. doi: 10.1136/bjo-2023-323860. Online ahead of print.

ABSTRACT

AIMS: To compare the diagnostic performance of 360° anterior segment optical coherence tomography assessment by applying normative percentile cut-offs versus iris trabecular contact (ITC) for detecting gonioscopic angle closure.

METHODS: In this multicentre study, 394 healthy individuals were included in the normative dataset to derive the age-specific and angle location-specific normative percentiles of angle open distance (AOD500) and trabecular iris space area (TISA500) which were measured every 10° for 360°. 119 healthy participants and 170 patients with angle closure by gonioscopy were included in the test dataset to investigate the diagnostic performance of three sets of criteria for detection of gonioscopic angle closure: (1) the 10th and (2) the 5th percentiles of AOD500/TISA500, and (3) ITC (ie, AOD500/TISA500=0 mm/mm²). The number of angle locations with angle closure defined by each set of the criteria for each eye was used to generate the receiver operating characteristic (ROC) curve for the discrimination between gonioscopic angle closure and open angle.

RESULTS: Of the three sets of diagnostic criteria examined, the area under the ROC curve was greatest for the 10th percentile of AOD500 (0.933), whereas the ITC criterion AOD500=0 mm showed the smallest area under the ROC (0.852) and the difference was statistically significant with or without adjusting for age and axial length (p<0.001). The criterion ≥90° of AOD500 below the 10th percentile attained the best sensitivity 87.6% and specificity 84.9% combination for detecting gonioscopic angle closure.

CONCLUSIONS: Applying the normative percentiles of angle measurements yielded a higher diagnostic performance than ITC for detecting angle closure on gonioscopy.

PMID:38594062 | DOI:10.1136/bjo-2023-323860

BMJ Support Palliat Care. 2024 Apr 9:spcare-2023-004579. doi: 10.1136/spcare-2023-004579. Online ahead of print.

ABSTRACT

BACKGROUND: Social media with real-time content and a wide-reaching user network opens up more possibilities for palliative and end-of-life care (PEoLC) researchers who have begun to embrace it as a complementary research tool. This review aims to identify the uses of social media in PEoLC studies and to examine the ethical considerations and data collection approaches raised by this research approach.

METHODS: Nine online databases were searched for PEoLC research using social media published before December 2022. Thematic analysis and narrative synthesis approach were used to categorise social media applications.

RESULTS: 21 studies were included. 16 studies used social media to conduct secondary analysis and five studies used social media as a platform for information sharing. Ethical considerations relevant to social media studies varied while 15 studies discussed ethical considerations, only 6 studies obtained ethical approval and 5 studies confirmed participant consent. Among studies that used social media data, most of them manually collected social media data, and other studies relied on Twitter application programming interface or third-party analytical tools. A total of 1 520 329 posts, 325 videos and 33 articles related to PEoLC from 2008 to 2022 were collected and analysed.

CONCLUSIONS: Social media has emerged as a promising complementary research tool with demonstrated feasibility in various applications. However, we identified the absence of standardised ethical handling and data collection approaches which pose an ongoing challenge. We provided practical recommendations to bridge these pressing gaps for researchers wishing to use social media in future PEoLC-related studies.

PMID:38594059 | DOI:10.1136/spcare-2023-004579

J Reconstr Microsurg. 2024 Apr 9. doi: 10.1055/a-2302-7126. Online ahead of print.

ABSTRACT

INTRODUCTION: Thorough validation of novel microsurgical techniques is deemed essential before their integration into clinical practice. To achieve proper validation, the design of randomized controlled trials (RCTs) should be undertaken, accompanied by the execution of comprehensive statistical analyses, including confounder adjustment and power analysis. This systematic review aims to provide an encompassing overview of the validation methodologies employed in microsurgical studies, with a specific focus on innovative vessel anastomosis techniques.

METHODS: A literature search was conducted in PubMed for articles describing the validation of novel microsurgical vessel anastomosis techniques in animal or human subjects.

RESULTS: The literature search yielded 6,658 articles. 6,564 articles were excluded based on title and abstract. Ninety-four articles were assessed for full-text eligibility. Forty-eight articles were included in this systematic review. Out of 30 comparative studies, nine studies validated novel modified interrupted suture techniques, six studies modified continuous techniques, six studies modified sleeve anastomosis techniques, one study a modified vesselotomy technique, seven studies sutureless techniques, and one study a modified lymphaticovenular anastomosis technique. Twenty-eight studies contained animals (n=1,998). Fifteen animal studies were RCTs. Two studies contained human/cadaveric subjects (n=29). Statistical power-analysis and confounder adjustment were performed in one animal study. Out of eighteen non-comparative studies, five studies validated novel modified interrupted suture techniques, one study a modified continuous technique, two studies modified sleeve anastomosis techniques, four studies modified vesselotomy techniques, four studies sutureless techniques, and two studies modified lymphaticovenular anastomosis techniques. Ten studies contained animal subjects (n=320), with two RCTs. Eight studies contained human subjects (n=173). Statistical power-analysis and confounder adjustment were performed in none of the animal or human studies.

CONCLUSION: The current methods of microsurgical technique validation should be reconsidered due to poor study design. Statistical analysis including confounder adjustment and power-analysis should be performed as a standard method of novel technique validation.

PMID:38593990 | DOI:10.1055/a-2302-7126

Am J Perinatol. 2024 Apr 9. doi: 10.1055/a-2302-8828. Online ahead of print.

ABSTRACT

OBJECTIVE: Maternal pushing can yield lactate levels that are above the normal range for nonpregnant individuals. Many hospitals require lactate levels as part of sepsis bundles, and this can confuse the clinicians when measured during labor. The objective of this study was to observe lactate levels in uncomplicated labor.

STUDY DESIGN: This was a prospective study of patients presenting to Labor & Delivery in early labor. Patients met inclusion criteria if they presented at 37 weeks’ gestation or greater and were either 3-4 centimeters dilated, in early labor with rupture of membranes less than 12 hours or were being induced for oligohydramnios or postdates gestation. A baseline maternal lactate level was collected at enrollment. Further levels were collected at complete cervical dilation and every 30 minutes during the second stage of labor up to 3 hours or until delivery.

RESULTS: From January 7, 2021 through December 30, 2021, a total of 148 screened patients met inclusion criteria and 38 were enrolled. Eight (21%) patients withdrew after baseline lactate level was drawn. Twenty-three (61%) patients had a level drawn at complete dilation. Of the 12 (32%) patients with a lactate level drawn at complete and after thirty minutes of pushing, the mean change in lactate level was 2.0±1.8 mmol/L or 0.07±0.06 mmol/L/min (p < 0.01). This change is more pronounced in the second stage of labor for patients with chorioamnionitis (2.6 mmol/L), although this difference is not statistically significant (p = 0.41).

CONCLUSIONS: Lactate levels increase significantly once a patient reaches complete cervical dilation within thirty minutes of pushing. This increase is more pronounced, although significantly, in patients with chorioamnionitis. As sepsis is one of the leading causes of maternal morbidity and mortality, this pilot study is relevant for providers to see the natural course of lactate levels in labor.

PMID:38593986 | DOI:10.1055/a-2302-8828

J Am Med Dir Assoc. 2024 Apr 6:S1525-8610(24)00204-4. doi: 10.1016/j.jamda.2024.02.018. Online ahead of print.

ABSTRACT

OBJECTIVE: Delirium is a serious neuropsychiatric syndrome frequently occurring in hospitalized older adults, for which pharmacological treatments have shown limited effectiveness. Multicomponent physical exercise programs have demonstrated functional benefits; however, the impact of exercise on the course of delirium remains unexplored. The aim of this study was to investigate the effect of an individualized, multicomponent exercise intervention on the evolution of delirium and patient outcomes.

DESIGN: A single-center, single-blind randomized controlled trial.

SETTING AND PARTICIPANTS: Medical inpatients with delirium in an acute geriatric unit of a tertiary public hospital.

METHODS: Thirty-six patients (mean age 87 years) were recruited and randomized into 2 groups. The control group received usual care and the intervention group received individualized physical exercise (1 daily session) for 3 consecutive days. Primary endpoints were the duration and severity of delirium (4-AT, Memorial Delirium Assessment Scale) and change in functional status (Barthel Index, Short Physical Performance Battery, Hierarchical Assessment of Balance and Mobility [HABAM], and handgrip strength). Secondary endpoints included length of stay, falls, and health outcomes at 1- and 3-month follow-up.

RESULTS: The intervention group showed more functional improvement at discharge (HABAM, P = .015) and follow-up (Barthel, P = .041; Lawton P = .027). Less cognitive decline was observed at 1 and 3 months (Informant Questionnaire on Cognitive Decline in the Elderly, P = .017). Exercise seemed to reduce delirium duration by 1 day and contribute to delirium resolution at discharge, although findings did not reach statistical significance. No exercise-related adverse events occurred.

CONCLUSION AND IMPLICATIONS: Findings suggest that individualized exercise in acutely hospitalized older patients with delirium is safe and may improve delirium course and help preserve post-hospitalization function and cognition.

PMID:38593983 | DOI:10.1016/j.jamda.2024.02.018

Travel Med Infect Dis. 2024 Apr 7:102721. doi: 10.1016/j.tmaid.2024.102721. Online ahead of print.

NO ABSTRACT

PMID:38593968 | DOI:10.1016/j.tmaid.2024.102721

Hum Pathol. 2024 Apr 7:S0046-8177(24)00053-4. doi: 10.1016/j.humpath.2024.04.001. Online ahead of print.

ABSTRACT

Upper tract urothelial carcinoma (UTUC) presents diagnostic challenges due to small biopsy specimen size, poor orientation, and technical obstacles that can yield equivocal diagnoses. This uncertainty often mandates repeated biopsies to evaluate the necessity of nephroureterectomy. Prior studies have suggested cytokeratin 17 (CK17) immunostain as an adjunctive tool for diagnosing bladder urothelial neoplasia in both urine cytology and tissue biopsy specimens. We evaluated the utility of CK17 in differentiating UTUC from benign urothelium and its ability to stratify low-grade from high-grade neoplasia. Our study involved a cohort of previously diagnosed cytology (n = 29) and tissue specimens from biopsies and resections (n = 85). We evaluated CK17 staining percentage in cytology and tissue samples and localization patterns in biopsy/resection samples. Our findings showed a statistically significant distinction (p < 0.05) between UTUC and benign tissue specimens based on full thickness localization pattern (odds ratio 8.8 [95% CI 1.53-67.4]). The percentage of CK17 staining failed to significantly differentiate neoplastic from non-neoplastic cases in cytology or tissue samples. Additionally, based on prior research showing the efficacy of CK20/CD44/p53 triple panel in bladder urothelial neoplasia, we utilized tissue microarrays to evaluate if these markers could distinguish UTUC from benign urothelium. We found that CK20/CD44/p53, individually or in combination, could not distinguish urothelial neoplasia from non-neoplasia. Full thickness CK17 urothelial localization by immunohistochemistry was highly reproducible with excellent interobserver agreement and may play a supplementary role in distinguishing upper tract urothelial neoplasia from benign urothelium.

PMID:38593961 | DOI:10.1016/j.humpath.2024.04.001

Chemosphere. 2024 Apr 7:141868. doi: 10.1016/j.chemosphere.2024.141868. Online ahead of print.

ABSTRACT

Antibiotics, as a class of environmental pollutants, pose a significant challenge due to their persistent nature and resistance to easy degradation. This study delves into modeling and optimizing conventional Fenton degradation of antibiotic sulfamethoxazole (SMX) and total organic carbon (TOC) under varying levels of H₂O₂, Fe²⁺ concentration, pH, and temperature removal using both statistical and artificial intelligence techniques including Multiple Regression Analysis (MRA), Support Vector Regression (SVR) and Artificial Neural Network (ANN). In statistical analysis, ANN model showcased an elevated predictive accuracy compared to its counterparts due to having lowest RMSE values of 0.986 and 1.173 for both SMX and TOC, respectively. Sensitivity showcased H₂O₂/Fe²⁺ ratio, time and pH as pivotal for SMX degradation, while in simultaneous SMX and TOC reduction, fine tuning the time, pH, and temperature was essential. Leveraging a Hybrid Genetic Algorithm-Desirability Optimization approach, the trained ANN model revealed an optimal desirability of 0.941 out of 1000 solutions which yielded a 91.18% SMX degradation and 87.90% TOC removal under following specific conditions: treatment time of 48.5 min, Fe²⁺: 7.05 mg L^-1, H₂O₂: 128.82 mg L^-1, pH: 5.1, initial SMX: 97.6 mg L^-1, and a temperature: 29.8 °C. LC/MS analysis reveals multiple intermediates with higher m/z (242, 270 and 288) and lower m/z (98, 108, 156 and 173) values identified, however no aliphatic hydrocarbon was isolated, because of the low mineralization performance of Fenton process. Furthermore, some inorganic fragments like NH₄⁺ and NO₃^– were also determined in solution. This comprehensive research enriches AI modeling for intricate Fenton-based contaminant degradation, advancing sustainable antibiotic removal strategies.

PMID:38593957 | DOI:10.1016/j.chemosphere.2024.141868

Environ Pollut. 2024 Apr 7:123925. doi: 10.1016/j.envpol.2024.123925. Online ahead of print.

ABSTRACT

Legacy and emerging per- and polyfluoroalkyl substances (PFASs) were measured in livers of finless porpoises (Neophocaena asiaeorientalis; n = 167) collected in Korean waters from 2002 to 2015 to investigate their occurrence, bioaccumulation feature, temporal trends, and ecotoxicological implications. Perfulorooctane sulfonate (PFOS), perfluoroundecanoate (PFUnDA), and perfluorotridecanoate (PFTrDA) were the predominant PFASs found in the porpoises. The concentration of 6:2 chlorinated polyfluoroalkyl ether sulfonate (F-53B), an alternative to PFOS, was comparable to that of PFTrDA. Perfluorooctane sulfonamide (FOSA), a precursor of PFOS, was also detected in all the porpoises examined. All PFASs, including F-53B, accumulated to higher concentrations in immature porpoises compared with mature specimens, implying substantial maternal transfer and limited metabolizing capacity for PFASs. A significant correlation was observed between PFOS and F-53B concentrations, indicating similar bioaccumulation processes. Based on prenatal exposure and toxicity, F-53B is an emerging contaminant in marine ecosystems. Significantly increasing trends were observed in the concentrations of sulfonates, carboxylates, and F-53B between 2002/2003 and 2010, whereas the FOSA concentration significantly decreased. During 2010-2015, decreasing trends were observed in the concentrations of FOSA and sulfonates, whereas concentrations of carboxylate and F-53B increased without statistical significance, likely due to a gap for the implementation of regulatory actions between sulfonates and carboxylates. Although PFOS and PFOA were found to pose little health risk to porpoises, the combined toxicological effects of other contaminants should be considered to protect populations and to mitigate PFAS contamination in marine ecosystems.

PMID:38593937 | DOI:10.1016/j.envpol.2024.123925